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�STATB
Arizona
Employing and Moving
people Off Welfare
and Encouraging
Responsibility
Program
Arkansas
DBSCRIPT:ION
State-wide project would not increase benefits
for additional children conceived while
receiving AFDC; limit benefits to adults to 24
months in any 60 month period~ allow recipients
to deposit up to $200/month (with 50%
disregarded) in Individual Development
Accounts; require minor mothers to live with
parents; extend Transitional Child Care and
Medicaid to 24 months and eliminate the 100
hour rule for AFDC-U cases. Also, in a pilot
site, would provide individuals with short-term
subsidized public or private OJT subsidized by
grant diversion which includes cashing-out Food
. stamps.
Under Arkansas' demonstration, AFDC
parents age 16::r r younger will be
o
required to attend school regularly or
face reductions in benefits if they
fail to do so. If appropriate, teenage
parents can meet the requirement by
attending an alternative educational
program. In addition, Arkansas will
implement a policy of not increasing
AFDC benefits when additional children
are born into a family receiving
welfare. . Family planning and group
counseling services focusing on the
responsibilities of parenthood will be
included in the demonstration.
:ISSUBS &ISTA'l'US
Key issue:
* Time limit work without
extensions or work for
those who play by the
rules.
* Food stamps cash out
* Family cap
* Evaluation
status:
120 Days
Date
received:
8/3/94
120 days:
12/1/94
Delay due to
w·orkload and
complexity
of the
issues.
Sent state a list of
issues and questions which
result from a federal·
review of the application
12/5. State's response,
received 1/12, leaves
unresolved a number of
difficult policy and legal
issues. Meeting with
State official 1/13
indicates Governor and
Legislature are unwilling
at this time, to let
agency official discuss
any changes that might
resolve these problems.
Date
received:
1/14/93
Date
Approved:
3/5/94
�,
california
Work Pays
Demonstration Project
(WPDP) Amendments
Work Pays
Demonstration Project
(WPDP) Amendments
Assistance Payments
Demonstration Project
(Amendment)
(APDP)
statewide, California's demonstration will
encourage teenage AFDC parents to regularly
attend school by paying them a $100 cash bonus
for maintaining a C average, and $500 for
ultimately graduating from high school.
Teenage parents who fail to maintain a D
average can have their AFDC payments reduced by
up to $50 a month for two months. The
demonstration will also permit AFDC families to
accumulate $2,000 in assets and have $4,500
equity in a car. In addition, families will be
able to deposit $5,000 into savings so long as
the funds are used to purchase a home, start a
business, or finance a child's postsecondary
education or training. Finally, the
demonstrat~on will allow recipients who work
but who have low AFDC benefits -- to opt out of
the program. They will remain eligible for
health care under Medi-Cal as well as other
services, such as child care, which are
available to AFDC recipients.
Date
received:
9/29/93
Date
approved:
2/28/94
s~ate-wide project 'would amend Work Pays
Demonstration Project by adding provisions to:
reduce benefit 'levels by 10% (but retaining the
need level); reduce benefits an additional 15%
after 6 months on assistance for cases with
able bodied adult; time-limit assistance to
able-bodied adults to 24 months, and not
increase benefits for children conceived while
receiving AFDC.
Key Issues:
State-wide project would amend the Assistance
Payments Demonstration Project by: exempting
certain categories of AFDC families from the
state's benefit cuts; paying the exempt cases
based on grant levels in effect in California
on November 1, 1992; and renewing the waiver of
the Medicaid maintenance of effort provision at
section 1902(c)(1) of the social Security Act,
,which was vacated by the Ninth Circuit Court of
Appeals in its decision in Beno v. Shalala.
Key Issues;
Date
received:
3/14/94
* Time-based benefit
reduction not tied to
ability to find work.
120 Days:
7/12/94
status:
Holding at
State has asked us to hold
state
the application-because'-___ ~~.!!st
the legis-lature has not
------authorized the reduction
in assistance payments.
'I
* Benefit cut below May
1988 level; may include
groups who cannot respond
to benefit cut as a work
incentive.
Status:
State indicates they will
not be able to respond to
list of issues and
questions which result
from a federal review of
the application until late
February. Significant
public comments have been
received.
Date
received,
8/26/94
120 days:
12/24/94
Holding at
state
request
�Work Pays
Demonstration Project
(Amendment)
(WPDP)
Not increase benefits for children conceived
while receiving AFDC.
Key Issues:
A Statewide family cap
provision.
Status:
Date
received:
11/9/94
120 days:
3/9/95
Expect to send state a
list of issues and
questions which result
from a federal review in
the next two weeks.
AFDC and Food Stamp
Compatibility
Demonstration
(AFDC/FS) Project
San Diego County
II
Demonstra~i9n Project
State-wide project would make AFDC and Food
stamp policy more compatible by making AFDC
households categorically eligible- for Food
Stamps; allowing recipients. to deduct 40
percent of self-employment income in reporting
monthly income; disregarding $100 per quarter
in non-recurring gifts and irregular/infrequent
. income; disregarding undergraduate student
assistance and work study income if payments
are based on need; reinstating food stamp
benefits discontinued for failure to file a
monthly report when good cause is found for the
failure; and simplifying vehicle valuation
methodology.
lCey Issues:
* No major issues pending
status:
Sent draft terms and
conditions to state
1/20/95. Could be
approved soon.
Date
received:
5/23/94
120 days:
·9/20/94
Complex
waiver due
to
evaluation
proposal and
the need to
tie it to
other
pending
waivers.
---proj ec~-requiresAFi:iCreciplEmt-s-ages-16-1.8-to_P(~Y Issues:
attend school or participate in JOBS.
- - - - - - - --1-----_
* No major issues pending
Date
received:
status:
12/5/95
Expect to send state draft
terms and conditions by
mid-February.
Demonstration Project
Statewide, would require 100 hours CWE~
participation per month for JOBS mandatory
individuals who have recieved AFDC for 22 of
the last 24 months and are working fewer than
15 hours per week after two years from JOB?
assessment and; have failed to comply with JOBS
without good cause, _have completed CWEP or are
in CWEP less than 100 hours per month, or have
completed or had an opportunity to complete
post-assessment education and training; provide
Transitional Child Care and Transitional
Medicaid to families who become ineligible for
AFDC due to increased assets or income
resulting from marriage or the reuniting of
spouses; increase the duration of sanctions for
certain acts of fraud.
120 days:
3/5/95
Key Issues:
Status:
Expect to send state list
of issues and questions
which result from federal
review by mid-February.
Date
received:
12/28/94
120 days:
4/28/95
�Colorado
Personal
Responsibility and
Employment Program
This waiver includes a number of major
revisions to the State's AFDC program. The
demonstration will operate in five counties.
Under the demonstration, parents who are able
to work or able to participate in a training
program must do so after receiving AFDC
benefits for two years. Individuals who refuse
~o perform the assignments can face a loss of
AFDC benefits. Additionally, the demonstration
will "cash out" Food Stamps for participants,
meaning that the value of the coupons will be
added to the monthly AFDC payment.
Asset
levels and ru~es pertaining to ownership of an
automobile will also be chanqed.
6/30/93
Date
approved:
1/15/94
"A Fair Chance" initiative is designed to
increase supports, incentives, and work
expectations for AFDC recipients. It has two
A Fair Chance:
components, Pathways and Family Strength.
Pathways and Family
Pathways requires AFDC recipients to work a
Strength
minimum of 15 hours a week after two years of
AFDC, 25 hours a week after three years, and 35
hour.s a week after four years. Pathways will
also help families leaving welfare to increase
their incomes by paying the difference between
the non-custodial parent's child support
payments and a state-established minimum.
Family Strength .provisions raise the resource
limit for AFDC eligibility from $1,OQO to
------- $3,-000_~J1~ extend transitional child care and
medical benefrts-an--additiol.l~J. year, to a total
of two years. Family Strength--wfl-l-be-----------.. __
implemented statewide and Pathways will be
implemented in the New Haven and Manchester
areas.
Connecticut
----:--11---------
~.
Date
received:
Date
received:
12/30/93
Date
approved:
8/29/94
I
I ------------:---.---_---1-------____
1
�Florida
Family Transition
Program
Georqia
-
Florida is implementing a "Family Transition
. Program" for AFDC recipients in two counties.
Under the plan, most AFDC families will be
limited to collecting benefits for a maximum of
24 months in any 5-year period. Individuals
who exhaust their transitional AFDC benefits,
but. are unable to find employment, will be
guaranteed the opportunity to work at a job
paying more than their AFDC grant. The
demonstration also provides a longer period of
eligibility -- 36 months in any 6-year period.
~- for families who are at a high risk of
becoming welfare dependent~ Medicaid and child
care benefits will be available in the
demonstration. Local community boards will
playa large role in overseeing the program.
Other elements of the demonstration include an
increase in the earnings disregard formula and
asset ceilings, as well as a statewide
requirement that AFDC parents must ensure that .
their children have been immunized.
.This project strengthens federal ~ork
requirements that must be met in order to
"Personal
receive cash benefits. Georgia's.welfare
Accountability and
agency will now be able to e~clude from an AFDC
JRe~ponsibility
grant any able-bodied rec~pient between the age
Projecf"-lPAR)---~ ___of 18 to 60 who. has no chl.ldren under the age
0·f--14-and--who__wl.J.l.fully refuses to work or who
leaves employment witnout-good-cause. _The_rest
of the family will continue to be eligible for-
AFDCbenefits. The plan will also allow the
state to deny additional cash benefits for
additional children born after a family has
been on welfare for at least two years if the
child was conceived while the family was on
welfare. However, PAR would allow recipients
to "earn back" the denied benefits through tne
receipt of child·support payments or earnings.
Medicaid and Food Stamps eligibility will
continue for all family members.
In addition,
Georgia will offer family planning services and
instruction in parental skills to AFDC
recipients.
Date
received.:
9/21/93
Date
approved.:
1/27/94
Date
received.:
5/18/93
Date
approved.:
11/2/93.
�Work for Welfare
Project
Hawaii
Creating Work
Opportunities for
JOBS -Families (CWOJF)
--___
In 10 pilot counties would require every non
exempt recipient and non-supporting parent to
work up to 20 hours per month in a state, local
government, federal agency or nonprofit
organization; extends job search; and increases
sanctions for JOBS noncompliance. On a
statewide basis, would increase the automobile
exemption to $4,500 and disregard earned income
of children who are full-time students.
Key Issues:
.. Evaluation
status I
Sent State a list of
issues and questions which
result from a federal
review of the application
on 11/22. State indicates
they will get back to us
at a later date.
Programs, job-ready JOBS recipients who would
otherwise expect to wait at least three months
to be placed in a regular education or training
activity are required to pursue job leads
developed by JOBS program specialists. The
positions are part-time (up to 18 hours per
week) private sector jobs at minimum wage, and
will allow participants to gain work
Lexperience~ ~evelop their skills, and better
target~tra-l;n-l:ng-needs ___________ _
Date
received:
6/30/94
120 days:
10/28/94
Complexity
of several
components
including
evaluation.
state has
not
responded to
the federal
review of
the
application
Date
received:
11/3/93
Date
approved:
6/25/94
---~-I---
1
Illinois
Project Fresh Start
The Work Pays component, added to the'
previously approved Project Fresh Start,
encourages employment and thereby self
sufficiency by enabling recipients to keep more
of their earnings than is normally allowed.
The State will disregard two of each three
dollars earned for as long as recipients
continue working.
Date
received:
8/2/93
Date
approved:
11/23/93
�,
Indiana
Manpower, Placement
and Comprehensive
Training Program
Under this program, at any point in time, up to
12,000 job-ready individuals will be assigned
to a "Placement Track" and receive help in job
search and placement. Once on this track, AFDC
benefits will be limited to 24 consecutive
months. The time limit applies to adult
benefits only; children's benefits will not be,
affected. Case management and supportive
services will continue for a period after AFDC
benefits end. For all recipients who become
employed, earnings will be disregarded in
determining Food Stamp benefits for the first
six months. There will be increased sanctions
for quitting a job or for failure to comply
with program requirements. There will also be
fewer exemptions from current JOBS
participation requirements. Another provision
will extend subsidies to employers who hire
welfare recipients for a maximum of 24 months.
A family benefit cap provision will disallow
. additional AFDC benefits for children conceived
while on-AFDC although the child will be
eligible for Medicaid. Children will be
required to attend school and be immunized.
IMPACT is a statewide waiver that will operate
for seven years.
Date
received:
6/21/94
Date
approved:
12/15/94
�Iowa is implementing a reform plan that will
encourage AFDC and Food stamp recipients to
take jobs and accumulate assets through a
Iowa Family
program of "Individual Development Accounts."
Investment Plan
Funds deposited in an-account can only be'
withdrawn to pay for education, training, home
ownership, business start-up, or family
emergencies. The current law which limits each
family's assets to $1,000 will be changed to
allow each applicant to have up to $2,000 in
assets and each AFDC family to possess up to
$5,000 in assets. Additionally, the vehicle
asset ceiling will rise from $1,500 to $3,000.
Recipients will also be encouraged to work
under a new formula which disregards 50 percent
of their earnings in the calculation of
benefits. For recipients lacking in
significant work histories, all income will be
disregarded during the first four months on
AFDC. A Family Investment Program will be
created for most AFDC parents, requiring them
to participate in training and support services
as a condition of AFDC receipt. Only parents
with a child under 6 months old at home, those
working at least 30 hours per week, and the
disabled are exempt. Individuals who choose
Transitional child
not to participate in the Family Investment
Care Waiver
Agreement will have their AFDC benefits phased
____I_out over six months and will not be able to
reapply-for-another_s,.i,~ months.
Iowa
------
Date
received.
4/29/93
Date
approved,
8/13/93
Key Issues
statuB'
Just receives not yet
Date
received.
1/19/95
-----_~L£eviewed
Statewide, would provide 24 months of
transitional child care to employed families 1)
who voluntarily terminate their AFDC benefits
and 2) whose AFDC benefits are terminated due
to receipt of child support, but deny
eligibility or establish waiting lists for
applicants in the event state funding is not
sufficient.
-- - -- _ _ _L120 days I
5/17/9'5----11--
�,
Kansas
Actively Creating
Tomorrow for Families
Demonstration
Maine
. Project Opportunity
State-wide project would, after 30 months of
participation in JOBS, make adults ineligible
for AFDC for 3 years; replace $30 and 1/3
income disregard with continuous 40\ disregard;
disregard lump sum income and income and
resources of children in school; count income
and resources of family members who receive
SSI; exempt one vehicle without regard for
equity value if used to produce income; allow
only half AFDC benefit increase for births of a
second child to families where the parentis
not working and eliminate increase for the
birth of any child if families already have at
least two children; eliminate 100-hour rule and
~ork history requirements for UP cases; expand
AFDC elig~bility to pregnant women in 1st and
2nd trimesters; extend Medicaid transitional
benefits to 24 months; eliminate various JOBS
requirements, including those related to target
groups, participation rate of UP cases and the
20-hour work 'requirement limit for parents with
children under 6; require school attendance;
require minors in AFDC and NPA Food Stamps
cases to live with a guardian; make work
requirements and penalties in the AFDC and Food
Stamp programs 'more uniform; and increase
sanctions for not cooperating with child
support enforcement activities.
State=wide'-pro:ject-wo,u ldincrease part icipat ion
in Work Supplementation to 18 montlis-;-use-Wor-k
Supplementation for any opening; use diverted
grant funds for vouchers for education,
training or support services; and extend
transitional Medicaid and child care to 24
months.
Key Issues:
* Time limit work without
extensions or work for
those who play by the
rules.
* Severity of sanctions
Status:
Have resolved most
significant ,issues with
state. Have began to
draft terms and conditions
which we expect to send to
state by the end of
January.
Key Issues:
* Provision of-support--services
status:
Sent state a list of
issues and questions which
result from a federal
review of the application
11/30 ' which state
response, received
1/12/95, did not resolve.
Proposal involves legal
and policy issues which we
expect we can resolve with
state once new agency
officials are in place.
Date
received:
7/26/94
120 days:
11/23/94
Presented
challenging
and complex
policy
questions.
Date
. received:
-8/-SI-9A_~_
11--
120 days:
11/29/94
Complex
issues.
Staff spent
substantial
amount of
time working
with the
state in an
attempt to
resolve the
most
difficult
issues.
__
�Maryland
Welfare Reform
Project
Statewide, eliminate increased AFDC benefit for
additional children conceived while receiving
AFDC and require minor parents to reside with a
guardian. In pilot site, require able-bodied
recipients to do community service work after
18 months of AFDC receipt; impose full-family
sanction on cases where JOBS non-exempt parent
fails to comply with JOBS for 9 months;
eliminate lOa-hour rule and work history
requirements for AFDC-UP cases; increase both
auto and resource limits to $5000; disregard
income of dependent children; provide one-time
payment in lieu of ongoing assistance; require
teens parent to continue education and attend
family health and parenting classes; extend
JOBS services to unemployed non-custodial
parents; and for work supplementation cases
cash-out food stamps.
Key Issues:
* Statewide family cap
* civil Right Issues
Date
received:
3/1/94
120 days:
6/29/94
status:
Waiver raises significant
concerns in the State
between the legislature
and the Former Governor.
Waiting fo.r guidance from
the new Governor.
Unresolved
policy
issues.
Key issue:
Date
state-wide project would end cash
received:
assistance to most AFDC families,
Empioyment
requiring recipients who could not find * Capacity to generate 3/22//94
Support
full-time unsubsidized employment after sufficient positions
60 days of AFDC receipt to do community for placement of
12.0 Days:
Program
service and job. search to earn a cash
individuals after 60
7/20/94
"subsidy" that would make family income days
equal to the applicable payment
Until
----'-standard;_.provide direct distribution
status:
January,
of child support-corle-ct·ions-~0-,-and_
____
no action
cash-out food stamps for·, those who
contfiluing-discussions- -due._to____
obtain jobs; continue child care for
between the Governor
incomplete
working families as long as they are
and the legislature.
action by
income-eligible (but requiring sliding
state has asked us to
state
scale co-payment); restrict JOBS'
hold application.
legislatur
education and training services to
e and
those working at least 25 hours per
Governor.
week; extend transitional Medicaid for
a total of 24 months; and require teen
parents to live with guardian or in a
supportive living arrangement and
attend school.
Massachusetts
�Michigan
To Strengthen
Michigan Families
Mississippi
This expansion of Michigan's "To strengthen
Michigan Families" welfare demonstration
requires AFDC recipients to participate in
either the Job opportunities and Basic Skills
Training program (JOBS) or Michigan's "Social
Contractu. activities that encourage work and
self-sufficiency. Michigan is also testing the
requirement that AFDC applicants participate in
job search by actively seeking employment while
eligibility for AFDC is being determined. The
demonstration also requires that pre-school-age
children be immunized and disregards the value
of one vehicle in determining eligibility.
Additionally, 'in two counties, Michigan will
evaluate mediation services to determine if
this increases compliance with child support.
The demonstration will extend previously
approved waivers until October 1999. It will
include a rigorous .evaluation.
Mississippi's reform plan promotes health and
education for children receiving welfare
assistance and supports work efforts by their
A New Direction
parents. The demonstration includes a
Demonstration'Program
statewide component and two projects, "Work
First" in six counties, and "Work
Encouragement" in two counties.
The statewide component requires all children
receiving AFDC aged six through 17 to attend
---I-scheel-and _tho-1!le ~nder age six to. be immunized
and receive regular-fieart;n-checkups.--It_als.o___ _____
I
extends AFDC eligibility for two-parent
families by allowing mothers or fathers to work
more than 100 hours a month. The "Work First"
componeQt provides subsidized, private-sector
employment for job-ready participants. In
addition, each "Work First" participant will
have an "individual development account" for
family savings, to which employers will
contribute one dollar per hour of work. The
"Work Encouragement" component allows
recipients to keep more of their earnings and
still receiveAFDC, by raising the earned
income limit from 60 to 100 percent of state
established need levels. Time limits on income
disregards will also be waived. The "Work
First" component will be implemented in Adams,
Harrison, Jones, Lee, Hinds and Washington
Counties. The "Work Encouragement" component
will be implemented in Leflore and Oktibbeha
counties. Under both the "Work First" and
"Work Encouragement" components, courts may
require unemployed, non-custodial fathers to
participate in the JOBS program to meet child
support obligations. The demonstration will be
in effect for five years.
Date
received:
3/8/94
Date
approved:
10/5/94
Date
reeeivede
12/10/93
Date
approvede
12/22/94
---1-·---_-
�\
Missouri
Families Mutual
Responsibility Plan
First phase of state~wide project would require
minor parents to live at home or in other .
adult-supervised setting; disregard parental
income of minor parents if less than 100% of
Federal Poverty Guidelines; disregard. earnings
of minor parents if they are students;
eliminate work history and 100-hour rule for
two-parent families under 21 yrs old; exclude
the value of one automobile in calculation of
payment level.
Second phase of project: To be submitted
Montana
Families Achieving
Independence for
Montanans
Key Issue:
* Proposes to eliminate
good cause provision which
allows minor mothers not
to live at home under
certain circumstances.
status:
Letter sent to State 11/23
addressing issues which
result from a formal
review of the application.
We have not heard back
from the state.
Date
received:
8/15/94
120 days:
12/15/94
state has
not
responded to
issues.
Statewide waiver. Would establish: (1) Job
Key Issues:
Date
supplement Program consisting of a set of AFDC
received:
related benefits to assist individuals at risk
* Reduction in Medicaid
4/19/94
of becoming dependent upon welfare; (2) AFDC
benefits.
Status:
Pathways Program in which all applicants must
120 days:
enter into a Family Investment Contract and
8/16/94
adults' benefits would be limited to a maximum
HICFAand state officials
of 24 months for single parents and 18 months
are working to resolve
Extremely
for AFDC-UP families; and (3) community
some remaining issues.
complex
·-ser-v-ices_Pr.ogram requiring 20 hours per week
Draft terms and conditions
issues.
for individualSWhOreach-the'-:AFDC-t-ime-limit _ . are being developed and we
but have not achieved self-sufficiency. The
expect-to-send-·them·-upon~_I _ _ _ __
office culture would also be altered in
_
resolution of above
conjunction with a program offering a variety
issues.
of components and services; and simplify/unify
AFDC and Food stamp intake/eligibility process
by: 1) eliminating AFDC deprivation requirement
and monthly reporting and Food stamp
retrospective budgeting; 2) unifying program
requirements; 3) simplifying current income
disregard policies. Specific provisions
provide for cashing out food stamps, expanding
eligibility for two-parent cases, increasing
earned income and child care disregards and
resource limits, and extending transitional
child care.
�Nebraska
I
statewide waiver. Would require recipients who
qualify to choose either a Time-Limited High
Disregards Program or a Time-Limited
Welfare Reform Waiver
Alternative Benefit Program. Assign recipients
Demonstration
with mental, emotional or physical barriers to
self-sufficiency to a Non-Time-Limited Program.
Under all three programs would eliminate
increase in benefits for birth of children
conceived while receiving AFDC; raise resource
limits to $5,000 and exclude the value of one
vehicle; require school attendance; deem, to
the family, income of parents living with a
minor parent in excess of 300% of the poverty
level, but where minor parent lives
independently, secure support from the minor's
parents. Under the Time-Limited, High
Disregards Program, would provide cash
assistance for a total of 24 months during a 48
month period (with provisions for certain
exemptions and extensions); cash-out Food
Stamps; reduce AFDC payments, but replace
earned income disregards with a disregard of
60% of earned income; require all adult. wage
earners to participate in educational job
skills training, work experience, intensive job
search, or employment;
I mak~ employment a JOBS component, but only for
a joodeemed-to-lead-to-sel-f-sufficienc}'J _ __
extend job search requirements; require both
parents in two-parent families to participate
in JOBS; impose first JOBS sanction for at
least one month, the second for at least 90
days and the third permanently; extend
transitional Medicaid and child care to 24
months; eliminate 100 hour rule and work place
attachment requirements for AFDC-UP cases.
Under the Time-Limited, Alternative Benefit
Program the same provisions would apply except
that .recipients of this program would have
somewhat higher benefits, but with the' current
earned income disregards.
New Hampshire
Earned Income
Disregard
Demonstration Project
Statewide waiver. AFDC applicants and
recipients would have the $200 plus 1/2 the
remaining earned income disregarded.
Key Issues:
*
Date
received.
10/4/94
Family cap
* Time limit work without
extensions or work for
those who play by the
rules.
120 daysl
2/1/95
status:
Met with Nebraska
officials. Working with
them to resolve issues.
Sent state a list of
issues and questions which
result from a federal
review of the application
1/10/95. State has. not
yet responded.
l
I
Key Issues:
*
None
statu-s:
State asked to hold their
request. Expect to
withdraw request within a.
month.
11--__
Date
received:
9/20/894
120 daysl
1/18/94
Hoiding at
state
request.
�New Jersey
Family Development
Program
New Mexico
Untitled Project
Limit AFDC payments based on the size of the
family at the point at which they begin
receiving public assistance.
Change the JOBS sanction policies for AFDC
families with youngest child 2 years or older
if they refuse to work,
continue their education or take part in
training or vocational assessment.
Require
vocational assessment for otherwise exempt
cases with youngest child under 2 (no further
JOBS activity would be mandatory).
Provide
benefits to married families in which the
husband is not the father of the children
receiving AFDC benefits as long as family
income is no more than the higher of 150
percent of the poverty level or the State need
standard for the family size.
The Department is being
sued over its granting of
an 1115 waiver that would
allow New Jersey to not
raise the payment standard
for children born on AFDC.
The Federal judge in the
case has granted the
defendants motion for a
summary judgement. A
ruling may be made soon.
Date
received:
5/20/1992
Statewide waiver. Would increase vehicle asset
limit to $4500; disregard earned income of
students; develop an AFDC Intentional Program
Violation procedure identical to Food Stamps;
and allow one individual to sign declaration of
citizenship for entire case.
Key Issues,
Date
received,
7/7/94
*
Evaluation
status:
_0
Date
approved I
7/14/1992'
120 days:
11/9/94
ACF sent the ,state a list
of issues and questions
State did
which resulted from a
not respond
federal review of the
until ,
appHcation-915/94 .-The- _ _ ll'1LL95
state response, received
------1/9/95, does not resolve
key issues.
�New York
"A Jobs First
Strategy"
North Dakota
Early Intervention·
Program
This demonstration gives applicants
alternatives to welfare, provides new
incentives for recipients to find work and
create businesses, and encourages the formation
and preservation of two-parent families. The
demonstration allows applicants otherwise
eligible for Aid to Families with Dependent
Children the option to receive child care or
Job Opportunities and Basic Skills Training
program services in place of AFDC. The program
will also provide one-time cash assistance or
other services necessary to remedy a temporary
emergency which has resulted, or may result, in
job loss or impoverishment. The demonstration
allows children in AFDC families to receive
AFDC for up to two years after a caretaker
parent marries and the new spouse's income
makes the family ineligible, so long as the
household's income does not exceed 150 percent
of the federal poverty guidelines.
It extends
to a full year transitional child care benefits
for employed recipients who leave the rolls
because of child support payments. In
.
addition, clients are encouraged to develop
their own business enterprises by excluding
certain business income and reso~rces,
including vehicles. The demonstration will be
-~mplemented-in-s~x-sites_in_fo~r counties
(aroome, Onondaga, Er ie, and up to three sTtes .
in Brooklyn), and will operate for five years.
It will include a rigorous evaluation.
This demonstration will provide federal AFDC
matching funds to the state for low-income
women during the initial six months of
pregnancy with their first child. Such
payments are usually not available until the
last trimester of the pregnancy. In addition,
the demonstration links AFDC to a requirement
that individuals enroll in the State's welfare
to-work program and pursue education or
training activities both during the first six
months or pregnancy and after their child is
three months of age.
Date
received:
6/1/94
Date
approvedz
10/19/94
I
1---------
Date
received I
12/28/92
Date
approved:
4/12/94
11---
�Training, Education,
Employment and
Management Project
Ohio
"A State of
opportunity" Project
II
statewide waiver. Would require families to
develop a social coritract specifying time-limit
for becoming self-sufficient; combine AFDC,
Food Stamps and LIHEAP into single cash payment
with simplified uniform income, expense and
resource exclusions; increase income disregards
and exempt stepparent's income for six months;
increase resource limit to $5000 for one
recipient and $8000 for families with two or
more recipients; exempt value of one vehicle;
eliminate 100~hour rule for AFDC-UPi impose a
progressive sanction for non-cooperation in
JOBS or with child support; require a minimum
of 32 hours of paid employment and non-paid
work; require participation in EPSDT; and
eliminate child support pass-through.
This demonstration project involves three
demonstration components to be piloted in
different sites. The Communities of opportunity
component focuses on diverting AFDC and Food
Stamp benefits to a wage pool to supplement
Lwages-of-at--least._$8_p.er hour. The Families of
opportunity component would provide fTrl-tne
gap budgeting for 12 months from month of
employment; increase child support pass-through
to $75; provide a one-time bonus of $150 for
paternity establishment; provide an additional
6 months of transitional child care; and
increase automobile asset limit to $4500 equity
value. The Children of opportunity component
would require regular school attendance by 6 to
19-year-olds; and continue current LEAP demo
waivers (Le., .eliminate many JOBS exemptions
and provide incentive payments and sanctions).
.
Key Issues:
*Time limit
Date
received:
9/9/94
*Severe family sanctions
*Food stamps cash out
Status:
Met with state officials
11/18/94 and sent State a
list of issues and
qUestions which resulted
from a federal review of
the application on
1/10/95. Have not heard
back from State, but
Congressional delegation
has made inquiries
regarding issues list.
Key Issuesl
* Resolved all major
issues
statusz
.
ACF has been working with
the state. State sent
draft terms and conditions
1/17 and, if accepted by
State, could be approved
before end of January.
.
120 days:
1/7/95
Delays due
to state
sending in
revisions at
later dates.
Date
receivedz
5/28/94
120 days:
9/25/94
11----
Consideratio
n was held
at the
request of
the state
until food
stamp cashout issue
was resolved
by Congress
and
implementa
tion process
was
initiated by
USDA.
�Oklahoma
Oklahoma
Demonstration Project
(ODP)
Mutual Agreement, A
Plan for Success
(MAPS)
This demonstration seeks to encourage welfare
recipients to regularly attend school and
ultimately graduate from a high school or
equivalent educational program. The
demonstration provides that AFDC recipients
between the ages of 13 and 18 need to remain in
school or face a reduction in benefits if they
drop out. The plan applies to teenage parents
as well as children.
Five pilot demonstrations would test provisions
which: 1) eliminate lOb-hour rule for UP cases;
2) increase auto asset level to $5000; 3) time
limit AFDC receipt to cases with non-exempt
JOBS participants to 36 cumulative months in a
60 month period followed"by mandatory workfare
program; 4) provide intensive case management;
and 5) apply fil1-the-gap budgeting.
Date
received:
12/28/92
Date
approved:
1/25/93
Key Issues:
*
Date
receivedl
No major issues pending.
2/24/94
120 daysl
status,
6/28/94
ACF has been working with
the state and sent draft
terms and conditions to
the state 1/9/95. State
concerned about sample
size.
After
initial
discussion,
state
requested
time to
restructure
parts of the
waiver
--·-p:t'oposal.
�Oregon
JOBS Plus
----II
This demonstration provides individuals with
short-term (up to nine months) subsidized
public or private employment at minimum wage or
better. The state will provide supplemental
payments if an individual's income is less than
the combined AFDC and Food Stamps benefits.
participants will continue to be eligible for
Medicaid and will receive workplace mentoring
and support services. The state also will pass
on to the family all the child support payments
it collects on the family's behalf.
Each JOBS Plus participant will also have an
Individual Education Account (lEA), to which
employers will contribute one dollar per hour
of work. After a participant begins working in
a non-subsidized position, the state will
transfer the lEA to the State Scholarship
Commission. The Commission will then make
funds available to the participant or the
immediate family for continuing education and
training at any state community college or
institution of higher learning.
ETCCP:
Expansion of the
Trans.ft"ional-Ch-l1:d-- 1 - - - - - -____- _
Care Program (ETCCP)
rrOVl.ue l:;ranSl.l:;l.onal child care oenefi:t-s
without regard to months of prior receipt of
.AFDC and provide benefits for 24 months.
Date
received:
10/28/93
Date
approved:
9/19/94
Key Issuesz
I··
Status:
State asked ACF to hold
the waiver.
Date
receivedz
B/8/94
-'--"'-------11---
120 daysz
12/8/94
Holding at
state
request
Increased AFDC Motor
Vehicle Limit (AMVC)
AMVC:
Key Issuesz
Would increase automobile asset limit to $9000
for AFDC and Food Stamp cases.
* Evaluation
* Cost neutrality
Status:
State had asked ACF to
hold request but
subsequently requested
that review move forward.
working with the state and
FCS to try to resolve
evaluation issues.
Date
received:
8/8/94
120 days:
12/5/94
�\
Pennsylvania
"Pathways to
Independence"
This demonstration project provides incentives
and support for single and two-parent families
moving from welfare to self-sufficiency.
It
increases earned income disregards so that
recipients can keep more of what they earn
before they become eligible for public
assistance. Additionally, it raises AFDC
resource limits, including the value of a
family's vehicle, and increases the time that a
family is eligible for tr.ansitional child care
and Medicaid after the family leaves welfare
due to earnings.
It will operate in Lancaster
County. To further aid the transition to work,
Pathways extends case management counseling and
referral services to up to one year after the
family leaves welfare. Families will be able
to deposit money· into retirement savings and
education accounts without penalty.
.
Furthermore, after two months of employment,
recipient families can also choose to receive
cash payment of their monthly Food Stamp
benefit. The demonstration will operate for
five years.
Date
received I
11/12/93
Date
approved:
2/3/94
Priority
given to
JOBS Plus.
State then
put on hold.
�School Attendance
Improvement
Program
In 7 sites, would require school attendance as
condition of eligibility.
Key Issues:
Date
received:
*
Penalty for parental
failure to grant consent
to relea,se school records.
9/12/94
120 days:
1/9/95
status:
State has
not
responded
Sent the state a list of
issues and questions which
result from a federal
review of the application
11/30.
State indicates they are
unable to respond to
issues at this time.
Iteylssues:
Savings for Education
Program
Statewide, would exempt as resources college
savings bonds, and funds in savings accounts
earmarked for vocational or secondary education
and disregard interest income earned from such
acccunts.
None
STATUS:
Date
Have informed State they
received:
may be able to implement
12/29/94
changes under current
-------------------------------------------------1 authority. State is
120 days:
,reviewing thJ:s-option and -4/-29/95---11 ______
may withdraw request.
I
��South Carolina
Self-Sufficiency and
Parental
Responsibility
Program
This waiver sets work requirements, provides
transitional assistance for program
participants, and significantly reduces
case loads for participating AFDC caseworkers.
After completing Individual Self-Sufficiency
Plans (ISSP's) to help prepare them to become
s~lf-sufficient, AFDC recipients have 30 days
to find a job in a designated vocational area.
If they fail to secure such employment,
recipients receive an additional 30 days on
AFDC to find any private sector job, after
which time they must participate in a community
work experience program in order to continue to
receive AFDC benefits. Progressive sanctions
for non-compliance, up to and including removal
of the entire family from assistance, are
components of this program. To aid in the
transition to work, recipients who would
otherwise no longer be eligible for AFDC
because of employment can receive reduced
benefits for up to 12 months. Families remain
eligible for Medicaid and child care during
this phase-down period, and regular
transitional Medicaid and child care benefits
begin at the end of this period. The program
also raises resource limits to $3,000 and
exempts the cash value of life insurance
policies, one vehicle and interest and dividend
payments. Children of rec{pients are required
to attend school regularly and obtain
appropriate immunizations. The demonstration
will operate in Berkeley, Dorchester,
Charleston, and Barnwell Counties for a period
of five years.
Date
received:
6/13/94
Date
approved *
1/9/95
�South Dakota
"strengthen-ing of
South Dakota
Families Initiative"
Utah
Single Parent
Employment
Demonstration
This demonstration encourages welfare
recipients to undertake either employment or
education activities. The program assigns AFDC
participants to either an employment or
education track that enables them to move from
dependency to self-sufficiency. Individuals
enrolled in the employment track will receive
up to 24 months of AFDC benefits; those
participating in the education track will
. receive up to 60 months of AFDC benefits. Upon
completion of either track, participants will
be expected to find employment, or failing
that, will be enrolled in approved community
service activities.o Individuals who· refuse to
perform the required community service without
good cause will have their benefits reduced
until they comply. In addition, in conformance
with the Food Stamp program, AFDC benefits can
be denied to any family in which an adult
parent quits a job without good cause. The
sanction period will last three months, or
until the parent acquires a comparable job.
This waiver aims to change AFDC from an income
maintenance program to an employment program by
requiring self-sufficiency planning prior to
eligibility determination for financial
assistance. Other components of the waiver
include: coordinating with AFDC and JOBS;
"fast-tracking" certain populations;
prioritizing workloads based on self
sufficiency and collections criteria; and
eliminating current JOBS exemptions to expected
participation of all parents and children not
attending school with a $100 reduction in
family's gr~nt for nonparticipation. This
waiver also simplifies eligibility and benefit
determination and creates financial incentives
for work by: raising resource limit to $2,000;
the auto limit to $8,000~ replacing current
disregards with $100 (for applicants and
recipients) plus 45 %; and expanding
eligibility for transitional Medicaid and child
care services. Families in public housing are
given opportunities to be included in housing
self-sufficiency programs and the escrow
provision for earned income.
Date
received.:
8/6/93
Date
approved.:
3/14/94
Status:
Approval during Bush
administration with some
evaluative elements
available.
Date
received.:
6/29/92
Date
approved.:
10/5/92
�,
vermont
Family Independence
Project (FIP)
This waiver promotes work by enabling AFDC.
recipients to retain more income and accumulate
more assets than is normally allowed. FIP also
requires AFDC recipients to participate in
community or public service jobs after they
have received AFDC for 30 months for most AFDC
families or 15 months for families
participating in the unemployed parent
component of AFDC. Current child support
payments will now go directly to families
entitled. to them.
Date
receive:
10/27/92
,
Date
approved.
4/12/93.
�\.
virginia
Welfare Reform
Project
(WRJ)
Welfare to Work
Program
This waiver proposal will encourage employment
by identifying employers who commit to hire
AFDC recipients for jobs that pay between
$15,000 and $18,000 a year and by providing
additional months of transitional child care
and health care benefits •. A second statewide
project. will enable AFDC families to save for
education or home purchases by allowing the
accumulation of up to $5,000 for such purposes,
encourage family formation by changing the way
a stepparent's income is counted, and allow
full-time high school students to continue-to
receive AFDC benefits until age 21. Further,
in up to four counties, AFDC recipients who
successfully leave welfare for work may be
eligible to receive transitional benefits for
child and health care for an additional 24
months, for a total of 36 months. In one
location, Virginia will offer a guaranteed
child support "insurance" payment to AFDC
families who leave welfare because of
employment to assist the family in maintaining
economic self-sufficiency.'·
statewide, would provide one-time diversion
payments to qualified applicants in lieu of
AFDC; change first time JOBS non-compliance
sanction to fixed period of one month or until
compliance and remove the conciliation
requirement; require paternity establishment as
condition of eligibility; and remove the
conciliation requirement; require paternity
establishment as condition of eligibility;
remove good cause for non-cooperation with
child support and exciude from AFDC grant
caretakers who cannot identify, misidentify, or
fail to provide information on the father;
require minor parents to live with an adult
guardian; require AFDC caretakers without a
high school diploma, aged 24 and under, and
children aged 13-18, to attend school, require
immunization of children; allow $5000 savings
for starting business; and increase the
eligibility for Transitional and At-Risk Child
Care. Require non-exempt participants to sign
an Agreement of Personal Responsibility as a
condition of eligibility and assign to a work
site under CWEP for a number of hours
determined by level of benefits divided by the
minimum wage.
Date
received:
7/13/93
Date
approved:
11/23/93
Key Issues:
* Time limited benefits
*
*
Family Cap
Food Stamp Cash-out
* Paternity establishment
conditions for eligibility
Status:
we expect to send to state
a list of issues and
questions which result
from a federal review in
the next two weeks.
Meeting between ACF and
state officials scheduled
for 1/27/95
Date
received:
12/29/94
120 days:
3/16/95
�Washington
Success Through
Employment Program
Statewide waiver. Eliminate 100-hour rule and
Key Issues:
work history requirements for AFDC-UP cases and
subtract client earnings from 55 percent of the * Evaluation
State need standard rather than the payment
standard.
I * cost Neutrality
status:
Waiver has· been on hold.
State was "~xpected to
resubmit modified waiver.
That would incorporate
welfare reform provisions
passed by the state
legislature. However, new
legislature on fast track
to pass more significant
welfare "reform bill.
Wisconsin
"Work Not Welfare,"
This demonstration will require that most AFDC
recipients either work or look for jobs. The
plan provides case management, employment
activities, and work experience to facilitate
employment. Receipt of AFDC benefits will be
limited to 24 months in a 4-year period, except
under certain conditions, such as an inability
to find employment in the local area due to a
lack of appropriate jobs. Upon exhaustion-of
benefits, recipients become ineligible for 36
months. With exceptions, children born while a
mother receives AFDC will not be counted in
determining a family's AFDC grant. In
addition, child support will now be paid
directly to the AFDC custodial parent in cases
where the funds are collected by the State.
Date
rec::eivedl
11/16/93
120 days:
3/16/94
Initial
delay in
state
response,
followed by
state
request to
submit a
changed
proposal.
ACF has not
received-new
proposal.
Date
rec::eivedl
7/14/93
Date
approved I
11/1/93
�,
Work Not Welfare
(WNW)
AFDC Benefit Cap
(ABC) Project
This waiver will require that most AFDC
recipients either work or look for jobs. The
plan provides case management, employment
activities, and work experience to'facilitate
employment. Receipt of AFDC benefits will be
limited to 24 months in a 4-year period, except
under certain conditions, such as an inability
to find employment in the local area due to a
lack of appropriate jobs. Upon exhaustion of
benefits, recipients become ineligible for 36
months. With exceptions, children born while a
mother receives AFDC will not be counted in
determining a family's AFDC grant. In
addition, child support will now be paid
directly to the AFDC custodial parent in cases
where the funds are collected by the state.
Date
received:
7/4/93
Date
approved:
11/1/93.
Date
received:
2/9/94
Date
,approved:
6fl"-L94
Eliminate increased AFDC benefit for additional
children conceived while receiving AFDC.
wyominq
New opportunities and
New Responsibilities
Welfare Reform
Demonstration
This demonstration wil~ encourage AFDC
recipients to enrolli~,school, undertake a
training program, or enter the workforce.
Wyoming's plan will allow AFDC families with an
employed parent to accumulate $2,500 in assets,
rather than the current ceiling of $1000.
Wyoming will promote compliance with work and
school requirements with tough penalties: AFDC
minor children who ref~se to stay in school or
accept suitable employment could have their
monthly benefit reduced by $40; and adult AFDC
recipients who are requ:ired to work or perform
community service, but 'refuse to do so, face a
$106 cut in their monthly benefit. Also,
Wyoming will severely restrict eligibility for
adults who have completed a postsecondary
educational program while on welfare, and will
deny payment to recipients who have confessed
to or been convicted of program fraud until
full restitution is made to the state.
Unemployed, non-custodial parents of AFDC
children who are not paying child support can
now be ordered, by the courts, into Wyoming's
JOBS program.
Date
received:
5/20/93
Date
approved:
9/7/93
;';'
;,
�MASSACHUSETTS
Massachusetts has submitted an 1115 waiver
.application, entitled MassHealth. The
demonstration has nine component strategies which
are intended to cover a portion of the 524,000
. uninsured in Massachusetts, as well as provide
assistance to the low-income insured. The proposed
strategies address needs specific to the mixture of
social economic groups that are uninsured in
Massachusetts, which include the employed, the
short-term unemployed, and the long-term
employed. The proposal includes direct strategies
that provide public health care and indirect
strategies that seek to promote market forces and
responsible decision making by providing financial
incentives in the form of tax ·credits to employers,
tax deferred medical saving accounts for insured
individuals, and subsidies in the form of insurance
__~I1 ____ . _________ Lvhouchers for employees with incomes up to 200% of
,
MICHIGAN
MINNESOTA
January 20,
199~
A negotiating team from the Department and OMB
met with Massachusetts on November 30 to discuss
outstanding issues. The main concerns were with
providing Federal Medicaid funds to subsidize
employers and premiums of the low-income currently
insured, establishing the budget neutrality baseline,
maintaining adequate DSH funds for uncompensated
care during the demonstration, and the State's
resistance to collecting 100 percent encounter data
from the health plans.
Proposal received
4115194.
120 days: 8/13/94
The negotiating team has been in close
communication with the State and has reached .
agreement on most issues. A counter proposal on
budget neutrality was sent to the State on January 18.
An agreement in principle should follow shortly after
resolution of the budget neutrality issue. .
The employer mandate enacted by the Dukakis
-administration.has been delayed by the State
legislature. The ex.pectation is thafthe manaate-will-I
be delayed for at least a year while the State
considers alternatives.
11 _ _ _
'
None
Minnesota has submitted a waiver proposal with
three major components: (1) integration of low-.
. income and uninsured programs; (2) ex.pansion of
the managed care delivery system; and (3) linkage of
Medic~re to overall State health care reform efforts.
The proposal would be implemented in two phases.
Phase I would involve the first two components. In
Phase 2, Minnesota would develop a framework for
implementing broader reforms in subsequent years. ,
- Medicaid Statewide 1115 Demonstrations
HCFA sent a comprehensive set of questions about
the proposal to the State for comment on
November 7 and the States responses were received
on January 6.
Proposal received
7/28/94.
120 days: 11/25194
The HCF A Administrator met with representatives
from the State on January 6 to dis<;uss outstanding
issues, including Minnesota's method of achieving
budget neutrality and the lack of expansion to the
uninsured. HCFA agreed to focus on the innovative
eligibility streamlining of the demonstration, rather
than minimal eligibility expansion, and will work with
the State on budget neutrality.
7
�MISSISSIPPI
None
MISSOURI
Missouri's Department of Social Services has
submitted an 1115 waiver proposal that will provide
managed care medical services to the State's
Medicaid population and to the uninsured.
HCFA sent a comprehensive set of questions about
the proposal to the State for comment on October
21. Conference calls were held with the State on
November 4 and November 16 to discuss and clarify
issues.
Proposal received
6130/94.
On January 15, the State requested an indefinite
extension for their formal response. The State may
respond by proposing a smaller-scale project.
State requested
indefinite extension.
Questions sent to
State 10/21/94
120 days: 10/28/94
MONTANA
The State has submitted a concept paper focusing
on mental health managed care. The State seeks a
program which will provide effective and efficient
mental health services to low income Montanans
through a consolidated, capita ted system.
HCFA met with the State on November 3 to discuss
their concept paper.
Concept paper
received on 10/24/94.
HCFA is concerned that the State is seeking to
refinance its State mental health program with
Federal matching funds. Institutional mental health
has traditionally been the responsibility of the States.'
" Congress lias excluoed-Medicaid"paymenHor-these--1
.
services from the Medicaid law.
NEBRASKA
None
NEVADA
None
NEW HAMPSHIRE
New Hampshire submitted a proposal entitled, "The'
Granite State Partnership for Access and
Affordability in Health Care". The State proposes
to expand Medicaid eligibility to adults with incomes
below the AFDC cash standard, and introduce a
public insurance product for low-income workers.
Also, the State proposes to implement a number of
pilot initiatives to help to ultimately redesign the
State's health care delivery system.
HCFA sent a comprehensive set of questions about
the proposal to the State for comment on 9/28/94.
The State response was expected by 1219194, but has.
not yet been received. The State has indicated the
responses may be detayed another 4-6 weeks.
New Jersey has had preliminary discussion's with
HCFA's Regional Office about possible projects.
11 _ __
The States' proposal is in the conceptual stage.
NEW JERSEY
January 20, 1995 - Medicaid Statewide 1115 Demonstrations
Proposal received
6114/94.
120 days: 10/12/94
J
8
�New York had been discussing an 1115
demonstration with the focus of creating incentives
for Medicaid recipients to join HMOs. One
possible incentive system would be to decrease
optional seMces for those recipients in the fee-for
seMce system. The State envisions using the
savings generated by this program to expand
eligibility to uniJ!sured State residents, including
individuals in need of health benefits as they
transition from the public welfare system to
employment, and uninsured pregnant women and
children.
NEW YORK
NEW MEXICO
The concept paper based on this design was
submitted on December 30, however, the State's new
Administration may pursue other options.
Concept paper
received on
12/30194.
I None
NORTII CAROLINA I None
NORTII DAKOTA
------
I None
I
'-.": ..t::U:l
11."""'£'MPrl
List
OKLAHOMA
Oklahoma has submitted an 1115 waiver proposano- -HeFA-is-currently_re~i~wing Oklahoma's proposal.
•
implement "SoonerCare". The focus. of the program Once ~ey issues and questions have been-iaenlified-,-\-116195_--- _____11 ___
is on development of managed care In rural areas,
they Will be communicated to the State for response.
120 days: 5/6/95
through three partially capitated delivery models.
The State is encouraging the use of safety net
i_
providers through various mechanisms.
OREGON
See Approved List
PENNSYL VANlA
None
RHODE ISLAND
See Approved List
January 20, 1995 - Medicaid Statewide 1115 Demonstrations
9
�,
SOUTII CAROLINA
SOUTH DAKOTA
TENNESSEE
South Carolina submitted an 1115 waiver application
entitled the South Carolina Palmetto Health
Initiative. The program would extend Medicaid
eligibility to include residents with incomes up to
100% FPL. South Carolina expects to cover
approximately 240,000 additional recipients. Most
Medicaid recipients' will be enrolled in managed
care programs. South Carolina ~ould also
implement a 500-member long term care pilot
project to demonstrate the effectiveness of a
targeted managed care system that emphasizes
home- and community- based services for the
nur~ing facility population.
During its review, the Department found that the
State's proposal needed substantially more
development. Because of the lack of detail and
concern over South Carolina's limited experience with
managed care, HCFA approved the framework of
their project and agreed to work with the State to
meet a set of milestones over the coming year. When
South Carolina successfully completes these
milestones, HCFA will act expeditiously on their
request for waivers.
Proposal received
3/1194..
1.20 days: 6/29194
Approval of
framework granted
on 11/18/94.
I None
See
nnrrnll>rI
List
The State has indicated that they will be submitting
--a-section_1l15_waiver proposal focusing on Medicaid
-------
managed care.
I The State's proposal is in the conceptual stage.
.
UTAH
Utah has indicated that they will be submitting an
1115 waiver proposal to increase Medicaid coverage
to 100% of the FPL. Utah will develop managed
care networks with traditional HMO systems in
urban areas and primary care case management in
rural areas. As of 7/1194, the State began to enroll
all children up to 100% FPL. Eventually, Utah will
expand coverage to all individuals up to 100% FPL.
Also, the State is considering a voluntary insurance
program for low-income workers.
Utah plans to submit a formal waiver request in
either January or February of 1995 with a projected
implementation date of September 1995.
COncept
Paper, 10/25/94.
VERMONT
The State submitted a concept paper for a
demonstration entitled Vermont Health Security
Plan. In the demonstration they intend to expand
coverage to uninsured individuals up to 150% of
FPL and integrate Medicaid beneficiaries into
managed car.e plans.
Vermont intends to submit a formal proposal in
February.
;
Concept paper
submitted on
12/24/94.
January 20, 1995 - Medicaid Statewide 1115 Demonstrations
10
�\
VIRGINIA
None
WASHINGTON
State seeks to guarantee health insurance for aU
State residents by 1997 through: employers,
expansion of State*subsidized Basic Health Plan, and
expansion of Medicaid. Prohibits exclusion for
medical conditions.
Washington's Medicaid Director has indicated that
the State will be seeking an 1115 demonstration in
the future.
Proposal passed
State legislature
04125/93.
HCFA has had no recent discussions with the State
on their proposal.
The plan provides for basic coverage for the
uninsured, authorizes up to 10 health insurance
cooperatives, requires employers to contribute to
health insurance premiums. Also provides for the
Health Services Commission to explore the
mechanics of implementing the goals of the plan,
outline cost controls and market reforms, define
minimum benefit package, and set maximum
premiums.
None
None
None
January 20, 1995 - Medicaid Statewide 1115 Demonstrations
11
�\
STATIJS OF OUIER STATE MEDICAID INITIATIVES
January 19, 1995
STAlE
INITIAL CONTACT/·
CONCEPT DISCUSSIONS
PROPOSAL RECEIVED/
TECHNICAL REVIEW
CLEARANCE!
DECISION
APPROVED·
DISAPPROVED
AWARD
ANNOUNCEMENT/
ACCEPTANCE OF
T&Cs
OPERAnONAL
START
NEW
ACnVrfY
I
I
I
AZ
DE
X
8/93/10193
12/93
MD
X
8193/09/93
10/93
MD
X
12/94
SC
I
X
X
12/93 / 02/94
7/94
VA
CA
X
11/92 /11/92
6/93/3193
3/93
8/93
ME
07/13/93
12/23/93 _
I
I
I
I
X
04/19/94
1
X
04107/94
X
X
IA
j
!
!
X
~MN
NH
MN
WI
T
X
X
!
.!
I
,
MI
X
I
DC
X
:
RI
X
OH
X
WA
X
MT
X
MT
X
VA
X
I
'--
January 19, 1995
Other Medicaid Initiatives
i
:
X
�,
STAlE
INITIAL CONTACT!
CONCEPT DISCUSSIONS
PROPOSAL RECEIVED!
TECHNICAL REVIEW
VA
X
NM
DISAPPROVED
AWARD
ANNOUNCEMENT!
ACCEPTANCE OF
T&Cs
OPERATIONAL
START
NEW
ACllVITI
X
GA
APPROVED
X
MD
CLEARANCE!
DECISION
X
AL
X
MA
X
lX
X
NY
X
UT
X
X
-
**Dates in parentheses represent expected dates.
**NOTE: Approved projects are since 6!93, (exceptions: Arizona and Virginia Vaccine Demonstration)
January 19, 1995 - Other Medicaid Initiatives
2
�'.
SECllON 1115 WAIVER ACTIVITY
ornER MEDICAID INITIAl1VES
ARIZONA
Arizona has a long standing statewide Medicaid
managed care program. The initial program was
implemented in 1982.
A 3-year extension of the
approved 8/92.
DELAWARE
Delaware has been granted waivers to develop a
pUblic-private managed care system which enrolls,
on a capita ted basis, Medicaid-eligible children in
pediatric clinics. The Nemours Foundation is
developing the clinics & is subsidizing a portion of
the service cost.
Waivers approved 7(}.7/93.
Maryland has been given waivers 10 establish a
preventive and primary care program for children
receiving Medicaid program.
demonsl~alion
Waivers approved 8/9/93.
MARYLAND
lAND.
I~Maryland ",:,ilI be imp~ementin.g an. ~~ 15 ~a~~~._
demonstration that will establish limited Me(hcalo~
eligibility and provide family planning and related
preventive reproductive services to women who
have just delivered under the Medicaid pregnant
woman and children category. Under the
program pregnant women, whose incomes are at
or below 185% of the FPL (and who are not
for Medicaid otherwise), are elil!.ible to
receive Medicaid for a five year period.
SOUTI-I CAROLINA
South Carolina was given waivers to extend
Medicaid family planning services to Medicaid
eligible pregnant women beyond the 60-day post
partum period.
was
The State has a number of new initiatives
for which they have submitted proposals.
Delaware began operations in December
1993.
Acceptance of special terms and conditions 10/93.
Operations began in October 1993.
Acceptance of special terms and conditions 9/93.
I
Proposal received 6/11/94.
Waivers approved 12/5/94.
I I
I 'I~e MD proposal ,:",~s approved and
..
slS!!ed by the Administrator December 5.
- - ..
llte award letter was sent to the Statc on
1/18/95.
Waiver approved 12n/93.
Operations began 7/94.
Acceptance of special terms and conditions 2/3/94.
llte State indicates that they will be
submitting an amendment 10 their
demonstration. They wanl all women
with incomes under 185% of FPL to be
eligible for Medicaid-covered family
planning services, instead of just the
post-partum women.
January 19,1995 - Other MediCaid Initiatives
J
..
�VIRGINIA
CALIFORNIA
The Medicaid Direct Purchase Vaccine Program
(MDPVP) is a program which allows States to
reimburse the manufactures directly for vaccines.
"Vaccine manufactures send each private physician
treating children on Medicaid a shipment of
vaccines on consignment at no cost to the
physician. As physicians inoculate Medicaid
children with the vaccines, they bill Medicaid for
the office visit but not for the cost of the vaccine
itself. The Medicaid program reimburses the
manufacturer based on the number of vaccines
administered.
Operations began in California on 8/1/93.
Acceptance of special terms and conditions for
Virginia 11/23/92.
January 19, 1995 - Other Medicaid Initiatives
4
�SECTION 1115 WAIVER ACTIVITY
OTHER MEDICAID INITIATIVES
STATE
INITIATIVE
MAINE
IOWA
___II
Maine requested J 115 waivers in order to
eliminate two optional categories for XIX
recipients through changes in their State plan:
medically needy with income's greater than $1302
per month and categorically ne;edy with incomes
between $434 and $1302 per month. Maine
needed 1115 waivers in order to grandfather
individuals in these two categories residing in
nursing homes before 711193.
Proposal requested waivers of the transfer to
assets requirements. Iowa sought to extend the
look-back and penalty periods from 30 to 60
months. as well as implement other changes
related to the penalty periods.
MINNESOTA
I
KEY DATES
I
COMMENTS
Disapproved 7/13193.
Rec'd proposal 4/5/93.
Disapproved 12f23193.
The State has submitted a request to waive
Proposal received 10/14193
--Sections_1902(a )(5J )(ll) and 1917(c) of the SSA
This section 1115 waiver proposal would permit-- -Disapproved-04107/94~--~--~_ _~_
the State to: (1) increase from 36 to 60 months
1-----------------
for Medicaid nursing facility eligibility the length
of the look-back period for asset transfers;
treat the uncompensated transfers of excluded
assets in the same manner as non-excluded assets;
and (3) apply any resulting penalty period to the
loss of coverage of all Medicaid services, not just
long term care services.
II
-
January 19, 1995 - Other Medicaid Initiatives
5
�STA"IE
NEW HAMPSHIRE
January 19,1995 - Other Medicaid Initiatives
INI11A'nVE
New Hampshire is requesting a waiver to develop
Project 1'00111, "The Project Toward
Occupational Opportunity Through Health."
Project TOOTH will provide comprehensive
dental treatment for approximately 200
AFDC/JOBS program participants whose
'disfiguring dental status is the major impediment
to their employment following jobs training, They
are requesting funding and the waiving of
comparability requirements to create a group of
Medicaid recipients eligible for comprehensive
dental care.
KEY DAlES
Received proposal 12/6/93.
Disapproved 4/19/94.
COMMENTS
�\
SECTION 1115 WAIVER ACllVlTY
OTIIER MEDICAID INITIAllVES
STATE
MINNESOTA'
WISCONSIN
MICHIGAN
_ _ _ II
DISTRICT OF
COLUMBIA
INITIA-nVE
KEY DATES
The State submitted a Medicare and Medicaid
waiver proposal for a demonstration which
integrates long-term care and acute care services
under combined Medicare and Medicaid
capitation payments for elderly dual eligibles.
Proposal received 4/18194.
Wisconsin submitted a request to waive section
1902(r)(2)(A) and (B) and 1613(d) of the SSA.
This would permit the State to establish a limit on'
the amount of exempt funds that may be set aside
to meet the burial and related expenses for a SSIrelated Medicaid .",,,;nil'.nl
Proposal was received 3/9/94
Michigan has submitted a new welfare reform
proposal, 'To Strengthen Michigan Families
1994. The proposal requests Medicaid waivers to
.. permit-managed.care-buy-in-afterthe -I05s-of--
transition benefits and to permit family planning
services for all women under 185% of FPL.
The District of Columbia has submitted an 1115
waiver application that proposes to implement a
specialized managed care program, targeted to the
needs of its Medicaid-eligible disabled children .
. There would be mandatory enrollment of the
eligibles into a newly-formed health plan- Health
Services for Children with Special Needs, Inc.
(HSCSN). Full financial risk would be transferred
to HSCSN, in the form of monthly capitation
payments.
Review panel was held 5/24/94.
I
Review panel was held 3/31/94.
I
Proposal received 3/4/94.
I
Conference call held with the State to discuss the
I'
Proposal received 3/25194.
-proposal~ 3/17194
Review panel was 'held 5/17194.
COMMENTS
A meeting with the State was held on
December 6. Outstanding issues include:
payments rates and the role' of the State in th.
Statel Federal partnership. HCFA currently
expects a response from the State. Minnesota
met with the Administrator January 6 on
payment and State-Federal partnership issues.
Regulations arc: being drafted that may affecl
this demonstration. ORD is waiting for an
indication from OGC about the regulations
before making a decision on the proposal.
ORD and the State are discussing HCFA's
concerns about their.welfare reform
demonstration. Michigan is proposing a
for-familiesleavi=n=g--
Transition Medicaid Assistance, with an
eligibility income limit of 400 percent. I-ICFA
has concerns about the viability of this
proposal. ORD will be asking Senior Staff for
guidance on this matter.
HCFA sent comments to D:C on their draft
responses to the special terms and conditions
on 12/30.
January 19. 1995 - Other Medicaid Initiatives
7
�STATE
RHODE ISLAND
INIllAllVE
KEY DATES
Rhode Island submitted a proposal has been
received entitled "CHOIGE<:.'';'', an acronym for
Citizenship: Health, Opportunities,
Interdependence, Choices and Supports. This
program proposes to consolidate all current state
and federal funding streams for adults with
developmental disabilities under one "managed
care/managed competition" Title XIX waiver
program. CHOICES consolidates into a single
program with a single set of rules the following
separate 'ntle XIX programs: ICF/MR, Home and
Community Based Waiver, Community Supported
Living Arrangements, State Plan Rehabilitation
Services, and Acute/Medical Care.
OHIO
Ohio submitted an 1115 waiver application thai
would allow them to implement the ·Pay~in
Spenddown Pilot" Waivers would permit Franklin
COunty, Ohio to pilot a pay-in spenddown option
demonstration.
WASHINGTON
DRAFf proposal received 9/23/93.
Proposal received 4/5/94.
Review panel was held 5/16/94.
I
Washington has submitted a proposal for a family
planning demonstration. The project would
provide family planning services for an additional
10 months postpartum to low income women,
giving coverage to for one year.
MONTANA
The State has submitted a 1115 proposal which is
part of a welfare reform demonstration. They will
reduce the scope of Medicaid for AFDC eligibles.
the savin!J;li being used to offer adult AFDC
participants health benefits (focusing on
preventive services).
Proposal received 04/28/94.
COMMENTS
HCFA staff conducted a site visit in Rhode
Island on December 22. Medicaid Bureau and
ORD will meet with representatives from the
Governor's office. State Medicaid Agency and
the Division of Developmental Disabilities.
Questions have" arisen about whether the
project is legal under the Americans with
Disabilities Act (ADA).
A conference .call was held on August 25 to
discuss with the State the fact that they need t<
revise their proposal and emphasize the
research merits of the project before it can be
considered by ORD.
Proposal received on 4/21/94.
Panel meeting was held for July 14.
I
Proposal received on 4/18194.
withdrawing this waiver application and that il
intends to submit a redesigned proposal
sometime in the future.
Consensus has been reached on the proposal.
Draft terms and conditions are being drafted
by ACF and HCFA.
January 19, 1995 - Other Medicaid Initiatives
8
�\
STATE
INrnAllVE
KEY DATES
COMMENTS
MONTANA
llte State has submitted a concept paper focusing
on mental health managed care. The State seeks
a program which will provide effective and
efficient mental health services to low income
Montanans through a consolidated, capita ted
system.
I
Concept paper received on 10/24/94.
HCFA met with the Slate on November 3 I.
discuss their" concept paper. On November
ORD, Denver RO, 'OMC, MB, and the Stal.
discussed the proposal via conference call.
the expanded population would receive only
mental not physical health services, HCFA
decided to discourage the Stale from
submilling a formal proposal. HCFA is
awaiting any alternative proposals from
Montana.
'
VIRGINIA
Virginia's Department of Medical Assistance
Services (DMAS) has submilled a proposal for an
1115 waiver to expand its eligibility for children in
the State funded KIDS CARE program. The
State anticipates a reduction in the costs to the
Medicaid program by offering a more limited
services packal!.ed that encourages prevention.
I
Proposal received 5/18/94,
'The State will not bc responding to our
questions, because the fate of the project is
,unknown due to State budgetary constraints.
HCFA is waiting for some indication from th.
State as to what they plan to do.
VIRGINIA
Virginia submitted a conCept paper entitled
"Virginia's Catastrophic Health Care Program" for
review by HCFA In this demonstration the State
would like to offer subsidized health insurance
Comments on the concept paper were sent to
the State 6/28/94. A conference call was "held
with Virginia on 8/19/94 to discuss their
Conference call on 8/19/94.
responses to our questions, Discussions
- - - - - - - - - - - - - - - - - - - - I - c o n t i n u e ' with-the-State'-.--'- - - -
Concept received 6/94.
would be defined by the State 's E~sential Health
Plan (EHP) which was formulated by legislatively
mandated panel, and incorporated into a recent
reform of the small employer health insurance
market. The Slate would reconfigure the
"Indigent Trust Fund" into a vehicle for
subsidizing the plans.
MARYLAND
Maryland has submitted a proposal for 1115
waivers to allow them to proceed with a
demonstration of integrated care management
systems for high·cost, high-risk Medicaid
recipients. The goal of the demonstration is to
test whether new forms of case management and
managed care can significantly lower the cost of
eare for clinically-focused groups of high
cost/high.risk patients, while maintaining or
improving service quality.
Proposal received 7/8/94.
Terms and conditions [or award have been
drafted; a conference call with the State is
scheduled for early January.
January 19, 1995 - Other Medicaid Initiatives
9
�INIllKnVE
STATE
GEORGIA
Georgia requests 1115 waivers to establish
"Georgia Children's Benefit Plan" which will
provide preventive/primary care to children ages
one to five years with income between 133 and
185 percent of the Federal Poverty Level.
Proposed project period is July 1, 1995 to June 30,
KEY DATES
COMMENTS
Proposal received eRD 12/12194.
The State is considering withdrawing their
waiver application. lbe technical review panel
will be held on 1/20.
Proposal arrived in ORO 11/1/94; proposal
received ORO 12/9/94.
lbe proposal was distributed 12/22194 to
HCFA and DHHS components; comments are
expected bv 1/15195.
2000.
NEW MEXICO
New Mexico requests 1115 waivers to provide
Medicaid family planning services to all women of
child-bearing age with incomes at or below 185
percent of the Federal Poverty Level. The
program will be statew:,e; however, participants in
four community/county areas selected as pilot
areas will receive enhanced services in addition to
those covered under Medicaid.
January 19,1995 - Other Medicaid Initiatives
10
�SEcnON 1115 WAIVER ACTIVITY
OTHER MEDICAID INITIATIVES
STATE
ALABAMA
INITIATIVE
Alabama indicates that they are considering a
Medicaid managed care demonstration in Mobile
County. All Medicaid recipients in the County will
be enrolled in a managed care plan. lhere are
approximately 38,000 recipients in Mobile County.
KEY DATES
COMMENTS
On 3/31/94, a consultant from the University 01
South Alabama met with representatives from
ORfJ, MB, and OMC to introduce the goals
and objectives of the
HCFA received a letter from the Governor
indicating the State
MASSACHUSETIS
Massachusetts will be submitting a concept paper for
a demonsttation:focusing on the dual eligible .
population. It will be a combination of the Pace
Program, a primary care physician model, and
another op!ion.
The State expects to submit the concept papel
sometime in September.
TEXAS
Texas has indicated that they are interested in
It is anticipated that Texas will be submitting
demonstration will involve family planning services
being provided to women who have already had a
ehild under Medicaid or it will target all high risk
wom"en of childbearing age.
January 19, 1995 - Other Medicaid Initiatives
II
�\
SECTION 1115 WAIVER ACllVllY
OlHER MEDICAID ACTIVIlY
NEW YORK
New York has indicated that they are interested in
trying to develop a managed care system for people
with serious mental illness.
Conference call held with the State on June 17.
A conference call was held, on 6/17, with the
State to discuss their concept. One of the
main topics was 'whether they should be
seeking 1915(b) or 1115 waivers.
UTAH
Utah has indicated that they are considering an 1115
demonstration that will focus on long term care.
Conference call held with the State on July 6.
A conference call was held with the State to
discuss their interest in developing a
demonstration focusing on long term care.
;.
January 19, 1995 - Other Medicaid hlitiatives
�JAN I 9 1995
NOTE TO:
MARY VOLLIN
SUBJECT:
BIWEEKLY WAIVER TRACKING SHEET FOR THE OFFICE OF
MANAGED CARE (OMC)
I
..
,.
Attached is the biweekly waiver tracking sheet. Below we have
listed waivers that are consid~red to be controversial or unique:
Freedom of Choice Waivers
o
Alabama 03 - (State stopped clock on 1/20/94)
This waiver represents the State's initial effort in
mandating managed care for AFDC recipients. OMC will work
closely with the regional office (RO) in expediting the
review process. HCFA has requested additional information
from the State and rec~ived the State's responses. This
waiver request is cont~oversial in that the local
hospital-based providers claim that the payment rates
would be inadequate;a~d question whether a sufficient
provider network will ~ontract with HMOs. The State has
stopped. the clock to resubmit information.
o
California 17
. This waiver is unique in that California proposes to .
implement a single sed'ice delivery system of psychiatric
inpatie~t hospital ser~ic.s.
It represents the first
phase of transition into a fully capitated managed care
delivery system for all Medi-Cal funded specialty mental
health services. OMC and the RO will work closely with
the State to facilitate their request. HCFA has requested
additional informatiorl from the State.
.--
o
Georgia 02
This waiver allows Georgia to provide pregn~nt substance
abusers with access t6 substance abuse treatment and
mothers and babies with coordinated systems of care
through its Pregnant Substance Abuse Day Treatment Program
(PSADT). The renewal request is controversial due to its
vagueness and lack of evidence of State program
monitorihg.In addition, the State has provided
unsatisfactory documentation of cost effectiveness and
waiver impact. OMC ·and the RO are working closely on a
request for addi tionall information.
I
I
I
.
�Page-2
o
Kansas 02.
This waiver is unique in that Kansas is requesting to
selectively contract with certain nursing iacilities to
furnish nursing facility care to Medicaid recipients. We
have received correspondence from Congress persons,
providers, and beneficiaries expressing their concerns
about this program .. After reviewing the State's request
and the concerns raisedlby others, HCFA requested
additional information from the State.
I
o
Kentucky
.
·04.R03~MOl
This waiver is unique in that Kentucky requested that they
make it mandatory to enroll the aged, blind and disabled
recipient eligibility-~~oups into the KenPAC program.
OMC and the RO will be forking closely with the State to
facilitate review of the waiver request.
o
Kentucky 05
This waiver is unique in that Kentucky proposes to
implement non-emergenc¥ transportation services.
Initially, the State p~ans to contract for these
non-emergency medical transportation services in three
metropolitan areas a~djone rural Area Development District
of the State. The contracting agency would become a sole
source provider in thejareas specified. This waiver will
not affect emergency transportation which will continue
to be available on demand. OMC and the RO will be working
closely with the State to facilitate review of the waiver
request.
--o
New York 09
This waiver is unique ~n that New York would allow
hospital-based outpatient departments and diagnostic
treatment centers to provide coordinated health care
services to Medicaidr6cipients. We will work closely
I
.
with the State to faci[itate its request. OMC and the RO
has requested additionkl information· from the State . .
~eed
If you have any questions or
further information, please
contact Anna Meyers on 410-966-5364.
Rita Johnson
Director
Medicaid Managed Care Office
Attachment
�DESCRIPTI10N OF WAIVERS
I
;
1915(b)--Freedom of Choice Waivers--The f~eedom of choice waiver
was enacted as part of the Omnibus Budgetr' Reconciliation Act of
1981 and incorporated into thej Social Secbrity Act at section
1915(b). These waivers, also ~nown as section 1915(b) waivers,
allow States to apply to HCFA for exclusibn from freedom of
choice requirements, as well a~ from requIrements of uniform
Statewide operation (Statewidertess) and identical benefits for
different types of beneficiari1es (comparability).. Freedom of
choice waivers allow States to; develop in.novative programs that
will manage care and improve ~oth access ,to services and quality
of care for Medicaid recipients.
(
. i
�JAN' 9 1995
NOTE TO:
SUBJECT:
Mary vollin
List of Program Waiver Approvals
I
I
APprived
Freedom of Choice Waivers 1915(b)
state
Arkansas
0l.M01
,
1!
5/
r
1/9/95
Colorado
~
" 02. R07
the
The above are approvals that have now been deleted from
report.
I f you have any que!stions I please call me on
410-966-5364.
, I
"
Anna Meyers
�BIWEEKLY WAIVER TRACKING SHEET
STATE
PROPOSAL
AGENCY
(new States in bold)
RECEIVED BY
AGENCY
STATUS
(ne. ite.s • changes in bold)
==========================================================================
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------FREEDOM OF CHOICE
1915(b)
RECEIVED
HHS/HCFA
11/04/93
To provide comprehensive services on a
State stopped 90-day clock on 1120/94
Alabama
prepaid payment basis for AFOC and
to resubmit information.
03
~~~~~~~~~-S0B~reci~~~~e~d~~fuJe~r~=n~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
and Shelby counties.
California
16
To establish a Primary Care Case
management Network.
HHS/HCFA
07/06/94
Pending in HCFA; 90th day is
02/07/95
�Page 2
California
17
To provide a single service
delivery system of Medicaid
psychological inpatient hospital services.
HHS/HCFA
·10121/94
California
18
To provide a single service delivery
system to Medicaid recipients.
HHS/HCFA
11/16/94
Pending in HCFA; 90th day is
02/14/95
'Fo-provide-DentaLSenricesJo_Medicaid
recipients. To prevent unnecessary
utilization.
HHS/HCFA
11/1/94
Additional Information request sent
. foRO on 12109194;ttIerefortr90;;dayclock has stopped. Awaiting State's
response.
Colorado
04
To provide a primary care case
management program.
HHS/HCFA
12/30/93
.Additional information request sent
to RO on 2125/94; therefore 90-day
clock has stopped. Awaiting State's
response.
Georgia
02.ROI
Waiver renewal to provide day treatment
for pregnant substance abusers.
HHS/HCFA
09127/94
Additional Information requested on
sent to RO on 12/14/94; Requested
response by 1117/95; 90-day clock has
stopped.
-Ealifornia
19
Pending in HCFA; 90th day was
1/20/95. Clock stopped 1/17/95.
Awaiting State's response.
�Page 3
Kansas
01.R05
Waiver Renewal to provide a Primary
Care Case Manag.ement Program.
HHS/HCFA
11/1/94
Pending in HCFA; 90th day is 1/30/95
Kansas
02
To provide for appropriate and cost
effective coverage of long term care
services for beneficiaries to remain in
the community rather than an
institutional setting.
HHS/HCFA
03/25/94
Additional information request sent
to RO on 5/13/94; therefore 90-day
clock has stopped. Awaiting State's
response.
HHSLHCFA
08/08/94
Additional information request sent
to RO on 107T2/94;fnerefbre 90:aay
clock has stopped. Awaiting State's
response.
-Kentucky
04.R03.M01
Waiver·modification-to-request
mandatory enrollment of the aged; blind,
. and disabled recipient eligibility group.
Kentucky
05
To provide non-emergency medical
transportation services.
HHS/HCFA
08/22/94
Additional Information. equest sent
toRO on 10/27/94; therefore 90-day
clock has stopped. Awaiting State's
response.
Louisiana
02.R01
Renewal--To provide a primary care
case management program.
HHS/HCFA
5/12/94 .
9O-day clock restarted 1/13/95.
Awaiting State's response.
�Page 4
Louisiana
02.M05
Waiver modification to add Allen Parish,
Beauregard Parish, Cameron Parish,
Jefferson Davis Parish and Vernon
Parish effective 11/1/93.
HHS/HCFA
5/31/94
Mass.
01.R01
Renewal- to provide a primary care case
management program.
HHS/HCFA
09/09/94"
Additional Information request sent
to RO on 11/21/94; therefore 9O~day
clock has stopped. Awaiting State's
responses.
Michigan
08.R01
Renewal - to provide a primary care
case management program.
HHS/HCFA
06/27/94
Additional Information request sentto RO on 8/18/94; therefore 90-day
clock has stopped. Awaiting State's
response.
Renewal-to provide a Managed Health
Care Program
HHS/HCFA
11/23/94
Pending in HCFA; 90th day is 2{2.l/95
To allow medicaid recipients to select a
Primary Care Provider (PCP)
HHS/HCFA
12{28/94
Pending in IiCFA; 90th day is
-"
- Missouri
01.R03
Montana
02.ROI
Additional information request sent
" to RO on 8/5/94; therefore 90-day
clock has stopped. Awaiting State's
response.
03/28/95
�·,
Page 5
New Jersey
02
To provide adequate access to
quality care for Medicaid recipients.
HHS{HCFA
10/21/94
New York
07.ROl
Waiver renewal to provide health care to
medicaid recipients through 7 HMOs
and 1 PHSP.
HHS{HCFA
10/03/94
New York
To allow hospital-based outpatient
departments and diagnostic and
treatment centers to provide coordinated
health care services.
HHSfHG-FA
111/28/9-4
New York
10
To provide transportation In a cost
effective manner. To offer local socal
service districts alternative methods for
transportation.
HHS/HCFA
11/18/94
New York
11
To provide accessibility to drugs by
recipients in rural and outlying reigons
of N ew York State, This program will
provide access to drugs to recipients who
may be unable to obtain their
medications.
HHS/HCFA
12/19/94
09
. Pending in HCFA; 90th day was
1/19/95, but State stopped the clock
on. 1/9/95. Now awaiting State's
response.
State stopped clock on 12/1/94;
Pending in HCFA; 90th day is
02/24/95
Pending in HCFA; 90th day is
02/16/95
Pending in HCFA; 90th day is
03/19/95
�,
Page 6
North Carolina
02.R01.M01
Modification to expand operation of the
program to the following counties.
Lendir, Caswell, Cleveland, Onslow,
Chatham, and Lee
HHS/HCFA
11/10/94
Pending in HCFA; 90th day is 2/8/95
Ohio
05.R02
Renewal--To provide a primary care
case management system.
HHS/HCFA
11/03/94
Pending in HCFA: 90th day is 2/1/95
To provide services for AFDC and, . i,.
Healthy Start recipients in Hamilton
County.
HHS/HCFA
10/18/94 :
.
'I.!
Ohio
11
To selectively contract for ADC and
healthy start eligibiles
HHS/HCFA
Texas
To provide non-emergency treatment,
inpatient care to Medicaid beneficiaries
HHS/HCFA
10/18/94
Clock was stoppp.d on 12/23/94;
To provide the inpatient services for
Medicaid recipients and increases the ..
state's ability to manage the Medicaid
program.
HHS/HCFA
10/14/94'
Pending in HCFA: 90th-day is
01/12/95
Ohio
-10
06
Washington
05.R03
";"'
11/14/94
!,
Additional Information requested on
12/16/94; 9O-day clock was stopped on
12/16/94
Pending in HCFA; 90th day is 2/12/95
'.
'';'
�DEPARTMENT OF HEALTH&. HUMAN SERVICES
.
.'
Health Care Financing Administration
I
6325 Security Boulevard
Baltimore. MD 21207
January l8, 1995
NOTE TO:
Mary Vollin
SUBJECT:
List of Program Waiver Approvals
I
Home and community Based Waiver 1915(C)
I
State
Approved
Connecticut
0153.90.01 .
I
112/23/94
Illinois
12/23/94
Indiana
40151. 90.03
12/22/94
Louisiana
0200.90.02
12/15/94 .
Louisiana
0251. 01
01/13/95
New Mexico
0161.90
01/12/95
Michigan
0233.90
12/12/94
Oklahoma
0179.90.03
12/6/94
Pennsylvania
0279
12/21/94
Utah
40183
12/23/94
Wisconsin
0275
12/29/94
re
cal~ on
() Htss;f\- S
If. you have any questions, P1et,e·
Debby
Dan~els
410-966-3764.
Higgins
�DEPARTMENT OF HEALTH &. HUJ\\ANSERVICES
Health Care Financing Administration
I
6325 Security Boulevard
Baltimore. MD 21207
JAN I 8 \995
NOTE TO: MARY VOLLIN
SUBJECT: BIWEEKLY WAIVER TRACKING SHEET .FOR THE MEDICAID BUREAU
(Ma)
There are no waivers that are considered to be controversial or
unique for the period 1/5/95 - 1/19/95.
.I
. !
U~.
Jd;tttvv<-
ilvtU~1~ ~j
l~ ,
t
l'
~. Rozann Abato
~~ Deputy Director
Medicaid Bureau
-'
Attachment
�~'
.
.
DESCRiPTION OF WAIVER
1915(c)--Home andCommunitYrBased Services Waivers--The home and
community-based services (H~BS) waiver program was established
by section 2176 of the Omnilbus Budget Reconciliation Act of
1981, and incorporated into'I the Social Security Act at , section
.
'
1915(c). Under a HCBS'wai~er, States may provide a broad array
of home and community based services (excluding room and board)
not otherwise c9vered undet the Medicaid program as an
'
alternative to institution4l ,care. In order to accomplish this,
States may request waiverslof the requirement that services be
available Statewide, and that services be available in equal '
amount, duration and scope 1 States may also request waiver of
certain eligibility requir~ments to allow HCBS services to be
provided to individuals whb would otherwise be eligible for
Medicaid only in an instithtional setting.
�\
BIWEEKLY WAIVER TRACKING SHEET
STATE
AGENCY
PROPOSAL
(new States in bold,
RECEIVED BY
AGENCY
STATUS
(new
i~ &
change. in bold)
==================~=========================================================================================================
RECEIVED
============================================================================================================================
1915(0)
Alabama
40162.02
HOME AND COMMUNITY-BASED
Waiver modification to request
exemption of independent
assessment requirement.
To provide case management,
environmental modifications,
transportation, specialized medical
-----------,equipmenLand_supplies ,_:personal
emergency response systems,
companion services, physical
therapy, occupational therapy,
speech, hearing and language,
prescribed drugs and home
delivered meals to the disabled.
Arkansas
0258
HHS/HCFA
07126/93
Additional information request
sent to RO on 10/8193; therefore
90-day clock has stopped.
Awaiting State's response.
HHS/HCFA
10114/92
State stopped 90-day clock on
12/11/92 to resubmit information.
The State is reevaluating this
request due to budgetary
, constra.ints.
California
0164.90
Renewal--To provide case
management, home health aide,
respite, environmental
modifications, skilled nursing,
utility coverage and Medi-Cal
supplementation for infants and
children in out-of-home care to
physically disabled.
HHS/HCFA
02103/92
Additional information request
sent to RO on 4/17/92;
therefore, 90-day clock has
stopped. Awaiting State's
response. The State is
currently finalizing systems
changes which need to be made
before it can respond.
California
0183.05
Waiver modification to increase the
number of participants served by
the AIDS waiver to 2,500.
HHS/HCFA
08123/93 .
Additional information request
sent to RO on 11/16/93;
therefore, 90-day clock has
stopped.
�,
Pap 2 (Received)--1915(c)
Colorado
000S.90.R2.01
Waiver modification to change PETI
procedures and calculations.
HHS/HCFA
Colorado
0211.90.01
Waiver modification to change PETI
procedures and calculations.
HHS/HCFA
Colorado
0007.91.R2
Renewal--To provide personal care,
respite, transportation, residential
services and case management to
MR/DD.
HHS/HCFA
07/11/94
Additional information request
sent on 10/7/94; therefore, 90
day clock has stopped.
Colorado
40180
To provide services to a small
group of children with significant
needs.
HHS/HCFA.
05/17/94
State stopped 90-day clock on
8/8/94 to resubmit information.
Delaware
0009.90.R2
Renewal--to provide case
management, day habUitation,
residential habilitation, respite,
clinical support services and minor
physical adapts to the mentally
retarded / developmentally disabled.
HHS/HCFA
5/12/94
A-dditional-huormation-request-
sent to RO on 8/5/94; therefore,
90-day clock has stopped.
Awaiting State's response. (RO)
Florida
0194.05
Waiver modification to request
exemption of independent
assessment requirement.
HHS/HCFA .
01/23/92
Additional information request
sent to RO on 3/25/92;
therefore, 90-day clock has
stopped. Awaiting State's
response.
Illinois
0205.04
Waiver modification to target all
remaining openings only for
persons who are deinstitutionalized
as of 12/1/93 and to delete the
services they have not implemented
and change formula.
HHS/HCFA
12/02/93
State stopped 90-day clock on
1/27/94 to resubmit information.
01/09/95
Pending in Denver RO; 90th day
is 4/9/95.
01/09/95
Pending in Denver RO; 90th day
is 4/9/95.
�\
'
Page 3 (Received)-..1915(c)
Indiana
0249.02
Waiver modification to increase the
C value from 700 to 830 individuals .
for waiver year 3.
HHS/HCFA
12/01/94
Pending in HCFA/MB; 90th day
is 3/1/95.
Indiana
Waiver modJfication to increase
value 3 from 700 to 830 individuals.
HHS/HCFA
01/04/95
Pending in HCFA/MB; 90th day
is 4/4/95.
HHS/HCFA
12/12/94
Pending in HCFAj· 90th day is
3/12/95.
HHS/HCFA
12/28/94
HHS/HCFA
10/28/94
State stopped 90-day clock on
10/24/94 to resubmit information.
0249.03
Iowa
0242.05
Waiver modification to increase the
number of individuals eligible for
supported community living and
. respite.
Iowa
4155.90.02
Massachusetts
0059.92.R1
Renewal--To provide case
management, chore, homemaker,
social day care, and respite to the
frail elderly.
Michigan
40119.90. R1
Renewal--To provide psychosocial"
habilitation, skilled training,
. p sychological/behavior treatment,
respite, extended home health,
nursing, chore and medical
equipment· and supplies to mentally
retarded/developmentally disabled.
HHS/HCFA
09/20/94
State stopped 90-day clock on
12/02/94 to resubmit information.
Waiver modification for individuals
with traumatic brain injury.
HHS/HCFA
,11/21/94
Pending in HCFA/MB; 90th day
is 2/19/95.
Minnesota
40169.03
�\
Page 4 (Received)--1915(e)
Mississippi
0282
To provide personal care, respite,
.habilitation, PT, OT, speech,
hearing and language to MR/DD.
HHS/HCFA
11/21/94
Pending in HCFA/MB; 90th day
is 2/19/95.
Mississippi
0283
To provide personal care to elderly
and disabled individuals.
HHS/HCFA
11/21/94
Pending in HCFA/MB; 90th day
is 2/19/95.
Missouri
0239.90
Renewal--To provide habilitation,
environmental mods, behavior
therapy, OT, PT, ST and·
transportation and specialized
medical equipment and supplies to
MR/DD individuals inappropriately
placed in NFs.
HHS/HCFA
7/1/94
Additional information request
sent on 9/8/94; therefore, 90
day clock has stopped. Awaiting
State's response.
Nebraska
0246.01
Waiver to expand statewide HCBS
to infants i:md toddlers .with
disabilities.
HHS/HCFA
10/31/94
Pending in HCFA/MB; 90tli day
is 1/29/95.
New
Hampshire
40177.02
Waiver modification to expand
eligjbility over age 65 and to
clarify income disregards.
HHS/HCFA
08/02/94
State stopped clock on 10/5/94 to
resubmit information.
HHS/HCFA
05/05/94
Additional· information request
sent on 7/8/94; therefore, 90
day clock has stopped. Awaiting
State's response ..
New Jersey
0160.90.04
_Waiver modification to expand the
eligibility to HIV and children up
to age 13.
�Page 5 (Received)--1915(c)
New York
0238.90
Renewal--To provide case
management, respite, resident and
day habilitation, environment mods
and adaptive technologies to
MR/DD.
. HHS/HCFA .
07/07/94
Additional information request
sent on 10/4/94; therefore,. 90
day clock has stopped. Awaiting
State's response. (NYRO)
New York
40163.90
Renewal--to provide case
management, respite, nutritional
counseling, R T and home mods to
DD children.
HHS/HCFA
07/06/94
Additional information request
sent on 10/4/94; therefore, 90
day clock has stopped. Awaiting
State's response. (NYRO)
North
CaroHna
0132.90.Rl.0l
Waiver modification to amend
elfgibWty groups.
HHS/HCFA
12/28/94
North
CaroHna
0154.90.06 .
Waiver to change elfgibWty groups
due to change from 209(b) to 1634
states.
HHS/HCFA
12/28/94
North
CaroHna
40141.90.04
Waiver modification to change
elfgibWty categories to include
children elfgible for Medicaid while
Hving at home.
.
HHS/HcrA
12/13/94 .
North Dakota
0037.90. R2
Renewal--To provide case
management, homemaker, adult,
personal care and adult day health
to mentally retarded/
developmentally disabled. .
HHS/HCFA
01/13/94
Additional information request
sent to State on 3/28/94;
therefore, 90-day clock has
stopped. AwaitingState's
response.
Ohio
0218.90
Renewal--To provide respite,
environment mods, transportation,
home delivered meals, personal
support to inappropriately placed
for mentally retarded/
developmentally disabled.
HHS/HCFA
04/14/94
State stopped 90-day clock on
6/22/94 to resubmit information.
Pending in Atlanta RO; 90th day
is 03/28/94.
Pending in Atlarita Raj 90th day
is 3/28/95.
Pending in Atlanta Raj 90th day
is 3/13/95.
�\
Page 6 (Received)--1915(c)
Ohio
0274
To provide a delivery system to
persons over 65 requiring nursing
facility services.
HHS/HCFA
02/14/94
Additional information request
sent to RO on 5/11/94;
.
therefore, 90-day clock ha~
stopped. Awaiting State's
response.
Pennsylvania
0147.90.04
Waiver modification to. increase
waiver recipients in year 5.
HHS/HCFA
10/27/94
Pending in Philadelphia RO; 90th
day is 1/25/95.
Pennsylvania
0192.90
Renewal--To provide skilled
nursing, home health aide,
supplies/nutritionals and homemaker
services to AIDS or HIV patients.
HHS/HCFA
06/24/93
State stopped 90-day clock on
9/2/93 to resubmit information.
HHS/HCFA
12/28/94
Pending in HCFA/MB; 90th day
South
To provide rehabrutatio~
CaroUna
(residential and day) communication
is 3/28/94.
0284
services to person with head and
--________________ spmal~ord_m~rleL,__________________________________~~------------------------_______
South Dakota
0044.90. R2 .01
South Dakota
0264.02
Texas
0281
Waiver modification to increase cost
and utilization estimafes for
mentally retarded/ developmentally
disabled.
HHS/HCFA
02/07/94
Additional information request
sent to RO on 4/26/94;
therefore, 90-day clock has
stopped. AwaitingState's
response.
Waiver modification to' increase the
number of individuals who will
receive service through the waiver.
HHS/HCFA
12/02/94
Pending in HCFA; 90th day is
3/2/95.
To provide case management,
respite, habilitation, environmental
mods, skilled nursing, chore, adult
residential care to developmentally
disabled 18 and over with deaf
blindness and mUltiple disabilities.
HHS/HCFA
11/08/94
Pending
2/6/94.
in HCFA; 90th day is
�Page 7 (Received)--1915(c)
Texas
01l0.90.R1.01
Waiver modification to expand the
number of individuals served for
years 1-5.
HHS/HCFA
01/05/95
Pending in Dallas RO; 90th day
is 04/05/95."
Utah
0247.02
Waiver modification to request
exemption of independent
assessment and include regs cite
for senior companions for senior
companions as respite providers.
HHS/HCFA
11/29/94
Pending in HCFA; 90th day is
2/26/95.
Virginia
0227.90
Renewal--to provide residential and
day support, habilitation,
therapeutic consultation, personal
assistance, respite ~ skilled nursing
and environmental modifications and
specialized medical equipment to the
mentally retarded/ developmentally
disabled.
HHS/HCFA
4/22/94
Additional information request
sent to State on 7/14/94;
therefore, 90-day clock has
stopped. Awaiting State's
response. (RO)
��SECTI'ON 1115
DEMONSTRATION IWAIVER APPROVALS
DUR;tNG THE
BUSH AND CLINTON ADMINISTRATIONS
TYPE OF WAIVER
APPROVED
Welfare Reform
statewide Health
Reform
I
BUSH
ADMINISTRATION
1/21/89 - 1/21/93
CLINTON
ADMINISTRATION
1/21/93 - 1/18/95
".11
24
o
7
�MEDICAID WAIVER APPROVALS
DURING THE
BUSH AND CLINTON ADMINISTRATIONS
TYPE OF WAIVER
APPROVED
Section 1115
Statewide Health
Reforms
BUSH
ADMINISTRATION
1/21/89 - 1/21/93
-0
CLINTON
ADMINISTRATION
1/21/93 - 1/18/95
7
Section 1115
Sub-state
Demonstrations
16
22
Home and
Community-Based
Services
140*
108*
Freedom of Choice
118**
TOTALS
274
89**
226
*Includes new waivers and waiver renewals
**Includes new waivers, modifications, and renewals
�-'
SECTION 1115 WELFAR~ REFORM
WAIVER APPROVALS
1987-'Present
Reagan
Administration
second term*
(01/87 - 01/89)
113
Bush Administration
(01/89 - 01/93)
111
* figures prior to 1987 are not available
Clinton
Administration
(01/93 - Present)
124
I
�Reagan Administration (Second Term. 01/87 - 01/89)*
'AL
Avenues to Self-Sufficiency Through Employment and Training
Services (ASSETS)
Approved 1989
GA
Child Support Enhancement and simplification Project,
Approved 1988
IL
A Chance for Self-Sufficiency
Approved 1989
IA
Family Development and Self-Sufficiency Program
Approved 1989
MD
Cash Incentives in a Self-Sufficiency Program
Approved 1989 ,
. NJ
Realizing Economic Achievement (REACH)
Approved 1987
NY
Child Assistance Program (CAP)
Approved 1988
NC
Child Day Care Recycling Fund Experiment
Approved 1988
OH
Transitions to Independence (TIP) and
Learning, Earning, and Parenting (LEAP)
Approved, 1988
TX
Towards Independence
Approved 1989
WA
Family Independence Program (FIP)
Approved 1988
WV
Self-Sufficiency Through Self-Employment
Approved 1988
'WI
*
Learnfare I
Approved 1988
waiver approval information prior to 1987 is not available
�Bush Administration
CA
Assistance Payments Demonstration Project (APDP)
Approved 1992
IL
Fresh start Demonstration 1
MD
Primary Prevention Initiative
Approved 1992
MI
To strengthen Michigan Families 2
Approved 1992
MO
People Attaining Self-Sufficiency (PASS)
Approved 1992 .
NJ
Family Development Program
Approved 1992
OR
JOBS Waiver Project
Approved 1992··
UT
Single Parent Employment Demonstration Program
Approved 1992
VA
Virginia Incentives to Advance
Approved 1992
WI
Two-Tier Welfare Demonstration Project
Approved 1992
L~arning
(VITAL)
WI
Parental and Fmaily Responsibility Demonstration Project
Approved 1992
1. Approved as Multi-Pronged Demonstration Project and later
renamed Fresh Start. Significant amendments to Fresh Start
approved later by Clinton Administration.
2. Significant amendments approved later by the Clinton
Administration.
�._'
SUMMARY OF ACTIONS ON WAIVER APPLICATIONS
CLINTON ADMINISTRATION
,RECEIVED -' 59 Applications from 36 States
(9 Applications from 7 States were left pending from
the previous Administration)
APPROVED
states
Applications - 24 Applications, from 23, States
Arkansas '(Welfare Demonstration Project)
. .
.
California (California Work Pays Demonstration Project)
Colorado (Colorado Personal Responsibility Project)
Connecticut (A Fair Chance)
Florida (Family Transition Program)
Georgia (Personal Accountability and Responsibility Project)
Hawaii (Creating Work Opportunities for JOBS Families)
Illinois (Work Pays Project)1
Indiana (Manpower, Placement and Comprehensive Training Program)
Iowa (Iowa Family Investment Plan)
Michigan (To.Strengthen Michigan Families Demonstration
Expansion Project)
Mississippi (A New Direction Demonstration Program)
New York (Jobs First Demonstration)
North Dakota (Early Intervention Program)
Oklahoma (Oklahoma's Learnfare Program)
Oregon (JOBS Plus Demonstration)
Pennsylvania (Pathways to Independence)
South Carolina (Self-Sufficiency and Parental Responsibility
Program)
1 Added component to Illinois Fresh Start Demonstration
�•
South Dakota (strengthening South Dakota Families Initiative)
vermont (Family Independence Project)
virginia (Welfare Reform Project)
Wisconsin (work Not Welfare Demonstration)
Wisconsin (AFDC Benefit Cap Demonstration project)
Wyoming (New opportunities and New Responsibilities Welfare
Reform Demo~stration)
DENIED
states
Applications - 3 Applications from 3 States
Illinois (Relocation to Illinois Project)
Massachusetts (Child Care Co-Payment Project)
Wyoming (wyoming Relocation Grant)2
WITHDRAWN OR REVIEW TERMINATED
states
Applications - 6 Applications from 4 States
Illinois (stepparent Encouragement Project)
Illinois (One Step at a Time Project)
".---
Ohio (Automobile Assets Disregard Project)
South Carolina (Private\for Profit Work Experience Project)
Texas (Two Parent Families Demonstration Project)
Texas (Teen Opportunity Project)
PENDING
states
Applications - 26 Applications from 19 states
Arizona (Employing and Moving People Off Welfare and Encouraging
Responsibility Program)
2 -Waiver requested as. part of New Opportunities and New
Responsibilities Welfare Reform Demonstration approved above.
�.......
Pennsylvania (School Attendance Improvement Program)
Pennsylvania (Savings for Education Program)
Virginia (Welfare to Work Program)
Washington (Success Through Employment Program)
"
. I
�California (California Work Pays Demonstration Project
Amendments) 3 .
California (Assistance Payments Demonstration Project
Amendments)
California (AFDC and Food stamp Compatibility Demonstration
project)
California (California Work Pays Demonstration Project
Amendments) 4
California (School Attendance Demonstration Project)
California (California Incentives to Self-sufficiency
Demonstration)
Georgia (Work for Welfare
~roject)
Kansas (Actively Creating Tomorrow for Families Demonstration)
Maine (Project Opportunity)
Maryland (Maryland Welfare Reform Project)
Massachusetts (Employment Support Program)
Missouri (Missouri Families Mutual Responsibility Plan)
Montana (Families Achieving Independence f6r Montanans Project)
Nebraska (Welfare Reform Waiver Demonstration)
New Hampshire (Earned Income Disregard Demonstration Project)
New Mexico (Untitled Project)
North Dakota (Training, Education, Employment and Management
Project)
Oklahoma (Mutual Agreement, A Plan for Success)
Ohio ("A state of Opportunity II Project)
Oregon (Expansion of the Transitional Child Care Program)
Oregon (IncreasedAFDC Motor Vehicle Limit Demonstration Project)
3 Would add 'provisions' to decrease benefits after periods
of time on assistance to the previously approved California Work
Pays Demonstration Project.
4 Would add family cap prOV1S10n to the previously approved
California Work Pays Demonstration Project.
�
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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[Welfare Waivers]
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Carol Rasco
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Box 128
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
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dd99af865a14ec827db97ecc76f93546
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E X E CUT I V E
OFF ICE
o
F
PRE SID E N T
24-Jan-1995 10:28am
TO:
(See Below)
FROM:
Julie E .. Demeo
Domestic Pblicy Council
SUBJECT:' Conference Call
To follow up on our conversation yesterday, here are the deiail~
for Thursday's conference· call with. the staff of the elected
officials and Congresspersons who will be at the welfare working
group meeting on Saturday with the POTUS:
Time: 12:00-1:00pm EST
Date: Thursday, Jan 26th, 1995
Call in number: 757-2104
Call in CODE: #8901.
FORMAT: White House Staff should be in EOB 211. There will be a
speaker phone. Other invitees have a choice of calling in or
attending the briefing in EOB 211, however space in the room is
limited.
*Anna Winderbaum will call the elected officials' staff and
(notify Marcia Hale to be in EOB 211) .
*Ann Cattalini will call the congressional staff and (notify Pat
Griffin and Susan Brophy to be in EOB 211) .
*Julie Demeo will notify Carol Rasco and other WH staff to be in
EOB 211 and will notify the DHHS staff who are invited to call in.
Anna, Ann, and Julie will be responsible for IIwaving inll those on
their respective lists, who want to attend in person.
Distribution:
TO:
TO:
Anna Winderbaum
Ann M. Cattalini
CC:
CC:
CC:
Carol H. Rasco
Jeremy D. Benami
Susan Brophy
�E X E CUT I V E
OFF ICE
o
F
THE
PRE SID E N T
24-Jan-1995 01:03pm
TO:
(See Below)
FROM:
Julie E. Demeo
Domestic Policy Council
SUBJECT: UPDATE
This is an update of meetings and conference calls for the week.
TUESDAY & WEDNESDAY:
1:00 1:30 daily working group prep conference call. Call in
numbers: 456-6755, 456-6766, 456-6777, CODE #4059. Or you can
participate from Carol's off
THURSDAY:
11:30-12:00 conference call/meeting to prepare for the 12:00,call
with congressional/elected
ficals' staff. Everyone that is on
the daily call should be on this 11:30-12:00 call: In addition,
Emily Bromberg, Mary Jo Bane, ~ David-Ellwood should be
OEOB
211 with Carol, Bruce Reed, Jeremy Ben-Ami, Marcia Hale, and Susan
Brophy for this call. Those who will be calling in to access this'
conference call can dial eit~er: 456-6755 or 456-6766, CODE #4059.
12:00-1:00pm Conference Call with the staff of those elected
officials and Congresspersons who will be at the Sat. weI
working group. All of the people on the daily call should also
participate. You can either go to OEOB 211 or call 757 2104, CODE
#4059. Room 211 is fairly small, so please let Julie (456 2216)
know if you are planning to participate from OEOB 211.
1:00-1:3Dpm daily conference call
in case there are other things
that need to· be addressed. Those in the daily call group who are
in OEOB 211 can stay there for1this call. Others can access it by
dialing: 456-6755, 456 6766, or 456-6777, CODE #4059.
FRIDAY:
1:00-1:30pm Daily Conference Call with regular group. Call in
numbers are: 456-6755, 456-6766, 456-6777, CODE #0691.
�THE WHITE HOUSE
WASHINGTON
January 11, 1995
MEMORANDUM FOR MRS. VALENTINER
BLAIR HOUSE
.,(/
tt<~':Carol H. Rasco, Assistant to the President for
FROM:
Domestic Policy
,
SUBJECT:
Saturday, January 28, 1995.
Thank you for your time on Friday of last week. I appreciated
your willingness to meet on such ~hort notice. I hope this busy'
week for you is proceeding as you hoped it would; I have been
thinking about you.
I have shared our discussion in detail with Emily Bromberg,
Special Assistant to the Assistant Secretary for the Departmerit.
of Health & Human Services (HHS) , who has been named by Donna
Shalala to serve as our meeting coordinator and liaison to you.
She will be working with Jeremy Ben-Ami', my' chief of staff, and
Rosalyn Miller, my executive assistant.
Emily will be discussing HHS' previous events at Blair House with
David Homan, and she is eager to wo~k with you to assure the
financial arrangements 'are handled expeditiously.
I am delighted to have met with you and, look forward to working
with you.
.
Thank, you again for your assistance.
�
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Carol Rasco
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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2010-0198-S Segment 2
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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92 folders in 7 boxes
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Welfare Reform Working Group Folder
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Carol Rasco
Issues Series
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Box 128
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Clinton Presidential Records: White House Staff and Office Files
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6ebdd4d5051a558f914771f9ff324e89
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.t
\
April 6, 1995
MEMORANDUM TO DISTRIBUTION*
From:
Subject:
\
\
Jeremy Ben-Ami
Gaynor McCown
Education Related Materials
Attached please find the materials produced to support the
education themes of the ASNE and NEA speeches on April 7 and
April 8. These materials represent the joint effort of the DPC,
NEC, and the Communications Office. They have been shared with
the press office which will be including them in the press packs.
American Society of Newspaper Editors
o THE CLINTON RECORD: EDUCATION
a one page summary of the
President's lifelong learning agenda
o THE CLINTON RECORD ON EDUCATION AS GOVERNOR OF A~KANSAS -
two page history to demonstrate his long-term commitment
o STATE BY STATE IMPACTS -- 50 one-pagers analyzing the impact
of the Republican cuts on education program in each state.
As an example, the sheet for Alabama is attached. AlISO
states are available
National Education'Association
o EXECUTIVE SUMMARY: CDC REPORT ON SCHOOL ASSOCIATED DEATHS
a one page summary of a CDC study that the President will
highlight in~his speech Saturday
o SCHOOL RELATED VIOLENCE: DIMENSIONS OF THE PROBLEM
page fact sheet
o CLINTON RECORD ON SCHOOL SAFETY -- Administration
accomplishments related to this particular issue
~-
one
�,
THE CLINTON RECORD: EDUCATION
A LIFELONG LEARNING AGENDA
President Clinton, early in his term, announced his commitment to a Lifelong Learning
Agenda - expanding and improving edu,cation and training from early childhood through ,
adulthood. This agenda reflected his belief in the critical role of education in building
America's future and the federal government's role as a partner in that effort.
HEAD START
o In his first two budgets, the President increased Head Start spending by $760 million,
and now proposes an additiorial $400 million in FY96 for this program which provides
comprehensive services for disadvantaged children, ages three to five, and their
families.
o The President appointed the Head Start Ad;visory Commission to examine' the program
after 25 years of operation and to recommend ways to improve its operation. The
Commission's recommendation formed the basis of the 1994 reauthorization, passed'
with bipartisan support.
GOALS 2000
o Passed in 1994, the legislation supports meaningful state and community school
improvement efforts, based on raising academic and occupational standards, improving
teaching and expanding the use of technology.
o The President's FY96 budget requests $347 million in increased funding for states and
communities to proceed with their education reform agenda. More than 40 states have
already chosen to participate in Goals 2000 and with the leadership of local
commun~ties, parents, teachers and school ~dministrators have developed their own
. strategic plans for educational reform .
. NATIONAL SERVICE, With passage of the National Service legislation, Americorps has
20,000 volunteers working in schools, hospitals, neighborhoods and parks. Reiterating his '
belief that National Service can change the way government works by enabling participants to
further their education while helping to change communities, President Clinton is asking for
$812.~. million in 1996 to expand the program to 47,000 participants. '
DIRECT LENDING With the passage of the Student Loan Reform Act, 104 schools and
, over 300,000 students are already participating in the program. This year mote than 1,400 ,
schools - representing 40% of the total number of loans and the maximum ,allowed under this
year's authorization - have committed to enrolling. This program cuts bureaucracy and saves
taXpayers and students billions of dollars, while allowing more borrowers flexible repayment
arrangements ;-- including pay-as-you-:-eam plans through Individual Education Accounts.
ELEMENTARY AND SECONDARY EDUCATION ACT Designed primarily to help
.disadvantaged children, this law focuses on improvements in teaching in more than 50,000
schools and has a direct impact on five million children in high poverty areas. By increasing·
school flexibility to use federal aid and supporting effective innovations, this law is a
significant step in helping all students meet high academic standards.
SCHOOL TO WORK ACT Broadens educational, career and economic opportunities for
students not immediately bound for four-year colleges through local partnerships among
businesses, schools, community organizations and state and local governments. By equipping
students with the knowledge and skills necessary to pursue work or post-secondary training,
this law helps ensure that America will be capable of performing and prospering in a
competitive global economy.
(April 7, 1995)'
�THE CLINTON RECORD ON
EDUCATION REFORM AS GOVERNOR OF
ARKANSAS
"In Education, we must not only continue our effort to improve our public
schools so our graduates can compete, we' must also substantially increase
the college-going rate for ali sectors of society. /I
Governor Bill Clinton, 1988
President Clinton has a proven track record of commitment to education
reform and has consistently stressed the importance of improving education
in ensuring America's 'competitiveness in the' global economy. In 1989,
Arkansas was cited by Time Magazine as one of three leading states in
"real'" education reform. With extensive professional development, smaller
classes, an increase in advanced and vocational education classes, test
scores 'improved dramatically and the high school completion rate was the
best in the region.
NATIONAL LEADERSHIP
NATIONAL GOVERNORS' ASSOCIATION When Clinton became Cltairman of the
National Governors' Association in the summer of 1986, he made it clear that
education - "one of the most fundamental issues of our time" - would be apriority. '
The NGA report published while Clinton was Chairman - "Making America Work:
Productive People Productive Policies" - focused on alleviating the barriers that
prevent millions of Americans from taking full advantage of the best education
possible and becoming productive citizens.
.
(
NATIONAL EDUCATION GOALS
At the 1990 Education Summit, Clinton took the lead as the prime author of the
National Education Goals, which served as the basis for America 2000, an education
reform initiative introduced by President Bush and' then Goals 2000: Educate America
Act, signed into law in March of 1994.
�"REAL REFORM" IN ARKANSAS
GRADUATION RATES AND TEST SCORES UP Clinton's education reforms led to
an increase in the graduation rate. Arkansas also saw a steady improvement in test
scores. From 1981 to 1991; graduation rates incre~ed to the highest in the region.
EXPANDING THE CURRICULUM Clinton's reforms created hundreds of additional
science, math and vocational courses in high schools. While only 5,100 students were
enrolled in advanced math courses in 1983, over 75,000 were enrolled in 1991.
REQUIRED COMPETENCY TESTS FOR STUDENTS' Arkansas was the first state
to require eighth graders to pass competency tests before going on to high school.
SCHOOL CHOICE As Governor, Clinton made Arkans~ one of the first states to
permit parents to choose what public schools their children attended.
INVESTING IN 'EDUCATION Under the leadership of Governor Clinton, Arkansas
. spent more than 71% of all state general revenues on education. At the time, only two
other states spent a greater share of total state and local expenditures on education.
During Clinton's tenure as Governor, Arkansas had the second largest funding
increase for higher education in the nation. While funding was declining, 1%
nationwide, it increased 25% in Arkansas. '
Clinton established an Education Trust Fund to be used only for education and fought
'
to insure that is was fully funded.
TEACHER SALARY INCREASES In 1991, by persuading the legislature to set aside
a half-cent sales tax increase in a' special fund, Clinton provided teachers with $4,000
_ average salary increase.
POLICE CORPS Arkansas was the first state to create a Police Corps program, which.
provides college scholarships to police officers and young people in exchange for
service in a law enforcement agency.
ADULT EDUCATION Under Governor Clinton's leadership, adult education and
literacy programs expanded. The U.S. Department of Education indicated that
Arkansas had,the "highest percentage of full-time adult basic education instructors in
the nation." The number of adult students participating in adult. education programs;
workplaCe literacy programs, local literacy programs and public television literacy
programs increased from 14,555 in 1983 to 60,000 in 1991.
COLLEGE BOND PROGRAM Clinton established a college bond program allowing
parents to buy short or long-term college bonds, not taxed in Arkansas, to help
finance their children's education.
�PRESIDENT CLINTON SAYS EDUCATION KEY TO AMERICA'S FUTURE
Vows to Fight GOP Cuts in Education and Protect Investment in Alabama's Families
"Cutting education in the time of global economic competition would be like cutting
defense spending during the Cold War." -- President Clinton, March 14, 1995
Education and training are cornerstones of President Clinton's economic policy, designed to
expand opportunities for all Americans. Now, more than ever, opportunity in the global economy
depends on skills and educ<}tion. Yet Republicans plan significant cuts in the very educational
programs that help working families. Here is what that means to Alabama:
.
o
STUDENT I,-OANS President Clinton supports student loans.and opposes Republican
efforts to make them more expensive. Republicans want to help pay for their tax cuts for
the wealthy by eliminating a grace period that allows 4.5 million students to defer interest
charges while still in school. President Clinton will fight to stop Republicans from raising
the costs of college and job training for 55,778 students in Alabama. The Department of'
Education estimates that ending this grace period would mean that a student who borrows
$17,125 over four years would' owe $3,150 more, and have his or her monthly repayment
amount increased by more thill ~ 8%.
.
o
DIRECT LENDING The President wants to expand his Direct Lending program which
simplifies the application process, reduces fees for students, and offers borrowers
convenient repayment options, including pay-as-you-can. Direct Lending is saving
taxpayers $6.8 billion in administrative expenses. The President opposes Republic~m
efforts.to help banks by capping participation in Direct Lending and preventing thousands
of schools and millions of students from receiving its benefits. In the -1995-96 school
year, 19 schools in Alabama will participate in direct lending. The Republican proposal
would prevent any further schools from entering the program.
o
.MAKING COLLEGE AFFORDABLE President Clinton wants to offer a tax deduction
of up to $10,000 to help middle-Class Americans pleet the cost of education and job
training. Families in Alabama would receive approximately $291 million from this
deduction over the next five years. The President opposes Republican efforts to cut
education to pay for tax breaks for the wealthy.
o
NATIONAL SERVICE AmeriCorps, President Clinton's service program, offers young
people a h8l!d paying for their education if they give a hand to their community. The
President opposes Republican efforts to gut AmeriCorps and prevent 317 students in
AlabapJa from serving their communities.
o
GOALS 2000 The President won passage of Goals 2000 to help states and local
communities train teachers and upgrade standards for their schools. RepUblicans call for a
40% cut in the program that would reduce support for high standards by $2,366,125 in as
many as 68 schools in Alabama .
.
o
SAFE AND DRUG-FREE SCHOOLS President Clinton recognizes that safety in school
is a major concern of parents, students, and teachers. Republicans want to gut a program
- that 121 out of 129 school districts in Alabama have already implemented - that
teaches students to avoid drugs and violence, and enables schools to purchase metal
detectors and hire security personnel.
o
DEPARTMENT OF EDUCATION The President believes strongly in the federal role
in education. Republicans want to abolish the Department of Education.
April 4. 1995
�A STUDY OF SCHOOL-ASSOCIATED VIOLENT
DEATHS IN THE UNITED STATES, 1992 -1994
Executive Summary
April 8, '1995
The Centers for Disease Control arid Prevention (CDC) is today releasing this advance
executive summary of its study of school-associated violent deaths. According to the CDC,
this is the first attempt to gather national information on school-associated deaths as there is
no national reporting system for such incidents. The data being made available today indicate
that the problem of violence in schools is much more serious and potentially life-threatening
than previously believed. These findings highlight the extent to which violence-in
communities has crept into schools, once viewed by parents as "safe pavens" for cJ:lildren.
The key findings of the Study include:
o The CDC has identified 105 violent,school-associated deaths in the last two school
years (1992-3 and 1993-4) across the country.
'
o Twenty-nine (28%) of the fatal injuries happened inside a school building, another
thirty-seven (36%) occurred outdoors on school property, and the remaining thirty-six
(35%) occurred off Campus
o These deaths included 84 homicides, 18 suicides and 3 unintentional fireann-related
deaths
o '65.3% of the victims were students and 11% were teachers or staff. The remaining
victims (23%) were community members killed on school property
While the study js still underway, early findings suggest that violent deaths can occur in
schools and communities of all types and si~s.
As researchers continue to analyze the data collected for this study, they hope to
identify risk factors for school-associated violent death and ultimately prevent other fatalities.
Violence has long been recognized as an important public health and social issue, especially
for young people. This study underscores the degree to which violence has crept into
students' lives and into their schools. The result is students who are so frightened by the
,possibility of violence, they feel compelled to find new and "safer" routes to school and home
again, or to avoid school altogether. Others feel the need to carry a weapon for protection,
unaware that this will put them' at greater risk.
'
The 105 deaths are, of course, only the most startling example of the growing
epidemic of school violence. A full report on this study is expected in early 1996. The study
was conducted by the CDC, in conjunction with the United States Departments of Education
and Justice and the National School Safety Center.
�SCHOOL RELATED VIOLENCE:
DIMENSIONS OF THE NATIONAL PROBLEM
In a speech at the National Association of Education's Summit on Safe Communities
- "Safe Schools on Saturday April 8, President Clinton restated, his challenge to parents,
educators and communities to be part of the solution to make our schools and neighborhoods ,
safe.
"
SCHOOL VIOLENCE WIDESPREAD ...
Nearly" 3 million -16,000 per school day,or one every six. seconds -' thefts and
violent crimes occur on or near school campuses every year. [Dept. of Justice, Bureau '
of Justice Statistics, 1991] .
.Nearly 8 percent of all students in grades 9.- 12 reported that during a 30 day period
they had been in at least one physical fight that resulted in an injury requiring
treatment by a doctor or nurse. [Center for Disease Control and Prevention, Youth
Risk Behavior Surveillan~ System (YRBSS), conducted by Xavier University for the
National School Boards Association, 1992]
,
,
In a survey of 65,000 teens, USA today found that 37 percent of students don't feel
safe in school; 50 percent of students know someone who switched schools to feel
safer; 43 percent of public school kids avoid school restrooms; 20 percent avoid
hallways; and 45 percent avoid school grounds.
WEAPONS ARE INCREASINGLY COMMON ...
One out of 14 students (7 percent) were threatened or injured with a weapon on school
property in a' 12 month period. [YRBSS, March 1995]
More than one in five (22 percent) students surveyed claimed that they carried a
weapon to school during the last school year and 4 percent said that weapon was a
handgun. 59 percent said guns are easily obtainable, while 35 percent said it would
take them less than 60 minutes to get one. [Lou Harris Poll sponsored by the Joyce
Foundation and prepar~d for the Harvard School of Public Health, July 1993.]
DRUG USE ON THE RISE . .. '
One out of 20 st~dents (5 percent) has ,at le&stone drink on school property per
month. [YRBSS, March 1995]
Nearly one quarter of students (24 percent) were offered, sold, or given an illegal drug.
on school property during a 12 month period~ [YRBSS, March 1995]
�THE CLINTON RECORD ON -SCHOOL AND
COMMUNITY SAFETY
"...letls give our children a future. Let us take away their guns and give them books.
Let us overcome their despair and replace it with hope. Let us, by our example, teach
them to obey the law, respect our neighbors and cherish our values.
/I
President Bill Clinton
. State of the Union Address
January 25, 1995
Safety in schools isperhaps the number one concern of parents and educators
throughout the country. President Clinton recognizes the importance of this issue and has
put together an extensive record of legIslative and executive action aimed at tackling the
problem. Among his administration's legislative accomplishments are:
GOALS 2000: EDUCATE AMERICA ACf -- The centerpiece of President .Clinton's
education agenda, the Act recognizes the need for a comprehensive approach to
violence prevention. It provides resources to states and communities for education
reforms aimed at helping all students reach challengh~g academic and occupational
skill standards. It addresses school readiness, school completion, competency in
challenging subject matter, science and mathematics achievement, literacy, safe and
drug-free schools, and parental participation. It affirms the President's belief that
education is central to America's future and that the federal government is an
important partner of stat~s and communities in improving education and making
schools safe places for children to learn.
THE SAFE SCHOOLS ACf -- A one year program that prov'ides competitive grants to
local school districts for prevention programs such as conflict resolution, hiring
security guards and installing metal detectors. At the end of January, the Department
of Education awarded $18 million worth of grants to schools in high crime areas.
THE SAFE AND DRUG-FREE SCHOOLS AND COMMUNITIES ACf -:- The
Na~ional Education Goal 6 challenges the country to create safe, disciplined and drug
free schools for our children. The Elementary and Secondary Education Act (ESEA),
reauthorized last year, created the Safe and Dr:ug-Free Schools program to address
that goal. In fiscal year 1995, $482 million was appropriated to support
comprehensive strategies including drug abuse prevention curricula al)d programs
linking schools and communities.
�THE VIOLENT CRIME CONTROL AND LAW ENFORCEMENT ACT OF 1994
One of the President's most significant legislative achievements, the 1994 Crime Bill
balanced policing, prevention and punishment, and embraced a tough, smart strategy
on youth crime. With new penalties and punishment -- The, Crime Bill sent a strong
NO to gangs, guns and drugs. It bans handguns for juveniles; creates stiff penalties
for crime-committing gang members; establishes Boot Camps and Drug Courts to .
.discipline first-time, non-violent and drug offenders; and provides for hardened young
criminals -- as young as 13 years old -- to be tried as adults.
/
With Smart Prevention Programs --The Crime Bill also reinforces the difference
between right and wrong by investing in after-school, weekend and summer programs
which give young people something to say "yes" to.
The Community Oriented Policing Services (COPS) Program -This initiative
will eventually put 100,000 more police on the streets. Already, it has helped more
than half of the nation's law enforcement agencies fund nearly 17,000 new police .
. Many of them will be involved-in school violence or drug abuse prevention through
community policing initiatives.
The President's Crime Prevention Council -- The Crime Bill established the
Council to. coordinate the administration of federal crime prevention programs, to
assist communities. and community-based organizations seeking information about
these programs, and to develop services for program integration and grant
simplification.
.
Community Schools and Family and Community Endeavor Schools Program -
Provides an opportunity for educational institutions to play a broader role in the lives',
of children, families and the community. Both of these programs,will provide
resources to schools and coalitions of community groups ($36 million in fiscal year
1995) to keep schools open after "normal" school hours.
'
THE
PRESIDENT~S
DIRECTIVE ON GUN FREE SCHOOLS -- Ensures that States
will enact "zero tolerance" policies .that prohibit kids from bringing guns to scho()ls.
To make this policy real, the President has also ordered the U.S. Attorneys to work
with the Department of Education to develop strategies for enfor~ing the juvenile
handgun ban (included in the Crime Bill) and the zero tolerance adopted by schools.
NATIONAL SERVICE -- Today 20,000 AmeriCorps Members are helping communities to
meet their own needs while earning aid for their education. AmeriCorps represents a
powerful new resource for civic associations that are struggling to stop gang violence,
immunize infants, educate children, and help older Am~ricans lead more independent
lives. Because national service represents government at its best, President Clinton is
asking for $290 million in additional funds to expand the program to 47,000
Americorps members.
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BOWLING ALONE: AMERICA'S
DECLINING SOCIAL CAPITAL
\
Robert D. Putnam
Robert D. Putnam is Dilloll Professor of Internatiollal Affairs alld
director of the Center for,lnternatiollal Affairs at Harvard University.
His most recent books are Double-Edged Diplomacy: International
13argaining and Domestic Politics (1993) and Making Democracy Work:
Civic Traditions in Modern Italy (1993), which is reviewed elsewhere in
this issue.· He is ~ow completing a study of the revitalization, of
American democracy.
~.,
....
.'
Many students of the new democracies that have emerged over the
past decade and a half have emphasized the importance of a·strong and
active civil society to the, consolidation of democracy. Especially with
regard to the postcommunist countries, scholars and democratic activists
alike have lamented the absence or obliteration of· traditions of
independent civic engagement and a widespread tendency toward passive
reliance on the state. To those concerned with the weakness of civil
societies in the developing or postcommunist world, the advanced
Western democracies and above all the United States have typically been'
taken as models to be emulated. There is striking evidence, however,
that the vibrancy of American civil society has notably declined over the
past several decades.
Ever since the publication of Alexis de Tocqueville's Democracy ill
America" the United States has played a central role in systematic
studies of the links between democracy. and civil society, Although this
is in part· because trends in American life are often regarded as
harbingers of social modernization, it is als~ because America has
traditiona·lly been considered unusually "civic" (a reputation that, as w~
shall later see, has nol been entirely unjustified) .
When Tocqueville visited the United States in the 1830s, it was the
Americans' propensity for civia association that most impfessed him as
the k:ey to their unprecedented ability to make democracy work.
"Americans of all ages, all stations in life, and all types of disposition,"
]ouTllal of n..rrwcrocy Vol"",,. IS, Nrm./Jl!r I ]a",mrv
IOO~
/'
�'.,
66
.Journal of Democracy
he observed, "are forever forming associations. There are not only
commercial and industrial associations in which all take part. hut others
of a thousand, different types-religious, moml, serious. futile, very
general and very limited, immensely large and very minute. . . .
Nothing, in my view, deserves more attention than the intellectual ali~
moral associations in America....1
Recently, American social scientists of a neo-Toclluevillean bellt have
unearthed a wide range of empirical evidence that the quality of public
life and the performance of social institutions (and not only in America)
are indeed powerfully influenced by normS and networks of civic
engagement. Researchers in such fiehb; as education, urban poverty.
unemployment, the control of crime and dlllg abuse, and even health
have discovered that successful outcomes are more likely in civically
engaged communities. Similarly, research on the varying economic
attainments of different ethnic groups in the United States has
demonstrated the importance of social bonds within each group. These
results are co!,!sistent with research in a wide range of settings that
demonstrates the vital importance of social networks for job placement
and many other economic outcomes.
"
Meanwhile, a seemingly unrelated body of research on the sociology
of economic development has also ftlcused attention on the role of social
networks.' Some of this work is situated in the developing countries, and
some of it elucidates the peculiarly successful "network capitalism" of
East Asia. 2 Even in less exotic Western economies, however, researchers
have discovered highly efficient, highly flexible "industrial districts"
based on networks of collaboration among workers and' small
entrepreneurs. Far from being paleoindustrial anachronisms, these' dense
interpersonal and interorganizational networks undergird ultramodern
industries, from the high tech of Silicon Valley to the high fashion of
Benetton.
'
The norms and networks of civic engagement also powerfully affect
the performance of representative government. That, at least, was the
central conClusion of my own 20-year, quasi-experimental study of
subnational governments in different regions of Italy.) Although all these
regional governments seemed identical on paper, their levels of
effectiveness varied dramatically. SystematiC inquiry showed that the
quality of governance was determined by longstanding traditions of civiC
engagement (or its absence). Voter turnout, newspaper readership,
membership in choral societies and football clubs-these were the
hallmarks of a successful region. In fact, historical analysis suggested
that these networks of organized reciprocity and civic solidarity, far from
being an epiphenomenon of socioeconomic modernization, were a
" .
precondition for i t . '
No doubt the mechanisms through which civic engagement and social
connectedness produce such results-better schools, faster economic
Robat D. Putnam
67
development, lower crime, and more effective government-arc multiple
and complex. While these briefly recounted findings require further
confirmation and perhaps qualification, the parallels across hundreds of
empirical studies" in a dozen disparate disciplines a!1d subfields are
striking. Social scientists in several fields have recently suggested a
common framework for understanding these phenomena, a framework
that'rests on the concept of social capital.· By analogy with notions of
physical capital and human capital-tools and training that enhance
individual productivitY-"social capital" refers to features" of social
organization such as networks, norms, and social trust that facilitate
c<lordination' and cooperation for mutual benefit.
Fora variety of reasons, life is easier in. a community blessed with
a substantial stock of social capital. In the first place, networks of civic
engagement foster sturdy nor:rns of generalized reciprocity and encourage
the emergence of social trust. Such networks facilitate coordination and
communication, amplify reputations, and thus, allow dilemmas of
collective action to be resolved. When economic and political negotiation
is embedded in dense networks of social interaction, incentives for
opportunism are reduced. At ,the same time, networks of civic
engagement embody' past success at collaboration, which can serve as
a cultural template for future collaboration. Finally, dense networks of
interaction probably broaden the participants' sense of self, developing
the, " ... into the "we," or (in the language of rational-choice theorists)
enhancing the participants' "taste" for collective benefits.
I do not intend here to survey (much, less contribute to) the
development of the theory of social capital. Instead, I use the (central
premise of that' rapidly growing body of work-that social connections
and civic engagement pervasively influence our public life, as well as .
our private prospects-as the starting point for an empirical survey of
trends in social capital in contemporary America. I concentrate here
entirely on the American case, although the developments I portray may
in some measure characterize many contemporary societies.
Whatever Happened to Civic Engagement?
"
We begin with familiar evidence on' changing patterns of political
participation, not least because it is immediately relevant to issues of
democracy in the narrow sense. Consider the well-known decline in
turnout in national elections over the last three decades. From a relative
high point in the early 19605, voter turnout had by 1990 declined 'by
nearly a quarter; tens of millions of Americans had forsaken their
parents' habitual readiness to engage in the simplest act of citizenship.
Broadly similar trends also characterize participation in state and local
elections.
It is not just the voting booth th,at has been increasingly deserted by
�fill
JOlmUl! of D"mocrac,V
Americans. A series of identical qUl'stions posed by' the Roper
Org:lIIization to national samples ten times each year over thc last two
decades reveals that since 1973 the numher of Americans whu report
that "in the past year" they have "attended a public meeting 011 town or
school affairs" has fallen by more than a
third (from 22 perccnt in 1973 to 13
By almost every
percent in 1993). Similar (or even grcater)
relative declincs are evident in responses to
measure, Americans'
questions about attending a political rally or
direct engagement
speech, serving on a committee of some
ill politics and·
local organization, and working for a
goventme1lt lIas
political party. By almost every measure,
fallen steadily
Americans' direct engagement in politics
a1ld s/zarply over
and government has fallen steadily and
the last generation.
sharply over the last generation, despite the
fact that average levels of education-the
best individual-level predictor' of political
participation-have risen sharply throughout this period. Every year over
the last decade or two, millions more have withdrawn from the affairs
of their communities.
Not coincidentally, Americans have also disengaged psychologically
from politics and government over this era. The proportion of 'Americans
who reply that they "trust the government in Washington" only "some
of the time" or "almost never" has risen steadily from 30 percent in
1966 to 75 percent. in, 1992. .
These trends are well known. of course, and taken by themselves
would seem amenable to a strictly political explanation. Perhaps the long
litany of political tragedies and scandals since the 1960s (assassinations,
Vietna!1l, Watergate; Irangilte, and so on) has triggered an understandable
disgust 'for politi~ and government among Americans,. and that in turn',
has motivated their withdrawal. I do 1I0t doubt that this common
interpretation has some merit, but its limitations become plain when we
examine trends in civic engagement of a wider sort.
'Our survey of organizational membership among Americans can
usefully begin with a glance at the aggregate results of the General
Social Survey, a scientifically conducted, national-sample survey that has
been" repeated 14 times over the .last two decades. Church-related groups
constitute the most common type of organization joined by Americans;
they are especially popular with' women. Other types of organizations
frequently joined by women include school-service groups (mostly
parent-teacher aSSOCiations), sports groups, professional societies, and
literary societies. Among men, sports dubs. labor unions, professional
societies, fraternal groups, veterans' groups, and se':Vice clubs are all
relatively popular.
Religious affiliation is by far the most common associational
Robert D. Putl/ll/n
\
69
membcrship among Americans. Indeed, by many measures America
continues to he (evenmorc than in Tocqueville's lime) all astonishingly
"churched" society. For example, the Unitcd 'States h:ls more' houses of
worship per capita than any other nation on Earth. Yet religious
sentiment in ,America seems to be becoming somewhat less tied to
institutions and more self-defined.
How havc these complex crosscun:ents played out over the last three
or four decades in tenns of Americans' engagement with organized
religion? The general pattern is clear: The 1960s witnessed a significant
drop in reported weekly churchgoing-from roughly 48 percent in the
late 1950s to roughly 41 percent in the early 1970s. Since then, it has
, stagnated or, (according to,. some surveys) declined' still further.
Meanwhile, data from the General Social Survey show a modest decline
in membership in all "church-related groups" over the ,last 20 years. It
would seem, then, that net participation by Americans, both in religious
services and in church-related groups, has declined modestly (by perhaps
a sixth) since the 19605.
For many years, labor unions provided one of the most common
organizational affiliations among American workers. Yet union
membership has been falling for nearly four decades, with the steepest
decline occurring between 1975 and 1985. Since the mid-1950s, when
union membership peaked,.the ·unionized portion of the nonagricultural
work force in America has dropped by more than half, falling from 32.5 '
percent in 1953 to 15.8 percent in 1992. By now, virtually all of the
explosiv.e grQwth in union membership that was associa~ed with the New
Deal has been erased. The solidarity of union halls is now mostly a
fading memory of aging men. s
'
The parent-teacher association (PTA) has been an especially important
fonn of civil' engagement in twentieth-century America because part!ntal
involvement in the 'educational process' represents a particularly
productive fonn of social capital. It is, therefore, dismaying to discover
that participation in parent-teacher organizations has dropped drastically
over the last generation~ from, more than 12 million in 1964 to barely
5 million in 1982 before recovering to approximately 7 million now.
Next, we tum to evidence on membership, in (and volunteering for)
civic and fraternal organizations. These data show some striking patterns.
First, memberShip in traditional women's groups has declined' more or
less steadily since the mid-1960s. For exampl\ membership in the
national Federaiion of Women's Clubs is down oy more than half (59
percent) since' 1964, while membership in the League of Women Voters
(LWV) is off 42 percent since 1969.6
Similar reductions are apparent in the numbers of volunteers for
mainline civic organizations, such as the Boy Scouts (off by 26 percent
since 1970) and the Red Cross (off by 61 percent since 1970). But what
about the possibility that volunteers have simply switched their loyalties
�'/ollrt,.,1 of DClllocrncy
7()
to other organizations? Evidence on "regular" (as opposed to occasional
or "drop-by")· volunteering is available from thc Labor Departmenl's
Current Popu lation Surveys of 1974 and 1989. Thcse estimatcs suggest
that serious volunteering declined hy roughly ollc-sixth over" these 15
years, from 24 percent of adults in 1974 to 20 percent in 19119. The
multitudes of Red Cross aides and Boy Scout troop leadcrs now missing
in action have apparently not been offset by equal numbers of new
recruits elsewhere.
Fraternal organizations have also witnessed a substantial drop in
membership during the 1980s and ·1990s. Membership is down
significantly in such groups as the Lions (off 12 percent since 1983),
the Elks (off 18 percent since 1979). the Shriners (off 27 percent since
1979), the Jaycees (off 44 percent since 1979). and the Masons (down
39 percent since 1959). In sum. after expanding steadily throughout most
of this century. many major civic organizations have experienced a
sudden, substantial, and nearly simultaneous decline in membership over
the last decade or two.
The most whimsical yet discomfiting bit of evidence of social
. disengagement in contemporary Ameri~a that I have discovered is this:
more Americans are bowling today than ever before, but bowling in
organized leagues has plummeted in the last decade or so. Between
1980 and 1993 the total number of bowlers in America increased by 10
percent. while league bowling decreased by 40 percent. (Lest this be
thought a wholly trivial example. I should note that nearly 80 million
Americans went bowling at least once during 1993, nearly a third more
ilIon voted in Ihe 1994 congressional elections and roughly the same
number as claim to attend church regularly. Even after the 1980s'
. plunge in league bowling, nearly 3 percent of American adults regularly
bowl in leagues.) The rise of solo bowling threatens the livelihood of
bowling-lane proprietors because those who bowl as members of leagues
consume three times as much beer and pizza as solo bowlers, and the
money in bowling is in the beer afld pizza, not the balls and shoes. The
broader social significance, however, lies in the social interaction and
even occasionally civic conversations over beer and pizza that solo
bowlers forgo. Whether or not bowling beats balloting in the eyes of
most Americans, bowling teams illustrate yet another vanishing form of
social capital.
Countertrends
'\
"
At this point, however, we must confront a serious counterargument.
Perhaps the traditional forms of civic organization whose decay we have
been tracing have been replaced by vibrant new organizations. For
example, national environmental organizations (like the Sierra Club) and
feminist groups (like the National Organization for Women) grew rapidly
Roh,'rt D, Plllllam
71
during thc 1970s and 1980s and now count hundreds of thousands of
dues-paying memhers .. An even more dramatic example is the American
Association of Retired I'crsons (AARP), which grew exponentially from
400,000 card-carrying members in 1960 to 33 million in If.}93. hecoming
(after the Catholic Church) the largest private organization ill the world.
The national administrators of these organizations are among the most
feared lobbyists in Washington, in large part because of their massive
mailing lists of presumably loyal members.
These new mass-membership organizations are plainly of great
political importance. From the point of view of social connectedness.
however. they are sufficiently different from classic "secondary
associations" that we need to invent a new label-perhaps "tertiary
associations." For the vast majority of their members. "the only act of
membership consists in writing a check for dues or perhaps occasionally
reading a newsletter. Few ever attend any meetings of such
organizations, and most are unlikely ever (knowingly) to encounter any
other member. The bond between any two members of the Sierra Club
is less like the bond between any two members of a gardening club and
more like thc bond between any two Red Sox fans (or pl!i"haps any two
devoted Honda owners): they root for the same team and they share
some of the same Interests. but they are unaware of each other's
existence. Their ties, in short, are to common symbols, common leaders,
and perhaps common ideals, but not to one another. The theory of social
capital argues that associational membership should, for. example,
increase social trust, but this prediction is much less straightforward with
regard to membership in tertiary associations. From the point of view
of social connectedness, the Environmental Defense Fund and a bowling
league are just not in the same category.
.
If the growth of· iertiary organizations represents one potential (but
probably not real) counterexample to my thesis, a second countertrend.
is represented by the growing prominence of nonprofit organizations,
especially nonprofit service agencies. This so-called third sector includes
tlverything from Oxfam and the Metropolitan Museum of Art to the
Ford Foundation and the Mayo Clinic. In other words, although most
secondary associations are nonprofits, most nonprofit agencies are not
secondary associations. To identify trends in the size of the nonprofit
sector with trends in social connectedness would. be another fundamental
7
.
,
conceptual mistake.
A third potential countertrend is much more relevant to an assessment '
of social capital and civic engagement. Some able researchers have.
argued that the last few decades have witnessed a rapid expansion in
"support groups" of various sorts. Robert Wuthnow reports that fully 40
'percent of all Americans claim to be "currently involved in [al small
group that meets regularly and provides support or caring for those who
participate in it."8 Many of these groups are religiously affiliated, hut
"'
�72
Joumol of Democracy
Robert D. Putnam
many others are not. For example, nearly 5 percent of Wuthnow's
national sample claim to participate regularly in a "self-help" group,
such as Alcoholics Anonymous, and nearly as many say they belong to
book-discussion groups and hobby clubs.
The groups described by Wuthnow's respondents unquestionably
represent an important form of social capital, and they need to be
accounted for in any serious reckoning of trends in social connectedness.
On the other hand, they do not typically play the same role as
traditional civic associations. As Wuthnow emphasizes,
confirms our earlier conclusion: American social capital in the form of
civic associations has significantly erodetl over the last generation.
Good Neighborliness and Social Trust
Small groups may not be fostering community as effectively as many of
their proponents would like. Some small groups merely provide occasions
for individuals to focus on themselves in the presence of others. The
social contract binding members' together asserts only the weakest of
ohligations. Come if you have time. Talk if you feel like it. Respect
everyone's opinion. Never, criticize. Leave quietly if you become
dissatisfied. . . . We can imagine that [these small groups) really
substitute for families, neighhorhoods. and broader community attachments
that may demand lifelong commitments, when, in fact, they do not.'
All three of these potential countertrends-tertiary organizations,
nonprofit organizations, and support groups-need somehow to be
weighed against the erosion of conventional civic organizations. One
way of doing so is to consult the General Social Survey.
Within all educational categories, total associational membership
declined significantly between 1967 and 1993. Among the
college-educated, the average number of group memberships per person
fell from 2.8 to 2.0 (a 26-percent decline); among high-school graduates,
the number fell from 1.8 to 1.2 (32 percent); and among those with
fewer than 12 years of education, the number fell from 1.4 to 1.1 (25
percent). In other words, at all educational (and hence social) levels of
American society, and counting all sorts of group memberships, the
average number of associational memberships has fallen by about a
fourth over the last quarter-century. Without controls for educational
leve's, the trend is not nearly so clear, but the central point is this:
more Americans than ever before are in social circumstances that foster
associatiollal involvement (higher educaiion, middle agl!, and so on), but
nevertheless aggregate associational membership appears to be stagnant
or declilri"g.
'
Broken down by type of group, the downward trend is most marked
for church-related groups, for labor unions, for fraternal and veterans'
organizations, and for school-service groups. Conversely, membership in
professional associations has risen over these years, although less than
might 'have been predicted, given sharply rising educational and
occupational levels. Essentially the same trends are evident for both men
and women in the sample. In short, the available survey evidence
73
'1
I noted earlier that most readily available quantitative evidence on
trends in social connectedness involves formal settings. such as the
voting booth, the union hall, or the PTA. One glaring exception is so
widely discussed as tq require little comment here: the most fundamental
form of social capital is the family, and the massive evidence of the
loosening of bonds within the family (both extended and nuclear) is well
known. This trend, of course, is quite consistent with-and may help to
explain--our theme of social decapitalization.
A second aspect of informal social capital on which we happen to
have reasonably reliable time-series data involves neighborliness. In each
General Social Survey since 1974 respondents have been asked, "How
often do you spend a social evening with a neighbor?" The proportion
of Americans who socialize with their neighbors more than once a year
has slowly but steadily declined over the last two decades, from 72
percent in 1974, to 61 percent in 1993. (On tlie other hand, socializing
with "friends who do not live in your neighborhood" appears to be on
the increase, a trend that may reflect the growth of workplace-based
social connections.)
Americans are also less trusting. The proportion of Americans saying
that most people can be trusted fell by more than a third between 1960,
when 58 percent chose that alternative, and 1993, when' only 37 percent
did. The same trend is apparent in all educational groups; indeed,
because social trust is also correlated with education and because
educational levels have risen sharply, the overall decrease in social trust
is even more apparent if we control for education.
Our discussion of trends in' social connectedness, and civic
engagement has tacitly assumed that all the forms of social capital that
we have discussed are themselves. coherently correlated across
individuals. This is in fact true. Members of associations are much more
likely than' nonmembers to participate in politics, to spend time with
neighbors. to express social trust, and so on.
The close correlatiqn between social trust and associational
membership is true not o~ly across time and across individuals, but also
across countries. Evidence, from the 1991 World Values Survey
demonstrates the following:lo
1) Across the 35 countries in this survey, social trust and civic
engagement are strongly correlated; the greater the density of
associational membership in a society, the more trusting its citizens.
Trust and engagement are two facets of the same underlying
factor--social capital.
�74
J ol/mal of (Jeff/vcracy
2) America still ranks relatively high by cross-national standards on
both these dimensions of social capital. Even in the 19"Os, •• ftcr several
decades' erosion. Americans are more trusting and 1II0re engaged than
people in most other countries of the world.
3) The trends of the past quarter-century, however. have apparently
moved the United States significantly lower in the international rankings
of social capital. The recent deterioration in American social capital has
been sufficiently great that (if no other country changed its position in
the meantime) another quarter-century of change at the sart:Je rate would
bring the United States, roughly speaking, to the midpoint among all
these countries, roughly equivalent to South Korea, Belgium, or Estonia
today. Two generations' decline at the same rate would leave the United
States at the level of today's Chile, Portugal, and Slovenia.
Why Is U:S. Social Capital Eroding?
As we .have seen, something has happened in America in the last two
or three decades 10 diminish civic engagement and social connectedness.
What could that "something" be? Here are several possible explanations,
along with some initial evidence on each.
TIle movemellt of women into tile labor force. Over these same two
or three decades, many millions of American women have moved out
of the home into paid employment. This is the primary, though not the
sole,reason why the weekly working hours of the average American
have increased significantly during these years. It seems highly. plausible
that this social revolution should have reduced the time and energy
available for building social capital. For certain organizations, such ,as
the PTA. the League of Women Voters, the Federation of Women's
Clubs, and the Red Cross, this is almost certainly ·an important part of
the story. The sharpest decline in women's civic participation seems to
have come in the 19705; membership in such "women's" organizations
as these has been virtually halved since the late 19605. By contrast,
most of the decline in participation in men's organizations occurred
about ten years later; the total decline to date has been .approximately
25 percent for the typical organization. On the other hand, the survey
data imply that the aggregate declines for men are virtually as great as
those for women. It is logically possible, of course, that the male
declines might represent the knock-on effect of women's liberation, as",
dishwashing crowded out the lodge, but time-budget studies suggest that"
most husbands of working \'fives have assumed only a minor part of the
housework. In short, something besides the women's revolution seems
to lie behind the erosion of social capital.
Mobility: The "re-potting" hypothesis. Numerous studies of
organizational involvement have shown that residential stability and such
related phenomena as homeownership are clearly associated with greater
75
Robert D. Plllllam
civic engagement. Mobility, like frequent re-potting of plants, tends to
disrupt root systellls, and it takes time for an uprooted individual to put
down 'new roots. It seems plausihle that the automobile, suburbanization,
and the movement to the Sun Belt have reduced the social rootedness
of the average Americlln, but one fundamental difficulty with this
hypothesis is apparent: the besl evidence shows that residential stability
and homeownership in America have risen modestly since 1965, and are
surely higher now than during the 19505, when civic engagement and
social connectedness by our measures was definitely higher.
Otller demographic transformations. A range of additional changes
have transformed the American family since the 1960s--fewer marriages,
more divorces, fewer children, lower real wages, and so on. Each of
these changes might account for some of the slackening of civic
engagement, since married, middle-class parents are generally more
socially involved than other people. Moreover, the changes in scale thai
have swept over the American economy in these years--iIIustrated by
the replacement of the comer grocery by the supermarket and now
perhaps of the supermarket by electronic shopping, at home, or the
replacement of community-based enterprises by outposts of distant
multinational firms--may perhaps have undermined the material and
even physical basis for civic engagement.
The technological transformation of leisure. There is reason to believe
that deep-seated technological trends are radically '''privatizing'' or
"individualizing" our use of leisure time and thus disrupting many
opportunities for social-capital formation. The most obvious and probably
the most powerful instrument of this revolution is television.
Time-budget studies in the 1960s showed that the growth in time spent
watching television dwarfed all other changes in the way Americans
passed their days and nights. Television has made our communities (or,
rather, what we experience as our communities) wider and shallower. In
the language of economics, electronic technology enables individual
tastes to be satisfied more fully, but at the cost of the positive social
externalities associated with more primitive forms of entertainment. The
same logic applies to the replacement of vaudeville by the movies and
now of movies by the VCR. The new "virtual reality" helmets that we
will soon don to be entertained in total isolation are merely the latest
extension of this trend. Is technology thus driving a wedge between our
individual interests and our collective interests? It is a question that
seems worth exploring more systematically.
What Is to Be Done?
The last refuge of a social~scientific scoundrel is to call for more
research. Nevertheless, 'I cannot forbear from suggesting some further
lines of inquiry.
�76
,/
JOllrnal of Democracy
We must sort oUt the dimensions of social capital, which clea~ly is
'nol a unidimensional concept, despite language (even in this es.'iay) that
implies the contrary. What types of organizations and networks most
effectively embody--or generate-social capital, in the sense of mutual
reciprocity, the resolution of dilemmas of
collective action, and the broadening of
We need to explore
l!ocial identities? In this essay I have
emphasized the density of associational life.
creatively how
In earlier w.,rk I stressed the structure of
public policy
networks, arguing that "horizontal" ties
impi1lges all sodal
represented more productive social capital
capital fonuatio1l.
than vertical ties. 11
1ft some well-kuow1l
"Another set of important issues involv.es
iftstallces, public
macrosociological crosscurrents that, might
policy has destroyed intersect with the trends described here.
Itig/fly effective
What will be the impact, for example, of
sad"I rretworks and electronic networks on social capital? My
ltonlls.
hunch is that meeting in an electronic
forum is not the equivalent of meeting in a
bowling alley--or even in a saloon-but
hard empirical research is needed. What about the development of social
capital in the workplace? Is it growing in counterpoint to the decline of
civic engagement, reflecting some social analogue of the first law of
thermodynamics--social capital is neither created nor destroyed, merely
redistributed? Or do the trends described in this essay represent a
deadweight loss?
'
. " A rounded assessment of changes in American social capital over
the last quarter-century needs to count the costs as well as the benefits
of community engagement. We must not romanticize small-town,
middle-class civic life in the America of the 1950s. In addition to the
deleterious trends emphasized in this essay, recent decades have
witnessed a substantial decline in intolerance and probably also in overt
discrimination, and those beneficent ,trends may be related in complex
ways to the erosion of traditional social capital." Moreover, a balanced
accounting of the SOCial-capital books would need to reconcile the
, insights of this approach with the undoubted insights offered by Mancur
Olson and others who stress that closely knit, social, economic, and
political organizations are prone t.o.,inefficient cartelization and to what
political economists term "rent seekmg" and ordinary men and women
call corruption. 'l
• Finally, and perhaps most urgently, we need to explore creatively
how public policy impinges on (or might impinge on) social-<:apital
formation. In some well-known instances, public policy has destroyed
highly effective social networks and norms. American slum·clearance
policy of the 1950s and 1960s, for example, renovated physical capital,
17
Rob"rt D. Putnam
but. at .a very high cost to existing social capita]. The consolidation of
country post offices and small school districts· has' promised
administrative and financial efficiencies, but full-cost accounting for the
effects of these policies on social capital might produce a more negntive
verdict. On thi: other hand, such past initiatives as the county
agricultural-agent system" community colleges, and tax deductions for
charitaIJle contributions illustrate that government can encourage social
capital formation. Even a recent proposal ill San Luis Ohispo, California,
to require that all new houses have front porches illustrates the power
of government to influence where and how networks are formed.
The concept of "civil society" has played a central role in the recent
.' globai dcbat'e about the preconditions for democracy and democratization.
In the newer democracies this phrase has properly focused attention on
the need to foster a vibrant civic life in soils traditionally inhospitable
to self-government. In the established democracies, ironically, growing
numbers of citizens are questioning the effectiveness of their public
institutions at the very moment when liberal democracy has swept the
battlefield, both ideologically and geopolitically. In America, at least,'
there is reason to suspect that this democratic disarray may be linked to
a broad an<L continuing erosion of civic'.'i!ngagement that began a
quarter-century ago.' High on our scholarly agenda should be the
question of whether a comparable erosion of social capital may be under
way in other advanced democracies, perhaps in different institutional and
behavioral guises. High on America's agenda should be the question of
how to' reverse these adverse trends in social connectedness, thus
restoring civic engagement and civic trust.
NOTES
I. Alexis de Tocqueville, Democracy in Aml!'rica. ed. J.P. Maier, trans. George
Lawrence (Garden City, N.Y.: AnChor Books. 1969},513-17.
,
2. On social' nelworks and economic growth in the developing world, see Milton J.
!:sman and Norman Uphoff. Local Orsanimtioru: Int"rmedlaries in Rural Devt!'iopment
(lIhac~: Cornell University Press, 1984), e5p. 15-42 and 99·180; and Alben O. Hirschman,
Gelling Ahead Collectively: Grassroots ExperiencB in La/in America (Elmsford. N.Y.:
Pergamon Press, 1984), esp. 42·77. On East Asia. see Gu~tav Papanek. ~The'New A~ian
Capitalism: An Economic Pontail," in .Peter 1.. Berger and Hsin-Uuang Michael IIsiao,
. eds., In Search of an East Asian Development Model (New Brunswick, N.J.: Transaction.
1987); 27-80; Peter Il Evans. "111e State as Problem and Solution: Predation, Embedded
Autonomy and Structural Change,~ in Stephan Haggard and R~rt R. Kaufman, ed~., Tlte.
Politics of Economic Adjusrm"nt (Princeton: Prina:lon Universit~ Prc:ss, 1992). 139.111; and
Gary G. Hamillon. William leile, anti Wan·)in Kim, MNelwork Structure of East Asian
Economies. 8 in Siewart R. Clegg and S. Gordon Redding. cds., Capitalism in COII/ro.•ting
CulturB (Hawthorne, N.Y.: De Gruyter. 1990). 105·29. See also Gary G. Hamilton and
Nicole Woolsey I1iggart, ~Market. Culture, and Authorily: A Comparative Analysis of
Managemcnl and Organization. in the Far EaSl: Amrrican Journal of Sociology
(Supplement) 94 (1988): S52·S94; and :Susan Greenhalgh. uFamilics and. Networks in
Taiwan's Economic Devclopment,8 in Edwin Winckler and SUs:ln Greenhalgh. cds.•
Contending Approaches to the Political Economy of Taiwan (Amant, N.Y.: M.E. Sharpe,
1987), 224-45.
�"
Journal of Democracy
711
3. Roben 0, Putnam, Maltil/g Democracy Work: Ci.ic Trutlilions i" Mo.lem Itnly
(Princeton: Princeton University Press, 1<)93).
4. James S: Coleman deserves primary credit for dcveloping thc "social c.1pit:II"
theoretical framework. See his wSoci,,1 Capitnl in the Creation of Human Capital,"
American Journal of Sociology (Supplement) 94 (191111): S95-S 120. a.~ well as his 111,'
Foul/datiolls of Social Theory (Cambridge: Harvard University, Prcs.~, 1990), 3011-21. Sec
also Mark Granovetler. wEconomic Action and Social Structure: The Problem of
Embeildedness." American Journal of Sociology 91 (1985): 481-510; Glenn C. loury,
-"Why Should We Care About Group Inequalily?~ Social Philosopiry and Policy 5 (1987):
249-71; and Roben D, Putnam, "The Prosperous Community: Social Capital and Public
, Life'.~ Ame,rican Prospect 13 (1993): 35-42. To my knowledge. the first scholar 10 use the
term "social capital" in its corrent sense was Jane' Jacobs, in The Death and Life of 'Oreal
American Cities (New York: Random House, 1961), 138. ,
"
5., Any simplistically )lOliti.cal interpretation of the collapse of American Unionism
would need to confront the fact that the steepest decline 'began more than si~ years before
the Reagan administration's'allack on PATCO. Data from the General Social Survey sho",
a roughly 40-pcrcent decline in reponed union membership between 1975 ond 1991.
6. Data for the LWV are available over a longer time span and show an interesting
patlern: a sharp slump during the Depression, a strong and sustained rise after World War
II that more than tripled membership between 1945 and 1969, and then the po5t-1969
decline, which has already erased virtually all the postwar goins and continucs still. This
,same historicaf pattern applies 10 those men's fraternal organizations for which compar:ible
data are available-5teady increases for the firsl seven decades of the century, interrupter!
only by the Great Depression, followed by a collapse in the 1970s and 1980s that hal
'
already wiped out most of the postwar expansion ':ind continues apace.
.
, ..
/>
..
7. Cf. Lester M, Salamon, "The Rise of the Nonprofit Sector," Foreign Affairs 73
(July-August 1994): 109-22. ~ also Salamon, "Panners in Public Service: The Scope and
Theory of Government-Nonprofit Relations,~ in Waller W. Powell, cd .• The Nonprofit
Sector: A Research Handbook (New Haven: Yale University Press, 1987). 99-/17.
Salamon's empirical evidence docs not sustain his broad claims abOut a 'global
qassociational revolution" comparable in significance 10 the rise of the nation-state several
centuries ago.
8. Robert Wuthnow, Sharing Ihe Journey: Supporl Groups and America's New Quest
for Community (New York: The Free Press, 1994), 45.
9. Ibid., 3-6.
10. I am grateful to Ronald Inglehan, who directs this unique cros...-national project,
for sharing these highly useful data with me. See his '1be Impact of Culture on Economic
Devclopment:Theory, HypOtheses, and Some Empirical Tcsts" (unpublished manuscript,
Universit~ of Michigan, 1994).
'
11. Sec my Making Democracy Work, esp, ch. 6.
12. Sec Mancor Olson, Thll: Rise and Decline of Nations: f;conomic GroWlh,
Stagflation, ,and Social Rigidilia (New Haven: Yale University Press, 1982). 2.
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3. Who
In keeping with the goal of having a working session, we will
keep tha number of invitations small. In discussions with Pet
Griffin and Marcia Hale, we have tentatively agreed to th~
following invitation list:
6 Governors
NGA Chair and Vice
Ch~ir
welfare leads (0 and' R)
NGA Human Resources Chair and Vice Chair
NGA
6 Senators and 6 mem.Det;s of the House
Pat will work with the majority and minority
leaderships to,determine representation
4 local elected officials
We will invite 2·3 Mayors and 1-2 county Or
other local officials. Marcia will
coordinate these invitations.
4 representatives of the Administration
Yourself, the Vice president, Secretary
Shalala, and Alice Rlvl1n
A m.i.nimal t).umbe.r of other staff including, Leon Panetta, myself,
Bruce Reed and other staff
a!;
appropriate.
DiSlapprove
Approve
D1.sc\.lse
4, ~~Q,!.:.!~~t / ~ched..!::i~
We envision the following schedul.e:
Friday evening
6:00
Arrival
5:30
8:30
Din':(lel:
9:30
Saturday
8:00
IntroductC'Jry Diacu!:Jsion
Movie/Other entertaj.nment
8:30
Breakfast
Working Sessions
2:00
Conolusion/Press st$tement
t";ctking l.,unch
PHOTOCOPY
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VI H i l' £ 1-\ 0 U S S
DeC6(nbeI: 12. ;
1994,
J
MEMORANDUM TO THE PRESIDENT
"\
FROM:
CAROL H. RASCO (1
11HROUGH:
WORKING
\ \,11-.,.,..
LEON PANETTA
SUBJECT:
:"\
'~':""l
MEE~!NG
ON
WELF~RS
RSrORM
Following up your announcement of a working session on welt'are
reform with a bipartisan group of elected officials, we naed to
make a series of decisions about the meeting's structure and
format. The plan sketched out below envisions a true working
session, held at Camp David, with mtn1rnal press coverage other
than statements by partiCipants at the close of the meeting.
Decisions
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is more corti:::colJ.El\1, and tba f1ett'lnqin mor~ Pl,'9.91,!entteJ .
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either around the House itself (although that
i.sh to use
i~cl1itiea,
t
may be impossible due to renovations) or At the Jackson Place
Conference CentQr.
data would be Friday .and Saturday, .: OTl:":f;U"Y
13-14, whiCh would give us e way to get into the middle of th9
poll t.1(Jo.1. d~bate barore the S·tll'(:e (':If the U.ni,on.
Wa are work:1.!'lg
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~he
dBte today or tomorrow_
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P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
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01-25-1995 12: 2S
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P.0l/04
CL 1NTON TRANS.
. 501 399' 71961
y
~ Nattonal GOMmon' Asaodatlon
.....
'
NGA WELfAJE REFORM POLICY
AdOpt.d .6ruary 24. Ii.'
Job-9rtntt4 Welfare Rlform
W, btU. . that pubUc utistanc:e prOgrams mUit fost.r tb. ci.ation. Itrengtbentng
and pr•• lrvatloa of I lOUd familv StNCture ill which parent, can do productive .workanct
ralae bealthp chllclrtn. The" mUit providl lnctndve. and opportllnhi•• for incllvicluals to
get daI training thew need and to Illk jobs. ' It is our aim to cr.1 te a sVitem where it 1.1
alW'lyl bitter to ....k than be on public a..inane..
.
The GcwlmOfl are convinced that' the provision of' genuln. employment
opportunitle. r.prelena thl surest route out of poverty lorOW' nltlon's poor famID.. and
childten. For tbis reason, thl current lv-tan m.t be refocused to place primary
emphasis on. the p.cemlnt of recipients into Jobs and the removal of emtlDs barriers to
.eononuc l.lf-tUlftciIIlCY.
'
Our appraach to ••llu,· r.form i. groUNl.dln the notion that" can and mUlt
RJ'evlftt depeadenev Oft .Ilfar, by'strengt.b.mlng the famity anc:tby -nrlllively providing
opportunities for work. Tb1I preventlvl- approac:.b reflects OW' belief that Lnvestmlnt in
human development iI a critical pan of any Igenda for ecCMom1c IIfOatdl.The initial .
COles of this investmeat may b8 somewhat higher than eun.. ~ expm:llt\lrl 1Ive1l. but we
believ. thalt pubUc expenditure. will Ivencually be lowered 11 we cIn tatget fllOUlcea on
proglllnl that will reduce thl need of chlldra, BDCl their famiUu to rlsort to the "'Ilfare
tvatlm. .
'
The fedetal govemment and the.tates nwst be prepar.d to invist in programs that ,
addrell the lMfty flCOllUld needs whiCh ...... 'flctora in \1IlUarl dependency. A major
NGA Iffort. ntitled ")rlnging 00_ tbeBarriefs", 11 currently identifying .trategia to
help usaddr•• the.. probllms at thl criticaluages 01 childhood and Idolescence. Initial
SClPS have beeD tun wida publlc ancl privatI •• ctor funds, but we must str,nlthm and
further dev.lop lnituulvee to reduce thl' 1ncidencland COrIIlqU.ncll of tlln pregnancy;
Iner.... the ratl of hiSh school compledon and. advlt literac,,; iner••,acclI. to prlnata'
and prim-IV health care for cbildr,n and their .famUiel; increase the collec1ion of child
support from abient parenti; improve pIlflDtini skills; and reciuce alcohol and drug abuse.
Sound prevll1dv. iAitlatlve. in thll' ar... sill pevoff. "'1 are COIlvinced. in • reduc.d
ne.d forwe!ful ...utancl In the-fUMe. '. "
.
HALL Of1H1 STATU -444 Nom CIpIIrat Stlttt.·........ D.c.1OOO.- "'I • (101~ 614·1100
�01-25-1996.12:26
501 399 7196
P.02/04
CL INT()\I TRANS.
1'NII nodon of a IOda1 contract '. recognlill that the .,lfat. lystem·1Il'VII
IndIvldualI willi • . , . range ud. varllty 01 netcll. We cunot ,.CI that walfOnD
tr.atmlDt of -cue__• wUI melt IRdlvlduall' .cUC\Unltancl' with .. tltf.ctory rIN1t1.
The Gauernan blU• .,. dlat thlr, 11 ","udal gatn in tM notion of servtces and
caatrlCca taIlor,d to individual falnllin.
.
In this nv, we hope to prlvent loDg-tlnn wllfare depender\c. by blingln,lnto thl
employment Itflam parlnt' who have be. . . .lfarl recipientS for rilativily tbort pertodl
of riml. We also ..Hevl that· tbJ.t recommlDdlltlaft renectl currlDt soctal 1Ni· .COROI'ftic
rnUtlt•• loa affordable. quality child carl for younglr childllD becoml••vallabkt. . .
belil.. thaI recipient. with chlldren 191 1 or older CaD IUcca.fully participate In III
IducatlCll or iobs progrll11•
. 'Be GovtmOJI belllVl It it crlclCal to give hlgh priority to young. first-tim,
mothlrs. Stuclle. tbow that OVll 60 perC8llt of AfDe mother. u.nder agl 30 had their fir.t
chlJd u t.enagen. 1ft many CUtlI, it II .uler to ttaID and find jobI for thotl iIIdlvtduall
thin fot 1000g-tlrm recipilnt.. P!Jr a rlladvlly modest Inve.tmeat. ther• • the potential
for .ubI.dal aWl,llf tbl.. individuals c:u be' ci1verted from the ..lfate syatlm into
the jab lueam. ThIs wauld alia tend to "Iciac, the incldence of ••,CDDd or tb!rd birth.
At tbllImI tim•• dl8 Governors blUeVl that the employm.nt nelda of long-tll'm
..lfarl tldplents mUit be addresled. At indIcat.d by iuccalfu1nl" employment ancl
ualnln, tDitJedvtl, lonS-tenn ••1Iare rlCipl.ntl can achieve Silf-lutficiacv if glven the
DlCnsuv tralDlngand .\apport Mme.... Thtrl'forlt in dellplng OW' employment and
training progruna. we arl.11kewlle COIftft\ittld to helpln, ·these individuals reduce their
dependenc. Oftw.lf.,e.
..
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eLI NTON TRANS.
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. Mldlc:ald and..... jobI • not provide bnlth coverage :can be provtdM hiaIda IIMCII,
and .e .erad"towark .ncb the AdmInIItrl1ian aDd Congrua GIl tbIa·luutl. ,For
lample. III. our poUcy ora "Health Can for UnInIund Indlvlduall· •• r.~tftd an
........ Of pooIiIll ~tI.
.umpdODl lor _81th can premll8'ftl patd by
worbn, for contlDuatton covenre.. ad chang.. lD. au poUev .w:b u
equitable tre.tlDPt for buUh CllrtlCOVIrase at uaiacorporat.d butlDe..... .
..
.....,.,..cI
"I
n., Gove~ also rec:agnJze dUll urapllld cbUd support repraentl .. Ilzable resource
lor 10. iftccine famW.. and we .01 Coatlnul to Itrengthen currtfttentorcllftent elfor ...
Towud mat _
.e are camm1ttld to full lmplemeataUoa of dw 19M Federal child
eupport amenc:tnantl. Moreover. the Govemon .w CODd.nuI to lap.e odlerproposl"
such .. l.acreaMci lI1...tat. coopendan. end Iftforc. .lftt; e1l:'tllllan of employmtut and
tndlllnt to I'IGIl-CUItodlal parmts; and iI'IIplemeatation of tlqultablt IUpport gv.lde1lDe., to
betp I11I\II'1 that INiivIdua1I fulfW their.balc pal'lftt81 rapaaaibUlty of Incomtr support for
dullr chUdrn.
The most pt_lDg.pp~oach forlmpltmentln, the cODIrlctls cue.managem8Dt, In
wblch the relpoaatble govemmtnt agll)CV tnd caseworker brobr and coordlnate the
multiple 1CIClal. health, educ:atloa.' and lIIlP10vmelu I.mc•• · nlClIIIII1I 10 promote
Mlf..lUlfldt!lCV and to ItrlftgthenfamUy ILf.. Senral Itatt. haw shovm that . . can
personalize the • •Iuctacy ttvCNgh this approach. and that the, one-to-one relatlGNhlp
provide••normously important inc.ntlva for both parti•• to succeld.
.
finally, the contract must bI enforc.ablt.· If the reciPient doa not mect his or h.r
obllptlonl UDder the contract. thea· lb. adult'. portloa of. the ueiataDce p8srment should
be .Um.iDatlCl untU. he or Ibe meets th. tetml of tbe COftuac:t. Support for tb, cblld would
be pr.Hrved. SlmiWly. 1f govemmmt dots not fulfW ita obUgatlona. cbeu tbe CODtract
. . wauld DOt bI enforceable ant.l full udstDCi to the entire fImlly na1d cantlmaa.
Under the awrlftt 'Yltem. f,deral speadlng devoted specifically to the. tralnJng and
pblCtlmtllt .of ..11. . m:lplenta repr....ta rubatllltlaUli leu than one percent of the
·lDlOUDt lpent far APDCblntfltl. Notbtngcou1d lDd1cat. more dramaticaU" tb. lack of·
.lObI focus 1ft our currlnt prottam.·
. . .
In irnplementlnt 1M' . .lfar. reform pi. . It " crltlc:al that i.dual ftIIlcblng fuads
be ....... available for aU semen whlcb' at. . .tended to tlctpiatl •
att required to
tD tbI ... PfOII'IID. Purmer." tmpbult OIl jabI IbauId be "fi.ctlcl In ttie
. '_ral malchlllg ratl. Ultlmat'ly.... belWve tba~ thae ebauId be • blgur matcblng
rate for the JobI progrllll Cha for· the IAc:ome aulataDC8 PfOII'IDl.
.
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�501 399 7196
, GLI NTON TRANS.
P.04/04
•
t.
._rat
W. art wUlIaI to be Judged on OUIperfOftDlftClIn ........ f.deral . . .tat.' funcis Oft
Job tI'IInIIaI ad pIIoaaIat plOII'''' . . art wWInt to work with tt. '''r.l
IO"lIDIftt to cIn1H •. . . ,... which relleet r.I1 ......... 01 outCGale - 1.1., . . lMIly
cURti ......
IDto -tint jobI," to .... t .~8ftt II . .
clepndeDCp reductd?,
'. . . . oppoII
nqutrltMfttt dlat ttUlll how to Implallllfttjab-r.iatid IaVlctl.
liar.
nerl Is DO _ _daD to dat cba1l1ft141 oll'lll~blU., .ad Job placllftnt. The' lladmg ,
IftncMldoaI hav. com. tram die .tetliin dUI ar.a, and the Ilitta mutt have ma.lmum
nllibWty III ••lgniraf tbelf .dYcatlon" ttaInIng lind .mplovmenc ,prOl!'amafot .,lful
rldpllDti.
'
Rtform of . . . AMIItpCI
The Imm.diatl fOIl of thl Govcmorlls to put into plael the previntivi lDltlatlvlJ
ad tile', JobI prop..... recomnatnded above. AI thai begin to tiki eff.ct, rlducillg
depIndency on _Ifare and fl.traiJUn, pub1lc MMnding Oft, pubUc aulItancl. WI believi
dIIt ,.'onn of the bulc cuh 1111Itance program, Aid to PamiUI. with ,Dependent
,f
ChUdrID (AfDC). mUit be undettlklft. It b our Intent that the r.fomu in the mcoml
UlbtlllCl prop.... will til fundld with tavinll t.alizldtlvOllgh our prlvention initiative
lid IbrGUJb OW' jabI program.
It ... OW' equally important - -if lOllSllf-ruge - pI to provide _qUlUI income
euppart for famlJ.lel ia which no IndlvlUl can work. In 1Gftl. I f. . of the ClDUDUv ancl for
IGIDI tlclplnts., bIDIflt llvlla' arc DOt "quail to IIlllt mi.nImal m:palrlmlnt•• n..r. II
DO Iyslaatic or UIIiIonn "v of Slutill bentflu, IDCl 1.".... u. datlradAecl with Little
reprd for the COlt 0' m•• dq thI bUic requirements of -.appottJDe. fudly.
"
car,. lte. It would be
on a 'tltl-b¥-tlltl bull, us. . a nationaUy-conIiIt.ftt .Itbodolosw. Support
COIl
PUUoIIInV.
deUtrmiiDId
cIotb1nl. btllth
Ibould be provided for cunnt AfDC recipi.nt. plus t __ parlDt famllie. . ."that
opdon II DOC ava1labl.. CDVUII' sbou1d be 1ncr. . .d paduaUy to au' famW.. Uving
. below 1M famJ1y 11" •..,d.
,
"
,
"
GI';' limited rldlial ud .tat,
thla new' Incom.
must
1fIduaIl,. UvIDt .tmldard. TblI ptrClftt.,1 should t. tupport PlWI'DIllt'tim., be
laittal paymntl shoUld t. 'It at a ....donal mlldmt.lm percenta.e 01
ads .tatl'. femil"
tacr....d over
II
tllOUfca,
pbucd In
'auo., _til the soa1 bein, the, payment of thl full family llvtns standard.
FumIIDg of tbI aadoaa1 m1ftimum peren.... shoUld be prlmarllv flderali but re'Cain a
IlgaiflClllt ltate mateb. If. ltatl 1UPP1emints paV!DlIlt. above cbt nationallDinimum.
the fedlral mateb IbouId .tart a' currnt APDC IIHllcbirag rlt.. and lDcr.... as t.be
. . . .tlDcn....
,,'
tttOGrea
It II cridcallbat bas.fttl In thiI ""tern be Itructured ~ that It II Ill-VI flnuadally
better far 1M rteiptat CO work 'tball to receive ouh auiltllnCl. Tbt IWItem maat be
dlllpeel car.fully .. tbal tbtr. are 110 dIIiDcIfttlve. for Implovers to provide ..... abavl
lbllIIaIatIIaIIm or CO reduce or eUa:dnati btl1th car. cov.ra,•.
.VI
,.e NCOIQIIediat . . . . . of the .....tud. . .
tlCOC'nIM8d.d maw not be
. . . . .1Ibed owndpt. WI &110' raJlal that our .... can be achI.".d III ftWIlUOUS
-VI- WI art prcpu.cI to work with all of our ...._n lD gWeI'IIIDIDt ud ID lilt privati
_tor co dtVIlap IGUIId piau wblch will Jll'lVnt IIDd reduce . . dapa:aclaa of femW•• on
. . . .U." ",,11m.
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01,..25-1995 12: 35
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CL I NTClN TRANS.
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cable New. Network,' Inc.
111 Maaaachusetta Avenue, N.W.
Washinqton, DC 20001
202-898-7900
PLEASE
CREDIT
I
'
,
BXCBRJITS TO ·CD'S' NBWS;"MAJ:ER SUNDAY."
HBWSJlAl(at SUNDAY
AIR'TIMES.
Sund.y, FebrUary 22, 1987; 10:30 All; 5:30 PM
Monday February 23, 1987; 1.30 AM, E'l'
ORIGINATIONs
Waahington, D,C.
TOPIC:
The state of the Stat..
GUESTS.,
GOVERNOR BILL
CLINTON (D., Ark.)
Chairaan, National Gov.rnor.' A.aociation
COVllUfOR JOHN' StJHUNU (R., N. H. )
Vie. Chairman" National Governors,' Asaoci-tion
,
MODERATOR
,
' ,Linda Taira - New_aker Sunday
Ell... Free
PRODUCER
ASSOCIATE
'
PRODUCER
Suaan Cheiken
EDITOR.. ThiB ia' a L"'Uah transcript provided tor the, information and
of the pr•••• Print and broadcaatme4ia are permitted
to quote thi& tran.cript provided', credit i. qiv.n to "CNN'. NEWSHAKD
SUNDAY.- video and audio ca••ett.s ara available upon reque.t to the
media. For further intormation pla••e contact Bli••• Pree or Susan
ch.iken at (202) 898-7900.
conv.nien~e
copyri9ht 1987, Cable Wewa Network, Ina. All R1qhts Reserv.d.
�y
01~25-1995
12:36
NEWSNAKER S1JHDAY -
CLINTON TRANS.
501 399 7195
February
22, 1987
P.02/12
.
TAIRA' Welco.e to Nenmaleer sunday. I'. lIinda Taira 1n
W hin.ton. From saa to .hining .ea, Ameriaa face. tremendous
••
MS.
challenge., with probl... ranging tram druq.abu.e to jo~ creation.
We'll check for the heartbeat of the eo. atate. today on Newamaker
sunday.
.
The nation'. governors have ,ath.red this weak inWa.hinqtcn
for their annual winter ..eting. Thia 1. the group at chief executives
who must d..l with a ahrinJt1ng .hare·of·the Federal budgetaa the
populatione and probl... in the1r·.tata. vrow larqer and more complex.
Prom lIaine to California, the picture 1a the ....: how to deal with .
teen preqnancy, alcohol and dru9 ·abu.e and hom.le••ne•• , how to
confront'the murderous threat of AIDS and the akyrocketing coats of
cata.trophic health care. Bow to fix what many avree ia an outdated
walfare .y.te. and how to move peOple off the public rolls and into
j oba while talc1nq care of the children of the poor. Bow to. stimulate
the economy and create n.w jobs.HOV to leeep jobs in field. b.inq.
eroded by forei9ft c01Dpetit10n~ But all i~ not l08t, th.B CJovernore have.
~iq plana and eo do Convre•• and the Pre.ident.
.
PRESIDENT REAGAN' (On tape): My fellowaitiz.n., America
isn't finiahea. Her beat days bave just be9Qn.
..
MS. TAIRA: Our que.ta today on NIWSMAKlRSUNDAY are De.ocratic
Governor Sill Clinton of Arlean.aa, chairman of the National Governor.'
Association; and, Republican Governor John Sununu of Mew Hampshire,
,
Vice Chainnan of the National Governors' Maoeiation.
Gentle.en,on lIonday, you will be . .etinq with the President
,
to talk' a little blt about walfare reform and soma of the chanqes the
Pr••ident has propo.ed. I would like to .tart with you,· Governor
Clinton. What will you t.ll the President about his Adminiittration's
proposal which ie .till in draft fora? .
GOVERNOR CLINTON: Well, w.'z.e soing to ••e it wa caft,reconcila
what he r.commends witb what we recomaand. The 90~ernor. have been
working tor a year now to try to chanq. the welfare ay.tem, to focus on
weltare prevention and to ·focu. on work instead ot weltare. The
.
Pre.ident wants to qive the .tat.s more flexibility to d••19n local
experiments for the next five y.ar., not only with tbe weltare and the
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01-25-1995 12:37
501 399 7196
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NEWSMAKER SUNDAY - february 22, 1987
Food Stamp and the Medicaid Progra., but with about !L; other programa.
We think that may be fine, but we'dalao like to begin ri9ht now to
change the welfare ayatern from an incoaa syat•• with a very a..ll work
co.ponent to fundaaantally a wcrk ayat.. that givea people income while
they're learninq to be prOductive and it'aa big iaaue with U8. We
think we've delayed too long already and wo want to start now to change
the wbole value syat.. underlying the welfare isyate., to put people to
work, make the. 1ndependent. And clo' it by IUJdnc; th_ 81qn • contract
sayin;, AIf you want welfare, you auat agree to 90 back to achool, to
loarn What you need to knawto ,et job train1n, and to take a job."
MS. TAIRA: Let lila au a question.of Governor sununu on that
point and that 'i. the ooncept of qettin., people into job. which m08t
poople agrea muat be dono to vet people off the welfare rolls. But
there'. also a tempt.tion ~.n't thereto ..y~ force people into jOb.
when they're not r••dy. It's b.an a proble. that h•• bedeviled a lot
of state. that have tried to have job creation provr•••• Kow do you 9at
around that? How do you d•• l withthia ia.ue which haa really act
resolved it.elf?
'
GOVDNOR SUNUN'a I The tact that i. .- i. that for mo.t people
a job i. really the beat welfare pro;ralll you can give them. virtually
all people that bave an opportunity to work, I think, generally, would
11ke to work and I think wa bave discovered that- particularly up in
the Northea.t where job opportuniti•• have grown quite rapidly - that
thia i. true. In New Ramp.hire, wa're down to tvo and a halt percent
unemployment and the biq benet iciary of that ba. been .0000e of the hard
core folka that have been cl•••iriedas hard core welfare ca.e. that
are aotually findin; a'willinqna•• in the work place amongat the
employers to ;ive thea the extra trainin9~ We have dropped the number
of rolks on our welfare and AFDC atruotur. by 41 percent in the pa.t
tour ye.rs by virtue of the reality ot job opportunity. so" I don't
think we're--we're giving the.e tolk. the credit they're due. They are
due that credit ,in recognizinq that they do want to work. And it we
qave them tha .killa and ,ava them a job opportunity, they would qo out
and do that.
MS. TAIRA: Governor Clinton, you have a
�• 01-25-1995 12: 37
tL I NTON
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GOVERNOR CLINTON: Well, ve'vedi.covered, interestingly .
enow;h that even in the .tates, in the heartland, where unemployment i.
high becau•• of theeri.i_ on the tara and the 10••. of raetory jobs,.
even there it you really .pend .ome mare money on education and
training and vive people the tool. they need.tc go baole. to'work, ev.n
there you can reduce the welfare roll. and aake paople mora productive
an4 in the prooe•• create aor. job•• A lot of ourunemployaant rat.,
maybe on. or two percent, which i.a lot, is cau.ed by the di.ability
10 many million. of Amerioan have ot not being able to work and we need
to change that and V8 can.
M8. TAIRA: Th. plan that the MGA, the .ational Governors'
.
A••ociation, i. outlining i ••ai4 to have a price tay of $1 to $
billion .ore a year than the Pederal Govarment i. now .pending. How
is congre.. going to bUy .oaethin; like that? Or how will the people
buy something like that when we're already .eeirig a .aasive tederal
d.eficit?
GOVERNOR CLINTON: Well, first of all, a lot at the money
that va Bay thi. prevr.. will coat i. already contained in
Admini.tration propo.ala. Secretary Broak want. toepend. nearly.
billion dollal. in new education and training proqrama and that would
overlap lot of what we'ra recommending. So, the extra money ve
recommend would just be to tran.ition, it you will, to take people fro1\!.
welfare into the work place and would cover child care oo.t., it you're
talking about a weltare sother with a three year old, for example, who ,
would otherwi.e be taking care ot her own Child, and ot Medicaid COlts
it the job i. a low payin9 job with no medical in.urance •
. An4to inve.t a little bit more now in independence will Bave
literally tens of billions of dollars in the out years. We can dO it
and that'. the way we're 90inq to pitch and I think that'. why'CongrB••
and I hope the Pre.ident will embrace it.
GOVERNOR SUNUNU: The Iyetem W8 have rigbt now really have
di.incentive. in it. YOU have folk. on welfare that can't leave it
bBcau.e they don't want to 10.8, in some ca.e., the .ecurityof health
.ervic.s that they get under the Madicaid structure. What we're aiminq
fori. both the flexibility an4 a little bit of help to carry the
transition
(
�01-25-1995 12:38
·501 399 7196
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NEWSJW(D. SUNDAY - J'ebl'Uary ~2, 1987
throuqh, .0 •• they 90 into the early .tave. of • work oareer, the
training part of tbeprogr... and 80.e of the· initial joba that may be
a little bit lower payin9; that· we'll be able to aa.ure th•• that they
have the Medicaid .truct~., that they bave a re.pona. ,and .upport in
tena of takinq' care of; the ld.da and a capacity to 9ive thea the'
'
confidence tbat they ar.not lo.ing evezYthing that they thought w••.
there by virtue of thaweltare aide or the program, that th. work fare
basic need not 10•• the capacity to tie a••ured of soae ot the .atety
net pr09t'a.a that are there.
.
c;oVDNOR CLINTON: '1'0 Clive- you an lelea of how a..ll the .
•pending ie in the context ·of tbe overall weltare.yat.., today, even
thouqh all the politlciana .aY we're for people workinq who are on"
welfare, we .pend one percernt ot the welfare budset on education,
traininc; and jab plaeaent. One percent. And all we're propoainq i .
that we qo to .o.ewbere between .ixan4 nine percent to make it more of
an lnvaat.Jlent proqro anel not just an inco.e ..intenance'dependeneY.
' .
proqrUl.·
.
.
MS. TAIRA: On that note, we'll be taking a br.ak and we'll be
rlght back aftar t h i a . ,
'
MS. TAIRA: Walcome baele: to NIWSMAXD 8tltfDAY. Covernor
Clinton, I'd. like to brinq up the i ••u. of catastrophlc bealtheare,
which the Federal Goveranent ia propo.lnq that the stat.. • ••enti.lly
c- .t the Nap -sr- .the federal Gov.rnment won't be able to 'pick up the
piac••• What do you think ia the beat ..e~od for the .tate. to pitch
in and help, especially with tho.eunder 65, for instance?
GOVERNOR CLINTON: Well, to be rair,I think we have to qive
the Adainiatration it. due. Dr,. Bowen, the Director- of the Department
of Health and Human Service., ha. p~opos.d a fund.in; mechanism for
cata.trophic health inauranoa that will cover basically older people.
\ I think the state. 40 have a r ••pol'Isibi11ty and it's part of our
overall indlqent health care re.pon.ibility. Each atate will find a
different way of meetinq it, but I .- there'. hardly a state in the
country now that'. nottryinq~o tind .om. way to deal with the
indigent health care proble.., which would include ,the cata.trophic
ll1ne•• co.ponent.
.
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February 22, 1987
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,MS. TAIR.l:Gc::vernor Sununu, what i. your state propo8inq aa
tar aa t h i a g o . a ? · ,
,
GOVERNOR StJNUNU: One of the things'that. I bav. done i8 I
bave ••t with so.. ot the health car. deliverers and I think unle••
they're aotlve participants in giving u•• framework at • program that
can d"al with both, the" concerna of the ho.p~tal. and other providera-
have -- ot ~- in t.ara. of the expensive 11de of health care, whlch is
what we're talking about., then the ayatami.n't going to work. We're
trying to gather the lnforaatlon, put it together and we're waitinqto
.e. what doe. tollow in Wash1niton in t.era. of the cataatrophic aiel
program proposed by the adainl.tration and then try end dovetail
aoril-thirlc3 to pick up what 1. not p10ked up at the faderel level.
MS~ TAIRA: Well, already, 80.e at the stat.. bave) voiced ldaas
at -- tor lnatance, th.re'. talk of perhaps, tyinq car reqiatration-
in order tc register. your car, you have to show. valid h.alth
insurance policy with cataat.rophic health caverage in there. 00 you
,
view that as eo.ething tea.ible?
GOVERNOR eLINTOH~ I don't, no. I'. not aura we need to go
that far yet. We're -- to be fair, I have '.pent moat Of my time
worrying about how W8 can .et up an indigent health care proqra., that
would compliment this welfare prevention .trateqy; that is, how can we
do better with pregnant mother. an4 their newborn. an4 keep their
babies alive and healthy. I think there are 80118 ........ that we'll have
-_0 fill. Butt I think if ~. lowen's propoeal pa.aea the Congre.s, .
then moat ot the problem will be dealt with. We'll have to then .ee
what el.e we ahould do, but I think we have a 11ttletime on that.
MS. TAIRA: Well, since youbrou9ht up the aub~ect of pregnancy,
let'. talk a littl. bit. about t.enag.pregnancy an4 prevention. In th.
lehool., there's a lot ot 4ebate 90iftQ on, .hould the eohool. be
teachinq.teenagera about family planning? your atate, for instance,
Arkan... -- can you tell u. what you .ee a. the most workable solutien
there? There'. CJreat debate all .,ver the country an4 within·
cODunitiea.
..'
.
",
GOVERNOR CLINTONr Wall, you know, I think allofua who
think about it have Jaixad fMlinq8. I Mean, the.rqwaent 1. that if
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6
(
f
. you have any .ort of ••x education oour.. in the Ichoola that 10mahOW
. you're t.llinv Children that it'l okay for thea to have .ex. And I
d1aaqr•• with that. I think you can pr.ach that you oU9ht to .ay
"no," that the children oU'lht to ab.tain from .ex, but atill tb.r.
needa to ba ao.. aort of way of bringin9 the.. childr.n who .ay have no
other place in the wide vorla to l.arn about what they .houl,a not do
-- ana we know they can learn about what th.y lihould or what they oan
do on the atreet. -- into a kind ot • eonatructive fram.work. I think
to be ta~r, even 11010. illportant than prec;nancy 8ctucaticn or .ex
education~or family plannin9 i. makin9 aure th•• e kid. know how to
protect th.... lv•• and liv.9.n.rally. If you let th••• children get
out ot grad• .chool with 90oa, .trong balieskilla, bain9 able to ·read
and writ••nd balft9 able to function ana convince the. they have a
future, that may be the be.t thing wacandc to pr.v.nt teen pregnancy.
But I think .oae amount of r ••pon.iol. education to promote not only
abstinence, but to pro.ot•••If-pr••lrvation i. a good thinq to do.
MS. TAIRA: Governor. SUftW\u, do you a91='a. with that?
",
GOVERNO. SUHUNU:W.ll,you know, in tha fir.t ••••ion at
this conterence, we had lOll. inter••ting data pre.ented that indicated
,that the onapara••ter that corralat.. acrol. ethnic groupe and. aero••
income lev.le a. an indic.tor of likelihOOd to have theprobla ot
t ••nag. pregnancy ia the capacity or, the kide involv.d to have the
baaic skill•• And although thoa. that are arguing tor the ••x education
' •• being good in the lehoolth. tact i. -- i. that the Iloat important
part of educ.tion'in the .cbool i ••till the basic education. And I
think that wh.n that ia part of thl •••••V. that the govarnor. bave
been tryinq to pr••ch tor thela.tyear or.o, it i. part ot the
. cODlibi.nt I thinkjuat about every stat. has ..d. in teras ot fundift(j
the ba.ie progr1UD8 within .ducation in their .tat.. and I think, on the
Daais, at laa.t, ot',th. data we've heard, that we're goin; to have the
~reat••t impact by recognizing that d.liv.ring the baaio akills, the
reading, writing andarithlletic, you've c;aat.a .,citizen that ia much
1I0ra capabl. ot d.alinqw~th that i.au. than anythinq el•• w. ean\do.
GOVERNOR CLINTON: If you look at all th••• probl... we're
.
�01-25-1~5
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dealin; with -- teen pregnancy, drugabUae~ alcohol abua., droppinq
out otachool-- if you look at th. .,they're baaically·the probl.ms of
people why don't. teel valued, who aren't aure that they have a future,
who aren't au;e that they bave a role in lite, who aren'.t .ura what it
ia. And I reallybelleve that the more we can do to get the•• cbildren
off to a qood. start in" lite, the'mor. w. can do to make the.e pre;nancy
rate. drop, to aake the drug abu•• rat•• drop, to make.th. drop-out
.
rat•• drop, if you bainq riqht, and you qive the.e kids a .en•• of
th.ir potential, their power aahwaan beinqa, that'. probably more than
all the te.n pz'eqnanay cour••• we could .ver do will contribute
more to a h.althf lita.
MS. TAIRA I You lust brouqht the problem of 4ru; abu.e. v.ry
quickly, would you tell me if you would support the Administration's
propo••l on drug' te.ting tor federal work.r•. to stat. workers?
'
GOVERNOR CLINTON: I think-- I wouldn't .upport it aero••
the board. I would.upport it in ca••• where you either have reason. to
believe that apartcular qroup of peopla were disproportionately
involved in drUq abu•• or whera the .ensitivity olthe job ju.tified
it. But as tar aa blant.ttesting in advance, I'm not for that~
,MS. TAIRA: Governor sununu, verYqUiokly, do you .upport it?
GOVERNOR SUNUNU: No. I aupport it only in those ca.e. where
there'. a .ar.ty issue involv.d, eith.r tha .afety of workers or the
••faty of the pUblic. In caaea .11k. that, I tbinkit's appropriate.
The int.r.st1nqthinq ia -- i. the biqga.t complaint. we have about the
u.e of alcohol an4 drugs by .tat. . .ploy••• i. other atat••mployee.
who are uncomfortable in the'work plac• ., and I have auqg••t.4 to our
state employee union that they co•• up with a .uggestion that allow•. U8
to balance what W8 think i • • sliqbt conflict in ri9ht., the ri;hta of
individual., and, yat, the riCJht8'ot paople that don't want to De
involved in a work place with tho•• th.tar.~.inq drugs and aloohol, .
to have 80m. kind ot a ra;ulation and an inhibition to u.ing tho••
matarials.
.
MS. TAIRA: Gentle.en, wa will have to taka a bre.k, 80
plea•••tay with u••
I
�01-25-1995 12:41
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8
)fS. TAIRA: Wclco.e back to NEWSMAJ:ER SUNDAY. Our guests ~
today are De.ocratic Governor'Bill Clinton of Arkanaa., Chairman of the
National Governor.' b.ociation1anel, Republic Governor John Sununu 0,
New Hamp.hire, Vice Chairman of the National Governora' As.ociation.
Gentlamen, there 1. the issue that we can't i;nor8 here 1n
Waahington and that i. the Iran/Contra affair., I a. vondering if you
can tell me how thia hal affectecl your state in tera. of what the,
people are ••yinCJ? Is .aabington too wrapped, up with thi., and .hou14
, we juat forqet about thi.? What are people telling you, Governor
Clinton?
'
GOVERNR cLINTON: Well, I thlnk it'. a very serious i ••ue.
But I th1nk it '-- it'. not cutting a lot out in the country now. There
aren't a lot of people talking about'it any mor~.It, I think, ha.
damaged our relatlon. with a lot of our allies and we're going to have
to work hard on our forel9ft policy.' And I think that there are
subatantive que.tiona ,.tll1 to be re.olved about what happene4to all
the money and who 4id what when and the Conqre.B
to 4eal'with that.
But 'I think it would be • 9reat mi.tate for either the Pr••i4ent or the
corlgre•• to be so wrapped up in that that they don't continue to ,
pursue the economic and soolal probl... of the country with great
vigor. Because the people out there are interested in the .conemy and
th.future of America ana I don't -- I find very few people who even
want me talk to talk about it in Arkane.a. They ~ant to know, what we're
qoinq to do about their'major economic concern. they have and how their
children are 901nq to have a better future.
MS. TAIRA:, Governor Sununu, are your con.t'ituenta alck and
tired ot it?
GOVERNOR SUNUNU: I think they think it'. an i.eu. th.ywould
like aome anaver. on'. But as Bill .ay., I think moet of t.hem are
concerned that congre•• an4 the pre•• in Wa.hinqton are.o wrapped up
in it that we're not qo1ng to get action on critical 1••uea. I would
-- you know, we/vetalked about welfare reforr~. That'. an important
issue. I think the constituent. back home would like to think that
something a8 important a. welfare r*form wa. set asida ju.t t.o satisty
this wi-tiGn that .eame to exist down here ,in the Beltway~ We want
he.
�01-25-1995 12:42
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eLI NTOf'1 TRANS.
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the citizen. and all of u. involved in politica, we want anawers,ve
want to know what happened. But I don't think we want to .ee this
carried on to the exclusion ot what i. much more important bU8ine.. for
Conqre.. to addre.s.
','
.
I
'
MS. TAIRA: Governor Sununu, a. a Republican Governor, do you
thi~ that this is hurtinq the President?
.
QOV!RNOR 8UNUNU: I think that certainly the Pre.ident hasn't
benetitted trom it and there are a lot of ·folks that have lo.t a little
bit ot the relatively high e.tee. that he va. held in before. The
polla have shown that. But I think in'term. of hurting the Pre.ident'.
capacity to do things, it, ve can qet folks to tocu. on is.ue. and beqin
the dialoque between the President an4 Congress, the Administration and
Congre•• , I don't think it'. going to be, in the long run, that
significant a change.
MS. TAIRA: We have an election co.in~ up next year and you.
name, Governor Clinton, has been mantiofted as one of tho.e to be to••ed
into the presidential rinq. We have Governor Cuomo bovine; out, and '
perhapa Governor Dukaki.. What are your plan.? What are youqoinq to
conaider betore you .aka a decision?
GOVERNOR CLINTON: .ell, betore I can even talk about, I have
to fini.h my legislative ••••ion at hom•. For four y.ara, I've been
working hard to give our state a nationally competitive education
system and now because ot the probl••• of our farmers and our factory
workera, our revenu•• are way down and ve're involved in a very complex
matter. W. have to aalvage our .chool program. And I ran for r.
.l.ction on the promi•• to do that and my commitm.nt 'to that just
precludes me .ayinq much about it. I'm very flattered to be mentioned.
I've be.n flattered to be ••ked by a number of people around the
country to, run, but I can't really think about it until I tiniah over
the next month or .0 what I promised to do for my own people.
MS. TAIRA: It sounds to .e that maybe in another month or .0
you might have tim. to think about it. So, ar.you -- you're sayinq
that you have not clo••d the door on it.
GOVERNOR CLINTON: Well, to put it in the terms ot my own
�. 01-25-1995 12: 43'
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pre•• corps, they aay why don't you juat tollow the old drug 'abuse .
Ilogan, "JUlt .ay no,"'so I haven't done that, but I haven't done~more.
MS. TAIRA: What about Gcvernol: CUomo's boWing out of the
raoe? What'doyou tbinkthat tbis doe.·tothe racs itaelt? Do•• it
put Gary Hart up f r o n t t ·
.
GOVDHOR CLIlITON:Y•• , it give. hi. a much longer l ..d. You
](now, now be's the onlycanc1idate -in th. l:a08 .,ith anything that
approaches national nama recognition, with the capacity to raise lIloney
nationwide, and with a national orqanilation. so, .it'. a biq beoet for
him'in tbe near term. Over the lon;- run it might be a·big.boo.t tor
otbera that might want to get in. Governor Dukakis ba' been mentioned
and be'a alaost the Democratic Governor of New Hampshire, becau•• he
bas the New Hampshire television market down in Boaton, you know, so,
it's like New .ampabire'a got a De.ocrat and a Republican. I think it'a
a boost tor bi•• YoU.know it clearly mak.a,hia chances look better. But
tor all. others who, miqht wiah to run and think, "Well, it I can j.ust·
finiah -CGnc~, you know, the -irci-: .tLln-or two, I'll be okay." I
. think it's an encouragement. .
.
GOVERNOR SUNUMU: I'll. let yo~ know if Clinton shows up in
New Hamplhire. tt'll be a determinant.
MS. TAIRA: A little bit about New Haap'hire and the pri.ary.
Ia there -- are the peopl. of Nev Haapahire -- are they qiving you any
indications about who tbey li~a there?
GOVBlUfOR SUNUNU: Well, we bad poll that· ca.. ou.t lalt
w••k. It .howed on the Daaocrat aida Gary Hart with a signiticant lead
and on the Republican side, Vice President Buah, I think, was fir.t
with Senator .Dole ceming 1n .eeond. But it's early. Those polla
-- you know, tho•• polla are really jUst meaauras of na•• recognition
- and New Hampshire voter. like to take a good, lonq, hard lOOk. They
like to aee the can4idate., vieit, they like to talk to the. face to
tace and I think it'. gOing to me a very exciting primary aeaaon in our
state and I think across the country.
MS. .TAIRA: Do you have any plana thatuybe yeu wi 11 reveal
riqht hare?,
�-
01-25-1995 12:44
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. CL I NTON TRAI'5.
NIWSMAKBR SUNDAY - ,'ebruary 22, 1987
11
GOVERJfOR SUNONU: I'll not runninq. And that' •• ci.ar 'Ino."
GOVIRHOR ,CLlliTON: Tough.,
MS. TAIRA: GOvernora, a. far a. your •••ting hare, do you
think that this is -- you've--the qovernor-- the Democrats have lost
a little.4gehere, but they .till retain, and edge within the
governor's seats. Is this 90in9 to be a bipartisan year?, Are ve .aainq
--/I .ean, in Contre•• ve're .ee1n9 a lot of c!1vi.1on. What about the
governors, very quickly?
,
GOVBRHOR CLIlf'1'Olf: There'. more conversion, more unity aBOng
the qovernors. I think probably because of the,nature ot the job. w.
have to .olv.probl... and when you actually bave. to make decisions
that atrect people.' live. it tend. to pull you togethar. I think aleo '
we've worked to try to pre••rve ha~ony and we think we ought to -- all
ot UI think veought to have welfare reform. We ouqht to prevent
Welfare. We oUght to deal with the•• i ••ue. and I ~hink that whether
you're Democrat or Republican, you can identify with that and the
. country neads'it and ve've triad to work in thatapirit.
MS. TAIRA: From W
••hin'lton, I'. Linda Taira •. Thankyoufor
joining U8 today on HEW.MAKER SUNDAY.
/
�:.. "'""""t· Nadonal Governors' AssocIAtion
~.. ~*
* .
Testimony of
Bl11 Clinton
,
Chat run of .
the National GOvernOrs' Association
the
Ho~orab1e
together wi th
Governor JohnH; Sununu, Nelw Hampshire
Vice .Olairman, National Governors' Association.
Governor James:a. 1hocnpson.. Illinois
~mber of the Executive Committee
Past ChaIrman, N4tional GQvernors t Association
Governor Terry E.Branstad, Iowa
Chair, Committee on Agriculture
(
Governor Michael S. Ilakakls I Massachusetts
Chair, Committee on EConomic Development and .1echnological Innovation
Governor Michael N.· Castle I :telaware
Chair, Conni ttee on H.nan P.e source s,
\.
Governor Richard F•. Celeste I Ohio
.
Clair, Subc.OIIIDittee on laployment·and Training
Governor Martha layne Collins I Kentucky
Clair t Task. Porce on Alcohol and Drug Abuse Prevention
before
too
Committee on Ways and ~ans
U.S. rbuse of Representatives
PebNary 24, 1987
HAU Of THE STATtS' 444 Nortl'l CapitOl Street· Washington, D.C. 2oool·15n. • (202) 624-5300
'SM:ltU NOl.NII.J
961:L'
�f.
!.ntroduction
Mr. Olairman and members of the cOIIIIIittee, thls is the first opportunity
l
I
that most of us
.
.
haw had to. thank. you . in person fortbe tremendous job you did
,
last year in· leading Congress in passale of the most signific.ant tax reform
You are to be r.artlly conaratulated.
legislation in forty years.
You in
. particular, .Mr. O1airman, wne lIIost couraseous in taking up the President 's
I
challenge and foqtna passage of a Iiluse btll when most said it couldn't be
done.
Your leadership made tax reform possible •
. Mr. Chai rman, the leadership of the National Governors l AssoCiation wants
also to thank you for your aesiR to hear from the Governors.
We appreciate
the special hearings and sessions you, had with the Governors on tax 1'8fol'll,
and once alain you have given us an opportuni.ty to expres.s our concerns on
major issues now before the Ways and M!ans Conwittee.
Overview
Today I we would like to focus on welfare prevention and refom, dislocated
I
workers, job creation, education, econcuic growth, and competitiveness.
Governors see these issues
loS
to be succ;essful on any.
interdependent. and progress must be made on all
There will be no public funds for .education and
welfare reform ·-if our nation is not competitive
"
. growth.
and
does not maintain steady
Also, there will bene lona-teI1ll growth if millions of Americans are
undereducated, ill, unproductive. and living in or near poverty.
·z·
£V20'd
The,
·SN'\j~.L
NO.LNll.:l
�Econaaic Disruptions
Over the last decade,
\118
have been pulled into a world economy that
longer dominate, and for which
\Ie
are still largely. unprepared.
we no
While the
percentage of our. 8rossnational product directly tied to trade his grown
13 percent,
we
have net m:ai~tainl!d our share of world export.
economies have captured many
.
to'
Newly emerging
of our former . markets by providing quaU ty
,
prcductsat labor costs \1M can't hope, to match.
Paralleling these developments have been deep IlllCl troubling changes iir the
fabric of,.4medean society: a dramatic rise in 'til! number of single-parent
,.,
households; latchkey children i huge nwabers. of yoWlg women and children in
poverty; millions of adults so' Uli terate they are unemployable i and. nigh
rates of welfare dependency. teeD
drug abuse.
pre8~Y,
school dropouts, and alconol ana
Unle$S \1M can 'do more with tb! econcmic and. sOc.ial problems that
limit the· ability of our people to work, we cannot p1'8serve the American dream '
as we know it.
We must face sqJ81'ely our responsibility to ute
~ricllns
"
more competitive and to reverse tlE: tide of lostlunan potential.
Productive
~ople.
Productive Policies
As Governors. we are taking up these responsibilities by working c.losely
on six task forces
that, are- tied. tOiether,
by desian,
so that we an
collectively tackle both the economic barriers and social barrieTs to our
productivity as a nation and our achievement as individuals.
the
theme
Productive
of
our
~ople,
maj or year-long
initiative
.. -
''Makins
\lie believe that
AlDer,i.ea Work:
Productive Polici.e s'I .. - reflects ourcOIIIJIi tment to solving
the problelllS that economic: and social changes have brought to America over
last two decades.
-3
£V£0'd
. SfWt!.1. NO.1.N II:l
96'l:L 66£ t0S
t~
�,We have created as part of this initiative the Task Porce on Jobs, Growtn.
and Competitiveness.
growth
It will concentrate on the barriers to pnxluchvit), ana
state
developing
by
revi talization.
actions
plans
for
l~al
and
regional
The work of this task, force will relp us recognize the very
real differences amona our regions and tab special account of the terrible
crises in the rural heartland.
Mest Governors already spend lots of time on economic development.
We are
all more sophisticated than we used to be. in our efforts to generate jobs.
But we stUl haw much to do to develop local and regional stratelies that are
really adeq.aate for the· competitive challenge we face.
be
de~te
Of course., there \'IlUst
about what national poliCies are needed. to ,make every state and
region competitive. but, as Governor's, we ,will emphasize policies that will
help us to help oursel,Yes.
Also .... and this is perhaps most important .- we hue set up five task
forces to deal with the major barriers to ,",ark.
ne
Welfare Ptevention Task
Force has already determined that investing more heavily and systematically in
prevention and early interventior. could begin to ease problems before they
demand the expensive solutions associated with Ue country's current we lfare
)
system.
The other four, task forces concentrate on barriers that were outlined in
too
welfare
population.
prevention plan,
but W'hich effect particular sroups
in the
The Task Force on Adult Literacy has a sp$cii.l emphasis on
getting all of us to focus on the problems of iUi terate adults and examine
projeccts throughout the country that are warkins to attack. adult illi.teracy.
The Task;, Force on Teen Pregnarr.y wtll bui.ld its work in part on docUlllents
pubU shed bf the Olildren IS: Defense Fund.
The Task Force on
will work. wi th the .&.1ucation, COOIIIlhsion of
~
States.
-4
£VI70'd
'SN\:tcU N01N I ':1
96TL 66£ T0S
Schoo~
Dropouts
The Task Force on
�Alcohol and D1\&I , Abuse Prevention will help us lIIoveaU%"essively to'reduce the
"~'
,
de_nd for deadly druas.
These five task forces will develop plans that involve aU states 1n
bdngirv down the, barriers to prcd.uc.the 11w,.
We all sa)'
want. to pranot.e
\e
work. not welfare; independence, not c:iependenc.e. 'Moit of us have done some
things toward that end.
Now is the time, for all of us to do mote.
11\ dealing with these
involve many
·~OIItIlittees
iSsues" the Gowrnors have recomendationsthat
of Q:U:I&r:ess.
Today t ft'ewill cOlXentrate on those
issues of direct concern to the Ways and
~ans
Cor.mlittee, but
~r
to discuss ant issue you, wish to raise.
,\Ie
are willing
major issues ,today, will ,be
welfare reform. dislocated worker assistance, trade and competition, and a few
tax issues.
Welfare Reforl!!
Prom tl» W'Ork. of our Welfare Prevention Task. Force has COII1! a specifiC
.
,
pollcy recCllllllendation, adopted thi.s day by the 'associauon. to reform' our
existing \elfare system.<A.1r policy focuses on edw;ation;, training. and
employment for thet families now dependent ontbe \elfare system.
alo~
with a
decent living standard with which these' fmilies can supPort, t~ir'children
while
tMY
stri w for se 1£ ~sufficie~y.
Brealdna the, deadenil\R' h,urden of
dependence for poor children and their families not only is
t~
to . do, it is critical to the success of aEl' long-term econanic
humanethina
d.ew~opnent
strategy.
'I'M key, components of our policy include:
o
A binding
ioverlJllent,
£VS0'd
c;ontractualagreement
setting out the
'SN'I1CJ.l NO.lNi..,:::l
between
rights and
tb!.
~ciplent
~sponsibllities
96T.L 66£ T.0S
and
the
of both
�The. asreelllent would require
parties.
recipients
to '. strive for
self -sufficiency' in return for bendi ts and the government 'to provide
adectUate
support
in return for . those efforts,
inclucliI\l income,
.education and training t child care.: medical care t and job placement.
o
A req.&irement that all recipients of cash assistance' ,with children
age three· or older participate in a work program.
o
Flexible work programs d.es1pd by tie states.
These programs could
lnclude remedial education, trainingtand job search and
o
place~nt •.
An enhanced case management systen.. which would provide each welfare:
recipient with a caseworker who would be a partJl!r in the brch
t()Ward ,'self -sufficiency.
helping
to
develop
an
inch vidualhed
program. then making sure' i. t is followed.
o
As a. long';range goal. a new cash· assistarx:.e :program wauldbe
implemented.
It would be ~sed on a national formula re£lectins the
actual cost of living within each state.
~ach'5tate
I
A consistent percentage of
sEamily living standard would be paid· .1o~ntly by federal
and state govemaent .
. These components, taken togetbet. represent. a new and better approach to
welfare reform.
sOLutions
to
It cOIIbines tb& states' unique capic;ity to dewlap creative '
the
problem.
and
the
federal
responsibility
to set national standards.
attack.ing
causes of welfare.
the
We
gown.nt IS
focus
on prevention,
-6
"S~Cl.L NO.LN I ,:l
and
It' reflects till importar.:e of
interve ntion.
£t/OO"d
ability
96tL 66£ t0S
as well
as
�The Governors' weifare reform policy turns t.tepresent Welfare system •
.,
,
which is primarily an income assistance program with a slII.I).ll jobs, COlllp018nt.
into a strong jobs program with in::oma asslstanceas a backup.
different orientation from our c~rrent system.
provide the real
This is avery
Our 'proposal will not on.1y
and opportuni ty for we lfare-depeodent people to move
too~s
permamntly toward self·sufficienc.y,
but it will' fundamentally alter the
V'dues of its participants.
How can.. afford to illlplemnt, at ,thenationa..l level.
the k.ind of
emphasis on training. education, 'and .atX:i11aty 'services contemplated by the
Governors' proposal?
.~
.
I
.
C\lr policy. recognizes the potential fOT iI);reased costs
to our state and federal ,overnment initially.
However., it is instructive to
note that federal spending'devoted specifically to the training and place.nt
of welfate recipients represents less than 1 percent of the amount currently
t
spent for AFDC benefiu.
We say we believe in
econo~ic:
independence J not'
,
dependel'¥:e.
,
If we want to do sOmething about it we must allocate
S<De
of our
resources to invest in'our most important building block -. our people.
Worke; Adjustment
If we are to
Our concerns " do not stop with the welfare population.
continue our goa'15 as caDpassionate peop~e in a vigorous, growing ec~nClll)' t we
must deal ...,ith a full continuum of problems and solutions and
our resources wisely along that continuum.
WI!:
must allocate
'lb! national econany
and
Mer,iean workers now operate in an environment where change is thenol"ll.
the,
Arrt
system deYieloped to deal with the effects of ehanae must be designed to
facilitate transition, rath!r than inhibit
it~
. lbat principle rust be applied
I
to all of our IIl9.jor social systems and 'structure.s frClll W!lfare refonD to
.J,
-7
. SM:tCli NOIN Il:::>
961L 66£ 1es
25:21 S661-S2-t0
�(
workar adjustment policies to the investMnt
of jobs, growth. and
we make, in our future in the fol'lll
ca.npetitiw~ss.
In today I s rapidly chans ing envi rorant t
parti~ul&r
The Bureau of
job will be a lifelons endeavor i.s unrealistic.
Labor Statistics (ILS)
between J.919,,:,1985.
Job
the tradi tional view that one
etanae
reports
that about 10.8 Million people lost jobs
Of that tctal. 5.1 million workers were "displaced."
is dellllJ'.ded by our new competitive environment as \readjust to
technological advances and the intemacionalhation of tlXt econcay.
We lIlust
develop a system i.n which cbanae is antiCipated, arid 1n which it is rerOinized
as.
hallmark of a vital economy.
We must squarely addtess the issue of
adaptiilg to change in order to benefit frOID the opportunities it provides.
O~
of
til':
most. pressiQl
challenges' . is
to assist workers who are
threatened with job loss because these workers are the "front line" in tte
process of change.
In responding to this challenge, we must addmss the human
needs of workers as they move from job to job,' without unduly interferina in
the
~ynamic5
of change.
Just this morning. the' 'Governors adopted a worker adjustment policy which
outlims the following strategy:
o
Govemorsshould hive discretionary, authority to develop programs to
lD8etthe needs of tb::ir states-
l
0
The defini tlon of dislocated worker should be broad enouih to include
all . dislocated workers.
recipients as \oleU as
including
those
famers
unemployment
who have exhausted
potentially dislocated workers,
their benefits,
and other stN:turally unemployed
individuals •
.0
£V80'd
Labor and manaleiDent cooperation should be strengtmned.
'S~~l 'N01NI'l::l
lnsuran:e
96t:L 66£
res
�o
Services available
alternatives.
should
include educatlonal
job search assistance
services.
tnin1na
support services, and income
assistance.
o
No presumptive deli very system should be !IIlndated..
o
Programs to help prevent job loss should be aUO\I':d.
o
PLmds should. be targeted to more accurately reflect total dhloc.ation.
The federal government must assist states bycollectiJ'lS and disseminating
information on local labor markets. industrial growth and'decline, and other
data that will he lp .states antic ipate and manase chanae.
:,-.
'
The problems facing most of America I 5
~artland
is not just a decline in
faI1Ding, but· ratter tbe transformation of the entire economic and social
systems of cOIIII'lUnities -- and only a few in positive and produc:tive ways.
The
problems of these cDIIIIlUDlties ate under the jurisdiction of other cOlllllittees
of the Heuse, but there is no question that this
COIIII1i ttee
of trade and competitive measures, as well as refoI'll of
programs.
The Governors urge· the Ways and
~~ans
i.s a def1ni te part
i1'X:aDe
assistaD:e
CAlaDi ttee to .1nvestigate how
. .i.tcan assist .tM states and individuals of rural America.
Pamers should be
eligible for dislocated workers' assistance and retraining, some form of tax
credit for nan-farm business ·enterprises 'in targeted .rural areas would. . .
I
. help,' a
national job bank, more pension portabili ty I and certainly aariculture must be
addressed in major trade' legislation.
Adaptina to change will require more cooperation of government and the
private sector to foster transition to a more competitive econoray.
Trade
and Competition
There are
SOIIl!
major provisions of the omnibus trade bill (H.R. 3) that
the National Governors I Association bas not addressed, such. as the extent to
-9
£V60'd
·SN'litl.l NO.lNli.:l
96tL 66£ Ti215
£5:21 566 -
�I
which
unfair
trade
practices
should' be . cOWltered,
intellectual property rights. and patent. processes.
protection
the
of
NGA. tupports provisions
/
that would:
1.
Assi st, n:train and employ. workers displaced by foreign competi tion.
includina farmers. selected industries. such
III
oil, and those who
have exhausted their W'l8mployment insurance benefits;
grants to
states tor literacy training. vocational education. math,
scie~e,
and fondgn language ed\.Cation.
2.
Provide
mote
state-federal
marketing
and
export· of
products,
especially agriculture prod\.Cts.
3.
Provide state-specific trade data on imports and exports that can be
used for market del'e lopment.
4.
Increase coordination of expanded federal research and development.
wi th. ongoina
research and deYelopuent work of state uni versi ties.
tncluding mOn)
guberna.torial
representation on natiOMJ.
research
coordinating councils.
Through the mw Task Force on Jobs,
Growth a.nd Competitiveness,
the
Governors are developing state action plans to relp make' the Unitea States
economy more ,competitive.
-
The major foc.us of this task. force will be on:
1. How to make our education and.j ilb training systems mom effective.
2.
How
to acc.elerate
the dissemination of
innovation throughout de private sector.
scientific
knowledge and
This would also include
university/business linkages and other similar activitie5.
-10
•Stll"v'Cll N01N I l:l
96 t:L 66£ 10S
£5:21: 5661:-
�'How
l.
to
develop
The
prodUctivity.
inf01.1llation ' on
prod~tion.
better
labor-managelDent
to' enhance
relations
(
statesciln assist in developins and disseminating
'new 'approaches
and new
structutes
to
organizing
,
While the states need to lead dID Way in these areas. it isilDportant that
the federal gove.rnment mAintain its fina~ial commitment, and. provide states
with more flexibility to tailor tRue programs effectively.
Selected Tax Matters
Mail
Order
i~reasing
~1rms
, J
Tax
Exemption.
1be
National
Governors',
Assoc:iation
its efforts for conaressional action thatwwld require mail-order
to collect state sales tues '£roa out-of-state purchasers.
would be paid without
'mail-order sales,
urdermining
is
state
JaDe
toll-free
'fol1ll of withholding.
phone
numbers.
and
Few taxes'
,The rapid expansion of
television advertising' is
tax enforcement and the profits of many
small, r:etail
businesses,' resultil'l8 in an estimated loss in state revenues of more than $1.5
billion annually., NGA stronaly supports thB efforts of Rep. Jack. Brooks and
others to enact corrective legislation.
1M National Governors' Association opposes
t~
adnHnistration's proposals
to eliminate the ~tate and local iovetl1lDent exemption Hem federal gasoline
.
and fuel taxes.
in tbe
buda~ts
.
This wouid cost us more than $SOO million annually. primarilf
. ,
of education and law enforcement. just when we ate undertakina
major edu::ation reforms and expanding l1Iuch-llSeded efforts for drug and alc:ohol
prevention. We urge
t~
Ways and M!ans Coimnittee to reJect the proposal.
. -11
.SM:tw N01.N I 1:1
961L 66£ 105
t::>5: 1:
�(,
NGA. has no posi tion on extending the Medicare tax) to all state and. local
employees.
This would affect .£lye states directly and IIlOst school districts.
It must not 'be f01'80tten. howeYer, that extension of this tax cteates I1n
increased tax somewhere elSe.
At a minilllUlll, this new tax should bephued-in
if enac:ted.
, Airport Trust Fund Tax.
Reauthorhation of t~ Alrport and Airway Trust
f\md and' the user' fees that support the airport improvement prosram is a
priority this year for NGA•. The. Govenioril are concerned with growing capac.i ty
problems at tte nation's more congested airports and Seek to enhance the.
development
potential
of
Il1I!dlUD1-size
encourage a gradual drawdown of
tne
airports.
. 1be
legislation
$4 bUlion surplus that continues .to build
in the' trust fund, with funding dedicated to improvell8nts in
airwa},
The
system.
importance
should
of
aviation
to
industrial
tte airport and
and cOIIIIIW\ity
development' and the proven . capacity . of the states to administer airport
programs in a cost-e££ectiw manner
block
grant
state
for
are
convincing reasons for establishina a
. administration
pf
but
all
tm
largest
professionallr-managed airports .
. COn:.lusion
'\
The'topic. of
listed above.
few.
U.S.ccmpe ti ti veress .. CO'lers every one of the specific issues
At a minimum, it involves mal'!)' solutions, not one I or even a
To make a national emp~sis of this malni tude work, it will req.&ire new
federal, state, arxl private partnerships that are
not now in place.
Pederal
and state departments and agencies' 'Wi.th multiple programs and services will .
have to become much more cooperative and flexible.
State laws' will have tOJ)e
C.ha1l8ed· to permit more public-private cooperation.
WelfaIe reform,
Nfal
economic diversificiltion, and new Jorms of research and deyelopment 'Will
-12
'S~t!l
NO.LNli:J .
96tL 66£ 10
�demand Joint action. of many separate programs. congressional cOIIIIitt.ees,and '
state agencies.
each state, 1n
In the American form of government, 1tis' the Governor of
lIlolt
cases, who is legally chaI'led with briqJing about
.
tnts
.
coordination for effective intergove mmenta 1 action.
But to dothh
we
IIlUst
have the legislative flexibility.
The key to success will be a rerewecl, cOlllli tment to flexibi 1i ty and trust
in the design of new approaches to improve U.S.
,c~titiveness.
If states
don't have the flexibility to package the best solution, we will waste reeded
funds and resources and still not .acccmpl1sh our tasKS.
, As Governors ,
we appreciate the chairman of the
COllIJ1i ttee
for invl ting our
comments and suaaestions .
•SN\:7tll NO.lN Il:J "
9.StL
ss£ tes
SS:2t ss t
-,
�,I
:**"".t N&donal Governon' AssocIAtion
lolln ". SunlllUl
Govemor of New H.unpahlr.
*
Cnalmwt
iCJt.*..
'
STA'lB&T 0'
THI JaatABLB lILt a.JMTOH
GOVIIJIIl OF
AuANSAs
NATIONAL GCMIUOItS' ASSOCIATIOH
,I
before the,
CCIIIl'rI'D
(If
PlKANCI
UMIT!D Sl'ATBS, SlINATB
October 14, 1987
HALL Of THE STATES' 444 North Capitol Street· Washlnlfon. D,C. 20001 -1512 . (101) 614.5100
0T/T0'd
'SN\:1~l
N01N Ii:)
'36TL 136£
T~S
1:1:n S66T-S2-T0
�. {.
,Mr. Chalr.an. distlnruished member~ of the commltt~, it is my pleasure to
be here today as a lead Governor on welfare refo~ Ear the National Governors'
Association.
Welfare reform has been thenumbor one priority for the nation's Governors
since our ~Weifar. Prevention Task Force va. first organized in the sprinS of
1986. We responded- to ,the challense issued by the President in his 1986 State
of the Union Address by developinl a welfare reform policy that captures the
thinking and experience of the states. State' have been the laboratories for
effect! ve strategies aimed at r~c1nl welfare dependency by increasinl
opportunities for meaningful education, traininaD and work.
We first presented our poUcy to you· in testilllOny on April 9. 1987.
includes six basic components:
It
o
A strons. .well-coordinatedchi Id support enforcement prolram that
underscores our basic belief that parents III1st support their, chUdren
through their own efforts;
o
A flexible,
o
A·
o
A binding .contractual Igreement betll88ft the recipient and the
government: that assilns clear, mutual obligations--the client to
strive for self-sufficlency and the lovernment to provide adequate
support services for a designated period of' time as the cllent moves
toward economic independencei
OV20'd
state-desianed work program that accolllDOdates remedial
education. tra1nlnl. job placement and experience;
requirellent that" ail . recipient~ of cash assistance with children
age three or older participate 1'n a work prolfam;
. ' SN'tICl.l NO.lN II:!
95E 66£ 105
£1:£1 5661-52-'\:0
�All enhanced case IIIIlnalelllent· system at the central polnt of intake
that assesses a cllent's needs, resources, and the step. necessary to
move the client towardself-sufficiencYi and
Q
.t
0'"'· A,we realize savings from a strcnl work program, 1II0vement toward a
cash assistance proaram that would ulUutely be ~ state-specific
family living standlrd developed accardinl to a nationally prescribed
percentage of that state's family I1vina standard.
.
i
These basic principles, incorporated' into a policy statement that
reatlvednearlY .,unanllDOUs, bipartisan support from the lonrnors, are
principles around· which I national conseDSUS has developed.
Pollcy
statements - issued by groups as diverse as the American PUblic Welfare
AssOciation, the National Alliance of Business, and the United Way. contain
the basic thouaht that as a matter of· national pol1cy,we IILIst turn a system
that is now silllply an inco..e· raaintenance system vi th a minor work component
into a system that offers welfare recipients a way out! The labor and
business collllllUltitie. have repeatedly told us that the Un! ted States. faces a
massive Shortage of 111 educated, trained work force IS we approach the
1990,.
We believe that .the opportunity we provide the adult ·welfare
population to enter tM workforee and, perhaps even Dlore llapOrtantly, the
opportunity we prOVide for the seven 1II1111on children livina on welfare to
arowup in housebolds where education. and wOrk are, the nOlll, is critical to
our future as a natlon. It is 100d social policy. It is loed business!
Senat~rs,
an opening for debate and action on welfare reform seems only to
corne once every five years. The Governors share Senator Moynihan' 5 belief
that .there -is a rare and' important IYZYlY, an alignment of individuals and
organizations around some basic and critical themes that should not be
denied. Unless Ne seize this opportunity swiftly and enact welfare rerorm. in
this session of the lOOth Congress. we will lose this rare ~ment for another
five years. The country cannot aErord this loss.
."
We applaud Senator Moynihan for his tremendous leadership on the issue of
welrare reform. His bill. S. IS11, supported by S6 of your colleagues. 1s an
-2
0V£0'd
':;NtI~U
NO.lN I IJ
96'tL 65£ 1.0S
£1. :£1. S661.-S2-1.0
�comprehensive. outline for' turnins our welfare sy.teaa' around. The bill.
consistent with aa.ich of the Governors' policy, seeks to ~ wat the Goyernors
.
,
believe IllUstbe done--that 11, to tum frOID a maintenance sYitem that trips
millions of women and their children in bopeless dependency toward a program
~hat offers 'opportunity and hope to those famll1es.
We believe that the
Senator's bill is the appropriate reference ,Point for' a discussion of welfare
refOrM in thls CDIIittee.
One of tbecOllOn themes Senator Moynihan strikes in his btll is the idea
that a funda_ntal underpinnina for welfare reform is ~ strong.
weU"coordinated child support enforcement syste!!! that enforces, the belief
that each parent has aresponslbility throuah his own effofts t to support the
children he' or she has brOuaht into the world: We appreciate this nphasis. '
The consensus that we DlIst do a better job with child Jupport 1s evldenced In
other bills before the Comm~ttee as well.
'tn introducing hls child suppOrt enforcement bUl f S. 869. senator Bob
. Dol", said.
II",. tim.
has
CDI'IIA
fnor, ("nncrrfIJlUI tn Nt ~I!Ti nUll •
..nut. ",,'nt"lllt na
nlll'
nat10nal welfare ~1stem and there' 1s a bipartisan ·commltment to do JUSt that.
Part of this effort will In,ol ve so_line tuning oE the EOrller chUd support
enforcement Ini tilt 1ve. II Senator Dole's bill provides five basic idea.. for
improvina our national performance in child support enforcement which h.~ like,
the Governors t sees as a first line defen~a.ainst welEare dependency: His
bill calls for: automatic wa.e w1thholdlna upon ,the issuance of a child
support award by a'court;, the incorporation Of cltlld support award auideUnes
1n state statute as rebuttable prestaption, the updating of all chUdsupport
award ord~rs, every two y.ars;the use' 'of '.ployment service data in tra'eklng
absent parents; and increased penalities to states for failure to co.ply.
We support all of these ideas with the caution that automatic wage
wlt~holdlnl requires a fully automated trackina system in all' but the smallest
of our states and. that 5tateS need sufficient lead ,tille to incorporate child
support .ward guidelines into state statute.
~T./170·d
•SNIv'cU NO.lN I OJ
96tL 66£ tOS
'
I7t:£t S66t-S2-t0
�Senator Bradley has also recolnized the, critical' importance of a strona
J
child support enforcementprosrlm and outlined hts stratesiesin S. 1001. His
btll would boost state efforts to estabUlh peterni ty,) particularly in cases
where childreo are recelvinS Aid to Pamiliesw1th Dependent Children;
incorporate state guidelines forestablt.hinl child support awards into state
statute that are. b1ndinS on the judiciary; establish four state demonstrations
to ' test and evaluate model procedures Eor revlewina child support awards.
provide for immediate Wile wlthholdtnl unless both parents aSree to an
alternative arran,_nt, _ndate an autOllated tracking and aaonitoriD. system,
establish Coalssion on Interstate Child Support to IDIlke recOlllDendations 'for
lmprov1nl interstate child 1,'Uppor-t" 5yst.S and revhln. the UnHonl Reclpr~al
.enforcement of Support Act i and Ii Ye states access to the Department of
Labor'S INTBRNBT syst81 for purposes of locatin. absent parents.
a
Alain, .... support these' ideas. We are avare that states have not (always
done a good job of cooperat1nswith one another in trackina absent parents or
1n enforcina sister. state chUd support award~. Wet therefore, especially
, weltome the, idea of' a colllllission f'otuled on developlnS better' interstate
reiationsbips. We would sUSlelt that. If such a ca.hsion is estab~1sbed,
Governors, he represented on' tbepanel.
Clearly, there is a, broad consensus to focus !lOre attent.ion on child
support enforte.nt. including the, cCllllilon theme. of' autollltic wale
withholding, the estabUshment, of child support award suidelines( in state
statute, intensified efforts to establish, paternity, automated trackinS
systems, and wider use of ellployUnt data. to track absent parents. The
Governors stand ready to' implement these ideas.
The second Eundaaumtal underp1M1nl in both Senator Moynihan'S btll and
the Governors' pollcy, ,isa comprehensive education, elDployment and train1n.
program that, provides critical support services that will assist adult welfare
recipients' become employable and elllPloyed. Further, our polity and Senator
.J
'
MoynIhan's btll propOse that loveruent help relllOve disincentives to t«Srk and
smooth the transition to self·sufflciency by' providin. key ancillary services
like day care and health care coverage for a tille, after an individual leaves a
training program and, enters private employment.
,
~
,
-4
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'SN'l7~l
NOlNI-'::)
96tL66£ tOS
\
�I would Uk. to use my rell81ntng tilDe to offer a fell COIaents on same
criti,cal aspects of the pendlnl bill!.
1.
senator Moynihan's bill requires each state to design and operate a
flexible tr.1n1na proarall, for welfare recipients.
While we
appreciate theflexlbUity that the Moynihan bill offers the states
in this relard, we are concerned. that. state 'might' siiDply implement
a job search prolram and consider the jab done. Many of our welfare
clients are in need of intensive services. Many caMot read or
wt"ite. ' Others have had no connection with the labor' IDIrket and have
no marketable skills. We would sUliest that the, bill require that,
all states provide a range of services to include education.
trainina. and' on-the- job trainlnl, wi ihout spec1fylnl the specific /
services to be provided. Such langu1ae w111ensure that the intent
of our pol1cy··that each recipient, receive as wide a fanle of
services as is possible, consistent with' a ,tate's economic
carried
forward ,without
ten!nl each state
condl tion--ts
specifically how, to do so.
2.
There is much disagreement' about Which ,recipients shOUld be served by
an emplo)'lient and training prosrall. H.R. 1720" the House Ways and
Means COIIIIIll ttee bill, requires participation of an recipients whose
youngest chUd is three or older.' States have the option to require
participation of recipients with children down to ale one. 1£ they
receive a, federal watVfJr and aUlrantee appropriate child care. The
Moyn11-.an bill is sillilar except: that it does' not require federal
waiver to serve, ieci,phtntswlth children aSe one to three and,
,
arguably, does not guarantee ,child ,care t:oprogram participants.
H.R. 3200, the Michel bill introduced 1n the Senate by Senator Dole,
requires participation of all'recipients with children age 6 months
or older. ' We would sUllest, as a !Diddle ground ·for this debate that
parUcipation in education. ,trdninl and emplO)"lDent be mandatory for
recipients with children ale three or old~rbut only with a guarantee'
/ that saEe. appropriate 'child care will be available' to their
children. Further. we sUliest that sta~es be, allowed the option of
,
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�servina only those recipients' w1 thyounaer children who volunteer for
the ~rlal. Tlkln. volunteers vi th very' YOUR. ,c:hlldren ensures that
recipients will come forward only if a.,proprlate· chUd care is
available.
Another criUcal issue surround1n. the establishllent of an education.
elllPloyment and tralninlprolru for welfare recipients is fundin••
The Governors believe strongly that this prolram lUst operate with an
open-ended llatch. ,States wUl only invest fW'lds. both federal and,
state. up to tho polnt where it is cost effective 1n the 10nl run;
that 1s. where APDC benefit savinls offset the, inlUal investment.
Currently le.s than one pe~cent of all APDC expenditures 10 towards
the support of welfare recipients 1n their quest to bocCie
econollically 1ndependent. Our proposal for open-ended fundinl. even
under ,the most lenerous ass...pUons. will see us spending only 6 to 1
, percent of our .\PDC dollars on education. etIIplo)"llltmt t and tralnina.
If we are tp giVe lion than Up ,service to the ldea that people can
be educated and trained. than we IlUlt be vU11ng to invest 1n that
ldea.
3.
r
The Governors would be willin,. however. to look with the Congress at
reasonable ideas, for capplnl administrative costs Eor the prolram.
Llm1Utioris on administrative, COlts would ,increase state efficiency
in rumina the 'prolram and wouldencourale states to ut11he existing'
eaployment and traininl 5Yst. .S ~ther than, ereatina wholly new
systecns.
,
4.
"
Another criticalcollponent of tbe Governor's polley that bears,
dhcui.lori is the idea of transition serVices. All of the bills
currently before the Congress recognhe the need to extend healtb
care coverale to recipients who leaveAFDC Eoremployment. H.R. 1720
calls; for six months of continued Medicaid coverale, the Micl1el bi 11
uses 'current law, and the Moynihan bi 11 calls for four months of
extended cover,.e w1th five additional months provided on a ~Jlidlnl
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�fee $C.le. we would sUI18st that states provide ~dlcald coverale to
fallllles leav1ng the APDC rolls for lncreased eaminas due ,to" work
Eor a perlod of nine months, the last ftve IlOnths of which states .Y
~!. charle an incOII8-related premitll at' their option.
Addltionally. we.
wouldrecOllllend to the collliDitt•• that states be liyen the optton to
extend health care coverale to recipients for an additional nine
mOnths coDdi tioned on the paylleDt of an inco...related premium or
offerinl ,alternatives llk.e enroU.-nt 1n an elllPloyer' s group health
plan, enro 1Iant in the state ellployees health benefit progra.,
enrall_nt in a state' basic health care plan Eor the uninsured or
enrolllllent. in an 00. We' ..at fashion a solution that recognizes
that one of the major dislncentivel to work. for our current welfare
population 1s loss of health care covera,e for themselves and their
children.
S.
The other trans1 ttonal service WIt feel ,trongly' about is the
provision of day care tofa.illes, leavlna the APDC rolls for
ellployment. Hardly a day goes by without a newspaper report of the
Ireat unlet need for child care for our warkinl famll1es. And durinl
the course of our work on welfare prevention last yeer, I18ny walfare
and foraer welfare mothers stressed ,the need (or a healthy,
appropriate day care setting for' their children. We support senator
Moynihan provis10n for nine IIOnths of trans 1tional day care on 8
s11dinl fee scale.
t,
6.
In our pallcy, the Governors call for a new way of peyinl benefit' to
elilible recipients.
Rather than 8 national mlnimu. benefit level,
an idea whlch always seells to die ,hi the glare of budget reaH Ues.
we proposed a' Puil y ,L1 vinl '.. Standard. deve loped accordlnl to a
national .thodololY but using state-speeific costs to arrive at a
state-specific· stand"rd of livinl. OUr propolal inc hided the
extension ot such a ,beneft t to intact families as well as single
parent faailles. While we reC0lni:e that· thll is not the year to
achieve this proposal, weencour~le ,you to include 1n a final bill. a
study of our 1dea or other proPosals for a. IIOre rational way to
provlde cash assistance to famille, \410 w111 continue to need our
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help. Welfare refol'll wUl not be fully accomplished until we, as a
nation, confront the difficult problem of widely vary1na standards of
need in this country.
7,
For almost as lona as we bave been debating welf,re reform, the issue
of whether or not to provide cash assistance to intact families .has
been controversial. Consensus is ,rowin. around the' idea that. you
. caMot eneourage the formatlon of stable., healthy families w,hlle
pursulna a national poUcy that provides assistance only to fam! lies
with an absent parent. We believe that the extension of the
unemployed parent proaram to all states 15 loed policy. We would
sUlsest that asa part of the extension of UP,. cne parent in a
two-parent fal1l11y receiving benefits be required to participate in
the education, training, and employment program.
8.
A final it_ lor comment is the concept or broad waiver authority to
allow the states to experiment with alternative approaches which meet
a specific list of pollcy golls. This idea was first introduced by
the Administration as ~ result of its year-lool welfare study, and
was included in the Mlc:helbll1. and, less broadly I in the Moynihan
bill. It is an idea with merit. It recolnil~s that the states and
local c:ollllllUnltles have. provided !!lOst of the creative solutions now
beina used to cOilbat welfare dependency.
WhUe we support flexible
'waiver authority. we do not want to compromise the entitlement naturo
of critical safety netproirllllS in an era of massive federal budget
def1cits. While it is clearly Conlress', perosatlv'e to decide its
jurisdictional lines. we leave you with the thoulht that, with
appropriate protection of the· entitleoumtnature of the programs,
most Governors support waiver authority.
Chalrun, members of the cOlllllli ttee. we' hope our ~QlIlIIents have been
helpful to you. In closing. I would 11ke to come back to one crt tical idea.
The similarities alllong the variou$ pieces of legislation are IIIOre hrportant
than the differenco.. lhe similarities speale. to the broad consensus on this
issue. But consensus is a Erasile thing. It can qu~ckly COile apart 1n the
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swirl of deficit reduction" cOmpetitiveness strate.ies' and presidential
politics. On ,behalf of the, nation's Gover~ors,' I url~Lth1s coaalttee,this
senate. and this CODaress not to let this historic opportunl ty pess. We 'IIIU!It
act. We must act now.
, Thank yqu. '
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�I.
STATE OF ARKANSAS
.Bill Clinton
OFFICE OF THE GoVERNOR
S'III. COI*ol .
Cow,.,..,.
La,la Roc'iTJ201
BILt CLINTON
GOVERNOR OP ARlA~SAS
"TH! FUTURE OF WELfARE IN
AM~RrCA·
r
BOSTON UNIVERSITY
SCHOOL OP SOCIAL' WoRJ( SYMPOSIUM'
NOVF.MBER6, 1987
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�I was interested, Mr. Hudson,.in hearing you say what you 'did
about get .ontology and my hav! n9 been elected at the 41ge of 32.
What that means is that I ought to be the object of a special
study by you because . I 1m now the oldeat man. my age in America.
It's an interesting program this morning. I'm 'supposed to
give a speech, then weare g01ng to have a panel. that means 11m
su~poBed to raise the heat and they're supposed to shed the light.
Paneli are generally more enlightening, than speeches are, but I
will try to make some contribution to the beginning of this fine
celebration.
I've been asked to talk about the future of welfar. in
A~erlca which, of cour8~, in,large measure Is the future of social
work and social workers,ih America. I think, ironically, that
future Is very bright beoause America is, in trouble today. When
we are in/trouble we begin to look more to the basic human needs
of our people, to eee whether they are being met and what the
consequences of our failures are.
.
The recent precipitous decline oh Wall Street, aven though
its full ireplications are not 'yet clear, at least haa convinced
everyone of two things. First of ~ll, that there is high level of
instability in our economy, and s~corid, that our future 1s very
much intertwined with peopleatound the. world. You know, now when
you get up in the morning, as soon you find out what the market
did, t hey tell you what happened i.n Lonoon, Hong KOn(}, Tokyo, and
"Australia. It i. very inter~stin~ to go into a coffee shop in a
small town in rural Arkansas and hear the farmors talkin<;labout
what happened on the stocki~arket in Bong Kong.
His, l·.thinkj, very important that we all understand that
awareness, which has spIea~ throughout the popul~ce~ opens up. a
whole different set of opportunities for people working together
t~at, in my view, ware not there before the la.t year or 80.
People know that the onli way we can get dut of our trouble is
through developing the capacities of our people.
My own view is that this is one of the most impclrtar.t periods
of American history. Having come to the end of the post~World War
II era, an era .in which;we dominated the world -- politically,
economically, and militarily, we are now confronted with a new and
very different age in which we must lead by working with our'
allies to create a new world order, which promotes growth and
opportunity around the world, and then with our own people to
secure the pl~ce of America and Americana within that order. We
can only do that by de~eloping the capJclties of our people to a
far gre~ter exte~t than we-have to date. If you look at the other
~ations with which we 'are competing today, almost without
exception, they have lower rates of school dropouts, lower rates.
of teenage plegnancies, and lower rates of alcohol and drug abuse
among younQ people. They don't parmit one in fourJ o £ their
children to live in poverty in the most cIitical years of their
lives -- the early years. Accordingly, they h~ve much higher
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�levels of performance.!n public schools based on comparative
testing. These are things people who are 1nsoc1a1 work know,
things many of you have taken for granted p~rhaps, but which now
are being thought about, very seriously, by all different kinds of
people. There. is a broad understanding that we are all in. this
together. Whethe~ they like it or not, the.,defen$e contractor 1n
Califol:nia and the stockbroker .1n New York have .a future bound :up
with the busted farmer Inlowa and the poor, black school child in
Mississippi. That represents a profound shift· in public thinking
.in this country. I have seen it in my own attempts to stir up
supp'O[t for welfare [eform. 1 can go now to the National Alliance"
of Business or the Boston Chamber of Commerce or the Executive
80ard of the United Way and make the 8ame speech 1 make to ~rban
League or to the Children's Defense Fund or the American Public
Welfare Association. This shift in public thinking I:an change the
politics of America though that possibility is too little
appreciated by people in both parties.
\
Havi ng be.on in government and havl ng been elected And·
defeated in elections, I hav~ learned the hard way that success in
public endeavors depends upon, Jas much as' Anything elae, getting
people to see the facts in the same way. You should'be very, very
happy because more, more than anytime in my experience, the
AmeIican. people are beginning to seethe facts in the ssme way,'
from a perspective sympathetic to the endeavors in which you are
engaged. Of Coutse, people do not always see the same fActs in
the same way. I-hope this stety will illustrate just how
important the present state of affairs is.
There was an elderly couple, who had been married alnost a
half a century, sitting on their porch, [ocking In their r6ckers,
their shoulders covered· with Shawls. The husband looked at the
wife and said, "You know, Sarah, we've bee~ married nearly fifty
'years and Ilm a man of few words. There are 80 many things that I
should have said to you over the course of our man fed life, but I
never did. 8efore time luns out, I want to get them off my
conscience. When we got mar~ied, we.·had such high hopes for··the
futu:e and you believed in me, you thought I had a gc)od future,
and then .the Depression came along·and wiped us out <)f my little
business only six months after I started. But you stuck by me,
didn't you?" She said, wYeah."
Then he said, "Then you know the
war came along and-! went 'off and sustained that terrible wound
and it took me two full year s to recover; hut you hung' in theI e
with me." She said, "Yeah, I did." He said, "Then you know after
the war in the es:ly 19508, we finally saved up enough money to .
move into our horne and we weren't there eight months befere a
.
tornado Came along and tote it down.· Then it took six years fO.l
us to get in the house againr hut you hung in there with me,
didn't you?W She said, ~Yeah, I did." He said, "Well, Sarah,
be~ore it's too late, .1 just want to say ~orneth{ng.
You'rebad
luck."
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�That ie plai nly a good. example of what happens if people
don't always see the.same facts in the same way.
Today there is more of a consensual There is 8 real senee
that we ought .to invest more in th.development of our people and
and that we have to tackle our'problems by workin~ together -
people in government, in business, In the schools, individuals,
and communities •.
Before I get into what I think our agenda should be, I want
to mention three cautionary notea in termeof the future of aocial
welfare and its work.
First, just because we are moving beyond Reaganomics and the
political legacy of Reagan, we should not forget one important
thing that we learned; which is that money alone won't solve the
problems. You can I t solve the pr cbleme without. money, but money
alone will not solve them either. There is today a renewed
emphasis in the welfare teform bill, in education, and in many·
other endeavor: a deal! ng wi th· human development on 1 ndi vi dual
responsibility and institutional accountability_ We alway. have
to be asking and Ie-asking these questions. We always have to
have systems which impose individual responsiblftyand
institutional accountability.
Secondly, I think we must all acknowledge that a welfare
agenda alone is not sufficlent. We have to have a program that
deals with the problems of the poor, coupled with the. universal
efforts to improve education and training .and to develop 1;.he·
capacity of the American people. An interesting study was
released by the Children's Defense Fund a few months ag6j for
example, which examined teenage mothers and th.e question of what
was the most· s i gni Heant deterrent to iii young gil 1 who had one
child having a second child. The conclusion of the study was that
the most significant deterrent to having the second child was the'
acquisition of <;tood basic learnin<;t skills, which gave one a'sense
of capacity·, a sense of potential', and a sense of the future~·· So,
you can't isolate the welfare agenda from the education a<;Jenda,
from the broad developmental goals we have for all of our people,
The third cautio~ary note I would issue relates to the budget
bind and the difficult decisions which both Democrats and
Republican~, liberals and conservatives ha~erefu8ed to make.
If
·you listen to this budget debate now, it sounds 11ke a broken
record. You know, the President still sayj we've gotthis'big old
deficit becauee the Democrats are overspending. .The fact is that
if you look at the budget he has presented to the Congress in the
last seven years, the Congress has actually appropri~ted -several
billion dollars leBs than he asked for and taxed several billion
dollars more than he warited. So that If.hehad had his way, the
deficit would be even bigger than it is~ On the other hand, the
Democrats say well, you know, the deficit is bad beoalise the·
President just neve~ met a weapon he didn't like: and if we didn't
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overspend on defense, everything would be wonderful. That is not
true. This 1s where those~of you who are interested in the
welfare of 8mall children, those of you who ale interested in the
welfare of older people, with the over-eighty age group growing
faster than any other group in soeiety, have go~ to come to grip.
with some very tough realities. In 1979, we wexe spending 21.5.
percent of OUI Gross National Product through the faderal
government. In 1985, we spent 23.8 percent of our GNP through the
fedelal government, it went up. In 1919, we were taxing our
people at 18.9 percent of GNP and we had a very large deficit, and
you heard Ronald Reagan tell everybody how lou.y it "lias. In 1986,
we taxed at 18~S percent of GNP, taxes went down. But here's the
rubJ what did we spend in the 23.8 percent, how did we spend it?
Well, 6.6 pelcent, moxe or less, went to defense. A little higher
than it wae undet Jack Kennedy, but not much, 1.3 percent went to
pay interest on the national debt, which is the least you can get
away with unless interest rates fall, right. ~ouJve got to pay
the interest. Keep iff mind that last year, 1986, we had a
government debt that equaled S.3percent of our GNP, so we paid
1.3 percent in interest on the debt1 4.4 percent went to what's
called non-defense discretionary spendinQ, that's every investment
program we have--th~t's all the non-entitled and social programs,
all the things that you ale ~nterested 1n, investing In kids, all
the education programs, all the civilian· research and development,
all the highway money, everything. Everything that lnvests i~
America is 4.4 percent of theGHP or about 20 percent of the total
feder cl'l budget. Now I 11. 5 percent of the total budget were
entitlements, that's where you come in, not just Social Security
and Medicare, but also, pensions ._- civil service pensions,
veterans pensions, veterans benefits, all those thinga. 80th
parties have said, we not only can't fool with the baaeline
entitlements, we can't fool with the rate of increaso 1n them.
Right? So everything we have to cut, we have to cut out of the
rest of what's left. So if you give up 11.5 and 1.3, that's 12.8
peI<:ent $0 all you have is the other 11 percent to fc)ol wi tho .
In ot.her words, if you believe that the time is right for a
major. investment in the American people, you· have to 8ay one of
two thingsl We're either going to have to drastica.l1y change our
priolities at the national level because there is a limit to how
much we can increase taxes without provoking a wcirldwide recession
undel theae political realitIes -- if the Germans and the Japanese
would ·heat up their economy, we could do more -- or Vlelre going to
have to do that or going to hav~ to do it at the state and local
level, which will give you wide and variOus results be~ause the
revenue generating capacity of Massachusettssnd New England
generally!s far greater, for example, than revenue generating
capacity of Texas, Arkansas, and Oklahoma and the farming states
and the states that generally rely on production. WE'! just have to
face that. We're going to have to·do more and that has not been
happening.
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�The fHpside of that"budget tale of woe I'just told you is'
that in the states, by and large, for the last aeven yeare there
have been major increases in the in~~8tm~nts in people. and that
the, vote~8, being closet to the problem, have been" wtlling to
undergo the pain of 1aising their own taxes, even in states with
difficult economic problems, to solve these isaues~ Still, we
have to be realistic 1n terms of the capacity of the next
President, whomever be may be, to generate large federal funds
barr~ng a major chang~:in our willingnesato allocate the,
resource. we now have. Having said that, we know enough now to
know that we have no choice, but to move forward.
Since President Reagan has been in office, w~ have had major
new divisions in the American people. It's been kind of ,11 good
news, bad news story. Remember back'!n 1990 when Reagan'was
elected, basleally out of frus,tratlon and fear of, the American,
people of high 'intereat Iates' and high inflation,' and the,
humi liation of out hostages in Iran, he said YO\1 eleet me and
here's what 'I'll do: "t'll cut your taxes, 1111 cut inflation,
r'll cut interest rates, r'll raise defense 8pendi~g and I'll
balance budget." Now, ,you got to give him credit. He did four;of
thoae five things.' Right? He couldn't balance the budge~ because
supply-aide economics defies arithmetic ,and so, that could be,
those other things w.te done, but, as conservatives"never tJreof
saying, there is no such thing as a flee lunch. So the pliceof. '
doing the filst four was more than d6ubling the defi,cit. The
price of doubling the deficit while doing the fhst four, keepIng
down inflation. keeping down interest rates, incteas'ing, defense,
'all of that, waslo do two things t 1) Put the squeez'e en
discretionary nondefense spending, the investment in :'he future at
the time, we need it the most. So you had real dolla:r terms of 14'
percent reduction in education~ 25 percent reduction 1n civilian
research and development, and on and on. 2) We had to have, for,
four yeals, a very high dollar which 'taxed our ',own exports,
.
subsidized imports into this country and dislocated people in, low
wage,' low skill industries who were the most vulnerable of any
where of what was g01ng' om So, if you look at the laatf,ewy,ears
we have had a phenomenal growth in jobs, 14 million jobs, but we
have also had deep, new divisions in society. In'1985, for the
first time, the statistics tell us that people over 65 became lees
poor than the American people as a whqle. That'S a wonde~ful ,
achievement. The f11pside i$ that~e'still h.ve a Bplaw11ngnew
class of peor people who are ,almost 'exclusively young women and'
their little kids. Aleo, if you look ~t the birth rate, that :
population" young women, and their llttlek!d,e, are-increasingly
widening the minority and the poor and'they ale ,the people who are
gqing to be the workforce· of the future; In the year 2000 welve'
got a dozen states who hae themajoiity of the public ,8chool
population for minority kids. When you put all that tb~e~het, an
astonishing thing happened between 1981 and 1996.: And wh,enever I
say this some 'of my friends In federal government say that I'm
picking bad yeats because 1981 and 1982 were ~o bad, but
none,theless the feder ill'gover nment stat i at 1cs, indicat:e ,'that:
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�between 1981 and 1986, 40 perceht of the people had a~ increaae:in
their income, 20 peicent held on and 40 percent had a reduction,
in real terms.
So I ask you when you see that apli t occur i ng agat nst the
background of Amerfca's,increasing dependence on world wide growth'
for its own prosperity and,our inability to· compete which means .
that, for example, real wages peaked ,1 n 1973 and ha~e dropped'
consistently since then. And the present exchange rates of at'
least 10 countries with higher~et c.plt~ outlets than we have.
You have to aak yourself, Itean we pleservetheiAmer1can dream as
we know it, if we don't do something to better develop our'
people?" Now, that is why there ie 80 much support for what you
have been interested in because to a greater or lesser degree,
millions· of American have gone through that thought process and
have come out where you are. And so it is clear that what we need
to do is to have a policy that no longer mortgages ths future to
pay fot the present, 'that's what we're doing. It.'s okay to borrow
money and go into debt bIJt you oIJ9ht to do it to' invest in the
future when you borrow. We're dOlng just the r.evetae with our
huge trade deff.cit and our huge budget deficit., You know,
everybody complainsabout·the Japanese. We had a$60 billion
trade deficit with the Japanese last yeai. We did •. And if they
droppec all their barriers it would have been 5 or 6 percent less.
That's our total trade deficit. Our Japanese trade deficit would
have been probably 30 percent les8, if they dropped all their
trade barriers. But what people who critioize that, don't alao
. point out is that last ~ear the Japanese put S100 billion into the'
Amerioan economy--Coldcash. They went down in the stock market
just li.ke we did. They also purchased a lot. of cor~orate and
government debt. What'&going to happen to ~s if the Japanese,
the Germans, and the others decide to quit sinking money into the
country? What are we going to do?
We have got to begin, all of us, whether welre liberal~
conservative, Republican or Democrat, to talk sense .lbout the need
for Ametica to.have a program that is baaed on investment,
pIevention o.f problems before they develop, and promotion of the
strongest possible capacity within the family to raiae people to
be productive. And I believe there are at l.ast three things that
we ought to do.
Fltat of all ~eoughi to continuw our amph~si8 on early
chi Idhood development. One. of the real tr i umphs for Bocial causes
in the last two years in the midst of all the.Gramm-Rudman bIJdget
cuts, has been the determination of Congress to continue to expand
Medicaid coverage for poor kids in this country. Late last year
Congress passed a bill which permitted states to cover pregnant
mother and their cbildren, up to age five, up to 100 pe~cent of
the federal poverty line even if those people were not eligible
for welfare in their respective state. OIJr .s'tata was the fitst
state to implement a.. program under that opt i on and WEI are now
coved rig pregnant mothers and their kids up to age 2 ~ We' Ie g01 ng
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�up to age S within the next three years •. We need to do mOla of
that. The Committee for Economic Development, a distinguished
group of business people headquatter~d 1n New York, recently
1eeued a stunning report saying that what we need to do if we want
to develop the economy is invest In ~lds early because theIejare
too many POOl' kids and they are lost before you know it. It 1s a
very important political development, but we need to do mOle.
In our state now we are experimenting with a program we
brought in from Israel called HIPP1, Heme Instruction Program fOl
preschool Youngst~rs. The premise'of the progrAm is to take
at-risk kids from poor families with mothers, usually, sometimes
fathers, who ate almost always uneducated themselv~8,sometlme8
totally 1lliterate and teach the mothers to teach the child
certain basic things to try to help the child prepare fOlschool.
We now have 1,000 children in 10 school districts engaged in this
program. As I said, we borrowed it from Israel which instituted
it 20 years ago to deal with the large population cf orie,ntal Jews
coming l~to a very sophist,ieated, highly, educated, more'
westernized society.' It worked in ISlael. I think HiS working
in Atkahsae. There ale 9maller projects Involved in foutothel
states', Those ate the kinde of things that we have to do more of.
The second thing we need to do is to ~hange)th9 welfare
system even though as was pointed out last night when I was at the
John F. Kennedy School of Government at a forum on this, there are
so r.tany more poor people Jhan those who are encompassed in the
welfare system that we can't eV81 lqse sight of that and so many
other problems that reach beyond it. Still we have a system which
is basically~ because it is purely an income maintenancs system in
most states, pro-dependence. All ,the gover nor,s, you know I we III
all make noises about how we're putting people on welfare to work
and we t 11 ,br 8g about how well we do' it, and how well we do it
often is . a function of the u[t'lemployment rate of a ·g1 venstate.
But the truth is, that because of the way the program 1s set up
nationally, we only spend, on average, 1 perc.nt of the welfare
budget on educat:!.on, training-and work. You do better than· that
in Massachusetts. Mass.chusetts has a ~ery, very good program~
But you've got the economy and the tax revenue to support i~.
What the governors recommended was that we adopt a welfare system
thatspenda 6 to 9 percent, not an exorbitant amount of money, on
education, trairt1ng and work. One that becom~~ an indep.ndent
rather than a dependent sy.tem. One that required the recipients
to gat, for individual responsibility, to sign a contract to get
the check and commi t to pur s~d n9.8 path of independence whi ch
includes mandatory participation in the education, tla1riing and
work placement prcgrams--Ind1vldual responsibility. It also
'included institutional accountability by requiring the state in
tu~n to manage the welfare· case with a case managern~nt system with
some public employee taking personal responsibility for the
recipient and the reCipient's family. ~nd in addjtion to that
remove all the disincentives to work by providin~ tTansitio~al
expenses into the work force for Medicaid, if the job that a
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�welfare recipient gete doesn't have health insurance, an~ for
child care. The two biggest ~isincentlves fot welfare I~cipient8
taking work in states where the wages are low and there's not a
job shortage like there 1s in a lot of New England statea, are the
loss of health insurance for the kids and the increaaed cost of
child care. Now, we've really been working on that trying to get
the Senate and House and the Whlte House togethet which is not
easy to do bu~ that has basically been our position. And I hope
there will be a vote on the welfare reform bill in the House.
sometime be'fore the end of the year certainly in thi's CongreSst
and I hope we get Senator Moynihan's bill up in the Senate, welre
trying to strengthen some of the provisions of that. 'the Congress
did, last week in the budget reconciliation, adopt one very
important part of this, and ~h~t was the M~dicaid extent ion. So
that now every welfare recipient which goes to the workforce will
have ·their children covezed. for u~ to six months and'the states
have the pption to pick it up for anoth~r 18 months, with the
federal match. I'd like to say, parenthetically, that raises tha
whole issue of what to do about health insurance because now
you're going to ha;ve, woxking at the 1.ocal.fast food place, a
welfare mom who's got two ~ids who has health insurance for two
years next to another person who's never been on welfare who's got
t~o'kids that don't have any health insurance.
So that's going to
raise the total i,_ue that you're grappling with here·in
Massachusetts which ie how to get eve~ybody covered without
breaking the bank. But anyway, we'r.e making progress and it's
ver.y impo):tant to continue that. It is symbolically Significant,
fat beyond. the numbera of people who will be affected. Because
what we want to do is tuxn the system on its head and take the
st.and for independence in individ.ual responsibility and
institutional accountability, all of which has been lacking.
·Flnally, we have to continue to make the educational system
more effective In. two ways. We have made dramatic progress 1n the
last five years in public schools in this countr.y. Nearly.
everywhere the test scores ate up, kids are learning more, they're
taking more courses, schoolsaIe offering more courSflSt teacher
performance i~ improved. Right acr~.B the board yo~ 6an see that
all the indicators are good. That's the good news. The bad news
. 1s 'that compared to the competition we're still having real
problems.
.
We have to continue our efforts to increase learning, not
only basic skills but higher order thinking eki11s.
.
The average factory work.r tomorrow will have to, 1neffect,
recreate the manufacturing process on a dally basis because of the
way you'll have to he structured Hwe're goinQ to.maintain
man~facturing base in this country.
So we:must continue that and·
we must continue to make sure that more of our kids learn.
There's a big debate going on now about whether this dropout
problem is as bad ~s we say itis because America haa more
dropouts than its competitors b~t we also have ~dulteducation and
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.
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�people to dEopout and come back 1n and all that. I'm tell! ng you
IS a bad problem.
And even if people come back and finish high
school thlOUgh an equivalency, not· all the equivalency programs
are 8S good as high school, number one, and number two, if they
finish when they're 22, 23 or 24 it makes it even less likely that
they'll go to colle~e.
cit
The way we catch up to our competitors i.through our
Our college' system is better than that afour
competitors in two ways: l.t is bettet substantively and it
encompasses more people. We have a higher percentage pf people
going to higher education institutions than the Gezmans and
Japanese do, for example. So we make up for the fact that we
don't go to school a8 long, we don't take the same courses, we do
all.theee things fot the college education. The problem is we
have this dropout rate the way it is, they may come back and
finish high school but they're. not going to be paxt of the college
now, by and large. And if welre not going to increase the school
year and 1nctease the school day, do all those things, then we
have to continu. to dramatically increase the percentage of our
children going on to college if we're .going to be compet.itive.
col1e~es.
So I hope you w111 maintain your interest and your commitment
to issues which are supportive of your effoItsin sooial welfare.
And I hope you will attempt to establish new al1iancelS~ there are
terrific opportunities now toeetablish an agenda for national
unity, around a simple idea of unleashing the God-given capac~ties
of every American, becauee now more than ever befoIe, people
understand that it's in thei~ self-intereat to do so.
I'd just like to ciose with twolittre stories. In order to
do what I think we need to do, we have to find a way to translate
into policy this generalized concern about the futule~ Because
the truth is for the last seven years we've been talking tough and
living easy. And we ha.ve literally been mortgaging the future to
pay for t.he presenL .When I was at George,town Un! ver sHy 23 years
ago r took a course in western ci,vilization taught by 8 velY--'-'
idiosyncratic and oontrover:'sial and brilliant man, Ca.rroll
Ouig1ey, who got all his degrees across the ~iver at Harvard. He
pushed an idea which I have carried with me to this day. He said
to us, as we eat in a room like thi., "You know, the reason youlre
here today, the reason western civilization has been able to pull
80 many people out of the deprivation and poverty and brutality of
life which has characterized the existence of me~ forcent~~ies,
is the centlal belief in the 'futur~, the belief that the future
will be better than the present, and that every individual has a
personal, moral obligation to make it so. He said, ftThe simple
idea of future preference has bean the engine of progress for
western civilization, and if this co~ntry ever sinks it is going
to be because the people no longer prefer the future enough to pay
the price to achieve it." He 'said the reason we were there In a
school with such high tuition is that our parents prefelred our
future to their present. Now people want to prefer the future but
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�they need mechanisms, they need alliances, they need agendas to do
it.
The second story illustrates that we really are in this
together. When I was a kid I was raised by my grandparents until
I was four.
They didn't have much education but they were bright,
smart people~ And I remember when I was 2 or 3. year. old when my
grandmother set me up in a high chair at breakfast time and she
tacked playing cards up on the wooden frame of the windows and
taught me to count, taught me to read out of the Dick and Jane
readers way before kids were doing that. And my grandfather would·
sit there While she was teaching me to lead and say, "Yo~ got to
do this, Bill, because you can do better than we did. You can do
better than we did but you got to have an education." ! eee all
of you nodding your heads whower. raised with sort of idea. The
whole idea was future preference, you can do better than we did,
!ight? They took the health of the system for granted. ~merican
would always be there, the jobs would· always be there, the
prosperity would always be there but you have'to do better than we
did and the way to do it is to get an·education.
A. .few monthB ago I went, to my daughter t s Bohool, a publi c .
school in Little Rock~ The L1ttle Rock school system Is 60
percent black and 40 percent white and her school is about
two-thiI ds black andone-thi rd whi teo She had a marvelous black
teacher and black principal, it'. a good jnt~r9ratad, working,
functioning public school. I was sitting there eating lunch with
her and all her little friends buzzing around. Some of those kids
are desperately poor. I was sitting there looking at her,
thinking, remembering back to my youth. I want her to do better
than t have. But I was looking all thoss-other kids thinking, you
know, I want them to do well, too. Because if they con't all do
well, what kind of fut~re will I have? Who will finance my
retiremen.t if I live to be ·85? Who will preserve the American·
dream? So we want them all to do well, not just for them but for
us.
...
That sho~ld be, it aeems to me, a source of grent
encouragement and hope to you on the occasion of the fiftieth
anniver~ary of thia great institution.
But remember, the fact
that wetrebeginning to prefer the future again and the fact we
understand we're all in this together, ~on't amount to a hill of
beans unless someone attempts to unify people and generate some
constructive agenda to get us out of it. That's up to people like
you and me. We can look to Washi noton for sorr.• leadershi p but
given the realities of ,the constraints theIe, we're going to have·
to do a lot of this oureelvee~ And we should JUBt resolve to do
it ..
Thank you very much.
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�STATE OF ARKANSAS
OFFICE OF THE GoVERNOR
.
S,.C.,."
Cow".",.
" LiI.", Roch 1J201
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••
Council of state GoverDmenta
May 2, 1988
. SlWtll' N01N I i:J
Bill Clinton
96TL 66£ 105
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WHY nLPARB RBJORK?
WHY HOW?
,Forty years &qo,' at the' encl" of World, War II, in the year
I waa born, our nation "as basically alone, attha pinnacle of
the world in terms
polittcal
of
economic and military power and
Quite properly we set about tne, taak of.
influence~
,rebuilding our allies and our former foes.' We had learned
the harsh"lassons of 'our
m~atake.
after World War I very
We rebuilt Europe with the MarBhal+ Plan: w. worked on
well.
tr,yi,ng to help Japan get atartedaqain; and vedi4 a lot of
other thiiuJs to try' to' ,inv.atmoney 'thrau9hout the, world;
.'
' .
both unilaterally and l'Iluitilaterally, to promote qrowth' and.
prosperity.
Inevitably we were 'sowinq'the
'~
,
•
('"
s~eds
.'"
;,
'.
.
of our own,unc1oinq
'
'¥
, as the' dominant.ecnomic and political power in ,the world.
,
Someday 'we ,would ~>nce ,aqain, have to share', world lead.ership
.,'
with other countries.
Over the last ten to fift.en:(ears
that prooeashas' taken place, and ,it baa been
,
,
apret~y
touqb
,
rol.lercoAstartor,Ameriea because'we weren't really prepared
..
f,or beingme:r;ely a major player, in a
compet~tiv.
economy
r~ther than the dominant player in an eeon~~Yin which others
wereeompetinq,with us ,for markets at home and abroad.
The cons.cp.tenoe. of 'these eeonomic chanq•• , catehiiDq ua
unprepared t ',have been pretty tough on a lot ot ADlerleans.
"
\
Averaqe hourly waqes have dropped .teadily 1n,real terms
since 1973.
OV20'd
aetween ,1981 and 1986, tor the first time in my
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�lifetime, 40 per cent of the Amerlcan people suffered a
decline in real income, 20 per cent held their own, and 40
per cent di4 Detter~
Just think about the. income redistribution trends of the /
.
.
last five years. as theY'would look as line. on a graph.. on·
I
that qraph add another 5, 10, or lS years, and ask yourself,
if
w~.don't
turn those lin•• around, can we preserve'the
American society that moat of us grew up in?
American dream?
can there be an
Thereie a lot of evidence rthat we can turn
•
those lines around, including increased industrial productiv
ity, a lower dollar, and an impending labor shortaqa.
Still,
wa're qoing to have to do aome pretty tough things and make a
sustained, disciplined effort to do it.
Our difficulties .s a nation have baeh aqqravated' by a
;seriae of destructive social developments, especially the
riSing number of single parent households.,. full of poor young,
mct~ers
and their. children•. While we .ucceeded in 1995 in .
doinq something, that we.hadnever done.before 1n this
country, making people over 65 leas poor than people under
6S, "we now have . a whole new eet of dilemmas rooted in. the
lives ot the new poor -- young mother. and usually abs.nt
fathers who are larqely uneducated, otten illiterate;
sometimes abu.areof drugs or alcohol: and their children,
otten born without adequate
pre~atal
and
postnat~l
care,
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�clearly. at riak of falling into the same traps aa their
parents.
Thus, at the very time in our history when we need our
people to be better prepared than ever b.fore for the riqors
of the world economy, we;face an unprecedented. crisis in hu
man develoPment.
We are wasting our moat valuable resource
our people -- at rates far higher than our oompetitors, as
measured .by
inta~t
mortality and low
birth~.iqht
rates, teen
pregnancy, and druq abuse rates, adult illiteracy and achool
dropout rates.
Perhaps one of the moat important questiona to come out
of our work in education is bow can we make aure that
everyone ))enefits from education reform, from hiqh stanclard.s?
We can't be effective if we have a 25 per cent sohool dropout
rate aa we do now.
We can't develop the human potential of
our people with the hiqh levels of druq abuse and teen
preqnancy we hava •. We can't be effective in the near term
with the people who will be in the work foroe in the 2000·it
. millions of them can't read.
developinq our
.,
co~ntry
We can't-be effective in
with a huge new ol••s of young poor to
rep1aee the elderly poor, simply because they bad t . h e . ;
misfortune of beinq born to • child or to a Mother who qet••
divorced and ha. no defense.
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�What can we do about theaethings?
chairmanShip ot.ths National. Governors'
Last year c1uring my
we
Aasociati~n,
\.. .
.
identified five barriers that limit the American people's
drive to become more productive individuals:
welfare
dependence, druq and alcohol abu.. , teenage pregnancy, school
dropout., and adult illiteracy.
At the year's end, we
produced a major work "Bringing Down the. Barriera".to provide
a blueprint for state action to beqin to tear theae barriers
down.
The specific issue before u. today is welfare reform.
A
lot of people think that,welfare is a bad thinq because we
pay people so mueh money that we keep them dependent.
I
In
fact, real welfare payments on the average have dropped even
is
more than wag.s over the last
system c10aa foeter dependency.
years.
Nevertheless, the
Why? 'Becau.e you don't have
l
to doanythinq to get the
YOU
paymen~
except be income eligible.
don't hav.to commit to pursue a path to in4ependence.
Alao, even though the welfare payments may be very low in a
given atate, it still may not pay a mother with small
children to qo to work because by taking, a job ahe usually
loses medical
c~veraqe
for her ehildren and incurs extra
expenses for ehild care •. A weltare mother might well
conclude it wouldn't be reaponsible to take a job if it left
her children without any guarantee of medical help when it's·
needed.
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�Over two years ago, a graup' of ten qovernors came
together to
~evelop
a
po~iOY
on welfare retorD for the
Nati'onal GOvernors' A&.~ciatlon'Whloh, ~ile not pJ::omiainq
'miracles, would begin to turn the whole value.yatem of
welfare on its head, by turning welfare 'from an income
maintenance proCJrUl with minorproviBions for education,
traininq~
and work, to a proqram that makes a real inve.tment
in builc11nq 'independence tor people -on welfare and their
ol'lildren, . while providing maintenance tor people While they
.re becominqmore productive.
The'governors at their 1987 winter meetinq overwhelm
'ingly adopted a policy
wh~chproposed
the following chang•• :
(1) Everybod.y on weifare'should sicjn .acontact co_itt.inq
himself or herself, 1n return for the right to receive
.benefits, ,to the re.ponsibility to' puraue independence;
~he
(2)
contract shoUld be enforced throu9h a casework manaqement.
system in every atatewith' a caseworker known 'to the
recipient who 'WOUld be p~rscmallY re.ponsible ,for draw1nq up
the terms ,of the contract and personally responsible for
,
'
enforcing it;.
. welfare
(3)
~ollara
Instead of spendinq l' per cen.t. ot total,
on education andtraininq and work placement,.
we ahould 90 to Bomewhere between 6 per cent and 9 per cent:
(4) Everyreoipient with a child/three years old or older.
ahouldhave to pursue; this route in order
to
get the
benetita; (5) If a job is available, which doe. not inolude
, child care coverage and MeCSicaid for the ehildren, there will
.._,._.,.. _....,.....
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�be,atransition'period from welfare.to work durinq which the
qovernment would still' pay for those coats; and
(6) , We should increase our efforts to collect child support,
to require even themost,penurioua ot fathers to make some
kind of token contribution to the welfare of their ch1ld.reni
because that, too, is part ofchanqing the value, system that
/
underlie. the whole concept of·walfare in the United statee.
This basic approach haa now been adopted by the House of
Repre.entatives in the form of House Resolution 1720, pas.ed
1n early .necember.
It haa also been adopted in Senat.eBill
1511, sponsored by Senator Moynihan, and overwhelmingly
.
,
passed April 19,
198~,:by
the Senate Finance Committee with
atron; bipartisan support.
The billa have obvious difference..
For a start, the
House version of welfare reform will cost roughly $7 billion
over the next five years, and the Senate version will cost
$2.8 billion
ov~r
the same period.
Thera ,are' differences ,in
thalevels of.preacriptionto .the stat•• about. how to
organize and
op.r~te program.~
Tberear. differences 1n the
approach to benefits ,and levels of ooveraqes.
But the
ences.
8imilari~i ••
are mor••t.rikinq,than the differ
Both billa recoqnize, a. 40 the qovernors, that we
m";1st begin now to invest in our CO'IIUIlon future by providinq
OVL0'd
. StWtlJ. NOJ.N Il::l
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~2:£t
S66t-S2-t0
�real opportunity
to~
educat1on, traininq, and work to mil
lions of our new poor.
Both billB recoqnize the importance
at a stronq child aupportenforcement syatem to instill the
eense of value for parents to support their own children.
/
Both billa call tor a sustained federal commitment to aseiet
inq tha atates with tunding ao that they miqht continue to do
what many atates are already doinq quite oreatively.
It is the similarity ot V,ision ,ancl'purpoa. we must focua
on to accomplieh welfare reform in this congress., The
reeearCh community haa told
U8
that there are two baaic
components of successtui welfare to work proqrams:
atate
',(
flexibility in deaign and operation and ,a susta1ned tederal
funding source.
Tha•• ·are the basic tenets which must be
incorporated in whatever piece 'ot legislation is ultimately
agreed to by the Congress and the Pre.ident.
The qovarnora' approach to welfare reform is 'really
quite s'lmple.
Me will Bay to"our welfare cliente, let's make
a deal -- we'll qive.. you~oney, you'll have to try to become
independent.Secondly, everyone with a childthre. years old
oroldermuet pursue a particular path
t~
independence.
And
third, it a job iB found that ia a lo~r paying j~b,and
those are, primarily the ones that w1110e available in a lot
of states with bigherunelllployment rates, let'. don't ask the
mother to aacrifice the 'child.'. welfare by qiving up meaical
·ooverage for the children or by re.orting to interior child
I
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96lL -00£ 105
I
�(
. oare
b~c::au.e
ahe lacks the money to pay tor it..
We'll
provide transitional expen.es in theae areas •. The heart of
reform ia the idea that in return for the. right to receive
something from the government, you have a re.pon8ibility to
pursue a path to indepenelence.
I don't really know, and I don't think anyon• •lae does,
what. the end of all theae sve.pinq economic changes golng on
in the world will be.
NO one,knows for aure whether America
is going through a profound period of change that will lead
to a new explosion of prosperity or Whether median income
won~t
willke.p falling.' We
d.ominate the worle! again any
time 800n.
But we can-and sl;lould lead. by getting people
",
toqetherand.working toqetherinstead ot just telling
everybod.y else what to do.
We should not begrudge people
around the world the capacity to feed them.elves, eduoate
their children, and. earn 'a decent living.
What we should do
1s lead a new movement toward worldwide economic growth and
prosperity, while developing the capacit.ies of our own people
to make aure they can take advantage of that opportunity.
If
we do that, then America is not in the autumn of ita lite
it's in thesprinqtime.
It'. ju.st another crt.isof growth
that will end with renewal and a better future.
Oliver Wendall Holm•• fought in the Civil War and then
sat on the Supreme Court
He once was caught
by
t~
~
an older age than anyone else.
his law clerk 'reading a dog-eared. copy
(
-8
0U60'd
. SN\1tu. NO.lN I l:J
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52:£1 5661-52-10
�ot Plato's BopUhlio at the aqe of 91.
"Mr. Justice, why are you doing .that?"
I'm try1nq to improve my mind."
springtime.
The clerk said,
ae said, "Young man,
He was always in the
Holmes is known ,best for the sloqan.which I
believe captures the obligation all. concerned citizens have
today:
ItAs lite is action and passion, one must be involved
in the action and passion of this time, for tear Qf being
judged not to have lived."
The act.ion and passion ofou:r; time must.be rooted 1n'
efforts to rescue the
God~qiv.n
,unconscionable squandering.
capacities of our people from
Welfare reform is an important
part of that effort.
-9
0V0l'd
. SN'l:ttu. NOJ.N Il:J
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S2:£t S66t-52-t0
�STATE OF ARKA.~SAS
OFFICE OF THE GOVERNOR "'
BW.. ClilliOD
Srcat. CfllJilDl
I.Mrle Red 12201
COIIIIrlloGr
Contact:
GOVERNOR' 8 W3B1a.Y ADDRESS
June 24, 1988
Embargoed relea••
Mike Gauldin
SUlan Whitacre
371-2345
GOY. aILL CLIII'1'OII
A44re•• on the Arkalula. ladio Retwork
Rmbargoad for 7:30 •••• SaturcSay, June 25
Por tape4 leeel, call 661-7640 between 8 a .•• and noon June 25
Thi. i8 Governor Bill Clinton.
I believe the Conqr••• will soon
.end to the Prelident a bill de.19ned to reform our welfare
sy.tem.
The United statel House of aepre.entativ•• and the
,
senate have already passed welfare reform billa and the
I
Congressmen are about to meet in the conference committee to
work out the differences 1n the two pieces of legislation.
Thi. effort owes a lot to the work of America'. governors who,
more than two years ago, came together to develop a policy to
turn welfare from an income ma1ntenanceprogram into one
deligned to get people off welfare through investmenta in
\
education, training, and work, and requirement. for welfare
recipients to pursue thoae opportunities.
I've been proud to
playa leading role in thOle efforts.
A.
lot of people think welfare promotes dependence because·
benefits are too high.
But real welfare payments have dropped
..
even more than average waqes over the last 15 yeara .. Still, the
system Ooe8 encourage dependency.
Why?
Becauee you don't have
\
'SN\;;I~l
N01NIi:J
961:
�to 40 anything to get weltare payMents except be eligible by
income.
You don't have to commit your.elf to. improve your
situation.
About half the peopie on welfare get otf after a
ahort period.
But t.he other· half, the huge
•
"
ma~ority
at which
c:
are motherswi.th small children, are usually discouraged froll
going to work becau.a by taking a paying job they 101. medical
coverage for their children or they
ha..
t.o pay extra expenses
they can't attord for child care.
Last year,. whan I walchairman of the National Governors'
As.ociation, we voted overwhelmingly t.o adopt a policy on
welfare reform which is really quit.e simple.
It aays to
welfare clienta: "Let'lmakea deal -- we'll 9ive you income
maintenance, but ·you'll
ha.~
to try to become independent· by.
getting a job or getting training 80 you can go to work .. "
Second, everybody with a child three years old or older must
pursue a particular path to independence through education,
..
t
(
training, and work.
Third, if a job is 'foUnd that'. • lower
paying job without the kind of supporting benefits a mother
n••dB,· let's con'task the mother to sacrifice the child's····.
welfare by giVing up medical coverage for children or re80rting
to inferior Child. care beeau.e Ihe can't affor4 to pay for
. bettar care.
these areaa.
Instead, we' 11 provide transitional expenae8 in
The . governors think government should help by
.
\
increasing the total of weltare dollars spent on education,
traininq, and work.
£0/20"d
Anel fourth, .the 90vernment should increale
"S1\ro'Cll N01N I u
.
961.L 66£ 105
82:£T. 5661.-52-1.0
�'
,
efforts to collect child aupport from abaent fathera who won't
do right
on
their own.
The heart, of welfare reform ia the ide. that in return for the
right to receiv.something from the government, welfare
recipients should have,arespon8ibility to pursue a path
~o
independence.
It the representatives of the unitea statea Senate and the Hou.e
of aepresentativeacan reach agreement ona welfare reform bill
the Pre.iaentwill 8ign, Arkansas will be better for it. jOur
own senator David Pryor i8 on the conference committee.
That'.
good news because he'S very c;ood. at gettinq people tQgether for
a good 'cause.
I wish him well, and I'll do everyth1nq I ean on
behalf of Merica'. govern,ora to help bia aucceed.
(
In Arkana.s, we
~on't
have a person to waste.
We n.ea to
develop the capaeitles of our people to do-the jobs we're trying
to recruit to our atate,.
.~
1
) .
£0/£0'd
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'.
01-25-1995 12:59
, :,
501 399 7196
.
'q:
I NTON
t,
TR~S.
'.
.
Why welfare eform
J n.
DY 8111 Clinton
WIt 40 "are ago. at the end of
amonl. them, it the lncfeasins
World War our nation wu
numbers of single. poor. young
at the p1nDac1e of the world in mothers aDd their t:hildren. In
terma of economic and military
1985, for the tInt time in hi8tory,
power and political influenca. Hav. . people over 86 W'el'e 1ell poor than '
, ina lea;mec;l the hanh leaon8 ofthe people under 65. Awhole nlW set of
aftermath of World War I. we re. tUlemmu ill rooted in the Uvea of'
built .Europe with the Marshall
the new poor - young, linrle
Plan &Ad. balped Japan fecover.
motb8l'l who aN larply un~
AmeriWII bMatai DlOaey tbJoouJh·
and often illiterate and IOmetime.
out the world to pl'OJllote srowth
abusers of drugs 01' .alcohol. Their
and pro8perity.
chl1drell e.re often born without
Inevitabl1, "" eowad the seedJ of adequate ptenatai and pOltnatal
our own downta11 a. the world'. care and are at riak offallillf into
domialnt, ecooomic and political the lame trap... their parent.a.
power :- ~'the time WII
would ,b.arI World leadenhip with
WIltt"Q l'Ium." talems'
other tlOWltri... The lut 10 to 16
.At the \'er)' time in our hiltoJj
yeU'll hu been a roUer couter for
America bec:.\lIe '" wren', pre when our people need to be better
pared. tor beiDI merely a ~ prepared than ever
for the
player io a competitive economy, . rilOl'l oIth. world 1C01lO1n)', we face
rather tlum a dominant pl.,.r in
an unprecedented c:riaisin human
an ecOnomy wheN others were com- , d.evelopment. We
wutinf our
petiDg with 'WI for market. at home
mOilt valuable resource - our pe0
, and &broad.
ple - at ratu far hi.her than oW'
,
eompetitoJ'l. Th.ia 'IIV'Ute can be ...n ,
Crowing DOVertv
,n infant mortality rate.. teen preg.
,naney, dna, abun, adult illiteracy
and ecbool dropouts.
..
The conaeque~a of the.. eco
P.rhapa 01'1.8 .of the moat iJnpor
nomi¢ cha• • have been touih on
a lot rI Amaricane who were caurht tant education goals ia to make
unpfttpanci. Awrap hourly wagee
lure 8'W!I')'One 'benefit.. from educa- .
have dropped Nadily iD real terms
tion reform. We can't be etl'ective it
we ha". a 215 percent high school
.iI:lee 1973. Between 1981 .and
1986. tor the ftrst time 1n40 yean, . dropout rate. We can't develop the
40 pel'Ul1t 01 the American people
potential otour people at curreut
I\Ii1ereci a _line in real incom, 20
hmll of drui abUII and teen pre,'
perCeDt hebl. their own and 40 per nancy. We can't compete if millions
cent· improVed.
of people can't read. We can't elfee·
tiv.ly.develop Our country ifa hu,.
There is BV1cience that WI can in
ft8ue indUltrial product1vity.lotwer . new e1au of young poor' replaces the
the dollar and avoid an impendJl1i elderly poor.
labor ehortap. StU). to do 10 will
Lalt yev, under lIlY chairman
not be easy and will require a tWl·
!hip! the National Governora' ABao
taiD.ld.I dJactpl1ned effort.
;,
.eiation identified fi.,. barriers that
limit the Am.e:rican people'.ciri,.. to
The nation's difficulties have
become more productive Inclivid·
been agrravated by a eeriel of' de·.
stzucti'M aocial development.. Chief uata: weltt1r8 dependency. drUg and
alcohol abUM, teenap prernancy,
school dropouts IU1d adult illitenq.
NGA produced "BriagiqDowD
Gov. Clinton JusrvJ"'ri his fourth term
as governor of Arkansas. He istl'le 1m· the Banters" ,to provide a blueprint
meaJ_t*t Wrmat'I of tne National for state action. l8 welfare reform.
Thell111U8 today
Govemors' ASsocI,tlon IIIJd Is currenr·
Many people tbink that welfare is
IY leading NCA efforts in SUDoort of
feoeral welfare reform. .
bad beeaUN people are paid 80
won
are
A whOl, new lit Of
dilemma" rooted In
tn. lives Of the new·
poor - young, .,ngle
mottt'll whO are I,roe",
untrained and Often
IllIterate anti sometllt'llS
abusers Of drugs or
a/collo/. Th.,r CI'Illtlren
art Often bom wIthout
adeQu,te prenatal,na
,re
M",
-
I'Ostnatal Clre ,nd
at risK Of fIIllln" Into the
same traps .s
parents.·
1t State Covernment News June 1988
�01-25-1995 ":13:00 "
501 399 7196
much money that it encourap.
them not to find work. In reality.
real welfare· paymenta . O'll tbe
averaP haw dropped even more
than w..... onr the leat 18 yeUl.
Nev.rthele.1, the
doee
Corter dependency. wn,? BecaWle
there it no need to do aD)'thin. to
collect a welfare check except be in·
com. eli8tbJe. No commitment
must be made to punu... path to
.Y'' 1I1
CL I NTON TRANS.
work during which. the lOY'I'JUllent
Would eontinue to pay those eoN.·
• Goftrn.m.entllhould increale
dorts . to collect ehlld mpport.
requiri,na" 8Wln the mOlt pernurioua
of fathers to make at leut token·
contributiolll. beC&UJe that. too. is
part of acbanpDI value syetem
that u.nclerli.s the whele concept of
wel£a.re in the Unitecl State..
iadepenclence.
MOlIOV'Ir. awn thoqh a Htate'l .I SeekinG aflCI8r'II commitment
welflre pa,ymenta may be wry low,
it gill providea mOre IIICW'ity than
This baste approaeh hae been
a wellue moth.r milJht haw "with , adopted bytb. HoUle of Repre
a low-payinl job. By taking a job, . MDtative, in the form of HOUle
sheuaullyloMuD8dJ.wc:overap Ruoluticm 1720. paaaecl in early
for berc:hildren &nd mUli pay child December. It alsa h.u beta adopted
care. A _lfare moiI;ier mi,bt well in Senate BUl ,l611, tpOl'l8Ond by
conclude it wou1cl not be ntp011Ii
Sea. Daniel Moynihan. O-New
bletotabajobuultonettmecUeal
York. owrwbelmtnlly approved
help for her children or leaw tb.em last April by tht Se_te Finance
UlUlttePClecl while she works.
Commi~ 'With monl bipartiJan
IUPpOrt·
The Houee od senate bill. have
omou.a d1tfereJ1C8tL The HO'UH ver
. ProDOIlng new poliCY
liou 01 welfare reform will coat
about $7 hUlloD over the next five
More than two
a,o. 10 p .. years. The Senate Ye1'81on will coSt
. arum deYelopecl the NOKe policy " 82.8 billion ewer the elUDe period_
on welfare reform. 'I'hourh not There, "allO are dift'erencea in the
" promiliq mtraclu, the policy pzrc>
leYel.a r:lprelCription to the NtH in
how to Ol'IJanize &ad operate pro
poNd to I'8Y'&mp we1£are'. value
~ WelfllN would turufioDl an
srama aa4 di&reDcn iD the ap
income maiDtenace PJ'OI"Ul. to a proach to beMfits and lew" or
prorram wbiGh buUdI indepen ooversp.
But the limilarities are more
dence for people. The JOY8I'D01'I at
thetr 1987 'fI"inter meeting aver
striking than the dift'ereneea. Both
wbelmiDlb' adopted a poitoywh1ch bUll rocopize. as do the govemora.
that'M9 mUit
noW to invaJt in
p~ tho fOllowin. ehanpa:
QUI' eommon t'IItuN l7! proridiDI op.
• £wrybody on wel.fare ahould
portunitiee for education. trainiDi
11m a contract committing to pur
sue independence in return." for
and work to milliona of oW' poor.
Both bills reeopJze the lmportaACl
beneftt&
of a Jtroq child 8Upport enforce
• The contract wuld be eDfore
ment aystem to lutill the IItnM of
ad throuih • caMIWOJ'k manap
value {or parenti to IUpport their
ment .ystem in "".'" state with a
eaeeworksr, 1uwwn to the recipient, children. Both bUla call for a.u. "
pel'lOllally relpODlible for the en
tained federal commitment to aB
. forcement.
.
.istinr ':he statu with iUnci1ng 10
• Tlui percent of wellare dollars that thay might continue to do
spent on education, tra1ni1ll e.nd what ~ Itatea ant already doiq
quite creati~y_
work placement MOuld tncreue
It ia the .im.ila:rity of vi.ion and
from 1 percent to betwI!eD 8 pe:reent
aDd 9 percent.
" PUl"'POM we m1J.l\ foe'll. on to ac
• Every recipient with • cbUd of . oompliah welfare ref01111 in this
at leali three
old Ihouldpur
Coape.L The pvemon' approach
lue education and· trainiQl to to weltSl'e reform is simple. We will
say to our welfare elients. let','
quality for benefits. .
• If a job 1s available. wlUch doe. make a deal- we'lllJ1w you money
not pay for child care or the child
and you'll have to try to becorn. in
ren'. health coverage, there wi 11 be dependent. Secondly, if you have"a
child at least Uu'ee yean old you
a trUlitioD period from welfare to
.
t
,.8.1'1
P. 03/03
®
must punu. a partiCular path to indepeDCleDC& And third, if a job is
found that ilalower-payingjob, ....
won't ask you to Aeriftce your
child'. health by givinl up medical
eo¥el'8p or by reaortinl to irat,rior
child care. We'll provide tranli.
tional apeniet itlthese areas. The
heart of the reform is the idea that
in return for tbe rilht to receive
sometbing from the rovenament. .
welfue recipients han a l'tIpOn•
lJibllttyto punne a path to indepen
dence.
.
I clon't nally know what the end
nlult will be of "such neepilll
chanpe. No one knOWl whether
thiJ profound period or chanp will
lead to a new explosion ofproaperi
ty or an increa.. in pcmIrt7. We
won't dominate the world.,amimy
time flOOD, but we .bould tab the
lead in pttm, people to work
topther. We should lead. a new
movement towal'd worldwide ec0
nomic powtb and prosperity, whil.
developiJ:qr the"capacities ofoUr~
people to euu:re they tab advan·
tap oftbOl8 opportwUtieI. Itwe do
that, then America is not in the
autamn of ita life - it'. in the
Iprillltime. It', just another crisil
of rrowth .that will end with
renewal and a better future. 0
berm
,.IU'I
The Council of State GOvernments 1!
�STATE OF ARKANSAS
OFFICE OF THE GOVERNOR
Bill Clinton
Stat.C~
GOVItntdr
Uule Roc" 72201
OOVBRBOa BILL CLIWTO•
. DLJI.a.D . . .0 " COD8. .BC.
t..1'l'T1dI ROCK, &1UUUJ8M
. DItCH 19, 1•• 0
It's, a great pleasure for me to be here today, and as you can
see I'm still hoarse but at least I have some measure of my'voice
back.
Let me begin by thankinq Pat Flaniqan and walter Day and
other members of the leqislature'who have supported Arkansas'
efforts to ba in the vanguard on
welfarereform~
and I want to
thank the people who are here from the private sector and from
government who have worked so haret to put our state in the
position to make this law work.
I'd like to spend just a couple of minutes trying to put this
issue in perspective for you.
You saw these former welfare
recipients come up here and talk a faw minutes ago ...- they're the
most important people here.
In 1991, the United States Labor
Department says, America will have a labor·shortage.
That means
places like Arkansas, where most people believe that you still
have a moral obligation to qet up and give a day's
w~rk
tor a
day's pay, and where because ot past educational deficiencies and
economic problems we've had a high unemployment rate, will be a
gold mine of opportunity it, but only if, we've done a good job of
developinq our people and their skills.
The other thinq
I
want to, say is that if you really look at
the welfare dependency issue, it is just part of a breathtaking
change in the nature of family and child rearing and personal
habits which 'have occurred in this country in the last generation.
'SNtft!
j
1,
:'"'
-
?
�Right after World War II when I was born, there were no
differencBs in the divorce rate. or the out of wedlock birth rates
of blacks and Whites or urban. dwellers and rural citizens.
The
country was continuing to come together economically even as our
per capita inoome began toris\e.
In the last decade, we have ••en a dramatic change in that
with the upper
20
percent of the population gaining a great deal
of income, the lower
20
percantlosinq a great dealef income, the
next 20 percent losinq a little bit, and the middle 20 percent
just barely hanqinq on. .The country began to split apart
economically.
We/ve also seen a dramatic increase in the number of single
'; parents from d1 vorce and' an increase 1n out of wedlock births,
with a wideninq racial disparity_ . We've seen a huge shift in the
burden of poverty away from the old to the young.
In 1985, for
the first time, people over 65 had a lower poverty rate than the
population as a'whole.
Almost all poor people today are young
women and their little Children.
There are almost no two parent
families that are below the federal poverty line.
When you see
what'has happened, particularly in theblg cities and the
decimated rural areas of our country, economically ana socially,
and you lay on to that the fa.ct that America's drug abuse rate is
10 times what its per capita rate should be -- that is, we have 4
1/2 percent of the World's population and we use over 50 percent
of the world/s druqs every year -- it is not surprisinq that we
have problems.
We
do.
2
. SN'I1tu. NOl.N r ,:J
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�Wa have to aae this welfare'reform issue in the context. of
learning how to.give Dirth tQ' and rear children 'in
a proper
way
and how to make sure, aa the 19908 come upon ua, we really act as
."
'.
'.
r
.
if we: don't have a person to waste and we understand that there
are a lot of people who have had difficulty who can be turned into
extremely productive citizens.
We
m~staccept
peoFle want to 40 that for themselVes.
the fact that most
I' think that',1!J the most'
important thing.
I had a' science teacher when I was fourteen named Vernon
Oakey -- I believe he waa the
uql~est
and I loved him like a daddy.
man
.~
ever laid eyes on
I don't remember anythinq
in ninth qraae science I out I ctoremember this:
r learned
Vernon Dokey saict
one time, "you kids need to learn aomethinqabout human nature if
you 'don't remember anythinq else I tauqht you.
of you think I'm pretty.
You take me.
None
But every morning I get uprand I go in
the bathroom and I put the.having cream on my face and I shave
and when I .t'iniah I look at that mirror and I say Vernon; you're
beautiful."
It's an important insight in human nature.
People
want to Dalieve the best about themselves.
In our administra'tion, for the last several years, wEi .1:ried
to do thinqs that wouldrebu11d the family and increase the
capacity of people to succeed. as parents and children.
We reduced
the infant mortality rate in the decade by 40 percent.
We were
the first southern state to reach the national average in intant
mortality.
Now there are tour or five and some of those with more
urban populations are even below us because they have a better.'
delivery system.
We~ve
begun to 9ive direct state assistance in
3·
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�child care and have done what we could to train more child care
workers and that· feeds into the weltare issue because we've·
trained a lot
Qf
weltare reoipients ·to be child care worxersand a
lot ot them are very good at it, indeed.
child support enforcement efforts and
We've strengthened our
trl~d
not to let women be
the sole bearer of the burden of breaking the cycle ·of welfare
dependency.
One of the things about the, Act that's qoodis that it
requires all the states to cover two parent households'.
The
national welfare laws used to permit states, and we were one of
them, not to cover two parent households whiph meant ~hat we were
being penny wise and pound foolish by actually encouraging the
break up of families.
I
think that's been a very
pos1t~ve
change.
We have done some liberal things like spending more money on
child care and some conservative things 11ke requiring parents to
get their' kids to school and
~ak1nq
them subject to fines if they
let them remain absent for no good reason;
and making children
subject to losing their drivers' licenses if they drop out of
school for no good reason.
We tried to. do new .and different
things thatdidn't,.fall, necessarily, .within somebody's
.preconce1ved notidn of good government or no government becauee .
we have new and different problems.
If you look at all that in terms of this welfare issue, it is
perfectly apparent that
nob~y
in their right
m1n~
would want to
stay dependent on a welfare system that has lower,real benefits
1
today than it dId fitteen years ago.
One of the. biqgest myths in
the world is that the check itself keeps people on welfare.
H,(!70 'c
'S~J'dHl
N01N I i j ,.
96"tL 66£ 10S
££:£l S661-S2-t0
�That's nuts.
close.
It has not kept up with inflation or even come
What has kept people on welfare is that they didn.' t want
to put their children at risk by losing Medieaid or by the
'.
I
inability to provide child care on a minimum wag_ job.
Some
people stay on welfare because they're literally unemployable
.
·v
because ot illiteracy or lackot skills.
Qf course, .there are
some people who think they.can beat the system, but most
dependents are trapped in this.system.
This is an issue I go back a long way with.
Jimmy
Cart~r
In 1980, before
and I qot ourselves beat (he was an oxymoron,
Democrat who wat\; president) "
a
I asked for and received permission
for Arkansas to be one of five states experimenting with welfare
reform.
We began then in 1980.
We had 8 great little effort
going to try to get people on welfare into work proqrams, making
it optional for counties to require able bodied but unemployed
food stamp recipients to do Bome sort of work in the county·.
or six counties still do that.
Five
The effort stalled.whon we left
office, then at the end of 1982 the Reagan administration started
its WIN demonstration project and. when I 99t back in office in
1983 we were very eaqerto partiCipate 1n that and cHd.
But it
was obvious that th,ere were still some terrific problems in .that
program.
In 1987 the qovernor of ·Oelaware, Governor Castle, and.. I
·were asked to be the leaders of the qovernors' association qroup
on welfare reform and to come
with the system.
up
with a:whole new way.of dealinq
We hammered out a program,qot all but one
governor to vote for it, and then began to'work with the Congress
and WhiteHouse to try to rewrite the weltare laws.
I cannot say
5
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�enough about the cooperation I personally received from both the
leaclers of Congress ,and the White House.
I was invited to sit in,
on the mark up ••••ion -- the actual bill writinqsession of the
House Ways and Means committee -- no on~/~ould ever remember a
.
,
time when a Governor had been asked to sit with Congress ancl
, actually write a bill.
I'm saying that not to brag, but to point
out that what happened was sort of magic.
Everyb9dy in the
congress knew that the welfare system needed to be ohanged.
~he
Republicans and Democrats, the liberals and ;onservatives -- maybe
they' had ditterences around the edqes, but all of,a sudden there'
wal~ this big consensus that this program, was not working.
The bill that was signed ~y President Reagan in October,
1988, emerqed from that process.
Then Ark.ansas became one ot' 'the
first fifteen,states to implement the program last July.
You've
already heard. it described, but'I' want to emphasize a few 'things
about the program.
N1.1ml::Ier orie,it/,s a new social oontract.
It basically says
the people who come needing pu»lio assistance, we're going to mllke
a dlfferent deal'with you.
We'll give you the check.
In return'
for that, you've got to make a commitment to become independent if
youean through education and training and'job placement.
~ake
If you
a job and it doesn't pay mUCh, we'll help you with child
I
care, and we'll help you with Medicaid for your kids so you don't
have to punish the children for doing what we want you to do.
If
there are two )of you at home, the husband doesn't have to leave
home for you to get a check if he's genuinely unemployed and
.
unemployable.
But even'if your baby is a newborn, one of you must
6
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�be involved in this proqram from
~ay
one..
If a mother i, home
alone, the mother has to be involved from the time the child is
three, or if child care is available, >'one year old.
That new deal has prc4UCed soma remarkable results since
July.
We have focused this proqram on hard to place, permanently
dependent, welfare people.
We have some of our state employees
here who've done all this work.
I just give the talk.
They
deserve . the medals.
;'
.
Since July, we have placed on average, over 220 hard core
-,
welfare folks' in permanent Arkansa. jobs per month.
wanted to do it.
Most of them
Most of them are eager to do it.- You've heard
theBe people talk.
It's not 'any fun d.rawing.. that lousy little
check every month.
And I'm sure there are still some prOblems
with the system that we'll have to work out, but I want to hammer
'"
that home.
Over 220, on averaqa t per month since July and the
numbers are goinqup and they will continue to qoup if we have
the kind of work that you can provide,
The reason I wanted us to have this' conference is that there
are lots of good ideas!n the world -- 1 qat ten ideas a week and
at least two of them are pretty good -- and there are lots
o~
laws in the world, but somebody's got to deliver the qOOQs.
qood
We
have too many occasions when our system doesn't deliver the
promise of our laws.
I'll give' you one example now. ' Congress has
done a great thlnq that has coat us a lot of money, requiring us
to cover pregnant women and. their children. up to aqe five up to
133 percent of the
federa~
poverty level. That's a qreat thing.
tried last time to get the legislature to let me set up a
I
s~hool
7
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�health proqram for other kids who were uninsured, and if I'm there
in 1991, I want to try that again.
You can
provi~e
coveraqe, but
if you don"t have a delivery system, ,it won't work.
The ;blgqest
problem we have in rural America now is the delivery system for
maternal and, child. health. 'How do you get the mothers to the ,
Why don't we have enough nurse
doctor in their first trimester?
midwives to
out there and drive the rate down below the
qo
national average if we know this cen be done in Crittenden County
and Mississippi County? Really hard delivery questions.
what you have to figure out.
All these details.
That's
There's a whole
lot more of life in the details than I used'to think there was.
All the speeches in the world won't keep a baby alive, won't
educate a person who wants ,to get off welfare, and won't put them
in jobs.
The details do that, the system does that, whether it
works or not does that, and that's where you come in.
There are
ill
lot ot very successful programs represented out here today.
,
Brownie Ledbetter qave "me this outline of har project today;
"competency training and placement for child care professionals in
home based day care."
That's an important part of !ttplementinq a
system that will work.
If we're going to operate this program successfully, we've
qot to have the business community in partnership with the
pu~lic
sector.
Let me say one ether thing.
terrific'point.
I thouqht Pat Flanigan made a
The people 'Who a.re paying the bills, the
taxpayers, most of them think we do a lot of meet and confer and
not much do.
We spend a lot of· time cominq up here to talk about
8
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�it and don'tqo home and do much.' We don't change our behavior
and therefore they qet cynical
far, as
abo~t
their money being wasted.
As
"
I
can tell, ,everybody Pat described shouldn't be payinq
income tax in Arkansas anyway Decause:they don't pay federal
income tax.
I
did\my best to.takethem all oft the state rolls,
t~at
and I oertainly hope in 1991 we can atlaaat say
nobody in
Arkansas wl11 pay. state income tax it,he doesn't pay federal
income tax.
We have over
~70~OOO
tamilies paylnq state income tax
. who don't pay tederal income tax and they only pay about 13 or 14
million dollars.
It's not all the money in the world, but it's
Whale lot of money to
a
t~em.
one of the things that we bave done in qovernment that has
,done a lot 'of damage to . .my"party that I thlnk' is terrible is to
.
~
allowawsc1qetobe driven'between the poor and the middle class
by not' being fair 1n the, way w, raise and spend money_
,It is not
'fair for people who are out there working, tryinq to raise their
kidS, tryinq t9.,. do what's right, willinqto pay their share when
they pay the sales tax, to pay their income tax that they don't,
have to pay at the federal level.
I hope next time we can correct
that.
Let me close with,thisthouqht.
Ed1tor in one of the papers .today.,
didn/t 11ke'it very much.
knowledqe.
He said,
another term.
true.
fit
I
read a letter to the
The guy was cussinq me so I
But I also wanted
to
qivehim an
"F" on
don't know why w.e ought to qive Clinton
Arkansas .is last' in everythinq. If
We're last in teacher pay.
That I s just not
You know why?
Because we're
lest or next to last in the money we spend per child inedueation.
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�We've got 329 school
with more people on the payroll aa
dis~r1cts
a percentage ot population than all the states
sone qood. in that:,
We're 47th
There's
that's one reason the drop out rate's low.
But you can't get blood out of a turnip.
that.
us.
aroun~
in
So, yeah/we're last in
per capita income, which is better than we
were five years ago, and we're 13th and 18th the last two years in
high schccl'qrad~ation rates.
We were one of the first states to
put the new welfare reform program in, and l'lldety you to find
,
I
another state that has better results.
It you had all day lonq, I
could give you a list Of twenty other areas where we rank in the
top t'en states in the country.
One of the things that just drives me bananas about the
people of this state is we won't take constructive criticism from
outsiders.
If somebody comes in here from outs1<1e and tries to
tell us what to do, we'll take up a baseball bat and run him
I
across the state line.,
But you 'qet a D\lnCn of natives ,in the
room, and you"d have thought we'd all' just come ott a forty-day
drunk.
We never did anything
r~q~t.
We're sorry ,as can be.
meant us to be last, and everything's awful.
God
Isn't that right?
You need to quit that.
It is not true.
W. can be first in most things •. We can't
make ourselves rich overnight, and our per cap1'~a income is not
going to go ,up until the skill levels of our people go 'up.
is what determines income.
But we ,can make progress in that.
Meanwhileianythinq'that,~doesn't
it, nearly, we can be first.
have a dollar sign in front of
We can be, first in this.
telling you" look at, these people.
,
That
W~
I'm
can't afford to waste them •.
\
10
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�01-25-1995 13:41
501 399 7196
CLINTON TRANS.
Why should they have unproductive lives?
,
taxpayers?
Why
.ho~ld
P.03/03
Why shouldn't they be
their children have to grOw up thinkinq
there's something wrong with them because it didn't work out for
their folks?
I'm tel11n; you, we.c1on'thave to do that.
The law is on the books/land the rhetoric is 1nthe air.
it's al.1 the details, and that IS· where you come in.
very much.
11
Thank you
Now
�STATE OF A~~SAS
OFFICE OF THE GOVERNOR
BW Clinton
G. .MOP'
Stat. CepU04 .
IMII; Roc" 'f2flOl
IILL CLtlrl'O.
00'9'1Il101 01' UDlfIU
before tile
.OICOKMITTII O. BOKAH lZaOURCI.
OOXMI~II
waYI AKD xa&HI
UHIT.D ITATle BOU.I O~ ..' ...8BTATI"1
o.
on
fAMILY SUPPORT ACT 01' 1'••
••
April 30, 11'0
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-
Hr. Chairman anel Mr'. Anelraws, it i. a honor to teetity betore you
today on a i ••ue that has been clo.. to my heart tor the past
several years. I am excited about the commltaentaand progreas
Arkanaaa has aade in ttla area ot weltare retora and prevention
over the pa.t .everal year.. t alao want to per.onally thank
Congre.sman Downey for the hours and hours of work he put into
this eftort. I believe there would have been no way this would
have'pae.ed through Congre•••o quickly had it'not been for hi.
work.
It is an example of the kind of th1ngour country 1. going to have
to do more of inth. future, breaking out of the old, liberal and
conaarvative preconception and .erging the be.t el••anta ot both
into a program with common ••nae.
Welfare retormha. the conaenative notion that nobody ought to
draw a check from the government who can earn one tor him.elf or
heraelf and that the condition of giving the check in the fir.t
place ought to be a commitment to take a job,a. aoon a. possible.
Welfare retorm alao embodi•• the liberal ide. that We will help
people who take low waqejobs with no fringe b.nefit. vith
tran.itional coata for child care and Medicaid cov.rage tor their
childr.n. These two ideaa, one liberal I the other conaervativ.,
reflect a COftU'Don sanse oompromi.e ba.ed on the tact that veltare
benefit. alone don't keep the p.opl. on weltar.i In real dollar
terms, ben.tits arel.s. that they were 15 y.are a90. People .tay
on welfare either becau.e they are unemployable or b.cau.e th.y
have young children an4 it they take • •inimum vaq. job, they have
to com. up with child care and th.y lo.e .edical coverage for
their children under M.dicaid.
I want to talk thialIIorning about'my involv.ment'in this eftort
and what I believe we neeclto do to continue the prOQr.... The
governors realized in 1986 that the tim. va. ripe tor everyone in
this country to embark on, an ag.nda of national unity to enable u.
to restore the Am.rican drealII. We had to revitalize our hop. by
developing the God-qiven capaciti•• of our people to ba fUll
citizens and by restorimJ real aneS balanced economio growth to
this c o u n t r y . '
At that tille, Governor Micha.l Ca.tle of O.laware anet II agreed to
co-chair the National Governors' Association'. Taak Farca on
Weltare Reform. The group vas formed to study w.lfar. reform t but
quickly conclueSed,.that ~h. b.st way to reform the existing aystem
was to reduce the need for. it. , So we Changed the name of it to
the Taak Force on W.ltar. Prevention. At the .... time, as
chairman ot NOA, I named four othor groups to work on, axobl..s
which r.late to welfaredepaneleney, b1Jt which have th.ir own
impact on looiaty t teen preCJnancy I drug and alcohol al::.I\:I.e, aChool
dropouts and adult literacy. Together, thes. tive ta.k forcea '
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�formed the !fGA Br'inginCJ Down tha 8arriers Projeot, our attempt to
bring down, with action, the barriers which keep 80 many at oUr
people trom becomin9 productive citi.en••
One important re••on the weltare system needed draatic reform waa
because the ayatem in this country waa developed decade. ago tor a
aoeiety which no longer exi.t.. When welfare wa. first
in.tituted, the typical recipient of welfare w a We.t Virqinia
••
miner'. widow, 80meone who.e hUlband went into unlafe ainel, died
on the job, anc! had an inadequate pen.ion. 'Tho widow had Children
who were too young to aupportthemaelve•• Shewa. a woman living
ina lociety where women were not expected to work, and where,.h.
would be h.ld blame1e.. for having a sixth or ••venth grade
'
eduoation., For her, the .yst.m worked fairly well.
But the welfare syatem will not work when half of tho•• on welfare
are in a class of permanently dependent individuals, sometim.s
pasaing their dep.ndency from gen.ration to gen.ration; the
welfare .ystem will not work when th.re are no re.ponsibilitiea
imposed on recipients to break the chain, of dapendancy and when
there are no provisions tor the kind of education and IUpport
servic•• which would enable th.m to do .0.
The syst.m will not work when far more than half the working
mother. from middle cla.s fa.ilie., without reqard to raco, are in
the workforce, but welfare mother. are penalized if th.y accept a
low paying job, which ia all many can get, becauae they have to
;iv. up their children'. medical in.urance and pay .o.eone .1•• to
provia. the child car. they w.re providi~9 them••lv•••
Welfare had become fundamentally • SUbstitute child support
syatem--an income maintenance .ystem for the childr.n.
Unfortunately, the problema which brouqht the parent. to welfare
were not addr••••el at all by,the .ystem whiCh provide. the check.
The qovernors kn.w things not only could, but must be chanqed.
Some atates, like Arkanaas. had already bequn with th.ir own
initiative.. The Kanpower C.monstration R••earch C.nt.r has
surveyed atat•• ' .fforts to put w.lfare r.cipi.nt. to work. We
workeel very harel on it in Arkansas and they 9ave u. an .xcell.nt
r.eport and provided valuabl.experti.e to .tat. official. over
.ev.ral year. in h.lping to implem.nt our proqram in the .arly
19S0' s. But more had to be dona._
In February of 1987, 49 of the 50 governors Voted to adopt a
comprehensive bipartisan weltare retorm policy, which repre.ented
a considerable departure from the pr••ent system. What we propo.ed
to do waa to turn this syatam on ita head, to chan;e it from an
income maintenance proqram to a true edueation, traini~9 and work '
program, and in .0 dOin9 prepare p.opl. to pursue th.ir own path
to indep.nd.nca.
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�The policy proposed the, follovinq changesl
.
1)
EVeryone on welfare ahould .ign a contract co..ltting to
pursue independence in retur.n to~ benefits. .
2) The contract .hould be enforced through a casevork .ana,..ent
aystem in every .tate with a ca.eworker, known to the; recipient,
'. personally responsible f~r theenforce1lle~t. .
.
3) The percent of'weltare dollars spent: on'eelucation" training
and work placement .hould.increa.e fr01ll one percent to betve.n six
. and nine percent of the budqet.
4)
!very recipient with a child of at lea.t three year. old
should pursue education and training to ~ality for benetit••
5) If a job is available Which does not pay for child care or the
children's health coveraqe, there will be.atransition period from
.. we~ fare .to work durinq which the qovermaent will continue to pay
tho.e co.t•• · ' .
.
.
..
.
.'
' . .
6) Government....hould increa•• ettort. to· collect child .upport,
( requiring evan the moatpernurioua of fathers to make at leaat
token contributiona, because that, to~, i.part of a changing
value .y.tem,that underli•• the whole concept of welfare in .the
United Statei.
.
.
The governor.' policy w tran~mitted to t~e Hou.e and .anate
••
where it was ineorporat.ed into' bill. encompasaing the qovernor'B
ideas 'about welfare reform. Over a period ofnearly'tvo years
(anelat times it.eemeel much lonqer than that) "the ConCJ"•• ,
.
working with the MGA,'produced a con.ensu. on welfare reform that
was p••sed in September 1988 bya vote of 96·1 in the senate and
347-53 in the ~ouse. president Reagan, who had earlier .upported
hi. own welfare reform packaqe, aiqned t.he bill on.~ctober 13,
1988."
. "
I,waB convinced atter the bill was aiCJn.d that vehad to have an
adequate pla.,ninq prece.. in ',the state, st.rtinq froll the ground
floor and working up.' I i1lUllediatelyappointed a s'@cabinet group
to begin to encourage interagency cooperation •• we planned to
implement our proqra1ll, Project Suocesa. I al.o.ppolnted a
statewide Advisory committee on Independence,' whiCh included
aocia1 wor~ers,' weltare clienta,proqram administrators and agency
directors to hel~ ~. devi•• and conatruct Project Succ••••
Becau.e of the.eqroupa' effort., agencies are .h.rinq resources
and information, conductinqjolnt planning and coordin.~inq
policiea. Thi. coordination can be difficult to achieve, but it
i.absolutely critical to providing the comprehenaive .ervic••
that many clients and their familie. need to become .elf
sufficient.
3
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�,
.
.
,
On March 19, I was happy to help spon.o~ the ~ountry'. first
statewide conferance on the Family Support Act. We had treat
support from state aqenciea, community action agencie., the
leqislature, the reliqious community, non-profit ol"9anilationa,
volunteer qroups and clients on this project. More than lOO
people at~.nded the d.y-10n; evant.
\.~
the newest aspect of Project Succeas cue from this conference.
aspect, .which entails the graatest change from previous
programs and is potentially the moat important, i . tha local .
planning and community lnvolvementinit1ativa. This initiative,
which is'now being implamentedand. which I understand i. the only
one of ita kind in the U.s., will allow oach community to mold
Project Succe•• to best fit ~t. particular resource. and naeds.
It is based on the premise that each community is differant and
can help ita diladvantaged membera in unique waya. Already, many
ccmmunitities have developadinnovative programs. By brinqinq
toget.har provider., cl,ients, .advocate. and other community
leaderB, vehope,that communities will take ownership of the
pro~lems and, with our a••i.tanca, d~velop their own solutions.
~1s
We have done .averal thing8 in A~kan8 •• to ••power clients: 1) We
have been aDle to a~pandthe HIPPY program.-- Ho•• Instruction
Program tor Preachool youngstars to reach about 4,000 childran and
adult,S in 18 proqrama in 27 cOl,lnti.s a~ound the atate. Mothe~s
involved in the program spend 2Q minuta. a day, tive days a w.ak,
30 weaks a year with their preachool children for two year. trying
. to help them learn basic thinking and r ••soning and speaking
concepts and davelop a. laarners. We have.found even completely
illiterate mothers can do thia: and as they eto it, t.hey want to
laarn themselves. Results from the program have been phenomanal.
2) OUr child cara voucher system allows parents to choose their
car_qiver. and we are workinq with the educational institutions to
make sure tha~. appropriat. day care is acce.aible at or near each
achool. I know that Congre•• 1s currently movlnq toward adopting
. a voucher syst.m... My only advice to the co_itt.e would be to
take it slowly and allow. tim.' tor allot the processes to be
vorkadout.· I pre·ter this approach because it allowa parental
choice and increase. acee.8 to quality child. care * but it requires
a different· delivery system and procedural changes that simply
take time to implement.
,
.
I8 this proqramwork1n; in Arkans.s? Since July, vhen Project
Succ••s was implemented, we have •••n about.220 people in tha.
proqram mova from walfare to employment per month.' In'th~ old WIN
DeliO program, va were averagin') about halt that amount. Alao, we
are .erv~nq about six time. as many peopla in eduaatioO'proqrama
under Project Succe.8 a. we w~r. able to under WIN Demo. Clearly,
~th. program i. having a'profound effect on thousand. of Arkansans
each month and it i. my hope that tha.. nWllber. will continue to
incr,eaae.
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�.. .'
While I have bean very pl••••4 with what w. bave b••n ~le to do
.0 tar with the leqial.tion, Ido have on. m.jor conc.rn: Although
th.r. 1. money tor child' care, and tr.ftllportatlon ,if th. . .
•ervic•• are not available to client. wb.re tfteyllv., v. are not
allowed the tlexability ~o u•• that money to develop .ervice. and
therefore our ettorts to help.th••• ,.ople to .elt-sufficiency .re
thwart.d. I hope that in the near future money vill be ••de
'
available forth.se type of developmental activiti.s, which are'
crucial for small rural state. like Arkansas, '
What ia most exciting at>out this legisl'ation, th. 'amily Support
Act of 1'88, is that 1t off.rs .oth.rs a chance to bec~
,contributing citiaena withoutb.in; baeS mothers. It offers them a
chance to break the cycle ot dependency and to r ••cu. &;roup of
ch11dren and young .dult. who d•••rv. a chance to partiCipate and
Who are -901n; to be needed I:>y their country. ,Beeau•• of the
comin; labor .hortage we don't have a peraen to wa.t•• w. could
not atford to continue a welfare system that i8all ccnauaption,
no investment and no PaY I:>ack. That 1. why ;overnora, congre••men
and advocates worked to pass welfare reform legi.lation.
ot
I believe that the components
the newl.gislation, taken
t0gether, represent a new .nd b.tt.r approaeft to w.lfare r.torm.
It conbine's the statea' \lniqu. ca,acity to d.velop cZ'••tJ.ve
aolution. to tneproblem and tha tederal government'. ability and
responsibility to .et national,.tandaE'ds. It,refl~ct. the
importance ot,eliminating the cause. of velfare. We focus on
prevention, .a w.ll •• intervention.
R••••rch, experienee and instinct have .hown that th.r• •r.key
points 1n the lite of .n individ\lal when it 18 po••ible to take
action to prevent laterprobl.m. in 'life, or to int.n.n.to h.lp
an "at-ri.k t • individ\lal. 'Intervention and prevention now will
prevent the n.e~ for the dra.tic and tar more, expen.ive solution.
a••ociated with our current welfare aystem. Intervanin; in the
lives 'of yO\ln9 children can prev.nt h.alth and education proble..
that could lead to future d.pendency •. Intervention and prevention
will nowenabl. soci.ty to deal product1vely 1n the future with /
the problema of worker'cUsloc.tion.
.
,
,W.lfare prevention efforts focus on training, education and.
ancillary .ervlc... We recogniae that ~his will co.t lIloZ'e money
initially, b\lt if we be11ev. in economic indep.ndence and ••If
sufficiency, w.~u.t allocate aome of our reso\lrces to inve.t in
the critical building block--our people. Iven, in th••• tough
economic timea, Congress/realiz.d that we need to spand more money
on education .nd training, we ne.d to _pend more money to
guarantee quall~y ch11d care and we n••d to .pend moreton Medicaid
for people who move into jobs that pay 80 little that It i. not
profitable for th.m to q.t off welfar., qiveup food stampa and
loa. Medicaid.
5
20/?'O'd
·SN'l:ttll. NOl.NII:J
96rL 66£ T0S
LS:£t 966t-S2-t0
�\
'
Ona of tha most valuable thinqs about thia program ia that-it
will chanqa the values underlying the ayate. and the way the
American government relatea to the people who ara on'welrare.
Thia program aaya to everybody: "We don't want to . .tntain you.
We don't th,ink you have a right to anything other than aa.iatance
in return tor your best ettorta and we believe in you enouqh to
~elleve that you can become independent.
aovernment can put it. arma around the problema, but you can't
atract averyona diractly with a ;overnmant proqram. still, you
can change tha value. and tha cultura within which 100,percant of
the people act. I bali.ve that with the impl.mentation ot thla
aystem nationwide, we are aaying 80mething entirely different to
every welfara racipient. Wa areaaying that you can be ao.ebody
and you're qoin; to be if wa have anything to aay about it. And,
when you go home tonight, evan if you don't have a job, you will
have baen qoing to an adult educationprovram to ;et your high
achool diploma or you will ba in a job training proqra., and whan
your child aeea you at night, your child vill know that you're out
there trying to amount tc aomathinq, trying t.o be a product,iva
citlzan and maka a batter lifa tor him.
Yes, we may attect 10, 15 or 20 parcant in tha early y.ars inatead
ot 90 or 100 percent. But 100 parcent ot the people will ba
atfected by what the naw rula. ara and by what the new rula. .ay
about what wa think cf all the Amaricana an4 thair potantial.
I canatill vividly remambar a clasa I took when I vaa a freshman
at Gaorgetown Univarsity. I ha~ a brilliant prof.saor of Westarri
Civilization, Carroll Quiglay. I .till remember a lot of hi.
lectura. vividly. Ona was most important to ma. Ha .aid that
Wastern Civilization ha~ been mora aucca•• tul than any of it.
preciee••acrs in l:Irin;'inq t.he qreat JII'asa of people out of poverty,
i;noranca and daprivation tor oneaimpls rea.onl that at the
heartot our civilization thare ia a belief in the tuture, a
convictien that, the future can De better than the pre.ent and that
each of us has a personal, moral, even a religious obliqation to
try to make it .o~I ramamber how he pointed out to the claas and
.ail1, "You know, the raason you are at Qaorqatown, a. hiCJhaa
tuition is hare, ia becau.e your parents preteryour futura to
their.preaent. Mark my word., if this country ever qets to tha
point whan tha people Who run thinqa don't prater their children'.
future to their pre.ent,wa/ra finished." For tha pa.st aevaral
year., we have baen actinq like wa'ra at least ambivalent about
wh8thar va believe the futura can be better and whather we are
willin9 to untterqo the pain and the sacrifica to pay for it. ' We
can change that, and I firmly believa that vith thepa.saqe of the
Family Support Act of 1988, that .om. of thoaa walla that hava
been dividin; U8 for _0 many yaars will alowly be,in to tall.
Agaln, thank you Mr. Downey and Mr. Andraws tor your support ot
this initiative. I appreciata your taking tha tima to vi.it '
Arkansa. and hopa your t.ime hera will ba helpful aa wa .. all work to
improve tha livasof the paople of our oountry.
6
R,",
,C;
C;
�01-25-1995 12: 58
501 399 7196 . .
TIII..WASHINGTON POST
CLINT()'\J TRANS.
IE. 10 1In
/JiUQinlon
WeHare Reform
As an Investment.
P.01/03
�c.
'"'-
.
...
~.
. WELFARE REFORM AND ADMINISTRATION
* Governor Clinton helped write The Family Support Act of 1988, a major
revision of the Aid to Families with Dependent Children Program and Title IV
of the Social Security Act. The goals of the Act are to emphasize work, child
support and family benefits, and to encourage and assist needy children and
parents to obtain the. education, training and employment necessary to avoid
long7term welfare dependence.
.
* Although states were not required to implement JOBS programs under this
Act until October 1, , 1990, Arkansa's' moved quickly to obtain increased training
and support services.
Building:on a WORK program initiated in Clinton's first
administration, Clinton made sure that Project Success, Arkansas' name for the
new program, was implemented at the earliest date possible, July 1, 1989.
,
*A follow-up survey completed in August of 1991 on those.participants
whoseAFDC ca~es closed in 1990'due to earned income revealed that:
-72% remained off AFDC
--58% of those remained off AFD~ and were still employed; the remainder had
married or were no longe:r:; receiving bene{its for other reasons;
75% had retained the same job; and
--The average incr~ase in wages' was 16%.
* In Fiscal Year 1992 alone, 9,622 peopie entered employment with help
from Project Success.
* Since the beginning of Project Success, almost 17,000 cases have been
closed and over 5,000 benefits have been reduced as a result of employment.
* From June 1979, to June 1992, while the number of AFDC recipients
nationwide increased by 33.7%, the number of recipients in Arkansas declined
by 14.4%. [Green Book, Table 25, U.S. Dpt of Agriculture]
* Among the tools used by the Child Support Enforcement Unit are income
withholding for children/Is health care coverage, reporting overdue support
payments to consumer reporting agencies, and the establishment of a
rebuttable presumption of paternity' if £he father's name and social security
number are recorded on.the biith record.
* As a result of a reorganization of the Department of H~ma~ Services in
1985, the definition of "welfare administration" changed from one office with
seven employees to cover several existing divisions with several hundred
employees. The change was in budget classification, not new bodies and costs.
If "welfare administration" were still defined today as in 1983 the actually
growth in costs amounts to a modest, inflation-adjusted 7%.
* Arkansas has been cited by the U.S. Department of Health and Human
Services for efficiency in, administration of ~ts welfare program.
* In fact, the latest available figures show that Arkansas has fewer
state and local welfare employees per ~O,OOO population than the national
average. (Census Bureau "Public Employment in 1990)
�* AFDC error rates in Arkansas are well below the national average, and
the cost per case of administering the program is the 13th lowest in the
nation. (House Ways and Means report 5/7/91 and the US Department of Human
Services)
* From July, 1989, to June, 1992, Arkansas' AFDC caseload increased by
11.9% (23,966 to 26,818) while the national figures increased by 27.?2%
(3,758,756 to 4,793,000).
* From July, 1989, to June, 1992, Arkansas' Food Stamp caseload has
increased by 27.32% (80,918 to 103(027), wh~le the national figures increased
by 38.19 (7,216,964 to 9,972,914).
�501 399 7196
CLiNTON TRANS. '
P.01/02
-,-,{
smuw, RUOJK
l'JIB FlDIIAL tAlllLY SVPPOlt" At::
I
I
I
or
AlQ)'
AJ)IIINl.mtA1'IOB
191.",
.. Governor Cl!ntonhllpld w:1C:I ,The, , ..Uy S"'PPort Act of 1988, •
"."Ie~ins nvision" of thl A1d. 1:0 FarrlUu with Dep_aGent Chl1d.nn 1'1'01%'_
aad Title IV of ,the Social SecY:lty Ace. the 10&1. of thl Ace are eo
emphaliz. work. child .upport aftd family blnefle., &04 to encou:age and
....i.t needy chl1dr.n and ,"Ints eo obtdn. "ehe e,d.w::at10n. crainLn, and
.mplo~ftt fteca'.ary,to avoid lott,.ee:m wilfare deplftdenci. (Aaloc.aee4
10/1.3/88: ... oclated
10/14/88]
,
'
h...
Pr...
!'IDJBC:% SUCCUS
,
* Alf:bO\l&ft .au. wire not raqu.iZ'ld eo apt-un: JOBS, 1'1'011'''. u.nd81:' thb
Act U.l\c:11 October 1, 1990 Arkauu IIOved qu!ckly to obtain' l.=r....4
I
e:a1n1l'11&l'l4 ,\l'P'P0rt lemc'.. lulldUl, Oft a WCIX pros;'_ in1tiac••, 1n
Cl1ntott' 8 nne adaItn.1nraciOft, CUncon INde lure ehae Projece Succ....
ukanaa.! n&III for tha nl"pZ'0lr... va, 1fIIpllMl1C.d. at the .arU•• t, date .
pOll1b18, July t. 1989.
'
"*
It. .follow-up survey completed. in Aupt" of lJ91. on tho.e partidpaftU
who.e AlDC caee. elosl~ In 1990 due to lar:=ed inco.. ~.v.aled. Chat:
,*'
'*
72% r.ulnecl off me
.581: of tho.. n ....ined. off,
ramaind.er had 1IAn'1ecl
r....ou;
*
*'
0%
,
AJ'I)C and. were still .~101ed; thl
tOt15I" r.ce1vinl beuftg· for: oth.r
".re no
,
TSZ had ret&1ned the .... job; and.
The .v.r... incr.... 1n wall. wa. 16%.
*' In F1acAL Year 1992 alone, 9-,622 p.ople tnt-recl employment with help
froll P~oj.ct Succ....
" , '~
,. Unce a. be.1m.1.'C.I of Projeet S",ccI.i 11,000 c.... have been clo.e.
and. OVa" .5,000- b.l1ef1t.1 hav. be.n red.ucecl ... anllult of ·employaent.
(A:'kaM•• D'par=el1t of H\mI.&a Servici' 8/92]
,
,
_
I
AI'DC DeUIIII'!S
,. Froll June 1979 to June 1.992. while', the 'number of AFl)C nc1pient'
nAtioaw14e 1ncna.e~ by 33.72:, the "numb." of rec1:pi.nts I.n AZk&naa.
clacU.nedby 14. "':. ,[ 1992 Qreen look, table 2' , U.S. Dep&remenc of
AI:r:lc\lltu.re; u:S. _
Q'l'8Z''CUDC of HUIIWI. S.~ic ••• SOcial Sacudty lullltin
12/9,0 • vol. '3 , no. 12]
"
'
*
Froll July 1989 to June, 1992, Arkan.&I' mc ca.. loaci iftCtI. . .el ~
11.9% (2,3, 966" to ' 26 • 818) DUe ;hI nAUgHl fill"" 'DS'....d hy 2Z, ~n
(3. 7!11. 756 co 4,793,000) .
I
*
FrollJuly, 1989. to June 1992, Ar1c.uul•• ' Food. StaIrp cAaloa4 ha.
increased by 27.321 (80,91.8 to 1031.027), "hI... :AI Melppal ,1ll1rt.
Ipsnll.4 bv 38, US (7.216.964 to 9.9/2.,.914).
.
.
.
' . ' "
cm.o- S'OIJIOtT
~,
,
tooU u,..d by, the Child Support EN.'orcelllnt Un1 t ara
* AIIonl' the
p&,..ftC8
&,_=1...
inco..
withhold.ln. for t:hlldren', h...lth car. cov.r..... reportinl overclu. 1\lJ)port
to c:oftl\lllllr report1nl
ancl the .stabU.Ment of a
'UDucuble pr.,umpeion of l&t.m1~ it, the, father'. nul Gd. .ocial
,.curley ftUIIber: an ".corele Oft tha "birth reoord.. (Aot 15 .ot 1986]
E:n1CIDT VlLEAIlI .AJ)lWlISTJ.A'nOR
,. Ar1can.... ha.baen eit.d by the U.S. Oe~arem.nt: of Health and HUlUn
S.rv1~..
for effic1ency in adm1ni.cracion of ita welfare prolraa.
[Covernor', Oftl~. retea•• 5/4/90j "From V.lfare to Vork-l
wIn tact, the lateat available figures.how that Aricaneu hal fewer acaci
and local welfare l=\,loy8ea per 10,000 population than the naelonal
31
�... 501 399 7196
CL I NTON TRANS.'
P.02/02
:a... (C.tI.IWJ aU:tau -P\1bUc_loyua.t La. 1990)
:"DC .rro'C rat.. 1n Ark.uLtu ere w.ll bdow elle national ~""'C.I' I enG
con 9.Z- ca•• of adIIin1acer1nl m. "Prol't.. i.e the 1.3cb lowe: 1n. ell.
,n. (Ioua. Way. a'nd. Kaau repo'Cc '17/91 &I\d. the U5.0.,&rtll.n«:. of H\.aaJ.'l.
. .
ic.~)
• t ••ule of a 'taorl8Qiz&c1on of the n.9&rtment of Human S.rvic.s in
;. the cSet1c1.t1ou of "'welfar. adm1nbcraUol\- cha",.el £%'0. OM ·off1cI
. ..ven •
to co..,.r
ubt1. eli.vbf.ona. with ••".'C&1· '
:.el
the cllAnle " .. 1n b~.C cla••lf1c&e10n, DOt: a.ew .
.•• &114 cosca. It ·wlt.I'. . . .i.ftUtrat10n .
e1:111 cief1ne4 tod&y ..
. US, d:le ac::eu.ally p'ovth 1n con. .AIIOUftC. CO • IIOdII.C •
.&e1on-acljWle.el 71. [AGe 348 of l"'i lA.p of Vo..n Votel:'
IZ'U8nt !.n ArkaM..- 19.9]
.,101...
_loy....
'.""1'&1
".1:.
32
�01-25-1995 12:31
}
501 399 7196
.P.02/02
CL 1NTON TRANS.
• Another Clinton ma.ura provld.. Income withholding for h.alth car.
prlmlums ~f mlnor.chUdran a'a pa" of child ,upport, to prOvld. batter health care for'
children.
. ,
Regarding the problema of tho.a who ar. homela..:
,
\
.
,
-Governor Clinton a.tabll.had tha Arkan.a. Interagency Council for tha
. Homele•• to survey the Arun... homala•• population and to coordinate the urvlce.
of 30 .tate aganclel for maximum Impact. The number of Identlflld homale..
ahelters. ha. quadrupled slnca 1988..
.
• The Arkan... Homel... Children'. Office (AHeO) wa, e.tablished in tne
Education Department to addre.s barriers keeping homeIe.. children out of school.
AHCO collects and dlltrlbute. Information, conductl work.hops, ,awards grantl,
facilitate, effoIU betWeen .ervlce provider, and school, to expedite enrollment,
transportation, and educatlonelaervlc••, and encouragel,advocacy for the homel...
Ichool·8g1 child .
.• Tha Arkansas Adult Education S.ction has 'Irved thou,ands of homel..s
adulta .t local,lte. throughout the atatu in homel... IheIter. I lubetance abuse
treatment facllltl••, ahelters for abused women, and schools.
.
- Additional .paelel "'ylce. have b8en provided for the homel... elderly; the
homele•• mentally III, and homele.i veteran••
-2&
��ARKANSAS: A RECORD OF ACHIEVEMENT
Project Success:.
_" ...... , '.' , ___~".__~._'___ ,_
•
To comply with the Family Support Act he helped author, then Governor Ointon
implemented Project Success in 1989. 'By providing participants with Medicaid, child care,
and other needed assistance, the program moved 17,000 ~ople from welfare to work.
Child Support Enforcement:
•
Ointon was also a national leader in the effort to identify fathers and aggressively
enforce child support orders. Under his leadership, the statets Arkansas Child Support
Enforcement Unit withheld income for childrents health care coverage, reported some
overdue support payments to consumer reporting agencies, and established a rebuttable
presumption of paternity in some cases. The Arkansas Child Support Enforcement Unit
received national recognition for identifying fathers and aggressive enforcement of child
support payments.
Tax Breaks for the Working Poor:
•
In 1991 Clinton eliminated taxes for 252,000 low income taxpayers, and reduced taxes
for another 122,000 lower-middle-income people.
'
)
�THE CLINTON RECORD ON
WELFARE REFORM AS GOVERNOR OF ARKANSAS
President Clinton has a proven track record of commitment to welfare
reform. Since his first term as Governor, he has stressed his belief that
welfare should be a second c~ance and not a way of life. As Governor of
Arkansas, he moved 17,000 people from welfare to work, cracked down on
deadbeat parents, and provided tax relief for low-income families. A
driving force behind national reform, his leadership as Chairman of the
National Governor's Association was central to the passage of the Family
Support Act of 1988.
I
J
NATIONAL LEADERSmp IN PASSING FAMILY SUPPORT ACT
As Chairman of the National Governor's Association, Clinton helped guide to passage
'the landmark Family Support Act of 1988, a comprehensive revision of the Aid to Families
with Dependent Children Program (AFDC). Launching a major effort by the nation's
governors to restructure the federal welfare laws, ~e hc:lped secure support for maj9r changes
in the foCus and nillUCI;; 'of the country's we!!;!!e prograni~ The result was the Famihr Support
Act, which requires welfare recipients to move toward independence through ed~:.i!!nn,
training and work. The Act was based in large measure on a proposal adoptCd by the
National Governor's Association in 1987, when Clinton was Chairman.
,..
In the spring of 1986, Clinton led the nation's governors in'the organization of the
Welfare Prevention Task Force. The task force then developed a policy which captured the
thinking and experience of various state-wide welfare reform efforts.
,..
At their annual winter meeting in 1987, the governors overwhelmingly adopted this
policy which would begin the effort to transform welfare from an income maintenance
program into an empowerment program encouraging independence and work.
,..
Clinton testified about the Governors' policy pOsition before the House Ways and
Means Committee in February 1987.and before the Senate Finance Committee in October
1987.
,...
The goals of the Family Support Act, signed into law into 1988, are to emphasize
work, child support and family benefits, and to encourage and assist parents to obtain the
education~ training and employment necessary to avoid long-term welfare dependence.
j
I
�
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PDF Text
Text
THE SECRETARY.OF HEAL TH AND HUMAN SERVICES
WASHINGTON. 0.(;.
20201
FEB' I 3 1995
Tte Honorable E. Clay Shaw
Chainnan, Subcommittee. on Human Resources
Committee on Ways and Means
U. S. House of Representatives
Washington D.C. 20515
DI!ar Mr. Chainnan:
This letter expresses the Administration's views .on the Chainnan's mark for welfare reform
le.5islation under consideration by the. House Ways and Means Subcommittee on Human
Resources.
Tile Administration shares the corririlitment of the Congress and the American people to real
welfare reform that emphasizes work, parental responsibility, state flexibility, and the
protection of children. Last year, the President submitted a bold welfare reform bill, the
Work and Responsibility Act of 1994, which embodied these values. It imposed tough work
re:quiremeilts while providing opportunities for education, training, child care and supports to
working people. It included a stringent set of child suppon enforcement provisions. It
n:quired each teen mother to live at home, stay in school and identify her baby's father. It
increased state flexibility without sacrificing accountabil~ty. And it maintained a basic
SIructure of protections for children.
1 he Administration looks forward to working cooperatively with the Congress in a bipanisan
way to pass bold welfare reform legislation this year. The Administration has, however,
s·!rious concerns about a number of features of the Chainnan's mark that appear to
undennine the values to which we are all committed. The Administration seeks to end
vlelfare as we know it by promoting work, family and responsibility, not by punishing poor
children for their parents' mistakes. Welfare refonn will succeed only if it successfully
moves people from welfare to work.
,.vork
For years, Republicans and Democrats alike have agreed that the central goal of welfare
refonn must be work. That· is' still our goal: People who can work ought to go to work and
I:arn a paycheck not a welfare check. The Administration believes that no adult who is able
1.0 work should receive welfare for an unlimited time without working. The Administration
believes that from the first day someone comes onto welfare, he or she should be required to
panicipate in job search, job placement, education, or training needed to' move off welfare
:md into a job quickly. It. is government's responsibility to help ensure that the critical job
placement, training, and child care services are provided. Individuals who are willing to .
work should have the opportunity to work and not be arbitrarily cut off assistance.
�The Administration therefore has serious concerns about [he Chairman's mark before you:
a
It eliminates requirements that recipients panicipate in job search, education,
work or training as a condition of receiving welfare, and ends any
responsibility of state welfare systems to provide education, training and
placement services to move recipients from welfare to work. The proposed
legislation effectively repeals the bipanisan Family Suppon Act signed by
President Ronald Reagan in 1988.
o
The proposed legislation includes only minimal and unenforceable
requirements that recipients work. The bill requires only that persons on the
rolls for more than 2 years engage in "work activities" loosely defined by the
state welfare bureaucracy, rather than a real work requirement. The proposed
panicipation standards are very low. In many ways, the work requirements
are even weaker than those in current law.
o
The proposed legislation provides no assurance of child' care to recipients who
workor are preparing to work--even if a state requires them to participate. It
offers no promise of child care for those who leave welfare for work or for
those who could avoid falling onto welfare if they had some help with child
care. While it repeals provisions of existing law that provide funding for child
care, this bill is silent on whether any additional funds will be .available for
subsidized child care for low income working families.
o
The proposed legislation repeals the current rule that anyone who leaves
welfare for work can receive Medicaid for an additional year to ease the
transition. This would funher reduce health care coverage and make it harder
for people to n1()ve from welfare to work.
a
The proposed legislation would deny all cash assistance to families that have
received assistance for more than five years, even if the adult in the family is
unable to find a job or prevented from holding a job because of illness or the
need to care for a disabled family member. Children would be seriously
jeopardized even' if their parents. cannot find any work ..
The Administration supports an alternative approach that would genuinely transform the
welfare system into a transitional system focused on work. It would have strict requirements
for recipients to participate in and clear responsibilities for states to provide education,
training and placement assist:ance;it would have seri()us time limits after which work would
be required; it would ensure that children would' not be left alone when parents were working
by providing assistance for child care; it would put parents to work, not just cut them off;
and it would ensure that children can expect suppon from two' parents.
2
�Parental Responsibility
The Administration believes [hat welfare reform should recognize the responsibility and
encourage the involvement 0f both parents in their children's lives. The Administration
considers child support enforcement to be an integral part of welfare reform, particularly
t'ecause it sends a strong message to young people about the responsibility of both parents to
support their children. The Administration was pleased that you had agreed to add child
support enforcement to your welfare reform bill, and sorry that your proposals are nor yet
part of the bill now under consideration. The Administration looks forward to working
dosely with you on this issue in the corning weeks.
o
The only child support provision included in the Chairman's mark is one that
allows states to reduce payments to children for the first 6 months if paternity
has not been legally established. This provision seems ineffecwal and unfair.
Even if a mother fully cooperates by giving detailed information identifying
the father and his possible location, and even if the state is diligent in pursuing
the father, it can easily take 6 months to get paternity legally established.
There is no reason why the child should be punished during this period.
The Administration believes that it makes far more sense to deny benefits entirely to any
parent who refuses to identify the father or to cooperate in locating him. However, once the
'nother has done all she can, the family should qualify for aid, and then the state should
I~stablish paternity within one year.
The Administration believes that the welfare system should encourage the formation and·
support of two-parent families. The Administration is therefore concerned about an
important omission in the proposed legislation:
.
o
The proposed legislation would encourage the break-up of families by
repealing the requirement that states provide cash assistance to two-parent
families in which a parent is unemployed or unable to work. It allows states
to discriminate against married, two-parent families by treating single-parent
families better than two-parent families.
The Administration supports an approach that both encourages the formation of two-parent
families and makes sure that both parents take responsibility for children in all cases.
Teen Pregnancy
The Administration and the American people agree that the best reform of welfare would be
to ensure that people do not need it in the first place. Welfare reform must send a very
strong message to young people that they should not get pregnant or father a child until they
are ready and able to care for that child, and that if they do have children, they will not be
3
�aole to escape the obligations and responsibilities of parenthood. We must be especially
C)ncerned about the well-being of the children who are born to young mothers, since they
are very likely to grow up poor.
The Administration .therefore has serious concerns about the bill before you:
o
The proposed legislation would deny all federal cash benefits for eighteen
years to any child born to an urunarried mother under 18, as well as to the
parent. This provision appears to punish children for their entire childhood-
18 years--for the· mistakes of their parents.
o
The proposed legislation does not require that teen mothers live at home, stay
in school, and identify the "child's father. It weakens requirements in current
law, and may make the prospects for mother and child even worse.
o
The proposed legislation establishes only minimal expectations for states to
provide services to urunarried parents. and provides no additional funds to "
support them.
"
The Administration supports an alternative approach that would require minor mothers to live
~lt home, stay in school, make progress toward self-sufficiency, and identify the father of the
child. The Administration also supports a national campaign to prevent teen pregnancy. It is
time to enlist parents and civic, religious,. and business leaders in a community based strategy
10 send a clear message about abstinence and responsible parenting. The Administration also
1;uppons a state option not to increase benefits for children born to mothers on welfare. This
decision should be made by the state, not the federal government.
:;tate Flexibility with Accountability
The Administration embraces the creativity and responsiveness of states, and the
'Jpportunities for real reform when states have the flexibility to design and administer welfare
iJrograms tailored to their unique circumstances and needs. Already this Administration has
.~ranted waivers to nearly half the states for weJfare reform demonstrations. National welfare
reform should ~mbody the values of work and responsibility in a way that assures taxpayers
that federal money is being spent prudently and appropriately. For reform to succeed, the
funding mechanisms for welfare should not put children or states at risk in times of "
recession, popUlation increase or unpredictable growth in demand.
In this context, the Administration has serious concerns about the proposed legislation:
o
The spending cap in the proposed legislation makes no allowances for potential
growth in the need for cash assistance because of economic downturn,
population growth, or unpredictable emergencies. It could result in states
4
�running out of money before the end of the year, and thus having to turn away
\\forking families who hit a "bump in the road" and apply for short-term
assistance. It could preclude states from investing in job placement, in work
programs, in education and training, and in supports for working families.
o
The proposed legislation removes the requirement that states match federal
.funds with their own state funds. With none of their own money at risk, states
will have many fewer incentives to spend the funds efficiently and effectively
to improve performance and increase self-sufficiency.
o
The proposed legislation provides virtually no accountability. There are no
incentives for good performance and virtually no penalties for failure. There is
no provision for the recovery of monies paid out fraudulently or in error.
There are no mechanisms for ensuring that states are actually spending the
money on needy children rather than on state bureaucracies, or for monitoring
whether federal money is being used to help parents gain self-sufficiency,
. require work, and enforce parental responsibility. Indeed, the federal
government is forbidden from taking any meaningful steps to ensure program
performance and accountability.
.
.
The Administration supports proposals that significantly increase state flexibility but also
ensure accountability for achieving national goals. The Administration supports a funding
mechanism that will not put children and states at risk down the road, and that enables states
10 succeed in moving people from welfare to work and in supporting working families. The
. <Xdministration has significant doubts about the ability of a pure block grant funding
:nechanism to adequately protect both children and states.
Protection of Children.
The Administration recognizes that the protection of children is the primary goal both of cash
assistance programs and of child welfare and child protective services. Cash assistance
programs assist families to care for children in their own homes. Child protection services
help those children who are abused or neglected or at risk of abuse by their parents and who
need special in-home services or out of home placements to assure their safety. Strengthening
families, and where appropriate, preventing removal of children from their homes also are,
key goals of child protection services. There are problems in a number of areas.
Denial of Benefits to Children on AFDC
The legislative proposals that would reform cash assistaQce have a number of provisions that
would put vulnerable children at greater risk.
.
.
5
�o
As noted above, the legislation would deny cash assistance to children of
unmarried minor mothers fortheir entire childhood, to children born while the·
parent was on welfare, and to children whose parent had received welfare for
more than five years, whether or not a job was available or the parent was
unable to work.. The funding caps could have the effect of denying cash
assistance to children when states used up their allocated furids, for whatever
reasons. Children in low income working families, who may be forced onto
cash assistance in times of economic downturn, could be most affected.
rhild Protection Services
Some of these children could well come into a system of child protection services that is
already seriously overburdened and that is failing to provide the most essential services.
F:eported child maltreatment and out-of-home placements have both been increasing sharply.
Hany state systems are in such distress that they have been placed under judicial oversight.
The proposed legislation responds to these increasingly serious problems by consolidating
existing programs that protect children into a block grant with nominal federal oversight.
The Administration has serious concerns about this approach.
o
The proposed legislation caps spending for child protection programs at a level
considerably lower than baseline projections. This could lead to uninvestigated
maltreatment reports, and to children being left in unsafe homes with minimal
services. It could also seriously hamper states' efforts to improve their child
abuse prevention and child protection systems.
o
The proposed legislation eliminates the adoption assistance programs, and
leaves it up to states whether they will significantly sustain the subsidies that
enable many special needs children to find pennanent homes, and whether they
will honor commitments to those adoptive families ~at now receive subsidies.
o
The proposed legislation virtually eliminates federal monitoring and
accountability mechanisms. It makes it impossible for the federal government
to ensure the protection of children.
o
The proposed legislation is silent on the fonnula for allocating funds to the
states. Because of serious imbalances among the states in spending on child
protection, it is hard to imagine a fonnula that would not disadvantage either
states that' have been heavy spenders, or states that are only beginning to
improve their systems.
Substantial improvements need to be made in the child protection system and in the federal
role in overseeing that system. The Administration·supports a careful and thoughtful review
of the programs before actions are taken that might seriously hann millions of vulnerable
children.
6
�Denial of Benefits to Disabled Children on 551
Administration is deeply troubled by the changes proposed in the program designed to
help disabled children--55I.
Th~
o
(I
The proposed legislation essentially eliminates 551 benefits for children, with
the exception ofa small group of children currently receiving benefits. Within
6 months, over one hundred thousand disabled children would lose eligibility
for 551 benefits--some would lose medical protection as well. And in the
future, no child, no matter how disabled, will be eligible for any cash benefits
for 551, except if cash benefits prevent them from having to be
institutionalized. These proposals appear to penalize parents who are
determined to care for their child no matter what the economic consequences
for the family. 551 recipients are among the neediest and most vulnerable
children, in the poorest families.
50me of the money saved is put into a' new block grant for services to disabled
children, which would require the creation of a new state bureaucracy to
decide on appropriate services. This idea is untested, and no one knows what
impact it will have on the most vulnerable of children and the parents who
care for them. The 5-year cut off in AFDC for all persons along with the
elimination of 551 cash for disabled children may leave these children
extremely vulnerable.
Tile Administration sees the need for careful reform in this area. with its potential for serious
hcl.rm [0 extremely vulnerable children. Last year the Congress established a Commission on
CrJ.ildhood Disability to look into' these issues in consultation with experts from the National
A:ademy of Sciences. The Commission will provide its report to the Congress later this
y<:ar. The Administration believes prudence dictates waiting for this short time until this
bipartisan commission, following a thorough review of all aspects of this important program.
has an opportunity to make recommendations.
Benefits to Legal Immigrants
The Administration strongly believes that illegal aliens should not be eligible for government
welfare support. But the blanket prohibition of all benefits to legal immigrants who are not
yet citizens is too broad, and would shift substantial burdens to state and local taxpayers.
These legal immigrants are required to pay taxes. Many serve in the armed forces, and
cJntribute to their communities. The Administration strongly favors a more focused
approach of holding sponsors accountable for those they bring into this country and making
the sponsors' commitment of support a legally binding contract.
7
�In summary , the Chainnan's mark espouses goals for the refonn of welfare--work, parental
re:iponsibility, prevention of teen pregnancy and state flexibility--that the Administration and
the American people share. But the translation of general goals into specific legislation
m:,sses the mark in fundamental ways. The proposed legislation doe~ not represent serious
work-based refonn. It does nothing to move people from welfare to work, and it does not
require everyone who can work go to work. It neither holds state bureaucracies accountable
nc;r cushions state taxpayers against recession. It puts millions of children at risk of serious
hann. There are alternative approaches to refonn that achieve our mutual goals in far more
constructive and accountable ways.
The Administration reiterates, its commitment to real welfarerefonn and its desire to work
cooperatively with Congress to achieve it.
The Office of Management and Budget advises that there is no objection to the transmittal of
th is report to Congress.
A similar letter was sent to Representative Harold E. Ford .
.
.
~reIY'c,
. . O--(~
Donna E. Shalala
cc;: Members of the Subcommittee on Human Resources
8
�THE SECRE rARV OF HEALTH ANO HUMAN SER.VICES
WASHINGtON. 0 I..
FEB 22
10101
9.l)
The Honorable William F. Goodling
iJldirnldn
.
Committee on Economic and Educational Opportunities
House of Representatives
Washingtqn, D. C. 2051-5
Dedr Mr. Chairman:
This letler expresses the Administration's views on .the Chairman's mark for child care
.:onsolidation and the repeal of several child welfare programs under consideration by the
<:::ommittee on Economic and Educational Opportunities.
.
The Administration believes that both child care and child welfare are important issues for
.A,merican families, and both issues have a distinguished bipartisan history in the Congress
,:md in this Committee. Child care is of significance to millions of working parents and their
:hildren, as well as to those families who are trying to gain a foothold in the labor market. "
Child welfare services assist millions of our most vulnerable children and families in this
Nation each year, often in times of crisis.
The Administration looks forward to' working cooperatively with the Congress to pass
bIpartisan child care legislation and to reform and strengthen the child welfare system. The
Administration has, however, serious concerns that a number· of the features of the
Chairman's mark would undermine the values of work and family to which we are all
committed, and might undermine the economic independence of families and the safety and
well-being of children.
Child Care
The Administration believes that quality child care is an important component of a welfare
reform strategy that is truly about work. Successful child care policy promotes the economic
independence of families and children's healthy development; provides parents with real
. choices among quality alternatives for children of all ages; and encourages continuity of care
for the child, regardless of changes in the parent's employment.
Last year, the President submitted a bold welfare reform bill, the Work and Responsibility
Act of 1994, which embodied these values. It continued the assurance of child care as
families move toward self-sufficiency, and made important new investments in child ccue' .
jor working poor families. At the same time, it extended health, safety, and quality
provisions to all the major federal child care programs.
These important supports that enable parents to work and to ensure children's safe and
healthy development appear to be missing from the Chairman's mark before you. Thereiore,
�Page 2
Ihf'Administration hds
CI
number of concerns:
o
The proposed legisldtion provides no assurance of child care to AFDC
recipients who work or dre preparing to work -- even if a Sidle requires them
to partiCipate in work or training .. We should and must require all parents to
become aCllve and productive workers. And al the SBme lime, we should
assisl them in their efforls to care for their children so thai Iheir children are
nOI .Ieil home alone or in unsafe'situations.
o
The proposed legislation may require states to choose belween serving
families making the transition from welfare to work and working families thai
need child care assistance to keep them from falling onto welfare. With a cap
on total funding for child care far below projected spending under current
. law, and no separate guaranteed source of child care assistance for welfare
recipients, the legislation could conceivably reduce assistance by limiting
availability to only approximately 200,000 of the million children of hard
working American families by FY 2000 currently receiving federal child care
support. The Administration believes that we should support working families
and that families should not have to go on welfare to receive child care
assistance. Moreover, as demonstrated by the waiver applications the
Department has received, states which are committed to making AFDC
recipients work view child care as an indispensable tool in their efforts.
o
The proposed legislation repeals' provisions for children's health and safety
, contained in the Child Care and Development Block Grant. These provisions
were passed with bipartisan support in Congress and signed into law by
President Bush after an extensive national debate. They represent a carefully
crafted balance between state flexibility and the national interest in children's
safety and healthy development. The provisions do not specify any standards
at the federal level but instead require that states have such standards in three
areas: control of infectious diseases, physical premises safety, and provider
training. A study released in the last few weeks reported that most child care
is far from adequate and that 40 percent of infant-toddler centers provide poor
quality care. We believe that the proposed legislation could increase risks to
chil~ren's basic health and safety.
o
T-he proposed legislation also repeals the provision in the Child Care and
Development Block Grant that provides resources for quality care, as well as
early childhood, before-school and after-school programs. This provision has
been instrumental in ensuring that parents have choices among quality
alternatives for their children. States have used these resources to build the
supply of quality care, provide critical consumer education to parents,
improve licenSing and monitoring, and increase the training and supports to
child care providers. The repeal of this provision raises concerns .
•
�Page 3
'ihe Administration supports an approach to child care that genuinely supports work ior
parents, and safety and heahhydevelopment (or children, Such an approach would assume
child care (or families moving toward seli-sufficiency and expand child care opponunilles
'lor working f~milies ,who want to avoid weliare dependency. We believe that ensuring
quality choices for parents, and providing ior continuity of services for:children and famille ...
·;hould be an element of such d proposdl,
•
Children become part of the child weliare system because they have been abused or
neglected or are in danger of abuse or neglect. The Administration has serious concerns.
I~xpressed in the letter to Ways and Means Subcommittee Chairman Clay Shaw and Ranking
Member Harold Ford last week, about the proposed block grant approach to child
protection. There is unanimous agreement that the system for serving abused and neglected
children and their families is seriously overburdened and unable to respond adequately to
i:he needs of children today. The block grant approach potentially endangers the safety of
'ihese children by reducing funds for services and for foster and adoptive homes, eliminating
,I:ritical protections for their well-being, and potentially halting progress in states that are
moving forward on the reforms that are needed in this system.
The proposed legislation consolidates existing programs into a block grant with nominal
federal oversight and reduces resources significantly from the current services baseline. The
A.dministration has serious concerns about these provisions. First, the proposed legislation
caps spending for child protection at $5.6 billion less than projected baseline spending over
5 years. This cut could force states to gamble with children's well-being - choosing
whether to: leave maltreatment reports uninvestigated, leave children in unsafe homes with
minimal services, cut payments to foster parents, or eliminate prevention. Second, the
proposed legislation virtually eliminates federal monitoring and accountability mechanisms
and also eliminates federal support for research, training, technical assistance, and
demonstration projects. It would be virtually impossible for the Federal Government to '
assure the safety of children' or help states improve their systems.
The Chairman's mark repeals the Abandoned Infants Assistance Act, the Child Abuse
Prevention and Treatment Act, the Adoption Opportunities Program, the Crisis Nurseries
Act, the Missing Children'S Assistance Act, and the Family Support Centers program under
the Stewart B. McKinney Homeless Assistance Act. The activities authorized under these
programs would be permitted but not required under the Child Protection Block Grdlll
approved by the Ways and Means Subcommittee on Human Resources.
In addition to general concerns about the' block granting of child protection funds. the'
Administration has several specific concerns about the proposed repeal of programs within
the jurisdiction of your Committee,
�P,lge 4
o
The proposed legislation repeals the Adoption Opportunities program and eliminates
the Adoption Assistance program, leaVing It up to states whether they can afford the
subsidies that enable many special needs children to find permanent homes. These
repeals could slow the progress that hds been made on adoptions since 1988.
(')
The legislation repeals the Abandoned Infants program, whi<;h was established to
respond to the continuing crises of AIDS and crack cocaine. These crises have
disproportionate effects on families and child welfare systems in selected urban dreas.
o
The proposed legislation eliminates all direct federal support ior non-profit agencies,
community-based organizations and public-private partnerships, such as Children's
Trust Funds, as well as all earmarked support for prevention of child abuse and
neglect.
1he Administration is committed to improving the child welfare system. The system must
ensure the safety of children and strengthen the capacity of parents to nurture healthy
children. Given the critical nature of these services, the Administration supports an
Clpproach to change that provides states and communities with flexibility to develop services
that are responsive to the needs of their citizens, but within the context of a national
framework that maintains a commitment to federal resources, and strong, effective
protections for children and families.
In summary, the Administration looks forward to working with the Committee in a bipartisan
lashion to promote two key goals: work for families and safety and healthy development for
children. But we are concerned that the proposed .legislation does not move toward these
goals. II does nothing to provide child care that would move families from welfare to work,
and il risks moving families who are now working back onto welfare as they lose child care
.lssist;mce. It weakens protections for children's safety in child care, and gambles with their
well-being if they are abused or neglected. It neither holds state bureaucracies accountable
!lor cushions state taxpayers against recession or growing family needs. We believe there
·.ue alternative approaches to reform that achieve our mutual goals in far more constructive
and accountable ways.
The Office of Management and Budget advises that there is no objection to the transmittal
of this report to C<:»ngress.
A similar letter also was sent to Representative William Clay and members of the Committee
on Economic and Educational Opportunities.
.
Sincerely,
Donna E. Shalala
�ESTIMATED REDUCTION IN FEDERAL SPENDING FOR CHILD CARE FROM PROPOSED CHILD CARE BLOCK GRANT
(Numbers in millions)
ESTIMATED REDUCTION IN FEDERAL SPENDING
UNDER CHILD CARE BLOCK GRANT USING
IlliS BUDGET AUTHORITY BASELINE FIGURES
5 Year
Total
1996
1997
1998.
1999
2000
AFDC/JOBS
.TCC
At-Risk
CCDBG
Child Devment Associate Scholarships
Dependent Care Planning and Devment Grants
Native Hawaiian Family Centers (CBO est.)
734
220
300
1,049·
1
13
5
784
234
300
1,049
1
14
5
829
248
300
1,049
1
14
6
869
260
300
1,049
2
14
6
911
272
1,049
2
15
6
SUBTOTAI.. HIlS BASELINES
2,322
2,387
2,447
2,500
2,555
12,211
CHILD CARE BLOCK GRANT
REDUCED SPENDING FOR CHILD CARE
PERCENT REDUCTION IN SPENDING
1,943
-379
-16%
1,943
-444
-19%
1,943
-504
-21%
1,943
-557
-22%
1,943
-612
-24%
9,715
-2,496
-20.4%
..
. Notes:
I. This Child Care Block Grant freezes funding at the FY1994 levels estimated in CBO's baseline.
2. The numbers above are IlliS estimates based on baseline figures from the President's FYI996 budget except for
the Native Hawaiian Family Centers estimate which is from the CBO baseline. .
3. CBO estimates were based on January 1995 CBO Baseline figures. They estimate five year savings
of $1. 7b or a 15 percent reduction in spending. These differ from IlliS estimates due to baseline differences.
4. Savings projected by the EEO committee are based on CBO baseline figures.
300
4,127
1,234
1,500
5,245
7
70
28
�REDUCED FEDERAL CHILD CARE ASSISTANCE FOR STATES AND CHn.DREN IN FYlOOO
LOSS IN FEDERAL REDUCfION IN CHILDREN
CHILD CARE ASSISTANCE
RECEIVING FEDERAL
.
FROM BLOCK GRANT CHILD CARE ASSISTANCE
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTlctrr
DELAWARE
DISTRICf OF COLUMBIA
FLORIDA
GEORG~
KAWAU
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KEN'llJCKY .
LOUISIANA
MAINE
MARYLAND
MASSACBUSETI'S
MICHIGAN
MINNESOTA
MlSSISSPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORm CAROLINA
NORm DAKOTA
omo
OKLAHOMA
OREGON
PENNSYLVANIA
PUERTO RICO
RHODE ISLAND .
soum CARoLINA
soumDAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
TRIBES
TElUUTORIES
ALL STAT1!'S
Percent RedudloD
$11.3
$1.5
$10.3
$4.6
$53.7
$6.3
$7.0
$1.9
$1.8
$25.7
1$21.2
. ; ,,2.0
$2.4
$12.1
$12.3
$4.8
$6.4
$10.6
$11.3
$2.0
$11.1
$16.3
$15.2
$11.1
$6.6
$12.0
$13
$5.0
$1.9
,
$2.1
,
$10.5
$5.3
$37.0
$27.7
$1.5
$21.9
$11.3
$8.8
$24.2
$7.7
$1.7
$73
$1.5
$16.8
$44.4
$6.8
$1.6
$11.3
$16.4
$4.5
$10.1
$1.4
$18.4
$3.1
$612.0
24.0411
6,970
930
6,350
2,840
33,130
3,890
4,320
1,170
1,110
15,850
13,080
1,230
1,480
13,630
7,590
2,960
3,950
6,540
6,970
1,230
6,850
10,060
9,380
6,850
4,070
7,400
1,170
3,080
1,170
1,300
6,480
3,270
12,830
17,090
930
17,830
6,970
5,430
14,930
4,750
1,670
4,870
930
10,360
27,390
4,190
990
6,970
10,120
2,780
6,230
860
11,350
1,910
377,680
Notes:
1. The blGdt gnmt amoUDt is set at FYl9N CBO BaseIIae levels.
2. FuDds are aIJoc:ated aceontiug to HBS figures OD FYl9N apeDdltuns aDd aDocatIoDS.
3. FYlOOO figures are FYl9N a.Ilocatious aDd espeudItures acijusted by the uaUoual growth rate figura.
4. CbBdrea served WIIS detenDIued by dh1diug total federal aIIoc:aUoasaDd expeaditures
by au average federal apeadIture O.pre of $lQl~ 'I1dI1s DOt a full-Clale equtvaJ.eat.
5. Numbers may DOt aaetly equal ~ual ~ due to roUDdiug.
�REDUCED FEDERAL CHILD CARE ASSISTANCE FOR STATES
AND CHILDREN IN FY 2000
This table shows FY 2000 losses in funding and in numbers of children receiving federal assistance
under the new child care block grant.
FUNDING LOSS
,
•
The funding loss is the difference between the FY 2000 block grant distribution and the expected FY
2000 funding level under current law. FY 2000 funds are distributed according the proportion of
federal child care funds received in FY 1994, as is proposed in the draft EEO bill.
REDUCTION IN CHILDREN RECEIVING FEDERAL CHILD CARE ASSISTANCE
The reduction in children is derived from the State's funding loss and the national average child care
funding per child. Average funding per child was calculated by dividing the total federal child care
funding in FY 1993 by the total number ofchildren served through federal child care programs in
that year. This number is nota full-time equivalent cost. It does not contain state or parent
contributions to the cost of care. The FY 1993'funding per child was inflated to Fy 2000 according
to the HHS baseline.
�,
Talking Points Child Care
Key themes
1.
~. .ilies
affor4~le
struggliDg to ~ecome self-sufficieDt Dee4 access to
chi14 care iD or4er to participate iD e4ucatioD,
traiDiDg aD4 work.
o Studies indicate that when child care arranqements break down,
families are more likely to drop out and qo back on welfare.
o More than 400,000 children each month receive child care
assistance throuqh the AFDC and Transitional Child Care quarantees.
Assistance for these children and their families is in jeopardy if
child care funds are capped. If women are forced to work without
adequate child care, their chi14reD cou14 ~e left home aloDe.
2. ~. .ilies shou14 Dot have to go iD the welfare liDe to get chi14
care assistaDce.
o Almost one million children of workinq poor families receive
assistance throuqh the At-Risk and Child Care and Development Block
Grant Proqrams. If child care funds are capped, these hard workinq
American families could be cut off and put at-risk for welfare
dependency.
o Millions of other workinq families are already in need of
child care assistance. Low-income families who pay for child care
spend more than a quarter of their income on child care expenses.
GAO found lonq waitinq lists. for child care assistance in 5 out of
6 states they visited. For example they found 40,000 children on
the waitinq list in Texas and 225,000 children in California.
3. The quality of care is far from a4equate. Poor quality care
threatens childrens' development. The recent study conducted by
economists and child development experts confirms that quality care
is related to child outcomes. The vast majority of care in the
country was found to be mediocre, with 40 percent of infant care
considered poor.
Child Care and the Clinton Administration
,
I'
,
.
o The President has included increases in child care in every
budqet submitted to Conqress. Furthermore, the Work and
Responsibility Act introduced last year included the continuation
of the child care quarantees for families movinq towards .economic
independence and an investment of $1.5 billion for workinq poor
families at-risk for welfare dependency.
�o The administration has worked .to make programs more
consistent and coordinated: proposing new regulations to reduce red
tape, improve quality, and give states more flexibility and
streamlining child care operations into a single Child Care Bureau.
o The administration has revamped and strengthened technical
assistance" to the states, territories and tribes to ensure that
they have access to the best available information on quality
issues, particularly health and safety. In addition, we have
launched a National Child Care Information Center for policymakers
and the general public.
.,
�'r
Children in the child Protection system
Abused children
• 2.9 million children were reported as abused or
neglected in 1993.
Among sUbstantiated cases of· child maltreatment, 44%
were for neglect, 22% were for physical abuse, 13% for
sexual abuse, 5% for emotional. maltreatment, and 16%
for other forms of maltreatment.
• 1,028 child fatalities from maltreatment were
reported by 46 states in 1993.
(The National Committee
for Prevention of child Abuse estimates that there were
1,261 child fatalities from maltreatment in all the
.
states in 1992)
Childr~n
in Foster Care
• Approximately 444,000 children are projected to have
been in foster care at the end of 1993; the number of
children who enter and exit foster care each year is
substantially higher.
.
• Of these children, about 245,000 qualify for federal
reimbursement under Title IV-E Foster Care Maintenance
payments.
• During 1990, the number of children in care increased
by 11.8%, the largest increase since 1982.
• Two-thirds of the children leaving care return to
their own families.
Adoption
• During 1990, an estimated 17,000 children who had
been in foster care had their adoptions finalized.
• During 1990, 69,000 children in the foster care
system had the goal of adoption, 20,000 of whom were
legally free (i.e. parental rights had been
terminated) .
• During 1990, the median length of time that children
waited for adoption was 1.8 years.
The data are from the National Child Abuse and Neglect Data
System (NCANDS) and the Voluntary Cooperative Information System,
1993 (administered by American Public Welfare Association)
�Talking Points on Shaw child Protection Block Grant
• The proposed Chi'ld Protection Block Grant will not protect
children in crisis nor reform the child welfare system. The
amount of the block grant is set at $4.1 billion in FY96
compared with, $4.75 billion that would have been available
if current programs were continued. Over five years, $5.6
billion of federal funding for state child protection
systems will be lost.
• The child protection system today is overburdened and unable
to respond adequately to the needs of children. Nearly 3
million children - 4% of America's children - were the
subjects of abuse and neglect reports in 1993, a nearly 25%
increase from 1988; 40% of the reports were substantiated,
affecting 1 million children. Over one thousand children
die each year from maltreatment.
During that same period, foster care case loads increased by
almost 50%, reaching 440,000 children in foster care at the
end of 1993. Close to 25% of children entering foster care
are under age one, and many were exposed to drugs
prenatally.
• capping foster care and adoption assistance payments
eliminates a critical safety valve for the states.
State
laws appropriately require courts to place children in
foster care ~hen they will not be safe at home, and
placement is affected by many unpredictable factors such as
population growth and poverty, economic dislocation,
parental drug use and the numbers of abused and neglected
children being identified.
Other parts of the Personal Responsibility Act, which reduce
funds for AFDC, SST and other programs that provide basic
support to society's vulnerable children, may also increase
the numbers of children needing protec~ion and State care.
t
Eliminating adoption assistance payments and including them
in a capped block grant could lead to sharp cutbacks in
efforts to recruit adoptive parents and place children in
adoptive homes •
• The proposed use of a funding formula which allocates funds
to states based on past claims of Federal dollars severely
disadvantages States that have growing needs or that are
only beginning to reform and improve their systems. Given
limited resources and burgeoning need for protective
intervention and foster care, few resources will be
available for critical services that promote improved
outcomes for children: community-based prevention and
permanency.
�• Under this proposal, more States may come under court
supervision of their child protection systems. In the past
few years, courts in 22 States and the District of Columbia
have found that the child welfare system violates state and
federal laws for protecting abused and neglected children.
Courts have found that many reports of child abuse are not
investigated, chi~dren in foster care lack case plans and in
some instances even have no caseworker, children are not
provided with basic protections and children under agency
care continue to be damaged both at home or in foster care .
• The proposal virtually eliminates Federal accountability and
enforcement mechanisms. Local citizen review boards
authorized in the bill have no enforcement powers and the
bill specifically prohibits federal enforcement of any
provisions of the Block Grant that relate to protecting
children, even if a State is not complying with any of the
activities it certified it would carry out.
�.SUMHARY BUDGET TABLE POR
SHAW CHILD PROTECTION BLOCK GRANT
This table summarizes the likely budgetary impact of the Shaw
proposal to block grant child welfare programs. As reflected in
the table~ between FY 1996 and FY 2000, states will lose almost
$5.6 billion, or 20 percent of their funding.
Notes:
1.
FY 1994 levels are actual expenditures. Levels for FYs
1995-2000 reflect projected outlays based on the President's
current services baseline.
2.
CAPTA community Based Family Resource Program (CBFRP) was
first funded in FY 1995 as a consolidation of three programs: the
Emergency Protection Grants Program; the CAPTA Community-Based
Prevention Program; and the Family Resource and Support Center
Program. The FY 1994 level reflects the sum of the levels for
the three consolidated programs.
�BUDGETARY IMPACT OF SHAW CHILD PROTECTION BLOCK GRANT PROPOSAL
Current law estimates as compared to proposed block grant: Outlays in $ millions
FY 1995
Estimate
13-Feb-95 FY 1994
Actual
FY 1997
Baseline
FY 1996
Baseline
FY 1998
Baseline
FY2000
Baseline
FY 1999
Baseline
5-year
Total
$2,655
314
61
267
1
5
4
7
17
12
24
10
12
10
3
77
7
2
$3,118
407
71
304
67
6
4
10
22
16
28
15
15
12
10
76
7
3
$3,506
475
70
301
148
6
4
29
23
15
32
15
14
13
7
78
7
3
$3,740
519
70
308
212
6
5
31
23
15
34
15
14
13
8
81
7
3
$4,090
562
70
318
237
7
5
33
24
16
35
16
15
14
9
83
7
3
$4,471
608
70
328
253
7
5
34
25
17
36
16
16
14
9
86
8
3
$4,884
658
70
338
263
7
5
35
26
17
37
17
16
15
9
88
8
3
1
g
g
g
g
g
g
$3,489
$4,192
$4,749
$5,107
$5.544
$6,006
$6.498
$20,691
$2,822
$350
$1,592
$1,112
$34
$24
$162
$120
$81
$173
$79
$76
$69
$43
$416
$37
$16
I§
$27,905
Shaw Block Grant Levella
$4,145
$4,308
$4,471
·$4,631
$4.789
$22.344
Difference
-$604
-$1,073
-$1,375
-$1,709
-$5,561
IV-E Foster Care
IV-E Adoption Assistance
IV-E Independent Uving
IV-B Child Welfare Services
IV-B Family Preservation/Support
IV-B Research and Demonstration
IV-B Training
CAPT A Commun. Family Resource Program
CAPTA State Grants
CAPTA Discretionary
Family Violence Prevention and Services
.Social Services Research
Abandoned Infants
Adoption Opportunities
Family Support Centers
Family Unification Program (HUD) la
Missing and Exploited Children (DoJ) la
Children'S Advocacy Centers (OoJ) la
Prosecution of Child Abuse (OoJ} /a
Total, Child Welfare programs
Percent lost
-13%
-$799.
,.
-16%
-19%
FY 1994 figures are actual outlays. All other Figures are based on Administration baseline projections.
/a Assumes all funds outlay In the year they are appropriated.
~
-23%
-26%
-20%
-
�'"
'I
..
EFFECTS OF THE CHILD PROTECTION BLOCK GRANT IN THE YEAR 2000
FY 2000 Current Law Estimate':
FY 2000 Proposed Block Grant Level:
Amount of funds that are cut:
$6,498,000,000
-$4,789,000,000
$1,709,000,000
Estimated Federal cost per
foster child in FY 2000 2 :
$15,282
Number of foster care slots losf:
111,831
I ,
1
Based on Current Services estimates from the President's FY 1996 Budget
2Projection based on Federal share of costs for Federally subsidized foster care.
3 Assumes
that States apply the $1.7 billion cut to foster care.
�E X E CUT I V E
OFF ICE
o F
PRE SID E N T
THE
OI-Mar-1995 06:20pm
TO:
Carol H. Rasco
FROM:
Bruce N. Reed
Domestic Policy Council·
SUBJECT:
Sorry to miss the staff mtg -- we're crashing on the welfare
speech for NACO -- they decided they wanted a draft for Friday.
We're trying to come up with a few new stories about real people.
Do you remember anything special from either the meeting with
child support moms in January or the meeting with welfare moms in
Kansas City last June?
We had another good day on the Hill, beating. the Repubs up on work
(they can meet their work reqts just by cutting people off) and
stirring dissension among the pro-lifers (two Repubs circulated a
Dear colleague to strike the under-IS provision).
I
�Il/5c:'r;~ ~'1
F-
.1'11-0-,
I.
@
Talking Points on
. ;~\ .
y
~/~. 'f?
~
\
--'Republican Rescission proposals:
(J
,'.
"A War on Chilelren anel 'the Poor"
rescis~ions
lIe••&9'e: The House
pr0P<;'sed
would
. severely hurt the most ~~~~~~~~~~anB-==~~~~~ and
the poor -- in order "to
l.es Amerl.can.
The proposals are mean-spirited and short~sighted. They are
part of a .larger Republican effort that represents tea war on
children and the poor." The effort includes the recent deCiSion
to terminate the school lunch program and, as part of welfare
reform legislation, to slash child care assistance and child
welfare services.
'
1i
The proposed rescissions would eliminate summer jobs for
.over 600,000 youth; cut· 15,000 slots fornation,al service
programs in America's communities; deny the WIC nutrition.'
program's services and food packages to about 100,000 women,
infants, and children for six months; deprive 100,000
. disadvantaged children of special servicesjeliminate housing
assistance to nearly 90,000 low-income households ,or homeless
families; cut funds to train teachers in 4,000 ,school districts;
and eliminate a program that supports ,drug-prevention efforts in
94 percent of school districts.
The cuts are targeted squarely on 'Children and the poor. Of
the $17.1 billion in rescissions that House Appropriations
subcommittees approved last week,
".
nt come from
rams ,,1
for low-income Americans, according to the Center on Budget an
\\
policy Priorities.
While they are mean~spirited, the cuts also 'are penny-wise .
and pound~foolish. As the Committee for Economic Development, a·
respected business group, has.writteri, programs ,such as WIC save
several dollars in reduced social costs for every $1 invested'in
the program.
'These actions are only the first steps in House Republican
efforts·to target their spending cuts on the most vulnerable
members of. society. Their "reverse Robin Hood" strategy would
take from the poor, especially poor children, in'order to give to
the most well-off.
�The impacts.ofthe cuts' in the rescission package include
the following:
Children and youth
, • "'E 1 iDiifiate" :illfidifi9"~ior ·'th"Ef'" S'i.U.CIlil.er '. 10o.t:.h. Emp lOym6·!it.· progr am'
in each of the Summers of 1995 and 1996, wiping out job
opportunities for 1.2 million disadvantaged youth over the
two summers.
• cut 15, 000 ,(out of 33,000) AmeriCorps members, cutting"job
opportunities for youth and such,.... National Service activities
......
. "
as:
,-
-"
~- providing thousands of low-income and migrant
. children with immunizations;
"
-- wo'rking with' children in environmental clean-up
activities; and'
-- working in inner-city recreation areas to combat
drug traffic and violence •
• -Deny the WIC nutrition program's services and food'
, packages to about 100,000 women, infants, and children for
six months.
Education
.'''·Cut the Goals 2000 program, thus depriving 4,000 schools
in 46 states pf seed money to train teachers and upgrade
. their academic standards. .
. ' ... , . . '.'
• ,Deprive 100,000 educationally'disadvantaged children of
special services, under ·the Title I program.
• Eliminate the Safe· and Drug-Free Schools and communities
which supports drug-prevention programs in 94
percent of all school di~tricts as well as anti-violence
efforts.
'
program~
,Housing and the Hoaeless
, • '.' ,
~;.i'
:".
• ·-Eliminate subsidized housingas~ista.nce to;:'; 63., 000 needy
low-income h o u s e h o l d s . , ,:
, '·f";;,. .!.:'(
:
.~:LPrevent 24, OOOhomel'ess families .from moving. to
transitional o.rperlnanent housing this year.
~r,)
I
,
.·Eliminate the up-front funds needed to tear down the
nation's worst public housing projects.
.".
�THE WHITE HOUSE
WASHINGTON
August 3, 1995
MEMORANDUM ON BUDGET INFORMATION
TO
ALL CABINET SECRETARIES
FROM
KI1TY
HlGGINS~ ~.
FYI -- Attached is a copy of the "GOP Medicare Recess Packet."
�.
08/01/95
....................... .i. ..... 94562878
16: 46
NO.076
P002
<.
.,..,.
'.
MEDICARE PRESENTATION
SUGGESTED TALKING POINTS
GENERAL THEMES
••
•
•
•
•
Bipanisan agreement that Medicare is loing banlaup[
YOLl are personally.committed to saving die Medicare system
Traditional Medicare will rema.iD - but it may cost more
We caD protect. preserve and streDgthenMedicare
Medicare spending per·individual will increase ttom 54800 to S6700 • an
increase of Dearly 40 percent
CHART 1:
•
•
•
•
•
•
•
Purpose of the Town Hall meeting is toWk about saving Medicare
Bipanisan consensus that this is a vital program
UnfortUnately, Medicare is in deep fl.lW'lCial trouble
.It can.be fued-- aDd.we can·continue to increase spending
Holding this foromto give cODSUtueDU informatioD - and to listen to their ideas
OD how to fix Medicare
We're lisreniDg to expertS around the coumry and gathering input from seniors,·
We want to do this right,
. CHART 2:
•
Many Americans still don't realize the serious fInancial crisis facing Medicare
Ask how 1'N1Jf"j people knew Medicare was going banJcruptbejore rhey came 10 ..
the meeling)
•
The fll'st part of che meeting I want to discuss the problem with you
•
CHART 3:
•
•
April· 3 repon oftbc Medicare Trustees shows Medicare is going banlaupt
(Bold up G COJ11 of th, "pon)
Stress the bipaniSaD nature of the Trustees -- Shalala, RUbin. Reich.
Commissioner of Social Security and two public Trustees - including a
,Republican appointed by George Bush .
"
CHART 4:
;
•
•
•
BiJI Clinton and Newt Ginaric:b aaree ~- Medicare is going banlcrupt.
' But Clinton t s budget proposal 'StiJJ allows Medicare to 10 banlaupt
We hope he and Congressionbal Democrats will work with us [0 save Medicare
�•••••••••••••••••••••••••••
~
94562878
NO.B76 PBB3
....
'0'
CHART 5:
•
Problem beeins next year'. In 1996. the Medicare Trust Fund begins
more money than it is taking in.
.
Firsllime in thirty year history of the, program this bas happened
•
10
spend
CHART 6:
, According to the ~ipanisan Trustees repon. by 2002 the Trust Fund is empty.
After 20021he,problem grows, exponemially worse as we approach the baby
boomers retirement.
(Point to how ,'"ply 'hI lin, pllUlgtS aft" 1999)
•
•
CHART 7:
•
•
•
,
0
The problem is out-of.conanl spendinl. Medicare spends mon: per beneficiary
than the beneficiary pays into the system in premiums and taXes.
Dis is Dot Wbody's rault ~~ tbal's just 'how tile system is designed - full of
incendves for waste. fraud and. misuse
,
'
Buftbe,problem must be fixed - a system that speDdS 5117 thousand more per
couple than is paid into the, systeM is not sustainable:
CHART 8:
'•.
The problem must be solved now or else it grows worse every year.
There will be fewer workers suppotting each retiree on Medicare as the baby
boomers retire
CHART 9:
•
The alternative to slowing the growth of Med.icare is to raise taXes on working
Americans ..• aad tilling jobs.
CHART 10:
•
'.
We ,arc listening to all Americans. We have told doctors and hospitals that they
~ve a responsibility to help us fmd a solution anel we want to'hear what you'
have to say about what does anel doesn't work in Med.icare today.
(Stop tuUllllk, CDmpI,nn on w/uJl they think is w""n,'Dday)
�•••••••••••••••••••••••••••
~-94562878
NO.076
P004
CHART 11:
•
We believe r.bc private sector can teacb us how to slow the growth of Medicare.
The private sector bas increased choice and controlled costs.
There is DO reason why, Medicare spendina must increase at rwicelhe rate of the
private sector.
,-
•
'CHART 12:
•
Keeping growth above private sector growth allows us to keep Medicare from
loinl bankrupt and stiU increases spending.
•
We bave suengdlencd our commirmem to Medicare.
•
Medicare spending can intrease. it just can't continue to increase at over teD
. percent a year.
•
' ,Medicare will increase its commitment from $4800 per beneficiary to 56700 per
beneficiary
CHART 13:
We will spend 51900 morepcrson than we do IOdaY..
,We Ie'count for increased population and still spend $1900 more per person,
•
CHART 14:
•
Learning from the private ,sector. we willlivc seniors the right to choose
We waDtseniors to have the !tame rights as other Americans - including
Members of Congress.
•
Like Members of Congress. you will bave Ihe right to choose from a series of '
plans.
•
There are several concepu used in thi: private sector that we are coasidering for
Medicare options.
'
•
Basic Mtdic;are will remain. Premiums will increase, just as
they would if did
nothing.
Mana&ed Care is IDOthcr option available to millions of Americans, including
Members of Congress. Manaled Care uses a Mcworkof physicians to oraanize care
for patients. It may provide more benefits and/or lower premiums. If that's wbat
important to you. you can choose it
.
.
EmplQ)'er/AnociatiOD-based Medjcm: Right now. when a senior rums 6S. ·he or she
is forced off their hea.lth care plan aDd onto Medicare. Many retirees wam the right (0
stay on their private plan. If you want to stay on your private plan. we' will remove the
�e8/e1/95
16:46'
•••••••••••••••••••••••••••
~
94562878
ND.076
Pees
,
......
bureaucratic obstacles so'that your employer or labor union has the opportunity to offer
that choice to you. '
Mcdic:aJ sanna Accounts is a new idea desianed to live seniors more control over
their health We dollars. Beneficiary would have a high deductible catastroPtlic
insurance policy. Meclicare deposilS funds in your,own inte,rest-bearing Medical
Savings Account each year. You keep any money you c10n t use. Eacb year, a
_
beneficiary gets ~thcr deposit from Mec1icare. At the end of life. any unspent fwlds
pass tax-free to your love ones. The Medisave option provides more comroJ over
medical dollars.
l
CHART 1S
•
•\
The private sector has controlled costs by iDcreasingcompetition.
The options will force providers to serve your needs - not Washington's needs
'
CHART 16
We will simplify the Medicare system. If you want traditional Medicare - you
c1on't have to do anything - it's that simple.
•
CHART 17
If you want to consider other options. you'will receive ;mormation on each plan
- just the way Members of Congress choose each year.
.'
,
•
,CHART 18
'.
After taking time to discuss with family and friends. choose the best plan for
you ~- and know that next year you will be able to choose again.
'CHART 19
MEMORIZE THE PRINCIPLES
•
•
•
•
These are, options we are considering. which have been suggested by experts'
a~ by seniors who use the system and know where the problems arc now'
None of the options are fmalized
,
We are still collectipg your comments and ideas
Wben we put together the details. we will ~e sure they'are consistent with
Ulese prUociples
�~:
,.
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,
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•
•
•
•
•
•
.MEDICARE
•
•
•
•
•
•
•
•
•
•
•
•
..•..•••
....
•
....
:'i
fR
We are committed to preserving, .
protecting, and strengthening this vital
". . ru
~
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progr~m
~
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....
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Time is Running Out on
. Medicare
lD
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....
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~
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•
•
•
•
•
•
•
•
•
•
• Medicare's hospital
.trust fund wi II spend
more til an it takes in
next year.,
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
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• The trust fund will be
empty in seven years.
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,
gj
.What the Clinton Trustees Said in
April of This Year About Medicare's
Hospital Program:
~
•
•
.
....
,
lSI
~
....
(J)
A'
-\J
.
Under all the sets ofassumptions, the trustfund is projected
to'becon.e exhausted even before the major demographic shift
begins. " (page 3) .
•
•
•
•
•
•
•
•
•
•
•
•
•
• II
"The/act that exhaustion would occur under a broad range of
.future economic conditions, and is expected io occur in the
relatively nearfuture, indicates the urgency of addressing the·
HI trustfund'sfil,ancialin.blliance." (page 13)
Source: April 1995 Annual neport oflhe Boent of Truslecs of1he federal Uospital Insurance Program,
stCllCd by Sccrelaril!s ({uhin, Shalala and Reich
.
page)
•
•
•
•
•
•
•
•
•
•
•
•
•
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, MEDICARE REFORM IS 'A
.BIPARTISAN ISSUE
~
....
(J\
.b
-.J
•
•
•
•
•
•
•
•
•
.,
"We cannot leave the system the way it is .... When you think
about what the baby. boomers require ..• that's going to require
significant long term structural adjustment. '"We'll have to look at
.wllat we can do there. But the main thing we can't do-- we can't
have this thing go broke in the meanwhile. ",
" (President Clinton, 6/11/95) ,
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
4
W
.b
UI
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IV
,.
. ttl do think.· the (President put his finger on something here where I
think .we analyze it slightly different but we both have the same _
commitment ... I think in spirit we're not that far apart. The thing'
't'
. that is driving us is that the trustees reported that Medicare will go·
broke by 2002. "
..(Speaker Gingrich, 6/11/95)
page 4
'"
--_._._-----_.
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5
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~
MEDICARE HOSPITAL TRUST FUND
STARTS GOING BROKE IN 1996
....
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~
....
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-.J
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
,(spending greater than revenue)
$BIlLIONS
. $10
$0
($10)
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($20)- .
"
($30)
....
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, ($40)
($50) I J
($60)
($'70)
I '' . i . '
1994 1995 1996 '997 1998 1999 2000 2D01
,m. '
'i"J5J,J
F,
i.
2D02 2003 2004
..(j
Source: 1995 Annual RepDrt of the HI Trusta.s. April 189& p. 13
~
0"1
page 5
~
....
IS)
�"
/
m
~
....
,
MEDICARE HOSPITAL TRUST FUND
" EMPTY IN SEVEN YEARS
IJ)
(J1 .
....
()"I
A
...J
(Trust Fund Reserves)
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Sbillions
$150
$100
$50 .
I
=>. . .
I
..
'<
...
$0
,..
't.'
($50)
I
($100)
I
(5150)
*
Rl
ro
...J
ro
...L-'
'"
'\:
----------~--------
1993
.1995
1997
1999
2001·
2003
a
~
Source: 1995 Annual R~port ot the HI Trustees, April i99S, p. 13
pageS
;!l
....
....
�..
~
(SI
(I)
"
"
(SI
.....
tD
UI
.....
Me~icare
Spending Per Beneficiary
Ecxcee'ds Contributions
m
llo.
--:J
•
•
•
•
•
•
•
•
'.
•
•
•
•
•
•
•
•
•
•
•
•
•
For a two-earner couple retiring in 1995. over their lifetime,Medicare. will spend
$117 thousand more than the couple paid in taxes and premiums
'.•
•
•
•
..
200
\D
llo.
t'!
150
WI
o
.. '. .
\
"
a
..
(I)
100
-
;
UI
N
(I)
--:J
m
50
CIJ
"
c:
CIJ
~
.c
o
taxes and premiums
Medic.re Benefds
a
IS)
~
-
Source: Gene Steurle, Urban hlstitute
page 7
;E
.....
N
�1
i
m
,
....
,
I:SI
. Current Medicare Crisis Will Only
Get Worse as Population Ages
\0
UI
....
0'1
l\.
-.J
•
•
•
•
•
•
•
•
•
•
•
•
•
ratio of active workers to Medicare beneficiaries
•
•
•
•
•
•
•
•
•
•
•
•
•
•
I
3.5
3.0
'"
. 2.0
2.5
V1.
UI
,.
,:
2.0
0'1
I\J
(I)
-.J
(I)
1.5
1.0
0.5
0.0
1995
2005
'
2015
2025
a
2035
I:SI
~
page 8
-
~
....
w
�m
(1)
,
m
.....
,
m
.....
ID
~
(1)
J'
If We Don't Reform Medicare,
Payroll Taxes Will Have to
Double by 2020
to Avoid Bankruptcy
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
4
~
N
,
•
ot' .
(1)
-.J
(1)
"
Source: 1995 Annual Report of III Trustees, page 20
page 9
a
~
clJ
.....
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(JJ
"
....
IS)
We are working to make Doctors and
. Hospitals part of the Medicare solution, not
part of the Medicare problem.
....,
..
"
~
....
IJ"I
A
(JJ
•
•
•
•
•
•
•
•
•
•
•
•
•
•
..
•
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I'
•
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.., " - - '
)d~~
~.
U)
,.~
1 11
'
A
Ul
IJ"I
1\1
!~
(JJ
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oJ
. J~~~
,,,,v~
\\\~
i\
{i) II
I,
e
IS)
~
page 10
~
....
Ul
�There is Hope:
.Private Sector Has Made Improvements
that Can I-Ielp Medicare
"!,
.,
IS)
'?!
IS)
.....
"
m
.....
(J'I
.Do
m
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
'.
(1994 Spending. Growth)
•
•
•
•
•
•
•
•
•
•
•
12.00/0
10.0Ofo
",a..
8.0%
6~0%
~
~
(
4.00/0
2.0%
0.0%
-2.00/0
Medicare
Part A
Sources: t995 Annuat Report
"
large
.
employer
health
spending.
of HI Truslees and "HCFA actuaries
a
~
page 11
;B
tn·
�.
91
,
m
,
~
Per Beneficiary Spending Will
Increase 40 Percent
1.0
U1
~
(J'I
b
ro
•
•
•
•
•
•
•
•
•
•
.,
:tr
•
•
•
•
•
•
•
$',000
'••••.
$6,5OD
•
•
•
•
•
'8,000
.",
$5~500
'Ul
:R
$6,000
{I)
~
$4,500
$4,000
"
$3,500
e
$3.000
1995
2002
~
(J'I
page 12
.
~
t-:"
""
'
�m
,
....
,
UJ
IS)
U1
....
(J'\
b
m
•
•
•
.'~
.. Medicare Spending .
WillIncrease· .
...$1 ,900 per Person / .
.
,
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
...
'J1.
aq
'I\J
~.
.
'
tj
page
n
~
.(J'\
.~
....
m
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~
.....
SENIORS SHOULD HAVE THE RIGHT '
.....
(T\
A
rn
, TO CHOOSE
,
~
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
-:"
,
OPTIONS WE ARE EXPLORING'
4o'
•
•
•
•
•
•
•
•
•
•
,.
Your' Current Medicare Plan,
Coordinated Care choices
Employer/Association based Medicare
Medical ,Savings Accounts
I.D
A
tn
~
.'
a
rage 14
~
~'"
I.D
�m
,
THE RIGHT TO CHOOSE WILL HELp·
SLOW THE GROWTH (!~;~~ MEDICARE
m
.....
,
~
.....
(J\
.A
m
•
•
•
•
I"
~,
_I
-v Private sector forces
provider~
to compete for the
individual's business~-- 'not the government's business
~
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
.'
Private sector forces providers to simplify the system and
give seniors moreinf~rmation
'"
'f1
~
, N
(IJ
aJ
'.,.; Bureaucrats will no 'longer' be allowed to make all the
decisions and keep all the information in Washington.
•.
page 15
e
~
~
~
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,
lSI
m
lSI
~
IF YOU WANT TO .KEEP YOUR
·MEDICA1~. ~ .
.~
tR
~
(J'\
'~
m
.
YOU DON'T HAVE TO DO ANYTHING
,
·
•
•
•
•
•
•
•
.
.!
.
•
•
•
•
•
•
•
•
•
•
•
'"
'l1.
~
~
m
.YOU ARE AUTOMATICALLY'
ENROLLED'
"
YOUR BENEFITS WILL CONTINUE
a
pa'ge 16 "
~
;B
·N
~
.
�,.
~
THE RIGHT TO CHOOSE WILL BE REAL:
lSI
....
~
....
(J\
b.
(I)
:.
-,
Each Year Medicare Beneficiaries will
Receive Information About the Medicare
Menu of Options
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
...
'11.
f8
~
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o
page 17
!g
(J\
~
~
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•
•
•
•
•
•
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•
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•
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•
•
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•
•
..
,ft
• "l
..
•
.
•
•.
.
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~
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m
.--1
. AND -THE NEXT YEAR -- IF YOUR .
NEEDS CHANGE -- YOU CAN CHOOSE
AGAIN
page IR
·0
.
~
.~
l;J
�.
..
.
Strengthening Medicare for the 21st Century
A Statement of Principles
~ We must act immediately to preser~eMedicare for current .
"retirees and to protect the system for the next generation
"
.
!
....
,
w
U1
....
(J)
A
W
•
•
•
•
•
•
•
Medicare spending must increase, but at a slower rate
.'~
~ Senior citizens deserve the same choices available to other
Americans
•
•
•
•
•
•
•
•
•
•
..
•
•
•
•
•
•
•
•
•
~
Government must "not interfere in the relationship between
patients and their doctors
'"
m
W
A
~
OJ
" Senior citizens shoul~ be rewarded for helping root out waste,
fraud,) and abuse"
"
;
"" Stre~gtltening Medicare is too important to be left to "politicsas-usual
page 19
ft
o
.
~
~"
·A
�THE WHITE HOUSE
I
WASHINGTON
MEMORANDUM
To:
Pat Griffin
From: Chris Jennings
Date: December 6, 1994
Re:
cc:
Senator Packwood and Health Care Reform
I
Carol Rasco
Bob Rubin
Janet Murguia
During the Congressional reception, Senator Packwood raised a number of interesting
issues related to health care reform that I thought I should pass on to you.
The soon to be new Finance Chairman said he thought health care should be one of
the top priorities for the Republicans this year -- certainly within their top five. As far as
he personally is concerned, he thinks that the Finance Committee should take on this issue
because (1) there will be no trade legislation and (2) he thinks welfare reform will "either
happen or not happen." (Although he did not say so explicitly, he certainly indicated that tax
policy changes will likely be the Committee's first priority.)
Senator Packwood thinks there is a real chance for some bipartisan health initiative'
and he also stated h~ was interested in meeting on this issue (with Carol, Bob and other
appropriate Administration reps) soon after he gets back from his io day recess, which begins
next week. Two points of particular interest: (1) insurance reforms should be pursued and
(2) Republicans will reject all taxes -- except that he's been surprised that a number of them
do not characterize assessing tobacco a tax. Senator· Packwood said that "voters, for whatever
reason, don't have a problem with this." (He indicated he would be supportive and, not too
surprisingly, that it would make it easier for him if we initiated the proposal.)
Pat, I will see you tomorrow to go over this ,and help you prepare for Thursday's
meeting. See you then.
�'i
.I'
AGENDA
NOVEMBER 23, 1994
COST CONTAINMENT
I.
Introduction
II.
Presentation of Health Care Expenditures Data and Projections
III.
Review of Previously Proposed Scorable Cost. Containment Initiatives
1. Expenditure Caps
2. Premium Caps
3. Traditional Medicare Savings
4. Cost Containment Commission
IV.
Market-OrientedlTax-Incentive Cost Containment Alternatives
1. Tax Caps
2. High Cost Plans Assessment
3. Medical Savings Accounts
V.
Medicare and Medicaid Structural Cost Containment Initiatives
1. Reform Payment Procedures
2. Promote Competition
,
3. Managed Care: Medicare and Medicaid
VI.
Closing Remarks and Description of Meetings to Follow
l=
,,
carol
Ras~:
__
�>
,,/
PERCENT INCREASE IN INFLATION-ADJUSTED
. NATIONAL HEALTH SPENDING, 1970-1993
12%1 NIXON 1973:
PRICE CONTROLS
l
CARTER 1979:'
,PRO,VID,ER
,EFFORT
.
I
. --T-
w
Cf)
~
cr:
o
V,
::J'-'---'
OLUN. T, ARY
.
REAGAN 1984:
---1-----'--,. ----..,..
,
.. 1%. _ _ _..
_ _
.. J.o/II ....
__ .. _ _
.. .... _
Z
U
0::: 5%
w
0..
2%·..
0%
1973
1976
W8L1NT0N199;-----.-1
MEDICARE REFORMS
PUSHES HEALTH PLAN
.~
I
Z
W
1970
".
1979
1982
SOURCE: HEALTH CARE FINANCING ADMINISTRATION AND BUREAU OF LABOR
STATISTICS. DEFLATOR IS CPI·U
.
_,
_ ....
Jj'1l.
....
.. ....
..
.. _
J
�-~~
>.
•
,.II'
'"
National Health Expenditures
As a Percent of G.ross Domestic Product
1960 to 1993
$884 billion - actual 1993
$903 billion estimated in 1992 for 1993
14%
12 %-~ -
---- --
10% + -- -------
------
------- ---------------
8%
-- - - --- -------- --- --- --- ---
6%
---~~------,~---
4%
2«7'(
O
-------
---------------- -------
-----------~~--
------
--------- -------
I
_.
..-
----
---
---
----
---
--
-- --
0% .....---,---r-,--.-.---,,-----r-~--r-::~II--r-r.::-r::-:;II~-T.~J_=II~~;r_~~f\I)"rrT()h
1
._1
Source: HCFNOflice of the Aclltary & OMI3; Analysis: OMBlHealth Finance Branch
�Growth in National Health Expenditures
As a Percent of Gross Domestic Product
Three Possible Scenarios
$3.959 trillion
9.2% Rate of Growth
260/0
I
Actual
. Projected
-1- -------
/0
24 °/
----- ----- ---- ----
I
22%-~--
-
trillion
8.8% Rate
.----,----- ----- ------ - ---.--- ----- ----- ----- --./
,/'
I
20%
----- ----- -----
----
I
18% -- - --16 °/ ~
/or
J
~ -
..... . ...
12%[
8.0% Rate
~
I
I
---
I
.__ __
___ _ _ ___ ____ _
--. -- -~
140/0 -:--.
1990
1--
--
~
~
I
19§5
'20bo
1992-93 Growth in Medical Price & VI - .
I
1980-93 Growth in Medical Price & VI
Note: VI means Volume and Intensity
Source: HCFNOfficc of the Actuary & OMB; Analysis: OMB/Health Finance Branch
.1
'20bs
I
1965-93 Growth in Medical Price & VI
�Private &PubJic Health Spending
Relative to their 1980 Levels
500%
I
The Office of the Actuary
expect the growth nite for
Medicaid to slow significantly
starting in 1994.
.
Medicaid
en 400%
......
=
=
----------
--------
~
/
"CS
~
~
r.f1
/"
o
~ 300%
..I"""!
Medicare
_ \__
o
......
~
>
......
......
-
4->
IF
Consumer Payments
~.
~ 200%
--
100% ~.... ~~-,---,-----.---,-----r-~---r----r---'--'---::--::-c-::--~------r-~---'
1985
Medicare
Source: HCFAlOffice of the Actuary; Analysis: OMBlHealth Finance Branch
-
Medicaid·
1990
Consumer Payments
�Consumer Price Index
All Goods v. Medical
10%
CI.I
~
..=
U
t'>1
8%
......
.=
CI.I
!U
6%
CI.I
=
=
4%
.
2%
~
t'>1
=
<
CI.I
eJ)
t'>1
~
<
0% -I
IIIIIIIIIII!IIIIIIIIIII
% Change in CPI-U
Source: OM£3; Analysis: OMl3fHealth Finance Branch
% Change in CPI-M
�Ratio of Employer Paid Premiums
. to Compensation of PrivateWorkers
6% .----------:------:--:-----'-:---------:--:------
=:
o
.....
.""",
a50/0·-1-CI.I
--' ------ -- ------ --------"- --------- ------.----- -.- - - -.------. -------:-
c.
e
8
~
.....
4% -1-
------ --
----
_ _ ___
___
_ _ ___ ____ __ _ _ ___
_ _ _ _ _________
o
E-4
CM
~ 30/0
o
r.I'l
~
r.I'l
e 2%
=
s
.""",
CI.I
~
Source: HCFNOfficc of the Actuary; Analysis: OMB/Heallh Finance Branch
--
�-
-
,
MEDICARE BENEFIT OUTLAYS
.
1995 President's Budget v.
1995 Mid-Session Review
,
13.0%
'<:1)
~ 12.0%
<:1)
resident's Budget FY 1995-99: $1,078 B
id-Session Review FY 1995':99: $1,095 B
~
~
.- . . . . . . . . . .'. . . . . . . - . . . . - . -
:: 11.0%
~
r~·~,
=
.= 10.0% ' ,
,-<
-
- ..
.
-
.. .. . ..
..
.. . .. ..
- . -
9.0%
..
""
.. ... ..
-
....
.
- .. .
..
- ... - .. .
..........
-
..
.. .. .. .. ..
-
1995
1996
.
. ..
..
-
.'"
--. -. -. -.
..
-. -
'"
..
.
.. ............ -
- . .. .. .. .. ..
..
..
..
...
.. .. .. ..
.. . .. .
..
..
....
.. ....
. .. . .. -.
................
1998
1997
President's Budget Mid-Session Review'
-
Source: HCFAJ Office of the Actuary
Analysis: OMB! Health Finance Branch
-+-
.
~
.......... -. .. ..
..
-.
-
... ..
""
..
.
.
...
.. ... ..
..
.
................ - ........ ..
1999
�MEDICAID OUTLAYS
1995 President's Budget v.
. 1995 Mid-Session Review
13.0%
QJ
~ 12.0%
QJ
~
<:.J
= 11.0%
'";
::;
= 10.0%
<
~
9.0%
-
-
..........
----
- ... -
...
--
..
--
-_.
~
...
-- ..
- ....
....
-
...
~-
_
....
..
*
-
..........
- .. --
",
....
......... - ..
-
........
_
...
-
"'
............
..
--
--
_---
.
.....
-
.....
-
_- .... - ..
..
_
.....
_ .......
-
-
.........
--
..
'"
President's Budget FY 1995-99: $615 B
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ . ___ .. _ IMid':"Session Review FY 1995-99: $573 B
!
1996
1995
1997
1998
President's Budget Mid-Session Review
. --+-
•
Source: HCFN Office of the Actuary .
Analysis: OMBI Health Finance Branch
'
...~
WE
we
1999
�Medicare & Medicaid As Percentage of Total Federal Outlays
6%
10%
16%
''''''::::::::::::::::,i:iiiiiii
,:::::"::::::,,::::::,;::::::
35%
,15%
m;!;!!II!II!!,II,II,III'!!,;!!' 43%
12%
13%
1984: Total OutlayS=$852 B
1994: Total Outlays=$1,467 B
16%
10%
20%
,
26%
14%
15%
2004: Total Outlays=$2,488 B'
,II
Medicare
II
Medicaid
D
Social Security
III
All Other Mandatory _
Data: CBO, "The Economic and Budget Outlook," February 1985 and August 1994. Analysis: OMB/HFB.
Net Interest IillillII Discretionary
�Factors Accounting for Growth
in PReE, 1970-93
1970-1980
13.0% Growth
1980-1990
10.8% Growth ~
Volume & Intensity (30.40%)
Medical Price Inflation (3.70%)~
Medical Price Inflation
"--Generallnfl.tion (58.70%)
1990-1993 ~
8.5% Growth
Population (13.31%)
Volume & Intensity
General Inflation (35.64%)
Medical Price Inflation (30.23%)
ouree:
HerAlOffiec of the Actuary
F"--r..np•• llnflation (44.90%)
�TAX CAP AND HIGH COST PLAN ASSESSMENTS
I.
Background.
A.
Current law for employer-provided health, insurance.
B.
Other
1.
2.
Ir.
preferences for medical expenditures.
25 % deduction for self-employed.
Itemized deduction for medical expenses above 7.5% of adjusted gross
income.
Reasons to tighten current law treatment of employer contributions for health
insurance.
A:
B.
III.
tax
Cost containment.
Revenue.
Tax cap options.
A.
Supplementals.
B.
Co-payments and deductibles.
C.
Dollar caps.
1.
2.
D.
Additional issues.
1.
2.
IV.
Equity issues.
Administrative issues.
Need for basic benefit package.
Employer vs. employee cap.
High cost plan assessment.
A.
8,
C.
1994 Senate proposals.
Similar problems in designing base.
Additional concerns.
�Tax Cap
Comparison of Excise Tax Vs. Inclusion in Individual Taxable Income
Income Tax
15%
Income Tax
28% :
Excise Tax
48.81 %
IncomeTax
20%
0.00
0.00
48.81
0:00
Lll
..Lll
-3.47
Lll
Sub-total
7.11
7.11
45.34
7.11
Loss in Wages
7.11
7.11
45.34
7.11
FICA Tax
7.11
7.11
-3.47
7.11
Income Tax
13.93
26.01
- 9.07
18.58
28.15
40.23
32.80
32.80
Employer Taxes
Excise Tax
Employer FICA Tax
Employee Taxes
Total Loss in After-Tax
Income
Notes:
Assumes $100 taxable benefits.
Excise tax rate applies to all individuals.
�MEDICAL SAVINGS ACCOUNTS
1.
Overview of why we are considering Medical Savings Accounts (MSAs).
A.
B.
C.
II.
What is an MSA?
A.
B.
C.
III.
On the surface they sound good even though they may have undesirable effects
that outweigh their desirable effects.
Support in Congress for MSAs.
Need for cost-containment.
Description of how it works in general.
Variety of proposals.
Different designs Jead to different magnitudes of effects.
What is the problem that supporters claim MSAs will solve?
A.
Bias against catastrophic plans.
1.
2.
B.
Do catastrophic plans reduce costs?
1.
2.
3.
C.
Tax-exclusion of employer-provided health insurance.
Limited deductibility of out-of-pocket health costs.
Empirical evidence.
Catastrophic plans vs. HMO type managed care.
Total spending vs. out-of-pocket costs.
Other ways to encourage catastrophic plans.
1.
2.
Tax caps.
Expanded deductibility of medical expenses.
�IV.
Effects of MSAs.
A.
Expansion of coverage.
B.
Cost containment.
C.
Impact on health insurance market and distributional effects.
1.
2.
D.
Tradeoff between cost containment and distributional effects.
1.
2.
Y.
Healthy and upper income benefit. .
Less healthy and lower income lose.
Outcomes depend on participation rates.
Examples.
Ways to reduce adverse effects.
A.
Risk adjustors.
I.
2.
B.
Tax instead of, or in conjunction with, risk adjustors.
1.
2.
C.
Political feasibility.
Likely effectiveness.
Political feasibility.
Likely effectiveness.
Other design features.
1.
2.
3.
4.
Contribution limits.
Tax treatment of earnings in MSAs.
Availability of funds for nonmedical purposes and tax treatment.
Definition of medical withdrawals.
�MSA Example Under Identical Risk Pools
Comprehensive
Plan
$500 Deductible
Premium
Catastrophic
Plan
$3,000 Deductible
$3,350
$1,950
MSA Contribution
$1,400
Change in Deductible
$2,500
Out-Of-Pocket Exposure
$500
$1,600
Notes:
Premiums are for a family plan.
Assumes increase in deductible results in 10 percent reduction in total health spending.
�..
'
..
MEDICARE AND MEDICAID STRUCTURAL COST CONTAINMENT INITIATIVES
1. Reform Payment Procedures
a.
Medicare prospective payments for outpatient departments and skilled nursing
facilities.
2. Promote Competition
a.
Competitive bidding for Part B services.
b.
Market rate reimbursement for durable medical equipment.
3. Managed Care: Medicare
a.
Reduce benefits in fee-for-service Medicare as an incentive for beneficiaries to
enter HMOs.
b.
Strengthen current risk and cost contract program and create additional
incentives for participation.
c.
Create more flexible managed care options.
4. Managed Care: Medicaid
a.
Increase State flexibility.
b.
Remove current prior approval barriers.
c.
Mandate managed care.
�PRESIDENT'S PRINCIPLES ON HEALTH CARE REFORM
.•..
Security
Savings
Simplicity
Quality
Choice
Responsibility
�EXAMPLES OF STATE LAWS WITH ERISA COMPLICATIONS
Except where noted, the following state laws are either clearly
preempted by ERISA or are likely to be vulnerable to a colorable
claim that they are preempted by ERISA.
Except where noted, these state laws have been enacted but not
implemented. The list does not include laws that were seriously
considered by a state -- for example, through a task force or
interagency commission -- but not proposed in legislation (e.g.,
payroll taxes in Colorado and Vermont). The list also does not
include measures that are part of a governor's health care plan
but have not been enacted into law (e.g., global budgets in New
York) •
"PURE" EMPLOYER MANDATE
-Washington
-Hawaii 1
PAY OR PLAY
-Oregon
-Massachusetts
"EMPLOYER CONDUIT"
(employers must offer, but need not pay for, insurance)
-Iowa
TAXES ON HOSPITAL SERVICES & GROSS EARNINGS
(to fund uncompensated care)
- Connecticut2
PROVIDER TAX
(to fund coverage expansion)
. • Minnesota 3
RATE-SETTING
-New York 4
.Maryland 5
1
�GLOBAL BUDGETS
(limits on spending or rate of growth)
-Vermont 6
-washington
-Minnesota
, -Montana?
REQUIREMENT THAT HEALTH PLANS ARBITRATE/MEDIATE MALPRACTICE
DISPUTES BEFORE GOING TO COURT
-Washington
DATA COLLECTION8
-Washington
-Minnesota
-New York
-Vermont
BASIC INSURANCE REFORMS SUCH AS MODIFIED COMMUNITY RATING,
RESTRICTING PREEXISTING CONDITION EXCLUSIONS, RESTRICTING MEDICAL
UNDERWRITING, AND PORTABILITY
One or more of these types of reforms has been enacted (for
fully-insured plans) and/or implemented in every state
except Nevada, Michigan, Pennsylvania, Georgia, Alabama, and
Hawaii. 9
2
�1. Hawaii has been able to implement its legislation because it
is the only state to be granted a waiver of ERISA preemption by
Congress. However, Hawaii's waiver limits the state to its
health plan as it existed in 1974. Currently, Hawaii is seeking
an expansion of its waiver to allow it to modify the mandated
benefit package, require coverage for dependents, and update its
cost-sharing formula for insurance premiums.
2. Connecticut's legislation has been implemented and challenged
in court on ERISA grounds. A federal district court judge held
recently that the legislation is preempted by ERISA.
The system
Connecticut previously had in place to pay for uncompensated
care, an uncompensated care pool funded by a portion of each
insured patient's hospital bill, had also been struck down on
ERISA, preemption grounds.
3. Implemented; challenged in court on, ERISA grounds.
4. New York's legislation has been implemented and challenged in
court on ERISA grounds. The Court of Appeals for the Second
Circuit held recently that the legislation is preempted by ERISA.
The United States Supreme Court has agreed to hear the case.
5. Maryland's all-payer hospital rate-setting system has been
implemented; although it may be vulnerable to a court challenge
on ERISA grounds, no lawsuit has been 'brought at this time.
Maryland has announced that it is interested in changing its
rate-setting system to finance uncompensated care and medical
education more equitably and that it has not yet done so because
it does not want to defend a .lawsuit brought against the state on
ERISA grounds.
6. Implemented for public and private hospital spending only.
7. Montana's legislation establishes a commission charged with
developing two health care reform plans; both plans must include
a global budget.
8. The data collection laws in these and other states are not
preempted by ERISA because they do not apply to self-insured
plans.
The four states listed here have expressed a desire to
obtain data from ?uch plans; currently, they request the self
insured plans to contribute data voluntarily.
9. These laws are not preempted by ERISA because they do not
apply to self-insured plans.
3
�\.
TH E y/HITE HOUSE
.
~.
WASH I NGTON
.(
.Dec~ber
,
.
,'\,
"
"
7, ·1994
'
,
MEMORANDUM TO THE FIRST LADY
ROBERT' RUBIN '
I
CHRIS'JENNINGS
JENNIFER KLEIN
. FROM: .\
SUBJECT:
,..'
CARO~'H~ ,'RASC~~
-
'
.
,
AIDS-AND HEALTH CARE REFORM
..
'
. .
1 requested a short health care.refornl memo from
OUI; AIDS 'office.
and feel the attachedsllccinctly .outlines·the issues I hear
repeatedly throughout. the various sectors of the AIDS . community.
/.
.\
.
.,
. !
. (
'.,
.
,; .
�"'''{,
"\
.' DEC-136-1994
13: 36 ,FROM
LJH ITE HOUSE ,AIDS PCll:.I CY
TO
RASCO"
"P.132
", r
•
THE WJ.:(ITE HOUSE
," ,
W:ASH I N GTO N
,
'
.'
J,
"" " December 6, 1994
.
.
,
.'
"
"MEMORANDUM FOR CAROL RASCO
,
"
.
FROM:
SUBlBCI':
•l~ffLeviI"Health care reform "
,The c:oocemsof the ~I AIDS CQmmunfty regarding ht21th care ·ref~are n~t very.
,,
,different froin 'those of any chronic qiSeise group. The basic principleS endorsed 'in the last
go-round by the AIDS community" (along with lots of other chronic" diseaSe groups) amainly.
should still apply m context of anyatternpt at comprehensive refonn~ These. do not
the
require extensive elaboration, but i~lude:,
."
""'
'"
\',
I
eUniv~ cOverage, ·not just aCcess,'should be·guaranteed. If there is a standardberi~ts'
, pacbge, it sho~ld De the same for ,everyone,reprdless o(paY,or or'health status:, Ideally,. .'
"the ~ff.is package should be legWativ~ly g~teed.
.
, , "
""
,
,
, • CommUnity" rating is critical io making coverageaffor4able
to e~one. ..'
\
: ,. 'confidentiality and anti-<iiscril'flil:1ation protectiOns..
• Cosfcontainment should: be parto! any reform .~ for,the individual (thiough maXimum
O1Jt~f-pocket paymen~ and premium subsidies) and ,for- the system (some mechanism of "
" ,. Capping health care costs);"
,
.
".
",
,
That;s ,the easy part. When more incremental reforms areconsidered~ the follo~g are
'some key criteria (which ,can be expande~l':upOnifyou ~ish):
,
i'
-"
.
.
}'
• Small market refomtwithout community rating and Open: enrollment does, not assure access' .
to insuranc:e.,Eliminatirig ~sting conditions, or assuring ponabilityof coverage'does not .....
make that wverage qffoiriable.. It might actually price. some out of the. market. People With, .-:"
HIV disproportionately' wOrk in smallerbusin~. Th~ is also the tremencious ,irony that
'
" . AlDS·re1atfd community based organizations ~: the.very.orgariizauons contributing to. '"
. keeping health. cafe costs down.-- are dropping insurance ~oVerage, or 'una111e to offc;r it in
the, first plaCe. Their coverage is beCOmipg increasingly unaffordable due to experience
'~ngof org~izations that tend, to hire people with mv ~
,
.
/'
:,' eSiDlUarly, portability
~ more complil;3.ted thail moVing from job to jobfo~'the
. person with IDV.· People with'chrOnic'diseasesofteri sv.;ikh from full·time to"part:.time ..
. '.Slatul, and back' again ~ or move in anQout of the work· force - and need .to be assured
" .pOrtability in those contexts as well.
'
guarantees
",
,
"
.
�,
,'DEC-06-1S!94
13.: 36· FROM
TO
WHITE HOUSE ,AIDS POLICY
"
RASCO:
)
P;'03
.
Memo to Carol Rasco/DeCembet 6, '1994/Page 2
. :
.
"
.... :.
'
that would bring"the self-ipsured
into 'the community pool. (Witness·the New York State. experi.etK:e,when·the~ativ.ely
small pool as part of wmmunity ra~ng resulted in high premiums.)
... Communitymtingcannot work without ERISA refonns
.If there i~ not cOnsensus at th~ federal 'level for cOmprehensive
reforms, let the'federal government set minimum ,standtirds~ without precluding broader
refonn efforts iri the laboratory of.the States. Thlswould include easier'· mechanisms for;
including ElUSA plans in, the state's refonn 'effOrts., '
. ,
.• Let the states do more.
• The federal goveriun~t must set CleDT standards ,~,protect people with 'clu-onic diseaSes
such as,mv 'during these, state eXperiments ...:. Whether broad scaled or lirDited to Medicaid
'programs., Your OQ~atign at one ofthecommuriity meetings that we need some -v:ery
. specific criteria (rather than. gerieral coneem,aboutpeople with HIV) when reviewing ,
. M~icaid waiver applications is well taken - and I will, over the next few weeks; wor~ with.
some key folks in the HlV community to de,veloptbese.'
"
'
,
,
a
, .
\
'
reform
' . Medicaid
alone would hav~a'majorjmpact on theHiv community. Over 40.% of
people with AIDS are on- Medicaid. ThiS means that Medicaid and'Medicare cuts. will affect'.
people with mv/AIDSdispl'\)pomonateJy.
'
.Anti"<iiscrim~tion and cOnfidentiality protections\temain. keylssues foi the HIV .
. community. Anti'!'(fiscrimination protections 'sho¢d not just ccrver indiViduals, but shouJd
also addresS insuranCe company.p@Ctices; especially regarding marketing.,,' Thu's, reforms .
such as,admiriistrative simplification must cOme with appropriate safeguardS in these areas. '
,
Do'
-'
,
'
.
'
)
This all seems ,rather simple and st:raight forward ~but getting from thesepnnciples to real
, legislation,.I know; is not simple. The mv-specific concerns' really tend to arise in the
details (e.g'., how one defines experimentaltr:eatments, who sets the fonnulary for a
prescription drug benefit, <lCCes.s to specialists .as gatekeepers and affordable point of service
options within managed Care plans, or what kindS of appeals procesS is in place regarding :
coverage decisions). Once w~ have a'senseof thepaiameter5 of the discussions,itrnay be·
possible to offer more specific rec:ominen4ationsthat will meet.the concerns, of the mv' ~
community within the cOntext of your discussions.' .
,,
,
"
"'
. ,
.
'
.
'
commu~ity was significantly mobil~ during theIast effort. ·The need Jar, reform I
is obvious to,this constituency. But to mobiJ,ize'them again, we need to offer Some very
'. tan~ble, if incremental, b~nefits.
ne:HIV
,
,
,
,
,\
,
J
'
'
'
�TH E WH ITE HOUS E
WASHINGTON
December 6, 1994
MEMORANDUM FOR CAROL RASCO AND BOB RUBIN
FROM:
CHRIS JENNINGsc1
JENNIFER KLEIN :JK
KIM O'NEILL .~o~
SUBJECT: Preparation for Meetings with the President
We are in the process of preparing for the meetings with the President that are
currently scheduled for December 12th and 13th (although, as Carol stated, it is very possible
this time frame may change). We wanted to bring to your attention some issues that need
to be resolved concerning content and format of the meetings. The following memo outlines
how we think the meetings might be structured. Also enclosed is the simplified decision tree
that you requested.
STRUCTURE OF MEETINGS WITH THE PRESIDENT: . We are facing increasing
pressure from principals' staff to decide: 0) how the meetings will be structured, (2) what
information will be presented to the President and, (3) who will be invited to the meetings.
We have a few recommendations.
Attendance: While the Map Room meetings have involved a number of different people,
we recommend that the meetings with the President be a "principals-only" meeting.
Under this definition, those invited would include: The Vice President, Mrs. Clinton, Mrs.
Gore, Secretary Bentsen, Secretary Reich, Secretary Shalala, Alice Rivlin, Laura Tyson,
Leon Panetta, Pat Griffin, George Stephanopoulos, Ira Magaziner, Carol Rasco, Bob
Rubin, Bill Galston, Gene Sperling, and Chris Jennings.
Structure and Content: The Map Room group has covered a wide range of issues,
many which will be of particular interest to the President. We think that these issues can
be condensed down to seven pieces of health care reform: financing, coverage, cost
containment, insurance market reform, state flexibility, Medicare and Medicaid, and other
issues. In our view, the first three areas should be the focus of the first meeting with the
President because they may have implications for the budget process.
One possible format for the first meeting would be the following:
We assume you will give a brief introduction and overview of the map group process
and a review of the seven pieces of health care reform (Financing, Coverage, Cost
Containment, Insurance Market Reform, State Flexibility, Medicare and Medicaid,
�I
and Other Issues). It would also be helpful to give a brief description of why the
meeting would focus on financing, coverage and cost containment, with the other four
pieces to be discussed in the next meeting.
After the introduction, we suggest you do a presentation on the sources of funds that
have been reviewed by the Map Room group. This could be followed with the uses of '
funds presentation and, in particular, the coverage packages, self-employed tax
deduction, and long term care.
We view the cost containment discussion as separate from the financing/coverage
presentation. Consequently, this issue could follow a complete discussion of the first
two presentations. Your cost containment presentation could briefly outline all of the
possible options (tax cap, regulatory options, market reforms, medical savings
accounts), noting that the first three are pretty untenable in the current political
environment. We expect that the cost containment discussion will focus on medical
savings accounts, which we will have to prepare for in more detail.
Map Room Preparation Meeting: Once we decide on a basic structure, for the
meetings with the President, we will be able to plan for this Thursday's Map Room group
meeting (December 8th), which is the last meeting scheduled before the first meeting with
the President. We would like to go over the coverage packages with the group, as well
as give them a proposed format for the meetings with the President.
Unless you disagree, we believe it is not necessary and is, in fact, not advisable that the
larger group of principals meet. We do recommend that either Bob or Carol call Secretary
Jesse Brown to explain that we are still in the initial stages of developing more limited
reform initiatives.
Enclosure
cc; Bill Galston
Gene Sperling
Jeremy Ben-Ami
Sylvia Mathews
�DECISIONS FOR HEALTH POLICY DEVELOPMENT
The following questions outline the essential decisions that must be made at
the principals' level and, of course, ultimately by the President. If health care
reform is going to be included in the budgetJ the following decisions need
to be made by early next week.
1.
Do we want to use any Federal health spending for deficit reduction?
• If yes, how much?
• If yes, where should the spending reductions come from?
2.
Do we want to use any Federal health spending for health care reform?
• If yes, how much?
• If yes, where will the savings come from?
3.
Are there any policy options for which we are willing to raise money from
other sources?
• If yes, where will the additional revenues come from (tax cap, cigarette
tax, other)?
4.
Do we want to extend the self-employed tax deduction?
• If yes, which option should we assume (25%, 100%)? spend)?
5.
If we are willing to allocate revenues toward coverage expansions, which
ones to we want to propose (welfare to work, kids, unemployed, low-income
workers, broad-based low income)?
• For each coverage expansion, how much can we spend?
6.
If we do not want to increase spending, are there other policies that we
would like to consider (Insurance market reforms, ERISA, state flexibility)?
�
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Carol Rasco - Issues Series
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Carol Rasco
Issues Series
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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92 folders in 7 boxes
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[Welfare Reform Republican Bill] [2]
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Carol Rasco
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Box 128
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
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https://clinton.presidentiallibraries.us/files/original/4e966b8dd88c198f5de8f79540927738.pdf
ad2d3af519d30cb2c0b242cd73df36da
PDF Text
Text
WithdrawallRedaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. note
DATE
SUBJECT/TITLE
0112611995
to Caro re parking (partial) (I page)
RESTRICTION
P61b(6), b(7)(C)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8506
FOLDER TITLE:
[Welfare Reform Republican Bill] [I]
20 I0-0 198-S
kc230
.' RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(1) National security classified information [(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(B) Release would disclose information concerning the regulation of
financial institutions [(bleB) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(I) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice hetween the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of tbe PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�FEB - 9 1995
~.:cte
'f
..
L~~"
1o<S~~.~
Q&A for USDA Under Secretary Ellen Ha.3s
(as cleared by O:MB 2-7-.95)
Prepared for,- February 8 hea.rl.ng before the House Subcommittee on
Nutrition and Foreign A.griculture
Q.
A.
.
. ~ f'1'fJ . .i.
-./
V, al>..k(('
./ pr-- ,
partment Operations,
Does the Adminjstration <lPpose block granting the nutrition programs?
_ ~ 13lock granting Food StatIips would have substantial negative cons
ences for the
~afetY net of food assistance programs now in p~ace; for the nutrition and health of low
in.come Americans; for the food and agncultureeconomy. and for the level and
. distribution of federal support to States.
Under any block grant proposal:
•
The Food Stamp program wou~d be unable to respond to changing economic
circum<;tances. During economic downturns. States would have to decide
whether to.cut benefits, tighten eligibility, or dedicate their own revenues to the
Foo~Stamp prograni.
•
Reduced investment in the Food Stamp program will adversely affect the nutrition
,and health of Jow-income famiUe$ and individuals. Low-income households are at '
greater risk of nutrition-related disorders and chronic disease than the rest of the
population. Since the nationwide expansion of the Food Stamp'program. the gap
between diets of low-income and other families has narrowed.
,.
.Reduced support and cash-out oi'the Food Stamp Program would result in
reduced retail food sates. reduced gross'!arm incomes and, in the short run, job
losses. In the long'"'term. a block grant would reduce employment in farm
production, food processing and distribution. The economic effeCts would be felt
most heavily in rural.America.
•
Any fOnllula.for distributing grant funds will result in winners and loserS among
the States. Over time all States willfare worse than under current law.
.
.
February 8,1995
1/1
.
�THE WHITE HOUSE
WASHINGTON·
February 13, 1995
MEMORANDUM FOR THE PRESIDENT
FROM:
CAROL RASCO
SUBJECT:
Kassebaum Medicaid for Welfare Swap
PURPOSE
To provide you with backgrounq information on the Kassebaum MedicaidlWelfare swap as a
.follow-up to the discussion you had with the Governors at Blair House. In addition, to .
provide you with a status report on the level of Congressional interest in and receptivity to
this proposal.
BACKGROUND
As you know, Senator Nancy Kassebaum has proposed a major restructuring of the social.
welfare system in which the Federal government wo.uld take over full responsibility for
Medicaid acute-care and the states would .take over the food stamp, AFDC, and WIC .
programs. During a five-year transition period, a maintenance-of-effort requirement would
bar states from reducing overall expenditures on cash and food assistance to the poor and
states would continue to bear some share of Medicaid costs.
At least initially, States are attracted to this proposal because it would allow them to relieve
themselves of their future Medicaid spending -- which continues to outpace inflation -- and
have the Federal govenunent take over. The downside from the Federal Government's
perspective is that iinplementing this proposal would increase the deficit in both the short
term and the long-term. The swap could be modified to be more balanced by giving more
programs to the states or by swapping only parts of the Medicaid program. However, any
tradeoffs that would m~.!h~ swap budget-neutral or deficit-reducing would increase costs
to many or most states (certainly over the long-run) and are unlikely to be received favorably
by the Governors. Since the Rebublican Congress is <;lesperately looking to save money, it
sems unlikely that this conflict will be resolved this year.
There are other significant policy implications of the Kassebaum proposal other than the
deficit issue. TIle DPC/NEC health policy development working group raised four additional
major policy concerns about the swap proposal, which are outlined in the following pages.
�POLICY IMPLICATIONS OF THE KASSEBAUM SWAP
I. Likely Reductions in Welfare Programs. Experience with states over the past 25 years
suggests that states will not maintain existing eligibility requirements and benefits for the
welfare programs. In fact, state spending on welfare programs has declined dramatically in
real terms:
AFOC benefits in the median state have fallen 47 percent in real terms since 1970,
even though the Federal government paid 50 to 80 percent of the benefit costs during
this period. Combined AFOC and food stamp benefits for a family with no other
income. is now at the level of AFOC benefits alone in 1960, before the food stamp
program was created.
Even though slate appropriations for WIC generally qualify a state for·a larget Federal
WIC allocation, states have been cutting state funds for WIC in recent years. In the
past two years, state funding for WIC fell 33 percent in real terms.
Furthermore, if a balanced budget amendment is passed, prospects that states would maintain
cash and food assistance for the poor (after the transition period requiring some maintenance
of effort ends) become even less likely.
.
In contrast, in the two programs where benefits arc 100 percent Federally-funded and
national benefit standards exist -- the food stamp program and the Federal SSI program -- .
there has been no .benefit erosion over the past 20 or 25 years.
II. Varying Impacts Among Stales . . Any swap is likely to have different distributional
impacts among states. States that spend more on welfare than Medicaid (according to
Kassebaum there arc 14 such states) will be losers. At least initiall y, the other 36 states will
be winners -- meaning that Federal government will be picking up some portion of their
current spending. The size of the losses and gains could vary dramatically among states.
As some states cut baCK on their welfare programs -- as is likely under a swap proposal -
variations in welfare benefits among states will increase even more. A key feature of the
Federal food stamp program is its role in helping moderate. what otherwise would be huge
differences between states in the benCfits they provide to poor children. Today, food stamp
benefits arc large in states that pay low AFOC benefits, because a family'S food stamp
allotment depends on its income level. This moderating effect would disappear once the food
stamp program devolved to thc slates.
.
Thc· State of Connecticut provides a family of three that has no other income with an
AFOC benefit of $680 per month,. about two':"thirds of the poverty line. Mississippi,
by contrast, pays a family of three only about one-sixth as much -- $120 a month,
which is less than 12 percent of the poverty line. When food stamps arc added in, the
benefit package in Mississippi climbs from about one-sixth to one..,.half of tbe size of
the Connecticut package.
�III. Weakening Automatic Stabilizers. The amount of Federal food stamp benefits
provided in a state automatically rises when the state economy turns down and unemployment
and poverty mount
making the program the Federal government's most important
automatic stabilizer after unemployment il1surance: .If AFDC and food stamps are devolved,
states will be forced to choose ~mong absorbing the additional benefit costs during recessions,
reducing food and welfare benefits, or putting new applicants on waiting lists.
IV. Complications in Creating a Federal Medicaid Program. If the M~dicaid program
became entirely Federal, it would be difficult to justify maintaining the wide variations that
now exist among states in the categories of households eligible for the program, the health
services that are covered, and the reimbursement rates that are paid to providers. If the
Federal government chose to provide uniform coverage similar to that now offered in some of
the least generous states, the number of the uninsured would likely rise and beneficiaries in a
number of states would lose coverage for some services. If the Federal government instead
chose to provide coverage similar to that offered in the most generous states, the cost to the
Federal treasury would be great.
NGA AND CONGRESSIONAL RESPONSE TO SWAP
At least at first glance, the Governors and the NGA were very interested in the Kassebaum
proposal. Trading virtually anything to rid the states of their expensive, time· consuming and
frequently politically unpopular Medicaid obligations has real appeal. As a result, the
Governors directed NGA staff to study the implications and potential of the prop()sal.
. However, in recent weeks, the Governors, the NGA staff, and the Republicans in the
Congress seem to have cooled to the Kassebaum concept
The Governors now appear to be less interested in the proposal primarily because, in an
environment in which the Congressional Republicans' number one priority is obtaining large
Federal savings, a Medicaid/welf~re swap to achieve this seems either unlikely or will almost
invariably and unevenly hurt the states. Second, proposals to block grant welfare -- that·
particularly the Republican Governor,s are advocating -- run contrary to the idea of swapping
.entire programs.
The Republicans in Congress are concluding the Kassebaum proposal has diminished appeal
because they are increasingly believing that this proposal would necessitate complicated and
controversial negotiations. lis attractiveness further diminishes when they contrast it with
block granting proposals that are less complicated and more likely to produce larger Federal
savings. Senator Dole's office reports that there is little or no interest in this pro'posal on the
Finance Committee. This is significant because the Finance Committee (not Kassebaum's
Labor Committee) has legislative jurisdiction over the Medicaid and AFDC programs.
CONCLUSION
Despite the states' desire.to trade away the Medicaid program, the Congressional interest in
producing significant Medicaid savings as well as the major policy implications of the
proposal indicate that this type of swap is unlikely to go very far in the 104th Congress.
�THE WH ITE H'OUSE.
WASHINGTON
February 13, 1995
MEMORANDUM FOR THE PRESIDENT
FROM:
CAROL RASCO
SUBJECf:
-Kassebaum Medicaid for Welfare Swap
PURPOSE
To provide you with background information on the Kassebaum Medicaid/Welfare swap as a
follow-up to the discussion you had with the Governors at Blair House. In addition, to
.
, provide you with a status report on the level of Congressional interest in and receptivity to
this proposal.
.
BACKGROUND
As you know, Senator Nancy Kassebaum has proposed a major restructuring of the social
welfare system in which the Federal government would take over fuil responsibility for
Medicaid acute-care and the states would take over the food stamp, AFDC, and WIC
programs. During a five-year transition period, a maintenance-of-effort requirement would
bar states from reduCing overall expenditures on cash and food assistance to the poor and
states would continue to bear some share of Medicaid costs.
At least initially, States are attracted to this proposal because it would allow them to relieve
themselves of their future Medicaid spending -- which continues to outpace inflation -- and
have the Federal government take over. The downside from the Federal Government's
perspective is that implementing this proposal would increase the deficit in both the short
term and the' long-term. The swap could be modified to be more balanced by giving more
programs to the states or by swapping only parts of the Medicaid program. However, any
tradeoffs that would make the swap budget-neutral or deficit-reducing would increase costs
to many or most states (certainly over the long-run) and are urilikely to be received favorably
by the Governors. Since the Rebublican Congress is desperately looking to save money, it
semsuniikely that this conflict will be resolved this year.
There are other significant policy implications of the Kassebaum proposal other than the
deficit issue. The DPC/NEC health policy development working group raised four. additional
major policy concerns about the swap proposal, which are outlined in the following pages.
�POLICY IMPLICATIONS OF THE KASSEBAUM SWAP
I. Ukely Reductions in ,Welfare Programs. Experience with states over the past 25 years
suggests that states will not maintain existing eligibility requirements and, benefits for the
welfare programs. In fact, state spending on welfare programs has declined dramatically in
real terms:
AFDC benefits in the median state have fallen 47 percent. in real terms since 1970,
even though the Federal government paid 50 to 80 percent of the benefit costs during
this period. Combined AFDC and food stamp benefits for a family with no other
'
income is now at the level of AFDC benefits alone in 1960, before the food stamp
program was created.
Even though state appropriations for WIC generally qualify a suite for a larger Federal
WIC allocation; states have been cutting state funds for WIC in recent years. In the
past two years, state funding for WIC fell 33 percent in real terms.
Furthermore, if a balanced budget amendment is passed, prospects that states would maintain
'cash and food assistance for the poor (after the transition period requiring some maintenance
. of effort ends) become even less likely.
In contrast, in the two programs where benefits are 100 percent Federally-funded and
national benefit standards exist -- the food stamp program and the Federal SSI program-
there has been no benefit erosion over the past 20 or 25 years.
'
II. Varying Impacts Among States. Any swap is likely to have different distributional
impacts among states. States ,that spend more on welfare than Medicaid (according to
Kassebaum there are 14 such states) will be losers. At least initially, the other 36 states will
be winners -- meaning that Federal government will be picking up some portion of their
current spending. The size of the losses and gains could vary dramatically among states.
As some states cut back on'their welfare programs -- as is likely under a swap proposal -
variations in welfare benefits among states will increase even more. A key' feature of the '
,Federal food stamp program is its role in helping moderate what otherwise would be huge
differences between states in the benefits they provide to poor children. Today, food stamp
benefits are large in states that pay low AFDC benefits, because family'S food stamp
,allotment depends on its iricome level. This moderating effect would disappear once the food
stamp program devolved to the states.
a
The State of Connecticut provides a family of three that has no other income wit.h an
AFDC benefit of. $680 per month, about two-thirds of the poverty line. Mississippi,
by contrast, pays a family of three only about one-sixth as much -- $120 a month,
which is less than 12 percent of the poverty line. When food stamps are added in, the
benefit package in Mississippi climbs from about one-sixth to one~half of the size of
the Connecticut package.
�III. Weakening Automatic Staililizers. The amount of Federal food stamp benefits
,provided in a state automatically rises when the state economy turns down and unemployment
and poverty mount -- making the program the Federal government's most important
automatic stabilizer after unemployment insurance, If AFDC and food stamps are devolved,
, states will be forced to choose among absorbing the additional benefit costs during recessions,
reducing food and welfare benefits, or putting new applicants on .waiting lists:
IV. Complications in Creating -a Federal Medicaid Program. If the Medicaid program
became entirely Federal, it ' wouid be difficult to justify maintaining the wide variations that
now exist among states in the categories of households eligible fOr the program, the health
services that are covered, and the reimbursement rates that are paid to providers, If the
Federal government chose to provide uniform coverage similar to that now offered in some of
the least generous states, the number of the uninsured would likely rise and beneficiaries in a
number of states would lose coverage for some services. If the Federal government instead
chose to provide coverage similar to that offered in' the most generous states, the cost to the
Federal treasury would be great.
NGA AND CONGRESSIONAL RESPONSE TO SWAP
At least at first glance, the Governors and the, NGA were very interested, in the Kassebaum
proposal. Trading virtually anything to rid the states of their expensive, time consuming and
frequently politically unpopular Medicaid obligations has real' appeal. As a result, the
Governors directed NGA staff to study the implications and potential of the proposal.
However, in recent weeks, the Governors, the NGA staff, and the Republicans in the
Cons,ress seem to have cooled to the Kassebaum concept.
The Governors now appear to be less interested in the proposal primarily because, in an
environment in which the Congressional Republicans' number one priority is obtaining large
Federal savings, a Medicaid/welfare swap to achieve this seems either unlikely or will almost
that
invariably and unevenly hurt the states, Second, proposals to block grant welfare
particularly the Republican Governors are advocating -- run contrary to the idea of swapping
entire programs.
The Republicans in Congress are concluding the Kassebaum proposal has diminished appeal
because they are increasingly believing that this proposal would necessitate complicated and
controversial negotiations, Its attractiveness- further diminishes when they contrast it with
block granting proposals that are less complicated and more likely to produce larger Federal
savings, Senator Dole's office reports that there is little or no interest in this proposal on the
Finance Committee, This is significant because the 'Finance Committee (not' Kassebaum's
Labor Committee) has legislative jurisdiction over the Medicaid and AFDC programs.
'
CONCLUSION
Despite the states' desire to trade' away the Medicaid program, the Congressional interest in
producing significant Medicaid savings as well as the major policy implications of the
proposal indicate that this type of swap is unlikely to go very far in the 104th Congress.
�HiE WHITE HOUSE
-'
WASHINGTON
February 13, 1995
MEMORANDUM FOR THE PRESrDENT
FROM:
CAROL RASCO
SUBJECT:.
Kassebaum Medicaid for WelIare Swap
PURPOSE
To provide you with background information on the Kassebaum MedicaidlWelfare swap as a
follow-up to the discussion you had with the Governors at Blair House. In addition, to
provide you with a status report on the level of Congressional interest in and receptivity to
this proposal.
.
"BACKGROUND
As you know, Senator Nancy Kassebal:1m has proposed a major restructu ring of the social
welfare system in which the Federal government would take over full responsibility for
Medicaid acute-care and the states would take over the food stamp, AFDC, and WIC
prograrps. During a five-year transition period, a maintenance-of-effort requirement would
" bar states from reducing overall expenditures on cash and food assistance to the poor and
states would continue to bear some share of Medicaid costs.
At least initially, States are attracted to this proposal because it would allow them to relieve
themselves of their future Medicaid spending -- which continues to outpace inflation -- and
have the Federal government take over. The downside from the Federal Government's
perspective is that implementing this proposal would increase the deficit in both the short
term and the long-term. The swap could be modified to be more balanced by giving more
programs to the states or by swapping only parts of the Medieaid program. However, any
tradeoffs that would make the swap budget-neutral or deficit-reducing would increase costs
to many or most states (certainly over the long-run) and are unlikely to be received favorably
by the Governors. Since the ·Rebublican Congress is desperately looking to save money, it
sems unlikely that this conflict will be resolved this year.
There are other significant policy implications of the Kassebaum proposal other than the
deficit issue. The DPC/NEC health policy development working group raised four additional
major policy conceFnS about the swap proposal, \vhich are outlined in the following pages.
�POLICY IMPLICATIONS OF THE KASSEBAUM SWAP
I. Likely Reductions in Welfare Programs. Experience with states over the past 25 years
suggests that states will not maintain existing eligibility requirements and benefits for the
welfare programs. In fact, state spending on welfare programs has declined dramatically in
real terms:
AFDC benefits in the median state have fallen 47 percent in real terms since 1970,
. even though the Federal government paid 50 to 80 percent of the benefit costs during
this period. Combined AFDC and food stamp benefits for a family with no other
income is now at the level of AFDC benefits alone in 1960, before the food stamp
program was created.
Even though state appropriations for WIC generally qualify a state for a 'larger Federal
WIC allocation, states have been cutting state funds for WIC in recent years. -. In the
past two years, state funding for WIC fell 33 percent in real terms.
Furthermore, if a balanced budget amendment is passed, prospects that states would maintain
cash and food assistance for the poor (after the transition period requiring some maintenance
of effort ends) become even less likely.
In contrast, in the two programs where benefits are 100 percent Federally-funded and
national benefit standards exist -- the food stamp program and the Federal SSI program
there has been no benefit erosion over the past 20 or 25 years.
II. Varying Impacts Among States. Any swap is likely to have different distributional
impacts among states. States that spend more on welfare than Medicaid (according to
Kassebaum there arc 14 such states) will be losers. At least initially, th<:,: other 36 states will ,
be winners -- meaning that Federal government will be picking up some portion of their
current spending. The size of the losses and gains could vary dramatically among states.
As some sta.tes cut back on their welfare programs -- as is likely under a swap proposal -
variations in welfare benefits among states will increase even' more. A key feature of the
Federal food stamp program is its role in helping moderate what otherwise would be huge
differences between states in the benefits they provide to poor children. !oday, food stamp
benefits arc large in states that pay low AFDC benefits, because a family'S food stamp
allotment depends on its income level. This moderating effect would disappear once the food
stamp program devolved to the states.
The State of Connecticut provides a family of three that has no other income with an
AFDC benefit of $680 per month, about two-thirds of the poverty line. Mississippi,
by contrast, pays a family of three only about one-sixth as much -- $120 a month,
which is less than 12 percent of the poverty line. When food stamps arc added in, the
benefit package in MiSSissippi climbs from about one-sixth to one-half of the size of
the Connecticut package.
�, III. ,Weakening Automatic Stabilizers. The amount of Federal food stamp benefits
provided in a state automatically rises when' the state economy turns down and unemployment
and poverty mount -:... making the program the Federal government's most important
automatic stabilizer after unemployment insurance. If AFDC and food stamps are devolved,
states will be forced to choose among absorbing the additional benefit costs during recessions,
reducing food and welfare benefits, or putting new applicants on waiting lists.
IV. Complications in Creating a Federal Medicaid Program. If the Medicaid program
be2ame entirely Federal, it would be difficult to justify maintaining the wide variations that
now exist among states in the categories of househoids eligible for the program, the health'
services that are covered, and the reimbursement rates that are paid to providers. If the
Federal government chose to provide uniform coverage similar to that now offered in some of
the least generous states, the number of the uninsured' would likely rise and beneficiaries in a
number of states would lose coverage for some services. If the Federal government instead
chose to provide coverage similar to that offe[(~d in the most generous states, the cost to the
Federal treasury would be great.
NGA AND CONGRESSIONAL RESPONSE TO SWAP
At least at first glance, the Governors and the NGA were very interested in the Kassebaum
proposal. Trading virtually anything to rid the states of their expensive,' time consuming and
, frequently politically unpopular Medicaid obligations has real appeal. As a result, the
Governors directed NGA staff to study the implications and potential of the proposal.
However, in recent weeks, the Governors, the NGA staff, and the Republicans in the
Congress seem to have cooled to the Kassebaum concept.
The Governors now appear to be less interested in the proposal primarily because, in an
,environment in whieh the Congressional Republicans' number one priority is obtaining large
Federal savings, a Medicaid/welfare swap to' achieve this seems either unlikely or will almost
invariably and unevenly hurt the states. Second, proposals to block grant welfare -- that
particularly the Republican Governors are advocating -- run contrary to the idea of swapping
,
,
entire programs.
"
The RepUblicans in Congress are concluding the Kassebaum proposal has diminished appeal
because they arc increasingly believing that this proposal would necessitate complicated and
controversial negotiations. Its attractiveness further diminishes when they contrast it with
block granting proposals that are less complicated and more likely to produce larger Federal
savings. Senator Dole's office reports that there is little or no interest in this proposal on the
Finance Committee. This is significant because the Finance Committee (not Kassebaum's
Labor Committee) has legislative jurisdiction over the Medicaid and AFDC programs:
CONCLUSION
Despite the states' desire to trade away the Medicaid program, the Congressional interest in
producing significant Medicaid savings as well as the major policy implications of the
proposal indicate that this type of swap is unlikely to go very far in the 104th Congress.
�,.
THE WHITE HOUSE
WASHINGTON
February 13, 1995
MEMORANDUM FOR THE PRESIDENT
FROM:
CAROL RASCO
SUBJECT:
Kassebaum Medicaid for Welfare Swap
PURPOSE
To provide you with b(ickground information on the Kassebaum MedicaidlWeifare swap as a
follow-up to the discilssion you had with the Governors at Blair House. In addition, to
provide you with a status report on the level of Congressional interest in and receptivity to
this proposal.
BACKGROUND
,
As you know, Senator Nancy Kassebaum has proposed a major restructuring of the social
welfare system in which the Federal gov'ernment would take over full responsibility for
Medicaid acute-care and the states would take over the food stamp, AFDC, andWIC
programs. During a five-year transition period, a maintenance-of-effort requirement would
bar states from reducing overall expenditures' on cash and food assistance to the poor and
states would continue to bear some share of Medicaid costs.
At least initially, States are attracted to this proposal because it would allow them to relieve
and
themselves of their future Medicaid spending -- which continues to outpace inflation
have the Federal government take over. The downside from the Federal Government's
perspective is that implementing this proposal would increase the deficit in both the short
tenn and the long-term. The swap could be modified to be more balanced by giving more
programs to the states or by swapping only parts of the Medicaid program. However, any
tradeoffs that would 'make the swap budget-'neutral or deficit-reducing would increase costs
to many or most states (certainly over the long-run) and are unlikely to be received favorably
by the Governors. Since the Rebublican Congress is desperately looking to save money, it
sems unlikely that this conflict will be resolved this year.
There are other significant policy implications of the Kassebaum proposal other than the
deficit issue. The DPClNEC health policy development working group raised four additional
major policy concerns about the swap proposal" which are outlined in the following pages.
�.'
POLICY IMPLICATIONS OF THE KASSEBAUM SWAP
I. Likely Reductions in Welfare Programs. Experience with states over the past 2S years
suggests. that states will not maintain existing eligibility requirements and benefits for the
welfare programs., In fact, state spending on welfare programs has declined dramatically in
, real terms:
AFDC benefits in the median state have fallen 47 percent in real terms since 1970,
even though the Federal government paid 50 to 80 percent of the benefit costs during
this period. Combined AFDC and food stamp benefits for a family with no other
income is now at the level of AFDC benefits alone in 1960, before the food stamp
program was created.
'
a
Even though state appropriations for WIC generally qualify a state for larger Fed~ral.
WIC allocation, states have been cuttingstate funds forWIC in recent years. In the
past two years, state funding for WIC fell 33 percent in real terms.
'Furthermore, if a balanced budget amendment is passed, prospects that states would maintain
cash and food assistance for the 'poor (after the transition period requiring some maintenance
of effort ends) become even less likely.
'
'
In contrast, in the two programs where benefits are 100 percent Federally-funded and
national benefit standards exist -- the food stamp program and the Federal SSI program -
there has been no benefit erosion over the past 20 or 25 years.
II. Varying Impacts Among States. Any swap is likely to have different distributional
impacts among states. States that spend more on welfare than Medicaid (according to
Kassebaum there are 14 such states) will be losers. At least initial! y, the other 36 states will
be winners -- meaning that Federal government will be picking up some portion of their
current spending. The size of the losses and gains could vary dramatically among states.
As some states cut back on their welfare programs -- as is likely under a swap proposal
variations in welfare benefits among states will increase even more. , A key feature of the
Federal food stamp program is its role in helping moderate what otherwise would be huge
differences between states in the benefits they provide to poor children. Today, food stamp
benefits arc large in states that pay low AFDC benefits, because a family's food stamp
allotment depends on its income level. This moderating effect would disappear once the food
stamp program devolved to the states.
The State of Connecticut provides a family of three that has no other income with an
AFDC benefit of $680 per month, about two-thirds of the poverty line. Mississippi,
by contrast, pays a fam'ity of three only about one-sixth as much -- $120 a month,
which is less than 12 percent of the poverty line. When food stamps are added in, the
benefit package in Mississippi climbs from about one-sixth to one-half of the size of
the Connecticut package.
�III. Weakening Automatic Stabilizers. The amO.unt of Federal food stamp benefits
provided in a state automatically rises when the state economy turns down and unemployment
and poverty mount -- making the program the Federal government's most important
automatic stabilizer after unemployment insurance. If AFDC and food stamps are devolved,
states will be forced to choose among absorbing the additional benefit costs during recessions,
reducing food and welfare benefits, or putting new applicants on waiting lists~
.IV. Complications in Creating a Federal Medicaid Program. If the Medicaid program
became entirely Federal, it would be difficult to justify maintaining the wide variations that
noy.' exist among states in the categories of households eligible for the program, the health
services that are covered, and the reimbursement rates that are paid to providers. If the
Federal government chose to provide uniform' coverage similar to that now offered in some of
the least generous states, the number of the uninsured would likely rise and beneficiaries in a
number of states would lose coverage for sonle services. If the Federal gQvernment instead
chose to provide coverage similar to that offered in the most generous states, the cost to t.he
Federal treasury would be great.
NGA AND CONGRESSIONAL RESPONSE TO SWAP
At least at first glance, the Governors and the NGA were very interested in the Kassebaum
proposal. Trading virtually anything to rid the states of their expensive, time consuming and
frequently politically unpopUlar Medicaid obligations has real appeaL As a result, the
Governors directed NGA staff to study the implications and potential of the proposaL
However, in recent weeks, the Governors, the NGA staff, and the Republicans in the
Congress seem to have ~ooled to the Kassebaum concept.
The Governors now appear to be less interested in the proposal primarily because, in an
environment. in which the Congressional Republicans' number one priority is obtaining large
Federal savings, a Medicaid/welfare swap to achieve this seems either unlikely or will almost
invariably and unevenly hurt the states. Second, proposals to block grant welfare, -- that
particularly the Republican Governors are advocating
run contrary to the idea of swapping
entire programs:'
The Republicans in Congress are concluding the Kassebaum proposal has diminished appeal
because they are increasingly believing th~t this proposal would necessitate complicated and
. ' controversial negotiations. Its attractiveness further diminishes when they contrast it with
block granting proposals that are less complicated and more likely to' produce larger Federal
savings. Senator ,?ole's office reports that there is little or no interest in this proposal on the
Finance Committee. This is significant because'the Finance Committee (not Kassebaum's
Labor Committee) has legislative jurisdiction over the Medicaid and AFDC programs.
CONCLUSION'
Despite the states' desire to trade away the Medicaid prograni, the Congressional interest in
producing significant Medicaid savings as well as the major policy implications of the
proposal indicate that this type of swap isunlikcly to go very, far in the 104th Congress.
�•
,1/
THE WHITE ,HOUSE
WASHINGTON
February 13, 1995
r
MEMORANDUM FOR THE PRESIDENT
FROM:
..
SUBJECT:
. CAROL RASCO
Kassebaum Medicaid for Welfare Swap
PURPOSE
To provide you with background information on the Kassebaum MedicaidlWelfare s\vapas a .
follow-up to the discussion you had with the Governors at Blair House. In addition, to
provide you with a status report on the level of Congressional interest in .and receptivity to
..
this proposal.
BACKGROUND
As you know, Senator Nancy Kassebaum has proposed a major restructuring of the social
welfare system in which the Federal government would take over full responsibility for
Medicaid acute-care and the states would take over the food stamp, AFDC, and WIC
programs. During a five-year transition period, a maintenance-of-effort requirement would
bar states from reducing overall expenditures on cash and food assistance to the poor and
states would continue to bear some share of Medicaid costs.
At least initially, States are attracted to this proposal because it would allow them to relieve
themselves of their future Medicaid spending -- which continues to outpace inflation -- and
have the Federal government take over. The downside from the Federal Government's
perspective is that implementing this proposal would increase the deficit in both the short
. term and the long:-term. The swap could be modified to be more balanced by giving more
programs to the states or by swapping only parts of the Medicaid program. However, any
tradeoffs that would make the swap budget-neutral or deficit-reducing would increase costs
to many or most states (certainly over the long-run) and are unlikely to be received favorably.
by the Governors. Since the Rebublican Congress is desperately looking to save money, it
sems unlikely that this conflict will be resolved this year.
There are other significant policy implications of the Kassebaum proposal other than the
deficit issue. The DPCINEC heaith policy development working' group raised four additional
major policy concerns about the swap proposal, which are outlined in the following pages.
�POLICY IMPLICATIONS OF THE KASSEBAUM SWAP
I. Likely Reductions in Welfare Programs. Experience with states over the pas't 25 years
suggests that states will not maintain existing eligibility requirements and benefits for the
welfare programs. In fact, state spending on welfare programs has declined dramatically in
real tenns:
"
AFDC benefits in the median state have fallen 47 percent in real terms since 1970,
even though the Federal government paid 50 to 80 percent of the benefit costs during
this period. Combined AFDC and food stamp benefits for a family withno other
income, is now at the level of AFDC benefits alone in 1960, before the food stamp
program was created.
Even though state appropriations for WIC generally qualify a state for a larger Federal
WIC allocation, states have been cutting state funds for WIC in recent years. In the
past two years, state funding for WIC fell 33 percent in real terms.
Furthennore, if a balanced budget amendment is passed, prospects that states would maintain
cash and food assistimce for the poor (after the transition period requiring some maintenance
of effort ends) become even less likely.
In contrast, in the two programs where benefits are 100 percent Federally-funded and
national benefit standards exist
the food stamp program and the Federal SSI program -
there has been no benefit erosion over the past, 20 or 25 years.
II. Varying Impacts Among States. Any swap is likely to ha~e different distributional
impacts among states. States that spend more on' welfare than Medicaid (according to
Kassebaum there are 14 such states) will be losers. At least initially, the other 36 states will
be winners -- meaning that Federal government will be picking up some portion of their
current spending. The size of the losses and gains could vary dramatically among states.
As 'some states cut back on their welfare programs -- as is likely under a swap proposal -
variations in welfare benefits among states will increase even more. A key feature of the
Federal food stamp program is its role in helping moderate what otherwise would be huge
differences between states in the benefits they provide to poor children. Today, food stamp
benefits are large in states that pay low AFDC benefits, because a family's food stamp
allotment depends on its income level. This moderating effect would' disappear once the food
stamp program devolved to the states.
The State of Connecticut provides a family of three that has no ot1;er income with an
AFDC benefit of ,$680 per month, about two-thirds of the poverty line. Mississippi,
l
•
by contrast, pays a family of three only about one-sixth as much -- $120 a month,
which is less than 12 percent of the poverty line. When food stamps are added in, the
benefit package in Mississippi climbs from about one-sixth to one-half of the size of
the Connecticut package.
�.
III. Weakening Automatic Stabilizers. The amount of Federal food stamp benefits
provided in a state automatically rises when the state economy turns down and unemployment
and poverty mount -- making the program the Federal government's most important
automatic stabilizer after unemployment insurance. If AFDC and food stamps are devolved,
states will be forced to choose among absorbing the additional benefit costs during recessions,
reducing food and welfare benefits, or putting new applicants on waiting lists:
IV. Complications in Creating a Federal Medicaid Program. If the Medicaid program
became entirely Federal, it would be difficult to justify maintaining the Wide variations that
now exist among states in the categories of households eligible for the program, the health
services that' are covered, and the reimbursement rates that are paid to providers. If the
. Federal government chose to provide uniform coverage similar to that now offered in some of
the least generous states, the number of the uninsured would likely rise and beneficiaries ill a
number of states would Jose coverage for some services. If the Federal government instead
chose to provide coverage similar to that offered in the most generous states, the cost to the
Federal treasury would be great.
'
,
'
NGA AND CONGRESSIONAL RESPONSE TO'SWAP
At least at firs~ glance, the Governors and the NGA were very interested in the Kassebaunl
proposal. Trading virtually anything to rid the states of their expensive, time consuming and
frequently politieally unpopular Medicaid obligations has real appeal. As a result, the
Governors directed NGA staff to study the implications and potential of the proposal.
However, in recent weeks, the Governors, the NGA staff, and the Republicans in the
Congress seem to, have cooled to the Kassebaum concept.
The Governors now appear to be less interested in the proposal primarily because, in an
environment in which the Congressional Republicans' number one priority is obtaining large
Federal savings, a Medicaid/welfare swap to achieve this seems either u,nlikely or will almost
invariably and L\nevenly hurt the states. Second, proposals to block grant welfare -- that
particularly the Republican Governors are advocating -- run contrary to the idea of swapping
entire programs.
The' Republicans in Congress are concluding the Kassebaum proposal has diminished appeal
because they are increasingly believing that this proposal would necessitate complicated and
controversial negotiations. Its attractiveness further diminishes when they contrast it with
block granting proposals that are less complicated and more likely to produce larger Federal
savings. Senator Dole's office reports that there is little or no interest in this proposal on the
Finance Committee. This is significant because the Finance Committee (not Kassebaum's
Labor Committee) has legislative jurisdiction over the Medicaid and AFDC programs.
CONCLUSION
Despite'the states' desire to trade away the Medicaid program, the Congressional interest in
producing significant Medicaid savings as well as the major policy implications of the
proposal I indicate that this type of swap unlikely to go very far in the 1041h Congress.
.
is
�:1/ ~ I~$
\l~
'A1
, Overview of Ways and Means Provisions
in the House Republican Welfare Reform Bill,
,"'Febi1iary 1995
Title I:
Title II:
Title m:
Title IV:
TitlcrV:
~
O\Ucl ~\
Block Grant for TempOrary Assistance for Needy Families
Child Protection Block Grant
Restricting Welfare for Aliens
Supplemental Secttrity Income Refo~
Child Support Enforcement Reforms
Title I; ,Block. Grant for Temporary Assistance for Needy Families,
1. Purposes.
a~
Provide assistance to needy families with children
b. End the dependence of needy parents on government benefits by promoting
work and marriage
'
c. Discourage, illegitimate births
2. Eligible states; State plan. States must submit the following to the Department of
Health and Human Services and update the information every three years:
a. A plan that contains an explanation of:
-.theirprogram for, providing cash benefits to needy families ,
··their welfare-to-work' program, including,suppon services'
·-how they are meeting the requirement of mandatory work after the family
has been on welfare for 2 years (or less at slate option)
--how, and whether they are meeting the requirement to place 2% of their
caseload in work prognims in 1996, rising to 20% by 2003 and thereafter
--their program to red,uee the, incidence of illegitimate births
b. A certification that the state will operate, a child support cnforceJ:Q.ent program
c. A certification that the state ,will operate 'a child protection prognim
d. A certification that the state will operate a foster care and adoption program
3. Grants to states. '
a. The block grant money is an entitlement to states
b. The amount of money in: the block gmnt is 515.355 billion each year between
1996 and 2000
I;COffYl
'
c. Each state receives the same proportion of the block grant each year as it
received of AFDC spending In 1994
.
d. Use of Funds:
.
--in any manner reasonably calculated to accOmplish the purposes (see above)
--in the case of families that have lived in a state for .less than 12 months, states
may provide them with the benefit level of the state from which they moved .
--states may transfer up to 20% of the funds,in any given block grant to other
�,
I
2
block grants
" '. '.
--states may, for up to 6 months,' pay a reduced benefit to a needy family with
, a child whose paternity has not been established
--states are encouraged to implement an electronic benefit transfer system for
providing benefits and are authorized to use block grant funds to set up and
conduct such a system
e. Penalties. States are subject to three possible penalties:
-if an audit detennines that states have spent money on activities not consistent '
with the purpose of this legislation, the amount of misspent funds' win be
withheld from the state's payments during the following year (with the
restriction that not more than 2S percent of a quarterly payment can
be withheld)
--the annual grant would be reduced by 3 percent if states fail to submit the
perfonnance data, required withm 6 months of the end of the fiscal year so that
Congress can prov.ide' oversight
--states would be fmed 1 percent of their annual grant if they fail to participate
in the Income and Eligibility Verification System designed to reduce welfare
fraud
,',_e"
4. Prohibitions. Block grant funds ,cannot be used to provide:
a. Benefits to a family that does not include a minor child
b. Renefits to an individual receiving benefits from old-a~e ~istance.'
,foster care, or Supplemental Security Income - c..~ ~~"
'
c. Benefits (0 noncitizens unless the individual is a refugee who has
'resided in the U.S. for less than S y~ or is 8 legal resident over age 75
who has lived in the U.S. for more'than 5 years
d. Cash benefits to a minor child born out of wedlock to 8 mother ~der
age 18 or to the mother (Medicaid and 'Food Stamps would continue)
e. Cash benefits for additional children born to families already on welfare
,
(Medicaid and Food Stamps would continue) .
f. Cash benefits for families that have reCeived bloCk grant funds for S years
(Medicaid and Food Stamps would continue)
g. Benefits to a family with adults not cooperating with' the state child support
enforcement agency
h. ' Benefits to a family with an adult who has not assigned to the state the chiIdts
claim rights against a noncustodial parent
S. Data collection and reporting. States are required to submit annual data on several
important measures of their Temporary Assistance Block grant; e.g., the number o(
faItlilies receiving benefits, the earnings of families, other welfare benefits received
by families, and the number of months on welfare
�3
-- 6. ~"Audits~· Each state must submit to an audit every, second year under tenns of tlie--...c,..:··,:_:
Single Audit Act,
Title II: Child Protection BlockGram ..
1.·. Purpose..The purpose of funds provided to states, in this block grant are to help
. states:
a.. Identify and assist families at risk of abusing or neglecting their childfen
b. Operate a system for receiving reports of abuse or neglect of children
c. Investigate families reported to abuse or neglect their children
d. Assist troubled families in providing the proper protectio~ and nurture for
their children
e. Support children who must be removed from or who cannot live with their·
families
f. Make timely decisions about permanent living arrangements for children who
must be removed from or who cannot live with their families
.
g. Provide for continuing evaluation and improvement of child protection laws,
,regulations, and services
,
2. Eligible states. In order to be eligible for block grant funds, states must:
a. submit a written document to HHS that describes how they intend to pursue the
'
purposes described above
b. certify that they have a sta~ law requiring public officialS and other
professionals ·to report actual or'suspected cases of abuse or neglect
c. certify that they have procedures for determining quickly whether a report of
abuse or neglect is credible and fortakirig action if it is
d. certify. that they have procedures for ensuring that children removed from their.
families for protection are placed in safe and nurturing settings;
e. certify that they h~ve procedures for ensuring that children removed from their
families have a written plan that specifies the goal for achieving ·a permanent
placement, that the plan is reviewed every 6 months, and that information about
the child is collected reguJarly and recorded in the case record
f. within three years. of the date of passage, declare quantifiable goals of their
child protection program and report quantifiable information on whether they
.
are making progress toward achieving their goals
The Secretary of HHS· can determine whether the state plan'includes all of the
elements reviewed above but cannot add new elements or review the adequacy of
state procedures .
.
�4
3. Grants to states for--child-protection~
a. The block. grant money is an entitlement to states for five years
h. The amount .of money in the block. grant is $4.145 billion in 1996, $4.308
billion in 1997, $4.471 billion in 1998, $4.631 billion in 1999. and 54.789
billion in 2000
c. Each state receives the same proportion of the block grant each year as,it
received of payments to states by the federal go~emment' for child w~lfare
programs in the average of the years 1991, 1992, and 1993
.
d. Use of funds.. States can use block grant funds
--in any manner reasonably. calculated to accomplish the purposes (see above)
-to transfer up to 20% of the funds in any given block grant to other block .
grnn~
.
,
e. Penalties. States are subject to two possible penalties:
--if an audit detennines that states have spent money on activities not consistent
.. with the purpose of this legislation, the amount of misspent funds will be
withheld from the state's payments during the following year (with,~the
restriction that not more than 25 percent ·of a quarterly payment can be
withheld)
--the annual grant wiUbe reduced by 3 percent if states fail to submit within 6
months required data reports
4. ChiJd protection standards. These standards are included in the bill to indicate what·
states must do to assure the protection. of children and to provide guidance to the
citizen review panels:
a. The primary standard by which a state child. welfare system shall be judged is
the protection of children
h.. Each state shall investigate reports of abuse and neglect promptly with due
regard to the potential danger to children .
.
c. Children removed from their homes shall have a pennanency p]an and a
dispositional hearing by a court or a court-appointed body within 3 months after
a: fact-finding hearing
. d. AIJ child welfare cases with an out-of-home p]acement shall be reviewed every
six months unless the child is aIfeady in a long-tenn placement
5. Citizen review panels.
.
a. States must have a least one citizen review panel for each metropolitan area of
their state
'
b. Panel members must be broadly representative of the coriununity from which
.they are drawn
c~ Panels muSt meet at least quarterly
�s
d. Panels, are charged with the responsibility ofreviewiilg'cases from the child
welfare system to determine whether state and local agencies receiving funds
under this program are carrying out activities in aecord with the State plan, are
achieving the child protection standards, and are meeting. any other child welfare
criteria that the panel considers important
' .
e. Panels must produce a'public report after each meeting and states must include
infonnation in their annual report: detailing their responses to the panel report
and recommendations
.f. . Panels must protect the conf.identiality of individual cases
6.. Audits. State expenditures are audited every second year; any funds spent for
purposes other than those stated for this block grant will be repaid to the federal
government
\ '
7. Data collection and reporting. States must annually report an extensive set of data
to the federal government. The information that must be reported includes the
number of children reported as abused or neglected, the number of children
removed from families, the number of families that received preventive services,
the average length of stay in foster care, the number of children in foster care with
a goal of adoption, and several additional performance measures. States' must also
include in their report a summary of the data measuring whether they are making. , .'
progress toward their goals (see above), a summary response to the findings and
recommendations of their citizen review panels, ana, if funds were transferred to
another block grant. an explanation of why the funds were transferred.. The
Secretary of HHS must prepare an annual report based on state reports and make
the report available to both Congress and the pubJic.
TitleJII: Restricting Welfare for Aliens
1. Ineligibility of aliens for most public welfare assistance. With the exceptions noted
below, noncitizens are not eligible for 41 means-tested.pro~ (sec attached list)
2. In order to help noncitizens improve their job preparation skills, they remain'
eligible for eleven programs that provide edu~tional or training services. AduJt
and children noncitizens are also eligible for emergency medical services and for
immunizations against preventable diseases (see attached Jist); states can usc their
own funds to provide benefits to aliens as states see fit
3. Exceptions:
a. Refugees are not ineligible for means-tested' programs until five years after their
date of arrival in the U.S.
.
�6
. ~b~ . Noncitizens over. the age of 75 who have lived in the U.S. for at leaSt 'five yettts'
may also continue receiving welfare benefits
4. Current resident exception. The ineligibility for means-tested benefits of
noncitizens currently living in the U.S.' does not take effect until one year after the
date of enactment of. this bill
5: Notification. Each federal agency that administers a program from which
noncitizens are to be disqualified must provide general notification to the public
and program r.ecipients of the eligibility changes
6. AFDC. agencies required to provide information. Agencies administering the Aid to
Families with Dependent Children program must provide the name and· address of
illegal aliens with children who are citizens of the U.S. to the Immigration and
Naturalization Service
. 7. Sponsorship agreements. The document by which individuals agree to sponsor
immigrants by making their income available to the immigrant is made legally
binding Wltil the immigrant becomes a citizen (the agreements are not now legally
binding and last for either three or five years)
.
. Title IV: Supplementa.l Security Income Refonns
1. Denial of SSI Benefits to Drug Addicts and Alcoholics. '.
a. An individual shall not be considered disabled if his primary diagnosis is that he
is addicted to alcohol or a drug
b. As a result drug addicts and alcoholics lose SSI benefits and Medica.id coverage
c. Part of the savings realized will be block granted to States for drug treatment
2. 5SI Benefits to Certain Children.
a. Restrictions on eligibility for cash benefits
. --repeal "comparable severity" teSt for detennining disability of children, so that
eligibility for cash benefits or new medical services will. be bas cd on medical
listings only, and not "individual functional assessment"
.
·-children currently receiving cash benefits because of a disability specified in
the medical listings will continue to be eligible for cash benefits; howevcr,
(children not already on SS! on enactment will only receive cash payments if
institutionalized or otherwise would be in the absence of the cash payment
--children considered disabled but not receiving cash benefits will be eligibJe for
additional medical services provided through block grant described below
�·7
b. At least once every· 3 years States must conduct continuing disability reviews. for
children eligible for cash benefits (except those whose condition cannot
improve)
c. 6' month grace period for current SSI recipients
d. Social Security shall issue regulations. within 3 months of enactment
Social Security must notify within 1 month those whose eligibility wilt terminate
f. Block Grants for, children With disabilities
. --Social Security to make grants; grants arc an entitlement to States
•..remove individual entitlement to benefits
-grants sp.ent. only on authorized medical and non-medical servic;es for qualifying
divjduals
'
.'
.'
,
\~::t . .
- tates decide which services from prescribed list may be paid for with grants .
"
,
~ )<' --"qualifying individual" means a child who is either (1) eligible for cash S8I
c.,~ I bcn'efits under this title; or (2) who is not eligible for cash but is disabled by a
~:b-' condition in the medical listings .
.
.
"5 ~ ';:f. -·State grant based on number of children eligible' for. additional services,
e.'
·
Pf
,~
\'
I'ooudlne
..
�Programs for Which.Aliens Would Be Ineligible:
Programs for Which Aliens Wo~ld Reinaln Eligible:
1. Medicaid
I. Emergency medic:aJ scrvlc:e.s
2. Stafford student loan Pro&JUll
3. Basic edUc:alionaJ· opportuDity grants
4. Federal work study
S. FcdCral supplemental eduaition opportunity grants
6. FedcnJ Perkins loans
.
.
7. Gnmts to statU for stale student i.ncentiuves
S. Grants and fellowships for graduate programs
.
9. Special programs for students whose families arc 'engaged
in migrant and seasooal firm work
10.. Loans and Scholarships for Education in the Health
Professioll5
1L Grants for Immunizations Against Vaccine-Preventable
Diseases
2.
3.
4..
S.
6.
7.
8.
9.
Maternal & Child Health Services Block Grant Piograms
Community Health Center Services
Family Planning Methods and Services
Migrant Health Center Services
AFOC
Child Welfare
SSI
foster Care and Adoption As,sistanco
10. Food Assistance Block Grant Programs
11. Rental Assistance
12. Public Housing
13. Housing Loan Program
14. Housing Interest Reduction Program
IS. Loans for Rental and Cooperative Housing
16. Rental Assistance Payments
17. Program of Assistance Payments on Behalf of
Homeowners
'
18. Rent Supplement Paymeots on Behalf of Qualified .
Tenants
19. Loan and Grant Prognsms for Repair and lmprovement
of Rural Dwellings
20. Loan and Assistance Prognsms for Housing Fann Labor
21. Grants for Preserv8lion and Rehabilitation of Housing
22. Grants and Loans for Mutual and Self·Help Housing and
Technical Assistance
23. Site Loans Program ..
24. Grants for Screening. Referrals, and Education
Regarding Lead Poisoning in Infanl~ Md Children
25. Block GranlS for Preventive Health and Health Services
26. Title X~X·B subparts 1 and n Public Health Service Act
27. Programs of Training for Disadvantaged Adults under
Title II-A and for Disadvantaged Youth under Title U.cof
the Job TrainingPartnersbip Ad
28. Job Corps Program
.
29. Sununer Youth Employment and Tmining Programs
30. Older American Conununily Service Employment Ad
Programs
3 l. Title HI Older Americans Act Programs
32. Tille H-B Domestic Volunteer Service Act Programs
33. Title U·C Domestic Volunteer Service Act Programs .
. 34. Low·Income Energy ASSistance Act Program
35. Weatherization Assistance Prognun
36. Social. Services Block Grant Program (Tide XX SSA)
37. Community Services Block Grant Act Programs
38. Legal Assistance under Legal Services Corporation Act
39. Emergency food·and Shelter Granrs under McKinney
Homeless Acti ·
•
40. Child Care and Development Block Grant Ad Prognuns
41. Slate: Prognun for Providing Child Care (section 4020)
SSA)
.
�'~ - 15c. e'.s
.lt...
rOl...)S
~
THE WHITE HOUSE
WASH I NGTON
February 9, 1995
MEMORANDUM FOR THE PRESIDENT
FROM:
Bruce Reed
SUBJECT:
Welfare Reforrn Update
I. House Republican Bill
Today, Clay Shaw announced details of the welfare reform bill he will mark up in
. subcommittee next week. He has agreed to include most of our child support provisions, but
his bill is still heavy on conservative micromanagement and puts states at financial risk.
An outline of the Shaw bill is attached. It converts nearly 50 means-tested programs
into three capped entitlement block grants. Funding levels .are frozen for five years at 1994
levels, for a federal savings of $14 billion ($7.6 billion from capping 'AFDC). Immigrant and
other SSI provisions save another $23 billion.'
Although Engler and Thompson helped negotiate the bill, the governors ended up with
more strings and 15% less money. The bill mandates several provisions the NGA resolution
specifically rejected, requiring all states to deny aid to young unwed mothers and legal
immigrants, and imposing the family cap nationwide. Work is mandatory for everyone after
2 years, and states are required to cut off families after 5 years on welfare.
Our strategy as this bill moves through the House will be to: 1) highlight areas where
the Republican plan is prescriptive and mean; and 2) call attention to the potential cost shift
in key st{ltes and districts with moderate Republican Congressmen, Senators, and governors.
II. Democratic Alternatives
The Mainstream Forum, led by Nathan Deal and Charlie Stenholnl, reintroduced their
welfare reform bill today. Their bill is a souped-up version of ours: move people to work as .
quickly as possible, family cap state option, minor mothers live. at home, national c,ampaign
on teen pregnancy, all our child support provisions, but a faster phase-in.
�The Mainstream Forum bill gives the states a great deal of flexibility, but maintains
the individual entitlement. It calls for a four-year lifetime limit, but lets states keep people
on longer jf they wish. Their bill would cost $17 billion, but they propose a host of offsets:
cutting off legal immigrants (but this time they plow $6 billion' back to the states so it's not
an unfunded mandate), the EITG fraud provisions from our FY96 budget, and counting
welfare benefits as taxable income.
House Democrats are galvanizing around the theme that welfare reform should be
about work, not just punishing the poor. On Friday, Gephardt will hold a press conference
with House Democrats from across the spectrum (from Eleanor Holmes Norton ,to Nathan
, Deal) to announce a united front. They will propose that as of October 1, 1996, all new.
applicants who can work must be working or moving toward work .. For now, they see this
more as a unifying theme than a concrete policy proposal.
On Friday, we' also expect Gov. Carper to send a letter to governors wamil)g them that
the current version of the Republican bill puts their states at financial risk and :imposes
numerous strings the NGA specifically rejected.
/
�02/09/95
13:51
'6'202 690 i3~.._.
HHSOS ASPE nSF
[4] 00 ~
PAGE A
"
Overview of Ways ami Means and Opponunities
'
Committees Portions of the House Republican Welfare Reform Bill
Februs.ry 1995
Title
/Title
'Title
Title
[;
1[;
III:
IV:
Title V:
Title VT:
Block Grant for'Temporary Assistance for Needy Families
Child Care 'Block Grant
Child Protection Block Granl
Restricting Welfare for Aliens
Supplemental Security Income Refonns
Child SUPPOI1' Enfor.:ement Refonns
Tirle 1: Block Gran! for TempQran; Assistance for Needy families
1. Pwposes
,a. Provide assistance to needy families with children
b. E.nd the d~pendence of needy parents on government benefits 'by promoting
work and marriage
c. Discourage illegitimate births'
2. Eligible sta{~s: State ~lan. States ml..lSt ::ubmit th~ following to the Department of
Healtha.nd Human Services on an annual basis:
a. A plan that (',orttains an explanation of:
··their program of cash benefits to needy families
~-their welfare-to-work program. including support services
.
··how Un:y are meeting the requirement of mandatory work after the family
has been on welfare for 2 'years (or !ess at state option)
--how a.od whether they are meeting the requirement to place 2% of their
caScload in work progrttmS in 1996, rising to 20% by 2003 and ther~fter
--their program to reduce the incidence of il1c:gitimate births
b. A certific3tion that the state will operate a child support enforcement program
~. A certllication &lat the state will OperaH! a child prOTection 'program
d. A certification that the state will operate a foster care and adoptioTl program
,), Grants to states:
3. The block grant money is an enritlement to states
b. The amount of money in the block grant is $15_265 each year between
1996 and 2000
c. Each state receives the same praporti6!l of thi:: block ~t 611:::h year as it
received of AfDC sp~nding in 1994
d. Use of Funds:
--in any mAnner r~asonably calculated to accomplish the purposes (see above)
--in the case of families thaI have lived in Q state for less than 12 months, states
m3Y pro~'ide them with the b~nefit level of the state from which the~' moved
\
'
�02/09/95
13:51
ft202 690 i3.83·
HHS OS ASPE n5F.
PAGE
2
··states may transfer up to 20% of the funds in any given block gran~ to other .
block grants
.
--~tJlt~s may. for up ~o 6 months, PiY a reduced benefir to a needy family with
a child whose patcmity has not been establisbed
c. Penalties. States are subject to three penalties: .
--if an audit determines that 5taU:S have spent money on a.ctivitie5 cot consistent
with the PllllX's..e of this legislation, the wnount of misspent f\.u1d.s will be
withheld from the stale's paymentS during the toHowitig year (with the
restriction that not more than :S perce.nt of a quarterly paymt:nt can .
be withheld)
--the W1J1ual grant is reduced by 3 percent if states fail to submit the
performance.: data required so that Congress can provide oversight on state
accomrlishments
--:;tateS are fined 1 percent of lh~lr annual grant if they fail to participate in the
. Income and Eligibility Verification Sycaem de~ig:nedto reduce welfare fraud
4.
Prohibitions.' Block grant funds' cannot be used to provide:
l1. Bt:r:efiLS to a fwnily .that does not include a minor 'child
6. Benefits to an .individual receiving benefits from old·age assistance,
foster care, or Supplemental Security Income
.
c. Benefits to noncitizens unless the individual is an alien who has
resided in the U.S. for over 6 years or a iegal resident over age 75 who ha.s
lived in the U.S. for more than 5 yea..rs
d. Cash benefits to a minor child born nUl of wedlock (0 a moth~r u.nd~r
age .18 or to the mother
.
c. Cash benefits for additional children born to f:&miIies already
wei fate .
f. Cash benefits for families that have recf:iy.!d block grant funds for 5 years
g. Benefits to a family with adults not cooperating \\<ith the statech.ild support
enforcement agency
.
h. BendiLS to a family with an adult v"'ho has not assigned to the state the child's
claim rights against the noncustodial paren[
.
on
5. Data collectior. a..,d reponing. States are requir:d [0 submit annual data on several
importan: mea5UIes of their Temporary Assistance Block grant; e.g., the number of
flmilies receiving benefitS. the earning of f£mlilit:s., other wd[are benefits received
by families. and the numbtr of months on welfare
6. Audits. Each state must submit to an audir every second year under
Single Audit Act
t~rms
of the
5
�13:50
02/09/95
"lt202 690 i383
141 002
HHS OS ASPE 415F
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"'''4.1...... '1••. c ...t~('IA .....
;tU ..ct:'WIJlY. Lt:'XJt4t.a......
~ h......,..n,ry t,.I!c:c..oua.
~"E
c_
......... r.:__, ,_ _
'","so..-
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-'(\I"OA
.".pit~i~.
..-.:... c .....,yfwn ...
TO:
MefC\bers. Committee c:;. Ways and Means
fR:
E. CldY Shaw, Jr.
I
c~airm4I)Suhcommittee
on Human
Re~ources
In a speech at t.h~ U.S. Chamber of C.ommerce lat:.er this
r.1o::-ni71~. : wi:"1 px:-esent an outline of the d.irecti0n my chairman'!!
ma~k, will ~ak~ Ci8 we begin corisideration of welf~re refcrrn in
su~comm!t:ee next week.
Later today, we will delive~ to all
Memb·:rs ot :he Commi::.tee a complete 8x-planat1on of all of the
provisions, w~ch the exception of child support enforcement
provisions whieh are in the final design stages. We are
expe~~ing some changes between now and Mcnday's markup~
Here lS an outline of th9 plan we have developed:
Cash welfare Block Grant
• G current Aid tc Families with Dependent Cbildr~n programs
will be replaced with a single block gr~~t to States.
• Spend~~g ~n :aah wel£are will be capped for 5 years, saving
~axpay~rs $7.6 billion.
• St~tes wi!l be probibiced from using federal tax dollars to:
(1) pay cash welfare eomothere und~r 18 ~ho have children
·jUt; -of -wedlock;
(2) gi veextra p~yrr.~nt:.EI to families' that have
~or.e c~':::'lc.rcp. While on wel:are: and (3) pay cash welfa:re r:o a
aingl~ family for ~ore than 5 years.
a 'tie 1 f.'i rp. re<;ipients must work: to cor..tinue getting cash
paymen~s after two years.
child Car@ Block Grant
• ~ou~d ten current federal child care prog~ams will be merged
inco an~:her block granL, achi~ving S3.Gbillion in aavi~gs.
•
As with othe= block grants. States will be given enormcus
f:i.C::A.lbil ity to bet:. ter lH~rve t.heir residents. simplify .
9ro9rams, and
save
tax?aye~s
money.
(
C;:':"ld Welfare Blo'ck Gr;nt
•
•
Mere c~ar. 24 current p~cgyam9 will be =o~~ir.ec into ancthe~
b':'uck g:rant 1:0 hel~ .scacesprotect neglected and abusec
cnildre~. saVing nearlv $4 billion over' five years.
Neglec~ed and abused children will b~ f~eed from federal
=egu!a~~on6 to realize qui~ker adopti6ns, more
::orr1"\t,~r d bB ~ ~v ~r.d fewe: a!"b~ttl~ fUl~9
UlJQhington.
rrnm
�02/09/95
13:51 ,___
fr202
6~i383
HHS OS ASPE415F
141003
PAGE 3
- :2
•
~S
wich other block grants, States will be required to send
~n:ormatior. about their programs co the federal government,
so 'We can figure out what worke,'
Reducing Welfare Ro11.8
Dr-.lg addictS ar.d alcoholics will nc lcnO'er be considered
disaoled a~d'therefcre eligible fer cash pa}~en~s from SSI,
• Ae in the Contrace. non·~iti%ens would no longer be
eligible for, mOG~ 'Welforeprograms. 'Excepe1ons will remain
for refugees and legal, long term residents over 75; non
citi%enG 'Will ~till qualify for educat~on and training
programs so they can improve :heir job preparation to ~eccme
mere productive future citi~ens.
• SpunBorship provisions ~ill be ~t~engehened.
,
•
•
CEO es~lmates Lhes~ provisions will r~duce welfare spending
by abou~ S23 billio:1o.....er 5 years (although mUC!l of. this .
!::idV'iol'lgs will accrue to St:ar,es because of the block g'!"ants
descr~bed above) .
�02/09/95
16:27
'CDNGRESSMRN NRTHRN DERL
-7
94565557
NO.734
P005
Individual Responsibility Act of 1995 - Sumr:nary
OutHne of Welfare Reform Bill
Title I:
' Time-Limited Transitional Assistance
Title II:
Make Work Pay
Title III:
The Work First Program
Title IV:
Family ResponSibility and Improved Child Support Enforcement
Title V:
Teen Pregnancy and Family Stability
Title VI:
Community Service
Title VII:
Program Simplification
Title VIII:
Financing
Time-Limited Transitional Assistance:
Imposing a time limit on welfare
eligibility is the only way to fundamentally change th~ system from one that writes
checks to one that puts people'to work.' The two-year lifetime, Work First time
limited assistance program will transform 'a system based on the right to income
maintenance into a system based on the obligation to work. This time-limited
assistance would be phased-in, beginning in FY 1997, When 16,% of a state' 5 AFDC
families must participate in the program. This percentage increases to 20% in FY
1998, 24% in FY 1999, 28% in FY 2000, 32% in FY 2001, 40% in FY 2002, until
reaching 52% in FY 2003 and' each succeeding fiscal year.
II
' Making Work Pay: The bill would ensure th'at a welfare recipient will be better
off economically by taking a job than by remaining on welfare. To do this. the
current disincentives within the system that make welfare more attractive than work
must be eliminated. There are five vital components in this regard:
.
* Health Care - Extended Transitional Medical assistance (TAM) from one to
two years.
"
'
* EITe. - The bill would improve outreach efforts to both recipients and
employers to ensure that they make use ofEITC.
·Child Care - Federal funding for child care assistance would be consolidated
into a single program under the Title XX· soCial services block grant. States would be
required to submit one plan for all aSSistance under this program,instead of be
required to comply with four different sets of federal regulations for different federal
child care programs. Title XX is a capped entitlement program without specific
authorization. A consolidated block grant of $ 1.2 billion a year would replace the At
Risk Child Care program and'the 75% of the Child Care Development Block Grant
used for direc~ child care assistance. There would be an individual entitlement for
child care assistnance for individual participating in the Work First· program or who
are leaving welfare. The Federal government would reimburse states for the cost of
the individual entitlements at 70% or the Medicaid matChing rate plus ten percent,
whichever is higher.
�CONGRESSMAN NATHAN DEAL
~
94565557
NO.734
P006 ,
.
... AFDC Work. Disregards - The AFDC benefit structure provides little financial
incentive to work harder and earn more. In general, a rise in earnings is largely
offset by a corresponding drop in AFDC benefits. As a result, welfare recipients who
try to work are only marginally better off than by remaining on welfare. The proposal
would allow states to liberalize the earned-income disregards within an established
federal guideline.·
". Asset Limitation - While work is a first step out of poverty, asset
accumulation is necessary to keep a person out of poverty. The proposal would
increase the vehicle asset threshold to $5,000; increase the non-vehicle asset
threshold for either AFDC or food stamps, capped at a level of $2,000 or up to
$8,000 for specific use in setting up a microenterprise, purchase of a first home, or
for higher education.
III
Work First Program: . The bill would establish a WF program to move welfare
recipients off of welfare into jobs. The WF program would be administered at the
state level. The bill encourages the states to tailor programs which· meet their
individual needs. However, the bill also recognizes that states may not be able to
develop a WF program immediately. Thus, the bill establishes a Federal Model which
each State would use until it develops its own program.
•
•
.•
The Federal model is expected only 10 be a transitional program until states
develop their own programs.
.
.
States are required to submit their ·own programs within five years of the
enactment of this bill.
States could choose to adopt the Federal Model or adopt their own program
within the broad federal guidelines set in . this bill that require states to place an
emphasis on placing individuals in private sector employment.
Community Service - At the end of two years, if a welfare recipient has not found
full-time employment, he or she will no longer be eligibJeto receive AFDC, but the
state will have the option to provide a welfare recipient with a full-time (30 hours or
more' community service job and/or have access to placement and support agencies
. nd/or subsidized jobs as described in the "Work First" section. States may readmit
a
up to 10% of their caseload who have not found employment after two years of the
Work First program an.d.. two year community service, Q! those who left welfare after
finding employment and were forced ~o return but have no· time left on the clock. In
addition, states may petition the Secretary.·of HHS to increase this percentage up to
15 % if they meet the economic hardship conditions set forth by the Secretary. All
recycled recipients will be reevaluated by a caseworker or case management team
and a new employability contract will be established.
'
�CONGRESSMRN NRTHRN DERL
~
94565557
NO.734
P007
'IV.
Family' Responsibility and Improved Child Suppon' Enforcement: The goal of
the proposal is to maintain and improve the child support program by promoting the
benefits of two supportive and responsible parents.
Establish in each state a central registry to streamline the current collection
and distribution of child support by keeping track of all support orders
registered in the state.
Improves interstate enforcement through the adoption of UIFSA and other
measures to make interstate enforcement more uniform.
Establish hospital-based paternity by: requiring states to offer
paternity/parenting social services for new fathers; making benefits contingent
upon paternity establishment (recipients provide full cooperation in establishing
paternity to receive benefits); require hospital based paternity establishment
for all single mothers.
Enforce child support through demanding and unc'ompromising punitive
measures for deadbeat parents including: strongly reinforcing direct income
'withholding; requiring states to establish procedures under which liens can be
imposed against lottery winnings, gambler's winnings; insurance settlements
and payouts, and other awards; and require non·compliant noncustodial
parents delinquent in their child support payments to enter a work program in
which they work to payoff benefits going to support their child.
V.
Teen Pregnancy and Family Stability: The bill promotes individual reproductive
responsibility by giving states the option to implement the family caP;
requiring minor mothers to live with a responsible adult, preferably a pa~ent;
supporting a national education c~mpaign to teach our children that children
who have children are at high·risk to endure long-term welfare dependency;
providing iricentives for teen parents to stay in school; providing funds for
states to create or expand programs for minor noncustodial parents to promote
responsibility and work;' and giving states the option of eliminating current
'
disincentives to marriage.
Program Simplification: Streamline the waiver process which is bureaucratic
VI
and gives too much discretion to the Secretary of HHS to deny state waivers simply
because they do not like their program. In its place, the bill sets forth guidelines that
if the state plans meet, thEm it will be approved by the Secretary of HHS.
States' bear a heavy administrative burden in implementing the AFDC and Food
Stamps programs, mainly because of complicated, inconsistent and rigid policies.
The operation of these programs should be simplifiedby unifying the policies that
determine eligibility for these programs. The bill would simplify the application and'
eligibility process for AFDC and Food Stamps. Some of the most time-consuming
�/
CONGRESSMAN NATHAN DEAL
-+
94555557
NO.734
P008
and difficult tasks in administering these programs are the initial procedure now
required to take and process applications. Twenty specific provisions are included in
this bill that will significantly improve this process. These include provisions to unify
the application, deductions, eligibility, income, resources, certification and
recertification rules for AFDC and Food Stamps.
S51 Reform: If Congress fails to act within 90 days after the submission of
VII
theSlanery Commission Report, then funding for the children portion of SSI will be
frozen at the FY 94 level.
J
Financing: The plan would save $20.3 billion over five years by ending welfare
VIII
for most noncitizens except tor emergency medical services. Exemptions will be
made for refugees and asylees for six years after they arrive and noncitizens over
age 75 who have been legal residents for at least five years. It ,does not abandon
new immigrants. Rather, it merely transfers responsibility for their welfare from the
government to where it truly belongs--their legal sponsors, the American citizens who
by law must endorse most i.mmigrants' applications for citizenship based on the
promise that immigrants will not become public charges. We propose six billion
dollars of monetary assistance to states to be used under state discretion to aid their
immigrant populations who will be detrimentally affected by this cut. In addition, we
propose to give states the authority to sue a sponsor if an immigrant applies for state
or local assistance and to mimic the federal government if,! denying state benefits to
noncitizens.
The bill would raise $9 billion over five years by adding income from AFDC, Food
Stamps and housing assistance to taxable income so. that a dollar from welfare isn't
worth more than a dollar from work. The bill would increase EITC enforcement to
reduce fraud in the program to save at least $3.5 billion over five years. It would
make several other smaller changes within the welfare system to save approximately
$2.5 billion over five years.
Funding: The bill provides more funding for states to help meet the costs of the WF
program as well as the increased caseload for child care costs. For the WF program,
our bill would have a seventy percent matching rate or the Medicaid matching rate +
ten percent, whichever is higher for the states. For Community Service, our
matchin~ rate would be seventy, percent matching rate or Medicaid matching rate +
ten percent for the Administrative costs, whichever is higher for state. For wages, it
,would be the Medicaid matching rate.
�.;
February 9, 1995
MEMORANDUM FOR SENIOR STAFF
FROM:
Carol H. Rasco
SUBJECT:
Welfare Reform Update
I. House Republican Bill
Today, Clay Shaw announced details of the welfare reform bill he will mark up in
subcommittee next week. He has agreed to include most of our child support provisions, but
his bill is still heavy on conservative micromanagement and puts states at financial risk.
An outline of the Shaw bill is attached. It converts nearly 50 means-tested programs
into three capped entitlement block'grants .. Funding levels are frozen for five years at 1994
levels, for a federal savings of $14 billion ($7.6 billion from capping AFDC). Immigrant and
other SSI provisions save another $23 billion.
Although Engler and Thompson helped negotiate the bill, the governors ended up with
more strings and 15% less money. The bill mandates several provisio.ns the NGA resolution
specifically rejected, requiring all states to deny aid to young unwed mothers and legal
immigrants, and imposing the family cap nationwide. _Work is mandatory for everyone after
2 years, and states are required to cut off families after 5 years on welfare.
II. Democratic Alternatives
The Mainstream Forum, led by Nathan Deal and Charlie Stenholm, reintroduced their
welfare reform bill today. Their bill is a souped-up version of ours: move people to work as
quickly as possible, family cap state option, minor mothers live at home, national campaign
on teen pregnancy, all our child support provisions, but a faster phase-in~
The bill gives the states a great deal of flexibility, but maintains the individual
entitlement. It calls for·a four year lifetime limit,but lets states keep people on longer if they
wish. Their bill would cost $17 billion, but they propose a host of offsets: cutting off legal
immigrants (but this time they plow $6 billion back .to the states so it's not an unfunded
mandate), the EITC fraud provisions from our budget, and counting .welfare benefits as
taxable income.
�House Democrats are galvanizing around the theme that welfare reform should be
about work, not just punishing the poor. On Friday, Gephardt will hold a press conference
with House Democrats from across the spectrum (from Eleanor Holmes Norton to Nathan
Deal) to announce a united front. They will propose that as of October 1, 1996, all new
applicants who can work must be working or moving toward work. For now, they see this
more as a unifying theme than a concrete policy proposal. '
On Friday, we also expect Gov.' Carper to send a letter to governors warning them that
the current version of the Republican bill puts their states at financial risk and imposes
numerous strings the NGA specifically rejected.
Talking Points/Questions and Answers
,
.
Yesterday, I sent around a copy of talking points and questions and answers on how to
handle the difficult question of whether we support would be able to support a bill that did
not contain an individual entitlement. As the President did yesterday in responding to press
questions, we must give ourselves room' on this issue by always redirecting the discussion to
the test we want to hold welfare reform to: Does it move people from welfare to work? Does·
it hold parents responsible for supporting their children? Does it take on the teen pregnancy
problem? Does it avoid punishing kids because their mothers are poor, young or unmarried?
I will continue to provide you updates next week as the debate in the House
. Subcommittee unfolds.
.
�FEB-09-1995 13=18 FROM
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PAGE 2
.COMMI1TEE ON WAYS AND MEANS
v.s. HOUSS O~ AEPREifiNTATlYES
WASHlfliGTON. DC
206'~'a
l'ebruary 9, 1995
TO: . Members, Committee on ways and Means
FR:
E. Clay Shaw, Jr., Chairman Subcommittee on Human Re8Qurcee
In a 8p~eeh at tho U.S. Chambar of Commerce later this
morning,! will present an olJtline of the direction my Chai:;-man'.
mark will ta.ke iiLS we begin consideration of welfare r!!form in
subeommiceee next. week. Later today, we will deliver to all
Members of ~he committee a complete explanation of all of the
provisions, with the exception of· child 8upport enforcement
provisions which are in the final design· stages. We are
expecting some changes between now and Monday'S markup.
Here is an outline of the. plan
W8
have developed:
Caih' wAlfare Block Grant
• G current Aid to Families with Dependent Children programs
will be replaced with .a single block grant to States.
• spending on c•• h welfare will be capped tor 5 years, saving
taxpayer. $7.6 billion.
• States will be p:.rob,1b1ted from using federal tax dollars to:
(1) pay cash welfare to mothers under 18 who have children
o~t-ofwwedlock: (2) give extra payment. to families that have
more children wh1le.on welfare: and (3) pay cash weltare to a
single family for more tha.n S yearSl. .
• Welfare recipients must work to continue getting cash
payments atter two years.
Child Care Rlock Grant
•
•
ten eurrent feaeralchild ~are programs Will be merged
into ano.ther block grant, achieving $3. {; billion in savings.
As with other block grants, States will be given enormous
flexibil~ty to better serve their residents, Simplify
programs. and tIlaV8 taxpayers money.
Aro~nd
WeI taro Block GraDt
• More than 24 current programs will be combined into another
blOCK 9r~nt to help seates protect neglected and abused
cld.ldren, ,sa v lng nearly .$4 billion over t'ive year•.
• Neglecte~and abused children will be freed from federal
regulations to realize quicker adoptions, more
'accountability, and fewEir arb~ttl¥Y pul~1
{>~e. ....H!..V- Q..("~:t.r... V"y ('v\.e....~ f.ro~ WGl~"'iW'\~-hY\.
~g
ffnm W.1Qhinqton.
�FEE-'09.-1995
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TO
FlUE No. 760 02)09 '95 12:04 ID:CONG. MATSUI
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.. 2 •
•
All with.other block grantfl,· States will be required to send
information about their programs to the federal government,
._0 we can figure out. what works.
Regycing Welfa;e Roll.
• Drug addicts and alcoholics will no longer be considered
d~.~led and therefore eligible for cash payments from SSI.
• As in the Contract. non~citizens would no longer be
eligible for most welfare programs. Exception. will remain
for rAfugeea a.nd legal, long-tenn residents over7S; non·
cie1zens w~ll still qualify for education ana training
programs so they can improve their job preparation to become
·mora productive fut.ure citizertl..
• Sponsorship provision. will be. strengthened.
•. cao e.timatea these provisions will reduce welfare apendi.ng
by about $23 billion Qver S year. <although much of this
.
savings will accrue to Statee because of the block grants
de8cribea above} .
P.03/10
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3
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,
Overview of Ways and Means and Opportunities
Refonn Bill
February 199,S
Commjtt~s Portions of the House Republican Welfare
TItle I:
Title II:
Title III:
Title IV:
Title V:
Title VI:
Block Grant lor Temporary Assistance for Needyl"amilies
'
Child Care Biock Grant
Child Protection Block Grant
Restri~ting Welfare for Aliens
Supplemental Security Income Refonns
Child Support Enforcement Refonns'
Title 1: Block Grant fot T,m.ppratY Assistanee for NeQdy families
1. Pwposes
a. Provide as~istance to needy families with children
b. ' End the depe'ndence of needy parents on government benefits by promoting
work and marriaae
c. Discourage illegitimate births
2. EIigib1e states; State plan. States must sQbmit the following to the Department of
Health and Human Seh'ices on an annual basis:
'
fl.
A plan that contains an explanation of:
·-their program of cash bencfits to needy families
--their welfare-to-work program. includine support, Services
··how they are meetinj the requirement of mandatory work after the family
has been on welfare for 2 yean (or tess at state option)
--how and whether they are meeting the requirement to place 2% of their
cascloadin work programs in 1996, rising to 20% by 2003 and thereafter
·-their program to'reduce the incidence of illegitimate births
b. A certification that the state will operate a child support enforcement program
c. A certificat~on that the state will operate a child protection program
d. A certification that the state will operate a toster care and adoption program
3. Grants
10
states:
a. The block grant money is an entitlement to states
b. The amount of money in the block grant is SlS.26S each year between
1996 and 2000 '
c. Each state receives the same proportion of the block gnmt each year as it
l"eceived of MDe spending in 1994
d. Use of Funds:
--in any manner reasonably calculated to accomplish ~e purposes (see above)
'--in the case of families that have lived in a state for less than 12 rt1~nths, states
may provide them with the benefit level of the state from which ther moved
P~GE
4
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ID:qoNG. MATSUI
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2
...states rna)' transfer up to 200/0 of the funds in any given block grant to other
block grants
.
--staLe:; may. for up \0 6 m()nth~, pay II redU\fed bellefit to a needy family with
a child whose p~tem'ty has not been established
.
e. Penalties. Stales are subject to three penalties:
--if an audit dctcnnincs that states havc spci1t mODc), on activities Dot consistent
with the: purpose uf this lcgi:tlutiun, th~ amuunt of misspent funds will be
Ylithheld from the stAte's payments duriJlg the fotloWLnI year (with the
restriction that not more than 2S percent of a quarterly payment can
be withheld)
--the annual grant is reduced by 3 percent if states fail to submit the
performance data required so that Congress can provide oversight on state
. accomplishments
-.~tales are flned 1 percent of their :mnua) grant if the)' fail to participate in the
Income and Eligibility Verification System designed' to reduce welfare fraud
4. Prohibitions. Block grant ·funds cannot be used to provjde:
a. Benefits to a family that does not include a minor child
h. BenefitS to an individlJal receiving benefits from old-age assistance,
foster care, or Supplemental Security Income
e. Benefits 10 noncitizens unlesS the individual is an alien who has
resided in the U.S. for over 6 years or a Jegal resident over age 7S who has
lived in the U.S. for more than S )'cars
do Cash benefits to a minor child born out of wedlock to a mothcrunder
age 18 or to the mother
e. Cash benefits for additional children born to families already on welfare
f. Cash benefits for families that have rec:eiv~ blo<;k grant funds for 5 years
g. Benefits to a family with adults not cooperating with the state child support
enfor\fement 8gcn\;y
.
.
h. Benefits to a family with an 'aduit who has not assigned to the state the child's
claim rights against the noncustodial parent
.
S. Data. collection and reporting. States are required to submit aMual data on several
imponam measures of their Temporary Assistance Block grant; e.g.. the number of
families receiving benefits. the earning of families. other welfare benefits received
by famitie!li. and the number of month$ on welfare
6. Audits. Each slate must submit to an audit every second year under tertn$ of the
Single Audit Act
.
.
.
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FiLE No. 760 02A)9 '95 12:05 IO:CONG. MQTSUI
3
Iig~ II: Child ~"e Blodc
Iitle ill:
Grant
Child ProtecliQ.tl Bloc"
Gunt
,
I. Purpose. The purpose of funds provided to statfl$ in thi~ block
-
,
smnt are.to help
states:
a. Identify and assist families at risk. of abusing or neglecting their children '
b. Operate a system for receiving,repons' of cuse or neglect of childf.en
c. Invcstigate families rcported to abuse or negJec.t their children
d. Assist troubled families in providing the proper proteetion M.d nurrure [or
their children
e. Support children who must be removed from, or who cannot live with their
famBies ,
'
f. Malee timely decisions about pennanent livirJa arrangements for children who
must be removed from or who
~Ilnnot
live with 'their families
8. Provide for continuing evaluation and improvement o[ chUd protection laws)
regulations. and services
'
2. Eligible states. In order' to be eligible for block grant funds, states must:
a. submit llwrltten document toHHS that describes how they intend to pursue the
purposes described above
b. certify that they have 8 state Isw requiring public officials and other
, professionals to report ~ctual or suspected cases of abuse or neglect
c. certify that they have procedures for determininl quickly whether a report of
auuse or
u~~l~";L
i!i .,;rcdiblc and for 'laking
a~tion
if It is
d. certi fy that they have procedures for ensuring that children removed from their
families for protection are placed in safe 8lld nurturing settings;
e. certify that they have procedures for ensuring that children removed from meir
home have a written pJan that spctifies the goal for achieving a permanent
placement, mat the plan is reviewed every 6 months, and that information about
the child is collected regularly and recorded in the ease record
r.
within three years of the dare of pa$sagc, declare quantifiable goals of their
child protection program and report quantifiable infonnation on whether they
are making progress toward achieving their goals
g. the Secretary of HHS can determine whether the state plan includes aU of the
elements reviewed above but cannot add new elements or review the adequacy
of state proli:edures
'
3. Orants to states for child protection.
8. The block grant money is an entitlement to states
b. The amount of money in the block grant is
for five years
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.'
.
\
.
.
c. Each state reccives the same proportion of the block snmt Nch year as It
received. of payments to stales by the fedenJgovemment for chUd welfare
prowams in the ,\leraie of Ute years 1991, .1992,and 1993
d. Use of funds. States can use block grant funds.
--in any manner reasonably calculated to aQCOfJ1plisb the purposes {see above}
--states may transfer up to 20% of the funds in any given block grant to other
block grants
.
e. Penalties. States are subject to two penalties:
·-if an audit determines that states have spent money on activities not consistent
with the purpose of this legislation. the amoont of misspent funds will be
withheld from the state's payments during the fo11ewing )lear (with the
restriction that not more than 2S percent ofa quarterly payment can be
withheld)
.
4. Child protection standards~ These standards are included in the hill fo intiieate what
states must do to assure the protection of children and to provide guidance to the
citizen review panels:
a. The primary staudaid by which a sta'e child welfare system sh,aI! be judged is
, the protection of children
.
. b. Each state shall investigate .reports of abuse and nealect promptly with due
regard to the potential danger to children
c. Children removed from their homes shall have a permanency plan and a
dlspos Itional hearing bya court or a court·appointed body within 3 months after
a fact-finding hearing
..
d All child welrare cases with an out-of-home plQccmcnt shall be reyicwcd evc:ry
six months unless the child is atread¥, in a Jong-tenn placement
S. Citizen review panels.
a. States must have a least one citizen review panel for each metropolitan area of
their state
.
b. Panel members must be broadly representative of the community from which
they are drawn
c. Panels mU$1 meet at least quarterly
,
d. Panels are charged with the responsibility of reviewing cases from the child'
wc:lfarc system to determine whether state and t~al agencies recei\lins funds .
under this program are carrying out activities in accord with the Stare plan.
are
achieving the chitd protection standards. and are, meering any other chilcl welfare
criteria that the panel considers ;mpot'llnt
e. Panels must produce a' public report after each meeting and states must include
infonnation in their annual report detailing their responses to the panel report
and recommendations
.
�•
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fiLENu. 760 021'Q9 '95 12:06 m:CONG. MATSU]
5
6. Audits. State expenditures arc audited every second year:; any funds spent for
purposes other than those stAted for this block grant will be repaid to the federal
government
7.\OaT3 collection and reportin,. States must annuIty report an extensive set of data
to the federal govemment. The information that must be reported includes the:·
number of children reported as abused or neglected. the number of reports of abuse
or neglect that were subsequently substantiated. the number of substantiated cases
that received services, the number of children removed from families. the' number
of families that received preventive services. the average length of sta), in foster
care, the number of children in foster care with· 8 eoa1 of adoption, and a number
of other perfOrInWlCe measures. States must also include in ,their report a s\u:nmary
of the data measuring whether the)' are mak.ing progress tOVi1U'd their Boals (see
above), a summary response to the find ings and recommendations of their citiz.en
review paneJs, and. if funds were transferred. to another block grant, an explanation
of why the funds were transferred. The Secretary of HHS must prepare an annual
report based on state reports and make therepon available to both Congress and the
pub tit.
Title IVi ResiristiCg Welfare for Aliens
1. IneJigibility of aliens for public welfare assistance. With the exceptions noted
below, noncitizens are not eligible for 4t means-tested proy.uns (see attached Ii,st)
2. In order to heJp noncitizens improve their job preparation skills. they remain
eligible for eleven programs that provide educational or training services. Adults
and children noncitizens are also eligible for emergency. medical services and for
immunizations against pr~ventable diseases (see aaached list)
3. EX"Plions:
Refugees are not ineligible for means-tested programs until five years after their
date of a.rrival in the tJ. S.
',
b. Noncitizens over the age of 75 who have lived' in the U.S. for at least 5 years
may also continue receiving welfare benefits
.
8.
4. Current residem exception. The ineligibility for means-tested benefits of
nondtizens currently living in the U.S. dOes not ta.ke cffi:;"t until om:
date of enactment of this bill
.
,c:ar a:fler the
�. •
~ILE
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No. 760 02A>9 '95 12:06 ID:<DJG.• MATSU[
6
S. Notification. Each federal Blenc), that administers a propam from which
.
noncitizens are to:be disqualified must provide general notification to the public
. and program recipients of the eugibility changes
6. AFoe agencies required to provide infonnation. Agencies administering the Aid to
Families with Depcndent Childml program must provide the name and ad.dRs.s of
illegal aliens with children who are citizens of the U.S. to the'lnunigrationand
Nanualization. Service
7. Sponsorship agreements. The document by which individuals agree to sponsor
immigrants by making their income available to the 'immigrdIlt urcmude legally
binding until the inunigrant ~mes a citizen (the agreements are not now leaally
binding and last
fOf
eith.er three or five yean:;)
Title V: Syg,plemental SecuOt}· lricom£ &efonns
.
. '
1. Denial of SSI Benefits to Drug Addicts and Alcoholics:
a. An individl,lal shall nnt be COf1!;idered disabled if his primary diagnosis is that he
is addicted to alcohol or a chug
b. As a result drug addicts and alcoholics lose SSI benefits and Medicaid coverage
c. Part of the savings realized will be block gJ8nred to States for drug treatment
2.
sst
Benefits to Certain Children:
.
a. Restrictions on eligibility for cash benefits
•• repeall'comparable severitylt lcst for detennin~g disability of chiJdten, so that
eligibility for cash benefits or new medi~l serVices will be based on medical
listings only. and not "individual functional assessment"
--children cUrrently. rcceivin, cash ben;fiu because of G disabiHty sp~ificd in
the medical listings wiU continue to be eligible for cash bene~ts; however,'
children notaire&dy on SSI On enactment win only receive cash paymenlJ if
institutionalized or otherwise would be in the absence of the cash payment
--children considered disabled bUl not receiving cash benefits will be eligible for
additional medical services pro\'ided through block grant described below
b. At least once every 3 years States must condutt C()ntinuin, disability reviews for
children eligib1e for cash benefits (exceptthos,e whose conditjon cannot
improve)
,
c. 6 month grac.e period for current SSI recipients
.
d. Social Sc:turity shall issue regulations within 3 months of enactment
e. Social Security must notify ....ithin 1 month those whose eligibility will tenninate
f Block Grants fot children ~;th disabilities
.
, ··S6eial Securiry to make grants; grants are an entitlement to States
�•
I-I:.B-1219-1995
15: ~~
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r' • J. ",1/ J.l!J
PAGE 10
• FILE No. 760 02/09 '95 12:07 ID:CONG. MHTSUI
7
--remove individual entitJcmcnt
to
benefits
...;.grants spent only on authorized medical and non·medical serviteS for qualifying
.individuals
··States decide which services from prescribed list may be paid for with grants
qualifying individual" means a child who is either (1) elisible for ~h SSI .
benefits wldcr this title~ or (2) who is not eligible for c8$h but is disabled by a
condition in the medical listings
.
.
• •1f
··State grant based on number of children etisible .for additiorull· serVices
�JAN-26-1995
-
10:06
FROM
P.01·
FACSIMILE TRANSMISSION COYER sOEET
. ADMINlSTRArrONFOR CHILDREN AND FAMlL1ES
OFFICE OF THE ASSISTANT SECRETARY
310 L'BNFANT PROMBNAD& S.lY.
. WASHINGTON, D.C. 20447
FAX:(20 ~!)401-4618 CONFIRM:(202)401.2331
-~E:~~
OFFICj:':
94562878
TO
-----------------------
PROH1:
YSb -;J;J./ I.e
FAXNl':
DAT.E:
.
.
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PAGES
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-.
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. note
DATE
SUBJECTffITLE
01/2611995
to Caro re parking (partial) (l page)
RESTRICTION
P61b(6), b(7)(C)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8506
FOLDER TITLE:
[Welfare Reform Republican Bill] [1]
2010-0198-S
kc230
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
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P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(J) National security classified information [(b)(J) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the ForA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)( 4) of the FOIA]
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PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�JAN-26-1995
1111:1216
FROM
TO
94562m8
P.02
Caro:.-
to 0 ::08 Room 211 at 11: 30 am tor our meet
1
Than ':5 tor the reminder about Ray scheppach--you were riqht--he
was 'lot on I nterqovermnenta 1 ' s list •.
I wi:_l call you before the meeting at, 11:30. I have a mea.tig
with the Secretary at 10:30 so I will try you closer to 10;00.
I think welre almost there!
~o~
�~2/17/95
09:41
..
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�, 'i
Welfare Reform Daily Talking Po,nts
Monday, February 13, 1995:
WELFARE REFORM MUST BE STRQNG ON WORK,
NOT CRUEL TO CHllDRE,N
Today, Clay Shaw's House Subcommittee on Human Resources begins marking up
the Personal Responsibility Act, the welfare reform plan contained in, the Contract
with America. Over the past week, Democrats have united against the Republican
proposal, which is tough on children and low-income families, but weak on requiring
work. As House Democratic Leader Richard Gephardt said on Friday, "for the
Republicans, welfare reform is just a way of. passing the: buck, kicking people off the
welfare rolls, and leaving innocent children out in the street."
o
In fact, the work requirements in the Personal Responsibility Act would be
weaker than those under current law. In 1996, under current law, 11.5
percent of welfare recipients (595,000 people) would be working --either in
'part-time private sector jobs or in mandatory work.programs. 'In contrast, under
the Republican plan, only two percent of welfare; recipients (105,000 people)
would be required to participate In "'work activities" in 1996.
o
President Clinton's principles for welfare reform will not change. ,As he said in
his State of the Union address: "We have to help those on welfare move to
work as quickly as possible, to provide child careand'teach them skills if that's
what they need, for up to two vears. And after that, there ought to be a simple
hard rule: anyone who can work must go to work.
II
This Administration believes that:
o
Welfare reform must be ab~JJt a paycheck. not' a welfare check. We won't
have ended welfare as we. know it until the centra! focus of the program is to
move people off welfare and into a private sector job so that they can support
themselves and their families.
o
Our goal must be to lift people up fromdependf.mce to independence, not to
punish them because they happen to be poor, young, or unmarried. We intend
to work with Congress on a bipartisan basis, but we continue to oppose any
plan to deny assistance to young mothers, break up families, punish children
for their parents' past mistak,es, or put children, in orphanages.
o
Tough child support enforcem~nt must be a centerpiece of welfare reform.
We're pleased that House Republicans intend t6 adopt our proposals for child
support enforcement, which was a key agreement reached at the Working,
Se~sion on Welfare Reform~ If we're going to end welfare as we know it, we
. must make sure that all parents -. father~ and mothers alike -- take
responsibility for the children they bring into this world.
,
,
,
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It:60
S61Ll/60
�·..02/14/95
DDS-PUBLIC AFFAJ
12: Ue202 890 S873
Ii002
Welf.,e Reform Dally Talking Points
.
Tuesday, Fabrullrv 14. 1995
~
,',
,
..
REPUBLICAN ASSAULT. ON CHILDREN CONTINUES
i
Today, the Subcommittee on Human Resources will continua to mark up the House
Ftopubllcens' welfare reform plan, focusing on provisions to eliminate or reduce federel
sulttanee to abused, neglectBG and disabled children •. The Republican assault on children ,
began late last night, 05 the lubcommlttee majority continued to Insist that unwed teenage;:::' i.:;
mothers and their children bEt Ineligible for assistance. The Republican proposal would
'
simply end benefits to these young mothers, While dOing nothing to address the crltir:$,I1
problems of teen pregnanoy end welfare dependency.
o
Short on work. lo'ng on punishing kid.. Yest"rday. Secretary Shalsla sont a letter to
subcommittee members restating the Administration's Position that the Republican
bill punishes innocent children. while doing nothing to require serious work-basad
reform. It't does nothIng to mova people from welfare to work. and It does n~t
require everyone who can work to go to work," she wrote. "It puts millions of
children at ri~k of serious harm. There are alternative approechea 10 reform that
achieve our mutual goals in far more constructive and accountable ways ...
o
their solution: orphlnage8, last night, House RepUblicans stuck with their position
on orphanages, defeating 8 Oamocratlc amendment that would assure that children
would not be taken from their homes simply because of the economic
circumstances, age, or marital status of thoir parenti, Republicans also defeated a
Democratic amendment that - instead of cutting off aid to teen mothers antiraly -
would-~ondltion benefits on 8 minor mother IIgreelng to live at home. stay in school,
and identify har child's father.
.
a
More ,crualty to kids. Today, Republicans BrB expected to Insist on child wt:lfare
provisions thAt would roduoa federal assistance to abused, noglected and abandoned
children by $5.8 billion .. Along with the provisions Cutting off assistance to disabled
children, and to children born to unmarried mothers under' 8, this portion of the
Rcpublic;Brl plan represents a new lavel of cruelty to children.
o
Republicans say It belt. In today's Wall Street Journ,l, Senator Olympia Snow a
specifically criticized the requirement that states eliminate federal assistance for all
unmarried parents under age 18. ·Oenylng them payments Isn't going to rectify EI
bad situation," she ssid. "It's going to make It worsa for tho child end the teenager
who Is having the baby.- Representative Hanry Hyde made a similar point last week
in it New York Times Interview. liThe children need Clothing, sheltor, Bnd nunure."
. he said. "You don't want to roward promiscuous pregnancy, but on the other hand,
you don't want to maka the childran suffer for the transgressions of their potents. II
And the Heritage Foundation'S Robart Ractor told Knight Ndder that "Thl. Is major
embarrassment to many Republicans. They have whittled down the work
requirement to nothing. u.
'
800/COO III
::lSnOH aLIO
c:t: GO
9G/n/to
�Walfar. Reform Oally Talking Point.
Wednesdey, Flbruary 15.. ., 995
THIS IS WELFARE REFORM?
Today, the Subcommittee on Human Resources is expected to finish action on the House
Republicans' welfare reform plan, marching In lockstep to pass the wrong-headed proposal~
in the CDntrBct with AmerIca. On Monday, Republicans refused to accept Democratic
amendments to strengthen their weak work requirements. Yesterday, they Insisted on
reducing federal assistance to abused, neglected and abandoned chlldre" by billions of
dollars. Today, they're expected to turn their attacks 8g8",st disabled chlldre", postpone
. action on chUd support enforcement, and pass a bill that gets the problem right -- but the
solution fundamentally wrong.
o
Stili waak on work. On Monday, Republicans voted against requiring teen mothers to
stay In school and participate in education and training as a condition of receiving
benefits. They stuck with meaningless wo'rk requirements that would have even fewer
welfare recipients working than under current law. And ·Oemocrats had to force the
subcommittee majority to add even a modest penaltv for states that don't meet the
bill's minimal work st~ndards.·
.
.
o
Still cruel
to kids. The Republican approach is clear: punlsh children for their parents'
mistakes. and abandon the federal role for protecting abused and neglected children.
Today, they will go even further -- and Democrats will offer amendments tD protect
dIsabled children from arbltrary benefit cuts. Republican plans to cut back on SSI .
come at a time whan a blue-ribbon commission Is already studying more thoughtful
reforms .- and offer more proof that cruelty, not caring, is the Republican approach to
change.
.
,
o
All punishment and no parental responsibility. After promising to add child support
enforcement provisions to their bill, Republicans now plan to postpone action on child
support for weeks ... until the bill reaches the full committee. Just last week. President
Clinton urged Republicans to. support slrong child support enforcement. "If we're
going to. end welfare as we know it," he wrote Chairmen Shaw. "we must make sure
that all parents .- fathers and mothers alike -- take responsibility for the children they
brIng into this world.
This remains the Adrrtinisuation's pOsition •• and Democrats·
will tak.e the battle to the full committee.
'
It
o
goo/too~
Right problem. wrong solution. Democrats believe that the welfare system must be
fundamentally reformed - but' in a way that rewards work, requires parental
responsibility, and prevents teen pregnancy and welfare dependency. Weak on work
and cruel to kids, the Republ1can legislation does nothIng to truly reform the welfare .
system. We won't have ended welfare 8S we know It until Its central focus Is to move
single parents ·off welfare and Into a private sector job so they can support thGmselves
and their families.
.
lsnOH ,1lIHM
LSSS9St~o~~
~t:60
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�Wllfa,. 'Raform Dally Tallelng Points
Thursday. February 16, 1995
REPUBLICAN PLAN WOULD CUT FUNDS TO STATES
Yesterday; House RepublIcans passed a bill out of subcommlUee that gets welfare
reform backwards. Weak on V'Jorkand tough on kids, the Republican legislation does
nothing to truly reform the walfare system. Today, Democratic members of Congress
and governors will loin together to point out another fundamental flaw in the current
bill: It would create 8 massive cost shift to states. .'
o
Passing the buck to the statas. While certain' states would' fare worse· than
others under the current Republican funding proposal, all states would suffer
in the end. States would lose almost $18 billion In federal funding over five
years under the Ael)ubllcans', plan to block grant AFDC cash assistance and
child welfare fundi"g. This capped block grant would not adjust for recessions,
,population growth, or other events that could increase the need for services -- .
even though the National Governors AssociatIon recently adopted a bipartisan
policy statement insisting that any welfare reform proposal must address these
factors..
o
Governors speak out. In order to create real, lasting welfare reform that
rewards work, requires parental responsibilitY, prevents teen pregnancy. and
reduces welfare dependency, states must have adequate reSDurces to get the
job done. As Governor Carper said in a letter to the other governors this
morning, "I understand that this block grant proposal does riot include'
adjustments for rec8&sions, population gtowth, disasters, and other events that
.could result in an Increased need for ssrvices. II Governor Carnahan also said
today that "Oemocratic Governors want reat welfare reform that moves people .
from dependency to self-sufficiency, from ,the welfare rolls to private payrolls.
The Republican plan doesn't help us achieve that goal. ~ ,
o.
o
800/S00~
Children would lose. Govern.or Carper also noted the risk to children in today's
letter to governors..., believe that this proposal's reduction in funding and lack
. of a safety net threatens to limit the very flexibility we seek to make work pay
. more than watfare. In partIcular. , have deep concerns about this proposal's
impact on children.
Reform must be faal. 'The AdminIstration remains committed to working wllh
Congress and the nation's governors to craft bipartisan welfare reform
legislation that is tough and fair. The 'American people want to see the welfare
system changed from one that is about a paycheck, not a welfare check. That
means that its central focus must be to move sIngle parents off welfare and
into a private sBctor job so they can 5upport themselves and their families.
aSI10H a:.IIHM
£t:60
S61LT/60
�:..
~.
,
WELFARE REFORM REPORT CARD
DAY ON!
Fet)ruary 13,1995
On the first day of the welfare reform mark up held t)y tne.SUbcommlttee on
Human Resources Of the c~mmlttee on Ways and Means, ~Y virtually unaolmoys ¥.otes:
a
The ReJ2ubllean
m~Jorlty
RIJICTED tougher wark requirements.
Reo. sander levIn ro., Mn offered an amendment to require states to rmplement a self- .
5ufflcfenev plan aimed at the fastest possIble movement Into the workforce for each
welfare recipient.' No't:)eneflts would be paid for anyone who refuses t9 worle. refuses
to look for worle. or turns down a Job offer. No one who 15 wlllfng to work COUld be cut
off If no worle IS available. The Levin amendment would have required States to put, 2S'
percent of recipients to work bY 1998 and 50 percent by 200!.compared to the 2
I
'.
percent required by the Republican plan.
a
The Reput»lIcan majority REFUSED to ailure child care for mottaers'WI'Iogo' to
work.
.
Rep. Barbara KennellY (D., en offered an amendment co make certain that parents are
not forced to leave theIr children alone or In an unsafe environment when the state
requires work.
.
a
The Republican majority REFUSED to reQuire private sector Jolts•.
. Rep. HarOIQ FOra (0., TN) proposed that states place at least haff of those welfare
recIpients WtlO are reQuired to worlCin private sector jobS.
o
The Republican majority REJECTED state flexibility In favor of conservatIVe
mlcromanagement.. '
.
Rep. Charles Rangel (0., NYl prOPOSed to strike the S·vear lifetime limit on 'welfare
benefits - and leave tl'1Js matter to the Scates to deelae.
Rep. pete Start CD.,CA) DroDosed to strike mandatOry ca~s on benefits paid for children
born to families receiving welfare - and leave tl'1ts matter to the states to decIde. as
Republican ana Democratic Covernors have suggested.
°
The lepuRlRan maJority RlFUS&D to protect locallcwernmentl 'rom
unfunded mandates.
,
,
An amendment by Rep. Ford would have prevented states from shifting welfare costs
to counties, cities Of loal g~vernmQnts.·
.
o
The
RepU~ncan
majority REJECTED a ,esponsllila DOlle" for teen 'Irents.
/
LSSS9St2:0ZA
ct:60
S6IL't/ZO
�. Rep'. sander levin croposed to reaulre teen r:aarents to live at home or under adult
supervision. to stay in school. ana toeoaperate fully wl~ paternity establishment In
order to receIve welfare benefits. The Republican majority rejected this proposal In
favor ~f a pollCV that sImplY makes the child Of the mfnor pClrent Ineligible fOr welfare ..
fOC life.
et
Th, R,.,ubllcan majority REFUSED to protect alalnst over2ealous
Governmont Intervention Into family matters.
An amendment "y Rep. Ford would tlave prohibited states from Placing a child In an
out-of·home setttng against the wishes Of the child'S custOdial parent SOLELY because of
the economIC Circumstances. marital status, or age of the parent. The provfslon would
not have interfered With State efforts to Intervene In aDuslVe homes.
WELFARE REFORM REPORT CARD
DAY TWO
TuesdaY,February 14,1995
,On the second day Of the" welfare reform mar1c up held by the subcommittee on
Human Resources of tne'Commltteeon Ways and Means, by ~rttJally ynanlmous votes:
.
.
o
ThO Re12ubllcan majority REFUSED to allure the safleyo' children In faster
care and REJECTED Stat., accountability .or deaths In .oster care;
ReO. Cnarles !'langei (0., NY) offered an ame"dment to Subject states Who are found by a
court to have neglected chUdren In their C1Jstody, to an annual re\tlew and tne
development and ImOlementatlon of a remedial Dian. HHS would also be required to
~eview States when tnere Is an increase In the number of child aOuse or neglect·related
, fatalities. or when a child dies while under State care. CT'wenty states, InClUding Florlaa
,and New YOrk, have entered Into settlements or consent decrees to resolve IItlgation "
over problems In their child welfare systemSJ
o
The RepUblican majority REFUSm to assure tI'Iat a Sife foster homo will be
aYalistale for each neglected or abuSeciellUClln the ltata.. '
Rep. sander levin (0., Mil offered an amendment to maintain the entitlement status for .
foster care maintenance payments and for adoption aSSistance payments, to ensure
that all abused and neglected Children who need It can,be placed in foster or adoptive
homes.
Rep. Barbara Kennelly CD., en proposed to bar states frOm transferring funds out of the
Child welfare bloCk grant to omer clock grants. The Republican btu permits 30 percent
of the fundS deSigned to protect abused and neglected cnlldren to be used fOr other
purposes.
800/LOO~
.
3Si10H 3110
LSSS9StZOZ~
tt:60
S6/Lt/ZO
�a
f.".
The .epuln'can malorlty ••PUSID ta retain ••netltll fOr yeteran, or lor legal
Immigrants who hnl INdd axe. for
yean.
' ,
ReI', Charles Rangel proDosed to exempt legal 'Immigrants who are veterans, or who
served In the U.S. Armed Forces cand for tnelr children and survivors) from the strict
limItS on aUen benefIts In the Republican bill.
.
ReI'. pete Stark to.,eA) progosedto exempt legal' ImmIgrants who pay taxes fOr at least
5 Vears from the strict limits on allen benefIts In me Republican bill. Under the
Republican plan, legal Immigrants wOUIG be Ineligible fOr 36 Federal programs.
WELFARE REFORM REPORT CARD
DAY THREE
vvedneSdav.Februarv 15.1995
On the third day of the welfare reform mark up held by the SUbcommittee on
, Human Resources the Committee on. ways and Means. by y,nanlrnous yqtC§:
. of
.
'
o , ,The Re"u~lIcln majority RIr:USED to commlt'the net saving, fram cyaKn
walfa,. programs ~o deficit reduction.
....
Rep. Harold Ford m-TN) offered Republicans the Chance to deliver on their promises to .
reduce tne aeficlt ana cut taxes. They pUntea, refUsing to commit any savings· from
soendtng
o
cuts to deficIt reduction,
'The Republica" majority REFUSED to prelerve SSI benefits for cortaln
medically dlsableca children.
Rep. sander L.evin ([)'MIJ offereCl an amendment to grandfather eashbeneflts fOr
cnlldren whO are mealcally dlsaOled. but wno Qualified fOr SSl by meeting a less
stringent test of functional atllUty. Tne Republican bill repeals that fUnctional
assessment test and diSQualifies the CI1I1C1 for SSJ cash payments.
o
. The Republican
etallel needs.
majority R!PUSED to let Darents decide which servlcel their
Rep. pete stark fD<A) offered an amendment to assure that parenti get to choose.fram
array of services for their children. Instead of leaving the question of What services
will be provided to the State bureaucracy.
a fUll
I I I
900/900~
··""·3snoH 3lIIW
LSSS9SHO~Q,
n:60
S6ILtI~O
�I
THE WHITE HOUSE
~WASHINGTON
/
I
February 20, 1995
MEMORANDUM FOR LEON PANETTA;
FROM:
SUBJECT:
RAHM EMANUEL
BRUCE REED
. WELFARE REFORM STRATEGY
The Welfare Working Session brought us back into the game on welfare reform and we had a
good first week in sub-committee hearings, The Republicans in Congress were put on the
defensive on' weak work requirements and cruel aspects relating io children, However, unless
we continue to pursue a strategy to niise the Administration's and the President's profile, our
progress may dissipate.
During the Working Session we thought we made great progress with the Governors by
keeping them from endorsing the Congressional Republican welfare proposal. Since that
time, GOP Governors have signed onto a GOP Congressional-backed welfare bill. The price
the GOP Congress has paid is that their proposal has weak work requirements, which has
provided us with a tremendous opportunity.
.
Our goal within the next three weeks is to build upon the progress we made during the
Welfare Working Session while highlighting weaknesses within the GOPprop'osal', We have
the political high ground vis-a-vis our positions on various aspects of welfare reform There is
a great deal of capital to be gained in the political middle on welfare.' If we are disciplined,
and focused, we can make the GOP pay a price for the extreme positions they have adopted.
Attached please find a communications schedule through March 7, 1995 that is coordinated
with the legislative calendar. It includes communication by the .President, communication by
HHS, outreach to surrogate groups, such as governors, children advocacy groups, etc., and
Congressional activity. '_,__ ,__
---"~""
There are only three events that we request the President to participate in;
1.
Radio Address on the Exe~utive Order about child. support. (Feb. 25)
2.
Lunch with Oregon private sector CEO's that have structured an innovative
program under the welfare waiver in their state to move people to work from
welfare. (March 3)
.
,On' March 7, the President's will speak to the National Association of Counties. At
, 3.
this event, he should announce that he has granted his 25th welfare waiver, and now
, ,half of the states are operating under the welfare waivers the President granted.
�.'
,
,
In addition, we recommend that the Administration use the lull between sub-committee and
committee hearings to call attention to our message. The two primary goals for this time
period are:
1.
Increase the profile of both the Administration and the President on this issue. It is
important that we communicate that the President'is making real welfare reform
happen now, rather than waiting.
2.
Establish some contrast with the Republicans. There are two distinctions we need to
make:
a)
they have been· slow to include a child support enforcement mechanism
which is essential. to welfare reform, and
b)
their proposal is backwards: they are weak on work and .cruel to kids.
Briefings by the WhiteHouse and HHS have brought Hill Democrats together to
communicate a unified message: that the Republican plan is weak on work and cruel to kids.
Friday's Washington Times and Sunday's Washington Post show that this message has gotten
through, (see attached). We have been pushing for the Hill to use this message and now it is
beginning to get coverage.
In short, the Communications goal for irns and Hill Democrats is to show the Republicans as
cruel and out of the mainstream. The communications goal for the President is to show that
he has worked. a long time on welfare reform and he is committed to his prin~iples of work
over welfare ~d ending the days of something for nothing. ,
/
�J
FEB~17-1995
19:46
FROM
TO
94566423
,February/March 1995
,Welfare Reform. Schedule
17
lRIDAY
, ( )ntinue Targeted Editorial Calls*
1: 8S Interviews for Sunday Stones
~
[ONDAY
20
E )llday ,
2]: CHILD SUPPORT
JUESDAY
:E HS Press Release on Record Increase in IRS Cbild Support:CoUections* ,
F )ssible DES RadiofI'V Interviews
~rEDNESDAY
22: CHILD CARE
louse EEO Committee Mark-Up: Child Care
F KS Releases Views Letter
E HS Releases State by State Numbers·
r ES BreakfaSt:
House Conservative Democrats Budget Group
F >mble ABC-TV News Segment on Child Care
JHURSDAY
, 23:
MEAN TO VULNERABLE KmS
louse'EEQ Committee Mark-Up: Child NutritioD and Child Welfare
t SDA Releases Views Letter
{ SDA Releases Letter from Pediatricians (Brazelton?)
{ SDA Pitches Morning Shows (Brazelton? Haas?)
t SDA Releases State by State Numbers?
"
S mate Budget 'Committee Hearing: DES testifies
F YI: Child Care Providers Day on the 'Hill/Rally at the Capitol'
* 1 egional Media
P.02
�,FEa-17~1995
19:47
FROM
EUDAY
TO
94566423
2!: '1
P )1'(]S Lunch with Women Members of Congress OR State of Oregon Waiver
G~up?
'
F '1: Post Secondary Training and Education Subcommittee of. the House BEO
Committee Hearing
S\TIlRDAY
25:
CHILD SUPPORT? '
P )TIJS Signs Executive Order on Chlld Support in Federal Govermnent?'
P )TUS Radio Address on· Child Support?
;b:ONDAY
..27: 24th WAIVER
s cretary Speech at APWA - 24th Waiver
]UESDAY
E
28: WORK .
)Ose Ways and Meam Committee Mark-Up
R ~lease Administration
Vi~wsLetter
F (I: House Agriculture Committee Mark-Up?
~~DNESDAY
E
iJU5e
F
(I:
1: REPUBUCAN DISSENTION
Ways and Means CoDlJDittee Mark-Up
House Agriculture Committee Mark-Up?
• F :gional Media
P.03
�,FE!il-17-1995
19:47
FROM.
IEURSDAY
HOl
TO
2: MEAN TO KIDS .
se Ways and MeaDS Committee Mark~Up
Chi d Disability Day?
Sfa' ~ by State Numbers of Kids Cut-Offl*
EElDAY
Ho
lSe
..3.:.
WRAP-UP
Waysaod Means Committee Mark·Up
T£ ESDAY
7: 25th WAIVER
PO rus Speecb to NACo - 25th Waiver
* Re ;ional Media
94566423
P.04
�Welfare Reform Daily Talking Points .
Friday~ February 17, 1.995
THE WEEK THAT WAS
,
,
,
This week,. House Republicans passed a bill out of subcommittee that is weak on work
and tough on children. The Clinton Administration, members of Congress, governors,
and former welfare recipients spoke out against the shortsighted and punitive
provisions in the current Republican proposal.
o
Secretary Shalala: "The Administration look,s forward to working cooperatively
with the Congress in a bipartisan way to pass bold welfare reform legislation
this year. The Administration has, however, serious concerns about a· number
of features of the [Republican proposal) that appear to undermine the values to
,which we are all committed. The Administration· seeks to end welfare as we
know it by promoting work, family and responsibility, not by punishing poor
children for their parents' mistakes. Welfare reform will succeed only if it
successfully moves people from welfare to work."
o
Representative Steny Hoyer of Maryland: "Welfare must become a step-up, not
a step*down. Welfare reform must reconnect recipients to the world of work
and reestablish the traditional American values of family, work, and individual
, responsibility. "
.
.
o
Representative Harold Ford of Tennessee: "The bill we are about to approve is
mean-spirited and shortsighted. It punishes children for the mistakes of their
parents, and it asks us to embark on a great experiment. But that experiment
is using our most important -- and vulnerable -- resources as guinea pigs. I
won't be part of an experiment that uses America's children as crash test
. dummies."
o
Gpvernor Tom Carper of Delaware: "The Republican ADFC proposal is the first
. of several that, when taken together~ would deny welfare recipients who go to
work in low-wage jobs the child care, health care and nutrition assistance they
need to keep their children healthy and,safe.· That is simply impractical and
wrong. "
o
Representative Sander Levin.of Michigan: The Republican plan would "send the
bucks and get out of the way, no matter who the kids are, the level of abuse,
or the failure of the state to do a good job."
o
Ellen T. Harold. former welfare recipient, quoted in U.S. News and World
Report: "I have yet to see any mention of the accountability and responsibility
of the father ... This should be a major focus of any welfare reform as most of
the women receiving Aid to Families with· D,ependent Children do so because
of lack of child support'. "
�THE WHITE HOUSE
WASHINGTON
February 15, 1995
MEMORANDUM FOR THE PRESIDENT
FROM:
Bruce Reed
SUBJECf:
Welfare Reform Activity in the House
I. Markup in House Subcommittee
Clay Shaw will finish markup of the Republican welfare reform bill in his
subcommittee today. On straight party-line votes, Republicans rejected Democratic
amendments to dramatically strengthen work requirements, require minor mothers to live at
home and stay in school rather than just cutting them off, and allow legal immigrants who
have paid taxes for 5 years to remain eligible for benefits. They put off action 6n child
support enforcement until full committee markup on the bill two weeks from now.
House Republicans may continue to march in lockstep, but there are encouraging signs
of dissension in Republican ranks. The current bill is vulnerable in at least three ways:
1. Weak on work: The Heritage Foundation called the work requirements in the
Shaw bilt a "major embarrassment to many Republicans." They're much weaker than ours,
and weaker even than current law. Democrats will keep pushing that real welfare reform is
about sending people to work, and the Shaw' bill is just about cutting people off.
2. Mean to children: Some Republicans have begun to distance themselves from the
punitive provisions of the bill. This week, Henry Hyde and Olympia Snowe broke ranks to
criticize the cutoff of young unwed mothers (which Dole and Kassebaum already oppose).
So did Tommy Thompson.
.
3. A bad deal for states: Congressional Republicans will have a hard time holding
onto their governors by offering more micromanagement and less money. We will put out
statc-by-state numbers on the cost shift of their various block grants (food stamps, AFOC,
child welfare, child care) as well as the impact of all their conservative strings (numbers cut
off because of provisions on young unwed mothers, legal immigrants, SSI kids, etc.).
CLINTON LIBRARY PHOTOCOPY
�..."/
II. Communications Strategy
This week, we used the subcommittee markup to issue the attached Administration
views letter outlining our differences with the Shaw bill, which was well-received by the
press· and by Hill Democrats who were looking to us for direction. We also put out the
attached comparison of Republican work requirements with current law, as well as an
estimate ofthe impact of child welfare cuts on foster care (states would lose a third of the
projeeted 310,000 slots they need in the year 2000) and an analysis of the funding formula
showing that Michigan would benefit most and New York, Florida, and Texas would be big
losers.
On Thursday, Carperand Carnahan will hold a press coriferencewith Gephardt and
Hoyer on why the Shaw bill is a bad deal for states. At the same time, the White House will
get state-by-state cost-shift numbers out- to local and regional press. Later this week, PPI
will issue a devolution study criticizing current Republican block grant proposals on welfare
and crime.
pver the next few weeks, we will be resurrecting many of the tactics that worked for
the crime bill: targeting editorial boards in districts with moderate Republican members;
inviting Democratic and Republican members to bring their constituents to the White House
for welfare reform briefings; circulating daily talking points in Washington and around the
country; and so on.
III. Developing an Alternative-·
We are working to develop a raJlge of options on what our ideal bill would be, and
how to get there. Ideally, we could start working. with Daschle, Breaux, Moynihan, and
others (including the governors) on a bill that gives states real flexibility at less financial risk,
and puts a stronger emphasis on work and responsibility. In the short run, we will need to
work with House Democrats over the next month to develop a Democratic .substitute for the
floor debate (expected in early April). In the Senate, Kassebaum and Packwood will start
hearings soon, but-no action is-likely until May.
�U':':'.l;)/::1;)
.It:'..,
nn~-rUDL1~
nrrn&
, 'I:!:J
AFDC Recipients in Work under
House Republican Proposal and Current Law
5,212,000
Average Monthly Caseload 1996
,
,
CURRENT LAW REQUIREMENTS
Number of Adults in Two Parent Families
required to work under Current Law
205,000
4%
Number of Current Recipients working full
or part time,
360,000
7%
Number of JOBS participants in oiT, Work
, ,Supplementation or CWEP
30,000
.5%
595,000
11.5%
TOTAL WORKING UNDER LAW IN 1996
HOUSE REPUBLICAN PROPOSAL
Required to participate in "work activities
II
105,000
2%
Note: OJT IS on the ]tramm ; CW ht' IS commuruty work expenence pro gram
ob g
HHS\ASPE preliminary staff analysis based on 1993 Quality Control Data and 1993 JOBS Form
108 Data
13 Feb. 1995
\
.
VV.:
�
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ef747665f27537cfbf93bac58cda29ec
PDF Text
Text
WithdrawallRedaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. letter
SUBJECTffITLE
DATE
03/06/1995
Personal friend (2 pages)
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number:
8506
FOLDER TITLE:
[Welfare Reform Legislation] [7]
2010-0198-S
kc229
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(1) National security classified information [(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�07/06/95
12: 41
tl'2024565557
[aJ 002/001~
WHITE HOUSE
Ar/lllillis/r,(llioll'if WiWal/l J, (:1111(<111, 1995 I F,,!J. 27
321
(lJ) lkqllircS' all F\~&·ral ag('lIcies. iuclllcl
ing
tht~
Ullifurlll(,d S(~I"k·I·$. to (;()()pt~rtl[('
fully ill dTort:; tt:) ,'stublish
Executive Order 12953-Aclions
llequired of All Executive Agencies
Tn Facilitate Payment of Child
Support
FabnmnJ 27, 199.5
Children mied and deserve the e!ll~tjon:d
,tnd flnanc:i,d support of both thc~ir {>arcl1l'S,
The F(:dcral Gov~~rnmt~nt rC(luireS St'll[e~·
:1I1t1. through the1\1,·puhliC' and pri\'ale ~m
l',lo),el's [0 take. actions necessary to ensure
duit monies in payment of child sUpp'ort ouli
gations are withheld and transferred to tilt!
child's C.'arcbkc:r in tUl erfic:ient t\J1d expedi
tious manrl\.:r,.
.
Th{~ Federal Government, through its ci
\'ili.m employees &1lld Uniformed Ser\·;ces
members, is the Nation's largest single em
ployer and as such should set an t'xtllllple of
leadership and encollragl:!nlr.mt in ensuring
thil~ all children are prOpl.lrJ)1 slipportt:·d.
Now, Therefore, by the twthorit), v(~sted
ill llIe <I: Pre:;ic.lcnt br till: (.;onsti£lltion and
the laws of the Ullit<"d St~.tC$ ofAme.-ric:I. ill
cluding section :301 of tide 3, ll,)il~rl S!;I\('S
Code, it is h~'rd.ly or(kr/;:d ali roll(l\\,~;
Part I-PURPOSE
SectirlYl 101, This t~xecuti\'(:· order: {a} Es
tablj"lw~ ! h{:" (,~t'C'lIti\(' bmnch of till:' Fed,'nll
CI)\'Nnll)i~I;'. [hmllgh its ~'i\ilbtl ~'IIJpk'~'e~'s
:·tlld llnii'orlll('(\ Sr·ryiC't·s lllt·mber~. as :I
lnocl,'I(·lropl()~·,'r itJ pnuhoting aJlC; r"diit,ltilt)!
dl(- f'st;lhli~h!lJt"lIr ;lnd ("lli0n::t'!lrt.'lIt Il r:hilt.!
sllppor1.
pfll(:rnil),
and d1il(1
support oTd(.·r~ t~lld to C'n ror<',;· I h(· collc!(:1 irlll
of child lIml H1t'uil.'ul supporl ill ~11l sit\J;\ti{1I1.~
where such u(:tioIlS Ilia:, U(' n·/-jufr(·d,
(c) Rcquir(!s. (~:1,'h Fedcr~il :l~l~IH:;:. includ.
ing Ih.. Uniformed Sen'ice" [0 pro\'iut: iuror
Illation to irs employees 011'<.1 melllue::Ts ubollt
actions thot the\' should tnk!:.· ~tI1d SC:'r\'ic,'~ tll:tt
<Ire u\'ai!ilbk1 to't'lIstlrt' tbt thdr (·bildTl'n an'
pro\idcd the support to wide\. 111(,:- :In: I,·,
gaily entitled,
.
Part 2-l)£FIN ITlO!\S
For purposes of this ord("r:
Sec. 201, "P'exkral i1g(·lll·~.'· IIH"ilm ,lilY ;lll
rhoril)' as defil1(:d <it:; U.S.C. 105, including
the Uniforn',ed Ser\rices; ~lS dt'flned in s(:l,tioll
202 or this order.
Sec: 202. "UniforlllC.'d S('r\'i<'~'{' Iltl:lI11!i
. the Ann}'. Navy. MarilH: Corps, Air F()«('(:.
CO:'l:.it Guard. and the CMll11issioued Corps
or [he National Oceanic and Atmospheric:
Administration, and the Public- llf:>.dth Sc.'r\'
ice,
Sec. 203, "Child suppOrt enfOrCl'II1f:'llt'·
means ilnv administrative or judidal lldion
by 11 court or "dmillistr:lti\T r'lJtity 01' a S'tal('
IIccessary to t,:;tiiblisll Pillt"J'liily CIT ":s[:1hli~11
a child supporl order, including il medical
'!ill[lpor! ordl~r. and any dctions neC;E.'5S,lry to
enforce a child support or 1J1(:dk'll support
, order. Child support acti')I1~ lIlay h(' hrQlIgll1
under the c.:i\'ilC:lr crilninal h\\'$ or a Stilte
tlm.l :\Wl\ot lilllit(·d In aC'tioll~ brought on ht"
hlilf of the Slare or indi\r;duaJ by State .1gen
C'ics pW\'ic1ing ser\ices under title IV-D of
the S"C'it~1 SeCIlI'ilY Act, 42 USc. 651 t:i s!J{{
Sec. :UJ.t. "Sh'lt(,"
JlI(':Lns :uW of til£"
nrl'\'
States. the DistriC'l of Colll11,I,ia, th(;' tt~l'J'i
turi~ll), the !)()$SCSSions, and thl" (:omIl1011
\\'e~IJths uf l\u:r!() Rico alit! {)r lb" ~brian,i.
Isbnds.
1'<111 3-IMMEDlATE :\C.:TIO:\S Tel
£NSUH.J::ClllLDH£NA1H\ SllPPORTED
I3Y TIIElH PAHJ~~TS
-Sec. 301. \Va;!,c \W;II'/Idldillg. (a· \\'ill.lI,
from the date Ill' ll,j~ I.m.l,·r. ·,·\·I,r\,
rf'd.,r;ll ;lg€,IIC~' ~I..ln H" kw il ~ jlr'lC."'<.!nr":N
1M \\';lg.~' \\'itldl,)ldiJl~ ullli"r ·11 t:.S.C. (i.'i~J
alld jl!lpkl!l~'!ltillg rr:'glJlali"II'; t() ':Il~lir ..' tI.:\!
it bill 1·1111 c.:oll1pli:lJH.'r: wid, il,l' r"'lIJir'~IIH'IlI~
(ID d,l\':O:
#.
�.'
07/06/95
\
,
,
12:42
~ 003/004
WHITE HOUSE
f!'2024565557
"
Feb. 27 I AriminisirrJlim10f Willi(Hn J. ClintoTl, 199.5
322
or rhal
section, .and sllall endeavor. to the
e~!(:111 b1sibk. to process wage withholding
actions cOllsishmt witll the reguirements
crossnuitchC$ arc routinel), madc between
Fedcral pcrsonnd rc(.'Ords and Slatl~ records
or on individuals who owe child sUPIX>rt. llnd
42 U.S.C. 666(b),
(bl Beginllillg 110 later than July 1" 1995.
rhe Director of till: OlTice of Personnel Matl
agl'!ml~IH (OrM) shall publish annually in the
Ferlerrll Regislttr the-list or <lgcnts (and th~ir
addresses) designf.lted to receive selvicc
Withholding notic(~$ for federal emp,loyees.
or
Sec.•102. Sen;icecif Legal Process. EvelY
inform employees IIOw to initiate voluntary
wage Withholding requ(;sts.
Sec. 305. At;(JilaiJility of St:n.;Jce. All Fed
(;r:~l agcllcies shall "dvise current and pro··
spective employc:cs or services alJthorii'.[~d
under .title IV-D
Lhl~ Sc:id<ll Security Act
that are aVailable throllgh tIl(: St:~te:;. At :1
minimum. information shall be provjded all
rllI:llIy to current employees through the Ell1
ployee Assistance Program. or similar pro
grams, and to new employeesdllring rolltinl~
orientation,
Sec, 306. Rqmri em i\ct;OTlI> 'faken. Within
90 days of rhe date of this order, all F'cd(~ral
.agencies' shall ,report to the Director
the
Office of M allagl~mcIIt and l3udget (0 M J3)
on the actio·ns they have taken to comply wi I h
this order ,ll1d nny statutory, regulatory, and'
administrative barriers that hinder them
from cOmplying with the requirements or
part 3 of this order.
Part 4-ADDlTlONAL ACflONS
Sec. 401. AfMitjt)floi Rer:.ieu.: for tht: Uni
or
Federal ag~ncy shall ,Issist in the seJ"\lice of
leg-al process in civil uctiolls pursuant to or
del's of courlS of States to estlblish paternity
and estahlilih Qr enforce a support obligation
by milking Federal employees alld members
of the Uniformed Services slatiol)cd outside
the United States available for the service of
process. Bucll !Igency shall designateal1 offi
cial who shall b(~ :rcsponsiblc for facilitating
a Federal employee's or mcmber's availabil
ity for service of process, regardless ofthe
location of the employee's workplace or
IIl1;anbds duty station. The OPM shall pub
lish a list
these offici:lls an'nuaUy in the
Fedllr(J. Rtlli;,isttr, beginning no later than july
1,1995,
.
formEd Sen;iccs.
.
.
Sec. 303. FtJdl.wlJl PlJrenf Lnr:t1lOf', Every
,(3) hI addition to th(~ requirements out
Federal agency shall cooperate with the Fed
lined ahove. the Secretary of the DepartmMI
eral Parent Locator Service. established of Defense (DOD) will chair a task force.
under 42 U.S.C. 653. by providing complete, with participation by the Department of
timely and 1\(:cur;HC inrormatioll that will as
Healtl1 and Human Seryices (HHS), the De
sist in locating noncustodia.l parents ;~nd their partment ofCommerce, and the Department
employers.
of 'rransport<ltioTi. that sbll conduct .t full
Sec .. 304. CrOSSmlJtdl for DelirlqlJent Ob. review of current policies and practices with
ligon;. (a) The master file of delinquent obli in thl'! Uniformed Selvices to ensure rhM
gors th!d each State cbild support enf9rce. children of Uniformed Services personnel
mcnt agcnc::y submits to the Internal Reve· are provided financial and medical support
nue Service for Federal income tax refund in the same manner and Within the S.ll11e
offset purposes sball LI:: Ill<ttched at least an· time frames as is mandated for all other chilo
IIlmU)' with the payroll or personnel files of dren due such support. This re\;eW shall in
federal agenc:1l:ls iTi order to determine if . clude, but not be limited to, issues related
therl: arC (til)' rdcntl employees with child to withholding non-custodial parents" wages.
support dclinqul~ncks, The list of matches service of legal process, acti\ities to lo(~aIC:
5h,\U lx~ forw(\rd~d to the appropriate State' parents and their income ~md ass(;.~ts.. r(:h~ali.·
child support NlrorccfIlcllt ~tgellcr to deter· thm.: to att(,md. l'hil patemity and $:IlPPOlt
mine. in cad. instance, whether w.tge with· proce(;.~dillgs. and h(:~lIlth inslln~n(~~ coverage
holding or otlll~r l:nforCClllellt action·;; should under the Civilian Ht.:"lth and Medic;tl Pro·
gr;ull
of
the
Unirnrlllt"d
Sl"H"\iI.;\·S
be c.-omn~enced. AI! marc:hes will be PN
fOl'lned in accordance "'irh ,5 U.S.C. 5,52«(0)
(CHA./i.'IPUS). All rekv;\lH exisring statut~~s:
includillg lhe: Soldiers and S:lilor~ Civil Belief
(u)'.
:
(b) All Fcd(:r(11 agcfl6(:s sll;'111 inform (~lIr Ad or 1940. Ih... Unirl)rrn.·rI S,',,;ces FOfllll"'r
rc-nl. :tlld prosp(:(:ti\"t;: (:Tllployee~ that SPOllSl'S PI'olection Act, anrlrh .. Tax Equity
or
or
�07/06/95
12:43
WHITE HOUSE
'6'2024565557
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.-,r/millislmtit11!11 William}. Clintoll, 1995 I Hf1h. 27
Fiscal Hellpollsibility :\(ot 1.11' 19152. .shall
IIlent. by qUl1Si-gov~m 11)("llt~tl ag~fl(·il:s.
I,,;· m\;ewed :l1ld appr(~prklte legislath'e'
advisory groups. ,md cornrllissions: and
IIlodilic:ations sh:dl be irkntillt!(1.
(vi) anillysis of whetht:r compliance with
, ([)) Withill 1$0 days of the dar~~ of this
support orders shotild be·;'I. factor 11Sl':d
oT<il-r. DOD sir:tll submit tu OM B 11 rt.:port
in defining suitability for F(:d~ml em
I.msed on rhis re"iew. T111:: report shall rec
ployment.
.
UJlllllend additional policy. regulatory nod
(b) The recommendacions are due within
(t'gisbti\,t'! dlUllges that would impruve and ISO days of the: date or this order. The ree
enhancerh(~ Federal Co\'ernmC!Of's t:ommir
ommcudations ~ue to be submitted in writing
'Ilt~nt ro' en!:uring parental. support for all to the OfIlce of Management and Budget.
children.
Sec. .SOl. Illuml(Jl MfJ.111igeml.int. This
Sec. 40:2. t\dclUio1UJi Ft:c1eml Agency lie impro~e the liner
order is intended ol)ly to
finTlS, (:1) OPM :~Ild HHS sh~ul..ioinrly study
nal managem(!llt of the (.'xecutive bran<.·h with
:lTld prepare r(!commendatioIlS concc~rning
reglud to child suppqrtenforceilleot a.nd
additiollal administrative, regulatory, and leg
shall not be interpreted to create ;1(1)' right
h;Jativ'(! improvements.in the polit'it!5 and pro or' benefit. subJ:hmtiv~ or procedural. en
c:edul'r.s of Federal agencies affectillg child forceable ,~t law by a party against the Unitcd
support enforcement. Other agencies shall States, its officers, or :tny other person.
be indudedin the devdopment of rec
. Sec. 502. Sovtlreignt!j (>f the Vnitt:d States
ommendatiOll:> for specific items ;,1.<; appro C<'l)6rmnent. This order is intended only to
priate. The recommendatiolls shall address, prOvide that the Federal Government h,\s
among other things:
elected to re~uire Federal agencies to adhere
(j) liny changC!s thut would be needed to to the same standards as are ,applicable [0
, (:lIsure thilt Federal employcl~s cOlTlpl~ all other employers in the Nation and shal!.
wilh child support orders thllt require not be interpreted a~ subjecting the. Federal
[hl~ril to provide hoalth il1surallCtl CO""j' Governn1el1t to any Sta.te law or requIrement.
erage for their childrclI:
This order should not be construed a.~ a waiv
(ij) changes !Il:(:lded to tOnsure thal more !'lr of the sovereign immunity of the Unit~d.,
:ll'Curate and IIp-to-date data about eMIt Shttes Cover1l1nent or of any existing st;ttu·
i:ln {tlld uniformed personnel who are tory or regulatory provisions, includiug ·12
being sOl,ght in cOlljuflc:tion wilh Stat~ U,S.C. 659, 662, and 665; 5 CFR Part 581: .
pllternity or .child Sllpport actioJ1~ eml b~ 42 CFR Part 21, Subpart C; 32 CFR Part \
54; aod 32 CFR Part 81.
. .
.obtained from Fedcr(tl ugencic~S
'1
Sec. so.,. Defense emll Securily. This
their payroll and per~onnd record!:".to
improve eITorts to IOC:lt(; f19ncusrodidl order is not intended fO require aoy adion
rhat would compromise the defense or .1I:t
p"rents ilnd their incomt~ ';,uld <lssets;
(iii) chilnges ne(:dcd for selecting, Fedei'?1 tioll:tl seculity interest of the United SI:ltes.
ltgencies to Icst and, evalu;lte new ai?"
William J. Clinton
,
prollches co the establishment and en
Tbe Whitc! House,
forcl:ment of child support obligation~;
Fdm1:lry27,1995.
(i\') prc)pos.lls to·improvc sCI';ce nf pnx:e!s
(M civilian employecs nnd lliP"'.lbcrs br [Filed with tht.: Offi(.'e or Uu: reueml R':gistl:!i'.
thp. Uniformed Serviccs stationed ouff. 11:33 ii,III,. felmtiUj' 27, Hm.S]
sidp. thc' United .States. including tile
1')O!lsihility of serving process hy c(:rtinJd N()TI::: This I::x<:cutive order W;L~ publisht:ll in thf~
Pet/auf Rei!Lw:r ()T1 !-'"hn,ary 21:1.
m.,il in (!stablishmrent and enforc(;lIlcht
c:asp.s Or of designating an ageilt for 51:1+
ice of process that would hnve [he SIHn!:! . Remarks at the American Red Cross .
,
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dTect <lOci bind employees to the ~<1llI(: FcbTtlonj 27, 199.5
I;;xtent ilS actual service upon the c,llI
. ployees; .
...
. ' Thank you.·very much. ladies llud gentle
(v) strategies to facilitate (:ompliancp. with
men, .1n<1 tlmnk you, EliZ<lbeth Dole. Thank
Federal and Stute child Sllpport reglli~~- you for your remarks, and thank yOll ~spe.
:111(.1.
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THE WHiTE HOUSE
WAS H>INc:;TO N
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J:une 13,' 1995
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MEMORANDuM FOR, THE ~RE'IDENT . .J,'
FROM:
,Carol
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'Rasco~
.W~iv~~+nd welf~re Refo~m
SUBJECT:
,You asked for ,a summar.y of .our record in gr,anting'waivers to'
"stat'es fbr welfare, ref6rm 'demonstrations in our pursui,t of' qur.
goal ,of e~di~9 welfarel as ~e . know' it.
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Overview.:'
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We have appr~ved, 3-2. ";elfare waiv~rs in 29 states", more than' the
twb previous Administriations ,c¢mbined: " , (Twenty-one s,tates have'
·,waivers from prior Adnhni'strat'ions'.) , :The,attached map
iliustrates ,t'pa't thes~' waivers are "'broadly distributed. throughout,
, the nation:,Iri an avdrage month," these: dembnstrati6ns ciOver 48%,
"of AFrlC recipie~ts, ~l 6.8~illion peopie:
de~i~e,~' t~
.~f'
, ,If' 'HHS;
grabtalI
tl)e";aivers, now, p'e'nding ,'the "
,nu~ber df statei with(ap~roved w~ivers'w6uld,~row ~rom ~9 io'37~
'and the numbe;L of wai/liTerS' wo~ldgr9w,from 32 to,> 5.;t. ,i,(A state may"
hay,€ : mpre' than, one' , waiver be<:=ause many, waivers a,re'" implemented
,
only in, portions o,f 'tllJe, state" c;tnd b,ecause a,state may request
'waive'rs of different' parts 'of 'thEilaw 'at _dit'f.erent' tim~s.)
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The Aqministrat'ion' S p6l,icy qf encourag'ing; state ,welfare reform
',demonstrations has, a]lowed us to' make sigdifi,cant' str,ides toward
.. a' new welfare system J " The state' demonstrati'ons havE?' the same '
them~s of work i r~sp+nsibility, opport~nit~, arid family as our·
,welfare reformprdpo?al.' I'n, some ways i ' welfare" is no longer the,
same program it, was, for almos\t,' half ,of all· 'recipients -'-' and that
propor,tion is growing..
The,. ,welfare system that these,recipie'nts
encounter' includesofr' will' soon' ',include' some combination dftime"
limits education an tI'aining, work: incenti ve's, stron'ger Child;
support enforcement~ and/or asking parents to ~ake more,
,responsibility for their chi~dren. I '
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ImportantConsideratiions:
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rst, 'and most imp<Drtant ,yqu ,shOUld. 'be 'awar~ ,'that ,the :2 9 states
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with waivers includes ,states that are implementing any, ,eJ:ement of
, 'welfare reform. )'Feter than', half· qf the 29 stat:,es: with waiv'ers.
'haveuridertaken' what we ,would consider 'comprehensive ,r,e-form. ' For,
, : example, only 16 Qfl the 29 states ,have 'w.:aive,rs ·,that will place , .
,"tim~\ limit:s o,n cash assistance~•. ,brily 14" states have wa,ivers, that
combine incr.€ : ased' eaucat;i:ori'and'trp,ihingwi tP~,time limi tl:? . Only
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seven states ~ha\Te,comb,jJned the reforms above wi th ih~r~ased 'ch:Lld
support enforcement, r~moving disi..nceiltivestowork, C!-nd
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proIJ1ot~ngparental res~onsibilit.y! As'~ result" ,arguing :,that 48%
of AFDG recipients will be P?irtic:Lpating in ,wci:ivers and,
therefore, ,real 'welfar~ ref0rm' could be criticized as ,an
"J,overst~tement . ~ , ," './'.,
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'Second,' ohe key element of ,welfare reform -- st;rel1gthening child '
support enforcem~nt-':I require's anatiori~l policy_. This is. .', '
because ef'forts to track down non-custod~al parents so ,:ofteh' must
c~oss state 'lines;' a:ndlbecausethe most important changes don't,
invo.lve' the w,elf~r7 S~S~elTL, : We !leed the child support. ,", " ;
enforcement prov~s~ons, ~n t:he' cUrrent welfare ,reform bl:lls ,in
order to ma~e 8ubstand'ial progre.ss in this 'area.
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Third, waivers dep~nd on Governors to implement 'them.
In New ,
York, 'fOr, example, 'we granted a w2l:iver to the"pri0r Governor that
wil1pre'sumably' pever be imp'lemented. 'Instead,' ,-the new Governor
is expect'e<;1to submit his own waiver request,. ,Also, ,by the time
they actually get their' wai v~rs, most Governors 'are so fed up'
, with ,the red tape that they rarely give the Adrhinistra'tion' much
credi t " ,
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'F~urth,im~as~rin~"the o~tcome
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o~; ~aiv~r' pol~~Y
diff~c~lt.
'Of,'
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: Idealiy, we would IJ1easure the success of our pO,l~cy,' by ,Iook~ng at
"th7 number of people /qloved, from welfa,.re to' work as"a re~ult6~
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,wa~vers,' However, because of the'nature of these exper~ments, wei
\yill not be able t.o,cto th:j.~ for' another' co'tiple of, years, ,Many"
, ,states that, have,beeri ,granted 'waivers:have not yet implemented
them; and, for those'/thathave, ~ei elements 'suc~ as,time limits~
~ a!ld family ,caps don0t usually kicK. in for' two yea,r~ and ten
mont?s '~e~P€!ctiv~IY"1
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, ,We ·have' 'some 'early a:rtdpositive' results in Iowa (wh'ichis, ,the
only state/so farwhbre AFDC!recipients have reached time' limits
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and been removed from the r:olls), "As ,you know:, Florida hap been·
, able' to demo.nstrate,!some) iimited success 'lri mov~ng, people to ,wprk,
thro~gheduca,t'ion and training',' But, it :wilrbe <;iifficultto make
a ~omprehensJve, 'eva~\lp;tion o,f the" ~ffect of our waiverpol~cy
,
,th~s year or next'y~ar"
(Ofcou~se, ,the Hpus€!c and Senate welfare
reform pla,ns are 'not scheduled' to be implemented before October
of t~iS year: a,t tqe+e.~rlie7t")",
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,Finally, waiversare,bY,nature'experiments ·in ,how to end welfare
,rather than an end to welfare'themselves, A few' of the more'
, r~cent waiver requekts push the envelope, and pomedemon'strati6ns
, are', stCi,t~-w~de,' Hore"er,:~hevast, majori,ty of' ~aivers, are pi~ot
, pro] ectsthq.t, may, produce ~nterest~ng les,seonp, Wil th the pot~nt~al
, , for' broader applicaition, :b:ut wil.1 do little· to change
expectations Or opportunities tor the bulk of, the, cuiren't
'caieI6ad:
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Spec.ific Wai:ver Accomplishments :'
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To measure our success we must rely' for 'now on mea~uring the'
actionsst,ates, ,are tC3:king' in an' effort;: to, rnove 'people from "\
welfare, to ,work. Those-actions'are grouped below,under five
central prin\;iples of weI
reform, pri,nciples that we have'
long, articulated and, that were. included' iIi ou'r, ,bill.,' r:
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',We :have m'ad~; it clear ,t~at work 'mu8:t !be the,
centerpiece of any tru~.welfare~ reform plan.'~wenty states are
using waiver;s to'" help ,move people from: welfa:re to wO'rk., To,
accompli~h this! the states' af"e.: '
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'Welfar'eto Work':
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requiring ti1o~e, people ."to p~rticipate" in education~ "ana.
traihing,pr6gramsj ,
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'incl;-easing sanct'ions fo~ tihose who, do not comply with these
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expandil1g case management services; 'and' '
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o,~ 'jobs foi:welfare, recipi,ent!3;
Time Limited B~nefits: Sixteen statesqre;using waivers'in an
effor:t to t;ransform' ,weI'
from' a way-of Ii
:,toa transitional
support, system>' They are~oing so by placing a! time limit, on:
. benefits! or:' by requ,iring welfarerecipfents to· participate in,:
.work or' 1;:rain~ng after a' certaiI]. period 'of time in order to' "
'continue to rec'eive benefits; ,'As in the AdminIstration l s Work
" and' Respon'sibi'lity Ae:t! ma~y state;;s require r~cipients to, deve,lop,
:plans wi:th'specific goals' and deadlines, and enforce thes~,plan~
'with" san'ct:ipns . that~ reduce or deny benefits." Time, limit,s' range
up"to five. years> butar'ef,lexible for: participants who make
,go'od faith effort's to firid work., 'However, since many states
implement waivers 'ih 6nly,- a few counties, thE;' nurupe,r cif ':.t\.FDC '
, recipients affected by" time l,imits, may' be fair,ly 'small,.' 'We are,
,following up' to get" this number.
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Child, stipport Enfor~eInent~' Establi~'hing pat~rnity' aIld enforcing
'child support ,are critical, to, our efforts to move, people' towarc;i
self -sufficie,ncy. Fourteen :states: 'are ,strE!ngthening child
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support 'enforcemeIit'by allowil1g families, to keep more in support'
'paymen'ts, or enrol;ting ,the" non-custodial, p~rEmt' in job,t.:r:aining
programs. ' '
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A ~ore comprehensive app'roach ,to child~ support erif;rci=ment~
howev'er, requ'ires fede,ral' act. ion .' ,This Administra:tion has
-,proposed sweeping nation:-wide chaI].ges.'in paternity e~tabl~shmE:mt,
license revocation, and lnterstate C-ollection'.
The 'House and
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, Sen'ate have adopted our appr0<:ich~n this issue in their welfare
,reform bills."
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, .Mak,~:qg ~ork:Pay:
Twenty-Jive states are' removing the'
,disincentives to work ,in: 'our current welfare system by:
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'increasing ~the 'amount' that' recipients can', earn or save,
w±t::.hou't, losing benefits'; (this' reform has been enacted, by,
\. morest~tes- than ~nyoth~r);
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>.'!el<:x,ing the limit,of $1;500onthe valu~\of,a 'familY"s'car;
extel1ding ~hiJ.:d ~a:ie and/or Meditaid coverage to farriilies "
afte:!; they leave the 'welfare rolls, in order to giv~
families critical support as,they make th,etran~ition .from ~'
wel~are to work; :'.
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o(fering a one-time payment', ch,ild' care, or medical"
assistance in lieu of'AFDC'for'thosewith a temporary need
,for assist;:cmce,' in order to prevent 'aP!21icants'from' joining
, 'the
AFDC, rolls;· '
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allowing-married par~rits who woi:-k'more tharilOO. hours a
month',t,o.klS!e p re9:=iving be~ef,its; and
combining' A'~Dcbenef i t,'.s 'with the', cash equiva'l'ent of a '
family's' Food Stamp's ,'allotmemtto giv~ ,families, flexibility
anci,respor:J.sibil~ty in managing:theii' income.
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Parenta'l ,ReSp0I?-s'ibili ty~ Twenty-~two stat~~ are e'n~ouraging
,greater , responsibility amongAFDC recipients by: '
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payiflg bonuses or imposil)9,penaltieson, families based on
, childreri's sc~ool attendance record;
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: paying bonuses' o'r imposing penalties to encourage teen
parents to stay in school, . maintain adequate grades, and:
' graduatE; .from hig.h 'school; . .
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al,lo~irig famiiies'to put ,money aside ·forchildren' s .
~~ucat~on in~~ecial
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i'r:nri1Uniz~q and re,ceive regular. . hea:ltll check-ups '; ..,
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"requiring teen,par~ntsto,\ liv'e', in' superv~sed settings or go,
to school" Cj.nd offering them 'c<:runselingi; and,> ..
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denying add{tib~al:~eneiits.~o'famili~s~whena parent has'
another 'child" while on AFDC, (.family cap). .
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Conclusion:,
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Our ' policy' on welfare, i:-eformw.ai verSt has acc9mpli~h~d.much. to'
date.'·, lam prepared to, discuss this with you fu:!;th\=r.
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STATUS Of 'WELFARE WAIVERS
...
, \
'
,
•
/
Ari z,ona '
0' ,
Colorado
,0 ,'Flor:ida' "
o
Ill,inols
0'
• Michigan
o '
Montana
o
' , North Daikota
o
Oregon"
.
o
South Dakota,',
0'
W,isconsin' (2)
9
0
0
0
0
0
0
". :\
.
Q
,0
0
0
0
0
0
0
0
0
,0
,0 ,
,'0
-
0,
0
Arkansas'
'; Connect·icut
.
:"Georgia
Tndiana
Mississippi
Nebraska,
.,
Ohio
'0
0
,0,
'i /.
,.
0
'0
0
PEmn,sylv~n~a
0,
vermont
Wyoming
"0
0
0
,
'
!
0
0
'.
Californfa (2 )
Delaware
Hawaii'
Iowa
Missouri
New York
'Oklahoma (2)
South Carolina,
Virginia'
California,'(4 wa'J.,-:ers)
Georgia
Hawaii:'
kansas :
Maine
, . Maryland
, Massach~setts'
, Mississippi " '
- North Dakota',
Oregon
Texa's ,
Utah" '
Virginia
Washing'ton
west Virginia
,
Wisconf:'lin(2 waivers)'
',' Reguested
, 8/94"~ , ;1.2/94
7/94
5/95
.7 /91
4
8/94 . "
" '3/94"
, '4/95,'
'2/95
'9/94""
,
11/93
4/95 ' ,
'5/95'
'
'12/94- '
'2/95
4/95,
4/95
" 1iO' Days ,
12/94 ,',4/95
, 11/94
9/95""
'11/94
1:2/94
7/94
, ',8/95
,)
\'
6/95
1/95
3/94
8/95
9/95
'" 4/.95
, 6/95
',8/95
, 8/95'
•
"
3i ap~lications,f~om26 stat~s
,
.
Anticipated: '
"
,
' '
20 9-pplications fr.om.' 16, s'tates',
(inc~udes date of 'r'equest, and 120-day point)
Under 'Review:
0
, i
I
"0
,
"
I
32 'applica'tions' from, 29 ;states
" 'Approved:
, ,
~
,
"
,
'(
,
,'
I
,
'
,
J
o
0,
o
'b
o
, 0,
Alaska'
Connecticut
Illinois (3)
':Maryland
'Nevada""
New york
0
'.0
,:0
, ,0,'
,
0
,
0 '
0"
,Or~gon
0
o
,South Carol:Lna(2),
'0
0,'
;~est:Virg{nia
0
, Arkansas'
' , ,0
, Californi'
D:C:
'0'
Florida
, Kentucky'
".'
0
Maine
, ' Minnesota' ,
Massachusetts: (2)'
0
'New Jersey'
New Hampshire,
0
·Ok:lahoma ,
NoithCarolina
0
Pennsylvania (2),,'
0 \,'
Rhode Island
"Texas'
, ,
,0\ '
Washington
Wyo~ing
,
"
"
,
I
,
,
"
�',.
'.
•
"
;...
State Welfare Reform :Demonstrations'
-'
"-
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NEW MEXICO·
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":..,
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HAWAII
Clinton Administration
As of May ZS; .l,995 " .
<'
E.SJ Previo~s AdministratioJ;l~
:* 'IJc!Jlll~str~ti~nAlso
Approved
~n l»rcvious Administration;
,
�'
j
WORK FIRST PLAN.
..
.
TWO FUNDAMENTAL GOALS
.
emphasis on work
protection of children
CHANGING THE WELFARE CULTURE
•
.•
turning welfare offices into employment offices
caseworker retraining to focus on employment
~'~,
WORK FIRST EMPLOYMENT BLOCK GRANT
.
•
. focus on job creation and· employmeht in the private' sector tlvough: ,
•
•
placement services/vouchers; 1!'icroenterprises/self-employment; work
Supplementation; a GAIN type program (as operated in Riverside County, CA,
. which sorts clients into two strealns: (a) those needing education and (b) those
job-ready who will be moving quicker into the workforce); a JOBS Plus type
program (as operated by Oregon, which pr,ovides clients with on-the-job training
at minimum wage in public or private sector jobs by cashing-out food stamps and
AFDC); a Family Investment type program (as operated in Iawa, designed
to move families offwelfare and into self-sufficient employment); workfare or .
other work related options to employ welfqre reCipients
tough work performance requirements
tough penalties
TEMPORARY EMPLOYMENT ASSISTANCE
•
•
•
no unconditional receipt Qf assistance
time limits - lifetime limit of five years; if after 24. months a family receiving TEA
includes an adult who is not working ,at least 20 hours per week,· the state must offer
workfare or community service (to be designed by the states). If the adult refuses, the
household grant is reduced by the 33%.
no bona fide offer: of work may be refused (without good cause)
PA~NT
•
•
•
EMPOWERMENT CONTRACT
contract must be signed to ,receive TEA
.,
intensive job search is required
contract designed to move the parent info the workforce as soon as possible
.
.
I •
.
.
FAMILY SUPPORT
•
•
•
encourages families to stay t o g e t h e r ,
,/
extends Medicaid for two years during transition from welfare to work
consolidates existing child care programs into 'one block grant and extends child care for
two years during transition from welfare to work
STATE FLEXIBll..ITY
•
•
•
•
grandfathers existing state waivers and expedites waiver process
eligibility and benefit levels set by states
.
resources, assets, and income disregard policies set by states
employment block grant options designed by states
-~
.
'. .
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STATE FLEXIBILITY UNDER WORK FIRST
l
States. would have an unprecedented a~ount of flexibility:
•
States set their own benefit levels, countable,assets, resource limits, and income disregard
policies'
':
" ,', '
',,'
,
.
..
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.
•
States design their own progr~ins for moving .recipi~nts from welfare to work.
•
States design the Parent Empowerment Contracts outlining how each welfare recipient will
,
' ,': '
,
become employed.'
•
States have the freedom to consolidate and streamline welfare operations to function more
efficiently and tum welfare offices into employment offices.
•
States design their own jobs~arch programs geared to helping welfare recipients look for
work.
, " :
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,
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,
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,
:
•
States determine the form ofsupport to provide to recipients: direct benefits, wage
subsidies to employers, vouchers, etc.
'
•
States determine who their employment block grant will serVe (from welfare mothers to
unemployed fathers).;
':,
•
States design and determine workfare or commuqity ~ervice jobs appropriate for those
,"
'
welfare recipients not employed within 2 years.:
•
States determine whether t~ey will treat "interstate"
•
States are provided with "seamless" chil,dcrui~sist~mce ~o .that the need of the family,
would determine the ,assistance they receive, not;the category of federal program money
that's available.
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•
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i~grants
differently.
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•
States retain the option of'administering their programs under existing waivers.
•
States have the option of requiring participants ~o undergo appropriate substance abuse
, treatment where necessary.
:
•
States have'the option ofproviding more than the $50 pass through of child support to
' l '
welfare families.
•
States have the flexibility to design innovative:tetm 'pregnancy prevention programs,
'.
, States have greater freedom to,design programs to keep fathers in the home, induding
, offering employment services to noncustodial parents.
•
States have the option of using a portion oftti~ir employment block grant funds for other'
work-related purposes ~ecessary to help clients get and keep ajob (including emergency
day care,uniforms, eyeglasses, and transportation). ,
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dpcbackgrJlUndbriel
June 8,1995
Publication: SS-8-Social Services
Democrats Unveil
Welfare Reforni Plan
"
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Today, the Democratic leadership in the Senate will announce their welfare reform
plan'-a plan that promotes work. but protects kids.' TheUWoi1<: First" plan will
dramatically change thecurrerit welfare system by: .
'.
.• replacing Aid to Families with Dependent Children (AFDC) with a condi
tional entitlement of limited duration, Temporary Employment Assistance
;
.
.'
(TEA);
• requiring allable-bodi~d recipients to work;
.
,
• tUl11ing welfare offices' into employment offices;
.
• guaranteeing child-care assistance; and,: '
.
• requiring both parerit~ to contribute iotti~support of their children.
1
The "Work First" Plan
Temporary Employmf,,,t Assistance:
. Under the Democratic ,plan, . AFDC is abolished and replaced~y TEA,
. a c~:mditional entitlement of limited ,duration fdr families.
I
I,
.
• Assistance is conditional. hi order to receive assistance, all recipients
must sign a Parent EmpowermentCoritract. This contract will contain an
indi~idualized plan' to move the parent into the workforce as soon as
possible. Those'Who refuse to'sign contract won't get assistance and
, tough sar'!ctions a'pply to those not complying with the contract.
a
Democratic Policy Committee
. United States :Senate
Washington; '~;~051 0-7050
-
Tom Daschle, Chainnan
Harry Reid, Co-Chainnan
, :,!
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�• Assistance istime-.I,imited. From day one, all, able-bodied
recipients will be required to engage in ~n intensive job search.
After two months, onlYiclients who have signed the Parent Empow-,
~rment Contract and ,are working toward' its objectives can con
tinue receiving assist~nce. After two years, if an individual is not
working. States will be required to offer'workfare or community ,
service. Again, tough sanctions apply to those who refuse to
participate in workfar~. No family may receive assistance for more
, than five years except in limited circumstances.
• Children always are protected. ,Even if a parent loses TEA,
benefits, vouchers, in the. amount of a child's. portion of the grant,
will be available to: provide for the child's essentials, such as
housing. In additio~, children will rema~n eligible for food stamps,
school lunch and school breakfast, and Medicaid.
,
WorkFi~t,
The Democratic plan emphasizes work by· establishing the 'Work First"
.Employment Block Grant for States. The focus is on work:. providing the
means and the tools needed to get welfare recipients into jobs and to keep
them in the wprkforce. "
All able-bodied recipients must work. For those recipients still looking for
work after the initial two 'months of job sear¢h. the State may provide any of
a number of service~ to assist recipients in obtaining jobs, including, but not
limited to:
.
• job-placement vouchers;
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• wage subsidy/Work supplementation; ,
I
.
,
,
• microenterprise development/self-employment;
• a GAIN-type program like that operated by Riverside County,
California whic,h sorts clients into two streams: (a) those needing
education and (b) thosejob-ready who will be moving more quickly
into the workforce;
,
.
DPC Background Brief
.
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p.2,
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• .. a JOBS Plus-type program like that operated by the .State of
, Oregor:'which provide.s on-the-job training opportunities for clients
in private and public isector jobs· by cashing out AFDC and food
.' stamps; and.
.,
' .
.• ' aFamily Investnient~type program like that operated by the State
·of Iowa. designed to move families' off. of w~lfare and into selfsufficient employm~nt; and. .
,
•
.'
on-the-'job training other training ore~ucation for work prepara
tion that will bring about employment the private sector.
or
h,
States given the resources to emphasize ,\york. Under the Democratic
plan, States are given the!resources to help welfare recipients not only get,a
job but also remain in the workforce. .
.
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Flexibility: States would set all eligibility rules, enabling States to
make work pay more than' welfare.; States set benefit levels~
· resource limits, asset levels, and income disregard policies.
I
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• Funding: the 'Work First" block grant provides States with. the .
. . funds necessaty;',to assist them with the cost of putting welfare
recipients to wor1<; Funding would qe increased and the Federal
match rate would be increased to 701,30 with ten percentage points
.. higher thf,ln the Medicaid match rate.
i '
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'. Child Care: to help recipients keep a job, child care assistance
would be made;available to all thos'e re,quired to prepare for work
or work. Three current child care programs (AFDC qhild care,
· transitional child care, and at-risk child care) would be consolidated
· into the Child Care Development Block Grant Program (CCDBG)
, authored by Se,nators podd and H~tch in 1990. The CCDBG would
be expanded t,b cover welfare recipients required to work,those
transitioning ,frpm welfare to work,' and the working poor up to the
poverty level. ;1'he Federal match rate would be inc~eased to 70/
30 or ten perc.entf,lge points higher-than the Medicaid m~tch rate.
• Health, care:: to .·encourage 'clients 'to. stay in jobs' by making
employment more attractive than welfare,' Medicaid coverage will
.be extended ,by an additional 12 ,months beyond the cLlrrent one
year transition period.
ope Background Bri,ef
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p.3
�We count work, not "participation." Under the ''Work First" plan, States
would focus on getting reci,pients into real jobs, getting credit o,nly for:
• those leaving welfar~ for work;
• those working 20 hours or more per week (even if still receiving
'benefits); and, '
• those working 20 hours or more per week in subsidized jobs (but
not workfare) unless recipients live in areas of high unemployment.
By the year 2000, States will be required to achieve a work performance rate
of 50 percent, wh~ch w<?uld mean an unpr~cedented· number of welfare
recipients would be working.
CommunitY ~ervice for those who don't ~ork. Those not working within
two years must perform workfare or .community service as designed by the
State. Even those who are exempt from the work requirement (ill, aged,
incapacitated recipients, those caring for a disabled child or relative, or those
with a child under age one) will have oblig~tions. They could be required to
perform community se~iceas defined by the State, such as volunteering at
their .children's school; or they must take responsibility as outlined in their
PareQt Empowerment Contract, such as having their children properly
immunized
I
.
Absent Parents
Absent parents. Absent parents who are delinquent on their child support
payments may:
.
,
• choose to enter into a repaY,ment plan with the State; or;
• choose betWeen a community service job or jail.
States would have!the option of providing job placement servic~s to absent
parents, on the condition that, once employed, they meet th~ir child support
obligations.
Keeping families together. States imay serve unemployed fathers in job
placement under the "Work First" ,Block Grant program in an effort to
encourage families to stay together to work their way off welfare.
DPe Background!Brief
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Teens
.."
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Teen parents. Under the Democratic plan, the message to teen parents is
clear: stay at home and stay in school. No longer will a teenage parent be able
to drop out of school and ~stablish a separate;household, creating .the cycle
of dependency that is,difficult to break.
'
,
• Stay at home. C~stodial parents un~er the age of 18 would ,be
required to live at home with an adult family member or in an adult
supervised group!home, in order to qualify for TEA benefits'.
• Stay in schoo!.: Teen mothers would be required to remain in
school or in an alternative technical or trade program through age
18 (age 19 at State option) in order to qualify for TEA benefits. In
addition, teen mothers, would be required to participate in sub
\ stance ab'use tr~atmentprograms, when deemed necessary.
,
.
Teen pregnancy pr~vention. The number of children born to unwed
teenagers has rise~ sharply in recent ye~rs. The Democratic plan addresses
this problem by including grants to States for the design and implementation
, of teen pregnancy prevention programs~~uch programs would be operated
, by State agencies, local agencies, publicly supported organizations, private
, nonprofits, as well 'as consortia of such entities. Governors would ,select
projects with preferences given to those; targeting: '
• both young rt;Ien and young women;
.~
• areas with high teen pregnancy.'rates; or,
•
'
• areas. with
I
. •
a high incidenc~ of ilil~ividuals receiving AFDC.
,
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Waivers
.
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.
, All existing waivers are grandfathered. At State option, States can opt out of
their waivers. ,In conSidering an application for anew waiver, there will be,a
presumption for ~pproval for requests similar to one already approved.'
ope BaCkground Brief
p.5
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BRIEF COMPARISON OF'MAJOR PROVISIONS IN WELFARE PLANS
,
~
Item
AFDC Entitle
,
ment
House bill '
Abolishes AFOC
TUrns AFOC into a
state entitle~ent
. lock grant, which is
b
capped. No;
guarantee of
assistance for a poor
family.
Finance Committee
Dem Leadership
Abolishes AFOC
TurDs AFOC into a
state entitlement
block grant, which is .
capped: No
guarantee of
assistaIice for a poor
family.,
Abolishes AFOC
Creates new
Temporary
Employment
Assistance, a
Conditional
individual '
entitlement of
limited dUration.
;'
Time Limits
State Match!
benefits
5 year lifetime linnt,
with state option for
less time. ;
5yeadifetime limit,
with state option for
less time.
5 year lifetime limit,
with reduced grant
after 2 years for
parents refusing
workfare or
community service.
No state, match
required:' Benefits
can be cut to any
level.
No state match
required. Benefits
can be cut to any
leveL
Retains state match
requirement.
Retains current law:
benefits can be
reduced, but not
below 1988.
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State Plan
Personal Contract
Plan submitted to
,
H;HS Sec.
Plan submitted to
HHSSec.
Plan submitted to
,HHS Sec and
deemed approved if
not rejected w/in
120 days.
None;
None
Parent
Empowerment
Contract. Must
, sign to receive aid;
must follow or
~ penalty.
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2
Item'
JOBS program
Participation rates:
(Current law is
20%)
House bUI
Ab9Iishes JO;BS;
JOBS woUIdbe
, i
consolidated with
AFDC in a:'"
, ',fixed amount of $
over 5 years:
.unfunded mandates,
for statesto;nieet'
work requirements.
Participation
Requirements
,
Rainy day fund
Abolishes JOBS.
JOBS .would be
consolidated with
AFDC and child
care funding and
, frozen ~t FY94
levels for 5 years.
Unfunqed mandates
for states to meet
, work requirements.
1
. Parqcipation
Req~irements
Oem Lead~rship
Abolishes JOBS.
Creates new Work
First Employment
, Block Grant.
Sufficient funds are
provided to ensure
that no unfunded
mandates are passed
on to states in
meeting work
requirements.
Federal match
increased to 70/30
or 10 percentage
points above FMAP.
'" Work
Requirements'
,
I
FY9610%
FY97 q%
FY9820%
FY9925%
FY002;7%
FY0129%
FY0240%
,
FY0350%
Hours of work per '
week req'd. (cUrrent
law is 20 hours per
week)
'FinanceCommittee
fY9620%
FY9730%
'FY?835%
.FY9940%
FY0045%
'FY9150,%
FY0250%
'FY0350%,
FY96 20
,97&98 20
FY99 ,25
FYOO 30
'FYO'l 30,
FY02+ 35
FY96·
. '97&98
FY99
FYQO
FYOI
;FY02+
Rainy Day Loans
Loans to be repaid
with interest. LOans
, triggered by VI rules
,(ill % in excess of
615%) " .. ~
Rainy Day Loans
, $1,7 billion loan'
fund created. Loans
to be repaid with
interest within 3
years. Loan not to ,
,
'/"
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20
20,
20
20
20
20
FY963Q%
FY9735%
.FY9840%
'FY9945%
FYOO 50%
FYO! 50%
FY0250%
'FY0350%
* only work is
counted; the rates
measure work, not
, , "participation"
FY96 20
'97&98 20
FY99 20
FYOO ' 20
FYOI
20
FY02+ 20
. (State option for 30
hours per week)
Bonus for
Employment
Since entitlement,
'no need for "rainy
day fund", but bonus
system for
�lt:
3
Item
House bill
Oem Leadership .
exceed 10% of stat~
grant. Only states
that have never had
a penalty may
qualify fora loan.
Rainy Day fund
(cont'd)
Finance Committee
emploYment.
Bonus $ can be
used for Work First
Employment block
grant or child care
I
State Penalty .
Failure to Q'leet
participation rates
would result in 5% '
cut in state annual
:
grant.
Failure to meet
participation rates
would result in 5%
cut .in state annual
grant.
Sec. can make
recommendations
for improvement
(1 st time) and .
require a 10%
reduction in the
federal admin match
for TEA
administrative
expenses (2nd time).
Individual Penalty
State determines
level below current
benefit.!
State determines
level below cirrrent
benefit.
33% cut 1st time;
66% cut 2nd time;
'off TEA 3rd time.
Earnings
Resources
Assets
State decision.
State decision.
:
State decision.
'State decision.
State decision.
State decision ..
State decision.
State decision.
State decision.
Minor Parents
No$ .
State decision.
Live at horne or
.w/adults.
X-fer $
Allows x-fer of30%
of bl9ck grant for
other purposes.
Child Care
Authorized funding
only; no guarantee
of 6hild care
assistance for those
transitioning to
work.
,
!
Silent on transfer
Issue.
No x-fer, but bonus
$ can be used for
Work First
Employment block
. grant or child care.
I
I
... - .._
consolidated with
' AFDC & JOBS $.
No guarantee of
child care
assistance for those
transitioning to
. work. No guarantee
of child care for
patents with
children age 6 or
older. No additional
child care~~~y
. I$
. ,~. : :~;:;':l~, ,~
Existing child care.
programs
consolidated into I
block grant.
Guarantees child
care for those
. required· to wor~ or
prepare for work. 1
year transitional
coverage r'etained
and extended an
additional year on a
�'
"
•
4
Item
House Bill
Finance Committee '
;
Oem Leadership
'f
child care
(continued)
provided to meet
,
mcreasmg
participation rates.
"
,!
Medicaid
Current la.w, 1 year
oftransitional .
Medicaid: for those'
working.!
,.
,:
'.
Current law,. 1 year .
.of transitional
Medicaid for those
I
' working.
sliding fee scale at
state option.
Working poor
fam.iiies with
income up to 100%
of poverty phased
in. Fed match
increased to 70/30
or 10 percentage
points higher than
. FMAP.
1 year transitional
. coverage retained
and, extended for
one year on a
sliding fee scale.
�JUN-;:I39,-:1995
lq: 1219
TO
' FROM
"'
RF1SCO
P.03/21
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'Daseble Pre,S~ Conferelwg gn ,"Wock'fiat- 6/Bf9S
)
,
The ,folloWing members made opening statementS:, '
, Daschle~ Mikulski, BreaUx, tor~~ Dorgan and Rockefeller ' '
,
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"
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,
Some of their statements ate included tn the atta~hed packet Daschle said that the
Democrats plan arid 'the Pa~kwood plan both save inoney; but,the difference is that th~ , '
" Democratic~pproach takes s~viIlgS and generates' wort protects children, and allow$'
..
"state flexibiliiy. -Daschlc allowed a brief amount of tilne for questions. 'The questions
" focussed on the following:
"
. . , ' , ."
"
~Q ~S:Qrina-Daschle and BreauX said 'GBO is 'currently ,scoring, tne ,1'Work First
plan. Breaux emphasiz~d that savings cr.eated by the plan will cover the costs
l1
, "so there"will be no additional 'dollars incurred.
~,
!'
,
"
'
'
ReciPients whQ canno'i find jobs;.Daschle, explained that able-bodied welfare, '
recipients will have tWo y~arsto find ajob. They will also/be allowed io find"
, a job over the course of five yea~s, but' no Ingre. ' , ' , ' ,',
:"',, State flexibility~Daschle said states \yilt have "~h~ppportUnity, to set up
ci1temative work plans', Le:Workfare, vouchers...Theywill ~ot have the option ,
,to do I+ot:qing..
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:Peficjt Redtictiou-Cuts Social Security: Disability, e~c~ will creat~ sa~ng~
that ~n be \!Sed in the :welfare program. This' plan ,allows. for extra' d()llars to go
towards deficit reduction:
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, dminjstration~s PQsitiOn-Daschle said the President state'd hissupport for ,"Work
A
First" yesterday. The President said. this is the approach that should be used as we
ref?mt the welfare sy~t~m:. Hc.str;sscdhis oppositiont~ the Republican pian.
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" WORK FIRST PLAN
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,Two FUNDAMENTAL GOALS
• '
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emphasis Oft. work. " ,
protection, ofchildren,
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, CHANGING THE WELFARE cULtuRE
•
tUrning we]fare offices into employment offices '
0'
, ca&eWorker retraining to focus
employment'
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on
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"
WORK FIRST-EMPLOYMENT BLOCK GRANT
0
, focus on jobcrealion andcmpioymcnt in the 'priVate sector tMo\1gh: ,
, ", placement serv;cesi'VoUchers; microenterpriseSlselj-employment; work, :
'suppiementation; a GAlNtype program (as operated in RiYel'side County., CA.
which sorts clients ,into twp s,tr~ams: (a) those needingeducilliun wid (If) ilia.
job-reodj ,who will be mOving quickerinto the workforce); a,JOBS Plvs fJIpe ',' "
, program (as oper'ate4 by Oregan., which piovitks client:; with on-the-job training'
at minimum ,wage in public or prlvatesector jobs by a:i.shing-out food stfZ1!lPS and '
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AFbc);~ a Family i'IJ,VestTnent type program (as operated in. Iowa, designed '
, to move families, offwelfare and tnto self·~..,jfficient employment),. worlifare 01'
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,other: work related options to employ welfare reCipients
, ,tough work perfonT)ance, requirements .
.
, tough penalties· .
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TEMPORARY EMPLOYMENT ASSISTANCE
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no unconditional receipt; of assistance' "
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time iinuts ~- lifetimelirmt of five years; ifafter 24 months a family receiving TEA'
inc1u~es an adult who is not working at least 20 hours per week,tbe safe must.offer
, , V(orkfare or community service (to be.,designed by,the stateS), If the adult iefuses>,the
.
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househuld grant is reduced by the 33%.,
'
n~ bon~ fide offer ofwork may be refused (without ~ood'cause)
PARENT EMPoWEgM;ENTCONTRACT
, \contract must be signed to receive TEA
•
.. , intensive job search isnqulred '
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"cOntract designed to move t~e p¥ent into tpe workforce as soon ~possible , '
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, FAMn,y SUPPORT
,•
encourages'&rmliesto stay together ' ,
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extfmds M~ic8id for twoyears during transitioll'frOrIrwelfareto wqrk',
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' c~:)Osolidate~ existit:lg child care programs into one block grant ~d ~ds child care for
two years during transition from welfare to work "
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" STATE ~xmiLIn'
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'grandfa~h~s existing statevvaive~s and expedites
eligibility and benefit leyeis set by states
wmver proces~"
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,resources, assets, a~d income disregard policies set by states
emp~oymcnt block grant options designed by state."l \
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·JUN~1219-1995
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16: 1121 'FROM
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'P •1215/21
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.'·dpc background IIriel
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. Publication: BS-8-SOdal Services \'
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JuneS; ,995' . "
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Democrats 'Unveil'
Welfare Reform, ,Plan· ,
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Today, the Democratic le!1cte'rship i,n,the Senate will announce th~ir:~elfare'refom1 '
plan""';a plan'1hat pro!,!\otes work, t?ut protects kidS. ' The ~ork First" plan will ,
drarnaticaIlY,:change, the currentwelfare systert:1 by:
, ' • "replacing Aid to Families with Dependent Children (AFDC} With acOndi" < 'tionarentitlemenfof limitedduration; Temporary Employment ASsiStance \
(TEA);.'"
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• reQuiring all abl~bodi~d recipients to work; ,
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-turning welfate offices, in.toemploymentbffices;
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,.,,' guaranteeing chUckare ~istance;, and!'
, - requirihg botf:1, 'parents, t~ contribute ;to the support of t~eir children.' ~ ,
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. , The'~"YIorki First", -Plan
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Temporary Employment~ssistBnce
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Under the DemocratiC' plan, .AFDC is
.
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a~olishe~
a conditional entitlem~nt C?f limited duration for families.,
...
and replaced by ,'TEA,
,
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- A_aistanceis conditional., In order to receive 8:ssistance:-aJ/i'eCipients '
mustsignaP~rent Empowerment C,ontract. This contract will contain an '
individu~lized 'plan to' move ,the, parent,' into the workforce as' soOn' as
poaslble.,' Tho:S8 who refus~ to ,sign a contract won't g.at assistance and" '
tough'sanctlons apply to thQse nofcomplying·with the contraCt., ' (,
Democratic 'Policy Committee '. ,
'Tom DUcr'lle, ChalnTllm
United States Senate: '
Washington. D.C. 20510,:7050
HarrY Reid, Co-ChBirma" .
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.' Assi.tance I. ' tiin,.tlmtted. From ,dayorie, all abieabodied',,'
recipients wiU be requirSd to engage in an intensive job search.
, ".After tWo months, only clients who have 8i9ne~ the,Parent Empow·
erment 'Contract and are working toward its objectives can con
tinue receiving assistanc•. After two years, if an individual' is not
working, State,s will· be' required to offer workfare or cornmunity
.ervice. Again, toughsanclions apply to those Who ~fuS$to '
participate in ~otkfare~ No family may receive assistance for more
than five years except i~ ~imited circumB!ances~ ',', '
':...,
• ,Children aiway~ are,protected. EVen if a parent loses TEA,
'
'benefits, vouchers, in the amount of a child's P9rtion 6f the, gram,
will, be available to provide for the ~hild's ~ntialsf such as
housing. In addition,children will remain eligible forJood Stamps,
school lunch and schaol breakfast. ~ar1d 'Medicaid.,' .
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,,Work' FI,.,st
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The Demoeratic plan emphasizes work, byi establishing, the .~ork Firsr.
,Employment Block Grant for States. The focus is on work: providing the
means and the tools needed to get welfare recipients into Jobs and to keep .'
them in the 'workforce. ,
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AU able..boclie,d ..ecipie~bimust work•. For those recipients stili looking for,
,'-work after the. initial two ",onths 'of job search; the Stcitemay provide any of '
" . a number of serVices to assist recipients;" obtaining JObS, including, but not
limited to:
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• w.ge subsidy/work,supplementation: .
, ' . • . mi~roenterprise deve.'opmeriVself..employm.r.t; , '.
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• .. a GAIN-type program, liketh~t operated by Riverside County,
, . Califon:'!ia whi~h sorts clients into two streams: (a) those' needing
, education and (b) those job·ready who will be moving more qu'ickly :-'-'
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p.2
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• , ~ JOBS
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Plus~type
program 'like that
.Tated ,by the. St~te qf
Oregon-which provides on-1he·job training opportunities forell,ents
in private and public 8e9lor jobs 'by cashing out ,AFDC and food
" stamps: and,
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• 'a Family InvestmenMyp~prOgram like that operated bY the State" ,-,'
',' of loW-a, designed to move families off of welfare and into seJf~·
,
~ufficient employme~t; land,
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,.on-the-job'trairiing or'other lraining or ed~cation fOr ,work prepara-:\
,tionthat wjll bring about employment in'the private sector.' ,
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States, given the r~sources to emphasize. work. Under:the :Qemocratic
,plan. States are given,the reso~rcesto helpw~lfare recipients noronly get a'
job but also ,email) iothe workforee. ,'. " . " '
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• Flexlbiiity:' Stat~swouldset an eligrbility rules. enabling 'States to
make ,work pay more than welfare:' States set benefit levels, ,
'resource limits, asset levels. and income disregard polici~s. " .'
• Funding:thel"WorkFirSr block grant provides States with the,'.
funds n~essary' to,' assist ,them with th~cost of, putting welfare
recipients to work. funding would be increa$8d and the Federal
match rate wO,uldbe increased to 70/30
ten percentage pOints
higher. than the Medicaid match 'rate., ' '
.
with
'"
, ,., Childca~e:,to help. recipients keep a1ob, ohild
care a.siltanee
would be made available to all those required to prepare for work
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or work. Three current child care,,programs '(AFDC child ,care,
transitional childcare, and at-risk child care) would be consolidatecl
',into the Child Care' [)evelopment Block Grant Program {CCDBG}
authored by Senators Dodd and Hatch in 1990. The CCOBG would '
, be expa.ndedto cover welfare, recipients required to work, those
, transitioning from welfare to work. and the working poor up to the
, poverty level. The Federal match rate would be 'increased to ,701
30 or ten percentage points higher than the Medicaid match rate.
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Health' Care: to encourage 'clients to stay in jobs bym~king "
'8.!"ployrnent more attractiVe than welfare. Medicaid coverage will;
, " be,extended by an, additional 12 months beyond the curreritone-
" 'yeartransition period.
ope &ckground Brief
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We·count work. not "participation.", Under'the -Work'Firsr, plan,States
"would focus ,on'getting recipieTlts, into ,eal jobs, getting, credjJ onlY for:
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• ,those:leaving welfare for .work; , '
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• those wOrlang ,20 hours or more per,w8ek(even if still receiving
,bene!its);and, ,
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" o!: 'those working 20 hours or more per week: in subsidized,lobs (bUt
not workfare) unless .recipients live in areas ofhIgh unemployment.
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, By ~e year 2006: states will be ~uired ~ChieV~ work performance rate
ot ~o ~rCen~, which wOL!Jd,mean,an unprecedented number'otwelfare'
,recipients wo~1d be, workin,g., '.,:",
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ThOse not wori<ing within
': two1yearsmust perform workfare or.community service asdesign~bythe'
State,>, Even those, who are exempt from the, work reoquirement (iU, age,d.
, incapacitated recipients; those caring for,a disabled child or relative; or those
With a child unde~ age one) will have ob!igations. T~y, Could be required to '
perform community'service asdefin~ by the State/such'as volunteering at '
, ", theirchildren'ssehoel, or they must take~ respensibU,ity as outlinecfintheir .
,_ Parent ~mpowerment Contract.' ,SUch 'as having their children property
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immunized
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" Absent Parents '~
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Absent parents~ Absent parents who are delinquent on their child support
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,payrryents may:,
.' 'choose to enter into a rep~yment plan with the State; or, ', " ..
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• choose betWeen a communfty~ice job or, jail., . .,. ,
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the oPtion of P~iding jOb placem'ent SerYic8s to, absent "
parents. 91, the condttion'~hatt once employed. they meet their,child'support
obligatio"~. , ' : '
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Kee~ing, fam III,. ,together., States may serve unemDloyecUathers in job
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placeme~ under tne 'Wo*, First BJo~ ,Grant' program in 1m effort to , ;
,, encoura9~ far:nilies to stay together to work their way off welfare.'
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, Teen parents.: UndertheDe~rat~c plan, the m9ssage toteeA ,parents is
, clear: stay at home and stay in schoct No longer will ateenage parent be able
:to drop ?ut otsch60land establish a Separate househoJd,Crea~ing the, c,vCle
, of dependeric:y that is difficUfUo break.' ,': "
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,. '~Stay at home: Custodial ~rents 'under the
18 wQUld be '
',' required live athome,with ~ adu~ family 'member in an aduH '
'
, supervised 'group home, in order to quality for TEA t;lenefits.,
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, , •• "stay inschOOI~ ,Teen ,mothers would 'be requjre~' to ~main ~n
,
, school or in 8f' altemativetechnica,1 or trade program through age
, , 8 (age 1,9 at State option) in or:derto qualify for TEA bcmefits~ -In
adQltion, teen mothers would be required to participate i'n sub-'
'( stanc8,abuse treatment programs, when deemed necessary.
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T~en. pregnancY preventlon."'e 'number of children bom: tp Unwed'
, teenagers has risen sharply in reCent years; .111e DemoCratic pian addresses '
this problem by including gran,s to States for the design and implementation
, .ofteenpregnancy,prevention programs~, Such programs would be operated' ,
by State agencies, local agencies. publicly s~pported organizations. private ' .'
nonprofits as well as consortia of such entities~ Governors 'would 'select " .
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. projects with preferengesgfven, to those targeting:
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Waivers" '.
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,~lJexisting waivers ~re grandfathered.. At'State optic;mr States Can opt ~ut of '
their waivers. In cOnsid~ring an application for a new waiverithere will be a
pr~sumption for approval for r$quests sim,ilartoOnealready, approved.
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BRIEF COMPARISON OF MAJOR PROVISIONS IN WELlfAllE'PLANS
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AlOe Entitle
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House biD
Item'
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AboliSheS.AFDC. ,
",Tums MDC into a ~
Abolishes AFDC.
Tums MOe into a
state ~t1ement ,
blockgrailt, which is
,state entitlement: .
block grant, Whith is "
capped.N",
'
. guarantee,of
,,assistanoe for, a poor '
'" family,:'
capped. No
gUarantee
of ,"
assistance for a J)O')f
.'
", AboJiSh~ AFDe.
cre~llew
,Tealporary
Employment '
Assi$tante. a
, conditional.',,'
,individual
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,limited dmatiori.
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,
,5 year lifetime limit,
Mth stab? Option for
,It:~ ,time.
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".TIme'U IUln~.
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'er:rtitlcmem of' ;
, family.
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"Dem Leaclenbip
. .5 year lifeti:Irie limit;
i with state option for
,
.5 year lifetime ,Jhnit, ,
with reduced grant
'" ,after· 2 years for
"parentsI'l3fusing. ,
less time.
,Workfiire or
'conmi\Dlity service,! .
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. No. state ~tji;h :
,
,State Match!
..No state mlUch '
, ~requ1red. Benefits,
requir~.
benefits
\',
Benefits
can be cut to any ,
leVel.'
"
can be cut to any ,
,
l~e1:
,"R.etaiDs state match
. requirement
Retains tuITent law: '
beDefm; ~an be'
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reduced. but not·
below 1988..
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State PIaa'
• Plan submine(i to'
" ,HHSSec.,'
, Plan:»ubiuittedto
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'H,HS See.
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Plan subDritted ,to
HIlS Sec and .
: demried appi:owd if
~ not rejected wrm
,120' days. .:
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Personal Co~ti-ac:t',' " None, ','
NOne'
. 'Parent
,EmpOMrment '
. Contract. Must
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sign 1Orecei-ve'md;
must follow or .
. penalty,
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16: 13 /" FROM
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, House biD
, JOBS .,ror;ram '
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Abolishes JOBS. _',
AboliShes JOBS.
JOBS would be
' , •.JOijS.would be
consolidated with '
conSolidated with
., , AFDC and Child,
',AFDC in a
, care funding and ,
fixed amount $
over 5 years,
, frozen it FY94: .
UiltUiuted mandates, . , " leveb fOl; 5 yem.
for'states to meet
Unfunded mandates
. tAlnrk requirements.
for'states 'JD meet' \
, ',~lc requ;irements: ~,
Item
. AbOlishes JOBS.
Cre8tes DCW Work
}Vim Employment '
Bloc:kGraat
Sufficient funds are
, provided to ensure
that i:lO 'unf.Ui1ded .
mandates. are p'assed'
on to states in
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meeting work
requiremen:1s.
,Fede:rn.l match
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, " increased to 70130
, Or H~ percentage:
" ,poin~above~.
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Partidpadoil '
200~)
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PSlr:1icipSitioD'
' Requirements
Parddpation raleS:
(CUITen~ lawis
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,Requii;ementi"
FY9610%,
FY971S% '
'.I:'Y9620%
:'FY9730%
·FY9835%
FY99400io
fYOO45%
FY9820% "
FY992~%
,
FYOO 27% ,',
FYOI2~/O'
FYO} $0%,
FY0240010
1'Y03 50% .
,
. FYO~ SOOIo
FY03
S~Io,
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Work "
'Requirements
FY9630%
'F:Y9735%
FY98400/0. '
FY994S%
FYOO 50% ,
s~{,
FY01
FY0250%
,FY03 50% '
, • only work is
_counted; the rates
j
; ,.,measure work, not
"participation"
,Houn of work per' , , ,FY96 20,,',
97&9820
week req'd:(cUiTent
law is 20 hours'per
week) ,
'
, 1~992S
FY99
20
',FYOO 20'
. FYOl,20
FYOO 30
FYOl 30
FY02+35
,~"'(02+
.\
"
Rai~y day fund
, ;FY96, 20
'97&9820
.Rainy Day Loans .
20
')
'FY96 20
- '97&98 20 '
FY99 '20
',FYOO,' 20
,.FYOI 20
F:Y02+ 20,
(S~'optionJor 30 ,
hours per week) ,
Rai," Day,LoaasBonld for,
$1. ibillionloan ,', '
':E~ploymeDt '
VJ.ith interest, Loans , ,~d created. LOans ' Since,entitlement,
uiggered by ,UI rules .' "robe repaid with
no need 'for "rainy
(Ul % in excess of
interest ~3 ' '
~y fimd", but bonus
y~. Loan not ~o,'
,. , system for
6.5%) "
, ,,
JAans to
be repaid
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·FiDaBel Committee·
. RaidY,Dayfund
:'(tont'd) . ,
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grant. OnlY,states:
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~I~ent
8onu.~ S cari'be
,tbathavenever had .
a penalty may ,
, ,qualitY fur a' IOSIL .
Failure to meet
. . 'participatiOn rates ' /
participatiOn rates
would result'in 5%,
would Rsult in;5% _
,. cut in State ~ua1
cut in state annual
. grant. .'
grantFdure to meet •
,
Dem lA~denhip
eKceed 10010 of state
. Item
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.'· used for Work First
,
.
Employment block
grant or child care:
.Sec.. can make
feCommenda1ions
fOr impIOWInent, .
(lst~e)and
· require a 10%.
reduction in the
federidadmiD match ,
forIEA ,
adminis1rative·
expense$ (2nd,time).
,
S~ determm~s
·State detemiines .
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level below·cwrent
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level below CuTrent .
. benet1i.
benefit." , :
,State decision.
State decision. .
, state decision:
. 'Earnings
Resources
.Assets
. :'state deciSion.: ..
'State decision.
·.State decistnn.
,.·.33~ cut 1st time;
· 66% cut 2nd time; \
(,'Iff TEA 3rd time.
.,' S1a.te\ decision~
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~ State ciecision..
" Stat,e decision.
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Live at home or .
Minor ParentS' .
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w/adults.
. Allows x.•fer 000%
X-fer $
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Silent ,on transfer'
. issue:
'of block grant for .
other purposeS:' .
.. : No x-fer. but bOnUs '
. . Scan be used 'for' ,
Work First. , '
Employment block
grant orcblld care,',
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Child Care
, $ consolidated Witti
. 'AFDC & JOBS'$~
. No guarantee of . '
· inld 'care
c
.AuthQnzed .funding
ooIy; no guarantee
. .of child can::
. .assistance for those
trarisiuoning to "
work.
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assiStance for those ..
transitiomng to
Work. No guarantee
ofclri1d care for
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parents With ;
c~dren age (i or
obl!:J. No ·additional
'child care money' ,
,;
·.Existing clnld care,
.. 'programs .
"C(m~lidated
. }oc~ gnlDt
b
into 1
.
GwUmtees clrild'
care for thuse
· required to work or
prepare for, :work. 1
year transitional',
caverage'retllined
and extended 'an •
additional year on a
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DeDI Leadenbip, '
Itew '
childc~
.sliding fee sCale at'
providedtp ~
,
increasing
,'. (co,olinued) "
s_opbon.
.'
parti~abon rites..
'Working poor
families With ,
in~me up to 100%
1 '
of 'poverty pb8Sed
" in. Fed ~atch
.', : iricr~ed1D 70139
" or 10 ~errtage
poims,hlgher than .
FMAP.
, C~erit law, I,year
CurmJt law, I year
oftransitional
.
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_WorJcing. "
. ,I year tiansitional
, Medicaid fat th~e
.' ~rlcing:,:
, of tranSitional
, 'Medicaidlor those,
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and CKteDded ,for
coverage ~ed
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one 'year on a
sliding f~ scale..
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... 'STATE FLEXIBILITY UNDER WORK FIRST,'
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,.. states would have an UIl}JI'C'-"'Cdcntcd amount of fIexibili't)':
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policies .
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States design their own pro~sfor moving recipientS from welfare to work.
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" -states bav~ ,the freedom to consolidate ap.d streamline welfare operations to function mare
'efficiently and tum welfare officesinto employment offices. .
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States deteITI!ine the foim of,suppon to provide.t~ recipients:, direct benefits, wage
subsidies to employers, vouchers, etc. ,',."
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, State~ deterrnmewhoth~iremplOyment bl~~~8nt wil~ serve (from welfare'mothers,to' .
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unemployed fathers). ' , . ,', "
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wel~arerecipi.ents
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Sta~s have ~e op'don of ~uifjni pa.rudpan~ toundc~goap~ate substance abuse
treatment where necessary.
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welfare fanulIes.
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pass U1rough of ~hlId support to~
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have the flexibility to design iruiovati~ tet;n pregnancy 'picvention ~gnuUs~ .
S~ have greater'freedo~ to design programs to keep fathers in the home, including
offerIng employment services to. noncustodial parents.'
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,that's aVaIlable..
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. .. would det~nnine the assistance they recei~e, not the'categoO' .offeaeral progr~ money
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not empI~yed within 2 y . e a r s . · ,
States ~termine'whether they will 'treat <'interstatt!" imnupts differently.
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work.
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'States have the option of using a'portion ,of their emplo~t block grant funds for ~her
work~related,purposes necessi:l.lY tohc~pclients get and keep ajob (inch1diIlS emergency'
day care. unifonns, eyeglasses. and transportation):
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,STATEMENT OF 'SENATOR JOHN B~ BREAUX
, LEADERSHIP, WELFARE REFORM 'SILL
, JUNE 8,1995 '
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I' think ~~ery' American kno~s that~,jobs, with real pay' and
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responsibilities, are \,tile come~tone of welfare reform. When people on welfar~ , ' :'
become productive, taxpaying ~itizcns, VIe "all Win.
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'Our ,DemoCrati~" welfare reformplari i~ c~tled "WorkF~irsttl, because, its"
:pnndpa1 goal. is getting'people 01';\ welfare ;irito jobs, 'IJ.ot another: gov~ent
prograni., ',:' " . '.''-'
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, The RepUblican plan)~ not aboutwqrk rat-all., Theu- plan is about cutting'
the budget today', not·the welfare rolls tomorrow. : , '
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Work First plan gives' states ;financial.assistarice when they' pu~ pe,ople
, " , in jobs, 'while the 'GOP pian. gives dollars 't~ States when they put- people., in .
Our
programs.
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,,': Our pl~ 'is a real contract "that promotes work.. We i~vest in people' and . ~ " "
expect returns.' We gIve' the suites' and people on' welfare the tools they need to'
',find and;hold, down jobs '-- then we hold them'to their end'of the b~gain. "
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Work~"First,
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states get. feder3.1
d~lIars
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by putting people into paying,
jobs aIlel keeping them there.,.The,Republieans want to monitor, something they,
call the ttparticipatio~ I7!te ft for welfare recipients, which in theii' plan includes
"people in training 'programs
govenunent "make'work." That~s not.refomI.. ' , .
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. Under Work First, states thatdon't meet our clear job goals suffer a reat
, 'penalty in federal dollars. And states that do ~more to, P,l0ve people ,Irolil welrare ' .
'. tOr work earn bonUses. The Republican plan has only a ,weak penalty for . ,
1inderperfonillng states ';'it could be cis littb:faS a dollar";"; andllQ incentives·for
, states to 'exc,eed their 'goals.
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In fact, the' nonpartisan Congres.sio~aiBudgetOffi.ce tells ·us.~at44.s~tes:··
.woUld find it che~per to' f:ake the maxim~,Republican penalty than to spend .
.more of their own money to meet the Republicans' so-calle~ "participation
. rates." 'Ib.at's seven out of eight states mi~ing the work targ~.' .That kind of
\.
.' , empty promise is not refonn. ,
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Work First requires a' contract betweenthegovemmenfand welfare. _ ,.
. . .' recipients ;-;. .breaking the.contract means strong penalties.'Governinent will dO..
. its share to end welfare; citizens must do theirs. . ' ,
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responsibility? Which is real refoim?' ' . .....
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on work and~hared
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a 'blaqkcheck ~o .stat,s an~tells stat~s you don~t ha~e
'.to spend any of your own moriey~ you can use'it for roadS, bridges or payroll, .
and not lose a dim~ of feciern1. money., That's 'not fair: Work 'Fir'Stjoins
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Tti~GOPpla.n,gi';es
the '.
. ,states' in a partnership and 'matches ·,their commitment with federal resoUrc,es'. .It '
, doesn't giveaway the store.'" " ,
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, I ,ch~llenge our GOP colleagu~~to' sit'down with us.and work together on'
a rea,lweltare reform Pl3.Il tha~ fundamentallychal1ges our ~urrent system -.:. and'"
"do.esn ~t juSt send the problem to the states. ."',
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", .' . If we can't.work t~getheroti a real,welfare refonn 'bill, ~~~ay e~ch', '
,pTodl1c~ ~l product that can't become 'law b~caU:Se' it can~t pass Cpngress. or it ' ,
, can't 'be s~gned by,the President.
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.'. ,', The politicians may win in th,e .shortteIm,bu~ .the· American peoPle will ~ ,
. lose in the long run '-;' 'and we can do better thant.b8.t '. .
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THOMAS A. OASCHI..IS
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, State~entby Senate Dem,oaatic Le~der rom Daschle
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"on G.enuine Welfare Reform:"
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., Thursday, June 8~ 1995
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Two ~eeks a.go" when the
Finance Commjttee .began markup·. on the
plan, we said we, would take a har~loOk at their pl~
, Republican welfan!~/reform"
and
whether we'could, suppo.rt-it. ' , ; " :,,'
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,We have:
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we can' t.
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, Th~l;e are,oply threcs~andards to measure a welfare reform plan: .
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, 6i>e~the'plan help welfare recipient; get jobs,' and keep them? .
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Does it
prOte~fchildren?
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Dges,it guara~tee~that there 'Will ~e' a
minim~l safetY
net for t;hildrcn? ' , '
And', does the plan encou~age families to: stay together? '
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On all three counts, the Republican plan fails, and
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( '~et's be honesf>, The RepubUcanplanjs not about reforming welfar~i!-t alL, '
Al)d jt's certainly not about moving people from welfare ~owork. It's ,about ~utting
the budget, re,moving the,federal government £rop' ~clfare/and dumping,',
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responsibility for welfare on'to the states."
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That's not refoI'lll:' It's 'a retreat. Irs 'a' retreat from evetythi~g we;ve leain~
about wha~ it takes to'bieak the, cycle of welfare dependency; once and, for all.
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, '.' ,So we will be introducing'a~ alternative .plan whera ,the Republican proposal '
comes ,the flooi:. '
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Let
Out plan.. which we call1tWork First/~ will cost'DO n~w IXloney. '
ntesay
that ,again. Our plaD will COlt no new money. 'In fact, it will save money in the'
-' long-run, ,Instead of stashing 'welfare sptmdingblindly, we'll cut Wisely, and we'll
pump the savings back'into job training, he~th car~ and child care. '
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" ,_.' ,Is oUr plan tough? Yes.: We itnp~se Bwork requirement, 'tl,lI1e, limits on . ",
'. ~eIfa:te ben.efits and other- conditions welfare recipients p:lust' meet 'if they want to '
, keep their benefits~ , There should ,be rio more s'omething for no~hing. - " . ,',
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But our ,plan als({'protectskid~. - Chi1dre~;ec~ive benefit~ basaf on fatnily
'incom~not some block. grant that may run out-ifwelfare caseloads swell be~ause of
'a '~ecessipn or a, plant dosing Or any other fact~r ~eyond their families' ,controL
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, ," Abo,:e '2\1l~ o~r plan offershc:ip~ for genuinely improVing.'th~ fate of' welfare
of merely increasi,rtg their misery.:.our plap is 'about"work and, self·, ' ,
sufficiency. "
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famiI~es instead
~t's;good for familit!~:
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It's good for states.
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'FOR ¥ORE 1NFORMATION,PL,EAsE 'CONTACT:
Ranit Schrnelze~ or Molly Ra""l~y ,
(2.02)224-2939- '
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News Frorn,
U.s>SenatorBarbara A~ Mikulski
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Dembcrat from Maryl~nd: '
FOR IMMEDIATE RELEASE,'
,'JuDe 8, 1995' '
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CONTACT:
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Raehell(:UDZler
(101)' n3-1122
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"",STATEMENT OF U.s. SENATOlt BARBA.R.t\ A.ltIOOJLSKI '
PRESS 'CONFERENCE ON WELFARE ~O~ BILL INTR.ODUcnO~
I'm
pr~ud to jom Senators Dasehle and Breaux in ii:droduciDg'this bill. '
, I'm 'proud of ,t~e blll w.e~re introduemgtod'ay.
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Our, plan, is firm on work. It helps people, get' oft welfare and helps them' stay off, '
by 'prOviding a safety net for kids, briDging men:ba~k i'ntoltheir families, anel movillg " '
, ,from 'an eligibility, mind set to, ~D empowerm,nt miDdset' '
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" I;mthe Senate's only social worker., ,Aodr'm Dot new to ~etra~ reform. ' This. is
,something like my eighth 10 ,aroUDd~ But unlike: other welfare reform proposals, our, '
plan has the publie policy underpinning, that will belp e~d th.' cyete of poverty aDd end
theclIlture ,of poverty. ' ' "
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How will our plaQ. do this? It.is based
on 'empowerment, not eUgibility•.'
, .It focusses on getting people into jobs, and once people get jobs, helpmg them'staY'in
those lo~5 by eDdiug'thc't'cliff'efr~d~""
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" .'.' " And we want to bring ,men b~ck iJ,Ito the families, because, kids nee<i a mom and
, a dad. ' We believe ~hat wliile you have to be tough '011 child support, a dad IS more .thaD
a payeh~k.
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Our plan ends th~ iDeeDtiv~s thatkeep~en from ~iDgiDv~lved iD ,their famjJi~,
~ like the tt"- 8D iD the, house rule. tf, And itenas theiDceDtives that, k~p people, on' ,
'welfare instead of working, -~ by making wud~ pay more thaD ,welfaR. "
,
" , We have spent many monthsfashioniDg a real welfare ~fo~ pJim that ~ddresse~,
welfare reform iDter:ms of today's econoDlicand social realities.' Aad unlike the,
" "
.Republican proposal,we Democrats are, ready to put o~r values into our lawboeks.
, , That's 'whll.t ,this', piau 13 about.
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STATE OF DELAWARE .
.OFFICE Of TIll: ,GoVE~OK
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. THOMAS ci.RPER.
CO\'UHOR .
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The Honorable Thomas A. .Daschle
SOC) Hart Senate Office Building
Washington, I),C. 20515
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'Dear Senator Dasehle;
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We would like to take this opportUnity to applaud you and Senators Mikulski and Breaux
,and your coUea~es for your leadership on the issue ofwelfare,fefOnn. As Democratic ",
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, Governors who are impJem~nting we~fare reform irutiativesirt our states, we stron'~y supJX?~ .
" your elTons in working on cOmprehensive wCitlfare reform legislation.
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We b~liev'e ~tthe litmus test for welfare reform is whether or not'it' an~ers the!
. fo]]owing three qu'estions: 1) Does it prepare welfare ~ecip~ents fc;>r ajob?'2) Does it enable:
. , welfare recipients to find ,ajob?'3)Does it help welfare. recipients to maintain ajob? We believe"
yOur bill tncets'lhesecriteria and are disappoinled, that SenaforPackWood's bilI fails to meet this
test.
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. .Under the PackwoodbiU, it ise~dept that the ~~publicanleadershipin Cungress is
•interested in political rhetoric than in ~rue welfare refonn. Altboughth~ Packwood bill requires
high work participation rates. !he PackW.ood bin· takes away. aU the tools and resourCes necessary
fo.l-states t,o meet thes~ rates in prder to enact e~eciive welfare-to-work'p'rograms. . '.' "
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, We are deeply distressed about the Congressional Budget Office's estimates of the Seriate.
. Finance Committee legislation' whichindic8:te5 that Oldy six out the 50 staies are ~ted to '.
meet the work participation rates in th~t bill. As governors on .the front line ofwelfare refoml. we .
View tbe'cUrrentRepublican proposalscotriing o11,t of the Congress to be largely a cost shift of ,
enormous'proponions to the states under the guiseoitlexibility: We·believe that the principles in
.yoUr prop4lSalmore adequatelyrecogni?'..e the cr:iticaI. issue ofw.orkand we appreciate your .' ..
,recognition of the essential t:Jeed.to provideap,equate child c~rein,ordei' for wetfare-to·~ork
, progra.-:ns t~. ~e succesSfuL,
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.Wesuppprt the federal·state ,partnership embodied in'your bill because it gives states
'protections dilling.times ufr~oll. poputationgn;wth, . increased neecl~·anddisaster. . ,
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We are very encouraged by the national movement towardsgivihg .states greater fleXibility"
in designing welfare programs. A!, yoU finaliz~ your proposal.'we trust that you will take '
additional steps to ensure the bill will be,the least prescriPtive and give governors the maximum'
fle,ubility needed to. operate effective and,efticient programs whieh move welfare!reeipients'to
,Work.'
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- 'CARVELSTATE-OmCi: BLDG.
LroISlJ\.TIVE HALL
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',DOVER:, DE 19901
, 3021739-4101
FAx 30".u1~277E;· ,
, WILMINGTON, DE 19801 ': '
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. We look f~d to continuing,Jo wOrle with you in your efFo~s to develop a comprehensive
, ,welf~e reform proposal which the President will sign into law in which we'U truly enable welfare
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recipients to'become. and remain, self-sufficient"
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dov~mor Mel Cam8ban' '
'Governor l:Ioward. ~
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Governor Roy Romer
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tirm for Ibc:m to 're~"the lela. ,TbJI )c _haL:au M~ in tbe uaemploymcntOOtapel1Jllial' ,)'Stan ",
where mates bave~y bioi unw11l1ag to take, ad'V8J1tap at' fed_low tither for extend.~ UI benefits ',,'
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":' ,&ndates tough wOrk rcq~ Wi pfovIde., ~ fJOW'facliDg for welflm>to..work~ or child care.
All a iIIUlt 1be ~aa1 B'UdaIt Offkia eJttmIr.ti d'iat emIt .t.. __ wiJl be able to eam.WI, the b1l1'.
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, MQlIII8J"1 up.froD,t lzweStui&fttl while eaeo1lJ'l.... statts to Uve,witbID. their block put .nocallaa.'
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coW.cl draw dowu each Year. !be oapt would ac act D. ~ ofach 1IIla'•. ~loc~ ItIDt:,
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foreump~ WouldaUow _ I tbe'opd.oD of
c1a.I.minIfedenl sa.bios fuacIa up tG ~ followiD& ~ of \b:V block paDt al1otmc:m.s:. 09&, mFi' 96
3" in 1Y 97, 3tJIn Py 91. 5fi ia Py 99"w ,'II hi Py 2000.
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. ,,' eooJd ,oa1y meed thaae cape.! it ~8a", a.eMu. 'lCOaamlc do~ aid lu unemplO1l=lt rate " "
, iat:reae. bY 2 percemap l'C)iIlCs in a qUltCltovertbe ~~nde tor" aamopetloclia cIdlerof~' ,
, pmviaua two;~ While alCU:'a CHlOIQY WIS, m
~tllODt it Would be eligible to draw down ~', ' , ' ,
, uxappecl amcnmt of tednl ft.LadI at 'eQe Medicaid l'iardi rate. (1'ba cost or dais fa in che S2.4 biDJon 00 ' ,
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be coDdltlonai on . . l'DIi.atmlucc..of-etiOrt aad 8tce mateh. A CBfe muat maimi.D tho aame lewl of state
spendil18 in the QB8'BaDl' tor .prOsnwa iDolodod,intbo ~lookaXmt u.Wt _ spent in fisCal 1994 ill·
,
order to have accesuoc:oatirllcncyfuncls anh6 Medic:aici match rate.
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• A state. oplicm coDtiDpncy' fund decs DOtcostsigulfiarm1Y,morc than aJt.emativc soluti~ns thathavo b=1' ,
prop~ for aA1dreasU&g'ttleaame,is.Ucs ~pamtely ~ could Rp_th~ altemaltves,. fOr uample, making
~o bin', federal rainy ~y .l01LD fWll!l a'graarfuad: would ~st 51.7 bUlioc _ adding the House bill's •
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,\ supplemental gral1U1 for populatloJ\ 8Z'Dwth would c;:gsf $400 rDllilOri, a totar01 ~f l,biUion. .
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16: 38'
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fS'202.4565557
!\•• , .. ,•.••.• ~. HJ~'~.I;~~,.: •. ~: :.::
DT: 5/1119$
WORK FIRST PLAN
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TEMPORARY EMPLOYMENT ASSISTA~CE
AFOC is ab.olisbed and replaced by Temporary Employment AssistAnce. a conditional
entitlement for families of limited duration. .
PARENT EMPOWERMENT CONTRACT
: . ' In c)rdcr to rdeive assIstance, all recipients"rnust slgti'an individualized contract outlining
a plan get them into the workforce as soon as possible.
to
FINITE TIME FOR ASSISTANCE
, Assjstance is conditignal All recipients must sign i contract. All recipients must follow
the contract (tough sanctions apply to those who don't),
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Assi$lIOSt;jslimited. During the first two months, all able·bodied rec:ipientS must
c:nsagc: in intensive job :search (as designed by SllilcS). After tWO years, states will be
required to otter workfare,or community service to any recipient not working for at least'
20 hour!; per week. Refi.1$al toengase in workfare ca.uses benefit reductions. No family.
may receive assistance for more than five years.
WORK FIRST EMPLOYMENT BLOCK GRANT'
The JOBS program for welfare rccipicncs is replaced by the Work First Employment
Block Grant. which emphasizes!lQIk as the ,objective:
. All able-bodied recipients must work.
For those recipientsstil1100king for wQrk after the initial two months ofjob search, the
state may provide any of a number of services to assist 'recipients in obtaining jobs.
including, but not limited to:
job searc:;h
placement vouchers
W3.ie subsidy/work supplementation .
on-lhe-job..training
rnicroenterprise development!self.employment
.a GAIN type program operated by Riverside County, CA
a JOBS'Plus type program op"rated by Oregon
other trainin~ or education for work preparati~n to bring about employment .
We Count~, Not '·Participation."
Under the Work First plan. states would focus on getting recipient5 intn rea.l jobs, gettingc:redit
only for:
.
those leaving welfare for work . ,
those working 20 hours or more per week (even if still receiving benefits)
those working 20 hours or more' per week in subsidized jobs (but not workfare)
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�05/25/95
16:38
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WHITE HOUSE
,••••: •. ~.I •.• '~":''''''];'I•• """h~"".,
2
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E.xYC;ptl2D: ~tl2te5 with potkcts of lJ.i~h unemployment could allow workfare (1000/0 subsidized
'.
jobs) to count.
The state work performance measure would n:llchSO% by the year 2000, which would mean an
unprecedented Dumber of welfare recipients would be working.
We Give Stata the Resources to EmphasiJe Work
- FJU,ibilitx: states would set all eligibility roles. en'~bling them to make work pay more than
welfare. States set benefit levels. resourees, assets, and income disresard policies.
!IlUdinl: the federal government would share in the cost of putting welfare recipients to work.
The Work First Employment Block Grant would be used for employment activities, job
placement assistance. work supplementanon. on-the..job-training. transponation, child care~ in
essence, whatever a state decides is necessary to enable 8. welfare recipient to go to work and
retain a job. Funding would be increased and the federal match rate would increase as weU.
Child Carei Existing child care programs would be consolidated with the Child. Care
Develo~ment Block grant negotiated by Senators Dndd and Hatch in 1990.
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Within the block grant, 10% ofthe nmds wo~ld be set-aside for quality improvements
and 10% would be set-aside for expansion to ensure that states can help mal.ce child care
safe and available in conunumties with 10llg waiting lists or where child care simply isn't
available.
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ChHd carp. assistance Ulould be available for 2 years for those ttansitioning from welfl1re
to work (Jonger at state option) and would be based on a sl,icing fee scale. Working poor
families with income below the poverty line would be phased-in over time.
MediQld: Medicaid would be 'available for 2 years for those rransitioning from welfare to work
and would be based on a sliding fee scale.
Even Those Who Don't Work Must Perform Community Service
Those not in real jobs within 2 yeats must perform workfare or community service as
designed by the state for 20 hours per week.
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Those who aTe exempt from the work requirement (ill. aged. incapacitated recipients.
those caring (or a disa.bled child or relalivc, ur thu:::ie with a c:hild under six months old)
must perform community service as defined by the state, such as volunteering at their
children's school, or must take responsibility a's outlined in tneir Parent Empowennent
Contracf, such as ha.ving their children properly immunized.
�05/25/95
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STATE FLEXIBILITY UNDER wORK FIRST PLAN
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States would be provided.with an unprecedented amount of flexibility:
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States set their own bcncfi~ levels, countable aS$ets. resources, and income disregard
policies.
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States have the flexibility to consolidate and streamline welfare operations to function
more efficiently and tum welfare offices into employment oftic~s .
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States design Parent Empowerment Contra~s to pro"idc & blueprint for eac:h welfare
recipient ;0 become employed.
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States desisn their own job search.programs geared. to helping welfare recipients look for
employment.
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States design their own employment programs to assist welfare recipients in obtaining a
job and in preparing for a job. States also determine the fonn of suppon to pruvidc to
recipients: direct benefits. wage subsi~es to employers, etc, ..
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States determine who their employment block grant will,sclVe (&om welfare mothers to
unemployed (athers).
•
States design and determine workfare or community service jobs appropriate for those
welfare recipients not employed within 2 years:'
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Stares determine wnether they will treat
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Sllltl:S
"imc:::nLIlLc~' ~lrunigra.nts difrercntly.
would,be provided with II seamless" child care assistance so that the need of the
family would determine the assistance they receive. not the category of federal program
money .that's available.
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.States retain the option of administering their programs under existing waivers.
States have the option of requiring participants to'undergo appropriate substance abuse
treatrn~nt
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where necessary.
States have the OPf,j on nf' providing a S50
pass through of child suppa" to welfare
families.
•
. States have the flexibility to design innovative teen pregnancy prevention programs.
�04/05/95
09:02
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WHITE HOUSE
i;,
PARTICIPANTS FOR MEETING WITH DEMOCRATIC SENATORS
PARTICIPANTS:
-.
porus
VPQTIJS
Secy. Shalala
MEMBERS:
Sen. Tom DuchIe
Sen. Daniel Patrick Moynihan
Sen. John Breaux
'
Sen .. Chris Dodd
Sen. Ted Kennedy
Sen. Patrick Leahy
Sen. Barbara Mikulski
Scn. Carol Moseley-Braun
Sen. Jay Rockefeller
STAFF:
Leon Panetta
Pat Griffin
. Carol Rasco
Harold Ickes
Erskine Bowles
George Stephanopoulos
Rahm Emanuel
Bruce Reed
Paul Carey
Susan Brophy
III 003/005
�.. 04/05/95
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WHITE HOlT.SE
SUGGESTED TALKING POI~rts
1. This is a monumentally important debate about our greatest social problem.
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• The welfare reform debate goes to the core of how we're going to deal with our
most pressing problems -~ reducing teen pregnancy and illegitimacy, rebuilding the family,
reinventing goveriunent to refleetour basic values. We can't allow this to become just
anotherpoliticaJ debate about just, another political issue. It's too important -- .what we do
this year can have vas[ consequences that will outlive any of 'us here.
c
• This is hard. I've worked on this for 15 yeats. Pat has been working on it for 30.
Humility is in order -~ history is littered withre,fonns in this area that failed or fell short. .
/
2. I am troubled by the course the debate has taken so far.
• I don't like the bill the House passed because it's not real reform:
-- It won't move people from welfare to work. ,In fact, it cuts child care that
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people need to get' and stay .off welfare.,
.:..~ According, to CBO, its work requirements ~rc unworkable.
--It effectiveiy repeals the Family Support Act, and removes any reat
responsibility for stateS to help people move from welfare to work .
.-- It punishes small childreri for their parents' mistakes.
"
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The child support enforcement provisions showed what can be done with a
bipartisan effon. The Senate should forget the rest of the House bill and start from scratch.
!II
" 3. J want to see real welfare reform that is tough on work'andresponsibility, but good
to kids -- arid that gives states "real Oexibility, not just more problems and Jess money.
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• The test of real refonn is whether it moves people from welfare.to work. We need
time limits and tough work requirements that make sure people who ,can work must go to
. work. But if people need child .care or job skills in order to go to work, they should get it.
• . We should give. states a 101 mor~ fleXibility to achieve these goals. live given 25
waivers. ,I think we sho).dd go further; and give states the option to start doing what now .
requires a" waiver on the,ir own, without having to ask olJrpcrmission.
• But we wonlt get flexibility or real .reform "if all Congress does is ship everything
off to ,the states and expect them to solve more problems with less money. Last week, I
spoke to the Florida state legislature about what would happen to a high-growth state like
Florida under these block grants. Republicans and Democrats alike were nodding their heads
, and applauding. If we wain real reform, we can't solve ap our budget problems here in '
Washington at the .states' expense. We shouldn't put states and children at risk.
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4. We must do everything we can to make this a bipartisaD issue.
• Most Americans without regard to party agree on what must bcdone to rcfonn
welfare. If we can't put politics aside and agree On this issue, we never wm. In the House,
the Republicans went their own ~ay -- and the bill they passed suffered for it We cannot
let that happen in the Senate.
• If they try to jam this through the Senate as part of reconcilation, without real
cooperation and debate, they will destroy a bipartisan national conSenSus that goes back to
Ronald Reagan. If we work together, we can pass a sweeping. landmark bill that 90% of the
people in America will support. If they decide to go it alone~ this issue will divide the
country. both parties will suffer. and millions of children will pay the price.
, I believe it would be an enonnous political mistake for them to go that route. As,
we found olit, there's no better way to hide your light under a bushel than through
reconciliation -- just try to' find a voter who has, ever heard of the EITe. But morc .
important, this issue is too important to most Americans. They don't want to see another
bitter. partisan debate. They don't trust either party enough right now for that. As Pat
Moynihan has said many times, nothing this important should be done without support from
both parties.
'
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. letter
DATE
SUBJECTrrITLE
Personal friend (2 pages)
03/0611995
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8506
FOLDER TITLE:
[Welfare Reform Legislation] [7]
2010-0198-S
kc229
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Freedom of Information Act - [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(1) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5)'of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b )(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
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PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�'.
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THE WHITE HOUSE
WASHINGTON
MEMORANDUM
TO:
Distribution
February 13, 1995
FR:
Chris 1.
RE:
Senate Democrats' Health Press Conference and Principles
As you may know, SenatOr Daschle led a large contingency of Democratic Senators to
a press conference today challenging 'the Republicans to move on health care reform. The
questions focused largely around the Daschle bill, which incorporates many of the priorities
layed out by the President in his December Congressional Leadership letter and his State of
the Union Address.
'
It is unclear how much press coverage the event attracted, but it has made the wires.
Since the Democrats are not talking about how they would finance their package, their event
may be viewed,as largely political by a health care press corps that is cynical and tired of this
issue. '
What may be the most newsworthy devCiopment is that 19 Democrats -- including
, some moderate to conservative Dems like Ford, Breaux, Pryor, Conrad and Bryan -- have
signed ontO a set of "Democratic Health Care' Principles'," which also mirror the President'S
health care "vision." Attached is that set of yet to be released principles, along with the
current list of Members who have signed on.
�DEMOCRATIC HEALTH CARE PRINCIPLES
. We are' committed to continuing the fight for health care refonTI, because w~
believe hard working American families deserve quality health care ata price
they can afford. We are encouraged that members of the Republican leadership
have stated they share our views on the importance of beginning the process of
health care reform, and we look forward to working with the Majority to ensure
that a bill is considered and passed this year.
As a first step, we believe Congress should pass reforms that enjoyed wide
bipartisan support last year, including measures that
Refoffil the insurance market
Provide 100% health insurance tax deductibility for the self-employed
~1ake
coverage affordable for and available to children
Help workers who, lose their jobs keep their health coverage
Make a wider range of horne and com'munity-based options accessible to
and affordable for families caring for a sick parent or a disabled child
Members who have signed on:
Daschle
Akaka
Breaux
Bryan
Campbell
Conrad
Dodd
Feingold,
. Ford
Harkin
Inouye
Kennedy
Leahy
Levin
Mikulski
Pryor
Reid
Rockefeller
Wellstone
�HEAL'l'H CARE
JAN - 4 1995
As both Republican and Democratic leaders might announce new
health care proposals as early as Wednesday, it is essential that
you layout a clear, succinct vision of how the nation Should
move towards full health care security. This is quite important,
because if Republicans announce an insurance market reform bill
or Democrats announce a children's package next Wednesday, even
if we suggest at that time that those are· good, though not fully
adequate, steps, the press may perceive our position as another
case of "me-tooism ll - - however unfair or unjustified that would
be. On the other hand, if you layout a very clear three or four
step process for how you want to get full health security, then
you are making clear before anyone has spoken that you remain
committed to your core vision but that you are simply laying out
a pragmatic legislative process for gett~ng there over the next
few years. If you can make that three or four step process clear
enough in the next few days, then when Democrats or Republicans
propose one of those steps, it can be perceived by the media as
fitting within the framework that you have laid out.
Proposed Q&A
Q:
What are your plans for health care?
A:
First, people being with their families over the holidays
reminds all of us that every really important policy issue is
ultimately about the security and well-being 'of our families.
Crime legislation is about the physical security of our families
economic policy is about the economic security of our' families
-- and health care reform is still about the insecurity that tens
of millions of' Americans feel because they know at any time they
can lose their coverage, or cost for their coverage can be
raised, or coverage can be denied to them.
Health care also hurts us in a more hidden way. Its exploding
costs drain away resources, not· on.ly from national savings but
f~om things we need to invest in for our future.
All of these
problems still exist today, and that is why we still need to be
committed toward reaching health security.
while I think there was a strong logic in trying to do all this
in qne legislative step, I think it is clear -- whichever
analysis of last year you accept --that we may need to proceed
towards that goal through a series of legislative steps, each one
importa~t and necessary but not ultimately sufficient •.
I want to make clear that, after reflecting on the past year and
studying this issue further, I believe that this nation should be
able to move forward through a bipartisan three step process, and
I will take\seriously any proposal .that makes a good faith effort
to achieve a~y of these three steps, either separately or
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together. Our goal is to work together in crafting legislation.
But if necessary, we are willing to layout our own specific
plans, and we are just as willing to work off of constructive
proposals laid out by either Democrats or Republicans.
Step 1: Insurance market reform - Preventing Americans from
being discriminated against because of their health -- Without
universal coverage, we cannot ,provide full insurance market
reform, which is one of the reasons we must stay committed to
full health security. However, there is a considerable amount of
good that we can do, that both Democrats and' Republicans agree
on, to prevent Americans from being locked in their jobs or
losing their coverage or paying' an exorbitant cost for their
coverage because of an illness of a family member. This could
also reduce the amount of administrative'costs spent on figuring
out how to exclude people, as opposed to covering people at good
quality and a,good price. There is no reason Democ~ats and
Republicans cannot start working together to get this done.
Step 2: Covering all children and helping those who lose their
jobs (this could be defined as either a single Step #2 or as Step
#2 and Step #3) --:- One major step to secure health care -~ that
Democrats and Republicans should be able to make together and
,that we would all be proud of -- is to say we have provided full
health security for every child whose parent could reasonably be
seen as having trouble paying for it. We ,can do this through the
private sector and encourage competition for covering children,
and we can do it at a reasonable cost. We also could do more to
provide more security for the overwhelming majority of Americans
who work and have health insurance but fear that they are always
one pink slip and one illness away from financial devastation.
Just as the unemployment system ensures that your family will not
go hungry while you are looking for a new job, we can also do a
lot more to ensure that tens of millions of Americans don't fear
that they will lose, their home when a child falls ill while they
are looking for a new job because they have lost their health
insurance.
Step 3: Health security for all Americans -- While we must make
every effort to achieve the 'steps just mentioned, we must
remember that we will never be able to keep costs under control,
prevent uncompensated care and have true health security until
health care insurance truly is part of a middle class bill of
rights. The last year has taught me how difficult it is to
achieve that goal all in ore step, and it' has shown the
'
importance of convinCing people that this can be done through the
private sector, through guaranteed private sector insurance,'
better private sector competition, and without making anyone who
currently has insurance worse off.
�~/St
rt
r-1
p - f~~\ I.
Talking Points on '
RepUblican Rescission proposals:
;z;~
..
7'
.
'.
"A War on Children and the Poor"
Kessag.: The House Republicans' proposed rescissions would
severely hurt the most vulnerable of Americans -- children and
the poor -- in order ,to help pay for huge tax cuts for the
wealthiest Americans.
The proposals are mean-spirited and, short-sighted. 'They are
part of a larger·Republican effort that represents "a war'on
children and the poor." The effort includes the recent decision
to terminate the school lunch program and, as part of welfare
reform legislation, to slash child care assistance and child
welfare services.
The proposed rescissions would eliminate summer jobs for
over 600,000 youth; cut 15,000 slots for national service
programs in America's communities; deny the WIC nutrition
program's services and food packages to about 100,000 women,
infants~ and childre,n for six months; deprive 100,000 "
disadvantaged children of special services; eliminate housing
assistance to nearly 90,000 low-income households or homeless
families; cut funds to train teachers in 4,000 school districts;
and eliminate a program that supports drug-prevention efforts in
94 percent of school districts.
The cuts are targeted squarely on children and the poor. Of
the $17.1 billion in rescissions that House Appropriations
subcommittees approved last week, 63 percent come from programs
for low-income Americans, according to, the Center on Budget and
Policy Priorities.
While they are mean-spirited, the cuts also are penny-wise
and pound-foolish. As ~he" Committee for (Economic Development i a
respected business group, has written, programs such as WIC save
several dollars in reduced social costs for every $1 invested 'in
the program.
These actions., are only the first steps 'in House Republican
efforts to target their.spending cuts on the most vulnerable
'
members of society. , Their "reverse Robin Hood II strategy would
take from the poor, especially poor 'children, in order to give to
the most well-off •
•
,.;
,
�The impacts of the cuts in the rescission package include
·the following:
Children and Youth
• Eliminate funding for the Summer Youth Employment program
in each of the Summers of 1995 and 1996, wiping out job
opportunities for 1.2 million disadvantaged youth over the
two summers •.
• cut 15,000 (out of 33,000) AmeriCorps members, cutting job
opportunities for youth and such National Service activities
as:
-- providing thousands of low-income and migrant
children with immunizations;
-- working with children in environmental clean-up
activities; and,
-- working'in inner-city recreation areas to combat
drug traffic and violence.
G-Deny.theWIC nutrition program's services .and 'food
. packages to about 100,000 women, infants, and children for
. six months.
Education
• Cut the Goals 2000 program, thus depriving 4,000 schools
in 46 states of seed money to train teachers and upgrade
their academic standards.
-Deprive 100,000 educationally disadvantaged children of
under the Title I program.
sp~ci~l.serv~ces,
- Eliminate the Safe and Drug-Free Schools and Communities
program, which supports drug-prevention programs in 94
percent of all school districts as well as anti-violence
efforts.
Housing and the Homeless
.-Eliminate subsidized housing assistance to 63,000 needy
low-income households.
• Prevent 24,000 homeless families .from moving to
transitional or permanent housing this year.
• Eliminate the up-front funds needed to tear down the
nation's worst public housing projects.
�Today, the House Appropriations
REPUBLlCAN:<RESCISS]:ciNS~: •.
~::~~e;es:~~iJ~:e_~:~:u~~~i~::'
would hurt the most vulnerable of .
. •.AND THE POOR ( .
Americans -- children and the poor -
March 2; 19.95.. •• C.> ...•• ....•...... . alit0 hi p payor t ax cu ts f,or th e
f,
e
_________________-..__ ~~Itllie~t ,Am~t9~~~JI~,~."'.~h~,J!r~,$ident is
fighting to protect children and the poor,.
A"WAR<ONCHILDREN
~ • ...:....
.:.;" • • .::
:"'~
:. 1 ' ./
THESE PROPOSALS ARE MEAN-SPIRITED AND SHORT·SIGHTED. They are part
of a larger Republican effort that represents "a w:ar on children and the poor.1I That effort .
.includes recent decisions to terminate the school lunch ·program and, as' part of welfare reform
legislation, to slash child care assistance and chil~ welfare services. The proposals would:
•
cut national service in America's communities for 15,000 young people;
•
cut healthy nutrition packages to about 100,000 women, infants, and children
,for 6 months;
•
eliminate summer jobs for over 1.2 million youths over two years;
eliminate housing assistance for nearly 90,000 low-income households;
•
cut teacher training in 4,000 school districts; and
•
eliminate support for drug-prevention efforts in 94 percent of school districts.
'. ·!~b~~k~a.t:t;heir .resciss;i~n: '
p"cjf#q.~
. .What::theyw~~t..<t9 ...
. dO'#:!1:.;:·tomakewar, •• on·~~~.kl!as·
,,~j!\!~i£g;~~~i~~~ci~~~~g®l~j~lj;
:,:,
These Cuts are Targeted at Children
and the Poor. Of the $17.1 billion in
rescissions that House subcommittees
have approved, 63 percent come from
programs for low-income Americans.
(Source: Center on Budget and Policy
Pri?rities)
These Cuts are Short-Sighted. The Republican cuts are'penny-wise and pound-foolish.
Nutrition programs for women, infants and children save several dollars in reduced social
costs for every $1 invested, as the Committee for Economic Development 'has noted.
Vice President GOl'e Goes on the Offen'sive. In·a speech today at American University, the
Vice President will hit back at the GOP assault on .children's television programming. Gore
will make Clear that public t.v. needs reform, but he will tie cuts in school lunches and
summer jobs for childr~n to the assault on children's public television. Public tv., above all .
'else, is an educational tool for our children. Gore will point out that about 40% of Americans
do not have cable because they live in rural areas or cannot afford it., Those families rely on
public television to teach their children.
�PAGE
.
FEB-24-95 07.58 FROM.OMB LA
Impact of Selected House Rescission 'Proposals
•
Summer Jobs
The rescission would eliminate funding for'the Summer Youth
Employment program in each of the Summers of 1~95 and 1996,
wiping out job opportunities for 615,000 disadvantaged youth
in each of these summers.
.
National Service,
The rescission would cut 15,000 AmeriCorps members from the,
33,000 Congress authorized and funded to begin service in
latter half of 1995. Examples of National service
activities: ,providing thousands of low-income and migrant
children with immunizations; nursing and health professions
students are providing health education and primary care to
senior citizens; working with children in environmental
clean-up activities; and, working in inner city recreation
,areas to work against drug traffic and violence.,
the
A $2,5 million rescission of the Special Supplemental
Nutrition Program for, Women, Infants, and Children CWIC)
would reduee, the projeeted caseload of women, infants, and
children by as much as 100,000 by the end of FY9S.
•
Subsidized Housing
This cut eliminates assistance to 63,000 needy low-income
households which would receive Federal housing assistance.
This would inelude 12,000 homeless families, 2,000 disabled
, individuals and 3,000 people with HIV/AIDS who are already
homeless or in danger of becoming s o . '
.
Homeless
Approximately 24,000 fewer homeless families could be
preverited,from movinq to transitional or permanent housing.
. ...
.
,
Housing Assistance to PersOns with AIDS
The rescission eliminates funding for a proqram that would
otherwise provide over 1,OOO'units of housing and other
assistance to people suffering from AIDS.
•
Domestic Violence Hot Line
The reseission would eliminate funding for a 24' hour
domestic violence hotline that would provldecrisis
counsalinq and service referrals for battered women and
their family members. More than one million women are the
victims of domestic violence.
2/;3
�FES-24-95 07.58 FROM.OMS LA
PACE
.;\.
-e"
•
Elementary· and Secondary Education
The $105 million reduction could deprive an est~mated
100,000 educationally disadvantaged children of special
serVices.
•
Ryan
White and" AIDS PreventiQJl
The Ry~ White reduction will result in the loss of early
. intervention services to an estimated 2,000 individuals.
The AIDS Prevention reduction .couldpotentially reduce
access to HIV counselin9 and ·testinq DY an estimated 380,000
persons.
•
Rural Rental HOUsing
"This rescission would eliminate all FY 1995 fundin9 for the
Federal Government's primaryru.ral multi-family rental
housinq direct loan program.. Tllese funds are used to
construct· low-cost rental or cooperative housinq for
elderly, handicapped; and'very low-income families in rural
America. This rescission would eliminate all funds for the
construction or rehabilitation of 3,'750 units"
•
Community DeyelOpment Banks
The proposed rescission of $125 million would terminate the
program. Without this fundinq, the Fund would not. be able
to. provide: $10,000,000 in direct loan subsidies to support
over $23,000,000 of direct loans tOCDFls: $50,000,000 in
CiJrants, technical and other financial assistance to CDPIs;
land $20,000,000 in community development incentives for
depository institutions. T.be FUnd's investments in CDFIs,
Danks, and thrifts areestimatec1 to. leverage approximately
$500,OQO,000 in investments, loans and financial services in
the country's most distressed communities.
•
Goals 2000
A 38% reduction in funds for State and Locals Goals 2000
funds. means that approximately 4,OOO·fewer schools in 46
"states will receive seed money to implement more
challenqinq academic standards.
•
'.
Safe and Dryg-Free SChools and COmmunities
The Safe and Druq-Free Schools and communities proqram
provides counselinq,in~tructional and other druq prevention
services in 944 of all school districts, servinq 93% of'
public school children and 82t of all public and private
school students. If .the program is eliminated," these school
d1s~rictswill lose all federal support for druq-prevention
programs and ,not receive start-up funds to institute new
anti-violenceproqrams.
3/3 .
�•
Number of children served by CCPBG
In FY 1993, average number ofchildreD receiVing child care subsidies through:
CCDBG
755,904/year
(as reported by: 50 states, DC, Guam, Palau, VI)
Numbers of children served by IV-A Child Care programs:
In FY 1993, the average number of children receiving child care subsidies through:
TCC
ARCC
201,3891 month *
137,85Slmonth** .
84,682/month**
219.017/month*
Total IV-A progra,ms: .
642;943/month
AFDC/JOBS
non-JOBS AFDC
(as reported by:
*43 states, DC, PR, VI
**50 states, DC,Guam,PR, VI
***47 states, DC)
�
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Carol Rasco - Issues Series
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Carol Rasco
Issues Series
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Clinton Presidential Records: White House Staff and Office Files
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[Welfare Reform Legislation] [7]
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Carol Rasco
Issues Series
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2010-0198-S Segment 2
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Box 128
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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2010-0198-Sb-welfare-reform-legislation-7
-
https://clinton.presidentiallibraries.us/files/original/5794b246453bca238951161d060fcef9.pdf
de27f4092177594bb313d40c8626d979
PDF Text
Text
·
.
I
WithdrawallRedaction S/Iheet
Clinton Library
DOCUMENT NO.
AND TYPE
I
SUBJECTfflTLE
DATE
RESTRICTION
i
OOL. list
I
Welfare Meeting attendees (partial) (1 page)
12107/1994
P6/b(6)
I
I
I
I
I
J
I
I
I
i
/
I
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8506
I
I
I
I
FOLDER TITLE:
[Welfare Legislation] [6]
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)J
PI
, P2
P3
P4
National Security Classified Information [(a)(l) of the PRA)
Relating to the appointment to Federal office [(a)(2) of the PRA)
Release would violate a Federal statute [(aX3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(ale 4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [aX5) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed In accordance with restrictions contained in donor'S deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
I
I
20 I0-0 198-S
Freedom of Information Act - [5 U.S.C. 552(b»)
I
b(l) National se~urity classified information [(b)(1) of the FOIA)
b(2) Release woJld disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(bX3) of the FOIA)
b(4) Release wohld disclose trade secrets or confidential or financial
Informatloh [(b)(4) of the FOIA)
b(6) Release wJuld constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release w6uld disclose information compiled for law enforcement
purposes r(b )(7) of the FOIA)
b(8) Release wpuld disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release ~ould disclose geological or geophysical information
concernirig wells [(b)(9) of the FOIA)
I
kc234
�54076
TO
NAVSUPPFAC THURMONT
FROM
DEC-20-1994
P.02
CABIN ASSIGNMENTS
CABIN
SUNDAY
I
----------------------------------------------------r-------------------
BIRCH
' I
SATURDAY:
MSTR (K)
I
BR (2 T)
;'
I
,
-----------------------~-----------~~--------------T------------~-------"
,
I
DOGWOOD
MSTR (K)
I
BR (2 T)
;;~;-----------------------------------"---------:-~r---------------------
MSTR (K)
I"
"
BR (2 T)
""
"
iip-Qii-------------------------------------------l---------------------
MSTR (K)
"/
BR (2 T)
i
~:~~~:~----------~--------------------------T--------------------BR (2 T)
I
c.,
;;~;;;;;-------------------------------~---------l-----------------------
I
BR (1 Q)
-------------------------------------------------------------------------
I
SOUTHERN PINE
BR (1 Q)
;;;;;Q;;-----------------------------------------i----------------------
MSTR (K)A
I
BR (2 T)B
"
I
;;~~~:~:-------------------------------------l-----------------------BR (2 T)A
I
;
~~~;~:-~--------------------------------------i-----------------------""
I
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;iLNYT------------------------------------------r-----------------------
BR (2 T)
BR (~ '1')
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;;:;i~rr--------------------------------r----------------------
-----------------------------------------------1-------------------------
HilLOCIt
BR (l Q)
I I ,
,
,
-----~------------------------------~~----~---------~~---~-------------Key: MSTR = Master
BR .. Bedroom
K ... King size bed
, I
T = Twin size bed
I
I
I
!
r
TOTAL P.02
�THE WHITE HOUSE
CLINTON UBRARY PHOTOCOPY
�--
...
"
~
I
PHOTOCOPY
PRESERVATION
�, Comparison of Work and Responsibility Act and the Personal Responsibility Act
,
ACT
1'- ' I i
I·
"
,
:
Work and Responsibility Act
I
' .'
I
Personal Responsibility Act'
.
"
,
I
WORK
"
Job Searchl
Training
ReqUirements
Employable recipients req~ired
to participate in job: search,
. education, and trainirig activities
immediat~ly .
I
'.
None: State option.
..
..
,
,
Work
Requirements
Work required :of ALL
employable'persons after 2
years.
Sanctions and
Benefit Cutoffs
No benefits for persons who.
No benefits for persons who
refuse to work in subsidizedjob refuse to Iwork or who refuse a
or who refuse a private' sector
private sector job offer. All
'
I
job offer: Persons 'willing to
persons. p,ermanently cut off'.
I
work who cannot find a private
after 5 years (state option 2
sector job can 'get help, but only . years) e~en if they are willing
if willing to work for benefits.
to work but can't find a job, or
"
.
unabl e to work due to
Fifty percjbnt of all recipients
must eventually pe in workfare
,or other torkactivi'iY.'
",
I
.'
.. "I
,dlsablhtJ; .
Protections for
Disability
'None.
Persons with disabil,ities or
parents caring for disabled ch~ld
exempted until able to work .
. RESPONSmILriY
I
Few child support provisions
I '
and a cap which would,
actually!I reduce resources for
.
enforcement (child support
bill protnised, later.)·
I .
Child Support
Enforcement
Dramatic improvements in child
support, including central state
registries, license revocations,
etc.
Paternity
Establishment
"No AFDC benefits for child
No AFDC benefits until state .
certi,fies applicant has
until pdternity has been
cooperated' fully in paternity
established - whether or not
es.tablishment. State then
motherl has cooperated fully
required to locate father 'within ' and wnetheror not state has
,j
. ,
1 year.
made a senous. effort to locate
I
the fatller.
J
I
Fraud
Improved. information systems
and data collection to reduce
welfare fraud and catch those
who owe child support.
None.
Penonnance
Measures
New state performance
measures based on placement
rather than pr<?cess.
No changes.
I
�n:\-l~f\ .
~E
~
r--------·----.-·_·~----~~------~--~_r------~+I----~--------_,
TEEN PREGNANcy,REACHING
NEXT GENERATION··
/
i
Mothers under 18 must live at . Children b6ni to 'mother under! '.
home, identifY their child's. ' ... ' . 18 (st~te '(jption under 21)
·father, and stay in school to get
permanentI.)'.: denied aid for
l
benefits. C()mp~el1erisive case
their entire. Chi,I,.dhoOd..... .
managers for teens,:'
Teen Parents
r
Community based pregnancy
prevention initiatives in"! 000
schools.. Comprehensive
pr.egIlancy prevention
Teen
Pregnan'cy
Preventio~
Initiative
· ~emonstrati·ons.
None
,,'
I
State option to. provide no
additionl;ll" benefits' for. children
conceived while the mother is
on welfare.
Phas~-in
State .re~~;irementt~ provide
no additIOnal benefits for .
children donceived:while the .
.
mother is Ion welfare..
.Youngest recipients phased-in
first.
'. .
Family Caps
States endourageCi.to. phase-iri .
recipients l with oldest children.
.
..I
I'
ornER PROVISIONS
Legal" imbigrant~ barred from
virtually lall public benefits.
Sponsors held financially
accountable for legal
, irrunigrants .
Legal .-.
Immigrants'
.
.' . .J,
1 "
!.
'
'
.'
Food stamps, WIC;' child
.
nutritionlprogr~ms converted
into. single block grant with
.
I
'.
very fewcond~tionsand cut by
None
Nutntion
Cutsl Block
Grants
.
I... ,'.. .,'
12%.
State option' for AFDC' block
." ...... ' .
grant. '. ./
'.
· Eligible persons' c~· always
enroll..
Benefit
Protections
I
1
. '.
, ' .
..... ,.,.
",
<
~'.
·0
,
. ,
Entitlement to AFDC, SSI, and
1
.. '
•
nutritiQ~ programs ended,'
Programs become .'
discreti~nary.· Aid ~ight' •.be
I
denied because annual budget
I
'
is exhausted..
..
"
�.,
..
.MEDICAID FOR WELFARE SWAP
.:
ImpactonFederal and State Budgets
•
'Trends in Welfare and Medicaid Costs
•
Coverage and Cost Issues for Medicaid Program
'
•
Impact I Issues for Welfare
�·
Expenditures For the Swap: 1996
, ,
$80·
T
State Medicaid:
'$78 billion
Fed. Welfare:
;' ,,$48, billion'
'
,.. ' "
,,'
DSH: $9b
(J)
c:
,$60 '
, .- 0
.
i:il
L..,
Kids & Adults: ~
$22 b
'Acute:
,$43 b
Aged &.
Disabled:
$47 b
WIC:$4 b '; ,
.!:$40 "
(J)
Non.:.acute:
$25 b'
"
,
'«J
o
Food
Stamps:
$27 b
,
':0 $20
1
,$0-+-
By.Services
B.y Recipients
�-
-
-
Federal We-Ifare & -State Medicaid
Comparisionof Expenditure Trends
-
-
-
-... :- _
$200
'
-
-.-------,;-------'-------~~~----~----:---,--..,...,
- $175
-$180
~-$160
o
-;: .$140
1
-m
.~$120
-en
-,
- ~$100
£3 -$80
I
$70-
$60t$~
$40 r .1 ...
$42
····:1
.
1
-
1993
- '1995
·1
-1997
.
-1999
1
1 .
1.
2001 - - 200.3
;;
FStatervledicaid . -
1
FederaiWelfare
'
-2005
I
�•
Estimated State Fiscal Effects of
Medicaid for.AFDC/F~~d Stamps!WIC Swap'
..
.
.
'
(state fiscal effects in millions)
"I
..
Fiscal Year 1996
. State Gain
Projected State
Projected
Costs on Acute: Federal Costs(Loss).
Care Medicaid _ --AFDC +FNS
I
"
State
Fiscal Year 2002
- Projected State
. Costs on Acute
Care Medicaid
Projected·'
Federal Costs
AFDC +.FNS
State Gain
(~oss) _
'.
$647 '
$3,540'
($428)
($1',492)
, $410
$3,830
$48,297
' ($5,147)
, :$6,882.
"$478
$778 -r
- $2,086
,$219
$2,048
U.S. Total.
"
>
$12,979$835
. $1,388 $2,962
$6,941:"$446 .
$742 $1,584
Missi'ssippi, '
Texas
-
-
$59
-'($32)
- ($36)
($502)
California.
Connecticut
Indiana
Michigan
, $43,150 ,
$8,838
$614
$999
'
u
'$831
$4,546 '
, ,$80,700
$62,022
• Medicaid estimates for 1996 were calculated by HCFA; estimates for 2002 Burne the I\8tiona1 growth rate fot acute care ~ .
.. Food &
~ prograin estirnati..
2000
calculated by AsPE staff.
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Nu1rition
Past
were
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$2.67~
$4,141
$221 -'
' $389
$283
($421)
($716)
. $18,678
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STATE 'FLEXIBILITY AND WELFARE REFORM
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Broad Range
ofStra~egies
~
Uniform riational system -"e.g. Food Stamps"
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National fra'mework with st,ate flex'ibility - e.g. Work a:nd
Responsibility Ac~
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Block grants'to states - e.g. likely Republican
,~,
,Medica,d for
.",
w~lfare
proposa~
swap -, e.g. Kassebaum, pr~posal
.
Key Issues
~
National reform objectives
"
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Promote work and par,ental responsibility, reduce
teenage pregnancy, support families
'.. ,' ' Protections and u'niformity,'
~'
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,Fiscal and economic
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Preserve a s'afety net, prevent hunger· among children
and adults, prevent discrimination ,
stab~lity
'Ensure stability in funding over time, cushion ,states
against economic cycles
" Accountability
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Minimize fraud and waste, ensure efficient u~e of ,
resources
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INDICATORS OF STATE COMMITMENT TO NATIONAL 'OBJECTiVES
EVIDENCE FROM WAIVERS
/
California
Connecticut
Indiana
Michigan
Y
Y
Y
Y
Y
N
Demonstrations
Requiring Work
N
N
N
Y
Small
Subset
N
Demonstrations Promoting
System-Wide Culture. Change
N
Y
Sub-State
Y
Sub-State
N
Demonstrations Providing
Financial Incentives to Work
Y
Y
N
Y
Y
N
Demonstrations Speaking to Child
Support, Teen Pregnancy, or Family Cap
Y
Y
Y
N
Y
N
Demonstrations Incorporating
.
Time Limits
y
N
Y
N
N
N
,
'
, Waiver Demonstrations
Operating or Requested
'
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Mississippi
III-
Very few state demonstrations require work.
111-,
Even with waivers, many states are not pursuing national objectives.
Texas
�INDICATORS OF STATE PERFORMANCE
V
V
v
.~
Connecticut
Percent of Adult AFDC Recipients
Participating Monthly in JOBS (1993)
8
10
6
20
8
10
% of Adult AFDC Recipients Participating
in OJT, Work Supp. & CWEP (1993)
.3
.2
.5·
.6
.7
_, ,.05
Paternity Establishment Rate (1991)
28
39
26
68
65
35
Percent of IV-D Cases
with Collections (1992) .
14
20
14
18
9
13'
5.8
4.1
7.5
8.0·
QC Error Rate (1991)
I .
3.5
I
2.7
I·· fudiana
I~ichigan
.1· California .1
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States vary greatly on basic indicators of performance.
..
Some 'States perform po~dy, even with federal requirements.
�FISCAL CAPACITY AND NEED
.OF SELECTED STATES IN 19,92
State
_ Per Capita
Income
Poverty Rate
Mississippi
$14,050
-24.5% ,
Indiana
$18,384
_11.7%
Texas
-Michigan
$18,449
$19,~81
-
,
17.8%
13.5%
,-
California
Connecticut
- $21,599, _'
$27,154
15.8%
9.4%
..
U.S. Tot8J. '
-~
$20,131
14.5%
Both fiscal capacitY, and need -vary dramatically across ,states.
�~'
BENEFIT VARIATION ACROSS PROGRAMS
AFDC and Food Stamp Monthly Benefits
.For a one-:-parent family of three persons, July 1994
AFDC & Food
Stamps Combined
(State Contribution)
AFDC
Benefit
Food Stamp
Benefit
Mississippi
$120
$295
$415
Texas
$188
$295
Indiana
$288
:M;icbigan
$459
California
$607 '
Connecticut
$680
State .
Percent of Total
Benefit Provided
By State,
($25) ,
6%
' ,$483
($67)
14%
$278
$566
($105)
19%
$227
. $686
($200)
29% .
·$183
$790
. ($304)
38%
$161
$841
'($340)
40%
.II
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r-
There are, sizable variations in AFDC benefits by State,even though Federal match rates are
much higher in States'like Mfssissippi and Texas. '.
iii-
Because Food Stamps is a uniform national nutrition program designed to ensure that adults
and children do not go hungry in any' state, .it helps fill in the gap in lower benefit states.
iii-
In low benefit states, virtually all of the money spent on AFDC and Food Stamps comes
from the Federal goveriunent.
'
�TRENDS IN MAXIMUM BENEFIT LEVELS
OVER THE PAST 25 YEARS
(Percentage changes reflect changes in real dollars)
100% Federally Funded Programs
. Food Stamps
3%
Basic SSI
6%
Shared State and Federal Programs
.
AFDC
1~0% State Fnnged
-47%
~rograms
SSl Supplement (elderly individuals)
_SSI Supplement (elderly couples)
General Assistance
-63%
-75%
NA
Federal Block Grants
Title XX
.II .
(l975~
1994) -
Puerto Rico Nutrition (1982 - 1994)
-58%
-6%
Benefit levels in 100% Fe9.eral entitlentent programs have generally kept pace with inflation.
Food Stamps has been a critical nutrition safety· net.
II-
II-
.
II-
.
Benefit levels in programs with a heavy state contribution have fallen dramatically over time
when adjusted for inflation ..
Block grants may be more vulnerable to budget cuts.
�. EXAMPLE :OF A DISTRIBUTION FORMULA BASED ON NEED
.
~.
.-.
Effects of a Nutrition Block Grant in the
Personal Responsibility Act (itllocated by the number of "needy persons" in the state)
on USDA Food Assistance Programs by State in Fiscal Year 1996
(Dollars in millions)
.
... Level' of Food.Assistance .
State
Proposed
.California
.
Connecticut .
.
Indiana ....
$4,'170 .
,
$297' .
..
Percent
$4,820
Ctirrel1:t
,
+i6%
$248
-17'%
,
Michigan
Mississippi
$713 .
State Gains and Losses
$691
$1,390
$1,1.09 " .
$730
$603 .
.
r •
.
-3%
.
-"20%
-17% '
'.'
Texas
US
..
~
$3;819
$40,764
rOTAL
$2,665
' $35,600'
-30%
.'-13%
Block grants 'allocated according to' need create la~ge state winners and"
losers relative to the current system.
'.
�EXAMPLE OF
DISTRIBUT~ON
FORMULA BASED ON PAST EXPENDITURES
Hypothetical Effects of AFDC Benefit and Administration Expenditure
Block Grant if Personal Responsibility Act had been adopted in 1988
(Block Grant set at 1030/0 of FY 1987 expenditures)
(Dollars in millions)
I
FY 1993
State
California
Connecticut
Indiana
Michigan
Mississippi
Texas
US TOTAL
~
Current Law .
. $3,197
-
$207
$158
$751
$75
$384
$13,843
,
Block Grant
Percent Chan!!e
$2,157
$124
$111
$777
$69
$207
-33%
-40%
-30%
4%
-8% - -46%
$10,243
-260/0
Block grants set according to current spending can create unpredictable and highly
variable impacts due to inflation and changipg economic and demographic conditions.
�POSSIBLE APPROACHES TO 'KEY ISSUES
National Objectives·
'.. . St~te plan requirements - e.g., work and cooperation with
. . child ~upp~rt
...
Program performance standards geared to national objectives
Protections and Uniformity
..
National safety net against hunger
..
Individual protections within a more flexible welfare program
. Fiscal and Economic Stability
.
..
.
Individual entitlement structure with more state flexibility
Adjustable spending c~ps for states
Accountability
.Audit and reporting requirements
Fiscal performance standards
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, '.THE' WHITE, HOUSE
,I
" 'Office rof the Press Secretary'
December
Embargoed for Releas,e
66 A.M.'
Saturday, : pecember 10 ;1994'
',until~6:
...
v
1994
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RAI?IO, ADDRESSB¥ THE PRESIDENT',.,:~', THE' NATION
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'The Oval Office
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,5,:,36 P.M,. ,EST
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,: THE PRESIDENT:' Goodmo~ning'. , Earlier' this w~ek, , I' '
signed the GATT ,agreement, the most far-reachip.g international trade
,pact in ,our history':, And'this weekend/in: Miami, we in, the United
States are hostiilg ,the ,Summit of the Americas, where the' lead,ers .. of
,34,?Ounti"ies have' gCllthered to p,romotfa,: trade in' our 'o~n hemispher,e,., '
This ,suuit of th'e Am~r ic:as, 'and GATT,' and everything
we've, done' to, expand international, trade ,is 'rea,Lly about, opening up
,foreign lllarkets ,to America's gooq.sand', services, so' ,that we can
"
,create, high-wage j'obs.'and new opportu:rtities for our people here at
hqme. '
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,But despite all the progress we've made, despite th~"
fact, that we have'over '5 million ne~ jobs in theiast22 mop.,ths,"the'
biggest' expansion o~ trade in history, we've had more new ,
construction j~bs tchis IY~ctr tha:rt in"the, last nine years ,'c9mbined" ' and
we,'ve had:a year.'ofmanufacturing' 'job growth for 'the first time in a
,'decade.' ::In'~p±te of all ~that, millions, ofhardworking"people are ,
sti1:!. ,out': the;-e' killing themselves, working longer ,hours, for lowex;:
pay, paying more for health care -- ,or l'osing thei.r health coverage
: than' eV,er ,before .J'More,\and 'more' Americans, eV,en in this 'recovery,
~~,e 'worried that, 'they' cO\lld lose: th~J;.r j'ob,; o~ their ,'be,nefitsat any
t~me. '
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, T h e r e ' s ~iess disposabie ,incpmefor' most wQrking' ,>
Americans, than there was just ,a decade ago.' 'Melny people can~t even
,image ~eing' able "to aff'ord a vacation anymore , let alone send their
childre,n' 'to ,college ~ , ' And I' ,m tal~ing, ab,?uthard~orking, Americans, "
who' play by the rules'1 they're, tired' of watching th~ir' earnings'
benefi t people wht;:> don't.
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" There's 'no greater gap 'betw,een ma,instream American
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'value,s and modern government than we find in: .the welfare,system. The
welfare system was. set up'for all the' right 'reasons; ~- tqhelp peopie :'
, who had fallen on hard times temporarily, to give them a hand up for
,a little while so they could put their lives back in o~der and, move
on. And it st,ill works that, way, fo~ ap:awful lo~ ~ofpeople.,
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But for mill'ions and millions; ~f·pe9ple, : the >systfanl is"
broken badly ,anQ. it undermines. the/'very' values ~~:work;' family and
respons:i,bility.;..- tha:t:people, need to put themselves back on track.',,'
. The people who are'stuqk on 'welfare, permanently ,will be the first to
'tell,you,that i'f we're going. to fi~ it,. 'Ne have, to return to those
values; ,and we l1aveto put them fr9nt and center. ' ~eople' who, ,have, '
wc)rked,their way offofw~lfat='e; 'after-being afraid they 'dbe on -it' ,
'forever, will be the .strong'est ,in sa:yi'ng~. we.' vegot' to put work, '
family and res'ponsibility back into', '
the system._ " ,
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,:Wehave to cha'nge.welfa:t:'e so that it, d:tiV,es people
toward 'the' freedom of -work~, ,not: the confines ,of dependence.. Work 'is
'still the best social 'program ever invented. Work ,g~ves,.hope an,d'
structureq.nd mean~ng;
pe"ople" s 1 i ves.· And, we won't have ended:;,
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welfare as we ,know it;' until its central focu's is to'l,l\ovepeopl,e ,off:' '
· ,welfare.and into .a. job 'so ,that they can ~upport themselves and .their
, families;' '"
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We' have .to' change ~elfareto ,that ,it ~trengthens"
, families arid notwea'ken them .. There'is no, substitute" -- none --: ,for
the ioving devotion and equ'allylovingdiscipline of "car,~ng paFerit's ".
Governments don't raise children" parents' do. " Th~re' s s.ome people
out there 'who argue that ~e should le,t 9 0me sb~t of 'big,'· new, ' .
. , institution take .pa,rents' ,place, that' we sh9uldevEm take children
away from parents' as 'we cut them. off welfare,eveni:f, .their .doing a,
" good job as parent~, and, put the; children,' iIi" orpl,lanages.· .Well tp.ose:
people' are dead. wrong.: We ,need less. governmental 'ihterferencfi,
family life; not inore,~ ,'.' ,:.:. .' "
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in
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'" We have to change the- w~ifare:-Syst;:ein'sothat' it"'demandS
the:same,resPQnsibility alreadyshi:;)Uld~red by" milli,(~ms, and millions .
ofAm~:t;icanswho 'already.getup every'daygo to work. and ~truggle·to
,'make ends meet and raise their, children." Anyone .who ~ dan work should
do.'so. Anyone,who ,brings ,. a' child int,o. this world ought to take'"
'.
responsibility.' for that child. .'And no one-:--:-.no'one' ~-' should, get '
pregnant ',or father a child Who iSri'. t prepared to' ra~se the .child~: "
love the child· and take financial ,and persQnal responsibility ,for,the"
'child's future.,' ,
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.", That 'SWhY'~elfare,refo~ must ',J..nclude . a 'national, \,
campaign 'against teen pregnancy'; 'arid' the.. toughest possible' .'.
· enfo~cement of ou~child, ,support laws; 'along with .the reqllirement ,
. that people' on welfare .will'have to get, of,fof . it. and go to work '
aftei: a specified' period, of time ~ , It also 'mei:lns ,: that if you' re,going ,
to requi,re that ,t~erehas, to be . a -j,obthere f,or them, and. support., .
fOr people who .are wor]{i l1 g' te,rais'e their' chiidren in the prop~r '. way.
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..... " ,I've'worked ontl),i8 .:welfare reform issue for 14, years,
since I first.'becatne 'Governor "of my state. ,I'.ve worked.'with other
Governors,. with members of Congress· from both parties', but ,most
'impo~tantly, with 'pepple, on .welfare and people, who" ve' worked their
way 6,ff of ,ft. 'I know that most ,peop1e ,out th.ere' on wel~are qon't
. like' ita bit, would, give, anything to ,get' off,. and, reaJ,ly warit. to be' ,
"good" 'hardworking 'citizens and' successful. . '
parents.· ,:. .", " .
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'. 'Th(a~e, are a- lot 'bf. i(ieas out ',there: 'fbi:' reforming welf~re
:--,some are, J;ea+ly good;, and some 'are just, political attentio~ : ' , . ,
. g etters. . Since', I. became ·'President, I "veworked hard on' 'this . I've' , ,
already ..'introduced- we'~fare:- ref,orm iegis'lation in the' 'last session of
Congress. 'We Ive' also' given' 20 ,states', relief, f;rom' cumbersqme fed~ral'"
bureauc:racyrules,so. that,tlley' 9an pur'su,e w:elfare' reform pn thei,r :'
own. We've' done. that. for, more, states, than, .th~ previous two '.. ' . '
administrations combined.. '
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Th~re 's $,till' soin~' disagr~emEmt abdut what ,we ought ,to
, '"
, do, bu't',ev'erybodyagrees that, .the 'system i,8' bad;Lybroken,and needs' to
"be Jixed.lf's a bad-,deal' ·forthe taxpayers who pay'the,bills~and'.'
~t's a ".l0;-se deal for, th~,famili~s who are permC!lnen~lystU:Ck on it.
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.' '. TW~ days ago., after meetin'g with, governors:frotn both the
· Democ:t;at.l.c. 'and, Republican '.Parties , ·'r announced that' we're going to
, 'ho~ta 'national,'bi'part;isan,working: s'ession on' welfar~reformat the
'WhiteHouse in; January. I call for this, session as' a' first.step in,
an honest and "forthright discussion about', America! s"welf.a:r;-e sYE1tem'
'and"how: to'.fix it. "It's nqt going't,o beeqsy,:~ but our responsibility
.tothe.American'people is to put aside partisan diffeI'~rices,' and to'
turri' o:ur full attention tot~e:problemsat hand.'. The :Americanpeop'!'e
iiese:;v'e a· gove:.r;nment that. honors their, val4es' and,spends ,th,e~r ,~.ohey .
wisely, and a country that ,rewards ',people .who work' hard'.:and pl,ay' by
the rules ; working.Jtogether ,'" that's ·what we can, give ,them.
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Tha,nks,for ,;Li:st,en.j.ng.
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�THE WHITE HOUSE
Office of the Press Secretary
December 8, 1994
Embargoed for Re1ea~e
Until 10:06 A.M.
saturday, December 10, 1994
RADIO ADDRESS BY THE PRESIDENT TO THE NATION
The Oval Office
5:36 P.M. EST
THE PRESIDENT: Good morning. Earlier this week, I ,
signed the GATT agreement, the most far-reaching international trade
pact in our history! And this weekend in Miami, we in the United
States are hosting the Summit of the Americas, where the leaders of
34 countries have gathered to promote ,trade in our own hemisphere.
This Summit of the Americas, and GATT, and everything ,
we've done to expand international trade is really about opening up
foreign markets to America's goods and services, so that we can'
create high-wage jobs and new opportunities for our people here at
home.
'
But despite all the. progress we've made, despite the.'
fact that we have over 5 million new jobs: in the last 22 months, the
biggest expansion of trade in' history, we"ve had more new
.
construction jobs this year than in the last nine years combined,. and
we've had. a year 'of manufacturing job growth for the first time
a
decade. In.spite of all that, millions ot hardworking people are ..
still out there killing themselve~, working longer hours for lower
pay, paying more for health care -- 'or losing the,ir health coverage'
.1;:han . e'ler befoJ:i:::.,: More and lll0'reAmericaris; even in this recovery,
. are worried .thatthey could lose their job or their benefits .at'''any
time.
in
There's 'less . disposable income for most working'
",
Americans. than there ,was just a:decade ago. Many people can't':. eVen'
image being able to afford a.vacation anymore, let alone send,their~
children to college. And I'm: talking ab~ut hardworking Americans,
who play by the rules; they're tired of' watching' their' earnings --.
benefit people who don't~
.
There's no greater gap between ma,instream American:
,
values and modern government than we find in the welfare system. Tne
welfare system was set up' for all the right reasons -_·to help people
who had fallen· on hard times temporarily, to give them a hand up.,-for·
a little while so they could put. their lives back in' order. and move
on. And it'still works that way for an awful lot· of people.
. But for millions and millions of people, the system is.
broken badly, an4 it undermines the very values --work., family and
responsibility -- that.people need to put 'themselves back on,track.
The people who are stuck on welfare permanently will be the first to
tell you that if we're going to fix it,' .He have to return to those
values, and we have to put them front and center. People who have:
worked their way off of welfare; after being afraid they'd be on it
forever, will be the strongest in saying, we've got·to put work,
family and responsibility back into the system.
We have to change welfare so that it drives people
toward the freedom of work, not the confines of dependence. Work is
still the best social program ever invented. Work gives hope and'
structure and meaning to people's lives. And we won't have ended "
MORE
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welfare as we know it, until its g:J~D,tral focus is to move people of~'
welfare and into a job sO.that they can support themselves and their
families.
We have to change welfare to that it ~trengthens
families and not weaken them. There is no substitute -- none -- for
the loving devotion and equally loving discipline of caring parents.
Governments don.' t raise children, parents do ~ There's some. people
out there who argue that we should let some sort of big, new,·
institution take parents' place, that we should even take children
away from parents as we'cut them off welfare, even if their doing a,
good job as parents, and put the children in orphanages. Well those'
people are dead,wrong. We need less governmental interference in
family life, not· more.
.
We have to change the welf~re system so that it demands
the same responsibility already shouldered by millions and millions
of Americans who already get up every day go·to·work·and st!uggle·to
make ends meet· and raise their. children. Anyone who can work should
do so. Anyone who brings a ',child into this world ought to take
responsibility for that child. And no one -- no one -- s~ould get'
pregnant or father a child who isn't prepared to raise the child,:
love the child and take financial. ana personal responsibility for-the
child's'future.
.
That's why welfare reform.mustinclude a national
campaign against teen pregnancy, .and the toughest possible'
,
enforcement of our .child support laws, along with,the requirement .
that people on welfare will have.toget off.ofitandgo to work
after a specified period of ,time. It- also means that if ,you're: going'
to 'require that, there has to be a job there for themi'and support"':
,for people who are working to raise, their children in' the prope.r'way.
;< ,. '•.
I;! ve' worked on this welfare reform issue for 14 years,
since I. first bec~urie Governor of my state. I've .worked with other"
Governors, with members of Congress from both parties, but most··
-l_.............- ... n+·' .1.
T.r.;+..... p""o-l'" 0··....,.... ,~ w .... ·....... d .t'....
.............;.,'" T··hol .. ,.~:.r.... -'II-od tho ..·....·.,.
.....1:'"" ............. - .... ..."
...
g
I:"
w_ ... .......way off of' i t·~ . I'''kriow that most'. people out ther.eon welfare don't:::.. '
.like it· a . bit; would give anything to get off, and really want.:..to..:be::',
'. " . . ' ..
good,. hardworking citizens and successful parents.
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There are. a 'lot of ideas .out·there for, reforming weIfare ,-:
some are re,ally .good, and some are just':. political ,attention" .'..,..
getters'~
since I' became president·, I'.'ve worked hard on "this. I:~,ve;;·,
already .introduced welfare reform"legislation' in the last' session::of~:.
Congress. We've also given 20 states relief from cumbersome' federal'
bureaucracy rules, so that --they can pursue welfare reform on their:':
own'. We've done that ,for' more states' than the previous two
administrations combined.
.
. There '·s still some disagreement about what we. ought::.to:, , .
do, but everybody.agrees that· the system is badly broken and needs ;·to~:
be fixed.· It" s a bad deal for the taxpayers who pay the· bills~and
it's a worse deal for the families who are permanently stuck on i~~
.
.
.
'
Two days ago, after meeting with governors from both:the
Democratic and Republican 'Parties, I".announced tha.t we're going. to~; .
host a ,national, bipartisan working session on welfare reform at···the .
White House in. January. I.·call for this session as a first step .in--;
an' honest and forthright discuss'ion' about America I s welfare,. system.·..,
and. how to fix it~ It.' s not going to 'be easy, but our responsibility'
to the Americian people is to put.aside partisan differences, and to_
turn our'" full attention to the . problems at hand. The American' people
deserve a government that honors their values and spends their'money.
wisely, and a.country that rewards"people who work hard and play by
the rules; working together, that's what we can give .them.
Thanks for listening .
. END,
�,
,
.
'STATE FLEXIBILITY AND WELF'ARE REFORM
Broad'Range of Strategies
.. '.' Uniform national system - e.g., Food Stamps
'..
' ,Mixed nationallstate system, ~ ,e.g. AFDC
.
(,
"
'
..Block grants to states - e.g. 'Personal: Responsibility Act
I,.
..
"
Medicaid for welfar.e swap" - e.g .. KassebaupJ proposal
' , ' ! "
, ~ - .~~
•
.,
.
"
,
•
.
Key Issues
..
National objectives:" "
..
,..
Promote work and 'pc:uent'a~ re'spons,ibility, reduce tee~age
pregnancy,support.families
'
Protections and uniformity
..~reserve
a safety': n~t, prevent hunger, prevent ,
discrimination, avoid competition to lower benefits:
•
..
"
•
•
'
' , '
,Fiscal and econo'mic stability, ,',
..
, ,.
! ~
. ,,-,
,Ensure stability in funding over time, cushion states,
, against economic cycles,
" ,
Accountability
l,VIinimize fraud and' waste, ensure efficient use'of'
resources
December 15. 1994
",
�1.;
.:..""
Indicators of State Co~itment to National.Objectives
Evidence from Waivers
-
Mississippi
Texas
Indiana
Michigan
California
Connecticut
Y
N
Y
Y
Y
Y
Small
Subset
N
N
Y
N
N
Sub-State
N·
Sub-State
y
N
Y
N·
Y
Y
N
Y
,
Waiver Demonstrations
. Operating or Requested
Demonstrations.
Requiring Work
Demonstrations Promoting
System-Wide Culture Change
. Demonstrations Providing
Financial Incentives to Work
Y
Demonstrations Speaking to Child
·Support, Teen Pregnancy, or Family Cap
Y
.
N·
N
'.
·Y -
"
Y
N
..
�!"
_.!-'
Indicators of State Performance
'.
Mississippi
Texas
Indiana
Michigan
California
Connecticut
JOBS Participation Rate (1993)
13
. el2
. 15
19
10
16
Percent. of JOBS Participants in
OJT, Work Supp; and CWEP (1992).
4.0
0.4
2.8
4.1
4.3
1.2
Paternities/Non-Marital Births (1991)
65
35
26
68
28
39 .
9
13
14
18
14
20
7.5
8.0
5.8
4.1
3.5
2.7
Percent of IV-D Cases with Collections
QC Err~r Rate. (1991)
�I'
';
----"',
Need and, Capacity of
Selected States in 1992
,"
Poverty Rate
Per"Capita·
, Income
State"
Mississippi '
$14,050' ,
Texas
$18,449
J7.8%
Indiana',
$18,389
11.7%
$19:681
. 13.5%·,
California
$21,599
15.8%
Connecticut
$27,154
9~4%
... .;.
24.5%
.
Michigan
IU.S. Total
"
I
' $17,387.
I
14.5%
-
I
�t
-,-~
.
"Trends in Maximum Benefit Levels
Over the Past 25 Ye-ars
(Percentage changes reflect changes in real dollars)
~,
100% Federally Funded Programs
Food Stamps
Basic SSI
3%
6%
. Shared State and Federal"Programs
AFDC
-47%
100% State Funded Programs
SSI Supplement
elderly individqals.
elderly couples
General AssIstance
Federal Block Grants
Title xx (1975-1994)
Puerto Rico Nutrition Block Grant (1982-1994)
;.63%
-75%
NA
-58%
-6%
.....
�.
BENEFIT VARIATION ACROSS
PRO~RAMS
.
:AFDC and Food Sta'mp Monthly Benefits
For a .One-parent family of three persons, July 1994
AFDC
Benefit
State
Mississippi
Texas
'Indiana
Michigan
California
Connecticut
Food Stamp
Benefit
.
.
$120
$188 '
$288
$459
$607
$680
$295
'$295
$278
$227
$183
. $161
:
AFDC & Food Starn
% of Total
Combined
Benefit Provided
(State Contribution)
By State
,6%
415 (25)
483 (67)
14%'
566 , (105)
19%
: ,686" (200)
29%
790 (304)
38%
.40%
.841 (340)
".
�\:
Effects of the Nutrition Block Grant in.
tl1e. Personal Responsibility Act (Contract with ~erica)
·on USDA Food A~sistance Programs by State in Fiscal Year 1996 .
(Dollars in, millions)
..
. State Gains and Losses
Level of Food Assistance
'State'
Total
Percent
$603
Loses $127
~r7%
$3,819
$2,665
Loses· $1,154
-30%
$713
$691
M.ichigan
$1,390
$1,109
Loses $281
-20%·
California·
$4,17.0
$4,820
Gains $650 .
+16%
Loses $49
:17%
Mississippi
-.
Proposed
C\lrrent .
Texas.
Indiana
Connecticut
1 US
$730
' . $297
TOTAL-·I . $40,764
'"
.,
Loses $22 .
$248.
1
$35,600
I
Loses $5,164
1'
-3%
:'13%
I
~..-,'
�Annual Federal and State 'Expenditures for AFDC and Food Stamps
Per Poor, Person in 1992
- - -...
Federal
~-
..
State
"
.,
. Total
,-,
Mississippi
,
Texas
Indiana
.
Michigan
California
AFDC
$771
$893
$900
$1,313
$1,117 ' '
IU.S. Total
$1,015
$651 '
$36 '
$769
$653
$717
$472 "
$5~6
$645
$683
$1,201'
I
'AFDC
$120
$114
$247
<
Connecticut
Food Stamps
I
" $374
$518
I-
$641
' . $75
$154
$493,
$645
$683 '
' I " $311"
I
�.,
Federal Share of AFDC Benefit and Administrative Expenditures:
Comparison of Actual Payments with Payments Under a Hypothetical Block Grant Set at 103 Percent of FY 198i Federal Payments
FY 1989
Current Law
Block Grant
$10,648,492,503
$10,243,028.,639
$2,420,190,912
$2,157,472,766
$138,080,821
$117,917,791
$744,476,840
$73,576,531
. $249,810,477
15-Dec'
FY 1993
Difference
($405,463,864)
Percent
Change
-3.8%
. ($262,718,146) ·-10:9%
$124,080,435
($14,000,386)
-10.1 %
$110,512,970
($7,404,821).
-6.3%
4.4%
$777 ;378,236
$32,901,396
($4,275,521)
-5.8%
$69,301,009 .
($42,886,890)
-17.2%
$206,923,588
- Difference
Current Law
Block Grant
$13,834,160,000
$10,243,028,639
($3,591,131,361)
$3,196,720,479
$2,157;472,766
$206,853,692
$124,080,435
$157,526,485.
$110,512,970
$751,005,987
$777,378;236
$75,180,843
$69,301,009
$383,514,016
$206,923,588
($1,039,247,713)
($82,773,257)
($47,013,515)
$26,372,249
($5,879,833)
($176,590,428)
Percent
Change
-26.0
-32.5%
-40.0%
-29.8
3.5
-7.8
-46.0
.-41
�15-Dec~
Federal Share of Food Assistance Program Expenditures:
Comparison of Actual Payments with Payments Under the Personal Responsibility Act Food Assistance Block Grant
(if implemented in FY 89)
FY 1989 .
Current Law
ATIONWIDE.
Block Grant
$21.697,000,000
$18,941,000,000
FY'1993
Difference
,($2,756,000,000)
Percent
Change
~12.7%
Current Law
Block Grant
$35,397,000,000,
$23,369,000,000,
Difference
Percent
Change
($J2,028,000,000) -34.0
','
i
�t
The Personal ~l/'-'J/1""""""1.A
·'
Responsibility
"'().....;
ct
An Analysis
Summary
Dan Bloom
Sharon Parrott
Isaac Shapiro
David Super
CENTER ON: BUDGET
. AND POLICY PRIORITIES
777 North Capitol Street, N.E. Suite 705
Washington, DC 20002
November 1994
�Contents
Included in this packet are:
•
The summary of the Center on Budget and Policy Priorities' analysis of
the Personal Responsibility Act.
•
An appendix on the overall impact of the Personal Responsibility Act on
children, including a description of how the Center estimated the
numbers of children and families who would be denied AFDC benefits.
The Center's full report on the PRA will be available the week of November 28th.
.
�The Personal Responsibility Act: Summary
A new welfare reform proposal, the Personal Responsibility Act (PRA), is part of
the "Contract with America" unveiled in September 1994 by Republican members of
the House of Representatives and congressional candidates. The PRA differs in
important ways from other recent welfare reform plans. Key elements of the bill
include the following:
•
•
The bill would deny Aid to Families with Dependent Children and
housing benefits to many poor children bornto young unmarried mothers
for their entire childhood, diverting these funds to support programs such
as orphanages for poor children. In addition, children whose paternity
has not been established - 29 percent of all children currently receiving
. AFDC - would be denied benefits even if their mothers were fully
cooperating with state efforts to track down absent fathers and establish
paternity.
•
.-
The PRA proposes deep cuts in a broad range of programs for low
income households and eliminates the entitlement status of most major
low-income benefit programs, including the Supplemental Security
Income program for the elderly and disabled poor and the food stamp
program. The effect would be a net reduction in low-income programs of
at least about $57 billion over the four~year period from 1996 to 1999, with
the cuts escalating over time..
The bill would establish extremely stringent time limits and work
requirements. States would be required to terminate both cash assistance
and work opportunities for families who had received AFDC for a total of
1
�five years; regardless of their circumstances, these families could never
receive assistance again. States would have the option of ending welfare
assistance for families after they receive aid for a total of two years. The
PRA would not provide work opportunities for parents who reach these
time limits and are unable to find jobs even if the parents fully complied
with work requirements while on assistance and made faithful efforts to
find employment. During the period in which they would receive aid, a
large fraction of recipients would be required to work their benefits off at
"wages" that would equal $2.42 an hour in the typical state and range as
low as $0.79 an hour in Mississippi.
•
In combination, various PRA provisions that would prevent certain
categories of children from receiving AFDC benefits and the mandatory
time limit would ultimately deny assistance to a substantial majority of the
children who would be eligible for AFDC under current law. If the
provisions were fully in effect today, more than five million children
would be denied AFDC. At least 2.5 million fewer families would receive
AFDC benefits.
The Personal Responsibility Act represents a dramatic departure from the
principle of "mutual responsibility" that has guided bipartisan welfare reform efforts
such as the Family Support Act of 1988. Under this principle, welfare recipients are
expected to move toward self-sufficiency by participating in education or training, by
working, or by looking for work, while government agrees to maintain a basic safety
net beneath poor children and to provide services and supports to help recipients
improve their prospects in the labor market.
.
.
The PRA largely abandons the. government's side of this bargain. The bill would
deny basic income support to numerous poor families, including many families in
which the parents comply with all program rules and are willing to work but cannot
find a job. The bill also would weaken the safety net through deep cuts in programs
that provide food, cash, and housing assistance to the elderly and disabled poor, as
well as poor families with children. Further, the bill undercuts programs to improve
the earnings prospects of poor parents.
The PRA encompasses far more than what is usually labeled "welfare reform."
Under this rubric, it proposes sweeping changes that would begin to dismantle the
basic features of the safety net that provide vital support to people in need.
",
2
�Budget Provisions Would Reduce Benefits for Low-Income People
In addition to making specific cuts in AFDe, the PRA includes three provisions
that would make substantial cuts in a wide range of programs for low-income families
and individuals. The bill would: (1) merge federal food assistance programs into a
block grant and set the block grant's funding level several billion dollars below what is
needed to maintain current benefits; (2) place a number of other major programs for
low-income households under a spending cap that would require large cuts in these
programs and end their entitlement status; and (3) make poor legal immigrants
ineligible for nearly all government benefits and services.
.
Food Assistance Programs
The PRA would cut an estimated $18 billion over four years from food assistance
programs. Virtually all domestic food programs, including food stamps, WIC, and the
school lunch program, would be consolidated into one block grant, thereby ending
their "entitlement"status. The bill would set a ceiling on how much could be
appropriated for the block grant each year, placing this ceiling several billion dollars a
year below current funding levels. (Backup materials to the PRA estimate the
reductions from these provisions as $11 billion over the four-year period, but this
estimate appears to be significantly understated.)
A substantial majority of the cuts in food assistance would come from programs
targeted on the families that now receive food stamps; assistance to these families
would likely be cut almost $4 billion a year. The food stamp program currently
provides an average benefit of 75 cents per person per meal, and more than 90 percent
of food stamp households live in poverty.
.
In addition, ending the entitlement status of programs such as free school meals
for poor children and food stamps means these programs would no longer expand
automatically during recessions when unemployment and poverty rise and more
people qualify for such benefits. During economic downturns, states would have to
reduce benefit levels, establish waiting lists, make some categories of needy families or
individuals ineligible for benefits, spend additional state funds, or implement some
combination of these approaches.
.
The New Caps and the End ofEntitlement Status
.'
The PRA would impose a cap on aggregate spending for an array of important
programs for the poor: Supplemental Security Income (551); AFDC; the child support
enforcement program (which helps establish paternity, locates absent parents, and
collects child support from them); the at-risk child care program (which subsidizes
child care for low-income working families that are at risk of going onto the AFDC
3
�program if they cannot secure affordable child care); and low-income housing
programs. The cap governing these programs would be set at a level well below what
the programs would cost under current law.
/'
The impact of these,caps would first be felt in fiscal 1997. According to estimates
from the HouSe Republican Conference, the caps would cut spending by $18 billion in
the three-year period covering 1997 to 1999. The magnitude of the cuts would grow
ea~year.
The bill alSo would convert the programs in this group that are now entitlements
- such as AFDC, 55I, and the child support enforcement program - into non
entitlement programs whose funding level is set each year through the appropriations
process. 5ince the budget constraints governing non-entitlement programs are likely to
become much more severe in coming years - especially if much tighter discretionary
spending caps are enacted to help balance the budget'by 2002 - subjecting these
,programs to the appropriations process may result in deeper cuts over time than those
described here.
Eliminating the entitlement status of these programs would also undercut their
ability to cushion families and the elderly against economic shocks or other unexpected
developments. If funding proved insufficient during a fiscal year for AFDC or 55I
as could occur during an economic downturn or if a greater-than-expected number of
poor elderly people applied for 55I - either benefits would have to be reduced, some
eligible people would have to be denied assistance,additional state funds would need
to be spent, or waiting lists would be created.
.
'Ending these programs' entitlement status also is problematic because the PRA's
formula for adjusting the cap from year to year is flawed. The formula for setting the
cap includes an adjustment for changes in the size of the poverty population, but
because of data availability problems, this adjustment would lag almost three years
behind the actual change in the number of poor people. Had the PRA been in effect in
recent years, the cap governing these programs would have been subject to a
downward poverty adjustment in 1990, 1991, and 1992 - years in which
unemployment rose - to reflect the decrease in the number of poor people three years
earlier in 1987, 1988, and 1989, which were recovery years.
Legal Immigrant Provisions
Under current law, illegal immigr~nts are ineligible for benefits under most
major federal programs. Certain categories of low-income legal immigrants, however,
are generally permitted to participate in federally-assisted programs. The legal
immigrants allowed to participate include many permanent residents who have "green
4
.
-.
)
-.
�cards" as well as some categories of immigrants fleeing oppression abroad. Legal
immigrants are subject to the same taxes in this country as citizens are.
The PRA would make most legal immigrants ineligible for about 60 federally
funded health, education, job training, housing, social service, and income security
.programs. The main means-tested aid the PRA would allow these legal immigrants to
receive would be emergency medical services. Denying AFDC, SSI~ and most Medicaid
services to these legal immigrants would result in benefit reductions totaling
approximately $18 billion from fiscal years 1996 to 1999.
A few examples illustrate how broadly these blanket cuts would reach:
•
Poor immigrants granted political asylum or parole in the United States
because they face danger of persecution in their country of origin would
be denied all subsistence aid except emergency medical services.
•
Legal immigrants disabled on the job in the United States would be
denied SSI benefits; non-citizen migrant farm workers legally in the
United States could not have their children treated at migrant health
centers; and legal immigrants who are children would be denied access to
foster care payments if their parents died.
•
Some programs indirectly help American citizens by assisting
immigrants. Immunization and preventive health programs cover
immigrants partly to help avoid the spread of contagious diseases that
could infect U.S. citizens. Pre-natal care and nutrition benefits are
provided to pregnant women partly to reduce the likelihood that their
children - who will be U.S. citizens - will be born with significant
health problems and need costly health and special education services.
All such assistance, too, would be ended.
Net Effects
The reductions in the three provisions described above would total $54 billion
from 1996 to 1999. In combination with other provisions in the bill, the net reductions
in low-income programs under the PRA would total about $57 billion over four years.
The cuts would grow rapidly, equaling $21 billion in 1999 alone.
By 1999, the cuts in basic entitlement programs for the poor - AFDC, SSI, food \ \
stamps, and Medicaid - would be double the combined effects of the cuts in these
program enacted during President Reagan's first two years.
"
5
�This would exact a steep price from programs that represent a small portion of
federal spending. AFDC, 55! and food stamps combined account for about nine
percent of total spending on mandatory programs (excluding deposit insurance) and
about four percent of all federal spending.
The estimate here of the net reductions in programs under the PRA - $57 billion
over four years (fiscal years 1996 to 1999) differs significantly from the House
Republican Conference estimate of about $40 billion over five years (fiscal years 1995 to
1996). One part of the explanation is that the estimates for particular provisions - such
as the reductions resulting from the food assistance block grant requirement - are
higher here.
A second part of the explanation is that the Conference considers fiscal 1995 in
their estimates even though the PRA would not begin to take effect until fiscal 1996.
Naturally, the estimates for fiscal 1995 are therefore zero. 50 the Conference cost
estimates are themselves four year estimates. Under either method, five year estimates
that would include fiscal 2000 would be more than one-quarter higher since the size of
the reductions escalate each year. Because of data limitations, however, precise.
estimates for the year 2000 are unavailable.
Denying Assistance to Poor Children
The PRA includes several sweeping provisions that would deny cash aid, and in
some cases housing assistance, to poor children and their families .. The bill would deny
benefits to children born to young unmarried mothers, to children for whom legal
paternity has not been established, and to children whose parents received welfare at
any time during the 10 months prior to the child's birth.
Denying Aid to Children Born to Young Unmarried Mothers
The PRA would establish a complicated set of AFDC rules for children born to
young, unmarried mothers. Under the PRA:
•
Families in which a young unmarried mother had a child before her 18th
birthday would be denied AFDC and housing assistance. Because the
food stamp program is repealed and put into a discretionary block grant,
these families also could be denied food assistance if their state chose to
target them for some of the cuts it would have to make in food benefits.
•
States would have the option of denying cash aid and/or housing
assistance to families in which an unmarried mother had a child before
her 21st birthday.
6
'.
�•
In general, as long as their mothers re~ained unmarried, these children
would remain ineligible for cash assist~nce throughout all of their
childhoods. Such children could become eligible for assistance only if their
parents married or if they were adopted. The mother could receive
assistance if she had a subsequent chil~ when she was older, but the first
child would remain ineligible.
•
Women who, prior to the passage of tllis legislation, had children outside
marriage when they were young would be ineligible for assistance once
the bill took effect. Consider a mother who had a child when she was 17
years old, has worked ever since, and ,has never received AFDC. She is
now 27 years old and her child is 10. If after implementation of this
legislation she lost her job due to a company cutback and applied for
AFDC, she and the child would not b¢ eligible'to receive aid.
Because children born to young, unmarried mothers would generally be
ineligible for assistance throughout their childhoods~ a large proportion of AFDC
families would be affected. More than one in ten fCimilies currently receiving AFDC
was begun by an unmarried mother under the age :of 18. In states that took the option
to deny assistance to children born to unmarried mothers under 21, the number of
children denied assistance would generally more ~ double.
,
Paternity Establishment
Children for whom legal paternity has not been established would also be
denied cash assistance under this bill. Such children would remain ineligible even if
their mother was cooperating with state officials by providing all the information she
had about the father. (The mother would be eligible for AFDC benefits, as long as she
cooperated with the child support agency. Also, if the family included a mother and
two children, one of whom had paternity established, that child would be eligible for
an AFDC grant.)
,
Some 29 percent of all children receiving AFDC - or 2.8 million children - do
not have paternity established. If this PRA provision were now in effect, these
children, with very limited exceptions, would be ineligible for assistance.
c.
This provision would apply to children of all ages and to those already receiving
welfare. So a mother with a ten-year-old child wpo had not had contact with the child's
father for many years would be required to establish paternity in order for the child to
remain eligible for assistance. If the mother cooperated fully but the father could not be
located, the child would never be eligible to receive assistance.
7
�The process of paternity establishment often takes a long time evert if a mother is
cooperating. The state agencies charged with helping families establish paternity and
child support orders are often overburdened and unable to assist families in a timely
manner. Many child support caseworkers are responsible for as many as 1,000 cases.
Under federal regulations, a state child support agency has 18 months to establish
paternity after the father is located, and states often take longer than that; under the
PRA, children would be denied AFDC in the meanwhile.
Furthermore, state paternity establishment rates vary widely. At one extreme,
West Virginia established paternity in 85 percent of the cases that needed paternity
established. Oklahoma, by contrast, establishes paternity in only three percent of its
cases that year. These data suggest that state processes, rather than the cooperation of
mothers, largely determine state paternity establishment rates. Under the PRA,
however, children living in states which have poor records of establishing paternity
would be especially likely to be denied eligibility for AFDC.
Finally, while the PRA would deny AFDC benefits to children for whom
paternity was not established, the bill would also place the child support enforcement
system under the outlay cap described earlier. This would make it likely that this
already-overburdened program would be faced with reduced federal resources.
Child Exclusion
The bill also includes a IIchild exclusion" provision (sometimes called a IIfamily
cap") that denies AFDC to children born to families already receiving welfare or to
families that received welfare at any time during the 10 months prior to the child's
birth. This child excl usion provision would deny assistance even to some poor children
who were. conceived while the family was working and not on welfare. Consider the
case of a married pregnant woman who has one child. Suppose her husband deserts
the family, and she receives assistance from the AFDC program to meet basic needs
during the latter months of pregnancy. Her newborn would be ineligible for assistance
throughout his or her childhood even though the child was conceived while the mother
was married and not on welfare.
Child exclusion proposals are often based on the belief that AFDC families are
large. Some 73 percent of AFDC families, however, include two or fewer children.
Families receiving AFDC are no larger than other families with children, and the size of
the average AFDC family has dropped sharply over the past two decades.
Furthermore, research has shown that both benefit levels and the benefit increase
associated with an additional child have little bearing on the likelihood that a woman
will have another child.
8
','
�Orphanages and Adoptions
I
.
The bill allows states to use the money saved from denying assistance to
children born to young unmarried mothers to suppott orphanages and promote
adoption. The bill will likely drive some parents to relinquish their children not
because the parents are abusive or neglectful, but be~ause they are destitute. Their
destitution may simply reflect the fact that they live in a high unemployment area and
cannot find a job.
~
f
The Relationship Between AFDC and Out-oj-Wedlock Births
The above provisions stem in large part from!the view that welfare is the
primary factor behind out-of-wedlock childbearing in general and teen childbearing in
particular. While there is strong, justifiable concern:about the rise in the proportion of
children living in poor families without their father&, research does not suggest that
welfare is the primary factor behind out-of-wedlock childbearing. Out-of-wedlock
childbearing is a complex, society-wide phenomeno,n not limited to teenagers, the poor,
or welfare recipients.
This summer, a statement by 76 leading researchers addressed this issue. It said:
As researchers who work in the area of poverty,.the labor market, and family
structure, we are concerned that the research10n the effect of welfare on
out-of-wedlock childbearing has been seriously distorted. As researchers, we
are deeply concerned about the rising rates df out-of-wedlock childbearing and
the high incidence of poverty and welfare use among single-parent families.
However, the best social science research suggests that welfare programs are not
among the primary reasons for the rising nuinbers of out-of-wedlock births.
l
...ending welfare for poor children born out-bf-wedlock does not represent
serious welfare reform, and would inflict harm on many poor children. We
strongly urge the rejection ojany proposal that would eliminate the saJety netJor poor
children born o~tside oj17Ulrritzge. Such policies will doJar more harm thangood
[emphasis in &e original text].
:
Work and Time Limit Provisions
Like several other recent bills, the PRA would impose a time limit on AFDC
receipt and establish new work requirem~nts for AFDC recipients. However, the new
1
9
�bill's time limit and work provisions differ in important ways from those contained in
other welfare reform proposals, including some earlier Republican proposals.
Moreover, the PRA would likely lead to cuts in some programs which can help welfare
recipients earn their way off welfare and out of poverty.
A Different,Kind ofTime Limit
Under the PRA, each state would be required to place a time limit on AFDC
receipt. At most, a state could provide AFDC to a family for five years; after that point,
the family would be permanently removed from the welfare rolls. States would be
permitted to remove families permanently from AFDC after two years, as long as the
parent spent one of these years in a work program.
.
The PRA's time limit would be cumulative;that is, the "clock" would not be.
reset if an individual left AFDC, even for an extended period. Thus, in a state choosing
the more restrictive option, a mother who received welfare for two years in her early
twenties, left the rolls and worked for 10 years, and then needed assistance during a
. recession would be ineligible for any aid (as would her children).
One of the key differences between the PRA's time limit structure and the time
limits proposed in some other bills, such as the Clinton Administration's Work and
Responsibility Act of 1994, is in the definition of what would happen to families that
use up their allotted months of AFDC receipt. Under the administration's plan,
recipients who had received two years of cash assistance would be required to work. If
a parent was unable to find an'unsubsidized job, she would be provided a subsidized
10
�I
work slot and would be paid at least the federal minimum wage for the hours she
worked. As long as a parent was willing to work, she would be given access to a work
i
slot.
I
"
By contrast, under the PRA, the time limit would not be defined as the point
after which a recipient would be required to work; instead, time spent in a work
position would itself count toward the two- to five-year time limit. Upon reaching the
time limit, a family would be permanently barred from receiving both AFDC and a work
slot, The PRA's time limit provisions would require:states to remove families from the
AFDC rolls even if the parent was willing to work and had performed faithfully in a
work slot for a long period of time but was unable to find a job due to adverse
economic conditions or poor basic skills.
.
There would be no exceptions or extensions to the time limit; for example,
families headed by parents who are temporarily disabled or caring for disabled
children would be removed from the rolls upon reaching their state's time limit. In
fact, children receiving AFDC who live with elderly! grandparents would also be
subject to the time limit.
I
Recent studies show that two-thirds of the fainilies who enter the AFDC
program for the first time leave within two years, often because the parents find jobs.
However, the same data show that many of those who leave welfare subsequently
return, often because they lose the low-wage jobs they obtain. This means a large
fraction of AFDC recipients would eventually reach the PRA's time limit and be denied
assistance. One recent study found that 48 percent of the current AFDC caseload has
accumulated at least five years of welfare receipt. (This accumulation often occurs in
more than one spell; only about 14 percent of first-time welfare recipients stay on
AFDC for five or more years in one continuous spelL)
I
.The PRA's Work Program
,
Although the PRA would not offer jobs to recipients who. reach their state's time
limit and are unable to find work, it would require states to impose work requirements
on a growing proportion of AFDC recipients while ;they received assistance. An
estimated 1.5 million work slots would be required by.the year 2001. The conditions of
the work program are exceptionally stringent:
•
1
Most recipients placed in these slots would be required to work 35 hours
per week in exchange for their welfare grants;l since the maximum AFDC
The PRA would allow state work programs to provide wdrk supplementation (a program that uses
~!
11
(continued...)
�grant for a family of three in the median state is $366, this means most
recipients would be working at far less than the federal minimum wage of
$4.25 an hour. In the median or typical state, the work slot "wage" would
equal $2.42 an hour. In Mississippi, recipients would be "paid" 79 cents
an hour.
"
•
The PRA establishes no exemptions from the work requirement. For
example, states could require parents caring for disabled children or
infants to work full-time.
The PRA's work provisions would likely impose a large administrative and
financial burden on states. Federal matching funding for the administrative and child
care costs associated with the work program (an estimated $6,000 per year per slot)
would be included under the aggregate spending cap the PRA would establish for an
array of key low-income programs. This means the federal share of the work program
would need to be funded through cuts in the other capped programs. If Congress
decided not to cut the other programs, it would be necessary to reduce the size of the
work program or pass more of its cost onto states. In any case, states would need to
find enough money to finance their share of administering the work program and
providing full-time child care to participants. The administrative challenge of
developing 1.5 million or more work slots would be enormous, considering that less
than 20,000 AFDC recipients nationwide are currently in work positions.
Absence ofStrategies to Increase Employability or "Make Work Pay"
Many AFDC mothers lack employment-related skills; fewer than half have
. graduated from high school. Women with low levels of skills face high unemployment
rates and earn low wages when they work. Jobs that are temporary or part-time and
without benefits are often their only option. This suggests that many recipients need
help finding and holding jobs that allow them to support their families.
Rigorous studies have shown that adequately funded programs offering a mix of
. employment-oriented education and training services can increase the number of
recipients who find jobs, reduce the number receiving AFDC and, in some cases, save
money for taxpayers. The PRA, however, provides no additional support for such
programs. The existing Job Opportunities and Basic Skills (JOBS) program - which
provides federal funding for state education and training programs for welfare
recipients - would receive no new funding under the bill, and states would not be
1 ( ...continued).
welfare grants to subsidize wages paid to recipients by employers) instead of or in addition to work
experience. However, this option has been available to states for some time but has rarely been used. Of
those participating in JOBS, 0.1 percent nationwide are in work supplementation programs.
12
�required to provide parents with these services. In fact, faced with the new
requirement to create a rapidly-growing number of work positions, states might be
forced to divert funding from JOBS training services to pay for the high cost of the
work slots.
.-
By contrast, most other recent welfare reforni proposals would expand funding
for work preparation services and require states to provide such services to large
fractions of their welfare caseloads.
i
Finally, the PRA does not contain measures to "make work pay" even though
many adults who leave welfare for work obtain low-wage jobs that are insufficient to
support a family. In this respect, too, the PRA differs from other proposals. The
previous House Republican bill supported by a large majority of Republicans would
have allowed states to change the current rules under which recipients who work lose
up to one dollar in benefits for each additional dollar they earn. Similarly, a bill
introduced by the Mainstream Forum - a group of moderate and conservative House
Democrats - would have mandated such a change and greatly expanded child care
subsidies for working poor families.
Indeed, the PRA would likely reduce assistance for the working poor. For
example, it places under the outlay cap - and the~eby makes susceptible to cuts - a
key child care program for working poor families that are not on welfare. Since the cap
would be set below current levels, funding for child care services for low-income
working families could be lowered even as cash assistance for many poor families with
children was being withdrawn. Furthermore, some of the nutrition assistance
programs that would be merged into the PRA's nutrition assistance block grant and
then cut back, such as the food stamp program, provide important supports to many
low-income working families.
The Overall Impact on Poor Children
The Personal Responsibility Act includes niunerous provisions that would deny
AFDC benefits to poor children and their families~ These features include the denial of
housing and cash assistance to families in which the child was born to a young
unmarried mother, the denial of assistance to children for whom paternity has not been
established, and the child exclusion and time limi,t provisions.
To estimate the total number of children aAd families who would be denied
benefits under the PRA, one cannot simply add up the independent effects of the
different provisions (such as 48 percent of the families being denied A.FJjC because of
the time limit plus 29 percent of the children denied benefits because of the paternity
establishment provision). Some of the provisioll$ would affect many of the same
13
�people. For example, some of the children who would be denied benefits under the
paternity establishment provision would also be affected by the time-limit provision.
An analysis of the effect of the various provisions makes clear, however, that the
impact of the numerous provisions to deny AFDC benefits to poor children and
families would be dramatic.
•
If the PRA were fully in effect today, well over half of the children who would
be eligible for aid under current law would be denied assistance. This translates
into more than five million - and perhaps as many as six million poor
children who would not be receiving AFDC.
•
At least half of all families receiving assistance today would be denied
AFDC if the PRA were fully in effect. This translates into at least 2.5
million families who would receive no cash assistance.
Among those families faced with large benefit reductions or made completely
ineligible for assistance, it is likely that many parents would be unable to provide basic
necessities for their children. Because food assistance is also cut substantially and
would no longer be an entitlement, some children made ineligible for AFDC might not
be assured even a minimal safety net to help them meet their nutrition needs. An
alread y-overburdened child welfare system would likely be asked to find foster care
and institutional placements - temporary and permanent - for many children whom
their parents are forced to relinquish.
An Imbalanced Approach
The public and policymakers from across the political spectrum agree that the
AFDC program needs fundamental reform. There is also wide support for further
efforts to reduce the federal budget deficit. The PRA, however, fails to strike a
responsible balance between these goals and the important need to maintain a basic
safety net beneath poor children, the elderly, the disabled, and other vulnerable
groups. The bill would make deep cuts in basic support without including strategies
for improving employability or making work pay. Increases in poverty, homelessness,
and hunger for millions of children would almost certainly result, and states would
. likely end up paying a greater share of the costs of programs for the poor.
14
�I
,
Appendix: The Overall Impact of the AFDC Proposals On Children
and Their Families
I
I
Thl? Personal Responsibility Act includes nmPerous provisions that would deny
AFDC benefits to poor children and their families. In combination, these features
the denial of housing and cash assistance to families in which the child. was born toa
young unmarried mother, the denial of assistance to children for whom paternity has
not been established, and the child exclusion and time limit provisions - would have
far-reaching consequences.
How Many Children Would Be Denied Benefits? :
" It is difficult to estimate the total number of children and families who would be
denied AFDC benefits under the PRA with absolute; precision, primarily because the
various provisions would affect many of the same people. 2 For example, some of the
children who would be denied benefits under the paternity establishment provision
would also be affected by the time limit proposal. Similarly, some of the children who
would be denied assistance because they were born to a:young unmarried mother
would also have been ineligible because they did nbt have paternity established .
Because of these "interactions," one can not simply add the number of children that
would be denied aid by each provision independently to determine the total number of
.children affected. (For a description of the assumptions about the behavioral responses
to PRA provisions and caseload effects, see the box on page X.)
.
,
2
This analYSis assumes that states do not choose the AFOe block grant option.
i
I
�Even though we were unable to determine the precise extent of these .
interactions, it is nevertheless dear that the PRA would ultimately deny basic cash
assistance to substantially more than halfof the children who would be eligible for aid
under current law. In 1993, an average of 9.5 million children received AFDCbenefits
each month. The PRA would ultimately deny AFDC to at least halfofall families who
would be eligible under current rules. In 1993, an average of almost five million
families· received benefits each month.
The steps toward this conclusion begin with an examination of the mandatory
time limit provision that would remove entire families - that is, poor adults and their
children - from the AFDC program, regardless of individual circumstances such as
parents' ability to find jobs.
.
•
As noted, the PRA mandates that states terminate assistance to families
that accumulate 60 months of AFDC receipt. While about two-thirds of
families who enter the welfare system for the first time leave welfare in .
less than two years, most eventually return to the program when they
again need assistance. 3 As a result, nearly half of all families now
receiving AFDC benefits would be affected by the time limit if it were
currently in place. (For a discussion of recent research on how. long
families receive welfare, see box on page XI.)
,
• -
Approximately 48 percent of families currently receiving AFDC have
accumulated at least 60 months of welfare receipt, with many
accumulating this time over several welfare spells.4
•
If the five-year time limit had been implemented before these families
first received welfare, an estimated 2.4 million families and at least 4.6
million children now receiving AFDC would be ineligible. s
;
•
The PRA gives states the option to set the time limit at as little as two
years. Many additional families would.be denied benefits if any states
3 LaDonna Pavetti, "The Dynamics of Welfare and Work: Exploring the Process by Which Women Work
Their Way Off Welfare," Doctoral Thesis prepared for Harvard University, 1993.
,
' . .
Harold Beebout, Jon Jacobson, and LaDonna Pavetti, "The Number and Characteristics of AFDC
Recipients Who Will Be Affected By Policies To Time-Limit AFDC Benefits/' presented at the Annual
Research Conference of the Association for Public Policy and Management, October 1994 (cited with
permission of the author.).
4
5 In fact, the number of children who would be affected is likely to be higher than 4.6 million because
larger families are more likely than smaller ones to remain on welfare for long periods of time.
II
�exercised the more restrictive option.: Approximately 73 percent of
families currently receiving AFDC -: or 3,.6 million families - have
accumulated more than 24 months of,welfare receipt. 6
While the time limit would always eliminat~ AFbc benefits for entire families,
the other PRA provisions would sometimes affect entire families and sometimes just
, the children in the families. Large numbers of additional children are likely to be
affected by these other prQvisions as well.
,
•
I
'
Some 29 percent of children - or 2.8 'million children - currentl y
-,
receiving AFDC do not have paternity established. These children would
be denied assistance under the PRA.7!
I
<
i
I
•
•
6
7'
i
About 12 percent of families currently receiving AFDC were begun by an
UItJ:riarried mother under the age of 18; allchi'ldren born to unmarried ,
mothers under age 18 are denied AFI?C u1!-der the PRA. 8,9 This provision
would affect many more families if states opted to deny AFDC to families
in which an unmarried mother gave birth before her 21st birthday (the
PRA would give states this option). I'
'
.
i
I
, Additional children would be denied; assis~ance because they were subject
, to the Child exclUsion provision. Poor legal immigrant families would
'
also be denied assistance under the provisions denying numerous forms
of aid to legal immigrants.
:
Beebout, op; cit.
,
I
U.S. Department of Health and Human Services, Charactef:;stics and Financial Circumstances ofAFDC
Recipients, FY 1992.
8 If the family consists of only an unmarried mother and a child she had prior toher 18th birthday, both
she and the child would be ineligible for assistance. If she has1an additional child when she passes her 18th
birthday, she and the second child would be eligible for assistance.
I
,
I
9 According to the May 1994 General Accounting Office report, Families on Welfare: Teenage Mothers Least
Likely to Become Self·Sufficient, some 42 percent of all families or AF:OC were begun by a mother under the
age of 20. The report also notes that about tw~thirds of those mothers who started families as teens never
, married. Thus, approximately 28 percent of families now on AFDC were begun by an unmarried mother
under age 20. In 1992, approximately 44 percent of all births to unmarried teen mothers were among teens
under the age of 18. The 12 percent estimate in the text was computed by multiplying this 44 percent
figure by the estimate that 28 percent of all familieS receiving AFOC were begun by an unmarried mother
under the age of 20. The data on overall births to unmarried teens by the age of the mother is from the
National Center for Health Statistics report, Advance Report of Final Natality Statistics, 1992.
III
�Even after adjusting for overlap among these categories of families and children
who would be denied assistance, when those people affected by these provisions are
combined with the'48 percent of families who would be wholly ineligible for aid
because t~eir family hit the mandatory five year time limit, the effects are striking:
•
Well over half of the poor children who would be eligible for assistance
under current law would be denied aid once these provisions were fully
implemented. This translates into more than 5 million poor children-,
and perhaps as many as 6 million children - who would not receive cash
assistance to help them meet their most basic needs.
•
At least half of all families who would be eligible for assistance under
current law would be denied AFDC once the PRA was fully
implemented. This translates into at least 2.5 million families with
children who would receive no AFDCcash assistance.
'
It is interesting to note that even without the time limit provision, a large
proportion of children who would be eligible for assistance under current law would
be denied aid under the PRA. The paternity establishment provision alone would deny
,aid to 29 percent of children who would otherwise be eligible. In combination with
other provisions, it is likely that at least 35 percent of children who would receive
, AFDC would be made ineligible by this bill even without the time limit provision.
What Would the Consequences Be?
The consequences for the millions of poor families and children who would lose
their benefits would be serious. Most obviously, families that are already quite poor
would become even poorer.
•
Currently, for a single-parent fainily of three with no other income, AFDC
benefits in the median state total $4,400 a year, or 37 percent of the
poverty line. '
•
Families that become wholly ineligible due to the time l.imit provision or ,
the provision denyirig assistance to young unmarried mothers and their
children would, of course, receive no AFDC income. to
10 Under current law, the vast majority of AFOC families also receive food stamps. For the typical
. single-parent,famiIy of three with no other income and who lives in the median state, food stamps lift the
family's annual income to $7,580, or 64 of the povertY line. Under the PRA, the Food Stamp Program is
. repealed and placed within the nutrition assistance block grant. No family currently receiving food stamps
(continued ... )
IV
�,
•
\
Most of the children denied AFDC urlder the PRA would live in families
that would eventually become wholly ineligible for assistance, but in
other cases only the children in the family would lose assistance. If one
child in a typical AFDC family were denied AFDC benefits, the income of
the family would drop to $3,530 - a 20 percent drop in income. A single
parent family consisting of a mother and one child, would suffer a 28
percent drop in their cash income if the child became ineligible for
assistance. More than four out of 10 AFDC cases include two or fewer
recipients.
,
. Among those families faced with large benefit reductions or those made .
completely ineligible for any assistance, it is likely:that many parents would be unable.
to provide basic necessities for their children. SOIIJ,e rent would go unpaid and food
budgets would be cut back -~ homelessness and hunger could increase, particularly
among families made wholly ineligible for assistance. Because the food stamp program
is repealed under this bill and the money converted to a block grant, children made
ineligible for AFDC might not be assUred even th~ minimal 'safety net of food stamps to
help them meet their nutrition needs.
I
I
Research Underscor~ Hannful Effects ofChildhood Poverty
I
Each of these propos~ls to deny AFDC eligibility to some children would
intensify child poverty which research has found,to be harmful to children in
identifiable ways. One recent study found that ''Poor children are more likely to be low
height-for-age [i.e., shoder thannonpoor children of the same age], low weight-for
height [Le. thinner than other childten of the same height], and to score poorly on
indicators of cognitive and socioemotional development than middle- and upper
income children. Long-term economic disadvant~ge is also associated with deficits in
rates of growth in height."11 In short, this study showed that poverty can dramatically
affect the physiCal and emotional health of children.
I
Furthermore, poor children are more likely to drop out of high school than more
affluent children. Among children with single and married parents, among blacks and
whites, and among families in which the mother is and is not high ,school graduate,
a
10 (...continued)
.
would be guaranteed to receive any nutrition assistance, let ,alone a food stamp increase if their AFDC
benefits fell.
I
Jane Miller and Sanders Korenman, "Poverty, Nutritional Status, Growth and Cognitive Development
of Children in the United States," Princeton University's Office of Population Research Working Paper
Series. June 1993.
11
v
�.
'poor children are far more likely to drop out of school than nonpoor children. ,For
example, among white two-parent families with a mother who has graduated from
high school, poverty increases the likelihood that children will not graduate high
school by 8 percentage pointS. 12 '
Some Parents Would be Forced to Give Up Their Children
Under the PRA, an already overburdened child welfare system would likely be
asked to find foster care and institutional placements (temporary and permanent) for
children whose parents - in the face of AFDC and other cuts - determine that they
are unable to feed, clothe, and house their children. Yet the child welfare system is
already overwhelmed with the task of finding appropriate placements for children who
have been abused and neglected; as a result, children often languish in inadequate care
for long periods of time. In 1993, about 460,000 children were in foster care, an increase
of more than 70 percent from 1982.13 The'system now would also have to find
placements for children whose parents are not abusive or neglectful, but who live in
families which.lack the income to care for them.
'
To place the massive cuts in AFDC eligibility into perspective, it is interesting to
note that the number of children who will ultimately be denied basic cash assistance is
more than 10 times the number currently in foster care. The child welfare system could
face a substantial increase in their caseload which could mean that it will have fewer
, resources to devote to assisting abused and neglected children.
In addition to an increased reliance on temporary out-of-home placements, some
parents could be forced to relinquish their children permanently. In fact, the sponsors
of the PRA appear to understand that this might occur. The bill allows states to spend
the money saved by the provision denying benefits to families in which the child is
born to a young unmarried mother on orphanages and program~ to foster adoption.
This increased emphasis on taking children from their parents and moving them
to foster care or other out-of-home arrangements including orphanages is in contrast to
the direction the child welfare system has taken to try to help families stay together and
to limit use of institutional care. The child welfare system has largely moved away
from group care settings, especially for younger children, in recognit?-on that such
12 Data are from tabulations of the Panel Study of Income Dynamics and are reported in Wasting
America's Future: The Children's Defense Fund Report on the Costs ofChild Poverty by Arloc Sherman. Some 4.8
percent of white children living in nonpoor, two-parent families in which the mother has graduated from
high school drop out of high school. Among children in families that have these same characteristics except
that they are poor, some 12.3 percent do not finish high school.
13
Data are from the Child Welfare League of America.
VI
�settings deny children the individual attention and continuity of care critical to their
development. Proposals to institutionalize childre~ are also in direct contrast to the
growing movement, based on clinical experience, to help families in crisis work out
their p~oblems so children can stay with their parep.ts rather than b~ placed in foster
care.
Many who talk about such provisions often :assume that the children taken from
their parents would be newborn babies whose parents are unable to care for them.
Many of the children affected by these provisions, ;however, would not be infants, but
children already attached to their parents.
"
}
'
•
Some 45 percent of young women tui.der age 18 who have children
outside of marriage do not go onto i\FDC in the year following the birth
of the child. 14 Many of these familie& eventually need cash assistance, but
when they do their children are no longer infants. The provision that
denies assistance to families in which a child is born to a young "
unmarried mother applies to all families that apply forAFDC after the
date the provision takes effect. Ther~fore, a 27 year-old 'mother with a 10- .
year-old child who has never before ;received welfare be,nefits - but who
loses her job and applies for AFDC after the bill's passage -"'would be' ~,.
ineligible for assistance.
•
Many of the 'children affected by theitime lirrut proposal will certainly be
older, as the time limit applies to families that have already received"
"assistance for five years.
"
i
i
•
The paternity establishment requirement would also deny assistance to
children of any age if their paternity. was not established. Establishing the
paternity of older children is often quite difficult 'and may, in many cases,
be impossible. The reduction in the !AFDC grant in conjunction with
other benefit reductions could lead some families to lose a significant
percentage of their incomes.
'
If a denial in benefits forces mothers to give up their children either temporarily
or permanently, the consequences could be serio4S. Psychologists ~ve long
recognized th~ importance of children's attachments to their caregivers (generally
,
"
14
1994 Green Book, Committee on Ways and Means, U.S. Jiouse of Representatives, pg. 454..
VII
:
j
�parents) and have noted that disruptions in the relatio~hip between the child and the
caregiver places the child at risk for serious developme~tal problems. 15
While many parents may ultimately be forced to,relinquish their Children on
either a temporary or permanent basis, it is also important to recognize that it is likely
that many parents will take extreme measures to keep their families together. Some
may move to dangerous, or more dangerous, neighborhoods to save on rent. Food
budgets might be cut back placing children at nutritional risk. SOllle mothers might be
forced to rely on an abusive boyfriend for help in meeting their children's basic needs.
It is, of course, impossible to know what mothers would do when faced with a sharp
reduction in or total elimination of cash assistance. It does seem plausible, however,
that many mothers would be faced with difficult choices - either break-up their family
or make decisions that might otherwise seem unwise such as living in an unsafe
apartment to save rent. .
~
Policies Would Cause Far More Harm than Good
In short, the negative consequences of the PRA would likely be extreme.
Poverty would deepen, homelessness and hunger could:rise, temporary and permanent
out-of-home placements and institutionalization of chilW'en could increase. Some
might argue that this is the price that must be paid to re~uce out-of~wedlock
childbearing and increase employment among welfare recipients. But, does the
research support the view that these policies are likely to work?
Research has shown that most welf~e recipients lbave AFDC in less than two .
years - many leaving to take low-wage, unstable jobs. This research suggests that the
most pressing problem is not forcing'AFDC recipients to leave welfare for work,'but
helping them move into jobs that are more secure and px:oviding them the necessary
supports so they are able to meet their families' needs.
The evidence also indicates that welfare is not the primary cause of out-of
wedlock childbearing in general or teen pregnancy in particular. In June 1994, a group
. of 76 leading researchers issu.ed a statement on the relationship between welfare and
out-of-wedloCk childbearing.16 The researchers concluded that welfare was not the
primary cause of out-of-wedlock childbearing:
Barbara M. Newman and Philip R. Newman, Development Thro;gh Life: A Psychosocial Approach.
Brooks/Cole Publishing Company, 1991. Children's attachment to their caregivers typically occurs in the
first one to two years of life.
15
16. The statement was organized by Sheldon DanZiger, professor of social work and public policy at the
University of Michigan. The Center on Budget and Policy Priorities provided technical assistance to the
researchers in this effort.
.
VITI
ec
�As researchers who work in the area of poverty, the labor market, and family
structure, we are concerned that the research on the effect of welfare on
out-of-wedlock childbearing has been serio\:lsly distorted. As researchers, we
are deeply concerned about the rising rates ~f out-of-wedlock childbearing and
the high incidence of poverty and welfare use among single-parent familie~.
However, the best social science research s4ggests that welfare programs are not
among the primary reasons for the rising nlfTIbers of out-of-wedlock births.
Most research exainining the effect of higher welfare benefits on out-of-wedlock
childbearing and teen pregnancy finds that benefit levels have no significant
effect on the likelihood that black women and girls will have children outside of
marriage and either no significant effect, or1only a small effect, on the likelihood
that whites will have such births. Indeed, cash welfare benefits have fallen in
real value over the past 20 years, the same period that out-of-wedlock
childbearing increased. Thus, the evidenc~ suggests that welfare has not played
a major role in the rise in out-of-wedlock quIdbearing.
.
The researchers' statement also addressed on the issues raised by proposals to
deny welfare benefits to families in which the chi,ld was born outside of marriage. The
researchers concluded that such a policy would be ill-advised:'
.
,
,
~.
,:"
.,...
"',
'"
'
. ·...ending welfare for poor children born o~t-of-wed:lock does not
represent serious welfare reform, and woUld inflict harm on many poor
children. We. strongly urge the rejection ofany proposal that would eliminate
the safety net for poor children born outside of:mamage. Such policies will do far
more hann than good [emphasis in the original text].
,
,
I
I'
�x
�.
~,
XI
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE .
SUBJECTITITLE
·001. list
Welfare Meeting attendees (partial) (I page)
DATE
J2/0711 994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAiBox Number: 8506
FOLDER TITLE:
[Welfare Legislation] [6]
2010-0198-S
kc234
RESTRICTION CODES
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PI National Security Classified Information [(a)(I) of the PRA]
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, an agency [(b)(2) of the FOIA]
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,
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1,(9) Release would disclose geological or geophysical information
,
concerning wells [(b)(9) of the FOIAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�WELFARE MEETING
wednesday, December 7, 1994
1:30-2:30
OEOB 472
Donna Shalala - Nancy 690-6610
David Ellwood - Gerri 690-7858
Mary Jo Bane - Arlene 401-2337
Jerry Klepner - Bee 690-7627
Avis Lavelle - .
B~lle Sawhill - Marty 54844
Susan Brophy - Erin 62230
Marcia Hale - Jenny 67060
George Stephanopolous - Marlene 67105
Bruce Reed - Cathy 66515
Mark Gearan/Rahm Emanuel - Christen. 62531
Jeremy Ben-Ami
:
Alice Rivlin - Val 54840
Leon Panetta - Rose/Jennifer 54840 - FYI
Gene Sperling - Paul
Alexis Herman - Ruby 66455
Jen O'Connor - 62421
Laura Tyson - 55042
�CENTER ON, BUDGET
AND POLICY PRIORITIES
CONTACT: Michelle Bazie
Isaac ShapirO
(202) 408-1080
FOR IMMEDIATE RELEASE:
Tuesday, November 22, 1994
"CONTRACTU WOULD ULTIMATELY DENY BENEFITS TO FIVE MILLION POOR
CHILDREN, REPORT FINDS
I
The Personal Responsibility Act (PRA) in the ,House Republican "Contract with
America" would deny AFDC benefits to at least half the families and children that would receive
aid under current law, according to a report released today by the Center on Budget and Policy
.:
Priorities.
The Center found that if the bill's provisions were fully in effect today, at least 2.5
million families and more than five million children currently receiving assistance would be
ineligible for benefits. This would result from a strict time limit on welfare receipt and
provisions denying aid to children born to young unmarried mothers, children whose paternity is
not legally established, and children born when their parents are receiving we~fare.
Cuts in a Wide Range of Poverty Programs Total Much Larger
than in the Early 1980s
I
The report also noted that the PRA contains reductions in a range of benefit programs for
the poor that substantially exceed the reductions enacted during the early 1980s. Among the.
programs subject to cuts, according to the Center, are the Supplemental Security Income (SSI)
program for the elderly and disabled poor, child care assistance for low-income working families
that are not on welfare, child support enforcement, and the school lunch program. The
"entitlement" status of these programs would also be ended.
According to the report, the net effect would~ be a reduction in benefits for low-income
families and individuals of about $57 billion over the four-year period from 1996 to 1999, with
the cuts growing with each passing year. By 1999, the cuts in basic entitlement programs for the
poor would be double the combined effects of the cl;lts in poverty programs enacted during
'
President Reagan's first two years.
The bill also would alter a key feature of the: safety net under which programs such as
food stamps and free school lunches for poor children expand during recessions when
unemployment and poverty rise, the study noted. Under the PRA, some low-income families or
elderly people could be denied benefits during such: periods. Alternatively, low-income families
could be placed on waiting lists or benefits for all eligible families could be cut across-the-board.
more:
I
...
777 North capitol Street, NE, Suite 705, Washington, DC 2(x)()2 Tel: 202·408·1080
Iris J. Lav and Isaac Shapiro, Acting Co-Dlrectors
'
"
fax: 202·408·1056
�PRA Analysis
November 22, 1994
Page 2
The Center's analysis also examined the new work requirements that the bill establishes.
By 2001, an estimated 1.5 million recipients would be required to work 35 hours a week for
their aid. In the typical state, these work slots would "pay" $2.42 an hour for a mother in a
family of three, the report said, well below the $4.25-an-hour minimum wage. In Mississippi,
recipients would be "paid" 79 cents an hour.
;
Time Limits
Of particular note, according to the report, is the :PRA' s time limit. Unlike President
Clinton'S proposal and other bills (including earlier Repbblican bills) that allowed or required
states to provide work slots to families that reached a tirr.e limit, the PRA would end eligibility
for both work slots and cash aid. Mothers who accumulated five years on welfare over their
lifetime (or as little as two years, at state option) would :be permanently barred from receiving
either further: cash aid or a work slot. Mothers willing to work but unable to find an
unsubsidized job to support their children - including mothers who had faithfully worked
nearly full-time for several years in a work slot - would be denied aid once they had passed the
time limit.
I
There would be no exceptions or extensions to the time limit, the report noted. This
means, for example, that families headed by parents who are temporarily disabled or caring for
disabled children would be removed from the rolls up~n reaching the time limit. Children
receiving AFDC who live with elderly grandparents would be subject to the time limit as well ..
,
,
In addition, in a state choosing a two-year time limit, a mother who received welfare for
two years in her early twenties, left AFDCand worked for 10 years but then needed assistance
during a recession would be ineligible for any further aid, as would her children. Recent studies
show that most people who enter the AFDC program leave within two years, often because they
find jobs, the Center said. The same data, however, s~ow that many of those who leave welfare
subsequently return, often because they lose the low-'rage jobs they obtain.
"The PRA differs in important ways from
and is much less balanced than - other
recent welfare reform plans, including anearlier planioffered by a majority of House
Republicans," said Isaac Shapiro, the Center's acting ico-director and co-author of the report.
"The Act begins to dismantle basic features of the safety net, even for poor parents who want to
work and have met all work requirements imposed on them."
-more-;
�"
PRA Analysis
November 22, 1994
, Page 3
Sweeping Provisions
In addition to the time limit, the bill's provisions include:
,
•
A denial of both cash and housing benefits:throughout their childhoods to poor
children born to young unmarried mothers j' States could use the savings to
support programs such as orphanages. Aniunmarried mother who had a child 10
years ago as a teenager, but who applies fdr AFDC after losing her job, would be
ineligible for aid under this provision.
•
A denial of benefits for children, whose paternity has not been legally established;
this includes 29 percent of all children currently on AFDC, These children would
be ineligible regardless of whether their mothers were cooperating with state
efforts to establish paternity. Paternity es~blishment is usually neither swift nor
certain, the 'report said, and state bureaucracies frequently take one to two years to
establish paternity in a case after a mother has provided the relevant information.
The children in question would be denied benefits during this lengthy process.
Children whose fathers cannot be located would never have paternity established
and, therefore, would never be eligible for assistance.
I
Looking at all of the provisions together, the report said, the PRA' s effect would be to
disqualify more than half the low-income children who;would be eligible for aid under current
law. Five to six million poor children would be rendered ineligible for any cash assistance. On
average, 9.5 million children received AFDC in 1993. ISimilarly, at least'2.5 million of the five
million families now receiving assistance would be made wholly ineligible for AFDC if the PRA
were fully in effect.
Many families made ineligible for assistance would likely be unable to provide basic
necessities for their children. There isa strong risk, the report warned, that an already
overburdened foster care system would then be asked to find foster care and institutional
placements for large numbers of children whose parents were forced to give them up because
they were destitute.
Reductions in Other Safety Net Programs
I
The Act would reduce other programs for the poor in addition to AFDC. It would:
merge federal food assistance programs for poor hou~eholds into a blol:.':k grant and set the block
grant's funding level several billion dollars below the levels needed to maintain current benefits;
place a number of other major programs for low-inco,'me households under an expenditure cap
that would require large cuts in these programs; and make poor legal immigrants ineligible for
nearly all government benefits and services.
-more-'
�PRA Analysis
November 22, 1994
Page 4
The PRA would cut about $18 billion over f~ur years from food assistance programs, the
Center said. Virtually all domestic food programs,including food stamps and the school lunch
program; would be consolidated into a block grant. the bill would set a ceiling on how much
could be appropriated for the block grant, placing this ceiling several billion dollars a year below
I
the funding level needed to maintain current levels of food assistance.
A substantial majority of the cuts in food assistance would be targeted on fa.rililies that
are now eligible for food stamps. Assistance to these families would be reduced almost $4
billion a year, according to the Center's analysis. Currently, the average food stamp allotment is
just 75 cents per person per meal. About two-thirds of food stamp beneficiaries are children or
elderly or disabled people.
In addition, the PRA would impose a cap on .total expenditures for an array of major
programs for the poor: the SSI program for the elderly and disabled poor; the child support
enforcement program (which helps establish paternity); a key child care program for working
poor families not on welfare; low-income housing programs; and AFDC. The cap governing
these programs would be set at a level well below what the programs would cost under current
law. This would require these programs to be cut $1:8 billion in the three-year period from 1997
to 1999, according to estimates from the House Republican conference. The cuts would grow
larger with each passing year, found the Center.
The bill also would convert low-income benefit programs that are now entitlements, such
as AFDC and SSI, into non-entitlement programs. Eliminating the entitlement status of these
programs would weaken their ability to cushion families and the elderly against economic
shocks or other unexpected developments. If funding proved insufficient during a fiscal year for
SSI or AFDC - as could occur during an economid downturn when poverty mounted or if a
greater-than-expected number of poor elderly people applied for SSI - either benefits would
have to be reduced, some eligible people would have to be denied assistance, waiting lists would
have to be created, or additional state funds would have to be spent.
Food stamp-type assistance and school lunch programs would lose entitlement status as
well. Funding for free school meals for poor childr¢n and food stamp-type assistance would no
longer expand automatically during recessions when unemployment and poverty climbed.
Legal Immigrants :Hit Hardest
The PRA also would make most legal immigrants ineligible for nearly all health, educa
tion, job training, housing, social service, and income assistance programs, the study said.
(Illegal immigrants are already ineligible for most programs.) For example, legal immigrants
disabled on the job in the United States would be ineligible for SSI benefits. Non-citizen
more-'
�c'
PRA Analysis
November 22, 1994
, Page 5
migrant farm worker families legally in the United states could not have their children treated at
a migrant health center. Legal immigrants who are children would be denied access to foster
care payments if their parents died and could not be screened for lead poisoning.
i
Legal immigrant children also would be ineligible' for immunization programs. These
programs currently cover immigrants partly to help avoid: the spread of contagious diseases that
could infect children who are U.S. citizens. Legal immigrants are subject to the same taxes as
. ,
U.S. citizens.
Net Budgetary Imp~cts
i
Overall, the bill would reduce safety net program's $57 billion over four years, the Center
said, noting that cuts of this magnitude are unprecedente,o in programs for the poor. The cuts in
AFDC, SSI, food stamps and Medicaid would be double, the size of the cuts made in these
programs by the budgets enacted in 1981 and 1982, when the previous deepest reductions in
poverty programs were made. The programs targeted for cuts represent a small fraction of
federal spending: AFDC, SSI, and food stamps combine;d accounffor 4 percent of federal
expenditures.
:
I
,
An Unbalanced Proposal
,
I
"People across the political spectrum agree that 'welfare needs fundamental reform,"
Shapiro said. "There is also wide support for further efforts to reduce the federal budget
deficit."
'
I
"The PRA, however, does not strike a responsible balance between these goals and the
need to maintain a basic safety net beneath poor childr~n, the elderly, the disabled, and other
vulnerable groups. The bill would make deep cuts in vital programs without helping welfare
recipients earn their way out of poverty. Increases in poverty, homelessness, and hunger for
millions of children almost certainly would result, and;states would likely be saddled with
,
significant added costs as they face the destitution cre~ted by these harsh policies."
The Center on Budget and Policy Priorities conducts research and analysis on a range of
government policies and programs, with an emphasis pn fiscal policy issues and on issues
affecting low- and moderate-income households. It i~ supported primarily by foundation grants.
####
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Carol Rasco - Issues Series
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Carol Rasco
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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[Welfare Reform Legislation] [6]
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SUBJECTtrITLE
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001. note
handwritten, logistics re meeting (I page)
nd
P61b(6), b(7)(C)
002. label
FedEx Overnight (partial) (I page)
0111111995
P61b(6)
003. fax
Personal business (9 pages)
0211611994
Personal Misfile
004. letter
Blue Cross Blue Shield paperwork (4 pages)
03/31/1993
Personal Misfile
005. form
Federal Employees Health Benefits Program enrollment (I page)
02/28/1993
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8506
FOLDER TITLE:
[Welfare Reform Legislation] [5]
2010-0198-S
kc228
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. SS2(b)]
PI
P2
P3
P4
b(l) National security classified information [(b)(]) of the FOIA]
b(2) Release would disclose Internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
person III privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(ale]) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
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PS Release would disclose confidential advice between the President
and his advisors, or hetween such advisors [aleS) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
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of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document wlll be re,;ewed upon request.
�141 001/001
·02/27/95
tt
PROM OASPA NEWS DIY
12:21
02-Z'l-9~ lO:~JAM.
TO 94565557
Wel'a,.
>
P002/Q02
Reform Daily Talking Points.
Monday, February 27, '995
.OUA PLAN VS. THEIR PLOY
Today. in a speech to the American Public Welfare Associat'on,Hearth and Human Services
Secretarv Oonnl Shalela lays out the fundamental differences between the President's
.vision for welfare reform,· and House Republicans' "warkfak'e." Our position remains, as
Secretary Sharefa says this morning, that "we want to fashion a bipartisan bill this year, but
we will notendorss provisions in the House Republican proposal that undermine American
values of work, family. responsibility, and state flexibility. II Her speech also makes clear
that the President is demanding two things from the Ways and Means Committee bill: rea!'
work require'ments, and tough child support enforcement.
'
Highlights from the speech:
o
Toughe, work requirements, Meaningful reform must be, first and foremost, about.
moving people from welfare to work. A paycheck.. not iii walfar& check. That means
Insisting . on parantalresponsibility, strengthening child support enforcement,
preventing teen pregnancy, providing safe and reliable child care, offering education
.and trDining, end putting I,n place work requirements that have real ,teeth. The
current House Republican proposal·· weak on work and tough
kids •• is not real
reform. It's a ploy, not a plan.
on
0,
Responsible parenting. Our approach also includes strong ohifd support enforcement
-- something the Republicans have agreed, at our Urging, to add to their bill. Today,
President Clinton signed an Executive Order that will make it easier to eollact child
aupport from federal employees. Our message to parents is clear: if you're not
providing for your children, we'll garnish your wages, suspend your driver's and
professional licenses, track you across state lines, and if necessary. make you w.ork
off what you owe. We're committed to holding both parents responsible for raising
their children. It's the .ciab1 thing to do -.., and the smart thing to do.. As the
President said today, "Any parent who is avoiding his or her child support should
listen carefully: we will find you, we will catch you. and we will make you pay."
o
Increased state flexibilitY. In just two years, the Clinton Administration has granted
more welfare waivers than all the previous administrations combined. Today, the
Clinton Administration granted. welfar. reform wqlve, 'to Nebraska. making this the
24th state to recaiva a Gr.en light 10 implement welfare reform on a local leval.
Nebraska'sdemonstralion program •• like others approved by our Administration ••
is about strengthening families, keeping them together. and giving real hope to the
next generation. That's welfare reform •
.,
. Svonger fqmlll••• Woirs not willing to give·up on tean parents. Because giving up
on them would be giving up ,9" .tha value of responsibility. Our.spproach,provides
tim.·limited benefits for teen mothers, but Dnly .if they live at ,home with their
parents ora responsible adult, identify their child's father, and stay in school. As the
President IBid today, "We need a welfare reform plan that is tough on deadbeat
parents, not on innocent children""
�MACK MCLARTY
Dec. 5, 1994
~o:
Carol Rasco
Surprise, Surprise -- A pretty
thoughtful column from John
Robert Starr regarding ~elfare
reform.
. I
We probably need to discuss
at your convenience.
vGLJ"
. ,.......
.
~ . ",
CLINTON L1BP~RY PHOTOCOPY
�
"-:A,',';t,:X :,-W"
e);,;,',
"'.'lrl7"
~ ~~
"
'
(,'.
continues to proVide a
That idea seemedi8s'alien to those wor·,,11'r,@ef;yiilet forJolks who temporariijJind
y,gefttl~men!~;a,Q,QU!.1ItMwe.nar~ alt6'~l'lthemse.lves in ufd'ortunate circums~Uces,
Invmced that·the best'~~; .~ I challenge hberals - as I challenged
t~I:J.UUl)..l i l ~ucJ.~"!",~~M lOnger to be roupd~:\~ those.mina-,de~.~university profess,ors'
.
In the umyers\ti~s(:L'i'~~ .;c",
,
, , ' '~,ii!! !9: sh~'#.! me any}ack of compassIOn In that
, !rIie Iiberal~hvhowere swept from pow-'~:" 'proposal.
'
,
er ~ov, 8 ~ op.~,p~!A~ ~~ citizen revol.tS:~'·l~r
,'<
agamst bJg and\Oppresslye government m "',J," John R Starr is the ji:mn.er managing editor pfthe
thisceh~ will,,tWi,tashafd, fot the stafusL;: Mkill'isasDemoerat-Gazette. His column' diml1ars
"
welfaref~,.~~ill~il~pilblicariS',willi;:;',,~dail..'
,
,.,Tor
quo in
----._-..:.
,#--"
\'
... ,
--.';;:'
.,e
.....
:',:,
~"",q" ;"''!;~~~'';~j\:t~T:::;'':',t'!I'
":;!\"n;""
,."':'.,
4
�Into this emotional and heated de
bate now comes a new and critical
study of the qualitY of child care. A
;team of psychologists and econo
mUsts from four universities-Yale,
UCLA, the universities of Denver
Ellen Goodman
a;nd North Carolina~xamined 400
Who Will
1ake Care
Of,the
Children?'·
BOSTON-When the talk of the
times turned to orphanages for non
orphans. I confess that a small. car
toon-like light bulb went on over my
head. Here was an idea with great
potential.
'
,'
If we were going to take the
children of poor' mothers and raise
them in group homes or" centers,
why not start modestly and cheaply.
Why not start with part-time orphan
ages? Why not keep them' opendilr-' '
ing ,working hours? ,We',could"caIUt '
day care.
'
': , ':
,
, After aD. the folks who favor 24
hour care would" certainly favor'
tight- or lO-bour care. Anyone wbo
likes Boys Town would like Pre
school Towns.
.
I, know, I know, they might see
through my ploy: It'willbehard to
get: a child care, sUbcontract' into the '
Contract With America. FOr reasons
that escape Die,' child care, is consid-" '
erect a tired, old liberal 'idea while
orphanages are'8 bright n~w:conser- ,
vativeidea., Maybe it's,adi(ference
of day and night. ",,':::;,'~I&Kii·rc:;.~'i;;""",
Still, the~,',whole argiuDenua~t" ",'
poverty and worit; welfare and work":' . ,,'
fare, bangs ,on ,8 ,very familiar ques-,:"'> '
tion: Who will take care of the'
,,~, ,
dren?' .::;,~~,,~~~. ~::;. ,<i{f:::'~',~\' ·~~;f:i'~: 'f
For decades now;:::many on7;,the",'
political right have ,;be1ievect: ,that,
mothers with" smaU,~ children
shouldn't work'outside the home but
that welfare ,. mothers '; should "get 'a
job. Meanwhile, many onthe'political
left have defended working mothers
but haVe been uneasy pushing poor ,
women into their ranks.-,' ':,{l~;"
Today, at the ideological CO!e':of • ,
this debate arec the fainilies. sti'ug·,'?'c
,.I:"g
;,.~..!;..,..
..... and J_a, ~Ji'f>Worlt:i~;and"':':
,,'
"""
kids, who have come, to;tbe, conc.IIi-' ' .
sion that if they' cando it. so can
welfare mothers. More,to the,poiDt;
if they, ItaH to do; it.~ So', should
welfare mothers.
I
'
"
'
, child care centers and tested chil
dren in four states.
, They came to the depressing but
not surprising conclusion that the vast
Il12\jority of children in these centers
were getting care that was "mediocre
in qhality,' sufficiently poor to interfere
witIl children's emotional and intellet:*
tual development." Only one in seven
centers provided both the security and '
the stimulation that was worthy of 8
, ,,, bigh rating.
, The youngest of the children. fare
the worst. About 40 perceut of the
infant and toddler rooms were rated
poor, and as Yale's Sharon Lynn Ka
gan says, '"When I say poor, I mean
poor-broium 'glass on the play
ground, unchaDgeddiapers."
This study is one of the first to
relate the cost of day care to its
quality and outcome-bow kids actu
ally fare. It shows, in the wnrdsof
Barbara Reisman of the· Child Care
Action Campaign, that "the ones that
have more money do better." This
conclusion, she.says laugbing,"\\Iould
make my daughter say;, ·DUH,Mom·...
But she,says it·s rarely spelled out this
clearly.
>:."';;,:,1,, ' ; ' " , : ,
"
In fact; the better centers didn·t.,
, : ',~' the parents more. The extra
,.' " money came' to the centers from "
" ': 'sources like block grants; private
" funds. corporations.. The' difference in
',', the price tag, of mediOcre and good
,eire was as little as 10 percent. But
, ';'wben they hadtbe dollars. and had to'
liVe up to"state,standards. centers .
'Used the ~ in;ways that mat- ,
,' . ...-.in the'quality, quantity and con-' "
, )stancy of staff. ' < ,,'; ,,',' -:' ,
,
' ,,:,', Perhaps the mOst startling, finding
,:; ;;,"m~the :study iiJ-'>:.bout parents. ,the
buYers m the cbikkare'markeL,While
,: :" .;,' the researi::beri' :said" mOst· care;'wa8.;; , j
,':' mediocreor.>~r 9o'pereentof;the;: ,
~
parents said their:C:hiJd care was good.', ~
{' . " The parents'.vieWsmay'be,a form "
" ' Of,myopia brought OIl~by::gUilt. HOW ,,'
",Could I leave my kid at a place I i.tidn't '
" think was goOd? ,Or it cwldbe inexpe:.,
"rience; How many~ts have seen
"the kind of centers that are the norm
',iDFrance or Japan?
" ',' ',:, " '
, ,'J3Ut,anyway you look at it. this is a'
, ,'CaSe ,Of' low consUmer" ,expectations.
, ' , ADd a market that meets them. '
,.;, for:;~ 1on&: child care bas ,been
,taDgIed up in. arguments abOut WOOl
',ea's roles rat:ber than Children·slives.
:Middle class" mothers felt ;·that'any'" ',:
'criticisiilof d8f'.care wiasreally 'criti- '
.dSiD of theiD."L9Wer~ and, es
peCiaIly; single mothers. were forced '
, to be grateful for any child care.at aD.
, ,Now we may haVe a wave of AFDC'
mothers searching for,pIaces in an
~
'system,' threatened
even further by CUts in block grants.
.In_this environment; researcher Ka
gan says that parents have to become
, much more knoWledgeable' and de
manding consumers.Th'ose who care
about kidstuff' have to be savvjer citi
¥
"
zens.
'
The question isn'tjust who wiD take
"'care of kids but how they'D be tal«m ,
care of.
..',,'::
'Have you heard the promises from
the orphanage fans? They insist that
these won't be Dickensian warehouses
but, warm, nurturing, bigh-quality.
group settings for children. Well.
okay. Let's, give them a try. How,
, about dawn to dusk. Monday through
~.:: Friday. '
,':";:' ':--',.. ",".:~:'",~,:,
........
..,.,~
~
�02/02/U
11:30
~002
RESOURCES - OEMS
ts'2D2 22! 1169
r
January 31. 1995
TO:
FROM: George Miller
,
Rti: Web; Debat;JWOlk
Ks~iRmcnlS/F~
subiL
Dw'ing 'Ibc debate Ott welfare l'Ofonn, mOlly
will he dcbarod hetWeeD Ibc Ikmocta1I
and the Repub1icms (cut off tel under 18 year ola, family cap, S.S.I., 2-year limi'-t etc.).
,
I
None will be more 'imporl3Dt !baD this: wbat requiremenll will be imposed on thole wbo
.r:cWvc ~APDC &fIIIt fioaa the tapaym?
I,
'
OrigJrially, the AFDC grant wu made to a family that found itself without financial support
due to circumstances beyond i:s cOllttnl (e.g., dbath or divorce). This is no longer true.
Today an individual can hecOtlle eligible for a ~ by vUtue ofhi8 or b. own acti91li.
They can fail to 'study in lChoc)lBDd he UJ1eIi:aployable. tbey am become pregnant, use drugs
~ereby become diIab~ .(~ UDeinPloyab1c., A5 a
it is widely pe~ceived tha~
indiv1duals em make a C(Jl'JSCIOUS' ehoiceto ,get on AFDC at tbe expense of the Axnencan
:emIt
and:
taxpayCl'. "
'
-
T1lis mates for 1811'1 tupa~'crs! I
APDC by itself no JOllier can address the,needs of the population which bas beeome, in
IIlIDY QISCS, dcpeudCllt on it. It mu.u be part <if a larger undc,ntandjng hct'Ween govc.rnmcnt
and recipients.
,I
Dcmocf'QU IIUUf 1f'IrlU clear tlw we come dtiw71 OIJ 1M sitU 0/ work. This has been our
historic position on broader sccia1 and economl' issues. s~h as the Humphrey-Hawkins Act:
, fun participation in the American economy byi all.
. It is also a there dJat draws (,ur party together. Charlie .Rangel, Nathan Deal, George
Miller. ad Bill. Orton aU m.ve the same d~ire to see work and self-sufficiency become the
. substitute for AFDC, as well is the basis. tOr~elfare reform.
.
But our meuagc. bas not
~ml: throughloud .'nct clear because we arc· raising too many
pf wbich will affect the outcome. We must
ei
II1Cillary COIlCCnlS during tbisdebate - noac
become more focused aroLi11d a theme that
rally
II
witte diversity of Demoaal$.
We are not without potentialltllles. Many o~ the worst Republican welf'are pJ:tJPWNlls cae as
unacceptable to the Oovernon. as they are to .1nembers of om caucus in the House. On the
other haDcl. if the GovcmotS !:ign off on & pt.jm, it will happ=. and we caumot stop it.
So let". simplify the
mes5al~Clll!
�SENT BY:Xerox Telecopier 7020 : 2-
••
02/02195
11: 31
11 ;,0
2-~~
tt202 225 7189
RESOURCES - DEHS
'Page Two
January 31. 1995
.1 believe there is I prapoiBl tbat meets our key goals: (1) it CID. unify our own caucus; (2) it
CIUl enlist support outside WasbiDgtun; (3) it brings work directly into the welfare debate: (4)
it ~i!l be!!cfit ret!p!~!!ts L'!d tt.e!! fl!mme~. and (5) it provicl!.~ !I'..!!"'~ wi.~b. m'l.'1imnm
f1c:xi~.
PgOegSAI.
,I
AS of October 1, 1996, lAY able bodieriiDdividual trilll' children added to receive lID
AFDC graDt IbaIl be req,u.in ICl to be emplo~ed, or provided employmBllt, emoHed ia. . .
education, recciviDl job tra.i.o.ing or be the !Nbjcc:t of au. lIldividua1j z ed plan developed
by die state leacUaglo cconclmiC aclf-srifficieDcy.
1. The dcfmitiOD of liable bodied" will be leJ to the state (UDder 18. with young clUld.
Jackiug basic skills, disabled, ,etc.) - flexibilitY.
~1B:tc
~c:es ~
2. The
will decide what
aie
to lead to se1f-suftideac:y'. (This is
'C1IlTcutly the ~.t:te law· inUtalI .~ Gov .. LE~...i tfis the chaiT ,of, the Oov:mots Conference:.)
flexibility..
.'.
"
3. ThIs plan will allow 11K stll5 ta par up
to new appllcaDts for A~ -. tlCJtibility.
l.
I
. ..
' .
.
rlllOlllble fasbioD since it will oaly apply
.
.
4. This plan scads a very IUClDg l'DeSSage to potential recipients that responsibility will be
" required of those who seck thn ClXpaYe6' helP - flcxibilky..
..
.
. .
I~:p
5.. The governor> will be free ta d~iin a Syste-~Ii~ tile resldems of the
stU thlt are nut dceiD.c:d able hodied •• fl~:tjbi1ity.'
.
..
,
'
6. The state shall file an a.n.mial report wlth the ~"' uf WiS.
.
'I
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..
_W-J
.
.
.
.
7. HHS shall conduct IUl lI;Sd:.t of the use of lfedcral funds, the effectiveness of State
programs, and the outcomes cf childrcnin weJ.fare families every three yean.
NOTI
Nothing in this proposal woul;l' keep memberS of the CaDaJs from raising other issues around
welfare reformtbat are impor:a.ot to them orltD'-the Party. Tbis memo is emIy i.D.U:Ddcd to
provid.e a cCDtral orptriziag theme for the DCmoenstaun welfll'c reform: work IDU . .
rapoIIIibility .
�I
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,
,
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>
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WithdrawallRedaction Marker
Clinton Library
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DOCUMENT NO.
AND TYPE
001. note
DATE
SUBJECTrrITLE
RESTRICTION
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handwritten, logistics re meeting (1 page)
nd
P61b(6), b(7)(C)
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COLLECTION:
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Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8506
/.
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FOLDER TITLE:
[Welfare Reform Legislation] [5]
2010-0198-S
kc228
RESTRICTION ICODES
Presidential Records Act· [44 U.S.C. 2204(a)]
P1
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P3
P4
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Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [8)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
Freedom of Information Act· [5 U.S.C. 552(b)]
I
b(1i National security classified information [(b)(1) of tbe FOIA]
b(2j Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
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h(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
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�January 18, 1995
Dear
I am writing to follow up on the Pres~dent's invitation to you to
participate in the working session on wel
reform on January
28. The President is looking forwa.rd to the opportunity to work
with you cooperatively across party lines and levels of
government.
Finally, because of space limitations at Blair House and to
ensure that this remains a working s:ession, we are asking
participants to bring only one staf~ person with them to the
meeting; For security reasons, we tieed to receive this person's
name, date of birth, and social secJrity number in advance of the
meeting. We would appreciate if th~s could be submitted along
with the background materials by Jaduary 24;
...
�."
,l~'
J
January 18, 1995
Page 2
Thank you again for ydur cooperation with the preparations for
this session, and I look forward to wbrking with you on the' 28th.
Sincerely,
Carol H. Rasco
Assistant to the president
for Domestic Policy
CHR:ram
.
(
�..,to
Working Session on Welfare 'Reform
I
January 2B, i1995,
Blair House
Each participant is invited to provide up tos pages of material to be
distributed in advance.
Materials should be provided on B~.f"x11~J white paper, single-sided, in
black type of standard size (10 or 12 dharacters per inch).
Materials must be re.ceived by 5:00 opm
rn T~eSd.ay,
January 24, 1995 at
0
Office of the Ass~stant secretary forPlann~ng and Evaluation
Department of Health and Human serv~ces
HUbert H. Humphrey Building, Room 415P
200 Independence Avenue SW
washington, DC 20201
Attention: Naomi Goldstein
ph: 202-690-7858
fax: 202-690-7383
�,
,
~,
Participants in 1/2S/95 meeting
Governors
Honorable Howard Dean
Governor of Vermont
109 State Street
Montpelier,Vermont 05609
Contadt: Kathi Hoyt
p-S02:"S2S-3333
f 802 828 3339
The Honorable Tommy Thompson
Governor of Wisconsin
Capitol, Room 115E
P.O. Box 7863
Madison, Wisconsin 53702
Contact: Mary Sheehy
p 202-624-5870
'
f-202-624-5871
The Honorable Arne H. Carlson
Governor of Minnesota
130 State Capitol
St. Paul, Minnesota 55155
Contact: Kathleen McCright
p-202 624-5308
f-202-624-5425
The Honorable Mel Carnahan
Governor of Missouri
State Capitol Building
Room 216
Jefferson City, Missouri 65101
Contact: Brad Douglas
p 202 624-7720
f-202 624 5855
The Honorable Thomas R. Carper
Governor
Delaware
Carvel State Office Building
320 N. French Street
Wilmington, Delaware 19801
Contact: Liz Ryan
p-202-624-7724
f 202 624-5495
The Honorable John Engler
Governor of Michigan
P.O. Box 30013
Lansing, Michigan 48909
Contact: LeAnne Redick
p-202-624-5840
f-202-624 5841
�Mayors
The Honorable Greg Lashutka
90 West Broad Street
Columbus, Ohio 43215
p - 614' - 64 5 - 7 6 71
f-614-645-8955
Democratic Mayor (?)
County Officials
The Honorable Yvonne Brathwaite Burke
Chair, Los Angeles County Board of Supervisors
500 West Temple Street, Room 866
Los Angeles, California 90012
p-213-974-1075
f - 213 - 68.0 - 3 2 83
Mr. Michael Pappas
Freeholder, Somerset County
P.O. Box 3000
Somerville, New Jersey 08876
p-908-231-7030 .
f-908-707-4127
State Legislators
The Honorable Wayne Bryant
Member, New Jersey State Assembly
200 North Fifth Street
Camden, NJ 08102-1204
Contact: Valerie
p-609-757-0552
f-609-541-0426
The Honorable James Lack
Senator of the State of New York
Albany, New York 12247
p-518-455-2071.
f-518-455-3234
;'
;
",
.':'
"",
�Senate
The Honorable Robert Dole
Majority Leader
United States Senate
Washington, DC 20510
ATTENTION: Sheila Burke
p-224-6521
The Honorable Daniel Patrick Moynihan
Ranking Memberj FinanCe Committee
United States Senate
Washington, D.C.
20510
ATTENTION: Lawrence.O'Donnell
p-224-4451
The Honorable Bob Packwood
Chairman, Finance Committee
United States Senate
Washington, D.C.
20510
ATTENTION: Lindy Paul
p-224-5244
The Honorable Nancy Landon Kassebaum
Chairman, Labor and Human Resources
United States Senate
Washington, D.C.
20510
ATTENTION: Susan Hattan
p-224-4774
The Honorable Edward M. Kennedy
Ranking Member, Labor and Human Resources
United States Senate
Washington, D.C.
20510
·ATTENTION: Nick
ttlefield
p-224-4543
The Honorable John Breaux
United States Senate
Washington, DC 20510
ATTENTION: Marc
Jones
p-224-4623
The Honorable Barbara A. Mikulski
United States Senate
Washington, DC 20510
ATTENTION: Kevin Kelly
p-224-4654
�House
The Honorable Richard A. Gephardt
Democratic Leader
United States House of Representatives
Washington, .DC 20515
ATTENTION: Andie King
p 225-2671
The Honorable Newt Gingrich
Speaker
.
United States House of Representatives
Washington, DC 20515
ATTENTION: Jack Howard
p-225-4501
The Honorable Bill Archer
Chairman, Committee on Ways and Means
United States House of Representatives
Washington, D.C. 20515
ATTENTION: Phil Moseley
p-225-2571
The Honorable Sam M. Gibbons
Ranking Member, Committee on Ways and Means
United States House of Representatives
Washington, D.C. 20515
ATTENTION: Janice Mays
p 225-3376
The Hqnorable Bill Goodling
Chairman, Committee on Economic and Educational
Opportunities.
I
United States House of Representatives
Washington, D.C. 20515
ATTENTION: Jay Eagen
p-225-5836
The Honorable William L. Clay
Ranking Member, Committee on Economic and
Educational Opportunities
United States House of Representativep
Washington, D.C. 20515
ATTENTION: Gail Weiss
p-225-2406
�January 18,
~995
Dear
I am writing to follow up on the President's invitation to you'to
participate in the working session oh welfare reform on January ,
28.' The President is looking forwa,r~ to the opportunity to work
with you cooperatively across party lines and levels of
government.
,
I,
The President and I feel strongly t~at, to be effective, the
agenda and content of the session must be developed cooperatively
with all the participants. To that lend,' staff from the
'
administration, will, by the end cifbhis week, have set up
meetings with staff from all invited offices to develop the'
format and agenda of the sess~on.
] would be very happy to talk
with you personally about the sessibn as well, ,and your staff
should feel free to contact my offide (202-456-2216) at anytime
with questions and ideas.
•
I
I
I have asked the Department of Health and Human Services to
prepare ,background materials fordi~tribution to all participants
in advance of the meeting, including factual information about
existing welfare programs.
In addition, I would like to invite
each ,participant to submit up to fi~e pages to be distributed as
part of the background materials. ~ou may wish to provide a
summary of reforms you have proposea or implemented; descriptions
of model programs; or a discussion bf key issues you would like
to highlight.
'
If you choose to provide materials, I have enclosed more. detailed
information on the format in which they should be provided. We
need to receive your five pages by 5:00 p.m. on Tuesday, January
24 to ensure their distribution in advance to the o,ther
participants.
Finally, because of space limitations at Blair House and to
ensure that this remains a working I session, we are asking
participants to bring only one staff person with them to the
meeting.
For security reasons ,wei need to receive this p~rson' s '
name, date of birth, and social se~urity number in advance of the
meeting. We would appreciate if this could be submitted along
with the background materials by Jknuary 24.
'
�,.
January 18, 1995
Page 2
Thank you again
your cooperation with the preparations for '
this session, and I look forward to working with you on the 28th.
Sincerely,
Carol H. RascO
Assistant to the President
for 'Domestic Policy
CHR;ram
\
�I'
I
I
,Working Session on welfLre 'Reform
I
,
I
January 29, 1995
Blair House!.
I
Each participant is invited to provide up to's pages of material to be
distributed in advance. '
, I
e~nx111t
Materials should be provided on
lbite paper, single-sided, ,in
black type ,of standard size (10 or 12 ohJtracters per inch).
Materials must be recelved by 5:00 pm on! Tuesday, January 24, 1995 at
.
I
I
I
,
Office of the Assistant secretary for/Planning and Evaluation
Depar,tment of Health and Human Services'
HUbert H. Humphrey Building, ~ Room 41S'F
?OO Independence Avenue SW
/'
washington, DC 20201
Attention: Naomi Goldstein
\
ph: 202-690-7858
fax: 202-690-7383
__J '
�January 18
1995
I '
Dear
I am writing to folldw up on the President's invitation to ,you to
participate in the working session bn welfare reform on January
28.
The President i~ looking forwa~d to the opportunity to work
with you cooperatively across party lines and levels of
I
government.
. I
,
.
I
The President and I feel strongly that, to be effective, the
agenda and content of the session mhst be developed cooperatively
with all the participants. To thatl end, staff from the
.
administration will, :by the end of this week, have set up
meetings with staff from all invited offices to develop the
format and agenda of the session. tr would be very happy to talk
with you personally about the sessibn as well, and your staff
should feel free to qontact my offibe (202-456-2216) at any time
with questions and ideas.
I
.
I
I have asked the Department of Health and Human Services to
prepare background mqterials for dibtribution to all participan~s
in advance of the meeting, including factual information about
existing welfare programs.
In addition, I would like to invite
each partiGipant to submit up to fi~e pages to be distributed as
part of the backgrou~d materials. You may wish to provide a
summary of reforms yqu have proposetl or implemented; descriptions
of model programs; o~ a discussion hf key issues you would like
to highlight.
I
If you choose to pro~ide materials, I I have e~closed more de'tailed
information on the f~rmat in which they should be provided. We
need to receive your five pages by ~:OO p.m. on Tuesday, January
to ensure their distribution in advance to the other
participants.
,...
I
..
Finally, because of space limitations at Blair House and to
ensure that this rem~ins a workingkession, we are asking
(participants to bring only one staff person with. them to the
meeting.
For security reasons, we heed to receive this person's
name, date of birth, land social sechrity number in advance of the
meeting. We would appreciate if th~s could be submitted along
with the background materials by Jahuary 24.
�I
/:-
January 18, 1995
Page 2
Thank you again for your: cooperation wi:th the preparations for:
this session, and I look: forward to woli-king with you on the 28th.
Sincerely, .
\
Carol H. Rasco
Assistant to the Presid~nt
for Domestic Policy
CHR:ram
�, I
wor~inq
Session on Welfare Reform
,
1
January 2
,
1995
Blair House
~"Each_participant
is in;vited to provide up to,s pages of material to be
distributed in advance'.
',,' I '
Materials ~hould be priovided on 8~J"X+1" white paper, single-sided, in
". black type of standard si~e(lO or 12 characters per inch}.
,
I'
Materials must be rec~ived by 5:00 pm on Tuesday, January 24, 1995 at
I
Office of the ~ssistant secretary for Planning'and." Evaluation
Department of Health and Human Services
Hubert H. Humphrey Building, Room 415F
'200 Independ.ence Avenue SW
wBshington,:OC 20201
Attention: Naomi Goldstein
ph: 2,02-690-7858
tax: 202-690-7383
"
",;
�. THE WHITE HOUSE
To:
--~.-------
Draft response for POTUS
and forward to CHR by: ------~~~r...~1.I.lfI"'l_.
Draft response for CHR by: --~-----...----+-1'----.::~
Please reply directly to the writer
(copy to CHR) by: _ _ _ _ _ _ ~ _________~~__---'.--=--
"y,~:===:::::~~;~~~~~~~~
Please adviseb
Let's discuss: _
For your information:
----.=-1110
Reply using form code:_-=--"-"~=-~"''''''::'';:''_ _+-:::---r__
File: ---------:::---o-~-:-.c. . . .L-.:!::-~.....P_;..,,..,.'-"''''''''
Send copy
Schedule? :
Designee to attend: _ _ _ _ _ _ _ _ _ _ _ _ _-;-_ __
CLINTON LIBRARY PHOTOCOPY
�--.....
~,11'
THE HENRY
J.
KAISER
FAMILY
'JAN / 2 /995
FOUNDATION
DREw E.
January 11, 1995
ALTMAN, PH.D.
PRESIDENT
Ms. Carol H. Rasco
Assistant to the President
,
for Domestic Policy
,
The White House
1600 Pennsylvania Avenue, I NW
Washington, DC 20500 " ,
.l.
f;
Dear Carol:
,
Enclosed are the' results :of a new Kaiser Family Foundation/Harvard survey on
welfare reform we will ~e releasing in Washington, D.C. on Thursday, January
12 ..
We found strong support for time limits, denying additional benefits for women
who have children while 6nwe1fare, caps on welfare spending, and state
flexibility. We also found that support for these' policies falls off if
people believe that they!wi11 be implemented in a way that leaves low-income
people without some means of basic support.
We would be happy to proyide a detailed briefing to you or your staff if that
would be helpful.
Sincerely yours,
9.~ ::;~:--ft
DEA:1am
Enclosures
2400
SAND HILL ROAD
WASHINGTON OFFICE:
M~NLO PARK, CALIFORNIA
1450 0 ST~EET
NW, SUITE
250
94025
WASHINGTON,
FAX
DC 20005
202347-5270
415854-4800
FAx
202 347-5274
�News Release
THE HENRY J.
KAISER
FAMILY
EMBARGOED FOR RELEASE:
9:00 a.m. EST
Thursday, January 12, 1995
FOUNDATION
For further information contact:
2400
Matt James or
Tina Hoff
SAND HILL ROAD
MENLO PARK
CALIFORNIA
94025
TEL
415 854-9400
FAX
415 854-4800
SURVEY SHOWS "TWO FACES" OF PUBLIC OPINION ON WELFARE REFORM
Americans Support Time Limits and Tough Work Requirements,
But Reluctant to Abandon Those In Need
Public Defines Welfare Broadly
Understands Key Details of Welfare Programs
Menlo Park, CA -- A new Kaiser/Harvard survey of Americans nationwide has
found that the public supports strong welfare reform measures, such as time
limits and work requirements, but is reluctant to simply cut people off and
leave them without some means of basic support.
The survey identifies four core beliefs that shape the public's policy
preferences. Two lead the public to support time limits and other strong
welfare policies: the belief that welfare causes more harm than good because
it discourages work and causes family break up, and the belief that welfare
costs the taxpayer too much money. But two other core beliefs make the public
concerned that these same strong policies will leave low income people without
basic support: th~ belief that lack of economic opportunity as much as
personal responsibility is the reason people need welfare, and the belief that
both government and people themselves have a shared responsibility for
ensuring that people have a minimum standard of living.
Two·thirds (68%) of Americans favor ending welfare payments after two years
for all able·bodied welfare recipients, including women with pre·school
children, and requiring them to take a job. But support for cutting off
payments drops to 26 percent if the job pays low wages that would make it
difficult to support a family, and to only 16 percent if the person is unable
to find a job.
Large majorities favor government providing job training (87%) and public
service jobs (74%) for people on welfare, and providing child care to low·
income mothers who work or are in job training (85%). After education,
training, health and child care benefits have been provided, 56 percent
believe welfare recipients should be required to do community service work in
exchange for continued benefits or have benefits cut off after a specified
period of time. Only 10 percent believe the government should end all aid
under these circumstances, and 25 percent believe the government should cut
recipients off only after guaranteeing they have a job.
-- more -
WASHINGTON OFFICE:
1450 G
STREET NW, SUITE
250
WASHINGTON, DC
20005
202347·5270
FAX
202 347·5274
�The public's desire to "do something" .about welfare is also reflected in
support for limits on welfare. Majorities favor requiring mothers to report
the name of a child's father before they can receive welfare (81%), setting
limits or denying welfare to non-citizens, including most legal immigrants
(64%), denying additional benefits to women who have more children while on
welfare (59%), and government limiting how fast welfare programs can grow,
regardless of how many people may need assistance (capping welfare) (57%).
Nearly equal proportions of Americans say: 1) "We shouldn't let people who
can't get or hold a job go hungry or homeless, and we need to continue welfare
payments to these people" (44%), and 2) "We should have 'a firm limit on how
long people can stay on welfare, regardless of the consequences, in order to
get them to work" (43%).
"The jury is still out on what the public will support on welfare reform. At
the moment they want four things that may be incompatible -- get people off
welfare within two years, get them jobs that provide a minimum standard of
living, don't let families suffer severe hardship, and don't raise taxes or
cut government programs to do these things," said Drew Altman, Kaiser Family
Foundation president and former welfare commissioner in New Jersey under
Governor Tom Kean.
Two-thirds of Americans (66%) oppose a proposal that would end welfare
benefits for unmarried women and their children if that meant some of the
children would have to be cared for in group homes or orphanages. If such a
proposal were enacted, the public overwhelmingly prefers having the government
pay for group homes where mothers and their children live together (56%),
rather than providing orphanages for the children (8%) or doing nothing (8%).
A fourth of respondents said none of the above.
One important caveat should be added. The public is not prepared to sacrifice
very much to see reforms enacted. Only about half are willing to pay more
taxes or see other programs cut to provide job training (53% willing to 40%
unwilling) and public service jobs (47% to 45%).
Awareness of Reform Proposals
At this early stage, the public is not yet following the welfare reform debate
closely. In sharp contrast to the 47% who said in October 1993 that they were
following news stories and other information about health care reform very
closely (Kaiser/Harvard Survey, October 1993), only 13% say in this survey
they have been following stories about welfare reform very closely.
Only three in ten Americans say they understand President Clinton's welfare
proposals very (5%) or fairly well (25%). A similar proportion understand the
Republican proposals very (7%) or fairly well (24%).
"Americans do not yet know the consequences of the various welfare reform
proposals," said Dr. Robert .J. Blendon, Professor and Chairman of the
Department of Health Policy and Management at Harvard University. "As the
debate continues and begins to focus on the implications of particular
proposals -- whether they be severe negative consequences for individuals and
families or increased taxes or cuts in other government programs -- the public
is likely to become more cautious."
2
�Welfare Spending'
i
Asked to choose from a list pf six areas which two consumed the largest share '
of federal spending, only 14; percent ~orrect1y named Social Security and 37
, percent ,named defense as one' of the top two. Four-in-ten Americans (40%)
thought welfare was'one of the two largest areas of federal spending.
When asked'to define welfare, the public identified the following six major
federal government programs !from a list of nine as being welfare progr,ams:
food stamps (93%), AFDC (Aid to Families with Dependent Children) (85%),
public housing (85%), WIC (the Women, Infants, and Children program) (72%),
the school lunch program (62%) and Medicaid (60%). Most did not regard
Supplemental Security Income (SSI), the federal cash assistance program for
the aged, blind, and disabled, as welfare. These six major programs labelled
by the public as welfare make up 10.2,' percent of the 1993 budget, ranking
behind defense (21%) and Social Security (21%), and equal to Medicare (10.2%).
State and Federal Roles
The public wants to see the'states playa major role in welfare reform. Given
four choices, a maJority (5.2%) thought government officials should experiment
with reform at the state leyel, compared to 29 'percent who preferred reform at
, the national level, 7 percent who wanted to leave welfare as it is, and 6
percent who would prefer to: e1iminate'all welfare benefits.
,
,
But Americans are wary of letting states determine their own 'policies withou,t
,some federal guidelines. wrile 36 percent thought each state,shou1d determine
the best way to aid poor pepple, 50 percent believed the fedel;"al government
needs to set guidelines whe,n' it give's money to stat~s, in order to assure they
will treat'everyone fairly land do the, right thing for poor people.'
A majority of Americans (58%) also favor a "swap" proposal, where states would
'be in charge'of welfare and the federal government would take responsibility
for paying for the ,health care of 'poor people, instead of both
responsibilities being shal¢ed as they are now. Twenty-four percent' are
opposed, and 18 percent sa~d they didn't know.
Core Beliefs and Values
Americans' beliefs about what policies and r~forms'should be enacted can be
related back to 'f?ur core values they hcild'about welfare and poverty:
,
"
I
'
1) Americans see the welfare system as doing more harm (56%) than good (33%)
because they believe it encourages the bre'akup of' the family' and discourages
work. The overwhelming maJo:rity (81%) think that most welfare recipients' are
able ,to work., The idea th~twelfare discourages people from working was
,
I
identified by half of Amer,icans (49%) as what bothers them most about the
current welfare system ranking far ahead of concerns such as costing taxpayers
too much (14%) and causing families to break up (13%). Two-thirds (68%) say
that welfare encourages WOmE!.TI to have more children than they would, have if
they were notable to get ~elfare.
,
I
3
"
,r
�.;,
2) Most Americans believe thecountIY spends, too much' (64%) or'the right
amount <17%) rather than too i little Cl2%) on welfare. They ar'e somewhat'
9-ivided in their willlngness!to pay more' taxes or see other programs cut to
provide job tra,ining (53% willing to,40% unwilling) and public s~rvice jobs,
(47% to 45%). ,The public is; also split nearly evenly, on whether people who,
receive money from welfare could get along w'ithout it, (46%) or' really nee'd
this help (44%).
"
I
3) Americans perceive a vari!ety of reasons for 'people being on welfare. some,
rooted in individual responsibility and others in social conditions and lack
of economic opportunities . ,When questioned :about possible ,reasons people are
on welfare, most often, rate4 as maj or rea,sons were: welfare, pays better than,
some jobs do (71%); people C7hoose not to,wo,rk (6~%); poor education (64%)";',and
women having babies i,n order, :to collect ,ad9,itional w~lfare benef,its (62%).'
Americans are spli,t on whet4er welfare, recipients ,.really want ,to work (40%) ,or',
choos~ not to (47%). More broadly, ~8,percent,believe, lack of, ,pel:'sonal effort
is the main reason for povefty in the U~S.; 42 percent lack of opportunities '
and jobs.
'
r
'
"
.
,
But the public also, sees economic and social obstacles that preyent p'eople
from leaving welfare . The vast, maj ority of Americans (72%) ,believe" there are
jobs for most welfare recip~ents who really want to work. But; only 22 percent
believe that most of these Jobs pay enough to support'a family., ' 'While 42
percent say "It's important; fo~ a mother with young, children to ,'stay at,home
eVen if it means having to provide' her with welfare," 35 percent believe "We
, should not pay welfare to mothers with young children becailse, it's so", ,
important 'that people work.!" ,'The survey suggests that because Americans,
believe that both individu~ls and society share', in the responsibility for
people being "onwelfaJ:'e, ~ericans' support for reform proposals may decline
if they' think that ,the refcfrm will not le,ad to, amit}imal sta:ndard of living or
will 'create sevel:'e hardshi~ for familie~." .
'"
4) Most Americans believe thatgo~ernment and welfare, recipl~nts'havea shared,
responsibility for ensuring that people have 'a minimum standard of living',
'Asked who should be primarily responsi,ble for making sure that 'non-working
low-income people .have a 'mf.nimumstandard, of living,S. majority (57%) 'said
that responsibility ,should1be shared between government and people themselves,
friends,~ndvoluhtary agencies; 26' percent said people th~mselves ,and friends
and voluntary agencies; and only 14 percent said' government, should be '
primarily responsible . Significantly, however, most of those, who believe in ' .
, sb:ared responsibility wantigovernment"s 'role to, last only for a limitedti~e "
(71%). Only 25%'said gove:rnment responsibility should last "as 'long as i't
takes .'~ The 'theme is -clear: the, public,.believes that. able,:bodied people have
a~ obligation to help the'nlselves: 'but also that governnient has aro~e in
maintai~ing a S!i~etynet ~,or 'a reasonable but' notun,limi ted' perio( o( time. ,.....
public Kno~ledge
,1,
I
'With ~ome sigOificant exc~ptions, the
the welfare system.' .For example:
•
publ~c is reason~bly well; ,informed aboti't'
the public (90%) kn~ws that more women and children are on w'~lfare than:
men. (In 1992, two~thirds of AFDG recipients, or 9.2 million,' were
children) ;
4
�..
.
•
I
a majority of the public (57%) knows responsibility for running welfare
is shared between feder~l and state governments. (Federal funds pay on
,average 55% of AFDC benefits plus 50% of administrative costs);
•
a plurality (32%) knows: how much public assistance mothers are receiving
each month. (The avera:ge benefit in 1993 was $399 per month for a
family of three);
•
seventy-one percent say that. they know what Medicaia is and 43 percent
know that it pays not only for hospital and'doctor services for poor
adults and children, b~t also for services for the elderly in nursing
homes and the blind and disabled. (The public was least knowledgeable
about Medic~id financi~g for the blind and disabled, the program's
fastest rising major c~st).
•
the public ov~rwhelmingly believes most people on welfare are
minorities. ' (In 1992'i 39 percent of AFDC recipients were white, 37
percent black, 18 percent Hispanic, 3 percent Asian, 1 percent,Native
American, and 2 percent unknown);
".
. !..
,
"
,
•
..
when asked how long people .stay on welfare, 43 percent said continuously
until their children grow' up, 26 percent. said on and off until' their
children grow up, and!15 percent said a few years before leaving welfare
for good. (Thirty~four percent stay on welfare less than one 'year and.
another 44 percent for up to five. years. A majority of those who leave
welfare return later. to the welfare rolls. Welfare dependency is
characterized more by: repeat spells of dependency than continuous
dependency on public assistance.)
MethodologY'
,
.
'1
The Kaiser/Harvard Survey was a random-sample, telephone survey of adults
'nationwide. The national sample consisted of 1,200 adults and was conducted
, between December 27 and 29; 1994. The survey was designed by the Harvard
University School ofPublicp Health's Department of Health Policy and
Management and the Kaiser Family Foundation, ari4 was conducted by KRC
Communications Research, a1national opinion research firm located in Newton,
Massachusetts .. The margin' of error in the national sample is plus or minus 3
percent. The survey isth.~· first conducted under a new program, the
'
Kaiser/Harvard program on the Public and Health/Social Policy, designed to
monitor' public knowledge,' values and beliefs on health and health-related
issues.
J
.
The Kaiser Family Foundation, based in Menlo Park, California, is a non
profit, independent national health care philanthropy and, is not associated
with Kaiser Permanente or;Kaiser Industries. The Foundation's work is focused
on four main areas: health policy, reproductive health, HIV,'and health and
development in ~outh Africa. The Foundation does not support any particular
proposal or approach to welfar,e reform.
- - 30 -
�I
, I
THE HENRY J.
KAISER
FAMILY
FOUNDATION
,
KAISER/HARVARD PROGRAM ON THE
,
PUBLIC AND HEALTH/SOCIAL POLICY
,
,
Survey on Welf,are Reform: Basic Values and
Beliefs; ~upport for Policy Approaches;
Knowledge About Key Programs
,
January 1995
, I
EMBARGOED FOR RELEASE UNTIL:
. ,
,
,
I
9:00 A.M. l;ST, THURSDAY, JANUAay 12, 1995
,
,
, HARVARD UNIVERSITY
Robert J. Blendon, Sc.D.
Director, Kaiser/Harvard Program ~n the
Public and Health/Social Policy!
'Professor and Chairman, Department of Health
Policy and Management
'
Harvard University School of Pu~lIc Health
(617) 432·4502
KAISER FAMILY FOUNDATION
Drew E. Altman, ·Ph.D., President
Matt' James,' Vice President
Communications and Media Programs
2400 Sand Hili Road
Menlo Park, California 94025,
(415) 854-9400 Fax: (415) 854-4800
�,
.
:
...
.
i
I'
TABLEt
i
I
OOFS mE WELFAR.E SYSTEM 00 MORE GOOD OR MORE HARM?
VieWS of American Adults By Political Party Affiliation
Total
Dem.
Rep,'
family and discourages work
S6,«.It
SO«.lt
,71«.lt
Tbe welfare QStem does more go9d' than harm,
because it provides assistance an.. Craio.iog
for those who are without jobs ~d are poor ,
33%
43%
2l«.lt
DoD't koowlRefmed
11%
7%
7«.1t
I
Tbe welfare QStem does more balm than good,
because it eacouragesthe breakup of the
,i
',' "
\:
I
Source: KaiserIBamlrd Program on the Public and Health/Social Policy Survey, January 1995
, ,
i '
, !
I
•
�TABLE 2
ARE PEOPLE WHO RECEIVE WELFARE ABLE ,TO WORK!
Views of American Adults
More people who receive welfare.••
Are able to work ,
81.,
Have disabilities tbat keep thtm .
from working
,
Other (vol.)
Don't know
Source: Kaiserlllanard Program on the Public and Health/Social Policy Survey, January 1995
,
r
,
�TABLE 3
WHAT BOTHERS AMERICANS
ABOUT THE WELFARE SYSTEM
VIEWS OF AMERICAN ADULTS
-WORK- D-ISINCENTIVE
49%' .
COSTS TAXPAYERS TOO
MUCH
BREAKS UP FAMILY
_ WORSENS CRIME RATE
NOT BOTHERED
OTHER/DON'T KNOW
Source: Kaiser/Harvard Progarm on the Public and Health/Soclal.Pollcy, January 1995
�TABLE 4
DOES WELFARE ENCOURAGE WOMEN TO HAVE
MORE CHILDREN THAN THEY WOULD HAVE IF
THEY WERE NOT ABLE TO GET WELFARE?
.
. VIEWS OF AMERICAN ADULTS
NO
23%
DONIT KNOW/REFUSED
9%
Source:
~18er/Harvard
Program on the Public and Health/Social Policy Survey, January 1995
YES
68% .
�TABLES
,
,
I
i
AMERICANS' VIEWS ABOUT U.S. SPENDING ON WELFARE
'
f
'
Views of American Adults By Po6tica1 Party Afrdiation
,
I
.'
,
Total
Dem.
Rep.
Spend TooMudt
' , MCJJ
57CJJ
7SCJJ
Spmd Too Little
UCJJ
14CJJ
SCJJ
Spend About Right Amo. .
17CJJ
UCJJ '
9CJJ
~'t'Know
7CJJ
JCJJ
SCJJ
,
I
,
,
Soun:-e: Kaiserlllar'fanl Program on the Public and BealthJSociaI Policy Survey, January 1995 '
I
'I
,
,
I
,
I '
!
, I
,
,
�,.;;
TABLE 6
.. AMERICANS' VIEWS OF WELFARE RECIPIENTS
-.,. ··,-·VIEWS OF.AMERICAN ADULTS
.MOST PEOPLE WHO RECEIVE
.
MONEY FROM WELFARE
. ' .
MOST WELFARE RECIPIENTS
. REALLY NEED THIS. HELP
REALLY WANT TO WORK
44%-----,_~
10%
'.
___
--'--40%
---,-
12%
DON'T
I
. KNOW
DON'T
., KNOW
46%
COULD GET ALONG
WITHOUT IT IF
THEY TRIED
Source: Kaiser/Harvard Program on the Public and Health/Social Policy Survey, January 1995
(
47%
DON'T REALLY
WANT TO WORK
.3
�-,
TABLE 7
MAJO"R REASONS WHY PEOPLE
ARE ON WELFARE
VIEWS OF AMERICAN ADULTS
~PAY$_BI;IT_EF.t TtiA~N ..~~MI;
.'
710/0 -.
CHOOSE NOT TO WORK
POOR EDUCATION
HAVING BABIES TO
. RECEIVE BENEFITS
BREAKDOWN OF THE
FAMILY
"
DECLINE IN MORAL
VALUES
NOT ENOUGH JOBS·
RACIAL DISCRIMINATION
. BY EMPLOYER
Source: Kaiser/Harvard Program on the Public and Health/Social Policy Survey, January 1995
�TABLES
AMERICANS' jVIEWS OF WELFARE RECIPIENTS
. VieWS of'American Adults By Political Party ,AtTillation
Most people who receive iDooey froDi welfare.••
,
if: J, tried
,Could get alcmg without it
Really Deed this help
Don't knowlRef'used
10%
Most welfare redpients..~
10%
10%
:
. Do DOt really want to work
47%
i
Really want 'to work
Don't knowlRef'used
10%
So1Jl'Ce: Kaiser/llarvard Program on the Public and Health/Social Policy Survey, JanUary 1995
I
i
,
,
..
,
,
I
.
I
,
I
i
I
I
I
I
,.
,
I
"
,
.
I
i
i.
\
�. TABLE 9 .
AMERICANS'
VIEWS ABOUT THE AVAILABILITY
OF JOBS FOR WELFARE RECIPIENTS
. Views of American Adults .By P06tic3J Party AffUiation
..
I
;
;
Total
Dem.
Rep.
72~
Q~
&S~
And most of tbeie jobs pa~ enougb to
support a family
22~
16~
31~
But most of tbeie, jobs do ~t pay enough
;
to support a family
37~
3S~,
40~
12~
11~
14~
I
~ are jobs available for most welfare rec:ipierds who
i
naIIy WBDt to work
:
I
Amoug aD of those who nsponded ~ the question:
I
I
But don't know if they pay enougb or
i
depends on family size
Jobs are not available
Don't know if jobs are available :
.
.
Source: Kaiserlllarvard.Program on the Public and UeaJtblSociaI Policy SUl"'fey. Jan.:.ar,. 1995
~
.,
�TABLE
to
AMERICANS' VIEWS O¥ WELFARE MOTHERS OF YOUNG·CHlLDREN
V
, iews of American Adults
It's imporfaot for a mother with young children to stay at home
if it means _ring to provide her with welfare
eftII
42'11
I
We should not pay welfare to mothers with young children because
it's so important that people work
35'11
Other (yol.)
14'11
Don't knowlRefused
10'11
Source: KaiserIBamlrd Program on the Public and Health/Social Policy Survey, January 1995
�TABLE 11
AMERICANS'VALUFS CONCERNING THE WELFARE SYSTEM
Views of American Adults ·By Political Afrdiation
I
Total
Dem.·
Rep,
paymeam to these people
44%
44%'
4S'II
,
We should have a fum limit on how long people can stay
on welfare, regardI~ of the oooseqtH.i:nces, in order to
get them to work
43%
43%
44'11
Other (vol.)
7%
6%
, 6'11
Don't know/Refused
5%
7'11
5'11
We sbouIcIo't let people who can't get ,01" hold a job go
I
, hungry, 01" booleleg, and we need to. continue welfare
Soun:e: Kaisel'1IIarvard Program on the Public and Health/Social Pollcy Survey, January 1995
�TABLE 12
AMERICANS' VIEWS OFwnO sHOULD BE PRIMARILY RESPONSmLE
}DR MAKING SURE THAT NON-WORKING LOW-INCOME PEOPLE
HAVE A MINIMUM STANDARD OF UVING
VIeWS of Anierican Ad~
.Respou.g."bility should be shared
57%
People thtmseIves, friends, and voluntary agencies
should be primarily responsible :
Govemment should be primarily· ~nsible
I
14%
Don't know
Source: KaiserIBamlrd Program on the Public and Health/Social Policy Suney, January 1995
,
I.
�TABLEt3
PUBLIC KNOWLEDGE ABOUT THE WELFARE sYSTEM.
•
90'11 know that more men ad dilldren are OD welfare than men
• .
A llU\iority (57'11) knoWs that responsibility for ruimiog welfare is shared betweea federal
and state govf!l'llllleDtlil .
.
•
A plurality (31'11) ~ how much public assistance mothel's are receiriog each month
•
71'11 say they know what Medicaid is ad 43tf1 .know it pays DOt ooIy for hospital ad
doctor serrices for'pOOr adults ad dilldren, but also for serrices for the.elderly in
IlUI'SiDg homes ad for the blind and disabled
.
.
:.
.
.
I
•
A IIU\iority (57'11) ~w that most people OD welfare are minorities
Sourte: Kaiser/llanard Program on ~ Public and BealdlISociai Policy SUlTey, Jmuary.199S
.
.
I
.
t·
I
•
�TABLE 14
,
AMERICANS' VIEWS ABOUT WHICH GOVERNMENT PROGRAMS ,ARE
iWELFARE PROGRAMS
Views of American Adults
'(from a list of 9 programs)
% sayiDg each of the following
is a welfare program
Food stamps
AFDC, or Aid to, Families With Dependent Children
I
Public bousing
WlC, or the Women, Infants, and Children program
The scbooll~
prOgram
Medicaid
SSI, or Supplanental Security Income
I
. MecIicare
;
Social Security
93%
85%
85%
72%
62%
60%
43%'
30%
IS%
Sollfte! KaiserllIarvard Program on the Public and HealthISociaI POlicy SUl'Yey, JanUary 1995
i,
�TABLE 15
,
WHAT PUBLIC VIEWS AS WELFARE*
(fr:om a list of 9 programs)
I,
i
,
Programs
.
Billions of dollars
as ofFY 1993
'
'I '
,
I
Medi~d
,$76
Food Stamps
AIDe' (Family Support)
, Child Nutrition Programs/WIC
Public: Housing ~
,
Total Feder.d Spending
on The;e Programs
Total Feder.d Outlays
Public's DermiOOn of
Welfare as Pen.-.eotage of
Total Feder.d Outl3ys ,
$2S
$16
$7
,~
$144 '
$1,408
10~~
I.
I
Soun::e:
Co~onaI Budget
0fIice,
~ and House
Committee on Ways and Means, 1m
-Based on tile ~ority of responses ~vided in the Kaiser/lIa.nard PrognuD on the Public and Health/Social
Policy Survey, January D.9S and correlated to the'fedecal budget FYtm
�TABLE 16
AMERICANS' ,VIEWS OF THE TWO LARGEST.
AREAS OF FEDERAL GOVERNMENT SPENDING
Views of American Adults
(from a list of six programs)
1.
• Foreign aid
41%
2(t).
, Welfare
40%
2(t).
: Int.em;t on
the
federal debt .
40%
4.
Defense
37%
5.
Social Security.
14%
,.
Health
8%
,
Source: K,a;ser/llarvard Program on
the Public and HealthJSocial Policy Survey, January 1995
,
,
I
.... .,.....
�. i
!
TABLEt7
AMERICANS' VIEWS OF ENDING WELFARE PAYMENTS
TO ABLE-BODIED RECIPIENTS AFrER TWO YEARS
ViewS of American Adults
Favor eDding welfare payments to able-bodied welfare recipieofs,
iDduding WOIDeD with pre-5ChooI: children, after two years, and
requiring them to fake a job
.
68'"
Would continue to favor eYeD if'the joh the perso~
cakes pays a low wage that would make it difficult
to support a family
26'"
Would continue to favor eYeD if the person is unable
to_a~
"'"
SoIll'Ce: .Kaiser1Banard Program on the Public and Health/Social Policy Survey" lanua.ry 1995
,
i '
.'
. TABLEtS
AMERICANS' VIEWS ON WHAT SHOULD HAPPEN IF WELFARE RECIPIENTS
ARE CUT OFF t\.FTER A SPECIFIED PERIOD OF TIME AND AFrER. EDUCATION,
TRAINING, AND HEAL1H AND.CHILD BENEFITS, HAVE BEEN PROVIDED
.'
; Views of American Adults
Favor'requiring welfare recipients to do
community service work in ~e for
,
' I
.
continued benefits '
. !
Favor cutting off benefits ~ guaranteeing
jobs to recipients
'
Favor cutting
ofT benefits
Don't know/Retused
i
SoIll'Ce: Kaiser/Barvard Program onithe Public and Health/Social Policy Survey" Janua.ry 1995
.
i
.i
�I'
I'
I
. TABLE 19
,
"
, THE PRINCIPAL GOAL OF WELFARE REFORM
Views orAmeriean Adults· By Political AtTdiatiOD
;
i
I
t
'Getpeople off Welfare, .,ui ooly ifwe·can get thtm
dea!ot jo_ ,by proridiog job' training. and education :
63%
,,%
60..,
Get peOple off welfare eveD if it means they have to
take .. low-payiog job
2''''
22..,
33%
,%
.,..,
SS
Provide people on welfare ~th more money so that they
2%
have 8 bigber standard oC ~~
s..,.
2'11
I'll
1..,
I
t
Get people off welfare reg3rdIfSS oC the consequences
I
Other (voL)
2% .
Source: KaiserIBananl Program on ~ Publi~ and BealtbJSocial Policy Survey, Jan~ 1995
�TABLE 20
PUBUC SUPPORT FOR PROPOSAlS TO CHANGE THE WELFARE SYSTEM
I
"
"
Views of American Adults
Don't
Knowl
Fayor"
OPIJOSe
Refused
87"
10.,
3.,
85.,
13.,
2.,
74.,
"21.,
5~
Govemmentshould require each mOther to
report the name of a dWd's father before
she can receive welfare
81.,
16.,
.3.,
Government should limit or deny welfare Bid
to non-citizens. This would include most
legal immigrants as well as all illegal
immigrants
64.,
27.,
,.,
Women who 'bav~ additional dW~ while on
welfare should not receive addition3l benefils"
for those dilldren
59%
34%
8"
57%
31%
13.,
L GoYeJmnent Should Provide Training & Support
Government. should provide job training for
people on welfare
!'
,
Government sbouId provide dWd care to
Iow-iDoomemothers who are on welfare who
Cake jobs or are in job training
,
Government should provide public ~
jobs for people on welfare
n. Government Should Get"ToU2h~""
,
Govemment" should set a limit on ~ fast
"the cost of welfare program<i can grow,
rePnDess of how many People may need them
Soun:e: KaMIHarvard ~ on too Public and Health/Social Policy Survey, January 1995
,
,
,
,
"
I
�TABLE 21
,i
AMERICANS' WILLINGNESS TO PAY MORE IN TAXES
OR SEE OTHER PRqGRAMS CUT TO PROVIDE JOB'TRAINING
AND PUBUC SECTOR JOBS SO PEOPLE CAN GET OFF WELFARE
. Views of American Adults
.
,
I
Don't
Knowl
Willin: ,
Unwillina:
Job trainiog
53%
40%
7%
Public serrice jobs
47%
45%
8%
Refused
,
i ,
Source: ICaiserIllanani Program on ~ Public and HealtbISociaI Policy Survey, January U9S
'j
,
I'
�TABLE 22
AMERICANS' VIEWS ABOUT ENDING WELFARE BENEFITS TO
'. UNMARRIED MOTHERS AND THEIR 'CHILDREN
AND .ABOUT CARE;IN GROUP HOMES ANi> ORPHANAGFS .
Views· of American AdultS
Don't
Knowl
Favor
Oppose
Refused
A proposal that would end an welfare !
benefils for umnarried mothers and tIuir
childreo, even if it meaos that some '
of the children woUld have to be cared'
for iD group homes or orphaDages
I
If such a proposal were, enaded, which one of the foRowing three things would 10U prefer that govermnent
do for umnarried mothers with chilctren who cannot support themselves?
' .
(
,
, I
. The government pays for group homes where mothers
and their children live together
56%
I
,
'
.
The govermnent' provides orPhaDages for the
childreD
8%
The government does nothing
8%
None of the above
23'11
DOn't know
Source: KaiserlIlarfard Program
5%
00
~ Public and H~thISoclai Policy S!l"e1',Jaouar,y 1995
�AMERICANS' VIEWS OF 'wHo SHOULD BE PRIMARILY ~PONSmLE
FOR MAKING SURE TIiAT NON-WORKING WW-INCOME PEOPLE
HAVE'A M1NIMUM STANDARD OF UVING
Views of American Adults
"
I
,
1
Rep.
Total
Dem.
GoVenJlDent should be primarily respo~"ble
144](,
204](,
74](,
People themselves, friends, and voluntary
agencies should be primarily responsible
264](,
224](,
274](,
Ra;poIlSl"bility should be shared
57%
714](,
634](,
714](,
25%
334](,
174](,
44](,
24](,
54](,
34](,
44](,
44](,
;
Among those wbo believe the respoDSi~ility should be shared:
With government role lasting ooly for a
limited time
,
,
With govermnent role·1asting 'as long
as it takes for the individual to get a job
But doD't know how long government role
should last
,
,
,
I
DoD't know wbo should be primarily'respoDSible
Soun:e: Kaiserlllarvard Program
OD"
Public and HealtbiSoclai Policy Survey, January 1995
�, TABLE 24
STATES VS. FEDERAL GOVERNMENT
QUESTION: REGARDING WELFARE REFORM, DO YOU
THINK THAT GOV'ERNMENT OFFICIALS SHOULD ..•
, EXPERIMENT AT STATE
LEVEL,
-
~
52%
-"
REFORM AT NATIONAL;
LEVEL
29%
LEAVE WELFARE AS IS
7%··
ELIMINATE ALL WELFARE
BENEFITS
6% ...
DON'T KNOW/REFUSED
7%
~ource:
Kaleer/Harvard Program on th.e Public and Health/Social poncy Survey, January 1995
�....
,
· TABLE 25
HOW MUCH STATE FLEXIBILITY?
QUESTION: WHICH OF THE FOLLOWING 'STATEMENTS COMES CLOSER TO YOUR POINT OF VIEW:
(1) The federal government has to set guidelines when It gives money to states for welfare
In order to assure that the states will treat everyone fairly and do the right thing for poor
people.
(2) Each state should be' able to determine on Its own the best way to aid poor people and the
federal government should Just give them the money without telling them what to do.
STATEMENT ONE
50%
STATEMENT TWO
36%
OTHER
7%
DON'T KNOW/REFUSED
7%
Source: Kal8er/Harvard Program on the Public and HeaJth/Soclai PC?lIcy Survey, January 1995
�TABLE 26
.
THE WELFARE/MEDICAID ilSWAp ll
QUESTi'0N: TODAY, THE CO~TS.AND RESPONSIBILITIES FOR WELFARE AND THE MEDICAID
PROGRAM ARE SHARED BY THE FEDERAL AND STATE GOVERNMENTS .. RECENTLY SOME
PEOPLE HAVE SUGGESTED DIVIDING THESE RESPONSIBILITIES DIFFERENTLY, WITH THE
STATES BEING IN CHARGE OF WELFARE AND THE FEDERAL GOVERNMENT TAKING THE
RESPONSIBILrTYFOR PAYING FOR THE HEALTH CARE OF POOR PEOPLE. DO YOU
FAVOR OR OPPOSE THIS"SWAp·· PROPOSAL?
FAVOR
58%
OPPOSE
24%
DON'T KNOW/REFUSED
18%
Source: Kaleer/Harvard Program on the PLiblic 8!ld Health/Social Policy Survey, January 1995
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
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DATE
SUBJECTfflTLE
0111111995
FedEx Overnight (partial) (1 page)
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8506
FOLDER TITLE:
[Welfare Reform Legislation] [5]
2010-0198-S
kc228
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�~',4
.....
--Tj na Hoft Ivg]
KAISER FAHIL9 FOUNDATION
2400 SAND HILL RD SLOG 1
HENLO PARK CA 94025
(415)854-9400
TO; Carol 11. Rasco
,
,
SHIP DATE: WANg!;
ACCOUHT J r:Ieer(b)(6):::J
IfAN-WGT: 1 1~3~~
(202)456-2216
The White House
1600 Pennsv Ivan i a Avenue, N, II.
Asst. - Pres i dent for Domest i c PItv
ifils!lill9ton, DC 2es~
~
.241 5~14 b3l .
~~1531'
.
POWERSH IP. 3
b32
REF:
PRIORITY OVERNIGHT)
CAO • 84641
Irk·
l1JAN9S
IHU
AA
FedEli Letter
247 5374 632
lAD
20515-DC-US
C4WAS
(
,<
�j
E X E CUT .I V E
OFF ICE
o FT H E
PRE SID E N T
24-Jan-1995 01:03pm
TO:
FROM:
SUBJECT:
(See
Belo~)
. Julie E. Demeo
Domestic Policy Council
UPDATE
j
This is an update of meetings and conference calls for the week.
TUESDAY & WEDNESDAY':
1:00-1:30 daily working group prep conference call. Call in
numbers: 456-6755,1456-6766, 456';"6777, CODE #4059.
Or you can
participate from Carol~~ office.
THURSDAY:
11: 30-12: 00 conference call/meeting to prepar'e for the 12: 00 call
with, congressional/elected officals' staff.
Everyone that is on
the daily call should be on this 11:30-12:00 ,call.
In addition,
Emily Bromberg, 'Ma:r;y Jo Bane, & David Ellwood should be in OEOB
211 with Carol, Bruce Reed, ~eremy Ben-Ami, Marcia Hale, and Susan
Brophy for this call. Those who will be calling in'to access this
conference cal'l can dial either: 456-675,5 or 456-6766, CODE #4059.
12:00-1:00pm Conference Call with the staff of those elected
officials and Congresspersons who' will be at the Sat welfare
working group. AII:of the people on the daily call should· also
participate., You can either go to OEOB 211 or call 757-2104, CODE
#4059. Room 211 is fairly small, so please let Julie (456-2216)
know if. yoU are planning to participate from OEOB 211.
1:00-1:30pm daily ¢onference call -·in case there are other things
that need to be addressed. Those in ,the daily call group who are·
in OEOB 211 can stay there for this call. Others can access it by
dialing: 456-6755,!456~6766, or 456-6777, CODE #4059.
,.
FRIDAY:
1:00-1:30pm Daily Conference Call ~ith regular group.
Call in
numbers are: 456-6755, 456-6766, 456-6777, CODE #0691.
Please note that the CODE for Friday changed slightly from the
�original fax sent out liast Friday.
Please call me if there are any problems.
THANK YOU!
Julie (456-2216)
Distribution:
TO:
TO:
TO:
TO:
TO:
TO:
TO:
TO:
TO:
TO:
TO:
TO:
TO:
TO:
TO:
Julie E. Demeo
,
FAX (96905673,melissa skolfield)
Jeremy D. Benami
Cathy R. Mays
Christa T. Robinson
Erin A. O'Connor ,I
Marti E. Easton j
Ann M. Cattalini
Anna Winderbaum :
FAX (94014678,Br,omberg/Bane)
,FAX (96907383,David Ellwood/Gerri)
FAX (96907380,Klepner/Tarplin)
FAX (96905672,John Monahan)
FAX (96903100,E+len Haas/Sherri)
CarolH. Rasco
�THE WHITE HOUSE
WASHINGTON
:December 12,1994
MEMORANDUM
94 DEC 13,
A
8 : 53
TO~bENT
RASCO~
FROM:
CAROL H.·
THROUGH:
LEON PANETTA
SUBJECT:
WORKING MEETING ON WELFARE REFORM
F!:7
Following up your announcement of a working session on welfare
reform with a bipartisan group of elected officials, ,we need to
make a series of decisions about the meeting's structure and
format. The plan sketched out below envisions a true working
.session, held at Camp David, with minimal press coverage other
than statements by participants at the close of the meeting.
Decisions
1. Where
')
We recommend holding the summit at Camp David rather than the,
White House. The atmosphere is more relaxed, access to the press
is more controlled, and the setting is more Presidential.
Approve
Disapprove
Discuss
If you do not wish to use Camp David, we recommend using White
House facilities, either around the House itself (although that
may be impossible due to renovations) or at the Jackson Place
Conference Genter.
'
2. When
Our first choice foria date would be Friday 'and Sc;tturday, January
13-14, which would give us a way to get into the middle of the
political debate before the State of the Union. ,We are working
with NGA to finalize'the-date today or tomorrow.
�3. Who
In keeping with the goall of having a working session, we will
keep the number of invitations small. In discussions with Pat
Griffin and Marcia Hale,: we have tentatively agreed to the
following invitation list:
6 Governors·
~ ~senators
~~ ~'
and 6 members of the House
~: ~4
~
~
NGA;Chair and Vice Chair
NGA'Welfare leads (D and R)
NGA'Human Resources Chair and Vice Chair
Pat will work with the majority and minority
le~dershiPs to determine representation
local elected officials
We,will invite 2-3 Mayors and 1-2 county or
other local officials. Marcia will
coordinate these invitations.
4 representatives of the Administration
Yourself, ,the Vice President, Secretary
Shalala, and Alice Rivlin
A minimal number of other staff including, Leon Panetta, myself,
Bruce Reed and other staff as appropriate.
Approve
Disapprove
Discuss
4. Format/Schedule
We envision the follqwing schedule:
Friday evening
6:00
6:30
~:30
9:30
Saturday
8:00
:8:30
2:00
Arrival
Dinner
Introductory Discussion
Movie/Other entertainment
Breakfast
working Sessions
Working .Lunch
Conclusion/Press statement
)
'
�#
,
-.
The discussion sessions on Friday and Saturday would be
structured thematic conversations perhaps based on .materials
circulated in advance. 'We do not envision in-depth
presentations, rather free-flowing dialogue and discussion
structured around our key themes.
Approve
Disapprove
Discuss
5. Goals
We should be realistic 'about what we can accomplish at a summit
with such a broad range of leaders. This is not the place to
agree on financing or draft legislation. Our objectives should
be more like the Education Summit -- to reach agreement on broad
goals and principles. 'The summit could be organized around a few
themes -- work, responsibility, family -- that would lead the
,saUSSion toward agre!'lllent on our key principles.
.
~
Approve
Disapprove
Discuss
6. Next Steps
TO put this plan in motion, we would like to announce on
Wednesday the date and place for the working session, in
~onjUnation with granting the Indiana welfare reform waiver.
~
Approve
Disapprove
Discuss
Based on your approval of the general framework outlined above, I
will work with Pat and Marcia to,begin outreach to NGA and
congressional staff to put the planning into motion. We plan to
conduct extensive staff work between now and the meeting and need
to get started as soon as possible.
We have a meeting scheduled with you for Friday, at which time we
can discuss the session with you in more detail.
cc:
George Stephanopolous
Pat Griffin
Marcia Hale
Bruce Reed
Rahm Emanuel
�THE: WHITE HOUSE:
WASHINGTON
MEETING WITH LEAD GOVERNORS
OF THE NATIONAL GOVERNORS ASSOCIATION
. December 8, 1994
The Cabinet Room
3:30 pm
.:
Opening Remarks
3:30
.
\~
\
Leon Panetta
We~fare-
Reform-
Discussion lead by: The President
<'1
~
pu:t euJ\
~
Discussion lead by: Carol Rasco
Balanced Budget Amendment/Unfunded Mandates
--hD~
, Discussion lead by: Leon Panetta
~~
(}\~.m~
:,
.
.~~~~~p{~\~ vnd
,
:t
�, l
�~~-
.. j
,
........
THE WHITE HOUSE
WASHINGTON
CLINTON LIBRARY PHOTOCOPY
�THE WHITE HOUSE
Office of the Press 'Secretary
December 15, 1994
For Immediate Release:
"
ADDRESS BY THE PRESIDENT
TO THE NATION
The Oval Office
9:00 P.M. EST
THE PRESIDENT: Good evening. My fellow Americans; ours
is a great country with a lot to ~e proud of.' But at this holiday
season, everybody kn'ows that all is not ,well with America; that
millions of Americans are hurting, frustra~ed, disappointed, even
angry.
'
'In this time of 'enormous change, 'our challenge is'both
political and personal. It' involves government, all right, but'it'
goes way beyond government, to the very core of what matters most to
us. The CJUestioni~, what are we going to do about it?
'
,Let's start with tha economic situation. I ran for
president to restore the 'American Dream and'to prepare the American
people to compete a~dwin in the new American economy. For too long,
too many Americans ~ave worked longer for stagnant wages and less
security. For two years, we pursued and economic strategy that has
helped to produce over five'million new jobs. But even though the
economic statistics: are moving up, most of our living standards,
aren't. It's almost as if some Americans -are being punished for.
their productivity in this new economy. We Ive got'- to change that.
More jobs aren't enbugh. We have to raise incomes.
,
Fifty years ago, an American president proposed the G.I.
Bill of Rights , to ~help returning veterans from World War II, go to ,
college, buy a home, and raise their children. That built-this
country. Tonight, ,I propose a Middle Class Bill of Rights.
'
,
, There :are four central ideas in this Bill of Rights:, '
First, college tuition should be tax deductible. Just as we make
mortgage interest 1;:ax deductible because we want'people to own,their
own 'homes, we should make college tuition deductible because we-·want
people to go to college.
Specifically, I propose that all tuition for college;
community 'college,: graduate schooliprofessional school, vocational
education or worker retraining after high school be fully deductible,
phased up to $10,000 a year for families making up to $120 ,000 'a
year. Education, after all, ha~ a bigger impact on earnings and'job
security than ever, before. So let I s invest the fruits of today IS' ,
recovery into tomo'rrow I s opportunity.
I
Second, bringing up a child is a tough job in this
economy. So we s~ould help middle-class families raise their
children. We made ,a good start last year by passing the Family Leave
Law, making college loans more affordable, and by giving $15 million
American families 'with incomes of $25,000 a year or less an average
tax cut of more t~an $1,000 a y~ar.
MORE
. ; ..J . '
~,
�\.
,~'.,
- 2
."
Now, I want to cut taxes for each .child under 13, phased
up to $500 per child. This tax cut wou;Ld be available to any family
whose income is less than $75,000~
I
Third, w~.should help middle",:,incom'e people save money by
allowing every American family earning under $100,000 to put $2,000 a
year tax-free in an IRA, an Individual Retirement Account. But I
want you to be able tq use the money to iive on, not just retire on.
You'll be able to withdraw from this fund, tax-free -- money for
education, medical exPenses, the purchases of a first home, the care
of an elderly parent. •
Fourth, since every American needs the skills necessary
to prosper in the new. 'economy -- and most of you will change' jobs
from time to ·time -- we should take the billions of dollars the
government now spends, on dozens of different training programs and
. give it .directly to y.ou, to pay for training if you lose your job or
want a better one.
We can'~ay for this Middle Class Bill of Rights by
continuing to reduce :government spending, including subsidies to
powerful interests based more on influence than need. We can sell
off entire operations the government no longer needs to run, and turn
dozens of programs oyer to states and communities that know best how
to ~olve their own problems •
. My plan; will save billions of dollars from the Energy
Department, cut down! the. Transportation Department'; and shrink 60.
programs into four at the Department of Housing and Urban
f
Development •. Our reinventing government initiat:ive, led by Vice
President Go:r;:e,. alre'ady has helped to shrink bureaucracy and free up
'.. ' .·. ,.~mon~y~t.Q_.":p'a,y~dp~w,n~the __d.ef.i(:i,t;:-a,nd_-ihy.e~t.~in-our~pe9Pl.!!a;;~-.AJ.~ead.y,., 'c'
: we I ve passed budgets to reduce the. federal government'to its smallest. .'
.. size in 30 years, and to .cut the deficit by $700 billion. That' s
over $10,000" . '
for every American family.
.
.
'
In the ;next few days, we'.ll. unveil more of our
proposals. And I've instruct.edtheVice President to review every
single government department program for further reductions •.
We've worked hard to get control. of this deficit. after'~
the government· debt incJ:"eased four times. over in the 12: years before,
I took office. That's, a:: big burden of you. About five .percent:of
your income. tax goes to pay for 'welfare and foreign aid, but 28:
percent of' it· goesltopay for interest on the debt run up between
1981 and the day I. was inaugurated president.
L challenge the new
Congress to work wfth me to enact a Middle Class Bill of Rights
without adding, to the deficit .andwithout any. new cuts in Social"
security or Medica~e.
.
I
I -know some people just want. to cut the. government'
blindly, and I know that's popular now. But I .won't do it. r.want a
leaner, not a meaner government, that's back on the side of hard
working Americans: 'a new government for the new economy --.creative,
flexible, high quality, loW cost, service oriented __ just like our
most innovative private companies .. '
I
I'll work with the new Republican majority and my,fellow
Democrats in Congress to build a new American. economy and to. restore
the American Dream'. It: won't be .easy. .Believe you me , the special
interests have not; gone'into hiding just because there was an
election in Novemb1er. As a matter of fact, they're up here stronger
than ever.. And th;at' s why, more than ever , we' need lobby reform,
campaign finance'reform and reform to make Congress live by the laws
it puts on other people.
!
MORE.
.
',;
..'
�!
I
- 3
Together" we can pass welfare reform and health care
reform that work. I' 1,1 say more about what I'll do to work with the
new Congress in the state of the Union. address in January.
But here ':s what I won't do. I won't support ideas that
sound good, but aren't paid for -- ideas that weaken the progress
we've made in the previous two years for working families; ideas, that
hurt poor people who are doing their dead-level best to raise their
kids and work their way into the middle class; ideas that undermine
our fight. against crime, or fora clean environment, or for better
schools, or for the strength and well-being of our Armed.Forces in
foreign policy. In other words, we must be straight with the
American people about,the real consequences of all budgetary
decisions.
My test will be: Does an idea expand middle class,
incomes and opportunities? Does it.promote values like family, work
responsibility and co~unity? Does it contribute to strengthening
the new economy? If it does, I'll be for it, no matter who proposes
it. And I hope Congress will treat my ideas the same way. Let's,
worry about making progress, not taking credit.
But our ~ork in Washrngton won't be enough. And that's
where you come in. This all starts with you. Oh, we can cut'taxes
and expand opportuni~ies, but governments can't raise your children,
go to school for you" give your employees who have earned it a,raise,
or solve problems in~your neighborhood that require your personal
commitment •. In short, government can't exercise your citizenship.
It works the other way aroUnd.'
,
,
'.' .'.
" , The problems
.
'
~fthis
"
, . . '
.
new world,a;r:e.complicated,arll:i
;we 'v~,:,,:~.l;~_:;qnt/',f\;:,:I;t:'~,:t.~ . ']l~a r.n i'~, • • 'rnh.at: ~,me.~,ns:,c:i:t:t:r.~ns.,J{8:v.e::. t.o 1,.~~~'t::A.~'?:,!-s
.
less.hot,rhetoricandmor,eOpenconversation;
lessmallce;and more charity. :Weneed to put aside the pol i t'icsof
personal. destruction and demonization· that have dom.inated too much of,. ,"
our debate.. Most of; us are good people trying to do better. And if
we all treated each .other that way , we would do better.. We have gc;>t( .
to bea.communityag~in.
'
.
well'as:\.'talk~':,W~need
"
.
Yes, some people do take advantage of the rest of,·us·~,-by breaking"the law, abusing the welfare system, and flaunting our
immigration laws. ~hat's wrong, and'I'm.working to stop it. But: the
truth is that most people in this.country, without regard to their
race, their religion, their income, their position on divisive
issues, most· Ame'ricans get up every day, go to work, obey the, law,
pay their taxes and :raise their' kids the best they can. And most~of"
us share the same r~al challenges in this'new economy •. We'll do,a
lot better job of meeting those challenges if we work together and
find unity and stre~gth,in our diversity.
'
We do have more in. common, more uniting us than dividing
us. And if we start acting like it, we can face the future· with ';
confidence. I'stil+ believe deeply that there is nothing wrong with
America that can't be. fixed by what's right with America. This' is '.'
not about politics as usual. As I've said for years, it's not'about
moving left or right, but moving forward; not about government' being
bad or good, but about what kind of government will best enable us to
fulfill our God-given potential. And it's not about the next
election, either. ;r'hat's in your hands.
I
Meanwh'ile, I'm going to do what I think is right. My
rule for,the next ~wo years will be: country first and politics as
usual dead last. I hope the new Congress will follow the same rule.
And I hope you will, too.
'
This country works best when it works together. For
decades after World War II, we gave more and more ,'Americans a chance
to live out their ~reams. I know -- I'm blessed to be one of them.
MORE
�·1
.-".4'
I was born to a widowea mother ata time when my state's income was
barely half ,the national averaqe;.the first person in my family to
finish college, thanks to money my parents couldn't really afford -
scholarships, loans, and a half a'.'dozen jobs: It breaks my heart to
see people with their~own dreams for themselves and their children
shattered. And I' 11\ going to do all. I., can to turn it around • But I'
need your help. We can do it.
I'
I
With all,of our problems, this is still, the greatest
country in the world";'-.standinq not at the twilight, but at'the dawn
of our greatest days.'I We still have a lot to be thankful for. Let's
all remember that.
I
,
Happy holidays, arid God bless America.
END
9:12 P.M. EST
:'.
i.,.
I
'
�Welfare Logistics FOII0w-~pIMeeting
Thursday, December 22, 1994/
3:00 - 4:00 pm
I
CHR's office
I
j
1. CHR
2.
3.
4.
5.
6.
Mark Gearan - x62640
Mary Jo Bane - 401 9200
David Ellwood - 690 7858
Bruce Reed - x66515
Emily Bromberg - 401-6953
I
I
Melissa Skolfield
John Monahan
Jerry Klepner
Rich Tarplin
I
7. Stephanie Street - x675pO
Rich Fi~zpatrick - x517~7
8. Susan Brophy - x62230 I
9. Marcia Hale - x67060
10. Glnny Terazan<;> . ,. x62580
1
11. Jeremy Ben-Aml - x65584:
I
•
I
yes.
wi
probably send designate
no
no
no
yes
yes
yes
yes
yes
no
will send designate (Major McDew)
yes
yes
probably yes, (will
1 back)
yes
I
I
I
I
I
I
I
I
!
�·
THE WHITE HOUSE
WASHINGTON
.---
-
ClolNTON LIBRARY PHOTOCOPY
�,
FRO!"!
NAV5UPPFAC THURMONT
54075
TO
P.02 '
C~~~.r. f: ~ ~\+t fdr£-{"
3q'S-\ llt
l
CABI~ ASSIGNMENTS
SVlmAY
SATURDAY
CABIN
--------~-------------~-------------------~---------~-------------------
aIRCH
MSTR (K)
SR (2 T)
-----------------------~------------~----------.-------------------------.
DOGWOOD
MSTR (K)
BR (2 T)
. '
I
------------------------------~~-------~--------------------------------
MAPLE
MSTR (K)
SR (2 T)
----------------------~----~~-~------~----------------------------------
RED OAR
MSTR (K)
SR (2 T)
-------------------------~--------------------------~--------------~----
ROSEBUD
MSTR (Q>
BR(2 T)
~~~;~x:~----------~-------]---------------------------------------
~~~:fi;;---------------r---------------------------------
-----------------------------~-------------------------------------------
HAW'l'HORlf
MSTR (K)A
BR (2 T)B
------------------------~--~-----------~-~------------------------------
SYCAMORE
I
MSTR .(K)B
SR (2 T)A
~i~;~:-:~--------------------r-----------------------------------------
-----------------~--~----------------------------------------------------
WALNll'l'
BR (2.T)
BR (~ T)
----------------------------~-I------------------------------------------
WITOH HAZEL
BR (2 T)A
(~ T) B
,
.
I
ugr~-~~----------------~T-------------------------------------
,
I
-----~----------------------~------------------------------------------
Key:
MSTR
BR
K
=
.. Mastersize bed
Bedroom
... K1ng
T = Tw1n size bed
TOTAL P.02
�I
WithdrawallRedaction Marker
Cllinton Library
, I
DOCUMENT NO.
AND TYPE
003. fax
DATE
SUBJECTffITLE
0211611994
Personal business (9 pages)
RESTRICTION
Personal Misfile
I
I
i
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8506
FOLDER TITLE:
[Welfare Reform Legislation] [5]
I
20 I0-0 198-S
kc228
,!
I RESTRICTION CODES
I
Presidential Records Act - [44 U.S.C. 2204(a)J
Freedom of Information Act· [5 U.S.C. 552(b)J
PI National Security Classified Infor~ation [(a)(1) of the p~J I
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRAJ
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRAj
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
I
I
I
C. Closed in accordance with restrictions contained in donor's deed
of gift.
I
PRM. Personal record misfile defined in accordance with 44 U:S.C.
2201(3).
RR. Document will be reviewed upon request.
bel) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b )(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b){6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
.
b(8) Release would disclose information concerning the regulation of
.
financial institutions [(b){8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b){9) of the FOIA]
�-..
-
-
RETAIL PRESCRIPTION DRUG CLAIM FORM
Service Benefit Plan for Federal
Employees and Retirees
BlueCross BlueShield
Federal Employee Program
PLEASE TYPE OR PAINT IN All CAPITAL LETIERS. SEE REVERSE FOR INSTRUCTIONS
SUBSCRIBER INFORMATION
-
This claim form is to be used for retail pharmacy prescriptions only. Please submit ali
SUBSCRIBER'S NAME & AOORESS other charges to your local Blue Cross Blue Shield Plan.
I I I I I~
-
-
~
SUBSCRIBER'S SOCIAL SECURITY NUMBER
Illmllll o
MARK
IF NEWADDRESS
PATIENT INFORMATION
-
-
-
-
-
-
-
-
IR I I I I I I I I
I
""
-
Mail completed form to:
Service Benellt Plan
Retail Pharmacy Program
P.O. Box 52057
Phoenix, AZ 85072-2057
For information, call
1-800-624-5060
IDENTIFICATION NUMBER
PATIENTS RELATIONSHIP TO SUBSCRIBER
Salf
0 Spouse 0 Child
o
~ Is
the pallenl covered by Meo'ocar Pan 8?
0
Yes
0
No
If yes, effective dale of coverage _ _--'-_ _ _'--_ _
'If the patient does not
" yea, etlective dale of coverage _ _ ---'-_ _ _'--_ _ have other prescription
drug insurance, please
skip to the "Pharmacy
~ Old the pallenl use aPresalptroo Drug Card from the other I ural w
pure!' ng mesa pr
puons I
Yea 0 No
information" section.
Please attach a copy of the Notice of Payment or Explanation of Benefits from the other Insurer, if available.
~ Is lhe pallent covered by addJliooal prescnpllon drug Insur3nce1
0
Yes
0
No'
o
PHARMACY INFORMATION
PHARMACYNAME _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___
STREET _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
PHARMACY 10# or NABP #
(If Available)
CITY, STATE, ZIP _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
PHONE
(
DJi IIIII
PRESCRIPTION INFORMATION
INSTRUCTIONS
~
,
,Ai
1. If you received your prescription(s) from a Preferred pharmacy and used your
Service Benefit Plan drug card, just complete boxes A, B, C & O. Otherwise,
complete ALL Prescription Information boxes below, except the claim authorization
number box O. If you do not have all the information, please call your pharmacist.
R~ NUI~BE~
B, t ITE RXILLED
, " 'iTtt
I
Dhj,. tW.l£ !iT1![l.(lTH AND FOP}."
C,
S~IMC
',If " I
JNT r.1-I,
Rr.1
2. Tape your receipts to the back of the form.
3. Use additional forms if you have more than three
prescriptions or you are filing for more than one family
member.
0, C .AI~IAL rHC HIL IlL
NL MBER(lf
.'HI:iIlIl
I
O!I\J.., MANUFACTURER ."
._,
-
I I I I I I I I I I I I I I I I IITIJ H"f_~Lt I I I I I I I I I I
-
~ I I AI
, II i f I 'I I I I I I I I
-
-
-
I I I I I I I I I I I I I I I I IITIJ o l 11 11' , , , ,
-
-
> 1I I I I I I II I I I I~IAA II I I I I I I I
_
J
OUIoNTfH
mTlOIlAI.. tlPlIG COIlE INOeI
A' NU"BEA
B.D
~Im
IH: .8X.
'Il@
I,-\'j 011 REFill
C. SAMOUNT CHARGED
,
DRUG .... r.tE $TPB-KlTHANO FORM'"
NADOt>AI. OmtG cooe; "IOCI
DAVS SUPl'L'/
CMJIJ'<T!TY
DAVSSUPl'\.V
PP£SCllIB,t"l PIIVc;JCIA.11 S ll&I UUI.!!IEI'I 00 NAME
0, C .AlII AL 1t\I.JHlfr ,IIUN
I\lt IURI=R
(If
ft, '1 1,1.'
II
ORUC\ lllNoIUFACTUREH Y
~WOAAEFIU.
0
I
, PI1~ SIClAN
SI
-
!NMIE
~
REf
A. RXNUMBER
B. DATE AX FILlED
C. $ AMOUNT CHARGED
OIiUG tW,'£, S1lIEMiTH ~NO fOIW ."
D. eLA1l1 AL rHO RI4I ,IIQi I NlllARI=R (I! ,~""
D!·iJG M.v.~ACTlIREIi'"
...
-
z
-
, , , , , I , , , ,, I , , " , , , n
0
N~-roNAL ORUO
OOCI' ;M.Cj
SUBSCRIBER CERTIFICATION
OUA/ffiT'i
DA~ 5 SUPPI.Y
NEW OR FlEfII.L
"E~ILI
. I PHrliJCJMI1I OLMI1IIJ&R 01' ,~
,hi
51
1-
I~
,,,,IIIII
I certify all informalion provided on Ihis form 10 be true and correct 10 the besl of my knowledge:
SU8SCRIBER'SSIGNATURE _ _ _ _ __ _ _ _~---------------------
Dale _ _ _'--_ _-'--_ _
�INSTRUCTIONS
1. Please complete a separate claim form for each patient.
2. Send original receipts only. Photocopies of receipts are not acceptable, except when submitted
with another carrier's explanation of benefits or notice of payment.
3. When you have completed this form, tape your itemized receipts on this page. PLEASE TAPE only the
top and bottom edges of the receipt.
4. Itemized receipts for covered prescriptions are required and must include the following:
• Name and address of the pharmacy
• Full name of the patient
• Date filled
• Name of drug, strength (e.g., 500 mg) and dosage form (e.g., capsules, liquid or cream)
• Prescription number
• Charge for each prescription
5. A Preferred pharmacy will supply you with the Claim Authorization Number to be included on this form.
This does not, however, always represent an approval for benefits. The final benefit determination will
be made when this claim is processed.
6. You must answer the Medicare Part B and other prescription drug insurance questions in the
Patient Information Section and sign at the bottom on the front of this form or your claim will be
returned.
7. Only claims for prescriptions purchased from a retail pharmacy are to be sent to the address on the
front. Claims for all other services should be sent to your local Blue Cross and/or Blue Shield Plan
using a Federal Employee Program Healtn Benefits Claim Form. Example of claims sent to your local
Blue Cross and/or Blue Shield Plan includes:
•
•
•
•
Prescriptions filled before January 1, 1993
Drugs dispensed by a physician or hospital including allergy sera
Home health care medications
Durable medical equipment
8. If you are outside the U.S. or Puerto Rico, continue to submit all of your claims, including those for
prescription drugs, on the regular Overseas Claim Form. Send those claims to: FEP Customer Service
Dept., 550 12th Street SW, Washington D.C. 20065-8344.
9. Claims must be submitted no later than December 31 of the calendar year following the year in which
the drug was purchased.
• Form MUST be filled out in
ALL CAPITAL LETTERS.
• Please use black or blue ink pens to fill out this form.
• Do not use felt tip pens or red ink pens.
NAME
IJblHll I IDkJlEI I I I I I I
N
l
OFFICE USE ONLY
• Mark the appropriate areas as shown:
COmlCt
IXI
•
er
Incorrect
[!)
8
�II
II
I
,
I
-
..
RETAil PRESCRIPTION DRUG CLAIM FORM
Service Benefit Plan for Federall
Employees and Retirees
BlueCross BlueShleld
-
-
Federal Employee Program
.pLEASE TYPE OR PRINT IN ALL CAPITAL LETTERS. SEE REVERSE FOR INSTRUCTIONS.
SUBSCRIBER INFORMATION
This claim form Is to be us8d for retail pharmacy prescriptions only. Please submit all
• • I • •
other charges to your local Blue Cross Blue Shield Plan.
-
IDENTIFICATION NUMBER
IR I I I I I I I I
I
OR
PO Bot
~Iumbof
SUBSCRIBEA'S SOCIAL SECURITY NUMBER
Mall completed form to:
Service Benefit Plan
Retail Pharmacy Program
P.O. Box 52057
Phoenix, AZ 85072·2057
For information, call
1·800-624-5060
Illmllll o
MARK
IFNaY ADDRESS
PATIENT INFORMATION
::iNT'S
Last
PATIENT'S DATE
OF BIRTH
-
I I I I I I I I I I I I I I I I I IR~t I I I I I I I I I I I
: 1,=I.=
r; ~I==:::I~:::::I-.L-...I.-..L........L...;:::::=PA=Jl=ENT=S=EX~~-'
S=
0
0
.
Male
Initial
D
PATIENT'S RELATIONSHIPTO SUBSCRIBER
Self
0 Spow;
0 Child
o
Female
"'Is the pallen! covered by Medicare Part 91 0 Yes 0 No II yes, effective dale of coverage _ _ ---'-_ _ _'--_ _
'lithe patient does not
"' Is the pallen! covered by additional prescription druginsurance?
0 Yes
0 No'
II yes, effectiva date of cOvlrege _ _--.L._ _ _L--_ _ have other prescription
drug insurance, please
skip to the ' Pharmacy
• Dltl the pauenl LIse a Prescription Drug Card Irom Ihe other Insurer when purchasing these prescriplions?
D yes DNo
Inlormation' section.
Please attach a copy of the Notice of Payment or Explanation of Benefits from the other insurer, If available.
-
PHARMACY INFORMATION
-
-
PHARMACYNAME _________________________________________
STREET _______________________________________________
CITY, STATE, ZIP _ _ _ _ _ _ _ _ _ _ _ ____________ _ _ __
PHARMACY ID# or NABP #
(If Available)
PHONE (
[]] IIIII
PRESCRIPTION INFORMATION
INSTRUCTIONS
-
-
C, SAMOI JNT CHARGED
B, DATE RX FILLED
A. AX NUMBE=i
-
~ I I I
! II I
I I' I I ! I I
CLAt ~ IAL 1MUHILA IIU,
I Nl ,MBEA
(II ,Au..liohl,,'
DRUG MANLIFAC;TURER "
I I ! ! I I I I I I I ! I I I I II~rr!
OIJANTITV
I I! I ' I I II I
- I I I I I I I I I I I I I J-' I
-
~; .?AT7~RT cl ''' oul
- I>
PRESCRllIIlIOPt t y~ ;Clm8 Oe.-IiUt.lBfA OR NAME
NEWOR REFILL
R~
C. $ ,Me JNT CHtRGI D
B. [ ITERX ILLED
I I A A' NU"BEA
I
O.
. 'I ;I;;I[":a1
DRUG NMtE, STRENOni ANtI FORM "
NATlONAL ORUG COOE IHOCI
>
2. Tape your receipts to the back of the ionn.
3. Use additional fonns il you have more than three
prescriptions or you are filing for more than one family
member.
1. If you received your prescription(s) from a Preferred pharmacy and used your
Service Benefit Plan drug card, just complete boxes A, B, C & D. Otherwise,
complete ALL Prescription Infonnation boxes below, except the claim authorization
number box D. If you do not have all the infonnation, please call your phannacist.
I I ..A" I I I I I I I
I
D. C
IALrHa Ril. riO! ! NlIMBER_
otI.
uj
DRUG I(4ME, STFIENIffit ANO FOOM "
:::l
DRoo MAN!Jf.u;nJRER "
.5
~
c:
QUANTlTY
NAOOIIAl. 0Il00 COD E1
NOel
t
CAYS SUPl'\.V
/lEW OR fia'lU.
o
o
N
NEW
REFILl.
I'l
I I
-
Ai AXNUMBER
~
l
~
a:
a.
1I.4TlCNAl. DRUG COPE (NOCI
II
I I
IIII
0, CLA fMAL MUHILA I IUI NL!~ IBEI
OAUG MANUFACTVRER T
SUBSCRIBER CERTIFICATION
n.
OUAH11TY
I I I
III II1
II
ORUG NAI.IE, S1'REI'KmIANO FORM ..
~
w
0
w
I II
,PH'fSiClAA'S OEA NUt.fllER 00 NAME
IIII
II
NEWOR,Ii.EFIll.
I
R:u. I
...
, PHYSlGIA!('S!lEA IIUt.mER OR NMi£
I I I
II
I certify all information provided on this form to be true and correct to the best of my knowledge:
SUBSCRIBER'SSIGNATURE _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Date _ _ _.!....-_~_'_~_
�INSTRUCTIONS
1. Please complete a separate claim form for each patient.
2. Send original receipts only. Photocopies of receipts are not acceptable, except when submitted
with another carrier's explanation of benefits or notice of payment.
3. When you have completed this form, tape your itemized receipts on this page. PLEASE TAPE only the
top and bottom edges of the receipt.
4. Itemized receipts for covered prescriptions are required and must include the following:
• Name and address of the pharmacy
• Full name of the patient
• Date filled
• Name of drug, strength (e.g., 500 mg) and dosage form (e.g., capsules, liquid or cream)
• Prescription number
• Charge for each prescription
5. A Preferred pharmacy will supply you with the Claim Authorization Number to be included on this form.
This does not, however, always represent an approval for benefits. The final benefit determination will
be made when this claim is processed.
6. You must answer the Medicare Part B and other prescription drug insurance questions in the
Patient Information Section and sign at the bottom on the front of this form or your claim will be
returned.
7. Only claims for prescriptions purchased from a retail pharmacy are to be sent to the address on the
front. Claims for all other services should be sent to your local Blue Cross and/or Blue Shield Plan
using a Federal Employee Program Health Benefits Claim Form. Example of claims sent to your local
Blue Cross and/or Blue Shield Plan includes:
•
•
•
•
Prescriptions filled before January 1, 1993
Drugs dispensed by a physician or hospital including allergy sera
Home health care medications
Durable medical equipment
8. If you are outside the U.S. or Puerto Rico, continue to submit all of your claims, including those for
prescription drugs, on the regular Overseas Claim Form. Send those claims to: FEP Customer Service
Dept., 550 12th Street SW, Washington D.C. 20065-8344.
9. Claims must be submitted no later than December 31 of the calendar year following the year in which
the drug was purchased.
• Form MUST be filled out in
ALL CAPITAL LETTERS.
• Please use black or blue ink pens to fill out this form.
• Do not use felt tip pens or red ink pens.
NAME
IJblHINI IDOIEI I I ~ I I I
OFFICE USE ONLY
• Mark the appropriate areas as shown:
Correct
rKJ
•
Inc:omJct
Et
I!l
8
�- ..
-
RETAIL PRESCRIPTION DRUG CLAIM FORM
I
Service Benefit Plan for Federal
Employees and Retirees
BlueCross BlueShleld
Federal Employee Program
PLEASE TYPE OR PRINT IN ALL CAPITAL l .ETTERS. SEE REVERSE FOR INSTRUCTIONS.
SUBSCRIBER INFORMATION
-
This claim form Is to be used for retail pharmacy prescriptions only. Please submit all
•
. .•• •
other charges to your local Blue Cross Blue Shield Plan.
-
IDENTIFICATION NUMBER
IA I I I I I I I I
I
I I I I IS-Itl
SUBSCRIBER'S SOCIAL SECURITY NUMBER
Illmllll
DMARK
IF NEW ADDRESS
PATIENT INFORMATION
~~~~NT'S Last I I I I I I I I I I I I I I , I I If1rsl I I , I I I , I , I
PATIENTS RElATIONSHIP TO SUBSCRIBER
6~n~~;;DA~ ~I~~I=;~~I~~~I~--~~~~D==~=~=E=Nr=8=~=~==ale~~
o Sell D Spouse 0 CMd
-
'Inillal
0
DYes
~ I tho patient covered by Medicare Part 6?
0 No II yes, effective date 01 coverage _ _--'-_ _ _'--__
'11 Ihe palient does not
. Is Ihe paIIenl covared by additional prescnplion drug In ullInce?
0 Yes
D No'
If yes, effectivi dat or cOvl!f1Ige _ _--'-_ _--L1___ have other prescription
drug insurance, please
skip to Ihe 'Pharmacy
,. Old lhe patlllni use a Prescripllon Drug Card Irom the other Insurer when purchasIng these prescriptions?
DVes ONo
Information' seclion.
Please attach a copy of the NotIce of Payment or Explanation of 6eneflta from the other insurer, If available.
-
PHARMACY INFORMATION
-
PHARMACYNAME __________________________________________
PHARMACY 10# or NABP #
(If Available)
CITY, STATE, ZIP _______~--------------------------------- PHONE (
STREET _______________________________________________
ITH
IIIII
PRESCRIPTION INFORMATION
INSTRUCTIONS
1. If you received your prescription(s) from a Preferred pharmacy and used your
Service Benefit Plan drug card, just complete boxes A, B, C & O. Otherwise,
complete ALL Prescription Information boxes below, except the claim authorization
number box O. If you do not have all the information, please call your pharmacist.
2. Tape your receipts to the back of the form.
3. Use additional forms if you have more than three
prescriptions or you are filing for more Ihan one family
member.
D. C..AI' 'AL rHC Rill rlOI Nl MBER)lf Availablel
.'liI'
I
- I I I I I I I I I I ! I ! I I I JITIJ
- I I I II
II C.
DRUG MANUFACTU~ ,.
IlI'lUO NAME. S'mEN01l1 AND FOR"'''
NATIO/W. DflUG CODE (NOCI
_ <~
ClUAlITm
DAYSSUl'f'lY
?ATE~X~
A. RXNUMBa,
~
_
Mall completed form to:
Service Benefit Plan
Retail Pharmacy Program
P.O. Box 52057
Phoenix, AZ 85072-2057
For Information, call
1-801l-624-5060
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SUBSCRIBER CERTIFICATION
I certify all Information provided on Ihis form 10 be lrue and correct to the best of my knowledge:
SUBSCAIBEA'SSIGNATUAE _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Dale _ _ _'--_ _-'--_ _
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I
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INSTRUCTIONS
1. Please complete a separate claim form for each patient.
2. Send original receipts only. Photocopies of receipts are not acceptable, except when submitted
with another carrier's explanation of benefits or notice of payment.
3. When you have completed this form, tape your itemized receipts on this page. PLEASE TAPE only the
top and bottom edges of the receipt.
4.
•
•
•
•
•
•
Itemized receipts for covered prescriptions are required and must include the following:
Name and address of the pharmacy
Full name of the patient
Date filled
Name of drug, strength (e.g., 500 mg) and dosage form (e.g., capsules, liquid or cream)
Prescription number
Charge for each prescription
5. A Preferred pharmacy will supply you with the Claim Authorization Number to be included on this form.
This does not, however, always represent an approval for benefits. The final benefit determination will
be made when this claim is processed.
6. You must answer the Medicare Part B and other prescription drug insurance questions in the
Patient Information Section and sign at the bottom on the front of this form or your claim will be
returned.
7. Only claims for prescriptions purchased from a retail pharmacy are to be sent to the address on the
front. Claims for all other services should be sent to your local Blue Cross and/or Blue Shield Plan
using a Federal Employee Program Health Benefits Claim Form. Example of claims sent to your local
Blue Cross and/or Blue Shield Plan includes:
•
•
•
•
Prescriptions filled before January 1, 1993
Drugs dispensed by a physician or hospital including allergy sera
Home health care medications
Durable medical equipment
8. If you are outside the U.S. or Puerto Rico, continue to submit all of your claims, including those for
prescription drugs, on the regular Overseas Claim Form. Send those claims to: FEP Customer Service
Dept., 550 12th Street SW, Washington D.C . 20065-8344.
9. Claims must be submitted no later than December 31 of the calendar year following the year in which
the drug was purchased.
• Form MUST be filled out in
ALL CAPITAL LETTERS.
• Please use black or blue ink pens to fill out this form.
• Do not use felt tip pens or red ink pens.
NAME
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OFFICE USE ONLY
• Mark the appropriate areas as shown:
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Incorrect
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RETAIL PRESCRIPTION DRUG CLAIM FORM
Service Benefit Plan for Federal
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BlueCross BlueShield
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Federal Employee Program
PLEASE TYPE OR PRINT IN ALL CAPITAL LETTERS. SEE REVERSE FOR INSTRUCTIONS.
SUBSCRIBER INFORMATION
-
ThIs claIm form Is to be used for retail pharmacy prescrIptions only. Please submit all
';I~~"t other charges to your local Blue Cross Blue Shield Plan.
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Retail Pharmacy Program
P.O. Box 52057
Phoenix, AZ 85072-2057
For information, call
1-800-624-5060
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IF NEW ADDRESS
PATIENT'S
NAME
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Yes
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0 Yes
No'
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Please attach a copy of the Notice of Payment or explanation of Benefits from the other Insurer, If available.
-
drug insurance, please
skip to the ' Pharmacy
Information' saction.
Dyes DNo
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PHARMACY INFORMATION
-
PHARMACYNAME _________________________________________
STREET ___________________ _ _ _ _ _ _ _ _ _ _ _ _ ___
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CITY, STATE, ZIP ____________________________
PHARMACY 10# or NABP #
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PHONE (
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PRESCRIPTION INFORMATION
INSTRUCTIONS
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complete ALL Prescription Information boxes below, exceptlhe claim authorization
number box D. 'If you do not have all the information, please call your pharmacist.
B. DATE RXILlED
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2. Tape your receipts to the back of the form.
3. Use additional forms if you have more than three
prescriptions or you are filing for more than one family
member.
1. If you received your prescription(s) from a Preferred pharmacy and used your
Service Benefit Plan drug card, just complete boxes A. B, C & D. Otherwise,
DRUG MANl5ACTUAEFI'"
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-
SUBSCRIBER CERTIFICATION
1 certify
all information provided on this form to be true and correclto the best of my knowledge:
SUBSCRIBER'SSIGNATURE _ _ _ _ _ _ _ _ _ __
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Date _ _ _'--_ _'--_ _
�INSTRUCTIONS
1. Please complete a separate claim form for each patient.
2. Send original receipts only. Photocopies of receipts are not acceptable, except when submitted
with another carrier's explanation of benefits or notice of payment.
3. When you have completed this form, tape your itemized receipts on this page . PLEASE TAPE only the
top and bottom edges of the receipt.
4. Itemized receipts for covered prescriptions are required and must include the following:
• Name and address of the pharmacy
• Full name of the patient
• Date filled
• Name of drug, strength (e.g., 500 mg) and dosage form (e.g., capsules, liquid or cream)
• Prescription number
• Charge for each prescription
5. A Preferred pharmacy will supply you with the Claim Authorization Number to be included on this form.
This does not, however, always represent an approval for benefits. The final benefit determination will
be made when this claim is processed.
6. You must answer the Medicare Part B and other prescription drug insurance questions in the
Patient Information Section and sign at the bottom on the front of this form or your claim will be
returned.
7. Only claims for prescriptions purchased from a retail pharmacy are to be sent to the address on the
front. Claims for all other services should be sent to your local Blue Cross and/or Blue Shield Plan
using a Federal Employee Program Health Benefits Claim Form. Example of claims sent to your local
Blue Cross and/or Blue Shield Plan includes:
•
•
•
•
Prescriptions filled before January 1, 1993
Drugs dispensed by a physician or hospital including allergy sera
Home health care medications
Durable medical equipment
8. If you are outside the U.S. or Puerto Rico, continue to submit all of your claims, including those for
prescription drugs, on the regular Overseas Claim Form. Send those claims to: FEP Customer Service
Dept., 550 12th Street SW, Washington D.C. 20065-8344.
9. Claims must be submitted no later than December 31 of the calendar year following the year in which
the drug was purchased.
• Form MUST be filled out in
ALL CAPITAL LETTERS.
• Please use black or blue ink pens to fill out this form.
• Do not use felt tip pens or red ink pens.
NAME
IJOI'HINI IDKJIEI I I I I I I
I
.
OFFICE USE ONLY
• Mark the appropriate areas as shown:
COffecl
~
B"
Incorrect
~
8
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. letter
DATE
SUBJECTrrITLE
03/31/1993
Blue Cross Blue Shield paperwork (4 pages)
RESTRICTION
Personal Misfile
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8506
FOLDER TITLE:
[Welfare Reform Legislation] [5]
20 I0-0 198-S
kc228
RESTRICTION CODES
Presidential Records Act • [44 U.s.c. 2204(a)]
Freedom of Information Act - [5 U.s.C. 552(b)]
PI National Security Classified Information [(a)(I) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of tbe PRA]
b(1) National security classified information [(b)(I) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the "'OIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance witb restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. form
DATE
SUBJECTffITLE
Federal Employees Health Benefits Program enrollment (l page)
02/2811993·
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8506
FOLDER TITLE:
[Welfare Reform Legislation] [5]
2010-0 198-S
kc228
RESTRICTION CODES
Presidential Records Act. [44 U.s.C. 2204(a)]
Freedom of Information Act [5 U.S.c. 552(b)]
PI National Security Classified Information [(a)(1) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets 01' confidential commercial 01'
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, 01' between such advisors [aX5) of the PRA]
P6 Release would constitute a clearly unwal'l'anted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b )(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Carol Rasco - Issues Series
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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92 folders in 7 boxes
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Dublin Core
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Title
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[Welfare Reform Legislation] [5]
Creator
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Domestic Policy Council
Carol Rasco
Issues Series
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2010-0198-S Segment 2
Is Part Of
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Box 127
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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2010-0198-Sb-welfare-reform-legislation-5
-
https://clinton.presidentiallibraries.us/files/original/a01351bd4851156dd91f7b1b3d77105b.pdf
421269901388126dbb2078249eaa9de5
PDF Text
Text
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Workin9 Session on welfare Reform
;Loqistics
Whel'e:
The Blair House
Entrance at 100 Jackson Place
Washington, DC
Access to Blalr House for all participants is at
this entranc. only
security check will occur at this entrance only
I
ftell:
•
saturday January 28, 1995 .
8:00 am -1:30 pm
1
I
Continental Breakfast begins at 8:00 am
Working Session begins promptly at 8:30 am
Working Lunch served at approximately Noon
Session will: end at approximately 1:30' pm
Attl !ndance:
Each participant is limited to one staff person
The Secret S,ervice will allow only one' staff
person per participant into Blair House
All staff must give their date of birth and social
security number to Naomi Goldstein at:
'(202) 690 - :7858 (ph)
(202) 690 - ,7383 (fx)
Par] :iJlg: .
There is no 'reserved parking available at Blair
House
PhoJ,e Hum.ber:
On Saturday~ January 28 only, Blair House can be'
contacted at:·
I
(202) 393 - 6492
(202) 647 -;0668
Secl:rity:
Secret Serv~ce provides security when the
President is at Blair House
A holding rpomwill be provided for all other
protective ~etails
Pre! ~s:
Blair House' is closed to the press
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MEMORANDUM
EMILY BROMBERG
c/e OmCE OJ'·Tinc SECHTHY,
FROM!
BDiEDIC'J'E VAmtN.'TINER
DATE:
JANUARY 2.3. 119.
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SUBlECT. PRESIDENT CLINTON'S WKUAU REFORM
WORKING SBS~ON. SATURDAY, JANUARY 21. I'"
TbCac arc
O'GI'
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meaus,
aext Satarday:
I
CONTINENTAL BREAKFAST
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MU:FFINs
A CROISSANTS
APJUCOT..c:HP2SEDANlSH
:APPLB TURNOVERS
RAsPBERRY PINWHEELS
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P.03
�January 19, 1995
WORKING SESSION ON WELFARE REFORM
Tentative Agenda
Goal: To explore vigorously and thoughtfully the key issues surrounding welfare refonn with
elected officials from all levels of government. In a small, off-the-record fonnat, participants will
be able to speak openly and prac;:tically about the critical policy questions.
Structure: The working, session will include a mix of Governors, members of Congress, state
legislators, and local officials, both Democrats and Republicans. It would be divided into
discussions of four topics. Approximately one hour would be available for each issue. For each
topic, several designated participants would' begin with very brief presentations designed to help
frame the issues from their perspectives. Discussion'would then be open-ended with the President
acting as a participant/moderator.
Topics: The list of topics could include:
)york/Welfare--This discussion would focus on ways to make welfare transitional and to move
"people ihto work. Work requirements, time limits, and job opportunities would be induded in this
. discussion.
I
The primary topic in this category would be th~ need for non-custodial
lJa~ " ..uo to do their share to support and nurture their children. rKey issues would include specific
ways to' estabiish paternity, improve child support enforcement, and the proper role of the states and '
federal government in these efforts.
~Teen Pregnancy/Out-of-Wedlock Childbearing--This category'centers on strategies to reduce t,een
~regnancy
andout-of-wedlock childbearing. -Specific ideas include community-based prevention
strategies, eliminating benefits to minors and children born to minors, and requiring minor parents
to complete school and live with a responsible adult.
j
State Flexibility~- This discussion would include creating more flexibility within the individual
entitlement structure, block grants, entitlement versus discretionary' -funding, and waiver issues.
I'
--,
";
'"
�Conference Call With State & Local Elected Officials
In Preparation for Welfare Working Session
January 23, 1995
Conference Call Numbers:
456-6755
456-6766
Code Number: 4059
Uat vf Participants
Mayors
Greg Lashutka (R)
Mayor of Columbus, Ohio
** Joseph Serna, Jr. (0) (has not yet been confirmed)
¥ayor of Sacramento, California
county Officials
Yvonne Brathwaite Burke (0)
Chair, Los Angeles County Board of Supervisors
Michael Pappas (R)
Freeholder, Somerset County
. Summerville, New Jersey
State Legislators
J
Wayne Bryant (0)
.
i Assemblyman of the State of New Jersey
James Lack (R)
Senator of the State of New York
"
'j
Administration Officials
I
Marcia L. Hale
Carol Rasco
Bruce Reed
John Monahan
�. Welfare Reform
Talking Points:. Welfare Working Session
,January 20, 1995
This working session has been an Important step in an honest bipartisan dialogue about
what we must do to fix this country's broken welfare system. President Clinton has sought
to reform welfare for years, and welfare reform isa top priority for his Administration,
Congress, governors, local officials and the American people. Todayhe~brought leaders
. together from around the country to look. for common ground on the problems and solutions
. to welfare reform.
.
The American people want their elected officials to put aside politics and work In new ways
· o solve the,r problems. With this vision, President Clinton met today with Democratic and
t
Republican governors, local officials and members of Congress to discuss a common gOill:
making· welfare a transitional system leading' to work.
Today's session proved that when we put aside politics as usual, the distance betwee'n our'
goals for welfare reform is not very great. Although we did not anticipate reaching a'
consensus at this session, we did learn that there are some fundamental provisions for
reform on which we can all agree. Democrats and Republicans agree that anyone who can
work should do so, that welfare reform should include time Jir,nits, and. that anyone who
brings a child into this world ought to be prepared to raise the child and take financial and
personal responsibility for that child's future: And we agree the.t teen pregnancy end out
of-wedlock childbearing are important problems that must be addressed through
comprehensive welfare reform.
While there are areas where we disagree, ,we will continue our efforts to ~nd a bipartisan
· consensus. 'We are committed to working together across party lines to produce real,
lasting change. The American people deserve a government that honors their values and
spends their money wisely, and this common goal must guide our efforts to reform welfare
over the coming months. We don't want politics to get in the way of fixing a welfare
system that needs fundamen~al change.
.
Real measures t,o help welfare recipients move from welfare to work must be a central part
of any reform plan. The President put forward a strong centrist proposal earlier this year
with work requirements, time limits, and temporary supports like education, training, and
child care. We won't have' ended welfare as we know it until the central focus of the
program is to move people off welfare and into a job so that they can support themselves
and their families.
· Welfare reform is part of our larger effort to reward work and responsibility in every
government program. The Earned Income Tax Credit has already been signed into law,
cutting taxes for 1 5 million working Americans and creating an incentive to work and stay
'off welfare. As a next step, the Middle Class Bill of Rights will reduce taxes for millions
more Americans who work hard to save money, raise their children and train for a better
· economic future. The welfare system, like the tax system, must be changed to reward
. work and responsibility.
\.
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28 chairs at table:
~~'-~
POTUS
VPOTUS
Panetta
Shalala
Rivlin
Rasco
12 members of Congress
.~ ~EU,~--+--'::Ji
6 Governors
4 locals (Hale still determining configuration) ~'f \H"~J''''
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. viii .~ .... . " ~:Orfi
Griffin still receiving a lot of pressurWf't.o expand Congressional
list, particularly from Daschle who wants to send Mikulski and
Breaux as his designees. Griffin says he(Pat) is willing to hang
tough on NOT increasing the numbers if we all remain tough.
.--.'
In addition to numbers of chairs at the table, there is the issue
of sleeping accommodations .... it is going to be difficult if we
---'add to' the number,·and-·I-a·ssurne--if-....e-'add--cn- the_('D1~side.:--wemust~ ____- '",. ~_,=--o
add to the (R) side.
.
Do you agree we keep the numbers as currently configured?
ISSUE 2:
Staff .•.•. there is significant pressure from Congressional
members and Governors for each of them to have at a minimum ~'rii~.
staff member present. At present we had talked about limited
staff if any .•• that will not be feasible as the group will
probably never reach agreement on which person gets to send
his/her staff.
�:r: ~ ~tr1 hM" to oj- ~~ '~
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THE WHITE HOUSE
WASHINGTON
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14:57
FRI]~l
CDF 8TH FL':'62-.::S80
1,-,
T:.:E ?RESiJtNT HAS 7Nj
.
? - ~ ~~ .
. January 30, 1995
The Honorable William 1. Clinton'
President
The White House '
1600 Pennsylvania Avenue
Washir~loIl, D.C. 20500
Dear Mr. President:
Thank you for singling out Head Start. immunizations, childhealth, WIC,schoollunehes, and gun
fUI your \:CI.ll tu nuse the minimum wage 111 your State ofthe Union Addn::ss. And t.b.anb for the
passion with which you spoke against putting poor children out in the streets.
cunlrul, wu]
Thi~
letter ill tn urge ynu t.n nght unwaveringly to maintain tbe entitlement status or key ch.Dd
survival programs includin: AIDe, food stamps, foster care and adoption assistance, child nutritioo,
Med1cdd, SSI, aDd cl.illd suPP011 enfol"cement. And that messace must be trammittecJ dearlY and
ilnmediately to Democratic aovemors and to tbe Congress who are letting muddied or DO slpals from
your Administration. While we face a multi-front war,.against the Medusa·Jike Contract with America which
would r('("ldessly slash protections for chiMr~n lmd the poor, t.he ~ngle mo.d important and defining ksue
is the entitJemeDt battle. If we lose this. battle. we lose the hard~made federal safety net for children. poor,
, disabled~ and dtl~rly in til1l~ uf ul1jJ.rcUiclaul~ ualwal a.nu economic disasters, and we lose the moral anehor
a decent national government must provide all of its children and citizens regardless of where they live.
.
,
It 'W~uld be. the. be.ight of tnagi~ irony for the New n~l'~ mMt important legacy or iaatloDal coneem
for the needy to be dismantled during your watch.
'
I
For decades, the federal government has assured the availability of funds for key child survival
programs because the consequences of not doing so .- \\idespread childhood destitution, hunger, homelessness,
illne'$$, abuse, ~nd np,g1f!ct ~. are llnthin1rnhle. , Yet ~ome governors seem to be on the verge of forgettina why
child survival pro&rams are funded. on an entitlement basis and are willing to forego the. federal funding
~U;;UAl\le(;:S
jn exchan,e for greater control over the deUtJ' and implementation of these pro,rams.
As a former governor I you know the enormous risks for state and lc:x:al taxpayers as well as tor ChUdten
documented need. When recession or natural disaster hits and
" caselo8ds rise, states will exhaust their federal funds and have no choice butto set.up waiting lists, cut benefits
a.ml SCI V lees across the board, or make up the shortfall with state and local dollars. The automatic stabilizing.
effects of child survival programs channelirig additional funds into states and regions during 'economic
in sp.vP.rine the linle hetween funding levels and
~ 5 E S!r(:,,:, NW
'. W~n, DC :W()ill
Telepl'w:lnc :WZ b28 IIift7
Fax 2'n.662 l~1O
�:Ar j- 30-1995
14: 58
FROM
TO
CDF 8TH FL. b62- 3580
2
.
.
downturns will be lost. And noiwithstanding any pledges by the congressional leadership this yea.r,funtfutg
for th~ programs in future years could be slashed repeatedly in response to tight discretionary spending caps.
How can w:e contemplate circumstanc~ under which a penniless mother and child might be turned away
from a county or city wel:fa.r'e office simply because AFDC Cum.b f()r .lhal monO! ur year alrc='d.uy bad IJc;;gI
spent? What p1JllX'se will be served by denying hungry children school lunches or food stamps that ensure food
on the table at dinnertime? .And who can imagine the suffering if children fa~ng imminent danger of abuse
or neglect are placed on waiting lists rather than removed
immooi~tely
from their hom~!I?
Much £!!U Ue done lO -respond. to govemors' concerns and improve the effc:ctiven~! of federal progra.nu .
rvmg children and families. Many narrow categorical programs can be consolidated at the federal level.
iving states more ability to design:initiatives responsive to their unique needs. A genuine welfare reform plan
flecting our sh::.red values of oprvll"tnnity, ~lf.sufficiency, personal re.'I;.fIOn~ihi1ity.faime~Cl. and cnmpa.'~nn·
ward those in need can be enacted. Wasteful spending can be eliminated and the federal deficit sharply.
u\ieU. Bul we musL nOL wSllIanLle in 100 days 0' a Single yt:a! the structure of child and family investments .
uilt painstakingly and incrementally over the course of decades.
.
Your c.learvo1C'.e and strong mornl
1I':tcJ~"'~hip ;~
I1reently needed to remind all
American~
that the
protection of children and the poor - particularly those who work and who are the previous beneftciaries of
lUauy of I.he prog.rams and policies of your AQllllnistntioll -- is one of our most deeply held and broadly shared
II
national values, one that must not be sacrificed in upcoming budget debates. Children and families who meet
the basic eligibility rules of child survival programs must be able to rely upon Americats promise not to turn
it~ back on them. This is the c.rucial area in which you can define for the American people the differenCC$
between your Administration and the new &¢publican leadership in Congress.
..
'
did ca.I1 for change in November and voted for less and more effective lovernment. But they
did not vote for more callous government or to balance the budget unfairly on the backs of children•. They did
. nor vote to ~.a.rve hungry children or tum their backs on struggling families in crisis. Please stand firm in
protecting all of our children and ensuring that every child has a chance to get a heal~y start, a head start, a
Voters
fair start. and 'a sUe start in life.
We, are working very hard to support your leadership.
Sincerely yours,
vv.~~- Edelman
Marian Wright
TOTAL P.03
�01/25/95
18:28
.-
III 001
HHS OS ASPE 415F
ff202 690 7383
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ASSISTANT SECRETARY FOR PLANNING AND EVALUATION
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PHONE: (202)690-7SSS
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FAX: (202)690·7383
Date:_ _ _ __
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To:
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Division:
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City
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Office Number:
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Fax Number:
Fax Number: _ _ _ _ _--:....
Number of Pages
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�01125/95
18:29
f$'202 690 7383
HHS OS ASPE 415F
Welfare Reform Working Session
Agenda
I(
8:30 am
Opening
Preside.nt.
vice-President
8:50 am
Work/Welfare
Lead Discussants:
Governor Arne carlson
Governor Mel carnahan
9:45 am
Parental Responsibility
Lead Discussant:
Govern.or Tommy Thompson
10:30 Elm
Teen Pregnancy/Out-of-Wedlock Childbearinq
Lead Discussant:
Governor Tholnas Cal.'per
11:15 am
State Flexibility
Lead Discussant.s:
wrap-up'
1:30pm
Adjourn
Governor John Engler
Governor Howard Dean
raJ 002
�~
PROMOTING NUTRITION SECURITY
Food, Nutrition, and Consumer Services
U.S. Departmemtof Agriculture
February 13, 1995·
�i'
USDA NUTRITION PROGRAMS
o
USDA's nutrition programs get food to people who need it. They improve health by
preventing hunger and promoting good nutrition.
o
Three anchor programs -- Food Stamps, Child Nutrition, and WIC -- serve 45 million
people every month.
o
Food
~tamps
Serves 11 million households each month (27 million participants)
82 percent have children, elderly, or disabled
21 percent have earned income
_
91 percent have income below the poverty line
40 percent receive AFDC
o
Child Nutrition
Serves 25 million lunches every day
55 percent of all participants receive a ,free or reduced-price lunch
Serves more than 2 million' children in child care every day
o
WIC
Serves 7 _
million women, infants, and children
Serves 40 percent of all babies born in the U. S.
�t'
Food Stamp Program
Participation, Poverty,and
Unemploym~nt
Historical Relationship is Changing
Millions of People
40~1--~------------------------------------------------------~
Poverty
30
\
Food Stamps
\
20 ~..
Unemployed
"
10
o
I
70
I
72
74
76
78
80
82
Year
84
.
86
88
90
92
94
�NUTRITION AND HEALTH ACCOMPLISHMENTS.
o . Since the nationwide expansion of the Food Stamp Program and the introduction of
Wle, the gap between the diets of low-income and other families has narrowed.
Between 1965-1966 and 1977;.. 1978, the percent of low-income households that met
100 percent of the RDAsfor 7 key nutrients grew from less than 40 percent to about
50 percent. This increase is more than double the increase -- from 50 percent to 55
percent -- seen in the general population.
o
The incidence of growth stunting among pre-school children has decreased by nearly
65 percent -- falling from 22.8 percent in 1974-1'976 to just 8 percent in 1992.
o
The incidence of low birthweight babies has fallen from 8.3 percent in 1965-1967 to
7.0 percent in 1990.
o
The prevalence of anemia among low-income pre-school children has dropped by 5
percent or more between 1980 and 1991 for most age and racial/ethnic groups.
\
�ACCOMPLISHMENTS ENDANGERED BY BLOCK GRANT PROPOSALS
o
Current Congressional nutrition and welfare proposals
House: Agriculture and Economic and Educational Opportunity Committees will
mark up block grant legislation this month. Ways and Means block grant does
not include nutrition programs. Floor action on combined block grant legislation is
expected by mid-March.
Senate: Will await House action. "Swap" and modified block grant bills have
been introduced by Senators Kassebaum and Grassley.
o
Significant program cuts and the elimination of nutrition standards would reverse 30
years of accomplishments in nutrition and health.
o
Nutrition programs would be unable to respond to changing economic circumstances.
The automatic adjustor in hard times would vanish.
•
Between 1'990 and 1 994, the number of food stamp participants rose 37
percent.
•
Between 1990 and 1994, the number of free meals served in the school
programs rose by 23 percent.
States would be forced to reduce benefits or serve fewer people.
�o . Over time, all States will fare worse under a block grant than under current law. The
attached table illustrates what would have happened during the recession of the early
1990s if a block grant had been in effect sinJ:e 1989.
No rainy day fund could have adequately addressed the losses States would have
faced.
o
Reduced support for nutrition programs and the increased likelihood that States would
convert targeted food assistance to cash would lower retail food sales, reduce gross
farm ~.ncome, and increase unemployment.
In the short run, a block grant like that in the Personal Responsibility Act could·
reduce food sales by $4 to $10 billion, reduce farm income by as much as $4
biilion, and cost the economy 126,000 to 138,000 jobs .
.
.
In the long run, a block grant could reduce employment in farm production, food
processing, and distribution.
The economic effects would be felt most heavily in rural America.
�USDA'S REFORM AGENDA
o
The Administration's investment in cost-effective WIC program.
The Administration's investment in WIC will support benefits for 7.4 million
women, infants, and children in 1996, a 1.5 million person increase from the 5.9
million served in 1993.
o
School Meals Initiative for Healthy Children was announced in June 1993.
Updates nutrition standards to conform with the Dietary Guidelines for
Americans.
Uses a comprehensive, integrated approach to improve school meals through
technical assistance, training, nutrition education, streamlining administration, and
building partnerships with private industry.
�USDA'S REFORM AGENDA
o
Reinvent the Food Stamp Program
Transform the 30-year old Food Stamp Program into a national nutrition security
program for the 21 st century.
Integrate nutrition, prevent fraud, expand administrative flexibility, and use
electronic benefit technology to deliver benefits.
o
Principles of Reform:
Nutrition Security: the necessary safety net for American families in hard times
.
Program Integrity: a balanced focus on fraud prevention and -penalties
Modern Delivery Systems: a single-card, user-friendly, uniform benefit delivery
system
State Flexibility: focus on results, not process
Economic Responsiveness: assure adequate levels of assistance regardless of
economic conditions
Personal Responsibility:- promote personal independence and responsibility.
�. January 26, 1995
What Would Have Happened if a Block Grant had been
Created in 19897 The Effects on Food Assistance Program Funding
for States in Fiscal Year 1994
(Dollars in millions)
level of Food
Assistance
State
1994
Actual
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Flo"rida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas.
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
"
-
$711
93
656
368
4,049
364
274
83
131
1,970
1,110
33
215
113
1,551
630
259
278
642
998
164
527
547
1,228
459
614
720
104
169
136
86
759
335
2,902
827
Inflation
Adjusted
Block
Grant
$571.
60
399
291
2,083
284
166
49
81
992
713
25
140
90
1,317
410
229
202
571
914
104
360
386
1,011
338
614
51'1
86
131
68
42
509
228
2,004
571
. Difference
Total
- $140
- 33
- 257
- 77
- 1,966
- 80
- 108
- 34
- 50
- 978
- 397
-8
- 75
- 23
- 234
- 220
- 30
- 76
- 71
- 84
- 60
- 168
- 161
~ 217
- 122
0
- 209
- 18
- 37
- 68
- 44
- 250
- 106
- 898
- 256
,
Percent
-
20
36
39
21
49
22
39
41
38
50
36
25
35
21
15
35
11
27
11
-8
- 36
- 32
- 29
- 18
- 27
0
- 29
- 17
- 22
- 50
- 51
- 33
- 32
- 31
'" 31
�•
, .
level of Food
Assistance
State
Difference
1994
Actual
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
. Wyoming
American Samoa
Outlying Areas
Total
, Notes:
Inflation
Adjusted
Block
Grant
77
1,503
509
376
1,474
1,371
114
516
92
861
3,471
204
73
699
40
617 .
356
420
54
0
4
66
. 1,303
373
285
1,091
1,363
74
394
88
615
2,229
,160
47
456
35
399
296
350
44
6
8
- 12
- 200
- 135
·91
- 383
-8
·39
- 122
-5
- 245
- 1,242
- 44
- 26
- 244
-8
- 219
·60
- 70
-10
6
4
26,218
- 10,710
.36,928
Total
Percent
- 15
• 13
'·27
-24
·26
-1
- 35
- 24
-5
- 29
- 36 .
- 22
·36
- 35
- 20
- 35
- 17
- 17
- 19
•
116
- 29
Individual cells may not sum to totals because of rounding.
Each State's block grant amount equals their 1989 food assistance
program funding adjusted for the percent change in the CPI-U for
Food at Home.
�USDA
Welfare Reform Talking Points
February ZI, .1995
BLOCK GRANTS WOULD JEOPARDIZE NU'I'RITION OUTCOMES
FOR CBII;DREN
the
, The House Economic and Educational Opportunities Committee'will shortly mark up
nutrition
element of the Republican welfare reform plan. Democrats are opposing the proposal, which·will
block grant USDA's nutrition programs: WIC aDd School Meal Programs among others. The
legislation will place children at riit by creating a funding mechanism that can't respond when the
economy changes, and by eliminating nutrition standards respoiuible for improved children's health.
o
The risks to chlldreD's health would 1DaeaSe dmiDg reCessions UDder bloc grants.
Between 1990 and 1994, the .number of children applying for free school lunches increased by
23 percent, due to the ri:ce.ssion and rising ehi1dhood poveny. USDA's nutrition programs
expanded to Meet the need. But block grants don't protect children from recessions. If the
School-Based Nutrition Block Grant had been enacted in 1989, 20~ fewer resources would
have been available to feed school cbildren in 1994. Children's health would. 'be jeopardized
by States' limited ability to me:Ct growing nc:ecIs. Nulrition b~fits reduced. or unavailable.
just when c:b.iIdren need them most.
o
Natioaal standards proted chDdrea - DO matter where they Bve. Federal standuds have a
fifty year history 'of successful health outcomes for chilclreD; growth stunting has decreased
by 657D low birthweight has been reduced. ami anemia among 'low-iricomepre-schoolers bas
decreased. The Republican plan could result in widely varied nutrition standards between
states. and no accountability mechanism would gua.rantee tbat these standards would be met.
Thus. children's health would suffer if States' set - or alter - standaJUs to meet shifting
t
budgetS.
o
States that sert'e a larger percentage of low-mcome children thaD the national averale
would be peaalized. States that serve more total meals fare better in the allocation formula.
Since it coits more to serve free meals to low-income children. States have an incentive to
serve more affluent studeDts. Without national standards, .states might also be inclined to cut
the quality oramoUDt, of food provided in order to serve more meals~
The A~OD is opposeclto block IJ'8Dfa for DUtritiOll p1"OII1IIDa:
o
President CUntOD has said that nutritiOD prDIl"8IDI are in the national intereSt. Programs
must be more flexible -and easier for States to administer. Buc we won't suppon changes that
jeopardize children's health - olgening food to people who need it. Only a national system
of federal nutrition prosnms can establish and meet nutrition standards. respond to economic
changes. aDd ensure children's hca1thwill be protected.
.
o
We're ready to Work with Conma to bring about lUting and meaningful change in
federal nutrition pmgnpns. We suppon preserving the health and mmidon goals that are in
the national interest, consolidating what's redtmdant. and refonning what's outdated and
u.nneces.lary. Nutrition security is an importai'lt.pan of weifare reform and Federal nutrition
programs are the foundation for children to grow on.
.
�.
""
•
TALKING POINTS
Food and Nutrition Block Grant
February 22, 1995
WE OPPOSE BLOCK GRANTING CHILD NUTRITION AND WIC PROGRAMS
The current
progr~msare
Block granting puts
effective
c~ildren
at nutritional and health risk
THE RISK TO CHILDREN'S HEALTH WOULD INCREASE DURING
RECESSIONS UNDERcBLOCK GRANTS
During recession, our food programs expand to meet rising
need. But block grants don't.
If the School-Based Nutrition Block Grant had been enacted
in 1989, 20 percent fewer resources would have been
available to feed school children in 1994.
NATIONAL STANDARDS PROTECT CHILDREN - NO MATTER WHERE THEY LIVE
Federal standards have protected kids' health fqr fifty
years - growth stunting has decreased by 65%, low
,
birthweight has been reduced, and anemia among low-income
pre-schoolers has decreased.
.
The Republican pl'an abandons these standards - leaving wide
variation in standards possible and no accountability to
guarantee health outcomes.
STATES THAT SERVE A LARGER PERCENTAGE OF LOW INCOME CHILDREN THAN
THE NATIONAL AVERAGE WOULD'BE PENALIZED
The Republican plan rewards states ,that serve the most
m~als.
States will therefore'have incentives to:
Serve meals to more affluent students who can pay, for
part of th,e cost
Cut the quality of· meals to cut costs and increase the
. number ofimeals
�"
THE PROPOSED £LOCK GRANT COULD RESULT IN LESS OVERALL FUNDS FOR·
FOOD AND NUTRITION FOR CHILDREN.
States would have the abilitV to transfer up t~ 20 percent
·of the funding out of these programs to other uses.
The Republican proposal also includes a-reduction of about 4
percent in total funding - in the first year.
WE ARE READY TO WORK WITH CONGRESS TO MAKE OUR FOOD AND NUTRITION
PROGRAMS BETTER AND FLEXIBLE -- BUT WE HAVE A NATIONAL INTEREST
IN THE HEALTH AND NUTRITION OF OUR CHILDREN.
�Date: 02/22/95
Time: 11:20
Clinton Meets Democrats, Decries GOP School-Lunch Cuts.
WASHINGTON (AP)
Drawing new battle lines against Republicans,
President Clinton pledged today to oppose GOP efforts to repea'l
school lunch and breakfast programs, saying "it would be a
terrible mistake" to end them.
"It seems to me this is one of the things that we hired on to
do, to stick up for the interests of children;" Clinton said after
a strategy session on Capitol Hill with House Democrats.
Clinton visited with Democrats on the 50th day of the
Republicans' 100-day drive to vote on issues ranging from welfare
reform and term limits to tax cuts and a balanced-budget amendment
to the Constitution.
Urging his party to stand united against Republicans, Clinton
singled out the GOP effort to end free meals in schools for poor
children.
"An old conservative adage used to be, if it ain't broke don't
fix it," Clinton said, standing alongside House Minority Leader
Richard Gephardt, D~Mo.
"Here's a program that isn't broke, (that's done a world of good
for millions and millions of children of all races and backgrounds
all across our country and I think it. would be a terrible mistake
to put an end to it, to gut it, to undermine it. And I hope that my
party will stand against this.
"I do not agree with it,' Clinton said. "I do not think it is
right."
'
Joining in, Gephardt said cuts in the school meal programs were
. "mean-spirited and they're wrong."
Republicans want to repeal the school 'breakfast and lunch
programs, and a host of other programs for the poor, and replace
them with block grants to the states.
The states, in turn, then could choose to spend the money as
they wish.
,
Clinton's criticism was part of a new White House effort to draw
sharp lines of distinction with the Republicans, painting them as
the captives of big business and special-interest lobbyists while
portraying Clinton as the champion of the middle class,.
.
Taking aim on another issue, Clinton said tax cuts proposed by
Republicans were too large and couldn't be paid for without I
inflating the deficit.
'
APNP-02-22-95 1123EST
.;
I
�!S;
NGA Summary of House Ways and Means Welfare Bill
(as amended QY the Human Resources Subcommittee)
, , TITLE I -:; TEMPORARY ASSISTANCE FOR NEEDY FAMILIES
• Combines into a single block grant the AFDC program-which includes cash grants to families, state
administration, and Emergency Assistance.:- and the JOBS employment and training program.
• Funds the block grant as an entitlement to states capped at $15.4 billion annually for five years. Ends
the individual entitlement to assistance that needy families have under current hiw.
• Creates a federal rainy day loan fund of one billion dollars that states may, borrow from if their total
unemployment rate for any given 3-month period exceeds 6.5% and is at least 110% of the same
measure in either of the previous 2 years. States may not borrow more than $100 million or 50% of
its annual share of block grant funds (whichever is less) and must repay the loans with interest within
3 years.
• Gives states considerable flexibility to design their programs, eliminating the federal waiver process,
and simplifying state plan requirements.
• Limits state flexibility by barring states from giving cash assistance to certain families that are now
eligible, including legal noncitizens, families who have received five years of aid, and chi!dren born
to parents under age 18 and their families.
• Allows states to create a rainy day fund with unspent federal funds and transfer up to 30% of the
funds received under this block grant to the existing Title XX block grant, the proposed child
protection block grant, and the soon-to':be proposed block grants for food and nutrition and child
care.
• Requires states to place in work or work programs families who have received aid for more than two
years, including before enactment of the bill, and to 'enroll an increasing percentage of their total
,
caseloads in work activities over time. '
• Requires states to report detailed characteristics data on each family that receives aid, including
information on aid received by these families from otherfederal programs.
, '. Requires states to repay misspent funds, as determined by federal,audits under the Single Audit Act,
up to a total of 25% of their block grant. State's would also face a penalty of 3% for failing to report
required program data and 1% for failing to' participate in the existing Income and Eligibility
Verification System.
• Repeals existing child care entitlement programs for federal savings of $6.1 billion (a new child care
block 'grant will be created under separate legislation, restoring some of t~is funding. Rep. Shaw' has
said that riet federal savings in the child care programs will be $3.6 billion.)
• CBO estimates federal savings for this title at $12.8 billion, including the child care savings.
,
TITLE II -
I
CHILD PROTECTION BLOCK GRANT PROGRAM
• Combines into a s~ngle block grant 23 child welfare, family preservation, and adoption assistance
programs including IV~B Child Welfare Services and Maintenance Payments; Family Preservation,
and Support; Independent Living Program;' IV-E Foster Care and Adoption placement, maintenance,
administrative and training costs; and other child abuse and treatment programs (see attached list).
• Funds the block grant as an entitlement to states capped at $4.1 billion in fiscal 1996, $4.3 billion in
fiscal 1997, $4.5 billion in fiscal 1998, and $4.6 in fiscal 1999, and $4.8 in fiscal 2000. Freezes
funding for five years for most foster care and adoption assistance at fiscal' 1994 levels. Caps two
�NGA 2116/95 Page 2
entitlement programs, foster care maintenance and adoption IT!aintenance, at the CBO baseline for
fiscal 1996 thr:ough fiscal 2000, without inflation. Distributes funds according to the share states
received of total federal spending on these programs in fiscal 1993.
• Allows states to create a rainy day fund with unspent federal funds and transfer up to 30% of the
funds received under this block grant to the existing Title XX block grant, the proposed AFDC block
grant, and the soon-to-be proposed block grants for food and nutrition and child care.
.
• Requires states to submit detailed data on families served by the programs and on program activities
and outcomes.
.
.• . Requires states to meet certain child protection standards .set by the bill .and to establish·local citizen
review panels empowered to report on whether a state is meeting those standards.
• Requires states to repay misspent funds, as determined by federal audits under the Single Audit Act,
up to a total of 25% of their block grant. States would also face a penalty of 3% .for failing to report
required program data, 1% . for failing to participate in the existing Income and Eligibility
Verification System~and 3% for failing to meet work percentage participation requirements.
• Total federal savings,' according to CBO, from freezing or capping these programs is $1.9 billion
over five years. The CBOestimate does. not include an additional $2.5 billion in federal spending
reductions over five years resulting from repeal of discretionary child welfare programs.
TITLE III - RESTRICTING' WELFARE FOR ALIENS
• Makes most legal noncitizens ineligib!e for 36 federal programs (see attached list). Exempts from
the ban current residents for one year, refugees who have been in the U.S. for less than five .years,
and the elderly (age 75 or older) who have been in the U.S. for at least five years.
• Declares sponsorship agreements to be binding until sponsored immigrant becomes a citizen. I
• Authorizes states to deny assistance to legal noncitizens. 2
• CBO estimates federal savings of $17.4. billion over three years for this title.
TITLE IV --- SUPPLEMENTAL SECURITY INCOME
• Removes cash SSI and medicaid. coverage for an individual if drug addiction or alcoholism is a
contributing factor material to his or her disability and who cannot qualify based solely on another
disabling condition..
.
• Shifts $100 million of the federal savings from denying benefits to addicts to a federal program
aimed at expanding drug treatment availability and to federal drug abuse' research.
• Removes cash SSI and categorical Medicaid coverage for children whose disability does not meet the
impairment listings in current federal regulations. These listings are a stricter eligibility requirement
than has been applied to children in recent years. The bill repeals the "comparable severity" test and
ends the use of "individualized functional assessments;"
• Continues cash SSI and Medicaid coverage for children currently receiving aid Who meet. the
impairment listings and for new child applicants who are very severely disabled and would otherwise
be institutionalized:
lIt is not clear whether this provision would be upheld by the courts. Changes in U.S. immigration law would ..
, probably be also necessary; this law is under the jurisdiction over the House Judiciary Committee.
2See above footnote.
.
�NGA 2116/95 Page 3
• Creates a new block grant to provide medical and non-medical services, but not cash grants, to new.
child applicants who meet the federal impairment listings but are less' severely disabled. An
amendment passed in the subcommittee February 15th requires each state to offer these block grant
services ":to disabled children who meet the listings but are denied cash benefits. A second
amendment passed in' subcommittee would prohibit states from substituting block grant funds for
"
'
. , services currently paid for by the state.
• Does not specify, total federal funding for the block' grant but provides that a state's allotment equal
75% of the average cash SSI benefit in the state and the number of children in the state receiving
non-cash SSI benefits under the bill.
• CBO estimates $13.4 billion in saviqgs from these provisions.
(Title V, the child support provisions, is being analyzed separately.)
�./
.
.;:
Child Welfare (23 Programs)
+Foster Care Maintenance Payments
+Foster Care Administration
+Foster Care Training
t Adoption Maintenance Payments
+Adoption Administration
+Adoption Training
+Indepcndent Living
+FamilyPreservalion and Support
+Title IV-" Research
+Title IV-B Training
+Titlc IV-B Child Welfare Services
Abandoned lnnmts Assistance
Child Abuse SHale Onml I'rogram
Child Abuse Demonstration and Research (,rants
Community-based Family Resource Program
Adoption ()ppurtuilities· Program
Family Violence State (irant l'rugram
Family Sllpport Centers
Soci.,1 Services I{cscarch
Missing anJ Expluited ChilJren 's Program
Grants to improve the iilVestigationand prosecution uf chilJ abuse cases
Children's Advocacy Centers
Family Unification Ilrugram
Subtotal
.,";
'\
�-. .,;;;.
. ".
i\\\-t',~ c.,__ ~t:h~ \\)\(. ~O\
:
In order 10 help noncitizens improve" their job
prep.alion skills and 10 rrotect the health and
'pfely of residcrilS of the U.S" noncitizens would'
,emain elilible for the followinl health.
immunizalion. and educalion and joblraining
propams:
I. Emerlency medical senices
2. Stafford siudent loan propain
), Basic educalional opponunity granls
.
S. Federal supplemental educalion opponunil,
4. Fedenl work sludy
....IS
..
6. Federal Patins loans
'7. 0ran1S 10 Stales for .tale student incentives
•. Orants and felloWships for ......Ulte pro8JM1l
9. Special pro8JM1lfor students whose families
Ire allapl in mi .....l and scuonal fum wort
10. 1..GlU'lS and sd.oI....ips for Education in
the licalth Professions
II. Gnnts for tmm....za1lons Alainsl Vaccine
Ptevenlable Disciua
12. Job Corps
I). ,Summer Youth Employment and Traininl
14. Propns of Trainlnl for Disadvantapd
Adults under Tille II·A and for Disldvantaaed
Vouth under Tille 1I-C of the Job Tralnln,
Partnenhip Act
~\\<.,,,<) ~ (\0\ E\\~\~\~ \or ;
I. Medicaid
2. Malernal .t: Child Health 5crvices Block
Granl Propams
1. Community Heallb Cenler Senrices
4, Family rlaMinl Methods and Senrices '
j''&
S. Mi....t lIealth Cenler Senrices
: 6. Supplemental Security Income
7. Food Assislance Block Granl Programs
I. Renlal Assistance
,9. Public llousinl
10. liousini toan Program
II. liousinginieral Reduclion Program
. 12. loans for Rental and Cooperative llousin,
I). Raltal Assisl.a.nOl: PaymenlS
14. Program of Assistance Paymalls on Behalf
of Ilomeownm
.'
IS. Renl Supplement PaymenlS on Behalf of
Qualified Tenants '
16. loan and Grant Programs for Repair and
ImproYClnenI of Runl Dwellings
17. Loan and Aui.tance Pro8JM1l for II000ini
Fum labor
II. GnnlS for PrescrYalion and RehabiJitalion of
1(ouSinl
'.,
19. GnnlS and lowas for MUlualand Self-Ilelp .
Uousinl and Technical Assistance
20. Sile Loan.s Program
,
21. GnnlS for Saec:nin,. Refanls• .t: &fucaliOn ,
Re.ardinl l.ead Poison in. in InfanlS .t: Children
22. Tille XIX·B subparu I and II Public lleaJlh
Senrice ACI
.
, 21. Tille III Older Americans Acl Programs
24. Tille 11·1) Uomalic Volunteer Senrice Acl
Programs
,25. Tille II-C Domestic Volunteer Service Act
Programs
•
26. Low· Income EnerlY Asiis....ce Act
Prolfam ."',
'" 27. Weatherization Assistance Program
, . II. Social Services Block Grant Program (Title
" XX SSA)
:
,
'. : 29. Communit, ScrYica Block Granl Act
Programs
.
10. Lelal Assistance under Lelal Services
.
, Corporation Act ..
] I. ErMrlalcy Food and Shelter GranlS '
under McKiMCJ lIorneless Ad
12. Child Care and Dnelopnient Block
Grant Act Pro8JM1l '
.
]). S..te Propam for ProYidin. Child Care
(section 402(i) SSA)
, . )4: Temporary Family Auistance Block Gnnt
Pro...... · ' ,
'
)S. Child Care Block Orant Propams
)6. Child Protection Block Orant Programs
�:.
OVERVIEW OF FISCAL IMPACT
OF WAYS AND MEANS BLOCK GRANT WELFARE BILL
(as amended by the Human Resources subcommittee)
Background
The bill consolidates and reduces eXisting cash assistance to n~edy families and child welfare programs,
repeals existing child care entitlement programs, makes most legal noncitizens ineligible for a variety of
federal aid, dramatically scales back federal disability benefits to children and eliminates such disability
payments to substance abusers. (The bill would also make a number of change& to the child support
enforcement system. These are being analyzed separately.)
.
.
In place of existing cash assistance and child welfare programs the bill establishes two blQck grants that
provide states with much greater flexibility to design,their programs and to keep federal savings. The
block grants do not require any state match or state maintenance of effort. The bill, however, restricts
state flexibility regarding cash assistance by limiting aid to anyone family to five years, by barring aidlo·
some currently eligible families, and by greatly expanding welfare work requirements. The bill also
requires states to report much more extensive data on cash assistailce and child welfare aid recipients
than is now required. The bill also creates a third block grant for medical and non-medical services to
some disabled children in place of the current entitlement to federal disability aid. This change may
result in a shift of some poor children from the. Supplemental Security Income (SSI) program to the new
cash assistance block grant program.
.'
.
The Congressional Budget Office (CBO) estimates .that the Titles I, IT, III and IV of the bill will save the
'
federal government $45.5 billion over five years. 1 No CBO estimates are yet available for Title V.
Fiscal Impact of Title I
The temporary cash assistance (Title I) block grant would be a capped entitlement to states. The.block
grant is capped for five years at fiscal 1994 levels for the consolidated programs; the cap is $7.8 billion
below what CBO estimates would be spent by the federal government on these programs over the five
year period under current law. Most of the programs replaced by the block grant are currently open-ended
entitlements to states or to individuals. The bill generally does not provide for any adjustments in the
funding levels to respond to growth in the target populations, inflation, or sudd~ increases in need due
to such events as economic downturns or natural disasters.
The impact of grants on any individual state of converting cash assistance to poor families and children
to a capped state block will depend upon a number of factors. For the temporary cash assistance grant,
Title I, the most immediate factors are:
.• Status of the state program in base years (fiscal 1991 through fiscal 1993). These include each
state's federal match rate, benefit levels, caseload levels, and the proportion of the caseload
represented by families made ineligible for assistance under the bill.
• Future state policy decisions. The freeze· in federal funds at fiscal 1994 levels shifts to the states
the costs of any new investments in welfare-to-work programs and the costs of any policy changes
I A new child care block grant created under separate'legislation is expected to restore ~bout $2.5 billion of the $6.1 .
billion in child care cuts in Title I, so the net federal savings in child care would be $3.6 billion. The CBO estimate
does not include an additional $2.5 billion in federal spending cuts resulting from repeal of child welfare
discretionary programs..
�I
NGA 2116/95 Page 2
that have the effect of increasing benefits or eligibility, such as increasing earned income disregards,
raising assetlimits, or aiding more two-parent families. At the same time, any savings resulting from
state policy decisions would be kept by the state and could be used to offset some of the costs of
. these new investments or of meeting federal work requirements.
• Federal work requirements. The cost of meeting the Title I work requirements will depend in large
part on the type ofactivities selected by the state, and whether child care isprovided recipients in
work.
.
• Increases in caseloads due to structural changes or cyclic;al changeS. Structural changes would
, include long-term trends in the economy or in the number of low-income families. Cyclical changes
would include short-term economic downturns or natural disasters.
,
The actual fiscal impact is a combination of twofactors. The first is the total amount expended in the
state on welfare. The second is the amount of that expenditure that can be funded from the federal block
grant. In the latter case, the amount that can be funded from the federal block grant is limited both by the
size of the grant and by the expenditures that can legally be made under that grant. On average, if total
expenditures increase over fiscal year 1994 levels, these costs will be borne 100 percent by the state. It is
worth noting that while some states have expenenced caseload reductions, nationally AFDC caseload~
are currently one-third higher than they were five years ago.,
Status of the State Program in'the Base Years
The distribution formulas for the Title I and II blpck grants are based on historical levels of federal
assistance and essentially freeze into place federal support according to existing variation in state match
rates, benefit levels and caseload levels. Federal match rates would no longer be adjusted as poverty
rates in states changed nor would each state's allotment increase as caseloads grew. States with low
benefits would be unable to secure federal support to increase benefit le~elS. States with high federal
match rates would find it more difficult than low match rate states to continue benefits to families
ineligible for federal aid because these ineligible families represent a larger loss of federal funds (e.g.
70% instead of 50%) and a smaller amount of existing state funding (e.g. 30% rather than 50%) that can
'
be shifted from other families to cover the ineligible ones.
Conversely states with high benefit levels would have the ability to cut benefit levels in order to invest in
other policy changes or to offset the costs of work requirements. States with low federal match rates
would lose less federal funding for ineligible families and would have more existing state funding in the
welfare system to shift to continue benefits to those families.
State Policy Decisions
The total amount expended in the state on welfare will be largely determined by state decisions regarding
benefit levels and eligible populations and by theeost of meeting any federal requirements regarding
work activities and reporting. Whether or not a state's block grant allocation proves sufficient will
depend not only on the state's future economic growth and demographic changes; on its current federal'
match rate and benefit levels; but also on whether the state wants to make up-front investments in policy,
changes such as earned income disregards, expanded ed,ucation or job training, or,expanded child care.
A number of states project long-term savings from policy changes aimed at encouraging family"
formation, increasing child support, reducing unwanted pregnancies, and/or increasing employment
Most states expect, however, that the increase in required work-related activities will result in at least a
short term increase in costs. If the costs of meeting the work requirement exceed savings from other
.'
.:
i
�·NGA 2116/95 Page 3
policy changes, there will be an overall increase in work program costs. These increases could be offset
by the degree to which a state is willing or able to deny state benefits to families excluded from federal
benefits, or make other cuts in benefits or eligibility. Additional costs can be expected if stat~s increase
benefit levels or extend benefits to new groups of intact families.
The block grant is analogous to the annual cost·neutrality policy for waivers that states faced up until two.
years ago-there would not be any extra federal funds available each yearto invest in policy changes that
states believe will result in savings in later years. Any up-front investment would be paid ~or entirely by
.the state.
.
Work Requirements
Title I has two different work mandates and it is not clear whether th~y apply separately or together. The
first provision requires every adult who receives benefits for: more than 24 months to engage in work
activities .. The 24 months applies to all monthsof aid, whether or not they are consecutive, and applies to
aid received before enactIT.Ient of the bill. The second work maI1date requiTes that an increasing percent
of the total caseload, beginnin~ with 2% and rising to 20%, work or be placed in work activities:
If states must meet both requirements separately, then it is the first requirement that will have the greatest
fiscal impact because the percent of cases on the rolls that have currently been open for more than 24
months already exceeds the maximum target rate of the other work requirement (20%) by almost twofold.
If the 24-month standard is binding, then over two million families would be required to be in work .
activities by October 1995-a more than three-fold increase over the work requirements under current
law. CBO estimates for past welfare bills have put the cost of placing a recipient in a 20-hour per week
work slot at $6,000 annually, including the costs of creating and supervising the work slot and paying for
child care. (Separate legislation is being considered by Congress which would create a child care block
.grant and reduce federal child care funding by $3.6 billion over five years.)
It is unclear how the 24-month work requirement will be enforced, however, and whether violation of it
would be considered a federal auditexception under the bill. An amendment adopted in subcommittee on
February 13th would give the Secretary of HHS the authority to reduce a state's block grant by up to 3%
for a state that fails to meet the second work mandate, the percentage participation requirement
The actual cost of meeting the work requirement is likely to vary greatly from st~te to state, depending on'
the work activity selected, the hours per month required, and whether child care is provided. For most
states, meeting the 24-month requirement is likely to entail significant new costs above their current
combined federal and state spending on welfare-to-work activities? These new costs would have to be
offset by. state savings in other parts of the cash assistance program, or by new state spending.
Increases in Caseloads D~e to Cyclical and Structural Changes
Title I, the temporary cash assIstance block grant, does not provide for adjusting total federal funding or
individual st!lte allotments in response to longer term structural changes in the economy !Jr popUlation of
a state. This is problematic not only because the total amount of the block grant is fixed but also because
. the distribution among states of block grant funds is also fixed at the average levels they received during
The administration estimates that if the 24-month requirement is met through a combination of recipients w~rking
in the private sector and working off their benefits in 20-hour a week public jobs, with child care provided, then
meeting the requirement with federal funds alone would consume about a third of total block grant funds in fiscal
1996 rising to over half of the block grant in fiscal 2000. .
.
2
.
.
�NGA 2116/95 Page 4
fiscal years 1991 through 1993. States experiencing population growth or generally declining or static
economies may see the need for services expand disproportionately and thus see an increasing demand on
state resources, even if total federal funds are adequate to meet the need for aid nationally .
.' While Title I pro~ides both federal and sttte rainy day funds to insulate states-against the impact of
cyclical downturns, these protections are limited in nature. The state rainy day fund allows states to set
aside unused federal dollars to be used when the economy suffers a downturn. However, as noted above,
the ability to accumulate moneys in such a fund in the short te'rm may be limited because of the overall
reduction in federal aid (relative,to CBO's caseload projections) and the cost of meeting Title I's work
requirements.
The federal rainy day fund provides loans to states which experience an unemployment rate that both
exceeds a federal trigger and the state's historical average unemployment rate. While helpful, the
proposed trigger will only help with relatively short term economic downturns and only while the
situation is deteriorating. Moreover, it is likely that the demand for assistance and state tax revenues will
only return to historical levels once a downturn is past. The result is that it may be difficult to come up
with the funds needed to repay a loan; Ahistorical example can be found in the unemployment
compensation system where states have generally been unwilling to take advantage of federal loans either
for extending UI benefits or for restoring the solvency of state UI trust funds.
Fiscal Impacts of Title II and III
The chiid protection block grant (Title II) is also a capped entitlement to states but unlike Title I it does
allow for some growth in the need for services over the five year period. The cap rises from $4.1 billion
. in fiscal 1996 to $4.8 billion in fiscal 2000. The cap reinains, however, $1.9 billion below what would
have been spent on these programs over the same period, according to CBO. (The CBO estimate does
not include an additional $2.5 billion in federal spending cuts resulting from repeal of discretionary child
welfare programs.) An amendment adopted in subcommittee on February 14 would require states to
honor existing adoption assistance contracts. Such contracts entail ongoing maintenance payments and
represent a large financial commitment that would have to.be paid for either out of the block grant or
from state funds.
The restrictions on aid to legal noncitizens woula result in federal savings of $17.4 billion over five
years. It is unclear what proportion of these costs are shifted to states because the legal authority of states
to deny state assistance to legal noncitizens is being reviewed by the courts and because sponsorship
agreements in the past have been held by the courts not to be binding. In addition, -many legal
immigrants are not required to have sponsors. If states cannot enforce the obligation of sponsors to care
for sponsored immigrants.and cannot deny state aid to legitl nOl,lcitizens,-then Title III could result ina
large cost shift to the states. The bill attempts to make spon'sorship agreements legally binding and to
. give states the authority to deny aid to legal noncitizens but it is not clear whether these provisions would
be upheld by.the courts.
.
�<'.
2/16195 Page 1
COMPA~ISON
OF NGA WELFARE POLICY TO HOUSE WAYS AND MEANS WELFARE BILL
Issue
NGA Policy
Shaw Bill
Block Grants
vs.
Entitlements
Governors have not yetreached consensus on
whether cash and other entitlement assistance should
remain available as federal entitlements to needy
families or be converted to a state entitlement block
grant. Any block grants created from entitlement
programs, however, should be entitlements to states
and not 'discretionary grant programs. The
Governors recognize the special responsibility of
government at all levels in meeting the needs of
children and families.
Funding for the Title I cash assistance and Title II
child protection block grants would be capped
entitlements to states. The bill would end the
individual entitlement to assistance that needy
families have under current law for most of the
programs replaced by these block grants. The bill
retains the overall individual entitlement to
Supplemental Security Income but restricts
eligibility.
Funding
Levels
.;.~-
.
l
Comments
-Title I freezes FY 94 funding for the AFDC and
Total federal savings from Titles I, II, III, and IV,
Federal budget cuts are needed but Governors are
concerned about the cumulative impact on the states JOBS program~ five years for federal savings of
according to CBO, are $45.5 billion over five
of federal budgetary decisions. The federal budget
$7.8 billion, according to CBO. State allotments
years. (CBO estimates are not yet available for
.should be balanced through true savings, not by
from the annual funding 0[$15.4 billion would be .
Title V.) The CBO estimate does not include an
shifting costs to the states. Any biock grant proposal according to the average federal share each state
aaditional $2.5 bi1lion in federal savings resulting
should be an opportunity for Congress and the
received of total spending in FY 91 through FY 93,
,from the repeal of discretionary child welfare
president to provide needed flexibility for states, not Title I also repeals existing child care entitlement
programs. $6.1 billion of the $45.5 bi1lion total is
a primary means to reduce the federal budget deficit. programs for federal savings of $6. I billion over
due to repeal of child care programs; net federal
. Block grant funding should be guaranteed over five
five years .. Title I makes available $1 billion in
child care savings would be $3.6 bi\lion if the
years at levels agreed to among the states, Congress, . "rainy day" loans to states.
proposed child care block grant were enacted.
and the.administration. States would consider an
-Title. II freezes funding for five years for most
Title I appears to entail significant new program
initial allot:tnent based on the average of several
foster care and adoption assistance at FY 94 levels.
costs for placing more than two million AFDC
prior years.
Two entitlement programs, foster care maintenance
recipients in work slots beginning in October
and adoption maintenance are capped at the CBO
1995 .
. baseline with inflation removed. States would
receive the same share of the total they received in
Whether or not a state's block grant allocation
FY 93. Total federal savings, according to CBO,
proves sufficient will depend 011 the state's future
from freezing 6i)capping these programs' is $1.9
economic growth and demographic changes; on its
billion over five years.
current federal match rate and benefit levels; and
~Title III ends the eligibility of most legai
.' whether it wants to make up-front investments in
noncitizens for a variety of federal assistance
policy changes such as eamed income disregards,
programs. CBO estimates federal savings for this
, expanded education or job training, or expanded
title at $17.4 billion over five years, which includes
child care. The block grant is analogous to the
SSI and Medicaid savings but not AFDC savings,
annual cost-neutrality policy for waivers that states
since the block grant amount is not reduced by the
faced up until two years ago-there would not be
amount of current payments to legal aliens.
any extra federal funds available each year to
-Title IV eliminates future SSI payments and
invest in pollcy changes that states believe will
Medicaid to all but the most severely disabled
result in savings in later years. Any up-front
children and ends aid to children currently 'receiving investment would be paid for entirely by the state
�2/16195 Page 2
Issue
NGAPolicy
Comments
Shaw Bill
or from federal savings in benefit payments.
SSI due to an individual functional assessment who
do not meet the impairment listings. The bill also
Future SSI cash payments will be limited to
ends SSI eligibility for disabled adults for whom
alcoholism or drug addiction is a contributing factor children who would otherwise be mstitutionalized;
material to their disability. It retains the existing .' this represents about 6% of currently eligible
entitlement status of aid for the adul~s and children
children:
who remain eligible. The title creates a new block.
The SSI substance abuse provisions are expected
grant to states for providing medical and non
medical services to disabled children who are no
to end SSI paym,ents and Medicaid benefits to
approximately 100,000 adults. The majority of ' .
longer eligible for cash benefits. CBO estimates
federal savings for thistitle at $13.4 billion over five these adults have been diagnosed with physical or
,'other conditions in addition to their substance.
years.
abuse problems.
(Title V, the child support provisions, will be
analyzed separately; no CBO cost estimates are
available yet for it.)
,
Flexibility of
Use of Funds
and State
Match
.
.
~
.
The effectiveness of state rainy day funds will
Block grants should not have maintenance-of-effort
Under Title I, a state may create an account for the
pUfposes of carrying forward unspent federal funds · depend on the ability of the states to find savings
provIsions, and states should be allowed to keep aIL
· despite the overall reduction in federal aid for
from year to year. When funds' in this account
savings as long as the federal allocation was spent.
Titles I and II of$11.2 billion (excluding
Unexpended federal funds should remain availa"le . exceed 120% of that year's alIotment to that state,
. the state may transfer the amount that exceeds 120% reductions from repeal of child care programs but
to states to maximize flexibility and to encourage
the creation of a~'rainy day" fund and would not be
to the general revenue fund of the state. Title II does including the $2.5 billion reduction in federal
· di~cretionary child welfare spending).
subject to reallocation by the federal government.
not have a similar provision although funds do
remain available for a second year.
Under Title I states may choose to pay new residents
of the state (less than 12 months) the benefits paid in
their previous state of residence.
The option to treat families who have recently
moved to the state differently than other families
may not be constitutional; cases on this topic are
curient~y pendiitg before the Supreme Court .
. Under Title I and Title II, states may transfer up to
30% of the funds received under the two block
grants to, the existing Title XX block grant, the "
proposed child protection block grant, and the soon
to-be proposed block grants for food and nutrition
and child care.
Under Title II states must honor existing adoption
assistance contracts.
!
The requirement to honor existing adoption
assistance contracts means that ~ome portion of
, each state's block grant has effectively aiready
been obligated.
�2/16/95 Page 3
Issue
NGA Policy
Adjustments
for long-tenn
program
growth
The Governors will work with Congress and the
administration to provide appropriate budget '.
adjustments that recognize' agreed-upon national
priorities, inflation, and demand for services.
AdjustmeiltS
for'
cyclical or
. disaster-related
program
growth
To provide for significant changes in the cyclical
economy and for majofnatural disasters, an
additional amount should be set aside each year for'
automatiC and timely distribution to states that
.
experience a major disaster, higher-than-average
~nemployment, or other indicators of distrt!ss.
Shaw Bill
Comments
Neither Title I nor Title II contains provisions for
adjusting funding to meet changing needs due to·
. inflation, long-tenn economic trends~ or
demographic shifts in the target population.
Part of Title II funding is based on CBO estimates
that include growth in the need for foster care and
adoption maintenance paymentS, but not inflation.
However, since the allocation of these funds will
be based on FY 94 allocations, there are no
provisions for state-by-state variation in growth.
Title'I establishes a federal "rainy day" loan fund of ' Title I's federal "rainy day" fund raises some
questions: .
one billion that states may borrow from if their total
-Will states be willing to risk taking out large
unemployment rate for any given 3-month period
exceeds 6.5% and is at least. 110% of the same
loans that they may not be able to repay? Because
.
measure in either'ofthe previous 2 years. States may' state revenues drop duririg economic downturns .
.and in disaster-situations, a state may be reluctant
not borrow at anyone time more than $100 million
to take out a loan without knowing when its tax
or half of the state's annual block grant allotment,
whichever is less. States must repay their loans with' base may recover. An analogous loan fund is the
interest within 3 years. Title II does not have a
extended UI benefitS program which only 8 of
fifty states have opted to participate in..
similar provision.
.-What happens to states that experience natural .
..
. . disasters? They may not hit the unemployinent rate
..
trigger even though the need for aid has increased.
Also, tax revenues typically drop aftera disaster,
,weakening the ability of the state to meet
increased need for services with its own funds .
. -What about states that experience substantial
increases in unemployment (e.g. from 4% to 6%)
but fail to hit the 6.5% trigger? .
-:-What about the lag time between increased need
and the ability to borrow funds? In the last
recession AFDC caseloads began rising before
unemployment rose significantly. Also, monthly'
state unemployment data typically isn't available
until four or five months later.
.
-What if one billion is not enough? In 1991, .
federal AFDC spending was almost $2 billion'
higher than in 1989 before the recession began .. In
1992 federal AFDC spending was up by $3
billion. The $100 million per state limit raises
t,
. similar questions.
'
State Plan
Re<ju irem ents
,~
Governors urge Congress to take advantage of the
Title I requires states to submit a plan every three
opportunity both to examine the allocation of'
years that describes the state's program for low
responsibilities among the levels of government and . income families with children. The programs must
It is unclear how broadly the audit authority
applies here.'
.
---Can states, for example, be required to pay back
�2/16/95 Page 4
NGA Policy
Shaw Bill
Comments
to maximize state flexibility in areas of shared
responsibility. However, the Governors believe that
children must be protected throughout this process.
Issue
include cash benefits, work experience, work
preparation and employment assistance. States
would have to certify in their plans that they operate
child support enforcement, foster care and child
protection programs in accordance with federal law.
funds spent to aid families who are not in work
activities but have received aid more than 24
months?
-If a large proportion of poor or abused children
in a state are not being aided under the program,' '
will auditors determine that the state's program
fails to carry but the purpose of the block grant?
grants should include Ii clear statement of purpose,
including mutually agreed-upon goals for the block
grant and the measures that will be used to judge the
effectiveness of the block grant. The block grants
musfrecognize the nation's interest in:
• services to children;
• moving recipients from welfare to work;
and
• reducing out-of-wedlock births.
There should be no micromanagement and states
should be required only to ensure that the funding
received is used to provide services for poor
children and their families. Although ,each state
would be required to describe their program in a
state plan and to provide periodic reports to the
public, state plans would not be subject to federal
approval or federal revision. Financial and
compliance audits would be conducted to ensure
that funds were properly spent, and states would be
, required to pay back any misspent funds.
Title II requires each state to submit a plan that
outlines its child protection programs, sets child
welfare goals, and certifies the existence of certain
laws and procedures regarding child abuse and' '
neglect and removal an,d placement of abused and
neglected children.
'
The Secretary would not have approval authority
over the substance of the Title I or Title II plans and
would only determine if it contained the required
information.
It is not clear how the Citizen Review Panels
under Title II ,would operate or how much power
they would have to enforce state compliance with
the standards in the bill. Some of the standards are
very general (e.g: state systems will be judged -by .
how well they protect children) and are likely to
be open to subjective interpretations of
compliance.
Titles I and II require states to repay misspent funds,
as determined by an audit under the Single Audit '
Act, up to a total of25% of their block grant. States
would also face a penalty of 1% if they failed to
participate in the existing Income and Eligibility
Verification System.
'
Title II requires states to meet certain child
protection standards set by the bill and establishes
local citizen review panels empowered to determine
,whether a state is meeting those standards.
Reporting
Requirements
Specific program outcome data will be collected by
the states and publicly reported.
~
..
Titles I and II require states to collect and report
detailed characteristics data on program recipients.
Title I and II reduce by 3% a state's block grant if
the state fails to submitthe required data.
Title I requires states to collect and report detailed
data on each and every program recipient rather
simply collecting this data for a small,
representative sample of recipients as they do now.
Some of this data relates to recipients' use of other
programs and may not be readily available without
significant new investments in automated systems.
Title II requires much more extensive data
collection than is now required under these
programs .
�2/16/95 Page 5
Issue
·NGAPolicy
Work
Requirements
Although the Governors recognize the legitimate,
interest of the federal government in setting broad
program goals in cooperation with states and
territories, they also believe that states should be
. free from prescriptive federal standards, including
key aspects of the welfare system, stich as work
requirements, benefits to teen parents and to legal
immigrants, and time limits on benefits.
Shaw Bill
Comments
Under Title I states must enroll in work activities at
Title I has two different work requirem~nts that
least one parent in families that have received 24
appear to apply independently. The mandate to
require work from those who have received aid for
months of aid, whether or not those months are
24 months or more is likely to be difficult and
consecutive and regardless of whether the aid was
received before or after passage of the bill. The bill
expensive to achieve. This mandate renders the
participation rate requirement irrelevant, as the
also mandates that states must enroll a rising
number who hit the 24-month limit on aid without ...
percentage of their case loads in work activities,
work will far exceed the percentage of caseload .
beginning with 2% of the caseload in 1996 and
rising to 20% in 2003. It is unclear how these two
required to be working under the bill.
. work provisions interact and whether one or both are
.
.
binding..,.
·The 24-month limit on aid without work applies
. retrospectively. This means that by October 1995,
. States will be penalized up to 3% of their annual
even if only cases with 24 consecutive months of
allotments for failure to meet the percentage of
aid are counted, states would have to enroll more
than 2 million recipients in work activities or fmd
case load work requirement. It is not clear how the
24-month work requirement would be enforced.
them jobs~ver three times as many recipients as
are required to be in work under current law ..
The work requirement applies whether or not the
24 months is consecutive, which suggests that over
time the great majority of recipients would have to
be enrolled in work activities. CBO estimates that
states must spend approximately $6,000 for each
welfare recipient in a work program, taking into
account the costs of developing the work slot and
supervising the recipient, and the costs of child .
care.. The bill does not require states to provide.
child care.
Eventually· the ban on aid to families who have
received aid for more than five years will start to
reduced caseloads but this ban~ unlike the work .
requir!!ment, applies only prospectively and so it
.. will not have any immediate impact on caseloads.
Moreover, if a state chooses to continue aiding·
these families, the ban may merely shift federal
costs to the states.·
'
..
'
�2116/95 Page 6
Issue
Prohibitions
on Aid
NGA Policy
The Governors believe that the next two years will
present an enormous opportunity to restructure the
federal-state relationship. The Governors urge
. Congress to take advantage of this opportunity both
. to examine the allocation of responsibilities among
the levels of government and to maximize state
flexibility in areas of shared responsibility.
However, the Governors believe.that children must
. be protected throughout this process.
Although the Governors recognize the legitimate
interest of the federal government in setting broad
program goals in cooperation with ~tates and
territories, they also believe that states should be
free from prescriptive federal standards, including
key aSpects of the welfare system, such as work
requirements, benefits to teen parents and to legal
immigrants, and time limits on benefits.
Shaw Bill
Title I prohibits states from giving cash assistance to
certain families now eligible for aid. These families
would remain eligible for food stamps and
Medicaid, although food stamps, which are now an
open-ended entitlement, may also become a capped
entitlement under separate legislation. Title.·1 bars
cash aid to the following groups:
-Legal noncitizens, unless they are refugees who
have been in the U.S. under five years or are over 75
years old and in the U.S. at leaStfive years.
-Any child born to a parent younger than ag~ 18,
or to the mother of the child. Such children would
.not become eligible for aid until they become adults.
-Any child born to awelfare recipient, or
conceived while a parent received aid. Such
children would not become eligible for aid until they:
become adults.
.
-Families of individuals over age 18 who have
received benefits for·60 months or more, regardless
of whether those months of aid were consecutive.
This prohibition covers only aid received after the
effective date of the bill. States would be able to
. exempt up to 10% of the case load from·this
requirement.
-Families that include someone who is not
cooperating with the state to establish paternity or
who has not assigned child support rights to the
state..
In addition Title I requires states to sanction
recipients who have cooperated with the state but for
whom paternity has not been established. The
penalty may be up to $50 or 15% of monthly
benefits and must last a minimum of 3 months but
no more than six inonths.
Title III makes legal noncitizens ineligible for a
variety of federal programs, except for refugees and
the aged, as long as they have been in the U.S. for at
least five years. (See attached list of programs for
which legal noncitizens would be ineligible.) The
Comments
The prohibitions raise a number of questions:
.--:could the federal courts construe an individual
entitlement that would require states to provide
benefits to any population, so long as federal funds
are available?
-How would states meet the long term needs
(over 5 years) of child only AFDC units? Would
states be able to switch these cases to foster care?
-D!les the bill in fact make sponsorship .
agreements legally binding and relieve states of
the responsibility to aid legal noncitizens? The
courts have held that sponsorship agreements are
not binding and that states do not have the legal
'authority to deny welfare benefits to legal
noncitizens. The bill attempts to change this
situation butit is not clear this can be done without
revising federal mimigration law. If states do not
have such authority, then the prohibition on
federal assistance to these families would represent
a sizable cost shift to states.
In additioQ, states that do not wish to deny benefits
to some or all of these types offamilies would lose
their federal match and have to fund these benefits
solely from state dollars. While this could be
financed at least in part by using available federal
funds to pay.a higher percent of the costs of those
eligible for federal benefits, s~tes with high
federal match rates and a high proportion of
ineligible recipients in their case loads could face
increased state costs.
HHS estimates are that 100,000 disabled children
would lose eligibility within six months of ..
enactment of the bill. In the future most disabled
children would not qualify for SSI benefits unless
cash assistance would prevent them from being
institutionalized. Many of these children and their
families may then tum to the AFDC program,
placing additional demands on' the limited block
grant funds under that program. Moreover, the five
�2116195 Page 7
Issue
Shaw Bill
Comments
eligibility of legal noncitizens currently residing in
the U.S. continues for one year after enactment of
the bill.
year limit on AFDC assistance could leave
disable~ children without 'any income assistance
after that time.
The title makes sponsorship agreements to be legally
binding until the immigrant becomes a citizen and
authorizes'states to deny assistance to legal
noncitizens.
NGA Policy
SSI benefits are entirely federally funded
(although some states supplement these benefits
with their own funds). A state that wishes to
~ontinue to aid to any of the groups denied aid '
under the bill will, therefore, have to make up all
of the lost federal funds with new state spending.
States thatcurrently supplement federal SSI
benefits wou'ld have some existing state spending
to shift over to cover the federal gap, but only if
they cut benefits by eliminating the supplement to '
the remaining SSI recipients. "
Title IV denies Supplemental Security Income
benefits to several groups that are now eligible.
Unlike Title I, those who lose aid under Title IV also
lose Medicaid coverage (unless they are otherwise
eligible). The groups are:
-Disabled children currently receiving SSIifthey
are eligible due to an individual functional
assessment and do not meet the impairment listing,
-Most disabled children who are not currently
receiving SSI, unless their disability would
otherwise require them to be institutionalized.
-Disabled adults for whom alcoholism or drug
addiction is a contributing factor material to their
disability.
Title IV establishes a block grant to states for the
purpose of making medical and non-medical
services available to disabled children. The state's
allotment equals 75% of the average cash SSI
benefit in the state and for number of children in the
state receiving non-cash SSI benefits under this
section. States are required to offer block grant
services to children who remain eligible but are
denied ,cash benefits. States are prohibited from
, , substituting block grant funds for services currently
paid for by the state.
'"
Last year Congress limited SSI benefits to
substatice abusers to three years and required
treatment as a condition ofreceivlng benefits.'
�,
I
\
i
J
;
I
I
l
\
Child Welfare (23 Programs)
+Foster Care Maintenance Paymcnts
+FOSler Care Administration
+Foster Care Training
+Adoption Maintenance Payments
+Adoption Administration
. .
+Adoption Tr~ining
+Indepcndenl l.iving
. +Family Prescrvation and Support
+Tille IV-B Research·
+Titlc IV-B Training
+Tillc IV-B Chnd Wclfare Services
Abandoned lnnmts Assistance
Child Ahllse Stllte <inant Prognlln
Child Ahuse Demonstration and Research (iralllS
Community-hased Family Resuurce Program
Aduplion ()pportunities Progral~l
Family Violence Stale <irant I'rogram
Family Support Centers
Suci.il Scrvkcs i{escan;h
Missing and Expluitcd ('hildren's Program
-<irants to improve the invc.stigalion and prosecutiun of child abuse cases
Chlldrcn's Advocacy Centcrs ..
Family~Unification Program
Subtotal
.-.
'.>.
�P\\\~I'''.:. o,\'e.... E\\~ \ \)\~
'0
\=0\:
In order
help noncililCnsimprove their.job
prep...alion skills and to protect the hulth and
..fety of residen.. of the U.S., noncilizenswould
remain diaible for the followina health.
immuniution. and education ....d job "aininl.
. proarams
: '
~.
I. Emeraency medic.al services
2. S..fford student loan proaram
3. Buie educational opportunity ........s
4. Fedenl work sludy
5. F~I .upplemen..1 educ.ation opportunity
.........
.6.Fcdcnl Pcrlr.ins loans
1. Onnll eos..tes for ....e sludcn. incenliv~
•. OrIn.. an4 fellowahlpa for ....du.te prolfllDJ
9. Special pro........ for .tudcn.. whose families
... en.~aed in ml ........ and seuoul fum work
10. 1.QInJ and Scholarshipa for Education in
1M Ilca1th Profesaiona' .
.
II. Onn.. for lnununiutiona Aaainsl VaccinePrnentable D i _
.
12. J~ Ccwps
n. Swnmer
Youth Employment and Trainina
14. Pro........ ofrralnina for Diudv......a ed
Adul.. Under Ti.le II-A and for DiSldv...... aed
. Youth under Title U-C of the Job Trainina
,
PU1nenhip A c t ' .
)\\,-(,/\'. ~ (\0\ E'\~\\o\e. ~\ ,
I. Medic.aid
.
2. Malernal A Child ..ulth Scnices Block .
Oranl Pro.,.....s
,
1. CommW1il, HulthCenter Services
4. Funily Planninl Methods and Services
5. Miaran' Ilealth Center Services
. 6 .. Supplemenl8lSc:curity Income.
1. Food Assistance Block Granl Programs
I. Rental Assislance .
9. Public llousinl
10. llousinll.oan Prosram
II. Iiousin8 Interat Reduciion Progiam
12. Loans for Ren..1 and Cooperative llousinl
I 3. Renlil Assisllllcc Payments
14. Pro.,.... of Aaislance Payments on Behalf·
of Ilomcownen
.
.
15. Rent Supple~1 Payments on Behalf of
Qualified Ten......
16. Loan and Gr..... Prosnms for Repair' and
Improvement of Rural Dwellinp .
11. I.oan Md Aai.tanc:c Proarams for flousinl
Fum Labor
.
II. Oran.. for Preservation and Rehabilitalion of
flousina
19. Grants and loans for MUIu.1 and Self·llelp
Jlousina ....d Technic.1 Assistance
20. Sile loans Program
21. Grants for Screeninl. Referral.s, &. Educ.ation
Re8ardin8 tead Poisonin8 in Infants &. Children
22. Title XIX·B subparts.! and II Public lIealth
Service Act
.
2). Tille III Older Americans Acl ProgiBn1s
24. Tille 11·0 iJomestic Volunteer Service Act
Programs
2S. Tille 11-<: Domestic Volunleer Service Act
Programs
26. low·lncome Enerp· AaiSl,lnCe Acl
. Program .
21. Wutheriution Assiswlce Pro.,....
28. Social Services Block Grant Progiam (Tille
XX SSA)
29. CommW1ity Services Block Granl Act
Pro........
30. leaal ASsistance under Leaal Services
COIJIOi'alion Act. ....
31. Emeraency Food and Shelter Grants
under McKinney lIomclcss Ac'
Child Care and Developmenl Block
·Grant Act Pro........
33. S..te Prosrun for ProvidinlChiid Care
(section 402(i) SSA)
34. Tanporll')' Family Aaistanc:c Block Oranl
Pro'
.
35. Child Care Block Oran, ProIP'lfM
36. Child Protection Block Onnl Pro.......s
n.
.........
�AFDC BLOCK GRANT ALLOCATION COMPARED TOFY 1994 ACTUAL DISTRIBUTION
State
. FY 96 AFDC State Block
Grant Allocation based on
FY94 Actual Distribution
FY91·FY93 Averaae
Percent Difference
FY96 Block Grant
FY94 Actual
15.00%
NGA estimates based on HHS data. All data in millions of dollars.
�United States Congressman
HAROLDFORD
WASHINGTON OFFICE:'2211 RAYBURN HOUSE OFFICE BUILDING. WASHINGTON, D,C. 20515·12021225-3265
MAIN DISTRICTOF.FICE: 369 FEDERAL BUILDING' 167 NORTH MAIN STREET. MEMPHIS, TENNESSEE 38103 ·19011 5444131
Honorable Harold Ford
Ranking Democrat, Subcommittee on Human Resources
Committee on Ways and',Means
Closing Statement
February 15, 1995
In just a few minutes, Mr, Chairman, we will take the first really important vote of
the 1011th Congress. It has been along three days, but I'd like to take a moment to
revieW our work and tO,explain 'quite clearly why I have no choice. This bill is soft on
work, weak on prevention, and tough on kids. I must vote NO this afternoon.
The Chairman's mark proposes to replace our nation's GO-year commitment to the
financial security of children with a new commitment'-- state revenue sharing.
Instead of guaranteeing that this money goes to children, we are going to
guarantee that it goes to the Governor and hope for the best -- in effect, put the money
in a plain brown envelope, and turn our backs. Ask no questions, attach no strings.
Well, that's not quite true. There are a few strings -- but we don't call them that
when they are mandates that advance the conservative ideology. Then we call them
, gqod policv.
I believe it is a fundamental mistake for America to walk away from our
commitment to children. The bill we are about to approve is mean-spirited and short
Sighted. It punishes children for the mistakes of their parents, and it asks us to embark
on a great experiment. But that experiment is using our most important -- and
vulnerable -- resource as guinea pigs, I won't be part of an experiment that uses
America'S children as crash test dummies.
But the Democrats haven't sat here and just said no. We have done our best to
perfect your mark, Mr. Chairman, to make constructive suggestions for cushioning the
pain that we fear you and your contract with America are inflicting on our children.
You have rejected our improvements at every turn.
We proposed rigorous,but fair paternity establishment rules. You told, us to
wait, we would deal with it when we discussed child support. Now those issues will be ,
delayed until full Committee. In the meantime, the bill requires states to pay reduced
benefits for six months when paternity has not been established -- even if the mother
has done all we could ever expect of her to cooperate and it is the state that has failed
to do the job. That'S just plain mean.
We proposed to hold teen parents responSible, but give them a chance to make
up for their mistakes. Our amendment would have required the teen mom to live at
", home or in another supervised setting.sne would have had to stay in school and
cooperate fully with efforts to establish paternity. But if she played by the rules, sh'E=
and her baby could get cash benefits. You, rejected our amendment. Instead, your bill
punishes the baby of that teenager for 18 years. That is just plain mean.
We proposed to let Sta~es decide the circumstances under which cash benefits
are paid, to let the State choose to limit benefits when a child is born to a family already
on welfare, But youJejected state flexibility, preferring to attach a conservative
"string" that dictates how States must spend limited resources.
-MORE
�we proposed to retain the basic safety net for abused and neglected children,
arguing that in the midst of all these other experiments, children need to be able to,
count on one thing: that if they are abused or neglected, they. will have a safe place to'
go. Again, you rejected our amendments, even though there is ample evidence that we
cannot just trust the states to do the right thing: 20 states, including your own, are
currently under court order because they have been found to have neglected children
in their care.
The fundamental reason we began this welfare reform debate was a sense that
Americans want a welfare system based on worK. They want new rules of the game,'
from the first day a family walKs into the welfare office. They won't get it with this bill.
what the American people will get with the Republican bill is the illusion of a
worK·based welfare system. The bill wishes for more work, but doesn't reQuire U .. It
proposes weaker work reQuirements than current law, does nothing to hold states
accountable for performance and - as if by magic - expects more families on welfare to
go to work. If that doesn't happen, do the states get punished? No. The children pay
the price. The Federal government is prohibited under the bill from taking any steps to
assure that the states are doing their job.
Again, the Democrats didn~t just sit here and shoot holes in your proposal. we
offered alternatives. We proposed stronger worK reQuirements. we wanted worK
activities from day one on welfare. We said States should develop a plan -- for each
recipient -- that charts the path to finanCial independence. we said help those who
need It with education and training. worK out child care and health benefits for every
family going to work, and make certain at least half of those jobs are in the private
sector.. But you voted no:" Instead, you want to trust the states and punish the children.
This bill places our nation'S future worKforce in jeopardy. The generations of
children affected by the bill will start life not only poor, but without the stimulation, ,
nutrition and support that could empower them to be successful citizens. Your bill,
instead, heaps punishment on top of poverty and destroys the best incentive of all:
HOPE.
Time after time In this process, I have voted to protect our children. Time after
time, I have voted ,for tough, but fair, work reQuirements. You have said NO each and
every time.
It is with sadness but a clear ConSCience that...Lwi II , for the first time in this ~arkup, vote NO. America'S children deserve better, ,
, .
###
i'
�WELFARE REFORM AGENDA
November 22, 1994
I.
PROCESS.
y-~".
\,
CHR state that she will be chairing meetings on a regular basis -- coordinating
policy, legislative, and other strategy -- and that this will be the basic group.
II.
STRATEGY
(*
* CHR'review: the President and COS have made clear that .this is an area where we
are looking to find bipartisan agreement. We need to work with both parties in the
.
coming months to produce a bill we can sign.
III.
POLITICAL OVERVIEW·
* Legislative: Discussion of legislative timetable and outlook
* Intergovernmental: Marcia to report on contacts with governors and others
* Communications: Rahm and Bruce to discuss current communications posture
*
Communications/Outreach Plan: CHR should request Rahm and Bruce to work with
A~J :Y>ts Pat & Jerry's offices, Marcia's office, Avis's office, and report back to next meeting
with a preliminary communications and outreach plan for· December and January.
\ .
IV.
POLICY NEXT STEPS
*
*
Direct Bruce, Jeremy, David, Mary Jo, and Belle to report back to this group in 2
weeks with recommendations on policy changes and cost and financing options.
Bruce and Kathi will convene a policy meeting here at WH next week .
..
*
V.
.
.
W~
c,fu\h
~t&Q~. ~
Ofi/W¥Jt
Research on GOP .Contract: HHS to produce analysis of key Items of likely
contention in GOP bill; cost estimates on cost shifts to the states; comprehensive
analysis of orphanage issue; other areas where GOP bill may be weak, such as child
support enforcement and fraud.
'
FINANCING
+0 rYteRt @It ...Q..~
*
Review Panetta direction to develop a plan at $9.3b or less. ~
*
Rivlin/Sawhill report on status of options. Possii:lly discuss question of whether to
include WR in budget
�THE WHITE HOUSE
OFFICE OF DOMESTiC POLICY
CAROL H. RASCO
Assistant to the President for Domestic Polic
To:
Draft response for POTUS
and forward to CHR by: _ _ _ _ _ _ _ _ _ _ _ _ _ __
Draft response for CHR by: _ _ _ _ _ _ _ _ _ _ _ _ _ __
Please reply directly to the writer
(copy to CHR) by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Please advise by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Let's discuss:
For your information:
/"
-"'\2:'-________________
Reply using form code: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
File: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Send copy to (original to CHR):
Schedule? :
o Accept
o Pending
o Regret
CLINTON LIBRARY PHOTOCOPY
�NOV 1,7 1994
, THE SECRETARY OF HEAL n~ AND HUMAN SERVICES
,
'.WASHINGTON, D.C. 20201
,DETERMINED TO BE AN
ADMINISTRATIVE MARKING
INI~IALS: ,,@ . DATE: 08
IOS/' ()
"0
C81rfF18BNTh1h MEMORANDUM
I
'/
.
.' .
NOV, ./ 7 /994
To:
'to
Leon Panetta
Carol Rasco
From:~t~
, Subje'ct:
Welfare Provisioris in Republican Contract With America,
This accompanying paper describes the Personal Responsibility Act (orPRA) contained as
partof the Republicans' Contract With 'America, indicatingboth the key provisions and the
likely impact they will have. Understanding the. differences between this proposal and the
original Republican plan (HR 3500) will be crucialas we begin to work with Congress to
fulfill the Administration's 10ngstIDtding commitment to ~elfare reform. .
..•.
cc: Laura Tyson, Robert Rubin
�' ..... ;
Brief Description and Analysis of the Pe~onal Responsibility Act
The Personal Responsibility Act (or PRA) is the welfare reform bill contained as part of the
Republicans' Contract With America. The memo briefly describes its key provisions and'
gives a preliminary analysis.
It is important to understand that there 'are major differences between the original House
Republican welfare reform plan introduced last year (HR 3500) and the Personal
Responsibility Act. Like the Administration's Work and Responsibility Act, HR 3500 built on
the Family Support Act of 1988 and required participants to engage in training and placement
services for up to two years. It then required them to work if they had not found private
sector employment.
In contrast, while the PRA does require work for a portion of the caseload, it does not require
people to participate in the education or training services necessary to prepare them for work.
Indeed, it removes the req\lirements and structure of the JOBS program which was the key
element of the Family Support Act. The PRA also does not create a "two years and you
work" framework or contain any child support enforcement provisions, although there are a
limited set of child support enforcement proposals in other parts of the contract. Instead, its
focus is simply reducing the welfare caseload, in large part by dramatically limiting eligibility
for children born to unmarried mothers and an unconditional cutoff of assistance (including
any sort of work opportunity) after five years.
Sectio~-by-Section
Analysis
The Personal Responsibility Act contains the major welfare reform provisions of the Contract
, With America. It has seven titles as listed below and runs 53 pages:
L Reducing llIegitimacy (16 pages)--This section denies cash aid to all children born to
unmarried teenagers under age 18. The child is barred from aid for the entire 18 years of
childhood unless the mother marries the father or another man who legally adopts the child.
There are no exceptions, even for rape or incest. States have the additional option of
permanently denying both cash and housing aid to children born to unmarried mothers who
are between the ages of 18 and 20. The fedr~:ral money saved by this provision is to be
returned to the states for use in pregnancy prevention programs, orphanages, or similar
programs, but cannot be used for direct support of the children or families. A family cap is
required in every state.
The bill also denies cash benefits to chiidren ba:'n to mothers of any age for whom paternity
has not been established. In other words, even if the mother had cooperated fully in
providing information needed to help locate the father, the child would stilI remain ineligible
for cash aid. (The mother could continue to receive her portion of the grant.) J30th the
mother and child would remain eligible for Medicaid. Just over 50% of children on AFDC
are born out-of-wedlock, and in roughly two thirds of these cases, paternity has not been
�I,
:..'
"
established. The provision seems to be effective immediately. If so this provision alone
appears to render roughly one-third (3 million children) of all children currently on AFDC
ineligible for aid.
R Requiring Work (8 pages)--This section requires that a certain percentage of the caseload
be required to work at least 35 hours per week (or 30 hours plus 5 hours of job search) rising
from 2% initially to 50% after the year 2002. This applies to all persons regardless of the
size of the grant they receive or the current state-by-state variation in AFDC benefits. For
example, under PRA, some families in MissiSsippi would be required to work 140 hours for a
$120 monthly grant, plus whatever nutrition assistance was available, The legislation appears
unclear as to whether states are required to provide child care either during work or program
participation.
All other federal requirements for participation in education and training activities are
eliminated, effectively making the JOBS program, which was the core of the Family Support
Act of 1988, optional, although states are allowed to impose rules of their own. After 24
months of aid (including at least 12 months of being required to work), states may
permanently terminate eligibility. After an absolute maximum of 60 months, states must
unconditionally and permanently terminate eligibility. No exceptions are allowed, even for
persons suffering from illness or disability, advanced age or responsibility for a disabled child.
Families would be cut off after 2 to 5 years even if they are were willing to work for their
benefit.
\
ID. Capping the Aggregate Growth of Welfare Spending (3 pages)--This section caps the
aggregate growth of AFDC, SSI, housing assistance and JOBS. It also reclassifies AFDC and
SSI as discretionary rather than entitlement programs; thus benefits would not be guaranteed.
The cap is set at current expenditures, plus inflation and the growth in the poverty rate.
However, because the expenditures would be discretionary, money would have to be
separately appropriated each year. The bill does not specify what happens to persons who are
qualified for one of these programs when the cap has been exceeded: there could be an
across-the-board benefit cut, or new applicants could be placed on a waiting list. Because
these provisions apply to both AFDC and SSI, large numbers of disabled and elderly
Americans, as well as young parents, would be affected.
IV. Restricting Welfare for Aliens (5 pages)--This provision eliminates the eligibility of most
legal immigrants for 60 Federal programs including AFDC, SSI, non-emergency Medicaid,
foster care, nutrition programs and housing assistance. The provision is retroactive in the
sense that current beneficiaries under age 75 would have their current benefits taken away
after a one-year grace period. Some exemptions are included, for refugees, for example. We
estimate that approximately 1.5 million legal residents would be affected.
V. Consolidating Food Assistance Programs (15 pages)--This repeals essentially all food and
nutrition programs, including Food Stamps, WIC, school lunch and other programs, replacing
them with a $35.6 billion discretionary appropriation paid out as a block grant with a very
limited set of "strings." (It must be spent on "nutrition assistance" for persons who are
economically disadvantaged, at least 20 percent must go for school lunch, breakfast, milk, or
�similar programs, etc.) It also requires that many recipients of state food aid work. Our
preliminary estimate is that this $35.6 billion figure is 12% less than the aggregate $40.4
billion projected to be spent on such programs in FY 1996. The distribution formula would
also significantly redistribute the current flow of nutrition funds to states, with low AFDC
benefit states hit the hardest.
VI. Expanding Statutory Flexibility of States (5 pages)--This allows states to convert AFDC
into a federal block grant equal to 103% of the 1994 federal expenditures. The only
requirement is that the money be used to fund a system of cash payments to needy families
with dependent children. No state maintenance of effort is required. It contains numerous
other smaller provisions such as an allowance to pay interstate migrants at the old state's
benefit level, an allowance to require school attendance of all children, "married couple
transition benefits," and microenterprise changes.
VII. Drug Testing for Welfare Recipients (1 page)--This requires all persons determined by
the state to be addicted to drugs or alcohol to participate in treatment (if available) and be
periodically tested for drugs.
Overall Effects
Results are still preliminary, but initial work suggests the following:
o Burdens on states would increase dramatically. States could lose at least $5 billion a
year in federal matching funds for AFDC, although states do retain the option of
taking a block grant for their current AFDC allotment. In addition, states would be
asked to design their own nutrition programs to replace food stamps, WIC, and other
existing programs for $5 billion p~r year less than is currently provided by the federal
government. Close to $5 billion per year now going to support legal immigrants on
SSI, AFDC, and food stamps would be lost. Demands on state child welfare systems
are also likely to ,increase.
o A' major effect of the bill would be to reduce the number of children receiving aid by
making them ineligible for benefits. Because of the paternity establishment, teen
parent, and unconditional 60 month cutoff provisions of the PRA, millions of children
would be dropped from AFDC, whether or not their parents were able or willing to
work. While further analysis is needed to determine the effects of the bill over time,
nearly a third of children on AFDC appear to be ineligible immediately, and ultimately
at least 60% of children would be cut off. . Thus 5-6 million children would eventually
be affected.
�Brief Description and Preliminary Analysis of the Personal Responsibility Act
The Personal Responsibility Act (or PRA) is the welfare reform bill contained as part of the
Republicans' Contract With America. The memo briefly describes its key provisions and
gives a preliminary analysis.
It is important to understand that there are major differences between the original House
Republican welfare reform plan introduced last year (HR 3500) and the Personal
Responsibility Act. Like the Administration's Work and Responsibility Act, HR 3500 built on
the Family Support Act of 1988 and required participants to engage in training and placement
services for up to two years. It then required them to work if they had not found private
sector employment.
In contrast, while the PRA does require work for a portion of the caseload,· it does not require
people to participate in the education or training services necessary to prepare them for work.
Indeed, it removes the participation requirements of the JOBS program which was a key
element of the Family Support Act. The PRA also does not create a "two years and you
work" framework or contain any child support enforcement provisions, although there are a
limited set of child support enforcement proposals in other parts of the contract. Instead, its
focus is simply reducing the welf~re caseload, in large part by dramatically limiting eligibility
for children born to unmarried mothers and an unconditional cutoff of assistance (including
.
any sort of work opportunity) after five years.
Section-by.,.Section Analysis
The Personal Responsibility Actc~mtains the major welfare reform provisions of the Contract
With America. It has seven titles as listed below.and runs 53 pages:
I. Reducing Dlegitimacy (16 pages)--This section denies cash aid to all children born to
unmarried teenagers under age 18. The child is barred from aid for the entire 18 years of
childhood unless the mother marries the father or another man who legally adopts the child.
There are no exceptions, even for rape or incest. States have the additional option of
permanently denying both cash ·and housing aid to children born ~o unmarried mothers who
are between the ages of 18 and 20. The federal money saved by this provision is to be
returned to the states for use in pregnancy prevention programs, orphanages, .or similar
programs, but cannot be used for direct support of the children or families. A family cap is
required in every state.
The bill also denies cash benefits to children bomtomothers of any age for whom paternity
has not been established. In other words, even ifthe mother had cooperated fully in
providing information needed to help locate the father, the child would still remain ineligible
for cash aid. (The mother could continue to receive her portion of the grant.) Both the
mother and child would remain eligible for Medicaid. Just over 50% of children on AFDC
are born out-of-wedlock, and in roughly two thirds of these cases, paternity has not been
�established. The provision seeins to be effective immediately. If so this provision alone
appears to render roughly one-third (3 million children) of all children currently on AFDC
ineligible for aid.
II. Requiring Work (8 pages)--This section requires that a certain percentage of the caseload
be required to work at least 35 hours per week (or 30 hours plus 5 hours of job search) rising
from 2% initially to 50% after the year 2002. This applies to all persons regardless of the
size of the grant they receive or the current state-by-state variation in AFDC benefits. For
example, under PRA, some families in Mississippi would be required to work 140 hours for a
$120 monthly grant, plus whatever nutrition assistance was available. The legislation appears
unclear as to whether state~ are required to provide child care either during work or program
participation.
All other federal requirements for participation in education and training activities are·
eliminated, effectively making the JOBS program~ which was the core of the Family Support
. Act of 1988, optional, although states are allowed to impose rules of their own. After 24 .
months of aid (including at least 12 months of being required to work), states may
permanently terminate eligibility. After an absolute maximum of 60 months, states must
unconditionally and permanently terminate eligibility. No exceptions are allowed, even for
persons suffering from illness or disability, advanced age or. responsibility for a disabled child.
Families would be cut off after 2 to 5 years even if they are were willing to work for their
benefit.
ill. Capping the Aggregate Growth of Welfare Spending (3 pages)--This section caps the
aggregate growth ofAFDC, SSI, housing assistance and JOBS. It also reclassifies AFDC and
SSI as discretionary rather than entitlement programs; thus benefits would not be guaranteed.
The cap is set at current expenditures, plus inflation and the growth in the poverty rate.
However, because the expenditures would be discretionary, money would have to be
separately appropriated each year. The bill does not specify what happens to persons who are
qualified for one of these programs when the cap has been exceeded: there could be an
across-the-board benefit cut,or new applicants could be placed on a waiting list. Because
these provisions apply to both AFDC and SSI, large numbers of disabled and elderly
Americans, as well as young parents, would be affected.
IV. Restricting Welfare for Aliens (5 pages)--This provision eliminates the eligibility of most'
legal immigrants for 60 Federal programs including AFDC, SSI, non-emergency Medicaid,
foster care, nutrition programs and housing assistance. The provision is retroactive in the
sense that current beneficiaries under age 75 would have their current benefits taken away
after a one-year grace period. Some exemptions are included, for refugees, for example. We
estimate that approximately 1.5 million legal residents would be affected.
v.
Consolidating Food Assistance Programs (15 pages)--This repeals essentially all food and .
nutrition programs, including Food Stamps, WIC, school lunch and other programs, replacing
them with a $35.6 billion discretionary appropriation paid out as a block grant with a very
limited set of "strings." (It must be spent on "nutrition assistancell for persons who are
economically disadvantaged, at least 20 percent must go for school lunch? breakfast, milk, or .
�similar programs, etc.) It also requires that many recipients of state food aid work. Our
preliminary estimate is that this $35.6 billion figure is 12% less than the aggregate $40.4
billion projected to be spent on such programs in FY 1996. The distribution formula would
also significantly redistribute the current flow of nutrition funds to states, with low AFDC
benefit states hit the hardest.
VI. Expanding StatutoI)' Flexibility of States (5 pages)--This allows states to convert AFDC
into a federal block grant equal to 103% of the 1994 federal exp~nditures. The only
requirement is that the money be used to fund a system of cash payments to needy families
with dependent children. The bill language does not specifically say whether states that take
this option will still have to implement the requirements of the other titles, though it appears
that all requirements of AFDC are eliminated tor states that take the block grant. No state
maintenance of effort is required.
This section contains numerous other smaller provisions such as an allowance to p~y interstate
migrants at the old state's benefit level, an allowance to require school attendance of all
children, "married couple transition benefits," and micro enterprise changes.
VII. Drug Testing for Welfare Recipients (1 page)--This requires all persons determined by
the state to be addicted to drugs or alcohol to participate in treatment (if available) and be
periodically tested for drugs.
Overall Effects
Results are still preliminary, but initial work suggests the following:
o Burdens on states would increase dramatically. States could lose at least $5 billion a
year in federal matching funds for AFDC, although states do retain the option of
taking a block grant for their current AFDC allotment. In addition, states would be
asked to design their own nutrition programs to replace food stamps, WIC, and other
existing programs for $5 billion per year less than is currently provided by the federal
government. Close to $5 billion per year now going to support legal immigrants on
SSI, AFDC, and food stamps would be lost. Demands on state child welfare systems
are also likely to increase.
o A major effect of the bill would be to reduce the number of children receiving aid by
making them ineligible for benefits. Because of the paternity establishment, teen
parent, and unconditional 60 month cutoff provisions of the PRA, millions of children
would be dropped from AFDC, whether or not their parents were able or willing to
work. While further analysis is needed to determine" the. effects of the bill over time,
nearly a third of children on AFDC appear to be ineligible immediately, and ultimately
at least 60% of children would be cut off. Thus at least 5 million children would
eventually be affected. If states adopted a cut off of children born to mothers age 18
21, or imposed a 2 year cutoff, the impacts would be even greater. Note, however,
these effects could be significantly mitigated if states instead accepted the block grant,
�though then state behavior would be unknown. Since no state maintenance of effort
is required, some states might significantly cut back their own expenditures and reduce
support for the poor.
�
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Carol Rasco - Issues Series
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Carol Rasco
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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[Welfare Reform Legislation] [4]
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Carol Rasco
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Box 127
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
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2010-0198-Sb-welfare-reform-legislation-4
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https://clinton.presidentiallibraries.us/files/original/7753818b05f565f5bba33fbc002c606d.pdf
8985e1a9288017b33109dd3d503ecabe
PDF Text
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Clinton Library
DATE
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AND TYPE
SUBJECTfflTLE
00 I. list
Participants in 1128/95 Meeting (partial) (2 pages)
nd
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ON Box Number: 8506
FOLDER TITLE:
[Welfare Reform Legislation) [3)
2010-0198-8
kc227
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. SS2(b)]
PI National Security Classified Information [(a)(1) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [aleS) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(1) National security classified information [(bXl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Office of Congressional ~nd
Intergovernmental Affa~s W
200 Constitution Avenue. . .
Room 5\325
Washington. D.C. 20210
_n
(202) 219-6141
Fax: (202) 219-5120
NANCY R. KI RSH N ER
.
JAN /91995
~~'~~6'/
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I
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DEPARTMENT OF LABOR • 202-219-6141
PHOTOCOPY
PRESERVATION
�1995 BE I'IER JOBS AND WAGES AGENDA
The Goal:
We need to put working people first. Anyone willing to work
hard and play by the rules should have a fair shot at" the American dream.
The Problem:
o Since 1979, real household income has grown by 5767 billion-about a
52,000 increase for the averae;e household. But the average figure conceals the
bigger story: About 97 pereent of the income increase (adjusted for inflation and
population growth) has gone to· the top fifth of households. Everyone' else-$O
pereent of American households-has shared just 3 pereent of the growth.
o In the early decades following World War II, we grew together. Every
income group, from the pOorest one-fifth to the richest, essentially doubied i1s
income. But today, we are growing apart.· Between 1979 and 1993, the incomes of
the bottom one-fifth fell by 17 pereent (adjusted for inflation); the next one-fifth lost
8 pereent; the middle fifth lost three pereent; the next fifth gained five pereent and
the top fifth saw their e~mings' rise .18 pereent.
o The problem is not that some of us· are getting rich. The problem is that
most of us
a~
getting now,here.
"
I
o We've cleaned up the economic mess we inherited, and created 5.6 million
new jobs. But more jobs isn't enougfL Americans need better jobs with higher pay
if we are to rebuild our middle class.
o .It used to. be that if you womed hard and played by the rules, you had a
fair chance to I;et ahead. This was America's economic covenant.
o . Technological transfonnation and global marke1s have rewritten the rules •
. Hard work isn't enough any more. You need education and skills. '
o ' Restoring the covenant means preparing ordinary hanl-working Americans
, to prosper under the new rules.. This is our agenda for 1995 and beyond.. Doing
this-and doing it without increasing the deficit-is the goal of the Middle Qass Bill
of Righ1s~
�·'
1979 to 1992 --.Who Got the Growth?
Shares of Average Household Income Growth
100
Percent Accruing Lo Income Group
~
80
. (;'.
60
40
20
o
Top 20%
Everybody Else
Source: Based on data from the Census Bureau, CurrenL PopulaLion Survey. Household income is in constant 1992 dollars,
and adjusted by CPI-U-Xl, and populalion is normalized to a consLanllevel.
�1950 to 1978
--
Growing Together
Real, Family Income ,Growth 8yQuintile
160%
140%
138%
---~----~-
~-~~----------
----------
--------._-
---.----_._-.
120%
98%
106%
Second 200/0
Middle 200/0
99%
100%
80%
600/0
40%
20%
0%
Bottom 200/0
Fourth 20%
SOURCE: Census Bureau, DOL calculations. All data converted to, 1993 dollars.
Top 20%
�'
1979 to 1993 -- Growing Apart
Real Family Income Growth By Quintile
20%
15%
100/0
5%
.r • . .
" ..
..
•..
. • . . . • . . .
. -
.-.
•.•
.
0%
... ~3°/0.
-5%
~8°/0__
-10%
. _ . _.
...
. _. _.. _ .. _
:'150/0
-17%
-20%
Bottom 20%Second 20%
Middle 20%
Fourth 20%
SOURCE: Census Bureau, DOL calculations. All data converted to 1993 dollars.
Top 20%
.. 1
/'
�1995 BEllER JOBS AND WAGES AGENDA
Skills Matter More Today
rf0'
o We're well on track for meeting or exceeding the President's piedge
of 8 million new jobs. But our success on job quantity highlights the stakes
of job quality. Working Americansne~d a fair shot at higher incomes.
Increasingly, skills and education are' the entry tickets to good jobs
paying middle-class wages. The three-fourths, of American workers without
college degrees have suffered the sharpest drop in wages and' benefits.
, 0
o Fifteen years ago, a male college graduate earned 39 percent more
,than a man with a high-school diploma. .But by 1993 the average male
college graduate was earning 80 percent more, than his high-school
,counterpart. (The ~ap is just slightly narrower for women.)
Health-care and pension coverage at work is low, and falling, for
less-skilled workers.' Better-educated workers. get better benefits.
,
0
o The lower the level of education' and skills, the higher a worker's
risk of unemployment.
o rhe key to rebuilding the
mi~dle
class is empowering ordinary ,
workers with the education and skills they need to earn good livings in the
new economy.
o A traditional four-year degree is not the only entry ticket to the
middle class. Today's economy is creating new middle-class jobs requiring
~o years or less of technical~training, usually available at community
colleges. Some examples of new middle-class careers:
'
•
•
•
•
,•
•
'.
"•
Nurse practitioners
Desktop publishing specialists
X-ray technicians
Num~rically-controlled machine tool operators
Sales technicians
Spreadsheet operators
Automobile diagnostic technicians
Physical and occ.. pational therapists
�SkiUsMatter I\tlore: Earnings
Average Annual Earnings of Men
, by Educational Attainment
60
1993 Dollars
On thousands)
60
College Grads
'!tar
50
____ ...;
50
Some College
-.
40
.. -----.....
s·······
~.
30 . t-.
....... .
40
%
. .. .. _. _. . . . . . .. . ......... ~i~~ .~c!l~ol Grads
~
---:~--.-----
"'WIll
30
Less Than High School
,
.
1979
, 1981
1983
1985
1987
1989
1991 '
Note: Workers 25 years of age and older, working year round, full time. Data on educational attainment for 1991
through 1993 are not directly comparable to those from prior years. Numbers for 1993 used 1990 population
weights, whereas data for other years used 1980 population weights.
Source: Bureau of the Census. Current Population Survey
Prepared By: OASP 1/18/95
�Skills Matter More: By Gender·,
Average Annual Earnings by Educational Attainment
1979 - 1993
1993 Do...", (In thouaanda)
Men
Women
1993 Dollarn ~n thousands)
'SO
60
College Grads
.
50
-
.
.
~
~
~
-.
50
40
40
Some College
........
(;vllt::YII
"."
(;alISO ..
30
~iQh. Sc~?~1 ~!,a.d~
-
Some College
20
'.
less Than High School
10
!f'1m
!
1~
1~
less Than High School
••
-
HigtlSCllOOl Grads ,
1~
~
1~
1~
!'
1~
30
-
•
-
•
-
-
•
••
•
••
-
•
-
-
-
-
-
••
_.
1981
1983
_4
20
~10
"
1979
•
1985
1987
1989
-
1991
1993
Note: Workers 25 years of age and older, working year round. full time, Data on educational attainment for 1991 through 1993 are not directly comparable to '
those from prior years. Numbers for 1993 used 1990 population weights, whereas data for other years used 1980 population weights.
Source: Bureau of the Census, Current Population Survey
Prepared by: GASP 1/18/95
�Skills Matter More: Benefits
Employer-Sponsored Benefits
by Educational Attainment, 1979 - 1993
90
80
Paraanl of ....... and......,y ........ -
Pension
Health
Percent 01 all wage and Balmy workel'll
90
• - -
70
- - - - - - - - - - - - -
~--~--
...
College Grads
- - - - - - - - - - - - - - ____ -
- - - - • 80
SdlODl Grads_ - _ _ _ _ _ _
~~-~--
______
______
70
College Grads
11111' I ~"d )'_Hli tAl
,.'.1 ti
60
50
_____
F-Less than High Schoo ---
-----
~~
_ --:'~~il
------ -----I
Some College
eo
40
- • 40
..
- - - - - -
20
L._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
HI79
1983
SoUrce: Current Population Survey
• 30
~----------~-----------J
1988
20
1993
1979
1983
1988
Prepared by: OASP 1/16/95
1993
�Skills Matter More: Risk of Joblessness
Unemployment Rates by Educational~Attainment
1979 - 1993
20%
200/0
- _.. . . . " - . . " . . .. - - . . . . . - . ....
15%
- -.. 150/0
..,
Less than" High School Diploma
10%
10°/.
High School Grads
Some College
5°/0' I~
,
7'
..-:1IiIII
. 4-year College Degree ......._.H~
.
00/0
LI_ _ _ _ _ _ _ _ _ _~~_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _----~--------~--~------~----~
1979
1981
1983
Source: Bureau of labor Statistics
1985
1987
1989
1991
.50/0
0%
1993
Prepared by: OASP 1/18/95
�1995 BETIER JOBS AND WAGES AGENDA
Tax Refonn to Favor Skill-Building
.j
Current tax policy fails to fully reflect the importance of education
. and training as investments.
0,
o The President. has proposed to fix this., Under his proposal,
Americans could deduct from· their taxable income the money they spend on
post-secondary education for themselve~ or their families. Up to $5,000 of
education spending per year will be deductible starting in 1996, rising to
$10,000 in 1999. '
'
o Taxpayers would not have to itemize -their deductions to get the
education and training deduction., And' educatio,=, expenses would not be
subject to the 2-percent "floor" on miscellaneous deductions.
o To focus the tax cut on the middle class, deductibility would be
phased out over the income range of $100,000 to $120,000 for a couple
filing jointly, and between $70,000 and $90,000 for individuals.
o The President has also called for letting more Americans ,make tax
favored' contributions to Individual Retirement Accounts, and letting them
use their IRA's to finance education and training.
Competition among America's thousands'of learning institutions
would block attempts by schools to capture all the benefits of ihe tax break
by raising tuition.
'. ,
i
(
0
o Paying for school is a potent kitchen-table issue. A Dece,mber poll,
following the President's Middle Class Bill of Rights Proposal, found that 84
percent supported' tuition tax deductibility, com pared with 78 percent
favoring a $500 per child tax credit and 56 percent favoring capital gains
tax cuts.
o The Republicans want more tax
b~eaks
for corporations, and for
people who are already wealthy. We say no more corporate welfare.
Instead, we want the tax code to empower hard-working people to make it
in America.
'
�Who Gains fro l11 the Republican Contract?
Annual Benefits fron) the Contract's Package
30
or Individual
and Corporale rl~lx CUlS .
·Dllllars lin Billilll1s)
25 ...... .
r
20 .....
"1"-
15
10
5
o·
IL..-_ _L..
Lcss than
$IO,OOO~.
$10,000
$20,000
$20,000$30,000
. $30,()OO
$50,000
$50,0()()
$75'()()()
Family Im:lll11c
Sourcc: Orticc llf Tax Analysis. Departlllcl1I llf Treasury. Prelimillary Jala.
$75,()()()
$I()(),()()()
$100,000$200,000
MllJ"C Ihall
$200,OO()
�1995 BEITER JOBS AND WAGES AGENDA
Edu~ation
and Training:
From Programs to Purchasing Power
i
o Beyond tax breaks to favor education and training, the Middle
Class Bill of Rights also calls for a fundamental reform of fe~eral training
programs, oriented around Skill Grants. Seven core principles together
define. a radical restructuring of employment and training policy:
o
Individual Empowerment. Instead of going where some
bureaucracy sends them, .individuals should be empowered with resources
so they can choose' for themselves what ~kills they need to boost their
."
earning power.
'"
,
• Unemployed and low-income workers, who often can't benefit from
, the tuition tax deductions President Clinton has proposed, can get
Skill Grants worth. up to $2,620 per year, 'for up to two years, that
they can use, as they choose for learning new skills.
• Both tuition tax breaks and Skill Grants will be supplemented by ,
Individual Education Accounts. These low-cost loans will be available
to any person, with flexible' repayment options, to enable every
American to invest in their skills arid repay at the pace their future
income allows.
o Leaner Government. The proposal inciuded' in the Middle Class
Bill of Rights would eliminate 'over SO separate programs, replacing them
with an integrated system that minim~es red tape and maxim~es individual
choice.
C
o Good Data to Guit/.e Choices.
A skill-building system rooted in
individual choice requires good data to inform decisions about what skills to
get and where to learn them. ,Reforms woven throughout the initiative-and
centered on the networks of One-Stop Career Centers already under
construction in the States-will give workers and job seekers access to
reliable information on jobs, careers, and the success records of training
institutions, so that they can make good choices to improve their futures.
,',
�1995 BETfER JQBS AND WAGES AGENDA'
o AccountabUity. Too often today, training providers aren't held
accountable for results. The reform package will fix. this by emphasizing
individual choice and competition so that individuals can pick providers
who deliver; by providing good performance data so people know what .
training pays off; and by setting quality standards for training providers to
cut off the frauds and the incompetents.
o State FlexibUity. Washington doesn't have all the answers. States
should have the flexibility to reflect local conditions and respect local
priorities~ The President proposes to give states the freedom to tailor
training programs and delivery systems as they see fit. Most federal rules
dictating administrative proc-edures will be wiped out. States can get
waivers from most of the rules that remain, and will be able to pl~w the
savings back into individual training.
.
o Private-Sector Partnership.·' At base, employment and training
policy isn't about government. It's about jobs, and that means the private
sector has a central role. Business and labor will be full partners in
designing and running training, job-search, and information services. New
awards will recognize excellence in creating workplaces that expand
opportunity by capitalizing on and re~arding worker skills.
,
.
o Paths from School to Work.
Preparing AmeriCa's youth for the
world of work, including disadvantaged youth, isa vital task that is too
often done badly today. To fix this, employment and training programs
for young people, including vocational education, will be folded into the
school-to-work movement already underway in every State. The youth
component of this reform initiative represents a major extension of the '.
system building and consolidation unleashed by the School to 'Work
Opportunities Act of 1994-includinga school-to-work "second chance" to
replace most existing youth ero:ployment and training programs.
�~,'
More·Education, Higher Earnings
Median Earnings of Male Workers in 1993
$40,000 .
$35,000
'-1
- - - - - - - - - - - - - - ' - - - - - . , . - - - - - - - - - - - - ,
----~..
~~-
.. --.---
---------
~--~--------
$30,000
$25,000
$20,000
$15,000
$10,000
High School Graduate.
,
. 2-Year Degree
Bachelor's Degree
.
SOURCE: Census Bureau, median earnings of males 25 years and older.
�Average weekly earnings of·full-time workers by
educational attainment and training received, 1991
/'
Dollars
----:=====-----~----~--~---,-,.,
1,000
I'
III_
NOli"
auung
'0 ~kill
..
lmpCovemed II~
II Q~
goo
..
tr.alnD!,g
II
~
80th
of trllll'lllg
785
(,( 10
400
200 .
o
Sourc~:
High school
Current Population Survey
Some college
College degree
�1995 BEI'IER]OBS AND WAGES AGENDA
Securing Middle-Class Status
For Wor~ing Americans
Our efforts to boost the earning power of working Americans must
be backstopped by steps to ensure that they aren't robbed of their chance at
'middle-class status.
Health Care
o Health care reform 'remains as urgent as ever, despite the lack of
action in the l03rd Congress. Today, 39 mmion~Americans are uninsured.
Every day we wait to take action, more families li"e in jeopardy of losing
their coverage due, to illness or j~b loss-and with their' coverage, losing
their grasp on middle-class security.
"
,
At the same time, increasing health-care costs and decreasing
coverage burden' government budgets at the federal, state, and local levels.
.0
,
o The Administration' plans to ,work with Congress to take the first·
steps towards health-care security by passing to reform the insurance
market, making coverage available and affordable for children and
,
unemployed workers.'
o We must make sure that those currently covered by Medicare and
Medicaid remain protected.
o And weinust reduce the costs of health care if we are to keep the
federal deficit on a downward path.
�.
.
1995 BETfER JOBS AND WAGES AGENDA
Making Work Pay
o Real average wages have fallen since 1979 for workers with high
school educations, for both men (down by 19%) and women (down by 3%).
o The real value of the minimum wage is now 27% lower than it was
in 1979. The last increase in the minimum wage (to 54.25) was in 1991.
Since then, inflation has cut its real value by nearly 50 cents.
o Two-thirds of an minimum-wage workers are adults. The average
minimum-wage worker brings home about half of his or her family's weekly
earnings (based on 1990 data.)
o An American working fun time, all year at the minimum wage
doesn't earn enough to bring a family of three above the poverty level (even
when he or she gets the Earned Income Tax Credit.) The ranks of the
working poor are growing.
o. The erosion of the minimum wage since, 1979 accounts for an
estimated 20 percent of the increase in wage inequality among men, and 30
percent of rising inequality among women. .
o Recent studies have found that modest minimum-wage ,increases
have not significantly cut employment, and boost. total worker income.
I
o The last minimum wage inc .-ease passed both the House and the
Senate with overwhelming bipartisan support.
.
.
o A December Wall Street Journal-NBC poll found 7S-percent
support for. raising the minimum, wag~witheven higher support among ,
blacks, women, and young people.
�•
'1
1995 BElTER JOBS AND WAGES AGENDA
Pension Security
o Losing tbe pension earned by a lifetime of bard work is one of tbe
cruelest risks faced by ordinary Americans. Tbe Administration launcbed
work.9n pension security in its first montbs in office.
o Tbe gap between pension promises and pension-fund assets
widened from $27 billion in 1987 to $53 billion in 1992•.
In mid-1994 tbere were 1.2 million workers and retirees fn
underfunded plans at troubled companies (and B. million in all underfunded
plans) and tbe deficit of tbe Pension Benefit Guarantee Corpo~ation stood
at $2.9 billion.
O·
o
Last'year, tbe Administration and Congress acted. Reform
legislation was drafted to tigb'ten funding requirements, give 'tbe PBGC
better tools to enforce tbe law and prevent comp~nies from walking away
from pension promises, and putting tbe burden of insuring against
underfunding on tbe plans causing tbe biggest problems.
o Congress passed tbe Retirement Protect,ion Act of 1994 as part of
tbe legislation implementing tbe Uruguay Round trade agreements under
tbe General Agreement on Tariffs arid Trade.
.
o Congress and tbe Administration bave taken action to reduce tbe
pension risk facing ordinary Americans, giving us a model for tbe rest of .
tbe better jobs and wages agenda.
,"
�•
More Working Families are Poor
Percentage of Working Families in Poverty: 1975-1993
Percent in·Poverty
12 . ---,- - -
.
11
,-
- .
~
- -
~
~
-
- . - -.
-
~
.
~
~
-
- -, - - . -
".
,10.
9
..
8
. .
..
7
1975
--.~
-
1980
- -
~
.. -
- -
- - - - ..
1985
1990
.1993
Source: Bureau of the Census, Current Population Survey. A working family is defined as one with children
where someone in the household worked.
�Minimum Wage Work No Longer Lifts
Families Out of. Poverty
Annual Earnings at the Minimum Wage as a Percentage of the Poverty Line:
1959-1995
120
Percent of Poverty Une
110·
....
100
I
. .....
~
~
-
*
-
~
-
-
-
-
~
-
~
~
~
-
-
•
~ ••
-
-.
-
~
,-
90 ..
.J
80·
....
........
. . . . . . . . . . . . . . . . . . .. ..
70 '.. . . . . . . .. .... ..... .... .......... '... ..... .... . ..... .
60
1960
1965
1970
1975
1980'
1985
1990
1995
Note: Annual earnings for a family of three with one full-time, year-round minimum wag~ worker as a percentage
of the three-person poverty line. The three-person poverty line for 1994 and 1995 are from Congressional
Budget Office projections.
.
�'.
AGENDA
(1/18/25)
Update on Invit~s,'.
1.
.
.~: Ikw ~ (~ ~{JIV12.-
r
,2. "Update on Staff Meetings
,
- Review schedule of pre-meetings,
3.
Prep for Hill Staff Meetings
4.
Logistics Update
5: Next Steps
" - Daily staff calVmeetings
"
.. '%~~~~
~i~""'"
"
... ·~G
(~iJ)
�"
Curre~t
Schedule of Meetings
.This Week
By January 19 .
I
. All individual Hill staff meetings complete
January 19
.Democratic Hill Staff
January 20
.Bipartisan Hill .Staff
r- .
j
By 1/20: Meeting with Gov staff(?)
' J/ J,Q)Conference Call with Locals
~i~_ ~'Il$-~.
·~lJ{). ArVNext Week:
January 25
.Staff Attendees Identified ;
Background Materials Submitted
January 27
\.
POTUS Briefing
To Be SchedulCd
Follow up Staff meetings
(?) All Dem staff meeting - Thursday or Friday -:
Distribute talking points, go over strategy?
�"
, WELFARB SUMKIT LIST
SENATB:
The Honorable Bob Dole
Majority Leader
United states senate
Washington, D.C. "20510
contact: Sheila Burke :2;2 ¥ - C?!:,;Z J
The Honorable John B. Breaux
516 Hart Building
united states Senate
Washington, D.C. 20510
,
~:
;;;':2.
"
"
'f - ,+c,;;. 3
The Honorable Bob Packwood
Chairman, Finance Committee
United states Senate'
Washington, D~C; 20510
contact: Lindy Paul ;).:4 ~ - s";;" L/ 'f
The Honorable Daniel Patrick Moynihan
Ranking Member, Finance Committee
united States Senate
Washington, D~C. 20510
contact: Lawrence O'Donnell ~:2.. tf - 'f<fS/
The Hpnorable Nancy Landon Kassebaum
Chairman, Labor and Human Resources
United states Senate'
Washington, D~C. 20510
contact: Susan Hattan :;)..;). y- !..f 774
The Honorable Edward M. Kennedy
Ranking Member, Labor and, Human Resources,
United States Senate
Washington, D.C. 20510,
contact: Nick Littlefield" ~4- - if:s 'f 3
,
,
.'
"
.
.~.
:
'
,.,
J .~. . . . ,
..
~-:
'
"r'
';'.
�BOUSE:
The Honorable Newt Gingrich
Speaker
House of Representatives
Washington, D.C. 20515
. cont~ct: Jack Howard .;/..,2 5"'- 'fS 0/
\
. The Honorable Richard A. Gephardt
Democratic Leader
House of Representatives
Washington, D.;C. 20515
contact: Andie King
::l;l.5: - ~"71
I'
..
,
,/,'
The Honorable Bill Archer
Chairman, Committee on Ways and Means
House of Representatives
Washington, D~C. 20515
contact: Phil Moseley ;;2;;2.5'"- :2S 7 I
The Honorable Sam-Gibbons
Ranking Member, Committee on-Way~and Means
House of Representatives
Washington, D~C. 20515
contact: Janice Mays
;2:;1.5"- 537&
The Honorable William F. Goodling
Chairman, Committee on Economic and Educational
Opportunities
House of Representatives
Washington, D.C. 20515
contact: Jay Eagen
.2.;1.S"" - 52/:3f.t;·
·The Honorable William Clay
Ranking Member, committee on Economic and Educational
OpportunitiesHouse of Representatives
Washington, D.C. 20515
contact: Gail Weiss
;J.).S - ;). Yo ~
.'
, .
.:.:' -'
.~
-
..
"~.
• 1•.• •
-.
,
'A
;("'~' •
~.'
�WithdrawallRedaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. list
DATE
SUBJECTffITLE
Participants in 1/28/95 Meeting (partial) (2 pages)
nd
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Pol icy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8506
FOLDER TITLE:
[Welfare Reform Legislation] [3]
2010-0198-S
kc227
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(1) National security classified information [(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b )(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
.
National Security Classified Information [(a)(1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record rriisfile defined in accordance with 44 U.S.c.
2201(3).
RR. Document will be reviewed upon request.
�/
Participants in 1/28/95 meeting
Governors
The Honorable Howard Dean
Governor of Vermont
109 State Street
Montpefier, Vermont 05609
p-802-828-3333
f-802-8
The Honorable Tommy Thompson·
Governor of Wisconsin
'
S~ate, Capitol, Room 115 E
P . 0 . B'ox 7863
Madison, Wisconsin 53702
p-60~-~66-2734 .
f-608
The Honorable Arne H. Carlson
Governor of Minnesota
130 State Capitol
St. Paul, Minnesota 5515.5
p-612-296-3391
. f-
9
:\.:.~ '.!
::,~(;
~~'
;t
The. Honorable Mel Carnahan
Governor of Missouri
State Capitol Building
Room 216
Jefferson City, Missouri 65101
p-314-751-3222
,t~~~~~ ~}!5J~r~1~~
The Honorable Thomas R. Carper
Governor of Delaware
Carvel State Office Building'
320 N~ French Street
,Wilmington, Delaware 19801 '
p-302-577-6636
The Honorable John Engler
Governor of Michigan
P.O. Box 30013 .
~.
",
.
�woj]
Lansing, Michigan
p-517-373-3400
f-517-335-6949
Mayors
48909
(R.) ~£.2iL{m~{1) (fA~(l ,~
not yet confirmed
.
County Officials
The Honorable Yvonne Brathwaite Burke
Chair, Los Angeles County Board of supervisors
500 West Temple Street, Room 866
.~os Angeles, California
90012
p-213 - 974 -l075 .
£-2l3-680-3283
Mr. Michael Pappas
Freeholder, Somerset County
P . 0 . Box 3 000 . '
Somerville, New Jersey 08876
p-908-231-7030
. 'f - 908 -707:"4127
,
.
State Legislators
Democratic State Leg!slator- not yet confirmed
The Honorable James Lack
Senator, of the State of New York
AlbanYi New York 12247
p-S18-45S-2071
7 -~/8 -
't-S.s- - ¢;.:l.3
\.
Y
:,'.
�,
:
--_ ..... -----...
DEPARTMENT, OF AGRICULTURE
OFFICE OF THE SECRETARY
--- Ce.,·
\
WASHINGTON, D.C: 20250
Carol Rasco
Assistant to the President for Domestic Policy
The White House
West Wing - 2nd Floor
Washington, D.C. 20500
.Dear Carol:
U.S.D.A. today released the enclosed report: The Nutrition, Health and Economic
. Consequences of Block Grants for Federal Food Assistance Programs. The report takes a
hard look at the consequences of proposed block-grants of Federal food assistance programs
for states and those who rely on these programs. I think you will find that the report makes
an important contribution to discussions about the future of these programs. .
I hope you will find the report usefuL If you have any questions, please don't hesitate
to give me a call.
Sincere]y,
Ellen Haas
Under Secretary for Food, Nutrition
and Consumer Services
Enc10sure
.'
.
AN EQUAL OPPORTUNITY EMPLOYER
�\.
\\'
,
,
'.
\
'\
NOTE: On page 36, the percent change in farm income for peanuts
without loss of Section 32, under Section V, should read -0.6 (instead
of 0.6).
�. The Nutrition, Health, and, Economic Consequences
of Block Grants ,for Federal Food Assistance Programs
Executive Summary
U.S. Department of Agriculture
January 17. '996
Food Md Con......... ServlOil
Eoonomio Research ServlOil
.
.
.
The proposed Personal Responsibility Act,
a key component of the Contract with
America, would make sweeping changes
that alter the very character'of the existing
food assistance programs. Specifically, the
Personal Responsibility Act, if enacted, :.,
would:
o. Combine all USDA food and
nutrition assistance programs into a
single discretionary block· grant to
States;
.
o
Authorize an appropriation of $35.6
billion in fiscal year 1996 for food
and ,nutritlonassistance;
o
Eliminate all
standards; .,
o
uniform
national
c:;ive States broad discretion to
design food and nutrition assistance
programs, provided' only that no
,more than 5' percent of the grant
support administration, at least 12
percent support f60d assi~tance and
nutrition ,education for .women,
infants, and young children~ and at
least 20 percent 'support school
. based and . child-.cClre ,meal
programs; and
o
Eliminate USDA's 'authority to
donate commodities; USDA could
only sell bonus commodities to
States.:
The consequences of these changes on the,
safety.net of food assistance programs, the
nutrition and health of low-income
Americans, the food and agriculture
economies, and the level,and distribution of
"Federal support to States for food
assistance are significant.
. The Personal Responsibility Act would
'significantly reduce federal support for food
. and nutrition assistance ..
o
Federal funding 'for food and
nutrition assistance would fall by
. more than $5 billion in fiscal year
1996 and nearly $31 Dillion over 5
years (Table 1).
o
All food and nutrition assistance
would be, forced to compete for
limited discretionary funds. States'
ability to deliver nutrition benefits
would be subject to changing
annual appropriation priorities .
o
., Programs would: be unable to
responq 'to changing economic
�If Congress appropriates the full
·amount authorized, all but.8 States
would lose federal funding in fiscal
year 1996. California could gain
about $650 million; Texas could
lose more than.$1 billion (Table 3).
By reducing federal -support for. food
assistance and converting all remaining
food assistance ·to . a block' grant, the
Personal Responsibility Act would lower
retail food sales, reduce farm Income; and
increase unemployment.
o
o
Under the proposed block grant;
States could immediately cash-out
any ·and all food asSistance..
. programs in spite. of evidence that'
an in-kind benefit .is more effective'
in stimulating food purchases than
. a. similar benefit provided in cash.
,
,
"
,
,
o
In, the short-run.. the bill could
reduce retail food sales by as much
as $10 billion. reduce gross farm
income by as much as $4 billion.
increase f.rm program costs. and
cost the economy as _
many as .
138.000 jobs.
o
In the long ,run. the bill could reduce
employment in farm 'production by
more than 1 5,000 jobs and output
by more than $1' billion. The food _
processing an~ distribution.sectors .
could lose as many ,as 83.000 jobs .
and $9 billion in output. _
o
The economic effects would be felt
most heavily in rural America. In
both the short- and long..;run,rural
areas would suffer disproportionate .
job losses.
o
Every $1 billion in, added food'
assistance generates about 25,000
jobs. providing an automatic
stabilizer in hard tim·es..
The proposed basis for distributing grant
. funds would result in substantial losses for
most States.
iii
.\
Although some States initially gain
funding. all States would eventually
fare worse than under current law.
Over time. the initial gains will
erode because the: block grant
eliminates the automatic funding
adjustments built into the existing
Food Stamp and Child Nutrition
programs.
�"
"
, Table 2 - Histdrical illustration of Food Assistance Block Grant
'. .(Dollars'in millions)
.
Year
Actual
FoOd
Assistance
./
Without Initial Reduction
With Initial Reduction •
Adjusted.
Difference
Block
Grant' .. . Total' . Percent
Adjusted
Block
Grant
':'12.7
$21,697
N/A
N/A
-$2,756
Difference
Total
Percent
1989
$21,697
.1990 .
24,778
.20,666 ,
.04,112 :
-16.6
23,672
-$1,106
.04.5
1991'
28,849.
21,971.
-6,878
-23.8
25,167
-3,682
-12.8
' 33,519
.23,232
-10~287
-30.7
. 26,612
-6,907
-20.6
.1993 .
35,397
23,369
-12,028
-34.0
26,769
-8,628
-24.4
1994
36,928
24,374
-12,554.
-34.0
27,920
-9,008
-24.4
1992
$18,941
Notes: Actual food assistance 'includes total federal cost of all USDA food assistance programs,
excluding Food Program Administration. The cost of food programs operated by the
Administration on Aging in the Department of Health and Human,Services are not included.
These figures assume that Congress would have appropriated the full amount authorized in
. each year. The block grant authorization is adjusted by the change . in total U.S. population
and the Consumer Price Index for Food at Home in the preceding year (ending on July 1 for
population and in May f,?r the CPl). .
.
•
The initial 12.7 percent reduction in the ,first year is equivalent to the estimated percentage
. reduction in food assistance funding in the first year of the Personal Responsibility Act as
shown in Table 1.
,'
..
'
v
�;,
..
'~
.
;
State
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
',South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
. Total
Notes:
.. ,
'.,
.
.
•Level of Food ..
Assistance .
Current
Proposed
1,768
528
410
1,617
128
602
99
983
3,819
234
76
783
660
405
467
57
1,287
475
346
1,465
101
546
95
743
2,665
277
66
597
444
309
··442
57
40,764
-.
35,600
. Difference
Total
Percent
- 481
- 53
. - 64 .
- 152
- 27
-.56
-4
- 241
- 1,154
43
-10
- 185
-216
- 96
- 25
•
- 27
-10
-16
-9
- 21
-9
-4
- 24
- 30
18
-13
- 24
-.33
- 24
-5
1
- 5,164
-13
Individual cells may not sum to totals because of rounding.
Total includes the Commonwealth of Puerto Rico, other territories
and outlying areas, and Indian Tribal Organizations.
This table assumes that Congress appropriates the. full amount
.
authorized for fiscal year 1 9 9 6 . '
• equals less than $1 'million.
vii
�..
,,"'
. .
,
.
-The Nutrition,Health~ and Economic ,Consequences
of Block Grants for Federal Food Assistance Programs
'u.s. Dep.-tmant of Agriculture
Food Md Coneum. s.vta.
Eoonomlo . . . . . . Servia.
INTRODUCTION
The U.S. ,Department of Agriculture
administers the Nation's domestic food and
, nutrition programs (Appendix A).
Together, these programs serVe more than
, 45 million Americans every month. The
Food Stamp Program (FSP) alone, serves
about 27 million people monthly, more than
half of whom are children, over a quarter of
whom ,live in households with earnings,
and about 7 percent of whom are elderly.
The National School Lunch Program (NSLP),
serves 25 million children each day. WIC
provides food assistance, nutrition
education, and critical health care referrals
to nearly 7 million women, infants, and
children monthly.
"
The Food Stamp Program is designed to
help meet the basic nutritional needs of all
eligible low-income families or individuals;
other food and nutrition programs provide
supplemental benefits to those with special
needs, ,such as ,children or, pregnant or
lactating women. Together these programs
fashion a network of food and nutrition
assistance that ensures that every
American, regardless of income, has
access to an adequate and nutriti,ous diet.
While food and ,nutrition programs have
long enjoyed broad support, current fiscal
J ....uary 17, 1996
realities compel a careful review of the
merits of all federal programs. It is in this
context that the Personal, Responsibility
Act and other proposals that could affect
food assistance programs are being
discussed.
The ersonal Responsibility Act (HR 4), a
P
·key component 'of the Contract with
America~ would make sweeping changes
that alter the very character of the existing
food assistance programs. Specifically, the
Personal Responsibility Act, if enacted,
, would: '
o
Combine all' USDA' food 'and
nutrition assistance programs into a
single discretionary block grant to
States;
o
Authorize an appropriation of $35.6
billion in fiscal year (FY) 1996 for
the Food Assistance Block Grant;
o
Eliminate all
standards;
o
uniform
national
' Give States broad discretion to
design food assistance programs,
provided only that no more than 5
percent, of the grant support
administration, at least 12 percent
support food assistance and
�.;.:'
Table 1 - Effect of the Personal Responsibility Act on USDA Food Assistance, Program Costs
"
,(Dollars in millions)
,
",
Rscal Year
,
Total
1996
1997
1998
1999
2000
$27;777
.$29,179
$30,463
$31,758
$33,112
$152,290
·8,681
.' 9,269
.9,903
10,556
11,283
49,692
3,924
4,231
4,379
4,513
21,291
382
351
351
351
351
1,784
40,764
43,029
44,962
47,042
49,260
225,057
"35,600
37,138
38,756
40,457
42,214
194,166
-5,164
-5,891
-6,206
..-6,585
-7~046
-30,892
-12.7%
-13.8%
-13.8%
-14.0%
-14.3%
-13;7%
,
Current Law: ,
..
.'
-
'"
Food StampsJNAP
.'.
·Child.Nutrition
,
..
WlC
. All Other
..
"'Total
Proposed Law:
Diffarence
Percent Difference
4,245·
.
Notes: Based on current service program level for USDA food assistance programs in Department
.estimates of September 1994 (excluding projected costs of Food Program Administration
"but including anticipated mandatory spending for WIC, consistent with Presidential policy).
This table does not include the budgetary effects of food programs operated by the
Administration on Aging in the Department of Health and'HumanServices.·
....
~
,
.
~
.
The Food Stamp total includes the cost of the Nutrition Assistance Program in Puerto Rico.
The Child Nutrition totSl includes all administrative and program costs for the National
School Lunch, School Breakfast, ,Special Milk, Summer Food Service, Nutrition Education
and Training, and Child and Adult Care Food Programs, the value of commodities provided
to schools, and support for the Food Service Management Institute.
The All Other total includes all administrative and program costs for the Com~odity
"Supplemental Food Program, the Emergency Food Assistance Program, the Food
,Distribution Program on Indian Reservations, the Nutrition Program for the Elderly, and
Food Distribution to Charitable Institutions and Soup Kitchens and Food Banks.
Proposed levels for the block grant in fiscal years 1997 through 2000 are increased from
the 1996 emount using the projected increase in total population and the 'cost of the Thrifty
Food Plan for the preceding year. Totals may not equal sum of columns due to rounding.
This table assumes that Congress appropriates the full amount .authorized in each year.
Page 3
�Table 2 - Historical Illustration of Food Assistance Block Grant·
. " (Dollars in milli9ns)
Without Initial Reduction
With Initial Reduction •
Year
Actual
Food
Assistance
Adjusted
Block
Grant
Total
Percent
Difference
Adjusted
Block
Grant
Difference
Total
Percent
.1989
.$21,697
$18,941
:-$2,756
-12.7
$21,697
N/A
N/A
1990
.24,778
20,666
-4,112
-16.6
23,672
-$1,106
-4.5
1991
28,849
21,971
-6,878
-23.8
25,167
-3,682
-12.8
1992
33,519
. 23,232
-10,287
-30.7
26,612
.-6,907
-20.6
1993
35,397
23,369
-12,028
-34.0
26,769
-8,628
-24.4
1994
36,928
24,374
-12,554
';34.0
27,920
-9,008
-24.4
Notes: Actual food assistance includes total federal cost of all USDA food assistance programs,
excluding Food Program Administration. The cost of food programs operated by the
Administration on Aging in the Department of Health and Human Services are not included.
.
.
~,
.
.
'These figures assume that Co~gress would have appropriated the full amount authorized in
each year•. The block grant authorization is adjusted by the change in total U.S. population
and the Consumer Price Index for Food at Home in the preceding year (ending on July 1 for
population and in May for the CPl).
.
The initial 12. 7 percent reduction in the first year is equivalent to the estimated percentage
reduction in food assistance funding in the first year of the Personal Responsibility Act as
shown in Table 1.
Page 5
�Table 3 - Distribution of Program Funds Under the Proposed Block Grant and Current Law
'.
,
..
. (Dollars in millions'
FIScal Year
Total
. 1996
' 1997
1998
1999
$1,780
· $1,857
$1,938
$2,023
4,272
4,457
' 4.651
4~855
5,066
.23,301
7,120
7,428
7,751
8,091
. 8,443
38,833
. All Other
22,428
23,397
24,416
25,488
26,595
122,324
Total
. 35,600
37,139
38,756
40,457
42.214
194,166
2.958
3,042
3,154
3,273
15,291
. 3,414
3,685
3,699
.3,817
3,937
18,552
8,321
8,884
9,480
10,088
10,766
47,539
27,503
28,742
29.984
31,283
143,677
43,029 .
44,962
47,042
49,260
225,057
-.1.104.
-1,131
-1, f63
-5,583
2000
Block Grant Funding:
Administration (5 %)
" ,
. Womennnfant/Child(12%)
Child Nutrition (20%)
$2,110'
,
$9,708
Current Law Funding:
.
.
, I
Administration
WIC
2,864 .
'.
Child Nutrition
.
All Other
,
~
Total
26,165
,
40,764
..
'.
Difference:
Administration '.
-1,084
· -1.101,
858
.7.72
952
1,038
1,129
4.749
Child Nutrition
-1,201
':1,456
-1,729
-1,997
-2,323
-8,706
All Other
-3,737
-4.106
-4,326
-4,496 .
-4,688
-21,353
Total
-5,164
-5,890
-6,206
-6,585
-7,046
-30,892
"
Women/Infants/Children
.
Notes: The current law estimate of spending on administration includes federal funding of State
,Administrative Expenses for the Food Stamp, Child Nutrition, and Food Distribution
programs; administrative funding (excluding the cost of providing nutrition education. health
care referrals. and other services' for WIC; other program costs (such as printing and
shipping of coupons) for the FSP; research and evaluation; coordinated review for the
school meals programs; funding for the Food Service Management Institute. dietary
guidelines implementation. and communication activities related to the Child Nutrition,
Program. Federal Food Program Administration is not included. Nutrition services, health
care referrals. and other similar costs for WIC are included as a WIC benefit.
· Page 7
�. .;:.
more common in low-income populations
o . The prevalence of health conditions .:
directly or indirectly,relatedtopoor: . :.', : than' in the U.S" population as a whole.
.....
;nutritionalstatus : ~is' 'generally
.The existing, food assistance programs
"highest among the low-income
population; ,
contain a direct link to nutrition and health.
, '
Food stamp benefits across the. country are
.. tied to the cost of, a modestly-priced
o 'The risk' of . nutrition-related
nutritious diet sufficient to sustain an
.disorders is generally greater inlow
income ,groups than in groups with .
active, healthy life. The key components'
. of WIC include food packages tailored to
highe~ i~comes; :. "
",'
,',:. . . . .
#.- '~.:.:' ."t •. ' -_ .. ' ~ "
'.' specific nutrition requirements, nutrition
. education, health care referrals, and
o The prevalence of iron deficiency is .
immunization screening.
The Child
greater among women below the .
, Nutrition Programs contain standards that
poverty line than among women ,
, ensure school ,hleals served to 'America's
above it;
children meet certain nutritional
o I , : Intakes of a' number of vitamins and. . · requirements •.
minerals are lower among the poor
.' Since..the nation,wideexpansion of the
than· among the non poor.. For
example, on average, low-income . J · Food Stamp Program and the introduction
women ,have inadequate intakes of
of WIC, the gap between the diets of low
income and other families has narrowed.
vitamin' E, ,vitamin, 8-6, folacin,
, ' USDA has conducted periodic surveys to
calcium, magnesium, iron, and zinc.
,. assess the eating habits of the American'
Their intakes for these m.it:rients are
, people. These data show that'the diets of
below :those of ~omen, at higher
'income' levels; an~' '" .
.'
the .poor improved markedly between
...
1965-1966 and,1977-1978, a period that
.0
The rate o,f anemia is substantially
marked the nationwide expansion of the
higher' among poor children below'
Food Stamp Program~nd the introduction
the age of 4' than among. nonpoor
of WIC.The percent of low-income
children in this 'age group.
· households with diets that met 100
percent of the . Recommended Dietary
Allowances ,(RDAs) for 7 key nutrients
Most .of the food assistance and nutrition
programs were. started in .response to
essential to good health -'protein, calcium,
. "documented problems of under
iron, vitamin A,. thiamin, riboflavin, and
,consumption and undernutrition in the
ascorbic acid - grew from less than 40
United States in the· 1960's and early
percent to about 50 percent. This increase
. 1970's. Results from three major nutrition
is more than double the increase - from 50
percent to 55 percent - seen in the general
surveys - the Ten State Nutrition Survey
(1968..1970), the Preschool Nutrition
population over the same period.
Survey (1968-1970), and the first Health
'and Nutrition Examination Survey (1971
Nutritional status in the United States. as .
. 1974) .indicated that problems of growth
measured by growth, low birthweight, and
deficits, anemia, and dental caries were
hematological status has improved.
A
-. "
,
• .
*
~
, -
.'
"
.,' .
•
.,,;,
~ ~
"
'
,',
.
'
i
.
"
\
.;.
Page 9
�: G u ide Ii n e s. , 'The 1 9 ~4
., reauthorization of the Child Nutrition
Programs. funher endorsed the
Dietary Guidelines as' national
standards by making them a.
program req~irement by law.
o
·The Personal Responsibility Act
threatens, the key components of
WIC. Much ofWIC's success rests
on a tightly prescribed combination
·of targeted food package, nutrition ,
counseling, and. direct links to
health care for expectant and post
panum mothers and their children.
Under the Personal Responsibility
.Act, States no longer would be
required to provide any of these key
components.' The potential loss of
these comppnents is' panicularly
problematic given the· 'significant
body of evidence that shows
investments in WIC return
substantially larger savings.in publicr
.
health care costs.
: . .'
Rigorous studies have demonstrated
that WIC reduces infant deaths, low
binhweight, premature binhs,and
. other .problems. . Prenatal . WIC
panicipants have better binh
outcomes than eligible
nonpanicipants.
Panicipation in
WIC increases average gestational
age and binhweight while reducing
the incidence of· very low
binhweight babies' and' infant
. monality. As a result, Medicaid
eligible women who panicipate in
WIC·have lower health care costs.
: In the first 60 days after binh, the '
Medicaid savings for newDorns and
their mothers averaged between
$1.77 and $3.13 for every dollar
spent 'on WIC. The ratio of savings
to costs was larger when measured
over the first year, ranging from
$1.92 to. $4.21.
.
WIC improves the nutrition of'
. panicipants. The program played a
significant role in the decline in the
incidence of iron deficiency anemia.
Children panicipatirig in WIC have
more nutrient dense diets than
eligible nonpanicipants, with higher
intakes of iron, vitamin C, thiamin,
niacin and vitamin 8e•
WIC panicipation is also responsible
.for better health care use. Pregnant
panicipants . are more likely to
receive prenatal care. WIC also
significantly increases the rates of
childhood immunization.
, States would, not be held accountable for
results. While the Personal Responsibility
· Act .eliminates all nutrition standards, it.
provides'· no mechanism to ensure.
accountability for achieving· results and
ensuring proper stewardship of federal
· funds.
There are no requirements or
vehicles for State reponing of activities,
federal oversight of operations~ or reponing
to Congress and the American public on
the services provided .or the results
,achieved with a multi-billion dollar block
grant.
Consequences for Food, Agriculture, and
the Economy
The' Personal Responsibility Act would
· ultimateJy mean less money available to
suppon food purchases and agricultural
incomes. This effect occurs in three ways.
First, the bill would reduce the amount of
'Page 11
�potentially reach $315 million and program
cost would increase by $191 million~"
For peanut producers, gross income losses
could, vary between $0 and $26 million
depending on the extent to which the
existing section 32 surplus removal policies
absorbed the excess supplies. Likewise,
,peanut program costs could increase from
$14 million to $37 million.
We also estimated impacts beyond the
farm sector using economywide models
that incorporate intersectoral linkages
among different goods and -service
producing sectors.
Impacts were
estimated for several scenarios as detailed
in Appendix B. ,Short run impacts, were
estimated assuming constant wages and
prices.
In the short run, the Personal Responsibility
Act could add a tenth of a, percent to
aggregate U.S. unemployment. 'A $5
billion reduction and conversion to block
grants could cost 126,000 to 138,000
, jobs, the majority of which are in the 'food'
, sector. Farm and food sector output could
fall by as much as $6 billion to $16 billion,
and output in the nonfood sector could
decrease by as much as $4 ,billion. (In
some scenarios, output in the nonfood
sector could increase by, $2 billion.) In
general, every $1 billion reduction in food
assistance costs the, economy about
25,000 jobs.
" ,
'In the long-run, the Personal ResponsibUity
Act would reduce employment in farm
production by 15,000 to 45,000jobs and
output by more than $1 bilDon. Food
, processing and distribution sectors could
lose between 28,000 and 83,000jobs and
between $3 billion and $9 billion in output.
" Employment declines in the food sector
would be offset by non-food job increases.
While some of the short-run impact would
be mitigated as the economy adjusted back
to full employment, there would be lasting
changes in the composition of output and
in the distribution of employment. We
estimated long, run impacts with an
economywide model that allows for wages
and prices to adjust to restore a balance
between the supply and demand for labor
and for various goods and' services in the
economy.
The economic effects wOlild be felt most
heavily in rural America. For both the
:short-run and long-run scenarios,
nonmetropolitan areas would, suffer
disproportionate job 10,sses. ' In the short
run, in response to a $5 billion food
. assistance funding, reduction with
conversion to a block grant,
, nonmetropolitan areas would lose twice as
many jobs as urban areas as a proportion
of employment levels.
In addition to
'farming, food processing activities are
located in these,areas. ,In the long run, the
,nonmetropolitan employment and output
losses diminish but would not entirely
disappear. Conversely, employment in
urban . areas would actually increase
slightly, thus permanently shifting
employment "from nonmetropolitan to
metropolitan areas.
j
,Under the Personal Responsibility Act, the
,amount of commodities maile available to
.support food assistance would be
significantly reduced. USDA would have
authority only to sell bonus commodities to
States. Eliminating federal food assistance
programs would remove a significant outlet
for the commodities obtained under price
support and surplus-removal' programs.
Page 13
�,Table 4 ,-' Effect of the Personal ResponslbUIty Act
·on USDA Food Assistance Programs by State In rlScai Year 1996
. (Dollars in millions' ,
Level of Food·
Assistance
Difference
State.
Current
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Rorida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada'
New York
North Carolina
North Dakota
$818
'97 .
663
422
4,170
412
297
92
137
2,194
1,209
215
127
1,741
713
297
307
740
1,141'
'188
576
608
1,390
508
730
810
111
187
89
836
361
145
3,101
930
86
Page 15
Proposed
$713
84
554
403
4,820
417
248
58
85
1,804
934
198
176
,1,483
691
266
270
582
765
167
404
577
1,109
: 490
603
754
140
175
94
704
321
150
2,661
849
76
Total
. - $105
-13
-109
-19
650
5
- 49
- 34
- 52
- 389
- 275 .
• 17
49
~ 258
'. - 22
- 31
..37 "
-157
- 375
-; 21
-172
- 32
- 281
-18
. - 127
- 56
29
-12
5
- 132
- 40'
5
- 440
- 81
-9
Percent
-13
-13
-,16
-4
16
1
·17
- 37
- 38
-18
- 23
.-8
'38
:15
-3
. 11
'- 12
- 21
- - 33
- 11
- 30
-5
,- 20
-4
-17
-7
26
-6
5
-16
- 11
3
- 14
-9
- 11
�is in the West region (which has a relatively
high income limit),h~sa food stamp
, participation rate 13 percent below the
national average, pays $593 per month on
average to food stamp households on
AFDC, and would gain more than $650
million in funding under the block grant.
Texas, on the other hand, is in the South
region (which has the lowest income limit),
.has a participation rate 6 percent higher
than the national average, pays only $174
. ,on average to food stamp households on
AFDC, and would lose more than $1 billion.
.Funding reductions of the size called for in
the Personal Responsibl7ity Act would force .
States to reduce the number of people
served by the FSP, benefit levels, or both.
An estimated 34 States would lose funding
, for services to individuals currently served
by the Food Stamp and Food Distribution
Programs. Even if all spending on Food
Distribution Programs were eliminated, half
of \these States would not have enough
funding to. serve the current food stamp
population.
Unless States can fill the gap between ,
current service and block grant funding,
they will be faced with the choice of'
.reducing 'benefits across the board,'
restricting participation, or some
combination of both. 'As shown in Table 5,
most States would have to make dramatic
reductions in food' stamp case loads or
, benefits.
funding available to the'. Food Stamp
, Program would ,require States to serve 6
million fewer food stamp participants, a 22
percent reduction. Ten States would have
to restrict participation by more than 40
. percent. This would mean lowering the
income eligibility guidelines from the
current limit of 130 percent of poverty to
below 60 percent of poverty.
Alternatively, States could continue serving
the. current food stamp caseload, but
reduce benefits across the board. If States
adopted this approach, the average benefit
per person would fall by about $11 per
month (14 percent). In 9 States, the pro
rata benefit reduction needed to sustain
current participation would exceed 30
percent.
These estimates assume States spend only
the 20 percent minimum OD child nutrition
services. If States spend more on child
nutrition, the reductions needed in services
to current Food Stamp' and, Food'
Distribution Program recipients would be
even larger.
If States spend no more than the minimum
on child nutrition services, the reductions in '
funding for child nutrition could be just as
extensive. Based on current spending for
Child Nutrition programs, all but 8 States ~
will lose funding. Total child nutrition
funds could be cut by over 25 percent in
19 States (Table 6).
\
States could, for example, choose to
accommodate the lower funding available
by lowering eligibility limits for the Food
Stamp Program, restricting participation to
those with the least income and the'
greatest need. Applying this approach to
, projections for FY 1996, the reduction in
Under current law, the School Lunch and
.School Breakfast programs provide means
tested support for all meals served to
children. ,Modest subsidies provided to
higher-income children help support the
. infrastructure to serve nutritious meals to
Page 17
�','
.
,
"
.;.l
.,
"
-..
:
'"
"
'"
! .
'"
,
'
,"to
,
,
"": ;I,: ..:~
,
.
"
"
'-1,--:-" .', -.• :' ,.'.'.',.,
"
.
"
,
...
"
,Change in
' Food
Stamp/Food
Distribution
,
"
I
If 'States Adjust, ,', '
'If,States Adjust Benefits:
..
"Caseload:
','
:
State
"
,
.
,
Assistanc~
"
Change U1
Average
Monthly
Participants
,
'(millions'
'.'Qhio·
'Oldahoma' , ~,
':Oregon
Pennsylvania
Puerto Rico
Rhode Island "
South Carolina
South Dakota
Tennessee
Texas
. Utah,
Vermont
Virginia
Washington
West Virginia
,·,Wisconsin '
,Wyoming
,
:' ~427
-627,000
·-73,000
" ,-32
.: ·'50'
-120,000 '
-332,000
-185'
-44
-56,000
-19
-32,000
3,000
'3
10
11,000
' " ;,"0:207,
..360,000
- 826 -1,250,000
61,
72,000
,-8,000,
'-3
..220,000
·-126
-146
-207,000
-113,090
- 88
18,000 '
14
,
6,000
5 -.
,
.,-'~
"
.
'"
....,"".; , ..;
"
,
"
,
...•
,
' ,
"
"
"
'
.
..
Chal1ge U1
Average
Benefit per
Person
Percent
Change
-49
:.20
-42
-28
-4
-34
1
20
-46
-47
54
,-,14
-41
·45
-35
5
17
-27.45
-6.55
-13.75
-12.40
-2.50
-16.79
.60
14.75
-21.55
-25.20
38.20
-3.80
-18.90
-25.60
-22.1'0
3.35
12.50
-34
-9
-18
-16
-4
-23
1
20
-30
-32
54
-6
-24
·34
-31
5
17
-10.80
-14
' ,
-
,
- 3,734
Total'
Percent
Change
-6,311,000
';22,
-'
Notes: Based :on projected block grant funds available for all other programs within each State
"after setting aside 5 percent for administration, 12 percent for food as~istance and nutrition
services to women, infants, ,and young children, and 20 percent for child nutrition.)
,
'
'
In those States, where the remaining funds are insufficient to support ,the projected
current service level for tl:\e ,Food Stamp and Food Distribution programs, this table
, assumes that States will first eliminate Food distribution programs and then either
(a) lower the food stamp income eligibility limits to eliminate participants with
relatively high incomes or (b) make a pro rata reduction in benefits across the board.
In those States where the remaining funds exceed the projected current services
level for the Food Stamp and Food Distribution programs, this table assumes that
States will maintain food distribution and add new food stamp participants or
.increase food stamp benefits across the board as funds permit.
I
,
In both cases, the impacts on caseload and benefits are based on projections of the
number of participants and the average food stamp benefit per person in each State
'
in fiscal year 1996.
Page 19
�,
. Table 6 - Effect of the Personal Responsibnity Act
'; 'on Child Nutrition' Programs by state In Rscal Year 1996
..... , , '
$ Change
(millions'
Children Made
Ineligible for NSLP
(thousands'
-18%
-$ 32
1,400
-29%
-$ 7
69
·19%
-$ 26
525
Cut exceeds size of SBP and
SFSP.
-26%
-$ 29
262
Cut exceeds size of Child and
Adult Care Food Program
(CACFP) and SFSP•
.. ·Califomia
-6%
-$ 60
2,800
Colorado
-10% '
-$ 9
400
Cut exceeds aize of SBP and
SFSP.
-24%
-$ 16
337
Cut exceeds size of CACFP and
SFSP.
-51%
-$ 12
71
District· of
Columbia
-22%
-$ 5
32
Fiorida
-17%
-$·75
1,120
Cut exceeds size of CACFP and
SFSP.
Georgia
-31%
-$ 85
732
Cut equals size of SBP, CACFP,
and SFSP; or more than 40
percent of r,-JSLP.
Hawaii
+21%
+$ 7
137
Grant increases, while. three
.quarters of children in NSLP
would be made ineligible.
+8%
+$3
148
Two-thirds·of children in NSLP
would be made ineligible.
Percentage
Change In
dollars
State
.'
..Alabama
..
..
",
,.,
.
'.
'
..
..
'. ','.
Alaska'
..
..
'
.
.,
,
. Arizona' .
.
'.
Arkansas
... ,,, .
,".,'.'
'
,.
'
,.'
.. ,
Connecticut
. Delaware
Idaho
..
Page 21
Potential Program Impact
Cut exceeds size of the School
Breakfast Program (SBP' and the
Summer Food Service Program
(SFSP'.
Cut exceeds 40 percent of NSLP.
Nearly 3 million children would
lose eligibility for NSLP benefits.
Cut exceeds size of NSLPi or SBP
·and CACFP.· Two-thirds of
.children in NSLP would be made
ineligible.
Cut exceeds size of SBP and
SFSP.
I
�State
Minnesota
I,
I
• Change
(millions)
Children Made
Ineligible for NSLP
(thousands)
1..$ 60
584
Cut almost equals size of CACFP:
or SBP and SFSP: or more than
70 percent of NSLP. Almost
three-quarters of children in NSLP
would be made ineligible.
196
.Cut almost equals size of SBP
and CACFP; or exceeds size of
SBP and SFSP. Almost threequarters of children in NSLP
would be made ineligible.
2
596
Two-thirds of children in NSLP
would be made ineligible.
1
98
While grant increases, almost
two-thirds of children in NSLP
would be made ineligible.
-$ 27
210
Cut exceeds size of SBP, CACFP,
and SFSP; or more than 75
percent of NSLP. Almost threequarters of children in NSLP
would be made ineligible •
+$ 4
138
While grant increases, almost
three-quarters of children in NSLP ,
would be made ineligible.
+$ ',5
154
While grant increases, more than
four-fifths of children in NSLP
would be made ineligible.
-$15
983
Cut exceeds size of SBP. Almost
three-quarters of children in NSLP
would be made ineligible.
-$ 24
Percentage
Change in,
, ,dollars
149
Cut almost equals size of CACFP;
or exceeds size of SBP and SFSP;
or equals 50 percent of NSLP,
,
-38%
I
I
I
, ~29%'
Mississippi '
,
·1-$ 49.
.'
I
I
Missouri
Montana
I ~$
f+$
-2%.
+3%
,
'
I
,
,
Nebraska .
-44%
"
,
.
Nevada
New
. Hampshire.
. '.
'
+14%
.'
"
".':<
"
,
+.3%
New Jersey"
~10%
New Mexico
.
-27%.
'.
I
New York
-$ 53
-9%
,
North Carolina
Potential Program Impact
. ~27%
1,620
-$ 64
700
,
I
Page 23
Cut exceeds size of SFSP; or
more than two-thirds of SBP; or
one-half of CACFP,
Cut exceeds size of SBP and
CACFP,
�,,"
,I
j
"
.. ' l '
!
"
[
Percentage
Change in
dollars
$ Ch~nge
(milli,ons)
. Children Made
Ineligible for NSLP
(thousands'
-12%
State
J$ 2
76
Vermont
r
I
'Potential Program Impact
Cut exceeds size of S8P and
SFSP, Three-quarters of children
.in NSLP would be made
ineligible,
I
Virginia
'_1$ 36
!
693
Cut exceeds size of CACFP and
SFSP. More than two-thirds of
children in NSLP would be made
ineligible.
652
Cut exceeds size of CACFP and
SFSP, or more than 50 percent
of NSLP. More than two-thirds
of .children in NSLP would be
made ineligible.
3
185
Cut exceeds size of SFSP.
/-$24
-23%
629
Cut exceeds size of CACFP; or
S8P and SFSP, Three-quarters of
children in Nslp would be made
ineligible,
72
Cut equals size of S8P and SFSP,
Three-quarters of children in
NSLP would l;Ie made ineligible.
I
"
., ,
J
Washington
1$ 47
-35%
I
.
,
,
I
.'
I
West Virginia
Wisconsin
. 1-$
. -5%
-21%
'. I..
.Wyoming
"
U.S. Totals
I
.'
'.
-$ 4
-24%
..
'
'
..
,'.
"
.,
-14%.
-~1,188
I
,.
27,406
Notes: These estimates assume States spend no more than the 20 percent minimum level
established in the Personal Re~ponsibility Act. The dollar change in funding represents the
difference between 20 percent of each State's block grant and'the current service estimate,
excluding administrative costs;'
!
"
.
.
The estimates.of children mad~ ineligible for the NSLP assume all children not approved for
.
I
free and reduced-price meals (who must have incomes below 185 percent of poverty)
would be ineligible. This assutnPtion is conservative, since proposed law would set a lower
maximum income level - bet~een 140 percent and 170 percent of poverty, depending on
region and urbanicity, "
.
I
.'
.' .
This table assumes that Congress appropriates the full amount authorized in fiscal year
1996.
I'.
I
I
. Page 25
! .
.
�· r '
Appendix A: . USDA 'Food.
Programs
Assistance
The federal government pays for the benefits
issued through the Food Stamp Program and
shares with the States the cost of
administrative expenses.
i
I
USDA's Food and Consumer Service is charged
with providing access to a healthful diet to
needy Americans through. its 15 food
assistance programs and nutrition education
efforts. USDA works in partnership with the'
I
States in all its' programs.
I
I
I
Food Stamp Program
.
i
,
' I
The Food Stamp Program is the cornerstone
of the USDA food assistance programs. I
Initiated as a pilot program in 1961 andlmade
permanent in 1964, the program issues I
monthly allotments of coupons that are
redeemable. at retail 'food stores, or pro..,ides .
benefits through electronic benefits transfer
(EBT).·
.',.J'
i
'
Eligibility and benefits are based on hoJsehold
size, income, assets, and other factors; The
amount of the maximum food stamp b~nefit
is linked to the value of the Thrifty FoOd Plan
and provides eligible households with the
resources to purchase a low-cost, nutritious
'.'..
diet.
. ,
I
,
.
The Food Stamp Program provides as~istance
to essentially all financially needy hou$eholds
without imposing nonfinancial categor,ical
criteria on such things as household I.·
composition. ' In summer 1993, over half ,of
all food stamp 'participants were child~en, ,
most of whom lived in single-parent f~milies.
'
I
Households containing elderly persons
represented about 16 percent of ,all food
I
stamp households. Almost 21 percent of
food stamp households had earned iricome.
,
I,' .
The Food Stamp Program served an average
of more than 27 million people each month in
FY 1994. Average monthly benefitsJ were
$69.00 per person. Congress appropriated
$27.7 billion for the Food Stamp Program for
FY 1995. .
',!
Special Supplemental Nutrition Program for
.
Women, Infants and Children (WIC'
WIC's goal is to improve the health of low
income pregnant, breastfeeding and non
breastfeeding postpartum women, infants,
and children up to 5 years old. WlC provides
supplemental foods, nutrition education, and
access to health services. Participants
, , receive vouchers that can be redeemed at
retail food stores for specific foods that are
rich sources of the nutrients frequently
, lacking in the diet of low-income mothers and
children.
WIC has been shown to be effective in
improving the health of pregnant women,
new mothers, and their infants. A study
done for FCS in 1990 showed that women
who participated in the program during their
pregnancies had lower Medicaid costs for
themselves and their babies than did women
who did not participate. In the five States
, studied, ,savings in Medicaid dollars ranged
from $1.77 to $3.13 for each ·dollar spent in '
prenatal WlC benefits.
Th~ 'FY 1995 appropriation, at $3.5 billion,
takes the program' one step closer to full
funding.. The 1995 appropriation will allow
WIC to serve 7 million people.
National School Lunch Program
Every school day, more than 25 million
children in 93,000 schools across the country
eat a lunch provided through the National
School Lunch Program. More than half of
these children receive the meal free or at a
.reduced price.
Page 27
r
I
I
I
�,~...
I ."\.
-l".
',j
. . .. 'I
serves the elderly •. As in WIC," food packages
are tailored to the nutritional needs of
'participants. Average monthly CSFP'
,
.participation in FY 1994 was more thanl
363,000 people. Congress appropriated
$84.5 million in CSFP for FY 1995, down
from $104.5 million in FY 1994
I .', :" '
,I
I
Special Milk Program
,
I
Children in schools, summer camps and child
, care :institutions that have no federally-I' .
supported meal program receive milk t~rough '
the Special Milk Program. In 1994, mdre
than 150, million half-pints of milk wer~
served through SMP. Congress appropriated
I
$18.1 million for the program in FY 19~5,
down from $20.3 million for FY 1994./
Food Distribution Program on Indian
Reservations and the Trust Territories
This program provides commodity foods to
Native American families who live on 6r near
Indian reservations, and to Pacific' Islanders.
,
I
Also known as the Needy Family Program, ,
this is the oldest FCS Program, going back to ,
"
,the Great Depression of the 1930's. 1
,
'
I
An average of more than 116,000 people
participated in the program each month in ,FY
1994. A decline in participation and • large
inventory of food on hand led to a reduction '
in funding needed for this program in 11994.
Congress appropriated $68.6 million in FY
1994, down from $81 ~6 million in 1~93. The
1995 appropriation is $33.2 million, ~ut large
on-hand inventories of 'food will allow the
program to continue to meet the needs of all
eligible households.
I
Nutrition Program for the Elderly
'more than 936,000 meals every day in fiscal
year 1994. Congress appropriated $150
million for NPE'in FY "995, the same as for
" '1994.
Commodity Distribution to Charitable
Institutions and to Soup Kitchens and Food
Banks
Commodities from USDA surplus stocks are
provided as available to non-profit charitable
institutions that serve meals to needy persons
regularly~ In addition to surplus food,
Congress appropriated $40 million to
purchase food for soup kitchens and food
banks for FY 1995, the same as for 1994.
,Nutrition Assistance Program
(Puerto Rico and the Northern Marianas)
The Food Stamp Program in Puerto Rico and
the Northern Marianas was replaced in 1982
by a block grant'program. 'The two territories
now provide cash and coupons to participants
rather than food stamps or commodity foods.
Congress appropriated $1.143 billion for the
·1995 Puerto Rico NAP block grant; up from
$1.091 billion for FY 1994. ,For the Northern
Marianas, funding has held steady at $3.7
million each year.
I
~OOdS'I~O
Provides cash and commodity
States
for meals for senior citizens. Food is' served '
in senior citizen centers or delivered by
meals-on-wheels programs. The Nutrition
I
Program for the Elderly served an average of
I
'
Page 29
�,
I..
» .. •
.,.-:•
',.
~
,1
'
,
•• ' 1,'
,
t
I
j
I
"
...
:
Ok,
" ...." . ' .
:'
"
~
•
.-.
"
'.
,
I
•
~
I
•
•
•
:
, cuts that do not involve any changes in current
program structure. Correspondingly, thelhigh
slippage'''~ ..assumption . is' 'appropriate I for
considering impacts ,of a complete remoJal of
nutrition standards and unilateral cash-outlof all
food assistance. (There is no combinatibn of
low supplementation and high slip~age,
·because this would imply an overall negative'
impact of cash food assistance transfers;)
.
:..;
.....
.
j
.Di~~ct,l~p~~"on Food RetaUS~endingl
. Direct. impacts of, federal funding cutS and
conversion of food assistance can be derived
from supplementation and slippage
assumptions as shown below:
!. . .
I
I.
Direct impact on food retail spending =
SUPPLx change in federal funding + I
SLIP x amount of food assistance
I
. converted to cash.
. .)
Direct impacts on food retail spending' ~or the
five scenarios are as follows: Scenario :1, $.75
billion: Scenario II, $1 :75 billion; Scenario IU,
$4.25 billion; Scenario IV, $5.25 billion; and
Scenario V, $10;5 billion.
I
Farm-Level Impacts
.
.
I·
'To estimate farm-level effects, ERS distributed
, the estimated direct impacts on food spending
for the five scenarios among key ag~cultural
commodities based on food spending·patterns
of.low-income households. (See Table!B-2).
I
.
It also closely examined the implica~i~ns of
commodity support and surplus jremoval
policies currently in place. ,USDA provides two
I
types of commodity support to food assistance
programs in addition to cash as~istance:
entitlement commodities and I bonus.
. commodities. Entitlement commodities are
required ~y current laws. 'For examplel,schools
participating in the NSLP are entitled to receive
14.5 cents worth of commodities /for each
USDA meal. served in fiscal year 11995. In
addition to entitlement commodities, when
I
supplies permit, NSLP ·,andother assistance
programs .' :'can receive bonus commodities
obtained ,through price support (Section 416,
.CCC) ,and surplus removal (Section 32)
activities •.
· To assess the impact of revisions in commodity
· donation activity, ERS made several key
·assumptions. At the outset, it was assumed
that states would not use their block grant
. funds to replace any of the lost USDA donated
. bonus commodities resulting in pound for
pound reductions in market demand for those
commodities. Secondly,' the removal of the
mandatory milk requirement in the NSLP was
projected to reduce fluid milk sales for school
use to somewhere in the range of 25 to 75
percent. Finally, alternative assumptions were
made in peanut demand to account for the loss
of Section 32 purchases.
The farm price, in~ome and program' cost
impacts of a $5 billion reduction in food
assistance are shown for each of the five
scenarios. in Table' B-3. Without a slippage
effect (Scenarios I and 11), impacts on the farm
sector are relatively minor. However, impacts
are magnified when food program structures
:
. are changed and slippage occurs (Scenarios III,
IV and V).
Economy-Wide Impacts
Economy-wide output and employment impacts
were estimated 'using simulation models.
These models include a short-run, input-output
model and a long-run, 'computable-general
. equilibrium model that account for multiple
layers of linkages among sectors in the U.S.
economy. For the short-run model, output and
consumption are allowed to decline in response
to declines in food demand caused by cutbacks
in federal food assistance spending. The-long
run model simulates the ,adjustments that
would occur in two to three years if prices and .
wages were allowed to adjust in order to
restore full employment and readjust supply
. and demand for other goods and services.
I
j
I·
I
,Page 31
�~,
;:
.~.
'/
'f~r three short-run scenarios: zero slippa~e; low
'slippage (.10) and high slippage (.35). Similarly
three long-run scenarios were analyzed fbr each
of the deficit regimes. (A ~ingle
supplementation rate of .26 was used in all
regional analyses.) Results of the ~egional
analysis are summarized in Tables B-7 to 8-9.
Some points to note from these tableJ' are as
follows: .
o
. : '.
.
'
'1
..
Nonmetropolltan employment accounts
for '16.6 percent of total employment.
.
I
. '
I
o
For· . the three •.short-run scenarios,
r
'.' output losses range from $7.4 billion to
$8.8 billion in metropolitan areas and
from $1.7 billion to $5.2 billion in
Job losses
nonmetropolitan areas;
range from 84,000 to 991000 in
metropolitan areas and from 22,000 to'
55,000 in nonmetropolitan ar~as.
o
The nonmetropolitan areas of the'North
Central and Plains States are the most
./..
heavily impacted areas.
o
Long-run impacts reduce most of the
output and job losses, but /result in
. permanent job losses of larger
magnitudes in ·the North Cehtral and
Plains regions. .
I
Page 33 .
�, I'
."
I
1
Table B·2- Direct Impacts
Altema.ive Food Asllstance Reform Scenarios
on Fobd and Nonfood Spending
r (Dollars in millions'
.
I
· Food Group
I
I
Total
Nonfood
· Food
Reduction in spending
Scenario
If
Food
Budget Share
~
II
III
I~
V
5,000
3,250
1,750
5,000
750
. 4,250
5,000
·250
5,250
5,000
-6,501
10,501
5~JOO
'NA
NA
4,~50'
100.00
750
. 14.12
106
247 .
600
741
1,482
8.23
3.75
3.10
147
128
I 8
1
23
·109
88
18
54
285
159
44
132
327
197
55
183
854
394
110
325
15.27.
1115
267
649
802
1,604
.33.79
253'
591
1,436
1,774
3,548
240
149
17
114
71
583
382
41
"278
173
720
447
343
214
1,439
894
100
887
427
27
70
66
171
81
211
162
422
73
98
90
121
179
242
. I
j
Dairy products
Ruid milk
Cheese
Butter
Other
1.04
Grain products.
Meat, poultry,
and seafood
Beef
Pork
Other
· ,Poultry.
Fish and seefood
13.71
·8.52
0.98
8.54
4.07
Eggs
· Sugars and awe,ets
I
I
103
1.54
4.02
84
7
49.
31
12
130
13 .
17
1.71
. 2.31 .
White and brown sugers
Other
30
40.
50
18
41
99
123
245
1.18
'0.08
0.21
0.89'
9
'1
.. 2
20
1
4
'18
49
3
9
38
81
4
11
47
122
8
22
94
9.40
70
164
.399
493
987
8.02
2.17
0.88
.0.34
45
. 18
.8
3
6.51
49
114
277
342
' 683
'5.85
0.68
.0.05
. 0.15
42
5
0
1
99
12
1
3
240
28
2
8
297
35
3
8
593
89
5
18
1.15
9
20
49
60
121
0.88
. 0.29
8
2
15
·5
37
12
45
15
90
30
Fats. and ons
1.60
12
28
.68
84
168
Shortening
Saled and cooking
Saled dressing
QIherfoods
0.33
0.48 .
0.81
10.28
2
3
'8
72
8
8
14
14
20
34
437
17
24
43
35
2.34
Potatoes
Fresh potatoes . .
Canned potatoes .
Frozen potatoes .
Other potatoes
Vegetables
Fresh vegetables
Canned vegetebles
Frozen vegetables
Other vegetables
Fruit·
Fresh fruit
Canned fruit
Frozen fruit '
Other fruit
Nuts
Peenuta
Other
I
•
7
105
38
15.
8
258
92
37
15
180
318
114
45,
18
540
I
Note: Negative numbers in this table denote an increase in expenditures.
.
.
.
..
.
. I.
i
.
..
Page 35
.
833
228
90
38
49
85
1,079
�': : , .
'''I
,"'
,
.'
,
. L, '. '~~ ':
"
.','
"
Corrimodity
'f'
"
..
"
'I
:.
Scenario
II
III
-.42
-48
-.7
0
-1.01
-111
-1.8
0
"
"
"
"
..
.
"
,
-2.50
-275
-4.0
0
~.93
1
.
·r
.'
"
",
"
'.
,
';31
-12
-1.4
0
'.
-.75
-29
. -3.3
0
-38
-4.0
0
-1.88
-73
-8.1
0
-.02
·54
-.3
31
-.05
-122
-.8
80
-0.07
-159
-.8
,95
-.13
-315
-1.5
191
-.05
-120
-.8
88
-.08
-194
, -1.0
114
-.09
-224
-1.1
132 '.
-.18
-380
-1.9
228
-.09
-220
-1.1
124
-.11
-250
-1.2
142
-.15
-354
-1.7
206
-.22'
-501
-2.4
302,
,.,
Dairy (no' NSLP losst '
Fann price (e/cwt)
Fann incomeCemil.)
,Fann Income (%,
Program Cost 'Cemil.'
-;13
. ~5
-.8
0
"
-90
-.4
50 .
.',
-;01
-25
'
,"
"
'.',
~.1
,
'13,
I'
I
Dairy (25% NSLP losst
Fann price ce/owt)
Fann Income' emil;)
Fann Income ,%,
Program Cost ,emil.'
,
','
"
,Dairy (75% NSLP .Ioss)
Fann prioa ,e/cwt,
Farm i';oomeCemil.;
Fann Inoome C%, ~ . ,
'Program Cost C.miI.)·
V
J
'
Fann price (e/cWt)
,"
"Fann IneomeCemil.)
Fann Income ,%)
Program Cost (emil.'
,
IV
-1.25
-137
-2.0
0
.'
'
-.18
.20 .'
, -.3
0
"
......
Turkeys
"
"
,
I
ce/owt,
'Fann prioe
, Fann,lnoomeCemil.' , .
Fann Income C%, ,,
Program Cost Cemil;, '.
...
,
','
f
Broilers
~.
,
J"
J
.
,
,
"
\,
,
."
:
..
• less than 0.005. '
Notes: ,Farm income is gross. There
-
0
.
.
-~04,
~.14
-324
~1.8
188
,
i~ no measurable impact on seafood.
I
Page 37
�i'{'
"
....
I
,
J
,
I,
,",
,,'
.
"Table 8-6 - ,'A1temative Scenarios - Changes in Jobs
,
I,
,:. .
"
,
"
FOOD PROCESSING
TRADE.TRANS-FOOD '
RESTAURANT, '
"
NON.fOOD: '
, NON·DURABLE MFG
DURABLE MFG
CONSTRucnON
TRADE.TRANS-OTHER
SERVICES
TOTAL
SECTOR:
'
II
FARM PRODUCTS
FOOD PROCESSING '
, TRADE.TRANS-FOOD
RESTAURANT
NON.fOOD:
NON-DURABLE MFG '
DURABLE MFG
CONSTRUcnON
TRADE.TRANS-OTHER
SERVICES
TOTAL
SECTOR:
,
FARM PRODUCTS
FOOD PROCESSING
TRADE.TRANS-FOOD
RESTAURANT
NON.fOOD:
NON-DURABLE MFG
DURABLE MFG
CONSTRucnON
TRADE.TRANS-OTHER '
SERVICES
SCENARIOS:
I
U
-41.1 '
-8.3
-8.8
-10.0
-18.2
-78.9
-5.8
-8.9
,-1.4
-17.7
-45.3
-120.0
I
-3.8
-2.8
' -4.3
-8.9
I
-1103.2
-7.3
-11.7
-1.9
-23.1
·59.2
,I
'I
"
(1000.'
14500
' 2600
1700
'2700
7700
.
112900
4700
14700
6800
' 24800
82100
127500
JOBS 1993
I
I
I
IU
-73.4
-22.8
~19.3
,
-28.9
-2.4
·53.1
I
IV
-91.0
-28.5 '
-24.3
-38.2
v
-178.2
-58.4
-48.4
-72.2
-2.0
0.8
37.8
-38.0
-3.9
·7.5,
-1.0
-4.0
-7.8
-1.1
-15.1
-25.3
-126.5
-0.8
-4.2
-0.2
~5.7
SCENARIOS:
I
I
I
I
-8.5
,
-1.3
-3.1
-2.9
-3.8
-1.8
-4.3
19.8
-2.4
22.6
0.1
I
-32.9
I,
0.0
"
0.7
24.2
23.1
8.8
-0.5
-0.5
2.1
15.4
17.5
67.2
25.8
4.0
43.3
0.0
V
-128.0
-45.3
-38.3
-58.1
9.7
14.8
15.1
13.6
"
-1.8
20.0
21.8
5.3
-25.2
21.0
I
IV
-56.1
-19,4
-15.8
-24.2
3.2
58.1
-43.3
-15.5
-12.8
-19.3
-10.1
.8.5
I
I
1M
0.5
·19.8
~1.3
0.0
0.0
128.0
0.0
/LONG-RUN CHANGES IN JOBS IN A TAX-REDUCnON REGIME 11000.)
, I
I
BASE RUN
11000.'
14500
2800
1700,
2700
7700
112900 '
4700
14700
6600
24600
62100
127500
I
23.7
-20.0
19.1
-129.0
-138.5
-120.8
LONG-RUN CHANGES IN JOBS IN ADEFICIT-REDUcnON REGIME (1000.'
,
FOOD:
TOTAL
,
' SHORT RUN CHANGES IN JOBS lin 1000.'
' -1'7.8
BASE RUN
FOOD:
( "
I
(1000.,
14500
2800
'1700
" ,2700
, 7700
112900
4700
14700
8800
24800
62100
,127500
JOBS 1993
'
FARM PRODUCTS
I
j
BASE RUN
FOOD:,
JOBS 1993
"
SECTORS:
"',
'. I
,", r
;
SCENARIOS:
-7.8
-1.8
-1.5
-2.2
-2.4
-0.8
-0.8
-0.9
-1.0
3.3
7.8
0.1
1.0
:0.9
2.2
I
I
I
I
~14.9
-11.9
-18.8
9.5
36.0
0.2
2.3
2.1
5.2
-1.9
-0.8
0.0
1M
-38.0
I
I
-3.3
0.0
Page 39
2.1
2.4
0.7
9.7
21.1
0.0
IV
-49.4
-18.6
-,14.9 '
-23.6
7.7
49.4
4.0
4.7
1.2
7.1
32.4
0.0
V
-118.3
-44.0
-35.2
-55.5
18.4
118.4
8.2
4.7
0.6
41.7
65.2
0.0
�I
,
Table 8-7 - Short-Run Estimates of Output and Job Losses by Region
.
I
'
I
I
CHANGES IN JOBS
CHANGES IN OUTPUT
1$ Milionl'
I
REGION
Metro
I
Non-M~tro
.
Total
(In
Metro
1000.1
Non-Metro
Total
ZERO SLIPPAGE ASSUMPTION
Northeast
-1880
I
-17~
-2053
-25.7
-2.4
-28.1
North Central
-1693
-42'9
,-2122
-21.5
-5.3
-26.8
-615
-287
·-7.9
-3.6
-11.5
Southeast
-9.15
-3q5
~1220
-12.6
-3.8
-16.4
Plains
-736
-265
-1001
-8.9
-3.0
-11.9
-4.6
-1.9
-6.4
-1354
-17.2
-1.5
-18.7
-1704
-9151
-99.0
-21.5
-120.4
.2039
'-22.3
-2.9
-25.2
-2810
-21.1
-9.4
-30.6
. -7.7
-4.7
-12.4
Appalachian
.Mountain
Pacific
TOTAL
I,
I
I
-323.
-140
-1250
-104
-902 .
-463 .
'/
I
-7447
LOW SLIPPAGE ASSUMPTION
Northeast
-1798
. -2h2
North Central
-1933
. -87,7
·1
I
I
Appalachian
-664
.-402
~1056
Southeast
,.975
-610
I
·-1485
-12.0
-5.4
-17.4
-587
. -1395
-8.7
-6.1
-14.8
I
i
Plains
-807
Mountain
-337
-252
-589
-4.2
-3.2
-7.4
-1404
-215
-1618
-17.1
-2.8
-19.8
-11013
-93.4
-34.5
-127.9
·-349
I
-11574
.2042
~16.6
-3.6
-20.2
-3907
~20.4
-15.8
-36.2
1585
I
-1312
-7.2
-6.5
-13.7
L827
"'1904
-11.0
-7.7
-18.7
-l088
-2018
-8.3
-11.0
-19.3
-3.6
-5.2
-8.8
Pacific
TOTAL
.I
I
I
I
-7929
-3084
HIGH SLIPPAGE 'ASSUMPTION
Northeast
North Central
I
-1692
-2333
Appalachian
Southeast
-727
-'077
Plains '
-930
Mountain
I
-367
Pacific
TOTAL
1-428
I .
-1661
-795 '
1-386
-2047
-16.9
-4.7
-21.6
-,5237
-14024
-84.0
-54.5
-138.5
i
-8787
Note: The Zero Slippage estimates are ~naverage of the results from Scenarios I and II. '
The Low Slippage estimates are Ian average of the results from Scenarios III and IV.
The High Slippage estimates arel the results from Scenario V.
I
I
Page 41
I
�.
J
'.
.
.
.
. Table. 8-9 - .Long-Run Estimates of Output and Job Losses by Region
.
I
.'.
..
I
T,xReduction Regime
CHANGES IN JOBS
CHANGES IN OUTPUT
'$MIUlona)
(In
1000.)
REGION
Metro
Nonmetro,
Metro
Total
Nonmetro·
Total
ZERO SUPPAGE ASSUMPllON
I
26
0.03
-0.04.
-0.02
12 '.
0.02
-O~28
-0.28.
·6
0.03
, -0.05
-0.02 :
-3/
8
0.06
-0.03
0.02
-191
Northeast
-18
0.00
-0.22
-0.22
28
-1
, :29
North Central
Appalachian
-4
Southeast
-17/"
11
.. -2
Plains
i
6
-61
o
0.05
-0,09
-0.04
24
-4,
20
0.14
-0.08
0.07.
95
~52"
43
0.31
-0.79
-0.47
·51
-65
-116
5.7
-0.1
5.~
-285
-361
i
-99
,
-645
, 2.8
-3.1
-0.3
·148
1.2
-0.8
0.8
·265
2.0
-0.9
1.2
Mountain
Pacific
TOTAL
LOW SUPPAGE ASSUMPllON
Northeaet
North Central
-49
Appalachian
Southeast
·93
I
I
I
-172 '
I
-117
Pacific
·379
1.2
-2.4
·1.2
.911
~117
1.0
,-0.9
0.1
·188
'Mountain
-262
·26
Plains
·82
I
-1132
·270
2.2
-0.9
1.3
·1929
16.5
-174
·341
15.3
-0.4 .
14.9
·8.2
-0.9
·797
TOTAL
!
·9.0
7.4
HIGH SUPPAGE ASSUMPllON
Northeast
·167
I
North Central
-814
·952
·1767
7.3
Appalachian
·127
·268
-395
3.2
-1.7
1.5
Southeast
·258
·720
5.4
-2.4
3.0
Plaine
-313
·462
!
·882
-998
3.2
-6.2
·3.0
·317
2.5
-2.4
0.1
-757
5.8
-2.5
3.1
. -5287
43.1
-23.7
lli».4
-78
Mountain
I
I
I
-239
-541
·2273
Pacific
TOTAL
I
·218
·2~94
I
fr~
Scenarios I and II.
Note: The Zero Slippage estimates are en aJerage of the results
The Low Sljpp~ge estimates ara an aJaraga of the results from Scenarios III and IV.
The High Slippage estimatas ara the r~sults from Scanario V.
,
I '
,'
I.
r
Page 43
..
�DRAFT
WORKING SESSION ON WELFARE REFORM
Prelirriinary Ideas
JAN I 3 1995
Goal: To explore vigorously and thoughtfully the key issues surrounding welfare reform with
elected officials from all levels of government. The hope is that in a small, off-the-record format,
participants can speak openly and practically about the critical policy questions.
Structure: The working session would include a mix of Governors, members of Congress, state
legislators, and local officials, both Democrats and Republicans. It would be divided into
discussions of four topics. Approximately one hour would be available for each issue. For each
topic, two or four participants--one or two Democrats and one or two Republicans--would open with
very brief presentations designed to help frame the issues from their perspectives. Discussion would
then be open-ended with the President acting as a participant/moderator:
.
Topics: The list of topics could include:
WorkiWelfare--This discussion would focus on ways to make welfare transitional and to move
people into work. Work requirements, time limits, and job opportunities would be included in this
discussion.
Parental Responsibility--The primary topic ,in this category would be the need for non-custodial
parents to do their share to support and nurture their children. Key issues would include specific
ways to establish paternity, improve child support enforcement, and the proper role of the states and
federal government in these efforts.
Teen Pregnancy/Out-of-Wedlock Childbearing--This category centers on strategies to reduce teen
pregnancy and out-of-wedlock childbearing. Specific ideas include community-based prevention
strategies, eliminating benefits to minors and children born to minors, and requiring minor parents
to complete school and live with a responsible adult.
State Flexibility--This discussion would include creating more flexibility within the individual
entitlement structure, block grants, entitlement versus discretionary funding, and waiver issues.
�January 13, 1995
MATERIALS for
WORKING SESSION ON WELFARE REFORM
I. Briefing Book for all participants
option One:
Send .the following factual information to all participants on
January 24 (Tuesday).
- Description of each Bill: ask each party to prepare
summaries
- Mqdel programs in each of the four topic areas--ask .
Governors and local officials for examples or produce
ourselves from the state/city/county represented
Data/demographics for each topic area
- Waiver summary
- Fact sheets on current programs (how they are funded, who is
eligible,' cost sharing, where state flexibility exists):
AFDC, Child Support, JOBS
- State by state chart of federal and state spending on
welfare programs
.Option Two:
Ask ~ac~ participant to send briefing material of their choice by
Friday', January 20 (limited to 5 pages). Assemble. and distribute
on Tuesday, January 24.
II. Additional materials for Democrats
Distribute through surrogates (DGA, NGA, etc).
- State impact of AFDC and Food stamp block grants in PRA
- Other state impact numbers (e.g. kids cut off)
- Summary of the PRA and WRA
- Analysis of the PRA
- Talking points on themes and principles
�WELFARE REFORM WORKING SESSION
-
.Planning Meeting Agenda
1113/95
I.
Update on Invitations
- Senate and House
- Intergovernmental
II.
, III.
IV.
Meetings with Staff
- Schedule
- Review of Content
I _ see suggested agenda
. - Materials
- see suggested list of materials '
l
Report on Logistics
Review ~f Next Steps
- Next core group meeting
- PresIdent's bnefing
O~18 ~~
.
.
~.
.
'~-:-J
~ht..J
�,
'
STATUS OF INVlTESIBRIEFING MEETING
Invitee
• Sen.
~ breal1'X
Sen. Moynihan
?en. Kenn~dy
AcciDecllN.R.
rl:V
,1 ~_
I
""
\, ~
r&rtrb
Sen. Dole
Sen. Kassebaum
~@nk
Sen; Packwood
I
laJf rLl~vY\o}j
Ih
Congo Gingrich
Congo Archer
Congo Goodling
\
to
"
DHMf-/
I
M-t.d.f-'
, Congo Gephardt
-
• Congo Gibbons,
.....
I
;~ /
UQ
Congo Clay
l
Gov. Dean
!
Gov. Thompson
lUi
Gov. Carper
III
Gov. Engler
U
'Gov. Carnahan
, Gov. Carleson
Local #1
Local #2
rYl~
\
I
Il~I
IAr
'0
.
ftIQJAtrr
en i uglJlrlQ / IAr
Local #4
r)(lbna.~ ~(\ e
,,
D
Local #5 l?0I "
Local #3
Loca~[j),: kac~~
/1
0
Staff Meeting
�.J
.
PROPOSED STAFF MEETING SCHEDULE
WEEK OF JANUARY 17-20
Congressional
Individual staff to staff meetings
Complete all D's by
1/19 group meeting
Complete all R's by
1120 group meeting
Democratic staff
January 19
I
Bipartisan staff
January 20
GoVernors
Democratic staff (group)
Republican staff (group)
Option: bipartisan
Locals
Democrat staff
Republican staff .
All Democrats (option)
Dem gov, local and Hill staff
by January 18'"
by January 20 /
All Participants
.
"
~~
pre-January 20 bipart
WEEK OF JANUARY 23
,
January 24
option for others as necessary between January 24 and 27
.
�Participants in 1/28/95 Welfare Meeting
as of 1/24/95 7:15pm
>
Governors
The Honorable Howard Dean
Governor of Vermont
109 State Street
Montpelier, Vermont 05609
Contact.: Kathi Hoyt
p-802-828-3333
f-802-828-3339
The Honorable Tommy Thompson
Governor of Wisconsin
State Capitol, Room 115 E
P.O. Box 7863
Madison, Wisconsin 53702
Contact: Mary Sheehy
p-202-624-5870
\
f-202-624-5871
The Honorable Arne H. Carlson
Governor of Minnesota
130 State Capitol
St. ~aul, Minnesota 55155
Contact: Kathleen McCright
p-202-624-5308
f-202-624-5425
The Honorable Mel Carnahan
Governor of Missouri
State Capitol Building
Room 216
Jefferson City, Missouri 65101
Contact: Brad Douglas
p-202-624-7720
f-202-624-5855
The Honorable Thomas R. Carper
Governor of Delaware
Carvel State Off
Building
320 N. French Street
Wilmington, Delaware 19801
Contact: Liz Ryan
p-202-'624-7724
f-202-:624-5495
The Honorable John Engler
Governor of Michigan
P.O. Box 30013
Lansing, Michigan 48909
Contact: LeAnne Redick·
p-202-624-5840
f-202-624-5841
�Mayors
The Honorable
Lashutka
90 West Broad Street
. Columbus, Ohio 43215
p-614-645-7671
f-614 645-8955
The Honorable Joseph Serna, Jr.
Mayor of Sacramento
Sacramento, California 95814
p-916-265-5407
f-916-264-7680
county Officials
The Honorable Yvonne Brathwaite Burke
Chair, Los Angeles County Board of Supervisors
500 West Temple Street, Room 866
Los Angeles, California 90012
p-213-974-1075
f-213-680-3283
Mr. Michael Pappas
Freeholder, Somerset County
P.O. Box 3000
Sbmerville, New Jersei 08876
p-908-231-7030
f-908-707-4127
State Legislators
The Honorable Wayne Bryant
Member t New Jersey State Assembly
200 Nbrth Fifth Street .
Camden NJ 08102-1204
Contact': Valerie
p 609 757 0552
f-609-541 0426
t
The Honorable James Lack
Senator of the State of New York
Albany, New York 12247
p-518-455-2071
f-518-455-3234
�Senate
The Honorable Robert Dole
Majority Leader
United States'Senate
Washington, DC 20510
ATTENTION: Sheila Burke
p-224-6521
The Honorable Charles E. Grassley
135 Senate Hart Building
United States Senate
Washington, DC 20510
ATTENTION: Ken Cunningham
p-224-3744
The Honorable Hank Brown
716 Senate Hart Building
United States Senate
Washington, DC 20510
ATTENTION: Bill Brack
p-224-5941
The Honorable Daniel Patrick Moynihan
Ranking Member, Finance ~ommittee
United States Senate
Washington, D.C.
20510
ATTENTION: Lawrence O'Donnell
p-224-4451
The Honorable Bob Packwood
Chairman, Finance Committee
United States Senate
Washington, D.C.
20510
ATTENTION: Lindy Paul
p-224-5244
The Honorable Nancy Landon Kassebaum
Chairman, Labor and Human Resources
United States Senate
Washington, D.C.
20510
ATTENTION: Susan Hattan
p-224-4774
The Honorable" Edward M. Kennedy
Ranking Member, Labor and Human Resources
United States Senate
Washington, D.C.
20510
ATTENTION: Nick Littlefield
p-224-4543
�The Honorable John Breaux
United States Senate
Washi~gton, DC
20510
ATTENTION: Marcia Jones
p-224-4623
The Honorable Barbara A. Mikulski
United States Senate
Washington, DC 20510
ATTENTION: Kevin Kelly
p-224-4654
House
The Honorable Richard A. Gephardt
Democratic Leader
United States House of Representatives
Washington, DC 20515
ATTENTION: Andie King
p-225-2671
The Honorable Harold E~ Ford
2111 Rayburn Off
Builing
United States House of Representatives
Washington, DC 20515
ATTENTION: Mark Sherman
p-225-3265
The Honorable Newt Gingrich
Speaker
United States House of Representatives
Washington, DC 20515
ATTENTION: Jack Howard
p-225-4501
The Honorable Bill Archer
Chairman, Committee on Ways and Means
United States House of Representatives
Washington, D.C.. 20515
ATTENTION: Phil Moseley
p-225 2571
The Honorable Sam M. Gibbons
Ranking Member, Committee on Ways and Means
United States House of Representatives
Washington, D.C. 20515
ATTENTION: Janice Mays
p-225-3376
�The Honorable Bill Goodling
Chairman, Committee on Economic and Educational
Opportunities
United States House of Representatives
Washington, D.C.
20515
ATTENTION: Jay Eagen
p 225-5836
The Honorable William L. Clay
(Ranking Member, Committee on Economic and
Educational Opportunities
United States House of,Representatives
Washington, D.C.
20515
ATTENTION: Gail Weiss
p-225-2406
(One additional Congressman will be determined by Gingrich)
�Welfare Reform
. Talking Points: REPUBLICAN PLANS
January 21, 1995
"Welfare reform is a top priority for my Administration, for the governors, for the
new Congress, and above all, for the American people. Americans have asked
their elected officials to put aside politics as usual and begin earnest work to solve
our nation's problems -- and welfare reform is at the very top of our agenda."
President Clinton, 12/8/94
President Clinton has sought to reform welfare for years and we are pleased that
Republicans have developed legislative proposals that share many of his priorities.
President Clinton sponsored innovative programs as governor of Arkansas and was
Instrumental In the passage of the Family Support Act of 1988. His campaign
focused attention on welfare reform, and we're pleased that Republicans agree oli ,
the heed for change.
Republican plans offer proof that the consensus on the need for reform reaches
across party lines. Everyone -- Democrats and Republicans, administrators and
recipients -- agree that we must reform the welfare system. With this goal, .
President Clinton will 'convene a national.bipartisan working session on welfare
reform on January 28. This meeting will include Republican governors and
members of Congress, marking the beginning of change not just for the welfare
system, but for how our government ,works .
. Republican legislative proposals share many of the central principles of President
Clinton's vision for welfare reform. Democrats and,Republicans agree that anyone
who can work should do so, that welfare reform should include time limits, and
that anyone who brings a child into this world ought to be prepared to raise the
child and take financial and personal responsibility for that child's future. And we
agree that teen pregnancy and out-of-wedlock chitdbearing are important problems
that must be addressed through comprehensive welfare reform.
While we are committed to flndlng bipartisan agreement on welfare reform, we are
firmly opposed to some provisions of the House Republlcans~ Personal
Responsibility Act (PRA). Our approach would take strong action to address the
" problem of teenage pregnancy, but would not give up on teenage parents and their
children. In contrast, the Republican plan would deny benefits to children born to
mothers under age 18, regardless of whether their parents are willing to work or
are properly caring for them. We strongly oppose the Republicans' orphanage
proposal which could cost billions of dollars, create a new government
bureaucracy, and divide families instead of strengthening them.
Welfare reform must also require responsibility from both parents. The Clinion
Administration has proposed a comprehensive plan to improve child support
enforcement and ensure that both parents contribute to their children's well-being.
�In contrast, the House Republican plan contains few child support enforcement
,provisions and could actually reduce resources for enforcement. We must do
, more, not less, to ensure that both parents live up to their responsibilities.
We must refocus the welfare system on the nadonal objectives of work and
, responsibility I while maintaining our partnerships with the states. The- House
Republican plan would eliminate the fEideral commitment to fund AFDC, S51, and
,other low-Income programs, creating a massive cost-shift to the states and
threatening the safety net for millions of poor children. While the Administration is.
committed to an earnest dialogue about state flexibility, we must be honest about
, . the consequences~of the Personal Responsibility Act for both states and
, individuals.
�, =
"
Welfare Reform Working Group
Talking Points: OVERALL PLAN
REDRAFT: December 22, 1994
"I believe we must end welfare as we know it, because the current welfare system is a bad deal
for the taxpayers who pay the bills and for the families who are trapped on it. The' American
people deserve a government that honors their values. and spends their money judiciously, and
a country that rewards people who work hard and play by the rules. "
"
President Clinton, 12/8/94
The President's commitment to welfare reform,is part of his lonptandinl commitment to
the middle class values of work, responsibiUty and family. While lovernor of Arkansas"
President Clinton worked cloSely with -elected officials from both parties to pass the Family
Support Act. As Presi~nt, he has liven more than 20 stateS the flexibility to reform welfare ,
, at the, local leVel, and introduced the most comprehensive welfare reform legislation ever
proposed.
Now he's invited the country's bipartisan leadership to come together to forge a national
consensus on welfare reform - 'and restore American values toa badly broken welfare
system. Americans have ~ked their elected officials to put aside politics as usual and begin
earnest work to solve our nation's problems .- and welfare reform is at the top of our agenda.
People want their leaders to stop the partisan bickering, come together, and roll up their sleeves
and get to work.
The President is fighting to reward work and responsibility In ,every lovemment procram.
The Earned Income Tax Credit had already been signed into law, cutting taxes for IS million
working Americans and creating an incentive to work and stay off welfare. As a next step, the
Middle Class Bill of Rights will reduce taxes for millions more Americans who work hard to'
save money, raise their children and train for a better economic future. The welfare system~
like the tax system, must be changed to reward work and responsibility.
Welfare reform must ensure that taxpayers' money is well spent. The federal government
should help young mothers and their children escape welfare, but it shouldn't support long-:term
dependency. That is why the President would invest in edu<ration and training, not orphanages;
devote more resources to child support enforcement, not less; put a two year time limit on
welfare benefits; require ,work for those who are able to work; and mount a new effort to fight
welfare fraud. The American people deserve a government that honors their values, spends their
money wisely, and rewards people who work hard and play by the 'rules.
Welfare reform should givesingJe, parents a chance at the middJe class. Work is. still the
best social program ever invented, and anyone who can work should do so. But if you're going
to require work, there has to be a job there, along with the requirement that people on welfare
will have to get off it and' go to work after a specified period of time. There also has to be
support for people who are working and raising their children -likeeducation, trainitig and chil"
,care.
�I
•
Welfare reform must strengthen rammes, because tbere is no substitute for carini families
wben It comes to teaching chUmo the value of work aod responsibUity. We need to launch
a national campaign against teen pregnancy, and make it clear that no-one should get pregnant
or father a child if they're not prepared to take responsibility for that child's future. Teenagers
who do have a child must be required to live at home with their parenis, finlsh high school,
work and pay child support, but they must also get the help they need to become good role
models for their children. Arbitrarily denying aid to young mothers and putting their children \
, in orphanages will weaken families, not strengthen them.
.
�
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"
THE SECRE TARY Of' HEAL TH AND HUMAN S£ RVICE S
WASH:INGlON, 0 (.;.
20101
FEB I 3 1995
The Honorable E. Clay Shaw
/
Chainnan. Subcommittee on Human Resources'/
Committee on Ways and Means
U.S. House of Representatives
Washingwn D.C. 20515
Dear Mr. Chairman:
This letter expresses the Administration's views on the Chairman's mark for welfare reform
legislation under con§ideration by the House Ways and Means Subcommittee on Human
Resources.
The Administration shares the commitment of the Congress and the American people to real
welfare reform that emphasizes work, parental responsibility; state flexibility" and the
protection of children. Last year. the President submitted a bold welfare reform bill. the
Wor~and Responsibility Act of 1994, which embodied these values. It imposed tough work
requirements while providing opportunities for education, training, child care'and suppqrts to
working people. It included a stringent set of child support enforcement provisions. It
required each teen mother to live at home, stay in school and identify her baby's father. It
increased state flexibility without sacrificing accountability.' And it maintained a basic
structure of protections for children ..
The Administration looks forward.to working cooperatively with the Congress in a bipartisan
way to pass'bold welfare reform legislation this year. The Administration has, however,
serious concerns. about a number of features of the Chairman's mark that appear to
undermine the values to which . are all committed. . The Administration seeks to end
" \ . . we
welfare as we know ,it by promoting work, family and responsibility, not by punishing poor
children for their parents' mistakes. Welfare reform will succeed only if it successfully
moves people from welfare to work.
Work
For years, Repubt'icans and Democrats alike have agreed th~t the. central goal of welfare
reform must be work. ,That is still our goal: People who can work ought to go to work and
earn a paycheck not a welfare check. The Administration believes that no adult who is able
to work should receive welfare for an unlimited time without working. The Administrati.on
believes that from the first day someone comes onto welfare, he or she should be required to
participate in job search, job placement, education, or training needed to move off welfare
and into a job quickly: It is government's responsibility to help ensure that the critical job
placement, training, and child care services are provided. Individuals who are willing to
work should have the opportunity to work and 'not be arbitrarily cut off assistance.
"
�The dministration therefore has serious concerns about the Chainnan's .mark before you:
A
o
It eliminates requirements that recipients participate in job search. education,
work or training as a condition of receiving welfare. and ends any
responsibility of state welfare systems to provide education, training and
placement services to move recipients from welfare to work. The proposed
legislation effectively repeals the bipartisan Family Support Act signed by
President Ronald Reagan in 1988.
o
The proposed legislation includes only minimal and unenforceable
requirements that recipients work. The bill requires only that persons on the
rolls for more than 2 years engage in "work activities" loosely defined by the
state welfare bureaucracy, rather ,than a real work requirement. The proposed
participation standards are very low. In many ways; the work requirements
are even weaker than those in current law.
o
The proposed legislation provides no assurance of child care to recipients who .
work or are preparing to work--even if a state requires them to participate. It
offers no promise of child care for those who leave welfare for work or for
those who could avoid falling onto welfare if they had some help with child
care. While it repeals provisions of existing law that provide funding for child
care, this bill is silent on whether any additional funds will be available for
subsidized child care for low income working families.
o
The proposed legislation repeals the current rule that anyone who leaves
welfare for work can receive Medicaid for an additional year to ease the
transition. This would further reduce health care coverage and make, it harder
for people to move from welfare to work.
.
o
The proposed legislation would deny all cash assistance to families that have
received assistance for more than five years, even if the adult in the family is
unable to find a job or prevented from holding a job because of illness or the
need to care for a disabled family member., Children would be seriously
jeopardized even if their parents cannot find any work.
The Administration supports an alternative approach.that would genuinely transfonn the
welfare system into a transitional system focused on work. It would have strict requirements
for recipients to participate in ahd dear responsibilities for states to provide education,
training and placement assistance; it would have serious time limits after which work 'would ,
be required; i\ would ensure that children would not be left alone when patents were working
by providing assistance for child care; it would put parents to work, not just cut them off;'
and it would ensure that children can expect support from two parents.
2
�Parental Responsibility
. The Administration believes that welfare reform should recognize the responsibility and
encourage the involvement of both parents in their children's lives. The Administration
considers child supportenforcemeht lo bean integral part of welfare reforrp, particularly
because it sends a strong message to young people about the responsibility of both parents to
support their children. The Administration was pleased that you had agreed to add child
support enforcement to your welfare reform bill,. and sorry that your proposals are not yet
part of the bill now under consideration. The Administration looks forward to working
closely with you on this issue in the coming weeks.
o
The only child support provision included in the Chainnan's mark is one that
allows states to reduce payments to children for the first 6 months if paternity
has not been .legally established. This provision seems ineffectual and unfair.
Even if a mother fully cooperate~ by giving detailed infonnation identifying
the father and his possible location, and even if the state is diligent in pursuing
the father, it can easily take 6 months to get paternity legally established.
There is no reason why the child should be punished. during this period.'
The Administration believes that it makes far more sense to deny benefits entirely to any
parent who refuses to identify the father or to cooperate in locating him. However, once the
mother has done all she can, the family should qualify for aid, andthen the state should
estabiish paternity within one year.
The Administration believes that the welfare system should encourage the fonnation and
support of two-parent families. The Administration is therefore concerned abput an .
important omission in the proposed legislation:
o
The proposed legislation would encourage the. break-up of famiiies by
repealing the requirement that states provide cash assistance t6 two-parent
families in which a parent is unemployed or unable to work. It allows states
to discriminate against married, two-parent families by treating single-parent
families better than two-parent families.
.
The Administration supports an approach that both encourages the fonnation of two-parent
families and makes sure that both parents take responsibility for children in all cases.
Teen Pregnancy
The Administration and the American people agree that the best reFonn of welfare would be ..
to ensure that people do not need it in the first place. Welfare refonn must send a very
strong message to young people that they should not get pregnant or father a child until they
are ready and able to care .for that child, and that if they do have children, .they will not be
3
�able [0 escape [he obligations and responsibilities of parenthood. We must be especially
concerned about the well~being of the children \Vho are born to young mothers, since they
'
are very likely to grow up poor.
The Administration therefore has serious concerns about the bill'before.you:
o
'The proposed legislation would deny all federal cash benefits for eighteen
years to any child born to an unmarried mother under 18, as well as to the
. parent., This provision appears to punish children for their entire childhood-
18 years--for the mistakes of their parents,
o
The proposed legislation does not require that teen mothers live at home, stay
in school, and identify the child's father. It weakens requirements in current
,law, and may make the prospects for mother and child even worse.
o
The proposed legislation establishes only minimal 'expectations for states to
. provide services to unmarried parents. and provides no additional funds to
support them.
The Administration supports an alternative approach that would require minor mothers to live'
at home, stay in school, make progress toward self~sufficic~ncy, and identify the father of the
child. The Administration also supports a national campaign to prevent teen pregnancy. It is
time to enlist parents and civic, religious, and business leaders in a community based strategy
to send a clear message about abstinence and responsible parenting. The Administration also
supports a state option not to increase benefits for children born to mothers on welfare. This
'
decision should be made by the state, not the federal government.
State Flexibility with Accountability
The Administration embraces the creativity and responsiveness of states, and the
opportunities for real reform when states have the flexibility to design and administer welfare
. programs tailored to their unique circumstances and needs. Already this Administration has'
granted waivers to nearly half the states for welfare refonn demonstrations. National welfare
reform should embody the values of work and responsibility in a way that assures taxpayers
that federal money is being spent prudently and appropriately. For reform to succeed, the
funding mechanisms for welfare should not put children or states at risk in times of
recession, population inqease or unpredictable growth in demand.
.
In this context, the Administration has serious concerns about the proposed legislation:
o
The spending cap in the proposed legislation makes no allowances for potential
growth in the need for cash assistance because of economic downturn,
population growth, or unpredictable emergencies. 'It could result in states
4
�running out of money before the end of the year. and thus having to rum away
working families who hit a "bump in the road" and apply for short~term
assistance, It could preclude states from investing in job placement, in work
programs. in education and tra'ining, and in supports for working families" '
o
The proposed legislation removes the requirement that states match federal
funds with their own state funds. With none of their own m01'\ey at risk; states
will have many fewer incentives to spend the funds efficiently and effectively
to improve performance and increase 'self-sufficiency,
o
The proposed legislation provides virrually no accountability. There are no
incentives for good perfonnance and virtUally no penalties for failure. There is
no provision for the recovery of monies paid out fraudulently or in error.
There are no mechanisms for ensuring that states are acnially spending the
money on needy, children rather than on state bureaucracies, or for monitoring
whether federal money is being used to help parents gain self-sufficiency,
require work, and enforce parental responsibility. Indeed, the federal '
government is forbidden from taking any meaningful steps to ensure program
performance and accountability.
,
,
'
The Administration suppons, proposals that significantly increase state flexibility but also
ensure accountability for achieving national goals: The Administration supports a funding
mechanism that will not put children and states at risk down the road, and that enables states
to succeed in moving people from welfare to work and in supponing working families. The
Administration has significant doubts about the ability of a pure block grant funding
mechanism to adequately protect both children and states.
Protection of Children
, The Administration recognizes that the protection of children is the primary goal both of cash
assistance programs and of child welfare and child protective'services. ,Cash assistance
programs assist families to care for children in their. own homes. Child protection services
help those children who are abused or neglected or at risk of abuse by their parents and who
need special in-home services or out of home placements to assure their safety. Strengthening
families, and where appropriate, preventing removal of children from their homes also,are,
key goals of child protection services. There are problems in a number of areas.
'Denial of Benefits to Children on AFIJC
The legislative proposals that would refonn cash assistance have a number of provisions that
would put vulnerable children at gr~ater risk.
5
�o
As noted above, the, legislation would deny cash assistance to children of
unmarried minor mothers for their entire childhood, to children born while the
parent was on welfare, and [0 children whose parent had received welfare for
more than five years, whether or nOl a job was available or the parent was,'
unable to work. The·funding caps could have the effect of denying cash
assistance to children when states used up their allocated funds, for whatever'
reasons. Children in low income working families, who may be forced ~nto
cash assista,nce in times of economic downturn, could be most affected.
Child Protection Services
Some of these children could wetl come into a system of child protection services that is
, already seriously overburdened and that is failing to provide the most essential services.
Reported child maltreatment and out-of-home placements have botn been increasing sharply.
Many state systems are in such distress that they have been placed under judicial oversight.
The proposed legislation responds to these increasingly serious problems by consolidating
existing programs that protect children into a block grant with nominal federal oversight
The Administration has serious concerns about this approach.
o
,o
The proposed legislation caps spending for child protection programs ala level
considerably lower than baseline projections. This could lead to uninvestigated
maltreatrilent reports. and to children being left in unsafe homes with minimal
services. It could also se'riously hamper states' efforts to improve their child
abuse prevention and child protection systems.
The proposed legislation eliminates the adoption assistance programs. and
" leaves it ,up to states whether they will significantly sustain the subsidies that
enable many special needs children to find permanent homes, and whether they
will honor commitments to those adoptive families that now receive subsidies.
,
'
,
o
The proposed legislation viitually eliminates federal monitoring and ' "
a~countability mechanisms. It makes it impossible for the federal government
to ensure the protection of children.
o
The proposed legislation is silent on the formula for allocating funds to the
states. Because of serious imbalances among the states in spending on child
protection, it is hard to imagine a formula that would not disadvantage either
states that have been heavy spenders, or states that are only beginning to
improve, their systems.
Substantial improvements need to be made in the child protection system and in the federal
role in overseeing that system. The Administration supports a careful and thoughtful review
of the programs before actions are taken that might seriously harm millions of vulnerable
children.
6
�· Denial of Benefits to Disabled Children on SSI
The Administration is deeply troubled by the changes proposed in the program designed to
help disabled chiidren--SSI.
o
o
The proposed legislation-essentially eliminates SS!. benefits for children, with,
the exception of a small group of children currently receiving benefils. Within
6 months, over one hundred thousand disabled children would lose eligibility
for SS1 benefits--some would lose medical protection as well. And in the
future, rio child, no matter how disabled,' will be eligible for any cash benefits
for SS1. except if cash benefits prevent them. from having to be
institutionalized. These proposals appear to penalize parents who are
determined to care for their child no matter what the economic consequences
for the family. SS! recipients are among the neediest and most vulnerable
children, in the poorest families.
.
Some of the money saved is put into a new block grant for services to disabled
children. which would require the creation of a new state bureaucracy to
decide on appropriate services: T~is idea is untested, and no one knows what
impact it will have on the most vulnerable of children and the parents who
care for them. The 5-year cut off in AFDC for all persons along with the
elimination of SS1 cash for disabled children~ay leave these ch,Hdren
extremely vulnerable.'
.
The Administration sees the need for careful refonn in this area, with its potential for serious
hann to extremely vulnerable children. Last year the Congress established a Commission on
Childhood Disability to look into these issues in consultation withexpens from the National
Academy of Sciences. The Commission w.ill provide its report to the Congress later this
year. The Admirustration believes prudence dictates waiting for this short time until this
bipartisan commission, following a thorough review 'of all aspects of this important program,
has an opportunity to make recommendations.
Benefits to Legal Inunigrants
The Administration strongly believes that illegal aliens should not be eligible for government
welfare support. But the blanket prohibition of all benefits to legal immigrants who are not
yet citizens is too broad, and. would shift substantial burdens to state and local taxpayers.
These legal immigrants are required to pay taxes. Many serve in the armed forces, and .
contribute to their communities. The Administration strongly favors a more focused
approach of holding sponsors accountable for those they' bring into this country and making
the sponsors':commitment of support a legally binding c.ontract.
7
�..
In su'mmary, the Chainnan\~ mark espouses goals for the reform cif welfare--work, parental
responsibility, prevention of teen pregnancy and state t1exibility--that the Administration and
the American people share. But the translation of general goals into specific legislation
misses the mark in fundamental ways. The proposed legislation does not represent serious
work-based refonn. It does nothing to move people from welfare to work, and it d().e_~.. not
require everyone who can work go to work. It neither holds.state bureaucracies accountable
nor cushions state taxpayers against recession. [1 puts millions of children at risk of serious .
. hann. There are alternative approaches to reform that achieve our mutual goals in far more
constructive and accountable ways.
The Administration reiterates its commitment to real welfare refonn and its desire to work.
cooperat.ively with Congress to achie.ve· it.
The Office of Management and Budget advises that there is no objection
this report to Congress.
[Q
the transmittal of
A similar letter was sent to Representative Harold E. Ford .
. ~elY'S
O--(~.
Donna E. Shalala
cc: Members of the Subcommittee on Human Res~urces
8
�HiE SECRETARY OF HEALTH AND HUMAN SERVICES.
WASHING1"ON,O.<':.
20201
FEB I 319.95
The Honorable E. Clay Shaw
Chairman, Subcommittee on Human Resources
Committee on Ways and Means
U.S. House of Representatives
Washington D.C. 20515
Dear Mr. Chairman:
This letter expresses the Administration's views on the Chairman's mark for welfare reform
legislation under consideration by the House Ways and Means Subcommittee on Human
Resources.
The Administration shares the commitment of the Congress and the American people to real
welfare reform that emphasizes work, parental responsibility, state flexibility, and the
protection of children. Last year, the President submitted a bold welfare reform bill, the
Work and Responsibility Act of 1994, which embodied these values .. It imposed tough work
requirements while providing opportunities for education, tra~ning, child care and supporis to
working people. Itincluded a stringent set of child support enforcement provisions. It
required each teen mother to live at home, stay in school and identify her baby's father. It
increased state flexibility without sacrificing accountability .. And it maintained a basic
structure of protections for children. .
The Administration looks forward to working cooperatively with the Congress in a bipartisan
way to pass bold welfare reform legislation th~s year. The Administration has, however,
serious concerns about a number of features of the Chairman's mark that appear to
undermine the values to which we are ail committed. The Administration seeks to end
welfare as we know' it by promoting work, family and responsibility, not py. puni~hing poor
children for their parents' mistakes. Welfare reform will succeed only if it successfully
moves people from welfare to work.
"
'
. Work
For years, Republicans and Democrats alike have agreed that the central goal of welfare·
reform must be work. That is still our goal: People who can work ought to go to work and
earn a paycheck not a welfare check. The Administration believes that no adult who is able
to work should receive welfare for an unlimited time without working. The Administration
believes that from the first day someone comes onto welfare, he or she should be required to
participate in job search, job placement, education, or training needed to move off welfare
and into a job quickly. It is government's responsibility to help ensure that the critical job
placement, training; arid child care services are provided. Individuals who are willing to
work should have the opportunity to work and not be arbitrarily cut off assistance.
{
�,.~
,
The Administration therefore has serious concerns about the Chairman's mark before you:
o
It eliminates requirements that recipients participate in job search, education,
work or training as a condition of receiving welfare, and ends any
responsibility of state welfare systems to provide education, training and
placement services to move recipients from welfare to work. The proposed
legislation effectively repeals the bipartisan Family Support Act signed by
President Ronald Reagan in 1988.
o
The proposed legislation includes only minimal and unenforceable
requirements that recipients work. The bill requires only that persons on the
rolls for more than 2 years engage in "work activities" loosely defined by the
state welfare bureaucracy, rather than a real work requirement. The proposed
participation standards are very low. In many ways, the work requirements
are even weaker than those in current law.
o
The proposed legislation provides no assurance of child care to recipients who
"work or are preparing to work~-even if a state requires them to participate. " It
offers no promise of child Icare for those who leave welfare for work or for
those who could avoid falling onto welfare if they had some help with child
care. While" it repeals provisions of existing law that provide. funding for child
care, this bill is silent on whether any additional funds will be available for
subsidized child care for low income working families.
o
The proposed legislation repeals the current rule that anyone who leaves
welfare for work can receive Medicaid for an additional year to ease the
transition. This would further reduce health care coverage and make it harder
for people to move from welfare to work.
o
The proposed legislation would deny all cash assistance to farriilies that have"
received assistance for more than five years, even if the adult in the family is
unable to find a job or prevented from holding a job because of illness or the
need to care for a disabled family member. Children would be seriously
jeopardized even if their parents cannot find any work.
"The Administration supports an alternative approach that would genuinely transform the
"welfare systeIl1 into a transitional system focused on work." It would have strict .requirements
for recipients to participate in and clear responsibilities for states to provide education,
training and placement assistance; it would have serious time limits after which work would
be required; it would ensure that children would not be left alone when parents were working
by providing assistance for child care; it would put parents to work, not just cut them off;
and it would ensure that children can expect support from two parents.
.
"
"
2
�Parental Responsibility
The Administration believes that welfare reform should recognize the responsibility and
encourage the involvement of both parents in their children's lives. The Administration
considers child support enforcement to be an integral part of welfare reform, parti,cularly
because it sends a strong message to young people about the responsibility of both parents to
support their children. The Administration was pleased that you had agreed to add child
support enforcement to your welfare' reform bill, and sorry that your proposals are not yet
part of the bill now under consideration. The Administration looks forward to working
closely with you on this issue in the coming weeks.
o
The only child sup~ort provision in~luded in the Chairman's mark is one that
allows states to reduce payments to children for the first 6 months if paternity
has not been legally established. This provision seems ineffectual and unfair.
Even if a mother .fully cooperates by giving detailed information identifying
the father and his possible location, and even if the state is diligent in pursuing
the father, it can easily take 6.months to get paternity legally established.
There is no reason why the child should be punished during this period:
The Administration believes that it makes far more sense to deny benefits entirely to any
parent who refuses to identify the father or to cooperate in locating him. However, once the
mother has done all she can, the family should qualify for aid, and then the state should
establish paternity within one year.
The Administration believes that the welfare system should encourage the formation and
support of two-parent families. The Administration is therefore concerned about an
important omission in the proposed legislation:
o
The proposed legislation would encourage the break-up of families by,
repealing the requirement that states provide cash assistance to two-parent
families in which a parent is unemployed pr unable to work. It allows states
to discriminate against married, two-parent families by treating single-parent
families better than two-parent families.
The Administration supports an approach that both encourages the formation of. two-parent
families and makes sure that both parents take responsibility for children in all cases.
,
.
Teen P regnancy
The Administration and the American people agree that the best reform of welfare would be
to ensure that people do not need it in the first place. Welfare reform must send a very
strong message to young people that they should not get pregnant or father a child until they
are ready and able to care for that child, and that if they do have children, they will not be
3
�able to escape the obligations and responsibilities of parenthood. We must be especially
concerned about the well-being of the children who are born to young mothers, since they
are very likely to grow up poor.
The Administration therefore has serious concerns about the bill before you:
o
The proposed legislation would deny all federal cash benefits for eighteen
years to any child born to an unmarried mother under 18, as well as to trye
parent.' This provision appears to punish children for their entire childhood-
18 years--for the mistakes of their parents.
o
The proposed legisla'tion does not require that teen mothers live at home, stay
in school, and. identify the child's father. It weakens requirem'ents in current
law, and may make the prospects for mother and child even worse.
o
The proposed legislation establishes only minimal expectations for states to
provide services to unmarried parents, and provides no additional funds to
support them.
The Administration supports an alternative approach that would require minor mothers to live
at home, stay in school, make progress toward self-sufficiency, and identify the father of the
child. The Administration also supports a national campaign to prevent teen pregnancy. It is
time to enlist parents and civic, religious, and business leaders in a community based strategy
to send a clear message about abstinence and responsible parenting. The Administration also
supports a state option not to increase benefits for children born to mothers on welfare. This
decision should be made by the state, not the federal government. '
State Flexibility with Accountability
The Administration embraces the creativity and responsiveness of states, and the
opportunities for real reform when states have the flexibility to design and administer welfare
programs tailored to their. unique circumstances and needs. Already this Administration has
granted waivers to ne~rly half the states for welfare reform demonstrations. National welfare
reform should embody the va:lues of work and responsibility in a way that assures taxpayers,
that federal money is being spent prudently ,and appropriately. Forieform to succeed, the
funding mechanisms for welfare should not put children or states at risk in times of
recession, population increase or unpredictable growth in demand.
In this context, the Administration has serious concerns about the proposed legislation:
The spending cap in the proposed legislation makes no allowances for potential
growth in the need for cash assistance because of economic downturn,
population growth, or unpredictable emergencies. It could result in states
o
4
\
�running out of money before the end of the year, and thus having to turn away
working families who hit a "bump in the road" and apply for shott-term
assistance .. It could preclude states from investing,in job placement, in work
programs, in education and training, and in supports for working families.'
o
The proposed legislation removes the requirement that states match federal
funds with their own state funds. With none of their own money at risk, states
will have many fewer incentives to spend the funds efficiently and effectively
to improve performance and increase self-sufficiency,
o
The proposed legislation provides virtually' no accountability. There are no .
incentives for good performance and virtually no penalties for failure. There is
no provision for the recovery of monies paid out fraudulently or in error.
There are no mechanisms for ensuring that states are actually spending the
money on needy children rather than on state bureaucracies, or for monitoring
whether federal money is being used to help parents gain self-sufficiency,
require work, and enforce parental responsibility. Indeed, the federal
government is forbidden from taking any meaningful steps to ensure program
performance and accountability.
The Administration supports proposals that significantly increase state flexibility but also
ensure accountability for achieving national g'oals. The Administration supports a funding
mechanism that will not put children and states at risk down the road, and that enables states
to succeed in moving people from welfare to work and in supporting working families. The
Administration has significant doubts about the ability of a pure block grant funding
'mechanism to adequately protect both children and states.
. Protection of Children
The Administration recognizes that .the protection' of children is the primary goal both of cash
assistan~eprograms and of child welfare and child protective services. Cash assistance
programs assist families to care for children in their. own homes. Child protection services
help those children who are abused or neglected or at risk of abuse by their parents and who
need special in-home services or out of home placements to assure their safety. Strengthening
families, and where appropriate,preventing removal of children from their homes also are,
key goals of child protection services. There are problems in a number of areas.
Denial of Benefits to Children on AFDC
The legislative proposals that would reform cash assistance have a number of provisions that
would put vulnerable children at greater risk.
5
�o
As noted above, the legislalion would deny cash assistance to children of
unmarried minor mothers for their entire childhood, to children born while the
parent was on welfare, and to children whose parent had received welfare for
more than five years, whether or not a job was available or the parent was
unable to work. The funding caps could have the effect of denying cash
assistance to children when states used up their allocated funds, for whatever
reasons. Children in low income working families, who may be forced onto
cash assistance in tiines of economic downturn, could be most affected.
Child Protection Services
Some of these children could well come into a system of child protection services that is
already seriously overburdened and that is failing to provide the most essential services.
Reported child maltreatment and out-of-home placements have both been increasing sharply.
Many state systems are in such distress that they have been placed under judicial oversight.
The proposed legislation responds to these increasingly serious problems by consolidating
existing programs that protect children into a block grant with nominal federal oversight:
The Administration has serious concerns about this approach ..
o
The proposed legislation caps spending for child protection programs at a ,!eve I
considerably lower than baseline projections. This could lead to uninvestfgated
maltreatment reports, and to children being left in unsafe homes with minimal
services. It could also seriou;;ly hamper states' efforts to improve their child
abuse prevention and child protection systems .
.0
The proposed legislation eliminates the adoption assistance programs, and
leaves it up to states whether they will significantly sustain the subsidies that·
enable many special needs children to find permanent homes, and whether they
will honor commitments to those adoptive families that now receive subsidies.
o
The proposed legislation virtually eliminates federal monitoring and
accountability mechanisms. It makes it impossible for the federal government.
to ensure the protection of children.
o
The proposed legislation is silent on the formula for allocating funds to the
states. Because of serious imbalances among the states in spending on child
.
.
.
protection, it is hard to iinagine a formula that would not disadvantage either
states that have been heavy spenders, or states that are only beginning to
improve their systems.
.
Substantial improvements need to be made in the child protection system and in the federal
role in overseeing that system. The Administration supports a careful and thoughtful review
of the programs before actions are taken that might seriously harm millions of vulnerable
children.
6
�"
Denial of Benefits to Disabled Children on SSI
The Administration is deeply troubled by the changes proposed in the program designed to
help disabled children--SSL
o
o
The proposed legislation essentially eliminates SSI benefits for children, with
~he exception of a small group of children currently receiving benefits,· Withip
6 months, over one hundred thousand disabled children would lose eligibility
for SSI benefits--some would' lose medical protection as well. And in the
future, no child, no matter how disabled, will be eligibJe for any cash benefits
for SSI, except if cash benefits prevent them from having to be .
institutionalized. These proposals appear to penalize parents who are
determined to care for their child no matter what the economic consequences
for the family, SSI recipients are among" the neediest and most vulnerable
children, in the poorest families.
Some of the money saved is put into a new block grant for services to disabled
children, 'which would require the creation of a new state bureaucracy to
. decide on appropriate servIces. This idea is untested, and no one knows what
impact it will have on the most vulnerable of children and the parents who
care for them. The 5-year cut off in AFDC for all persons along with the
. elimination of SSI cash for disabled children may leave these children
extremely vulnerable.
The Administration sees the. need for careful reform in this area, with its potential for serious
harm to extremely vulnerable child~en. Last year the Congress established a Commission on
Childhood Disability to look into these issues in consultation with expens from the National
Academy of Sciences. The Commission will provide its repon to the Congress later this
yeac The Administration believes prudence dictates waiting for this shon time until this
bipartisan commission, following a thorough review of all aspects of this imponant program,
has an opportunity to make recommendations.
Benefits to Legal Immigrants
The Administration strongly believes that illegal aliens should not be eligible for government
welfare support. But the blanket prohibition of all benefits to legal immigrants who are not
yet citizens is too broad, and would shift substantial burdens to state and local taxpayers .
. These legal immigrants are required to pay taxes. Many serve in the armed forces, and
contribute to their communities. The Administration strongly favors a more focused
approach of holding sponsors accountable for those they bring into this country and making
the sponsors' commitment of support a legally binding contract.
7
�'.
[n sUinmary, the Chairman's mark espouses goals for the reform of welfare--work, paremal
responsibility, prevention of teen pregnancy and state f1exibility--that the Administration and
the Americail people share. But the translation of general goals into specific legislation
misses the mark in fundamental ways. The )proposed legislation does not represent serious .
work-based reform. It does nothing to move people from welfare to work, and it does not
require everyone who can work go to work. It neither holds state bureaucracies accoumable
nor cushions state taxpayers' against recession. It puts millions of children at risk of serious
harm. There are alternative approaches to reform that achieve our mutual goals in far more
constructive and accountable ways.
The Administration reiterates its commitment to real welfare reform and its desire to work
cooperatively with Congress to achieve it.
The Office of Management and Budget advises that there is no objection to the transmittal of
this report to Congress.
A similar
lett~r
was sent to Representative Harold E. Ford.
~elY'~
/
0---( ~
Donna E. Shahlla
cc: Members of the Subcommittee on Human Resources
8
�THE SECRE TARY OF HEAL TH AhlD HUMAN SERVICES
WASi1INGTON,O.<':
20201
FEB I 3 1995
The Honorable E. Clay Shaw
Chairman, Subcommittee on Human Resources
.
Committee on Ways and Means
U.S. House of Representatives
Washington D.C. 20515
Dear Mr. Chairman:
This letter expresses the Administration's views on the Chairman's mark for welfare reform
legislation under consideration by the House .Ways and Means Subcomtniuee on Human
Resources.
The Administration shares the commitment of the Congress and the American people to real
welfare reform that emphasizes work, parental responsibility, state flexibility. and the
protection of children. Last year, the President submitted a bold welfare reform bill, the
Work and Responsibility Act of 1994, which embodied these values. 1£ imposed tough work
requirements while providing opportunities for education, training. child care and supports to
working people. It included a stringent set of child support enforcement provisions. It
required each teen mother to live at home, stay in school and identify her baby"s father. It
increased state flexibility without sacrificing accountability. And it maintained a basic
structure of protections for children ...
.
.
The Administration looks forward to working cooperatively with the Congress in a bipartisan
way to pass bold welfare reform legislation this year. The Administration has, however,
serious concerns about a number of features of the Chairman's mark that appear to
undermine the values to which we are all committed. The Administration seeks to end
welfare as we know it by promo'iing work, family and responsibility. not by punishing poor
children for their parents' mistakes. Welfare reform will succeed only if it successfu.lly .
moves people from welfare to work.
.
Work
For years, Republicans and Democrats alike have agreed that the. central goal of welfare
reform must be work. That is still our goal: People who can work ought to go to work and
earn a paycheck not a welfare check. The Administration believes that no adult who is able
to work should receive welfare for an unlimited time without working. The .Administration
believes that from the first day someone comes onto welfare, he or she should be required to .
participate in job search, job placement, education, or training needed to move off welfare
and into a job quickly. It is government's responsibility to help ensure chat the critical job
placement, training, and child care services are provided. Individuals who are willing to
work should have the opportunity to work and not be arbitrarily cut off assistance.
�The Administration therefore has serious concerns about the Chairman's .mark before you:
o
It diminates requirements that recipients participate in job search, education,
work or training as a condition of receiving welfare, and ends any
responsibility of state welfare systems to provide education, training and
placement services to move recipients from welfare to work. The proposed
legislation effectively repeals' the bipartisan Family Support Act signed by'
President Ronald Reagan in 1988.
o
The proposed legislation includes only minimal and unenforceable
requirements that recipients work. , The bill requires only that persons on the
rolls for more than 2 years engage in "work activities" loosely defined by the
state welfare bureaucracy, rather than a real work requirement. The proposed
participation standards are very low. In many ways, the work requirements
are even weaker than those in current law.
o
The proposed legislation provides no assurance of child care to recipients who
work or are preparing to work--even if a state requires them to participate. It
offers no promise of child care for those who leave welfare for work or: (or
(hose who could avoid falling onto welfare if they had some help with child
care. While it repeals provisions of existing law that provide funding for child
care, this bill is silent on whether any additional funds will be available for
subsidized child care for low income working families.
o
The proposed legislation repeals the Current rule that anyone who leaves
welfare for work can receive Medicaid for an additional year to ease the
transition. This would further reduce health care coverage and make it harder
for people to move from welfare to work.
.
o
.
,
.
The proposed legislation would deny all cash assistance to families that have
received assistance for more than five years, even if the adult in the family is
unable to 'find a job or prevented from holding a job because of illness or the
need to care for a disabled family member. Children would be seriously
jeopardized even if their parents cannot find any work.
The Administration supports an alternative approach that would genuinely transform the
welfare system into a transitional system focused on work. It would have strict requirements
for recipients to participate in and clear responsibilities f~rstates to provide education, '
training and placement assistance; it would have serious time limits after which work would
be required; it would ensure that children would not be left alone when parents were working
by providing assistance for child care; it would put parents to work, not just cut them off;
arid it would ensure that children can expect support from two· parents!.
2.
�Parental Responsibility
The Administration believes that welfare reform should recognize the responsibility and
encourage the involvement of both parents in their children's lives. The' Administration
considers child support' enforcement to be an integral part of welfare reform, particularly
because it sends a strong message'to young people about the responsibility of both parents to'
support their children., The Administration was pleased that you had agreed to add child
support. enforcement to your welfare reform bill, and sorry that your proposals are not yet
part of the bilt now under consideration, The Administration looks forward to working
closely with you on this .issue in the coming weeks.
o
The only child support provision 'included in the Chairman's mark is one that
allows states to reduce payments to children for the first '6 months if paternity
has not been legally established. This provision seems ineffectual and unfair.
Even if a mother fully cooperates by giving detailed information identifying
" the father and his possible location, and even if the state is diligent in pursuing
the father. it can easily take 6 months to get paternity legally established.
There is no reason why the child should be punished during this period.
The Administration believes that it makes far more sense to deny benefits entirely to any
parent who refuses to identify the father or to cooperate in locating him. However, once the
mother has done all she can, the family should qualify for aid, and then the state should
establish paternity within one year.
.
The Administration believes that the welfare system should encourage the formation and
. support of two-parent families. The Administration is therefore concerned abot,tt an
important omission in the proposed legislation:
o
The proposed legislation would encourage the break.;.up of families by
. repealing the requirement that states provide cash assistance to two-parent
families in which a parent is unemployed or unable to work. It allows states
to discriminate against married, two-parent families by'treating single-parent
,.
. families better than two-parent families.
The Administration supports an approach that both encourages the formation of two-parent
families and makes sure that both parents take responsibility for children in all cases.
, Teen Pregnancy
.
.
.
The Administration and the American people agree that the best reform of welfare would be
to ensure that people do not need it in the first place. Welfare reform must send a very
strong message to young people that they should . not get pregnant or father a child until they
are ready and able tQ care for that child, and that if they do have children, they will not be
.3
�able to escape the obligations and responsibilities of parenthood. We must be especially
concerned about the well-being of the children who are born to young mothers, since they
are very likely to grow up poor.
.
,
'
The Administration therefore has serious concerns about the bill before .you: .
o
The proposed legislation would deny all federal cash benefits for eighteen
years. to any chil~ born to an unmarried mother under 18. as well as to the
parent. This provision appears to punish children for their entire childhood-
18 years--for the mistakes of their parents.
o
The proposed legislation does not require that teen mothers live at home, stay
in school. and identify the child '.s father. It weakens requirements in current
law, and may make the prospects for mother and child even worse.
o
The proposed legislation establishes only' minimal expectations for states to
provide services to unmarried parents, and provides no additional funds to
support them.
The Administration supports an alternative approach that would require minor mothers to live
at 11.0me, stay in school, make progress toward self-sufficiency. and identify the father of the
child. The Administration also supports a national campaign to prevent teen pregnancy .. It is
time to enlist parents and civic, religious, and business leaders in community based strategy
to send a clear message about abstinence and responsible parenting. The Administration also
supports a state option not to' increase benefits for children born to mothers on welfare. This
decision 'should be made by the state, not the federal goverrunent.
a
State Flexibility with Accountability
The Admiilistration embraces the creativity and responsiveness of states, and the
". - opportUnities for real reform when states have the flexibility to design ani:!' adniiiii'ste'r welfare
programs tailored to their unique circumstances .and needs. Already this Administration has
granted waivers to nearly half the states for welfare reform demonstrations. National welfare
reform should embody the values of work and responsibility in a way that assures taxpayers
that federal money is being spent prudently and appropriately. For reform to succeed, the
funding mechanisms for welfare should not put children or states at risk in times of
recession, population increase or unpredictable growth in demand .
.In this context, the Administration has serious concerns about the proposed legislation:
o
The spending cap in the proposed legislation makes no allowances for potential
growth in the need for cash assistance because of economic ,downturn,
population growth, or unpredictable emergencies. It could result in states
4
�running out of money before the end of the year, and chus having to turn away
working families who hit a "bump in the road" and' apply for shof(-term
as~istance. It could preclude states Jrom investing in job p,laGement, in work'
programs, in education and training, and in SUPPOf(S for working families.
o
The proposed legislation removes ,the requirement that states match federal
funds with their own state funds. With none of their own money at risk. 'states
will have many fewer incentives to spend the funds efficiently and effectively
to improve performance and increase 'self-sufficiency,
.
o
The proposed legislation provides virtually no accountability. There are no
incentives for good performance and virtually no penalties for failure. There is
no provision for the recovery of monies paid out fraudulently or in error. '
There are no mechanisms for ensuring that states are actually spending the
money on needy children rather than on state bureaucracies. or for monitoring
whether federal money is being used to help parents gain self-sufficiency.
require work. and enforce parental responsibility. Indeed. the federal
government is forbidden from taking any meaningful steps [0 ensure program
performance and accountability.
The Administration supports proposals that significantly increase state flexibility but also
ensure accountability for achieving national goals. The Administration supports a funding"
mechanism .that will not put children and states at risk down the road. and that enables states
to succeed in moving people from welfare to work and in supporting working families. , The
Administration has significant doubts about the ability of a-pure block grant funding
mechanism to adequately protect both children and states.
'
Protection of Children
The Administration recognizes that the protection of children is the primary goal both -of cash
assistance programs-and of-child welfare and 'child protective services. Cash assistance
programs assist families to care for, children in their own homes. Child protection services
help those children who are abused or neglected or at risk of abuse by their parents and who
need special in-home services or out of home placements to assure their safety. Strengthening
families. and where appropriate. preventing removal of children from their homes-also are,
key goals of child protection ser:vices. There are problems in a number of areas.
Denial of Benefits to Children on AFDC
The .legislative proposals .that would, reform cash assistance have a number of provisions that
would put vulnerable children at greater fisk.
'
5
�o
As noted above, [he legislation would deny cash assistance to children of
unmarried minor mothers for their entire childhood, to children born while the
parent was on welfare, and to children whose parent had received welfare for
more than five years, whether or not a job was. available or the parent was.·
unable to work. The funding caps-could have ~he effect of denying cash
assistance to children when states used up their allocated funds, for whatever
reasons. Children in low income working families, who may be forced onto
cash assistance in times of economic downturn. could .be most affected.
Child Protection Services
Some of these children could well come into a system of child protection services that is
already seriously overburdened and that is failing to provide the most essential services.
Reponed child maltreatment and out-of-home placements have both been increasing sharply.
Many state systems 'are in ~uch distress that they have been placed under judicial oversight.
The proposed legislation responds to these increasingly serious problems by consolidating
existing programs that protect children into a block grant with nominal federal oversight.
The Administration has serious concerns about this approach.
.
.
o
The proposed legislation caps spending for child protection programs at a level
considerably lower than baseline projections. This could lead to un investigated
maltreatment reports, and to children being left in unsafe homes with minimal
services. It could also seriously hamper states' efforts to improve their child
abuse prevention and child protection systems.
o
The proposed legislation eliminates the adoption assistance programs. and
leaves it up to states whether they will significantly sustain the subsidies that
enable many special needs children to find permanent homes, and, whether they
will honor commitments to those adoptive families that now receive subsidies.
o
The proposed legislation virtually eliminates federal monitoring and
accountability mechanisms. It makes it impossible for the federal government
to ensure the protection of children.
o
The proposed legislation is silent on the formula for allocating funds to the
states. Because of serious imbalances among the states in spending on child
protection, it is hard to imagine a formula that would not disadvantage either
states that have been heavy spenders,or states that are only beginning to
improve their systems.
.
Substantial improvements need to be made in the child protection system and in the federal
role in overseeing that system. The Administration supports a careful and thoughtful review
of the programs before actions are taken that might seriously harm millions of vulnerable
children.
6
�Denial of Benefits to Disabled Children on SSI
The Administration is deeply troubled by [he changes proposed in the program des(gned to
help disabled children--SSI
o
o
The proposed legislation essentially el iminates SSI benefits· for children. with
the exception of a small group of children currently receiving benefits. Within
6 months, over one hundred thousand disabled children would lose eligibility
for SSI benefits--some would 'lose medical protection as well. And in the
future, rio child, no matter how disabled, will be eligible for any cash benefits
for SSI, except if cash benefits prevent them. from having to be·
institutionalized. These proposals appear to penalize parents who are
determined to care for their child no matter what the economic consequences
for the family. SSI recipients are among the neediest and most vulnerable
children, in the poorest families.
Some of the money saved is put into a new block grant for services to disabled
children, which would require the creation of a new state bureaucracy to
decide on appropriate services. This idea is untested, and no one knows what
impact it w"ill have on the most vulnerable of children and the parents who
care for them. The 5-year cut off in AFDC for all persons along with the '
elimination of SSI cash for disabled children may leave these children
extremely vulnerable .
. The Administration sees the need for careful reform in this area, with its potential for serious
harm to extremely vulnerable children. Last year the Congress established a Commission on
. Childhood Disability to look into these issues in consultation with experts from the National
Academy of Sciences. The Commission will provide its report to the Congress . later this
year. The Administration believes prudence dictates waiting for this shorttimeuntil this
bipartisan commission, following a thorough review of all aspects of. this important. program.
has an opportunity to make recommendations.
Benefits to Legal Immigrants
The AdminIstration strongly believes that illegal aliens should not be eligible for government
welfare support. But the blanket prohibition of all benefits to legal immigrants who are not
yet citizens is too broad, and would shift substantial burdens to state and local taxpayers.
These legal immigrants are required to pay taxes. Many serve in the armed forces, and
contribute to their communities. The Administration strongly favors a more focused
approach of holding sponsors accountable for those they bring into this country and making
the sponsors' commitment of support a legally binding contract.
.
7
�[n summary. the Chairman's mark espouses goals for the reform of .welfare--work, 'parental
responsibility, prevention of teen ·pregnancy and state flexibility--that the Administration and
the American people share. But the translation of general goals into specific legislation.
misses the mark in fundamental ways. The proposed legislation does not represent serious
.work-based reform, It does nothing to move people from welfare to work, and it does not
require everyone who can work go to work. It neither holds state bureaucracies accountable
nor cushions state taxpayers against recession. It puts 'millions of children at risk 6r'serious
harm. There are alternative approaches to reform that achieve our mutual goals in far more
constructive and accountable ways.
.
The Administration reiterates its commitment to real welfare reform and its desire to work .
. cooperatively wit,h Congress to achieve it.
The Office of ~anagement and Budget advises that there js no objection to the transmittal of
this repon to Congress.
A similar letter was sent to Representative Harold E. Ford.
Donna E. Shalala
cc: Members of the Subcommiltee on Human Resources
8
�. f'
THE SECRETARY OF HEALrH Ar.. o HUMAN SERVICES
WA$t1INGTON.0.<':
20201
FEB I 3 1995
The Honorable E. Clay Shaw
Chairman, Subcommittee on Human Resources
Committee on Ways and Means
U.S. House of Representatives
Washing(On D. C. 20515
Dear Mr. Chairman:
This letter expresses the Administration's views on the Chairman's mark for welfare reform
legislation under consideration by the House Ways and· Means Subcommittee on Human
Resources.
The Administration shares the com.rnitment of the Congress ,a[Jd the American people to real
welfare reform that emphasizes work, parental responsibility, (state flexibility, and the
protection of children .. Last year, the Presidt;ht submitted a bold welfare reform bill, the
Work and Responsibility Act of 1994, which embodied these values. It imposed tough work
requirements while providing opportunities for education, training, child care and supports to
working. people. It included a stringerit set of child support enforcement provisions. It
required each. teen mother to live at home, stay in school and identify her baby's father. It
increased state flexibility without sacrificing accountability.· And it maintained a basic
structure of protections for children ..
The Administration looks forward to working cooperatively with the Congress in a bipartisan
way to pass bold welfare reform legislation this year. The Administration has, however,
serious concerns about a number of features of the Chairman's mark that appear to
undeimine the values to which we are all committed. The Administration seeks to end
.
welfare as we know it by promoting work, family and responsibility, not by punishing poor
children for their parents' mistakes. Welfare reform will succeed only if it successfully
moves people from welfare to work.
.
Work
,
For years, Republicans and Democrats alike have agreed that the. central goal of welfare·
ref<?rm must be. work. That is still our goal: People who can work ought to. go to work and
earn a paycheck not a welfare check. The Administration believes that no adult- who is able
to work should receive welfare for an unlimited time without working. The Administration
believes that from the first day someone comes onto welfare, he or she should be required (0
participate in job search, job placement, education, or training needed to move off welfare
and into a job quickly .. It is government's responsibility to help ensure that the critical job
placement, training, and child' care services are provided. ,Individuals who are willing to
work should have the opportunity (0' work and not be arbitrarily cut off assistance.
"
J
�The Administration therefore has serious concerns about ,the Chairman's .mark before you:
o
It eliminates requirements that recipients participate in job search, education,
work or training as a condition ofreceiving welfare, and ends any
, responsibility of state welfare systems tQ provide education, ,training and
placement services to move recipients from welfare to work. ,The proposed
legislation effectively repeals the bipartisan Family Support Act signed by
President Ronald Reagan in 1988.
o
The proposed legislation includes only minimal and unenforceable
requirements that recipients work. The bill requires only that persons on the
rolls for more than 2 years engage in "work activities" loosely defined by the
state welfare bureaucracy, rather than a real work requirement. The proposed
participation standards are very low. Iq many ways, the work requirements
are even weaker than those in current law.
o
The proposed legis'lation provides no assurance of chUd care to recipients who
work or are preparing to work--even' if a state requires them to participate. It
offers no promise, of child care for those who leave welfare for work or for
those who could avoid falling onto welfare if they had some help with child
care. While it repeals provisions of existing law that provide funding for child
care, this bill is silent on whether any additional funds will be available for
subsidized child care for low income working families.
o
The proposed legislation repeals the current rule that anyone who leaves
welfare for work can receive Medicaid for an additional year to ease the
transition. This would further reduce' health care coverage and make it harder.
for people to move from welfare to work.
o
The proposed legislation would deny all cash assistance to families that have
received assistance for more than five years, even if the adult in the family is
-..... "'Unable to find a job or prevented from holding a job because of illness or the
need to care for a disabled family member. Children would be seriously
jeopardized even if their parents cannot find any work.
The Administration supports an alternative approach that would genuinely transfonn the
welfare system into a transitional system focused on work. It would have strict requirements
for recipients to participate in and clear responsibilities for states to provide education, '
training and placement assistance; it would have serious time limits after which work would
be required; it would ensure that children would not be left alone when parents were working
by providing assistance for child care; it would put parents to work, 'not just cut them off;
and it would ensure that children can expect support from two parents.
2
�Parental Responsibility
The Administration believes that welfare reform ,should r~cognize the responsibility and
encourage the involvement of bo.th parents in their children's lives. The Administration
considers child support ,enforcemencto be an integral part of welfare reform, particularly
because it sends a strong message to young people about the responsibility of both parents to
support their children. The Administration was pleased that you had agreed to add child
support enforcement to yOlJr welfare reform bill, and sorry that your proposals are not yet
part of the bill now under consideration. The Administration looks forward to working
dosely with you on this issue in the coming weeks.
o
The only child support provision included in the Chairman's mark is one that
allows states to reduce payments to children for the first 6 months if paternity
has not been legally established. This proVision -seems ineffectual and unf(iir.
Even if a mother fully cooperates by giving detailed information identifying
the father and his possible location. and even if the state is diligent ,in pursuing
, the father. it can easily take 6' months to get paternity legally established.'
There is no reason why the child should be punished during. this period.
The Administration believes' that it makes far more sense to deny benefits entirely to any
parent who refuses to identify the father or to cooperate in locating him. However, once the
mother has done all she can, the family should qualify for aid, and then the state should'
'
establish paternity within one year.
, The Administration believes that the welfare system should encourage the formation and
support of two-parent families. The Administration is therefore concerned about an
important ,omission in the, proposed . legislation: .
o
The proposed legislation would encourage the break-up of families by
repealing the requirement that states provide cash assistance to two-parent
families in which a parent is unemployed or unable to work. It allows states
to discriminateagaiiiS-i'mamed, two-parent families by treating single-parent
families better than two-parent families.
'
The Administration supports an approach that both encourages the formation of two-parent
families and makes sure that both parents take responsibility for children in all cases.
, Teen Pregnancy
The Administration and the American people agree that the best reform of welfare would be
, to ensure that people do not need it in the first place.WelfarerefQrm must send a very.
strong message to young people that they should not get pregnant or father il child until'they
are ready and able to care for that child. and that if they do have children, they will not be
3
�able to esc.ape the obligations and responsibilities of parenthood. We must be espec'ially
concerned' about the well-being of the children who are born to young mothers ,since, they
are very likely to grow up poor.
")
The Administration therefore has serious concerns about the bilt before you:
o
The proposed legislation would deny all federal cash benefits for eighteen ,
years to any child born to an unmarried mother under lS, as well as to the
parent. This provision appears to punish children for their entire childhood-
lS years--for the mistakes of their parents.
0,
The proposed legislation does not require that teen mothers live at home. stay
in school, and identify the child's father. ' It weakens requirements in current
law, and may make the prospects for mother and child even worse.
o
The proposed •legislation establishes only minimal expectations for states to
provide services to unmarried parents, and provides no additional funds to
support them.
The AdminIstration supports an alternative approach that would require minor mothers to live
at home, stay in school, make progress toward self-sufficiency, and identify the father of the
child. The Administration also supports a national campaign to prevent teen pregnancy. It is
time to enlist parents and civic, religious, and business leaders .in a community based strategy
to send a clear message about abstinence and responsible parenting. The Administration also
supports a state option not to increase benefits for children born to mothers on welfare. This
decision should be ~ade by the state, not the federal government.
State lexibility with Accountability
F
The Administration embraces the creativity and responsiveness of states, and ,the
,
opportunities for real reform when states have the flexi6ilityto'desigri and administer welfare"
programs tailored to their unique circumstances and needs. Already this,Administration'has
granted waivers to nearly half the states for welfare refonn demonstrations. 'National welfare
reform should embody the values of work and responsibility in a way that assures taxpayers
that federal money is being spent prudently anci appropriately. For reform to succeed, the
funding mechanisms for welfare should not put children ,or states at risk in times of
recession, population increase or unpredictable growth in demand.
.
.
'
.
"
'
In this context, the Administration has serious concerns about the proposed legislation:
o
The spending cap' i'n the proposed legislation makes no allowances for potential
growth in the need for cash assistance because of economic downturn,
population growth, or unpredictable emergencies. It could result in states
4
�running out of money before the end of the year, and thus having to turn away
working families who hil a "bump in the road" and apply for short-term
assistance. It could preclude slates from investing in job placemem, in work
programs. in education and training. and in supports for working families.
o
The proposed legislation removes the requirement that states match federal
funds with their own state funds .. With none of their own money at riik, states
will have many fewer incemives to spend the funds efficiemly and effectively
to improve perfonnance and increase 'self-sufficiency.'
o
The proposed legislation provides virtually no accountability. There are no
incemives for good perfonnance and virtually no penalties for failure. There is
no provision for the recovery of monies paid out fraudulemly or in error.
There are no mechanisms for ensuring that states are actually spending the
money on needy children rather than on state bureaucracies, or for monitoring
whether federal money is being used to help parems gain self-sufficiency,
require work, and enforce parental responsibility. Indeed, the. federal
government is forbidden from taking any meaningful steps to ensure program
perfonnance and accoumability. .
The Administration supports proposals that significantly increase state flexibility but also
ensure accountability for achieving national goals. The Administration supportS a funding
mechanism that will not put children and states at risk down the road, and that enables states
to succeed in moving people from welfare to work and in supporting working families. The
Administration has significant doubts about the ability of a pure block grant funding
mechanism to adequately protect both children and states.
Protection of Children
"The Administration recognizes that the protection of children is the primary goal both of cash
. ---assistimce programs and of chi.1d welfare and child protective services. Cash assis~nce--
programs assist families to care for children in their. own homes. Child protection services,
help those children who are abused or neglected or at risk of abuse by their parents and who
need special in-home services or out of home placements to assure their safety. Strengthening
families, and where appropriate, preventing removal of children from their homes also are.
key goals of child protection services. There are problems in a number of areas .
. Denial of Benefits to. Children on AFDC
The legislative proposals that would refonn cash assistance have a number of provisions that
would put vulnerable children at greater risk.
5
�a
As noted above. the legislation would deny cash assistance to children of
unmarried minor mothers for their entire childhood, to children born while the
parent was on welfare. and to children whose parent had received welfare for
more than five years. whether or not a job was available or the parent was
unable to work... The funding caps could have the effect of denying cash
assistance to children when states used up their allocated funds. for whatever
reasons. Children in low income working families, who may be forced onto
cash assistance in times of economic downturn, could be, most affected.
Child Protection Services
Some of these children could well come into a system of child protection services that is
already seriously overburdened and that is failing to provide the Illost essential services,
Reported child maltreatment and out-of-home placements have both been increasing sharply, .
Many state systems are in such distress th~lt they have been placed under judicial oversight.,
The proposed legislation responds to these increasingly serious problems by ,consolidating
existing programs that protect children into a block grant with nominal federal oversight.
The Administration has serious concerns· about this approach.
o
The proposed legislation caps spending for child protection programs at a level
considerably lower than baseline projections. This could lead to uninvestigated
maltreatment reports, and to children being left in unsafe homes with minimal
services. It could also seriously hamper states'. efforts to improve their Ghild
abuse prevention and child protection systems.
•
o
f
The proposed legislation eliminates the adoption assistance programs, and
..
leaves it up to states whether they will significantly sustain the subsidies that
enable many special needs children to find pennanent homes, and whether they
'will honor commitments to those adoptive families that now receive su~sidies.
o
The proposed legislation virruaUy eliminates federal monitoring and
.. accountability mechanisms .. It makes it impossible for the federal government
to ensure the protection of children.
'
o
The proposed legislation is sile~t on the fannula for allocating funds to the
states. Because of serious imbalances among the 'states in spending on child
. protection, it is hard to imagine a fonnula that would not'disadvantage eithe,r
states that have been heavy spenders, or states that are only beginning to
improve their systems.
Substantial improvements need to be made in the child protection system and in the federal·
role in overseeing that system. The Administration supports a careful and thoughtful review
of the programs before actions are taken that might seriously hann millions of vulnerable
children.
6
�Denial of Benefits to Disabled Children on SSI.I
The Administration is deeply troubled by the changes proposed in the program designed to
help disabled children--SSI.
o
o
The proposed legislation essentially eliminates SSl·benefits for 'children. with·
the exception of a small group of children currently receiving benefits. Within
6 months, over one hundred thousand disabled children would lose eligitJility
for SSI benefits--some' would rose medical protection as well. And in the
future, no child, no matter how disabled, will be eligible for any cash benefits
for SSI, except if cash benefits prevent them. from. having to be
institutionalized. These proposals appear to penalize parents who are
detennined to care for their child n'o matter what the economic consequences
for the family. SSI recipients are among .the neediest and most vulnerable'
children,' in the poorest families.
Some of the money saved is put into a ne~ block grant for services to disabled
children. which would require the creation of a new state bureaucracy to
decide on appropriate services. This idea is untested. and no one knows what
impact it will have on the most vulnerable of children and the parents who
care for them. The 5-year 'cutoff in AFDC for all persons along with the
elimination of SSI cash for disabled children may leave these children
extremely vulnerable.
The Administration sees the need for careful refonn in this area, with its potential for serious
hann to extremely vulnerable children. Last year the Congress established a Commission on
Childhood Disability to look into these issues in consultation with experts from the National
Academy of Sciences. The Commission will provide its report to the Congress later this
year. The Administration believes prudence dictates waiting for this short. time until this
bipartisan commission, following a thorough review of all aspects of rhisimponant program.
has an opportunity to make recommendations.
. Benefits to Legal Immigrants.
The Administration strongly believes that illegal aliens should not be eligible for government
welfare support. But the blimket prohibition of all benefits to legal immigrants who are not
. yet citizens is too broad, and would shift substantial burdens to state and local taxpayers.
These legal immigrants are required to pay taxes. Many serve in the anned forces, and·
contribute to their communities. The Administration strongly favors a more focused
approach of holding sponsors accountable for those they bririg into this country and making
the sponsors' commitment of support a legally binding contract.
7
�In summary, the Chainnan's mark espouses goals for the reform of welfare--work, parental
responsibility, prevention of teen pregnancy and state flexibility--that the Administration and
the American people share. But the translation of general goals into specific legislation
misses the mark in fundamental ways. The proposed.legislation does not represent serious
work-based refonn. It does nothing to move people from welfare. to work, .and it do.es not
require everyone who can work go to work. It neither holds state bureaucracies accountable
nor cushions state taxpayers against recession .. It puts millions of children at risk of serious
harm. There are alternative approaches to reform that achieve our mutual goals in far more
constructive and accountable ways. .
The Administration reiterates its commitment to real welfare refonn and its desire to work
cooperatively with Congress to achieve it.
The Office of Management and Budget advises that there is no objection
{his report to Congress.
fO
the·transmittal of
A similar letter was sent to Representative Harold E. Ford .
.
.cs·
0----(
~ Y
. .' S. in.cerel -'
.~
Donna E. Shalala
cc: Members of the Subcommittee on Human Resources
8
.
�fH£'S£CR£ fARY OF H£AL fH Ar~f) HUMAN SERVICES
FEB I 31995
The 'H6i1orab'le E, Clay Shaw
Chairman. Subcommittee on Human Resources
Committee on Ways and Means
U.S. House of Representatives
Washington' D.C. 20515
Dear Mr. Chairman:
This letter expresses the Administration's views on the Chairman's mark for w~lfare reform
legislation under consideration by the House Ways and Means Subcommittee on Human
Resources.
The Administration shares the commitment of the Congress and the American people to real
welfare reform that emphasizes work, parental responsibility, state flexibility, and the
protection of children. Last year, the President submitted a bold welfare reform bill, the
Work and Responsibility Act of 1994, which embodied these values. It imposed tough work
requirements while providing opportunities for education, training, child care and supports to
working people. It included a stringent set bf cpild support enforcement provisions. It
required each teen mother to liye at home, stay in school and identify her baby's ,father.. It
increased state flexibility without sacrificing accountability.' And it maintained a basic
structure of protections for children. .
'
The Administration looks forward to working cooperatively with the Congress in a bipanisan
way to pass bold welfare reform legislation this year. The Administration has, however,
serious concerns about a number of features of the Chairman's mark that appear to.
undermine the values to which we are all committed. The Administration seeks to end
:
..
.
welfare as we know it' by promoting work, family and responsibility, not by punishing poor
children for..theit parents' mistakes. Welfare reform will succeed only if it successfully
moves people from welfare to work.
Work
For years, Republicans and Democrats alike have agreed that the, central goal 'of welfare
reform must be work. That is still our goal: People who can work ought to go to work and,
earn a paycheck not a welfare check. The Administration believes that no adult who is able
to work should receive welfare for an unlimited time without working. The Administration
believes th~t from the first day someone comes onto welfare, he or she should be required to
participate in job search, job placement, education, or training needed to move off welfare
and into a job quickly. It is government's responsibility to help ensure that the critical job
placement, training, and child care services are provided. Individuals who are willing to
work should have the opportunity to work and not be arbitrarily cut off assistance.
�The Administration therefore has serious concerns about the Chainnan's .mark before you:
o
h eliminates requirements that recipients participate in job search, education,
work or training as a condition of receiving welfare, and ends any
responsibility of state welfare systems to provide- education, training and
placement services to move recipients from" welfare to work.. The propose4 .
legislation effectively repeals the bipartisan Family Support Act signed by
President Ronald Reagan in 1988.
o
The proposed legislation includes ofiIy 'minimal and unenforceable
requirements that recipients work. The bill requires only that persons on the
rolls for more than 2 years engage in "work activities" loosely defined by the
state welfare bureaucracy, rather than a real work requirement. The proposed
participation standards are very low. In many ways, the work requirements
are even weaker than those in current law.
o
. The proposed legislation provides no assurance of child care to recipients· who
work or are preparing to work--even if a state requires them to participate. It
offers no promise of child care for those who leave welfare for work or for
those who could avoid falling onto welfare if they had some help with. child
care. While it repeals provisions of existing law that provide funding for child
care, this bill is silent on whether any additional funds will be available for
subsidized child care for low income· working families.
o
The proposed legislation repeals the current rule that anyone who leaves·
. welfare for work can receive Medicaid for an additional year to ease the
tranSition. This would further reduce health care coverage and make it:harder
for people to .move from welfare to work.
o
The proposed legislation would deny all cash assistance to families that have·
received assistance for more than five years, even if the adult in the family is .
unable to find a job or prevented from holding a job because of illness or the
need to care for a disabled family member. Children would be seriously .
jeopardized even if their parents cannot find any work.
The Administration supports an alternative approach that would genuinely transform the
welfare system into a transitional system focused on work. It would have strict requirements
for recipients to participate in and clear responsibilities for states to provide education,
training and placement assistance; it would have serious time limits after which work would
be required; it would ensure. that children would not be .left alone when parents were working
by providing assistance for child care; it would put parents to work, not just cut them off;
and it would ensure that children can expect support from two parents.
2
�Parental ReSI)Onsibility
The Administration believes that welfare reform should recognize the responsibility and
encourage the involvement of both parents)n their children's lives. The Administration
considers child support enforcement to be an integral part of welfare reform,particulafly
because it sends a strong message to young people about the responsibility of both parents to
support their children. The Administration was pleased that you had agreed (0 add -child
support enforcement to your welfare reform bill, and sorry that your proposals are not yet
part of the bill now under consideration. The Administration looks forward to working
closely with you on this issue in the coming weeks.
o
The only child support provision included in the Chairman's mark is one that
allows states to reduce payments to children for the first 6 months if paternity
has not been legally established. This provision seems ineffectual and unfair.
Even if a mother fully cooperates by giving detailed information identifying
the father and his possible location, and even if the state -is diligent in pursuing
the father. it can easily take 6 monthsto get paternity legally established.
There is no reason why the child should be punished during this period.
; The Administration believes that it makes far more sense to' deny benefits entirely to any
parent who refuses to identify the father or to cooperate -in locating him. However, once the
mother has done all she can, the family should qualify for aid, and then the state should
establish paternity within one year.
'
The Administration believes that the welfare system should encourage the formation and
support of two-parent families. The Administration is therefore concerned about an
important omission in the proposed legislation:
o
The proposed legislation would encourage the break-up of families by
repealing the'requirement that states provide cash assistance to two-parent
families in ~hich a parent is unemployed or unable to work. It allows states
to discriminate against married, two-parent families by treating' single::parent
families better than two-parent families.
The Administration supports an approach that both encourages the formation of two-parent
families and makes sure that both parents take responsibility for children in all cases.
, Teen Pregnancy'
The Administration and the American people agree that the best reform of welfare would be
to ensure that people do not need it in the first place. _Welfare reform must, send a very
strong message to young people that they should not get pregnant or father a child until they
are ready and able to care for thatchild. and that if they do have children, they will not be
3
�able to escape the obligations and responsibilities of parenthood. We must be especially
concerned about the well-being of the children who are born to young mothers, since they
are very likely to grow up poor.
The Admiriistrition therefore has serious concerns about the bill before you:
o
The proposed legislation would deny all federal cash benefits for eighteen
years to any child born to an unmarried mother under 18, as well as to ~he
parent. This provision appears to punish children for their entirechildhood-
18 years--for the mistakes of their parents.
o
The proposed legislation does not require that teen mothers live at home, stay
in school, and identify the child's. father. It weakens requirements in current
law, and may make the prospects for mother and child even worse.
o
The proposed legislation establishes only minimal expectations for states to
provide services to unmarried parents, and provides no additional funds to
support them.
.
The Administration supports an alternative approach that would require minor mothers to live
at home, stay in school, make progress toward self-sufficiency, and identify the father of the
child. The Administration also supports a national campaign to prevent teen pregnancy. It is
time to· enlist parents and' civic, religious, and business leaders ina community based strategy
to send a clear message about abstinence and responsible parenting. The Administration also
supports a state option not to increase benefits for children born to mothers on welfare. This
decision should be made by the st~te, not the federal government.
State lexibility with Accountability
F
The Administration embraces the creativity and responsiveness of states, and the
opportUrutles"for 'reil reform when states have the flexibIlity to design and administer welfare _
...
programs tailored to their unique circumstances and needs. Already this Administration has
granted waivers to nearly half the states for welfare reform demonstrations: National welfare
reform should embody the values of work and responsibility. in a way that assures taxpayers
that federal money is being spent prudently and appropriately .. For reform to succeed, the
funding mechanisms for welfare should not put children oestates at risk in times·of
recession, population increase or unpredictable growth in demand.
In this
o
conte~t,
the Administration has serious concerns about the proposed legislation:
The spending cap in the proposed legislation makes no allowances for potential
growth in the need for cash assistance because of economic downturn,
population growth, or unpredictable emergencies. It could result instates
4
�running out ,of money before·the end of the year, and thus having to rurn away'
working families who hit a "bump in the road" and apply for short-term
assistance. It could preclude states from investing in job placement, in work
programs, in education and training, and in supports for working families.
o
The proposed legislation removes the requirement that states match federal' .
funds with their own state funds. With none of their own money at risk, states
will have many fewer incentives to spend the funds efficiently and effectively
to improve performance and increase ·self-sufficiency.
o
The proposed legislation provides virtually no accountability _ There are no.
incentives for good perfonnance and virtually no penalties for failure. There is,
no provision for the recovery of monies paid out fraudulently or in error.
There are no mechanisms for ensuring that. states are actlJ,ally spending tqe
. money on needy children rather than on state bureaucracies, or for monitoring
whether federal money is being used to help parents gain self-sufficiency',
require work, and enforce parental responsibility . Indeed, the federal
government is forbidden from taking any meaningful steps to ensure program
performance and accountability.
· The Administration supports proposals that significantly increase state flexibility but also
ensure accountability for achieving national goals. The Administration supports a funding
mechanism thatwill not put children and states at risk down the road, and that enables states
· to succeed in moving people from welfare to work and in supporting working families. The
Administration has significant doubts about the-ability of a pure block grant funding
mechanism to adequately protect both children and states.
Protection of Children
The Administration recognizes that the protection of children is the primary goal both of cash
assistance programs and of child-welfare-and" child protective services. Cashassistance
programs assist families to care for children. in their. own homes. Child protection services
help those children who are abused or neglected or at risk of abuse by their parents and who
· need special in-home services or out of home placements to assure their safety. Strengthening
families, and where appropriate, preventing removal of children from their homes also are;
key goals of chiid protection services. There are problems in a number of areas.
Denial of Benefits to Children on AFDC
The. legislative proposals that would refonn cash assistance have a number of provisions that
would put vulnerable children at greater risk.
5
�o
As noted above, the legislation would deny cash assistance to children of
urunarried minor mothers for their entire childhood, to children horn while the
parent was on welfare, and to children whose par~nt had received welfare for
more than five years. whether or not a job was available or the parent was'
unable to work. The funding caps could have the-effect of denying cash·
assistance to children when states used up their allocated funds, for whatever
reasons. Children in low income working· families, who may be forced onto
cash assistance in times of economic downturn, could be most affected ..
. Child Protection Services
Some of these chil~ren could well come into a system of child protection services that is
already seriously overburdened and that is failing to provide the most essential services. .
Reported child maltreatment and out-of-home placements have both been increasing sharply .
. Many state systems are in such distress that they have been placed under judicial oversight.
The proposed legislation responds to these increasingly serious problems by consolidating
existing programs that protect children into a block grant with nominal federal oversight.
.. The Administration has serious concerns about this approach.
o
The proposed legislation caps spending for child ,protection programs at a level
considerably lower than baseline projections. This could lead to uninvestigated
maltreatment reports, and to children beiIlg le:ft in unsafe homes with minimal
services. It could also seriously hamper states' efforts to improve their child
abuse prevention and child protection systems.
.
o
The proposed legislation eliminates the adoption assistance programs, and
leaves it ·up to states whether they will significantly sustain the subsidies that
enable many special needs children to find permanent homes, and whether they
will honor commitments to those adoptive families that. now receive subsidies.
o
The proposed legislationviitually eliminates federal mOQitoringand
accountability mechanisms. It m~es it impossible for the federal goverrunent
to ensure the protection of children.
o
The proposed legislation is silent on the formula for allocating funds to the
states. Because of serious imbalances among the states in spending on child
protection, it is hard to imagine a formula that would not disadvantage either
states that have been heavy spenders, or states that are only beginning. to
improve their systems.
Substantial improvements need to be made in the child p,rotection system and in the federal
role in overseeing that system. The Administration supports·a careful and thoughtful review
of the programs before actions are taken that might seriously'harm millions of vulnerable
children.
6
�Denial of Benefits [Q Disabled Children 011 SSI
The Administration is deeply troubled by the changes proposed in the program designed to '
help disabled children--SSL
o
o
The proposedlegisiation essentially eliminates SSI benefits for children,. with
the exception of a small group of children currently receiving benefits, Within
6 months, ov~r one hundred thousand disabled children would lose eligibility
for SSI benefits--some would lose medical protection as well. And in the
future, rio child, no matter how disabled, will be eligible for any cash benefits
for SSI, except if cash benefits prevem .them. from having to be
institutionalized. These proposals appear to penalize parents who are
detennined to care for their child no matter' what the economic consequences
for the family. SSI recipients are among the neediest and most vulnerable.
children, in the poorest families.
Some 'of the money saved is put into a new block grant fot services to disabled
children, which would require the creation of a new state bureaucracy to .
decide on approp~ia(e.services, . This idea is untested, and no one knows what
impact it will have on the most v~lnerable of children and. the parents who
care for them. The 5-year cut off in AFDC for all persons along with the
elimination of SSI cash for disabled children may leave these children
extremely.vulnerable:
The Administration sees the need for careful refonn in this area, with its potential for serious
hann to extremely vulnerable children. Last year the Congress established a Commission on
Childhood Disability to look into these issues in consultation with experts from the National
Academy of Sciences. The Commission will provide its report to the Congress later this
year. The Administration believes 'prudence dictates waiting for this short time until this ,
bipartisan commission, following a thorough review of all aspects of this important program,
has an opportuniry to make recommendations.
Benefits to Legal Immigrants
The Administration strongly believes that illegal aliens should not be eligible for government
welfare support. But the blanket prohibition of all benefits to legal immigrants who are not
. yet citizens is too broad, and would shift substantial burdens to state and local taxpayers.
These legal immigrants are required to pay taxes. Many serve in the anned forces, and
contribute to their communities.- The Administration strongly favors a more focused
approach of holding sponsors accountable for those they bririg into this country and making
the sponsors' commitment of support a'iegally binding contract.
7
r
�In summary, the Chainnan's mark espouses goals for the reform of welfare--work,parental
responsibility, prevention of teen pregnancy and state tlexibility--that the Administration and
the American people share. But the translation of general goals into specific legislation
misses the mark in fundamental ways. The proposed legislation does not represent serious
work-based refonn. It does nothing .to move people from welfare to work, and it does not
require everyone who can work go to work. It neither holds state bureaucracies acc;ountable
nor ·cushions state taxpayers against recession. It puts millions of children at risk of serious
hann. There are alternative approaches to reform that achieve our mutual goals in far more
constructive an~ accountable ways.
"
The Administration reiterates its commitment to real welfare refonn and its desire. to work
cooperatively with Congress to achieve it.
The Office of Management and Budget advises that there is no objection to the transmittal of
this report to Congress.
A similar letter was sent to Representative Harold E. Ford.
~elY'S
cr(~
Donna E. Shalala
cc: Members of the Subcommittee on Human Re·sources
8
�THE SECRETARY OF HEAL TH Af~D HUMAN SERVICES
FEB. 1 3 1995
The HonorableE Clay Shaw - -,--...... t"
Chairman, Subcommittee on Human Resources
Committee on Ways and Means
U.S. House of Representatives
Washington D.C. 20515
(
Dear Mr. Chairman:
This letter expresses the Administration's views on the. Chairman's mark for welfare reform
legislation under consideration by. the House Ways and Means S'ubcommittee on Human
Resources.
The Administration shares the commitment of the Congress and the American people to real
welfare reform that emphasizes work, parental responsibility. state flexibility, and the
protection of children. Last year, the President submitted a bold welfare reform bill, the
Work and Responsibility Act of 1994, which embodied these values. It imposed tough work
requirements while providing opportunities for education, training, child care and supports to
working people. It included a stringent set of child support enforcement provisions. It
required each teen mother to live at home, stay in school and identify her baby's father. It
increased state flexibility without sacrificing accountability _. And it maintained a basic
structure of protections for children.
.
.
The Administration looks forward to working cooperatively with the Congress in a bipartisan
way to pass bold welfare reform legislation this year. The Administration has, however,
serious concerns about a number of features of the Chairman's mark that appear to'
undermine the values to which we are all committed. The' Administration seeks to end
.
welfare as we know it by promoting work, family and responsibility, not ,by punishing poor·
children for their parents' mistakes ... Welfare reform will succeed only if it successfully.
moves people from welfare to work.
.
,
.
Work
For years, Republicans and Democrats alike have agreed that the central goal of welfare
reform must be work. That is still our goal: . People who can work ought to go to work and
earn a paycheck not a welfare check. The Administration believes that no adult who is able
to work should receive welfare for an unlimited time without working. The Administration
believes that from the first day someone comes onto welfare" he or she should be required to
participate in job search, job placement, education, or training needed to move off welfare
. and into a job quickly. It is government' s responsibility to help ensure that the critical job
placement, training, and child care services are provided .. IndiViduals who are willing to
work should have the opportunity to work and not be arbitrarily cut off assistance.
�/
The Administration therefore has serious concerns about the Chairman's .mark before you:
o
[t eliminates requiremei1ts that recipients participate in job search. education,
work or training as a condition of receiving welfare, and ends any
responsibility of state welfa~e systems to provide education, Haining and
placement services to move recipients from welfare to work. The proposed
.Iegislation effectively repeals the bipartisan Family Support Act signed by
. Presid!!nt Ronald Reagan in 1988.
o
The proposed legislation ,includes only minimal and unenforceable
requirements that recipients work. , The bill requires only that persons on the
rolls for more tl1an 2 years engage in "work activities" loosely defined by the
state welfare bureaucracy, rather than a real work requirement. The proposed
participation standards are very low. In many ways, the work requiremerts
are even weaker than those in current law.
o
The proposed legislation provides no assurance of child care to recipients who
work or are preparing to work--even if a state requires.them to participate.' It
offers no promise of child care for those who leave welfare for work or for
those who could avoid falling onto welfare if they had some help with child
care. While it repeals provisions of existing law that provide funding for child
care, this bill is silent on whether any additional funds will be available' for,
subsidized child care for low income working families. .
o
The proposed'legislation repeals the current rule that anyone who leaves
welfare for work can receive Medi~aid for an additional year to ease the
transition. This would further reduce health care coverage and make it harder
for people to ,move from welfare to work.
o
The proposed legislation would deny all cash assistance to families thai have
received assistance for more than five years, even if the adult in the family is
unable to find ajob or prevented from holding a job"'because of illness or the
need to care for a disabled family member. Children would be'seriously
jeopardized even if their parents cannot find any work.
The Administration supports an alternative approach that would genuinely transform the
welfare system into a transitional system focused on work. It would have strict requirements
for recipients to participate in and clear responsibilities for states to provide education,
training and placement assistance; it would have serious time limits after which work would
be required; it would ensure that children would not be left alone ~hen parents were working
by providing assistance for child care; it would, put parents to work, not just cut them off;
and it would ensure that children can expect support from two parents.
2
�Parental Responsibility
The Administration believes that welfare reform should recognize the responsibility and'
. encourage the involvementof both parents in their children's lives. The Administration
considers child support enforcement to be an integral p'art of welfare reform. particularly
because it sends a strong message to young people about the responsibility of both parents to
support their children. The Administration was pleased that you had agreed to add: child
support enforcement to your welfare reform bill, and sorry that your proposals are not yet
part of the bill now under consideration. The Administration looks forward to working
closely with you on this issue in the.coming weeks.
o
The only child support provision included in the Chairman's mark is one that
allows states to reduce payments to children for the first 6 months if paternity ,
has not been legally established. This provision seems ineffecuial and unfair.
Even if a mother fully cooperates by giving detailed information identifying
the father and his possible location, and even if the state is diligent in pursuing
the father, it can easily take 6 months to get paternity legally established ..
There is no reason why the child should be punished during this period. '
The Administration believes that it makes far more sense to deny benefitsentitely to any
parent who refuses to identify the father or to cooperate ,in locating him. However, once the,
mother has done all she can, the family should qualify for aid, and then the state should
establish paternity within one year.
The Administration believes that the welfare system should encourage the formation and
support of two-parent families. The Administration is therefore concerned about an
important omission in the proposed legislation:
o
The proposed legislation would encourage the break-up of families by
repealing the requirement that states provide cash assistance to two-parent
, families in which a parent is unemployed or unable to work. It allows states
to discriminate against married, two-:-parent families by treating single-parent ... ,. .. . ,.,
families better than two-parent families.
The Administration supports an approach that both encourages the formation of two-parent
families and makes sure thilt both parents take responsibility for children in all cases.
. Teen Pregnancy.
The Administration and the .American people agree that the best reform of welfare would be
to ensure that' people do not need it in the first place. Welfare reform must send a very
strong message to young people that they should not get pregnant or father a child until they
are ready and able to care for that child, and that if they do have children, they will not be
3
�able. to escape the obligations and responsibilities of parenthood. We must be especially
concerned about the well-being of the children who are born to young mothers, since they
are very likely to grow up poor.
'
The Administration therefore hasseiious concerns about the bill before you:
o
The proposed legislation would deny all federal cash benefits for eighteen
years to any child born to an unmarried mother under 18, as well as to the.
parent. This provision appears to punish children for their entire childhood-
18years--for the mistakes of their parents.
..
o
The proposed legislation does not require that teen mothers live at home, stay
in school, and identify the child's father. It weakens requirements in current
law, and may make the prospects for mother and child even worse.
o
The proposed legislation establishes only minimal expectations for states to
provide services to unmarried parents, and provides no additional funds to
support them.
The Administration supports an alternative approach that would require minor mothers to live
at home, stay in school, make progress toward self-sufficiency, and identify the father of the
child. The Administration also supports a national campaign to prevent teen pregnancy. It is
time to enlist parents and civic, religious, and b\lsiness leaders in a community ,based strategy
to send. a clear message about abstinence and responsible parenting. The Administration also
. supports a state option not to increase benefits for children born to mothers on welfare. This
.
decision should be· made by the state, not the federal government.
State Flexibility with Accountability
The Administration embraces the creativity 'and responsiveness of states, and the
opportunities for real reform' when states have the .flexibility to design and administer welfare
programs tailored to their unique circumstances and needs. Already this Administration has
granted waivers to nearly half the states for welfare reform demonstrations. National welfare
reform should embody the values of work and responsibility in a way that assures taxpayers
that federal money is being spent prudently ahd appropriately. For reform to succeed, the
funding. mechanisms for welfare should- not put children or states at risk in times of
recession, population increase or unpredictable growth in demand.
In this context, the Administration has serious concerns about the proposed, legislation:
o
The spending cap in the proposed legislation makes no allowances for potential
growth in the need for cash assistance because of economic downtunl,
population growth, or unpredictable emergencie~ .. It could result in states
4
�running out of money before the end of the year. and thus having to tum away
working families who hit a ~'bump in the road" and apply for short-term
assistance. It could preclude states from investing in job placement, in work
programs, in education and training, and in supports for working families.
o
The proposed legislation removes the requirement that states match federal
funds with their own state funds. With none of their own money at risk, s~ates
will have many fewer incentives to spend the funds efficiently and effectively
to improve performance and increase ·self-sufficiency.
o
The proposed legislation provides virtually no accountability. There are no
incentives for good performance and virtually no penalties for failure. There is
no provision ,for the recovery 'of monies paid out fraudulently or in error.
There are no mechanisms for ensuring that states are actually spending the
money on needy children rather than on state bureaucracies, or for monitoring
whether federal money is being used to help parents gain self-sufficiency,
require work, and enforce parental responsibility. Indeed, the federal
goverrunent is forbidden from taking any meaningful steps to ensure program
performance and accountability.
.
The Administration supports proposals that significantly' increase state flexibility but also
ensure accountability for achieving national goals. The Administration supports a funding
mechanism that will not put children and states' at risk down' the road,' and that enables states
to succeed in moving people from welfare'to work and in supporting working families. The
Administration has significant doubts about the ability' of a pure block grant funding
mechanism to adequately protect both children and states.
Protection of Children
The Administration recognizes that the protection of children is the primary goal both of cash
assistance programs and of child welfare and child protective services. Cash assistance
programs assist families to care for children in their. own homes. Child protection services
help those children who are abused or neglected or at risk of abuse by their parents and who
need special in-home servi~es or out of home placements to assure their safety. Strengthening
families, and where appropriate, preventing removal of children from their homes also are,
key goals of child protection services. There are problems in a number of areas.
Denial of Benefits to Children on AFDC
The legislative proposals that would refonn cash assistance have a number of provisions that
would put vulnerable children at greater risk.
5
�o
As noted above. the leg'islation would deny cash assistance to children of
unmarried minor mothers for their entire childhood, to children horn while the
parent was on welfare. and to children whose parent had received welfare for'
more than five years. whether or not a job was available or the parent was
unable to work. , The funding caps could have the effec;t of deny-ing- cash---- ---
assistance ro children when states used up their allocated funds. for whatever
reasons. Children in low incom~ working families, who may be forced onto'
cash assistance in times of eCQnomic downturn, could be most affectf!d.
Child Protection Services
Some of these children could well come into a system of child protection services that is
already seriously overburdened and that is failing to provide the most essential services.
Reported child maltreatment and out-of-home placements have both beeri increasing sharply.
Many state systems are in such distress that they have been placed under judicial oversight.
The proposed legislatiori responds to these increasingly serious problems by consolidating
existing programs that protect children into a block grant with nominal federal oversight.
'
The ,Administration has serious concerns about this approa~h.'
o
o
The proposed legislation eliminates the' adoption assistance programs. and
leaves it ,up to states whether they will significantly'sustain the subsidies that
enable many special needs children to find pennanent homes, and whether they
will honor commitments ro those adoptive families that now rec~ive subsidies.
o
The proposed legislation virtually eliminates federal monitoring and
accountability mechanisms. It makes it impossible, for the federal govermnent
to ensure the protection of children.
o
I
The proposed legislation caps spending for child protection' programs at a level
considerably lower than baseline projections. This could lead to uninvestigated
maltreatment reports, and to children being left in unsafe homes with minimal
services. It could also seriously hamper states' efforts t9 improve their child
abuse prevention and child protection systems.
The proposed legislation is silent on the 'fonnula for allocating funds to the
states. Because of serious imbalances among the states in ,spending on child
protection, it is hard to imagine a fonnula that would not disadvantage either
states that have been heavy spenders, or states that are only beginning ro
improve their systems.
Substantial improvements need to be made in the child protection system and in the federal
role in overseeing that system. The Administration'supports a careful and thoughtful review
of the programs before actions are taken that might seriously hann millions of vulnerable
children:
. '
'
6
�Denial of Benefits to Disabfed Children on SSI
The Administration is deeply troubled by the changes proposed in the program designed to
help disabled children--SSI.
o
eliminates SSI benefits for children. with
the exception of a small gr~:)Up 'of childrencurrently receiving benefits. Within
6 months, over one hundred thousand disabled children would lose eligibility
for 5SI benefits--some would lose medical protection as well. And in the
future, no child, no, matter how disabled, will be eligible for any cash benefits
for SSI, except if cash benefits prevent them from having to be
institutionalized. These proposals appear to penalize parents who are
determined to care for their child no matter what the economic ·consequences
for the family. SSIrecipients are among the neediest and most vulnerable .
children, in the poorest families.
o
Some of the money saved is put into a new block grant for services to disabled
children, which would require the creation of a new state bureaucracy to
, decide on appropriate' services. This idea is untested,. and no one knows what
impact it will have on the most vulnerable of children and the parents who
care for them. The 5-yearcut off in AFDC for all persons along with the
elimination of SSI cash for disabled children may leave these children
extremely vulnerable;
.
The~proposedlegislationessentially
.
,
'
.
. The Administration sees the need for careful reform in this area, with its potentiiil for seriou~
harm to extremely vulnerable ·children. Last year the Congress established a Commission on.
Childhood Disability to look into these issues in consultation with experts from the National
Academy of Sciences. The Commission will provide its report to, the Congress 'later this
year. . The Administration believes prudence dictates waiting for this short time until this
bipartisan commission, following a thorough review of ali aspects of this important program,
.has an opportunity to make recommendations.
Benefits to Legal Immigrants
The Administration strongly believes that illegal aliens should not be eligible for government
welfare support. But the blanket prohibition of all benefits to legal immigrants who are not.
yet citizens is too broad" and would shift substantial burdenS to state and local, taxpayers.
These legal immigrants are required to. pay taxes. Many serve in the armed forces, and
contribute to their communities. The Administration strongly favors a more .focused'
approach of holding sponSors accountable for those they bring into this country and making
the sponsors" commitment of support a legally binding contract.
7
�[n summary, the Chairman's mark espouses goals for the reform of welfare--work, parental
responsibility, prevention of teen pregnancy and state flexibility--that the Administration and,
the American people share. But the translation of general goals into specific'legislat,ion
misses the mark in fundamental ways. The proposed legislation does not represent serious
work-based reform. It does· nothing to move people from welfare to work, and it does not
'require everyone who can work go to work. It neither holds state bureaucracies accountable
nor cushions state taxpayers against recession. It puts millions of children at risk of serious
harm. There are alternative approaches to reform that achieve our mutual goals in far more
constructive and accountable ways .. "
.
. . "
The Administration reiterates its commitment to real welfare reform and its desire to work
cooperatively with Congress to achieve it.
The Office of Management and Budget advises that there is no objection to the transmittal of
this repon to Congress.
'
A 'similar' letter was sent to Representative Harold E. Ford.
~eIY·S X+1 () ()
0--(
~~.
Donna E. Shalala
, cc: Members of the Subcommittee on Human Resources
"
8
.
�THE SECRETARY OF HEALTH AI~O HUMAN SERVICES
WASt1INGTON.O.t:
.:'0]01
FEB I 3 1995
The Honorable E. Clay Shaw
Chairman. Subcommittee on Human Resources
Committee on Ways and Means
U. S. House of Represencatives
Washington D.C. 20515
Dear Mr. Chairman:
This letter expresses the Administration's views on the Chairman's mark for welfare reform
legislation under consideration by the House Ways and Means Subcommittee on Human
Resources.
The Administration shares the commitment of the Congress and the American people to real
welfare reform that emphasizes· work, parental responsibility, state flexibility, and the
protection' of children. Last year. the President submitted a bold welfare reform bill, the
Work and Responsibility Act of 1994. which embodied these values. It imposed tough work
requirements while providing opportunities for education, training, child care and suppons to
working people. It included a stringent set of child support enforcement provisions. It
required each teen mother to live at home, stay in school and identify her baby's father. It
increased state flexibility without sacrificing accountability. And it maintained a basic
structure' of protections for children.
The Administration looks forward to working cooperatively with the Congress in a bipartisan
way to pass bold welfare reform legislation this year. The Administration has, however,
serious concerns a.bout a number of features of the Chairman's mark that appear to
undermine the values to which we are all committed. The' Administration seeks to end
welfare as we know it by promoting work, family andresponsibility, not by punishing poor
children for their parents' mistakes. Welfare reform will succeed only if it successfully
moves people from welfare to work.
Work
For years, ~epublicans and Democrats alike have agreed that the, central goal of welfare
reform must be work. That is still our goal: People who can work ought to go to work and
earn a paycheck not a welfare check. The Administration believes that no adult who is able
to work should receive welfare for an unlimited time withoucworking. The Administration
believes that from the first day someone comes onto welfare, he or she should be required to
participate in job s~arch, job placement, education, or training needed to move off welfare
and into a job quickly. It is governrt:lent's responsibility to help ensure that the critical job
placement, training, and child care services are provided. Individuals who are willing to
work should have the opportunity to work and not be arbitrarily cut off assistance.
�The Administration therefore has serious concerns about the Chairman's .mark before you:
o
It eliminates reqLiirements that recipients participate in job sear:ch, education,
work or training as a conditio~ of receiving welfare, and ends any
responsibil tty of state welfare systems to provide education, training and ..
placement services to move recipients from welfare to work. The proposyd
legislation effectively repeals the bipartisan Family Support Act signed by
President Ronald Reagan in 1988.
o
The proposed legislation includes only minimal and unenforceable
requirements that recipients work. The bill requires only that persons on the
rolls formore than 2 years engage in "work activities" loosely defined by the
state welfare bureaucracy, rather than a real work requirement. The proposed
participation standards are very low. In many ways, the work requirements
.
are even weaker than those in current law.
o
The proposed legislation provides no assurance of child care t~ recipientS who
work or are preparing to work--even if a state requires them.to participate. It
offers no promise of child care for those who leave welfare for work or for
those who could avoid falling onto welfare if they had some help with child
care. While it repeals provisions of existing law that provide funding for child
care, this bill is silent on whether any additional funds will be available for
subsidized·child care for low income working· families.
o
The proposed legislation repeals the current rule that anyone who leaves
welfare for work can receive Medicaid for an additional year to ease the
transition. This would further reduce health care coverage anq make i~ harder
.
for people to move from welfare to work.
o
The proposed legislation would deny all cash assistance to families that have .
received assistance for more than five years·, even if the adult in the family is
unable to find a job· or prevented from holding a job because of illness or the -.- .
need to care for a disabled family member. . Children would be seriously
jeopardized even if their parents cannot find any work.
The Administration supports an alternative approach that would genuinely transform the
welfare system into a transitional system focused on work. It would have strict requirements
for recipients to participate in and clear responsibilities for states to provide education,
training and placement assistance; it would have serious time limits after which work would
be required; it would ensure that children would not be left alone when pare{1ts were working
by providing assistance for child care; it would put parents to work, not just cut them off;
and it would ensure that children can expect support from two parents.
.'
2
�Parental Responsibility
The Administration believes that, welfare reform should recognize the responsibility, and
encourage the involvement of both parents in their children's lives. The Administration
considers child support enforcement to be an integral pan of welfare reform, particularly
because it sends a strong message to young people about the responsibility of both parents to
support their children,. The Administration was pleased that you had agreed to add child
support enforcement [Q your welfare reform bill, and 'sorry that your proposals are not yet
part of the bill now under consideration. The Administration looks forward to working
closely with you on this issue in the coming ~eeks.
o
The only child support provision included in the Chainnan's mark is one that
allows states to reduce payments to .childr~n for the first 6 months if paternity
has not been legally established; This provision seems ineffectual and unfair.
Even if a mother fully cooperates by giving detailed infonnation identifying
the father and his possible location, and even if the state is diligent in pursuing
the father, it can easily take 6 months to get paternity legally established.
There is no reason why the child should be punished during this period.
The Administration believes that it makes far more sense to deny benefits entirely to any
parent who refuses to identify the father or to cooperate in locating him. However, once the
mother has done 'all she can, the family should qualify for aid, and then the state should
establish paternity within one year.
The Administration believes that, the welfare system should encourage the fonnation and
support of two-parent families., The Administration is therefore concerned about an
important omission in the proposed legislatiori:
o
The proposed legislation would encourage the break-up of families by
repealing the requirement that states provide 'cash assistance to two-parent
families in which a parent is unemployed or unable to work. It allows states
to discriminate against married, two-parent families by treating single-parent
families better than two-parent fa~ilies.
'
The Administration supports an approach that both encourages the fonnation of two'-paren,t
families and makes sure that both parents take responsibility for children ih all cases.
, Teen Pregnancy
The Administration and the American people agree that the best refonn of welfare would . be
to ensure that people do not need it in the first place. Welfare refonn must send a very
strong message to young people that they should not get pregnant or father a child until they
are ready and able to care for that child, and that" if they do have children, [hey will not be
3.
�able to escape the obligations and responsibilities of parenthood. We must be especially
concerned about the well-being of the children who are born (0 young mothers, since they
are very likely to grow up poor.
The Administration therefore has serioiisc6ncernsatiou( the biU'beforeyou:
o
The proposed legislation ,Would de'ny all federal cash benefits for eighteen
years to any child born to an unmarried mother under 18, as well as to the
'parent. This provision appears to punish children for their entire childhood~18 years--for the'mistakes of their parents.
o
The proposed legislation does not require that teen mothers live at home, stay
,'in school, and identify the child's father. It weakens requirements in current
law, and may make the prospects for mother and child even worse.
o
The proposed legislation establishes only minimal expectations for states (0
provide services to 'unmarried parents, and· provides no additional· funds to
support them.
The Administration supports an alternative approach that would require minor mothers to live
at home, stay in school, make progress toward self-sufficiency, and identify the father of the
child. The Administration also supports a national campaign to prevent teen pregnancy. It is
time to enlist parents and civic, religious, and business leaders in a community based strategy
to send a clear message about abstinence and responsible parenting. The Administration also
supports a state option not to increase benetits for children born to mothers on welfare. This
decision should be made by the state, not the federal government.
State Flexibility with Accountability
The Administration embraces the creativity and responsiveness of states, and the
opportunities for real reform when states have thti'tlexibility to design and administer welfare
programs tailored to their unique circum~tancesand needs. Already this Administration has
granted, waivers to nearly half the states for welfare refonndemonstrations. National welfare
reform should embody the values of work and responsibility in a way that assures taxpayers
that federal money is being spent prudently and appropriately. For reform to succeed, the
funding mechanisms for welfare should not put children or states at risk in times of
recession, population increase or unpredictable growth in demand.
r
In this context, the Administration has serious concerns about the proposed legislation:
o
The spending cap in the proposed legislation makes no allowances for potential
growth in the need for cash assistance because of economic downturn, .
population growth, or unpredictable emergencies. It could result in states
4
�running our of money before the end of the year. and thus having to turn away'
working families wh'o hit a "bump in the road" and apply for short-term
assistance. It could preclude states from investing in job placement. in work
programs, in education and training, and in supports for working families.
o
The pr.oposed legislation removes the requirement that states match federal '
funds 'with their own state funds. With none of their own money at risk, states
will have many fewer incentives to 'spend the funds efficiently and effectively
to improve performance and increase ·self-sufficiency.
o
The proposed legislation provides virtually. no accountability. There are no
incentives for good performance and virtually no penalties for failure. There is
no provision for the recovery of monies paid out fraudulently or in error.
There are no mechanisms for ensuring that states are actually spending the
money on needy children rather than on state bureaucracies. or for monitoring
whether federal money is being used to help parents gain self-sufficiency,
require work, and enforce parental responsibility. Indeed, the federal .
government is forbidden from taking any meaningful steps to ensure program
performance and accountability.
.
The Administration supports proposals that significantly increase state flexibility but also
ensure accountability for achieving national goals .. The Administration supports a funding
mechanism that will not put children and states at risk .down the road. and that enables states
to succeed in moving people from welfare to work and in supporting working families. T~e
Administration has significant doubts about the ability of a pure block grant funding
mechanism to adequately protect both children and states ..
Protection of Children'
The Administration recognizes that the protection of children is the primary goal both of cash
assistance programs and of child. welfare and child protective servic.es. Cash-assistance·
programs assist families to care for children in their. own homes. Child protection services
help those children who are abused or neglected or at risk of abuse by their' parents and who
need special in-home services or out of home placements to assure their safety. Strengthening
families, and where appropriate. preventing removal of children from their homes also are,
key goals of child protection services. There are problems in a number of areas.
Denial of Benefits to Children on AFDC
The legislative proposals that would reform cash assistance have a number of provisions that
would put vulnerable children at .greater risk.
5
�o
As noted above, the legislation would deny cash assistance to'children of
unmarried minor mothers for their entire childhood, to children horn while the
parent was on welfare, and to children whose parent had received welfare for
more than five years. whether or not a job was available or the parent was
'unable to' work~" The funding caps could have the effect of denying cash
assistance to children when states used up their allocated funds. for whatever
reasons. Children in low income working families, who may be forced onto
cash assistance in times of economic downturn, could be most affected.
Child Protection Services
Some of these children could well come into a system of child protection services that is
already seriously overburdened and that is failing to provide the most essential services.
Reported child maltreatment and out-oI-home placements have both been increasing sharply.
Many state systems are in such distress that they have been placed under judicial oversight.
The proposed legislation responds to these increasingly serious problems by consolidating
existing programs that protect children into a block grant with nominal federal oversight.
The Administration has serious concerns about ,this approach.
o
The proposed legislation caps spending for child protection programs at a level
considerably lower than baseline projections. , This could lead to uninvestigated
maltreatment reports, and to children being left in unsafe homes with minimal
services. It could also seriously hamper states' efforts to improve their-child
abuse prevention and child protection systems.
o
The proposed legislation eliminates the adoption assistance programs, and
leaves it ,up to states whether they will significantly sustain the subsidies that
enable many special needs children to find permanent homes, and, whether they
will honor commitments to those adoptive families that now receive subsidies.
o
The proposed legislation virtually eliminates .federal monitoring' and
accountability mechanisms. It makes it impossible for the federal government
to ensure the protection of children.
o
The proposed legislation is silent on the formula for allocating funds to the
states. Because of serious imbalances among the states in spending on child. '
protection, it is hard to imagine a formula that would not disadvantage either
states that have been heavy spenders, or states that are only beginning to
improve their systems.
Substantial improvements need to be made in the child protection system and in the federal
role in overseeing that system. The Administration supports a careful and thoughtful review
ofthe 'programs before actions are taken that might seriously harm millions of vulnerable
children.
6
�Denial of Benefits to Disabled Children on SSI
The Administration is deeply troubled by the changes proposed in the program designed to
help disabledchildren--SSI. .
.
o
o
The proposed legislation essentially eliminates 'SSI benefits for children. with.
the exception of a small group of children currently receiving benefits. Within
6 months, over one hundred thousand disabled children would lose eligibility
for SSI benefits--some would lose medical protection as welL And in the
future, no child, no matter .how disabled, will be eligible for any cash benefits
forSSI, except if cash benefits prevent them from having to be
institutionalized. These proposals appear to penalize parents who are
determined to care for their child no matter what the economic consequences
for the family. SSI recipients are among the neediest and most vulnerable
children, in the poorest families ..
Some of the money saved is put into a new block grant for services to disabled
children, which would require the creation of a new state bureaucracy to
decide on appropriate services. This idea is. untested, and no one knows what
impact it. will have on the most vulnerable of children and the parents who'
care for them. The 5-year cut off in AFDC for all persons along with the
. elimination of SSI cash for disabled children may leave these children
extremely vulnerable. .
. The Administration sees the need for careful reform in this area, with its potential for serious
harm to extremely vulnerable children. Last .year the Congress established a Commission on
Childhood Disability to look into these issues in consultation with experts from' the National'
Academy of Sciences. The Commission will provide its report to the Congress later this
year. The Administration believes prudence dictates waiting for this shorttime until this
bipartisan commission, following a thorough review of all aspects of this important program.
has an opportUnity to make recommendations.
Benefits to Legal Immigrants
The Administration strongly believ.es that illegal aliens should not be eligible for government
welfare support. But the blanket prohibition of all benefits to legal immigrants who are not
yet citizens is too broad, and would shift substantial burdens to state and local taxpayers.
These legal immigrants are required to pay taxes. Many serve in the armed forces, and
contribute to their communities. The Administration strongly favors a ~ore focused
approach of holding sponsors aCGountable for those they bring into this country and making
the sponsors'· commitment of support a legally binding contract.
7
�[n summary, the Chairman's mark espouses goals for the reform of welfare--work, parental
responsibility, prevention of teen pregnancy and state tlexibility--that the Administration and
the American people share. But the translation of general goals into specific legislation
misses the mark in fundamenta:I ways. The proposed legislation does not represent serious
work-based reform. It does nothing to move people from welfare to work, an.d it does not
require everyone who can work go to work. It.neither holds state bureaucracies accountable
nor cushions s~ate taxpayers against recession. It puts millions of children at risk of serious
. harm. There are alternative approaches to reform [hat achieve our mutual goals in far more
constructive and accountable ways ...
The Administration reiterates its commitment to real welfare reform and its desire to work.
,cooperatively with Congress to achieve it.
.
.
The Office of Management and. Budget advises that there is no objectionro the transmittal of
this report to Congress.
A similar letter was sent to Representative Harold E. Ford.
Donna
E: Shalala
(
cc: Members of the Subcommittee on Human
R~sources
8
�
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https://clinton.presidentiallibraries.us/files/original/13de90e4a27e0bcad8f94166e69c1ee3.pdf
b33e3b14fdc81bb7c17bd72532569f6d
PDF Text
Text
THE SECRETARYOF HEALTH AND HUMAN SERVICES
WASHINGTON. D.C.
20201
FEB I 3 1995
'The Honorable·E. "Clay Shaw
Chairman, Subcommittee on Human Resources
Committee on Ways and-Means
U.S.' House of Representatives
Washington D.C. 20515
Dear Mr. Chairman:
This letter expresses the Administration's views on the Chairman's mark for welfare reform
legislation under consideration by the House Ways and Means Subcommittee on Human
Resources.
The Administration shares the commitment of the Congress and the American people to real
welfare reform that emphasizes work, parental responsibility, state flexibility, and the
protection of children. Last year, the President submitted a bold welfare reform bill, the
Work and ResponsibilitY'Act of 1994, which embodied these values. It imposed tough work
requirements while providing opportunities for education, training, child care and .supports to
working people. It included a stringent set of child support enforcement provisions. It
required each teen mother to live at home, stay in school and identify her baby's father. It
increased state flexibility without sacrificing accountability. And it maintained a basic .
structure of protections for children ..
The Administration looks forward to working cooperatively with th~ Congress in a bipartisan
way to pass bold welfare reform legislation this year. The Administration has, however,
serious concerns about a number of features of the Chairman's mark that appear to
undermine the values to which we are all committed. The Administration seeks to end
.
welfare as we know it by promoting work, family and responsibility, not by punishing poor
children for their" parents' mistakes. Welfare reform will succeed only if it ,successfully
moves people from welfare to' work ..
~
.
.
Work
For years, Republicans and Democrats alike have agreed that the. central goal of welfare
reform must be work. That is still our goal: People who can work ought to go to work and
earn a paycheck not a welfare check. The Administration believes that no adult who is able
to work should rec~ive welfare for an unlimited time without working. The Administration
believes that from the first day someone comes onto welfare, he or she should be required to
participate in job search, job placement, education, or training needed to move off welfare .
and into a job quickly. It is government's responsibility to help ensure that the critical job
placement, training, and child care services are provided. Individuals who are willing to
work.should have the opportunity to work and not be arbitrarily cut off assistance.
�. The Adni'inistration therefore has serious concerns about the Chairman's .mark before you:
. .
"
,
o
It eliminates requirements that recipients participatcin job search, education,.
work or training as a condition of receiving welfare, and ends any'
responsibility ofstate welfare systems'to provide education, training and
placement services to move recipients from welfare to work. The proposed
legislation effectively repeals the bipanisan Family Support Act signed by
President Ronald Reagan in 1988.
o
The proposed legislation includes only minimal and unenforceable
requirements that recipients work. The bill requires only that persons on the
rolls for more than 2 years engage in "workactivities" loosely defined by the
state welfare bureaucracy, rather than a real work requirement. The proposed
participation standards are very low. In many ways, the work requirements
are even weaker than those in current law.
o
The proposed legislation provides no assurance of child care to recipients who
work or are preparing to work--even if a state requires them to participate. It
offer~ no promise of child care for those who leave welfare for work or for
those who could avoid falling onto welfare if they had some help with child
care. While. it repeals provisions of existing law that provide funding for child
. care, this bill is silent on whether any additional funds will be available for
subsidized child care for low income working families.' ,
0,
The proposed legislation repeals the current rule that anyone who leaves
welfare for work can receive Medicaid for an additional year to ease the'
transition. This would further reduce health care coverage and make it harder
for people to move from welfare to work.
o
The proposed legislation would deny all cash assistance to families that have'
received assistance for more than five years, even if the adult in the family is .
unable to find a job or prevented from holding a job 'because of illness or the
need to care for a disabled family member .. Children would be seriously
jeopardized even if their parents cannot find any work.
The Administration supports an alternative approach that would genuinely transform the
welfare' system into a transitional system focused on work. It would have strict requirements
for recipients to participate in and clear responsibilities for states to provide education,
training and placement assistance; it would have serious time limits after which work would
be required; it would ensure that children would not be left alone when parents were working
by providing assistance for child care; it would put parents to work, not just cut them off;
. and it would ensure that children can expect support from two parents.
2
�Parental Responsibility.
The Administration believes that welfare refo~m should recognize the responsibility and
encourage the involvement of both parents in their children's lives. The Administration
considers child support enforcement to be an integral part of welfare reform, particularly
because it ,sends a strong message to young people about .the responsibility of both parents to
support their children. ' The Administration was pleased that you had agreed to add child,
support enforcement to your welfare reform bill, and sorry that your proposals are not yet
part of the bill, now under consideration. 'The Administration looks forward to working
'
closely with you on this issue in the coming weeks."
o
The only child support provision included in the Chairman's mark is one that
allows states to reduce payments to children for the first 6 months if paternity
has not .been legally established. This provision seems ineffectual and unfair.
Even if a mother fully cooperates by giving' detailed information identifying
the father and his possible location, and even if the state is diligent in pursuing
the father, it can easily take 6 months to get paternity legally established.
There is no reason whyihe child should be punished 'during this period.
The Administration believes' that it makes far more sense to deny benefits entirely to any,
parent who refuses to identify the father or to cooperate in locating him. However, once the
mother has done all she can, the family should qualify for aid, and then the st~l.te should
establish paternity within one year.
'
The Administration believes that the welfare system should encourage the formation and
support of two-paren~ families. The Administration is therefore concerned about an
important omission in the proposed legislation: '
o ,The proposed legislation would encourage the break-up of families by
repealing the requirement that states provide cash assistance to two-parent
families in which a parent is unemployed or unable to work. It allows states
to-discdminate against married, two-parent families 'by treating single-parent
families better than two-parent families.
The Administration supports an approach that both encourages the fOmlation of two-parent
families and makes sure that both parents take responsibility for children in aU cases.
Teen Pregnancy
The Administration and the American people agree that the best reform of welfare would be
to ensure that people do not need it in the first place. 'Welfare reform must send a very
strong message to young people that they should qot get pregnant or fatner a child until they
are ready and able to care for that child, and that if they do have children, they will not be
3
�able (0 escape the:: obligations and responsibilities of parenthood. We must be especially
concerned about the well-being of the children who ;ue born to young mothers, since they
are very likely to grow up poor.
The' Administration therefore has serious concerns about .the bill before you:
o
The proposed legislation would deny all federal cash benefits for eighteen
y'earsto any child born to an 'unmarried mother under 18, as well as to the
parent. This provision appears to punish children for their entire childhood-
18 years--for the mistakes of their parents.
.
o
The proposed legislation does not require that teen mothers live at home, stay
in school, and identify the child's father. It weakens requirements in current
law, and may make the prospects for mother and child even worse.
o
The proposed legislation establishes only minimal expectations for states to
provide services to unmarried parents, and provides no additional funds to
support them. '
The Administration supports an alternative approach that would require minor mothers to live
at home, stay in school, make progress toward self-sufficiency, and identify the father of the
child. The Administration also supports a national campaign to prevent teen pregnancy. It is
time to enlist parents and civic, religious, and business leaders in a community based strategy
to send a clear message about abstinence and responsible parenting. The Administration also.
supports a state option 'not to increase benefits for children born to mothers on welfare. This"
decision should be made by the state, not the federal government.
State Flexibility with Accountability
The Administration embraces the creativity and responsiveness of states, and the
opponuruties for reai reform when states have the flexibility to design and administer welfare
programs tailored to their unique circumstances.and needs. Already this Administration has
granted waivers to nearly half the states for welfare refonn demonstrations. National welfare·
reform should embody the values of work and responsibility in a way that assures taxpayers
that federal money is being spent prudently and appropriately. For reform to succeed, the
funding mechanisms for welfare should not put children or states at risk in times of
recession, popUlation in<;:rease or unpredictable growth in demand.,
In this context, the Administration has serious concerns about the proposed legislation:
o
The spending cap in the proposed legislation makes no allowances for potential
growth in the need for cash assistance because of economic downturn,
population growth, or unpredictable emergencies. It could result in states
4
�running our of money before the end of the year. and thus having to turn away
working families who hit a "bump in the road" and apply for short-term
assistance. It could preclude Slates from investing in job placement, .lfl work
programs. in education and training. and in supports for working famities.
o
The proposed legislation remo":.es the requirement that states match federal
funds with their own state funds. With none of their own money at risk. states
will have many fewer incentives to spend the funds efficiently and effectively
to improve performance and increase ·self-sufficiency.
o
The proposed legislation provides virtually no accountability. There are no
incentives for good performance and virtually no penalties for failure. There is
no provision for the recovery of monies paid out fraudulently or inerror.
There are no mechanisms for ensuring that states are acrually spending the
money on needy children rather than onstate bureaucracies, or for monitoring
whether federal money is being used to help parents gain self-sufficiency.
require work, and enforce parental responsibility. Indeed, the federal
government is forbidden from taking any meaningful steps to ensure program
performance and accountability.
.
The Administration supports proposals that significantly increase state flexibility bur also
ensure accountability for achieving national goals. The Administration supports a fundi.ng
mechanism that will not put children and states at risk down the road, and that enables states
to succeed in moving people fromwelfate to work and in supporting working families. The
Administration has significant doubts about the ability of a pure block grant funding
mechanism to adequately protect both children and states ..
Protection of Children
The Administration recognizes that the protection of children is the primary goal both of cash
assistance ptograms -and of child· welfare and child protective services. ·tash assistance
programs assist families to care for children in their own homes. Child protection services
. help those. children who are abused or neglected or at risk of abuse by their parents and who
need special in-home services or out of home placements to assure their safety. Strengthening
families, and where appropriate, preventing removal of children from their homes also are,
key goals of child protection services. There are problems in a number of areas.
.
Denial of Benefits to Children on AFDC
The legislative proposals that would reform cash assistance have a number of provisions that
would put vulnerable children at greater risk.
5
�o.
. As noted above. the legislation would deny cash assistance. to children of
unmarried minor mothers for their entire childhood. to children horn while the
parent was on welfare, and to children whose parent had received welfare for
more than five years, whether or not a job was available or the parent was
unable to work. The funding caps could have the effect of -denying cash
assistance to children when states used up their allocated funds. for whatever
reasons. Children in low income working f(!,miiies, who may be forced onto
cash assistance in times of economic downturn, co~ld be most affected.
;
. Child Protection Services
Some of these children could well come into a system of child protection services 'that is
already seriously overburdened and that is failing to provide the most essential services.
Reponed child maltreatment and out-of-home placements have both been increasing sharply.
Many state systems are in such distress that they have been placed under judicial oversight.
The proposed legislation responds to these increasingly serious problems by consolidating
exislingprograms that protect children into a block grant with nominal federal oversight.
The Administration has serious concerns about this approach~
o
The proposed legislation caps spending for child protection programs at a'level
considerably lower than baseline projections: This could lead to uninvestigated
maltreatment reports, and to children being left in unsafe homes with minimal
services. It could also seriously hamper states' efforts to improve their child
abuse prevention and child protection systems.
o
The proposed legislation eliminates the adoption assistance programs. and
leaves it ·up to states whether they will significantly sustain the subsidies that
enable many special needs children to find pennanent homes, and whether they
will honor commitments to those adoptive families that now receive subsidies.
o
The proposed legislation vinually eliminates federal monitoring and
accountability mechanisms. It makes it impossible for the federal government
.
to ensure the protection of children.
o
The proposed legislation is silent on the fonnula, for allocating funds to the
states. Because of serious imbalances among the- states.in spending on child
protection, it is hard'to imagine, a fonnula that would 'not disadvantage either
states that have been heavy spenders, or states that are only beginning to
improve their systems.
.
Substantial improvements need to be made in the child protection system and in the federal
role in overseeing 'that system. The Administration supports a careful and thoughtful review
of the programs before actions are taken that might seriously hann millions of vulnerable
children.
6
�Denial of Benefits to Disabled Children on 55I
The Administration is deeply troubled by the changes proposed in the program designed to
help disabled children--5Sl.
u
o
the proposedlegisiation esSentially eliminates 5S1 benefits for children.· with
the exception of a small group of children currently receiving benefits. Within
6 months, over one hundred thousand disabled children would lose eligibility
for SSI benefits--some would lose medical protection as well. And in the
future, no child, no matter how disabled, will be eligible for any cash benefits
for SSI, except if cash benefits prevent them from having to be
institutionalized. These proposals appear to penalize parents who are
determined to care for their child no matter what the economic consequences
for the family. SSI recipients .are among the neediest and most vulnerable "
children, in the poorest families:
Some of the money saved is put into a new block grant for services to disabled·
children, which would require the creation of a new state bureaucracy to
decide on appropriate services. This idea is untested, and no one knows what
impact it will have on the most vulnerable ·of children and the parents who
care for them. The 5-year cut off in AFDC for all persons along with the
elimination of SSI cash for disabled children may leave these children
extremely 'vulnerable.
.
. The Administration sees the need for careful reform in this area, with its potential for serious
harm to extremely vulnerable children. Last year the Congress established a Commission on
Childhood Disability to look into these issues in consultation with experts from the National
Academy of SCiences. The Commission will provide its report to the Congress later this
year. The Administration believes prudence dictates. waiting for this short time until this
bipartisan commission, following a thorough review of all aspects of this important program,
has an opportunity to make recommendations.
Benefits to Legal Immigrants
The Administration strongly believes that illegal aliens should not be eligible for government
welfare support. But the blanket prohibition of all benefits to legal immigrants who are not
yet citizens is too broad, and would shift substantial burdens to state and local taxpayers.
These legal immigrants are required to pay taxes. Many serve in the armed forces, and
contribute to their communities. The Administration strongly favors a more focused
approach of holding sponsors accountable for those they bring into this country and making
the sponsors' commitment of support a legally binding contract.
.
7
':,./
�In summary, the Chairman's mark espouses goals for the reform of welfare--work, parental
responsibility, prevention orteen pregnancy and state tlexibility--that the Administration and
the American people share. But the translation of general goals into specific legislation
misses the mark' in fundamental ways. The proposed legislation does not. represent serious
work-based reform. It·dGes nothing to move people from welfare to work, and it does not
require everyone who can work go to work. It neither holds state bureaucracies accountable
nor cushions state taxpayers against recession. It puts millions of children at risk of serious
harm. There are alternative approaches to reform thal achieve our mutual goals in far more
constructive and accountable ways .
.The Administration reiterates its commitment to real welfare reform and its· desire to work.
cooperatively with Congress to achieve it.
The Office.of Management and Budget advises that. there is no objection (0 the transmittal of .
. this repon to Congress.
A similar letter was sent to Representative Harold E. Ford.
~relY'S?' ~ () (} '. .
~
.~.~
.
Donna E. Shalala
cc: Members of the Subcommittee on Human Resources
8
- - ..
- - - - - - ' - - - - -..
-.~
.
�THESECRErARY OF HEALrH AI~O HUMAN SERVICES
WASt·HNGTON,O.C
20201
FEB I 3 1995
The Honorable E. C1aY'Shaw ...... .
Chairman, Subcommittee on Human Resources
Committee on Ways and Means'
U.S. House of Representatives
Washington D.C. 20515
Dear Mr. Chairman:
This letter expresses the Administration's views on the Chairman's mark for welfare reform
legislation under consideration by the House Ways and Means Subcommittee on Human
Resources.
The Administration shares. th~ commitment of the Congress and the American people to real
welfare reform that emphasizes work, parental responsibility, state flexibility, and the
protection of children. Last year, the President submitted a b<;>ld.. welfare reform bill, the
Work and Responsibility Act of 1994, which embodied these values. It imposed tough work
requirements while providing opportunities for education, training, child care and supports to
working people. It included a stringent set of child support enforcement provisions. It
required each teen mother to live at home; stay in school and identify her baby's father. It
increased state flexibility without sacrificing accountability.· And it maintained a basic
structure of protections for children ..
The Administration looks forward to working cooperatively with. the Congress in a bipartisan .
way to pass bold welfare reform legislation this year. The Administration has, however,
serious concerns about a number of features of the Chairman's mark that appear to
undermine the values to which we are all coIrimitted. The Administration seeks to end
welfare as we know it by promoting work, family and responsibility. not by punishing poor
children for their parents' mistakes. 'Welfare reform will succeed only if it successfully
moves people from welfare to work.
C
Work
For years, Republicans and Democrats atike have agreed that the. central goal of welfare
reform must be work. That is still our goal: People who can work ought to go to work and
earn a paycheck not a welfare check. The Administration believes that no adult who is able
to work should receive welfare for an unlimited time without working. The Administration
believes that from the first day someone comes onto welfare, he or she should be required to
.participate in job search. job placement, education, or training needed lO move off welfare
and into a job quickly. It is government's responsibility to help ensure that the critical job
placement, training. and child care services are provided .. Individuals. who are willing to
work should have the opportunity to work and not be arbitrarily cut off .assistance.
.
.
.
�.' he Administration therefore has serious concerns about the 'Chairman's ,mark before you:
T
o
o
It eliminates requirements that recipients participate in job search, education,
work or training as a condition of receiving welfare, and ends any
responsibility of state welfare systems 'to provide education, training and
placement services to move recipients from welfare to work. The proposed
legislation effectively repeals the bipartisan Family Support Act signed by
President Ronald Reagan in 1988.
The proposed legislation includes only minimal and unenforceable
requirements that recipients work. The bill requires only that persons on the
rolls for more than 2 years engage in .. work activities" loosely defined by the
, state welfare bureaucracy, rather than a real work requirement. The proposed'
participation standards are very low. In many ways, the work requirements
are even weaker than those in current law ..
o " The proposed legislation provides no assurance of child care to recipients who
work or are preparing to work--even if a state requires them to participate. It
offers no promise of child care for those who leave welfare for work or for
those who could avoid falling onto welfare if they had some help with child
care. While it repeals provisions of existing law that provide funding for child
care, this bill is silent on whether any additional funds will be available for
subsidized child care for low income working families.
o
The proposed legislation repeals the current rule that anyone who leaves
welfare for work can 'receive Medicaid for an additional year to ease the
transition. This would further reduce health care coverage and make it harder
for people to move from welfare to w·ork.
o . The proposed legislation would d.~ny all cash assistance to families that have
received assistance for more than five years, even if the adult in the family is
unable to find a job' or prevented from holding a job because of illness or the
need to care for a disabled family member. Children would be seriously
jeopardized even if their parents cannot find any work.
The Administration supports an alternative approach that would genuinely'transfonn the
welfare system into a transitional system focused on work.,' It would have strict requirements
for recipients to participate in and clear responsibilities for states to provide education,
training and placement assistance; it would have serious, time limits after which work would
be required; it would ensure that children would not be left alone, when parents were working
by providing assistance for child care; it would put parents to work. not just cut them off;
and it would ensure that children can expect support from two parents.
2
�Parental Responsibility
.. .
..
The Administration believes that welfare reform should recognize the responsibility and
encourage the involvement of both parents in their children's lives. The Administration
considers child support enforcement to be an integral part of welfare reform, particularly
because it sends a strong message to young people. about the responsibility of both parents to
support their children. The Administration was pleased that you had agreed to add child
support enforcement to your welfare reform bill,. and sorry that your proposals are Qot yet
part of the bill now under consideration. The Administration looks forward to working
closely with you on this issue in the coming weeks.
.
.
o
.The only child support provision included in the Chairman's mark is one that
allows states to reduce payments to children for the first 6 months if paternity
has not been legally establjshed. This provision seems ineffectual and unfair.
Even if a mother fully cooperates by giving detailed information identifying
the father and his possible location, and even if the state is diligent in pursuing
the father, it can easily take 6 months to get paternity legally established. .
There is no reason why the child should be punished during this period .
. The Administration believes that it makes far more sense to deny benefits entirely to any
parent who refuses to identify the father or to cooperate in locating him. However, once the
mother has done all she can, the family should qualify for aid, and then the state should
establish paternity within one year.
The Administration believes that the welfare system should encourage the formation and
support of two-parent families. The Administration is therefore concerned about an
important omission in· the proposed legislation: .
o . The proposed legislation would encourage the break-up of families by
repealing the requirement that states provide cash a$sistance to two-parent .
families in which a parent is unemployed or unable to work. It allows suites
. to discriminate againSt married-, two-parent families by treating single-parent
. families better than two-parent families.
The Administration supports an approach that both encourages the formation of two-parent
families and makes .sure that both parents take responsibility for children .n all cases.
.
. Teen Pregnancy
The Administration and the American people agree that the best reform of welfare would be
to ensure that people do not need it in the first place.. Welfare reform must send a very
strong message to young people that they should not get pregnant or father a child until they
are ready and able to care for that child, and that if they do have children, they will not be
3
�able to escape the obligations and responsibilities of parenthood. We must be especially
concerned about the well-being of the children who are born to young mothers, since they
are very likely to groW up pOOL
'
The Administration therefore has serious concerns about the bill before you:
,0
The proposed legislation would deny all federal cash benefits for eighteen
years to any child born to an unmarried mother under 18, as well as to the
,parent. This provision appears to punish children for their entire childhood-
18 years--for the mistakes of their parents.
o
The proposed legislation does not require that teen mothers live at home, stay
in school, and identify the child'sfather. It weakens requirements in current
law, and may make the prospects for motherand child even worse.
o
The proposed legislation establishes only minimal expectations for states to
provide services t() unmarried parents, and provides no additional funds to
support them.
The Administration supports an alternative approach that would require minor mothers to live
'at home, stay in school, make progress toward self-sufficiency, and identify the father of the
child. The Administration also sup'ports a national campaign to prevent teen pregnancy. It is
time to enlist parents and civic, religious, and'business leaders in a cotnmunity based strategy
to send a clear message about abstinence and responsible parenting. ' The Administration also
supports a state option not to increase benefits for children born to mothers on welfare. This
decision should be! made' by the state, not the federal government.
State Flexibility with Accountability
The Administration embraces the creativity and responsiveness of states, and the
opportunities for real reform when states' have the flexibility to design and administer welfare
programs tailored to their unique circumstances and needs. Already this Administration has
granted, waivers to nearly half the states for welfare reform demonstrations. National welfare
refonn should embody the values of work, and responsibility in a way that assures taxpayers
that federal money is being spent prudently and appropriately. For refonn to'succeed, the
funding mechanisms for welfare should not put children or states, at risk in times of
recession, population increase' or unpredictable growth in demand.
In this context, the Administration has serious concerns about the proposed legislation:
o
The spending cap in the proposed legislation makes no allowances for potential
, growth in the need for cash assistance because of economic downturn.
population growth, or unpredictable emergencies. It could result in states
4
�running out of money before the end of the year. and thus having to rurnaway
working families who hit a "bump in the road" and apply for short-term .
assistance. [t could preclude states from investing in job placement, in work
prog:~ms, in education and training, and in SUPpOrlS for working families.
o
The proposed legislation removes' the requirement that states match federal
funds with their own state funds. With none of their own money at risk. states
will have many fewer incentives to spend the funds efficiently and effectively
to improve performance and increase 'self-sufficiency,
o
The proposed legislation provides virtually no accountability. There are no
incentives for good performance and virtually no penalties for failure. Ther~ is
no provision for the recovery of monies paid out fraudulently or in errOL
There are n'o mechanisms for ensuring that states are actually spending the .
money on needy children, rather than on state bureaucracies, or for monitoring
, whether federal money is being used to help parents gain self-sufficiency,
require work, and enforce parental responsibility., . Indeed, the federal
government is forbidden from taking any meaningful steps to ensure program
performance and accountability. ,
.
The Administration supports proposals that significantly increase state flexibility but also
ensure accountability for achieving national goals. The Administration supports a funding.
mechanism that will not put children and states at risk down the road, and that enables states
to succeed in moving people from welfare to work and in supporting working families. The
Administration has significant doubts about the ability of a pure block grant funding
mechanism to adequately protect both children and states ..
.
\
Protection of Children
. The Administration recognizes thai the protection of children is the primary goal both of cash
assistanc~ programs and of child welfare and 'child ~protective services. Cash assistance
programs assist families to care for children' in their. own homes.' Child protection services
help those children who are abused or neglected or at risk of abuse by their parents and who . ,
need special in-home services or out of home placements to assure their safety. Strengthening
families, and where appropriate, preventing removal of children from their homes also are,
key goals of child protection services. There are problems ina number of areas.
Denial of Benefits to Children on AFDC
The legislative proposals that would reform cash assistance have a number of provisions that
would put vulnerable children at greater risk.
5
�o
I
As noted above, the legislation would deny cash assistance to children of
. unmarried minor mothers for"their entire childhood, to children horn while the
parent was on welfare, and to children whose parent had received welfare for
more than five years, whether or not a job was available or the parent \yas .
unable to work. The funding caps could have the effect of denying cash ..." .'-' .,..
assistance to children when states used up their allocated funds. for whatever
reasons. Children in low inq)me working families, who may be forced onto
. cash assistance in times of economic downturn, could be most affected.
Child Protection Services
Some of these children could, well come into a system of child protection services that is
already seriously overburdened and that is failing to provide the most essential services.
Reported child maltreatment and out-of-home placements have both been increasing sharply.
Many state systems are in such distress that they have been placed under judicial oversight.
The proposed legislation responds to these increasingly serious problems by corisolidating
existing programs that protect children into a block grant with nominal. federal oversight.
The Administration has serious concerns about this approach.
o
The proposed legislation caps spending for child protection programs at a level
considerably lower tlJan baseline projections. This could lead to uninvestigated .
maltreatment reports, and to children being left in unsafe homes with minimal
services. It could also seriously hamper states' efforts to improve their child
abuse prevention and child protection systems.
o
The proposed legislation eliminates the adoption assistance programs, and
leaves it ·up to states whether they will significantly sustain the subsidies that
enable many special needs children to ·find pennanent homes, and whether they
will honor commitments to those adoptive families that now receive subsidies.
o
The proposed legislation virtually eliminates federal monitoring and
accountability mechanisms. It makes it impossible for the federal government
to ensure the protection of children.
o
The proposed legislation is silent on the fonnula for allocating funds to the
states. Because of serious imbalances among the states in spending on child
protection, it is hard to imagine a fonnula that would not disadvantage either
states that have been heavy spenders, or states that are only ~eginning to
improve their systems.
.
Substantial improvemen~s. need to be made in the child protection system and in the federal
role in overseeing that system. The Administration supports a careful and thoughtful review
of the programs before actions are taken that might seriously hann millions of vulnerable
children.
6
�Denial of Benefits to Disabled Children on SSI
The Administration is deeply troubled by the changes proposed in the. program designed to
help disabled children--SSI.
o
The proposed-Iegislationessentially eliminates SSI benefits for children, with
the exception of a small group of children currently receiving benefits. Within
6 months, over one hundred thousand disabled children would lose eligibility
for SSI benefits--some would lose medical protection as well.. And in the
future, no child, no matter how disabled, will be ~ligible for any cash benefits
for SSI, except if cash benefits prevent them from having to be
institutionalized. These proposals appear to penalize parents who are
determined to care for their child no II1atter what the economic consequences
for the family. SSI recipients are among the neediest and most vulnerable
children, in the poorest families_
o . Some of the money saved is put into a new block grant for services to disabled
children, which would require the creation of a new state bureaucracy to
decide on appropriate services .. This idea is untested, and no one' knows what
impact it will have on the most vulnerable of children and the parents who
care for them. The 5-year cut off in AFDC for all persons along with the
elimination of SSI cash for disabled children may leave these children
extremely vulnerable.
The Administration sees the need for careful reform in this area, with its potential for serious
harm .to extremely vulnerable children. Last year the Congress established a Commission on
Childhood Disability to look into these issues in consultation with experts from the National
Academy of Sciences. The Commissiqn will provide its report to the C~ngress later this
year. The Administration believes prudence dictates waiting for this short time until this
bipartisan commission, following a thorough review of all aspects of this important program,
has an opportunity to make recommendations.
.
.
Benefits to Legal Immigrants
The Administration strongly believes that illegal aliens should not be eligible for goverrunent
welfare support. But the blanket prohibition of all benefits to legal immigrants who are not
yet citizens is too broad, and would shift substantial burdens to state and local taxpayers.
These legal immigrants are required to pay taxes. Many serve in the armed forces, and
contribute to their communities. The Administration strongly favors a Illore focused
approach of holding sponsors accountable for those they bring into this country and making
the sponsors' cOlnmitment of support a legally binding contract.
7
�)
In summary, the Chairman's mark espouses goals for the reform·of welfare--work, parental
responsibility, prevention of teen pregnancy an'd state flexibility--that the Administration and
the American people share. But the translation of general goals in'to specific legislation
misses the mark in fundamental ways. The proposed legislation does not represent serious
work-based reform. It, does nothing-to move-people, from ,welfare to work, and it does not
require everyone who can work go to work. It neither holds state bureaucracies accountable
nor cushions state taxpayers against recession. "It puts millions of children at risk of serious
harm. There are alternative approaches to reform that achieve our mutual goals in far more
constructive and accountable ways.
The Administration reiterates its commitment to real welfare reform and its desire to work
cooperatively with Congress to achieve it.
The Office of Management and Budget advises that there is no objection to the transmittal of
this report to Congress.
A similar letter was sent to
Represent~tive
Harold E. Ford.
Donna E. Shalala
cc: Members of the Subcommittee on Human Resources
8
�THE SECRETARY OF HEAL TH ANO HUMAN SERVICES
WASHINGTON,O.c:.:.
20Za!
FEB I 3 1995
The Honorable E. Clay Shaw'
Chainnan. Subcommittee on Human Resources
Conunittee on Ways and Means
U.S. House of Representatives
Washington D.C. 20515
Dear Mr. Chainnan:
This letter expresses 'the Administration's views on the Chainnan's mark for welfare refonn
legislation under consideration by the House Ways and Means Subcommittee on Human
Resources.
The Administration shares the commitment of the Congress and the American people to real
welfare refonn that emphasizes work, parental responsibility, state flexibility, and the
protection of children.. Last 'year, the President submitted a bold welfare refonn bill, the
Work and Responsibility Act of 1994, which embodied these values. It imposed tough work
requirements while providing opportunities for education, training, child care and supports to
working people. It included a stringent set of child support enforcement provisions. It
required each teen mOther to live at home, stay in school and identify her baby's father. It
increased state flexibility without sacrificing accountability~' And it maintained a basic
structure of protections for children ..
The Administration looks forward to working cooperatively with the Congress ina bipartisan
way to pass bold welfare reform legislatio'n this year. . The Administration has, however,
serious concerns about a number of features of the'Chairman's mark that appear to
undermine the values to which we are all committed. The Administration seeks. to end
welfare as we know it by promoting work, family and responsibility, not by.punishing poor
children for their parents' mistakes. Welfare reform will succeed only if it successfully
,moves people from welfare to work.
'
Work
For years, Republicans and Democrats alike have agreed that the central goal of welfare
refonn must, be work. That is still our goal: People who can work ought to go to work and
earn a paycheck not a welfare check. The Administration believes that no adult who is able
to work should receive welfare for an unlimited time' without working: ' The Administration
. believes that from the first day someone comes onto welfare, he or she should be required to
participate in job search, job placement, education, or training needed to move off welfare
and into a job quickly. It is gbvernment' S responsibility to help ensure that the critical job
placement, training, and child care services are provided. Individuals who are willing to
.
.
work should have the opportunity to work and not be arbitrarily cut off assistance.
�The Administration therefore has serious concerns aboul the Chairman's .mark before you:
o
It eliminates requirements that recipients' participate in job search, education,
work or training as a condition of receiving welfare, and ends any
responsibility of state welfare systems to provide education, training and
placement services. to move recipients from welfare to work. The proposed'
legislation effectively repeals the bipartisan Family Support Act signed by
President Ronald Reagan in 1988.
o
The proposed legislation includes only minimal and unenforceable
require,ments that recipients' work .. The bill requires onJy that persons on the
rolls for more than 2 years engage in "work activities" loosely defined by.the
state welfare bureaucracy, rather than a real work requirement. The proposed
participation ,standards are very low. In many ways, the work requirements
are even weaker than those in current law.
o
The proposed legislation provides no assurance of child care to reCipients who
work or are preparing to work--even if a state requires them to participate. It
offers no promise of child care for those who leave welfare for work or for
those who could avoid falling onto welfare if they had some help with child
care. While it repeals provisions of existing law that provide funding for child
care, this bill is silent on whether any additional funds will be available for
subsidized child care for low income working families.
o
The proposed legislation repeals the current rule that anyone who leaves
welfare for work can receive MediCaid for an additional year to ease the
transition. This would further reduce health care coverage and make it harder
for people to move from welfare to work.
o
The proposed legislation would deny all cash assistance to families that have .
received assistance for more than five years, even if the adult in the family is
unabl~ to find a job or prevented from holding a job because of illness or the
need to care for a disabled family member. Children would be seriously
jeopardized even if their parents. cannot find any work.
The Administration supports an alternative approach that would genuinely transform the
welfare system into a transitional system focused on work. It would have strict requirements
for recipients to participate in and clear responsibilities for states to provide education, .
training and placement assistance; it would have serious time limits after which work would
be required; it would ensure that children wouid not be left alone when parents were working
by providing assistance for child care; it would put parents to work, not just cut them off;
and it would ensure that children can expect support from two parents.
2
�Parental Res()onsibility
The Administration believes that welfare reform should recognize the responsibility and
encourage .the involvement of both parents In their children's lives. The Administration
considers child sup'po-n enforcement to be an integral part of welfare reform, panicularly
because it sends ,a strong message to young people about the responsibility of both parents to
support their children. The Administration was pleased that you had agreed to add child
suppon enforcement to your welfare reform bill, and sorry that your proposals are not yet
pan of the bill now under consideration. The Administration looks forward [Q working
closely with you on this issue in the coming weeks.
o
The only chi19 support provision included in the Chairman's mark is one that
allows states to reduce payments to children for the first 6 months if paternity
has not been legally established. This provision seems ineffectual and unfair.
Even if a mother fully cooperates by giving detailed information identifying
the father and his possible location, ,and even if the state is diligent in pursuing ,
the (ather, it can easily take 6 months to get paternity legally established. ,
There is no reason why the child should be punished during this period.
The Administration believes that it makes far more sense to deny benefits entirely to any
parent who refuses to identify the father o~ to cooperate in locating' him. However, once the
mother has done all she can, the family should qualify for aid, and then the state should
, establish paternity within one year.
The Administration believes that the welfare system should encourage the formation and
support of two-parent families. The Administration is therefore concerned about an .'
important omission in the proposed legislation:
" 0
The proposed legislation would encourage the break-up of families by
repealing the requirement that states provide cash assistance to·two-parent
families in which a parent is unemployed or unable to work. It allows states
to discriminate against married,' two-parent families by treating single-parent
families better than two-parent families.
The Administration supports an approach that both encourages the formation of two-parent
families and makes sure that both parents take responsibility for children in, all ,cases.
'
Teen Pregnancy
.
The Administration and the American people agree that the best refqrmof welfare would be
to ensure that people do not need it in the first place. W~lfare reform must s~nd a very
strong message to young people that they should not get pregnant or father a child until they
are ready and able to care for that child, and that if they do have children, they will not be
3
�able to escape the obligations and responsibilities of parenthood. We must be especially
concerned about the .well-being of the children who are born to y~ung mothers, siI}ce they
are very likely to grow up poor.
The Administration therefore has serious cDncerns about the bill before 'you:
o
The proposed legislation would deny all federal cash benefits for eighteen
years·to any child born to an unmarried mother under 18, as well as to the
patent. This provision appears to punish children for theirentir'e childhood-
18 years-.-for the mistakes of their 'parents.
o
The proposed legislation does not require that teen mothers live at home,' stay
in school, and identify the child's father. It weakens requirements in current
law, and may, make the prospects for mother and child even worse.
o
The proposed legislation establishes only minimal expectations for states to
, provide services to unmarried parents. and provides no additional funds to
.support them.
'
,
The Administration supports an ,alternative approach that would require minor mothers to live
at home, stay in school, make progress toward self-sufficiency, and identify the father of the
child. The Administration also supports a national campaign to 'prevent teen pregnancy. It is
time to enlist parents and civic, religious, and business leaders in a community based strategy
to send a clear message' about abstinence and responsible parenting. The Administration also
supports a state option not to increase benefits for children born to mothers on welfare. This
decision should be made by the state, not the federal government.
State 'Flexibility with Accountability
The Admiilistrationembraces the creativity and responSiveness of states, and the
opportunities for real reform when states have the flexibility to design and administer welfare
programs tailored to their unique circumstances and needs. Already this Administration has
granted waivers to nearly half the states for welfare refonndemonstrations. National welfare
refonn should embody the values of work and responsibility in a way that assures taxpayers
that federal money is being spent prudently and appropriately. For refonn to succeed,the
, funding mechanisms for welfare should not put children or states at risk in times of
recession, population increase or unpredictable growth in demand.
'
In this context, the Administration has serious concerns about the proposed legislation:
o
The spending cap in the proposed legislation makes no allowances for potential
growth in the need for cash assistance because of economic downturn,
populatiof). growth. or unpredictable emergencies. It could result in states
4 .
�runnIng our of money before the end of ~he year, and thus having to turn away
working families who hit'a "bump in the road" and apply for short-term
assislimce. It could preclude states from investing in job placement, in work
programs. in education and training, and in supports for working families.
o
The proposed legislation removes the requirement that states match federal
funds with their own state fu~ds. With none of their own money at risk, states
will have many fewer incentives to spend the funds efficiently and effectively
to improve performance and increase 'self-sufficiency,
o
The proposed legislation provides virtually no accountability, There are ,no
. incentives for good performance and virtually no penalties for failure. There is
no provision for the recovery of monies paid out fraudulent\lyor in error.
There are no mechanisms for ensuring that states are acrually spending the
money on needy children rather than on state bureaucracies, or for monitoring
whether federal money is being used to help parents gain self-~ufficiency,
require work. and enforce parental responsibility. Indeed, the federal
govenunent is forbidden from taking any meaningful steps to ensure program
. performance and accountability.
The Administration supports proposals that significantly increase state flexibility but also
ensure accountability for achieving national goals .. The Administration supports a funding
mechanism that will nm put children and states at risk down the road, and that enables states
to succeed in moving people from welfare to work and in supporting working families, Th~
Administration has significant doubts about the ability of a pure bl~ck grant funding
.
mechanism to adequately protect both children and states.
Protection of Children
The Administration recognizes that the protection of children is the primary goal both of cash
assistance programs and of child welfare and child protective services. Cash assistance
programs assist families to care for children in their own homes. Child protection services
help those children who are abused or neglected or at risk of abuse by their parents arid who
need special in-home services or out of home placements to assure their safety: Strengthening
families, and where appropriate, preventing remov~l of children from their homes also are,
key goals of child protection services. There are problems .in a number of area~.
Denial of Benefits to Children on AFDC
The legislative proposals that would reform cash assistance have a number of provisions that
would put ~lnerable children at greater risk.
5
�a
As noted above, the legislation would deny cash assistance to children of
unmarried minor mothers for their entire childhood, to children born while the
parent was on welfare; and to children whose parent had received welfare:for
more than five years, whether or not a job' was avaltable or. the parent was
unable to work. The funding caps could have the effect of denying cash
. assistance to children when states used up their allocated funds, for whatever
reasons. Children in low income working families, who may be forced onto
cash assistance in times of economic downturn, could be most affected.
Child Protection Services
Some of these children could well come into a system of child protection services that is
already seriously overburdened and that is failing to provide the most essential services.
Reponed child maltreatment and out-of-home placements have both been incr.easing sharply.
Many state systems are in such distress that they have been placed under judicial oversight.
The proposed legislation responds to these increasingly serious problems by consolidating
existing programs that protect children into a block grant with nominal federal oversight.
The Administration has serious concerns about this approach.
o
The proposed legislation caps spending .for child protection programs at a level
considerably lower than baseline projections. This could lead (0 uninvestigated
maltreatment'reports, and to children being left in unsafe homes with minimal
services. It could also seriously hamper states' efforts to improve their child
abuse prevention and child protection systems.
o
The proposed legislation eliminates the adoption assistance programs, and
leaves it up to states Whether they will' significantly sustain the subsidies that
enable many special needs children to find permanent homes, and whether they
will honor commitments to those adoptive families that now receive subsidies.
o . The proposed -legislation virtually eliminates federal monitoring and ,
accountability mechanisms. It makes it impossible for the federal government
.
to ensure the protection of children. .
.0
The proposed legislation is silent on the formula for allocating funds to the
states. Because of serious imbalances among the states in spending on child
protection, it is hard to imagine a formula that would not disadvantage either
states that have been heavy spenders,. or states that are only beginning to
improve their systems.
Substantial improvements need to be m.ade in the child protection system and in the federal
role in overseeing that system. The Administration supports a careful and thoughtful review
of the programs before actions are taken that might seriously harm millions of ,vulnerable
. children.
"
6
�Denial of Benefits. [Q Disabled Childrel1 on SSI
The Administration is deeply troubled by the changes proposed in the program designed to
help disabled children--SSI.
o
o
The proposed legislation ess~mially~eliminatesSSI benefits for children, with.
the exception of a small group of children currently receiving benefits. Within
6 months, over one hundred thousand disabled children would lose eligibility
for SSI benefits--some would lose medical protection as well. And in the
future, no child, no matter how disabled, will be eligible for any cash benefits
.
for SS!, except if cash benefits prevent them from having to be
institutionalized. These proposals appear to penalize parents who are
detennined [Q care for their child no matter what the economic consequences
for the family .. SSI recipients are. among the neediest and most vulnerable
children, in the poorest famil ies.
Some of the money saved is put into·a new block grant for services [Q disabled
children, which would require the creation of a new state bureaucracy to
decide on appropriate services. This idea is untested, and no one knows what.
impact it will have on the most vulnerable of children and the parents who
care for them. The 5-year cut off in AFDC for all persons .along with the
elimination of SSI cash for disabled children may leave these children
extremely vulnerable .
. The Administration sees the need for ca·reful refonn in this area, with its pot~ntialforserious
hann to extremely vulnerable children. Last year the Congress established a Commission on
Childhood Disability to look into these issues in consultation with expertS from the National
Academy of Sciences. The Commission will provide its report to the Cong~ess later this
year. The Administration believes prudence dictates waiting for this short time until this
bipartisan commission, following it thorough review of all aspects of this important program,
has an opportunity to make recommendations.
Benefits to Legal Immigrants
The Administration strongly believes that illegal aliens should not be eligible for government
welfar~ support. But the blanket prohibition of all benefits to legal immigrants who are not
yet citizens is too broad, and would shift substantial burdens to state and local taxpayers.
These legal immigrants are required to pay taxes. Many serve in the armed forces, and
contribute to their communities. The Administration strongly favors a more focused
approach of holding sponsors accountable for those they bring into this country and making
the sponsors" commitment of support a legally binding- contract.
7
�..
In summary, [he Chainnan's mark espouses goals for the reform of welfare--work, parental
responsibility, prevention of teen pregn~ncy and state tlexibility--that the Administration and
the American people share. But the translation of general goals into specific legislation
misses the mark in fundamental ways. The proposed legislation does not represent serious'
work-based refonn. It does nothing [0 move people from welfare tQ..work. and it does not
. require everyone who can work go to work. It neither holds state bureaucracies accountable
nor cushions state taxpayers against recession. It puts millions of children at risk of serious.
hann. There are alternative approaches to reform that achieve our mutual goals in far more
constructive and accountable ways.
The Administration reiterates its commitment to real welfare refonn and its desire to work.
cooperatively with Congress [0 achieve it.
The Office of Management and Budget advises that there is no objection To the transmittal of
this report to Congress.
A similar letter was sent to Representative Harold E. Ford.
Donna E. Shalala
cc: Members of the Subcommittee on Human Resources
8
�I'
THE SECRE TARY OF HEAL TH AND HUMAN SERVICES
WASHiNGTON, D.C.
l0701
FEB I 3 ,1995
The Honorable E. Clay Shaw
Chairman. Subcommittee on Human Resources'
Committee on Ways and Means
U.S. House of Representatives
Washington D.C. 2,0515
Dear Mr. Chairman:
This letter expresses the Administration's' views on the Chaiman's mark for welfare reform
legislation under consideration by the House Ways and Means Subcommittee on Human
,
Resources.
.
.'
The Administration shares the ,commitment of the Congress and the American people to real
welfare reform that emphasizes work, parental responsibility, state flexibility, and the
protection of children. Last year,the President submitted a bold welfare reform bill, the
Work and Responsibility Act of 1994, which embodied ihese values. It imposed tough work
requirements while providing opportunities for education, training, child care and supports to
working people. It included a stringent set of child support enforcement provisions. It
. required each teen mother to live at home, stay in school and identify her baby's father. it
increased state flexibility without sacrificing accountability. And it main~ined a basic
structure of protections for children: .
'.
The Administration looks forward to working cooperatively with the Congress in a bipanisan
, way to pass bold welfare reform legislation this year. The Administration has, however,
serious concerns about anumber of features of the Chainnan's mark that appear to
undermine the values to which we are all committed. The Administration seeks to end
welfare as we know it by promoting work, family and responsibility, not by punishing poor
children for their parents' mistakes. Welfare reform will succeed only if it successfully
moves people from welfare to work;
Work
For years, Republicans and Democrats alike have agreed that the central goal of welfare
reform must be work. That is still our goal: People who can work ought to go to work and
earn a paycheck nota welfare check. The Administration believes that· no adult' who is able
to work should receive welfare for an unlimited time without working. The Administration
believes that from -the first day someone comes onto welfare, he or she should be required to
. participate injob search, job placement, education, or training needed to move off welfare
and into a Job quickly. It is government's responsibility to help ensure that the critical job
placement, training, and child care services are provided. Individuals who are willing to
work should 'have the opporrunity to work and not be arbitrarily cut off assistance.
�,
The Administration .therefore has serious concerns about the Chairman's mark before you: .
o
It eliminates requirements that recipients participate in job search, education,
work or ~raining as a condition of receiving welfare, and ends any
responsibility of state welfare systems to provide education, training and
placement services to move recipients from welfare to work. The proposed
legislation effectively repeals the bipartisan Family Support Act signed by
Presidem Ronald Reagan in 1988.
.
o
The proposed legislation includes only minimal and unenforceable
requirements that recipients work. The bill requires only that persons on the
rolls for more than 2 years engage in "work activities" loosely. defined by the
state welfare bureaucracy, rather than a real work requirement. The proposed
participation standards are very low. In many ways, the work requirements
are even weaker than those in current law.
o
The proposed legislation provides no assurance of child care to recipients "Yho
~ork or are preparing to work--even if a state requires them to participate. It
offers no promise of child care for those who leave welfare for work or for·
those who could avoid falling onto welfare If they had some help with child
care. While it repeals provisions of existing law that provide funding for child
care, this bill is silent on whether any additional funds will be available for
subsidized child care for low income working families .
.
.0
o
J
.
The proposed legislation repeals the current rule that anyone who leaves
welfare for work can receive Medicaid for an additional year to ease the
transitiori. This would further reduce health care coverage and make it harder
for people to move from welfare to work.
The proposed legislation would deny all cash assistance. to families that have
received assistance for more than five years, even if the adult in the family is
unable to find a job or prevented from holding a job because of illness or the
need to care for a disabled family member. Children would be seriously
jeopardized even if their parents cannot find any work.
The Administration supports an .altemative approach that would genuinely transform the
welfare system into a transitional system focused .on work. It would have strict requirements
for recipients to participate in and clear responsibilities for states to provide education,
training aI}d placement assistance; it would have serious time limits after, which' work would
be required; it would ensure that children would not be left alone when parents were working
by providing assistance for child care; it would put parents to work, not just cut them off;
and it would ensure that children dm expect support from two parents.
'
2
�. Parental Responsibility
The Administration believes that welfare reform should recognize the responsibility and
encourage the involvement of both parents in their children's lives. The Administration
considers child support enforcement to be an integral part of welfare reform, particularly
. because.it sends a strong message to young people about the responsibility of bO[h parents to
support their children. The Administration was pleased that you had agreed to add child
support enforcement to your welfare reform bill, and sorry that your proposals are not yet
part of the bill. now under consideration. The Administration looks forward to' working
closely with you on this issue in the coming wee~s.
o
The only child support provision included in the Chairman's mark is one that
allows states to reduce payments to children for the first 6 months if paternity
has not been legally established. This provision seems ineffectual and unfair.
Even if a mO[her fully cooperates by giving detailed information identifying
the father and his possible location. and even if the state is diligent in. pursuing
the father. it can easily take 6 months to get paternity legally established.
There is no reason why the child should be punished during this period.
The Administration believes that it makes far more sense to deny benefits entirely to any
parent who refuses to identify the father or to cooperate in locating him: However. once the
mother has done all she can, the family should qualify for aid, and then. the state should
. .
establish paternity ~ithin one year.
The Administration believes that the welfare system should encourage the formation and
support of two-parent families. The Administration is therefore concerned about an
important omission in the proposed legislation:
o
The proposed legislation would encourage the break-up of families by
repealing the requirement that states provide cash assistance to two-parent
families in which a parent is unemployed or unable to work. It allows states
to discriplinate against mamed, two-parent families by treating single-parent
families better than two-parent families.
.
.
The Administration supports an approach that both encourages the formation of two-parent
families and makes sure that both parents take responsibility for children in all cases. .
Teen Pregnancy
The Administration and the American people agree that the best reform of welfare would be
to ensure that people do nO[ need it in the first place. Welfare reform must send a very
strong message to young people that they should not get pregnant or father a child until they
are ready and able to care for that child, and that if they do have children, they will not be
3
�able to escape the obligations and responsibiliLies of parenthood, We must be especially
concerned about the well-being of the children who are born to young mothers, since they
are very likely to grow up poor.
The Administration therefore has serious concerns about the bill before you:
o
The proposed legislation would deny all federal cash benefits for eighteen
years to any child born to an unmarried mother under 18, as well as to {he
parent. This provision appears to punish children for their entire childhood-
18 years--for the mistakes of their parents.
'
o
The proposed legislation does not require that teen mothers live at home, stay
in school, and identify the child's father. It weakens requirements in current
law, and may make the prospects for mother and child even worse.
o
The proposed' legislation' establishes only minimal expectations for'states to ,
provide services to unmarried parents, and provides no additional funds to
support them.
The Administration supports an alternative approach tnat would require minor mothers .to live
at home, stay in school, make progress toward self-sufficiency, and identify the falherof the
child. The Administration also supports a national campaign to prevent teen pregnancy. It is'
time to enlist parents and civic, religious, and business leaders in a community based strategy
to send a clear message about abstineace and responsible parenting. The Administration also
supports a state option not to increase benefits for children born to mothers on weifare. This
decision should be made by the'state, not the federal government.
State Flexibility with Accountability
The Administration embraces the creativity and responsiveness of states, and the,
opportunities for real reform when states have the flexibility to design and administer welfare
programs tailored to their unique circumstances and. needs. Already this Administration has
granted waivers to nearly halfthe states for welfare refonn demonstrations. National welfare
reform should embody the values of work 'and responsibility in a way that assures taxpayers
that federal money is being spent prudently and appropriately. For reform to succeed, the
funding mechanisms for welfare should not put children or states at risk in times of
recession, population increase or unpredictable growth in demand.
'
In this context, the Administration has serious ,concerns about the proposed legislation:
o
The spending cap in the proposed legislation makes no allowances for potential
'growth in the need for cash ,assistance because of economic downturn,
population growth. or unpredictable emergencies. It could result in states
4
�. running out of money before the end of the year, and thus having to turn away
working families who hit a "bump in the road" and apply for short-term
assistance. It could preclude states from investing in job placement, in work
programs, in education and training, and in supports for working families.
o
The proposed legislation removes the requirement that statesmaich federal
funds with theit own state funds. With none of their own money at risk, states
will have m~ny fewer incentives to spend the funds efficiently and effectively
to improve perforinance and increase self-sufficiency.
o . The proposed legislation provides virtually no accountability. There are no
incentives for good performance and virtually.no penalties for failure. There is
no provision for the recovery of monies' paid out fraudulently or in error.
There are, [10 mechanisms for ensuring that states are actually spending the
money on needy children rather than on state bureaucracies, or for monitoring
whether federal money is being used to help parents gain self-sufficiency,
require work, and enforce parental responsibility. Indeed, the federal
government is forbidden from takingany meaningful steps to ensure progra'm
performance and accountability.
.
..
The Administration supports proposals that significantly increase state flexibility but also
ensure accountability for achieving national goals. The Administration supports a funding
mechanism that will not put children and states at risk down the road, and that enables states
to succeed in moving people from welfare to work and in supporting working families. The
Administration has significant doubts about the ability of a pure block grant funding
mechanism to adequately protect both children and states.
Protection of Children
The Administration recognizes that the protection of children is the primary goal both of cash
assistance programs and of child welfare and child protective services. Cash assistance
programs assist families to care for children in their own homes. Child protection services
help those children who are abused or neglected or at risk of abuse by their parents and who
need special in-home services or out of hoineplacemen~ to assure their safety. Strengthening
families, and where appropriate, preventing removal of children from their homes also are,
key goals of child protection services. There are problems in a number of areas.
Denial of Benefits to Children on AFDC
The legislative proposals that wou'ld reform cash assistance have a number of provisions [hat
would put vulnerable children at greater risk.
5
�o
As noted above. the legislation would deny cash assistance to children of
unmarried minor mothers for their entire childhood, to children born while the
par,ent was on welfare, and to children whose parent had received welfare for
more than five years. whether or not a job was available or the parent was
unable to work. The funding caps could have the 'effect of denying cash
assistance to children when states used up their allocated funds. for whatever
reasons. Children in low income working families, who may be forced onto
cash assistance in times of economic downturn. could be most affected.
Child Protection Services
Some of these children could well come into a system of child protection services that is
already seriously overburdened and that is failing to provide the most essential services.
Reported child maltreatment and out-of-home placements have both been increasing sharply,
Many state systems are in such distress that they have been placed under judicial oversight.
The proposed legislation responds to these increasingly serious problems by consolidating
existing programs that protect children into a block grant with nominal federal oversight.
The Administration has serious concerns about this approach.
o
The proposed legislation caps spending for child protection programs at a level
considerably lower than baseline projections. This could lead to uninvestigated
maltreatment reports, and to children being left in unsafe homes with minimal
services. It could also seriously hamper states' efforts to improve their child
abuse prevention and child protection systems. '
o
The proposed legislation eliminates the adoption assistance programs, and
leaves it up to states whether they will significantly sustain the subsidies that
enable many special needs children to find permanent homes, and whether the¥
will honor commitments to those adoptive families that now receive subsidies.
o
The proposed legislation virtually eliminates federal monitoring and
accountability mechanisms. It makes it impossible for the federal government
to ensure the protection of children.
.
o
The proposed legislation is silent on the formula for allocating funds to the
states. Because of serious imbalances among the states in spending on child
protection. it is hard to imagine a formula that would not disadvantage either
states that have been heavy spenders, or states that are only beginning to
improve their systems.
'
Substantial improvements need to be made in the child protection system and in the federal '
role in overseeing that system. The Administration supports a careful and thoughtful review
of the programs before actions are taken that might seriously harm millions of vulnerable
children.
'
6
�Denial of Benefits to Disabled Children on SS!
The Administration is deeply troubled by the changes proposed in the program designed to
help disabled children--SSI.
o
o
The proposed legislation essentially eliminates SSI benefits for children, with
the exception of a small group of children currently receiving benefits. Within
6 months, over one hundred thousand disabled children would lose eligibility
for SSI benefits--some would lose medical protection as well. And in the
future, no child, no matter how disabled, will be eligible for any cash benefits
for SSI, except if cash benefits prevent them from having to be
institutionalized. These proposals appear to penalize parents who are
determined to care for their child no matter what the economic consequences
for the family. SSI recipients are among the neediest and most vulnerable
children, in the poorest families.
Some of the money saved is put into a new block grant for services to disabled
children, which would require the creation of a new state bureaucracy to .
decide on appropriate services. This idea is untested, and no one knows what
impact it will have on the most vulnerable of children and the parents who
care for them. The, 5-year cut' off in AFDC' for all persons along with the
elimination of SSI cash for disabled children may leave these, children '
extremely vulnerable.
The Administration sees the need for careful reform in this area, with its potential for serious
.
harm to extremely vulnerable children. Last year the Congress established a Commission on
Childhood Disability to look into these issues in consultation with experts .from the National
Academy of Sciences. The Commission will provide its report to the Congress later this
year. The Adnlinistration believes prudence dictates waiting for this short time until this
bipartisan commission, follOWing a thorough review of all aspects of this important program.
has an opportunity to make recommendations.
.
,
Benefits to Legal Immigrants
The Administration strongly believes that illegal aliens should not be eligible for government
welfare support. But the blanket prohibition of all benefits to legal immigrants who are not
yet citizens is too broad. and would shift substantial burdens to state and local taxpayers.
These legal immigrants are required to pay taxes. Many serve in the armed forces, and
contribute to their communities., The Administration strongly favors a more focused
approach of holding sponsors accountable for those they bring into this country and making
the .sponsors' commitment of support a legally binding contract.
7
�,.
'
In summary, the Chairman's mark espouses goals for the reform of welfare--work, part;ntal
responsibility, prevention of teen pregnancy and state tlexibility--that the Administration a.nd
the American people share. But the translation oLgeneral goals into specific legislation
'
misses the mark in fundamental ways. The proposed legislation does not represent serious
work-based reform. It does nothing to move peopl!! from welfare to work, and it does not
require everyone who can work go to work. It neither holds state bureaucracies accountable
nor cushions state taxpayers against recession. It puts millions of children at risk of serious
. harm. There are alternative approaches to reform that achieve our mutual goals in far more
constructive and accountable ways.
The Administration reiterates its commitment to ~eal welfare reform and its' desire to work
cooperatively with Congress to achieve it.
The Office of Management and Budget advises that there is no objection r.o the transmillal of
this report to Congress.
A similar letter was sent to Representative Harold E. Ford.
Donna E; Shalala
cc: Members of the Subcomri:1iuee on Human Resources
8
�.
,
,
''
THE SECR£ TARY OF HEALTH Af-lO HUMAN SERVICES
WAS.,'ftNGTON.O.<':.
;.:.'0('01
FEB I 3 ·1995
The Honorable
Clay Shaw'
Chairman, Subcommittee on Human Resources.
Committee on Ways and Means.
U. S. House of Represent(!.tives
Washington D.C. 20515
Dear Mr. Chairman:
This letter expresses the Administration's views on the Chairman's mark for welfare reform
legislation under consideration by the House Ways and Means Subcommittee on Human
Resources.
The Administration shares the commitment of the Congress and the American people to real
welfare reform ,that emphasizes work, parental responsibility. state flexibility, and the
protection of children. Last year. the President submitted a bold welfare reform bill, the
Work and Responsibility Act of 1994, which embodied these values. It imposed tough wor~
requirements while providing opportunities for education, training, child care and supports to
working people. It included a stringent set of child support enforcement provisions. It
required each teen mother to live at home, stay in school and identify her baby's father. It
increased state flexibility without sacrificing accountability. And it maintained a pasic
structure of protections for children. .
.
The Administration looks forward to working cooperatively with the Congress :in a bipartisan
way to pass bold welfare reform legislation this year. The Administration has, however,
. serious concerns about a number of features of the Chairman's mark that appear to
undermine the values to which we are all committed. The Administration seeks to end
welfare as we know it by promoting work, family and 'responsibility. not by punishing poor
children for their parents' mistakes. Welfare reform will succeed only if it successfully
moves people from welfare to work.
Work
For years, Republicans and Democrats alike have ag'reed that the central goal of welfare
reform must be work. That is still our goal: People who can/work ought to go to work and
earn a paycheck not a welfare check. The Administration believes that no adult who is able.
to work should receive welfare for an unlimited time without working. The Administration
believes that from the· first day someone comes onto welfare, he or she should be required to
participate in job search, job placement, education, or training n,eeded' to move off welfare
and into a job quickly. It is government' s responsibility to help ensure that the critical job,
placement, training, and child care services are provided. Individuals who 'are willing to '
work should have the opportunity to work and not be arbitrarily cut off assistance.
�The Administration therefore has serious concerns about the Chairman's .mark before you:
',1
o
h eliminates' requirements that recipients participate in job search, education,
work or training as a condition of receiving welfare, and ends any
responsibility of state welfare systems to provide education, training and
placement services to move recipients from welfare to work. The proposed
legislation effectively repeals the bipartisan Family Support Act signed by
President Ronald Reagan in 1988.'
o ,The proposed legislation includes only minimal and unenforceable
.
requirements that recipients work. The bill requires only, that persons on the
rolls for more than 2 years engage in "work activities" loosely defined by the
state wei fare bureaucracy, rather than a real work requirement. The proposed
participation standards are very low. In many ways, the w~rk requirements
are even weaker than those in current law.
o ' The proposed legislation provides no assurance of child care. to recipients who.
work or are preparing to work--even jf a state requires them to participate. It
offers no promise of child care for those who leave welfare for work or for
those who could avoid falling onto welfare if they had some help with child
care. While it repeals provisions of existing law that provide funding for child
care, this bill is silent on whether any additional funds will' be available for
subsidized child care for low income working families.
o
The proposed legislation repeals the current rule that anyone who leaves
welfare for work can receive Medicaid for an additional year to ease the,
transition. This would further reduce health care coverage and make it harder
for people to move from welfare to work.
o
The proposed legislation would deny all cash assistance to families that have'
,received assistance for more than five years, even i f the adult in the family is
unable to find a job or prevented from holding a job because of illness or the
need to care for a disabled family 'member. Children would be seriously
jeopardized even if their parents cannot find any work.
The Administration supports an a~temative approach that would genuinely transform the
welfare system into a transitional system focused on work. It would have strict requirements
for recipients to participate in and clear responsibilities for states to provide education,
training and placement assistance; it would, have serious time limits after which work would
be required; it would ensure that children would not be left alone when parents were working
by providing assistance for child care; it would put parents to work, not just cut them off;
and it would ensure that children can expect support from two parents.
2
"
�Parental Responsibility'
· The Administration believes that welfare reform should recognize the responsibility and
encourage the invol vement of both parents in their children's lives. The Administration
considers child support enforcement to be an integral part of welfare reform, particularly
because it sends a strong message to young people about the responsibility of both par~nts to
support their children. .The Administration was pleased that you had agreed to add child
support enforcement to your welfare reform bill, and sorry that your proposals are not yet
part of the bill now under consideration. The Administration looks forward to working
closely with you on this issue in the coming weeks.
o
The only child support provision included in the Chairman's mark. is one that
allows. states to reduce payments to children for the;! first 6 months if paternity
has not been legally established. This provision seems ineffectual and unfair.
Even if a mother fully cooperates by giving detailed information identifying
the father and his possible location, and even if the state is diligent in pursuing
the father, it can easily take 6 months to get paternity l~gally established.
There' is no reason why the child should be punished during this period.
The Administration believes that it makes far more sense to deny benefits entireiy to any
parent who refuses to identify the father or to cooperate in locating him. However, once the
mother has done all she can, the family should qualify for aid, and then the state should
establish paternity within one year.
.
The Administration believes that the welfare system should encourage the formation and
· support of two-parent families. The Aclministration is therefore concerned about an
important omission in the proposed legislation:
.
o
The proposed legislation would encourage the break-up of families by
repealing the requirement that states provide cash assistaIice to two-parent
families in which a parent is unemployed or unable to work. It allows states
to discriminate againSt manied, two-parent families by treating single-parent
families better than two-parent families.
The Administration supports an approach that both encourages the formation of two-parent
families and makes sure that both parents take responsibility for children in all cases.
· Teen Pregnancy
The Administration and the American people agree that the best reform of welfare would be
to ensure that people do not need it in the first place. Welfare reform must send a very
strong message to young people that they should not get pregnant or father a child until they
are ready and able to care for that child, and that if they do have 'children, they will not be
3
�able [0 escape the obligations and responsibilities of parenthood. We must be especially
concerned about the well-being of the children who are born [0 young mothers, since they
are very likely to grow up poor.
The Administration therefore has serious c(frfcerns about the bill before you:·
o
The proposed legislation would deny all federal cash benefits for eighteen
years to any child born to an unmarried mother under 18, as well as to the
parent. This provision appears to punish children for their entire childhood-
18 years--for the mistakes of their parents.
o
The proposed legislation does not require that teen mothers live at home, stay
in school,. and identify the child's father. It weakens requirements in current
law, and may make the prospects for mother and child even worse.
o
The proposed legislation establishes only minimal expectations for states to
provide serVices to unmarried parents, and provides no additional funds [0
support them.
~
The Administration supports an alternative approach that would require minor mothers to. live
at home, stay i!l school, make progress. toward self-sufficiency, and identify the father of the
child. The Administration also supports a national campaign to prevent teen pregnancy. !tis
time to enlist parents ·and civic, religious, and business leaders in a community based strategy
to send a clear message about abstinence and responsible parenting. The Administration also
supports a state option not to' increase benefits for children born to mothers on welfare. This
decision should be made by the state, not the federal government.
State Flexibility .with Accountability
The Administration embraces the creativity and responsiveness of states, and the.
opportunities for real refonn when states have the flexibility to design and administer welfare
programs tailored to their unique circumstances.and needs. Already this Administration has
granted· waivers to nearly half the states for welfare refonn demonstrations. National welfare
refonn should embody the values of work and responsibility in a way that assures taxpayers
that federal money is being spent .prudently and appropriately. For refonn to succeed, the
funding mechanisms for welfare should not put children or states at risk in times of
recession. population increase or unpredictable growth in demand.
.
'
.
In this context, th~ Administration has serious concerns about the proposed legislation:
o . The spending cap in the proposed legislation makes no allowances. for potential
growth in the need for cash assistance because of economic downturn. '
population growth. or unpredictable emergencies. It could result in states
4
.
(
.
�running out of money before the end of the year. and thus having to rurn away
working families who hit a "bump in the road" and apply for short-term .
assistance. It cbuldpreclude states from investing in job placement, in work
programs, in education and training, and in supports for working families,
o
. 0
. The proposed legislation removes the requirement that states match federal
funds with their own state funds. With none of their own money at risk, states
will have many fewer incentives to spend the funds efficiently and effectively
to improve performance and increase ·self-sufficiency .
The proposed legislation provides virtUally no accountability, There are no
'incentives for good perfonnanceand virtUally no penalties for failure. There is
no provision for the recovery of monies paid out fraudulently or in error. .
There are no mechanism~ for ensuring that states are acrually spending the
.money on needy children rather than on state bureaucracies, or for monitoring
whether federal money is being used to help parents gain self-sufficiency ,
require work, and enforce parental responsibility, Indeed, the federal
.
government is forbidden from t~king any meaningful steps to ensure program
performance and accountability.
.
The Administration supports proposals that significantly increase state flexibility but also
ensure accountability for achieving national goals. The Administration supports a funding
mechanism that will not put children and states at risk down the road, and that enables states
to succeed in moving people from welfare to work and in supporting working' families. The
Administration has significant doubts about the ability of a pure block grantfunding
mechanism to adequately protect both children and states.
'
Protection of Children
The Administration recognizes that the protection of children is the primary goal both of cash
assistance programs and of child welfare and child protective services ... Cash assistance
programs assist families to care for children in their own homes. Child protection services
help those children who are abused or neglected or at risk of abuse by .their parents and who
need special in-home servi,ces or out of home placements to assure their safety. Strengthening
families, and where appropriate, preventing removal of children from their homes also are,
key goals of child protection services. There are problems in a number of areas.
Denial of Bent!fits to Children on AFDC
The legislative proposals that would refonn cash assistance have a number of provisions that
would put vulnerable chiidren at greater risk,
5
�o
As noted above. the legislation would deny cash assistance to children of
unmarried minor mOlhers for their entire childhood, to children hOrn while the
parent was on welfare, and to children whose parent had recdved welfare for
more than five years. whether or not a job was available or the parent was
. unable to work. The funding caps could have the effect of denyjng cash
assistance to children. when states used up their allocated' funds:. for whatever
reasons. Children in low income working families, who may be forced onto
cash assistance in times of economic downturn, could be most affected.
Child Protection Services
Some of these children could well come into a system of child protection services that is
already seriously overburdened and that is failing to provide the most essential services.
Reponed child maltreatment and out-of-home placements have both been increasing sharply.
Many state systems are in such distress that they have be,en placed under judicial oversight.
The proposed legislation responds to. these increasingly serious problems by consolidating
existing programs that protect children into a, block grant with nominal federal oversight.
The Administration has serious concerns about this approach.
o
The' proposed legislation caps spending for child protection programs at a 'level
considerably lower than baseline projections. This could lead to uninvestigated
maltreatment reports, and to children being left in unsafe homes with minimal
services. It could also seriously hamper states' effons to improve their child
abuse prevention and child protection systems.
o
The proposed legislation eliminates the adoption assistance
programs, and
leaves it, up to states whether they will significantly sustain the subsidies that
enable many special needs children to find pennanent homes, and whether they
will honor commitments to those adoptive families that now receive subsidies.
o
The proposed legislation virtually eliminates federal monitoring and
accountability meChanisms. It makes it impossible for the federal government
to ensure the protection of children.
o
The proposed legislation is silent on the fonnula for allocating funds to ttie
states. Because of serious imbalances among the states in spending on child
protection, it is hard to imagin~ a fonnula that would not disadvantage either
states that have been heavy spenders, or states that are only beginning to
improve their systems.
Substantial improvements need to be made in the child protection system and in the federal
role in overseeing that system. The Administration suppons a careful and thoughtful review
, , of the, programs before actions are taken that might seriously hann m.illions of vulnerable
children.
6
�·
.
Denial of Benefits to Disabled Children 'on 55I
The Administration is deeply troubled by the changes proposed in the program designed to
help disabled children--55I.
'
o
The proposed legislation essemiaHyeliminates 551 benefits for children. with
the ex.ception of a small group of children currently receiving benefits. Within
6 months, over one hundred .thousand disabled children would lose eligibility
for 5SI benefits--some would lose medical protection as welL And in the
future, no child, no matter how disabled. will be eligible for any cash benefits
for SSI, except if cash benefits prevent them. from having to be
institutionalized. These proposals appear to penalize parents who are.
determined to care for their child no matter what the economic consequences
for the family, SSI recipients are among the neediest and most vulnerable
children, in the poorest families.
, 0
Some of the money saved is put into a new block grant for services to disaqled
children, which would require the 'creation of a new'state bureaucracy to
decide on appropriate services. This idea is untested, and no one knows what
impact it will have on the most vulnerable of children and the parents who
care for them. The 5-year cut off in AFDC for all persons along with the
elimination of SSI cash for disabled children may leave these children
extremely vulnerable.
, The Ad~inistration sees the need for careful.reform in this area, with its potential for serious
harm to extremely vulnerable children. Last year the Congress established a Commission on
Childhood Disability to look into these issues in consultation with experts from the National
Academy of Sciences. The Commission will provide its report to the Congress later this
year. The Administration believes prudence dictates waiting for this short time until this
bipartisan commission, followi~g a thorough review of all, aspects of this important program.
has an opportUnity to make recommendations. .
.
Benefits to Legal Immigrants
The Administration strongly believes that illegal aliens should not be eligible for government
welfare support. But the blanket prohibition of all benefits' to legal immigrants who are not
yet citizens is too broad. and would shift substantial burdens to state and local taxpayers.
These legal immigrants are required to pay tax.es. Many serve in the armed forces, and
contribute to their communities. The Administration strongly favors a more focused
approach of holding sponsors accountable for those they bring into this country and making.
the sponsors' commitment o,f support a legaHy binding contract.
7
�)
[n summary, the Chainnan '$ mark espouses goals for the reform of welfare--\,.jork~ parental
responsibility, prevention of teen .pregnancy and state flexibility--that the Administration and
the American people share. But the translation of general· goals into specific legislation
misses the mark in fundamental ways. The proposed legislation does
represent'serious .
work-based refonn. It does nothing to_move people from welfareJo work, and it. does not
require everyone who can work go to work. It neither holds state bureaucracies accountable
nor cushions state taxpayers against recession. It puts millions of childr.en at risk of serious
hann. There are alternative approaches to reform that achieve our mutual goals in far more
constructive and accountable ways.
nO[
The Administration reiterates its commitment to real welfare reform and its desire to work.
coopera~ively with Congress £0 achieve it.
. The 'Office of Management and Budget advises that there is no objection ro the transmittal of
this repon to Congress..
A similar letter was sent to Representative Harold E. Ford.
Donna E. Shalala
cc: Members of the Subconunittee on Human Resources
/
8 .
�THE SECRETARY OF HEALTHAI~O HUMAN SERVICES
WASHINGTON. D.C.
20201
FEB·I·3 1995
The Honorable' E. Clay Shaw
Chairman, Subcommittee on Human Resources
Committee on Ways and Means
U.S. House of Representatives
Washington D.C. 20515
Dear Mr. Chairman:
This letter expresses the Administration's views on the Chairman's mark for welfare reform
legislation under consideration by the House Ways and Means Subcommittee on Human
'-..
'
Resources.
The'. Administration shares the commitment of the Congress and the American people to real
· welfare reform that emphasizes work, parental responsibility. state flexibility, and the
protection of children. Last year, the President submitted a bold welfare reform bill, the
Work and RespoQsibility Act of 1994, which. embodied these values. It imposed tough work
requirements while providing opportunities for education, training, child care and supports to
working people. It included a stringent set of child support enforcement provisions. It
required each teen mother. to live at· home, 'stay in school and identify. her baby's father. It
increased state flexibility without sacrificing accountability. And it maintained a basic
structure of protections for children ..
The Administration looks forward to working cooperatively with the Congress in a bipartisan
way to pass bold welfare refonn legislation this year. The Administration has, however,
serious concerns about a numberof features of the Chainnan's mark that appear to
· undermine the values to which we are all committed. The Administration seeks to end
· welfare as we know it by promoting work, family and responsibility; not by punishing poor
children for their parents' mistakes. Welfare reform will succeed only if it succes'sfully
moves people from welfare·to work.
Work
For years, Republicans and Democrats alike have agreed that the. central goal of welfare
refonn must be work. That is still our goal: People who can work ought to go to work and
earn a paycheck not a welfare check. The. Administration believes that no adult who is able .
to work should receive welfare for an unlimited time without working. The Administration
believes that from the first day some~ne comes onto welfare, he or she should be required to
participate in job search, job placement, education, or training needed to move off welfare
and into a job quickly. It is government's responsibility to help ensure that the critical JOD
placement, training. and child care services are' provided. Individuals who are willing to
work should have the opportunity to work and not be arbitrarily cut off assistance ..
�The Administration therefore has serious concerns about the Chainnan's .mark'before you:
o
[t eliminates requirements that recipients panicipate in job search, education,
work or training as a condition of receiving welfare, and ends any
responsibility of state welfare systems to provide education, training and
placement services to move recipients from welfare to work, The proposed
legislation effectively· repeals the bipartisan Family Support Act signed by
Presi~ent Ronald Reagan in 1988.
o
The proposed legislation includes only minimal and unenforceable
requirements that recipients work~ The bill requires only that persons on the
rolls for more than 2 years engage in "work activities" loosely defined by the
. state welfare bureaucracy, rather than a real work requirement. The proposed
participation standards are very low. In many ways, the work requirements
are even weaker than those in current law.
--"
o
The proposed legisJiltion provides no assurance of child tare to recipients who
work or are preparing to work--even if a state requires them to participate. It
offers no promise of child care for those who leave welfare for work or for
[hose who could avoid falling onto welfar~ if they had some help with child
care. While it repeals provisions of existing law that provide funding for child
care, this bill is silent on whether ariy additional funds will be available for
subsidized child care for low income working families.
.'
o
The proposed legislation repeals .the current rule. that anyone who leaves'
.welfare for work can receive Medicaid for an additional year to ease the
transition. This would further reduce health care coverage and. make it harder
for people to move from welfare to. work.
o
The proposed legislation would deny all cash assistance to families that h,ave
received assistance for·more than five years, even if the adult in the family is
unable to find a job or prevented from holding a job because of illness or the
need to care for a disabled family member. Children would be seriously
jeopardized even if their parents cannot find any work.
The Administraticinsupports an alternative approach that would genuinely transfonn the
welfare system into a transitional system focused on work. It would have strict requirements
for -recipients to participate in and clear responsibilities for srates to provide education,
.
training and placement assistance; it would have serious time limits after which work would'
be required; it would ensure that children would not be left alone when parents were working
by providing assistance for child care; it would put pare.nts to work, not just cut them off;
and it would ensure that children can expect support from two parents.
2
�Parental Responsibility
The Administration believes that welfare reform should recognize the responsibility and
encourage the involvement of both parents in their children's lives. The Administratfon
considers child support enforcement to' be an integral part of welfare reform, particularly
because it sends a strong message to young people about the responsibility of both parents to
support their children. The Administration was pleased that you had agreed to add ~hild
support enforcement to your welfare reform b~ll, and sorry that your proposals are not yet
part of the bill now under consideration. The Administration looks forward to working
closely with you on this issue in the coming weeks. .
o
The only child supportprovision includedin the Chairman's mark is one that
ailows states to reduce payments to children for the first 6 .months if paternity
has not been legally established. This provision seems ineffectual and unfair.
Even if a mother fully cooperates' by giving detailed information identifying
the father and his possible location, and even if the state is diligent in pursuing
the father, it can easily take 6 months to get paternity legally established.
There is no reason why the child should be punished during, this period.
The Administration believes that it makes far more sense to deny benefits entirely to any
parent who refuses to identify the father or to cooperate in locating him. However, once the
mother has done all she can, the family should qualify for aid, and then .the state should
. establish paternity within one year.
.
The Administration believes that the welfare system should encourage the fomation and
support of two-parent families. The Administration is therefore concerned ·about an
important omission in the proposed legislation:
.
o
The proposed legislation would encourage the break-up of families by.
repealing the requirement that states provide cash assistance to two-parent
families in which a.parent is unemployed or unable to work. It allows states
. to discriminate against married, two-'parent families by treating single-parent
families better than two-parent families.
The Administration supports an approach that both encourages the formation of two-parent
families and makes sure that both parents take responsibility for. children in all cases.
. Teen Pregnancy
The Administration and the American people agree that the best reform of welfare would be
to ensure that ,people do not need it in the first place. Welfare reform must send a very
strong message· to young people that they 'should not get pre'gnant or father a child until they
are ready and able to care for that child. and that if they do have children. they will not be
3
�able to escape the obligations and responsibilities of parenthood_ We must be especially
concerned about the well-being of the children who are born to young mothers. sillce they
are very likely to grow up p o o r . ·
.
The
Admini~tration
therefore has serious concerns about the bill before you:
o
The proposed legislation would deny all federal cash benefits for eighteen
years to any child born to an unmarried mother under 18. as well as to the
parent. This provision appears to punish children for their entire childhood-
18 years-- for the mistakes of their parents.
o
The proposed legislation does not require that teen mothers live at home. stay
in school, and identify the child's father. It weakens requirements in current
law, and may make the prospects for mother and child even worse.
o
The proposed legislation establishes only minimal expectations for states to
provide services to unmarried parents, and provides no additional funds to
sUI?port them.
'
,
.
.
The Administration supports an alternative approach that would require minor mothers to live
at home, stay in school, make progress toward self-sufficiency, and identify the father of the
child. The Administration also· supports a national campaign to prevent teen pregnancy. It is'
time to enlist parents and civic, religious, and business leaders in a c0tllIfiunity based strategy
to send a clear message about abstinence and responsible parenting. The Administration also
supports a state option not-to increase benefits for children born to mothers on welfare. This
decision should~e made by the state, not the federal government.
State Flexibility with Accountability
The Administration embraces the creativity and responsiveness of states, and the
opportunities for real reform when states have the flexibility to design and administer welfare
programs tailored to. their unique Circumstances .and needs. Already this Administration has
granted waivers to nearly half the states for welfare refo.nn demonstrations. National welfare
reform should embody the va:lues of work and responsibility in a way that assures taxpayers
that federal money is being spent prudently and appropriately. For reform to succeed, the
funding mechanisms for welfare should not put children or states at risk in times of
recession, popUlation increase or unpredictable growth in demand.
In this context, the Administration has serious concerns about the' proposed legislation:
o
The spending cap in the proposed legislation makes no allowances for potential
. growth in the need for cash assistance because of economic downturn,
population growth. or unpredictable emergencies. It could result in states
4
�running ou[ of money before the end of the year. and thus having to turn away
working families who hit a "bump in the 'road" and. apply for short-term
assistance. It could preclude states from investing in job placement, in work
programs, in education and training; and in supports for working families.
o
The proposed legislation removes the requirement that states match federal:
funds· with their own state funds. ' With none of their own money at risk, states
, will have many fewer incentives to spend the funds efficiently and effectively
[Q improve performance and increase 'self-sufficiency.
o
The' proposed legislation provides virtuaJlyno accountability. There are no
incentives for good perfonnance and virtually no penalties' for failure. There is
no provision for the recovery of monies paid out frauduiently or in error .
. There are no mechanisms for ensuring that states are actually spending the
money on needy children rather than on state bureaucracies, or for monitoring
whether federal money is being used to help parents gain self-sufficiency.
require work, and enforce parental responsibility. Indeed, the federal
government is forbidden from taking any meaningful steps to ensure program
perfonnance and accountability.
The Administration supports proposals that significantly increase state flexibility but also
ensure accountability for achieving national goals. The Administration supports a funding
mechanism that will not put children and states at risk down the road, and that enables states'
[Qsucceed in moving people from welfare to work and in supporting working families. The'
Administration has significant doubts about the ability of a pure block grant funding
mechanism to adequately protect both children and states.
Protection of Children
The Administration recognizes that the protection of children is the primary goal both of cash
assistance programs and of child welfare and child protective services. Cash assistance
programs assist families to care for children in their. own homes. Child protection services
help those children who are abused or neglected or at risk of abuse by their parents and who
need special in-home services or out of home placements to assure their safety. Strengthening
families, and where appropriate, preventing removal of children from their homes also 'are,
key goals of child protection services. There are problems in a number of areas.
Denial of Benefits to Children on AFDC
The legislative proposals that would refonn cash assisl3nce have a number of provisions that
would put vulnerable children at greater risk. .
5
�o
As noted above. the legislation would deny cash assistance to children of
unmarried minor mothers for their entire childhood, to children horn while the
parent was on welfare, and to children whose parent had received welfare for
more than five years. whether or not a job was available or the parent waS
unable to work. The funding caps· could have the effect of denying cash
assistance to childr~n when suites used up their allocated funds. for whatever
reasons. Children in low income working families, who may be' forced onto
cash assistance in times of economic downturn, could be most affected.
Child Protection Services
.Some of these children could well come into a system of child protection services that is
already seriously overburdened and that is failing to provide the most essential services.
Reported child maltr~atment and out-of-home placements have both been increasing sharply.
Many state 'systems. are in such distress that th~yhave been placed under judicial oversight.
The proposed legislation responds to these increasingly serious problems by consolidating
existing programs that protect children into a block grant with nominal federal oversight.
The Administration has serious concerns about this approach.
o
The proposed legislation caps spending for child protection programs at a level
considerably lower than baseline projections. This could)ead to uninvestigated
maltreatment reports, and to children b~ing left in unsafe homes with .minimal
services. 'It could also seriously hamper states'efforts to improve their child
abuse prevention and child protection systems.
o
The proposed legislation eliminates the adoption assistat:Ice programs, and
leaves it up to states whether they will significantly sustain the subsidies that
enable many special needs children to find permanent homes, and whether they
will honor commitments to those adoptive families that now receive subsidies.
o
The proposed legislation virtUally eliminates federal monitoring and
accountability mechanisms. It makes it impossible for the federal government
to ensure the protection of children.
o
The proposed legislation is sHenton the formula for allocating funds to the
states. Because of serious imbalances among the states in spending on child
protection,. it is hard to imagine a formula that would not disadvantage either
states that have been heavy spenders, or states that are oilly beginning to
improve their systems.
Substantial improvements need to be made in the child protection system and in the federal
role in overseeing that system .. The Administration supports a 'careful and thoughtful review
of the programs before actions are taken that might seriously harm millions of vulnerable
children.
6
�Denial of Benefits to Disabled Children on 55I
The Administration is deeply troubled by the changes proposed in the program designed to
help disabled children--5SI.
·0
o
..
The
proposed legislation essentially eliminates 551 ·benefits for children. with
the exception of a small group of children currently receiving benefits. Within
6 months, over one hundred thousand disabled children would lose eligibility'
for SSI benefits-~some would lose medical protection as well. And in the
future, rio child, no matter how disabled, will be eligible for any cash benefits
for 551, except if cash benefits prevent them from ·having to be
institutionalized. These ·proposals appear to penalize parents who are '. '
determined to care for their child no matter what the economic consequences
for the family. SSI recipients are among the neediest and most' vulnerable
. children. in the poorest families.
Some of the money saved is put into a new block grant for services to disabled
children, which would 'require the creation of a new state bureaucracy to
decide on appropriate services. This idea is. untested, and no one knows what
impact it will have on the most vulnerable of children and the parents who
care for thein. The 5-year cut off in AFDC for all persons along with the
elimination of 551 cash for disabled children may leave these children
extremely vulnerable.
, The Administration sees the need for careful reform in this area, with its potential for serious
harm to extremely vulnerable children. Last year the Congress established a Commission on
Childhood Disability to look into these issues in consultation with experts from the National
Academy of Sciences. The Commission will provide its report to the Congress later this
year. The Administration believes prudence dictates waiting for this short time until this
bipartisan commission, following a thorough review of all aspects of this important program,
has an opportunity to make recommendations.
'
Benefits to Legal Inunigrants
The Administration strongly believes that illegal aliens should not be eligible for government
welfare support. But the blanket prohibition of all benefits to legal immigrants who are not
yet citizens is too broad, and would shift substantial burdens to state and local taxpayers.
These legal immigrants are required to pay taxes. Many serve in the armed forces, and .
contribute to their communities. The Administration strongly favors a more focused
approach of holding sponsors accountable for those they bring' into this country and making
the sponsors" commitment of support 'a legally binding contract.
'7
�,
,
In summary, the Chairman's mark espouses goals for the reform of welfare--work, parental
responsibility, prevention of teen pregnancy and state t1exibility--that the Administration and
the American' people share. But the translation of general goals into specifi~ l~gislation
misses the mark in fundamental ways. The proposed legislation does not represent serious
work-based reform. It does nothing to move pepple from welfare to work, and it does n01
require everyone who can work go [0 work. It neither holds state bureaucracies accountable
nor cushions state taxpayers against recession. It puts millions of children at risk of serious
harm. There are alternative approaches to reform that achieve bur mutual goals in. far more
constructive and accountable ways.
The Administration reiterates its commitment to real welfare reform and its desire to work,
.
.
.
cooperatively with Congress to achieve it.
The Office of Management and Budget advises that there is no objection r.o the transmittal of
this repon to Congress.
A similar letter was sent to Representative Harold E. Ford. ,
Donna E. Shalala
,/
cc: Members of the Subcorru:nittee on Human Resources
,
8
�
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PDF Text
Text
RAfT
MEMORANDUM FOR THE PRESIDENT
FROM:
Alice M. Rivlin
SUBJECT:
Welfare Reform -- Conference Issues
Earlier this week, the Senate passed by 87 to 12 a welfare reform
bill that represents a significant improvement over the bill the
House passed last March. Senate conferees will be pressured to
compromise on the bill's provisions with their House
counterparts,' undoing improvements in many areas, such as ~he
added child care funding, a State maintenance of effort provision
and fewer benefit restrictions. These would be serious losses.
If there is to be a bill that the Administration can approve in'
good conscience, it is, imperative that we act fo prevent erosion
of, the Senate bill's gains and, wherever possible, make,
improvements. We should tell the conferees clearly that where
,the House and Sen~te bills differ on a major issue, th~ House
provisions are unacceptable and that a move to adopt them
jettisons the possibility that the bill can be signed.
But movement towar9sthe House bill,is not our only problem. The
Senate bill still has serious, shortcomings. Specifically, it
includes a very modest countercyclical mechanism, limited
resources for child care and job training, 'and deep cuts in the
,SSI kids, and immigrant provisions. The food stamps block grant
proposal also raises very serious concerns.';
This memo highlights the key differences between the House and
the Senate bill and flags key concerns.
MAGNITUDE OF THE BUDGET CUTS
After lengthy deliberations this summer, you proposed $38 billion
in 7 year savings in all low income 'non-health entitlements; The
Congressional Budget Resolution cuts far deeper in thi~ area than
the President's budget (about $110-120 billion over 7 'years) :- ,
The sayings in the,welfare bill represent the major component of
these savings goals.
'
,
,
,
'
As this memo highlights, the budget cuts inthe Senate bill,
_"
while maj or improvements, still create ,serious problems. If the;~,
conference moves closer to, the HoUse cuts, the problems, worsen'" "
The following table summarizes the, savings in the welfare bills.
1
�a
If
welfare bill is enacted as a freestanding bill, then the
Congress will be close to its budget targets for low income
non-health entitlements, {except for EITC, social Services Block
Grant, and some additional food stamps savings}. It is clear
that any final welfare bill will include considerably more cuts
to these programs than you have proposed.
KELFARE BILL SAVINGS
($ billions over 7 years, CSO, net of discretionary cap adjustments)
, Senate Bil1* '
President's
Plan*
AFDC/JOBS/Child Carel
CSE/Child Protection
Immigration, DA&A and
SSI Kids
Nutrition (excl.
, Imml.grants)
Total
House Bill*
o
-4
-16
-13
-31
~44
-33
-66
-102
*Ooes not include EITC or Title xx Savings
THE AFDC BLOCK GRANT
The Senate bill made many major improvements. More resources are
provided, particularly for child care, which is funded by a grant
and a setaside in the Senate bill. states must maintain some
level of effort to receive federal support., States would receive
bonuses for moving recipients into jobs. The punitive mandates
such as the family cap and 'teen moms restrictions included 'in the
House bill are gone. The foster care program is not cut
drastically. Work requirements are more responsible. A more
realistic proportion 'of welfare moms are exempted from the work
requirement. And states would have access to a contingency fund
to provide added resources in an economic downturn. These _are
very important improvements to the House bill that should be
retained.
While the Senate, made the AFDC,block grant much more acceptable,
there are still two significant problems with the Senate bill:
The first problem deals with funding ,;": ,
for training and, child care. The Senate bill toughens work ;:,":'c:, '"
program req'uirements on states while providing nearly flat
funding at the FY'1994 'level for AFDC cash benefits and 'work
Training and Child Care:
2
~
':
.. ,
1
:
, ..
....
. '.':
~ \~:~: .~
,
�programs, and significantly underfundschildcare. The House
bill cuts funding by $14 billion for these activities and. the
senate cuts $4 billion. For a point of comparison, senator
Daschle's bill adds $14 billion over seven years to pay for
implementation of work requirements. Given the low overall level
of Federal funding for the proposed block grant, states will be
forced to make tough choices -- either significantly increase
their own resources,cut the level of cash benefits, mandate some
of the punitive restrictions included as options in the Senate
bill, forego child care for, some children, and/or forego meeting.
the work requirements. The fiscal bind on states will worsen
over time.
contingency: The second problem with the Senate bill relates to
the contingency fund. The Senate established a very important
principle when it agreed to provide added resources during a
recession. But the funding level is insufficient. Between 1989
and 19~3, a period'encompassing the last n~tional economic
downturn, AFDC caseloads grew by roughly 32%, and total Federal
AFDC,expenditures grew'by $8 billion. The provision in the
Senate bill provides a total of $1 billion in countercyclical
assistance over five years. This is a pitifully small amount -
just 1% of Federal program spending' for the proposed AFDC, JOBS
and child care block grant over five years. Clearly, the
contingency in the Senate bill would not have been adequate in,
the last recession, and it is extremely unlikely to provide a
meaningful cushion. in future downturns.
NUTRITION PROGRAMS '
On three out of four counts, the changes to the nutrition
programs in the Senate version of the. bill are vastly preferable
to the House version. ,The House.welfare bill would:
(1) create block grants for the child nutrition programs
iricluding school lunch,
(2) cap the overall. level of food stamps spending, so that
. a r.ecession would cause a nationwide reduction in
. benefits,
(3) cut food stamps benefits by about $34 billion over 7
years, reducing benefits by almost 25% in FY2002 and
about' 35% by FY2005, . and
(4) establish an optional food stamps block grant
but
~ for those states with a' fully eS,tablished
.,'
comprehensive electronic benefit system (EBT)to replace
food coupons.·
..
effectlve ln
\'~":", :, -\~":'i:.~.~ ',~, !, ,~.~r.:,~,:'·,
""}; ~.;:.;~~'tl~ji~:.. '.
strongoppositlon
In the Senate, we were
our
. House child nutrition block grants and the'fo~d
·3
stamp~
to the
cap. The
�senate bill rejects these two policies and pared back food stamps
only about two thirds as deeply as the House, but created an
open-ended option for states to block grant food stamps.
Budget Cuts: The Administration's budget proposal was fashioned
to reduce spending in the Food stamp program while preserving
uniform, national eligibility for most of those currently
entitled to the program. Our seven yearf,ood stamps ,savings are
$19 billion. While our spending cuts proposal is tough and the
Senate proposal very tough, the House proposal can only be
characterized as downright draconian. We need to try to hold the
line here.
'
Food stamps Block Grant: The one area where the House bill is
preferable to the ,Senate relates to the food stamps block grant.
We have always maintained that the preservation of a national
food stamp entitlement program is critical if there is to be an
AFDC block grant, since a national nutrition program helps to
moderate the effects of the AFDC changes on low income families.
The House provision requires that States be able to provide food
stamps electronically via Electronic Benefit ,Transfer (EBT) and
that they dedicate all of the benefit monies to food assistance.
The EBT requirement will delay State's decisions to block grant
food stamps for a couple of years'. And by requiring that the
block grant be for food assistance alone, States will be
precluded from making whole a family'~ AFDC cuts by converting
Food Stamps to cash. The House ap'proach, while not perfect,
basically keeps Food Stamps as a national program.
Unfortunately, the'Senate's food stamp' block grant option'
essentially endangers ,the national progra~ by taking a big step
towards abdication of th~ national role in, c6mbating nutritional'
deficiency. Because the, Congress plans to cut the program so
deeply, many States, at leas~ initi~lly, will receive less
federal funds if they stay in the national program rather than
opt into the block grant. And if a large number of states opt
out of the unifdrmentitlement, political support for the progra~
will fall. In addition, since the bill requires that only 80% of
the block grant be used for' food assistance, the current language
would allow States to make even deeper nutrition cuts. ,The
remaining 20% of the grant' can be used for non-nutrition
purposes, making up for fiscal pressures elseWhere.
'
In conference, we need to significantly tighten up the f~~d
,'
stamps block grant, stop the House child nutrition block grants
and the food stamps cap and try to keep overall savings in the
range of the Seriate bilL
":"~;~'
BENEFITS FOR IMMIGRANTS
"'- l~~'"
.'
/;'"'5:~~<
.'
Both the House and Senate bills ,include very steep reduct10ns in
benefits to legal immigrants. If these proposal~ become law,
"~~j:~r:
4
�billions of dollars in costs may be shifted to states with high
immigrant populations unless th~ states also choose to restrict'
. benefits. House and Senate immigration savings amount to $26
billion and $19 billion, respectively, over the next 7 ye~rs.
Your budget plan, on the other hand, proposed only $5 billion in
cuts affecting immigrants. The House bill _.... the more severe of
the two approaches -- would ban from the rolls over 1 million
immigrants currently enrolled in eit:Qer SSI,Medicaid,or food
stamps.
While the Senate legislation on immigfants is somewhat softer
than the House bill, it still makes dramatic changes. The Senate
bill denies SSI benefits to approximately 400,000 elderly and
disabled non-citizens currently receiving benefits -- almost all
immigrants now on the SSI rolls. For all Federally funded, needs
based programs, including Medicaid, the bill would limit access
to benefits for many immigrants currently in the country and
would ban most new immigrants from a wide range of benefits for 5
years after entering the country. The Senate bill would also
deny benefits to naturalized citizens for up to seven years after
they become Americans (the Vice-President has expressed the
Administration's opposition to this provision). Under the Senate
bill, a working poor legal immigrant who becomes disabled would
be ineligible for any cash or non-emergency medical assistance.
A number of provisions could make th~ legislation more
acceptable. First, benefits could be allowed for naturalized
citizens. Second, benefit termination could be limited to cash
benefits, thereby continuing Medicaid for poor i~migrants.
Finally, exemptions could be made for current SSI recipients
and/or immigrants who become 'disabled after entering the country.
All of these proposals have merit, but would significantly reduce
savings. The Congress will strongly resist efforts to soften the
immigrant provisions.
DI SABLED KIDS'
The Senate bill is vastly preferable to the House bill on its
approach to reforming the SSI children's disability program. The
House bill cuts $14 billion over 7 years and terminates. all cash
assistance to 170,000 kids now on the rolls and 875,000 by the
year 2000 (only 20% of currently eligible kids would receive cash
assistance). State provided support services would be provided
to about. half of the eligible kids denied cash benefits' through a
new Federal block grant.
. '
The Senate bill does not cut eligibility as deeply and continues",
cash benefits for all eligible children. But the Senate, bill . ,'"
Viould still, terminate benefits for 170,OOO,disabled kids now' ori;:i;;;
the SSI rolls and another 225,000 by the year 2000. The Senate' ", '.
bill saves nearly $9 billion over 7 years, compared with $5
.
billion in your plan. Both the Hou~e and Senate bills ~o too far;
5
" (,
�we could argue for a final bill that makes special arrangements
for kids already on the rolls, but this would reduce savings.
CONCLUSION
As outlined in this memo, we believe.that the Senate bill, while
vastly preferable, still has shortcomings, and most problems
can't be fixed without added resources. We need to try to fix
the Senate problems. But-- at a minimum-- if we aren't in a
position to strengthen the Senate bill, we have to' push hard to
maintain the gains won in the Senate and to draw the line on
additional .cuts in low-income programs.
It is likely that the bill will move quickly to conference. The
Administration needs to work quickly on its conference strategy
in the hopes of . influencing the final outcome of the bill. Since
we need to articulate our positions clearly to the Congress, we
will develop an Administration statement on the bill as soon as
possible. We will draft. such a statement for clearance within.
the white House.
, , " ,t,
6
�September 22, 1995
MEMORANDUM FOR THE PRESIDENT
FROM:
Bruce Reed
Rahm Emanuel
SUBJECT:
Welfare Reform Conference Strategy
I. Overview
From the outset, our strategy bn welfare reform has been to steer the debate our way
by exploiting Republican divisions between moderates and conservatives, governors and
Congress. Those divisions enabled us to hold the center in the Senate. While the Senate bill
is far from perfect, we have made significant progress on the lines you have drawn all year
long: promoting work (child care, work performance bonus, state match, contingency fund)
and protecting children (child support enforcement, school lunch, requiring teen moms to live
at home instead of cutting them off or sending their kids to orphanages) .
. Our strategy should be much the same in conference -- to use Republican divisions to
our advantage. Once again, we need to insist that welfare reform must be tough on work
and fair to children. We need to use Republican moderates in the House, Senate, and
statehouses to help hold onto the gains we have made. And we need to make Republicans
understand that a conference· report that veers too far from the Senate bill will not pass the
Senate, let alone get past your desk.
Conferees will be named next week, but the timing of the conference is up in the air.
Dole appears to be pressing for a quick, stand-alone conference. Gingrich is tom between
conservatives who think they can get more of "what they want by putting welfare reform into
reconciliation, and a smaller camp led by Clay Shaw that wants to make some concessions in
our direction .. More than likely, the Republicans will pursue welfare reform on parallel
tracks, with a conference committee that can be severed if reconciliation bogs down or their
poll numbers continue'io drop and they need to produce something.
1
�II. Pre-Conference Strategy: Framing the Debate
A. Tough on Work, Fair to Children
While Congress gears up for conference, you have an opportunity to frame the debate
at a time when the press is more focused on this issue than ever. Your goal should be to
hammer home the message you delivered .this week: If Congress stands up for the bipartisan
common ground of work. responsibility. and family. we'll have real welfare reform and it
will be a great thing. But if Congress tries to weaken the work provisions or punish
children. that wi11 kill welfare reform. because we haven't come this far together to settle for
welfare fraud.
By framing it along those lines -- tough on work, not tough on children -- you will
lay the groundwork to sign the bill if it's acceptable, and veto it without regard to the politics
if it's not. If the conference stays close to the Senate work provisions and rejects the teen
cutoff and cuts in child welfare and school lunch, you will have spelled out good reason to
sign the bill. If the conference guts maintenance of effort, child care, and other key work
provisions, mandates the teen cutoff, and cuts school lunch, you will be able to make a
.
strong, pro-reform case for a v e t o . ·
Your public focus should continue to be on making the case for real reform that
doesn't punish children -- not on the particulars of what you would sign or veto. We should
be as clear as we can with the Hill about what we can and cannot accept, and Leon and
Donna Shalala can press a tough line in those discussions. But in your public statements,
you should remind people of our first line of defense: a bill that lacks bipartisan support and
is weak on work and tough on children cannot pass the Senate and will never reach your
desk.
B. Seizing the Bipartisan High Ground
Another objective in the run-up to conference should be to remind the elite media that
. we occupy the high ground in this debate. With the general public, you are running even or
ahead of the Republicans on this issue -- a 20-point shift in the last eight months. But we are
taking a beating among the editorial elite, who want to blame the Gingrich revolution on us
because Congress didn't pass welfare reform last year. We should do three things to·tum
that around: 1) take every opportunity to point out that 87 Senators voted for the Senate bill,
and that House Democrats plan to offer a motion to instruct the conferees to support the
Senate bill; 2) meet with the leading columnists on welfare reform (see below); and 3) step
.,up the attack against the cut-off of unwed teen mothers.
The press is particularly attune to the illegitimacy issue because it divides the
Republicans, and it will help us remind everyone of the real moral divide in this debate:
Back in November, the Republicans were talking about cutting off teen mothers, putting their
children in orphanages, and embracing Charles Murray's Bell Curve. By speaking out on
2
�the issue all year, you helped lead the Senate back to real welfare reform that's about
.
promoting work instead of punishing illegitimate children.
C. Communications
We will set up a number of opportunities for you to deliver your message:
•
Waivers: The North Dakota waiver, which includes time limits and a personal
responsibility contract, is ready to go. We will find an opportunity for you next week
to use the North Dakota waiver to send the message that if Congress can't deliver a
bill that's tough on work and fair to children, you'll continue to end welfare one state
at a time.
•
Work visit: As you suggested, we have put in a scheduling request to visit a' work
site that is operating under one of your state waivers. This will give you another
chance to promote work, highlight your record on waivers, and underscore governors'
bipartisan desire for a bill that provides resources to put people to work and doesn't
force states to cut off young mothers and their children.
'
•
Columnists: We would like to bring back in the opinion leaders you met with in
January (Ron Brownstein, E.J. Dionne, Mickey Kaus, Jacob Weisberg, etc.). One
way to seize the .high ground in this debate is for you to sit down with the handful of
columnists who genuinely'care about real reform, and explain to them how far the
Republicans have come our way and why. the Senate bill has the potential to be better
than the current .broken system. Shalala can host a similar meeting with reporters
who cover the welfare beat.
•
Other events: We should continue to use radio addresses, waiver announcements,
and other opportuni~ies to drive this debate. Because the press is focused on this
issue, everything you say about welfare reform over the next month will be news.
m.
Conference Strategy
Dole and Gingrich know they can't stray too far from the Senate bill in conference.
Dole can't pass a conference report without his moderates, and a significant number of
House moderates went along with Gingrich in March only after he promised that it would be
improved in conference. Our success in conference depends on where House and Senate
moderates decide to draw the line.
'
A. Major'Issues
The most difficult issues to reconcile in conference will be:
3
�1. Money: The Senate bill saves $66 billion over 7 years; the House bill saves $102
billion. If the conference accepts something like the Senate number, they will have to find
other savings later (from Medicaid or EITC) to meet their targets in reconciliation. But
accepting House cuts in child welfare, child care, or school lunch could kill the bill in the
.Senate. The conference might look instead at food stamps and SSI, which the House cut
somewhat more deeply than the Senate.
2. Dlegitimacy: Conservatives say they need "something" on illegitimacy to go
along with the bill. We will beat them on the mandatory teen cutoff, which the Senate
rejected 76-24 and is wildly unpopular with the general public. Similarly, they know a
mandatory family cap cannot pass the Senate. The most likely face-saving compromise (if
governors and moderates go along) will be what House Republicans proposed in their bill last
year: mandating the family <;:ap but allowing states to opt out. That may give everybody
cover: conservatives can say they passed a family cap, but governors and moderates will
know that the choice will still be left to the states. (Under a block grant, the difference
between opt-out and opt-in is mostly cosmetic, because every state will design its own plan
from scratch anyway, and have to resolve dozens of questions like this as part of enabling
legislation before anything can take effect. For that matter, even the mandatory family cap
in the. House bill is an empty -- although offensive -- gesture, since the strings only apply to
the federal money and states could continue to pay additional benefits out of their own
funds.) The moderates should hold out as long as possible on this issue -- it's their best
leverage to get conservatives to go along with everything else.
3. Maintenance of Effort: On most issues in conference, Republican moderates and
Republican governors will be on the same side with one another and with us. In fact,
Gingrich has asked Engler to try to sell House freshmen on the Senate'bilt. But maintenance
of effort will be a tougher battle because the moderates· are for it but the governors are not. .
We'll get something -- the question is whether Chafee will hold out for a provision that lasts
the fullS years. We have talked with Breaux about a strong fallback position that would let
states out of the maintenance of effort requirement only if they are meeting their work
requirements (which they'll be hard pressed to do without spending their own money). OMB
is also working on a new trigger for the contingency fund that would score the same as the
Senate version but provide the states a lot more money in an economic downturn.
B. Influencing the Conferees
Once conferees are named., we can .launch an aggressive campaign to shape their view
of what can pass the Senate and what can become law. Our allies fall into three camps:
1. Senate and House Moderates: Because their loyalties are to Dole and Gingrich,
not to us, their bottom line may be slightly different from ours -- but not by much. In each
house, we expect moderates to gather as many signatures as they can for public letters to the
conferees on their main concerns -- maintenance of effort, child care, child welfare, school
4
�lunch, and punitive mandates: We' will do everything we can to reinforce their resolve with
regional press and editorials in their home states, phone calls from Democratic governors and
Republican mayors, and encouragement from religious organizations and other outside
groups. They will,also look to us for help in taking certain things off the table, like block
granting child welfare and school lunch. '
2. Governors and State/Local Officials: They can help us on the money issues and
on mandates. During the Senate debate, the NGA sent a bipartisan letter that called for
almost everything we wanted: more money for child care, contingency fund, performance
bonus, and no punitive mandates. We need to energize the Voinovich wing of the NGA,
including Whitman, Ridge, and Bush. Other groups will weigh in as well -- NACO, APWA,
NCSL, and the mayors.
3. Catholic Church, Religious Groups, and Pro-Life/Pro-Choice Coalition: The
same groups that beat the teen cut-off and mandatory family cap in the Senate will be
outspoken in conference. They can help bolster the moderates not only on the mandates but
also on child care, child welfare, and school hinch.
C. Bottom Lines
Sometime soon, we will need to talk with you about what to say in the official
Administration letter to the conferees on what we like and don 't like in both bills and what is
unacceptable. We have made our priorities clear all along, and most of them are addressed
in the Senate bill. But we need to discuss what level of specificity we should provide
, (publicly and in private) on what would prompt a veto. We have to approach this decision
with extreme care -- not only to avoid boxing ourselves into a comer, but also to avoid
undercutting the moderates. In the end, the biggest issue between the House and Senate in
conference may be over whether to send you a bill you can sign or force you to eat a veto.
We have to do everything we can to make sure Dole and Shaw win that argument, not
Gingrich and Haley Barbour.
For now, our best guess is that it would be helpful (at the right moment) to declare
some things absolutely unacceptable: the teen cut-off, a mandatory food stamp block grant,
and block granting child welfare and sch~llunch. The Senate rejected the first two by votes
of 76-24; the latter two were so far out-of-bounds that the right never even brought them to
the floor. At the same time, we can say that the work provisions are essential to the bill
(maintenance of effort, child care, work bonus, personal responsibility contract, contingency
fund), with the private understanding that marginal changes like 75 % maintenance instead of
80% are not necessarily beyond the pale. Finally, there are difficult-to-improve areas like
the SSI and immigrant cuts where we should make a lot of noise without signalling a veto, so
that.even if you sign this bill, you reserve the right to try to soften those cuts as part of,
reconciliation. On the family cap, we can say we will not accept a bill that gives states no
choice in the matter.
5
�We should talk next week about how to proceed from here.
6
�SEP 28 1995
THE SECRETARY OF HEALTH AND HUMAN SERVICES
WASHINGTON, D.C, 20201
SEP 27 1995
MEMORANDUM FOR THE HONORABLE CAROL RASCO
SUBJECT:
Policy Recommendations On Immigrant Eligibility For
Benefits
The issues regarding immigrant eligibility for benefits are
complex and difficult, and the accompanying debate is often
emotional and misinformed. As you know, there are currently a
variety of 'proposals -- in pending welfare and immigration bills,
as well as by the Jordan Commission on Immigration Reform -- that
would affect immigrant eligibility for benefits. Most of the
proposals would affect hundreds of thousands of legal immigrants'
and -- in some cases -- even naturalized citizens.
Since many of the proposed changes would affect programs under ~y
management, I have undertaken a thorough review of p~licies in
this area. The attached recommendations, which I have approved,
represent consensus among the operating and staff divisions in my
Department. These recommendations were developed with careful
consideration of the various proposals under debate. Since both
welfare and immigration proposals are reaching late stages in the
legislative process, I urge that these recommendations be
seriously considered by the Administration in current legislative
discussions.
I look forward to talking to you about these policy
recommendations.
Donna E.' Shalala
Attachment
�.,
ATIACHMENT
POllCY RECOMMENDATIONS ON IMMIGRANT ELIGIBILITY FOR BENEFITS
1.
Deeming and Affidavits of Support
We strongly believe that immigrants should not become "public charges" after entry into
the country, and that sponsors should be held responsible for immigrants. they have '
agreed to support. Changes in deeming policies and in the affidavit of support are
necessary to strengthen these obligations and responsibilities. At the same time, we also
support continuation of family reunification and the equitable treatment of legal
immigrants and naturalized citizens, particularly given the many positive politiCal,
economic, social and cultural contributions that .immigrants and their families have made
to this country. Any changes inbenefit eligibility rules must strike a reasonable balance
between these mutual goals.
We recommend extending the period of deeming to 10 years or until the immigrant becomes
a naturalized citizen, whichever occurs first We also recommend applying these extended
deeming rules only to the three Federal programs that currently implement deeming: AFDC,'
SSI, and Food Stamps. These deeming changes should apply prospectively to new
immigrant applicants (ie., current recipients should be grandfathered under current deeming
rules) to minimize the disruption to individuUJs and communities. State and local cash
general assistance programs should also be ,allowed to use these same deeming niles.
This policy represents a significant toughening of current eligibility rules. A' lO-year
deeming period is double the current (temporary) S-year SSI deeming period, and more
than triple the current 3-year AFDC and Food Stamp deeming period. It sends the clear
message that we take seriously the, commitment made by immigrants to not become
public charges. Once immigrants become citizens, however, we should recognize that
they have become full partners in our society and accord them the same rights, including
benefit eligibility, provided to other citizens. In addition, we have been advised by the·
Department of Justice that applying sponsor deeming rules beyond citizenship raises
serious Constitutional issues.
'
We recommend administering deeming rules only in the cash or cash-like entitlement
programs, although the affidavit of support would be enforceable. against the receipt of
the
other benefits (see discussion below). In particular, expanding deeming rules
Medicaid program, public health clinics, child welfare and social services, maternal and
child health block grant, etc., would undermine overall public health while increasing
administrative complexity. In addition,. requiring doctors, nurses, Head Start
teachers, and, other community providers to verify alienage and apply deeming rules
making certain legal immigrant children and families ineligible for services would have a
to
�Page 2
pernicious effect on communities. It would undermine the critical authority of and
respect for those individuals within their communities, and diminish the role of their
institutions in many ethnic communities. These effects are counter-productive to HHS'
mission to protect childreri and families.
We recommend making the affidavit of support legally binding on sponsors for the same
period of time as deeming: 10 years or until the immigrant naturalizes. We also recommend
that the affidavit commit sponsors to meet the ongoing needs of immigrants, including
income, food, housing, and medical needs. The affidavit should also be enforceable with
respect to similar state and local programs of assistance.
This policy unquestionably imposes greater responsibilities on sponsors compared to
current law. Enforcement of deeming and affidavits of support for 10 years or until
citizenship is more' stringent than some proposals (e.g., the House Republican
immigration bill -- H.R. 2202), and less stringent than others (the Senate Republican
immigration bill -- S. 269 -- and welfare bill -- S. 1120 -'- the House Republican welfare
bill -- H.R. 4; and the Jordan Commission). While our recommended deeming and
affidavit policy imposes much greater responsibilities on immigrants and sponsors, it is
also reasonable enough to allow continued family reunification. It would be harder to
immigrate under the conditions we propose, but unlike the more stringent proposals, it
would not be so hard as to deny reunification to many immigrant families, particularly
middle income families.
The interaction between the recommended deeming and affidavit of support policies
could create a "pay-and-chase" situation for some sponsored immigrants. For example,
since we are recommending not to extend deeming to Medicaid, a sponsored immigrant
may become eligible for and receive Medicaid services. As long as the affidavit of
support was still applicable, however, the immigrant s sponsor would be liable to
reimburse the government for the cost of services rendered the immigrant. So while the
sponsored immigrant is "paid" the benefit, government will be authorized by the affidavit
of support to "chase" after the sponsor to compel reimbursement for the amount of
benefits provided to the immigrant. We recognize that this policy may be somewhat
difficult to administer, but we think it is a necessary policy choice to balance the goals of
improving public health and safety while protecting and conserving public expenditures.
We recommend proViding "good cause" exemptions from the new deeming and affidavit of
support rules. Immigrants who can prove that their sponsors refuse to support them should
be exempt from deemin& although the affidavit would be enforced against the sponsor along
. with a monetary penalty. Immigrants or sponsors who become severely disabled within the
deeming and affidavit enforcement periods should be exempt from the deeming and affidavit
rules. Similarly, a sponsor who becomes bankrupt should be exempt from the affidavit of
support, and the sponsored immigrant should be exempt from the deeming rules, until the
circumstances of the sponsor have improved.
�Page 3
The longer deeming and affidavit periods we are recommending are likely to result in
more cases in which either the sponsor or the immigrant experience severe reversals of
fortune. Current deeming rules exempt sponsored immigrants who become disabled
after entry. This principle should be expanded to include other potential "good cause"
exemptions. The situation regarding an immigrant denied support from a sponsor would
lead to the same type of "pay-and-chase" situation described earlier. It should be noted
that since the legally binding affidavits of support could be applied only to new' entrants
coming into the country, there would be some immigrants already in the U.S. to whom
the extended deeming period recommended above may apply but whose sponsors would
have signed the older non-binding affidavits of support (i.e., those current immigrant
residents who are not currently benefit program recipients who would be grandfathered).
If these immigrants became eligible for benefits as a result of the "good cause"
exemption from deeming due to a delinquent sponsor, there would be no mechanism to
compel reimbursement from their sponsors ..
Since the affidavit of support is a document required for immigration purposes, we
recommend that the Immigration and Naturalization Service -- or another law enforcement
agency -- be responsible for identifying delinquent sponsors and enforcing reimbursement on
behalf ofgovermnent agencies that provide benefits to persons whom they have sponsored.
We also recommend that some conditions be required of sponsors at the time they petition
for the entry of immigrants, similar to the current practice that requires sponsors to
demonstrate that with their responsibilities for the prospective immigrant they can maintain
income levels above the poverty line.
Consolidating enforcement of the affidavit of support within a single law eriforcement
agency would be more efficient than spreading such enforcement responsibilities among
many benefit programs. In addition, it would be useful to consolidate information
regarding sponsors within the INS, particularly information on delinquent sponsors, since
such persons should not be allowed to sponsor any additional immigrants until, they have
fully met their finaJ?cial responsibilities.
The current requirements on sponsors petitioning for the entry of immigrants provide a
modest threshold and allow middle income families to be reunited, in addition to
wealthier families.
2.
Health Insurance
Both the Jordan Commission and the House Republican immigration bill (H.R. 2202)
would require immigrant parents (or their adult children sponsors) to purchase and
maintain health insurance as long as they are living.in the U.S. H.R. 2202 would require
the purchase of private health insurance comparable to Medicare (parts A and B) and
Medicaid long-term care coverage. The Jordan Commission has proposed allowing such
immigrants to purchase upon entry Medicare insurance (parts A and B) and Medicaid
�Page 4
long-term care at an actuarially fair price .. Immigrants over age 65 are currently eligible
to purchase Medicare only after 5 years of residence.
We recommend opposing a health insurance mandate for immigrant parents because it
cannot be administered and it would be inequitable. [OMB cOTlCUffed with this. .
recommendation in the Administration's bill report on iLR. 2202J
Failure to mandate health insurance coverage could be misperceived as allowing
continued reliance on taxpayer-funded services. However, as noted above, we are
recommending the affidavit of support be binding with regard to taxpayer-funded health
services. Therefore, we expect a significant reduction in participation in Medicaid by
sponsored immigrants, particularly the elderly immigrant parents of citizen adult
children.
Such a mandate would not be administrable. Private health insurance policies'
comparable to Medicare plus the long-term care benefits of Medicaid may be .
unavailable at any price. The long-term care insurance industry in particular is in its
infancy. Availability, type and quality of benefits, consumer safeguards, and regulation
by state insurance departments all vary widely. It is not known whether current
premiums will· provide sufficient revenue to pay promised benefits many years in the
future. In addition, since long-term care policies generally contain far more limited
benefits than Medicaid they could not be considered comparable.
There would be other complications with such a re,quirement. For example, insurers
generally require medical examinations and tests before they will offer individual acute
or long-term care policies and are unlikely to accept tests performed outside the U.S. A
health insurance mandate on immigrant parents would necessitate reliance upon state
insurance departments to determine the acceptabIlity of individual policies, to monitor
and enforce continued coverage, and to convey this information to consular officials
worldwide.· No additional resources are provided to fund this additional administrative
requirement on the states.
.
To the extent health insurance coverage could be purchased, the cost would be
prohibitive. Our preliminary estimates indicate that, for parents age 65 and over,
premiums for Medicare comparable acute care coverage plus a minimally acceptable
long-term care policy would average between $7,000 and $13,000 per person per year,
with costs only slightly lower for parents under the age. of 65.. These insurance
requirements would effectively allow only wealthy American families to bring their
parents' to the United States as immigrants.
Finally, such a health insurance mandate would be inequitable because it would apply
. only to qualifying parents and ·not to other classes of 'immigrants or U.S. citizens whose
age, health, and uninsured status make· them equally likely to incur uncompensated care
�Page 5
costs. Further, imposing a mandate upon purchasers of health insurance, absent a
corresponding mandate that insurers offer such coverage on an equitable basis, would set
standards that are virtually impossible t'o meet.
We recommend that current law be modified to allow elderly immigrants (over age 65) to
purchase Medicare immediately at an actuarially fair price -- that isl nearly $5,000 per year
with non-subsidized Part B coverage.
Given that affordable health plans for elderly individuals covering doctor and hospital
services are not generally available, it is appropriate to provide a realistic option to such
immigrants and their families.· The part B premium for such individuals would revert to
the subsidized rate after 5 years residence (similar to current law).
We recommend against the option to allow immigrant parents to purchase Medicaid long
term care benefits.
There is curreritly no Medicaid premium or actuarial pricing of Medicaid benefits in
general, let alone the long-term care portion of Medicaid. Such an option would require
more personnel and newadmiriistrative structures to be established either by states or
the Federal Government. If states administered the option, there would be the issue of
uniformity of benefits and premiums across states. If the Federal Government
administered the option, there would be the issue of imposing a uniform federal
requirement on the several states.
3.
Eligibility Definition, Illegal Immigrants, Number of
Programs Affected, and Verification
Illegal immigrants are currently ineligible for entitlement benefits, other than emergency
medical services. However, many discretionary programs -- such as Head Start, the
public health clinics, and the block grant programs -- do not verify immigration status as
a condition of eligibility. In addition, under the HHS entitlement programs that do
verify immigration status (AFDC, Medicaid, SSI) the courts have determined that certain
individuals with specific· marginal legal immigration statuses (e.g., voluntary departure)
should be considered "permanently reSiding in the U.S. under color of law" (PRUCOL),
and therefore eligible for benefits.
The Administration's welfare reform bill -- the Work and Responsibility Act of 1994
(WRA) -- proposed a new, more restrictive definition (similar to the 'current Food Stamp
definition) of eligibility that would be applied to AFDC, Medicaid and SSI. The
Republican legislative, proposals tighten even more the range of immigrants who would
be eligible for benefits and generally apply that definition to all federal 'programs and
benefits, including discretionary spending programs.
�Page 6
We recommend the more restrictive definition of eligibility proposed in the WRA, (l1lI1
recommend applying that definition to AFDe, Medicaid, and SSL Ilabsolute co",slstency is
desired then we could suggest that Food Stamps use the same immigrant eligibility definition.
State and local cash and medical ge(leT'al assistance programs should also be allowed to use
the same definition of immigrant eligibility for their programs. 10MB communicated a
similar position in the Administration's bill reports on S. 269 and H.R 22021
Requiring additional discretionary programs to establish new immigrant eligibility criteria.
would also require such programs to begin verifying immigration status .. This would be
espe9ially problematic for a number of HHS programs, such as. Head Start, child welfare
services, public health clinics, social services and maternal and child health block grants.
Denying such services to illegal immigrants would undermine general public health and
safety, and have the type of pernicious effects that would result from extending the
deeming requirements to such programs.
Many immigrant families are of "mixed status" -- consisting of members who are both
citizens (usually children, but also parents) and immigrants, both legal and illegal
(usually parents or other adult relatives). If additional HHS programs were required to
begin verifying immigration status to deny benefits to illegal immigrants, it is likely that
many families would not bring their children to those programs for assistance out of fear
of being identified. Even legal immigrants would avoid these services for fear of being
mistaken for illegal aliens. This "chilling effect" would be harmful, increasing poverty
and affecting the overall health and welfare of families and the communities they live in.
HHS' mission is to protect children and families, and we strongly believe that a broad
requirement to verify alienage would undermine our fundamental mission.
In addition, requiring new verification procedures under discretionary-funded programs
would result in the expenditure of limited appropriations on those procedures, leaving
fewer resources to provide critically needed services.
Our recommended policy of a more restrictive eligibility definition targeted to major
entitlement programs would provide entitlement savings without diminishing
discretionary services or the general public health and safety.. It would also allow for
continued reliance on the Systematic Alien Verification for Entitlements system (SAVE)
which operates effectively to ensure that only legal immigrants receive entitlement
benefits. While some improvements should be made to the system, particularly related
to sponsorship information, this approach.would not require significant new resources. If
a new centralized data base is established in the.' future with regard to employment
verification needs, as has been proposed, then it may be more effici~nt to use such a
system for benefit eligibility verification purposes as well. However, there would still be
issues related to privacy, reliability,. government intrusion and potential for discrimination
that would need to qe considered under suchan approach.
.
�Page 7
4.
Reporting Illegal Immigrants To INS
Current benefit program .statutes have privacy provisions that have been interpreted 'to
effectively prevent AFDC and Medicaid from reporting illegal immigrants to INS. In
addition, the SAVB system also has a statutory provision prohibiting use of information
received from that system from being used for enforcement purposes.
Both the House Republican immigration bill (H.R. 2202), and the Congressional Task
Force on Immigration chaired by Rep. Gallegly (R-CA), would allow program personnel
to report illegal immigrants to INS. The Jordan Commission has been silent regarding
such reporting requirements, although they have noted the lack of resources to carry out
current apprehension and deportation priorities.
We recommend maintaining the status' quo which generally prohibits health and welfare
workers from reporting illegal immigrants to law enforcement agencies.
Such reporting requirements would exacerbate. the pernicious and "chilling" effects
summarized earlier relate9 to expanding verification of alienage status to additional
discretionary programs. Requiring HHS to assume such a law enforcement role would
undermine our fundamental mission to protect children and families.
5.
Refugees, Asylees and Other Sponsored Immigrants
Both the Jordan Commission and the House Republican immigration bill (H.R. 2202)
propose statutorily restricting the number of refugees admitted each year. It is
anticipated that Senator Simpson (R-WY) will introduce a legal immigration bill to
restrict even further the number of refugees. The Adminirtration has opposed such
provisions on the grounds that they unnecessarily restrict the flexibility of the President in
setting the annual refugee ceiling, and we recommend continuing that policy. We also
recommend that refugees, asylees and others who are victims ofpersecution be generally
exempt from the benefit limitations proposed for other immigrants, such as deeming or
requiremeitts for legally binding affidavits of support.
On a more technical issue, we are concerned that changing policies related to the
migration of Cubans and residents of the former Soviet Union (primarily Jews) may
create unintended consequences, particularly in light of the increased restrictions we are
recommending for legal immigrants in general. We recommend that in the case of various
parolee groUps, the Attorney General should identify classes of sponsored immigrants who
have been paroled into the U.S. for compelling humanitarian reasons (e.g" Cubtinsand Jews
from the former Soviet Union) and have the authority to waive the conditions of the affid(JVit
of support.· In consultation with the Attorney General, the Secretaries of RHS and
Agriculture and the Commirsioner of Social Security could decide to waiVe the deeming rules
for these classes of parolees. This approach is consistent with the one proposed in the
�Page 8
WRA with regard to immigrant eligibility and allows immigrants that are similar to
. refugees except for immigration status to be treated as refugees for purposes of public
assistance.
�Attached is my draft that analyzes major points that arise from
the House and Senate Welfare bills and legal immigrant
eligibility. I wish it were shorter, but it remains unclear to me
whether all of this is known and has.been rejected previously or
whether these issues were considered secondary because of the
overriding issue of how citizens would be treated. If the former,
then you can safely ignore most of the text -_. although because
of the importance of the issue, I urge revisiting it for
conference committee purposes .. If the latter, then I think the
length of the memo is necessary to set out the outline of what is
about to be done and a few ideas of how to address these matters
given what we must work with in the provisions of the Senate and
House welfare bills.
Thanks.
Let me know whatever follow-up may be helpful.
�BENEFITS AND LEGAL IMMIGRANTS
The restrictions on benefits for legal immigrants in the House
and Senate bills will create one of two outcomes: hardship for
many immigrants who find themselves in need of a temporary safety
net or, if other levels of government provide this protection,
significant cost-shifting to states and localities.
I. Summary of Relevant Provisions of the Legislation
A. House Bill
•
Bars legal immigrants (with limited exceptions) from
receiving SS1, AFDC, Food stamps, nonemergency Medicaid, and·
Title XX block grant services.
- ilLegal immigrant" does not include: refugees <5yrsi
legal permanent residents >75 years old' in u.s.
>5yrs; veterans, active duty service members, and
spouses and dependents; those too disabled to pass the
naturalization exam.
•
Deems for life or citizenship (applies only to new
immigrants) for all federal, state and local means-tested
programs, except federal housing.
•
Ma.kes affidavits of support legally enforceable.
B. Senate Bill
•
Bars legal immigrants for 5 years for any needs-based
assistance funded in whole or in part by the federal
government. Exceptions:
-Emergency Medicaid;
-short-term emergency disaster relief;
-assistance or benefits under the National School Lunch Act;
-assistance or benefits under the Child Nutrition Act of
1966;
-public health assistance for immunizations and for testing
and treatment of communicable diseases if the Secretary of
HHS determines that such testing and treatment is necessary;
-Head start;
-title 1V-E foster care and adoption assistance [Boxer
Amendment]
:...programs specified by th~ Attorney General in the Attorney
General's sole and unreviewable discretion after .
�consultation with appropriate Federal agencies and
departments, which (1) deliver services at the community
level, including through public and private nonprofit
agencies; (ii) do not condition the provision of assistance,
the amount of assistance provided, or the cost of assistance
provided on the individual recipients income or resou~ces;
and (iii) are necessary for the pr6tection of life, safety,
or public health [Kennedy Amendment]
•
SSI -- Bars noncitizens from SSI. Exception: Those who have
worked a sufficient amount of time to qualify for social
security insurance benefits (thus limiting eligibility by
elderly); those who are honorably discharged veterans (and
spouses and children); refugees and asylees during first 5
years inU.S.i and persons for whom deportation has been
withheld. Effective upon enactment, but current recipients
would not lose eligibility until 1/1/1997 (this would
presumably kick many elderly immigrants off without
support) •
•
Deems for new immigrants. for life or .10 years of work (40
qualifying quarters) regardless of citizenship. Deems for
current legal immigrant beneficiaries for five years~
•
Makes affidavit of sUPP9rt legally binding.
II.' current Law' Policy
Immigrants can be excluded from entering the U.s. if theY,appear
likely to go on welfare [i.e. become a public charge}. To
overcome this, a sponsor is required to sign an affidavit of
support. And for the purposes of qualifying for the three main
means-tested programs: AFDC, SSI and food stamps (3-5yrs.), the
sponsor's income is deemed to be available, whether it is or not,
to the immigrant~ Usually this is enough to make the immigrant
ineligible.
.
The primary weakness in the current system is that the affidavit
of support is,not legally binding. There is also an issue of how
long the'deeming period should be. But basically, making the
affidavit legally binding, in conjunction with reasonable
deeming, should be sufficient to address the concerns of those
who want to check welfare use by legal immigrants.
III. policy Issues
Some of the primary issues raised by the Senate and/or House bill.
include:
•
creating a two-tiered u.s. citizenry. ,
The Senate bill divides citizens based upon where they are born.
If you are born in the U.S. you will be eligible for benefits, if
�you are born elsewhere you will be denied, even after you are a
citizen.
The Department of Justice has determined that this appears
subject to Constitutional challenge on equal protection grounds.
The Vice President and other Administration officials have
observed in public statements that we should not create two
classes of citizens.
.
Cost-shiftinq to states and localities
•
Legal immigrants are concentrated in a few states and cities.
Seventy-six percent of immigrants live in just six states.
Ninety-three percent of immigrants live in metropolitan areas.
It appears to follow, then, that either the costs or the
hardships will be disproportionately felt in the major cities in
the following states: California, Texas, New York, Illinois,
Florida, and New Jersey. This will have enduring policy
implications for these areas. Because this is a policy
discussion, I leave it to others to assess the political
implications of this.
•
Overbroad, Harsh Reform
Sure the legislation will save dollars, but except for refugees
(who generally come here fearing for .their lives and without
sponsors) and elderly immigrants whose use of SSI has skyrocketed
. recently, study after study has shown that immigrant welfare is
approximately comparable to the native-born population. In the
past, it has been somewhat lower. Addressing disproportipnate
use by the elderly and refugees, and lowering welfare utilization
by legal immigrants generally, can be achieved through the less
severe means of legally enforceable affidavits, deeming for a
reasonable period, and an approach to better integrate refugees
and immigrants into our communities and workforce.
This reveals the present legislation to be harsh and overzealous
in denying benefits so broadly. Both bills will result in loss
of care to people who are old, disabled, no matter what their
need or cause of their need, because they came to our country as
immigrants. The Administration bill proposed to address these
issues in a more reasonable and humane ma.nner.
The leqislation is contrary to the Jordan Commission
recommendations
The Jordan Commission Report states: "The Commission recommends
·against any broad, categorical denial of public benefits to legal
immigrants." The Commission recommended the following principles
to guide policy:
•
•
The safety net provided by needs-tested programs should
be available to those whom we have affirmatively
accepted as legal immigrants into our communities.
�•
Sponsors should be held financially responsible for the
immigrants that they bring to this country (through
legally enforceable affidavit of support and deeming).
•
A serious effort to enhance and enforce the public
charge provisions should be made.
These principles parallel the Administration's welfare reform
proposal and positions taken in the debate over immigration
legislation, but the House and Senate have clearly gone far
beyond the Commission's position.
•
The Administrative Problems of Verification
An issue that does not seem to have been fully appreciated in
Congress is the enormous burden the restrictions will place upon
the Administration or states and localities to verify the
immigration status for all individuals, including citizens
(otherwise discrimination issues exist), for all needs-based
programs. Verification apparently would be required for such
programs as food banks, job training, homeless shelters, and for
nonemergency hospital care. This has the potential for being a
bureaucratic nightmare.
Recommendation:
A strategy in conference committee should include the following
Administration positions to reform welfare eligibility for legal
immigrants:
1) We should continue to push for legally binding affidavits of
support.
2) On deeming, we should oppose efforts to deem past citizenship.
Creating a two-tiered society is probably unconstitutional and is
antithetical to. our national heritage.
.
3) We should support the more reasonable restrictions on
eligibility over broader, harsher restrictions in each case and
work to ensure that the Kennedy amendment is retained out of
conference. It grants the Attorney General some discretion to
include other health and safety programs in the exception.
Application should be limited to future immigrants.
4) We should support reform to slow the growth of SSI use by
elderly immigrants with a legally-binding affidavit to ensure
family financial support" but oppose any requirement that would
kick current elderly and disabled off the program and very likely
result in making many elderly and disabled destitute. In this
regard, the House bill is more protective of the elderly.
�•
~.
5
OCT 11 '95
08:44AM NGA 202 624 5825
T,6mmy G, ThompsOn
Rarmond C. Scbcppach
Governor ofWiscoruin
&;:,;cuth'c
DiTt!<"\'{)T
chairman
Bob Miller
Vice Ch~itman
Hall "fthe Sram
444 NNrh Capi!,,! S,:cct
'.t'il,lIin1jTon, D,C. 20001.1 ~ 12
Tdepho[1~ (202) 624·5300
October 10, 1995
Dear Senator:
As the Senate and House work toward a conference agreement on welfare reform legislation,
H.R. 4, the'nation's Governors would like to provide you with some recomm,endations based on
our experiences to date' in redesigning state welfare systems.
Goyernors believe that
development of successful welfare-to-work and child care systems will require flexibility in
designing programs, adequate funding for child care, and access to additional funding during
times of economic downturn.
Child Care. The Governors are concerned that the work requirements in the bill could
represent a significant unfunded mandate on the states if adequate child. care funding does not
c~ntinue to l:ie provided at the federal level. Additionally, wOe believe that the funding should be
provided as an entitlement to states and th~t states should have maximum flexibility' in
administering child care programs. To this endJ;the GoveJ!lors urge House and Senate conferees
to accept the following recommendati.ons.
:,'.
.
• Adopt t~e Senate provision that provides an additional $3 billion (over five years) for child
care services necessary to meet work requirements.
• Support providing all child care funding as an entitlement to states.
• Reject the Senate provi'sion that requires all child care funds to be spent according to
CCDBO rules. We oppose prescriptive earmarks that limit state fle;'{ibility in admi'nistering
prqgrams. Quality set-asides and mandated resource and referral programs detract from
st~tes' ability to provide needed child care services.
• . Adopt rhe Senate provisions that give states options for limiting child care needs because' of
the work requirements. These state options include exempting families with children below
age one from the work requirements and limiting the required hours of work to twenty hours
'per week for families with children below age six.
• If the Senate provision that prohibits stat~s from sanctioning families who fail to work
because no child care is available is adopted. then we believe that states should not be
,sanctioned for failing to meet state work participation rates because of lack of child care
funding.
Economic Contingency Fund. The Senate bill includes a $1 billion contingency fund that
provides additional matching grants to states during periods of high and rising unemployment
when states may not have the fiscal capacity to meet the 'growing need for assistance. The House
bill does not, include any such contingency grants and the House loan fund is .not sufficient to
help meet states' needs during economic recessions. The Governors strongly urge you to accept
the Senate provision for a contingency fund. .
�OCT 11 '95
08:44RM NGR 202 624 5825
NATIONAL
,. GOVERNOPS
ASSCA:IA110N
(
Tommy G. Thompson
C""ovcmor ofWi5con~in
ChlIirm2.n
Bob Miller
Governor ofNC\""d~
Vice Chairman
Raymond C 5~hcpp''';h
Execul;v", Dir~ror
Hall of the: Stare;
444 Norch Capitol Su~ct
W2Shing'on. D.C. 2000)·); 11
,'dephollc (202) 624-5300
October 10, 1995
Dear Conferee:
As the Senate and House work toward a conference agreement on welfare reform legislation.
H.R. 4, the nation's Governors would like to provide you with some recommendations based on
our experiences to date in redesigning state welfare systems.
Governors ~Iieve that
development of successful welfare-to-work and child care systems will require flex.ibility in
designjng programs, adequate fu~djng for child care, and' acces~ to additional funding during'
times of economic downrurn.
Child Care. The Governors are concerned thar the work requirements in the bill could.
represent a significant unfunded mandate on t~~ states if adequate child care funding does not
continue to be provided at the federal leveL A4ditionally, we believe that the funding should be
provided as an entit1e~nt to states and that. slates should have maximum flexibility in
administering child care programs. To this end, the Governors urge House and Senate conferees
to accept the following recommendations.
• Adopt the Senate provision that provides an additional $3 billion (over five years) for child
care services necessary to meet work requirements.
• Support providing all child care funding as an entitlement to srates.
o Reject the Senate provision. that requires all child care funds IO be spent according to
CCOBG rules. We oppose prescriptive earmarks that limit state flexibility in administering.
programs. Quality set-asides and mandated resource and referral programs detract from
states' ability to provide needed child care services.
• Adopt the Senate provisions that give states options for limiting child care needs because of
the work requirements. These state op[ions:'include exempting families with children below
age one from the work requirements and lirbiting the required hours of work to twenty hou~s
per week for families with children below age six.
• If the Senate provision that prohibits states from sanctioning families who fail to work
because no child care is available is adopted, then we believe that states should nOl be
sanctioned for failing to meet state work participation rates because of lack of child care
funding.
Economic Contingency Fund. The Senate bill includes a $1 billion contingency fund that
provides additional matching grants to states during periods of high and rising unemployment
when states may not have the fiscal capacity to meet the growing need for assistance. The House
bill does not include any such conlirigency grants and the House loan fund is not sufficient to
help meet states' needs during economic recessions. The Governors strongly urge you to accept
the Senate provision for a contingency fund~
�OCT 11 '95
08:45RM NGR 202 624 5825
P.4/6
October 10. 1995
Page 2
State· Flexibility in Program D~ign. In the past, federal restrictions on eligibility and conditions on
assistance have served to contain federal costs given the open-ended entitlemen.t nature of federal cash
assistance funding. The Governors believe that .such federal "strings" have no place, however, in a block
fixed. regardless of the eligibility and benefit choices made by each
grant system where federal COSts
state. In addition, the Governors believe that specific program design choices, such as how to structure work
programs, are most appropriately left at the state leveL We believe maximum flexibility should be given to
states so that we can respond to different and changing {leeds. Accordingly. we have the following
recommendations for the conferees.
:
5,
e· Oppose the Senate provision that requires all block grant funds to be reappropriated by state legislatures.
This preempts state law or coun rulings in at least six states. Congress should not use ~elfare reform to
rewrite state laws.
• Support Senate provisions that give states the option of denying aidIo teen parents or [0 additional
children born to welfare recipients and oppose the House mandates in these areas.
• Support Senate provisions allowing states to exempt up to 20 percent of the caseload from time limits
due to hardship.
• Clarify that time limits and work requirements apply only to recipients of cash aid, and not to those
receiving only child care assistance.
• Support. Senate provisions giving states greater latitude in the design of welfare-to-work programs.
These include state options to count a limited amount of vocational. educational training and to exempt
.'
families with children below age one.
• Support. House provisions on the required participation ra~~s for work programs.
.
• Support. Senate language on welfare waiver programs.··
• Support. the House provision for transferability between the cash assistance and child care block grants.
a
Oppose the 15% percent cap on administrative activities.
.. Oppose Senate mandates for community service requirements and for personal responsibility contracts.
The Governors support both of these as state oprions and believe states should have the flexibility to
design the specific components.
are
Accountability. The Governors believe that states should be held accountable for the u'se of federal block
grant funds and for paying back any misspent funds. However, we believe the penalties must be fair and not·
punitive as Governors face the challenge of implementing major changes within a short timeframe ..
Accordirigly. we urge the conferees to take the follOWing action .
• ' The Governors support the concept of rewarding states with high performance but not at the expense of
each state's basic allocation. Therefore, we urge you t~:;oppose the Senate financing mechanism that
funds the bonuses out of thec.ash assistance block grant, thereby reducing every state's block grant just
auhe time that stale costs related to work requirements and caseload growth will be rising.
• Adopt the House language with respect to the level of penalties and the House provision which limits
the penalty for unlawful use of funds to the repayment of misspent funds.
• Oppose· Senate penalty provisions as punitive and based on subjective determinations of when
disallowed expenditures constitute intentional misuse of funds. Also oppose Senate language requiring
states to replace reductions in their grant due to penalties by spending additional state funds in an
amount equal to the penalty.
• Adopt the Senate· language setting the effective date of the penalties at si~ month~ after the secretary
. issues final rules or October L 1996, whichever is later.
a Adopt the Senate language' permiuing Slates to enter into a corrective action or compliance plan to
J;
.
correct violations in lieu of paying penalties.
�OCT 11 '95
..
08:45RM NGR 202 624 5825
October 10, 1995
Page 3
• Oppose the burdensome data collecrion and reporting requirements in the Senate bilL
requirements are unreasonable and would impose substantial costs.
These
Immigrants. The Governors believe that the elimination of federal benefits to legal nonciti~ens 'does nOt in
itself change any state's legal responsibilities to make state services available to all legal immigrants.
Policy adopted by the Governors clearly states that because the federal go,(ernment has exclusive
jurisdiction over OUf nation's immigration policy, all costs resulting from immigration paJicy should be
paid by the federal government. Although we can support d~ming requirements for some programs and
changes to make. affidavits of support enforceable, we oppose federal restrictions on aid that shift costs
to states. We have the foHowing recommendations for conferees in this area:
• Oppose the House ban on benefits to Jegal noncitizens from Aid to Families with Dependent Children
(AFDC), food stamps, Medicaid, and Title'XX.
• Support the Senate deeming requirements with the modification to restrict deeming to food stamps and
cash assistance, to end deeming at citizenship and to include House and Senate exemptions for
individuals.',
. '
III
Support Senate SuppJemenral Security Income' (SSn provisions regarding noncitizens, including both
House and Senate exemptions for individuals,
• For five-year prospective bar in Senate. include both House and Sen,ate exemptions for individuals.
• Suppon Senate language giving states the option co deem state and local programs.
Child Support. The Governors believe that a more effective ~hild support system is a critical component of
welfare reform, and both the House and Senate bills make mahy. changes that will strengthen the system and
improve interstate collections. The Governors support a continued federa).;,state partnership and urge the
conferees to adopt the following recommendations.
• Adopt the Senate language for the distribution of child support arrearages. This gi~es states the option
of distributing tothe.family first the arrearages that accrued before Of while the family received welfare.
The Congressional Budget Office (CBO) estiinat~s that under the House bill, which mandates
distribution to the family first, the federal government .would 19se $1 billion and state governments
would lose $766 million in the first three years [his provision is in effect
• Add new provision permitting states to supplement temporary assistance"with current month child
'support payments up to the state's standard of need, This would enable states to continue "fill-the-gap"
policies with child suppOrt payments.'
'
• Adop( rhe Senate language for' a two-year extension of thf; deadline and enhanced federal match for the
creation of child suppon systems required by the Fam{iy Support Act of 1989, States are having
difficulty in meeting [his deadline partially because the:! Department of Health and Human Services
failed to issue final regulations and grant approvals in a timely manner.
• Adopt the Senate language for the creation of a new performance-based incentive system with incentives
. paid from collections that would otherwise be reimbursed to the federal government. We urge you,
however. to strike the 90 percent cap that would be imposed on reimbursements. The House bill would
pay incentives by increasing the federal match, reducing states' ability to use incentive dollars for
program innovations.
III , Oppose Senate and House mandates for states to ban aid to those in arrears on child support. Support
. Senate option for Slates to deny food stamps to those in arrears.
Food Stamps. Governors have long supported grealer confonnity between the food 'stamp program and
AFDC and appreciate provisions in both bills that will facilitate program simplification. and give states
, .
, ' f , '
;:}
"
,
�OCT 11 '95
08:46RM NGR 202 624 5825
October 10, 1995
Page 4
greater flexibility, in administering the' food stamp program. We advise conferees to take the following
action.
• Adopt the Senate provision that expands waiver authorifY for states. The provision permits states to
request waivers to test innovative reforms, promote work.('~r allow greater conformity with other federal,
state, and local public assistance programs. The House bill does not include a provision on waivers.
o Reject the House provisions on food stamp quality control. The House bill repeals the 1993 quality
control reforms resulting in a roll-back IC? the provisions that were in effect in 1988. The 1993 food
stamp qualityc:qntrqLCQC) ref<:)J:rn~.received wide bipartisan support by the nations' Governors because
they helped to make the system fairer .and more equitable. The Senate does not make any changes to the'
food stamp quality control system. We urge you to strike the provisions in the House bill regarding food
stamp quality controL
.
• Accept the Senate language [hat reauthorizes the food stamp program in its present uncapped form.
Under current "paygo" proyisions, it would be very difficult to provide additional funding beyond a cap
if unforeseen circumstances such as a recession Dr natural disaster resulted in increased demand.
,
o Support Senate provisions (with minor modifications) on the simplified food stamp program, food stamp'
work requirements, and on funding and design of food stamp employment and training programs.
,
.
.
~:)
Supplemental Security Income. The 'Governors have the foil owing recommendations for conferees on the
SS! disability program.
• Support Senate provisions regarding children's eligibiJity for SSl.
,. Support the Senate provision allowing states to repeal their 5S! state supplements.
• Support the 'House funding level for substance abuse treatment ($400 million over five years) bur
funding should flow through the Substance Abuse Block Grant rather than through the Capacity
. Expansion Program,
• Suppon the Senate effective dates for all SSI changes.
Electronic Benefits Transfer. Delivery of benefits 'through Electronic Benefit Transfer (EBT) systems
reduces costs and cuts down on fraud. The federal government should encourage and support the delivery of
services through EBT. To this end, we recommend that conferees take the following action.
• Adopt the House provision that exempts all state and loc~l government EBT programs from Regulation
E. The Senate Regulation E exemption is limited to food ~tamp EBT programs.
• Adopt the Senate provisions that give states the option of receiving increased federa~ support to develop
food stamp EBT systems.
We thank you for considering our views.
Sincerely,
8~./)jA
Govemor Bob Miller
�
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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FAX MESSAGE COVER SHEET
Telephone: 2021408·1080
CENTER ON BUDGET AND POLICY PRIORITIES
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Washington, DC 20002
Fax: 202/408.1056
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please ca1l202f408·1080.
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�19:27
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4562878
CENTER ON BUDGET
AND POLICY PRIORITIES
FOR [MMEDIATE RELEASE: '
Thursday, Jnnuary 12, 1995
,JAN I 3 1995
CONTACT: Michelle Bnzie
Robert Greensrein
(202) 408·1 Ogo
FOOD BLOCK GRANT PROPOSAL CIRCULATED BY REPUBLICAN
GOVERNORS WOULD HAVE SEVERE, UNINTENDED RESULTS,
ANALYSIS FINDS
. A block grunt proposal presemedto Congressional Republic.U) leaders last week by a group of
Republican governors would cause slIbs[antial reductions in rood ilssiscance for poor families and
elderly people. nccording [0 an anllysis of the proposal by the Center on Budge( and Policy Priorities.
Als() affected would be the school lunch program which incilldes benefits to middle-income children.
If (he proposal hud been in effect since 1989, the large majority of states would have received
at lellst.20 percent less in federal food assistance in 1994. the report found. If the proposal is pm into
place tOday, scates would have nearly $8 billion less in food assistance over the next fOllr ye~\Is. even if
no recession OCCUr5.
Under the proposal, all federal food assistance programs would end in their current form and
be convened to :l block grant. Funding for the block grant would be set at the amount expended for
these progrruns in fiscal year 1994. adjusted only for inflation. Each scare's share of the block grant
would be permanently set :1t its percentage share of federal food assistance funds in 1994.
Proposal Unresponsive to Recessions
The Center'S :Ulalysis shows that block grant funding levels would fail to respond to sllch
as increases in poveny during recessions and rising school enrollments. As a result, it would
cause major reductions in food assistance. Had an identical proposal been pMsed five years a.go and
been based on federal funding levels in fiscal 1989, a year before the recession of the early 1990s
began, every srate in the nation but one would have received less to meet the needs of its residents than
W<l'.; actually provided last year. Some 35 slates would have lost more than 20 percent of the federal
food assistance funds they received la'$t year.
t~lctors
California would have lost nearly half- 48 percent - of' the federal food u'':Isistance fililds it '
received last year, nenrly $2 billion. Florida would have lost 49 percent of the t\mds jt received. Other
stiltes that would have lost 30 percent or more of the funds they received to provide food /lid to dle poor
include Alaska, Arizona, Connecticut. Delaw::ue" the District of Columbia, Georgia. Hawaii, Indiana.
Maine, Maryland. Nevada., New Hampshire, New Jersey, New Mexico, New York, North 'carolina.
, Rhode Isl~lnd, Texas, Vermont, and Virginia. (State-by-st:lre data are included in the fulll'eport.)
-1l10r~
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. Food Block Grant Proposal
January 12. 1995
Page 2
Nearly $8 Billion Clit Over Ne~t Four Years, Even if 110 Recession
Even if no recession were to occur for years into the future - an unlikely scenario - federal
funding for food assistance would be reduced in coming years below the amountsthat would be
provided under current law, accordingto the Center's analysis. If no recession were to occur between
now and 1999 and the economy were to perform in accordance with the Congressionru Budget Office's
assumptions, grates would lose,$7.8 billion over the first few years of the block grant. The reductions
ill funding, as compared ro funding levels under current law, would grow larger each year, the Center
said.
The Center's analysis found that while the overall level of federal block grant funding would be
adjusted for inflation, it would fail to reflect several other key factors such us increases or decreases in
poverty and unemployment and school enrollment. The Depanment of Education, for example.
estimates that the number of elementary and secondary school children will rise eight percellC over the
next five years: this will resuJt in more children eating'schoollunches. Under current law,federal
school lunch funding would rise to met this additional increase and later decline if school enrollment
subsequently decreased. Because the school lunch and other food aid programs would be merged into
a block grant that did not respond to such chunges in need, however, the governors' proposal would
force states to choose between such actions as raising the amounts middle-class parents must pay for
their children '5 lunches and clltting food a'3sistance to poor chUdren and elderly and dio;abJed people
(the vast majority of food aid recipients) even lUore than would otherwise be the case under the
proposal.
"I doubt the governors who designed tbe proposal fully undel'Stood its ramifications," the
Center's director Robert Greenstein noted. "It would hanil sta.te treasuries along with poor families,
children and elderly people."
"The next time a recession hits DJld millions of Americans lose their jobs, lUDJly of the newly
unemployed will seek fooda.')sistance to get thelli through a rough period," Greenstein noted. "Stares
would be forced to choose between meeting the increased need entirely with state funds - and
probably raising stLltetaxes in the middle of a recession to do it - or leaving the need unmet and
witnessing steep rises in hunger, hnrdship, and destirution."
The Center on Budget and Policy Priorities conducts research and analysiS on a range of
government policies DJld programs, with an emphasis on those uffecting low- and moderate-income
people. It is supported primarily by foundation grants.
#4## #
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CENTER ON BUDGET
I·
~FOilIiiI AND POLICY 'PRIORITIES
JelrlUllry 12, 1995
HOW WOULD A FOOD ASSISTANCE BLOCK GRANT
ADJUSTED FOR INFLATION AFFECT STATES?
By Robert Greenstein. and David Super
\.
,
A group of Republican governors have proposed replacing the current federal
nlltrition assistance programs with a block grant to states. Under their proposal, the
overall size of the block grant each year would equal the amount expended in these
programs in PY 1994, adjusted for inflation. ,In addition, each s!ate's ~hare of the total .
federal appropriation would equal its share of federal food assistance spending in fiscal
year 1994.
Some governors may believe that annually adjusting the block grant funding
level for inflation would protect states from cuts in nutrition funding that would have
resulted under earlier food block grant proposals. In fact, the Republican governors'
new proposal itself would result in substantial and rapidly rising cuts in federal
funding to states for food assistance.
•
If no recession occurs between now and 1999, states would lose $7.8
billion over the first four years of the proposed block grant, compared
with the amounts states would be provided under current law. These
cuts would grow larger over the years; by fiscal year 1999, the cut would
.
equal $3.3 billion per year.
•
If a recession occurs, the cut would be far more severe~ During recessions,
existing food assistance programs such as food stamps an.d free school
meals expand automatically to meet rising need as poverty and
unemployment increase. Federal funding under the proposed block grant
would not expand during economic downturns and would fall far behind
need '":-;:" and far behind what the existing programs would have provided.
This is particularly true because the base year that would be used to
calculate the amount provided for block grants - presumably 1994
was a recovery year, when econorriic conditions were far more favorable
.
than during recession years.
During past recessions, federal spending on food assistance progran'\s has
risen sharply. When ensuing economic recoveries subsequently reduced
unemployment and poverty rates, federal spending has receded. At pre':'
serlt, the entitlement funding of the food stamp an.d child nutrition
777 Nort.hC.l1nitol
~trppt.
NP. Suitt>
70~. W~ . ~hinntnn.
or. 2l100')
Tpl~
20'2.4l1R.1l1Rl1
F'"x~ '20'2.4nR.ln~A
l104
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NO. 469
programs ensures that the federal government bears the added burden
during economic dpwnturns. Under the proposed block grant, states
would have to meet the increased need during recessions entirely with
state funds.
An analysis of how states would have fared last year if an identical block grant
proposal had been enacted five years earlier illustrates this point. Had a block grant
been passed that set the block grant at the overall level of federal expenditures in fiscal
year 1989, adjusted for inflation- and fixed each state's share of the block grant at its
share of the FY 1989 expenditures - more than $10 billion in fiscal year 1994 food
assistance support - 29 percent of the total food assistance nationally - would have
been lost. (See Table 1.) The onset of recession. in the interverung years accounts for a
substantial share of this loss in funds; under the block grant proposal, 110 additional
funds would be provided when unemployment and poverty rose during economic
do '\IV n turns.
If such'a block grant had been passed in 1989, every state in. the nation but one
would have received less in food assistance funding in 1994 than was actually
, provided. All but four states would have lost more than 10 percent of the funding
provided in the state in FY 1994. Some 35 states would have lost more than 20 percent
of the funds received under the current programs. California and Florida each would
have lost about half of their food assistance funds, with California losing 48 percent of
the food assistance funding it received in fiscal year 1994 and Florida losing 49 percent.
Even if no recession were to take place for years to come, states would still lose
funding throughout the rest of the 1990s under this proposal. A block grant that '
adjusts only for inflation is likely to leave states with inadequate resources to meet food
assistance needs for several reasons:
•
The block grant would not take into account increased need for school
lunches and breakfasts as school enrollments rise. The U.S. Deparhnent
of Education projects that the number of children in grades K through 12
will rise more than eight percent over the next five years!. This is One of a
number of reasons that, even without a recession, the proposed block
grant would represent a cut in projected federal grant levels to states.
•
Similarly, the proposed formula does not account for projected increases
the number of low-income children who will be enrolled in child care
institutions and qualify for meals under the child care food program. As
states move more poor mothers from welfare to work, the number of low
income children in child care will rise. Federal funding under the child
. care food program expands automatically to meet mcreases in need; a
in
2
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19:29
block grant would not do so and would leave states further short of
funds.
•
Rolling the WICprogram into a block grant that expands only at the rate
of inflation also would efiecti,vely end prospects for achieving the
national, bipartisan goal of achieving full funding for WIC so all eligible
mothers and children can be served. The WIC program has been found to
reduce infant mortality,low birthweight, and child anemia - and state
and federal Medicaid costs.
•
Finally, as described in another recent Center analysis, Congress could
reduce the amount appropriated for the block grant below the amounts
specified in the legislation that establishes the block grant. With deep
cuts in total federal spending required if the federal budget is to be .
balanced by fiscal year 2002, the block grant could still undergo substan
tial additional cuts.
Problems with Distributing Funds Among States
,
'
:
One other problem looms.· Freezing each state's percentage share of block grant
funds at its share of total nutrition spending in fiscal year 1994 would expose some
states to particularly sharp funding shortages. Under the existing programs, states
whose economies are performing poorly al.ltomatically receive additional federal food
stamp and school lunch dollars to meet the needs of the newly unemployed. In the
same way, any state with increased school or child care enrollment automatically
receives increased federal child nutrition funding. This means tha.t states whose
ecol1omies fare more poorly than the average state economy, whose population growth
is above average, or whose school and child care enrollment is rising at an above
average rate, could receive too small a share of the funds available nationally. Suppose,
as the Republican governors' proposal suggests, each state's share of the block grant is
set at its share oHotal federal food assistance expenditures in fiscal year 1994. As the
years pass and 1994 recedes farther in the past, the inequities among states will grow
larger. These inequities will become particularly acute during recessions when some
states s4ifer sharp increases in unemployment while others do not.
.
/
The problems that this distribution formula would cause can be seen by looking
at the distribution of federal food assistance funds to states in fiscal year 1989 and fiscal
year 1994. Suppose the percentage share of funds each state received in fiscal year 1994
were held to the same level as in fiscal year 1989. What would have happened? Even if
the block grant proposal were redesigned so the total amount offunds distributed.
nationally in 1994 equaled the amou.nt actually distributed last year, most states would have
lost or gained more than five percent. D"elaware, for example, would have gotten 15
3
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"
percent less in federal funds than it actually received; Florida would have lost 28
percent of its funds; California would have lost 27 percent. Meanwhile, Wisconsin
would have obtained 19 percent more t~an it received under current law, while
Michigan received 18 percent more. (See Table ~.) As noted above, these proble1l1S
deepen when one takes into account that under the proposal, the amount of food
assistance foods distributed nationally - and thus to each state - would be less than
would be the case under current law.
Finally, states vary in the degree to which their eligible populations can be
served with the federal WIC funds they receive. As a result, a portion of each year's
WIe appropriation now is allocated to help expand WIC participation in states that his
torically have received lower-than-average WIC funding. A block grant that froze each
state's share of total nutrition funding at 1994 levels would lock in current inequities in
the distribution of WIC fWlds.
4
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TABLE 1: The Effect the Repllblk.m G()Venl(lrs' Pood Block Grant Proposal Would H.we Had in 1994
if it Had Befm Adopted in 1989
(in millions '1f dollars)
Federal Share of Federal Nutrition Cain (Loss) if BY 1Q94 Fund~ Set
Federal
Nutrition Nutrition Nutritior Fund,. in FY '1994 atFY 191N Levels Plus InAation and
Funds in Funds in F\mds in if GOP G,)V. Prop. SI:<\te % Shares Set .\t 1989 Shares·
(percent)
FY 198C} FY 1C)C)4 FY 1989 Adopted in 19fN
($ million,.)
(132.4)
-18.7%
Alabamrt .
$708.3 2.30%
$.575.9
$471.1
-35.6%
(32.9)
59.5
48.7
92.5 0.24'Y"
Al!'18kCl
-38.6%
(252.4)
401.5
Arizon<l
328.4
653.9 1.61%
(72.1 )
-19.7'Y"
ArJ.:cml'llt.1
241.0
366.7 1.18%
294.6
-48.1%
(1,941.2)
2,tJ94.2
1,713.2
4,035.4 8,38%
Ci'iliforni<l
2tj6.S
(76.0)
-21.0'Yu
Col()rado
362.5 1.15'Yu
234.4
lAA.9
(103.7)
·38.0%
13S.2
272.6 0.68%
Connecticut
-39.7%
(32.R)
.40.R
R2.fi 0.20% .
49JI
Delaware
(48.5)
-37.1%
0.33%
Diat. of Cc..)l.
67.2
130.6
82.1
(%3.6)
-49.1%
1,962.6 4.00'Y"
999.0
IH7.2
Florid'l
(3RR.9)
-35.2%
586.Q
1,106.3 2.R7%
717.4
Georgin
(73.4)
140.5
Hawiui
114.9
213.9 0.56%
-34.3'Y"
Ql.6
74.9 .
(21.5)
-19.0%
113.0 037%
Idaho
.14.1%
1,328.3
(217.2)
1,086.6
1,545.4 5.31°/"
TlIinois
(212,9)
-33.9%
414.5
Indiana
339.1
627.4 1.66%.
ll)wa
(26.1)
-10.1 'Yu
189.6
257.8 0.93%
231.8
27(';.9 0.82%
]67.3
(72.4)
-26.2%
204.5
K,U\$c'$
(63.7)
-lO.O'Yu
470.9
639.3 2.30'Y...
575.6
Kentucky
.7.7% .
(77.1 )
750.7
994.8 3.67%
917.7
LouisIana
(57.5)
-35.2%
Mc,in~
l05.~~
163.4 0.42'Yo
86:6
(161.3)
-30.7%
298.0
525.5 1.46%
364.2
Maryland
(154.8)
-28.4%
390.2
Mal:lsadlU!let.t.$
.545.1 1.56%
ZI.19.2
(203.5)
1,224.4 4.08%
MJchigall
835.1
1.020.'1
.16.6°/"
(117.7)
-25.7%
MinM$Om
278.3
458.0 1.36%
340.3
0.7%
Mi$als$ippi
504.1
611.8 .2.46%
616.2
4.4
Mis:muri
(202.1 )
421.0
716.8 2.06%
5J4.6
-28.2%
(l6.3)
-15.7%
Montana
71.3
103.4 0.35%
87.1
,132.9
(35.4)
-21.0%
lOS.7
168.3 0.53%
Nebrask.l
68.(;
(66.5)
-49.2%
Nevada
56.1
135.1 0.27%
65.S 0.17<'10
(22.9)
-34.9%
New Hnmpshire
34.9
42.7
(239.6)
-31.7%
422.3
755.9 2.06%
516.2
New Jen-ey
22C}JI
New Mexic(')
(103.7)
1RR.O
333.5 0.92%
·31.1%
-30.0'ljo
(868.3).
1,658.8
2,896.0 8.11%
2,027.7
New Yorl<
-30.1%
576.1
(248.1)
North Carolina '
471.3
824.3 2.30%
(11.0)
54.2
M.2
·14.3%
Nm'th Dakota
77.2 0.26%
Ohit)
-12.3°;',
1,074.2
1,497.3 5.25%
l,313.2
(184.1 )
308.6
(129.9)
-25.6%
507.1
1.51%
Oklahoma
'77.2
235.1
374.4 1.15%
287.4
(R7.0)
Oregnn
·23.2%
(373.6)
1,4(~8.2
895.4
4.38°/0
1,094.6
-25.4%
Pellllt>y!v.\ni.\
(39.0)
-34.5%
Rhodtllsll.'ll1d
60.7
113.1 0.30%
74.1
(119.0)
323.4
514.3
1.58%
395.4
-23.1%
South C"rolht'"
(3.1)
South Dcll<('Ittl
72.9
92.1 0.36%
~9.1
-3.3%
(236.6)
-27.6%
Tt!nntll:'t:il:j~.
508.1
857.7 2.48%
621.1
2,24Q.5
1,840.2
3,45R.5 9.00%
(1,209.1 )
Texns
.35.0%.
(42.3)
203.2 0.64%
-20.8%
131.6
160.8
Uta"
-35.~)U/o
38.2
72.7 0.19"/"
46.7
(26.1 )
Verlnont
.
4(;3.1
37R.9
fi9fi.9
(233.8)
Virginia
1.85%
-33.5%
(21M)
329.0
-34.6%
Washington
615.2 1.61%
402.2
297.1)
(56.8)
-16.0'Ya
West Virgini<l
243.7
354.7 1.19%
41Q.0 1.42%
Wisconsin
(65.0)
289.7
354.1
-15.5%
(9.0)
W
36.B
53.9 0,18%
45.0
-16.6%
20,455.1 35,345.3 100.00"/..
25,004.7
(]0~340.6)
·293%
TOTAL
.
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."
TABLE 2; How the Distribution ()f Fed!!l'lll Food A!I8i5timce FuJ'\cliJ'\~ Would Have Been Affected
in 1994 if E<!chStale's FlUldlng'H:id BccnSct Equ.11 to Its I'efrontage SharI) in 1989'
(in million!; of dollars).
Federal Sh>lreof Pederlll Nutrition C.ain (Lo!ls) if FY 1994 Funds
federal
Distributed. According tl)
NutritIon Nutrition Nutrition Fund;; in FY 1994
Stllt!}S' FY 1989 Shares
' If Sharl.l Froz(,'l\
Funds in. Funds Lil P\ulds in
(percenl)
at FY 1989 Level
($ miJlioM)
FY 1994 FY'I989
PY 1989
14.9%
2.;10%
105.7
$708.3
$814.1
$471.1
Alabatl\a
-9.0%
(8.3)
84.2
AIII.'1ka
92.5
0.24%
48.7
(86.3)
-13.2'Yo
567.5
328,4
1.61%
653.9
AriJ.:On.ll
13.5%
49.7
416.4
1.18%
Arknn.sll~
366.7
241.0
-26.6%
(1,075.1)
2,960.3
4,035.4
8.38%
1,713.2
CaliforJlia
11.7%
42.S
US%
405.0
234.4
362.5
Colorodo
-12.4"10
. (33.9)
238.8
0.68%
272.6
138.2
Connecticut
-14.7%
. 40.8
(12.2)
70.4
82.6
0.20%
Delaware
-11.1%
(14.5)
116.0
0.3..1"10
67.2
130.6
Di$t. of Col,
(550.5)
·28.0%
1,412.1
817.2
1,962.6
4.00%
florida
-8.3%
(92.2)
1,014.1
58(>.9
187%
Georgia
1.106.3
.7.2%
(15.3) .
198.5
213,9
0.56%
Hawaii
. 114.9
14.5%
129.5
16.4.
74.9
113.0
0.37%
Idaho
21.5%
332.1
1.877.6
5.31%
1.545.4
nUnoi,
1.086.6
-6.6%
(41.5)
585.9
3..19.1
1.66"10
627.4
Indiana
27.1%
69.8
0.93%
327.6
251.8
189.6
Iowa
4,4%
12.1
0.82%
2S9.0
KlIlU;as
161.3
216.9
27.3%
174.3
813.6
2.30%
Kentucky
470.9
639.3
30.4%
3UH
1.297.2
150.7
3.67%
LQltisiana
994.8
-8.4%
O.42~,{)
(13.7) .
'163.4
149.7
86.6
Maine
·2.0%
(10.7)
1,46%
514.8
525.5
298.0
Marylruld
1.2%
6.6
551.6
1.56%
545.1
Massachusctts
319.2
17.9%
218.7.
'1,443.1
4.080/0
1,224.4
835.1
Michignt\
5.0%
23.0
481.0
Minnl!Sota
458.0
1.36%
278~'
42.40/0
259.3
871.1
Milll-i'l~ippi
2.460/0
611.8
504.1
10.7
1.5%
727.5
716.8
2.06"10
Mis$()lui
421.0
19.1%
19.7
0,35%
Montan.,
123.1
100.4
. 71.3
11.6%
19.6
108.7
168.3
0.53%
187.9
Nebraska
(38.1)
-28.2%
96,9
0.27%
Nevada
135.1
56.1
(5.2)
-8.0%
34,9
0.17%
60.3
65.5
New Hampshire
(26.1)
-3.5%
755.!) 2.06'0
729.7
Ntlw Jersey
422.3
(8.7)
-2.6%
324.8
0.92% .
NeW Me:w;ico
333.5
18S.0
(29.8)
·1.0%
2,866.3
2,896.0
8.11%
1.658.8
New York
·1.2%
(9.9)
824.3
814.4
411.3
North Carol1n.,
2.300/"
21.2%
16.4
54.2
77.2
93.6
North Dakota
0.26%
358.9
24.0%
1,856.2
5,25%
1.014.2
1,t97.3
Ohio
5.1%
507.1
26.1
1.51%
533.2
308.6
Oklahoma
:.'11,8
8.50/0
406.2
374.4
1.15%
235.1
Oreg'ln
5.4%
79.1
4.38%
1.547.3
1.468.2
Pennsylvania
895.4
.7.4%
(8.3)
104.8
0.30%
Rhode Island
60.7
113.1
8.7%
44.5
514,3
558.8
1.58%
South Ciltoli""
323.4
36.6%
33.8
125.9
South Dakota
92.1
72.9
0.36'0
20.2
2.4%
871.9
2.480/0
857.1
508.1
Terulessee
.8.1%
(278.8)
3,179.7
Texas
9.00%
3,45&.5
V\40.2
11.9o/~
24.2
227.3
131.6
203.2
Utl1h
0.640/"
(6.8)
65.9
-9.3"0
0:19%
72.7
Venno,,!
38.2
(42.2)
J.85o/c,
·6.10/0
654.7
696.9
Virgini.iI
378.9
. -7.6%
(46.7)
. 615.2
1.61%
56S.s
Washington
329.0
11:1.7%
66.3
421.0
West Virginia
354.7
243.7
1.19'0
19.4%
500.5
81.S
Wisconsin
289,7
419.0
1.42%
11.9%
9.6
63.6
0.18%
Wyonling
36.8
53.9
0.0%
35,.145.3
0.0
100%
20,455.1 35,345.3
TOTAL
l
�19:31
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NO. 469
"
lVc'~e .(1'" ..... [~·.~hn· do' 'a~'Q.e+~'?ol((.'1 ~("i~:'·i+·i('s ~ T~~~ is
of +ht: ~Iu<\ prr;'9t>~(:!,'tJ: ~~ S'o"·,,,~· R~('vbUc,t\'" Govet'r'\c:'<i.
·tt
te'f'j
Republican Governors' Association
Welfare Reform Session
I.
Qbjecti'Le.
. to have e thorough discussion
on the broad outline of welfare reform among the
GOP Governors and House and Senate Republican leaders.
') II.
lis!.l,es for
Discussion
A. arock GrantS GOP Governqrs support B/()cl< Grants in 3 malor areas of
welfars and social spending: AFDCfCash Assistance, Food, and Child Care. GOP
Governors '6ra interested In expt9ring Block Grants 'i" 6 additional areas: Child
Welfare. Social Services, Employment nnd Training, Health, and Housing ..
n
•
The programs
tor inclusion in the above
3 Block Grants are:
~.. Food Stamps, Nutrition Assistance for Pue(to Rico.
Special
Milk Program, Child NutriUon, Child Nutrition Commodities, Food
Donations, Women, Infants, Children Program (WIC), Emergency Food
Assistance Program, Congregate Meals, and Meals on Wheels.
Each State will f6ceive that portion of 'the Block Grant that
equals the portIon of the total Federal spending reoeived by
each State in FY 1994.. This amount would be adjusted each
year for inflation.
AFDGlCa~b. -- Aid to Families with Dependent Children (single parent
and two parent families)' Emergency Assistance, AFDC
'
. dministration, and Job Opportunities and Basic Skills (JOBS)'
A
program.
Each State would receIve the amount equal to the average of
spending in FY 1990 - 1994.
crnld Cat~ -- Title I (EdtJc8tion for the Disadvantaged},. Migrant
Education, Native HawaHan Family Education Centers, Child and Adult
Food Program, Child Care. Eind Development Block. Grant, Child.
Development Associate Credential Scholarship, State Dependent Care
P1annlng and DeveJopment Grants, Temporary Child Care for Children
with Disabilities, At-Risk. Child Care. Transitional Child Care, Head
Start,. snd Even Start.
Each State will receive that portion of the Block. Grant that
equa's the portion of lhe total Federal spending received by
/;11121
�19:32
CBPP ... 4562878
NO. 469
"
each
·Stat'e in
FY 1994.
B. FunQing _. Funding is a State entitlement. See above for distribution.
C. .Admjnist(i'tjoQ Maximum flexibility for States to design and administer
programs would be given In the Blo.ck Grants. Reporting requirements and federal
regulatIons would be minimized .. Programs would be audited and States would
rep~y any misspent funds.
.
n
More specifically:
•
will use the funds to
meet the broad goals of each Block Grant. A copy of the plan will be
sent to the Secretary I and e·ach State will also submit an annual
report, with information on the number of people ·served, services
provided, and funds expended.
•
Audi'ts wIU determine whether funds have been.,migspent, and States
will repay such amounts.
States will dave-lop plans, detailing how tbey
.
.
The Secretary's ability to require additional reporting from States and
Impose restrictions on States will be limited.
•
Ststes may transfer ~p to SO percent from one Block Grant to another.
States may carryover funds from one fiscal year. to the next.
III.
Outstanding
rS$ue.~
A. Medicaid ..• Current eligibility ti.ed to AFDC receipt; AFDC maintensnce of effort,
in MedicaId statute, needs to. be eliminated:, Other Medicaid/AFOC lInkages need
exploration.
B. Legal AUens - Allow States the option to provide assistance to this population.
Adjust base amount for each State to reflectthe legal alien popufation they would
no longer have to $8rv8,
C. Waivers·- States would be released frorn ClIfrent waiver and cost-neutrality
agreements.
D. Automatfon,,:,;, Funding for inform,atlon systems needs d·iscussion.
Gl11
�01/12/95
19:32
NO. 469
CBPP ... 4562878
1#12
nTr.n v . CONSOLIDATL'lG FOOD ASSISTANCE PROGRAMS
,
,
SECTION I. POOD ASSISTANCE BLOCK GRANT PROGRAM.
(a) PURPOSE.
(1) The purpose of this act is to consQudate Federal food
assistance into a single blot~ grant to provide greater flexibility
to States to meet the food needs of the State; as far 'as practicable
under the eOllditions in that State.
(b) AUl'HORITY TO MAKE BLOCK GRANTS.
(1) The Secretary of Agriculture shall make grants in accordance
with this section to States to provide food and nutrition assistatLce
to individuals and families.
'
(c) DISl"RlBUTION OF FUNDS.
(1) The funds appr,opriated to cany out this section shall, be
allottedamollg the States as follows: A State shall receive that
portion of the block grant. that equals the portion of the total
amoUIlt that State received for FY 1994" under the following
programs: (see attached)
(2) The amount received for FYs 97 • 2000 shall not be less than
the amount received for IT 1996. This amount shall be an .
entitlement for States.
(3).The amount allotted. unqer paragraph (1) shall be adjusted each
fiscal year by the Secretary· to reflect the percentage change in the
food at };tome component of the Consumer Price Index For All
Urban Consumers for the 1 year :period ending May 31 of such
preceding fiscal year.
'
(e) METHOD OF PAYMENT.
,(1) The Se~retary may xnake payments to a State in installments,
in advance or by way of reimbursement, with necessary
adjustments on account of overpayments or underpayments, as
the Sacl'etary may de~erm1ne.
(d) SPENDING OF FUNDS BY STATE.
(1)
~ayments
to a State from the allotment u~der section I for any
.I
�01/12/95·
19:33
NO. 469
CBPP ... 4562878
(;J13
Dec 29 '94
n'scal year 'may be obligated by the St<>:.te in that fiscal. year or in
the succeeding fiscal year. Twenty percent of the :paymeots to a
State from. the allotment under Section I for any fiscal year may be
transferred. to ,other block grant progTams.
(e) EIJGIBILlTY TO REcrrv! GRANTS.
/
(1) To
be eligible
to r~e1ve a grant in the amoUllt allotted to a
State for a fiscal year, such State $hall sublllit to the Secretary a .
, State plan containing assurances that
(A) such gze.nt will be-expended by the ~tate to providetood
and nutrition assistance to resident lndividuals in the State,
and
(B) such gTant V¥il.l be us.ed for a(ilninistrative costs incurred
to provide assistance under this section.
(2) Prior to expenditure by a State of payroe~ts made to 1t under
this section for any fiscal year, the State .shall report on the
i.l:1tended use of the payments the State Is ~o receive Including
infonnatjoh oli the types' of activities to "e supported and the
categories or characteristics of persons to b~ served. The report
shall be transmitted to the Secretary and lIla-de public within the
State in' such lllanner as to facilitate cotnlllent by any person
(including any Federal or other pUblic.: agency) during developm.ent
of the report and after its completion. The report shall be revised
throughout the year as may b'enecessary to reflect substantial
changes in the activities assisted under this section. and any
revision shall be subject to the requirements of the previous
sentence. The Secretary shall not impose additional reporting
requirements on States.
(f) ANNUAL REPORTS AND AUDITS..
(1) Annual Report! Not later than December 31, 1996, and
annually thereafter, a State that receive.s a grant under section' I
shall prepare' ~lld submit to the Secretary a report,
(A) Specifying the uses for which the State expended funds
spedfied under S~ct1on I and the amount of funds expended
. for such uses: and
(B) Contai:uing available data OIl the manner in which the
food and nutrition needs of famllies in the State are being
fulfilled l including ilJfol"lIlation <:oncet'ning the number of
illdividuals 8l1.d families being assisted ,with funds provided
�19:33
CEPP ... 4562878
NO. 469
"
"
~14
•....
"
under 'Section 1 during the period for which such report Is
reqUired to be 3ublI.l1tted.
(2) Audits:
(A) Requ1:re.tuent. A. State shall" after the close of each
program period covered by a report subtoitted under section
I audit its expenditures during such program period fTOlD
amounts received under this section. .
(B) Independent Auditor. Auctits under this section shall be
conducted by an entity that is lndepettdent of any agency
administering activities that receive assistallce under this
section and be in 8ccordanee 'With generally accepted
auditing principles.
(C) Subtnission..· Not later than 30 days .after the completion
of an audit'under this. section, the State shall submit a copy
of the ~dit to the legislature of' the State and to the
Secretary. "
shall repay. to the United States
any amounts determiDed through an audit under this
section not to have been expended in accordance 'With this
section, or the Secretary may offset s~ch amounts against
any othEl' amounts to which the State is or may be entitled
under this settion.
(0) Repayment. Each State
SECTION n. DEFINITIONS.
(a) Secretary.
(l)
Secretary refers -tothe·Secretary of Agrioulture.
�01/12/95
CBPP
19:33
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NO. 469
4562878
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�E X E CUT I V E
o F ::i' ICE
o F
THE
PRES ID E N T
06-Jan-1995 10:19am
TO:
TO:
TO:
Carol H. Rasco
Jeremy D. Benami
William A. Galston
FROM:
Bruce N. Reed
Domestic Policy Council
SUBJECT:
Daschle Teen Pregnancy Bill
Yesterday, Daschle introducedS~8, which addresses teen pregnancy,
paternity establishment, and other parental responsibility issues.
Almost all of it, is a version of what we have in our welfare
reform plan.
1. MINOR MOTHERS: Requires minor mothers to live at home or in
supervised living arrangements. 'Provides $95m a,year for group
homes. Requires minor mothers to stay in school and finish their
degree. Gives states the option to offer LEAP-style inc~ntives
for minors who stay in school. 'Requires drug t+eatment for minor
mothers whose employability plan ,calls for it.
-- Our plan includes all these'provisions except the $95m
for-group homes.
"
2. PATERNITY/CHILD SUPPORT: Gives states performance incentives
to raise paternity establishment. Gives states authority to deny
driver's and professional licenses to deadbeats. Streamlines"
paternity establishment process. 'Improves voluntary paternity
establishment outreach.
-- All of this is i~our plan.
3. TEEN PREGNANCY: Allocates up to $75m a year by formula to
states for g+ants to local agencies or community organizations
with programs to reduce teen pregnancy. Calls for study of what
works. Establishes National Clearinghouse on Teen Pregnancy.
-- Similar to our plan, al~hough the grants are not quite
as targeted.
4. FINANCING: ,The bill doesn't cost much (less than $lb over 5).
They pay for it with a piece of our alien financing, which comes
from making the eligibility requirements uniform for SSI,
Medicaid, and AFDC.
�FEB 03 '95
08:40AM NGA 202 624 5825
Policy Position
Adopted January 31,1995
PRINCIPLES TO GUIDE THE RESTRUCTURING OF THE
FEDERAL-STATE PARTNERSHIP
'
Governors believe that the next ~o years present an enormous opportunit:y to fe$tructure
the federal-srate relationship. The Governors urge Congress to take advantage of this
opportunity both to examine the allocation of responsibilities among the levels ofgovernment
.and to maximize Slate fkxibility in area5 of shared responJibility. However, the Govemors
believe that children must be protected throughout this process.
As· the federal government begins to
move toward a balanced budget the pressure to reorder
federal priorities and cunail feder(J1 grants will increase. Already; lIumerous proposals for
program consolidation and reduction are on the rable.
While federal budget cuts are needed, the Governors are concemed ~bout the cumulative
impact on·the stales of federal budgetary decisions.· The federal budget.must be balanced by
true savings, not by shifting costs to the states.
Governors recognize the special responsibility of government at alf levels in meeting the
needs of children and families.
Governors have taken the lead in carrying out these
responsibilities in the past: The Governors believe that the federal government must maintain
. a financial role in assisting states and localities to continue to meet these responsibilities.
WELFARE REFORM
All Govemors recognize the importance of a federal role in financing income assistance to
families and children. However, the continuation ofthe cu"enc welfare system is unacceptable.
Tinkering and changes at the margin will not be sufficient Congress should create a new,
simpler, and more responsive federal role.
•1•
�FEB 03 '95
08:40AM NGA 202624 5825
Governors have not yet reached consensus on whether cash and other entitlemenc
l
assistance should remain available as federal entitlements to needy families or whether i1 should
be converted to a state entitlement block grant.
Governors do agree, however, lhat in either
case states should have the flexibiliry co enact welfare reforms without having ro request federal
waivers. While Governors recognize Ihe legitimate interest of the federal government in setting
broad program goals in cooperation with stales and territories, they also believe that states
should be free from prescriptive federal standards including key aspects of the welfare system,
s.uch as work requirements, benefits to teen parents and to legal immigrants, and time limits on
benefits.
A State Enntlement Block Grant Program
Governors believe that block grants as discussed in this section should be entitlements to
states and ndt discretionary grant programs. The Governors view any block grant proposal as an
opportunity for the Congress and the President to provide needed flexibility for stares, not as a
primary means to reduce the federal budget deficit. The block grant should tnclude a clear
statement ofpurpose including mutually agreed upon goals for the block grant and rhe measures
that will be used toJudge the effectiveness of the use of block grants.
The block grants must
recognize the nation ~ interest in
• services to children, ,
, • moving from welfare to woTlc, and
• reducing out-of..wedlock births.
Under this concept, there should be no micromanagemenl and states should' be required
.
only to ensure. that the funding received is used to provide services for poor children and their
families. While states would be required io describe their program in a state plan and to provide
peri'Odic reports to the public, the plans would not be subject to federal approval or federal
revision. Financial and compliance audits would be conducted to ensure that moneys were
properly spent, and states would be reqUired to pay back any misspent funds. Specific program
outcome data will be collected. by the states and publicly reported•
. z·
�FEB 03 '95
08:41RM NGR 202 624 5825
Block grant funding should be guaranteed over five years at levels agreed to among the
states. Congress, and the Administration, Governors will work with the Congress and the
, Administration to provide appropriate budget adjustments that recognize agreed upon national
prion'ci.es, inflation, and demand for services,
In return for -this broad flexibility, states would consider an initial allotment based on the
average of s~eral prior years. Federal funds would be automatically available under a capped
entitlement strucr.ure instead of being subject to
~nnual
discretionary appropriations. There
would be no maintelUlnce of effort provisions and state! would be allowed to keep all savings
so long as the federal allocation was spent. Unexpended federal funds would remain available
to states to maximize flexibility and to encourage'the creation of a "ramy day" fund and
would not be subject to reallocation by the federal government.
To provide/or significant changes in the cyclical economy and for major natural disasters,
an additional amount should be set aside each year for aUlomatic and timely distribution to ,
states that experience higher-than-average unemployment, a major disaster, or other indicators
ofdistress in their states.
An Individual Entitlement Pro~ram
If the federal government preserves the federal entitlement of all needy families, to "
assistance, the Govemors believe the current AFDC program should' be replaced by a new
national program that establishes clear policy objectives and certain minimum standards, but
provides scates wah broad flexibility 10 design key program elemmts.
Federal policy objectives and standards could include bur should not exceed the following:
.Ttme·Limited Aid to Families With Der;endent Children. Assistance in the form of cash
grants to families and children should be available for a time-limited period during which
acriviries rhal are designed to mtJke the transition from welfare to work take place.
Social Contract.
The expectations and responsibilities of both the recipient and the
\.
government should be clearly defined and incentives and sanctions should be designed to ensure
-3
�FEE 03 '95
08:41~M NG~
202 624 5825
that those responsibilities are carried out. States should be granted broad flexibility in defining
the components of the social contract, including requirements
maximum time is exhausted. Receipt of assistance should be
10
begin work before the
~ondilioned
upon ongoing
compliance with the social contract.'
SUf2Qon SenJices. Stare programs could include, as appropriate, the education, training,
and support services necessary to help participants become self-sufficient. Such services should .
be funded either as a component of the income support program or through broader block
grants.
Long Tenn Assistance. Continued federa~ stare, county, and
lo~al
assistance under the
national program after the rime-limited period should be dependent upon a requirement of work
or work-related activities unless no job, community .service work opponunity, or community
service placement is available. Federal funds equi\lalent to the assistance payment should be
available to the states to .rupport the creation of needed work. States should be allowed to
create work directly and through subsidies ro rhe private sector. The on-going financial needs of
children must be addressed in any time-limited system.
\
flexihility. States opPQse prescriprive federal management of the Aid to Families With
Dependent .Children program. Federal guidelines should be reasonably general in narure and
Slates should have broad statutory authority to adjust benefit levels and to detennine the form
and condition of assi.stance. This flexibility should be in the form of allowable options and
.
.
.should not require federal waivers or plan approvaL
States should have the ability to extend assistance as needed, with full federal financial
participation,.jor a limited period beyond the federal standardJon a case-by case basis in order
to ensure that recipients complete education or job training programr, complete treatment for
substance abuse or other physical or mental impaimzents, or resolve emergency situations such
as homelessness.
.".
�FEB 03 '95
08:42AM NGA 202 624 5825
PROGRA..l'vf CONSOLIDATION
The Governors believe that mtUimwn budget savings are possible only if the concept of
flexibility is extended beyond the income assistance program.' The simplification of the cu"ent
categorica~
non entitlement federal granc-in:aid. system must also be a Congressional priority.
Governors have argued that such simplification would both increase administrative efficiency
and encourage state and local efforts co develop more effective programs.
The history of block grants is long, going back at least, to general rellenue sharing and the
broad block grants,of the Nixon era. Block grants were also an important part of the Reagan
"New Federalism ll of the 19805. At that time the consolidation of programs also came with
;funding cuts. While block grant proposals have generally begun with a theme ofsimplification
and consolidation, the actual legislation has, often retained significant federal restrictions.
Equally important, over time the federal gO'lemment has tended to establish additional
set-asides and place new restrictions within the block grants that have been established. Future
reform must recognize and address these problems.
Go,,'ernors belie"'e thar ~'uch consolidation must:
• Recognize the national interest in protecting and serving children.
• Include a clear deJinilion ofnational purpose a1,d national objEctives.
• Avoid set-asides or otherprescriptive conditions for the funding.
• Include significant n·an.iferability offunds between the block grants. '
.' Preclude cost-shifts to the states.
• Be consisrent with the way in which stare government delivers services 10 citizens.
• Incorporate distribution fomlulations consistent with the distribution implicit in existing
,
categorical grants.
• ,Allow the Jli!x.ibifity needed to ma:rimize efficiency and to minimize the expansion ofstate
\ government employment.
,
. .
�\
.
FEB 03 .'95
08:42AM NGA 202 624 5825
P.7/7
Block grants provide a vehicle for the federal government to assist states and localities meet
,
high priority domestic'needs that they would otherwise be unable or unlikely to accomplish.
\,
RESTRUCTURING MEDICAID
Governors have significant policy relaring to the resrructuring'of Ihe Medicaid program and
to health' care reform overalL Because of the close link between income policy and health
polky•. Governors will be better able to achieve welfare reform if the policies proposed by the
,
Governors in the area of health care are enacted. Governors' recognize that Congress is
considering substantial cuts in the federal contribution to the Medicaid program. Governors
believe there may be potential for savings in the acute care portion ofthe Me~icaid program and,
"
-
direct NGA staff to develop the option of restricting future program growth ,in excht;lnge for the
federal government assuming responsibility for the long-term care program.
Governors believe that there is some potential to attain savings in the acute care portion of
the Medicaid program and they are willing to consider reasonable restrictions on future program
growth. However, such restrictions must be accompanied by significant stalUl9ry flexibility in
program delivery Including flexibility in setting eligibility and benefits lel/eIs, much greater use of
managt;d care, and greater opponunily to define reimbursement methodologies.
Govemo~aIso
believe that there are savings to be realized in long-term care, including the use of allernatives ~o
institutionalization and adoption ofstrategies that will improve the cost effectiveness of nrming
home care. The Governors look forward
10
working with Congress to address acute and long
r'
term care com.
EQUITABLE TREATMENT FOR TERRITORIES IN NATIONAL WELFARE REFORM
Governors believe the territories should be treated equitably in any welfare reform proposal
brought before Congress.
.6.
�FEB-09-1995
13:38
TO
FROM
RASCO
P.0V10
Office of tht'l AARlJ,lf:ln\ Seeretary
UtPAKTMENT Of HEALTH II. HUMAN SERVICES
for Legislation
WashinglOl'l. D.C. 20201
. TO:
MARY JOBANE
DAVID ELLWOOD
BRUC,F. REED
CAROL RASCO
EMILY BROMBERG
ANN ROSEWATER
WENDELL PRIMUS
SUSAN BROPHY
PAUL CAREY
JANET MURGtnA
KEN APPEL
JEREMY BEN-AMI
AVIS LAVELLE
MELISSA SKOLFIELD
JOHN MONAHAN
401-4678
690-7383
456-7028
456-2878
. 4014678
401-4678
. 690-6562
456-6220
456-2604
456-6221
395-5730
456·7028
690-5673
6go...S673
690-5672
FROM:
HHSI ASL STAFF (Jim Hickman 690·7627)
DATE:
February 9, 1995
PAGES:
10 (including cover)
NOTE:
Attached is a copy of a memo sent to members of the Ways and Means
Conuuittee by Human Resources Subcommittee Chairman Clay Shaw (R-FL)
outlining the provisions of the Chairman's mink on welfare reform.
Chairman Shaw (R-FL) announced this plan at a speech earlier today to the
Chamber of Commerce. Ron Haskins from the.Ways & Means Committee will
be conducting a pn:~ss uttly briefing on the Chairman's mark at 9:00 am tomorrow.
�FEB-09-1995 13:38 FROM
FiLE No" 7SO 021'09 '95 12: 03 I D: CONG • MATSU I
TO
RASCO
P.021'10
PAGE 2
COMMITTEE ON WAYS AND MEANS
U.S. HOUSE OF R£PREiiNTAnVES
WASHINGTON. DC 2061D-063C'
Pebruary
~,
1996
MSf!1QIWJD'QM
TO:
Members, Committe. on ways and Means
FR.:
E. clay Shaw,
Jr.,
Chairman Subcommittee on Human Ae8ource!l
,
In it epeeeh at thaU.S.Chambar'of Commerce later this
morning. I will present' an o1Jt.line of'the d1reetion my chairtnan/a
mark will take as we begin consideration of welfare reform in
subeommieeee next w~ek. Later today, we will deliver to all
Members of ~he committee a complete explanation of all of the
provision., 'with the exception of child 8upport enforcement
provision. which are in the final design stages. W. are
expecting some changes' between now and Monday's markup.
Here is an outline of the 'Plan
W8
have developed:
Cal; ~l!a;1 Plogk Grane
• 6 current Aid to Families with Dependent Children programs
will be replaced with a single block grant to States.
• Spending on c ••h welfare will be capped for 5 years, saving
taxpayer~ $7.6 billion.
• States will b.c' p~oll.1b1t.d from uaing federal tax dollars tOI
(l) pay cash'welfare to mothers under 18 who have children
out-ofww.dlockl (2) give extra payment. to families that have
more children wh1le on welfare; and (3) pay cash weltare to a
single family for more t.han S year•. '
.
• Welfare recipi8n~s must wo~k to continue getting cash
payments atter two year•.
ChJ.ld careB1Qck Grant
.
Aro~nd ten eurrent federal child care programs
•
•
Will be mergea
:l.nto another block ~irant t achieving $3. ~ billion in savings_
As with other block grant•• States will be given enormous
flexibiltty to better serve their residents, s1mp11fy
programs. and save taxpayer. money_ '
•
WOlEI" i~oC1c aran;
More than 24 cu..rentpr¢grams will he eombined into another
block gr~nt to help st.ates protect neglected and abused
•
Neglecteci Bnd abused children will be freed from federal
regulations to realize quicker adoptions, ,more,
cbi~g
chllareo, sav1ng nearly $4 bi.llion ovar five yea••• ,
accountal,ility,
anc1few&r arbittlfY PUiAI frBm WJghington.
~~vJe.:r "('\o:'\v~II"V ~v\-L~ ;:-"'0""" WCl.~\W'\\l ~.
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- 2
•
M with other block grantri, Btatell will bA required to send
.0
information about -their programs to the federal, govarnment t
we can figure out what work•.
Regycing Welfa;e Boll.
• ,Drug aedict. andalcoholic& will no longer be consider8~
d!a&bled and therefore eliaible for. cash payments from SSI.
• 'As in the Contract, non-citizens would no longer, be
eligible for mo8t welfare programs. Exception. will remain
for rAfugeaa and legal. long-term residents over 75; non
citizens will still qual:1fyfor education and training
programs so they can improve their job preparation to become'
•
•
mnre productive f~ture citizen..
,
Sponsorship provisions will be .trengthenea.
CBO •• timates these provisions wi,ll reduce welfa;re spending
by about $23 billion over 5 year. (although much of this ,
savings will accrue to Stat.es because of the block grants
de8cribed above) .
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FILE No. '(SO 02/09 '95 12: 04 ID :CONG. MATSU 1
Overview of Ways aDd Means and Opportunities '
Commineel Portion's of the. House Repuhlican Welfare Refonn Bill
Febnwy 1995
.J
TitJe 1:
Title fi:
Title
Title
Title
Title
OI:
IV:
V:
VI:
Block Grant tor Temporary Assistance for Needy fo'amUies .
Child Care Block Grant
Child Protection Block Grant
Restricting Welfare for Aliens
Supplemental Security Income Refonns
Child Support
Enforcement Refonns
Title 1: Block Grant for ImnRpratY AHistNlc,e for NetGy families
1. Purposes
.
a. Provide as~istance to needy families with children
b. End the depe"dence of needy parents on iovemment benefits by promoting
work and ma.niaae
,c. Discourage illegitimate births
2. Eligible states; State plaIt States must submit the following to the Department of
Health and Human Services on an annual basis:
a. A plan' that contains an explanation of:
-·their program of cash benefits to needy families
--their' welfare-ta-work program. includina support services
•..how they are meetinj the requirement ,of mandatory work after the family
has been on welfare for 2 years (or less at state option)
--how and whether they are meeting the requirement to place 2% of their
caseload in work programs in J996, rising to 20% by 2003 ancl thereafter
··their program to reduce the incidence or. illegitimate births
h. A certification that the state will operate a child support enforeement program
c.. A certification that the stale will operate a child protection program
d. A cei'tification that the state will operate a toster.cate and adoption program
3. Grants to states:
The block grant money is In entitlement to states'
b. The amount of money in the block grant is S15.265 each year between
,8.
1996 and 2000
c. Each state receives the same proportion of the block grant each year as it
r-eceived of MDe spendin•• in 1994
d. Use of Funds:
··in any manner reasonably calculated to accomplish the purposes (see above)
··jn the case' of families that have lived in a state for less than 12 months, states
may provide them with the benefit level of the state from which ther moved
PAGE 4
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FILE' No. 760 02/09 '96 12:04 IO:CONG. 'MATSUI
,2
....slates may transfer up to 20% of &he funds many given block granl to other
block grants
'
' '
--:nat.cs may for up '0 6 month~, pay II redu~ed benefit to II needy (amil:)" with
J
a child whose paternit)' has not been establisbed '
e. PenaJtie~. St.a1cs are subjKt to three penalties:
-if an audil d~ennines that states have spent mODe), on accivities Dot ~nsistent
with the pwpo:;c; uf this lr:gi~llltiUllt tb~ amuunt uf nlisspent fUnds will be
withheld 110m the stale's payments ouriDl the folloWLn, year (with the '
restriction that not more than 2S percent' of a quarterly' payment un
be withheld)
--the annual pant is reduced by 3 percent if states fail to submit the
perronnancedata required so that Congress can provide oversight on state
accomplishments
-·~tates are fined 1 percent' of their annual grant if they raU to pattieipate iJ\ the
,Income and Eligibility Verification System designed '10 reduce welrare fraud'
4. Prohibitions., Block grant funds cannot be used to provide:
a. Benefits to a family that does not include a minot child
b. Benefits to an individual re~civing hel'lefitsfrom old-age a&sista.n~e,
foster care, or Supplemental Security Income
'
c. Benefits 10 noncitizens unleSs the individual is an alien who has
resided in the U.S. for over 6 'years or a legal. resident over agc 75 who bas '.
Jived in the U.S. for morcthan S years
d_ Cash benefits to a minor child born Cut of wcdJoek to II mother under
age 18 or to the mother
e. Cash benefits far additional children born to families already on welfare
f. Cash benefits for families Ulat bave received bloek arant' funds for S years
g. 'Benefits to a family with adults nat cooperatinB with the state ebild support
enfor~emenl a,en\:), ,
.,
'
b. Benefits to a family with an adult who has not assigned to the state the child's
claim rights Blainsl the noncustodiaJ parent
' ,
S. Data collection and reporting. States are required to submit aMual data on several
imporwnmeas'ures of their 'l'emporary Assista.tJct Blcxk grant; e.g., the number of
families receiving benefits. the ea.rning of families. other welfare benefits received
by families. and the number of months on welrare
6. Audits, Each s~te must submit to an audit,every second year Wlder terms orlbe
Single Audit
Ac~
,
'
,
,
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No •. 760 02A)9 '95 12:05 ID:CI>JG. MATSUI
3
Iitl~ II: Child ~'"' Block
Grant
. Title HI: Child Protec(ism Block Grant
.
.
I. Purpose. The purpose of funds provided to stateS in thi'll block grant are to help
states:
L IdentifY and assist families at risk of aDtlSing or nejlecti.n, their children
b. Operate a system for receiving reports of abuse or neglect of chlldren
.c. Investigate families reported to abuse or .neglect their dliJdren
d. Assist troubled families in providing the proper proteerion. and nutrure for
their chjJ~n
.
e. Support children who must be removed from or who caMot live with their
families
.r. Make timely decisions about pennanenl living ammaements for children who
must be removed &om or who Gannot live with their families
S. Provide for continuing evaluation and improvement of child protection laws,
.regulations, and services'
2. Eligible states. In order to be eligible for block grant funds, states must;
&. submit a 'Written doeument to MHSthat describes how they intend to pursue the
purposes described above
b. certify that they have a state lsw requiring public officials and other'
professionals to report actual or suspecled cases of abuse or neglect' .
c. certify that they have procedures for determining quickly whether a report of
auu:se
"I'
m:~h:1,;1 i» {,;rcdibl~
alld for Laking
a~tion
if It is
d. certify that they have procedu.tes for ensuring that children removed from their
families for protection are placed in safe and nurturing settings;
.
c. certify thai they have procedures ror ensuring that children removed from their
home have It written plan that spccifia the goal for achievina a permanent
placement. mat the plan i5 reviewed every 6 months, and that information. about.
the child is.collected regularly and recorded in me ease record
/
C. within three years ,of the dace of pauage, declare quantifiable goals or their
child. protection program and report quantifiable information on whether they .
are making progress toward achieving their goals
g. the Secrewy of HHS can dcnermine whether the state plan includes. aU of the
elements reviewed above but cannot add new elements or review 1he adequacy
of state
pro~edures
.
.
3. Grants 10 states for child protection.
8. The block grant money js an entitlement to states for five years
b. Th~ amount of money in th~ bJoc:k pnt is
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4
c. Each state reeeives the same proportion of the block pant each year as it .
received of payments to stales by Ihe federal government for chUd welfare
proarams in the ,verase of tile years 1091, 1992, and 1993
d. Usc of funds. States can use block grant ftmds
--in any manner reasonably calculated to accomplisb the purposes (see above)
··states may transfer up to 20% of the funds in any given block grant 10 othr.r
blc:x:k F a n t s .
'
e. Penalties. Stat. are subject to two penalties:
-~if an audit determines that states bave spent money on activities not consistent
with me purpose of this legislation. the amount or misspent funds wjJl be
withheld from the state's payments during the following year (with the
resaictlon that not more than 2S percent of a quarterly payment can be
withheld)
4.. Child proteclion standards. These standards are included in the hill fo indicate what
states mu-st do to assure the protection of children.andto provicie: guidance to the'
.
citizen review panels:
a. The primary standard by which a state child welfare system shall be judged is
the protection of children
b. Each stale shall investigate reports of abuse and nealect promptl)' with due
regard to the potential danger to ~hjJdten
c, Children removed from their homes shall have a permanency pJan and a
dispositional bearing by a court or a court~appointcd body within 3 months after
a fact-rlJ1ding heario,
d All child welfare cases with an out·or-home plQ~ement shall be reviewed
six months unless the child is already in a long-tenn placement
ev~
S. Citizen review panels.
a. states must have a least one citizen review panel for each metropolitan area of
their state
b. Panel members must be broadly representative of the community from which
they are d r a w n · '
.'
c. Panels must meet It least quarterly
d. Panels are ~har,ed with the. responsibility of reviewing cases from the child
welfare s),stem to ddC'rmine whelher Slate and local agencies receivins. funds
under this proaram are carrying out activities in accord with the Stue plan, are
achieving ~e child protection standards. and are meeting any other child welfare
criteria that the panel considers impotl8nt
e. Panels must produce a public report after each meeting and states must include
infonnation in their annual report detailing their responses to Ute pane) report .
and recommendations
�FEE-09-1995
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FILE No. 100 02...09 '95 12:06 m:COI'-JG. MFlTSU]
s
6. Audits. State expenditures are audited every second year; any funds spent for
purposes other than those stated for this block graDt will be repaid to the federaJ,
govemment
7. , Data collection and reportin,. States must annually report an .lrterwive eet of data
to'the fedeta1 govemment. The information that must be reported includes the
number'of children reported as abused or nc,Jected. the number of Iq)Orts oC abuse
or neglect that were subsequently substantiated. the number of substantiated cases
that received services. the number of ehildren removed &om families, the number
of families that
receiv~
preventive servlcel. the averap Jenath of 8tay in foster
care. the number of children in foster care with a aoa1 of ,doptiori, and a number
of other performance measures. States must also include in their report a sllmmary
of the data me.,.uring whether they are making prosress toward their Boals (see ,
above), a summary response to rhe fmdings and recommendations of their citizen
review panels, and. if funds were transferred to mother block pant. an explanation
of why the fUnds were traniferred. The Secreta.ry of HHS must prepare an annual
report based on state reports and make the report available to both Congress and the
public:.
Title IV;
Rc5'riS~D& Welfare
for AUcns
1. Ineligibility or aliens for public welfare assistance. ,With the exceptions noted
below, noncitizens are nol eligibJe for 41 means·tested proarams (see auached Ii,st)
2. In order to help noncitizens improve their job preparation skills. they remain
eligible for eleven progr~s that provide educational or training Services. Adults
and children noncitizens are also eligible for emergency medical servicea and for
immunizations' against, preventable diseases (see aaached list)
,
3. Exceptions:
a. Refugees are not ineligible for means-tested' programs until five years after their
date of arrival in the U.S.
b. NODeitizens over the age 0(,75 who have lived in the U.S. for at least S years
may also continue receiving welfare benefits'
,
. 4. Current residenJ exception. The ineligibility for means-tested benefits of
nonciti2ens currently living in tho U.S. does Dot tak~ cfFc"t until oue lRC aner the
date of 'enactment of this bill '
,
'"
'
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PAGE 9
S. Notifteadon. Each fedetal alone), that administma propam from which
'
noncitizens are to be disqualified must provide general notification to the public:
and program rec;ipients of the eligibility ehanges
6. 'MOe agencies requited to provide infonnation. Agencies administering dle Aid to
Families with Ikprcnucnt Children program must provide the name and ad.circs.s
illegal aliens with children who are citizens of the U.S. 10 the Immigratioo and
or
.Naturalization Service
7.. Sponsorship agreements. The document by whichinc1ivich1als agree to sponsor
immj~u by making their income anilablc to
immigrant un: made legally.
me
binding unlil the inunigrant becomes a citizen (the agreements are not now.leJally
',binding and last (or either three or five ye.m:)
Title V: SugplementaJ Security Incomc:Rcfonns
1. Denial of SSI Benefits to Drug Addicts and Alcoholics:
a. An individlJal shalt nof be c.on~idered disabled it his primary
diC\ano~is is that he
to alcohol or a druS
.",'
.
b. As a result drug addicts and alcoholics lose\SSI benefits and Medicaid coverage
c. Part of the savings realized will be bI~k granred to States for drug treaanent
is addicted
2.
ssr Benefits to Ceruin Children:
a. Restrictions on eligibility for casb benefits
·-repeal "comparable severity" lest (or' dele.mUniog disability of children, so that
eligibility for cash benefits or new medi~l services will be based on medical
listings only. and not "individual functional assessment"
··c:hiJdren currently rcceivin, cash benefits because of Ii disability sp~ified in
the medical listings will QOnlinue to be eligible for cash benefits; .however,
c:hildren not already on SSI On ena~ent wi]) only receive cash payments if
institutionalized Or odlerwi.se would be ill the absence of the casb payment
•..children considered disabJ~ but not receiving cash benefits will be eJigible for
additional. medical services provided through block. grant described below
b. At least once c\-eryJ years States must conduct continuina disability reviews for
children eligible (or cash benefits {except th01!.e whose condition cannot
improve}
.
.
c. 6 month grac.e period for current SSI recipients
d. Social Security shall issue regulations within 3 months of enactment .
e. Social Security must notify \Ir'ithin J month those whose eliiibility will tenninate
f. Block Grants· for children with disabilities
.
··Social Security to make grants; Jrants are an entitlement to States
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7
--remove ind.ividual eotitJcment
Lu
benefits .
spent only on authorized medi~l and non·mecUcal services for qualifying
individuals
"'
··S1ateS decide which services 'from prescribed list may be paid for with grants
••"qualifYing individual" means a child who is either (1) elisible for eash SSI
benefits Wlder this title; or (2) who is not eligible for cash but is disabled by a
condition in the medical, listings
-gl'ln1S
,··State grant based on number of ehildren elisible for additional servic::es
�,~iFEB-0~-1995
17:00
FROM
TO
DEPARTMENT OF HEALTH .. HUMAN SERVICES
RASCO
P.01/11
Olfice of the Assistant Secretary
for te;itlatlon
,
Wa$ningtOn, D.C. 20201
, FEB - 9 1995
TO:
MARY JOBANE
DAVID ELLWOOD
BRUCE REED
. CAROL RASCO
EMILY BROMBERG .
ANN ROSEWATER
WENDEJ.1. PRIMUS
SUSAN BROPHY ,
PAUL CAREY
401-4678
690-7383
456--7028
456-2878
401-4678
401-4678
. 690-6562
456-6220
456·2604
JANET ,MURGUIA
456-6221
KEN APFEL
395-5739
45(j-7028
. JEREMY BEN-AMI
AVIS LAVELLE
MEliSSA SKOLFIELD
JOHN MONAHAN '
.690-S673
690-5673
690-5672
FROM:
HHS/ASL STAFF (Jim Hickman 690-7627)
DATE:
February 9, 1995
PAGES:
11 (including cover)
NOTE:
Prepared Remarks byCbcUclruin E. Clay Shaw (R-FL) hefore the US Chamber
of Commerce; US Chamber of Commerce Press Release on speech 'and·
impediment~ to hiring welfare recipients.
�TO
'/'"
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.. ":
P.02/11
Preparea Remarks by
Congressman E. Clay Shaw
Chairman, Subcommittee "on Human Resources
, of the Committee on Ways and Means
The U.S. Chamber of Commerce
February 9,1995
Gooa morning.
Let me thank you very much for 91v1ng me the opportunity to come
,here today'tospeak about a very important subject.
That subject is the complete overhaul of our nation's broken
down, failed welfare system.
When Republicans stood on the steps 'of the Capitol on September.
27th last year, we made a contract with the American people. We
said that if the people made us the majority party in the House
of Representatives, we would ,bring to the floor of the House
within one hundred days ten major bills to get America back on
track.
I am here toqay to say that our contract will be honored.· Our
word will be kept .
.
On Monday next week, the Human Resources Subcommittee of the Ways
and MaanliJ Committee will begin to pass a bill that fundamentally
changes welfare in the Unitea States. The Economic and
Educational Opportunities committee the Agriculture Committee,
and other committees are also hard at work on their parts of the
Contract with America bill.
I
The bill we will consider Monday will mark an end to a welfare
state that has failed.
_ t'
The welfare state failed because for too many years,
,equated compassion
~i th
money,'
It failed because Congres:a equated solutiong w::'th
Congress
one-si:ze-fit,s
all bureaucratic remedies.
And it failed because Congress was ilfraid to make the tough
decisions that must be made if we are going to really help the
beneficiaries of the current welfare system. as well as the
ta.xpayers :without, whom no system. of help eould be possible.
1
�" FEB-09-1995
17: 1211
FROM
TO
RI=1SCO
P.1213/11
Some have asked why I chose the United States Chamber of Commerce
as the place to make this speech. Let me explain.
I believe the American people are the most compassionate people
on earth. No one opens their hearts, their wallets, and their
minds to the needs of the poor more than the people of this great
count.ry.
Tell the American people .thatthere is a social need 'that must be
met, and the American people will rush to meet it. That is true·
for all Americans, ftom the poorest taxpayer who has a little to
give to the richest who has much.
But after thirty years of spending five trillion tax dollars on
social progra~s, can you blame the American people when they ask
if the money they have spent on welfare has done any good?
I am
must
here at the Chamber because if we are to fix welfare, we
reali?p. that every American, rich or poor, has a stake in
this debate. The Chamber of Commerce does recognize that. You
have been meeting regularly to come up with solutions to the
welfare problem. I salutp.' your efforts ,and thank you for your
ideas.
the end, there can b~ n(') solution to welfare unless you
the taxpayer are willing to care and to contribute.
For in
you to care,about the plight of the welfare mother, the
needs of welfare children, and the conditions of our troubled
towns and cities where poverty. and welfare are too often the
We need
rule.
Arid because you do care
our nation'c needy.
I
I know that you will answer the callo'f
And . make no mistake - 'as we move forward to overhaul we-l fare #
without the taxpayer, no colution will be possible. Without
support from you and tens of millions .of working Americans like
yourselves, welfare will ,remain a problem that never gets solved.
That is why y.our support is so important. That is why your ideas
are needed~ That is why I am with you today.
Before next week is through, we will have passed a bill in
subcommittee that improves the lives of welfare beneficiaries by
, helping them rediscover the dignity of work and. the strength of
the family.
2
�'. FEB-0S1-199S
Our bill
1:7: 01
~is
TO
FROM
RASCO'
P. 04/11
based on three major principles:
One - Republicans want to make able-bodied people find dignity
through work if they are able to work and receive welfare
benefits. OUr proposal will require 2% of recipients to work in,
1996, increasing to a maximum of 20% bY.2003 and thereafter.
After tW9 years on welfare, and less eimethan that at the option
of the states, all recipients will be obligated to participate in
a work program.
Similarly~ our bill stops welfare f~om being a lifelong program.
After. five years on welfare, the av~rage family will have
received $60 000 in government welfare benefits. The Republican
bill will cut off cash benefits to anyone who has spent more than
five years on welfare. We will continue to provide !,oo,..Q Starpps
ana Medicaid, but we believe we can no longer provide cash .
forever.
'
1
There must be a date certain when the aid starts to diminish.
say five years is enough. '
We
The second principl,e we want t.o \lnderscore is the need for people
,to take personal responsibility for·their decisions and actions,
especially as they relate to their families. Republicans want
people to find the great !ltre,ngth that can only derive fr(')m a
loving, united family.
'
There are provJ.Sl.ons in this bill. that are eontrovereial be-cause
Republicans are not afraid to deal directly with some of
welfare'S most vexing problems. No problem is greater than
t.eenage pregn,anoy and illegitimaoy.
Single, teenage mothers who have children while on welfare are
ohaining themDelves and their babieD to an endless life of
poverty passed from one generation to the next. For too long,
the government has added to the problem by paying people whose
#
Qctions are solf-destructive.
'
If the American people believe - and they do - that it is wrong
for unmarried teenagers ,to have children, thenie it not aleo
wrong for unmarried teenagers on welfare to have children? ' Why
then does our welfare system today pay unmarried teenagers on
welfare for having a child?
To underscore the need for people to face the consequences of
Lhelz;' Clc;L.l(')lll:f eUlU Lv Lak.e ,i)ez;'l:fvmtl J::el:fpoul:fibJ.lity !o.c; Lhe..i:L"
ivin tax a er-provided, AFDC cash
benef!.~~_!;9 peQPleJiq.Q~", actions are se
. e will
decisions, our bill sto s
provide the motne:rs and \..11811: families wit.h food
stamps and medical ca~" but we will stop pr~dlng cash
inducements to teenagers who have Children they know they can not
continue to
affora to ral.se.
3
�.. FEB-0~-1995
17:02
FROM
TO
RASCO
P.05/11
It is time for society to send a sl.gnal to our teenager's. We
must say STOP. Do not sleep with someone and expect the
taxpayers to bail you out if you have' a child. ,Your behavior is
harmful to yourself'and your children. Singl~ teenagers must
reflect carefully~ Above all, they must find relationships that,
nurture the wonderful strength that can only come from a loving,
united family. Anything else is self-de,struc:tive.
4
On'this point" another important word must be said.
There are many in our nation today whose d~fficult plights are
, ,made worse because of the' irresponsible I imm()ral, and illegal,
behavior of those around them.
"
To those dads and moms who skip out on their children, leaving a
single-parent, often the mother. behind to make ends meet - we
have a simple message - you can run but you can't hide.
Our bill will help ..~'!tes,track down deadbeat parents and make
these-cnaracters pay their-cn~ld support.,
'
Often, child support can make the difference between a single
parent who c~n provide for themselves and their children, and a
single parent who is forced onto welfare. Every time a parent
leaves a child behind, they break a little piece of that child'R
heart. They cause that child damage that many times can never be
repaired.
If our bill can accomplish anything, we hope it will se'nd a
signal that there is no greater institution of hope, love,
strength" a.nd opportunit.y in America than the traditional
. American family.
And if parent~ walk away from their families, the Republioan bill
will be a powerful device put into the hands of the states so
they can'find these parents and make them pay their due.
to~.-.::--=-==
is returnin
ower, flexibility, and funding
ey are in a,bet er pOel.tioD Eo help ,those
t
in
We want to move welfare solutions closer to people's homes and
communities, saving taxpayers money as
middleman.'
'We
take out th,= federal
I don't need to t,ell the ,Chamber abou.t redUndant, bUl:eaucl:at:.i(:,
federal regulations that do more harm than good. " But did you
know that there are currently 336 ~verlapEing federal welfare
programs that represent a rigid, categorical, bureaucratic,
solution to'our nation's welfare 'problem?
'4
�FEB-0~-1995
17:02
FROM
TO
RRSCO
P.06/11
The wel£are proLlems of the South Bronx are not the .same as the
welfare problems of South Dakota - and neither are their
solutions.
The Governors have told us that they can accomplish more with
less money from Washing~on if we. would only get off tbeir backs
and allow the~to design and implement their own welfare
proposals. The Governors are right.
Our bill creates a formula that provides +evel funding of welfare
for five years at 1994 levels. Many Governors are pleased with
this' level ot funding and so am I. The Governors will be able to
do more with less, and the taxpayers will save $14 billion from
the three block grants ~der jurisdictioE of the Ways and Means
C,ommi t tee.
.
As we turn power over to the states, much has been said about the
s,o-called "strings attached" issue. Some Governors have asked
for block grants from the federal government that come with no
"strings,;"
As I have said before and say again today, this we can not do.
As your elected representatives in Washington, you have sent us
here to be stewards of your federal tax dollar,S. We, simply can
not fulfill our role as stewards by signing a blank check to
anyone, even to our nation's Governors,.
In return for restorin~ower and flexibility to the states, some
s-trlngs will remai'ii-attaCI)ed.
-
Let me speak to one or two of the most important.
Speaker Gingrich asked us recently to rethi~k the Contract
provision which called for terminating most welfare payments to
legal immigrants.
Together with other members of the Ways and Means Committee, as
well as with many other members of the House, I met with the
Speaker sevel;"al times to discuss this issue.
The Speake~'sconcern was to provide flexibility to the states
most rmpacted by legal ~mm1grationand to ensure that hardship
immigration cases were not subjected to unfair regulation,s.
But a fundamental issue remains.
5
�"FEB-09-1995
17:03
TO
FROM
RASCO
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When immigrants comt:='to America, we welcome them onto our shores,
and hope they have com~ here to enjoy our liberties and freedoms.
OUr nation offers immigrants an incredible opportunity: come to
Che nation wi~h,the'most individual freedont of any nation on
earth and join an economy, that has' produced a net increase of 54
million jobs since ,1960. In return, we ask two things: first,
obey our laws; secona, become· a citizen before, USll welfar.
This is Republican po cy. It is supported by the American
people. It, is clear. It is fair. We intend to pass it.
Republicans continue to believe. that immi*rants should not come
to this country to receive welfare. In t e case of some legal
i'fiimlgrants,'they t:hemselves are hara at: work, but: ~hey t:ake
.
advantage of our system by sending for their family to legally
come to Ame~ica, and then the family winds up going on public
assistance.( 1'L:..1I'Io(. ~;tI ?<.. ~. f'II'Uo ~e 6? ht)/lslN f ...uU41&"61"1)
.
This is wrong and our bill will stop it. OUr bill will cut off
weltare benetits tor most legal immigra~ts. Thqse aqeO 95
and older will continue to receive welfare and so too wlll
le~r:!¥ reco@£zeg refugees~ ~ wdl SIlK(, .t:.lL.v;i:1,tl; Ju 5~ -rJ".~J$ 41t//
m~st
J:w,; ~ wl(lu~ or..J .'
.
'
Let us now turn our attention to the Supplemental 5ecurityln£ome
program, one of the nation'S most abused welfare programs.
I said earlier that the American people are the most
compassionate in the world and will pay the price for a program
,that works.
'
.
But the American people are also wise and they know that when you
give out checks to the needy, some pretend thac they are needy so
they can defraud chesystem and steal from you, me, and the
legitimate welfare beneficiary.
Nowhere is this more true than in the Supplemental Security
Income program, S51. Under welfare today, we pay cash to
children who are taught to act, quote, age inappropriate,
unquote, in order to collect a check. There are documented cases
in which children are coached by their parents how'to act up in
school and are encouraged to fail classes so they can qualify for
this·program .
. Just last month, the Baltimore Sun published a superb series
about the SSI program. They 'told us about a Louisiana woman who
collected nine SSI checks - for herself, her common law husbandl
and all 'seven of her children. Her take was $46,716 in tax-free
income per year. There apparently was nothing wrong with these
children. But there is something wrong with parent:s like this.
W=-~ill tig~te~YR the 5S1 law to stop the fraud.
.
In addition, alcoholics and drug addicts currently qualify for
SSI payments.
6
�"FEB-0S1-1995
17: 12!4
TO
FROM
RASCO
P. .12!8/ 11
In this regard; there can be no clearer case that'shows the'
terrible, perverse incentives of our welfare system today. 'In
effect, ~e say to addicts: "Drink or drug yourself into a 'stupor
so you can't woz"k. "Tht:u Lbe government will ta.ke tax money and
give you a guaranteed income of over $450 per month and,medicaid
coverage. Take that cash and buy yourself more booze or drugs."
This is anorrible policy. Our bill will stop it.
Our bill will protect the needy on 9SI, but we will cut off those
wno do not deserve to quality for this important program.
Changing a sy~tem as large and as important as welfare will
inevitably lead to some disagreements. Even among our sood
friends, the Governors, there may still be some differences of
'-»
•
.
opl.nl.on.
Nevertheless, when our bill is passed, Republican:s believe deeply
that life in America will be changed for,the better. Life for the
welfare benef~ciary and life for the taxpayer.
Mucn like tough-love, our bill 'faces welfare's most difficult
problems directly and sends ,a powerful signal that the government
can not and will not solve everyone's problems.
,
,
Republicans believe in individual li.berty, freedom,
responsibility and opportunity. Our current welfare sys.tem
systematically destroys these virtues.
Welfare as it stands today has become a cruel hoax that too often
hurts its supposed beneficiaries. It has destroyed
responsibility, diminished personal dignity, and created economic
disincentives that bar people from success ..
In .our system today, crime runs rampant, fathers run away, and
leaders run from real solutions.
Republica:ns..want welfare beneficiaries to have better· lives; we
want our fellow Americans on welfare to rediscover dignity by
ioining the mainstream of taxpayinq working Americans. We want
to end the cycle of welfare dependency tbat is crippling our .
cities and our citizens .. And we wa.nt taxpayers t.o know their
money is being put to good use.
Our three principles - work, perSOnal responsibility, and state
control - are the keys to unlocking the welfare prison that has
kept our fellow citizens trapped.
The time has come to say that the federal welfare, state has
fallen and' it can not get up. For the sake of the beneficiaries
and for the sake of the eaxpayers, it must be replaced.
Beginning Monday next weeki 'we will replace '1 t.
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Thank you very much.
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FEB-0S-1995 17:04 FROM
FEB-09-1995 ·13: 5S FROM ~/CJPR
v
P.09/11
'IU
US. Chamber of Commerce
1615 H St.• NW
WaehingtDn,DC 20062-2000
MedIa. RAlAtinns DeJ:lartment (~~) 4&3-MS?
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~.s.awO~BLEASESWELrAJlElU!IOtMWBlIE'P_tiu.TDETArul,
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:t;EGAi, DISINCEN'.l1VJS ro lIJ1IING WJ!UARt; R~
,
.
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; : W.umN<mlN -l1ae U.s. (."hamIwrr ofCotOiJ.cetoc1ari...... \1iite,.;.that ~ .
tbemriDl!!mus Wen1,1aWc·tluatpreaeat 6.pDwte -=tor wi6 Up dj":en~ to ~ C\'eD: tbobest~ .
~ we1farewdpicara.
~ Also today, fa. speedi1D •
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_ _ Jeaderl884 JlOlpSat the QarriIw" ~~ Clay Shaw(&- . .', \
!ILl, Chain"'" oftlae Boase WIl)'SIIDd MIDI Subcc",..iit'ee. Bamm~ 1I'I:lYei1ed the
,..,..,'vM&rc lef.bIm bill tbr 1he 104th Coqras&
"
:
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-chis Vr'hile paper details 19 fedcqJ. Jawsdaat act IS cIItoi1ceutives to]ld.9ate an;,1oyeBJairiq
\
wdimi ~7f IliidJeffivy R losqt~ Chamber\'icepresidlllt fix' dome8t$~.
, '. ',WJ."hc IT.s. 0 .......ita IJIIJa.1i!911'1 cleepqOOlIM.dttcd to wvrkiaS ~~ SWiw, '
_die
Hoaie W.,. ancl Meas Cuu1aIittEe," 1va:pJa IiBif, DGtiDg tlIaC alecent SIZI'Vey of"."... "
.,,«j~ Ywwed wt:UiD refimDas cae ofthe top ~ prio.dtieI fbcti 100000Coipas.
~ dDpD mrweUirm Ic:Ibmlis «wvrldinDDt wdfsre..-JoatIh said. ~~-riIh1o~
. ' i
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1 ' ftAmrt.plaJi erMsioDs ~ a ar))st11JJial madJer ofwel&unecfpleats iuto pvate'sectejobA. : .
:
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'D.IeQm_, uf.'-priuIIB sector'JlJllStbelddle&Sed.
. -rile u.s. 0 .... uf~lnmefQi: woa1d be'YISJ~ wiIk myplm t1aat 4Or:sDOt·address.
dIese ~ and we kMtkto Ccmsreasw ... 6IIt ¥~toJm:ia&~Jerwipiaabl."
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~ Imp damaiw to CM!:I'ZI!:I1uas~ . . . . ."uiaal::iDa or",.Rmg&r~IF plsmtje.",
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FEB-e9-1~
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CaSh 'Wel£ate R1o~~ BrsPt
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. : 6: c:urrent Aid to Fami11es with DepeD.C!ent ~drert p~og:.c8IUS
, will be :replaced with a si.ngle block grant to Stat.e.~
• ! ..9Pendi:ngon cash welfare will be capped for 5 year8~ saving
taxpayers $7~6 billion.
..
:
• : ' States will be p:oldMted f%'Oll us1Dg federal'tax do+lars to:'
(l) pay cash welfare to ,lIIOtbera UZlder 18 who have chilQren
out-of-wedloc:k; (2) give. extra paymente to fami11u 'tl:Ia1: have
more kids while on welfaze 1 aDd (3) pay aaah, wel~ 't.o a
:':
single fudly for mon than 5 years. Bach point' is :drawn
atraigb.t frOID Contract language.
.
,
• ; Welfare recipients IRUst work to CODt.iJ.rue getting cash'
'
payments after twa yean.
'
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ggld Care Ilock Grant
,
,
• ; About a. Clozen current federal child. care prog:z;iiIlltS' wil1 be
: mergecJ i;uto ,aDut.her black vrant.. ach.i.ev.ing $3. (; billiODin
, savings. '
"
As with other ~lock granes, StateR will be givan'enOrmous
f:l., exibil!ty to better Serv'e ~beir' J:'OlJide:r.J.t.s" si-l,t A.
"
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pxograzu, and save t&Xpayen IIODey. We will' at-last..Tdo ilway ; '\
w11:h t:b.e old canard tbat. more federal spending equals mere,'
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c;:ompaBBiou. :It c10es %3O't..
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FEB-09-1995
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1naarl.y $4· billion over five years..
.
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• : Ifeg-lected: and a.b\1.sed cb11ctren will be froe" frot'rl
ou:rt'erlt
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; morass of feeleral'regulatiODS to ~a:l.iae quie~ ~a.ions,
: mOre accoun~abilit:.y. an4 fewe~ arb:l.t.~TY riles f~
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, WaShiDgtCr1.
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• ! M wi't.b ~her' :block gz:a.'Ats ,states will be ~i~t:O sGlJd.
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'iufol1lilLt!on about their prograu to the f8de~l gpve~t,
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: so we GiW i:igure ~t 'wbat wm!'ks iJ:Ll!lt.ead Of'ld,mp;tt t~g
: IlIOn '1Doney at our society's IROct· difficult pz'Cblems_
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; disabled 'u,d therefore eligible fer e_h' payzllm1ts fram SSI.
: we v.ill, 'U8c;t p;trt of the aaviDgs to pay for d:t'ug ~t1!lClt and
; reJ:>ate the :re!St .back tot::a:payers.,
:
• : As in the Contract., bOD-cit1zeDS would DO longer!be eligible
, for lIIOS't' welfare pr,xUlS. BXeepticma w11l l:e1IIain for
'
• : l>r'ag addicts aud alcobolicG will
. z:efl19'GM!rs and legal.
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tl1ey CaD improve tbeir job praparaticm to become :mo:re
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proclu.ctive future CitiZens.
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• Spo:;t.aorship provisicm& will be strengthened. " :
•
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bY about $2:3 .bU1101l over 5 years (altl:sough 'IIU.Ch:of this
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's;aviDg's will accrue to Stat•• because of the hlOCk' grants
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�FEB-09-1995 11:56
• -.
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P.0V06
,
fEB '"- 9 1995
....,..\'I\:r,
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FROM
Office of the A8,istant
DEPARTMENT OF HE4.LTH. HUMAN SERVICES
~retary
for Legislation
.
.
TO:
W&S"lngton. D.C. 20201
MARY JO BANE DAVID ELLWOOD
BRUC.E REED
CAROL RASCO
EMILY BROMBERG
ANN ROSEWATbK
WENDELL PRIMUS
SUSAN BROPHY
PAUL CAREY
JANET MURGUIA
ISADELL SAWHILL
JEREMY BEN-AMI
AVIS LAVELLE
MEUSSA SKOLFIELD
JOHN MONAHAN
401-4678
690-7383
456-7028
456-2878
401-4678
401-4678
690-6562
-456.6220
456-2604
456-6221
395-5730
456·7028
690-567:l
690-5673
690-5672
FROM:
HHSI ASL. STAFF (Jim Hickman 690-7627)
DATE:
Fepruary 9, 1995
PAGES:
6 (including cover)
SUBJECT:
Background information on the Individual Responsibility Act of 1995. the
Mainslreain Forum welfare reform legislative proposal
�FEB-09-1995
()
11:56
RASCO
TO
FROM
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P.02/06
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Work First I,("ogram to mo~~ welfare rccipi(mts into workfon.."C a.~ soon
».s possible. .Work·Fi.rst detnand'i that job search begin ilUlncdiately.
o Wm'k F'kst would have a. federal mode:l, .whlle providing incrcac;cd
flexihility to states that call·opt out of federal progr3Jn and into their
own tbrol.gn a simplified, less cum.bersom.e waiver process.
.
(I
·IRlpwies 3. two-yt>.al" Ufetime lim.it to benefits througb Work First·with
an additional option of two years in a Community Service pcogram..
Np
m9l"~,601~.ethiK
fQr
nothim!.
o Provic:k5 sanctions against those who do Dot cumply.
o Generatiooal dependency is no longer an optio.u.
o Minor mothers must live with a pfirent and remain in school to recei~
benefits.. Minor fathers
stay in school and work in c:ommuility
senite if they cannot provide support otherwise.
must
o
Demands' paternal identifiCation at birth in· exr.hange (or benefits.
Grandparents of the minor child's children would be·fiDanclaDy·
liable for thefr
\:un~-
.
o Unlike otlIer welate reform. propoSals, states would
establish commUDity service progna.ms. . .
.
DOt
be required to
o Under OUf bill, states can drop weirare recipients after two y~ if·
they dJ.oaw.. It also jives them the UptiOD or re<:yding U much
as 10 percent of a particular ~'ear's caseload.
o States caD impose a family cap luniting beneDt increases to tbose who
. have additional children while receiving weUare assistance, and
.
eliminate existing dfiadvantages for IIUIrri3geo
.
4)
Consolidates existing patchwork of child care pnlgrams into a single
pro~am with limited' federal strin~, and allows states to esfl:lbJish
their own Work .~lrst programs with few minimum standards.
f
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NO.691 P003
MajDr Differences Between Individual, Responsibility Act and
Personal Resporisiblity Act (Contraet with America weJfarerefonn)
1. State ~- The proposal gi'VCS' ,s.tates flexibility in the followUI& areas. in whiGh the:
Contract does not provide flexibility:
a.. S'nms' have option to zecyolc up to 10 percf:ut ordll': ~ back into the W(JIX ·...irst
program;
b. Allows state the option to distinguish between classes ofaliens for state prognullS.
c. SI4Ics ha-vc option to implement family cap and climiaate the crutretIt disad*ttages for
BUWd~c;
.
d. Allows states to use the asist.aIlce iivcn to o~ immigration poposal in the mmmcr
they seent
2. Give States ~ Negssary Fag to Operate Work Ptu.1:3pg - The Individual Responsibility
Act sets more ~nable Dlltcbing rates that staXs Qan ~ for panicipedQD in the WF component
EIlJd Communit) Sc.rv:ioe Program.. The bill establisbes the following matdJiqg rates:
a JOBS coinpoaent - 8e'111:Ilty percent marr.biog rate or the Merlic.aid. m.atcb.ins rate plus ton
'
pen:ent,. whichever is higher.
h. Community Se.rvic:e • SeYeaty pezee.ut IIRItohing rate or Medlcai.d Jm&1I,;birJg rate plus teIJ
pertent for the Admioistrative C'OSt!, whichever is bigher. ,For wage$.Medieaid matching
rate W«lld apply. ,
The Contract prOposal requires states to dmw down JOBS :funds uDder the ~urrent match before
WORK money would be available. Qvertwo-thirds ofstates curremly do not draw dawn lOBS
funds because offinanciaJ constraints. The Contract proposal would:feme Slates to either
, dnunat:i<:al1y increase state speading OIl weIfare programs to uwet Federal participation
requHements. or not participatf: in the won ptogc&rD at au. EDnc:tiDg wclfare (c;form wlllauut
providing the staleS with resaun:cs to implement the reforms will repeat the mistakes oftbe JOBS
program.
Iime-Limite.Il Traat!itioMl AsslIIpce .. The Individual Res,rxmsibility Act places a four year
limit on total.participation in the WOlk Fint and Community Service:programs. The Contract'
places a five yvar time limit on participation in the Work Program.
3~
4. l!utritioo Proa"'_ -The Individual Responsibility Act does not eliminate CD.titIcm.cnt smms of
,"utrition prognuns.
'
5. DegyiDg Bqefits to.Minor: Motbgs - 1be lnClividual Responsibility Act does not dmry benefits
to ir.ulividuall UlNer 18 years 014 but requires tbem to live with pale:ats or guanliBDS to receive
,benefits... It requires minor mother to live w:itb parents to receive benefits.
�FEB-09-1995
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rq].691
P.04/06
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(;. Qftd f&re • The Individual Responsibility Act would eomolid'a1e all child care progtatll.'C into a
capped. enti~lement program that.is ifistrlbuted through a block grant that provides stale flexibility.
Increases funding to oeeoDlDlOdak cascllM1 w::.u cl:im.inates exlstfng fUDding shortfall, in ord£t to
provide assistance 10 all familie$ Vrho need dJild care assis1:am:c to work to gel off I stay affwe1fare. '
The ContJ:ac.t ~ not provide sufficient funding to elimiDate MS in assistance. Wi1hout adequate
fuoding tOr cl:Iilci care ass1stam:e. many families will be farced back into we1fate programs.
7. Parlici,gati.w Rates - The Indi:viwml RcspolIsi'bility Aet would put more people in the
WF(JOBS) and Community Service:PJ03r3mS than the Cmmaa; with America. The fonowing is a
comparison of the r..ombined prrti<:ipation in WP (JOBS) and Commanit.1 Service program fbl'the
('..ontract with Amcri~.a and 'our proposal.
'
latfilidaai RaJIQ_ibilil1 Act PnIpoIal (l'fumbel"lllt tboUsands)
nw
16"f701)
"~"~
'2OPA(905)
240/0(1111)
ffOO
28~I32S)
"
Con:traet fur America (NUJ.BIIen ill tboasaDds)
FY97
FY93'
FY99
40/0(214)
&0/0(439)
12%(613)
FYOO
170/a(914)
The IIl~lIiduai Responsibility Ad: would aI£t:Id TIanSitioca1 Medical Assi!Jtancefrom one to 'two
yean. ~ 3S.1et limitati()~ allow States to liberalize worlt dislcganis aDd pravide additiOnal
emld care assistance to ensure that individuals. are better off finaDciaUy by working tmm tIIey were
on welfilre. The Contract doe$ not intludc auy ofthese proposals to make work. pay.
9. Immigljldl-D:" The ;mmigratiou proposal in the Individual ~ponsibi[ity Act is not aspmdtive '
as the Contract.for America.
a. EJimiaat.es assistance to aliens for four proglws-SSI, food Sf.aDI.p6, Medicaid andAFDC
for most ~jti~. 'The: ContIact eliminatEs benefits for aliens under 61 jm:Jgrams.
h. Makes affidavits ofsUPJ'li'd legally enfon:eable.
d. C.on1ains provision allowing states to deny state-funded, public be.oefi1s to lc:gaJ aliens. '
e. The bill authorizeS S1 billi.on over 5 years to nffi:et costs. that may occur as a ftSl:llt of the
imm.ignttioo. proposal.
10 .P.~enii..,. &tab.Jtmeat - The Individ:oal RespOnsibility Act would tlRSte a '"good faith..
exemption lO requirement for paternity ,es!abtishme.tlt. The ContI2ct would deny benefits to
, individualr. who make: a good. faith effurl to determine patallity bur are uaabJe to do SO because the
$ta~ doe& X10t have the l'eSOurtU for paternity establishment.
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.......................... _ . . . . . . . . . _ .
_ _....... ....
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IS)
~~
INDIVIDUAL RESPONSIBILITY ACT
....
om
u'
~~
CONTRACT WITH AMERICA
CUr~TON
Two-year flmlt on WORK; $1ata
optton to devalop own .
Two-vear limit on JOBS: ~t.rte
must develop Community
Service program (WORK': No
PLAN
OF 1991)
Il.
Tkna4..imlt$
Two-vear limit on Work Firat; State
op.~on to deveop oWJl Community .
ServicB Program; Mandatory OV8tll11
4-year limit
Ccmmunlty Servtce Program;
Mandatorv 5"YEMlr tlme..Jimlt
mandatory dme~nm't
_
.'
Work Program
o
.....
0\
I,
, Making Work
Pay Mor. than
Welfare
Keeps JOBS program with
gre~e,
Nc provJsione.
Expandad child eire e8shrtaneei
transitional Medicaid and state opti()n
to eI'mlnate J)tOVtalona whk:h
panallzt; AfDC raclplentl who work.
par1icJpation
requirements
Pro\ltdes child cart 88sla1.nee
and state option, to inctel!lse
Income! disregards in AFDC
StateF1exibllltv
.!
~
i
~3
.l1.
[RlJ
,
program
v
tBxsbte incoml 80 thlt a dollar from
wmfare is not worth more than iii
dmlw from wcrk •
~
-
Raplace8 JOBS progra.... with
WORK; States free to develop
own won IC program;
Includes waltere aeslltance in
.,..
.~
RepJacesJOBS program with Work
Firat: States oan develop own Work
Firat program focusing on moving
individuate In.to work.
,
Allows Btates to craatsown
States would develop own Work
work program. Statol Clan opt
First program within ganeral federal
out of AFDC program and
guidelines, .tate opdons provided
convert AFDC programs Into a
Include: creation of Community
Service progtam; eblllty to recycle up . block gran,.St&te optical to
to .1 0 percent of caseloed back into . deny bene~ to mothers undol
Ig8 21 (mandatory for mo1hers
programi optkm 10 implement fIImllr
oap I eliminate marriage disincentives under 18). Conaofidet91 most
nutrition progratT's into btock
or libet'lllize income disregards •.
State option to eliminate
mardage di8incentlv8$
I
gr,nts
~5:i
..-1-1
If)n
(TIT!
~O
I "
(TI\1
cp~
co
UJ
l1.
Federal/StlltD
Relationship
Maintains antl11emen1 statue for'
AFDC end increues the fedsra1
shere for child cara and Work First
program
Block grants AFDC. child clre
and nuUition prooram8: Keeps
exi8thl9 metchlng rMea :n plo.ce
torex.istlng dollats .
Maintains entlttemen1 status fOl
AfDC and increases 'he federat
share for child care and JOBS
prcwam
,
~
�\D
~~
Tough child BUpport enforcement for
pf
o~
gS!
astsbllstlment in aU caseSi
Minor chang8$ln Interstate
mothers and states; Unlfonn
inter_te uacklng~ Holds grand-
Q..
Mand ate a paternltv
deadbttet parents; Strong paternity
establishment requtrament, for
Child SLlPPort
«rtorcemant procesl
Teenage
Require minor mothlne to live wit"
Pregnancy
parent or gu,rdlan &. continua
education: NBttonai Camp$ign on
implement family
.~
~
~
".
financing
~
$~
00
UJ
U.
maintains
Individual entltk!mant for
participants invlOrk programs
and Individuals moving off
welfare.
Sa".. $53 billion thtousih
tmmlgretion. overalr cap on
Saves . , bUlion It!rough
fmm;qration chang88 and cuts
both in out of the welfare
con~ljdlt. pr0{nmSi
system
programs
Immigration
Provides .8 billion In assistance \0
offset immIgration costl: Makel
ai fidlvit of 8upportIJ enforceable:
Eliminates DS$istance '0 legBI
811ens f.om mote than 50
discretionary programs
Participation
Retea
Will require 1,326,000 in work
programs by FY 2000 ------_._.-
Will re(J.Iire 974,000 :n work
Will require 1,198,000 in work
Program by FV 2000
- _ . ~fC)graml by !=v 20()O~ ____
-
~
ME
Indh,lduBI entitlement for
IndMdual. In work programs or
who_ ere moving off welf.re.
in taKable Income, mereasud
enforcement of fraud In ElTe
program, other chungee.
;
0'1'
tncrePSQI chQd care funding for
existing progrlmSi dOGS not
States provide assistance with
faderal block grent. Bimlnetes
immigration cheng_, includlng AFDC· mtl·po.vertV prourams and
food stamps and hOusing Hsiltl1lce consolidation Dr molt nutrition
~
KH~
pt'oposa
Savel .35 b)lnon thro\.lgh elite within
the wel".,e system. induding:
I
Mr-i
cep.
Require minor mothers to I)y.,.
with responsible adulat National
Campalg1 on TEI.nage
P1egnancy; StaIB option to
Implemerd famltv cap
into one program. Maintains the
individual entitlement for participenta
in employmont programs .,d
individuals moving off waliere:
provloes al:fdlUonai funding to etetes
for child oare 8ulltEWlC8.
o
;:'5)
ltates; Uniform interstate
tracking; Incentive stRicture fr>r
good porformancr.' by states
Consolidates child care Bsliatence .
cnlld Care
fR~
Denies mnor motl1itr under age
of 18 AFDC benefit"; Stete
option to incroa&t this up to
age 21 ; Mandates family cap
Teenage Pregnancy; State option to
,
~~
i
parem$ liable for ftnlncialeupport;
~.
~.
Stronger pat.rnhv estab'~8hment
requlml1l!lnts for motoo8 and
--
~
Sponsor inoome is counled In
determining welfare eligibtUty of
aliens for INS y&af'S,
--_._.-
• Nol& this is baaed upon the aS$umption that the Ad""lnl8tration would push back the effective date of their JOBS and
Community Service program
.~
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�HHS-PVBLlC AHAl
,.
Child Support,270
Federal Government Takes Delinquent Child Support Prom Tax hfunde
WASHINGTON (AP) - Ths<federal government collected a record $703
million in delinquent child support by yanking the money out of the
income tax refunds of parents who weren't paying, the Department of
Health and Human Services reported today.
Nearly 1 million familie.benefited under what i8 known as the
tax-offset program in 1993, HBS said. The year's collections were
13.6 percent higher than in 1992.
"When absent parents are not paying child support, we need to
take every appropriate step - including seizing the tax refund,
which the delinquent parent would otherwise receive," BBS
secretary Donna Shalala said.
<
<
Onder the tax offset program, state child support enforcement
agencies report ths namea of parents who owe child support and the
overdue amount to the federal 'Administration for Children and
Pamilies.
The parents who owe child 8upport'are notified that their tax
refunds will be withheld, but have the right to contest the action.
Parents whose children receive Aid to J'am1.lj"e8 with Dependent
Children and whose unpaid child support totals $150 or more may
have their fedaral income tax refunds withheld. Refunds were
withheld for more than 721,000 APDC families in 1993.
Por families not on welfare, the child support debt must be at
least $500 before the income tax refund can be withheld. A total of
253,829 families benefited.
Por 1993, the average collection was $728 for non-APDC casea and
$682 for AVDC cases. Collections for 1994 will begin as income tax
returns are filed this year. <
<
AP-WX-02-21-9S 0840EST<
"tUIvv ....
�WELFARE REFORM REPORT CARD
DAY ONE
On the first day of the welfare reform mark up held by the Subcommittee on
Human Resources of the Committee on Ways and Means, by virtually unanimous votes:
o
The Republican majority REJECTED tougher work requirements.
Rep. sander Levin (D.,' MI) offered an amendment to require states to Implement a self
sufficiency plan aimed at the fastest possible movement Into the workforce for each
welfare recipient. NO benefits would be paid for anyone who refuses to work, refuses
to look for work, or turns down a job offer. NO one who Is willing to work could be cut
off If no work is available. The Levin' amendment would have required states to put 25
percentof recipients to work by 1998 and 50 percent by 2003, compared to the 2
percentrequlred by the Republican plan.
o
The Republican majority REFUSED to assure child care for mothers who go to
work.
'
Rep. Barbara Kennelly (D., en offered an amendment to make certain that parents are
not forced to leave their children alone or In an unsafe environment when the state
,requires work. '
'
o
The, Rep.,.bllcan majority REFUSED to require private ~ector jobS.
Rep. Harold Ford (D., TN) proposed that states place at least half of those welfare
recipients who are, required to work in private sector jobs.
o
The Republican majority REJECTED State flexibility in favor of conservative
mlcromanagement.
Rep. Charles Rangel (D., NY) proposed, to strike the 5-year lifetime limit on welfare
benefits - and leave this matter to' the states to decide.
Rep. pete stark (O.,CA) proposed to strike mandatory caps on benefits paid for children
born to families receiving welfare - and leave this matter to the states to deCide, as
,Republican and Democratic Governors have suggested.
'
o
' The Republican majority REFUSED to protect local governments from
unfunded mandates.
'. . '
An amendment by Rep. Ford would:have prevented States from shifting welfare costs
to counties, cities of local governments.
o
The Republican majority REJECTED a responsible polley for teen parents.
"
.
Rep. sander Levin proposed to require teen parents to live at home or under adult
supervision, to, stay In schoOl, and to cooperate fully with paternity establishment In
order to receive welfare benefits: The Republican majority rejected this proposal in
favor of a polley that simply m~kes the child of the minor parent Ineligible for welfare - ,
for life. '
'
o
The Republican majority REFUSED to protect against overzealous
, government Interventlo~ Into family matters.
An amendment by Rep. Ford would ,have prohibited states from placing a child In an
out-of-home setting against the wishes of the child'S custodial parent SOLELY because of
the economic circumstances, marital status, or age of the parent. The provision would
not have Interfered with state efforts to Intervene in abusive homes.
,
/
�WELFARE REFORM REPORT CARD
DAY TWO
Tuesday, February. 14, 1995
On the second day of the welfare reform mark up held by the Subcommittee on .
. Human Resources of the Committee on ways and Means, ~y virtually unanimous votes:-·
o
The Republican majority REFUSED to assure the safety of children In foster
care and REJECTED State accountability for deaths In foster care.
.
.'
.
"
" ,
Rep. Charles Rangel <0., NY) offered an amendment to subject states who are found by a
court to have neglected children in their custody to an annual review and the.
development and implementation of a remedial plan. HHS would also be required to
review states when there is an increase in tile number of child abuse or neglect-related
fatalities, or when a Child. dies while underState care. ITWenty states, including Florida
and New York, have entered into settlements or consent decrees to resolve litigation
' ..
''
over problems in their child welfaresystemsJ :
a
o .. Tlie.Republican majority REFUSED to assure that safe· fost~'r": home-wii.· be
"
available for each neglected or abused child In the state.
Rep. Sander Levin (D., Mil offered an amendment to maintain ttie entitlement status for
foster care maintenance payments and for adoption assistance payments, to ensure ..
that all abused and neglected children who need It can be placed in foster or adoptive
homes.
.
Rep. Barbara Kennelly (D., en proposed to bar states from transferring funds out of the
child welfare block grant to other blOCk grants.·· The Republican bill permits 30 percent
of the funds designed to protect abused and neglected children to ,be used for other
'purposes.
o
The Republican majority REFUSED to retain benefits for veterans or for legal'
Immigrants who have paid taxes for five .years.
Rep. Charles Rangel proposed to exempt legal immigrants who are veterans, or who
served in the U.S. Armed Forces (and for their children and survivors) from the strict
limits on alien benefits in the Republican bill.
.
Rep. Pete Stark (D., CAl proposed to exempt legal Immigrants who pay taxes for at least
5 years from the strict limits on alien benefits In the Republican bill. Under the
Republican plan, legal immigrants would be ineligible for 36 Federal programs.
�WELFARE REFORM REPORT CARD
DAY THREE
,Wednesday, February 15,1995
on the third day of the welfare reform mark up held' by the Subcommittee on
Human Resources of the Committee on Ways and Means, by unanimous votes:
o
The Republican majority REFUSED to commit the net savings from cuts in
welfare programs to deficit reduction.
Rep. Harold Ford m-TN) offered Republicans the chance to deliver on their promises to
reduce the deficit and cut taxes. They punted, refusing to commit any savings from
spending cuts to' deficit reduction.
o
The Republican majority REFUSED to preserve SSI benefits for certain
medically disabled children.
Rep. Sander Levin (O-MU offered an amendment to grandfather cash benefits for
children who are medically disabled, but who Qual,ified for 551 by meeting a less
stringent test of functional ability. The Republican bill repeals that functional
assessment test and disqualifies the child for 551 cash payments.
o
The Republican majority REFUSED to let parents decide which services their
child needs.
'
,
Rep. pete Stark offered an amendment to assure that parents get to choose from a full
array of services for their children, instead of leaving the Question of what services will
be provided to the state bureaucracy.
###
�,', .
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�CWWI
Child Welfare league of America, Inc.
440 First Street. WJ. Suite 310. Washington. DC 20001-2085
202/638-2952 • FAX 2021638-4004
February 9, 1995
Carol,
It was good seeing you at the White House.
Attached is the alert that was sent to CWLA's over
800 member agencies. I'll be sure that you receive
future alerts.
.
all
We look forward to working with you to stop this
insanity.
GUARDING CHILDREN'S RIGHTS. SERVING CHILDREN'S NEEDS
.....,
PHOTOCOPY
PRESERVATION
�URGENT
URGENT
URGENT
URGENT
CHILD WELFARE LEAGUE OF AMERICA
440 First Street NW Suite 310
Washington, DC 20001
LEGISLATIVE ALERT
February 7, 1995
'ff~B' 16 1995
HOUSE SUBCOMMITTEE PLANS MEGA CIDLD WELFARE'BLOCK GRANT
ENTITLEMENT PROTECTION OF VULNERABLE CHILDREN IN JEOPARDY
At the end of last week, majority members of the House Ways and Means Subcommittee on Human
Resources announced a plan to "redo the entire child welfare system." While the Subcommittee is still
working on the plan and no written proposals are available, we expect that the proposal would eliminate
critical protections and support provided under the federal foster care, adoption assistance and child welfare
services programs. CWLA will follow up this call for action with regular updates and alerts on the status
of proposals and directions for further action over the next few weeks. In the interim, if you have
questions or want more information, call CWLA's public policy office at (202) 638-2952.
We anticipate that the initial plan would repeal P.L. 96-272, the Adoption ~istance a~d Child ,
Welfare Act of 1980, and fold the Title IV-E Foster Care and Adoption Assistance programs; Title
IV-B Child Welfare Services Program, Family Preservation and FamilY'Support, independent Living
Program, Child Abuse Prevention and Treatment programs and some 20 other child abuse related
discretionary programs such as the Adoption Opportunities and Abandoned lrifants Programs, into a
block grant to the states at reduced funding levels. It would eliminate pari or all of the federal
entitlement guarantee for protection and services under these programs and would reduce funding for
'the new block grant by 10% or more.
Although the proposed child welfare block grant is expected to contain some standards, it would eliminate
federal enforcement, relegating enforcement to the citiz~ns in each staty.
CHILD WELFARE BLOCK GRANT EXPECTED TO MOVE SOON IN mE HOUSE, ALONG
WIm TROUBLING PROPOSALS ON WELFARE AND RELATED REFORMS
The House Ways and Means Subcommittee on Human Resources is expected to act on the child welfare
block grant proposal and a child care block grant proposal as part of its work on' welfare reform scheduled
for a vote as early as February 13. The welfare reform bill is expected to eliminate the AFDC entitlement
- for poor children and convert the program into a block grant to the states. The child care proposal also is
expected to consolidate many programs and to eliminate guarantees of care for those on public assistance.
Under these plans, states might no longer be required to provide cash assistance, jo~, training and other
basic services to poor families, ending the federal safety net for poor children and potentially incre~sing the
number of children needing child welfare services. All of the proposals will be voted on in the full 'Ways
and Means Committee soon after Subcommittee consideration and the House could vote on them:' ~ithin the
next few weeks. '
�ACTION NEEDED NOW AT NATIONAL, STATE AND LOCAL LEVELS
CONTACT YOUR FEDERAL AND STATE REPS
.
.
I
Because the proposals will dramatically affect federal and state relationships and funding, your
member of Congress, your governor, and Iyour local elected officials need to hear from you. Let them
know how eliminating the entitlement protecbons under such a child welfare block grant proposal could
impact the ability of your agency and the cobmunity to protect and care for abused, neglected and other
vulnerable children .. Give your elected reprbsentatives specific infonnation about the needs for protective
services and what, based on your experiencd, is required to meet those.needs. Also let'them know how
I
.
limitations on eligibility and funding for AFDC could affect the number of children who may come into the
child welfare system needing care and Protition.
.
U.S~
House of Representatives --' Dial the IU.S. Capitol switchboard at (202) 224-3121 and ask to be
connected to your Representative's office. Ask for the staffer who handles child welfare/welfare issues .
. Page three lists Members of the Ways and *eans Committee where the first votes will be taken.
THE MESSAGE: ENSURE GUARANTEED PROTECTIONS FOR MOST VULNERABLE
CHILDREN
Retain the Title IV-E Foster Care and Adoption Assistance Programs as an open-ended entitlement.
Consolidating these programs in a discretio~ary block grant will mean that children in state custody will no
longer be guaranteed the services they needi to protect them. Preserve the full Title IV-E entitlement,
.
including "administrative costs" and training, because these categories support critical casework
activities, as well as the planning, review aPd decision making by citizen reviewers and the courts that are
essential to protecting and caring for the children, and achieving pennanency in a timely fashion. The
training resources are similarly essential to breparing foster parents and caseworkers to serve very
vulnerable children and families appropriately. Without this entitleme~t resource, which currently provides
three federal dollars for every state dollar, training would likely not remain a priority.
I
.
Ensure enforceable protections by providing standards for the care and protection of children and by
keeping a critical federal role to enforce ,the protections in whatever new systems and arrangements are
developed. While the federal government should get out of the way and allow the states flexibility to craft
services to the needs of their populations, it is in the interest of the nation and its children for the federal
government to assist the states and to hold Ithem accountable. Widely varying resources and perfonnance
among the states make this federal role essential.
Maintain .the Family Preservation and FlmilY Support Program as a capped entitlement. This important
effort, recently enacted with bipartisan support, provides vital incentives and resources to the states to
develop and expand services to prevent unnecessary placement, to allow children to return safely to their
families, and to support services to. securepennanence for children who have come to the attention of the
state because of family difficulties. The support and direction provided by this capped entitlement remain
essential for children and families that are :clearly in crisis, but are not yet at the brink of destruction. Also,
preserve the Independent Living Program as a capped entitlement. This is the only guarantee for
supports that young people who are leaving foster care to assist them in their transition into adulthood.
�,
irs AND :MEANS COMl\flTTEE
HOUSE WA
Wally Herger (R) 202/225-3076
Robert T. Matsui (0) 202/225-7163
*Fortney "Pete" Stark (0) 202/225-5065
William M. Thomas (R) 202/225-2915
Connecticut -
Florida -
Nancy L. Johnson (R) 202/225-4476
*Barbara B. Kennelly (0) 202/225-226~
Sam Gibbons (0)
(Ranking Member) 202/225-3376
*E. Clay Shaw, Jr. (R)
(Subcommittee Chairman) 202/225-3026
Minnesota
Jim Ramstad (R) 202/225-2871
Missouri
Mel. Hancock (R) 202/225-6536
Nebraska
California --
Jon L. Christensen (R) 202/225-4155
Nevada
*John E. Ensign (R) 202/225-5965
New Jersey
Richard A. Zimmer (R) 202/225-5801
New York
Amo Houghton (R) 2021225-3161
*Charles B. Rangel (0) 202/225-4365
Ohio
Rob Portman (R) 202/225-3164
I
Georgia -
*Michael "Mac" Collins (R) 2021225-5901
John Lewis (0) 202/225-3801
Illinois -
Philip M. Crane (R) 202/225-3711
Indiana -
Andrew Jacobs, Jr. (D) 202/225-4011
Iowa -
*Jim Nussle (R) 202/225-2911
Kentucky -
lim Bunning (R) 2021225-3465
Louisiana -
*Jim McCrery (R) .202/225-2777
Pennsylvania
Tennessee
William J. Coyne (0) 202/225-2301
*Philip S. English (R) 202/225-5406
. *Harold E. Ford (0) (Subcommittee Ranking
Member) 202/225-3265
Texas
Virginia
Lewis F. Payne, Jr. (0) 202/225-4711
Washington
Maryland -
Bill Archer (R) (Chairman)
202/225-2571
Sam Johnson (R) 202/225-4201
Jennifer Dunn (R)* ·202/225-7761
James A. McDermott (0) 202/225-3106
Wisconsin
Gerald D. Kleczka (0) 202/225-4572
. Benjamin L. Cardin (0) 202/225-4016
Massachusetts - Richard E. Neal (0) 202/225-5601
Michigan -
*Dave Camp (R) 202/225-3561
*Sander M. Levin (0) 202/225-4961
* Member of Subcommittee on Human Resources
�, WE OPPOSE nLOCK GRANTING CHILD NUTRITION AND WIC PROGRAMS
•
•
The current programs are effective.
Block granting puts children at nutritional and health risk.
I '
'
, THE RISK TO CIIILDREN'S HEAL Til WOULD INCREASE
DURING RECESSIONS UNDER BLOCK GRANTS
fo~ pro~~
•. During recession, our
Jxpand'to meet rising need. But block grants don't. ' "
' ,
• If the School-Based Nutrition Block Gbnt had been enacted in 1989, 20 percent fewer resources would have been
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available to feed school children in 1994.
I
NATIONAL STANDARDS PROTECT CHILDREN WHERE, TilEY LIVE
•
•
•
-
NO l\IATTER'
~.
j
Federal standards have protected kids'; health for fifty years - growth stunting has decreased by 65%, low birth
weight has been reduced, and anemia bong low-income pre-schoolers has decreased.
The, Repuolican plan abandons .these Jtandards - leaving wide variation in standards possible and no
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accountability to guarantee health outcomes.
I
STATES WITH LARGER PERCENTA(;E OF LOW-INCOME
CHILDREN WOULD BE PENALIZED
~e
The RepUblican plan rewards states that serve
most meals. States will therefore have incentives to:
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• ' Serve meals to more affluent students who can pay for part of the cost.
I
• Cut the quality of meals to cut costs land increase the number of meals.
THK,PROPOSED BLOCK GRANT COULD RESULT IN LESS OVERALL
FUNDS' FOR. FOOD AND NUTRITION FOR CHILDREN
,.
,
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•
States would have the ability to tran,sfer up to 20 percent of the funding out of these programs to other uses.
• . The Republican proposal also inclu<;les a reduction of about 4 percent in total funding
in the first year.
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�
Dublin Core
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Title
A name given to the resource
Carol Rasco - Issues Series
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
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2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
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Clinton Presidential Records: White House Staff and Office Files
Publisher
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Clinton Presidential Library & Museum
Extent
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92 folders in 7 boxes
Text
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Original Format
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Welfare Reform [4]
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Is Part Of
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Box 127
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
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Adobe Acrobat Document
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Clinton Presidential Library & Museum
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Reproduction-Reference
Date Created
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12/4/2013
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2010-0198-Sb-welfare-reform-4
-
https://clinton.presidentiallibraries.us/files/original/29bbe19aa4ca3c493bb9fffacf4a7891.pdf
12ee120a94b8d99a63dd7e702dc9b28e
PDF Text
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Clinton Presidential Records
Digital Records Marker
. This is not a presidential record. This is used as an administrative
marker by. the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
•
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library'S Research Room. '
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�PHOTOCOPY
PRESERVATION
are
Bulletin
Child Care Bureau
May/June 1996
•
Issue 9
Using Technology to Serve Children and I;families
T
he child care community is
utilizing technology in many
creative and exciting ways.
The trend toward integrating tech
nology into child care programs is
accelerating at a rapid pace. More
than a year ago, the Child Care In
formation Exchange surveyed the
publication's advisory panel of cen
ter directors who are regarded as
leaders in the field. The directors re
ported that nearly all (97 percent) of
them utilized computers in admini
stration and more than two-thirds (68
percent) used them in the classroom.
Technology in child care pro
vides a more efficient means of ac
complishing familiar tasks, while it
expands options to meet the needs of
children, families and program staff.
Child care resource and referral
agencies have pioneered the use of
computer systems to link families
with service providers and devised
strategies to use data for planning
and needs assessments. Distance
learning using satellite transmission,
CD-ROM, and other multimedia
techniques is beginning to make staff
training and parent education readily
accessible to child care programs in
remote locations.
The Child Care Bureau utilizes
technology to improve services for
children and families in a number of
ways. Through the World Wide Web
(WWW), a part of the Internet con
sisting of multiple cross references
and interconnections via computer,
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u.s. Departmcnl of
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information is exhanged. The Ad Nations Listserv connects admini
ministration for Children and Fami strators of tribal programs, federal
lies and the Department of Health staff, and other ACF partners to dis
and Human Services are available at cuss topics relevant to improving the
lives of American Indian and Alaskan
these Home Page addresses:
Native children and families.
http://www .acf.dhhs.gov
The Child Care Bureau also uses
http://www .os.dhhs.gov
Additionally, the National Child audioconferences as a means to con
Care Information Center (NCCIC) vene administrators, organizations,
Home Page is a central point of ac and others in the field on a regular
cess to infonnation on various topics basis to discuss child care issues.
and to links· with other related
The state and tribal grantees are
organizations. The NCCIC is also encouraged to apply for Child Care
developing a Home Page for the and Development Block Grant funds
AmeriCorps Early Childhood Tech and to file the annual CCDBG ACF
700 report electronically.
nical Assistance Center.
This issue of the Child Care
The Child Care Bureau utilizes
electronic discussion groups on the Bulletin highlights examples of tech
Internet to quickly exchange infor nology in child care, including ways
mation with groups of individuals in which the Internet can be used to
from across the country. For in .share knowledge among profession
stance, the CCAdmin ListServ is a als and parents.r: The Bulletin synthe
discussion group for state and fed sizes a range of approaches to using
eral child care administrators. Par technology in training, streamlining
ticipants are encouraged to post in and automating state systems, com
fonnation about innovative programs municating with families, programs
and colleagues, and disseminating
or to ask about specific issues.
The Child Care Bureau's First information.
Health and Human Services
Admlnlstrallon for Children and Families
Admmistratlon on Children.
Youth and Families
Child Care Bureau
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Electronic Conne'ctions for Child Care Information
The World Wide Web (WWW) sites listed on these pages include general clearinghouses and individual organizations
that provide relevant information for ACF child care grantees and others in the child care field. Sites are listed alpha
betically by organization name, followed by the electronic address.
.. Child Care Bureau: http://www.acf.dhhs.gov/ACFPrograms/CCDBG/index.html
Information on the Child Care and Development Block Grant, links to other Administration on Children and Families sites
and other information within the Department of Health and Human Services, with links to other related child care sites.
... Children" Youth and Family Consortium: http://www.fsci.umn.edu/cyfc
This resource site of the University of Minnesota contains links to other useful web sites organized by categories, chat
groups, focused information on topics such as father involvement and work and family issues and general information on .
children and families.
.. Electronic Policy Network: http://epn.org
A resource site, including information and links to national organizations working in child and family policy, welfare
reform, health policy and economic research.
.. ERIC Clearinghouse on Elementary and Early Childhood Education: http://ericps.ed.uiuc.edu/ericeece.html
Provides access to an extensive body of education-related literature with a focus on child development, caring for young
children, and parenting.
.. FedWorld Information Network: http://www.fedworld.gov
This site lists recent government reports and lets the user search government information by keywords.
.. Library of Congress' State and Local Government Resource Page: http://lcweb.loc.gov/global!state/stategov.html
Lists indexes of state and local sources of information on the World Wide Web and provides maps of every state. Also
links to other Library of Congress information resources and to other government sites.
.. National Child Care Information Center: http://ericps.ed.uiuc.edu/nccic/nccichome.html
Sponsored by the Child Care Bureau, Administration for Children and Families, Department of Health and Human
Services, this site provides a central access point for child care related ·information. It also includes links to other or
ganizations and provides full-text documents.
.. Native Web -- http://web.maxwell.syr.edu/nativeweb
A site that provides information about the lives and cultures of Native Americans, Alaskan Natives, and other indigenous
peoples. The topics include languages, education, organizations, newsletters, and other sites which focus on Native issues.
.. Thomas Legislative Search: http://thomas.!oc.gov
Full-text of all federal legislation proposed in the House or Senate is included on this site and can be searched by keyword,
short or long title or legislative topic .. The site also has links to Congressional web sites and to other sites in the Federal
government that have legislative information.
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ADA and Disability Information -- http://www.public.iastate.edu/ - sbilling/ada.html
Bureau of Labor Statistics -- http://www.bls.gov
Center for the Future of Children -- http://www.futureofchildren.org
Child Care Aware -- http://www.dhc.com/TargetWWW/htmllchildOl.htm
Child Welfare League of America -- http://www.handsnet.org/cwla
Children Now -- http://www.dnai.com/-children/
Children's Defense Fund -- hup://www.tmn.com/cdflindex.html
Consumer Product Safety Commission -- http://www.cpsc.gov
Department of Education -- http://www.ed.gov
Department of Health and Human Services -- http://www.os.dhhs.gov
Department of Labor
http;//www.dol.gov
Empowerment Zone/Enterprise Communities -- http://www.ezec.gov
Indian Health Service -- http://www.ihs.gov
Labor Project for Working Families -- hup://violet.berkeley.edu/ - netsy
National Agricultural Library -- http://www.nal.usda.gov
National Association for the Education of Young Children -- http://www.naeyc.org/naeyc
National Association of State Information Resource Executives -- http://www.state.ky.us:80/nasire/NASIREhome.html
National Center for Children in Poverty -- http://cpmcnet.columbia.edu/dept/nccp/
National Center for Health Statistics -- http://www.cdc.gov/nchswww/nchshome.htm
National Clearinghouse on Child Abuse and Neglect -- http://www.calib.com/nccanch
National Coalition for Campus Child Care
http://ericps.ed.uiuc.edu/n4c/n4chome.html
National Conference of State Legislatures -- http://www.ncsl.org
National Resource Center for Health and Safety in Child Care
http://nrc.uchsc.edu
NEC*TAS -- http://www.nectas.unc.edu/
School-Age Child Care Project -- http://www.wellesley.edu/Cheever/saccp.html
The ARC -- http://thearc.org/welcome.html
The Urban Institute -- http://www.urban.org
U.S. Bureau of the Census -- http://www.census.gov/
Yale Bush Center in Child Development and Social Policy -- http://pantheon.cis.yale.edu/-chunga/bushcent.html
This information has been compiled by the National Child Care Information Center. At the time of printing. it was as accurate
as possible; however, due to the ever-changing nature of the Internet. some addresses may not be available. The NCCIC does
not endorse any organization, practice, publication or resource.
National Child Care Information Center
301 Maple Avenue West, Suite 602
Vienna, VA 22180
Phone: (800) 616-2242
Fax: (800) 716-2242
TOO: (800) 516-2242
World Wide Web: hnp://ericps.ed.uiuc.edu/nccic/nccichome.html
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�National Child Care Infoffilation Center
301 Maple Avenue West, Suite 602
Vienna, Virginia 22180
Phone: (800) 616-2242 Fax: (800) 716-2242 TTY: (800) 516-2242
The National Child Care Information Center (NCCIC) has been established to
complement, enhance and promote child care linkages and to serve as a mechanism
for supporting quality, comprehensive services for children and families.
NCCIC activities include:
"'Dissemination of child care information in response to requests from States, Territories
and Tribes, other policy makers, parents, programs, organizations, child care providers and
the public.
"'Outreach to ACF child care grantees and the broader child care community via a toll-free
800 number, and by fax, mail and electronic media to provide the following information and
connections:
•
•
•
•
electronic networks and databases
clearinghouses and national organizations
sources of child care funding
ACF issuances
•
•
•
•
State and Territorial program activities
Tribal program activities
promising practices
other child care resources
"'Publication of the Child Care Bulletin, distributed 6 times a .year to Federal
administrators, ACF child care grantees, national child care organizations and others
interested in child care issues.
'"Child care data. The NCCIC supports the Child Care Bureau in the collection and
analysis of child care data and maintains the database of information reported by State, Tribal
and Territorial Grantees. The Information Center assists the Child Care Bureau with its
analysis of programmatic and expenditure data.
"'Adjunct ERIC Clearinghouse for Child Care. Information and resources are available
on-line through the Internet. The address of the NCCIC Gopher is: ericps.ed. uiuc.edu then
select the menu item for NCCIC. The address of the World Wide Web site is:
http://ericps. ed. uiuc. edulncciclnccichome. html
For additional information, please contact: National Child Care Information Center, (800) 616-2242
Anne Goldstein, Director,agoldstein@acf.dhhs.gov
The National Child Care Information Center is an activity of the Child Care Technical Assistance Project funded by the
CHILD CARE BUREAU, Administration for Children and Families, U.S. Department of Health and Human Services, through a
contract with Trans-Management Systems Corporation in cooperation with Collins Management Consulting, Inc. (CMC).
The Information.Center is administered by CMC.
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Major Changes .
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A single, integrated child care
system under amended CCDBG
Act·
-
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Repeals
- AFDC/JOBS Child Care
- TransiticnalChild, Care -,
-At-Risk Child Care
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Funding Streams
for States
• Additional funding
sources for
'. States:
Discretionary
Mandatpry.
Matching
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- Maintenance of·
Effort
- State matching funds
. - Transfer of TANF .
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�State'and Tribal
Plans
, • Interim plans for new fundscq~o\q"
• New Comprehensive Plans 'must be '
submitted for all three funding streams:
Discretionary," Mandatory, and
Matching.:-1 \ 1\ Lf7
.' ublic hearings ar~ required as a part of
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the process for new plans. '
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�Child Care and Development Fund
(States)
Service Delivery Support
Services Such as:
Eligibility Detennination
. Participation in hearings
Child care plaeeme.nt
Reauitment, licensing•
.inspection, reviews. and
supervision of placements
Resource and Referral
.
Services
Training
Establishment and
maintenance of
computerized infonnation
Quality
Activities
Minimum =
4%
Direct Child
Care Services
Child Care paid through:
• Certificates
• Contrads
Earty Childhood
Development Programs
School-Age Care
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Administrative
CoSts
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Such as:
Resource and Referral Services
Provider Training
Grants/Loans to Improve
Provider Quality .
Monitoring
Compensation
. Such as:
Program/Plan Development
.Complaint Files Management
Report Preparation
.Public Hearing Infonnation
ProgramlMonitoring Coordination
~valuating Program .Outcomes
Personnel Management
Travel, Equipment, Supplies
Audits
Indirect Costs
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- TANF Child Care Provision
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Temporary'assistance can·not be reduced or
terminated for parents of children under 6 ,
years of age if they have ,been unable to
obtain child care for the following reasons:
- Unavailability of appropriate child care within a
reasonable distance from work or h.ome
" - Unavailability or unsuitability of informal child care
, by a, relative orunder\otherarrangements
- Unavailability of appropri~Jeand affordable formal
child care arrangements
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Child Care and Development Block Grant Amendments of 1996
The Amendments authorize and appropriate a total of $13.9 billion in mandatory funding for
FYs 1997-2002 and authorize $7 billion in discretionary funding for FYs 1996-2002. States
would receive approximately $1.2 billion of the mandatory funds each year as a capped
entitlement based on federal IV-A child care expenditures in each state in FY94, FY95 or the
average from FY 92-94 (whichever is... &reater).
The remainder of the mandatory funds (after an allocation to tribes) would be available for
state match (at the 1995 FMAP rate) based on the At-Risk allocation formula. In order to
be eligible for these new matching funds, a state must maintain 100% (maintenance of effon)
ofFY94 or FY95 state child care expenditures (whichever is greater) AND exceed the state
set-aside described above.
Total funding, inc1uding mandatory funds and $1 billion in discretionary funds for each year:
2.967 billion
$ 3.067 billion
. $ 3.167 billion
$ 3.367 billion
$ 3.567 billion
$ 3.71.7 billion
$
for FY 1997
for 'FY 1998
for FY 1999
for FY 2000
for FY 2001
for FY 2002
Once funds are transmitted to Grantees, all funding will be subject to the requirements of the
Child Care and Development Block Grant Act,as amended.
Effective Date
The effective date of the Child Care and Development Block Grant Amendments is October
1. 1996. The authorization of appropriations for the discretionary funds takes effect on the
date of enactment.
Eligibility
Changes family income limit from 75% of State Median Income to 85 %.
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Lead Aeency
The Amendments retain CCOBG lead agency requirements, but allows the lead agency to
administer the program through other -gove~mental or nongovernmental- agencies.
AppHeation and Plan
Under the Amendments, the parental choice provisions (requiring that parents be given the
option to enroll their children in grant or contract slots or to receive a certificate) wiHapply
to the entire program.
.
The Amendments expand the current law requirement for a public hearing on the state plan
to specify that the state must provid.: sufficient time and statewide distribution of notice of
the hearing.
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Administrative Costs
The Amendments limit administrative costs to S% of the aggregate funding and specify that
administrative costs shall not include the costs of providing direct services.
Repon language clarifies that the Secretary should issue r~gulations that define and determine
true administrative costs prior to the deadline for submission of State plans .. Eligibility
determination and re-determination, preparation and participation in judicial hearings, -child
care placement, the "recruitment, licensing, inspection, reviews and supervision of child care
placements, rate setting, resource and referral services. training, and the establishment and
maimenance of computerized child care information should not be considered administrative
costs" '
Consumer Education
The Amendments replace the current law requirement "that specific consumer education
information be made avaiJable (concerning licensing and regulatory requirementS. complaint
procedures, and policies and practices relative to child care services within the State) with a
general" requirement that the state will collect.and disseminate information that will -promote
informed child care choices. "
Quality
. The Amendments set aside not less than 4% of total funds for activities that are -designed to
"provide comprehensive· consumer education to parents and the public, activities that increase
parental choice, and activities designed to improve the quality and availability of child care
(such as resource and referral services.) - This provision replaces the current law description
of activities to improve quality (r&r; grants or loans to meet state and local standards;
monitoring of compliance with Ii~nsing and reg~lation; training; and compensation).
2
�Compliance with
state Licensine Reguirements
The Amendments replace current law requirements that the State assure that an child care
providers comply with state and local licensing or regulatory requirements, including
registration, with a requirement that stateS have in effeci licensing requirements ~d .provide
descriptions of the requirements and how they are enforced. The Amendments ehmmate
registration requirements.
Hea1th and Safety
The Amendments retain current law CCDBG Health and Safety requirements and apply them
to all of the child care funds.
Payment Rates
- The Amendments .add a requirement that states provide a summary of the facts used to
determ ine that rates are sufficient to ensure equal access.
It also eliminates the requirement that payment rateS take into account variations in the costs
of providing care in different settings and to different age groups, and the additional costs- of
providing child care for children with special needs.
Set-Aside: The Amendments require a minimum set-aside for Tribes of 1% of the aggregate,
funding and allows the Secretary to set aside up to 2%.
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,
."
. Minimum Standards: The Amendments add a requirement that the Secretary, i n - '
consultation with tribes and tribal organizations, shall develop minimum child care standards
for tribes and tribal organizations.
Construction or Renovation of FacUities: The Amendments give the Secretary authority to
allow Tribes or tribal organizations to use program funds for construction or renovation
purposes as long as that will not result in a decrease in the level of child care services
provided. by the tribe or organization as compared to the level of services provided in the .
preceding fiscal year. The Secretary is directed to develop and implement uniform
procedures for the solicitation and consideration of requests to use funds for this purpose.
ReaUotment: The Amendments add a provision giving the. Secretary authority to reallocate
any portion of tribal set-aside grants to other tribes or organizationS if she determines that the
funds are not being used in a manner consistent with the statute· and time period for which
the grant or contract is made available.
3
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�Other Organizations: The Amendments add under the definition of tribal organizations.
·Other organizations-. which includes a Native Hawaiian Organization and a private
nonprofit organization established for the purpose of serving youth who are Indians or Native
Hawaiians.
. ~rritorjes
The Amendments eliminate the Trust Territory of the Pacific Islands from the list of eligible
Territories and Possessions. The Amendments do not include territories in the definition of
States eligible for mandatory and matching funds.
Enforcement
. The Amendments eliminate the authority of the Secretary to terminate payments for failure to
comply with the state plan or any provision of the law and replaces it with disallowance
authority for improperly expended funds.
Reports & Audits .
The Amendments replace the current law annual reporting requirement with requirements
that states collect a specific Jist of data on a monthly basis and submit it to the Secretary
quanerly. It also requires biannual reports from the states (beginning 12/31197 and every six
months after) containing other aggregate data. The data elements are substantially broader
than current law reporting requirements.
The Amendments also require the Secretary to submit biennial reports to Congress beginning
in 1997. '
While the Amendments maintain current law audit requirements, it requires only that the
audit entity be independent of the State. replacing the requirement that it be independent of
-any agency administering activities that receive assistance under.this subchapter.·
Qther Definitions
Child Care Certificates: The Amendments add child care deposits as an allowable liSe of a
child care certificate.
Eligible Child: Changes family income limit from 75% of State Median Income to 85%.
Eligible Child Care Provider: Adds great grandparents and non-resident siblings to list of
eligible providers and eliminates the r~quirement that relative providers be registered.
Otber Organizations: The Amendments add 'under the definition of tribal organiZations.
-Other organizations-, which includes a Native Hawaiian Organization and a private
4
�nonprofit ·organization established for the purpose of serving youth who are Indians or Native
Hawaiians.
.
Miscellaneous Deletions
The Amendments eliminate the CCDBG sections regarding the rationale for reductions in
standards, review of state licensing and regulatory requirements. and
supplementation/supplantation.
Strikes current law language specifying issues that may be considered during consultation
with local governments on development of the State plan.
.
The Amendr.lents eliminate the requirement that ·states dedicate funds to early childhood
development or before and after schOOi child care programs.
Related Child Care Provisions in Temporary Assistance for Needy Families (TANI').
Repeals
Repeals Title IV-A Child Care programs, thus eliminating guaranteed child care for needy
ind ividuals.
.
,.
Funds Transfer·
The TANF block grant allows states to transfer up to 30% of the temporary assistance funds
into the child care or social sery.ices block grants. No more than a third of this amount may
be used for the· Social Services Block Grant.
.
,
.
Failure to Provide Child Care
The TANF block grant prohibits states from sanctioning a single parent who fails to
participate in work because she cannot access child care for a child underage 6. The
Secretary can impose a penalty of up to 5 % of the family assistance grant a~ount on $tates
that fail to maintain assistance to adult single custodial parents who cannot obtain child care
for a child under age 6,· The amount of the. penaJty will .be based on the severity of the
failure.
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�Meeting Participation Rates!Work Requirements
Meeting Work Requirements
Single parents with a child under the age of 6 are deemed to be meeting work participation
requirements if the parent is engaged in work for 20 hours/week.
The TANF block grant adds to the definition of work activities: -the provision of child care
services to an individual who is participating in a community service program.
Sense of tbe Congress
The TANF block grant includes a Sense of the Congress that encourages each state to assign
the highest priority to requiring adults in 2-parent families and adults in single parent families
that include older preschool or schooJ.aged children to be engaged in work activities.
Two-Parent Families
With the exception of a disabled parent or families with a severely disabled child under the
. parent's care. the TANF block grant requires thaUf child care is .provided by the State, both
spouses in a two-parent family must work, but' the second parent must onJy work a minimum
of 20 hours per wee~~ .
.
.
"
Optional Exemption
The TANF block grant include~ a state option to exempt singJe parent families with a child
under the' age of 12 months from engaging in work. The state may disregard the parent in ..
determining work participation ra~s for up to 12 months.
.Title XX
The welfare reform bill reduces Title XX funding by IS% until FY 2002.
6
�ESnMATED FY ,117 STATE ALLOCAnoNS FOR THE ,CHILD CARE AND DEVELOPMENT FUND
Mllndlltory
Funds 11
Stlltll'
Stllte Shllre
Requirement (MOE) 2
Alabamll
Alnkll
Arizona
Mil nan
California
Colorlldo
Connllcticut
O'lIllIwllrll
District of Columbia
Floridll
Georgia
Hllwllii
Idllho
Illinois
Indiana
Iowa
Kanaa.
Kentucky
Loui.iana
Maina
Maryland
Messechuaen.
Michigan
Minnesota
Mississippi
Miar,ouri
Montana
Nabreak.
Navada
Naw Hampshira
New Jer.ey
Naw Mexico
New York
Nonh Carolina
Nonh Dakotll
Ohio
OkLahomll
Oregon ,
Pennlvl"'lInoll
Puano R,co
Rhoda 1.land
South Carolona
South Dakotll
TennelSea
Texlls
Utllh
Vermont
Vrginia
Weahington
We.t Vrginia
Wl8conain
Wyoming
•
111,441,707'
3,644,811
18,880,887
.6,300,283
Stllta Total
• 1.199,050.700 '!
82~846,868
~
10,173,800
18,738,367
6,178,361
4,720,614
43,026,624
38,622,787
6,220,834
2,867,678
68,808,473
26,181,888
8,877,746
8,811,868
18,701,803
13,864,662
3,137,106
23,301.407
44,873,373
32,081,822
\ 23,367,643
, 6,283.116
24,668.668
3,180.681
11,338.103
2,680.422
6,061,606
31,662.663
8,702,684
104.893.634
69.639.228
2.606.022
70.444.783
24.809.878
18.408.790
66.336.804
6.633,774
8.867.439
1,710,868
37,702.046
68,844.129
12,691.664
4,148.060
21,328,766
41,848,341
8,140,727
24,611,361
2.816.041
8,886,416 •
3,644,811
10,066,324
1,886,641.
82,846,868
8,886,888
18,738,367
6,178,361
4,720,614
33,424,300
22,187,213
6,220,834
1,176,818
68,608,473
16,366,848
6,288,427
8,672,888
7,274,366
6,218,484
1,828,161
23,301,407
44,873,373
24,360,687
18,680,386
1;71 6,431
16,648,766
1,316,288
6,866,068
2,680,422
6,061,606
31,662,663
3,034,328
104,883,634
37,878,186
1,017,136
46,628,364
10,660,306
11,714,881
46,628,830
6,321,126
4,087,361
802,887
18,876,714
34,681.426
4,474,826
2,804,331
21,328,766
38,768,113
2,871,383
16,470,677
1,663.781
Mlltching
Funds 31
Oiac;lItionary
Funda 61
Stlltll Sharll of
Mlltching Funds 41
11,087,223 •
2,028,763
12,783,447
8,827,808
88,,184,172
10.286.028
8.668,338
1.8no~ 182·
1.286,816
36.884,881
20.202.308
3.323.884
3.482,470
33.026.668
16.284.178
7.288,822
7.161.278
8.883.668
12.714.868
3.118.238
13,667,018
16,376,682
26.216,778
12.863,121
7.766,786
14.267,606
2.371,213
4,638.602
4,298,070
3,102.286
20,876.406
6,213,342
48,686,868
18,861,163
1.720,613
28,668,734
8,884,837
8,188,260
30,311,476
4.864,680 •
2.028,763
8,468,812
2.368,088
88.184.172
8.084,141
8.668.338
1.800.182
1.288.816
27.838.888
12.281.828
3.323,884
1.488.814
33.026.668
8.870.738
4.366,874
4.880.112
4.312.288
4.786;867
1.806.728
13,667.018
16.376.682
18.807,040
10.838,863
2.114,413
8.664,626
877,486
2.876.286
4.288,070
3.,102.286
20,876.406
1.888,024
48,686,869
10.336,129
782.826
18,146,722
3.846,801
4,842,866
26.641.621
2,626.420
8,806,962
2,096,014
13,666.688
67.033,621
6.836,604
1.618,624
17,061,683
14,818,126
4,132.278
13,868.837
1..347,236
2.026,706
4,061,886
883,173
6.823,186
33,062.664
2,467.430
878.227
17,061.883
13.684,718
1,406,868
8.312.801
786.666
'908,252,925! 723,891.800
!
551.288.747
!
20.236,066'
1.806,673
18.612.030
11.888,068
120,488,748
11.068,882
7.224,686
2.111.807
1.878,408
60.048,337
.32.167.871
3.882.386
6.133.866
37.706.676
18.066,411
8.228,278
8.888.881
17.842.748
28.880,163
3.873,126
13.203.338
, 14.386,1 16
28.217.881
13,483,420
17.368,322
18.227.212
3.212.636
6.636,816
4.133.817
2.666.866
18,838,612
8,446,628
67.482.836
28.148.318
2.344,878
36,118.218
16.232.803
8.872.888
32'.711.417
24,866,836
2.720.600
18.120,663
3.166,183
20,848,687
82,820,868
8,386,746
1.714,663
18.268.060
16,804,836
,7.718,176
14,823,837
1,626,838
972.500.000
NOTE:' Mandatory. Matching and DillCNtionary fund. ha". been reduced by one Quaner of one percent for technlc:aI a.am. . .,
pursuant to ',&Ii CFR 88.80Call1l. Mandatory and Matching fund. ha". been reduced by the tribal Nt-a.lde. DiKretIonery
fund. have been *uced by the tribal and territorial ..t-aalde. Territorie• •e not eligible for Mandatory or Matc~ fund••
, I Mandatory Fund. are allocated baNd on the Federal .hare ofaxpendlture. for IV·A child care In FY , 884. FY , 885. or the .".,..,e
of FY 1882·1984. whichever Is oreateat. Allocation. are ba.ed on expenditure data a. of Feb. 28 and AprU 28, '885.
21 Preliminary calculation ba..d on available ..,oregate data: may need to be Mjuated. I~ order to be eligible for Matching Funn. State•
• e required to maintain the oreater of FY '884 or FY '885 expenditure. for IV·A chIIcI c:.r8.
31 Matching Fund. are allocated according to the proportion of children uncIer eoe '3 u.ing Censu. data a. of July, '885 (in 8CCOrd..::e '
with the At-Ri.k Child Care program allocation formulal. Each State'. maximum alloc:atior1ls .hown; unused funcl. wHi be redistributed
/
, among State..
., State expendlt'ure. above the MOE level are matched ba.ed on the FY '895 FMAP rate.
51 Di.cretionary allocation I. preliminary and b.Nd on the ., bDlion In authorized fund•• FIn8I State eIIoc:atlona may change.
For OilCretionary Fund •• PuIIno Rico Is included In the State allocation formula
,23·AUO·98
�UKAt-1
.')
CHILD CARE AT tHE CROSSROADS:
A Call For Comprehensive
State and Local Planning ,
'T'he Child Care and Development Block Grant, Amendments of 1996 provide an
1 important opportunity for states and communities to plan a 1T!0re cohesive child
care system that responds to the needs of all. families and helps promote safe and
, healthy care for children of all ages. Federal funding !evels over a six year· period
allows for multi-year planning.
C
hild Care assistance is at a cros$roads.lt it can grow to become a critical support .
for children and families or it car be stretched too thin, providing minimum
protections for children, and leaving many hard working families without access to child
'
care support they nee~.
S
tates and communities are encouraged to consider the following .five principles
during the planning process.
.
.
BUILD CAPACITY
to ensure quality, supply, and system support
I
n order to IT)eet the increasing demands for child care, ensure parental choice and
ensure qu'lity environments for children; states and communities will need to build
capaCity In critical areas. States should consider establishing or expanding:
"
•
Apprenticeship arid other professional development programs that lead to
state recognized credentials for all categories of care and all levels of
. providers.
• Resource and Referral, including consumer education and outreach ,to
parents and providers.
• Adequate payment rates that assure families equal' access to a range of
services 'in their community.
.
• Outreach campaign and resources to build th~supply of family child
care, infant care, school-age care', night-time care, and care for special
needs populations.
'
• Systems for data collection and reporting.
• Staff capacity for administration, coordination, 'licensing and monitoring and
oversight.
�DRAFT
EXPAND ASSISTANCE
to families to pay for services
I
n their efforts to provide child· care assistance to' more families, states and
communities should consider the need to:
,
• Serve both working families and those transitioning off welfare
• . Make all families below a certain income level eligible for' child care
assistance (ie a percentage of state median income assistance)
• Provide enough assistance so that no family is forced to pay more than'lO
perce:1t of their incor:ne for quality care.
'
DEVELOP LINKAGES
to promote comprehe.nsive services to families
'T"o remain self-sufficient, many' families need other services along with child care.
1 State and local planning should link child care to the following ten critical services:
o Health
"
,
O. Family Support Services
"'0 Head Start
o School and Youth programs
o Employment Services
o Transportation
o Housing
o Child Support Enforcement
o Temporary Assistance to Needy Families
o Child Welfare
LEVERAGE
private sector funds
he growing demand for child care assistance will strain the limited public funds
available. In order to build up resources that can be used to provide assistance to
an increasing number of working families ·and to ensure quality, we need to leverage
private sector dollars.
T
tates and comm~nities Sh.OUld ~onsider using so~e of ~heir new child care funds,to
reach out to bUSinesses In their area to hejp bUild child care funds that will g~
'over time. Public dollars can be used to establish a "Working Parent Assistance Trust
S
�DI~Afr·
Fund' in a community or a state. Corporations Could be challenged to donate resources
to this fund which in tum would help improve the supply' of quality services for the total
community or provide targeted scholarships to help families pay for ca~e.
EVALUATE '
resources, needs and progress
I
n the past, there have been very few. efforts made to evaluate public investments in
child care. States and· communities should take this opportunity to:
.
• Include parent and provider feedback into the evaluation of services. .
• Evaluate the supply of child care available, the current level of assistance,
. and the anticipated demand.
• Establish benchmarks or targeted g~als for the use of child care funds.
• Measure progress in reach.ing. the goals
• . Develop research and evaluation projects that assess the quali~ of care
provided, the effect on children and the' impact on the parents' ability
work.
to
• Improve data col/ection and reporting
�·
NOTE TO JEREMY BEN-AMI
FROM JOHN MONAHAN
x,
Ate'a~hed you will find a draft version of the proposed joint
memorandum relating to, welfare reform implementation
Please share with your colleagues. Thank you, very much.
issues.
'.
'.~'"
�DRAFT'
DRAFT
MEMORANDUM TO LEON PANETTA
FROM:
Following is the current thinking of HHS and
regarding
three key issues that have emerged in our implementation of the
welfare reform law: how the 45 day comment period, requirement
should be handled for states that have submitted plans within 45
days of .. enactment i interpretation of the Section 415 waiver
authority; and certifying "completeness" of TANF state plans.
There is a need for quick resolution of these issues.
45-Day Comment-Period Requirement
Section 402(a) (4) of the Act, as amended by the PRWORA, contains
a requirement, that a state include in its state plan a
certification
that ,local· governments
and
private
sector
organizations have been. given at least 45 days to comment on the
plan.
In order for this comment-period requirement to be
meaningful, the comment period must occur at a'time when the plan
has been formulated and the law under, which the plan will operate
is known.
'
,
Maintaining the integrity of the comment-period requirement is of
prime importance, since there may be no other forum for the
citizens of a state to learn about and influ'ence the structure of
the state TANF. progra'm. While the PRWORA was being considered in
Congress,
the
Administration
advocated
vigoro~sly
for
an
opportunity for public input in each state I s plan development
process.
In that light, the Department proposes that with respect to any
state that submits its plan after October 1, 1996, the following
procedure be followed:
The state will be notified of the
, Department's receipt of its plan and that the 45-day comment period
must have occurred at a time when the plan had been formulated and
the law under which the plan will operate (the Social Security Act,
as amended by the PRWORA) is known.' We will suggest that the
state, if it has not done so already, begin the comment period.
We will assure the state that once the comment period has expired,
the state has informed us of any amendments the state wishes to
make to the plan as a result of comments received, and the state's
plan' has otherwise been determined by the Department to be
complete, the state will be declared to be an eligible state and
will receive TANF block grant funding calculated from the day the
plan was first received by the Department.
For
TANF
state. plans
submitted
prior
to
October
1,
1996,
a
�diiferent rationale is necessary.
DRAFT.
The PRWORA stipulates that a.state cannot receive block grant funds
for ariy fiscal year unless it was an "eligible state" (i.e., had
submitted a TANF state plan that the Department had found contained
all of the elements listed in section 402 of the Social Security
Act, as amended by the PRWORA) during that fiscal year. Thus, in.
order to receive any TANF funds for fiscal year 1996, a state must
be an eligible state before October I, 1996.
wlsconsin submitted its TANF plan on August 22 and Michigan
submitted its TANF plan on August 26.
Both states are eager to
start receiving funding under the block grant as soon as possible •.
Michigan has notified the Department that it began a comment period
with respect to its state plan submission on August 15, 1996.
,Thus, it will be possible for the Department to find that Michigan
'fuet"tnecomment-period requirement before the end of fiscal 1996
and provide Michigan withTANF block grant funding as of August 26,
1996 (assuming the plan it has submitted otherwise meets the
requirement~ of section 402).
While Wisconsin has not conducted a comment period formally so
s.tyled, the Department believes that Wisconsin has had in effect
an informal comment period since at least August 15, 1996.
Wisconsin's plan is based quite extensively on its waiver
application, which was the subject of a· formal federal,comment
period.
Additionally, during the Wisconsin legislative process
and thereafter, there was opportunity for public comment. The W2
plan continues to be publicly available. ThUS, the Department is
able to find that Wisconsin met the' comment-period requirement
before the end of fiscal 1996 and provide Wisconsin with TANF block
grant funding as of August 22, 1996 (assuming the plan it has
submitted otherwise meets the requirements of section 402).
section.415 Waiver Authority
with very limited exceptions, new section 415 of the Social
Security Act allows states to delay the application of any
provision of the new legislation (not just title I, the Temporary
Assistance for Needy Families Block Grant) to the extent that such
provision is inconsistent with one or mor~ approved waivers that
were applied for before enactment and approved before July I, 1997.
The delay is effective to the expiration date of the waiver,
determined without extension,' and the exceptions are that all
states are subject to the repeal of title IV-A child care, and all
states approved after enactment and before July 1, 1997 are subject
to the section 407 work requirements.
.
Because they· have· penalties associated with them, two of the
significant areas of potential inconsistency with the PRWORA that
.states are most concerned with are whether section 415 allows
�states to havealte:native,
and
pres:m~~~~~~~~!~!:',;1':ork.· ~
requirements, and to have alternative time limits.
with respect to 'work requirements, although it has not been
suggested that the participation rates not apply, to all
states, probably about one-half of all states would be able
to count more activities as work than ,would be allowed under
TANF if section 415 were read to permit that flexibility.
With respect to time limits, a large number of states would
.... ....
,'
.
~ ~_~
~~~a~
~'
~n
:..,~
'
1
L
~'~
provide for more generous extension policies than the 20% TANF ,~
exemption policy would allow, and there, is the open question ~~'~.'
of ~hether a waiver demonstration with no time limit could b e ,
det~rmined under section 415 as allowing a state to not impose
. th~ 5-year time limit.
.~
The statement of .Managers suggests a narrower reading of the
statute that would not ,permi:t. states to continue some of these
waiver policies ,under section 415.
However, some members of
Congress,
including Charles .Stenholm who has' written the
Department, believe that the floor debate supports providing a
broad interpretation.
Any approach will involve a. trade-off
between, on the one hand, broader ~tate flexibility and a large
number of states that would advocate for it both with their members
of Congress and with the Executive Branch, and, on the other, a
tighter view of state' accountability for, enforcing a. narrower
interpretation of work requirements and time limits under TANF.
A decision based on a. narrower interpretation is likely to be
criticized as undermining state flexibility and disrupting the
progress of the states that have been most in the forefront of
welfare reform.
A decision grounded on a broader view is likely
to be 'criticized as undermining work requirements and time limits.
These potential criticisms could be directed at either'the Congress
or the Executive Branch to the extent that either ±akes action to '
advance an interpretation.
HHS favors an approach that wouldiriiti~lly request that states
identify in their state plans specific provisions of their
demonstrations that they believed were inconsistent with the
PRWORA.
We would also alert them that subsequent legis'lative or
regulatory action regarding TANF penalties might limit their
flexibility in the future, although such action wouid,be effective
only prospectively. Seeing ,how states view this issue through ,the
state plan process could lead to better informed decisions on an
interpretation of section 415.
The Department has recently
received a joint letter from Chairman Archer and Chairman Roth
strongly supporting this approach.
TANF state plan guidance
The Personal Responsibility and Work Opportunity Reconciliation
Act of 1996 (Pub., L. 104-193) replaces the AFDC, JOBS and EA
programs with a new block' grant -- the Temporary Assistance to
Needy Families program. To be eligible to receive its block grant
funds, the law requires, a state to submit a ,state plan to the
Secretary no later than July; 1; 1997, which the Secretary has found
. meets the statutory requirements.
�:.' -: '~.
.
..
.
.
Section 402 of the Social Security Act (as revised by . the
legislation) provides, in general. terms, the statutory framework
of. the .state plan and requires states to outline the program of
job preparation, work, support services and benefits which will
enable clients to become self-sufficient.
Because of the enormous flexibility that states have under the
PRWORA, it is extremely important that the plan layout in some
detail the benefits and services that the state will provide, the
eligibility criteria for benefits and services, the requirements
'that the states will impose on recipients and other features of
their program. The plan will be the basic document through which
citizens and potential recipients will understand program rules.
There are many constituencies that have an interest in this
information. Clients, advocacy groups, state officials, Congress
and thta administration all have an interest in a
clear.
understanding of the state1s program. Moreover, the plan will be
the basic document from which the federal government obtains
information' about what states are doing, to compare with their
reports of how well they are doing.
To help states develop complete plans,
ACF has prepared a draft
guide for states to use in preparing their plan submissions (draft
attached) consisting of an overview, the statutory text,' state. plan
certifications and funding instructions.' Rather than the current.
uniform preprint state plans, we envision a very descriptive plan
that clearly outlines for the public the expectations, services and
benefits available.
.
Toas~ist
states in preparing a "complete".program description that
is understandable to the public and addresses all statutory
requirements, ACF is planning to supplement the state plan guidance
with a more detailed checklist that states can use to make sure
they have covered the required' elements of the plan. This checklist
will also. be used by ACF in determining whether or not the plan is
complete for purposes of funding. (s ..... ,++c..c:.\o.,&) . .
�',"',
..
\."
"
ATTACHMENT
�~!-O'
,•... olir nationfs answer. to
:
[r-
-.
this' great social challenge will
no longer be a never-enqing,cycle of welfare, it will be the
dignity, the pOwer and the ethic of work. Today, we are
taking an historic chance to make welfare what it was meant
to be: a second chance, not a way of life."
Pre~ident
, William' J ~ Clinton
"
. ..
l>~~
...
'," ' '!:,.
STA'l'EGUIDANCE
FOR THE
-
TEMPORARY ASSISTANCE
F9R
NEEDY FAMILIES
:pROGRAM
"
"
,
Department of Health and Human Services
Administration for Children and Families
370 L',Enfant Promenade,S.W., Washington, D.C. 20447
september 199~
, ,
~
" .'
I
;
__ J
"
I
"
Co.
�-~ '-~ .'.
,
2
A New Beqinninq•••
. The Temporary Assistance for Needy Families (TANF) Program
On August 22, President Clinton signed into law the "Personal
Responsibility and Wdrk opportunity Reconciliation Act of 1996,"
a comprehensive bipartisan welfare reform.' bill that establishes
the Temporary Assistance for Needy Families (TANF) program. This
legislation will dramatically change,the:nation's welfare system
into one that requires work in· exchange for,time~limited
assista~ce.
It contalns,strong work requ'irements,
performance
bonus to reward states for moving, welfare recipients into jobs,
state maintenance of effort requirements, comprehensive child
support enforcement, and, supports for families moving from
_~_~~!~~~e.to work. '
.
a
In signing the bill, President Clinton said, "This i$ not the end
of welfare reform, this is the beginning.'"He went on to say:
,
.
.
Today, we are ending welfare as we know it. But I hope this
day will be remembered not for what it ended, but for, what.
it began -- a new day that affers hope, honors
"
responsibility, rewards work, and,changes the terms of, the,
debate ...• "
, '
The new legis'lation gives states the opportunity ~o create a new
system that promotes work and. responsibility, and strengthens
families. It challenges us all to remedy what is wrong.with the
old system, and to provide opportunities that will help needy'
families under a framework of neweX,pectations.
'
,
.
startinq the Proqram
The new TANF program replaces the AFDC, JOBS and EA programs'with
a new block grant program. 'A state is eligible to participate in
the new program no earlier than ,the submittal of its state TANF
plan. A state will receive its block grant funds once the
Secretary has found the State's plan to be complete. ,
•
"',.
I
_
'
states mustsubmit their TANF plans no ,.later than Julyi, 1997"
but 'can submit them earlier if they choose. states should '
consider several factors in deciding whether to implement the
. TANF program prior to,J~ly 1, 1997. In States with reduced
caseloads, funding for the AFDC, EA' and JOBS programs may be less _
than tlie amounts the States would receiveitinder the new block,
grant. Thus, it may be financially advantageous for some states
to accelerate their effective date.
In' addition to the financial implications I stat~s should also_
weigh other considerations in determining when to implement the
new program. Given'the,complexityof ,the newlegislatidn.'andthe
.'
�.
3
tremendous range of options available, designing and implementing
a new program will reqUire a significant effort on'· the' part of
states. They must consult and coordinate with'n~erous,parties,
undertake· staff training and modify computer systems. .:InadeqUate
attention to these activities could undermine the long-term
effectiveness of the state IS program. Further, once states
submit their plans, the work reqUirements and the5-year time
limit begin •. Penalty and data collection requirements' begin July
1, 1997, or 6 months after the plan has been submitted, whichever
is later.
'. suqqest,~ state Plan Outline
The statute requires states to outline how they intend to conduct
a program that provides assistance to needy families with
__._._ ..._. _._.Children and provide parents with job preparation,. work and
.
support services to enable them to leave the program and become
self-sufficient.
We recommend that states use,the state plan process to consider
and address a set of important questions, and to outline to the
citizens of the state, other interested parties, and the Federal
government how those questions will be addressed in the operation
of the state's program. Toward that ,end, we suggest that·a state
plan include discussion of the issues outlined below as well as
addressing all other requirements specified in the law.
Attachment A provides a copy of the statutory text.
A possible format is a 15-20 page document that describes the
state's program goals, approach, and program features. Some'
states may emphasize some areas more than others depending on the
circumstances in the state. states must submit plans every two .
years~
They may submit amendments to keep the plan .current
whenever they wish to make changes in the administration or
operation of the program. A State plan will be considered
complete as long as it includes the information required by the
Act.
GOALS, RESULTS AND PUBLIC INvOLVEMENT'
What are the Qverarching goals for your program? How'were local
gqvernments and private sector organizations involved in
designing the TANFplan? How has, the public been involved in
program design and has the public had the opportunity to 'provide
input? How will You judge and measure progress toward goals?
What results will be measured and how will a'ccountability be
ensured?
NEEDY 'FAMILIES
Who will be assisted under this program? How will "needy
families" be defined? will all families in the state have access
�4
to the same program or will it vary? ,will the same services be
offered to families who have moved ~rom another state? ' How will
,eligible non-citizens be treated within the program? How will
the privacy of ,families be protected? What rights will'
applicants and beneficiaries have to challenge decisions?
�5
WORK AND
SELF-SU~FICIENCY
What are your overall goals for work and self-sufficiency? How
will the program move families to work and ultimately to self
sUfficiency? What services will be available to move clients to
work? How will you identify and provide additional, targeted
support to victims of domestic violence .and others who may have
particular difficulty successfully making the transition from
welfare to work? How will current workers be protected from
displacement? How will various community, education, business,
religious, local governments,' and non-profit organizations be
involved' in the effort to provide work for clients? How will the
'delivery of services vary across the state?
BENEFITS
What benefits will be given ton~edy families? will bene~its be
delivered through cash, in-kind, vouchers, or electronic benefits
transfer (EBT)? How will time limits and sanctions be
incorporated into the program? What supportive services will be
available to clients? How will child care be provided to allow
parents to go to work?
CULTURE CHANGE
What measures will be taken to change the culture of 'the welfare,
office to support work and self-sufficiency? What kind of
training will take place for staff who will be involved in
administering the program?
PARENTAL RESPONSIBILITY
How will parental responsibility be encouraged? How will child
support enforcement interact with the TANF program? will non
custodial parent be involved in any work programs? What efforts
will be made to reduce the incidence of out-of-wedlock births?
How will problems of ' domestic violence and statutory rape be '
addressed?
TRIBES
How will you ensure equitable access to your program ,for members
of Indian tribes who are not eligible for assistance under a
tribal family assistance plan? How will you assist tribes in,
implementing their programs? What kind of assistance will be
available to tribes in implementing their programs?
ADMINISTRATION
What is the. structure of the agency administering the program?
What will be the role of public or private contractors in the
delivery of services? How will elements of the program be
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6
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phased-in? Will the imp~ementation date differ from the plan
submittal date?
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WAIVERS
Do you intend to continue one or more individual waivers as
provided under section 415?' If so, please identify each 'waiver
provision and each. provision of new law that you believe are
inconsistent; and provide the basis for your assessment of
inconsistency. (YoU may wish to consult with the chief law
officer of your state in making this assessment.) What is the
,name of the 1115 demonstration which contains the waiver? What
are the beginning and ending dates of the demonstrat'ion? Isthe
waiver incorporated into your TANF plan ,applicable statewide? If·
not, how.will TANFoperate in 'those areas of the state not
covered"by the continuing waivers? Note: Future legislative or
regulatory action may limit which provisions of, the TANF may be"
considered inconsistent with waivers for purposes of determining
penalties~
If this happens, states will have an opportunity to .
submit a new plan in ,order to come into compliance with the
requirements.
.
Description of Attachments
In'additions to.th~s guidance, we are pr~viding tQree attachments
that State policy makers may wish to use in developing their .'
State TANF plans. Attachment A is a copy of the statutory.
requirements regarding the state plan. Attachment B contains
suggested formats, for the required certifications'that must'be
, submitted with a state plan.. Attae:hment C provides technical
information for, financial officers of the' program regarding
funding and a mechanism for states to requestTANF funds."
Paperwork Reduction Act
.
,
The information in the state TANF plan is collected in accordance
with section 402 of the Social Security Act, as amended.
..
Information received in the .state plans sets forth how the TANF
program will be administered and operated in the States.
.
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The response burden for this collection of information is
,estimated to be 60 hours per response, including the time for
reviewing the statute; this guidance gathering and 'preparing the
information, .and reviewing the'information.
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The int'ormation collected is mandatory in accordance with the
above-mentioned citations.'
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This information .is not considered confidential; therefore, no
'additional safeguards are considered necessary beyond that
customarily applie~ to routine government information.
Inquiries,
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8
Inquiries should be addressed to the appropriate Regional
Administrator, Administration for Children and Families.
Information about all State plans will be posted on the ACF. home
page.
�ATTACHMENT. A
• Statutory Text Relatinq to State Plans •
�i,
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"
'statutory
,:
~ext
STATUTORY TEXT
The Personal Responsibility and .work Opportunity Reconciliation
Act of 1996 (Public Law 104-193) was signed by the President
August 22. The following is the 'statutory language relative to
'the state TANF plan.
'
SECTION 402 -- STATE PLAN REQUIREMENTS
'(a)(l) .oUTLINE.oF FAMILY ASSISTANCE PROGRAM.
(Al-General Provisions.-A written document that outlines how
the State intends to:
, '
"
(i) Conduct a progr~m, designed to serve all political
subdivisions in the State (not necessarily in a uniform
manner), that provides assistance to needy families
with (or expecting) children and provides parents with
job preparation, work, and support services to enable
them to leave the program and become self-sufficient.
(ii) Require a parent or caretaker receiving assistance
under the program to engage in work once, the State
determines the parent or caretaker is ready to engage
in work, or once the parent or caretaker has received
assistance under the program for 24 months, whichever
is earlier.
(iii) Ensure that parents and caretakers receiving
assistance'under the program engage in work activities
in accordance with section 407.
(iv) Take steps to restrict the use and disclosure of
information about individuals and families receiving
assistance.
(v) Establish goals and take action to prevent and
reduce the incidence of out-of-wedlock pregnancies,
with special emphasis on teenage pregnanci~s, and
establish numerical goals' for reducing the' illegitimacy
ratio of the StatefGr calendar years 1996 through
2005.
.
(vi) Conduct a program that provides education and
training on the problem of statutory rape so that
teenage pregnancy prevention programs may be expanded
in scope to include men.
(B) Special
p~ovisions.-·
(i) The document shall indicate whether the State
intends·to treat families moving into the state from
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statutory Text
111
another state differently than other families under the
program, and if so, how the state intends to treat such
families under the program.
(ii) The document shall indicate whether the state
intends to provide assistance under the program to
individuals who are not citizens of the united states,
and if so, shall include an overview of such
assistance.
(iii) Thedocum~nt shall set forth objective criteria
• for the delivery of benefits and the determination of
eligibility and for fair and equitable treatment,
including an explanation of how the state will provide
opportunities for recipients who have been adversely
affected to be heard in a"state administrative or
appeal process.
(iv) Not later than 1 year after the date of enactment
of this Act, unless the chief executive officer of the
state opts out of this provision by notifying the
Secretary, a State shall, consistent with the exception
provided in section 407(e)(2), require a parent or
caretaker receiving assistance under the program who,
after receiving such assistance for 2 months is not
exempt from work requirements and is. not engaged in
work, as determined under section 407(c), to
participate in community service employment, with
minimum hours per week and tasks to be determined by
the state.
.
(2) . CERTIFICATION THAT THE STATE WILL OPERATE A CHILD SUPPORT
ENFORCEMENT PROGRAM.-A certification by the chief executive
officer of the state that, during the fiscal year, the State will
operate a child support enforcement program under the state plan
approved under part D.
(3) CERTIFICATION THAT' THE STATE WILL OPERATE A FOSTER CARE AND
ADOPTION ASSISTANCE PROGRAM.-A certification by.the chi~f .
executive officer of the State that, during the fiscal year, the
state will ,operate a foster care and adoption assistance program
under the State plan approved under part E, and that the State
will take such actions as are necessary to ensure that chi'ldren
receiving assistance under such part are eligible for medical
assistance under the State plan under title XIX.
(4) CERTIFICATION OF THE ADMINISTRATION OF THE PROGRAM.-A
certification by the chief executive officer of the State
specifying which state agency or agencies will administer and
supervise the program referred to in paragraph (1) for the fiscal
year, which shall inclUde assurances that local governments and
private sector o'rganizations
�·,
statutory. Text
(A) have been consulted regarding the plan and design of
welfare services in the state so that services are provided
in a manner appropriate to local populations; and.'
(B) have had at least 45 days to submit comments on the plan
and the design of such services.
(5) CERTIFICATION THAT THE STATE WILL PROVIDE INDIANS WITH
EQUITABLE ACCESS TO ASSISTANCE.~A certification by the chief
executive officer of the State that, during the fiscal year, the
State w~~l provide .each member of an Indian tribe, who is
domiciled ,in the state and is not eligible for assistance under a
tribal family assistance plan approved under section 412, with
equitable access to assistance under the state program funded
under this part attributable to funds. provided by the Federal
Government.
.
(6) CERTIFICATION OF STANDARDS AND PROCEDURES TO ENSURE AGAINST
PROGRAM FRAUD AND ABUSE.-A certification by the chief executive
officer of the State that the State has established and is
enforcing'standards and procedures, to ensure against program
fraud and abuse" including standards and procedures concerning
nepotism, conflicts of interest among individuals responsible for
the administration and supervision of the State program,
kickbacks, and the use of political patronage.
(7) OPTIONAL CERTIFICATION ,OF STANDARDS AND PROCEDURES TO ENSURE
THAT THE STATE WILL SCREEN FOR AND IDENTIFY DOMESTIC VIOLENCE.
(A) In General.-At the option 'of the State, a certification
by the chief executive officer of the State that the state
has establ,ished, and is enforcing standards and procedures
to
(i) screen and identify individuals recel.Vl.ng
assistance under this part with a history of domestic
violence while maintaining the confidentiality of such
iridividuals;
(ii) refer such individuals to counseling and
supportive services; and
(iii) waive, pursuant to a determination of good cause,
other program requirements such as time limits (for so
long as necessary) for individuals receiving
assistance, residency requirements, child support
cooperation requirements, and family cap provisions, in
cases where compliance with such requirements would
make it more difficult for individuals receiving
assistance under this part to escape domestic violence
or unf;:drly p~nalize such individuals who are or have
�statutory Text
·m
been victimized by such violence, or individuals who·
are at risk of further domestic violence.
(b) PUBLIC AVAILABILITY OF STATE PLAN SUMMARY.-The State shall
make available to the public a summary of any plan submitted by
the State under this seCtion.
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ATTACHMENT B
• state Plan certifications •
-This has been designed to enable the Chief Executive Officer of a
state to certify that the state-will operate its Temporary
Assistance to Needy Families (TANF) program in accordance with
the statutory requirements in section 402(a) (2) through (7).
�CERTIFICATIONS
The state will operate a program to provide Temporary Assistance
, to Needy Families (TANF) so, that the children may be cared for in
their own homes or in the homes of relatives; to end dependence
of needy parents on government benefits by promoting job
preparation, work; and marriage; to prevent and reduce the
incidence of out-of-wedlock pregnancies and establish annual
numerical goals for preventing and reducing the incidence of
these pregnancies; and encourage the formation and maintenance of
two-parent families.
This program is known as ____________________________________________
Executive Officer of the state (Name) _______________________________
In administering and operating a program which provides ~mporary
Assistance for Needy Families with minor children under title IV
A of the Social security Act, the state will:
1.
Specify which state agency or ,agencies will administer and
supervise the program under part A in all political
subdivisions of the State:
is (are) the agency(ies)
responsible for administering the program;
is (are) the agency(ies)
responsible for supervising the program;
2.
Assure that local governments and private sector
organizations:
(a) Have been consulted regarding the plan and design of
welfare services in the State so that services are
provided in a manner appropriate to local populations;
and
(b) Have had at least 45 days to submit comments on the
plan and the design of such services.
3.
Operate a Child supportEnforc~ment program under the State
plan approved under part'D;
4. 'Operate a Foster Care and Adoption Assistance program in
accordance with part E, and certify that the State will take
all necessary actions to ensure that children receiving
assistance are eligible for medical assistance;
�1.
certifications
5.
Provide each member of an Indian tribe, who is domicil~d in
the State and is not eligible for assistance under a Tribal
Family Assistance plan approved under Section 412, with
equitable access to assistance under the State program
f~ded under this part attributable to funds provided by the
Federal Government. '
6.
Establish and enforce standards and procedures to ensure
against program fraud and abuse, including standards and
procedures concerning nepotism, conflicts of interest among
individuals resPQnsible for the administration and
'
supervision of the state program, kickbacks, and the use of
political patronage. '
'
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Make available', ,to the public a summary of the State plan;
and
OPTIONAL CERTIFICATION
[] The state has established and is enforcing standards and
procedures to:
(1) Screen and identify individuals recel.Vl.ng assistance
under this part with a history of domestic violence,
while maintaining the confidentiality of such,
individuals;
,
(2) Refer such individuals to counseling and supportive
servicesi and
(3 ) waive I pursuant' to "a determination of good cause, ()ther
program requirements such as time limits (for as long
as necessary) for individuals receiving assistance,
residency requirements, child support cooperation
requirements, and family cap provisions, in case where
compliance with such requirements would make it more
difficult for individuals receiving assistance under
this part to escape domestic violence or unfairly
penalize such individuals who are or have been
victimized by such violence, or individua~s who are at
risk of further domestic violence.
CERTIFIED BY ,THE CHIEF EXECUTIVE OFFICER OF THE STATE:
Date
Signature ,and Title
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ATTACHHEN'l' C
+ Funding +
�19.
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FUNDING
section 403(a) (1) (A) provides that each eligible State' shall be
entitled to receive for each of the fiscal years 1996 through
2002, a grant in an amount equal to the ~tate family assistance
grant as defined in section 403(a)(1)(B).
I. Payments to Agency Administering the TANF·Program
Payments for the TANF program will be made to the '.
organization managing theAFDC/JOBS programs as of
August 22, 1996, unless the state indicates that the
TANF administering agency .is changed. If a change is
made, describe the name, address and EIN number.of the
new organization.
II. state Payments for TANF Program
~section
405 requires that grants be paid to states in
quarterly installments 1 based on state estimates. The
state's estimate for each quarter of·the fiscal year by
percentage is:
For FY 1998 and Future Years
1st
quarter
•
2nd
quarter
3rd
quarter
4th
quarter
For FY 1997 1 states should indic~te below. the
percentage of TANF funds requested for only those
quarters in which they plan to operate the program.
ForFY 1997
. 1st
quarter
2nd
quarter
3rd
quarter
4th
quart
er
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xxx. Changes
•
and Xnquiries
If a state determines that these estimates require
changes, a letter indicating the change in p~rcentages
should 'be sent to your ACFRegional Office and to ACF1s
Central Office. The Central Office address is: .
The Administration for Children and Families
The Office of Program Support
The Division of Grants Management
6th Floor, Aerospace Building
370 LIEnfant Promenade
Washington, D.C. 20447
�Revised
8/15/96
For backgroutid use only - Not Jortjuotation or attribution
. COMPARISON OF WELFARE REFORM MAJOR PROVISIONS,
!
.AFDC - RELATED PROVISIONS
. ORIGINAL HOUSE BILL
. VETOED BILL (H.R. 4)
Child Care,
A child ~e block grimt would be
authorized at S2.1 billion annually as
discretionary spending forFYs 1996
through 2000. Overall, child care would
. be cut by SI .?5 billion ov~r 7years.
Increases mandatory child Care funding
over current law by SO.3 billion over six
years (April) 996 CBO baseline).
Authorizes S9.9 billion in mandatory
funding for FYs 1997-2002 and S7
billion in discretionary funding for FYs
1996-2002. States would receive
approximately S I billion of the
mandatory funds as a.capped
entitlement. The remainder would be
available for state match (at the
MediC3rd rate). Requires states to
mainmin 100 percent of FY 1994 child .
care expenditures to draw down
mandatory funds. No child care
guarantee, but single parents with
children under six who are unable to
find child care are exempted from
sanctions and penalties. Eliminates
health and safety protections.
Increases mandatory funding over
current law by S3.5 billion over 6 years
(April 1996 CBO baseline). Authorizes
a total ofSl3.9 billion in mandatory
funding for FYs 1997-2002 and S7
billion in discretionary funding for FYs
1996-2002. States would receive
approximately SI.2 billion of the
manpatory funds each year as a capped
entitlement. The remainder would be
available for state match. Requires
states to maintain 100 percent of FY
1994 or FY 1995 child care
expenditures (whichever is greater) to
draw down (at 1995 Medicaid rate) the
mandatory funds. Single parents with
children under 6 who are unable to find
child care are exempted from sanctions
and penalties. Maintains current law
health and safety protections.
Performance
No provision
No provision. States that exceeded a
performance threshold with respect to
these measures would have their
maintenance of effort standard reduced
by up to 8 percentage points.
SI billion would be available through
FY 2003 for performance bonuses. The
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Secretary ofHHS (in' consultation with
the NGA and APWA), would be
required to develop a formula measuring
state performance using employmentrelated criteria, taking the
unemployment conditions in the state
into 'account. States would receive a
bonus based on their score on the
measure(s) in the previous year, but the
bonus could not exceed 5 percent of the
family assistance grant.
Bonus~o
Reward Work
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Time Limits
Families who have been on the rolls for
5 cumulative years (or le'ss at state
option) would be ineligible for cash aid.
Stales would be permitted to exempt up
to 10% of the caseload from the time
limit. States would be permitted to
pro\'ide noncash benefits to families that
have reached their time IilTjits,
Pe'rsonal
Responsibilit~'
Contra'ct
, '.
Familie's who have been on the rolls for
:s cumulative years (or less at stale
option) would be ineligible for cash aid.
States would be permitted to exempt up
to 15% of the case load from the time
limit. States are permitted to use block
grant funds provide noncash benefits
vouchers to families that are time
limited.
No provision
No' prov ision
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CURRENT BILL
a
Same as vetoed bill,except includes
20 percent exemption and states would
not be permitted to use federal, funds to
provide noncash assistance to families
that reach the time limit. States could
use their own funds, and federal Title
XX funds, for vouchers,
I
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States are required to make an initial
assessment of each recipient's skills,
work experience, and employability,
Personal responsibility contracts could
be developed at sta'te option.
�ORIGINAL HOUSE BILL
No contingency fund. States with high
unemployment could borrow from a $1
billion national Rainy Day Joan fund. '
Funds would have to be repaid.
Economic
Contingency
Grant Fund
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VETOED BILL (H.R. 4)
The bill includes $1 billion 90ntingency
fund (FYs 1997-2000) for grants to
states with high unemployment (state
must match): payments from the fund
for any fiscal year would be limited to
20 percent of the state's base grant.
$800 millio~ grant fund for states with
, high populaiion growth, benefits lower
than 35% of the national average, or
above average growth and below
average AfDC benefits (no state
match); and $1.7 billion loan fund,
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CURRENT BILL
Adds $1 billion to the contingency fund
for a total of $2 billion. States could
meet-one of two triggers to access the-'
contingency fund: the unemployment
' trigger in the H.R. 4 Conference
Agreement or a trigger based on food
'stamps. Under the second trigger, a
state would be eligible for the
contingency fund if its food stamps
case load increased by 10 percent over
the FY1994~95 level (adjusted for the
impact of the bill's immigrant and food
stamp provisions on the food stamp
case/oad)., Payments from the fund for
any fiscal year would be limited to 20
percent of the state's base grant for that
year, A state's federal match rate (for
drawing down contingency funds)
would be reduced if it received funds for
fewer than 12 months in any year, Also
includes a supplemental fund for high
population growth states and loan fund
I
as in H.R. 4 Conference Agreement
I
Block Granting
AFDC
Block grants AFDC, EA, and JOBS into
a single capped entitlement to states,
No individual guarantee of assistance,
Block grants AFDC, EA, and JOBS into
a single capped entitlement to states,
No individual guarantee of assistance,
Block grants AFDC, EA, and JOBS into
a single capped entitlement to states.
No individual guarantee, but the state
plan must have objective criteria for
delivery 'of benefits and ensuring
'equitable treatment.
The state must provide opportunities for
recipients who have been adversely
affected to be heard in a state
administrative or appea,l process, There
are no provisions to give the Secretary
,authority to enforce this provision,
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,Explicitly allows states to use block
grant money for programs to fund
individual development accounts for
recipients, Individual development
accounts would not be counted as
income in determining benefits, and
, could be used by individuals to finance
a small or micro-business, to pursue
post-secondary education,or to
purchase their first nome,
.
Maintenance of
Effort.
No provision
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States.would be required to maintain
75% of FY 1994 spending on AF:DC
and related programs for FYs 1996
2000, States with best or most
improved performance on speCified
measures would have their maintenance
C!f effort requirement redu~ed by upto 8
percentag:: points,
Requires 80 percent maintenance of
effort (reduced to 75 percent if a state, '
meets its work requirements) and
tightens the definition of what counts
toward the work requirement. No
additional;reductions in,MOE.
;
�ORIGINAL HOUSE BILL
Transferability
A state would be permitted to transfer;
up to 30 percent of the cash assistance
block grant to one or more of the
following: the child protection bloc~ ,
grant, the Title XX block grant, any
food or nutrition block grant, or the '
child care block grant.
il
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VETPED BILL (H.R. 4)
A state would be permitted to transfer
up to 30 percent of the cash ~sistance
' block grant to one or more of the
following: the child protection block
grant,the Title XX block grant, or the
child care block grant. '
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CURRENT BILL
A state would be permitted to transfer
up to 30 percent of the cash assistance- •
block grant to the child care block grant
and the social services (Title XX) block
grants. No more ,than one-third of the
amountcan be transferred to the social
services block grant, and alI. funds must
be:spent on programs and services for
children and families with incomes that
do not exceed 2'00 percent of poverty.
Title XX funds can be used for
vouchers.
�ORIGINAL HOUSE BILL
Work
Requirements
VETOED BILL (H.R. 4)
CURRENT BILL
..
A state's required work participation rate A state's required work participation rate A state's required work participation
would be set at 10% in J996, rising to
would be set at 15% in 1996, rising to
rate for all families would be set at 25
50% by 2003. Provides pro' rata
50% by 2002. Provides pro rata
percent i~ FY 1997, rising to 50 percent
redliction in the participation rate for
reduction. in the participation rate for
in FY 2002 and thereafter. Includes
reductions in caseload levels below FY
reductions in cas~load levels below FY
pro-rata reduction in rate due to
1995 that are not due to federal law.
1995 that are not.due to eligibility
caseloads below FY 1995 Jevels.
Individuals must work an average of 3~ . changes. Recipients would be required
Single-parent recipients would be
hours in FY 2002. Work activities
required to participate 30 hours per
to participate 35 hours per week by FY
include un.subsidized or subsidized
2002. Activities that count toward the
week in FY 2000 and thereafter: Twoemployment, work experience, four
work requirement include urisubsidized
parent families must work 35 hours per
weeks ofjob search, education and
week immediately. In families
and subsidized employment, work
sk ilis training directly related to
receiving federally-funded child care,
experience, community service, four
employment., and teens in secondary
weeks ofjob search and 12 months of
both ·parents must work at least 20 hours
school.
. per week, unless caring for a severely
voCational training. States.have.the
,
option to exempt single parents with
disabled child. The bill allows mothers
with childreri under age 6 to work 20
. children underage 1 from work
requirement. No part-time work option
hours per week. States could el'empt
for mothers with young children.
from the work requirement single
Parents of children· under six who
parents with children under age one for
cannot· find child care cannot be
a total of 12 months (not necessarily
penalized forfailure to meet work
consecutive). Parents of children under
:equ irements.
age 6 who cannot find child care cannot
be pena}ized for failure to meet the work
. requirements; butstates may not
disregard such an adult in calculating
work rates. Allows 6 weeks (no more
-.
than 4 consecutive) of job search, 12
weeks if state unemployment is at least
50 percent above the national average.
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Activities that count toward the work
requirement are similar to those in H.R
4, except states could allow 20 percent
of caseload to count 12 months of
vocational training and secondary
school for teens (up to age ·19) toward
work requirement. Also counts hours
parents spend providing day care for
other welfare families.
:
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"
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:
.'
i
States which receive approval for'
welfare reform waivers before July 1,
1997 have the option to operate their
cash assistance program U11der some or
all of these \\'ar~ers. For states electing
this option, ·some provisions of the new
law which are inconsistent with the
waivers would not take effect until the
expiration of the applicable waivers in
the geographical areas co~ered by the
waivers.
'.
Family Cap
!
States could not use federal funds to
provide cash benefits to children born
whik parent is receiving assistance.
..
(
States would be required to de~y cash
benefits to children born to welfare
recipients unless the state legislatLire
expli¢itly votes to provide benefits.
No provision (due to Byrd rule), so state
option. If state has family cap. state
may use Title XX funds to provide
vouchers:
�VETOED BILL (H.R. 4)
ORIGINAL HOUSE BILL
Teen Parent
Provisions
States would be prohibited from
. providing cash benefits to minor
mothers.
',In order tor~ceive assistance, unmarried
. minor parents would be required to live
' with an adult or in an adult-supervised
setting and participate in educational or
training activities.
'.
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"
.
"
$75 million per year would be set aside.
from the Maternal and Child Health
(MCH) Block Grant for an abstinence
education program.
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"
For FYs 199&-2000, an additional $11
. billion would be authorized to .assist
states in locating or providing "second
chance homes."
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'.
CURRENT BILL
In order to receive assistance, unmarried
minor parents would be required to liy"e_
with an adult or in an adult-supervised
setting and participate in educational or ,.
training activities. In addition, states
would· be. responsible for locating or
assisting in locating adult-supervised
settings forteens. Starling in FY 1998, '
$50 million a year in mandatory funds
would be added to the appropriations of
the Maternal and Child Health (MCH)
Block Grant for abstinence education.
In addition, the Secretary of HHS will
establish and implement a strategy to (I)
prevent non-marital teen births, and (2)
assure that at least 25 percent of
communities have teen pregnancy
prevention programs. No later than '
1/1197; the Attorney General would
establish a program that studies the
linkage between statutory rape and teen
pregnancy, and that educates law
enforcement officials on the prev~ntion
and prosec,ution of statutory rape,
�MEDICAID PROVISIONS
"
Medicaid
Guarantee
ORIGINAL HOUSE BILL
,Welfare Bill: States would b~ required
to use rules in effect as of March 7,
1995, thus freezing pre-welfare reform
AFOC rules for Medicaid eligibility.
CURRENT BILL
VETOED BILL (H.R. 4)
Eliminates guarantee of Medicaid
coverage for cash assistance recipients.
Medicaid Bill: Eliminates guarantee of
Medicaid coverage for cash assistance
recipients.· ..
"
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"
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Mei:licaid
Coverage After,
Five-Year Time
Limit
Welfare Bill: Requires states to use,
state plan provisions in effect on March
1. 1995 to determine Medicaid
eligibility,
States have two options for providing....
Medicaid coverage: 1) States may
guarantee' coverage for individuals and
families in accord with current AFOC
income and resource standards; or 2)'
states may run a single eligibility system
prQvided that eligibility is no more
restrictive than the income 'and resource
standards in effect as of July 16; 1996.
(Note: for both provisions; states may
return to May I, 1988standards as
allowed under current law). States may
deny Medicaid to any adult receiving
both Medicaid and benefits under the
cash benefits whose benefits are
terminated because of failure to meet
work requirements.
States determine eligibility; no '
guarantee of Medicaid coverage. No
provision'on Medicaid coverage for
families that reach thetime limit.
Coverage continues as long as fan:tilies
would have qualified for AFOC under
July ) 6, 1996 rules.'
No provision
Families receive one year of tr~sitional'
Medicaid if the family leaves welfare
because of increased ,earnings,
Maintains current law of providing
transitional Medicaid for four months to
families who leave welfare due to
increased child support. Provisions are
extended ,through 2002.
Medicaid Bill: States determine
eligibility; no guarantee of Medicaid
coverage.
One-Year
Transitional
Medicaid
Coverage
No provision, Transitional, Medicaid
Assistance is therefore allowed to sunset
on 9/30/98 per current law, '
.
i
�FOOD STAMPS PROVISIONS
:
ORIGINAL HOUSE BILL
CURRENT BILL
VETOED BILL (B.R. 4)
"
Food Stamps
The House bill would cap federal
program expenditures regardless of
gro\\1h. The bill would limit maximum
benefit increases to 2% per year,
regardless of the increase in food costs.
It would terminate benefits for nondisabled childless individuals between
18 and 50 years old unless they are
working at least half-time or in a work
.program. ' Optional food stamp block
gran! would be available to states that
operate a statewide EBT system. The
bill would freeze the standard income
deduction and the limit on excess shelter
expense deductions at their current
levels.
The conference bill disqualifies ablebodied adults between 18 and 50 if they
received food stamps for more than four
months in the last year and did not work.
or participate in a work program, unless
they Jive in an area with greater than 10
perq:nt unemployment. An optional
food stamp block grant would be '
available to states that have a fully
implemented EBTsystem or meet
certain payment accuracy standards.
States choosing block grants would be
required to meet specified requirements.,
, -~
Eliminates the block grant option. -.
Limil$ childless able-bodied adults
between 18 and 50 to three months of
food stamp benefits in a 36-month
period, unless they were laid. off, in
which case the exemption is fora total
of 6 months. Allows two months ofjob
search or job search training and
hardship exemptions for up to 20,'
percent of persons subject to this '
requirement. Freezes the cap on the
shelter deduction at $342 after 111197
and reduces the standard deduction t9
,$132 in FY 1997 and $122 in FY 1998
2002; indexing of standard resumes
afterward.
.'
�,I OTHER PROVISIONS
' ,
I
ORIGINAL HOUSE ~ILL
,i
VETOED BILL (H.R. 4)
Child Nutrition
:1
Replaces child nutrition prograins
No mandatory child nutrition block
operated outside of schools, WIC,and
grants, but permits up to 7 school ,
commodity distribution programs with a ' nutrition block grant demonstrations,
block grant to states, Creates a separate
WIC remains a separate program, Child
block grant to states for school-based
nutrition spending would be reduced by
child nutrition programs, These
about $6.3 billion over 7 years.
provisions would result in cuts of $10
billion o~er 7 years.
Child Support
Includes major comprehensive child'
Includes major comprehensive child
support enforcement measures proposed support enforcement measures proposed
, by the Clinton Administration,
.by the Clinton Administration,
including paternity establishment, state
including paternity establistunent, state
central registries of child s':!pport orders, central registries ofc,~lld support orders,
uniform procedures·for interstate cases,
uniform procedures for interstate cases,
and, penalties such as license revocation. and penalties, such,as license
Eliminates the $50 pass-through of child revocatiO'n. Eliminates $50 passthrough of child,supportto cash
supportto cash assistance recipien.ts.
,assistance recipients.
I
I
: SSI For
, Children
Children who are now eligible for SSJ
' under the medical listings would
continue to receive cash benefits and
Medicaid, For applicants after
enactment, cash benefits would only ,be'
available for children who meet the
medical listing and are institutionalized
or would be institutionalized if they do
not' receive personal assistance services.
required because of theirdisability. All
children who meet the medical listings
would be eligible for services under a
state block grant funded at 75% of the .
amount otherwise payable in cash
benefits. There would be no guarantee
of ser"i ces under the block grant.
",
II
CURRENT BILL
.'
Upon enactment for pending and new
applications, would e'liminate the
comparable severity standard, the IFA,
and references to maladaptive behavior
in the listing, and would establish a new
disability definition for children.
Effective January I , 1997, for current
recipients and new applicants, a 2-tiered
benefit system would be established.
Children who. need personal assistance
in order to remain at home would
receive 100% of the benefit. Children
who meet the listings but not the
personal assistance criteria would
receive 75% of the benefif Continuing
disability reviews would be conducted
for low birth weight children within one
ycar of birth, and at least every three
years on children under age 18.
Representative payees for children
would be required to present evidence at
the time· of a continuing disability
review that the child receiving treatment
for his or her condition. Eligibility
would have to be redetermined, using
the adult criteria within one year
following a recipient turning 18.
No school nutrition block grant.
-.
Similar to vetoed bill, except it
eliminates a' provision in current law
which requires that child support awards
in AFDC cases be periodically reviewed
and adjusted to ensure that awards are
adequate., Also includes a minimum
reduction of25 percent of monthly cash
assistance for an individual's failure to
cooperate with paternity establishment.
Upon enactment for pending and new
applications, would eliminate the
comparable severity standard, the IFA,
and references to maladaptive behavior
in the listing, and would establish a new
disability definition for children. '
Current beneficiaries found ineligible
would lose benefits no sooner than July
1,1997. Continuing disability reviews
would be conducted for low birth
weight children within one year of birth.
and at least every three years on
children under age 18. Representative
payees for children would be required to
present evidence at 'the time of a
continuing disability review that the
child receiving treatment to the extent
considered necessarY and available for
his or her condition. Eligibility would
have to be redetermined, using the adult
criteria within one year following a
recipient turning) 8. For privately.
insured, institutionalized children, cash
benefits would be limited to $30 per
. month, No two-tier benefit system.
�ORIGINAL HOUSE BILL
Child
Protection and
Adoption
"
VETOED BILL (ltR. 4)'
,
Eliminates the current federal
entitlement for Foster Care and
Adoption Assistance, the capped
entitlements for Family Preserv~tion and:
Support and Independent Living, and a
number of discretionary programs for
abused, neglected. abandoned; and atrisk children (inclu~ing the Child Abuse
Prevention and Treatment Act, and the
Missing and Exploited Children's Act),
Replaces these programs with a capped
entitlement block grant t01he states, and
reduces funding available to th,e states
by $6.3 billion over 7 years.
CURRENT BILL
Maintains the entiilement for foster care ' No hlotk grant. Current bill: (I) gives
and adoption assistance maintenanCe
states authority to make foster care
maintenance payments using JV-E fUI~'ls
payments and block grants
on behalf of children in for-profit child
administration and child placement
services funding, as wen as IV-B parts I ,care institutions;. (2) extends the
enhanced federal match for statewide
and 2 and Independent Living~ CAPTA
automated child welfare information
and several discretionary programs are '
systems through 1997; (3) appropriates
combined into a Child and Family
$6 million per year in each ofFYs
Services block grant, Overall. reduces
1996·2002 for a national random sample
mandatory funding by $400 million
study of abused,and neglected children;
over 7 years.
..
and (4) .
requires that states consider
,
'
giving preference for kinship
placements, provided that relatives meet
state standards:
.
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"
,
Immigrants
With certain exemptions, nOl1citizens,
would be ineligible fot'SSJ, Medicaid,
food stamps, transitional assistance, and
social services block grants. Immigrants
would become'eligible upon
naturalization. Exceptions include
immigrants too disabled to naturalize
and immigrants over 75 with five years.
residence. Most federal and state needsbased programs would be required to
deem the income and resources of
sponsors.' Deeming would be extended
until the immigrant naturalized and
would apply to current recipients.
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II
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Most legal immigrants would be
: Sam.e as H.R. 4, except: (1) eliminates
ineligiOIe for SSI and Food Stamps until eligibility of legal immigrantsJor SSJ
arid Food Stamps immediately at the
citizenship. Current recipients would
lose eligibility after January I, 1997..
time of redetermination, rather than one
States would have the option to make
year after the date of implementation;
most current legal immigrants ineligib~e ,(2) allows non-qualified immigrant
for Medicaid, AFDC, Title XX Social
. children to be eligible for school
Services, and state-funded assistance
,Iunchesi'breakfasts ifth~y are eligible
for a free public education; (3) adds
until citizenship. Future immigrants
would be ineligible for five years for
JTPA and Head Start to the list of
most federal means-tested programs,
programs explicitly exempted from the,
including Medicaid.
5-year eligibility ban on future legal
immigrants; and (4) provides states the
All applicants for most federal, state,
opt,ion to determine whether nonand local programs would be subject to
qualified immigrants are eligible Jor
new verification requirements to
WIC and other child nutrition·programs.
determine if they are "qualified" or
"non-qualified." Qualified immigrants
would include legal permanent .
residents, refugees, asylees, immigrants
. whose deportation has been withheld,
and immigrants who hav~ been granted
parole status by the INS for a period of
one year. Non-qualified immigrants
would be ineligible for benefits (except
emergency medical; short-term disaster;~.
limited public health assistance; non
profit, in-kind community services such '
as shelters and soup kitchens; and
certain housin~ programs).
Future sponsors/immigrants would be
required to sign new, legally binding
affidavits of support. For,these future
immigrants, H.R. 4 extends deeming to
citizenship, changes deeming to count·
100 percent of a sponsor's income and
resources, and expands the number of
programs that are required to deem,
including Medicaid.
�U.S. DEPARTMENT OF H~AL TH AND HUMAN SERVICES
. August 1996
Contact:
HHS Press Office
. (202) 690-6343
Th~ Personal R~sponsibility and Work Opportunity Reconciliation Act of 1996
On August 22. President Clinton signed"intolaw ."The Personal Responsibility and Work
Opportunity Reconciliation Act of 1996," a comprehensive .bipartisa~ welfare reform plan that will
dramatically change the nation's weifare system into one that requires 'work in exchange for time
limited assistance. The bill contains strong work requirements, a performance bonus to reward
states for moving welfa~e recipients into jobs~/state maintenanc~ of effort requirements,
comprehensive child support enforcement, and supports' for families moving from welfare to work
..:- including increased fiJ.nding for child care and guaranteed medical coverage:
Highljgh~s
1996" follow.
of "The Personal Responsibility and ,Work Opportunity Reconciliation Act of
.
MAKING '''ELF ARE' A .TRANSITION TO WORK
o
Work requirements. Under the new law, recipiepts must work after 'two years on
assistance, with few exceptions. Twenty-five percent of all families in each state must be
engaged in work activities or have left the rolls in fiscal year (FY) 1997, rising to 50
percent in FY 2002. Single parents must participate for at least 20 hours per week the ·first
year. increasing to at least 30 hours per week by FY 2000 .. Two-parent families must work
35 hours per week byJuly 1, 1997.
'
,
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Supports for families transitioning into jobs. The new welfare law provides $14 billion in
child care funding -:.. an increase of $3.5billion over current law ~- to help more mothers'
move into jobs. The new law also guarant~es that women on welfare continue to receive'
health coverage for their families, including at least one year of tfansitional Medicaid when
they leave \Velfare for work.
'
o
Work Activities. To count toward state work requirements, recipients will be required to
participate in unsubsidizedor subsidized employment, on-the-job training, work experience,
community service, 12 months of vocational training, or provide child care services to
individuals who are participating in community service. Up to 6 weeks of job search (no·
more than 4 consecutive weeks) would count toward the'work requirement. However, no
more than 20 percent of each state's caseload may count toward the work requirement solely
by participating in vocational training or by being a teen parent in secondary school. Single
parents with a child under 6 who cannot find child care cannot be penalized for failure to
meet the work requirements. States can exempt from the work requirement single parents
. with children under age 'one and disregard these individuais in the calculation of
participation rates for up to 12 months.
.. .
�o
A, five-year time limit. Families who have received assistance for' five cumulative years (or
less at state option) will be ineligible for cash aid under the new welfare law. States wilt' be,
permitted to exempt up to 20 percent of their caseload from thetime limit, and states
have the option to provide non-cash assistance and vouchers'to families that reach the time
limit using Social Services Block' Grant or state funds. '
will
o
' Personal employability plans. Under the new plan, states are, required to make an initial
assessment of recipients' skills. States can also develop personal responsibility plans for
recipients identifying the education, training, and job placement services needed to move,
into the workforce.
'
o
State maintenance of effort requirements. The new welfare law requires states to
maintain their own spending on welfare at at least 80 percent of FY 1994 levels. States
must also' maintain spending at 1'00 percent of FY 1994 levels to access a $2 billion
contingency fund designed to' assist states affected by high population growth or economic
downturn. In addition 1 states must maintain 100 percent of FY 1994 or FY 1995 spending
on child care (whichever is greater) to access additional child care funds beyond their initial
allotment.
' , -/
o
Jop subsidies. ' The law also allows states to create jobs by taking money now,used for
welfare checks and using it to create community serviCe jobs or to provide income subsidies
or hiring incentives for potential employers.
o
Performance bonus to reward work. $Lbillion wiltbe available through FY 2003 for
performance bonuses to reward states,for moving welfare recipients into jobs. The
Secretary of HHS, in consultation with the National Governors' Association (NGA) and
American Public Welfare Association (APWA), will develop criteria for measuring state
performance.
"
,
o
State flexibility. Under the new law, states which receive approval for welfare reform
waivers before July 1, 1997 have the option,to operate their cash assistance program under'
some or all of these waivers. For states electing this option, some provisions of the 'new
law which are inconsistent with the waivers would not take effect until the expiration of the
applicable waivers in the geographical areas covered by the waivers.
,
,
, PROMOTING RESPONSffiILITY'
Comprehensive child support enforcement. The new law includes the child support enforcement'
measures President Clinton proposed in 1994 -- the most sweeping crackdown on non-paying
parents in history. These measures could increase child support collectionS by $24 b~llion and
reduce federal welfare costs by $4 biIlionovet 10 years. Under the new law, each state must
operate a child support enforcement program meeting federal requirements in order to be eligible
for Temporary Assistance' to Needy Families (TANF) block grants. Provisions include:
o
a
National new hire reporting system. The law establishes Federal' Case Registry and,
National Directory of New Hires to track delinquent parents across state, lines. It also
requires that employers report all new hires to state agencies for transmittal of new hire
information to the National Directory of New Hires. This builds on President Clinton's
June 1996 executive action to track delinquent parents across state lines. The law also
expands and ?treamlines procedures for direct withholding of child support from wages.
�o
' Streamlined paternity establishment. The new law streamlines the l~gal process for
paternity establishrilent, making it easier and faster to establish' paternities. It also expands
, the voluntary in-hospitalpatenuty establishment program, started by the Clinton
Administration in 1993, and require~ ,a state form for voluntary paternity ackno~ledgement.
In addition, the law mandates 'that states publicize ~e availability and encourage the use of -.
voluntary paternity establishment proGesses. Individuals who fail'to cooperate with paternity
establishment will have their monthly cash assistance reduced:by at least' 25 percent.
o
Uniform Interstate child support laws. 'The new law provides for uIrlform rule,s,'
procedures, and forms for iriterstate cases. '
'.,
,
o
Computerized'state-wide collections. The new law requires states to establish ~entral
registries of child support orders and centralized collection and disbursement units. It also
requires expedited state procedures for child support enforcement.
o
' Tough new penalties. Under the new law, states can iniplement tough child support
enforcement techniques. The new lawwill expand wage garnishment,allow states to seize
assets, allows states to require community service in some cases, and enable states to 'revoke
drivers and professional qcenses for parents who owe del!nquent child support. , '
o
"Families First." Under a new ;'Family First" policy , families no longer receiving
, assistance will have priority in the distribution of child support arrears,., This new policy
will bring families who have left welfare for work about $1 billion in support over the first
six years.
o
Access and visitation programs. In an effort to increase noncustodial parents' involvement
i~ their children's lives, the new law includes grants to help states establish programs that
suppon and facilitate noncustodial parents' visitation with and. access to their children.
, Teen Parent Provisions
,
,
o
Live at home and stay in school'requirements. Under the new law, unmarried minor
, parents will be required to live with a responsible adult or ill an adult-supervised setting and
panicipate in educational and training activities' in order to receive assistance. States will be
responsible for locating or assisting in locating adult-supervised settings for teens.
.
o
"
.
Teen Pregnancy Prevention. Starting in .fY 1998, ,$50 million a year in mandatory funds
would be added to the appropriations of the Maternal and Child Health (MCH) Block Grant
for abstinence education. In addition, the Secretary of HHS will establish and implerpent a
strategy to (1) prevent non·marital teen births, and (2) assure, that ~t teast 25 percent of
communities have teen pregnancy prevention programs. No later than January ,1, 1997, the
Attorney General will establish a program that studies the linkage' between statutory rape and
teen pregnancy, and that educates law enforcement officials on the prevention and '
prosecution of statutory rape.
�IMPROVEMENTS OVER THE VETOED BILL
President Clinton vetoed the previous 'welfare refonn bill (H.R. 4) submitted by Congress because
it did too little to move people into jobs and failed to provide the supports -- like child care and
'heal~h c~re -- that families need to move from welfare to work. "The Personal Responsibility and -.
Work Opportunity Reconciliation Act of 1996" includes several improvements over the vetoed bill,
including:
'
o
Guaranteed medical coverage~ The new iaw preserves the national guarantee of health
care for poor children, the disabled, pregnant women, the elderly, and people on welfare.
, H.R. 4 would have ende~ the guarantee of Medicaid coverage for cash assistance recipients.
o
Increased child care funding and mandatory child care maintenance of effort. The new
law provides $14 billion in child care fuJ)ding --an increase of $3.5 ,billion over 6 years -
allowing more mothers to leav'e welfare for, work. States will receive an initial allotment
each year from a fund of approximately $1.2 ,billion. To access additional funds, states
must maintain their own spending at 100 percent of their FY 1994 or 1995 spending on
child care (whichever is higher). By contrast;' H.R. 4 increased child care funding by just
, ,$300 million overcurrent law, and did not require states to meet child care maintenance of
effort requirements to access additional federal child care funding, allowing sta.tes to lower
their· own' spending.
'
o
Incentives for states to move people into jobs. The new law includes a $1 billion
performance bonus to reward states that meet perfonnance targets. H.R. 4 did not contain a
,,' cash p~rformance bonus. '
o
Preservation of nutrition programs. H.R. 4 would have given states the ,option of block
granting food stamp benefits. The bill would have also capped fed.eral food stamp program,
,
'expenditures, limiting maximum benefit increases to 2 percent per year, regardless of
growth in need for assistance. The new law maintains the national nutrition~l safety net by
'
eliminating, the block grant option as well as the food stamp cap.
o
'Current law child protection and adoption. Unlike H.R. 4, the new plan maintains
current law on child protection and adoption, and does not reduce funds for child 'welfare,
child abuse, foster care and adoption servic~.s.
o
Improved contingency fund. " The new law includes a $2 billion, contingency fund to
,protect states in times of population growth or economic downturn. H.R. 4 included a $1
billion contingency fun~l.
o
Current law child care health and safety standards. The new law protects cpildren by
maintaining health and safety standards for day care. H.R. 4 would have eliminated health
and safety ,protections.
o ,
Protection of disabled children. H.R. 4 would have cut SSI 'by 25 percent for many
disabled children. The new law eliminates this proposed two-tier system.
o
Optional family cap. Under, the new law, states have the option to implement a family
cap. H.R. 4 required states to deny cash benefits to children born to welfare recipients
unless the state legislature explicitly voted to provide benefits.
�,NE(:ESSA.RV
IMPROVEMENTS
'. ' , . '
President Clinton has stated that the new law requires several improvements.' Specifically, he has-
pledged to fix two provisions of the welfare bill which he believes have nothing to do with welfare
reform.
' "
, , '
,
o
Food Stamps. According to President Clinton, the new law cuts deeper than it should in
, Food Stamps; mostly for working families who have high shelter costs.
•
o.
• • • •
!'
•
Legal Inurtigrarits .. ,The law includes provisions that would deny most' forms of public
assistance to most legal immigrants for five years or until they attain citizenship. The
President has said that legal' immigrants who fall on hard times through 'no fault of their own
and need help should get it, although their sponsors should take additional responsibility for
them.
'
BUILDING ON tHE PRESIDENT'S WORK TO END WELFARE AS WE KNOW IT,
Even i?efore Congress passed welfar~ reform legislation acceptable ,to President Clinton, states were
acting to try new approaches. With encouragement, support, and cooperation from the Clinton
Administration, 43 states have moved forward with 78 welfare reform experiments. The Clinton
Administration has also required teen mothers to stay in school, required federal employees to pay
their child support, and cracked down 9n people who owe child support and cross state lines. ,As a
, result of these efforts and President Clinton'S efforts to strengthen the economy, child support ,
collections have increased by 40 percent to $11 billion in FY 1995, and there are 1.6 million fewer
, people on welfare today than when President CHilton, took office. "The Personal Responsibility and
, Work Opportunity Reconciliation Act of 1996" will build on these efforts by allowing states
flexibility to reform their welfare sysiems and to build on demonstrations initiated under the Clinton
Administration.
'
,
�For Internal Use Only,
'
,
,
.
,
Questions and Answers on Welfare Reform
, August 21, 1996
Q:
Why did the President sign the wem~re refomrbHI?' '
A:
The President signed this bill because it will change the nation's welfare system into 'a transitional
assistance program that requires work in exchange for time-limited assistance, The bill contains
strong work requirements, a performance bonus 'to reward' states for moving welfare recipients into
jobs, ,state maintenance of effort requirements, comprehensive child support enforcement, and
supports for families moying from welfare to' work --including increased funding for child care and
guaranteed Medicaid coverage. As the President has said, this legislation gives us a chance lito
traps form a broken system that traps too many people in a cycle of dependence to one that,
emphasizes work and independence, to give p~ople on welfare a chance -to draw a paycheck, not a
welfare check." ,
combiited with the EITC and the minimum wage increase 'won by, this Administration, the new;
transitional welfare system will help move AFDCrecipients from welfare to work. In Colorado, for
example, a mother, with two children will increase her income by more than ~O percent -- from
$8,000 to $12,600 -- even if she only works part-time at the minimum wage. Plus, she'll receive
health care, Food Stamps, help in collecting child support, and child care assistance if she needs it.
,
,
.
"
.
The President has pledged to fix the provisions in the bill that would deny assistance to legal
inunigrants and cut back on Food Stamp assistance for working families.' As the President has said,
these provisions are wrong, and his Administration will work to correct them.
Q:
Isn't it true that the President only decided ,to sign the bill because . of political concerns?
.
A:
Not at aIL ,This is a' President who has always stood on principle. OlIr opponents have criticized
his children's tobacco initiative, but he has not backec;l down. They have criticized, his success at
getting handg~ns off the street, but he has not wavered. Reforming the welfare system is something
that he's always been conunitted to, and he believes it is important to begin changing the failed
system as quickly as possible. .
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"
Overall, there is more good than bad in this bill. Child care spending, .for example, is almost $4
,billion above current law. The child support enforcement provisions-- all included at the, request
of the Administration -.: will bring in $24 'billion for America's children and free up billionsniore
in welfare,payments that can now be used· for job training. This legislation makes other significant
improvements over the bills the President vetoed,-- it drops the deep cuts and devastating changes
in foster care, adoption assistance, child abuse prevention programs, the school iUQch program, and
,aid to d,isabled children.'
�,
Q:
A:'
,
Isn't it tnle that all of his policy advisors recomrnendtXt a' vet6?
No. Some Administration officials have expressed concerns about the final bill, but that's not new.
Th~ official letters sent to Congress have always expressed concerns.'
But the Administration believes that there is more good than bad in this bill. Child care spending,
forexample, is almost $4 billion above current law. The child support enforcement provisions -
all included at the request of the Administration -:. will bring in $24 billion for America's children
and will free up billions more in current welfare payme~ts that can now be used for work activities.
Every Administration official also knows that this bill is much improved from the legislation the
, President vet~d last.ye~r. It's still not peIfect, but it's imperative that we move away from the
failed status quo.
"
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Q:
But won't this bill result in more poverty? How can you say that you care about children, and still
sign this bill?
"
~/
A:
Very few bills are perfect, and this bill does have some flaws. However, it's important to remember
how many victories the ' President has won since he vetoed the previous bill. " This legislation' does
not dismantle foster care; adoption assistance, child abuse prevention programs, or the school lunch
, program. It does not deny cash assistance to disabled children. And it includes more funding for
child' care,
,
,
Overap, the Administration believes that there is more ,good than bad in this bill. Child care
spending, for example, is ~lmost $4 billion above current law. The child support enforcement
provisions, -- all included at the request of the Administration -- will bring in billions of dollars for
America's" ,children arid free 'up, billions Plore in welfarepayments that can now be used for job
training:
It's also important to, remember that this Admini~tiation expanded the Earned Income Tax Credit,
and convinced Congress to increase the minimum wage. ' Together wit'h the work incentives in this
bill, those actions will make many low-wage families be~ter off, and' will make work a better deal'
than welfare. In Colorado, for example, a young mother with two children receives only $8,000 a
year in welfare and Food Stamps, and ,IIlay never be encouraged ,to look for work and become
independent. But with our new strategy, she will increase her income by more than 50 percent -
to $12,600 -- even if she only works part-time at the minimum wage. She'll still receive health care
for herself and her children. She'll still re~eive Food Stamps. She'll get help collecting child
support. And she' II get help with, child care if she needs it.
�Q:
Studies, such as the Urban Institute study, have indicated that this reform package will force millions
of kids into poverty. Is this true? What' are. you going to do ensure~that it does not force children'
into poverty?
A:
Let's not forget that millions of children and their parents are trapped in poverty now. No computer
model can predict with 100 percent 'accuracy how individuals will ,respond when the system is
fundamentally transformed: We believe that many women on welfare want to work and will do so
if they can fmd child care for their children. We believe that when society demands that absent'
parents pay child support, they will do so. Under the new,welfare law ,people will be required to
move into jobs, but they will also receive the supports they need - like child care and health care,
- to move' from welfare to work. The legislation also contains tough child support enforcement
measures that will increa~e collections by'$24 billion Over ten years -- providing an enormous amount
'of'money for children's food, clothing, and shelter. It's also important to note that the Urban
Institute study did not include the minimum wage increase the Administration recently won, which
'
will have a significant'impact for many of these working families:
.
~
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,We strOIlgly believe that work is better than welfare.' 'In Colorado, for example, a young mother
with two children now receives only $8,000 a year in,welfare and Food S~ps, and may never be
encol,lraged to look for work ,and become independent. But with our new strategy that includes the
EITC an,d the minimum wage increase won by this Administration, she will increase her income by
more than 50 percent -- to $12,600 -- even if she only works part-time at the minimum wage. She'll
still receive health care for herself and her children. She'll still receive Food. Stamps. She'll get
help collecting child'support. And she'll get help with child care if she needs it.
,
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bu~ still' hasn't acted
Q:
Why has the Administrati'on granted other states' waivers,
A:
Some states have asked HHS to go, ahead and approve their waivers, even though they may not be
necessary under the new'law. There is no special treatment here for any othei' state over Wisconsin
- 'these states' requests have been! pending longer and are simpler (some states simply submitted
amendments to a currently' operating' demonstration). ,
on Wisconsin's?
(Background: Hawaii's waiver request was received on 5/7/96; Indiana's on 12/14/95, with
additional amendments received on 2/6/96; Maryland's request was received on 4/26/96; Minnesota's
AFDC waiver was 'received on 4/4/96, with amendments received on 5/28/96, and Minnesota's Work
First waiver was also received on 4/4/96. Kansas' waiver request was received on July 26, 1994,
with amendments received on April 30, 1996. DC and Idaho submitted fast-track waiver requests
on August 6 and 8, respectively. Wisconsin's official waiver request was received on 5/29/96).
Q:
What are the Administration's plans for the Wisconsin waiver since Congressional legislation has
now been pass~d?
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:A:
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,In fact, no, action may be necessary, since the new federal law appears to give Wisconsin all of the
flexibility it needs to move forward on it$ reforms. We won't know for sure until we've carefully
reviewed the final bill and report language.
'
�.
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Q:
But Governor Thompson says he still does need the waiver, and is accusing the President of reneging
on his l'romise to grant it. Is he right?
A:
It appears that the new federal law gives Wisconsin all of the flexibility it needs to move forward
on its reforms, so the waiver request may be moot. .' However, the new law'is quite complicated, and .
we'll need to carefully review the fmal bill and report language before we'll know for sure.
Q:
How will the federal government monitor the states under the new program? How can the federal
government ensure that recipients are protected from unfair treatment or discrimination resulting in
loss ·of benefits?
..
.
Although states will receive considerable flexibility under the Personal Responsibility and Work Act
of 1996, the law provides some level of federal oversight and protection for recipien~ from unfair
treatment. The law requires states to submit plans' outlining how they will implement the new
provisions. These state plans must include objective criteria for delivering· benefits and ensuring .
equitable treatment for recipients. States..must also' provide opportunities for recipients who have
been adversely· affected to be heard in ,a state administrative or appeal process.
A:
In addition, the new law penalizes states that fail to meet bill 'requirements or misuse federal money
by removing a portion of their block grant funding. States that are penalized must expend additional
state' funds to replace fed~ral grant reductions.
Q:
How do you justify removing the federal guarantee from women and children, particularly when the
President is so far ahead in the polls? What will be the safety net for women and children who fall
on hard times?
A:
Presiderit Clinton signed "The Personal Responsibility and Work Opportunity Reconciliation Act of
1996" into law because the current system is broken,. and because Congress made many of the
changes he sought under welfare reform. His judgement was based on policy, not politics .
. The new law will provide protections for women and children who fan on hard times, including
time-limited cash assistance, child care, Medicaid, Food Stamps, and nutrition assistance, while
helping recipients move toward work and self-sufficiency. It also contains the toughest possible child
support enforcement -- which will provide new resources for children's food, clothing, and shelter.
And, unlike the vetoed bill, it maintains the open-ended federal commitment to Food Stamps, foster
care, and adoption services.
�Q:What makes you thlnkthis dramatic shift will make a difference? '
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,
A:
As the.President said, this law gives us a chance to reform'oui" broken welfare system. The law is
strong on work. It provides almost $4 billion more for child care' so that mothers can move from
welfare to work, and protects thdrchildren by maintaining health and safety standards for day care.
It gives states powerful performance· incentives to place people in jobs. It requires states to hold-tip
their end of the bargain by main~ining their own spending on welfare.' And it gives states the
capacity to create jobs by-taking money now used for welfare checks and giving it to employers as
income subsidies,as an iilcentive to hire people, or to create COnlmuriity service jobs. The law also
includes the child support 'enforcement measures the President proposed two years ago -- the most
sweeping crackdown on' deadbeat parents in , history. And it preserves the national, guaran~eeof,
health care for poor children! ,.the disabled, pregnant women, the elderly, and people on welfare.
This Administration:has already given 43 states the flexibility to reward work, and created millions
of new jobs. Welfare rolls have already dropped by 1.6 million since 1992, and we, think that
continue. Finally, because of the EITC and the minimum wage increase won by this
progress
Administration, the typical welfare recipient will be better off working -- even 20 hours per week
- than she ,was on welfare. In,ColoradO,~fQrexample, a young mother with two children receives
only $8,000 a year in welfare and Food Stamps, and may never be' encouraged to 10Qk for work and
become independent. 'But with our. new strategy, she will ipcrease her income by more than 50
percent-- to $12,600 -- even ifshe Only works part-time atthe minimum wage. She'll still receive
health care for herself and her children. She'll still receive Food Stamps. She;ll get help collecting
'
, chiid support., ,And she'll get help with child care if she needs it.
will
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Q:
The President has acknowledged the diversity o(welfarerecipiehts. Are there pro,visions in the bill '
to take into consideration tlie special, circumstances women often face?
A:
Yes. The new law enables states to allow women with children under age six to work only 20 hours
per week,and exempts single parents with children under age six from the wqrk requirements and
penal ties if they' are unable to find ,child care. States can also exempt women with children under
age one for a total. of 12 months. ,In addition, the bill allows states to exempt 20 percent of welfare
recipients from the time limit.
'
Q:
How will the Administration ensure that women are aware of the exemptions they may be allowed,
such as in cases of battering ()r abuse? What must women do to prove that they fall into these'
categories?
A: '
The law provides several avenues through which women can be made aware of any exemptions for
which they may quaHfy. For example, states will provide this information in their state plan, which
will be a public document. States will have the option to establish procedures for the screening of
domestic violence situations, as well as for referral to appropriate counseling. States may also waive
other program requirements (such as time limits) in such cases. For all states, we anticipate that the
state plan will specify the exemptions which the state has elected. The Administration plans to issue
some guidance'to states on this subject.
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, The statUle requires that states set forth objective criteria for the delivery of benefits, determination
of eligibility, and for fair and equitable trel:1tment. As part of these criteria" it must explain the
administrative or appeals process which will be available to individuals adversely affected by 'state
agency decisions. Tbe Administration believes this provision is critical to ensuring that individuals
within each state receive the benefits and protections available' under the state program.,
�. Q:
Isn't it unfair that people with disabilities will be ~ffected so adversely by this legislation? Won't
the long-term impact be greater for ind~viduals who are forced into institutions as result of being cut
off from SSI?
'
A:
Under the new law, most legal immigrants will be ineligible for SSI until citizenship. The'
Administration opposes this provision, and the President has pledged to fIx this flaw in the bill. The
.Presid~nt has said that immigrant children and disabled immigrants who need help should get it. .
.
•
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. (The law narrows SSI's d~fmition of disability for children. However, over 95 percent of these
children who would lose SSI are expected to qualify for Medicaid, through the phase-in' of poverty
level children or other mechanisms).
Q:
How, will the children of mothers who are cut off from Food sUunps get fed?
A:
'If a mother were to hit the time limit; she and her'family would continue to ~eceive Food Stamp
benefits, and the Food Stamp benefits would slightly increase to. offset some of the loss in cash
assistance. And everyone in the family would. continue to receive Medicaid. Childr~n of mothers
cut-off from Food Stamps for failing to meet work requirements will continue to receive Food Stamp
benefits. In those rare, cases, the USDA will redetermine the families' eligibility excluding the
. '
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mothers' needs in calculating total benefits.
Q: .
How is the additional $4 billion for child care distributed? Who gets the/money?
A:
The new law increases child care funding by neariy $4 billion over 6 years, allowing more mothers
to leave welfare for work. States will receive an initial allotment each year from a fund of
approximately $1.2 billion. To access additional funds, states must maintain their own spending at
100 percent of their .FY 1994 or 1995 spending on child care (whichever is higher) .. Additional
funding will be available for state match at the. 1995 Medicaid rate.. By contrast, the bill the
President vetoed increased child care funding by just $300 million over current law, and did not
require states to meet child care maintenance of effort requirements to access additional federal child
care funding, allowing states to lower their own spending.
. .
Q:
How do the expanded child support enforcement measures work?
A:
The new law includes the child support ellforcement measures President Clinton proposed in 1994
:-- the most sweeping crackdown on non-paying parents in history . These measures could increase
child support collections by $24 billion and reduce federal welfare costs by $4 billion over 10 years.
Provisions include:
National new hire reporting system. The law establishes a Federal Case Registry and National
Directory of New Hires to track delinquent parents across state lines. Italso requires that employers
repon all new hires to state agenCies; which will then report to the National DirectOry of New Hires.
The law also expands and streamlines procedures for withholding child support from wages.
Streamlined paternity establishment. The' new law streamlines the legal process for paternity
establishment, making it easier arid faster to establish paternities', It also expands the voluntary in
hospital paternity establishment 'program, started by the Clinton Administration in 1993, Individuals
who fail to cooperate w!th paternity ,establishment will have their monthly cash assistance reduced
�1.,.
by at least 25 percent;
Uniform interstate child support laws. The new law provides Jor uniform rules, procedures, and'
fohns for interstate ,cases.
or
Computerized state-wide collections. The new law requires states to establish central registries
, child support orders and' centralized collection and disbursement units. It also requires expedited
state, procedures for ,child support enforcement.
Tough new penalties. Under the new law, states can implement tough child support enforcement
techniques: . The new law will expand wage garnishment,allow states to seize assets, and enable
states to revoke drivers and professional licenses for parents who owe delinquent child support.
"Families First." Under a new "Family First" policy, families no longer recdving assistance will
have priority in the distribution' of child support arrears. This new' policy will bring families who .'
have left welfare for work about $1 billion in support over the first 6 years.
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Access and visitation programs. In an effort to increase_noncustodial parents' involvement in their·
children's lives, the new law inclu'des grants to help states establish programs that support and.
facilitate noncustodial parents' visiration with and a.ccess to'their children.
Q:
.What are individual,development accounts? Are .they optional ot included in every state?
A: .'
The new law explicitly ,allows states to use block grant money for programs to fund individual
development accounts for recipients. These accounts would noi be counted as income in determining
benefits, and could be used by individuals to finance a' small or' micro':business, to pursue post
secondary education, or to purchase their first home. Twelve states have already. done something
similar under waivers we've granted ..
Q:' Why are you still granting waivers, to states? Is this. a way to undermine'the work requirement
provisions of the new law?
A:
Although most states will no longer need waivers to implement welfare reform under the new law,
HHS is continuing to grant waivers to states that have requested them. Some states with pending
waiver requ~sts asked HHS to either approve the entire waiver request or to extract provisions that
would apply under the fast track waiver approval process. A few states without waivers already
approved or p~nding have also submitted applications under the fast track approval process. The
Clinton Administration has already'approved 78 demonstrations for 43 states, and we~re continuing
our commitment to state flexibility.
.
This is not going to' und~rmine the work requirements in the new law. The welfare reform
legislation includes provision that would give states the option to continue their' welfare reform
demonstrations. Also under this provision, states would. not have to fol1ow the new legislative
mandates if those. features were inconsistent with the state's demonstration, which include defined
work activities, time limits, etc. HHS, a10ng with the states, is seeking to clarify the language ,of
the bill with respect t6 this provision. However, it is the departme'nt's understanding that all states
. would have to meet the work participation rates in the legislation.
a
�·Q:
How does the exemption from the time limit work? Is it 20 percent over a year or at anyone tiIne?
A: . The law states that the nu.niber~of exempt families for a fiscal year may not ex,ceed 20percent of the
average monthly caseload. HHS will issue further guidance on calculation· of this liInit in the future.
Ho~ever, it is important to note that the welfare bill vetoed by the President contained only a 15
percent exemption, and the Administration worked very hard to ensure that the welfare legislation
included adequate exemptions from.the time limit. We believe that the 20 petcent exemption in the
new law is adequate.
Q:
Do you have any estimates on how many states will make use o'f the domestic violence exemption?
Does this exemption apply to the work requirements as. well as to the time limit?
A:
We do not have estimates on how many states will make use ofthe time-limit exemption, which is
optional. We will have that information when the states submit their plans.
The law does not include a specific exemption from the work requirements. However, the bill does
allow states to waive program, requirementS for victims of domestic violence, and allows states to
exempt io percent of welfare recipients from the time limit. . States may also take this factor into
consideration in developing individual responsibility plans and in making decisions about how to
reach the participation rates specified in the bill.
'
Q:
Now that Medicaid will be separate from AFDC, how will the Medicaid eligibility be determined?
What will happen to the families who are no longer eligible for AFDC under the new system?
A:
President Clinton insisted that welfare reform not end guaranteed health care coverage for pregnant
women, poor children, the disabled, and the elderly -- and the new law preserves the Medicaid
guarantee. In general, individuals who would were eligible for Medicaid before welfare reform will .
still be eligible for Medicaid under the new law. In addition, families that lose cash assistance
eligibility due to the time limit will remain eligible for Medicaid. The new law also provides one
year of transitional Medicaid for families that leave welfare because of increased earnings, and
maintains the current law provision of four months of transitional Medicaid for families who leave
welfare due to increased child support.
States do have the option to end Medicaid coverage for some adults :..- except pregnant women -- who
lose their cash assistance eligibility because they failed to meet work requirements. ·(This is similar
, to current law, whIch denies Medicaid to adult recipients who refuse to cooperate with paternity
establishmen't). However, children will retain Medicaid eligibility even if their mother is deemed
ineligible..
.
Q:
In the past, SSI has been the gateway for certain individuals to receive' Medicaid and Food Stamps.
Will those deemed ineligible for SSIunde( the new legislation still be,eligible for Medicaid or Food
'Stamps?
'
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A:
For current legal immigrants, states have the option to eliminate Medicaid assistance along with SSI,
:but we don't expect states to do so. Immigrants who a,rrive in the future will be barred from
Medicaid for five years. ,The Pr~sidentopposes' these provisions, and will work to change them.
As the President said, "This, provision has nothing .to do with welfare reform; it is simply a
budget-Saving measure, and it is not right ... Iamconvinced when we send legislation to Congress
�to correct it, it will be corrected." In any case, immigrants will still' be eligible for emergency
medical assistance and other limited kinds of care, such as immunizations.
The law narrows ssrs defInition of disability for children. However, over 95 percent of these
children who would lose SSI are expected to qualify for Medicaid, through the phllse-in of poverty
level children orother.mechanisms. "
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Q:
How will this legislation impact legal immigrants and when?
,
A:
,
Under the new law, most legal immigrants will be ineligible forSSI and Food Stamps until
citizenship. Current recipients may ,lose eligibility for these programs iminediately at the time of
regular redetermination for eligibility. States, have the option to make most current legal immigrants
ineligible for Medicaid, AFDC, Title XX 'Social Services, and state-funded assistance .until
citizenship. Future immigrants will be ineligible for five years for most federal means-tested
'programs, including Medicaid, but these immigrants will be eligible ,for Head Start and the Job
Training Partnership A c t . '
,
All applicants for most federal, state, and local programs will be subject to new verification
requirements to determine if they are "qualified" or "non-qualified." Qualified immigrants will
include legal permanent residents, refugees, asylees, immigrants whose deportation has been
withheld, and immigrants who have been granted parole status by'the INS for a period of one year. '
Non-quaiified immigrants would be ineligible for benefits (except emergency medical, school
lunches/breakfasts if they are eligible for a free public education, short-term disaster, limited public
health assistance, non-profit, in-kind community services such as shelters ahd soup kitchens, and
certain housing benefits).
'
Future sponsors and immigrants would be required to sign flew, legally binding affidavits of support.
For these future immigrants, the new law extends deeming to citizenship, changes deeming to count
'100 percent of a sponsor's income and resources, and expands the number of programs ,that are
required to deem, includirig Medicaid.
The President opposes these provisions, and will work to change them. As the President said, "This
provision has nothing to do with welfare reform;h is simply a budget-saving measure, and it is not
right ... I am convinced when' we send legislation to Congress to correct it, it will be corrected. "
In any case, immigrants will still be eligible for emergency medical assistance and other limited kinds
of care, such as immuniZations.,
Q:
When will you propose legislation 'to reverse the discrimination against legal immigrants? What will '
that legislation look like?' Where will the, furiding come from to provide, assistance for these
individuals?
'
A:
The President has said that he will work to fix the Food Stamp and l~gal,immigrant problems in the
bill, and the Administration is working on legislative proposals to remedy these flaws, We do not
have a timeline yet for this process, but we'll work 'with Congress and the states to get it done. The
President has said that legal immigrants who .fail on hard times through no fault of their own and
need help should get it, although their sponsors should take additional,responsibility for them, The
Administration's proposals. will still save money over current law:
.
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�Q;
One hundred and twenty-three D~mOcratic members of Congress supported this package. Didthey
understarid the impact of the provisions affecting legal iuimigrants, and did they support these
provisions,or did they support the ,bill' in spite of those provisions?
A:
Democrats and Republicans voted .for this legislation because they know.that the current welfare
system is brokeiland must be fixed. Like the President, many members of Congress are concerned ,
about the provisions affecting legal immigrants,and they are supportive of the Administration's plan
to fix this flaw in the law. Let's remember that this bill is much better than what the President
vetoed. That legislation was soft on work and tough on children. It failed to provide adequate child
care and health care. It imposed deep,and unacceptable cuts in school lunches, child welfare, and'
help for disabled children. The bill came to President Clinton twice and he vetoed it twice. This
new legislation is much improved. Congress has removed many of the worst elements the President
objected to, and has included many of the improvements the President called for.
'
Q:
What specifically is the Administration planning to do to address 'the flaws 'in the legislation? And
'
when? What about the AFDC portion of the, legislation?
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A:
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The President has said that he will work to fix the' Food Stamp and legal immigrant problems in the
,bill, and the Administration is working on legislative proposals to remedy ,these flaws. We do not
have a timeline yet for this process, ,but we'll work with Congress and the states to getit done. In
terms of the AFDC provisions, states will be able to use their block grant funds, which initially
'provide most states with 'more resources than they currently receive, to move people' into jobs and
help employers create new positions for welfare recipients. Additional child care funding, new
resources from child support enforcement,and the guarantee of nutrition assistance, foster care and
adoption services, and health care coverage will work together to help families move from
dependence.to self-sufficiency, We will closely'monitor the states to be sure that they are rewarding
work and meeting the goals of the legislation. This new law gives states powerful performance
incentives to place people in jobs, We also kI).ow that 43 states are already promoting work and
protecting children under welfare waivers granted by the Clinton Administration.
Remember, the minimum wage and EITC improvements we've won for will make work pay. In
Colorado, for example, a young mother with two children receives only $8,000 a year in welfare and
Food Stamps, and may never be encouraged to look for work and become independent. But with '
, our new strategy, she will increase her income by more than 50 percent -- to $12,600 --even if she
only works part-time at the minimum wage. She'll still receive health care for herself and her
children. She'll still receive Food Stamps,' She'll get help collectirig child support." And she'll get
help with child care if she needs it.
"
Q:
When does the new welfare system take effect?
A:
The new law, goes into effect on July 1, 1997. States are required to submit plans by that date
detailing how they will meet the law's provisions, and these plans will be reviewed for completeness,
by HHS. Upon completion of their plans, states will ~e able to draw down block grant funds.
�will the resources
Q:
How will states address such needs" as transportation and job training? Where
come from?
'
A:
Most states will initially receive more funding under the cash assistance :b~ock grant than they
currently receive .:.- resources that will enable states to provide transportation, job training, and other
work-:related services to move people from welfare 'to work. And, as rolls continue to shrink, states
will also be able to use money now used for welfare checks to provide these work-related services,
community service jobs, or, income subsidies for employers to hire people.
Q:
What is the President's position on Senator Wellstone's resolutioricalling for a continued safety net
for battered women? This did not pass as part of the welfare refonnbill -- will the President work
, .to have it reintroduced as iegislation when C6ngr~ss comes back into session? '
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A:
The Administration has not yet decided what woul(j be included in a legislative package to improve
the welfare legislation Congress passed.
Q:
How will you protect teen mothers who are required to live at home but are at risk of being sexually,
physically, or emotionally abused in those settings?
'
,A:
The law requires teen parents to live at home or in an adult-supervised setting in order to receive
assistance: States will be required to locate alternative living arrangements for those teens who may
'
be at risk of abuse in their homes.
Q:
There is a two-year limit for women to find jobs,:"'::- where will these jobs come from?
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A:
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This bill gives states the ability to create jobs by taking money now u~ed for welfare checks and give
, it to employers as }ncome,sl:lbsidies,' aS',an incentive to hirepeople,orto' create community service
jobs. It ~lso builds on the reforms taking place in 43 states under waivers granted by the Clinton'
Administration. 'Some of these states are securing private sector jobs for welfare recipients by
providing wage subsidies and forging ,newprivate/public sector . partnerships. ,In other states,
employers are providirig:work place mentoring for paiticipants and contributing to special accounts
that recipients can later use to ivcrease their education and training:' The new law requires that adults
be engaged in work activities)\iithin two years, but allows states some flexIbility in defining those
'activities. Pri~ate sector jobs, yolunteer activities, and 'commuruty service Jobs all count as"work,
and welfare recipients initially have, to. work only 20 hours per week to meet the 'requirements.
.
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�Q:
'Some Democrats have said that this legislation is just the peginning of needed reforms to .the welfare
'system. Do you agree? What do you plan to do to build on this, 'and \\'hen?
.
,"
A:
This welfare legislation is a critical step in transforming our broken welfare system irito one that
requires work and promotes parental responsibility. The new law will make sweeping changes to
'. the welfare system -- through time limits, work requirements, child care resources, and the toughest
ever child' support enforcement. When combined with an increaseq. minimum wage and, the EITC,
we expect that it will make a fundamental difference in moving people from welfare to work. In
Colorado, for example, a young mother with two children now receives only $8,000 a year in
welfare' and Food Stamps, and she may never be encouraged to look for work and become
independent. But with our new strategy" she wilUncrease her income by more than 50 percent -
to $12,600 -- even if she only works part-time at the minimum wage. She'll still receive health care
for herself and her children .. She'll still receive Food Stamps. .She'll get help collecting child
support. ' And she'll get help. with child care if she needs it.
'
The President is also planning. to take other steps to increase the availability of jobs for welfare
recipients, .which he wiiI announce soon.
'
Q:
Did you speak with the people whQ will be affected most by these changes?
A:
The President and other 'members Of the Administration have met with welfare· recipients to discuss
their experiences an9 ways to best change the system. ThePresident also met with welfare, re~ipients '
at the Blair House meeting on welfare reform last year. ' As the President said in his 1995 State Of
the Union Address, "I may be the only President who, has had the opportunity to sit in a welfare
office, who's actually spent hours and hours talking to people on welfare. 'And I am telling you, the
people who are trapped on it know it doesn't work, ..
,
.
'
Q:
For those who have not'compleu.id high school, lack sufficient language skills ,and are functionally
illiterate, what kind of work can they expect to' get?
A:
The new law requires that adults be' engaged in work activities within two years, but allows states
some flexibility in defining those activities. Private sector jobs, volunteer activities, and community
service jobs all count 'as "work," and welfare reCipients initially have to work only 20 hours per
week to meet the requirements. 'We strongly believe that work is better than welfare. In Colorado,
for example, a young mother with two children now receives only $8,000 a year in welfare and Food
Stamps, and'may never,i:le encouraged to look-for work'and become independent. But with our new
strategy that includes the EITC and minllnum wag'e, increase won by this Administraticm, she will
, increase her income by more than 50 percent -'- to $12,600 -- ,even if she only works part-time at the
mininmm wage: She'll still receive health care for herself and her children. She'll still receive' Food
Stamps: She'llget helpcollecting child support. And she'll get help with child care ifshe needs
it.
Q:
A:
Will children of legal imrhigrants be denied sclloo) lunches under the n(,'!w law?
All. children, including those of legal immigrants, who are eligible for public school will continue
receive free school br,eakfasts and lunches under'the pew law.
to
�Q:
How does this reform affect public housing? ..
.
.
A:
This new law does not affect public housing -- .the Clinton Administration is maintammg our
investment in housing for poor families~ Poor families will also continue to receive Medicaid and
Food stamp benefits.
Q:
Who
A:
Most states will initially receive more funding under the cash assistance. block grant than they
currently receive -- resources that will enable states to provide transportation, job training, and other'
work-related services to move people from welfare to work. And, as rolls continue to shrink, states '
will also be able to use money now used for welfare checks to provide these work-related services,
community service jobs,- or income subsidies for employers to hire people.
Q:
The social services agencies that deal with child abuse and neglect, teen pregnancy , and juvenile
crime, are already overwhelmed. Will this ,legislation result iri an iricreased needfor'these services
,
'
without providing funding? .
' -~
A:
This legislation preserves the fo~ter care, adoption, child welfare,and family preservation programs
- the federal government and the states will continue to work to meet the needs of children and
families at risk. ,In addition, the legislation contains new funds forteen· pregnancy prevention and
abstinence programs; and it requires at least 25 percent of communities ,to have teen pregnancy
prevention programs ip place.
Q:
If corPorate Ameri~a has been laying off~mployees and downsizing, a!ld the job market is filled with,
skiJIed laborers, how will unskilled workers fit in?
.,
'.
.
A:
~il1
'
create and fund the needed job traiIiing programs?
"
'
,
.
.
"
Since taking office, the Clinton Administration has created 10 million new jobs and provided new
welfare rolls continue to
employment opportunities for workers of various skill levels. And,
shrink,states will 'be able to use money. now. used for welfare checks to provide work..,related
services, community service jobs, or income subsidies for employers to hire welfare recipients:
as
�For Internal Use Only
Work Will Pay More
Un~er
Welfare Refonn
People On Welfare Who Work Will Be Better Off'
Because of the ch~nges we've proposed in the :miniinum wage and the EITC, the typical welfare
recipient will be. better: off working ~-even 20 hours' per week -- than she wason welfare.
,
.
,
' .
.
..
'
.
"
.
.
.In Colorado, for example, a young mother with two children receives only $8000 a year in
welfare and Food Stamps, and may never be ,encouraged to look for. work and becom~
independent. But with our new strategy, she will increase' her income by more than 50 percent
- to $12,600 -- even ifshe only works part-time at the minimum wage. She'll still receive health
care for herself and her children .. She'll .still receive Food Stamps. She'll get help collecting .
child support. And she'll get help with child care if she needs .it.
People Who Move From Welfare To"Work Will B~Better Off
Because of the EITC and minimum wage increase: single parents who are already working will
, also be better off. A woman working 20 hours a week will'see her take-home. pay increase from
$10,000 to $12,600. And a woman working full-time will see her earnings increase from
$12;680 to $15,700 -- an increase of25percenL
�
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Carol Rasco - Issues Series
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Carol Rasco
Issues Series
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Welfare Reform [3]
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Carol Rasco
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Box 127
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
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2010-0198-Sb-welfare-reform-3
-
https://clinton.presidentiallibraries.us/files/original/c95c5eca2d4e73f4cbcb2ceae120d16b.pdf
fba2393cf74a4bc80c9a14b93d14adaa
PDF Text
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Clinton Presidential Records
.Digital Records Marker
This is not a presidential record. This is used as an administrative
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of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
�PHOTOCOPY
PRESERVATION
Re ort
Office of Child Support Enforcement
Vol. XVIII, No. 10, October 1996
Reform: For the Sake of the Children
David Gray Ross
W
en I was appointed operating head of the
Office of Child Support Enforcement (OCSE)
a little over two years ago, welfare reform
was an important issue. I was very excited about the
prospect of its passage, in part because child support
enforcement was a critical element in that proposed
legislation. It would mean new resources for us in the
child support community, enabling us to provide bet
ter support to our ultimate customers: children and
families in need. It would also mean new tools for our
partners in the states and localities, so that those who
refuse to accept responsibility for the children they
bring into this world would have less success in evad
ing those responsibilities.
.
On August 22, I was privileged to be present when
the President signed The Personal Responsibility and
Work Opportunity Reconciliation Act of 1996-wel
fare reform. With that action, new demands and new
responsibilities were placed on us, which, upon
reflection, are really new opportunities.
We must never forget that the support of children
is the essence of our work. The banner that I placed
over my office door my first week at OCSE is still
there: a banner that reminds me each day that I have
just one job and that is to put "Children First."
On signing the welfare reform bill into law, Presi
dent Clinton said: "There is no area where we need
more personal responsibility than child support." He
was referring to the responsibility of parents to meet
their obligations to their children, to pay their legally
and morally obligated support.
But his words apply as well to those of us who
work in the program. There is no job where a daily
personal and professional display of responsibility is
more needed: the kind of responsibility that says,
U.S. Department of
Health and Human Services
Adminislration for Children and Families
Office of Child Support Enforcement
"Whatever it takes to get the job done, whatever is
needed to put children first, that's what I'll do."
This bill is good for child support enforcement
there can be little doubt about that-and that's excit
ing to think about. We can be sure that in years to
come millions of children will live better lives and
have expanded opportunities because of this legisla
tion.
As child support enforcement professionals who
have labored hard to improve the program, you can
justifiably take pride in knowing that part of the credit
for this historic change belongs to you. Many of the
new enforcement tools derive from lessons learned in
the field.
On behalf of all us here in OCSE and, more impor
tantly, on behalf of our nation's children, whom you
have consistently and generously put first, let me say,
"Thank you."
This issue of CSR carries several articles about the
new legislation and how it will affect your work. After
you have read them, won't you take a moment to drop
us a line to let us know your views? We'd like to hear
from you .•
�·i
•
October 2, 1996
Dear:
The Omnibus Consolidated Appropriations Act, which the President signed
September 30, 1996, makes a significant change to implementation of the food stamp eligibility
provisions for noncitizens of Public Law 104-193, the Personal "Responsibility and Work
Opportunity Reconciliation Act (PRWORA) of 1996.
Under Public Law 104-193, all currently participating noncitizens were to have the new
provisio'ns for food stamps applied at the time of the household's next recertification. The
Omnibus Consolidated Appropriations Act delays these new eligibility, provisions (Section
402(a)(1) of Public Law 104-193) until April 1, 1997, for individuals who were receiving
benefits on August 22, 1996. The Act requires State agencies to redetermine the eligibility of all '
noncitizen recipients between April 1, 1997, and August 22, 1997.
'
This new provisio~ is retroactive to August 22, 1996. Thus, any immigrant who was
determined ineligible at recertification on or after August 22, 1996, as a result of the application
of P.L. 104-193 shall be reinstated to eligibility and any household containing a reinstated alien
is entitled to restored benefits for ,the period during which benefits were denied.
I also want to respond to questions about the 120-day "hold harmless" period provided for
quality control error measurement purposes under the Food Stamp Act which applies whenever
there are changes in program policy. such asthose enacted in- Public Law 104-193.
Since the Omnibus Consolidated Appropriations Act did not change the effective date of the
noncitizen eligibility provisions for new applicants, the State is entitled to the 120-day hold
harmless if it implemented on or before September 23. If it implemented after September 23, its
120-day hold harmless period would be reduced by one day for each day beyond September 23.
�2
Enclosed are· a copy of the relevant provision of the, appropriations act and a description of· '
how the quality control':hold hannless works. The FeS regional office staff will be able to
answer any questions specific to your State.
.
.,
Sincerely,
Bonny O'Neil
for
Enclosures
YvetteS. Jackson
Deputy Administrator
Food Stamp Program
�Sec. 510.
.
.
TRANSITION FOR ALIENS CURRENTLY RECEIVING BENEFITS
UNDER THE FOOD STAMP PROGRAM
Effective as if included in the ,enactment of the Personal Responsibility and Work
Opportunity Reconciliation Act of .1996; subclause (I) of section 402(A)(2)(d)(ii) (8 U:S.c.
.
,
1612(a)(2)(D)(ii)) is amended to read as follows:
I!(I) IN GENERAL.--With respect to the specified Federal program described in
paragraph (3 )(B), ineligibilitY under paragraph (1) shan not apply until April 1, 1997,
to an alien who received benefits under such program on the date of e'n'actment of this
Act, unless s'uch alien is determined to be ineligible to receive such benefits under the '.
Food Stamp Act of 1977. The State agency shall recertify the eligibility of all such
aliens during the period beginning April 1, 1997, and ending August ~2, 1997.".
�o
120-DAY QC VARIANCE EXCLUSION PERIOD
Attached is a one-page chart depicting the 120-day "hold harml'ess" period
that is provided for QC under the Food Stamp Act.
• The top line shows the time frame if a State implements' timely and gets
the full 120 days.
• The middle fine shows that if a State implemented earlier, the 120 days
would begin when it actually implemented.
• The bottom line shows .that if a State is late in implementing, ,it loses
part of. the ,120 days.
• In summary, if a State ,implements these PRWORA provisions, which
are effective upon enactment on or before September 23, it would be'
, "held harmless" for any errors reSUlting from thoSe provisions for any
cases certified .or recertified during a 120 day period following
implementation. The '~hold harmless" would endfor a case'once it is
certified or recertified outside of the 120 day period.
• Several of the provisions of the PRWORA, including the updating of
the Thrifty Food Plan (to be implemented October 1,\ 1996) and the
adjustment to the cap for the Excess Shelter Deduction (to be ,
, implemented,January 1, 1997) are mass changes. There is no 120 day
variance exclusion period for provisions which must be implemented as '
.
mass changes.
,
,
This provision went into'effect in 1990.·
�/.JI'
120 nAy QC VARIANCE EXCLUSION PERIOD
(Example For Provision Effective Upon Enactment)
8122196
9123/96
IMPLEMENTATION AT 30 DAYS
9/12196
rl--~~----------------~------~------------------------------'
120 Day Variance Exclusion Period- Sept. 12 through Jan. 9
IMPLEMENTATION PRIOR TO 30 DAYS
10/15/96
I
I
.
99 D.y v.,;••"
<,"",... P,dod. 0<1. ISlh,,".h J••. 21
IMPLEMENTATION AFTER 30 DAYS
II
c
�October 1996
WELFARE REFORM IMPLEMENTATION_
SUNDAY
TUESDAY
MONDAY
WEDNESDAY
I
2
Senate Judiciary
Subcommittee on
Immigration
(Simpson) will hold
a hearing on the
implementation of
immigration and
'naturalization laws
10 a.m. Dirksen
Rm.226
,
-
SATURJ)AY
FRIDAY
THURSDAY
4
3
,Coalition on Human
Needs and other
Human Services
Groups Briefing pn
5
Welfare Reform
IffiS/ACF •• John
Monahan. Ann
Rosewater, Olivia
Golden remarks
(Washington, DC)
University of San
Francisco Family
Support Council.
Presidential Forum
, on "The State of
Welfare versus the
Welfare State"
"
,
.
.
Sharon M. Fujii, ACF
Regional
Administrator
remarks
..
'
USDA/FCS
Midwest Region
Welfare Reform
Meeting, (Oct. 3·4)
Chicago,IL
,
7
6
National Assoc. of
Exec. Com'!1ittee
ofthe Nat. Assoc.
State Medicaid
Directors Annual
of State Medicaid
Conference
Directors,
HHS/HCFA,
(Oct. 7·9)
and various
intergovernmnt'I
National League of
groups meet to
Cities Conference
discuss
on "Achieving
implementation of World Class Local
Welfare Reform
Economics." There
and Kennedy
will be discussion on
Kassebaum Bill
issues related to
local economic
growth and job
creation.
Columbus, OH
(Oct 7-10)
8
~'
..
..
II
I
~~
~.~.
0nJ.
The Smith Center
for Private
Enterprise Studies.
California State '
Univ., Hayward,
features Eloise
Anderson, CA
Directorof Social
Services, speaking
on Effective Welfare
Reform, 2:45 p.m .
;
10
9
National
Association of
Counties (NACO)
. Teleconference on
welfare reform .
implementation
(Washington. DC)
,
13
14
1.5
16
17
18
Nafl Assoc. of State
Budget Officers
Fall Meeting
(October 19.20)
Washington, DC
19
20
21
22
23
Women Work,
The Nat'l Network
for Women
Employment
24
25
26
'.
Coalition on Women'
and Job Training I
Meeting
i
..
�~
. UPCOMING EVENTS:
••
•
Nov. 7 -- Casey Foundation & APWA Impact ofWelfare Reform on Recipients (Washington, DC)
. Nov. 10 -- Council of State Governments Southern Legislative Can! (SLC) Fall Committee Mtg. (White
Sulphur, NM)
.
•
Nov. 16-19 -- Council of State Governments Western Governors' Annual Meeting (Santa Fe, NM)
•
Nov. 19-20 -- National Governors' Assoc. (NGA) Workfirst on "It's Not Just About Welfare" (Cleveland, OR).
•
Dec. 6-10 -- Council of State Governments Annual Meeting and State Leadership Forum (Cleveland, OR)
•
Dec.7-10
•
Dec 7-11 - APWA Winter Meeting (Washington, DC)
•
Dec 10-12--National Association for State Community Servic:es
Nat'l League of Cities Annual Meeting (San Antonio, TX)
�...
. 10/2 / 96 4: 3 0 PM
. DRAFT
TANF.· STATE PLANS TRACKING
SUBMISSION AND COMPLETED DATES
STATE
DATE
RECEIVED
DATE OF
LETTER
CONFIRMING..
C9MPLET;ElfESS
WISCONSIN
8/22/96
9/30/96
MICHIGAN
8/26/96
9/30/96·
OHIO
9/19/96
VERMONT
·9/20/96
.FLORIDA
. 9/20/96
MASSACHUSETTS
9/23/96
MARYLAND
9/27/96
OREGON
9/27/96
OKLAHOMA
9/30/96
TENNESSEE
·9/30/96
MAINE
9/30/96
,,'
.
KANSAS
9/30/96
KENTUCKY
9/30/96
MISSISSIPPI
r10/1;1'96
ALABAMA
10/1/96
UTAH
9/30/96
CONNECTICUT
10/1/96
NEW HAMPSHIRE
10/1/~6.
TEXAS.
..
10/1/96
INDIANA
10/1/96
NEBRASKA
10/2./96
MISSOURI
10/i/96
LotiI SIANA .
10/1/96
1·
�THE PRESIDENT HAS SEEN
'o·::l1·9~
THE WHITE HOUSE
WASH INGTON
..
.95 OCT £2 'Po: tl8
October 22, 1996
MEMORANDUM FOR TIlE PRESIDENT
~
FROM:
Carol H.
SUBJECT:
Waiver Status .Report
You had asked for a report on the number of waivers approved by this Administration in four
. categories. Attached is a chart that lays out this information.
'
In sum, we have approved:,
o
o
o
o
79 welfare waivers in 43 states
43 food stamp waivers in 35 states
13 state-wide Medicaid waivers in 13 states
2 child welfare waivers in 2 states
Not all of these waivers have been implemented by the states; some plans put forth by
Governors and approved by HHS are still awaiting state legislative approval.
Welfare: As you know, the intersection between the welfare waivers and the new welfare
reform law is complex. The law includes a grandfather clause for waivers granted befor~ the
law was signed, allowing states to continue to operate waiver programs with time limits and
work'r,equirements that vary from the terms of the new law. HHS has told the states,
however, .that the Administration believes that all state programs should comply with the law's
provisions on time limits and work partiCipation rates. HHS also told states that, .if they do
not follow the new law, Congress will almost certainly act to limit the grandfathering
provision, and we would support this action.
Food Stamps: Almost all food stamp waivers are part of a larger welfare reform waiver
package (although not all welfare waivers affect food stamps).
Medicaid: Included in the Medicaid category are only major state-wide reform
demonstrations. In addition to these, HCFA has granted hundreds of other, more minor
waivers, waiver renewals, and waiver modifications. These inClude "freedom of choice"
waivers, which .let states experiment with managed care; "home and community based
services" waivers, which let states serve people with disabilities in communities instead of
institutions; and research waivers that cover only part' of a state or are not comprehensive in
. nature.
'--_....... -..-.--.---..._-
'-'~"""'--'-'-.-'."
.-...
--~
.
�-2
Child Welfare: Child welfare waivers were first authorized by Congress at the end of 1994.
Congress created a new special waiver authority (section 1130) for HHS to allow up to 10
states to conduct cost-neutral demonstrations, with waivers of IV-B and IV-E allowed.
After 'HHS issued guidelines, 14 states applied. Minnesota since· dropped out.' .States that
have applied are: Oregon, Delaware, D.C., North Carolina, Georgia, Ohio, New york,
Indiana, Illinois, California, Michigan, West Virginia, and Maryland. HHS required all
applicants to produce a cost-neutral plan.
Delaware and Illinois have been approved~ Three more -- Ohio, North Carolina, and Oregon
-- may be approved in the ,coming weeks. As part of our review of the overall child welfare
system, we are working with HHS on how the remaining waivers can best be utilized for
testing various ideas.
cc: Leon Panetta
�STAlE
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
D.C.
Florida
Georgia
waH
Idaho
Illinois
Indiana
Iowa
Kansas
Kentuckv
Louisiana
Maine
Marvland
Massachusetts
Michil!an
Minnesota
Mississiooi
Missouri
Montana
Nebraska
Nevada
New Hamoshire
New Jersev .
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Orel!on
Pennsvlvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virl!inia
Washinl!ton ..
West Virl!inia
Wisconsin
Wvominl!
Total
WAIVER STATUS CHART
Welfare
Food Stamos
Medicaid
1
imminent
1
1
6
1
Child Welfare
1
1
1
1
I
2
1
I
3
2
2
1
I
1
4
1
2
2
1
I
1
1
1
I
1
1
1
1
1
1
1
1
2
2
1
2
4
3
I
1
1
1
1
1
1
1
I
1
1
1
2
2
3
2
2
1
1
2
1··
1
1
1
3
1
1
1
1
1
1
2
2
1
1
1
2
2
1
2
1
1
1
1
1
3
1
1
3
2
79 (43 states) .
2
43 (35
state~
13
2
�10128/96
17:39
litJOOi 1010
I
! ,
I,
t~
1
Social Security Administration Letter Sent to State Hu,man Services Directors,
October 24, 1996 Describing New EligibilityRequirem~:nts and Timefratfles for Non-citizens
.
Dear Human Services DireCto,:
'
I
I
!
On August 22, 1996, the Personal Responsibility and Work Opportunity Reconciliation Act
of 1996 was signed. This law contains several provisions affeCting the payment 6f
'
Supplemental Security Income (5S!) benefits to noncitizens. The Administration is
committed to working to ensure the new law is implemented in a manner that fully protects
the rights of those affected.
" ",
:
,
These provisions affect noncitizens who are curreritly r,~ceiving SST benefits, as well as
noncitizens who may apply for benefits in the future. 'We want to inform you of our plans
for implementing the major provisions of the law so your State is equipped to provide help to
~~osewho may have questions or concerns.
,i,
l;:.-
•
t
The new law prohibits payment Of SSI to many, but not all; noncitizens'. '
The law is effective upon enaCtment for noncitizens applying for 55! benefits after August 22,
1996. For those currently receiving SST benefits, their benefits will continue until we have
reviewed their case, which will occur next Spring and',Summer. Only the following
noncitizens remain eligible for 551:
''
'
.:ii
Refugees, asylees and noncitizens whose deportation has heen withheld (subject
to 5-year eligibility limit).
'1
;~~i
Certain active duty Armed Forces per~pnnel and honor~bly discHarged
veterans. Their spouses/children also rhay qualify.
!
'..
LaWfully admitted aliens who have 40. qualifying work quarters (quarters
earned by spouse/parents m..1.y also colint).
.
,Y
1:
Weare asking for your help in informing your const~tuents who are irhmigrants about the
new law. In particular, to avoid alarming SSI beneficiaries that their benefits will terminate
immediately under the new law, we are asking for ypur help in making sure that noncitizens
currently receivIng 55! understand that their benefits will not be stoPRed until the fol1owi'ng
.' .
..
!
steps have been followed:·
I
•
.
. .
They receive a notice (sometime in: Februari,~or March 1997) f~om the Social Security
Administration (SSA) telling them we ,will b€ reviewing their citizenship or
immigration status and they have 90. days to (~espond.
.
f
�10/28/96
17:40
,::~
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!
il!
[f1] 008/010
i'
i~'
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After the 90-day-period, if they are not in one o(~he eligibility cat~gories! they will
receive another letter from SSA telling them when their benefits will be stopped. This
letter will explain how they can appeal the decision and. how they I'can have their
benefits continued during their appeal.
:
A general informational fact sheet describing how the. ' affects noncitizens is enclosed.
new law
,
,
;
Sin~~rely, .
. 1
./
Car~lyn W. Colvin
Deputy Commissioner
f6r Programs and Policy
I,'
i
I
,
Enclosure
t.'
�10/28/96
17:40
l4J 009/010·
,.
Social Security Administration Letter Sent to Advocacy:Groups, October; 24, 1996 Describing
New Eligibility Requirements and Timeframes for Non-ci~izens
·1
Dear Colleague:
On August 22, 1996, the Personal Responsibility and Work Opportunity. Reconciliation Act
of 1996 was signed. This law contains several provisions affecting the payment of
Supplemental Security Income (S5!) benefits to noncitizens. The Admin;stration is
committed to working to ensure the new law is imple~ented in a manne,r that fuiIy protects
the rights of those affected.
:.
'
These provisions affect noncitizens who are currently n~ceiving SSI benefi~s, as well as .
noncitizens who may apply for benefits in the future. :,We want to inform you of our plans
for implementing the major provisions of the law so y~u are equipped t9 provide help to any
legal immigrants with whom your groups works.
The new law prohibits payment of SS! to many noncitizens. The law is ~ffectiveupon
enactment for noncitizens applying for SSI benefits af1;er August 22, 1996. For those~c:urrendy
,receiving SS! benefits, their benefits will continue until' we have reviewed their case, ';"'hich
. will occur neXt Spring and Summer. Only the followj.ng noncitizens remain eligible for SS!:
',!
'
.
Refugees, asylees and noncitizens whos'e deportation has been withheld (subject
to 5-year eligibility limit) .
. Certain active duty Armed Forces perl§nnel ~nd honorably discharged
veterans. Their spouses/children also ~rnay qualify.
\ ~. ~
Lawfully admitted aliens who have 40 ,qualifying work quarters (quarters'
earned by spouselparents may also count).
. H
' .
~
,
,
I
.
It would be help~l if you would inform your constit:~entswho are immigrantS"'aoout the
. new law. In part'ieular, to avoid alarming 55! beneficiaries that their benefits will terminate
immediately under the new law, you can assist us in:informing noncitizens currently receiving
SST that:their benefits will not be stopped until thef<;>l1owing steps have been followed:
,I'
•
•
,
They receive a notice (sometime in February or March 1997) from the Social Security
Administration (SSA) telling them we will be;reviewingtheir citizenship or
. immigration status and they have 90 days to;'~espond.,
.
After the 90-day-period, if they are not in on~ of the eligibility categories, they will
receive another letter from SSA telling the1l],when their benefits will be stopped. This
letter will explain how they can appeal the ct~cision and how they can have their
benefits continued during their appeal.
:/:,;
' " " .',:';,
,
\
�17:40
@010/010
.
"
, ''''.1,.
A general informational fact sheet describing how the nJ;' law:'affects
.
.~.
non.~itizens is en~Yosed.
SincJ~ely,
j
:' ;:{
Joa~~\vainwright
,
Dep~ty Commissioner
for: Communications
k:
'
.
I
Enclosure
·'11,'
..
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.,'
'.')
, "'!
.!
,I
�10/28/96
17:38
!41 001/010
MEMO TO WELFARE IMPLEMENTATION SUBGRQUP
l !\
f
W'
FROM:
SU~JEct:
Jeremy Ben....Ami
Diana Fortuna .
Domestic Policy Council
'HJ
If
~\
t~
t;
At~ached, !--etter for Distribution
I"
.!
:.'~ ",,~, !,:,
Attached please find a letter from the Social Security Admi~listratioll that ha~ b~el1 widely circulated
to provide infonnation to advocacy organizations and state: governments abopt the welfare law's
impact on legal immigrants' receipt of SS!. "Please distribute this'letter as widely as appropriate both
within your agency and to interested organizations to ensure that the correct; information regarding
the impact of welfare reform is as widely shared as possible.
I
~',!
'j
~-;
.
'f
'l' •
Please call Dorothy Craft at (202) 456-5571) if you exper,fcllce any problems in receivillg this fax.
Thank you.
.
.'.
. ' ':);
.'
.!,'
:W
DISTRIBUTION LIST ill! Page Fax):
Louise Sheiner, Treas.
ph:' 622-0563 .
,.
fax: 622-2633
Glen Rosselli, Treas.
ph: 622-0090
fax: 622-2633
~.
,.
VI ~ •
Mike Compsol,l, Treas.
ph: 622-2351.·
fax: 622-1294
Randy Moss, Justice
ph: 514-3745
...
fax: 514-0539
Kevin R. Jones, Justice
.
ph: 514-4604
·1
fax: 514-9112
.'
Robert Bach, INS
ph: 514-:--3242 or 616.:..7767
fax: 305-0134
'.
,
.
rlbgov@aoLcom
·tt
it;
{,':'
~!
Carolyn Colvin, SSA
ph: 410-965~4512
fax: 410-965-9063··
carolynw . col vin@ssa.gov
K~f
t:
,.
~~
...
f",;:
'. ,
v "
�10/28196
. 17:39
."
bany .eigen@ssa,gov
Barry Eigen, SSA
ph: 410-965-2528
fax: 410-966-3372
Diane Blackman', SSA
ph: 410-965-3571
fax: 410-965-8582
brian.coyne@ssa.gov .
Brian Coyne, SSA
ph: 482-1128 '
fax: 482-7105
'.'.
i
Judy Chesser, SSA
ph: 482-7148
fax: 482-7153
.
judy.chesser@ssa.gov··
"
Joan Lombardi, HIiS'
ph: 401-6947
fax: 690-5600
Ann Rosewater, HHS
ph: 690-7409'
fax: 690-6562
..
,
i
~,
1;
i' ,
1
,
141002/010
�10/28/96
17:39
14I 003/010
Jeff Merkowitz~ FIBS
ph: 690-7858 :
fax: 690...7383 ;
jmcrkow@osaspe.dhhs:gov
Ann Segal, HHS
ph: 690-8410 .
fax: 690-6562 .;
asegal@osaspe.dhhs.gbv
John Monahan, HBS
ph: 690-6060
.
fax: 690-5672
jmonahan@os.dhbs.gov
I
;
I
Judy Moore, HHS (HCFA)
ph: 410-786':'3230
. fax: 410~786-0025
Dennis Hayashi, HBS
ph: 619-0403
fax: 619-3437
jmoore@hcfa.gov@inct
dhayashi@os.dhhs.gov
t r',
Mary Boilrdette, HBS
ph: 690-6311
fax: 690-8425
(?
Helen Mathis, HHS
ph: 690-7627
fax: 690-7380
Dan Williams, HHS
ph: 401-6614
fax: 690-6562
.
'~
.
'.
,
Cheryl Tates-Macias, USDA
ph: 202-720,,:,7095
fax: 202-720-8077
Yvette Jackson, FNS
ph:
703~305-2026
•
.i
Yvettejackson@FCS.USDAGOV '
fax: 703-305-2454
Steven Carlson, FNS
ph: 703-305-2133 .
fax: 703-305..,..2576
Stacy Dean, FNS
ph: 395-4686
fax: 395-0851
Stacy.Dean@FCS.USDA~GOV
I
•
�10128/96
17:39
I4J 004/010
Bonnie O'Neil, FNS
ph: 703-305-2022
fax: 703-305-24?4
Bonny_ONeil@FCS.USDA.GOV
,
I
Arthur Foley, FNS
ph: 703-305-2490
fax: ,703-305-2486 ,"
Jon Weintraub, DOE
ph: 205-5602
jon.....weintraub@ed.gov
,
. i
.
fax: 260-9183
Jessica Levin, DOE
ph: 401-3389
fax: 401 ~4353 .
t
jessica_levin@cd.gov: .
t.:
,
,
,.
Gerri Ratliff, DOJ
ph: 514-3392
fax: 514-9077
·i~
i .
i .
. i
David Ogden, DOJ
ph: 514-6909
fax: 514-9368
I
Mark W. Morin, DOL
ph: 219-8065
fax: 219-6896
Paul Leonard, HUD'
ph: 708-3896 ext. 240
fax: 708-0309 .
. Peggy Lewis, FLOTUS .
ph: 456-6266
fax: 456-6244
Emily Bromberg,
Intergovernmental Affairs
ph: 456-2896
fax: 456-6220
. J
.!
,
LEWIS_P@A1.cop.gov
. BROMBERG_E@A1.eop.gov
Debbie Fine, Polito Affrs.
ph: 456-5572
fax: 456-7929 or 6-7163
Elena Kagan, Gen. •Counsel
ph: 456-7900
fax: 456-1647
I
J
�J.Ulll:l/96
11:39
~ 005/010
Anne McGuire, Cbilt. Affes.
ph: 4,56-2572
fax: 456-6704
MCGUlRE_A@Al.eop.gov
.,.,
,
,
,
·Barry White, OMB
; .
WHlTE_B@Al.cop.gov
ph: 395-4532
fax: 395-7752
GREEN_R@Al.eop.gQv·
Richard Green, OMB
I;
ph: 395-7398 .
fax: 395-0851
"
,.
Keith Fontenot, OMB
FONTENOT_K@Al.eop.gov
ph: 395-4686
fax; '395-0851
I
,
I
i
I,'
.J
I
Jeff Farkas, OMB
ph: 395....4686
fax: 395-0851
FARKASj@Al.cop.gov
Matthew McKearn, OMB
MCKEARN_M@A1.eop.gov
.
ph: 395-4686
.
fax: 395-0851
~ \~
,
.Cindy Smitb, OMB
SMITH_CM@A1.eo'p.gov
ph: 395--4686
fax: 395-0851
""
Wendy Taylor, OMB
ph: 395-7316
fax: 395-6974
TAYLOR_W@A1.eop.gov
Dan Cbenok, OMB
CHENOCK_D@Al.eop.gov
,
ph: 395-7316
fax: 395-6974
Laura Oliven, OMB
"
,
','
OLIVEN_L@Al.eop.gov ,
ph: 395-7316
fax: 395-6974
Debra Bond,
OMB~'
BOND_D@ALcop.gov
I;,
ph: 395-7316
fax: 395-6974
Steven M. Mertens
ph: 395-4935
fax: 395-0850
,!
. t
I'
,
�lO/2~<96
17:39
~_
@006/010
MYERS_B@Al.eop.go.v
Betsy Myers
Women's Office
ph: 456-7300
fax: 456-7311
!
i
I
i
I
Mark E. Miller, OMB
ph: 395-4930
fax: 395-3910
Jac~ Smalligan~
I
I,
OMa
, !
ph: 395-7759 '
fax: 395-4875
Paul Dimond, NEe
ph: 456-2800
fax: 456-2223
Jennifer Klein
fax: 456-2878
Nicole Rabner
fax: 456-6244
,
:,'
Beverly Godwin, NPR
ph: 632-0150
fax: 632-0390
.\
Molly Brostrom
ph: 456-2216
fax: 456-7028
,
.,
i
�September 30, 1996·
Welfare Refonn Act - Issue Paper
Application ofthe 20% Cap on Vocational Education and Teen
Heads.of Household
Issue.;. How should States apply the_20 percent cap on vocational education training and eligible
teen heads of households for purposes of calculating a State's minimum rate of participation in
work activities?
Discussion~ Section 103 of the Act replaces Part A (Aid to Families with Depe~dent Children)
of title IV of the Social Security Act (SSA) with the Block Grants for Temporary Assistance for
Nee~y Families (TANF) program. T ANF requires that States establish mandatory work
..
requirements for reCipients of assistance.
Under new section 407(a) oftl!e SSA,States are required to achieve a minimum rate of
participation in work activities .of 25 Percent'in 1997, increasing to 50 percent in 2002, for all
families, and 75 percept in 1997, increasing to 90 percent in 1999, for 2-parent families "Work
activities" is defined, under s~ction 407(d), to include the following educational a<?tivities: (1)
vocational educational training (not to exceed 12 months); (2) job skills training directly related
to employment; (3) education directly related to employment for those who have not received a
high school diploma or its equivalent; and (4) satisfactory atten~ce at secondarY school or a
course of stl:ldy leading to a general equivalency certificate for those who have not completed
. secondary school or ~eceived stich a certificate. Thus, recipients of assistance under TANF .
.participating in one of these educational activities are also engaged in a work activity and,
therefore, counttoward fulfilling the State's work participation requirement. .
,
Section 407(c)(2)(D), however, limits the credit given these educational activities. That
section provides that for purposes of determining morithly participation rates: "not more than 20
percent of individuals in.all families and in 2-parent families may be determined to be engaged in
work inthe State for a month by reason of participation in vocational educational training or
deemed to be engaged in work by reason of [being a single head of a household under 20 years of
age and maintaining satisfactory attendance at a secondary school or its equivalent or
participating in education directly related to employment for the requisite number of hours]."
Section 407(c)(2)(D) is not explained in the conference report; nor is it mentioned in
House and Senate reports· of the bill. While the section ch;~arly limits a State to counting only a
certain number of recipients in vocational training and eligible teen heads of households as
working; it is unclear, 01) its face, how many such individuals the States can count as working.
The language "individuals in all families and in 2-parent families" in the section could refer
dther to: (1) all individuals receiving assistance under TANF; or (2) all individuals required,
under the minimum participation rate schedule~, to participate.in wor~activities under TANF.
Under the first reference, 20 percent of all recipients could be enrolled in vocational education
training or be an eligible teen head of household and enrolled in secondary school or its
�equivalent, and count for the State as working. Under the second reference, only about 5 percen~
of such individuals could count as working ..
OPTION 1. Encourage HHS to pennit States to count more individuals in education as work
participants (Le., by interpreting section 407(c)(2)(D) as applying the 20% limitation against the
encourage States to do so.
State's total TANFcaseload base)
and
Pros: (l)Would encourage. education (especially for teen p~ents) by making
education a more broadly available meartsof satisfying the work requirement,
Jhereby:
.
,- creating an im;entive for State~ to appropriate more'funds for
vocational and other education programs;
;; encouraging recipients of assisttmce under TANF to p~r~ue and
continue their education (e.g., New York indicates that.about 20%
of its AFDC base are teen parents); and
.
-enhancing opportunities to ~cquire enough education to gain
higher-paying, higher-skilllev~l jobs.
(2) It is a legally ~upportable interpretati~n.
.
'~
(3) If States define "vocational ed~cation training" broadly, adult education, ESL,
and family literacy options under TANF could also increase (see the Adult
EdlEven Start: Adult Work Require~ents issue paper).
,
'
Cons:' (1) Counter to the overail approach of the bill (as reported by some
congressional staff) that States should take a bottom-line approach and move
recipients to jobs as quickly as possible. ' .
(2) Might strain the.vocational education system,'especially ifno additional
appropriations were forthcoming ...
(3) High enrollments of disadvantaged students might make it difficult for
vocational programs to achieve the goal of educating vocational education
students to challenging academic and technical skill standards..
OPTION 2: Leave interpretation to the. States without Federal guidance (which would make'
more likely an interpretation ofsection 407(c)(2)(D) that would counrfewer individuals in
education as work participants).
Pros: This is'clearly consistent witli the philosophy oftJ"te Act. (Note: Section
,2
.
�417 prohibits the Federal government from regulating "the conduct of Stat~s .
under this parL.except to. the extent expressly provided'! in the Part.)
Cons: (1) May limit educational options of recipients and force some who are
.participants in current vocational and adult education and literacy progr~s to
drop out of those prograins as work and family responsibilities increase.
(2) May result in a confusing array of State policies ..
. (3) It would make it very difficult to demonstrate the national impact of
vocational educatiQn investments.
.
Recommendation: Sllpport Option 1. Numerous reports document: (1) the educational
. disadvantages faced by low-income families (e.g., those now receiving assistance under AFDC
and about to receive assistance under TANF); and (7) the. n~cessity of education in securing .
meaningful employment (especially higher-paying, higher-skill level jobs). To require work-for
assistance without also facilitating educationai opportunities to gain, and advance in, such work
.'Yill discourage our m?stvulnerable citizens from choosing and continuing their education.
"
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�, September 27, 1996
Welfare Reform Act - Issue Paper
Adult Education: Adult Work Requirements
Issue: Mayan adult's participation in an adult secondary education program. presented in a
vocational education ,context (either under the Adult Education Act or the adult education portion
of a family literacy program such as Even'Start) qualify as a "work activity"?
Law: Section 407( d) defines work activities to include "vocational educational training (not
'to exceed 12 months)." This is the major "work activity" for adults (persons other than
single teen parents under age 20) thatcouid include an adult education program (and only
, to the extent the program.is presented in a vocational education context).
Policy: The following national positions 'should be taken to maximize participation of the
nation's low-income adults who,lack a secondaiy-Ievel education in educational programs:
o
A broad interpretatio~ of 'ivocational educational training" (see,related issue paper) that'
includes adult secondary education programs to the extent those programs ().I'e presented
in a vocational coritext ,Under the Adult Education Act (and the adult education portion of
the Even Start.family literacy program).
'
o
Clarification to States that adult secondary education programs under the Adult Education
Act may be'presented in a vocational education context as appropriate (and under Even
Start so long as the focusremainsliteracy);
,
Pro: Provides maximum incentive for low-income adults who lack a secondary-level
education to continue their education~ (Because an adult secondary/voc program may not
be available for the minimum number of work hours required (20 hrs/wk for a single
parent), an adult may still have to combine this educatiomil activity with another work
activity.) Problems evenwith this interpretation: n~ither adult basic education (ABE) ,
nor ESt training qualifies as a "work activity," so even,this broad interpretation will
result in an increasing class of persons with such low-literacy and limited job skills that
they will not qualify for vocational-education programs (e.g., a community college AA
program).
Con: 'Emphasis on voc ed CQuid shift Adult Education funds away from OED to adult
,secondary education (ASE) programs with a vocational focus for welfare populations,
and shift Even Start funds away from ABElESL to ASE with a vocational education
focus.
'
4
�•
'I
Action:
•
Encourage'HHS to interpret "vocational educational training" broadly to include' adult
secondary education programs ~hen presented in a vocational 'education context under
the AdultEducationAct (and the adult education portion of the Even St~ family literacy
program).
'
. ,
•
Notify States that adult seconp.ary education programs under the Adult Education Act
may be presented inavoc~tional education context (and under the.Even Start family
literacy program 'so long as the.f~cus remains literacy).
•
Propose including language in an amendments package to expand major work activities
for adults to inClude adult. basic education; ESL, and adult secondary education programs
that meet for a minimum number of hours per week. (A similar amendment was
proposed in the Senate (Simon) but was rej~cted in conference.) .
.
.
,
,
5
.,
�September 27, 1996, .
Welfare Reform ACt - Issue Paper
Adult Education: Secondary School !'Equivalent"
Issue: Do adult secondary education programs (either under the Adult Education Act or.the
adult education portion of a family literacy program such as Even Start) qu~lify as a "work
activity" for a single parent,under age 20 (teen parent) who i~ not pursuing a GEDprogram?
Law: . Section 407(c)(2)(C) allows a single parent under age 20to meet the work participation
requirements if that teen satisfactorily attends. secondary school or the "equivalent."
Section 407(d)(1l) (generally applicable only to these teen parents) defines "work
activities" as attendance at a secondary school or "in a course of study leading to
certificate of general equivalence" (GED) .. Section 408 requires .unmarried parents less
than age 18 to attend high school or its."equivalent" (or an alternative program approved
.'
.
.
by the State).
a
Policy: Taking a national position that adult secondary education programs under the Adult
Education Act (and the Even Start family literacy law) are the Itequivalentlt of secondary school
would encourage teen parents to participate in these programs even if the student is not working
toward a GED. This serves the goal of keeping 'teens involved in secondary education programs
as long as possible, even if less participation hours are required than for secondary school or
GED classes. States'otherwise may interpret the work activity provisions to exclude secondary
,level programs that are not secondary school or GED classes. (Adult basic education (ABE) and
ESL training do not currently appear to qualify in any event asa "work activity.")
Pro: Would encourage maximum teen parent participation in adult secondary education
programs, even if a teen is not attending secondary school or GED classes. Could be
considered consistent with the spirit of the legislation. Congress desired to exempt from
work requirements, to a degree, students in school orworking toward a GED, and may
. npt have realized that some secondary-level programs are ~ot technically OED programs.
Con: Could enable a teen parent's receipt of a small amount of educational services to count as
if it were full-time attendance at secondary school. If these secondary education
progr~s were not considered as the "equivalent" to secondary,school, teen parents might
have an incentive to attend 'secondary school or GEDclasses to meet their work activity
requirements, thereby obtaining a more intensive secondary education.
.
.
Action:
•
Encourage HHS to interpret the WRA to include adult secondary education programs
under the A~ult Education Act (and the adult education portions of an Even Start family
6'
�literacy prOgram) as the "equivalent" of secondary school for the purpose of single teen
. parent work requirements, whether or not a participant is engaged in a course of study
.. leading to.a GED.
.
•
Propose including language in an amendments package to expand this provision to allow
adult basic education and ESL programs that meet for a min,imum number ofhours per
w~ek to count as "work activiti' for single teen paren.ts. . .
a
7
�,
1
September 27,1996
,Welfare Reform Act - Issue J>aper
Definition of "Vocational Education" for Purposes of Calculating,
Participation Rates to Fulfill the Statewide' Mandatory Work
Requirements
..
Section 407 of Title IV, Part A of the Social Security Act, as amended, establishes minimum
work requirements fo.r the new Block Grant to'States for Temporary Assistance for Needy
Families. The so-called"TANF" program supersedes the Aid to Families with Dependent
Children (AFDC) program.
'
.
,
Section 407(;a) establishes the minimum Statewide participation rate for mandatory work
requirements, which constitutes one of the most notable changes in TANF from AFDC. The
minimum participation rate for all families is 25 percent for fiscal year (FY) 1997; the rate for
two-parent families is 75 percent for that year. These rates increase incrementally to a maximum
of 50 percent and 90 percent; respectively, by FY 2002.
'
Section 407(d) defines "work activitie,s" to include-
(1)
unsubsidized employ~ent;
(2)
subsidized private sector employment;
(3)
subsidized public seCtor employment;
(4)
work experience (including work associated with the refurbishing of publicly assisted
housing) if sufficient private sector employment is not available; ,
.
"
(5)
on-the-job training;
,
(6)
job search and job readiness assistance;
(7)
community serVice programs;
(8)
vocational educationaltraining (not to exceed 12 months with respect to any
individual);
(9)
job skills training directly related to employment;
(10) education directly ~ela~ed to employment,in the case of a recipient' ~ho' has not received
8
�a high school diploma or a certificate of high school equivalency;
(11) 'satisfactory attendance at s~condary school.or in a course of study leading to a certificate
of general equivalence, in the case of a recipient who has'not completed secondary school
or received such a certificate; and'
,(12)
Jhe provision of child car~, services to an individual w,ho is participating ina community
servi.ce program. ,
, For purposes of the minimum hou~ per week of work activity,re<Iuired by section'
407(c)(I)(A) and·(B) for all families and the first spouse in a: two-parent family, only those
activities listed in paragraphs (1) - (8) and (12) of section 407(d) can be counted for 20 hours
for all families of the minimum weekly hours (which.increases from 20 in 1997 to 30 in
2000) and for 30 of the 35 hours for the first spouse. For the second spouse in a two-parent
family, paragraphs (6), (8); and (12) are excluded from the above-listed activities for pUrposes
of the minimum 20 hours.
Section 407(c)(I)(C) allows teen heads ofhousehoids to be considered to be engaged in work
for any month that the teen either maintains satisfadoryattendance at secondary school or the
equivalent or participates in education directly. related to employment for at least the'
minimum average nUmber of hours per week required for all fami'lies (20 hours' for FY:1997).
Issue: Can the apparently overlapping and inconsistent provisions of section 407(d) be
interpreted to allow teen heads of households and other recipients to receive;vocational andother
education and job training for more than 12 month?
Law: The provisions of section 407(d) are ambiguous as to whether the 12-month limitation on
"vocational educatiomil training" is applicable to all-re¥ipients. Section 407(d)(8) makes
"vocational educational training" an ,allowable work activity for only 12 months with
respect to the first 20 or30 hours of work required, d~pending on the category in which a
" recipient falls., Section 407(d)(lO) makes "educatio~ directly related to employment" an
allowable work activity for recipients who have not received a high school diploma or
the equivalent without a 12-month liJ?1itation,and section 407(c)(I)(C) J?1akes
participating in education directly related'to employment an allowable activity for
recipients who are teen heads of households without a 12-month limitation. Yet,
"education directly related to employment" is the generally accepted definition of
vocational education. Furthermore, none of these provisions indicates expressly when
paragraphs (9), (10), or (11) of section 407( d) are allowable work activities even though
they are included within the definition of "work activities."
Policy: The Department should encourage'an interpretation of section 407(d) that maximizes
recipi~nts' opportunities to receive adequate vQcationaland other educational opportunities in
',9
�order to prepare these recipients for high-wage, high-skill jobs.
Pro: Although the work ~ctivities listed for teens appear to overlap with the 12 months
of vocational education training permitted for otlter recipients, these provisions
"can be read harmoniously to allow the teens to participate in the activities listed in
section 407(c)(l)(C) without regard to a 12-month limitation. Under this
interpretation,teen heads of households may complete their secondary education
under section 407(c)(1 )(C)(I), including a secondary vocational component, and
then receive additional "education directly related to employment" until the
recipients reach 20, years old or an additional 12 ~onths of postsecondary ,
vocational education training under section 407(d)(8), which would be counted
fully toward the minimum 'number of hours required per week, ifthe recipient has '
.reachedage 20.
'
, ,
"
Moreover, although the work activities listed in paragraphs (9)Gobs skills
training directly related to employment), IO(education directly related to
employment, in the case of a recipient who has not received a high 'school
diploma or a certificate of high school equivalency), and l1(satisfactoiy
attendance at secondary school or in a course of study leading to a certificate of ,
general equivalence; in the case of a recipient who 'has not completed secondary
school ,o'r,received such a certificate) are not listed as anallowable activity for the '
first 20 hours for all families or a,second spouse or for the first 30 hours for the
first spouse in two-parent families, section 407 could be interpreted to allow these
activities (essentially vocational and other education) to be counted for any
required work time over these amounts. For example, the first spouse ina 2
parent family is required to work 3.5 hours per week. Such a recipient could not
courtt vocational education for more than 12 months toward the first 30 hours
worked. However, since such a recipient must work at least 35 hours, vocational
education could be counted for the last 5 of the 35 required hours even after 12
months of vocation~ education.
Con: Congress'may have intended'the 12-month'limitation on "vocational educational
training" to be absolute for all participants even though it is not be clear how this,
is distinguished frQm"education,directly related to employment." ArlY attempt by
HHS or this Department to interpret the 12-monthlimitation broadly may result in
, ~ specific amendment resolving this and other ambiguity against the above-stated
interpretation. If the Federal government is silent, States may adopt these'
interpretations' by the~selves.
Action: The Department's policy to maximize opportunities to all individuals to receive
adequate vocational and other educational opportunities in,order to prepare these recipients for
hig~-wage, high-skill jobs is so fund~ental to the Department's mission that it favors taking
10
�action to encourage HHS to issue guidance interpreting the abov~ provisions as extending
vocational education beyond secondary school for teen heads of households at least until they
reach 20, and aiIowing vocational and other educational participation to 'count as an allowable
work activity for thy minimum hours required above 20 and 30 hours a week for the respective '
"
,
'categories of other recipients. ,
Iss,ue: Should "vocational educational training" be defined?
..
Law: Section407(d)(8) does not d~fine "vocational educational training."
:
I
•
"
'
Policy: An interpretation of "vocational educational training'~ that includes basic skills and other
academic, education that is integrated with'vocational training would encourage States to give '
recipients broad education options. (See related issue paper on adult education and Even Start.)
.
,
,
.'
'
,
.
j
','
.
'
"
.
.
,
Pro: A broad interpretation of vocational education-would encourage States to '
encourage higher..:quality educational 'programs, which in tum would prepare
'
recipients for highe~-skiJI,higher-~age jQbs. ' "
Con: This interpretation would result in States' limiting adult education or other basic
skills partiyipation to 12 months because this is the limitation on vocational
education. Without a definition that includes basic skills, adult education could
.
.
not be pursued by'thoseindividuals counted toward the 20 percent cap Unless the
" individuals were teen heads of households, 'which ~reates no incentive for States'
to' provide adu,lt education o~ for individuals to seek adult education. Rather, by
allowing States to penalize persons aged 21-50 for not working toward aGED if
, they do not have 'secondary degrees, ,section 404(j) provides a disincentive to
States to provide adult education because the State could decrease the benefits to
' ,
, , these persons; ,:", '
. " "
Action: Although HHS is prohibited from regul~ting, this Department crin encourage HHS to
promulgate non-'regulatory guidance, including a definition o("vocational educational training"
that iilcludes'a broad range ohiducation programs, basic skills, academic majors,certificate, and
.' degree programs so long as the overall thrust: is vocational educ~tion -- not just basic skills and
, ,academics by t4emselve~.
'
'
Issue: Should the 12-month limitation o~ counting "vocational educational training" as a "work
,activity" under a State's minimum , . extended to 24 months?
participation rate be
.
'
Law: Section 407(d)(8) indicates that ''vocational educational trainfng" c~ be consi4ered to '
be an allowa,ble work activity for "not to exceed 12 months with respect to any
individual."·, ,,'
' , '
11
�..
\
'
,Policy: The Departm~nt strongly supports the Stales' providing recipients with broad~~.and
higher-quality educational options that would be more likely to lead to high~wage, high-skill
jobs. '
Pro: Extending the time that recipients can participate in vocational education would
provide an incentive for States to encourage more education as a means to
recipients' finding higher-wage, higher-skill jobs after the end of welfare
.eligibility.. Existing vocational education programs to train persons for such jobs
typically requir~ 24 months' of vocational education after secondary school. ,.
UltiI!lately, this would save publjc funds by decreasing recipients' future
dependence on publicly subsidized serVices, such as housing, child care, food
stamps, and reduced-price school'lunches, which continue for individuals in
. minimum-wage jobs ..
Con:
The 12-month limitation is consistent with the overall aim of the welfare act to.
place recipients into jobs as fast as possible. The conference committee rejected a
proposal to substitute "educational training (not to exceed 24 months ... )" for the'
, 12 months ofvocatio.nal education allowed by-the welfare act. Additionally, there
are existing vocational programs that could be completed in 12 months (i.e., 2
semesters + a surn.rner session). These would qualify recipients fOl'entry level
, jobs (e.g., medical hilling and records) even though an individual would need'
. additional vocational education to advance beyond that level.
Action: Because the welfare act is clear that vocatiorial educational training, can count as a work
activity for only 12 months, the Department should request that HHS to include in its proposed
legislative changes an amendment to section 407(d)(8) to allow vocational education to count as
. a work activity for at least 24 months: (Note: This would not be a "technical amendment" but
would be included in'the Administration's package of amendments to improve the program.)
Issue: Should the requirement that recipients who are' in vocational education as an allowable
work activity be in that activity for 20 to 30 hours per week be amended to simply allow .
r~cipients to be in a full-time vocational education program even if it provides less than 20 hours
ofvocational education per week?
.
Law: For purposes of whether the State has met its minimum participation rate in a particular
year, section 407(c) (1) (A) and (B) defines the minimum number of hours that an
individual'must be participating in voca.tional education or a~other allowable work
activity to be counted as working. For all families, the number of hours is not fewer
than 20 hours a week for (FY) 1997, and, for 2-parent families, the number of hours·
for the first spouse is not fewer than 35 hours a week. If a 2-parent family is receiving
Federally-funded child care assistance, then the second s(Jouse must be in allowable
work activities not fewer than 20 hours a week.
12
�Policy:, The Dep~ment should encourage an interpretation that maximizes reCipients'
opportunities to receiv'e adequate vocational and other educational opportunities in order to
prepare"these recipients for high-wage, high-skill jobs. '
..
,
Pro: Although section 407(d)(8) allows vocational educational training to count as an
allowable work activity'for certain recipients for up to 12 months, the recipient
must be engaged in 20-35 hours of allowable, work activity a week to be counted
toward the' St~tewide .minimum participation rate. While vocational education
programs afthe postsecondary level typically involve this ~any weekly hours,
'
. part of those hours are spent in courses to develop basic skills related to the
vocational training. (One study estimated the ratio of vocational courses to non
vocational course is 2-to":I.) It is not clear whether the non-vocational hours
would be counted toward the work requirements. If they are not, a recipient also '
would have to be engaged'in another allowable work activity'to make up the
shonfall in hours. An amendment to recognize that a full-time vocational
education course does not typically involve this much instructional or classroom
time but makes demands on a student's time outside of the classroom would allow
recipients to go to vocational education training full time.
Con: Congress may have intended for States to create a new means 'of delivering
vocational training at a faster, more intense pace than is the case in existing
programs. Thus, while ,typically the States have not delivered vQcational training
in this manner, the 12-morith limitation on vocational trainingC'oupled 'with the
20-35-hour-per-week requirements would seem to dictate change on the States'
, parts. Additionally, removing the minimum entirely would'permit individuals,
,who are engaged in vocational training on a trivial basis (in addition to those who
, , are enrolled in full~time programs that meet less than 20:.35 hours per week) to
" qualify. For instance, a student might be enrolled in a correspondence course that
'takes no more than a few hours a week: This result would seem to defeat the "
purpose of the law, which is that more and more welfare recipients should be fully
involved in work or education toward work.
Action: The Department'~ policy to ,rnaximize opportunities to all individuals to receive
adequ~te vocational and other educational opportunities in order to prepare these recipients for
high-wage, high-skill jobs is so fundamental that the Department should encourage HHS to seek
a legislative amendment to modify the 20-35 hour requirement to make it more flexible for
recipients enrolled full-time in vocational education.
13
""""
·
�September 26, 1996
.. Welfare Reform Act- Issue Paper .
,
Welfare Reform:, Issues Affecting Children and Schools
Question:
What are the issues that impact children, particularly children with disabilities,
and what role should we piay in the continuing policy making process?
(I). How many children will lose benefits as a result of the changing SSI
definition of disability?
.
. I
(2)
How will reduced eligibility for SSI and thus Medicaid impactthe IDEA
program with regard to school support services?
(3)
What will ~ the effect 011 IDEA and,schools that have children who have,
,been Medicaid eligible bec'ause of AFDC and lose health.care coverage?
Background: Thenewly enacted welfare bill inchides: (I) significant changes to .the eligibility
requirements of the SSI program for disabled children; (2) replaces the AFDC program with "
TANF, a block grant to states which requires the head of families to .work within two years and
sets a lifetime limit of five years of welfare assistance, and decouplesautomatic Medicaid
coverage from welfare eligibility. Both the SSI and AFDC are programs that traditionally have
served as the gateway to Medicaid eligibility for disabled,and disadvantaged children. HCF A
estimates that 60% of the all children currently rec~iving Medicaid are linked as a result of '
AFDC or SSI eligibility.
"
Adequate health coverage for'these vulnerable populations is importan~ to t~e ed~cation
community as a means of attaining the Nation's first education goal of having "all children ready
to learn". Schools have undertaken an increasing role in providing health services -- much of
which are reimbursable through Medicaid -~ particularly for low-,income and disabled ~tudents.
In the case of children with disabilities, schools are required by law to provide health services
that are necessary for the child to benefit from their education. This requirement under the IDEA
has been critical in ensuring both the health and education of children with disabilitie~ -
however, schools rely heavily on'Medicaid-to p~y forthose services, given that: (1) 40-60% of
children served under the Individuals with Disabilities EducationAct.(IDEA) are currently
Medicaid eligible; and; (2) the estimated cost to local school districts for health related services
for combined Medicaid and lion-Medicaid disabled students is $1.8 billion.
'
Concerns: As a result of the changes to the disabled children's SSI program, ~BOestimated
thal315,000 children will require re-determination undet: the new rules. SSA estimates that 50%
or 157,000 children will be eligible under another SSI diagnostlccategory, thus retaining
,
14
�Medicaid coverage. HCFAesti'mated that'50 % 'of the remaining 157,000 or approx. 80,000
.children will be eligibl~ for Medicaid as a result of meeting one of the mandatory poverty
.groups --- initially.leaving 80,000 children without Medicaid coverage, all of whom are likely to
· 'be eligible forhealth-relate'd' services under the Individuals with Disabilities Education Act
(IDEA) because of the expansive definition of disability in the ~DEA. There is significant room
for interpretation regarding the statutory definition of disability within the legislation, as well as
questions regarding the continuation of SSI benefits during an appeals process. Both of these
issues will heedJo be clarified, by SSA.
,
,
A second ~verall concern deals with the identification and iietermination of children whose
eligibility continues both under SSI and Medicaid'. The welfare legislation was amended to
require states to provide Medicaid coverage to families thatmeettheir states' July 1996 AFDC
. income and assets standards, thus linking coverage to the 1996 AFDC standards, not to receipt of
aid under the new T ANF block grant. However, ensuring that eligible families know they need
to go through the two, separate eligibility process~.$ will be a challenge.. This same concern holds
true for the redetermination process imder. SSI. Although SSA estimates that 50% of the 315,000
children will be found eligible for SSI under another diagnostic category, the . challenge will be
· 'getting them to the redetermination process.
'
This memorandumis intended to examine issues related to: (a) the chlIdren's SSI eligibility
requirements and appeal process and, (b) the de-coupling of AEDC and Medicaid',eligibility; and .
lay forth preliminary ideas for how to address these concerns as the Administration continues to
.
work with the implementation ofwelfare reform.
Impact of changes to the SSI Program for disabled children
Law
,
,
'A: As part of the eligibility process for children's SSI, the law repeals (under Section 211) the
use of the Individualized Functional Assessment, which is used ~o determine whether or not a
child is able to engage in age-appropria~~,activiiies of daily living, and the concept of
"comparable severity", as well as eliminating references to ~'maladaptive behavior" within the
personallbehavioraldomain ofthe medical listings -- replacing it with the ~ollowing:
J
· "An individual under the age of 18 shall be 'considered disabled for the purposes of this title if,
that individual has a medically determinable physical or mental impairment, which results in .
marked or severe functional,impairment, and which can be expected ~o result.in death or which
has lasted or Can be expc;;cted to last for a continuous period of not less than 12 months; and no'
individual under the age of 18 who engages in substantial activity (determined in accordance
with regulations prescribed pursuant to subparagraph (E)), may be considered disabled."
B. Sec. 211(d)(1)(A)(I)(ii) is silent on whether payment of benefits will continue when an
individual haS requested an appeal ofan unfavorable decision;
15
�Issue:
How should the level ,of disability severity requir~d to meet the new"marked and
severe" functional impairment be defined?
Policy:
, The Department should encourage HHS to include in regulation,' an additional
step in the determination process (in addition to qiagnosticgroupings), that is
stricter than the IFA but properly evaluates children too young to test, children,
who have multiple impairI?ents, and children with unlisted impairments.
Pro:
The intent of the evaluation is to assess how an impairment affects each child~s
functional ability, using a higher level of severity or disabilitY threshold than was
, ,provided by the IF A~. ,Sole reliance on the listings-level severity standard would
not adequately meet that in,tent. An evaluation process that determines whether a
child has ail impairment that meets, or medically or functionailyequals~ a
category in the medical listings requires anadrlitional step in the process.
,
- Con:
. Issue:
Policy:
Pro:
,
1
The intent of the Congress was to serve only severely disabled children in this
program. The sUbjective nature ,of a "functional" approach may be perceived
loophole to s,erve'less disabled children in the program.
'
as a
, Will there be a period of benefits continuation if the family appeals?
The Department' shouidencourag~ SSA to include in regulation, the continuance
, of SSI benefits through a hearing and a decision by:an Administrative Law Judge.
Given that a new standlifd' will be in place, and the impact ~f loss ~f benefits for
those who may be found eligible as a result of adjudication, maintaining benefits'
. throughout the process should be considered part of the due process requirements.
-'-'
Con:
For those children who are not found eligible via an ALJ hearing, the issue
remains of recouping dollars already paid to familie,s.In addition, the savings
, realized from the lack of payment during the hearing' process may be significant,
,as ~here is no mention of retroactive payment in the legislation.
ISsue:
What mechanisms will be p'lace to identify 'and support children' and
'. families who need redetermination for SSI, ,or who are eligible for Medicaid
regardless ofTANF after'1I9??
Policy:
in
The Department should encourage the Administration to set up an iQteragency
ta,sk force, including, at a minimum, SSA, HHS, HCF A, and ED, to determine
how best to support ~he children and families who are both eligible or no longer
.16
�eligible for'benefits under these programs, as welfaiereform is implemented..
'Pro:
The issue ofeligibility determination and/or re-deter.n1ination under the various
programs will be complicated. It is in the interest dfaII cQncemed to work
together to ensure that those intended to 'receive benefits' under the reform are \
assisted in the process, and that those who no longer receive'. benefits are directed
to other existing resources. At present there are prelIminary discussions occurring
iri HHS about using ,school-based clinics or schools as a site for public program '
outreach. This is an area where the Department of Education needs ~o be involved
in the discussion.
Con:
If the process of eligibility is difficult for families, then fewer families may apply'
-:-thus saving Federal and state dollars. As private industry begins 10' contract with
. states to manage their welf~e reforn1 systems, there is less incentiv,e to ','find",
eligible individuals from a financial perspective .
. Conclusion:
As welfare reform becomes implemented, it will ultimateiy be the synergy afforded by the
aggregate effect of coordinating public programs such as IDEA, SSI, Medicaid, and TANF that
will support the vulnerabl,e children" whether they are disabled and/or disadvantaged, to receive
services and supportS in their homes and communities,.incl,uding schools, to achieve positive
..
educational r~suIts and a Pro9uctive future in a global economy.
17
(
�September 27, 1996
Welfare Reform Act - Issue Paper
Eligibility of Unqualified Aliens for Department Programs
,
,
Issue: Are unqualified aliens eligible to participate in and receive the benefits of Department
.programs?
Law: Welfare Reform Act.:. Section 401 (a) prohibits unqualified aliens froql receiving any' ,
Federal public benefit. The definition of "Federal public benefit" in section 401(c)(I) includes
any "grant, contract [or] loan: . ,.provided by ...the United States or by appropriated funds of the
United States" and any "postsecondary education" benefit or "any other similar benefit for which
payments or assistance are provided to an individual, household, or family eligibility unit" by the
United States or,by appropriateli funds of the United States. Section 433(a)(2) provides that the
Act should not be construed as addres~ing eligibility ofaliens for a basic, public education under
the U.S. Supreme Court decision in Plyler v. Doe.
Case Law - Under Plyler v. Doe, states may not deny a free public education (K-12) to
undocumented immigrant children.
'
Policy: With the exception of postsecondary education programs that provide ~enefits such as
Pell grants directly to individuals, the Department's programs do' not fall within the definition of
"Federal public benefit." The rationale for this position is that while grants and contracts by the
United States are included in the definition of"Federal public benefit," the Department does not
typically provide 'grants ~d contracts under the Department's programs directly to individuals, '
but, rather, to entities that pro'vide services under the~e programs. Nor does the Departmen~ ,
typically provide payments or assistance directly to individuals, households or family eligibility
: units under its programs (again, with the exception of postsecondary education programs). Thus,
individuals participating in these programs are not receiving a "Federal public benefit" within the
meaning of the Welfare Reform Act, and unqualified aliens remain eligible for services under the
bepartment's programs. This position serves the Department's mission of. providing access to
education. (Note: To the extent that, in the 'implementation of any of the Department's
programs, grantees or subgrantC!es provide stipends, vouchers or other assistance to individuals;
such assistance could be interpreted as a "Federal public benefit" and, thus, prohibited for
unqualified aliens.)
.
"
,
With respect' to any postsecondary education programs that provide benefits liirectly to
individuals, households, or family eligibility units, however, it appears that unqualified aliens are
not eligible for such programs under section 401 (c)(l)(B) of the Welfare Reform Act. (Note:
Under current law, qualified aliens (as defined in section 431(b) of the Welfare Reform Act),
. with the exception of those able to provide evidence from the Immigration and Naturalization
Se~ice that they are in the United States with the intention of becoming permanent residents, are
18
�not currently eligible for these postse~ondary education programs.) ,
In any event, the Department sho~ldtake the po'&ition, consistent with section 433(a)(2) ofthe
Welfare ,Reform Act,'that the Act'sprbvisions were not intended to deny undocumented
immigrant children the rig~~ to a free public education un~er Plyler v. Doe.
Action: (I) Confirm that the Department and HHS are interpreting the term "Federal public
benefit" in the same manner. '
(2) Notify the Department's grantees'through guidance that unqualified aliens remain eligible for·
.all Department programs, except for postsecondary education programs that provide benefits
'
.
I
, directly to individuals, households or family eligibility units. Also, notify grantees that the
'provisions of the Welfare Reform Act do not ch~ge the eligibility of undocumented immigrant
children for a free public education under Plyler v. Doe.
19
�I V/
1:J/:l0
u',+ • .;)Or-I"I
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,.
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,rH"~UI'1
I~
:'
MQL-
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VI
~
}) A New Initiative'of the U.S. Department of Health and Human Services
Project on State-Level Child Outcomes: ' Eilhancing Measurement of Child Outcomes
in State, Welfare Evaluations and Other State Data Collections
The, Administration for Children and Families (ACF) and the Office of the Assistant Secretary for
Planning and Evaluation (ASPE) are starting a new initiative to work together with states on
measuring child outcornes in state welfare evaluations and in other state data systems. ACF will
provide grants to states instituting welfare reform demonstrations to augment'their demonstration
evaluations with measures of child outcomes and also expand their data capability to measure and
track child outcomes on an ongoing basis. Under ASPE funding, the states will receive technical·
support on these activities from leading researchers in the areas of measurement of child outcomes,
. impact evaluations of social programs and policies, and research methodology. lbese researchers
a're a part
the National Institute of Child Health and Human Development (NICHD) Research
Network on Family' and Child Well-Being, and their technical support effort' will be led by Child
Trends. In addition to the core funding to be provided by, ACF and ASPE, we anticipate that other
federal agencies and private foundations will provide supplementary funding, and the scope of the
overall effort will depend on the magnitude of this additional support.
or
I'
Context for the Initiative
.
Innovations in welfare policy were occurring even before enactment of national welfare reform.
Since January 1993, over 40 states have received federal waivers to implement welfare reform
demonstrations. The current initiative depends in large part on augmenting the evaluations of some
of these demonstrations. The new legislation eliminates the need for these states to have waivers to
cOntinue the innovative policies they have implemented. There is" however, reason to be optimistic
that many will maintain the evaluations they have established for the derrionstrations. The welfare
reform legislatiol1 directs the Secretary of-Health and Humari Services to encourage states to
continue to evaluate the effects of their waivers, and the Depa11ment intends to pursue approaches to
implement this. vigorously. Also, several states,' in~luding some that have be~n selected to
participate in the planning phase of this initiative, have indicated that they intend to continue their
waiver evaluations
//
To gauge the effectiveness of welfare reform innovations in relation to children'S well-being and
development and to guide further innovations in policy, child outcome data are needed at the state
leveL National data sources which are currently available do not allow adequate, understanding of
the effects of state-specific programs. National surveys may not measure concepts that are the focus
of state policy-making efforts and, from a technical perspective, the surveys 'tend not to have designs
'
that permit state-level estimates or assessments of causal relationships.
Though rigorous evaluations of state welfare reform demonstrations are being' conducted which
contain child o'utcome measures, these evaluations focus primarily on adult behaviors. and outcomes
such as changes in earnings and welfare dependency, and the child measures typically lack depth
and uniformity. However, because children may be as affected as adults by some of the welfare
provisions which are being implemented, it is important t,o obtain more systematic and uniform
information on the effects of welfare reform on children. For example, some provisions require the
development of a "social contract" which covers all family members. Others have specific
requirements regarding immunizations for children and school attendance standards . .Time limits .
and provisions to limit or reduce cash benefits for additional children are directed towards parents, .
but might also have effects on children. Provisions designed to increase parental empl9yment, such
UVJ
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1~':lV
V-... . ..J :11- 1"'
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VI
:~)
as tougher JOBS requirements or increased earned income disregards may affect children~ The
effects of these changes on children --positive or negative --will not be known unless appropriate
measures of child health and well-being are consistently included ,in the demonstration evaluations ..
These research, needs which relate directly to changes in welfare policy combine with broader
research needs to measure and track child outcomes at state as well.as national levels.
Children are affected by the social, physical, and economic environments in which they live in
innumerable ways; it is not possible, therefore, to capture the total picture of how children are
faring through specific program evaluations. To gain a 'broader sense of the trends in child health
arid well-being, child measures need to be institutionalized into state data collection systems. This
initiative will provide states with assistance in developing and utilizing state data ,on child well-being'
from administrative data bases and state surveys.
Deta;L<; of the Initiative
The initiative will have two phases, a one-year planning phase and a three-year implementation
phase. The twelve states selected for the planning phase, which began on September 30,1996, an!:
California, Connecticut, Florida, Illinois, Indiana, Iowa, Michigan, Minnesota, Ohio, Oregon,
Vermont, and Virginia. Core support is to be provided by ACF and ASPE for technical support
activities and for grant awards to these states to participate in the planning phase and to
approximately five states to continue into the implementation phase where additional child data will
be collected and analyzed. We anticipate that other federal agencies and private foundations will
provide supplementary funding. The scope of the, overall effort will depend on the magnitude of
these additional dollars.
During the planning phase, state welfare administrators and their evaluators and state staff involved
with other child service systems and data bases will work with researchers from the NICHD
Network and federal 'staff to develop plarisf6r augmenting their state welfare evaluations and
improving their state data system capacities, The primary goal of this phase is the selection of a
core set of measures, developed and agreed upon by the participating states, which will be used to
augment the state welfare evaluations during the implementation phase. In addition, states also may
receive assistance in identifying other supplementary child measures appropriate to their specific
demonstrations. The data capacity work will entail identifying improvements to or linkages between
existing state adininistrative data bases or other state surveys for tracking child well-being on an
ongoing basis. States will submit competitive applications approximately eight months into the
planning phase for consideration for continuation funds to implement additional data collection
activities over the three-year implementation period.
The initiative, then, will result in waiver evaluations which capture the effects of welfare reform on
the development of children and in .enhanced state capacity to track trends in child outcomes in at
least five states. If the remaining six states are not funded through implementation, by the end of
planning phase, they will at the very least be poised to pursue these enhancements through other
venues. And, finally, ASPE will fund the NICHD researchers who will have worked on this
initiative to summarize and synthesize states' efforts in reports for use by additional states or other
audiences.
For 'additional information, contact:
.
Alan Yaffe, AeF, (202) 401-4537, ayajj'e@acfdhhs.gov
Martha Moorehouse, ASPE, (202) 690-6939, mmooreho@osaspe.d/zhs.gov
VV~
�\....
,;;.
.
Nevada
1.
How much new child care money will Nevada receive from the
Feds under the new welfare reform law?
In FY 1997, Nevada is eligible to receive a total of $6,878,492
in Federal Mandatory and Matching funds.
Based on the latest
reports for FY 1996 (Federal expenditures for AFDC Child Care and
Transitional Child care of $1,688,141, and Federal expenditures
of $1,433,868 for At-Risk Child Care) the Federal FY 1996 share
for title IV-A child care in Nevada is $3,122,009. Thus, if
Nevada accesses all of its Matching Funds, it will receive a
projected increase of $3,756,483 in Federal Mandatory and
Matching funding over what it received in FY 1996 Federal funds
from the former IV-A child care programs.
Additionally, it should be noted that on September 30, 1996,
Nevada received $3,824,970 from the Child Care and Development
Block Grant, which, under welfare reform, we are calling
Discretionary funds.
Nevada also will receive $79,047 in FY 1997
Discretionary funds as a result of the funds set aside for
school-age care and child care resource and referral programs in
the Omnibus Consolidated Appropriations Act of 1997. There is no
matching requirement for these funds.
Thus, if Nevada accesses all of its Matching funds, it will
secure a total of $10,782,509 in Federal child care funding this
fiscal year.
2.
How much new money will Nevada have to spend, that Nevada is
not currently spending on child care, to draw down the maximum
amount of Federal funds available?
The State would have to spend $3,756,483 in new money, as
explained below. The State's total commitment of its own funds
for FY 1997 would be $6,878,492.
(This consists of $2,580,422 in
estimated Maintenance-of-Effort expenditures and $4,298,070 as
Nevada's share of the Matching Fund.)
Based on the most recent
financial reports from the State, Nevada's share of its FY 1996
title IV-A child care funds was $3,122,009. Thus, to access the
maximum amount of Federal funds available, Nevada will have to
commit $3,756,483 in additional funds.
3.
By what date will Nevada have to spend the new money to draw
down all of the available Federal funds?
To access all available FY 1997 Federal funds, the State must, by
the end of Fiscal Year 1997, i~e. by September 30, 1997:
a.
Obligate all FY 19.97 Mandatory funds.
b.
Expend from its own funds an amount that equals the
State's Maintenance-of-Effort threshold.·
c.
Obligate all FY1997 Matching funds.
(Note:
Matching Fund obligations must be liquidated by
September 30, 1998.)
These
�~
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THE WHITEHOUSE
.
l~~
THE PRESIDENT HAS SEEN
I"
.~ ---'1
~
ME~
.'"
FOR THE
'96 NOV 12 PM12:57
WASHINGTON
.
(f-~b-rc
November II, 199f(f)=-u.-.lik.
P~IDENT
~
@~_') ~ ~~
From:
Carol H. Rasco
Subject:
Report for October· 22-November 11, 1996
UPDATES ON KEY INITIATIVES
WELFARE REFORM IMPLEMENTATION
State Plans for TANF Block Grant -- HHS plans to certify TANF state plans in Kentucky,
Nevada, and New Hampshire today, bringing the total number of state plaris certified to 11.
Twenty-two states have applications pending with HHS. Connecticut's plan is expected to
be certified soon. In their plans, most states are indicating that, for now, they will operate
their programs as they ,were under'the old law or under their waivers. More changes are
expected in the spring when state legislatures convene.
Welfare Waivers with Transitional Medicaid -- The Administration should make a decision
soon about whether to allow states to cORtiRU@ waivers. that offer an extra year or two of
transitional Medicaid to people leaving the welfare rolls for work.· Many welfare waiv~rs
include this feature. Under the law, we are able to continue the v7aivers but there is a
problem because of our requirement that waivers be budget neutral. We always assumed
that transitional Medicaid benefits were "paid for" through savings in the AFDC program,
but the new block grant does not afford the opportunity for such savings. We are working
with HHS and OMB on options.
Guidance to States on "40 Quarters" Exemption -- USDA released guidance to states on
how to determine whether legal immigrants still qualify for food stamps because they have
worked for 40 quarters in this country.
Options on Medicaid/SSI Linkage -- Legal immigrants on SSI could lose Medicaid even in
states tl~At take advantage of their option to continue Medicaid coverage of legal
immigrants. This is because they are eligible for Medicaid by virtue of their SSI eligibility,
and they may not qualify for other entry points to Medicaid such as having dependent
children. HHS is investigating whether it is possible to construct a mechanism by which
legal immigrants could automatically keep Medicaid, but has not yet determined whether
this is legally feasible.
�Housing Issues -- One of the areas of most serious concern among service providers to low
income communities is the impact of the welfare bill on affordable housing. On the one ~.
. hand, they are worried that those families losing income -- e.g., immigrants;1OOd stamp
~
.recipients -- will have greater difficulty paying rent and will lose their ho~g. On the ~
other hand, they au: worried that bousing. rent P?licies ?O not S!lP~ox:t welfar~-to-:w:ork
' ~~
efforts. Those leavmg, welfare for work m pubhc housmg or SectlOn 8 housmg wIll find
their rents increasing and a large percentage of their disposable income going toward
housing costs. HJ In is looking at possible act jon to address botb of tb~se probl~ms. '
Welfare to Work -- OMB has convened a working group to develop the specifications of
the $3 billion Welfare to Work plan announced at the Convention. They hope to have the
details finalized for decision meetings in early December. There will be some difficult
issues concerning the extent of public vs. private sector jobs. targetjng. and wbo should
administer the progra,m. DPC, NEC, and OMB will be preparing issue papers and decision
memos to move the program forward.
'
Department of Education Outreach -- The' Department of Education has been working with
HHS and constituency groups in the education and disability communities to discuss
provisions of the new welfare law affecting them. Disability groups are concerned that
schools may have reduced access to Medicaid funds in the face of the children's SSI cuts
..~d the changeover from AFDC to TANF. Mas;' srhools rely on Meqicaid to fund speci!l
education therapies EducatjoD groups are rODeemed about restrictions in the law on the
amount of vocatjonal training n.dlich can seOO:t ~e',J,card the 2!.Q!,k participation reCjUlrements.
.
-
Letter to Advocacy Community and States on Timing of SSI Changes -- On October 24, a
. letter went out to advocacy groups and to states to clarify that SSA will not drop legal
immigrants or children from the SSI program until the middle of next year at the earliest.
There has been some misinformation in communities that the cuts could be coming much
sooner.
IMMIGRATION
Illegal Immigration Enforcement and Welfare to Work -- On November 1, the INS
agreement with the Commonwealth of Virginia to replace illegal workers with
unemployed legal workers who are on welfare rolls in jobs that they want, need and are
qualified to perform. Unckr tbjs first-ever agreement with a state, INS will immediately
notify officials of the Virginia Department of Social Services when the INS removes
unauthorized workers from an employer's workplace in the state. This early notification
:;.11 giy:~. the Virginia Employ~~nt Commission an opportunity to .refer qualified workers
--.t announced
,
/'"
/
~
.
~'0 are unemployed and reCOlvlI1g state welfare benefits to these Jobs.
.,,·Gi
�CHILD WELFARE
Child Welfare Chat Sessions -- On Oct. 31, we completed a series of seven· small two-hour
discussion sessions in my office over the past four months. We talked with a total of 35
child welfare experts from atoundthe country. In addition, in October we visited the
National Council of Juvenile and Family Court Judges in Reno, Nevada during the fall
training session, sitting in on classes and meeting with faculty and participants. We will
now begin working to propose action steps in this field.
CRIME AND DRUGS
I4lAMA
:
:::
Medical Marijuana -- DPC staff is working with the ONDCP, Department of Justice, and
Department of Education to begin to coordinate an Administration response to the medical
m1ll"ijuana initiatives passed last week in Arizona and California. The ballot initiatives
passed in both states (Propositions 200 and 215, respectively) would legalize marijuana use
for a variety of medical conditions. Both ballot initiatives are loosely worded and V{Qllld
make enforcement of laws prohibiting unauthorized marijuana use difficult. It~ns
Unclear "'rbetber federal laws will preempt the new state laws.
<
President's Remarks to the IACP -~ Because you were unable to attend the annual
conference of the International Association of Chiefs of Police (lACP) in Phoenix on
October 29" 1996, we provided them with your taped remarks. The video was shown
before 2,000 police chiefs at their general assembly. IACP was very grateful and your
. remarks were well received.
.
Drug Testing-Driver's Licenses -- DPC staff is providing guidance to ONDCP, DOT and
other relevant agencies on their response to your October 19, 1996 directive -- tlReducing
Teenage Driving under the Influence of Illicit Drugs." The directive instructs agencies to
report back by January 17, 1997.
ENERGY AND ENVIRONMENT
Human Radiation Experiments -- This week, the Department of Energy plans to announce
it has reached final settlement with the families of 11 people injected with plutonium and
one person injected with uranium. These families of experimental subjects represent 12 of
the 18 that the President's Advisory Committee on Human Radiation Experiments
.
~ recommended for compensation. The settlements include an agreement for the Secretary of
~"!~:~f::;:O meet with ti1e families. We may send a White House representative to that
..
�HIV/AIDS
v (
~
African American Meeting -- October 22, a group of about 90 African-Americans met at
the Harvard AIDS Institute to discuss the growing AIDS epidemic among blacks and what
can be done to turn it around. Blacks are disproportionately affected by the epidemic.
From 1990 to 1994, the annual AIDS i.ncidence grew 69 percent among African-Americans·
compared with 14 percent among whites. B"y the year 2000. more than half of all AlPS
cases in the U.S. are expected to be amon black Patsy Fleming, Alexis Herman and
represen ves 0 many natlOnal black organizations attended as well as providers· of care
and prevention services. The outcome of the meeting was a call to action for the African
American community including clergy, the media, the government, community-based
organizations, educators and all others who can intervene in this. deadly disease. .
EXTERNAL ACTIVITIES
MEETINGS AND SPEECHES
Wednesday, October 23, I keynoted a Child Care and Economic Diversification Policy
Summit in Reno, Nevada sponsored by The Children's Cabinet, a child advocacy resource
center which also provides services to children and families in the area. The conference
was designed in conjunction with the DPC to bring together about 25 business people in
that state with an equal number of child-serving agency personnel in Nevada to discuss
child care and business within the context of welfare reform. Glenda Bean of Arkansas
was also brought in to discuss the state's experience designing quality early childhood
experiences through collaboration with all sectors, including the business community.
Sen. Bryan as well as Gov. Miller were present for parts of the day. It was an excellent
format for talking about what business can do, and what business must be aware of as they
accept their share of responsibility in welfare reform. The group left with a defined set of
. next steps for improving early childhood experiences for low-income children and involving
businesses in welfare reform.
J
.
Thursday, October 24, I visited the National Council of Juvenile and Family Court Judges
training program which is based at the University of Reno. I met with the Dean and
facuity/project managers and held a roundtable with jUdges/probation officers and staff from
state social services from around the country in for training on various facets of legal
matters regarding children and families. I also attended four class sessions. The
information from this visit will be invaluable as we further review initiatives to undertake
in imp}.wing the child welfare and juvenile justice systems.
Friday, October 25, I met with the Police Chief in Reno, Nevada to discuss his
department's comprehensive community policing and youth development programs.
Among the youth programs is the GREAT program (Gang Resistance Education and
Training) which is overseen nationwide by the ATF Bureau. This is a middle school
program that in a comprehensive system follows upon DARE in the elementary schools.
then visited a seventh grade classroom where a Reno police officer was leaching a class:
�followed this with a full class discussion as well as a smaller roundtable with four students,
the officer and the teacher.
Thursday, November 7, I attended a Welfare-to-Work Programs and Substance-Abusing
Populations seminar sponsored by' the Annie E. Casey Foundation, American Public
. Welfare Association (APWA), the National Association of State Alcohol and Drug Abuse
Directors, the National Center on Addiction and Substance Abuse at Columbia University,
. the Legal Action Center, the Urban Institute and the Welfare Information Network. It is
important to address substance abuse issues as we implement welfare reform given that a
significant percentage of welfare recipients have substance abuse problems. Failure to
address the substance abuse problems of current welfare recipients who will also be faced
with time limits' on assistance could have negative effects on child welfare.
Last week, I also met with Liz Robbins and her clients from LexislNexis who are starting
to work with states on electronic search programs for parents who owe child support
arrears. Jeremy Ben-Ami of DPC will continue the dialogue with Liz and the company.
�;
2
.
.
1·
I
�.,
.
.
SPECIAL ANALYSIS
. Will There Be Enough Jobs for Welfare ,Recipients?
An important concern following the enactment of welfare refonn is whether those
who leave the welfare rolls because of work requirements. and time limits will be
able to find jobs. Supply and demand analysis suggests many will, but their en'!!y
may reduce wages in the less-skilled lahor market, Moreover, these jobs are likely
(
to be highly sensitive to cyclical fluctuations.
,
~
Impact on jobs and wages. Millions of jobs are created during economic
expansions-far more than the number of new job seekers who will be coming off
welfare. But welfare recipients have fewer skills than the typical worker and they
. will have to compete in the more limited market for less-skilled workers.
T~main
impact of welfare refonn will be to increase the number of less-skilled
eo Ie looking for work at any given wage an outward ShIft In the su t curve).
Because finns do not fin It profitable to hire more workers at the prevailing market
wage, ~ wage wjll have to fall to induc
,
Effect of Welfare Refonn on Less-Skilled Labor Market mare hiring. But some workers will no
&
longer wish to work at a lower wage.
~
Thus, the net increase in employment
will be smaller than the outward shift i
the supply curve (see chart).
{U I~>
~
l.u. J
much more so than that of the workforce as a whole. For instance, the share of
Weekly Economic Briefing
3
November 22. 1996
"
~ ~ ."
~ I.
.
~(_
\f1,~
Simulations based on plausible demand and supply curves suggest that if 2 million
additional less-skilled, welfare recipients seek work, c:IPEloyment in the less-skilled l~
labor market would increase by over 1 million and wages for less-skille'd workers
would fall by abQ}.l1: 11 percent. Under assumptions that are more optimistic about ,
job growth-but still within an empirically plausible range-employment.would
Increase by 1.8 million and wages would fall by 12 percent.
Cyclical sensitivity of employment. Because roughly half of all welfare recipierits
.
~ ~'0
The actual outcome will depend on the
slopes of the supply and demand curves.
If, for example, employers are very
willing to hire more workers when the
. wage drops just a little (a relatively .flat
demand curve), most of the new job seekers will be successful and wages will not
drop much. But if employers are reluctant to hire more workers even in the face of
a substantial lowering of the wage (a relatively steep demand curve), employment
will not increase much even as wages fall. The magnitude of the supply response of
workers matters as well.
~e younger high school dropouts, therremployment is likely to be highly cyclical,
,
iI,
~~ 4
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�,.
•
Cyclical Effects on Employment by Education
15
.r-------:...........::....--....:;...-.----,
f
a10
I
5
~
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0
I"
younger high school dropouts with a job
fell almost 10 percent in the recessionary
years of 1982 and 1991, compared to
about 2 percent for the population as a
whole (see chart). These employment
losses were reversed in the subsequent
economic expansions.
,l;
1"10
Job loss following employment spells as
short as 9 months to a year may qualify
101\1
many of these fonner welfare recipients
for unemployment insurance. These benefits would reduce some oftheir income loss
but could put additional strains on the unemployment insurance system.
U.l$
11111
1...
1M2
11184
Weekly Economic Briefing
1_
1_
10C10. lt1l2
4
November 22. 1996
�.'
To:
Virginia Cox'
Anna Durand
Liz Hyman
Betsy Myers
Joan Silverstein:
From:
Lyn Hogan
Debbie Fine·
Date:
September 13, 1996
Re:
Domestic.Violence Initiative
Attached is the draft options memo Debbie and! prepared.
I have
.__.___._.. :f..~x~d. _a._<:::c>py to Wendy Jacobson in Ann Rosewater I s office at HHS.
Jeremy Ben-Ami asked Wendy to. attach the m~mo to a larger welfare
reform issues memo she is coordinating. That memo will go to
Leon Panetta. However, before the memo goes.to Leon, the draft
will circulate to the appropriate people for comment.
.
Please call me if you have any questions.
Thanks!
-cc:
Lsco
Bruce Reed
Jeremy Ben-Ami
Wendy Jacobson
�'t ,
September 13, 1996
MEMORANDUM FOR
FROM:
SUBJECT:
I.
Domestic Violence Initiative for Welfare Recipients
PURPOSE
. Throughout the welfare reform debate, domestic violence activists and women's groups have
raised serious concerns that battered women and victims <;>f sexual assault could be penalized
under the new welfare system. We feel it is important that the Administration take
appropriate action to encourage the states to recognize the special circumstances that battered
women often face. Additional resources ·or flexibility in meeting requirements under the new
law would help recipients with a history of abuse successfully and safely move off of welfare
and into the workforce .
.In this memo we will outline several options for Administrative action that wou.ld e~courage .
states to help battered women make the transition to work without weakening enforcement of
the new welfare law. These options would also allow the President to underscore his
longstanding commitment to fighting doillestic violence. .
.
II.
BACKGROUND
As you know, domestic violence has a devastating impact on families and communities".' For·
all women, including wornen on welfare, it often seriously undermines the self-sufficiency
and independence of its victims. I:n addition to the profound mental and physical effects of
domestic violence, abusers frequently ipterfere directly with their victims', efforts to pursue
education and employment. This tendency could have se'rious implications for successful
welfare-to-work initiatives if special efforts are not made to address it.
While there is no comprehensive or federal data that tracks' the incidence of domestic violence
among welfare recipients, there are some i,ndependent studies that show high . levels of
incidence:·
,
•
. A r~cent study by the Taylor I:nstitute estimates that 50 to percent of women
receiving AFDC 'are past or current victims of domesti~ abuse. Further, the ·study
1
�reports that 50 percent of employed battered women lose at least three days of work
. a month due to domestic violence,· that 70 percent report· difficulty in job
performance because of abuse, and 'up to three-quarters experienced on-the-job
harassment from their abusers.
•
An article in the Journal of the American Medical Association (figures to come)
In order to promote the safety and self-sufficiency of welfare recipients who are survivors of
domestic violence, the. new welfare law includes an important provision: the Family Violence
Amendment (FVA). The FVA is a state option to increase services and to waive
requirements in cases of domestic violence and sexual abuse. Specifically the FVA:
.'
.
•
All~ws states to Certify standards and procedures to screen for and identify domestic
violence in their state plans.,
.
Invites states to provide increased services for battered women through their welfare
programs, including: screening and confidentiality provisions, referrals to shelters,
counseling, legal representation, and other important supportive services.
.
•
Permits states to implement temporary and flexible "good cause waivers" of any
program requirements, if complying with those requirements would make it harder
for recipients to escape violence' or where the requirements would unfairly penalize
past, present, or potential victims of physical abuse or sexual violence. Such
requirements include: mandatory participation rates, the two .and five-year limits,
child support cooperation, child exclusion, and residency.
The FVA originated as the Wellstone/Murray Amendment to the Senate version of the
welfare bill as a requirement for states to provide these services and make necessary waivers,
but was converted to a state option by the Conference Committee. Whileiinplementation of
tpe Family Violence Amendment is an essential tool to help battered women and their
families safely transition from welfare to work, it is currently an optional provision without
any strong incentive for states to choose to implement the Amendment. .
.
lll.
OPTIONS
OPTION 1: The President would direct the Secretary of Health and Human Services and the
Attorney General to assist and encourage states to implement the Family Violence
Amendment. The President would further direct the Secretary of Health and Human Services
to commit to learn more about' the linkages between welfare and domestic violence with a
study. The components to the directive follow:
1) The President would direct the Attorney General and the Secretary of HHS to develop
guidance to assist states with the implementation of the amendment. HHS and 001 would
2
�consult with victims services, women.'s advocates, law enforcement, medical professionals,
and others involved in fighting domestic violence. The guidance, which would be non:-;
binding, would. address ,~he following:
•
The standards and procedures that should apply when when screening for
,a history of domestic vi?lence;' ,
'
'
•
•
i
'
'.
.
'
.
"
.
The standards and procedures that should apply for determining what is
good cause to waive the requirements of PRWORA.
2) The President would direct the Attorney General and the Secretary of HHS to provide,
states with t~chnical assistance to develop standards and procedures to screen, identify and
assist victims of domestic violence as part of the Temporary Assistance for Needy Families
programs.
3) The President would direct, the Secretary ofHealth and Human Services to provide
discretionary funding to study the incidence of violence in the lives of welfare recipients; the
impact of domestic violence on welfare program rules and requirements; and the best
assessment, referral, and deli~ery models to improve safety and self-sufficiency for welfare
recipients who are victims of domestic violence.
, OnION 2: The President would propose an HHS regulation on participation rates to provide,
a regulatory incentive for implementation of the FVA illld would direct the Secretary of
Health and Human Services and the Attorney General to assist and encourage states to
implement the Family Violence Amendment: Further, the President would direct the"
Secretary of Health and Human Services to commit to learn more about the 'linkages between
welfare and domestic violence with a study. ,
In addition to directives, contained in Option 1, the President would 'direct the Secretary of
, Health and Human Services to:
1) Propose regulations providing the states that fall below the required participation rate will
be found to have reasonable cause for failing to compl)i with the participation rate
requirement and will not be penalized if the reason for the low rate is the number of domestic '
violence victims exemptedforn1 the work requirement and if the state has in place adequate
programs to assists victims of domestic violence.
2) Propose any other regulations necessary to ensure, to the extent allowed by law,that the
penalty structure under section 409 of the PRWORA does not operate inadvertently to. '
, discourage states from exercising their option under section 402 (a) (7) of the PRWORA '(the
Wellstone!Murray amendment) to screen, identify and assist victims of domestic violence.
3
�"
'''!
OPTION 3: Highlight the FVA state option with a statement by the President, a letter to the
states, and a commitment to a federal study. A description of these components follow:
1) The President would make a statement.to the states encouraging them to implement the
FVA, and to establish adequate programs to assist the victims of domestic violence. .
2) Follow the President's statement with a letter from the President to the Governors
challenging/encouraging them to take advantage of the Family Violence Amendment. The
letter would outline the linkage between domestic violence· and securing empl'oyment, and
str4;:ss the importance of providing additional services and flexibility for women in those
circumstances. The letter would further outline the kinds of services he is challenging them
to increase 'and· monitor; including screening, counseling, service referrals and support
services.
-3) Announce the study described above in Option 1.
IV.
RECOMMENDATION
4
-.
-.
�DRAFT·
FEDERAL AGENCIES' TOP ISSUES
ifiIs:
o
How to design work programs and post-employment supports
o
How to assess families coming into the system
o
How to ensure that there are sufficient child care funds for
TANF families, working families, and families that need after
school child care
o
General clarification of Medicaid eligibility for immigrants
o
Specific clarification of Medicaid eligibility for immigrants
within the context of TANF
USDA:
.
.
o
How will the requirement for a three-month time limit on food
stamps for able-bodied childless adults aged 18-50 be
implemented? ~ow will waiver to this provision work?
"
o
How will waivers that were in effect· when law was enacted be
affected?
o
How can states implement the law in a timely way, especially
those provisions effective on enactment -- particularly given
. states are simultaneously 'implementing TANF, and conversion
requires
substantial
systems modifications
and· worker
training?
o
.What steps are required to. implement the "40 quarters,i
exception to the ban on food stamp· l?enefits for legal
immigrants?
o
Timeliness of regulatory clearance process
SSA:
How will SSA process requests from states and other agencies
o
regarding
the
40 quarters of coverage exception
to
restrictions on alien eligibility for public benefits?
o
How will children currently receiving SSI disability benefits
affected by the legislation? (Issues include definition;
due process: when will children be terminated from the rolls;
how many children)
o
How can Federal and State agencies work together to prevent
fraud due to false alien documents and other sources?
be
�~~PF'96
P.2/3
09:48RM NRT'L GOVERNORS'RSSOCIRTION .
lUy~ond C:'Sch~p~ch
. Bob,MilIer ',"
Governor of Nevada
GOViRNoPS'
Executive Director'
Chainn~n
ASSatlATION
Hall of the SCQtc.!
444 North C:l.llitOl Strm
W;shington. D.C. 20001-1512
Telephone (202) 624·5300 .
George V. Voinovich
Go~Ctri~r ofOhio
Vic:c Chairman
September 17, 1996
MEMORANDUM.
To:.
Diane Fortuna
From: Evelyn Ganzglass and Susan Golonka
Re:
OUT Top
Five Issues on Welfare Reform'
1. Clarify which issues will be addressed through regulations and which not. Reach agreement on a'
.
.
timetable and proce'ss for consultation with the states regarding the development of federal
.'
regulations and the timely resolution of non regulatory issues such as the foHowing:
• . State concerns about being penalized {or actions taken prior to the promulgatiol'l of .
.
.
regulations or other federal guidance;
• What the Secre[ary's interpretation will be regarding what "inconsistent with the act"
. means for purposes of states' ability to continue certain provisions of existing waivers;
• What will be included in the definition of administrative costs for purposes of federal
audits and penalties..
.2. Establish a: process for developing outcome-based measures for use in awarding bonuses from the
performance fund.
3. Clarify issues related to the state plan
s~bmittal
process including the tinie frames for certification
"
of completeness; when do the TANF fundin~rand requirements for time limits and penalties beiin .
in states' that are found not to have submitted a complete plan?
4. Establish
an interagency working group on information systems.for TANr.the child care block
grant, the new food stamp work requirement and the child support enforcement program to
coordinate efforts. develop a system that will allow cost sharing among programs, and provide
technical a~sistance to states to en~ure that one system may meet multiple purposes
"
"'.'
�""" .... ~,
SEP 17 '96
'..
09:49AM NAT"L GOVERNORS' ASSOCIATION
'"
Page 2
'
.
.~.
. '
' .
,
..' 5. Try to reach agreement on areas which,require technical amendments. Our current iist includes
the following;
•
Permit transfer of Targeted Assistance for Needy Families (TANF) block grant funds directly into
$
the Social Services Block Grant.
-
Allow states the option to count as a single-parent fami,Iy for purposes of the work requirement '
.
t~ose
.
two-parent fa'milies in which one spouse is incapacitated.
• Modify the reconciliation and MOE provisions of the contingency, fund so needy states ~il1 be
able to access the fund.
-Reconcile the effective dates for eliminating the federal,' contribution to the $50 child support
pass-through and repealing the actual pass-~hrough., '
.
.
,
.
• Clarifythatstate spending on immigrant families
wh~
'
'.
,
become ineligible for TANF will count as
qualified spending for purpose of meeting the TANF maintenance-of~effort.
• Permit adjustments in the maintenance of effort requirements for state SS! supplements when.
caseloads decline.
-
Reconcile the "look back" dates to state AFDC programs for child welfare and Medicaid
eligibility.
We look forward to discussing these 'issues with you at our next meeting.
�amen
.U!}!~~y··
.. lhe
.
MEDICAL CENTER
.
CENTER FOR HE.aJ.TI1 POUCY RESEARCH
,
MEMORANDUM
To:
Dennis Hayashi, OCR
From:
Sara Rosenb(ium
Subject:
Proh~bitions
Date:
~
.
September 13. 1996
on Aid to Non~Citizens under Welfare Reform
The provisions ofthe Act that deny coverage for undocumented and
,future legal entrants (Section s 401 and 403) are drafted in such a way that most public
health programs (and I would guess many ~ocial service progra,ms) should not be affected'
because they do not 'serve individuaisbut instead are community-wide programs.
.
•
..'
' , $ '
..
, Despite this fact. HHS seems to be running into real problems With the justice department. .
As people fromHHS havecalled'm~ to getmy read on·thestatute. I have suggested a '
"Law 101 n approach that ,entails preparing·a side-by,,:,side chart which compares the
lang'4age of.sectIon 401 cmd 403 to each program about which there is disagreement.
Section 401: Section 401 applies tofederal public benefits that are
furnished to individuals. Specifically, Section 40 1(a)provides that "[a]ny alien who is,not
a qualified alien is nO,t eHgi~le for anyFe~eral public benefit," Section 401(c) defines a
c'Federal public benefit" as "any grant. .. provided by an agencY, ..or by appropriated funds
ofthe United States; and any·· ·benefit for which payments or assistance are provided to
an individual, household or family eligibility unit**"'''; Thus, in order to be a prohibited,
federal public benefit; the benefit must flow to an individual via an individual gT8nt or to an
eligible assistance unit:
The exceptions list in 401 does not suggest a contrary result. Inmy
opinion the exc~ptions list merely pulls out ofthe prohibited group those individual
benefits that Congress either desired to exempt or that it authorized the Attorney'General
to exempt. The exceptions categories under section 402 add nothing to the meaning
the definition under section 4 0 3 . <
.
'
,
of
9/S;"d
2021
K STREET, N.W. • SUITE 800 • WASHINGTON, DC 20006
0
.
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Dt.-nni.s Hayashi
Page 2
S<.:ph:mber 13. 1996
Section 403. Section 403 'bars future legal entrants from receiving ''federal
. means tested" benefits. There is no definition of what constitutes a federally means tested
benefit. Therefore, the Attorney General must derive a meaning for the phrase based on a
.
common-sense reading ofthe statute.'
The purpose ofthis section of the statute appears to be to end aid to
individuals who are not U.S. citizens (or whO do not fall into classification exceptions for
, qualified aliens) under programs that are designed to assist eligible individuals. The
Attorney General would be acting within ~er djscretion if she. were to derive a meaning
based on existing welfare Jaw. Under existing entitlement and welfare law, afederal means
.tested benefit would consist of benefits (whether cash or in~kirid services) that are
furnished to eligible individuals, famili~s or household units, and for which individual
eligibility is conditioned on income, Nothing about the exceptions list in Section 403
suggests a contrary result; once again, the list indicates exceptions to the individual benefit
prohibition and does not provide direct aid in defining what constitutes a federal means
tested benefit" .
Programs under the Public Health Service Act (and 1 presume other federal
programs as well) are aimed at ~Qmmunities not individuals, The 3.idflows to
community and not to any particular individual inthe commuruty. None of the programs
creates any individual right or" ~xpectation of assistance in the sense of either' Suter v Artist
M.. or Virginia HQspital Association v Wilder, In the absence of the ability of any
individtialto claim a right assistance, coupled with a statutory structure that targets
program aid to communities, J would conclude that the prohibitions do not reach these
.
.
programs.
a
to
In sum, the wording ofthe statl!te and the sparse legislative history indiCate
that neither sections 401 nor 403 describe progr~s that are appropriated to communities
rather than individuals, I can find nothing in the law that would prevent the Attorney
General from dra'Wing such a distinction under her administrative" discretion. A side-by
side comparison of the eligibility requirements of laws aimed at &QmmunHies ill
populations (e,g" health profes~ions shortages, medica] underservice, primary care
underservice) would" help the Justice Department distiIl,!,ruish between the two types of
programs"
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95 !,UG Zl
August 21, 1996
MEMORANDUM FOR THE PIWsIDENT
. FROM:
.
. SUBJECf:
carolR~~aCk~//
Status Of'?tlfare!efonn Imple,\entation
"This mem~ will update you on er0rts to ensure that welfare reform is implemented smoothly.
~<
and effectively.
e
/
.' '
. We have formed an inter-agency working grou,p!to coordinate implementation, which met for
the first time on August 9 and w ill meet on ~:.'~~ekly basis. We have established three
subgroups. One will monitor key' implen:!entation milestones, identify and resolve issues, and
ensure deadlines are met. A seco\,]D group is developing 'proposals, to expand job opportunities
for those leaving welfare. A third group will coordinate Presidential welfare events. Separate
~ork is going forward on developing proposals to~orrect the major flaws in ~elfare reform
which you have identified.
'1"
imPlem~ntatio1,iS
state~throUgh
. . .
Govern~rs' *~
ri""
One keY,element of
'':l:,ork lith·.!!)!;
the National
Asso~taUon (NGA), ~e .Natlonal C1nference of S~te Le~l~lators (NCSL), a~d t?e Arn,Wcan~~ L '
PublIc Welfare ASSOCIatIOn (APWAJ) to ensure smqoth federal'7 state commumcatlOn. , ~
Intergovernmental Affairs is coordi:b.ating Cabinet agency contact will,t state and iocal offiCials
~
qn all implementation issues. NGA\NCSL, and APWA will meet on ImplementatIOn issues ,~,
on September 9 and 10, iifuluding gOVf,rnors' senior policy staff, state legislative leaders, and
'J
state social service commissioners.' Intergovernmental Affairs is working with NGA to
negotiate the agenda of that meeting, irlhl1lding making Federal officials available for briefings.
~bgrouP
~Plementation.
·This memo summarizes the work of the
dealing with
There are a
trrmepdmJS Dumber ,Of difficult jmplergeptltjPll cMU,pges Iiised by the bill. All affected
! ! , .
f
agencies are at work developing· their own titpelines and workiplans. We will be compiling
these agency pla1\S so that there is one overaW{ramework for ¢onitoring implementation.
The following iSla list of some of the main deaalines and challenges that we have so far
identified."
\
.
,
,
,
.TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) BLOCK GRANT
,
,
~
\'
"
As you know, the bill creates the new block gran(t<? replace AFDC and requires that states
.
,
~
,
transform their AFDC systems to T ANF by July 199\7~: There are ,several maj,or issiles that w.e
will be tracking as' HHS manages this transition:.
"
A
•
,
,
t
i
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J
\
PHOTOCOPY
PRESERVATION'
.
�.
'
o
,
,
§farm
',.
.".
o
o
o
""
Early Implementation -- States have the option of implementing the block grant
immediately, and it is financially'advantageous for them to do so. Some states
may be ready to go immediately on enactment. We will be working to clarify
with HHS the process and timetable for approving these plans. You should
insJudjPi CaUfgwia w;U peed to 87i1.k apnrQ:fAL~
know that,maw
+heir state Jegj§laO'ljG§ h;tore submitting plans. No states are expected to call
speCial sessions this fall on these issues.
Regulations -- HHS is preparing a prelirniilary list of areas in which it sees a
need to regulate under the statute. We will be working with HHS to ensure
.. , ~
that the new program is aEProeriately. byt not oViirlY..[e1ll!I~. (\l\CD>.No. ~
~
+:o~,!3.~~~
)\ro
GUIdance to States -- HHS IS also consldermg Issumg guld.!l:nce to states on ow ~
to construct their new block grant plans. We will be working closelY'with HHS ~ .
on this guidance to ensure that it is useful and helpful to the states.. .
. .' . ~
. '
.' . . .'.
"
Approved Waivers --The bill lets states continue to operate existing waivers.
However, the bill's language is unclear about the scope of these provisions,
especially the treatment of work requirements and time limits. It appears that
the b'1I's d r '
intend to exem t states fro th work partici ation "\ ~
.
es bu 0
.
•
. ••
in defirun w
ac 'vitie~)&
In ad Itlon, waiver~ that apply to only a.few counties in a state cannot b~~~~
extended to the entIre state.
.'
~.~.§:;;&::~
Michig~n
.<
~.~~
As for time limits,
has waivers that do not include a time limit on
benefits and has indicated it will continue on this course in the plan it submits,
~-?·r
rather than adopt time limits as required by the bill. New Hampshire may
follow suit. Whether the intent of the waiver provisions can be clarified by
t.
.
administrative action has yet to be deterinined. Deciding upon the best course ~
.
for clarifying' the intent of the waiver provisions -- seeking legislation or ~I~~
through regulation (which would be our first preference) -- will be one oithe . ~~:~~
implementation grOup's first major issues.
4~~.~
o
o
~~~
Pending and Future Waivers -- HHS has approved eight waivers in the past
days, three of which arrived after you announced you would sign the bill (D~C~, ~~
Idaho, arid Kansas). Wisconsin is not yet apprOved. HHS is prepared to act on ~ ~
future waiver requests until July 1, 1997 should states ask for them.
. "
Other issues -- There are a whole series of operational issues the group
be
addressing including the establishment and management of the Perf~e q~
will
ijonus Fund and 1M contiDgCOC: Funl!, .
____
~~
�CHILD SUPPORT ENFORCEMENT
The bill requires an increased Federal role and significant state activity in this area. States
must have enabling legislation in place by the end of their 1997 sessions. Federal data
"'processing systems have be able to interact with state systems by October..!..997. We must
I,deyelop a registry of new hires and a case registry, and enhance the Federal Parent y?cator
, \ S~rvlce. HHS has scheduled training conferences and set up joint working groups with the
states. One change of interest is that states will no longer be required to pass the first $5~of
monthly support collections to th~ family receiving assistance as of October 1, 1996. --.J . . . .
IMMIGRANTS
lli
~_ .
~~~
Obviously,the cross-cutting impact of the immigrant provisions of the bill will be a central
concern on implementation. 'Among the key impacts:
o
Food Stamps -- Upon ,enactment, legal aliens applying for food stamps will no
longer be eligible. Immigrants currently receiving benefits will lose them at the
time of their regularly scheduled recertification. These recertifications would
. begin immediately upon enactment, with all such immigrants to be removed
~
(' from the program within one year of enactment. About 900,000 participants
'. ' 6 ~ ~
'(including 300,000 children) will be ineligible in the first year; approximately
'., 11.iu b"l\ •
250,000 Iflrticipants,williose benefits in the frrst three months after ,enactment.
~~~-"
.
o
Supplemental SecuritY Income (SSI) -- Upon enactm~nt, most immigrants who
apply for SSI will not be eligible. Current immigrant recipients wil.Lget
'pene
until th
.
ecurity Administration (SSA) determines they are no
lQDger eligible. By March 1997, A m ' 0 e 1.1 million
current recipients who IPay be leg~l immigrants and req!!.est evidence of th~:
citizenship status. If the immigrant provideS evidence that he or she is not .
eligible or fails to respond, SSA will notify the individual that benefits will be
".' . '
• :,JJJ...."\\u.
~. stopped. The amount of time the recipient has to respond to the firs~ notice ,
rro h . '»1 ~tM (' 'appears to be at SSA' s discretion, although all redeterminations mus.t,.be
.
~"
~
com,pleted With,in one ye.ar of enactment. SSA is exploring timing options, with
~,'
the intent of providing recipients as much time as possible within the law to
,
.
.'~.
.
naturalize. An estimated 300,000 to 400,000 recipients are expected to come
,
off the rolls.
,
"
,
, , '
~
~
We will be focusing on two overarching issues in implementing these and the other
immigration provisions:
o
Verification -- Developing a workable and fair system of verifying citizenship
status that meets the needs of the various systems affected is a daunting
challenge. The legislation outlines ambitious timelines, and an administration
workgroup is already at work putting proposals and options together:
3
�-.
,
.
.
..
<.'
o
Naturalization -- In anticipation of the restrictions on benefits, many immigrants
have already applied for citizenship and many more will apply as the restrictions
take effect.' INS has been working on initiatives to speed up the naturalization
,process.. The Citizenship U.S.A. initiative is designed to respond to the large 4
increase in applications and expects to naturalize 1.2 million immigrants thA' ~ ,
,
. "f}scal year. INS isalso working with SSA and OMB on a new regulation that ~~~.
. ~, "'l will waive English and civics test requirements for immigrants with certain
,,'
and perhaps establish a special waiver for many disabled
IInnugrants recelvmg SSI.'
,
'"
'~ ,
,
,
,
~_
. \I~eri~us disabiliti~s.
~
FOOD STAMPS - NON-IMMIGRANT PROVISIONS
Eligibility for 18-50 Year-old Childless Adults -'- Most able-bodied adults without children will
now be limited to 3 months of food stamps in a 36-month period if they are not working or
participating in a work or workfare program. For current recipients, this limit is effective 3
months after enactment. One million current recipients will become ineligible within six' .
months. Households remain ineligible for the balance of the 36-month period unless they
"-::
obtain work or get a slot in a job training or workfare program.
Making tlte extensive changes to their computer systems to determine the eligibility of
individuals who are dropped from the rolls and to track new recipients against the time limits
will be a major implelllFntation challenge to states.
Benefit Leyels '-- Changes to the standard, income deduction and the excess shelter deduction
Will reduce benefits for nearly all of the 25 million monthly participanj!). Food stamp
allotments will still increase under these changes, but much less than under prior law. The
( impact increases over time -- by 2002, average benefits will be nearly 20% lower.
These prQvisions involve relatively simple computer changes. ' The'Department of Agriculture
(USDA) expects most states will be able to implement them on October 1 and January 1,
respectively, without delay. "
'\
'
OTHER KEY PROVISIONS
~
SSI for Children -- The bill tightens SSI eligibility for children with disabilities. Upon
enactment, new applicants who do not meet the new standard will be ineligible. Current
recipients will get benefits until SSA makes a redetermination that they are no longer eligible.
Children whose cases must be reviewed will receive notices by January 1997. Those found no
longer eligible will be sent a notice that benefits will be stopped. In certain cases, benefits
may continue until the first level of appeal is completed. The bill calls for all redeterminations
. to be completed within one year of enactment. An estimated 285,000 initial notices will be
sent and an estimated 190,000 children are expected to come off the rolls. SSA is working on,
the plan .for the timing of the release of the first notices and the subsequent processes.
,
L!
, :;j
~~'r~,
~c.:.~~~_
.
4
'
'
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.
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~~~V~~~·~
~
~
Medicaid -- The Medicaid program faces two major challenges in implementation: (1)
deli~ing eligi~ili~y for ~edicaid from the welfar~ syst:m,. and ~2? as~~ssi~g the ~pac.!..on
pendmg and eXlstmg waivers. The Health Care Flnancmg AdmlDlstratlon IS' working closely
with other parts of HHS and with SSA to meet these challenges.
' "
,
"
,~,
c~ild
programs~
~
Child Care -- The bill block grants several
care
effective at the J?eginning c;f8",
the fiscal year. Whil~ these chan~es are mostly positive, the timeframe for implementation is ~ ~
challenging. .
•.•
..
~6fr,4 .
. ...
*~~
Monitoring and Evaluation -- One key overarching issuewilJ be to ensure that agencies are
......
aRd..
capabilities to identify
~~ ~tie~e llldllll.duals and tnStltutl0ns~
r~bljsbin~~ffect~~ ~~atigR,
JOB OPPORTUNITIES
,
~act o~~..t,'
.
m~n;~
%
,
The interagency working group on the welfare jobs issue is nearing completion of a packag~ of
options. At this point it appears that the components will likely be: about $1 billion in
enhancements to the Work Opportunities Tax Credit passed in the minimum wage bill; a $100
million expansion of the Community Develpoment and Financial Institutions program to
enhance economic development in distressed areas; a $1.bjUjOD spending pmgnp:n to place one
'<L, / miIJ jon hard-ta-employ welfare recipients in unsubsidiezed jgJ>s, with the key feature of
,.
~ withholding full paymen~ to States until successful job place~ent andJetention. -.. .
.e -\
'"
:'.','
.. ,',"
NEED FOR LEGISLATION
G.,~~~\j ~~ ~lk~,
Work has begun on developing proposals to correct the major flaws in the welfare reform bill:
Among those you have noted are: (I) the too-deep cuts in the Food Stamp Program, including the
cap on the amount that can be deducted for shelter costs when determining an individual's
eligibility; (2) the denial ofFederal assistance to legal immigrants and their children, and the
state option to do the same; and (3) the failure to provide Food Stamp support to unemployed
childless adults who are willing to work, but not offered a work slot.
------.
----..,.
v{, ( ...t
~
Additional issues requiring corrective action include: (l) the failure to provide sufficient
contingency funding for States that experience a serious economic downturn; and (2) the lack of
a provision for in-kind vouchers for. children whose parents reach the five-y~ar Federal time limit
without finding work.
~, '\1_ ~~
,... "
__
I>
~t-~~\j~
CONCLUSION
~~~,~
We will keep you up to date on developments as we go forward .
:e
. >•.
cc: Leon Panetta
5
J..,
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, '
'~~
.,.
~~
L. ~,
,
�
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Carol Rasco - Issues Series
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Carol Rasco
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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c8d1952874e684d1c7d91a9288c0989e
PDF Text
Text
,
:
---
---., ---
____ A
_____
-
.~
'
Summary of Provisions
Personal Responsibility and. Work Opportunity Reconciliation Act of 1996 (ILR. 3734)
Prepared by the Office ofthe Assistant Secretary for Planning & Evaluation, DR.lI.S.
...
,
,
TItle I; Block Grants fOr Temponu:y Assistance for Needy lamDies
•
BloC;k Granting AFDC and JOBS: The bill block grantc; AIDe, Emerg(mCY Assistance
(EA): and JOBS into a single capped entitlement to states. There is a separate allocation
specifically for ohild care.
•
IndividQal Entitlement: No individual guarantee, but the state plan must have
"objective criteria for ,delivery of benefits and determining eligibility" and provide an
uexplanation of how the state will providc opportunities for recipients who have Qeen
adversely ~ectc(.1 to t>e heard in an,Sppehl process." There are no provisions to give the
Secretary authority to enforce this requirement
•
Time Limits: Families who have been on the rolls for S cumulative years (or less at state
option) would. be ineligible for cash aid. States would be pennitted to exempt up to 20010
of the caseload from the time limit Exemptions from the time limit would be allowed for
individuals living on Indian reservations with '8 population of at least 1.000 and an
unemployment rate ofat least 50 percent. states would not be permitted to use' federal
block grant funds to provide noncash benefits (e.g., vouchers)to children that reach the
five-year lime limit. Title XX monies could be used to provide non-cash assistance to
families after the fe.deral time limit State funds that are used to count toward the
mainteriance ofeffort requirements may be used to provide assistance to families beyond
the federal time limit
•
•
.Block Grant Funding: The total cash assistance, block grant is estimated to be $16.4
from FY 1996 to FY2003. Each state would be allotted a fixed
billion for 'each
, amount - based on expenditures for AFDC benefits and administration, Emergency
Assistance, and JOBS - equal to the greater of: . (1) the average of federal payments for
. these programs in FYs 1992-94; (2) 'federal payments in FY 1994; or (3) federal
payments in FY 1995. states could carry over unused grant funds to subseq~nt fiscal
years.
year
Work Requirements: As part of their state plan,' states must demonstrate that they will
require families to work after two years on assistance. However, there are no penalties i(
a state does notmeet this requirement. A state's required work participation rate for all
families would be set at 25% in FY 1996, rising to 50% by FY 2002 (states would be
pen~d for not meeting these rates). The bill provides pro rata'reduction in the
participation rate for reductions' in caseload levels below FY 1995 that are not due to
eligibility changes. The rate for two-parent fumiHes increases to 90% by FY 1999.
AlIguJt
9. 1996 (JO.38am)
page 1
-.
�Single-parent recipients would be required.to participate at least 30 hours per week by FY
2000. Smgle parents with a child under age 6 -WOuld be deemed to be meeting the work
requirement::;lfthey.worle 20 hoUrs per week. .Two..parerii families must work 3S hours
per week.. Single parents ofchildren under age 6 who cannot find child care cannot be
penalized for failur~ to meet work requireinents. States could exempt from the work
. reqUirement single parents with children wider age One aDd disregard these individuals in
the 'calculation ofp8rticipation rates for up to 12 months. For two-p~t fa:milies, the
second spouse required to participate 20 hoUl'S. per week in work activities ifthey
. receive federally funded child care. (and are not disabled Or caring for a disabled child).
Individuals who receive assistance for 2 months and are not working or exempt for the
work x:equirements would be reqUired to participate in community service, with the hours
and tasks to' be deterniined by the state (states could opt-out of thiS provision). ,
is
•
'Vaiven: A state which had waivers ~ted under Section 111 5 (or othCrwise It!lating
to the AFDC program),bcfore July 1. 1991 would have the option ofcontinuing to ~
operate its cash assistance program,under some or all ofthese waivers. If a state elected
this option with respect to some or all of~ts waivers, the provisions of the welfare refonn
legislation which were inconsistent With the continu~ waivers would not take effect until
.the expiration ofsuch waivers excep,t that the new child care pro\isions would apply
immediately (billiunguage is unclear; this section may be subject to different
interpretations). States which have waivers approved after the date ofenactment must
also'meet.the V'lork requirements, even ifmconsistent. States operating their programs
under waivers would·still receive their block grant amounts.
,.
•
Work Activities:
count toward the work requirement, individuals would be required
to participate at least 20 hours per week in unsubsidized or subsidized employment, OQ
the.job training, work experience, community service, 12 mo.t:lths of vocational training,
or providing chUd ,care services to indiyiduals who are participating in community
service. Up to 6 \veeks of job search (no more than 4 conse.::utive weeks) would count
toward the requirement; except that states with unemployment rates at least 50 percent
above the national average may count up to 12 weeks ofjob search. Teens (up to age 19)
in secondary school would also count toward work requirement. However, no more than
20 perCent of the caseload could count toward the work requirement because they were
participating in vocational trainirig or were a tee·n parent in secondary school. Individuals
who bad been sanctioDed (for not more than 3 of 12 months) would not be inclUded in the .
.
denominator of the rate.
•
SupplemeotalFunds:The bill establishes 8$2 billion contingency fund. State spcnding
(by eligible states) on cash assistance mid work programs above the FY 19941cvels (not
including child care) would be matched at the MediCaid rale to draw down contingency
fund dollars. States could meet one oftwo triggers to access the contingency fund: 1) on
unemployment rote for a3-month period that was at least 6.5% and 110% of the rate! for
the corresponding period in either of the m'o preceding calendar years.; or 2) a trigger
To
page 2
�based on food stamps. Under the second trigger, a state would be eligible for the
contingency'fund if its 'food stamp ~eload increased by 10% over the FY 1994-1995
level (adjust~d for the unpact of the hill's 'immigrant and food stamp provisions on the
food stamp caselo8d). PaYments frOm the fund for any fiscal year would be limited to
20%'of the state's base grant f~rtb8t year. A state could draw down moretban 1112 of its
rnaxi.D:tumann,Ual contingency fund amount in a given month. A state's federal match
rate (for drawing down contingency funds):would.be reduced if it received funds for
fewer than 12 months in any year. The bil1 also includes: 1) an $800 million grant fund
fur states with exceptioDauy high population growth, benefits lower tfum 35% ofthe:
nntionol average, or above average growth and below average AFDC benefits (no state
match) and; 2) a S1.7 billion loan fund.
•
Maintenance of Effort: Each State would be required to maintain 80% of FY 1994 state
spending on J\.FDC arid related programs..:.;, For states who meet the work participation
'requirements, the maintenance ofeffonprovision would be reduced to 75%.
•
Transfers: A state would be pennitted to transfer up to 30010 ofthe cash assistance block '
grant to the child care block grant and/or the Title XX block grant. No more than one
third oftransferred amounts could be to Title xx, and all funds transferred must be spent
on children and their familiesvvhose income is less than 200 percent ofthe poverty line..
•
Penalties: The penalties that could be imposed on states would include the following:
(I) for failure to meet the work participation rate, a penalty of S% ofthe state's block
grant in the first year increasing by 2 percentage'paints per year for each consecutive
failure (with a cap of21%);(2) a 4% reduction'for failure to submit required reports; (3) .
up to ~ 2% reduction for failure to participate in the Income and Eligibility Verification
SyStem; (4) for the misuse of n.m.ds, the amount offunds misused (if the Secretary of
HHS were able to prove: that the misUse was intentional, an additional penalty equal to
5% of the block grant would beiroposed); (5) up to a 5% penalty for failure, by the
agency administering the cash assistance program. to impose penalties requested by the
child support enforcementagency;(6) escalating penalties of 1% to 5% of block grant
payments for poor performance with respect to child support enforcement, (7) a 5%
. penalty for failing to comply with the 5-year limit on assistance; and (8) a 5% penalty for
failing to maintain assistance to a parent who cannot obtain child care fora child under
. age 6. States that are penalized must expend additional state funds to replace federal
grant penalty reductions. .
.
•
Personal Responsibility Agreement: States would be required to make an initia1
assessment of recipients' skills. At state option. Personal Responsibility Plans could be
developed,
,A"(iU1t
9. 1996(1Q:3(/0"l)
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an
Teen Parent Provisions: Unmarried minor parents would be required to live with
adwtor in an adu1t~supervised settilig and participate in educational and training "
, activities in order to receive ass_Ceo States would be responsible for locating or
assisting in locating adult-supemsedsetttng for teens, but there are no additional funds
for "second chance homes."
•
Teen Pregnancy: The Secretary ofHHS to establish and implement a strategy to: (1)
prevent non·marital teen:' and (2) assure that at least 25% ofcommunities have teen
pregnancy prevention progl'ams. The Department Vvill have report to Congress annually
in respect to the progress in 1hese areas. No later than January 1 1997, the Attorney
General shall establish and implement a program that provides research, education and ,
training on the prevermon and prosecution of statutoI}' rape. '
,
j
•
Performance Bonus to Reward Work: The Secretary ofHHS, in consultation }Vith
NOA and APWA, wow4 be required to1ievelop a formula measuring state pc:rf01Ill8Ilce
relative to b10ck grant goals. States woUld recejve a bonus based on their score the
measUre(s) in the predous year. but the bonus could not exceed 5% of the family ,
assistance grant. S200million per year wouid be available for pcrformance bonuses (in
addition to'the block grant), for a total of $1 billion between FYs 1999 and 2003.
on
•
Family C~p: No provision. States implicitly have complete flexibility to set family cap
poHcy.
•
UJegitimHcy Ratio: The bill establishes a bonus for states who demonstrate that the
number of out-ofwedlock births that occurred in the state in the most recent two-year
period decreased compared'to the numherof such births in the previous period (,without
an increase in abortions). The top five states would receive a bonus of up to $20 million
each. Ifless than five states qualify, the grant would be up to $25 million each. Bonuses
are authorized in FYs 1999 • 2002.
•
Persons Convicted of Drug-Remted Crimes: Individuals who aftertbe date of
enactment
conVicted ofdrug-related feionies will be prohibited for life from,receiving
benefits Wlder the temporary assistance for needy families and food stamps programs.
Pregnant women and individuals participating satisfactorily in drug treatment programs
.'
are exempted. States may opt out ofthis provision.
me
lith; II; Supplemental Security Ipcome
•
Disability Defmition for CbUdren: Provides a new definition ofdisability for children.
Under this new definition, a child will be considered to be disabled ifhe or she has a
medically determinable physicru or mental impainnent which results in marked and sever
functional limitations, which can be expected to result in death or which has lasted or can
be eXpeCted to Last for at least 12months. In addition, this bill instructs SSA to remove
AUgJJI9,
1996 00:38am)
page 4
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references to ~daptive ~vior as Ii medical criteria in its listing of impairments used
for ~valuating :m~tal disabilit;.es in childlen..All ofthese provisions will apply to new
claims filed on or after enactment
to all claims that"have not been finally adjudicated
.(including cases pending' in the courts) prior to the enactment ofthe bill. SSA is also
required to redeterritinc the cases ofchilctren CUIl'eD.tly receiVing S8I to determine
whether they meet ~e new definition of disability.
.
and
•
Redet~rminations: Redeterminations ofcurrent recipients must be completed during the
year following the enactment of the bill. The earliest that a child cu.rrently receiving SS!
could lose benefits woUld be July 1, 1997,' If the redetermination is made after that date,
. '~en bet:J,efits would end the month following the month in which the redetennination is
made. SSA is required to· notify all children potentially affected by thecbange in the
definition by January!, 1997, .
An additional $150 million forFY 1m,"'and $100 million for FY 1998 is authorized for
continuing disability reviews and redetenninations.
•
Benefits: For privately insured, institutionalized children, cash benefits would be limited
lo $30 per month. Requir~s that large retroactive SSI payments due to child recipients be
deposited into dedicated savings accounts, to be used only for certain specified needs
appropriate to the child's condition.
Provides that large retroactive benefit amounts would be paid in installments (applies to
children and adults).
Title III: Child Support
•
Child Support Enforcement Program: States must operate a child support
enforcement program meeting federal requirements in order to be eligible for the Family
Assistance Program.· Recipients must assign rights to child support and cooperate with
. pateinity establishment efforts. Distribution rules are changed so that families no longer
on assistance have priority in receipt of child support arrears. Current law $50 pass.
through is not required.
•
Establishing Paternity: Streamlines the process for establishing pateql.ity and expands
the in-hospital volWlttu"y paternity establishment program.
•
State Requirements: The bill requires states to establish central registries of child
support oiders and centralized collection and disbursement units. Requires states to have
expedited procedures for child support enforcement..
August 9. 1996 (lO:38am)
page 5
-.
-.
�Establisltcs a Federal Case Registry' and National Directory ofNew Hires to track
obligors across stateS lines. Requires that employers report all new hires to state agencies
and new hire information to be transmitted to the National Directory ofNew Hires.
, Expands and streamlines procedmes for dircct withholding ofchild support from wages.
Provides for uniform niles; procedures, and forms for interstate cases.
Requires state.c; to have numerous new enforcement techniques, including the revocation
ofdrivers and professional licenses for delinquent obligors.
i
Provides grants to states for access and visitation programs.
Title IV: Restrictin2 Welfare and Public Benefits fOr Aliens
•'
5S1 and Food Stamps: Most legal ifilllllgrants (both current-and future. and inCluding
current recipients) would be banned until citizenship (exemptions for: refugeeslasylees,
but only for first.s years in eouittIy; veterans; and people with 40 quarters). Cut-off
current recipients immediately based on rolling redeterminations within a year after
enactment.
•
Medicaid, AFDC, Title XX Social Services, State-funded Assistance: States would
haye the option to ban until citizenship most legal immigrants already in the U.S.,
including current recipients (with same refugeeJasylees, et.al. exemptions as above).
Current recipients would be eligible to continue receiving benefits until January 1, ]997.
•
Future Immigrants (entering after enactment): Must be banned for five years from
most fedem1 means-tested programs, including Medicaid (exemptions below).
•
New Verification Requirements: Imposed on all applicants and on virtually all federal,
State, and local programs in 'order to deny all benefits to non-:qUalified (or illegnJ) alicns
(except: emergency medical; short·tcrm disaster; limited public health for immunizations
and communicable diseases; non-profit, in·kind commtq1ity services such as shelters and
soup kitchens; certaib. housing programs; and schoolluncheslbreakfasts if the child is
eligible for a free public education)~ States would have the option to provide or deny
WIe and other child nutrition and com.i:nodity benefits. Definition ofqualified alien
more~owthan current PRUCOL and AdmiIlistration's proposal. Not later than 18 '
months after enactment, the Attorney General in Consultation with the Secretary ofHea1th
and Human Services shall issue regulations requiring verification. States that administer a
program that pro\ides a Pederalpublic benefit have 24 months after such regulation's are
issued to implement a verification system that-complies with the regulations.
Aut;Ust 9, /996 (JO:38am)
page 6
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•
Deeming: For sponsorsfunmigrants signing new, legally binding affidavits of support
(which are to be promulgated by the Attorney Oeneml90 days after enactment): extend
deeming ttntilCitizenship; change' deeming' to count 100 percent ofa sponsors income'
and resources; and eXpand the number of pro'grams that are required to deem, including
Medlcaid{eXemptions below). These ~es are effective immediately with regard to
prognims that. currently deem, and effective 180 days after enactment for programs that
do not currently deem. However,smce the new deeming rules apply only to
sponsorsfLmIDigrants who have signed the new affidavits ofsupport, and new entrants are
.generally barred from receiving benefits.for their first S years in the coun1Iy. these new
deeming rules and effective dates will be relatively irrelevant in practice..
•
Exemptions (from S-year ban on future immigrants and deeming):
)
.
People Exempted: Refugees/asylees, veterans, and CubanlHaitian entrants receiving
__:.F~
.
.
refugee/entrant assistance.
.
.
'
. Programs Exempted: Emergency medical; short-term. disaster; school lunch; \VIc/child
nutrition; limited public health for immunizations wid communicable diseases; payments
. for foster care; non-profit, in-kind community senices such as she'tters and soup' kitchens;
programs of student assistance under Higher Education Act and Public Health Senice
Act; means-tested elementary and secondary education programs; Head start; and ITPA.
Title Y: Child Protection
•
. Provisions: Block grant provisions have been dropped. CUlTent provisions are: (1)
. authority for states to make foster care maintenance payments using IV-E funds on behalf
of children in for-profit child care institutions; (2) extension of the enhanced federal
match for statewide automated child welfare information systems tluough·1997; (3)
appropriation of$6 million per year in each ofFYs 1996 - 2002 for'a national random
sample study ofabused and neglected children; and (4) a requirement that states consider
. giving preferencefor kinship placements. provided that the relative meets state standards.
Title VIi Child Can:
•
Funding: The bill authorizes $13.9 billion in mandatory funding for FYs 1997·2002.
States would receive approximately $1.2hillion of the mandatory funds each year. The
remainder would be o.vwlable for staiematch (at the Medicaid rate). Requires states to
maintain 100% of FY 1994 or FY t 995 child care expenditures (whichever is greater) to
draw down the matching mandatory' funds. Also authorizes $7 billion in discretionary
funding for FYs 1996·2002.
.
A "gU3( 9, J 996 (10' 3!Jrlf'f')
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Health and Safety Protections: Retains current law requirement that all states establish
. health'and ,safety standards for prevention and Control of infectious diseases including
irnlnl,Ulizations. building and physiCal premises Safety, and minimum health and safety
traming. Health and safety'protections apply to all federally funded child care.
•
Quality: Provides not less than 4 percent of the total consolidated mandatorY and .
discr~onary funds. Appropriate activities under this set-aside include consumer
education, enhancement ofparental choice. and improvement ofthe quality and
availability of child care (such as resource and referral services).
•
Entitlement to, Child Care: The bill provides no child care guarantee, but single parents
with children Under 6 who cannot find child care wouid not be penalized for failure to
engage in worle activities.
Title VU: Child Nutrition Promms
•
AlienEJigIDllity: The bill makes individuaIswho are eligible for free public education
benefits under state or loc.allaw also eligible for scbool meal.benefits under the National
School Lunch Act and the Child Nutrition Act of 1966. States would have the option .to .
, provi~ or deny WlC and other chiid nutrition benefits.
•
ReimbursementRJttes: Effective for the summer of 1997. reduces maximum
reimbUrsement rates for institutions participating in the Swnmer Food Service Program to
$1.97 for each lunch/supper,,$L13 for each breakfasl, and'46 cents for each
snack/supplement. , Rates are adjusted each January and rounded to the nearest lower
cent.
Restructures reimbursements for family or group day care homes under the Chlld Care
Food Program to better target benefits to homes serving higher proportions of children
below poverty and reduces reimbursement rates for tier n homes to 95 cents for
lunches/suppers, 27 cents for breakfasts, and 13 cents for supplements.
"
.
.
'
ROllIlds down to the nearest cent when indexed the reimbursement rates for full price,
meals in the school breakfast and school lunch programs and in child care centers, and
'rates for the special milk and commodity assistance programs.
•
Other Provisions: Eliminates School Breakfast start-up and cxpansion grnnts. Makes
funding for the Nutrition EducatiQn and Training (NET) Program discretionary.
A"Cl4Jt 9, 1996 (10: 380'") .
page 8
�DUe ym; Food Stamps and Commodity Distrlbuti.on
,
,
•
'
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Alien Eligibility: Most legal imniigrants (both current and future, and including CWTent
recipients) WQuld'bC banned until citiienship (eXemptions for: refugeeslasylees, but only
for ,the first five yea,rs in the U.S.; vetenuls; and people \\ith 40 'quarters ofwork). Cuts
off current recipients immediately based on case redetenninafions within a year. Future
inmiigrants mUSt be baimed for five years (~xemptions as noted earlier).
For sponsorsf1l1lllligrants signing new legally binding affidavits of support: extends
deeming 'until citizenship; and changes 'deeming to' count 100 percent ofsponsor's
income'and resources.
•
'
Maximum Benefit Levels: Reduces maximum benefit levels to the cost of the Thrifty
'Food Plan and maintains indexing. '
•
Income and Deductions: Retains the cap on the excess shelter deduction and sets it at '
, $247 through i2l31196; $250 from 111191 through 9130/98; $275 for FYs 1999 and 2000;
andS300 from FY 200I'on. Free7~ the standard deduction at the FY 1995 level of $134
for the: 48state:s and DC;nnd makes similar reductions for other: areas. Includes as
income for the Food Stamp Program eru:rgy assistance provided by state and local
government entities. Lowers the age for exclUdingfrom'income the earnings of
elementary and secondary students from under age 22 to those who are 17 and under.
Requires individuals 21 and under living with a parent to be part ofthe parent's
household.
'
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'Vork Requirements and Penalties: Establishes a new work requirement under which
non-exempt 18-50 year oids without children would be ineligible to continue to receive
food stamps after thrce months in 36 unless they are working or participating in a
workfare, work, or employment and training program. Individuals may qualify for three
" additional months out of 36 if they have worked or participated in a work or workfare
program fat 30 days and lose that placement. Pcnnits states with waiver requests denied
by August 1 1996 to lower the age at 'Which a child exempts a parent/caretaker from food
stamp work rules from 6 years to 1 year old.
J
•
Program Integrity alld Additional Retailer Management Controls: Doubles recipient
.penalties for fraud violations to one year for first offense and two years for second '
offense; peimanently disqualifies indi'viduals 'convicted of trafficking in Food Stamp
benefits of$500 or more; disqualifies for 10 years those convicted of fraudulently'
recehing multiple benefits; mandates state participation. in the Federal Tax Refund OITset
Program (FTROP); allows retention of 35% of collections for fraud claims and 20% for
other client error claims; and allows allotment reductions for claims arising from state
agency errors,
August P, 1996 (lO:38am)
, page 9
�•
The bill also requires a ~ting period for retailers denied approval; permits
disqualification ofretai1ers'disQualified underWIC; expands criminal forfeiture; permits
permanCnt disqUatitiawon 9f reW1eril who hrtentionally submit falsified applications;
and iriiproves USDA"s ability to monitor authorized slores.
•
eliDd Support;, Gives states the option to require cooperation with Child Support
Enforcement agencies'for~odial and nori-custodial parents. Permits states to
disqualifY non;-custodial parents with child support orders who are not paying support.
•.
Work Supplementation: Pennits private sector employment initiatives that cash-out
benefits to certain employed participants.
.
•
Program Flexibility and Simplifica~on: Simplifies program: administration by .
eXpanding states' fleXibility iIi seumg customer service requirements. Allows states to
subm.it Standard cost allowances to use in calculating self-employment income;
eliminates fedenil stan4ards applyingt6hours ofoffice operation; deletes detailed federal
. requirements over application form; deletes detailed fedei'al customer setvice over areas
,such as ton·fr~ telephone numbers; extends expedited service processing period to seven
days and extends expedited service oruy to homeless persons who meet financial criteria;
makes use of the incomcond eligibility verification system (IEVS)and the immigration'
, status verification system (SAVE) option:aI; permits states to deternrlnetheir own training
needs; and authorizes the Simplified Food Stamp Program, through which states can
employ a single set of rules for their 'state caSh assistance progmms and the Food Stamp
Program. Expands Food Stamp waiver authority to permit projects that reduce, within set
parameters, benefits to families. Cash-out of.benefits is prohibited under the new waiver
authority.
•
Asset Limits: Sets and free7.~s the Fair MarketValue for the vehicle allowance at $4650.
•
EHT: Requires EBT implemenlatiou by all states by October 1,2002, unless waived by
USDA. Exempts Food Stamp EHT from the requirements ufRegulation E.
•
Commodity Progra~s: Consolidates the Emergency Food Assistance Program and the
,Soup KitchenIFood Bank Program; provides for $100 million in mandatory spending in
the Food Stamp Act to purchase commodities. Provides for state option to restrict
benefits to illegal aliens.
Title IX: Mi:!cellaneQUs
•
Title XX -- Social Services Block Grant: Annual funding for the Social Services Block
Grant would be reduced from $2.8 billion in FYs 1990-1995 to $2.38 billion (15%
reduction) in FYs1996-2002, and returning to S2.8 billion in FY 2003 and each
succeeding fiscal year. NOh-cash vouchers for children that become ineligible for cash
. assistance under Title IV-A time limits are authorii.cd as an allowable use of Title XX
funds.
August 9, 1996 (lO:38am)
page 10
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Abstinence Education: Starting in FY 1998, $50 million a year in mandatory funds will
be added to the appropriations ofthe Ma.te1lUII and Child Health (MeH) Block. Grant.
The funds would be allocated to states using the saine formula used for Title V MCH
block grant funds.. Foods would enable states to provide abstinence education with the
. option of.targetmg
funds to high risk groups (i.e•.groups most likely to bear children
·out-of-wed1oek). Education activities are explicitly defined
the
•
Drug Testing:. Nothing in federal law shall prohibit states from performing drug tests
'on AFDC recipients or from sanctioning recipients who test positive for controlled
substances.
August 9, /996 (JO:38am)
page 11
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THE WHITE HOUSE
Office of'th 7 Press
s~cretary
August 22,
For'Immediate ,Release'
1996'
REMARKS ,'BY THE PRESIDENT
AT THESIGNniG,'OF THE
PERSONAL RESPONSIBILITY AND
WORK OPPORTUNITY RECONCILIATION ACT
ThEi Rose Garden
11:15 A.M. EDT
THE PRESIDENT:: Thank you very much. Thank. you very
'much. Lillie, thank you.' Thank you, Mr. Vice President, to the
mel!lbers of the Cabinet. All o,f the' members of Congress who, are here,
thank you very much.
I'd like to say to Congressman Castle, I'm espeCially
glad to see you here, because eight years ago about this time when
you were the Governor of Delaware and Governor Carper was the '
Congressman from Delaware, you and I were together at a signing,like
this.
'
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Thank you, Senator ,Long, for coming here.
Governors Romer, Carper, Miller'and Caperton.,
Thank you,
I'd also like ,to thank P~nelope Howard 'and Janet Ferrel
for coming,here. They, too, have ~orked' their way from welfare to
independence and we're honored to have them ,here. I'd like to thank
all of the people who worked on this bill who 'have been introduced
from our staff and Cabinet, but I'd' also like' toe,specially thank
Bruce Reed, who did a lot to do with working on the final compromises
of this bill: I thank him.
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Lillie Harden was up there talking, and I want to tell
you how she happens to be, here today; Ten years ago, Governor Castle
and, I were asked to cochair'a Governors Task Force on Welfare Reforra,
,and we ,were asked together on it, and when ,we met at ,Hilton Hf1lad in
south Carolina, we had a little panel. And 41 governors showed up to
listen to people who were, on welfare fro:n several states.
So I asked Carol Rasco to find me somebody from our
state who had been'in one of our' welfare reform programs and had gone
to. work. She found Lillie Harden and Lillie .showed up at the
program. And I was conducting this meeting and I committed a mistake
that they always tell lawyers never to do: never ask a question you
'do not know the answer to., (Laughter.)
,
But she was doing so well talking ,about i't, as you saw,
how well-spoken she was todl1y--and I said, "Lillie, what's the best
thing about being off welfare?" And she looked me straight in the
eye and said, "When ,my ,boy goes ,to school and they say what does your
mama do for a living~'he can give an'answer." I have never forgotten
that. (Applause.) And when I saw th~ success of all of her children
and the success that she's' had in the past 10 years, :+ can tell you I,
YOU've had a bigger impact ,on me than I've had on you. 'And I thank
you for the power of your example, for your family's. And for an of
America, thank you very, much. ,(Applause.)
What we are trying to do today is to overcome the flaws
of the welfare system for' the people who are, trapped on it. We all
MORE
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know that the typicai family on welfare today is very different from
the one that welfare was designed to deal with 60 years ago, 'We all,
know that th,ere are a lot of good people on welfare who just qetClff
of it in,the ordinary course of business, but that a ,significant
number 'of people are trapped on 'welfare for a very long time, exiling
them', from the entire' community of work that gives structure to our
lives",'"
,
Nearly 30 years ago, Robert Kennedy said, "Work is the,
meaning of what this country isal! abe>ut. We need it as ,
'
individuals, we need to sen'se it ,-l,n' our fellow citizens, and we need
it as a society and as a l?,eople;lI, 'He was right then, and it I S right
now.
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From now on, our nation's answer to this great social
challenge will no ,longer be a never-ending cycle of welfare, it will
be the dignity, the power~nd tne ethic of work. Today, weare
taking an historic chance to make welfare what it was meant t9 be: a
second chance, not a wayof,life.
\
The bill ,l'm about to sign, as I have said many times,
is far from perfect, but it has:,come a very long way. Congress sent
me two previous bills that I strongly believe failed to protect our
children and did too little to move people from ,welfare tCl work., I
,vetoed both of them. This -bill had broad bipartisan support and is
mUCh, much ,better on both'counts.
,
The new'bill restoresHAmericals basic bargain of
providing opportunity' anddeman",ing in return responsibility. It
provides $14 billion for child, care, $4 billion more 'than the present
law does. It is good because without the assurance' of ,child care
it's all but impossible for a mother with young children to go to
work. It requires states to maIntain their own spending on welfare
reform, and gives them powerful performance incentives to place more
people on welfare, in jobs. It gives states the, capacity to create
jobs by taking money now used for welfare checks,' and giving it to
employers as subsidies as incentives to hire people; This bill will
help people to go to work so'they can stop drawing a welfare check
and start drawing a paycheck.','
' ,
It I S also better for. children. It preserves the
,
national safety net of food stamps and school lunches. It drops ,the
deep cuts and the devastating changes in child protection, adoption,
and help for disa~led children. It preserves the national guarantee
of health care for poor children, th~ disabled, the elderly, and
people on welfare -- the most im~ortant 9reservation of all.
,
It in~ludes the 'tough child supportenforcemerit measures
,that, 'as far as I know, every,mel!lber of Congress and everybody ,in the
administration and, every thinking person in the country has supported
fOr more than two'years.
'
It's the most sweeping crackdown on deadbeat parents in
history. We have succeeded in increasing child support collection 40
percent, but over a third of the cases where there's delinquencies,
, involve who cross state l'ines. For a' lot of women and children, the
only reason they're on welfare today -- the only reason -- is that
the father up and walked away when he could have made a contribution
to the welfare of the children. That is wrong. If every, parent paid
the child support that he or she owes legally today, we could move
800, 000 women and children off'/welfare immediately.
'
With this bill ,we 'say, if you don't pay the child
, support you owe we'll garnish your wages, take away your driver's
license, track you across state lines~ if necessary, make you work
off what you pay -- what you"owe., It is a good thing and it will
,help dramatically to reduce 'welfare, increase independence, and
reenforce parental responsibility. (Applause~)
, MORE
�....
I,
,
,
- 3
As the Vice President said, we ,strongly disagree with ,a'
couple of' provisions of this bill. We believe that the nutritional'
cuts are too deep, ,esp~cially as they affe'ct' low-'income working
people and children. We should not be, punishing people who are
,
working for a living already; we should do everything we can to lift
them up and keep them at work and help them to support their '
children. We also believe that the congressional leadership insisted
in cuts in programs for legal immigrants that ,are far, too deep,.
.'
. "
"
'These cuts, however, have nothing to do with the
fundamental purpose of welfare refo'rm. I signed this bill because
this, is an historic,chanc'e -- where Republicans and Democrats got
together ,and said" we're going tot,ake this historic chance to try tq,
recreate the nation's social bargain with, the poor. We're going to
try tochanqe the para1!leters of the ,de,bate. We',re going to make it .
,all new again and.see 1f we can't,create a system of incentives which
reenforce work and ,family and independence.
,'
We can change what is wrong. We should not have passed
,
this historic opportunity to do what is right. And so I want to ask
all of you, without regard to party, to think through the
implication,S of these other non:"welfare issues on the Alnerican people
and let's work together in good' spirits ,and good faith to remedy what
is wrong. We can balance the budget ,without these cuts, but let's
not obscure the fundamental purpose of the welfare provisions of this
legislation which are good and solid, and which can 'give us at least
the chance ,to end the terrible, almost physical isolation of huge
numbers of poor people and their children from the rest of mainstream
i\merica. We have to do that. (APPlaufe.)
,
Let me also say that there's something really good about
this, legislation. When I sign it we all have to start again. , And
this becomes everybody,' s responsibility. After I sign my name to
this bill, welfare will no longer be a political issue. ,The two
parties cannot attack each other over it. Politicians cannot attack
poor people over it. There are no encrusted habits, systems and
failures that can be laid at the, foot of someone else.< We have to
begin again. This ,is not the end of welfare reform, this,is the
beginning. And we have to all assume responsibility. (Applause.)
)
Now that we aresayinq with this bill we expect work, we
have to make sure the people have a chance togo to work. If we
really value work, everyb,ody in thIs society -- businesses, non
profits, ,religious institutions, individuals, those in government
all have a responsibility to, make sure the jobs are there.
These three women have great stories. Almost everybody
on welfare would like to have a story like that. And the rest of us
now have a responsibility to give them that story. We cannot blame
the system for the jobs they donlt have a~ymore. If it 'doesn't work
now, it's everybody'S fault -- mine, yours, and everybody else.
There is no longer a syst,em in the way. (Applause.)
I've worked hard over the past four years to 'create jobs
and to steer investment into places where there are large numbers of
people on welfare because there I s bee,n no economic recovery. That IS
what ,the empowerment zone program was all about., Thatls what the
community development bank initiative was all about. That's what our
urban Brownfield cleanup initiative was, all about -- trying to give
, people the means to make a living in areas that had been left behind.,
I think we have to do more h~re in washington
that, and I III have more to, ,say about that later. But let
again, we have to build a new work and 'family system.' And
everybody'S responsibility nqw~ The people on welfare are
just like these three people we honor here today and their
MORE
-_
."
.. ,
,
to do
me say
this is
people
families.
�-4
They are human beings.' And we owe it to all of them to give them a
chance 'to come back.
I talked the other day when the Vice President and I
went down to Tennessee and ,we were working with Congressman Tanner's
district, we were working ona church that had burned. And there was
a'pastor there from a church in North Carolina that brought a group
of his people in to work. And he 'started asking me about welfare
reform, and I started telling him about it. And I said, "YoU' know
what you ought to. do? You'ought to go tell Governor Hunt that you
. would hire somebody on welfare. to work in your' church if he would
give you the welfare check as a wage supplement, you'd double their
pay and you'd keep them employed' for a year or so and see if you
couldn't train them and help their families and see i f their kids
were all right." I said,"Would you do that? II He said~ "Ina
heartbeat. II
'
.
.
.
I think there ~re people all. over America like ·that.
(Applause.) I think there ~re people allover America like that.
That's' .what I want all of you to be thinking' about today -- what are
we going to do now? 'I'hisis not over, .this is just beginning. The
Congress deserves our thanks for creating a new reality, but we have
to fill in the blanks. The governors asked ,for this responsibility:
now they've got to live up t9it. There are mayors that have
. responsibilities, county official~ that have responsibilities. Every
employer in this' country that ever made a disparaging remark about
the·welfare system needs to think about whether he or she should now
hire somebody from welfare and go to work. Go to the state and say,
,okay, you give me the check, 1111 use it as an income supplement,
~Ill train these. people, I'll help them to start their lives and
we'll go forward from here.'
Every single person needs to be thinking -- every person
in America tonight who sees a report of this who has ever said a
disparaging word about the welfare system' should now say, "Okay,
that's gone. What is my responsibility to make it better?"
(Applause.)
"
Two days ago we signed a bill increasing the minimum
·w.age here and making it easier for people in small businesses to get
.and ke~p pensions. Yesterday we signed the Kassebaum-Kennedy bill'
which makes health care more available to up to 25 million Americans,
many of them in lower-income jobs where. they're more vulnerable.
The bill I'm signing today p~eserves the increases in
the earned income tax credit for working families. It is now clearly
better to go to work than to stay on welfare ~- clearly better.
Because of actions taken by the Congress in this session, it is
~learly better.
And what. we have to do now is to make that work a
reality.
"
I've said this many times, but', you know, most Americ.an
families find that the greatest challenge of their lives is how to do
a good job raising their kids and do a good job at work.' Trying to
.bala.nce work and family is the chall~nge that most Am.ericans in the
workplace face. Thankfully, that's the challenge Lillie Harden's had
to face for the last 10 years. That's just what we want for
everybody. 'We want at least the chance to strike the right balance
for everybody.
Today, we are ending welfare as we know it. But I hope
this day will be rememb.ered not for what it ended, but for what it
began -- a new day that offers .hope, honors responsibility, rewards
work, and changes the terms of the debate so that no one. in America
ever feels again the need to criticize people who are poor on
welfare, but instead feels the responsibility to reach out to men and
women and children who are isolated, who need opportunity, and who
are willing to assume responsibility,. and give them to opportunity
and the terms of responsibility; (Applause.)
.
.
�,
.
j
- 5
'.
NOw, lid like to ask Penelope Howard, Janet Ferrel, ,
'Liilie Harden, the governors' and the members of Congress from both
'parties who arellere to come up and join me as I sign the welfare
, :reform bill.
'
.
Q
Mr. President, before you sign the bill, can you
tell us whether you think it's right'to regulate tobacco or nicotine
as a·' drug?
,"
THE PRESIDENT: You know" Wolf, under the law, I'have to
wait until the OMS makes 'a recommendation to ,me. I think we have to
anticipate things. I ,can't say more than that right now.
(':the bill is signed.) ,
o ,Mr. President, some of your core constituencies are
furious with you for signing this bill. What do Y9u say to them?
THE PRESIDENT:: Just what I said up there. We saved
medical care. We saved food 'stamps. We saved child care. We saved
the aid to disabled children., . We,sa.'vedthe school lunch program. We
,saved the framework of support. What we did was to tell the state;
now you have to create a system to give everyone a chance to go to
,work who is able-bodied, give everyone a chance to be independent .
.And we did -- that is the right thing to do.
And now, welfare is no longer a political football to be
, kicked around. It's a personal responsihility of every American who
, ever criticized the welfare system to help the poor people now to
1Il0ve from welfare to work. , That I s what I say.
This is going to be a good thing for the country. we1re
going to mqnitor it and we're going to fix whatever is wrong with it.
o ,What guarantees are there that these things wIll be
fixed,' Mr. President, especially i f Republicans remain in control of
Congress? '
THE PRESIDENT:
That's what we have elections for.
. END
�·., .
.,.
THE WHITE HOUSE
Office of the Press Secretary
-"':'
August 23, 1996
For Immediate Release
STATEMENT BY THE PRESS SECRETARY
,
,
'
As the President has said. the welfare reform bill he signed into law yesterday offers a
historic opportunity to end welfare as we know it and replace it with a system that offers
hope, demands responsibility, and rewards work.
'
,,
However, as the President has alse~said. the welfare reform bill contains provisions
that Will cause unfair and unwarr,anted hahn to many families. That is especially true of legal
immigrant families. who have followed thetules, worked. and paid taxes, and who ·have
suffered a calamity that has forced them to seek assistance.
'
The President has vowed to repair these provisions of the bill. In the meantime,
however, he is determined to ensure that they are implemented carefully. and that no
, individuals not actually covered by these provisions are improperly denied the benefits they'
,
and their children need.
For that reason. the President has today issued two directives to ensure that legal
immigrants and their children who remain eligible for benefits under the new law do not have
those benefits cut off mistakenly. andthat legal immigrants who are eligible to become '
citizens can do so as quickly as possible: '
The first measure directs the Secretary of Agriculture to ensure that States have the
maximum time allowed under the law to make sure that legal immigrants who remain eligible
for food stamp benefits continue to receive them. The Secretary is to grant waiver 'allowing
any state, subject to certain legal restrictions. to extend the certification periods for eligibility
for food stamps that apply to legal immigrants receiving assistance. The extension will give
States time to develop the procedures needed to make accurate determinations of the many
facts -- such as immigration classification. veteran status, or work history -- that the new law
makes relevant to eligibility. In this way, the directive will decrease inaccurate or inequitable
decisions to cut off food stamp benefits.
a
Under the terms of the new law, benefits to legal immigrants and their children, are cut
off only at the time of recertification of their 'eligibility for food 'stamps_ When a State
extends the certification period, it will. in effect. push back the date on' which a legal
immigrant will be deprived of food stamp benefits.
-mOI"C
�The waiver has specific time limits.. Under current law, the Secretary may not allow
states to eXtend certification periods beyond one year for most aliens or two years for c.ertain
elderly or disabled aliens. For states that already use that maximum certification period, the
. waiver will not have a significant impact. For those that.have shorter periods, however, the
. waiver will permit extensions to a full year or 24 months.. The Department,however, may
not aliow states to extend any recertification beyond August 22, 1997.
The second measure directs the Attorney General, the Secretary of Health and Human
Services, and other agency heads to make continued efforts to reduce bureaucratic delays in
the citizenship process for legal immigrants applying to "become citizens. The INS already
has made great 'progress in this area, devoting more resources to processing naturalization
applications and reducing long waiting lists. This directive instructs the Attorney General to
continue to increase staff used to review citizenship applications and to develop other
. effecti~e means, including joint efforts with community groups, of assisting applicants for
citizenship.·
-~
In addition, the directive instructs the heads of all relevant agencies to dey.~lop
public/private partnerships devoted to providing English-language training to applicants for
citizenship; make outreach efforts to those wishing to become citizens; and provide special
assistance to refugees and those seeking asylum.
Also today, the Attorney General, under authority granted by the welfare reform Jaw;
will issue a memorandum containing a provisional list of non-cash services not conditioned on
income or resources that may not be denied to. immigrants, because they are "necessary for
the protection of life and safety." These services include soup kitchens, medical services,
child protection, and services for victims of domestic violence. The Attorney General may
amend the list at a later date. Additional information is available at the Justice Department
from Myron Marlin, (202) 616-2765.
'
-30-30-30
--.
.
�. r: .; .
THE WHITE HOUSE
Office of the Press Secretary
August 23, 1996
For Immediate Release
August 22, 1996'
MEMORANDUM FOR THE SECRETARY OF AGRICULTURE
-~....-/'
..... SOBJECT:
Eligibility of Aliens for Food Stamps
Under the'provisions of the Personal Responsibility and Work
Opportunity Reconci'liation Act of'1996, which' today I signed
into law, aliens receiving food stamps as of the date of enact
ment will continue to receive benefits until recertification of
.. their eligibility, .which shall take place not more than 1 year
·after enactment of the law. The results of the certification,
including decisions as to an individual's immigration classifi
cation, veter~status, or work history, will determine whether
the individual remains eligible for benefits under the Food
Stamp program. Implementation of these new procedures will
.
pose a substantial challenge for all involved Federal and State
agencies.
that eligibility determinations are made fairly,
accurately, and effectively, I direct you to take.the steps
necessary under your authority to permit the State agencies
to extend the certification periods of currently participating
aliens, provided that no certification period is extended to
longer than 12 months, or up to 24. months if all adult household
members are elderly or disabled, and provided that in no event
shallcertification~ be extended beyond August 22, 19~7.
Toens~re
I
further direct you to notify the states of the actions you
have taken.
WILLIAM J. CLINTON
# # #
�I'
THE WHITE HOUSE
Office of the Press Secretary
· For Immediate Release
August 23, 1996
August 22, 1996
MEMORANDUM FOR THE ATTORNEY GENERAL
THE SECRETARY OF HEALTH AND HUMAN SERVICES
AND OTHER HEADS OF EXECUTIVE DEPARTMENTS AND
AGENCIES
SUl3JECT:
Naturalization
Citizenship is the cornerstone of full participation in
'our democracy. ·To become a,United states citizen through
naturalization represents a'pledge to u~qertake the
responsibilities of being a full member/of our national
community.
.
.,'
:
,
'"
~'.
-.\.
Naturalization is the best example of our legal immigration
system at work.. It reflects our society's recognition of
those who came to this country to work hard, play by the
rules, and pursue shared ideals of freedom, opportunity~
and responsibility.
;
.. '
;'.
In the past, hundreds of thousands of eligible people have had
to wait unnecessarily to become citizens. In some parts of the
.country, these people have had to wait well over a year after·
filing their application to realize their dream of united states
citizenship.
. . __.. _t__".' .
~_,",,
This'Administra~ion is committed to eliminating the waiting
· lists of those eligible for citizenship. To accomplish this,
·we launched "Citizenship U.S.A.," the most ambitious citizenship
effort in history. In fiscal year 1996, the Immigration and
· Naturalization Se~ice (INS) will spend more than $165 million
for naturalization.
'Citizenship U.S.A. combines three broad strategies: hiring
more people to handle applications, improving the naturalization
process, and expanding partnerships with local officials and
community organizations.
Weare·already making progress. We have increased the staff
235 percent in the five districts with 75 percent'of the pending
applications: Los Angeles, New. York, Miami, San Francisco, and
:Chicago~
In Los Angeles, where one-fourth of all new.
.
applications are filed, we have opened three ne~ processing
centers. <:lnd have more than quadrupled the number of INS off·icers
handling citizenship applications.
.
::.:..... '
But this is just the beginning. This Administration's target
Is to process and swear-in. within 6 months of application all
individuals eligible for citizenship. As we meet this target,
more than one million newcomers will become citizens by the end
of this year. After that, INS sh~ll maintain those reforms
necessary to stay current with the demand of new citizen
applicants.
more
(OVER)
~.,
�/'.
2
Using all of' the tools at your disposal, I ask you to ensure
policies and practices necessary to accomplish these
targets of one million new citizens sworn-in and the elimination
, . of the waiting list are implemented. This includes continuing, .
expan4ing or accelerating, as appropriate and practicable, the
'following:
.
·~t
-~~~~\.::
1) Hew Hires. Hiring, training, and deployment of fui! staff
to assist naturalization efforts should proceed to completion as
..<I,Uickly 'as possible.
It'.
,2) 'CUtting' Red Tape. This includes: establishing electronic
filing and mailing-in of citizenship applications, extended
weekday hours and saturday interviews, further expansion of
.processing facilities, and improvements to make it easier for
people to obtain forms arid get immigration information by
telephone or computer. ,
.:'.'.
'
3) 'Working with Local Officials and Community-Based Groups •
. We are working in partnership with local officials and community
'groups to'expand outreach. II direct you~o expand these efforts
to help get naturalization information-to people, assist them in
.fillin~ out applications, offer more local sites for interviews,
'especially for the elderly and the homebound, and seek other
means to jointly fa,cilitate the process. 'We also will work to
expand the availability of local hotlines providing naturali
zation information.
4)
English Training. To assist legal immigrants to move
toward citizenship, I request relevant agencies to work with
the Domestic Policy Council, the National Economic Council, .and
other White House offices to present to me by December 30, 1996,
a report making recommendations with respect to public/private
efforts to teach English to those needing to improve their
English-language skills. This report should consider po~sible
roles by private companies, educational institutions, unions,
community organizations, and the AmeriCorp program to accomplish
this goal.
5) Interagency Outreach. I direct each executive department
and agency to take steps to promote naturalization outreach
consistent with ydUr agency's mission. In particular, in
materials sent to welfare recipients .concerning eligibility,
I direct that, to the extent authorized by law, you include
naturalization information.
6) Refugees and Asylees. Those who flee persecution' and
suffering in their home country are often in the weakest
,position to acquire the skills they need to enter the job
.market, maintain self-sufficiency, and achieve U.s. citizenship.
I.direct the secretary of Health and Human Services, in'
conjunction with other agencies as appropriate, to present to
me by December JO, 1996, through the Domestic Policy council,
a report setting out a strategy of additional steps that we can
'take to. promote social adjustment in the United States, economic
self-sufficiency, and naturalization.
In taking these steps, this 'Administration shall maintain and
strengthen the. standards and requirements of the naturalization
test that demonstrate an individual's readiness to accept the
responsibilities of citizenship and full participation in our
national community. You are directed to continue vigilant
.oversight to uphold these standards ,"
Hundreds of thousands of people are seeking the dream and the
promise of American citizenship. They have worked to become
united States citizens, and these steps should ensure that they
are not made to wait un"'.ecessarily.
WILLIAM J. CLINTON
#-
#-
#
�:Welfare Refonn Talking Points
For ImernaJ. Use Only
()
A broken system. When PresIdent Clinton ran for president four years ago , he pledged to end'welfare
as we know it. Since taking office, President Clinton·has done everything in his power to transform the
welfare system into one that rewards work, protects children, and promotes parental respoilsibility. '.
Although we've given 78 waivers to 43 states,thePresident has emphasized from the, start that w~eed
national legislation to help build a better future for the women and children. now trapped in poverty.
o
A much improved bill. We've come a long. \\lay in this debate. Lasf year the Republican majority in
Congress sent President-Clinton legislation that had its priorities backward: it was soft on work, and tough
on children; . Ii failed to provide adequate child care and health care. It imposed deep.and unacceptable
cuts in school lunches, child welfare, and help for disabled children. The bill came to President Clinton
twice and 'he vetoed it twice. This new bipartisan legislation is significantly better than the bills the'
President vetoed.
o
Rewarding work. The new law is ,str~mg on work. It provides almost $4 billion more for child care, and
it gives states powerful 'perfonnance incentives to place people in jobs, It requires states to hold up their
end of the bargain by maintaining their own sp'~nding on welfare. And it gives states the capacity to create
jobs by taking money now used ~or welfare checks and giving it to employers as inc'orne subsidies, as
incentives to hire people, or to 'create community service jobs. When combined with the EITC and 'the
minimum wage increase won by this Administration, it means that the typical welfare recipient will be
better off ~orking than on welfare.' In Colorado, for example, a mother with two children
ipcrease
. her income by more than 50, percent -- from $8,000 to $12,600 -- even if she only works part-time at the
minimum wage. Pl,us, she'll receive health care, Food Stamps, help in collecting child support, and child
care assistance if she needs it.
will
o
Protecting Children.' This new law. is better for chi14ren than the two bills President Clinton vetoed. It
. maintains the national nutritional safety net by eliminating the Food Stamp cap and ~he optional block
grant. It drops the deep cuts. and devastating changes iIi school lunch, child welfare and help for disabled
children. It allows states to use federal money to provide vouchers to children Whose parents can't fmd,
work after the time limits expire. It helps protect children by maintaining health and safety standards for
day care. It allows, the 43 states with existing welfare refonn demonstrationS to use their own work
requirements and time limits. And it preserves the national Medicaid guarantee for poor children, the
disabled, pregnant women, and the elderly. '
o
Demanding responsibility., The 'law requires teen parents to stay in school and live at home, and it
includes the tough child support enforcement measures President Clinton proposed -- the most sweeping
crackdown on deadbeat parents in history. We can now say to parents, if you don't pay the child support
you owe we will garnish your wages, take away your driver's license, track you across state lines and if
necessary make you work off what you owe. Over 10 'years, the child support improvements in this bill
\yill provide an additional $24 billion for America's children.
o
Parts of the law still need to be fixed. Parts of the legislation are· wrong, and the President has pledged
'to fix them. The law still cuts Food Stamps deeper than it should, mostly for working families with
children who have high shelter cost$. In addition, the law includes provisions that will hurt legal
immigrants; denying medical and other help to families with children who fall on hard times through no
fault of the\r own. This Administration is committed to changing these provisions.
o
A record of accomplishment. Over the past three and half years, the Clinton Administration has given
43 states the flexibility 'hey. need to promote work and protect children. Tl1e Administration has also
required teen mothers to stay in school and cracked down on people who owe child support and cross state
. lines .. As a result, child support collections are up 40 percent to $11 billion, and there are 1.6 million
fewer people.on welfare today than' when PresidenfClinton .took office.
�For Internal Use Only
A NEW SYSTEM l!NDERWELFAREREFORM
The Current WeJfare System
, Aid t~ Families ~ith ?epen~ent Children (AFDC) is a ca~h assistance program, ,providing aid ,to poor sin,gle
mothers and theIr children, as well as :t<) a few poortwo..:parent families. As of May 1996, 12.5 million
individuals rece,ived AFDC -- down from 14.1 niillion:when ,President Clnlton took office. Of those 12.5
million people; approximately ,4 ,million are adults.
'I,
•
Medicaid pays for health care for' AFDC recipients andal~ pregnant women and children up to age 6 with
, , family income up to 133 percent of the federal poverty line~' Medieaid coverage is also being phased in for
poor children under age 19 by the year ~OO2. The Food Stamp program provides nutrition assistance to all
poor Americans, including AFDC recipients, the elderly, and many' poor working families.
,The elderly, blind, and disabled also receive public ,assistance, primarily through the Supplemental Security
Income (SSI) program, whieh provides monthly cash benefits, as well as thfough, the Medicaid and Food Stamp
programs.
Changes under Welfare R e f o r m ' "
,
Under the new law, federal AFDC funds wilIbe"delivered to'states -in the form, of fIXed block grants, and
adults will be limit~d to 5 years of cash assistanc:e (states wiil be able to exempt 20 percent of the case load '
from the time limit). In addition, recipientSwill.be required to work within tw,o years of receiving assistance,
through activities such as unsubsidized or subsidized employment, on-the-job'training, or community service.
These changes build on the reforms already taking place in 43 states under waivers granted by the Clinton
Administration. '(For example, 30 s,tates and the District of Columbia currently have some form of time limit
in place), The new welfare law preserves MedicaId coverage for poor children, the disabled, pregnant women,
the elderly, and' people who would have qualified under thepreviousAFDC rules. It also maintains the Food,
Stamp program" pres~rving the national nutritionalsafety neL -It includes new fundi,ng for child care and
several measures to increase child support collections:
''
•
t.
_
'.
_
The law also includes proyisions opposed by,the Administration that would deny SSIand Food Stamps to most
legal immigrants for five years or until they 'attain.c~tizenship. Stit~s ,would have ,the optIon to deny Medicaid
and AFDC benefits to legal immigrants. Future'immigrants would be ineligible for 5 years for most·.federal
means-tested programs, including Medicaid. The President has pledged to fix the provisions in the bill that
would deny assistance -to legal immig;antsand, cutback on Food Stamp assistance for working families.
.
.
' "
.
- :
.
A Fundamental Improvement over the Status Quo '
,
This comprehensive bipartisan welfare reform legislation will change the nation's welfare system into a
transitio'nal assistance program that'requires work in exchange for time-limited assistance. The law contains
, strong work requirements, a perfornlance bonus to reward states for moving welfare 'recipients into jobs, state
maintenance of effort requirements, and supports" for families moving from welfare to work -- including
increased funding for child care and guaranteed Medicaid coverage. It also includes tough new child support
,provisions which will increase collections by $24 billion over 10 years. As the President has said, this
'legislation gives us a chance "to transform a broken system that traps too many people in a cycle of dependence
to one that emphasizes' work and independence, to give people on welfarea chance to draw a paycheck, not
a welfare check ... ,
.
.
"
Combined with the EITC and the,minim~m wage increase won by this Administration, the new, transitional
, welfare system will help move AFDC recipients from welfare to work., In Colorado, for example, a mother
with two children will increase' her income by more than 50 per~ent -- from $8,000 to $12,600 --even if she
works parte time at the mjnimum wage., Plus,. she'll ,receive health care, ,Food Stamps, help in collecting child
'
,support, and child care assistance if she needs it:
�VETOED BILL
"
CURRENT BILL
NO
YES
YES
NO
YES
'. NO
YES
NO
, YES
NO
YES
NO
Guaranteed Medicaid
Block Grants Food Stamps
,
Block Grants Foster Care
Cuts Funding for Foster C~re
Block Grants Adoption Assistance
_/
.'
:
Cuts Funding for Adoption Assistance
,
,
YES
NO
20% Exemption From Time Limit
NO
YES
Adequate Child Care Fu'!ding,
NO
YES
Child Care Health and Safety Standards
NO
YES
NO
YES
YES
YES
Cuts Funding for Investigation of Child"Abuse
,
.
:
,e
.
80% Maintenance ,of Effort Required
'
,
Teens Required to Live at Home
"
NO
Performance Bonus for States
..
YES
'"
Child Support Enforc;ement
YES
,
,
,
"
,
.
Cuts Cash Assistance by 25'/0 for Som~ Di~~bled Child~en,
..
YES "
YES
NO
-,
�More Than Half the Nation Enacting Welfare Reform Under the Clinton Administration
I
The Clinton Administration has approved 78 welfare reform demonstrations in 43 states and the District of Columbia -- more than all previous Administrations combined.
In an average month, thedemonslrations cover over 10 million people -- approximately75 percent of all recipients. All of the waivers which we have granted build on
many of the centr~l principles of President Clinton's vi~ion for welfare reform, including:
..
'
PRINCIPLE
DESCRIPTION
STATES APPROVED
Work
ThirTy-Six slales are helping people move from
36 - Arizona; Connecticut, Delaware, District of Columbia,
welfare to work, from receiving welfare checks
Florida, Georgia, Haw~ii, Idaho, llIinois. Indiana, Kansas,
to earning paychecks, by increasing education and Maryland. Massachusetts, Maine, Michigan, Minnesota,
training opportunities and creating public/private
Mississippi, Missouri, Montana, Nebraska, New Hampshire,
sector! partnerships.
.. ,
North Carolina, North Dakota, Ohio, Oklahoma, Oregon, SOUlh
Carolina. South Dakota, Tennessee, Texas, Utah, Vermont,
Virginia, West Virginia, Wisconsin, Wyoming
,
Time Limited Cash Assistance
ThirTy-One Slales are making welfare a
transitional ,support system, rather than a way of,
life, by providing opportunity, bUi demanding
responsibility in return.
Child Support Enforcement"
Twenty-Seven stales are strengthening child'
support enfon:ement and sending a clear message
. that both parents must be responsible for their
. children. '.
31 - Arizona,
Colorado, Connecticut. Delaware, District of
Columbia; Florida, Georgia, Hawaii, Illinois, Indiana, Iowa,
Louisiana, Maryl~d, Massachusetts, Michigan, Missouri.
Montana, Nebraska, New Hampshire, North Carolina, Noph
Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota,
Tennessee, Texas, Vermont, Washington, Wisconsin
27 - Arizona, Connecticut, Delaware, Gj:!orgia,' Hawaii! Illinois,
Indiana, Kansas, Maine, Maryland, Massachusetts, Michigan,
Mississippi, Missouri, Montana, New Hampshire, New York,
North Carolina, North Dakota, Ohio, Oregon, South Carolilla,
Tennessee, Texas, Vermont, Virginia, Wisconsin
Making W,ork Pay
Forty-One stales are providing incentives and
encouraging families to work not stay on welfare,
so they can ac'hieve and maintain economic self
sufficiency.
Parental Responsibility
Thirty-Nine Slales are promoting parental
39,- Arizona, Arkansas, California, Colorado, Connecticl\t ..
responsibility by encouraging education, or
limiting benefits for families who have anOiner
child While on AFDC.
Delaware, District of Columbia, Florida, Georgia, Hawaii,
Illinois, Indiana, Iowa. Kansas, Louisiana, Maine. Maryland,
Ma~sachusetts, Michigan, Mississippi, Missouri, Montana,
Nebraska, New York, North Carolina, North Dakota, Ohio,
Oklahoma, Oregon, Pennsylvania, South Carolina, Tenriessee,
Texas, Utah, Vermon!, Virginia, Wisconsin, Wyoming
41 - Arizona,
California, Colorado, Connecticut, DelaWare, .
District o(Columbia, Florida, Georgia, Hawaii, Illinois, Indiana,
Iowa, Kansas, Maryland, Massachusetts, Maine, Michigan,
Minnesota. MiSSissippi, Missouri, Moiuana, Nebraska, New·
. Hampshire, New York, North Carolina, North Dakota, Ohio,
Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota,
Tennessee, Texas. Utah, Vermont, Virginia, Washington, West
Virginia, Wisconsin, Wyoming
�STATEMENT BY PRESIDENT.CLINTPN ON WELFARE REFORM LEGISLATION
WEDNESDAY, JULY 31, 1996
PRESIDENT CUNTON: Good afternoon ..
When I ran for president four years ago I pledged .tQ end welfare
. as we know it. I have worked v~r.x hard for four years to do just
that. Today the .Congress will vote on legislation that gives us a
chance to live up to that promise ;.-to transform a broken system that
traps too many people in a cycle of dependence to one that emphasizes
work and independence, to give p~opleon welfare a chance to draw a
paycheck, not a welfare check. It gives us a bett~r chance to give
those on welfare what we want for all families in America, the
opportunity to succeed at home and at work . .
For those reasons, I will signit into law.
The legislation is, however, far from perfect. There are parts· .
of it that are wrong, and I ~ill work -- I will address those parts in
a moment.
But on balance, this bill is a real step forward for
. our country, our values, and for people who are on welfare.:
For 15 years I have worked 'on this problem, as governor and as
the president. I've spent time in welfare offices, I have talked to
mothers on welfare who desperately want' the ~hance to work and support
their families independently .. A long time ago I concluded that the
.
current we~fare system undermines the basic values of work,
responsibility and family, trapping generation after generation in
dependency and hurting thevety people it was designed to help.
Today we have an historic. opportunity to make welfare what it was
meant to be: a second chance, not a way of life. And even though the
bill has serious flaws that are Jmrelated to welfare reform, I believe .
. we have a duty to seize the opportimity it gives us to end welfare as
we know it.
..
. Over the past three and halfy~ars, I have dorie everything in ·my
power as president ~o promote Work and responsibility, working with 41
states to give them 69 welfare reform experiments. We've also
required teen mothers to stay,in school, required federal employees to
pay theirchqd support, cracked· down on people who owe child support
and cross state lines. As·a result, child support collections are up
40 percent to $11 billion, and there are· 1.3 million fewer people on
. welfare today than there were when I took office.
�From the outset, however" I have also worked with members of both
parties in Congress to achieve. national welfare reform bill that
. will make work.and responsibility the law of the land.
.
a
I made my principles for real welfare reform very clear from the .
beginning. First and foremost, it should be about moving people from
welf~re to work. It should impose time limits on welfare. It should'
give people the child care and the health care they .need to move from
welfare to work ,without burting their children. It should crack .down .
on child support enforcement, and it should protect our' chiJdren ....
This legislation meetS these principles. It gives us a chance we
haven't had before to break the cycle. of ciepende~cy that has existed
for millions and millions of our fellow citizens, exiling them from
the world of work. It gives structure, meaning, and dignity to most ' ,
of our lives.
We've come a iong way in this debate. It's important to remember.
that not so very long ago, at the beginning of this very Congress,
some wanted to put poor children in orphanages and take llway all help
from· mothers simply because they were poor, young, and unmarried. :
Last year the Republican majority in Congress,sent me legislation that
had its priorities backward: It was soft .on work,arici tough on
children. It failed to provide child care ?,nd health care. It
imposed deep and unacceptable cuts in school lunches, ch~ld welfare,
and help for disabled children. .
The bill came to me twice and I vetoed it twice. The bipartisan
legislation before the Congress t9day is significantly better than the
bills I vetoed. Many of the worst elements I objected io are out of
it, and many Of the improvements I asked for are. included.. '
.
.
First, the new bill is strong on work. It provides $4 billion
more for child care so that mothers can move from welfare to work, and
protects their children by maintaining health and safety standards for
day care.' 'These things are very important. You cannot ask somebody
on welfare to go.to work if they~re going to neglect their children in
doing it. . It gives states powerful performanc,e incentives to place
people in jobs. It requires, states to hold up their end of the
bargain by maintaining their own spending on welfare. ,And it gives
states the capacity to create jobs by taking money now used for "
welfare checks and giving it to' employers as income subsidies, as an
.incentive to hire people, or being used to create community service
jobs.
�is
Second, this new bilI better for,children than the two I
vetoed. It keeps the national' p.utiitional safety net intact by
eliminating the food stamp cap and the optional block grant. It drops
the deep cuts and devastating changes in school lunch, child welfare
and help for disabled children. It allows states to use federal money
to provide vouchers to children whQse parents can't find work after
the tirrie limits expire'. And it preserves the nationaJ guarantee of
health care for poor chlIdrel), the disabled, pregnant women, the
elderly, and people on,weJfare.
Just as' important, this bill continues to include the child
support enforcement measures I proposed two ye~rs ago -- the most
sweeping crackdown on deadbeat parents in history. If ,every parent
paid the child support they should, we could-move 800,000 women and
children off welfare inlmediately. With this bill, we say to parents,
,if you don't pay the child support you owe we will garnish your wages,
take away your'driver's license, track you across state lines and if.
necessary make you work off what you owe.
It is a very important advance that could only be achieved in
legislation. I did not have the executive authority to do this
without a bill. So I will sign this bill, first and foremost because
the current system is broken; second, because Congress has made many
of the ,changes I sought; and third, because even though serious
problems remain in. the non-welfare-refoIln provisions of the bill, ~is'
is the best chance we will have fora long, 'long time to complete the
work of ending welfare as we know it, by m~ving people from welfare·to
work, demanding responsibility, and doing better by children.
However, I want to' be very clear. Some parts of this bill still
go too far, and I am determined to see that those areas are corrected.
First, I am concerned that although we have made' great strides to
maintain the national nutritional safety mit, this bill stiiI cuts
deeper than it should in nutritional assistance, mostly.for working
families with children. In the budget talks, we reached a tentative
agreement on $21 billion in food stamp savings over the next several
years.' They are included in this bill. However, the congressional
.majority insisted on,another cut we did not agree to, repealing a
reform, adopted four years ago in Congress :which was to go into effect.
next year. It's called the excess shelter reduction, which helped
some orour hardest-pressed wor~ing families. Fimi.lly we were going,
to treat working families with children the same way we treat senior
citizens who draw food stamps today. Now,. blocking this change I
believe -- I know -- WIll make it harder for some of our hardest
�pressed working families with children. This provision is a mistake,
and I will work to correct it.
Second, I am deeply disappointed that the congressional
leadership insisted on attaching to this extraordinarily imporulnt
" bill a provision that will hurt legal immigrants in America, peqple
who work hard for their families, pay taxes, serve our military. '
This provision has nothing to do with welfare reform; it is simply 'a
budget-saving measure,and it is not right. These immigrant families
with children, wno fall on hard times through no fault of their own -
for example, because they face the same risks the rest of us do from
accidents, from criminal assaults, from serious illness -- they should
be eligible for medical and other help when they need ·it.
'
in
The Republican majority could never have passed such a provision
standing alone. You see that in the debate in the immigration bill -
, ror example, over th'e Gallegly amendment -- and the question of '
education of undocumented and illegal immigrant children. This.
provision will cause great stress for states, for localities, ,for
medical facilities that have to serve large number of illegal-- of
legal immigrants -- legal immigrants. It is just wrong to say to
people, "We'll let you work here; you're helping our country. You'll
pay taxes. Yqu serve in our military. You may get killed defending
America. But if somebody mugs you ona.street corner,: or you get
cancer, or you get hit by a car, or the same thing happens to your
children, we're not going to give you assistance anymore."
I am convinced this would never have passed alorie, and I am
convinced when we send legislation to Congress to correct it, it will
be corrected.
In the meantime, let me also say tnat I intend to take further,
executive action directing the INS to continue to work to remove the
bureaucratic roadblocks to citizenship to all eligible ,legal
immigrants. I will do everything in my power, in other words, to make
sure that this bill lifts people up and does not become an excuse for
anyone to rum their backs on this problem or on people who are '
, genuinely in need, through no fault of their own.
This bill must also not let anyone off the hook. The states
asked for ·this responsibility; now they have to shoulder it and not
run away from it., We have to make sure that in the coming years,
reform and change actuallY'result in moving people from welfare to
work. The business community must provide greater .private-sector jobs
that people on welfare need to build good lives and strong families.
I challenge every state to adopt the reforms that Wisconsin, Oregon,
Missouri and other stales are proposing to do~ to take the, money that
1
�used to be available for welfare checks and offer it to the private
sector as wage subsidies to begin to hire· these people, to give them a
chance to build their families and build their lives.
All of us have to rise to. this challenge and see this refoml not as a
chance to demonize or demean anyone, but instead as an opportunity to
bring everyone fully into the mainstream of American life, to give
them a chance to share in the prosperity and the promise that most of
our people are enjoying today. And we here in Washington must
continue to do everything_in our power to reward work and to expand
opportunity 'for all people.
.
The earned income taX credit which we expanded in 1993.
dramatically is now rewarding the work of 15 million working families.
I am pleased that congressional efforts to gut this tax cut for the
hardest-pressed working people, have been blocked. This legislation
preserves the EITC and .its benefits for working families.
Now we must increase .the minim~m wage, which also will benefit
millions of working people with families' and help them to offset the
impact of some of the nutritional cuts in this bill.
Through these efforts we all have to recognize, asI said in
1992, the best anti-poverty program is still a job.'
I want to congratulate the' members of Congress in both parties
.who worked together on this welfare reform legislation. I want to
.challenge them to put politics aside and continue to work together to
meet our other challenges, and to correct the problems that are still
there with this legislation. I am convinced that it does present an .
historic opportunity to finish the work of ending wei fare as we know .
it, and that is why I have decided to sign it.
�Transcript of Today's White House Press Briefing by Shalala and
Reed (l of 2)
To:. National Desk
.
Contact: White House Press Office, 202-456 . 2 100
WASIDNGTON, July 31 "tU.S. Nt.:wswirel - Following a tnlIlScript ;
of today's White House press briefmg by Secretary of Health and .
Human Services Donna Shalala' and Assistant to the President for .
Policy Planning Bruce R,eed (1 of 2):
" ,
The Briefuig Room '
.
3:12 P.M. EDT
MS. GLYNN: Good afternoon, everyone.
fmish the briefmg on
welfare refonn we Mve Secretary' of Health and Human Services Donna
Shalala and Assistant to the President for Policy Planning Bruce ' .
,-~
Reed.
"
".SECRETARY S~ALALA: Thank you very'much. I think thePreside~t
outlined his reasons for signing the bill brilliantly. Let. me talk .
a little about the reasons why the President vetoed earlier bills
and what we've gained, what the policy gains have been in this
bill.
First, Medicaid is a stand-alone entitlement program. No longer
. is it linked -- it's not linked to welfare, and the Medicaid .
prograJTl is allowed to continue. We would still lij(e some refonns in
that Medicaid program, but the important thing is that welfare
recipients will not be losing their Medicaid, and Medicaid will
continue for millions of poor Americans who need health care ..
. Second, there's $4 billion'more for child care in this bill; and
we were able to restore the health and safetystandards for the'
, child care system in this country, w~ch were absolutely critical.
There was an attempt by the Republicans to,remove them.
Third, there is no food stamp ,block grant. The food stamp
program stays intact. There's ,no ceiling limit on it. Th~ President,
did outline that we have some concerns. about the way the cuts were
. taken, and we'll be looking at those as we doour detailed
analysis.
'
.'
'
Fourth, there's no chiid welfareblock grant The child welfare
services, which have been the most sensitive kind of services in
this country, to limit them in any way -: these are" the 'services
that cover foster care, adoption services~ 21 states are already
under some court order. The Republicans origmally wanted to curb
those services, put caps on it, block grant, it. We said not a
chance. These are the most vulnerable children in our society and
. you have to back away from those proposals.
There are greater protections in' this bill for disabled ' .
children. There is a doubling of the 'contingency fund to protect
against 'economic downturns. It's now $2 billion, instead of $1
biliion, which is \vhat they had in previous biJls. That's extremely
is
to'
�'>.
important.' ,
. , For those that believe that we ought'to continue to entitlement,
the contingency fund becomes criticaL That's whatis taken up and
used if there is an economic downturn in a.state. If a state goes
.
into an economic downturn, the peopl~ that need help are working
folks who get laid off from their jobs and need to come into the
welfare system for a very short period of time. So acoritingency
. fund or an alternative like an entitlement becomes increasingly
important. The contingency fund here is $2 billion to protect '
against economic downturns. '
There is a 20 percent hardship exemption, which gives the states
the flexibility of exempting a large group of people who cannot,
. meet either the work requirements or the time requirements for one
reason or another. There is no mandatory family cap. You'll
remember that the Catholic Church in particular has been deeply
concerned about a f~ily cap that would limit the payments that a
state gives, a national family cap if afamily·has another child ':"~
if a woman has another child. The \york requirements in this have
actually been made more flexible at the 11th hour. A very'
interesting change was put in place in this bill, which has not
actually beenwritten about, which allows the states to keep the .'
work requirements 'th~y negqtiated with us in their waivers, as
opposed to moving to the work Tequirements that are in the bill. So
the states will have the options during the course of their
waivers, and these waivers ,have been gninted between five and 11
years .. So for many state~ they'1l have flexibility on the packages
.they put together.
,
The school lunch and the nutrition block grant was eliminated in
this 'bill. We fought that early
And any kind ofcut ~ "
unn'larried teen moms from getting assistance was eliminated. There
are major gains in this bill that ,made it possible for the
.
President to sign the, bilI, but more impo~mly from our point of •
view, made it possible for the bill to work..
Q Secretary Shalala, you have outlined a number of improvements
of thiS bill over the previous two that he vetoed, but in your
opinion is this a good bill; is this an improvement on the status '
quo? Secondly; did you reconimend to the President this morning or
last nigQt that he in fact sign jt? And third, .did you ever
consider resigning over this bill?
SECRETARY SHALALA: First, on the issue of is this an improvement
over the status' quo, it is a significant improvement over the'
,
stattls quo, -As early as 1984 a number of my colleagues who are now
with me at the Depanment of Health and Human Services, includ'ing
Marv Jo Bane 'and I; recommended . to Governor Cuomo that we move to
an employment-based program with time limits. This program moves us .
into the modern age, moves -- gives people genuine opportunity to'
on.
~
�move from welfare to work 'and puts the support systems around. If
you combine this with Earned Income Tax Credit and with the minimum .
wage, we have powerful incentives to support. people, even as
.
they're entering entry-level jobs in this country. And the
. . President has always believed, as all of us do, that the best .
opportunity for anyone in this C9untry' is a job ..
This is a significant improvement over the status quo. As to the
other two questions. I never reveal publicly advice I give .to the .
President.· And I never considered resigning.
'
.
Q Ms. Secretary. on the 10 things that you named for us, I
wanted to just ask a: couple of clarifying questions. The doubling
. of the contingency fund from $1 billion to $2 billion, is' that over
what period of time?
.
SECRETARY SHALALA: Over six year~,
Q Arid the same is-true of the $4 ,billion more for child care;
SECRETARY SHALALA: Yes.
,
Q What does that bring the total to of child care for the six
years?
· SECRETARY SHALALA: Fourteen billion dollars.
· Q And the 10th thing -- one other question, guys. Will that 10th
thing that you named -- you listed -- the unmarried teen moms -
SECRETARY SHALALA: Remember, one of the original bills -
· Q What's the provision now?
SECRETARY SHALt\LA: Unmarried teen'moms will be able to finish
high school. They'll ,get support while they're finishing high
school as opposed to,being cut ·off from' any kind of aid.
Q Is that required or is it up to the states -
MR. REED: When the House Republicans put forward their bill
early last year, they' Included a. provision that would have required .
. every state to ban every teen. mother from receiving assistance just
'because they were poor, young and unmarried as the President said.
Q It wasn?t in the bill that ,went ,to the President the fIrst
time was it?
.
MR. REED: No, no. That's ,something that was in the original.
House bill and the .President singled that out in his, 1995 State of
the Union. We had a hard-fought battle which'we~on early on, and
it's not included in the final bill. .
SECRETARY SHALALA: Remember, for'many of us, it's the improvement
since our first discussions with the RepublicanS.· Dragging them
originally, into getting child support into the bill became very'
important. They did not have it in their original ,bill; we insisted
on it. Child support enforcemein for the first time will have the
national dimension to it, which means we'll be able to. track people
down successfully across state lines. .
Q Secr~tary Shalaia, you neyer said'whe,ther you liked the bill
in response to the last yuestioI1, And, also, you have liberal '
�Dem~cnits like Charlie Rangel going to the floor saying my
, President will boldly throw 1 million children into the street. How
do, you, react to ~ose sorts ofcormnents?
SECRETARY SHALALA: WeiI,frrst, I hope, that the governors intend
- to prove Charlie, my good friend Charlie Brown -- CharJieRangel
-.,Charlie Rangel wrong. And it's the way they're going to manage
this program.
Second, I do think it's a good welfare bill. There are parts of
it that the President outlined that are outSide the welfare bill
that we have deep and serious concerns about that include the
immigration provisions and the nutrition provisions and, hopefully,
we'll be able to make significant strides in getting improvements
over our concerns.
Q Will you outline what it is exactly about the nutrition' ,
provisions that are objected to?
,
, SECRETARY SHALALA: The President outlined the shelter allowance
as one example. For people that --' for low income people working
people in some cases, who have very high shel!er costs having $eir
calculation for food stamps based on taking into account a certain
amount of their 'shelter costs, the issue is -- it's over 50 percent
of their shelter cost, how'much above that will be taken into
,account.
This bill makes some dollar improvements but the law was
actually going to take off the limit over '50 percent, a law that
high
was passed which would have protected those who live
housing cost areas. That becomes extremely important for working
families because they do hav,e some income, because they have jobs,
but they also need food stamps to supplement and we need to take
into account those higher shelter costs.
That becomes a very sensitive issue for us,
Q -- bill does what as ~-' "
SECRETARY SHALALA: The bill puts a cap onthat amount, and we
simply want to be able to take a very careful look at that; In
, , addition, the bill goes into the food stamp program and removes
soine increases that .,J,e have some concerns about, and we will be
reviewing those. But remember, we, got this bill 'at midnight last
, night. The President needed to make a decision'fast, so we've done
the analysis -- ,
"
,
'MR. REED: Just to add to what'Donna said; there isa cap in
current law that was set to expire, effectivc::ly next year, and this
bill maintains that cap and shaves the increase -
, SECRETARY SHALALA: It was the Mickey Leland Food Act, and it was
'Mickey Leland's legacy to take off that cap.
Q Madam Secretary, when you came this morning to this meeting,'
did you have a sense,'or did you know in your bones what th~
outcome' would be -- '
m
�.
SECRETARY SHALALA: No.
.
Q -- and was it what you expected?
.sECRETARY SHALALA:. No, I didn~t. I expected it to. bea full and
discussion and thoughtful discussion with the President.
And 'as he described it, that's exactly what it was.
Q And did you believe when you came that either outcome was
possible and we just happened to arrive at this outcome?
SECRETARY SHALALA: I don't -- I don't know. Icame for a
. di~cussion. Th~ President has never invited me to a meeting in
which he has already made up his mind, so it was a full discussion
. this morning .
. Q Could you give some of the flavor of that meeting?
SECRETARY SHALALA: No, I think it~s inappropriate., We have never
described the meetings or the -flavor of ,the meetings. I think the
President described the meeting, 'and I'll stick with the
President's description.
.
Q The President said there is an element of experiment about
this. Nobody can say with absolute cero,tinlY' ho:\v it will work or
how different states will approach it. What do you think fs a fair
window of time to be reviewing what the states are doing? And if
there is a race for the bottom, when will we know?
SECRETARY SHALALA:Well, as you well know, we have essentially
taken the first step towards for 'welfare reform using the waiver
process, so we know somethmg about state behavior and we're just
starting to get in the evaluations on state behavior and wha:t's '
happening in those particular states. The President would want us
to monitor what's happening very carefully~ We, will be able, to tell
whether states are adding additional money. We will know how many
states'are moving people into jobs and whether they're staying in
those jobs. So we will have information, hopefully state by state"
that will 'tell us what's happening and be able to report to the
President and report toCongI'ess about what's going to happen ..
The important thing about this bill, and every piece of research
has told us, that the states must have a stake' in the outcome. They
, must bea full partner. The more they're involved in it, the more
likelyyou are to get success in terms of state programs. That's
what the MDRC told us in their research, and so we have moved
dramatically to give ;the states the authority to design their own
-programs.
Q Will the bill change anything that's, happening in the many, '
states with waivers? Are they exempt -- in addition to being exempt
from the work requirements in the biB, are they exempt- from any
other provisions?
."
SECRETARY SHALALA: Well, the states will be able to,:,":we have to
go back and look at this very carefully, I think that they will be. '
able to take their waiw'rs, look at the new bill,and be able to
he~lthy
�shape what their overall program -- and remember, some of our'
waivers are for one county. They will have a lor more flexibility
.in tenns of statewide programs now, in tenris of expanding some of
those county activities. And so I do expect some changes in the
states.
.
Q Will· they be forced to change anything, though, or -
SECRETARY SHALALA: The bill basically allows them to keep their
waivers and to work with the rest of the bill. So to the extent
.
. that they're forced to it, is -- I think the answer is, there is no
forcing, but there are more opportunities in the new bill that they
will want to take advantage of. And I think tha~'s the best way to
characterize it.
Q -- follow up to that. What's'the fate of the Wisconsm waiver?
SECRETARY SHALALA: Well, 'Wisconsin now has -~ I can't talk about
Wisconsin. You're going to have to answer-Wisconsin. I'm recused.
.
Go ahead. I'm going to Wisconsin -- .
, . .
MR.REED: When this bill becomes law, Wisconsin should be able
to do the welfare refonn plan that they submitted to us.
. Q In other words, the 'President will take no' action on the
pending waiver'request? What's the -
Q Is it moot -
MR. REED: Yes, I think it's essentially moot.
Q Bruce, when will -- the Presidentsaid he'd be sending
legislation up to
some of the holes, the problems he saw with
the bill, notably the immigrants who will not get Medicaid and
other proposals. When will that legislation be ready? When are ypu
planning to send -:.
,'
SECRETARY SHALALA: He is -- you know, we just analyzed this bill
for the President. We just .got it, and he told us to get to work.
.
So, we'll let you -~
MR. REED: I think that the prospects of enacting that
legislation in this Congress are not very good given the
circumstances we've run into in the last several weeks.
Q Just to follow up, the prospects of enactment have in the past
. not necessarily stopped you from the process of promulgation. And
the President made it sound as if,he thought that was a serious
enough concern. Will a proposal from the administration be
forthcoming in the remainder of this year or would that wait for
the second tenn?
MR. REED: Well, I think it's likely, but I -
Q Which is .likely -
SECRETARY SHALALA: I think it's--what the President told us to
do -- let 'me go back to the point. What the President told us to do
was to get ,to work and to look at those -- we have to finish our
, analysis of this bill. We've seen, obviously we've read it and seen
enough of it. We need '0 come back to him and tell him specifically
fix
�wh~t in the immigration parts of the bill, what in the food stamps '
parts of the bill that we need to change. And so we're going' to
work immediately.
You're detail questions about when we're going to have the '
'
legislation, we '.II just have to answer later.
" Q Can I just follow up one second'; I think the question is
prompted by the President's confidence in expressing that that as a
apparent resolve
stand-alone provision wouldn't nave passed and
in saying that it's so unjust and really unjustifiable as to
require a relatively i.mrilecfiate response by you and'that it would in '
.
.
'
fact prevail.'
believes that
MR. REED: I flll:nk as the President said, that
over time as more is leimied about the potential impact of these _
provisions that a .consensus will emerge to fix them. But, you know,
we have a month left in this Congress. It doesn't seem JikelYthat
it would happen.
Q Secretary Shalala, when the Republicans went after politically
popular middle class programs' frqm Medicare .and on down -- some of
them that they tried to block 'grant to the states~- the President
fought like a tiger and said he waS willing to, put his politiCal
future on the line Jor them. Now here, he has a bill where he
himself points, to serious flaws affecting children and affecting'
legal migrants. Is it just a coincidence that those' who are
adversely affected by this bill, by y~urown,and by the President's.
own admission, don't have the vote? ' , "
'
SECRETARY SHALALA: In fact, I' coine to t1i~ opposite conclusion.
We fought like tigers to make sure Med,icaid wasn't block grant,'
which hurts.-- seriously hurts poor people in this country. We
fought like tigers to. make sure food stamps wasn't bloc~ granted.
We fought like tigers to make sure the, child welfare services were
not block granted or nutrition services. We were successful. in "
holding off some of the most vicious proposals and in shaping a
bill that sets out the goals and meets the President's goals that
he laid out both in the campaign in the beginning and throughout,
, this administration. And that combined with the eamedincome tax
credit and the minimum wage are significant steps forward for low
income Americans and genuine' opporrunities for them, which after.
'
all, is what welfare reform is all about.
Do you want to -~ ,
MR. REED: Can Ijust make one more point about how far we've "
come in this debate? The original House bill had $75 billion in
budget savings related to welfare; refoI1ll.and $34 billion in EITC
cuts -- a total of $109 billion in their welfare package. 'This bill
that the President has indicated his support 'for' has $57 billion.
So we think that we've come a long w a y . '
,
Q But from your 0\\;'1 starting point -
his
he
�MR. REED: Our own starting point was, I think-
SECRETARY SHALALA: J?eficit-neutral, pasically .. ,
MR. REED: The P~esident's 1996 welfare reform plan saved $42
billion combined.
.
.
Q No, I mean your own staitmg point when -
MR,. REED:, In 19941,.
'.
QYes.
,
, .
MR. REED: Which was deficit .-. SECRETARY SHALALA: Which was deficit-neutral, basically. Let me
also pomt out that the President has laid out a series of gains
for the low income people. in this country. Fro~ food stamps to Ryan'
White,. to protections in the Medicare program, we have a superb
record in this administration. For a generation· of vulnerable
Americans, .this. is the most Unportant.step we can take --to move
from the status quo, to move people from dependency on the welfare _
system to a job. And I support t,he President in his decision.
. Q Secretary Shalala, can you talk about: the sufficiency of the
$2 billion contingency fund? If we had a serfous national downturn
SECRETARY SHALALA: If we have a serious national downturn, we
need to go back to Congress and make changes. Everybody lqtows that ..
The Republicans know that. We know that. The Fed just put out a
report in Cleveland pointing out the irilportance of the economic
stabilizing effect offederal money. If you don't, recessions go
deeper and broader in states.' And the business community could
hardly be taxed to pull them out. And everybody will be clamoring .
back for more resources in the contingency fund. And that, I think,
. everybody .has conceded.
MR. REED: But also, 'saving the food stamp program has an even
greater stabilization effect: Food Stamps is much more responsive
to economic downturns than the current AFDC program.
THE PRESS: Thank you.
. .
END 3:34 P.M. EDT
-0
. IV.S. Newswire 202~347-27701
APWR-07-31-961719EDT
Copyright (c) 1996 The Associated Press
Received by NewsEDGE/LAN: 7/311965:23 PM
�The Total NUlllber of AFDC Recipients Has '
Declined Under the Clinton Adlllinistration
"
15
14~5
14.2 million
(/)
'5
14
~'
'C13.5'
'
Q)
..c.
§,
z
'13
12.5
12
,1993
1994
, 1995
May 1996 '
Source: Admini'strationfor Children and Families, U.S. Department of Health & Human Services
"Preliminary Estimat~
P92 SG416F
�1
-Work and Training Activities Among AFDC Recipients
Have Increased Under the Clinton Administration -
7.5
A.'
•
7
o
o
o 6.5_
o
o
650,000*
T
(Jj
(1)
E
6
~
5.5
5
1992
-
1993
1994
1,995
-
Source: Administration for Children-and Families, U.S. Department of Health & Human Services
*Preliminary Estimat~ (All Numbers Rounded)
P92 SG416E
�.Child Support Collections Have Increased
.Under the Clinton Adlllinistration
12
$1·1 billion*
11
CJ)
c
o
.
= 10
Co
c
~
en
o
9
Q
8
7
1992
1993
1994
1995 .
Source: Administration for Children and Families, U.S. Department of Health & Human Services
·Preliminary Estimate
P92 SG4!6A
�j
Families Served by Child Support Enforcement
Have Increased Under the Clinton Administration
4.5
4
(I),
3.8 million*
c:
.0
~
.~
3.5
(I)
.(1)
'E
as
u..
3
2.5
1992' '
1993'
1994
1995
Source: Administration for Children and Families, U.S. Department of Health & Human Services
*Preliminary Estimat~,
Pa2OO4168
�.I'atemity Establishments Have Increased
Under the Clinton Adtninistration
.8
7.5
o
o
o
o
o
-r-
735,000~
.
-7
~._5
(/)
Q)
E
i-s
5.5
·5
1992
1993
1994
1995
Source: Administrationf()r Children and Families, U.S. Department of-Health & Human Services·
*Preliminary Estimat~ (All Numbers Rounded)
P92 SG416C
�Teen Birth Rates Have Declined'
Under the Clinton Administration*
.
65
I
.
------~----------~--~--~~----------------------~-----,
0)
.,... 63
LO
I
.,...
I
62.1
"0
<D.
:f
c
.61.
<D
E
0
~
0
0
0
59
_
...."
__ .1IiIiIItIiIi
-
.,...
' -..
<D
n... 57
55
1991
1992
1993
1994
" Source: "AdVance Report of Final Natality Statistics, 1994," Monthly Vital Statistics Report, Centers for Disease
Control and Prevention, Vol. 44, No. 11 (s), June 24, 1996 . . .
..,
.
* Uve births per 1,000 women aged 15-19·
P92 SG4100
",'.
�TIMELINE OF KEY DATES FOR WELfARE IMPLEMENTATION
Date
Agency
Action
October
October 1
October 1
October ASAP .
HHS/ACF
States can enter TANF program
HHS/Child Support State lawson expedited procedures and
paternity establishment (with exceptions)
go into effect
Child Care Block Grant goes into effect
HHS/ACYF
. USDA
OMB/GC/DOJ
Letter to states on new policy on food
stamp eligibility
Definition of Means Tested Benefit to be
worked out
early October
. USDA
Guidance to states on waiver of 18-50
year-old work requirement
early. October
SSA.
Guidance to field needed on children's .
disability detennination
early October
HHS/HCFA
Guidance to states on opting in or out of
state option on Medicaid/fANF/SSBG re
legal immigrants
early October
USDA
Guidance to field needed ASAP on 40
.quarters detennimltion
October 7
HHS/HCFA
Meeting with State Medicaid DIrectors
October 13
INS
Comment period ends on reg re
naturalization and disability
October 22
SSA
Draft reg on children's SSI to OMB
�November 6
DOl
Comment period on interim reg defining
"Lawfully Present" ends
November 17
HHS
State reports on Child Poverty due
November 22
HHS
Secretary's report on Technical Corrections
due
November 22
USDA
3 month clock starts ticking on 18-50 year
olds
November 22
SSA
New reg on childhood disability to be
published (by statute)
November
SSA
Notices start going to families of children
on SSI subject to redetermination (must be
complete by 1/1/97 by statute)
November
HHS/ACF
December
HHS
First T ANF regs to be put out for comment
December
HHS/OCSE
First Child ,support regs to go out for
comment
December
HHSlHCFA
Medicaid Guidance to be issued
December 15
INS
Reg on naturalization and disability to be
finalized
lanuary 1
HHS
Teen Pregnancy Strategy to be published
January 1
HHS
States may exercise option to deny legal
immigrants TANF, SSBG, Medicaid
January - March
SSA
Notice to legal immigrants on SSI go out
(by 3/31 by statute)
February 22
SSA
Report to Congress on implementation of. .
SSI children's changes
. Child Care Interim Final Rule published
�WELFARE REFORM IMPLEMENTATION ISSUES UST
10/1/96
ISSUE
WHO
PRODUcr
NEXT STEP
USDA
1. Immigrant Recipient
Eligibility
USDA letter to states to go
out on October 1 clarifying
change in CR and other
effective date issues
FNS, Emily, Diana
Letter ready?
2. 18-50 Waiver guidance
Draft waiver guidance
Yvette/FNS
Draft needed this week
3. Chiles letter on QC waiver
Response to Chiles
USDA to draft and
coordinate with
Intergovernmental
SSA
1. Children issue
Implement new definition
SSA, OMB, DPC
2. Maintenance of effort on
.state supplementation
HHS·
1. Medicaid Issues:
- Delinking w/AFDC
- SSI for imm/children
- waivers
- $500m enhanced match
State Medicaid Directors
meeting on October 7 should
offer clarification for states
2. Series of technical
questions from NGNNCSU
APWA
Responses by 10/9 weekly
intergovernmental meeting
State Medicaid Directors
meeting on Ion. Meeting at
White House to review on
Wednesday 10/2
�3. Technical amendments
Report from Secretary to
Congress on 11/22
4.· Perforniance Fund
proposal
loint proposal from HHS and
the intergov groups due one
year after enactment
5.· Mechanics of 1/97 state
option on Medicaid, TANF,
SSBG for legal immigrants
Guidance?
HHS to identify options
6. Redoing cost neutrality for
existing waivers (includes
USDA)
New agreements with states
HHS and OMB should
convene meeting
ASAP
1. Disability Regulation
Final rule (December?)
INS working with OIRA
Interim rule out for 30 day
comment; Need Meeting to
Finalize
2. "Means Tested"
Government-wide definition
of means tested must be
developed ASAP - fonnat
and disseminationTBD
Elena Kagan and OMB
working group
OMBlElena to set meeting
by October 4
3. "Lawfully Present"
DOl regulation defining
"Lawfully Present"
DOl
Interim reg is out for 60 day
public comment - ends
11/6/96
4. AG memo excepting
programs
Memo from AG
D01/OPD
Initial memo out for
comment; revision due
when?
HHS beginning to
coordinate?
HHS and groups have
discussed a cooperative
process
Immi~tion
2
�5. Verification
(1) Options for interim
verification; (2) Longer term:
DOJ system
Steve Warnath!Elena/DOJ
6. Affidavit 'of Sponsorship
.Develop new affidavit and
address process issues
INS
Need to ensure process for
determining veteran status of
various groups (Hmong,
Filipinos) and process for
determination generally
Steve Warnath!Elena
Meet with VA, DOD, DOJ,
INS week of 9/30
8. Applicability to
CubanlHaitianentrants
NSC
Steve to check with NSC on
timing/status
9. Treaty issues
INS and DOJ/OPD .
INS 'and DOJ/OPD looking
at issues; will report on
status/timing
INS putting issue memo
together; options. Will
report on status/timing
New affidavit within 90
days; effective 60-90 days
. after
-
7. Veterans
10. Reporting of Illegal
Immigrants
Quarterly reports from states
,
to INS
INS
11. Citizenship Materials
INS to produce materials
agencies can use to inform
regarding naturalization
INS
12. "Federal public benefit"
Determine whether any·
flexibility.in definition
Steve Warnath
Steve will explore what
flexibility there might be
13. "State or Local Public
Benefit"
Determine whether guidelines
needed
DOJ
DOJ to report to Steve
Warnath
3
�14. Housing and Community
Development Programs
Determine what programs
covered by this exception
Steve Wamath/HUD
Steve to consult with HUD
15. U.S. Nationals
Determine how law applies to
nationals
001
001 to review and get back
to Steve
4
�,;T-02' 96 18:08
..
FPOM:
2024562215
TO:202 456 7311
.PAGE: 02
THE WH'ITE HOUSE
WASH I NGTON
MEMORANDUM FOR THE SECRETARY OF HEALTH AND HUMAN SERVICES
THE ATTORNEY GENERAL
SUBJECT:
Guidelines to States.for Implementing
the Family Violence Provisions
-Domestic violence has a devastating impact on families and
communities.
Each year, hundreds of thousands of Americana
are SUbjected to assault, rape, or murder at the hands of an
intimate family member. Our children'S futures are severely
threi'ltened hy the fact that thp.y livp. in homes with domestic
violence.
We know that children who grow up with such violence
are more likely to become·victims or batterers themselves.
The
violence in our homes is self~perpetuating and eventually it
spills into our schools, our .communitieg, and our workplaces.
Domestic violence can be particularly damaging to women and
children in low-income families.
The profound mental and
phyoical effecta of domest~c violenoe can often interfere with
victims' efforts to pursue education or employment -- to become
self-sufficient and independent.
Moreover, it is often the case
that the abusers themselves fight to keep their victims from
becoming independent.
As we reform our Nation's welfare system, we· must make sure
that welfare-to-work programs across the country have the tools,
the training, and the flexibility necessary to help battered
women move successfully inco the work force and become
self-sufficient.
For these reasons, I strongly encourage States to implement
the Wellstone!Murray Family Violence provisions of the Personal
HeRpr.mRihi lity <=lnci Work Oppnrtnnity Rf!!conciliation Act (PRWORA)
of 1996 (Public Law 104-193, section 402(a) (7}).
TheSe
provisions invite States to increase services for battered women
through welfare programs and help these women move Bucceesfully
and pp.rmanently tnto t:he workplace.
The 1='amily Violence pro
visions are critical in respondin.g t:o the unique needs faced by
women and families subjected to domestic violence.
..
�:T-02·96 18:08
FROI'1:
2024562215
TO:202 4::>b 1..:)11
2
As we move forward on our hietorical mission to reform the
welfare ~y~t:~m, . r:hi..~ Administ:r~t:ion :i s r.()mmitt~d to offering
States assistance in their efforts to implement the. Family
Violence provisions.
Accordingly, I direct. the Secretary of the Department of Health
and Human Services and the Attorney General to develop guidance
for States to assist and facilitate the·implementation of the
Family Violence provisions.
1n crafting this guidance, the
Departments of Health and HUman Services and Justice should
work wit.h St.at.f!R, domestic violp.nce AxpArr.s, victims' services
programs, law enforcement, meqical professionals, and .others
involved in fighting domestic violence.
These agencies should
recommend standards and proc~dure5 that will help make transi
tional a9sist~nc~ programs fully responsive to the needs of
battered women.
.
The secretary ot Health and Human Services is further directed
to provide States with technical assistance-as they work to
implement the Family Violence provisions.
Finally,. to more accurately stUdy· the scope of the problem, we
should examine statutory rape, domestic violence, and sexual
a~~al]l~ a~ thr~~~s to saf9ty and barri9r~ t~self-sufficiency.
I therefore direct the Attorney General and the Secretary of
Health and Human Services to make it a priority to understand
the incidence of statutory rape, domestic violence, and sexual
assault in the lives of poor families, and to recommend the best
assessment. referral; and delivery models to improve safety and
self-sufficiency for poor families who are vietirns of domestic
violence.
.
I ask. t:hp. ARr.r,p.t:ary of Health and Human Services and the
Attorney General to report ~o me in writing 90 days from the
date of this memorandum on the specific progress that has been
made toward these goals.
�TIMEUNE OF KEY DATES FOR WELFARE IMPLEMENTATION
Agency
Action
October·
October 1
States can enter TANFprogram .
HHS/ACF
HHS/Child Support State laws on expedited procedures and
paternity establishment (with exceptions)
go into effect
Child Care Block Grant goes into effect
HHS!ACYF
October 1
USDA
Letter .to states on new policy on food stamp
eligibility
October ASAP
OMB/GC/DOJ
Definition of Means Tested Benefit to be
worked out
early October
USDA
Guidance to states on waiver of 18-50year
old work requirement
early October
SSA
Guidance to field needed on children's
disability determination
early October
HHSlHCFA
Guidance to states on opting in or out of
state option on Medicaid/TANF/SSBG re
legal immigrants
early October
USDA
Guidance to field' needed ASAP on 40
quarters determination
October 7
HHS/HCFA
Meeting with State Medicaid Directors
October 13
INS
Comment period ends on
naturalization and disability
October 22
SSA
Draft reg on children's SSI to OMB
reg
re
�November 6
DOl
.Comment period on. interim reg defining
"Lawfully Present" ends
November 17
HHS
State reports on' Child Poverty due
November 22
HHS
Secretary's report on Technical Corrections
due
November 22
USDA
3 month clock starts ticking on 18-50 year
olds
November 22
SSA
New reg on childhood disability to be
published (by statute)
November
SSA
Notices start going to families of children on
SSI subject to redetermination (must be
complete by 1/1/97 by statute)
November
HHS/ACF
Child Care Interim Final Rule published
------------------~--------------------------------------------------
December
HHS
First T ANF regs to be put out for comment
December
HHS/OCSE
First Child support regs to go out for
comment
December
HHSIHCFA
Medicaid Guidance to be issued
December 15
INS
Reg on naturalization and disability to be
finalized
Ianuary 1 ,
HHS
Teen Pregnancy Strategy to be published
Ianuary 1
HHS
States may'exercise option to deny legal
immigrants TANF, ~SBG, Medicaid
Ianuary - March
SSA
Notice to legal immigrants on SSI go out
(by 3/31 by statute)
----------------------------------------~---------------------------~
February 22
SSA
. Report to Congress on implementation of
SSI children's changes
�,
Personal Responsibility and Work Opportunity_,Reconciliation Act
1996
Child Support Enforcement
Sec. 101. Block Grants to States.
In 'order to be eligible for
the family assistance program, a state must certify that the
state will operate a child support enforcement program' under the'
State plan approved under part D. States must' deduct not less '
than 25 percent of the assistahceprovided to a family for any
individual not cooperating with ,the 'child support agency and may,
at state option, deny the entire'familY'assistance,' States must
require that a member of a family receiving assistC!-nce assign any
right to child support, ,not exceeding the total amount of,
assistance provided to the ,family, which accrue before the date
the family leaves the program, If. the assignment occurs after
October 1,' 1997, the assignment shall not apply to support
accrued before the family received assistance but not collected
from October I, 1997 to October I, 2000 (other than support
- collected pursuant to., sect;ion 464, the tax refund offset). If
the assignment occurs after October 1" 2000, if', does not . apply to
any support accrueo.'before the family receives assistance but not
collected before the family leaves assistance (other than support
coll~cted pursuant ,to section '464, the tax refund offset).
States are prohibited from requiring the assignment of post- .
assistance' ariears;
Sec. 301. State Obl'igation to,Provide Child Suppor't Enforcement
Services. Imposes a state obligation to provide child support
enforcement services such ,that services will be, provided for each
child receivingassistanc~ under IV-A, IV-E, atid Title XIX.
'
Services must also be provided for others who apply for' services.
States must provide continued child support services for those
famili.es ceasing to receive ass~stance without regard to a new
applicat.ipn.
'
Sec. 302. Distri:Qution of Collected Support. Changef? ,distribu-,
tion priorities to provide that famil
leaving welfare receive
priority ,in payment of arrears; Changes are effective October I,
1997 for p6st assistance ~rrear~'andOctober I, 2000 for pre
assistance 'arrears. Exception is made for the collections from
the tax refund ,intercept program. Provides a hold harmless provi
sion so that states are protected i,f the amount they lose because
of changes in distribution exceed what they gain from the
elimination of the'$~O pass-through. $50 pass-through is,
eliminated'Octoberl:, ,,1996.,
Sec. 303. Privacy Safeguards.
Protects privacy rights with re
spect to confidential information.
'
Sec. 304. , Rights to Notificatipn and Bearings. Requires states
to have procedures forproviding,.notices of proceedings arid
�·
'.
copies'of orders to recipients of program services or parties to
cases_being served under Title IV-D.
Sec. 31'1 ~.
State Case Registry . - Includes requirements for the
central state regi'stry, including maintaining and updating a pay
ment record and extracting data for matching with .other
databases. Allows automated linkages of local registries.
!
.
.
'
Collection and Disbursement 'of Support Payments.
Includes requirements f'or the centralized collection and
disbursement of support payments, including the monitoring of
payments , 'generating wage' withholding notic~s., arid automat-ic use
of administrative-enforcement remedies. Requires States to have'
sufficient staff to carry out these·activities. Permits' linkages
of local disbursement units to form centralized State dis
bursement unit for collection and disbursement of child support
payments provid€=!d Secretary of HHS agrees that the system will
not cost more nor take mor'e time to establish or operate than a
centralized system and employers have one point of remittance for'
income withholding-; Requires distribut;ion w/in 2 business days
of receipt ofcolle'ctionj transmission of withholding orders to
employers w/in 2 business days of notice of income source subje-ct
to withholding with an exceptlon to the requirement to allow
delay in disbursing arrearage collections pending resolution of
any timelY,appeal regarding amount of arrearage owed:
Sec. 312.
,.
Sec'. 313. .State Directory of New 'Hires. Requires employers and
labor organizations 'to report, name, address, Social -Security
Number and Employer Identification Number on new hires to State
Directory of Ne,w Hires wi thin 20 days of hire (in the' case of an
'employer transmitting reports magnetically or electronically,
reports may be made, by 2 month'lytransmissions)i requires the
report to be the W-4 or equivalent at option of the employer;
contains a multistate employer provision that allows an employer:.
to report to a designated state wherE: it's employees work i state
option for a nominal penalty for failure to. report, enhanced
penal ty based on conspiracy i . . information reported on new hires to
the State Directory.must be entered into the database within 5
business days of receipt; State Directory must perform database
matching using SSNs ahd report findings to any State; Directory
must also report information to the National Directory within 3
business days, issue withholding notices within 2 business days
of match, provide extracts of SESA informat,ion to National .
Directory quarterly, as.well as other uses of·new hire.
Amendments Concerning Income' Wi thholding. Strengthens
and expands income' withholding from wages to pay child support,.
Reduces the time for employers'fo remit withheld wages to 7
; business days; adds' a St-ate law requirement allowing issuance of
.
withholding orders by agency electrqnically'and without notice to
obligor j makes reyisions to cur_rent statutory language governing
providing notice to obligors c~:)li.terning wag~ withholding' actions '.
Sec. 314'.
'2
�and procedures 'for contesting such.
law in interstate wage withholding.
Sec. 315.
·Pr'ovides ,rules for choice of
Locator 'Informati'on from Interstate Networks.' In
cludes requirements for access ,to locator information from state
motor vehicle and la:w enforcement systems.'
'
Expansion of the, Federal Parent, Locator Service. The
authority-of FPLS to obtain information and locate individuals is
exp,anded under this section. The' language perini ts .access to FPLS
for the enforcement· of child custody and visitation orders but
requests must come through courts or child,support agencies.
This section g:r;ants the right of gov:ernmental enti,ties to ,be"
reimbursed for fees under this ,section. A federal case registry
of child support orders is to be ,established. Guidelines for the
National Directory of New Hir.es are detailed, in'cluding, a
requirement that data be entered into the National Directory two
days after receipt. ,The ,Social' SecuritY,Administration is called
upon to verify SSNs. Also ,allows disClosure of SSNs and
addresses to agents of child support enforcement agencies.
Allows disclosure of certain information, including Federal tax
offset amounts, to agents.
Sec. 3,16,.
Sec. 317. Collection and Use, of Social Security Numbers for Use
in ,Chi'ld Support Enforcement. ,Requires use of Social Security
Numbers on,applications for professional licenses, commercial'
driver:~ license, occupational lic~nse or marriage licenses and
:iri re'cordsfor div()'tce decrees, support orders, paternity
determinations ,or acknowleqgements and,' death certificates.
Sec. 321. "Adoption of Uniform' State Laws.
Mandates adoption of,
the Uniform Interstate Famiiy Support Act.
'Sec. 322. Improvements to Full, Faith and Credit for Child Support:
Orders. Clarifies priorities for recognition of orders.
Sec. 323~
Administrative Enforcement in Iriterstate Cases.
'Requires states to respond within 5 business days ,to a request'
from another state to e,nforce a support order. 'Electronic means
are allowed for transmitting requests.'
Sec. 324. Use 'of Forms in Interstate Enforcement. ,Calls for the
,promulgation of forms to be used in interstate income withholding
case,s, the imposition of lien!;;, and administrative subpoenas
across state lines, after consultation with State IV-D 'Direct'ors. ,
Sec. 325. State La,ws Providin'g Expedi.ted Procedures. State IV-D'
programs are granted the authority to take action "without the
necessity of obtaining, an order from any other jUdicial or
administrative tribunal; but subject to due process safeguards as
appropriate,.," T1!.ese actions include ordering genetic testing for
paternity establishment, issu.ing~a subpoena for financial or
3
�'.
other information, and requiring ,all entities to respond to re
quests for information. States are granted access to' public re
cords such as v.ital statistics of marriage. birth and divorce,
state and local tax records, real. and title~pers6nal property,
license records, employment security records, public assistance
programs, motor vehicle I7ecords and corrections records. Also
grants access to cert~in private records such as public utility
and cable television r~cords and financial institution data.
Other 'administrative measures provided in this ,section include,
the power, to change the payee to the state,too_~det income
withholding and to seize assets to satisfy arrearagesand to
increase the amount of the award-"to pay arrearages. This section
also provides for presumed address of the obligor statewide.
.'
jurisdiction. Automation must be used as a means of, implementing
the expedited administrative procedures .
. Sec .. 331.
State L~~s Concerning Pate;-ni ty Establfshment.·
Streamlines the legal proc.essef?, for establishment of paternity ..
.Allows establishment of paternity anytime before a child turns
18. Provides for mandatory g'enetic testing in contested cases.
Enhances the process for voluntary acknowledgement ·of paternity
and requires a state form for vo'luntary acknowledgement. States
may have" good cause exceptions. Establishes -a threshold
probability for the establishment of'paternity.Requires default
orders in certairi cases. Does not ,allow trial by jury., Orders
temporary child support in certain cases. E"stablishes a national
paternity acknowledgement affidavit.
"
Sec. 332.
Outreach for Voluntary Paternity Establishment ..
Mandates tha.t state programs "publicize the availability and
encourage the use' of pro~edures for voluntary establishment of
paternity and child support by means the State. deems appropri
,~te."
"
,
Sec. 333. Cooperation by Applicants for and Recipients of
Temporary Family Assistance., Specifically shifts to the state
IV-D agencies the re~ponsibil:ity for'· determining and redeter
mining whether recipients of temporary assistance for needy
familieS (Title IV-A) are cooperating with child suppore enforce
ment efforts. It furtl).er specifies actions with which, ,the State
must require recipients to cooperate, 'as well as the duty of the
IV-D agency to, promptly notify the individual and the State Title
IV-A agency of the det,ermination and basis ·for any finding of
noncooperation.
Performance-Based Incentives and Penalties. The
Secretary of HHS shall develop a ,new incentive system.by March I,
1997 which shall provide additional payments to any State based
on such State's perfonrance under suth program f.or fiscal year
1999.. Incentive, system must be cost neutral. IV-D paternity
establishment percentage is changed so that states with PEP from
75 to 90 must improve 2 perc.ent per. year . Sate may uS,e either
Sec. 341.
4
�the,IV-D system rate, or th'e rate for all out-of -wedlock births, in
, the state.
Sec. 342. Federal and State Reviews and ~udits.Changes the
audit process to be based on performance measures.
Sec. 343. Required Reporting PrOcedures. Requires states to
collect ,and report program data in ,a uniform manner as a state
plan requireme,nt.
Sec. 344. Automated Data Processing ,Requirements.
Revises
requirements for the state automated data processing systems.
'Contains a new ,implement3tion timetable that extends the deadline
to 10/1/97 by which ,a state must have an automated case tracking
'and monitoring system meeting ,all Federal IV-D requirements up
througp the ena~tment of the'Family Suppor-tAct of 1988. Sets a
deadline of October 1, ,200,0 for' implementation of new require
ments except, that the' deadline shall be extended, by one day for
each day (if any)': tliat the Secretary':fails to meet the deadlin~
,for prescribing final regulations.
The Secretary is to prescribe
fi~al regulations not later than two years after enactment .
.
.
., . '
Extends 90 percent funding for the amount approved for states in
the Advance' Plcmn~ng Documents submitted on or before September
30" 1995.
Sets : funding at 80 percent for new re'quirements.
Caps
,aggregate spending on the new automated system at $400;000,000.
,Sec. 345'~ Technical Assistance.' S'ets ,aside one percent of' the
federal share of reimbursed public' assistance' for information
dissemination and 'technical assistance to states, training 'of
state and feder~l staff', ,staffing studies and 'related activities
needed to improve programs including'technical assistance
concerning state autbmatedsystems; and research, de~onstration,
and special projects of re~ional or national significance
relating to the operation of state programs. An additional two
per~ent is set aside for the operation of the Federal Parent
Locator Servi~e to conduct its expanded responsibilities,
including those for interstate cases.
Sec .. 346.
Reports and Data Col'lection by the Secretary .
Conforms data collection requirements and eliminat'esreq1.lirements
for unnecessary or duplicative information.
Several new data
reports are tci beintluded irithe annual re~ort to Congress
including information about compliance,by state, with standards
for program operations such as time, limits for service delivery
,and distribution of payments.
' .
Sec.. 351'.
Simplified Process for Review and Adjustment of Child"
Sup~ort Orders.
Require~ processes',fur periodic modification of
all child support orders.
Reviews would occureve~y three years,
,but only upOI1 request.
Language permits states to either review
against guidelines or use a COLA:· or 'automated method with the
5
�..
opportunity t.o contest the award and make a reqUest for a review
using guidelines; permissive reviews based upon substantial
change in .circumstances outside the three year review process;
and notice. provided af right to request reviews every three
years.
'
Sec. 352.
Furnishing Conswrier Reports for Certain· Purposes
Relating to Child Support. Expands access and use of consumer
repoits' by' child support agencI'es for establishing and'modifying
child support provided"paternity has been established; child sup-:
port agencies must notifY,the party that the state agency is ob
taining a ~eport.
Sec. 353. Nonliabili ty for Depository Ins'ti tutions Providing
Financial Records to State Child Support Enforcement Agencies in
Child Support ~ases.
Specifies that depository' institutions
would not be liable for disclosing financial information to the
child support enforcement agency; child support enforcement
.agency would 'be prohibited' fram 'disclosing information obtained
e~cept for child support purposes.
.
Sec. '361.
.Internal Revenue Service Collection of Arrearages.
Makestechriical correction to IR~ full collectiori-proc~ss so that
additional fees may not be charged for adjustments to an amount
previously certified.
Sec., 362. Authority to Collect Support from Federal Employees.
,Eliminates separate withholding rules for federal employees.
Applies to w:i,.thholding of Federal compensation for'death
benefits, black lung benefits, and workers' compensation. Adds
protection from penalty/liability against feqeral employees for
disclosure .. , Determination of the amount of withholding would
exc~ude certairi taxes~ health and life. premiums and retirement
contributions . . Specifies that ~oney subjec~to this process are
due from the executive, legislative and judicial" branches of the
federa1 .government., ,
Sec. 363 ..
Enforcement ,of Child Support 'Obligations of Members of
Sets forth processes for payment ,and
'enforcement of child support obligations for'members of .the armed
forces.
the Armed Forces.
Sec. 364.
Voiding of Fraudulent'Transfers.
Requires state laws
regarding voiding-of fraudulent transfers.
Sec . . 365. . Work Requirement for Persons Owing Child Support.
Requires the 'state to seek a judicial- or administrative order
that requires any individual owing past-due support to pay such
support or participate 'in work activities.'"
.
,
Sec. 366.
Def ini tion of' Support Order.
defi~itionof
a,support order.'
6
Prov~de
'f or the,
�Sec. 367. Reporting ArrearagestoCredit Bureaus. Requires .all
delinquencies and-,their amounts to be reported to credit 'bureaus.
Sec. 368. Liens . Requires liens on real ariel' personal property
by o~eration of law~nd extension of full faith & credit to liens
arising in another State without.regi~tr~tion of order in State
where property is situated.
'
Sec. 369.. State Law Authorizing Suspension of Licenses. '
Requires states to have laws providing for t.he'suspension of
driver's, professional,. occupational/ and recreational licenses.
Sec. 370. Denial of Passports for Nonpayment of child Support.
Establishes a process by which HHS ·can s,ubmit the., names of
delinquent obligors in excess of $5,000 to 'the State Dep~rtment
for thedert~al of their passports.
Sec. 371. International Child Support .. Secretary of State with
the c,oncurrence of the Secretary of Health and Human Services is
authorized to declare any foreign" country 'to be a foreign
reciprocating country for purposes of establishment and
collection of child support obligations: De'tails responsibility,
of HHS and states'under state plan requirements for enforcement
of international child support.
,
'
!
Sec. 372. Financial Institution Data Matches.
to enter agreements with finan~ial institutions
with the State to develop a data match system. ,
institutions are to provide certain information
to respond to notices of liens or levies.
Requires States
doing business
Financial
on ac.counts and
Sec. 373. Enforcement of Orders Against Paternal Grandparents in
Cases of Minor' Parents., Adds a State option that a child support
order of a child of minor parents, if the. mother is receiving
cash assistance, may be ~nforceable against parents of the
noncustodial parent of the child.
Sec. 374. Nondischargeability in' Bankruptcy of ,Certain Debts for
the Support of a Child. Child·sti~port assigned tb state in
assistance cases is no~ dischargeable in bankruptcy.
Sec. 375. Child Support Enforcement for Indian Tribes. States
may enter cooperative agreements with 'Indian Tribes and the
Secretary may make direct federal 'funding' to Indian tribes
meet
certain criteria.
Sec. 376. Technical Correction' to ERISA Definition of Child
Support Order. Expands and clarifies ,definition.
Sec. 377. Enforcement of Order~ for Health Care Coverage. It
adds a new State law requirement to section 466 of the Act which
provides that t.he State IV-D ~geficy have procedures for notifying
,
.
7
�. new employer of an absent parent·,. when the ab'sent parent was
proyiding.health care coverage of the 'child in the previous job,
-of--· the medical support obligation. The notice. would operate to
enroll· the child in the absent. par·ent / s healt.h plant' unless the
absent parent contests the notice.
.
Sec. 381. Grants to States for Access. and Visitation Programs .
. Authorizes. grants to States for access and visitation programs~
'j
...
.'
8
.
. \
�
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PDF Text
Text
CENTER ON BUDGET
AND POLICY PRIORITIES
To:
From:
Date:
Carol Rasco
Bob Greenstein
Gt.e \ 9 1994
c..c...'.
December 16,1994
As discussed, I'm enclosing several sets of materials.
•
The materials the Center has produced to date for Governors Romer and Dean on
the balanced budget amendment. There is a 2-page overview memo and then two
2-page attachments. We are now revising this material to make it suitable for
Republican governs as well. Governor Dean then plans to distribute it.
•
Some material I received from Governor Dean's office regarding Democratic
governors and the balanced budget amendment.
•
A piece I've prepared, based in part on Mark Greenberg's thinking, on how to
accord states much more flexibility in AFOC
and some added flexibility in food
stamps - without block-granting these programs and causing the problems that
flow from a block grant. In a sense, this proposal would let states "have their cake
and eat it too." The piece I wrote that the President gave you is an early version
of this paper.
Governor Dean's staff (Bob Rogan) has expressed interest in this, as has Gary
Stangler, who is Governor Carnahan's welfare commissioner (and also eIther the
chair of APW A or of the Council of State Human Services Administrators - I
forget which), Dean's staff plans to distribute this piece to welfare commissioners
of those Democratic governors who are coming to the welfare summit.
Incidentally, the concepts set forth in this paper have been discussed in the past
few days with Senator Chafee' s staff, who also .expressed significant interest in
them.
I hope this is useful.
777 North Capitol Street, NE, Suite 705, Washington, DC 20002
Tel: 202-408-1080
Fax: 202-408-1056
�CENTER ON BUDGET
AND POLICY PRIORITIES
STATE AND LOCAL GOVERNMENT AND THE
BALANCED BUDGET AMENDMENT
Governors have expressed strong concerns that a constitutional balanced budget amendment
not l~ad to the federal government shifting massive. fiscal burdens to states. Some governors have.
asked that a "no unfunded mandates" provision be added to the baianced budget amendment to
ensure this does not occur.
An unfunded mandate provision, however, is limited in the protection it can'offer states
against massive cost-shifting. The major threat to states from the balanced budget amendment is the
unprecedented amount of cuts in grants-in-aid and other programs'affectirig state budgets that will be,
required to achieve a balanced federal budget by fiscal year 2002. This threat looms particularly large
because ofthe emerging fiscal strategy of the new Republican Congre~sionalleadership. That
strategy is both to impose a series of bmding expenditure caps that achieve budget balance by 2002-,
while taking Social Security, defense, and taxesoff-the-table through a series of statutory and '
procedural changes - and to cuttaxes deeply.! The more than $1 trillion in cumulative cuts required
to balance the b,udget over the next seven years would be squeezed out of the remaining types of
federal expenditures. Under these circumstances, an unfunded 'mandate provision fails to address the
problem of disproportionate cuts in feperal funding for state and local functions and leaves states
largely unprotected.
"
The arithmetic of achieving a balanced budget without cutting Social Security or defense or
raising any revenues- and while'cutti1)g taxes as called for in the Contract with America- assures a
heavy hit on states a,nd localities.
•
All federal expenditures other than social security and defense (and the required
interest on the national debt) would have to be cut by, more than one dollar out of every
four compared to spending projected.under current law for fiscal year 2002.
Congressional Budget Office data indicat~ that if there are no tax cuts, 20 percent to 25
, percent of non-defense, non-Social Security spending would have to be eliininated by
fiscal year2002 to balance the budget that year. With the Contract's tax cuts factored in,
the percentage rises to 25 percent to 30 percent.' ,
'
•
Grants to state and local gov~rnments cqnstitute one:-,third of t~e total spending that'will
have to be 're9.uced by approximately one,dollar in four. In fiscal year 1994, federal
grants to st,ate and local governments absorbe'd 32 percent of the federal budget when
Social Security, defense, and interest paYIl1ents on the debt are excluded.
1 The potential chang~s to budget procedure~ ~~e described in Attachment L The impact of the tax cuts
proposed in the Contract with America on federal revenues is described in Attachment 2. [n addition,
Attachment 2 disctis~es ho~state revenues would,be reduced by the .tax cuts at the same time that the
federal government w6uld be sharply scaling back grants to states and localities.
777 North Capitol Street, NE, Suite 705, Washington, DC 20002 ~el: 202-408-1080
Iris J. Lavand Isaac Shapiro, Acting Co-Directors
fax: 202-408-1056
�Spending important to state and local governments is likely to bear a highly disproportionate
burden of the required cuts. Of the portion of the federal budget that would remain on the table,
significant portions of the two-thirds not devoted to grants to stat~ and local governments either
cannot or will not be cut very much.
.
•
. Essential federal functions such as protecting the borders, maintaining embassies
overseas, fighting forest fires, constructing and opera'ting federal prisons, operating the
FBI and Social Security offices, and making pension and disability payments to veterans
are unlikely to suffer more than modest cuts.
•
In addition, there is virtually no chance that Medicare would be cut by as much as 20
percent to 30 percent
which would constitute a cut of $70 billion to $105 billion in
fiscal year 2002 alone. Cuts of that magnitude in Medicare would lead to massive cost
shifting to employers and almost certainly swell the ranks of the uninsured as a result.
In addition, doctors/hospitals, and elderly groups are too powerful for Medicare cuts of
this size to be secured.
•
To the extent that large portions of the budget other than Social Security and defense
spending are reduced by significantly less than one dollar in four, the likelihood
increases that grants to states and localities will be cut by substantially more than one
fourth.
Accordingly, state and local officials may wish to withhold support for a balanced budget
constitutional amendment unless they are off~red more than protection from unfunded mandates.
They may wish to call for the deferral of consideration of the balanced biidget amendment, at least in
the Senate, until legislation laying the framework for getting to a balanced budget and potentially
taking large pieces of the budget off the table is taken up. State and local officials may wish to
establish a basic principle that their support for the balanced budget amendment is dependent not just
upon relief from unfunded mandates, but on assurances that spending caps will not result in costshifting and disproportionate reductions in state and local aid
in short, that the federal budget not
be balanced heavily at their expense.
Unfunded mandate protection would affect only those situations where the federal
government requires other levels ofgovernment to perform certain tasks without paying the cost of
the tasks. Unfunded mandate measures do not prevent highly disproportionate cuts in aid to states
and local governments resulting from large parts of the federal budget being placed off-limits. Nor
would an unfunded mandate measure forestall federal decisions to shed functions that some level of
government must perform and thereby leave other levels of government little incentive but to pick up
the pieces without any federal funds to Undertake the work. It would not, for example, protect
against increases in Medicare cost-sharing requirements that drive up state Medicaid costs under
"medically needy" programs. It would not protect against cuts in child care programs that would
increase the load on public schools that operate pre-school programs with' state or local funds. Nor
would unfunded mandate protection replace lost federal funding for primarily state-local functions,
such as mass transit, education, or economic development.
The potential problems for state and local government must be considered up~front, before the
constitutional amendment passes Congress and especially before governors consider endorsing the
amendment in return for unfunded mandate protection. If an amendment is sent to the states for
ratification in a form that is a dagger aimed at state and local government, governors may have
political difficulty in opposing state ratification if they have earlier endorsed the amendritent.
2
�State and Local Government and the
Balanced Budget Amendment
Attachment 1: Likely Changes in Federal Budget Procedures
The proposed balanced budget amendment would require the budget to be balanced
by fiscal year 2002. Congressional Budget Office data show that if taxes are neither cut nor
raised, federal spending would have to b~ reduced about $1 trillion over the next seven
years to achieve balance. (This excludes savings on interest payments on the national debt
and represents the level of programmatic cuts needed.)
.
This figure understates the magnitude of the spending reductions required. The
Republican Congressional leadership-is planning to move·aseries of substantial tax cuts.
The House Republican Conference estimates that the tax cuts in its "Contract with
America" will lose $190 billion in revenue over the next fiv~ years; the revenue losses from
these tax ctits would be much larger over the long term. Several of the Contract's principal
tax-cutting mea'suresare designed in such a way'that the measures produce orily modest
revenue losses or even revenue gains in the first five years but then lose much larger
amounts of money after that. 2 Based on past revenue estimates of tax provisions similar to
those in the Contract, the cost of the Contract's tax provisions appears to rise from $190
billion in lost revenue over the first five years to more than $400 billion over subsequent
five-year periods. If these proposed tax reductions pass, the level of spending cuts needed
to achieve budget balance rises to still higher levels. Including the Contract's tax provisions
would require spending cuts of about $1.3 trillion to $1.4 trIllion over the next seven years
to balance the budget by fiscal year 2002.
Squeezing Down the Federal Budget with Large portions of it Off the Table
After consideration of the balanced budget amendment, the Republican
Congressional leadership plans to pass a Congressional budget resolution and then a
"budget reconciliation" bill. The emerging strategy calls for the reconciliation bill to
contain provisions that effectively exempt Social Security and the Pentagon from budget
cuts. Other procedures would make it very difficult to raise new revenues. As a ,result, the
remainder of the federal budget would have to shoulder th~ massive cutting needed to
achieve balance by fiscal year 2002. Here's how this would occur.
•
. The budget reconciliation bill would establish a binding cap on the total
amount that could be spent each year on entitlement programs other than
2 Federal budget rules require tax cuts to be "paid for" through offsetting entitlement cuts or tax
increases for their first five years. This has led Members of Congress from both parties to design provisions
whose true fiscal impacts do not emerge until after the five-year point passes. See Attachment 2 for
.
description of the growth in the cost of the proposed tax cuts.
3
�Social Security. In any year that the cap would, otherwise be breached,
entitlements other than Social Security would be cut across-the-board by a
sufficient amount to bring entitlement costs under the cap. Reducing Social
Security costs would serve no purpose, since Social Security expenditures
would not count under the cap. Social Security would effectively be off the
table.
•
The existing spending caps on non-entitlement spending (or discretionary
spending"as it is called) would be extended through fiscal year 2002 and
lowered sharply. In addition, a protective wall, would be placed around the
defense budget so that all of the cuts needed to comply with the discretionary
caps would come from non-defense discretion~ry spending. Non-defense
discretionary spending is the category of the budget in which much federal
aid to state and local governments, including most, block grants, are found.
•
These two caps - the entitlement cap and the discretionary spending cap
would be set at1e.vels so stringent that, by themselves, they reduced the
deficit to zero by fiscal year 2002. All of the required deficit reduction thus
would come from the part of the budget that remains when Social Security
and defense are taken off the table.
'
•
Steps making it difficult to close any 9f the budget gap by raising taxes also
would be taken. The Contract calls for the balanced budget amendment to
include a provision r:equiring that any tax increase be approved by three-fifths
of the full membership of the House and Senate. The Senate may decline to
include such a provision in its version of the balanced budget amendment.
, But regardless of whether such ~ provision is i,ncluded in the balanced budget
amendment, the new House leadership plans -, and has the votes - to
establish a rule requiring a three-fifths vote for any tax measure to pass the
House floor. This rule will be established as soon as Congress convenes in
January. Under the new rule, three-fifths app!oval will be required on the.
House floor even-for a measure to extend,an expiring tax or to finance a tax
cut with an offsetting tax increase.
4
�State and Local Government and the
Balanced Budget Amen~ment
Attachment 2: Impact of Proposed Tax Cuts on Federal and State Revenue
The Contract with America calls for federal tax changes that the House Budget
Committee minority staff estimate would reduce federal revenues by about $190 billion
over the next five years. The revenue proposals include a new tax credit for children, a
ne~ type of Individual Retirement Account, reductions in the rate of taxation of capital
gains income for individuals and corporations, a reduction in taxes for busine~ses that
invest in buildings, machinery, and equipment, and a reduction in the extent to which
Social Security income is taxable for higher-income taxpayers.
Many state tax systems would also experience revenue losses from these provisions,
as a result of conformity to federal definitions of adjusted gross income and corporate net
income.
The revenue loss from these tax proposals would rise dramatically after five years.
The IRA, capital gains, business depreciation, and Social Security provisions in the Contract
are designed so they lose smaller amounts or even raise revenue over the' next five years
but then lose much larger amounts of revenue after the five-year budget period ends. In
subsequent five year periods; the federal revenue loss is likely to exceed $400 billion.
•
The IRA prop'osal is said to raise $5 billion over the next five years. Short-term
revenue gains come from incentives for holders of current-law IRAs to pay
taxes on those holdings now, rather than at retirement, and roll over the funds
to the new, more generous, and more flexible IRAs. After the rollover window'
expires, however, the revenue losses mount. Past analyses of similar proposals
show they eventually lose as much as $50 billion over subsequent five-year
periods.
•
The Contract puts the cost of the capital gains proposal at $56 billion over its
first five years. The proposal includes both an adjustment of the gain for
infla tion and an exclusion from taxation of half the ,remaining gain. In the years
immediately after implementation, revenues are assumed to be boosted by an
increase in asset sales to take advantage of the new provisions. Over time, '
however, asset sales level off and the cost of inflation indexing increases. The
Joint Committee on Taxation has estimated that the cost of such a provision in
the second five-year period after enactment would exceed $160 billion.
•
The Contract lists the depreciation proposal as raising $20 billion over the first
five years. This costly proposal is turned into revenue gainer for this initial
five-year period by decreasing, in the first few years, depredation allowances
for equipment that turn over frequently, such as computers and vehicles. But
a
5
�depreciation for longer-lived assets is made much more generous, and the long
term costs of this proposal are large. Past analyses of similar proposals suggest
the revenue loss in subsequent five-year periods could reach $58 billion.
•
The proposal to roll back the percentage of Social Security benefits subject to
taxation is shown as costing $17 billion over five years. The repeal would be
phased in gradually over the five-year period, however, so the cost in
subsequent five-year periods would be approxi~ately $25 billion.
State Revenue Loss Would Grow as Budget Cuts Hit
Most states conform the definition of individual adjusted gross income and corporate
net income used in their income tax codes to the federal defirutions of such income. Several
of the major tax cuts proposed by the Republican leadership - such as the cuts in capital
gains tax, the expansion of individual retirement accounts, and the more generous
depreciation schedules will be incorporated into many state tax codes if these measures
are enacted at the federal level. The result would be narrower state tax bases and some loss
of state revenue, and this would occur at the same time that the federal government was
sharply scaling back grants to states and localities.
November 281 1994
6
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802 828 3339
DEC.14 '94 7:16PM OFFICE OF GOVERNOR
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[.
DEMOC&ATIC GOVijJl.NOU' ASSOCIATION
CovcIuor EYaD Bayb
StiPe uI' IruIi.via
("J.ir
DEMOCllATlC GOVERNoas
, AND KEY STAn'
TOI
KatIe WheIu
6;(t(1.'TIV£ COMMrIT2~
DouIllIdIanIsoD
~G8!ItDtI Cap!~
Se_ of War;
.I
,·itaWa
CGnaaaiad_ SIa$,tCIY
. GOIYcmor HO'IIVd Dean
.SR~(lfV~1
)lecember 12. UN '
Cin'Hl1lDl' ..... trfiIkt&o
!lal:cc(~_
I.
GoY!lltOOt Add ~
s=ot,.~
..
11Ie pupoII of, tbia memo is
to oUtUn.e' a' ptopoecd commllDicatioDs
strate&Y for ~ Oovemors OIl die. ~ bud&« 1.JtJJCa't4uaeat.
'l1ai$ sttatcgy wooid be .i.m,p1c:aieaJed, subJeet CO DGA Bxec:utivo
Committee 8ppnwal, ill Ibt; case that Jlepublican ~ refuse to
join in a bi:partbm ettort on the baJ~ccd'bIIcI&U ~t.
~llof:aomer
Srllr~ of CQ/GtQ4Q
GoYaRoI' BraceSwtdhm
~Q(~IA.nd
GoYerno&' ,0118 Waihcc
~d'HQIaii
.
Gonmar David WIII.._
Sci= ofOklihoma
'
The straacIY would include Ihe
XadKrinc Whd:ua
-A Je.adcrsIdp
~ Coo&rcasiaDal1eadeA.
,
to11oWtna stepS:
medias betwcal ~
I!;rmuiaDWw
Govcmort _
"
'.
..-A .... COIlfenIlcz o"tJiNns ~ GoVanoII' posldoll
QII tbc b;t1ancid budpt ameadmtnt and
":vine mtbt naDm CH1 t:bc impact
of the amcndmaIt OIl various lilia, IWitiJ. an rmpbaail OIl tlIo ~ of
shiftiu& ClOStI aDto by states witb ~ ~
,
-me
-A D(jA poIiCyforumt pcdJaps 00
same day as me DeWS
the: isaua thl¢; ncod _ be addrc:.s.w.d c!urinS tba
to
~ over tbc balilllCCd bud&ct amendmcat. Tbis sbouId be doGe in me
poriod baween mi4-'Oeeedlb« aJ1CI mkHlIJlUUY.·
~~. cfdamng
-Possible oplnioDpap .~ by Govcmors Daa
Carnahaa.
and
-A 1cUcr fIom Dcrnac:radc, Oovam,ou to 111 ascmbea of
sw.omuizinc'the issues tbat c;tU&ht to be addmaed during the
~
-,
ba1ar1ccd b\KIpt' debato.
_
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430 Sour:b ClpitQJ Strci;t, So£. • W:wbington. D.C. lOOOS • '( 202) 479-5153· fAX (202) 479-5156
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.......
�TallUllfG. ~
lbll of OK Sulas .
#4 l'=onb wpi.ta! ~I'II'CI
VICII~'
T~ IlQ:16:ZH~
'~~-ua
W"~~It. D.C.loao.I.141~
MEM01\ANDUM
Balanced BddS«
FM",: Bany Van
b:
~isionIlD
To:
0,/'
._IPIJ'
Attached are the ~ilCd wrsioos oftbe &4Sug:sre4 ~onaI ~'ad "7aJfdnI Po_ for
IN ~iAlwith CoDgrasicmat ~."
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T\lIIO c~ - tht inscni<ofi of tbc pbr.ue '"any ~ of federal ~
in point 6
or the
fanauaBc and . .addition otthe pMt,s.;, "ad _ have. d~ impIo& on rAe .
un" at the end t>f me first J*Iljrapb in daC ~ oft Budaet Cats _ PqraaD ledMip in the
talking palms - wwc agtII'Cd to by _ SAC. A tIriN cbanp .... InsertiOa or tho pbruc "in abe
. baJu\ced budpt ~c:nf' - was illMbld and shoWn at 'bracbts 011 pap 1 to serve at. focus £of It
~
.
'"
diSCIlSSionamoos the Govemors.
1 ·
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_Il1'0
It was aa;rccd ~ tho SAC would l'fiicwtbcSe revised ~ with 1beir GOvernors tid
dleit
approval ot suqated qvjsion$. Ta flCiliw.: c:Josun: cap die 1fI~ it tNOU!d be helpfUl if yotI
would 8M: me that feedbadt as quHokly as.possi'b~.
;,
.,
.
waS' funhet _pwd chat 1ft)' decision reprdi."g the aCed for short-term interim policy would be
defen-ed pcndina a discussion between GOYcrftOr Dean and Governor TlIomplOA.
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8102 828 3339
DEC.14 '94 7:17PM OFFICE OF GOVERNOR
.
12,",*,94
DRAFT
,
Nado.aI Gowrtaon' .AsaocldoD
Worldal CNap OD • Bah. . . B1ad1}K .A..aNnlllDlielit
Sqpstcd COIIMitutiOuJ LaaguJp
1.
"No obligation impoKd by or pnuaut to
aD
Mt of Coap::5s upon a SWc ihall be
~Io,- PCh,-.,untcss ~ F~ GO\'tnW~ pNYides fhc SWca the: ftmcls
needed to
PaY the Statets c:oIi of complying wkh 1be obtlpt:im.
"
,
.
asAsatnQe by • StakI shall b6 Mfotccablc apinst the ~ wiess tb. QOI'ldltiaIl ia <llNCtly
II'JCI aublrMUIIy rolatld to me spccifio wbjeot mmet t4~ ~ ad iadudat III ...
Milial UI.borizin8ltsisildOll....
3.
4.
f'No Actor Con8fCS$
,
an imP'*' on _" s_ .. obUgatioft to eD8cl or admiai518t a
"for putpo&I:S of tQls amondmem, tb8 term
~,
includes an)' sOOdivision, or
~ity of. State."
6.
"Nodlins' in thia ~md shall be constnred as ~derin, compatible with, the
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�802 828 3339
DEC.14 '94 7:18PM OFFICE OF GOVERNOR
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P.7
. DRAY[
I
H__at Cowl'1lOn' AaodatIoa
A.IP"_.f
. ·1
WorkiDl Group .... Baluc:.cJ aa4pt
TalJdacrolllil for Meedlllwttll CoqreaIoa.II ~
Domocmu.ic .aad J.tepu.b1ioan GovCmon Dp'M OIl the aeed to baJlmce the redaal badpt. At the
same tUne they bcIiCw: thac otfons 1'0 ~ 1ho fcdond bud~ must incl~ the ftcxl"bi1ft)t to
CftsuIc tne s1a&a an: aDIe to manae~ fcdoral prosraa1I ..me_1f aDd . . the Coapess - . Poe
.smA Ibturc oosts to tho stares tbrouP ~ PI_litis.
..
While·_ ~ mponsibility for tadfieatloa 01 a ~ .lmeMmCllt rcats whb state
lcp'amm!J. GcMmors.will play 11 major role In sbapiag public attimdas
lbe amendment
aud their suppon will t.ikd>' be aid;at to 1Imdy n1tifiCItioD. 1beir abilily to suppoIt . . . . . .
and nttific::atkJ.n depeqds ultimately on the imP'« tbal: tho final ~. wiD ~ OIl
local caxpaym and the abUity of__ and loca1idMlO fulfill theit own ~litiea.
towanJ
SIale.
The Wortd!!s Group on a Balanced Buds« ~CIDdDNnt bas bCCIQ oItmpd witJI ideati.fYio8 die
that dw.Y bolicvo must be addrcssc:d in Older to ~ gubematoriaJ support far
adoption and rarifiaWOD of a bab:ncocd budget aJDcadment. ~ concerns fall _ lWO =Uor
c:BtegDrics: (1) pn:m:ction ~ fimIn:: unfuDdccllDllldalq; and (2) ~ Ibat __ will
bo fairly trcatod in the fedoraJ budgat process and &ivea additional tIer.ibUiIy in cmying our lite
JctpOasibilitia they am givea WIder federal legislation. 1lJose coocems tid: addrasscd in more
cfccail in tile ~ below.
*'
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I(these conccms 1M'C addlelRd the Working Group expeQS to PfOpoGe aDd I'fleOIIlIDMd adopbOll
of jatmim N(;A pQlk:y in suppo&1 of a balanced budget arne.adm'enl As always. however. tho
final adopUon of an imerim poJicy position wUI n:qu1re torm~ adioa b)' two-tbirrJI. of the
E.xecudve Comml~ IPld apptovalby t'WOothirds of the Gowmo~ IE their noxt regular naeeting.
wi,.
Statea arid localities need IIIUJInCe that f~ respOnsibilities
bot be sbiW ro dte ...,. ill
of new grant ccmditions or unfunded man~ While 1hCy support lcplativCt actian to
adt:Ir1a tho issue otuatV.nded JI18.lI.datM. thay are ~ tbat such pmvdioni once CnaIdcd by
Con&n- oould cully be reldnclecl. ..u. ~ they believe: ih&t addi1loJ.lll coostitutioaal
. lanpase la ~ fin .. btdaaccd buds« amcadmeatJ to Idford tbenl IDOnI permanent IDd
asSURd protection. . . . oDinWal revRrwy the SQJff advisOry &roUP bellow . . sucm ~
could be provided duuugh inclusion ofdlc foUOWDs, provisions: :
the; fonn
I
Djm;t MImI_ - The federal govt:nUQCftt ShoUld no longer be able ta nwbWe $tIlW aacl
IO\'CIllmtnt acdoD wldlout providina adequate ftmdiDJ.
local
be:
Condb:jpnaJ Mlndates -
The federal govemmem shou.d ncx
allowed 10 force statts and.
localities to iilcur Dew ~ tbnxIp 'tho addition ofDCW COIIdicion$;to aisting pun programs. .
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�81212 828 3339
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AdmiOl$it.il:s: Obliptiou - lb. FedeoJ sovcmm- -shtJufd not be aJ)lt; tq campol
localities to act as it's ill- in ¢IV1Ym,
n::tpOQlibit~.
out'''''
*" aad
gI·L«aUsf. - Tho ~$ affordal to thu- saiiu **kl, .tao be 0I:i0adccl1O
looaHtioti ad otbor ~ities of srate aovemment.
loolwklD
Futurt ptfG • In ardor to avoid tb~ iztaHiv. dbruptiou ~:c=dsting fcdetaI pr~ the
prohl&kioaI ibany ~ should be: ~
,
Lim_ Etrc -. no omtli1drDeqt slloufd not ~ iowpt«cd as ~ increasmg the authority of ~
&dttal g.wCnJnlelOt to bn~ muM·res Fc&rol adioM eummtly pRJhi~by lbt Coa5ti1ution
shoUld remain ph)fu1J~
NodUns- in tht:se proposals ~ iaamded to alter dJ.6 ~ of C!W'I:CM ci'Vif rigbt$ legis1atino ot 10
modify OI! n:dnco in anyway the- audtoril,y of the ~ to protect abe right:t ~. to
Am~ ~-the COilsti1utioa.
~I'Y PnMI:cdo. fnI.as 'UIlf1uade4~.
~ ~-frvm fmnte lQl~ maacbd:eg wUl apt provide ~icn tbr . .
_ nd JocaJkie$ ~ abe mification. of a balanced budset amendmene. As a ~ -me
a
Goven.on seek AD ~ r~ the Consrcss(OMl ~p to support tbe idunedfate
~tnumt of strcmg. GlfOfCUblc lo.gislarlan tbat.wOQld prohibit DtW- UDftln<lM. ~ SUch
legislm:iOft shaakI • • ~ludt,2 prohitliUous against 1It.c ~eDt ofnew conditioDs on snajot
federal grw- aud: cnlitk:RHlnt prosrb;JM.
The Cungp:$s will likely. ~ a nUmbtr _ immC4iiate ~ to rdorm aDd: ~e
of
existing goVetYlDlCnW proglamS a$ it attempts 10 reduce fedetaJ expcnditun:s. These ch~&M
~ b.~ lipifrc.aat finaacial and ~Mic impacts on ~ states. It is vitil t!uU dt.c:
Congress ntc*= that fbt :ital.G$ .must ~ $I (4111 p!U'!iW' in me discu$siOM ·thaI dRape the!Ie
Jt~1!.tM! i~Ja~. The find legistation must iDCl'el:Se state ~ili[y to administer prQJt8IDS
tfficicnUy :m:d not shift additiOnat unavoidable C06fS to $'tal" In<! localities. As m· thi: Ctie or
unfUnded ~ the Gavcrnor$ Seek iI ~11Iiunent from 1M -Con~ ~ an
briac $wet; _l«anu~ IDlU tht: d~i()ft and ~i&11 of rro~ ~e~ t.o4lhcir ~noe
that- tteccs9U)' federal bl:J~et ~m.t wilt talr)y a"~t at! see~ and not. havc a d!spmpartionaM
impact .... ~
.
fiDal Sta1e Ktirm on miftcadnn of amendment ornse e~t1~ ""in ~nd bvUl OIl ~ WOnih¥i Qf
the am.endmeat ~lt ami on a ben~ that tile f~ctal goviirnment ~ (!Onuoiucd to a fAU
~wi:t.h.!Ulttg aw1 localities;. As a result. it isa~·crit:iad:tlmtCO.r~5~ movt'lniclcly 10
c:fkctivdy 3dd:es$ the ki8i~btive and hooget co~ idffiti'fied by the stdes4
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�ACHIEVING GREATER STATE FLEXIBILITY IN AFDC AND FOOD STAMPS
WHILE PROTECTING STATES AND POOR FAMILIES
Interest is growing in the idea of providing states greater flexibility in designing
welfare programs. One approach being pursued by some Republican Members of
Congress would be to turn AFDC and several smaller programs into a cash assistance
block grant and to turn food stamps and several smaller nutrition programs into a food
assistance block grant. .
.
Doing so, however, would cause serious problems.· The problems are of
sufficient gravity to make these undesirable policy options from the standpoint both of
state governments and low-income families. Fortunately, :there is an alternative way to .
give states substantially increased flexibility without using a block grant structure.
This memo discusses the problems with block-granting AfDC and food stamps and
describes an alternative that would retain the desirable features of a block grant
without its drawbacks.
:
Problems with Block-Granting AFDC and Food Stamps
Turning AFDC and food stamps into block grants would pose significant
problems.
•
Insufficient federal funds would likely be m~de available for the block
grant. These block grants would likely be structured by Congress as
discretionary - or non-entitlement - programs whose funding levels are
determined each year in Congressional appfopriations battles. While
some Republican Members of Congress and; governors have talked of a
block grant that would reduce the AFDC funds which states receive by 10
percent to 20 percent, the actual reductions would almost certainly be much
larger than that over time.
The block grant legislation might include an appropriations ceiling that
represents a 10 percent to 20 percent cut. But the actual amount
appropriated would likely be well below th~ ceiling. With Congress
about to tighten greatly the already-austere :spending caps that govern the
total amount that can be spent on discretionary programs (while raising
spending on defense at the same time), domestic discretionary programs
will be squeezed hard in the years ahead. Welfare block grants, which
have weak political constituencies, would likely fare poorly in the intense
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�competition for the shrinking pot of funds thflt will be available under the
spending caps. Over time, the federal funds provided to states for these
block grants are likely to decline substantially. In short, the potential
conversion of the federal funding structure for AFDC and food stamps
from one under which states and poor families have an entitlement to
funds to one in which the funding provided to states for these programs is
squeezed in each year's appropriations fight should be of profound
concern to states.
One additional concern on this front is that states frequently would not
know until October 1 (or even later) how much block grant funding they
would receive for the fiscal year starting October 1. Congressional
appropriations battles typically are not over I . and funding levels not
known - much before October 1. Often these issues are not settled until
November or December. This would make it difficult for states to plan
and operate their low-income programs efficiently.
•
Of equal concern is that a block grant would not respond to the ,increases
in need that states face during economic dovynturns. Under the current
financial structure for AFDC and food stamps, increased federal matching
funds for AFDC - and an increase in 100 percent federally funded food
stamp benefits - automatically flow into a state when recession hits and
more families apply for aid. For example, between June 1990 and June
1992, as the national unemployment rate jumped from 5.1 percent to 7.7
percent, the number of people receiving food stamps rose by more than
five million. Under a block grant, this provision of additional federal
resources during recessions would end. A fixed amount would be
, provided to a state at the start of a year. If unemployment subsequently
rose, the state would have to bear 100 percent a/any additional cash and food
assistance costs itself
I
This would pose serious problems for states. State revenues shrink
during economic downturns, and m'.lny state programs are cut. Under a
welfare block grant structure, states would be forced to choose between
raising taxes (or cutting other programs more deeply in recessions) to
address the mounting needs for low-income' assistance or instituting
across-the-board benefit cuts, making some categories of needy families
and children ineligible for the rest of the year, or placing poor families
that recently lost their jobs on waiting lists for aid.
If states instituted waiting lists, two-parent families could be significantly
affected. The subpopulation whose participation in AFDC rises most
sharply in recessions is two-parent families.'
2
�The loss of the automatic increase in federal ·funding during a recession
would have two other adverse effects as well. It could weaken the
national and state economies. The food stamp and AFDC programs
function as what economists call "automatic stabilizers" - federal
programs that moderate economic downturns by infusing more
purchasing power into state and local economies when recession sets in.
Under a block grant structure, the automatic stabilizer role played by
these programs would be lost. This is especially troublesome in the case
of the food stamp program, which is one of the most important automatic
stabilizer in the federal government's recession-fighting arsenaL
Converting these programs to block grants that fail to respond to .
recessions is likely to make recessions somewhat deeper and more
protracted.
•
These problems are aggravated by another shortcoming of a block grant
structure - it would badly misallocate funds among states. Any formula
that could be used to allocate block grant funds among states would be
based on data for a year in the past; the formula would not be able to
reflect economic and demographic changes since that time. States whose
economies had grown robustly since the year in which the data were
collected would receive more funds than warranted, while states where
economic conditions had deteriorated would receive too little.
Of particular concern is the fact that during a recession, the hardest-hit
states would likely be subject to a "triple whammy." First, there would
be insufficient federal funds nationally, since the federal funding level
would not automatically rise with a recession. Second, the allocation
formula would not recognize the depth of the downturn in states that had
been hit hard. Finally, the states hit hardest by the recession would
generally face large declines in state revenues and be among the states
least able to provide state funds to respond to the additional need the
downturn had created.
•
A block grant also could hinder welfare reform efforts in some states. A
number of states want to expand their JOBS programs, create work slots,
and impose work requirements more broadly. Some states may want to
expand child care for AFDC mothers seeking to work their way off
welfare and for mothers who have just done so. Since a block grant
approach would provide fewer federal AFDC funds - rather than
additional matching funds for states adopting such approaches - these
states could be forced to abandon reforms aimed at promoting self
sufficiency unless they were willing to cut AFDC benefits to pay for the
reforms.
3
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One final problem deserves mention as well. There would inevitably be a
major fight among states over the formula for allocating block grant funds
among them. If the formula reflected current expenditure patterns, it
would penalize states with low benefit levels and risk locking them into
that status permanently. Moreover, if the formula gave each state the
same percentage of federal AFDC matching funds that it currently
receives, this would fail to recognize the differences that will occur among
states in coming years in rates of population growth, demographic
changes, employment levels, or wages. If the formula attempted to adjust
for these factorsi it would be out-of-date (as noted above), always
reflecting economic and demographic conditions several years earlier.
And if the formula were based primarily on economic and demographic
data (such as the number of poor families in each state) rather than on
current expenditure patterns, the distribution of funds among states
would be substantially altered. Some states that pay above-average
benefits could suffer heavy losses of federal funds and be driven to cut
benefits significantly even though their current benefit levels leave
children below the poverty line.
It should be noted that once these programs lose their entitlement status and are
converted to block grants, there will be no turning back, despite whatever problems
may ensue. Given the federal government's fiscal problems - and the politics
surrounding these issues - it would be virtually i,mpossible to regain entitlement
status for programs such as these for years to come.
What About Administrative Savings?
A response sometimes offered to these funding problem issues is that states
would reap large savings in administrative costs if federal rules were loosened. This
response is weak. Even if significant administrative savings could be achieved, they
would constitute only a small fraction of the federal funds that states would lose under
the block grant proposals. Federal and state administrative costs combined make up
about 12 percent of AFDC and food stamp expenditures. Thus, if administrative costs
were cut a fifth, total program costs would be reduced just two to three percent. Under
the proposed cash and food block grants now being developed, the cuts in federal
funding would be far larger - at least 10 percent to 15 percent initially and probably
more in subsequent years.
4
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An Alternative of Greater Benefit to States and Families
The alternative is to give states extensive flexibility to design their own AFDC
programs, much as a block grant would do, while maintaining the federal-state
financial structure for AFDC. This would be done by identifying and eliminating every
provision of the Social Security Act that needlessly restricts state flexibility in shaping
their own AFDC programs and enabling states to largely fashion their own programs
without having to secure waivers. The federal government would continue to match
state AFDC expenditures on,an entitlement basis as it does now.
This avoids the drawbacks of block-granting described above, while providing
states great flexibility. States should prefer this approach to a block grant. It is in their
fisc'al interest to do so.
Under the alternative, each state would be free to develop its own rules
concerning such matters as:
•
what is income and how it should be treated (for example, how earnings
are treated, what income is deemed, etc.);
•
what resources would be permitted, and under what circumstances;
•
what requirements (JOBS, work, other) must be met to qualify for
assistance;
•
what time limits (if any) are to be imposed on assistance to adults and
what work or participation requirements would be imposed on adults
who reached the time limit;
•
circumstances where rules are varied in a part of the state, so that states
have broad freedom to attempt their own demonstration projects.
Under this approach states would also ha\(,e broad flexibility to design efforts to
boost self-sufficiency. For example:
•
States would have much greater freedom in deciding how to spend their
JOBS funds. Federal rules governing JOBS expenditures would be
minimal so states could determine how best to use their JOBS resources;
•
States could opt to convert AFDC dollars into wage subsidies to create
new employment opportunities for families;
6
�•
States could opt to extend child care assistance to working poor families
without requiring that the families first enter the welfare system.
This approach would allow much the same kind of flexibility as a block grant,
while retaining the principles that states have a duty to provide cash assistance to
families that qualify under their state plan and that the federal government has a duty
to join in the cost of assistance to eligible families. (In other words, families that meet
the state's eligibility criteria would continue to be entitled to benefits, and states would
retain their entitlement to federal matching funds for these benefits.) Federal rules
would be limited to those where there i~ a clear federal policy interest; in all other
areas, states would be free to establish their own rules. States would describe their
choices in their state plans. A federal role would be retained in gathering information
about state approaches, providing technical assistance to states, and providing for
research and evaluation efforts.
A question may be raised as to what the fiscal impact of this approach would be
on the federal budget. This approach should not entail significant new costs. States are
already free to set AFDC benefit levels wherever they wish, and these benefit levels are
the key determinant of program costs. Why should giving states more freedom on
what counts as income, what work requirements and time limits to impose, and similar
matters have a large impact on costs when states would continue to have to pay their
share of the costs created by the choices they make?
If, however, analysis shows there is some cost, it could be offset through changes
such as those the Administration and various Members of Congress have developed to
pay for their welfare reform bills. Similarly, if a reduction in federal costs of a
particular percentage is insisted upon by federal policymakers, offsetting savings
provisions (or modifications in the federal matching formula) can be designed to yield
these savings. Such an approach ensures that the funding reductions will be limited to
the percentage amount by which federal officials tell states that funding will decline,
without that amount being ratcheted down further in each year's appropriations
catfight. And it would ensure that when need increased in a particular state, federal
funding would increase along with it.
Food Stamps
This approach would not extend to food stamps. Food stamp benefits are 100
percent federally funded, and there needs to be a federal benefit structure.
The national food stamp benefit structure serves important functions. It
. provides the dnly national benefit floor under poor children. The benefit levels are
indexed to food costs, and federal food stamp resources rise automatically when need
increases during recessions or when wages for low-paid jobs erode.
7
�Moreover, the food stamp program is the only major low-income benefit
program that serves all categories of the poor under a single benefit structure in which
the same benefit formula applies to low-income elderly people and to poor families
with children. The fact that reductions in food stamp benefits hit the low-income
elderly along with poor children has provided important protection to poor children
over the years and is one reason food stamp benefits have kept pace with inflation
during the past quarter century, rather than eroding as AFDC benefits have.
Still another of the food stamp program's attributes is that it moderates what
would otherwise be extremely large differences among states in the benefits they
provide to poor children. In states paying low AFDC benefits, food stamp benefits are
greater, since a family's food stamp allotment depends on its income leveL This is of
particular importance for poorer states with limited fiscal capacity and for the poor
children living in these states. For example, the AFDC benefit level in Mississippi is
one-sixth the level in Connecticut; when food stamps are taken to account, the ratio falls
from 6:1 to 2:1.
With food stamps being 100 percent federally funded, there also is another
reason why it would not make sense to authorize states to set their own food stamp
benefit levels and benefit structures. Doing so could lead to sizeable increases in
federal costs.
Thus, the question is how the federal food stamp benefit and financing structure
can be maintained while according states increased flexibility, especially in areas where
food stamp rules cause problems for states. We suggest states be given more flexibility
in certain key food stamp areas.
•
The limitation on food stamp cash-out projects written into the FY 1995
agriculture appropriations bill could be repealed. States could be given
more flexibility concerning the delivery of benefits through coupons,
Electronic Benefit Transfers or cash.
•
States could be given more flexibility in how to use their federal food
stamp employment and training funds. This would enable states to make
changes to increase coordination with JOBS. In addition, states could be
given more flexibility to use food stamps to provide wage subsidies to .
employers.
•
States could be allowed to modify the rules on what counts as income and
resources in the food stamp program so that one set of rules covers
families applying for both AFDC and food stamps. States could modify
these rules just for the portion of their food stamp caseload that receives
8
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AFDC if they chose. Federal review and approval would be needed, but
approval would be limited to assuring that federal costs would not rise.
j"'
This approach provides added flexibility without unraveling the national food
stamp benefit structure that serves as the only national floor under poor children and
the "gap filler" between high-payment AFDC states with strong fiscal capacity and
low-payment states with more limited fiscal capacity. The important role of the food
stamp program in responding to and cushioning the effects of recessions also would be
retained.
Conclusion
This alternative would represent a major departure from current practice. It
would enable states to design their own AFDC programs and to modify their food
stamp programs in certain ways without having the federal government shift costs to
them during recessions or through cuts to fit within a discretionary cap. This approach
would represent a new partnership between the federal government and the states.
This alternative reflects a basic judgment: states should not be forced to take a
block grant to get substantially enhanced flexibility. This approach seeks to provide
that flexibiiity without the major pitfalls involved in block-granting AFDC and food
stamps.
It should be noted that the issue of block granting food stamps arose once before
in the mid-1980s when the Reagan administration and Senator Jesse Helms, then
chairman of the Senate Agriculture Committee, proposed making food stamps a block
grant at state option. The National Governors Association opposed this proposal,
which was defeated. NGA recognized that even as a state option, this approach was
dangerous for states because it would begin to unravel the fiscal structure under which
the federal government funds 100 percent of state food stamp needs on an entitlement
basis.
.
December 16, 1994
�, Impact of GO~ WelfareRefonn~nd 1995 'Rescissions
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Executive Summary
,I. WELFWREF'oRM '
AFDC/JOBS Block Grant
• Caps and block grants AFDC, JOBS and Emergency Assistance~"
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Cuts Federal funds for the p~ograms 'by $S.7billion (in budget' authority)/S years
,(preliminary 'CBO.)
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Child Welfa~ Servi~es Block 'Grant
• ,3 Hou,se committees propose to reduCe chiid welfare spending: '
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,.funding for, foster care, and adoption assistance, family preservation and to
consolidate discretionary chiid :welfare service programs; ,
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, "million in discretionary child ab\1se prevention grants.
'
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years (preliminary CBO).(The,bills assume that discretionary spending would,
,increase by $1.3 billion in budget authority.), ' ' . , ,
Child Care
• Education and Economic OpPortuniti~s Committee ~ouldconsOlidate the' four
major child 'care prog~ms and six small Pf9grains under a revised Child Care and
, Development Block Grant.,
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• Reduce funding by $2.1 billion, or 18 percent, in budget authority below the
President's budget over Syeari.
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• Over 300,000 children-could lose child care assistance in 2000.
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Child Nutrition '
• R~ the Nation3.I SchObl ~unch Act and the Child Nutrition Act.'
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• Combine 7 food assistance programs, including WIC, into two bloc.k grants.
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• Capped Federal Junding auth9rization level for both grants repre~nts $6.6 billion'
culovercurrent spending path proposed in the President's budget.
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• School-Based Block Grant would no longer guaranteefree meal to needy children.
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• The block grants would eliminate the mandatory' national nutrition standards which
ensure. that chi1dr~n ha~eaccess' to healthy meals at school.,
Food Stamps ,
., House proposal calls for' $21 billion in cuts over 5 years -- and about $3 billion 'in
,increased spending due to AFDC cuts -'- for a net reduction of $18 billion over five
years. .
• Eliminates the Food stamp entitlement and replaces it with an annual spending cap.
• 14 million food stamp recipients are children.
,
Supplemental Security Iiicome (SSI)"
:"
.,:Ways & Meari~ Committee mark (starting poini)wo~ld remove estimated 165,000, '
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children from SSI due to tightened eligibility standards and 30,000 adults with ,
substance abuse.
• Total Federal funding ,for diS<lbl~ 'individuals reCeiving benefits would' drop by
over $11 billion ~}Ver five years (CBO preliminary).
• Changes in alien eligibility would reduce
.years."
benefit~by ariother $10 billion over five
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,II. 1995 REsCISSIONS
Foster .Care·
• Noted above, HouSe Labor/HHS appropriations proposes to rescind over $100
'.
'million in 1995 from Foster .~are,funding for States.
�Special Supplementat.Nutrltion Program, for Women,. ~ants and Children (WIC),
..
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.' $25 million rescission' from WIC would cut, 'by 600,000, the numb~r of benefit
,
, packages that could be' provided in 1995 and 1996;
• Equivalent to' not serving 50,000 monthly participants for a year, or 100,000 for
" six months.'
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Education Department,
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• Goals 2000 -- About 4,000 Jewer schools in 46 states will receive 'seed money to '
implement reforms based on challenging aeademicstandards. '
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.. ' Safe and Drug-Free, Schools and COIDDlUnities .;~ Eliminates pr~gram providing
counseling, instructional and other drug prevention services in 94 Percent of all school
'districts, 'serving 93 perCent of public school children and 82 percent of ail public and
, private' school students~
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• FSEA Title I -- $105 millioricut for Grants to Local Educational Agencies could
, depriv~ up to 100,000 educationally 'disadvantaged children of special services'
, . .designed to achieve to challenging academic standards:,
, Labor Department
JTPA Summer Jobs"-~ Eliminate funding for the Summer Y~uthEmployment
Program in summers of 1995 and 1996, wiping 'out job opportunitfes for 615,000
disadvantaged youth in ea\:h summer. "
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Job Corps-- $10 million rescission eliminates DOL's ability to iriitiate four new
, ' residential training centers;': to serve 2,300 severely disadvantaged youth per year
when fully operationru. '
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HouSing and Urban Development Department' .
Assisted HoUsing -- $5~ 7 billion r~~ission will impact 630,000 families with
children.
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will
Homeless Familles-- Rental ass~stance
be reduced and 12,000 horheiess families
with children will be denied assistance.'
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:National Service
• Cut 15,000 AmericorPs membersfrom the 33,000 Congressauthorize(hmdfund~'
begin service in the latter half of 1995.
to
�'.Examples of National Service activities at risk'of being cut:
, , -- providing thousands of low-income and migrant children with
immunizations; ,
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.:- working with children in eJ)vinmmental clean-up activities;' and
-- working in irtner-city recreation areas 'against drug trafficking.and violence. '
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OHiee of 1he Alsistant Sdcrstary
DEPAIITMENT OF HEALTH. HUMAN SERVICES
tor Legillation
WastllTl\jlon, D.O. 20201
TO:
MARY 10 BANE
DAVID ELLWOOD
401-4678
690-7383
456-7028
456-2878
BRUCE REED
CAROL RASCO
EMILY HkOMBERG
ANN ROSEWATER
WENDELL PRIMUS
SUSAN BROPHY
PAUL CAREY
401-4678
690-6562
456-6220
456-2604
JANET MURGUIA
456-6221
KEN APFEL
395-5730
456-7028
JEREMY BEN-AMI
AVIS LAVELLE
MEUSSA SKOLFIELD
JOHN MONAHAN
401-4678
,,'1
690·~673
690-5673
690-5672
FROM:
HHSI ASL STAFF (Jim Hickman 690-7627)
DATE:
March 2, 1995
PAGES:
9 (including cover)
Letters Stating the AdIllinistration's Viewpoint on the House 'WllYS and M
Committee Chainnan's Welfare Reform Mark
E: This was forwarded to the House Ways & Means Committee last ·night.
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THE SECRETARY OF HEALTH AND HWAN SERVICES
WAS"INGTOff. I)..C. ·20201
MAR'~
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The HonOrable Bill Archer
Cho.irman
Committee on Ways and Means
House of Representatives
Washington D.C. 2051S
Dear Mr. CbaiIman: .
This letter expresses the Admi.nisttation's views on the Chaitman's malk
for welfare tefOrm
legislation Wider oollSidcration by the House Committee aD Ways and Means.
The Administration shares the commitment of the Congress and ~e American people to real.
. welfare reform that emphasizes work, parental responsibility, smte tlexibility, and the .protection
children. Last year, the President submitted bold welfare reform bill, the Work and
, ~bility Aot of 1994, which embodied these values. It if:tcluded tough work requiremen~ .
while providing opportuDities for education,. trBining, child care and supports to working people.
It included a stringent set of child support enforcement provisions..It required ~ teen mother
to live at home, stay in school and identify her baby's. father. It increased state fiexJDility without '.
sacrificing accountability. And it maintained a' basic structure of protectionS for children.
of
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The ~on looks forward to working cooperatively with the Congress in a bipartisan way
to pass bold welfare reform. legislation this year. The Administn;Ltion bas, however, seriOus
concerns about a number of features uf Ihe Chairman's mark that appear tQ undermine the values .
to which we are all committed. The Admjnistration seeks to end welfare. as we' know it by
. promoting work. family and responsibility, not Dy punishing poqr cbil~en for their· parents'
mistakes. Welfare reform will succeed only if it successfully moves' people from welfw:c to
work.
Work
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For years, Republicans and Democrats alike have agreed that the central goal of 'Welfare reform' '
UlUb1 be w~ That is still our goal: People who can work ought to go to work and earn a
paycheck not a welfare check. The AdIDinistration believes that no adult.who is able to work
should receive welfare for an unlimited time without working. The Administration believes that
from the fIrst day someone comes onto welfare, he ot she shuuld be required·to participate injob
search, job placement, education, or training needed to move off welfare and into a job quickly_
It is government's responsihiJity to help ensure that the critical job placement, training, and child
care services are provided. Individuals. who are willing to work should have the opportunity to .
work and not be arbitrarily cut off assistanCe.
�M~R-02~1995
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The Administration therefore has serious conCerns about the CbaUman's mark befon= YOIl:,
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While:: seemingly higher'tlum those in the bill reported out of subcomtilittee,' the,
work standards continue to be weak,and now contain perverse incentives for states
to cut people off, rather than put them to work. Far from requiring stata to,put
people to work, the bill allows states to C01.Ult as "workiug,", pc!SO!1S who were
simply'cut from the welfare rolls for any reason. Cutting people off' welfare is not
the same as putting people to work. In addition. because the bill authorizes the
block grant only through the year 2000, work requirements in the out·years seem
at this point unenforceable and thus more figurative than real. To the extent that
states try to meet the Work standan1s by putting people in jobs rather than cuttiDg
them off, proposed 'fWiding cuts in child care and other programs Would force a
considerable in,crease in state exPenditures' or cuts in benefits.
,0
The proposed legislation provides no assurance of child care to recipients who
work or are prepariIlg luwol'k-evca. if a state' requires them to participate. It
offers promise of child care for those who leave welfare for work or for those
who could avoid falling onto welfare if they had some help with child care. It.
repeals 'provisions of existing law that provide open-ended. funding for ~C8 '
that need child care in order to work or go to school, while the provisions passed
in the mark of the COmnUttee on 'Economic and F.ducational Opportunities
significantly reduce total existing funding for child care and the child care tood '
program. In addition, states may be forced to cut back c:hild care assistance to low
income working families just to meet the child care needs of welfare n:cipicnu..
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The proposed legislation effectively repeals the bipartisan Family SuPPort Act '
signed by President Ronald .Reagan in 1988. It removes any real responsibility of
state welfare systems to provide e4ucation, training and placement services to
move recipients ftQm welfare to work. Indeed, the bill imposes new rest:riQtions
on states which want to provide education or training to move people quickly off
welfare. States should have the flexibility to provide recipients the services they
.need to move from welfare to work as quickly as possible.
.
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The proposed legislation would deay all icdcra1 cash assistance to'most familieS
that ha~e received assistance for more than five years.' Even if the adult· in the
family is unable to find a job or is prevented from holding a job because of
disability or the need to care for a disabled faDilly member, states are prohibited
from exempting from the lifetime limit no more than ten percent of the aseload.
Children,wuuld be seriously jeopardized even if their parents cannot find any work
and are not included in the exemption.
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The .Administration supports an alternative approach that would genuinely tral:IsforDulie weli'are"
system into a transitional system focused OD work. It would have Strict requiIements, on'.
participation and ~lc:w: responsibilities for Slates to provide education, training and placement
assistance; it would have serioUs time limits.after which work would be required; it would ensure
tbat children would not be'left alone When parents were workiDg bj'proVicting assistance for child
care; it would pUt parents to work, not just cat them off; and it would ensure Ihat ~hil~ can
expect support from two patents.
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Pl.I'eDtal RespoQ,Sibility
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The Administration believes that welfare reform should recognize 1be.' respOn!lbility .'8nd .
enooumge the involvement of both parent! in their Children's lives. The AdminiStmtionconsiders
child support enforcement to be an integral part of welfare reform, particularly because..it sends
a strong message to ,young. peOple ·about the ,responsibility of both parents·to support ·their
children. The Administration was pleued when more than one month ago, Chairman Shaw
agreed to add child support enforcCinent to your welfare refonn bill.
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While the new child support proVisions have not been. released. by the Committee" we· do "have
concerns with the one child support provision which is included in the mark distributed thus far:
o
,We are troubled by the provision that requires states to reduce payments to
children for the first 6 months if paternity has not been legally established. This
provision seems ineffectual 'and unfair. EveD if a mother fully cooperates by
giving detailed infOnnatioD identifying the father and bis.possible location, and'
even if the state is diligrmt in pursuing the firther. it can easily take 6 months·to
get paternity legally established.
is DO reason why the cbi1dshDulcl be '
punished during this period..
There
The Administration believestbat the welfare system sho'!lld encourage the fOImalion and support
of two-parent' families. The Administration is therefore concerned about an important omission
. in the proposed legislati(>:n:
o
The proposed legislation would encourage the lm:uk-up of families by rcpeoImg
the requirement that states provide cash assistance to two-parent families in which
R parenti~ unemployed or unable to work. It allows states to discriminate against
manied. twOo-parent families by treating single-parent families better than two
parent families.
The Administr~tion supports an approach that both encourageS the fonnation of two-parent
families and makes sure that both parents take responsibility for children in aU cases.
�M~R-02~1995
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Teen Pregnancy
The Administration and the American people agree that (he best reform of weJfare would he to
ensure that people do,.not need it in the first pIace~' Welfare reform must send a very strong
mesSage to young people that they Should not _ pregnant or mtber a child until they are ready
and able to care for that child, and that if they, do have children, 'they will not be able toeseape
the obligations and responsibilities of parenthood. We mUst be especially concerned about the
well-being of the children who are bam to yaUng mothers, since they are very likeJy to grow up
poor.
The Adminlstration ~ore has serious c:oncemsabout the bill before you:
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unmarried mother under 18 as well as to the' parent until the parent is 18 years
old. This provision p1l11ishes and abandons children rather than helping families
to get them on the right track.
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,The, proPu~ legislation would deny all federal eamto any child bom to an
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'The proposed legislation does not require that teen mothers below the age of 18
live at home and stay in school. It weakeos requirements in current law, ~d may
make the prospects for mother and child even, worse.
The Administr~OD supports an alternative 8pproach that would require minor mothers to live at
home, stay in school, make progre.~ towlrd self·sufticiency, and identify the father of the child.
,The Administration also supports a national campaign to prevent teen pregnaney. It is time to
enlist parents 8Jld ch.ie, religious, and business leaders in a coInmunity based' strategy to send a
clear message about abstinence and respuosible parenting. 1'he Administration also mJPPOrts a
state option not to increase benefits for children bam to mothers on welfare.
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State Fle:dbUity with Accountability
The Adminis1::[ation embraces the creativity and responsiveness of states, and' the: opportunities
,for real reform when states have the flexibility to design and administer welfare programs tailored
to their unique circumstances and needs. Already this Administration has granted WfUVCIS to half
the states for ~lfare reform demonstrations.. National weJiare refonn should embody the values
of work. and responsibility in a way that assures taxpayers that federal money is being spent'
prudently and appropriately. For refonn to succeed, the funding mechanisms for welfares~ould
not put children or. states at risk in times of recession,. population inereaseor unpredictable
growth in demand.
In this context, the Administration h8:.~ serious concerns about the proposed l~gislation:
o
While states' now have an option to choose among allocation formulas, the
spending cap in the proposed legisiatioI11l1akes no allowances for potential growth
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in" the need for cash assistance' because of economic do.wnf:l.U:n. or unpredictable
emergencies. There is only a tiny fund to help" adjust for population changes and
a small loan fund from which states can·borrow. These provisions could result in
"states running out of money before· the end of the year, and thus having to tum "
" away working'falnilies who· hit a "bump in the road'· and apply for short·teim "
assistance. It could prec1u4e states from investing in job placernent; in work
. programs, in education &tid training, and in supports for working ~amilies.
o
The proposed legislation removes the requirement that states match federal funds
with their own state funds. With none oftheii- own money at risk, states will have
fewer incentives to spend the funds efficiently and efl:eetively to Improve
performance and iDc~" self-sufficiency.
The Admi~on supports proposals that sigDificant1yincrease state flexibility hut also ensure
accoUIUability for achieving ilational goals. The Administration supports a funding ID.CQhamsm
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that will not put children and states at risk down the road, and that enables states to succeed in
moving people frolD welfare to work ami in. supporting working families. The Administration
has significant doubts about the abilitY of a pure block grant funding mechanism to adequately
"protect both children and states.
Pro_dOlI of Children
The Administtation recognizes that the protection of children is the primary goal both of cash
assistance programs and ofchild welfare and child protective services. Cash assistance programs
assist families to care for children in their own homes. Child prOtection services help those
children who are abused or neglected or at risk of abuse by their parents and who need special
" n-home services or oUt of home placements to assure their safety. Strengthening families, and
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where appropriate; preventing removal of children from their homes also are, key goals of child
protection services. We believe then: are problems in a. number of areas.
Denial of Benefits to Children on AEDC
The legislative proposals that would reform cash assistance have a number of provisions that
would put vulnerable ~hiId.rcn £1t grea.wr risk.
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The legislation would deny cash assistance to teen mothers and their children. to
children born while the parent was on welfare, and to children whose parent bed
received welfare for more than five years, whether or not a job was available or
the parent·was unable to work. The funding caps eould have the effect of denying
cash assistance to children when states used up their allocated funds> for whatever
reasons. Children in low income workingJamilies, who may be forced onto cash
assistance in times of economic c1owntum, could be most affected.
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Child frotection...Seryices,
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Some of these children could well come into a system of child protection services that is already
seriously overburdened and that is failing tQ proride the most essential services. Reported child
maltreatment and out-of~home placements have bOth been increasing sharply. Many state systems,
are in such distress thnt they 'have been pl~ under judicial oversight. The proposed legislation
responds to these increasingly serious problems by consolidating existing programs that protect
, children into a block grant with nominal federal oversight.' The Administration bas' serious
'
conceins about this approach.
o The proposed legislation caps spending for child protection programs at a level
amsiderably lower than baseline projections. This, could lead to uninvestigated
to children being left in unsafe homes.
maltreatment reports,
and
o The proposed legislation etimiDates many important protections now guaranteed to
children in foster care. These protections were put in place to correct situations in which
children were being lost in the foster care system.
o The propoSed lcgilSlaLiun e1tminates the adoption assistance pro~ and leaves
it up to states, whether they will significantly sustain' the subsidies that enable
many special needs children to find permanent homes.
o The proposed legislation virtually elimimites federal monitoring 'and accountability
mechanisms. It mnkes it impossible for the federal govcmmcnt to ensure the
protection of children.
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patterns. Because of serious imbalances among'the states in spending on child
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protection, it is hard to imagine an allocation that would not disadvantage either
states that have been heavy spenders, or states that are only beginning to .improve
their systemS.
Substantial improvements need to be made in.the child protection system and in the federal role.
in overseeing that system. ('riven the dramatic changes in which other aspects of the Committee's.
mark may have on other support systems for children; the Administration urges caution before
actions are taken that will disrupt the child protection system and, as a result, might seriously
balm millions of children.
DJmial of Benefits to Disabled Children on SSI
.
Although modifications have been made to the Subcommittee report, the AdmInistration is still
deeply troubled by the changes proposed in the program designed to help disabled child!en-~SSI.
�i
1.MAR-eJ2:"1995
'I'
~
I •
113:56
FROM
RASCO
TO
P.eJ8/eJ9
~
L
1
i
l
Page 7
u
sI~
SSr. bencfilS for cbildren. Within G
mo~ over one hundred thousand disabled children wOuld fail to gain eligibility
for S8I benefits as well as medical protection. And' in the future, no child, no
The propOsed legislation dnunu.f.k:W,ly
matter how disabled, will be eligibl~ for any cash benefits for 881, except if cash
benefits prevent them from having to be institutionalized. These proposals appear
to pcno1izc parents who arc dotc:rmiued. to care for,their cbild·no matter what·the
economic corisequences for the family, S81 recipients are among the neediest and
most vUlnerable children, in the poorest families.
.
.
!
o
Some of the money saved is put into a new block grant for services to disabled
children; This change would shift choice of services frOm families to a new state
bureaucracy that uiay lack sufficient resources to serve children affected. The idea
is untested, and no one knowS what impact it will have on the most vuhlerablc of
children and the parents who· care for, them. The 5-year CUt off in AFDC for all
perSons along .with the elimination of SSI cash· for, disabled children may leave
these children extremely wlnerable.
The Administration sees ,the need for careful reform in this area,. with its potential fOf'serio:us
hunn lIJ CAln:mely vulnerable children. Last year the Co~tt wtablUdlcd
il
Comruisxlon un
Childhood Disability to look into these issues in consultation with experts from ,the National
Academy of Sciences. The CommisSion will prOvide its report to the Congress later this
:The Administration believes prudence dictates waiting for this short time until this bipartisan
commission, follo~ a thorough review of 'all aspects of this important program, has· an
oppOrtunity to make recommendations.
year.
..
i
, Benefits to Legal Immigrants
. i
The Administrau()n strongly. believes that illegal aliens should not be eligible for government
welfare support. But the prohibition of all benefits 'to legal immigrants who are not yet citizens
is too broad, and. would shift substantial burdeDS to state and local taxpayers. These legal
immigrants are required to pay taxes.. Many serve in the armed forces, and contribute to their
communities. The Administration strongly favors a more focused approach of holding sponsors
accountable for th()~e they bring into this oountTy and making the sponsors' commitment of
support a legally binding contract. .
, .
I .
i
�TO
FROM
RASCO
,
Page 8
In summary, the Chairman's mark espouses goals for the reform of welfare-work, parental
responsibility, prevention of teen pregnancy and state flexibility--that the Administration and the·
, American people share. But the translation.of general goals into specific legislation. misses ~e .
mark in fundamental ways. The proposed··legislation does not represent serious work-based
reform. It doea nothing to move people from welfare to woik, and it does Dot n:;qu.ire eVC1'yon.e
whO can work to go to work. It neither holds state bureaucracies accountable nor cushions state
taxpayers against recession. It puts millions of children at risk of serious harm. There are
alternative approaches to refonn that achieve our mutual goals in far more constructive and
. accountable ways.
.
The Administration reiterates its commitment to real welfare .reform and its desire. to work
cooperatively with Congress to achieve it. .
r
i
,
!.
I
I
The office of Management and Budget advises that there is no objection to the lrimSmirial ofthis
~to~~
.
A similar letter was sent to Representative Sam M. Gibbons and memberS. of the Ways and
Means Committee.
.
Sincerely,
Donna· E. Shalala
.
i
,
�,~,
March 3, 1995
Honorable Carol Rasco
Assistant to the President
Domestic Policy Council
Old Executive Office Building
The White House
Washington, DC 20500
~(~R
- 6 /995
Dear Carol:
Enclosed you'll find a copy of Work First: A Proposal to Replace Welfare With an
Employment System. This PPI policy briefing presents a radical alternative to cash
entitlements and education and training programs. Our proposal calls for converting the
welfare system into an employment system, using a flexible, state-based system that
relies on performance grants and vouchers. We hope you find it useful.
If you any further questions, or need additional copies, please call Jay Sumner at
(202)547-0001.
Sincerely,
Chuck Alston
Communications Director
518 C Street, NE, Washington, D.C. 20002 202/547-0001
""">5
Fax 202/544-5014
�'1
I
•
POLICY BRIEFING
March 2, 1995
WORK FIRST:
A Proposal to Replace Welfare With an Employment System
By Will Marshall, Ed Kilgore, and Lyn A· Hogan
With each passing day, it becomes clearer that welfare reform cannot be
achieved by the old Democratic prescriptions or the new Republican nostrums. Thus
far, neither side has produced a plan that meets the goal overwhelmingly supported
by the American public: helping welfare recipients achieve self-sufficiency through
work. This conceptual paper is intended to fill that crucial gap.
President Clinton's 1994 welfare reform proposal set the right goal but did not
chart a clear path to reach .it. By imposing a two-year limit on unconditional cash
assistance, the plan ended welfare's status as a permanent entitlement and created a
powerful incentive for its recipients to work. But the White House blueprint did not
include a practical means for moving welfare recipients into jobs: Instead, it
maintained and even expanded the existing welfare bureaucracy, pumping more
money into education and training programs that have largely failed to connect
welfare recipients to the world of work and responsibility. While the Clinton plan
offered states significant new latitude to pursue previously tested reforms without
going through the cumbersome waiver process, it did not go far enough in
".
empowering the states, the private sector, and welfare recipients themselves to find
imaginative new soh,ltions to welfare dependence.
Though GOP leaders dismiss the President's proposal as insufficiently bold,
they cannot even achieve agreement on the objective of welfare reform. Republican
efforts to craft legislation will either succumb to internal divisions-or achieve unity
at the expense of genuine reform. In either event, Congress needs a clearly focused
alternative that builds on public support for work-based welfare reform and supplies
the resources and incentives to make it happen.
A ltepublican Retreat From Work-Based Reform
Some Republicans support work-based welfare reform in principle; others
accept the more controversial premise that discouraging illegitimate births by cutting
off benefits to unwed teen mothers will break the cycle of welfar,e dependence. Still
The Progressive Policy Institute
518 C Street, NE, Washington, D.C. 20002
202/547-0001
�other GOP leaders, especially among governors, oppose any national reform of the
welfare system, contending that states should take the lead with a minimum of
federal guidance. Meanwhile, all three Republican perspectives on welfare reform are.
cramped by short-range federal budgetary concerns, including the need to generate
savings to pay for promised tax cuts and defense spending increases.
The welfare block grant proposal announced in early January by House and
Senate GOP leaders appeared to endorse the Republican governors' strategy for
reform, explicitly abandoning any national goal for welfare reform other than
reduced federal spending and total latitude for states. Moreover, the proposal
repudiated national work-based reform by freezing federal funding for welfare
related services such as food and nutrition, child care,and employment and
training-'all key building blocks for any strategy to "make work pay" for welfare
recipients.
But the various House committees charged with implementing the overall
block grant plan are steadily subverting the promised state flexibility by inserting a
mixed bag of negative prescriptions, including the Contract With America's ban on
aid to legal immigrants and unwed teen mothers, and weak and ill-defined work
requirements. Still missing in the GOP proposal is any clear and positive national
blueprint for reform.
Thus, even in the supposedly focused and disciplined House, Republicans
cannot produce a logically compelling or internally consistent welfare reform
package. The amorphous legislative product will likely be "block grants" without
flexibility, and an assault on benefits for'immigrants and illegitimate children that
may not survive the Senate-with only a rhetorical nod toward work without any of
the resources or mechanisms needed to make work available.
The one. '~lement of the Republican package that will undoubtedly emerge'
unscathed is tHe block grant funding principle: converting welfare-related programs
from entitlements to discretionary progra~s with funding levels arbitrarily frozen. In
the absence nf any national commitment to fundamental change in the welfare
system, this. step represents little more than a shift of power from federal
bureaucrats to state bureaucrats, done on the cheap. The dismaI result is likely to be
phony welfare reform, achieved through phony devolution.
Refocusing Welfare Reform on Wark
Welfare reform is too critical a task to be sacrificed to Republican disunity on
goals, or Republican expediency on cost. But the President's 1994 proposal, welcome
as it was as a step toward work-based reform, is an inadequate alternative that
supplies too few bridges between welfare recipients and private labor markets, and
too many detours into income maintenance or ineffective education and training
programs.
2
�.
,.
'."
The Progressive Policy Institute (PPD Work First plan aims to convert welfare
into an employment system through three main steps:
(1) Abolish both Job Opportunities and Basic Skills (JOBS):-the primary
federal education and training program for welfare recipients, created by the 1988
Family Support Act-'-and Aid to Families with Dependent Children (AFDC), and
substitute a Work First employment system that would establish as national policy
that: (a) unsubsidized private sector work is the goal for public assistance recipients;
(b) immediate work experience, not participation in education and trainirig programs,
is the best preparation for permanent employment for the vast majority of welfare
recipients; and (c) all recipients of public assistance should perform some work, with
community service as a fallback. In effect, the time limit for income maintenance
would be zero.
(2) Pool AFDC and JOBS funding, calculated by the current formula but with
a single match rate, to create a performance-based grant that offers financial
rewards to states that succeed in placing and keeping welfare recipients in full-time,
unsubsidized private sector jobs .
. (3) Give states financial incentives to convert a portion of their employment
system dollars into job placement vouchers that welfare recipients-as well as
fathers of children on welfare who might contribute to family support through
work-may use to purchase welfare-to-work services. Such services would comprise
job placement and support, rather than education and training. By putting·
purchasing power directly in the hands of welfare recipients, vouchers would help
stimulate a competitive market for job placement and draw private as well as public
investment.
. The PPI proposal promotes real devolution of decision-making on welfare
reform, not phony devolution by block grants. Our more radical alternative
transforms income maintenance and education and training programs.i!lto a single
flexible, performance~basedgrant that allows states to design individual benefit
packages targeted to what each recipient naeds to quickly enter the workforce. It
also strongly encourages the use of job placei'nent vouchers to bypass federal and
state bureaucracies and place resources directly in the hands of welfare recipients.
This approach supplies unprecedented flexibility to respond to local econoinic
conditions and program characteristics; moreover, it also gives the federal
government a potent lever for reinventing social policy in ways consistent with the
broad public consensus for programs based on work and reciprocal responsibility.
By abolishing the existing AFDC and JOBS programs, this proposal also
simplifies the task of work-based welfare reform. Able-bodied recipients would no
longer be entitled to cash assistance or sp,ecific education and training services for
any length of time. By requiring recipients to pursue private sector job
opportunities-and where necessary, community service work-as soon as possible,
3
�.,
the new system renders such action-forcing devices as time limits less significant,
arid perhaps even redundant. The presumption would be that the proper time limit
for income maintenance or education and training prior to job placement is not two
years .or five years but zero. In addition, the proposal would allow' states to begin
addressing the "missing link" in welfare reform-absent fathers-by offering job
placement services to noncustodial parents as part of an overall effort to create non'
welfare streams of family income.
The "Work First" Architecture'
/
The first step in work-based welfare reform is to put work first, changing the
current system's incentives to make permanent employment in private sector jobs
the paramount and immediate goal for every able-bodied recipient of public
assistance, with serious COInmunity service work as a fallback option when
necessary. '
Many existing reform plans would f3xpand education and training by
increasing funding for JOBS. Yet careful, intensive studies conducted by the
Manpower Demonstration Research Corp. and other reputable research groups have
concluded that education and training programs produce only marginal results, at
best modestly increasing earnings and de,creasing welfare costs. A recent General
Accounting Office report on JOBS also concluded that it is not well focused on
employment instead concentrating more on participation requirements than on
getting recipients jobs. The research also shows that programs that stress work and
maintain strong ties with the private .sector produce better results. For example,
Riverside, California's work-focused Greater Avenues For Independence (GAIN)
program accounts for 19 percent of all job placements while serving only 4 percent of
the state's caseload.
Private organizations are reinforcing the case for emphasizing job placement
over education and training. Examples include nonprofit orr.;anizationssuch as
Project Match in Chicago, as well :::ts America Works, a for-profit company that has
placed more than 5~OOO welfare' recipients in private jobs at various sites around the
country. The Work First system envisions a healthy competition in welfare-to-work
services among public as well as private entities. Other options might include
temporarily subsidizing private and public sector jobs with cash and food stamp
benefits paid out as a wage as Oregon has done in its JOBS Plus program, and
converting job training funds to loans for microbusinesses.
The Work First Employment System is based on the premise that the vast
majority of those receiving welfare are capable of working if given the opportunity.
Too many welfare recipients are shunted through ineffective education and training
programs, or, worse, given nothing but a check and the option to sit at home. The
system must change. The' Work First system' requires that everyone who can work,
will work.
4
�'"
The Work First philosophy assumes that labor markets can absorb welfare
recipients if the right supports and links to employers are in place. According to
Gary Burtless, a prominent labor market economist with the Brookings Institution:
With roughly 7 million jobless workers; even at full employment, is it plausible
to expect employers could offer an additional 2-3 million jobs for AFDC
recipients forced to leave the welfare rolls? Surprisingly, most labor
economists probably believe the answer to this question is t'Yes."
Employers can accommodate a new supply of low~skill, low-cost labor. But we
need an employment system that builds a bridge between this potential demand and
the welfare recipients that can supply it. '
"
The following elements make up a Work First Employment System:
•
The new employment system would replace the AFDC and JOBS programs,
converting funding for those programs-with additional federal money
allocated by Congress-"into a single flexible, performance~based grant that
allows states to design individual benefit packages targeted to what each
recipient needs to quickly enter the workforce.
•
The new system would give states flexibility to design systems that put
maximum pressure on welfare recipients to seek employment, but it would bar
them from preemptively disqualifying any category of recipients currently
"
eligible for aid, including teen mothers and immigrants. However, states
would have the latitude to make receipt of assistance conditioned on
compliance with its rules (e.g. sanctions for nonwork, time limits, etc.).
•
The pool of money to be used for the employment system would be allocated to
states using anew, single match rate set at 60 percent or the Medicaid match
rate, whichever is higher. The federal match rate for implementing job
placement voucher programs would be set at a higher level to encourage states
to pursue vouchers over other strategies, thus increasing the match rate for
dollars put into vouchers. States would receive" a cash bonus equivalent to six
months of federal funding (i.e., savings) for each welfare recipient placed in an
unsubsidized full-time, private sector job for six months. They could reinvest
this pool of savings in job placement vouchers or other incentives such as cash
bonuses to recipients who find and stay in private jobs and to caseworkers who
excel in job placement.
•'
Applicants for aid would apply at a government office and be evaluated by a
caseworker or case team to determine individual needs. A screening process
would divert those deemed immediately employable from the Work First
system. No unconditional aid would be granted. At any point, a recipient who
turns down a private sector or community service job would be denied access
5
�to further employment services. Severely disabled applicants deemed
unemployable would be moved to the Supplemental Security Income· program.
(1)
(2)
Those not diverted would enter the employment system. States could
require those entering the Work First system to engage in intensive job
search before taking advantage of placement and support services.
Recipients would sign an "employability contract" charting their
individual paths to self-sufficiency through private sector work. A
relatively small percentage of recipients will not be job-ready: people
who can't read, those with serious drug or alcohol problems or a
temporary disability, and mothers with children aged 16 weeks or
younger. All but the last category may be referred to programs that
offer counseling, training, or other services. But everyone, even if they
are not ready for private job' placement, should perform some
community service work.
(3)
•
Those with short-term, one-time emergencies and immediate
employment prospects would receive Temporary Emergency Aid (also
called IIgrant diversion"). Applicants would receive a one-time cash grant
to cope with an emergency such as car trouble or overdue rent. If these
recipients are determined to be in need of further assistance, they will
enter the Work First Employment System at a reduced or zero benefit
rate for a number of months determined by the state as adequate to
repay the emergency grant. Modeled after Utah's grant diversion
program, this approach aims to prevent people from unnecessarily
entering the new employment system.
The Work First employment system would offer job placement services,
but not cash assistance, to the fathers of AFDC children (on the
condition that, once employed, the fathers meet their child support
obligations). In addition, mothers could agree to give their place in the
system to fathers, in a step that may encour2,~e families to stay together
or reunite.
.,
A state could choose to refer recipients to either private intermediaries
offering job placement and support services or to state employment offices
offering similar services ..
•
Private nonprofit and for-profit intermediaries and state offices would offer
subsidized private sector work experience, job placement, and support services
as needed, always with the goal of moving a recipient into full,.time private
sector work. Placement and support organizations would receive payment in
full for performance only; for example, once a recipient has been placed and
retained in a full-time, unsubsidized job for six months, one-third'might be
paid to the intermediary upon three months of job retention, with the
6
�remaining two-thirds paid upon six months of job retention. State employment
agencies could provide job placement and support services in competition with
private intermediaries. Job placement organizations, whether private or
public, would have a strong job development component as well as follow-up
support services to help people stay in their jobs.
Job Placement Vouchers
By giving job placement vouchers directly to recipients, states could tap into
and build a growing market for public and private agencies providing placement and
support services.
Job placement vouchers can reduce costs, improve service delivery, shrink
bureaucracy, and most importantly, empower low-income and unemployed Americans
by giving them the resources to choose their own providers where and when they
need a particular service: The job placement voucher proposal is aimed at
significantly cutting long-term public costs by moving those on public a/iSsistance into
productive private sector jobs. A strong federal cOIl\Illitment to a feasible job
placement strategy is much more cost-effective than any short-term block-and-cut
approach that abandons federal responsibility for welfare reform without supplying
incentives to work.
States would individually set their voucher rates and develop a list of service
providers eligible to redeem the vouchers-including placement agencies and private
employers. The list would be made available to welfare recipients who enter the
employment system and have. completed intensive job search. Recipients would use
the lists to make their service choices. A voucher would offer recipients quick access
to placement and support agencies such as: America Works in New York; the Good
Will Job Connection in Sarasota, Florida; high performance, state-run job placement
programs such as the GAIN initiative in Riverside, California; temporary private
sector work experience supplied by employers and subsidized with income assistance
and a cashed-out food stamp benefit; microenterprise training programs; and other
, employment-based services.
In a full-:fledged application of the voucher approach, state welfare
bureaucracies could be transformed into agents for job placement in two ways: by
performance incentives accompanying federal funds, and by direct competition' with
private providers for voucher benefits.
Additional Elements of a Work First Strategy for Welfare Reform
Aside from changing the incentives of the system from income maintenance
and education and training to job placement, several other steps are necessary to an
overall Work First strategy. First, we must make work pay more than welfare, and
7
�recognize that any work-based reform of welfare is inconsistent with "on the cheap"
approaches that make public assistance more attractive than private sector jobs.
The current system offers most recipients a package of welfare benefits worth
thousands of dollars more than a full-time minimum wage job. Asset limits and
welfare reductions for earned income penalize work and savings. To ensure that
work, not welfare, is the rational choice for men and women alike, even entry level
jobs must always pay more than the package of available welfare benefits. Raising
the minimum wage, however, is the wrong answer, since most minimum wage
earners do not live in poor families. The Clinton Administration in 1993 adopted the
right approach: a $21 billion expansion of the earned incometax credit, a direct
subsidy to low-wage workers. Other changes necessary to make work pay include
toughening child support enforcement, expanding child care support for the working
poor, and providing health care subsidi~s to low-wage workers.
Second, we must develop an empowerment strategy to encourage the poor to
build personal capacities and assets, replacing the paternalistic welfare bureaucracy
as the primary source of income in impoverished communities. To encourage asset
based policies, we must promote saving and remove barriers to asset building, such
as welfare's limits on how much people can earn or save, and housing rules that
raise rents as incomes rise. Individual D~velopment Accounts (lDAs) for low-income
families are a particularly promising device. Like Individual Retirement Accounts for
the .middle class, IDAs would be tax-favored, annual contributions used only for
college, home ownership, retirement,and small business start-up. Individual
contributions could be matched by government, churches,. community groups,
businesses, and unions .
. With adequate asset levels in place, we can pursue policies such as
microenterprise that promote self-employment by making loans for small business.
Based on successful lending projects in developing countries, U.S. microenterprise
ventures tap the latent entrepreneurial talents of poor people, especially women, who
face limited options in formal labor markets.
Third, we must improve child support enforcement, both to supply non
welfare streams of income to children on public assistance and to reinforce the
responsibilities and benefits of parenthood, especially among fathers of children on
welfare.
America's poor children deserve the support of both parents. Yet government
estimates show that families actually collect less than one-third of the court-ordered
payments to which they are entitled. Toughening child support enforcement and
allowing mothers to keep a larger share of child support payments should
dramatically increase collections. This will reduce public welfare costs and give
mothers another source of income, so that even part-time work may be enough to lift
them out of poverty. PPI's Work First strategywould require mothers to establish
8
�•
t
paternity at birth as a condition for receiving public assistance, improve collection
and enforcement of child support orders, and offer access to the employment system
(but not cash benefits) for those non-working fathers who are delinquent in their
,child support payments.
Fourth, we must adopt a comprehensive strategy to prevent teen
pregnancy-combining unambiguous condemnation of irresponsible child-bearing
with community-based solutions that strengthen and support families and reinforce
community values.
PPI urges leaders in public and civic life, as well as in the media, to launch a
national campaign to spread the message that it is morally wrong for teenagers to
have children they cannot support financially or emotionally. We would reinforce
that message with policy changes that end unconditional public assistance for
unmarried teen mothers, hold fathers accountable to their children, and ensure more
swift and certain punishment for sexual predators. At the same time, we should
replace welfare's perverse rewards with a new set of positive incentives for young
men and women to avoid premature parenting and finish high school.
Most importantly, PPI envisions a shift in the primary responsibility for
reducing teen pregnancy from government to community institutions. For example,
we propose creating a network of community-based second chance homes that would
allow teen welfare mothers and their children to live in safe and supportive
environments and provide the structure and discipline they need to finish school and
raise their children. This would provide an alternative to teen mothers~ setting up
separate households or remaining in their parents' homes if those homes are unsafe
or unstable. But it would stop short of punishing teen mothers by denying them
public supports altogether, as House Republicans have proposed.
Conclusion
Genuine welfare reform can occur in this Congress, but only if the debate is
refocused on work-based reform and practical ways to link welfare recipients with
real-life work options. The Work First Employment System is designe'd to tum the
incentives of the current system inside out. It would make private sector work the
primary objective for both recipients and states, giving states accountable
performance standards but great flexibility in achieving them. If implemented in the
context of an overall Work First strategy, .the new system could help deconstruct
welfare and build a new empowerment strategy for poor communities and their
citizens.
Will Marshall is President, Ed Kilgore is Senior Fellow, and Lyn A. Hogan is the
Social Policy Analyst, of the Progressive Policy Institute.
9
�Changes in Federal Law Needed fora Work First Employment
System
.
•
Existing AFDC and JOBS programs would be abolished
and replaced by a single performance-based grant offering
financial rewards to states that succeed in placing and
keeping recipients in private sector jobs.
•
All who would be eligible for the AFDC system under
current rules would remain eligible, including teen
mothers and legal immigrailts; states could offer
noncustodial fathers job placement and support services
but not cash benefits.
•
States would receive funds previously available through
AFDC and JOBS under a new match rate of 60 percent or
the state Medicaiq match rate, whichever is higher, as long
as a Work First system is designed.
•
ThoSe deemed eligible for help would enter and remain in
the employlnent system until they are placed in a privat~
sector job; states would ~e given an option to adopt a
"grant diversion" program of a one-time emergency
payment to those With immediate employment
opportunities needing only temporary assistance to see
them through their emergency. States could require a job
, search before offering placement opportunities to
recipients who are not "diverted" from the system.
•
Any funds used by states to endow job placement vouchers
would be matched at a higher rate, plus states would
receive six months worth of foregone federal payments
(i.e., savings) for each full-time unsubsidized job
placement, as long as each recipient is placed and retained
in the job for six months.
•
States coulq at any point require community service work
from recipients enrolled in the Work First Employment
System.
10
�03/02/95
12:52
. Welfare Reform, Daily Talking Points
Thursday March 2. 1995
f
A FAILING GRADE
Today, the House Ways and Means Committee continues to mark up its new
welfare reform bill. This proposal, weak on work and cruel to kids, is 'not real
reform ~~ and we've given them a midterm report card that proves it. On the
welfare reform front, the House Republicans are light.years away from the honor
roll. In a speech to the Child Welfare League today, Secretary Sha,lala gives them
the following grades:
,
o
. An "F" on work. To move people from welfare to work, you nee,d both
tough expectations ~ clear pathways of 'opportunity. The House
Republicans claim that they require 17 percent of recipients to be invorved in
"work-related" activities by the.year 2000. But, they count people who are
dumped off the welfare rolls as "working." Since when is getting cut off the
same as working? Not since the Reag'an Administration called ketchup a
vegetable have we seen such fundamental distortions.
o
An "Ati for cruelty to kids. WefflJre reform must be about strengthening
families - not tearing them apart or writing them off. Our goa'( must be to
lift people up, not'punish them because they happen to be poor or young .
... We need to be tough - !lSl.t cruel. Crue' Is the only way to describe
proposals to abolish nutrition programs for children. Cruel is the only way to
describe plans to reduce assistance to thousands of abused, neglected, and
abandoned children. And, cruel. is the only way to describe denying benefits
to children of teen mothers.
',
'.
,
o
A "C" on responsibility. You can't reform welfare without tough child
support provj~ions -- and, we were, surprised that the initial House
.
Republican bill was silent on the issue. They keep promising the language
will be there _. but it still has not been introduced. Unfortunately, what little
we have seen suggests that they still have a long way to go~
,
o
·An "Incomplete" on ending·welfare as we know it. Incomplete because they
have shown no clearvision. fncomplete because they have shown no true
commitment. And, incomplete because ,they have shown some - but not
enough -- willingness to work together for common-sense solutions. We
believe that meaningful reform must be about moving people from welfare to .
w()rk. It must be about a paycheck -- not a welfare check. And, it must
reinforce the core values of work, responsibility, and reachihgthe next
generation.
".
�~UUI/UV.L
03/03/95
03/03/95
12:19
11:37
ft
~202
e90 5673
HHS-PUBLIC AFFAI
Welfare Reform Daily Ta,lking Points
Friday, March 3, 19~5 '
'fiTOUGH ON KIDS AND EASY ON GUYS"·
Today, the House Ways and Means Committee will finish its markup of a bill that
manages to give "welfare ,reform" a bad name. In drafting a plan that is tough on
kids and weak on work, Committee Republicans have, in the words of
Representative Barbara Kennelly of Connecticut; been "easY,on guys," adding as
an afterthought 'J\!hat should be a centerpiece of welfare reform: aggressive child
support enforcement. In a letter to theChalrrnan of the Ways and Means
Committee yesterday, President Clinton urged Republicans to make good on their
commitment to pass tough child support.
Here's why:
o
O.
Not enough enforcement. While the Republicans have now picked up many.
of the President's suggestions, they have forgotten one essential means of : .
collecting support, suspending driver's and professional licenses. President
. Clinton has a different message for struggling families owed child support:
"If absent parents ar,en't paying child support, we will g~rnish their wages,
suspend their licenses, track them across state lines, and if necessary, make
them work off what they owe."
o'
\
,Not enough commitment. Critical elements to comprehensive child support ..
include· qenying welfare benefits to any unwed ·mother who does not
cooperate fullyin identifying the father, supporting powerful measures for
tracking interstate cases, and enforcing serious penalties for parents who
refuse to pay what they owe. As Secretary Shalala said in her speech
yesterday, "'t is simply not acceptable for parents to walk away from the.
children they helped bring into this world."
o"
\
Governments don't ~aise children, people do. As Presiden,t -Clinton wrote to
Chairman Bill Archer of Texas, "When absent parents don't provide support,
the inevitable result is more welfare, more poverty, and more difficult times
for our children. It is ,essential that all Americans understand that if they
parent a child, they will pe held responsible for· nurturing and providing for
that child."
Still barely a "C. n "You can't reform welfare without tough child support
provisions," Secretary Shalala told the Child Welfare League yesterday, "and
frankly, we were surprised that the initial House Republican bill was silent on
the issue." Republicans have learned a little in the past week, but the time
is now to crack down on absent parents. As Secretary Shala'a said.
yesterday, Republicans barely get a "C~' on this issue.
�.'
REPUBLICAN FOOD AND NUTRITION CUTS
Facts and Figures - as of March 3, 1995
L
Food Stamp Proposal
Status: House Agriculture Committee will mark up on Tuesday March 7.
Information on exact proposal still sketchy. Following information drawn from USDA, AP,
FRAC, CBPP, OMB and other indirect sources.
Elements of Republican Proposal
Some of the elements of the plan seem to be:
Cut Food Stamp spending by approximately $16 billion over 2 years
May limit indexation for inflation of benefits, asset limits, other aspects of. program
Will limit benefits to able bodied single adults (without kids) between 18 and 50
requiring work as a condition of benefits after 90 days. Could cut off people willing
to work and play by the rules
o Will further restrict legal immigrants' access to food stamps
o. Will allow block grant of food stamps to states that move to eleCtronic benefits
systems (EBT) -- removing federal. safety. net in those states.
o Could restore the annual cap on expenditures that was repealed in 1990.
o
o
o
o Will include $500 million increase in funds for soup kitchens, other food programs
II.
Other Food and Nutrition Block Grants in Welfare Reform
Status: The House EEO Committee last week marked up its pieces of welfare reform
including combining school lunch, WIC and other nutrition programs into two block grants.
Impacts:
T~e
Republican proposal:
Reduces funding for child nutrition by $7 billion over 5 years -- $1.3 billion from
school based programs, and $5.3 billion in the family nutrition block grant.
o . Block grants would allow up to 20 percent offunding to be .used for other purposes,
posing further potential cut in child nutrition programs.
o Latest CBPP estimate: WIC would be able to serve 168,000 less ~omen, infants and
children in FY96 than this year.
o
�o
o
Major WIC impact could be elimination of the Infant Formula Rebate which. could
cost $1 billion annually, impacting as many as 1.6 million mothers and children every
month.
Eliminates national standards, increases state exposure to economic downturn,
penalizes states that provide more subsidized meals since funding based on total meals
~~
. 0
o·
III.
.
Ends entitlement to school lunch and breakfast, Child and Adult Care Food Programs
and Summ~r Food Programs.
,
Child and adult care and summer food programs would be hardest hit. Block grant
reduces non-WIC programs by 45 percent from our proposed FY96 funding.
House Rescission Package
Status: The House Appropriations Committee has approved a rescission package for
FY95 that would cut WIC by $25 million. In a six month period, $25 million would fund
service~ to 100,000 mothers and children.
Important Note: The WIC program generally ends the year with unspent funds.
These get rolled over to the next year. The rescission would not directly cut off funds to
mothers and children this year, but will have the impact of reduced availability of funds
overall in future years.
I .
�~4~b'(4)]
HUM USUA-F
f'UUUUU~
TALKING POINTS
REPUBLICAN FOOD STAMP BWCK GRANT PROPOSAL
MARCH 3, 1995
The Food Stamp Block Grant proposal unveiled yesterday by House Committee on Agriculture will eliminate
the national nutrition safety net for children and families. The bill would cut $16 billion out of nutrition benefits
for people who need them, render the Food Stamp Program unrecognizable, and make program administratioD
unmanageable. Based on our initial analysis, this proposal will:
Eliminate the national nutritional safety· net
o
,The bill is a double· hit on children; last week, the House Ways and Means Committee reduced
nutrition benefits to children at school; this week the House Agriculture Committee takes aim
on children at home.
'
,
o
The bill will dramatically reduce nutrition b~mefits to people who need them immediately. and
then cap expenditures in future years, eliminating the automatic adjustor in hard times. It will
erode the nutritiOD support for needy families by failing to keep pace with inflation.
Eliminate national eligibility and benent standards
The proposal allows individual sti\tes to design Iheir own eligibility and henefit 5tandards. This
bad idea could result in needy families being treated in ftfty different ways. under ftfty different
state programs, using fifty different eligibility standards, and receiving fifty different levels of
benefits, depending on where tbey live. Basic nutrition needs 'are the same no matter where
a family Lives; benefits should reflect that. le~dership.
o
Elhnlnate economic responsiveness
o
By placing a hard cap of program expenditures in future years and creating an optional block
grant. this bill eliminates the ability of nutrition programs to respond to changing economic
circumstances.
o'
In the next recession, the Food Stamp Program will not be there to 'cushion hard times in
affected communilies and States. And benefits won't keep pace with inflation .
. Undermines a national, unlronn EBTsystem
o
This proposal allows every State to pursue their own independent path to EBT. It even
requires the Secretary to waive any provision of the act that a State claims hinders their ability
to implement EST.
.
Proposes unworkable work requirements
o
The Republican bill proposes a work requirement program that holds nutrition programs
hostage to jobs that may not exist
Is weak on fraud
o
This proposal is not as tough oil eriminals who defraud the Food Stamp Program as the
Administration's proposals unveiled two days ago.
Ignores the distinction between nutrition programs and income security programs
o
Nutrition programs are different from income security programs; they produce different results,
and should be measured on different standards.
o
Sixty years ago, FDR's aide responsible for designing a relief program to help victims of the
Depression, understood that difference. Harry Hopkins was testifying before a Congressional
committee chairman who didn't believe food assistance was as important as strategies to help
the economy "in the long run." "That's the difference. Senator," he said. "People don't eat in
the long run. They eat every day."
�~31a2/95
09:03
.rll 001
HHS OS ASPE 415F
U202 690 7383
-r-o~~~~(
f " 0 r'V\ ~'Y\.AJ~c; \ -
Dear Chairwan Archer.
·1 am.writing to reiterate my strong position that comprehensive child support enforcement·
legislation be ulcluded as an iotegral pari of welfare reform. It is essential that all Am~Iicans
W1dcrstand that if they parent u child, they
be held responsibile for fJ.urturing and providing for
their off,>pring. Ids patticularly disrurhing that so many noncustodial parents simply avoid their
, responsibilitY to provide support. The inevitable result is more welfare, more poverty, and 'more
llifficu1t timC;.:s for ourchildcen. I know :we both. agree that we are sending the worst possible
message to our children if we say that parental responsibility ends if a parent does not live with
the child. At the Working Session on welfare Refonn at Blair House. there was near unan:imlty
that clear national standards were essential for effective child slIpport enforcement.
""ill
I wns (Illite disappointed that child SUppOI1 eufol'cemetlt Wi!; not included in the original welfare
reform proposal. So I was pleased \,,/hen Chainnan Shaw indicated his intention to .include
enforcement in the bill produced in Subcommittee. Unfortunately~' there w~s no language
included in the Subcommittee mark~ and language was. promised for full coJlllIlittee. I lml'ierSland
you arc trying to complete wo'rk on language soon to indudeserious child support enforcement in
the full committee bill. I W'ge you to complete:work as q\uckly as possible_ We very much want
to work in a bipartisall, way VVitll the Committee 00 this central issue, but time is running short.
111crc are already a number of bills including the one offered by Nancy Johnson and Barabara
KeMelIy which are very similar to the meamres I -introduced with the Administration welfare
reform bill last year. These bills can and should serve as the toundation for any effort to reform
child support. Critical eleulenis include cltmying welfare benefits to nny unwed mother who docs
.
!lot cooperate fblly in identifYjn.g tile father, powerfu1 ~~r trackin.g interstate cases,
sClioU5 pcnalties--including immediate wage withholding;w,q.Hsence··~spensions-.for paTents ~o .
refuse to pay what they owe. And we must indude both the p'eiTl"Inl'l-ance: incentives and
resources states oeed to do the job right.
I believe this is' the time to finally getting serious about child support in this country. Tlook
. forward to working with the Committee to ensure the job is done right.
\
�NATIONAL .
GOVERNORS'
;;
..
Howard Dean. M.D.
Governor of Vermont
Chair
ASS<D:IATION
Tomm,' G. Thompson
Go"ernor ofW'isconsin
Vice Chair
,
.
R.a\·mond C. Scneppacl;
execuu\'e Dire~((lr
( ~
Hall of the State,
444 l'orth Capitol Street
Washinglon, D,C, 2000 ).) 'i 1~
Telephone (201) 624·5.'00
. ..:..
",,'
,
,-~
,
February 23. 1995
The Honorable Bill Arch,er
Chainnan
Committee on Ways and Means
United States House of Representatives
Washington, D.C. 20515
Dear Mr: Cbainnan:
o
We are writing to expressour views on the Personal 'Responsibility Act, as amended by the
Subcommittee on Human Resources." The Governors appreciate the willingness of the
subcommittee to grant states new flexibility in designing cash assistance and child welfare
programs. We are concerned about a number of the bill's provisions. how~ver, that limit state
fl~xibility or shift federal costs to states.
The Governors believe Congress has at this moment an enormous opportunity to restructure the
federal-state relationship. The Governors urge Congress to take advantage of this opportunity
both to examine the .allocation of responsibilities among the levels of government and to
maximize state flexibility in areas of shared responsibility. We believe. however, that children
must be protected throu~out the restructuring process. 'In addition, although federal budget
cuts are needed, the Governors are concerned about the cumulative impact on the states of
federal budgetary deCisions. The Governors view any block grant proposal as an opportunity
for Congress and the president to provide needed flexibility for states, not as a primary means
to reduce the federal budget deficit.
The Governors have not yet reached consensus on whether' cash and other entitlement
assistance should remain available, as federal entitlements to needy families or whether it
should be converted,to state entitlement block grants. We do agree, however, that in either case
states should have the flexibility to enact welfare' reforms without having to request federal
waivers.
Federal Standards for Block Grants
If Congress chooses to pursue the block grant approach proposed by the Human Resources
, Subcommittee, the block grants should include a clear statement of purpose, including mutually .
agreed-upon goals for the block graJ?t and the' measures that: will be used .to judge the
effectiveness of the block grant.
�Page 2
Cash Assistance Block Grant
The Governors believe that a cash assistance block. grant for families must recognize the
,
.
nation's interest in:
"
.
•
•
•
,~"'
...
.. '.
"
services to children;
moving recipients from welfare to work; and
reducing out-of-wedlock births.
Although the Governors recognize the legitimate interest of the federal government in setting
broad program goals in cooperation with states and territories, they also believe that states
should be free from prescriptive federal standards.
We appreciate the flexibility given to states in the bill to design programs, to carry forward
program savings, and to transfer funding between block grants. We must oppose, however,
Title I's prohibitions on transitional. cash assistance to particular families now eligible for help
·and ask instead that states be given the authority to make these eligibility decisions themselves.
Some states may want· to be more restrictiv~ than the bill-by conditioning aid on work, for
example, sooner than two years-while other states· may decide it· is appropriate to be less
restrictive.
The federal interest should be limited to ensuring the block grant is used to aid low-income
children and families. In the past fedei"al restrictions on eligibility have served to con~ .
federal costs given the open-ended entitlement nature of the Aid to Families with Dependent
Children program. Such restrictions have no place, however, in a capped entitlement block
grant where the federal government's costs are fixed, regardless of the eligibility and benefit
choices made by each ·state.
Similarly, while Governors agree that there is a national interest in. refocusing the welfare
system on the transition to work, we will object strongly to any efforts to prescribe narrow
federal work stan~s· for the block grant. The Governors believe that all Americans should be
productive members of their community. There are various ways to ac~ieve this goal. The
preferred means is through private, unsubsidized work in the business or nonprofit sectors. If
the federal government imposes rigid work standards on state programs, such standards could
prove self-defeating by foreclosing some possibilities~ such as volunteering in the community,.
that can be stepping stones to full-time, private sector jobs. A rigid federal work standard
would also inevitably raise difficult issues about the cost and feasibility of creating a large
number of public jobs, and the cost of providing child care for parents required to work a set
number of hours a week in a particular type of job.
. Child Protection Block Grant
Governors view the child protection block grant as overly prescriptive and urge Congress to
refocus it on achieving broad goais, such as preserving families, encouraging adoption and
protecting the health and safety of children. We also oppose the mandated creation of local
�Page 3
citizen review panels. We believe that it is inappropriate for the federal government to dictate
the mechanism by which' Governors consult the citizens of their state on state policies.
Block Grant Funding ).
We appreciate the subcommittee's willingness to create ,block grants whose funding level is'
guarant~ over five years rather than being subject to annual appropriations. It is essential.
however, that block grants include appropriate budget adjustments that recognize agreed-upon
. national priorities, inflation, and demand for services. The cash assistance block grant does not
include any such adjustments for structural growth in the target populations. , While some
growth is built into funding for the child protection block grant, it is not clear whether it will be
adequate especially given that states are likely to be required by the courts to honor existing
adoption assistance contracts. Governors will continue to protect abused and neglected
children by intervening on their behalf and we believe that federal funding must continue to be
available for these services.
Governors also ask that any blOCk grants include funding adjustments to provide for significant
changes in the cyclical economy and for major natural disasters. An additional amount should
be set aside each year for automatic and timely distribution to states that experience a major
disaster, higher-than-average unemployment, or other indicators of distress. While the bill does
prove to be an
include a federal rainy day loan' fund, we are concerned that this loan fund
inadequate means of addressing sudden changes in the need for assistance. States experiencing
fiscal problems will not be able to risk taking out' federal loans that they may not be able to
repay. Furthermore•. one billion dollars over five years may not be sufficient if many states
experience economic downturns or natural disasters at the same time. as was the case with the
last recession or with the midwestern floods. rmally. an unemployment rate in excess of 6.5%
~y not be a sufficient proxy for identifying increases in need and should not be the sole
trigger for increased aid.
will
We also urge the committee to change the funding base year and formula for the two block
grants. We ,believe that initial allotments to states for the cash assistance and child protection
block grants should be the higher of a state's actual funding under the consolidated programs in
fiscal 1994 or,a state's average funding during fiscal years 1992 through 1994. This change
would help protect states with recent caseload growth from receiving initial allotments far
below actual need.
Accountability in Block Grant Pr9grams
We believe that block grants should include a clear statement of purpose, including mutually
agreed-upon goals for the block grant and the measures that, will be used to judge the
effectiveness of the block grant. We are concerned. however, that the reporting requirements in
both the cash assistance and child protection block grant go far beyond what is necessary to
monitor whether program goals are being achieved. We encourage the committee to restrict
reporting requirements to outcome and pe,rformance data strictly related to the goals of the
program. and hope that those reporting requirements can be mutually agreed upon by Congress.
the administration. and ourselves.
�Page 4
.,
We agree that states should be required louse the block grant funding to provide services for
children and their families. We do have questions, though, about how broadly the bill's audit
provisions would be applied. Would the audit process be used, for example, to determine
whether the block grant goal of assisting needy children and families was being achieved? We
.would also suggest that rati)er than the federal government reclaiming audit exception fu~ds,
that these funds remain available to a state for allowable services to families and childrer;t.
Implementation
Governors also ask Congress to recognize that moving to a block grant structure raises many
implementation issues. Almost every state is operating at least one welfare waiver project. We
believe that states with waivers currently in c;;ffect should have express permission either to
continue their waiver-based reforms, or to withdraw from the waivers, and be held harmless for
any costs 'measured by waivers' cost neutrality provisions. Savings from individual state's
waivers should be included in the state's base. Some states have negotiated a settlement to
retain access, subject to state match, to an agreed upon dollar amount of waiver savings.
Legislative. language converting AFDC to a block grant should not terminate these agreements
and thereby preclude states from drawing down the balance of these previously negotiated
amounts.
Implementation of block grants would also pose enormous difficulties for state information
systems, and we are concerned that there may not be sufficient funding or lead time to allow
states to update these systems as necessary to implement the legislation. While states that are
ready should be able to implement any new block grants as soon as possible, other states should
be allowed at least one year after enactment to implement the new programs. We also believe
.that a consultative process. between Governors, Congre'ss and the administration would be
necessary to ensure that the transition to a block grant system is made in an orderly way and
that children's needs continue to be met during the transition.
Federal Aid to Legal Noncitizens and Federal Disability Benefits
The Governors oppose the bill's elimination of most federal services to legal noncitizens. The
elimination of federal benefits does not change any state's legal responsibilities to make
services available to all legal immigrants. Policy adopted by the Governors clearly states
that since the federal government has ~xclusive jurisdiction over our nation's immigration
policy, all costs resulting from immigration policy should be paid by the federal'
government. This bill w9u1d move the federal government in the opposite direction, and
would shift subs~tial'costs to states.
The Governors also oppose the bill's changes to the Supplemental Security Income (SSI)
program. We recognize that the program is growing at an unacceptable rate, and that serious
problems exist regarding the definition and diagnosis of disabilities. The changes in the bill go
far beyond admessing those problems and represent a substantial and unacceptable cost shift to
states. The Governors believe that Congress should wait for the report of the Commission on
Childhood Disability before acting to change eligibility for disability benefits to children: We
�•
•
PageS
also ask that Congress allow last year's amendments regarding the substance abuse population
to be implemented before enacting new changes in that area. If changes inSSI are enacted that
deny benefits to hundreds of thousands of families imd children. the result may be a sharp
'increase in the need for aid from the new cash assistance block grant at a time when those funds
would be capped.
Thank you for your consideration of our views on the first four titles of Chairman Shaw's bill.
We are also reviewing the child support provisions and will be forwarding our comments on
them to you separately. '
. Sincerely.
}I~4-
'"'
Governor Howard Dean, M.D.
Chair
')
ahc~
,ov=orJO~!
Gov~:
Co-Lead
Co-Lead Governor on Welfare
Z/&l' '
Governor Mel Carnahan
Chaif
Human Resources Committee
Welfare
\\ \.,,~~
~r
.
Arne H. Carlson
Vice Chair
Human Resources Committee
�Talking Points
_USDA's Food Stamp Program Anti-Fraud Initiative
March I, 1995
<
I
For over 20 years USDA's Food Stamp Program has been the cornerstone of our nation's fight
against hunger" and malnutrition. It gets food to people who need it, especially children and
needy families. Unfortunately, retailers and individuals who abuse the program by illegally
trafficking food stamp benefits have Wldermined the program, and hu:i:tthe people it serves.
I
Over the past two years the Clinton Administration has made restoring public trust in government
a top priority. As part of the Administration's comprehensive strategy to reinvent the Food
Stamp Program, the A~inistration is today asking Congress for broad new powers to counter
attack those who have exploited the program.
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The measures we are taking, involving both legislative and administrative changes, represent a
three-tiered attack on trafficking. involving: 1) pre-authorization screening; 2) post-authorization
controls, and 3) stiffer penalties. Details follow:
'
Pre-Authorization Screenin&: Participation of retailers in the program is a privilege, not a
right.
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We will cut fraud and abuse off at the source. Any form of trafficking-~the exchanging
of food stamp benefits for cash--must, sooner or later, involve a corrupt retailer who is
authorized to -reo.eem food stamp benefits. USDA is going to tighten retailer requirements
to keep fake or illegitimate stores from becoming authorized.' Retailers will have to
. provide better documentation of their legitimacy up-front. And they may be subj~ct to
provisional authorizations of short periods to give USDA time to make sure they clearly
meet requirements.
<
Post-Authorization' Controls: If a retailer abuses the privilege of participating in the Food
Stamp Program, that privilege will be revoked.
We will enhance our monitoring ofauthorized retailers by moving quicker on suspensions,
accessing more ~nformation from more sources. about business and tax integrity, and
tracking' stores using better technology.
!
Stiffer Penalties: Violations of the public trust should be punished.
I
We will impose tougher penalties on r~tailers and reCipients convicted of ripping off the
program. Property over $5,000 used in, or derived from, felony food stamp transactions
will be forfeited to the government. Evidence such !itS food stamp. redemptions that
-exceed reported food sales or highly suspicious account records avail~ble on electronic
benefit transfer systems ~ll be used to suspend or debar retailers. Ret~ilers and all those
in cahoots with them on trafficking schemes will be punished more severely. Food ,stamp
clients who sell their benefits will face tougher penalties as well.
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Fact Sheet
I,
USDA's Food Stamp Program Anti-Fraud Initiative
March 1, 1995
The Department of Agriculture today outlined a major initiative that will continue its push to
eliminate fraud in the Food Stamp Program.
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In letters to House Agriculture Committee Chairman Pat Roberts and ranking house
Agriculture Committee Minority member E (Kika) de la Garza, Acting Secr~tary of
Agriculture Richard Rominger proposed changes giving the Department authority to impose
tighter controls to ensure that retailers do no cheat the program, and tougher penalties if they
do so.
'
The $27 billion Food Stamp Program, administered by the U.S. Department of Agriculture ,
through its Food and Consumer Service, helpsput food on the table for more than 27 million
American in 11 million households every day. It provides low-income hous~holds with
coupons that can be redeemed at most food stores to ensure that people have: access to a
healthy. nutritious diet.
'
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Under program rules, only people who hav~ been determined to be in need o:f food help
because of low income and limited resources can use food stamps. Only those. businesses that
have been authorized by USDA can accept them.
The initiative announced today, which involves both legislative' and administiative changes,
constitutes a comprehensive strategy developed in cooperation between USDA's Food,
,Nutrition and Consumer Services, the office of the Inspector General, state partners, members
ofCongress, and industry groups that speak for thousands of honest retailers :who share the
Department's commitment to program integrity.
The powers USDA is set:king represent a three-tiered attack on trafficking, involving 1) pre
authorization ,screening, 2) post-authorization controls, and 3) stiffer penaltie~. ,Details follow:
Pre-Authorization Sc~eening: Participation of retailers 'in the program is: a privilege, not
a right. The Department's proposal wiil cut fraud and abuse off at the sourqe. Any form of
trafficking--the exchanging of food stamp benefits for cash-.:.must, sooner or later, involve a
corrupt retailer who is authorized to' rede~m food stamp benefits. USDA is going to tighten
retailer requirements to keep fake or illegitimate stores from becoming authorized by -
• Requiring applicant retailers to provide sales and income tax filing documents and written
'
permission for all tax filings to be verified with other agencies.
• Requiring retailers to permit USDA to obtain corroborating documentation from
'
.independent sources to verify store legitimacy.
• Establishing a six~month waiting period before stores that initially failed to meet'
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�authorization criteria can reapply.: This will reduce the participation of retailers who
temporarily stock a store to meet minimum requirements solely to be authorized.
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.. Setting time limits for retailer authorizations, including shorter periods (e.g.,' six months)
to permit provisional authorizations during which time USDA could determine with
greater certainty whether a firm meets all requirements.
Post-Authorization Controls: If a retailer abuses the privilege of participating in the
Food Stamp Program, that privilege will be revoked. The Department's proposal will
enhance monitoring of authorized retailers by -
•
Suspending violating retailers from the program while their cases are pending.
administrative and judicial review. This will eliminate the ability of stores to continue to
abuse the program during the appeals process.
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• Allowing USDA to determine the length of time the store ?,ould be barred or removed
from the program when stores are found to have business integrity problems, such as
convictions for embezzlement, insurance fraud, etc. ,
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• Allowing USDA to share social security and employer identification numbers of retailers
with appropriate state investigation .and law enforcement agencies. This will enhance
USDA's ability to cross check .data and helps detect illegal activity.
Stiffer Penalties: Violations of the pubUc trust should be punished. The Department's
proposal will impose tougher penalties on retailers and recipients convicted of ripping off the
.
program' by - - '
.. Subjecting to forfeiture any property used in, or derived from, felony foo4 stamp
transactions which involve violations of $5,000 or more.
..
Allowing USDA to suspend or debar stores based on evidence such a. food stamp
redemptions that exceed reported food sales or highly suspicious account records available
on el~ctronic benefit transfer systems.
• Disqualifying retailers that have ,been disqualified from the
"
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• Requiring states to collect outstanding claims against households arising from fraud and
inadvertent household errors by offsetting federal income tax refunds..
• Doubling the penalties against clients who engage in fraud.
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.. . Permanently disqualifying retailers who intentionally submit a falsified application.
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For 30 years,the Food Stamp Program has been the comerstone of our nation's fight
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against hunger and malnutrition. It gets food to people who need it, especially children' and
/
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needy' families. 80 percent of the 27 million Americans receiving food stamps in 11 million
households are children. USDA is justly proud of the nutrition and health gains made
because of the program.
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But, the positive health outcomes achieved by Fooq Stamp recipients are not the only
.
:
reality of the program.
The American public
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is legitimately concerned by fraud "and abuse in
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the Food Stamp Pro~am. Those pr~fiting by this crime steal more than mo~ey and
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. undermine public trust. They steal food out of the mouths of child~en and needy families.
President Clinton and USDA wiIlnot tolerate the criminal diversion of food stamps.
I
For two years, USDA has explored every aspect of the program, designing refonns to. make it .
more accountable to taxpayers. This Administration is
oppose~
to block-granting nutrition
.
i
programs because they are' in the national interest. Recent reports that Congrrss will retain
,
.
the Food Stamp Program is an important step forward. What is needed now is
a concerted
effoCt to prevent fraud and defend program integrity as we reform the entire program.
Together with the Inspector General, we identified the problems. We; consulted with
'
.
.
!
retailers, recipients and local program operators. We worked with state and local law
enforcement officials. We met with and listened to Congress.
LOO/900d
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�,
.
Today, we are taking to Congress to support a bold legislative proposal that is a key
part of the redesign and refoml of the Food Stamp Program. Our plan will prevent fraud
. and abuse by cutting it off at the source..
This initiative is a practical, comprehensive three~tiered attack on trafficking.
First, pre-authorization screening. Retailer participation in the program is a
privilege not a right. We will prevent fake stores from being certified. Retailers will have
to document their legitimacy up-front and may have to wait 6 months while
.
.
out.
We
check the~
.
.
We will limit auth.orization periods and frequently check to make sure'retailers meet,
ptogram requirements.
.
.
Second, post-authorization controls. We improve cooper:ation, coJrtmunication and
sharing of documen~s with our State and Federal law enforcement partners. Retailers
violating the rules will be. immediately suspended. Retailers with' tax fraud, insurance fraud,
I
I
I
I
,
or embezzlement problems will be excluded from the Food Stamp Program. ' .
I
I
I
Finally, stiffer penalties., Property valued at over $5,000 obtained tIP-ough food
stamp fraud wiilbe forfeit to the government. We will suspend and debar re~ailers.with
excessive redemption records and suspicious account activities identified thrc)~gh Electronic
I
I
I
Benefit Transfer systems. .Retailers disqualified by other USDA programs wiil be kicked- out,
and we will permanently disqualify those who submit false applications. We will double the
pena'lties for recipients who traffic. in food stamps.
LOO/900d
8L829Sv60J
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!
·. This initiative· is more than an incremental change or a slap on the wrist. It'is a tough,
1
serious package of reforms necessary to stem food stamp fraud and strengthen public trust.
We look forward to working with Congress and passing legislation giving USDA the tools
neede~ to confront food stamp traffickers and criminals,and punish them for their crimes.
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16:41
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1.1995
Welfare Reform DallV Talking Paints
Wednesday, March 1, 1995
--DUMB AND DUMBER" ,
Today,the House Ways and Means Committee begins marking up its new we'lfare
reform proposal. Although the bill has been slightly modified, its basic structure
'remains the same. The bill still punishes innocent children and does nothing to .
move their teen mothers towards serf-sufficiency•. WiII the Republicans ever learn?
o
Still ~'xtreme •. Although they've slightly changed the provision, the bill still
bans cash assistance to teen mothers and their children. Even Republicans
acknowledge that their proposal Is off the mark: "Just bocause a woman .
made a mistake when she v.-8S, young." Representative Nancy Johnson said
yesterday, "doesn't mean that she ,and the child should be penalized for
life." And now Republicans have added an "illegitimacy bonus" that. as
Representative Stark pointed out, would give states a bounty for reducing
access to abortion
I
o
Stili stupid. Denying assistance to a 'teenage mother won't do anyU"ling 'to
move her toward self-sufficiency. Our approach would .. It conditions aid on
staying in school, Jiving at home. and ide,ntlfying her child's father.
o
. Still a sham. Under their fourth version of "work, requirements," caseload
reductions count as ·particlpatlon In work. But cutting people off is not the
same as getting people to work, and it's a sham to pretend it is. The bill
also contains an easywav for states to avoid the participation requirements
altogether. For somo.states,taking a five percent reduction il,lheir federal
grant would be cheaper and easier than running on-the-job training and work
programs. Even Representative Johnson agreed that the work requirements
are "very easy to circumvent." '
H
()
Still dishonest. Requiring work is more expensive than just sending a check
.. as Republicans admitted in last year's bill. Now they're just passing the
costs 0' their political cover on to the states. Gov~rnors who are serious
about work want resources for child care, training# and job placement .- not
new unfunded mandates'•. As Representative Harold Ford said, "This bill is
nothing but a fraud...'
,
.
I)
To sum up, the Republican proposal is stiU, as Secretary Shalala described,
"weak on work and tough on kids. It reminds me of the hit movie, 'Dumb
and Dumber.'"
�•
02/24/95
20:24
e~02
890 5673
HHS-Pt:BLle .\FFAI
141 002/ 003
ClDLD SUPPORT ENFORCEMENT:
THE CLINTON"RECORD
Backaround .
The goal of the Child Support Enforcement (CSE) program, established in 1975 under Title IV-D "
of the Social Security Act, is to ensure that children are supported financially by both of their
parents.
Designed as a joint federal, state, and local partnership, the muiti-Iayered program involves 50'
sepaJate state systems, each with its own unique laws and procedures. ,Some local child support
offices are run by courts, others by counties, and others by state agencies. At the federal level,
the Department of Health and Human Services provides technical assistance and funding to states
through the Office of Child Support Enforcement and also operates the Federal Parent Locator
System, a computer matching system that uses federal information. to locate non-custodial parents
who owe child support. .
.
Today ~ despite recent improvements in paternity establishment and collections, this child support
. system fails many families. Paternity is not establisheQ for most children born out of wedlock,
. child support awards are us"ually low and rarely modified, and ineffective collection enforcement
allows many non-custodial parents--especiallyin interstate cases--to avoid payment without penalty.
As a result, non-custodial parents paid only $14 billion in child support i-:t 1990. But if child
support ord~rs reflecting current ability to pay were established and enforced in all cases, single
mothers would have received $48 billion: money for clothing, food, utilities, and child care.
Closing that $34 billion gap is a top priority for this Administration.
Clinton Administration Increases and Innovations
o
Federal employe8S. Because of a complicated maze of overlapping federal laws and court .
decisions, it is sometimes difficult for the partners of federal employees to serve legal
papers attempting to establish paternity and to collect child support payments. These
problems ate especially acute as they relate to the Armed Forces.
Today I the President signed an executive order to make the federal. government a model
employer in the area of child support enforcement. It requires all federal agencies,
including the Armed Forces, to cooperate fully in efforts to establish paternity, and t6
ensure that children of federal· employees are provided the support to which they are legally
entitled.
.
The order would take a number of important steps, including: reducing by half the time
agencies take to garnish federal paychecks and provide the support the employees'
children; requiring the Office of Personnel Management to publish a current listing of
officials designated to handle child support cases so that parents can seek help; researching
ways to improve the computer matching system that helps states find federal employees
"who owe child support payments; and cross-matching all cases referred by states to the IRS
(for garnishment of income tax refunds) with federal persoMel files.
to
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[4)003/003
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Increasing fundina. President Clinton has proposed yearly expansions in federal spending
, Qn child support, increasing' fedcrat. spending by more than 25 percent since taking office.
In 1993, the federal-state child support enforcement system' collected a, record $9 bUlion
from non-custodial parents.
o
Seizin& tax refunds. On February 21, 1995, HHS announced the collection of a record
$703 milllon in delinquent child support for 1993 by garnishing income tax refunds of non
paying parents. Benefiting neariy one million families, the amount was 13 percent more
than collections for 1992.
o
Improving paternity establishment. Alre8dy, the,Clinton Administration has proposed,
and Congress has adopted, a requirement for states to establish hospital-based paternity
programs, as a proactive way to establish paternities early in a child's life.
o
Prosecuting non-payers. Billions of dollars more in support is owed to nine million
children whose parents have crossed' state lines and failed to pay. The JustiCe Department
is aggressively investigating and prosecuting these cases under the Child Support Recovery
Act.
Chan&es Under Welfare Reform
Building on the best state and federal initiatives, President Clinton'S child support plan, introduced
as part of last year's welfare reform legislation, would create an aggressive, coordina~ system
with, automated collection and tougher enforcement. While the federal-state <?hild support .
~nforcement system collected $9 billion from non-custodial parents in 1993, the reformed system
under our plan would collect $20 billion in the year 2000. The plan focuses on:
Universal paternity establishment. Performance incentives will encourage states to establish
paternity for all births, and hospitals will expand efforts to get parents to voluntarily acknowledge
paternity. Streamlined legal procedures and greater use of scientific testing will facilitate
identification for those who do not voluntarily acknowledge their responsibilities. And we also'
will require each welfare applicant to supply the name and location of the child's father in order to
receive benefits.
Fair award guidelines and periodic updating. A commission will study whether national awards
guidelines should be adopted. States will automatica11yupdate awards for familiesasnon-custodial
parents' incomes change..
Automatec:t monitoring and tracking. States will centralize and modernize their· child support
structures through the use of central registries that monitor payments automatically. A new
national child support clearinghouse \\ill catch parents who try to evade their responsibilities even
if they flee across state lines.
,New penalties' for those who refuse to pay. Expanded wage':'withhoidingand data-base matching
will be used to enforce compliance.' As a last resort, states will withhold the drivers' and
professiona1licenses of parents who refuse to pay support. Even the threat of license suspension is
a proven enforcement tool, and suspension also reaches self-employed people unaffected by wagewithholding.
.
�Date: 02/22/95
Time: 08:43
Government Employs Thousands Who Refuse to Pay Child Support
~c-.
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Ct
WASHINGTON (AP)
More than 100,000 federal workers and Postal
\ _~~~.
Service employees are wanted by states for failing to pay child
~~'
support or refusing to' acknowledge paternity, says the agency that
found the deadbeat parents on the payroll.
~
About .three-fourths of the non-paying parents work for the
~~~
Defense Department
as either military or civilian employees
and e '
the rest work for an assortment of federal agencies,' the judiciary 1c~\~-'
or the Postal Service, according to figures provided by the
~
Department of Health and Human Services ..
The number of deadbeat federal workers could be embarrassing for
President Clinton, who promised tougher child sup~ort ~nforcement
during his campaign, ·made it a central part of his welfare reform
plan and brought it up during his State of the Union address in
January.
.
. .
Paula Roberts, a child support specialist with the Center for
Law and Social Policy, a libeial research and advocacy
organization, said the federal government has known about the
problem for years but has done little to fix it.
"It's really a disgrace. It's a little hard for them to get on
the moral high ground about all the deadbeats out there, when they
can't" even clean their own house,"
Roberts said."' 'The governm~nt
does have the ability to go after its qwn, and reinforce the moral
and financial me~sage, and it has chosen not to do that."
States are responsible for collecting child support and
establishing paternity .. the fi~st'step in getting court-ordered
support
but they need .help from Washington if the parent is a
federal employee.
When. a state requests help, the federal Office of Child Support
Enforcement, a part of HHS, searcties federal and military personnel
records for the addresses and employers of non-paying parents.
With that information, states can try to get the parents into
court and deduct child support from their paychecks. But Roberts
,and federal officials' say the process is cumbersome and in need of
reform.
Melissa Skolfield, a spokeswoman for HHS, said the ipsue
involves
"maze of laws and court decisio"ns.' , .
"The issues are particularly complicated as they affect the
armed forces, and we are actively.reviewing a number of strategies
for making improvements,' 'she said.
According to HHS, its locator service last year found 74,880
non-paying parents employed by the Defense Department, either
military or civilian, and,30,831 deadbeat parents working in other
parts of the government.
.
HHS did not break down the number of parents by agency or
mil,i tary service branch .
. The dep~rtment. does not track how much mone~ is owed, but an
investigation six years ago documented the cost of the problem. In
1989, theHHS inspector general found 64,310 federal ~mployees who
owed as much as $284 million in child support. In two-thirds of the
cases, the children were on welfare.
Nationwide; deadbeat parents owe an estimated $34 billion'in
suppo'rt payments to 14 million children, federal figures show.
According to current HHS estimates, non-paying parents represent
3.2 percent of the Defense Department's work force and 1.3 percent
of the overall feder.al work force, including the Postal Service.
a:
�David Gray Ross, who oversees the federal child support off
said the gover:r;tment is sending the wrong message by failing to
tough with its own employees.
But legislation be
drafted in Congress as part of wel
reform will help address the problem by establishing cent
registries that track child support orders and all new hires,
said~
Rep. Clay Shaw, R
a., who is overseeing the Republican effort
to rewrite the, nation's wel
laws, said it is the' 'height of
hypocrisy"
for the White House to cl'aim to be tough on deadbeat
parents wheti
has f
to make federal workers pay.
Shaw said Clinton should use the power of his office to
federal employees to
,and that the government should set'the
siandard for the rest
nation.
Roberts of the Center
Law and Social Policy said
president could
s at l~ast part of th~ problem by
order, starting with a requirement that the military cooperate with
state agencies.
'
Some base commanders refuse to allow employees to be
court orders requiring them to payor appear in court,
to
let parents attend
until they are on leave
service, she said.
APNP-02-22-95 0846EST
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l)p~~~
EXECtlT1Y.E OlUlER '
PROPOSED A.CTIONS REQ'UJRED OJ! ALL :nl)~ AGENCIES
, TO' FACILlTATIrPAiMENT OF CHILD StlPP:ORT "
Mol 111'. dUld.ma lUed (,'IJfI./. dauve the emDtiDMlIWl /fntIndtJl SUPPfJ" 0/ bDth wir
pan!A:.;
~"IZS', 1M Flll:enzl Go1161'M1J!W 1'Iiqr,dru SlDIa w. Ihrollgh them.. pUblic IWI. priWlle
cmplD I'm ttl ~ IlCIit1Iu 'lll!.Cl!Zf1J1'1 ttJ IMIJ1'ethDl monlu In ptrj1NllV 0/chlld SIlppD1f
obi" IUms in witMe1d t1II4l1Tl11Sj&rre.d to , . t:hi1!1!s ~r In QlJ eJlfdrN fl1IIl
1%pf'Jl11tRls llf1l11l11tl': G1Itl
W1rNa ,1f. t1ut F6IimJl Oo\lUn1tlllll. thmugh its civllltm tWl UnJjb11lll4 Semcu :MOrt /D1t%, is
1M. ,:fDII',ltvgur :i1Ig~ tmployu 41Id as such lhDuIIl UI tZ1J taIl1IIrJ." o/ludushlp twl
..",U 1'Il,tme1Il bll1Url1'i1Ig tluJI dB t:hIIdren tn pftJ1lU/:y supptJned; .
NIIW, !'llltnjQre, by the t/1I.IhtJrily W!SUil ill 1M. lIS P1t!SiJJvu by thl! CDnstiluJiD1I tlNl 1M 1Ilws
fJ/tIM U1Illtil SlIIlu 0/A.mI:riCIJ. bu:lIiIJiJrg sa::tIDJi 301 of tIt~ J. it· ii Jl4nd1y D'IdI:rtJl tzi
/olli'n ,I:
. ..
.
. . . ,.
Part 1 • PUR.POSB
Sa::.. .01' 'This Eucutive Older:
0
(I) ! :.cablishes the Em:utive B~cb of ~e Pcderal Govemment, tbiough its·dviIiazl an~
: tTDifc lmed SetVia:s went: force; a !Uad~ employer in promoling ad facilitating the
establ isbment of· patemity aDd the at2bUshment and cnfon::ement of'ehUd support.
:'u
'.'
.
..•
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r,
.
0 ' 0
the
'"
(b) ·l.eqaUea aU Fcdemlageacles, including
uDironned selviceI, tq ~ fully in·
effort ~: to establish pau:mity and fa estab1&h ad' enforce the collectiOn of child and lIledicll
IUPJ.X :tt in all"liluatimlS that mch. actions may be requind. '
ee) . J .=q,u1res eidl Pederal agency; inclO4ins the Uniformed SeMces, to pmvidc information
CO its work force about actions Chat employees should 1ake md' ~ that are available to
easur:: that thcirchUdral ce pro'fi.ded d1e.upport to which they U'crleplly entitled.
Part:! • DBFlNITIONS
For l'urposcs Of'l'11is Onicr:
Sec. :~1. ·Pederal Agency· means any department, agency, Uniformed SetYic:e or other
instrI.mentality of the Eucudvc Bmnch as defined under S U.S.C. 551(1) :and 552(f).
�.
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~003/006
.,'
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~,-
Executive ~dcr
Sec. : ,lYl. ·UDifonned Serviccs- 'meaiaa the Army, Navy. Marino
CcNps, Air Porce; Caul
GGIft-,-and the Co~ned Corps of the NmonalOccanic anc1"ACinoaphc:ric: Administm·--
lion I:Ld the Public Health Serrice.
Sec. : ~CJ3. -Child Suppcxt Enforccmcnt- manllllY ~ve
or judicial. mion
"
neca:uy fa establish patemitY" establish a child sUpport order. incl~1 a ma1ical SUpport
Older and any act:lcm8 Decesmry to enfoa a child support or medicilsupport order. Child
, IuppC It actions may be bmught undIt the dvil or crim:inaJ. laws of die State and are aot
UmitI:1 fa actions 1m:KJghtOD bebalf of the Stale or iDdMdWll by state lleaciCi prcwidillg
servk I!S under litle IV-D of tbe Social Security Act..
Put; ..'IMMl!DIATB AC'l'IONS TO ENSURB CHILDREN ARB SUPPORTED BY
TBlilll PARENTS
",
Sec. :101. !lUI WitbboldjnK
(a) ",'itbin 60 days,fmm the date of'this Exa=ive 0*. ffNrrry Peda'alagency. sbal1
, imp1c Inen.t wap withholdin, fa the fUllest c:m=.nt possible in acc:mdabce with tl;le time 'fQun=s
, and Clher n:quirCmeDtI ill witbhol_ notices issued in I&:cmdance With 42 U.S.C. ~(b) ,
aDd i l1plemmdnl nfc'daflaDi.. "
'
, (b) 1:eginnfnl DO Ider tbaI11uly .1, 1995, the Office otP~ MmqemenC (OPM) sba1l "
publ1 ill al1'lianmJally, in the N¢ml Regjpr tha list of acems (and tbeJr addtesses)
dcsiB 'md fa receive servic:e of withholdins notices for PcdCra1 employees.
,
,
,
h
"
Sec. ;,02. Sejyjee of Prpcgs
"
.
'M
....
,
",
I
"~'II.~
sernce
,
•
,.",
'~' PederalapllC:Y shaD. assiIt. in the
of procca iii ,CiviJ..acti,!nl to establish' .
pater :,ity and e&Ulblish or c:nforce a IUppc:ut oblipJiOn by makin, F~eralemplayees or
·mCzii:cs of the 'UlL\formed Sarvices -.1ioncd outside the U.S. a'Yl.il8b1c for the senic:c of '
procc:& Each apncy sbalJ ~ IJl offidal who Ihall be respoDsib1c for cmurlDg a
Pede 'II emp1oyc:e's availability fot scrtiP= of ptOCCU. ngardle:ss o,'tho locatiOll of the ernp
, lo~ I s ~k place.. OPM shall publish a list of these ofiicials semiannually in the Federal
~ :••
bc:ginD.iDg 110 later than luly 1, 1995.
Sec. :&03.f'edml Parent I.pcatpr
shall cooperate 'with the Peden1 Parent L.oc:ati:lr Service, estabtilbed
UILC!e' 42 U.S.C. 653, b:,.pmYidina camp1et&, timely and ,accurate information that wiD. help
in lo:adng IlOIlCUStod.ial parcrltS and their employers.
Bvcr " Fa!era1 agency
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'~
Pap ~ .. Bxecutive Older
Sec. ~ 1M'.
C)pqmatch fgr DetiDi1WnI Qbticom
~,_
_
.__
:"'M~
_
<a) T:~ mas. file of ddinqucnt oblicon which each S1ate eNid support enfDrcCmatt ',-", ,."..
IPftC: t submitl to the Intemal Revenue Service for Federal income tal mundoffset PU!:pC:lSe$
Ihalll ," mafCked' at last annually with the payroll or ~ files of Fedem qencies in
order 10 cIcrI::tmbHI it there am InY Pedeal employees with child suppon delinquencies. The
,list of ma.tcha Ibal1 be foIWarded to the appropriate St:ate chikt suppon euforcem=t agency
to del!nnirIe, in each inltanc:e, whedler wage witbboldiD& or odu:r eafonzment actions
sboub be CIOIIUnCIlC:ed. AU matdJ. will be performed in accordance with S u.s.c. SS2a{o).
CU).
(b) .A!1 Pedal
acendet sbaU iDform CU1'I'eQt and prospective employees that c:mssmatchcs
ue rc: litiDely made between Pede:ral peno.nne1 nco:ds aACI Stare records OD individuals who
'
ow cidld support wi. inform empIoyee.t how to inida1c wl~tary wage withhold.ing ~~
,
, ' , '
,
i
'
,
\
..
Sec. ~ 35. Axlilability of Services
,
,
All It !denJ. acmcic:a abal1 advise c:m=t and pmspeCd.v. employees of .wz:s' authorized
UDder title IV..D ofth8 Social Secudty AI:t that am aYli1ab1c through'the Stares. At a '
,JDimm IOID:, iACarmati.oA abaJl 'be pmyided unuaUy CD cumm ~ tlmJaah the'
!mpII !y. AISi'ta.Jla: ProFIID~ o~ slaiiJa:r: pzogramJ, and to aew,ernp'h)yce.s duzing JOutiDe
odaal :&doD.
.
Sec. : iD&. Rprt·OO Adiqna Takeji
...
/:
/~
:
'
W'ltIU :1 90 days of the elate of thii'BucutiveJ~' all Pedenli agenCiea shall report 10 the '
Offic: of J4alIigement ancl'Budget (OMB) OIl, the actioas they, hav~ takeA to comply, with the'
Elect ,live Older aDd of any atatnfbry. recuJa.tcry, lD4/or ~ve 'barriets that prevent
them :mm c:ompl~1 with the RquireD;LeDW 'of Part 3 of !his :&ccutive Order.
Part .' .. ADDmONAL ACl"IONS·
,
![
'
Sec.. ·101.· Addjdgnat BeYjew fgr the Unifgrmed Servjem
.
(a) I', addition to Che RqUUements outlined above, DOD in cotlSullatlon with. HBS (ami with
parde Lpation, as aec:apryJ by other apprapriaro agenc:ia) lball conduct a full review of
CIJIft :t policies and practices withiD the Uniformed. ScMca to e:&1.S'Um that cbildreD of
Unit'c rmed Senicca personnel am provided financial ad, medic:a1 support in the same manner
and t ,ithIn the same timeframes U is maadah:d lor all other dIil4reD due such· support. 'Ibis
levie II sha1l1Dclude~ but DOt be limited to issues related to wirhholdina o.on-custodial pue.ots'
wage, icrvic:e of process. a=viCiea to locate parents and their income and assets. release
rime 0 atrend civil patcmity and. support ptee'"ftiings, and bealth insurance COYerBgO under
. the C :vilian Health and Medical Program of the Uniformed Servicc:.s (CHAMPUS). All
,
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02/23/95
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Page. .. Eul::utive Order
re1M :It emting .tutes, h'lc1udiDg the Soldiers and Sailon Ci'Vil Rdfef Act of 1940, the
, Unito 'mat Services' Pormer- Spouses, Pmtcctioll Act. and the Tax EqUity and Fi.Jcal Responsi
billty :\" of 1982, shall be reviewed and appropriate Iepslative mbdifications shall be
i~ti'~.
.
(0) 'Y'ithin 180 daY' of the dare of tlUs Bxcculive Onter, DOD shall IUbmit 10 OMB a report ,
based ;,)11 this RNiew. The report Iball R!COmmencl additional policy.. rqulatDry and Jqisla
dYe c :anles tJlat.wauld improve and enhance the P'ederal Govcaur&eate.commitmcnt to
ensuri III parcntallUpport for all cbi1dren..'
Sec. ; -12~
Additional
FedmJ Aaeng Actions
(I) C?M and BHS shall jointly ptepaIC ra:omm&Ddations far additiow admini.s'In.tive.
tegtW ''«1 or Jqi.aIative improvements in the pnJidellDd procedures of Pederal agencias
affect:3I chlld ,Iupport Cnf'OICIIDeAt. Other agencies will be l.nc1ucled in the: development of
n:coJt :nendalions for specific itaDI u appropriate. "l'be recommendations sha1l include:
"
("I) p:gcedures to CDSUEe !bat P'cdezal apaciu nquire employees to cm.oU th~ .
c:Iaildtea ill health iDsulmcc plans wheal an employee n:quired by a child suppolt.ozdet
fa pnMde sach auppott baI f.ailc:d ID do 10 aDd· pEOCedutu tG.eaame tba1 Pedc:al '
Employees ReaJlh BesJefia Pm&nm iDsura1 do not me po1id9 or pacriCCl which
lIS\Ilt III refiJsaI taearoll a child based on'dle resmeace of the child or the .marital
. . . of the employee.. .'
'
'.
("d) pIOCCdurea to ensure;QW m~ aCRIl1ItJ! aDd up-to-date ~ about civilian. and
UIIiformed peaonnd. who' . beUir sought in conjunction ~ a Slate paternity or
child aUpport ac:tioD ,em i* obtaiDcd. f,ro~edeta1 agencies 'and lheir payroll aDd. "
penonnd RilXllcIs w1ah which to im~e' efforts to ~ J2Ql\-castodiaJ parents 8Dd.
their income aDCl a.uets; "
. ,
, (Ui) procedures for sc:1cding,Pefde:al agencies to pilot test ~eva1uam new
appraac:hel 11) die c::stab11sbment ~ caforcem.eat of child s~ obligatioua;
..
'..
(Iv) addiIional pioposals to improve serric= of process for civillaa employees and,
members of the military stationed outside the UDited States, iDduding the pouibiIity
of .wag prace:ss' by certified mail In e.stablishment, and ea.forcement cases or of
desipaling an agent fot sezvicc of procas which would have the samo effect and
bind employcc.s to the same cxtent as actual, service upon the·em.ploYI1II!i
(~) stzatecia
fiu:ilitare the compliance With P'edem1 and sia.te child support .
mquiftmentl by qvasi~mc:l1ta1 agencies, advisory grD1liJS' and commissions.
to
(vi) ·whedler a single agency should be designated to receive and effectuaf4 wage
wichholdinc orders (or all' Feder.al employees; and
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WHITE HOUSE
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Pace! - Executive Order
(vii) whether compliance with support obliptions should be a condition of Pederal
employment or a factor used in defUliitg suitability for Pe.dcral employmcaL
(12) 1,": e na;rmlllClldalions for item (I) are due within 90 days of dle dati: of this Execudve
Order. The recommc:udalions for iIems (ii) - (vii) are dUe wit.hiD 180 day. of thcclab: of this
Execu .lYe Order. no ra:::ommendations are to be submiued to OMB.
I
Sec. !
u.
Int;maI ¥mll'menl
This I recutive Order is intelldad only to improve die intemal manacemeat of the Bzecutive
Bcmd with n:prd to child support enforcement and.1baI1 DOt be itdapr=d Ia·cmate any'
light ( r benefit, IUbsranti_ or pxacedural. enfozceab1o at law by a party' againIt the 'UnlCl:d'
SU:I ill officera, or any other person. .
See. S:l2.. Soyerejcow of the UnUed S*, Goyemrnont
.
1bb J ,-ave: Olda' is int&ncled only. to pmvic!e tha1 the PedeI:al Govemment bas e1ecta1 to
NquIr " PeeleD1 'IImdcs to adhere to the'same stmdazds u am applicabla to ~ otba: ...•
empIc ... mthe NatioD ami abaU ftOt be intelpretl:d as IUbjectiq tho Pcdcza100YallDilllt to
lAy II a Jaw or u:qui.n:meDt. This Order mould DOt be CD.D.StnIed u a waiver'of die'
Sova i&DtY of lbe l1aiteCl S1:at.es Government or of any aisdDl statutcry or re:uIatoIY
pow iau. ildudiDg, the following: 42 U.S.C~ 6S9 and 662; 5 CPR. Part 581; 42 C!F.R Part
ZI. S1 bpalt C; 32 a:B. Pm 54; ·eel 32 en Part 8 1 . '
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:!'f'iuU:eAmerica.. wJU~ wou1c! compromise
any acQ.OD,
. the de =- or security intaat of the Unita4 S o f
.
I
Punh« r, tbls Executive Order u.iWt imen~
.
.
.
. Sec..! ;)4. Bffectiye pat;
..
Un1~ ; odIerwi&
Slated the pravUiOl1I ~.this Order shall be effective immediately~
_It
.
•
."
�President Clinton begins the week by
moving forward on his pledge to end
welfare as we know it.
REFORMING WELFARE
TODA Y. THE PRESIDENT SIGNS AN EXECUTIVE ORDER MAKING IT EASIER TO FIND.
PARENTS WHO OWE CHILD SUPPORT AND,TO·MAKE THEl\f PAY WHAT THEY OWE.
•
DEMANDING PERSONAL RESPONSIBILITY. The President's action is another
important step in the effort to bring the federal government in line with the values of our
people. Parents have a responsibility to take care of their children -- and any parent who isn't
paying child support should be forced to pay. Too many children in this country suffer
because of a parent's irresponsible behavior. Responsible welfare reform must include
measures to enforce child support obligations.
•
MAKING PARENTS PAY WHAT THEY OWE. The President has made child support
enforcement one of his top priorities, and this executive order will make it easier to ftild'
federal employees who don't meet their obligations to their children. It will also improve our
ability garnish theirparchecks and force them to pay the·support they owe.
•
BUILDING ON A RECORD YEAR FOR ENFORCEMENT. The President's action today
builds on the work he has done the past two years to step up child enforcement. . Last week,
the Department of Health and Human Services reported that we had collected a record $703
million in delinquent child support for 1993 by garnishing income tax refunds of parents
who. failed to pay. This 13% increase in. collections helped almost one million families.
MORE DEMOCRATIC ACTION ON WELFARE REFORM
•
Another Welfare Waiver. On Monday, Secretary Shalala grants another federal waiver for
state welfare reform, bringing to 24 the number of states that President Clinton has given
flexibility to improve their system.
• .
Opposing Efforts to Cut School Lunches. Also on Monday, Governor Howard Dean (VT),
the Chairman of the National Governors' Association, and other Democratic' Governors release
a study showing the harm GOP cuts in school lunches would do to children in their states .
. A WIN FOR AMERICAN
WORKERS.. This weekend, the Clinton
Administration won another battle in the
fight to create high paying jobs for
Americans.
ELIMINATING UNFAIR TRADE PRACTICES
This weekend's intellectual property agreement with China will eliminate practices that have
cost Americans over $1 billion a year in high value expor~s. It will mean thousands of jobs
for Americans in key industries, including computer software, pharm~ceuticals, agricultural
and chemical products, books, and audio visual products.
�HOUSE REPUBLICAN RESCISSIONS
L REPUBliCAN RESCISSIONS REFLECT A STRATEGY TO CUT INVESTMENTS
FOR THE MIDDLE CLASS AND POOR CHIWREN TO FUND LUCRATIVE TAX .
CUTS FOR THOSE.MAKING OVER $200,000.
REPUBLICAN SAVINGS ARE GOING TO PAY FOR UNJUSTIFIED TAX
CUTS FOR THE WEALTHY.
• The Republican "Contract with America" includes a 5700 billion tax cut
over 10 years --with half the benefits going to families making over
5100,000.
• A capital gains tax break that will cost $18'3 billion over 10 years--with
nearly half the benefits going to families making over $200,000. The cost of
one year of the capital gains cut would be larger than all rescissions
approved through Friday, February 24.
'. A boondoggle "neutral cost recovery" tax break that the Wall Street
Journal says· "is a ';"ery sweet deal. for the nation's capital intensive companies...
[and] could allow some big and profitable companies to escape taxes
altogether." ·(12/5/95) Cost: $120 billion over 10 years.
THE REPUBLICAN BUDGET MAKES DRAMATIC CUTS IN PROGRAMS FOR
CHILDREN SIMPLY TO PAY FOR THE PORTION OF THE TAX CUTS GOING
TO HOUSEHOLDS MAKING OVER 5200,000.
.
Indeed, the· following cuts' all go to paving for only a portion of the capital gains tax cut
going to households making over $200.000.
• 15,000 young people will be denied opportunities to engage in national service;
($210 million, or 2% of the one-year average price of neutral-cost recovery)
.. 100,000 women, infants, and children will.be denied proper nutrition by , WIC
,
cuts;
• 615,000 disadvantaged youths will be denied summer jobs this summer because
of the elimination of funding for the summer jobs.programs. ($1.7 billion)
• 4,000 school will be denied funds for higher standards and better teaching
through cuts in GOALS 2000 ($164 million) ,
• 3.{,000 youth in 17 communities around the country will lose training
opportunities through elimination of Youth Fair Chance.
. • 94% o f all school districts will lose funding for keeping drugs out of their
schools through elimination of funding for the Safe and Drug Free Schools and .
Communities Program.
All of the above cuts would pay for only a portion of the average capital gains tax cut that
goes to households making over $200,000.
.
,
�IL POUTICS ~USUAL OVER POLITICAL REFORM: THE REPUBLICANS tALK
ABOUT CHANGE, BUT IT'S JUST MORE PORK AND POLITICS AS USUAL -
. WHILE THE MIDDLE CLASS AND POOR GET CUT.
.
.
~
'
600,000 Summer Jobs vs. $600,000 Increase for the Speaker's Office: Behind the
rhetoric about revolution, you'll find the same, old porkbarrel politics: While the
Republican leadership is calling for eliminating over 600,000 summer jobs for young
people, Newt Gingrich is giving his own office $600,000 more for its own needs.
Paying for a Pork Visitor Center for a Republican Official Is More Important than·
Weatherizing Homes for Low-:-Income Families: _As the New York Times stated: !lOne
trade-off speatcs volumes about Republicans priorities;· they decided it was more important
to pay for a visitor's center in Oregon, the home state of a GOP Committee member. than
to help weatherize homes of low income families. (2/24/95)
II
.
.
.
.
In. EXTREME CUTS VS BOLD, SENSIBLE REFORM: PRESIDENT CLINTON IS
CREATING A LEANER, SMARTER GOVERNMENT THAT HELPS MIDDLE.
CLASS AMERICANS HELP THEMSELVES. THE REPUBLICANS ARE TAKING
AN EXTREME "CUT-AND-GUT" APPROACH THAT HURTS WORKING
FAMILIES.
Through the National Performance Review, President Clinton has already cut more than
100,000 federal jobs and saved $63 billion and is making bold. but sensible reforms that make
government work better for working families. By contrast, the Republicans have an extreme
ideological agenda, and they are cu~ng programs whether they work or not. .
Example: The Administration is making a bold, sensible reform of the Agriculture
Department while RepUblicans are calling for slashing successful nutrition programs
for children. The Administration has closed 1,100 unneeded agriculture field offices while
expanding WIC. That makes sense. GAO says WIC saves $3.50 for every $1 spent while
improving birthweighis and reducing infant mortality and child anemia. Republicans are
drastically slashing this and other successful programs. Indeed. in addition to their
rescission package they are also calling for cuts in WIC and school lunches totaling $860
million in 1996 and $7 billion over five years.
Example: The Administration has called for dramatic reform of the Department of
Housing and Urban Development -- consolidating 60 programs and eliminating 4,400
positions, while Republican rescissions 'threaten housing for the neediest. Republicans
are simply calling for slashing housing assistance for 63,000 families, most with poor
children, including 12,000 homeless families, 2,000 disabled individuals and 3,000 people
. with HIV-AIDS who are homeless or in danger of becoming so. ($2.7 billion)
Example: This President signed the inter-state banking legislation -- an historic
reform, while the House Republicans are calling for eliminating funding for
Community Development Banks: After 20 years of effort, this Administration passed the
Interstate Banking Efficiency Act -- a major deregulatory accomplishment. The House
Republicans would deny hundreds .,- even thousands -- of community banks funding by
eliminating funding for the Community Development Bank and Financial Institution bill.
�
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Carol Rasco - Issues Series
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Carol Rasco
Issues Series
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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2010-0198-S Segment 2
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Clinton Presidential Records: White House Staff and Office Files
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92 folders in 7 boxes
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[Welfare - NGA]
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Domestic Policy Council
Carol Rasco
Issues Series
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Box 127
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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2010-0198-Sb-welfare-nga
-
https://clinton.presidentiallibraries.us/files/original/1a9375653ee14d777aeffa7d002adab8.pdf
7c845a532d357c4c72b080d9d8f88467
PDF Text
Text
EXECUTIVE OFfiCE OF THE: FRESIDENT
OFFICE: OF r,1A"'AGEMENT At\JD BUDGET
WASH 11\ll;i,'ON•. 0. C. 2050::;
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AOiv1tNISTRATOR'
OFP'lcC;: Of"
INFORMATION AND
R ECSULATOR'f ·"','F;AIRS .
January 1, 19,95
MEMORANDUM FOR/JACK QUINN/KUMIKI GIBSON
.../: CAROL:p.ASCO/PAUL' WEINSTEI,N
PAT; GRIFFIN IBARI3ARA: CHo.W.'lJ~.Err; I1URGUIA
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GOV;E?inrneri:tal.A~,f~~r:;; ,·9~n1r.tft~ee.;:n.e·a:tiri.g;:;~oni' unf:unqec;l: m,anda:t.es?
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DRAFT
(J~nuary
1, 1995)
OF SALLY KATZEN
ADMINISTRATOR
STATEMENT
OFFICE
OF INFORH1\TION~ANDRIGULATIORY AFFAIRS
OFFICE OF MANAGEKENT'" AND .BUDGET
. ' 'BEFORB'l'HE:"
I ,,'
COMMITTEE, ON
GOVERNMENTAL Ali-FAIRS
UNI.TEDS':1'~T~S':~~ENATE '
January 5, 19,95'
Good morning, Mr. Chairman and Members of the
Commit~ee.
I
appreciate the opportu,nityto telf'ttfy today: on unfunded Federal
mandates. This is a very important' issue for the Administration.
state, local , and tribal government~have e~pressed deep-felt
.
.
-.;.
.
concerns about the difficulty of complying.~it.hF~d,eral'Uf!.fUnded
mandates. As Governor of Arkansas', pre~ider,t> Clintonwa~s .fully
aware of these concerns. As he said on· ,J)lne 13" 1994:
.
-
..,
As a former governor who faced the burdens of Fed.eral
,
l'I1a..nda:t a,s for: 1:2, -:,long;:,;y,~a,fsi':';,-l :>:k-n9w"',h,:C:)¥!;:lg:uei:!.t·fory;$?{(:)!~,E=:ii~::':.~::;,;·';::l'~';:ci~';V;' .' . .
funding concetn~'~V$rYthii1g;; elS!e· you i·[.mf1;yo:r:sJ.do:, ";';':"from '. '..
putting more poll-ceon thes.treet' to p;rov.ld.lns; .clean water
'
for people in your cities. 1
i
We have been moving, with the President's active encouragement,
to help solve this difficult problem of unf.unded mandates. Last
year, we worked to enact S. 993, a bill su~ported by Senators
Kempthorne and Glenn~ President Clinton noted his support for
this effort to the conference of Majors:
[O)ur people have been working with Members of Congress who
are focused on this man.dates issue. .I can report to you
that we're getting closer to a workable bill. And although
there are still a few issues th,at remain to be resolved, I
Remarks by the President in
of Majors, June 13, 1994.
Satelli~e
Feed to Conference
PHOTOCOPY
PRESERVATION
. .. ,
�SENT BY:OMB/Management/Rm350
:# 6
2023953047'"
think we can see legislation acceptable to the nation's
majors soon. 2
Two days later, on June 15, 1994, then-OMB Director Leon Panetta
wrote this Committee:
w.i th the Committee mark-up tomQ.rrow of. J ~.99,3.], I wanted! to
express the Adlninistrat:ion's support .f,or· your efforts to '
fashion a bi.-partisan' compromise< on .tl:ris issue •. :. . . . The
compromise that. has"been'craft;ed-wil1. improve-the process
tha·tdeals with·the,issua 'of· u'nfunded: manda,tes without " ..
increasing t.hegr~dl()ck: that the··~r~'sident~was' e,fected' to
eliminate.:I .
As then-Director Panett~ noted, S~ 993 was a ~i~pa~tisan. ~ffort.
and White Housestaffworked,.extensively ~i'ththe; s1;af.f of
other Meml;lers of Congress f.' both Rep1..1blican',and: Oemo9rat,to
fashion' t~e bill that';'ent.· to mark~up.' While discussions were
cooperative and l~.
good-natured', there was dtsaqre.~m..~n~1..-;,'t;Q.;.!r~"_,~!~~". """,
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gi've-and",;,take:~>" Blit,: :tniQugW,:lt;'. ,1'11\ \t.nti~e'walS: ·,g.Qod~w,i.l;l. e;tnd.the ,\.
final version was som~thi~gthat b~th 's~nat~r~ Kempthor~e and
Glenn and the Administration could and did wholeheartedly
endorse.
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Such collegial, bi-partisan effort is important. Without such
efforts, it is harder to make the difficult, but necessary
compromises that will assure the resulting legislation serves the
needs of the state, local, and tribal governments, but does not,
as then-Director Pan,tta wrote, llincreas[e] the gridlock that the
President was elected to eliminate." It must be productive and
workable.
l
Remarks by the· President in Satellite Feed to Conference
of Majors, JUne 13, 1994.
3
june 15, 1994 lattar from then-OMS
to Chairman John Glenn.
Dire~tor
Leon Panetta
PHOTOCOPY
PRESERVATION
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the work that has already gone into s. 993, we think it can
serve as· a vf?hicle for prompt passage and signing of unfunded
mandate legislation. H?1vinC] this be the first bill introd~ced
demons~rates its importanoe to ~heSt~~e, ~pcal, and tribal
governments, and to the Plll;.liic. SinceS. 9,9Jserved as the basis
for s. 1, it also demonstrat~s.thatthis new Congress is willing
to coptinue with and build uPQn-ti,lecooperative, bi-partisan
efforts that; all of us here engaged in on this issue last term.
Gi~en
We appreciate that we have been 'able to dj.scuss various drafts of
S. 1 with'.Senators: ~ernpt:ho;neand . Gl,erm r a,s well as. their staffs
and the s,!;affsof: .a flUltll:ier,o~ other Senator,s. 'W~acti vely
support thClseprovisions thata:r::e,'based:~upot:rthe. c?irE7flllly :
.
drafted .language Of S,. 9~..J, ,as,i:t wasplaqed'iptornark7up la'st
year•. We ha~e. also had the /J:r:?pqrt,:,unity <.to're.v.iewat lea~t some'
of the ':other provis'i ons~tha t ;'hav~ 'been added ,to S ~ 1 'and 'we ,can
work with them.
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We understand that there are other provisionsbein'g' drafted as .I
drafted. this testimony which, obviously, we have lacked i::he time
not onl~ to read but, mare importantly to think through so that
we have a high degree of confidence that the' proposal is.workable
and will not have unintended adverse consequences.
1
• •
•
•
I
One of the often r.epeated complaints from State and local
governments is ,tha,t provisions are added to legislation with the
best of intentions but at the last minute, without providing an
opportunity for analysis. such provisions have sQlUetimes
compounded the unfunded mandates problem. We do not seek delay,
but we should not fall into the same pattern that has le.ad to the
leqitimate complaint to which we are being responsive.
What we are doing will bind us -- as it should -- for the
foreseeable future.; we should ~hus .m~ke sure that it really
·achieves our shared objective. We are ma,king progress. The
\PHOTOCOPY
PRESERVATiON
I
�SENT
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BY:UMB/Management/Hm~~u
- 4
bipartisan efforts last term, as well as through ~he holiday
season, have been productive, and I am optimistic that we can
work together to achieve a productive and workable solution. We
cannot continue as we have in the past, but neither can we
abandon or unwittingly impair our ability to govern.
Tpis hea~ing helps with understanding the underlying structure
and intent behind the new provisions of S. 1 and provides an
opportunity to consider concerns that are raised by them.
I appreciate the opportunity to appear here today before you, and
I look forw.ard to working with you on this important .matter.
# # # # #
PHOTOCOPY·
PRESERVATION
·0
�SENT
BY:OMB/Mana~a~ent!Rm350
1- 2-95
4:45PM
2023953047..
EXECUTIVE OFFiCE OF' THE
i
PR~SIDENT
OFFICE. 01'" IvlA,·"."GE,\ryi!NT .J.,.. D SLJDC,t:T
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AOM'tN1STRA. TO!=2
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iNFCH~~lA·r:C'r·~ AN.C;
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Fic.GuL.:'TO~Y A.f!'~A.IR::;
2 1995
MEMORANDUI'1 FOR OI.STRIBU'110N '"
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SUJ:lJEC,T:Update. on Unfunded Handates
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The Republicans ,vant:'· to]mo,.ve, vffr.y fae,t"in t'h7,sena·t~ ·(to.. '"
showt:he . Hou~ethat: they, 'tooca,nIilOve' when' there'i.lS good'reason
t0dc ~ro and .to·f.or,estal'l, introdu'c.ti'on.o·f'a' m'ore.:' controversial:·
b.il:l in the "House):.,:,:1he;·re'l'evant'Republ:lcanstaffers
..:( Kempthorne," 'D91:e,,:~R6th);::hav;a;, been meet irig' W'i~h :pemocr.atic, .
, .. staffers ;all,ias.t t:we;~k:;,' :;:Th:e:,~urieirt'· pla:n;(as ..p:e.l~~e .F;r:iday}is .
that',. Dol~"afld 'b'asch~er>K,~.~pt}j:,b~D~:'.a.nd'~lel1nl :Dom,~r:;Jc:i::and 'Exorl /.'
Roth.';and ·others,(~:r;-w:irl 'm'e'E;lta,t :~' ,'or 3 ,cmTuesda'y,:'1ock: up the . ',
bill (S. 1) f . and'il1tl~bdlice" i t''f'irstthi.i1<J;W.edne·Sd,aY·; ',Gqvernment" .:"
,.. )V~:~ri:rs~,rid:B,,!l';,9},,~(p~;;'~,_~~ c:...:1Jl.!:,;!)'.. holcl'ing a hearingo'n Th,ursday( I' .. '. , ....
,',ha've:been: inv.ited '.:as{;the~:1idm-ili':hii~::r<Ci1ait;Jro;nlr:;:>"',ci:!~;i1ai.:.s;;"" '~" .~;.i.::::h" :;;,c. r 1..: -'..lD • .:;.r,
Fitda y,': a nd'a\""o t C;l':: ~~\~ti~:::~§t;,Fi~~~';'~'Q,~< tlf~:'~}.~l: '?P:~:~¥9tti1~:7~,~('~~!:';;;!~~i)ir".;'~i(0·1~!i~5'!~?:~:I:;,:~~~~~/;l
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Negotiation!!
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Democra:ticnegotiators have be,en 'le.<;lpy Gle~n 's' s.t·af fi '>{.ith·
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so;r.'l~ involvement·py' Daschle,.s~,sta:f.f>and"the"s.taff:of' Budgetan,d
Appropriations~, A, .se,nseof resignation and:pE.dplessness.··'·
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per,vade,s... :They havebeen:less.·tnan.fo~cefulinexpressing their.·
views, and some. ' (partiqularly"tGl~n:n'~~) s;t.atf):s~em,to' jUSt:WCll}t'to
get. II it" done,withqut regar-ci :tc;>'~,hat,~!'it"~mig.ht do.
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Katie, p.aulan9·Iw~nt to: 'one meeting wi th the D~mccratic
s.taffe~siI att~r9i~d:':on~'~eet'ing; wi,th, Ke~pthQrne' s'staff
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.:< Kemp thorne s~t· lrif 9rr ;about:20' 'mi:l1utes},' .. and tl1ere' 'have· been
inany·teJ.ephone'ca11s,.vd·:t:ti';Das.chle/~::staff:.·pE!r~Pn'(;Er ic Washburn
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Issues
sunset -- This is anewappr.oachi some provision should be
made for sunset/.reappra.is.al a,.f·ter experience. Apparently, the Rs
,will agree, butonly~f~er arlels~is.settl~d. We were asked to
keep pushing on' this one. You may recall,we had init'ially wanted
a sunset after 5-7 years.·
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PHOTOCOPY
PRESERVATION
�~tNI ~Y;UM~/Management/HmJbU
Baseline -~ When there is a reauthorization of existing law
that already contains a mandate, only the additional (as opposed
to the embedded) mandate is subject to the new procedures.
Apparently, the Rs intended the legislation to be prospective
only, and have no problem with accepting this interpretation (and
making _it explicit). This is very important for Safe Drinking
Water.
2.
3. State/Looal Activities Comparable to private sector -- When
the state, local, or tribal government is dOing something that
the private sector does (e.g./ operates a fleet of cars, provides
health benefits l etc.) it should not trigger the special
provisions of this bill. ' The Rs are thinking about having the
committees do an analysisj the Ds h,avebeen thinking ·of carving
out an exception for certain spacified activiti~s. But-
"Expressiounius, e~texqlusio al t.erius " ! (UTheexpression of one
thing is ,the exciusicm of others III for those' 'who, did not. struggle
through Latin 1 or Law 2! r, Le.st we not anticipate all, the ','
a.ctivities we want excluded, Isuggestedthat:'they define
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II intergovernmentalman'date
as a mandate that'" ~iql)ifieantly'.~lld '
uniquely affects sta.te local, and' ,tri!ba'l governments~II' This,' is .
the other issue that the· Rsare',!)olding:;back,on>untii the .Tuesday
af.ternoon meeting. We should, weigh inhG!re' (prefe+"aply'\-!ith, .my ,
suggestion).
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Requlationsjpriva.te sec::tor impact
Someone (perhaps
Domenici) has stuck back language in the section on iegula~ion~ ,
" th'qt"r~qllire$' each·,'C\g$n.cr.;y..,,,:tp .• au!\lyz:ethc macro-economic effec,ts '
. of each' regu'iatiorl'~-·n:ame,ty·,~~tn~'·'~'ffsc't'\1'fCi't"'~'th'e:~~egi~:l~.?it;P·rl:QP."'tQ~)i"!':
economic· growth , creation of jobs", global competitivenesfr;,I')'etd;:f~
We had argued against such language in the. Moran bill bec'auseit
will be a very rare event (where the cost of'the regulation is
over $1 billion) that there will be any measurable impact from a
single regulation. While it is probably'a useless activity, and
we thought it silly, it is probably harmless sinoecwe can develop
some poilerplate that would go in 95% of the analyses (to the
effect that the macro .. economic aff~cts of this regula:tion are not
measurable). We can a.+so ask that'ltmeasurable n be added to the
statutory language, On this one, apparently, Kempthorne's staff
think they have to include something for whomever inserted it,
but they have told the 0 staffers that they will riegotiate it
with me. Instructions please • . .
5. Point of Order -- The BIG issue: After LP's meet:iiig with
Kempthorne and Glenn, in Which a point of 'order on APPROPRIATIONS
was suggested, the hill staffers rejected that idea and came up
with a new scheme that calls for a point of order unless (1)
there is the requisite statement from CBO, AND (2) the mandate is
fully funded (by direct spending authority or increase in
receipts) OR there is {a) a specification of the direct cost of
the mandate over its' life , (b) an identification of which
appropriation bills are expected to produce that amount/ and (c)
a provision saying what the congress wants to happen if the full
amount is not appropriated in any year. The authorizing
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PHOTOCOPY
PRESERVATION:
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�SENT BY:OMB/Management/Rm350
2023953047-+_
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committee has two choices -- it may (i) authorize the agency to
approve a proportional mandate (Le' l manda.te fits the money) or
it MAY (ii) say that if evelrY dollar is not appropriated , ,the
mandate will NOT exist (io e. no money no manda.te).
Kempthorne's staff say they need to have some "no ,money, no
mandate lt language I but they are wil1in9', to make it' the, second (as
oppo,s~d to the first) .-choicein the statute.
They argue that
the,re are some times .When you cam-lot-tailor the· mand.ate to the
amount· of money , but they s&enlunwtl'ling to make the clause
applicableon,ly when the- mandate '/tis not divi-sib_le" (my
suggestion) .
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Meanwhile, I came up with a IIcounterpunchll that would shift
the r~sponsibilityfor ~voidillg the mandate to the_state, local
or tribal of,ficlals,by sta-ting'.thatco:mpliance with any mandate
wouldbe.·,wa~vecl :where ther_e wa,s n_ot fulF_:t).lnding I provided that
the highest ~lected09_ff:iciahintheappli~able 'jurisdiction
certified'that'there-,wer:,~:no, oth~rf,ed_eral f:unds available and
that hel shethou.9ht,thj.~,;znandate-~as:'lef3sirn.port'ant;' than ,',others.
This i'deawas:floG\.ted',by Daschl~/s_,staff'and there'ai,e no ' " '
f inge:tprint~ th~t' caT1be-tra,ced"back/~to-ln~~ '. The'D "staf,fers are
talking, -about -a' provisi.on~'onthe":lIno money,'n()mal)date"-lang,uage,
that :,the:mandate ',cancont.inue' in effect IF- the local -official, ,"
w,an'ts 1t;:.to continue, i}:)utthen_the'-presumptlon -is' that -th'e-'
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mandate will, not exist "unless-·they :do:somethfng>af~1r:m~tiv~ly to
extend it -- i.e., backwards of what, we would want the ", '..
-,. "p;r;~;:>,MlJlPt~Rn to?~ b~,: ___ ~.r!1is will be debated more at the:staff level;
but, I am S,\13:'_9 "~ ii::.·-~>fl-fi'c.oflte:"\:lp',~~a;~f;~~,\t:fJ~,:;,'m_~~,$-J.ng(::!,JA~.~?'~YrafJ:e_rnoon.
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Judioial Review -- I was warried that the ,Re want--to· add
judicial review somewhere{but I have seen_ nO-language to. this
effect and I k~pt repeating that this is a deal break~rfor us.
PQliti;s
One VERY IMPPRTANT piece of this puzzle is that we have not
included the- House Democrats. Gephardt's person was out last
week and so far as .X· know I .they. are completely in the dark on
this issue. Recall that las-t year we got o,U,r heads_ handed to us
·by Dingell and Waxman because we had struck _a deal on the senate
side and had . not cons,ulted· them. We must make contact
immediately.
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Distribution:
Alice Rivlin
Jack Quinn
Carol Rasco
Pat Griffin
Katie McGinty
Martha Foley
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PHOTOCOPY
PRESERVATION, \1
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�PHOTOCOPY ,
PRESERVATION
�Talking Points For Pat Grifrm
On , nfunded Mandates
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The President continues to support, and wants to sign unfunded mandate
legislation early this year. But he wants to sign legislation that is reasonable, and will
not produce Congressional gridlock. The legislation must balance the need to provide
relief from t~e'burgeoning growth ,of unfunded federal mandates while insuring the
federal government's ability to act in the national interest.
Of all the outstanding issues, the most important for the Administration is the
point-of-order.
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Point of Order -- The Administration has serious concerns about the, new
language on the point-of-order. The proposed ad~itions to S. 993 are
overly cumbersome, probably unworkable, and places too much
responsibility in the hands Senate and House Parliamentarian. We
understand the need to head off more radical "no money, no mandate"
proposals, but a point-of-order on appropriations makes much more sense.
However, if that is not acceptable to the appropriations committees, most
of our problems with regards to the "no money, no mandate" proposal
could be resolved if our language was included that would require the
most senior state or local official to certify, 'that he/she does not wish to
implement the mandate.
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Judicial Review -- The Administration opposes adding judicial review
language to the bill. Reducing unfunded mandates is an issue for the
Congress and the Executive Branch to address, not the courts~
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Baseline -- The Administration supports including the proposal, to establish
a baseline so that only additional unfunded mandates are subject to the
new procedures. We are concerned how this will actually work, but we
believe the approach is correct.
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Sunset -- We strongly support sunsetting the legislation. This is consistent
with-reinventing government, which calls for sunsetting new legislation to
, insure it is working correctly.
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State/Local Activities Comparable to Private Sector -- The Administration
strongly recommends that you define lIintergovernmental mandate" as a "
mandate that "significantly and uniquely affects state, local and tribal
government. II
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Regulations/Private Sector Impact -- The Administration continues to
argue that this bill is about the federal, to state, local, and tribal
intergovernmental partnership, and should not include provisions relating
to the private sector. However, understanding the desire certain Members
�of Congress to include something, we strongly encourage that language
requiring that "each agency should analyze the macro-economic effects of
each regulation j, be changed to "the measurable macroeconomic effects of
each regulation."
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.r:r:he·,:e91lowing~·are the more iiT!port~nt',is~ue~ rem'aining 'OiT the
unfunded 'ma'ndates' bithatcanbe,"presented' to'Kempt,horrle/,':ih
".'6r~er of' imp9r.t~~de:I'
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'su~set proV1s'ion 'has 'st<fll ,flOt be,en, incorpor'a'ted
:into,the bili. The :d~bateh~d\ bf=e:nwhether : it. snould'pe ,sunset::)'
"ih1998, (L e .. ; in .twoc6'ngresses) ·or,' in. 200.2/···.when:'the balanc~d
. budget amendment goes,lnto ,effect: ~M6re· .re:Centl'y I' .we I ve, neard
:,that- ,some' are Opposing ahy,~un'set6n th~ gr,01.lndthat with: a.'
.' balanced b.udget' amendment," argua.bly·;l.mfy.ndl!=d,mandates ....
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legis,laticin' 'w.oulCi·b~,~~ededIJiore than, eyer~, 'The anpwer
th~s·e.", . /
.' : cpncerns; is that .'u'nfunqed ·mandates legislat:.i:on ,is untri.ed'and .
.' rrlevaluatio~' is'appropr,late; ,a'f.t!3r. we llav~: S'om'e' e,xp~r~,ehc~· y.d th
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3"•. ',Applicability afCosts' Imposed'en state/LecaLGeveirnments,
When' They 'Functien as an~ Empleyer~, orPrepriet.or;' (e .g.. ,when a,
i ' ,.state'.orlocal gqvernmerlt Qwns'a ·fleet/' ef cars, or acts'as' the
'empley"er'ef' teachers) .•...... cu~re'n)tl'y, .there i9a'pr9visien :in; the' ,
"purpes.es·": ~'ect;',rentl}at stat~s.,that the. hill'is, n9tdesigned 'to'.'
...... give, the"publ,ic sector a ceinpetit~v~ .edge, but: 'these .types .of: .' '. '..
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. al together. . It' weu;J.a' .take·. an adcq..tien, to' th~ list,o;f: exempt~ens"
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, '. 194 (c) (']"ii) (IV) (aa) provides that 'a: mandate may' be'.·ineffestiye if
approppiati,ons .do ,net meet :the direct cost-.e'f'. a mandate.' 'Seme
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. cOnstrue. this tOl1l'ean '~ch<;lt the mandate',weuld not b~. '~ffec.tive·fer "
. all purposes and. fetall' indi.viduals."':;·~'se that, fo'r.example, "if~, .
.,'- ,a ·:regula:.ticm ·rem.l,ires· all, :'car.s t.O.have antileckbrakes',,'and 'this;'
reguJ.,atien' Js yiewedas .amandate·,·.(.becau:se '<;1 c~ty: 6wns;\a~'Jleet of
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,cpr!:? and.' there is net full. ·fundin·g), thEin no. one, includirigithe'
,:priyat;e ;secte,r,wQuid have tb comp,ly.:}'lithi ,the' re'gu'latipn'~' '.:'
." ObviouSlY,·thi·s ,sigriifida'ntly lnc;:reases. th~s'cope:ai1d "'"
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7 ~ 'ACIR:.Role:'· Titl~ '1:11-' establishes ,a Cemmissi6ntQ' investigat,e
and re.view the' impqct ef, unfunded mandates . .', At the ·'Gov. Aff<;1irs
hearing, Senato'r' Dor'ga'n 'asked. why 'this was'n ',t the' ACIR. We see , .. '
119 .basis to reipla'C'e ()ne. comm~ttee, w;ith 'qnotherapctwouid
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.therefere, ,liketo':see :'ACIR's.role reestablished~"" (This may/be
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,'104 (c)'( iii} (IV:) Caa') ',Jwhere the agencymedif'ies: the. mandat~ to fit
.' the, al?J?r<?pri<;lt~on) ,·if. 'the F~a~e/10ca1..:,offic'i,a:l;~ . ~gr:ee~i .t<:)',\~,'bUt'.
. there1.s no ~cemparabl'e prpv1.s1.en under 104 (c)' (1.1.1.) (IV) (bb.) (where
. ,th~: jnandate'b~6emes iI:'ieffect~ ve-): .,. : Obv'iouslY',';if there is,'an ept
in. 'provi~i:Oi1, it,'Shoul<i be applicable in beth ·,ci.rcumstances •.
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4., E'i'fective. Date:'. 'It, currentlyapp~ars.tob~ JanU<?-FY I" i9,96
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.' ,'~na'c.tmel!-t) .··Why ·net,~ake .·i t, etfective; imme<?-iately, toavoid~· ; "
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�FEB - 9.1995
TH E WH ITE HOUS E
WASHINGTON
February 8, 1995 .
MEMORANDUM FOR THE VICE PRESIDENT
TIlROUGH: Jack Quinn
FROM:
Paul Weinstein
SUBJECf:
Unfunded Mandates
STAGE 1:
COMMITTEE ACTION
J
.J
Under the Unfunded Mandate Refonn Act (S.1/H.R.5), procedures for considering legislation
(other than appropri3;tions bills) in the Senate and House will change substantially. The purpose of this
memorandum is to provide you with an outline of the new procedures.
.
Step 1:
Legislation IS Introduced·
Assume the Senate is considering Bob Dole's health care reform bill from the last Congress.
According to AFSCME, the Dole health refofll1 proposal would have created $115 billion in new
federal inandates over the next eight years (Squeezing the States, AFSCMEJuly 1994). Despite the
size of the mandate, the Majority Leader decides to reintroduce his bill, and the parliamentarian refers
the legislation to the Senate Finance Committee.
.
Step 2:
Committee Of Jurisdiction Decides To Markup Legislation
If the Chairman of the Senate Finance Committee plans to markup the Dole bill and send it to
the full Senate, he would most likely request assistance from the Congressional Budget Office (CBO)
estimating the number .and cost of any mandates contained in the bilL The .Committee will need this
information later when it makes its report.
Step 3:
Bill Is Agreed To In Committee
Once the Finance Committee reports the bill, it must provide the legislation to the Director of
CBO, with a list of mandates contained in the b i l L '
.
step 4:
CBO Analysis In Report Language
As required by S.l/H.R.5, thereport language accompanying the Dole bill must include an
estimate by CBO of the direCt cost of aU intergovernmental mandates of $50 million or more and
mandates' on the private sector of $200 million ,or more ($50 million in the House bill). , If the Director
of CBO determines that it is not feasible to estimate the cost of the mandate, the Director must state
why in the report. Failure byCBO to submit an estimate is grounds for raising a point of order, even if
CBO documents that it is not feasible to make the estimate.
�STAGE 2:
FLOOR DELIBERATION
Assuming CBO has estimated that the Dole health care legislation contains a mandate of over
$50 million annually, the Majority Leader must decide how to deal with the possibility that a Member
'of Congress may raise a point-of-order against the bill. His options are:
Option 1:
Waive The Point Of Order
The Majority Leader may decide he wants to require this mandate without full or partial federal
,funding. Under S.1/H.R.5, Congress can continue to place unfunded mandates on state, local, and tribal
governments by waiving the point of order by simple majority (51 votes in the Senate, 218 votes in the
House). In the Senate, where you often need 60 votes to reach cloture on controversial legislation, the
simple majority requirement may not create much additional gridlock. If the point of order is waived,
and the legislation is enacted, the mandate takes effect whether or not there is federal funding to cover
the direct costs.
This is an important point. As the Washington Post notes in its editorial endorsing the S.l, (see
attached) "the legislation doesn't ban uI,1funded mandates as so much of surrounding rhetoric on both
sides would suggest. It would merely create a parliamentary presumption against them and require
explicit majority votes in both houses to impose them."
Option 2:
Create EntitiementlIncrease Receipts To Cover Cost Of Direct
Mandate
If the Majority Leader determines he has enollgh votes to pass his bill but not 'enough to waive
the point of order, he could try to avoid the point of order by funding the mandate through one of the
following mechanisms. First, he could include in the legislation language to create new or additional
entitlement, funding to cover the direct cost of all the mandates in the bill. Since many health care
programs are entitlements, there is precedent for funding the Majority Leader's proposed bill through
this mechanism. Second, he could include language to create new or increase existing receipts
(including taxes) in an amount equal to the direct costs of the mandate. However, since Ways and
Means and Senate Finance are the only committees that can increase receipts or create new entitlements,
and there is a general disdain in Congress towards raising 'taxes or expanding entitlements, it is not
likely that either of these means for ,covering the cost of mandates will be greatly utilized.
Option 3:
Placing Conditions On The Mandate Taking Effed
A third way for Dole to avoid the point of order would be to include in his billa, directive that
the mandate shall not take effect if all direct costs are not covered or a schedule for reducing the
mandate by the amount not funded. In addition, the Senate language, amended by Senator Byrd,
'provides another option that would allow Dole to direct the agencies, upon determining that there are
insufficient funds to provide for the estimated direct cost of the mandate, to re-estimate the cost of the
mandate or rewrite the mandate to fit the funds available, and, submit to Congress within 30 days
legislation that would enact their recommendation. The Senate bill, unlike the House legislation,
increases congressional accountability by' placing the decision to implement the mandate with Congress.
However, two improvements should be made to the ,Senate language. 1) ,The mandate should take
effect until. Congress votes on the agency recommendation; 2) Mandates that expire because they are
not funded should remain in effect as applied to the private sector.
�..... ,
A18
Tm:SIJAY, JA"iUARY
17, 1995
AN
TilE W,\SI!I
INDEPENDENT
NEWSPAPER'
---------------------------------------------
------------=---~---------.
M01~e 011 til,e l~{andates
1f 1'I OUSE REPUBLIC.I\NS
Issue
partiv disamled the
would be subject to <I point of order. A member could
..f'_
keepmg a prOlwse and qwetly [l.\Jng one defect
bst \veek in committee. They should fix anouler when
the bill comes to the floor, perhaps this week.
The mandates bill could well be the first major
building block of the Republican congressional agen
da to pass. The Senate's version is Orl U1e floor as
.well, and the president has said while avoiding details
that he too favors such a measure. The Republicans
look upon it in part as the ·key to achieving other
goalc-such as a balanced budget amendment to the
Constitution and perhaps welfare reform. Governors
and other state and local officials are feartul of being
stranded by the spending cuts implicit· in both of
these and conceivably could block them. The prom
ise that at the same time they will get relief from
federal mandates is meant to assuage them.
In fact, the legislation doesn't ban tJnfunded man
dates as so much of surrounding rhetoric on both
sides would suggest. It would merely create a
parliamentary presumption against them and require
explicit majority votes in both houses to impose
them. That's the right approach. Though there is a
genuine problem that needs fixing here, not all
JJlfunded mandates are unjustified, nor are'state and
iocal governments, which .receive a quarter trillion
dollars a year in federal aid, always the victims rhey
,)ortr;:;y ulemselves to be in ilie federal reiationship.
What would happen is simply that future bills impos
;ng mandates v.:'ithout the filllds to carry them out
waive it and there would be a vote. That works in
the Senate. The problem in the House W.,S that the
rules would not have allowed a waiver Illotion. 1\
single member, raising (I point of order that the chair
would have been obliged to sustain, would have been
enough to kill a bill. The Rules Committee fOillld a
way around that rock last week. The bill now
provides expr~ssly for the majority votes that the
sponsors say are its main point.
The other p!"0bJem involves judicial review. TIle
Senate bill would rightly bar appeals to the courts by
state and local officials or othe~s on grounds the terms
of the bill had been ignored, the theory being that is
mainly an internal matter-Congress agreeing to
change its own futui:'e behavior-and a political accom
modation of the sort that courts should have no role in.
The House bill contains no similar ban, in part because
a section woUld require. the executive branch to do
certain studies before issuing regulations and the
sponsors, or some of them, .want that to be judicially
enforceable. But Congress has power enough to
enforce' these requirements itself; it needn't turri to
the courts. The Republicans rightly say in other
contexts thaf there is already too much resolt to the
courts LIl this COillltry. They ought to stick to th;;t
position. In fact. because the House bill is silcnt on tJ1C
malter, it isn't clear wheuler it would pem1il rcsOlt to
tJ:e courts not. The House should say not..
~~l criti~ of their wuunded m~ndate~ biB by . raise the point of order, anoU1er would move to
or
�
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Carol Rasco - Issues Series
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Carol Rasco
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Unfunded Mandates
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Carol Rasco
Issues Series
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Box 126
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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2010-0198-Sb-unfunded-mandates
-
https://clinton.presidentiallibraries.us/files/original/a6eaac63ee5d2d7bf9c6cd7d29362eaa.pdf
45fab8cb2b825a60940f0bfaaeb6b7d8
PDF Text
Text
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Talkinq Points on
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Republican Tax. and Spendinq ~~l.icies:
"cuts. inB4ucation .topay· for
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,Apr~l 3, 1995
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'j(essaqe: The. House tax' and spending pO,licies center around'
sharp cuts in programs that serve average Alnericans --' notably,
education -:- to·pay for huge tax'cuts for ~he wealthiest
Americans.
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.
, These: proposals highlight a: sharp.d~s~inction· between the.
President' spriorities and those "of Republ.i;cans. The' President
wants to'target tax, cuts to middle';';'income ~ericans and help"
.
those Americans get the educatlon and skills,they need to compete
in ,toaay's economy •. Republicans, by contrast,' advocate a kind of ..
"reverse 'RobinHoodtt'~pproach, giving more;to,the'most well-off·
and taking from: the most vuln~rablewhile 40ing little 'for ,those
in the middle.
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Republican,tax cuts and welfare'reform proposals would
provide' $31.3 billion·more·in taxbenef.its'for t.hose.makinq at
least, $200,000 a year, and $11.5 billion l.ss in benefits for
·those ~~kinq less thail$50,000.,
'
.
.
Republl.can priorit'iesshow up in 'the: major tax and spending
proposal:s before Congr~ss.
' ' I ' ,. '
1. Tax cuts,
OVerall: . The President wants 1::0 target tax relief to middle:"
not.yetshal:'ed in the economic'
recovery and pay for, it by cutting waste, and pork from the,
budget. Republicans want to provide:jtax breaks that would
go disproportionately to the' wealthiest. Americans and pay
for' it by,' cutting eqUcatioI), school lunches; and ,other
. programs that help m.lddle--.lncome Amer,.lcans and those most
vulnerable.'
,inco~e,Americans'whohave
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-give more than half of ·its berie~its to the top 12
. Amer.lcan· fam.ll.les --those making,at, least'
percent'of '
$160,000 a year;
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This ,will still be true Jven if Bouse,
Republicans cap their fuili taX:~redit at those
makinq up,to,$95,OOO a year.:
'
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• explode the deficit by' costing:a whopping $630
, ,billion over 10 yea:t:s. , ";,'
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Republicans, also want to protect a lo~phole,that allows,
about ,24 multi-millionaires,' to, avoid payinq t;axes by"
renouncinqtheir citizenship:
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• T~e prov1s10n was part of, a ,separate measure to '
, extend, ,and then increase, the ,25 percent deduction of
'health 'insurance 'costs incurred,li>y self":employed
, , individuals;
~lose
• The President has proposed to
,this loophole.
:"
"
• The provision would have raised $1.4 billion over
five years ,-- just, by "collectinq; taxes from ,these 24
individuals.
• At the urging'of House confere~s,'a House-Senate
conference committee dropped this provision from the
tax measure,
.. '
2. Budqets
' ••
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'
Overall: House Budget Chairmal)"John'K~sich has proposed a
five-year budget of $190 billioninspendingcuts--:: all to
pay for the Republican tax cuts ' but no' specified 'savings
,to z:educe the def1c1t.
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.• Kasich's cuts .include:
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.:...... Discretionary savings ($100 l:)illion),
,. Examples include: '
-~ Reduce, Funding for :Training arid
Employment,
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Reduce ViolentCrinieTrust Funding,'
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Reduce FundIng for iGoals 2000 and School
to';"Work, and
-';"Reduce Corporation',:forNational and
Community Servic~.
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Welfare reform (food stamps, ;child nutrition, etc.)
($64.66illi6n),
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program~' (1~
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billion),
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Spectrum auction, extension (2.5 billion), and
Uranium enrichment privatization($L 6 billion) •
• Xasich's deficit reduction come~ fr9m:
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·--'$91' billion in unspecified discretionary savings
that he would apply to deficit :r;eduction •
.
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, .... ,..Thu~; ,de~pite Republican criticism. that our, budqet ,
was weak on deficitr~duction, K*sich's plan provides
. only marginally more deficit reduction than Qurs ~-$91
bill'ion, . compared ,to our $81 b i l l i o n . "
,3. .Rescissions:
, , . The 'House bill would make deep cuts in the followinqareas:
",
Bducation
• cut the Goals 2000 program, depriving'4,000
schools in 46 states of seed money to train.
,teachers and. upgrade their academic standards~'
, ,. "Deprive 1'00, OOO'~ducatiori~lly disadvantaged
children of special' services 'under, the 'Ti ~le "I
program. ,
• Eliminate, the Safe and 'Qr~g-Free Schools, and '
program, whi,ch supports, drug:"', ,
'prevention ,programs in'94 percent of all school'
" districts as well as anti-violence efforts'. '
,
~ommunities'
Children 'and youth
' . Shut, down the ,national service program, , sending, '
home 20,000 Americorpsmembers and cutting funding
,for school-based programss'erving over 300,000, ' ,
children.
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migrant children :withimmunizations;
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clean-up activit~es; and
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• working in inner,-city recreation areas
'to,', cOlnbat, drug traffic and .violence.
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• Eliminate, funding for the :Swiuner Youth,'
'Employment program in 1995 and 1996, wiping out
job opportunities' for, -i. 2, inillion" disadvantaged
youth,over those two summers.
,
,
• Deny' the WICnutrition program's. services an9.
food packages to about 100,000 women, infants, and
.children for six months.' ;
Bousinq and the Bomele'ss
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• Eliminate subsidized housing assistance to
63 i 000 needy low-:income households.
,
• prevent' 24, 000' homeless f~milies froln moving to
. , . ,transitional or permanent housing this year.
• Elimiriate the up-front fUllds needed to te~r down
,.the nation's, worst p~blic housing projects. '
The Senate'bill is 'an improvement over the 'Bouse version,
but the Administration remains, oppo'sed because of i'ts deep
c~~s in v~luable proqrams:
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'Bdu~ation
,
.
,~
.
'
• Cut $100 milliori from the; Safe and Drug-Free
,Schools and' Communities program, which ~upports
drug"';prevention pr:og:rams in! 94 percent ,of all
school districts' as, well as: anti'-violence'efforts.
• Cut: the ,Goals 2000 'program ,by $68mill,ion,
greatly red~cing support through which states ,and
communities train teachers land'upgra:de their
,academic standards,! ' ., .. ',.
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• cut, the Title'1 program ~or the educationally
, disadvantaged by $80, millidn.
Children' ,and Youth
'. cut $210, million fro~'the PresidEmtis national
service program,depri,v:ingi15,ooO young adults o~
th~chance to serve ,their communities and earn"
.
education benefits~
• Cut $35 mIllion from thetWIC program, resultillg
'in 840,000 fewer food pa6k~ges,for.women, infants,
andchildreri. '
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• Eliminate'f~nding for' the ~Ummer Youth
Employment program in 1996, wiping out job
'opportunities for 615,000 disadvantaged youth that
, summer.
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Carol Rasco - Issues Series
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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Clinton Presidential Library & Museum
Extent
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92 folders in 7 boxes
Text
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Original Format
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Paper
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Tax Cuts
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Domestic Policy Council
Carol Rasco
Issues Series
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2010-0198-S Segment 2
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Box 126
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
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Adobe Acrobat Document
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12/4/2013
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2010-0198-Sb-tax-cuts
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speech, 30th Anniversary of Medicare (9 pages)
0712411995
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�July 12, 1995
MEMORANDUM FOR THE SECRETARY OF EDUCATION
THE ATTORNEY GENERAL
SUBJECT:
Religious Expression in Public Schools
Religious freedom is perhaps the most precious of all
American liberties -- c;::tlled by many our IIfirst freedom."
Many of the first European settlers in North America sought
refuge from religious persecution in their native countries.
Since that time, people of faith and 'religious institutions
have played a central role in the history of this Nation. In the
First Amendment, our Bill of Rights recognizes the twin pillars
of religious liberty: the constitutional protection for the free
exercise of religion, and the constitutional prohibition on the
establishment of religion by the state. Our Nation's founders
knew that reiigion helps to give our people the character without
which a democracy cannot survive. Our founders also recognized
the need for a space of freedom between government and the
people -- that the government must not be permitted to coerce the
conscience of any individual or group.
In the over 200 years since the First Amenqment was
included in our Constitution, religion and religious
insti-tutions have thrived throughout the United States. In
1993~ I was proud to reaffirm the historic place of religion when
I signed the Religious Freedom Restoration Act, which restores
a high legal standard to protect the exercise of religion from
being inappropriately burdened by government action. In the
greatest traditions of American citizenship, a broad coalition of
individuals and organizations came together to support the
fullest protection for religious practice and expression.
RELIGIOUS EXPRESSION IN PUBLIC SCHOOLS
I share the concern and frustration,that many Americans
feel about situations where the protections accorded by the First
Amendment are not recognized or understood. This problem
has manifested itself in our Nation's public schools. It appears
that some school officials, teachers and parents have assumed
that religious expression of any type is either inappropriate, or
forbidden altogether,' in public schools.
As our courts have reaffirmed, however, nothing in the
First Amendment converts our public schools into religion-free
zones, or requires all religious expression to be left behind at
the schoolhouse door. While the government may not use schools
to coerce the consciences of our students, or to convey official
endorsement of religion, the government's schools also may not
�discriminate against private religious
school day.
~xpression
during the
I have been advised by the Department of Justice and the
Department of .Education that the First Amendment permits -~
and protects -- a greater degree 6f ~eligious express~on in
public schools than many Americans may now understand. The
Departments of Justice and Education: have advised me that,' while
application may depend upon s~ecifi~ factual contexts and will.
require careful consideration in particular cases~ the following
principles are among those that apply to religious expression
in our schools:
'
Student prayer and reliqious discussion: The
Establishment Clause of the First Amendment does
not prohibit purely private reiigious speech by
students. Students therefore have the same right
to engage in individual or group prayer and
religious discussion during t~e school day as they
do to engage in other compara~le activity. For
example, students may read their Bibles or other
scriptures, say grace before ~eals, and pray
before tests to the same extent they may engage in
comparable non-disruptive activities. Local school
authorities possess substantial discretion to
impose rules of order and othdr pedagogical
restrictions on student activities, but they may
-not structure or administer such rules to
discriminate against relig~ous activity or speech.
Generally, students may pray in a nondisruptive
manner when not engaged,in school activities or
instruction, and subject to the rules that
normally pertain in the appli6able setting.
Specifically, students'in informal settings, such
as cafeterias and hallways,. may pray and discuss
their religious views with ea6h otheri subject
to the same rules of order as'apply to other
studeNt activities and speech~ Students may also
speak to, and attempt to persuade~ their peer$
about religious topics just as they do with regard
to political topics. School officials, however,
should intercede to stop student speech that
constitutes harassment aimed at a student or a
group of students.
Students may also participate in before or after
school event;'s with religious content, such as "see
you at the flag pole" gatherings, on the same
terms as they may participate in other
noncurriculum activities on school premises.
school 'officials may neither discourage nor
encourage participation in such an event.
�The right to engage in voluntary prayer or
religious discussion free from discrimination does
not include the right to have a captive audience
listen or to compel other students to
participate. Teachers and school administrators
should ensure that no student is in any way
coerced to participate in religious activity.
l
Graduation prayer and baccalaureates: Under
curr~nt Supreme Courtdecisions
school officials
may not mandate or organize prayer at graduation
nor organize religious baccalaureate ceremonies.
If a school generally opens its facilities to
private groups, it must make its facilities
available on the same terms to organizers of
privately sponsored religious baccalaureate
services. A school may not extend preferential
treatment to baccalaureate ceremonies and may in
some instances be obliged to disclaim official
endorsement of such ceremonies.
l
l
Official neutrality regarding 'religious activity:
Teachers and school administrators, when acting in
those capacities, are representatives of the state
and are prohibited by the establishment clause
from soliciting or encouraging religious activity,
and from participating in such activity with
students. Teachers and administrators also are
prohibited from discouraging activity because of
its religious content and from soliciting or
encouraging antireligious activity.
I
/Teaching about religion: Public schools may not
provide religious instruction but they may teach
about religion including the 'Bible or other
scripture: the history of religion, comparative
religion, the Bible (or other
scripture) as-literature, and'the role of religion
in the history of the United States and>other
countries all are permissibleipublic school
subjects. Similarly, it is permissible to
consider religious. influences: on art, music
literature and social studie~. Although public
schools may teach about religious holidays,
including their religious aspects, and may
celebrate the secular aspects of holidays, schools
may not observe holidays as religious events or
promote such observance by students.
l
l
1
l
Student assignments: Students may express their
bel fs about religion in the form of homework,
artwork, and other written and oral assignments
free of discrimination based on the religious
content of their submissions.' Such home and
�classroom work should be j'udged by ordinary
academic standards.of substance and relevance, and
against other legitimate pedagogical concerns
identified by the school.
'.
I
Rellqious literature: Students have a right to
dist~ibute religious literatur~ to their
schoolmates on the same terms as they are
permitted to distribute other literature that is
unrelated to school curriculum or activities.
Schools may impose the same reasonable time,
place, and manner or other constitutional
restrictions on distribution o,f religious
literature as they do on nonschool literature .
generally, but they may notsi~gle out religiotis
literat~re for special regulation.
Religious excusals: Subject t:o applicable St"ate
laws, scho0ls enjoy substanti~l discretion to
excuse individual students from lessons that are
objectionable to' the student or the students'
parents on religious or other .iconscientious
grounds. School officials may neither encourage
nor discourage students from availing themselves
of an excusal option. Under 4heReligious Freedom
Restoration Act, if it is proved that particular
lessons substantially purd~n a student's free
exercise of religion and if t~e school cannot
prove a compelling interest i4 requiring
attendance, the school would pe legally required
to excuse the student.
'
-Released time: Subject to applicable State laws,
schools have the discretion to dismiss students to
off~premises religious instru~tion, provided that
schools do not encourage or discourage
participation or penalize those who do not attend.
Schools may not allow religio~s instruction by
outsiders on school premises cluring the school
day.'
:
Teachinq values: Though sch09ls must be neutral
with respect to religion, they may play an active·
role with respect to teaching civic values and
virtue, and the moral code that holds us together·
as a' community. The fact t;hat· some of these..
values are held also by relig~ons does not make it
unlawful to teach them in school.
Student garb: Students may display rel:i,.gious
messages on items of tlothing to. the same extent
that they are. permitted to display other
comparable messages.' Religious messages may not
be singled out· for suppression, but rather are
J
�.>
subject to the same rules as generally apply to
comparable messages. When wearing particular
attire, such as yarmulkes and head scarves, during
the school day is part of students' religious
practice, under the Religious Freedom Restoration ,
Act schools generally may not prohibit the wearing
of such items.
I hereby direct the Secretary of Education, in
consultation with the Attorney General, to use
appropriate means to ensure that public school
districts and school officials in the United States
are informed, by the start of the coming school year,
of the principles set forth above.'
THE EQUAL ACCESS ACT
The Equal Access Act is designed to ensure that,
consistent with the First Amendment, student religious
activities are accorded the same access to public
school facilitie~ as are student s~cular a6tivities.
Based on decisions of the Federal courts, as well as
its interpretations of the Act, the Department of
Justice has advised me of its posi'tion that the Act
should be interpreted ~s providing, among other
things, that:
.
General orovisions: Student rceligious groups at
public secondary schools have Ithe' same right of
access to school facilities a~ is enjoyed by other
comparable student groups. u4der the Equal Access
Act, a school receiving Federal funds that allows
one or more student noncurriculum-related clubs to
meet ,on its premises during noninstructional time
may not refuse access to student religious groups.
Prayer services and worship exercises covered: A
meeting, as defined and protected by the Equal
Access Act, may include a prayer service, Bible
reading, or other worship exercise.
Equal access to means of publicizing meetings:
A'
school receiving Federal fund~ must allow student
groups meeting under the Act to use the school
media - - including the public: address s'ystem, the
school newspaper,and the school bulletin board
to. announce their meetings on, the same terms as
other noncurriculum-related student groups are
allowed to use the school media. Any policy
concerning the use of school ~edia must be applied
to all noncurriculum-related student groups in a
nondiscriminatory matter. ,Scpools, however, may
inform students that certain groups are not school
sponsored.
�Lunch-time and recess covered:' A school creates a
limited open forum under the Equal Access Act,
triggering equal access rights for religious
groups, when it allows students to. meet during
their lunch periods or other npninstructional time
during the school day, as well as when it allows
students to meet before and after the school day.
I hereby dire~t the Secretary pf Educat{on, in
consultation with the Attorney General, to use
appropriate means to ~nsure that p~blic school
districts and school officials in the United States
are informed, by the start of the coming school year,
6f ~hese interprebations of the Equal Access Act.
WILLIAM J. CLINTON
# # #
�President Clinton Champions Religio?s Liberty
,Wednesday,. July 12,1995:
.
"The Firs:t Amendment protects religious
expression ~- it does not convert our
public schools into religion-fr~e zones.
Wherever and whenever the religtous rights
of our children are threatened or
suppressed, we must move""cn;ickly; and
decisively ,to correct it. We want, to make
it easier arid more acceptable for people
to express and celebrate their ~aith."
President Clint~n
Wednesday, July; 12, 1995
C"
Today, President Clinton speaks at James
Madison High,School, in Virginia about
religious liberty and the need for'America to
find, common ground. He.will direct 'the
Secretary of Education and.th~ AttoFney
'General to provide every school district in
America, before school starts in the fall,
with a detailed explanation of the religious
expression permitted in America's sqhools.
I
Deep Commitmen,t to Protecting Religious
Freedom.
In 1993, the President signed the
Religious Freedom Restoration Act t6 reaffirm
the protections the Constitution and First
Amendment give to religious expression.
secretary Riley and the President have worked
to make sure that America's children have an
opportunity to learn the responsibilities and
basic values of good citizenship in: school.
I
America Has a Noble Tradition'of Protecting
Religious Freedom. Religious freedom is our
"first freedom." It opens the Firs~
Amendment. Today, we have the freedom to
enjoy and express our own beliefs. : We have
the protection that government cannot be used
to coerce people's conscience or. suppress
people's faith.
America Has Built the Most Vibrant and Diverse
Religious Culture in the World. ,There are
more than 250,000 houses of worship' in
America. More people go to. chu.rch t:han in any
other Western nation. America is home to more
different religions than any other nation.
Religion thrives in America, because it is
unfettered by government.
�Government Must Not Inhibit Religious
Expression.
Some Americans have been denied'
the freedom to express religion. Th~
President believes that must stop. ~overnment
must not prevent the expression of specific
,religious views in the, name of the F,irst
Amendment.
No Need for a Constitutional Amendment.
President Clinton believes we do not: need a
,
constitutional amendment to protect ireligious
expression. We already have one - ,the First
Amendment. The First Amendment works and has
granted America unrivalled religious: liberty.
The First Amendment Does Not Bar Religious
Expression from Our Schools. The F~rst
Amendment does not require students ito leave
their religion behind at the schoolhouse door.
Students, should bring the~alues tHey learn
from religion to school. Reinforcirig those
values is an essential part of a school's
mission.
Broad Protection for Religious Expression
under the First Amendment. The Fir~t
Amendment protects and permits a broad array
of religious expression and worship:
o
Students can pray privately and'
individually, whenever they want. They can
say grace to themselves before lu~ch.
Students can pray to themselves before tests.
o
Student religious clubs in high' school can
and should be treated just like a~y other
extracurricular club. They can ad~ertize
their meetings, meet on school grounds, and
use school fa~ilities just like those clubs.
o
When students can cnoose to read a book to
themselves, they have every right~to read the
Bible to themselves.
o
Teachers can and should teach about
religion and the contributions it has made to
history, to values and knowledge, ito music
and art, in America and around the world.
o
Students should feel free to express their
religion and beliefs in homework,; through
artwork, and during class present~tions, as
long as it's relevaht to the assi~nment.
�""'.
"
.'
o If students can distribute flyers or
pamphlets that have nothing to do with
school, they can distribute ~eligious flyers
and pamphlets und~r the same rules.
'
o If'students can wear t-shirts advertizing
sports teams, rock groups and politicians,
they can wear t-shirts about relig~on.
o If certain subjects or activities are
objectionable to students or their parents
Hecause of religious beliefs, then schools
may, and sometimes must, excuse those
students.
.
o Schools cannot advocate religious beliefs,
but they should teach mainstream v'alues' and
virtue.
Must Deepen Our Understanding of the First
Amendment.
The President believes we must
work together to help all Americans ,understand
exactly what the First Amendment does:
o
Protects freedom of religion byiallowing
students to pray,
,
o
Protects freedom of religion by preventing
schools from telling them how to pray.
Executive Action to Explain Religious Liberty.
The Pre~ident is directing the Sectetary of
Education and the Attorney General to provide
every school district in America, before
school starts in the fall, with a d~tailed
explanation of the religious expression
'
permitted in our schools. Parents, students,
educators, and religious leaders cah u~ethis
directive to work together, to understand
their differences, protect students~ religious
rights, and find ,common ground.
�Responsible Citizenship and the American
At Georgetown
speech on the
work together
themes of his
(1)
(2)
(3 )
co~unity
University on July 6, President Clinton delivered a
responsibilities of citizenship, urging Americans to
to find a new common ground.
Building on central
Presidency, the speech
distinguished his "New covenant~ approach to solving
the country's problems form that of the Contract with
America;
challenged the American people and their leaders to
take greater responsibility as ~itizens; and
called on Americans to work through their differences
and to find a new common ground'.
Challenges to Responsible Citizenship
The President offered his sense of the specific
citizens and of political leaders:
Three ,Challenges to Citizens
to ask of themselves:
responsibil~ties
of
The President encouraged all citizens
1)
What do you have to do for yourself and your family (child
care, education, economic security, etc.)?
2)
What can you do in your community (community groups,
religious groups)?
3)
What can you do as a citizen (the responsibilities of voting,
staying informed, actively guiding the direction of elected
government) ?
Four Challenges to Leaders
leaders of all stripes to:
The President encouraged political
1)
Generate more conversation, less combat (like the New
Hampshire handshake with
Speaker Gingrich)
2)
Offer alternatives when differences ~merge; no more "just say
no" politics.
3)
Help the American people understand the long-term roots of
problems we face.
4)
Avoid berating the worst in America and spend more time
celebrating the best.
Finding the Common Ground
President Clinton offered three key approaches to building common
ground in America:
Belief in Our Possibilities - Move beyond ~ivisions and resentment,
beyond cynicism to a sense of possibility - "Failure is not an
option."
(Apollo 13).
Civil Discourse - Respect differences, tra1nsform shrill voices of
discord into a chorus of harmony where all voices can be heard.
"You cannot solve complex problems . • • i'f you have too much
extremism of rhetoric or excessive partis~nship."
Citizen Responsibility - Mobilize cit~zens and'every sector of
society (government, business, labor, ent~rtainment, media,
religion, community organizations) to be more accountable for their
respective roles in making America work.
�/
THE WHITE HOUSE
WASHINGTON'
95Jlll3 p6: 3D
/
July 10, 1995
MEMORANDUM FOR THE PRESIDENT
LEON PANETTA ,
FROM:
SUBJECT:
Q~'
.
RAHM EMANUEL'\'-'
.
'DRUG STRATEGY
I know that you have wanted to enhance the Administration's profile on the drug war:and
recently the ONDCP has made improvements in our press coverage. However, we do not
, have an overall message on 'drugs that is resonating thro\Jghout the nation. As I stated in an
earlier memo (3/22), we have a policy on drugs, but lack a coherent message. In contrast,
Presidents Reagan and Bush each had a simple message, although they lacked a policy. '
We do not have a coherent drug strategy that can be articulated to the public. What the
Administration does have is a series of actions it has taken in the drug war. Therefore, our
ob}ective must be to develop a simple message that is commensurate with a strategically
thoqght-through policy.
We are ,not starting from ground zero, The public does not separate crime and drugs, they see
it as one problem. First and foremost, they see it all as part of the breakdoWn of family
values. As Stan Greenberg's recent polling shows, you have credibility with the public in the
\
.
area of fighting crime and gun-violence in America. Therefore, as we develop our dr:ug.
strategy message, we must build upon the foundation you have .Iaid in the area of fighting
cnme,
,
.
,
,
With this notion in mind, the Administration's drug' niessage must be understandable, simple,
and put ,in popular terms. Second, we need to highlight the fights which draw attention to the
Administration's drug strategy. You 'need, to focus on the aspects of your strategy that deal
with the public's concems: 1) their kids and 2) the threat that drugs perpetuate crime.
POLICY
There are two .areas of drug use which enable us to build upon your crime fighting
credentials: (I) casual use ahd (2) hard core use, Right now our policy of treating hard core
users is couched in the wrong terms and is not receiving significant funding in relation to
,
,
•>
.'
�interdiction to be noticeable. In addition, we. do not have a message concerning casual use
although we have the makings of a policy.
I recommend that we announce a four-point drug strategy to deal with casual drug use. Here
are the cornerstones of that policy.
I.
CASUAL USE
Casual use is what every parent, such as yourself, is c~ncerned about. Their children,
from 6th grade to high school, are under peer pressure to try drugs -- everything from
marijuana to more dangerous substances. I believe our message about fighting casual
drug use among teens should encompass these four ideas.
1.
SAFE AND DRUG
FRE~
SCHOOLS
We have funded the only federally-funded d'rug education program that teaches
kids about the dangers and hazards of drug use. .
You have proposed fully fund ing this p.'ogram, The Repu blicans will try
to 'cut this pi'ogram, Their cuts will cause a fight over drug-education and
positi,on the Administration ~n the public's side, We want this battle.
2.
DRUG TESTING OF HIGH SCHOOL ATHLETES
The Supreme Court's decision in the Vernonia School District v. Akon
reinforces how.serious this Administration is about curbing drug use: if kids
take drugs, we will catch them and they will be punished.
To trumpet this. success and make this victo.'y yOUl' own, the Attorney
Geneioal and D.'oB.oown should visit schools tillooughout the counh'y to
explain the decision to students and teachers,
"
3.
LOCKER ROOM SEARCHES
During the campaign, you came .out in favor of locker room searches. This
should be incorporated into your drug-education message.
The Justice Department should develop' ~. blue-p.oint fo. o how schools can
implement locke.o .ooom seal°c,hes wjth constitutional safegua.odso
. 4.
BEING A FATHER
You need to discuss the drug war. as a father who is dealing with your own
daughter. This will help keep the focus on children. The First Lady and
Chelsea could become involved by encouraging families and teens to discuss
this issue more among themselves.
�You should announce that you are tackling c~sual d.-ug use by speaking
dil'ectly to kids and encouraging kids to speak to each other_ There al'e a
lot of kids out thel-e who al-en't using d.-ugs and we need to tell .them that
they are doing. the I'ight thing by creating peel' pl'essUl-c and other types of
pl'essul'e for them not to do drugs_
II.
HARD CORE USE
The public's concern about ~ard core drug use is not about the hard core user. It is
about taking criminals off. the street. People fundamentally believe that hard core drug
users drive crime and violence in this country; and this should be the basis of any
strategy to address this problem. Iri essence, we need to change OUf focus on fighting
hard core drug use away from reha.bilitation and more, towards fighting crime and
violence; so th,at it is ·consistent with our overall crime message.
Right now our hard core drug use policy is based on treatment for long term drug
users. Because of our ,policy, funds between interdiction (U1d treatment are roughly
split down the middle. This provides an opening for Republicans to argue that we are
cutting interdiction. As you can see from the Washington Post story this week, we are
being attacked for cutting interdiction 'and, although the money was transferred to
treatment, the amount was too minimal to make a significant impact to justify the
emphasis on treatment. Furthermore, this is being substantiated by government
officials who are angered by the cuts in their interdiction programs.
Therefore, I recommend that we launch anew policy to address the problem of hard
core drug use that is different from what we are currently doing, but that still
,'" incorporates our treatment philosophy .. We should require that every ex-convict on .
parole or on probation for a drug-related crime undergo mandatory drug tests twice a
month. If anyone fails the test, they are immediately charged.
In addition to being consistent with other aspects of our drug and crime strategy, this
initiative has three advantages:
I,
'CHEAPER
This is cheaper than .. treatment - we currently spend $30,000 - $40,000
per person on treatment. There are 2 'million hard core users.
2.
.ACADEMICALLY SMART
'Mark K leinman from the Harvard Kennedy School of Government has
been a big proponent of this policy and we could build an intellectual
case supporting it. .
3,POLITIC ALL Y SMART
It is politically sellable because it is a policy backed with substance and
action, rather than the intangible reasons to· support t~ea.tment.
�In order to distinguish your policy, it should create controversy. This idea is
controversial, but, more importan'tly, it is consistent with and builds upon your
credentials in fighting .crime and violence. Remember, the issue of treating hard core'
users in not about the hard core user, it is about getting them off the streets and
preventing them from committing crimes.
If you can~otimplemennhis policy fully, I strongly recommend that by Executive
Order you direct the Drug Office to 'start instituting this policy on a pilot project basis.
COMMUNICA TIONSIPOLITICS
Our battle on drugs needs to be incorporated into the fight against crime and violence which
you have'been engaged in throughout your .Presidency. In short, the overall objective fora
drug message is that it be built upon your credentials in fighting crime and :violence. There
is no reason to abruptly change the tone or launch a new war.
Besides annquncing the policy changes recommended above, the following activities could
also strengthen your anti-drug and violence strategy.
'
.
•
At the beginning of next school year, you could address an entire high school
on the dangers drug use.
•
You have been invited to.appear on a CBS produced show on fighting drugs
that will be linked to 3,000'tommunities. We should accept this invitation ..
.
.
•
I have asked former Secretaiy Califano, and he h~s agreed, to write an Op-Ed
supporting the Administration's approach to dealing with drugs.
•
You could go to Miami to highlight the success of. the Miami community
coalition which has been able to reduce drug usage by more than' 50% below
national figures. You could announce a.goal for the entire country, based on
the Miami example, to reduce drug use 50% by the year 2000.
·
'
•
You could schedule regular WhiteHouse meetings with government officials to
discuss our drug strategy.
We are in th~processof scheduling a National Family Partnership eyent that
will take place at the end of the summer.
You could meet with major news networks and ask them to cover more drug
stories. Since 1989, there has been a significant ~ecrease in the amount of
network news coverage. of drug storie·s. Meanwhile, public service
advertisements and drug use have increased: Therefore, it is incumbent upon
the networks to enhance their effectiveness in addressing this issue, and to take
their share of the responsibility In communicating the societal hazards'of drugs .
•
f
•
•
�•
The drug team has assembled several accomplishment documents that we could
distribute to media outlets and surrogates to clarify our position and
effectiveness on fighting drugs.
•
There is an unfinished study that will show that crack use is declining in the
U.S. The ONDCP will leak this part of the study to encourage news coverage
of this success. You could also make a statement or speech that focuses on the
finding.
In order to prepare for Republican attacks blaming. the President for increased drug use in
America, I have asked the ONDCP to produce several documents to promote the
Administration's efforts to fight drugs. Attached please find a preliminary fact sheet on the
President's accomplishments with regard to drugs: O~CP is also preparing a long term
strategy memo for the President and you to review.
'
�ADMINISTRATION ANTI-DRUG. RECORD
"I'm going to do everything I can to implement the 1995 National Drug Control
Strategy... We propose to work more closely with foreign governments to cut
drugs off at the source~ We propose to boost community efforts to educate.
, young people about the dangers and penalties of drug use... We will work to
break the cycle of crime and drugs providing treatment to hardcore drug users,
who consume most of the drugs and cause much of the crime and health
problems. And we will punish people who break the law more severely."
.
.
President Clinton
February 8, 1995
VICTORIES AND THE ENORMOUS CHALLENGE
*
This Administration seeks to target the hardcore users---the 2.7 million
users of heroin and cocaine with intensive treatment progra,ms.
•
r~gular
In 1979. there were 24 million casual (once a month or more) drug users,
to 11 million now ...- a drop of well more than half.
~9mpared
:.
•
~
I
Americans are spending 23% less on illegal drugs than five years ago -"'- $49
billion versus $64 billion,' still an enormous drain on our economy but a marked
improvement.
THE COLOMBIAN CALI DRUG CARTEL
*.
President Clinton, by being the first president to decertify Colombia, is causing
the carte'I, the source of 80% of the cocaine that reaches our shores, to be
dismantled through U.S.-Colimbian efforts. In the last month alone, Colombia
has taken into custody three of the top five leaders of the Cali Cartel. Under .
the pressure of the President's power, to "decertify", Colombia can be banned
from receiving international loans and U.S foreign aid it if does not cooperate.
•
Despite Colombia's having been the original source of nearly all our cocaine for
decades, President Clinton is the first President to decertify them, and only
grant them a "national interest" waiver that will be removed if they do not bring
down. Cali cartel leaders.
1
�•
A major sting operation in Miami, presaged the Colombian arrests. In May, the
" Miami High Intensity.Drug Trafficking Area (HIDTA), which is coordinated by the
President's National Drug Policy DireCtor, indicted several Cali leaders and
shared intelligence with the Colombian government, in advance' of the
Colombians' arresting of the Cali leaders in their own land.
•
The U.S; indictments 'included several American lawyers representing the cartel,
effectively "Benedict Arnolds" who crossed the line. One U.S. laWyer indicted
by our task force has now pled guilty to the allegation of assisting in money
laundering for the cartel.
'
DRUG FREE SCHOOLS .
•
The President used his first veto to protect $482· million the Congress tried to
cutin half for 1995,and to zero out for 1996, for the Safe an(j Drug Free
School program, the only federally funded drug education program in the
nation~s school districts, which reaches 94% or 30 million of our children in
grades 7-12. The program establishes innovative and successful anti-drug
counseling, education,intervention. and conflict resolution programs that have
reduced drug ~Jse as much as 25% in many schools.
•
On June 7, the President recognized the 100 best schools in the White House
.Rose Garden.
DRUG TESTING SCHOOL'ATHLETES
'-
..
•
On June 27, the Supreme Court agreed with the Administration's position,
argued to the Court by the Solicitor General supporting the school district, that
a school district may subject student athletes to drug testing.· The
Administration believes,' and the Court ruled, that the time involved in a drug
test is minimal compared to the invaluable message that there can be no drug
. use by these athletes to whom the entire student body pays so much attention.
"
NO DRUG USE MESSAGE IN PROFESSIONAL SPORTS
•
Throughout May and June, the President's .National Drug Policy Director
criticized the Yankees for "sending the worst possible message to the youth of
America" by hiring multiple drug and criminal offender Darryl Strawberry.
Director Brown, Yankees' owner George Steinbrenner, and 'players'
representatives have agreed to meet in the near futL\re to assure a strong anti-.
drug policy by Major League Baseball and to discuss the rehabilitation of
athletes during and after a drug proolem.
.
•
Director Brown is alsb arranging meetings with representatives 9f basketball,
Office of National Drug Control Policy
2
�i
hockey, and football to assure a no drug use message in professional sports.
ONE BATTLE, ONE TEAM
•
The Administration. has created seven "high intensity drug trafficking area" joint
task forces around the country pulling together all federal, state. and local law
. enforcement and treatment officials into "one battle, one team." These task
forces, each of which receives $10 - 38 million annually from the Office of
National Drug Control Policy, are: New York, Los Angeles; Miami, Houston, .
Baltimore-Washington, the Southwest Border, and Puerto Rico-Virgin Island.
•
In addition to'the critical Colombian Cartel indictments mentioned earlier, these
task forces have dismembered some of the most significant and heavily armed
.
,
drug distribution :networks.'
* New York - $11.6 million: The EI Dorado Joint Money Laundering Task
Force dismantled ten money laundering operations linked to South America and
Hong Kong. '
.
*, Los Angeles :-$11.5 million: Local Los Angeles HIDTAagencies--working
in conjunction with the Newark, New Jersey, Drug Enforcement Administration
Field Division, dismantled a Colombian distribution network that received
cocaine in Los Angeles and Houston and transported it to the East Coast.
, * , Houston-$1 0.1 million: Dismantled five cocain'e,one heroin and one
' . ,marijuana trafficking organizations in FY '1994 .
. ..
~
* Southwest Border- $37.7 million: Small task forces dispersed along the
2,000 mile border, dismantled trafficking and drug money laundering
org naizations.
* Washington, D. C.lBaltimore. MD. ...: $12.6 million: Newly activiated, bringing
together the largest component Of drug treatment and prevention professionals
with law enforcement officials to work together as a team, tackling the drug
problem from both sides, demand and supply reduction.
* Puerto RicoNirgin Islan'd - $9 'million: Newly deSignated.
•
Around the country, there.are a total of eighty similar smaller task forces, and
the Administration will be announcing three new major city task forces over the
next month.
.
Office 9f National Drug Control Policy
3
�-'1-
STOPPING GUN PROLIFERATION
•
•
The President fought for and, signed the Brady bill, which requi~es, a background
. check before the purchaSe of a handgun.
The President fought for Gongress to ban and signed into law the ban on
assault weapons, the arm. of choice. for drug. traffickers and cop-killers.
"HARD LINE- BORDER S"rRENGTHENING INITIA"rlVE
•
$70 million allocated to stop' drug smugglers from driving recklessly through our
ports to move illicit drugs. The immediate impact' was a 38% reduction hi port
.
runners and the associated violence. "Hard Line ll has' resulted in the
'. dismantling ofa major port-running organization in EI Paso. The group is
reputed to have smuggled drugs in over 2,000 instances through the port of
entry.' We are prqcuring new equipment and increasing manpower to
, strengthen the border.
'
TOUGHER SENTENCES -'- AND DRUG TREATMENT THAT WORKS:'
•
. The President's 1994 crime bill expanded death penalties to include drug.
kingpins and providing tougher sentences for cocaine dealers. Complimenting
this approach is the President's expanded drug treatment for users.
.
.
•
\ A California .study shows that for every dollar spent on drug treatment, we get
.. ' ~even dollars back in health care and crime cost savings. The .Administration is
·in a battle with CONGRESS, which has CUT the President's treptment funding
request for hard core users for FY 1995 from $355 million to $S7million
(Congress did maintain $42 million for drug treatment.in federal ~nd state
prisons).
DRUG COURTS: TOU~H, SMART ALTERNATIVE TO PRISON
•
The Attorney General foui1dfrom her Florida experience that drug courts force
offenders to chose between treatment and prison and save enormous
manpower from the legal system. Unfortunately, Congress cut $17 million of
the President's $29 million request for FY '95. The President saved $12 million'
for this program.
.
MAKING. THE DRUG POLICY DIRECTOR
•
A CABINET MEMBER
Despite the 1988 AntiDrug Abuse Act requiring it, President-Clinton was the
first President to make the National Drug Policy Director a Cabinet member.
Because fighting drugs requires all areas of the government lo cooperate -
Office of National Drug Control Policy
4
�-)
-
-
-
foreign, domestic, education, treatment, prevention, law enforcement, etc. -
and because the law provides that the Director dversee the national anti-drug
budget and strategy, the Director needs direct access to the heads of all
departments as well as to the President. President Clinton gives this status
and access to Lee Brown.
The President has repeatedly emphasized a -"no use'" drug policy because of
-tJle devastating impact of drug abuse on kids and families. The Administration
is sending one signal: stop using, buyirig, and selling dr'ugs. From submitting a
$14.6 Billion comprehensive enforcement and prevention anti-drug bUdget (FY
'96) to a strategy which attacks at all fronts -- tougher sentences, education,
and treatment at home,interdiction at the borders, econo'Tlic pressure on
_
source countries, destruction of drug crops and labs, and indicting and arresting
.
drug kingpins -~ the "no use" message is the same.
Office of National Drug Control Policy
5
�Detailed Accomplishment List
I.
the Fight AgainstDrugs .
Fighting For American Values: Strengthening
Strengthened White House Drug Control .Efforts .
Unlike the previous Administration. made the Director of Office of National
Drug Control Policy a full cabinet level position.
•
Strengthened the Directors' authority to identifyne9ded resources and drug
policy priorities in approving federal agency drug control budgets.
•
Gave the Director more authority to address drug interdiction and appoint .
*
Inter-Agency WorKing Group reports to the Director of ONDCP
Put forth largest and smartest d,rug control budget ever.
•
•
In FY 1995, the President requested $13.8 billion to fightdrugs, the largest
bud§et ever. In FY1996, the President has requested $14.6 billion.
. The Presiden~fought for and saved $232 million the Republicans wanted cut .
from drug, programs in the Rescissions bill.
.
Stopping Gun Proliferation
•
•
Drugs
The President fought for <;lnd' signed the Brady bill, which requires a background
check before the purchase of a handgun.
.The President fought Congress and signed·into law, a ban on assault weapons,
the arm of chOice for ,drug traffickers and cop-killers.
Enlisted
AIIF~deral
..
Agencies in Supporting American Values and Fighting .
.
•
Multi~agency
•
HlID'sOperation Safe Homes
Empowerment Zones and Enterprise Communities program to
revitalize and strengthen distressed neighborhoods and fight drugs.
prbg~am
to reduce drugs and
Office of National Drug Control Policy
g~ns
in public
6
'..
�housing and Pulling America's Communities Together (PACn program to
address the problem of drugs, crime and violence in cities throughout the United
States.
•
II.
Department· of Transportation industry workplace program to ensure safe and
. secure travel and transportation.
against drugs
Enforcement -Supported the toughest fight
Increased funding to State and local law enforcement by 18 percent. .
•
Instituted a program of new community. policing grants to put 100,000 new
police' on the streets and increasing police presence by 20% to help local
jurisdictions get drugs out of American· neighborhoods.
i ..
)
•
Included resources to make treatment and prevention available with expanded
drug courts, boot camps, and treatment in the criminal justice system to prevent
criminals from returning to our streets to entice our kids wtth drugs and
endanger them with violence.
Strengthening U.S; Borders
•
The Custom's Service Operation Hard Une· initiative has already shown success
by dismantling a port runner smuggling organization and the violence and
cocaine this group brought· into the. U.S. in more' than 2,000 instances of
reckless, high speed driving through the border. ONDCP is working wtth
Treasury to identify $70 million to add 60 Customs agents and procure Jersey
barriers, bollards, and other equipment to strengthen our border.
Increased Border Patrol Agents _
.
.•
.,
Reque~ted
a tota.l increase of 150 border patrol agents in 1995 and 700 border
. patrol agents in 1996 to prevent Illegal entry attempts along the U.S. Border.
Tougher Sentencing
•
Since 1992, the Administration has' opposed the U. S. Sentencing Commission's
proposed reductions in the sentencing levels for those who launder the proceeds
from criminal activity and for the crack offenses.
.
Office of National Drug Control Policy
7
�FederallState/LocalDrug Control Teamwork Pays Off
•
The Miami High Intensity Drug,Trafficking area (HIDTA) jOint task force played
an important role. in drug trafficking indictments of 24 individuals including four
, Cali Cartel leaders and six United States lawyers, including a former Deputy
Assistant Attorney General of the United States. DEA, Customs, FBI, IRS,
Bureau of Alchohol Tobacco and Firearms,' and State and local agencies
leveraged the small federal investment of $11.6 million for the Miami HIDTA into
federal indictments that will save billions of dollars the drug trade costs in crime
and health care.
•
HIDTA jOint task force programs in Los Angeles, New York, Houston and the
Southwest border are joined by newly designated task forces in
Washington/Baltimore and Puerto Rico/ U.S. Virgin Islands. Federal, State and
local law enforcement, treatment and prevention work together to measurably
reduce drug trafficking anddrug-related~iolent crime and chronic, hardcore
drug use throughout the region. Three new major city task forces will be
announced over the next month.
Improved Enforcement Technology
•
, !
III.
ONDCP's Counterdrug Technology Assessment Center (CTAC) has established
a national counterdrug research and development (R&D) program to coordinate
the R&D efforts of all Federal agencies with drug law enforcement missions., '
This National Program will aid law enforcement agencies at all levels by
fostering the introduction of advanced technology in support of the law
. enforcement mission~ Specific technology areas under development byCTAC
for law enforcement applications also hold promise for improving anti-terrorism
capabilities and demand reduction.
Global - Continue to Lead World Fight on
Drugs
Dismantling the Cali Drug Cartel
•
Th~ PreSident, has demanded that the Colomb'ians get tough with the Cali .
Cartel, and has provided them with modern intelligence-gathering techniques,
law enforcement training, and technical support. His approach is paying big
dividends.
'
.
'j
•
The arrests of Cali Drug ,Kingpins Gilberto Rodriguez Orejuela and Jose
Office of National Drug Control Policy
c
8
�Santacruz Londono, and two {)ther important cartel leaders, are major
accomplishments. The Colombians have taken important steps with new laws, .
legal infrastructure, law enforcement professionalism, eradication, and
demonstrated political will to seriously challenge the rest of the drug cartels.
Tough sentences for Rodriguez Orejuela and Santacruz Londono will be an
important barometer.
Turning Up The Heat on Drug Producing and Trafficking Countries Produces .
Immediate Result.s
.
.
•
•
~
The President has .used his power to pressure drug producing and trafficking
countries (decertification) in a tough and smart way. He decertified Colombia,
Peru, Bolivia, and Pakistan with a national interest waiver, to show them that the
U.S. considers drug trafficking as a serious threat to our national security and
that we are dissatisfied with their effort.
.
The Colombians and Peruvians immediately' stepped up their counterdrug ·efforts
with major arrests and the interdiction and seizure of large quantities of illegal
drugs and 'chemicals during the last six months. Pakistan has extradited a
notorious heroin kingpin to the U.S. The fully decertified Nigeria has appointed
a drug czar, enacted counterdrug legislation, 'and extradited some traffickers.
Significant Coca Eradication Shows President's Power
:,;'
Peru and Bolivia have made significant improvements in their coca eradication
effort: the Peruvian strategy will eradicate· 50 percent of its coca crop by the
year 2000 and Bolivia has eradicated more than 2,000 hectares of coca since
January. Colombia's well established aerial eradication program, has eliminated
nearly 25,000 acres of coca and opium poppy crops in 1995 and sent a
message to its South American neighbors that it is serious about fighting. drug
trafficking ..
Passed "Shoot down/intelligence sharing legislation
II
•
Previous administrations had not addressed the legality of shooting down civilian
aircraft suspected of being involved in drug trafficking. Despite sharp
opposition, we still passed the "shoot down/intelligence sharing" bill that protects
individuals in our armed forces from being sued if another' country's citizen is
killed as a resultof the sharing of our information. We now have a set of rules
of engagement that in recent cases .in Colombia and Peru have been working
effectively. in. tracking and capturing narcotics trafficking aircraft.
Office of National Drug Control Policy
9
�Historic Agreement at Summit of the Americas Fights Drugs in the Hemisphere
•
IV.
Thirty-four Presidents of countries' in this hemisphere have signed an agreement
'to work together to combat drug trafficking, including production, distribution, and
consumption.
'
Drug Use
Prevention - Maintain Fight Against Casual
Overall Casual Use Down '
•
Casual drug use, or non-addicted drug use, declined substantially. The total
number of individuals who use drugs on a casual basis declined from 24 million
users in 1985 to 11 million users in 1993. A decline in marijuana use that,
began after 1979 accounts for most of the success (the number of users
declined from 23 million in 1979·to 9, million users in 1993). Declines in cocaine
use also contributed greatly to the overall trend, as the number of users
declined from'5.3 million' in 1985 to 1:3 million in 1993.
Created and signed into law the Safe and Drug Free Schools and Communities
Act
,
•
..
~,
,
The President used his first veto to save nearly all funding for'the only school
based federally funded drug prevention program the Republicans voted to cut in
half and appear ready to eliminate in FY 1996. Some 40 million students
benefitted from education programs about drugs in 94 percent of the schools in
the country. '
Preventing' gangs
•
~HS FY 1996 budget includes $10.5 million for the Youth Gang 'Initiative
Program.
'
•
Treasury's $7.2 million for the Bureau of Alcohol, Tob~cco, and Firearms
administers the Gang Resistance Education and Training program (GREAT)
where ATF agents work directly with youth to discourage gang involvement.
•
Justiqe Department's Office of Juvenile Justice and Delinquency Prevention
,funds $ 139.2 million in programs to prevent anti control juvenile delinquency
and illegal drug use, gangs and drug trafficking. ,
Office of National Drug Control Policy
10
�1\
Drug Free Workplace - All Federal, agencies are
i~
compliance.
Sending Strong No Use" Message To Kids
II
•
President has spoken out about drugs more than 50 times in the last two years.
AdminislrationUrges Supreme Court To Support School Athlete Drug
Testing
,
,
•
J
,
The President had urged'the Supreme Court to support school district drug
, testing of athletes in Vemonia School 'District Y.' Acton. The President
applauded the Court~s decision' in favor of testing: Q[This] case sends exacHy the
right message to parents and students: drug use will n9t be tolerated in our ,
schools.
.
,
No Alcohol Use By Minor Drivers
•
The President in his June 10th radio address' called on Congress to pass the,
same law as 24 states and D.C., which consider a driver under age 21 to be
'driving while impa.ired after just one full drink of alcohol. These laws work
alcohol:"'related crashes involving teenage drivers are down as much as 10-20
percent in those :states. 'The Senate has passed such a provision and the
House is likely to vote on a measure this summer.
ll
V.
Treatment
Smart Use of Federal Treatment Dollars,Saves America Money
I
•
•.
Expanding treatment for drug users would break the cycle of drugs, crime and
violence and proposed $ 355 million to address the 2.7 million hard core drug
addicted users of cocaine and heroin, who use 80 percent of the drugs and
commit the, f11ajority of crimes.
In FY 1995, the President requested $29 million for Drug Courts to require drug
addicted offenders to get treatment or go to prison. The President fought for
and saved $12 million for the program in the rescission bill. For FY 1996 the
President has asked for $150 million for drug courts, an increase of $121
,million. Drug courts can reduce recidivism and we know that treating drug
users can save seven dollars for every one dollar spent.
Office of National Drug Control Policy
11
�-t~-•
. The President requested $267 million for treatment .research in FY 1996 to find
new medications to block the action of cocaine.
•
The Ryan White HIV/AIDS law provide a network of health care services for
persons living with HIV infection and AIDS including those infected drug users.
For FY 1996 the President requested $692 million.
*
CTAC, in conjunction with Federal State and local agencies has intitiated
a cocaine· blocking agent that uses ·artificial enzymes being"developed for use' in
drug treatment and rehabilitation. This extremely important work could provide a
breakthrough in providing effective therapeutic drugs that block cocaine for
extensive periods of time. .
J
Office of National Drl1g Control Policy
12
�.--(~
Drug Control Requests of the Bush and Clinton Administrations
(dol.lars in millions)
Clinton Requests·
, Bush Requests
1990
Function
Criminal Justice Syster:n
, Treatment
'**
1991
'$4.279 '
1993
1992
1995)
1996
$4,995
$5,362
$5,927
$7,167
$925
1.492
1,655
2.124
2.874
2,827
1.176
1,242
1,515
1,617
2.051
1.975
449
690
7J9
428
399
Interdiction
'**
2.373
2.109
2.220
1,206
1,278
Research
'**
383
488
511
532
571
Intelligence
'**
172
114
129
163
334
$7,864
$10,631
$11,655
S12.729
$13,180
'1993
1995
1996
r
Prevention
International .
Total
768
."
,
$14;550
• ONDCP under direction of Lee Brown.
'**Funding not tracked using these categories in FY 1990 request .
....
Supply/Demand Split
\
Function
"
Supply
Demand***
1990
1991
1992
70%
71%
70%
68%
59%
64%
'30%
29%
30%
32%
41%
36%
I
-Includes Prevention and Treatment R&D funding;
The Bush Administration emphasized supply-side programs to a much greater extent
than the Clinton Administration.
The first request submitted by ONDCP under Lee Brown requested 41 % of total drug
control funds for treatment and prevention programs ..,. Durfug the Bush Administration,
the drug control strategy included no more than 32% of its total funding request for
treatment and prevention programs.
.
The Criminal Justice System item includes law enforcement, the I;>resident's program
for 100,000 more police on America's streets, and prisons;
,
�JULY.7! 1995
·MEMORANDUM .
TO: RAHM EMANUEL
FROM: BOB
.
WEINER~
RE: SUMMARY DRUG BUDGET
INFO~TION
.
* BUSH'S
LAST (1993) ANTI-DRUG' BUDGET. WAS, $12.7.BILLIQN;
PRESIDENT CLINTON'S 1996 REQUEST IS.$14.5 BILLION
* FOR
FY 1995, THE REPUBLICAN BUDGET AND RESCISSION AS ENACTED BY
CONGRESS REMOVED:
$229 MILLION FROM PRESIDENT CLINTON'S TREATMENT FUNDING
REQUEST:
$242 MILL~ON FROM PRESIDENT CLINTON'S REQUEST FOR
PREVENTION PROGRAMS; AND
$118 MILLION FROM THE PRESIDENT'S REQUEST FOR INTERNATIONAL
COOPERATIVE EFFORTS TO STOP DRUGS COMING FROM SOURCE
COUNTRIES
(For full details,. see two charts at eJ;ld of earlier memo: "Drug
Control Requests· of the Bush and Clinton Administrations", and
"Effect of Corigressional Action~' on . the FY. 1995 brug Control
Request" ) .
\ .
.
NOTE: Additional information requested 'for changes in·memo
will be provided Monday; have' set Noon as time for everybody to
have finalized, and will get to you then.
Bob
�.
.
HOUSE APPROPRIATIONS SUBCOMMITTEE
.
.
ON LABOR, HEALTH AND. HOMAN SERVICES,
EDUCATION AND RELATED AGENCIES
preliminary ADalysis
and
Comparison to the president's Budqet Plan
.
/
July 19, 1995
�INVESTING IN EDUC,ATION AND TRAINING
VS. CUTTING EDUcATION AND TRAINING:
PRESIDENT'S 1996 REQUEST VS.
REPUBLICAN 1996 EXPECTED ACTION
..
'
"
PRESIDENT C~INTON'S 10-YEAR' BUDGET
REPUBLICAN CUTS
Increase'to $750 million in 1996, supporting
improvements for over '8 million children in
~ 6,000 'schools. By 2002, funding would
increase to $896 million, supporting
improvements for over 44 million children in
85,000 schools.
Eliminate all funding for education
reform.
Increased by $573 million over the last 2
years; increase by $302 million in 1996,
serving up to 300,000 more children that
year alone, and providing increases in ·the
future.
Reduce, funding by $1 .1 billion in
19'96, cutting 1.1 million children
from ttle program that year. A freeze
at this level would, by 2002, cut
another 600,000 children from the
program.
Safe and Drug-Free
Schools and
Communities
Fund at $500 million per year, providing
safer, more drug-free learning environments
for 39 million children in over 14,000 school
districts.
Reduce funding to $200 million, a 60
percent cut from the President's
request, depriving over 23 million
students,of services next year.
flead Start:
Comprehensive
services for pre-school
youth & toddlers to
increase school
readiness
Increase 1996 funding by $400 million and
add 32,000 new Head Start slots Jor
children in 1996 -. and 50,000 new slots by
2002.
Cuts funding by $135 million from
1995 level, cutting 45,000-50,000
children off current Head Start in
1996 to maintain program quality.
Freezing funding at the reduced level
would cut off up to 230,000 children
below the' President's proposed level
for 2002.
"
Goals 2000:: Help,
states and schools
raise academic
standards and student
achievement
I
, Education for
disadvantaged
students: Help lowincome students
achieve high standards
,
"
'
Summer Jobs for
disadvantaged young
people
Job Training for
. dislocated workers;
low-income adults
Funding for about 615,000 jobs for,
'
disadva'ntaged young people in the summer
of 1996.
,
,
"
'
Program eliminated beginning in
1996, wiping out job opportunities
for some 4.3 million disadvantaged
youth over the next 7 years.
Put Skill Grants directly into hands of
disadvantaged and dislocated workers, with
800,000 recipients in 1996. Increase 1995
funding by 40 percent, to $3.1 billion.
Cuts funding by 50 percent below
' the President's request, and 25
percent below 1995,..
AmeriCorps: College
Aid for National Service
(in VAIHUD
appropriations bill)
Expand by $242 million to provide nearly
50,000 opportunities for community service
and college aid, and 580,000 youth (K":12)
other service opportunities.
,Eliminated. Over 4.3 million service
opportunities for youth in their
communities abolished over 7 years.
ALL EDUCATION AND
TRAINING
INCREASE EDUCATION, TRAINING AND AID
TO STUDENTS BY $40, BILLION IN
DISCRETIONARY OUTLAYS OVER 7 YEARS
(Budget Function 500)
.
,
THE BUDGET RESOLUTION CUTS
OUTLAYS FOR EDUCATION AND
.
TRAINING BY $36 BILLION
INCLUDING $10 BILLION IN LOAN '
BENEFITS TO STUDENTS
'
�DEPARTMENT OF EDUCATION
The Subcommittee cuts Education Department discretionary
funds by $3.9 billion belo\lf 1995 and $5.4 billion below the
President's request.
Goals 2000.
Subcommittee:
• Eliminates program, setting back state efforts to set
educational standards and reform education so ,the
standards can be met.
President:
• Provides $750. million in 1996 to raise academic
. standards in 16,0.0.0. schools in 48 states.>
Scbool-to-Work (ED and DOL).
Subcommittee:
• cuts funds to $190. million, impa1r1ng efforts of 28
states to complete reforms begun in 1994 and 1995, and
denying 22 states the chance to implement their reform
plans to raise student skills 'and build a more
competitive workplace.',
President:
• Boosts furids to $40.0. million (half in ED" half in
DOL), 60. percent increase over 1995, to support states
building school-to-work systems with 1-year planning
and 5-year implementation grants.
,Safe and Drug-Free Scbools and Communities.
Subcommittee:
• ,cuts funds by 60. percent, to $20.0. million, depriving
over 23:million students of services in 1996 alone.
President:
I
• Provides $5QQ'million to combat violence and drug use
in 97 percent, or over 14,0.0.0., school districts serving
39 million students.
�Title I, Education for disadvantaged students.'
Subcommittee:
• cuts $1.1 billion, cutting up to ,1.1 miliion children
from program.
President:
• Boosts funds by '$302 million, to $7 billion, to help
states raise academic ,achievement of 6.4 million
disadvantaged children.
Federal Direct Student Loan Program.
Subcommittee:
,
,
• cuts funds to $320 million, less than what's needed
to admipister the direct, loan program.
\
-- Will stop growth' of efficient, cost-effective'
direct lending and keep paying banks,' state
,agencies, and'secondary markets.
President:
• supports Student Loan Reform Act of 1993, which
provided $550 million in 1996 to administer the direct
l~an program and the transition from guaranteed to
direct loans.
student Financial Assistance programs.
Subcommittee:
• Eliminates, from Pell 'grants, about 300,000 students
who would get awards of $400-$600 under President's
proposal.
President:
• Raises maximum Pell grant award by '$280, to
vocational and Adult Education.
\
$2,620~
'
Subcommittee:
• cuts funds by j7 percent below President's request,
to $1.06 bil'lion:
'-- denying 'assistance needed by communities and
states to train students for high-skill, high-wage
jobs, and
�-- eliminating adult education services to over
125,000 adults.
President:
• Provides $1.679 billion in 1996:
to pr~pare youth to pursue productive careers
jn a changing economy, and
to help adults improve their basic and literacy
skills.
.
.Bilingual and
~mmiqrant
Education.
Subcommittee:
•. Cuts President's request for Bilingual Education by .
almost 75 percent and for Immigrant Education by half,
severely reducing instructional services f9r over
700,000 limited English speaking children and ad.ults.
President: .
• Provides $200 million for Bilingual Education .and
$100 million for Immigrant Education.
�DEPARTMENT OP LABOR
The Subcommittee cuts the Labor Department by almost $1.9
billion, or 18 percent, below 1995 and almost $3.6 billion,'
or 30 percent, below President's request.
Adult job training (cut 46 percent).
Subcommittee:
• For dislocated workers, provides $850 million, 39
percent below President's request, denying reemployment
services to 273,000, compared to the President.
• For low-incom~ adults, provides $830 million, 21
percent below President's request, denying training
opportunities to 84,000 compared to the President.
• For adult training resources, denies President's
request to boost funds by $660 million.
President:
I
• For dislocated workers, provides $1.396
billion~
• For low-income adults, provides $1.055 billion.
Youth job training (cut
49
percent).
Subcommittee: '
• Eliminates Summer Youth Employment Program, denying
job opportunities in Summer of 1996 for 615,000 urban
and rural disadvantaged youth.
• Cuts DOL's portion of School-to-Work by ,53 percent
from President's request~
,
-- Deilies.' chance for remaining 22 states to
implement their reform plans to raise students'
skills; likely to cut second- and third-y,ear
grants ~or existing 28 states.
-- Tens ,of thousands of students will move into,
job market without adequate preparation.
• cuts President's $289 million request for JTPA Title
II-C youth by,56 percent, eliminating 92,000 training
opportuniti~s.
.
,
"
�. Pres ident :
• Provides $872 million for Summer Youth Program; funds
615,000 summer jobs.,
• Provides $200 million (the DOL share) for School-to
Work initiative,.to support states building school-to-.
work .systems with .1-year planning and 5-year
.
implementation grants.
.
• Provides $289 miilionin JTPA Title II-C youth grants
to fund job training services for 185,000 disadvantaged
youths.
Worker protection.
Subcommittee:
• cuts OSHA and other agencies that protect workers,
ensure they are paid legal wages, and .guard their
pensions, by total of $200 mil'lion (almost 25 percent)
below President's request.
-- will reduce worker protection and increase
riskiness of workplaces.
Legislative riders.
Subcommittee: .
• 'Bars using funds to implement President's Executive
. Order on striker replacements.
I
•
•
.
• stops OSHA from 1ssu1ng any ergonom1csworkplace
protection standard.
.
• Bars DOL from promoting use of economically targeted
investments in p~ivate'pension plans.
• Eliminates language that barred use of helpers on
construction projects under Davis-Bacon.
/
�DEPARTMENT OF HEALTH AND HUMAN SERVICES
The subcommittee cuts discretionary budget authority" for HHS
by $1.6 billion below 1995, reflecting the effects of H.R.
'19.4, and by $4.6 billion below the President's. budget.
Head Start.
Subcommittee:
• cuts funding by $135 million below 1995 and $535.
million below President's request, cutting· 45,000
50,000 children off Head start in 1996.
-- Freezing funding at reduced level would cutoff
up to 230,000 children, compared to President's
proposal for 2002.
President:
• Fu,ndingincreases by $400 million in 1996, adding
32,000 new slots for children.
-- By 2002, adds: total of 50,000 slots to the
current 756~000.
Low Income Home' Energy Assistance program (LIHEAP).
'Subcommittee:
• Eliminates LIHEAP and LIHEAP emergency fund.
'-- cuts off federal :heating and cooling aid to 5~6
million low-income families, 30 percent of which
include at least one elderly member and 20 percent
of which include at least one disabled member •.
.-- Ends federal capacity to provide heating or
cooling aid to states ,in the event of unusually
. severe cold or hot weather or a natural disaster.
President:
• Provides $1. 319 billion' in 1996, matching 1995 level.
substance.Abuse and
Mental.~ealth
Grants.
Subcommittee:
• Cuts.75 percent, to $144 million,co~pared to
President, jeopardizing substance abuse and mental
health services ~or tens of thousands of pregnant
women, high-risk youth, and others.
�President:
• Roughly maintains 1995 ·level of $566 million.
SAMHSA/Homeless.
"
)
.
Subcommlttee:
• Eliminates state grants to provide drug treatment and
mental health services to the homeless,. ending services
to over 90,000 individuals.
'
Pres ident: '
• RoughlYr maintains 1995 level of $29 million and
consolidates the program into a Performance Partnership
to give states more flexibility to use the' funds but
hold them accountable for results.
Administration
on
Aqinq (AoA).
Subcommittee:
• Ends 7 of 12 programs and cuts funds for'all but 1.
,
'
-- Organizations like Meals ,on Wheels would be
reimbursed for over 5 million fewer meals
delivered,toolder Americans.
'Pres ident :
;
,
• Boosts funds by $21 million, to $897 million.'
-- Maintains 1995 level for nutrition programs
that include,Meals on Wheels, serving over 3
million older Americans.
"
Immiqration initiative. ,
Subcommittee:
• Does not fund President's request, withholding
federal assistance to the 7 states most heavily
affected by immigration.
President:
• Provides $1~0 million in 1996 to help states pay 'for
,their
share of the Medicaid costs of providing
emergency medical servlces for undocumented aliens.
�Leqislative riders.
Subcommittee:
• Bars funding pf Surgeon General position, eliminating
public spokesperson on personal and societal health
. issues.
r
,
'
�SOCIAL SECURITY ADMINISTRATION
subcommittee:
• cuts President's request by $285 million, to $5.960
billion.
--'Thl:'eatens'SSA's ability to complete its
modernization and reach expected productivity and
service improvements.'
-- Slows' SSA's efforts to cut sUbstantial backlog
in disability claims.
President:
• Increases funds by $673 million above the 1995 level,
to $~.237 billion.
\
�. CORPORATION FOR NATIONAL AND COMMUNITY SERVICE
Subcommittee:
• cut by 36 percent, or $94 million, President's
request for·national service activities funded under
the Domestic Volunteer Act, which includes VISTA,
Retired Senior Volunteer Program, Foster Grandparent
Program, and Senior companion.Program.
-- Would deny nearly 170,000 older Americans the
opportunity to help the homebound elderly,
disabled children, and others in their
communities.
President:
• Increases funding'by 22 percent for these programs.
/
�..
~IDDLE CLASS BILL'OF RIGHTS.
t"
hel hard-working American families:
To P and educate .thelr ch'ld reno
.
I
Raise
Train for higher-paying jobs.
Buy a first home.
Save for retirement•
".,
STATft;9F.JFJKEUNION .
THE PRESIDENT IS FIGHTING FOR:
.(jJA NEW ECONOMy .... preparing our people
for the demands of the New American
. ec~king to raiSe incomes. ... .
A ~S> Bill of RightS to help middle
class families raise and educate their children
train for higher-paying jobs,. buy a first·home: .
. and save for retirement.
.
Vigilance ,on the deficit.
Reducing barriers to American exports:
Enacting health care reforrrt. . .....• ..
(~NEW GOVERNMENT -creatinga
.
. smaller~ more effective govemmentto meet
new challenges, not serve old intereSts.
.
Smallest federal work-force since Kenitooy...
Cutting unnecessary spendingandprog~~S:-l-:
Real lobbyiflg and campaign financetef()rm;\(}~ll
Q)A NEW COVENANT of rightsand~;~)')i
responsibilities between govemmentalldthe .
American' people. . ..
. .., ...•...•.••.....•..•.•...
Helpingpeople obtain the toollth~l1e~tHo ....
improve their lives; asking them to take
..
responsibiJityfor themselves and their
.' ...
communities.
...
.. . • ,>.. ... .
Reforming our welfare, system tOdertlaltd< .. .
responsibility and move peopleto\vorkY
.,.
Continuing the. fight againstcrime.,«
Building on the national service progr8fu:> .
WORKING. WITH CONGRESS'~'~~T·> .•. •
possible, but not allowing·Corigresst~>iat¥e··
us backWards.. No rolI-backo(pcogressWe've
made cutting the· deficit, reforiningedtib~tI6ri· .
.
.
fighting crime. '.2! improving publichea1Hiiand.'
the environment .
.'
':
','
-"-,"
"',,,,,--,,,-,,,,',,
~
"
-));,<;,
Child Tax Credit -- Up to $500 for.~ach
child 12 years old and under, for famlhes
earning less than $75,000.
Education Tax Deduction -- Up to $10,000
deduction per family for tuition for college,
community college, vocati(:mal colleges,
graduate school. and worker retraini.lg for
families making less than $120,000.
Expanded IRA -- Up to $2,000 in tax-free
contributions to an IRA account, or tax-free
withdrawals, for families with incomes up to
$100,000. Penalty-free withdrawals for
education. major medical expenses and the
purchase of a first home.
Skill Grants. Up to $3000 in grants as well as
loans to empower dislocated and low-income
workers to get new skills. Paid for by
consolidating more than 50 training programs.
Investments in Education and Training.
Long-term investments in education and job
training to give Americans the skills they need
to compete in the global economy.
Paid For By Cuts in Govemment Spending.
The plan will be paid for by maintainin~ !he .
freeze on discretionary spending ($52 billion lD
savings) and by major cuts in Cabinet
Departments and agencies. ($24 billion).
�\
I ..
:'
J,
,
,
'
MEMORANDUM
,r
I
"
'TO: Laura Tyson
Carol Rasco
FR:
. July 24, 1995
' Chris J.
RE:
Medicare Speech/Coalition to Save Medicare
cc:
Gene Sperling
Jen Klein
'
.
'
....
Attached is the current 'draft of the speech with the suggested comments of Dick Morris. We
will be following the evolution of this spe<!ch very close'ly. As soon ,as we receive an updated
.' ,
copy, we will fOlWard it to you im$ediately. . , '
Also' attached is the press packet released at t~e "Coalition to Save MediCare '! press
. conference. AS'you will nQte, at least on the cover page, the Concord Coalition is not listed
as a founding member. .1 believe this is very good for us ..
The final attachment is a copy of the document distributed amongst Republicans concerning
the proper way to discuss Medicare with constituents: I belJeve this was a document .'
referenced in Sunday's; Post.'
.
\ '
.
.
I will be talking with you soon; if you have any questions, please do not
6-5560.
'
i'.
):
/
hesitat~
to call me at
�WithdrawalIRedaction Marker
Clinton Library
DOCUMENT NO.
ANDTVPE
001. draft
DATE
SUBJECTfTlTLE
07/2411995
speech, 30th Anniversary of Medicare (9 pages)
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Car91 Rasco (Issue Papers)
ONBox Number: 8506
FOLDER TITLE:
Talking Points [4)
2010-0198-8
kc733
RESTRICTION CODES
Presidential Records Act - 144 U.S.c. 2204(9)1
Freedom of Information Act -(5 U.S.C. SS2(b)1
PI
P2
P3
P4
bel) National security classified information (b)(I) of the FO(4)
b(2) Release would diselose internal personnel rules and practices of
an agency l(b)(2) of the FOIAI .
b(3) Release would violate a Federal statute l(b)(3) of the FOIAI
b(4) Release would disclose trade secrets or confidential or financial
information (b)(4) of the FOIA)
b(6) Rclease would constitute a clearly unwarranted invasion of
personal privacy J(b)(6) of.thc FOIAI
b(7) Release would disclose information compiled for law enforcement
purposes l(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIAI
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIAI
National Security Classified Information (a)(I) of the PRAI
Relating to the appointment to Federal office (a)(2) of the PRAI
Release would violate a Federal statute ((a)(3) of the PRA)
Release would disclose trade secrets or confidential commercial or
financial information (a)(4) of the PRAI
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors IaleS) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy l{a)(6) of the PRAI
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.c.
2201(3).
RR. Document will be reviewed upon request.
�1 - .... _
.MEDICARE
.COMMUNICATIONS
,GROUP
June 8; 1995
Dear Republican.Colleague:
During the Memorial Cay recess ·Frank. Luntt attendod s~ver.l town hall
, meetings and focus groups on Medicare. The attached memo summarizes the k$Y
fitidingsfrom ,the!ie meetings.
.
,,
,'
The
Frank Luntz. memo underscores that we must cont;nue to stre$S our tout
basIC themes:
'
'
1 ,,' ,Medicare is going bankrupt
,2,
3.
, 4.
Republicans are Committed to saving Medicare
'We will spend more money- an addition a! $1600 per,persor.
We are Ustening and want ideas fromeonstituents,
We hope this information is helpful and please give 81'1Y us a califf you have any
questions.
'
Sinoerely,
~\/~'
"
",
\t-~P~,~A~
, Dan MIller,
"
fJMc~rerY ,- / ' . '
,
-;
J.~
�"
.THl!
.
' ....
1,"'"14 1."Ali l\w,'
f'J!._~ ....
Vl.'..Jr . •J"".'4'.
.,'
,
..
..
. UNTzRESEARCH 'COMP ANlES
1
...
-
Memorandl.UD .
Interestro Panil!'l .
To:
. From:,
.Frank Luntz
., Re;
Eve!Vlh1ng
. '
You Ever WB.IlU!d to Know AboufCon::JIlunicaring
Mecllcate'
.
-.
"
June 7. 1995
Date!
•
. .~ We have a problem with the national (ltIirude. .There 'is a
feeling char, if I can get it. why nOI iala if. You see II in
Medicare every day. "
..We' Qre the patriot.r 0/Ameri,(J.. We're rhtl um:s who IuPtg
O'Ul' flags oul on Memorial Dtty. W12y should we be the ones
who are asked to sacrljfce yet again?"
With the help.of the United Seniors ArsOciadon. we have conducted more tban a
half dozen focus groups and three town hall meetings with pre-retirees and C\UTent .
Medicare r~cipienl" durine the Memorial Day t'ecess and over the p~t few weeks. Thb
memc summ~zes our key fmdings. We hope it will assist you in future communication
.effon.s...
AI IRE DEGINNIN.G,
1.
I,gu MllST communicale to your supporters as lfcU as Jh. OYtJ'IlI.ugW:
CQm mJlDibrt J$:eee in mind .that seniors arc very i~pack-orientQjfi mU Ale very
~ceetiblc to fol1owinJ..one very dominant person'sle&d. YO\! must
that
to
en:;ure
balance eJitistS at each town meeting. and be <:a.re-ful kecptindividual ~ecdotes
or isolated inddents from domin."ting (and driving> the p~ce"..
.
.,
Djstribute the Summaty of the Irni'''' Report tQ extQue p,,·tr a2~ Sf! If
you CaIl'{ eel a hold of eooURh cOples 'of the actUal summary. xetoy the k~y
. pa.ssage~ and dj~r.ribute them to yOUt constituents as they arrive for your meetings,
or pJace them on their scatS befolc they ~ve.Not.hing is more credible and
.powerful man the report itsc:If•. and informing yourco·nstituents. or the Trustees'
f:ndin!3s (reading 10 'htm word-for-word ",e most cgngious c(;}lI.ciu.siQ"s) must
t~ at :ilt'. ror-;;-~y()W' co~iiiotn ~t.ratcg)'.
._-- --.~
WiisonBouk .. ;;.rd •
SUItt:
9S<J • ArUngTon. Vlrgirm
::~09
• Pilant! (703) J5g·00~O • F:.tx (703) 358-0089
�i:. I
1 uu ab,aiutcly
"
I
Qt,uet tbat ttle I01LICC 5 iQs;luQSbigb~
level Clinton Admju~lnliQn ufficials ··Ust '!hg tbe)' 3(l by name. Your
3,
must tt'II.P.!Dole at ihe
,,"
.audience ~i1! recog.nize Humy of the D.8Iriet.. a.ndthat will give creilibiliry to your
Jcfense that your eff6rts te strcnl{thcn Medicare e.renon-rarti"nn ' R~aUnci your
constiluentS that these Tru.o;lces \..':!med in last year's repon that Medicare was
he;wedbr bankruptcy We crumot wait.wy longer to begin the rescue ot the
'system.
Personalizg YOCR in.t.u:tst in M~rc. ,This mlJ.:it take pla...:e llllhc v~ry
beginning of your presentation. Reassure your senlorsdlat
lssue affeatS you
persori.a11y, and nOt just in theory (otherwise you may come across as'
accOlmtant rather than a. human hrinE) Talk about your parent!:, relD.tiv<7s c>r life
long friends currently on Medlcare~ For those of you in your lalC 50s'or eady 60s.
you I.;$.ll ta!k abOUI yUUI own countdo..,.,'O to the day you ynurselfVlill qualify.
,4.
thjs
an
Your NYmber One PIiQrin: is rgsne Medicar~
"Saving, preserving and
<.-t::rengmening" Meciicore,ne;.ds to be ~tc:dasr.he central tllem~ at the
b~giruUcgl during the se~sioo ami at the close. Let your seniors know thm: ynu
personaUy Will not allow a prograt11 for 31 million }XX)ple to go bankrupt by
~gnoring itS currenT problems.
. .
5:
There nrc certain (;onununication rUiis that. apply to Medic¥e that don't apply to
. other issues. Words are especially important, and settine 'the righ~ tone at the'outset is
critical
1.
X.Du...MUSI aoarar bi"Qarris3Q, . The responses in our recent TO\\-'n Halls £ay i~
aU
,
- - -_
."
"
.
,
.
.
"We senryou all to Washington;o work/or us. nor play .fidei! We want
tile best/or all people. Demo.cratr undRepub/icans. You need (0 'Work
logerher for the good ofall rn(! CCWttr;. ". '
"The uniTY O/both parries is essential. If new broom sweeps dlaner. "
?' 3.,;--rl~ansh.ip also affects w~ether or net ~oplc: trust tht: :\iledicnr~ nwnbcrs you
offer. Right now, me Tn.I..'>ttC5· g.eporristhe most credible )ourcc hecause it lacks
~a..·"nsarj identification (CBO credibility~s questionable bCl.'ause oflhe word
'C<>ngn:ssionar' -- and noonek."lows what the initials mean by themselves), Be
. c..::.rdill not 10 c.om~ 3CtO:::; too hanhly a!laiU!'Il the Oems. hut It is acceptable to ask. ..
. tT.e:uric:a1fy lor
.Lur\~ R,.;~::~r:n
.
PreSTdern'Ctrnon' s help~--·-··
---..;...------,---i
",
T<)wl~
. Med;care
~,'-
;~n \1I!etll'l~$
.
,.
-:-~-----~~.....,.
2
�.,
,
_'.'
".l:.
,'II
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.,
.
'
,
; \;; C , ••I ........ ~
i.-I
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.,
...
~ro"inli !\!edic"rf ..- 'JiJ.\Uln::stLenOb~nin~'W We
uffcrH to rn)c .~"<P~ctanons. but that's c:,Xactl y wnar. ~ou will do' if you tell
noll.] ttJlk.
C.alUlO\
going TO ~'improvc" MC;;1tC;,u-,.. When selliors il~r the words
improve and M~dicdrt' ;n the same sentence. they irumedimeiy think: of lower
deductiblcs,1Tee prescription drugs. sub~iclized hearing illds and eye g!&.Ssc:.'i,
cheapcrm-hom~ cai~. a.nti redu~tion... In cv~rything else- they noW have to pay fot. '
, Th~ q'lickrsl palh io de/eat is 10 overpromisel'cn'ors.
'
<:I:ruors
J.,
yOL;' re
The n.e WSj211Jlr..e is Hili YeO' im..,RQfjant to sl:ninrs~p.~" diEgcn!:!ytead the •.,
--neWspaper. ar!O-they ottencfiparticles'about fraud and :abuse involving Nreaicarc.
'1ms is one i:;sue wheT!,; print medi~ 'b as impurtant as television o~ fadjo - if not
mort so. Consequcnriy. clip several local new~papcr articles a.bout Medicare.
waste and/Of fr..iud and bring them to ~our town haJI meetings todistribut~ TO
:lMend,...... s. The word \viI! sprelld rapidl:--.
. .
4.
Senior! reM (neir mail aDd scrutinize tbtir b2.Spital and doctor: hil!l, .
Evervone M.s a .!ilOr,v [0 tell.
thotlgh'i'lnoe
as poi@n3nt .as this one:
'
... '
..
in for eye swgtT)" and they charged mefor an autopsy. I'.'
cumplainedalld they ct1J11e back and !iald '['m .fO,.", Mn. Colby but ilia!
should kaye bee" for an EKG, ' J told them / didn " have one ofthose
.
"/ We'n<
either ';
We were bombarded 'With anecdotes of over-hilling, double-billing and false- ,
. hillin\l Ask \rour ccn!;titUents to write vn\,U
oml.:~
with dleiracooUIlts of ab1.lse and
. also de~o[e the first fifteen minutes of
meeting to "fraudtoids,.. ·· Beginnine
thiS way helps pave the way for. the follOWIng arguments about the need for
yuur
chan~e.
j
while also !ening,you know a! the outset who's withyou.ar'ld who's
againSt YOU.
mE EDUCATIONAL PROCESS
Thepuhlic in general. and the oldtr population in particular, is moving in oW'
direction. bur it has been and will continue to be a slow. deliberate proceSs. Seniors are
dislrustf'.l.1 of W;l$hington. know their Owll stre.ngt.". as a political constit'Li.ency•.and simply
do riot bdievf. the-ir e:ected officials will
thelt ba.:k on a such.a sa-oni votini; block.
rurn
\.'
....
.)
"
�.'
: ~l ••
' ',II
"
., .....
';",
,~C!.(.1 ~h;djl:"n will flsmally
i...,j'
!_' '.....
U bankrugt.
A growing numbt!Tof
$t:ruors are familiar with the cummt Medic::.re debate. hUT Ihl"'Y ~tm enter rht room
skepticaL TheY,h!lve ~re;:ndjfficulty truSungtbt: go\'cnun ent \ nwnbers whe~
IhC'v fe~1 they' ve been lied to in the -~a.5qW1d pt'opo~ed changes in how COLAs
,
.
, are c:ucuJated are making it worse).
.
2.
.:itnio OJ!'fII
OO!
.
'
.~'JUO ~ t .ha~u in Mod
Diid
iQ.L<.llU IiI II" LTC '2ov1DW
t,htil!Jtem's aDing hrQkt.Bdore talking about new·options·the need for reform
Lc: ,jariiied. lierlVtell now tJrui the July -Ilh recess, you need to concentrate
on educating the pubiicon (he problems w;tir Mfdit..~a"'l'atl'Ufl'" Ino"; talking 4hour
your soiuriol1sWe WII! be bit hard in September if we have not laid th!
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nlUSt
groundwork for' oUr ultiml1u; proposais.
ElJ.11ain ",hat
ro:enuts
,4..
bankruv,~y
'
reaUv means. andwby
!Iipphl~
to $JUUin' Ytedjeatl( is not aD qgWz,.n,
into gCDer.;l
'
,. TIlt dlfferenct ..l2~nrecD Medjgo:.and Meditaid is still DQ' wjdeJy knOlVll. As
a recent from page Wa.('hi"cr011 rimes headline can Attest. few people distinguish
, ber\Veen Medicare and Medicaid. It. is therefore not surprising tharcven when
quoting ~rine:n articles. sC!niors also d6n~tknow the differtnce between the two.
Make sure youexpjain tl;1e difference I"3l'fy io your prescnw.tion.
'
Seniors particularly hate
idea that legal
illegal aliens
recejvin~" ' .
,sovern.:ncnr benefits iu ~cneraL and Medicare or Medicaid in panicular.
,
the
and
are
&mind iUldimtes ~bQUt ebscges iDr:wremeru p.anerns overJbe PiUl..thiCty
y-e,w.. Seruors know thcir life eXlJe,Wlcy is sigruficantly longer now than it was
in-the 1960s. They recognize they
be spending more years in retil'ement. and
':u-e therefore taking more out of the system. This begins' to build the case for
wm
Medicare transforma.tion.
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/' . ; ' 1 /..nuw/llve it, a never~ntyer land· 1 don 'r care abovf
" , rhe meJico.i cfll.Jr~es because I'm' not pcrying lnr fJ-lf~m . .,
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"['he Hospuf.Ii tells ml!, .Why are you
w(JfTled
abour
CO.frs,
You dun .{ !)Q..... (or if Medicare doe's' ,If'S Ihur QlIifUdl!
, (hat caUSes pna,~ (0 go up. ,."
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111i:5iS:ll tht: ~nlx orour argument I(..!~(! .:an'\ prove \hllt~:~i~~~);()ing .
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ba..-J::rupL we -lj :1CV~r b: able w sell our ~vlutl(m~ Plan on l;pcnding no l~~~ 'mun _,0 ..
ml.."ltJtes :- andUp-io- al~}Ur-::-dir0I5stng Tfie num}-it.:~al(lnc You c:tnnOI mov<; ,Ofl\iotil
yo:.: ;)'udiencc fully lmdcrs\.lJ1J,s rile: iina.nci~i ram! iicatlCns'
Seniors r:~3lize tbal tbty'U': ~ettini it ir~at deal. Dnd=Olilndapb'. tiai:u
L
(0
:pvc it up,
It is :j,erdore ~)c:ct:~~ar>'.ll)
explain tMi w.hile they may
like what they have I~OW. it won't be there in the future unless real chant;es are
rnadt, 11m IS why so mucb effon must he devotd to ;.he. simple ULSk of
. reluctant
eXplai!ung that
Mt>dic:'tr~
is going broke.
':: '
Senigrs Use 5J)cculc fi&ll(lS to maisc,Jbc;jr 112inU. So sbogld Wt. When
.j
discussing waste and over.billing. a s1.l1T'rising number of sc)nio~ Foint to $10
aspir.ns. S15 {} eye exams. and Call remember the cost of their oo!\l'ital bill to the·
2.
penny. They have the aGility to remember the cost of a Single drng and a
panicular proctdure because L1ey persona/he rather t.han globaLiu thim mt>tiical
, care. We must do the same. InfQrnJin~Medi~lr$ u~igifl;U5 thai tn.t averagf
l1Hlple will '~ke out q\'£[ SlDOiOOO alQJ'C {rum MedIcate thag the" bil!$
..../'
(QJltribu{~ to tbe Slst(m l>eCiilnali~e$ ~hdicart's.impcndin2 banktulltcy
,
fuse naN Dumw:rs) in,the sam~ maQDef'a~ a.SlO aSpirj,n PCrs2D 1IJizes il5
ahuts.
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IhUlPtenI1aJ DupJOr jD're3sjng .premiwn~ by 300% js the ~Killtr Statl:..NJl "
.wlt kno~s tbiS. but the information i~ belirv£d. After seeiors an pn;stntcd
with the fina.'1ciallnfonnation on Medica!'c: thev v.ill inevii.ablv ask for {he: .
con:scquenccs, Showing them the chan abOUT ~hat happens lo'Medicare ,i it goes
bankrupt irr...rnediateiydisrupts the corrtplacentaonosphere, The ro"sibilhy thai· .
MedlcZc premiums will inc~aseby 300% i~"~imply not acceptable to senlors -'
:md thev .",ill do anything to prevent tlus from happening: (Note: The other.
options~ such as increasing taXes on workillg class families. pioduce vi~ll);no'
reaction:)
i!en' jf YOIl keeo M~dlt;u:( Gnd tbeJ.,.udect sCillr:a'e~ ')'Q.V[,'SQDsDtlJents ma'l!
nct. Be prepared, As mote than one participant voh~11eered~ "Republicans say'
rheyre goin)? to balarlCt! the budget ;n S'e~'i!" )'£!Qrs.
also f~ll u.s fhat
,\1ed:care is going broke in seven years. Ix thisjli.rfQ coi~cidtnce J" ,We ('Ire
StrcngllJeillng Medicate because we are committed to its survival.' We arc
~alanc;'ng the budget for our children and [ht!, next e~n~nHicm of Amr.f'lcans We
.... m ~uc:ceed <,m blJth counts be::ause we !!lUSt succeed' on both counts
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· The sarne people who believe ciimmnung.tbreign £ljd 'Ail!' h.uancc the bud~e( also
bei~evc that eliminating wa.~{e. fr.JUd. and abuse will solv~ the Medic::i.re probltfn. EDt
sct..!N'S, the govc:mment DiaV he tbe ~ncmv. hut the real emotional vellom,U ~s.eNedlOI..,- ..
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doctors_~d ho"'pitab. "Wfi4t.a earad.9~~ -:-.,the 'V~.~~hQ~.l<et:p (herr. a~Jve are
t1:le~~! people they' hate the m0st Everyone.has a stor:;' or complaint:
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. me doctor!
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of (hi pit: J~I yesrerda:;. Ihe
doctor charged me $150 just 10 wok OJ my nose. .,
' thay ail wanf a piC(;t:
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"'nle medica!.n1'njess 1 ;s millcing Meaica,-/: f;"C dOCIO,.9. d""g
suppliers and others in rhe medical industry. ,.1Ne)' 'remaking too
. much mone}', They ali don 'f need 10 drive a, Mtrcede.'i or BMW
Some rhould be driving Chevy!. ., '
~nU1lte WAn' (deftJuhe mfllticine) f.r.Qm fraud (deli~[ll.t~ ~t:nud'ingl frQJn,
Ih.uS~ (double billiot. mis·bUlioS).. WheIi seniors compiain about ''waste. fraud
" and abuse," tney actually mean three very distinct problems with the current
Medicare system. To seniors;
.
WIlSIe involves t!le unneccss.:uyand costly tests and procedures that ~cipienu
have tu Wldergo h~I1Se: the doctors and hospitAls arc practicing defensive
· medicine. SerJorshavc onlylimittd sympathy for doctor;; and hospitals in this
situation., .. Why don/Wi go after/he medical cornmz.;mty rodecttaS~,lhtir fees.
J
or ar/east srop recommending so many "frs. ••
, ,Fraud is the deliucrau: ameII;lpt by doctors and hospitals
(0
milk Medicare f o r J
every dime. Seniors want these people J:)rosecuted to the fullem't!Xfcnr'ofthe law.
"Some ofIhest doctors keep having thei,. patients co",e back and come back tutJi
,come bQck. and it's positively wrnecl1sJ·u.ry. ..
the non..delib~mttebilling rrtistakesthat Medicare fccipientSbelieve take
plu.e all the time. Well pver half of aJl3ellicrs Mve pc:rsof'l..elJ Cxp¢ticn\:1: "'1m'
Medicare abuse -. and they all want to.ia1k·about it. "Why can't tnt government
. train personnel (0 pull medical rec~rds likt rheincome fax and check to set if .
douors or hosprro/s overci1argl' ") 'Af(1yb, do,tor! ond hospila/sWor.dd bcmorc
careju! if (hey thought they would be 'Checked'"
Abus(! is
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Under~umd that the :::ombiflation of "waSte. fraud and abuse" ha." pmrltir.ed ~
-- -
vlrulemam[:physicianrnenuiItlY
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;';.!':;eJrd1-
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,rime eyes ofseruors,
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Wjlstc. fraud. aWi 3lut~c CUli.,tW{i \\'a~ We mLL"r be careful not to suggC:St l~
sctllor:t.t!uu MedicMe .will [,~ Cwe if we c:lirruna[~ illl the wa51.e. fraud .:mil :lbust Ul
the system, Seniors arc will.ir1g to accept the need fO,r reform because.of the many
problems they see with the system. but they will no! undersumd why they have to .
pay more for whAt they have
even after' aJl the Wil.5lC. fri1uu and abu....c; is
now
elimiMled..
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is not a bigb priQrity,!!lth Wlim, Medicare reci:pients ~ le~'i
concerned with choi;e of plans than they are with stability and mai.atniniug their
cUn"Cni do(;tor~ra.ticllt relatiunship. 1"his is especially true with older s~niors.
../
The)' must be told again and again that they will bcablc to maintain their current
~edicare ~it\lat10n if they so choose,
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Doult raise the Sodal Secgoll issue. Seniors ~ith good memori~s re~l when
Conifess to I,d them Soda! Security was going broke, They remernber'that
Congres,s made ehanets In the, $y~ and they dOll't expect to have to r.rv1sit it
anytime, soon. Anymention offuwre problems with Social Security only angers .
seniors and makes them less Willing to discuss changing theMedi~ system.
AIDIEE~n
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LeLYour cODs,ituentS know that' suber ,euipa! :roup, eJist. Show,~ .
seniors thaT AARP is not the onl-y_~cmiQrs:'a:pn:;~malivc on Capitol Hill or '
natiOnWIde. Snn'Z#infoanation about the United Selliors AssocllltiD" 'and other
gfoUpswho are d6ing good work on behalf ofthct elderly, and encourage p~ple '
to in\l~!tti!!~Te .alternative points of View. 'Th<: more ~e educ;;atc seniors to AAR.P
.alternatives. the more S\lCCeSsfW we will be.
&mind your alldieDce.thltB~publi,uu warU to !/lYc..!EASEJpendin c'bllr
1.1 a slower Cllta.:. ThIs language wor~~ . Remind your constituents that only in '
"f~/a.shi.ug\on is an incr~asc Crom S4,SOOto $6.400 (a 3:;%increase) pC: recipient·
defined as a cut.
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RtPHbIiWl~ J'llust RS':WJ\$ the V"ll \ZJl.iuP$i tbe PM1)' tbu tQ2~ OD.1b.;
;irgblenu..<li.l'!:k<i'iCI[.f,bCnd::,gp, It is the Demoe~dtS who are using HStu.rt
~:tics" by allowing prograrn.to ~o broke. to ~c riddled with waste and fraud. to·,
becume nv~rlybt.ircauc~tited without offering 41 !lolution ur ¢~cn l1<:kt~owl~dgi.Og ,
a
a problt!rn -. all ju.~t to s~ore politi~ai pOints.. RepubiicariswilJ. find a solution'.
f or our efforlS 10 be successful. ~ ha.::!.. 1!.!!!!!.k!!.Ii! !!gLus q~o Q w~tSe ()l!!,iol!
C.':::In cl1lJ.l1~
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4:' "t,gu m.u.!t ,Qlicil gtizGn
iiuuu. uGoVlrl1menr seems '"
(own
he rryH1g and 1.'1 wiUing to
and
Us old guys. .. said one
hall participlUlt Public opinion
input
m\.lSt Lc a key component of the proce~s, AUowinS scruors- and nOt just
Washiugton insiders - to work un CI'etlting a strengthen~d Medicare system will
help these seniors accept chaoges to the system.
liSlen fO
S.
IQu must have tb~ las, lYord jn this debate.
';1 havi gon~ from
an~gative "pinion 10 a more pas'ttiW! one
,/zhink yOt4 will makt progress 011 (his matter. ...
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1'1ri$ IS what -we need to hear. E9r tOO many seniors. i\ will be the, l~~t
~timatel~ them..; We need it tobo ours,' Don"1 end your lOWn meetings.
i.:1tl:fViews, 01 public !,,;olnmwu~iun c:ITons on a down nOle. Du nOlidSs\;Um: tha1
, JUSt because AHA or AARP hasn't targeted your district. or that onJy twopeoplc
came up a.1d talked to you about Medicare last week. that you are out of the
woods. 'I'b.is issue i~ U..-e and will rcmamso right up until ElectionDIlY..
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07/24/95
11: 25
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CoALiTION TO SAVE MEDICARE'
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"We ~ ~1itJ Cb#t
of til.
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Cb~ cn..iJ ".,..• . f)y
&b. tiD,rrtW condStioD
Mecli.lal't. 'nwt Faaers be ~c.(y .ddrusetl lUI a compl'lrba.iw ..'
billa, izJt:luf'.lmg • ft9iew of the lJI'OltCfI'J &aIDCDI ~, biutetlc
, .. pnMriGAf, lind deltrrq . . .IIidaI..
Social ~it1 and MediaN .8o&rd ot~. 1.' .
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'Steerinl Committee Mem1bers'
To dau; July 21. 11W5
.
Alliance for Managed Care
Citizens Against GovemmentWaste
Citizens for a Sound :Economy
...
Communicating for AgricultUre
COUDcilfor Affordable Health Insurance
HealthcareLeadership Council, '
National AssocIation ofManufactm:oers ,
NatiolW TaxpayersUnioft .'
, The Seniors Foundation
U.S. Chamber of Commerce
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�NO;793
P007
COALITION'TO SAVE MEDICARE
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tis. thJRi2Oi41 t:f>D.ditiOZl
ItWe Btf:atlGJr J'SCG.!1t.llIend ,t&at the mllUt p~l2ted by
01 tile Medicare Trust Funds be U!"fenUy addressed ~ a comprehensiw '
b.!uti~, ine1udin8' ~
Nvi.,w 01. the 1JI'tl1Jr'Blll!t'1I £iftJmemj meotboda, bs114!fit
Pl'ovi,jOflS, and delivery .trIecfuutisrwl. "
,Social Security aDd Medicare Board of Trustees. 1995
, For Immediate Release
Contact: John Gibbons, Coalition 10 Save
Medicare, 202..347-S731
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, ,Viek:i Lovett. the Seoi,ors CoaJiuou. 202·546--1 Sl7
Matt Bester, Healthcare Leadership COUDcil, 202·347·5131
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Coalition to Save Medicare Comprised ofDive~e Range of Groups
, Formed to Shape and Monitor the Medieare Reform De~ate:
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Washington, D.C. July 24, 1995'•.•The Coalition to Save Medicare (CSM) bas been. fonned to support '
efforts to prcsc;:rvc, simplify ~d streagthcn Medicaro and will serve ~ a clearinghouse for Medicare
reform infonnation. The group, representing it wide range of interestS from senior citiz.ens, small and
large businesses, to taxpayers and the bealth care indusay~will provide grass-roots iIiput and support far
legislation to prevent the impending bankruptcy ofthe Medicare Tn$ Fund. Co-chairs ofthe coalition
include Jake Hansen. vice president of government affairs, The Seniqrs Coalition, and Pam Bailey, '
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president. Healthcare Leadership Council (In.C). '
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. ".Medicare is in trouble. and we've formed this StOUp to set ~e message out that something
needs to be done to prevent the system from going bankrupt by the year 2002," announced Hansen. "The
makeup of our coalition membership itsclf sends a mon; DleSiagC th~ Medica1c affects a diverse range'
ofgroups, such 8$ businesses,healtb ~ groups, taxpayers and fami:1ies - not just seniors.
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Mrs. Bailey addect: "Medicare is too important ofan issue to!be left to politics. We hope our
efforts will result in workable solutions whic:h will give our older Anlericans choices and, most
'important1y. quality health care:" "
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According to the CSM inission statement. the solution d~s riot lie with higher taxes, dramwc
cost-shifting or reductions in the quality of medical,aire available to ,seniors. Instead, pol icy makers
shuuld lIimplify IUld imprt;lvc the system by opening it up to DeW optipns ,and opportunities while
avoiding inappropriate government intervention or selection.
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The CSM beHeves the,current fee for service Medicare progiam should remain available to.any
senior who wants it, but beneficiaries should alSo have the same health pJan choices that are available to
other Amencart!;. .
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CSM will be sending out alerts, mD.nning phone banks, and ~ub'lishin& op-ods and lct:b;r$ to
editor across the country. Talk radio bosts will be receiving weekhi updates about the 'progress of
Medicare reform.
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"By the time we're finished, voters in America will knowwllat's at stake," said Hansen. They
will know the reality behirid the Medicare crisis and what is being done to save the system."
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A mission s1atementand list of Coalition, membe~ appears
-30.
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on the following pages,
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• The Seniors CoaIition. Chair • Healthcare Leade:rsh.i~ Council. Chair •
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, p,O, BOx 75033. Washington. D.C, 20013' ,
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�NO.793
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COALITION TO
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SAVEMEDICARE
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"We ~1.Jt l'E'C'tm1I!l'.1e:aci
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~~ilJ P~l2 t.<.id l;ty ~., lib.a.llt:ifll ct>.:adiiicw
. . 01 .the Mecbi:are T.n.l$t Fwlds be Ill'teD.Uy addressed ~12 a com.preheilslvd
basis, inclll.diZ!g a mviflw nf the PJ'O,tn1m'S Mancini metbocLI. lu..I1eiit
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provisi01lB, and delivery mdC.&:anismS: n
. Social Security ani Medicare Board of 'li-wite~. 1995
tJ,a,Qt ene
Mission Statement
The Medicare SYstC~ is in a state of crisis, and the Coalition To ISave Medicare is dedicated to
preserving, simplifying and strengthening Medicare. We believ~ that the solution does not lie
with higher taxes, d.runul.tic com - shifting, or reducti01l8 in the qunlity ofmedical care avwa.blc
to the elderly. Instead, policy makers should simplify and impr~ve the system by 'openmg'it up
to new options and opportunities while avoiding inappropriate government intervention or
selection, thus using market forces to reduce excessive caste: an4 improve the quality of care
available.
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The COalition To Save Medicare further believes that strengtheDing Medicare is too important to
be left to upolitics~as.usualn. Rather, we mUst act immediately;to preserve Medicare for cmrent
retirees and to strengthen the system for future generations by holding the MediC31'e !lpending
increase to a slower rate of growth, We also believe that while.~e must preserve the existing
progi-am for those who want it, senior citizens deserve the samei cboices that are available to
other AmericanS and that they need to be encouraged to help ro9tout waste. fraud and abuse in
the system.
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• The Seniors Coalition, Chair • Healthcsre 4;ad.enbi~ COIl$ij, Chair •
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Biographical Data
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Chairs t The ,Coalition to Save ~edicare
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Jake Hansen. Vice President for Gover';"'ent Affairs, The Senio~s Coalition .
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1m HWlScn 50rves as chiefpolitica1 strategist for The Seniors Coalitio,n and is responsible for
formulating and implementing all policies which support the co*cerns oftQe organization's,
membership. He directs lobbying'initiatives on issues such as Medicare, taxation, s~
health care, Social Se.clJrity. The Seniors Coalition;", a 'nnn-I"~~n national organi7ation which
embraces a set of core beliefs: frugal and responsible government finance; tax policies that create
rather than destroy jobs; strong and ~le families; and the endtUing cOmpact betwelom uue:: ' , '
generation aild the next It accepts no t8xpayermoney.
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: Pamela O. Bailey, President. Healthcare Leadership Council
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Pamela Bailey has been involved in health
aovemment reladom. ,public policy and
communications for nearly 2S years, including service in both tb.e public and private sectors.
The Healtha!.rc ,Leadership COWlCil (HLC) is ~ grOup ofoyer SO ~th care industry ebief
executives .... leaders from the hospital, in.surince, p~eutic¥J technology, and
physiciaD'nurse sectors. The group was initiated in 1988 with ~e purpose of developing a health
industry consensus on solutions tl;' th~ problemseonfronting American health care. '
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• Tb.:I Stniora COAlition, ChQ;,i.. HIl'IIHhw" LuQ.l!'l"&hip Col.ll'1cil. Chair
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P,O, Oox ':'5033, WoshiI\~on. D.C, :!oo:3i
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LEADERSHIp·
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Statement by Pamela Bail$y
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President,Healthcare LeadersniR Council
. . Today marks thestari of the week commemorating the thirtieth anniversary of
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Medicare, ·Yet, this important health program is facing a fi'nancial crisis so severe that
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its future is at risk. It is in response to this crisis that we are announcing today the
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formation of the Coalition to Save' Medi~re.
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"rhe Healthcare Leadership Council (HLC) represents lea~ers from every sector of the
health care industry. We have joihed with the ~eniors CO~lition to fo-chair thi~
coalition.
r hIS coalition will accomplish two major goalS:'
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ToinformAmeri~n3 of theurgenfneed to eddres:{thefittanci~l crisis facing
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Medicare; and
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To promote a public conversation over,the right sol:utions to this crisis,
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JOining me today are" Jake Hansen, from The SeniorsCoafition,. and representatives
fro~ other Steering Commi,tt~~ Members; 8~ce Josten from the U.S: Chambe; of
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Commerce, Wayne~elson from Communicating for Agriculture, and David Keating, .
, from the National Taxpayers Union .. The,se,individuals sp~ak for large and small
, businesses, farmers and ranchers, and taxpayers. Medicare touches every American,
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and this coalition wIll represent the cross section of Intere:sts '[1 American society..
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The Healthcore Locdcr:Jhip Council has madcGsving, oirriplifying, and strengthening
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f:,/Iedicare our tor IAgisl~tiv~ ,priority Thp-rp- ~r~ ~c reasors why we decic~ed to help
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build this coalition, First. America must come to grips witlil the financial crisis facing
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Medicare. This fact, recognized by leaders of both
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politic~1
'lj>;dlh",;It· I t·:H1,·( ... hip (.nlllll,i\
1.-,lId k "111"'1 :\\1, "'I;ill' :\(,iJ
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Security and Medicare
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Boa~d of Trustees.,is profou~d. N~~t year, Medicare will
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to spend its reserves. In seven short years, Medicare will
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number of young people supporting an older population cr~ates an unsustainable ,
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financing situation using current methods. This is o{enomlous importance to all
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The second reason for our active involvement is that the'HLC brings a. unique
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perspective to this important issue. The Healthcare Leadership Council represents the
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innovative and quality institutions in the health care industfy. Its members include the
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chief executives of hospitalS. managed care companies, pharmaceutical companies,
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medical device manufactuier::i. and health care provider:;,. I We, provide a unique forum
for people knowledgeablo and experienced in the delivery10f health care' in which to
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find solutions to the challenges ahead, The HL'Chas
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beer working for months on
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solutions for strengthening- MediGare. We look fOlWard to Ipresenting our
re~mmendations to the leadership of both POliticalpartie~ and the Coalition, and to
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working with the coalition to inform Americans' ,abouti best preserve, strengthen
how to '
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Saving Medicare is an issue that can not be put, off, nor i~I it an 'issu'e that we ~n push
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under the rug. An apen, honest national discussion about how we can save Medicare
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and preserve Its promise to America's senior citizens is ctiliC"'dl
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solution. The COelJition to Save Medicare will
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be wor1dngiwith hundreds of
organizations to raise the public'awareness and understandil19 of
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::===~!=:~~~=========- Protecting the F~re.i You Have Earned:::.'=.====:=:
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CONTACT: Vicki Lovett
202-546-1537
FOR IMMEDIATE RELEASE
. July 24~ 1995
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Seniors Coalitioa i~ Supports Efforts of Coalition to S8v,e Meditare
Eagaged in All-out Effort to Protect tbe Elderly
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In a statement released today. Jake Hansen, vice president for governinezit atTairs ofThe S~niors
Coalition and co-chair of the Coalition to Save Medicare, said, "Fonriing the -Coalition is the best thirig
we could do to help protect and preserve the health care coverage nf ~enior Americans -.. for today and
tomorrow."
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The COalition to Save Medicare (CSM), formed to support efforts topreselVe. simplify and
strengthen Medicare' and serve as a clearinghouse for Medicare rerum. infurml1tiul~ i:.; Lauuprised of a
diverse range ofgroups. The CSM represenm the interests of all Aniericans, from the elderly to farmers,
taxpayersI businesses ofall sizes and healthcare providers. Hansen ~dds, "As Medicare enters ~ts 30th
anniversary. we see many opportunities to help encourage the national dialogue on the MedIcare crisis.
We wanl to show that Medioare has been a good prosram, but is now in trouble, and that it has an
across-the-board impact on the health, welJ.bt".ing, ann Hfe~le nfall American!; of all ages. not just
seniors. We know that ifsteps aren't taken to address the problems Medicare, then we all will face
_dire wnscqucnecs. Our messagQ is clcar: SAVB ME?ICARE.". . "
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. .According to Hansen. The Seniors Coalition believes that choices iilJl: u kt::y ingn;:dit:nl in t.lte .
Medicare refonn fonnllla. "We believe that people entering retirem~nt should be given the SaDle choices
that are prevalent in the private health care industry - whether it be HM:OS, PPOs, a voucher system or "
another fonn. ofselection." At the same time, he says that those who want to remain in the system
should be allowed to do so.
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Says Hansen, ~e're excited about the prospects ofthe CS~ and believe our actions will result
in legislation that is good for SQniol'i and "ood for our country. WeI hojXI QJl J\rQeriOf.UlS will benefit
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from the effects of our efforts. as they recognize ths:t we plan to preserves system that ~served SO
many so well." .
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The Seniors Coalition" is a non.profit organization ~thi two million members and
supporters which rerre~ntqthe interest.-; of older Americans. It keeps its members aware of
issues affecting their lifestyle, health and well-being thrOugh ai free hi-monthly newsletter,
legIslative ACtion alerts. (;orre~ondc~, free bool..dcts, rescan¥ papas, a monthly Q &. A
. column-and op.-eds: It is totally member supported and accep~s no taxpayer money.
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Ad.minianatlTe Office:
11166 Main Street, Suite 302 • Fairfax, Virginia 22030
Phone (703) 591.()66) • Pax (70J) 591.0679
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Lesi"Jative Office:
_,214 MlI5S8.ChUlidts.Avenue. NE, Suite 240. WlI$hington. Dc 20002
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Ph~ne (2.02) S46-5Z00'~ 'Fax G021 ~ 1720
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THE ALLIANCE FOR
MANAGEO'CARE:
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Statement of Support for th~
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Coalition to Save Medicare
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The Alliance for Managed Care is pleased to'annOWlce its participation in The
,Coalition to Save Medicare, The Alliance for Manageo.d !Care is ~de up offoUt of
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and The Prudential. Together, the membern of The Alli~cc for Managed Care
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(AMC) provid,e health care. coverage for over 60 millio~I Americans. The AMC will
serve 011 the Coalitioll's Sl~t!ring committee.
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The AMC's concern over'the future of Medic~e is deeJly heJd. This vital federal
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program is on the brink offinancial collapse. The progripn's rate of growth is not
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sustain8ble. The crisis confronting Medic~e tlrreatens~e'heaIth care security of
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current beneficiaries and future generations. As imp~~t,Medicare's runaway
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costs will continue to exacerbate all attempts to balance: the federal budget. The
AMC believes the Congress and President Clinton must,act to save the program by
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giving senior Americans real health care choices...just l,ke millions of American '
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For the sake of currerit generations and the'nation's fiscfll we1l-heing, AMC is
. pleased to announce'lt~ committed participation in The :Coalition to Save Medicare .
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U.S. Chamber of Commerce
1615 H St., N W '
WctShinglun. DC 20062-2000
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, Media nelatiom' Department (202)
463~56a2
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Contact (202) 463-5682 Frank Coleman
FOR IMMEDIATE RELEASE
laura WeIJf!r-"
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Monday. July 24,'1995
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U.S. CHAMBER LAUNCHES EFFORT TO SAVE MEDICARE
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WASHINGTON - The U.S. Chamber of Commerce today. helped kick off a -herculean
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effort to save Medicare at a press conference launching the 'Coalition to Save Medicare.
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"We believe the Medicare crisis demands a:timelycon~borative effort by the Cqngress
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and the American pebple,"said Bruce Josten, the Chamber's senior vice president for
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membership policy. "There is no other choice.
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"Today Medicare is the fastest growing program in the federal government. This year
alone, Medicare ~II add about $45 billion to the federal defi~it, about one-fourth of the total
deficit,D Josten said. UEven worse,the Medicare Board of Tr~stees anticipates that Medicare
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will be bankrupt in seven years.
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Josten called on Congress to redesign Medicare to pr,otect. preserve and improve Ule .
program for current and future beneficiaries 'llll'hile providing ~hoice$ of medical care to senior
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citizens and rooting out fraud,Waste and abuse.
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, uCIearly, thi~ is a crisis, but we must make it a cri!!\is of opportunity: Sitting back. and
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aI/owing Medicare togo bankrupt is not an option,D he said.: "Yes, this will be a herculean
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effort. But the Cost of doing nothing iS,an unconscionable price to pay~'"
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.' Josten noted that
the Chamt;Jer membership supported the recently*passed 1996
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Federal budget resolution,wnich provides for $1.4 trillion of; Medicare spending ov~r the next
s~ven
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years.
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The U.S. Chamber of Commerce is the world's
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large~t
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business federation, with
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215,000 member businesses, 3,000 state and localchamb~rs Of commerce and 1.200 trade
and professional associations.
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••AI ,.. Nationtil Association.
'.UJ~.II. 0' IlllallUlacfll".,s
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CONTACTS:
95-167
MONICA OLIVA (202) 637-3093
. FOR IMMEDIATE RELEASE
roLIE CANTOR-WEINBERG (202) 637-3127
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REFORM; DON'T GUT, MEDICARE slAyS NAM
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New Coalition Emphasizes Broad Need for RestructuriDg
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WASmNGTON, D,C.; July 24, 1995 -~ "The NAM fUlly supports efforts to
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our nadon's budget deficit~ but targeting Medicare and! Medicaid for across-the
board spending reductions is not the solution. Instead, we ~st focus on modernizing
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Medicare'to ensure its' quality and' efficiency, without. shifting costs to the private
sector, said National Association of Manufacturers Senior V~ce President Paul Huard
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today.
"We're pleased
to be
a part of today's :annoUDeementto introdl,1ce the Coalition to
. Save Medicare. The very brE'..aoth .and ~;7.e of this erouJl dIO~ld.he a clear indiCarion of
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the importance and urgency of this issue," said Huard.
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"We must put some serious consideration intofindin~ ways to make the system '.
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work more effiCiently if we are going to both balance the budget and save Medicare
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from banbuptcy by 2002," Huard said.
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COMMUNICATING FOR
112 E. Linooln Ave•.
~GRICULTU,RE.
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Fergus Falls, Minnesota 56!)JI:.i·Oti/, .
Statement by Wayne Nelson. President
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RURAL AMERICANS SAY LETS .SAVE MEDICARE. ,'. AND MAKE IT BEITER.
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Communieat4ig for Agriculture has had a long history of actively; working to improve health care
in rural Amenca. We led a coalition of more than 100 agriculture and commodity groups in the
ht:iilth care debate of 1·993 and 1994.
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Another easyop~on would be'increasing the level of payroll ~esthat fundMedi~. But, as .
baby boomers move into retirement, the ratio ofworkers to Medicare recipients is going to shrink
, : from four to one, to two to one. The tax increase necessary woUld be difficult to bear, eSpecially
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among the self';employed and small business owners, the backb?ne of rural America.
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To ensure that Medi~e coverage will be.available when our'cllildren and grandchildren retire,
we need to make bigger changes. The biggest is a'cha11ge in philosophy: giving 'seruors'more.
choiocs. Let seniors select their own h~a1th care in.surer. If they choose Ie" expeMive coverage
wi~ higher deductibles, seniors would share the ~ost savings w:ith a rebate. Select more
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comprehensive coverages and seniors wouldpaythedi£f~ce. '!JUs pian gives seniors the same
choices as all Americans who pW'cbase insurance and rewards them for making wise health'.care .
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Managed care can also be a part ofthe solution, too, includJ.ng fl~ding ways to change the
reimhursement system so it is baSed on eompeti~ve bids:.' '. i·.,
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Ruralhea1th care deliv~ is,iliITtm:llt, from that in the city. Thcrciaie fewer people, older people:'
and, l1loremiles to cover. B~t that, doesn't preClude rural Ameri~ froniquality health care. We
'need to m~mize Medicare to make it work'for everyone.. '. i
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[NEWS
NAl10NAL
TAxPAYERS
t1MoN
FOf,Further Infonnation, Contact:
. Pete Sepp (202) 543·1300
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For Immediate Release
.TIlly 7.4 . 199:; t ;'
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Nation's Largest 'Taxpayer qroup Urges
Congress to Prevent Medicare;, Bankruptcy
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(WASHINGTON. D.C.) - The300,OOO-member N4tional Taxpayers Union
(NTU). the nation's largest taxpayer associarion. rqday anno~nced its active participation in
the newly formed Coolition to Save Medicare. , The Coalitio~. led by the Seniors Coalition
and backed by other dtiten and business organizations. will :work for implementation of
reforms to prevent Medicare's looming bankruptcy.
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NTU CK.ccutive vice presidcnt David Keating sa.i.d, ·'~edic(l.fe·s own Trustees
predict the program will go banknipt in just seven years. The Coalition to Save Medicare
., will woek tQ~nformthe public that reforms arc needed to a~oid bankruptcy.
"'The TlU$tees have dia&noseci Medicare's condition!as c:ritic;al and unstable. The
. prognosis for taxpayers -:-- arid seniors -- is grim, unless Cori,gress ,acts this year. Congress
liltlraJly ",annUL wforu w ~t;hsy ~rurUls Lhl:tL' will ~ol1U'ol the growth of Medicare spending
and rescue the system from certain 4oom. '
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"Some special inierest groups say Medicare shoul~'t be changed, The question is
nm Wherherchanges need (0 be made, but when tlIey·will ~ made, The program is headed
straight for a cliff. If Congress acts this year, drastic changes can be avoided later. If we
wait until disaster strikes from Medicare's bankruptcy. Ole pain caused by changes will be·
far worse,"
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Accor!.'ling to the 1995 Annual Report of Medicate'~ Board of Trustees, Medicare's
Hospital Insurance (lin Trust Fund will exhaust previously accrued surpluses and-becoine
insolvent by 2002. Forestalling this bankruptcy through tax hikes alone would, according
to K.eating. "place devastating new burdens On taxpayers and the economy. Medicare
payroll taxes would jump by more than $1 trillion over the n~xt seven. years, or$t ,500
every year for a worker earning $45,000." .
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The~ calculations do not account for rapid cpst growth (over 10 percent annually)
in ttleSupplementary Medical Insurance (Part B) portion Medicare. Taxpayer subsidies·
'for this program are expected to quadruple to $147 billion!by.the year 2004. Without other
remedies. these costs could trigger tax hikes on top of thOSe consumed by Medicare. .
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National Taxpayers Union. a non-:-profit. non-partiSan citizen organization with
.300.000 members in all 50 states, works for fiscal responsibility at all levels of
government. NTU has led the national campaign for a Balanced Budget Amendment [0 the
U.S. Constitution.
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. FOR
CITIZENS
AGAINST
t.GOVERNMENT
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. Contact: Sean Paige
for Immediate Release
~202) 467..5300
July 24, 1995·
.CCAGW Joins Coalition to
Save:Med~carc
Wushlnginn, n.£.:. -- The emmeil fo,()ti7.en!-; Aellim~tGovemment
Waste (CCAGW) today joill~d with other'prominent taXpayer. sen.ior arlu .
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business groups in an all-out effort to save,, simplify t strengthen the
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Medicare system, .which will be thirty years old this mQnth. Without action
. ·nuw, w:enrrling to the "Cnalitinn 1.11 Save Medicare," Ih~ heli.lth core
provider for seniors willli:0 bust earlyiu the 21st CentJry ..
last year, the rresidentfs Medicare Trustees, an fndependent pane!
whu1'-le jnh j!-; tn keep track nfthe timlncinl health nfthE'liPT'Owom, reponed
that Medicare was in poor shape and headed toward collapSe. Th.is year, the
trustcc:smade it even more explicit: Within one year, ~ooming costs and an
unsusminable growth rote will drain tbe Medicare Trust Fund. In seven
Yl!lars, the Jlrogr.im will bt: hankrupL
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tlA failure torefonn the program today will exac~ atenibltlluJlnn
America's seniors and all taxpayers tomorrow" said CACW President .
.Thomas. A. Schatz. "But before. we even begin. to look at adjusting benefits,
we should lawlch a .vigorous effort to ~limiJlala thalliri!! ilfblllium; of
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dollars in ",ute, fraud. and abuse within Medicare. E~ery dollar pilfered·
trom Medicnre by the gOl11ish gang of grifters who prey on it should be seen
as a personaiattIWk upun its parli(mlariy vulnerahle heill'~ticinrie9 and the
taxpayina public. II
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"Time is too precious, and the stakes are too high, to waste another
. niinute in fear-mongering, dtmial;and demngnglJery," \mid Sc,hatt."Evcty
. major poll reports that the public -- and Medicareenro)lel's inpl1rlicuiar -- .
demand that 'Congress take ~e steps neeessary to stretigthen the prog.t'am, to
Nimpli Iy it!o1 Tliles, and to protect every patient's right tc! a relationship with
their physician willie offering a r~l'Innahle number nfhE'.nlth-c.arc choices
and alternatives to the present system. Long':standins proposals !>uch as
rntldiual Kaving.., ncr.ounts, which 'arc strongly endorsed byCCAGW
members. willlik~ly now b., tmac~d IL"l one ofthe cholce.s offered to
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Medicare enrolI~s,1l
CCAGW Will work with the Coalition to Save ¥edicare and the .
House:: WId Senale leadf:IT~hip to preserve the system for current and future.
beneticiaries. .
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CCAGW is.a 600,OOO-m¢mber non·partisan. nonprofit urgalli;':'.al.ltm
Inhbying to eliminate waste, fraud and m.ismanageme~t in goverrunent.
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lROl Connr.r.tir.tltAvenllP., NW· Rllit.p. 400 'WI'l~hil'lgt,onJ '1C 20036·202-467-5300
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July 24, 199~
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For more information, contact:
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. Cristinl1 Biru, M~l:I.gt=r ufPubli\.i Affairs,
703..836-6200, '703-836-6080
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Statement of Greg ScandleD ;
E:.:ecutive Director
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Council (or Affordable Heakh Insu:ran~e '
to
The Council for Affordable Health Insuran~ (CAm) is proud be a partner in the Coalition to
Save'Medicare. The Coalition's goal is to preserve. simplify iUld strengthen the Medicare system.
This thements with CAHPs mission to alIow'market forces to r~uce costs and improve quality
of care.
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CAHI supports maximum ehoice ofiMurance options for senior~. Medical savings accounts, or
MSAs, can be a vehicle forsemors to pay for health care exp~es in retirement. CAlfi'sposition
is that the best way for seniors to finance their health care needs is through private vehicles rather
than through government programs such as Medicaid."
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Reforining the Medicare system is one ofthe greatest dilemmas;facing Members of Cougress
today, CAHI ~ submitted a compreh.ensiv~: list olshort-term ;revenue solutions and is working
on longatenn fixes for the Medicare program:
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CAHI enc~urases'a11 groups to support the mission ofthe Coalition to Save Medicare. Senior
citizens deserve the same health care choices available to other iAinericans. CAHI agrees with the
Coalition's goal of encouraging panty makers to simplify and 4nprove the Medicare system by
opening it up to new options and opportunities. "
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The Counoil fot AfFordable Health Insurance is an association br ~ma11 to mid· sized insurance
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,
companies that was formed in March, 1992 to fight for free matket solutions to the problems in
the health care, System. Co~ncil members covernearty 4,OOO.qoo people in the indiyjdu~ and,
,small group insurance markets.
'
112 s: West Street, Suite 400, Alexandria, VA22314 703-836.6200 Fax 703.0836-65SO
�I
. I
I
JUL 2 I 1995
4 ..
MEMORANDUM
(
.
TO:
. Carol Rasco
Laura Tyson
FR:
. July21, 1995
Medicare Part B Proposals
cc:
)
Chris Jennings
RE:
,
Gene Sperling
Jeremy Ben-Ami
Jen Klein
i
Because Republicans have the Part B .premium proposal i.q th~ir Ways & Means Medicare
working restructuring document, I thought you might be partiqularly interested in the attached
materials that illustrate the impact of various proposals. As y<;m will note, we have laid out
options that set premiums up to 35% of Part B program costs ;(we have done this because
Republican proposals provide for 3 options:. 31.5%, 33%, and 35%). I have·also provided
you with one line showing what premiums would be ifwe set-premiums at 30% of program
costs (this is one of the options that could be view~d'as "ratiopal,"but it is meant to be just
an example).
.1
[t is extremely important to remember that the savings number associated with all of the
. options will decline as overall Medicare Part B expenditures qecline as a result of any Part B
cuts 'the Republicans pass. Unfortunately, because there are no final proposals, the associated
.
savings numbers are difficult to project.
I hope you find this information useful.' 'If you have any qudtions, please do not hesitate to
call me 6~5560. .
. .
. '
�J
---
--
----
-
--
DRAFT.
I I
~
~
7J2Q1!lS 7m PM MCARECAPJCLS'
�Medicare Part B Premium
As Perce.nt of Program Cost: Current Law and
35.0%
""
DRAFt
.-1;'
A(temativ~
.j
I
[$55. 00 .1
I
[ $104.30
1
II'
I
30.0%
~
....
en
o
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ra
...
--r $82.80 I
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Q..
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r $4i.i<fl
o
.....
C
•• __fl)__
o
...
fl)
a..
. I
20.0%
--.- Current Law
1
. -e- 25% Premium
___ 31.5% Premium
I
I I
15.0%
+
1991
---f·-
~--
1992
1993
1994
________
f --
1995
l___
----L___
1996 '. 19'97
_
--~.,-----
1998
_ ____
1·---
1999
l
200('.
--------,
2001
.
2002,
-
. Calendar Year
Preliminary and draft estimates of CBO scoring. Assumel.> no other Part B savings proposals.
7f'1£J1i15 7;52"" fie
�DRAFT
.,
4'r'
:,~r;'"
Medicare Part B Premium: Current Law and Alternatives
$110.00
1
7-Year Savings
(FY 1996-2002)
I
$100.00 .)
I
I
$90.00·
i
25% Premfum: $21 billion
31.5% Premium: $69 bimon
I
I
I
I
33% Premium: . $80 billion
.$80.0°1
E
::::s
E·
(I)
....
35% Premium: $95 billion
I
$70.00 ~
I
0..
>.
..c.
~
. $60.00
c
0
:E
.$50.00
--,-,-,,--.,.
$40.00
I
.
$30.00Ij90··
I
I
$-20.00 -\-
.
.
. ---. -F--1i!IB
1991
1992
rmCuITent Law
I
I
1993
1994
1125% Premum
1995
1996
1997
I
1998
1999
2000
2001
2002
Calendar Year
L
031.5% Premium
Preliminary and draft estimates of COO scoring; Assumes no other Part B savings proposals..
712M;!S S:20 M.I
�
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;,
"
MIDDLE CLASS
BILL OF RIGHTS
FACT SHEETS·
&
CHARTS
�1124
The Goal:
We need to put working people tirst. Anyone willing to work hard and
play by the rules should have a fair shot at the American dream. To
restore our country's tradition of broadly-shared middle class prosperity,
we must widen opportunities for better jobs and higher incomes.
The Context:
New technologies are transforming the way -we live and work. Global trade
is expanding our options. We've cleaned up the economic mess we
inherited, and put our rIScal house in order. The economy is booming.
America has created 5.6 million new jobs since January 1993-including
more new jobs in 1994 than in any other year over the past decade.
The Problem:
It's not enough to create more jobs.. Americans need hieher incomes if we
are to rebuild our middle class. And only some of us are equipped to seize
the opportunities the new economy offers.
The Solution:
We must equip all Americans with the tools to take control of their
economic futures. Skills and education are the gateways to the new middle
c1ass~ Our challenge is to ensure that all Americans can get the skills that
let them earn middle-class living standards for themselves and -their
families-under the new rules of today's economy.
The Foundation:
Even as it struggled to tame the deticit in its tirst two years, the Clinton
Administration-with strong bipartisan support in Congress-laid the
foundation for a campaign of building skills for a better future: 1) The
Goals 2000: Educate America Act providers new incentives for better
schools, and catalyzes the development of voluntary occupational skill
standards. 2) The School-to-Work Opportunities Act is triggering
nationwide innovations in youth apprenticeships. 3) An expanded Head
Start means more kids begin with a better chance to learn. 4) Streamlined
access to student loans gives all Americans a simple, affordable way to
finance learning. 5) We've begun transforming the unemployment system
into a re-employment system, centered on One-Stop Career Centers.
Now is the time to take the next steps, so Americans can once more
grow together.
�To Grow Together Again
o In the early decades following World War II, we grew toe;ether.
Every income group, from the poorest one-fifth to the richest,
essentially doubled its income.
o But today, we are growing apart.· Between 1979 and 1993, the
incomes of the bottom one-fifth fell by 17 percent (adjusted for
inflation); the next one-fifth lost 8 percent; the middle fifth lost three
percent; the next fifth gained five percent and the top fifth saw their
earnings rise 18 percent
o Since 1979, real household income has grown by $767 billion-about
a $2,000 increase for the average household. But the average figure
conceals the bigger story: About 97 percent of the income increase
(adjusted for inflation and population growth) has gone to the top
fifth of households. Everyone else-80 percent of American
households-has shared just 3 percent of the growth.
o The problem is not that some of us are getting rich. That's good
news. The problem is that most of us are getting nowhere.
.
o It used to be that if you worked hard and played by the rules, you
had a fair chance to get ahead. This was America's economic
covenant
o Technological transformation and global markets have rewritten
the rules. Hard work alone isn't enough any more. You need
education and skills.
o Restoring the covenant means preparing ordinary hard-working
Americans to prosper under the new rules. This is our agenda for
1995 and beyond. Doing this-and doing it without increasing the
deficit and leaving the burden to our children-is the goal of the
Middle Class Bill of Rights.
�1950 to 1978 -- Growing Together
Real Family Income Growth By Quintile
160%
140%
120%
.....138°1c
, " .0.....
. ....... "
." ... , .. . .. - .. - ". ..' - .. -" -
. - - .... " - . - ... - . "
. ".. " -".... -" "". . ..... "" -. . . . . . . .. 1"1"1 %. " ..
.....
1000/0
80% '
'60%
40%
200/0
00/0 ·
Bottom' 200/0 .' •. SecC'lid 2()O/o
Middle. 200/0 " · Fou'rth 20%
.
.
.
.
SOURCE: Bureau of the Census, Departmentof Commerce. All data converted to 1993 dollars.
.
., Top '2.0 %
�1979 tot993 -- GrowingAp
. Real: Family Income Growth By Quintile
20 %
15%
•.... - - . . - • . . . . ..
. • . • • . • . . . . . . . . • • • • • • • . - • • . . • . • . . •.
.
""""'"
•
r~
10°X
°
10
5 01
.
- - - - - - - -
•..
-
. .... . . . .
. . . . . . -. " ..
-,.
. . . . . . . . . . . . . . . . .... .
____
- .. - - ...
A
___
_
'
0%
.-:3%. . . . . . . . .. .. ...'" _. . .
-5 %
--
-10 %
.
....
.8
.:.
..- .. 0F .- :: 10..
..
..
:",
..
- -
..
- .. .. ... ..
-.
.. .. ..
~
....
. .
.................... -; ..
.........
..
.. ..
..
.. .. .. .. .. ..
-15%
-200/0
-170/.0
:90ttom:200
/0
Second 20% . . Middle 200/~Fourth200/0
SOURCE: Bureal,J .of the gensus! pepartm.ent of Commerce. All data converted to 1993 dollars.
Top 20 %
..
�1979 to 1992 -- Who Got the Growth?
Shares of Average Household Income Growth
100
Percent Accruing to Income Group
80
/'
Top 50/0
60
. ""
40
20
o
Top 20°/6
Everybody Else
Source: Based on data from the Census Bureau, Current Population Survey. Household income is in constant 1992
dollars, and adjusted by CPI-U-X1, and population is normalized to a constant level.
�Skills Matter More Today
o We're well on track for meeting or exceeding the President's pledge of 8
million new jobs. But our success on job quantity highlights the stakes of
job quality. Working Americans need a fair shot at higher incomes.
o Increasingly, skills and education are the entry tickets to good jobs
paying middle-class wages. Most of our recent job growth has been in
professional, managerial, or technical 'careers-jobs with a future. But you
need the right skills to make the most of these opportunities.
o A traditional four-year degree is not the only entry ticket to the middle
class. Today's economy is creating new middle-class jobs requiring two
years or less of technical training, usually 'available at community colleges.
Some examples of new middle-class careers:
• Nurse practitioners
• Desktop publishing specialists
• X-ray technicians
• Numerically-controlled machine tool operators
• Sales technicians
• Spreadsheet operators
• ,Automobile diagnostic technicians
• Physical and occupational therapists
o Fifteen years ago, a male college graduate earned 39 percent more than a
man with a high-school diploma. But by 1993 the average male college
graduate was earning 80 percent more than his high-school counterpart.
(The gap is just slightly narrower for women.)
o Health-care and pension coverage at work is low, and falling, for less
skilled workers. Better-educated workers get better benefits.
o The lower the level of education and skills, the higher a worker's risk of
unemployment
o The key to rebuilding the middle class is empowering ordinary workers
with the edu~ation and skills they need to earn good livings in the new
economy.
�ills Matt r Mor
III
arnlngs
II
£!I
Average Annual Earnings of Men
by Educational Attainment
60
1993 Dollars (in thousands)
60
College Grads
50
40
30
- ... , . . . . . .
----~--.-------
..... _. " . _.
.
- ...
-------
50
~--------
. ... __ . __ ... __ . ___ . ~c!I'!l'? .~o-'l~gE? _ _ _ _ _ _ _.... _. _.. _
_. _ . _.... _ __ _ _ _ _. _. ___ . _ _ _ __
_
t!i9~ _S_c!1~~I_ ~~~d.s___ ~'"
~
40
30
I~__L-~__~__L-~__-L__~~__-L~~~::~~~~~:~: 20
20~ 1979
1981
1983
1985
1987
1989
1991
1993
Note: Workers 25 years of age and older, working year round, full time. Data on educational attainment for 1991 through 1993
are not directly comparable to those from prior years. Numbers for 1993 used 1990 population weights, whereas data for other
years used 1980 population weights.
Source: Bureau of the Census, Current Population Survey
Prepared By: OASP 1/18/95
�Skills Matter More: Benefits
Employer-Sponsored Benefits
by Educational Attainment, 1979 ~ 1993
Pension
Pan::enI. of all waga and &IIla.!y WO!'kIw
90
80
' • • • . . . . . . . • • . . • . • • • • • • . . . • . . • . . . . . . .
70
' . . .
. . . . • •
Health
.C.o!I~g~ ~!a..d:>
• .....
Percent of all wage and salary WOIker&
90
.....
. • - . . • . .• 80
High SGhool·{?;;'ads· . . ..
........
. ... - -
. . . - I 70
lege Grads
60
'
~
•
• . . . • . • ••
Some College
.•....••.•.....•.... •....
60
High School Grads
................................. .
~
~
r· .--...
...-.... -' -.. .. --..-. .
I
50
Less than High Schoo
Some Colleae
40
• . . .•
••..••..•••.•...•••
30
, .•••.•••••••••• _ . .
... •.••
40
• ....•.....•.•...•
......
············:···130
L -______________________________________________________~I
20
1979
1983
Source: Current Population Survey
1988
1993
1979
1983
1988
Prepared by: OASP 1/18/95
20
1993
�Skills Matter More: Risk of Joblessness
Unemployment Rates by Educational Attainment
.
1979 ~ 1993
20%
200/0
15%
f················· -" : . ..
-...
.--.
--- -----
----...-.. --. ---
~
150/0
ess
.... than High School Diploma
10%
100k
High School Grads
Some College
. - - - - - - - _.
~,:!,!~
4-year College Degree---.,.
'.......
5°k
r
SIIII. . . . . _ . . _-IiIi?7'f"""-jI
OOk
0%
1993
--------------------------------------------------------------------~
L'
1979
1981
1983
Source: Bureau of Labor Statistics
1985
1987
1989
1991
Prepared by: OASP 1/18/95
�Tax Reform to Favor Skill-Building
o Current tax policy fails to fully reflect the importance of education and
job training as investments.
o The President wants to fix this. Under his proposal, Americans could
deduct from their taxable income the costs of college or job training for
themselves or their families. Up to $5,000 per year will be deductible
starting in 1996, rising to $10,000 in 1999.
o Every taxpayer will be able .to use this tax break for education and
lifelong job training. Taxpayers would not have to itemize their deductions
to get the education and training deduction. And such expenses would not
be subject to the 2-percent "floor" on miscellaneous deductions.
o
Middle-class families will get a break when their budgets are tightest- .
when it's time to pay for school. And an estimated half-million more
Americans every year w.ill get education or job training because of the tax
deductions the president is proposing.
o To focus the tax cut on the middle class, deductibility would be phased
out over the income range of $100,000 to $120,000 for a couple filing
jointly, and between 570,000 and 590,000 for individuals.
o The President has also called for letting more Americans make tax
favored contributions to Individual Retirement Accounts, and letting them
use their IRA's to finance education and training.
o Competition among America's thousands of learning institutions would
.block attempts by schools to capture all the benefits of the tax break by
raising tuition.
o A December poll, following the President's Middle Class Bill of Rights
proposal, found that 84 percent supported tuition tax deductibility,
compared with 56 percent favoring capital gains tax cuts.
o The Republicans want more tax breaks for corporations, and for people
who are already wealthy. Instead of delivering corporate welfare, and
benefits to those who need them least, we want the tax code to empower
hard-working people to make it in America.
.
�Who Gains from the Middle Class Bill of Rights?
Distribution of Tax Cuts by Family Income Group
35
Percent of Tax Cuts
30
~
"
,
-
-
-
-
!"
-
-----
'--
-
--~---
-----------
25
20
15
10
~
-
-
-
-
~
5
o
,
. Less than.
$30,000
'$30'000-'
,
• $50,000
,
$50,000:'
, $75,000
$75,000
$100,000
" Family Income Group
'Source: Office of Tax Analysis, Department of Treasury.
.
$100,000
200,000
More than
$200,000
�Who Gains from the Republican Contract?
Distribution of Tax Cuts by Family Income Group
30
Percent of Tax Cuts
25
20
15
10
5
o
Less than
·$30,000
$30,000$50,000
$50,000$75,000
$75,000$100,000
Family Income Group
Source: Office of Tax Analysis, Department of Treasury.
$100,000
200,000
More than
$200,000
�Education and Training:
From Bureaucracy to Empowerment
o Beyond tax breaks to favor education and training, the Middle Class Bill
of Rights also calls for a fundamental reform of federal training programs,
oriented around Skill Grants. Seven core principles together define a
radical restructuring of employment and training policy:
Individual Empowerment. Instead of going where some bureaucracy
sends them, individuals should be empowered with resources so they can
choose for themselves what skills they need to boost their earning power•
o
• Unemployed and low-income workers, who often can't benefit from the
tuition tax deductions President Clinton has proposed, can get Skill Grants
worth up to $2,620 per year, for up to two years, that they can use as they
choose for learning new skills.
• Both tuition tax breaks and Skill Grants will be supplemented by
Individual Education Accounts. These low-cost loans will be available to
any person, with flexible repayment options, to enable every American to
invest in their skills and repay at the pace their future income allows.
Leaner Government. This proposal would eliminate over 50 separate
proe;rams, replacing them with an integrated system that minimizes red
tape and maximizes individual choice.
O·
o Good Data to Guide Choices.
Reforms woven throughout the initiative
and centered on the networks of One-Stop Career Centers already under
construction in the States-will give workers and job seekers access to
reliable computerized data on jobs, careers, and the success records of
training institutions, so that they can make good choices to improve their
futures.
o Accountability. Too often today, training providers aren't held
accountable for results. The reform package will fix this by emphasizing
individual choice and competition so that individuals can pick providers
who deliver; by providing good performance data so people know what
�training pays off in the working world; and by setting quality standards for
training providers to cut off the frauds and the incompetents.
o .State Flexibility. Washington doesn't have all the answers. States
should have the flexibility to reflect local conditions and respect local
priorities. The President wants to let states tailor training programs and
delivery systems as they see fit. Most rules dictating administrative
procedures will be wiped out States can seek waivers from many of the
rules that remain, and can plow the savings back into individual training.
o Private-Sector Partnership. At base, employment and training policy
isn't about government. It's about jobs, and that means the private sector
has a central role. Business and labor will be full partners in designing and
running training, job-search, and information services. On-the-job training
will get the support it deserves. New awards will recognize excellence in
creating workplaces that expand opportunity by capitalizing on and
rewarding worker skills.
o Paths from School to Work. Preparing America's youth for the world
of work, including disadvantaged youth, is a vital task that is too often done
badly today. To fix this, employment and training programs for young
people, including vocational education, will be streamlined and reshaped to
support the community-based school-to-work movement already underway
in every State. The youth component of this reform initiative represents a
major extension of the system building and consolidation unleashed by the
School to Work Opportunities Act of 1994-including a school-to-work
"second'chance" for dropouts and kids at risk.
The Tool Kit for Hieher Incomes:
The President's initiatives and proposals-tax deductions for education and
training; training reforms centered on skill grants; direct student loans
(with the option to repay at the pace your income allows); solid data
delivered through one-stop career centers; and school-to-work
apprenticeships-together deliver to Americans' a tool kit of skill-building
options. These tools will let working people take control of their economic
futures, and secure for themselves and their families a place in America's
expanding new middle class. They will help us grow together again.
�More Education, Higher Earnings
Median Earnings of Male Workers in 1993
. $40,000
$35,000
$30,000
. " " - - .
~
- - - -
~
. - -
~
-
-I·.··
"..,;"'4,:;.~ ..•'_-;,
.-".,
.... _"'-:·I.'t'\ ,,,;;p'''''' -':.
"vtr".::,
$25,000
$20,000
$15,000
$10,000
High School Graduate
2-Year Degree
Bachelor's Degree
SOURCE: Bureau of the Census, Department of Commerce. Median earnings of males 25 years and older.
�More Education, Higher Earnings
Median Earnings of Female Workers in 1993
$30,000
$25,000 .......................
. ................................. - - - -.... - - ... -. - - - -.. .
$20,000 .................... _...... .
$15,000 ....... - .
. .. - -. . . . . . .. "'
$10,000
$5,000
$0,000
High School Graduate
2-Year Degree
Bachelor's Degree
SOURCE: Bureau of the Census, Department of Commerce. Median earnings of women 25 years and older.
�Job Training Pays Off
Median weekly earnings of young workers by educational
training received, 1991
$700
attainme~t
and
Dollars
riiNOtraining DWith Training
$600
$600
$500
.............................................................................................................................................................................................................$480..··..
··....··
$440
$400 t·························..··················..·········....·$l8&··..······..·....-····.. ···..·.... ········..$;6~. · . . . · ·
$300
$200
$100
$0
High School
Some College
College Degree
Source: National Longitudinal Survey of Youth. Median weekly earnings of VIrOrkers aged 25 to 34, in 1991, by training received
between 1986 and 1991.
�Securing Middle-Class Status
For Working Americans
Our efforts to boost the earning power of working Americans must
be backstopped by steps to ensure that they aren't robbed of their chance at
middle-class status.
Health Care
o Health care reform remains as urgent as ever, despite the lack of action
in the 103rd Congress. Today, 39 million Americans are uninsured. Every
day we wait to take action, more families live in jeopardy of losing their
coverage due to illness or job loss-and with their'coverage, losing their
grasp on middle-class security.
o At the same time, increasing 'health-care costs and decreasing coverage
burden government budgets at the federal, state, and local levels.
o The Administration plans to work with Congress to take the first steps
towards health-care security by passing legislation to reform the insurance
market, making coverage available and affordable for children and
unemployed workers.
o We must make sure that those currently covered by Medicare and
Medicaid remain protected.
o And we must reduce the costs of health care if we are to keep the federal
deficit on a downward path.
Making Work Pay
o Real average wages have fallen since 1979 for workers with high-school
educations, for both men (down by 19%) and women (down by 3%).
o The President and Congress have expanded the Earned Income Tax
Credit, delivering a tax cut to 15 million additional working families and
encouraging work instead of welfare.
�We can't rely on the Earned Income Tax Credit alone to make work pay.
It phases out as income rises, so low-wage workers face a high "shadow"
tax rate. The minimum wage makes every hour of work pay more, and
complements the EITC.
·0
o But the real value of the minimum wage is now 270/0 lower than it was in
1979. The last increase in the minimum wage (to $4.25) was in 1991. Since
then,intlation has cut its real value by nearly 50 cents.
o By next year-if it is not increased-the minimum wage will be at its
lowest real level in four decades.
o Two-thirds of aU minimum-wage workers are adults. The average
minimum-wage worker brings home about half of his or her family's weekly
earnings (based on 1990 data.)
o An American working full time, all year at the minimum wage doesn't
earn enough to bring a family of four above the poverty level (even when he
or she gets the EITC.) The ranks of the working poor are growing.
o The erosion of the minimum wage since 1979 accounts for an estimated
20 percent of the increase in wage inequality among men, and 30 percent of
rising inequality among women.
o Recent studies have found that modest minimum-wage increases have not
significantly cut employment, and boost total worker income.
o The last .minimum wage increase passed both the House and the Senate
with overwhelming bipartisan support
o A December Wall Street Journal-NBC poll found 75-percent support for
raising the minimum wage--with even higher support among blacks, women,
and young people.
Pension Security
o Losing the pension earned by a lifetime of hard work is one of the
cruelest risks faced by ordinary Americans. The Administration launched
work on pension security in its first months in office.
�o The gap between pension promises and pension-fund assets widened
from $27 billion in 1987 to $53 billion in 1992•
In mid-1994 there were 1.2 million workers and retirees in underfunded
plans at troubled companies (and .8 million in all underfunded plans) and
the deficit of the Pension Benefit Guarantee Corporation stood at $2.9
billion.
. 0
o Last year, the Administration and Congress acted. Reform legislation
was drafted to tighten funding requirements, give the PBGC better tools to
enforce the law and prevent companies from walking away from pension
promises, and putting the burden of insuring against underfunding on the
plans causing the biggest problems.
o Congress passed the Retirement Protection Act of 1994 as part of the
legislation implementing the Uruguay Round trade agreements under the
General Agreement on Tariffs and Trade.
o Congress and the Administration have taken action to reduce the pension
risk facing workers and retirees, giving us a model for the rest of our
campaign to raise the incomes, bolster the security, and expand the
opportUnities of working Americans.
�orking amilies are Poor
More
Percentage of Working Families in Poverty: 1975-1993
12
Percent in Poverty .
11
10
,)
9
8
7
1975
1980
1985
1990
1993
Source: Bureau of the Census, Current Population Survey_ ·A working family is defined as one with children where
someone in the household worked.
�Minimum Wage Work Does Not Lift
Families Out of Poverty
Annual Earnings at the Minimum Wage as a Percentage of the Poverty Line: 1959-1995
110
Percent of Poverty Line
100
90
......... . ........ - . . .. .................. . ............................... .
80
With
EITC
70
60
50
1960
1965
1970
1975
1980
1985
1990
1995
Note: Annual earnings for a family of four with one full-time, year-round minimum wage worker as a percentage of
the four-person poverty line. The four-person poverty line for 1994 and 1995 are from Congressional Budget Office
projections.
�\
TRANSCRIPT OF
REMARKS BY THE·PRESIDENT
TO PEOPLE OF THE GALESBURG AREA
.
Sandburg Community ,College'
Galesburg, Illinois . ,
Thank you for that -w:onderful and warm welcome. It is wonderful to be here.
(Laughter.) Thank you, Dr. Crist, for making me feel so much at home. Thank you,
Congressman Evans, for coming down; and Congressman Poshard delighted to see you.
And Mayor Kimble, thank \f>u for making me feel welcome here. The representatIves of
Knox College and Blackhawk Community College, as well as Carl Sandburg Community
College, I'm glad to see all of you here.
. ' ,
. ,I~m glad that Secretaries Reich and Riley came with me, and I understand they
have already spoken, which makes anything I say perhaps redundant. (Laughter.) .
I met a college president .the other day; he looked at me and said, "I've got a lot
of sympathy with you. Being President is just like running a cemetery --:- you've got a lot
of people under you and nobody is listening." (Laughter and applause.)
I want to begin by saying how very, very happy and proud I am to be here today.
'
I believe as strongly as I can state that community colleges represent the very best of
America in 1995, and where we need to go as a country with all of our institutions -
community based, flexible, committed to quality, oPPQrtunity for everyone, ·with a real
sense of community. I'm honored to be here, and I'm honored to have all of you here.
.
I'd also like to recognize the peopl~ w:tto were ,with me just a few moments ago
who participated in our little roundtable, who have had some experience with this
institution. I'd like to ask aU of them to stand up that were in my private conversation -
(applause) -- because I want tQ thank them. (Applause.) Thank you. They're employers
of people who came out of this community college; they're students; they"re former
students; they're people who have taught here. They are a picture of America.
,
'
I came here to talk about America, about where we are and where we're ~oing.
And I don't think we could have picked a better place. This place is so steeped In our
national history, just as this community college is so representative of the best of our
present and our future. The Underground Railroad came through Galesburg and, as all
of you know and as you saw just a few moments ago, over 135 years ago, Abraham
Lincoln and Stephen Douglas met here for one of their famous debates. How'd they do
just a few minutes ago? (Applause.) Thank you. I met them outside and they were still
' .
.
arguing about who really won.(Laughter.)
I identified with what President Lincoln said. He performed so brilliantly in
those debates, but he lost the Senate race anyway. And he said that it hurt too much to
laugh and he was too old to cry. And then he said something I have always kept with
me -- in fact, I've got a copy of the exact quote on the wall in my private office in the
White House. He said after Douglas defeated him for the Senate, he waS walking home
�and it had been raining that day and the path was muddy, and one of his feet slipped
and hit his other foot and knocked his footing out from under him. But just before he
fell, he righted himself and he smiled and he said, "This is a slip and not a fal1."
(Applause.) Well, I think we all ought to try to keep that in our own minds as we deal
with life's challenges and adversity.
'
,
The Lincoln-Douglas debates, as you just heard for a few moments, were about
the course of our country and the proper role of government in a time of great change.
In 1858, of course, the issue was slavery. Lincoln believed that it was a national issue.
Long before he believed the government could abolish slavery, he at least believed the
government could stop it from expanding. Douglas believed it was not a national issue;
that it should just be up to the states or the territories. If they wanted to keep slavery,
they could vote for it and then come on in to the Union.
'
'"
The Republican' Party was born out of a conviction that even though we are a
country deeply devoted to limited government, there are some things that th~ times
demand natIOnal action on, and that at that moment, the times demanded, first, national
action to stop the spread of slavery, and then national action to stop slavery.
,\
About a half a century earlier, the Democratic Party was born in the presidency
of Thomas Jefferson, who passionately believed in limited government. I was driving \
across the beautiful Illinois farmland, feeling very much at home thinking about how
Jefferson loved being on his farm more than he liked being at the White House, and
how he wanted to limit government. But when he became President, he knew there
were certain things that he had to use the power of the nationaI government to do '
because the times demanded it.
He bought the Louisiana Purchase, $15 million -- peanuts, really, to us for all that
land. I like it because it included Arkansas. So if he hadn't done it I could never have
been an American, much less president. (Laughter.) But at the time it was a stunning,
sweeping thing. The price of Louisiana was the entIre budget of the national
government for a year. Can you imagine what you'd think of me if I wanted to spend
, that much on any piece of real estate? (Laughter.) But he did.
, Both believed in limited government. Both approved of action by the national
'government to meet the demands of the time, to do what the peoJ?le needed. Our
founders established this great country under a Constitution that lImits government. '
Mostly it limits what government can do to private citizens and gives us a lot of elbow
room to think what we please and say what we please and go where we please, and
worship God as we please. It aIso liririts government in othyr ways, dividmg it at the state
and local, as well as the national level -- the president, the Congress, the courts. But it ,
was set up to allow all of us to pursue life, liberty and happiness. And it was set up with '
enough flexibility so that over time we could have the kind of government that we
needed' as a people -- not the kind of people that the goverIiment needs, but the kind of
government that we need'as a people.
, , '
Now we're ~t ,another g'~eat sea-~hange period of Americ~n history. Everyone
knows we are movmg from an mformation age -- I mean, to an mformatIOn age from an
industrialized age in which all organizations were bigger, more hierarchical, more
, bureaucratic, to a time which is more flexible, more rapidly changing, more full of
opportunity and uncertainty.' And so we will have to have some changes in what we
expect our government to do, but we have to be clear about our purpose.
'
�I think our purpose has to be to keep the American Dream alive for all the
people in this country into the 21st century; and to make sure we cross the threshold of
the next century still the strongest country in the world, still a force for freedom and
peace and democracy at home and around the world.
f
Every American who works hard and obeys the law should be able to get ahead in
this new world. It should not be a province of opportunity for a few. To get that done
we face enormous challenges. Most of the people who are at a community college know
'
. better than I that for the last 10 or 15 years the majority of our people have worked
longer and longer work weeks for ~he same or lower wages; that in the last year alone
over a million American in working families lost their health insurance.
a
This is quite new phenomenon for us. From World War II until 1978, the
. American economy grew, and all income groups grew at about the same rate that the
American economy did. So we were rising together. For the last 15 years, the top 20
percent of Americans had a dramatic increase in their income; the next 20 percent, a
modest increase; the next 20 percent were stagnant; the bottom 40 percent had declines
in their incomes. We're talking now about working people, not people who are on
welfare.
'
So if a lot of Ame'ricans -- about half of us -- are working harder for lower wages
-- and actually, we also know now, sleeping a little less at night -- it's no .wonder that .
there's a lot of stress in this country. We also know that this is a time of great change.
It's not just the workplace that's changing, the nature of our communities are changing;
our families are under great stress. Life seems to be too random and too insecure for
too many people. And yet, we have to admit there is no country in the world that has
remotely an economy as strong as ours, as full of opportunity, as full of hope.
So what's the trick to br~dge the gap; to make sure that everybody who· wants to
do the right thing has a chance to make that leap into the economy of the future and
succeed? That must be the mission of the United States in these 'last five years of this
century. (Applause.)
)
,
I. told these folks that were good enough to spend about 45 minutes visiting with
me that I probably enjoyed it more than they did because before I became President,
when I was' a governor, I did this sort of thing all the time. I knew that my mission was
to generate more jobs and increase the education and skills' of our people .. And I lived
in a place that was small enough where it was more possible to talk about political life in
nice, calm terms, inStead of what normally tends to dominate the debate today. But I
couldn't help being just overcome almost in my admiration for their individual stories,
which wouldn't be all that much different from your individual stories. .
.
I ran for President because I wanted to do just what you clapped for. I do not
that we have to go into the future taking advantage of all these opportunities for
some and letting others fall behind and becoming more divided. But I think, as I have .
said now for more than three years, we must do three things. We've got to have a new
economic policy designed to help the American people compete and win in a global
ec~:momy i~ whic~ the gov~rnment is a partner with people In their private lives and' in
.'
prIvate bUSIness In expandIng opportumty.
believ~
In the first two years, that meant that we had to cut the deficit because we spent
the 1980s dealing with our economic problems, trying to spend our way out of them and
exploding the deficit. Now, I know that's not very popular; it's kind of like going to the
dentist. Everybody's for going to .the dentist, in general. Did you ever see anybody who
�wanted to do it in particular when it came their time to go to the dentist? That's the
way the deficit is. Everybody says -- you take a poll; people will say, yes~ cut the deficit.
But then we have to do the things to do it; it's not very popular. It's like goin~ to the
dentist. So I had a drill in your tooth the last two years. But we cut the deficIt by $700
billion, thanks to the help of these two gentlemeJ).. (Applaus~.) And that's $11,000 a
family; that's not a small piece of change. .
.
..
And we expanded trade, and that was controversial. A lot of my best supporters
said, why are you trying to do all these trade deals; the more we trade, the more we have
low-cost products from low-wage countries coming into America, putting pressure on
American wages. That's true, but it's only half true. Now, if we don't do anything, that's'
. happening; that's been happening for years. And it is true that some of our people have
.either lost their jobs or can't get wage increases because they're competing with products
'
overseas, produced by people who work fpr wages we can't live on; that's true.
.It's also true that when we sell things to other countries, em balance the people'
who make the things and the services we sell to other countries make wages above the
national average. So if we don't do' the trade deals, we'll get. the downside of the trade
war. The reason I fought for the, trade agreements was so we could create more
high-wage jobs in America by selling more world-class American products around the
world. And it's working. (AppIause.) So we need a new economic policy. We've got to
sell; we've got to produce; we've got to be productive; and it has to be a partnership.
The second thing we need is what I called durin~ my presidential campaign a New .
Covenant, a new approach to our society. It was then, It has been for two years and it
will always. remain my contract with you. (Applause.) But it's about more than a tax
cut, although cutting taxes are part of it.' I believe what this country needs on a national
basis is what I see at the community college here. What those of us in the position to do
so ought to be doing is expanding opportunity, but only for those who will exercise the
personal responsibility to make the most of those opportunities.
.
You build a community with opportunity and with responsibility; with rights and
responsibilities. You can't have one Without the other and last for a long time. You
can't have people being responsible all the time and never getting anything for it. Pretty
soon they get tired. (Applause.)
But neither can you have people getting things all the time and never giving
anything back. Pretty soon the well runs dry. (Applause.) . .
So that's what we've been trying to do. That's what. the crime bill was all about.
We cut the government bureaucracy over five years by 270,000 people and gave all the
money back to local communities to hire police, to build prisons; to drug treatment
. programs, to do things that would lower the crime rate at the grass-roots level for people
who use the money right and were responsible.
.
That's what I hope this welfare reform debate that we're ginning up again after a
year will be all about in Washington. I do not believe that most Americans really want
simply to reduce welfare so that we can punish poor people. I think what most
Americans want iSla welfare system that puts an end to welfare, that puts people to work
and lets them be responsible parents instead of just having kids. I think diat's what we
want. (Applause.)
And that's why we have invested so much in education because education, by
definition, is part of a covenant. You cannot educate somebody who will not be
�,j
li
\
. educated. All you can do is throw the life line of opportunity out· there and someone
either does it or not. They either exercise their own responsibility or not.
.
. So we worked to expand Head Start and to set standards that are great for our
nation's schools and to have new partnerships for young people that don't go to college
to get further education. And we reformed drastically the college loan program so we
could cut the costs and string out the repayments and make it something that could
really be used by people instead of just another headache. And that's all made a
difference I think. So.a new economic policy; a new covenant, a new social policy.
The third thing we've tried to do is to give you a different kind of government, to
have the government in w'ashington change the way the economy is changing -- to have
it be smaller, yes, but also more effective. To literally reinvent government -- to use the
Vice President's phrase -- by cutting the bureaucracy to its smallest size in 30 years but
increasing our ability to solve problems that the federal government needs to solve..
There are 100,000 fewer people working in Washington, D.C., or for the federal
government today than there were on the day I was inaugurated president, but we have
solved a lot of problems that were left too long. And I would just give you one or two
examples. (Applause.)
Small business people used to· have· to fill out a multi-page form that took them
hours to fill outlto get an SBA loan. We've taken that down to one page and you can
get an answer in tHree days now. So that's an example of what we're trying to do to
reinvent the government. (Applause.)
I don't know if the Secretary of Labor mentioned this, but at the end of last year,
we reformed the Pension Benefit Guaranty Corporation -- that's a mouthful -- that's the
group in Washington that's supposed to keep your pension well. And it's going to help
save the pensions of 8.5 million Americans whose retirement was at risk after years and
years and years of hard work. - .
Th-ere are problems the federal governri:J.ent still should be ~olving. -And when the
floods were raging here -- the 500-year flood -- up and down Illinois and Iowa, after
years in which the Federal Emergency Management Agency was to go to the federal
government and everybody complained about it, I think you saw by the way ,they showed
up and the way they performed that it is working now, it is effective, it is doing its job.
(Applause.) .
So we're moving in these directions. But it is not enough. What are the results of
the first two years, not from our point of view in what we did, but from your lives. Well,
we have 5.6 million more jobs; and that's· a good thing. And the unemployment raJe has
dropped very low by historic standards, although not low enough to suit me, it's still
dropped quite a bit - by more than 2 percent. And 5.6 million new jobs is nothing to
sneeze at.
"
'
.
.
,
And manufacturing jobs went up in ·every month in 1994 for the first time since
1978, which means that manufacturing is not inconsistent with the information age. It
helps our manufacturing come back when we increase productivity and use computers
and educate our workers. So that's good; that's all good. But most folks still haven't
~otten a pay raise out of this recovery. Many people are still worried about losing their
Jobs. Another million Americans .lost their health insurance. Why is that? That is .
because the wages are still set in an environment that is highly competitive because of
technological ,changes and foreign competition.
�Ie)
. · . s o if we want' to raise incomes, the only way you can do it. is to get more .
high-wage jobs in,this country;take less out of working people's 'pockets; or increase
education and training. There is no other way to do it. And that's what we have to do.
(Applause.) So what I want to dO now is ~- we worked hard to get the fundamentals
. fixed for two years -- I want to spend two years working on lifting incomes and prospects
and optimism and real hope for the future among people who are carrying the load in
this country. That'~ what we can do. And that's what the Middle Class Bill Of Rights is
all a b o u t . , ' .
I might as well have called it the Bill of Rights' and Responsibilities, because it
doesn't do anything for anybody who's not already doing something for himself or
herself. Anybody can give a tax cut, but what I want to do is cut taxes in a way that
strengthen families and raise incomes. That's what w,e need to be doing in these country
-- we need to strengthen families, we need to raise incomes.
Fifty years ago, the GI Bill of Rights helped transform a wartime economy into
. the most successful peacetime economy in history. It literally built the great American
middle class, helping .them get houses and education and to raise their kids. And now
what I want to do is. to implement this Middle Class Bill Of Rights -- these ideas that
will help us move into the 21st century with the American Dream alive for everyone.
'.' . Now, if you agree with the analysis I just gave you, I hope you will agree with the
particulars. First of all, I think people ought to be able to deduct the cost of education
after high school from their taxes. (Applause~) If you think about it, you can deduct the
interest on your home. Why? Because we want people to buy homes; we want t>eople .
to be homeowners. We think it's.a good thing -- it's important to being an AmerICan and
having a sold life. Well, in the 21st century, and in 1995, and with all the people I just
finished talking to, having a decent education is also important to being in the middle
class. And you may not get to the,lhome-ownership stage if you don't have an education
in the first place. So we· ought to let people deduct the cost of ap. education. .
(Applause.)
.
.
,
.
.
.
.
. '.
Secondly, we ought to try tosuj>port working families more, amI so I
recommended a tax credit, or a tax reduction, of $500 a child for every child under 13 in
families with incomes of $75,000 a year or less. In 1993, we cut taxes an avera~e of
$1,000 a year for working families who were on really modest incomes and haVIng a hard
time making ends meet. It's now $26,000 a year or less will ~etan average of $1,000 tax
cut, will owe what the taxes were when I took office.Bl;lt thIS will help people raise their
children."
.
.
.
.
Third, I believe we ought to bring back the IRA, the Individual Retirement
. Account, let people put $2,000.in it-- (applause) -- but under our 'proposal; you could
take the money out m any year, tax-free; as long as .you spent it on education, health
insurance, buymg a home for the first time or the care of ari elderly parent. This would
empower .people to solve their own problems. It's something that government can let
you do. for yourself. It requires no bureaucracy; it requires no:program. It requires
nothing --just letting you withdraw money you save, tax~free, to solve a problem for
yourselves and for the United .States. (Applause.)
.
. . Fimiliy, finaliy, we propose to take the literally billions of dollars the government
now spends on dozens -- lIterally dozens -:- of training programs and consolidate those
programs and make that money directly available to people who' are now eligible for it.
That is, today, people who are unemployed can get help from a government training
.' program. And people who are on quite modest incomes who are eligible, for example,
�. to participate in a job training and partnership act, training programs, can get help
. .
through a training p r o g r a m . ' .
But there are literally dozens of these programs. You've got to figure out what
you're eligible for, what the criteria are, what the program is, are you going to be in it. I
.mean, by the time you get through fooling with it, it may seem like .it's not worth the '.
trouble. We discovered that we could collapse SO of these programs and just give you
. the money if you're eligible for it and it would make people who are eligible able to get
a chit, a voucher for education only worth up to $2,600 a year for two years .
. Now, that's better than having a federal·bureaucracy. It's better than giving the
money to a state bureaucracy. Everybody in America, just about,' is within driving
distance of the community college now. We do not need all these separate government
p
. ro~rams telling people what to do. We ought to just give you the money if you're
eligIble for it and let you briI').g it here and get a good education. That's the fourth
element of our program. (Applause.)'
.
. I like this Middle. Class Bill of Rights a lot because it furthers all three objectives
that I had when I ran for president. It helps us build a new economy. The more people
we· educate, the more powerful our nation will be, the stronger our economy will be. It'
helps us build a new covenant. We offer more opportunity to people if they exercise the
responsibility to take it, they have the powyr to improve their own lives. All of you do.
\
You know that or you wouldn't be here today.
And it changes the way government works. Government is still being used t help
expand opportunity, but in a less bureaucratic, less mandatory, more empoweripg wax. I
like it, and I hope the Congress will like it as welL And I hope you will help them lIke it
by telling them that you like it. (Applause.).
.
.
Under this last proposal -- let me just give you one example. If we want to set up
centers where what the government does is make sure you have information on the jobs
that are available in an area and the educational opportunities that are available in one
place.
.
You could show ·up at the local one-stop center and find out, for example, here
about jobs opening up at Maytag because of the new $164 million retooling project
they've got underway. .Then you could figure out whether you could get the skills needed
to be a part of that project in this place. And if you could, you qualified, you could
simply take your certificate, show up here, and start to schooL Much better than having
..'
to enroll in some sort of program. .
_
. Here at this community college -- and this is true allover the country, maybe not
quite this good, but this is typical-- there is an extraordinary job placement rate of over
94 percent at an average wage of nearly $12·an hour. And believe me, that's a lot better
than a lot of people are facing who have no education and training and who have been
left behind by the changes that are going on in our economy.
This is the kind of opportuni!y that l believe the Middle Class Bill of Rights can
help. create. This will enable us to fInish 'the job. Yes, we have laid the foundations of a
disciplined, responsible economic policy. Yes, we have taken a strong stand against
crime. Yes, we know -- and. I hope we'll have a bipartisan consensus on what to do·
about problems like welfare. But 'until we know that we have done everything we can to .
�use the power of this country to give every American the opportunity to win in this
global economy, thejob will not be finished. That, more than anything else, can keep
the American dream alive in the 21st century.
.
So, as I go back to Washington, I ask all of you -- Republicans and Democrats -
to tell the people who represent you in Washington to adopt the same attitude about
these challenges that you have. If you think about it, in every new time our country
faces, there are new problems that have no necessary partisan solution. And the
problems fall over everybody and the opportunities come to people without regard to
their party, their philosophy, their race, or their region today. We should be united in
tackling these problems. They are America's problems and America's opportunities.
•You have seen over and over and over again, probably enough to make you
scream, that people in Washington know how to stop things for partisan gain; it's now
time for us to jom together and do things for the p'eople's gain. That's what you expect
us to do; that's what we need to do; that's what WIll take us into the next century WIth
the American dream alive and well, stronger than ever, and America stronger than ever.
I am convinced -- I am convinced -- having traveled the world now on your behalf,
having seen what is going on in Europe, having seen what is' going on in Asia, having
met with the leaders of all the Latin American countries, having a feel for what is
happening in this world, I am convinced more than ever in my life that the best days of
this country are still ahead of us -- (applause) -- if we remember that there are no
.
guarantees.
'
The founders gave us the'right to pursue life, liberty, happiness. That's what they
gave us the right to do. Over 70 years ago, your namesake here, Carl Sandburg, wrote a
poem inspired by the Washington Monument. And I want to close with the line from
that poem that meant the most to me: "Nothing happens unless, first, a dream." More
than anything, more even than our Constitution and laws, this country is a dream. And it
is our job to renew it.
Thank you very much, and God bless you all.
�,.;
THE WHITEHOUSE .
Office of the Press secretary
For Immediate Release
January 24, 1995
REMARKS BY THE PRESIDENT
IN STATE OF THE UNION ADDRESS
U.S. Capitol
9:14 P.M. EST
THE PRESIDENT: Mr. president, Mr. Speaker, members of
the l04th Congress, my fellow Americans: Again we are. here in the
sanctuary of democracy, and once again, our democracy has spoken. So
let me begin by congratulating all of Y0.l here in the 104th congress',
and congratulating you, Mr. Speaker. (Applause.)
.
If we agree on nothing else tonight, we must agree that
the American people certainly voted for change in 1992 and in 1994.
'(Applause.) And as I look out at you, I know how some of you must
have felt in 1992. (Laughter and applause.)
I must say that in both years we didn't hear America
singing, we heard America shouting. And now all of us, Republicans
and Democrats alike, must say: We hear you. We will work together
to earn the jobs you have giv·en us. . (Applause. ) For we are the
keepers of the sacred trust, and· we must be faithful to it in this
new and very demanding era.
Oyer 200 years ago, our founders changed the entire
course of human history by joining together to create a new country
based ona single powerful idea: "We hold these truths to be self
evident, that all men are created equal, endowed by their Creator·
with certain inalienable rights, and among these are life, liberty
and the pursuit of happiness."
It has fallen to every generation since then to preserve
that idea -- the American idea -- and to deepen and expand its
meaning to new and different times: To Lincoln and his Congress, to
prese~e the Union and to end slavery.
To Theodore Roosevelt and
Woodrow Wilson, to restrain the abuses and excesses of the Industrial
Revolution, and to assert our leadership in the world. .To Franklin
Roosevelt, to fight the failure and pain of the Great Depression, and
to win our country's great struggle against fascism. And to all our
presidents since, to fight the Cold War.
Especially, I recall two who struggled to fight that
Cold War in partnership with congresses where the majority was of a
different party. To Harry Truman, who. summoned us to unparalleled
prosperity at home, and who built the ar=hitecture of the Cold War.
And to Ronald Reagan, whom we wish well tonight, and who exhorted us
to carry on until the twilight st~ggle ~gainst communism was won.
(Applause. )
In another time of change and challenge, I.had the honor
to be the first president to be elected in the post-Cold War era, an
era marked by the global economy, the information revolution,
unparalleled change and opportunity and insecurity for the American
people.
.
mission
I came to this hallowed chamber two years ago on a
to restore the American ,Dream for all our people and to
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make sure that we move into the 21st century still the strongest
force for freedom and democracy in the entire world. I was
determined then to tackle the tough problems too long ignored. In
this effort I am frank to say that I have made my mistakes, and I
have learned again the importance of humility in all human ende.avor.
But I am also proud to say tonight that our country is stronger than
it was two years ago. (Applause.)
Record numbers -- record numbers of Americans are
succeeding in the new global economy. We are at peace and we are a
force for peace and freedom throughout the world. We have almost six
million new jobs since I became president, and we have, the lowest
combined rate of unemployment and inflation in 25 years. (Applause.)
Our businesses are more productive and here we have worked to bring
the deficit dqwn, to expand trade, to put more police on our streets,
to give our citizens more of the tools they need to get an education
and to rebuild their own communities.
But the rising tide is not lifting all boats. While our
nation is enjoying peace and prosperity, too many of our people are
still working harder and harder, for less and less. While our
businesses are restructuring and growin9 'more productive and
competitive, too many of our people still can't be sure of having a
job next year or even next month. And far more than our'material
riches are threatened; things far more precious too us -- our
children, our families, our values.
Our civil life is suffering in America today. Citizens
are working together less and shouting at each other more. The
common bonds of community which have been the great strength of our .
country from its very beginning are badly frayed. What are we to do
about it?
, More than 60 years ago, at the dawn of another new era,
President Roosevelt told our nation, "New conditions impose new
requirements on government and those who conduct government." And
from that simple proposition,he shaped the New Oeal, which helped to
restore our nation to prosperity and define the relationship between
our people and their government for half a century.
That approach worked in' its time. But we today, we face
a very different time and very different conditions. We are moving
from.an Industrial Age built on gears and sweat to an Information Age
,demanding skil~s and learning and flexibility. OUr government, once
a champion of national purpose, is now seen by many as simply a
captive of narrow interests, putting more burdens on our citizens
rather than equipping them to get ahead. The values that used to
hold· us all together seem to be coming apart.
So tonight, we must forge a new social compact to meet
the challenges of this time. As we enter a new era, we .need a new
set of understandings, not just with government, but even more
important, with one another as Americans •.
That's what I want to talk with you about tonight. I
call it the New Covenant. But it's grounded in a very, very old idea
-- that all Americans have not just a right, .but a solid
responsibility to rise as far as their God-given talents and
determination can take them; and to giVe something back to their
communities and their country in .return. Opportunity and
responsibility: They go hand in hand •. We can't have one without the
other. And our national community can't hold together without both.
(Applause.) .
Our New Covenant is a new set of understandings for how
we can equip our people to meet the challenges of a new economy, .how
we can change the way our government works to fit a different time,
and, above all, how we can repair the damaged bonds in our society
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and come tO,gether beh'ind our cOJlll'Oon purpose. We must have dramatic
change in our economy, our government and ourselves.
My fellow Americans, without regard to party, let us
rise to the occasion. Let us put aside partisanship and pettiness
and pride. As we embark on this new course, let us put our country
first, remembering that regardless of pacty label, we are all
Americans. And let the final test of ev.:!rything we do be a simple
one: Is it good for the American people?· (Applause.)
Let me begin by saying that we cannot ask Americans to
be better citizens if we are not better servants., You made a good
start by passing that law which applies ~o Congress all the laws you
put on tbe private sector, and I was proud'to sign it yesterday.
(Applause. )
But we have a lot more to d~ before people really trust
, the way things work around here. Thre'e time's as many lobbyists are
in the streets and corridors of washington as were here 20 years ago.
The American people look at their capital and they see a city where
the well-connected and the well-protected can work the system, but
the interests of ordinary citizens are often left out.
As the new Congress opened its doors, lobbyists were
still doing business as usual -- the gifts, the trips, all the things
that people are concerned about haven't stopped. TWice this month
you missed opportunities to stop these practices. I know there were
other considerations in those votes, but I want to use something that
I've heard my Republican friends say frcm time to time -- there
doesn't have to be a law for everything. So tonight, I ask you to·
just stop taking the lobbyists' perks. ,lust ·stop. (Applause.)'
We don't have to wait for legislation to pass to send a
strong signal" to the American people that things are really changing.
But I also hope you will send me the strongest possible lobby reform
bill, and I'll sign that, too. (Applause.)
.
We should require lobbyists to tell the people for whom.
they work what they're spending, what they want. We should also curb
the role of big money in elections by capping the cost of campaigns
and limiting the influence of PACs. (Applause.)
And as I have said for three years, we should work to
open the airwaves so that they can, be an instrument of democracy, not
a weapon of destruction by giving free T'iT time to candidates for,
,public office. (Applause.)
When the last Congress killed pplitical reform last
year, it was reported in the press that the lobbyists actually stood
in the hall,s, of this sacred building ana cheered. This year, let's
give the folks at home something to cheer about. (Applause.)
More important, I think we all agree that we have to
change the way the gover~ent works. Let's make it smaller, less
costly. and smaller -- leaner, not meaner.. (Applause.)
and well.
I just told the Speaker the equal time doctrine is' alive
(Laughter.)
The New Covenant approach to governing is as different
from the old bureaucratic way as the computer is from the manual
typewriter. The old way of governing ar:>und here protected organized
interests. We should look out for the interests of ordinary people.
The old way divided us by interest, constituency or class. The New
Covenant way should unite us behind a ccxmon vision of what's best
for our country. The old way dispensed services through large, top
down, . infl~ible bureaucracies. The New' Covenant way should shift
.these resources and decision-making frore bureaucrats to citizens,
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injecting choice and competition and individual responsibility into
national policy. (Applause.)
The old way of governing around here actually seemed to
reward failure. The New Covenant way should have built-in incentives
to reward success. The old way was centralized here in Washington •
.The New Covenant way must take hold in the communities all across
America. And we should help them to 'do that. (Applause.)
Our job
to empower people to
our security here at
do what we should do
a partner to help us
(Applause. )
here is to expand o~portunity, not bureaucracy;
make the most of their own lives; and to enhance
home and abroad. We must not ask government to
for ourselves. We should rely on government as
to do 'lI1ore for oursalves and for each other.
I hope very much that as we d~bate these specific,and
exciting matters,.we can go beyond the sterile discussion between the
illusion that there is somehow a program for every problem on the one
hand, and the other illusion that the government is a source of every
problem we have. Our job is to get rid of yesterday's government so
that our own people can meettoday's and tomorrow's needs. And we
ought to do it together. (Applause.)
Youknowi for years before 1 became president, I ~eard
others say they would cut government and how bad it was. But not
much happened. We actually did it. We cut over a quarter of a
trillion dollars in spending, more than 300 domestic programs, more
than 100,000 positions from the federal ~ureaucracy in the last two
years alone. Based on decisions already made, we will have cut a
total of "more than a quarter ·of a millio~ positions from the federal
government,making it the smallest it has been since John Kennedy was
president, by the time I come here again next year. (Applause.)
Under the leadership of Vice President Gore, our
. initiatives have already saved taxpayers $63 billion. The age of the
$500 hammer and the ashtray you can break on David Letterman is gone.
Deadwood proqrams, like mohair subsidies, are gone. We've'
streamlined the Aqriculture Department by reducing it by more than
1,200 offices. We've slashed the small business loan form from an
inch thick to a single page. We've'thrcwn away the government's
10,OOO-page personnel manual. And the government is working better
in important ways: FEMA, the Federal Emergency Management Agency,
has gone from being a disaster to helpir.g people in disasters.
(Applause.)
.
You can ask the farmers in the Middle West who fought
, the flood there or the people in California who have dealt with
floods and earthquakes and fires, and they'll tell you that.
Government workers, working:hand in hand with private business,
rebuilt Southern California's fractured freeways in record time and
under budget. And because the federal government moved fast, all but
one of the 5,600 schools damaged in the earthquake are back in
business.
NOW, there are a lot of other things that I could talk
about. I want to just mention one because it will be discussed here
in the next few weeks. University administrators allover the
country have told me that they are savin~ weeks and weeks of
bureaucratic time now because of our direct college loan proqram,
which makes college loans cheaper and more affordable, with better.
repayment terms for students, costs the ~overnment less, and cuts out
paperwork and bureaucracy for the government and for the
universities. We shouldn't 'cap that program. We should give every
college in America the opportunity to b6 a part of it. (Applause.)
Previous government progra1l"s gather dust. The
reinventing government report is getting- results. And we're not
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through. There's going to be a second round of reinventing
government. We propose to cut $130 billion in spending by shrinking
departments; extending our freeze on don,sticspending, cutting 60
public housing programs down to three, getting rid of over 100
programs we do not need, like the Interstate Commerce Commission and
the Helium Reserve Program. (Applause;) And we're working on
getting rid of unnecessary regulations a~d making them more sensible.
The programs and regulations that have. outlived their usefulness
should go. We have to cut yesterday's government to help solve
tomorrow's problems. (Applause.)
And we need to get government closer to the people its
meant to serve. We need to help move programs down to the point
where states and.communities and.private citizens in the private
sector can do a better job. If they can do it, we ought to let them
do it. We should get out of the way and let them do what they can do
better. (Applause.)
Taking power away from federal bureaucracies and g~v~ng
it.back to communities and individuals i~ something everyone should
be able to be for. It's time for Congress to stop passing on to the
state the cost of decisions we make here in Washington. (Applause.)
I know there are still seri.ous differences over the.
details of the unfunded mandates legislation, but I want to work with
you to ,make sure we pass a reasonable bill which will protect the
national interests and give justified relief where we need to give
it. (Applause.)
.
For years, Congress concealed in the budget scores of
pet spending projects. Last year was nc different. There was a $1
million to study stress in plants, and $12 million for a tick removal
program that didn't work. It's hard to remove ticks; those of us who
have had them know. (Laughter;) But, I'll tell you something; if
you'll give me the line-item veto, I'll remove some of that
unnecessary sp~nding. (Applause.)
But I think we should all remember, and almost all of us
would agree, that government still has i~portant responsibilities.
Our young people -- we should think of t~is when we cut -- our young
people hold our future in their hands. We still owe a debt to our
veterans. (Applause.) And our senior citizens have made us what we
are.
NOW, my budget cuts a lot. But it protects education,
veterans, Social Security and Medicare -- (applause) -- and I hope
you will do the same thing. (Applause.) You shOUld, and I hope you
will. (Applause.)
And when we give more flexibility to the states, let us,
remember that there are certain fundamental national needs that
should be addressed in every state, north and south, east and west -
immunization against childhood disease -- (applause) -- .school
lunches in all our schools -- (applause) -- Head Start, medical care
and nutrition for pregnant women and infants -- (applause) -- medical
care and nutrition for pregnant women ar.l infants. (Applause.) All
these things -- (applause) -- all these things are in the national
interest.
I applaud your desire to' ge.t rid of costly and
unnecessary regulations. But when we deregulate, let's remember what
national action in the national interest has given us: safer foods
for our families, safer toys for our children, safer nursing homes
for our parents, safer cars and highways, and safer workplaces, clean
air and cleaner water. Do we need common sense and fairness in our
regulations? You bet we do. But we can have common sense and still
provide for safe drinking water. We can have fairness and still
clean up toxic·dumps, and we ought to de.. it. (Applause.)
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Should we cut the deficit more? Well, of course., we
should. Of course, we should. (Applause.) But we can bring it down
in a way. that still protects our economic . recovery and does hot
unduly punish people who should not be punished, but instead should
be h e l p e d . ·
.
I know many of you in this chamber support the balanced
budget amendment. (Applause.) I certainly want to balance the
budget. OUr administration. has done more to bring the budget down
and to save money than any in avery, very long time. (Applause.)
If you believe passing this amendment is the right thing to do, then
you have to :pe straight with the American people. They have a right
to know what you're going to cut, what taxes you're going to .raise, .
and how it's going to affect them. (Applause.)
We should ,be doing things in the open around here. For
example, everybody ought to know if this proposal is going to.
endanger Social Security. (Applause.) I would oppose tha~,·and I
think most Americans Would.
.
Nothing is done more to und~rmine.our sense of common
.
responsibility than our failed welfare sistem. This is one of the
problems we have to face here in Washington in our New Covenant. . It
rewards welfare over work. It undermines family values. It lets
. millions of parents get away without paying their child support • .It
keeps a minority, but a significantmino~ity of the people on welfare
trapped on it for a very long time.
I worked on this.problem for a long time, nearly 15
years now. As.a governor I had the. honor of working with the Reagan
administration.to write the last welfare reform bill back in 1988.
In the .last two years we made
good start in continuing the work of
welfare reform •. OUr administration gave two dozen states the right
to slash through federal rules and regulations to reform their own
welfare systems, and' to try to promote work and responsibility over
welfare and dependency.
.
.
a
Last year I introduced the .,\lost sweeping welfare reform
plan ever presented by an admin~stration. We have to make welfare
what it was meant to be -- a second' chance, not a way of life. We
have to help those on welfare move to work as quickly as possibl~, to
provide child care and teach them skills if that's what they need for
up to two years. And after that, there ought. to be a simple hard
rule: anyone who can work must go to wock. (Applause.) If a parent
isn't. paying child support, they should be forced to pay.
(Applause.) We should suspend drivers' licenses, track the across
.state lines, make them work off what they owe. That is what we .
should do. ~overnments do not raise children, people do. And the
parents must take responsibility for the children they bring into
this world. (Applause.)
I want .to work with you, with all of you, to pass
welfare reform. But our goal must be to liberate people and lift'
them up; from dependence to independence,' from welfare to work, from
mere childbearing to responsible:parenting. Our goal should no;t be .
to punish them because they happen to be poor. (Applause.)
.
.
We should -- we Sho~ld require work and ~utual
responsibility. But we shouldn't. cut p.=:>ple off .just because they're
poor, they're young, or 'even because ·they're unmarried. We should.
promote responsibility by requiring young mothers to live at home
with their parents or in other supervised settings, by requiring 'them
to finish.school. But we shouldn't put theE and their. children out
on the street. (Applause. )
And I know 'all the arguments,' pro .and con; and I. have:
read and thought about 'this for a longtime. I still don't think we
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can in good conscious punish poor children for the mistakes of their
parents. (Applause.) My fellow Americans, every single survey shows
that all the American people care about this without regard to party
or race or region. So let this be the year we end welfare as we know
it. But also let this be the year that ~e are all able to stop using
this issue to divide America.
)
No one is more eager to end welfare -- (applause.) I
maybe the only president. who has actually had the opportunity to sit
in a welfare office, who's actually spent hours and hours talking to
people on welfare. And I am telling you, people who are trapped on
it know it doesn't work. They also want to get off. So we can
pro~ote together education and work and good parenting.
I have no
problem with punishing bad behavior or the refusal to be a worker or
a student, or a responsible parent. I just don't want to punish
poverty and past mistakes. All of us have made our mistakes, and
none of us can change our yesterdays~ . But every one of us can change
our tomorrows. (Applause.)
And America's best example of that may be Lynn Woolsey,
who worked her way off welfare to become a congresswoman from the
state of California. (Applause.)
:I know the members of this Congress are concerned about
crime, as are all,the citizens of our country. And I remind you that
last year, we passed a very tough crime ~ill -- longer sentences,
three strikes and you're out; almost 60 new capital punishment
offenses, more prisons, more prevention, 100,000 more police. And we
paid for it all by reducing the size of the federal bureaucracy and
giving the money back to local communities to lower the crime rate.
There may be, other things we can do to be tougher on
crime, to be smarter with crime, to help to lower that rate first.
Well, if there are, let's talk about them and let's do them. But
let's not go back on the things that we did last year that we know
work; that we know work because the local law enforcement officers
tell us that we did the right things, because local community leaders
who have worked for years and years to lower the crime rate tell us
that they work.
.
Let's look at the experience of our cities and our rural
areas where the crime rate has gone down and ask the people who did
it how they did it. And if what we did last year supports the
decline in the crime rate -- and I am convinced that it does -- let
us not go back on it. Let's stick with it, implement it. We've got
four more hard years of work to do to de that. (Applause.)
:I don't want to destroy the good atmosphere in the room
or in the country tonight, but I have to mention one issue that
divided this body greatly last year~ The last congress also passed
the Brady Bill and, in the crime bill, the ban on 19.assault weapo~s.
I don't think it's a secret to anybody in this. room that several
members of the last congress who voted for that aren't here tonight
because they voted for it. (Applause.) And I know, therefore, that
some of you who are here because they voted for it are under enormous
pressure to repeal it. I just have to tell you how I feel about it.
The members of Congress who voted for that bill and X'
would never do anything to infringe on the right to keep and bear
arms to hunt and to engage in other appropriate sporting activities.
I've done it since I was a boy, and :I'm going to keep right on doing
it until I can't do it anymore. But a lot of people 'laid down their'
seats in congress so that police officers and kids wouldn't have to
lay down their lives under a hail of assault weapon attack -- and I
will not let that be repealed. (Applause.) I will not let it be
repealed. . (Applause.)
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lid like to talk about a couple of other issues we have
to deal with. I, want us to, cut more spe••ding, but I' hope we won I t
cut government programs that help to preiJare us for the new economy,
promote responsibility and are organized from the grass roots up, not
by federal bureaucracy. The very best example of this is the
National service Corps -- AlneriCprps.
(Applause.)
It passed with strong bipa~~isan support. And now there
are 20,000 Americans, more than every served in one year in the Peace
Corps, working allover this country, helping people person to person
in local, grass-roots volunteer groups, SOlving problems and, in the
process, earning some money for their ed~cation. This is citizenship
at its best. It's good for the Alnericorpsmembers, but it's good for
the rest of' us, too. It I s the essence of the New Covenant, and we
shouldn I t stop it. (Applause. )
)
All Alnericans, not only in the states most he,avily
affected, but in every place in this country, are rightly disturbed
by the, large numbers of illegal aliens entering our country. The
jobs they hold ,might otherwise be held J::"{ citizens or legal
immigrants. The public service they use impose burdens on our
taxpayers. That's why our administratio~ has moved aggressively to
secure our borders more by hiring a recc:d number of new border
guards, by deporting twice as many criminal aliens as, ever before, by
cracking down on illegal hiring, by barring welfare benefits to
illegal aliens.
'
In the budget I will presen~ to you we will try to do
more to speed ,the deportation of illegal aliens who are arrested for
crimes, to better identify illegal aliens in the workplace as
recommended by the commission headed by former Congresswoman Barbara
Jordan.'
'
We are a nation of immigrants. But we are also a nation
of laws. It is wrong and ultimately self-defeating for a nation of
immigrants to permit the kind of abuse of our immigration laws we
have seen in recent years, and we must do more to stop it.
(Applause.) .
.
The most important job of oar government in this new era
is to empower the American people to suc~eed in the global economy.
America has always been a land of opportunity, a land Where, if you
work hard, you can get ahead. Welve become a great middle class
country. Middle class values sustain us. We must expand that middle
class, and shrink the underclass, even as we do everything we can to
suppo~ the millions of Americans who are already successful in the
new economy •.
America is once again the world's'strongest economic
power, almost six million new jobs in the last two years, exports
booming, inflation down, high-wage jobs are coming back •. A record
number of American entrepreneurs are living the American Dream. If
we want it to stay that way, those who w~rk and lift our nation must
have more of its benefits.
Today, too many of those people are being left out.
working harder for less. They.have less security, less
less certainty that they can eVEn afford a vacation, much
less'college for their kids or retirement for themselves. We canno~
let this continue.
~heY're
~ncome,
If we don I t act, our economy will probably keep doing
what it's been doing since about 1978, when the income growth began
to go to those at the very top of our economic scale and the people
in the vast middle got very little growt~, and people who worked like
crazy but were on the bottom then fell even further and'. further
behind in the years afterward ~- no matter how hard they worked.
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We've got to have a gove~.;nt that can be a real
partner in making this new economy work for all of our'people: a
government that helps each and every one of us to get an education,
and to have the opportunity to renew our skills. That's why we
worked so hard to increase educational opportunities in the last two
years -- from Head start ,to public schools, to apprenticeships for
young people who don't go to college, to making college loans more
available and more affordable. That's tne first thing we have to do.
We've got to do something to empower people to improve their,skills.
The second thing we ought to do is to help people raise
their incomes immediately by lowering their taxes. (Applause.) We
took the first step in 1993 with a working family tax cut for 15
million families with incomes under $27,~00; a tax cut that this year
will average about $1,000 a family. And we also gave tax reductions
to most small and new businesses.
Before we could do more than that, we first had to bring
down the deficit we inherited, and we had to get economic growth up. ,
Now we've done both. And now we can cut taxes in a more
comprehensive way. But tax cuts should reinforce and promote our
first obligation -- to empower our citizens thro~gh education and
training'to make the most of their own lives.
The spotl'ight should shine on those who make the right
, choices for themselves, their families a::ldtheir communities. I have
proposed the Middle Class Bill of Rights, which should properly be
called the Bill of Rights and Responsibilities because its provisions
only benefit those who are working to eaucate and raise their
children and to educate themselves. It will, therefore, give needed
tax relief and raise incomes in both the short run and the long run
in a way that benefits all of us.
a
There are four provisions. ,First,
tax deduction for
all educat;on and training after high sc~ool. (Applause.) ,If you
think about it, we permit businesses to deduct their investment, we
permit individuals to deduct interest on their home mortgages, but
today an education is even more importa~t to the economic well-being
of our whole country than even those things are. ,We should~o
everything we can to encourage it. And I hope you will 'support it.
Second, we ought to cut taxes, $500 for families with
children under 13. (Applause.)
Third, we ought to foster more savings and personal
responsibility by permitting people to, establish an Individual
Retirement Account and withdraw from it tax free for the cost of
education, health care, first-time home-buying or the care of a
parent. (Applause. )
,
And fourth, we 'should pass a G.I. Bill for America's
workers. We propose to collapse nearly 70 ~ederalprograms and not
give the money to the states, but give tne money directly to the
American people: offer vouchers to them so that they, if they're laid
off or if they're working for a very low wage, can get a voucher,
worth $2,600 a year for up to two years to go to their local
community colleges or wherever else they want to get the skills they
need to improve their lives. Let's empower people in this way. Move
it from the government directly to the workers of America.
(Applause. )
NOW, anyone of us can call for a tax cut, but I won't
accept one that explodes the deficit, or puts our recovery at risk.,
We ought to pay for our tax cuts fully and hQnestly. (Applause.)
Just two years ago, it was a.n open question whether we
would find the strength to cut the deficit. Thanks t~ the courage of
the peopl e who were here then, many of '\'thom didn' t return I we did cut
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the deficit. We began to do what others said would not be done. 'We
cut the deficit by over '$600 billion, about $10,000 for every family
in this country. It's coming down three years in a row for the first
time since Mr. Truman'was president, and I don't think anybody in
America wants us.tolet it explode again. (Applause.)
In the budget I will send you, the Middle Class Bill of
Rights is fully paid for by budget cuts in bureaucracy, cuts in
programs, cuts in special interest subsidies. And the spending cuts
will more than double the tax cuts. My budget pays for the Middle
Class Bill of Rights without any cuts in Medicare. And I will oppose
any attempts to pay'for tax cuts with Medicare cuts. That's not the
right thing to do. (Applause. )
I know that a lot of you have your own ideas about tax
relief, and some of them I find quite interesting. I really want to
work with ?ll of you. My test for our proposals will be: Will it
create jobs and raise incomes? will it strengthen our families and
support our children? Is it paid for? will it build the middle
class and.shrink the underclass? If it ioes, I'll support it. But
if it doesn't, I won't.
The goal of building the middle class and shrinking the
underclass is also why I believe that ycu should raise the minimum
wage. (Applause.) It rewards work. Two and a half million
Americans -- 2 ..5 million Americans, often women with children, are
working out there today for $4.2·5 an hour. In terms of real buyinq
power, by next year that minimum wage will be at a 40-year low.
That's not my idea of how the new economy ought to work.
.
NOW, I've studied the argumants and the evidence for and
against a minimum wage increase. I beliave the weight of the
evidence is that a modest increase does ~ot cost jobs, and may even
lure people back into the job market. But the most important thing
is, you can't make a living on $4.25 an hour. (Applause.)
Especially if you have children, even with the working families tax
cut we passed last year. In the past, the minimum wage has been a
bipartisan i~sue, and I think it should .be again. So I want. to
challenge you to have honest hearings on this; to get together; to
find a way to make the minimum wage a living wage.
Members of Congress have been here less than a month,
but by the end of the week, 28 days into the new year, every member
of Congress will have earned as much in congressional salary as a
minimum wage worker makes all year long. .(Applause. )
Everybody else here, includ;j.ng the President, has
something else that too many Americans do without, and that's health
care. Now, last year, we almost came tc blows over health. care. But
we didn't do anything. ,And the cold, hard fact is that, since last
year, since I was here,. another 1.1 million Americans·in working
families have' lost their health·care. ~_~d the cold, hard fact is
that many millions more, most of them farmers and small
businesspeople and self-employed people, have seen their premiums
skyrocket, their co-pays and deductible& go up. There's a whole
bunch of people in this country that, in the statistics have health
, insurance, but really what theY've got is a piece of paper that says
they won't lose their home if they get sick.
. Now, I still believe our country has got to move to~ard
providing health security for every American family. (Applause.)
But I know that last year, as the evidence indicates, we bit off more
than we could chew. So I'm asking you that we work together. Let's
do it step by' step. Let's do whatever we have to do to get something
done. Let's at least pass meaningful insurance reform.so that no
American risks losing coverage for facing skyrocketing prices.
(Applause.) That nobody loses their cov~rage because they face high
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11
prices or unavailable insurance, when they change, jobs and lose a
job, or a family member gets sick.
I want to work together with all of you who have an
interest in this -- with the Democrats who worked on it last time,
with the Republican leaders like senator Dole who has a longtime
commitment to health care reform and made some constructive proposals
in this area last year. We ought to make sure that self~employed
people in 'small businesses can buy insurance at more affordable rates
through voluntary purchasing pools. We ought to help families
provide long-term care for a sick parent or a disabled child. We can
work to help workers who lose their jobs at least keep their health
insurance coverage for a year while they look for work. And we can
find a way -- it may take some time, but we can find a way -- to make
sure that our children have health care. (Applause.)
You know, I think everybody in this room, without regard
to party, can be proud of the fact that our country was rated as
having the world's most productive econo~y for the first time in
nearly a decade. But we can't be proud of the fact that we're the
only wealthy country in the world that has a smaller percentage of
the work force and their children with health insurance today than we
did 10 years ago, the last time we were the most productive economy
in the world. So let's work together on this. It is too important
for politics as usual.
(Applause.)
.
Much of what the American people are thinking about
tonight is what we've already talked about. A lot of people think
, that the security concerns of America today are entirely internal to
our borders. 'They relate to the security of our jobs and' our homes,.
and our incomes and our children, our streets, our health and
protecting those borders. Now that the, Cold War has passed, it's
tempting to believe that all the security issues, with the possible
exception of trade, reside here at home. But it's not so. Our
security still depends upon bur continu~d world leadership for peace
and freedom, and democracy. We still can't be strong at home unless
we're strong abroad.
, The financial crisis in Mexico is a case in point. I
know it's not popular to say it tonight, but we have to act. Not for
the Mexican people, but for the sake of the millions of Americans
whose livelihoods are tied to Mexico's well-being. If we want to
secure American jobs, preserve American axports, safeguard America's
borders, then we must pass the stabilization program and help, to put
Mexico. back on t r a c k } , .
Now let me repeat: it's not a loan, it's not foreign
,
it's not a bailout. We will be given a guarantee like co
s~gning a note with good/collateral that will cover our risks.
This
legislation is the right thing for Ameri=a. That's why the
bipartisan leadership has supported it. And I hope you in Congress
will pass it quickly. It is in our interest, and we can explain it
to the American people, because we're going to do it in the right
way.
(Applause.)
a~d,
,
You know, tonight, this is the first state of the Union
address ever delivered since the beginning of the Cold War when not a
single Russian missile is pointed at the children' of America.
(Applause.) Arid along with the Russians, we're on the way to
destroying the missiles and the bombers that carry 9,000 nuclear
warheads. We've come so far so fast in this post-cold War world that
it's easy to take the decline of the nuc...lear threat for granted. But
it's still there, and we aren't finished yet •.
This year I'll ask the Senate to approve START II,to
eliminate weapons that. carry 5,000 more warheads. The united States
will lead the charge to extend indefinitely the nuclear
Nonproliferation Treaty
(applause); t.o enact a comprehensive
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nuclear test ban -- (applause); and to eliminate chemical weapons •
. (applause.) To stop and roll back North Korea's potentially deadly
nuclear program, we'll continue to impl~~ent .the agree.we have
reached with that nation. It's smart; it's tough; it's a deal based
'on continuing inspection with safeguards for our allies and
ourselves. (Applause.)
.
This year I'll submit to Congress comprehensive
legislation to strengthen our hand in combatting terrorists -
whether they strike at home or abroad. As the coward's who bombed
the World Trade Center found out, this country will hunt down
terrorists and bring them to justice. (Applause.)
Just this week,' another horrendous terrorist act in
Israel killed 19 and injured scores more. . On behalf of the American
people and all of you, I send our deepest sympathy to the families of
the victims. I know that in the face of such evil, it is hard for
the people in the Middle East to go forward. But the terrorists
represent the past, not the future~ We must and we will pursue a
comprehensive peace between Israel and all her neighbors in the
Middle East. .(Applause~)
Accordingly, iast night Isiqned an executive order that
will block the assets in the United Stat:s of terrorist organizations
that threaten to disrupt the peace process. It prohibits financial
transactions with these groups. And tonight I calIon our allies and
peace-loving nations throughout the world to join us with renewed
fervor in a global effort to combat terr\:)rism. We cannot permit the
future to be marred by terror and fear and paralysis. (Applause.)
From the day I took the oath of office,' I pledged that
our nation would maintain the best,equipped, best-trained and best
prepared military on Earth. We have, a~d they are. They have
managed the dramatic downsizing of our forces after the Cold War with
remarkable skill and spirit. But to make sure our military is ready
for action, and to provide the pay and the quality of life the
military and their families deserVe, I'm asking the Congress to add
$25 billion in defense spending over the next six years. (Appl~use.)
I have visited many bases ac home and around the world,
since I became president~ Tonight, ,I repeat that request with
renewed conviction. We ask a very great deal of our Armed Forces.
Now that they are smaller in number, we ask more of them.. They go
out more often t9 more. different places and stay longer. They are
called to service in many, many ways. ~Jldwe must give them and
their families what the times demand'and what they have earned.
(Applause. )
Just think about what our troops have done in the last
year, showing America at its best -- helping to save hundreds of
thousands' of people in Rwanda, moving with lightning speech to head
off another threat to Kuwait, giving freedom 'and democracy back to
the people of Haiti. (Applause.)
We have proudly supported peace and prosperity and
freedom from South Africa to Northern Ireland, from Central and
Eastern Europe to Asia, from Latin America to the Middle East. All
these endeavors, are good in those places, but they make our future
more confident and more secure.
Well, my fellow Americans, that,'s my' agenda for
America's future: Expanding opportunity, not bureaucracy; enhancing'
security at home and abroad: empowering our people to. make the most
of their own lives. It's ambitious and achievable, but it's not
enough. We even need more than new ideas for changing the world or
equipping Americans to compete in the n~w economy; more than a
government that's smaller, smarter and wiser; more than all the
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changes we can make in government and in the private sector from the
, outside in.
I
Our fortunes and our posterity also depend upon our
ability to answer some questions from within -- from the values and
voices that speak to our hearts as well as our heads; voices that
tell us we have to do more to accept responsibility for ourselves and
our families, for our communities, and, yes, for our fellow citizens.
We see our families and our communities allover this country coming
apart. And we feel the common ground shifting from under us. The
PTA, the town hall meeting, the ball park -- it's hard for a lot of
overworked parents to find the time and space for those things that
strengthen the bonds of trust and cooperation. Too many of our
children don't even have parents and grandparents who can give them
those experiences that they need to build their own character and
their sense of identity.
We all know what while we here in this chamber can make
a difference on those things, that the real differences will be made
by our fellow citizens -- where they work and where they live. And
it will be made almost without regard to party. When I used to go to
the softball park in Little Rock to watch my daughter's league, and
people would come up to me, fathers and mothers, and talk to me, I
can honestly say I had no idea whether 90 percent of them were
Republicans or Democrats. When I visited the relief centers after
the floods in California -- Northern California -- last week, a woman
came up to me and did something that very few of you would do -- she
hugged me and said, "Mr. President, I'm a Republican, but I'm glad
you're here." (Laughter and applause.)
Now, why? We can't wait for disasters to act the way we
used to act every day. Because as we move into this next century,
everybody matters; we don't have a persc~ to waste. And a lot of
people are losing a lot of chances to do better. That means that we
need a New Covenant for everybody.
For our corporate and business leaders, we're going to
work here to keep bringing the deficit down, to expand markets', to
support their success in every possible way. But they have an
obligation when they're doing well to keep jobs in our communities
and give their workers a fair share of the prosperity they generate.
(Applause.)
.
-For people in the entertainment industry in this
country, we applaud your creativity and ~'our world-wide success, and
we su~port your freedom of expression. But you do have a
responsibility to assess the impact of your work and to understand
the damage that comes from the incessant, repetitive, mindless·
violence and irresponsible conduct that permeates our media all the
time. (Applause.)
We've got to ask our community leaders and all kinds-of
organizations to help us stop our most serious social problem: the
epidemic of teen pregnancies and births where there is no marriage.
I have sent to Congress a plan to targets schools allover this
country with anti-pregnancy programs' that work. But government can
only do so much. Tonight, I call on parents and leaders all across
this country to join together in a national campaign against teen
pregnancy to make a difference. We can do this, and we must.
(Applause. )
And I would like to say a special word to our religious
leaders. You know, I'm proud of the fact the. United states has. more
houses of worship per capita than any country in the world. These
people who lead our houses of worship can ignite their congregations
to carry their faith into action; can reach out to all of our
children, to all of the people in distress, to those who have been
savaged by the breakdown of all we hold dear. Because so much of
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what we've done must come from the inside out, .and our religious
leaders and their congregations can make all the difference. They
have a rol~ in the New Covenant as well.
There must be more responsibility for all of our
citizens. You know, it takes a lot of people to help all the kids in
trouble stay off the streets and in school. It takes a lot of people
to build the Habitat for Humanity houses that the Speaker celebrates
on his lapel pin. It takes a lot of peoole to provide the people
power for all of the civic organizations in this country that made
our communities mean so much to most of us when we were kids. It
takes every parent to teach the children the difference between right
and wrong and to encourage them to learn and grow; and ·to say no to
the wrong things, but also to believe that they can be whatever they
want to be.
I kriow it's hard when you' r.e working harder for ·less,
when you're under great stress to do these things. A lot of our
people don't have the time or theemoticnal stress they th.ink to· do
the work of citizenship.
Most of us in politics haven't helped very much. For
years, we've mostly treated citizens like they were consumers or
spectators, sort of political couch potatoes who were supposed to
watch the TV ads, either promise them something for nothing or play
on their fears and frustrations. And more and more of our citizens
now. get most of their information in very negative and aggressive
ways that are hardly conducive to honest and open conversations. But
the truth is, we have got to stop seeing· each other as enemies·, just
because we have different views.
.
If you go back to the beginning of this country, the
great strength of America, as de Tocqueville pointed out when he came
here a long time ago, has always been our ability to associate with
people who were different from ourselves and to work together to find
common ground. And in this day, everybody has a responsibility to do
more of that. We simply cannot wait for a tornado, a fire, or a
flood to behave like Americans ought to behave in dealing with one
another. (Applause.)
I want to finish.up here by pointing out some folks that
are up.with the First Lady that represent what I'm trying to taik
about -- citizens. I have no idea what their party affiliation is or
who they voted for in the last election. But they represent what we
ought to be doing.
Cindy Perry teaches second graders to read in AmeriCorps
in rural Kentucky. She gains when she gives. She's a mother of
four. . She says that her service inspired her to get her high school
equivalency last year. (Applause.) She was married when she was a
teenager. Stand up, Cindy. (Applause.) She was married when she
was a teenager. She had four children, but she had time to serve
other people, to get her high school equivalency. And she's going to
use her AmeriCorps money to go back to c~llege. (Applause.)
Stephen Bishop is the poli~e chief of Kansas City.
(Applause.) He's been a national lea~er.
(Applause.) Stand up
(applause). He's been a national leader in using more police in
community policing, and he's worked with AmeriCorps to do it. And
the crime rate in Kansas City has gone down as a result of what he
did.
Corporal Gregory Depestre went to Haiti as part of his
adopted country's force to help secure damocracy in his native land.
(Applause.) And I might add, we must be the only country in the·
world that could have gone .to .Haiti and taken Haitian-Americans there
who could speak the language and talk tc the people. And he was on~
of them, and we're proud of him. (Applause.)
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�- 15
. The next two folks live had the honor of meeting and
getting to know a little bit, the Reverend John and the Reverend
Diana Cherry of the AME Zion Church in Temple Hills, Maryland. I'd
like to ask them to stand. (Applause.) I want to tell you about
them. In the early '80s" they left government service and formed a
church in a small living room in a small house, in the early '80s.
Today that church has 17,000 members. It is one of the three or four
biggest churches in the entire United states. It grows by 200 a
month. They do it together. And the spacial focus of their ministry
is keeping families together. (Applause.)
'TwO things they did make a big impression on me. I
visited their church once, and I learned they were building a new
sanctuary closer to the Washington, D.C., line in a higher crime,
higher drug rate area because they thought it was part of their
ministry to change the lives of the people who needed them.
(Applause.)
.
The second thing I want to say is, that once Reverend
Cherry was at a meeting at the White House with some other religious
. leaders, and he left early to go back to his church to minister to
150 couples that he had brought back to his church from allover
America to convince them to come. back together, to save their
marri~ges, and to raise their kids.
This is the kind of work that
citizens are doing in America. We need more of it, and it ought to
be lifted up and supported. (Applause. )
The last person 'I want to introduce is Jack Lucas from
Hattiesburg, Mississippi. Jack, would y~u stand up? (Applause.)
Fifty years ago, in the sands of Iwo Jima, Jack Lucas taught and
learned the lessons of citizenship. On February the 20th, 1945, he
and three of his buddies encountered tha enemy and two grenades at
their feet. Jack Lucas threw h'imself on both of them. 'In that
moment,' he saved the lives of his companions, and miraculously in the
next instant, a medic saved his life.· He gained a foothold for
freedom, and at the age of 17, just a year older than his grandson,
who is up there with him today, and his son, who is a West Point
graduate and a veteran, at 17, Jack Lucas became the youngest Marine
in history and the youngest soldier in this century to win,the
Congressional Medal of Honor. (Applause.)
All these years later, yesterday, here's what he said
about that day: "It didn't matter where you were from or who you
were, you relied on one another. You did it for your country."
We all gain when we' give, a.:).d we reap what we. sow.
That's at the heart of this New Covenant -- responsibility,
opportunity and citizenship. More than stale chapters in SOme remote
Civics book: they're still the virtue by which we can fulfill
ourselves and reach our God-g~ven potential and be like them; and
also to fulfill the eternal promise of this country -- the endur~ng
dream from that first and most sacred covenant.
I believe every person in this country still believes
that we are created equal, and given by our creator, the right to
life, liberty and the pursuit of happiness. This is a very, very
great country. And our best days are still to come •.
Thank you, and God bless you all.
END
(Applause.)
10: 35 P.M.
EST'
�THE WHITE HOUSE
Office of the Press Secretary
(Kutztown, Pennsylvania)
For Immediate Release
January 25, 1995
REMARKS BY THE 'PRESIDENT
TO THE PEOPLE OF THE KUTZTOWN AREA
Kutztown University
Kutztown, Pennsylvania
(\
12: 36 P.M ..EST
THE PRESIDENT: Thank you very much. You all.sit
down and relax. Cold outside, warm in here.
(Applause.) I
want-to thank Dr. David McFarland for that introduction and for
making me feel so very welcome here at Kutztown. I've had a
great. time already •. (Applause.)
I know that before I came out, your May~r, Mayor
Schwoyer and Congressman Holden who came up from Washington with
me today, Secretary Reich and secretary Riley talked, and I
thank them for what they said. And I thank, especially, my
colleagues, Congressman Holden and secretary Reich and Secretary
Riley for what they have done for the cause of education •
. I am so happy to be here with all of you today.
There are a lot of reasons. I came here. One is, I'm beginning
to feel old, and I peardthat you've got a guy my age on your
football team, and' I wanted to -- where is he? Where is Chuck
Roseberry? Where is he? Stand up. Where are you? (Applause.)
I know he's here somewhere. Where are you? Yes. That's good.
You know, it's all I can do every morning to get up
and go jog, and I resent you. I can't believe it.
(Laughter.)
But I'm impressed. I'm also glad to be joined here by your
former Congressman, Gus Yatron, and your former Senator, Harris
Wofford. I thank them both for being here --:- (applause) -
along with Catherine Baker Knoll, our State Treasurer. Thank'
you,Catherine Baker Knoll, for coming -- our State Treasurer.
I'm glad to see you, too. (Applause.) And our neighboring
Congressman, Paul McHale, wanted to come but he could not.
There's a very important vote this afternoon in the Congress,
and Congressman Holden has already gone back; besides, he's
heard this speech before. (Laughter.)
I want to say how very proud I am to be here,
because this .is a time of great challenge for our nation, and I
believe that this .institution tepresents a big part of the
answer to'that challenge.
�-
2
You know, just a few moments ago, I had a brief
roundtable with a lot of your community leaders, businesspeople,
teachers and students, who are associated with the efforts of
this fine institution to help solve the problems of this area,
to get an education to people, to help the businesses grow, to
help start new businesses.
I wanted to come here because I was very, very
impressed with your entrepreneurial development a~d global
education center, the work you've done for small businesses, the
work you've done for minority businesses, the work you've done
to try to bring together people of all ages and all backgrounds
who want to get an education, and who want to serve and who want
to help. And I'd like to ask all these folks who just met with
me to stand up, because I. learned a lot from them and I'm
grateful for what they did. '
much.
Would you all .stand up, please?
(Applause.)
Thank you very
There'S one other group of people I'd like to
acknowledge who are here who represent a lot of what I talked
about last night, who are young people trying to serve our
country at the grassroots level by helping people solve their
problems. They are the members of the Pennsylvania Service
Corps, part of AmeriCorps. (Applause.) They're working to help
people build housing, to reduce neighborhood violence, to clean
up the local environment, to help people with AIDS -- bus loads
of them are here, and you just heard from them.
(Laughter.) I
thank them for their enthusiasm, their devotion to their
country, and for symbolizing what I thin~ all of u~ have to do
more of: learn and gain by serving and giving..
You know, this is a beautiful rural area. I
understand I am the first President since 1948 to come to this
county, and the first person ever to visit thls community as
President. And I am delighted to be here.' (Applause.)
Pennsylvania as a whole, and this area have been
through dramatic and sweeping economic changes in the last
several years. The economic opportunity that made Pennsylvania
one of the great manufacturing states of America and o~e of the
great economic powers of the entire post-Cold War world have
changed -- those forces have changed dramatically. And as those
of you who are younger enter your adult years and look forward
to the future, you know that we have moved from an industrial
age to an information age; you will hear it everywhere.
What you may not hear is that it does.not mean that
manufacturing will be·less important; quite the contrary -- if
we do it right, it means that America will continue to be the
leading manufacturing country in the world. But more and more
and more, manufacturing will require more knowledge, higher
skills, a better education,' fewer people producing more things,
which means that. education will be important and it will also be
.important for us to continually be able to start more and more
new businesses.
Big enterprises are like the federal government ~
we're downsizing. We're making the federal bureaucracy smaller
so we' can give. the money back to you to educate people, to
provide tax relief, to bring the deficit down, to fight crime •
.That's what we're doing..
(Applause.) That is very, very
important. It matters to your future that federal debt is now
$10,000 a family less than it would have been if our deficit
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�- 3
reduction plan had not passed. (Applause.) It matters that the
economic programs have helped to contribute to this enormous
rise in productivity in America. And we have over 6 million new
jobs in our country now in the last two years t with low
inflat'ion and with every prospect of co::mtinuing our growth.
,
But what's going to enable us to solve our problems
over the long run is the ability and strength of the American
people to solve their problems at the local level; to make the
most,of their own lives; and to work together in communities,. I
said last night in my speech -- and ~ will say again today -
that I believe what our country needs is a New Covenant based on
an old idea-- the idea that, with opportunity must come
responsibility. They have to go hand in hand. If you don't
have both, you can't solve .the problems of America.
If you tell people to be responsible all the time
and they never get any benefit out of it, pretty soon they get
tired and quit. But if people just always say, I want my
rights t and we don't think about what responsible conduct is for
ourselves and our friends and neighbors, then pretty soon our
society comes apart. We have to have both. And we have to base
our efforts in community after community after community where
people can sit down t the way these people did with me today, and
talk to each other and work with each other to develop the God
given potential of all of our people.
In the world we are moving into, the success of the
United States as a whole will be more dependent than ever before
on the success of every community to educate and develop the
capacities of every person who lives in the community -~
everywhere and everyplace. We don't have a person in our
community we can walk away from and turn our backs on.
(Applause. )
That's why, even though we've been cutting
government sp~nding -- and last year for the first time in 25
years t we cut both defense and domestic spending t except for
Medicare and the health programs of the government, and Social
Security,' of course -- we cut domestic and defense spending for
the first time in 25 years to deal with the deficit.
(Applause. )
But we did not cut education. We expanded Head
Start, we expanded our efforts to help our public schools
achieve educational excellence -- (applause) -- we set up a
program to try.to support networks like the ones I saw today;
for businesses to work with schools to help young people who
don't go to four-year colleges at least get some education and
training after high school t so they can get bette~ jobs and have
higher incomes.
j
We reformed the college loan program so that
student loans now are less costly to middle class students, have
better repayment terms, and they actually cost the government
less in terms Of tax dollars. It is a good program.
,(Applause. )
And with ail of that, let me remind you of what the
fundamental facts are in this economy and why these efforts are
so important. Even thqugh we had six million new jobs in the
economy in the last two years, even though we had more high-wage
jobs coming back into our economy in 1994 than in the last five
years combined, most Americans are working a longer work week
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than they were working 15 years ago for about the same income
once you make adjustments for inflation.
Most of our people have found that 'this new
exciting global economy, which moves with lightning speed and
opens up vast opportunities for people who can take advantage of
it, has left them working harder for less, with less security.
All these' chang'es are great if you can always get a new job, but
i f you're the one losing the. job, the change doesn't look very,
good.
So what our job is, is to make more success
stories, like the programs I see here.
It is to empower more
schools to do what this one did:
to drop their categories and
open their walls and reach out to all kinds of people, and make
eiducationa community enterprise and a .lifetime enterprise.
That is what we must do.
And that is why I say to the American people and'to
the Congress, we have gotten the deficit down, and we have
gotten the economy going, and there are more cuts we can make in
government spending, and we can afford to provide some more tax
<relief to hard-working Americans, but we should do it with a
focus on education so that we can raise people's incomes who
have worked harder for less in the short run with the tax
relief, but in the long run with better education, which is the
only way to raise people's incomes over the long run.
(Applause.)
,
You think about the things that this country's done
in our past that really did something for the economy.
I think
you can make a compelling case that, at the end ,of World War II,
the passage of the G.I. Bill did more to explode the American
economy than any other single action, because it made it
possible for our returning servicemen ,to go back to school and
to get an education. And that,money has'repaid itself many'
times over.
So I have said that that's the kind of thing we
ought to focus on now. The Middle Class Bill Of Rights that I
proposed last night to the American people and to Congress -
and as I said, it might better be called a Middle Class Bill Of.
Rights and Responsibilities because you, by definition, ,have to
be responsible to take the benefits of it -- focuses heavily on
education in three ways; and I want to emphasize them.
First of all, I think you ought to be able to
deduct the cost of education after high school from your taxes.
(Applause.)
You can -- you think. about it:
If you own a home,
you can deduct the interest from your taxes~ And in the early
years of a home mortgage, it's almost all interest. Why do we
do that? Because we want people to be able to own their homes.
If you run a business and you invest in new equipment, you- can
deduct the cost from your ,taxes. Why do we do that? Because we
want our businesses to modernize. You know,'the stories I heard
over here before I came out were, the cost of equipment is going
up dramatically, but now we can produce more with fewer people.
We've got to support that.
But if our people today can't get an education -
not everybody needs a four-year college degree -- but if they
can't get an education, if the syste~s aren't there for that
education, they may not get to the homeowning. They may not
have the American D,ream that we want. ,So I say, if education is
the most important thing for personal success in the 21st
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J
century, we.ought, to permit people to deduct the cost of it from
their taxes. Raise your income in the short run, raise your
income in the longrun.
AUDIENCE MEMBER:
That's right, Bill!
(Applause.)
THE PRESIDENT: That's right. You know, we flew
that person up here from Washington, and I was beginning to
think they weren't going to say anything. (Laughter and
applause. )
The second thing I want to say is, we want to
broaden the number of Americans who can invest tax-free in an
IRA -- an Individual Retirement Account
but we want to let
people withdraw from the IRA, tax-free, to pay for education
expenses, sO.that you can take better care of yourself.
(Applause. )
The last education component is, we want to take
about 70 different programs the federal government runs in
training, which require enormous administrative costs, collapse
them and give the money to the American people who are eligible
for them. So.if·a person loses a job and is on 1:lnemployment, or
if a person is in a lower~wage job so they're eligible for
federal training help, instead of having to figure out which of
70 programs you qualify for, you just get a voucher of $2,600 a
year -- up to that -- for two years and you take it to this
school, or take it to a local community college, or take it
wherever you choose if you're eligible tollget it. It's a kind
of a G.I. Bill for American'workers. It will make a huge
difference. And it's the kind of thing government ought to be
doing -- less bureaucracy, more direct help to people to get the
education and training they need to grow and to learn.
(Applause. )
I want all of you to help me do this for you. We
are trying to change the focus of the national government to the
grassroots of America. There are a lot of other things that I
will be talking about over the next few weeks that are part of
this New Covenantj welfare reform, what we're going to do in
crime to lower the crime rate and implement the crime bill, what
we're going to do to try to grow the economy, and other ways.
But nothing, nothing can make a bigger difference than trying to
get more education and more people in more ways. So I hope that
you wil~ do two things: first, I hope you will say, with your
voices, without regard to your party: cut the deficit, cut
spending, reduce the size of the federal bureaucracy. Keep on
doing what you're doing, but do not cut education, increase
investm.ent and education so we can grow this economy and grow
America. (Applause.)
And Ilhope you will suppoit the Middle Class Bill
of Rights, and I hope you will support the AmeriCorps program in
Pennsylvania, and I hope you will support -- applause -- and I
hope you will support -- I hope you will support the programs at
this school to develop entrepreneurs because they're all
grassroots communit'y-building programs that develop the ability
of people to fulfill their own dreams and bring us together
across the lines that divide us.
You know, I don't have an -- literally, I don't
have a clue about which of the,people I was sitting and talking
with this morning were Democrats, which were Republicans, who
was an Independent. I don't have any idea who they voted for in
the last electionjI probably should have checked. (Laughter.)
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You know, I mean, I don't. Why? Why? Because
they are organized around developing the potential of the people
here. They have built a community of interest where everybody
wins by helping everybody else. NOw, that's what makes America
go; that's what makes America grow. I see it when I visited.
these community services programs. I see it, as I said last
night in my speech, when I go out after a disaster. I mean,
it's a terrible thing to say, but if you go to one' of these
places where they're putting sand bags on a levee against a
flood, or where theY're trying to help people deal with the
aftermath of the fires, as I saw in California, the earthquakes,
people have their 'shoulders back and their heads held high and
their eyes are clear and their voices are strong. Why? .Because
they know they matter.
And when Americans get in trouble, we would take
the shirt off our back for people. And we fight and we work in
these things, because we know we matter, because we're doing
something that makes us feel better and stronger, and we.' re
helping other people as well. We have to return that spirit to
our country every day, in every way, in all of our activities . .
(Applause.) That is'what this is all about, and we can do that.
(Applause. )
So what I want to say to you is, we've got a lot of
economic challenges, and we've got some profound social
'
problems. But we can deal with them, we can solve them, we can
move on them. I see it -- I have been allover tnis country, I
am telling you, there is not a problem this country this have
been allover this country. I am telling you, there is not a
problem this country has that is not peing addressed in a way
that all of you will be proud of by somebody, somewhere. What
we.have'to·do is to figure out a way to galvanize and organize
and energize all of that work so that it spreads across our
whole country.
The New Covenant is a way of thinking about that.
Responsibility in return for opportunity, building this country
.at the community level -- .that's what I'm committed to doing.
My role in that will be in this coming Congress to try to pass
the Middle Class Bill of Rights, to try to emphasize education,
to try to keep downsizing the federal government and controlling
the deficit and cutting unnecessary spending, but building up
those things which will enable people to make the most of their
own lives. That is my job.
Your job
to support institutions like this to
get all the education you can to break down the walls between
business and government and education at the grassroots level
and to try to help me pass this. Will you do that? I need you.
I hope you will, and I want your support for it. (Applause.)
Folks, the best days of this country are still
before us. This is the most exciting era we have ever known.
You are going to see opportunities in the next 20 years for
people to make a living in exciting and interesting ways that we
could not. have imagined 20 years ago.
But our job is to make sure that, as President
Kennedy said, "the rising tide lifts all boats." We can't have
an America where 20 or even 40 percent of us are the only ones
that really do well in this global economy, and it need not be
that ~ay.
.
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But if we want our best days to lie ahead, we have
got' to -- we have got to say we ar,e going to get, an education
for all of our people.
It's going to be a lifetime project.
Our educational institutions are going to become the center of
our communities. We're going to tear down the walls that divide
us. We're going to make education, available to everybody, and
we're going to use the power of government not to expand or
create a new bureaucracy but to empower people at the grassroots
level to chart their own future and to" make their own lives in
this new and exciting age.
That is our mission.
If we do it, our best days
are ahead.
I want that more than anything -- for you, for our
children and our grandchildren, and our country. And I can tell
you, the ,world still needs that. There'are a lot of things out
there in the rest of the world that' are still a threat'to
decency and humanity and progress.
You saw this terrible
terrorist attack in the Middle East the last couple of days.,
deserve it.
The world ,needs a strong Ame~ica, and Americans
And we're going to get it with your help.
Thank you and God bless you 'all.
END 1:00 P.Mr EST
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�',>
, TIlE PRESIDENT'S ECONOMIC PLAN:
A BALANCED BUDGET TIL\T PUTS PEOPLE FIRST·
I. FRAMEWORK TO BALANCE THE BUDGET: Buildiq,g on his 1993 plan that reduces
the deficit by $1 trillion over seven years, the President today is releasing his economic'
framework for balancing ~e budget by the year 2005 while still investing in education and
training; taking serious steps toward health reform while -strengthening' the Medicare, Trust
Fimd and protecting benefiCiaries; and targeting tax cutS only to working families. The
President's plan builds on the savings and investments in his FY 1996 budget and calls for real
cuts in most areas of government spending other than Social Security.
II. THREE FUNDAMENTAL. DIFFERENCES: While the President shares the goal of'
reaching a balanced budget with the Republican Congress, there are three fundamental
, differences in what the President will call for to make this a balanced budget that puts
working families first.
1. FIRST STEPS TOWARD HEALTH CARE REFORM WHILE.STRENGTHENING
THE MEDICARE TRUST FUND:
Republican Plan: The Republican plans call for deep Medicare savings that wou14
requiTe a: senior couple to pay $1500-$2000 a year more by the year 2002 -- only to
pay for unjustifiable tax cuts.
'
President's Plan: The President's plan calls for half the Medicare savings of the
Republican plans ($124 billion), no new Medicare beneficiary cuts, and takes the frrst
steps toward serious health reform. The President calls for one~third the level of'
Medicaid savings ($55 billion) of the Republican plans, gives states additional
flexibility, and protects Medicaid coverage by including a per person cap. Elements' of
the health reform plan include:
'. Protecting the, Medicare Trust Fund to 2005
•. Health SecuritY for Working Families Mter a Job Loss: (6 months of
health coverage for families who lose insurance when they lose a job)
• More Options for Medicare Managed Care that ProteCts choice
• Prevention: No Co-payments for Medicare Mammography Screening.
·"Alzheimer Respite Benefit
• 'Downpayment on Home and Community-based Long-term care
• Insuran.ce Reforms including.Portability and Limits on Exclusions for
Pre-existing <;onditions
, • Give Small Businesses Pooling Options, including Participation in FEHBP
•. Se~-Employed Tax Deduction Increased, to 50%
'
1
�,
,
,
2~'PROTECTING INVESTMENT IN EDUCATION AND TRAINING:'
Republican Plans: The Republican plans c;pt investments in education by $43 billion,
over seven years, cutting Head Start and seeking to eliminate or dramatically cut
GOALS 2000, Safe and Drug-Free Schools, AmeriCorps, student aid, and job training,
at all levels.
President's Plan: The President's plan puts people fIrst by preserving investments in
education and training, with signifIcant, increases in Head Start, Goals 2000,
'
AmeriCorps, student aid, a new GI Bill of Rights for Workers that increases' training.
through Skill Grants, and a $10,000 education tax deduction.
'
,
.
'
'
.
3. A TAX CUT THAT IS TARGETED ONLY TO WORKING FAMILIES:
Republican Plans: The Republican House plan calls for a $630 billion tax cut over,'
ten years that would give a $20,000 tax cut to the top 1% of taxpayers, and the Senate
budget calls for increasing taxes on 14 million working families.
President's Plan: The President's plan keeps his full Middle Class Bill of Rights tax
cuts: a $500 tax credit for children under 13; a $10,000 education deduction, and an '
expanded IRA that allows more working families not only to save for, retirement but
also to use the savings for education; afrrst home, or long-term care, for a sick
relative.
nI~ ~OMPONENTS
OF SAVINGS FOR BALANCING THE BUDGET: The President's
plan does not change the basic budget for FY1996, but it extends the savings pattern in
domestic discretionary spending through 2005 while calling for serious, but reasonable
entitlement savings.
'
,
• Medicare savings are $124 billion over seven years, less,than half of the Republican
, , plans, while protecting benefIciaries, securing the Medicare Trust Fund through 2005
and taking the frrst steps toward health reform.
·-Medicaid s'avingsare $55 billion in over 7 years -- one-third the size of the
Republican proposals _.. and incIllde a per person cap to protect coverage, rather than
, an aggregate block grant.
,. Welfare reform has savings of $35 billion which is less than halfof the Republican
proposals and essentially consistent with major Democratic alternatives.
.
• Corporate contribution of $25 billion over seven years through a bipartisan effort to ,
close corporate loopholes, special interest tax breatcs, and unwarranted corporate'
subsidies.'
.
�.'
-,
.
.
.
.
."
• Other than education, research and selected investments in the environment and . other
... areas, domestic discretionary spending is cut by over 20% in real terms near the end
of the plan.
.
• Defense outlays in the President's plan are above both the House and Senate levels in
. FY2002, yet savings are achieved by keeping budget authoritY constant from FY2002
2005..
IV. A MORE BALANCED APPROACH TO BALANCING THE BUDGET:
Republican Plan: The Republican plan calls for deep Medicare cuts and education'
cuts in order to pay for a tax cut going largely to the most well-off.. A top national
forecaster, WEFA, (formerly Wharton Econometrics) has proje'ct~d that this seven-year
path would slow growth, increase unemployment to over 8.5%, and .delay their. deficit
projections by at least two years.
President's Plan: By li.n1iting a tax cut to working families and by calling for a
moderately longer time path to. balance the budget, the President's plan avoids the
necessity of cutting education or calling for new Medicare beneficiary cuts .. This 10-·
year plan has the benefits of a solid balanced budget path with less of the downside,
. contractionary risks of the Republican seven-year proposals; .
3
�JUN 20 1995
CBO VS. OMB
Q. THE CONGRESSIONAL BUDGET OFFICE SAYS THAT THE
ADMINISTRATION'S NUMBERS ARE WAY-OFF WHEN THEY USE THE CBO
BASELINE. ISN'T THIS JUsr ANOTHER ROSY SCENARIO?
A. Absolutely not. We have a solid balanced budget plan based on numbers' are
consistent, conservative and professional. Indeed, using the assumptions of the top
private sector forecasters, our plan would get to balance.
There are some small differences between CBO and OMB in growth estimates and the
'health care baseline that get magnified over a 10 year period. We believe that our
baseline is superior. Even CBO admits that our growth estimates are more consistent
with the Blue Chip than theirs are. And our health care estimates are done by top,
career health professionals at the Health Care Finance Administration, who have the
best and most current infonnation.
Indeed, CBO acknowledges that the Administration is closer to the Blue Chip than the
CBO on the key economic assumptions that affect the deficit, including growth,
interest rates and the GDP deflator.
Yet, while we believe our baseline is the best and they clearly believe that their
baseline is the best, the key thing is that neither side should let honest accounting
differences be an excuse to not work together to avoid a train wreck and to come up
with the type of balanced budget plan that the American people could support.
FOLLOW UP: BUT DIDN'T YOU PROMISE IN 1993 TO USE CBO PROJECTIONS?
In his first budget, the President wanted to take away any disputes over numbers ..
Remember, Administration projections didn't have, the best reputation after 12 years of
magic asterisks and smoke and mirrors. Our accurate projections and suCcess on the
budget over the past two years have restored' faith in an Administration's ability to put
forward reasonable, fair budget projections. Indeed, we have been more on target than
CBO in projecting the deficit so far. So particularly when the Administration numbers
are exactly in line with the top private sector forecasters, it is appropriate and
necessary for the President to rely on OMS for his budget projections.
....
,
,~
�BACKGROUND INFORMATION ON THE OMB/CBO BASELINE DIFFERENCES
• By our best estimates, using the ecOnomic assumptions of the Blue Chip forecasts
and the career professionals at HCFA (Health Care Finance Administration), the
President's economic plan gets to a small surplus in the year 2005.
• Indeed, CBO acknowledges that the Administration is closer to the Blue Chip than
the CBO on three key economic assumptions that affect the deficit, including growth;
.interest rates and the GDPdeflator.
• A Federal Reserve Board of Philadelphia study of 59 top economists projected
average real GOP growth of 2.6% over ten years. The Administration has projected
average growth of slightly under 2.5%. Therefore, the Administration's numbers are
somewhat· conservative compared to many top private sector economists.
• There are differences between the OMBand CBO baselines, but they are based on
very small differences in two areas that appear more significant when they are
extended over a 10 year period.
• Indeed, after the House takes into account its economic assumptions based on the
. CPI, growth and interest rates, 60% of the baseline differential is already evaporated.
So the baseline difference between the Administration and the House is actually not so
. significant.
' .
• The record has proved that OMB was more accurate it its deficit forecast than CBO
when it presented the Administration's 1993 economic plan.
GROWTH RATES:
• Very Small Differences: We assume growth at slightly under 2.5% over the next several
years. CBO is a little lower, around 2.3%. Yet, with the growth dividend that the House
Budget Committee is taking with its plan -- and we are not -- the difference is virtually
non~existent. CBO stated that "the economic assumptions of the Clinton Administration and
the Congressional Budget Office are similar," and that our assumptions actually lead to more
conservative deficit estimates in the first two years of our forecast.
• Consistent with Outside Forecasters: Our proposals are consistent with those of the top
outside forecasters. Our growth forecasts are virtually identical to the Blue Chip between
1997-2001, and indeed, in both 1999 and 2000, the Blue Chip forecasts .4 and .3 higher
growth than the Administration does. Meyer & Associates calls for higher .growth than the
Administration in 1999, 2000, 2001 and the same in 2002. DR! is higher than we are for two
years, lower than we are for two years and the same two years. Ray Fair has higher growth
forecasts every year between 1998 and 2001. So it is clear that we have conservative growth
estimates that are consistent with the top private sector forecasters.
�Indeed, the April, 1995 CBO document that compares CBO and OMB states that "the
AdministfDtion is generally cLOser than the CBO to the Blue Chip's long-range
projections. The Blue Chip indicates the same average growth over the 1997-2000
period as the AdministrDtion and has similar projections for interest rates and the
GDP deflator. "
• This is Very DitTerent from the Rosy Scenarios of the Past: The Administration's growth
forecast is only about .1% higher than CBO's. This is very different from the rosy scenarios
that characterized'Republican Administrations. For example, Stockman's FY1982 budget
predicted growth a whopping 1.3% higher than the CBO. The next year, he came back again
. with a budget that predicted growth an average of 1.0% higher on average each year for his
plan. All four years of the Bush Administration called for budgets with growth rates that were
on average .75% higher every year than the CBOprojection. So when you see the differences
of .1% or .2% in the CBO and OMB growth rates, you can see that most years they are
1I1Oth to 1nth the degree of differential that we saw during the Bush/Reagan years .
• "Wedge Factor" DitTerences are Narrow: The CBO indicates the difference between the
estimates for the CPI and the GDP deflator has an important effect on the estimates of the
deficit. This difference is called a "wedge factor. II The Administration's estimate of wedge is
similar to the Blue Chip's estimate [assuming that both CBO and the Blue Chip make the
adjustment for re-benchrparking the CPI that CBO has already announced it will do in its
summer update.]
HEALTH CARE:
• One of the two main reason for the difference in the CBO and OMB baselines is.
that the Administration assumes slightly less growth in Medicare and Medicaid.
• We should recall that these numbers Come frOIJl the same HCFA actuaries that the
Republicans frequently use as authorities when discussing the need to strengthen the
Medicare Trust Fund. Certainly, they could not be questioning their credibility now.
• It is important to understand that the Medicare and Medicaid numbers are prepared
by the Office of Actuary in the Health Care Financing Administration. The actuaries .
are career professionals who have been doing these same numbers through the last two
Republican Administrations. Any notion that their estimates were affected by anything
other than their professional judgment cannot be justified.
• The whole difference comes from the fact that on' Medicaid the Administration
projects 9.3% growth and the CBO projects 9.9% and on Medicare the Administration
projects 9.1% growth and CBO projects .9.7%
• While we believe these are the differences of honorable career professionals on both
sides, we do beiieve that our numbers are more accurate.
• On Medicaid, the Administration has higher beneficiary growth rates, yet they end
�up with slightly higher overall growth assumptions because the Administration's
estimates of per beneficiary costs are lower than CBO's 53% and 7.0%. Yet, the
HCFA estimates are based on more up-to-date Social Security numbers regarding
disabled beneficiaries in Medicaid and up=to-date Treasury information on Medicaid
outlays - - which catches cu"ent changing trends.
• On Medicare, the Administration and CBO baselines for inpatient hospital services
(which represent half of Medicare costs) are virtually identicaL The only real
difference is that while both believe the high growth rates in home health and skilled.
nursing facility costs will come down, the Administration projects them coming down
somewhat faster.
"
ADMINISTRATION'S GROWTH NUMBERS VS. BLUE CHIP'S: The chart below
shows that the Administration's projection over five years comes to the same average growth
as the Blue Chip, while the CBO's is somewhat pessimistic relative to the consensus of
private forecasters.
LONG-RANGE FORECASTS OF GDP GROWTH
1997 THROUGH 2001
1997
Blue Chip (March)
Administration
CBO
1998
1999
2000
2001
2.0
2.5
2.4
2.3
2.5
2.3
2.9
2.5
23
2.8
2.5
"2.3
2.4
2.4
2.3
�.---'
,
\'
THE PRESIDENT'S NEW ECONOMIC PLAN: '
A BALANCFJ) BUDGET. TIlAT'PUTS PEOPLE FIRST
TALKING POINTS
• The key differences between the President's plan and Republican proposals are:
-- The President balances the budget over a longer period.
-- The President proposes a smaller, targeted tax cut.
• Those differences enable the President to:
, -- Cut much less from Medicare.
-- Invest in education and ,other priorities.
President's Plan
• 'Protect Medicare.
,. Continues investing in education and training.
• Cuts taxes for middle-income Americans,
• Balances the budget in 2005, by:
'
-- eliminating wasteful spending, streamlining programs, and ending unneeded
subsidies;
-- taking the first, serious step toward health care reform;
-- reforming welfare to reward work;
-- cutting discretionary spending by $.;. billion while providing more for defense and
investing in education, the environment, and anti-crime efforts.
Republican Plans
• Slash Medicare and Medicaid.
• Cut deeply into education and other important priorities.
,
'
• Provide a huge new tax cut for the Wealthy. '
�THE PRESIDENT'S ECONOMIC PLAN:
A BALANCED BUDGET THAT PUTS PEOPLE FIRST
r-
t
p~
t:,
j~r-!{Hj
9
---
f'
7
f'Y\ '
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--
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�"
THE PRESIDENT'S ECONOMIC PLAN:
A BALANCED BUDGET' THAT PUTS PEOPLE FIRST
AN OVERVIEW
The President today proposed a bold plan to balance the budget by 2005, cut taxes for
middle-income Americans, and continue investing in education and training -- all to raise ..
average living standards.
The President's plan provides a sharp contrast between his ~licies and those of the
Republicans. The President wants to balance the budget over a reasonable period of time --,
10 years -- so he can protect Medicare, and invest in education and training and other
priorities for the American people. Because Republicans balance the budget more quickly,
and also provide a huge tax cut for the Wealthy, they have to slash Medicare and Medicaid
and cut education .
• To help raise living standards of average Americans, the President's plan will:
-- balance the budget, freeing up capital for private investment;
-- invest in education and training to give Americans' skills to get high-wage jobs; and
-- take the first, serious steps to reform the health care system, expanding coverage
and reducing costs for average Americans.
• By contrast, Republican policies will:
.-- increase the "education deficit;"
-- tum Medicare and Medicaid into second-class health care systems; and
-- give huge tax. breaks to the wealthy.
The President would balance the budget the right way, by eliminating wasteful
spending, streamlining programs, and ending unneeded subsidies; taking the first, serious
steps toward health care reform; reforming welfare to'reward work; cutting non-defense
discretionary spending that doesn't include the President's investments by 22 percent in real
terms, while leaving room to provide increases for education, the environment, and anti
crime efforts; and targeting tax relief to middle-income Americans.
Republicans would balance the budget the wrong way: To reach balance in 7 years
and provide a huge tax break for the wealthy, they would slash Medicare and Medicaid and
cut deeply in education and other investments that help raise average living standards.
The President's plan builds upon the policies of his first 2-112 years that cut the
deficit, created nearly 7 million jobs, controlled interest rates and inflation, expanded trade to
create more high-wage jobs, and rewarded work by cutting taxes for 15 million families.
The President is also building on his efforts to create a new kind of government, one that
creates opportunity, not bureaucracy, and provides the tools that average Americans need to
build better lives for themselves and their families.
�mE PRESIDENT'S ECONOMIC PLAN:
HIGHLIGHTS
• The President, who has cut the deficit from $29<7 billion in 1992 to an estimated $190
billion this year, proposes to balance the budget by 2005.
.
-- Republicans, none of whom voted for the President's 1993 plan, now want to
balance the budget the wrong way -- cutting Medicare, education, and other important
priorities deeply to fund a huge tax break for the wealthy and reach balance in 2002 .
.
• The President proposes to take a first, serious step toward health care reform, providing
net savings of $124 billion in Medicare and $55 billion in Medicaid by 2002 while expanding
coverage and initiating insurance reforms.
-- Republicans would simply cut over $430 ~i1lion from Medicare and MediCaid,
enough to tum them into second-class health systems.
• The President would save $64 billion in non-health entitlements by 2002 by reforming
welfare, farm, and other programs.
-- Republicans would cut too deeply; for example, by increasing interest costs of
student loans.
.
• The President would cut $200 billion from discretionary programs by 2002 by eliminating,
cutting, or consolidating hundreds of programs and targeting available funds to defense,
education, children, and anti-crime efforts.
-- Republicans would cut education and anti-crime programs; for instance, their cuts
would throw hundreds of thousands of children off Head Start and nutrition programs,
and gut the President's anti-crime efforts.
• The President would target tax relief to middle-income Americans, enabling them to more
easily raise their children, pay for post-secondary education, and save for the future.
-- Republicans would' provide a huge tax break whose benefits would flow
disproportionately to the wealthy, and also would raise taxes on millions of working
families.
• The President proposes to work with Congress to save $25 billion by eliminating unneeded
corporate subsidies.
�,.
BALANCING THE BUDGET:
THE PRESIDENT'S 'ECONOM1C PLAN
DEFICITS, IN BILLIONS OF DOLLARS
350
I
PRESIDENT'S 1993
EC'ONOMIC PLAN
300
I:
I .
250 .
PRESIDENT'S
10-YEAR BALANCED
BUDGET PLAN
200
150
100
jI
50
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1981
1993
1996
2005
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�TIlE PRESIDENT'S ECONOMIC PLAN:
REACHING BALANCE IN 2005
• In 1993, the President faced a deficit that was ristng out of control -- from $290 billion in
1992 to more than $600 billion early in the next century.
• The President's 1993 economic plan has cut the deficit dramatically -- from $290 billion to
a projected $190 billion this year..
• More importantly, it cut the deficit as a percentage of the economy (GDP) -- from 4.9
percent to 1992 to an estimated 2.7 percent this year and 2.1 percent by the end of the
decade.
• If not for interest on the debt accumulated between 1981 and 1993, the budget would be in
balance today.
.
.
• But, largely due to health care costs, the deficit will begin to rise again -- gradually
reaching $266 billion in 2005.
• Now, the President proposes to' finish the job -- to balance th~ budget by 2005.
• In 2005, the President proposes to save:
-- $96 billion in entitlements:
Medicare, $67 billion
Medicaid, $19 billion
Poverty programs, $9 billion
Other entitlements, $1 billion
-~
$92 billion in discretionary spending:
Defense, $27 billion
Non-defense, $65 billion
-- $6 billion in corporate subsidies.
-- $117 billion in interest savings.
• The President would target tax relief to average Americans, costing $26 billion in 2005.
• All told, the President's plan would bring the budget at least to balance by 2005.
�mE PRESIDENT'S HEALm REFORM INITIATIVE:
A SERIOUS STEP TOWARD HEALm CARE REFORM
.
As the President has said, the key to long-term deficit reduction is controlling health
care costs through health care reform. Thus, in his plan to balance the budget by 2005, the
President presents a serious first step toward reform that:
..
• strengthens the Medicare Hospital Insurance (HI) Trust Fund, ensuring· Medicare
solvency until 2005;
• provides health security for 6 months for working families after a job loss;
.
• reforms Medicare to make quality managed care options more attractive while
.
preserving choice;
• improves Medicare with new benefits that (1) provide Alzheimer'S respite care, and
(2) waive the copayment for women who need mammograms;
• provides home- and community-based care grants for disabled and elderly
Americans;
• maintains Medicaid as a safety net for low-income Americans while reforming it to
target funds more efficiently and increase state flexibility;
• reforms the insurance market to ensure that Americans can keep their coverage if
they change jobs, that they won't lose coverage if they get. sick, and to improve the
availability and affordability of coverage for small.businesses;
• gives small businesses voluntary pooling 'options, including access. to Federal
Employees Health Benefits Program (FEHBP) plans;
• expands the self-employed tax deduction to 50 percent; and
• reduces the deficit by $271 billion over the next decade.
The President's plan expands coverage, cuts the deficit with less than half the
Medicare savings and a third of the Medicaid savings that Republicans propose, and imposes
no new cost increaseS on Medicare beneficiaries.
By contrast, the Republican budget proposals threaten Medicare beneficiaries, reduce
Medicaid coverage for millions of children and elderly Americans, and endanger many
hospitals, including academic health centers. The Republicans' cuts (assuming a 50/50
beneficiary/provider split) would increase out-of-pocket costs for couples by $1,700 in 2002
alone (under the House budget resolution). Moreover, the Republicans do not reinvest one
penny into 'health care; instead, the Republicans use Medicare and Medicaid cuts to pay for
hundreds of billions of dollars of tax cuts for well-off Americans.
.
�DETAILED EXPLANATION
1. Reronning the Insurance Market
Insurance reforms, based on proposals that both Republicans and Democrats
supported in the last Congress, will improve the fairness and efficiency of the insurance
marketplace.
• Portability and Renewability of Coverage -- Insurers will be barred from denying
coverage to Americans with pre-existing medical conditions, and plans will have to
renew coverage regaq:iless of health status.
• 'Small Group Market Refonns -- Insurers will be required to offer coverage to
small employers and their workers, regardless of health status, and companies will be
limited in their ability to 'vary or increase premiums on the basis of claims' history.
• Consumer Protections -- Insurers will be required to give consumers information
on benefits and limitations of their health plans, including the identity, location, and
availability of participating providers; a summary of procedures used to control
utilization of services; and how well the plan meets quality standards. In addition,
plans would have to pr~)Vide prompt notice of claims denials and establish internal
grievance and appeals procedures.
2. Helping Working Families Retain Insurance After a Job Loss
Families that lose their health insurance when they lose a job will be eligible for
premium subsidies for up to 6 months. The premium subsidies will be adequate to help
families purchase health insurance with benefits like the Blue Cross/Blue Shield standard
option plan available to Federal employees.
3. Helping Small Businesses Afford Insurance
• Giving. Small Employers Access to Group Purchasing Options: Small employers
that lack access to a group purchasing option through voluntary state pools would get
that option through access to the Federal Employees Health Benefits Program
(FEHBP) plans. This would increase the purchasing power of smaller businesses and
make the small group insurance market more efficient. Small firms would get
coverage from plans that also provide coverage to Federal employees through
FEHBP, but the coverage would be separately rated in each state, leaving premiums
for Federal and state employees unaffected.
• Expanding the Selr-Employed Tax Deduction: The President's plan provides a
fairer system for self-employed Americans who have' health insurance. Self-employed
people would deduct 50 percent of the cost of their health insurance premiums, rather
than 25 percent as under current law.
4. Refonning and Strengthening Medicare
• Strengthening the Trust Fund: The President's plan would reduce spending in
Medicare's Part A by $79 billion over 7 years to ensure the solvency of the Medicare
�HI Trust Fund
to
2005. The plan finds such savings by reducing provider cost
,growth, not raising beneficiary costs.
• Eliminating the CoPayment for Mammograms: Although coverage by Medicare
began in 1991, only 14 percent of eligible beneficiaries without supplemental
insurance tap this potentially lifesaving benefit. One factor is the required 20 percent
copayment. To remove financial barriers to women seeking preventive
mammograms, the President's plan waives the Medicare copayment.
• Expanding Managed Care Choices: The President's plan expands the managed
care options available to beneficiaries to include preferred provider organizations
("PPOs") and point-of-service ("POS") plans. The plan also implements initiatives to
improve Medicare reimbursement of managed care plans, including a competitive
bidding demonstration proposal. Also included in his plan are important initiatives to
streamline regulation.
• Combatting Fraud and Abuse: "Operation' Restore Trust" is a five-state '
demonstration project that targets fraud and abuse in home health care, nursing home,
and. durable medical equipment industries. The President's budget increases funding
for these critical fraud and abuse aCtivities.
s. Long-Term Care
• Expanding Home arid Community-Based Care: The President's plan provides
grants to states for home-and community-based services for disabled elderly
Americans. Each state, will receive funds for home-and community-based care based
on the number of severely disabled people in the state, the size of its low-income
population, and the cost of services in the state.
• Providing for a New Alzheimer's Respite Benefit within Medicare: The
President'S plan helps Medicare beneficiaries who suffer from Alzheimer's disease by
providing respite services for their families for one week each year.
6. Reforming Medicaid
The President maintains Medicaid, expanding state flexibility, cutting costs, and
'assuring Medicaid's ability to provide coverage to the vulnerable populations it now serves.
• Eliminating Unnecessary Federal Strings on States: To let states manage their
Medicaid programs more efficiently, the President's plan substantially reduces Federal
requirementS.
-- States will be allowed to pursue managed care strategies and other service
delivery innovations without seeking Federal waivers; and
-- The "Boren Amendment" and other Federal requirements that set minimum
payments to health care providers will be repealed.
• Reducing Medicaid Costs: The President proposes a combination of policies to
reduce the growth of federal Medicaid spending,' including expanding managed care,
�reducing and better targeting Federal payments to states for hospitals that serve a high
proportion of low-income people, and limiting the growth in federal Medicaid
payments to states for each beneficiary. Per-person limits, as opposed to a block
grant on total spending, promote efficiency while protecting coverage.
�REPUBLICAN TAX CUTS REQUIRE
'DEEP MEDICARE CUTS
DOLLARS IN BILLIONS
100
75
TAX CUTS
50
25
o
-25
-50
-75
MEDICARE CUTS
-$68
o.
-$86
-100
,
1996 . 1997
1998
1999
2000
2001
2002
,NOTE: House Budget Resolution numbers.
....~M_
�MEDICARE SAVINGS.
SEVEN YEARS
DOLLARS IN BILLIONS
350
i
REPUBLICANS
300
·HOUSE
250
SENATE
200
PRESIDENT
CLINTON
150
100
50
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�MEDICARE REFORM
IMPACT ON BENEFICIARIES IN - 2002
Republican Proposals
President's Proposal
• $1,700 CUT PER COUPLE
,-. NO- NEW BENEFIT CUTS'
~
Additional Costs
-
Higher Co-Payments
Higher Premiums
Coercive Plan
2nd Class Health Care
System for Seniors
NOTE: 'House Budget Resolution numbers.
• Additional Benefits
- -Home- and Community~
Based Care Grants
,- - Respite Benefits for .
Alzheimer's Caretakers
- Preventive Health Benefits:
No Mammography
CO-Payment
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�MEDICAID SAVINGS
SEVEN YEARS
DOLLARS IN BILLIONS
225
200
REPUBLICANS
HOUSE
175
SENATE
150
125
100
75
PRESIDENT
CLINTON
50
25
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�THE PRESIDENT'S PLAN:
REWARDING WORK AND RESPONSmlL1TY
For low-income programs, the President would move people from welfare to work
through strict work requirements and investments in >training and child care. He would
expand efforts to fight fraud and abuse, maintain the national nutrition safety net, target
support to the neediest, and protect poor children. These proposals would save $38 billion
over 7 years, after accounting for investments in child care and work and training for welfare
recipients. Republican proposals would cut more than $100 billion over 7 years, tearing
apart the social Safety net, imposing unattainable work requirements while slashing child
care, and putting millions of children at risk.
• For the Earned Income Tax Credit, the President proposes to continue the expansion of taX
relief for the working poor, save $3 billion over 7 years by improving error and fraud
control, and make sure illegal aliens who are not authorized to work in the U.S. do not
receive· the EITC.
-- By cutting the EITC by $21 billion over 7 years, Senate Republicans would raise
taxes on 10 million working families with children and 4 million low-income workers
without children.
• For cash assistance and social services programs, the Presiden-i would save $10 billion .
over 7 years by tightening SSI eligibility, tightening rules for AFDC, encouraging recipients
to move from welfare to work, curtailing abuses, and investing in child care and work
programs~
- Republicans would drastically cut funding for cash assistance ($29-44 billion over 7
years), remove requirements that States contribute to program funding, place new
strings on States, ana, in the House plan, ultimately deny cash to millions of children.
In addition, the House would eliminate SSI benefits for up to 170,000 disabled
children now receiving benefits and for as many as 550,000-850,000 who would
otherwise receive them over the next five years.
• Por benefits to immigrants, the President would save $5 billion over 7 years by tightening
sponsorship and eligibility rules for non-citizens, thus forcing sponsors of legal immigrants to·
bear greater responsibility for those whom they encourage to come to the U.S.
-- Republicans would slash $27-$33 billion over 7 years by denying assistance to low
income immigrants, including over I million legal immigrants now in the U.S.
• .For food assistance, the president would maintain the national nutrition safety net
programs while cutting mandatory spending by $20 billion over 7 years. He would protect
spending on WIC and give 600,000 more women, infants and children access to WIC's
important health and nutrition benefits.
-- Republicans would eliminate the national nutrition safety net, slashing $33-$49
billion over 7 years, by capping Food Stamps and block granting the school lunch and
other child nutrition programs. In addition, Republicans would force up to 300,000
women, infants, and children off WIC in 1996.
�THE PRESIDENT'S PLAN:
REFORMING ENTITLEMENT SPENDING
The President is proposing a series of reforms in entitlements and other mandatory
programs that will raise tens of billions of dollars .by targeting benefits to those who need
them and ensuring that taxpayers get a fair return on public resources. Republicans wouli1
cut too deeply into entitlements and threaten services and benefits on which millions of
Americans rely.
Veterans:
• The President proposes to protect pensions for poor veterans and compensation for
service-connected disabled veterans.
.
-- Republicans would restrict or eliminate cOmpensation benefits for certain veterans,
and redefine and narrow eligibility for service-connected disabilities .
. FannPrograms:
• The President proposes to save $4.2 billion over 7 years by 3.Ilowing farmers to use more
acreage to plant what the market demands, reducing inequitable treatment of farmers by crop
and region, and targeting payments to smaller farmers.
-- Republicans would cut farm program spending 3-4 times as much -- the House by
$17 billion over 7 years, the Senate by $12 billion over 7 years -- without specifying
how.
.
Spectrum Auction:
• The President proposes to raise $14.3 billion from 1996-2002 by expanding the Federal
Communications Commission's spectrum auctions to a variety of new wireless services.
-- The House and Senate also would expand the Government's auction authority.
�THE PRESIDENT'S PLAN: .
INVESTING IN EDUCATION AND TRAINING
The President proposes to invest more in education and training, giving average
Americans the skills they need to get high-wage jobs in the new economy. He would
increase investment in education and training by $9..5 billion a year by 2002. The
President's plan increases education and training by $40 billion over the next 7 years;
Republicans would cut it by up to $43 billion over the same period.
• For National Service, the· President would expand the Corporation for National and
Community Service, enabling nearly I million young Americans to serve their communities
and earn scholarships for higher education.
-:- The House would kill all national service programs.
• For the G1 Bill for America's Workers (excluding Pell grants), the President consolidates
70 programs and add an additional $2.3 billion in 2002 for adult skill grants and youth
programs.
-- Republicans would cut funding 25 percent below the 1995 level.
• For Head Start, the President would increaSe annual funding by $1.5 billion by 2002 to
reach another 50,090 children -- for a total of 800,000 per year-':'- and to improve quality.
-- House Republicans would cut up to 200,000 children, compared to 1995.
• For Goals 2000, the President would increase funding from $124 million in 1995 to $867
million in 2002, helping all Slates and school systems extend high academic standards, better
teaching, and better learning to 44 million children in over 85,000 schools.
.
-- House Republicans would kill support to help Slates raise education achievement.
• For Pell Grants, the President would increase annual funding by $3.4 billion by 2002 to
reach 960,000 more recipients (for a total of 4.8 million) and increase the maximum award
.
from $2,340 to $3,128.
-- Republicans would freeze Pell at the 1995 level.
• For Safe and Drug-Free Schools and Communities, the President would maintain funding
at $500 million per year, to help nearly ever school district fight drug abuse and reduce
violence.
-- Republicans would turn the program into a block grant and cut funding 30 percent.
• The President would phase in Federal Direct Student Loans quicker, affecting $25 billion
in loans to 6 million people a year, at lower cost to government, schools, and students.
. -- House Republicans would eliminate the in-school interest' exemption for 4 million
financially needy borrowers, requiring a low-income college graduate who borrowed
the maximum amount to pay $3,150 more for loans than under the President's plan.
�INVESTMENTS IN
EDUCATION AND TRAINING
DOLLARS IN BILLIONS
52
I
".
PRESIDENT'S PROPOSAL
48
44
40
SENATE PROPOSAL
/
36
/
.HOUSE PROPOSAL
32
1996
1997
1998
1999
2000
2001
, 2002
�THE PRESIDENT'S PLAN:
PROTECTING THE-ENVIRONMENT
The President proposes to protect the environment and our natural resources, but still
save money by focusing funds on legitimate Federai- functions, cutting or eliminating lower
priority programs, and increasing the use of user fees. Republicans would jeopardize the -,
environment by eliminating funds for' constructing municipal wastewater and drinking water
facilities, ending the acquisition of land for national parks and forests, and cutting park and
forest budgets by 10 percent below 1995.
• The President proposes to consolidate the Clean Water and Safe Drinking Water State
Revolving Funds that make loans for municipal wastewater and water treatment construction,
'giving States more flexibility in meeting local priorities. He would reduce funding over time
to $1.5 billion a year as States gain access, as a permanent source, to the repayments of
previous loans.
-- The Senate would eliminate these programs by 1998; the House would provide less
funding than the President.
• The President proposes to increase funding by $265 million a year by 2002 for the
Environmental Protection Agency's operating program, the backbone of our efforts to protect
the environment. This increase comes after $150 million in savings due to streamlining and
decreased EPA oversight of State delegated programs. The operating program increases
address global climate change" promote development and export of environmental
technology, and protect sensitive ecosystems.
-- Republicans would eliminate the program to develop environmental technologies
that improve the environment at lower cost while opening new export markets, and
terminate funding for' programs that protect water quality and preserve habitat for
ducks and fish.
.
• The President proposes increases each year for National Park operations and rehabilitation
in order to maintain parks and their facilities.
-- Republicans would cut national park construction by half, and park operations by
10 percent, the latter of which would strain the National Park Service's ability to keep
parks open and up to standards.
• The President proposes to phase-down spending on Federal'land acquisitions to $100
million a year, focusing on' high-priority projects and the expanded use of land exchanges.
-- RepUblicans would terminate Federal land acquisitions.
�mE PRESIDENT'S PLAN:
CONTROLLING VIOLENT CRIl\1E
The President proposes to expand his vigorous fight against violent crime, providing a
$6.7 billion increase a year by 2002 Jor grants to States and localities; more resources for
Federal investigations, prosecutions, and imprisonment; and more support for the Federal
Judiciary to try and convict violent offenders. The President would spend $7.5 billion more
in 2002 than House Republicans and $200 million more than Senate Republicans.
• The President proposes to. fully fund the Violent Crime Reduction Trust Fund (VCRTF),
providing the full $30.2 billion authorized by the VCRTF from 1995-2000. In addition, for
2001-02 the President would add $8.5 billion, bringing total VCRTF funding to $38.7 pillion
for 1995-2002.
-- House Republicans would cut programs authorized by the VCRTF from 1995-2000.
• The President's proposal for the VCRTF would finance:
-- 100,000 cops for State and local police forces, fulfilling a major promi~ of the
President and adding almost 20 percent to State and local police forces;
-- reimbursements to
State~
which have paid to incarcerate criminal illegal aliens; and
-- State and local grants to:
• ,bring new prison cells into service;
• confront the problems of viole'nce against women; and
•. finance "drug courts" which provide cost-effective ways to deal with first
time, non-violent drug offenders.
• The President would provide an increase of $1.7 billion by 2002 for Justice Department
crime fighting programs, inCluding heightened border enforcement, increased FBI and DEA
funding to address drug abuse, street crime, and terrorism; and increased resources for the
Federal Prison System for new prisons and costs tied to a growing population of violent. .
criminals.
-- Republicans would not provide specific increases for these programs.
• The President would increase funding by $500 million a year by 2002· for the Federal
court system to adjudicate violent criminal cases.
-- Republicans would not provide any increases for the Federal Judiciary.
• The President would terminate several unnecessary or redundant programs, such as the
State Justice Institute, the Administrative Conference of the U.S., and the U.S. Parole
Commission.
�mE PRESIDENT'S PLAN:
STRENGmENING OUR COMMITMENT TO SCIENCE AND TECHNOWGY
The President proposes to significantly improve the Nation's global economic
competitiveness through a balanced mix of basic research, applied research, and technology
development, much of it through cooperative projeGts with private industry. Republicans
would significantly reduce investments in basic research, applied research, and technology"
development.
• The President proposes to add $2.5 billion a year by 2002 for biomedical and behavioral
research at the National Institute for Health.
-- The House would cut biomedical' and behavioral research at NIH by $542 million.
• The President proposes that the National Science Foundation's investments in basic
research and education programs keep pace with inflation, adding $500 million a year by
2002.
-- Republicans would invest significantly less, with the Senate cutting $100 million
and the House adding $240 million.
'
• The President would provide $100 million more a year by 2002 for the science facilities
utilization initiative, ensuring more research time for scientists working on "cutting edge"
research facilitieS.
'
-- Republicans would force many of these valuable facilities to close their doors.
• The President proposes to add at least $500 million a year by 2002 for NASA's
investments in basic research, including Mission to Planet Earth, which will provide the first
global study of the impact ef man on the Earth's environment.
-- Republicans would cut these important research programs significantly.
• The President is proposing to increase the Advanced Technology Program (ATP) million
and the Manufacturing Extension Partnership (MEP) by almost $500 million a year by 2002. '
• ATP invests in partnerships with industry to accelerate the development of high-risk
technologies with significant commercial potential. The MEP is a nationwide, locally
managed network of manufacturing centers to help the nation's 381,000 small manufacturers
adopt modem manufacturing technologies.
-- Republicans would eliminate both programs.
The President is proposing to increase funding by $100 million from 1996-2002 for the
Defense Department's DOD Technology Reinvestment Project (TRP), which invests in
partnerships with industry to accelerate the development of technologies that are critical to
national security but can also benefit civilian purposes (Le., dual use).
-- The House would eliminate it in the draft 1996 authorization bill.
�TIlE PRESIDENT'S PLAN:
TARGETING TAX RELIEF TO MIDDLE-INCOME AMERICANS
The President also proposes to raise living standards with a tax cut for middle-income
Americans. The President proposes to help average- Americans to save, and to meet the cost
of raising and educating their children. Republicans would provide huge tax cut whose ..
benefits flow disproportionately to wealthy people and corporations and whose costs must be
offset by deep cuts in Medicare and other priorities.
a
• To assist families raising children, the President proposes a tax credit of up to $500 for
each child under age 13. The credit starts at $300 per child through 1998, and increases to
. $500 in 1999. It is phased out between incomes of $65,000 and $75,000 per year.
- House Republicans also include a $500 child tax credit, but phase it out .between
incomes of $200,000 and $250,000. Because Republicans propose a tax cut for
people of high incomes -- about 6 times that of the typical family -- they must cut
deeply into Medicare and other priorities.
• To help families meet the costs of education beyond high school, the President proposes a
deduction for post-secondary tuition and fees of up to $10,000 per year. The deduction
begins at $5,000 in 1996, rising to $10,000 in 1999. It is phased out at incomes between
$100,000 and $120,000 per year for married couples ($70,000 and $90,000 for other
taxpayers).
-.: Republicans have offered no such incentive for education.
• To help families save, the President proposes to expand Individual Retirement Accounts.
Income limits would double; couples with incomes up to $80,000 (and single persons with
incomes of $50,000) could make fully deductible contributions. The President would allow
penalty-free withdrawals for catastrophic medical expenses (including for parents and
grandparents), higher education costs, the purch~ of a first home, and unemployment. The
President proposes a new back-loaded IRA; contributions are not tax deductible, but
withdrawals after five years are tax free.
-- House Republican have a similar proposal but would allow back-loaded
contributions with no income limit -- again, forcing deep cuts in Medicare and other
priorities.
... ......
• House Republicans also have proposed enormous tax cuts for wealthy persons and
corporations, forcing them to cut deeply into Medicare and other priorities. The tax cuts
include: the virtual end of the alternative minimum tax for large corporations, costing $35
billion over 10 years; a liberalization of tax depreciation laws that would save large
corporations over $150 billion between 1999 and 2005; a cut in estate taxes for persons with
at least $600,000 of accumulated wealth, costing $20 billion; and a capital gains tax cut,
costing $90 billion and providing 58 percent of its tax benefits to the 2.5 percent of taxpayers
with incomes over $200,000 per year.
�SOURCES AND USES OF FUNDS
Medicare:
The Republican Medicare proposai cuts ($256/$288 billion SenatelHouse
over seven years) double the President's proposal and are likely to include huge
beneficiary cost increases. Not one penny of these cuts are.reinvested into
health care; instead, the Republicans are calling for· hundreds of billions of
dollars of tax cuts for well-off Americans. Moreover, relative to the·
President's proposal, the Republicans' Medicare cuts (assuming a 50/50
beneficiary/provider split) would increase beneficiaries out-of-pocket costs by
$3,100 over seven years. Couples would pay $1,700 more in 2002 alone.
The President proposes $99.3 billion in new Medicare savings over 7 years.
This amount, combined with the extensions of current law that were already in
the President's budget ($28.3 billion), proquces $127.6 billion in savings.
Out of the $127.6 billion in savings, $13.1 billion is used to pay for the new
long-term state grant program, a new Medicare Alzheimer's respite benefit, and
. for the elimination of the Medicare mammography co-payment. $88.6 billion is
used to ensure the solvency of the Part A Trust Fund to 2005. This $88.6
billion, plus the remaining $25.9 billion (out of the $127.6 billion total), also
contributes to deficit reduction.
Medicaid:
The Republican Medicaid proposal cuts ($177-$187 billion SenatelHouse
over seven years) triple the President's proposal. Rather than expanding
coverage and moving forward on health reform, the Republican cuts will take
us backwards and actually force states to cut coverage (to 5 million to 8
million children and pregnant women, and to 800,000 to 1 million elderly and
disabled.) Reduced coverage means that the cost-shifting burden of
uncompensated care for hospitals and for the currently insured (who pay for the
uninsured in increased premiums) would be further exacerbated.
The President proposes to reduce Federal Medicaid spending by $54.9 billion
over seven years by limiting growth and promoting flexibility. Of this amount,
$16.1 billion is used to provide health insurance subsidies for Americans who
are temporarily unemployed and to further expand the self-employed tax
deduction. The re~aining $44 billion is used for deficit reduction. .
�06/21/95
12:10
U202 401 7321
HHS ASPE/HP
III 0021002
Medicaid Per Capita Caps
Medicaid per capita caps limit the growth in Medicaid costs per recipient to some fixed amount,
like medical inflation or the growth in gross domestic product. Caps operate by setting a fixed
amount of Federal spending per recipient for each state, for each year. The total amountof
Federal funding that a state receives is the product ofthe costs per recipient in the base year, the
flxed growth rate per recipient and the nmnber of recipients. For example, say a state has 100
Medicaid recipients in 1996 and a cost per recipient ofS2,OOO in 1995, the base year. If the per
capita cap is 6%, then the state will receive in 1996: 100 times $2,000 times an increase of 6%.
If the state had a recession, and there were twice as many recipients in 1996, then the federal
payments would be twice as high.· Per capita caps allow for fluctuations in enrollment, while.
limiting growth in expenditures due to factors such as excessive health care inflation.
Per capita caps are different than block grants. Block grants like those proposed by the
Republicans in the House and Senate fix the total amount of federal spending in each state, for
each year. without allowing for changes in recipient growth. Each state receives the amount
determined by the fonnula, regardless of whether their Medicaid enrollment shrinks or grows.
As a result, Medicaid flnancing is no longer linked to Medicaid coverage -- which, given the
magnitude of the Republican cuts, will likely result in loss ofcoverage.
�, 06/2l/95
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STATEMENT OF
BRUCE C. VLADECK, Ph. D.
t~'"t
l
".
t~~
;~~!
I
~
n. .....
MEDICAR. • MEDl:AID
. . . .GIII AIIIIIIII
HEALTH CARE FINANCI
~002l018
�;
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-......::llI!
1Ir. Chairman M$1 llembers of the committee:
I welcome ·the opportunity to be here this morning to discuss the
hist.ory, accomplishments and future direction of the Medicaid
program.
This Administration has been working to strengthen
Medicaid's inherent partnership between the Federal government
and the States.
We know we need to continue building on this
partnership to make necessary improvements to the Medicaid
progrUl4
Intxoduction
Medicaid provides health coverage for
children,
seni~r
36~1
million Americans
Citizens, individuals with disabilities and
others -- through a partnership between the Federal government
and the states which provides States with substantial flexibility
over eligibility, benefits and delivery systems.
Recently, States have also been seeking additional flexibility in
the Medicaid program.
We have responded by using our
demonstration authority to enable States to pursue a number of
innovative approach.s to covering additional populations and
redesigning ••cUeaiel elelivery systeu.
Just last week, the
President also proposed important nev reforms that will control
Meelicaiel cost increases anel provide States with additional
programmatic flexibility_
1
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pe~iod
Bxcept fo% the
HHS ASPE/HP
~004/018
between 1989 and 1992, the Medicaid program
has grown 1.s. rapidly than the private sector on a per capita
basis (Chart l).The unsustainable growth rates during this time
were caused by several factors, inciuding a national recession,
States' use of statutory loopholes .to leverage Federal dollars,
and increased provider payments.
In response, the £xecutive
Branch worked with Congress and the States to bring program costs
under control while maintaining the Medicaid program
impo~tant
a8 ~
source -- often the only source -- of coverage for low
income Americans.
our'new east containment proposals .continue
this commitment. .
Medicaid is a Critical Safety Net
Medicaid 1s the primuy source of coverag'a for a wide variety of
Americans with diverse health care needs.
It covers preventive
.'
care for low and moderate-income pregnant women and children and
long term
~are
for low-income senior'citizens.
It also.provides
a variety of rehabilitative and adaptive services for persons
with diSabilities, chronic care for individuals with speCial
needs, and supple_ntal coveraget for low-income Medicare
beneficia%.1•••
Generally, Medicaid acute-care coveraqe mirrors the employerbased coverage available to most Americans, but ,Medicaid also
provide. long term care benefits for senior citizens and
individuals with disabilitieBthat are rarely available or
2
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affordable through other sources.
I4J 0051018
Because Medicaid covers these
services, the program ultt-ately helps a large number of working
American families care for their chronically ill family members.
Fo~
example,
61 percent of all nursing home residents rely on
·Medicaid to help pay for their care.
Many beneficiaries have
complex health needs or need long term care and therefore are
very expensive ~o care for.
In 1993, spending on all se:rvices
for elderly and disabled individuals constituted approximately 70
percent of all Medicaid SpendIng, eXCluding payments to
disproportionate share hospitals (DSH).
Approximately half of
these dollars were spent on long term care in nursing homes.
Without Federal Medicaid funding, many of 'these individuals -
the elderly, chronically ill, disabled and mentally ill -- would
be the sole responsibility of states, local co_unities and their
families.
The rell&ining thirty percent of Medicaid spending is
. dedicated t.o care for low-income adults and children who use
primarily hospital and physician services (Chart 2).
Americans who qualify for Medicaid are assured of financing for
their essential health services.
While eligibility varies fro.
.
St.ate to State, cert.ain national standards apply t.o all States -
,
notably coverage for low-income pregnant vODien ancl children, and
the low-income elderly and disabled.
States provide the full
range of .ervices to beneficiarie., from childhoOd immunizations
to nursing horae care.
Within the.e paraaieterl, Medicaid bas had
substantial success serving diverse low-income populations.
3
For
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example, ,Medicaid coverage improves continuity of prenatal care
,for low-income pregnant wOlllen and increases disabled children's
access to physicians.
Over the past few years,
e~loyer-based
whil,e Medicaid coverage has expanded.
coverage has declined
For example, wh.ile
employer coverage fell from 65 to, S9 percent of individuals under
age 65 between 1989 and 19'4, 'Medicaid coverage grew from,' ta
14 percent for the same,popu1at10n (Chart 3).
lIecliCaJ.d, provides
a safety net for some individuals and familiea who wou·ld
otherwise be uninsured and picks up costs that do not disappear
from the health system just because an individual 108es private
health .insurance.
Medicaid's Management Successes
HerA
and the states have worked together to develop an ef£.icient
program.
OUr low Federal and State administrative costs -- 3.1
percent of total program spending in
l"3~-
are an example af
our success in lDiniJDJ.zing administrative burden.
AS. result, we
can target program dollars towards,benefielarles and their health
needs.
In addit.ion, the Medicaid program has pioneered a number
of innovations that enhance program efficiency, expand access to
services, improve quality of care, and create new.delivery
mechanisms that better serve beneflc.iaries.
�06/21195
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7321
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IaJ 0071018
usini the flexibility inhe~ent in the Medicaid program, States
thei~
have developed programs that target
unique needs and have
pursued a wide ranqe of administrative and proqr....tic
innovations.
HerA ,has encouraged and supported State program
improvements, including:
Replacinq institutionalized,
n~rsing
home care with
home and community-based services for disabled and
elderly beneficiaries, thus reducing nursing home costs
while, improving quality of life for these patients;
Introducing magnetic-stripe cards to provide immediate
.
,
access to eligibility information, third party
liability and electronic claims filing;
Experimenting with new,
gatekeepe~-oriente4
forms of
managed care to, ..xlmlze enrollee choice vhile also
controlling costs; and
Implement'inq automated drug utilization review to
~ontrol
fraud and improve the quality of pharmacy
services
0
The Federal government continues working to provide substantial
assistance to the States and forge new paths for the Medicaid
program.
So. . notable examples include:
Developing innovative Federal quality assurance
quldelines for Neaieafd manaqed care orqanizatioras;
Spearheading the effort to define outcomea measures for
Medicaid enrollees to provide
s
q~eater
assurance that
�-'--t 06/21195
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raJ 0081018
managed, care enrollees receive high
quali~y
health
servi,cesi
.Developing "best practices pidelines tt for the States
on significant program innovationB,such as: primary
care case management programs;
Early,' Periodic
Screening, Diagnosis and Treatment (EPSDT)
implementation;
and quality-assurance in community-,
based programs;
Implementing a national drug rebate program -- thus
holding per person drug expenditures to 1988 levels
and providing states with' day-to-day technical
assistance to simplify rebate requests;
Strengthening our waiver approval process and
developing streamlined waiver applications -- these
improvements have eased State efforts to expand managed
care enrollment, which, now includes over 23 percent of ,
all Medicaid beneficiaries; and
Developing quality standards to protect seniors and
others in nursing homes.
Many of the•• Federal efforts focus on ensuring Nedicaid's fiscal
integrit.y, protecting
bene~lciaries
and ensuring that public
dollars are well spent'on high quality services, 'all within the
broader context of providing substantial support to state
programs.
6
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~009/018
1993, this Administration has taken remarkable8tep8 to
build upon HCFA'8 history of partnership with the states.
We are
working with a number of States to test nev, broad-based
approaches to health financing and de~ivery throuqh State~ide
health reform demonstrations under Section 1115 of the Social
Security Act.
This authority gives the Secretary broad latitude
to permit demonstrations that further the goals of ~he Medicaid'
program.
Throu9hth~se
programs, States may test the
effectiveness and efficiency of their own ideas.
Historically,
States had sought demonstration authority to test relatively
narrow changes, such a. changes to the Medicaid benefit package,
payment methodologies or eligibility requirements for a defined
group of beneficiaries or services.
Since 1993, States have
begun to develop broad, Statewide reform programs under this
demonstration authority.
To date, this
Administr~tion
has approved ten' Statewide health
reform demonstrations, and we are considering several additional
proposals.
The.e States vill experiment. with innovative
financing and delivery systellS on a broad scale.
For example,
'Florida int.end. to develop a revolutionary health alliance system
that will broker private health'coverage for low-income and
uninsured Flor1dia.ns through a cOJlDllunity purchasing network,
while Hawaii has achieved insurance coverage for more than 9S
percent of its population through • combination of Medicaid
expansions and an employer mandate.
'7
-'
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11: 12
We continue
'6'202 401 7321'
ou~
HHS ASPE/HP
~010/018
efforts to control growth in program spending_
The sUbstantial program growth' of the late 1980s and early 19905
was largely driven by States' use of provider taxes, voluntary
donations and disproportionate share hospital
leverage Federal matching dollars.
(DSS)
payaents to
Fortunately, because of our
work and Congress's efforts -- through this Committee' and others'
-- the worst abuses have been tempered.
Today,
we project that year-to-year expenditure growth 1n the
Medicaid program will average 9.3 percent through 2000.
Because
enrollment growth has driven much of the spending increases in
Medicaid, our per capita growth rates are much lower.
estimate that Medicaid's annual per
cap~ta
We
growth will average,
5.4 percent through 2000.
Improvinqthe Medicaid Proqram
As you know, the President recently suggested a number of ideas
,
,
for enhaftcing the Feeleral-State partnership and controlling
Medicaid costs.
I believe these,strat.egies represent the right
approach to improving the Medicaid program.
We believe the best st.rategy for improving the Federal-State
MecUcaid partnersh1pia to pursue changes that protect
beneficiaries yet give States additional program flexibility and
cost.-control lIlechanism.so
We believe that. thiS can best be
achieved within ,the current Federal-State partnership.
The
�06/21195
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@OIl/OlB
Medicaid program can and does provide flexibility for States, but
the program'. structure also ensures an.important degree of
continuity across States.
This contlnuitf is particularly
important 1n program eligibility --
lov-in~ome
senior citizens,
individuals with
disabilitie~
in every State.
Under the current Federal-State relationship,
and children are Medicaid-eligible
States also draw on Federal expert!se, buying-power and technical
assistance to aChieve program goals.
The President's proposal seeks $54 billion in Med!caid program
savings over seven years.
We want·to work with this Committee
and the Governors to determine how we can, best achieve these
savings., We are' interested in significant changes.
For example, .
we want to give States more flexibility to pursue certain widely
used managed care models by replacing current waiver requirements
with new statutory authority that would make these types of
. Medicaid managed care models a program option.
We are also interested Inbul1dlng upon our work with the
National Governors' Association (NGA).
For example, we worked
with the NGA to encourage States to expand their home.and
community-b••ed services programs. ·We believe that State
flexibility in these programs could be enhanced further.
Finally, we are evaluating nev strategies for guarante.ing access
to high-quality services that are more refined than the current
Boren Amendment and other provider 'payment require.ents.
9.
�06121/95
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~012/018
Beyond increasing State flexibility, we know that Medicaid cost
containment must be.continued.
However, we do not want to do
this in a way that risks Medicaid enrollees losing coverage.
Instead, the President has proposed per capita limits on Federal
Medicaid spending, which will provide an additional incentive for
States to control program spending but will not force them to
restrict Medicaid eligibility.
Under per capita spending limits,
Medicaid enrollment can continue to expand and contract with
economic conditions and individual needs.
With ehhanced
flexibility, States will be able 'to manage within these limits,
while Medicaid beneficiaries
including senior citizens,
disabled people and children
will ret.ain their healtb care
coverage.
Comparison to
Oth~r
Proposals
We believe, the House budget proposal would damage this critical
safet.y-net .program and harm the States, beneficiaries and
providers.
These impacts would be driven by the dimensions of
, the spending cut, its likely influence on State spending, and
prOjected cuts ln Medlcaid enrollment.
The magnitude of the' House spending cut -- $187 billion over
seven years -- 1s too big to absorb through efficiencies alone.
S1mply limiting overall Federal matchlpg payments will not make
health-related costs disappear.
Neither whole-scale use of
10
�06/21/95
'11:13
fS'202 401 7321
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,141 0131018
.;
managed care nor any other programmatic change will provide
sufficient savings to maintain current coverage levels.
In addition, enrollment growth would absorb most of the lower
growth rates perm1ttedunder the House proposal.
As the attached
chart (Chart 4) demonstrates, Medicaid enrollment growth
projections edge very close to the proposed spending limits on
~lock
grants.
As you know, medical inflation influences public
health care spending as well as. private spending.
Inflation,
added to anticipated enrollment growth, will drive projected
program costs well beyond the sp,endlng limits envisioned under
the House proposal.
Given the many fiscal,. legal and political
pressures at work on States, it will be virtually impossible for
States to maintain coverage of essential medical services for
current Medicaid beneficiaries under the block grant proposalo
To maintain current coverage levels, the HOllse budget proposal
would force Statel to either absorb a large cost-shift from the
Federal government, caUSing the proportion of State to' Federal
'dollars invested in a State' sMedicaid program to increase as
States are forced to adjust to lost Fe.deral matching payments.
The urban Institute concludes that if States chose to fill the
gap, States would, on average, have to increase their spending by
39 percent to make up for the loss of Federal funds.
However, in
th8 current fiscal climate, few States may be, able to devote new
State dollars to their Medicaid program.
11
�06121/95
Tber~
11; 13
'6'202 401 7321
HHS ASPE/HP
~014/018
are fundamental differences between the President's plan
- and the .House budqet resolution.
We rely on per capita limits to
allow for changes in enrollment, while the House proposal is
based on an aqgreq&te cap and therefore does not provide room for _
enrollment growth.
In addition, we believe that the States and
Congress can realize
meaninqf~l
savings and additional
flexibility without resort.ing_ to a block grant.
Conelusi2D
-The Medicaid program has. a substantial history of success
together, the Federal government and the States have provided a.n
essential safety net for children, seniors .. nursing home
residents, the disabled, and other vulnerable Americans.
We .re committed to maintaining and building upon Medicaid's
successes in order to better serve our beneficiaries.
We believe
aChieved 'by making the changes that we know will
al government and-the States control costs and
for the Americans we serve today.
12
�o
Q)
Annual Percent Increase in Medicaid Expenditures
per Enrollee vs. Private ,Health Insurance.
1976-2005
20
"
....
..",
"
CI)
en
....
....
....
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"'"
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-a
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a:
..c:10
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o
1976 . 1979
1982
1985
1988
Private
--
, 'Pflv,Ht:! tlt~allh expellthlurus pt~r
! Suwet:!, HCFA/~AC~~
tll":>lJlt:d P~IS()II
1991
1994
1997
2000
2003
Medicaid
. -.;. -II- - ..
J§J
o
....
en
& M~dl<':illd Expl!lIdt'IIII~S per rec.ljllcilt
PtH ASG1l;IC
"
o
....
(iO
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0)
"
Percent Distribution of Medicaid and
Vendor Payments by Basis of Eligibility
100
2%
16 %
, "
....
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Q)
(n
....
....
....
c.>
£I
N
1'1 0/0
o
Other
N
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....
Children Under 21
80
'cu
(5
t
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[J Disabled AF DC AdlAlts
, : .
o
60
o
Q)
e
Q)
AFDC Adults
~
en
(Unknown Represents
0.4 % of Recipients and
, 0.25 % of Vendor Payments)
c
40
....
c.>
....
N
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en
rg
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:=
."
0..
20
22%
13%
a
Recipients
Vendor Payments
Fiscal Year 1993
I!§;I
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PR./ AS619A
.' . _ ..... --_ .. -
_ _ _ _-1
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o
....
00
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Medicaid is a Critical Safety Net
-
"
.....
"
N
(0
en
.
Employer Coverage Reduced, Medi.caid Coverage Increased'
80%
•
c
o
~
.
66 0/0
",,». ;:;.
:J
Cj
N
o
....,
Employer Coverage
....
o
....
Medicaid Coverage
....,
c.t
0
&.
o
....
....
....
....
....
.N>
590/0
60%
LO
(()
-L- .
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.......
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1989
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1994
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....,
SUlJtCl:.
lIef-A.OIlIt,,\.: \>1
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1'1;1,\ AS6198
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o
....
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o
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.....
,
0)
Medicaid Population and Inflation Growth
CBO Projected An~ual Increases 1996-2002
All Beneficiaries
N
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en
....
....
....
....
tj
120/0
N
o
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....
o
....
CD 100/0
-a
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....
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ro
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L
(,)
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c
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m
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C.f)
co
......
c
Q)
>
C.f)
~
,
House Block Grant
4%
==
."
~
(J)
a.. 2%
0%
1996
1997
1998
1999
2000
·.l_~ Po~u'a'~on __D ~~g
2001
2002
MC-P1l
I§l
o
....
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...• ---.----~
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....
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�
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Carol Rasco - Issues Series
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Carol Rasco
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2010-0198-Sb-talking-points-3
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https://clinton.presidentiallibraries.us/files/original/6bee6730fd4ad16735043ac8d250be24.pdf
7357ed1fd1eff4a6a80cfd474a5ec3b8
PDF Text
Text
THE WHITE HOUSE
WASH I NGTON
February 8, 1995
MEMORANDUM FOR SENIOR STAFF
FROM:
Gene Sperling
SUBJECT:
Middle Class Bill of Rights Talking Points
We have been working in a coordinated effort with members of the
Domestic Policy Council, Treasury, labor and OMB on the following:
a.) Summary One-Pager on MBR.
b.) One-Pager on Education Deduction;
c.) One-Pager on IRA.
d.) One-Pager on $500 Child Tax Credit.
e.) One-Pager on G.I. Bill of Rights for Workers.
We also have background papers ~md Qs&As.
�THE MIDDLE CLASS BILL OF RIGHTS
THE PRESIDENT'S COMPREHENSIVE PLAN
TO RAISE MIDDLE CLASS STANDARDS OF LWING
A Successful Economic Plan: The President's economic plan is already cutting the deficit
by $600 billion -- nearly $10,000 per family. It's also increasing investment in technology,
education, and training--with new college loan, national service, school refonn , and
School-to-Work efforts. The President fought for NAFTA and GAIT, bringing two of the
best years for opening markets in history. Over 15 million working families received a tax
break through his EITe, and 90 percent of small businesses are now' eligible for tax relief.
The Economy. Has Responded with the Best Combination of Growth, .Job Creation
and Low Inflation· in 30 Years: The President's economic plan helped solidify the
recovery, create nearly 6 million jobs,. and hold inflation down...
Still, the IS-Year Pattern of Stagnant Wages Continues for Too Many Middle-Class
Families: Only the top 20 percent of households have seen their incomes rise since 1978.
THE NEXT STEP: THE MIDDLE CLASS BILL OF RIGHTS
To ensure that all Americans share in the recovery and to help families invest in the future,
the President is calling for a Middle Class Bill of Rights. It's based on three principles:
1. Targeted to the Middle Class: Unlike the Republican plan,' which mostly benefits
families earning over $100,000, the President targets benefits to middle-class families.
2. Rewards Investment in the Future: The President's plan rewards families who invest
. in the future -- espeCially education and skills for themselves and their children.
3. Paid For By Specific Spending Cuts: The President's plan pays for tax cuts with
specific spending cuts-Madding to the $616 billion in deficit reduction following his 1993
plan with an~ther $81 billion now.
.
THE MIDDLE CLASS BILL OF RIGHTS
1. Tax Credit to Help Working Families Rajse Their Children: Families earning up to _
$60,000 will' receive a $500 tax credit for each child under 13.
2. Education and Job Tralning Tax Deduction to Help Americans Get the Skills Tbey
Need: Tuition will be fully deductible up to $10,000 for families earning up to $100,000.
3. Expanded IRA to Help Working Americans Save for the Future: Families earning
up to $100,000 will be able to save up to $2,000 a year tax-free per earner--and use the
money for education, a first home, or medical expenses, in addition to retirement.
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. 4. A New G.1. Bill to Empower American Workers: The President will collapse 70
federal education and training. programs and offer low-skill or, laid-off workers a Skill Grant
of up to $2,620 per year to choose the training that works for them.
�EDUCATION AND JOB TRAINING TAX DEDUCTION
HELP MIDDLE-CLASS AMERICANS GET THE SKILLS THEY NEED
The President proposes making tuition for college, community college, technical school,
--- graduate school and job-training fully deductible up to $10,000. The deduction .wilL-be, ... : ,
fully available to families earning up to $100,000, and phased out at $120,000.
BROADEN OUR MIDDLE' CLASS AND NARROW THE GAPS BETWEEN US
Each year of college or job training beyond high school increases average future earnings
by 6 to 12 percent. And while workers with the right skills have seen their incomes rise .
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over the last 15 years, paych~cks for everyone else have declined.
STOP RISING TUITION FROM CRUSHING MIDDLE-CLASS FAMILIES
Wealthy students can afford higher education and lower-income students receive
fmancial aid. The middle-class gets squeezed as college costs rise. Between 1981 and
1991, average college tuition rose more than 130' percent--compared to about 50 percent
inflation over that period.
OFFER AN INCENTWE FOR EDUCATION SIMILAR TO BUSINESS INVESTMENT
The tax code already e~courages business investments. It's time to create the same
incentive for families to make the best investment they can make: education.
MILLIONS OF WORKING FAMILIES WOULD GET TAX RELIEF
Twelve million students would benefit from the deduction, 'over 80 percent of them with
incomes less than $75,000..
FAMILIES DON'T NEEiJ TO ITEMIZE TO GET THE DEDUCTION
The deduction will, be II above the line"--allowed in determining adjusted gross income-
so middle-class families that don't itemize, will still get the tax break.
TAX BREAKS WON'T TRIGGER TUITION INCREASES
. Little evidence links higher federal aid with higher tuitions: in the 1980s, education aid
virtually froze while tuitions jumped; in the last two years, President Clinton expanded.
student aid and tuition increases slowed. With 7,500 schools competing for students
today, schools that try to cash in by raising tuition will lose students--and money.
PART OF THE PRESIDENT'S COMMITMENT TO EXPAND CHOICE AND ACCESS
The President is already implementing Individual Education Accounts to make more
affordable student loans available to every American and save taxpayers billions of
dollars. Convenient "pay-as-you-can" 'options enable indIviduals to repay the investment
. as their earnings permit. In addition, the President is proposing to raise Pell Grants to
$2600 and extend Skill Grants to laid-off and low-wage workers who usually can't take
full advantage of the education' and training tax deduction.
HELPING MIDDLE-CLASS FAMILIES: AN EXAMPLE
For a family with a $50,000 income spending $10,000 to send a child to college and
improve skills for a spouse, .the tax deduction would be worth $1,500--a 31 % tax cut.
�EXPANDED IRA
HELP WORIaNG AMERICANS SAVE FOR THEIR FUTURE
The President' s proposal wouJd enable more middle-class families to save in two ways:
• First, he would double the income thresholds for tax ded.uctible IRAs: eligibility
would now be phased out for couples with incomes between $80,000 and $100,000.,
• Second, President Clinton would allow Americans to withdraw money from IRAs'
without penalty to pay for education an~ training, a first home, or medical
expenses.
EXPANDING IRAs WILL INCREASE PRIVATE SAVINGS
Private savings are key to creating good jobs and raising incomes in the long-run. Yet
our private savings rate has declined from 8.1 percent of GDP in the 1970s to 5.1
percent in the 1990s. Several empirical studies have shown that expanded IRAs can
increase private savings;,.-and the President's proposal will do so in three ways:
• Dramatically increase the number of families eligible for tax-free, IRAs, enabling
middle-income families now putting away less than they'd like to save more, tax-free.
• Giving families more incentives to, save by allowing them to use savings for purposes
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other than retirement; like paying for education or buying a home.
• Increasing awareness of IRAs, because as more people are eligible for IRAs, banks
will promote them more, and more people will decide to save.
ANOTHER WAY TO HELP AMERICANS PAY FOR COLLEGE OR JOB TRAINING
Middle-class Americans will be able to us~ IRAs to pay for education without penalty.
Together with the education tax break and the G.I. Bill for Workers, it's another way
that President Clinton is helping Americans to .invest in their future.
HELP A FAMILY BUY A H,OME
Families will now be able to save tax-free in an IRA and then use the money without
penalty to buy a first home--or help, a child buy one.
MORE CHOICES FOR MIDDLE-CLASS FAMILIES
The President's plan allows families to take the tax breaks from' IRAs either when they
deposit money or when they withdraw it. In contrast, the Republican plan ,requires the
deductions at the time of withdrawal. Arid President Clinton allows withdrawals without
penalty for more reasons--such as care of an elderly parent or unemployment.
TAX RELIEF TARGETED AT THE MIDDLE CLASS, NOT THE WEALTHIEST
President Clinton's proposal is targeted at those who have seen their incomes stagnate
over the last IS years--middle-class families with incomes under $100,000. The
Republicans' "Contract with America" offers them fewer options but offers a costly tax
break to people earning as much as $2S0,000--people, who are already saving.
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HELPING MIDDLE-CLASS FAMILIES: AN EXAMPLE
A two-earner couple has a $S5,000 income and is expecting a child; If they want to
begin saving for the child's education, each working parent can put $2,000 in the IRA
--and save $1,120 in taxes, a 15% cut.
�$500 CIDLD TAX CREDIT
GIVE TAX RELIEF TO MIDDLE-CLASS FAMILIES
President Clinton wants to give a $500 tax credit to families for each child under
age 13. The credit will be fully available to families earning up to $60,000 and
phased out at $75,000.
HELP RESTORE THE AMERICAN DREAM
Middle class families who work hard and play by the rules aren't getting ahead;
they're getting squeezed. The median family earned less in 1992 than in 1978.
THE COSTS OF RAISING CHILDREN CONTINUE TO RISE
For middle-class families, the costs of health care and education are rising faster
than inflation. In 1990, the average middle-income family with children in daycare
or afterschool care spent $3,000 ~:m day care alone.
RESTORE FAMILIES' ERODED PERSONAL EXEMPTION
In 1950, the personal exemption was worth $3,800 in 1995 dollars .. TQday, it's j~t
$2,500--a 34 percent decline. President Clinton wants to restore the value of the
personal exemption fot the people who need it· most--families with young children.
FOCUS RELIEF ON THE MIDDLE CLA.SS, NOT THE WEALTHY
President Clinton gives tax relief to families with incomes below $75,000~-the
middle class that's been hurt the last 15 years. In contrast, the Republican Contract
with America offers a child tax credit to families with incomes up to $250,000-
including some of the wealthiest 1 percent of Americans..
. TARGET RELIEF WHERE WORKING FAMILIES NEED IT MOST
The tax credit goes to the families with the greatest needs, those with children under
13 who may require child care or after~choolcare. For families with older children,
President Clinton has proposed a tax deduction for education expenses up to
$10,000. And for families earning less than $27,000, he has already expanded the
Earned Income Tax Credit--offering an average tax cut. of $1,000 to 15 million
families.
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. HELPING MIDDLE-CLASS· FAMILIES: AN EXAMPLE
A family of four with two working parents,·· two children under 12~ and a combined
income of $50,000 would receive a tax credit worth $1,000-- a tax cut of about 20 .
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A NEW G.I. BILL FOR AMERICA'S WORKERS
FROM FEEDING BUREAUCRACIES TO EMPOWERING INDIVIDUALS
• Collapse sonie 70 Federal programs for education and job training'
• Put the power to learn iq worker:s? hands-- offering low-income' and unemployed
workers Skill Grants for education and training up to $2,620 per year, and Individual· .
Education Accounts to get low-cost loans and repay them on' a flexible schedule. .
EMPOWERING WORKERS DIRECTLY
Instead of just shifting money from a federal bureaucracy to a state bureaucracy,. the
President 'consolidates programs and empowers workers directly with Skill Grants--so they
can choose the quality training and education they want, where and when they want it.
LEANER GOVERNMENT
The current maze of job training programs wastes money and doesn't get the job done.
The President will replace some 70 separate programs with one integrated system.
STATE FLEXIBIUTY
The President's proposal enables states to work with communities, schools, and the private
sector to tailor information systems, job search assistance, and on-the-job training to meet.
local goals. Most federal rules dictating procedures will be wiped out.
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GOOD INFORMATION TO GUIDE GOOD CHOICES'
The proposal encourages States and the private sector to develop a system of One-Stop ,
Career Centers or other information networks where workers get access to real job search
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help and reliable information on jobs and the records of training institutions.
A CCOUNTABIUTY
For the first time, training programs will have to .pass the same test as the private sector:
meet your customers' needs or lose business. Choice, competition, and good information
will empower individuals to pick providers who deliver; And performance standards for'
training providers will cut off the frauds and the incompetents.
PRIVATE SECTOR PARTNERSHIP
.' The President's proposal isn't about goverrl!l1ent. It's about jobs, so the private 'sector has
a central role. Business and labor will be full partners in designing new systems so that
workers and education providers know what skills employers will pay for. New awards
will .recognize excellence in creating workplaces that reward worker skills.
PATHS FROM SCHOOL TO WORK FOR YOUNG PEOPLE
This initiative will fold federal training programs for young people into the school-to-work
movement underway at the state and local level. Young people can look forward to clearer
. paths to new skills and better jobs.
HELPING WORKING AMERICANS: AN EXAMPLE
When a worker is'laid off, he becomes eligible for a Skill Grant. He can go to a One-.
Stop Career Center to learn about. the communitY college and job training programs
nearby and study their success records in detail. Then he can choose the program with
the best placement. record in a field that interests him, and use the Skill Grant to pay
for it. The worker will learn a new trade, and at the end of the program, receive job
search assistance with area employers.
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THE WHITE HOUSE
WASHINGTON
FEB - 8/995
February 8, 1995
MEMORANDUM FOR SENIOR STAFF
FROM:
Gene Sperling.
SUBJECT:
Budget Talking Points
The following is a one-pager on the President's budget designed to address some of
the issues raised over the last. few days.
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KEY POINTS ON THE PRESIDENT'S BUDGET
February 8" 1995 '
The President has the best proven record on deficit reduction. The President is now
proposing to add to the largest, deficit redu~tion plan -in-history.:, --His 1993 budget cut the
deficit by $505 billi()n, and with the new growth in the economy that resulted, will lead to
$616 billion in deficit reduction. He's now adding $81 billion in deficit reduction on top of
the $616 billion. And he is cutting the Federal workforce by 272,900 employees, to its
lowest level since the Kennedy Administration.
Without President Clinton's economic plan, the deficit would have reached $475 billion'
by the year 2000. The Reagan and Bush Administrations sent the deficit skyrocketing-
quadrupling the debt and deficit in 12 years.' President Clinton's leadership has brought the
deficit down for three straight years for the first time since Harry Truman was President. In
FY 1994, the deficit was over $100 billion lower than projected before the President's plan.
It was the largest two-year drop in history.
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President Clinton is honoring his commitment to cut the deficit in half. What matters
most for working Americans is the deficit as a percentage of the whole economy. Even
though the deficit became worse after the election, the President is still on track to cut it in
half. By the end of the President's five-year plan, the deficit will behalf what it was
. projected to be as a percent of GDP--going from 4.9 percent to 2.4 percent. That's the
lowest level since 1979--before the Reagan and Bush Administrations ..
Under President Clinton, the budget would be balanced--in fact, in surplus--if not for
the interest from the Reagan-Bush debt. Without interest payments on the deficits created
during the Reagan and Bush Administrations, the Clinton Administration would actually be
, running a surplus, with enough left over to pay for tax cuts. Except for that interest, we
are now spending less than we are taking in.
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The Republicans talk tough, but they don't m~e the tough decisions to cut the, deficit.
throughout the 1980s, the Republicans talked about balanced budgets while running up the
largest deficits in history. In 1993, they voted against $~05 billion in defiCit reduction. In
1994, they campaigned against the President's tough choices. And in 1995, they still haven't
proposed the hard, specific cuts to bring the deficit down.
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The Republicans haven't even proposed spending cuts to pay for the tax breaks in the
"Contract.'" The Joint Committee on Taxation estimates that these cuts cost $700 billion
over ten years. The capital gains tax cut alone costs $170 billion over ten years--and70%
goes to taxpayers earning over $100,000.
, President Clinton remains committed to entitlement reform-in the context of health care" '
reform. President Clinton proved his commitmeq,t to keeping entitlement costs under control
in,1993, when he cut nearly $100 billion from entitlement spending., The rate of growth in
\ Medicare and Medicaid costs has now decreased. As he said throughout 1994, the oilly way
to achieve lasting cuts in the cost of entitlements is to reform the health care system, and the
President looks forward to working with Republicans to achieve health care reform. Simply
slashing Medicare:.-as many Republicans propose--will cause cost-shifting to the private
sector, with higher costs for small businesses and higher premiums for middle-class families.
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.' CENTER ()NBuDGET.
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AND, POLICY,PRIOruTIES" ""
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,', , ,The,Cli.rlton Administr~tion budget issued tqqaymard,es midcUe-c1ass tax cuts
with a strong dose ofausterity in the ,domestic non~entit1ementSide of the budget;: It
would:reduce domestic,non.,entitlement spending'by fiscal year 20.00 to its 10west1~vel,
Il1easured either, as' a percentage: of the economY.'0t as percentage 'of the total fede~all '
budge~, since 1958.;, , ' ' ' ,
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,Compared to the budget paths~setfOrth in:- ilie' two"previoil~C1.inton budgets, 'this
budget contains substantially less for domestic non~entitlement programs -' including
...' " lower level~ for mvestment initiatives. ,It also contains more for, defense"and sizable tax"
cuts that io~al $157 billion over 10 years.
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research and developmEmt, education and training> and physical investments such a's
i~astructtire - would d,ecline ,betweenfis~al year,1995 and fiscal year ,1996, when
iriflation is taken into account. Expepditures in th~se three areas would total $137.9
billion in fiscal year ~996, up l€!~s than one perc~ilt from ,their fiscal ye,ar i995 level
despite tl:'te:budget's forecast of a,3.2 percentinflation rat~. '
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inflation rate, including biomedical 'research, dnnmercial technology research; lifelong
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learning programs, Hei:ld Start, the Job Corps ~nd the WIC program.
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,Most'of the budget's fisc(:ll.y~ar 1996 spending cut,s repres~rit sotind ways to
reduce the deficit. Proposals to accelerate the shift to 'direct student loans/institUte
royalty feeso~aciditiop.al ,auc~on,~l:l~prity f?r~~eof ~h~rq.dio spectrum, deny the ,,' ..
earned income credit to 'those with more Ula:n$2~500 in interest and dividend income, .
,sharply, scale backimpact education aid; arid extend provisions of cutre1}tlaw,that save
"money in Medicare and veterans program but are scheCluledto' expire in the next few .
years, among others! 'constitute ieasoI1ableways:to'a'chieve'rieeded deficit reduction.
LaIge'Reductionsiri.N~it-'Enti~len!tenfprograms'Lie Ahead, :
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additional, cuts in non-defense di'scretionary (Le., non-entjt1ement) programs'.to m,eet
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�the austere discretionary spending 'caps the Admirtistration is proposing for fiscal years
1997 through 2000. For these years, the budget assumes across-the-board reductions in
nearly all non-defense programs that are not entitlements. The budget assumes that in,
1997, funding for most such programs will fall three percent below the funding levels
requested for 1996, without any adjuSbnent for inflation. The decline would grow to
. five percentin 1998, seven percent in 1999, and nine percent in 2000.
When inflation is taken into account, this would represent a 20 percent across
, the-board appropriations cut below the 1996 levels for much of the federal government
except for defense and entitlement programs; The Administration apparently plans,
through its "Reinventing Government II" initiative and thrO'ugh proposals to be
included infuture budgets, to replace this large, indiscriminate across-the-board cut
with an array of deeper cuts and program eliminations in some areas and lesser cuts or
no cuts in other areas viewed as having greater merit. By proposing to loWer sharply
the spending caps governing non-entitlement spending, the Administration would
compel itself and Congr~ss to'produce these additional cutS. in the next few yeafs.
Clinton Discretionary Request
Compared to Spending Caps and Current Services
Oullays in Billions
$650 '
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=:.. ...:. '.:.;,'.:.;..,' ;,.:. ,...: ;. .':. :.;''~.'~"-i
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$5501+--==~~::::;:;:~='=' .. ~~ '~'.:.:'
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$4501-----.-----..------:-r----..---------l
1995
1996
,1997
1998
1999
2000
Fiscal Year
+ Current SelVices '* Current Caps ..:... Budget Request
Source: OMB, FY96 Budget, p.·180; Analylical Perspectives; p. 219.
Current Services are the estimated levels of spending needed to, maintain FY 1995 service levels. They are
based on the FY 1995 funding ,level" adjusted 'for projected inflation. The caps are specified by statute
through 1998, and assumed to grow with inflation thereafter.
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�.' Clinto~Proposes Lower Discretionary ,Spending Caps' .
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FY 1997'
FY 1996
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Cli~ton Cuts Belo~'C~pped
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FY 1999
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through 1998 and assumed to groW' with inflation thereafter.","
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Health Care and Other Entitlements
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touches entitlements lightl y. ,Entitleme~tsand other mandatory ,spending would be ' '..
reduced $29 billion over the riext five years, compared with a $101 billionreductlon in '
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Rising costs fo~ h~alth'care e~titlemerits represent thesiriglemajor reason the,
long-term defiCit forecast is so adverse; arid data from the Administration's budget
. undersconi~ the necessity:of reforming the U'~" n,ealth care system if our long-term"
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deficit problems are to be surmounted. OMB ca:lculationsshow the budget would be
·halanc::ed. by. fi,scal year 20031f per capita Meditare 'a~d, MedicaId expenditur~s grew in
. tandem<with'the general rate of inflation,and per capita outp'ut,.rather than at the
higher ratesa~ which health ca~e costs.in both the p~b1ic and private sectors hav~been'
:mounting arid., are expected to. continue to grow~' (See box on next page.)' . "" ' ; ,
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Simply e~acting l~rge cutsfro~ Medicare and Medicaid, in the absen~e of·
. 'larger-scale health care reform, will nO,t SCitlsfa,ctorily address this problem~, As'
Cbngre&sional Budget Office' director RoberfReiscnauer told the bipCirtisan Entitlerrten~
Commission lastsummer, imposing deep. cuts.on Medicare and Medicaid without. ."
system-wide healtli. care'reform would cause stlbstantiai'shifting of health care' costs to·
·the private sector~ adversely affectirlgemployers and employees, and also would,likely
reduce the quality of heal~ <;:areforfue,:elderlY'and,th~:poor .. At ti).e ear~estpcissible .
:point, Congress and the AciIllinistration s1:0W~,returnt~ t~e tough)oh of reforming the
health care system in ways that reduce the.rate"ofgrowth in both public and private
health care costs~'
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Deficit Reduction And Tax Cuts
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The "middle class bill of rights" - a.series of tax cuts targeted largely on those
with incomes between $20,000 and $100,000 - is central to the Clinton budget. These
Clinton tax cuts are preferable to those inthe Contract with America, in large part
because the Contract tax cuts would lose more than four times as much revenue over
the next 10 years and provide' four times aslarg'e a proportion of their benefits to those
with incomes exceeding $100,000.
Health Care and the Budget
The President's budget demonstrates once iigain that the rapid growth of Medicare
and Medicaid is the primary cause of stubbornly high deficits. Medicare growth is projected
to average 9.1 percent per: year and Medicaid 9.3 percent. The attached chart, taken from the
budget, shows that if Medicare and Medicaid grew at more nonnal rates, the deficit would
disappear by 2003.*
Expanded use of managed care might produce noticeable reductions in Medicare and
Medicaid costs. But absent broad measures to control the costs of .the nation's overall health
care sys'tem, maj~r red uction~ in the long-term growth rates of. Medicare and Medicaid costs
are difficult to achieve without (1) requiring Medicare beneficiaries to pay an increasingly
large share of their health care costs out' of pocket, (2) providing steadily poorer quality health
care for beneficiaries than the rest of SOCiety enjoys, or (3) steadily reducing Medicare and
Medicaid reimbursement rates, which is likely to lead doctors and hospitals to pass
unreimbursed costs on to employers and employees through added growth in health
insurance premiums, a hidden but gr~wing tax..
Percent & GDP
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Medicare and Medicaid were slower
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1993 '1995
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1999
2001
2003
2005
,. NOTE: OMB projected ~ slower leveI'o/health care growth by assuming that, starting in 1994, per-beneficiary
costs grew only as rapidly as general}njlation plus overall U.S. productivity.
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The savings achieved frbm the Administration's spending c'uts' ,would better be devoted
primarily to deficit reduction, and to a lesser'<;iegree to increas,ed financing for selected,
publi~ investments likely to have long-term 'economic payoffs. ,":
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tax cuts isn'tnef:ded. More private, investment spurred by long,:term.defiCit reduction'
'-' and more public investmentin'criticalareas:-, is likely to be of greater benefit in
generating long:..tetm economic growth and long:;;term income growth forithe' middle
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Paying for Tax Cuts
'Whilerriore deficitred~ction:wouldbe preferable 'to tax ~~ts,'the Clintonb4dget
,does pay for its, tax cuts o~er the next 10 years. There is a ris~,'l1o\yever, that tax cuts,
, approved on-Capitol Hilllat~r this year mi'ght not meet this test.",
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·Some House leaders rec~ntly indicated th~Y' heed produce only $200 billion in
'~pending cuts over the next fiye years to pay for the tax cuts in the ,Contract with
,America, ignoring the much larger revenue losses, the Contract taX'proposals ,would
generate in years after that -Both rreasliry and Senate Budget Committee Republican
staff estim~tes indicate that tIle rev,enue,losf',f,rpm the Con~~ct tax proposals would
~qual .or ,exceed $500'billion in ,the succeeding five-year period, frofl:t 2001 to 20~5. '
,"," A tax cl?-t package not paid for overthe'long term would~nlarge the long-term'
deficit. Whiler,the Clinton pudge,t,cai:t,pe criticiz,ed for not reducing the deficit more~ '.
some of its Congressional critics themselves risk making the long-term deficit problem
worse if they donQt~restra~ the ~xploding long:..term costs, of 'the Contrad's tax c~ts~' ",\
,Moreover~hadthe Ad~tr~tion pr~PQsed'ad,ditional spending cuts inits
budget~
these proposals would likely bf: used ,by Congres.s primarily tofina.nce larger
tax cuts rather than for deficit redu!=tiort.. For'this reason,additionai spending::cut
'
, propo~als probably shol;lld be ,reserved until the b~ddihg war ont"x cuts tpat threatens,
to overtake Capitol Hill has run its course. Presenting proposa1s for ildditlonaJ
" spending reduction.safteraction on tax cuts is completed, rather than' advancing such
,. ,proposals now, should increase the chances that further program cuts ate used for
, ",' deficit r~d~ctio'n anq. not for oyerly larg~ tax cut~ that are likely to provide the lion's'
: sha!E~ of their b~nefits to those: at higher ,iricome levels. i" I
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Comparing the ,Ointon 'and Contract Tax' Cuts
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The Clinton tax prop~salsand the po!tionof tfleContract that contai~ its .
midd~~~class t~~ cutsbear~o~,e' sii:I¥laFities.'~Q,th feature a;$500-:p~~-:child tax credit;
,th~'Contract's :tax 'cred~t cov~rs chilo/en to age +~, while the Clmton credit ~xtends
through age 12. Both also' ~xpan.d Individu()lRetirement~.Accouri.t tax benefits; . In, '
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�addition, the Clinton budget would 'provide a large deduction for tuition expenses,
which familiesc6uld use regardless of whether theyitemize d~ductions.
While the total size of the middle-class tax cut is somewhat larger under the
Contract than under the Clinton budget, the princip~l differences between the Clinton
tax cuts and the Contract tax cuts lie elseWhere - in the large tax cuts the Contract
includes for upper-income individuals and large corporations. These .provisions are the
primary reason that, 'as noted, the Contract tax cuts lose more than four times as much
in revenue over the next 10 years as the Clinton tax I:uts and confer four times as large a
proportion of their benefits on the top 10 percent of the population, those with annual
incomes over $100,000.
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COST OF CLIJtfTON AND CONTRACT TAX CUTS,
(in billions of dollars)
1996-2000
2001-2005
10-Year Total
'
$56
$101
$157
Contract?
$205
$520
$725
Clinton l
DISTRIBUTION OF TAX BENEFITS UNDERCLINTON AND CONTRACT TAX PLANS
Income Group
Percentage of
Benefits Going to
.Each Group Under
Clinton Tax Cuts
Percentage of
. Families in each
Income Group
Percentage of
Benefits Going to
' each Group Under
Contract Tax Cuts
< 50,000
65%,
29%
19%
50,000 - 100,000
25%
58%
30%
100,000 - 200,000
8%
i2%
22%
Over 200,000
2%
,1%
28%·,
Source: Office of Tax Analysis, Department of the Treasury
,
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This estimate of the cost ·of the Clinton tax cuts was issued by the Treasury Department on February 6,
1995. It includes the "middle class bill of rights" and a series of small revenue-raising 'measures in the
Administration's budget. It reflects revenue savings only and does not include $6 billion in outlay savings
over 10 years associated with the revenue changes the Administration is proposing. The "middle class bill
of rights~1 itself costs $63 billion over the first five years and $171 billion over 10 years.
1
2 This is the Treasury Department estimate of the cost of the Contract tax cuts, released January 10,1995.
On February 1, 1995; the Joint Tax Committee r~leased a similar estimate of the cost of the Contract tax cuts
in the first five years, $196 billion. The Joint Tax Committee has not issued an estimate of the cost'in the
second five,years.
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. ' ,The Clin~on budget de~oristrates that ~izabl~ midd1~-class' t~x~'cuts can be ~aid .:"
Jor without making majoicuts'i'n benefits for the middie-class:or the'poor. The Clinton .
. :;budget does not contain sharp increases in Medicare. premiums afldqeductibles, higher.:·
interest payments on studenUoans, or deep cuts i,TI,basic cash,.food, and health care . ' .
benefits for poorchildren an~ elderly people. If Members of Co~gr~ss-decide to add to
the C~intQn budget cuts a serfes of steep reductions in benefits for 'poor and middle-. ' .
class familIes and elderly pe?ple to pay for the much larg~r'tax c~ts.in the Contract,.
these benefit reductions will primarily be used to finance tax cuts f,or those at high
income levels; not the middle class.
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. Prop~sed.Change in'Budge~ Procedures Unwise;
In a: little noticed budget developm~~t, bbth the Administration ~nd Republican- ..
Congressionalleader,s are proposing to ,alter the budget procedures established in 1990 '
and allow reductionS in non-entitlement programs to be used to pay for tax cuts (and
for entitlement increases, if propbsed'm the future). This development. raises concerns.
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Under the 1990 budget agreement, tax cuts and entitlement increases must be
paid for" through offsetting tax increases or ,entitlement cuts.' Since tax' increases and ....
entitlement cuts are difficult to pass, this requirement has restramed Congress a,nd the .
executive branch from ad()pting fiscally impru~ent tax cuts and ,entitlement ex'pa'nsions '
in recent years.' " .
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Ctitting non-entitlement prbgra~s,is much ea~ierthan 'raising:~a.x·es br cutting
entitlementS because doing so initially entails simply lowering the cap governing non-,.·
entitlemerit spending. The details of which non~entitlement,pt;ograms' to cut generally, .
come much later, often in a subsequent Congress; 'Thus, the'proceduralcharige ;' , "
advocated,by the Administration and RepublicCin leaders \\.'ouldmakeit easier'both to'
enact ov~rly hirge tax ~uts ~syearand toena~tfiscallyiinprudent tax cuts or",' .':.,
~ntitlenient expansions in sub~equent years.' : .. " .•.
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,;.Thisappr6ad:lj~rri~de.~ore probie~ati~:by:th~,factthat thedomestie non~: .
enti~ementporti6~:0f the budget is the part,oft;he budgetwhete'most})Ublic ." .
inve~tmeri:t spendiJ..1g' isfound:, Under. 4teCli,htdnpf.oposals,thispart of the budget
would already be reduced to 2.8 percent of ,the' Gross Domestic Product by fiscal year "
2000/thesmallest proportion since 1958.' As a proportion of thet9,tal federal budget;
domes tie non-entitlement expenditures wotildJall to 13.7 percent This" too, is the
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,smallest propor~ion since 1958.
Difficult
to Assess Imp,act on Programs ~erving LolV-IncomeAmericans
. The budget inch.1des both increases and decre'ases in '1}0n-entitlement programs
,serving low-income fa.milies· and individuals. Few changes are proposed in low- '
.income. entitlements~ Among the low-income non-entitleme!l:t programs slated for' , .
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Domestic Discretionary Spending,in the Clinton Budget·
President Clinton's proposed budget squeezes do~estic discretionary spending to a greater
degree than is corrunonly realized. For example: '
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Domestic discretionary spending in fisca1.year 2000 will be limited to $261
billion, about the Same level as at prest;!nt. Since spending will hardly grow
but prices will, the purchasmg power of this part of the b.udget will decline 14
percent.
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In fiscal year 2000, domestic discretionary spending will comprise less than
one-seventh of the budget. At 13.7 percent of total spending, this is the lowest
share since 1958, well below the post-war peak of 23 percent reached in 1978. .'
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In fiscal year 2000, domestic discretionary spending will total 2.8 percent of the
nation's economy (Gross Domestic Product, or.GDP). This will be the lowest
percentage since 1958, well below the post-war peak of 4,9 percent reached in
1980;
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NOTE: Discretionary programs exclude entitlements or other mandatory programs, net interest, deposit
insurance, and offsetting receipts. They are controlled through the annual appropriations process rather than by
permanent law (such as permanent benefit f01'Jl1 ulas). In recent years, slightly more than halfofall discretionary
spending has ,been for defense and international programs. This box discusses the other half, covering such
programs as infrastructure, scientific research, education, veterans' hospitals, natural resources and the ,
environment, job training, assisted housing, WIC and Head Start, law enforcement and the Judiciary, and the
daily operations ofsuch agencies as the Treasury Department.
reductions are a number of the low-income housing programs and job training grants
for youth. The budget includes funding increases for such low-income programs as
Head Start, WIC, and the Job Corps;
It is difficult to Cissess immediately the net effect of the budget's proposals in the
low-income area because the Administration proposes to consolidate many programs
serving low- and moderate-income Americans into larger program' groupings. Some of
these consolidations would merge programs now targeted at low-income households
with programs also serving people at other income lev:els.
8
�. 'THE WHITE HOUSE
(Jh-tk~-
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. J ~~. ifLUL OWw lJJ~.VYlQiec,())jI{L
. Tht,A \\)5 -~ttyYl ~v~,cc~u R,\~llJ~ cit ''ii~.
(Y
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K~~.'f\~. ~ct'I\iOV(j
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)\~\~ W4~.~ . '~flUl:fc~' .~\. Gfu'ch~
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��THE WHITE HOUSE
WASHINGTON
. February 10, 1995
The HonorableWilliJ!!D J. Pa,..,.."
Secretary ot·Detense
The Pentagon
Washington, D.C. 20301.
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Dear Secretary perry:
.
The' President was very disturbed to read .
,in today's WAshinqtgn PoRt that' 'the
.. Depa.r1:a8Jlt_y not ))e, spending the tunds
provided by Collgreas tor breast cancer and
AIDS research.;. Be aaked that I JlBke clear
his'position with reapeetto this is.qe., .
,:~';~'J~~:;~~ident
believes that r;"earch to
combat these deadly diseases ia vitally
, important' to all Americana, . and it, is ot
special signiticance to Ilia. bary year, we
.ara loaing46, 000, 'WOIleD to breast cancer, and
some 183~000 WOlDaD are diagnosed with the . ,
diseas•• Last year. 40,000 Americans diad ot
AIDS';'.: The President believes that we cannot
attordto allow these tragic los.es to
continu.~' , .And that is why breast cancer and
AIDS research is a high priority tor this
. Ac1ministration.
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As' you' continue to carry out this'
important program, please keep the President
advised ot yourprogresa.
E. Panetta
Chiet ot Statt
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, ,THE PROBLEM'
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. DRUG USE 'IN AMERICA TODAY'
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i in. Americans ,has used &,n ' illicit drug
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1 in '9 Americans has tried cocaine
One half of high school seniors have'tried drugs}
l' in uses "drugs' regularly· '
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Chronic":hardcor~.d:tug useFemains~idespread
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responsibl'e'for much of .the' cI:'ime, .'violence, 'and
negative healthconsequence~
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accouhts for ·more ,than' two-thirds of illicit drug
\Jse, ; although only 20%9f'drug~using,population. '
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Alarm'ingNew Trends.:
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Casual ,drug use' is increasing, especially aniong
adolescer:l:ts :'" '
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fewer kids have' a .cle,ar 'understanding of the,
risks ,associated wit~drug us~;
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a1;ter years: of decline, drug use 'among 8th;
. lOth,·. and '12th gr'aders 'is increasing .•
Grpwing 'Availabi:li ty,'of . . ' high pu;ri ty H~roin:
cheap.
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potential to attract new users;
inciea$eq. uSe aJ1lon'g: users, especially, via
, ,. ',inhalation and sn9,r,ting •
. ,THE CONSEQUENCES, OF DRUG USE ,
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The, sociill ,cost 0'£ ,drug u~e is'.$61 billion: , 10"
is attributable to the costso£ crim~s; 30'" is"
'medical·and'death~related.
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THE ECONOMY:. "The'illicit drug trade is draihingthe
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u.s" economy . . ,In 199.3" the retail value of the illicit
" . drug business"totalled $50 bil'lion.,
, Drug, ~se iswe'akening,the,f,±sC?i1 heai"th of the public
sector .. , Federal,' state', and local governments spend .
$25 bill·ion on drug ,con.trol (50 cents for every 'dollar
spent by. drug :,consumers).
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,More thc;m. bO'% of :the Federal drug, control' Q~dget is '
directed' to'law enforcement; most state and 'local '
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governmen.t. spendingj.:s, qirected to 'the c~iminal justice,
system. (79~). '
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HEALTH CARE:
Drug use is straining the ,heaithcare
,system., In'1993, almo~t 500,000~rug~te~ated','
emergencies' occur;red / ,across the nation. (Robert WO,od
,Johnson' Foundation; ,Substance Abtise, October' 1993) ,
More than'one..:third,of AIDS· cases are drug-related.
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D~ug
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use and related crime devastates our
'commu'ni ties. ' In '1993, ' 1, 123.,300, were arrested for drug
offenses ..:...., "in,cluding sale ~ manufac~uring I and
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possession ~ -- f'l\or~ than 2 ',arre$ts per minute. ,D,rug
t~sts C?Qnf\i'rm" ,recen:t: drug use irrth~" maj ori fy ,0,£ those
, a,rrested .
(Drug', Use' Fore,casting )
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, :Homicide rates' byyollt~~a'ged '18' ,~md yciu,nger have
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doubled since lQ85. "'Kids involved with drugs ,are ',' :',
'" "arming themselves' and killi,ng one' another, over drug',
'money'.and~~rf.
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AVAILABIL~TY OF,\DRUGS IN OUR COMMUNITIES,
Drugs are readilY,available, to,anyone who' wants to buy
, ,'them. Cocaine, and hero'in. street prices are' lq\,!' apd- '
puri,ty is high ...:":' mak'ing',usemorefeasi1;>:le' and
affordable than ever ~ , ' '~"
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Marijuana ,is ',increasingly availabl'e-; potent,' 'and
cheap-~~nticinganewgeneiation~ \
Current,cdca cultivation'is 3 tim~s what" is,necessary,
to, 'supply the needs of the ,U.S. market.
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\THE PROBLEM
, Drug p,:r:obl~m,is "nati9.~al in, 'sqope', affec'ting, every citizen.
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Drugs are not a problem solely of,th~ poor, ,or of
mi~oiities, oi:~f innei-citi tesjd~Qts~
;'Themaj ori ty of people ,i~the -innE!r ci t·ies do, 'not Use
,illicit drt.1gs; ,but' they'are ,victimiz'ed :py those who do.
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THE SOLUTION '
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The Goal:, ,re<i'uction ,6f' f'liici t : drug use' & i ts con'seq~~_n6~s.
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,The -best way tc;> reduce the' problem ,of, il'licit dr\lg "
',use is to reduce, the, numbe'r' of chronic, hardcore"
users; because chronic, 'hardcore users account <for
pearly .2/3 of ' the ,drugs consUmed iIl,theU.'s.' , ,,'
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The best tIlay' toaccompl;j.sh this is 'by, provi~iing
effective ,drug treatment in ce;,rniriunities & prisons~
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Dr'ug prevent.l,on is key 1=0 ensuring, the f~ture of
'; the!, Nation ',syputh., To p'revent drug use"a '
nationwide media 'campaign ,will ,be l'aunched>to
"deglamorize drug use ,in ,the mind,'o~ every child'~
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Ott~' St~ategy, 'is :TO~GHER THAN F.:VE~, 'BUT SMA~T ,building on
,the C:r:::ime .control Act s'igned into law by: ,the President ..
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,Domestic, Law Enforcemtjmt .affortscreate 'important,
links bet~eentreatment, 'prevention;·and the
crimi:nal 'justice system,. , '
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, 'A recent's:tirvey found :tha,t 4, in' '10 Americans had
taken'safety precaution's because of:the 'threat of'
'drug-related~ crimeby,makirig homes' more, secu~e,.
sta,ying i~Side' at' nigh~t,' avoidiI"ig ~risafe, areas. ; \
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, Our, Strategy
responds to, these "fear~, by' creating
commun1.ty-'based ,programs' for drug education,
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tre,atment~ cprev:ention'~ and 'law 'enforcement'•
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"The Strategy has, .AC1IONS PLANS for :
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"REDVCING THE' DEMAND fOR' :ILL-ICIT DRUGS
'~'REDUCING CRIME~' VIOLENCE, -AND DRUG .AVAILABILITY
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'STRENGTHENING INTERDICTION:&,INTERNATIOJ:lAL E~FORTS
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THE SOLUTION
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'ACTION PLAN FOR ,REDUCINGTHE'- DEMAND"FOR 'ILLICIT' DRUGS
'REDUCING, DEMAND BY REDUCING,HARDCORE; USE
, Cost Effectiveness of Treatment':: CA, study ,found'
every dollar invested in diugtreatrrt~nt'in 1992,
saved ·7.dollars~, savi'n:gs' attributed to' decrea'~ed
': ' , ' drugs, 'P:lcohol, , andreductio~ ,in costs forr,c:r:ime
, healthcare.(CALDATA:, NIDA s'tudy copfirm~ d~'ta)
that for
taxpayers'
use of
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,Treatment' AvailapiJ), ty:' ,Tr:ea:t~entis 'avai'lable' f~r only 1'.4
"million of :the 2.4' millicm, 'drug u'serswhone~d and could
benefi t'from treatment.' More than I million who 'cou'ld "
" benefit fromtreatm,snt are unable' to.' access, prog:r;;ams. '
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"CIC>Si~g the ,treatment gap is :,a national pr'iori ty, and the
Administ'ration CO(ltin~es' to press' for, more tre,atment,'
facili,ties, espeCially 'wi thin,' the cri,~inal justice 'system., '
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Coerced Abstinence'
Drug ,Courts: , The cr:ime,Co~t:i'ol Act~roviges 'furids'for
,'expand drug 'courts to en~ure, certainty" and immediacy' of'
,punishment for d;rug-related. crimes. /"
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REDUCING ,DEMAND THROUGH PREVENTION '
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" Only 'eff,ective prevention, measores'can bring 'about long.,..t,~rm'
, ,sustainabl'e 'reduc:ti6n'in drug ,use.
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_Natio~al Preven:t:ion syst~:, ,a dcorpprehensive system to
address 'prevention needs across ,the cOllntry,.toplan for"
optimal use of prevention re'sotlrces, ahd to ad;dress What
~or~s? by, de,-;eloping effective evalu?tion tools~ ,
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,-'p'rograms that 'work, ,'l:ike. :Safe and,Drug-Free Schools,' and, the
'DrugFree, Workplace initiatives will be continued.'
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,Crime' ControiA~t,cre~tesiriew prog'rams I',ike Family>and"
, Communi tyEndeavor Schools, (FACES) in, high'-poverty,'and high...,
crimea·reas tokeepscho()ls" open after hours, 'weekends" and'
summers to ~eIpyouhgpeople~tay off, t1)e streets~
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Treatment"ih,Prison:' ,The ,Crime' Control Act 'provides
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funds for treatment in federal and state prisc:ms,' and,
aftercare for the 55% of Federal inmates and ,57'% of"
StGr~es inmates reported using' dru'gs' regularly. '
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African American' Male' Ini.tiativE! ·.hai; 'been establish~d' to .
respond to the special.pr6ble~s fac9Q,by young African'
,American' men' regarding drug's 'and' violence,.
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'ACTION PLAN FOR REDUCING' CRIME
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AND, DRUG AVAILABILITY
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CRIME, CONTROL ACT' OF 1994 /:',:
, 'I:he Na't,ion took a :major"step,,~ forYlard in,:red'ucing'drug
related crime and v.iol,enqe when i~. passed, 'Crime ,Control Act.
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Builds on the President ',sNa;tional 'Dr.ug' COJ1trol; Strategy~by
authoriz,irig .. new' polic~, punishment, andprevent.ion ,programs.
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100, OOO,'new polic~ officers on ,:city' streets;
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treatment for Chroni6, hardcore drug users in prison~;:
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mUl tij -urisdictioI1 al 'drug' enfOrC6!'lent'ta'sk forces;
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,crime' &, drug-prey-ent:ion progrqmS! in, communi ~ies .
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DOMESTIC LAW, ENFORCE'MENT~ P~~N: '
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efficiency ande'liminate ,duplication, of Federal ,,"
State, County and Ibcal'law',enforceI:l:leht agencies; , ','
Increase, coor~Hna,tion of, regiopal ,law enforcement, treatment,
and ,prevention, resources'
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, Mar~juana:" comprehensive
, and use of IT\arijuaha "
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initi~tive
'to decrease cuI iiva'tion
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Technology Ne~ds:
Intelligence~ te~hnologyand'advanc~d
'officer training' needs of Sta~te/local law enforcement
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,INVESTIGATE TRAFFICKING ORGANIZATIONS:
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,Federal investigative resources will tqrget domestic, ¢=ells
,of La,tin American criminal'.organizati'oris; major national
gangs; Asi~n ~nd':West African criminai' andtrafficking
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EXPANSION' OF ,BORDER CONTROL E,FF()RTS:
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,'Review 6u'rrent ',enforcememt' efforts atthe\ SOllthwe'st Border;
'determiri~', how to redl1c~ drugs smuggled acr9ss the 'border and
,~: reduc~, border, violencfi!'~"
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':', ·Customs Service' and INS "wi Ii' tnai:r'rtain the reduction o.f' drug
, smuggling'across ,the So.uthwest 'Borde:r:-:as'a top'; prior'i ty ~, '
" MONE)!, , L~UNDERI~G:,
"Facili tate,'collaborat1on between Treasury, arid Justice to ' '
',-develop, an actiori, plan' to c'oordinate ~omest'ic drug ';law '
enforc~ment,"~egulatory 'andpriyate indus~rY,e~forts, to '
target . laundering .ofd-rug prpceeds.' ,
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. ACTION PLAN TO ,ENHANCE riOMESTICPROGRAM FLEXtBILITY AND,
EFFICIENCY
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,EMPOWERMENT ZONES:,
in Dece'moe~, 1994, ....thePresiclent designated ,Q Empowerment
Zones, 13q enhance multifaceted and interconnected planrilng'
.to r~spond to drug use and trafficking in those· communities .
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WEED,AND SE~D:
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Weed and 'Seed programs' play ,an imp'ort, roi~ linking' la~
enforcement 'and drug prevention activities'q;cross the
coun,try. 'Communities cp,n first' identify the prqblems, and
. de.veiop ~ffective solutions;;
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. WORKPLACE, INITIATIVES:
Alcohol and drug testing' has.. been mandated for ,safety":'
se,n~i tive 'employees inaviati6n; motor carrier ~ra.ili6ad,'
pipeline" mari time, .and· mass transit industr:ies.
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STREAMLINING FEDERAL :DRUG CONTROL GRANTS:
'The 'Federal drug grant application process, will 'be'
streamlinedto'breate'a ~niversalgrarit.~pplicat~ori~,
TO
EXPAND. AND IMPROVEDATA'COLLECTION AND DISTRIBUTION
.LOCAL
COMMUNIT'+',ES:"
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To provide, drug data to communities.
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. IDENT.IFY EFFECTIVE COMMUN.ITY"':BASED,PROGRAMS:
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Provide information _on effective, law enfor.cement,' treatment'
and prevention . programs to c,ommuni ties·:. . Provide, 1;echnical: .
assist~nce to. comlTlUni13y based ,organ~zations,. .
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CUT THE ,RED TAPE:
, Eliminate .many Federal mandates and restrictions.; giving
. States 'the needed' flex'ibility' to target· funds, to high- '
priori ty communi ties.
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ACTION PLAN'TO'STRENGTHEN,INTERDICTION AND INTERNATIONAL EFFORTS
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U. S. drug con'trol agencies' have' developed an aggressive,
coordinated 'response to,the, cocaine, heroin,' and marijuana
tbreat~ facin~_this Nation.
IN,TERNAT,IONAL COCAINE
STRATE~;Y,
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1993 intE?ragency review:: '
Presidential Decision Directive:' the international cocaine'
, industry is a serious national security threat', requi,ring ,an
'extraordinary and coo~dinated response byallagex;'lcies
involved ,in national securi ty .
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~esponse:': ,4-pronged strat'egy' to. (1 )emphasize assist,ing,
institutions of nations~i~hthe political will to combat
na:rcotraff1cking; '( 2')destroy narcotrafficj{ing organizations;
(3}interdict narcotics trafficking fn both the source, '
,countries arid transit 'zones; and (4)increase international
cooperation;
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Controlled" Shift' in the emphasis' 9f coca:£ne' interdiction
, , priorities from the ' transit zone to 90urce" c:ountriesbecau,se ,it'
is more effective toattack'drugs'st the ,source of production
'where 'il'I:ic1t pr9ductio:n and, tran:~it'activitiesare morev±"sible
and'thus more'vulnerable. Also; sOurce countries are the, best'
source Q.f - infOrmation on smuggiing opera'tions 'throughout, the
Hemi~phere.
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U. S. INTERDICTION Co'ORDINATOR designated -to oversee ,
interdiction program~ and'to see that ,we have' enough
resources in the right places . to do the job.
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Measures ,of Effectiveness" to be developed for international,,;
host couiitry ,a~d' interdiction' p_rogram~. " ',,'
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CERTIFICATION
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A:nor,e aggressive use of -the, congressionally mandated
certification process that'conditions,ecO'nomic and'mi'lit:ary
assistance 'ori, cQunternarcotics ' p'erformant?e. '
,The 'P~esidEmt deni~d' ce~ti-fi'cat-i,~n' t04 ~cou'nt'ries > an:d '
granted national interest certifications 'to, 6 countries.
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,INSTITUTION BUILDING: " 'to, \stremgthe'n,democracy ," law enforcement
and,judicial'systems to enable Anaeal\l countries 'to preserve their,
democracies against criminal drug'thrl?at~ and carry 'a 'greater
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share ,of t;he counternarco.ticsburdert ,within their borders.
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Colombia:' assistance to control traffickers' use of
'air space, eradicate coca and pO'ppy: ,pressure Cali
cartel;, "
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,Peru: increase. support in respons'e to - willingness to
expB.f1d. counterdrug ef,forts;
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,dismantle dru9 .brganiza~iOris;· eradicate P?I:'>pyand c,?ca.
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~'EWINTERNATIONAL HEROIN STRATEGY
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Problem:
Increased herOin : low prices, 'ti;fgh -. puri tY,·
increase.d use' '.:.-:- .potentfalfor 'an: epid~mid~' ..
. Woi:;'ld~ide use of; 'opium .and her.oiri is 'increasing.
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Globa'l produ~tion: isat.rec<?rd levels .
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Re'sponse:' . International'opiumand heroin' control must·
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major foreign 'policy objective ,of :the United.
States. . .,..
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PresidentialDecis.i(:mDi~ect.ive on heroin in
~conjunction with ~heNationaiSecurityCoun6il.
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Administration will ,coordinate U.$ .. Goverriment· efforts
to engage Burmaoncounternarcotics e.
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Clarify ,;theU. S . role in' cOlnlJatting' ,drug.
production~ trafficking, and use in key
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Regional.St~ategi~s:
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. E'xpand contact:; in, princi'p'al,source;, ··trqrisit,'
"andc:6~suming countries 'to mobIlize,
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THE WHITE HOUS'E
WASH IN GTON
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February 14, ;1995
A MEMORANDUM TO ALL
D~CSTAFF
MCCOW~'
FROM:
GAYNOR
SUBJECT:
PRESIDENT'S
SP~ECH
TO THE' AMERICAN COUNCIL ON EDUCATION
As you ,knqw, President Clinton i,s' speakingtoday,to the"
American Council on EducatioI) .in,San;Francisco.
Attached yo'u
,will, find materials 'that ,have been generated,for,this 'event.,
Included are the following" doC'uments:'
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Talking Points on' the Education and the "Economy of the
Futu're;
'Press' Background Information; and '
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A State, by Stat,e ,~ressRelease
Lending.
on', S,tudentLoans
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and Direct-'
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,Please note that while ,we have done Press'Releases, for all
50 States, I ' m only including eight.' , The Presidentwill'doa '
radibinterview after the ", speech today ana 'each of ' these States
will be conne6tedviasatellite.
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hope
yo~, find >this i'nfoimatio~:'" useful.,
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�Februaty'14, ,.1995
Today, President Clinton addresses the American Council,oni!(~ucation, where he will
contrast his commitment to a natiOnal role in education with GOP efforts to eliminate "
opportunities we are cr~ating for American families and to increase the costs of higher
education.
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f10lding The Lille Agaillst GOP Efforts To Cut Education III vestm ent,
And IncI'ease The Cost Of Higher Learning
In his speech today, thePtesident will outline major differenceswitli the Republicans who are tT}:ing :0
cut government's role in promoting opportunity through education. Specifically~ the President will
protect investments, in:
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• Student Loans - Republicans want to add an extra $2 billion a year in costs to four
million students by removing the break on student loan interest for those in school. The
President opposes adding costs to students, and will fight to protect student loans and make
, college and advanced training affordable atld accessible.
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• Direct Lending - R~publicans want to eliminate the 'very program that cuts bureaucracy'
and saves taxpayers and students billions. The President wants to expand it to all schools
and all students.
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• Head Sb;lrt - Republicans want to scale back the Head Start program. Despite tough
fiscal times, th,e Presi~entproposes to expand itin an effort to support programs ,that work.
'. National Service '-, Republicans want to dismantle National Service, which expands
opportunity for young people willing to give something hackto their country . The ' ,
President is seeking to expand Americorps to help mo,re young people earn money for their
education, and he will fight any effort to abolish it.
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, • Department of Education' '-' Republicans wan'tto eliminate the Department of
Education. The President believes we must preserve national investment in educati()n,
while making government more efficient and responsive.
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. !',The'President Has'Mdde'JllveslmelltJ/l Educatioll'
A'ild. Training A Cellterpiece Of His Agenda '
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• The President's call for a New Covenant envisions government expanding opportunity so every
American can fulfill his or her potential, and indiv,iduals and communities taking responsibility
for making the most of,opportunities they are offered and for addressing their problems.
• Education is the defining exampleofgovemmenl's role in this bargain,- giving people the
,opportunity to get the tools they need to make it in the new economy. At the same time, those
given the opportunity must make the most of it by wo'rking hard and staying in school.
�, LOllg 'Learning Agenda
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Last year, the President outlined a seven-point ageMt;ljor education in this' country.
pieces passed last year.
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The first six
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• Reform and Expansion of Head Start -. Pr~vides comprehensive develop~ent~ servic~s
for America's low-income, pre-school childrenages3-5.
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Goals 2000'- A state- and locally-:-driven·prograrn which encourages high expectations and
high standards for all c~i1dren.. '
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-Reauthorization of the Elementary. and 'Secondary School Ad -" 'Designed to help
, disadvantaged students, this law fOCuses on improvements in teaching to help students meet
high. standards.
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School to Work - Broadens, educational, ~areer and economic opportunities for studentS not "
.immediately bound for four-year colleges throughlocru, partnerships among businesses, '
schools, 'community organizations and state and local governments.
• National Service - Enhances educational opportunity by enabling citizens to work in public
service positions where they will receive'a minin:lUm-wage stipend and eamedtication awards to
pay for future or past post-secondary ,education.•' '.
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Direct Lending - Allows student borrowers to secure student loans in a quick'and easy
manner, 'taking the expense and confusion out of how students finance and,pay for higher'
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education, ~ndsaving students and taxpayers billions of dollars.
• 'Reemployment Act -' Ensures that aU:Americanshave the knowledge, skills and
,opportunity'todo their jobs better and to get better jobs.
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The President Is COlltinuing To Expand Opportunity
With. Tile Middle Class BUr Oh Rights,
The President!u:U propo~t:da program to'help middle-c~assfamilies ra,i~e their children, pay for their.,~",
education and take partin the American dr~am. '
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• A tax deduction for all education and training'afterhigh schooL
• A $500 tax cut for each 'child under, age 13.
• Tax breaks for families who save for education.
• . Skill Grants givendire~tly to wo~k~rs,paid for by c6nsolidating federal programs.
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. Tlit.v President Will {,::ltallellge" Educators Alld, Students To Do' .Their: Parl·
Government can only be a partner in improvi~g American ;education ~nd preparing citizens for the 21st
century: Educators, schools, parents and students have to do their part as well.
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.• Challenges institutions !Jf higher educatij)n to hold tuition cost increases to the rate of inflation, bring
the technology, of the 21 st century into the classroom, and incorporate the spirit of community and
service through supp0'1 for Americorps and studentservicl?" "
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• Calls on students to take :respcinsibility for their live~ by staying in: school, reversing the growing
problem of teenage pregnancy, staying off drugs and away from crime, studying hard, making' the
most of theirpotehtial, and giving something back to their country.
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, THE TRIP OF THE PRESIDENT TO
SAN FRANCISCO, SANBE~ARDINO
,'AND INDIANWELLS,CA
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PRESS BACKGROUND INFORMATION
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, FEBRUARY 14-15, 1995
�The President last addressed the American CoUncil on Education -- an umbrella
organization representing the na~on's colleges and universities -- 'in Washington, D.C. on
February 22, 1 9 9 4 . '
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Backgrouod
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the Amenc8D Couocil
Educatioo
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~e A.C.B. is an independent nonprofit association founded in 1918 and has a
membership of more than 1,600 accredited, degree-granting institutions of higher education
and more than 200 national and regional higher education aSsociations. It provides a forum
for discussion of higher education issues of national importance and works to shape the
diverse interests of the higher education community into· a single voice.
The annual meeting of the ACE is the nation's largest meeting of college and'
university officials., This yearts meeting will draw approximately 1,200 participants, roughly
400' of whom will be college and university preSidents. The theme of this year's meeting IS
"Building Communities of Civility and Respect"
The speaking program for the President's address is as follows:
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Juliet Garci~ Chairman of the Board of Directors of A.C.E., wili make brief remarks
and will introduce Education Secretary Richard Riley.
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Secretary Riley will speak.
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Juliet. Garcia will introduce the President.
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The President will speak~
Prior to his speech, the President win meet privately with the A.C.E. Board of
Directors. The President will thank the Board for passing a resolution endorsing the tuition,
tax deduction and IRA provision in the Presidenfs Middle Class Bill of Rights.
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BACKGROUND ON mE BOB HOPE CHRYSLER CLASSIC
On Wednesd.aY, the President will join former President Bush, former President Ford
and Bob Hope for the charity golf tournament, the Bob Hope Chrysler Classic. The four will
form a team in the tournament along with golf pro Scott H;och, the Winner of last year's .
Classic.
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Originally called the Palm Springs Golf Classic, the tournament. wa s the first 90 hole
pro-am golf tournament in the world. The Classic's five-day, four-course format teams one
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pro with a different ~ateur team each day.
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The tournament's name was originally changed to the Bob Hope Desert Classic in
honor of its Chairman, Bob Hope, iIi 1965. It was' called the Bob Hop~ Classic in 1984 and
1985, and became.the Bob Hope Chrysler Classic in 1986. Today it is the 12th oldest
tournament on the U.S. tour.
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In 1961, CBS television presented the first live coverage of the' tournament and
event has received live coast-to-coast cover8$e· by NBC Sports since 1965.
the
Today, the tournament rotates among four of the following five country clubs: Indian
Ridge, Bermuda Dunes, Indian Wells, La Quinta arid Tamarisk. February 1994 marked the
35th ,anniversary of the tournament.
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ATfACBMENTS .
. . .The following are attached: embargoed excerpts from the President's address to the
A.C.E., fi.ct sheets on President Clinton's education agend~ background on, the roundtable
participants and a fact sheet on economic progress in California under the Clinton
Administration.
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�, BACKGROUND INFORMATION ON PARTICiPANTS IN RouNDTABLE AT
SAN BERNARDINO VALLEY COLLEGE
ADRIENNE HERNANDEZ: 17, Student at Rialto High School and the San Bernardino
Sl!eriff' Academy.
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Adrienne would like to pumie a career in law.' She has be~n motivated by the violence and
raciiltensions that she witnesses every day in school and by her father who is a police
officer. She is participating in a Sheriff's Academy school-to-work program that she says haS,
taught her "cOmmitment, discipline, and responsibility."
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GREG KYRITS'IS: 44, Sheriff's Lieutenant, San Bernardino.'
Greg has spent 21 years in law enforcement, including 10 as a trainer for police recruits.
, Greg helped, create a school-to-work program with Rialto High School and Valley ,College to
improve the skills of high' sch061 graduates, and encourage law enforcement as a potential
career. ,
CHRISTOPHER EMANUEL: 40, Student at San Bernardino Valley College & Student.
Member of the Board of Trustees for· the San Bernardino Community College District.
Christopher plans to transfer to the University, of Southern California and then earn a law
degree. .He is inspired by Thurgood Marshall and hopes to practice civil rights law in' an
urban area.
JACK BROWN: 56, Chairnlan, President, and CEO, Stater Brothers Markets. '
Once a student at San Bernardino Valley College, Mr. Brown began his career in the grocery
industry as a box boy. He has risen to become CEO of San Bernardino's largest employer,
operating III markets and employing nearly 10,000 'people in the region. Aimual sales for'
Stater Bros. are approximately $2 billion, also making it one of the largest supermarket chains
in the country. Mr. Brown is a winner of manypuolic service awards, sponsors educational
scholarships, and strongly encourages all of his employees' to continue their education~ .
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THANH - LAN'LY:'22, Student at San Bernardino; Lan was born in' Saigon. '
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, . At the age of 17, Lan risked her life to escape Vietnam with her family on a smalJ boat to
Malaysia. An avid leamer, Lan became an .English interpreter after 2, years at' a refugee
camp. In 1992, her family immigrated to the U.S: and Lan's ESL teacher encouraged her to
, 'apply to Valley Colleg~ where she is now studying to·become a nurse., She says that. "
. fmancial aid is her key to getting 'an education and proclaims, "I will not disappoint our '
government, I will give back because I am so grateful to be an American."
EVA CONRAD: 49, Vice President of InstruCtion at San Bernardino Valley College.
Born in Syracuse, New York, to working class ,parents, Ms. Conrad is a first-generation high
school and college .graduate. She has been a professor of psychology and health at Valley
College for 18 years, and was appointed· Vice President of Instruction for the college in July.
1994.
�DRAWlNGTHE liNE ON EDUCATION
In a speech to the American Council on Education today , President Ointon
emphasiZed his commitment to education and a new relationship between government arid '
people based on opportunity and responsibility. The President said he would fight for more
progress expanding educational opportunity indicated, and draw a clear line against
Republican px;oposals in ,several areas. In particular, tb'e President said he will fight to:
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1. E.rpiuul Direct utuling anti ·lndWiduIIl EduCtllion'Accounts, anti oppose
.Republi:etm eRortslo ClIp pII1tieipation tit 4IJI1o
2. Support successful CoUege Access progrll1lU, anti opPfJSe II1IJ attempl to
eUminDle 1M in-school interest ~ for 4 million: students~
3. E.rpiuul AmeriCorps Natiolllll Senice, antl oppose 1lIIY RepubUeo.n
proposals 10 disnumtle 1M inititltive.,
4. &palul GooJ.s 2000, allli oppose efforts 10 Dhowh Ihe DeptUtment of .
Eduetdion.
S. Offer a'ltu deduction up to $10,000 for education andjob training,
. oppose wosteful Itu proposalS liJce 1M ;CllpitDl gains anti
proviSions in House Conti-act
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co~-neutraJ
anti
recovery
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6. E.rpiuul Head Start, and oppose a"; effort to block grant or liniit fundi~g
for Head Start.
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3. £A.X INCENTIJlES FOR EDUCATION AND TRAINING;
Supports New Tax Deduction f9r Education, and Training: The President proposes
making.tuition for college, community cOllege, technical school, gtaduateschool and
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job.-training fully deductible up to $10,000. The deduction will be available to
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families earning up to $100,000, and phased out at $1~,000.,
Opposei Costly Tax Breaks that DO Not Mainly Benefit Worldng Families. The
"Contract with America" would change, bUsiness depreciation to a Neutral Cost
Recovery System-a $120 billion tax cutover ten years, according to the Treasury
Department. The Contract also proposes changes, in the capital gains tax rate that will
cost another $183 billion over ten years. Treasury estimates that over 50% of the
benefits from all the tax cuts proposed in the cOntract would go to families with
, incomes over $100,000. In contrast, 87%, ofthe' benefits from President Cinton's
Middle Cass ,Bill of Rights would go to families with incomes less than $100,000.
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4. NATIONAL ROLE IN ELEMENTARY AND SECONDARY EDUC4TION: ,
Supports GOALS 2000 - 'GOals 2000 affirms the President's belief that education is
central to America's .future. The Federal government is an impOrtant partner with
states and communities in improving education, setting common standards and
ensuring equitabie treatment for all the nation's' children. In, his 1996 budget, the' ,
, 'President Calls for a $347 million increase it, funding for states and ci>mmunitiesto
,proceed with their eduCation refotm agenda.
Opposes ElI'orts to Abolish' Department of Education and National Leadership
Elementary and Secondary Education: Prominent Republicans such as Lamar
Alexander and William Bennett have called for: abolishing the Department of
'Education.
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5. NATIONAL SERJlICE: '
Supports Expansion of AmeriCorps: Today 20,000 AmeriCorps Members are
helping communities to meet their own needs while earning aid for their own
education. AmeriCorps represents a powerful new resource for civic associations that
are now struggling t() immunize infants, ,educate children, stop gang violence, and help
older Americans lead ' more independent lives. Because' national service represents
government at its best, President Cinton is asking for $290 million in additional funds
, to expand the pro grain to 47,000 AmeriCorps, Members. (There will be 33,000 in
fiscal' year 1995).
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, Opposes any effort to Dismantle or Derail National.. Se"ice: .Some Republicans
have called AmeriCorps "coerced voluDteerism," and others have called for the
elimination of the initiative.
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THE MIDDLE CLASS BILL OF RIGHTS
THE PRESIDENT'S COMPREHENSIVE PLAN
TO RAISE MIDDLE CLASS STANDARDS OF LIVING
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A Successful, Economic Plan: The Presidenfs economic plan is already cuning ,the deficit
by $60.0. .billion .~ nearly $10,0.0.0. per family, It's also increasing .investmel)t in technology,
education, and training--with new college loan, national service, s,chool refonn " and
School-to- Work effons. The President fought for NAFT A and GATT, bringing two of the
best years for opening markets in history. Ove'r 15 million working families received a tax
break through his EITe, and 90. percent of small businesses are riow eligible for tax relief.
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The Economy Has Responded with the Best Combination of Growth, Job Creation
and Low Inflation i~ 30 Years: The President's eca'nomicplan' helped solidify the· .
recovery, create nearly 6 million jobs, and hold inflation down:
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Still, tbe 15-Year Pattern of Stagnant Wages Continues for Too Many Middle-Class ,.
Families: Only the top 20. percent of households have seen their incomes rise since I97 CO,
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THE NEXT STEP: THE MIDDLE CLASS BILL OF RlGHTS
To ensure that all Americans share in the recovery and to help families irwestin thefuture~
the President is calling for a Middle Class Bill of Rights. It's based on tbree principles:
1. Targeted to the Middle Class: Unlike ,the Republican 'plan, which mostly benefits'
families earriing over '$10.0.,0.0.0. .. the President, targets benefits to middle-class families, '
2.' Rewards Investment in the Future: The President's plan rewards families who invest
in the future -- especially education and skills for themselves and their cl:tiidren.
3. Paid For By Specific Spending Cuts: The President's plan pays for tax cuts with
specific spending cuts--adding to the $616 billion in,deficit reduction following his 1993 '
plan with another ,$81 billion now.
'
. ,
THE MIDDLE CLASS BILL OF RIGHTS
1. Tax' Credit to Help Working Families Raise Their Children: Families earning up to
$60.,0.0.0. will receive a $50.0. tax credit for each child under.! 3.
,
,
,
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,
I
2. Education and Job Training Tax Deduction to Help Americans Get the Skills They,
Need: Tuition' will 'be fully deductible up to $10.,0.0.0. for families earning up to $10.0..0.0.0.,
3. '. Expanded IRA to Help \Vorking Americans Save 'fo'r' the Futu're:Famiiies earning'
up to $100.,0.0.0. will be .able to save up to $2,0.0.0. a year tax-free per carner--and tlsethe
money foreducation, it tirst home, or medical expenses, in: addition to retirement. .
:.t A New
G.I.· Bill to Empower American Workers: The P"resident \vii!collapse 70.
federal education and training programs and offer low-skill or laid-o'ff workers a Skill Grant
of up to $2,620. per year to choose the train\ng lIla{ works for them.
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C:'JITED STATES DEPART:\tENT OFEDt;CATION
Pl'BLIC Mf..\IRS
...
William D. Ford FederalDirect'Loari Program
Individual Education Accounts
The Individual', Education Account will make the American dream' of an
affordable college education reality for many more young people and their families .'
who thought it was beyond their financial reach.
"
a
In the 'last fifty years" ever since the GI Bill, millions of Americans who never
would have gone to college have been given an opportunity to get an advanced
education. The creation of ,the Individual Education Account follows in this tradition
of ensuring that every generation of Americans gets the help it needs for a first-rate
postsecondary education.
'
.
The rising cost of an education ,in the last decade has led many more Americans
to borrow in order to go to college. But many .borrowers feel "sac;tdled" with the large
"fixed" monthly ,repayment requirement in the first months and years after they
graduate.
'
The newly-created Individual Education Account, part ofttie William O. Ford '
Federal Direct Loan Program proposed by President Clinton and passed by Congress •.
offers flexibility and security, streamlines the loan process, saves taxpayers money,
and gives borrowers more control over their career choices. And, it's family-friendly'.
Just like a home mortgage, the program gives borrowers a variety of repayment
options designed to fit the individual's financial situation. For example, if students
want .to pursue a public service career or start a business, the Individual Education
Account can help them manage their payments to make these career choices possible.
(
I. BENEFITS OF THE INDIVIDUAL EDUCA TlONACCOUNT:
, 1. CHOICE AND FLEXIBILITY FOR. BORROWERS: The Individual ,Education
Account allows' borrowers the choice and flexibility they need to repay their '
loans in 'the way that best fits their career paths ,and individual needs~ The
Individual Educ,ation ACCOUnt allows students options to pay back their Direct'
Loans in one of four ways -- and to switch plans throughout their work life as
their financial situations,chan·ge. The four repay.ment options are as follows:·
"
.
I
•
•
•
PaY-As-You-Can Plan,: Under this plan, a borrower's monthly
payment is based on his or her annual income and loan amount. Since
the repayment is a fixed percentage, repayments rise when income goes'
. 400 ~ARYl.A."iD AVE .. SW.
\I,i"SHINCTON. D,C, 20202-0131
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.
ou, "';ISSlon l,s (0 .. n,su,• ..quat acc."" ,10 .ducallon and 10 promole l"Clucallonal eXcellence II'IrO'ugItOul lit ..."oclon:
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II.
NA To/DNAL'
OPPORTUNITIES:
EFFORT
TO
ENCOURA GE
POSTSECONDARY
Study after study documents th~1t the ability to seek a postsecondary education
is criticalto the lifetime earnings and opportunities of Americans'. Yet, too few young
people do not fully understand their existing opportunities -- no less the new
opportunities offered by the William D. Ford Federal Direct Loan Program and the new.
Individual Education Accounts. As a ,resul~, Secretary Richard Riley and Deputy
Secretary Madeleine Kunin will lead an effort to promote new postsecondary education
opportunities. These efforts will include a 1-800 number; n~wspaper and .television '
campaigns addressed at yo.ung people; and mailing~ to guidance and financial aid
counselors at' high schools and postsecondary institut!ons regarding financing
opportunities.. '
. III. HOW DO PEOPLE GET INDIVIDUAL' EDUCA nON ACCOUNTS?
There are two ways' bor'rowers will be able to get ari Individual Education
Account. Fir$t, they can get a new loan from' one of the schools participating in the
, William D. Ford Federal Direct Loan Program. This year. 104 colleges and schools are
participating in the program, and more than 300.000 students are 'receiving these
loans .totalling $1.2 billion. Next year, approximately 1,500 colleges and schools will
participate in the Direct Loan Program, amounting to about 40 percent of new student
loan volume. Over the next five years. every ,college and school and over 20 million
Americans will have the opportunity to pay back their' student loans through an '
Individual Education Account.
-
j ,
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. The second way that borrowers can get an Individual Education Account is by
converting or consolidating their existing student loans that are in repayment into the
, new program.' The President has asked the Secretary .of Education to work with
Congress to devise a plan by January. 31. 1995 that will ensure that consolidation
opportunities are offered in a 'way that is effiCient. nianageable, and prudent.
.
Contact: Kathryn Kahler, 401·3026.
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t
GRADUAXION RATES AND TES'1!SCORES UP'
Clinton's educatip'h: reforms'led 'to an increase in the
, graduation rate. Likewise, Arkansas saw a steady
improvement in test scores •. Between 1981 and 1991, the
. '.graduation rate increased'to the highest in the region and
gains- in math and reading test scores were seen f,or fourth,
seventh and tenth, grade students.
'
•
REQUIRED COMEJEXENCY TESXS FOR S'.J:UDJi:N'.:rS
Arkansas was the first state in the, nation to require eighth
graders to pass a competency'test before going on to high
school.
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EDUCAXION musx, FUND
Clinton ,established an Education Trust Fund ~o'be used only
, for education and fought to insure that is was fully funded.
•
SCHOOL 'CHOICE
As Governor; Clinton made Arkansas one of the first states
to permit parents to choose ~hat pub1~c scnools ,their
children attended.
, . T.EACBER SALARY INCREASES
In 1991, by persuading the legislature to set'aside a half
cent sales tax increase in a special fund, Clinton provided
teachers with $4,000 average ,salary increase.
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POLICE CORPS
Arkansas was the first state to create 'a Police Corps
program; which provides college scholarships to police
officers and young people in exchange for service in a law
enforcement agency~
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ADULT EDUCATION
, Under Governor" Clinton's leadership, adult education and
'literacy programs ~xpanded., The U.S. Departm$nt of'
'Education indicated that Arkansas had the "highest'
percentage of full-time adult basic education instructors in
the nation." The ntuitber of adult students participating in
adult education programs, workplace literacy· programs, local
literacy programs and public television literacy programs
increased, from 14,555 in 1983 to 60, 000 in 1991. State
funding for ,adult education increased from $1~9 million in
1983 to over $14 million in 1991.
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COLLEGE BOND PROGRAM
Clinton established a collegel:;>ond program allowing parents
,,to buy short or long-term college bonds, not taxed in
Arkansas, to help finance their children's education.
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ECONOMIC PROGRESS IN CALIFORNIA UNDER PRESIDENT CLINTON .
.;sident Clinton's strategy to' strengthen the economy isj.based on reducing the federal budget deficit,
lowering trade barriers, and empowering· ~workers, 'families, busin~sses and communities to succeed.. Here are some of
the results for the nation and California after the first two years of the Clinton' Administration:
1 •
Improved Economic and Fiscal Conditions in the United Stales:
· • Under Clinton Economic Pl~, the deficit will be lowered by more th~ $600 blliion -~ the 'deficit will be cut for
. three years in a row for the first time,since Harry Trumcm was President..
.
,
• Almost 6 million new jobs created -- private sector job growth rate 8 times faster than during previous
.
Adm inistration.
• Federal government workforce will drop by 272,900 -- creating lowest workforce since the Kennedy Administration.
Improved Economic Conditions in California:
• The unemployment rate has dropped from 9.4% to 8.20/0.
• New business incorporations have increased 13%.
· • The Help Wanted Index' has increased 21 %.
• Consumer confidence has increased 54%.
• Home sales' have increased 7% per year
~- ,after, average
declines of 6.6% per yek
duri~g the previous 4 years.
,
· • Bankruptcy filings have dropped 6.1 % per year -- after increasing 13.4% per year duri.ng the previous 4 ·years .
. What President Clinton's Accomplishments Have Achieved for the People of California: .
,$10,000 OF REDUCED FEDERAL DEBT FOR EVERY FAMILY OF FOUR IN CALIFORNIA:
By 1998,
the. national debt will be more than $600 billion lower than was projected before the passage of the President's
economic plan. That's about $10,000 of reduced federal debt for each family of four in California.
10 TIMES MORE CALIFORNIA FAMILIES RECEIVE A TAX CUT THAN A TAX INCREASE: As a result
of the expanded Earned Income Tax Credit, 2,146,915 working families in California will receive a tax cut. This
compares to an increase in the incom'e tax rate for only the 218,777 wealthiest taxpayers in California.
TAX CUT FOR 178,917 SMALL BUSINESSES IN CALIFORNIA: The President helped entrepreneurs,'.
· proprietors, and other small businessmen ,and women by expanding the annual expensing allowance from $10,000 to
$17,500. About 178,917 small businesses in California are likely to benefit from the expansion of the expensing
, .allowance this year alone tind many more will benefit over the coming years.
4,959,000 CALIFORNIA WORKERs PROTECTED BY FAMILY AND MEDICAL LEAVE ACT: The Family
and Medical Leave Act allows workers to take up to 12 weeks of unpaid leave for the birth of a child. to care for a
sick family member, or if they become too sick to work. This law covers about 4,959,089 workers in California. and
. protects the jobs of 297,914 workers in California who are likely to use unpaid leave this year alone.
1.65 Mll..LION STUDENTS AND FORMER STUDENTS IN CALIFORNIA WILL BE ABLE TO BENEFIT
FROM STUDENT LOAN REFORMS: Approximately 1.65rriillion California borrowers -- Ll6 million current
bo~wers and 490,000 new borrowers in the next· few years -., ~,~ take advantage of the new direct student loan .
program by participating directly in the program or by consolidating guaranteed loans into direct loans. Some will
benefit from lower interest rates, and all will benefit from more. ~epayment options, including income contingent
repayment.
February / J. /995
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'PRESIDENT CLINTON DRAWS THE LINE ON EDUCATION:
WILL FIGHT TO PROTECT LOANS OF 363,800 CALIFORNIA, STUDENTS
February 14, 1995
In a speech to the Americ~n Council on Educati()n in Sari Francisco' today, President Clinton
drew the line on education~ saying:
'
'
,
,
,
Republican leadership ... proposals will cut investments in our future and increase the' cost '
of st1-ldent loans to 'our neediest students to fund tax cuts for the wealthY. They will limit
the availability' of lower cost direct loans to middle class students to increase profits for
'the middlemen. And they won 'treinyent the Department oJEducation as J have done 10'
make it a stronger voice for education -- they will abolish iI. To all of this, lsay: No. J
will fight these proposals every step of the way, and J want ,you to join me in this fight.,
/
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,
,
President _
Clinton specifically vowed to fight to:
.1) Expand .Direct Lending and Individual Education Accounts, and oppose Republican efforts to
cap participation at 40%;
2) Support successful College Access programs, and oppose any attempt to eliminate the iri-scho'ol
,
interest subsidy for 4 million' students;
3) Expand AmeriCorps National Service, and oppose':any Republican proposals to dismantle the
initiative;
,
4) Continue Goals 2000, and oppose efforts to abolish th~ Department of Education;
5) Offer a tax deduction up to $10,000 for education and job training, and oppose wasteful tax
. proposals like the capital ;gains and cost-neutral recovery provisions in the House Contract;
6) Expand Head Start, and oppose, any effort to block grant or limit' funding for Head Start. ,
.
. '
.
.
By opposing Republican proposals to end the iri-school interest subsidy, President Clinton -
will protect 363,800 current California borrowers from accruing interest charges on their
loans until after th~y finish school ~ndstart repaying tbeir lo~n~. The Department of Education
estimates that ending this subsidy would mean that a student who borrows $17 ,125 over four years
would ,OWe $3,150 more~ and have his or her monthly repayment amount increased by more than
18%.
By opposing Republican efforts to restrict expansion of the Direct Lending program apd
Individual Education Accounts (lEA), President Clinton will 'ensure that every American will have
access to the program within the next five years. In the 1995-96 school year, 175 California
schools will participate. in direct, lending; including:'
California-Institute of Technology,
California State College, Bakersfield
Fullerton College
_
Long Beach CommunitY College
Los Angeles City College
San Diego City College
,San Diego State University
San Francisco State Unive,rsity
San Francisco Theological Seminary
Santa Clara University
Sonoma State University
_UniversitY of California, Berkeley'
University of California, Rive,rside
University of.California, Santa Barbara
University of California, Santa Cruz
University of California, Davis'
University of California, Irvine
University of Pacific
University of San Francisco
. The new national Direct Lending program, which offers the Individual Education Accounts,
simplifies borrowing, reduces fees for students and offers borrowers several convenient repayment
options, including' income-contingent repayment. The program will, also -save the federal
government billions of dollars in administrative expenses.
�"
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PRESIDENT CLINTON DRAWS THE LINE ON EDUCATION:
WILL FIGHT TO PROTECT LOANS OF 7,300 DELAWARE STUDENTS'
February 14, 1995
In a speech to the 'American Council on Education in San Francisco today, President Clinton
drew the line on education, saying:
Republican leadership ,.. proposals will cut investments in our future and increase the cost of
student loans to our neediest students to fund iax cuts for the wealthy. They will limit the
availability of lower cost direct loans to middle class students to increase profits for the
middlemen. And they won't reinvent the Department of Education as I have done to make it
a stronger voice for education -- they will abolish it. To all of this, i say: No. I will fight'
these proposals every step of the way, and I want you to join me in this fight.
President Clinton specifically" vowed to fight to:
1)
Expand Direct Lending and Individual Education Accounts, and oppose Republican efforts to
cap participation at 40%;
2) Support successful College Access programs, and oppose any attempt to eliminate the in-school
interest subsidy for 4 million students; , '
,
3), Expand AmeriCorps National Service, and oppose any Republican proposals to dismantle,. the
initiative;
4) , Continue Goals 2000, and-oppose efforts to abolish the Department of Education;
5) Offer a tax deduction up' to $10,000 for education' and job training, and oppose wasteful tax
proposals like the capital gains and cost-neutral recovery provisions in the , House Contract;·
6) Expand Head Start, and oppose any effortio block: grant' or limit funding for Head Start.
By opposing Republican, proposals to ,end the in-school interest subsidy, President Clinton
will protect 7,300 current Delaware borrowers' from accruing interest charges Qn their loans
until after they finish school and start repaying their loans. The pepartmentof Education "
estimates ,that ending this subsidy ~ould mean that a student who borrows $17,125 over four years
would owe $3,150 more, and have his or her monthly repayment amount increased by more th~
18%.
'
"
"
By opposing Republican efforts to restrict expansion of the Direct, Lending progr~ and
Individual Ed~cation Accounts (lEA), President, Clinton will ensure that every American will have
access to the program within the next five years. In the 1995-96 school year, the following 4
,Delaware schools 'will participate 'in direct lending:
Delaware State College
'Delaware Technical & Community College
Schilling Douglas School of Hair Design
University of Delaware
The new national Direct Lending program, which offers the Individual Education Accounts,
simplifies borrowing, reduces fees for students' and offers borrowers several convenient repayment
options; including income-contingent repayment. The program will also save the, federal·
government billions of dollars in administrative expenses.
"
,
�PRESIDENT CLINTON DRAWS THE LINE ON EDUCATION:
WILL FIGHT TO PROTECT LOANS OF 61~100 KANSAS STUDENTS
February 14, 1995
In a speech to the American Council on Education in San Francisco today, President Clinton·
drew the line on education, saying:
Republican leadership ... proposals will cut investments in our future and increase the cost of
student loans to our neediest students to fund 'tax cuts for the wealthy.· They will limit the
availability of lower cost direct loans to middle class students to increase profits for the
middlemen. And they won't reinvent the Department of Education as I have done to make it .
a stronger voice for education -- they will abolish it. To all of this, I say: No; I will fight
these proposals every step of the way. and I want you tojoin me in this fight ..
President Clinton specifically vowed to fight to:
1) Expand Direct Lending and Individual Education Accounts;' and oppose Republican efforts to
.
cap participation at 40%;
2) Support successful College Access programs, and oppose any attempt to eliminate the in-school ..
interest subsidy for 4 million students;
3) Expand AmeriCorps National Service, and oppose any Republican proposals to dismantle the
initiative;
4) Continue Goals 2000, and oppose efforts to abolish the Department of Education;
5) Offer a tax deduction up to $10,000 for education and job training, and oppose wasteful tax
proposals like the capital gains and cost-neutral recovery provisions in the ,House Contract;
6) Expand Head Start, and oppose any effort to block grant or limit funding for Head Start.
By opposing Republi~an proposals to end the in-school interest subsidy; President Clinton
will protect 61,100 current Kansas borrowers from accruing interest charges on their loans·
until after they finish scnool and start repaying their loans. The Department of Education
estimates that ending this subsidy would mean that student who borrows $l7,125 over four years
would owe $3,150 more, and have his or her, msmthly repayment amount increased by more than
18%:
a
By opposing Republican efforts to restrict expansion of the Direct Lending program and
Individual Education Accounts (lEA), President Clinton will ensure that every American will have
access to the program within the next five years. In the 1995-96 school year, the following 17
Kansas schools, will participate in direct lending:
Academy of Hair Design
American Academy· of Hair Design·,
,Bryan Travel College
,
Cloud County CommunitY College
Dodge City Community College
Hays Academy of Hair Design
Highland Community College
Hutchinson Community College
Johnson County Community College
Kansas state University
. .Kansas Wesleyan University
Labaron Hairdressing Academy
Northeast Kansas Area Vocational
Southeast Kansas Area Vocational
Southwestern College
Superior School Of Hairstyling
Topeka Technical College
The new national Direct Lending program, which offers the Individual Education Accounts,
simplifies borrowing, reduces fees for students and offers borrowers several convenient repayment
options~ including income-con~ingent repayment.. The· program will also save the federal
government billions of dollars in administrative expenses.
�'.
•
"
PRESIDENT CLINTON DRAWS THE LINE ON EDUCATION:
.WILL FIGHT TO PROTECT LOANS OF 55,200 KENTUCKY STUDENTS
February 14, 1995
.
'
, Ina speech to the American counciion Education in San 'Francisco today, President Clinton
drew the line on education, saying:
Republican leadership ... proposals will cut investments in our future' and increase. the cost of
student loans to our neediest students to fund tax cuts for the wealthy." They will limit the
availability of lower cost direct loans to middle class students to increase profits for the
middlemen. And they won't reinvent the Department of Education as I have done to make it
a stronger 'voice for education ,.- they will abo,lish it.' To c:ll of this, Isay: ,No. I willfighi
these proposals every step of the way; and I want you to join me in 'this fight.
President Clinton specifically vowed to fight to:
1) Expand Direct Lending and Individual Education Accounts, and, oppose Republican efforts to '
,
cap partidpation at 4 0 % ; '
2) Support successful College Access programs, and .oppose any attempt to eliminate, the in-school
interest subsidy for 4 million students;
3) Expand AmeriCorps National Service, and oppose: any. Republican proposals to dismantle the
initiative;
"
"
.
,
4) Continue Goals 2000, and oppose efforts to abolish the Department of Education;
5) Offer a tax deduction up to $10,000 for education and job training, and oppose wasteful tax
proposals like the capital gains and co~t-neutral recovery provisions' in ,the ,House Contract;
6) Expand Head Start, and oppose any effort to, block grant or limit funding for Head Start.
By opposing Republican proposals to e~d the in-school interest s~bsidy,President Clinton
will protect 55,200 current Kentucky borrowers from accruing interest charges on their loaJ;1s ,
'
until after they finish, school and start repayin'g their loans. The Departmet:lt of Education
estimate's that ending this subsidy would mean that a student who borrows $17,125 over four years
would o~e $3,150 more, arid have his or her monthly repayment amount illcreasedby more than
18%.
,
.
.
' .
.
BY' opposing Republican efforts to restrict expansion of the Dire~t Lending program ' and
_Individual Education' Accounts (lEA),' President, Clinton will ensure that every American will have
access to the program within the next five years. In-the 1995-96 school :year, 37 Kentucky
i
'
,
. schools 'will participate indirect lending, . inclu'ding:
Ashland Community College
Elizabethtown Community College
Henderson Community College
Jefferson Commu'nity College
Kentucky Career Institute
Kentucky College of BUSiness
Kentucky State University
Lees College
Lexington Community College
Louisville Technical InstitUte
Morehead State University
Owensboro Community College
Owensboro Junior College of Business
Paducah Community College '
Somerset Community College
-Sullivan College'
,
'University of Kentucky
;Westem Kentucky University
. The new national Direct Lending program, -which offers the Individual Education Accounts, '
simplifies borrowing, reduces fees for students and offers borrowers several convenient repayment
optioris, including income-contingent repayment. The program will also save the federal
government billions of dollars in administrativeexpen~es. '
(
�PRESIDENT, CLINTON DRAWS THE LINE 'ON EDUCA.TION:
WILL FIGHT TO PROTECT 'LOANS OF 114,300 MISSOURI STUDENTS
'February 14,,1995
,
,
Ina speech to the American Council on Education in San Francisco today, President Clinton
drew the 'line on education, saying:
.
,
,
. .
,
.
Republican leadership ... prop~sals will cut investments in our future and increase· the 'cost of
student loans to our neediest students to fund tax cuts for the wealthy., They will limit the
,availability of lower cost 'direct loans to middle class students to increase profits for the
middlemen: And they won't reinvent- the Department of Education, as I have done, to make;t
a stronger voice for education ~- they will abolish it. -To all ofthis; I say.' No. ' I will fight
these ,proposals every step of the way, and I want you to join me in this fight.
President Clinton specifically ·vowed to fight to:
I) Expand Direct' Lending and Individual Education Accounts, and oppose Republican efforts to '
cap participation at 40%;
,
,
2) Support suecessful College Access programs, and oppose any attempt to eliminate the in..'school
interest subsidy for 4 million students; ,
",
3) Expand AineriCorps National Service, and oppose any Republican' proposals to dismantle the
initiative;
4) Continue Goals 2000~ and oppo~e 'efforts to abolish the Department of Education; ,
-5) Offer a tax deduction up to $10,000 for education and job training, and oppose wasteful tax'
proposals like the capital gains and cost-neutral recovery provisions in the House Contract;
6) Expand Head Start, ,and oppose any effort to block grant or limit funding for Head Start.
I
'
,
,
'
By opposing Republican 'propos~ls' to end the in-scho~l, intere~t subsidy" President Cli~ton "
will protect 114,300 current Missouri borrowers fr'omaccruing interest charges on their loans
until after they finish school 'and start repaying their loans. The Department of Education ,
estimates that ending thiS subsidy would mean thata' student who borrows $17,125 over four years
would owe $3,150 'more, and have his or her mOrithiy' repayment amount increased by more than
18%.
By oPPo,sing Republican efforts to restrict eXPansion of the Din~ct. Lending 'program and
Individual Education Accounts (IEA), President Clinton 'will ensure that every .American will have
access to the program within the next five 'years.: In the 1995-96 school year, 34 Missouri schools
will parti-;ipate 'in direct lending, including:
.
Central Missouri State
Culver Stockton College
'Deaconess College of 'Nursing
, Lael College and Graduate School""
Lincoln University' ,
Longview Community College
Maple Woods Community College
Maryville University
"
Midwest Institute for Medical Assistants ,
Missouri Southern State College
Missouri Technical School
Northwest Missouri State
Southwest Missouri State
, University of Missouri,Colurribia
University of Missouri, Kansas City
University of Missouri, Rolla
,University of Missou,ri, St. Louis
William Jewell College
The new national Direct Lending program, 'which offers the Individual Education Accounts,
simplifies borrowing, reduces fees for students ,and offers borrowers several convenient repayment'
options, including'income-contingent,repayment. The program will also save the federal
'
, goverriment billions .of dollars in administrative expenses.
�PRESIDENT CLINTON DRAWS THE LINE QN EDUCATION:
WILL FIGHT TO PROTECT LOANS OF 89,800 NEW JERSEY STUDENTS·
.
February 14, 1995
In a speech to the American Council' on Educati~n in San Francisco today, President Clinton
drew the line on education, saying:
Republican leadership .... proposals will cut investments in ,our future and increase the cost of .
student loans to our neediest students to fund tax cuts for !he wealthy. They will limit the
availability of lower cost dired loans to middle class students to increase profits for the
middlemen. And they won '( reinvent the Department of Educaiion as 1 have done to make it
a stronger voice for education -- they will abolish it. To all of this. I say: No. I will fight
these proposals every step of the way, and I want you to join me in this fig~t.
President Clinton specifically vowed to fight to:
1) Expand Direct Lending and Individual Education Accounts; and oppose Republican efforts to
.
.
cap participation at 4 0 % ; '
2) Support successful College Access programs, and oppose any attempt to eliminate the in-school
interest'subsidy for 4 million students;
.'
.
3) Expand AmeriCorps National Service, and oppose any Republican, p'roposals to dismantle the
initiative;
4) Continue Goals 2000, and oppose efforts .to abolish the Department of Education;
5) Offer a tax ded~ction up to $10,000 for education and job. training, and oppose wasteful tax
proposals like the capital gains and ,cost.,.neutral 'recovery provisions in the House Contract;
6) Expand Head Start, and oppose any effort to block grant or limit funding for Head Start.
By opposing Republican proposals to end'the in-school' interest sub~idy, President Clinton
will protect 89,800 current New Jersey borrowers from accruing interest charges on their
loans until after they finish school and start repayin'g their, loans •.', The Department' of. Education
estimates that ending this subsidy would mean that a studerit who borrows $17,125 over four years
would owe $3,150 more, and have his or her ' .
monthly. repayment amount increased by more than
.
18%.
"
By opposing Republican efforts to restrict. expansion qf the. Direct Lending program and
Individual Education Accounts (lEA), President Clinton will ensure that every .American will have
,access to the program within the next five years. In the 1995-96.school year, 44 New Jersey
schools' will participate indirect lending, including:;
Academy of Computer Graphics
Berkeley College of Business
Brick Computer SCience Institute
Burlington County College'
Jersey City State College
Kean College of NJ
Mercer County CommunitY College
Monmouth' College
Montclair State College
New Jersey Institute of Technology
Ramapo College of NJ
Richard Stockton College of NJ
Rowan College of NJ
kutgers StateUniver~ity of NJ
Seton Hall University .
St. Francis Hospital School of Nursing
Star Technical Institute
.
Stevens Institute of Technology
Trenton State' College
William Paterson College of NJ
The new national Direct Lending program, which offers the Individual Education Accounts,
simplifies borrowing, reduces fees. for students and offers borrowers several convenient repayment
options, including income-contingent repayment: The program will also save the federal
.
'
.
government billions of dollars in administrative expen~es.
�PRESIDENT CLINTON DRAWS THE LINE ON EDUCATION:
WILL FIGHT TO PROTECT LOANS OF 34~,400 PENNSYLVAI'lIA STUDENTS
1.;
February 14, 1995
In a speech' to the American Council on Education in San Francisco today, President Clinton
drew the line on education, saying:
Republican .leadership ... proposals will cut investments in our future and increase th~ cost of
student loans to our neediest. students to fund tax cuts for the wealthy. They will limit the
availabilitY of lower cost direct loans to middle' class s~udents to increase profits for the
middlemen. And they won't reinvent the Department of Education as I have done to make it
a stronger voice for education -- they will abolish it. To all of this, I say: No. [will fight
these proposals every step of ihe way, and I want you to join me in this fight.
.'
President Clinton specifically vowed to fight to:··
1) Expand Direct Lending and Individual Education Accounts, and oppose Republican efforts to
cap participation at 40%;
2) Support successful College Access programs, and oppose any attempt to eliminate' the in-school
interest subsidy for 4 million students;
3) Expand AmeriCorps National Service, and oppose any Republican proposals to dismantle the
initiative;.
.
4) Continue Goals 2000, and oppose efforts to abolish the Department of Education;
5) Offer a tax deduction up to $10,000 for education ,and job training, and oppose wasteful tax
.proposals . like the capital gains and cost-neutral recovery provisions in the House Contract;
. 6) Expand Head Start, and oppose any.effort to block grant or limit. funding for Head Start.
By opposi~g' Republican proposals to end the in-school interest subsidy, President Clinton
will protect 343,400 current Pennsylvania borrowers from accruing interest' charges on their
loans until after they finish school and start repaying their loans. The Department of EducatiQn
estimates that ending this subsidy would mean that a student who borrows $17,125 over four years
would owe $3,150 more, and have his or her monthly repayment amount increased by more than
18%.
.
.
""
, ,By opposing Republican efforts to -restrict expansion of the Direct Lending program and
Individual Education Accounts {lEA.), President Clinton w'ill ensure that every .Americari will have
access to the program within the next five years.' In the 1995-96 school· year, 60 Pennsylvania
schools, wiu participate in direct lending, including:
Allegheny Business Institute
Art Institute of Philadelphia
Eastern College
.
Geneva College ,
Gettysburg College
Harcum Junior College
.Laurel Business Institute.
Lebanon Valley Co \lege
Manor Junior College
Messiah College
Pace Institute
Pennsylvania Institute of Technology
Philadelphia College of Pharmacy and Science
Pittsburgh Institute of Aeronautics
Pjttsburgh Technical Institute
Robert ,Morris College
Rosedale Technical InstitUte
Tri State Busi.ness Institute
Yeshivath Beth Moshe
York College of Pennsylvania
The new national Direct Lending program, which offers the Individual Educatjon Accounts,
. simplifies borrowing, reduces fees. for students 'and offers borrowers several convenient repayment
options, inCluding income-contingent repayment. The' program will also' save the federal.
government billions of dollars in administrative expenses.
�•
-t.
PRESIDENT CLINTON DRAWS THE LINE ON EDUCATION:
, WILL FIGHT TO PROTECT LOANS OF 34,200 WEST VIRGINIA STUDENTS
February 14; 1995
In a speech to the Americ~ Council on Education in'San Francisco today, President Clinton
drew the line on education, saying:
Republican leadership ... proposals lvill cui investments in our future and increase the cost of
student loans to our neediest students to fund tax cuts for the wealthy.' They will limit the
availability of lower cost. direct loans to middle :class students .to increase profits jor the
'middlemen. And they wort't reinvent the Department of Education as {have don~ to make it
a stronger voice for edualtion -- they will abolish it. To all ofthis: f say: No. f will fight
these proposals every step of the way, and} want you tojoin me in this fight.
President Clinton specificaily vowed to fight-to:
.
I) Expand Direct Lending and Individual, Education Accounts, and oppose Republican, efforts to
cap participation at 40%;
2) Support successful College Ac;cess programs, and oppose' any attempt to eliminate the in-school
interest subsidy for 4 million students; ,
3) Expand AmeriCorps NationaISer'Vice, and oppose any Republican proposals to dismantle the
initiative;
,4) Continue Goals 2000; and opp~se efforts to'abolish the Department of Education;
5) Offer a tax deduction up to $10,000 for education and job training, and oppose wasteful tax
,
proposals like the capital gains and cost-neutral recovery provisions in the' House Contract;
6) Expand Head Start, and oppose any effort to block grant or limit funding for Head Start:.·
'
,
,
"
By opposing Republican proposals to end the in-school .interest subsidy, President 'Clinton
will protect 34,200 current West Virginia borrowers from accruing interest charges on their
loans until after they fini~h school and start repaying 'their loans. The Depaltmen~ of Education.
estimates that ending this subsidy would mean that a student who borrows $17,125 over four years
. would owe $3,150 more, and have his or her monthly:repayment amount increased by more than
18%.
By opposing Republican efforts to' restrict expansi~n of the Direct Lending program and
Individual Education Accounts (lEA), President Clinton will ensure that every American will have
access to the program within the next five years. 'In the 1995-96 school year, the following 15 "
West Virginia schools will participate in direct ·lending:
.
Alderson Broaddus College
Bethany College·
Bluefield State College
Fairmont State College
Glenville State college
Marshall University
Meredith Manor International
Potomac State College
Salem Teikyo Uniyersity r
Shepherd College
,Yalley Training Center.
West Liberty State College
West Virginia Career College
West Virginia l)'niversity
. Wheeling Jesuit College
. The new national Direct Lending program, which offers the Individual Education, Accounts,
simplifies borrowing, reduces' fees for students and offers borrowers several' convenient repayment
options, including, income-contingent repayment. The program will also save the federal
government billions of dollars in administrative, expenses.
�THE WHITE HOUSE.
PRESS OFFICE
Dr. Foster Nomination Picking Up Steam
February 16/ 1995
"Just in the past 48 hours/ I've witnessed a turnaround in
the kind of support and the strength there is for [the]
nomination. ' , (Senate Minority Leader Tom Daschle, 12/15/95)
Dr. Foster shows a "passion for dealing with some of the
tough issues that face America. Maybe some of the people
who care about families would do well to reconsider their
positions."
(Bishop Frederick James, AME Church/ 12/15/95)
BROAD SHOW OF SUPPORT FOR DR. FOSTER
Dr. Foster is receiving endorsements from groups representing a
broad cross-section of America. Today/ the American Medical
Women's Association, the National Education Assoc'iation, the
Planned Parenthood Federation of America/ the Association of
Schools of Public Health and other civic, religious and women's
groups will hold a press conference to announce their support of
Dr. Foster's nomination. Yesterday at the White House, 30 black
religious/ educational and medical groups leaders strongly
endorsed him and said they would lobby for his confirmation.
GOOD RECEPTION ON THE HILL
Today, .Dr. Foster will meet with leading Republican Senators for
an open dialogue on his distinguished record and qualifications.
Yesterday, he made a round of courtesy calls to Senate Democrats
who gave him high marks. Sen. Carol Moseley-Braun (D-IL) said,
"The more his reputation is known, the more he speaks, the more
people understand that his opponents have extremist views and
that his whole career has been about valuing life."
RESPONSIBLE REPUBLICANS GIVING DR. FOSTER A FAIR HEARING
Those Republicans who are interested in having .the best qualified
Surgeon General are determined to keep an open mind and give Dr.
Foster a
ir hearing. , Nancy Johnson (R-CT), whose husband is a
practicing ob/gyn, told a radio talk show this week that
"Republican senators .... have taken advantage of. the situation
to launch a very narrowly-based, mean-spirited campaign of
opposition. There isn't an obstetrician in America that was
trained during the time Dr. Foster was trained, that practiced
during the years he practiced/ that hasn't terminated a
pregnanriy. There isn't one."
�SETTING THE RECORD STRAIGHT
Right-wing extremists will escalate the rhetoric and let the
false charges fly. Groups that seek to criminalize a w~man's
right to choose have tremendous resources at their disposal and
will say and do anything to defeat this nomination. We will
rebut that misinformation and set Dr. Foster's record straight.
Dr. Foster is a highly respected obstetrician/gynecologist and
one of the leading medical educators in the country. In his
distinguished 38-year career, Dr. Foster has delivered thousands
of babies and instructed hundreds of young physicians. His "I
Have a Future" program to promote abstinence and fight teen
pregnancy is a national model --named one of\ President Bush's
Thousand Points of Light.
ORGANIZATIONS SUPPORTING DR. HENRY FOSTER
Advocates for Youth
African Methodist Episcopal Church
Africare
Alpha Kappa Alpha
American Academy of Pediatrics
American Association of Dental Schools
American College of Obstetricians and
Gynecologists
American College of Physicians
American for Democratic Actipn
American College of Preventive Medicine
American Medical Association
American Medical Women's Association
American Nurses Association
American Psychiatric Association
American Psychological Association
American Society for Reproductive Choice
Association of Academic Health Centers
Association of American Medical Colleges
Association of Minority Health Professions Schools
Association of Reproductive Medicine
Association of Schools of Public Health
Association of Teachers of Preventive Medicine
Black Health Association
Black Women's Network
B'nai B'rith Women
Catholics for Free Choice
Center for Black Aged
Center for Reproductive Law and Policy
Clara Bell Duvall Education Fund
'
Delta Sigma ,Theta
The Endocrine Society
Feminist Majority
Human Rights Campaign Fund
International Association of Black Fire· Fighters
Medical Students for Free Choice
National Abortion Federation
�National Abortion and Reproductive Rights Action League
National Association for the Advancement of Colored People
National Association for Equal Opportunities in
Higher Education
N~tional Association of Black Cardiologists
National Association of Public Hospitals
National Association of Social Workers
National Black Chamber of Commerce
National Black Nurses Association
National Black Police Association
National Black Women's Health Project
National Caucus of Black State Legislatures
National Council of Jewish Women
National. Council of Negro Women
Nationa~ Council of Senior Citizens
National Education Association
National Family Planning and Reproductive Health Association
National Hispanic Medical Association
National Medical Association
'National Progressive Baptist Convention
National Organization for Women
National Organization for Women Legal Defense and Education Fund
.National Urban ·League
National Women's Law Center
People for the American Way
Planned Parenthood Federation of America
Sexuality Information and Education Council of the United States
Voters for Choice
Zero Population Growth Zeta Phi Beta
�NATIONAL POLL FINDS LAW ENFORCEMENT
OVERWHELMINGLY SUPPORTS COMMUNITY POUCING
Febroary 23,1995
•
Police chiefs and county sheriffs support comm~nity polking.· A new poll has
fOllnd that a majority of the nation's police chiefs and county sheriffs believe
community policing _. one of the cornerstones of the 1994 Crime Act - is the best
way to tight crime.
suppoRT FOR COMmlNlTY POLICING
.*
Poll asserts Community poncing is cost-effective. 'The national poll /oUlld thai 56
percent 0/ the chiefs and sheriffs surveyed called community policing me. most eQ8(
d[ective srratecv for fighting 'rime. The. President·s 100,000 COPS Program is a
national community policing strategy - building partnerships between the police and
the citizens they serve to find pennanent solutions to crime problems.
I
• of
Pollidentwes Neighbol'hood Watch as effeCtive community policing. An example
a community policing partnership that effectively reduces crime is Neighborhood
Watch. Fifty-five percent 0/the chiefs and Sheriffs su~ed found these. progrrl11U to
be extremely cost effective at preventing crime.
high
enforcement agencies,
* Demand countryfor theto100,000 COPS Program. LawThe COPS Office has all
across the
want expand community policing.
is
received applications for community poliCing grants from over lO,OOOlaV{.
enforcement agencies nationwide - more than half of the police and sheriffs '
departments in America.
o
o
Close to 900 larger cities and ~unties with ]X)pulations above 50,000 applied
for COPS AHEAD grants •• more than 50 percent of the eligible jurisdictions.
Again, they did so with the knowledge that they would not receive a local
match waiver.
o
~OO flI
More than 7,100- 49 percent - of the cities, to'MlS and villages with
populations below 50,000 applied for COPS FAST grants under the Crime
Bill, knowing that no loc.al match waivers would be granted under that
program. They requested close to 18,000 additional office~ -- to fund all of
them would have cost S1.1 billion.
The Department of Justice received 2,764 applications for grants under the
Police Hiring Supplement ProgIalIl in FY 1994.
~so/roa
'['[ac
LOC
~o~,g,
C~:9t
S6/C~/~O
�•
The fact that chiefs and sheriffs believe in community policing should Dot
surprise anyone. The l()()tOOO COPS program was developed by the Clinton
Administration and a bipartisan' majority of the Congress with the~uidance and· .
support of every major national law enforcement orgatlizatiQn.
MORE EQUIPMENT
,
•
The 100,000 Cops Program provides training and equipment. The survey also
found that 56 percent of the chiefs and sheriffs surveyed said' that expanded trdining
and more equipment were very cost.effective in fighting crime.
8
Responding to the Demand: the COPS MORE (Making Officer
Redeployment Effective) program will provide grants to local police
departments to purchase equipment and technology, hire civilians~ or pay
overtime to help them move more officers into community policing.
•
Technical assistance and training is available from the COPS Office for local
police departments to help them expand community policing.
o
Innovative communitY policing glUts will be available for equipment,
overtime, tIaining, and other uses which will advance community policing
independent of redeployment or hiring requirements.
. . THE CRITICS ARE WRONG
Some folks say that Washington shouldn't Kforce" police to do community policing.
These critics fail to realize that police told the President and the Congress that they wanted to
. xpand COlnnlunity policing. Community Policine is· aboyt community control - about
e
providing communities with the tools to meet their speCific law enforcement needs and
concernS. That's why the 100,000 COPS· program was put in the Crime Bill. This
AdminiSlIalion is committed to keeping it there.
COO~
~SO/rO<I
H6C LOC
~O~..g,
t~:9t
S6/C~/~O
�..
DATE:
PAGE:
;?--.::1.5-,.,
3A
pon: COPS not in line with GOP
,
By Sam V.iAc:ent Meddis
.crime agenda
Chiefs' crime-fighting prk)rtHes
and MImi KaU
USA TODAY
!'low to distribute crlme-flghtlng.dollars.
here's wtlat police ~iefssay are the moat cost-effective
means of cui'bing cnme.
As Congress debates
A new pan ot poUce chiefs
8Ild Q)~ sherUf:l; 8C'.1"'1S the
l!.811on !bows a d.I1ferellee of
opinion ora some key parts of
Community policing
MOl'll pollel
the c:r'im&agntmg approach or
U1eGOPCb~
Among
.
lralnlng, equ!jlment
a:ae beungr.
.. $6% const.der cammuc1ty
. 1.1&"'0",004 nt'CtI
poUdnS a "verY' om-efective
W8't to cur. a1me.
.. 31 ~ ctte redudng dn.Ig
BbUge as 8 prima.ry toeus lD re
duCing VIolent crtme.
.. SB'lC support the death
penalty phila;opbica1ly but say
Irs DOt e1I'edive in law entoreemenL
~
'""I1IM
lOftier prtson
J.
anfenca
J4
MOI1'rug •
• ~hol progl'lllTtS
AIItI'f8nt enotll
_oslnl dea1fl
pe,naJ1Y mare
J32%
I~
"In their know Ul.at you 11l~~-~!!i.t!~!!U!!!l!:!!~~~iiilii~1®\'i'O(~
most (police)heart of Ileans. . Li
can't Incarcerate or execute
your
way
out or c::rime," says
James Fyfe, a temple Ulliver- . .
lity C'J1m!II.olog!st and ex-Ntw
York police Ueutenant. .
The su:rvey
386 top om~.
cers. released today by tb~
en
Deatb Penalty Information
Center. fallows passage in the
Bouse last .eek of a Republi.
call bill IllcreaSiDS pr1son
spending.
.
The new bW e1ao eUminates
.camml1.lli\Y poltdng requite
. InenIs in federal anti-crimc
grants. COmmul1itY poUting
takes cops out of c::ruIse~ Blld .
puts tb.em OD DeI&bborboOd
beats.
the GOP bW WOUld WIpe out
President Olntoll's plan to
spend $1'.7 blJl.lcn .tJIl pollee
CommuDlty policing SUD
porters say Ule poU may belp
and cr1me preveDttoD pro
the1.r fight In tbe SeDate. Wf)Jd:l
&q:leCted to mDSider the
GOP bW 10 tbe next few weeks.
to bJnI1OO,OOO more annmUDJ.
an tbe House side, but lflllDlna
srams -lrldud1Dg $8.8 bWJon
ty POUee ofllcers natlaowtde.
~ It wol.lld (live c::om
mWlll1es '10 bWiOIl ill 1IOl1ce
cd aime preyeaj10D paals 10
use as Ibey see It.
The GOP bW also 1DaCi&!S
tile 8.itJDUI'1t to be speut by
SIaleS on pi1soD c:onstrud1on
from $7.8 bUl10n lD ld year$
law 10 $1D.5 bWioo.
Rep. SteveD Schl.!, R-N'.M., a
former county prosecutor. dis
mfsges CI1tIcs Wb.O say tile GOP
bW WID el1mlDare pollee IlirlDg.
"The etl!Ie!lc:e of the Repllbll·
can bill Is that eac:h Q)mmunlty
Is dl!t'erent andQ)mmWlity po.
Udng may be No.1 In ODe com.
mw:dty but eQ.\IJpment may be
No. 1 In 8DtJther Q)mmWllty."
too~
Scb1tT S8)'S.
!)SO/rO<I
.Is
"'We.may bave klGt tile battle
to be a Dew day ID the Senate,..
gays Robert Sc:uUy of tile Na.
tloDlll kl;odaUoo of PoJke Or.
pnh:aUODS.
'
But Rep. Ftet1 Be1Ilemao, R•
N.t.. JaleIgb's poUce c1dct for
15 years before be retired. to
nm for Coap'ess. II4)'S Joo&er
prIsoo aenteru:es wm do more
to IgI1t c.rfme U:IaD IDOIe poll(:e
OIl tile streets.
. -Co.\:!!; are doing their Jobs..
prosecutors are· doJ.ns Ulelr
SObs. Judges are Clolag melt
lobs, but the prisIcm S)'Sb:m Is
faWnS the Amet1c:an people
the revOl~oor prison
sy&
tem that releasesertmlDsl
predators 8galn. and
Hec LOC CtOi!Q.
88B1n."
tCt:91
se/CCt/Cto
�,
THE WHITE HOUSE
WASHINGTON·
June 26, 1995
MEMORANDUM FOR:
FROM:
SUBJECT:
:::::: :::::~~
Immunizatio~:JOgram
Attached are talking points from HHS on the Vaccines
(VFC) program. The following is an overview of the i
Children
Background on VFC: VFC provides an entitlement to·free vaccine for
the ~ollowing categories of children:
o
o
o
Children on Medicaid: These children were always entitled to
free vaccine. The major difference under VFC is that costs
that were formerly shared between the Federal government and
the.states are now paid entirely by us.
This has not·
succeeded in immunizing more children, but has given the
states a major fiscal stake in preserving the program.
We
have letters of endorsement from Governors Eng
,Dean, and
Carnahan. Much of VFC's cost is simply the transfer of these
costs from Medicaid to VFC.
~
Uninsured children:
These children are entitled to
vaccine if (1) their doctors sign up to be a VFC prov ider; or
(2) they go to a public health clinic. Prior to VFC they
could receive free vaccine at public cli nics under a pre
existing (non-entitlement) program.
Children whose insurance does not cover immunization:
These
children are entitled to free vaccine if they
their shots
at a federally qualified health center.
Reasons for Opposition to VFC:
Vaccine Manufacturers' Profits: The government has the right to
purchase vaccine for the VFC program at below~market
, which
is why.the drug companies oppose the program so vigorously.
Prior
to VFC, CDC had negotiated a lower price with vaccine manufacturers
for the 50% of .the market that CDC purchased at that time.
Whe~
the VFC legislation passed, it automatically extended this lower
price to all vaccine purchase under VFC, even though the
government's share of the market was projected to grow to 70 80%.
In some cases, the discrepancy between the CDC price and the market
price is very significant.
The manufacturers al
that the
resulting revenue drop will significantly limit their research into
new vaccines.
VFC also gave states the right to purchase vaccine for
children
in the state at the low CDC price. Few have taken advantage of
this option, but it has particularly enraged the drug companies.
�,
:
2
How to Target Under-immunized Children: VFC's main advantage is
that uninsured children can receive shots at their private doctors'
offices, rather than having to make an extra trip to a public
health clinic.
It·is common for private physicians to send
uninsured children to.clinics for their shots because they are free
in that setting. However, often these children do not make it to
the clinic, resulting in missed opportunities for immunization.
Critics like Senator Bumpers say that the children most likely to
be behind on their shots are seen regularly by public clinics and
private doctors, and that they miss their shots not because of cost
but because their parents are not aware of the immunization
schedule (which is quite complex), or because the parents are not
well-organized or responsible enough to see to it that the
vaccinations take place. These critics pOint to the fact that
almost all children get their shots by age 6, when they must have
them in order to start school. They would prefer to focus on
enhancing public clinic outreach to these families rather than
creating a new child entitlement.
Our response is that we agree that cost is not the only barrier,'
which is why VFC is just one of five parts of the Childhood
Immunization Initiative. Other components include grants to states
and localities to expand public clinic services, a community-based
outreach effort to educate parents and providers, and better
.dete.ction of vaccination levels· and outbreaks of infection.
Options: . Staff from the Domestic Policy Council and the First
Lady's office have developed some options for modifying the
program's structure and eligibility; they have been discussed with
HHS and OMB. We are planning to convene a meeting with the chief
of staff very soon to decide on our legislative strategy, including
how strenuously to defend the program's current structure.
The likelihood that Medicaid.will be block granted means that the
program won't survive in its current form.
If Medicaid is block
granted, the best outcome would be to structure the vaccine program
as "entitled" grants to states for immunization.· Key questions are
whether to let states decide which children they will serve, or to
cut back explicitly on which children are eligible for the program.
We could respond as we have in the Medicaid block grant debate, by
fighting Congress's proposals but laying out our priorities and
offering to work with them on changes to the program.
In the meantime, we have more information on the program if you
need it.
cc: Erskine Bowles
Alice Rivlin
Mike McCurry
Doug Sosnik
Marcia Hale
Melanne Verveer
Carol Rasco
�;,
,
,
,
. raJ 003
BBS-PtiBLIC AFFAI
#202 880 3117J
12:08
08:/2S/DS
'I
Talk1n;
po1nt~ ~
accinea tor
Childr~n
" 'Z'b. val:c1Z1.. for ChillhQ!l. p~og'1'aa b all important part of the
: brcaaar ehildho04 % .uu1Iat1o~ Initiative. The ell includes rive
.
:i kay strat.Gqi~. t . ill1pl'ove pre.ehool. vacc 1nal:ion. rates. These
: inolude improving the qua11~y and quantity of v.ce~n~tiQn delivery
••rvle8I1i reduein vaccine costs; increasing avarQl'lo••., community
· pArticipation and a.rtnershipG1 i1llprovini the monitor1nq of d1t1Qa••
· and vaccination cverage; and improving vaCCinG8 And vaccine ·use.
pra~chobl
,; :J:mproviDq .
imlauDhation :01.1:..0, ie one of the Clirtton
: A4JainiatZ'atioZl.'. bi;he.t pr1or1ties.
Since taking otfice. the
Clinton Administration haa do~bl.d tun~1nq, and guaranteed funds
:for new vacc1n.~.
LQ9itlation to launch
new Childhood
·:!ll\lI\unizat1Qn InihtlY8 was introduced l.ioon atteI; pCBlli4ant
·:Cl.1.nton's lnauqur tiona
A epeciticqoal· was eet for 19'6:
• inarsl:I.sinc; vl1l;cin t10n llilvQ19 for t'W'o-Y.Q.r-lOIld. ghi14ran 'too 90
!:pereent for the mo t critiCAl doses. Ana a new pt:ogrzl1ll to provil;ie
':tr.. vaccines 'to milliona of poor and unlnsured children WaG
a
· in.titu;tad.
I
;IWbil" obi14 imm'lUl zat.ioh
Ima.sla• •pi4amio, ~' c: b
·!reaCh ~ha ono • llioZl
iYaooir:ur.t..eI tty aqa two.
rat•• bave lmprave4 a1uce tbe 1111-1'"
a kaf part of the national .trat.qy 'toa
Americu ch114rea
.h~
I.Z'G
Bat
fully
A 1993 .u.rvey fcunelt.hat. ~3 perc.nt of
iE.-SChOOl ch:J.ldre (Bvsraqa 8q. 2' months) had not rec.lv&a a full
!
eries ot the threr mostcritic,l vaccine. (XMR, DTP and polio).
lout 4S psccen't h,~ not received the HIB vaccine. vhich p.rotQctB
;OhildrQn against })a,ot.erial men1nq.1tis; and 84 percent hlld. not b.een
~vaccinl!t:.ed against! Hapati't:1a BI which cause. l i vsr disease.
..
1*_
.
an
I·
.
parti of tae QII,
.
Vaccine. tor CAi14~.n p~Qir~
',tVfirlUJ•• on Ill.:tinq Itr.s vaaaiu•• more wielely availabl• ., ~educ1ni
I~O.t. a~d lIli.s.d o~portuni~1e. fer immuni'at1ou., In the pa~~ tan
!years, immunizaticu"lcosts have increas8d. t.en-felda t.heprivate cost.
pf a t'ull seriga of il!lJ!lunbationaincreased frcM. about $;.17 in 1983
~o $270 in 1'94. A Sprinq t992aurvey by the Aaerican Academy of
,edia~rics chowud
hDt 43 peroent of pediatricians ha4 incre~5ed
~h.ir r_rarrals ~o ublic olinicsfor vaoolna~ionB in the preceding
~en years, prim~rl1
gecaUSa of costa.
.
ihte~ral
t~a
¥n4.:o ~h. vrc proqr. vaocin•• will ~oproYi4ad tree ~o ehi14re•
. • ha are enrolle4 in Kedioaid or uni~lured, aB4 to Dative Amerioans
.~d All.sJtall natives. That maanB that phys1cians will no lan9'_r have
","0 2:'cfar uninsured hild!'ah to puktlic clinics, a common practioe
'tohat maans miaaed Q portun1t1aa for immunizations and fragmented
CAre. And par8nts e~n oh~ose which provider ~akQ8 ·th~ moat sanz6
for their child, De~aus~ ~h. 41ffer~nce in prioe between the two
••ttinga ($270 and $129) won't be a tactor. .
..
.
,
#
••
•
'.,
l I
~
....
•
�12:08,
015,/Ztl/9S
r
'8'202 1690 ~n:l
~004
Thi. w111 make aremendoul dirf.ranaa fer
ai~a
mlllion UAinstira4
WhilQ Med.icaid recipients can reoeive free
, vacoinQe under cu~rent l~w, work1n9 fa~iliG8.have not had the same
. g'\le;r;ont.a. Under, vrc, more t.han one mUllon infant:s and. toddl,8l:11
'without ineurancelwill noW ~e quarant:oQcl tree vaccines, and their
, parents will pay only a modeat adm1niatration fQA. And bec:aus. ten
pereent: of ull Am ~~can children don't have hGalth insuranea, VPC
will also help m lUona mora old.er ehlldran who need follow-up
, "'.:d,oaZl o'b.ilcS:UZl.j'
vacc:ines at agl
f
ur and fiftoan.
'UZl4ar YFC, every •
i,~~le ohileS wlll raeeiva va•• inationa, evan it
palrellta aalLllClt af or4 t.o pay' tha a4millil'tr&tioJ!. fe..
Pri vats
.doetora will continue to serve their regular patientst aven if the
'parsnt or guardian cannot at'fcrd. to pl1Y the Rchllini.tration 1:Aa.
othor needy chilcir~n will not b. c:hilrged. at•• in pUhlio c:linic15.
lit.
fill
.1th
aa4itioJl" we
p~OVi4. tree vaaa1!u!ts te· e1t.i14:eza
l.ilIlU:Q4 ill.nu:'aD.Q. Zl ru, ral health cU.aiaa an4 :re4era11y QuaU.f1e4
ll.altb Ceht,ers.
In these eett1nqs f additional children Whose
inau2:'l1noe plans d n' t cove.r vaccino.t1ons will continue to be
eligible for freevaccine§.
lie" VIlOo1 as, will av.toaaticaUY ~. provided. t.TnClar vtc,
va~c;i el!l recomm@ndeci l:Iy I.l fed8zal advisory com:mittee
will a.utomatically' be purc;hasad:by thQ federal govflrlUllene and.
provided treG to a11gibla chilclren -- and. buaqat constraint. will
never again limit 0 delay federal purcha•• or new vacein•••
Fua4.
:
nAW
tOl:
ehilc!hoocl
ul to save IlClnar »J 0:'411"111; vaeo!!!.. .t tile
lover, qoY.r~.a.
ieoausa VFCw1l1 lower .tates' Medicaid.
~08t8 for vaccines, these BQvingw ~an be used to keep clinics opan
l'onger I or toke oth
mea6Ul'1il8 to increase il'lUllunization rates.
And
:more ,s'eatt2S will beuan,nteaa t.he lower CDC price tor 'tha "&eeines
they do pu.rchass.
•
' .
atate. vill liI.
PiiG..
pLo~egt..
(;!bil.d. immui8at:1oa
gb11draB &!14 aaves Iloney_ For exampl.,
every c1Qlla:r spent o;~ the MMR. {lftel.ales/mumpSl/rubella) vacc.ine ••vas
$21 in potential h a1th o~ra coate.
rot' the DTP (diphtherial
tetanus/pertussis)
coins, the cost-b.nefit ratio 1» 30 to 1. An~
for polio, it'. 6 eO 1.
'
.
,
I
.e
.:
bLJO I "
I
�oa/26/i~
r
!t202
12:08
III 0011
BHS-PUBLIC AffAI
90 6n3
QU••tiODS. a.nA
"1,,,5
Q:
The GAO hI.. challem,.d CDC Ie aSIiiJ.rtion that the
ntt? .
vaccin.1 1s
barrier or
bar~1.r ~o
Cost is a
aChieving
chilQhoOd
immuni~ationt
COiJ~
of
Ie cast a
arriar
it contributes to delay. in
fUll heimmuniza.tionthe pre.chool c::.h.ildnm with today'.
ot
vaccinas.
coat of
complete vl!lccine. •• ries hal
hQe.~..
iner.aBad t. -fold 1n th~ past 12 years. Since parents must
a~ou~ ,2 0 in vaccine COI~S and an additional amoun~ in
admini8trat19~ feas for the aeriea, those vi~hout a4.quate
insurance mal not seex inu.nization. fram 'their privat.
l1octors, hut roa P-q»l.ic: health cHafes "hore vaocine is tra.
or available' t. nominal Clost. Ha.vinq to make oxtra vis.1.t. to
public o.linic· ca.n result. 1n delay. and. lDisaed opportunities
pay
tor iMmunitat on.
NUmerous aurY ys of practitionarl'ahQ health departments have
alao document d inc:rcued reterra18 of patients from t.neir:
pZ'imary care roviders to pu);l.j,c clinics, wi th COS'l: aa the
mOI~ importan
reason cited.
lU;3 Alnerican AcadMY of
rccUatricl! lit .1:11' rsvaaled. thQt 255 pereent of pccUatrio1a.ns
ratar .o~e or all or thoir patient. to a pu~11c provider for
immunization••[ A 1992 North Carol11'1a survey sh'owed that 93'
.-
percent ot PhY~ioiang reterred patien~s ~o haaltb d.partment~
for i~~riizat$on5, anO .~ateB suoh as New ,York have showed
$ilUilar t.rendal.··
.
I
.
.
I
The GAO has reoommended that the VFC program shoUld be
tar9ated to cen~aln population9roupa ~n~ areas ~eforred to a8
"pock.tll ot ne~c1. ,. Ooesn' t. this ma);.e sense?
A;
~.~ th~
aft1
g~'l
We bali.va,
Congres. ha. ogreod,
proper
of
Faderal 1mmun1~'atloh &fforts 1. to ra1S6 immunieation levels
throuCJhout thG· n~..t1on, and to put in place a sustaina]:)le
8ys~tm th~t wi .1 .na~~e tnat Immuni!ation ratee remain high.
,The GAO conclU~lon assume. that "general i!lllllunilation rata'"
ara not nova. PlQblem a.na w111 not ]:)e ilL problo 1n the tuture.
1m:mpn1u.~ion r~tee have l:m~rov.c!
l1\GaSle..~14u.lc, VFC is. a k.ey part
While child.
,aihce the. 1989
of II national
strategy to rea1h the en. million Amarican ch11Qren under two
who. are un\,ilL'cC1r.~'t.d against one er mora deadly ciieeal5&!l5. A
1993 flUr"GY fOln~ that 48 percent ot pre-lIchoOl chil4r.n
(ava~aq. aqa 27 months) had net r.~e1vQd a full series of the
'three most crit cal vaooines (HHR, OTP and polio). About 40
percent had no rGoe.i ~ed. 'the H!B vaocine, \ihlen protect.
chll~r.n a g aIns, baote~ial m.nin~it111; and 84 perc_nt h~d not
b••n vaccinated aqainst Hepatitis 8, which caUGGI liver
H191
d.1seaBe~
I
i
i
\
�,
Q:
Doe~
the Adminisation oppose folding lhe Vaccines for Children (VFC) program
into a block grant"
A:
The Clinton A . istration ha~, a very simple goal _0 to improve preschoo I
immwllzation rate: Since taking office, the President has lead llIl aggressive,
campaign to Hatch that floal, and we have made great progreS:!l. But we believe that
our current invcstIlenl in children's immunizations must be maintained. Childhood
immu.nl.Z9.tions arc one of the most cos~·effective public health investments we CI:iIl
make .- they save ives and they S!1Ve money. To take just one example, for every
nollar spent on the measles/mumps/rubella vaccine, we ~A.ve $21 in health care costs.
We are more than ,rilling to work viith
COllgrell~
to make cha.nges to improve the
VFC program, Hu. we are not willing to watch i1~ Con2ress slashes funding for
childhood immuni :tions in just one more shortslghledattempt to ellt the budget.
Q:
A:
.e
•e
o
Is the:: Administrati n's pOSition that VFC must remain an entitlement?
Our position is ,le . We believe that the federal budget should be balanced, but in
a way that make~ snse. The President has la.id out a proposal that retains coverage
under Medicaid wI Ie reuucing spending arid giving states more flexibility.
Medicaid IS Q critic health clife program; it can certainly be improvcd,but not by
cutting it dramatie~ly to Qalance the budget. Th.e same applies to VFC. If we I.:I:iIl
improve the way wt arc going about our childhood immunization efforts, we're:
certainly willing to r,.vork On it. Dut We must maintain poor and. uninsured children's
acce!l.S to liie. savin~ and cost-effective vaccines .
/
�I
I
INVESTING IN EDUCATION AND TRAINING
VS. CUTTING EDUCAT'ION AND TRAINING:
PRESIDENT'S FY 1996 ,REQUEST VS.
,REPUBLICAN FY 1996 EXPECTED ACTION
7/12/95
.
PRESIDENT CliNTON'S , 0-YEAR ,BUDGET
Goals 2000: Help States
and schools raise
academic standards and
student achievement
Education for
disadvantaged students:
Help low-income
students achieve high
standards
Safe and Drug-Free
Schools and
Communities
REPUBLICAN CUTS
Increase to $750 million in FY 1996,
supporting improvements for over 8 million
children in 16,000 schools. By'FY 2002,
funding would increase to $896 million,
'.
supporting improvements for over 44 million
children in 85,000. schools.
Eliminate all funding for education,
reform.
Increased by $573 million over the last 2
years; increase by $302 million in 1996,
serving as many i!s 300,000 more children in
1996 alone, and providing increase~ in the
'\,
'future.
Reduce funding by $1.1 billion in FY
1996, cutting 1.1 million children from
the program in FY 1996 alone. A
freeze at this level would, by 2002,
cut an additional 600,000 children
from the program.
Fund at $500 million per year, providing safer,
more drug-free learning environments for39
million children in 14,000 school districts.
Reduce funding. to $200 million, a 60%
cut from the President's request. This
would deprive over 23 million students
of services next year.
,
H,ead Start:
Comprehensive services
tor pre-school youth &
toddlers to increase
school readiness
Increase FY 1996 funding by $400 million and
add 32,000 new, Head Start slots for children
in 1996, and a total of 50,000 new slots by
2002.
Child Care &
Development
Block Grant: Child care
assistance for working
poor families
Increase funding by $100 million in FY 1996.
States could use these funds to serve 70,000
80!000 more children of working poor
families.
Provides no added funding in FY 1996.
70,000-80,000 fewer children in
working-poor families could be served
than under the President's proposal.
Summer Jobs for
disadvantaged young
people
Funding for ab,out 615,000 jobs for
disadvantaged young people in the summer of
1996.
' Program eliminated beginning in 1 996,
wiping out job opportunities for some
4.3 million disadvantaged youth over
the next 7 years. '
Cuts funding by $135 million from FY
1995 level. 45,000-50,000 children'
would be cut off current Head Start in
1996 to maintain program quality.
Freezing funding at the reduced level
,
would cut off up to 230,000 children
below the President's proposed level
for 2002.
"
'
/
Job Traini,ng for
dislocated workers, lowincome adults .
AmeriCorps: College
Aid tor National Service
Expand by $242 M to provide nearly 50,000
opportunities for community servrce and·
college aid, and 580,000 youth (K -1 2) other '
service opportunities.
ALL EDUCATION AND
TRAINING
INCREASE EDUCATION, TRAINING AND AID
TO STUDENTS BY $40 BILLION IN
DISCRETIONARY OUTLAYS OVER 7 YEARS
Cuts funding by 50% below the
' President's request, and 25% below
1995.
Put Skill Grants directly into the hands of
disadvantaged and dislocated workers, with
800,000 Skill Grant recipients in 1996.
Increase. 1995 funding by 40% to $3.1 ,8.
(Budget Function 500)
Eliminated. Over 4.3 million service
opportunities for youth in their
cO'mmunities abolished over 7 years.
'
.
THE BUDGET RESOLUTION CUTS
OUILAYS FOR EDUCATION AND
TRAINING BY $36 BILLION INCLUDING
$ 10 BILLION IN LOAN BENEFITS TO
STUDENTS
�
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Carol Rasco - Issues Series
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Carol Rasco
Issues Series
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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92 folders in 7 boxes
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Talking Points [2]
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Carol Rasco
Issues Series
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Box 126
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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2010-0198-Sb-talking-points-2
-
https://clinton.presidentiallibraries.us/files/original/d9bd24ad3a814103c30171f7b9391e3d.pdf
4ae6c9306d74fe6b255835568a1c5cae
PDF Text
Text
HEALTH CARE Qs & As
~
Q. Why isn't health care in the budget? Doesn't this
illustrate that the President is no longer committed
to health reform?
Incorporating a specific health reform initiative within the
budget would not enable the Congress to work jointly with the
President to respond to the health care problems that confront
this nation.
Q. Did the President draw a line in the sand on Medicare?
The President will not allow Medicare to be cut to pay for tax
'cuJs. The President has consistently said that he opposes new
Medicare cuts outside the context of health care reform.
Q. The President opposes Medicare cuts to finance tax cuts.
Is the President willing to support Medicare cuts for
deficit reduction -- if it is in the context of "reform?"
The President has always said that an important component and
outgrowth of meaningful health reform is long-term deficit
reduction. Again, however, he opposes using Medicare as a
cash cow for tax cuts or deficit reduction outside the context of
reform.
Q. What is the harm of cutting the Medicare program
outside the context of health care reform?
Cutting without reforming makes our health care system
weaker and creates more problems. Cuts of the magnitude
now being discussed by some in Congress ($300 - $400 billion
by 2002) would simply mean that public programs would cost
shift onto the private sector -- particularly to small businesses
that have been burdened by the highest insurance premiums for
years. They could also make health care providers Jess willing
to see Medicare beneficiaries.
(over)
CLINTON LIBRARY PHOTOCOPY
�Q. What is your response to Newt Gingrich's and Bob Dole's
comments about Medicare and their suggestion that the
program needs to be restructured? What is the
Administration's position on managed care?
We have always welcomed ideas that strengthen the Medicare
program and provide more choices to beneficiaries. We
therefore look forward to reviewing any specific ideas that any
Member has. We sincerely hope, however, that a term such as
"restructuring" is not simply a code word for deep and
destructive Medicare cuts.
Q. The President says that he believes that we can make a
start on expanding coverage. How will he pay for it?
The Administration is committed to working with Congress to
ensure that any proposal 'will be paid for without increasing the
deficit.
PHOTOCOPY
PRESERVATION
�~--HEALTH CARE Qs & As
Q. Why isn't health care in the budget? Doesn't this
illustrate that the President is no longer committed
to health reform?
Incorporating a specific health reform initiative within the
budget would not enable the Congress to work jointly with the
President to respond to the health care problems that confront
this nation.
Q. Did the President draw a line in the sand on Medicare?
The President will not allow Medicare to be cut to pay for tax
cuts. The President has consistently said that he opposes new
Medicare cuts outside the context of health care reform.
Q. The President opposes Medicare cuts to finance tax cuts.
Is the President willing to support Medicare cuts for
deficit reduction _." if it is in the context of "reform?"
The President has always said that an important component and
outgrowth of meaningful health reform is long-term deficit
reduction. Again, however, he opposes using Medicare as a
cash cow for tax cuts or deficit reduction outside the context of
reform.
Q. What is the harm of cutting the Medicare program
outside the context of health care reform?
Cutting without reforming makes our health care system
weaker and creates more problems. Cuts of the magnitude
now being discussed by some in Congress ($300 - $400 billion
by 2002) would simply mean that public programs would cost
shift onto the private sector -- particularly to small businesses
that have been burdened by the highest insurance premiums for
years. They could also make health care providers less willing
to see Medicare beneficiaries.
.....
(over)
,.,.~
CLINTON LIBRARY PHOTOCOPY
�.•
t'
Q. What is your response to Newt Gingrich's and Bob Dole's
comments about Medicare and their suggestion that the
program needs to be restructured? What is the
Administration's position on managed care?
We have always welcomed ideas that strengthen the Medicare
program and provide more choices to beneficiaries. We
therefore look forward to reviewing any specific ideas that any
Member has. We sincerely hope, however, that a term such as
"restructuring" is not simply a code word for deep and
destructive Medicare cuts.
Q. The President says that he believes that we can make a
start on expanding coverage. How will he pay for it?
The Administration is committed to working with Congress to
ensure that any proposal will be paid for without increasing the
deficit.
CLINTON L1BRAHY PHOTOCOPY
'. ,'"--:-"1"
�PRESIDENT'S
STA.I'EME,~TS
ON HEALTH CARE
Excernt from December 27, 1994, Letter to the Congressional
Leadership
"While we could not achieve broad-based agreement on a
health reform initiative last year, there can be little disagreement
that we still face the enormous problems of increasing health
care costs and decreasing coverage. We need to confront
these problems on a bipartisan basis and address the insecurities
that too many Americans have about their health care .
.In the upcoming session of Congress, we can and should work
together to take the first steps toward achieving these goals. We
can pass legislation that includes measures to address the
unfairness in the insurance market, make coverage
more affordable for working families and children,
assure quality and efficiency in the. Medicare and
Medicaid programs, and reduce the long-term Federal
deficit. "
Excerpts from the State of the Union
"My budget pays for the Middle Class Bill of Rights without any
.
cuts in Medicare. And I will oppose any attempts to pay for
tax cuts with Medicare cuts. That's not the right thing to do.
Let's do it step by step. Let's do whatever we have to do to get
something done. Let's at least pass meaningful insurance
reform so that no American risks losing coverage for facing
skyrocketing prices. That nobody loses their coverage because they
face high prices or unavailable insurance, when they change jobs and
lose a job, or a family member gets sick.
We ought to make sure that self-employed people in
small businesses can buy insurance at more affordable
rates through voluntary purchasing pools. We ought to help families
provide long-term care for a sick parent or a disabled
child. We can work to help workers who lose their jobs at
least keep their health insurance coverage for a year while
they look for work. And we can find a way -- it may take some
time, but we can find a way -- to make sure that our children have
health care."
..
CLINTON LlBP,,~RY PHOTOCOPY
�P<RESIDENT'S STATEMENTS ON HEALTH CARE
Excerpt from December 27, 1994, Letter to the Congressional
Leadership
"While we could not achieve broad-based agreement on a
health reform initiative last year, there can be little disagreement
that we still face the enormous problems of increasing health
care costs and decreasing coverage. We need to confront
these problems on a bipartisan basis and address the insecurities
that too many Americans have about their health care.
In the upcoming session of Congress, we can and should work
together to take the first steps toward achieving these goais. We
, can pass legislation that includes measures to address the
unfairness in the insurance market, make coverage
more affordable for working families and children,
assure quality and efficiency in the Medicare and
Medicaid programs, and reduce the long-term Federal
deficit. tI
Excerpts from the State of the Union
"My budget pays for the Middle Class Bill of Rights without any
cuts in Medicare. And I will oppose any attempts to pay for
tax cuts with Medicare cuts. That's not the right thing to do.
Let's do it step by step. Let's do whatever we have to do to get
something done. Let's at least pass meaningful insurance
reform so that no American risks losing coverage for facing
skyrocketing prices. That nobody loses their coverage because they
face high prices or unavailable insurance, when they change jobs and
lose a job, or a family member gets sick.
We ought to make sure that self-employed people in
small businesses can buy insurance at more affordable
rates through voluntary purchasing pools. We ought to help families
provide long-term care for a sick parent or a disabled
child. We can work to help workers who lose their jobs at
least keep their health insurance coverage for a year while
they look for work. And we can find a way -- it may take some
time, but we can find a way -- to make sure that our children have
health care."
CLINTON LlBR~RY PHOTOCOPY
�CLINTON ADMINISTRATION
ACCOMPLISHMENTS - QUICK LIST
"Clinton's Presidency is the most ambitious since
LyndonJohnson's and has a substantial policy
record." -Thomas Patterson Syracuse University
ECONOMY
5.6 million new jobs in 23 months
Lowest unemployment in over 4 years.
Largest deficit-cutting plan in history -- over
$700 billion over five years
Cut spending by $255 billion
New tax cuts for 90 % of small businesses
EDUCATION
Signed Student Loan Reform Act
Signed National Service Act
Signed Goals 2000: Educate America Act
Signed School-to-Work Act
Signed Elementary & Secondary Schools Act
Increased Head Start funding by $760 million
CRIME
Signed the Brady Bill
Signed $30 billion Crime Bill wi Assault Weapons
Ban, 100,000 New Cops, 3 Strikes-You're Out
Expanded SAFE Schools Initiative
HEALTH CARE
.Signed the Family and Medical Leave Act
Signed Child Immunization Plan
Revoked Reagan/Bush restrict.ons on abortion
FREE TRADE
Signed NAFTA into law
- Signed GATT into law
Developed National Export Strategy
Secured Asia-Pacific free trade commitment
Agreed to negotiate Free Trade Area of Americas
Opened Japanese markets to more US goods
POLITICAL REFORM
Signed Congressional Accountability Act
Signed the Motor-Voter
Eliminated tax deduction for lobbying
imposed strictest ethics guidelines in history
COMMUNITY & ECON. DEVELOPMENT
Created 9 Empowerment Zones &
95 Enterprise CommwIities
Signed Community Development Bank Bill
Introduced Housing & Comm. Devel. Act
Signed Interstate Banking Bill
Defense Reinvestment & Conversion Initiative
. FAMILIES & CIDLDREN'
Expanded EITC by $21 billion over 5 years
Introduced Welfare Reform package & granted 24
state waivers for welfare reform projects
Passed FanIily Support & Preservation program
Signed Social Security Independent Agencies Act
REINVENTING GOVERNMENT
Conducted a National Perfomlance Review
On track to cut Federal Workforce by 272,000
Signed Govt. Performance & Results Act
Signed Federal Workforce Restructuring Act
Most diverse cabinet and administration in history
Reformed Pension Benefit Guarantee Corp.
ENVIRONMENT
Introduced Climate Change Action Plan
Signed California Desert Protection Bill
Developed consensus solutions for Northwest
Forests, Florida Everglades, California Water
Signed the Biodiversity Convention
Exec. orders to ensure green federal government
FOREIGN POLICY/NATIONAL SECURITY
Trilateral accord on denuclearization in FSU
Russian missiles no longer aimed at US
Established NATO Partnership for Peace
Strong commitment to nIilitary readiness
Denuciearization agreement wI North Korea
Restored democracy in Haiti
Reversed Iraqi threat to Kuwait
Strong support for demo reform in Russia & FSU
Supported S. Africa's transition to democracy
Helped achieve Israel/Jordan peace agreement
Reinvigorated the Middle East peace process
Contributed to cease-fire in Northern Ireland
January 24, 1995
�.1
'TALKIN:G POINTS ON "TRAINING'CHOICES FOR WORKING AMERICANS ACT"·
1.. We welcome theSenat~ Demo.cratic leadership's proposal toconsolid~t~ 'the dozens of
. 'federartraining. programs. for .adults and to put these lyarning resources; directly in the hands,
'. of individuals. This provides one way' to implement' a key element. of the' President's' Middle
. ! .Class Bill of Rights to empower hard-working families to invest in the skills they ~hoose to ,
. build a better fut~re .. Other key' elements of the,President's proposal will help middle clflSS
, families finance th~education and training they choose :-:.... thiough deducting' college tuition
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�THE MIDDLE CLASS BILL OF RIGHTS
"For too long, too many Americans have worked longer for
stagnant wages and less security ... [E]ven though'the
economic statistics are moving up, most of our living
standards are not
More jobs aren't enough. We have to
raise incomes."
President Clinton, Address to the Nation, December 15, 1994
The Challenge. Working Americans are riding a roller-coaster of
economic change. New technologies, global competition, and an
increasingly integrated world economy have 'been reshaping the
industrial landscape. While some workers are prospering in the
new economy,. the living standards of average American families
have been stagnating for a generation. Compared to twenty years
ago, many Americans are working longer hours for lower pay. For
much of our middle class, the American Dream is under siege.
Restoring that dream--the hope of a better future for our
families and our children--is our most urgent challenge.
The Beginnings of Change. In 1993, President Clinton proposed a
new economic direction for America. Two years later, the United
States has created 5.6 million new jobs, 92% in the private
sector, with more good jobs than in the previous five years
combined, and with the first 12-month increase in manufacturing
jobs since 1978. Our country has reduced the national
unemployment rate from 7% to 5.4% with 'the lowest rate of
inflation in twenty-five years, so that the "Misery Index"--the
combined measure of unemployment and inflation--is at its lowest
level since 1972. It has reversed the flow of federal red ink by
reducing the annual budget deficit for three years in a row. It
has signed new trade agreements to reduce the tariffs paid by
American consumers at home and American producers abroad, and to
tear down barriers to American-made goods and services all around
the world. And it is leading the world in the productivity and
competitiveness of its firms and workers.
The Opportunity. The strong evidence that lfnks education and
training with higher earnings and better jobs points the way to
build a better future for all Americans. As the .President noted
in his Address, "Education..• has a bigger impact on earnings and
job security than ever before .... Every American needs the skills
ne,cessary to prosper in ,the new' economy." A strong bipartisan .
consensus in the last Congress has already spurred significant
steps towarq building the skills and future earning power o~ the
children and students of working Americans, including major new
investments in education. The next step is the Middle Class Bill
of Rights, which will empower America's workers to acquire new
skills, obtain better jobs, and to earn higher wages and living
standards for themselves and their families.
�As the President observed in his Address, ."Fifty years ago, an
American president proposed the G.I. Bill of Rights, to.help
returning vet~rans from World War II go to college, buy a home
and raise their children. That built this country." The G.I.
Bill led to a generation of prosperity by putting learning
resources directly in the: hands of ordinary Americans. The
returning veterans turned their new skills into the higher
productivity, rising wages, and' soaring living standards that
opened the door into the middle class for tens of millions of
:Americans.
The President's Middle Class Bill of Rights will provide today's
aspiring workers' and job seekers the same kind of' opportunity.
Like the G.I. Bill, it puts resources directly in the hands of
'our people so that each individual will have a fair chance to
learn the skills needed to build a better future.
1. Education· and training tax deductions will help working
Americans pay for building new skills that lead most
directly to better jobs and wages. Deductions of up to
$10,000 'per'year for families making up to $120,000 per year.
will be phased in for tuition and costs for college,
community college, graduate schools, technical schools, and
worker retraining.
2. Tax credits for families with children of $500 per child
under 13 will be phased in. This will expand the budgets of
middle class families to invest as they see fit.
3. Expanded IRAs will enable working families making up to
$100,000 per year to. save $2,000 per year from current
earnings, tax-free, and to invest thesefunds--without
penalty--whenthey want to build new skills or buy a first
home, as well as providing for retirement or paying medical·
expenses.
4. A comprehensive reform of the employment and training system
will help unemployed workers and low-income adults and youth
--many of whom will not be able to benefit from the tax
incentives--find new and better jobs, learn necessary
skills, and·obtain Skill Grants with which to make their own
decisions about post-secondary training and education.
Student loans through Individual Education Accounts will
further ensure that all Americans have the opportunity to
finance learning new 'skills where and when they choose and
to repay these direct loans at the pace their future income
allows.
2
�THE MIDDLE CLASS BILL OF RIGHT: SKILL GRANTS
As a key component of the Middle Class Bill of Rights, the
President proposes to totally restructure the existing system of
employment and training. Seven key principles guide this change:
1. Individual Empowerment. ,Individuals should be empowered
with resources so they can choose for themselves what skills they
need to boost their earning power.
The President's proposal puts
buying power directly into individuals' hands, so they can get
skills at the time, at the place; and in the-way that makes sense
for' them:
o Unemployed and low-income workers can get Skill Grants
worth up to $2,620 per year, for up to two years, that they
Can use as they choose for learning new skills.
o Both tuition tax breaks and Skill Grants will be
supplemented by Individual Education Accounts. These low
cost loans will be available to any person, with flexible
repayment options including "pay as you can,1I to enable
every American to invest in their skills and repay at the
pace their future income allows.
2. Leaner Government.
The President's proposal eliminates
over 50 separat'e programs, replacing 'them with an integrated
system that minimizes red tape and maximizes individual choice.
3. State Flexibility.
Washington doesn't have all, the·
answers. States should have the flexibility to reflect local
conditions and respect local priorities. The President's
proposal gives states the freedom to tailor training programs and
delivery systems as they see fit, including expanding on-the-job
training in cooperation, with firms and workers. Most federal_'
rules dictating administrative procedures will be wiped out.
States will_be able to apply for waivers from the few rules that
remain, and to plow the savings back into additional training.
4. Good Information to Guide Choices. A skill-building
system rooted in individual choice requires good data to inform
decisions about what skills to get and where to learn them.
Reforms woven throughout the initiative--and centered on the
networks of One-Stop Career Centers already under construction by
the States--will give workers and job seekers access to reliable,
information on jobs, careers, and the success records of training
institutions, so that they can make good choices to improve their
~futures.
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�5. Accountability. Too often today, training providers
pren't held accountable for results. The President's initiative
will address this by emphasizing individual choice and
competition so that individuals can pick providers who deliver;
by providing good performance data so people know what training
pays off; and by setting quality standards for training providers
to cut off the frauds and the incompetents.
6. Private-Sector Partnership.
At base, the President's
proposal isn't about government. It's about jobs, and that means
the private sector has a central role. Business and labor will
be full partners in designing and running training, job-search,
and information services. The most competitive and productive
firms are also leaders in upgrading the skills of their
workforce: new awards will recognize excellence in creating
workplaces that expand opportunity by capitalizing on and
rewarding worker skills.
7. Paths from School to Work. Preparing America's youth for
the world of work ~nd a career of learning and applying new
skills to more rewarding jobs is a vital task. This initiative
will fold federal employment and training programs, including
vocational education, for young people into the school-to-work
movement already underway in every state as designed and
developed by the states, local communities and the private
sector. Aswith'the new private sector partnership, good
information, accountability and state flexibility for adults,
this ,new approach will provide clearer paths to new skills and
better jobs for youth.
The President's Middle Class Bill of Rights can arm every
American worker with the tools to learn new skills, find good
jobs and earn higher wages at more rewarding work. Like the G.I.
Bill, the President's proposal will put the' opportunity to learn
and apply new skills directly in the hands of the people. Now;
as then, it wil+ be'up to' individual Americans to accept personal
responsibility, ,to make the most of this opportunity to build a
better life for themselves and their families.
"The Middle Class Bill of Rights will further our common
mission as Americans -- to expand middle class incomes and
opportunities, to promote the values of work and family,
responsibility and community. And to help Americans compete
and win in the new American economy."
President Clinton, Radio Address, December 18, 1994
4
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THE WHITE HOUSE
,WASH I N GTON
January 18, 1995
Memorandum for Senior Staff
From:
Mark Gearan
Subject:
Two-Year Anniversary
As you know, Friday, January 20, 1994 marks the two-year'
anniversary, of President Clinton's inauguration and the mid-point
of the President's first term. In response to press inquiries to
the White House about the progress of the Administration in
meeting commitments proposed during the campaign, we have
prepared materials that we hope will also be helpful to you in
commenting on the Administration's record at midterm:
•
A short summary of the major domestic and national
'security accomplishments as well as the top
legislative victories of the ,President's first two
years.
•
Summary tables and
Administration has
promises listed in
and Putting People
charts of the progress the
made in accomplishing the
both the Washington Post list
First.
We have analyzed two existing written documents: 1)/the 162
campaign promises listed by The Washington Post on January 20,
1993, and 2) the 58 major policies proposed in the June 22, 1992
campaign pamphlet Putting People First. That analysis showed
that the President had made substantial progress to meeting the
commitments he made to the American people during the .campaign:
•
Of the 162 promises, from The Washin~ton Post list,
action was taken on 155 (96%) of the promises,
with 1,23 (76%) of the policy pledqes either
substantially or partially accomplished.
•
Of the 58 major policies mentioned in Putting
People First, action was taken on 57 (98%) of the
promises, while there has been substantial or
partial accomplishment on 45 (78%) of the
policies.
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I hope ypu find this material helpful. Please distribute it to
your st~~f and to people with whom you work regularly. Feel free
to call me if you have any questions about this material.
II
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�CLINTON ADMINISTRATION ACCOMPLISHMENTS
ECONOMY:
Signed the Economic Package, August 10, 1993.
The economy created 5.6 million new jobs in the first 23 months of this Administration.
Passed the largest deficit-cutting plan in history -- resulting in over $700 billion over five years.
On track for three consecutive years of deficit reduction -- for the first time since Harry Truman.
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Cut federal spending by $255 billion.
Made new tax cuts available to over 90% of small businesses.
Lowest unemployment in over 4 years.
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EDucATION:
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Signed the Student Loan Reform Act, August 10, 1993.
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Signed the National Service Act, September 21, 1993.
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Signed the Goals 2000: Educate America Act.
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Signed the School-to-Work Act on May 4, 1994.
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Signed the Elementary and Secondary Schools Act.
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Increased Head Start funding by $760 million.
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Introduced the Reemployment Act.
CRIME:
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Signed a tough $30 billion Crime Bill, September 7, 1994
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' Signed the Brady Bill, November 30, '1993.
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Signed the Assault Weapons Ban.
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On the way to putting 100,000 new police on the street.
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Signed the Police Hiring, Supplement, which awards $200 million for community policing.
•
Signed the Violence Against Women Act as part of the Crime Bill.
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Expanded funding for the SAFE Schools Initiative. '
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Introduced Operation Safe Home.
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Developed a clean sweep policy to keep crime out of federally-funded public housing.
REINVENTING GOVERNMENT:
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Conducted a National Performance Review of the Federal Government.
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Already cut the Federal Workforce by 100,000 -- on the way to lowest level in 30 years.
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Signed the Government Performance and Results Act of :1993.
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Appointed the most diverse Cabinet and Administration in history.
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Signed the Federal Workforce Restructuring Act of 1994.
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Eliminated 284 federal advisory committees. ,
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Initiated thorough review of human radiation experiments.
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~eformed Pension Benefit Gurantee Corporation to protect 8.5 million pensions.
COMMUNITY & ECONOMIC DEVELOPMENT:
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Created nine Economic Empowerment Zones and 95 Enterprise Communities.
Signed the Community Development Banking Bill, September 23, 1994.
Signed the Interstate Banking Bill. ,
Introduced the Housing and Community Development Act of 1993. "\
Instituted the Defense Reinvestment and Conversion Initiative.
Delivered over $9.5 billion in Federal aid for California earthquake relief.
�ENVIRONMENT:
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Introduced a Climate Change Action Plan.
Passed the California Desert Protection Act.
Developed a Forest Management Plan for the Pacific Northwest.
Signed environmental executive orders to ensure a· "green" federal government.
Signed the Biodiversity Convention.
Issued an Executive Order on environmental justice.
Introduced comprehensive Safe Drinking Water and Clean Water Act reforms.
Developed a plan to restore Florida's Everglades.
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Developed a plan to allow logging and presen'e old-growth forests in the Northwest.
Developed a consensus plan for the allocation of California water.
HEALTH CARE:
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Introduced the Health Care Security Act, November 20, 1993.
Signed the Family and Medical Leave Act,February 5, 1993.
Signed a comprehensive Child Immunization Plan.
Revoked the Reagan/Bush restrictions on abortion counseling ("the gag rule"), abortions' in military
hospitals, "Mexico City" policy and RU-486 imports.
Increased Ryan White CARE Act funding for outpatient AIDS care by $231 million.
Put the Women, Infants and Children Program (WIC) on a full-funding path.
FAMILIES AND CHILDREN:
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Expanded the Earned Income Tax Credit by $21 billion over five years.
, Introduced the Work and Responsibility Act - comprehep.sive welfare reform.
Passed the Family Support and Preservation Program.
Issued the Federal Plan to End Homelessness.
Passed major funding increases for homeless programs in both Houses. .
Approved 24 waivers to states permitting comprehensive welfare reform demonstrations.
Signed the Social Security Independent Agency Act.
POLITICAL REFORM:
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Signed the, Natioqal Voter Registration Act (Motor-Voter), May 20, 1993.
Eliminated the tax deduction for lobbying expenses.
Imposed ·strictest Administration ethics guidelines in history.
Fought for passage of Campaign Finance ~eform.
Fought for passage of Lobbying Disclosure Bill.
FREE TRADE:
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Signed NAFT A into law, December 8, 1993, which will create hundreds of thousands of US jobs.
Signed GATT into law, December 8, 1994, the largest trade agreement in history.
Secured free-trade commitments from Asia-Pacific Economic Cooperation (APEC) leaders.
Hosted Summit of the Americas and agreed to negotiate a Free Trade Area of the Americas by 2005
Developed National Export Strategy, eliminating export controls on $35 billion in exports.
Reinstituted Super 301 in order to eliminate major trade barriers around the world.
Opened Japan's cellular telephone, construction and apple markets.
�SECURITY CHALLENGESIPROMOTING PEACE:
Eliminating nuclear weapons in Ukraine, Belarus and Kazakhstan~ in 1994 brokered
agreement with Russia and Ukraine that opened way to elimination of nuclear weapons in
Ukraine.
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. Reached agreement with Russia to deta.'get missiles trained on US citizens and cities.
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Worked with Kiev to bring Ukraine into Nonproliferation Treaty, which permitted
START I entry-into-force, which will reduce by over 9,000 (40%) U.S. and Russian
strategic nuclear weapons.
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Facilitated.agreemerit between Russia and the Baltics allowing the complete withdrawal
of Russian troops. All Russian troops are out of Central and Eastern Europe for the first
time since World War II.
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Proposed and helped create Partnership for Peace and orderly NATO expansion process. \
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Maintained strong commitments to military readiness, inCluding a $25 billion increase
over 6 years.
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Prepared a "Bottom-Up Review" strategy for our armed forces to fight two major'
regional conflicts nearly simultaneously.
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Achieved agreement with North Korea that halts and leads to the eventual elimination
of North Korea's threatening nuclear program.
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Reversed Iraqi military threat against Kuwait.
•. Pursued and convicted terrorists, including World Trade Center bombers.
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Helped Israel and Jordan achieve a historic peace treaty and Israel and the Palestinians
fulfill their historic accord .
Contributed to an historic cease-fire in Northern Ireland.
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Carried out a massive humanitarian operation in Rwanda.
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Undertook, with NATO allies and UN, actions to alleviate suffering and end the conflict in
Bosnia.
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Reached an agreement with Cuba to normalize immigration and avert a mass influx o~
boat people .
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Signed into law the most comprehensive counterintelligence legislation since 1976.
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Worked to safely dispose of nuclear materials from the former Soviet republics and
took steps to prevent smuggling.
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, PROMOTING DEMOCRACY:
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,Assisted states, such as Russia and Ukraine, make progress toward democracy and
market reforms.
Assisted in South Africa's transition to democracy providing support for elections and .
development. .
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Restored democratically elected'Haitian President Aristide to power October 15, 1994;
created a secure and stable environment which will enable UN to take over the operation.
Hosted White House Conference on Africa.
' Made promotion of democracy a foreign aid priority especially in NIS, Russia, Central
Eastern Europe and South Africa.
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�CLINTON ADMINISTRATION LEGISLATIVE ACCOMPLISHMENTS
MAJOR LEGISLATIVE VICTORIES:
Below is a list of some of the most important legislation the Clinton Administration has passed:
• '. Family and Medical Leave Act, February 5, 1993.
This is an historic effort to allow working Americans unpaid time off work to care for a sick relative or a
new child. Over 42 million workers are covered by the new law and it is estimated that as many as 2.5
nullion workers will take advantage of it annually.
• Economic Package, August 10, 1993.
Evenly balanced between spending cuts and revenue increases, the President's five-year deficit reduction
plan is largely responsible for reducing the deficit by $708.4 billion -- $500. billion from policy changes
and the rest from strengthening .the economy and technical improvements. The greater economic security
has caused interest rates to drop, stimulating the economic recovery. One of the largest deficit reduction
plans ever, the Clinton deficit reduction will halve the deficit as a percentage of GDP by 1995.
• Student Loan Refonn Act, August 10, 1993.
The new direct student loan program will enable 20 million borrowers to consolidate their guaranteed loans
into direct loans. Borrowers will benefit from lower fees and the option Qf income contingent repayment
- taxpayers will save at least $4.3 billion over five years.
• Empowennent Zones and EJiterprise Communities, Augu:;t 10, 1993.
.
After a decade of failed attempts, President Clinton championed the passage of this legislation, which uses
tax incentives and flexible grants to promote economic empowerment and private-sector job creation in 104
distressed communities across America. Over 500 communities took up the"EZ" challenge; developing'
comprehensive strategies and forging unprecedented partnerships for community renewal that made all
applicants winners.
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• National Service Act, SePtember 21, 1993.
In 1994, 20,000 ,AmeriCorps members (more than served during the largest year of the Peace Corps)
tutored students, immunized children, reclaimed parks and patrolled streets -- and in return received
education awards that make college or job training more affordable. AmeriCorps is scheduled to increase
to 33,000 members in FYl995, with a total over the first three years of 100,000 Americans serving our
country.
~
Assistance for the New Independent States (NIS), September 30, 1993 and August 23, 1994.
The Administration secured'$3.3 billion in the FY1994 and FY1995 foreign operations appropriations bills
for the denuclearization and marketization process in the NIS.
• Reduced Military/Nuclear Threat from RUssia and N1S, November 11., 1993 and September 30, 1994.
The Administration included $800 million for denuclearization of NIS in the Department of Defense
appropriations bills for FY1994 and FY1995.
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• The Brady Act, November 30, 1993.
After stalling for several years in Congress, the Brady Bill became law under the leadership of President
Clinton. The Act requires a five-day waiting period during which all potential handgun purchasers are
required to submit to a background check. $100 million has been appropriated for implementation in
FY1995 and another $50 million is authorized for the next fiscal year.
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�• NAFTA, December 8, 1993.
The Administration forged· a bipartisan coalition to pass NAFT A, after concluding tough negotiations on
side agreements covering .workers ' rights, the environment and import surges. Exports to Mexico rose
23 % in the first 11 months of 1994.
I
• Federal Workforce Restructuring Act, March 30, 1994.
As a component of the National Performance Review, this act is part of a process that will help streamline
the federal government and improve the quality of federal government services. When the President and
Vice President's plan to reinvent government is fully implemented, the federal workforce will have been
reduced by over 272,000 workers and will be at its lowest level since the' Kennedy Administration.
• Goals 2000: Educate America Act, March 31, 1994.
The Goals 2000 bill codifies the National Education Goals and offers grants to states that commit
themselves to specific plans for systemic reform of K-12 education. Already 41 states and territories have
received federal grants, Funding for Goals 2000 in FY1995 will be $403 million.
• School-to-Work Act, May 4, 1994.
A crucial element of the Administration's lifelong learning agenda, this landmark legislation will provide
venture capital to spark a nationwide system for moving America's young people smoothly from the
classroom to a job with a future. This year, all states, plus the District of Colunibia and Puerto Rico,
have received funds for planning their school-to-work programs and eight states and 15 localities will
receive grants to implement their programs.
• The Crime Bill, September 13, 1994.
The Crime Bill attacks crime by adding 100,000 police officers, funding comprehensive prevention
programs and building more prisons. The legislation also includes strong punishment for criminals by
expanding the number of offenses eligible for the death penalty and implementing "three-strikes-and
you're-out" for repeat violent offenders .
•. Assault Weapons Ban, September 13, 1994.
President Clinton successfully challenged gun interests to ban 19 specific types of deadly assault weapons
while 'simultaneously protecting hunters rights by exempting over 650 hunting rifles.
• . Community Development Banking and Financial Institutions Act, September 23, 1994.
The legislation creates a nationat network of non-traditional grassroots community lending institutions and
will inject $4.8 billion of capital into economically distressed urban and rural areas.
• Interstate Banking Act, September 29, 1994•.
This legislation, which had been languishing in Congress for more thana decade before the Clinton
Administration made it apriority, will eliminate most of the remaining barriers to efficient nationwide
banking. By allowing banks to locate branches across state boundaries, it will make banking more
efficient and increase the convenience of banking for private consumers.
• The Uruguay Round of GATT, December 8,1994.
President Clinton forged a bi-partisan coalition to pass this agreement, which lowers tariffs worldwide by
$744 billion over ten years -- the largest international tax cut in history. It also cuts foreign tariffs on
manufactured products by more than one-third overaH and eliminates tariffs in major markets in a number
of sectors in which the U.S. is particularly competitive. When fully implemented in 2004, the Uruguay
Round agreement will add $100 to $200 billion per year to the U.S. GDP:
.'
'+-,'1,.,
�",
Promises from The Washington Post
Progress Report
..........-=
100%
i
80%
60%
~
40%
-- -
~
00/0
1~2 Total 90ITnnitments
*t'Jumbers may not add to 100% due to rounding.
:I.J
,."
f" : •
.:::0>
I
-,- - -I
. 1
20%
No
Action
J ; ... ~ ~ 1
j
;
:~,' ~
~
'. {
E>:
~.'
:.
• .
,
.
162 Total Commitments
•
.
I
(4%)
Action
Pending'
(7%)
�Promises from Putting People First
Progress Report
No
-c====
1000/0
-
•..I1 <~lfi;:::--~
..
.......
<•••.•
80%
l' -
60%
40%
20%
0%
I"~'-~
58 Total Commitments
."
;.
.
..; I
* Numbers may not add to 100% due to rounding.
,
:
<
.,'
...
,
"I'
..., ~,
','
;
58 Total Commitments
.
.
.:;!.
!
'
-
"
Action
(2%)'
Action
Pending
(5%)
�Progress Report: Clinton Campaign Promises from The Washington Post
I No Action,
Action Taken
Commitments from
155
i23
The Wa.'ihington Post
96%
76%",'
12
20
7%'
i2~
Categories Specified by
The Washington Post
4
Abortion'
100%
Agriculture
2
'2>
100%
AIDS
,AnnsCohtrol'
Arts' '
Budget
Cities
Civil Rights
Crime andJ)i"ugs
~'oefense
'.. .
Economy and Jobs , '
EduCation: ' '
.
•• : 0,;
,67%:'"
" , 0''<''
0010:, "
:2'"
33%
,
'
�Progress Report: Clinton Campaign Promises from The Washington Post
J
Total··
Commit- .
ments
Election and Government .
12
Energy and Environment
16.
Action •.
F~iIY'Planning
1
Families
3 .'
Health Care
Housing
.Immigration
International ReJation~ ".
Poverty and Welfare
Social Security
Space
Taxes
Trade
Veterans
7
.58%
15
94%
.12"
.' "7' 5'0/>
"
.i.
:::,(0:
.'
�Progress Report: Clinton Campaign Promises from Putting People First
Total,; ,
, Substantiator
Partial
Accom
'Icommit
ments
Putting People First
Excluding Health Care
SI ' ,
Categories Specified by
Putting People First
National Economic Strategy,
.I
Putting Americans to Work
.
/
24
Rewarding Work and Fainlly
:Lifelong Leaming
Health Care
A Revolution in Government,
4S
3
9
98%;
S8
57:
78%
S%
16%,'
50
44
1
98%"
Commitments from
86%
, ,',0,
"
6~
3
"
'6o/(j:;'
2%<';,;,:'
.
,;,'
'
�THE FEDERAL PAGE
• ~moreprinc,eirrft:ltmtal inu.eDmretSo
"'U.....
• ~"'lorlsrwi(o_teldrStMet:JnL
ABORTION
• P.... lhe ffftdom nl Chou Act that protecta &bofo
!Jon. ncm. Put aiJows IOt'nt tult ratrictiI:m. ..m "
CLINTON'S
PLEDGES
p,tmu.tl notUlGltJon.
• o.tnum!.an oroIUbitioI kOmI ~ hIrIdDtI,
• Rt:pnI &rIVI adrl'nttl$lf,tlJQln I'\IIn mrrrtioc: Ibort.ol
~1ftdmt>:;atNt~kdtrtlfIIDdL
• PtotKI WOl'I1tft ~• •baftau arw:I beJith are
.(I~
ftom mutboroon ptOttsUf'L
• RHlIltl«ut fedetal &ttm!, ~.'IIfOIf'*m:t.
• 4.l1ow tnlll'll IW-.486 abartlM gUJ,
or
ACRICULTURE
lult.ralld.i4tlu ..... ,.",..,.
T . . . . Pmidnt-d«iQi.14If'"
uU/,."",./k .., . " . . . ,...
.",.,.tlPlJPGVII (Mdp-·RtOI. .,Ii,..
u . . ttIU!I"-<tUfSIUI ..
• Qpea MW mn~1l tor
U.S, 0t0ducU, ~Iy 111
Entm\ Ew* an(Il!W 101'1I1t; ~ '""stlher•.
• ~ IftlttnallOl\ll food hd PtOIf.tmL
~.
AIDS
n._..On.,... . _,..'"
....
,,"tIiIttJ
IM"'~
811l.~riPdlA:lfdE.
·lncteu.eJundutflotlt~Cfl.lIUImer.tt_PfIlt¥e:D·
n,.c
~.c.,hlatCia/M
fIIfI8tUI .. ~ • ."..If1JItii..
1an..,.,..,...
Cllftau:s/M"'~do.u.
WIwf~."''''of..''''
1I.,..UJItN"'mMPGVII
ftIJii
.ElIdAlos..C'l.tl:td~_U'l'lllll~
ARMS CONTROL
It
RlrJr START I and SfART tllralD.
• Uw 1IAtIC{1OO.l 10 IHl II"""" f'IlIIl" CQUroD from
m.lIIUItt w:h Itthndotrn tot' ~ . . Glhrr U"ftI:$..
• Ptftml iorrll" tovt'1'TlfI'It'ntI hum \lUll qncuiUltai
Vldt'ltMrnon·mdltlrru:lCII . . . .
• £rsaOIe tile Wmllho'\&l AlomIc £an" t......, 10 em
4UC1~lI\IDIMlUl!ttlll<lP"""~
It f/'m;t cuunlrJt$ to pin !.be Wsait TtdmDioIY CoPua
R.,.....c
• Stri ~ Tel 8M: TIUt, mil an ~
liON.IQftt1'tItnlbliMWlfc.lwmlalftIIICQI.
TIlE ARTS
En
TIlE BUDGn
It
H.tlV!ftbeannf.lllit'derJiCudlelOriJc:diDtouryan.
- .. ,m-PP""'..-..dilf"'--""
JIOA&lBudre'tOUtetiorlmlillal~iolM.·
• ie:ek.W.1U1II WlOIOtllt W1:'IU'fuI . . . .
•"'""'* fn::'raIed
PUt1\'.
tfleit..,...
locatPtlOnllft.
~=o..f""""_''''''''''
fidd"lotdisad~lludtnll.
1'IImf'!~.fUL
.GiwIlCDooi~IlmbI:I:t,to~~tcrndllO
• E.q.ndkleal""'to"I'II(ft"'~~
_ _ ........... ItOMEPtIl"".c
~musi.oesw.uthty_ht.
• ~ Pt'OItama that hrip: ~ PI~.
.ot1t1l'ithUlrirc:tuidre1ton!IChooi~ ••
• Pn:M:5e ,.... lOr III!CUfltr and ftl~1 GetMnr. 11
tt'baabitUttleftittwm.
'.
.
1IIIIIIIGllAtIOII
'«1m
• Ct• .....,. ~ CD ~ ~qftII
tWLi
unld tiIIt COUlUl1'·I~ IfM'nUl-=u • resuwed.
11."_ _ ... _ to..........
&aid
• ReQuire UrIC ~ QlrItrlCh!h
(Illbl
.CUllbe'tW01'W~iItriodfarpeopllt . . . yt.
==:-.:::u"::-~.::
III to I" UAit«l:Statelll'fto.,e~ed from ifnme..
_It Wmty IIIrmben and rtduce 1M _ _ 011 ~
fJm:iir~."'IlmlIIrIit _ _
• Cbe"'ltftat .... _ ...... Iam..,~
.~DatrictalCal:umbiaa.tatr.Mod.
10 rut tnteIlD t.Iul
1IIo_£ncilo/L
EUC110NS AND IOVERNMEIIl
lDn- tbIt ItiJ en iIkpIlrriaicn*
• U.1ndt ~ ntIdDtourqe ~_
ftIian. Lrtift AmrrQn IIIfliIbbon.
.V~aJ)IP!"ftCtI:II.~nca_
...."'Us......
·
IIITUIIA1IOllAlIIWlIONS
LiaII_~_
• a.. OIK OIl
~1Mlft
til
E4ut Ii.... AmIrIO
60t
~ IiIal
~~. .
'*'
~
___
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_rpoUc"".
• Crau I N&lIonI1 Pula Coqa 10 _1IIiti:IMy . . . .
nd_~~1o"'._~
• Hnt fIIII·tUM!, . , . . , . . . . . tmI' . . . . .
..--am~r_QllIOI.
•
&2ac:tCOvP~tor
............... _
~CDdttttdorntMJc . . . . .
• *'-~flabllot~_~
Stydrqtductlioo~ lDd ........ dIIII&
.,...itoOmi1J'liif.tdq. . lotcria:te~.
tia~~a.
• 11l:lfDt1~""paaI:."""'~
banUMuitwetfl(laS_.~I:IaDrI:II"""
and_llCCft,llOm~"
• Sn:illlltl"fmtfot.,..~~.
·ttal;ntM.J.QOI~""~-
• Ct1didtMmoabltec::nDe:l.
· ..- .
_
~_ItIi_~fiII'ftIGl'I'
lIII1ISY A"O TIlE EN¥llIOIIlI£lIl
~CII1I:l11df!arpt.Iftf.
__
---"'_
---.
_
..
,..\mit6ot
.............
.u......,......... .. .......
...
.....
• Coow:n ~.tsirie fit« '0 cwural Pi,
.'-_
• Eao:aar_
•
~ IDd IUI!I'UIIM C'DItfCY ..~t •
"'~
wpoolanc_
'
...
• Ccb ..... mdtollic~_apad~ •
...,..~tntb_~
.EaIen::t~""'MliI:.tenat.Jar('Of'flOf'
au! potIICat _ _ DteCaIIIY.
r
. , . ..... to~IDCaiIDd~CiDllttol
fItd ..,...u.iaalUlettolllirlDla.-a.& .......
.Proto.s~AteDcHatioallWicUile""
•
*'
• .....,~to~_OCtbe . . .
JIIl'III'RUor_~~.. franI~.t . .
• Puaar.n Water Ad that . . . . . . - - t o f t
IiIIca ~«N:rte~ poIAliOlt fram . . . . . r.Dtm
.......
• AlIoIr ...... to_iedtnlw.acaJar ...... te
• SnI!'lOOWlK.latadltt:tft:w~CMrSyrt:ltl.,.
MOWboo.l:l:lr:ftU.UIiI8uIi ......... ~
prr--n IIIJ ~ .....", a::rtr ....
~ andprt:Hase4,.,... . . . . . . . . .
• c.. =tarf
_-_
Itn'I!IIi IS to 20,.,.,
• hJmlt1l'f~baratal~
.lktiIdam.C·17I2ffD~toapad
__....
... _
...
hlt~_~~bcta.
• ~ u.s. form
tn:qItbalma__
.
_-
• Stidlto"l» ...... WfttlDdtPQbc'y •
• l..i:miIcarW"'aMIlIIioDalOl~""'o,.zooo.
• , . .. . . . .tot!duCI ........... ~
• _Us. ........
_ _ _ _
....~_taoCCllliltt'falWJatona.
......
rAMIUU
• iwapr CO 7$,000-100..000
~co"ATO,
• IMaizlUinU.5.mihlD1pr-a ......
• MlitamIOatnl!rbuUt . . . . . . . . all,.
...
eoftllllllmr.ucilonl:watArd...,.,.. . . . . . . . . .
• c..~oa ..IC.~ . . . dIdeMt.
• Rftene bID (ill ~.lbe' alurY,
_
........
TIlE leoNOMl AND lOIS
• en-.NllioaaIr.oaar.r.:Cowa:iL
• ProtideilnonttM'mtuat!lCllttlto~dtltilMlt
itlU.s.-baf:dIMnU_~"""'"
• Mate b.~.u baIiDe.a • • UIICId
Sl:ltetw'thttlmfWltiaU.s.~
0000a$Opercaltta~ttI
buy ",... IDIW'IlIte or
... dOQort,..·
.
bt....... nrte•
.
• ftoIidt.anl:ltaltfJtl~_iIPdDdI::I~
.....
drUII. ....... beltt.bCll"'ftllll!.IDd~1rCQlIa
&Uta*'- ~;"""IDd""to",lliai: •
a:n. . . . . ometulDd~ bab:h ..... iarlftL
parubciDandnJlda.~_""""Itt·
_c
~CIf"""""""'c:.hnD
.....,.. ...
.... ===::='-=~I'
.......
~===~
-.........
__ -
a., ftIQIInBI aapIopen 10
:"~'=::".mta trcxa «IIIl(IItbDIt IoQj
• ED:!tu~IbM . . . . . ~to~
_"' _
REALTII CAl(
• PnMte ...... to ail Aatmtua tiIIlb QICt COI'itdJ
and
• ae.a.
JI:IitiI,ftn
to (XM:F ~ 1'ittI any tn«~
=::rab~~~=-.k:
........... w:atdtu6otfl:al'll:rdl . . . . . .
tstntM CDIU. .
• AIut ill ~ ........ aapIopen UIU4 cc.ta
'
.Dcorftopnew~~ihnIa:Ih . . .
ciriblDl'eIlW'dl_~""',
• a...tbemsrvmcmWqtIO . . . . . . iIIIIIzir&
__ _
:-~..."....topoalto~ .... '""'.
abientna..~
._--"' .. _
...
• irildadlfI!Id _ _
_
~
.
_
.1.irmI~for~,.,.,
• ~taI:n:tb6ot~dnta:~·
• ~ ....... 104tIIii:d ....... ~ . . .
. . . . . . . . . . . . . . lIMrUtm ......
II CICW...,.. .......
1IimiIa'~
EOUCATIOII
HOUIIII8
• CrauICWtoollten'lt't...-_ . . . . ClI:Ikae
1tudrAt.t4,.-,t*n:I ........ . . . . , . .......
• FuUyftmOtkadSt&rt_OI.ba'~~
edbyfbe:".. law~OQCNid:a.
• EMa _mill ..-ntaw
"'* IC:tIooIJ too bt
&W'1!'d"b~GDQft~
t
ilia
".
.......
~c:u...
...
"'*'
.. Kaiti'.,..
InTI: . . . . . . 10 rntore ... a::aI"U"'.~
ital&.patIada*Olber . . . . . . .
DEFOISE
•
tinQltw.
• '.'1 tuilaCCOlltIUnl fti POW••nd MIAs bdcn"-'
mAl RiIl__ lIh Vw.na.....
........ trom 21.$0:..... per piUllobtt...........
_S
CRIIIt AND DRUllS
•
• ED:! ,...ud a£roaairs .. Scrtua «t.lftl1O!'I QmCII
WIlli mteraticNI mi:tIUtf lam: d nKHQtf. f t IPWItI/III
me. ~ Jar IIfornlft • ttou.a
intrro
.~~Iede1ai~'PIta""'II.'~
A'lJlt'fI ...· fud ...,4"1. . . . .,
IUtboriclboD fOf air . , . . . _ Iaru:a.
. . . _U.s. __
Ean:Ipt1mGl.liit:fteoslot~~IiIItIIft_
••inslSetbia_W~·
.W"'II
1l.adI~1r
UJ("
thlt"'l'dIri~ifteo..
.U.3~8'lJl't'I'(,~m""'~",.
• Appoad I'I'IOf'f' _"'1 and _ _
tl,l ~flWftf
•
tndmIUllllot QIiu db
pt'(:IItalOft iIumIa ~aod oudeu ~taL
• StdI
• Makttup~ft"lp6edtenattolQbbor~""
.. thm jUnldlttim for Itve jt"an aCler 1eJ~ etta.
• I.ed&a lbe' White HouR atafl bJ 2S ~ and art
tOO.OOQtedenf . . tJironb altnllall.
....
• ~ fIe'lo1J Oual,,,
• Supporl MItt .,.., ~ 01 an
ItWCIl _ ldefll md rilhU'"
rlftlllP('rdIf:QIJ~,
~J Mldinr lor fl'WntflWlC't oC
;Ntral HOUIIftI AutMmy tftOI1"
liP llSutance to is percrn! 01 1M pnce: oi • heme •
_till
CMlIIGHfS
tnltdllq fundi.
SOCIAL SECURm
• R.a:i:.earai:q~1O ~QlI~
men
.....
• E.asareayatem-,tDhImty.
--- _
.. _-
tll$O"'I~fIOUIinI.
• ••1It the a!Jira, on
ftml$AOOlotbt'l.OOOWon~
• Etid~_IIlII)htJ-QlrItnbat. . IOPlftJa"
.000tuJndrerulAtarJa::eI'ItnoalO~1lI.u
• Ratrict~onTVadlUM!""QOddaIl'L
CTUle_"'lUbItI~ .....
• Sica lbe' MMo1,or Voter Act. ~
It PtOt'irir Nndlnr .and bb::i IP'IIIU to impraw Chaana:~
• Reouirt~codJldDteCDlinbut_lo~
hilt.
oIa~comtJ'IMtetbe<fort
,",dr,
• CtUCe • M'(WQfl 011 100 ttIIII'IIII8dr ~ .li.ftdtubrab""klObrint~
b.:IDbtO.udlDw~enttflll'Uftn_~
• IinWkKatrtl£l'"'mm:~6ottolllftla'Q:al
bl_
• Allow cHft CO I4W'ftd IS Pt"tn'Ct 011
en
1o'W-trw:onw AmtrDN to f!'nC'ourilll! ...~.,p With teditnl
SPACE
• Otwmp .... ieD CQIUy 1:Uzndll}"lle1ftt.
ratuct Oll'IInlNUons from PoWicai Action CGwmacea
CI1IU
two
• I.IUDdI: DiCn: wntum wrth £imlot. jap&n m1 Ruaia.
• ~ NAS.n ~ oIlfC*Z IIbr,:ntln and c:antIIMt
....... tottDto ...~eame~
• AUtkt ~ uft a Ql'I'mIIIif!nl Low !ncoDt
HOIdUJ, Tu. Credit.
. . . . ltVdt!uttnatlQi:n.IO~*~joblil.lb
tbroqlt II:JIUi:ICIIi ~1IZIIiI!f PtQCrml.
.R~~tofl)end l.!i ~ 011 PlT"JD
eost'(lDftionlJlftft tnmll'll tr. d fttttn.
• £ac<oIua. ~ion 8'1 ~bon by ,mna
ICI(QiOr
• ()ppaw miflClions on rn:ntJ " . tbI! ~
00tnnart foe' tbe Ana bPo:I OIl CCIIU'&.
CllIII!IW,IM, .tta
• Crem optJOM.I indml!.W ~ AeCllllaU ...
""....s.-...... F_
~u ,..,..NnI/IG"""'~
~ionjdfortl'od.tt.lt'ltllU~.tchooIa.
rt'PIT 1Im'iIfft .,th work in the
Y'9nalt~~Irldt.rllnm",
~~Qi"tIb4 . . .
iss., 11/ 1992." GN,., !iltplUJ""",
Cli"".~tv'IIII_~.. ifir«Ur,
• RtqaZtew«ate~ whUc:anWOftloflPdjabaor
nir"'''.I'ICftk,..f~/fw
__
1!Olni_..,.;.,.riItI..,.".,Wlilltl
fund tM Ry&o Wftl~CAR£ An.
• L.uInttt junk «iUClbOO and ~ procrw and
.~Rad:ioF,._<
PD¥DTT AIID WELfUE
1DOXIIIt1iantwrtil:lbertba'ldll&.
14l ...... 4tlint.
/I'tfIiIIU H4iM. ~ tat M"1U.tHo. . •• Cor\Uter ~ IDea CIa bmrilt. fIw ~~.
fllftti. . . ·S~gtUt~
It full~
thec:rtatJOnaltft~NtsI: . . . . .te.
CfiUnl...,kinpi.,ua)f1l'. Ellft
tJt/tMdwi_.,.IlIfiH,MU
"'rlT,nfllHlna.
It A(lpOIft( .. polk, coot_tor to tMCt ~.
Il<lntoflht NatlOO.ll~CllAIDS.
• ~ \lPttdfriU droll ~I praeas.
• ~~athe~_dbnllllnd..,.
• Moditr tRitIn lid pn::.,rma 10 J)fClClOtt dmon'ltY.
• Had ....... _~s-a_b
...
• T~ 10 ~ Gi.u trdend ....... todlamla
_odaIr~mrmmIlI.IIf..,.."'lbe'~
• U• ..,..... CIOtM:d 1IbIIt.tlJ baeIJ, for die IiIomNa
• PwMda...,.MIIJIIW(CD . . . . . . . tIIa,....okt
.~~~thI"OQ&tlHASA·•
• ea.wr...1O_~J)nIbrs_rGbouCD~
"""
.1:J.kt&.I,trom&ah . . . tor~"'oCthe_
and ~ trJ U.S. UU"OOIlIU, but tonl_ taentitit .
lludMllb INem:at.tQlt,lll, bnaftCt'd II'IIIlIC:m..
TAW II'tnMaII
.bitltIlII'ItNOft".,...nten . . . . . . . . .,a. ..
aaneI Itt f'fICI1! tha S2OO.oooor ~ . . . . AGII
an- mcndWl '150,000.
• ~Ik ~~ Men:imum Tu mefmra" ttl
26. %1 pctCml..
.ReQIIDft~t01\llfaIOJ)mZlll1olA"tU'.
• 0tIer ftUddleodlu tan:ubtt 160 lIi4bon • 1&1 aD CMif
lour,..,.. in the iona all UOO tu QIit per aq(iI (If •
1100 per child tft crcOt,
_1Dc::rt:aelbe f.anIcd latoN TuCmttt . . . . . . .
iqpo«•
lIIAOE
r.e..t
_
~ talblO ~ the
~c:eTuitft_T,.wbdt.~U.s.
.Co\tiINr
u-.
"'Sc:ptr lOl~ lalft 10 IKIftIIb _ _ WIUI ~
pr1ltU:'eIunslaltf1ilf.
'
• ~tbitfrb:1.!l~fIU!Tnde~.
...
1on1. __ aa:maCl8b1l1"t1d1it'111ontbl:~
.llMtJ.S.t.ndrI8tfOC. . ._ ...... ~
........ - .
ofl1riitlt fnn worbII ... iDbtlt'iIfl for fnm«n .....
.~
__
VA~lOno&-Wl".mt..
• IlcctaJe~DI'f'JIIidlIor_lpillJe'l'lrQfe.
-
wu-r_
• Hdi{rdr:sabIN
Oi btN'i1l chln_ irs 1Itma,
..... ••n......_ _ ...IiIIIIII":_ ... !... I _~ . . . .
·-_ . . _ _
_ _ _ no_ . . ... a
................
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�CLINTON CAMPAIGN PROMISES
From The· Washington Post
January 1995
I
PROMlSE
I
STATUS
I
LATEST POLlCYIRESULT
ABORTION: Pass the Freedom of
Choice Act that protects abortion
rights but allows some state
restrictions, such as parental
notification.
PROPOSED
Freedom of Choice Act did not pass in Congress.
ABORTION: Overturn laws
prohibiting federal abortion funding.
PARTIAL
ACCOMPLISHMENT
Federal law requires Medicaid to pay for abortions for poor women in c.ases of
rape or incest. Congress added rape and incest authorization to life of the woman
abortion funding.
ABORTION: Repeal Bush
administration rules restricting
abortion counseling in clinics that
receive federal funds.
SUBSTANTIAL
ACCOMPLISHMENT
Repealed by Presidential Memorandum January 22, 1993.
ABORTION: Protect women seeking
abortions and health care workers
from antiabortion protesters.
SUBSTANTIAL
ACCOMPLISHMENT
Signed and enforcinlt Clinic Access Law.
ABORTION: Reauthorize federal
family planning programs.
PROPOSED
Reauthorization is up for consideration in 1995.
ABORTION: Allow.testing of
RU-486 abortion pill.
SUBSTANTIAL
ACCOMPLISHMENT
AGRICULTURE: Open new markets
for U.S. products, particularly in
Eastern Europe and the former Soviet
republics.
SUBSTANTIAL
ACCOMPLISHMENT
AGRICULTURE: Expand
international food aid programs.
SUBSTANTIAL
ACCOMPLISHMENT
AIDS: Increase funding for research,
treatment and prevention.
SUBSTANTIAL
ACCOMPLISHMENT
·
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Increased Ryan White CARE Act funding for outpatient AIDS cart: by $231
million to $579 million for FY94
Proposed a 20% increase in NIH spending for AIDS research. Received $633
million for FY95; an 83% percent increase.
AIDS: Appoint a policy coordinator
to enact recommendations of the
National Commission on AIDS.
SUBSTANTIAL
ACCOMPLISHMENT
·
Appointed first ever AIDS czar to focus on consolidating federal resources
and funds to find a cure and address issues surrounding AIDS.
AIDS: Speed up federal drug
approval process.
PARTIAL
ACCOMPLISHMENT
·
·
Set up the National Task Force on AIDS Drug Development to Create a
pUblic-private sector partnership· to speed AIDS drugs to market.
The FDA has approved or provided new labeling indications for six products
for HIV and related condition.
;
. Clinical testing of RU-486 is now in progress in the U.S.
·
·
Enacted Freedom Support Act which authorized expanded Food for Peace
program in the Former Soviet Union.
Opened up Japanese and Korean rice markets. Opened apple .markets in
Japan and China to US producers.
Passed and signed NAFTA .
Passed and signed GATT.
Announced $800 million Food for Progress program expanding U.S.
agricultural exports to Russia.
Food aid extended to countries including Angola, Ethiopia, Congo, Croatia, .
Macedonia and Mozambique. Increased program.size in most cases.
I
�PROMISE
LATEST POLICYIRESULT
STATUS
AIDS: Fully fund the Ryan White
CARE Act.
SUBSTANTIAL
ACCOMPLISHMENT
AIDS: Launch education and
prevention program and support local
awareness and prevention efforts to
distribute condoms in schools.
PARTIAL
ACCOMPLISHMENT
·
·
·
·
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·
Increased Ryan White CARE Act funding for outpatient AIDS care by $231
million to $579 million for FY94.
Proposed a 20% increase in NIH spending for AIDS research, Received $633
million for FY95, an 83% percent increase.
Instituted community prevention planning for greater local control over HIV
education efforts.
Began Prevention Marketing Initiative aimed 'at young adults to change HIV
risk behaviors, including ads promoting both abstinence and consistent use of
latex condoms.
Issued memorandum to heads of executive departments and agencies
instructing them to implement ongoing HlV/AIDS education and prevention
programs and to develop nondiscriminatory workplace policies for employees
with HIV/AIDS.
Began National AIDS Awareness Advertising Campaign in January 1994.
Congress has mandated continuation of this policy.
AIDS: End AIDS-related immigration
and travel restrictions.
-
NO ACTION
ARMS CONTROL: Ratify START I
and START II treaties,
PARTIAL
ACCOMPLISHMENT
ARMS CONTROL: Use sanctions 10
seek stronger export controls from
countries with technologies for nuclear
and other arms,
SUBSTANTIAL
ACCOMPLISHMENT
ARMS CONTROL: Prevent foreign
govemments from using agricultural
and other non-military aid on
weapons,
SUBSTANTIAL
ACCOMPLISHMENT
ARMS CONTROL: Enable the
International Atomic Energy Agency
to conduct more inspections to stop
nuclear proliferation; .
SUBSTANTIAL
ACCOMPLISHMENT
ARMS CONTROL: Press countries
to join the Missile Technology
Control Regime.
SUBSTANTIAL
ACCOMPLISHMENT
Concluded agreements with Russia, Ukraine, and China to abide by MTCR
guidelines. Hungary and Argentina have joined the MTCR and Brazil has
committed itself publicly to adhere to the MTCR guidelines.
ARMS CONTROL: Seek
Comprehensive Test Ban Treaty and
an international agreement banning
chemical weapons.
SUBSTANTIAL
ACCOMPLISHMENT
Suspended nuclear testing and began work with other governments to achieve a
Comprehensive Test Ban Treaty by 1996. Obtained Senate approval for Open
Skies Treaty and sent to Senate the Chemical Weapons Convention, which would
ban an entire class of weapons of mass destruction.
ARTS: Oppose restrictions on grants
from the National Endowment for the,
Arts based on content.
SUBSTANTIAL
ACCOMPLISHMENT
No content restrictions on NEA grants have been imposed.
BUDGET: Halve the annual federal
budget deficit in four years, from the
$323 bill ion gap first projected by the
Congressional Budget Office ~or 1993
to $ 141 billion in 1996
SUBSTANTIAL
ACCOMPLISHMENT
President Clinton signed into law the largest deficit reduction plan in history
August 10, 1993. Under the plan:
the deficit, as a percentage of GOP, will be cut by more than one-half from
4.9"10 in 1992 to 2.4% In 1995; .
the deficit will drop by more than $700 billion dollars over 5 years; and
the deficit will drop 3 years in a row for the fIrSt time since Harry Truman
was President.
·
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·
START I entered into force on December 5, 1994.
START II hearings will begin in late January or early February in the Senate.
Sanctioned China and Pakistan for missile sales and Thailand for chemical .
weapons-related exports to Libya. Sanctioning Russia for Anns sales to Iran.
Provided export-control assistance to numerous countries, including Russia
and the NIS and Central European States.
Vigorously enforced prohibition on uSing non-military aid for military purposes.
No pending non-compliance cases.
·
·
Increased lAEA funding $10 million, a 33% increase in U.S. contribution to
safeguards.
Reached an Agreed Framework with North Korea ,that halts and will
eventually eliminate its dangerous nuclear weapons program and that eases
full lAEA access 'to nuclear sites.
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�!
-
PROMISE
I
STATUS
BUDGET: Seek a line-item veto to
cut wasteful spending.
PENDING
CITIES: Offer tax and regulatory
incentives to businesses that create
jobs in urban enterprise zones.
SUBSTANTIAL
ACCOMPLISHMENT
CITIES: Provide funding and block
grants to improve infrastructure.
PARTIAL
ACCOMPLISHMENT
CITIES: Create a network of 100
community development banks to aid
low-income entrepreneurs and
homeowners.
SUBSTANTIAL
ACCOMPLISHMENT
I
I
LATEST POLlCYIRESULT
·
·
In the 100th Congress, President Clinton is supporting the strongest version of
the line item veto, with the broadest scope and effective immediately.
In the 103rd Congress, President Clinton supported expedited rescission
authority, which was adopted in the House but never reached the full Senate
for consideration .
. President Clinton proposed and signed into law legislation for empowerment .zones
in August 1993 that will award $3.5 billion to 104 empowerment zones and
enterprise communities. President Clinton announced in December 1994 which
communities will be designated Empowerment Zones in 1995: (I) 6 urban
communities will each receive $100 million in block grants .and business tax
breaks; and (2) 3 rural communities will receive $40 million in assistance and
block grants.
·
·
$300 million has been appropriated for the new Economic Development
Initiative (EDI) of the FY 95 budget which will provide grants to assist
financing of economic development projects.
FY 96 budget calls for reinventing HUD, which will involve creating new
flexible block grants for community economic development and consolidating
a number of current formula-based and competitive programs.
President Clinton proposed and signed into law the Community Development and
Regulatory Improvement Act in August 1994 which authorizes $500 million to
encourage a network of new and existing Community Development Banks and
Financial Institutions (CDFls) across the country. The Treasury Department
projects that the act will:
lead to approximately $5 billion in new credit for economically distressed
communities;
provide .financial and technical support for as many as 75 new insured
community development banks; and
support as many as 916 new well-capitalized community development.
corporations and over 4,000 community development loan funds.
·
·
·
CITIES: Revise local reinvestment
. requirements for commercial banks.
PENDING
The federal banking regulatory agencies, at.the request of the Clinton
Administration, are in the process of approving fmal regulations which will:
provide clearer and more objective evaluation standards;
eliminate unnecessary documentation requirements; .and
improve the consistency of the Community Reinvestment Act examinations
and enforcement efforts.
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CITIES: Allow cities to spend 15
percent of their federal aid on local
priorities.
PENDING
CIVIL RlGHTS: Oppose racial
quotas
SUBSTANTIAL
ACCOMPLISHMENT
Continue to oppose racial quotas.
CIVIL RlGHTS: Support and seek
passage of an Equal Rights
. Amendment and federal civil rights
laws for homosexuals that exempts
religious o~ganizations.
PROPOSED
PROPOSED
Endorsed House and Senate bills in the 103rd Congress.
..
,
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.~
,
,:tc
Testified on behalf of Senate legislation in the 103rd Congress.
CIVIL RlGHTS: Raise caps on
damages in workplace discrimination
cases.
..
The Reinventing Government plan would give local governments more flexibility
in how they spend federal aid,
(
3
"
..
�PROMISE
STATUS
LATEST POLICYIRESULT
CRIME AND DRUGS: Put 100,000
new police officers to work and
expand community policing,
SUBSTANTIAL
ACCOMPLISHMENT
CRIME AND DRUGS: Create a
National Police Corps to put military
personnel and unemployed veterans to
work in law enforcement.
SUBSTANTIAL
ACCOMPLISHMENT
The Crime Bill created a police corps to give young people money for college and
. train them in community policing. A total of $100 million has been authorized for
the Police Corps program and $100 million has been authorized for in-service law
enforcement· scholarships.
CRIME AND DRUGS: Have
first-time, nonviolent offenders serve
out their sentences in community boot
camps.
SUBSTANTIAL
ACCOMPLISHMENT
The .Crime Bill includes a grant program for state corrections agencies to build and
operate correctional facilities, including boot camps to insure that additional space
will be available to put - and keep - violent offenders incarcerated.
- CRIME AND DRUGS:
Enact tough
penalties for assaults against women
and children to deter domestic
violence.
The President proposed and signed the Crime Bill, which will:
Put 100,000 new pol ice officers on'the street. More than I ,200 communili~s
have already received grants to hire nearly 10,000 cops,
Promote community policing, $1.5 billion was appropriated for cities in
FY95 to hire new police, if cities agree to establish a community pOlicing
plan. As much as 15% of the funds can be used to promote community .
policing in other Ways, such as, redeploying other officers, developing new
technologies, and offering special ized training to officers.
·
·
I
The Crime Bill includes formula and competitive grant programs which will:
Support police and prosecutor efforts to strengthen enforcement and provide
services to victims in such cases;
Authorize $325 million for battered women's shelters and other domestic
violence prevention activities;
Establish a' National Domestic Violence Hotline.
'\
The Crime Bill also provides for:
Prohibiting firearms sales to and possession by persons subject to family
violence restraining orders;
Enhancing penalties for interstate domestic violence.
SUBSTANTIAL
ACCOMPLISHMENT
·
·
·
·
·
CRIME AND DRUGS: Increase
federal funding for school-based and
community dru'g education programs
and treatment clinics.
SUBSTANTIAL
ACCOMPLISHMENT
CRIME AND DRUGS: Provide
federal matching funds for crime.
prevention in hard-hit comm ...nities.
The Crime Bill authorizes funding for:
Education prevention and treatment programs for at-risk juveniles;
Drug Courts program ;
Enhancing the education, providing substance abuse treatment and funding
job programs to prevent crimes.
SUBSTANTIAL
ACCOMPLISHMENT
·
·
·
The Crime Bill authorizes funding for:
The President's Prevention Council;
Rural anti-crime and drug efforts;
Local Crime Prevention Block Grant program to be distributed to local
governments;
Model crime prevention programs targeted at high-crime neighborhoods; up to
15 cities will be selected.
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,
CRIME AND DRUGS: Impose ·a
five-day waiting period ort handgun
purchases, ban assault weapons with
no legitimate hunting purpose, and
limit access to multiple-round clips.
SUBSTANTIAL
ACCOMPLISHMENT
Signed the Brady Bill into law on November 3D, 1993.
.
/
The Crime Bill also provides for the following:
Banning the manufacture of 19 military-style' assault weapons, assault
weapons with specific combat features, "copy-cat" models, and certain high- .
capacity ammunition magazines of more than ten rounds;
Banning imports of foreign assault pistols, such as the Uzi;
Strengthening Federal licensing standards for firearms dealers;
Increasing penalties for interstate firearms trafficking; firearms theft and
smuggling and use of semi-automatic weapons;
Prohibiting the sale or transfer of a firearm to or possession of ce~n
firearms by juveniles.
·
·
·
·
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CRIME AND DRUGS: Seek jail
terms for serious white-collar
criminals in "real prisons, not
high-tech summer camps."
The Crime Bill prohibits favoritism for white-collar criminals when making prison
assignments.
SUBSTANTIAL
ACCOMPLISHMENT
,
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�I
I
PRDMISE
CRIME AND DRUGS:
on hate crimes.
I
STATUS
LATEST PDlICYIRESULT
SUBSTANTIAL
ACCOMPLISHMENT
The Crime Bill includes an increase of tough penalties for federal hate crimes.
Hate crime violators will now be sentenced to an additional 12 to 15 months in
prison.
DEFENSE: Save $ 100 billion in
defense spending over 5 years, or $ 60
billion more than the Bush
administration proposed.
SUBSTANTIAL
ACCDMPLISHMENT
The $1.241 trillion military spending plan for FY94-98 matched this pledge, as
measured against the revised $1.365 trillion Bush defense budget for the same
years.
DEFENSE: Cut military personnel by
offering voluntary early retirement and
pro-rated pensions for those who have
served 15 to 20 years.
SUBSTANTIAL
ACCDMPLISHMENT ,
Dffered such benefits to certain personnel classes.
DEFENSE: Pay retiring personnel
for a year of retraining. 3
PARTIAL
ACCOMPLISHMENT
Several retraining programs have been implemented since January 1993.
PARTIAL
ACCDMPLISHMENT
Worked to ensure that C-17 manufacturers address all outstanding business issues
and performance specifications; requested funds for 6.. aircraft in FY95; 26 C·17S
now under contract.
Crack down
DEFENSE: Build fleet of C-17
cargo planes· to expand sea- and
. air-lift capabilities and enhance
rapid-deployment forces.
DEFENSE: Reduce U.S. forces in
Europe'to 75,000-100,000 troops but
maintain commitment to NATO..
SUBSTANTIAL
ACCDMPLISHMENT
to
to 100,QOO level.
..
· Dn target andreduceAllied approval ,
Proposed
won
·
to Europe's new democracies. for process of NATO's gradual expansion
·
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·
Led way in NATO. and with Central and Eastern European countries to set up
"Partnership for Peace" (PFP), offering former Sov.iet republics and CEE
nations practical military ties with NATO..
Held PFP first military exercise in Poland in September.
Intensified military relations with CEE, including offer of $10 million Baltic
Battalion, offer of$IOO million for military cooperation with new PFP
Partners, including $25 million for Poland.
DEFENSE: Maintain U.S. military
presence in Korea.
SUBSTANTIAL
ACCDMPLISHMENT
37,000 American troops remain in Korean theater. Patriot missiles were sent in
1994 when crisis I.oomed.
DEFENSE: Maintain 10 carrier
battle groups instead of 12.'
NO. ACTIDN
As
DEFENSE: Develop short- and
medium-range missile defenses and
continue research on limited
long-range missile defenses.
PARTIAL
ACCDMPLISHMENT
Requesting over $2 billion in FY95 funds to .continue research on national missile
defense and to develop highly effective theater missile defenses.
DEFENSE: Cut spending on large,
space-based missile defenses.
SUBSTANTIAL
ACc:DMPLlSHMENT
Reduced funding for space-based lasers and missiles. Eliminated SOlD and
created Ballistic Missile Defense Organizations in its place.
DEFENSE: Reverse ban on
homosexuals in the military.
PARTIAL
ACCDMPLISHMENT
New, more tolerant policy took effect February 28, 1994.
ECDNDMY AND JOBS : Create a
National Economic Council.
SUBSTANTIAL
ACCOMPLISHMENT
Executive Order ,12835 established the NEC on January 25, 1993.
ECDNDMY .AND JDBS: End tax
incentives that encourage companies
to export plants and jobs.
SUBSTANTIAL
ACCDMPLISHMENT
3
result of Bottom-Up Review, decided 11.5 carriers were required.
' Two Clinton Administration initiatives have advanced this pledge:
President Clinton's Economic Plan 1993 added a provision in the Internal
. Revenue Code that imposes a current tax on U.S. shareholders of controlled
foreign corporations that invest their earnings in an excessive amount of
passive assets abroad. By reducing the opportunities for unlimited deferral, the
incentive to shift plants overseas is significantly reduced; and
transfer pricing initiatives have reduced the opportunity to shift income to
foreign tax havens.,
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�I~II________P_R_O_M_IS_E________-FI_____
S_TA_T_U_S____-FI_________________ TE_S_T_P_O_L_IC_Y_fflESU_L_T
LA_
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ECONOMY AND JOBS: Provide
investment' tax credits to companies
that invest in U.S.-based plants and
American-made equipment.
PARTIAL
ACCOMPLISHMENT
ECONOMY AND JOBS: Make
foreign companies with businesses in
the United States pay the same taXes
as U.S. companies.
PARTIAL
ACCOMPLISHMENT
July 1994 the Treasury issued final regulations governing transfer pricing. These
rules, backed by severe penalties, are expected to ensure that an accurate amount
of multinational company profits are subject te tax in the United States. In
addition:
•
President Clinton's Economic Plan 1993 included a provision that will make
it more difficult for multinational companies to strip earnings out of the U.S.
through deductible payments such as interest; and
•
the Clinton Administration has budgeted significant resources to the
enforcement of these rules governing transfer pricing.
ECONOMY AND JOBS: Offer a SO
percent tax exclusion to those who
make long-term investments in new
businesses.
SUBSTANTIAL
ACCOMPLISHMENT
The Administration enacted, as part of its Economic Plan 1993, a SO% capital
gains tax exclusion targeted at investments in small businesses. The provision
allows investors who buy newly issued stock in small businesses and hold that
steck for more than S years to receive a SO percent cut in the capital gains tax on
the profit from the sale of the steck.
•
•.
Proposed incremental investment tax credit in 1993, but did not pass in
Congress.
The President's Economic Plan increased the small business expensing limit
to $17,SOO from $10,000 (an increase te $2S,000 was proposed). The change
allows small business owners te expense 7S% more of their purchases of
depreciable assets, a measure that small business had sought unsuccessfully
for years. The Treasury Department estimates that 1.3 million small
businesses will benefit from the provision this year.
ECONOMY AND JOBS: Create a
$20 billion-a-year fund for spending
on transportation and roads,
communications and information
networks, and environmental
technology.
PARTIAL
. ACCOMPLISHMENT
President Clinten announced a five-year $20 billion Defense Reinvestment
initiative in March 1993 that is centered on four major areas of new
investment: (1) worker training and adjustment; (2) community reinvestment;
(3) "dual-use" technologies with both commercial and military applications;
and (4) new civilian technology investments that provide diversificatio,n
opponunities
EPA's enacted budget for environmental technology doubled over the
FY1993-FY199S period, te $139 million. Other new funding for private
secter technology partnerships are I) U.s. Climate Change Action Program $232 million FYI99S enacted ~- and 2) Partnership for a New Generation of
Vehicles (Clean Car) -- $269 million FY\99S enacted.
The President's FY 1996 budget will propose establishing a network of State
Infrastructure BankS that will allow states to leverage federal funding, thereby
achieving a greater level of investment from a given level of federal
resources.
ECONOMY AND JOBS: Make
business tax credits for research and
development permanent.
PARTIAL
ACCOMPLISHMENT
The Administration secured a three-year extension of the Research & Development
tax credit, retroactive to June 30, 1992 and effective through June 30, 1995.
ECONOMY AND JOBS: Develop
new commercial technologies through
a new civilian research and
development agency.
SUBSTANTIAL
ACCOMPLISHMENT
The President has refocused defense R&D on "dual-use" technologies:
•
Removed the word Defense from DARPA's name (Defense Advanced
Research Projects Agency) te reflect a new commercial focus.
•
Launched the Technology Reinvestment Project, the largest multi-agency
technology program ever, to stimulate dual-use technology.
•
Increased budgetary 'support of civilian R&D. Funding for the Advanced
Technology Program has increased from $68 million in FY93'to $450 million
in FY9S.
'
•
Created the National Science and Technology Council te help derme and
achieve science and technology goals.
•
Government-industry partnerships have been launched in critical technologies
such as flat-panel displays, the "Clean Car", semiconducters, and
environmental technologies necessary for sustainable economic development
ECONOMY AND JOBS: Raise the
minimum wage to keep pace with
inflation,
PENDING
The National Economic Council is in the process of making a recommendation to
the President.
6
�I
PROMISE
I
I
STATUS
ECONOMY AND JOBS: Limit
deductions for executive pay.
SUBSTANTIAL
ACCOMPLISHMENT
ECONOMY AND JOBS: Allow
businesses to deduct bonus and
severance packages for executives
only if other employees are offered
similar packages.
NO ACTION
EDUCATION: Create a national
service program that allows college
students to repay federal loans with
community work.
SUBSTANTIAL
ACCOMPLISHMENT
LATEST POLlCYIRESULT
,
As pan of his Economic Plan, President Clinton signed legislation that denies a
deduction to any publicly held corporation for compensation exceeding $1 million
paid to CEOs or certain other high-ranked officers. Some forms of compensation,
such as qualified retirement plan contributions and performance-based awards
approved by shareholders, is exempt from the cap.
President Clinton proposed and signed the National and Community Service Trust
Act creating AmeriCorps September 21, 1993. AmeriCorps is already:
giving young people the chance to spend a year or more helping those within
our communities grow safer, smarter, and healthier - while earning an award
of nearly $5,000 to pay for college or job training;
engaging 20,000 Americans as' AmeriCorps MemberS in its first year - more
than the Peace Corps at its height; and
consolidating existing Federal agencies and supporting local efforts to meet
community needs.
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EDUCATION: . Fully fund Head
Stan and other programs
recommended by the National
Commission on Children.
PARTIAL
ACCOMPLISHMENT
Increased funding for Head Stan by $760 million over 2 years.
EDUCATION: Enact national
staildards for public schools to be
measured with examinations on core
subjects.
SUBSTANTIAL
ACCOMPLISHMENT
Proposed and signed the GOALS 2000: Educate America Act which codifies
national education goals, supports state reform efforts, including state standards.
41 states are now participating, and more will follow s90n.
EDUCATION: Help students ·not
going to college develop job skills
through a national apprenticeship
program.
SUBSTANTIAL
ACCOMPLISHMENT
President Clinton signed the School-to-Work Opportunities Act on May 4, 1994
that provides $250 million in 1995 for aliSO states to establish their own diverse
school-to-work initiatives.
EDUCATION: Help communities
open youth centers for teenagers who
drop out of schooL
SUBSTANTIAL
ACCOMPLISHMENT
The Crime Bill includes several provisions that fulfill this promise:
.Ile Community Schools Youth Services and Supervision effort will support
academic and extracurricular programs ·afier-school, on weekends, and in the
summer for children and adolescents (For 1995,.$25.9 million will be
available and $567 million is authorized for 1996-2000); and
the Family and Community Endeavor Schools initiative will improve
opportunities for at-risk children ($11 million is available for 1995 and $243
million is authorized for 1996-2000).
·
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EDUCATION: Require employers to
spend 1.5 percent of payroll costs on
education and training for all workers.
NO ACTION
EDUCATION: Encourage
competition in education by giving
parents public school choice.
SUBSTANTIAL
ACCOMPLISHMENT
Passed Charter School legislation which encourages state and local decisionmaking
to set up public school choice.
EDUCATION: Increase Chapter One
funding to "level the playing field" for
disadvantaged students.
SUBSTANTIAL
ACCOMPLISHMENT
Requested an additional $500 million for FY95 bringing the total budget to $7.2
billion.
President ClintOn has pursued providing training for all workers in a number of
different ways:
increasing funding for reemployment services by 150 percent, enabling
400,000 more workers to participate in 1995 than in 1993;
offering individual skills assessments and help with business stan-ups to those
applying for unemployment services; and .
helping states to plan or' assemble networks of one-stop career centers to offer
efficient, customer-driven access to counseling, labor-market information, job
listings, training and education, and other reemployment services (about onehalf of the states are doing so already).
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7
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PROMISE
STATUS
EDUCATION: Give school systems
flexibility to use federal funds to
reduce class sizes or as they see fit.
SUBSTANTIAL
ACCOMPLISHMENT
EDUCATION: Develop programs
that help disadvantaged parents work
with their children on school
assignments.
SUBSTANTIAL
ACCOMPLISHMENT
EDUCATION: Provide funds for
security and metal detectors at schools
that need them.
SUBSTANTIAL
ACCOMPLISHMENT
I
LATEST POLICYIRESULT
Enacted Goals 2000 and reauthorized the Elementary and Secondary Schools Act
which provide flexibility, including waivers. coupled with accountability for
results.
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Signed the ElementarY and Secondary Education Act reauthorization which
promotes partnerships between schools and families.
Signed Head Start and Goals 2000 legislation which expand and enhance the
role of parents in schools and pre-school programs.
Signed the Family Support and Family Preservation Act which authorizes 51
billion to support programs that help teach their children.
Proposed and signed the Passed Safe and Drug Free Schools and Community Act
and Safe Schools Act, which provide 5480 million in FY95 to help schools fight
violence and drug abuse. Schools can use funds for activities such as conflict
resolution, after school programs, and drug prevention programs. Schools can use
up to 25% of their funds to purchase metal detectors, develop safe zones, and hire
school security personnel.
'\
EDUCATION: Require large federal
contractors to sponsor jobs and
after-school employment for
disadvantaged youths.
NO ACTION
EDUCATION: Promote bilingual
education programs in which students
learn core subjects in their native
languages while also studying English.
SUBSTANTIAL
ACCOMPLISHMENT
ELECTIONS AND GOVERNMENT:
Support District of Columbia
statehood.
PROPOSED
Supported legislation to make the District of Columbia a state.
ELECTIONS AND GOVERNMENT
Voluntarily cap spending in
congressional races and reduce
contributions from Pol itical Action
Committees from $ 5,000 to the
$1,000 limit on individuals.
PROPOSED
·
·
ELECTIONS AND GOVE~MENT:
End unlimited "soft money"
contributions to parties.
PROPOSED
ELECTIONS AND GOVERNMENT:
Restrict prices on TV ad time for
candidates.
PROPOSED
ELECTIONS AND GOVERNMENT:
Sign the. "Motor Voter Act."
SUBSTANTIAL
ACCOMPLISHMENT
ELECTIONS AND GOVERNMENT:
Require lobbyists to disclose
contributions to members of a
congressional committee before they
can testify.
PROPOSED
ELECTIONS AND GOVERNMENT:
End tax breaks for lobbying expenses.
SUBSTANTIAL
ACCOMPLISHMENT
Discretionary grant program included in ESEA encourages students to learn
challenging academic content while also developing English skills.
J
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·
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.
·
Included in campaign fmance reform bills supported in the 103rd Congress.
The President sent a letter to leaders of the l04th Congress .urging them to
pass legislation on campaign fmance reform.
Included in campaign finance reform. bill supported by President Clinton.
,
Versions of the bill passed both houses.
On the first day of the current Congressional session, President Clinton called
on the Congressional leadership to enact campaign finance reform measures.
Included in campaign fmance reform bill supported by President Clinton.
Versions of the bill passed both houses.
On the fIrSt day of the current Congressional session, President Clinton called
on the Congressional leadership to enact campaign finance reform measures.
Proposed and signed the National Voter Registration Act on May 20, 1993. The
Motor-Voter law makes it easier for 70 million unregistered Americans to vote by
allowing them to register when they get their drivers licenses.
·
·
Proposed legislation barring lobbyists from contributing for one year to the
lawmaers they contact
The President sent a letter to leaders of the 104th Congress urging them to
pass legislation on lobbying disclosure and ban gifts from lobbyists.
President Clinton's Economic Plan 1993 repealed the tax provision, dating back to
1962, that al lowed businesses to deduct the cost of their lobbying expenses.
8
�PROMISE
.STATUS
LATEST POLlCYIRESULT
ELEcnONS AND GOVERNMENT:
Make top appointees pledge not to
lobby agencies within their
jurisdiction for five years after leaving
office
SUBSTANTIAL
ACCOMPLISHMENT
Signed Executive Order 12834 entitled "Ethics Commitments by Executive Branch
Appointees" on January 20, 1993 which restricts all senior appointees in executive
agencies from lobbying agencies within their jurisdiction for five years after
leaving office.
ELECTIONS AND GOVERNMENT:
Reduce the White House staff by 25
percent and cut 100,000 federal jobs
through attrition.
SUBSTANTIAL
ACCOMPLISHMENT
·
ELECTIONS AND GOVERNMENT:
Cut 3 percent in agency administrative
costs.
SUBSTANTIAL
ACCOMPLISHMENT
ELECTIONS AND GOVERNMENT:
Reform defense procurement and
foreign aid
SUBSTANTIAL
ACCOMPLISHMENT
ELECTIONS AND GOVERNMENT:
Appoint more women and minorities
to government jobs.
SUBSTANTIAL
ACCOMPLISHMENT .
.
ENERGY AND THE
ENVIRONMENT: Oppose
increasing federal excise gas taxes or
increased reliance oli nuclear power.
/
PARTIAL
ACCOMPLISHMENT
·
By. September 1994, 350 White House jobs had been cut from a staff of 1,394
during the Bush Administration .-. a 25% reduction.
There are already 100,000 fewer federal jobs than in January 1993. Under
the recommendations of the National Performance Review, the federal payroll
will be cut by 272,000.
President Clinton signed Executive Order 12837 in February 1993 which requires
that federal government"reduce its administrative expenses 14% by FY 1997.
Already, administrative costs are down by more than 3 percent.
·
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·
·
)
Signed Presidential Memorandum on Electronic Commerce to automate the
procurement system.
Defense Secretary William Perry has ordered dramatic procurement reforms.
Signed the Federal Acquisition Streamlining Act of 1994.
Undertook extensive review and restructuring of foreign aid programs.
The President has appointed· the most diverse cabinet and ad~inistration in history:
There are 6 women, 4 African-Americans & 2 Hispanics in the cabinet
Nearly half of all appointees are women (44%).
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No increased r;::liance on nuclear power. No new nuclear power plants.
Opposed large gas tax increase, but did sign a $0.043 per gallon tax increase
on transportation fuels.
ENERGY AND THE
ENVIRONMENT: Raise Corporate
Average Fuel Economy standards for
auto makers from 27.5 mileS per
gallon to between 40 and 45.
PENDING
Under the Climate Action Plan, the White House convened at FACA on climl!k
change and personal cars - "Car Talk." This is a public process aimed at
developing policies designed to reduce the contribution of cars to climate change.
ENERGY AND THE
ENVIRONMENT: Convert federal
vehicle fleet to natural gas.
SUBSTANTIAL
ACCOMPLISHMENT
ENERGY AND THE
ENVIRONMENT: Encourage
renewable and alternative energy
projects with tax incentives.
SUBSTANTIAL
ACCOMPLISHMENT
Federal partnerships launched to cost-share rene~able energy deployment; 20%
increase in renewable energy budget; and 10% investment tax credit was made
permanent
ENERGY AND THE
ENVIRONMENT: Use highway
spending to encourage car pooling and
mass transit.
SUBSTANTIAL
ACCOMPLISHMENT
Budget includes 21 % increase for mass transit and light rial systems. EPA hits
worked with business, state and local governments on programs to encourage
experimentation in transportation demanded management and trip reduction to
improve air quality in the nation's most polluted areas.
ENERGY AND THE
ENVIRONMENT: Changeregulations, and building standards, to
make energy efficiency profitable for
utilities and consumers.
SUBSTANTIAL
ACCOMPLISHMENT
{
{
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Issued an Executive Order increasing the numbers of federal vehicles that
should use alternative fuels to 1\ ,000 in 1994.
The Clean Cities program ensures the Executive Order levels will be
exceeded.
The administration is reaching out to American business with programs that·
increase energy efficiency. decrease energy use and help our international
competitiveness.
Improved efficiency standards on appliances implemented, and program
launched to assist states in upgrading building efficiency codes.
Dramatic increases in budget for building efficiency programs.
9
/.
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�PROMISE
STATUS
ENERGY AND THE
ENVIRONMENT: Curb industrial
and toxic emissions and expand
markets for recycled products with tax
incentives,
PARTIAL
ACCOMPLISHMENT
ENERGY AND THE
ENVIRONMENT: Enforce
environmental laws' with jail terms for
corporate polluters when necessary.
SUBSTANTIAL
ACCOMPLISHMENT
ENERGY AND THE
ENVIRONMENT: Push utilities to
consider social and economic costs of
fuel sources with incentives to adopt
least-cost planning,
SUBSTANTIAL
ACCOMPLISHMENT
ENERGY AND THE
ENVIRONMENT: Protect expanded
Arctic National Wildlife Refuge in,
Alaska from drilling.
SUBSTANTIAL
ACCOMPLISHMENT
ENERGY AND THE
ENVIRONMENT: Require
companies to recover some of the
waste they generate or buy "credits"
from companies that do.
PROPOSED
ENERGY AND THE
ENVIRONMENT: Allow citizens to
sue federal agencies for ignoring
environmental laws and regulations.
PARTIAL
ACCOMPLISHMENT
·
NO ACTION
ENERGY AND THE
ENVIRONMENT: Pass Clean Water
Act that includes incentives to reduce
"non-point-source" pollution from
household chemicals, pesticides and
other substances.
LATEST POLICY/RESULT
President Clinton signed an Executive Order requiring reduction of toxic
emissions from federal facilities by 50 percent 'by 1999,
The President issued a second Executive Order requiring that all federal
purchases of recycled products such as printing and writing that contains 20
percent post consumer material by the end of 1990 to expand markets for
recycled products.
" .,
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Over 200 criminal environmental cases were referred by the EPA to the
Department of justice in FY94.
Criminal charges were brought against 250 individuals and corporate
defendants and 99 years of jail sentences and $36.8 million in criminal fines
were assessed in FY94.
·
President's Climate Change Action plan launched program to advocate
integrated resource planning and expanded technical and financial assistance
to utilities' and state regulators to implement reforms.
Over 800 electric utilities comprising 80% of electricity generated in the US
are signing agreements with the Department of Energy to voluntariiy reduce
consumers' energy use.
·
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There has been no funher drilling in these areas.
",
"
Proposed to Congress a comprehensive set of Clean Water Act reforms. Congress
failed to act
ENERGY AND THE
ENVIRONMENT: Stick to "no net
loss" wetlands policy.
SUBSTANTIAL
ACCOMPLISHMENT
ENERGY AND THE
ENVIRONMENT: Limit carbon
dioxide emissions to 1990 levels by
2000.
SUBSTANTIAL
ACCOMPLISHMENT
·
·
The Clean Water Act reauthorization proposal supported the right of citizens,
to sue the Federal Government.
In addition, the Administration has aggressively implemented the Federal
Facilitles Compliance Act which provides citizens with the right to sue the
Federal government for violation of the nation's solid and hazardous waste
laws.
Supported broadening Clean Water Act so that citizen suit authority would
extend to radioactivity discharges.
Introduced Wetlands Plan to preserve wetlands.
'
. PENDING
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Announced plan to limit carbon dioxide emissions to 1990 levels in the year 2000,
~
Draft administration proposal under consideration .
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ENERGY AND THE
ENVIRONMENT: Push major blinks
to reduce debt burdens on developing
nations in exchange for land
conservation efforts.
.'
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�PROMISE
STAl1JS
r'AMILY PLANNING: Allow U.S.
funds to support international family
planning and population control
efforts.
SUBSTANTIAL
ACCOMPLISHMENT
FAMILIES: Pass a Family and
Medical Leave Act giving workers 12
weeks of unpaid time off a year to
care for' newborn children or sick
relatives.
SUBSTANTIAL.
ACCOMPLISHMENT
FAMILIES: Crack down on parents
who avoid child support.
PARTIAL
ACCOMPLISHMENT
LATEST POLICYIRESULT
·
·
Mexico City Policy revoked by Presidential Memorandum, 1122193, repealed
ban on funding to worldwide family planning groups.
Roughly $40 million, the first funding since 1985, was is in the budget for
FN94; the enacted amount for FY95 is $50 million.
Though President Bush vetoed Family and Medical Leave legislation twice,
President Clinton signed this legislation into law February 5, 1993, which offers
employees 12 weeks of unpaid, job-guaranteed leave for childbirth, adoption, or
personal or family illness. More than 40 million American workers will be covered
under the legislation.
·
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In itS first national push to crack down on dead-beat parents, the Department
of Justice filed 28 cases seeking over $1 million in overdue payments in
December, 1994, and more than 200 cases are under review. Also, each of
the 94 U.S. Attorneys has designated a child support enforcement coordinator,
and prosecution guidelines have been developed to assist them in going after
the most egregious violators.
President Clinton's Work and Responsibility Act, introduced in June 1994,
includes the toughest child support provisions ever. These provisions would
double child support collections to $20 billion by 2000 and place more
emphasis on the responsibility of fathers, regular award updates, and the
withholding of wages of those who do not regularly pay their child support .
Launching nationwide effort to improve health and safety in childcare through
public-private partnerships and technical assistance.
Launched 1st ever National Childcare Information Center to help share
promising practices across state lines.
FAMILIES: Create a child care
network like the network of public
schools and enforce new standards on
chiid care facilities.
PARTIAL
ACCOMPLISHMENT
HEALrn CARE: Provide. coverage
to all Americans with cost controls
and by requiring employers to buy
private insurance or pay into a public
system.
PROPOSED
HEALrn CARE: Allow people to
choose services from competing bcal
networks of insurers, hospitals, clinics
and doctors, who will be paid a fixed
rate.
PROPOSED
Included in the Health Care Security Act.
HEALTH CARE: Provide a core
benefits package that includes
ambulatory physician and inpatient·
hospital care, prescription drugs, basic
mental health coverage, and expanded
access to preventative treatments and
routine screenings.
PROPOSED
Included in the Health Care Securil)' Act.
HEALrn CARE: Create a board 0 f
consumers, providers and
representatives from government,
business and labor to establish a core
package of benefits and annual health
budget targets.
PROPOSED
Included in the Health Care Security Act.
HEALrn CARE: Require insurers
to cover individuals with any
.pre-existing conditions, charge all
businesses in a community the same
rate, and streamline billing practices to
cut administrative costs.
PROPOSED
Included in the Health Care Security Act.
·
Included in the Health Care Security Act
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11
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�PROMISE
LATEST POLlCYIRESULT
STATUS
HEALTII CARE: Phase in
requirements for small employers until
costs are reduced.
PROPOSED
Included in the Health Care Security Act.
HEALTIl CARE: Allow small
employers to pool to receive more
favorable rates from insurers.
PROPOSED
Included in the Health Care Security Act.
HEALTIl CARE: Eliminate tax
breaks for prescription drug
manufacturers whose prices increase
faster than incomes.
PARTIAL
ACCOMPLISHMENT
.
.
President Clinton proposed and signed legislation, as part of his Economic
Plan 1993, that will eliminate drug price gouging. Subsequently, 17
.;
pharmaceutical industry executives, representing two-thirds of the U.S.
pharmaceutical market, agreed to hold price increases at or below the generai .
inflation rate.
Also included in the Health Care Security Act
PROPOSED
Included in the Health Care Security Act.
HEALTIl CARE: Fully fund the
Women. Infants, and Children (WIC)
Program
SUBSTANTIAL
ACCOMPLISHMENT
President Clinton and Congress placed WIC on a full-funding path. Funding is
projected to increase by $610 million from 1993 to 1995 -' a 21% gain. As a
result, an additional one million people will have the opportunity to get the
nutrition and care they need to stay healthy.
HOUSING: Hold a Housing and
Homelessness Summit with urban
leaders to develop poverty and
housing programs.
SUBSTANTIAL
ACCOMPLISHMENT .
HUD Secretary Cisneros held 18 interactive homeless forums in 18 cities and a
National Housing and Community Development Conference with the Vice .
President attended by over 2,000 people.
HOUSING: Transfer 10 percent of
all federal housing to churches and
other non-profit community groups for
the homeless.
SUBSTANTIAL
ACCOMPLISHMENT
Support McKinney program which has cOntinued to provide opportunity to
nonprofit homeless organizations to have first bid at all surplus federal property.
HOUSING: Use housing at closed
military bases for the homeless.
SUBSTANTIAL
ACCOMPLISHMENT
Backing new process that will allow for reasonable process for balancing needs for
the honteless and community for closed' military bases: In place at Lowry AFB,
Long Beach, Ca and elsewhere.
HOUSING: Provide federal support
to programs that restore old housing
to sell to low-income home buyers.
SUBSTANTIAL
ACCOMPLISHMENT
Included in Housing and Community Development Act, 1993
HOUSING: Attract investment with a
pennanent Low Income Housing Tax
Credit.
SUBSTANTIAL
ACCOMPLlS]:IMENT
Pennanent extension of Low Income Tax Credit and Mortgage Revenue Bonds
included in OBRA '93.
HOUSING: Provide increased federal
funding for maintenance of existing
public housing.
SUBSTANTIAL
ACCOMPLISHMENT
Increased budget from $3.2 billion in FY94 to $3.7 billion in FY95.
HOUSING: Raise the ceiling on
Feder!!1 Housing Authority mortgage
insurance to 95 percent of the price of
a home in average metropolitan areas.
PENDING·
Introduced legislation to raise ceiling in 103rd Congress. Passed House but failed
in Senate.
HOUSING: Expand local authority
to make more low-income rental units
available through the HOME PrQgram.
SUBSTANTIAL
ACCOMPLISHMENT
HOME is funded at $2 billion for FY95.
, HEALTII CARE: Expand Medicare
benefits for the elderly and disabled to
include more options for long-tenn
care.
\
12
'I"~.
�PROMISE
STATUS
LATEST POLlCYIRESULT
IMMIGRATION: Give temporary
asylum to political refugees from Haiti
until that country's elected
government is restored.
SUBSTANTIAL
ACCOMPLISHMENT
Provided temporary asylum at Guantanamo Naval Base for Haitians fleeing the
military regime and restored democratic government to Haiti.
IMMIGRATION: Cut the two-year
waiting period for people seeking
visas to the United States who are
separated frorn immediate family
members and reduce the backlog of
extended family members in 'similar
situations.
NO ACTION
IMMIGRATION: Close "sweat
shops" and "abusive fann labor
contractors" that rely on illegal
immigration.
SUBSTANTIAL
ACCOMPLISHMENT
IMMIGRATION: Use trade
agreements with Latin American
neighbors to raise wages in that
region, discourage immigration and
protect U.S. jobs.
SUBSTANTIAL
ACCOMPLISHMENT
INTERNATIONAL RELATIONS:
Link most-favored-nation trading
status for China with progress on
human rights and nuclear
proliferation.
SUBSTANTIAL
ACCOMPLISHMENT
INTERNATIONAL RELATIONS:
Seek U.N. authorization for air strikes
against forces that disrupt relief efforts
in Bosnia while using U.S. and
European naval forces to .tighten
economic sanctions against Serbia and
Montenegro.
SUBSTANTIAL
ACCOMPLISHMENT
INTERNATIONAL RELATIONS:
End reported atrocities in Serbian
detention camps with international
military force if necessary, and punish
those responsible for atrocities in
Bosnia under international law.
PARTIAL
ACCOMPLISHMENT
INTERNATIONAL RELATIONS:
Get full accounting of POWs and
MIAs.
PARTIAL
ACCOMPLISHMENT
Best progress in recent years in the four key areas outlined by President Clinton
achieved by insistence on fullest possible accounting of POWs and MIAs.
Continued efforts with Russians produced return of remains of U.S. flyer shot
down during Cold War.
INTERNATIONAL RELATIONS:
Increase political and economic
pressure on Haiti's current leadership
to restore that country's
democratically elected government.
SUBSTANTIAL
ACCOMPLISHMENT
Restored democracy to Haiti on October 15 by leading a multinational coalition
force that peacefully returned President Aristide and his constitutionally established
government
INTERNATIONAL RELATIONS:
Encourage more private investment in
the former Soviet Union.
SUBSTANTIAL
ACCOMPLISHMENT
Enforcement in low wage industries, in which many illegal workers work, has been
increased and will continue to be increased.
·
·
·
·
Passed NAFTA.
Concluded and passed a s':lccessful GATT agreement.
Agreed to negotiate a Free Trade Area of the Americas by 2005.
Held successful Summit of the Americas to strengthen and safeguard
democracy and promote open-markets.
MFN was linked to China's human rights record for a year. Although the
Administration is not satisfied with China's progress in the area of human rights, it
delivered MFN in favor of increased dialogue and rule of law programs; continued
"Tienanmen Square" sanctions, a ban on munitions imports from China, and
vigorous enforcement of US laws on prison labor exports.
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Won NATO commitnients to protect UN forces with airpower and to threaten
air strikes to prevent strangulation of Sarajevo and other areas. Secured
NATO's February 1994 ultimatum imposing ban on he.avy weapons around
Sarajevo, relieving attacks on capital.
Tightened UN economic sanctions against Serbs. Participated in NATO
sanctions enforcement in Adriatic.
Enforced no-fly zone together with NATO allies.
On basis of NATO ultimatum, brokered truce between Muslims and Croats.
Through NATO decisions and support for UNPROFOR, have ended sustained
artillery shelling of Sarajevo' s civilian popUlation, reduced level of violence
country-wide.
Established UN War Crimes Tribunal. Published extensive documentation of
Serb ethnic cleansing, war crimes and acts of genocide.
Considerable expansion of US-Russia business ties, particularly aerospace and
high-technology.
Increased emphasis on trade and investment through more than $800 million
in OPIC loan guarantees and risk-insurance, and other programs.
Established innovative investment funds to sponsor private enterprise
development.
13
�PROMISE
STATUS
INTERNATIONAL RELATIONS:
Guarantee loans for Israel to help
settle Soviet Jews.
SUBSTANTIAL
ACCOMPLISHMENT
~
INTERNATIONAL RELATIONS:
Recognize Jerusalem as the capital of
Israei and oppose the creation of an
independent Palestinian state.
LATEST POLICYIRESULT
, Loan guarantees remain in place.
In September 1993, Israel and PLO agreed in Declaration of Principles that status
of Jerusalem should be dealt. with in final status negotiations to begin no later than
May 4, 1996. The President pledged during the campaign that he would do
nothing to disrupt peace negotiations. Sincetalcing office, he has strongly
supported the peace process, the IsraellPLO agreement and the peace treaty
between Israel and Jordan. Action is pending the outcome of the final status
negotiations.
INTERNATIONAL RELATIONS:
Modify foreign aid programs to
promote democracy.
-
PENDING
SUBSTANTIAL
ACCOMPLISHMENT
Undertook extensive review and restructuring of foreign aid programs and policies,
which now include democracy promotion as a major foreign aid priority that
includes information and exchange programs as well as major programs in South
Africa, the Newly Independent States of the former Soviet Union, Central and
Eastern Europe and countries in transition. Increased funding for the National
Endowment for Democracy,
INTERNATIONAL RELATIONS:
Establish Radio Free Asia.
PARTIAL
ACCOMPLISHMENT
Funds appropriated.
POVERTY AND WELFARE:
Require welfare recipients who can
work to fmd jobs or repay services
with work in the community after two
years of expanded assistance and
training,
PROPOSED
To reform welfare, President Clinton introduced the Work and Responsibility Act
in June 1994 that includes several critical components. The act:
limits welfare for those able to work;
expands funding for training programs and child care to help people get off .
welfare as quickly as possible in order to work; and
contains the toughest child support enforcement measures ever proposed,
I:;
POVERTY AND WELFARE: Create
optional Individual Development
Accounts for low-income Americans
to encourage savings with federal
matching funds.
PROPOSED
Included in Work and Responsibility Act proposed in Congress.
..
SOCIAL SECURJTY: Raise earning
limitations so recipients can collect
more income along with their benefits.
PENDING
Continue to support a reasonable increase in Social Security eaming disregard.
Testified on behalf of increase in the I04th Congress.
SOCIAL SECURJTY: Consider
higher taxes on benefits for wealthier
recipients.
SUBSTANTIAL
ACCOMPLISHMENT
Included in budget FY94.
SOCIAL SECURJTY:
system's solvency.
PENDING
Social Security Advisory Council is examining questions surrounding system's
solvency and will report in 1995.
SPACE: Launch more ventures with
Europe, Japan and Russia.
SUBSTANTIAL
ACCOMPLISHMENT
Congress approved funding for the international space station.
SPACE: Maintain NASA's fleet of
space shuttles.
SUBSTANTIAL
ACCOMPLISHMENT
Reduced operational costs of shuttle fleet while continuing safe flight program.
SPACE: Develop new, less costly
launch systems,
SUBSTANTIAL
ACCOMPLISHMENT
Presidential Directive (NSTC - PDD4) signed establishing new launch policy to
develop systems to lower costs.
SPACE: Increase environmental
research through NASA's "Mission to
Planet Earth,"
SUBSTANTIAL
ACCOMPLISH.M'ENT
Restructured the Landsat program through Presidential Directive (NSTC - PDD2).,
SPACE: Continue to use unmanned
probes and robots to explore other
planets.
SUBSTANTIAL
ACCOMPLISHMENT
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Ensure
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Supported reforms at NASA for faster, better, cheaper space science missions.
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�PROMISE
LATEST POLlCYIRESULT
STATUS
SpACE: Back away from Bush plans
for exploration of the moon and Mars
by U,S. astronaufS, but continue
scientific studies for internationally
financed missions.
SUBSTANTIAL
ACCOMPLISHMENT
TAXES (Personal): Raise tax rates on
joint-filers whose adjusted gross
incomes are more than $ 200,000 or
individuals whose AGls are more than'
$ 150,000.
SUBSTANTIAL
ACCOMPLISHMENT
TAXES (Personal): Increase the
Alternative Minimum Tax rate from,
24 to 26 or 27 percent
SUBSTANTIAL
ACCOMPLISHMENT
Increased alternative minimum tax rate from 24 to 26 percent (and to 28 percent
for high-income individuals.)
TAXES (Personal): Require
millionaires to pay a 10 percent
SUBSTANTIAL
ACCOMPLISHMENT
An additional 10 percent surcharge was imposed on taxpayers with taxable income
PENDING
President Clinton has, proposed a Middle-Class Bill of Rights that includes a $60
billion tax break for middle-class families that would provide:
a tax credit of up to $500 per child for families making less than $75,000;
0
a tax deduction for post-high school education expenses,ofup to $10,000 per
year for families making under $100,000;
0
an expanded IRA that allows people to withdraw money tax-free and without
penalty for education, medical expenses, or the purchase of a first home; and
0
a new re-employment program that makes individuals eligible for skill grants
of up to $3,000 and income contingent loans - while consolidating the web
of 50-60 federal training programs.
Refocus NASA ·resources on affordable programs in space flight, aeronautics,
earth sciences, and space science.
'
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Income tax rates were raised on the top L2% of tax payers.
Joint tax-filers making over $180,000 in adjusted gross income - saw their
income taxes increase.
Objective sources - including H&R Block, the Wall Street Journal and the
Congressional Budget Office - conftrm that only the top 1.2% saw their
income tax rates increase.
.
in excess of $250,000.
surtax~
TAXES (Personal): Offer
middle-class families $ 60 billion in
tax cuts over four years in the form of
a $300 tax cut per couple or a $ 300
per child tax credit
·
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TAXES (Personal): Increase the
Eamed Income Tax Credit for the
working poor.
SUBSTANTIAL
ACCOMPLISHMENT
President Clinton included in his Economic Plan 1993 an historic expansion of the
Eamed Income Tax Credit (EITC) that will:
0
exp~d the ElTe by $21 billion over 5 years to reward work over welfare;
and.
provide more than 15 million households with incomes of $27,000 or less
with either a new or increased EITC when the program is fully implemented.
·
TAXES: Encourage private investment
by providing a targeted investment tax
credit.
PARTIAL
ACCOMPLISHMENT
After originally proposing an increase in the small business expensing limit to
$25,OOO"President Clinton signed into law an increase to $17,500 as part of his
Economic Plan 1993. The change allows small business owners to expense 75%
more of their purchases of depreciable assets, a measure that small businesses had
sought unsuccessfully for years. The Treasury Department estimates that 1.3
million small busmesses will benefit from the provision this year, and millions
more in years to come. The Administration also has supported private investment
by securing a three-year extension of the Research & Development tax credit
TRADE: Continue international talks
to renew the General Agreement on
Tariffs and Trade while strengthening
U.S. "Surer 30 I" laws to punish
nations with unfair trading practices
unilaterally.
SUBSTANTIAL
ACCOMPLISHMENT
0
TRADE: Support the North
American Free Trade Agreement as
long as other accords can be reached
on the environment and labor
standards.
SUBSTANTIAL
ACCOMPLISHMENT
TRADE: Urge trading partners to
abaridon unfair trade subsidies in
shipbuilding and aerospace.
·
·
SUBSTANTIAL
. ACCOMPLISHMENT
0
·
Reached GATT agreement and signed GATT into law December 8, 1994.
The WTO took effect on January I, 1995.
I'resident Clinton reinstituted Super 30 I throu'gh an Executive Order and has
used it to bring our trading partners to the table.
Extended "Sup.er 301" in GATT legisl~tion.
Signed NAFTA into law December 8, 1993.,
On January I, 1994, the US opened a National Administrative Office to
handle NAFTA-related labor issues.
, President Clinton restarted talks on ship building that resulted in an agreement
reached in July 1994 to eliminate foreign subsidies and other unfair trade practices
by 1996. An aerospace agreement is pending.
15
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�PROMISE
"
STATUS
LATEST POLlCYIRESULT
TRADE: Ban U,S. trade negotiators
and all senior administration officials
from working as lobbyists for foreign
governments or businesses.
SUBSTANTIAL
ACCOMPLISHMENT
Signed Executive Order 12834 on January 20, 1993, prohibiting all senior
appointees from working as lobbyists for foreign governments or businesses within
five years of their employment termination,
VETERANS: Oppose opening VA
hospitals to non-veterans.
SUBSTANTIAL
ACCOMPLISHMENT
VA il0spita1s remain closed to non veterans.
VETERANS: Decrease waiting
periods for outpatient care.
PENDING
Implemented policies to reduce waiting periods at VA hospitals.
VETERANS: Notify disabled
veterans of benefit changes in
advance,
SUBSTANTIAL
ACCOMPLISHMENT
Initiated aggressive effort keep disabled vets informed of benefits changes.
,
16
�CLINTON CAMPAIGN' PROMISES
From Putting. People First
January 1995
PROMISE
STATUS
LATEST POLICYIRESULT
NATIONAL
ECONOMIC
STRATEGY: Cut the
deficit in hal f within four
years.
Substantial
Accomplishment
President Clinton signed into law the largest deficit reduction plan in history August
10, 1993. Under the plan: .
the deficit, as a percentage of GDP, will be cut by more than one-half from 4.9%
in 1992 to 2.4% in 1995;
the deficit will drop by more than S700 billion. dollars over 5 years; and
.the deficit will drop 3 years in a row for the first time since Harry Truman was
President
PUTTING ~RICA
TO WORK: Ask the very
wealthy to pay their fair
share of taxes.
Substantial
Accomplishment
Income tax rates were raised on only the top 1.2% of tax payers - joint tax-filers
making over S180,000 in adjusted gross income - saw their income taxes increase.
Objective sources - including H&R Block, the Wall Street Journal and the
Congressional Budget Office - confirm that only the top 1.2% saw their income tax
rates increase.
Partial
Accomplishment
Two Clinton Administration initiatives have advanced this pledge:
President Clinton's 1993 Economic Plan added a provision in the Intenial
Revenue Code that imposes a current tax on U.S. shareholders of controlled
foreign corporations that invest their eamings in an excessive amount of paSSive
assets abroad. By reducing the opportunities for unlimited deferral, the incentive
to shift plants overseas is significantly reduced; and
transfer pricing initiatives have reduced the opportunity to shift income to foreign
tax havens.
PUTTING AMERICA
.TO WORK: End tax
breaks for American
companies that move
plants' overseas.
·
·
·
.
·
·
"
PUTTING AMERICA
TO WORK: Eliminate
deductions for outrageous
executive pay.
Substantial
Accompl ishment
PUTTING AMERICA
TO WORK: Crack down
on foreign companies that
manipulate U.S. tax laws.
Partial
Accomplishment
PUTTING AMERICA
TO WORK: Create a
Rebuild America fund
that focuses on
transportation, a national
information network,
environmental
technology, and defense
reinvestment
Partial
Accomplishment
As part of his 1993 Economic Plan, President Clinton signed legislation that denies a
deduction to any publicly held corporation for compensation exceeding SI million
paid to CEOs or certain other high-ranked officers. Some forms of compenSation;
such as qualified retirement plan contributions and performance-based awards
approved by shareholders, is exempt from the cap.
July 1994 the Treasury issued fmal regulations governing transfer pricing. These
rules, backed by severe penalties, are expected to ensure that an accurate amount of
multinational company profits are subject to tax in the United States. In addition: ,
President Clinton's 1993 Economic Plan included a provision that will make it
more difficult for multinational companies to strip eamings out of the U.S.
through deductible payments such as interest; and
the ClintOn Administration has budgeted significant resources t£l the enforcement
of these rules governing transfer pricing.
·
·
·
:
·
·
President Clinton armounced a five-year S20 billion Defense Reinvestment
initiative in March 1993 that is centered on four major areas of ~ investment:
(I) worker training and adjustment; (2) community reinvestment; (3) "dual-use"
technologies with both commercial and military applications; and (4) new civilian
technology investments that provide diversification opportunities
EPA's enacted budget for environmental technology doubled over the FY1993
J?Y1995 period, to SI39 million. Other new funding for private sector
technology partnerships are I) U.S. Climate Change Action Program - $232
million FY1995 enacted - and 2) Partnership for a New Generation of Vehicles
(Clean Car) - $269 million FY199S enacted.
The President'sFY 1996 budget will propose establishing a network of State
Itifrastructure Banks that will allow states to leverage federal funding, thereby
achieving e greater amount of investment from a given level of federal resources.
1
, F,'
.,
."
�PROMISE
STATUS
LATEST POLICYIRESULT
PUTTING AMERICA
TO WORK: Target
funding to rebuild
America's urban
infrastructure,
Partial
Accomplishment
President Clinton's first attempt to fulfill this promise was stymied by Congress.
However, severa) other Administration initiatives target. federal funds for urban
in frastructure:
• $300 million has been appropriated for the new Economic Development Initiative
(EDI) program in FY 1995 that will provide grants to assist with the financing of
ecrinomic development projects; ;!ltd
• President Clinton's FYI996 budget proposal calls for reinventing the Department
of Housing and Urban Development (HUD), which will involve creating new
flexible block grants for community economic development and consolidating a
number of current formula-based and competitive programs.
PUTTING AMERICA
TO WORK: Create a
nationwide network of
community development
banks.
Substantial
AccOmplishment
President Clinton proposed and signed into law the Community Development and
RegUlatory Improvement Act in August 1994 which authorizes $500 million to
encourage a network of new and existing Community Development Banks and
Financial Institutions (CDFIs) across the country. The Treasury Department projects
that the act will:
• lead to approximately $5 billion in new credit- for economically distressed
communities;
• provide financial and technical support for as many as 75 new insured
community development banks; and
.
• support as many as 916 new well-capitalized community development
corporations and over 4,000 community development loan funds.
PUTIlNG AMERICA
TO WORK: Put 100,000
new police officers on the
streets.
Substantial
Accomplishment
President Clinton'S Crime Bill, which he signed into law on September 7, 1994, will
put 100,000 new police on the street.' More than 1,200 communities have already
received grants to hire nearly 10,000 cops.
PUTTING AMERICA
TO WORK: Establish a
national police corps.
Substantial
Accomplishment
The Crime Bill created a police corps to give young people money for college and
train them in community policing. A total of $100 million has been authorized for
the Police Corps program and $100 million has been authorized for in-service law
enforcement scholarships.
PUTIlNG AMERICA
TO WORK: Expand
community policing
Substantial
Accomplishment
A total of $1.5 billion was appropriated in FY 1995 for cities to hire new police if
they agree to establish a community policing plan. As much as 15% of the funds can
be used to promote community policing in other ways, such as, redeploying existing
officers (i.e., through overtime and new equipment), developing new technologies,
and offering specialized training to officers.
PUTTING Al1IfERICA
TO WORK: Fund drug
treatment.
Substantial
Accomplishment
President Clinton is expanding treatment availability through 3 initiatives:
• a $1 billion Drug Courts program in the Crime Bill, for which Congress
appropriated $29 million in FY1995;
• $383 million authorized by the Crime Bill to treat offenders in prison, including
$270 million in formula-based grants for states (these funds will be available in
FYI996); and
• a $42 million increase in the Substance Abuse and Mental Health Services Block
-
Grant
PUTIlNG AMERICA
TO WORK: Expand boot
camps.
Substantial
Accomplishment
The Crime Bill includes a grant program for state corrections agencies to build and
operate correctional facilities, including boot camps, to ensure that additional space
will be available so that violent offenders can be and will be incarcerated for an
adequate amount of time.
PUTTING AMERICA
TO WORK: Create urban
empowerment zones.
Substantial
Accomplishment
President Clinton proposed and signed into law legislation for empowerment zones in
August 1993 that will award $3.S billion to 104 empowerment zones and enterprise
communities. President Clinton announced in December 1994 which communities
will be designated Empowerment Zones in 1995: (I) 6 urban communities will each
receive $100 million in block grants and business tax breaks; and (2) 3 rural
communities will receive $40 million in assistance and block grants.
2
�PROMISE
.LAlEST POLICY/RESULT
STATUS
PUTITNG AMERICA
TO WORK: Improve the
Community Reinvestment
Act (CRA).
Pending
The federal banking regulatory agencies, at the request of the Clinton Administration,
are in the process of approving final regulations which will:
• provide clearer and more objective evaluation standards;
• eliminate unnecessary documentation requirements; and
• improve the consistency of the Community Reinvestment Act examinations and
enforcement efforts.
PUTITNG AMERICA
TO W9RK: Encourage
private investment by
providing a targeted
investmenl tax. credit.
Partial
Accomplishment
After originally proposing an increase in the small business expensing limit to
$25,000, President Clinton signed into law an increase to $17,500 as part of his 1993
Economic Plan. The change allows small business owners to expense 75% more of
their purchases of depreciable assets, a measure that small businesses had sought
unsuccessfully for years. The Treasury Department estimates that 1.3 million small
businesses will benefit from the provision this year, and millions more in years to
come. The Administration also has supported private investment by securing a three
year extension of the Research & Development tax. credit.
PUTITNG AMERICA
TO WORK: Help small
businesses and
entrepreneurs by offering
a 50 percent tax
exclusion,
Substantial
Accomplishment
The Administration enacted, as part of its 1993 Economic Plan, a 50% capita! gains
tax exclusion targeted at investments in small businesses. The provision allows I
investOrs who buy newly issued stock in small businesses 'and hold that stock for
more than 5 years to receive a ·50 percent cut in the cap.ita!. gains tax o'n the profit
from the sale of the stock.
PUTITNG AMERICA
TO WORK: Make
permanent the Research
& Development tax
credit.
Partial
Accomplishment
The Administration secured a three-year extension of the Research & Development
tax. credit, retroactive to June 30, 1992 (when it had expired) and effective through
June 30, 1995.
PUTITNG AMERICA
TO WORK: Create a
Civilian Research and
Development Agency.
Substantial
Accomplishment
President Clinton has focused defense-related Research & Development on "dual-use"
technologies by:
• removing the word "Defense" from the Defense Advanced Research Project
Agency (DARPA) name to retlect a new commercial focus;
• working along with the ARPA to launch the Technology Reinvestment Project,
the largest multi-agency technology program ever, to stimulate dual-use
development; and
• increasing budgetary support of civilian-related research & development'For
example, funding targets for the Advanced Technology Program, which takes
economic growth as its sole goal, have increased 'from $68 million in 1993 to
$450 million in 1995.
PUTITNG AMERICA
TO WORK: Open up
foreign markets to quality
American goods and
services.
Substantial
Accomplishment
The Administration has led the following set of successful initiatives to increase
trade:
• signed GATTIWfO into law December 8, 1994 (WTO took effect January I,
1995);
signed NAFTA December 8, 1993, making North America the world's largest
free-trade zone; and
haS won commitments to open APEC markets to free trade by 2020 and all of the
Americas to free trade by 2005.
PUTITNG AMERICA
TO WORK: Urge our
trading partners to
abandon unfair trade
subsidies in key sectors
like shipbuilding and
Substantial
Accomplishment
President Clinton restarted talks on ship building that resulted in an agreement
reached in July 1994 to eliminate foreign subsidies and other unfair trade practices
by 1996. An aerospace agreement is pending.
aerospa~e.
3
�PROMISE
STATUS
LATEST POLlCYIRESULT
PUTTING AMERICA
TO WORK: Pass a
stronger, sharper "Super
301" trade bill.
Partial
Accomplishment
President Clinton reinstituted Super 301 through an Executive Order and has used it
to bring our trading partners to the table. The United States and Japan reached
Framework agreements on government procurement (telecommunications, medical
technologies) and insurance October I, 1994 and on flat glass December 12, 1994.
President Clinton has also demonstrated his determination' to .act under Super 301 by
instituting investig:ltions of the practices governing Japan's' auto parts industry and
China's piracy of intellectual property. Also extended Super 30 I in GATT
legislation.
P~TTING AMERICA
TO WORK: Support a
free trade agreement with
Mexico.
Substantial
Accomplishment
The Administration secured Congressional approval for the largest free trade area in
the world after negotiating labor and environntental side agreements for the North
American Free Trade Agreement (NAFTA).
PUTTING AMERICA
TO WORK: Create an
Economic Security
Council.
Substantial
Accomplishment
President Clinton issued an Executive Order establishing the National Economic
Council (NEC) to help coordinate both domestic and international economic policy
January 25, 1993.
PUTTING AMERICA
TO WORK: Reform the
Office of the U.S. Trade
Representative, banning
trade negotiators from
cashing in on their
positions .
Substantial
Accomplishment
President Clinton signed Executive Order 12834 prohibiting all senior appointees
from. working as lobbyists for foreign governments or businesses within five years of
their employment termination January 20, 1993.
.'
. REWARDING WORK
AND FAMILIES:
Expand the Eamed
Income Tax Credit.
Substantial
Accomplishment
REWARDING WORK
AND FAMILIES: Lower
the tax burden on middle
class Americans.
Pending
President Clinton included in his 1993 Economic Plan an historic expansion of the
Earned Income Tax Credit (EITC) that will:
expand the EITC by $21 billion over 5 years to reward work over welfare; and
provide more than IS million households with incomes 0($27,OOO.or less with
either a new or increased EITC when the program is fully implemented.
·
·
President Clinton has proposed a Middle-Class Bill of Rights that includes a $60
billion tax break for middle-class families that would provide:
a tax credit of up to $500 per child for families making less than $75,000;
a tax deduction for post-high school education expenses of up to $10,000 per
year for families making under $100,000;
an expanded fRA that allows people to withdraw money tax-free and without
penalty for education, medical expenses, or the purchase of a first home; and
a new re-employment program that makes individuals eligible for skill grants of
up to $3,000 and income contingent loans - while consolidating the web of 50
60 federal training programs.
·
·
·
·
REWARDING WORK
AND FAMILIES:
Empower people on
welfare with the
education, training, and
child care they need for
up to two years so they
can break the cycle of
.oependency.
REWARDING WORK
AND FAMILIES; Pass
and sign into law the
Family and Medical
Leave Act.
Proposed
To reform welfare, President Clinton introduced the Work and Responsibility Act in
June 1994 that includes several critical components. The act:
limits welfare for those able to work;
expands funding for training programs and child care to help people get off
welfare as quickly as possible in order to work; and
contains the toughest child support enforcement measures ever proposed.
·
·
·
• Substantial
Accomplishment
\
.1
!
Though President Bush vetoed Family and Medical Leave legislation twice, President
·Cliriton signed this legislation into law February 5, 1993, which offers employees 12
weeks of unpaid, job-guaranteed leave for childbirth, adoption, or personal or family
illness. More than 40 million American workers will be covered under the legislation.
4
�I
PROMISE
I
STATIJS
I
I
LATEST POLICYIRESULT
REWARDING WORK
AND FAMILIES:
Strengthen child support
enforcement.
Partial
Accomplishment
In its fIrSt national push to crack down on deadb~at parents, the Department of
Justice filed 28 child support cases seeking over $1 million in overdue payments in
December 1994, and more than 200 cases are under review. Also, each of the 94
U.S. attorneys has designated a. child support enforcement coordinator, and
prosecution guidelines have been developed to assist them in going after the most
egregious violators.
President Clinton's Work and Responsibility Act, introduced in June 1994,
includes the toughest child support provisions ever. These provisions would double
child support collections to 520 billion by 2000 and place more emphasis on the
responsibility of fathers, regular award updates, and the withholding of wages of
those who do not regularly pay their child support.
LIFELONG LEARNING:
Improve the way parents
prepare their children for
school.
Substantial
Accompl ishment
President Clinton has pursued a comprehensive strategy to helping parents in their
effort to become more actively involved in their children's education:
Accomplishments to date:
signed the Elementary and Secondary Education Act Reauthorization which
promotes partnerships between schools and families that recognize that' each is
mutually responsible for promoting student leaming;
signed Head Start reform and Goals 2000 legislation that expand and enhance the
role of parents in pre-school programs and schools; and
Secretary of Education Richard Riley, at President Clinton's request, is leading a
, national campaign to promote parental participation in their children's education,
which includes gaining the support of religious, community, and business leaders.
·
·
·
LIFELONG LEARNING:
Fully fund Head Start.
I
Partial
Accomplishment
Increased funding for Head Start by $760 million over 2 years that will help improve
program quality and make it possible for thousands more children to participate in
the program.
LIFELONG LEARNlNG:
Fully fund the Women,
Infants, and Children
(WlC) Program.
Substantial
Accomplishment
President Clinton and Congress placed WlC on a full-funding path. Funding is
projected to increase by $610 million from 1993 to 1995 - a 21 % gain. As a result,
an additional one million people will have the opportunity to get the nutrition and
care they need to stay healthy.
LIFELONG LEARNlNG:
Dramatically improve K
12 education.
Substantial
Accomplillhment
President Clinton has signed three acts that will help transform K-12 education: (I)
the Goals 2000: Educate America Act; (2) the Improving America's Schools Act,
reauthorizing the Elementary and Secondary Education Act; and (3) the' Safe Schools
Act. Together, these acts authorize more than $ \3 billion in new support for reform
and will:
codify the national education goals;
encourage states and schools to dev~lop high standards for all students and
schools;
develop comprehensive, bottom-up reform programs, including technology
development, teacher training, and curriculum reform;
cut through tangled bureaucracies in order to get the education system to focus
on enabling students to achieve high standards; and,
enable schools to become safer, with violence prevention, efforts and new security
measures.
Some 41 states' are planning their' reforms right now-and more will follow soon.
·
·
·
·
·
LIFELONG LEARNING:
Provide funds for
violence-ridden schools to
hire security personnel
and purchase metal
detectors.
Substantial
Accomplishment
Passed the Safe and Drug Free Schools and Community Act and the Safe Schools
Act, which provide over $480 million in FYI99S to help schools fight violence and
drug abuse. Schools can use funds for activities such as conflict resolution, after
school programs, and drug prevention programs. Schools can use up to 25% of their
funds to purchase metal detectors, develop safe zones, and hire school security
personnel.
5
','
�PROMlSE
STATUS
LATEST POLICYIRESULT
LIFELONG LEARNING:
Help communities open
youth centers for
teenagers who drop out of
school.
Substantial
Accomplishment
The Crime Bill includes several provisions thai fulfill this promise:
• the Community Schools Youth Services and SuPervision effort will support
academic and extracurricular programs after-school, on' weekends, and in the
summer for children and adolescents (For 1995, $25,9 million will be available
and $567 million' is authorized for 1996-2000); and
• 'the Family and Com:7lunity Ende:vor Schools initiative will improve
opportunities for at-risk children ($11 million is available for 1995 and $243
million is authorized for 1996-2000),
LIFELONG LEARNING:
Develop a national
apprenticeship-style
system that offers non
college-bound students
training valuable skills.'
Substantial
Accomplishment
President Clinton signed the School-to-Work Opportuilities Act on May 4, 1994 that
provides $250 million in 1995 for all 50 states to establish their own diverse school
to-work initiatives,
LIFELONG LEARNING:
Create a national service
program that allows
young people to eam
money for college,
Substantial '
Accomplishment
President Clinton proposed and signed the National and Community Service Trust
Act creating AmeriCorps September 21, 1993, AmeriCorps, within its first year, is
already:
• giving young people the chance to spend a year or more helping those within our'
communities grow safer, smarter, and healthier - while eaming an award of
nearly $5,000 to pay for college or job training;
• engaging 20,000 Americans as AmeriCorps Members in its flfSt year -- more than
, the Peace Corps at itS height; and
• consolidating existitig Federal agencies and supporting local efforts to meet
community needs,
LIFELONG LEARNING:
Offer every AIDerican the
opportunity to pay
college loans back as a
small percentage of
income over time,
Substantial
Accomplishment
President Clinton inoorporated student loan reform in his Economic Plan signed in'
August 1993, which included creating Individual Education Accounts, Individual
Education Accounts will:
,
• enable any student to get loans to pay for college or job training and to repay
them in one of four ways, including ·pay-as-you-go" repayment as a small
percentage of income over time;
• reduce borrowing fees;
• cut red tlipe dramatically since more and more students will be given the option
to borrow directly from one lender; and
• save taxpayers more than $4.3 billion,
105 schools ate already participating in the new direct lending program. Some 20
million AmeriCP'lS wit" be able to benefit nationwide when the ,program is fully
implemented.
LIFELONG LEARNING:
Require every employer
to spend 1,5 percent of
payroll for continuing
education and training,
and provide training for
all workers.
No Action
President Clinton has pursued providing training for all workers in a number of
different ways:
• increasing funding for reemployment services by 150 percent, enabling 400,000
more workers to participate in 1995 than in 1993;
• offering individual skills assessments and help with business start-ups to those
, applying for unemployment services; and
'
• helping states to plan or assemble networks of one-stop career centers to offer
efficient, customer-driven access to counseling, labor-market information, job
i listings, training and education, and other reemployment services (about one-half
: of the states are doing so already),
6
�PROMISE
STATUS
LATEST POLlCYIRESULT
LIFELONG LEARNING:
Streamline the confusing
array of publicly funded
training programs.
Partial
Accomplishment
A substantial number. of the states are in the process of streamlining federal
education and training programs and labor market information~systems through state
design and development of convenient one-stop career centers.
;rhe Administration's education and training agenda for the next two years
includes the following objectives:
consolidate over 50 separate training programs into a set of customer-centered
financing options that put workers in control of their own learning;
boost workers purchasing power through Skill Grants that are big enough to
cover tuition and fees at a commun ity college for up to two years;
provide for common points of access at community colleges so all workers can
get easy access to reemployment services, performance data on training providers,
skills training, and labor-market information; and
.
help states extend unemployment benefits to tho~e dislocated workers who need
retraining.
·
·
·
·
President Clinton submitted his Health Security Act (HSA) to Congress September
1993. HSA called for caps on health insurance premiums.
'HEALTH CARE:
Establish annual health
care budget targets.
. Proposed
HEALTH CARE:
Ensure access to local·
health care all iances, .
comprised of insurers,
hospitals, clinics and
doctors.
Proposed
HEALTH CARE:
Eliminate tax breaks for
drug companies that raise
their prices faster than
Americans' incomes rise.
Partial
Accomplishment
The Health Security Act included provisions that:
create regional health care alliances that will be required to incorporate into the
organization any state-certified health insurer that is willing to enroll all eligible
individuals;
ensure that each health care alliance offers recipients the opportun ity to choose
their health plan and means of payment; and
encourage regional alliances to use prospective budgeting in establishing their fee
schedule.
·
·
·
J
HEALTH CARE:
Reduce the administrative
costs of health insurance
companies.
Proposed
President Clinton proposed and signed legislation. as part of his 1993 Economic Plan•.
that will eliminate drug price gouging. Subsequently, 17 pharmaceutical industry
executives, representing two-thirds of the U.S. pharmaceutical market, agreed to hold
price increases at or below the general inflation rate.
The Health Security Act included provisions which require that m.anufacturers of
drug products rebate part of their Medicare sales to the Secretary of Health and
Human Services, to provide Wl incentive for manufacturers to keep prices at
reasonable levels.
The Health Security Act included provisions which require that:
the National, Health Board develop standardized forms for insurance companies,
including a single claims form;
health insurers accept all those eligible and seeking enrollment, ban underwriting
practices that help seek out the best risks. and prohibit insurers from denying
coverage for those with pre-cxisting conditions; Wld
health insurers charge everyone in a region a community rate that CWl only differ
by family type.
·
·
·
HEALTH CARE:
Streamline the billing
systems of health
insurance companies to
control costs and reduce
billing fraud.
Proposed
The Health Security Act included provisions that:
provide for the simplification of claim forms;
require that Health Security Cards or "smart cards" containing essential he8Ith
information are distributed to everyone; Wld
toughen penalties for fraud Wld abuse.
·
·
·
/
7
�PROMISE
STATUS
LATEST POLlCYIRESULT
HEALTIl CARE:
Ensure that every
,American is guaranteed a
basic health care benefits
package.
Proposed
The Health Security Act called for establishing a National Health Board that would
be responsible for ensuring universal health care coverage through ............................ .
• require that every health insurer provide for all enrollees a basic health care
package that includes specific services;
• ensure that each health care alliance offers recipients the opponunity to choose
their health p!an;
.
• amend the Medicaid statute to specifY that all Medicaid enrollees 'are eligible to
receive long term care covered under their state's medicaid plan; and
• require that all eligible individuals enroll in a private health insurance plan and
pay a share of their health insurance premium; and
• require that each employer pay 80 percent of the health insurance premium for
each employee.
HEALTIl .CARE:
Protect small businesses
from excessively high
health care costs.
Proposed
The Health Security Act requires that health insurers charge those within a particular
region a community rate that can only differ by family type.
A REVOLUTION IN
GOVERNMENT: Reduce
the White House staff by
25% and challenge
congress to do the same.
Substantial
Accomplishment
President Clinton had fulfilled this promise by September 1994: 350 jobs were cut
from a staff of 1,394 during the Bush Administration. However, the new Congress
has only accepted President Clinton's challenge in part. House leaders have promised
to reduce. committee staffs by one-third, with no cuts in personal staffs. The Senate
has cOmmitted to no cuts.
Substantial
Accomplishment
President Clinton issued an Executive Order in February 1993 requiring federal
agencies and departments to eliminate 100,000 positions by ITI995.
Already there are 98,000 fewer federal government jobs than in January 1993.
The Administration is now projecting that 272,900 positions will be eliminated from
the federal workforce over five years, bringing it to its smallest level since the
Johnson Administration. By 1999, the workforce will be the smallest it has been
since the Kennedy Administration.
A REVOLUTION IN
GOVERNMENT:
Require federal managers
and workers to achieve 3
percent across-the-board
administrative savings in
every agency.
Substantial
ACcomplishment
President Clinton signed Executive Order 12837. in February 1993 which requires
that federal government reduce its administrative expenses 14% by IT 1997.
Already, administrative costs are down by more than 3 percent
A REVOLUTION IN
GOVERNMENT:
Eliminate taxpayer
subsidies for narrow
special interests.
Partial
Accomplishment
President Clinton and Vice President Gore established the National Performance
Review (NPR) unveiled in September 1993. At least 90 percent of NPR's
recommendations are already in place, including .the elimination of subsidies for such
goods as honey and mohair.
A REVOLUTION IN
Substantial
Accomplishment
A REVOLUTION IN
GOVERNMENT: Cut
100;000 federal
. government positions
through attrition by IT
1995.
GOVERNMENT:
Reform defense
procurement and foreign
aid.
Procurement reform has been a central goal of the Administration's reinventing
government initiatives. President Clinton signed a Presidential Memorandum on
Electronic Commerce to automate the procurement system in October 1993 and
the Federal Acquisition Streamlining Act in August 1994. Defense Secretary
William Perry has ordered dramatic procurement reforms as well.
The Administration undertook an extensive review and restructuring of foreign
aid programs and policies, which now include democracy promotion as a major
foreign aid priority that includes information and exchange programs as well as
major programs in South Africa, the Newly independent State of the fOlmer
Soviet Union, Central and Eastern Europe and countries in transition. Increased
funding for the National Endowment for Democracy.
8
�PROMISE
A REVOLUTION IN
GOVERNMENT: Ask
Congress to give the
president line item veto
authority.
LATEST POLICY/RESULT
STATIlS
Pending
In the I04th Congress, President Clinton is supporting the strongest version of the
line item veto, with the broadest scope and effective immediately. OMB Director
Alice Rivlin has already testified in favor of the line item veto and Associate
Attorney General Walter Dellinger is also scheduled to testify.
In the I03rd Congress, President Clinton supported expedited rescission authority,
which was adopted in the House but never reached the full Senate for consideration.
A REVOLUTION IN
GOVERNMENT:
Eliminate the tax
deductions for special
interest lobbying
expenses.
Substantial
Accomplishment
A REVOLUTION IN
GOVERNMENT: Stop
the revolving door for top
appointees.
Substantial
Accomplishment
President Clinton has required all top appointees to sign a pledge that they will
refrain from lobbying government agencies within their responsibilities for five years
after leaving office. He has also required senior officials to pledge never to become
registered agents on behalf of any foreign government.
A REVOLUTION IN
GOVERNMENT:
Lobbying reform.
Proposed
President Clinton fought for the Lobbying Disclosure Bill.
A REVOLUTION IN
GOVERNMENT:
Campaign finance reform.
Pmposed
President Clinton fought for the Campaign Finance Reform Bill, versions of which
passed both houses. On the flJ'St day of the current Congressional session, President
Clinton called on the Congressional leadership to quickly enact campaign finance
reform measures.
President Clinton's 1993 Economic Plan repealed the tax provision, dating back to
1962, thatallowed businesses to deduct the cost of their lobbying expenses.
;
9
". ,,-:
�,.
MEMORANDUM
To:
Distribution
. From: Chris Jennings
Jennifer Klein
Date: January 26, 1995
Re:
Health Care Talking Points
cc:
Secretary Rubin
Carol Rasco
Bill Galston
Gene Sperling
Sylvia Mathews
Jeremy Ben-Ami
Attached are the post State of the Union health care talking points. If you have any questions
or concerns, please contact Chris (6-5560) or Jennifer (6-2599).
�Health Care Questiolis and Answers - January 25, 1995
Q.
How is the Administration going to proceed on health care reform?
The President remains firmly committed to providing insurance coverage for every
American and containing health care costs for families, businesses and Federal, State
and local governments. While we did not reach agreement on legislation last year,
there can be little disagreement that the problems remain. As the President stated in
his December 27 letter to the Congressional Leadership and in the State of the Union.
Address, he believes that we should work and take. a step-by-step approach to achieve
these goals.
Q.
Last year the Administration said that insurance reform could not really be
achieved in the abSence of universal coverage. Has the Administration backed
away from this claim?
The Administration has not backed away from its commitment to provide Americans
with real health security. As the President said in his State of the Union address, last
year we bit off more than we could chew. This year we can and should take interim
steps forward. We can address the unfairness in the insuranCe market, make coverage
affordable for children and workers who lose their jobs, give self-employed workers
the same tax treatment as other business€?s, and help families get long-term care for a
sick parent or disabled child. But all of this must be done in the broader context of
eventually reaching univerSal coverage.
Q.
The President says that he believes that we can make a start on expanding
coverage. How will he pay for it?
The Administration wants to work with Congress t~ expand coverage and to ensure
that any proposal can be paid for without increasing the deficit.
Q.
Did the President draw a line in the sand on Medicare?
The President will not allow Medicare to be cut to pay for tax cuts. The President has
consistently said that he opposes new M~dicare cuts outside the context of health care
reform .
.Q.
Will there be a health care reform proposal in the budget?
The President has not yet announced his budget.
�·
,
Q.
Will the President introduce health care legislation?
Everyone knows where the President stands on health care. His goals have not
changed. He believes that w.e must act now to take the first steps toward these goals.
As he said in the State of the Union, the Pres~dent is committed to work in a
bipartisan fashion to put America on the road to health security. He will work with
Congress as Democrats and Republicans develop proposals. ,The President has made it
very clear that he will not give up the fight to guarantee affordable, high quality health
care for the American people.
Q.
What is the Administration's reaction to Senator Daschle's health care proposal?
Senator Daschle's proposal is consistent with the vision laid out by .the President in his
December·27 letter to the Congressional leadership. Both the President and Senator
Daschle want to work with fellow Defuocrats and Republicans on health care reform.
The nation's health care problems have not gone away and it is imperative that we
move forward.
Q.
How do you respond to the recent comments mad~ by senator Dole and Speaker
Gingrich about health reform?
We welcome their desire to work together and look forward to discussing their ideas.
We will be supportive as long as it moves our health care system toward the
President's end goals of cost containment and insurance protection for all Americans.
J
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�,f
,.
.:\
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TALKING POINTS ON HEALTH CARE REFORM -- January 25, 1995
Health reform is still the right thing to do. While there were honest differences of opinion
on some issues last year, and while we know that mistakes were made, we are proud that we
tried to pass meaningful health reform legislation. The problems remain. Without reform,
health care costs will continue to rise and coverage will continue to decrease. American
families, businesses, and governments will pay the price.
,
'
"
The most recent data' available indicates that the number of uninsured Americans rose
by 1.1 million. 84 percent of the uninsured were in working families.
By the end of the decade, health care costs per person will rise by more than 50
percent, from $3,300 in 1993 to over $5,000 by the year 2000.
From 1970-1991, real wages and salaries rose a total of 0.4 percent while spending
for health benefits increased 243 percent.
In 1993, total health benefit costs per employee rose eight percent, nearly three times
the rate of general inflation. And insurers charge small firms up to eight times more
than large firms for administrative costs.
•
•
•
•
We'remain firmly committed. We are firmly committed to guaranteeing health. insurance
for every American and to containing health care costs for families, businesses and Federal,
State and local governments. The President reiterated this commitment in a December letter
to the Congressional Leadership. In his letter, the President outlined his vision of how we
can take, the first steps toward reform.
We can take the first steps on a bipartisan basis. The President noted in his letter to the
Congressional Leadership and in the State of the Union Address that Republicans and
Democrats can and should:
'
·
•
..
•
..
•
•
Reform the insurance market so that Americans no longer risk losing coverage when
they change or lose a job, or a family member falls ill.
Provide assistance to states to establish voluntary purchasing pools to help small
businesses purchase affordable insurance.
Make coverage affordable for and available to children .
Help workers who lose their jobs keep their health insurance.
Level the playing field for the self-employed, by giving them the same tax treatment
as other businesses.
Help families provide long term care for a sick parent or a disabled child.
No Medicare cuts to pay for tax cuts. The President will not allow Medicare to be cut in
order to pay for tax cuts. In addition, the President has consistently said that he opposes new
Medicare cuts outside the context of health care reform.
.
/
�DRAFT
HEALTH CARE BUDGET QUESTIONS:
1. A lot of the good news in your deficit reduction line seems to come less from new
policies and more from just lowering your e§timatesof the Medicare and Medicaid,
baselines. The Administration has in the past bragged about using conservative
numbers but now ,your health care estimates are so much more optimistic than CBO's.
How can you call this conservative?
.In termsof being conservative, I think that our numbers are conservativc. Hcalth care costs
are slowing, the economy keeps improving, the Administration has increased efficiency in
both Medicare and Medicare. The HCFA actuaries -- career staffers at HHS who estimate'
the baseline every year -- just took these new developments into account when doing their
baseline this winter. Their numbers are as conservative as they have always been.
Our difference with CBO over 5 years is only 4 percent of total spending for Medicare and
Medicaid -- a pretty small variation when you're estimating the costs of programs that total
$1.75 trillion over the 5 year budget window. It is not uncommon for the Administration and
CBO to differ by about this much. In fact, the size of this year's difference is about average.
2. How can you explain why the baseline has come down so much? Doesn't this
contradict the Administration's past statements that Federal health care costs could only
come down through comprehensive health care reform?
There are a number of reasons why the Medicare and Medicaid baselines continue to come
down: first, the President's deficit reduction package and economic program have improved
the economy and brought down inflation; second, there have been programmatic changes to
both Medicare and Medicaid that have improved efficiency and brought down costs in the
programs; and third, new data and empirical evidence have given the HCFA actuaries
the
career staffers at HHS who estimate the baseline every year -- a better picture of what's
going on out there. As better information shows that Medicare and Medicaid costs are rising
more slowly than was previously projected, the HCFA actuaries reflect these changes in their
baseline estimates.
While we welcome the reduction in growth in sp'ending in the Medicare and Medicaid
programs, growth in these programs is still too high. As we have stated in the past, cuts in
the Medicare and Medicaid programs need to take place in the context of comprehensive I
health care reform in order to avoid cost-shifting to the private sector, particularly to small
businesses. That is why the Administration remains committed to expanding coverage -- and
has asked this Congress to take the first steps by covering children and helping workers who
'lose their jobs keep their health insurance:
�3. You say that you should only reduce Medicare and Medicaid costs in the, ~ontext of
overall health care reform, yet you have no proposals to control overall health care
costs. How can .you defend this position?
The Administration remains committed to providing insurance coverage for every American
and containing health cost for families, businesses, and governments. The President has
asked both Democrats and Republicans in this Congress to work with him to take the first
steps toward achieving ,these goals. The President believes Congress can and should:
Reform the insurance market.
Make coverage affordable for and available to children.
Help workers who lose their jobs keep their health insutance.
Level the playing field for the self-employed by giving them the same tax
treatment as other businesses.
Help families provide long-term .care for a sick parent or a disabled child.
As we have always said, cuts in Medicare and Medicaid without corresponding increases in
coverage and' improvements in the insurance market will merely lead to cost shifting to the
private sector, particularly to small businesses. The first steps laid out by the President
include steps to expand coverage and increase efficiencies in the insurance market -- which
are the first steps toward reducing costs in the system.
�.;
/
MEDICARE AND MEDICAID SPENDING SLOWS UNDER CLINTON ADMINISTRATION
Overview
•
Tne President's deficit reduction package and. economic
.program, combined ~ith improved efficiency in Program
administration, have resulted in a significant reduction in
the projected baseline growth in Medicare and Medicaid
spending. Under the Clinton Administration, projected
spending .on Medicare and Medicaid has dropped by more than
$200 billion, and the projected average annual growth rate
has Slowed by 3 percentage points for the years 1994 through
1998.
•
Health care cost growth continues to be a prob~em for both
public and private payers, and more needs to b~done to
address these problems in the context of health care reform.
Lower Projected Growth
Medicare
•
For Medicare, projections of the average annual rate of ,
growth for FY 1994. to FY 1998 were lowered from 12 percent
in the January 1993 baseline to 10 percent in the FY 96
President's Budget.
•
The Medicare program has benefitted from the success of the
Clinton economic program which has produced a slowdown in
both general and health care inflation in the economy.
•
In the"" FY96 President1s Budget, the primary contribution to
lower Medicare projections is slower growth in Hospital
Insurance (Part A) expenditures. The .slower projected HI
growth results primarily from a deCline in forecasted
hospital cost inflation and slower growth in the complexity
of Medicare inpatient cases.
•
The reduction in projected Medicare spending growth has
occurred despite the fact that projected Medicare enrollment
i;; higher than assumed in the January 1993 baseline. Over
the 1994 to 1998 period, w,e anticipate that on average we
will cover almost 700 thousand additional beneficiaries each
year compared to the January 1993 baseline. The reason we
are able to cover additional beneficiaries and still have
'lower projected spending is that growth in projected per
capita spending has been reduced by 2.5 percentage points~
1
�Medicaid
•
For Medicaid, projections of the average annual rate of··
growth for FY 1994 to 1998 were lowered from 14 percent in
the January 1993 baseline to 9 percent in the FY 1996
President's Budget.
•
Recent trends indicate that 1992 may have been a turning
point in the Medicaid program. Federal Medicaid
expenditures grew more than twice the average rate from 1988
through 1992 compared with. the growth from 1984 to 1988.
Average annual growth from 1984 to 1988 was 10 percent,
compared to 22 percent from 1988 to 1992.
The jump in the Medicaid growth rate from 1988 to 1992
can be attributed to m.any factors including
Congressionally mandated eligibility expansions and the
states use of creative financing meCbanismsto increase
Federal payments.
•
The drop in projected Medicaid spending is attributable to
several factors:
Similar to the Medicare program, Medicaid has
. benefitted from both the success of the clinton
economic program.
Lower projections of Medicaid spending also stem from
lower actual State spending, improved economic
conditions, slower projected growth in provider cost
inflation, and slower projected growth of the
population receiving Supplemental Security Income
benefits.
The bi-partisan passage of the. 1991 Provider Taxes and
Donation Law and the successful implementation of its
regulations have had a significant effect on the growth
of Medicaid Disproportionate Share Hospital payments as
well as limiting states'. use of creative financing
mechanism to increase Federal payments.
Improving Program Management, Increasing Efficiency, and
Increasing State Flexibility
Medicare
•
The Clinton Administration has made strides toward improved
management of the Medicare and Medicaid programs. These
items should help to improve program efficiency and
potentially keep spending on a ~lower growth track. For
exam.ple:
2
�Five underperforming Medicare contractors have been
replaced in the past two years. Contractors administer
the program on the state level. strict HCFA oversight
of the remaining Medicare contractors has resulted in
. more efficient provider payments.
Increased efforts by HCFA to combat fraud and abuse
have been successful in making sure that tax dollars
are used for medically necessary beneficiary care.. In
1994 1 HHS's Office of the Inspector General (OIG)
recovered over $400 million through settlements. For
example, a coordinated effort between OIG and several
other Federal and State agencies yielded the largest
health care fraud settlement ever to the Federal
Government. Also, in 1994, the OIG successfully
prosecuted 1,169 fraud and abuse cases, and imposed
1,334 administrative sanctions on Medicare and Medicaid
health care providers who were caught abusing the
system.
•
As with the private sector, more and more Medicare
beneficiaries are choosing managed care health plans.
Building on what we have already done, HCFA is working
on ways to increase the number and types of managed
care options available to Medicare beneficiaries.
Although we do not expect federal budgetary savings in
the short run, our immediate objective is expanded
choice. Managed care options offer many benefits to
enrollees, including reduced beneficiary cost sharing
and coordination of care across an array of providers.
To help ensure that the growth in Medicar~ managed care
produces savingpi we have undertaken several research
projects to.improve our payment methodologies and risk
adjustors.
HCFA is also working closely with the managed care
industry to develop new standards for quality assurance
and public accountability that will further help
beneficiaries make informed choices.
Xe4icaid
•
... Many States, with encouragement and support from our
Administration, are requesting waivers to restructure their
Medicaid programs. This Administration has approved
Statewide health reform demonstration programs in Florida,
Hawaii, Kentucky, Ohio, Oregon, Rhode Island, and Tennessee.
These States are reforming their Medicaid programs by
incorporating managed care concepts, redirecting payments to
hospitals for uncompensated care, and consolidating state
3
�health programs. states are expected to use the projected
savings to expand coverage to previously uninsured
populations. In fact, 530 thousand previously uninsured
individuals have already been covereq. in the States
operating demonstrations.
.
*****************************************************************
•
While we are encouraged by the Medicare and Medicaid
spending reductions that have been achieved in the last two
years, health care costs for both private and public payers
alike are still ~owing too quickly. We intend to work. with
the Congress in the years ahead to find ways that would
strengthen the programs for beneficiaries by improving both
service and cost-effectiveness.
�FEB-07-1995
11: 01
FROM
WHITE HOUSE AIDS POLICY
. TO
94562878
THE WHITE HOUS!
WASHINOTON
.I.
Statement By
Patricia S. Fleming
Na1ionaI AIDS Policy Director
on
Pr1::sidcnt CJ.inton's Piseal Year 1996 AIDS Budget
Febmary 6, 1995
GOOD AFI'BRNOON:
TbaDk you for joining us today.
Today. 1 am pJeasecl to present the President's fiscal year 1996 budget. fur tile Fc.deral
government's response to the BIV/AIDS epidemJc.· .As you will see, thi~ hu¥ rq)n~.'ioCllLs a
forcefUl, foc:used. and dynamic response to an epidemic that bas aJ.ready claimed the lives of
nearly a quaner of a million Amelicans.
.
,
'. Since be toOk office a IirtIe more tban two y~TS agt~, President Clinton .bas sharply
increasecl the Federal response 10 mv and AIDS wbiJe pmvlwllg the .impa.rtant national
leade.r&bip and 1\'x:us that this epidmnic demands in the arr.a.~ of rcscan:h, prevention.
educadont and services.
.
J,
'As a .resuk of these investment.'S, mure Americans are now ICCCiYine the kind of
infomwioD tbey need to prevent the l11ln.... ni!l.!~ioll of HIV. the ~ that causes AIDS. MON
Americans livwg with :mv and AIDS ate rccCiviDg the servicc:;s they need to stay alive and
to eqjoy ~ bd~ quality of life. And mOJe scieatism thaD ever arc pursuing our very
.impo1'tl1lt" goals - OOiler treatmenb for pt.q)lc living with AIDS, a vaccine to prevent
transmillsiun ur HIV t and, ultima1C1J a CUte ~ thU insidiousdi.acase.
Some have asked. why the govcroment isspeDding SO mucl1 on AIDS.. AI a tiDle
",hen allleVel.s of government axe t:eC;wnining bow they do wsiDess. this is a 1egitimaIe
question. .1 believe the facts show vr:;r:y clearly why we oeed this kind of commitmem.
I.
Just last week, the Centers fOt D.i.sc:asc Control aDd Prevemion made dlestl.ft11Dg .
that AIDS is now the leading cause of death for au Americans between the .
qes of 2S aDd 44. what we geaer:llly mer to as tb8 prime of Ute. 1rl1994 alone, nearly
81.000 new cases of A1D~ were.reported in the U.S., accounting tor ne::uly ooe-fifth of the
441,000 casc:s of AIDS. tbDt have been reponed in l11i8 country since tbeepidemic beg-m in
1981. In 1994. an average of 220 Americ:w "ere c:liagnose4 .wlth AIDS every day. .In the
last twelve months, more than 40,000 Americans died as a result of (bell' HIV inff.ct:ion.
acc:ouDtiDg for 16 perceat of AD>S-:r:el:Ued deaIhs since the beginning of tbe q,wemic.
aDDOu.uc.ement
'.
, .
J.
P.02
�,.
FEB-12I7-1995
11:1211'
FROM
WHITE HOUSE RIDS POLICY
TO
P.03
94562878
2
<
In other 'Words, in the. United Stares, an a",er.t~ nf200 IJa.,!lle are d1a811osed with
AIDS every day and more than 100 Am~n~ die or t.his dise:ase every 24 hours.
mv is iIueasiugly affea'1int ynung Americ.an~, including thQ~. who are in·their
teens. A m.:c:.u1 .1'eIX'rt estimate'.! ffutt. of the 40,000 to 50,000 new
intCCtions in the
United !\1)Jlco la.~ )'eal'._ one in four occum:d among peopJe under the age of 20', On.c-half of
new iml'l:1.iuns wen:: antong people under the; age; of 25. As a result ofthesc troubling
trends, it ill dtAr that AIDS will CODtinuc to ",.teak havoc with our next genemtion of leaders
uoless we act dec.i!lively to stem the tide..
mv
Beyond its human toll, AIDS is also ba..ing a severo impact on our economy. People
with AIDS account for a sharply increasing pctcal~ of entitlement program spending by
the Pcdcml govemment. In the coming fiscal year. we estimate that the Federal share of
Medicaid costs for people with AIDS will be 1.8 billion dolla:rs, an increase of 10 peICeDt
over fiscal 1995. S~s will bear a &imilar increase in their sbare of tbls program.
Mc:di!:are will spend approximately 690 million dollars in fISCal 1996, an increase of 15
percent over fl&Cal 1995. The Federal Smployees Health BenefitS program expects to spend
235 million doOm on AIDS care for federal workers and theiI families, an increase of more
than 9 percent.
:- ,
Perhaps the most troubling ~Vhlt!ll~ or lhe Q..'Ollolllk: llupact of AT),,)!; i8 in the Social
Security program. In fi1iC31 1996, Soc.ial SCUJIil), will spend 1.2 billion dnl1aT~.nn di!i3.hility
and other benefltS for pt~..;pl~ livillt: wil.h m:v illld AIDS. ThaJ.'s a 19 perceDt incn:a.sc over
fisca11995. Tn fact, over t.he lasll.wu yea..~, we lJaY~ seen Socia] Security costs iclatcd to
AlD., rise by an l\~toni:;hing 30 percent.
Pre,icient Clinton'~ fillcal J996 budget Tdlects this Admlnistration's continuing
cOllun~tment to
j.
I
fIght the battle a...oainst AIDS on every front .- research, prevention, aDd
services. nli5 budget focuses on some very important goals. First.. it sc:cks to reduce tbc
number of new mv infections in this COUDtry. Second, scientists 'Will. con~ue to examine
the AIDS virus and its impact on the human body 60 that we can lessen th31 etiect and.
eventuaUy.flnd Q VllceiDe ;md a cure. And. third. we will 91Ol'k to ensuru that people UviD.!;
witb H!V and i\II)S have a.ccessto the kind of high-quality cost-effecdve services that they
need to Jive longer and Jive better.
.
There have been some very promising·advances. in- AIDS-relaled tesearch in the last
funded by the National Instimlet of Health have discovered that the use of
AZT during pregnancy and childbirth can reduce the risk of BIV,transmission from inuthe.r
year. SCientistS
to chlld by 67 pe.rc:ent. This is the first time in the history of this epidemic that we've been
able to find a way to :u~nlally blodr tr;m~l11is.sil1n ('If the AmS vims. Sdent.i..tll.at. J3sI. wezk's
ret.rr.lviT.t11'l1tlf:"J.illf in WlishiTlgllm WenHft!fy I:~m:uur"'ft::dhy Ille C3Tly Tesu!l" ur lOtl" ur
pt\'rt.c'a~ inhibitors, a new clu5 of AIDS drug5 that help the body tqHlir its immune system .
.
.•.
�FEB~07-1995
11:02 FROM
WHITE ,HOUSE AIDS POLICY
94562878'
TO
..
.
,tl
P.04
3
We must continue our investment iA'A1DS zesearcb. President Clinton's,budget
includes 1.4 billion dollars for I\lDS research at tbe National Institutes of Health, a five
percent increase over fiscal 199;. 'I'm will allow us to increase our commitmeilt to basic
research uito how the AWS virus wo:rts. It will also allow us to coatinue the vigorous
research into new AIDS drugs and vaccines and to conduct clinical tria,tB of these, agents.
The NIH budget also vJ,iU continue our efforts iDto prevention, including the development of
a microbicide for women.
'
,
Until we are able to find a vaccine or a Cllre for ,HlV, edu(,:,.mon aud p~Vt'.ndl,11l
progr.uns aR\ I)ur only lw~ to slow the spl't'A4d of tWs epideolk. Coml1ll1llity~b;:t,~
prevention prugnans La~e hr~l 10 slow lhe l'ale of ilU«:lioll ,iJl segments \.'If. the POPllll1tion,
Amung Ifd.Y WI2l, sudl t:du(aLiou has re&u]terllu a de.::lin.iJlg peoc.entage of new AIDS r.a,~~
being TqJl.n1.ed ainong gay and bi$e,(uall.lJeIl. III 1994, 111e6e mea accounted fOI fewer than
111M (If new case..... nw's a sharp contrast to only a kw yc;aI5 ago.
PmaidentClinton's fi5a1l. 1996 budget includes 624.7 milli.en dollars for AIDS
education and prevention programs at the: CDC. 'a b J)C'tCQnt increase from. fisco1 1995. Of
this total, 327 million dollars will be spent on national. outrcoc.\l and, edUC4tiOn, tec.bnical.
assistance, and researcb'. The rcmainine 2~~ million dollars will be awarded, through Q, new
Periormanc& Pa:rtn.ership Grant with the states that 1 will describe &hortly.
I
With more than a million Americans livinl,': with mv, it is essential that we provide
the medical and soclal services necessary for them to continue to live independem lives and
retain their health for as long as possible. The President bas made a major commitment to
guaranteeing that an Americans living with HJV have access to
neec1e9 ~ice&. The
Ryan White CARS Act provided funding for more than 300,000 elJenlvlsirsin 1994. In
fisca11996, the President propoliei an additional 91 milliun dollar inm~~"~e, brlngiUg !.he
~yearim.:re:d.Se to 108 pt'.n.~L
these
'11.e 724 million dollar~ I'eqw::.\t..ed. fol' the Ryan "White Ad. will al1ow'u~ to illcll:ase
ur AmmClt~ls livinl wilh HIV whu n:u::ivc om::. II, wi111J1::l1uit all of lhe 42
metropolitan communitie.~ currently receiving Ryan White fonnula cants to receive at least
u mucb as they did in fiscal 199:5 and it will provide enough money to assist ten to fourteen.
DeW cities. It will also pennit us to iD«;:rease assistance to states, .recognizing the growing
impact of AIDS in sr.na1kr cities and rural communities: And it provides funding for
primary care services and care tor women and children with mv.
t~ nllml.,r
In addition to medicaJ and social 6ef\Iices. people Jiving with .lilV and AIDS
frequently need assistance with their housing costS. Early in this epidemic. we saw an
iDQrease in the number of people with .I\IIJS who were forced to live en the street \:Jec4use
tlley could DO longer afford their rent payments. The HousiJ'lg Opponunitiesfor People with
AIDS prognm. or HOpwA, has helped thousands of people find or keep their housing. The
President p.mposes w continue this prognm'and provide aoother 186 million"doIlars in fISCal
1996. SiJ:Jce the PresWeDt twJc office. funding for this program bas increased, by 46 peICeDt.
,I',
�FEB-07-1995
11:03 FROM
WHITE HOUSE AIDS POLICY
TO
94562878
P.05
!,
4
As I mentioDed, the increase in funding for tbe Ryllu While CARE Act bas heJped
thousands of Americang live with HIV. It abo hils 11l~lpal an increasing number of citic:J '
cope with the impact of lhis epideIlik:.
sJelCly
Title I of the Act, whicn pruvkk:s dii'ec-.t assistance to cities
aftOctcd by
AIDS, will recetve 401 million dlllhu~ in nscall996, an increase of 14 pcrecnt over fiscal
1995. Tltle I will :receive more than hilff uf the total bud~ for the Ryan White CAR..li Act.
;,
We;ut!. proposing a 2~,7 million doDar inc~.in funding for Title ll. which
providei assislaru.-e to the ~bltc.'. A5 a result, Title D will receive 221.9 million dolJars, or
31 pe.rcent ur IJIE~ total .
.Title nIB, which provides money to local clinics for early intervention services, will
receive 63 million dollars. an increase of lEd percent.
Finally, Title IV, wbicb provides assistance to women and children with mv, will get
32 milliDn dollars. an incr:casc of 23 peICeDt.
Let me flnisb uP by discussing our proposal to consolidate certain pmgrdT1lN ill tbe
CDC. As you know. this AdminiSuatlOll has been commillwlu Bupl\wing t.he wa.y that the
Fcdeml ~ovemment serves the people of this C(luntry aid (v strengthening the relationship
between Fedem1, State, and local govemmeotli.
. : . In lhe area of AIDS, we have already SI.R!ltglhcn~ our ties with state and local
and cummuoit),-based ocgani7ation~ through'a partnership on educaticin ODd
prevention. The propusoallu I,:vuliiolidate certAin HlV prevention activities with similar
~overnmen's
programs in the a:re'a1t of tulx-.n:ulosis l.".Ontrol and prevention of sexually transmitted ~es
will furtbe.r that (:u(1pt:rnl.iuu. nle collSOlidation will allow us to uni1)- programs serving
similar OT .()v~rlaIJIriJlg llOl,u1atioos and give hxal communi1ic8 greater tlexibility to provide
·OR~Mop ~hOJ,")ping" for needed scrvicca. Most importantly. the new proposal retains the
new r.ommunity planning effort and cvcnwally will expand that approach to 'l'B and.SIDs.
I,
In conclusion, let me say that th1s is II rem~k.able budget. In an era of'Zero-growth
budgeting. the national commitment to figb~ HIV :u'l.d AIDS remain!: very strong. 1bank
you.
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Dublin Core
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Title
A name given to the resource
Carol Rasco - Issues Series
Creator
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Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
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2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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Clinton Presidential Library & Museum
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92 folders in 7 boxes
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Paper
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Talking Points [1]
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Domestic Policy Council
Carol Rasco
Issues Series
Identifier
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2010-0198-S Segment 2
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Box 126
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Format
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Adobe Acrobat Document
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Reproduction-Reference
Date Created
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12/4/2013
Source
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2010-0198-Sb-talking-points-1
-
https://clinton.presidentiallibraries.us/files/original/080be040f39f2fd4d515dda6bd67cc85.pdf
63f4aef9de4404eff9d04ed035e66e07
PDF Text
Text
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CLINTON LIBRARY PHOTOCOPY
�PUI
MAY
I 1995
'1424C}:IESTNUT STREET
PHILADELPHIA, FA 19102
215-981-3700
Fax No. (215)
~81-0435
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�1424 CHESTNUT STREET
PHILADeLPHIA. PI>. 11)102
215·881·3100
FA,X ,,!i.\lR,.()4:\4
April 25, 1995
Jim Slar::tery
Chair, Childhood Di3ability Commission
Wiley, Rein & F·ieldina
1776 "K" St.n::et NW
W03hingtOn, DC 20006
I
RE: Commission Draft Policy
RecomrMmdationSl i Three ProblQms·
Dt;:Cl.!"
J..i.m:
Alt.houah many of the Commission draft recormnendations appear
to be sal utal."Y I . the one, that i5 ,the most far-reaching' in its
deleterious impact on disabled children now eligible for 55I is the
one that: would overturn' the
z~bley
supreme Court: decision and
eliminate the cu:t;rentindividualiz:ed functional asse55ment 5everity
test in favor of a "functionally &quals· sGverity test.,
The propo!al may have the, fCLcile appeal o'f addressing
"functioning", but it is a radical step backward toward the pre
zebley days of broad denials of severely disabled children for whom
there i~ a conoenouo that' they chould bo determined dicablcd.
A. "!unctional' equals" to the Listings test is deficient
because whatever functional gloss is given to the process, the teet
is pegged to the ext.reme severity 'criteria of the 'Listinas which
often manifest in· children ~ conditions where· there is a vil-tual
total 'failure of. treatment; repreSlGntativQ Listings thus .often
I
reQuire "recent and-recurrent" hospit.alizations as the only way to
CIuaIi fy.
This highSev'eri ty, standard was never intended by Congress as
the u.s. Supreme Court ha3 held, to be a fair and legal severity
standard for children. ~he Court repeatedly found that:
I
get
The Secretary explicitlYha5
the medical critGria defining
the listed impairments at a higher
level 'of severity t'hanthe statutory
standard, , .,
When the Scc:reto.ry· developed
the child-di~~hilitylistinas. he
set cheil: medical cd teria att;.he
same level of severity as that of
.the adult.s list-ings.
See 4:l Fed.
Reg:
.
.
14705 (1977), •
�Zeblev, 493 U.S. 531, 532-33, 110 S.Ct. g9:?'~ .~.!'ly :-:r..iljrer:'s t.est
p!=:g;Jp.d at or ec:rual to the Li.st.ings It;vt;b c:' ·seve:.·~ty is
~~~d~meh:al:~ unfair and unjust.
T:"le ,. functic:!al equals" prop()~ol does rni::l.'o:: the =ecent.ly
pe:.sseo!!ouse Republi:=an provieion and may inhibit more c:::.nstruc:tive
ar:c. s~~po::::ive proposal!::: pending now in the Senate. '::or.::::-a!y;:c
;::r.; Gr~oneous as~umpL.i.un of some, the IIc\.:.:se . I<.e~~bH::a::. Wc::Ea.rc
!Jill, :!.R.4, does provide for a pre-Zeb:i.t::'Y . "mp.et" Anr: "AC}t1r=.ls"
Lis:inGl"l t.Ast (although not. qenerallv with a provision fOI' ::.:o::.;ll
benefit..::.;).
The exact languQge (at pp. 255--260 of the bill)
provides in Sec, 602/a) tor a disabil;t.y :-.AS: w:'t!l:
Han impairment that meets th~' .
Listings .' . . or t:hat :i !;p.Quivalem;
in sever i tv to S u~h ll11f,.>d.i !:ment:. ...... .
{eI:'lphasis o.ddedl
This "equivalency" in this House bill Ceili ,L),tuvlde fo:: a Ufl;nctional
2;:r,.;.iv!i~er:cy" policy by the agency.
Thus we can a::curate!y describe
-.:!1e c:or.ll!\issi:m draft .r~.comrnennnt.iDn asthesams c.isabLi..it:.y test as
~~c
r.cuse Republican bill.
'!'he mOSt rev'!!a.lino bM.t.OlT\ lIne impact:. tor ch!.ldren, com!.r.~
3 " !t:.n;:::onalequals" tu LlsLings policy joining a "meets I'
from
~he
:"is tlng3 policy,. 1::; the: :::ecent. concl·.lsio:-; 0: the Congressional
Bt:.dget t;;;=~':.::e that H.~. ~'s "meets or ea:ua':'s" test, elirr.ir.ating t:.he
£;eb:ey If? \:.esr., would tt:tmlnate .abo·.;.t l?i, OCOcfthe ,2:;:5,000 /"
::h::':'o=e:: -now or. SS! ::'hough the IFA test. ]..lthough abou:: 40. OQO f'('i
5C. C0!J. c':·'; 1 r:rAf. ge~tlng 551 via the IFP.~es'::. c~uld :::-equ.a:':'fY,t.;lt;;
oreal: rr.ajor:li...v of IFA ch::'ldr~n would be terr.::'no.:ed
::k!'.ied ::..~ t.he
f·,;c .... re.
.We . can expect: a similer draccr.ia::;. impart frr.m WillT'
"f:.m:-.t.'('in~i equals" propoSal.
I have confirmed· with B~.t.:Y Elgen at
5S.~
Lhc:1L
OU1" nUmber:; .estimate· of
cho:oc terminated under the
"fu:lc,:':'o!".al equals" proposal is' reasonabi.E.
or
'!';'J.ere is simply no l:e:3t:'mony or evidence before che Comrr.ission
broad d~nial of S~T hAnAti~s to children
:ndeed the corrunission Ilt1:::i ht;c:uu Lest.imony from
t11!Hu~1. ollyourw:i..t:nes:!es about. how se·.jercly dicablcdchildren are
now receiving SSI wieh almos;t no reliable ~vid~ncl? of ~hl1~A of t..h(; .
IF7i. t.es: or its allowinQ children with ;:ninima.i Y;U::,.;lt;lll:; LQ l.·eceive·
;0 :ustify· such a
r.lIrrently eligible.
S5:.
':'he draft recomrnenda::icn, if it. hd.S a po:'iticl!21 as:sessment
racner the-nan empiric.:Ii policy baci.::, fa~le: 1:0 take into
acceun: upcoming initie~ivA~ • . esp~cially that of Sen. Kent
:"'or.rad's, intention co im::tuuu.~e d 55I cli.;'ldl.-e:'1's bill that make:;!
::no.ny re:orrr.s similar to many under Commission cohsidGrat.ior:, ~.
si;;rr.':"~:'cant;ly ke~ping the current TFA f.est with some' refinements.
Y~flcsis
I
rt:t:5 a po.l!.tical
asseS~l[lcJlL
Ll1dL H.R. 4 is t:heonlycong:-e:33icnal
2
�vehicle for chanQe is not an accurate one. we cannot believe that
the Commission would want to undermine more delibe~utive, wcll
grounded reform efforts in the Senate.
We currently have 0.
functional, cquale; teet t.hat. co-exist.s,
with t.he' IFA test, but i t qualities relatively few children
accordinq to SSA. 'TYpically <.:hildren with multiple problems each
,of which is evaluated ae "moderate" today would not qualify under
t hlO' pY("lposa L
Thus a Ch,ild wi th cerebral DarSY, wi th an' J.. U. in
ti1(;! Ivw 70's (a hmoderate" in ,t.he cognition domain), wich problem!;}
in walking but as yet without prestribed leg braces (a "moderate"
in the motor domain); and with speech difficulties but not
incomprehensible (0. "moderate· in communication), would not qualify
with a functionally "equals"L.istings t.est.because the List.ings
require multiple "marked" level of !;:!l;lvE:u:ity' fuw,;liuW:l.l .iu1!Jd.ir.1t1tmL::>.
U
II
Similarly, an epill?pt.ir: r:hild. with mental retardation whose
",mode.!d.Le" .incogll.ition) and whose
8,ei :i:ures are frequent over thc year but not weekly (i. e, not at
the epj,lBp~y r,i~tinO'l=: ~p.verity level), is again a child wno would
be denied, but tudQy wvuld l.ikely to be·allowed,
1.0. is in the low 70's. (i.l;l.
I
WP. 1'1l!;("l have great misgi vinO's to recommendar.ion f5 oria family
cap which seems to Ilut, unly address the question of multiple
bcncfitz for the eame·household, which we first brought up, but
nppBaY~ t.("l g("l much t\lrther by attempting to measure benefics solely
QS ndQL(;!d Lu 0 b)o.!L.icular child's special disa'bility related
ncedz., Such a proposal is unworkable and ignores SSI I S long
~ti1nrling purpose to address both basic needs and the child's
sPeclal needs. It i$ unworkQble because calibrating benefit~ for
tens of thousands of families, would immerse the. bureaucracy in
micro-management of farnilybudgetS and a never-ending inquiry into
what constitute~ appropriate ~pecial need:;,.
We also reiterate our ana the CCD opposition to an arbitrary
fluc Cilp on benefits ilnd urga 0. more€quituble declining benefit
st:',hed\lle for mi.!1tlple child h0l1!1l8holds.
Finally, we hav'c ctrong rcc,ervationc abouc :lwitching the 55I
r:hilr1ren 'g ,prcgrarn tc HHS. 'The lat'.I".Ar hA!; nil di rect experience or
SLl.·uCLUl.·e In dll.eCL o.dm.in.isu:d.L.ion vi Cl mCl~:S gI":l.Tlts benefit
programl ite welfare programs are fitatc admini8tered.
The
proximi t:.y in HHS f:('') (''It.hAr hAl'll t:h ;;nt'l 80el a 1 servicll? programs ha,s
W;:V\i;L In Lh\; Pd.:;;L o:;;:;;u:t'l;ld <:lIlY liuk-up::; with these services i a SSA
adminietered SSI program can link-up with other programs if there
is A legi!=.li'lr,i.vA fl("llir:y c'iir8ction to do so.
'Placing 'the S5I
children's program in HHS will risk it, aettinq lost in a larger
bureaucracy and putting it at greater risk of being "block granted~
to 'the states whic::h, w!")u] (j he a m~jor. step backward in insuring
national UJ1,l LO!flli Ly , <:lJ.H.1 mini1l1uIll standards' - the whole point: of
the SSI,la~ in 1992 that Precident Nixon ~dopted.
3
�CO ...... UNITY
LliLc.... 1..
Sr;;'QVICIltJ:.
In conclusion we tz:·u::IL1.h"'L 1.he Commiss.i.on will -lwt rush inLo
recommended policies without. ccmsideration of 'the above
~(,:lT'l~idp-rati0ns.
Too much is' at stake'· for too many deserving
t;.:blldrell.
Thank you for the opportunity to consider these
a
concerns~
•
N'~1'H~N
M.
S'T'P.TN
GeIlenll CoumH::l
JMS/dof
cc: CommioGion McmbarG
Elaine· Fultz. Statt Director
4
..
Ir-Ic.
�~NffY
. 1424 ChESTNUT
ST~EfT
Pl1ilADElPHIA, PA 19102
.SErwicES"NC.
Jim s:att:e:ry
Ch,::d. :::r.Cl:::, ~:hi Idhc<:,d !Jisal:: :.li I.y CClHunl:::;;:; i<.:n
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~!:commer.cla t i(;ns; f"),.iL I.!I
Ct;;(l!.
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Jim:
cmd CorranlsElon Jr.embcn::· ~f Acril ;:5
,na j or pl';)b:-.;m wi r:h tt:e dra ~ t ." pn~ j ! 01 in,; ry II
:t'-?CC~I~·,p.'\f;nd.:..t.ionc: itl'3' 3tc.tement of purp6~",,:s; l.imiting th~ l:-l!vg:..:;:n
t ) i'ne:?r.:ng r.h~ ·~:<,:,Y·.:;cl)sts" of caring' f;:;.r tha disabled chil'i
·,<io'.1:d br.i.n\,j· duuul d J~,j~£al restruccurinQ ot t!:e SSI r.hi ;dn:;!"",a.
p~·ogt"a!T\.
:>hc p::opc:ial igr,ores the I'edl wcd,d of pI)ven.YChaL L1l~:::;e
'fa:-r.i1:'-::s 1 i'/p. ~ n ;;~',d rendi;".fJpropr;sals in C,:mgrGss thai:: ·....ould
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",:;:<tra ccscs ,
but ...' ll:;Qr..hc b.::l:3:'c neces tie:s of life of ci.iba;·,i:~";
cr.: l.dren, Tr.deF:<"!. Sr.;!":·">t: (H' K~nt: C"nrad 's furthccming SST r",f..:>rm
bill, ,t::-:ac 1~e,6n!1\.:'J[1.~~:J u:,K1ay ~eCore the 5:::10:':; ci:1-=r1ceC'::.rr.rni".·.€i:,.
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Dublin Core
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Carol Rasco - Issues Series
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Domestic Policy Council
Carol Rasco
Issues Series
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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92 folders in 7 boxes
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SSI: Kids
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Carol Rasco
Issues Series
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Box 126
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
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2010-0198-Sb-ssi-kids
-
https://clinton.presidentiallibraries.us/files/original/23989168b8e79c3c06bb2c302cd41d6c.pdf
310c8ce98947f8aaed0a56381fca6e7b
PDF Text
Text
Carol: '
Attached is a packet of briefing ma1terial for the SSI meeting
tomorrow with Frank Raines and Shirley Chater.
. ~s,
"
Th e purpose'o f t h i as I un erstand ~t,. to come to some'
e meet ng, d I
agreement on what the options are here .;. - and not to make a
decision, since this is clearly one lof several issues that OMB
feels should be bundled and sent to the President for his decision.
The papers attached are:
1.
A draft white paper/memo by OMB staff. I believe Ken intends
for this to serve as the basis fot the ultimate decision memo.
(At the moment, it is far too t~chnical for that.) It is a
good document for you to'use tol recall the ins and outs of
this complex process.
I
Unfortunately, I was just hander the latest draft of this
paper by OMB 3 minutes ago, sq I have only looked at it
quickly.
The previous version, I which, I commented, on last
night, had a lot of useful description and information in it,
but I did not think it presented ithe facts entirely fairly -
it was a bit skewed toward the argument that we should take
the tougher standard of 2 markedl
'
e,
It ignored the fact that a group I of Senate 'moderates crafted
the new definition with an eye toward preserving SSA's legal
latitude to use" a standard below listings level.
We were
,
I
aware of this 'effort.
The memo presents it, as if the
advocates' position has come tot~lly out of left field, which
is not, the case.
It also doesn'l t convey that the advocates
know we have the legal latitude to do l marked, 1 moderate;
and that, if we don't, they will loudly blame us, not the
Congress, for cutting 100,000 orl more kids from the rolls. '
(I will email you if I see any significant concerns in the new
version of this white paper/memo,. )
The paper
pre~ents
4 options:
I
o
A straight "2 marked" standard, with no modi fica tions (no
one is advocating this optirn)
o
2 marked, but adding a new tjmotor domain" and a new form
that will heighten attent:f.on paid to the functional
assessment at the listings u.evel ("functional equals").
This is the option I got cortcerned about; it is what SSA
favors, and perhaps Ken aslwell.
One concern here is
that the advocates are not likely to believe that the new
form will make any differenbe, while SSA thinks it will
allow many more children tol remain on the program.
o
1 marked, 1 moderate (the advocates' proposal).
�o
Same as Option 2, but seeki legislation to grandfather
kids now on, the rolls or at least to delay their cut
offs.
Ken likes this oP~ion: since it depends on
legislation we will probably never get, I don't.
2.
Some material from the "SSI cdalition": it includes some
examples of children who could lbse eligibility (1 marked, 1
moderate) .
I
. .
3.
The colloquy on the Senate floorlthat many advocates point to
as evidence for their argumentth~t the Senate's intent was to
"tune up" the program, and not change it more significantly.
4.
A few charts from a report by th~ National A~ademy of Social
Insurance that give useful information about how the
disability determination process I works.
At the moment, I think we should push the advocates' proposal, but
I recognize we may not succeed. I thirtk it is just as well that we
do not put compromise options on the table at this point, because
we will just get watered down from thrre.
I
I still think it would make the most sense to select an option that
is somewhere in the middle, so that it isn't this tiiack and white
decision, and so I am continuing to t~y to develop such an option.
Ideally it should be based on clf.nicalfindings in some way.
However, it isn't easy because SSA reJects every idea, and has no
ideas of its own.
However, I had a very good conversation today
with Jim Perrin of the American Acade~y of Pediatrics. AAP is not
as wedded to the 1 marked, 1 moderate position as the other
advocates. He talked very frankly with me about 'how to change the
domains, suggesting that in addition Ito adding a motor domain we
could also add an "activities of daily living" domain that would
pick up many of the most compelling cases •. He doesn't think this
is such a major thing to design, and he does kno'w·a fair amount
about SSA and its processes.
I will keep working on this .
before the meeting ..
Let me know if you need anything else
-Diana
�WHITE PAPER ON NEW DEFINITION OF CHILDHOOD DISABILITY FOR
I
SUPPLEMENTAL SECCURITY INCOME
ISSUE: The welfare refonn law provided a new generLdefinitiOn of childhood disability for
the Supplemental Security Income (SSI) program intended to tighten eligibility requirements.
I
Both the Congress and the Administration proposed tightening the requirements with virtually
identical language. However, the statutory language is Inot precise. The Office of General·
·CQ.unsel at the Social Security Administration (SSA) believes that SSA has substantial discretion
in drawing the eligibility line.
The President's FY 1997 Budget Request proposed the new childhood disability provision as
part of a larger welfare reform bill with estimated savings of $8.4 billion over the six-year period
from FY1997-FY2002 and $1.9. billion in FY 2002. T~ese savings were based on OMB's
understanding at that time of where SSA would draw the line in tightening the eligibility
requirements. SSA also advised CBO of its intentions. When the legislation was enacted, the
provision was scored at these levels.
Given the potential for SSA to exercise discretion in this area, this paper provides four options
for drawing the eligibility line that differ considerably ih terms of how many children will lose
benefits. Option 1 represents the position on which the Iofficial scoring was based. Thus, from a
budgetary perspective, choosing any of the other three options, each of which represents looser
eligibility requirements than Option 1, has costs over tHe six -year period' and in 2002, the target
I
year for balancing the budget. Attachment 1 is a chart sum:marizing the impacts of each ofthe
four options.
The decision will affect both current recipients and ne,"; applicants. Under any of these options,
current recipients would not begin to lose benefits before July 1997. However, soon after a
decision is made, SSA can begin to process new claimsf Approximately 1,500 cases per day
have been held since enactment in August, pending a resolution ofthis issue. In addition, there
.
is a statutory deadline of November 20, 1996, for SSA to promulgate rules codifying the new
definition, although implementation can begin prior to Juch codification. The first three options
I
we have identified can be implemented immediately. l1he fourth can, in part, be implemented
immediately, but also would require legislation.
,
BACKGROUND: Under, SSI, an individual under the age of eighteen with physical ormental
impairments of sufficient severity may be determined disabled for purposes of receiving means
tested cash benefits. Prior to enactment of welfare refotm, a child was considered disabled under
the law if he or she had an impairment of "comparable Iseverity" with that of an adult. This lack
of statutory specificity in the mid-1970s gaveSSA considerable flexibility to implement the law.
In response to a 1990 Supreme Court decision (SullivaJ v. Zebley), SSA established an additional
step (known as the Individualized Functional Assessmeht or IF A) to the disability determination
process that it h~d established that allowed for a determ'ination of disability at a lower level of
�e·
severity than was in place prior to that decision.
Prior to the establishment ofthe IFA in 1991, there we~e 300,000 children on the rolls. Today,.
approximately one million children are receiving benefits. The growth has been attributed
I
mainly to a combination of the effect of the Zebley decision and an expected expansion in the
.
I
number of children with mental impairments on the rolls asa result of changes to SSA
regulations. If there had been no change in the law, SSlf\. estimates that the rolls would have
.
'grQwn to 1.3 million by FY 2002.
I.
.
Since the IF A was put in place, there has been a perception by many that the standard of severity
had been lowered too far. This perception has been reflected, in part, by media reports on
children receiving "crazy checks," Le., SSI payments f6r exhibiting behavioral problems
significant enough to qualifY for benefits under these ldwer standards. Although neither SSA nor
GAO has found any evidence of unqualified children bbing found eligible, the appropriate
threshold for eligibility clearly became an issue.
I
Under the new welfare reform law, a child is disabled ifhe or she has an impairment which
I
results in "marked and severe functional limitations." The new law also explichly eliminated the
IFA. By this action, Congress most clearly signaled itsl intention that the eligibility standards
.
I
should be tightened.
To understand the options better, a rudimentary discussion of the determination process is
helpfuL The specialized terms used in the options have: become familiar enough to
Congressional staff to allow them to appear in letters sent to the President by a number of
Senators and advocacy groups. Attachment 2 provides la brief description of the disability
determination process and the terms used in describing ktandards of severity.
OPTIONS: Below is a brief description of each OPtioJ
elimina~e
Option 1-- Significantly tighten eligibility -the IFA arid make no other changes.
An estimated 190,000 children currently on the rolls wduld lose benefits by September 1997.
.
I
This option is consistent with the assumptions in the FY 1997 President's Budget and, therefore,
.
I
has no cost in FY 2002 or over the six-year period from 1997-2002.
SSA would clarify the current procedures and regulatioL related to the detennination process
and eli~inate the IF A as required by the new law. ExJept for elimination of the IFA,
determination procedures would be essentially unchanged. The level of severity would be what
is known as "Listing level" or "two marked" (see Attachment 2).
Analysis: Option 1 is arguably closest to CongreSsionJI intent, as shown by the amount of
savings scored by CBO and 0 MB duririg the debate on ithis issue and at the time of enactment. It
is also the option with the largest impact and does not take advantage of SSA' s existing
I
regulatory authority to make changes to the disability determination process independent of the
2
�welfare reform bill.
Option 2 -- Tighten eligibility by eliminating the IFA, but modifying current process. An
estimated 145,000 children currently on the rolls woul4 lose benefits by September 1997. This
option would cost $0~6 billion in FY 2002 and $2.0 billion from FY 1997-2002.
After eliminating the IFA, SSA would modify the cuJnl process by adding a fifth "domain" 1.0
'the. four mental disorder-oriented domains currently usJd for the "functional equivalence"
,
I
evaluation described in Attachment 2. The fifth "domain" would be a "motor domain." The
I
addition of this physical disorder-oriented domain would ensure greater consideration of
limitations caused by combinations of physical impairnients. The level of severity would be
"Listing level" or "two marked," with the "motor dom~in" essentially providing an additional
I
opportunity to have a "marked" limitation in a second domain. In addition, SSA would put in
plage a standard forin that adjudicators would be requirbd to fill out when making their
determinations. SSA believes that this form would probote greater uniformity in decision
making and lead to more allowances than would otherJise occur.
,
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Analysis: Option 2, by adding a "motor domain" and ~romoting the greater discipline and
uniformity in the process that would result from the stahdard form, would be consistent with a '
policy to tighten eligibility ,and help ensure that a signiticant number of severely disabled
I
,
children are found eligible, without lowering the standard of severity below that explicitly
identified in the Conference Report as appropriate und~r the Listing. Independent of the passage
I
of the welfare reform legislation, these are changes that' make programmatic sense, at the same
time that they have the effect of reducing the number of children who would lose benefits
compared to the first Option.
I
Option 3 -- Tighten eligibility some by eliminate the IFA, modifying the current process,
and adding anew additional step with a lower severity standard. An estimated 45,000
children currently on the rolls would lose benefits by Sbptember 1997. This option' would cost
$1.5 billion in FY 2002 and $6.6 billion from FY 1997j2002..
.
. . .
.
.
I .
After eliminating the IF A, a new additional step at a "lqwer-than-listing level" of severity would
be included in the determination process. SSA's General Counsel believes that the legislative
,
I'
history can be read to allow for such a new step. In order to distinguish this option from the
I
process prior to the new law, the severity standard would be higher than the IF A standard. The
I
standard proposed by the advocates of "one marked and one moderate limitation" accomplishes
this purpose in a manner that can be immediately impl~mented.
'
I
Analysis: Option 3 would put SSA in the position of defending a much lower threshold than
was anticipated by either the Administration or the Codgressional conference committee at the
time of enactment. However, SSA believes it would b~ legally defensible to create a more
lenient test that would drop fewer children from the rolls. Given that SSI cash benefits link these
children to Medicaid coverage, and that the welfare'ref6rm bill simultaneously makes many other
3
�changes to the welfare system that could affect these families, it could be argued that it is
appropriate to err on the side of SSA using its legal disbretion to keep more children on the rolls.
At the same time, Option 3 risks going so far that it mi~ht revive the "crazy check" stories that
appeared in the media. To that extent, there is much Ids risk to Option 2 in terms of criticism
I
from Congress.
I
.
Option 4 -- Tighten eligibility as in Option 2 and propose legislation to phase in the new
"rules for current recipients. An estimated 145,000 children currently on the rolls would.1ose
benefits by 2002 as a result of continuing disability reviews. This option would cost $0.6 billion
in FY 2002 and $3.9 billion from FY 1997-2002.
I
Under the new law, current recipients who are on the rolls as a result ofthe IF A are to be
reviewed under the new definition no later than one year after enactment (August 1997). No
child currently on the rolls would begin to lose benefits! before July 1997. Under Option 4, the
eligibility rules would be tightened as in Option 2 and legislation would be proposed to phase in
I
the new rules for current recipients, such that those chilaren on the rolls as a result of the IF A
would not be subject to immediate review. These children would be reviewed under the new
rules at the time of their regularly scheduled continuing disability reviews.
I
Option 4A -- Tighten eligibility as in Option 2 and propose legislation to "grandfather"
,
I
current recipients from coverage under the new rules. No children currently on the rolls
would lose benefits. This option would cost $0.8 billioh in FY 2002 and $4.8 billion from FY
1997-2002.
As a variation on Option 4, the eligibility rules would be tightened as in Option 2 and legislation
would be proposed to "grandfather" current recipients, such that those children on the rolls as a
result of the. IF A would never be subject to the new rulJs, also eliminating any requirement for
immediate review.
I
Analysis: The number of children affected differs signi!ficantly betWeen Options 2 and 3.
Despite repeated efforts, SSA has so far been unable to iidentify an option that could be .
developed and implemented immediately that falls between these two in terms of the effect on
children currently on the rolls. Option 4 could serve aJI a compromise solution in terms of how
.
quickly children currently on the rolls would lose benefits. Option 4A would be even more
protective of children currenty receiving benefits. HoJever, both of these options would require
legislation, passage of which would be uncertain.
In this paper and the first two attachments, the options have been discussed in terms of the .
number of children who could lose benefits and the costs of the options in relation to savings
anticipated at the time the bill was enacted. Attachment 3 provides a brief summary. of which
I
.
interested parties might provide support or opposition for each option.
Attachments (3)
4
�e
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e
Attachment 1
COMPARISON OF OPTIONS FOR DETERMINING SSI CHILDHOOD DISABILITY UNDER WELFARE REFORM
.
r-"--""-----~·"""·-
-
. - - " - . - - - - - ...,,"
SEVERITY STANDARD
FOR DISABILITY
REDUCTIONS IN
NUMBER OF CHILDREN RECEIVING SSI
PAYMENTS
SSIAND
MEDICAID
COSTS
FROM
1997·2002
EFFECT OF OPTIONS ON OUTLAYS
IN 2002
CURRENT RECIPIENTS
REMOVED FROM ROLLS
BY SEPTEMBER 1997
(down from LO million before
welfare reform}
IN 2002
(down from 1.3 million
before welfare reform)
190,000
250,000
-TigntenEIigil5ility;"Modify
Determination Process
145,000
185,000
$2.0 billion
65,000
$0.5 billion
Add New Step with Lower
Standard than Options 1 or 2
45,000
50,000
$6.6 billion
200,000
$1.5 billion
Same as Option 2, but Slow
Phase·in of Current
Recipients
0
175,000
$3.9 billion
75,000
$0.6 billion
Same as Option 2, but
"Grandfather" Current
Recipients ...
0
110,000
$5.8 billion
140,000
$0.8 billion
,._.
"Additional Eligible
Children
Additional SSI
and Medicaid
Costs
~
Option 1
-Option 2
Option 3
! Option 4
~
Option4A
---
Significantly Tighten
Eligibility
0
0
�Attachment 2
I
DISABILITY DETERMINAIfION PROCESS
The disability determination process involves first identifying whether a child's
impairment can be found to "meet or equal" the numer?us impairments in SSA's IOO-page
tabulation of medical impairments (known as the "Listing of Impairments"). If a child's specific
''impairment(l) is not found in the Listing and (2) is not found by an evaluating physician or
psychologist to "medically equal" an.impairment in thdI Listing, the individual may still be
•
'
detetmined to be "disabled."
I
In this third step, he or she can be found to have an impairment that is "equivalent" to the
listing by an evaluation of the functional limitations ca~sed by the impairment in a number of
I
"domains" (or,functional areas). These four "dOmainS"! include personal behavior, social
behavior, cognition/communication, and concentration. In these cases, the disability
determination hinges on the level of severity ofthe funytionallimitation. Individuals are found
to have impairments "equivalent" to the Listing if they have "marked" limitations in at least two
of the four "domains"-- the "two marked" criteria has bbcome known as "Listing level severity."
The IF A essentially added an additional step similar to the step above, but allowing for eligibility
,
•
I
,
if a child had "one marked and one moderate limitation,' or "three moderate limitations."
It has proven very difficult to generalize about the children who do or do not qualify at
different levels of severity. The most meaningful distirlction appears to be from the perspective
ofthe decision maker determining whether or not the cfuild meets the eligibility requirements.
The decision maker is typically a State employee working on a claim in a State Disability
Determination Service office or an SSA Administrativ9 Law Judge adjudicating an appeal. The
attached table identifies some of the key differences between "moderate" and "marked" ,
limitations.
' I
'
,
The key point of the table is to illustrate the difficulty of the decision as to whether a
child's limitation in a given domain is "moderate" or "..harked." The core question is whether a
particular problem or limitation is "occasional" or "occ~rs sometimes" (and therefore is
"moderate") or whether the problem is "frequent" or "pbrsistent" or "constant" (and therefore
"marked"). The broad range ofjudgment involved in the determination that a given limitation is
'''moderate'' leads to the vast difference between the estimated effects of Option 2 and Option 3.
1
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Attachment 2 -- Table
Examples of Moderate and Marked Functional Limitations
CHILD #1 -- MENTAL IMPAIRMENT
14-year old boy with mild mental retardation who does not
have specific medical findings to meet listings
CHILD #2 -- PHYSICAL IMPAIRMENT
12-year old girl with juvenile rheumatoid arthritis who does
not have specific medical findings to meet listings
Example of Moderate in Personal Domain: can be on his own
only in familiar places; can only handle small amounts of
money; has to be reminded of personal care at home
Example of Moderate in Motor Domain: occasional pain and
stiffness in knees and ailkles limits walking when pain occurs;
unable to run; is sometimes symptom-free; sometimes has
general malaise from illness artdmedicatiori
Example of Moderate in Social Domain: has only occasional
difficulty maintaining relationships with children his own age
_ _ _ _ _ ,_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1
Example of Marked in Personal Domain: gets lost when on
his own; can't handle money; requires close supervision at home
for bathing and dressing
Example of Marked in Social Domain: has serious difficulty
maintaining relationships with children his age
Example of Moderate in Personal Domain: pain and stiffness
in wrist are less frequent and severe; when they occur, cause
som~ difficulty in self-'care activities such as eating, dressing,
toileting
Example of Moderate in Social Domain:_when_symptoms_are_I _ _ _ __
present, tends to be irritable and avoids interacting with people.
Example of Marked in Motor Domain: frequent pain and·
stiffness in knees and ankles requires cane to walk; unable to
run; is rarely symptom-free; frequent general malaise from
:
illness and medication
Example of Marked in Personal Domain: frequent pain and
stiffness in 'Wrists causes serious difficulty eating, dressing,
toileting, etc.; is rarely symptom free
Example of Marked in Social Domain: Because of frequent
illness and symptoms, is depressed, irritable, and socially
withdrawn
�i
I.
Attachment 3
I
IMPLICATIONS OF OPTIONS
Option 1 -- The tightest definition of childhood disability is consistent with assumptions made by
I
both the Congressional Budget Office and the Office ofI Management and Budget when scoring
.
this provision of the welfare reform bill. It represents the position we believe the majority of the
'R~publicanconferees would say was intended by the change in the law. This position is
reflected in the language of the conference report.
Option 2 -- The modifications to the. regulation envisiot;ted by this option represent the Social
Security Administration's best efforts to identify an option that moderates the effects of the
legislation without significantly reducing the.standard df severity for eligibility childhood
disability benefits. The expectation is that a majority of Republicans would not see this proposal
I
as contrary to the spiritof the conference agreement, while advocacy groups would see it as an
effort to atleast recognize the problems of severely disabled children with multiple physical
impairments who would not otherwise qualify for the r~lls. However, advoH~y groups
.
and Senate moderates could be expected to find either Option 1 or Option~~Ceptable.
/
Option 3-- The loosest definition is favored by various!advOCaCy groups. It is also being
championed by at least five Senators (Daschle, Conrad, Chaffee, Cohen, and Moseley-Braun).
.
I , ·
The rationale for this option comes from the position of advocates and some members of
•
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Congress that the Congress did not intend to establish ahigh severity standard; even after
eliminating the IFA. While this position relies more oriI what the conference report does not say
.
than on what it does say, it is not inconsistent with the SSA General Counsel's position that this
option is within SSA's regulatory discretion. There wo;uld undoubtedly be significant negative
reaction to this option from the Republican majority ana it could be represented as negotiating in
bad faith.
Options 4 and 4A -- Proposing legislation either to slow the phase-iIi for or to "grandfather" ./
I
current recipients has not been discussed outside of the IExecutive Office of the President. The
formulation for how long children currently on the roUJ who might be found no longer eligible
would continue to receive benefits was the last item ofhegotiation between the Administration
and the Republican majority in this title of the welfare teforn:l bill. These proposals would
represent an effort to undo that part of the negotiations.1 To be satisfied with either of these
proposals, advocates would have to perceive it as the best they could get under the
circumstances. From SSA's perspective, passage of le~islation would eliminate one of the
thorniest of the implementation issues -- reviewing a latge number of children in a relatively
short period of time.
�THE SSI COALITION
FOR A RESPONSmLE SkF'ETY NET
,
, ' I .
"
'
SUPPLEMENTAL SECURITY INCOME FOR LOW INCOME ELDERLY AND PEOPLE WITH DISABILITIES
I
I
205 West Monroe Street. Chickgo, IL 60606-5013
Telephone 312.223.9600 • F~ 312.263.3846
OCTOBER
r
2 , 1996.
'0
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1-
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-6
J.J- ~
WHO ARE THE· CHILDREN WHO WILL BE f:!1lT OFF CHILDREN'S SSI
\.
,A
nP
DISABILITY BENEFITS WHEN THE DISABILITY STANDARD IS AMENDED TO \~V.
DEFINE CHILDREN WITH IlMARKED AND SEVERE FUNCTIONAL LIMITATIONSII
!
The Clinton Administration is Iconsidering' at ,least two
radically
different
standards
that
the
Social
Security
Administration (SSA) will apply to determine disability for
children seeking Supplemental 'Security Income (SSI) benefits.
The first standard, drafted by
dis,abilities, defines disability for
while
iminating the Individualized
test:
'.
•
advocates for children with
lchildren seeking SSI that,
Functional Assessment (IFA)
I
recognizing the statutory mandate ,for a II functional
limitations II test, providesja new step that explicitly
considers a child's functional limitations and ,sets forth
different areas in which to measure that child's
funct ioning i 1 and
'
provides that children with at least one marked
impai'rment and one moderate itnpairment in different areas
(or domains)
functioning kill be found disabled.
This standard (II one marked and one moderate impairment test II) ,
strikes a middle ground between the extremes of Li,stings-level
severity and the former IFA test.
It will' permit the Soc
Security Administra~ion to terminate S$I eligibility for children
currently eligible, based on three'moderate impairments, and comport
with Congress' wish that the children's disability standard be
'These areas are modelled on the "Btl criteria' of the
children's mental impairment listings that were approved by
Congress when it modified the children's SSI program, and are
further refined to assure fairness ip evaluating children with
physical impairments.
National Academy of Social Insurance,
Report of the Committee on Childhood DI~sability of the Disability
Policy Panel at 29 (1996).
�(
\
'
"fine-tuned.
112
Contrary to this fine-tuning' approach, the second proposal,
akin to the rejected House version bf the law, would require
children to show that they meet or Jqual the extreme severity
threshol~s s~t forth in the Lis.tin~s of IImpairments. Children ,,:,ith
mental lmpalrments or comblnatlons of mental and physlcal
impairments would essentially be required to show that they had two
marked impairments
the liB II criteria of the mental impairments
listings.
This propos.:il (.11 two marked impairments test ") will lead
to loss of eligibility for up to dne third ·of all children
currently receiving SSI.
It is also tnuch closer to the' earlier
House bill that was
jected in the fin~l compromise provisions on
SSI~
' I
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'
In assessing what standard should be applied and then
determining what effect that any new I standard will have on the,
number of children receiving SSI, it must be recognized that SSA
has alre~dy greatly restricted the acthal eligibility process for
finding children disabled for SSI.
Se~ § A.
I
Below are set forth examples of children who stand to lose SSI
eligibility under the al ternativetests.
Under either test,
children with severe problems will be aenied SSI eligibility.
,
,
'
I
.
.
.
In § B (1), children who were found disabled with three
moderateimpairments--who' would be terminated from SSI under the
one marked and one .moderate impairmentltes~--are pr~filed.
,
In. § B (2), chlldren who were founddlsabled wlth one marked
impairment and one moderate impairment - -who would be terminated
from SSI under the two marked impairmeptstest are profiled .
A.
.
SSA HAS ALREADY GREATLY TIGHTENED UP ELIGIBILITY AS SHOWN IN
THE DENIAL RATE FOR CHILDREN'S' SSI CLAIMS UNDER THE OLD
STANDARD THAT INCLUDED THE IFA TEST
tikhten~d
SSA
already significantly
up t:.he
igibil'ity
process.
SSA ,data show a 43% allowa~ce rate in 1989, the year
before the Supreme Court de.cided Sulli{,an v. Zebley, which led to
the creation of the IFA test.
After a Isurge in the allowance rate
in 1991, that was fueled also 'by the congressionally mandated
outreach program for children, and issu~nce of newly revised mental
disorder
stings, the allowance ratel has steeply
lined.
By
April 1996, the allowance rate had fallen' to 31%, well below the
,
. I
1989 :3% allowance rate, the year beflre the
reforms were
Colloquy language between Slenators Chafee, Conrad, and
Dole, who along with Senator Daschle, shaped the compromise final
language of the new law.
Congo Recorl:i at S 13613:"'14 (Sept. 14,
1995) .
2
�out-of-control program in
implemented.
This hardly bespeaks
need of drastic cutbacks.
B.
PROFILES OF CHILDREN WHO WILL BE CUT OFF SSI UNDER A NEW
DISABILITY STANDARD) .
I
It is important to remember that, no matter which test is
adopted, a significant number of c~ildren, all with serious
disabilities, will be cut off.
The question is, given Congress'
mandate to !lfine-tune" the program, where the disability line
should be drawn.
1.
Significantly Disabled Child:tjen Found Disabled With Three
Moderate Impairments Will Be Cut Off SSI Under The One
Marked And One Moderate Impairment Test
I
Set forth below are summaries of children who will lose SSI if
SSA adopts .a standard t·hat provides SSI disability benefits to
.children with one marked impairment a~d one moderate impairment,
but denies disability to children with only three moderate
'impairments.
While it is difficult to profile the typical child found
disabled with three moderate impairments, certain patterns emerge
from reviewing case decisions of these children destined to be cut
off SSI:
•
•
many children with cognitive ,deficits (~Q$J;:::_ore~Qf 71 to ';)
74) qualify througp the IFA when those cognitive deficits
cause moderate limitations I in three of the domains i
100,000 children, or one thi~d of all SSI children with
a diagnosis of mental retar~ation (cognitive deficits)
qualif ied. for SSI because ofl the IFA test i 4
.
many children with a combinaFion
physical and mental
impairments, none of which singly meet the Listings of
3
The examples that follow are based on real cases collected
by Jonathan Stein of Community Legal S~rvices in Philadelphia and
Thomas Yates of the SSI Coalition in Chicago.
For privacy
purposes, identifying information has been deleted, and in some
cases, the names have been changed~
. 4
We do not know how many of these children qualified with
three moderate impairments. We do knowi that the term "moderate" is
not, in a layperson's understanding of the word, a very accurate
description for disabling conditions th1at have such adverse impacts
on children's functioning.
A child &ith an IQ of 71, although
deemed to have a "moderate" cognitive impairment by SSA, is
understood by lay and' professional pEkople alike to have a very
serious impairment despite the "modera!te" tag.
3
�, Impairments, qualify because those impairments
moderate loss of function inl three domains; and
•
cause
many children experience adve:rse life circumstances which
result in significant functibnal limitations: e.g. lead
poisoning from exposure ih unsafe housing; asthma
exacerbated by poor air qu~lity; ,sexual and physical
abuse leading to post-trau~atic stress disorder i and
prenatal exposure to drugsl and sexually transmitted
diseases that cause moderabe impairments in at least
three domains.
I
Jonnie, who is developmentally disabled:
i
Jonnie, who' is 3 years old,
moderate impairments.
was found disabled with three
I
~ was found to have a m0derate impairment in the
cognitjve domain based on a McCarthy profile that showed that he
was three standard deviations below I the norm on measures of
understanding numbers and other quantitative words, although the
complete results showed him within twol standard deviations of the
~~.
'.
"
He al,so had a moderate impairment lin
based on substantial deficit in language
age',
his
speech
consisted
o:t"
unintelligible, and he could not combihe
I
.
the communicative domain
development. At 3 years
. single
words,. mostly
words.
.
Finally he 'had a moderate impairment in motor development
because r at 3· years of agel he could riot balance on one foot for
two seconds, walk backwards, or broad jump.
He has minimally
decreased tone in his lower extremities\with a tendency to plantar
flex and toe-walk bilaterally. He also has difficulty running and
climbing stairs.
I
l
Janie, who has been developmentally disabled since birth:
~iving
Janie a 31 month old child now
with a relative, was
born with intraurterine exposure to c9caine and alcohol and HIV
positive. She was found disabled with ~hree moderate impairments.
I
She has a moderate impairment in cdrnmunicative development dtle
to a vocabulary limited to five wordk.
She could not combine
words, or point to any body parts. \ She also had a moderate
impairment in motor development based en test scores showing her
functioning between two-thirds and three-fourths of chronological
age in fine motor development and gross Imotor skills. Finally, she
was found to have a moderate impairment in personal/behavioral
development because she was not coop~rativel could not imitate
household tasks l and could not use a s~oon to eat.
4
�Harry, who has lead poisoning:
Harry,' a four year old child who!has severe lead poisoning,
was found disabled with three mOderatel impairments.
Harry was found to have a moderate, cognitive impairment based
on results, from Peabody. Picture Vocabulary test and McCarthy
Scales.
He also had a moderate impa~rment in motor fUtictioning
resulting from the lead poisoning- -hEk frequently suffered from
dizziness and headaches that aff~cted his motor abilities.
Finally,
he
had
a, moderate
impa!irment
in
concentration,
persistence, and pace based on his sho~t attention span.
.
I
.
, I
.
.
Tommy, ,who was a v~ct~m
I
0'f sexua 1 a b use:
Tommy, who is 6 years old, was atictim of sexual abuse and,
as a result, suffers from post-traumatic stress disorder. He was
found to have' three moderate impairments.'
I.
.
Tommy h as · a mo d ' ·1mpa1rment ~ln SOC1a I d eve I opment i h'
erate · ·
1S
history of sexual abuse makes it difficult for him to relate to
other children. He is physically aggressive with other children,
which is linked to the abuse he suffer~d. He also has a moderate
impairment .in personal/behavioral de~elopment with' history of
aggressive behavior and sexual acting...:out.'
Finally, he has a
moderate impairment in concentration, persistence, and pace based
on hyperactivity"': he has a very short attention span and difficulty
staying on t a s k . , I '
Brandon, who has retinoblastoma (cancer of the eye) and
dev'elopmental delays:
I . .
Brandon, at th~ age of 16 months, was diagnosed with cancer of
the eye~
To save his life and prevend the spread. of cancer, the
cancerous eye was removed.
At age 3 t iBrandon was found disabled
with three moderate impairments.
'. i
.
'
Brandon . had . a' moderate impairm1ent" in motor skills and
coordination arising from the lack of ~tereoptic vision. He also
had a moderate impairment in social fundtioning due to difficulties
in interacting with other children.
Finally, he ,had a moderate
impairment in personal/behavioral fun6tioning due to delays and
difficulty in learning· to take care bf his own needs' with his
limited sight.
I
Alfred, who has attention deficit hyperactivity disorder
and borderline intellectual functioning:
Alfred,
who
14
years oldl
has attention deficit
hyperactivity disorder and borderline intellectual functioning. He
was found disabled with three moderate 'impairments .
5
�Based on Alfred's full scale IQ ofi 74, he was found to have a
moderate cognitive impairment.
He klso was found to have a
moderate impairment in social functio~ing because he obsessively
talked to imaginary people and playedl with an imaginary vehicle
during class. He also was found to ha~e a .moderate impairment in
personal/behavioral functioning becausdhe often appeared helpless,
and, under stress, regressed to much younger behavior.
I
Shannon, who has depressive disorder, mental retardation,
and impaired adaptive b~havioral functioning:
,
I
Shannon, a teen-age girl, talked of suicide and lived in
isolation from her peers.
She was foJnddisabled based on three
moderate impairments,
in' the doma~ns of cognition,
social
functioning, and concentration, persistence, and pace.
.
I
.
Shannon was found to have a moderate cognitive impairment
because she had been diagnosed with mJderate ~ental retardation;
she. repeated ,the fifth grade three time1s. Her moderate impairment
in social functioning was based. on lithe fact that she had no
friends, played only with children who were much younger, and was
diagnosed as suffering from clinical depression.
Her depression
also caused a moderate impairment in d:oncentration, . persistence,
and pace.
I
Jason, who has psychiatric disorders:
I
.
Jason, a 8 1/2 year old boy, has behavl0r problems, problems
sleeping, and talks about suicide. Ja~on has be~n diagnosed with
dysthymia (a type of depression) wi~h borderline intellectual
functioning.
Jason was found disabled. with three moderate
impairments.
,
Jason has a moderate impairment in cognitive functioning based
on a full scale IQ of 75; and academi~ scores placing him in the
kindergarten to first grade level. He has a moderate impairment in
social functioning based on his anxiety, competitiveness,' and
overreaction in a school setting, and because he has no close
friends arid other children leave hifu lalone.
Finally, he has a
moderate impairment
personal/behavioral functioning due to his
need for constant supervision--far mor~ than would be required for
an average 8 1/2 year old child.
I
.
*
*
*
*
*
These children, who have significant problems, will lose SSI
eligibility under the disability defirtition proposed by the SSI
Coalition that ends disability allowancEks based on three "moderate"
impairments.
6
�2•
Additional Children Who· WOLld Be Terminated From
S~-I
Disability If SSA Goes Farth'er'And Adopts The Two Marked
Impairments Test
I'
.
,
Below are case summaries of the i types of children who will
lose disability if SSA adopts a standard that requires two marked
impairments.
It is the contention of Ithe SSI Coalition and other
advocates that these children should. remain eligible for SSI
because ,they are seriously disabled. To cut them off will make the
test too strict and defeat the purposk of the program.
~ll the
children listed below were found Idisabled with one marked
impairment and one moderate impairment.
'
Isabel~a'
and Elizabeth, foJr year old identical twins
with communicative and Icognitive problems:
.
.
i
.
.
Isabella and Elizabeth, four year old identical twins who now
live with an aunt, were. born prematureiy with respfratory problems
to parents who were mentally retarded. I At age two they were found
disabled based on a marked impa'irment in communication and a
moderate impairment in cognition.
Th~y both were functioning at
communication levels less than one half their chronological age,
leading to a marked impairment. Also they both were functioning
at cognitive levels more than two tfuirds t but· less than three
',fourths of chronological age,leading Ito,moderate impairments . .
t
,I
Their aunt could not afford to raise her nieces but for the
income of SSI.
Without such assistan6e, the children would have
been placed in foster care.
.
I
Sarah, who has cerebral pals¥!
Sarah, who is, 9 y~ars old, has cerebral palsy and double
hemiplegia.
She was found to have a imarked impairment in motor
development based on her cerebral palsy.
She is. enrolled in a
educat~onal program for children with physical disabilities, sways
from side to side to walk takes one I~tep at a time, and cannot
stand up from a sitting position on th~ floor without assistance.
Sarah was
also
found
to have a i moderate
impairment
in
concentration, persistence, and pac~ based on her teacher's
statements, and needed to work one-onJone with a teacher because
she cannot stay on task.
t
Justin, who has hemophilia:
Justin was 11 when he finally qJ.1alified for SSI.
He was
diagnosed as having bleeding disorders iwhen he was six months old.
Over a four year period his mother has had to rush him to the
emergency room 30 times for bleeding j6ints, hematomas, and other
injuries; he had another 60 doctor vi~its for 'bleeding problems.
While his diagnosis is hemophilia, hel did not meet the Listings
because medication partially controlled his bleeding and he has had
t
7
.
�no permanent joint deformities. Yet, Justin's condition severely
restricts his ability to function age-appropriately.
e
.Lv I\'t
) \ \i
i
Justin was found to have moderate impairments in motor skills
-his joint swelling is so severe that it affects his ability to
walk, and makes
impossible for himl to participate in physical
education or recreational activities. In part, as a result of his
exclusion from peers' activities, he was also found to have a
marked impairment in social skills -he does not report potentially
life-threatening injuries and becomes Iviolent when his classmates
do so for him.
.
.
Rashavie, who has severe aJthma and· communicative and
language delays:
Rashavie, now three years old, was born prematurely, and had
respiratory problems at birth.
Since I birth, he has had repeated
episodes of respiratory distre$s, has been diagnosed with asthma,
and has experienced a variety of developmental delays in almost all
areas.
He
was
found
disabled with a
marked
impairment
in
communication and a moderate impairment in
personal/behavioral
\,domain.
Because of defic
in ~uditory comprehension and
IIt~ (ij"expressi ve communication, his language I~was described as almost non
~\O
existent. Despite aggressive therapy, Rashavie was found to have
't
a serious delay in communication, lerading to the finding of a
~l'
marked impairment.
I
•
iJ\)
7
~
rN
Lv)
In addition,
he was given a
moderate
impairment
in
personal/behavioral development becau~e he was unable to dress
himself, was not toilet-trained, c6uld not feed himself, and was
unable to
low simple instructions.
.
Kimberly I
who
has
cogni tive
incontinence (enuresis):
delay
and
urinary
Kimberly, who is 11 years old, is three years behind her age
group in school.
She has great diff:iculty even in her special
education class, and was tested with· a full scale IQ of 70.
Kimberly also was diagnosed with funct~onal urinary incontinen~e,
trichotillomania (recurrent. pulling lout of one's hair),· and,
despite her age, she insists ort sleeping with her mother. Kimberly
was found disabled because she had ·a ~arked impairment in cognitive
functioning based on her IQ of 70i arid a moderate impairment in
personal/behavioral functioning based clm her urinary incontinence,
and trichotillomania.
I
I
Susie, who is developmentally delayed in communication
and motor dev~lopment:
r
Sus
, who is 3 years old, was found disabled with one marked
8
�"
.
impairment in the communicative domain and one moderate impairment
in the motor development domain.
She has a marked impairment in communicative development:
medical evidence shows that she suffere,d severe' delay in expressive
language and vocabulary; she was unabte to put words together to
form phrases and .~ftntences, and she c9uld not refer to herself by
name or use the "me" or "mine" concep~.
She also has a moderate
impairment in motor development with history of duodenal atresia
for which she has undergone four surgickl procedures; she currently
has G-tube for feeding and is undergoilng medical investigation to
discover the cause of recurrent vomit~ng episodes.
Je~iei who has' hydrocephal~s, is HIV positive, and was
exposed to drugs in
ut~ro:
I
Jennie, a 17 month old child, wa~ born testing po~itive for
cocaine, syphilis, gonorrhea, hydrocephalus and HIV. Since birth,
,she has undergone several hospitalizat!ions and undergone mUltiple
operations for the hydrocephalus.
She has a marked impairment in
l
motor development and a moderate impairment in social development.
"
I'
Her marked impairment in motor development was based on her
inability to perform any of the motor f~nctions appropriate for her
age.
She cannot sit alone, roll ove~f bounce actively, pick up
small objects with the thumb-'finger gr1asp, or turn while sitting.
She also has a moderate impairmJnt in social functioning-
because of her severe health problems, ishe has not acquired social
skills.
She is completely unable to engage in interactive play,
and cannot play pat-a-cake, peek-a-boo~ or hug.
~,
* h' ld
* h h ave slgnl lcant lmpalrments, wou I d
*
. I'f
.
*.
All ,t h ese c, 1
ren, w 0
lose SSI eligibility if SSA adopts an bverly strict standard that
finds only children with two marked imp~irments disabled. Although
this may. have b~en close to the intent hf the House bill, the views
are clearly rejected, in final compromise, by the full Congress
that approved the welfare reform law.
9
�EXHIBIT A
Children's SSIDisability Allowance/Denial RateS
YEAR
ALLOWANCE RATE AT
INITIAL LEVEL
I
1989
43%
I
1990
59%
f
1991
61%
I
1992
53%
I
1993
48%
1994
36%
1995
32%6
1996
31%7
,
I
I
I
5
Report to Congress of the'Natidnal Commission on Childhood
Disability, October 1995, p. 23.
I
6 I~itial
lowance rate is for fiscal year 1995 (Oct. I, 1994,
through ~eptember 30, 1995).
. I
7 Data is
fiscal year 1996 and covers period of October
I, 1995 through April 26, 1996.
10
�·THE SSI COALITION'
FOR A RESPONSIBLEi SAFETY NET
SUPPLEMENTAL SECURITY INCOME FOR LOW INCOME ELDERLY AND PEOPLE WITH DISABILITIES
I
OCTOBER 22, 1996
SOLE RELIANCE ON THE LISTINGS STEP OR THE LISTINGS SEVERITY LEVEL
OF THE CHILDREN I S SEQUENTIAL EVALUATION IS THE WRONG APPROACH
R~turning
the children's SSI ·lrogram to a definition that
provides that a child.is disabled on~y if she or he satisfies the
Listings of Impairments step ofl the children's sequential
evaluation is the wrong approach. A standard that requires a child
to show two "marked" impairments, or
functional equivalent to the
Listing's would be such a regression.
a
A.
The Listings Step
A child may be found disabled at step three in the S8I
childhood disability sequence if shelor he has impairment(s) that
meet or equal an impairment listed in 20 C.F.R. Part 404, Subpart
P, Appendix 1.. 20 C.F.R. § .4'16.924 (;e) .
. '
20 C.F.R. § 416.926a further
at the third step in anyone of
criteria; medically equalling the
equalling the listing criteria.
pro~ides that disa~ility is shown
th~ee .ways: meeting the listing
listing criteria; or functionally
.
I'
.
•
A child is disabled if s/he has an impairment that is
described in the Listings. 20 C. F . R. Part 4'04, Subpart P,
Appendix 1.
.
•
A child is disabled if s/he has an impairment(s) that is
.·the medical equivalent of 'a listed impairment. Medical
.' equivalence is shown in onb' of two ways:
•
•
if the child does noh exhibit one or more of the
medical findings .specified in the listing, or the
child exhibits all th~ medical findings, but one or
more of those find1ings is not as severe as
specified in the listling, the child is.disabled if
" s/he has other medic;al findings relating to the
impairment that are at least of equal medical
significance; or
if the medical findings of a child are of at least
I
205 WEST MONROE STREET • CHIG:AGO, ILLINOIS 60606-5013
I
, '
TELEPHONE 312.223.9600 .1 FAX 312.263.3846 '
o
�.'
i
equal' ,medical significance to' those of a cl,osely analogous listed
impairment.
•
A child is disabled if s/he has an impairment that is the
functional equivalent of a iisted impairment if the
functional limitations resulting from his' or her
impairment (s) 'is the same I as the disabling functional
consequences of a listed impairment.
'
Sole reliance on the Listings sJep for the entire'evaluation
or for the severity level required w~s never intended by Congress
or the Presldent, when the chlldren Is SSI program was reformed.'
Thus, they, cannot be adopted as the sole test for children IS
disability under SSI. . Moreover, returning to the pre-Zebley
criteria would reinstate many of the problems that led the Supreme
Court to invalidate the old approach!
•
•
I
I
B.
The Listings And Their Functional Equivalents Were Consciously
Written At A Highly Restr~ctivelLevel
. Most of', the Listings do not involve direct measurement of
function, the mental impairment listings· being the only notable
exception.
Even the mental impairment listings only attempt to
measure function in the mental healthl area, requiring a showing of
two "marked" impairments in but four inental health domains. These
Listings generally are set at very! high levels that are only
sometimes relevant to function.
i
in~tances
,
,
In,the three
after thel Supreme Court issued '
,
in which the Social Security Administration (SSA) promulgated new
Listings,l there is explicit acknowledgement that the Listings are
set at a very high level. While they define when. an impairment is,
disabling, they do not define when an impairment is not disabling.
Respiratory Listing § 103.00Ai Immune System Listing §
114. OOC. 6 i and Cardiovascular Listing § 104. OOA,.
C.
Doe~
Functional Equivalence
Not !solve The Problem Of The High
Threshold Of Severity Required To Satisfy The Listings
Similarly, the examples of fuhctional equivalence to the
Listings" set forth at 20 C.F.. R. §' 416.92qa(d) also represent
extreme and pervasive disability. TYpical examples listed are:
•
•
1
need for organtransplanti
'f-requent: need for a life-sustaining device (e.g. central
See Respiratory Listings, 581Fed. Reg. 52,346 (October 7,
1993) Immune System, Endocrine, . . ' Multiple Body Systems, 58 Fed.
i
and I'
.
Reg. 36,008 (July 2, 1993) i and Cardiovascular System, 59 Fed. Reg.
6 , 648 (Feb. 10, 1994).
2
�I
venous alimentation catheter), at home or elsewheie;
•
•
c,omplete inability to fuAction independently outside
one's home within age-appr6priate norms;
•
~::t~~~t~~L{~:~d!~~ i~be , into stomach) in a child ~hO
requirement of for 24-hour-a-day supervision for medical
or behavioral reasons; and
These examples in 20 C.F.R. § 416.926a(d) set, very hlgh
threshold levels of disability. Alt~ough there should be no doubt
that a child with frequent need f:or a life-sustaining device
suffers from "marked and severe functional limitations," it is also
true that children whose conditiorts, are not life-threatening
without such use of invasive. therapy are also impaired by "·marked
and severe functional limitations. '1
To use such examples as
screening tools raises the disability threshold far above the
statutory standard, as amended by weifare reform.
I
In addition, several of the exlmPles set forth impairments
that, in addition to being umarked and severe" are also pervasive-
they set forth impairments that signai some degree of impairment in
almost all areas of a child's functio&ing or body systems. A child
whose impairments 'are so severe that Ishe or he requires 24-hour-a
day supervision for medical or beharioral reasons has pervasive
impairments. Yet, the requirement of "pervasiveness" was stricken
as the children's SSI changes were being debated in Congress .. See
Congo Record at p. S i3615 (Sept. 14\ 1995).
I
D.
Functional Equivalence, Fails To Require Consideration Of
Functioning I~ All Relevant Dom1ins Of Functioning
I·
.
In addition to setting fort~ a threshold level for disability
that is ·far higher than envisioned tinder the statute as amended,
the
functional' equivalence
regJlation
fails' to
require
consideration of all relevant areas df a child's functioning. The
functional equivalence regulation faiils to set forth, or provide
guidance on assessing:
•
children who suffer from a physical impairment, or a
combination of physical and mental impairments that cause
loss of functioning in:
•
•
•
•
•
•
cognition;
Gommunication;
personal/behavioral functioning;
gross and fine motor functioning;
physical stamina; orl
.
concentration, persistence, or pace; and
I
3
�•
, E.
.children who suffer from a combination of mental
impairments only that ,caus~ limitations in all relevant
areas of functioning, inclUding those set forth above.
The Listings Do
N~t
Include Mant
Cliildho~d Disorders
~hat
SSA has repeatedly acknowledged
the childhood Listings of
impairments, like the adult Listings,l are flawed as a sole test of
disability because of their incompleteness. They only "evaluate
the more common impairments." 42 Fed. Reg. at 147006 (1977).
'
There are over 5,000 known rar~ diseases, see Report of the
Nat'ional Commission On Orphan Diseases xiii (1989), and the
disproportionate presence of rare disorders among children
demonstrates how a Listings-only or L!istings-equivalent evaluation
can ;never' fairly evaluate childhoodl impairments.
Where chronic
illness in adults "consists mainly'oD a relatively large number of
fairly common illnesses (such as Ihypertension, diabetes, and
osteoarthritis) and a few rare diseases, . chronic illness in
childhood is characterized by very riew disorders that are common
and by many that are quite rare." PI~ss & Perrin, Issues Common to
a Variety bf Illnesses, iri Issues in the Care of Children with
Chronic Illness 41, 43. (Hobbs & Perrin, eds .. 1985). For example,
children's skin disorders are so different from each other that SSA
does not have a skin disorder listing for children.
~bove,
And, as is discussed
li!ttle, and mostly incomplete,
guidance is. given to decisionmakers on making equivalence
determination~. This gap makes it mdre likely that children, with
disorders that are disabling but not Ispecifically described in the
Listings, will be found not disabledL
F.
The Listings Focus On Extreme pJtholOgyAnd Gross Failures Of
Treatment
'
The Listings measure sev:erity. by using proxy measurements--how
often a child has 'been .hospitalized, whether she or he uses
crutches or braces, or whether she orlhe has become malnourished or
experienced severe growth impairment. However, there are children
who "avoid recurrent hospitalizationsr' (Juvenile Diabetes Listing) ,
or other extreme measures of treatment because their parents put
extraordinary amounts of time . into I monitoring their health and
avoiding the need for hospitalizatiop.·
Thus, the parent of a child with1severe diabetes might succeed
in avoiding the need for repeated hospitalizations through constant
and vigilant monitoring and treatment. ~ Listings §§ 109.08A &
109.A.
Other parents may, with ext~aordinary efforts, prevent a
hemophiliac from severe bleeding. ~ Listing 107.08A (Inherited
Coagulation Disorder). Other parelJ.ts will prevent, with similar
efforts, a hypoglycemic child from having convulsions or lapsing
into a coma. ~ Listing § 109.12 (Hypoglycemia):
4
�There are a number of, other Listings, see ~ §§ 103.030 &
105.07, that refer to the growth imp~irment listing, § 100.00, as
a measure of severity of' the underlying illness. However, such an
approach only measures cases in whichl growth is severely impaired,
without looking to what extraordinary ,means might have been taken
to avoid Listing-level growth retardation.
'
. .
'.
I
h
,Rece1v1ng exce 1'1 ent proact1ve treatment d '
oes not rnak e suca
child any less disabled. Yet, the LiStings do not provide guidance
on how, such cases should be ass,essed 1 for disability.
G.
SSA Will Have Great Difficulty In Getting Its Decisionmakers
To Apply The Equivalence Standar;ds In A Uniform Manner To The
Variety Of Impairments, Either Alone Or In Combination, That
Could Cause Marked And Severe ItPPairments '
Although the present equivalehcb tests have been used sirice
1991, SSA statistics show that few decisionmakers rely on them to
make disability determinations. ' The functional equivalence test
was utilized in only 7.2% of all allbwances. See Exhibit A.
I
Many decisionmakers, at the BDDS and OHA levels, have stated
that they did not do functionai equiv!:xlence determinations because
they did not und~rstand how SSA intertded that ·,the test be applied.
Certainly, the regulation, 20 C.F.R.I § 416.926a, provides little
guidance. Others have stated, becaus,e it was easier to consider a
child's level of functioning at the IFA step, that they skipped the
functional equivalence assessment'oflthe Listings step.
,
I
Application of the functiona] equivalence test is also
problematic because SSA h?ls never r~quired its decisionmakers to
document that they explicitly conside*ed functional equivalence,' or
to provide some minimal articulation of their path 'of reasoning
that a child does not functionally equal a Listing when they make
a decision.
'
I .' ,,
These factors dictate against s0le reliance on this standard
because the institutional history that it is rarely used and rarely
understood will stand as a barrier tolthe widespread use that would
be required if it is allQwed to stand as the sole test in whichSSA
considers function in determining children's disability.
H;.
Raising The Disability StandardlTo Listings Level Is Not,The
Quick Fix That Its Supporters Claim
~o
To avoid returning
the Pigebn-hOle approach used before
Zebley, SSA must adopt a meaningfJl functional evaluation for
, children.
That is what Congress lias now explicitly directed.
Given that few, if any, of the,Listings other than those for mental
impairments, utilize any functioned a~ssessment, the Listings would
have to be completely rewritten, a task that SSA has avoided for 20
5
�years.2
f'
Merely using the functional crit~ria of the mental impairments
would seriously disadvantage childr~n with a. variety of diverse
physical impairments, such as cystic fibrosis, musculoskeletal
disorders, cardiac problems, si~kle Icell anemia, and cancer; and
children with combinations of p!;-ysical and mental impairments.
2
Historically, SSA has taken years even to amend the
Listings, particularly the children 'is Listings.
If Congress had
intended SSA to use the Listings as the source of functional
evaluations· it would have done so .'1 It' cannot be gainsaid that
Congress legislated a IIfunctional limitations ".. test .and never
provided for a wholesale rewriting of the Listings. .
.6
�EXHIBIT
.
.
l
I
.
. .
Stage Of Chlldren's Sequentlal :Evaluatlon In WhlCh'Chlldren
Were Found Disabled (Data From 2-11-91 To 12-31-94)3
NATION
STEP THREE (MEDICAL LISTINGS)
Met Listing:
% That Met Listing:
425,808
52.4%
Med. Equalled Listing.:
% That Med. Equalled Listing:
70,149
8.6%
Func. Equalled Listing:
% That FUnc. Equalled Listing:
58,506
7.2%
All Step Three Allowances
% Of All Step Three Allows.
495,957
68.2%
STEP FOUR (IFA)
IFA Allowance:
% Of IFA Allowances:
251,108
30.9%
MISCELLANEOUS
Misc. Allowance:
% Of Misc. Allowance:
6,838
0.8%
TOTAL ALLOWANCES
% OF TOTAL ALLOWANCES
812,409
100%
"
.
I
Report to Congress of the National Commission On Childhood
Disability, October 1995, App.7-D.
7
�~$eptember 14, 1995.
. CONQ.,RESSJ...ONAt RECORD-SENATE
(Q>U t;)qwr .. S 13613
· neglect will no longer be protected by'. . .:;::i'> CHILDREN'S SSI . ....
.
goal;' and help uPobtail'l a realistic pic
Mr. CONRAD. Mr.. President, I have a ture of how an impairment affects each
'CAPTA's immunity for reporting. Only'
good-faith reports will be protected.
series of clarifications concerning the child's abilities.
.
,
.'Finally, we have clarified the. defini': children'~ SSI program th~t I WOUldd . No dOU?it aboutt it, Itbe lchlldrten St SfSI
tion of child abuse or neglect to pro- like to dISCUSS with the majority lea - program' s ex feme.y. Ippor an
or
'vide additional guidance and assistance. eri . ' . '
."
. . . . . some children wlth disabilities. But as
t States as the endeavor to protect
But flrst,let me express I?Y. apprec!~- the S.enator from North Dak?ta made
~ildr f
. b ~se and neglect .
. tion to Senator DOLE for hiS leadership mention. there have b~en Widespread
c. ..en rom a. J.l. '.
'.
:
.
in helping 'us reach a compromise on allegations' that some children on SSI
A ' . Let me briefly. mentl?n the other this. issue. The SSI agreement is not are not truly disabled. or money is
. • . : programs authorlzed. In the 1995 everything I had hoped to achieve when spent in ways that do not benefit ·the
· CAPTA amendments: the new Commu- . Senator CHAFEE and I introduced the. child. I hope this study-in addftion to
nity-BasedFamUy Resourc~ and Sup- .Children's. SSI Eligibility Reform Act, the changes we have made in the law
port Grants repr~sent the result '~f but it Is Cieariy an improvement over wilt'help restore c\?nfidence in this pro~
nearly a .full. year s ,effort to consoll- the House bill.
.
.....
. gram.: .
" . ...
date the CommunIty Based Prevention
In addition I believe 'the agreement
Agairi,it is my expectation that this
Grant,. Respite Care. Program, and includes a nuriIber of extremely impof-- program will continue to serve children'
Family Resource Pro~ams; the Fam- tant provisions. to both address criti- . with severe' d·isabilities. and that in
· .ily . Violence Prevention. and Services cismsthat 'have been leveled against cludes properly evaluating children too.
Act ·.which 'provid~s 'assistance '. to' the Chlldr.en's SSI program and protect young to te~t, '~h1ldrenwith multiple.
States primarily for shelters; the Adop- chlldrim with severe diSab!l1ties. I am 'impairnlents, and children with rare or
tion Opportunities Act'which supports. extremely pleased' we were - able.' to' unlisted impairmentS which neverthe
· aggressive efforts tostrengthen the.ca-. reach 'a bipartisan'comproinise on this less result"inmarked'and severe func-····
.
· pacityof . States..to find. 'permanent issue,' and thank' Senator DOLE, Sen; ..tlonall1mitations..." ,... . ' .
b,omes for children with special needs; ator SANTORUM 'Senator DASCHLE Sen-'" Mr: CONRAD."Is it .expected that the
.Abandoned Infants Assistance Act ator CHAFEE, S~nator SIMPSON, Se'nator ~OCia:r .SecurIty Adlnlnistratlon and
· which .provides for' the needs of cpil- JEFFORDS;' 'and . others who were" so ~he" Congress wm rely heavily on the
dren ~ho. are abandoned; eSP,eciallYdeeply involved. . .... .f.· '.
.'.
expert advice of the National Acad~my
those with AIDS; the Children s J.usMr President I would.like to clarify oC Science when engaging in Cuture reg
tice Ae<t;'the Missing Children's Assist- f~r the RECORD 'the intent surroundingulatory activity and deliberations reance Ac~ and section 214 or the Victims several of the'provisions in the amend- . 'garding impalrrriimts of children In the
..0f.Chlld Abuse Act.... , .... ....
..' .
ment. First.. the amendment deletes ~SI program? ". ..'
. . .
,. Mr.' President, I .wouldUke to thank the word· ."perVaslve" from the definiMr. DOLE.. Yes. But I also hope we
'the members for their attention. These tion of child. disab1litythat. was in- hear from many others as well with
· are important programs and they w1ll cluded :In·. the .welfare reform. biUre- good, information tCl.offer, including
a.ffect many children and fainilies. I ported In May by the Finance Commit- . other experts: parents; and advocates.
urge.·the adoptlon.of the 1995CAPTA tee. This is an important change,.and.·· ~. CHAFEE. If! might.also ask the
amendments.
:.;
.
.
.
one that I fully support,.Would the ma- majority leader a quef)tion.TheJeader
.... ".
. '.•STU,.D EIIT·AI.D" :., ......
..
. ..'
.
jority leader clarify. his understanding ship amendm:nt 'and the Flnan,lte Com
..'
of the intent'of this change? . .
.
mittee proposal are both silent about
r.' Mr•. MACK., Mr. PreSident, with· reo. Mr. DOLE. I want to thank the Sen- the purpose of children.'s SSI,.However..
gard to title V of H.R.4. the Work Op- ator from North Dakota Cor his leader- unlike the House proposaJ. both retain
portunityAct, I am Interested in clari- ship and hard work on this issue. Chil- the cash benefit nature of the program.
,fying 'an ·isSue regarding the appl1cabil- dren' wi th . disabll1ties . are certainly 'rhis 1S a concept that S.enator CONRAD c
ity' oC the" tenn '. 'assistil.nc,e' •. * * ·.'for among those most at· risk in our soci- and I t h o~g h t was 'ex t i l mpor.ta n t
.reme y
,
. which el1g!Jj1l1tY"is based :on need" .·to ety , and we want to make sure we are when ~~ ln~POduced the Chlldh~od SSI
· 'various' student loan' programs. As lim- doing the, right thing by them~ ~He and Eligibll1ty Reform:Act, :!!ond ,I am
· .derstandthls legislation, eligibilt'ty' fot Senator .CHAFEE have. worked. ex~ pleased that th~ Il!ajority.leader s pro
needs-based public assistance will ei- tremely. hard to bring the Senate to posal retalris flexlbillW within the SSI
ther'be subject to a deeming period or this pohit. .•...
, . . .. _ .. ' program .by retaining the casp. nat,ure
will be forbidden for.a period of flve . As for the Senator;;' .question; i. un~ of the program. It is .important for the
years for most non~citizens.·: At this derstand that .the Senator. from' North SSI program'to reflect the l~pact a
time; there seems to be. an erroneous ·Dakota. was concernedtlui.tthe t.enn disability has on families. face~ with a
public, perception. that all . student fi~ ~.'pervaslv~~· inch:ided in the .earlier def- V.f1ri:ty of circumstances. 'SSI~·often
nanclai.aid progra.ms will. be subject to Inltion implied' some degree of impair- provldes important assistanc.e.to fami
these: provisions.· This is .not· the case. ment in almost 'all 'areas' of a child's.lies. by replacing a portion 'of· the inIn the Interests of responSible legislat- function'lng or body:systems.That was :come ..that is ·lost when a ~rent must
Ing; I 'think It is Important to clarify not the intent. of the earlier' proposed ·care for a disabled child. The flexible
that unsubsldized student loans are not change.. to the statute. It is expected nature of SSI is indispensable for many
needs-based and should therefore not 'that' the children's' SSI program .will parents. who' are. rendered unable' to
be subject'tothe"reQuirements of title' serve children with severe cfisab1lities. work because they·~ust stay at horrie
',' V; '.. ',.:. :" .•....... '.:;. ': ~ . .'::" :.' ,";. Sometimes chUdren will have multiple to provide care and supervision' to thei~
. Mr..SIMPSON.. Mr. President, Sen-. impairments: sometimes·they·will not. children with disabilities. Does the ma7
ator MACK' Is' correct.· Although the .•Mr:CONRAD. I also understand that jority leader share our assessment? .
term "assistance • •• for which eligi- the 'amendment is designed to' fadIiMr. DOLE.. No doubt about·. It. for
bility is'based on need" in title. V .of tate expert analysis of the SSI program some. families with a severely disabled
H.R. 4 would apply to 'most forms. of for children by the National' Academy Child. SSI canbea.l1fesaver. It allows
studentfinancl8.l aid. the unsubs~dized of Science to' ensure. that program them·'to care for. their child at·home
student t'oanprogram 'is indeed a .rina.ri~ changes. lricluding detennination . of who ·might· otherWise be 'ins,titutional
cial aid· program which is not 'based disablli ty. are based· on the pest pos- lzed at much greater cost to the gov
upon ·need. Therefore. this :pa.rtiCUlar sible science:, .
.. '.'
.
. . '.
ernmentc-or obtain services they could
program would'not be subject to· the . Mr.. DOLE. Yes. I think we can all not otherwise afford. ICa small pay
deeming-period or 5-year ban-esta~ agree'that the children's'SSI needs a ment can help a disabled child stay
l1shed.1n. title V of this bil1~ .... '
,~; tune up. The provision for a study ,by with his family; OD grow into a produc
:,;:Mi-.D()LE. Mr, . President, . I wo~ld the National Academy of Sciences of tive adult. 1~ is better fo,tthe child and
like :to·offer my support· of the com- the: disability detennination proce- better for ~9ciety: ?SI benefits provide ..
ments made by" Senators MACK. and dures'used by the Social ~ecurity A~-. the grea~e1St fleXlbll1~y. and the least
SIMPSON on this issue. .... . . '.. ministration will ..help accomplish this amount of.bureaucrat1~ red tape.. . . .
the
~-
e·
l
'e
..,.t.
i "tt4U.
-"'"
�<813614 .' ....
CONGRESSIONAL ,RECORD-.SENATE
September 14, '1995
B'ut I think there ~ay be so~e difThis measure has been a 'long time
COMMONWEALTH OF VIRGINIA,
ference of opinion. about the purpose of coming, and I do not just mean this
OFFICE OF THE GoVERNOR,
the program. The SST program. was summer: Our. distinguIshed colleague'
:
September 13, ?99S,.
·originally started to provide a small from Colorado; Senator' HANK BROWN, Him, 'JOHN W,WARNER,
....
d I
h
t '
"
; u.s. Senate,
:•
cash Income to indivi ua s w 0 canno did an outstanding job in 1993 and 1994 Washington, D C . . , .
...'
work because of age 'or disab1l1ty~ But as chairman' of the Republlcan Welfare ,; PEAR JOHN,. As the United. States Senate
.l;he·children's SSlJ)rogram had a some Reform .Task Force. Health Care Re- ,continues to debate welfare reform this
what different purpose-:-:-to help poor form diverted the Senate, bll,t it did not . week, I believe that our experiences In the
. families with. the 'extra costs of having diminish the value of their work. Much Commonwealth of Virginia can be Instruc·
A· a child withii diSability,' It seems the of .whatwe are considering today,: is . tliehOpe' you will consider. Virginia's plan to
•
program has expanded wIthout much bunt directly on the strong foundatIon be a model for the nation. Thecomprehen
' CongreSSional attention. In my view, of SenatorBROWN's early proposals,
. slve Virginia plan Is based upon the prinwe need to revisit the purpose of the
I also think back' to the' 1986 State of clples of the work ethnic and personal re
SSI prciiram. The Fina.pce coffimittee
.. .
sponslbility. Our eXP,erlences support tile
. .'
has not tackled this problem yet, but it the Union Address of President Ronald I need for an overall block' grant 'approach, .
should 'II.nd I .believe .it will. But the Reagan. That Y(larlieproposed Welfare ,that will give States the flexibility to appro
Senate decision to retain the cash ben Reform.· This. was another .step. The, prlately design programs that address the In
· ent 'is clearly a:.n importaritdifference . Reagan welfare 'reform plan, the ~am- .' divldual needs of the citizens of their State.
f.ro~ tile House. ..:
".
lly. Security Act. or 1988,Was guided to return AFDC toa program of temporary asMr' CONRADI would like to join in enactment by the fine hand of the then· slstance for those in need, and require work
.'
.'
'.
Fi .
C mmitt Ch i
. S
t
for all able-bodied reCipients.
.
.
.
· the comments of both of my colleagues
nance.. 0
e.e
a rman•. ena or .. ' I understand that there will be:a.ttempts to
· regarding. the cash benefit nature. of MOYNIHAN of New York, who Is, now . amend S: 1120 by attaching.' new chains on
the SSI. program•.. This provision' is serving wi~h such di~tinc;ion as the co~ ·the block 'grants to'the States: Asa staunch
critically 1mportarit, . and I. commend manager of this ·bill.• '.. : " . .
proponent of. federalism and self-determlna
· the ~jority Leader for including it. in " The'Fa:mUy Security Act . 'of 1988 .~ tion. Io.~pose suc,h ::hok~ .chal~?, whether
.the amendrnent:.Ir I might address one served.as
laboratory for S. i12o. In they a.re ,.conservatlve or liberal, ones, and
additional. question· to the majority 1988
fi t d It Ith th i
f .respectfully encourage and request that you
' .
,we rs
ea w :. e ssues 0
to do likeWise for Virginians..
.
leader, it is the inten.t of this ,Senator workfare versus. welfare, the dilemmas: . Experience shows that the States are per.and .()ther. supporters of this amend of teen .pregnancy and illegitimacy. the; fectlycapable of taking this rjlsponslbillty
: ment .on both sides. of the aisle. that high costs of work requirements, and . and exercising It .wlsely for our-citizens. Vir
this.amendment Is ~e posi~ion of the the need for broad federal waiver. au- " ginla's landmark welfare reform legislation
Senate. and that it will be. vigorously thority It is the State and lciCallevels Is a prime example. Our plan applies .to the
t· hi h drn1 1 te . th
entire AFDC .ca.seloa!1, with a work require
defended in conference with the Bouse
f
'
'of Representatives:' .Will the majority 0 governmen W c a . n s r . e:. ment for 48.000 of our 74,000 cases. It Incorc
leader insist on this proviSion during American welfare system, not the De-, porates common-sense . principles Into the
nf
Ith th Bouse'?
..
partment of Health and Huma.n Serv- , welfare system by rewarding responsible be
.
coMr DOLE This e . . ' ices, ' .
erence w is a bipartisan com
. . ' . .. -- or an d pro.. ng compassIona te , .bu.t
' . '--vi
''<di
..
".
,
.
•. .
.
. . . . ..
. temporary, assistance for those.ln need. '. .
promise with broad support, and in my
I am proud that under the waiver au- " '. In addition to providing opportunity and
view it should be a position to which thority established by the Family S~- . support to recipients. the program Is ex~
the Senate should tlrmly hold in con curity Act, the Commonwealth of Vir.- pected to save the taxpayers more than Sl3Q
ference•.: '. ' .' , :- . , . .
.
. ' ginia has been in: the vanguard of wel- :.mllllon over the nrst nve years, Already, we
.. .... Mr. CONRAD.:'Ba.Se: on these' assur fare reform ini tiatives: ,..
.
. ',.. :·have·had a s)gnlflcant drop In our ca.seload,
. ..
. . ... '. 11" . . . . ,
ances, I am pleased'to support the com
.' : Restrictive ..malntenance-of-effortrequlrepromise: we have developed on chi1
While we are strugg ng to come to- '. ments. rob States of the ability- to share In
dren's SSL This is not everything I had gether in the Senate to pass S. 1120~ my . these savings and the incentives to achieve
d' to' ., hi
. b t it i . riticall
State has already enacted and Is now.' them. Tbey should be opposed.' .
.'
h
?·pe
~. ev~ ~ ~ s c te
y implementing. what we call· the Vtr-·
As you know. Virginia received a waiver to
iiripo~t
.'
at
e' ena e. en r c0n. ginia Independence Program or .. "VIP" : ;begin .Imple~entlng this landmark welfare
fe
ion..
for short.. ;.' ':::':' . '
, reform plan on July 1 of this year. You.also
,
•
. . ' . • . sident,
am /
. . . . . ..;' =
......'. , .. '.-:.: .:... should be aware that, before this waiver was
pleaBed to rise as one of the origin8.1
VIP is the' ViSionary welfare reform '. granted, we spent the better. part of two
cosponsors of the Republica.ri leader program brought to the people of Vir- . months fending off efforts ~y the Clinton Ad
ship welfare reform bill.···· ... ' '.
ginla under the outstanding leadership ministration to completely rewrite .our plan.
·We have entered this historic debate of Gov. George Allen.' It was no ..easy ·.The administre.tlon proposed lltere.lly hun
because the30-year War on Poverty rl)-. task t·· battl asom times ho tile .<!reds of changes or conditions In the waiver
ma.1ns .'
b
th
ti
Iii'
.0
e. .
e
s
process: Many of them Involved very funa war, . ut. ena on s. os ng. state .legislature, .~o.minated by: the dament&t ·.thlngs; .If agreed to, they would
According to .re~ent analysis, aggre·other political party, aB well•. lI.8 tlfe .have·ralsedthe cost of the program:slgnin
· g ate ·government spending on· welfare mountain of redtape. required In secur- . ca.ntly and changed essential provisions:
programs' over the last 30 years haB sur 'lng the necessary: Federal.waivers.He· '.' We had a tougb nght In our state legisla
pa.ssed$5.4 trillion, an expenditure that succeeded splendidly,' however. in tu~w1th annal b1ll clea.r1ng•.the Gilnere.l
exceeds ow;' national debt.·c.
achieving 'his goals and' nowVirg1:r:iia Assembly only In the last hour .of the 1995
'. Despite this spending, America's na 'I i th
ful
'tchful
. 1 '... ~,.,.
legislative session. At.lssue were questions
,e{\.l' y s",::""es such as whether we would have a real work
,tional poverty rate remains·.at about s n . e care ,~a.
.". the same .. level as,l965. the year that of actu,al reform_ , .,. :',
...: ,.:, .... requirement and a real tlme limit; whether
· PreSident" Johnson' launched the War . Governor Allen; with ,his great cour- tllere would be a child cap and stron~ re- .
o P
rt
tesy persoruilly journeyed to:Washing. ' qu1rements for paternity establlshment, &;nd
nove y.
.:" ".
' .
whether we would require minor recipients
Despite"the best. of intentions, we ton. on .September 13 to' deliver a' to' stay '1n school and live' at home with a
.have a, ~elfare .system that, '~traps" thoughtful and, in my judgment, im- . pe..rent orgnardian . .' . . .... . ...
children and, !am11ies in.8. cycle of de mensely helpful letter. on what he beThis spirited debate was expected, given
· pendency, and ..that encourages behav Heves the Senate should:accompl1sh in ' the' fundamental nature of the changes and
ior 'lead1ngto . indefinite reliance on . welfare reionn. " . < .'
•
' . .
. reforms we were propOsing. We' did not ex
ani"
.'
: pect, howeve~fter the legislatlve process.
, . welfare., It fosters a: llfestyle that Is In . Mr' Pr id . I'" k
direct 0 . sition' to the motivators'
'.
es ent, .as. un . mous con- was completed at the state level and we had
· that . p~ th
t
t
d
to sent that my letter from Governor. declde'd what state law and'state policy were
.
prope 0 ers 0 ge up an go
Allen be printed in the RECORD 'at ~p.is. going tobe-that we .would have to turn
· we:;: e~ry~Y'1 adEll-8M '13 tiill m-'" point for the benefit of all of i:ny'col- around and renght all those. battles. with the
p..
e
leagues..'··.··
. . . . I Cedere.1 bureaucracy through the walv.er proc
e. pu C8.Il e
phasizes work:, fa.m1l;ies. and. genuine
. . , . . ess. A good example was the time limit. We
. . ~ .
hope for: the future while giving the
There being no objection,. the letter, w.ent to the wan with HHSover the Issue of.
States
greater
responsibility-and was ordered to be printed in the; whether we In Virginia would be able to: deflexibUity-:-for ~ welfare.
RECORD. as follows: .. :.
. . nne the circumstances that would allow
C",
,.
'.
','".'.
.,
'.'
'
a.
l
~
.
:',
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\ ..
,',
C
e.
".
.'
----------------~--------------------------------------------------------------------~-------------------~~~--
H
�1'1
I,
I
1 ".
Figure 5-2. SSA's Functionol Assessment of the Severity of DisoblingConditions
CURRENT POUCY ~
" .. ("'.'
,
'.
j...It::I"VV\OlI Y\~
Paragraph B of Adult Mental
Disorders Listings
Paragraph B of Chi,ldhood
Mental Disorders Listings
Children age 3-18
The required level of severity is met
wi!h TWO of !he following:
The required level of severity is
met wi!h TWO of !he following:
1. Marked restriction in acti~ities of
daily living.
1. Marked impairment in age- .,>.
appropriate cognitive/commu- r '
nitation functioning. ,
2. Marked restriction in social
functioning.
3. Deficiencies of concentration,
persistence or pace cousing
frequent foilure to complete tasks.
4. Repeated episodes of decompen
sation in work, or work-like settings.
2. Marked impairment in age
appropriate social functioning.
Childhood Individualized
Functional Asssessment IIFA)
"Guidelines" are ONE marked
, and ONE moderote limitation or
THREE moderate limitations
among:
1. Cognitiv~ function.
2. Communication function.
3. Motor function.
4. Social function.
3. Marked impairment in
personal/behavior functioning
as evidence by:
a. Marked restriction in age
appropriate activities of daily
living; or
b. Persistent maladaptive
behavior destructive ta self,
o!hers, animals or property. ,
5. Personal/behavior function
• activities of daily living
• maladaptive behavior.
6. Concentration, persistence
or pace.
4. Deficiencies of concentration,
persistence or pace which cause
frequent foilures to complete tasks.
to a finding of disability.34 As noted earlier, for
conditions with high prevalence in the population, a
broad spectrum ofseverity, and low likelihood of
34. Most of the functional domains are evaluated in terms of the
severity of the deficit. In the domain of concentration. persistence and
pace, the severity of the limitation is distinguished in terms of the
frequency of the child's inability to perform age-appropriate taSks. A
marked deficit in this domain is frequent inability to complete age
appropriate tasks in a timely manner. A moderate deficit in this domain
is illustrated by example in the regulations as: frequent inability to
complete age-appropriate complex tasks. and occasional inability to
perform simple age-appropriate tasks.
28
Restructuring SSI for Children
being so disabling as to be a basis for SSI benefits
such as ADHO and certain learning disabilities - it
is parti~ularly important to have clear criteria for
determining the severity of the disabling conse
quences of the condition. For ex~ple, deficiencies
of concentration, persistence or pace - one of the
functional domains - are characteristic of some
learning disabilities and ofADHO across the
spectrum of severity. Criteria must be very clear to
distinguish only the severely disabling levels of such
conditions.
�Table A-3. Basis for Allowance of Childhood Disability Claims by Detailed Mental Diagnostic Codes, 1994
0
Percent distribution by basis for allowance
Based on medical listings
Total
Code
Total
Total
Total
Number
Total initial allowances
. Physical (nonmental) disorders
Mental disorders
Percent
, Meets
167,991
52,960
115,031
Disorder
100
100
100
53
51
Medically Functionally
equals
equals
16
5
,~M~~i:aI(\i~orders by specific codes
3180
Total,
Total
3152
3152
Total
3140
Total
3010
3120
3138
Total
2940
2950
2960
2990
3000
3150
IFA
24
2
<./.~
,-.,
7
-: 42',
'-._."./
I
S
62,188
Behavioral disorders
Personality disorders
Conduct disorders (child)
Oppositional defiant disorder (child)
2
100
39
7
3
52
100
100
8
8
2
12
2
12
li8~]
18,934
100
(i:)
3
5.372
1.771
1.715
ADHD and behavioral disorders
Attention deficit hyperactivity disorder
63
2,941
2.075
Learning / communication disorders
Learning disorder (child)
Speech and language delays (child)
.100
457
Mental retardation
Mental disorders other than
mental retardation
100
100
100
48
28
26
7
7
9
2
2
43
63
64
100
56
7
4
33
100
100
100
100
65
42
66
36
6
5
6
6
2
2
2
2
28
51
26
56
100
31
8
7
53
Mental disorders other than mental retardation
Organic mental disorders
3.276
Schizophrenidparanoid
functional disorders
1.380
Mood disorders (children)
5.901
Develop. disability including autism
3.666
Anxiety-related disorders
2,340
Developmental/emotional
disorders (infant)
3,015
32
Y3 J f-A
\....67.
~.
61
a. 1994 data are through November 28, 1994.
Abbreviations: IFA individualized functional assessment, ADHD = attention deficit hyperactivity disorder.
Source: Social Security Administration. Office of Disability.
fr
c""\ 1.•,
,.."
....
i
,
'.
.J
Appendix A: Tobles
47
�Figure 8-1. Sequential Disability Determination Process
••
Children: Pre-Zebley
Adults
(~ilaren:~
'r
1, Are you working?
(Yes
2. Do you have a severe impairment?
2, Do you have a severe impairment?
(No
=Deny)
1. Are you working?
(Yes =Deny)
1. Are you working?
(Yes = Deny)
= Deny)
INo=Deny}
(
,
Compare impairment
to medical listings
Compare impairment
to medico/listings
Compare impairment
to medico/listings
Mental'"
30. Meet both
Mental
Other'
3a. Meet both
diagnostic (AI and
functional (BI
criteria?
(Yes = Allow)
3a. Meet
criteria in
medical
listings?
(Yes =Allow)
30: Meet criteria in
medical listings?
3b. Equal? Meet
(BI and some
of (AI
IYes = Allow)
3b. Medically
equal medical
listings?
(Yes = Allow)
3b. Medically equal
medicallistings?a
3b. Equal? Meet
(B) and some
of (AI
(Yes = Allow)
(Yes:, Allow)
Assess residual functional capacity IRFC}
4. Can you do pOst work?
(Yes
= Deny)
Consider age, education and
work experience
5. Can you do any other work?
(No = Allow; Yes = Deny)
(Yes
=Allow)
diagnostic (AI and
functional (B)
criteria?
(Yes
=Allow)
Other
30. Meet
criteria in
medical
listings?
(Yes = Allow) ,
3b. Medically
equal medical
listings?
(Yes = Allow)
03c. Functionally equal medical listings?
(Yes = Allow)
(f;i;;, indiv;du"@i;;;CtfUnctional assessment
4. Given IFA, is impairmen~sl of
comparable severity to that which
would disable an adult?
(Yes =Allow; No = Deny)
a. Before 1990, SSA policy in Social Security Ruling 83·19 explicitly prohibited using an overall functional assessmenllo find thai a claimant's
impairment equalled the medical listings. , A claimant with multiple impairments could meet or equol the listings anly if at least one impairment,
alone, met or medically equalled a specified listing.
b. The childhood mental disorders listings were modified in 1990 10 include functional criteria similar 10 those put in the adult listings in 1985.
Abbreviation: IFA = individualized functional assessment.'
Appendix B: Disability Determinations
51
�\
\
,
.
:
':,
..
" ,
•
j,
•
•
CONFRONTING THE NEW POLITICS OF. CHILD AND FAMILY POLICIES
.
.
,
~
. Projects!unded by The Carnegie Corporation and Th,e Ford Foundation
,The Columbia University School of Social Work New' York. NY 10025
622 West l13th Street - ,
New York, NY 10025
Co-Directors
Sheila B. Kamerman
Alfred J. Kahn
To:
Participants in'the October 11 ConsultationlMinl-Conference, "Child
Welfare in the Context of Welfare •Reform'" '
From:
Sheila B. Kamerman and Alfred J. Kahn, Co-Convenors
We look forward to greeting you personally at the Washington Marriott on Friday
morning, October 11. Continental breakfast will be available from 9:00 a.m. The session
will start at 9:30 a.m. There will be a buffet luncheon at 12:30p.m., and we plan
adjournment no later than 4:30 p.m.
'
You will fmd enclosed:
- The program for the day.
- The Mark Courtney background paper.
- The participant 'roster.
Rooms have been reserVed and guaranteed at the Marriott for all those who reqUired
them. If a last.,minute problem prevents your participation, please cancel with the hotel ,
(202-872-1500) before 6 p. m. to save us .the charge.., and let us know.
,
'
An activity of the Cross·National Studies Program
Kamennan 212.854)1.449 • Kahn 212.854.3048 • Fax 212.854.4320
5
�......
.
.
,
....
.... ,
;.
'.
, , '.. CONSULTATION/ MINI-CONFERENCE PROORAM
,Confronting th~ ,New Politics of Child and' Family Policy
.
in the United States
.
, Orgar¥zoo by the Carnegie Corporation-funded project
"
'
CHILD WELF ARE IN THE CONTEXT OF WELFARE "REFORM"
October 11, 1996
Washington Marriott Hotel, I221-22nd St..
, 9:00-9:30
9:30-10: 15
NW: Washington DC. 20037 (202-872-1500>
Continental Breakfast .
Introduction to' the Project and Presentation of the Chair:
Alfred I ~ Kahn
Chair: Barbara Blum, President, Foundation for'Child Development
Presentation of th~ Paper ,
-Dr. Mark Courtney
.
Institute for Research onPoverty, ,UniverSity of Wisconsin - Madison
,
Clarifying Questions
10: 15-12:30 Discussants,
fol~owed by
General Discussiqn
- Kimberly Barnes-O'Connor, Children's Policy Coordinator
Senate Committee on Labor and Human Resources
, - MaryLee Allen, Children'sDefense Fund'
.
- Sheri Steisel, Director, Human Services Committee
National Conference of State Legislatures
12:30-1:30
Buffet Lunch
1:30-3:15
Chair: Charles Bruner, Ex~utive Director, Child and Family Policy Center
The Experience ofFour States- To Be Presented By:
- Deputy Director Isaac Patmer(Oh1o)
-:- Commissioner Gary Stangler (Missouri) "
,. Director less McDonald (Illinois) ,
- Administrator lean R~gers (Wisconsin)
California: The Los Angeles View
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- Director G. Peter Digre '
Questions and Comments
3:15-4:30
What are the Promising Options?
Chair: Sheila B. Kamerman
General Discussion .
�WELFARE REFORM AND CHILD WELFARE SERVICES
Mark E. Courtney
InstitUte for Research on Poverty and School ofSocial Work
University of Wisconsin' - Madison
I
Preliminary Draft
October, 1996
For Discussion at Mini-Conference/Consultation on Child Welfare in the
Context of Welfare "Reform", Washington, D.C. October 11, 1996.,
Confronting the New Politics of Child and Family Policies Project funded by
. the Carnegie Corporation.
�2
of the Social Security Act), now known as AFDC. The federal role grew out of the recognition
that some states were denying ADC payments to children whose homes were deemed "unfit."
The 1961 regulations required that either states continue ADC payments and improve conditions
.
.
in the home or provide out-of-homecare for the,child. Federal financial participation was
available only for the placement of children who had been receiving ADC in the month preceding
foster ·care placement. Later amendments made the program permanent and mandatory for states
and allowed for payments to children in private, not-for-profit institutions. Eventually, eligibility
included children from families who were eligible for ADC when the child was
remove~
from the
home regardless of whether the family was actually receiving ADC at the time,
The size of the federal foster care program relative to its "mother" program, AFDC,
highlights the need to understand the relationship between the child welfare system and overall
poverty policy.l The number of child recipients of AFDC increased by 37 percent from
approximately 7 million in 1985 to about 9.4 million in 1995. The AFDC caseload declined
between 1994 and 1995. Over the same ten-year period of time, the foster care population grew
by 79 percent-over twice the rate of AFDC growth-from 276,000 in 1985 to about 494,000 in .
The relative growth in the federal costs of both programs provides an even more striking
contrast (see Figures 1 and~). Federal expenditures onAFDC benefits and administration grew
from $7.76 billion in 1981 to $13.74·billion in 1995. In contrast"federal expenditures for foster
care maintenance payments and administration leapt from $309 million to $3.13 billion over the
same period. Under current law-without taking into account the potential impact of welfare
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�4
In considering these trends, it is'importa,nt to note that federal foster care costs are for
Title IV-E eligible (i.e., AFDC eligible) children only, .less than half of all children in foster care.
States. match federal expenditures for IV:-E foster care and adoptiqn assistance at their Medicaid
,
m~tching rate. Although there are no reliabj~ national figures on the total cost (including state
and local expenditures) of the foster care program, an American Public Welfare Association
(APWA) analysis ofthirty-one state child welfare plans in 1990 found that states expected to
provide 68.1 percent of foster care maintenance.payments and 57.2 percent of foster care service
payments in that year. 3 In contrast, states and localities paid approximately 45 percent of total
AFDC· expenditures in 1993. Thus, an analysis. of federal ,spending alone considerably understates
the overall ratio ofgovernmental foster care expenditures to income maintenance expenditures for
poor families.
These recent caseload and cost trends underscore the child welfare services crisis. A
consideration ofthe factors contributing to the current child welfare services caseload, including
legislative and judicial elements of child welfare policy, leads to t~o conclusions: (1) it is highly
unlikely that caseloads will be reduced in the near future; and (2) ~his crisis presents problems for
,
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reform of public assistance programs.
The Nature of the Crisis Facing the Child Welfare System
.
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.The federal government grants the states great latitude in administering child welfare
programs. The consequent variation in foster care programs fro~ one state to another makes
difficult any effort to discuss national" foster care poiicy. Nevertheless, federal legislation in
II
conjunction with federal and state court decisions directly affected the child welfare system. In
..
�\
6
3 million, an increase of 63 percent sinceo1985.~ In contrast, about 670,000reports were filed in
"
Permanency Planning
By the late 1970s;interest in finding adoptive homes forhard-to:..adopt or "special needs"
children in foster care (e.g., ethnic minorities, older children, children with disabilities), along with
the perception that many children were being placed inappropriately in foster care or were
spending inordinate amounts of time in the system, led to demands for reform ofthe existing child
welfare services system. The primary legislative consequence of this reform movement was the
Adoption Assistance and Child Welfare Act of 1980 (public Law: 96-272):
,.
•
•
I
Public Law 96-272 transferred the foster care program from Title IV-Ato a new Title IV
E. The law altered the funding mechanism for foster care by retaining its entitlement status but
, linking it to Title IV-B (Child Welfare Services) spending ,in order to encourage states to use their'
,
,
IV-B monies for pr~vention ofout~of-:home placement and rehabilitation of families. 7 Previously,
many states had used much oftheir Title IV-B funding to help defer, state costs of fost~r care
'
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placement. It also created an uncapped entitlement program of adoption assistance payments to
parents who adopt children with special needs. Since 1986, Title IV-E funding has also been
available for services to prepare foster youth for independent living. This fixed appropriation ~s
currently $70 million per year.
,
Public Law 96-212 requires the states to implement a number ofprograms ~nd procedural
-,
reforms in order,to obtain maximum federal financial participation in their child welfare programs.
These include: a statewide information system and inventory of children in foster care; a
�8
fits-all" approach to program development has ,precluded a fair test of the potential ofservice
programs to improve family functioning and prevent unnecessary out-of-home placement. 10
Although the procedural and progratnmatic requirements associated with permanency
planning make sense,' in practice they lead to tiine spent o~ voluminous paperwork and court
meetings on the part of child w~lfare workers. These reforms were put in place just as reports of
,
'
'
child abuse-the primary source of "demand ll for child welfare services-were beginning to
skyrocket. Unfortunately, although foster care spending has grown with the foster care caseload,
the funding for casework services'under Title'IV-B Child Welfare Services has not (see Figure 3).
For example, while IV-Espending grew over 900 percent between' 1981 and 1995, IV-B
spending increased only about 80 percent over the same period, from $193,4 million in 1981 t6 an
estimated $294,6 million in 1995. Even after adjusting for inflation, federal foster care spending
grew by over 400 percent between 1981 and 1993 while IV-Bspending only grew by about 14
.
.
,percent. Furthermore, although a large but unknown portion of funds provided by the Title XX '
social services block grant are spent by the states on child protective services, these funds have
.
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declined in reat terinssince the early 1980s. Thus, ~fter the implementation of CAPT A and P. L.
96-272, the child welfare services system was left providing fewer services to a much larger,
clientele. 11
, The Changing Characteristics of the Foster Care Case/ODd
If foster care is intended to be the "life raft" for.children who can noionger remain safely
at home, then the boat is being swamped, not only by the sheer number of its passengers, but also
by their numerous and expensive special needs. Various studies have found that up to 60 percent
'.
�10
other age group, and even in texas they are st,!ying longer than all but adolescents. Thus, ,the
, recent rise in foster care caseloads includes a foster care "babyboom" that will almost inevitably
result in a historically unprecedented number of children being raised in some form of fost~r care.
,
,
",
African-American children are particularly likely to wind up in foster care. In 1990, the
,
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likelihood that African-:American children would be in foster care ranged from three times (Texas)'
to over ten times (New York) that of Caucasian children. 17 The overall foster care prevalence
rate in 1990 for African-American children was about 4.4 percent in California and 4.2 percent in
New Yode, the states with the largest foster care popula~ions. Oyer 5 percent of AfricanAmerican infants in these two states lived in foster care at any given point in time, in 1990.
Of course, an overall point-in-time prevalence rate likely underestimates the proportion of
children who will spend some time in foster care. For example, like other children, many African- .
Americans born in the past several years who did not enter care in their first year will do so' before'
they reach adulthood, given that about three-quarters offirst entries to foster care happen after
the age of one. IS Furthermore, since best estimates indicate that nearly two-thirds of children
.
'.,
entering care exit within three years19 and fewer than one-third of these reenter care20, prevalence
rates for older children are not exclusively, or even largely, a function of infants or other young
children staying in the system indefinitely. Thus, although an acc,urate estimate is not possible at
this time, current data. suggest that a large proportion of African Americans in at least some of our
largest states, if not across the country, will have spent some time in foster care.
"
�12
that the option of paying kin to care for a child, as opposed to hav:ing to find an appropriate foster
home, makes the difficult decision to remove a child from home easier for social workers and
judges.
Anecdotal (and some empirical) evidence suggests that child welfare workers believe that
placement with kin reduces the need to provide reasonable efforts to return children to their
biological families. 24 Presumably, kinship care frees up time for social workers to spend on .
casework activities related to other clients on their normally large and demanding caseloads. This
. relative lack of attention to kinship care may contribute to the slower rate offamily reunification
for children placed with relatives.
Though the emphasis in P.L. 96-272 on finding the most family-like and least restrictive
placement for foster children helps to make kin an attractive placement resource, judicial rulings
at the federal and state level have probably contributed most to the impetus to place children with
kin by.providing equitable financial support to relative caregivers.25 In particular, the ruling by the
u.s. Supreme Court in Miller v. Yotiakim opened the way for kinship care by requiring that
relatives not be excluded from the definition offoster parents eligible for federal foster care
benefits. 26 Ifa child considered for out-of-home phicementcomes from a birth-parentIs home that
.is AFDC eligible, relative caregivers are· eligible for the same reimbursement provided to non-kin
•
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foster parents, as long as the kin cari meet state standar~s for foster. care. Relatives who care for
children placed by court order whodo·notcome.from an.AFDC-eligible family are eligible only
for AFDC payments, rather than AFDC foster care payments. In practice, numerous states have
..
established more lenient standards for the approval of relative foster care homes than for non-kin
�14
process of triage. Agencies increasingly decline help to a'growing proportion of families being"
reported for child abuse and neglece8, and shuttle an increasing number of children to kin with'
little provision of supportive or pennanency planning services.
Further complicating the problems cited above is an apparent lack of political will to
refonn the child welfare system. At present, based on any objective measure of need, federal and
state governments do not allocate sufficient resources to child welfare services. Less than $1
billion spread over five years for an array of planning activities, family preservation, and family
support services cannot be expected to reduce the growth of troubled families and the demand for
foster care.' One need only consider that under current funding projections the federal
government will spend over $16 billio~ over the same period on foster care to appreciate that the
family preservation and support initiative--while a laudable experiment--doesnot represent a
significant fiscal commitment to supporting families and preventing out-of-home care. 'Neither is
there any evidence that state and local funding ofchild welfare services has kept pace with
demand.. In fact, in recent years over thirty states,have frozen or cut child welfare services,
spending. 29
Even without the complications presented by welfare reform, it is hard to envision how the
current crisis in the child welfare system can be overcome without a serious attempt to reconcile
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the competing demands ofcurrent child welfare policy, and the emergence ofa.political
commitment to allocate'the resources·necessary to run the systen;t. Ofcourse, the lack of rigorous
program evaluation research in the area of child welfare services-'partly a function of minimal '
,.'
federal funding-leaves policy makers and administrators with little concrete guidance as to what
to do even iffunds were forthcoming. 30
�16
.•
. states operating welfare programs undt:~ waivers of AfDC regulations are allowed to
continue to operate their cash assistance programs under some or all of the' waivers,
.
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although they will still receive funding at the block grant amount; ..
unmarried minor parents will be required to live with an adult or in an adult-supervised
•
.setting and participate in educational and training activities in order to receive assistance;
T ANF aid may not be used to provide assistance to a child who has been or is expected to
•
be absent from home for a period 0(45 consecutive days, though states may establish
good cause exemptions to this ruJe, and can choose to provide assistance for up to 180
days for children gone from home longer than 45 days;
•
individuals convicted of drug-related felonies after enactment of the legislation will be
barred for life from receiving temporary assistance or food stamp benefits, although states
. will have the right to optout of this provision;
•
the definition of child disability under the Supplemental Security Income (SSI) program is
narrowed,31 resultingin an estimated reduCtion of the SSI, caseload of about 315,000 lowincome children by 2002;32
•
elimination ofSSI and Food Stamp eligibility for most fegaJ immigrants until citizenship;
•
states are allowed to ban most legal immigrants until citizenship from receiving benefits
.. under the Medicaid (except for emergency services), Title XX Social ,
Services, child care,
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and TANF block grant programs;
•
,combines new child care funding with the existing Child Care and Development Block
. Grant to provide $13.9 billion in mandatory funding for child care in fiscal years 1997-
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decrease under P.L. 104-193. Perhaps most i".1portantly, the conflict in goals between the new
work-based assistance programs and the child welfare system-may lead to changes in the
operation of child welfare services. These possibilities are all. discussed in tum below.
Will Welfare Reform ¥ake Life Harder, or Better, for Poor Children and Their Families?
Advocates and opponents of P:L. 104':'193 paint very different pictures of the likely results
of the law for children and families. Advocates claim that reform will "rescue" families from
dependency and move them into the world of work. Employment, it is claimed, will lift families
out of poverty and in the process create a number of related benefits for parents and children
including: enhanced parental self-esteem; improved parental social support owing to connections
to others in the workforce; greater self-esteem for children who can now -look up to their _
employed parents; and, in some cases, improved child care for children whose daily supervisiori
will be shifted from ineffective parents to government-subsidized child care settings.
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Opponents of the law argue that the benefits of employment and subsidized child care that
are realized by somefamilies will be far outweighed by harm to others. Most notably, they claim
that many families will see a significant deterioration in their economic well:-being. Opponents
.
believe that families and children will suffer under welfare reform due .to a combination of a "race
I
to the bottom" between states trying to cut benefits and the inability of states to move enough
parents -into jobs. Under. this.scenario, families ~ho receive assistance will generally get less than
they would have from pre-reform programs, many children whose parents·are involved in work
programs will sufferfrom inadequate child care, and a substantial proportion of families will
ultimately be rendered destitute due to work performance sanctions or time limits on assistance.
�20
children are placed in foster care because ofneglect than because of physical and sexual abuse
combined. 36 Poverty is the best predictor of child neglect, as well as a strong predictor ofother
forms of child maltreatment. 37 . Indeed, the i~cidence 'of abuse and neglect is approximately 22
times higher among families with incomes below $15,000 per year than among families with
incomes over $30,000 per year. 38 Any significant change in the economic circumstances oflow
.income families is likely to affect the demand for child welfare s~rvices including foster ca~e. 39
Although it is impossible at this point to predict the ultimate impact ofwelfare reform on
the child welfare system, the potential magnitude of the impact is more clear. Specifically, the
increase in demand that might result from greater familial poverty and other stress on families is
far greater than the decrease in demand that could result· from improvement in the economic
circumstances of poor families. This is for a very simple reason: The financial benefits of work
are likely to be marginal for most families.that enter the workforce as a result of reform, whereas
the economic consequences of program sanctions for affected families may be devastating.
Experience with work pro~ams ~hows that the financial circumstances of families involved are
only marginally improved .over those offamilies not involved ip such programs. 4O In contrast,
under P.L 104-193 states will be able to deny families cash or in-kind assistance for a variety of
reasons--:most notably failure to comply with work requirements or exceeding the state benefit
tiQle limit--resulting in a drastic reduction in the families' ability to acquire basic survival
necessities. Moreover; changes in program eligibility and cuts in benefit levels for a variety of
federally-supported programs .will increase the riumber of poor families and children.
This is not to say that welfare reform will, of necessity, lead to increased demand for child
welfare services and out-of-home care. Still, the scenario that is most likely to result in a drastic
'.
�22
been eliminated, some stat~s may simply cut off benefits when economic or political Circumstances
result in inadequate funds to continue assistance to all families in need. .
cited .
Growth in child poverty owing to any or all of the reasons. . above is likely to lead to
an increase in child maltreatment, and a corresponding increase in demand for child welfare
services including substitute care.. The Urban Institute's microsimulation model of the impact of
the new welfare law indicates that about ·1.1 million more children will move into poverty under
the law, and this estimate is not significantly' affected by substantial variation in assumptions about .
how many members of the nonexempt caseload facing time limits will find jobs. 44 The "poverty
gap"--the difference between the poverty rate aild.poor families' incomes--is predicted to increase
by about $6 billion (12 percent) in comparison to current policies, with eight million families with
.children averaging income losses ofabout $1,300 per family.
Narrowing the definition of child disability under the SSI program may also increase
demand for out-of-home care. The debate over whether the children in question are truly disabled
may be largely irrelevant if the children are a burden,or are perceived to be so, by their.
caregivers. In particular, children who exhibit "maladaptive behavior" and are no longer eligible.
for SSI may be prime candidates for entry to out-of-home care when.their caregivers can no .
longer rely on SSI for financial support.
It is not merely the large number of children that P.L.. ] 04-193 might render poor that
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gives the law the potential to_wreak havoc_with the child welfare system~ the depth of poverty that
children may be subjected to is the greatest threat. Some families who under current law would
use AFDC, SSI, and/or food stamps to house and feed their children will lose all such aid under
•
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parents and'thdr children live with an adult rel~tive or legal guardian. These exceptions include
the unavailability of a suitable adult relative or guardian arid the potential for abuse ofthe minor
parent and/or their child(ren) if they were to live with an adult relative or guardian. The child
welfare system may also be left with the task of creating adult-supervised out-of-home care
settings when no adult relative or legal guardian is willing or able to provide a home fora minor
parent and the minor's chilrl(ren).
Child Welfare Funding in the New Era: Doing More with Less?
Not only does P.L. 104-193 have the potential to substantially increase pressure on the
child welfare system, it will most likely result in a reduction of the use of federal funds to support
.
.
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child welfare services other than out-of-home care. Little attention has·beenpaid in the debate,
over welfare reform to the ways that states have made use ofTitle IV-A Emergency Assistance
(EA) and Title' XX funding to run child welfare programs. P.L. 104-193 will have significant
effects on state child welfare operations by block gra~ting EAand cutting Title XX.
In recent years the EA program had increasingly evolved into a child welfare program: 46
Many states shifted the primary focus of theirEA programs from coping with national disasters to
services intended to help handle emergencies associated with child maltreatment, domestic
violence, and family crises such as homelessness. As of 1994, 44 ,states used EA to help cover the
costs of care and services to children and their fanulies,and most of the growth in EA'
expenditures since 1992 was associated with child welfare programs. Federal spending on EA
w~s approximately $700 millipn in 1994. 'EA was an uncapped entitlement program that required
a 50 per~ent state match for all assistance, service~ and administration. Under federal welfare
�26
TANF funds on child welfare services as they did under EA in 1994, this will be less than what
was projected to be spent under the uncapped EA program. Moreover, states do not need to
. spend anyTANF monies on child welfare programs, and child welfare agencies may lose out to
state economic assistance departments in any struggle o.ver TANF funds. Similarly, unless states
substantially increase the proportion of Title XX funds that they devote to child welfare services,
the decrease in Title XX funding under P.L. 104-193 will result in a reduction in federal funds
spent on child protection.
Kinship Care and Welfare Reform
In the absence of significant legislative or judicial action regarding the status of lQnship .
foster care, many children from familiesleft destitute und~r welfare reform may end up living with
extended family. The rapid growth of kinship foster care has al~ea:dy led many states to review
. their policies and, in some cases, inove to reduce payments and service support to kinship care
providers. 47 Furthermore, at least one state's welfare reform proposals explicitly call for the
development of kinship care programs to provide homes for cpildren displaced by program
changes, and other states may follow stiit,48 Still, "reform" of kinship care, like reform of public
assistance, is easier said than done. On the one hand, attempts to., minimize government support
.
for kinship care providers are consistent with the belief of some policy makers that extended
families should be held responsible fer the care ofindigent or dependent family members. It can
also be argued that reducing support to kin caregivers couJd save taxpayers' money. On the other
hand, attempts to limit the growth ~fkinship care or deny assistance to kin who are willing to care
for these children fly in the face of society's commitment to keep children with family, a
..
�. 28
not have signifi<;:ant numbers of children in AFPC-supportedkinship care prior to the passage of
the welfare reform bill will, not be able to take advantage of this funding' scheme..
Problems in Reconciling Welfare Reform with Child Protection
The political debate over how destitute children will be p~otected in the post-reform era
has often betrayed a poor understanding of the nature of the child welfare system: Givencurrent
federal and state child welfare policy, children who are put in harm's way by changes in program
eligibility or program sanc.tions will'not spontaneously appear at the doors of "orphanages" or
.other out-of-home care settings. Many ifnot most poor parents will attempt to raise their
children by any means necessary. Only when their behavior results in a child maltreatment report
will the child welfare system intervene .. Many 'children may suffer considerable harm before such a
report is made, and even the. filing. of a report does not guarantee timely intervention given the
precarious state of child welfare services. Indeed, preliminary data from the 1993. National
Incidence Study of Child Abuse and Neglect indicate that the proportion of maltreated children
whose situations were investigated by child protective services authorities declined from 44
percent in 1986 to 28 percent in 1993. 49 'Any additional maltreatment reports generated by .
increased stress on poor families owing to welfare reform will further stretch the already
overwhelmed child welfare system.
Unfortunately, P.L. 104-193 and most current state-level welfare reform initiatives make
little attempt to reconcile the principles of the new safety net with those ofthe child welfare
.
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. system. Federal. and state-level welfare reform plans are primarily concerned· with encouraging
parents to work instea~ of relying on public assistance. These reforms provide financial and in- .
�30
with program requirements, in many. cases the~r children will be placed in harm's way. Even if
child welfare agencies or private charities haQ the-ability to provide these families with all of the
basic necessities--an unlikely scenario given the limited resources available to these institutions-
,
such intervention would be inconsistent with the'imperative to punish parents for failure to work.
In states that decide to rely'heavily on sanctions, protecting children from'harm when sanctions
are levied will most likely involve efforts to interv:ene ~nd place the children in some form of out
of-home care. Indeed, many architects ~f welfare reform have openly ~alled for foster care or
institutional placement of children when their ,parents do not comply with work rules. Of course,
it has already been mentioned that current child welfare policy only justifies state intervention in
families 'in confirmed cases of child, maltreatment, not simply because a parent does not work.
Nevertheless, states choosing a "tough" approach to welfare reform will find it difficult to ignore
the plight of children in families that a~e denied economic support, and may seek to expand .the
grounds for state intervention to protect children.
.
>..
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•
On the. other hand, state-level welfare reform based on active family support and a
guarantee of work and child care forthose who make a good fait,h effort to improve themselves
may contribute to a decrease in demand for, and improved effectiveness of, child welfare services. ,
ludicioususe of incremental financial sanctions a.sopposed to abrupt termination of benefits
,
would lessen the likelihood th~t' children wili be placed in de~perate situations.
'
Mor~over, making
a rang~ of supportive services (e.g.,. job training md education, ,parent training and support
groups, substance abuse treatment) available to families involved with the new public aid system
would not only improve the prospects that parents will succeed in making the transition to work,
, it would also help identifY, before children have been seriously harmed, families that require child
".
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of-home care in the first place, and in recent years many states have cut child welfare spending in
the face of increasing demand for services. Furthermore, in many ,ways federal law remains the
primary method ofensuring that states provide.some basic level ofchild welfare services, even if
the federal governmentitselfhas donelirtle to enforce state compliance with federal law. 50
,
Litigation intended to improve child welfare practice at the state and local level has resulted in at
least 21 states being required to operate part or all oftheir'child welfare services programs under
some form ofcourt order. 51
To be sure, some statesare endeavoring to improve the functioning oftheir child welfare
systems, but for the most part these efforts either have not demonstrated substantial effectiveness
or are tinkering at the margins of the child welfare crisis. Family preservation programs
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theoretically have the potential to stem the flow of children into out-of-home care, but have to
date failed to demonstrate such an effect in any larg~~scale demoristration.
Subsidization ofguardianship arrangements with Title IV;.E funds is long overdue'and has
been approved by the U.S. Department of Health and Human Services on an experimental basis in
Delaware and Illinois. But this will have no impact on entries to the system, and should only .
marginally decrease long-term costs of the care of children involved since'maintenance payments
will be continued and the casework services provided to children inJong-term kinship care--the
primary candidates for the proposed guardianships--are already minimal.
Adoption has -also been champion~ by welfare reform advocates as a way to minimize the
impact of any increased demand for out-o£;home carestemrning from aid reductions. In
particular, racial preference policies hav~ been blamed for the low rate ofadoption offoster
children and the argument has been advanced that elimination of such policies will move a large
�34
child welfare system and its' clients ..FurthermQre, evaluation efforts should be required to take
into account the impact of welfare reform on child well':'being and child welfare system caseloads
and weigh these costs against possible benefits. Policy analysts have too long neglected the
importance of the child welfare system as a de facto poverty program. If we continue to do so
during this period of grand experimentation with the social safety net, many children may suffer
unnecessarily as a result.
'f
Notes and References
1.
Unless otherwise noted,
dat~
on the AFDC and child welfare services programs, including
foster care, come from the U.S. House of Representatives, Committee on Ways and Means, 1994
Green Book: Background Material and Data on Programs Within the Jurisdiction ofthe
Committee on Ways and Means (Washington, D.C: U.S. Government Printing Office, 1994), or
from unpublished data from the Office of the Assistant Secretary for Planning and Evaluation,
. U.S. Department of Health and Human Services.
2.
The foster care caseload numbers are estimates derived from the American Public Welfare
ASsociation's Voluntary Cooperative Infonnation System (VCIS). Fo~ d~ta on caseload trends
through 1992, see Toshio Tatara,"u.S. Child Substitute Care Flow Data for Fy 92 and Current
Trends in the State Child Substitute Care Populations," VCIS ResearchNotes 9 (1993): 1-14,
1993. The 1995 caseload estimate is based on unpublished preliminary VCIS data ..
.
3.
.
National Commission on Child Welfare and Family Preservation, ractbook on Public
..," .
Child Welfare Services and Staff (Washington, D.C.: APWA).
. 4.
For discussions of the growth of child maltreatment reports and. the impact on the child
".
�36
13.
U S. General Accounting Office, Foster Care: Parental Drug Abuse Has Alarming
Impact on Young Children (Washington, DC: US. General Accounting Office, 1994).
14.
Neal Halfon, Gail Berkowitz, and Linnea Klee, Health and Mental Health Service
Utilization by Children in Foster Care in California (Report to the California Policy Seminar,
University of California, Berkeley, CA, 1990).,,'
15.
Patrick A Curtis and Charlotte McCullough, "The Impact of Alcohol and Other Drugs on
'the Child Welfare System," Child Welfare 72 (November-December 1993): 533-542. '
16.
Robert M. Goerge, Fred H. Wulczyn, and Allen W. Harden, Foster Care Dynamics
1983-1993, California, Illinois, Michigan, New York and Texas: an Update from the Multistate
Foster Care Data Archive (Chicago, IL: Chapin Hall Center for Children, University of Chicago,
1995).
17.
Robert M. Goerge, Fred H. Wulczyn, and Allen W. Harden. Foster Care Dynamics
1983-1992, California,/llinois, Michigan, New York and Texas: a Reportfrom the Multistate
Foster Care Data Archive (Chicago,IL:Chapin H(ill Center for Children, University of Chicago,
, 1994).
18.
Ibid.
19.
Ibid.
20.
Mark E. Courtney, "Reentry to Foster Ca.re of Children Returned to Their Families,"
Social Service Review 69 (June 1995): 226-41; Fred H. Wulcz.yn, "Caseload Dynamics and Foster
Care Reentry," Social Service Review 6S'(March 1991): 133-156.
21.
Richard P. Barth, Mark E. Courtney, .Jill Duerr Berrick, and Vicky Albert, Pathways to
.
~
.
Permanence: Child Welfare Services Pathways and Placements (New York, NY: Aldine de
Gruyter, 1994); Goerge et al.,"Foster Care Dynamics, 1983-1993."
'.'
.,., ..
..
�38
31.
Under P.L. 104·193, the Individualized Functio.nal Assessment is eliminated as a means o.f
determining SSI eligibility. Under the new law, to. be co.nsidered disabled fo.r the purpo.ses o.f SSI
eligibility a child must have a medically determinable physical o.r mental impairment which results
.
.
.
"
in marked o.r severe functio.nallimitatio.ns, which can be expected to. result in death, o.r which has
lasted o.r is expected to. lastfo.r at least o.ne year. "Maladaptive behavio.r" is remo.ved as a medical
criterio.n fo.r evaluating mental disabilities in children:
32.
David A. Super, Sharo.n Parro.tt, Susan Steinmetz, and Cindy Mann, The New Welfare
Law (Washingto.n, DC: Center o.n Budget and Po.licy Prio.rities, August 13, 1996).
33.
34.
'Ibid.
P.L.104·193 requires each state to. establish a child SUPPo.rt enfo.rcement.program meeting
certain federal requirements in o.rder fo.r the state to. be eligible fo.r the TANF blo.ck grant. So.me
o.f the requirements fo.r states include: establishment o.f centralized registries o.f child SUPPo.rt
o.rders and centralized co.llectio.n and disbursement units; creatio.n o.f expedited pro.cedures fo.r
child suppo.rt enfo.rcement; and the use o.f a range of enfo.rcement techniques including revo.catio.n
o.fpro.fessio.nal and driver's iicenses, 'The law also. streamlines the pro.cess o.festablishing
paternity, establishes a natio.nal directo.ry o.f new hires to. track the, mo.vement o.f child SUPPo.rt
o.bJigers acro.ss state Iines~and expan,ds pro.cedures fo.r direct withho.ldingo.fchild suppo.rt fro.m
wages. Recipients o.f child SUPPo.rt must assign rights to. suppo.rt when they receive public
.assistance and they must coo.perate with paternity establishment effo.rts. The law ends the $50 .
pass thro.ugh o.f child support to. recipients o.f public assistance, but gives f~milies no. lo.nger o.n
assistance prio.rity in receipt o.f child suppo.rt arrears.
I do. no.t address the Po.tential impact o.f the child sUPPo.rtelements o.f P.L. 104~ 193 o.n the
"
�40
(Expanded version of paper presented at the 4th European Conference on Child Abuse and
. Neglect, Padua, Italy, MarchJ993)..
38.
The 1993 National Incidence Study of Child Abuse and Neglect provides data on the
relationship between family income and the incidence of child maltreatment. See press release
.from the U.S. Department ofHealth :and. Human Services, "Survey Shows Dramatic Increase in
.
.
Child Abuse and Neglect," September, 18, 1996.
39.
The long-observed association between poverty and child maltreatment is not the only
reason to be concerned about the potential of welfare reform to increase demand for child welfare
services. A time-series analysis of the number of referrals to child protective services in Los
Angeles County, Californiafound that a 2.7 percent cut in benefit levels in 1991 was associated
with an increase of about 12 percent in the monthly number of protective services referrals, while
a 5.8 percent cut in AFDC benefits implemented in two phase~ during late 1992 was associated
with an approximate 20 .
percent increase in referrals, after controlling for the overall trend and
.
seasonal variation in reports. See unpublished report of Robert E. Sherman to the Institute for
Human Services Management, Seattle, Washington, April 5, 1995.
40. .
See, for example, The JOBS Evaluation, Early Findings on Program Impacts ill Three
Sites (Washington, D.C.:
US~
Department ofHealth and Human Services and US. Department
ofEducation, 1995); James Riccio, Daniel Friedlander, and Stephen Freedman, GAIN: Benefits,
Costs, and Three-Year Impacts ofa Welfare-to-Work Program (New York: Manpower
Demonstration Research Corporation, 1994).
41.
. Super etal., "The New Welfare Law."
.,
�42
48.
Report to the Assembly Committee on.Welfare Reform of the Legislative Fiscal Bureau of
the State of Wisconsin on Assembly Substitute Aritendment,LRB 0286/1 to Assembly Bill 591:
I
•
•
•
•
•
Summary of Wisconsin Works Proposal. November 24, 1995.
49.
U.S. Department of Health and Human Services""S~rvey Shows Dramatic Increase."
50~
A recent study of federal enforcement of state compliance with the case plan review
guidelines of Title IV-B, found that many states were out of compliance with federal.law and that·
the Department of Health and Human Services had not rigorously monitored state efforts. In
addition, between 1987 and 1993 Congress repeatedly passed legislation that repealed penalties
against states for noncompliance with Title IV-B. . See Christine Ellertson., "The Department of
Health and Human Services' Foster Care Review System Needs a Major Overhaul," Children and
Youth Services Review 16, nos. 5-6 (1994): 433-444.
51.
Robert Pear, "Many States Fail to Meet Mandates on Child Welfare," The New York
Times (March 17, 1996): 1, 14..
52.
For a review of the potential impact of transracial adoption on the 'child welfare system,
see Mark E. Courtney, "The Politics and Realities of Transracial Adoption," Child Welfare (in
pres·s).
53.
Richard P. Kusserow, Barriers to Freeing Children/or Adoption (Washington, D.C.:
U.S. Department of Health and Human Services, Office of the Inspector General, 1991).
54.
For a discussion of the challenges posed by applying managed care principles to child
.
.
welfare programs, see Tracey Feild, "Managed Care and Child Welfare:
Welfare 54 (Summer 1996): 4-10.
Will It Work?" Public
'.
�I
. Figure 2: Percentage Growth in Federal Spending on Title IV-E Foster CC3!e and AFDC
Compared, Fiscal Years 1982 to 1995
L"";':' Title IV-E Spending
-
AFDC Spending
I
1000%
900%
00
0\
800%
700%
Il)
(.)
.5 600%
til
Il)
5 500%
'""
(.)
.5 400%
lj
(.)
'"" 300%
~
Il)
200%
100%
0%
1982
1983
1984
.1985
1986
1987
1988
.1989
Fiscal Year.·
.
1990.,1991
1992
1993
1994
1995
�"'
(
�. CHll..n WELFARE, WELFARE 'REFORM', AND THE NEW POLICY
CONTEXT
.Organized by the Carnegie Corporation-funded project
Confronting the New Politics of Child and Family Policy
in the United States
October 11, 1996
Participants
Dr.. Larry Aber'
National Center for Children in Poverty
Columbia University
154 Haven Avenue
New York, NY 10032
Tel: 212-927-8793
Mary Lee Allen
Children's Defense Fund·
25 E Street, NW
Washington, DC 20001
Tel: 202-628-8787 Fax: 202-662-3510 .
Kimberly Barnes-O'Connor
Children's Policy Coordinator
Senate Committee on Labor and Human Resources '
835'Hart Senate Office Building
Washington, D.C. 20510
Tel: 202 224-6770 Fax: 202-224-6510
Kay Bengston
Assistant Director for Advocacy
Evangelical Lutheran Church in America
Lutheran Office for Governmental Affairs
122 C Street, NW
Suite 125
Washington, DC 20001
Tel: ·202-626-7942
. Barbara Blum
President
Foundation for Child Development
345 East 46th Street
New York, NY 10017
Tel: 212~97-3150 Fax: 212-697-2258 .
Mary Bogle
Executive Director
Grantmakers for Children, Youth and Families
815-15 Street,NW
.
Suite 801
Washington, D.C. 20036
Tel: 202-393'~714
'.
1
�Mr. Charles Bruner .
Executive Director .
Child and Family Policy Center
218 Sixth Avenue, Suite 1021
Des Moines, IA 50309-4006
Tel: 515-280-9027 Fax: 515-244~8997
Dr. Mark Courtney .
Institute for Research on Poverty
University of Wisconsin - Madison
Social Sciences Building
1180 Observatory Drive
Madison, WI 53706
Tel: 608-262-3561 Fax: 608-263-3836
. haron Daly
S
Deputy to the President
Catholic Charities USA
1731 King Street.
Suite 200
Alexandria, VA 22314
Tel: 703-549-1390 Fax: 703-549-1656
G. Peter Digre
.
Director, Department.of Children and Family Services
425 Shatto Place
Los Angeles, CA 90020
Tel: 213-351-5601
Laurie Feig
Social Science Analyst
ASPElDHHS
HH Humphrey Building, Rm 450-G .
200 Independence Ave., SW·
Washington, DC 20201
Tel: 202-690-5938 Fax: 202-690-5514
e-mail: lauraf@osaspe.dhhs.gov
James W. Ford
Assistant Chief of Staff
Administration for Children's Services
80 Lafayette Street
New York, New York 10013
Tel: 212-266-2385 Fax: 212-266-3450
Dr. Robert Goerge
Associate Director
The Chapin Hall Center for Children at the University of Chicago
1313 East Sixtieth Street
Chicago, IL 60637
Tel: 312-753-5973 Fax: 312-753-5940
e-mail: goerge-robert@chmail.spc.uchicago.edu
2
�Mark Greenberg
Senior Staff Attorney
Center for Law and Social Policy
1616 P Street, NW - Suite 150
Washington, DC 20036
Tel: 202-328-5140, ext. 4 Fax: 202-328-5195
email: hh0248@handsnet.org
Dr. Ron Haskins.
Staff Director
House Committee on Ways and Means
SubcOmmittee on Human Resources·
Rayburn House Office Building·
Room B-317 .
Washington, DC 20515
Tel: 202-225-1025 Fax: 202-225-9480
e':mail:RHASKINS@hr.house.govSue Hoechstetter
Government Relations Director
National Association of Social Workers·
750 First Street, NE
Washington, DC 20002-4241.
Tel.: 202-408'-8600/1-800-638-8799 Fax: 202-336-8310
Andrea Kane
Senior Policy Analyst
National Governors' Association
444 North Capitol Street
Suite 267
Washington, DC 20001-1512
Tel: 202-624-7857 Fax: 202-624-5313
e-mail: akane@nga.org
Mary Lamer
Policy Analyst.Editor
The David & Lucile Packard Foundation
Center for the Future of Children
300 Second Street
Suite 102
Los Altos, CA 94022 .
Tel: 415-948-3696 Fax: 415-948-6498
.Michael LeVine
Program Officer
.• Carnegie Corporation
·437 Madison Avenue
26th Floor
New York, NY 10022
Tel: 212-371-3200
...
3
�or. David Liederman
Executive Director
Child Welfare League ofAmerica
440 First Street, NW
Washington, DC 20001~2085
Tel: 202-638-2952 Fax: 202-638-4004
JesS McDonald
Director
lllinois Department of Children and Family Services
406 East Monroe Street
Springfield, IL 62701
Tel: 217-785-2509 Fax: 217-785-1052
Professor Brenda McGowan
Columbia University School of Social Work
622 West 113 Street
.
New York, NY 10025
.------- Tel: 212-854-2824 Fax: 212-854-2975
e-mail: BGM@columbia.edu
Isaac R. Palmer
. Deputy Director
'. .
Office of Child Care and Family Services
65 East State Street, 9th Floor
Columbus, OH 43266-0423
Tel: 614-466-1213 Fax: 614-466-9247
Ms. Carol H. Rasco
Assistant to the President for Domestic Policy
The White House
.
. Washington,DC 20500
Tel: 202-456-2216 Fax: 202-456-2878
Ms. Jean Rogers
Administrator
Department of Workforce Development
1 West WIlson Street
P.O. Box 7935
Madison, WI 53707-7935
Tel: 608-266-3035 Fax: 608-261-6376
e-mail: rogetje@mail-state;wLus
Betsy Rosenbaum
American Public Welfare Association
810 First Street, NE
Suite 500
Washington, DC 20002-4205
Tel: 202-682-0100 Fax: 202-289-6555
4
�,.
Audrey Rowe
.. .
Senior Vice President & Managing Director
for Children and Family Services
Lockheed-Martin IMS
1200 K Street, NW
Washington, DC 20005
Tel: 202-414-3713 Fax: 202-289-8274
Ms. Laurie Rubiner
Legislative Assistant
Staff of Senator John H. Chafee
410 Dirksen Senate Office Building
Washington, D.C. 20510
Tel: 202-224:.6176 Fax: 202-224-5167
Ann Segal
Acting Deputy Assistant Secretary
for Human Services Policy
ASPEIDHHS
HH Humphrey Building, Rm 450-G
200 Independence Ave.,SW
Washington, DC 20201 .
Tel: 202-690-8410 Fax: 202-690-6562
Gary J. Stangler
Director
Missouri Department of Social Services
Broadway State Office Building
221 W. High Street
Jefferson City, MO 65102
Tel: 573-751-4815 Fax: 573-751-3203
email: dlortS@mail.state.mo.us
Sheri Steisel
. irector, Human Services Committee
D
.
Nationcl1 Conference of State Legislatures
444 North Capital Street, NW
Suite 515
Washington, DC 20001
Tel: 202-624-5400 Fax: 202-737-1069
Dr.· Ruby Takanishi
Assistant Director for Social and Behavioral Sciences and Education
Office of Science and Technology PoliCy .
Executive Office of the President
436 Old Executive Office Building
Washington, DC 20502
Tel: 202-456-6129 Fax: 202-456-6027
"
/'
Professor Jane Waldfogel
Columbia University School of Social Work
622 West 113 Street
New York, NY 10025
Tel: 212-854-7863
5
�...
Carol Williams
Associate Commissioner
Children's Bureau·
Department of Health and Human Services
Mary E. Switzer Building
3330 C Street S.W.
Washington, D.C. 20201
Tel: 202-205-8618 Fax: 202-260-9345 .
email: cwilliams@acf.dhhs.gov
Co-Chairs
Alfred Kahn
Professor Emeritus
Columbia UniversitY. School of Social Work
622 West 113 Street
.
New York, NY 10025
Tel: 212-854-3048 Fax: 212-854-4320
, email: ajk2@columbia.edu
Sheila Kamerman
Compton Foundation Centennial Professor for
the Prevention of Children's and Youth Problems
Columbia University School of Social Work
622 West 113 Street
New York, NY 10025
Tel: 212-854-5449 Fax: 212-854-4320
email: sbk7@columbia.edu
Rapporteur
Karen Staller
Columbia University School of Social Work
622 West 113 Street
New York, NY 10025
·i
6
�PAR TICIP ANT'S LIST - Supplement
Kathleen Feelev
AsSociate DireCtor
The Annie E. Casev Foundation
70 I St. Paul Street'
.
Baltimore. MD 21202
Tel: 410-547-6600 Fax: 410-223-2983
Claudia Schauffer
Executive Director
Youth Law Center
114 Sansome Street
Suite 950
San Francisco, CA 94104
Tel: 415-543-3379 fax; -1-15-956-9022
-.
.-'
�E
x E.¢ UTI V E
OFF ICE
o F
THE
PRE SID E N T
11-Nov-1996 04:17pm
TO:
Carol H.. Rasco
FROM:
Diana M. Fortuna
Domestic Policy Council
SUBJECT:
Middle option on children's SSI
If we decide to go with a new "middle ground" proposal, rather
than the advocates' proposal, here is what the options in OMB's
draft memo would look like. This includes collapsing some of the
non-options that OMB laid out in its draft.
option 1: OMB's preferred option (also SSA's): listings level
severity (2 marked), but add a motor domain and a new form, and
propose legislation that would let all kids losing SSI keep
Medicaid.
option 2:
Advocates' proposal (1 marked, 1 moderate)
option 3: Option 3 is more of a middle ground. It would also be
at the listings level, but in addition to the proposals in Option
1, it would also require adjudicators to give special
consideration to children with chronic illnesses, and would
have interdisciplinary teams re-review borderline cases (1 marked,
1 moderate).
Now that I look at this, Option 3 is closer to Option 1 than I had
realized. They are both at "listings level". But there is the
appeal of the extra protections for kids on the borderline.
We could also choose to back the advocates' position, and keep
these ideas in our hip pocket if we lose.
�
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eaa9d21359deafdb30842df8fe31ac4d
PDF Text
Text
I
.
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K!:N I CONRAD
C<.' .. II\h f"I'<! 16
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,
WASHING I UN. DC 205'O~3~OJ
September 4. 1996
Presldem Blli" Clinton
TIle White House
1600 PCMsylv,-nia Ave NWJ
Wcs,hington. DC 20500·0005
/lear Mr., President:
I am writing rCillrding [he Supplemental Security Income (SSOpruvisiuns or ltlCllt:W wclfillfc
law. As you know. !he,re are approxlm:m:ly 1 million children on SSt For [his reason. it i3
impcrl:ltllle Ih:lt ehe Social Security AUlIIinist:ation (SSA) impf~ment the new law with gr.:::ll
C3re and in a manner which e'nsurcs that disabled children are nO[ harmed,
\
-
'
Ttle~.sSA has significant laritude in interpreting [he new law which fer the first time in the
llisroi'Y of [hI: 25 year old program requires [l'Je ImpiCmenrarion of II. broad f\mctiona;
lillli(~t·!2n.'S tcst toeValullte children, retaining {he central tenants or' the earll~r r:l.Jnct;un<l! '
AS,5csimcnt test., Over 27.5.000 of (he t million thiJdren on SSI will SOOIi he ,\UbjCClCU (0
under rhi~ law. The Congrc3~ional Budget Office has told Congress Ih:u with
the discretion aftorded the SSA under (he new law, policies could eilher cut clv~e to 30
l'erc:ent of th~ rotll! I mtllion, 1/1' cut well ~el()w 10 percenr •• dependlnS( on the SSA's
interpremtion of tht: law.
'
ncY" I"Cvj,;;ws
I
The: Sellate debate an.d we legislati\le hi!ilory of th(; tinal S5! ·rcfoons make it r.lear Congress
Sid not call for or' incehdfor a rJ\o!ca.I overhaul of the: program, ' In fact, in a colloquy with
~
;'1
Scmltor Chaf!olt: and me un S~ptember '14, 1.995.. Scn!1.lOr 001= referred to the: 5SI Drugnllll ,,~
t.ir'nply in ~At1 of "rune up. "
'
a
r
.'
The
•
.
.'
imem of COlltres.5 in mandating reforms
WIl!;
to remove from [he 5S! program ,;hildren
who are nul t~ly disabled. I thus urge you co instruct the SSAco carefuJly develop policies'
that do not hann diSllbled children who rely onSSI. but orJy impacl the much $m21ler group .'
intended by Congress, Additionillly. r encourage you to pay careful ;onsider:lIion' to the
recommeod:uionsof naUon.ally recognJzell experts of chis program. such as L'le COITUTlullity
Legal Services of Philadelphia. TIll: An; (formerly AssociatIon ot J<~rarded C i(ill:nS), and the j
Judge nsvid L. B~elon Cllnter for Mentnl Haalch Law. in develop,ing a compreho nsiye
funcrional rest at a severity level thnt impacts the fewest n\.lmb~r u[ dis"blcd children
.
a
.
~
L,,......
relatC'd ml.ine~: Congress did noe expllc!t1y make the new law retroactive to c: [alms
pendlng on the date of enactment. Con~c:quel1tly. I urge that you clarify Ih:n the new law is
pro~pecrtve. T!1!t-IS. nunilies who properly receivedbenetlrs under exiSting n~l(;s prior to
passage of the new law should not now be, asked 10 repay these benefits tiS a r~~ult of this
On
cha.nS~·
�,: 0..9 -09-96 05 : I 7PM
."
'IP
F• J
Page 2
Also. for families At .risk of termin.ltion. J r~quest that you .instruct the SSA. to provIde
parents with chefollowing: (1) adequ(lrcinformation and appropriate assi~tance regarding the
medical and functional evidence of disability required to receive benefits: and (2) appropriate
assistance in fi nding legal represemation co appeal rheir cases: It is also irnpona nt that the
SSA continue benefits in cases of appeal until the.Adminlsrrative Law Judge hearing and
decision are final "'. an essential pror~ction given 'the lives and health of children are .at stakt:
and [he risk of errbris grear in mass. reviews under a complex, new law.
1 ;lppreciate your anemion
(0
these mauers and look forward to hearing from you.
jirt:
KENT CONRAD'
United SLates
Senate
KC:wmal'l
. cc: CQrol R£isco. Director
Domestic Policy ·Council
Shirley Cha(er ~ Commissioner
SoclalSecurlty Adminis(ration
.'
.'
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.
. . ...
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,,
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,
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;~
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. .
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:~
SSA's Functional Assessment of the Severity or Disahling CondltioDS
!:JstIa&I
Adult MeDbII DJser.... t.IstInp .
OdIdilood MIIlDl Dla:da.
The required Jew:I of left.ity it met with \
TWO of chc IoIlowina:
\
The required leftl of Im!I'jty It met
with 1WO of the followin&:
eGukleliDel- are ONE _led·mt ONE
1DOdera1e Ilmltllion. or mR.E.B mOderate
limillliom among:
'I. Markell ImpUmem in qe
1. CopIflft fuactioft
I. Marked restriction bt adlYItJeI .r
- dall.r Uyin,.
.lppIopr~ C8plItlftlCOlirmllDlratioa
'fuDctioL
c·
2.COIIIdI~1oa
.
4. RepeUI!d epiIocIeI or dec••ptmIIIoia
ftmI:dou
3. Motor fllllClbJ
2. Marbd lmpairDK!Dt ID ...
-mnrfati: IOdaI. fuoctioniDg
3. Deficleucia of eo............
paslsteaa or pM!I!
CIdIdhDocIlndlYldul.... FndJoIUII
Asleammt (lFA)
-
4. SedaJ·ftIII::tfoa .
3. Narhd IqJairmeut III
~.or~ ..
'evJdem:es- •
5.
6.
In wort., or work-lib settiDp .
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, ,F: \.JDG" H3734 \CONF\JOINT2.FIN
6
(1) Section 1614(b) (42 U.S.C. 1382c(b» is amend
ed
(A) by striking "or requests" and inserting ", on..
the, first day of the month following the date the appli- ..
cation is filed, or, in any case in which either spouse
requests"; and
. (B),.by striking "application or".
(2) Section 163i(g)(3) (42 ,U.S;C. 1382j(g)(3» is
amended by inserting "following. the month" after "begin
·th
.
rung WI the month". " ,
--~
- •
•. .J.
.
(d) EFFECTIVE DATE.-'
·(1) LlIl GENERAL.-The ,amendments made by this sec
tion ,shall apply to applications for benefits ,under title XVI
of the Social Security Act ,filed on or after the date of the
enactment ,of this Act,without regard.:tor'whether regula
tions have:'been issued to implement such"amendments.
(2) BEl-."EFITS ~"DER TITLEXVI;-For purposes of
term ('benefits'under'title XVI of the
, Social·Seciirity·Aet" 'iricludes stipplementarY' pa~ents pur
this subsectiori;;the
suant to an agreement for Federal administration under,
sectiol1' 1616(a) of 'the SOcial . Act,
8ect:irity
.
and payments
.
pursuant to an' ag:reementi entered' into,' under section
,"212(b)of PilblicL~w:93~~r6."""
.,' ,
.
, ,Subtitle B4.Benefits.ifor'Disabled
C'hildren t-;'
25
26
27 .
28
29
SEC. 211.. i>EFiNmON'A:Ntf ~GrinLITYRULES.
(a)DEFiNrnoN;' OF "cmWH~D DI~ILITY.-8ection
u.s.c.
1614(a)(3) (42
1382e(a)(3», as amended by section
105(b)(1) of the Contract "~th'Ameri~ Advancement Act of
,
",
30
~
"
,
,
'.'
,
. 1996, is amerided
31
(1) in subparagraph ,(A), by striking
.
"
32
33
and inserting
individual" ,
.
"E~pt
...
as
:'
provid~
'..
""
"An
individual"
in subparagraph (C), an
34
(2) in· subparagraph (A), by striking H(or, in the case
35
of an individual under the age of 18, if he suffers from any
,
JUly 29. 1996 (7:43 p.m.) ,
,~
,
'
�F:',JPG' H3734 \CONF\JOINT2.FIN
.7
,
,
2
medically deie~able physical or mental impairment of
comparable seyerity)";
3,
(3) by redesigri"ating subpar:agraphs (C) through (1) as
,subparagraphs (D) through (J), respectil:ely;
4
(4) by inserting after subparagraph (B) the follo~g ,
5
new subparagraph:
6
7~
,13
~'(C)(i) An individual under the age of 18 shall be consid
'ered disabled for the purposes. of this title if that individual has
a medically determinabh~ physical or mental, impairment, which "
,results in ___________ functional limitations, and which,'
'marked and severe
_____
can be expected to result in 'death or which has lasted or ~;-"
be expected to last for a continuous period of not less than 12
months.
14
... "(ii) Notwithstanding clause (i), no individual under the
8
9
T7=,~--
12
15
.age of 18 who engages in substantial gainful activity (deter
16 . mined in accordance with regulations prescribed pursuant to
17
18
19
20.
. 21
22.
subp8I'3gr8.ph (E» maY'be considered to be disahled."; ~d
.;(5) in subparagraph (F); .'as redesignated by para
'. graph (3), by striking "(D)".lUld inserting ~'(E)".
(b) CHANGE~ TO CmwHOOD SSIREGULATIOl'o'"S.
. (1) MODIFICATION TO MEDICAL CRITERIA FOR EVAL- .
...UATION,. OF MENTAL A.~ EMOTIONAL DlSORDERS.-The
23
Commissioner of' Social
24
112~OOC~2.
-25
26'
27
and
SecUrity
.112.02B~2.c.(2)
Sballmodify sections
of appendix 1 to ,subpart
P ofp&rt 404 of title 20, Code of Federal &gu1ations, to
. ~~i~~' ~~a4ap~behavior in the domain
of·,personal/beha.vorial function. '
28
29
. TIONAL
DI~NTI::NuANCE' OF, INDIVIDUALIZED FUNa
'(2)
ASSESSMENT.-TheCommjssi~ner of Social Seen·'
~nti.nue
30
rity shaD
31
ment for children set forth in sections AI6.924d and.
,32,
theindividua.lized functional assess
416.924e of title 20, Code of Federal &gu1ation,s. ,
33
.(c) MEDICALlMPRoVEMENT REVIEW STANDARD AS IT
34
APPLIES TO Th"DIViDt.ALS UNDER THE AGE OF 18.-Section
351614(a)(4) (42 U.S.C. 1382(a)(4» is amendedJuly 29. 1996(7:43 p.m.)
,
:/
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�PHOTOCOPY
PRESERVAnON
'DEFINIl'ION OF '11ISABILIl"/FOR CJIIL',DREN
, ·~he SSI p rognlln. 'The new
Since you filed this claim, a new Jaw ha:: .
lawc.hanges the detlnition or disability:
i1-.N.t>-w_.ndlniJi.uo_olllisahi.l Ltx.JucChi ~I'
'\:\te will considBr
definition
..
a child disabled only,'
ot:disab.ility for (:hildten.
.
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requires a (~hildfo have a physicfll or ti(ent:il condition or
, . ~Oljdi~ionsthatc..'1n be medi~~ally t;royen and which results in
liiilrk~il {Hlt.i:'s~y·~n~ fundio.ilHllimitatiolui;
,
,'re.qtlirt~s: th~tt'the nltx)itill1y proven physical ormentaJ ~olldiJion
......". .,:" .. t::'
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.,:<:;,:" /, .."':: ....
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, orsofiditi~risTrl~lst hlSf~lt:r~li:st 12 il'l'Ollths or b'e(~xt:)ected to>h:~stilt
iw,.;;'t.'-.. ··', ..•• ·".~~1
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';it!on of (]isability:
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says~ Ltj;i.t:ri.child ma)' not be considered disabled if he or she is
,
,;orking a't"~l job that 'Ne consider to he substantial \\-'ork.
f;
This new law alsO:~thanges the way \ve consider certain hehavior prohlems
caused by a child's condition Or' conditions.
;
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�THE WHITE HOUSE
WASHINGTON
�~ 09/18/96
12: 09'
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The· Wh iteHous8,..
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FACSIMilE TRANSMISSION COVER SHEET
TO:
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CaA¥ BaLl 0/;
FAX NUMBER: '..
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TELEPHONE NUMBER:
FROM:
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TELEPHONE NUMBER:
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12: 09
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W'l'HJCft'ADOIICI£.
'~"""'NC&e<w
The Honorable Bill Clinton
President of·the ,UNfed States
'nte White House
,
Washington, DC 20500
(~
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Dear~~=~ao..lw a . ~l P~;Jijw UnPk=~tion of
to
the
child.:en"'s Supplemental. Sec:wity In .:m, (SSl) pro~ions that were included in the
welfare reform. bill enacted last:men • ~e we. a;f:e. all interested in ensuring that
only children who are truly disabled ~v£SSI be:r;\ifits, we are equally concerned '
that those children who are, in tact,
~:Y disab~4 rem~ eligible fot the
'
program. The Social Security A~ttration (SSAl"has the difficult responsibility
of striking a balance between these q
Sjals.
:,:
.'
statuto~ language was in !~ed to give ~SA substantial discretion in '
dxa'CoVing the eligibility line for this pr am. Clearl~~: the new law c:a.nnot_be;re~.d,. tp,
illlow SSA to continue the c:urrent Ie ~ 9f severity Which drew.50 mum criticism..
. At ~ same time, the'newdefinition "~ never intencled to "gut" the program and,
in tad:.. affirms the i1:nportance or nmEo~ assessm~t as part of an effective
.
evaluation of childhood disability.: , " "i
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.
The debate over: thls lssue wa:s . ~~eq at tJJn~t but, ultitnately.. we reached a'
. The
compromise on the definition of dW~OGd dlsah. ili~ in Septem.bez:." 1995. That
definition 'became part of the overall azigre5siona1~,~or.npromise on SSt and was '
induded in the first two versions of; ~¥e:refon:n. ~pproved by CongreSs and then
finally in the bill enacted in August.; J'tlelcompror:ruse is notable in two ways. Erst,
it preserves a 'broad. fw:1.ct:ional a.PPl'O~.1 );sqgn£ ~ "1..i.stings of lrnpairments," in·
measurlng childhood disability. Seci:l d, ~t specifi~aij.y does not establish the listings
level of iev~ty, or any eq,uivalent 1_ leI of severity/~:~ the measure to be ~'t!t..~ _', "
assessing c;hildhood disability.
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'Ihe enclosed$e:nate colloquy,
~f!l\ those 91" us involved in ,this
ccu:nprol%tise is important in \mce:s ' " 'g the m~¥Ung of the ~ew deiinition.
'
,This colloquy was not entered. into ll~t1Yt Rathet# \~ was the subject of much
negotiatiOn and was key to the .6:na1 ,~a.ie of the.i!I.,.\~efinition regarcUng "'physical
and l'l'LEintal irnpa.in:nerit" which fault in l :nazked aiid. severe fu.nctio:na.l
."
ettect of the impainnent also b.
~.::=:;after dropping thereq
that
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�, 09/18/96
12: 09
SEP 18 '96 09:58
~ 003/003
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The Honorable BiD Clinton
, .'.~
September 17, 1996
Page two
';"1
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,:~""':*""" t;?I ......'!."Y.·:'{.:
'~ as the r~gWa1OtY agency, to adopt a
old IndiViq,ua.!ized Functional Assessment
(IFA), but which ~t ~very:$ . ~1~e1 ofite "~ting~:' The.proposal put .
fOI'fltlUd. .by severaraiS3.bility adve
s ~ or~tions Mth a>.n61d.etable expert'lSe
( - a one marked/one moderate Ievel.- '"an accefitable a:\d., reasonable approach that
ful£il1s the statutory d.e.mand for at t ~t allo~~ benefits only for marked. and
severe .func:tionallimitations, but d . jot req~e: that these limitations be
pervasIve.
;1 .
• ,
It is certainly appropriate lor
disability test that is stricter than
•
.
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.
The Congressional ~:ud.get Of
}CBO)
also ac:Ja:aowleclged ·tl:\at~SSA.-·
would have a great d.eal of fiexibi~ in ·meeting lthe require:men~ of the new law.
1he enclosed SaNte :Finance Com e~report staows that 00 estimated that the
new d.efuUtion of c:hildhcod disilbili~t c:~uld bar ~ywhere from. 10-28 percent of
.ch.Uclre.n·.fr?:n the pr0$l'arn, depen.· g
t:he~.egulatory interpretation of the
new definition.
,
..
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.
1pon
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.
I know. tha! r~ti will do evezy
'WIth severe ciisabilines who are
the new welfare law.'1'han'k you ~
Please do not hesitate tocontac:t me".
tn4
~.
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Sf'-..
.
yo~~}power
c.hild:e::
. in.
to en5\U"e that
d~ervmg ~e not harmed by the c.hanges
dv4nce Eor j;our attention to this matter.
I may be of{~ar..y further assistance.
~
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.
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Sin~~rely,
~,:1'
,
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~H. Chafee
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cc: SeCZ'etary Shalala'
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�E X E C U TI V E
OFF ICE
O,F
THE
P RE SID E N T
30-Sep-1996 05:38pm
TO:
Carol H. Rasco
FROM: .
Diana M. Fortuna
Domest·ic policy Council
CC:
Jeremy D. Benami
SUBJECT:
U}2date on children's SSI
Here is a (long) update on our progress on children's SSI.
Background:
As you know, we already decided one of the two key
issues here:
whether children who appeal SSA' s decision that
they no lo~ger qualify can keep benefits through the DDS stage or
the ALJ stage. We decided this issue in favor of the ALJ stage,
which means that children who appeal will lose benefits in 1999
rather .than 1997/98. This will please the advocates, but we may
get so~e flak from the Hill.
The other issue is how SSA should interpret congress's new
definition
of
childhood
disability:
.imarked
and
severe
functional
limitations. "You
will
recall
that
Congress
. explicitly repealed the old IFA test, which allowed children with
impairments at the "1 marked/1 moderate" level, as well as the "3
moderates" level, to get benefits.
They left untouched the
listings themselves, as well as a functionai test known as
"functional equals," which required "2 marked" impairments.
The advocates argue that.nothlng in the new law prevents SSA from
creating a new functional test requiring a level of severity that
is less than "functional equals" but more than the old IFA. The
want the sta_ndard to be "1 marked/1 moderate" -- essentially
dropping only the children who got on with 3 moderates.·
Legally, it does appear that we have ·a good deal of latitude,
which puts us in· a delicate spot~
Congress's intent may be
gleaned from the conference report, which says that they wanted
the standard to 'be 112 marked.. "
On the. other l1and, there are
other legal arguments on the other side.
Politically, it seems
likely that Republicans and many Democrats in Congress· would
criticize us. and perhaps return to' clarify their intent i'f we
were to construct a standard that preserved benefits for most of
the IFA children. The fact that we put the final proposal in our
own budget, along with savings that reflected going to a
listings-tevel ·standard, would also be thrown 'back in our face.
Chafee and Conrad have written us letters in support of the
�'.
advocates.
options:
Ken.Apfel. and I have met twice with SSA on this, and.
asked them to develop a variety of options:. designed to cushion.
the effect of this .change. We have made some important progress,
but there is still an.awfully large g,ulf between us and the
advocates.
option 1: Eliminate the IFA and make no other changes -- This is
the proposal. we assumed in .our budget.
We are not really.
considering this option at this, point; it is more of a benchmark
to compare our other options to;
�o
Would drop 190,000 children now on the rolls.
o
Timing:
SSAcould make their deadline of November 22
publish a regulation.
to
option 2:
Same as Option 1, but add new "Motor Domain" -- The
equals" test at the listings level requires marked
impairments in 2 out of 4 domains:
cognitive/communication,
social, personal/behavioral, and concentration/persistence/pace.
These domains were designed ,with mental impairments in mind, and
are,widely thought to give short shrift to physical disabilities.
Adding a fifth domain for motor skills is clearly a good thing to
do. It would include gross and fine motor skills, and could pick
up sOlne issues of stamina.
Many children with rare disorders
that aren' t in the listings would be picked up in this way
(although they would , require 'a marked impairment in one of the
other domains in order to be eligible).' Congress is very
unlikely to object to this change. Advocates would be pleased,
although mental health/MR advocates would be less so.
'~functional
o
Would dfoP 175,000 children,now on the rolls -- 15,000 fewer,
than Option 1.
o
Timing:
Might miss November 22 deadline; cases currently
being held would sit longer than, under option 1.
Option ,3:' Same as option 2, but add a "Functional Equals Fo~"
-- SSA would,require reviewers to fill out a 'special form for the
functional equals test.
Believe it' or not, SSA believes ,this
would make a big difference. Apparently, reviewers today pretty
much ignore the functional equals test. A special form that went
'through the 5 domains and had, to be filled out would draw
attention to this step and force reviewers to treat it seriously.
Politically, since this is no change from the current procedures,
it is unlikely to be criticized.
o
Would drop 145,000 children now on the, rolls -- 45,000 fewer
than Option 1 -- or 24 percent less.
o
Timing:
Would probably miss November 22 deadline, and
But still in
pending cases would sit longer than Option 2.
the ballpark.
Option,4: Advocates', Proposal: Add New Functional Step at
than Listings Level ,for "1' marked! 1 moderate"
The
difficuity here is political ..:..- so, few children are dropped
it seems likely that congress will a,ttack us and could
legislation to spell out a tougher standard.
Less
main
that
pass
o
Would drop 45,000 children now on the rolls -- 145,000 fewer
than option 1'-- or 76 percent less.
o
Timing:
not too different from Option 3.
�I have pushed SSA to define other options that fall somewhere
between options 3 and 4, ,but they don't seem to have any idea how
to do that,
and argue it would take them 1-2 years of
consultation alid regulation writing before they could put some
brand new and as yet undefined standard into place. This is not
tenable given the need to process pending cases and implement the
law.
So Ken and I are writing, a memo that will., lay this out, which
will probably go to you and Frank Raines. ,He and I are in
agreement that, we should definitely, go as far as Option 3, and
that Option 4 goes too far.
I am still struggling to think of
other optlons, whlle Ken ls morereslgned to Optlon 3. SSA would
accept Option 3 but doesn't want to' go further --' mostly they
want a decislon.
I was hoping that, when we advised the advocates how little their
option did, they would come back to us with another idea, but
that hasn't happened yet. I am trying to reach out very quietly
and discreetly to others who would have good judgment here and
are somewhat neutral, 'but there aren't, many people who answer
that description.
If we go with Option 3, the advocates will say we could have
created a new IFA-type test and preserved benei'its for tens of
thousands of children, but we chose not to.
In the meantime, rumors are rampant that we are about to announce
a decision against the advocates. Leaks could be coming from any'
of a number of places.
Medicaid: HeFA's estimate is that something like 50,000 of these
'children will also lose eligibility for Medicaid., The others
should be picked up by the Waxman Meaicaid changes, perhaps
medically needy, etc. 'HeFA is working with SSA on how to make
sure that SSA'S letters to families point them toward their local
Medicaid office, to minimize families falling through the cracks.
r will discuss this with HeFA a,t a meeting on Wednesday.
Examples:
r will send over to you some write-ups that Bazelon
did on different, children, to give you some se;nse' of how these
abstract terms translate into decisions about individual kids.
It's not, perfect, but it!s the best thing I have seen so far.
�CLINTON LIBRARY PHOTOCOPY
�,
"'"
~ ~09-12-1996
11:53AMFROM KCR 2028331508
TO
P.02
How the Individual functional Assessmellt
'('FA) Enables children to Qualify for
ss.
Many children have very severe disabilities that do not match
any of the exact medical criteria.for S51 o'n the Social Security
Administration's list of impairments. Some of them are able to
qualify for SSI through an individual functional assessment (IFl\).
In an IFA, examiners and physicians of the state Disability
Determination Service (DDS) look at a child's limitations in various
functional "domains" relevant to the 'child's age-areas of
development and functioning vital to a child's life. The domains are:
cognition, communication, niotor abilities, social skills, personal!
behavioral patterns, and concentration, persistence and pace .
. .(Another, responSiveness to stimuli, applies only to infants.) When
the DDS finds that a child has' "marked" or "moderate" limitations in
several of these domains, the child's impairment can be considered
comparable in severity to one that would disable an adult-the
ultimate ~tandard for a child's 551 e1i~bility.
Many children with mental retardation, for example, qualify
through an IFA when their IQ just above the limit established by
the listed criteria and they have moderate limitations in three of the
domains.
' .
'The IFA is also helpful when children have a combination of
mental and physical impairments. Even when no one impairment
meets the specific medical criteria, the IFA aJJows DDS examiners to
assess the total impact .on the child's ability to function. .
Further, children's health ~s often compro~ised by adverse Life
circumstances that are not among the listed criteria-problems such
asphysical and sexual abuse,;:Iead poisoning, prenatal exposure to
drugs and sexually transmitted diseases, exposure to violen t
behavior against others (stich as witnessing their.mother's murder)
.and the impact on health of abject poverty. When the result is
severely impaired functioning, the IFA enables them to receive
assistance.
The following examples illustrate hovv children who have severe
disabling conditions, yet do not match a listed impairment, aIify'
through an IFA.
is
BAZElON CENTER FOR MENTAL HEALTH LAW
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• :09-12-1996
11:54RM
FROM KCR 2028331508
TO
INDIVIDUAL FUNCTIONAL AS$ESSMENT-EXAMPLES
f'.03
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Justin, who, has hemophilia
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"'to - \\\rio{l ~,u.s'
,,~~O.. $()l\~\.. \
Q..r\ N'\<.A1',,"fJ
Justin was 11 when he finally qualified for 55!. He has had
bleeding disorders since he was six months old. Over a four~year
period, his mother has had ~o rush him to the emergency room 30
times for bleeding joints, hematomas and other injuries; he had
another 60 doctor visits for bleeding problems. While his diagnosis is
hemophilia, he did not meet the criteria for a coagulation disorder
because medication partially controlled his bleeding and he had no
permanent joint deformities. Yet Justin's condition severely restricts
his ability to function age-appropriately.
The IFA found moderate limitations in Justin's motor skills
because of jOint swelling so severe it affects his ability to walk. This
makes it impossible for him to participate in physical education or
recreational activities. In part as a result of this exclusion from peers'
activities, the examiner found that Justin has a marked limitation in
social skills and his ability to communicate age-appropriately. For
example, he doesn/t report injuries and gets violent when his
classmates doso for him. As a result, Justin's disability was
, considered severe enough for him to qualify for 55!.
I
I
I
Bill, who has cerebra/palsy
:1
:I
At29 months, Bill gets around by scooting on one knee and one
foot. When he stands it is on tiptoes. Although his primary diagnosis
is cerebral palsy, with a secondary diagnOSis of progressive
developmental delay, he does not meet the listed criteria for 55!.
From the age of three months, Bill has received physical therapy
and other developmental training. Recent tests found Bill's speech
andmotbr skills at less than two thirds those of most children his
age. He also gets upset very easily, The consultant who examined
t$\~\(I\'''~ Bill said he would continue to need physical and occupational
t,~a·,td1
I
IIY? a£
t\~~O
-
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ili~~
,'.
."
'
An IFA found that Bill has a moderate limitation in cognitive.
development and a marked limitation in communicative and motor •
development. The examiner concluded that these pronounced
impairments substantially reduce Bill's ability to perform or function
in an age.appropriate manner. He is eligible for 55!.
"
Jason; who has psychiatric disorders
Jqson is 8·1/2. Over the past year his behavior has grown out of
control. He has trouble sleeping and talks about committing suicide.
BAZELON CENTER FOR MENTAL HEALTH LAW
�• -.09-12-1995
11: 54AM
FRClM KCR 2028331508
TCI
4567028
INDIVIDUAL FUNCTIONAL ASSESSMeNT -EXAMPLES
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A psychiatric evaluation resulted in a primary diagnosis of
dysthymia (a type of depression), with a secondary diagnosis of
borderline intellectual functioning. During hospitalization for
, treatment Jason was very depressed; tearful, fearful and impulsive,
and had a lot of difficulty focusing on tasks.
On tests while he was in the hospital, Jason had a verbal IQ score
of 82 and performance IQ of 71. The resulting full scale IQ of 75 is
classified as borderline. His academic scores place him at the
kindergarten to first-grade level. The examiner described him as
.
having "intensely negative ~nd painful emotion." The IFA
considered the psychiatric d~agnosis and evidence of borderline
cognitive fu'nctioning,alonglwith reports of activities of daily living
from Jason's mother and teachers.
.
The DDS doctor concluded that because Jason's behavior gets in
the way of his learning, he has a moderate limitation of his cognitive.
functioning. His anxiety, competitiveness and overreaction in the
school setting create a moderate limitation in his social skills,
further supported by the fact that other children leave him alone
, and,he has no dose friends. Jason's personaVbehavioral functioning
, was also rated as moderately limited due to his need for constant
supervision-more than any other student. The limitations in
. Jason's attention and concentration further contributed to the DDS
doctor's overall conclusion that this child has a disability of .
comparable severity to one that would disable an adult.
Susan, who has developmental
t\i'O - t\'1~
P.04
de~ays
Susan, 3·112, lives with her mother and Siblings and attends a
therapeutic preschool. She has a primarydiagnosls of develop
mental delays with language disorder. When Susan applied for 551,
. the DDS 'ordered psychological testing and evaluation. She was
reportedly immature, impulsive and had few internal controls. She
would hit to get attention and her speech was barely intelligible.
Susan's test ?ummary included a performance IQ of 82, verbal scale
of 7S apd full scale IQ of 77.
Evaluating the. effects of her impairment, DDS examiners found
that Susan had moderately limited cognitive dev~lopment. Because
her speech was barely understandable by her mother, pediatrician
and psychologist, the examiners found that Susan had a marked ~
limitation in communication. Her motorde,,:,e]opmentwas found
moderately limited, as were her social development and
personaVbehavioral development, based both on her mother's
BAlElON CENTER F6R MENTAL HEALTH LAW
..
'
�i.
• ~ 09-12-1996
11:55RI'1
FROM KCR 2028331508
TO
4567028
INDIVIDUAL FUNCTIONAl'ASSESSMENT -EXAMPLES
P.05
4
reports and the examiner's testing. Together, Susan's impairments
'. are severe enough to be considered disabling in an adult
,ohn, who has hyperactivity disorder
John had prenatal exposure to both drugs and alcohol. Now
7-1/2, he w,as an unusually qUiet baby and showed early
.
developmental delays. He attended therapeutic preschool and has
been in spedal education since starting schooL John's primary
diagnosis is attention ?eficit hyperactivity disorder, with a .
secondary diagnosis of developmental delay. He has frequent
tantrums and has been taking medication, amitriptyline, for over a
. year.
With his 55I application, John's parents were able to provide very
thorough documentation of psychological testingby the schools,
~~ -t'\0\'T(t
several very complete individualized education programs (IEPs) and
a neurological evaluation. The DDS also paid for a psychiatric
t\~ - Mst~~\
examination. Both the neurologist and the psychiatrist reported
f\t-.~O . . C4t«t'TAA1\Ot' hyperactivity as the.most serious of John's problems. His
psychometric scores consistently placed him beLow the norm.
Through an IFA, examiners found that John has moderate
limitation in motor skills, with sensory integration a particular
concern; moderate limitation of personaV behavioral functioning
and a need for constant supervision and redirection; and ma~ked
limitation in thedomainof concentration, persistence and pace,
based on his inattention, distractibility and bizarre'behavior. The
DDS. doctor concluded that John needs significant structure in order
to function at all and that his impairments were comparable to those
that would disable an adult.
6l"f\"
Doreen, an abused adolescent
~~D - ~t-' fi\ V\-;
"'~ - 't ~f.\\\J S
. Doreen .was abused for many years before being removed to
foster care. At 15, she sucks her thumb whenever she isn't doing
something else with her hands. She has a primary diagnosis of
borderline intellectual functioning and a secondary diagnosis of
post-traumatic stress syndrome. Her full-scale IQ.is 74. .
.
Th.e IFA found Doreen's cognitive functioning at the first-grade
level in reading and written communication and the fourth-grade
level in math-a marked limitation. She had moderate limitations in
personaV behavioral functioning and in concentration, persistence
and pace, based on teachers' reports that she could not concentrate
for longer than four minutes at a time, could not complete
BAZElD.N CENTER FOP, MeNTAL HeALTH LAW
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11 : 55RM
FROM KCR 2028331508 .
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. (NDIVIDUAL FUNCTIONAL ASSESSMENT-EXAMPLES
P.06
5
assignments and required constant supervision. Doreen's
impairments were found coxnparable to those that would disable an
adult SSI applicant.
.
Mike, who' has multiple mental disorders
Mikel la, is being raised by his grandmother. He had suffered
abuse and t probably, prenatal alcohol or drug exposure. He had
abdominal surgery at four weeks and a traumatic blow to the head .
s.everal years later. His priIi)ary diagnOSiS is func~ional nonpsychotic
anxiety-related disorders, with a secondary diagnosis of ment21
.
. retardation. Mike is in special education at school, in a regular
classroom with considerablepul1~out time. While in .the classroom,
he has an aide. to keep him on task and provide safety for the other
students.
A psychiatric evaluation found that .Mike had no friends, picked
fights, argued constantlyand was very aggressive 'w~th others. He.
can change quickly from being very nice to very aggressive. He
tends to prefer playing with younger children, preferably girls. He
often says that he wishes he ;were a girl and dresses in his Sister's
clothes. Mike has sleep problems, nightmares and bed-wetting,
though this has improved with use of nightly, nasal spray. His
performance IQ was measured at 79 and all of the test scales were at
the borderline leveL
An evaiuation using the IFA found that Mike has moderate
limitation of cognitive functioning and marked limitation of sc<:ial
skills, of personaJlbehavioral functioning and in concentration,
persistence and pace. The effects of a structured setting and
adaptations were also considered, as all school activities and subjects
were modified for Mike. The DDS doctor concluded that Mike's
impairments substanti.illy reduced his a.bility to function
independently, appropriately and effectively in an age-appropriate
manner and were therefore comparable in severity to an
impairment that would disable and adult.
for more information abouuhe Individual functional ASsessment
and these cases, contact Rhoda schulzinger F 2
''l~ at the
Baze/on Center, 202/467-5730.
8AZELON CENTER fOR MENTALH.EALTH LAW
. !'
�..
OC±~02-52 12,16 FROM,
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~dth8"""IeQidItioft. D6e~~b .. ~thilttear
of c;c"gmsalanal bacH..., md cbilrary quotII tD Ina I FIt colt ~s
. l'houtd qQt be the cW.emIrirllJ fadota in tNt decision. We belirNe th2t the
daclaion Should fOcus en seaJng • new ~
that wW 'add1l'lSS
aw:erns abOLtt program abltel and restore pubIie contidenat in a
pn;gr.m. tNd ptCINidee·WaJ au'tMOI to hundred fA 1tDaand. of rc:.
incxIra ...... who want 10 ....... ChiliSNn wiIh KIWef8 dlsabUlties OIl
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n.w.,. ~~ 1 mUion d\lchnM~ ~ SSI benefi1s.
The program cMnges in .......... IIQjI,. . . wi aftIcl . . . 276.000
eNldIM \IMIe _ _ wm be I1MIIIIed betn1hey m. benefh
~ ....
MmdUIu
=::-i!
AIMugh S8A hee NIl ....... reguladona ~..... Iting tha ..., definition.
r.-&~
lheir data IMOjed that 185.000 cHdre:n ~ d bI m"ir:v.ed wit lese 1hr::i(
~~'1tIis. 87 pefc:arC ~.... Tbe AdmInistret'on
.
'1 ",.....,..1tlat Its ·00"-1& frit to eIirinate 2D percant at. . pn:Q aftl
.~ (I.e. 8IQUnd 200.000 d the 1 nIIiqn). but the leduc;lian
hawe a~ ~ i.OICI on. aJMIIt ~ of chldren.
~ !he chIIcSNa wtso are Iicely to 10M ber)efb . . 1ho&e with mental
mtardatklil. IUbercuIosii. CS\abetIe. organio ~ ~I autism.
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DilahilityacMx • • NNe f'8tD'Ii'l8\"Idad tJwt Sodal8ect.tity ..... a
standard . . . . . en&LIre that
with sr.wa. .)....
eligible nIthIr then one deaigned to CUI· till 8I1:MSrar} n.umbar d chidren to
1ItChine. ~ oost saWlgs.
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chid,."
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high' ~
C stftIaId ~....ay twc3IlC1't II'III¥ ....
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level d II!Mriy is required to ..... til .... ~WLlUtion of cNldNllOd.
+-0 e~a> la ('fl
......,. l'biIiII. U. deCision thlt . . . . . . . hair many. cHdren with..
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Adrhiuillration
~~
(S8A). to chillQe. . ~ 1itandaRI ..... ChIIdran" SuppIamental
~ £
Sea.riy Incoi•• (SSI) PCI¥em. Under tM ft!IW . ' . ~ mull have a .
~I~,:::,
"lfledicalt ......... phw.... or Inf!I"ItIIj in1pllirnW'f wNc:h I8IUb In
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sapt~ 30,.;,199'
III AID TO DtSABE.I'D CHIU-",:
CLDftQI aDlIXISraA,!,IQI CEBAftS CIWIG'ES
"tatS 01' 'l'WOICISIaXDS wu..I. BB N'rSCtiW
~L'I'I't("'..AL
eM BitlIS
,
A."f ODDS VlS ~ JiCt.:tcY'
Ba~oUNi~
of die Wel.fare ki.ll puae4 ~ c::Cacr...... aDd. a1gned .~
Cli.:)tGD 8iiU':lier. t.lda ~"
the .£oc:: ial sec:\lrity
_dIU;Ql.t:J:.~iOQ.(SSA' .MWI'C. ma.lco c. .t.a1.a claAA9M to ~ c11gj,bilit.y
1lit.4ndarcl.. · fQr the olIJ.l4ren'. Su.so1--.at.al sec..u:il=y T!w:0IDe (SS:I)
PJ:'~aD\.· UDCSer the .., law; i!::A1ldren -.list have a ·~e.ally
e:lc't.ar-.il'!l.a.ble phys.ic.alor .eo~l ,~t. which z:eINlt;.6 'in a.a.rkad
ABpill:t
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tuDctiODAl U ....i.tatioas.·
It fula
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cli8~i.li. cy .
1hla c:d.tical declalca vUl
4a~~
DeW. defiDi~iOD
ha?e it. t..rmeI'MlI
'haw seville a child' lIS diaAbi.lit.y INst l)e co..at:. !'.Ai.
'
or ......... , bl.ar.w.tr.cla of t:l'lIcl.lsAllrll:b of chilch'en wi.. th
sevexe cU.sahtl i 1::1.. cu! tbalz: faailiu.
i2!lpir1C!t:.
on
t~
"
aan.v
'!'be APA; iIIId
'otl:&ar a4Vac.atas ue eO!W:aned. that the
Cl.1zlt.on AdM1a i &tzati.cl:\ .v' set. too high .. ar.~ in o¥'dar to
Avo1d r!Grlg%'easiClfr,Lal badaUb., araa beca\We the .a:re dd.ldr(".rl droppad
t~<* che pr:~ .. the .~1:oC' 1:ha M'D'i..Is8a ·,4d.cb can 'be applied to
the. bu4g.t deficit..
'BtJweWlr, fe.az ot C~"'ONl ~k1.ab and
.arbit.t'UV quotas to i.l1cr..... cost savi.rlcl- He.!liDt &pprCJpriate
drivi.rlQ force. beh1.d public: polic:y:. "1'1'd. is especially t:r.uc when
t..ha wel.l:-beizag of tens of tbou&al'lda of children W1,tll severe
di~&b111C1elJ ;bazl,gs
.
in t.ba ba.l.<iUlce.
.
a.t ..
'rhe AFA'~lID4otAe:r. ha. . .r~~aD4ecl that. SQ
:st.andArd.
. wn,,1.Chis ~l:asM"'''ly de&igbed t:o ....ur.~t cb11dJia.:. Vit.b s~re
·di.:sabilit.ies \~.l'1B ain ellg1'Dl.e, rather daaq. ane GeaiSDed t.o cut: 4D
arbiuary a'l:!"berof
S avil:l4J!J -
phone
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to achieve a
It i,i5. c:r.:j;~i.c..a1 Uiat ~he 1IIIhite
c~ll&
4bOut this issue.
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.
pr"'~.~'1"ed
recoive' a large
east
Duaber
of
tllbac You CAll J)o:
call Pr.5~t ClictoD {2Q2J'S'~111;
../ Cal.l carol Rasco.. D1raet.or of ~e P:. .i.deDt.' s
Counc:.l tza2)~&56"'221'
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truly ~nt: aa asl;
1:be drlvt.Dg COE'ce ill 8ettiag .. DaW .!:.aiu5u'4 for SSI
el.igt.:Dili.ty ahou14 ... t.:be beat iAtuuc. of law 1Dccae children vim'
5t!"li1"aZ'. di.-.b1'li~1 .... Dot aDubiuey bwSQet figure j &Dd.
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'C.hi. . .aa..ge.t,o ~ c:al1..;gu.e.. aa4 16e.J.'jaaUlCl ot:berB. Aodlat .us
laioW5.f lfoU ma. . . . call.. Foz- add1'tlor&al i.btO'f"lM.~1.011. or to contt.z:m
tbat. you ra8pOl!ldecil... pleOJS6 cccuc:t: c::b.arlea ~e .. Pb .D. at' (202)
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"Suite 1212
1101 Fif:eenth StreetN.\V.
Washmgton D.C. 20005
J
. -~tltJl6..-
. Voice: 2021467-5730
TDD: 2021467-4342
~"
Fax: 202/223-0409
e-m:ul: hn166Q@handsnet.org
http://W'W'W.b:l.zelon.org
====1
JlJD<..i1: [)t\\'II) L.
I~~~~
CENTER
I'(.,)R
MENTAL
HEALTH
PLEASE DELIVER THIS FAX MESSAGE IMMEDIATELY
. \)\~y~ ~~,,~~
TO:
No. or'pllges. including this;
FAX#:
~
_.____f~OM:_. __
Rh.o:--d-:-a_S_c_hU_l,...;z.....;i!1:....:9:...;..e_r_ _ _ _ _ _ __
DATE:
_
"
_~.:::...~_\:~:--~~~..;:..:~=---_- Trnnsmitted by: _ _ _ _ _ _ _--.::
COMMENTS:
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NOTE:" If problems occur during tr;msmis~ion, ple:l.Sc c:lll 2021467.5730."
�22l1D ITaRYe,' level 1 printed In FU1.L fOI"II\'~,'
C:Opyr'thl 1996 P.C. PubLishingtc.
;·S
~
Iec>tetrber 2Z,1996, IImCf.y,
LOCAL, Pg.
SECTrOY~
LEMGTH:
8TA. EDl,TION
'7' va...
HEADLIN&=
CUTa cauLD BE FATAL' TO TODDbBA
weLFA~
BYLItlE: ELlEi M. PIiALPUTUR, POST' GAZETTE' STA'F WRiteR
BOD;:
,
Wun~ar
ta aotnt
re~rtebl~
'
~f~h
rare thlt vfctfms •• Ldam·U", paee 2 Y••"I.
.
a Genetfc 41 ••eie •
'
,
'
.',','
aut MOW, her parenti ••Y.
federlll Supplemental Sec
'II
wei. e
i
,
wilL fer a 23-mcnth-old
t
.
I ',
Hunter l • health could be thl!JtentdJby CUll
--..-
II'\ICCIIIe 1'0III1'1Ift lihl'h WII fl"lcll.IdKt In the
prea1dent CLInton al n
'.
fft
th
l"ItHII
n _U;Yat.
lIeCli..e of her 15J eLlgtbfL'~y. Hunter Stlllnftl, who lfve. wtth hel','flillllfly "
Clbael'Yltory HHt,'".. reclt ...M .ll!I)at' 200.000' fn'nurlltl'lll' lire In herlffl'!:l
.' one of 'Cke Jr..,. to hel' lloIf"vlval, ley hal' 118"8111., patH IIII"If lIIarc stafniu.
She ia. not, the only one to get IUch e~trGordlnlry help.
There,re '.15,000 chUdren netfonwtdo, tndUdt"' 15,000 11'1 PMr'I8ylvanla, wi h
severe P1yatcal and mermlt dl.aDl l Ide. £Ole cere mllr be In Jecpll'dy under th
r.".~dWllf'''8 lall, advocate•••y.
.'
.
'
KloII'Iter,lIIhQwP pr~filed i"the PittebUrgh PoIHialetc. '" lIay,hal • .,fn tit t
grow. 10 faat it CIIVt IInld qutckly ancuah_ 1I11"Iktn, becOlllOI IIC thick thot it
, tightens' u~ her chett uftd abdomen, and could choka he,. 11 also erac~1
elsily, opening hor.up to fnfectfona.
, . Shen"ds
10lIl& 1:
of' r
"cive medical
care
nea~
vel' II,'
tJhe~~l r
'
ft'. rno atur{llio:!e 1M,. Blttn 01' plleil'l8 preticriptfonGropa In her eyefI beea 8.h
.L ic18 do. "ot ahlolt .co""letelY~A bfollllfcllffir
~a be c=:onst."lly IIIOnftorod 10
the IIi r
kept properly mol It 1.0" Hunt,!,r1e,d.L leete 8kin • always bri sht ink
,lll h a
rew III'Id
r,
,"ea.
"
1"1".
.',
.'
I'
,
!
lIunter reql.lfr•• two bot'ClI•• da.,; each O!'le. taldng up cotlliO hour•• Ipoefal
ce,.. IlU8t be utc..n to r.movt u~....k'n frem nil' nGlIl'lla .nd eara.
The n"ree., !lied. pC&8;blo fhr!!W!b lSI eliajbility. Hlp HU!'IUC 1 ' fpmH" to
livo e" al,! nornal 'lb. The COl,lp11, who .LIIO hive Ii ta.n-IS_ daushter"
ihe". the reaponlibiliti" on their dlY'off frI11'II wort.
But, they .af~, they centt be ayallable 2' hoUrs'. dry.
I
!
'j
..
�i
'ate ,
nurDe every nleht of tho we.k 80 wa c.~ ,e~ 8~ Ileap."
The nurses, pe1d through the '~ICe, era prowfata b.eau•• of ~hl .ewe~lty of
M.."ter ' • dt.orO!tr, An II1'II& luaUOI\' proces• .".bl~ HIoII'I'.r to ep.IIllfy.
.
lut 'hi new w.lfert lew
elfm1~t ••
th;oUlh. Th.t proces! brCllldly
1iI0000td fall
throlol,h
'''''Il
I
chl.i.la.mln, procaee HYntar went f
cbUP'o ,ct!ij"lLfii 80 that ks !!1ldre
.1';.
Gracile,
Crltfco chlraed that the r~le ~de ft too eDSY for chfldrlft to be claa,'fl
whh ph)'&iCl~ 01' lIII"t.~ die.brUUn. They •• tel par.ntecoached theIr chlldr."
to "fin disabllltfes.
th. Glnera' ACcou~ifns Aft'S' oDd 'asf,l ItSHC'S¥rldplo1,tretfoo, howe.er,
.,e.,.l..- tPle... w "abeahol,.ly
..
ev'.,..••f wfdMp..I.G ........ "
•
"I'.
th. new l_ 1'.~'rI8 Sb to CCIIIII
\4)
•
wlCh • Mw 11I.II.nln1 ,roe.dure N late,
thaI'! Mcw. U.
'
',IIChildren IIIlCh tnedically doN'nIntecl dbabtl hf•• hi'll'. bltt.r chane.
remalnfng elfglble for beneflts,·t •• Id Tan Morgena~, CIA lpatlllel'l. 'hae
seem ~o tncll.de l4untel".
tt .
81.11:. Itld Jonathlln ltefn, general eClllolI'ISel of COI'IIIIJnh,- I.esal Servfces
P~il"ll!lh;l,
.,
.
"110 one ean aive IIn,-bcdy erIy'.ssurllll'lCe.
of
~owl
I
.
I
.tfR
ct tether. It .... ~t8ndlrd ".,he now,Slnee '11:1'1. la", ItIntfnto
2, there hal been no Itendord,c, SEefn aal , "We'l'l tn 11~bo." !
Mea"whlle, Hunter', ",..ata J~IGle 'hlfr schedules to ~., wf,h Hunter'a
candtt'on. Hlr moth II' Ie II Pittabur,h police officer whQ,~ede, about $ 'G,aOa
La.'II: Yr/llr. Her flther fs • 8irUilIJUnt l:II.I8ines811111'1 who rlc.ntly clOled hi,
fr~'no .hop on thl South sId••
•
Thefr fn;ame weI nOE'taken 'I'Ito co""dtrattcn ;1'1 decermiNinG SSI ,.l;gibilit
thefr dl~,ht.rI8 .. ~reme need for eire,
~ly
Ml.I\uI' t.l9flha '7 pound" 8 OUI'\CI. I'\CN • 12 pr.N"Id8 lIIIM"tha" her !"ireh woi,h •
Ihe has a dCsclt(ve prOblem thet makee i, dfffi;ult to keep food down.
-
~
Ufth;" che neat fe~ weet., Hunter w'll hpyt an 2p!1'!$fgo.t,· Inslrt I t~
her belly 8! her BSCe"t8 ell" fntI'8venoU'Ly'eeahe~ the.nutr'ents ah, Ior.ly
1'1.:.
'
.
,
Plt~f S~.1~ltl's pr;vlte medical InI"r&l'lCe ~aVI for some ~ICf".1 end
aUf it hal cepa 0" thl lmawnt it will al.perle ';1'1 Hunte~t. L1fetlme.'
She was born wft~ t~. d1.or~lr ,. I r ••~L' of
carried by hIt parent•• T~o condll{on·f.:pres,"t
every S m'llfo~ babfes bo~ft In the Ufttctd Stat••
chILdren, inclUdf~1 Hunter. fn the'Untled Stat••
lchehyoai,.
.
I
eO~&
I
rlre, rlCI•• IVI geneal
fn one to ftve ;hfldr.~ of
otoh yeel'. There are o"Ly!thr e
af.l~ wich Harlequin!
twa
"W'th~ijt ($SI), her care would decline Ina l"vIJter It riak Co tLlne.aea
end dllth.'· Pltti St.infea wrote to ctfnton • ~nth before ho .taned the
LeU
f?
-'
..
�,
.
w£lfere bill.
Tho IS! chal'll" cln also afflICt JlUI'Itlr l • • lfglbU Ity 101" other pro;NIDI that
help ufth her mlc;cDl care.
' 'flY
fl'lCtw. tile federal WOllen, Infenn and \:hUdren pi"OIrMl, wlHchprgy(
'the I'IUtrtt'ol'llll fOMlllolL •• ahe neada co efl8Ure 8he ,e~. the 1,300 calories a!day
h.r bc~ er....... A/"d t.~ •• -"1 atl11 prosr•• Ire pr«lfc'~.d. on 5S1
I,
.lflfbl~lty, the
new
law eowld alao affect whlth... t"1 8CI,. wauld;Aanr'nuf to
pay for early InterVinflan .trytcis - '8uch
I. 'phyafcil
therapy thee Hunter:now
rvcetw••
, '
i
The toddler, IIIho could barely Uft her heed I'll,. ffl"lt ..1.1', la 8. aeff", I
~~u'.ttfv. a. Iny
chiLd hlr ail,Seo,usa of the cansta,,'
a~ 4
healthy
e,eceiYe8,
he~
parent.
...
eaF.
'
~af"t.'n.
GRAPHIC; PMOTO (2). PNOTO:
Ann'. O·I.flIIPOIC·C.,et"I~
NUl'lt.1" Scetnftz
~
Wltht
1'10&1; few weeki, the ~fL~ have an operation to fnaere , cube 'n~e,. belly a
her; ,pa~.nt'a can 'n~rave~ly feed her ~h. ~trl.nc. ahe needa,; PHOTQ;'Pettf
'the
Stefnftz, c.nter,
.na Ha~ '"~ V.r~lo.
, nur.e wIth Inte..tm: Wurs'ftg,pta
NUI'It.r.:Hunter fl dol", rwa,.klDly vall fa
a 2!-lIIGI'Ith·olcl with. I.".tfc dl ••••ll 80 "II" that vlcll• • • ldCIIII "vi paet 2
year•• But ~ har ~8rent. laY.; Hunre"'a hellth couls be threet~ed
thafedarll 11.1 L
8IIIII'IC1; ee\,lr
C WIG I'IC 1u:Ied 1nth.
,,:Ual" ll'" that;
'liNgo ,fppesUn ",'Awe:. 'pilato, P••••
pMteboo whh, Stofl'lfU'8 • •
1.,.,
"'!
'[,,'din'
LOAD-CATEI September 25, 1996
".
. tOO'
at::> N013ZVg
60tOCZZZOZ YV.:l ,tt: Z1 Q3A\ '96n%t
��Receiving Benefits
4500
rJJ
~
~
~
rJJ
~
0
~
E-4
I
4~00
3500
3000
2500
2000
1500
1000
500
0
88
III!I Adults
III Children
89
90
91
92
Calendar Year
93
94
95
96
�Federal Payments To Children
25
IjJ
20
Children
III Adults
r:/l
~
.915
~
~
.~
~
10
5
o
88
89
90
91
92
Calendar Year
93
94
95
�Awards and Bases
SSI Disabled and Blind Children
250
rJJ
"'0
0
~
rJJ
~
0
DIFA
ljJ Funct Equal
III Equal
[j] Meet
200
150
,.c
E-4
100
50
o
88
89
90
91
92
Calendar year
93
94
95
�o
1996 Major Provisions
• The New Definition: Marked and Severe Functional
Limitations
• Repealed Individualized Functional Assessment (IFA)
• Changes in "behavioral" domain
�Policy Considerations
• Statute
~ Functional
~ Repeals IFA
• Conference Language .
• Budget Estimates
• Congressional Letters
�Time Table
SSA Must
•
•
•
•
Publish regulation by Nov. 22, 1996
Notify families before Jan. 1, 1997
Finish redeterminations of IFA children by August 22, 1997
Adjudicate new claims; 7000 per week; >40,000 pending
�Other Provisions
• Continuing Disability Reviews
~ Three years for conditions likely to improve
~. Not later than 1 year for babies of low birth weight.
~ All other optional
• Evidence Of Treatment
~ Rep payee must present evidence of necessary and available
treatment.
~ If fails, without good cause, we may:
~Suspend payment of benefits to that payee and select another;
- or
~Pay the child directly, if he or she is old enough.
-
• Redetermination At Age 18
~ Using adult criteria
�A New Childhood Standard
CBO
Today
~
Medical .IFA
Ij]
Medical
[j]
Removed
1M! Elig
eRemove IFA
-$7.49 billion saved
�Four Options.
(other than CBO)
A.
B.
C.
D.
Current
Advocates
Marked + 2 Moderates
Middle Ground
�CB 0 ............. A. Current
160
i
[j)
Medical
[j\
Removed tIJ Elig
eRemove IFA
e$7.49 billion saved
III Medical 1M! Removed III Elig
• add
~ physical
domain
~fonn
• $5.655 billion saved
�A. Adjudication Policy
• Uses existing policy to determine functional limitations through
"functional equivalence" to our listings. This approach most
often involves a showing of marked limitations in two of four
functional areas evaluated.
• Adds specific evaluation of motor limitations for children with
physical impairments;
• Requires aform to be completed by adjudicators for all
functional equivalence evaluations.
�Key Features of
Option A. "Current"
.......
• Requires adjudicators learn a few new
procedures
• Administrative cost: slightly more than "CBO"
approach
• Predictability: slightly less than "CBO"
• Advocates doubt that adjudicators will
understand this approach.
• Reaction
~~
@] cdtigfesS:
accept
~ Advocates:
reject as too stringent
�B. Advocates
• new IFA-like step
• drop mildest disabled,
255
45
• $1.6 billion saved
[I]
Medical
II]
Removed 1M! Elig
�B. Adjudication Policy
• Uses existing policy to determine functional limitations
through "functional equivalence" to our listings. This
approach most often involves a showing of marked
limitations in two of four functional areas evaluated.
• Adds an/FA-like procedure for those not eligible above.
Not really different from current IFA and likely to produce
very similar results.
• Drops only the 3 moderates.
• . "Moderate" impairments too easy to find.
�Key Features of
Option B "Advocates"
......
• Requires that adjudicators learn a few new '
procedures and some subtle distinctions
• Administrative cost: almost low as "CBO"
• Predictability: almost high as "CBO"
• Advocates believe that adjudicators will
understand this approach.
,
I
• Reaction
~ Congress:
many will object; a few have indicated
acceptance
~ Advocates: jubilant
�c.
Marked + 2 Moderates
• add
=1
physical domain
form
180
120
an IFA -like step
to consider
marked and two
moderates
• $3 billion saved
III Medical
III Removed 11\ Elig
�C. Adjudication Policy
• Uses existing policy to determine functional limitations
through "functional equivalence" to our listings. This
approach most often involves a showing of marked
limitations in two of four functional areas evaluated.
• Adds an [FA-like procedure for those not eligible above.
Not really different from current IFA and likely to produce
very similar results.
• "Moderate" impairments too easy to find.
�Key Features of Option C
"Marked --I- 2 Moderates"
• Requires that adjudicators learn no new
procedures but some subtle distinctions
• Administrative cost: almost low as "CBO"
• Predictability: lowest of all
• Advocates likely believe that adjudicators will
understand this approach.
• Reaction
Congress: many will object; a few have indicated
acceptance
~ Advocates: likely to accept, grudgingly
�D. Middle Ground
• add
~ physical
domain
200
100
~form
~ methods
for chronic
illnesses
• $3.9 billion saved
IjJ
Medical
III Removed
III Elig
�D. Adjudication Policy
• Uses existing policy to determine functional limitations through
"functional equivalence" to our listings. This approach most
often involves a showing of marked limitations in two of four
functional areas evaluated.
• Adds specific evaluation of motor limitations for children with
physical impairments;
• Requires a form to be completed by adjudicators for all
functional equivalence evaluations.
• Creates a separate procedure for chronic illness
�Key Features of
Option D "Middle Ground"
• Requires adjudicators learn many new procedures
and subtle distinction.
• Administrative cost: highest of all approachs
• Predictability: least of all options
• Advocates will be highly skeptical that
adjudicators will understand this approach.
• Reaction
~ Congress:
a few may question; most will accept
Advocates: reject as too complicated and too stringent
�Estimated Savings
CBO
Options
A. Current
B~ Advocates
C. Marked + 2 Moderates
D. Middle Ground
8
7
6
CI':J
~
o 5
7.5
5.6
1.6
3.0
3.9
.,....( ,
~
.
,....(
4
~ 3
2
1
o
CBO
A
D
C
B
�u
0
>-. >
ca -c
-c
0
t-
....
c:
(J.)
''
:l
"
m c
c(
•
r-,
I
[
;
I
L
:as• 0 • 0
m
«
0
t I f
N
,...
o
en
en
CD
·en
0
0
,...
C")
0
0
N
,...
0
0
,...
,...
spuusnoql
0
0
0
,..
0
0
en
�....
c
u
G)
0
J..
>. >
I
m "C Cl :::J 0
"C <C :E 0
•
•
• m
0
t-
,
f
m
"
II
, 1
" (
u
C
<C 0
I f t
o
co
0')
CD
0')
0
0
0
co
0
0
0
I'
SUO!II!ill
0
0
0
CD
0
0
0
Lt)
�COMPAIUSON OF OPTIONS FOR DETERMINING SSICHILDHOOD DISABILITY UNDER WELFARE REFORM
SEVERITY STANDARD
FOR DISABILiTV
REDUCTIONS IN
NUMBER OF CHILDREN RECEIVING SS!
PAYMENTS
. SSI AND
MEDICAID
.
COSTS'
.
I-~'.'"
----.CURRENT RECIPIENTS
FROM
1997-2002 . .
REMOVED FROM ROLLS..
IN 2002
BY SEPTEMQER 1997
(down from 1.3 million
(down from 1.0 million before
before welfare reform)
welfare
.
Significantly Tighten
Eligibility
Option I
f-.-
'
f--------!.
Option 4A
o
o
"",-~~ ••~~~~.
Add New Step with Lower
Standard than Options I or 2
1-------,...,11-,
Option 4
o
.
If
Option 3
.
"'~--r-' SSI
.
Additional
----··-·,··..--·---·--t··,~---··-~~· -··."-·,,I.. -"--·-·,,·--""""':'~-·~i··~·--···--·-.-------t~----,
Tighten Eligibility: Modify
185,000
$0.5 billion
$2.0 billion
Detennination Process
145,000
65,000
-II
Option 2
r" ..
~
Additional Eligible . . and Medicaid
C h i l d r e n ' Costs
250,000
190,000
r-,. ."
OPTIONS ON OUTLAYS
IN 2002
" ..
~
,-~
Same as Option 2, but Slow
Phase-in of Current
Recipients
Same as Option 2, but
"Grandfather~' Current
50,000
45,000
. ,-.."...
,~
i-·-..
.-~~
o
$6.6 billion
$·1·
175,000
·1
°
••••,..;.
..
110,000
,~-'=~-l
~",...
,m.
$3.9 billion
. •• ~-~
!.
."._.. = ,.
140,000
---.~-."
I
$0.6 billion
75,000
I·
. $5.8 billion
$1.5 billion
200,000
.,
' •.•
J
$0.8 billion
"
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Carol Rasco - Issues Series
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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Clinton Presidential Library & Museum
Extent
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92 folders in 7 boxes
Text
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Original Format
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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SSI Kids [1]
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Identifier
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2010-0198-S Segment 2
Is Part Of
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Box 126
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Format
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Adobe Acrobat Document
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Clinton Presidential Library & Museum
Medium
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Reproduction-Reference
Date Created
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12/4/2013
Source
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2010-0198-Sb-ssi-kids-1
-
https://clinton.presidentiallibraries.us/files/original/0c784ae01037d42099f61a3792e99a3f.pdf
7b0a0cf4e88a6978c533e34f36cfb4fd
PDF Text
Text
rurol.f/w
••
Thank you for attending the consultation on rural policy on
September 20. Our limited time kept us from hearing from more of
you about your work on behalf of the people living in small
communities throughout rural America. After the meeting, I
listened to more good ideas about how we can improve our service
delivery. These discussions .confirmed what we heard in the
meeting: there is a great deal of work that we can build upon as
we craf~ a national rural policy.
The meeting was a good first step toward improving the federal
government's working relationships with our rural customers.
Now, we need to take the next steps. Our goal is to develop, by
the end of December, a coordinated national rural policy. I
envision that the policy will include new actions in the relevant
. Departments to improve service to rural communities. In
addition, I expect that the policy will reflect a commitment to
an ongoing process to improve service, rather than the end of
that process.
with these goals in mind, please identify one person from your
Department or Agency who will be our contact and your
representative on an interim working group on rural policy.
Second, I am hopeful that this group will meet within the next
seVeral weeks to begin its work. Finally, I intend to reconvene
the Departments in several months to assess our progress.
In preparation for participation on the working group, each
Department should look for opportunities to improve service to
rural people and communities. This assessment should be
completed by November 15. Attaqhed is a list. of questions to '
help you assess the current status of your Department's ·rural
work, and to help identify these opportunities. This assessment
will be the beginning point for ,the working group.
While the Departmetit of Agriculture 'is designated by statute as
the agency responsible for coordinating a national rural policy,
we all need actively to contribute· for the results to make a
difference. Please send the name of your representative and by
November 15,a ~ummary of the results of your analysi~to Bart
Chilton of Under Secretary Long Thompson's staff .at USDA/Rural
Development (fax 720-2080, phone 720-4581). Should you have any·
questions, please feel free to contact me, Diane Regas of my
staff (456-2216) or Mr. Chilton at USDA.
Thank you for your assistance.
�.I
Assessment of Federal Service Delivery to Rural Communities
customers
Who are your rural customers?
Do they have special nee~~?
What are those needs?
What actions has your department, taken to address those needs?
Your customers and Your Current Program
How would you characterize the impact of your programs on your
rural customers?
What challenges do you face in serving rural customers--what, if
,anything, stands in the way ,of maximum service delivery?
What other public or'private resources do your customers use to
complement your programs or meet their needs?
,Change in Your Department
What changes have your made to your organization or programs to
respond 'to your rural customers' needs?
If you had a new dollar of federal money, how would you spend it
(what is your highest priority for improving service for rural
customers)?
Could you reallocate or reorganize current resources to achieve
this change?
'
Interagency
What other programs or resources does your Department typically
partner with to meet the needs of rural customers? What other
programs might also help get the job done?
, with what other public and private' agencies do you haVe joint
agreements to deliver services to rural areas?
What are some of the gaps in rural service that you are aware of?
Next steps
How would a unified national rural policy benefit your'
department ',S work?
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Carol Rasco - Issues Series
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Clinton Presidential Records: White House Staff and Office Files
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Clinton Presidential Library & Museum
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92 folders in 7 boxes
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Rural Policy Development
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Domestic Policy Council
Carol Rasco
Issues Series
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2010-0198-S Segment 2
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Box 126
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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Adobe Acrobat Document
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Clinton Presidential Library & Museum
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12/4/2013
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2010-0198-Sb-rural-policy-development
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https://clinton.presidentiallibraries.us/files/original/f9ac208cf4345c803622c0cc8714df01.pdf
453da19ca3319cf4102d32a3bbabd8c2
PDF Text
Text
~ULATORY
a~ .
REFORMj-l .. ,
TUESDAY, FEBRUARY 21, 1995 ~
I am determined to see 1
eform of our regulatory system. so that it costs less, meddles less,
and puts more responsibility in the hands of people. Today, I will take several specific
additional steps to retorin regulation. and charge our regulators with responsibility to carry
them out. But while wrl retorm, we must remember why we have these standards. We must
not strip away safegua~ds for our children,our workers, ourfamilies. There are'
proposals pendIng in thT Congress that go beyond retorm. that would freeze or gut our ability
to protect the public. ~nd they, are simply unacceptable. -- President Clinton, February 21,
1995.
CREATING A LESS BUREAJUCRATIC GOVERNMENT
. Since we took office 2 years agb, we have been determined to create a less bureaucratic and more
flexible government. Regulluiqn -- like the rest of government -- badly needs repair. Too often,
rule writers in Washington set rorthdetailed lists of do's and don't's, instead of setting clear goals
and challenging the private secJor to come up with ways to meet them.
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ANNOUNCING A NEW RE<iiULATORY REINVENTION INITIATIVE
We have made progress retor~ing regulation, but there is more to do .. That's why the President
today announced a Regulatory Reinvention Initiative including the tollowing steps:
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Page-by-Page Review of Rules. Regulators must immediately check each rule they
implement to see if it is obsolete; if there isa private sector alternative: if self-regulation or
a stine or. local govermlnent could' job more effectively? The results of those reviews
do the
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must reach the President's desk by June 1.
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Performance by Results. The President instru_cted regulators to develop ways to judge
performance by resultsl -- by its ability to improve the health and safety 01' our people. not
by their ability to incrJase bureaucracy and red tape. .
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Ret'orm Guided hy RLlity.The President ordered regulators to convene immediately
groups consisting of frpnt-line regulators and the people affected by them .around the country
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- not lawyers talking 1'0 other lawyers in WaShington...
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Partnerships. The P~esident begl,ln the move away from a system where lawyers write .
volumes to one wl1erelpeople create partnerships by asking each regulatory agency to submit
proposals tor negotiated rule-making.
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Vice President's Review. In the coming months. the Vice President will submit a series of
regulatory reform PrfPosals on the environment. health. tood. financial institutions and'
worker safety. The President will send them to Congress.
KEEPING PROTECTIONS FOR HEALTH, SAFETY AND THE ENVIRONMENT.
Republkans in Congress are ullnsiJering"reform" proposals that would hurt the middle class and
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benetit powert'ul interests. Those proposals would cost lives and dollars, and the President said
today that they are simply unhcceptahle .. The GOP is also consideririg an ill-advised ~egulatory
moratorium that would strip government's ability to protect the public's health, safety and
environment. It would block letforts to ensure the safety of our tood. make cars safer, improve the
accuracy of mammograms. ifhe President made dear that such a moratorium goes too far.
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THE WHITE HOUSE,
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FPR ,IMMEDIATE RELEASE
, TUESDAY, Fepruary 2( 1995 '
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PRESIDENT ORDERS, GOVERNMEN1WIDE. REFORM OF REGULATORY SYSTEM
" ReinventionInitiati~e To,Reddce Burdensome Regulations, ProteCt 'PubliiHealthand Safety
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, .' ,,' W, ASHIN,GTO~ •• Calli?g for a ne~ appro~ch to, the. way govern~ent regulates the,
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sect9r, the PresIdent tod~y armounced a major overhaolof.the natIOn's regulatory
sy~tem, directing the heads of aliI regulatory agencies ,to ,conduct within four months ',a
comprehensive review,of therures theyimplemtlnt to .identify obsolet,e arid b,urdensome . ", '
regulations, 'The system needs t6be ref~)fmed but 'not eliminated;, the, President s,aid, addi'ng'
effort~ to compietely strip away reg1jlations that pr~iect' public ' '
that he would oppose
health, and safety.
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amd~tetmin~d t,o s~e ~efor~ of ~ur regulatory systerrl, so thati~ costs less,ri,ed~le;
, less, aiId puts more responsibili~ in the hands of the people themselves. ' But whil~:we
, ~eform regulation, we cah~ot str!ip away safeguards 'foT'our children, oui,'workers, our,'
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families," the: President said.
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, , ' ,' :',', " '~It, ~s p6.ssible t~ cut. ~acf on the bulk 'of regul~tions,siinplify the~, ;mel get bettrr ' . '
"res~lts," saId VIce Preslde~t Gore who, has~een workl~gon regulatory reform, as 'part of the
NatIOnal Performance ReVle'w to make government work better, and cost less -- an effort that
has already .~aved taxpayer~ $631 bil,lion, "We, c~ .,i~prove 'the relationship~ ,betw~en, regulat9rs
and the peQple they: reglJlate to achIeve our natlonal goal of a roblJst econQmy th,at also"
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protects p~biic healtl,l andsafe~:i ~e ,Cited e~amptes ~f the Adm~riist~ati~~~s slJ~cessful ,
efforts to reduce bu,rdensome, regulatlonsand towork 10 partnershIp' With' 1Odustnes, states,
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, ,"Regulation'.- like the, rest of government -- badly needs reprui:,'" the
Preside~t. said.,
'~But there'~e some peopl~ 'whd would,use the need for reform as an excuse 'tl.? gOt vital', ','
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'consumer, worker and environrrlental ;protections. ' That's not what tire COlJ!ltry needs or wants.
,Thoseproposals that would fredze or gut our ability to protect the publIc are simply '.' .' .'
unacceptable.
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regqlatory advIsory members ~d some, cabmet members, the PresIdent announced the . '. ,
. Regulatory Reinvention InitiatiJe and ,issued a set of instructions to further.reform the nation's
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1) Cqnduct ~
page-bY-ha~e re~i.ewofall· rules and· regulations to :id~ntifyobsolete,
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: regulations thafcould'be better achieved'thro~gh the private sector, self-regulation, or ' '
" , state· and local go\:,ernl1lents., The resuIis of these :teviews must be reported to the "
PresidentbyJune 1, .1'995;
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2) 'R~form the way the:.gov:emment ·measures the perfor~anc~ of front-iine re~~lators
and regulatolo/ agencies so that those measurements are based 011 results and 'not on .
. process and punishments; , ,
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,3)· Convene immediately' groups ~onsisting'of frorit-liJ)e. regulators and people' .
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affected by regulations .so that reform is guided by reality and not special,.interest
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4)., Submjt.to t~Er.White House a list of pending rulemakings. that can be .converted
. into n~g<?tiat~d rulemakings :t() strengthen public~priva:te paltnerships.
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, The President stressed that a.n~w appro~ch to'regul~tion: was needed--one where, the'"
. federal g6vernmfmt carefully compares the costs and benefits of regulations and woiks to· ~"
create, partn'ershipswith the private ~ect~r: An importantfirst step in achieving that goal:is ,to'
change the way the federalgoverri~ent evaluates its adions,· "The. regulatory syste~· as a ",
',.' whole' and the people "who, work in it should be judged by their ability to improve the health
, and ~afetyof our people, not by their ability to inerease bureaucracy and red tape;" he said. '.
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" In addi.tion, heuneq~ivocally opposed effort~'by the'RepublicanCongress, which win
, , vote oil,an 'across.:.ihe-board freeze on aU federruregulationsthis week, to bring federal .
protection of public.health ~d' safety. ,to a grinding halt. "
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"Ne~ pr()tectibns from deadly bacteria in our driri.~irig\Vater. Safer' in~atand~poultry. "
. S~er cars: News,tandards to ensu:re. the continued accuracy of mammograms. Full ' ", '
eriforcementqf the law that lets parents' take leave) to care for a·sickchild.:If a .moratorium
takes effect, all the~e benefits to our people will ·be on hold for the foreseeable' future: We·
:~l¥lnot stripaw:aythese ,safegu~rds for working families.
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., regulatorY moratorium and these extreme .regulatoryme~ures would huftthe. middle class, .'
fUld b~n~fi~s, only thos,e powerful. interests who don't want to provide safer prodllcts ()r cleaner
water. They willcost.lives~8.nd dollars, They are, simpfy unacceptable .. Ahd I won't. let them
happen,"'the President said. .
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,REGULATORYREFORM, '
TUESDAY, FEBRUARY 21, 1995 '
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I am determined to s~e'reform of our, regulatory sys~em, ,so that i't' costs' less, medd,les '
less, and, p~ts more responsibility in the hands of people. Today, I will take '
" several specific additional 'steps to'refo'rm regulation, "But' while we" reform; we 'must <
ren:tembe~ why we have these,' standards.. ,We must not strip, away safegu'ardsfor
, our children, our workers, o~r families. There are proposals pending in the,
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Congress that go beyond refonn, that would freeze or gut our, ability to, protect the "
'publi~, And' they are simply unacceptable. ' -·Preside~t Clinton, Fe~ruary 21, 1995,. '
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CREATING -A LESS BUREAUCRATIC GOVERNMI;NT. Since we' took' (,')ffice 2 years
", ag(,'), ,¥e :have'been ,determined,t6 create, a ~ess bureaucratic andmo~e' flexible government.
,Regulation -- 'like the' rest'ofg6vernment -- 'badly ,needs repair. Too often, rule writers in '
,Washington set forth detailed lists of- dO's and don't's, i~stead bf setting' Cleat: goals and ' ,
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challenging the private s~ctor to com~up withw,ays to m'eet them. '
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ANNOUNCING A NEW REGULATORY REINVENTION INITIATIVE. W~ have made
progress reforming regulation, blit there is more to" do, '"That's .whY the President today
, announced i ~egulatory Reinvention Initiative ind\lding the followings~eps: ,
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Page-by-Page Review of Rules, ,Regulators must immediately ch~ck ~ules they'
, implement to see if they are obsolete; if there is a pri~ate seCtor alterna'tive~' if self
-regulation .or a state 9r local go:vemrrtent'~ould do the job ~ore 'effectively? ' Those
, reviews must, be on "thePresid~nt's desk by June- L'
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p'erformanc;eby Results, The President instructed regulators to develop w~ys to .
judge performance 'by results -- by its ability' to improve the health and safety of '
, our people, not brtheir ability to'tincreasebureaucfacy and red tape: ..
'Refor.:n Guided by ~ea:lity, The President ord~red'regula:tors to -'convene immediately
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g~oups consisting of front-line ~egulators and the people affected by 'them around t h e ' "
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Part~erships, The President beg~ the' move away fro~ a, system, where lawyers
write volumes to one wh~fe people create partnerships by as~irig, each regulatory "
agency to 'sub~it proposals for negotiat~Q rule-making, '
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. Vice Presidentt~Review, The Vice·Presidcmt will, submit, a series of regul~tory,
reform proposals on the environ~ent~health; food, financiaiinstiturions and wor'ker
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safety, 'arid thePreside~t will send them to 'Congress. ," ,
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'KEEPING 'PROTECTIONS 'FOR HEALTH, SAFETY 'AND TH'E ENVIRONMENT.
, Republicans inCongress are considering :'reform" proposals, that wQuld'hurt the middle 'class
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,J>resident said today thaf'they are sil'nplyuna.cceptabl~,,·; T,he GOP is 'also considering
illadvised regul atQry :moratori urn. that would s,trip .government's abi lity to ,protect the public's .
health; safety and environment, It would block efforts to ensure the safety of our fo04. make
,c'ats safer. improve the ,accuracy of mammo:gram,s, T~~ 'President mad~ I;lear that such a '
moratoriumgoes:too far.
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�· Potential Impact
ofRegulatory Moratorium .
February 21, 1995
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�· Table of Contents .
I.
Economic Growth and Competitiveness
Migratory Bird Hunting
Fisheries Management
China Sanctions·
II.
Public Health
Safer Meat and Poultry
Safe BottledDrinking Water
ID.
Public Safety,
Automobile Head Jmpact Protection
Commuter Airline Safety
Airworthiness Directives
Toy Labeling for Choking Hazards
IV.
Help for Families and the Middle Class
Family and Medical Leave
POW Burial at Arlington Cemetery
�ISSUE:
MIGRATORY BIRD HUNTING (DEPT. OF INTERIOR)
STATES AFFECTED: AU
Rule: This rule establishes the hunting season for certain migratory birds. The hunting season is
set on an annual basis by regulation, as required by law.' This rule also imposes certain restrictions
upon hunters, such as bag limits.
Beneficiary of the Rule: ' Bird hunters, communities and businesses where these hunters gather.
Impact ofH.R. 450:' It is estimated that there are over five million migratory bird hunters. On
an annual basis, these hunters spend approximately $1 billion related to their hunting efforts. A
moratorium could cause the derailment ofthe 1995-1996 season and losses of millions of dollars
to businesses throughout the hunting areas.
Date: Final Rule published November 21, 1994.
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FISHERIES MANAGEMENT (DEPT.'OF COMMERCE, NATIONAL
MARINE FISHERIES SERVICE)
STATES AFFECTED: All states with fisheries
Rule: These rules restrict the number of fish that commercial fishermen can catch in certain
fisheries each year. They are based on scientific data and are designed to allow for the maximum
take of fish while, at the same time, preventing depletion of fish stocks. "Depletion has been a
serious problem in many fisheries around the country.
Beneficiary of the Rule: All fishermen and the consuming public.
Impact of H. R.; 450: Many of these management specifications were published after November
20, 1994. A moratoriulTl could suspend these specifications, potentially allowing unlimited fishing
in these fisheries, which could lead to long-term decline in the number offish available'for future
fishing.
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CHINA SANCTIONS (UNITED STATES TRADE ~PRESENTATIVE)
STATES AFFECTED: All
Rule: The rule would impose trade sanctions against specific Chinese products, in retaliation for
Chinese pirating of patented and copyrighted U.S. products.
Beneficiary of rule: U.S. technology industries whose patented and copyrighted products
(particularly video cassettes and computer software) are being pirated with impunity by the
Chinese.
Impact of H.R 450: The moratorium could hold up the trade sanctions, affecting the
Administration's ability to set trade policy and to protect U.S. firms.
�ISSUE:
. SAFER l:'fEAT AND POULTRY PRODUCTS (DEPT. OF
AGRICULTURE)
STATES AFFECTED: All
Rule: This rule will eliminate a critical gap in the current meat and poultry inspection system,
potentially reducing the incidence offoodborne illness caused by contaminated meat and poultry
products. The proposed regulation will make our outdated meat inspection system more scientific
and will.focus bacterial control efforts on points in the meat production process where
contamination is most likely to occur.
Beneficiary oftbe Rule:' All.consumers of meat and poultry; especially the elderly, children, and .
persons with compromised immune systems, who are generally at greater risk for foodborne
illness.
Impact ofH.R. 450: . Fo.odborhe illness from all food sources range from 6.5 million to 81
million cases each y~ar, and up t09,000 deaths, according to the Centers for Disease Control.
Without this rule, the meat and poultry supply will be more vulnerable to contamination.
Date: Proposed Rule published.on February~, 1995.
�ISSUE:
SAFE BOTILED DRINKING WATER (DEPT. OF HEALTH AND
HUMAN· SERVICESIFOOD AND DRUG ADMINISTRATION)
STATES AFFECTED: All
Rule: This rule amends regulations concerning allowable contaminant levels in bottled water. It
ensures that bottled water is as safe as public drinking water.
Beneficiary of the Rule: Consumers will benefit from bottled water products that are at least
equal in quality to public drinking water. The bottled water industry generally favors such quality
standards because they promote greater consumer confidence in bottled water products. The
states will benefit from a uniform federal. standard that fosters interstate commerce.
Impact ofH.R. 450:. This rule would most likely have to be withdrawn ifH.R. 450 is enacted.
Date: Final Rule 'published December 1, 1994.
�ISSUE:
AUTOMOBILE HEAD IMPACT PROTECTION (DEPT. OF
TRANSPORTATION)
STATES AFFECTED: All
Rule: 'This rule will require protection against head impacts in the upper interior of cars,
light trucks, and light multipurpose passenger vehicles ..
Beneficiary of Rule: All drivers and passengers in automobiles manufactured after the
effective date of the rule, as well as insurance companies, will benefit. The National
Highway Traffic Safety Administration (NHTSA) estimates that, once the vehicles
manufactured under this rule replace the existing fleet, over 1,000 lives will be saved and over
600 serious injures will be avoided per year.
Impact of H.R. 450: Each year of delay in the implementation of this rule will cause over a
. thousand lives to be lost and several hundred preventable injures to occur over time ..
Date: In the absence of a moratorium, the final rule will be published in March or April 1995.
�ISSUE:
COMMUTER AIRLINE SAFETY STANDARDS
(DEPT. OF TRANSPORTATION) .
STATES AFFECTED: All .
Rule: This set of rules would upgrade the standards for commuter airlines to those of the major
airlines. For example, it would require pilots on small commuter aircraft to go through the same
sophisticated training as pilots of the large carriers. It also increases crew flight and rest
requirements.
Beneficiary of Rule: Commuter airline passengers. Commuter carriers~ which operate aircraft
with fewer than 30 seats, represent one of the fastest growing segments ofthe U.S. airline market
and often dominate airline service to many medium sized cities and rural areas.
Impact of H.R. 450: A delay in the implementation ofthis rule will slow the improvement in
standards for commuter carriers.
Date: Absent the moratorium, a proposed rule is planned for March, 1995, with the final rule
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anticipated by December 1995.
�ISSUE:
AIRWORTBlNESS DIRECTIVES (AD's), (DEPT. OF
TRANSPORTATIONIFEDEJ,tAL AVIATION ADMINISTRATION)
STATES AFFECTED:'
All
General Rules: Periodically~ the FAA issues airworthiness directives designed to rectify potential
safety problems'in illrcraft. Several examples ofairworthiness directives that could be suspended
are:'
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Restrictio~s on the operation of the ATR-42 and ATR-72 aircraft in icing conditions,
following the October crash ofan ATR-72 in Indiana;
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. Revision to' the Airplane Flight Manual to prohibit takeoff in certain icing cO,nditions
unless either an inspection is perfonned or specific takeoff procedures are followed.
Appli,cable to Fokker Model F28 Aircraft;
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Inspection and Modification of the tailcone release assembly of certain McDonnell ' .
Douglas aircr~ t()ensure that passengers can escape during an emergency evacuation;
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Inspection and 'repair oflanding gear brakes for certain Airbus aircraft. This rule was
prompted by an accident in which an aircraft was unable to stop on a wet runway;
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Replacement of certain bolts, nuts, and washers that hold together parts of the wing flap.
The new attachments prevent failures that could cause the aircraft to roll over upon lift
off. Applicable fO,Boeing 757 aircraft;
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. Requiring measures to prevent the sliding cockpit side windows from rupturing in
certain Air~us models. Failure to prevent the sliding cockpit side windows from
, rupture' can potentially result in rapid decompression of the aircraft.
Impact of H.R. 450: The moratorium could prevent these types of directives from being issued..
The safety concerns they address, -though significant, may not be sufficiently imminent to' qu~ify
for an exception under H.R. 450.
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Date: These Airwort~ness Directives were published after November 20, 1994.
�ISSUE:
TOY LABELING FOR CHOKING liAzARDs
(CONSUMER PRODUCT SAFETY CO:MMISSION)
STATES AFFECTED: All
Rule: These rules implement the toy labeling provisions ofthe Child Safety Protection Act of
1994. The law was adopted at the urging of consumer advocates and industry, which wanted a
uniform federal labeling standard. The rules provide guidance to industry to enable it to comply
with the law.
Beneficiary of rule: Parents buying toys for their children benefit from clear labeling describing
the toy industry benefits from the agency's clear description of the labeling
choking hazards,
practices that must be followed.
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Impact of H.R. 450: Passage ofH.R 450 could delay the clarity and certainty that parents .and
the toy industry are awaiting.
Date: The final rule will likely be issued in February.
�ISSUE:
FAMILY AND MEDICAL LEAVE ACT REGULATIONS
(DEPT. OF LABOR)
STATES AFFECTED: All
Rule: .The regulations implement the Family and Medical Leave Act of 1993 which allows
eligible employees to take up to 12 weeks ofunpaid leave a year for the birth of a child, adoption
of a child, or to care for a seriously ill relative.
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Beneficiary of the rule: Both employers and employees benefit from the clarification and
guidance provided in the final rules, includirig, for example, clarification ofwhat a "serious health
condition" is.
Impact ofH.R. 450: Without the final rules, uncertainties raised by the law and the interim
regulations would remain.
Date: Final rules were published on January 6, 1995 and will become effective on April 6, 1995.
�ISSUE:
POW BURIAL AT ARLINGTON CEMETERY (DEPT. OF
DEFENSE/ARMY)
STATES AFFECTED: All
Rule: The rule extends eligibility for interment at Arlington National Cemetery to any former
POW who served honorably in active military service.
Beneficiary of the Rule: A11.former POWs who die after the date ofthe 1994 Authorization
Act.
. Impact of H.R. 450: A moratorium could deny eligibility and needlessly dishonor deserVing
.veterans who died after the 1994 Authorization Act was implemented.
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Date: Interim Final Rule published November 25, 1994.
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For Immediate
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:BY THE PRESIDENT ,
: ';ATRE~ULATORY REFO.RMEVENT
REMARKS
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,THE PRESIDENT:: Thank you very much. I, want: to pegin by'
thanking the 'Vice, President for hisleadership,oh' thislssue. when
we formed our partnership ,back in J,9,92,,'and.' we'.talked about all the '
things we wanted tp, do ,anq., we 'had a· series' of, long ,fascinating. "
c:::onversations ip 'which,he talkedtoineaboutsci,ence' and technolcigy
and the:'envirorimerit, and I, talked to him 'about ~ducatiqn and' e,conontic
/ development 'and',reinventing gov.ernment: -- arid I ,told him that when: ,I'
. was a governor;, every cOtlpleof 'ye~rs' we'd eliminate an ,:?igemcy just,
.: ',to see if anYb'ociy noticed . . (Laughter~),' And normally" they'didri't.·
(Laug:q,ter.)· , 'And they never did complain wheri they,. did notice,.
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. "And,r'asked.:l1.l.m i~ ,he would ':'-then after we 'actually,
won a,nd, qameliere;.: I' asked hi~ if he would get. involved with this and
really ,try to,'make it work,fcir the American people, because I was ',.
convinced that, there was,' som~ch justifiable ameietyout there, am~ng' .
our p'eople about ,the way'governl\lent ,operates,', that' unle~s ' we coU:~d
change ,that, we'C;never ·be 'able to ~aintai:n',the faith, of, the' taxpayers
and, the integrity of. th7',federal1 government~ "
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,I als'o, asked, him t~ 'do'itbecause h~wa~' the' only person
I could trust to read 'all 15'0',000 in the Code of Federal,Regulations ' ..
. : -- (laughte\~.), At this vepj moment Tipper is :being treated for" ,
. insomnia at the' Georgetown Hospital.,:', (Laughter.') .But .he' s' just·
.ab.out . through., (Laughter.)
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'I also want to thank aJ,.l of you who are h~re who
\ represent realiy the future of the federal government,andth:e: future
of its ability tomain:taintpe confidence, oJ the Ame,rican people that
,we're 'prot,?cting arid pr<?mo'til)g :their interest "anci doing:,it ina way
,that 'reinforces instead' of defies common sense.
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I beli~ve. very strongly, ;in, the cause of, ,regul'atory",' ',' ,
, . reform'. And as tJ:ie~'Vice President said, we've been' working at it for'
about two years. now,. I also believe .that we have' to, hold fast' to
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certail), standards ~ I. believe ,we can bring back, CODon '.'sense and'
reduce .hassle without" strip'ping away safeguards for' 'our children, ,our
workers, our 'families."
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,Ther.e· are· proposals pending. ip the ',Congress' today which
go beyond reform ,to role back, 'argu~b1yeven ,towrecking-. And, I
oppose them; but, ,I ,believe- we have the burden: pf re~orm. And that'"
mean's w.,e have to" change in fundam,ental ,ways the cuiture ofregu1,ation,
,that has, permeated' this government thr'oughoutadministrations from
administration to adminfstratlori,' from Republicans. to. Democrats" ,
occupying the'WhiteHouse~
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The ,federal government to many peopfe is not the
. pr~sident'of 'the United States,' itt's'the person 'who ::shows upon the:'
" - door::;tep to ,check out thebailk records, .or the, safety in the' factory, ,
'_ 'or the integrity of the workplace, or' how ,the, nursing, ho~e is being~
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" ,.,run.' Ibeliey~ that owe have 'a.. serious, ob+igati6n in this
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,administration to wprk w~th, ,the' Congress to r,educe the. burden o{ ,;, ,;
, \ regulation and to increase the protection to the p1ibl'ic. And ,we have
(. '" 'an, obligati'on on ,our own to 'do what' we can'to change the'destructive'
, elements ·,of the'cultu:r;-e ,of r~gulationthat ,has b\iIl t/ up over. time ··and
'. eneig~'ze·the ,legitimate andd7cent things that 'we ,should !be;doing
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here 1n Wash1ngton ,.and', more l:mportantly,' that should be 'being done
all across t:t'le country.
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I' thank those who have "colt).e 'here today as' exampl es'.'of .
,the'. progress which ,has been made. We d,c want to get iid,of,
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, yester:day' s' gover'p~ent ,so ,we can meet the demands of ,this, "new time'.
· We do want results I no,t 'rules: We "want leaner governmEuit,not meaner<
gover:hment. ,A1: 21:. time when: I' have saidou'r 'obl:i,'gation' should be to' , .
'create moreppport:unity 'and also to 'provide ,more, re'spoI1;sibility" . our '
. re,spo:nsibility here 'fsto expan9- opportunity" empower people to, make;
· the most of the·ir. owri lives, enhance security, and to ,do it all while
'.we. are· ,snrinking, the federal 'bureaucracy; to give the ,:p~op~e' a' ': ' .
, governm~nt 'asef'fective a's our finest priv~te compcmies, ,to (give ,our,"
'taxp~yerstheir,;money's worth~. ' .
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. W~'ve;worked hard, t~, sol Vel p~oblem~ ,that': had bee~long: ..
ignored ,-~ ',reforming the. pension ,bene'!i t guarantee.' system to sefcure
'the pensions oiS .5,lt).illionworking Ame'ricans' whose ,pen'sions and' ~ , '
,retirement were at risk; reforming .qoyernmerrt ,procurement'so th~t 'the
'days of the' $500 ,hammer . and the' $10 glass ashtray "are over; turning
'FEMA." from' a· 'disaster ,into a d~sastei: relief' agency;' 'breaJdng gridlock,
on bills,' that hung around 'in Congress', for years :--..' si~ ,or ,seven years.
-;.. >iikethe'family"leave 'law ,.the mot~r voter law,' the Brad,y Bill and'
the crime bill,."
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, . B u t m~yb~' tJ:+e· most '~tubbornp.roblem,we. face is: this
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.Iproblem of. reg~lation,'~:' HC?w do we, do what :we' :re, supposed to do :here?".
HoW do we. help to ~einfbrce the social contract apd do our part ,to / '.'
· ,:work with the privat~·s'~ctor to.. ,protect the. legitimate: interests ,of,
. the ,American people 'without literally taking',leaveof our senses (and,
doing things that drive peo'pl up the wa~ l,~l:m t,don 'tmake .them '
" safer.
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,We' alI want·. 1:hebene.fi1:s of' regulatton ~ .we 'all want
clean 'air and 'ciean' wat'er: andsa,fe' fO,od and, toys ~that' ourichildren ,"
cal?-: playwith~ ,: But let's face it,. ,we all khow the regUla~ory system"
'needs' repa,tr .• 'Tcio, often ,the' rule w~ iters 'h~r~· in Washington, have
such detailed 'lists.! of, dos and don 't~ that the. dos. and. don'ts'
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. I'undermine the 'very,ob'jectives they'seek to achieve, when c;::lear goals
, and' operation for, co6p~ration'wouldw,Or]{ 'better~' Too often"
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( , especial+y smatl :businesse~, face a profusion' of'?verlapp~ng, ant;i,', ~
. 'sometimes conflicting rules'. We 've,·tried te> s'et' up ,an eftective .'
'procedure',here fQr/r~'sdlv.ing. t~ose, contl.icts';,but ,it drives people" "
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crazy .,I,' had s'omebody just, yesterday 1ll~nt.ionbeing :.subj ~ct ,to two
dir'~ctly conflictin9" rules, fromtw6federal agencies.
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~e h~ve t.o ~o'(e, oeyonq ~he': point', wh7 re 'Washington is, ' to .
, ,use the V1.ce, Presadent's phrase, the sort ,of nat1.onalnanny-that can\'
, always 'tel~l. businesses; :, co,nsumersand workers 'not only what to, do, "
but \ exactly' ho,w ' to' deft 'when" and with a' lOO";page 'guideline.' And as
"ha~a.lready b'een'said~ w~ have '~~9unto take~hefits,tst~p~i~ldo'ing
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", YOU:'veheard:ab~~t~h~f<th~ ~C6mptroller of ,the 'Currency
, " has done'" ,,'I can tell you ,one thing: ,When I was out in ,New Hampshire
~n 1992, I. heard more grief :about the regulati,on of theprivatEa
s'ector by, the Comptroller. of 'the, Currency ,than any other. single
thiI'l:g. ',Andnp~everytime' I gO t'o New/England; ithey, say, we're
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making, money, we're 'making" loans, and 'we can function,' ,because we
finally', got somebody down there i!l Washingt"ori who understands how to ,:
haVe ,responsible an?: 'safe banking regulations, a.nd, sti~l pr0mote
,economic grow't;h.' ,I hear 'it 'every time' I· go 'up there" and' I thank
you,,'sir;,.£qr what you,'ve done'on 'tha:t'. '(Applause~' "
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'.: We've gotin'dustry, and ~nviron~entalist~ alike, ",
suppo~:tiI1g Caro~ fB~own~:t:", t~e EPA!s co:n,unon(senseln~tic;ttiveand.our .
proposed overhauls of the Superfund and the safe , drl.nk1.ng' water ,laws
which'I pray; will"pass" in this 'section of 'Congr~s~, ,and r" believe '
"they"will; would increase'both flexibility and 'improve results!or
consumers.
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' We've slashed'the small business 10anfoi:1n; froIn :an inch
'thick, to'·asing~e page'. ,We haven "t had to',wait for legislation
'st;eamline all regul~tioIjs. ,we'veasked,regulatorsandinstructed"
them to use market ·mechaniS?ms, whenev~r 'possible"and' to ,openupth'"e '
regulatory proc'ess ,to more public scrutiny and i'nvolvement. ',' ,,' ,
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\ '\H~S 'has cut,its bl~Ck g~ant, appli'cation 'fo:rm'in l'falf' for
. maternal' arid child heal th,programs . ',EPA is explorJng using
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enforceable contracts instead of, regulati.on 'to' e1.iininat'e potential,
:l:"isk~ ..The: FAA isr~viewing ~ll cif its, rilles.to' identify ~hos~ tl1at
, are, out of, sync with state-:-of-the-art technology' practit:~s.And,
,~here's-n9thing more maddening to a'businessman than~being'told one
t}:ting ',on ,Monday by "OIle 'governmental, agenqy and another't:hing on
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Tu~sday by a . n o t h e r . , 'I'
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, ,Our Labor 'Depart~ent did so:inethi~g,unusu~i about that as '
it elates to regulati'o'ns that ,affect both labor and the environment.,
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:," They talked to EPA befqre issuIng their asbestqs\ rules' -- a stunning
departure' from past 'practices. ,(Laughter,.) So that 'atlea'st' there,
there'are now nocoritradictory instructions .~, " ,
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We ,'re also trying to bri~g common sens;;e' in':otherways
targeting high-risk areas, focusi,ng, for example~' qn ,leadl.'n day care
, ,,' centers than 'aircraft hc;tngars ." W~'remaking school 'lunches mqre ,"
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, nutrit:ious, ' but reducing the fonnsthelqpal, "schools have to fill' out
'to~a:Tify foJ. the program.:" ,,' \
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,To~ay' we' ~e:attempting 'to work, with 'members" of1both
"partiesin.:Congressto flfrther refotln,' regulation., ,Soon the .Congress,
will pass' legislation' so that <Wa$hington won ',t order stat'es to solve
, probl~ms:withoutgiv~ng t1;em: the' res,?urce,std, do 'it. '~e':r'7:working,
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. " to,gether' t9"pass "legi1.sl~t1.on, ,that, ensurEas that regp.lat1.on 1.S
" '~, '. especially .s;en~itive to. the: needsofi ~smal~ busines:s;;es and to reduce "
. paperwork. But we ,must'clearly do ~ore. We must ask, ourselves some
, questions, that are very ,'Very' import:4nt., ',And,I '~an~,to emphasize
,thos'e h~re-:- ,wo~ld'.you' taketpe carl't dow!1?' ~h1.s 1.S why I. asked. all'
Of you here', ""~"no.t· ] us.tto be, betwee,n me and the press,-corps.
(Laughter. t ,,"
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,Today f' thi~is what ,weaJ;:'e now,goipg t'o, dcL, I am'
instructing' all, regulators to' go, over, every 'single, regulation, 'alld qut.,
thosl='J::'egtilcitions which are ,obsol'?te; to ,work to reward, results~' n"ot,
, ,red' tape;',to . get' out of Washingtop 'and'go out into the, country to ' ' , ' "
'create grass;"rpots 'partnerships ,with"the "people who are, s'ubject to'"
these"regulations ,and 't.o 'l1egoti'aterather 'thandic1:ate,wherever"
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We shop.ld ask our'selves:--, let )ne go ,thi"ough,e,aqh, Qne' ,';',
on, the regulations, ,~e shou'ld askourselves: "Do 'we~reallyn~edthis
' i regulation? ,couid private 'businesses do this, just;' as well with ,some "
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"acccmntability,to:us? 'Cquld state,,'or local 'gqvernment do' the j-ob:
", ' ' better, making"federal regulation not, 'necessary?, '
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, , \ '., :i:wa~t to' ~eall y, work through',these things; and I want> ":,
" you;, ali o,f you, :to review alithe,se' regulations, andrg.ake 'a ,~epo:rt' to
me by June~lst" alcmg ,with,anylegisl,~tiverecommendations' you ,need ",;
:to implement ,the; changes 't:hat wquld::be necess?lry ':to reduce the ':
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,reguI'ato::-y' ,burd~n 'ori,t,he'.Ainericari,people ',' Second" I,~ wantev'fry' o~e , ",;'
,of, ypu tochang7 , the: way ,. we m~a~urethe' perfonnal1ce' of your agerc~es
'and, ,t!:le :front-:l;J..ne J::'egu~lators.'
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'I 16ve' the cOnmteilt the Vice, President hact:about people '
'in, custpms'beingevaluated abou::t ,how many' boxes ~hey' detain ~',
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I :believe safety inspections,:'sqould be judged"for."
:example" by how "many 'companies on their watch. comply, not by how/ many
,c.itations' ourregulato:rswrite. We'\oug~ttbbe interested'ih.'(:',
results ,no:t, pr,oces~..' , : '
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Third"Iwant yqu t6':Con:Jene" i~ediati!ly groups
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cc:msistingbf ,the 'front-line, regulators and 'the people a'ffected, by
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the,tr, ,regulations -- no,t' lawyers talldng' to' 'lawyers in washington , , or,
even: 'the, rest o,fUs tal~ing"to each Qther in washington, ,"!:?ut:a"" \:
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:conve~$;,ation that ,~ctually, takes: place arQund the count:'ry i 'at< :our '
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<;:lean-up sites, ':·ourfactoiies and, our (ports. Whel;-e 'thi's ,ha,s been '
'don~; as' we 'saw here, we have seen 'stunning results. ,:,
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',isa:t:,eason, for/'the'se"regulations, for:these'areas ,of, regulatioris~' .
: 'Arid, most' people' would be-. :qlore thall hap,py to, ~work~ to 'find a' 'way' that
would reduce, hassle ,and, still achievet'he publ'ic interest: we $eek, :to
'aChieve.,
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Fourth" IW?lnt, t():move ,from \a:process where'HlWyers, ,
w:ri,te volumes to',one '.wherepeople cteate', pal;'tnership,E! based on, common
"o:bje9tive~ and, co:inmon,s,ense~, ·I, 'want "each' regulatory.'agencYhead .to
submit to the White Hous~' ,a list"of pending p+,ocedures tlit;tt:. 'P?ln 'be
c6nverted., into consensual negotiations.
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By June-' the lS~;T'want' ,to ,know ,where obsolete "regulations :'we can cut""
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',and which, ones,yo~can'tcut witl1o~t ,help from,congtess. "Wee'want a
system 'that 'will ,reward res:ults~not red tape. ;We' want,tb get out of
wasbingtori' and' talkt6 people "who, aredoingihe" regulating, and who,
are being tegulatedonthefront line.; That', is the ,only way we will
ever chang,e, the culture that bothers Ipeople; ',we'could' stay, here from"
now ti::> 'kingdonf come: in this room and we WOUld' never ,get that done. " •
And'"finally, welI').eedto' look, ,for, the aI,"eas ip ,wh~ch, we can honestly'
"p.egq:t:i,~tet-o, produce the desired" results :r:~th~r'~han di'9tate.' .
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'F~nallYI the Vic~'pr~sident has,,'been.' cond~c:t,ing,'a' ,;, '
. ser'idus, ,review of regulation ,in the areas of greatest; C!¢ncern~, In
:the com'fng,jnonths,~, he"will' present to me, a ,series ofrecomme;ndatiqns
,for regulatory' ,reform on thec:environment, 'o'n heal~h, ,on f09 d ',,on" '.
financicil ,institutions,' on ,worker, safety. : 'And when appropriate and " ','.
,ne,cessa'l:-Y, ,r' w'ill" pre,sentthem ':to, the 'Cqhgress.~ .' , " " , 'Y'
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This' is what, we are going to do
And'it is. high ,time.
But' ,let 'me' also 'emphas'i:z;e what we ar~ ~ot gqing to· do. We have to ,
-'recognize that, done, right, regulatidn gives o~r: ,children .sa'fer· toys:,'
and 'food; protects. our', workers 'from' Ifnj ury i 'protects' famil ies' from
pollutIon;' and that whEm,we fai'll' it can have idisastrous, . '
conseCI1lences
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,The American economy~isithe envy of the world, inpa!t
because of the public hea.lth protect~cms, put ,in, place over the last
", 3 0 years. ,Toxic emissions by 'factorl~es have dropped by more ,than' 50, _
, percent,' and, lead levels' in childrenj'js blood have dropped by 170 ,
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,percent in' three d~cades. Lake, Erie'l once declared dead, is now' ,,-,
teeming w~th f~sh; 1,12., 000 people .' sunvivedcar crashes(b,ecau~e of
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auto, sa,fE:.ty rules; workplace deaths are down ,by 5,0 percent Sl.nce PSHA
was created •. Our ,food', is' safer:, and t.ie know its ,true nutriti,onal
c~,nt~en~' ~ec~use, th~':gov~inmeI1:t sto,odlluP"for p~blic in~~rests.
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littieconsumer frauc:ii 'toys 'are not, ~oosaf~;.tQe}environment is'
still notable ,to protect,its~lf. '. Sbme 'would ,use ,the need for'reform
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as a pretext tq'guy vl.tal consumer, worker,,' env1ronmental
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protections; even.things ,that' pro~ecR ':bus iness ' i tse,l f ~They don i t, :
wart reform; they ~eallyw:~n~ rig~r no~t~s~' .
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,Some 1n,Congress, are, pushl.nga' collec,tl.on of propo~als.
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. 'that, taken together;wouldbr1ngfeAeral protect10n, of public, health
'and safety to a halt. Laterthis'.week the House will vote Ion. an,
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across;":th~":,,board freeze ori, a.11 fededh re'gulations . I t ,sounds' good;.
, 'But this s'tops in itstra'cJcs,federa'lj action .that protects' the, ,,', . "
'env~:t'!onmen1:., proteqts:,consumers',' ,and 'protect's ;'workers.For example, _~
it,would ~top the government froI\1 all1.!ocating,rights to, cOlllli'lercial
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fisherm~n. \ 'One .-- a person:who' S wO~k:ed with those fO,lk!5 in
:Louisiana'i,s here,-t6day. ,It would stop ,the government from
authorizing,burials ~at Ar.1ingtonCem~tery., Itwouid stop ,good
regulat~ons, 'l?ad regulations., 'in-l;>et~eenregulati(:ms , a l l " ,
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regulatl.ons., "No ,judgment -- sounds good,. but ,no Judgment. It would
even ,pancelthe duckhunting,season.,H (Laughter.:>. That>gives me so*e,
hop~ that, it Will n'ot"prevail. " (Laug;hter.) ::, I':'
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" , I t wou:ld, stop' newprcrtectio,nfrom qeadly bact'eria in ,our
cirinking: water;. stop' safer: meat, andp.o\ll try; stop safer pars;' stQP ,
'final' implem7n.tati<;m' of, the law thatllle~s' pal:'ents, take a ~eave to ,
care for ~ Sl.ck ,ch1ld. . It wquld'underm1ne what we ':reti::'yl.ng to do to
, promotesa:fety,~nco~uter airlines ~'II If "a moratorium takes; ,effect~' ,
all these benefl.ts .wl.Il, be'on .holdf9r, ,the foreseeable future.'
Therefor~.'t~,me, ,amor~toriu~is ,non, ~cce~ta~le:, '"
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, I agree with the Republ1i.Jcans in Congress on' nianythings.
'We do need:;to change ~his sys1:em.:' 'W~ have, ,beenw6.rking, for two, years
to. change: 1t',and.beI1eve you me, 1 ' , ,we've,got a long way to, go . ,
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But, there is a right w~y to' dolt- and a ·'wrong w,ayto do it,. ,We can ' ..,
agree ;onma~y. things,' but:! am conYincedthat' a m<?ratoritil'O:wouJ¢l,h~rt
the, broad interests of the American' p'eople 'andwoulc:i bene,fit only'."
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cer~ai~ narrC?w. in~erest~,wh~" '. iI) thelimc:>ment, thinktJ;ey would bE?
~nde~1neci ,by hav1ng ,th1sor ,tha1;.par.t~cular regulat10n palSs.' :
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regulat1.Qni to" ,do the four .th1ngs that I ,have ,outI1ned;,not,to put
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these ,thJ;,ngs' on:,hold ; but: : to, put these. th1ngSl.n h1gh- gear. :That 1S.
the right way" to .do this~ :Istillbelleve 'that, .workingtogether '
with Congress, we can, achieve real ,and balanced regulatory',reform.
But weshouldn' tgo too far . ' .' For example,. we want' all agencies to.
c'arefully. compare the,costCarld' benefits of, ,regulations so,"that ,we', '
\ don't impo~e. any unnecessary: burdens6n,busine,ss~
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But '.tbe Contractl W1,th Amer1ca, ,11terally read, could
pile 'so many<new requirements? 'on, g"vermnentthat npthing ;would', ever
,get dQne. .It yiould add· to the very· things that "people' 'haveb,een
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, compl~i,~i!lg~ about for ,years -:"t06, many iawf;niits ,everything 'winds up' (
, in ciou:t;t .• ,The ,Contract, literally read" would override'everys'ingle,
health andsafet~'l:c;H,.,t ,on the book~,dii:storttheprocess' by, giving, ) ,. ,
. indu5b:y-paidscrentists undue, influeI),ce over rules 'that' govern ,their,
emploY,ers in the 'hameof.,priv~te property, could liteJ;allybust th~" ,<
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budge~ bYrequl.rl.I)gthe, government :to pay"polluters ,every :tl.me' an
erivironm~nta:l law puts' limits/on ,profits. '. ",' ,.'
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,,',"Thes~,ar~ ;~,xt~emeproposals.'.'.T:p.ey;,go:.too",far~, ",' Th~y'"
~lives arid dollars. ,A IsmaIl ,.army~f special 'inte~est
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khows they cq,n' nev'er 'getaway 'with. an ',outright: repeal of '
, qons,umer, ,oJ; , environmental ' protection. , But, why,' l:>other, i fyou can
paralyze the' gover.hment by process'? c Surely:, after years,and,'YeCirs
, , and years ,of people, screaming about, exce$siyegoy~rnment~'l pro'cess, , '
, ' we ,'won't just, 'go toap. even' bigger round:' of process tot;il t, the,'" ,(
, process i·tself' in, anqther direction. We' canhot,stiipaway,safeguards
for 'families in 'this country ; . " :
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Here'in ,ohr ~audience j::,oday,arere'al,peopleo~ Whose':
or We might :haveacted.' There's a: father ,in'thi?i'
,." audience whC)seson died from' E~, coli :bacteria, ahd , fQod that' might
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, "", have been discovered .if our prpposedrule ,had been. in, effect' when his,
','son' 'atethe' bontaminate<ifood.,' There are people her,e :whose lives "
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" we're savei:1 b~( air bags .: 'Let' s;riot 'fOrget" these.' peop~e as, we cut red.
t'ape and bureauc::racy . 'There',s a' woman here whose a breast , ,ca,l').cer
s,urvi VOl?' :who' lost' .a, chilq to cancer I who 1 i ves ,iri an area u:r:lUsuall:y
'high in, the de,nsity of people who suffer','from ca!,lc,er. !Jet's not
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forget, the ,kind of work ,that . still 'needs to.bedon~~
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, government., has always had to, cha~ge to'meet the needs, of changi,ng'
tim~s.~, And we ne'eel t,o change,po-w;'..' We need'a ,g'overnment that's'",
smalJer and'more entrepreneurial, ,that, pr,ovldesa, Ipt. less hassle, ·
that realizes' t:hat there are,an a~ful: lot 'of',people 'put/therein the
priv.ate'sector who have enlightened',v:i.:ews' and ,-,they wa:nt' to.. do the' ' , """
. right:: thing,,' and' they, need' to be' helped inste.ad of hindered' in t~at.! ; \'
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I" would never defend th~ culture 'of this coItununity' when '
"itis'wrong:':13uti~t"us also not forget thatas'w,e strive for 'a " ,', . '
government, that, iSi costing l'ess' and less and, is' more flexible l that
is'prodticing1;>etter :restilts and"not more rU,les,l ,'that, we, have a', job :to
db 'for. the American people, and'that:,peopleare,entitlf!d,to
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,". 'protection ~ , So ,',I echo ~gain ,what the. Vice l President' said earlier:,
, Reform" yes,. ", Bring. '~tori.: Roll back, 'no~~here'is toom~ch'good :to
'do to turn',this noble'enterpriseinto something-that w~ would: ,live to '
regJ;et .. ,'Le.t.'. us inste~dwork,~o
what' must be'done. '
do'
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THE WHITE' ,~OUSE
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Office of the ,:i?resssecretary ,
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'Forlmmediate~Release
, 'February 21 ,
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PRESS ,BRI'EFr'NG
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SALLY KATZEN,' ADMINISTRATOR FOR OFFICE OF
'" INFORMATION, AND REGULATORY ."FFAIRS ,IN, '
, qFFICE OF MANAGEMENT AND: BUDGET" AND ,
ELAINE KMARCK, SENIOR. POLICY ADVISOR TO ,THE VICE' ,PRESIDENT
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The ~riefing,Room
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. ' . , MR. MC9'£!RRY:." ,Goc;>d' afternoon,' laqi~s' a~d, g~ntlemen. ,',
'Be;Eore,' ~. start, my da,~ly br~ef~ng here at the,' WhJ:te ,House, -I wanted to
make' two, people' ~vailable to do some 'follow-up,questiqns on, ,the event
that, th~ presidei)t and the Vice ?res,iderit\ 'j ust; held ':6n reinventing' ,
'regulation. ' , , '
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most of, you know, Ela~ne ,Kamarck" who ~s', 'the ,
SeniorAdvis~r to the Vice, Pr!=sident;' ana, Sally Ki:rt:zen, the
Administrator in the O.f,fice'pf Information'and'Regulatory Affairs at
OMB. They're both; here; they, don't h?ve opening stat~meritsbecause<
tpeY'fjustthought they 'dtake any: follow-up, questio~s yq),l might have
: b~sed on the ,event.
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S'O I':llt),lrn' ,it over "to Sally ,'and, Elaine. '
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'a freeze on
'Wil1:the'president'veto,:legl.slation that:w~uld put
regulations? "
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'MS. KATZEN:' I think, he Isaidquite clearly this morning'
tl'iatthecurrent. form is uriacceptable'~, " , ",
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,MS • KATZEN:: It' sa'littie :early ,in th~' legislative
process., ' We ',ve" j~st had it marked up by conuil.ittee'and ,it's cqming to
'the House floor~ ':Butin its current form it's not acceptable. ", '
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Thepresident'sa±d that ,the 'Vice; President
doing'~ serious review, pf, envt:ronm~ntal andwor~er safety:' rules,
particularly OSHA 'a,n~,EPA'~~at ,does ,that inean? ,"
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" ,'MS ~:\ KAMARCK: ,It' means that we -are, gO;l:pg through a,
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process t.hat involves, staff, from Sally Katzenis office -- 'it involves
'extensiv,e cons1.l1tations with, people, in ,the agencies. We are' l;>ringing
them ihto the White House to" develop', reform packages for, each of '
!"the'se big areas 'of' requlat'oryreform. A.l!-dth:e ·goalof those reform
packages is very ,similar to the' goal of the ov~rallJllatiorial " "
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'Performance Review, which is tQ$t,re~mline regulatiqns, creat~ a
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govern:me~t;,:tha:t works :bette'r and costs less., ' , '
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MS .. ~CK:' Some of ~t w~ll be 'leg~slat~on. Aga~ni it
depends 'on ,what is needed, to do the-job. I ' Some of itwil:l, 1;>e '
legislative packages;' "other 'th:,ings we'll be able, todo·throligh' ou+"
own powers, through administrative powers. ,:And one' of ,the thingsydu
'will note, the ,President di-rected .,the regulatory,ag'encies today 'to, '
'" in fact, ,change ,the way th~y do e~:forcem~nt. And ',this, is something
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that ,has, been ~n,a,90up1.e places., We, know that they can do th~s~
:'This, is within their own po't<[er to make these' kinds, of culture, changes
within 'the" agencies. '
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enforcement?'
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MS'. 'KAMARCK: ',Well, :one of the things' that ,'Lynn Gordon' ,
did fn Miami was' begin' t.o bring in the business 'community -- that~ 'it '
was affected by' her regulatory activities in the Miami Port ,--.talk
to them'ab6uthow to better enforce th~ law, :p.ow to catch more drugs
c oming' in, which they are doiri'g, and hqw ,to' streamline 'the process
',' using 'newtechnol'c>gy, ?ind basically developing 'a dialogue 'between the
'pe'qple 'who 'are doing the regulating and the people· who' -- ' t;he '
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customers', ,the businessmen, out there, who have ,to' il'lteractwit,p :the
regulatory ,system •. ' '" ':", ' . ,':, ,.-," . . , . '
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'Q:El~'ine, could"you re:E:t:'esh' my memory,
,1?-~S:ithe
regulatory', agencies
President
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' MS .. KAMARCK:- , None.
"' "pe has" el,imip<:,-ted any.
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I don~t think,--: he didn't, say that
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one every,year; nobody noticed. '
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MS. KAMARCK:' Right, he, ';said that abo~t when he' was
He- did not say tl;iat abciut 'W'heri he was President .. ' .
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A:r;e there':any'regulatory agencies that, should' be
eliminated, ,or are al.lo~th,em'do,ing w6rthw~ile' things?,
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,MS. KAMARCK: This budget calls for' the eiiniination of:
the Interstate Commerce commission,the ICC.
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,MS. 'KAMARCK: That's the 'one 'i'nthis ]:'U9-get'.' I :don' t
know'if there 's,any" other, ones., qan you'"think' of· . 'any at, OMB?"
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:~ MS ~ KATZEN: Th~rearen It any elilJ\inations. , There's a"
, lot of streaml ining and some consolida~icms ~ ,wpich were fully briefed'
during the budget season. ' And} p,art 'of the process of the r~v'iew is
'to, see on a sector, by' sector basis ,.rather thap an., ag,ency by agency
'basis, _to ,'see' whEather ,further'.c6~~0Iidation streamlining is' ,
appropriate.
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issued. his regulat'ory, order, ,it. also' included, a 'directive' about
negoti~te¢l rulemaking. , How is' what ;the' Pre~ident talked, about here
"today al1dth,e ins,truction~ he' gave different.l"ll yo\?-r mind than what
'he di<;l .in september? , ,
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, MS. ~TZEN.: . They bl,lild"on:what was happening them.-,,',
When they g'aye some' of'the examples today,: :what Gene 'Ludwig .has d~ne"
at the OCC, what the Department: of Commerce has done il).rewriting
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, ' export" regu:lations -~ those were :all undertaken pursuant t'o the
, original execut.ive order., ,And at' the end 'oft1::le ·first y~ar ,we
though:t, ,that we would 'do' it, --,' ,we' d'id an. analysis to determ:L,ne, how we ,
were faring 'and thought ~e,had,achieveda lot oiprogress, but we
wanted
up the' ,ante; ,we wanted <to 'take g' dramatic step ~o:r;ward.
, And that was, the Vice p;-~sident' Sl effort~ ,wi:th the' review of' s.~ctor by
,sector 'basis; ancl.'. the President, here giving a firm dead"line and·
:underscoringth~ ,significance of this' so' that all 'agencies wi.llbe
',C!-ble- to ' fcidU~ ,in this 'way'.'
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MS,.KAMARCK:Thereis now,a firm deadline ,and ,it is
comb'ined' ,with a, White House-led, sector-by-sector r~view, which will
, resu+. t., in big reform ef~orts: in 'each of these ar,eas. "
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MS. 'KAMARci<:' Basic~liy,., the', same 'time,f~ame.i some, of, it
may a,,?tuflily be earl:i~er ,than June '1st.
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Hill rigpt now ,'would, you be uP ,here toda:ymfl~:dng: these" '
ann,ouncements?
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MS .. ',KATZE~: Yes~:'At":the"erid"Of th~' firstt year~
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septembe,r 30,'1994', 'we,.did an 'evaluation 'of the first' year,~s efforts;
and cqncluded. that'therewe're some additional things :we wanted, to do~
as the Presiden~ saidquitecle'arly. ',We' have 'mad~ progress)'''th!9re'~s'
a, lot more that we need to do~ Ahd ,we set these' in motion' well "" 1
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initiatives' are being, an.nounced \the we~k ,that theHou~e ~-,'
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,MS.' KATZ'EN:,' The reinventing, goverhment-,portion '-- \~nd',I '
, should ~et Elairie, speak to this-",:, has had sor.t ofasecond phase,'
, and the regulator¥, piece of, it, was pHlced,' in' there becausewe'thoug'ht,
,,'i~, would ,be ,most "effiqient and most effective 'to bring our offices,
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togethe:r:i our, work, to'gether, to 'achieve ~hat'wehavEa ,been, striving to -" ,
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MS.' KAMARCK: , I bel'±eve ,that the 'President .. announced the
regulatory reform ,as a"pie'ce of the 'second phase', of reinventing, " ,
, 'government iJ}'Dec~mb~r, w.hen' h~qrinouncedthe:,second 'phase' of
'~reinventing gqvernment.:' It did',not geta-' lotofpublicl.tybe'cause at
that PCl;lnt'w~ were dealing with the first" five agencies. But"'we'-,,:,, I
,think 'it, was" announced then, ' and we have actually' conducting the, '
review, fO'rseveral months now. -~ " ',',,' ,"
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Could -you walk -'through',the "sectors' that the' ,Vice,
President and 'you are"analyzing", give' :us a( list . Of, the' industries?'
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" MS., ~KAMARC:K:', .we have already ha~" an extensive' review on
, some "of the things you heard today; which i.s the ?lctual' enforoement ' " ,
of ,regulations' and' what happens on',the, ground' ,and 'what happens' in
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'the~e age!l~ies~ , Thc;.t was., ~n ,fc;tcti'our first' 'm7eting.,~ We have,' \
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revJ.ewed w~th the V~C~ p~es~dept,andarepreparJ.ng paper ,on a set of
changes to ,the environmental. PJ::'pt~ction ,sector.~ ,This afte,rnoon we
will "have ~ ,'meeting dealing 'with 'Foodan,c:i Drug,Adnlinistrat'ionand'
hear ,for i the firs:t' time\ sc;>me reform propbsa:l-s de'aling' 'WitQ, ,the, FDA.
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Last week"'.! ithipk ~t ,wa~~ Sally"" we dea;t't ".lith,
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financial institutions,,'W~ hea:r;dseveral ,proposals brdught forward
by an int~eragency team consisting 'of" Treasury ,CEA, acc, a'nd ',others
',dealing w,ith 'reform, ,at, financial institutions. ',' That package. is going,
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,MS. :KATZEN: Wel'l,;, 'next week will,' be' 'foods~fe'ty is what
we're 'scheduled t.o begin discussipg.We,'re 'also ,looking" at Labor/'
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" : schedul:ed- in a,' process that' involves large interagency, team's. 'They "
~eport~' to'" the, V:j.ce president.
:He ,makes ,a ,:seriesofkind of dec-isions"
pased,:on ,options ,presented to him. We 'go back,:refine, those more,
:, " and we', 1:1 start bringing :the~. tb:~he Preside,ntshortl¥.
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, Q ' ,what' were't'llose two dangerous industries in,'Maine
, ',that' OSHA ~snowworki~9' with? '
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MS~!KAMARCK: 'ActuailY, I don',tknow~" That's a':good
quest'ion. I' don 'tknow offhand,; , If' you want 'toeall, Joe Deere, ~ver' \.'
at OSHA, ,he will ,know; because this 'has been one ,of- th'edr,' reform, ,
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Is cost benefit one ,of' the, markers today, as it ,is'/
" ,\.;:ith' 'RepublicanSi' 01;" is 'ft,'mainly red ):a~e anci tightening up?, '
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, ,MS. KATZEN:!'; 'cost' be~efit'and r'isk anayysis .is' part.;Of,'
the original executive order.,' It ',s ,spmeth~ngthatwe ddevery 'single,
day'. ' ,And't 1:hink what the President 'wC,1$ saying 'is; whcile ,he ,believes
that agencies should ,use good"data, good ana,lysis and tb:ink ab'out the
consequencesoftpeir, actiQn;;' i1:.' s appropriate ',to consider when you,
, , ,do it'., , It 'i6n '"t appropriate in ,every single, solitary ,instance., And
what the Republicans 'have done with the bills that have 'been reported
,out; so far "is to have very , very broad;.' verY, "very prescriptive.. And'
so ,it's in that' seps,ethat the curren't versions, are not •appropriate
, t6the occ~sion. But 'we stand by, our .c;:ommitment to regulate','
'sensibly ,toregulate'with consideration of cost, arid, benefits,. We,
don' tdiffe~,' on the underlying ,philosop,hy ",'
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Can you, really' 'regulate co$t benefit', against
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humanity, aga,inst .safety, a,nd ~he~l th?',
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MS. ' KATZEN:' Qne, of the Qoncerns hasl alwaY$ been that
the costs are more easily quantified than the, benefits ,because how do
, " you put 'a dollar value OI) life. The' way we have been working it 'is
': in terms of quantitative and qualitative facto:r::s, 'and you can"
consider'how,they' would be framed one against the'other. That is one
, of the problems' tli~t J;ias, been raised :abou,tthe 'contract w,ith America'
in th'atit s,eeksto,make it very, precise,' very quantified and, lead to ,
distortions in;, the, pl;"ocess .
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'.... reCiding of the Contract' that' it wouid,' in terms of, risks ' and' cost
" bene'fit, ,supercede any existing requiremen:t,' or' existing• law,?
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MS:, KATZEN: "Yes.' If youlook',at the bills that were
reported' out by Cqmmerce and by ,Science' and are,:comingto the ,'fioor
.. next ,week,' marking ,up, Title '3 of H.~R. '9 i' which ,l,s one of, t-heir ,
highlights" it says in>13'line5 Qf text that if ,there's anything in
" here that disagrees with any existing ,'law',· ~l:lis takes, precedence;
this supercedes existing law. And ,what the "this" ,is, 'is pure cost'
, Ib,~:mefit analysis, so that, where' the cQurtshave ,'said you ca;nnot ' , "
" consider costs,: thQse are ,gone;' where the Congress,itsel'f, has said'
:1' technology';'based, ,those would be superceded~ 'And' one'Ofth,e 'p~obleins,
"that we have is, ,we don't 'know' what the 'effect will be. All we know
,is that anything ,that;' s inconsistent',with this WOUld, be' superceded,
jmd that ;seems a,little 'bit'odd way, of governi,ng. , , . " , ' "
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, . , , ' MS,. KAMARCK: 'see,' because, the' regu'latory, agencies ate,
usually, within Cabinet' agencie's',and' s,o'weh,ave togoactual'ly :,look
atth~ -'''/~ mea:p, we ,have it in\ t.hebroad', brush.
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Q, ' ,Have', the budgets' for f~cie~al regulations' since
Clint'ontook'officEj! 'gone up' or, gone'qo~ni 'and'thenuItlber,6r personnel'
involved in ,federal regulations been' increased 'or decreased over the'
past: two', years?
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,MS ~ KATZEN: ,l'm not sure that there is a direct tie, I
b~tween government 'r~d t~pe' ap9.:dol1 ars'sp~nt ,for ,the agencies.' The",
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, Department' of, Commerce, l's spending, dollars' to ~:edu~e r~d, tap~,~ ,It '
does not com'e, cost'-free to de;-e'gulate. It does, not come cost-free to
streamlfne~_ It takes the'same ,effort of a notice of proposed rule
; making and get the-:co~ehts",and-revi~w.th~ comment~and ,then strip
'" those regs from the, cFR, . from,the' ,Code of Federal, Regulations., And,
'so 'to measUre it in terms' qf dollars', spent by the ;regul,atory agencies
without knowing th~, product would not be prQdtictive.
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',Is there' any way the, moratorium could' ,b,e modified
to make it: acceptable, to the ,administration?,
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' ,-MS. ~CK:, ' Sally, YOll had better ,ta~e-- any way
moratorium can be modified to make it acceptable.
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MS. KATZ'EN: I testified ~bC;;ut a number of problefTls 'that
we'had with themoratdrium legisla_tion, and that was bef,orethe,
markup. ,And verfr fi?w, if ariy, of, those~, were paid attenti'on to :,during
the rmarkup,.-'and '\I' know the,-Demqcratic.' congr~ssmen rai;;eci a"series of'
, problems that they' ha«l, and those, ,were not/responded 1;0., '. 'And', I, think
'that' w,ould. give ,'yo-q ~ -good menu "of what' our '·pr9blems. are.
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Would any:klnd of timeout,' in going -forward, with
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,MS. "KATZEN: ,wh,at' s ' us'efuL is, the actual attempt by"""
" every r~gulatory' agency ,wn,ic1i wa,s' ordered, 'today by th~ President t.o
-actual;J.y' go'through ano. str,eamlihe their regulations.' 'Everything'
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else is' 'a gimI'liick of, one sort or' 'another ,okay? 'A timeout, , a ,
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: 'moratorium,' those, ~regimmicks • We' re, proposing' actual -change in the
regulatory'agenciE!s and culture of the government. ,And so everything
~lse is, 'kindpf gi~ickry' as ~ar ?is we' re co~cerne'd'''' ,
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I just, wanted to ask, ~::..; the' timing 'of this',
,'notwithstanding , , ,ahd 'you:rdetermina:t~on ,to ,,~~~ matter what happens ,
\ ' you're, presumably, 'not ,disappointeo. ~o' 'j:)e ,Ul? here", today, contrasting
'your appr9ach to ,this with what ',s, going 'on, up tp.ere, right,? ,'That's' ,
parto! 'the, point, of : this exercise and' ,why' you do' 'i't today as opposed"
·,to,'any' "other" day".
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: ,MS. ~CK,:/: Well, 'i-tl,s like';"'-' the, answer to that '{s
the same" answer I would give to the, brp?lder effort to, reinvent
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governmerit'.. ,They, talk, a lot C3;bout it". ; We deliv:er. They ~alk~d.) " "
about reducl.ngthe' federal ,work ,force. They've talked'about,makl.ng,
, the': agencies ,smaller. 'We did ,i,t. , They',talked about clianging the way
the' 'gove,rnment :relatcas \to'people so' that they treat people li,ke:";,'
customers'-We have done it. " And we' believe that we can'do, it in, the
rein~enting "regul~t'iqh
an:dth~t,.inf~ct,o,urapl?+oac.h 'is' going:"
to ,be better,and'mdre' r,eal,than agl.mm'l.ck: 11.ke ,moratOl:';LUm qr any of
th~ other thin,gs, theylve been,talking about.
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",The 'morator,ium.
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',MS ~ ,KATZ;EN: It's' s'upposed' to cOfu'e ~o"th~' Hciuse,fioor, and
',I, thin'k ,if youcourit~-, if the RepublicanslJ,oldranks as they have:· '
, been ~ the'y will have' enough votes,' t,o ,pass ,it 'from the House, and, th~n
,we will lo'qk at· the Senate, see· ~llat ,~appe~s t~e~e. '
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If Tqm'DeLay ~r MCI~tosh,or: Nidkles'were here,
they 'would say that, some:of the examples that you're using for the
morp.torium' would,'in fact; 'be~exempt'ed uno.ertheway that the.' bill, is
structured" both in the, House and th~ 'senate.. ' Are', you ,'complail1ing
about wlJ,at ,it would'q.o to ,$afety and hea:lth,' or about the oherous
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layer of ,rigillarole'that yoti would have' togo. through to"ex~mpt this
stuff?, 'Because, in ,fact, trade or' safety ~Qd health,st:uff would,be
.'ex'e-;npted.
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:MS. KATZEN:" NOW, If you look ~at the language, what ' they
say ,is not, qovered;' does not: square with the' language as w:ritten" and
~ we have 'raised a number' of issues on the, trade 'issue.
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"implement ii of':trade agreement, ',dissensi,ons' against.. the ,Chinese -..,
this is all 'in your press ',paCket' here -:- t:hesanctions 'again's,t the
'. Chinese 'are ncit' implementing. a tr~de' agr_eement, and tr'ade .is· separate
'. from foreign affairs .. 'They sald'that ~he duck hu.ritingseason ,isn't~· ,
· covered," because ,it's, a lIcense.' Licenses ,are individual "
applications, not,a~l.l').d ofablahket prqposal. .TheY say,: weil it~s
· elimina~ing,'s6Ine restrictions;. but there 'are bad ,limits. ,They have'
writ~en this,very, yery' carefully, and I'm sort of responding in ,some.
· sense' as a ,lawyer, but when I sEae a statute that· congress, has passed ,
,when we' have I,said there are problems with ·the language and they stick'
with. the lang\lage~then 'I h~:t'v;eto questic:m whether' or not their'.
intentions are as .'theystate tllem.,"
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effe6t~,velyto' cover ,the
the' exemption.s
,you' wQuidnqt be 'able to use
examples you '~e used/~
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It re-quires an' agency determination, it 'requires .,.
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'coricurrence .from .someone outside· the agency, and jUdicial review is . .
available •. : , S,O ,Whatever ,it, is' .that I say -- .and I I mnot worried by
" the extra 'paperwork that I have'{;o go',through-- Whatever. I"say will
be litigated,,'ln the'federaldistrict, courts,' and we will have ;'bigger
· overnment,' more government, more' bureal,lcracy rather· than, less'. \. It's
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counterpJ;oduc;:tive~ . As Elainesaidi, ,we should be looking at the
underlying problems, .resolve what's 'wrong, with the system as 'i~ ,
cexists" and get ,to' that rather than be . 'faced 'with.a .digress',ion, and'
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onthe,'duck'hllntingissue, which i's:/close, to the
Preside'nt's heart, why not let states regulate duck hunting? 'What' .'
're,lce dO.es, the fed'eral government have in duck hunting?
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MS.-, KATZEN:
In'part; the ,federal governmcent h~s a role
"through statute induckhunting:in'whichyo~ don't want.to have'
states ' competing, ,and this is' congressional det,erminations that'
govern. ' . In many of 'these areas .:.- ,inai.lofthese, areas acro~s the
· board, . there ,maybe legitimate questions. of what the federal,
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government is ,doing in ,this. area, . and' is it· doing it right,. Th,ose are
, the questions..,we ,are asking in the reinven:tion phase. We are not
'. "'"taking"·~,s a given. We: have to be,there, and we have,to do' it ,this
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O~ay. '. Can I . fo~'low up on that? You •fe ask.lngthe'
regulatqrf; themselves of the various agencies to go through and make
theirowh~ecommen9.ations . . But:can, yoti 'honestly expect peopl:e to:
, decide if they have no more jobs, that t~ey have no more'- .
re'sponsibrlitie~? ". Why are you' askingpeQple who ~ave a' ,vested
interest in this to make their own ,recommendations?
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KATZEN: . Because we 've' seen ij: happen~ I mean,., '
peoplema,dethe same'commen,t when we' asked the first 'fiveagenciesto
rad~cally reinver;:t the wayther. ~o bus,iness" and ,can w~· rea,ily.:ex;pect,
'Cab1net'secretar1es to.come upwl.th plans ,that would. cut 4,400: people
6u:t 'ofto'eir. work force? 'Well,' 'the a,nswer to that' is, yes;' Henry': ' '\
Cisneros: did it." ;
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We, have'fbu~d all "along' the''.waythatwhen ,you put ,an ..' ,
agencyorithe'spot~, 'you, give a very clear presidential directive,. and
then we follow up witpit', vigo~,ouslY',from the· Whi:te Haus,;:, which' is ,
what. the ,National' Performanc~.Reviewdoes, what happens 1.S you, do get
the' v.erY best' t:tJ,irigs coming out of· thee agency on the table."
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B~l'ieve~e, nobody is go~ng 'to, want", to show up in, th~
. - Oval"OI'fice on June I and s'ay, '~orry~ Mr~ President~ we looked," "
, through everythi,ng" we had ,and,'we ,couldn't' find a~ything ob~olete' and
we couldn't, .find anything: that the states can·do'better. 'In fact, ,we
'"kri'ow that' the,dynami'dis quite different,' that people will take a"
go()d, ,soli~dlook,at, it.
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MS., KAMARCK:, .Indeed, i+ :,I:.can- add ,tb" that', .'the .,
to, do precis,elyth,at' beca:use as ,the
'.' goverpment' iS,getting ~~alle,r,. yoU: !lave:'to use our ,res;-purces w,isely.·
And why'enforce'someth~ngthat doesn't make sense? Why p'l:lrsue .
'.;regulations which, in your oWrthea:.;-t of hearts', "you know is not"
'productiY,e? ' 'And that f swhat .we're seeing. i l1' :all' oiour. sessions,
. w here agencies are coming Ato the table, and the table is surroupded'
by other White' House' policY.groups who, are knowledgeable. about the'
areas. 'And ~we have .. seen :a ,very:, go,oddiscussion at these issues.',':
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: can I follow up ,on 'that?
Just as no Cabinet, ,
sec;::retarY,recommeI:J,deq. shutting dqwn his 'or "her, ,ciepartment, you, don't:
realistically ~xpec:::t ~any, kind' of a regulatory ag¢ilcy ':to' reco~end, .
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Because' the~e, regulatory agencies, generally -db. 'things that hav~, wide. ",
. cceptance' in the American .pUblic.' 'J:'hey protect things that pe'Ople " .
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care about • ·So 1, don't' think'that is nearly the issue. ; It~ s kind of
a false issue when the, issue is, in fact, how can we do the public
purposes for wh~ch' these were est'abl~shed ~n an eff~c~ent, "
streamlined and c'ost~effective waY?,I,think that if people' suddenly
, decide. in America'and ,they ,send a message loud and strong: that· they
don't:·. want their. cars being. safe': well, thEm maybe you, 9an; 'think
'abou~' it. "But ,they're not doing that t , ' okay'. ' They simply are not·/'
doing th~t 'and; 'therefore ~ I think thp,t' skindof 'riot really ,what;' is .
,at issue J:fere.
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list 'of r~gulations that's,i4entified'as
,'obsolete comes forward· i,n' .;rune, what wi;LI be the 'process then?'" W~ll
, it' be made sUbject to pub,lic:, review? will ,there' be a public comment'
period?'
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MS ;KAMARCK:, Any'regulati<;m whi9h is i;ri the qode of
federal'regulationshas to' 1:>e r.em9ved the. same' way i,t gets on the '.
books. And that .,means' a. notice of, prop'osed "ruiemaking comment' 'and
fi,nal.,action.· And ,'the cO\lrts havebee.nquit,ecle.azo; that. ypu h.~ve'to
go. through 'every single, solitary step in deleting as .you do and','
a<:idirig. We ,w'ant to get, that, started ,~ooner rath~rthan, later" like
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Whe're "they are, predicated 'on. statutes or whe~e they're
, "mahdated by statutes ".'we' re 'prepar,ed to go to the congressang, say,'.
help, us fix this.
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Q , I on,thl:~' page:"'by;...page 'r~vie~" haven I t regulatory
, 'agencies been, doing this 'ariyway,. and "withthis 'June, 1, deadline; do
, you expe.ct them to have , to p\lll people .of.f 'of more important things'
to go' dothi,s review" 'if. they haven '.t bee,n. , . \
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, MS. KAMARCK:' ,We don't think, there is anything -,~ trhere
are very· few things, that are as important",for particularly the
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'.:bureaucrats in washingto~ ,as9Pposed to the p'eople ,out i~ ,the 'field·
'. who do' the' enforcement~than actually conducting' this review. If you ' .
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.want a good exampl.~ 'of.how one agency profited from 'this,~revie~, you
.¢>ught to call .:rea,n Lu<;1wig at the; Of,f'ice of 'the, CO,mp"troller. 'of the
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, , Currency. . They actual1yd,idthis ~eview.'.
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,We did this review, wh'en we ,sunset,ted ' the 'F,ederal, '
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Personnel ManuaL' . Ittooktw,O months. 'The 'MPR 'origi,nally gaveOPMa')'
year' to do ',it; , they' actual;Ly got.1t, dorie in two months- with the r.iglit
committee'the ,right structure can be done", we've 'seen' it .
and .
.. So, it
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d'one before. "We"re now:,g-oing, to insist' that absolutely everyone go
th:rough . thi~ exereise ~ , . '
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Sq haven 't" like, th~' Federalco~unications or'the
SEC or groups like 'that don~,this .kind'of review all ,along'the way?'"
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Some:, have, some'h?lven't. ;
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KAMARCK:
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Who has? 'Wh~ h~S , already, done' the review? '
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MS. • I<AMARCK:\ ',we:m.entidn~d todayocc and. the /Department'
,of ,Commerce, the, FAA,', HHS-"; parts of HHS, have 'done, this; and ,in'
,
" different agencies" there are p'ockets ,where :;.,- and 'very large, pockets'
where"th.ey:have been' doing this. J:sut, remember, not all regti.lati,oh,; ,
is: bad, q,nd ,it, in fact, is not' inherently bad. -'Sometimes i,t':s hoW'
\. it's w'7itten, sometil,ltE?!Sit"s 'l;ow' it,'s, enfo:r:ced that is, ~\he-~estion. :'
, But .you, do -- you do' /,end up, wJ.:th serv1ng .valuable, funct10ns 1n , I
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providing' 'cleaner' air and- cleaner water and sa~er workplaces, and" .
'these' are. important values that we' carinot ligh~ly dismiss.
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, MS;: KAM;ARCK:' :The National Performance Review has
consistently worked" very: hard' to make, sure 'that the ;federal w'orkers
in, the ,government., 'get the message. ,That"wasd.±stributed to the '"
federal workers in' theauditp'riuritj ust, to make sure that, :they,' cah ' ,
remembe'r' this 'every day of their working 1'i ves,~ '",
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What agencies regulates ducks?'
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TH,E ' PRESS: ' .Thank you.'
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TH;E;WHITEHOUS;E ,
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'" 'Office' of 'the pr~s~; sec:tetary
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F:~bruary 21,/ 1995 '.
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PRE,SS BRIEFING'"
, BY' MIKE ,MCCURRY
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:The, Briefing,
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,MR. 'MCCURRY: "cont,inui'ng 'o/ith the remaind~r ',of" our: daily
briefing here at the White House,' let me start with' an',announcE?merit
first. The Presi'dent is delj,ghteQ, to 'arinotincetoday ,that he has
named W 11 iam , E .' "curry,: "Jr • a~ Counsel or to . thepres.iden~. " Curry
J.:
,will"work on 'a variety of domestic 'policy and political issues·,' and
because" of his, experience ,at' the state' level; ,he will focus ,.primarily ,
on issues relating to state' and'local government, brit, will b~
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~availablefcir a varietybf other,assignments "as well ~, ,Curry served"
~s 'Connecticut state Comptroller, 'from '1991 to 1995'" asa state
:sen~tor from,197,9:to 1983, practic~d law.froin 15185 to 199>1, and' he
, was the Dem,ocratic candidate for governor 'ofConnect'iclit in 1994.
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" Isn I,t :t1ack Counselor' to ,the Presid~nt?
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Counselor to 'bhe'/President. ,
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.He I s got, more ·than that.
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,title~· There's rtoexplusivity,tothe title Counselor.
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'MR'•. MCCURRY: " Curry.:And ,we've got a~p~ece of .paper'
that' s available for you.--:, it's', add.-i tiori~l biographic~l· de.tails and
a:' nic'equote.. frpm' the Chief, 6fStaff·..· ," '.,
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AnYth';ng on~ ~a~ra "Ty~ori, and the NEC today?
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Not at, this moment,' no.' .:.
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,I tho'ught 'you, said" that he, ,woU],d' ve,tq.the team act ~
"which is employee' ,involvement cOnunittees --~ this week he ,told the'
AFL-CIO that he was going:,:to'veto the team 'act and ,repea.;l. ,of ,Davis- ,
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MR. MCCURRY:, , , Is that ,in 'the contract se:r:viC'es . are~,' or'.'
. ",is it Cl :specif-ic aspect, of, Davis.-Bacon? .
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Emp;toyee,r invbivement' ~o:m.mittee's,· like:,total',-~,
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MR~' 'MCCURRY:'~
, NLRA.
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see,this' 'is' section 882 of the,
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,MR.' MCCURRY: ' ,The' President, feels that is a disruption
,in the balance ofp'ower that exists within federal, law relatEf!d to .- ,
collective bargait:ling ·th~t wduld represent' ,an int'rusioJ:i on t h e ' : ·
:ability of' labor and, ;manaqel'(l~nt to 'successfully ,and, 'ami~ably,_rescnve
labor disputes .
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',;Mike" can:you tell us what the President hopes' to
accomplish' by going to the, Hill tomorrQw.to talk to' the, ,House
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MR.' MCCURRY: ' The President is very much- looking 'forWard
,me~t ,with 'Democrats in the House -- one,' to ",
review the success ,w,e've had,"so far: in the ,194th Congress to shape
" emerging' ·legis;Lation ,to, ,the President 's~'" more· to' the President's,
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'liking.i.' two, to continue to press fo~ the successfjJ.l 'ccms iderat ion' of
the' Presidemt's"own legislative ,pac~ages, ',whether they be Middle' , ,
Class Bill of Rights or/other issues;, '~nd"three,. it,~sagreatoppo~tuni~y for him ,to :rally the troops, which we will increasingly'
" ',' ljeedas we look ahead and c,tttempt tothwartthos~ aspects of the' " "
,Contract with America't~at'are clearly not in t-he ,interest of ,the
M£i~rican people.'..
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,Just' to· ' follow up, What' isthEf! assessment of the ,
first 50~ or \so days, -~' I gue'ss that, I s why' lie ',s, go~n~\ up tomorrow' --':,
arid what I s the outlook for the, next 50?'
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,MR." MCCUI<RY: Ttie, Pres~dent I s assessment 1S that ,now",
", that the Rep.ublican'Majority is getting down ~o ,the fine p:t:intin 'the
, contract For Am~rica; , they I re finding tough going, and ' they I r~ having,
',a '1 i ttle rendezvous with real i ty now. "It' s,not 'easy 'to gov,ern~, and,'
the Republicans 'now aFe having a d±·fficult time producin'g :,the "
sp'e.cifics on how they would dq such, things as, balance the budget, by , ,,'
,the year 2 0 0 2 . '
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How,they would protect socials~curity,be~efits at a
time.when increasinglY'm:any'niembers of the, Republican ,Majority are'
'sayi;ngl that social' Security' will ,have' to be ,on, the table,,' ,how are ,
:they goingtop~bvide' educational opportunities, specifi,cally'college
'educational opportunities,. to students in Amer.ica· at a time when many
,in '~he Republican 'Maj ority ar~ calling, (upon cuts ~n the, pr9grarq.s ,'that
ass~st "those types of, stUdents "';'-, how are they, go~ngto make good on
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the', pledge that' the Congress and :the President made to, the American'
'people hlSt year to put 100,'000' cops in'~the streets .of' America
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'fightin~ crime'.,
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R~publ{can'Maja'rity begins to faceth~se speci,fic
, issues,/ at end of the 'halfway point' in the first 1.00 days of, the 10.4th
Congress, they~re}begiriningto·c6nfront the',reallty ,that it"s.not 'so
easy .to 'deliver on:tbose things when the American, people 'are ,,'
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,:begi.nriing t9 look more carefully :at: exactly the' na,t~re of" t.q.e ;pr"omise
and ~wha€ , it means.
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That'"s'a Closed eyent, according ,to the'schedule.
Is tn.eresome;venue in'which, he's .goingtoinake some "remarks, along
,the, line~ that, You.jus,t,didto '~~ke,'his ,trip up there' worthwhile in
getting himselfii"lvolvedin'the '50th .state celebr.ation?
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,'MR.,MCCuRR;Y:
are·t9morrow? '
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,Ar~ youaski'ng what the pressarl;'a,ngements '.
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I'm asking" is the ,pr,esid~nt going, to· speak' in
pu~l~c at ,any t'ime abouta~l,th-is ,"~since: the ~vent is listed as,
closed?, ,"
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,MR. MCCURRY:
, .ways for' liim 'to deliver. '
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'Q' I,fI:,:COY.ld ask ',a: refinemei1.t ony-our answer
, are' wewfthin' ma:tte,r of days or a matter of hours?
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MR.' MCCURRY : ',6,n ,th~, appointment of, ii' c~airfor the, '
National Economic Council?, lA mfltter of ·,hour,s. Of :col.irse, hours can
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MR.~MCCURRY:'I won:'t rule that out.;'
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Q , Have you senf, the Foster' nom'ination up, y~t?
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'MR,. MCCURRY:wehavenot·,-,~ my, und~rs't~ndlng'is, .the
Office of,theLegal Counsel continu'es to review 'the background"
i~formati(:mprovi:ded' by the; Federal 'Bur~au, q+'~nvestlg?lti?n.
And D+" .
.,Foster, hl.ms~lf "completes . ~omepaperwork.requl.red ,ofnoml.nee~ .to
,high o.fficea:t;l<? ohce,appropria;tely reviewed,. ,that:materi,al will be
'sent "f<?rwa,rd to t.he senate. , . T,he\: Semate" I,/do not .'b~lieve,: was in
,session.:today •. ,' So we wouldn't have ',had ahopportunity ',since '.
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'"receiving the, b'ackgroll;nd report ,..to 'sel)d,itup., ': ."
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, , " Q .DO'y~u' h:avea'commi:tmentfrom Senator Kassebaum':' ;
"thatrio'·witnesses'outside -- no outside witness will be 'part of, the
,hearing 'process?'
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MR. MCCURRY: '. 'I f 'we have such 'a' commi:tment ,-- ,and ,I'm'
~6t aware'of that. ,we'll,:have to<dheck',on'tha'E.:That's the first'
, .".: I'v~ heard of that. '
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"MR. 'MCCURRY: " NO, ' l.t !.s;~ Just· gOl.ng' through. the;inaterial,
" ,',:and making' snirethat they've gotanswerst()"ques,tions. '. But nothing
'more than what . .is customari+y d()ne, as a background, check, is reviewed.·
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MCCURRY:\',' No,b~b~u~e' I don,'f,-believe we've beeniri
receipt of, th~, :finalr$portyet.w~ 'll'b,e readyto:.move, on that, ,when
'everything is iri 'order': .
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M~ke,;CIiri:ton l.sgpinghuptoott~wa:i but 'Congress,. .
'has a gun:t9his :h,ead on, this ,liftin,g,1:he e:mbarg60\l~in Bos;nia., '.
, Chretien, has' threatened, obv.iously, .to!withdraw.Ca,nadian,.peacekeepers:
'~ if,theembargo.'is ,unila.terallyli:fted by th,etJnitedstates. ,How does
\ the ,'President plan to use this :summit toserid a message ,to the Hill ,',
on ~hissribject? ' ' , " , '
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,MR. MCCURRY: Well , ft,! ~ nO,t, the ,Hill' that needs ,to
receivethe.. message~It I s\~,the~; 'Pale Serbs,' 'Mr .><MJ.+osevic ,who has.
i,.bee'nasupporter "and ,J:?as"be~nreluctant to accept'a,! formtilapresented
to .him by the Corit.actGrbUp th~t;could su"ccessfully r,esult in"
sanctions ' relief, f9rSerbiaMonteneg,;t"0'."
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'What they are mis'sing ',at this, point is an agreeme'nt on'
,the ,part· of the ·Pale Serbs to, prooeecl,' with the', contact Group plan 'as
a, basis 'for a" settlem'ent of the' conflict 'in Bosnia, and the contact
Group ,had been h,eavily en.gag,ec~lin trying, 'to impres~: upon' :those~ who,
, m'ight have iri~luence with the Pa'leSerbs, specifically,. Mr~"., ,\ '"
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Mildse'vic ,that th~ time has:come' ndw .f9r;them ,to'turn, up the heat, on
Serbs' and briI'ig ,the .conflict',to~ an end~, ' ."
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Now,;thepresidentwill have an opportuhitywith Prime
Minister 'Chreti~n' to" review the" status of, the conflict in Bosn'ia . . "',
Canada has, done her01c work 1n Bosn1a as ,a' troop-contrrbut1ng
'participant 'in UNPROFOR" ,and I 1m sure that will, be amqng several"
items'tha:t ,are on ,the agenda ..~ " ' ' , ,,' ,'~
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Q. ", What Is,th~ nextst~p nciwafter
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MR. MCCURRY:'" Well ,Milbsevichas. not been forthcoming,
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instantly- with, the, recognition', of the terri:t.orialinte<;ttity of" both
"Bosni.a' an,d C~o'2lt~a ,in ,its ,c\lrrent,:~er~it<?ri~l bOUl:~aries~: :T?ere will
,befurth,er ,d1scuss10n:;;~, 'we hope iW1th, 'Mr .,M1loseY1c, perhaps " ,
involving',' some indiviqual participantswithipthe Co:ntact Group,'
g-ro:uping' -'-,'
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MR. "MCCURRY: ~'He IS
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IiL h~s meetin<iwith, the; Russ:tanJForeign Minister;'~fa ",
did' not 'indicate a' favorable disposition to proceeding with ,,\
territorial'recognition of Bosnia . ,',That was' part >Of a' formula "pl'aced "
'before h~m by' the Contact Group~. We cont:i,nue, to 'believe that' his
, options "are :few if he :~esires any ,'san9tions~elief for the people of'
Serbia Monteriegro ., ' '
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Now;, the'likelih'o.od tl1atsanction,swill persist forever
" :ifther,e I S not soine reasonable ,eff6rtto draw ',this, conflict to 'a
conclusioh,' , iscertairilythere.'
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'area and. pa:s, NATO', enforcement ,of the no ....:fly zone for al~ intents and '
purpose!:) stopped?
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MR~ 'MCCURRY:' 'NO. NATO continues'to,effectiyely dO.', ,
"those things called upon. --'when it is called upon to do s9by the
united Nations •. It '~eInains vig,orously in purs,uitof strict'." ','
enforcementot 'r~lev~mt lJ~N.Sequri'ty Council res,olutions. "
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Well, has the U.N. th~ri stoppe'd acting,' stopped" ,
enfor'cing with all '~he reports of helicopter' flights arid now, fixed~
wingai:t:'craft flights?: It,::appeaJ,:"sti:lat ' it'I,s over.;, '-,' ' : , ' , '
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MR. MCCURRY:,' .The monitoring of those flights has been
bpthby ,theUni,tedNations and by, NA~O as:; effec:tively,as it cando so
'u'sirig 't:h~m~ansthat are available for monitoring flights:.,
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QWhat: role,,~ if ,an:y~ Mike ~' is the, WhiteHouse
Counsell S' Office taking , in' the, matter, of secretary 'Brown now ' tl'i:at\t~e
.. ,Justice Department process i"s going forwarq?', Are they', involved at ,
all 'in d~ing, independen:t inquiry ,of tl?-~ir own? " ',;'
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careful, mopitoring of,:th,e, matter as ,it 'proceeds through the variety,'
of inquiries ':that are unde~~Yi~,
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not .aw~re I'of any' independent ", ' , ,
" " ,'~nvestigation, "aT~i+c>ugh ,they' J;'egtllar1y 'seek ,to clarifyinforwat'i:o~
,that, is, !2lvailahle::aboutthe sta:tus ofJ vari9us, pending allegations.
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Counsel again~,given
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"MR. MCCURRy::'lNot that I'm aware' of, although the White,
House Legal Cc:ninsel remains i in clos~, 'contqct with' secretary Brown I s
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comment: you wished
, to address? ,No; 'as the Pre'sidemt indica,ted on satu'rday, there has
: : ,not' been a decisiOri'maqe,' that wepireexploring with 'the Russian,
,government a variety, o~ :possibil;i.ties .:I'would ,$tress, that ,the
President has ,ehormous respect,' for, ,the people' of Russia and' for: ,the'
, , ' s?lcrifices:they made during World wal:: II,~, '" ''l'hose' sa.cri.f,ices,'were
ackno~ledged, in september of 19,94 when pre,~ideh~ Yeltsin, arid
" pre~identcliritonhe,ld,a'ceremony tha~: soine of you inightrecall ,: fri,
.',the, Rose Garden to honor both Russian and ,American ':veterans of the
con'fliet' in ,World, War II.
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"When you, ~ay, they're exploring a, humber of; .
possibilities. or 'a, v~riety of p,0ssibilities;, ,what level is that
discussion, taking place?'
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MR. MCCURRY: Well" it's taken plaCe at a variety ;of,
'levels, ±ncluding both embassy' cont,acts ,through Embassy, Moscow, but!.
,also contacts that Secretary Christopher has held, in the past with '
Fpre,ign Minister IKozyrey" and r; believe we've ,eIrot' some'l;ligh-ranking
':'visitors from the Russian F,qreign Ministry that· will: be here, later"
t-his, week -- the r,Deputy Foreign Minister '" ,if I 1m not mistaken,' 'wilt "
be' here in, ,town. ' '. " " , ' . , "
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conSUltations with them, on ava,riety: ofmC!tters/bu~ certainly t~e'
,'det,ermination to proceed :with some type of meeting' between.the " "
'Presidents' during the' 'first half o,f, 1995, ~sthe, :two ,Presidents
, ,'Clgreed ' last ,september ~ ,is. :part' of' the discussion, that ,y~u would
, expect high:~ranking diplomats from tlie Russian', F~deration to have' .
withtlieir U .,s~ 'counterparts.:
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Did'every:o,ne'~kno~, it,' sTerry' sbirthday? " ' '
Itw~s Mark's birth¢!.ay ~.yeste~day •
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MR. MCCURRY: ,Mr., Knollerls,bl.rthday --: Mr. Knoller"s
birth4ay ,wa,s, appropriately ,acknowledged' by' 't,h~ . President of the'
Uniteq States, if,I'mnot. mistake.n.
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the year? ': There} s nopu'Il-back, in, t,ha,t?
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~CcURRY: __ ' N'ol.' there: is, a practic~Lquestion of,' '"
deal'ing ,with the calendar, as,' i texists,. But that,' S' why, again,' the,'
. ~r~sident and his', .fqreign 'pol icy team are looking at Ci :variety of
possibilities as we examine al'l "thed.ifferent World War II
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dial,og'uewiththe president~ of" Rusi;da.',: ,',' "..
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Is, it 'still possi~le 'that the'Pr~sidentwill accept,
"Yeltsiri's invitati9n to'visit Mos'cow 011 ~ay 9th?
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'.1' thought :it was :May ,8th in western Europe and May'
9th in,MO~C?W., They celeb~a"~e it on t~o 'd~fferent'days -- V-E p~yr
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,will go .May 8th, 9th'or~ whatever the proper date is'.'~'.
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','So't'hat ' h~s' c:notbeen flatly ruled out , as' had been "
widely' reported?,
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"made on that,. point.
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Well, hOwd.o you- take;.these s,tateroentsby Russiar.l, ' ,
spokesmen' that it would ,b~ a snub ,of the ~ti,ssian' p~ople 'should the ',_
President 'rej'ect thisinvit:ation?
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MR.'MCCqRRY: ,Well, that's why" I ,pointed', out' eariier the
, e'no'rmbus respect., that the President has for the sacrifices made by
the Russian people.' R~ssia,'" as,a very closie ally of 'the United , '
$tates"inthe Second, World Wa:r,paid' an enormous price for yictory " '
against;",'fascism and. NazisIn,',and' the appropriate acknowledgement, of" '
,that sacr,if,ice ,has been a regular.fea':ture of the dialogue between"
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'Russiari' Presidents and U. S.Presidents, including, as I mentioned' '\,'
ea:r,:l'ier., , .just last, ,Sep~ember: when the two ,Presidents m~tand h~ld a
,ceremo~yi:t:l theRq,s~~:Garden.They will certainly,~ in the future, ,
,find additional, ways to (acknowledge app'ropriately the greatsacri,fic~, '
o~ the Ru.ssian people, in the 'sec~nd' World War,. " j
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,Well:,',they have;'~tepp~d'
,hav~n (t'they now in 'chechnyCi?"
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, , M R . ' 'MCCURRY: The fighting in "chechnya:conti~ue~l. "The
qoes not, appear to' have held beyond ,tneinitl.al first 48- "
, h04r period in which ,it IO,okedlike there was som.e ,subsiding'in the, '
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, ,90nflict'. ,But that's not, the' only factor 'that would go Into, "
consideration of a sumlnit meet~ng, ,as: we 'v-e, indicat~ed 'all along!
!'cease~fire
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Mike, '~n'th,e' Mexico agre~ments 'that were just,
signed ov:er' at Treasury --did the "President pers~:mally sign, off ,'on'
this? iAl1d at this point; 'are ther,e still some very 'serious, risks to
the' united states "for engaging in Ithis? '
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'Pre~ident is confidept, minimizes 'the ,risl<: to U.'S. taxpayers. "We , '
, believe that the steps that, ,the Mexican, government has, pledged to ,
,t+ndertake as ,a 'result of t,heagreement ~oday, minimiz~s the risk',cif
defaul;. t 'and, thus" minimizes ,'t~e exposur~ of,' U. S', taxpayers. 'What we "
'get 'in exc~ange is ari 'agreem~ntworki:ii.gwi th':' the government of, Mexico"
to put their economy 'back on 'tracK'so;it Will bea strong participant '
in the trade relationship thcitis, now exp~cted to devel'op' t.hroughout
the 'hemisphere ~ , , ,
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MCC~Y::, ,.Ess~ntially';w~¥tt.he president,. promises
we ,can to" strengthetl the' ~ex~can '
economy s6that,ft Can parti'cipate 'in tpe types' of trade ' ,
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, +el~tionships' tna~.' arEa most, important' to 'the 'Alilerican, people',;, thos~ , '
'that h~lp those who ,have jobs here in, America, generating goods and
serv:ice~ ,that (ire purchased, by r;texic,:an, consmners ~, And we believ:e, \
that",g~ventl}e stru~tureof th~s agrEaeJtl~n,t,', the way that very,'
specifi,c"cond'it;ions have ,been placed,'uponit,' we b~l~evethat' U.S'"
taxpayers will both ,be 'well protecited,"and well ,se~ed' by gynamic', '
growth in the Mexicanecdnomy 'in" future years. ,', ,',
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Q'" I?ack t6the.ineeting tomorrow ~ , What p~;t"'Of,' the'"
Contract has the'President,bel!n'able'tOba.ock'so'far, in tlie House? I
," 'know 'that starwar~' iri ,the Senate and, -- but what other things does' ,
"he"reallystopp:ed?:,",J"",'
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MCCURRY:',' Well~ ,it'sndt"a' quest~on,of blpcking ,
,things. He'lS indicated' specifically that he will veto', any'effort to
tamper' :t>J'i ththe co;nunitment t9 the, American people 't,<? pliif 100 ,OO~ cops
on Ithe street. I ,:think that's now going to have ,to' ~be cons id~r~d
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very ,carefully 'in the'Senat,e/ and ,some :Republicans in,",tne Senate haVE?, '
no\>{: ,indicated, ,second' tho:~fghtson th~tpoint,'
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'potentia'rly bee,n Ibilli6ns'.'ofdollars in. spen<;iingpn
ig'sos·tYpe Star
.. wj:tr's scheme that. 'frapkly, mo's,t people ;:J::hought.hadbeen dealt. with .and
debated in :the, '.last decade. But we>will ,'continue,,-- 'the President ,i ' ;
wil;l' pontinue ,to : speak' ,out 'in or,der t.o, ,shape th,ose' 'aSP~9ts of the'"
. contract that might ,better' serve'the interests· of"theAmerican'
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peopl'e. There are! ,ways in . which yo:u:can take ':someof ,theconiinitmen,ts
'"in that COJ,ltractand :mak~, them tur.ri out ~ l.ot :bett:er.ln. fact',',I . ,:\ .
,WOUld 'predfct, with' sbme,confid~nce, that at the"Emd o,f 10'0 days.,.' the '
,:consens'lis that ,develops about the :role' of gpve+"nment might look 'much' , ; .
:: more' like, the New' covenant: that. has'~,b~Em proposed by the President
. than, by, the,' contract For Ameri¢a ',asprop,osed'by Sp'eaker Gingr.ich and'
others~
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a pos!tiononextending,the ~5 pel;-cent deductil;>ility of·heaJ;1;:h care"
,'/for the self-.e11'lployed?,'
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'MR.'MCCURRY:' I·,thihk'w~< do, "andI ,think i.t '~stin',:this
'piece pf paper somewhere .' . The adininistrationsupports the p:t:"imary
, purpose 0.£ HR'.83f, ',wliichis to 'extend permanently tl}e 25perce,nttax
deduction for health insurance', premiums, ,for ~elf"'employe,d,' ,. .,
:individ'lials. .Itibel'i~V~,~,1:ha1:thp$ecosts_ mustbefully,offset,
howeve,r,'"
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,The admip,istration' opposes',on~ of the bill,'s' of'tsets,','
,which, is ~he r,epealof the' current tax. treatment. fPt: the s,aleof
radio and.' television broadcast 'facilities· and cable televisions
systemE$ for. min6rity-own~dbusinesses. 'That's'an aspect;of" the
legi!3l~tion(thatrs being debated, I' beli,e,?e,/inthe:Housetod~y,,if
"I'm 'not" mistaken., ,
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'. ,'Congre~s on "identifying appropriate .o·£fsets to, extend this, important,
health insuraricededuct'io:npe~anel1tly,~ /
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broadcasting provlision needs. to be. examined ;, .·looked 'at, reformed in.
. ' ).', ',anyway?",
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.MR~MCCURRY:"~The'admirtistrationbelieves it should not
· be·:~iiminated. "Doweneed, to ·look.ati how. it is used· arid under wh'at .
cir'cumstances' it' is used? ~. We do believe that, 'arid we'w111 do that .
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.,.",'Q .Mike ',; isn' t'this Mexico aid plan going to breed!'
· resentment'in Mexico' .towards ,the united states? And' what·if .it
doesn't 'work? H6~'sqori is the.u.S~goi:rlg to·come up' w'.itha '.. '
,?o,ntiT,lgenc::y pl~n irl,tlle, ev~nt:that .the$2 0 b~l~ion doesn' t~ork? ,
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.. , ',MR. MCCU~Y: 'Well, I 'm':"'~there' ,is "a. plan, there . is a
.series. of· ,things_;t:.hat happenurider.: ·theagre~nient··anriouriqed today ifr
.' i-t" "does. riot work.'" I.f. it', "does not . work, ":then the)~e~ican economy
'. would -not recover, from the' short,;"term crIs'is it now "faces.·. But'I
think thai the premiseoftpe p~ckage is that the opposite'would
, happen... .
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~ut' will it breed /resentment? The united states ,would
hope' not·. " We: 'believe "it's very important·, '.' j-u~t' ,as:' ,t~·epeople. of
Mexi6oh~ve.en<?rmous:concern fo~,.~hei.r own ability ,to self-govern,~ ~~
.wo~ld hope that;tl1e pe<?ple of Mexq.co woul'd understand that there are
legitimate concerns raised'by the elected ,representatives of the,
...' . Amer:ican ' people and that'thiss'tructure of thiS-agreement, is-one
l
"\ that/, in the view
thea.dministration,\ adequatelyser,vesthe.,. .
I,
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~nterest of the . Amer~can people., "'but certa~nlyhe:J.ps pro~pt~ the
., long..:term' .economic interests of the" Mexi.can people as well.
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, c ; { ;,Mike ,do (you) -know 'Cinything abo,uta~'letter \to
..
PresidentYeltsin:thatwould· ou:t1ine ~n approach-,t6,NATO that could'..
.,make it easier for th~ .Russians to join the Partriershipfor. Peace? .
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. MR.'MCCuRRY:'I know that, there have- beenciose .
con'sultations in Brussels lata meeting' over, the weekend of NATO
'permanent reps, right? . 'A,t the-perm~rient: representativ:e·level,.'in
_
, which' we'consulted.. wi th '. them about· the development of, the .partnership
'.fOr Peace prc>~ramand how,it m~ght-affect the 'Rus'shin 'Federatic>n.
.
',,'
-, ': .:·~ethero~ ~~t . ,that' take>,'~~entuallY" thesh~peof'a- ~ .'
'letter .from Pre'sident Clinton to President Yel€ s irl- remains to bee,
,,;,' ·seen. ' But :i: would-reniindyou that dec'isiori-making within NATO 'was' . _'.'
gone at 16, . and done -by 'c'oilsensu~ of· all, .the treaty' members .", . .'
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afternoon,_ ~ouldbe.also ,get the President down toannotince it,-ior","
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will·it· be 'just apiece of pap'er?, "
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MR ..' MCCURRY:
,'?\nyb,odY,else?:
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.was- going, to~have' a ......•..
rsession"with the AFL-CIOexecutive counc-ilthis afternoon and discuss
. . that 'further. Therear'e ,'some details that do, as I .think,' I "indicated
.to many·bf. youoverthe,'~eek.end·" some: details that' are, stTIl, beipg . ,
. exam~ned at the inter,agency ·.·level
:But· th~ .' President's: .
"
\.' . determination, 'after working'with tile Vice: president '. on this issue
: over,the/·.w~ekehd :is that<we proceed,as:promptly. as'po~sible to;,
· ..'promulga~e , . . . . . . . " , . . Order,' that. he 'has ,in mind . .
,the Executive
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THE PRES$ :. . T{,l'ank"yoll, ~,'"
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... Cut obsolete regulations
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~~ .N.egotiate, don't dictate. .
.,.":
�AN INDEPENDENT 'N:EWSPAPE'R'
MONDA!, FEBRUARY 20, 1995
.;~TheRush to Regalatory Reform·
.' T'
BE HOUSE. RepubliCans are about to tum - The riSk-a~t biD purports to Seek 'Only
;, to ~ formidable r~gu1atory proposals. on : to base future regu13.tioIis
b etter science. .·It
: their agenda. ~ measures ar~ o~ . would require elaborate risk. assessments and
bat msome respects. would have a ~ter jmpact cOSt-beDefit. analyses. suppOrted., by scleGtific'
~ the 1J19re. f;um1mr tax and spending pr~ . . ' ' .
before . _.1... ·
.hove'
_.........t·· L •....z·the
•
. peer revIeW.
,new ""'5U1AtioDs acer
-.. . . ~ye ~~
most attent.i<?D\
'tam coSt ttsresholds could be issUed. MUch of this .
A biD ,unposmg a reguJatory,moratonum re~.
.
"
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active to last November, when tbe'Republic:aDs: . IS a ~ idea-regulators ~gbt ~ have to meet
'WOIi'Coutrol of COngresS, is to be brought to the. ~ s~ before ~'costs-and.
floOr this week. The idea is to, suspend most III fact much of It IS already ~e...
,
federal tegulatory action until the rules govern. The problem is. that the biD is also written in,
,ing die issuance.of future regulations cao.. be. such.a way as ~ preempt the iegu!atory stan-.
chqed. But if all the RepubJicao.s want to dO is daids in many environmental and bealth' and
block particWar ieguJ2tiODs that· they find objeC- safety statut:eswithout examination of the:·stat
~. ~ ~ ~.~ ~ uieaas.. ute-by,;&tatute.effect.. It ~ open the regulato-, ,
at ~ cJisposaJ.. The moratoriumwoWd· be a:~. ry process .to much.more costly judic:iaI ~
. crude and. cqunterproductive· step that ought to and. delay'as weD.
. ' . ..
..' '.'
. be defeated and quite 'likelY wiD be in the SeDate'"
' '.
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if the Hoase,' for: reasons having.less to dO With '. Tbe~legislatioD ~ ~oes too far. It
subStaace tbanwitb shOw, perSists in pasSing it. would reqmre compensation of p~te property
. 'l\e mOratOrium will be foDowtd bY' a ~-as-., .holders whenever the value of their property was .
seBJlellt bill and 'possibly a takings biD. bOth of' reduced !-'Y 10 ~ or more by f~ reguta..
wbidl
aJso' Crude in their preseDt.
tory, a~ 1;'bat s m~ mo:e. ngid than the.
~ eff~ to balance the 'RgUlaiory' ~' long.estab~. standard .111 exJstmg law. Am?D'
tem.; the, in fact woWd serlously unbalanCe it. much else, it skips too quickly past the question,
House Speaker Newt Gingrich half acknowiedged,wbat if private property is being used in such a
. in a speech last week that some of the provisions way as to be a detriment to the public interest?
may' go too far. They willsureJy be 3mended in ' '. The likely effect would be to chll1 .Dot just
'the .SeQate. he ~ ill an· apparent effort to excessive regulation but commonplace and Sensi- .
.'. ~ the ~ He seeined tQ suggest that . bIe reguJat:ion as 'Well. These are complex iSsues'
to sOme' eJ:tent the. biDs should· be takeD' 0Dly '. and not the sort to be taken on faith and passed in
. , fi,..tiveIy. But if in some respects they are ~ ,a burry to meet a political schedule: Those·
:~as they,~the,ilouse should take. the, ~. . Rfomoting regulatory reform ought to take their'
to ~ them, not Send them cD. .
time and do it right.
'
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form.'
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NEWS OF THE WEEK
Mu·t1I1Yillg.·.•.the···.Waters·
78
NEWSWEEK
FEDI\UARy'S7. 1995.
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Dublin Core
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Title
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Carol Rasco - Issues Series
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Domestic Policy Council
Carol Rasco
Issues Series
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
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2010-0198-S Segment 2
Description
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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92 folders in 7 boxes
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Regulatory Reform
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Domestic Policy Council
Carol Rasco
Issues Series
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2010-0198-S Segment 2
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Box 126
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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Clinton Presidential Library & Museum
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Reproduction-Reference
Date Created
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12/4/2013
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2010-0198-Sb-regulatory-reform
-
https://clinton.presidentiallibraries.us/files/original/2b786a6c5fedfa0ea3342cfbcdd136e1.pdf
71239df2a81499c66f4fd7e0cadee9b9
PDF Text
Text
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PHOTOCOPY
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�PHOTOCOPY
pr:U:SERVATION
�E X E CUT I V E
OFF ICE
o
FT H E
PRE SID E N T
24-Jan-1995 01:03pm
TO:
(See Below)
FROM: .
Jul ie E. Demeo'
Domestic Policy Council
SUBJECT: UPDATE
This is an update of meetings and conferepce calls for the week.
TUESDAY & WEDNESDAY:
1:00-1:30 daily working group prep conference call.
Call in
numbers: 456~6755, 456-6766, 456-6777, CODE #4059. Or you can
participate from Carol's office.
THU~SDAY:
11:30-12:00 conference ~all)meeting to prepare for the 12:00 call
with congressional/elected officals' staff. Everyone that is on
the daily call should be on this 11:30 12:00 call.
In additicin,
Emily Bromberg, Mary Jo Bane, & David
lwood should be in OEOB
211 with Carol, Bruce Reed Jeremy Ben.-Ami, Marcia Hale, and Susan
Brophy for this call. 'Those who will be calling in to access this
conference call can dial either: 456-6755 or 456-6766 1 CODE #4059.
l
12:00-1:00pm Conference Call with the staff of those elected
officials and Congresspersons who will be at the Sat welfare
working group. All of the people on the daily call should also
participate. You can either go to OEOB 211 or call 757-2104, CODE
:~ ,
Room 211 is fairly small,so please let Julie (456-2216)
~know if you are planning to participate from OEOB 211.
1:00-1:30pm daily conference call- in case there are other things
that need to be addressed.. Those in the daily call group who are
in OEOB 21l,can stay there for this call. Others can access it by
dialing: 456-6755, 456-6766, or 456-6777, CODE #40~9.
FRIDAY:
1:00 1:30pm Daily Conference Call with regular group.
Call in
numbers are: 456-6755, 456-6766, 456-6777, CODE #0691.
�Welfare Reform Working Sessions Participants
Governors
~Governor Howard Dean (Vermont)
~Governor Tommy Thompson (Wisconsin)
~ Governor Arne H. Carlson (Minnesota)
~Governor Mel Carnahan (Missouri)
~Governor Thomas Carper (Delaware)
~Governor John Engler (Michigan)
. Mayors
VMayor Greg Lashutka (Columbus, Ohio)
~~ Mayor Joseph Serna Jr.
(Sacramento, California)
.
County Officials
v'Yvonne Brathwaite Burke (Chair, Los Angeles Board of Supervisors)
v Michael Pappas (Freeholder, Somerset County)
State Legislators
X, Wayne Bryant (New Jersey State Assembly)
~jaames
.Lack (Senator, State of New York)
Senate
Charles E. Grassley
VHank Brown
V Daniel Patrick Moynihan
vBob Packwood
v'Nancy Landon Kassebaum
~Edward M. Kennedy
V John Breaux
y"'Barbara Mikulski
~
House NOTE NINE NOT EIGHT - need to clarify
Richard A. Gephardt
~Harold E. Ford
X
vSam ,M. Gibbons
v-William L., Clay
~ E. Clay Shaw
X Dave Camp
~im Hutchinson
&.--""Jan Meyers
Administration
President Ciinton
Vic~~Pr~sident Gore
Carol Rasco
Leon Panetta
Alice Rivlin
Donna Shalala
�01/25/95
16:39
1t202 690 7383
. __
~.~02
HHS OS ASPE 415F
COM]>ARISON OF ADMINISTRATION'S WORK AND RESPONS181LITY ACT
ANll HOUSE REPUBLICAN'S PERSONAL RESPONSIBILITY ACT
Worl{ and Responsibility Act
Personal R~sponsibility Act
WORK
.Job Searchl
Training
Requirements
Work
Requirements
Sanctions and
Benefit Cut-offs
Employable recipients required
to participate in job s"'1I'ch,
education, and training
activities immediately.
None. State option.
Work required of ALL
employable persons after 2
years.
Eventually, SO percent of all
recipients must b~ in workfare or
other work activity.
No benefits for persons who
refuse to work in subsidized
jubur who refu.~ a private
sector job offer. Persons
-wilIing to work who cannot
find a private sector job can
get help, but only if willing to
No benefits for persons who refuse
wOl'k
fOl' benefi~.
to work or who refusc a pri vale
sector job offer. All adults
permanently cut off after 5 years
even if they are \Villing t() work
but can't find a job. or unable to
work due to disability, State option
to cut off entire family after 2
years, if f8mily already has been
offered work slot for a
Protections for
People with
Disabilities or
Temporarily not
Employable
Funding
Persons with disabilities or
year.
None.
parents caring for disabled
chi1d 01' very young c.hildren
exempted until able to work.
Additional capped entitlement
funding for states to expand
JOBS and establish WORK
program. Higher and simpler
Ft:deral match. Expands in a
national recession.
Additional discretionary fWIding
work program.' Higher Federal
match rate, but structure is not
simplified.
rOf
�01/25/95
16'40
I
raJ 003
HHS OS ASPE 415F
'a'202 690 7383
:;
1
Wor~
_
-
.
and RespoDsibility Act
I
Penonal Responsibility Aet
RESPONSIBILITY,
Child Suppurt
Enforcement
Dl'arrlatic and comprehensive
imprbvements in child support
illcluUing central state
registries, license revooations,
etc. I
.
(
Few child support provisions and a
cap which would actually reduce
resources tor enforcement (child
support bill promised later.)
Paternity
Establishment
No AlFDC benefits until state
I
certifies applicant has
coopJrated fully in paternity
establishment. State then
rc;qutl-ed to locate father within
1
I ear. "
. Y
I
No AFDC benefits fot" child until
paternity has been -established whether or not mother has
cooperated fully and whether or
not state has
a serious effort
I
F:i'aud
Performam::e
Measures
_
-JrnprJved information systems
and data collection to reduce'
I
'
welfare fraud and catch rho!;e.
I '
'w'{ho ,?we child support.
Inter+" state participation
standfds. New state
perfOll'lllance measures ba.~ed
1
ODou:~comes rather than
proce~s, to be developed.
/
made
to locate the father.
None.
State participation standards for
work..
�01/25/95
I '
DRS OS ASPE 415F
'6202 690 7383
16:40
I
Wor"- am] Responsibility Act
@004
Personal Responsibility Act
I
TEEN PREG~ANCY, REACHING THE NEXT GENERATION
I
.
Teen Parents .'
.Molliers under 18 must live at
horod. identify' their child' s
I
.
father. and stay in school to
geL btnefits. Comprehensive
I
case management for teens.
I,
Family Ca.ps
Pregnancy
Preventiun,
Grants for out-ot"
wedlock children
State loption to provide no
additional benefits for. children
cOllcdiveu while unmarried'
mothbr is on welfare. Can be
applidd only to children born
after ~nacm1ent.
I
I
.
Commwuty-based teenage
I
.
pregnancy prevention
initia~ives in 500 schools. .
I
Comp.reh~nsive pregnancy
prevehtion demonstrations.
State requirement to provide 110
additiunal benetit.~ for children
conceived or born while unmDlTied
mother is on welfare. Applies only
to children born after enactment
..
d'
I
Yotmgest .reciplents phasc-m
States encourageulo phase-in
recipients with oldest children.
I
Phase-in
,
.
•. fust' With Stall: flexibility on
.1 ,
Phas~g In 0 ther groups.
Funding for Child
Care
Chlldren born to mothers under 18
(state option wlder 21)
pcnnanently denied aid for their
entire childhood. Remain eligible
, for Medicaid. 18 yeEll' oids must
live at homc.
I
Significant new investments in
child ~are. Funding for all
child bare increases dut: La
.• I
1
trauung and wor..
requirbments. Does not change
I
'I
.
c'ucrl:nL enOt ement tior warleing
currerlt and fonner AFDC
~ 'Iii
lWIll
ps.
3
Fed. savings from denying benefits
to out-of-wedlock children nlay be
used· by statt= for orpha.1'lage~.
homes for unwed mothers.
adoptions, and programs to reduce
pregnancies, abortions excluded.
Removes entitlement to child CEll'C.
Funding included wlder aggregate
.!:pending cap which is below what
is currently spent
�01/25/95
16:40
I
"6'202 690-7383
HHS as ASPE 415F
I
'
Worl4 and Responsibility Act
I
Legal Immigrants
Nutrition Cutsl
SJRe.k Grant5
Entitlement
Protections
Personal Responsibility Ad
OTHER PROVISIONS
SponJors held fmancially
I
accol.Ultable for legal
immiarunts under major
entitlement programs.
-
Most legal immigrants cUlT~nLly in
the, U.S. barred from 52 programs
including entitlement programs,
child nutrition and immuni7.ation.
None) but States are givenFood stamps~ WIe, child llutritioll
I.L'I
'b'l' ,
more 'ueXJ Illy m many areas, - prognuns converted into single
block grant with vcry fcw
Manyl chonges in .AFDC/~ood
stamn::! La slr~amhne t achieve
conditions and cut by 12%.
1",
State option for AFDC block grant.
greaUjr conformity and make
work Ipay.
Eligil:he persons call always
CllfOlll
Individual entitlement to AFDe,
S51, and nutrition programs ended.
Funding is capped and programs
become discretionary, If annual
budgets are exhausted. states might
have to deny aid to the elderly.
persons with disabilities, and
children - unles;s; they eM put in
more state funds.
4
~005
�,-
01/26(95
HHS as ASPE 415F
09:57
444
KATHI WAY
!4l002/005
COMPARISON OF AD?tflNISTRATlON'S \VORK AND RESPONSIBILITY ACT
AND HOUSE REPUBLICAN'S PERSONAL RESPONSffiILITY ACT
Wor~ and Responsibility Act
I
Personal Responsibility Act
WORK
Job Search!
Training
, Requirements
Emplbyable recipients required
to pJticipate in job search,
edudtion, and training
activi~es immediately,
None. State option.
.Work
Requirements
Workl required of ALL .
employable persons after 2
yearsJ
'
Eventually, SO percent of all
recipients must be in workfare or
other work activity.
No benefits for persons who
No benefits for persons who refUse
to work or who refuse a private
sector job offer. All adults
permanentl y cut off after 5 years
even if they are willing to work
but can't find a job, or unable to
work due to disability. State option
to cut off entire family after 2
years, if family already has been
offered work slot for a year.
Sanctions and
Benefit Cut-ofCs
I
I
refusd to wo~k in subsidized'
job
dr who refuse a private
secto~ job offer. Persons
willidg,to work who cannot
find l private sector job can
get hJlp, but only if willing to
work for benefits.
Protections for
People with
Disabilities or
Temporarily not
Employable
Funding
Persohs with disabilities or
parenis caring for disabled
I
None.
. child lor very young children
exempted until able to work.
I
I
Additional' capped entitlement
ftmdihg for states to expand
JOBS: and establish WORK
progrr.n. Higher and simpler
Federal match. Expands in a
natiorlal recession.
I
Additional discretionary funding
for work program. Higher Federal
match rate, but structure is not
simplified.
�'01/26/95
09;57
HHS OS ASPE 415F
Work/and Responsibility Act
I
Child Support
Enforcement
Paternity
Establishment
Fraud
KATHI WAY
improvements in child support
I
..
including central state
registIil/" eSt license revocations,
etc.
I
. No AFDC benefits until state
certifibs applicant has
coope~ated fully in paternity
establishment. State then
requiJed to locate father within
yea}.
Impr6ved infonnation systems
I
and data collection to reduce
welfdre fraud and catch those
. who
child support.
Personal Responsibility Act
Few child support provisions and a
cap which would actually reduce
resources for enforcement (child
support bill promised later.)
No AFDC benefits for child until
paternity has been established •
whether or not mother has
cooperated fully and whether or
not state has made a serious effort
to locate the father.
None.
pwe
Performance
Measures
I
141003/005
RESPONSIDILITY
DIam~tiC and comprehensive
1
~~~
Interim state participation
standards. New state
perf~rmance measures based .
on outcomes rather than
I
process. to be developed.
I
State participation standards for
work.
�·01/26/95
09:57
HHS OS ASPE 415F
1
Wor¥ and Responsibility Act
~~~ K~THI
WAY
I4J 004/005
Personal Responsibility Act
TEEN PREGNANCy"REACHING THE NEXT GENERATION
.
I
'
Teen Parents
Moiliers under 18 must live at·
homcl. identify their child's
father, and stay in school to
get b1enefits. Comprehensive
case management forteens.
,I
Children born to mothers under 18
(state option under 21)
permanently denied aid for their
entire childhood. Remain eligible
. for Medicaid. 1g year olds must
live at home.
j
Family Caps
Statel option to provide no .
additional benefits for children
conc~ived while unmarried
motlier is on welfare. Can be
appli1ed only to children b~rn
afterl enactment.
State requirement to provide no
additional benefits. for children
conceived or born while unmarried
mother is on welfare. Applies only
to children born after enactment.
Pregnancy
Prevention t
Grants for out-of
wedlock children
Com!munity-based teenage
I
•
pregpancy preventlon
initi~tives in 500 schools.
Coniprehensive pregnancy
Fed. savings from denying benefits
to out-of-wedlock children may be
used by state for orphanages,
homes for unwed mothers,
adoptions, and programs to reduce .
pregnancies, abortions excluded.
Phase-in
Y mfgest recipients phased-in .
firstl.:vith State flexibility on
pha~ing in other groups.
States encouraged to phase-in
recipients with oldest children.
Fanding for Child
Care
prettiOD demonstrations"
Si~ificant new investments in
child care. Funding for all
child care increases due to
.1.
trammg and wark
reqJirements. Does not change
currfilt entitlement for working
currlent and fonner AFDC .
fam~lies.
,.
3
Removes entitlement to child care.
Funding included under aggregate
spending cap which is below what
is currently spent.
�• 011261-95,
09: 58
HHS OS ASPE 415F
Work land Responsibility Act
I
~~~
KATHI WAY ,
@005/005
Personal Responsibility Act
OTHER PROVISIONS
I
Legal Immigrants
Spons~rs
held financially
accountable for legal '
immig~ants under major
·tl I
entl ePlent programs.,
Most legal immigrants currently in
the U.S. barred' from 52 programs
including entitlement programs,
child nutrition and immunization.
Nutrition Cutsl
Block Grants
None,lbut States are given
more flexibility in many areas.
Many Ichanges in AFDC/food
stamps to streamline, achieve
greatet conformity and make
I
work ~ay.
Food stamps, WIC, child nutrition
programs converted into single
block grant with very few
conditions and cut by 12%.
State option for AFDC block grant.
Entitlement
Protections
Eligible persons can always
enrollJ
I
"
4
Individual entitlement to MDC,
SSI, and nutrition programs ended.
Funding is capped and programs
become discretionary. If annual
budgets' are exhausted, states might
have to. deny aid to the elderly,
persons with disabilities,' and '
children -- unless they can put in
more state funds.
�MEMORANDUM
to:
January 26, 1995
Carol Rasco
FR:
RE:
cc:
Attached is a backgrouno memo on the Medicaid block grant/cap that we hope you
I
will find useful in preparation for the short briefing we currently have sc4eduled for the
President at 2:15 today. In li~t of Governor Dean's supportive comments about the
Medicaid capping idea (see att~ched article, which by the way his staff is now trying to
I
disassociate himself from) and the virtual certainty that Republicans are planning to use
Medicaid as their cash cow, thi~ discussion seems more and more timely.
I
Consistent with your guidance, the presentation before the President will be drawn
from a much shorter, bulleted aocument. It will be broken off into four sections tentatively
titled: (1) Medicaid: the Curidnt Budget and Political Environment; (2) Advantages
Disadvantages of Going th~ M,~icaid Cap Route; (3) Budgeting Implications for State~; ~nd
(4) Possible Alternatives. <..::t*- 'i"'\\.!»~ J,.row" .£<:.."., #of. MeMO :&(.11 1
t ...Q..C't'"ct.A Q~G"" '+.1 Naf ~c.+
rc.c.J., Ar V"'Me "ftM~;).
,'t
Jen and I will be prepar~d to also discuss the ERISA issue, as well as to give a quick
update on the status of the newlcost estimates of the policy preferences he asked for at our
. Dec'ember 22nd briefing. Since he mentioned the outline of his health care reform "vision" in
the State of the Union and beduse health care is being reported in today's papers, we tholight
he might have some of these q~estions in mind. Hopefully, he won't because a solid briefing
on anyone of these issues would obviously take more than the 15 or so minutes we have'
available today.
.
Carol, one staffing questiion for the briefing: for political and budgetary reasons, Gene
I
.
Sperling is very interested in this issue. I am certain that he would likely very inuch want to
attend any briefing on it. . He dbes not know about today's meeting, but I am wondering if we
I
' .
should invite him to attend? I tlieve it might well be advisable.
.
Lastly, from what at least I am picking up, it still seems likely that most of the
I
. participants (even from Alan. \\jeU and his Goven;lOr) -- for different reasons -- do not want
this issue to come up at the NGA meeting. Having said thiS, the issue still seems likely to be
to be raised at the DGA meetink All the more important why you are there on Saturday
'. and why I will follow up on yolurnote to make sure that happens today. Talk to you soon. .
�01/25/95
......-; JENNINGS
18:20
I4J 002/002
..eOICINE & HEALTH
Gov. Dean Nears Medicaid Deal
4
A week after poblic1y applauding sweeping Mc:dic:aid
reform proposal pending in lite SeD8!&;. tile bead of
abe National Governors' Assn. (NGA) began priv.llely
cnftjog a Medicaid dcaI with ~c House Speaker.
NGA Chair Howard Dean (D-VT!) and Speaker Newt
Gingrich (R-GA) last week· clisdussed • pact uDder
Ytbic:h the ,wes would r=:.ive fe~er fedml Medicaid
. dollars than in yean; past. but "'ve more lilY over
how to use 1bcm. Uader the mact IikeJ1 I12Darlo,
ltates would rec:elve l1li aJUlJat Medicaid Wock
I
put equal to tile amout ~ved !be year before
plus 5 perceat. Dean told N&H Jan. 19. That inausc
.
I
would be far betow today', roughly 10 percent amwth.
but Dean wd be would be ~l1inB to live with
Ihc smaller rise because the blockLsrant funding mum
would free: him from MedicaidlI "cate,orica1 boCIps"
.
such as requiring federal permission to move rrcipicots
into managed caR. -rben:: is ~ real possibility of
• de8J" on the block: pant idea; ·he aid.. ""A lot
of governors would be intcrcstk!." Dean wiJl likely
ay to sell the idea 10 his fell'ow lovernoa 11 tbc
association"s annual wiDta mbiDg begiD.D.ing Jan.
28. Dean also lobbied Giagri~ to support SeDate
Human :Resources Chair Nancy/ Kassebaum". (R-KS)
bill. which would turn the Medicaid· Kate
care progiam entirely over to the states (M&H II
1619S). but 80l no commilDleot. IDean said the meetiDg
took place larsel)' because cDc ~pea.kCl' was iDuigucd
by statementS on Medicaid by ~c:w York Gov. Georae
Paraki (R.NY)•. He urged the House Ways & MelDS
Comminee J&O.. 12 to "provide /staIeS with iDccotivcS
- such as increased federal matchiDg weds - for
using their Mediwd dollars mort, efficiently. FoUowing
IUs conversation with Dean. jGmzriCb brought Ihe
block put proposal up with Go\'. Tommy Thompson
(R-WI), the Spcabt rep:ntcd at • Je. 19. c.pitol
Hill Dews confc:rcoce. Thompson, who wi11 IUc:cccd·
Dean IS NGA chair Ibis
-said he could
I
live with • S pen:ent inc:rease.j Ginsrich said. Idd.ias
that be has tapped the W'J.SC.G,DS1D IOvemor to bead
• task foree assjgned 10 address Medicaid rcfCII:DL
~fare
I
I
sutnmet.
GOP Budget Plans
,Grow Less Ambitious
......
House Republican leaden. who pledged to auk
out budgct-cutting legislatidD early in the l04th
Congress, are baviog ttoubl'e finding the revenuc
they Deed and have already /missed their first telf
imposed .deadline. The GOP plan at the Olltset
of the session was to
$200 billion in fiveI
yeM budget cuts by the end of January bqorc
raiJ
-
•
-- . . . . . .
~-
_L_
n ......I."..
- : ....
"y
cuts promised in the "'Contract .... ith Arncricll.- But
Budget Committee Chair John Kasich (R-OH) said
Jail. 18 that that Kbedule bas changed. No~ a
speDding reduction package will be released Feb.
9: a separate, more far-reaching budget reconciliation
bill that will be the "down payment" for balancing
the budget will be released later in (he spring.
bud,el aides said Jan. 20. The delay allows
R.epubUc:.aDS to sec: President Clintou's budget
to lie anveiled Feb. 6 before sbowi1l8 their
own baDd. Kasich', rationale is that lawmakers
Deed extra time to cumiae budget options "more
Cbouptfully." The Ohio RcpubJic.a.n backed away
from another promise: to propose a sevcn-year budget
with a ,urplus at the Cad. lo..nead. be s.l.id. GOPers
will release program c;bugc:s for fiscal years 1996·
2000 as a ""road map- (or rc.achieg· the uro wgct
by year seven. Meanwbile. a series of ftew reports
show just how daunting that target is. A Price
Waterhouse rcpon released Ian. 17 estimates that
if the Contract's tax cuts and the GOP', proposed
defense spending incrc&Se of $80 billion an: CQacle4.
aDd Social Scl;urity is exempted. Medicare, Medicaid,
aDd all discretionary pr02rams would have to
absorb nts of %4.1 perccat oyer leveD yun.
Democratic leaders .and the Center on Budget and
Polic)' Priorities have arrived at similar estimates.
GOP Offers Long Term Care Plums
The budget hits that Medicare will likely w.:e later
Ibis year could Stir up the powedul sea.iors" lobby.
but House Republicans arc considering lOme early
session long term care tax proposals to sugar-coat
me bit= medicine. The House Ways k Means
Committee last week: held separate hearings Oft Ihrcc
"'Cootrac:t with America" provisions designed to be.odit
the elderly: repc:aling 'a 1993 tax increase on Social
Security bendits (11 a five-year coSt of SIS billion):
providing a SSOO refundable tax cn:djl for ptovidiD8
long ~ c::are III bom.e ($8 billion); Iftd providing
till ioc;c.ntivc& for the purchase of long fI:ml c:are
jnsW'lUlce (S13 billioft). Owing • Jan. 19 bearing
on Cbe IU repeal, Amcrie.u Assn. of Retin:d Persons
spokesperson Bob Shreve argued thai. me 1993 law
dlat made: 85 pel'CCDl of Social Security benefits tax.able
instead of SO percent was unfair. sioc:.e the program
is ill surplus. Ways &; MUllS Committee Democnt
Andrew Jacobs (IN) agreed faxes oa the elderly
shoaJd be more proer~lv~ ,but said means tatiDg
of Medlc.are would be "better" thaa repealiD& the
Dew tu.. Several other IXmocrats arc wary of the
repeal. including Reps. Gerald K1cczka (WI) and
Benjamin Cardin (MD). because the reveoue goes
., pad the aiUng· Medie:arc . hospital cru.st fuDd..
•
�PURPOSE:
To discuss the implications for scates and for coverage under the Medicaid program ofNGA and
Republican proposals to cap Me~icaid spending through a block grant.
DISCUSSION:
The topic of capping the Medicaid program is likely to be raised at the upcoming meeting with the
Governors. NGA's proposed pdlicy would give states the choice between continuing Medicaid as
an individual entitlement or acce~tinga capped federal payment. In addition, the Governors have
been discussing a Medicaid blocf grant with the Republicans in Congress, and both Governor
Dean and Governor Thompson have indicated that they might be able to "live with" a Medicaid
block grant that caps the growt~ in federal ~ontfibution at a 5% growth rate. The projected
.
baseline rate of growth is about 9.3%.
The Governors are interested in block grants because they free states from federal requirements
. and oversight. They appear to ge willing to consider very large reductions in federal payments in
exchange for greater flexibility vhat results from eliminating the individual entitlement. You
should know that the type ofre~uctions that they are discussing are large initially and grow
dramatically over time (about $:375 billion over ten years). Under this type of block grant, states
budgets only after they reduced total program costs in response
could realize savings in their
to the $375 billion reduction federal payments. Otherwise, all oftbe savings that can be achieved
from the program will go to thd federal government.
0+
The desire of states for additiJaI flexibility can be accommodated without changing the
entitlement nature of the progrAm. For example, states could be permitted to implement managed
care and home and community1based care program~ without applying for a waiver. Boren
amendment restrictions on hospital payments also could be eliminated. The key difference is that
providing increased flexibility Jnder the ~urrent structure, in contrast to a block grant, assures that
co~erage will not be reduced.
Proposals to convert Medicaid to a block grant raise a number of serious concerns. Some relate
to converting Medicaid Eroman individual entitlement to a block grant. Others rdate to the effect
that significant reductions in fetleral payments would have on coverage. These concerns will be
discussed below.
Converting Medicaid From an Individual Entitlement to
it
Block Grant
Although some Governors apJear to favo; block grant's in order to get greater Qexibiliry,
convening Medicaid from an ihdividual entitlement to a block grant would be a radical change to
the structure of the program t~at would shift a substantial economic risk to the states.
•
States At Risk from Lflation and Recession. As an individual entitlement program,
Medicaid automatican1' adjusts federal payments to meet changes in medi~al C?sts or the,
level of need. For example, when a receSSIon occurs, the number of people without WOfi<
�that qualify for Medicaid Fan ns~ dramaticallY. increasing program costs. Under an
individual entitlement, the federal government shares the additional costs .. Under a block
grant, states must addres~ the increased need on their own, either by increasing state
spending or reducing setces and coverage
Block Grants Do Not R,ecognize Differences Among State Programs. A block grant
that fixes the growth in federal payments at a set percentage would benefit some states
and penalize others. Sta~e growth rates can vary for many reasons, including changes in
population, regional medkal costs, enrollment patterns or service mix. States also have
very different opportunities to achieve savings through managed care (eg., some states
already have achieved salvings; rural states have less capacity to implement capitated
payment arrangements). An·individual entitlement adjusts feder&l payments to these
changing circumstances; a block grant does not. The variation in state gro'V.rth rates for
the 1990 to 1993 period is shown in Attachment I.
States At Risk for Cost of Aging Population. As the population continues to age, the
growing need for long-tkrm care services will put increased stress on the Medicaid
program. Under a bloc~ grant approach with a fixed federal payment, states would bear
the burden for providin~ these services as the population ages.
•
Tough Choices Arc nLolved To States. Under a block grant approach, the federal
government can achievd substantial federal budget savings without taking responsibility
for identifying specific leurs in paymen(s, services or eligibility. The rough choices
about where to cut are Ileft to the stares. This problem is likely ro get worse over time,
since reducing the rate of growth of a block grant payment is much easier than making
specific program cuts.
Effects of Capping Federal Payments
Glven the magnitude of cuts Jcessary to fulfill Republican promises, a block grant would
inevitably result in a significantl reduction in federal Medicaid payments to stares. For example, the
5% growth proposal that Speaker Gingrich has discussed with the Governors would reduce
I
.
federal payments to states by ~13 0 billion between 1996 and 2002, and by about 5375 billion
between 1996 and 2006. (Undfr the slightly higher CBO baseline, the reduction is over $500
billion over the ten-year peri01) In 1997, projected federal payments would be reduced by about
7% to 10%; in 2006, the reduction rise to 35% to 40%. This is due to the cumulative effect of
annual reductions in federal Pi~ments Thi s is shown gra phic.lI), in Altachmen t 2..
You may hear from the Goverpors that managed care can produce enormous savings. Although
managed care can improve efficiency and thereby produce meanmgful savings, the savings are not
nearly enough to compensate for the levels of reductions bemg discussed wiih the block grant
proposals. Given the rapid exbansion that aircady is occurring in states, significant savings are
~Iready being realized Prelirrlinary estimates show that if aI' nondisabled. nonelderaly recipiems
were enrolled in managed car! by the year 1999, any additional savings through 2005 would be
less than $5 billion. Some ad~itional savings might be achieved 111 stares that can use managed
�care as a vehicle to further reduce provider payment levels below costs (as opposed to achieving
true program efficiencies).
Under the baseline, Medicaid per capita spending is growing at approximately the same rate as per
capita pnvate health spending. Tlhereforc, capping federal Medicaid payments substantially below
baseline assumes either that states can contain costs much better than the private sector or that
substantial reductions in the sco,. of the program are acceptable.
Illustration of State Responses to Capping Federal Payments
The following discussion iliustraL the impact on states of a block grant that caps the federal
payments at a 5% rate of growth!. For ease of presentation, the information is presented under the
assumption that states would resbond to reduced federal payments entirely through one of the
following: (1') higher state spending, (2) lower provide payments, (3) benefit cut backs, or (4)
eligibility cutbacks. States are a~sumed not to reduce their· projected levels of spending.
Increase State MediC.if Spending
.
If states chose to increase theIr own spending in response to the reduction in federal
payments, between 1996/ and 2002, state spending would need to increase by over 20%
over baseline projection . However, because the sIze of the federal payment reduction
1
would grow each year, the percentage increase in state spending would also need to grow:
•
•
In 2002, the incrLse in state spending would be 32% over baseline projections;
In 2005, the incr~ase in srate spending would be 43% over baseline projections.
Reduction in Provider Payments
If states chose to reduc9 provider payments in response to the reduction in federal
payments, between 1996 and 2002, payments to hospitals, physicians and nursing homes
would be reduced on avlerage by 13.7%. And because the size of the federal payment
reduction would grow each year, the percentage reduction in provider payments (relative
.
to baseline projectionS)JL.rould also need to grow. For example:
•
•
,.
In 1997, a 6% r duction in hospital payments would be needed;
In 2002, a 229°10 reduct~on ~n hospital payments would be neede~;;
In 2005, a 32.8% reductIon In hospItal payments would be needed.
These reductions are
J
top of Medicaid's already low payment rates. This. level of
provider cuts will dispr~pol1ionatelY harm public hospitals and climcs, tor whom Medicaid
is a significant payment source.
�•
Reductions in Benefits
States also could choose to reduce benefit levels in response to the reduction in federal
payments. The amount olf savings that could be achieved through elimmating particular
categories of benefits is shown in Attachment 3. For example, eliminating all dental
benefits could achieve abbut 28% of the necessary savings from baseline in 1997.
Eliminating personal carcl services would achieve about 55% of the necessary savings
howev~,
These reductions,
would not be sufficient overtime, because the size ofthe
federal reductIOn would increase each year, for example, In 2002, elimmatIng dental
benefits would produce Jnly 8% of the necessary savings, and in 2005, only 6%. In 2005,
eliminating all benefits fdr dental, prescription drugs, EPSDT, home health care, hospice,
personal care services anld payments for Medicare premiums and cost-sharing still would
not be sufficient to comdensate for the lost federal funding.
•
Reductions in prograJ Eligibility
States also could chooJ to reduce coverage eligibility in response to the reduction in
federal payments The dmount of savings that could be achieved through eliminating
particular eligibility catekories is shown in Attachment 3 For example, eliminating
eligibility for non-cash children (the OBRA expansions) would achieve about 62% of the
necessary savings in 19Sh, but only about 14% in 2005. Again, because of size of the
federal reduction would grow each year, the reductions in eligibility also need to grow.
In reality, states would respond through a combination of these approaches. For example, under
the 5% grov.1:h proposal, federal payments to states in 2005 would be $66.3 billion below baseline
projections. If a state were to JUocate this reduction equally across the four responses discussed
above, it could achieve the nec~ssary savings by (as compared to baseline projections):
..
..
..
..
Increasing spejing by about 11%;
.
Reducing provi!er payments by about 8%
Eliminating co vbrage for prescription dntgs, and
Eliminating covbrage for most noncash children and qualified and special Medicare
beneficiaries.
And, because federal Pryments would continue to decline, further reductions would be
needed each future year
Even under less extreme propLals, federal payment reductions can be SIgnifICant over time. For
example, a 2 percentage point IreductjO~ !n baseline rate of grov,,1h would result In a I.arge
reduction in federal payments -, - $ 66 bllhon-- between 1996 and 2002. In 2006, proJecred
federal payments to states wO\!lld be reduced by nearly 20%.
�CONCLUSIONS
Medicaid block grant proposals lunder discussion would dramatically reduce federal Medicaid
payments to states over time. Increased use of managed care cannot generate the savings
necessary to make up for these teductions and there is little room in state budgets to increase
state Medicaid spending to comhensate for the reduced federal commitment.
Unless states choose to offset fJderal reductions with increases in stare spending, they would
be forced ro respond by reducirig provider payments, services, and/or coverage. Given the
inflexibility of a block grant to I!respond to the needs' of individual stares and differences in state
.
political environments, the levea and narure of [he reductions in the scope of the program
would vary significantly from
to ,tate.
'ilate
Reducing the scope of the Medicaid program to such a large extent would not only put families
at risk, but also set: back movebent towards more comprehensive health reform in a number of
ways, including:
Increasing the numbe~ of uninsured. Recipient growth currently accounts for two
fifths of overall Medica1id program growth. In fact, spending per person under
Medicaid is increasing rl1: about the same rate as inthe private sector.
During the early 19905 Medicaid increased coverage as employers decreased coverage.
1
Tbis trend would be rerersed under a block grant, inCreasing the number of people who
are uninsured. The changes employer-based coverage and Medicaid are shown in
Attaclunent 4.
Exacerbating cost shifting. One of the central problems in our health system is the
shifting of uncompendted care costs and Medicaid underpayments (0 business and
I
families who purchase linsurance. Reductions in Medicaid provider payments or
increases in the number of people uninsured would exacerbate this pmblem.
Offe~
The Administration can
states flexibility without shifting costs to states or reducing
coverage. For example, regu1lations could be relaxed so that states could use managed care to
achieve savings without currein restrictions. And, the l11S waiver process could continue to
be used to provide states withlthe flexibiWy to change categorical eligibility rules. While these
changes would retain the individual enti[lement under Medicaid, they would provide stares
with -much of the flexibility tHey are seeking.
.
�----------------_ ....
__ _----..
------------- _._.,------,-,--
-.~---
,---....
_-_..
,,~-.-~-'.-
Medicaid Per Capita Expenditure Growth
Average Annual Growth Ratef, 1990-1993
30% '-,--
25%
20 9/0
L
15% .
DE
CA IN
TX CO MD
PA OF\ NV
::~. ~_L~~ :;IiTUfnnutnnm
_
L
* Note: Excludes Disproportionate Share Expenditures
Data from The Urban Institute and HCFA
KS NE
-----~---------~- ...-""-""-...-Itl-I- - - - - \ - - - - - -
�. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ,..,----------"--,--------,-,,--,--,--,--,-,--'-"---
Medicaid Per Capita Expenditure Growth
Difference from Average, 1990-1993
20%
-----
----~--
..-
150/0
L
10 %
5%
DE
+
CA IN TX CO MD PA OR NV KS NE
Ilfftl-~I
-50/0 --fIlii I NO sc OK
FL
-1 0%
tvl""
------,
--
---,-----------,--------,----------------,-,--------------,---,
,. Note: Average annual per capita growth rates, excluding Disproportionate Share Expenditures
Data from The Urban Institute and HCFA
�I
Medicaid Expenditure Growth 1996-2002
Capped Expenditures to States
$240
$220
35%
Reduction in
Expenditures
by 2006
(/)
§ $200
.
:== $180
co
~
<
.e $160
~
-
$140
~-U20=r
~
$100
$80
_L _ _ _ _ _ _
1996
1998
E- Baseline Growth
2000
-
2002
2004
2006
Baseline Minus 20/0 -_.. 5% Growth
�... _.
__ ....
.....
_--
--
_
......
_-
~
--
-
Medicaid Services and Recipient Expenditures
(Dol/ars in billions)
... --
.....
__
...
_
1997
-7.0
Cost of Services (Federal and State Share)
DenIal
Drugs
EPSDT
Home Health & Hospice
Medicare Premiums & Cost Sharing
Personal Care Services
Cost of Services for Recipients (Federal and State Share)
AFDC Adults
NonCash Kids (DBRA Expansion)
QMBs/SlMBs (1)
Medically Needy
I
-66.3
-1.9
Reduction in Total Program Funding
2005
-3.9
-17.6
-9.3
-1.1
-4.0
-2.5
-5.8
-4.7
-10.8
-7.1
-3.8
-12.0
-4.3
I·
-4.7
C.__
(\) Since the.e are no data thaI separatety eslimate cosls associated with QMBs/SLMBs. this estimate is the full ()(lsI
of Medicare premiums and ()(lst sharing.
NOTE: All 01 theS€ eltects vary signirICantly acro5-S slates.
-24.4
-9.5
-10.8
-38.8
I
�Changes in Insurance CO'verage
1989 to 1994
1989
1994
Employer 59%
Employer 66%
Uninsured 16%
Uninsured 16%
OHler 11 %
Olher 9%
Medicaid 9%
Medicaid 14°/"
SOURCE: The Urban Institute analysis of the TRIM2-edited March 1993 Current Population Survey.
The 1969 data represent an average of three years, 1988-1990, with 1989 data having a weighl of .50 and 1988 and 1990 data having weights of
:25. The 1994 eslimates are based on 1993 CPS data on insurance coverage as adjusted by The Urban Institiute's TRIM2 microsimulation model
and 1993 HCFA data on Medicaid enrollment. Estimates for 1994 were derived usirigCBOprojecuons of changes in insurance coverage.
�f
.
.
MEMORANDUM
TO:
FR:
RE:
cc:
Carol Rasco
Chris Jennings
porus Medicaid briefing
Jennifer, Jeremy
January 26, 1995
. Attached is a backgroun<d memo on the Medicaid block grant/cap that we hope you
will find useful in preparation f6r the short briefing we currently have scheduled for the
Pi-esident at 2:15 today. In ligh~ of Governor Dean's supportive comments about the
Medicaid capping idea (see atdched article, which by the way his staff is now trying to
..
I
disassociate himself from) and the virtual certainty that Republicans are planning to use
Medicaid as their cash cow, thiJ discussion seems more and more timely.
Consistent with your gUibance, the presentation before the President will be drawn ,
I
fro'm a much shorter, bulleted <document. It will be broken off into four sections tentatively
titled: (1) Medicaid: the Ctirreht Budget and Political Environment; (2) Advantages
, Disadvantages of Going the Metlicaid Cap Route; (3) Budgeting Implications for States; and
(4) Possible Alternatives.
'
Jen and I will be prepared to also discuss the ERISA issue, as well as to give a quick
update on the status of the new cost estimates of the policy preferences he asked for at our
December 22nd briefing. Since he mentioned t,he outline of his health care reform "vision" in
the State of the Union and because health care is being reported in today's papers, we thought
he might have sOme of these qJestions in mind. Hopefully, he won't because a solid briefing
.
I
On anyone of these issues would obviously take mote than the 15 or so minutes we have
. 'available today.
Carol, oile staffing question for the briefing: for political and budgetary reasonS, Gene
.
I
Sperling is very interested in this issue. I am certain tha:t he would likely very much warit to
. attend any briefing on it. He dbes not know about today's meeting, but I am wondering if we
should invite him to attend? I believe it might well be advisable.
,
Lastly, from what at IJst I am picking up, it still seems likely that. most of the
. I
(even from Alan "'Ieil and his Governor) -- for, different reasons -- do not want
this issue to come up at the NGA meeting. Having said this, the issue still seems likely to be
, to be raised at the DGA nieetink. All the more important why you are there on Saturday
and why I will follow up on your note to make sure that happens today. Talk to you soon.
p~rticipants
�Welfare Reform Working Session
Agenda
8:30 am
Owning
PrJident Clinton
Vicb-President Gore
8:50 am
wJrklWelfare
Lea6 Discussants:
9:45 am
10:30 am
parental
R~sponsibility
Lea~ Discussant:
Te~n
St+ Flexibility
LeaCl Discussants:
Wr'ap-Up
1:30 pm
Governor Tommy Thompson
Pregnancy/Out-of-Wedlock Childbearing
Lea1d Discussant:
11:15 am
Governor Arne carlson
Governor Mel Carnahan
Adjourn
. Governor Thomas Carper
,
Governor John Engler
Governor Howard Dean
'
�Welfare Reform Working Session
Agenda
8:30 am
Opening
PrJident Clinton .
8:50 am
:t:~:::eGore
. LeJd Discussants:·
9:45 am
Parnla] Responsibility
LeaCi Discussant:.
10:30 am
Governor Arne Carlson.
Governor Mel Carnahan
Te~n
Governor Tommy Thompson
Pregnancy/Out-of-Wedlock Childbearing
Leab Discussant: Governor Thomas Carper
11:15 am
'I
S~ar Flex)'b'l'Ily
I
LeaCi Discussants:
Wrap,.....Up
1:30 pm
Adjourn
Governor John Engler
Governor Howard Dean
�Welfare Reform Working Session
Agenda
8:30 am
Opening
I>d"
Prest ent
CI>mton
vit-PreSident Gore
8:50am
WorklWelfare
Lejd Discussants:
9:45 am
PaFental Responsibility
Lea1d Discussant:
10:30 am
Governor Tommy Thompson
Teen Pregnancy/Out-of-Wedlock Childbearing
Lejd Discussant:
11:15 am
Governor Arne Carlson
Governor Mel Carnahan
Governor Thomas Carper
I
">b>l>
Sta,te Fl eXl 1 Ity
Jd Discussants:.·
Governor John Engler
Governor Howard Dean
Wr:ap-Up
1:30 pm
Adjourn
�r
Welfare Reform Working Session
Agenda
Opyning
8:30 am
PrJident Clinton
ViJ-President Gore
"
8:50 am
I
WorklWelfare
Lea6 Discussants:
9:45 am
10:30 am
Parental" Responsibility
Lea~ Discussant:
Te~n
Governor Thomas Carper
Stale Flexibility
Leab Discussants:
. Wrap-Up
1:30 pm
Governor Tommy Thompson
Pregnancy/Out-of-Wedlock Childbearing
Lea6 Discussant:
11:15 am
Governor Arne Carlson
Governor Mel Carnahan
Adjourn
Governor John Engler
Governor Howard Dean
.
�Welfare Reform Working Session
Agenda
8:30 am
Opening
PrJident Clinton
Vick-President Gore
I
8:50 am
..
Work/Welfare
Lea6 Discussants:
9:45 am
palntal Responsibility
Leatl Discussant:
10:30 am
sial
Governor Thomas Carper
Flexibility
. Lea6 Discussants:
Wrap-Up
1:30 pm
Governor Tommy Thompson
Teen Pregnancy/Out-of-Wedlock Childbearing
Lea6 Discussant:
11:15 am
. Governor Arne Carlson
Governor Mel Carnahan
Adjourn
Governor JOM Engler
Governor Howard Dean
.
�THE CLINTON REi'CORD ON
'WfLFAREREFORM
.
Pres:Ldent. Cliriton has' a prov~n t:rack £ecord of.'
commitment to welf~rereform. Since' his first term a's
, . ~ove,r. ri61:,,, . he ,.ha.s ~s,tl'~essed h1,s ~~lie.f that w~~fare .
"should be a second chance and not a way of l1fe. As
.. .' 'G~vern6r ;of.'Arka:nsas f h~ mov~d. i .., , O'()Q, p'eople from
welfare.towork,· 6facked down 'ohdeacibeat parants, arid
.:' prc)'vid~Td' t~x'relielf ,'(or low-irlcorne families .., A '
.:.".dr:Lving·force b'ehihd national, r~form, his leadership
..a.s c~a.i:tman '~f t?el,~a~i~rial Gov:e.£~or' ~ . A~socia~ion was
central to' the passage of t~e Fam1ly Support Act of
19'88.
'
.
.
.:,
'
..
..
. NATfoWALLEADERS'HIP . IN PASS:i:NG FAMILY SUPPORT ACT .
'., . ,'- " .,.:', ',~ "., ...' .,.... " . ' ,.-I.' "",' '. '" '. ::'.';" .' :'. '. '.:: .
... ..
*
. As' Cnairman
'of tl'ie National 'Governor' s As'sociation,' 'Clinton
h~lp'ed ,:gu:L'de'to pa's§age the .landma'i:'k. Family Sup'port ACt'Of 1988.
(A c6rtlpr'etlensive revisi6n . Cif the Aid to ' Families. with ..
Dependent
"
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Children PrO'gram ahd 'FitleIV ofth'e Social Security Act).
.
sgovernors to restructure
L'aiu'ichi'ng ..,a'..maj or,,'eff6rt by, theriati6ri' .. ' ' .
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tl'ie federal. welfare laws,. he helped secure' support for welfare
tb~wdrk,),e.~#s~,~t~on~lthe,,~~esul t w~~ :,:t119 .Fa~ily . SUPPo:rt, A6't bf
1988, wh~ch requ~res welfare recip~ents to move . toward'.
inde'pendence . through' ~dudation, training and work. The 'act was'
based on a' proposal adopted by the '. National Governor's
· Associatioh.in 1987,' Jhen: Clinton was 'Chairman.
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.. ' fOI;C9"thell. develdpe'd,a policy. which', captured the thinking. and
,
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'e:xpef,~'~n~~~,~~ .. :;~~:r~~~'sl st~t~~wide. Wel~€l~'~, ref6r~ •.: efforts:....
'.~, ....
.
. . r'
" A.~ ;,tlleir annual. y,rinter meeting ,in', 1987 " the. governors .'
overwneliii'ingl'y adopted this policy Wh1.6h would begin the effort
, ." , t o transform welfare from an income maintenance program into an
.' :" empowerment' 'prO'gram ·et.icouI:a:~#ng indepehdE{nde arid support-.· .
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Clinton ..testified before the U,.S. House Committee on Ways
, .' ~:~d,..t~~,a~~,;c?·~· ~,~~,:r:uatr:124} ,~9:87 to,pr~'¥e,~t ~his, forwa~d':thinking
pol~cy wh~ch.would
Act on·:1988.
bea:ome the
. I
'.
centerp~ece
of
.theFam~ly
Support
'* .' As: ih:~lead Gove'ri1.6r On welfare're'fdrm, for the National
Gdve·tnor.' s'-t. AssociatioA, Clinton then testified before the u. S.
. ;
. .:'" ,)
· Senate Comm~ttee, on Finance on October 14, 1987 .
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The, goals.
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qf:t:h~sact"which
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Clinton helped write, are to
.:,' .. ,e.~I?,~(i,~~#:~;. :~9.~k~",.~hi~d,lsupp6r.t and:fam~lY. berief~ ~s, arid to , .
encourage and '. assist a:hildren and parents in need to obtain the
,."'
.:,
.
~:.
'
..
'
�, ,educatiOn", training and emI)loyni~rit necessary to avoid long-term
, 'welfare dependence.'
,p:coject',su:6ces's:,
',
.'
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.
, ..
* ,.To comply with, the Family Support Act he helped author, then
Governor. Clinton imp'l~merited Proje'ctSuccess in 1989 •., , By"
: "'"
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..- '
',pr'oviding ,participants "with Medicaid, . child care, and ,other
,,·.1,
.. '
',neede'dassistance,' the program moved 17,.000 people from welfare
'>. ", ,-"
',
.',
, to, work (over the couDse of a 3 year period ,Arkansas Department
of Hurifan SerVi~eS)..
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ARKANSAS: A RECORD
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*", ", c=.,~il1:t0n .wa.~,,~ls0.la na~ional ~e~&~r,,in ,,1:11:13 ,~ffort ,to
, Child Sup'pott ': EnforCel1)ent:
identify
fathers, and.' aggressively enforce child support orders. Under his
" leadefsJ:ii~ ,,::, ~l1~,st,~te, '1~. ~r~~nsas ".~hild ~,ilpport., E'l1forc~m:e-~t, u.ni t
, withheld ',1ncome for cJ:hldren' s health care coverage, reported
",f
.some, overque" support" payments to," ' , '
consumer reporting agencies, , and
,.
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estab11shed'arebuttaole presumption of,patern1ty in some cases.
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The Arkansas Child Support Enforcement' Unit "received national,"
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recognition for,identifyirig fathers'and aggressive enforcement of
~~~~da~~g~~'rtPilYiitehl Child suppOrt collections grew by 20% in
....
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Liftirifi ,A ,Poor ,Sb3.te l)p;Driving a Great Nation Down:
In spite of a 21% rise in the U.S. ' Poverty Rate from 1979
,,1
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, ..
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'rose.23%duririgthis 'same period (1979
1991), this figure
, declined .iii' A~karisas l!;y 14%.
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Tax Breaks:.,for\theWoli'king ,Poor: ... '
* '" In.1991. Clinton ~liminated taxes.
,
,taxpayert~f;
,-'.
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,,
for 252,000 low income
',a:nd reduced taxes for 'another 122, 000 lower..::rttiddle
,iri6oin~.peOple.
"
,
'.
\
�
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Carol Rasco - Issues Series
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Carol Rasco
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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POTUS Welfare Briefings 26 Jan. 1995 2-2:30
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<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
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2010-0198-Sb-potus-welfare-briefings-26-jan-1995-2-2-30
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https://clinton.presidentiallibraries.us/files/original/eddf98161b6361420bebec64cadbcb75.pdf
8c90830ad5c00f4bfd11728b992afe37
PDF Text
Text
January 5,' 1995
Dear 1-:
We have an opportunity to make historic change in the way
that Washington works and the government does the people's
business.
This week, the Congress has begun to take important and..
positive steps to change its operations for the better.
Shrinking the number of committees, re~ucing staff, and other
measures are valuable, and long overdue. The passage' of
legislation that would apply to Congress the laws that apply to
the public is only fair, is simple common sense, and is also long
overdue. I hope that this time, unlike the last session of
Congress, the Senate follows the House's action. I congratulate
you on these steps.
But true congressional reform must reduce the power of
lobbyists and special interests. The' power of organized money in
Washington hurts the middle class, bloats spending and the
deficit, and blocks needed change. Today, some'90,OOO people, in
Washington are associated with lobbying Congress on behalf of
specific interests, which too often are able to manipulate the
congressional process to insert spending projects or tax
provisions in legislation that do not serve the larger public's~
interest. Lobby power coupled with the ever-escalating cost of
campaigns, which has risen fourfold over the past ,two decades,
gives wealthy interests and wealthy candidates disproportionate.
influence in decisionmaking.
These are· ·not partisan conCern$i they are ~..merican ·concerns~
I urge you, as yqu.undertake the,task of reforming Congress, to,
take on these real political reform issues.
_·~" _ _ _ '~4_~
First, as you enact legislation to apply general laws to
Congress, i t is vital that professional lobbyists be barred from'
giving gifts, meals and entertainment to members of Congress
just as they are now barred from giving these benefits to
executive branch officials.
,
Second, Congress should also, quickly enact'legislation to'
bring professional lobbyists into the sunlight of public
scrutiny. The. current lobby disclosure'statute is cumbersome and
antiquated. Lobbyists should disclose who their clients are,
what bills they seek to pass or block, and how much they are
paid.
Third, I am pleased that the Congress wants to pass a line
�veto authority for the President, something that I have
consistently supported before and during the 1992 campaign and
since. The line item veto authority will help us cut unnecessary
spending and reduce the budget deficit. It is a powerful tool
for fighting special interests, who too often are able to win
approval of wasteful projects through manipulation of the
congressional process, and bury them in massive bills where they
are protected from Presidential vetoes. It will increase the
accountability of government. I want a strong version of the
line item veto, one that enables the President to take direct
steps to curb wasteful spending. This. is clearly an area where'
both parties can come together in the national interest, and I
look forward to working with the Congress to quickly enact this
measure.
i~em
Finally, we must clean up political campaigns, limit the
cost 'of campaigning, reduce the role of special interests, and
increase the role of ordinary citizens. Real campaign finance
reform, too, should be an area of bipartisan cooperation.
Requiring broadcasters to provide time to bona fide candidates
would cut the cost of campaigning and ensure that voters hear'all
arguments, regardless of candidate wealth. strong proposals for
free TV time have been introduced in previous years by Senator
Dole and by the new chair of the House Commerce Committee,' Rep.
Thomas BlileYi these proposals should be the basis of agreement
on reform.
I look forward to working with the Congress to achieve
results that are bipartisan, bold, and give the government back
to the people.
Sincerely,
The Honorable 2
washington, D.C. 3
�Possible Iilsed for POWS' memo reDemoetatic Leadersbip Meeting:
','
Health:
The House and Senate Democratic Leadership are taking different but generally
consistent approaches . to their health care legislative/political strategy. BOth Leaders
feel that ·the, Democ~tsshould challenge Repl:lblicansto produce a health care. bill
while, at the same time,' assuring that the Democratic health care position is not overly'
vulnerable to criticism. '
As you know, Leader Dasehle introduced his health refonn iriitiative on
Wednesday. ,It could be described as consistent with the. vision you layed out in the ,
attached December 27th letter which you sent to the Congressional Leadership. The
, package does NOT include specific fmancing.'
You may siJDply want to ask them their 'current thinking on political strategy with
regard to health refomi.
'
�;.
THEWHITE HOUSE
WASHINGTON
January 23, 1995
MEMORANDUM FOR
THE CHIEF-OF-STAFF
GEORGESTEPHANOPOULOS
MARKGEARAN
MIKE ,MCCURRY
PAT GRIFFIN
CAROL RASCO
FROM:
MICHAEL WALDMAN
SUBJECT:
POLITICAL REFORM PROPOSAL "WHITE PAPER"
;v.I
Attached is a document outlining the administration's political reform
proposals that are likel:y to be discussed in the State-of-the-Union.
These proposals have been approved by the President (in a meeting in
November) but not yet been publicly released by the administration. They are all,
in effect, a restatement of positions previously stated during the 1992 campaign.
The argument for releasing, these tomorrow is that it is a way to' release the
proposals in a way that will get some coverage -- but will certainly not dominate
coverage -- without scooping the rest of the speech.. We do not now have another
logical window on the schedule for the release of our political reform proposals ...
and I think it's a little strange to keep talking about these matters without a
fin.a.lized, public proposal.
'j'
The argument against releasing them is that they conflict, in some way,
with the intended news story and themes. That is beyond my purview.
cc:
Bruce Reed
Bill Galston
Paul Weinstein
Clifford Sloan
Ginny Terzano
�draft 1/23 6 pm.
PRESIDENT CLINTON'S
POLITICAL REFORM AGENDA
Proposals discussed in the State-of-the- Union Address
Embargoed until 9:00PM, January 24, 1994
SUMMARY
i,'
In tonight's State-cf-the~UniO!llAd~ess. Presid~nt Clinton will advo('.s.t~
strong political reforms to reconnect the government with the people. These are
based on the proposals he made during the 1992 presidential campaign:
-.a ban on gifts from lobbyists to Members of Congress
- lobby reform legislation
.
- campaign finance reform legislation based on the idea of free TV time for
candidates
THE PROBLEM
Americans no longer trust their government. They believe that the political
process elevates the voices of narrow interests over the national interest. And
they are demanding genuine change in the way that Washington works .
. In his first two years in office, Presi~ent Clinton has pursued a wide
ranging political reform agenda. He imposed the toughest-ever ethics code on his
appointees. requiring top officials to sign a pledge that they would not lobby their
agency for five years after leaving government, and that they would never lobby
for a foreign government. His 1993 budget closed the tax provision that allowed
corporations to deduct the costs of lobbying expenses. He signed the Motor Voter
.law, increasing voter registration. And he has taken concrete steps to bring the
government closer to the people -- cutting the White House staff by 25%.
eliminating executive dining rooms, and curbing the widespread use of
government limousines. In addition, he supported tough campaign finance and
lobbying reform legislation. Unfortunately, those bills failed to pass the last
Gongress. :
.
The underlying need to reform politics has not changed.
e.
Washington has 3 times as many registered lobbyists, and 6 times as
many PACs, as two decades ago. Interest group profusion really is
getting worse. By one estimate, the "influence industrytt now employs
90,000 people in Washington -- a number that would overflow RFK
stadium.
(
Campaign spending continues to soar, giving big money an even
bigger role on our democracy. In 1994, spending was up 23% from
�the last mid-term election four years ago.
•
•
The "influence industry" affects policy, to the detriment of the middle
class. Opponents of health reform spent $300 million to block reform,
according to Newsweek. . ,
'. The special interests haven't left town since November 9. For
example, earlier this month, according to B~ll Call, Phillip MorriS
lobbyists handed out invitatiop.s to Senators for a golf and tennis .
, .weekend in Palm Beach.
PROPOSALS
Banning gifts from lobbyists
Congress should enact legislation that bans professional lobbyists from
giving lawmakers and their staff gifts. expensive meals. vacations. travel and
entertainment. This proposal passed both chambers of Congress last year -- it
received 95 votes in the Senate -- but died when the overall lobby reform bill was
successfully filibustered at the end of the, 103rd Congress.
Lobby. disclosure
The current lobby disclosure laws are antiquate9. and contain numerous
loopholes that allow professional lobbyists to avoid disclosure. 1 Passed in 1945
and never since ainended,~ the lobby disclosure laws
The administration believes that Congress should quickly act on lobbying
legislation that:
•
·1 '.
-, .
Reguires all professional lobbyists to register. including those who
lobby the executive branch. (Current law only requires those who
lobby Congress to register.
•
Requires professional lobbyists to fully disclose who pays them and
how much they are paid -- including the memb~rship of Washington
coalitions that disg~e their expenditures by paying lobbyists.
•
Requires professional lobbyists to disclose with specificity their
interest (e.g., supporting or opposing a specific bill).
('
I
!
1
2 USC 261 et. seq.
2
�Lobby reform should not get sidetracked by 'provisions •• in particular, the
grassroots lobbying provision .. that were seized on by some as a reason to oppose
last year's bill.
.
.Campaign finance reform
Campaign finance reform is central to any effort to change Washington,
renew politics, and give government back to the American people .. The public
rightly believes that big money has too much influence on elections; that PACs
give ten times as much to incumbents as challengers because they are seeking to .
influence policy; and that lobbyists and narrow interests have overwhelmed
Washington. At the same time, voters are disgusted with contentless campaigns
that throw mud instead of.shedding light.
Campaign finance reform has been stalled by- partisan fighting and. by
controversies over public.financing. President Clinton calls. on Congress to break
through the gridlock and enact balanced, credible legislation.
•
Free television time for candidates who abide by voluntary spending
limits.
I
One reform would do the most to enhance democracy, connect
candidates with voters, diminish the need forfundraising from special
interests, and level the playing field between challengers and
.
. incumbents: requiring broadcasters to provide free television time for
bona fide candidates who abide by spending limits.
Broadcast costs are the chief factor in rising campaign spending:
.Today, at least 40% ·of all political campaign expenditures .• and up to
75% in some markets .. are spent on media advertising. By one
estimate, candidates spent $350 million for last November's election,
a 17% increase in two years. Requiring broadcasters to play their
part in democracy by giving ca.ndidates free time is an appropriate .
. condition for their public license. _ .
Free TV was advocated by President Clinton as a candidate in 1992,
and has been supported by Ross Perot and by a bipartisan panel '
brought together by Sens. Mitchell and Dole in 1991. The
administration believes that proposals already introduced should be .
the basis for bipartisan compromise:
3
�,"
I
Senate -- Legislation introduced by Sen. Robert Dole2 would
require each broadcaster to provide 5 hours of time to be
divided among candidates. This would be split among major.
party candidates; minor party ca:Q.didates would be eligible for
free time in a reduced amouilt.
House -- The strongest proposal for free TV time for House .
candidates has been introduced by Rep. Thomas Bliley, chair of
the House Commerce Committee.s It would require licensees to
give 2 hours to the state committee and 2 hours to the national
committee of the major parties, to be parcelled out by them to
candidates as they see fit. This would address the major .
complication for any broadcast reform proposal: the few
markets where as many as 40 candidates use the same
broadcast market..
The administration believes that this time should be used to improve
the quality of debate and break .the hegemony of the 30 second attack
ads..
- Candidates who accept free time should be required to debate.
- The television time would be made available by the station in
the form· of interviews, speeches, town meetings, or other
. formats that involve the candidate t8.J.king to the camera.
Spending limits should vary by size of state for Senate races; the
sp·ending limit should take into account the value of free TV.
•
Sharp limits on contributions from PACs
Political Action Committees should be. limited in their giving to $1000
per election per candidate _. the amount an individual can give ..
down from $5000 today.
.
•
Ban on contributions from lobbyists
As the administration urged in the 103rd Congress, lobbyists should
be barred from giving campaign contributions to, or raising funds for,
2
S. 7, 102d Cong., 1st Sess., section 501.
S
H.R. 2161, 102d Cong.lst Sess.'
4
�the lawmakers they contact for one year following the contact.
Similarly, the lobbyist would be barred from lobbying the lawmaker
within one year after the contribution. In addition, strict bundling
rules should be enacted to ensure that the limits on PAC and
individual contributions are not effectively evaded.
•
Self.financing candidates
In a democracy, indiViduals should riot be. able to try and buy public
office _. and non-wealthy individuals should not be "priced" out of
running for office. Yet today, wealthy individua4; can give their own
campaigns huge, unlimited contributions. [The problem is getting
worse: in the recent campaign, one candidate spent $28 million of his .
()wn money to. unsuCcessfully seek a Senate seat.] The administration
supports capping the amount that a congressional candidate can
contribute or lend to his own campaign.
Soft money
The administration's soft money proposal, passed by both chambers in
the last Congress, should be the basis for soft money reform .
•' The legislation bans the use of soft money in federal elections
and for national party committees except for narrow purposes
(e.g., for transfer to state parties).
- All state party grass-roots activity that benefits federal
candidates would be conducted through state party Grass Roots
Funds. These committees would be funded only through "hard
money," raised and disclosed under federal limits (i.e., no direct
.
corporate or union treasury money).
"',
/1'
..".
- Individuals would be able to donate up to $60,000 per cycle;
within that aggregate limit, individuals can donate up to
$25,000 to candidates, and $20,000 to the national party
committees and to state party Grass Roots Funds.
5
�MEMORANDUM FOR THE PRESIDENT
THROUGH:
THE CHIEF-OF-STAFF
FROM:
MICHAEL W ALDMANnJ
BRUCE REED ~ ,
SUBJECT:
LOBBY REFORM INITIATIVE
\ At your request, we have prepared a set of Initiatives that would put you out front on
the lobby reform and political refo~m issue.
We believe that this issue cuts to the core of why people have lost faith in government
and are angry at politics. The middle class truly believes that powerful interests hold sway,
and that their voice is too often ignored.. At a time when Congress' unpopularity is rising,
even as the GOP's overall popularity is holding steady, this issue allows yo'u to position
yourself against the part of Washington the public hates most.
However. this very cynicism makes it hard to persuade people that we are serious. and
risks bruising us if we are perceived not to be. Therefore. we believe that this issue is worth.
pressing only if it is done in a sharp and sustained way· .. if it can become and remain a
central theme over the next 18 months -- or it may not be worth· doing at alL Therefore, we
need a clear direction from you on how to proceed.
I. BACKGROUND
Political reform continues to be. a core issue for the Perot voters and independenis.
(Public opinion research is und~r separate cover.) It also has the potential to pe a wedge
issue between you and potential Republican opponents -- who tend to favor wealthy special
interests at the expense of the middle class. In fact, this is one of the few major areas where
the Republicans have completely ceded the field to us, if we choose to enter it. At the same
time, if we approach 1996 with few political reform achievements, we will be vulnerable to
attack from Perot or some other independent candidate from outside Washington.
If a decision' is made to engage on political reform, now is the time to do so, for
several reasons.
.
- Congress' First 100 Days is ending, with a sense that it has not reformed itself. In
particular, the defeat of term limits will mean that Congress passed no major reform of
�itself. In addition, the press is finally' beginning to paint the GOP Congress as a tool
of wealthy special interests -- as Time has put it, the GOP has granted "unprecedented
access" to lobbyists. (For example, the Washington Post reported that lobbyists wrote
the regulatory moratorium bill, and were even given a room off the House floor from
whiCh to operate; the New York Times reported that GOP members were refusing to
talk to1lobbyists who had contributed to Democrats; and it ~as widely reported that
the GOP used lobbyists to conduct the official briefing on their regulatory reform bill.)
- The GOP presidential race is being heavily defined by the so-called $20 million
. fundraising entrance fee.
- Your announcement of your own organizational plans will fQrce the issue of what
restrictions you are willing to put on your own fundraising. Next year, the need to
raise tens of millions of dollars will bring into higher relief the question of campaign
financing.
- Democrats in Congress are starting to become active on the. matter once. again, albeit
in a guerilla fashion. Rep. Bryant (with the support of the Democratic leadership) is
filing a discharge petition to bring up the ban on lobbyist gifts; Sen. Wellstone plans
to seek to attach the gift ban to legislation ~ometime before the Easter recess.
- A bipartisan group of moderate lawmakers is becoming visibly active. A group led
by Rep. Chris Shays has put forward a package of lobbying and other political
reforms, and will be pressuring the leadership to act.
- You led the State of the Union' with a call to act. but your Administration has not yet
fleshed out those proposals in public.'
II. OPTIONS
Here is a set of initiatives that could be announced immediately. They could be
announced in one major speech, or coulq be broken out (unilateral steps,legislative proposals,
a speech on democracy and citizenship) for maximum effect.
Lobby reform
1. Renew the call for a ban on lobbyist gifts, meals and travel to Members of
Congress. This is being pushed by Democrats in both chambers. During the State-of-the
Union, you called for Members of Congress to voluntarily give up . lobbyist gifts.· Because of
its stark simplicity -- lawmakers being treated to tropical vacations by lobbyists, etc. -- this
has the greatest resonance of any political reform proposal.
2
�2. Renew the call for reform ofthe lobby disclosure laws. The current lobby disclosure
laws, passed in 1946 and basically untouched since, are more loophole than law. Lobby
reform legislation would require all lobbyists, for the first time, to fully disclose for whom
they work, what they are paid, and what legislation they are trying to pass or kill. This
measure is ";lore .complex than the gift ban, and conservative grass-roots groups (such as the
Christian Coalition) may succeed in bogging it down; nonetheless, it is good policy and
resonates somewhat with the public.
Campaign reform
,
3. Spell out your free TV time proposal. Apart frpm your brief mention of it during
the State of the Union speech, we have never fleshed out your proposal to provide free TV
time for candidates. Senator Dole and House Commerce'Committee ctiairmanBliley have
proposed strong free TV bills, and the concept is supported by Ross Perot, the DLC and
Common Cause. This proposal could be laid out in a speech on democracy that could be
high-toned' and would not necessitate a subsequent crusade.
4. Alternately, propose a bipartisan commission to "cut the Gordian knot" on campaign
reform -- and pledge to introduce its recommendations. Former FEC Chair Trevor Potter has
proposed that the campaign finance reform conundrum be solved by legislation creating a
base closing commission-style panel that would make recommendations for reform. The
President would be required to propose the reforms unchanged, or reject them, and Congress
would agree to vote on them without amendment. Senator Dole has endorsed this proposal.
This commission itself would require legislation to be launched. (Alternately, you could
appoint your own bipa,rtisan c~inmission to make recoinmendations; but it would not have the
teeth of a base closing-type panel.)
Pro: This would actually bring us the closest to enacting sOIne form of reform. It
would also be a way to have the issue taken "off the table" for a time, and to enable·
us to refrain from making proposals that we do not live under.
Con: It eliminates this issue as an effective club to use against Dole, up.less he is .
unwilling to embrace the panel's proposals. In addition, we won't know in advance
what the proposal would look like -- it could be weak, or it could include proposals
that are hard for Democrats to swallow.
Unilateral steps on campaign reform
5, Lead by example. To reengage in this debate, you will need to show that you are
willing to act by restricting your own campaign committee. When you announce the
beginning of campaign activities on your behalf, you have· the following options:
3
�a. Direct the reelection campaign not to take PAC money (you did not tak,e PAC
money during the 1992 primaries either), but impose no further restrictions on your
own fundraising .. (Dole, Gramm, etc. are all taking PAC funds.)
b. Direct the reelection campaign not to take contributions from registered lobbyists .
. (This is now the standard followed by the Presidential Legal Expense Trust.) This
would go beyond what you did in 1992,
Pro: You have already legislatively proposed that lobbyist campaign
contributions be banned. In addition, the decision to refuse such gifts by the
Presidential Legal Expense Trust· has established a difficult-to-ignore precedent.
(Indeed, even if we say nothing, reporters will hone in on this inconsistency);
Given the small number of lobbyists who actually register (about 7000), it may
not directly cost the campaign that much money.
.
.
.
Con:.It ~ould raise a standard that the DNC will not be able to meet (i.e.,
"You won't take $1000 from a lobbyist, but the DNC 'will take $50,000 from
the lobbyist'S client. "). Moreover, it might anger some Democratic supporters
and fundraisers based in D.C. We can discuss potential fundraising·
.
consequences with you further if you desire.
Note: If the decision is made to refuse lobbyist contributions for the reelection
campaign, we recommend that the Presidential Legal Expense Trust return the
approximately $12,000 that was received from registered lobbyists.
c. Direct the reelection campaign not to take contnbutions donated by registered
lobbyi~ts, or raised by registered lobbyists.
Pro: This option would make sense.if you wanted to refuse campaign
contributions from lobbyists, but believed that the press: would regard that step
alone as phony or hypocritical.
Con: This would cost more money, and would raise the next question: what
about lobbyists raising soft money? There may be no end to the "what next"
questions,
d. In addition to, or instead of, b. and c., publicly ask the DNC not to raise soft money
for the general election campaign, if the RNC will agree to refrain from doing so as
well. In effect, this would challenge the RNC to a "mutually verifiable freeze" without
"unilateral disarmament." The GOP is highly unlikely to rise to the bait. This is
similar to the pledge you signed in New Hampshire i~ 1992.
4
�Foreign lobbyists
6. Take new action against foreign lobbyists by barring your officials from meeting
with lobbyists for foreign governments or corporations. Your executive order imposing post- .
employment restrictions has already barred senior officials from ever lobbying for foreign
governments, baired senior trade officials from lobbying for foreign firms, and barred all
officials from lobbying their own agency on behalf of any client for five years. A further
restriction would be to actually bar your offidals from meeting with foreign lobbyists.
Pro: This is sharp, clear, and understandable; the foreign .lobbying issue plays to
concerns over economic nationalism as well as political reform.
Con: The argument against it is that it would be unduly harsh, is unnecessary from a
reform perspective and possibly counterproductive from a policy perspective, and
would focus attention on those issues where we have worked with foreign lobbyists
(e.g., NAFTA) and on former fo;eign lobbyists in your ad~inistration (e.g., Sandy
Berger, Ron Brown, Charlene Barshevsky).
III. RECOMMENDATIONS
1. Renew the push for a ban on lobbyist ·gifts
_
Agree
_
Agree as amended _
Reject
No action
2. Renew the push for lobby disclosure legislation
Agree
Reje~t
Agree as amended _
No action
3. Spell out the details of your free TV campaign finance proposal
Agree
_
Agr~e
as amended _ . Reject
No action
4. In terms of unilateral steps:
a. Refuse to accept PAC contributions, as you did in 1992.
_
Agree
Agree as amended _
Reject
No action
b. Challenge the RNC to join with the DNC in not accepting soft money, as you did·
in 1992.
_
Agree
Agree as amended _
5
Reject
No action
�c. Refuse to accept contributions from registered lobbyists for your reelection
campaign (the standard used by the Presidential Legal Expense Trust).
_Agree
Agree as amended
Reject _
No action
d. Refusing to allow registered lobbyists to fundraise for your reelection campaign.
_
Agree
Agree as amended
Reject _
No action
5. Barring your officials from meeting with foreign lobbyists
_
Agree
_
Agree as amended
Reject
No action
The staff unanimously recommends that you:
-
renew call for ban on lobbyist gifts
push for lobby disclosure
discuss free TV time proposal
unilaterally refuse to accept PAC contributions for your reelection campaign
The 'staff unanimously recommends against:
, - barring your officials from meeting with foreign lobbyists
The staff does not have a consensus recommendation on:
- unilaterally rejecting lobbyist contributions
~ unilaterally rejecting lobbyist contributions and fundraising
- challenging the DNC and RNC to agree not to raise soft money
- proposing a bipartisan 'commission on campaign reform
6
�
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e6378329a84aedd35f99c214ba77d553
PDF Text
Text
03/31/95
,12: 18
III 0011011
MAR' 3 I 1995
EXECUTIVE OFFI~ OF TH~ PRESIDENT
OFFICE OF MANAGEMENT AND BUDGET
WASHINGTON, D.C. 2D5Q3
Jlarcb2'8, 1995
THE OlRECTOR "
11-95-Q8,
MEMORANDUM PORM HEADS OF EXECtf.r'IVE DEPARTMENTS AND AGENCIES ,.
FRQM:AlIceM. Rivlin
SUBJECT:,
,
r
'.
'pe~p'3nne~ ~ ~
~X
,
.....
'
The President's FY 1996 Budget includes several proposals that dramatically change the'
way theF,ederal' government, works.with Spites to, achieve tile goals we share. , These , •
"Per{onnapce Partnerships, n, which we have proposed in the areas of environmental protection,
public health, and housing, among .others. represent a fundamentally J1ew way of 'doing
business. Neither the block grants 'of the early 19805 and the mynad narrow categoriCal
programs thatexist today integrate flexibility and accountability. Irieontrast, Performance
Partnerships are an opportunity,'for the,Federal government and the States ro exchange funding
restrictions for anew, in~ntive-based focus on performance and outcomes.
Perfonnance partnerships work best: (1) when the Federal Government intends ,that
services be delivered, at' State, and loca1 levels, (2) where there is shared agreement am9ng ,
Federal, State and local partners about national goals' and objec~ves, and (3) where progress
toward the goals"and, objectives can be measured.'
,
'Perfo~ance partnerships consoiidate funding streams and eliminate ovc;rl~pping .',
.authorities" create incen,tives to reward' desirabl~, results and reduce micromanagemeot 'and
wasteful paperwork,. ,They begin to move programs away from process and focus on outcomes
and outputs as' the' basic measure of succes's. ,The, partnerships seek to empower communities to
make their own decisions about ~ to address, their' needs',
to be held accountable for
.'
results.
"
,
and
During the second phase of reinventing 'government, one of the major Q.uestions that we ,
are asking is whether arnot the work ~e do inWashingron ~ be done better by States,
localities or private citizens. You should use the attached "Performance PartnerShips
Summary and Guiding Prin,ciples~ as a Set of "reburtable presumptions" as you'design '
'
, perfonnance partnerships in, your agency.
Our goal must be,.to dramatically ies~cture the relationship.between the Federal
Government and the States and localities ro create stronger partnerships. Perfonnance
partnerships provide a~ew opponunity to provide StateS and localities more flexibility to· solve
theirprobleins•. in return for more accountability for results.
'
•
Attachment'
"
•
I
"
•
�..
03/31195
U
'12:18,
~002/01l
'
PERFORMANCE PARTNER'SHIP~ ,
'.'
:
SUMMARY
.,
'.".'
"
,
, .,'
,
,
.
.:
.
'WHAT ISA PERFORMANCE PARTNERSHIP?
"
,
, .,'
CONSOLIDATED' PROGRAMS WITH
INCREASED, FLEXIBILITY, . " .
-
,
I
.
,
.
,
ACC()UNTABILITY FOR'PERFORMANC~,
),
~
'.
"WHERE ,DO THEY MAKE SENS~?
•
IF PROGRArY'IS ARE DELivERED AT STATE AND, LOCAL lEVE,LS',
•
THERE IS SHARED,'AGREEMENT ON'GOAL'S ANO' OBJECTIVES, AND
•
YOU CAN MEASURE RESULTS.
,"
'HOWARE THEY DIFFERENT FROM BLOCK GRANTS?
,
"
,":,
,
'.
•
'," OUTCOMES (NOT' PROCESS) ARE THiPRINCiPAL,MEASURE OF SUCCE'SS;
AND
",
"
' '"
.
:
,
'
FU~DS AND' FLEXIBILITY ARE TIEO TO IMPROVED PERFORMANCE
"
, 'HOW ARETHEY"PARTNERSHIPS;1?
,
•
'
,
'
•
"
FEDERAL. STATE. AND LOCAL G,OVERNMENTS AND PROVIDERS JOINTLY
'DESIGN THE PROGRAM AND MEASURE PROGRAM RESULTS
'.
.
PARTNERS WORK '.TOGETHER 'TO REMOVE. BARRIERS TO SUCCESS
�12: 19·
03/31/95
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IgJ003/011
"PERFORMANCE PARTNERSHIPS
Guiding ~rinciples,
•
.Current Federal. grant system.
,
. A great deal Qfthecurrent grant
system tias broken'd9wn in a tangle
. of good' intentions gone awry. There
are too, many funding categories.,'
.suffocating regulations .snd, ,
paperwork,' misdirected emphasis on
, remediating rather than 'preventing .
problems. and no clear focus on ' ,.'
measurable outcomes .. The system' .
stifles initiative and squanders ' , ,
resources without achieving sufficient
results .. Performance partnerships
offer improvemerit~ to the current
system.
begin to treat outcom~s
and. outputs' as ttie basic
,measur~of- succes's··(e.g.~ ,
'teenage pregnancy rate
rather than' number of
visits to a clinic), and
create funding and other'
incentives to reward
desirable results and
performance toward~
results. .
, Where do performance,'
'partnerships make ,sense? "
What is a pe'rformance
partnership? ' ,
Performance partnerships work' best:
•
Performance partnership's provide
increased· flexibility on how a program ,
is rur, in exchange for inereased
acc.buntability ,for results.
•
Increased
flexi~mty
, ••
I
.
'.
"
"
..
includes: .
,
,
,lncreasedaccountabiJity for
, results ,means -the, partners will: ,
'
.
".' consolidated funding ,
streams
elimination of. mic,fo
management,
, devolved decision-making, :
(national goals and
objectives, with much
more flexibility for5tate .
and local partner-sto '
determine HOWthese'are
achieved), and
"
, reduced wasteful" ,
paperw:ork .
•
When the Federal GoverJ'lm~nt "
intends to deliver services at '
'State and local levels,
Where there is shared'
agreement among federal,
State ar:-d local partners' about
national g'oals and objectives.
and
Where progress toward the
, goals and, objectives can be
measured...
'Checklist of Guiding Principles
for ,Designing a Performance
Partnership ,
number of key' characteristics
should
considered in designing and,
implementing performance
'
partnerships:
, ,A
be
�03/31/95
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ft
I4J 004/011
,
", 1.,
,
Program consolida~ions
Partnership
3. Increased 'Flex,ibility'
Improved A,?cou!"l~ability
,4.
5.',
Mea'suring Performanc~
Per,formance I,n¢entives
6.
Shift in ~he' Locus of ,
,7,.
Oecision-making " "
S. Administrative Simplificatior,
9. Administrative 'Savings,
10.. Implementation
11'. , Entitl,ement Programs
,. 2,.
'j
,. " Progra~' 'consolidations
:.
, , Proposals should 'restructur:e
current grant program
, authorizations to consolidate
' program,s andlor fund~ng
streams' and eliminate
; 'overlappin~ authorities:,
>j • •
, The checklist which follows contains
principles which build u'pon the '. ,
description' of the Aaministration'~ six
proposed "perforrTJance partnerships,""
in the President's FY 1996 Budget '
(see ,pag'es 152·1 54). The guiding
principles should ,be r~garded ,a~
2. ' Partnership' :
",ebuttable p,esiJmp~Dns ~:"
(a)
:Every effort'should be ,
.made to merg .. 'funding
, streains which now. force
r~c;ipients to wastefully
,isolate administration and
'" delive'ry of one program
from another to avoid
being. penalized 'by
. auditors.
:;.
•
In any' policy arena in wnich
there is a ,strong n'ational
,j'nterest and a history ofFed~ral
grants and other ,assistance to',
State and local governments,
agencies should give 'str~ng , ' '
consideration ,to deve,lppl~lg one
or mQre performance
'partnerships., '
•
"Federal, State 'arid local '
partners should jointly design"
the, partner-ship and the
strategies to implement it. '
Performance partnerships
, snould accommodate different ,
program strategies with
different State 'and local ,
,pa~tners. "
,,
3. Increased Flexibility ,""
" '(bl ' ' If apropos~d performance
partnership is not consistent .
, with' particular principle, there, '
,should be a compelling ',' '
, argument about ,now the
program is otherwise
.
addressing local needs, ,st?PS
" micromanagement, and ,holds,
its partners accountable for '
" , .',: "
resu'lts;
,,
•
a
Performance partnerships '
snould:
Promote, multiple
approache,stomeeting ,
national objectives,
'Allow federally-funded
activities to be fully'
integrated with State,
2
,
.
�03/31195
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"ff
. raJ 0,05/011
..
".
inputs and process used by
Statesalid localities:'
,local, and provider
activities, and,
Allow flexibility, so that ,
'State and local,
institutional, forces and
incentives achieve the'
de'sired ·results. '.'
••
•
If State plans are necessary, ,
'multiple "State Plan~ .
requirements should be "
replaced with one "community
based strategic'plan~n Such a
plan would outline basic
strategies and tactics, and
accorom'opate much more
. diversitY from co:mmunity-to
community and state-to-state
'~han' ex.,isting approaches.
.
.
•
,Minimizeltr«;lquired"
service ,requirements,
••
~nd
Non·discrimination
, . requirements, for
·e~ample. will apply.
5 . Measuring Perlormance
4. l~pl'Qved Accour:-tabilitv' .'
Fede~al agencies and'state 'or
'local partners sho'uld dev.elop,
communicate~ and'monit()r '
measurable program 'goals an~
report progress toward.'
achieving them:
l
... ..
~otwithstanding increased
flexibility, performance
partnerships: will maintain
Constitutional an(i cr.itical.
national public po~icy
requirements:
'
,
Provide multi-year
funding.
'
.' .
•
. An emphasis. on results
. means, for example,
. conc;entratlng . on getting.
. cle,aner 'air (not the,
existenc:e of State
environmental .
-regulations) or whether
" " educational goals are .
being achieved (not the'
level of scnool .
. expenditures) .
partnerships should:'
...
•
,.
'.
Think in terms of shared
acc.ouritability .. , .
Performance partnerships
shoLlld, focu~ on outpUr$ and
oUfcomes (real results)' rather
than detailed asses.sment of-the
•
'Performanc~ partnerShip's'
should be structured, managed, .
and evaluated on' the basis of '
'results (i.e., progress 'in 'tern:ts
of agreed upon measures of
,performance).. .
, •. ",'Performance) measures wiil
typically include a mix of
outcome and output,measures,
including both measures of '
, progress toward natior:"algoals
. and measures of important
negative consequences that are
likely to' result ,from program'
,activities.
:.,
'.
'
�03/31195
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I4J 006/011
•
Partnerships should focus on
outcomes (not process) as the
principal criteria by which to
measure success.
•
'Authorizingl~gislati~n should,'
governments, providers and '
consumers, develop and,update
measures for determining State or
,local perfor,manee in achieving
.
progress toward the national goals
and objectives."
include a,st~tement of:,
Accordingly, performance
. me~sures and targets
should ~e:
.
"National goals and.
objectives" 'that the ."
partnership seeks to heip ,
achieve" and
.Mutually develop~d by
.the partners, or
.
In the case of certain
core indicators,
developed by··the Federal
Govern'men! in.
consultation vvith
grantees, and
supplemented with.
indicators mutually
agre'ed .to by the '
. grantees.
, Refined over time-in
. cqnsultation with the
gr,an,tees.
For example: "parental
responsibility. til '
Types· of "performance
information II that would.
indicate what types of'
.information would
,'indicate progress toward
the national goals and
objectives ..
, .For exsmple: ."paternities
established"
•
Tne Federal agency should be
authorized to develop nati:onal
goals and objectives where the
authorizing' legislation does not
specify them. '
'
'
, For example: ".the Secretary shall,
conjunction with the States, 'local' '
governments. providers ~nd
.
consum,rs. develop national'goals
and objectives."
•
, For example: -The Secretary shall; in
'
, .
. '
. . . '.
, .
Type of .
performance
information..
, (2) : Data source (or
sources).
,
(3) . Acceptable levels of'
.. pr~cisionand
,accuracy.
(4)
Domains of
. estimations (e.g., S~ates.
counties, etc.)
.
(5)' Frequency'of data
coliection.
.
(1)
in
.. Performance measures"· an'd
per.formance targets should not
be incorJ)0fated in ,authorizing
legisla.tion.'- '
..
conjunction.with States" to.cel
Performance measures require
specificati.on of at least the
followi.ng:
\,'
�OJ/Jl/9512:20'Zt
(6)'
~007/011
For ex~mple; "The
Time period,
covered.
, For extimple: for "paternities
established'
(1',1 t Percentage of new
welfare cases for which
'paternities have been .
established, ,for ,each '
fiscal year, cohort of n~w
, welfare recipients.
n ~2) Percentage "f the total
welfare easeload for
which paternities have
•
been established, ,as of
the close of each' fiscal
year. '
(2) Selected welfare system
,ease reeords and
,information obtained
through eliCternar' quality'
, control review.
(3t
Total estimation !i'lrror '
, not to exeeed 7% at the
, county'level and/or 1 %
at the State level.
'
14) The 'sample design must
suppan precision' a!'ld
, ,I
Assessing prC?gress:
...
The authorizing
legislati'on should include
'a requirement that the
Federal agency-wo.rk with
,the piJrtners to develop a
. system for. assessing the
extent of progress
,toward national
objectives.
F9rex,ample: "The Secretary
shafl. i!"l conjunction with the"
States. loealgovernments,
providers and consumers,
accuracy requirements
for State (county) level
estimates or for the "
'population generally.,
(e.g .• the entire sample
may be, alloeated'acros~
the State, ~r;lncases'
allocatee:! per county. or
, even "n~', ~ases per .",
1,000 per county).'
. (5) ,Annually.
,(6) The last fiscal year.
•
Secreta~y
shall/in conjunc~ion with the
States. local governments,
providers arid consumers: .
develop individual "
performance, agreements
which specify the program.
9,oal&. end objeciives, program
performance measures,
p,erfor,mance tar,get5, and the
timeframesfor achieving the, ,
performa,nee targets....
.
develop a system for .
assessing the extent 9f ' ,
progress toward the national'
Objectives...
Atleas~
annually, the
partners. should assess
the ,level of performance
achieved, the extent to
,which performance
,meets' or exc~eds agreed
ora performa'nce targets,
and the extent to which'
, performance has changed
, over time. ,These reports
should acknowledge the
influence of important·
external factors that may
Performance agreement~:'
,Federal agencies snould
develop individual, ' '
"performance,agreements
with each Statellocality
receiving funds.
5
�03/31/95
12:~0
'~'
IaJ 008/011
..
'.
"
From tim~, to time" annual
performance' reports
should be' supplemented
program evaluations
that estimate the 'net;' "
program .impacts caused
by the progra'm. These,
program evaluations
" '
would use'research
.
designs to estimate th~ ','
,difference that th!i1
, :program,maKes(Le., the',
difference between (a)'
the actual performance
levels achieved" and (b)
, 'the, performance levels,
that would have been
achieved in tbe absence
,of the, pro,gram).
, y"
b
•
•
Refining the measures over
time:'
It is expectE!'d that the '.,
, performance
measurement process',
and indicators 'will evolve
" over.time, as Federal
agencies and gr,antees
develop 'greater
experience with this
approach.
6.
Performance' Inc'eiltives
•
Agencies should consider
whether funds should be, '
allocated in parton
performance (but other factors
such as need may also be,
determinants, including
population, 'poverty, disease '"
,inciden'ce,morbidity. 'and '
mortality, as appropriate).
,Data collection:
'The partners will have to
id~n~ify or develop data
systems to define ,and
,assess "results" and
, , "improvement in results. ':
"
,
, Partners should consider
" whether and how to get
data ,that is' generalizable,
and consisient among,
and within States
overtime.
have affected the
performance levels "
achieved.
,
Fa; eXBmple:-The Secretary.
is'authorized to withholc;1uP to "
5 percent of the amount
,
'appropriated to the p,rogram'to'
,support the development and"
, :updating of ~ata systems tied " '
,.
closely to the national goals:
the development of ,
performance agreements with,
States; and data quality
assurance and data quality
improvement; and, research '
,Bnd development of ,
'
, perfor'man'ce measurement methodology. n
Partners shol.,Jld be recognized'
and rewarded for success _.
both high performance and
imprDved performance. "
Recipients should be rewarded,
"for achieving ambitious, r:ather
than readily-attainable,
performance targets.
6, '
,!
�.
03/31/95, 12: 20
-
.
!ilJ 009/011
"
•
.-
Some· portion of the funding
based cnactual
should
performance:
be
. funds into practic~s
successfully u~ed by high
performing. States and
localities, or
Requirements, for'~
additional commitments
'of State or local .
resourc;es, or ,
, .Reductio" OJ termination '
of Federal fundin.g.,
, Some portion of funding ,
should be available to'the
Federal agency as an, .
incentive for'$tates and "
localities that make
improvement. '
For' example: "The Secretary .
is authorized to reserve up ~o
10 percent of the funds
be
, used for performance
in.centive awards for recipients
making process toward
meeting national goals."
•
to
•
. Aewardsshould not be
di~ected toward orily
" "exceptional" ,.
performance, but allow
the Secretary to reward
high' or improv~d '
perfo~mance (Le.,
"progre~s tpward, "
achievin'g national
. Since there is shared
accountability for results,'
Federal agendes stio'uld also
.. ~esp~nd to problems by
·providing teChnical. assistance
abo~t p'romisingpractices: .
For example: -The Secretary ~hall
provide tecnnical assistance to the
States to help them expand. and
improve .......
•. States and localities should be
held harmless for cases where
· outcomes are not achieved
: despite. the, use of best
practices (given .the current
state 'of knowledge).
goals~·).
•
· Partners should avoid punishing
· innov~tion and experimentation:
Keep in mind: no one is'
-accountable for results
now under th'e current
system.
"Up toUis important,.'
since. it will ,first be
necessary to get a
sensible ,measurement
system inplace~before
attempting to award
performance incentives.
•
' A requirement to shift
High-performing States and
localities should be rewarded " '.
'with additional flexibility or
. reduced matching' requirements.
·
.
7. Shift in the locus of
Decision~making
•
Similarly, disincentives should
include reduced flexibility:
T~e
partners should decide
I!ilrgely on the "What" and leave"
7.
'(
.
�03/31/95
-
.
12:21
'ft
~010/011 '
'
-.
.
,
.,most of the ~How" ~o
States and loc'alities.
•
'.
0
0'
"
, micro-management, and
.wasteful paperwork: ' '
Rigid and costly program
restrictions ·should be
eliminated.
, Performance ,partnerships
should seek ,to empower
communities to make their own
decisions, about how,to address
,
',treir needs, and to' b~ held
accountable for resuJts.
• ' ,'Procedural, detailed application.
, financial ma"agement, auditing
and expenditure reportin'g .'
'
'requirements should be
. ,eliminated' or, simplified to
permit comprehensive, serv'ice
, deiivery:'
Front-line, .Iocal-Jevel providers
should have greater flexibility .
and responsibility for service
design, deliyery, and r,esults.
Partnerships should permit,;
customers and beneficiaries to '
shape pr,ograms to better match'
. their. individu'al needs -- by"
•
, givin,9. ~hem voice~ choice, ~nd
the m~ans to ,integrate services,
, from multiple providers"
The focus should be "Is
the commonity achieving
measurable resu'lts ,that
.. indicate progress toward, '
national goals?" -- rather
than ::"Were the dollars '.
, spent on the identi'fied
, . problem?"
Recipien~ jurisdictions should
have flexibility to set local
benchmarks that are consistent
with natio,nal program goal~.
,
•
8. ,'Administrative
'.
, ,Simplification
P'art'ners will seek 'to reduce'
barriers to success ..
•
,"
contract for meas,~rable' results)
,ratner than traditional cos~, . reimbursement, "Ievel-of-effort"
gr,nts.
"
'
•
-
"
'
"Rep0r:ti"g and monitoring~
should focus on performance'
(outcomes and outputs that
indicated progress toward
strategic goals) rather ,than
, inputs.
9 .-Administrative Savings
e'
. ,
Performance partnerships' ,
sho.uld reduce Federal :'
, regulation of inp,uts, :and; ~yoid"
'
Federal agencies should, to the
. extent feasible, establis~ or '
"egotiate performance targets,
rather thal'l specify th~ manner
'of compliance that States or .
- ,localities ml:lst adopt.
, ",
Partnerships :should resemble
• ,,"perfotmance'contracts" (i.e.,
"
'.
• Administnitive savings should'
... be realized through
consolidation and program and
administrativesimplifica~ion:
','
,
8
�03/31195'
12: 21
~011/01l
.',
.
'.
~cc
I
o
Consolidated planning
requirements, for
example,. 'should enable
more integr,ated services'
with less overhead. '
,',
i,
10. Implementation
,Proposals should co,:"sider:
~.
•
Phased-in
implementation,
Initially, shifting towar~
performance partnerships '
with self-selected or
"volunteer" States/local
partners that are ready. '
•
•
;.
There maybe a need to set
.' , ' specific common measures, but
allow for flexibility forl,?cal
circumstances:
Measures should, be. both
.' population- .and' client
based.
'Partnership, proposals should "
,'accommodate different degrees
of, devolution between Federal"
and ~arious' State and local
/
J>,
.'
,
,
'
,!
~
Initially allocate .funds to, '
States tO'match what
,they'currently receive", '~', '
Adjust'over time, fdr, '" ,.
growth of poverty
population and in'flatiori,·
Authorize'the Secretary,
to provide extra, funds' to,
States during economic , ' ;
downturns,
,
A.san' incentive (since ' '
funding levels 'are, fixed), ,
permit high-performing ,
, . 'States to re~direct ,their
matching funds,
,.",
.
"
.•t:
.
I
.
,
Performance partnerships ,for
entitlement programs might:
.
.
,
governm~nts;
',e
,,,-:
.Eligibility may ,nee~ to be
'simplified, for example, to'
,transform' public' assistance
offices from bureaucratic
eligibility offices into family
support and' jop_preparation
centers 'Unking...a Ipngfil of '
services.
--
, 1,. " Entitlem~nt, Pr~grams "
9
,"
.- .
'.
"
:
""
"
,
�
Dublin Core
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Carol Rasco - Issues Series
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Domestic Policy Council
Carol Rasco
Issues Series
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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2010-0198-S Segment 2
Description
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Clinton Presidential Records: White House Staff and Office Files
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92 folders in 7 boxes
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Performance Partnerships
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Carol Rasco
Issues Series
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2010-0198-S Segment 2
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Box 125
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
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2010-0198-Sb-performance-partnerships
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https://clinton.presidentiallibraries.us/files/original/71e07a59357fcce53c8ba22ac1dce3cd.pdf
1f25227f5e0e4aad448c0cb3ebd83c9b
PDF Text
Text
PHOTOCOPY
PRESERVATION
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ROSA LEE: Her adult children s dependence on her for shelter, food and money often ~verwhel~ Rosa Lee. Patty sleeps after a night of drug use as Rosa Lee prepares for church.
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she could not possibly afford them without Medicaid. She shares
them, with Patty, who has let her own Medicaid eligibility lapse.
When:we finally return to Rosa Lee's apartment late in the after~
. ; \ noon; she asks me to look through her papers to see if she is behind
~ in her rent. I realize that she is drawing me into her survival net
!:i) work, but I offer to sort the thick sheaf of papers at home.
,The next night, I return them, divided into oversized envelopes
'.' with 'bold, printed capital letters to help Rosa Lee recognize the
.:
words: WELFARE, MEDICAL, RENT, PATTY, BIRTH CERTIFI
CATES, and so on.
S' ~ Patty, Rosa Lee and I sit on the bed in Rosa Lee's bedroom. A cru
;~cifIx'ison a table next to her bed; often, when she is upset, she holds
the crucifIx close to her chest as she prays for relief or forgiveness.
~
Patty points to an envelope marked RICHARD. "What does that
_ ~, say?" i' • '
'!Don't you know your own brother's name?" Rosa Lee says in dis
$i; belief.
S~
Patty s,hrugs. Her reading skills, it turns out, are no better than
d.. Rosa Lee s. ,
, . .
~
" They deCide to draw up a plan to straIghten out theIr tangled fI
=:( nances, and they ask me to write it down. 'Patty, who hasn't received
....:, welfare or Medicaid benefits for eight years, will reapply. Rosa Lee's
~ituation is more complicated. ~he has been receiving $350 a month
III welfare and $280 a month In food stamps for herself and two of
~',
her,grandchildren; now that her daughter is out of jail and caring for
, ,her. oWIJ"children, Rosa Lee will lose some of that income. So she's
~ ,going t(). filld out if she's eligible for other assistance.
It sounds good, but it's impossible to ignore this fact: Welfare pay
tJ" ments and food stamps don't begin to account for all the money that
~, c:~e\~~nd goes in the apartment.
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The Torn Photo
1£'
;1'. Dash," Rosa Lee says one day in early October 1990.
"Why is it I can't filld a place with no drugs?"
She is standing in her living room, her hands spread in a gesture of
~ frustration and resignation, her voice competirig with the sound of an
~' afternoon soap opera on television.
~: ,.' Within a week of moving into a federally subsidized housing com
O ~ 'plex in Washington Highlands in March 1990, Rosa Lee ran into sev
~ eral drug dealers she had known for years. As broken ties were re
f) 0 newed, heroin and cocaine began to flow into her newly renovated
n ~ apartment, just as they had flowed into her apartment on Blaine
0 Street NE in 1989 and into various apartments on Clifton Street NW
... () I,for years before that.
; ~, .In recent months, she tells me, she has cut back her drug use to an
~}
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NOI.L'o'A~3S3t:jd
AdOOO.LOHd
occasional "speedball," a',ritixture of heroin and cocaine that she lets
Patty injec~ into her hanq.i'Thedope [heroin] I don't need," she says.
"It's that 'cain~. The 'caine gives you a rush. It stays with you a little
while, and it makes you ''!Vant more. You want that rush again. If I go
get a $10 bag o{'caine and shoot it all by itself, ZOOM!"
She says these infrequent lapses don't make her an addict, but I
don't think she's being candid with herself. For the first time since I
became a regular visitor
weeks ago, her eyelids have drooped no
ticeably during our conv~rsations and she constantly rubs the backs
of her swollen hands. W!:ien I ask her about these symptoms, she in
sists she hasll'tgone bac¥to full-time drug use.
By now, Rosa Lee is c2mfortable with me, putting up with my tape
recorder and agreeing,tp let a Washington Post photographer, Lu
cian Perkins, accompany.: me on some of my visits. Her background
could not be more different from mine: When Rosa Lee was strug
gling to take care of eight children in the early 1960s, I was a teen
ager attending high scllool in Manhattan. When she was serving her
first prison term for theft in 1966, I was earning a college degree at
Howard University an(v;orking for The Post as an intern. When she
was selling heroin on the streets of Northwest Washington in the
mid-1970s, I was writirfgabout the devastating effects of heroin traf-'
ficking on some of tho~,same streets .
She doesn't understand why I ask so many questions about her
childhood and her family,' but she does her best to remember details
that are important to me but not to her. She knows that her grand
parents, Thadeous anifLugenia Lawrence, picked cotton in North
Carolina, before cominif north sometime in the mid-1930s, but she
doesn't know much else<.
In fact, she has no keepsakes, no mementos, no record of her par
ents or her grandparerits-"-except for a single black-and-white phot<r
graph of her motheratid grandmother that somehow has survived
over the years. When I'fust saw it, it was lying loose atop a bureau in
Rosa Lee's bedroom, i}nframed and unprotected. its edges torn, its
emulsion cracking. _j~
Her mother, Roset~a LawrenceWright,dominates -the -photo,
much as she seems to ijave dominated Rosa Lee in her youth. Roset
ta is sitting on a chair that is too small for her large body, dressed in
what appears to be a white uniform, probably something she wore in
her job as'a domestic W:9rker. She dwarfs her own mother, Lugenia,
who is sitting in an overstuffed flower-print chair that seems to swal
low her slight, almost frail body.
The memory of her mother, who died in 1979, stirs feelings of an
ger in Rosa Lee, not tenderness. There was the time, Rosa Lee re
members, when her mother accused her of stealing a welfare check
out of the mailbox. RoSa Lee was about 9. She ran to her grandmoth
er's house, a block away. "She came around to my grandmother's
house and whupped me. I mean really whupped me! ... The next
morning the mailman Drought the check. My mother didn't say noth
ing. She just got mad at the mailman."
Most of Rosetta's other children don't share Rosa Lee's view of
their mother. They r~fuember her as a woman working hard to keep
six
her family together under difficult conditions. "She taught me, 'If you
want something, work for it!' " said Jay Roland Wright, one of Rosa
Lee's seven brothers. "I've always liv:ed by that."
Jay Wright is 15 years younger than Rosa Lee; her memories go
back before he was born. As a little girl, she says, she became devot
ed to her father, Earl Wright, an alcoholic who died when Rosa Lee
was 12. Her father doted on her, but he also took his fists to Rosetta,
much as Rosetta took hers to Rosa Lee. "He'd go upside her head,
bam, all the time. He'd be drunk. She'd take it dead out on me. I nev
er did nothing. I was too scared."
We look again at the photo. Rosa Lee has no idea when it was tak
en or why she has it. She knows only that her mother and grand
mother are sitting on the screened-in back porch of her grandmoth
er's house at 204 17th St. NE and that her grandmother bought the
house in the early 1960s.
This seems curious. Buying property is a sign of ,prosperity, not
poverty. How had Lugenia Lawrence scraped together enough mon
ey to become a homeowner? And why, two generations later, was
her granddaughter Rosa Lee a pennanent resident of public housing,
with drug dealers never far from her door?
_e:Wldi3i1i :I;13#8.
,Sharecropping Days
If) en !Vright is Rosa Lee's older brother. He also is the family his
!I&l) tonan.
"You have to ask Ben," Rosa Lee would say t<;> my questions about
her parents and grandparents. "Ben is the one who knows about
that."
For years Ben had organized family reunions, large gatherings
that brought together descendants of the Lawrences and the
Wrights; four-generations. thaUrace_th~iL roots to fertile farmland
along the northern bank of the Roanoke River in easterifNorthCar<r
lina and the tenant sharecropping system that served as the back
bone of Southern agriculture until World War 11.
The reunions brought together relatives from up and down the
East Coast. Branches of the family have put down roots in New Jer
sey, Philadelphia as well as Washington, and many have secured a
foothold in working-class and middle-class communities. Rosa Lee
had little in common with these more successful relatives, so after
attending two reunions in the 1960s, she stopped going.
She kept in touch with Ben, but their relationship had sour~din re
cent years. When I asked Rosa Lee why, she was uncharacteristically
vague, hinting that it was Ben's fault. Later, Ben told me that there
was nothing vague about their falling-out: He told her that he would
never set foot in her apartment as long as she was dealing drugs .
See ROSA LEE, A34, CoL 1
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whim askedabi:iu~faitiitY lj;i:Stofj:13enWnght, her
older b.rotner~ ~.tJu(fatii~Jj:~'bt(J:{iJI,fr::!f!J.rJe.ar,s, he
orgamzed reumonSana stayeg':~n;t0't4hw#h Rosa '
Lee, but theY hilda fallii,g'ilurov~t;~T:dY'#g use.
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.,:.: 'When Rosa Lee was jailed in New York on a theft charge in 1964,'
, . 'Ben bailed her out. But when she started shooting heroin, ,he drew"
·;the line. Ben's world-good job, steady income, retirement bene
'~;fits-had no place for Rosa Lee.
'
, So when Rosa Lee and I knock on the door of a trailer at the D.C.
DePartment of Public Works storage yard, where Ben worked, I'm "
not sure'what to expect. It is a raw, cold day, and I can feel the bite'
-;,~.,oLtheWiiid as I explain my project to Ben. He listens, looks at Rosa
': ',',Lee,
tlierniiVites us·tocomeinsid~to talk during his lunch break.
, Over ·.thenext Several months, Ben an;Cotners-provide-bits .and
'·pie_~s"oftlIe family history. '.
;>:;;.~·;~iiW.}i~~fi~s,Ro~tta,~n9~rIWright'l):first child,born on the ,
',r:,'firj>t<:!aY of·s1,iffiri:lel)~1193~;:theyear t.be(ireatDepiession foreveI' ':
l>\!t9/:!i#i~~~ifh~:~~e~ W:;th~':L.-a~~Qc~s'~id the.Wrights: Roseita was. 15 ": "
, , '.:, ;~tthetilr!e.·ana bvm.g WIth Lugeruaand Thadeous on the cotton farm
. ; , 'wh~re, the)lworked as sharecrop~rs, about four miles south of the
, " market' town of.Ri.ch ~uare, N.C.
.
Thadeous c"yas' the'Second generation of Lawrences to sharecrop
on the property, known as the Bishop and Powell plantation. By the
time Rosetta became a teenager, she had already helped with several
cotton crops. The countless hourS she spent in the' fields changed her
body and shaped her soul, and taught her the impOrtance of discipline
and stainina. She developed quick, powerful arms and a tough, stern
demeanor-a younger version of the grim, brooding woman in the
photograph in Rosa Lee's bedroom.
There is no available record on the Lawrence "share" in 1932, no
way to know whether the family earned enough to repay the white
landowner for the money he had advanced them over the course of
the year. According to family lore, Thadeous had a hidden source of
income that kept the family from falling into debt: a moonshine still
that he kept going even after the family moved up north. "My grand
mother said my grandfather did a lot of bootlegging," Said Ben.
Many sharecroppers, however, remained perpetually in debt, unable ~
.. 'to ma kp their share, yoked to the same landowner year after year. Most
_..
.
and
"Those weren't considered regular working"c1ass jobs. Those wei~
considered highly desirable jobs."
" "
Like hundreds of other rural black women who migrated to:Wash
ington, Rosetta became a domestic worker. Earl found work ,as:a ce
ment fmisher for a paving company. This fit a familiar pattep1. ac
cording to Elizabeth Clark-Lewis, a Howard University professor
who has interviewed domestic workers in her:study of the'period.
''The middle class was not, standing waiting for these ,p~ople with
open arms," Clark-Lewis.said. "Very few men ~~i.tld cOrr!e,inalld get
a governmentjob.~'I?o:r'most poor, rural women;:'she saig,';"domest,ic
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Thadeous and Lu'gerua found work too, bti}': it was Tha~~us's
bootlegging,that k~l?~ the family afloat.
woiY,ddisappearfdrsev
eral months at a time; oruy-laterdid·Ben learn~that.he~was going to
North Carolina to tend the still.: ';
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iRoset~a ,and, ~ri,settledrn t.he nelg~~.()rhOOq ~ui,trnorth?f the),~~yy
Yard, Wltmn a ,mJle ,of the ,CaPlto,l, rentmg ;asenes;ofhousesthaOfud
outdoor toilets and rioelectriCity>ROsatee'f~membersthe smell ohhe
kerosene lampsth~y lighted hch nighi:>As the familfgrew-Rose~t~
gave birth to 22 children, 11 of \vhom died: ~fore reacm__ng adulthood;...:., ,
Rosa Lee became accustomed to bedrooms crammed:\vith too many
people and living rooms with no p,!ate for privateconver.!3ations,
Ben has no way to prove it, but he's Certain that TH~~eous's moon
shine sales provided the money that enabled Thadeolls and Lugenia
to become' homeowners. The house in the photo, th,e one on 17th
Street NE, turned out to be the third of three houses owned by the·
Lawrence family.
'
'
Thadeous and Lugerua bought their first property,~ decaying two
story, wood-frame house on the outskirts of Capitol Hill. for $1,400
in 1949. Four years later, they bought a second house nearby for
$8,000. The seller gave them a mortgage so they c;ould make the
purchase.
The first house went to Rosetta; two years later; however. the
city condemned the property and Rosetta's fanlily had to move.
Thadeous died a few years later. Lugenia lived in the second house
until the city claimed it for the Southwest Expressway. paying her
!I:" <;flfl in rnnml'l>n<::ltinn Shl" hnllOht thf' thirel house.,anel when she
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Patty struggled to keep Rosa Lee froIii~!~~;~:a~d-h~~rd a man'
shouting from across the street. It wasAIVW,·h,etbioth¢r. He,was on; ..', i
duty, driving a, Metrobus north on .Georgia'Avenue/wheil';he saw, "I'U
Patty trying to hold Rosa Lee. "Get· M9miP~· t~ ·the',h9.spital," he', ~: ".
yelled from the driver's windo\y of his p~Ck~cI t>4S, "'., ',<: , "'"
,Patty, still high.from the heroin, maI1~iiyeied Rosa I::eejnto ataxi'.,h
At the hospital, .Rosa Lee's doctor, Wigstoh Eniderick, was furious:
'1f you suffedmother one of these seiitfres,: we may not be able
bring you back," she remembers 1.¥msafii1g::.;,c; ,"
'
Wqen she goes home on De~. 10, she ,vQW~;tQ, ~erself
oin days are over. But home is still the same apartIl1en
ton Highlands in Southeast, where BobbY;: Patty and
much of their time in pursuit oQheirqeX!:'high.·. .
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Rosa Lee ~ 'Christmas ..
~ays. settling int? the front's'~t;"~:~)\'
D. ?f. my car on Chnstmas mornmg 1990 for a tnp tq the ri1ethg~ '-,
&Uf5} oy,·what a night,:' Rosa Lee
done cIlfUC.
"
.
, 'Reco~ering drug addicts don't get holidays off. I{Rosa]
her daily dose of methadone, she still has' to' make.the'doss:towri\
trek from her apartment in Southeast to: the, cliniCon.N
not far from the Capitol. On the bestofgaYS;ifs <l3b-m;l:.·;.. ;;,~,.i;n':
Quiring two buses; the holiday ',I?us, sctle.d.ul~rrfuk~s it
journey that can last, more ihanan J~o,1.II'; :~he·i'·.§till'~
hospital stay, so I have offer,;..Il.;'- ;. . ";rI,,", _.' ."ie,' - '
When I arrive at 8:30 a~
one else is asleep, 'incIi.l~
waiting under )n }1.rJi{id?- ,"":-,
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lands, candy canesapd colored ,glaSs,bulJjs::PatnT;ls~stretc::hei:L(
a living room ;;..,.. ~h ·h;''; l":fnorp;lrTTi~D'aiidii.'ligdiri~wffii:e;~aiiie':;
, :,Aswe"
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�could not read or write, add or subtract, so they had no way to challenge
the landowner's tally at harvesUime. It was a harsh life, made even
harsher by ~he effect, the Depre~ion was having
the cotton farms
around Rich Square. The price of cotton dropped from $500 a bale to
$25 a bale. Joe Purvis,. who owned th~ land where the Lawrences were
fanning, was forced to close down the fann after the 1932hatvest. So
when a Maryland t6bacco farmer came through Rich Square looking for
, sharecroppers,' the Lawrences decided to leave their friends and rela
, :ti~es and the land$ey knew so well.
',: .They packed.their meager belongings and headed with their four
: children to Maddox's fannin S1. Mary's County, Md. Rosetta, her in
, . fant son Ben and her new husband, Earl Wright, joined the Law
rences on the journey north. '
,
'
Ben and his brother,. Joe Louis Wright, vividly remember the sto
ries that his mother and grandmother told them about their harsh life
in Southern Maryland. Theyhad:almost no money. Meals frequently
consisted of whatevh they could pick or trap. "They were eating a
lot of muskrat aiidwatercress," Joe Louis said. Watercress grew
abundantly in
c1ear,sptulgs nearby; and muskrat was then a popu
lar Southern Maryhind dish t:hat thefarnily never got used to. "My
mother would saydf sh~ever got a job and made any money, she was
never going to eat another inuskrat,"loe Louis said .."Had to eat it,
'be<::ause that's all ~eytould trap."
Mter the 1935 tobacco harVest, like thousands of other sharecrop
,pers during the 1930s ~d:l940s. Ro!?etta and Earl Wright gave up
ruraIlife and heade~ for the city. The Lawiences stayed behind with
:'Fyear-old Ben, afraid that the boy might starve if his parents
couldn't frod workili,Washington. Within a year, they too moved to
the District. Theif 's~arecropping days' were over.
on
t/le
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Segregated'City
ashington in the 1930s was not a land of opportunity for black
migrants from the South, especially poor sharecroppers. It was
a segregated city, but within the black community was a well-estab
, lished and educated middle class that traced its roots to the freed,
slaves who stayed here after the Civil War. Over the years, these 10
: cal black families had built an extensive network of churches,
, ~hools, theaters and other institutions. It wasn't a closed society,
. but neither did it reach out to embrace the rural migrants.
, : ' : Some of the more fortunate newcomers had friends or family here
"do help them through, the resettlement. Others, like the Lawrences
1'1 ~d Wrights, were on their own. Finding a job, any job, was a chaI
'/) Oenge. Most of the government jobs then open to blacks-the clerks
-31nd messengers arid cafeteria workers-went to middle-class blacks
"'" Ovho had connections or education. "Those jobs were very c()mpeti
;: ~ve,,, Portia James, the chief researcher at the Anacostia Museum,
:! ~d when I asked her to put the family's history into perspective.
g
B
t
died in 1985, she owned it free ot demo till i:llJlJlilptt t::;llllldLtU illS
value at $56,000.
..
In her will, Lugenia directed that the hOllse oe:sold and the pro
ceeds divided 'among five grandchildren. Rosa Lee was not among
them. I asked her why. "Because 1 was an addict when she died," she
said",and Lugenia was determined not to squander:this asset that had
taken a lifetime to b u i l d . , ' ~~.
The house wasn't sold immediately. Instead, th~':wandchildren de
cided to use it as collateral to borrow $55,000;' .which was divided
among the five grandchildren after expenses. That, satisfied the con
ditions of the will, aild left one granddaughter::with the house, a
monthly mortgage payment and a place to live.~,
But it didn't ~ork out as planned. Within a few ~o.nths, the grand
daughter fell behind ,on the mortgage payments. In late 1987, Lawan
Wright, Rosa Lee's youngest sister, moved in aft~r serving a two
month sentence for drug dealing. For the next two months, Lawan
says, she used the house to sell crack.
,:'
The mortgage holders decided to foreclose. So m:February 1988,
Lugenia Lawrence's house passed out of the farnily~s,hands for good.
,
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Emergency:;/;
Iil t
is Wednesday ~fterno~n, Nov. 28, 1990,~pd Rosa Lee is
Hstretched out on a bed in emergency room 63 at ~()ward Universi-,
ty Hospital, telling me about the seizure that has landed her there.
Actually, she's not tellmg me much, because she bl!l:~ked out and she
can't remember exactly what happened.
',';,,<,
The room is cool, and she has pulled the blanket1?"up to her chest,
exposing only the shoulders of her white hospitai, gown and her
drawn, tired face. She looks awfuL
:~
-This-is·her. secQlli:I seizure in two days, her third in six months.
The doctors don't know'tne catiseofthe-seizures,.so,they have, been
putting Rosa Lee through series of tests, which:~on't 'botner-ner '
nearly as much as the telephone calls from Patty an'<iDucky t,q settle
minor squabbles. "Why are they worrying me, Mr. Dash, while I'm in
the hospitaI?"she ~ys.
~.~
,
The doctors suspect that Rosa Lee's drug use has liomething to do
with triggering the seizures. On Monday afternoon,: Rosa Lee, and
Patty shared a "billy" of heroin-a small bag that sells for about $20.
Immediately afterward, she had a mild seizure that:sent ner to the
emergency room but didn't require a hospital stay. S!iII; she seemed
shaken enough bythe experience that 1 thought sheJvould stay away
from heroin for a while.
Not shaken enough.
"
On Tuesday afternoon, she and Patty bought another heroin billy
at an "oilin' joint" for heroin addicts on Georgia Ave:Ilue. Patty gave
,herself a hit, then Rosa Lee. As they went outside to j1aila taxi, Rosa
Lee suddenly went limp and her eyes rolled back in h~r head.
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It all started with Ducky's paycheck. Late in the afternoon, Ducky
brought home $270 from his job at Kentucky Fried Chicken, gav¢" ';
$150 to Rosa Lee for his share of the rent, food, cable TV and utili~. \
ties and left to buy cra<;k with the rest of the money.
. :.-'
Ducky owed Patty $20, so Rosa Lee gave it to her, setting off a cham ",;
reaction that lasted all'night long. Patty spent the $20 on crack, smoked'
it and wanted more. She begged Rosa Lee for another $20.
"I just-gave her $10," Rosa Lee says.
As soon as the $10 was gone, Patty was pleading for more. Instead
of saying no, ,Rosa Lee asked Patty to buy her some ice cream and
handed over another $20.
A few hours later, Patty returned with one of her regular
"tricks~-men who trade her drugs fO,r sex. Selling sex provides Pat
ty with a steady source of drugs, and other things seem secondary,
including the riskef spreading the AIDS virus.
The "trick" prepared a mix of powdered cocaine in Rosa Lee's bed- ,
room, gave himself a hit and offered some to Rosa Lee. She said no. "I
didn't even hesitate, Mr. Dash," she says. "I was so proud of myself." ':,
Nter Patty left, Rosa Lee fell asleep with the TV set on. About 2
a.m., she heardsoineone banging on the door. It was Patty's boyfriend,
Howard, demanding to know where Patty was. Rosa Lee didn't know.
At 6 a.m., Ducky woke Rosa Lee to say that Howard and Patty
were fighting in the hallway. Ducky pulled Patty, strung out from
smoking crack ana drinking liquor, into Rosa Lee's apartment. ,Pat~'
ty's leftforearm was bleeding. She told Rosa Lee that she had cut, ;
herself with a knife during an argument in Howard's apartment.
.,
Two paramedics arrived and bandaged Patty's arm. Moaning that she: i
still loved Hbward, she cried herself to sleep as Rosa Lee held her.
1 ,,~j
As 1 drop Rosa Lee off at her apartment, I try not to think about'll"j
what awaits her i n s i d e . ) '!
"Merry Christmas, Rosa Lee," I say softly as she opens the car/
door. "I'll see you next week."
"'I I
"Merry Christmas, Mr. D a s h . " ' , ;
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About Thli Series-
T
his series of articles grew out of Washington Post report~
II er Leon Dash's reporting on the interrelationships of rac
ism, poverty, illiteracy, drug use and crime, and why these
problems sometimes persist from generation to generation.
The series was edited by Steve Luxenberg, The Post's assis
tant managing editor for special projects. The articles will be
published daily through Sunday, Sept. 25, and The Post wel
comes readers' written comments or phop.e cabs. If you wish
to leave a recorded comment, please call Post-Haste at
334-9000, Category 4646.
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A34 SUNDAY, SEPTEMBER 18, 1994
,
I
,
I
I
1
ROSETTA AND LUGENIA: This is Rosa Lee's only photo
,0/her mother, Rosetta Wright, left, and her
'grandmother, Lugenia Lawrence. Rosettamui her ,
,huSband, Earl, were the first in the family to come to 'the ,,'
.'cIty. Rosa Lee remembers her with anger, not ier/derness:
I·
"
....
"
:;;
'"NORTH CAROLINA: The Lawrencesand Wrights' ,
."
: roots are deep in the cotton fields of the Bishop and
; piJwell plantation, where they were sharecroppers.
,';'Btft"in the 1930s, like many African Americans,
'Rosa Lee's people turned to the promise of the North.
,
"You have to ask Ben, " Rosa Lee wOuld say
'when asked about family history. Ben Wright, her
older brother, is the family historian. For years, he
organized reunions and stayed in touch with Rosa
'. Lee, but they had a falling out over her drug use.
il-~~:~~j243~~·~~~f~~~·"·~<
,:;}, " : ' . _'
ur
L:?~~i~~:~~~.-_.
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She h~ just one memetdp
,
'
ROSA LEE, From A33
, ,'When Rosa Lee was jailed in New, York on a theft charge in 1964,
'Ben bailed her out. But when she started shooting heroin, he drew
,the line. Ben's world-good job, steady income, retirement bene
fits-had no place for Rosa Lee.
So ;"hen ROM Lee amI I knock on the door of a trailer at the D,C,
r'
'j
~
~,
heitnother
,~,
''Those weren't considered regular worklIig,dass j;bs. Thos~ were
'"
considered highly desirable jobs."
Like hundreds of other rural black women, who migrated to Wash
ington, Rosetta became a domestic worker: Earl found work as a ce
ment fmisher for a pa\'ing company. This qt.a familiar pattern, ac
cording to Elizabeth Clark-Lewis, a Howard University professor
who has interviewed domestic workers in :her study of the period.
i. ',. \ I : ,
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Patty struggled to keep Rosa Lee from falling, and heard a mair~ :~."
shouting from across the street. It was Alvin, her brother. He was ont~r .'
duty, driving a Metrobus north on Georgia Avenue, when he saW,,'b, ,,"
Patty trying to hold Rosa Lee, "Get Momma to the hospital," he,,~. ",
yelled from the driver's window of his packed bus.
" • ,,' ..'
Patty, still high from the heroin, maneuvered Rosa Lee into a taXI:", ]. '
At the hospital, Rosa Lee's doctor, Winston Frederick, w~s furious.
' .,
~
�A34
SUNDAY, SEPTf:,l\t8ER
18, 1994
TilE WASHI;\GTON POST
ROSA LEE'S STORY
..... ~,,-
.ROSETTA AND lUGIENIA: This is Rosa Lee's only photo
-f!fhermother, Rosetta Wright, left, and her
:grandmother, Lugenia Lawrence. Rosetta and her
-hUSband, Earl, were the first in the family to come to the
.. :~tty: Rosa Lee remembers her with anger, not tenderness.
BY KEITH JENKINS-THE WASHINGTON POST
NORTH CAROLINA: The Lawrences and Wrights'
roots are deep in the cotton fields of the Bishop and
. Powell plantation, where they were sharecroppers.
But in the 1930s, like many African Americans,
Rosa Lee's people turned to the promise of the North.
tI
D"tJ
n:J:
'flO
~g
1>0
BEN: "You have to ask Ben," Rosa Lee would say
:!" .
::><.
.,. -.
"-
when asked about family history. Ben Wright, her
-older brother, is the family historian. For years, he
organized reunions and stayed in touch with Rosa
Lee, but they had a falling out over her drug use.
,
.
BV I.UCIAN PEIlKINS- THE WASHINGTON POST
�{j'
v
-,.,
'ON POST
SSl'ORY
ALVIN:
,One ofthe two,
,children who
6roke/ree' of the. '
, cjcliLofpoverty
and addiction;'
; AU,i;i'is somel/ne
" Rosa Lee cfin '
." 't¢j:~ to jor help;' '
He
get~:',: ,
ottin
, angry, at Dui;ky
.."atjdJ!'atty.t'l'fn '
. :siCk;4izd tired'o!
;'. yoii w~rrying
"
.'Md1titfia aboUt,
" "k'6iie),}nd"
, drngs,r lie tells
,them;"~
.
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,.
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.
,
. '.:
:·:-;~·;·id
,
...
�ERIC:
Eric is the other
son who has
secured a more
stable life. He too
helps when he
can, but Rosa Lee
is as likely to
encounter his
rage about his
childhood as she
is a moment of
shared laughter.
·,f.
DIUCKY: While visiting Ducky at an abandoned building, 1l0s.a~i)~~~·he,i(i1ji.e)ack·h~;,ne.Sh~had
put him out after he spent his paycheck on drugs and had no "!!0tf:e.l~~q qe.'j.t~J~¥~ toJ'!e hquseh:"old.
':
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t1ti Wa~~'f\)V1 'frut, , .
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Photographs by
.
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AS MONllAV, SEP'I'&\l8ER 19,1994
r
TUE W,\SHINGTO~ POST
ROSA LEE'S STORVf
z
itQ
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1
Ot(
~
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'Just trying
to survive
e
§ffi
Rosa Lee has used legal and illegal
°ffi
::I: a:;
ways-such as shoplifting.....,..to
I!ba,.
support her family. She began stealing
,
asa child to get what she wanted.
TAKING STOCK:
Rosa Lee, her son Di«:ky
and daughter Patty
assess the sweaters and .
shirts that Ducky slale
during a burglary. They
then pack the clothing in
a suitcase and go to a
fast-food restaurant to
sell the items. Rosa Lee
began stealing when she
was a child. It is an
activity that she carried
inla adulthood, and
several ofher children
followed her example, .
D~.
\1,
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1) ;
mediatCI I
flow orP!l'
ilr; C1G
,dayaddPI;
cy was utile.'
'" But thi
What odl~t
PIIotographs
By Lucian Perkins,
-The Washington Post
ROSA LEE, From Al
"hilnren to feed and clothe; stealing, she says, helped her to survlve:
doing, and then we'll think about it. But you're looking at jail time.
You're looking at a cemetery:
Rosa Lee had won, Stay out of trouble until JanuaT\'. Treanor had
life. He died of liver disease just aiter Rosa Lee turned 12, Her moth
er, Rosetla Lawrence Wright, brought in most of the family's money,
working as a domestic on Capitol Hill during the day and selling din
ners from the family's kitchen in " evening,.always•for cash so the
the
.
.,.
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"Y't... ••••
hours wa~o
. The U~ ~
is as a de C .
will be ou4 f'
sending U,'IOS'
tile enviroi
In retur'jU "
strong demdJ .
Jean-Bertra;'l1
committed (elf
the military;, .
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WA,I!I:'iCTO;l; POST'
,-'\.
19, 1994 A9
,i
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LEE'S STORY
I
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MAKING ASALE:
:l: Lll
0..0:
0_
At"fight, Rosa LM
and Ducky leave the
re,~taurant afler
selling 9S. many
tM shirtS and
, weaters as possible.
s
They then try to
peddle their g(J(}(/s to
a 'inOtOrist in the
Parillng 10L
" ",
"_,' asuCc~/~i ~i~~i:1n~the~',;t,<,
, and~on Ii#r!i to the'-~s~op wl.tJi~,nimpty sUit<;ase: 11 is. ?t' :
cold day in March 1992, and izs'thej wait/or tMbus; a/JrJjJe,
sJie wraps. hfr coatqYOlind hiin to keep him,w.arm. For 'il}ost, ,
0/ his adidt life, DuCky' has depended on !?osd Lie. ' ,'''', ,
_~~?~'~..e~S_~::~:I~~~~;_':():-,,~e~_~~~ ~~~~~=-r: ~t:~:~.e,~~~'3'~"-":
Z
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hit one("01.. Rosa Lee's children: When Rosetta heard aiJou(it, she was
o(
t
'f
,I, am an~ry~:,it~, R~sa,L.:e (or violating
'and I am angry
T ,,\...: __ '- .. 1 •• "
_1.._
�ltOSA LEE, From Al
children to feed and cl~the; stealing, she says, helped her to survive.
Later on, when she became a heroin addict in the mid-1970s, she paid
for her drug babit through her shoplifting.
he stole from clothing stores, drugstores, grocery stores, stuffing
items inside the torn liner of her winter coat or slipping them in
to' the oversized black leather purse that she carnes wherever she
goes. Her favorite targets' were the department stores. One of her
older brothers, Joe Louis Wright, joked with me one day that Rosa
Lee "owned a piece" of Hecht's and had put Lansburgh's out of busi
ness. "Man, she would get coats, silk dresses," he recaUed. "She got
me a mohair suit. Black. Three-piece. I don't know how the hell she'd
get them out of there: •
Her stealing has caused divisions and hard feelings in her family,
and is one reason why Rosa Lee has strained 'relationships with sev
eral of her brothers and sisters. They see Rosa Lee's stealing as an
extreme and unjustified reaction to their impoverished upbringing.
Two of her six sons, Alvin and Eric, always have refused to partici
pate in any of their mother's illegal activities; today, they are the on
ly two of Rosa Lee's eight children who don't have prisoll records.
ROsa Lee has served eight short prison terms for various kinds of
stealing during the past 40 years, dating to the early 1950s. Her
longest stay was eight months for trying to steal a fur coat from a
Maryland department store in 1965. She says that she went to pris
on rehabilitation programs each time but that none had much of an
effect on her. "1 attended those programs so it would look good on
my record when I went before the parole board," she says.
. Nothing seems to deter her from shoplifting, not even the specter
of another jail term. On the day that she stole her grandson's coat,
she was awaiting sentencing in D.C. Superior Court after pleading
guilty in November 1990 to stealing bedsheets from the downtown
Hecht's store.
'1'm just trying to survive: she says.
~1.~:'mii3iltW~
A Day in Court
osa Lee had choSen her ~Iothes carefully when she appeared two
months earlier before Commissioner John Treanor on Nov. 13,
1990. She wanted to look as poor as possible to draw his sympathy.
She bad worn an ill-fitting winter coat, gray wool overalls and a white
wool bat pulled back to show her graying hair. She bad removed her up
per dental plate, giving her a toothless look when she smiled. "My hom
ey look; she called it. "No lipstick. No earrings. No nothing!"
Her lawyer's statements that day matched her downtrodden look.
Rosa Lee's life was a mess, he told Treanor. She was addicted to heroin,
a babit she bad developed in 1975. She had the HIV virus. She was car
ing for three grandchildren because their mother was in jaH.
. Rosa Lee told Treanor that she was trying hard to turn herself
around. She was taking methadone every day to control her heroin
addiction and bad turned again to the church. "I got baptized Sunday,
me and my three grandChildren: she said, her voice breaking. "And
I'm asking you from the bottom of my heart, give me a chance to
prove that I'm taking my baptize seriously, 'cause I know I might not
have much longer:
.
Tears ran down her cheeks.,"l'm asking you for a chance, please,"
she begged Treanor. "I know I have a long record:
Rosa Lee was stretching the tnith. Yes, she had been baptized,
and yes, she was taking methadone. But no, she wasn't caring for her
grandcbHdren alone. Their mother's jaH term had ended several
months earlier, and she had returned to Rosa Lee's two-bedroom
apartment to take care of the children, with help from Rosa Lee.
Treanor hado't seemed moved by Rosa Lee's tearful performance.
He glowered at her, and Rosa Lee braced for the ledure she knew
was coming. Both had played these roles before.
.
.
"Every time you pump yourself full of drugs and spend money to
do it," he said, "you're stealing .from your grandchildren. You're
stealing food from their plates, clothes from their backs, and you're
certainly jeopardizing their future. You're going to be one of the
yOWlgest dead grandmothers in town. And you're going to have
three children that will be put up for adoption or going out to some
home or some junjor village or someplace:
That had been Rosa Lee's opening. "Can I prove to you that my
life has changed?"
"Yeah. vou can prove it to me. verv simply," Treanor answered.
R
i"
.>1
doing, and then we'll think about it~But Y~:re looking at jail time.
You're looking at a cemetery."
..... ,
.§{.
.
Rosa Lee had WOII. Stay out of trouble ltntH January, Treanor had
suggested, and she would stay out of jail. ';;:'
.
Rosa Lee came over to me, her cheeks still tear-staJ'!ed !Jut her
face aglow.
.
. r;
"Was I good?" she a s k e d . " ..
"Yeah,~ I said, startled at her boldness.
"Thank you," she said, smiling.. .
~.
,
-, .
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soon
Transf~rmatl9n
hen
returns
sentencfug on
a
Lee
She lOOks
She.has
WRosashefromstandsforbefore Treanor.Jan. seems good.transformeda
.the methadmie
She
to have done ev
clean report
22f;j991,
·clinic.
:fS
.
erything Treanor has asked. ' .. '; .
She usually dresses weI!, but I think she has outdone herself today:
two-piece, white-and-gray cotton knit suit, tim leather boots, tan
it·
.
pocketbook.
. "~'.
"What would you like to say, Mrs. ClllUlinghafu?" Treanor says.
''Well, your honor, I know 1 haven't been a gOlld person. 1know it,"
she begins
. v.
. ""I.
.
Treanor'cuts her off. His dem~or is softer,fus words more ~ympa
thetic tban in November. "Wait a minute, now. Why do you say tbat? ...
You're taking care of those three grandchildren:iSil't that right?':'
..
''Yes, sir," Rosa Lee says, keepmg up the pr~~nse.
"All right," he says. "Nowsou've raised oneJamily, and now you
have another one,"
'"', ~'i~
~~
"Yes, sir ," she says.
:. ,
t~,\, .
"Which is really too much to ask of anybodY.~So I don't think you
should sell yourself short. You're doing the Lor!!:s work. Your daugh
ter's in jail for drugs, right?'"
i'll;
''Yes, sir," Rosa Lee says:'
ti,
"And you have or rulve had a bad drug.probl~ yourself."
:'Yes, sir:
:.
.
Then Treanor laWlches into another lecture about drugs. He
'doesn't ask Rosa Lee why she steals. "You steal,to support yoUr hab
it: he says. "It's as plain as the nose on' your face."
,:
But it isn't that plain. Rosa U,e began steal;;;g long before she be
came a drug addict.
;
~f;
,
;. Finally; Treanor annOlmces his decision: no jail: Instead, he gives her
l a suspended sentence and one year of probation With drug counseling.
"Now, don't you come back here," he says. .J I
•
.
"
';'
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"ijl!~jiiail':li13~
Lunch Morily
R
Osa Lee sometimes puts on a public mask: the way she wants the
world to
her. She fudges a little, omits a little there, even when'
she is trying to be candid about her behavior. By her aCcolmt, her steal
ing started when she was a teenager.' It .was an older brother; Ben
Wright, Who told me that Rosa Lee;s stealing started when she lVas 9
years old. Her target: .the hmch money that her fourth-grade classmates
at the District's Giddings Elementary School kept in their desks.
"Jesus, Ben!" Rosa Lee shouts when I ask her about it
''What's the matterr I say. "You said I could interview Ben."
It is a late afternoon in January, not long after her court appear
ance. We are talking inmy. car, which' is parked outside Rosa Lee's
apartment. We watch the teenage crack deilers come al1d go, mak
ing their rounds of the low-income housing cOmplex in Washington
Highlands, a Southeast WashingtOIl neighborhood near the D.C.
Prince George's County tine. Rosa Lee's grandson and granddaugh
ter are playing nearby on a patch of dirt where the grass has been
worn away. The sun is beginning to sink behind the buildings as she
tells me about her first theft.
The year was 1946, and Giddillgs's imposing red-brick building at
Third and G streets SE was a bustling part of the District's then-segre
gated education system. The school, now an adult· education center,
served black children living in Capitol Hill neighborhoods; some, like Ro
sa Lee, c.ame from poor sharecropping families who bad moved to
Washington during the Depression, and they did not bave the new·
clothes and spending money tbat tbeir better:<'ff classmates
see
strong dem
lean-Bertr.·
committed
'the military·
when he rert:
may choose;
'~ltllOUgii the;
ed they wa;
qualms that
presence WOI
·t1ifficult. .
Throug'h
stretched well
tine Clinton h,
the major slid •
Willingness of
immediate de·
leaders or ar
The agreem
only for the
,once the H~
,granted thI
ileagues off
i "The sti
'insist on t'
on which 1
ersJ woul
president
life. He died
er, Rosetta L.1wrenr,e Wright, brought in most of the family's money,
working as a domestic on Capitol Hill during the <l.1Y and selling din
ners from the family's kitchen in the evening, always for cash so the
welfare officials WOUldn't know' about the additional income. They
lived in a rented house in the 800 block of Third Street SE that had
no electricity and no indoor toilets.
Other girls came to school with change to liuy "brownie-thins"
penny-a-piece cookies that the Giddings teachers sold with the free
milk at lunch. Rosa Lee's farnily was too poor to spare even a few
pennies. She knew it was wrong to steal from her classmates' desks,
she says. But she couldn't s!.1nd being poor, either.
Rosa Lee
found tbat she had plenty of opportunities to steal,
if she were daring enough. Selling the Nro-American newspaper .
· door-to-door on Tuesday and Thursday evenings during the swnmer
of 1948, when she was 11, gave her a chance to slip into neighbor
hood roW houses and rifle through the pocketbooks that women often
left on tlIeir dining room tables. Washington was a safer place in
those days, and Rosa Lee discovered that many families would leave
their front screen doors IUllatched while they chatted in their hack
yards, trying to cool off on hot summer nights.
In the fall, she fOlmd a new source of money: the coatroom at Mount
Joy Baptist Church, a nearby chUrch where her family had worshiped for
many years. She had started ushering during Sunday services and was
assigned to help in the coatroom. She noticed congregation members of
ten left money in tbeir coat pockets. '1 felt like if they wanted [the mon
·ey]. they wouldn't have left it in their damn pocket," she said.
· Rosa Lee said she would wait until the "singing and praying" started
before going to the racks of coats, patting the pockets and listening for
the jingle of coins. Once in a great while she would find dollar bills.
Her coatroom thefts continued undetected Wltil one Sunday, when
Mount Joy's minister. the Rev. Raymond M. Randall, announced to
the astonished congregation that someone had stolen several dollars
fiom a member's coilt pocket during the previous SWlday'S service.
Randall offered forgiveness and asked the culprit to come forward. If
the thief was hungry, the minister said, the church would try to help.
. Rosa Lee could not bring herself to confess in front of .her mother,
her family and her friends. "My mother would have KILLED ME! Do
you hear me? KILLED ME!" she shouted at me as she recalled the
scene. "And who is going to go up there and tell him that you're hun
gry? That would only embarrass the hell out of you!"
For the next few weeks, she stayed away from church. When she
returned to her ushering duties, she was careful to steal only change.
She often did not know what to. do with the money she stole. Her im
mediate needs were small and simple: 35 cents for the Saturday
movie matinee at the old Atlas Theater on H Street NE, or a dime
for the SflOW cones that she loved: She gave away small amounts to
brothers and sisters and friends, but never enough to attract her
.' mother's attention.'
,
Rosa Lee hid her stolen coins from her mother: '1 would roU it up
in a stocking," she said, and put the stocking under a rug, or under
her mattress or in her underwear.
Forty years later, Rosa Lee still hides her money every night
not from her mother, but from her five drug-addicted children.
Sometimes she goes to bed with a wad of bills stuffed into her sock.
"If I don't hide it, they'd steal it," she said.
ward/' S
.Cbristop
" Said·
was a"
not H
it w:
'inajo
'to P'
the·
,pet
·pn
tho
fr
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cs
~
Out of Style
II f Rosa Lee felt bad about not having a few pennies to buy cookies
II in fourth grade, she felt even worse about not having a stylish
wardrobe to match those of her friends in seventh grade. She hated
the secondhand clothes tbat her mother bought for her; they were al
most always out of style.
Rosa Lee already felt .at a disadvantage in attracting boys, and
thought fashionable clothes might help. "1 was dark-skinned," she
said. "I wasn't like the girls with long hair and light skin. The boys al
ways went for them."
One morning, a girlfriend lent ROS<1 Lee a new gray skirt with "two
pockets on the hip," one of the newest fashions. "My mother would
never buy Ole one," Rosa Lee told me, her voice still smoldering with
resentment. Rosa Lee loved how she looked in it.
.
During lunch, the girlfriend asked Rosa Lee in front of some class-'
mates to share her 35-cent meal. "I wouldn't give it to her," RoSl':
Lee said. "I was hungry!"
.
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�Rosa Lee's classmates howled with laughter at her embarrass
ment. As she rete Us the story. I can see that time,has not healed her
wound. Her voice hardens, her eyes narrow, her expression conveys
the raw Jx)wer of th~ memory. ,"That hurt," Rosa Lee says. "I
' . ' " , :.
thought,'G1id, this will never happen again to ,me.' "
Days later RoSa Lee walked into a five-lmd-dime store in the 600
block of Pennsylvania ~venue SE. She picked out a gray skirt and a
wHite Jace' blo~, folded them into' two tight :I>undles, slipped them
under tlie sliirt'sheWasweaiing ani! 'slowl:r'niade her way mit oftlle
store. As she tiirned t1ie comer, she crushed the skirt and blouse to
her chest iii glee."
:;' ,
She hid the skirt,and blouse from her mother. Emtroldened; Rosa
Lee branch~ out, to other stores iri tile C;iipitol Hill area. "I was de
terrninedto have what other 'girls had;" she Sitid.:' ':
"
At: a party in early 1950, she nlet a light-s!dM'ed boy who was at
tractingattention 'from the other girls. Arid Rosa Lee wanted to im
press her friends by getting his attention; she enjoyed the other girls'
envious looks when he asked to walk her home. '
She thought having sex, would cement their relationship. She Iie
carne pregnant; "I haven't seen him since: she said. ,
W1ien si::hool officials found out she was pregnant, they told her
slie would have to leave school until the baby 'was born. She never
went back: In November 1950, she gave birth to Bobby, naming him
Robert Earl Wright.
Y
Not long ;after ,Bobby was born, Rosa Lee decided 10 dress for
church in one of her stolen outfits. She knew it was risky, but she
was tired of wearing hand-me-downs when the other uShers usuaUy
came in stylish clothes. As soon as her mother spotted the gray
pleated skirt, she confronted Rosa Lee.
"Where did you get this from?" Rosetta demanded.
"I stole itout of a store. Please don't make me take it back to the
'store, Momma!"
'
ROsetta was furious. "I ain't going'to say nothing to, you now be
cause you told the truth, but don't bring nothing else in here that
you've been stealing! DO YOU HEAR ME?"
"Yes, ma'am: said ROsa Lee, trembling as she waited for her
to hit her.
',' '. ! " , '
mother just said: "Put it on. 'Let's' see what you look like in
it."
J,WM,:r!!imiUIll*JS
'" The Stolen Scarf
o~ de Ignored Rosetta's order to stop shoplifting. Whenever her
R
,mother questioned her about some new item, Rosa Lee just denied
that she.st~le iL "My mother would teU me, 'Stop that lying,' and then
let it go," ROsa Lee' said.
But a judge wasn't so kind when Rosa Lee was caught shoplifting a
few months later at a downtown department store, her first arrest. He
sent her to a facility for juveniles for 19 days in early 1951. Blit the les
son Seemed lost on the lS-year-old Rosa'Lee; after her release, she
went right back to shoplifting.
, When Rosa Lee was away, her mother cared for l-year-old Bobby.
Rosetta, who had her first child at age 15 in North Carolina, had accept
ed Rosa Lee's first pregnancy; but she was angry because Rosa Lee was
pregnant again, The father was another teenager in the neighborhood.
"What do you think you doing, bringing aU these babies in here?" Rosa
Lee remembers her mother saying.
Rosetta demanded that Rosa Lee have an abortion, but Rosa Lee
wasn't about to let her mother tell her what to do---about babies, or
shoplifting, or anYthing else.
Anxious to win her mother's affection, Rosa Lee decided to steal
something for Rosetta. One day after Rosetta came home from work,
Rosa Lee took a multicolored, cotton scarf from under her coat and
1umded it to her mother.
ROsetta took the scarf,
it over in her hands and looked
~ at tier daughter. Rosa
waved both her hands, a sign to her
not to, ask where she had gotten the Scarf.
,Her mother didn't. "Rose, I NEVER had something like this!"
Rosetta threw her arms around Rosa Lee. "She grabbed me, and I
hit one of Rosa Lee's children: When Rosetta heard about it, she was
angry. She stormed into Rosa Lee's home.
'
"She told me 'that aU 1 am 'is a troublemaker," Rosa Lee recalled. "[
told her that ·[theneighborj'shouldn't have hit mY,child. Momma said,
.'You.nothing btit a damnJlIIis.,n:ce,: and pow, right in my' mouth,"
RoSetta's blow left her daughter with one visible legacy of their re
to :replace the front teeth that Rosetta
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As much as she'went to
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'we ,Started Grabbing'
n the ham;y Thursday nigtit'of April 4, 19(i8, a few hours after
the assassination of civil rights leader Martin .Luther King Jr.,
looting and arson erupted in several of the District's major coriuner
cial corridors, overwhelming thC'City's police force.,
,
Rosa Lee watched as looters carried bags; boxes and portable tele
visions past the ramshackle house She was renting at 149 L St. SE.
"Where ya'~ get that stuff?" Rosa'Lee called out fiom her porch.
.
"H Street," folks shouted. ':{,\""
Rosa Lee; 31 at the time, tilid it vagtie.idea
improve life for' AfriCan Anu;rii:ans. Still, the destruction did not
disturb her: She did hot belie~e' the torching and trashing of busi
nesses had any connection to
The shops, she said, were rWI by
"gieedy" merchimts who gouged Cllstomers and took "whatever lit
tle money,! had!' .
,-~.L'
.
. So wh~nher'SonBobby, then 17, drove'up in a Buick that Rosa
Lee instinctively knew had been'stolen;'she didn't hesitate.
,
She turned to her seven oilier children and said, "All right! Who
wants to go?" As usual, Alvin'and Eric, then 15 and 12, held back.
On H Sqeet, Rosa Lee said;~"everybOdy was grabbing everytJUrig
they could get their hands on:;We started grabbing too. Didn't know
what we·weretaklng. Just graDiling, grabbing, grabbing."
next day, when the I~ting began again, Rosa Lee kept her
home; "We already;had so much stuff: she said. "There
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Shoppittgfor Bread
r. Dash," Rosa Lee sayS as I am driving her to her apartment in
, "February 1991, "stop~~t that High's so I can get a loaf of
bread.
'~,.'
,ll!lance at her. and she knows what I'm thinking. ''j'm not doing
,~
,
says.
Lee that I'cannot be a
we pull inti:> the
her oversized
e store5::l.
Fifteen minutes go by. My feet are getting numb from the cold, so I ,
decide to see why she's taking S(j long. Her head is visible above the dis
play counter of caniled goods? ~he is .putting something into a large
brown paper bag, too busy to notice I've come inside the small store.
"ROSA LEE!" ! shout.
,,"
She jumps at the sound of Jier name. She spots me standing near
the smudged glass door. She, crumples the top of the bag and walks
toward me. I feel her cold anger as she breezes past.
"That's the last time I waiffor you outside of a store!" I yell as we
walk to the car. "You told me you wer~n't going to steal anything!" '
She fires back, her words coming out in a steamy vapor from the,
cold. ''I'm trving'to feed mv familv and I don't have any money.
I am angry with Rosa Lee for violating my
with myself. The incident is a lesson to me: Why
would behave differently around ine?
and I am angry
I· think that she
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few ,weeks after the shoplifting.lncident at High's, Rosa Lee and
I are talking iii her apartment. After spending so much time with
I realize I don't always ask the questions that need to be asked.
~osa Lee," I say, "there's something I want to work out with you
about how
look at the world."
I
of the time she took her granddaughter
coat. They were on their way to church, but Rosa Lee t
girrs coat looked ragged, so they went to the thrift shop to,snOpUlt.
Rosa Lee nods.
"How do you put those two together?" I say. "One Sunday going to
church to be baptized, and the next Sunday going to shoplift a coat?
''j don't know," she says. '1 didn't like to take her to church with
that dirty-looking coat."
"But how do you take her out stealing then?" I say.
She protests that the thrift shop's white owner takes advantage of
his customers, who are mOstly black; "I don't understand how a thrift
shop can charge so much for things," she says. "Do you know that he
charges $8.95 for sttiff that don't cost that much brand-new?"
"That's a rationalizatiori"and it doesn't dance," I
That night, I am surprised to find a message from
Lee on
answering machine in the newsroom, tetling me that she had
"seco,nd thoughts" about taking her grandchildren to shoplift. The
next day, she explains. "You gave me something to think about," she
says. She told her grandchildren that our conversation had made her
see that it was wrong to steal coats for them. " '
Her granddaughter immediately' went to' the closet and got the
pink coat that Rosa Lee had helped her 'steal.
"What you want me to do with the cOilt?" she asked Rosa Lee.
"Keep it. Keep tlie coal. But we're not going to do any more steal
ing," Rosa Lee replied.
'.
"Are you going to stick to that?" her granddaughter asked.
"So help me to God,",Rosa Lee said, "I'm going to stick to that."
Rosa Lee looks at me',waiting for my reaction. I study her face .
She isn't promising never. to shoplift again; only that she w9n't in
volve the children. Nonetheless, she seems sincere.
"You have a powerful influence on those children," I Say.
"I know it,"
About. This Series
I n 1932, in the midst of the Great Depression, Rosa Lee
!:I Cunningham's grandparents and parents gave up their.
North Carolina sharecropping life for an uncertain journey
north. Rosa Lee is the link between past and present, be
tween a world that has disappeared and the one that her chilo
dren .lind grandchildren face today in Washington. Her life
1S a half-century of hardship iii blighted neighborhoods
far from the majestic buildings where policy-makers have
failed in periodic efforts to break the
of poverty
! trapped her and so many other AfTl"nl{,''''~
Many of Rosa Lee's relatives, induding two of her eight
children, managed to secure footholds in the mainstream of
American society; their relative success makes it all the more
important to try to underst"nd Rosa Lee's life. Although her
story is discolnforting and disturbing, she wants it told. "May
be I can help somebody not foUow in my footsteps." she says.
That story--of the choices she had and the choices she
made-offers a ch~nce to understand what statistics only
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TUF.'IDAV, SEI'IT.MBER 20,
1994
~~ .
THE "\SIII"iGT01l POST
ROSA LEE'S STORY
~
I
I
Illiteracy has helped to lock Rosa lee into
Rosa Lee can't
read this story
tj
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In::!:
poverty. Unsure of what official.etters say,
she's afraid to throw them away and carries
the tattered sheaf of papers everywh~re.
Rosa Lee's absences from Giddings school
went unnoticed.
-w,~
:no
:
§8 CHOOllNG:.
r,!
afng the mail is
iin ossible for Rosa Lee.
Though she can make out
some words, she can't fully .
understand them. That
leaves her at the mercy of
others when it comes to
routine tasks such as
handling a bill. Like her
mother before her, Rosa
Lee attended a segregated
school. She then was
segregated further, this
time by a tracking system
that placed her in a "slow"
class. She was promoted
each year until she
dropped out at age 13.
·1
!
•
\
!
.
�She vowed never to reveal her secret
.
'
,
. '
.
.
ROSA LEE, From At
Dilimtin doseS made her feel disoriented and weak; as she grew
weaker, she would add another pill, thinking it would make her feel
better.
"I didn't know, Mr. Dash; she said, her voice reflecting pain and
embarrassment. "I was trying to get well.·
~«9mla,*ltlII3!mlf.
Breaking the Code
R
Osa Lee cannot read these words I have written about her life.
She is aware that I planned to use intimate details from her past
and present for this series of articles about how several generations
of one Washington family have lived with poverty, drug abuse and il
literacy. We have spent hours discussing what I intended to write.
But she will have to rely on someone else's eyes to fmd out just what
I have written.
She can recognize certain words-enough to fool strangers-but
the newspaper itself is like Ii long string of indecipherable code:
Here's a word she knows, and here's another, but together they
make no sense.
She often asks me to break the code for her. One 1991 morning at
McDonald's on New York Avenue NE, where we often have break
fast after her daily visit to the methadone clinic nearby, she asks me
to explain a letter she has received from the D.C. public housing
agency.
She rifles through a rolled-up sheaf of tattered papers she always
carries in her pocketbook, scrutinizing each piece of paper for the
housing agency's recognizable letterhead. The bulky stack is her por
table filing cabinet, the place where she keeps all her documents,
some dating back years. She never throws anything away, because
she can't read well enough to decide what she needs and what she
can discard.
Finally, she fmd5 what she is looking for and hands it to me.
"This is the wrong letter," I say,
"No, it isn't!" she retorts. "Read the letter. It's from public hous
ing~"
I shake my head and point to t)'le date at the top of the letter:
1989. "This refers to public housing you lived in on Blaine Street NE
two years ago," I say, "not to the application you have filed for a new
apartment."
"Are you sure, Mr. Dash? Read it and make sure."
"This is not the letter. I've read it. In fact, you can throw this
away."
"Don't you dare!" she says, snatching it. "I might need it."
It is infuriating that someone with such a sharp and quick mind is
shut out from much of the world around her. She cannot find an unfa
miliar street on a D.C. map, but she skillfully navigates the
cated bureaucracy of D.C. public housing, repeatedly se-curing
ments for herself and her family ahead of other applicants on
waiting list. Balancing a checkbook is out of the question, but she
successfully handled large sums of money when she was dealing
drugs in the 19705 and 1980s, satisfying customers and suppliers not
known for patience.
She tries to hide her illiteracy by going on tlie offensive. Anyone.
spelling a name for her is ordered to slow down while she prints each .
letter in big, blocky capitals. Sometimes, she casually hands over pen
and paper and asks the person to write it for her, as if she were too
busy to be bothered. She's so good at covering up her illiteracy that I
fmd myself forgetting that she can't even read the few words 'on a
medicine bottle label.
, On the afternoon after her release from the hospital-a blustery'
March day that makes us welcome the warmth of her apartment
Rosa Lee and I are sitting on the plaid couch in her living room. The
hospital has given her a new prescription schedule, and she has asked
to help her take the medicine correctly this time.
~.
. '.
'
I pick up one of the amber·colored plastic containers, "This is th~
phenoharbital. 1 noticed they reduced the amount down to 30 milli
grams. When you left Greater Southeast, they had you up to 60 milli·
grams."
I shake several into my hand. "Now, do you recognize this tablet?
What do you see it as?"
.'
Rosa Lee squints at it. "The little white pill. That's the kind that
. makes me drowsy."
I print "little white pill" on a sheet of paper and hold up a different
pill. ''Tell me what you see this piu as. This is the Oilantin." .
"Is that one of the seizure
"Yes."
.
"A white and orange pill," she says. "That's the one I took so many
of."
"Right," I say. "That's what made you sick." I write "white and or·
ange" on the list.
, '
"Now this one:' 1 say,displaying a folic acid tablet that she takes as
part of her HIV treatment.,
-.
Rosa Lee studies it. "Little white pill," she says tentatively.
"No, no, no. That's the phenobarbital. This pill is the yellow pill.
Here, look at it again."
'
,:
''The yellow pill," she repeats, staring at the tablet.
"All right," I say, moving on to the last container. "This is the re
trovir, the AlT. This is for your:condition of being HlV-positive.
Now, you tell me how you see this pill."
"My blue and white."
:
I show Rosa Lee what I am writll)g.
"Okay," she says, "but please put.the p.m. and the a.m. for me."
"I am. Now read this to me." "
She reads each word slowly, carefully, like a rock climber ascend
ing a cliff. "Little white pill: 8 a.m.;· 1 p.m. and 6 p.m. The white and
orange pill: 8 a.m., 1 p.m. and 6 p.m. The yellow pill: 8 a.m."
I interrupt. "Yoo only take that once."
"Once. Okay. Blue and white piil:8 a.m., 2 p.m. and 8 p.m."
"Right," I say. "Now, will that work for you?"
"Yes," she says.
"
Rosa Lee taped the list to the Wa1l outside her bedroom so that her
grandchildren, who read better than she does, could help her, As her
strength returned and she spent more time away from home again,
she stuck it in her pocketbook. After several weeks, she memorized
the routine and the list became just nile more out-of-date item in her
portable filing cabinet.
~3:r.lidiMMItt1Ji'lSI
The Lessons Learned
D osa Lee has no trouble remembering when she began hiding her
Rilliteracy.
It was 1953, and she was 16 years old, separated from her hus
band ot' a few months and raising three children in her mother's
house near. Capitol Hill. It was the last place she wanted to be. Living
in RoSetta Wright's house meant living by Rosetta Wright's rules,
and those rules were choking Rosa Le~.
. Rosetta and her family had come to Washington in 1935, seeking
refuge from their harsh lives as sharecroppers in North Carolina and
Maryland. Her husband, Earl Wright, worked intennittentiy on con
struction jobs until his death in. 1948, bui Rosetta's domestic work
brought in money more regularly.
Just as Rosetta's mother had prepared her to be a sharecropper, Ro
setta schooled Rosa Lee in domestic work. Long before Rosa Lee
tumed 10, her mother taught her to scrub laundry on a washboard, to
wash a floor so it shined, to make a bed so it looked crisp and neat. Rosa
Lee's apartmeilt is a monument to those lessons; no matter how many
people are living there, it is alwa)'s tidy and well organized.
As the oldest girl, Ros.. Lee was expected to do laundry for every
one in the house; by the time she was in the third grade, she was
spending hours at the Scrub board every week, washing sweaters and
shirts for her parents and their 11 children. "My mother didn't ask
me did I have my homework done;" Rosa Lee said. "School wasn't
import.1nt to her, and it wasn't important to me."
Rosa Lee remembers asking her mother why she had to do so
many chores. Her mother told her, "You're going to find out. This is
the only kind of job we can find for black people."
Rosa Lee isn't sure how she made it as far in school as she did.
Each year, she was promoted In the next grade, despite her reading
problems. In the sel'enth grade, not long after her 13th birthday, Ro
sa Lee became pregnant and was forced to drop out of school. She
was supposed to return after the baby was born, but she had a sec
ond child at 15' and then, at 16, she married the father of her third
child.
Rosetta had insisted that Rosa Lee marry 20-year-old Albert Cun
ningham. Rosa Lee didn't love Albert, but she was thrilled anyway.
Marriage meant she could leave her mother's house forever. Four
months later she was back; her husband beat her after he found out
that Rosa Lee had been sleeping with a neighborhood boy. Rosetta
told Rosa Lee to come home.
Those few months of independence made it hard for Rosa Lee to
return. She and her rilOther argued often about Rosa Lee's welfare
checks; Rosa Lee wanted the money to come to her, but Rosetta said
she was too young. "What are you going to do with it?" Rosa Lee re
members her mother saying. "You don't even know how to pour piss
out of a boot."
Rosa Lee craved her mother's love and affection, but she also
feared her. She looked at her mother's broad back and powerful
h,1nds, and could think only about how to avoid the stinging slaps Ro
setta often delivered during their arguments. Forty years later, she
has almost nothing good 'to say about her mother. "My mother classi
fied me as very dumb," Rosa Lee told me one day. "It was almost as if
she was making fun of me."
.
Rosa Lee saw public housing as her escape. With the help of
friends, and without telling her mother, she found her way to the
public housing agency one afternoon.
She asked a clerk there for help, telling him that she could not fill
out the application by herself. The memory of his sneer shU causes
her mouth to tighten and her voice to thicken. "Back in those days,
they didn't give you any sympathy when you said you couldn't read,"
she said. "It was like. 'So what? It ain't my fault.' "
Humiliated, she trudged hack to her mother's house. She vowed
never again to reveal her illiteracy to someone she didn't know.
"Can you read?" she asked her then-current bOyfriend that day. Of
course he could read. Couldn't she?
No, Rosa Lee said defiantly. She sat next to him, brooding silently,
while he filled out the application to switch the welfare payments.
The showdown with Rosetta came four days later.
Rosa Lee waS relaxing on the front porch, feeling good that she
had completed her chores for the day, when she felt Rosetta's strong
fingers jab her in the shoulder.
"Why didn't you'tell me that you went and applied for I'ielfare?"
Rosetta demanded.
Rosa Lee had forgotten to check the mailbox. Now it was too late.
She decided it was time to stand up to her mother. "I wanted to get
me and my kids out of your hair," she remembers saying. "It seems
like my kids were getting on your nerves."
Her mother's questions were tinged with anger: \Vho helped her?
How did she know where to send it?
"I got somebody to help me! You wouldn't help mel" Rosa Lee re
torted.
"Who are you talking to like that?" Rosetta said in the tone that
Rosa Lee knew so well.
"Momma," Rosa Lee pleaded, "you would not help me fIJI it out."
"How am I going to help you fill it out when f can't even read my
self?" Rosetta shouted.
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Rosa Lee was stunned. "Why didn't you tell me you couldn't read?"
" 'Cause it wasn't none of your danUl business!" Rosetta said.
~1l:filai3il!li:!@lij;Ji1.
'She Was Teaching!'
he first-grade classroom that welcomed 6-year-{)ld ~o~·. Lee
Cunnmgham in the faUqf 1!!42 was a long way from tlie !tindof
school that· Rosetta Wright had attended 20 years earlier' .in rural
North Carolina.
, ' .
.
Rosetta's school year didn't begin in September and end in June. It
was geared to the rhythms of the cotton fields; from the spring
through the fall, the sharecroppers had to work the crop, leaving the·
winter months as the primary time for school. The harvest came
first, the classroom second.
.
The white landowners had no interest in encouraging' the black
sharecroppers to send' their children' to school. Education was a
threat to the sharecropping system that dominat~d much of North
Carolina' and the South' when Rosetta was growj~g up in the 1920s;
sharecroppers who could read and write might take t~eir labor else
where. Rosetta's parents, Thadeous and Lugerua Lawrence, had no
formal eduC!ltion; Rosetta went to school, but when she reacherl pu
berty, she went to work full-time in the fields;
There was one similarity' between the schools that Rosetta and
Rosa Lee attended: Both were part of segregated school systems.
Rosa Lee's difficulty.withreadilig afld:W:riting began in first grade.
soon after she enrolled at Giddings' Elementary at. Third and G
streets SE: She does not remember gettUig aily special help from her
teachers. "If you didn't learn it, you just didn't learn it," she said.
Then one moiningat the beginning off()uit~ grade in 1947, she
saw that school could be something more than a place of frustration:
She was talking with a girlfriend in her gii'ifriend' s classroom when
the teacher appeared and shut' the door. before Rosa Lee could leave.
Trapped, Rosa Lee decided to lilke a seat rather than draw attention
to herself: Besides, she was curious about the teacher, Miss White
head; Rosa Lee' hiIdheard Mi~s Whitehead did things differently in
her second-floor classrfum.'
. '.
Within a few hours; Rosa Lee felt as if she had stumbled into a new
school. On the iirsf floor,'wliere Rosa Lee had always been assigned,
she and her c1assrnates.rotated. among four classrooms everyday.
. But Miss Whitehead's suidentS stayP.d all day in the same classroom,
and Miss Whitehead handled all the'subjects.
On the first floor, the teachersseemed.to spend a lot of time in the
hall, talking to each other; while Rosa Lee and her first-floor class
mates played "and 'meddled with' each' other." By contrast, Miss
Whitehead's class seemed calm/orderly ari'd exci\ing.
For three straight days, Rosa Lee climbed the stairs to Miss
Whitehead's classroom and sat there, un<jetected. For the first time
.in he(life, s.lle found school (a'Scinating.YSile ~as teaching!" she told
me. "She made you feel like you were learning something." Rosa Lee
planned to stay upstairs forever.
.
Why weren't' the children downstairs taught like that, she asked
her girlfriend? The' friend told her that the frrst.-floor class was an
"ungraded class for slow learners."
.
No one hiid'told Rosa Lee that she was "a slow le...rner." She re
members angrily cutting her friend off.
.' ..
.
It seems difficult to believe, but Rosa Lee went unnoticed in the
class for three days. On the fourth day, she raised her hand to ask a
question. MiSs Whitehead appeared to notice her for the first time.
.
She asked Rosa Lee to stay behind during recess.
After the other students left, Miss Whitehead asked Rosa Lee
• where she was suppOsed to be, and then told her that she would 'have
to return to her assigned classroom.
..'
.
"But. I like the way you teach up here," Rosa Lee said. "Why won't
Y9U let me come up here?"
" "You're not supposed to be up here: she remembers Miss White
hO'lorl ~:'l.vino" ''You're suooosed to be downstairs:'
T
"Why?" RoSa Lee asked.
:,", .
,
"Because you're slow learried" Miss White~ead replied.
Rosa Lee retreated to the first floor. Her teacher, who seemed not
to h~ve nUssed lier', told R05aL~~;never to go upstairs again.
Later that sChool year, Rosa:I:ee' began skipping school frequently,
Oil niany mornings, she left thelIDuse as if she were going to school,
but she spent the day roaming the streets of Capitol Hill instead. De
sp,ite Jier.tmexpiained absenceSi'Slie was promoted to the fIfth and
sixth graQes..
> _
. )11 the spjilig 0[.'1949, after '2eing lleld hack twice, Rosa Lee was
called to the principal's office. !twas the end of her sixth-grade year,
and a 'scho'ol bfficiilltold her sh~; would be allowed to graduate to ju
l}iorhigh~ ~·She.'told.ine I was ifejng"passed 011 account of my age;;
Rosa Lee said, "not'beeause I ha,fpassed any of my classes."
a
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. " 'R¢ad 1i~/or Me'
orty;three ye~rslater, on aJ~~ua,.y morning in 1992, Rosa Lee IS
,fretting over j1er telephone liilL She stares at the eigb,( pages;
tfjing:to figure·out·how.herhil1rc6uldbe $241 when her monthly
SerVice.dJ~ts $15:38:,' ;
f~{('
.
.' She thnists'the'bill into my hanas; "Read it for me, Mr. Dash," she
says, Ii~r)ower lili, tf~mbling as ir~\Y~Ys does wh,en she's upset.
".As.we.talk,·,Ronme, Ducky alld~~chard are m the ltvmg room.
They are.watching a' movie on dble" which Rosa Lee had installed
for therli:Patty: is asleep 'on.the Coudi.None of them is working at
.t he 'l11oment andnQ ori~'is helpi,jg:~g: pay the $64 monthly rent, the,
electricity' and phone bills, or the cable. .
- RoSa Lee has the'.aniy steady inCllme, not all of which is legal. She
receives $437 a rrionili from the Su'pplemental Security Income pro
'gram for· the' disabled poor; the govenu'nent considers her disabled
. because her medical problems an"H~c~ of skills limit her job pros
·.tJ,ecis, The rest of her money comes from selling shoplifted goods.
': Money never' .lasts 10'rig'in the CuniUngham household, so when the
'phone bill arrived:.in, late December,' Rosa Lee was frantic. The
, ",\lords on .the ftist·i>age~~'Messagf;\iJ.nits" and "Federally Ordered
, - ; Subscriber Line 'Charge"-meant nothing to her. The subsequent
pages, each. sI10wing totals and subtb'tals, confused her even more.
She can't add or subtract;'So she coUldn't check the numbers, much
as her sharecroppjrig grandparents :iquld not check the landowner's
math when he added up their "share'! after each harvest.
Christmas, the phone com
She puUhe biUaside. Three days
.. pany disconnected the line. When her..disability check came after
New Year's, Rosa Lee paid $140 mid:the service was restored. But
with $lOlllllpaid .. Rosa Lee is worrled:'
.
I wasn't eager, to get caught up in her personal affairs again. I sug·
gested she:caU'her son, Alvin, who is. literate and willing to help when
his mothe!' calls. Alvin 'and· his hrother, Eric--who live on their
. own":"'ani tlieoilly,t\vQ 6fRosa Lee's'children who have never used'
drugs..
;.
.
.. "NO, NO, Ng:: 1I:0sa,Lee sc.reamed at me, tears trickling down
her face. "Alvin's going to be angry and fuss at me for letting these
grown-ass chiidienlive off of me! No!¥ou've got to help me! Yoi(ve
, got to call ~he' p~9ne company. If I calrthem, I'll only get flustered,
and they'll find out I Can't read: TIIese.bills are kicking my butt, ~nd
I:m not getting any help to pay them. PLEASE? PLEASE?" .' ,"
"Okay, okay, okay," I replY;!Dy head'pOupding, "but theywon't be
I
able to hear me if.you're crying."
I scan the bill, which shows a balance' of $137 from November, and
quickly notice severa! problems;
SOmeone has been making calls to "900" numbers that charge $4 a
minute for sexually explicit conversations. After checking with Rosa
Lee, I ask the C&P hilling office to put a block on the line that would
prevent any more calls to 900 numbers.
.
There also are 38 calls to directory assistance, at a ~ost of $9.88.
That' made sense: No one in the house can' read well enough to use
F
the printed phone book, so everyone uses directory assistance to find
phone numbers.
And there are 511 "message units" for local calls outside the Dis·
trict-to phone numbers in Maryland and Virginia. This is a mys
tery: Rosa Lee, who didn't realize that she had to pay extra for such
calls, says she doesn't know who might be making so many calls.
As 1get an explanation of the bill from C&P, I look at Rosa Lee ac
cusingly; The 511 "message units" were all calls to the same number
in Prince George's County. This was on top of 340 calls made to that
nunlber in November.What is gomg on? 1 ask.
.
Rosa Lee looks both surpriSed and sheepish. She had been letting
a young woman down the hall use the phone to call her boyfriend in
Prince George's County.' The woman's phone had been disconnected
for several months. But Rosa Lee had no idea the woman had been
making sO many caUs.
.
It didn't make sense. Why would' the woman call her boyfriend 511
times in one month, nearly 20 calls a day? And how did she do it with
out Rosa Lee's kJ\owledg~?
The answer, it turned out, was drugs. The woman's boyfriend was a
crack dealer, and 'the woman was relaying orders for neighborhood cus
tomers. She made most of the calls early in the day, when Rosa Lee was
out. One of Rosa Lee's children would let her in.
Rosa Lee is upset that the woman has taken advautage of her. But
she is reluctant to cut off her use of the phone.
"What?" I say. "Why?"
"Sometimes· I need some bread," Rosa Lee says. "Sometimes I
needsomesugar, or something ... and I ask her to get it for me."
When Rosa Lee's arthritic knee is too painful to walk to the store,
she ivould rather send the woman than one of her children. "They
spend my moiieyon crack· and don't come back with my change or
my food," RoSa Lee says:
.
1 get up to leave. '!NO!~ she shouts. "Don't leave! Stay with me a
little while!"
She picks up 'the large brass crucifix that she keeps on top' of her
television: clasping it to her chest.
"1 need somebody to stand·by me'" she says, her voice reverberat
ing off the walls and into the second-floor hallway outside, "1 don't
have nobody, I don't have nobody. I can't do it by myself."
AboutThis Series
iii n 1932, in the midst of the Great Depression, Rosa Lee
Ii Cunningham's grandparents and parents gave up their
"
. '
,
North Carolina sharecropping life for an uncertain journey
north, Rosa Lee is the link between past and' present, be
tween a world that has disappeareq and the one that her chil
dren and grandchildren face today in Washington, Her life
spans a half:century of hardship in blighted neighborhoods'
not far from the majestic buildings where policy-makers have
largely failed in periodic efforts to break the cycle of poverty.
Many of Rosa Lee's relatives, including two of her eight
children, managed to secure footholds in the mainstream of
American society; tlieir relative success makes it all the more
important to try to understand Rosa Lee's life. Although her
story is discomforting and disturbing. she wants it told. "May
be I can help somebody not follow in my footsteps," she says.
That story-of the choices she had and the choices she
made-offers a chance to understand what statistics only
suggest: the interconnections of racism, pOverty, illiteracy,
drug abuse and crime, and why these conditions persist.
The series, edited by, Steve Luxenberg, The Post's assis
tant managing editor for special projects, began Sunday,
Sept. 18 and will run through Sunday, Sept. 25. The Post
welcomes readers' ",riHen comments or phone calls. If you
wish to leave a recorded comment., please call PostHaste at
334-9000, Category 4646,
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TuliSDAY, SEPTEMBER 20, 1994
ROSA ~EE'$,STORY
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HOME AGAIN:
Richard helps his
mother with her coat
before they leave the
hOsPital. At home,
Rosa Lee is thrown
lxick into the stress of
her adult children s
dependence and
drug-addicted
behavior.' She kneels
beside IWr bed in
prayer·aS she listens to
daughter Patty .
arrange t01rade sex.
for drugs.
TH{iiISKS: Richard i.i:ises ilk 'mother befo~e taking Mr
hOm!! from Greater Southeast Commun ity#OsPital in
,l
February 1992. Rosa Lee has been hospitalized foiS!!izur.es
SI1l1erai times. Once she nearly died after laking toomuch.
medicine because she couldn '[ read the label for prcrper dosage:
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ROSA LEE'S STORY
~-~
~crIn Rosa Lee's community, drugs are easy to
Methadone
find. She first joined the culture as, a dealer.
Now sh,e is a recovering herein addict who
helps her cope
must face her children's addictions daily_
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Ducky countS money, some 01 It reserved lor drugs.
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A REGULAR STOP:
'For Rosa Lee, right.
,the daily routine
includes eating
>fweakfast.and chatting
with acquaintances at
a McDonald'i in
Northeast, where'she .
spends Several hours
after receiving her..
metlUuJone. The visits
are important. "The
only friends . .. 1 got
is up there,» she says.
ROSA LEE, From At
reason for Patty's nervousness becomes clear: Seated on the couch
are two teenage crack dealers, known to me only as Tw<rTwo and
Man. Between them is Ducky, 32, another of Rosa Lee's ehzht chil
dren. All three are staring at the television, watching an
soap opera.
Two-Two and Man have come to collect from Patty and DuckY. The
teenagers know they have a better chance of getting their money if they
shll'w up early, before Rosa Lee and Patty have cashed their che<:ks. I
have seen this ritual many times since I began spending several days a
week with Rosa Lee' to learn how several generations of one family have
lived with poverty, crime and drugs. Even so, Two-Twu and Man barely
aCicl'1,wledRe mv Dresence.
~
~
As soon as Two-Two and Man leave, Patty and Ducky are off in
search of more crack.
.
~BIl:r;tiii*ltW~
'Mama Rose'
A
t 8: 15 one january morning in 1992, Rosa Lee slams the brown
metal door to her one-bedroom apartment and walks slowly
down the stairs to meet the government-run van for the six-mile ride
to the city methadone clinic.
Ct. __ 0- .... _ _ _ •• ~
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adone clinic or the welfare office. Sometimes I am her translator,
helping her to decipher paperwork that baffles her beC.1Use she can't
read. More often, J am her confidante, listening to her· painful reo
criminations about her life and her children.
Staying at arm's length is difficult. My refusals don't deter her
from trying to get me involved.
"Mr. Dash," she says, tilting her head and softening her voice, "tell
me, what should I do?"
"I'm not in it, Rose." I'll say.
:' T m not in it, Rose: " she mimics.
do you always say that? I
need your help. I don't have anyone
to talk to."
That's why she enjoys her McDonald's visits. There, she can eSClpe
her problems for a while. One day, as slie ranted about her children's
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�lived with poverty, crime and drugs. Even so, Two-Two and Man barely
acknowledge my presence.
Rosa Lee greets them. The boys nod, their facial expressions
masks of cool indifference. They are dressed in hip-hop style: over
sized jeans, baggy shirts, expensive sneakers and baseball caps. Rosa
Lee has asked Two-Two and Man several times not to sell crack to
Patty and Ducky on credit, but they ignore her. I once asked hl
why. "Because they know Momma is going to bail her children out,
she says.
There is no hint of sarcasm or irony in Rosa Lee's voice, just a
simple statement of fact by someone trapped in a drug culture she
helped perpetuate. For years she sold heroin to addicts who would do.
almost anything for a fix; now her own children beg her for money to
feed their habits. She herself is a recovering heroin addict who didn't
quit until the fall' 01.1990, when an injection sent her into a life
threatening seizure. But Patty and Ducky haven't quit, nor have
three of her other children.
It's the kind of environment that sociologist William J. Wilson has
studied in his work on urban neighborhoods that have become domi
nated by. what Wilson calls "a concentration of poverty." Wilson said
it is "extremely difficult" for family members living in close quarters
with drug users to come away unscathed. Rosa Lee and her family,
he told me, reflect "the effects of living in neighborhoods that are
.::verwhelmingly impoverished with all the opportunities for illegal ac
tivities, with limited opportunities for conventional activity:
.
IUegal activity swirls around Rosa Lee every day. She resents hav
ing to protect her adult children from drug dealers, but she always
comes to their rescue. With some pride, she teUs me about the time
she saved Patty and Ducky from Two-Two's wrath.
It was Labor Day weekend in 1991. The checks had come early,
on Friday anli Saturday, because Sept. 1 fell on a Sunday. Before'
Two-Two and Man could fmd Patty, she had cashed her $252 wel
fare check and spent it aU in a few hours. She paid Rosa Lee the
$100 that she had borrowed for crack the month before, paid off sev
eral of the"other dealers who found her first and then spent the rest
on more crack.
So when Two-Two showed up Saturday afternoon to coilect $30
from her, $80 from Ducky and $150 from Patty's boyfriend, Patty
hid in Rosa Lee's bedroom and Ducky hid in the hall closet. "I want
my goddaron money," Two-Two yelled, banging his fist on Rosa
Lee's apartment door. "Mama Rose, I don't mean no harm. If we let
them go, everybody will think they can do it. Would you rather I
knock on the door or do you want me to knock them on their ass?"
Rosa Lee knew Two-Two and Man meant business. Though she
called them "young'uns," they were tougher and hiss patient than
many of the dealers she knew in the 1970s and 1980s, when she
made a living selling heroin in Northwest Washington_
She didn't want to pay them out of her $422 monthly disability
check. "I didn't see any way to make it through the month if I paid ail
bills and paid off their debts too," she told me.
,\II of a sudden," she said, "my mind started working." She decid
ed to become a crack seller, just for the weekend. She asked Two
Two to introduce her to a crack supplier.
"What can I make with $300?" Rosa Lee asked the supplier, a man
in his late twenties.
.
"You can double it: he said. Later that evening, Rosa Lee handed
over $300 in return for 30'plastic bags of crack, each containing one
"$20 rock." She then sent Patty and Ducky to round up customers.
As the supplier prepared the packages, Rosa Lee's 14-year"'>id
granddaughter walked in. She understood inImediately. "I don't want
you to go back to jail, grandma," she told Rosa Lee.
Buyers trooped up to' Rosa Lee's apartment until 5 a.m. She sold
some bags at a discount and gave in to Patty's and Ducky's pleas for
free samples. When it was all over, she hadn't made enough to cover
her $300 outlay. She ended up paying off the debts out of her own
funds.
"l could have made more if I hadn't given Ducky something now.
.
and then, and Patty something nOw and then," she said.
Exhausted from being awake all night, she washed up and got
ready for church.
Since that weekend, Two-Two and Man have looked to Rosa Lee
whenever Patty or Ducky can't pay up. This particular afternoon is
no different. The mailman rmally arrives, Rosa Lee agrees to cover
the debts, the checks are cashed at a nearby liquor store and the
money changes hands.
':.I
1I1C :->torlUo!) lU HU:t.'!t lIlt'! guvernment~run van ff)r tnt: S1-'t~ntllc l"i'.1t!
to the city methadone clinic.
She steps out into a biting wind, but is glad to leave hercrowded
apartment. Inside, her sons Richard, Ronnie and Ducky are a.leep on
makeshift beds in the Jiving room. Patty is in Rosa Lee's double bed,
which they have been sharing for weeks.
Rosa Lee looks forward to this part of her
clinic, she sees old friends she has known since
race in the 1970s and early 1980s. They greet ber with
"Hi ya doing, Mama Rose?"
''Ya'looking good, Mama Rose: .
"Nice to see you, Mama Rose."
"Mama Rose" is what they called her at Clifton Terrace. She likes the
name and the respect it implies. She drifts to the back of a line that
stretches down the corridor toward a counter encased in plcxiglass. A
sign on the plexiglass sets the rules: "Attention ... Your methadone
will be in 3 ounces of water. Please do not ask the nurse for less." Some
patients helieve the methadone works better if less diluted.
The line' moves forward methodically, dozens of people from tlif
ferent neighborhoods and different backgrounds, all bound together
by their addiction. Behind the glass, the nurse measures out the
blood-red methadone into a plastic cup, places it on a revohing tray,
then spins it so the patient can t..ke the cup through the opening.
The patients receive different doses. depending on their weight and
how much they need to effectively curb their craving for heroin.
. The nurse measures out Rosa Lee's dosage. Following the, rules,
Rosa Lee drinks it down as a nurse watches. The glass between.
them doesn't encourage conversation. The transaction over, Rosa
Lee heads for the door.
On many weekday mornings, I meet her outside at the clinic, a
modern two-story coffee-colored building at 33 N St. NE, and we
ride two blocks to the McDonald's on New York Avenue NE.
The McDonald's is Rosa Lee's preferred spot for breakfast. She
spends several hours there each day, chatting with other patients
from the methadone clinic and "regulars" who hang out there." Her
routine is the same: She orders Chcerios or the breakfast spedal of
pancakes, sausage and scrambled eggs.
TILis particular morrLing, she settles on Cheerios. She tears open
seven packages of sugar, dumps them in her coffee and then rips
open several more and empties them onto her cereal. She can't stand
to eat anything until she drinks her methadone, so this is her first
food of the day.
.
A woman approaches. She hands Rosa Lee $3 in a folded lump.
"More Darvon sales?" I ask.
"Yeah: Rosa Lee says.
Darvon is a prescription painkiller that some methadone patients
use for a cheap high. They like Xanax, a prescription tranquilizer,
even more. Rosa Lee often has a supply of Darvon and Xanal( to sell.
She was prescribed both drugs after she injured her back slightly ina
bus accident in August 1991. She has used the injury as.an excuse for
getting refIlls. As a Medicaid patient, she pays just 50 cents for the
60 pills that come in each prescription. She resells Darvon at $1 a pill
and Xanax at $2.
.
She can't refill them too often without drawing suspicion, so iI's
not something that brings in a lot of money. But it gives her a certain.
stature with the McPonald's crowd.
Some days, she will bring in clothes tbat she has shoplifted to sell
or give away. One time, she brought a toddler-sized yeUow sweat suit
that her sons stole in a burglary; she gave it away to a homeless
woman who was there with her 3-year"'>ld daughter. "I just felt guilty
trying to sell it to her," she told me.
A few months after I began visiting Rosa Lee regularly in the fan
of 1990, she told me that several of her McDonald's buddies couldn't
understand why she was allowing me to write about her. "They told
me. 'Stay away from reporters. They put people's business in the
street.' ~
I smiled and told her it was true. "We're nosy and intrusive. I want
your permission to follow you for a long time. There will be many
days when I will ask you about the Slime thing over and over again, .
and then come back months later and ask you again. You might end
.
cussing me o u t . " ·
,he laughed. "That's all right. You look like you could handle it:
Our relationship has emh'ed from those early days. ! have tried to
remain an impartial observer, but, inevit..bJy, I have become a vital
part of her life. Sometimes I am her driver, ierryinf( her to the meth
he; p;~bJe~~;
f~;'-a":;hrle."i5IJ~-d;y:-as~,J,e
ranted 'aiYJllt her children's
drug hnbits, she broke d,nll in tears about how trapped she felt.
J
f
"Mr. Dash," she said, "I don't have no friends. The only friends you.
know I got is up there:
\
"At McDonald's?"
"McDonald's. That's all. And they're not what you call friends. but \
thaI's all I got."
~9:ri!Wl't'll_)i.1
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I
The Cocoa Club
M
Ost of the McDonald's crowd is a generation younger than Rosa !
Lee. Once in a While, though, she runs into one of her old hero- \
in customers from the days when she waited tables at the Cocoa
Club, a nightclub that ooce operated at the corner of Eighth and H
streets NE. "That's way back," she says. "Not too many alive from
those days."
.
"Those days" were the 1950s and 1960s. In the world that Rosa
Lee knows, in the neighborhoods where she grew up, in the places
:
where she raised her children, on the streets where she once bought
'
and sold drugs, there are many people whose lives ended too early,
cut short by too much heroin or too much alcohol or just simply too
much misfortune.
One day at McDonald's, Rosa Lee pulls an old photograph out of
her pocketbook. It is a Polaroid, and it shows a younger Rosa Lee, in
her early thirties, dressed in a sleek black outfit, with matching pants
and top. Behind her is the dance floor of ttie COCG.1 Club.
The photo was taken sometime in the late 1960s by a regular cus
tomer at the dub. Rosa Lee had run into the man recently, and he re
membered the photo. He· ran home to get it, and insisted that Rosa
Lee keep it.
It is the only photo I have ever seen oJ: Rosa Lee at this age: she
looks smashing and vibrant. She looks as if she helongs.
She never planned to work at the dub. As a teenager in the early and
mid-1950s, Rosa Lee often went with her girlfriends to the Cocoa Club
to dance aod drink. The dub's owner noticed her and asked her if she
wanted to wait tables. It was her first job. She was 20, and had just giv
en birth to Eric, her fifth child. The year was 1956.
The pay was good, and it was in cash, so she could hide it from the
welfare office. She worked at night, leaving her mother. to take care
of her children. It was fun and exciting. There was live music and
flashy customers.
One was a heroin dealer. Soon after she started working at the
club, he took her aside and offered her a chance to make a litlle extra
money: If she would sell heroin to customers that he sent her way,
she could keep $25 of every $100 she sold.
She concealed the heroin, which was contained in small capsules,
inside her bra. The capsules sold for $1 each, and customers
bought three. "Friday nights was when I would sell them,"
Rosa Lee. "Friday nights, I would sell hundreds in there. The ownef
never knew I was selling heroin, but he was always asking me why
my tables would be full with customers when the other tables were
empty. I told him, " 'Cause I take care of my customers!' ..
The heroin business, she said. was nothing like the crack business
today. She nC'-er treated her customers the way Two-Two and Man
now treat Patty and Ducky. She thought of herself as several cuts
above the "jugglers," the dealers who sold their heroin on the streets.
She was a high-class dealer with high-class customers; they paid
promptly and in cash.
She resisted the temptation to take a hit herself. She saw the pow
erful grip that heroin held on her customers, and it frightened her.
Besides, she couldn't afford a heroin habit. By 1961, she had eight
children to support. She took a Second job at another H Stieet night
club, the 821 Club, as a "shake dancer"-slang for strip tease. Soon,
she was engaging in prostitution with club customers.
''The men would ask if they could take me home," Ros.1 Lee said.
come right out with it. 'Yeah, you can take me home. ( got eight
Iren at home. We need some money for food!' ..
She also picked up additional things by shoplifting: shoes for little
Patty, pants for one of the boys. She was caught occasionally, but the
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POST
Wt:Il~K'IlAr.St:I'fE~nEB
21,1994 A17
ROSA lEE'S STORY
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A PENSIVE MOMENT: Left, Rosa Lee worries ajUr
giving momry to three ofher children, who she knows will
sjJend it on drugs. She complains but ojUn giues in.
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TAKING AHIT: Patty prepares to giVe her,self Ii shot of
heroin. At age 11. she saw one ofher brothers injecting.
the drug. At,17, she became a regular user.
~':;';;;s-:';;;;g(~~1';';h~--irred' to
steal an eXp!!nsive coat from a
Itii'nd depaitriieiif store: Two security guards-"spotted her as she
' - --' -
, brown wool coat, stipped
one in its place.
_. th~judge ~ritenced her to
:'
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"
"After a few minutes, they come out of there completely changed,"
- she said, "They were relaxed, not worried about anything. They'd
tell me how good the dope made them feel. I was curious about what
dope could do for me, if I could feel good all day, ., But I was still
too scared to try it."
It wasn't long before police also heard abOut Rosa Lee's business,
That's when the raids began.
One night in 1969, the police battered down the door and the children
woke up to fmd officers. their guns drawn, waving Oashlights and
"What are you looking at?" she demands, hiding her hands in the folds
of her winter coat.
'1'01 looking at your swollen left hand," I say.
~H:!:l:;i13i"i~
'rrhulrl Tt Kill Mp.? '.
�Her mother was SItting In tne nrst row 01 spectator sealS.., r ou re
,t going to forget this!" yelled Rosetta Wright, waving her right
refinger at Rosa Lee's face. "You hear me? Leaving all those god;
"no children! You're not going to forget this!"
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'Are lOu Doing It?'
WOKe up [0 tUl\1
and
my
lex!.
'
"She told me, just like ·she told me when I started smoking ciga
rettes, 'You got to take care of your own habits!' "
~em!imi'ihl'!i_
'Get Outta Bed!'
8 n the neighborhood where Rosa Lee lived in the late 196Os, word
I got around that she had heroin to sell. Addicts flocked to her
apartment on 57th Place SE, a long street that ends in a cul-de-sac
near the Prince George's County line. Some were hanging on her
door before the sun rose.
"Some of them would be shaking," Rosa Lee told me. "Some said
their stomachs hurt, Some said their hacks hurt. And they were al
ways begging, begging, begging. They did not have the full price. I'd
sell to them at a discount because I couldn't stand the begging and
sniffling and wiping their noses. ' .. I wanted them to come back.
They'd pay full price when they came back that afternoon, after they
had a chance to steal something or hustle up some money."
Sha sometimes let them use her bedroom to inject the drug. Her
youngest children often were getting ready for school, so Rosa Lee
told her customers to make sure the door was closed.
'')
lll~~U
lSUUO Ulawu,
Wi:1VllIK
1I~!:!lutgHtS alia
r\{w.;)!'d"$ij: ", iii! 3iD jI'l't~
:D osetta took care of Rosa Lee's children for the eight months that
\\ Rosa Lee spent in jail, but Rosa Lee felt little gratitude. The ten
on between them was as bad as ever. Rosetta told the welfare of·
;e that Rosa Lee's prison term showed she was an unfit mother;
tis convinced Rosa Lee that Rosetta would like nothing better than
J have custody of the children and the welfare payments that came
ith them. Their battles only deepened Rosa Lee's resolve to re
ieve her children and move away from her mother's apartment as
uickly as she could.
After her release, she returned to her waitress job at the Cocoa
,Iub and resumed her heroin sales. Within a few months, she found a
ne:bedroom apartment on Bates Street NW, near North Capitol
treet. It was small and roach·infested, but it meant that she was no
)flger under her mother's thumb.
The children, especially the older ones, remember these years as
time of constant turmoil. Between 1966 and 1968, they moved four
Iffies before ending up in a public housing complex in the Marshall
leights area of Southeast Washington. The apartments had one
hing in common: All were'located in areas known for illegal drug ac
ivity.
Heroin was available to anyone who wanted it, including teenagers. In
,967, Ronnie became the first of Rosa Lee's children to try it. He was
.5
in the seventh grade.
As he remembers it now, his best friend offered him a capsule at.a
.arty, suggesting that Ronnie snort the'whitish powder. He had been
earching for something,that would give him more confidence, help him
o overcome his fear of girls and to control an embarrassing stammer
hat took over whenever he was under stress.
"I tried some," Ronnie said. "It stopped
stammering." Within a
ew months, he and his new girlfriend were "skinpopping" the drug in
heir arms.
He tried hard to hide his addiction ·from Rosa Lee, but there was a
.rail of evidence: He needed money to pay for his habit, so he would sell
lousehold items or steal from Rosa Lee's purse. He skipped school of
en and fwally just dropped out in the eighth grade.
Rosa Lee didn't connect any of this to a heroin habit. She had never
laid much attention to her children's performance in school, much as
~osetta had never paid much attention to hers. Then, one day in 1969,
,he found empty heroin capsules and syringes in Ronnie's room.
"Are you doing itr she asked him in a soft voice.
"Yeah: Ronnie said, ashamed. "You want me to get outr
Rosa Lee shook her head. Ronnie was surprised by what she said
OUI\:.1;I;:),
shouting, "Get ouUa bed! Get outt" b,'d!" Rosa Lee's youngest daugh
ter, then 8, remembers she was so afraid that she wet her bed.
The police never found anything. Rosa Lee kept her st~sh at a
friend's house nearby. But the raids continued, sometimes as often as
once a month.
The younger children had no idea why' the polke kept breaking
down the door. But the older childr-eu knew too well what was going
on. "They raided us so often," Ronnie &1iu. "We were so hot."
Rosa Lee ~ First Hit
R
Osa Lee's fltst drug use started with her desire to lose weight.
It was 1973, and the family was living in a four-bedroom apart
ment at Clifton Terrace, The police had hattered the door at the
57th Place apartment so many times that D.C. housing officials grew
weary of fixing it. In the sununer of 1972, they ordered R05<l Lee to
move. Rosa Lee said she gave $100 to someone in authority and her
name went to the top of the waiting list at Clifton Terrace.
One day, Rosa Lee 'found out that Lucky, a close friend, was regu
larly injecting something called "bam," the street name for Preludin,
an amphetamine-like stimulant. Luclj:Y told her that bam helped re
duce her weight by curbing her appetite.
Bam didn't frighten Rosa Lee the way heroin did. Lucky had been
using it for months, and Rosa Lee hadn't noticed any change in
Lucky's bebavior.
Rosa Lee's weight had been creeping up. She asked Lucky for a
hit. "Lucky wouldn't hit me," she said.
Rosa Lee asked one of Ronnie's girlfriends if she· knew anything
about bam, The friend, a school-crossing guard at nearby Eugene
Meyer Elementary School, told Rosa Lee that she used b"m in the
morning before she went to her post.
Every morning for the next year, the woman brought bam to Rosa
Lee's apartment. In the pre-dawn darkness, she would prepare the
solution and inject Rosa Lee and herself.
"I liked the feeling," Rosa Lee said. "I could feel it all in my stom
ach. That's the ftrst thing that shrinks. Your stomach. I would go the
WHOLE DAY without eating, with a WHOLE lot of ener!,')'! I would
dean up the whole house. Nothing was clean enough. I'd take two Or
three baths. I was on top of everything. In three weeks, I lost about
20 pounds."
.
By 1975, two more of her children had joined Ronnie as drug us
ers. Bobby, then 25, began smoking opium while serving in the Army
in Vietnam. And Patty, who had watched Ronnie shoot up when she
was 11, became a regular user when she was 17,
. Rosa Lee had plenty' of opportunities to try something stronger
than bam, but she still resisted. Then, at her 39th birthday party, she
gave in.
It had been a difficult month. She was going through a
three-year relationship, At her party, all she could do was cry.
suggested "a shot of dope" might help her get over her pain.
Aiter that October night in 1975, mother and daughter became
daily heroin users. Rosa Lee was never able to inject herself. If Patty
or Ronnie or Bobby weren't available, she went to a Clifton Terrace
"oilin' joint," and paid $3 for someone to give her a hit.
For 19 years, she had resisted the lure of the drug she sold. Now,
she fel). to the same depths as the addicts who had knocked on her
door and begged for a fix: Her eyes were red and watery. Her stom
Heh hurt when the heroin wore off. Her body quaked and shivered as
it waited for the next hit.
'
Over the next 15 years, nothing moti,'ated her to stop. In 1983,
she survived a misplaced injection that caused a bone in her neck to
become infected, and went right back to using heroin. In 1988, she
learned that she, Bobby and Patty had HlV, the virus that causes
AIDS. She continued to shoot up. Then a series of seizures nearly
killed her in the faU of 1990, and a doctor warned her that her next
injection ntight be her last.
Now her life is a daily struggle to stay on metbadone and stay away
from the drug use that spins around her, Mostly, she succeeds. There is
no evidence that she took-a single hit in all of 1991; she was doing SO
well that the clinic invited her to speak to a group of addicts about her
experience. That's why I am startled one day in early 1992 to notice
that the back of her left hand is swollen and red. It looks like the traces
of "skinpopping," a method of injecting heroin.
WOUtu 11,. AtU lrle:
)
D osa Lee isn't pleased that I have noticed the tell-tale sign,of her·
Ill. oin use, but she decides to tell me the story anyway.
Earlier in the week, she had heen sitting in McDonald's with sev
eral of her methadnne burldi~s. Everyone was chattering excitedly
about the Christm"s gifts they had received from their children. Ev
eryone except R05.1 Lee.
Most of Rosa Lee's children hadn't given her anything. "1 couldn't
say a word,",Rosa Lee told me. "I just sat there and looked, a[ld be
fore I knew it, I went into the bathroom and started crying.~.,
To cheer her lip. one of her friends suggested they share a "billy"
or two of heroin, the quarter-teaspoon package comltionly sold on
the streets of Washington. Ordinarily, Rosa Lee wOl!ld have dismiss
ed the idea. Not this time.
She wondered if it would be dangerous. "What would happen if I
did some?" she asked her friend. "Would it kill me?" Her friend
her not to worry, Rosa Lee decided to risk it.
As soon as Patty heard about the plan, she was eager to join in. It
would be like old times: Patty would give Rosa Lee the· hit, then hit
herself. Patty and the friend went looking for a neighborhood dealer.
A short while later, Patty sat 00 R05<1 Lee's bed and stuck the nee
dle ill the back of Rosa Lee's hand.
"Momma, can you feel it?" Patty whispered.
Rosa Lee shook her head.
Patty was' worried about giving Rosa Lee too much at once, She
remembered Rosa Lee's ftrst seizure, and the panic she felt as Rosa
•
Lee's eyes rolled back in her head.
"Are you ready to take it all?" Patty asked.
"If you stay here with me," Rosa Lee said.
Patty pushed the rest of the milky liquid ,into Rosa Lee's vein. Ro
sa Lee waited for the familiar nlsh, But it never came. The metha
done seemed to be blocking the high.
"I didn't feel anything I used to feel," she tells me.
·Why did you take a chance on dyingr
"
She wriggles uncomfortably in her seat. "I didn't see it that way,
taking a chance on dying. I thought I might have a, seizure, but I
didn't think I was taking a chance on dying;"
I remind her of the doctor's warning. She mutters something and
averts her eyes. We spar for a few minutes, and it becomes clear that
the conversation is going nowhere. Sh'e completes my next
before I can ftnish it.
.
"You really don't have a .. , r I begin.
"A good reason for why I took it?" she said. "No, I really don't."
About This Series
..
i
n 1932, in the midst of the Great Depression, Rosa Lee
Cunningham's grandparents and parents gave up their
North Carolina sharecropping fife for an uncertain journey
north. Rosa Lee is the tink between past and present, be
tween a world that has disappeared and the one that her chil
dren and grandchildren face today in Washington. Her life
spans a half-century of hardship in blighted neighborhoods
not far from the majestic buildings where policy-makers have
largely failed in periodic efforts to break the cycle of poverty.
Many of Rosa Lee's relatives, including two of her eight
children, managed to secure footholds in the mainstream of ,
American society; their relative success makes it all the more i
important to try to understand Rosa Lee's life. Although her I
story is discomforting and disturbing, she wants it told. "May
be I can help somebody not follow in my footsteps," she says.
That story-<lf the choices ,she had and the choices she
made-offers a chance to understand what statistics only
suggest: the interconnections of racism, poverty, illiteracy,
drug abuse and crime, and why these conditions persist.
The series, edited by Steve Luxenberg, The Post's assis
tant managing editor for special projects, began Sunday,
Sept. 18 and will run through Sunday, Sept. 25. The POst
welcomes readers' written comments or phone calls. If you
wish to leave a recorded comment, please call PostHaste at
334-9000, Category 4646.
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A10
THURSDAY, SEPTEMBER
22, 1994
... R
TliE W,\SHI:'iGTOi'i POST
RO~A LEE'S
....
,,':
STORY
.Eric:
,
(,
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'/ caught
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I
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f
myself in time
I
ANGRY
SON~
z
Eric helps hist
mother, but \
they :ojte1z '. ~
ari.~. TIle' ;
anger lie has
Ou
:tW
childhood is
a/waysiust
~a:
below the
iurf/ice. "You I
J
~.' ver instilled
any kind oJ
values in us IJ
that'riJere
Eric, who hoped for ~'niusIC career, worked for the District
until he was laid off In 1992. He now works temporary Jobs•.
wOrth
anything." he;
told her
i,.
i.l991.
)
Eric Wright joined the Army and spent a
j
year in the Job Corps. He works regularly
\
{
and has raised a son alone. As a child he
,
,
\'
benefited from a social worker's interest.
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.felt Since
0,
�so~.I1ard
to escape. By the time he re'ached Rosa Lee's apartment in
the low-income neighborhood of Washington Highlands, he was
steaming. He strode into the living room and stood in front of Ducky,
who was lounging on the couch after a nightlong crack binge.
"You've got to go,"Eric shouted.
"This is Morruna's house," Ducky said. "I ain't got to go nowhere!"
"You're going out of here!" Eric said heatedly.
Ducky looked at Rosa Lee. She refused to intervene, so Ducky
rose from thesofa.wjth a .resigneds~ug,shQ,ved,sorlJe, clothes in a
plastic bag and left.
/
Still smoldering, Eric turned to Rosa Lee. Recalling the scene· for , .
me later, Eric said that he felt Rosa Lee was playing the victim to
win his sympathy. But he had no sympathy for her at that moment,
only anger-UI~~~,apge~_tp~~ ~as b~~,ed, within him s~ce he w~s
5 years old and learned that he was wearlOg clothes shoplifted by his
mother.
''You never instilled any kind of values in us that were worth any
thing!" he raged at her.
''What do you mean, Cheetah?" she remembers shouting, using the
nickname she gave him as a little boy because of his tree-climbing
skills. "I'm not a good mother?"
Eric shouted louder . ''You never made it a point to see that we
went to school! The things that you have taught us is that manipulat
ing is good, if you can do it. Stealing is good, if you can do it and get
away with it. Using someone is good, if you can get away with it."
But Rosa Lee gave as good as she got, shouting louder still thai:
she had taught all her children "to survive!"
'
Eric stormed off. He had heard it all too many times. Survival was
always his mother's excuse. Well, he didn't buy it. He had survived
too-without resorting to drug dealing, prostitution or stealing.
equipment and secured a good job at the District's Blue Pla.ins .T~eat
ment Plant. Then in 1992 he was laid off because of the Dlstnct s fI
nancial woes. Since then, 'he has taken several temporary jobs while
,
looking for something permanent.
. '.
He has raised his son on his own; his rocky relationship With ~he
boy's mother ended in 1982, when he discovered that she was .usmg
heroin-and that Rosa Lee had introduced her to the drug. Enc has
never forgiven his mother for that. "She would do things that made
me turn totally away from her," he told me.
In their family, drug abuse has become, th~ divi~g wall. that no
one can scale. Alvin alld Eric don't spend holidays With therr bro~h
ers and·neither·one can remember the last time that Bobby, Ronme,
Richard' or Ducky came):o their homes for a visit. If they see each
other at all, it is usuaJIy when Alvin or Eric comes to straighten out a
problem at Rosa Lee's apartment.
" Rosa Lee can'texplain the different outcomes for her children. ~'J
didn't do anything more'for them than I did for any of my other ~hil
clren," she said during one of our many interviews on t~e subject.
"They always acted ,different, like they were shamed by It all. Even
when they were little."
.
Alvin, in particular, showed his indepen~ence early, she ,~Id.
"There wasn't any what you call 'role model for hIm to copy, she
said. "His father omy came around a couple of times when he w~s a
boy, and Alvin didn't see him again until he was an adult. No, he Just
sort of grew up like he did all by himself."
'
A
Motivating Forces
• n a spring night in 1991, not long before Eric's confro~tation
, with Rosa Lee, Alvin Cunningham is struggling to explal~ why
like Eric, had turned out differently from his brothers and s~sters. .
lNe are sitting at his kitchen table in his Northwest Washmgton
ne. A lawn service tends the grass; an alarm system protects the
Ise. He and his wife h3ve government jo,?s; Alvin drives a bus for
~tro, where he's worked since 1981. It's the kind of stabil~ty t~at
s missing from Alvin's childhood; Rosa Lee moved the famIly nme
les before he turned 16.
. '
\1vin leans back in his chair, contemplating his response. His face
imall and angular, and he looks much you~ger th~n 38. He is self
:Icing and slow to anger. When he loses his temper-:-as h~ s?me
les does when he visits Rosa Lee's apartment and fmds hiS sister
tty. or his brother Ducky engaged in drug activity-everyone
)WS it is best to scatter.
·It's not very complicated," he said finally, "For one, I don't like
IgS because I saw what they could do to you."
"
[ press him ~o say more, but he's not g~ven to long, mt~ospecttve
tements. hritially he didn't want to be mternewed. Enc too was
.villing at first. Not only would my questions open some painful and
:sonal chapters that they would rather forget, but they were con
ned about being associated With the family's troubled history.
\s they learned more about my efforts to understa~d hov(pover
criminal recidivism and drug abuse had affected therr family, they
Icluded that there was some value in discussing the contrast be
=en their lives and those of their ,brothers and sisters.
)ver the course of several interviews, it slowly became clear that
lin and Eric began to set themselves apart from the f~mily during
:ir frrst years of elementary school. It was not somethmg they co
linated. Nevertheless, both somehow CaIne to recognize that they
I real alternatives within their reach, that they had the power to
ke something of themselves if they didn't give up:.
'
fheir reactions to their upbringing became motIvatmg forces m
~ir lives. For Alvin, it was the shame and humiliation that he felt as
'oung boy; for Eric, it was the anger and disgust that he ha~ ca~
d to adulthood. At critical points, they benefited from an outsider s
ervention-a teacher in Alvin's case, a social worker in Eric's.
.3y the time they reached· their late teens, both decided that sepa
ion was the best way out. Alvin joined the Army at 18, marned
~ mother of the daughter he had fathered at 16, received his high
1001 general equivalency degree and took some college courses.
has been steadily employed since his discharge from t~e Army 17
Irs ago. Divorced from his first wife in 1978, he has SlOce remar
d.
C'
Eric followed Alvin into the Army, spent a year in the Job orps
rning the fme points of wallpapering and then tried to make a I.iv
: as a singer. When t~at didn't work out, he bounced from (;lOe ~b
another before landing a contract as a street .sweeper With . e
;!rict's Public Works Department. He worked his way up, earnmg,
Young Alvin
lvin Cunningham heard the horn of the green ~'welfare truck" an,d
bolted out the back door of his mother's apartment as fast as his
8-year~ld legs would carry him. Whenever th~ fla,tbe~ truck arrived
at the public housing complex for its monthly distrIbution of food, Al
vin would makeh.iffiself scarce.
'
Alvin still remembers the 'contents of those bags: tins of canned
meat.and corned beef, rice, powdered eggs, cheese and pinto beans,
along with other bulk items. Rosa Lee saw these ,staple.s as a godse~d
in her daily struggle to feed her eight children, mcluding a baby grrl
born just a few months earlier. Alvin saw the handouts, as an embar- .
rassment.
.
.
,
His brothers and uncles noticed his tendency to disappear when it
came time to unload the surplus goods that the government gave to
poor families. They assumed he was avoiding work. "He was embar
rassed?" Eric said. "All these years, I thought he refused to go to the
truck because he was lazy!"
"Sometimes I did go," Alvin said. "But it would bother me, I HAT
ED it!"
.
It annoyed Alvin that the truck's driver beeped his horn when he
pulled into the small courtyard near the sid~-~y-side, apart,ments
where Alvin's mother and grandmother were raIsmg theIr farrulIes III
1961. Alvin had a crush on a girl who lived across the courtyard; she
was a year older than Alvin and a grade ahead of him at Richardson
Elementary School. Both her parents had jobs, and although they still
qualified for public housing, they made eno,ugh mo~ey that they
didn't receive any surplus food. He was afraid thegrrl would shun
him if she saw him carrying the sealed bags into his home.
Alvin didn't understand why the family needed to take the free
,food. His mother w(iS working every night, waiting tables at the
nightclubs on H Street, and she often came back in the afternoon
with new clothes for .the family. "We had the best of shoes," he re
members. "Foot-Joys. She picked up expensive things for us. On Sun
day or Easter, we looked real nice. Extra nice! It never dawned on
me that she was shoplifting."
Rosa Lee didn't know what to make of her third-born son. Even as
a toddler he had bfhaved differently from his older brothers. He
would follow her around the apartment, observing everything she
' did. If she stopped to"do something, he sat nearby and watched.
Some of Rosa Lee's friends noticed his quiet behavior; Alvin over
heard them telling Rosa Lee that he would grow up to be a "good
,
person." He liked the sound of that.
He didn't like the things he overheard at school. Some of hIS
better~ff classmates at Richardson Elementary, where he was a
third-grader in .early 196,1, mad~ fun of chil~ren from lith: )ects"-:
the Lincoln Heights public housmg commumty where Alvm s famIly
liv~~n managed to escape much of this "Jone'in'," or t~asing. Maybe
it was because he didn't respond to the taunts; maybe It was because
he befriended some of the boys who lived in the private homes along
nearby East Capitol Street NE. Whatever the reas0l!, the things he
saw and heard while visitmg his new friends opened his eyes to a new
way of life.
He took a close look at the well-kept furniture at his friends'
homes comparing it 'with the worn secondhand furniture at his own. '
="
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PHOTOCOPY
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he family was living in a row house at 11th and"Cstrt!etsNE-; --, I-"~;;;-:;-H~="="", Knew J would
,been 'cti'arg€:d if the police
with Rosa Lee's mother, Rosetta, and nine of her children-19
,. ,\Ivin said. ''From thell on, I knew I had to
in all. Rosa Lee was looking over the equipment in the base
my life to stay away from this atmosphere."
It when Rosetta appeared on the stairs.
:osetta immediately understood the scene. She kicked off one of
slippers, grabbed it and smacked Bobby on his backside. She
~H:WidI3i"if:_
!amed at Rosa Lee to get the stolen equipment out of the house.
'hat night, Rosa Lee passed the word to several musicians at the
I, They bought everything for $275. Bobby remembers that Rosa
, gave him $200. It was the most money he had ever seen. He
e her $50 and split the remainder with two friends who had
he 1968-69 school year also marked a turning point for 12-year·
Jed in the burglary. Over the next several years, he broke into
old Eric.
~e than a dozen stores, schools and churches.
Until then, Eric had found school ao exercise in frustration and
,'hen, six months after Alvin's 12th birthday, Rosa Lee was ar·
anxiety. He prayed every day that teachers wouldn't ask him to read
ted for stealing a coat from a Montgomery Ward's in Prince
aloud. If they did, he would create a diversion "by saying something
Irge's County and jailed in a Maryland prison for eight months.
smart and getting in trouble," He often ended up in the principal's of
1Il her release, she collected her children from her mother and
fice,
an a series of moves that took the family to five apartments ()ver
Then he transferred to Shadd Elementary, where he met sixth
next three years.
grade teacher Hank Wilson. "He worked with you all the way to the
'inally, in 1968, the family settled into a two-story ~nartm"nt
point that you could understand what he was teaching: Eric said.
h Place SE, part of the sprawling public housing
Eric confided in Wilson that he had trouble with reading and
UHeights near the District-Maryland line. Alvin ,
ing. Wilson gave Eric special exercises to create sentences
ior High School, where he met a teacher who saw something in
words Eric knew, When Eric accomplished the task, Wilson
in-and he set about to help Alvin see it too.
out for pizza as a reward.
Wilson told Eric that the exercise demonstrated that Eric had an
aptitude for learning. No other teacher had ever said that. "I felt
~H:';liill~ifti'9atl\1B1
great about myself," Eric said, his voice still reflecting his excitement
25 years later. "I even went to school! I'd get up early and go to
school!"
Eric's sudden enthusiasm for school ended when he graduated
from Shadd and entered seventh grade at Evans Junior High School.
, artreJl Franklin remembers the exact date that he met Alvin
No teacher encouraged him or worked with him as Wilson had the
I Nov. 1, 1968, Franklin's first day as a history teacher in the D.C.
year before. He remembers being placed in an ungraded class with
,lie schools.
unruly, slower learners. He stopped going to school, and Rosa Lee
Joth were newcomers to Evans JWlior High School, an imposing
didn't intervene.
,-brick building on East Capitol Street in Southeast Washington.
About this time, social worker Nancy H. McAllister walked into
rtreJl was 23, fresh from Howard University and bursting with en-
his life. She came to Rosa Lee's apartment one morning to check on
and idealism. Alvin was 15, an eighth-grade transfer.
15-year-old Richard, who had just returned home after three weeks
wasn't Franklin's best student that first year. But Franklin
at the juvenile detention center for burglarizing a Marshall Heights
>arawn to him. "He seemed more mature than children his - -- "
home.
'
tnkIin recalled as we talked about Alvin at Franklin's sub
As a frequent visitor to Washington's poorest neighborhoods.
"He
ryland home. They have been friends now for 25
McAllister wasn't
to find several of Rosa Lee's children at
uld ask you things after class. Students didn't normally
that."
home during school
"For three or four families on that street
ust as the 8-year-old Alvin studied the differences between his life
at that time, school was not a priority,~ McAllister told me dl
I that of his middle-class friends, now the teenager Alvin soaked
interview. "The children knew that their parents wouldn't
the guidance and friendship of Gartrell Franklin. His conversa
them too much if they didn't get up." .. ,"
IS with Franklin revolved around black history and the,black con
McAllister asked Eric why he wasn't iii School.
)usness movement that had gotten started in the 1960s. Franklin
"He came out with some flimsy excuse." McAllister recalled.
;;mized an after-school Black History Awareness group; Alvin
Then Rosa Lee chimed in. "fhey won't listen to me. [ try to get
led and brought along three of his friends.
them up. Maybe you could do something.";
t was an exciting and difficult time to be young and black in Amer
McAllister did not believe Rosa Lee'fprotestations. She sent Eric
. Six months earlier, civil rights leader Martin Luther King Jr. had
back to Evans Junior High that afternooIi~
m assassinated. His death sparked civil disorders in many major
Eric latched onto her as a mentor, freQuently dropping by her of·
including Washington. Stores were looted, buildings burned.
fice at Shadd, his former elementary schooL She gave him books; he
a month before King's death, a presidential commission had
eventuaUy told her that he had trouble reading them. She arranged
ts findings on similar disturbances the previouJ! summer in
for him to be tested and found the resujts significant: They showed
wark, Detroit and other cities. The commission's conclusion was
that Eric had no apparent learning disabilities.
rk. "Our nation is moving toward two
one black, one
She persuaded him to accept tutoring on' Saturdays. Over the next
ite-separate and unequal," its final report
"Discrimination
18 months, she drove him to the tutor's'nouse. Gradually his reading
I segregation have long permeated much of American life; they
improved. although it never Ikcame eal'Y for him. Still, McAllister
v threaten the future of every American."
was pleased.
,,';
'n this atmosphere, Franklin preached against drugs and
It wasn't McAllister's job to keep up With Eric. She did that on her
in and his friends to make something of themselves. AMn re
own. She saw something in him-a stre'rigth of character-that she
mbers Franklin saying over and over: "Get that education. You
wanted to preserve. But she was fighting against forces outside of
:d that education!" Franklin was the first person in his life to em
her control.
'"
ISize the importance of education, Alvin said.
One force was sexual activity, In thc"spring of 1970, Eric learned
rhe boys regarded Franklin as more than just a teacher. "He said
that he was about to become a father. He,was 14-the same age as
the things that a father, if he were there, would say and do: Alvin
Rosa Lee when she, gave birth to Bobby~As soon as the pregnant
1. None of the boys had much, if any, contact with their father.
girl's mother told hun, he went to ROS<l.'Lee. "My mother had no
rile boys wanted to know everything they could about every black
probl;m with it," Eric said. "Alvin had a1r~ady gotten someone preg
:ler, IMng or dead, in America. The boys even visited Franklin at
ne on Saturday afternoons. They talked about the Black Panthers,
nant.
"
Alvin's daughter and Eric's son were bOrn about 10 months apart.
lcolm X and the Nation of Islam and King's Poor People's Camto ju,
Eric now thought of himself as a father 'aJid too "grown" to
They hung on Franklin's every word, Alvin said.
nior high'. McAllister implored him to stay in school, but
had
l!stlfled to Franklin because he was educated and forceful, "He
made up his mind. Alvin already had dropped out; at the end of the
'ays carried P!lperv.:0~k~around with him: Alvin said. "He looked
ing!' .. He stopped working for the prostitutes soon after.
Erir: and McAllister have 3t:ty~d in tfjuch. Eric credits her";
Hank Wilson with steering him away from a life of crime. "I was
my way" to jail. he said. "They showed me a better way of living.
They showed me the positive side of life. I already had the
They showed me what was possible if I just cared about
Eric ~ Mentor
~
MdH:I'!i4L·1.:l·m:b'$'AI
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Alvin ~ Friend
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'That ~. My Son!'
O
n a July afternoon in 1991, Alvin and [ are talking at his house,
reflecting on all that has liappened to his family in the last 20
years. He and Eric went into the Annv after their 18th birthdays,
served two-year stints and came back to Washington to find the
Iy in the grip of drug addiction.
"1 didn't let drugs grab me ," he says softly. "They were there. My
friends were using drugs. I'd seen them shoot needles into their
arms. Heroin, Cocaine. See, I was around it, I've seen them wrap a
belt around their arms and pump the veins up. I saw it. I ignored it. I
couldn't see myself doing it. My friends respected me. They would
'He don't do it!' ..
that Rosa Lee, after
a methadone treatment program and
tired of Rosa Lee's calls for help, tired rushing over to her
ment to act as a referee in a game that never ends, tired of I
money for her so that Ducky or Patty or Richard won't be able to
their hands on it.
There is a story that Eric tells about the divergent paths that he
and Alvin took from the rest of the family. It happened in 1982, while
Eric was working briefly as a D.C. correctional officer.
Getting the job made him feel good. Not only had he established
himself as a law-abiding citizen, he was now being entrusted with the
responsibility of guarding those who had taken the path he had avoid
ed. "[ felt great," he said. "I was Ul the government!"
He was assig[led to one of the Lorton prisons. but he often picked
up additional m,oney by taking an overtime shift at the understaffed
D.C. jaiL One night, he saw Rosa Lee, She was locked up on a shop'
charge.
spotted Eric in his n.wy blue uniform and shouted out excited
ly to the other prisoners.
"That's my son!" she said in a voice filled with
by, embarrassed, "That's f!1Y son!"
About This Series
iii n 1932, in the midst of the Great Depression, Rosa Lee
II Cunningham's grandparents and' parents
gave up their
NOlth Carolina sharecropping life for an
uncertain journey
north. Rosa Lee is the link between past and present, be
tween a world that has disappeared and the one that her chil
dren and grandchildren face today in Washington. Her life
spans a haJf-century of hardship in blighted neighborhoods
not far from the majestic buildings where policy-makers have
failed in periodic efforts to break the cycle of poverty.
I of Rosa Lee's relatives, including two of her eight
children, managed to secure footholds in the mainstream of
American society; their relative success makes it all the more
important to try to understand Rosa Lee's life, Althoul!h her
story is discomforting and disturbing, she wants it told.
be I can help somebody not follow in my footsteps,", she says.
That story -i)f the choices she had and the choices she
made--offers a chance to understand what statistics only
suggest: the interconnections of racism, poverty, illiteracy,
drug abuse and crime, and why these conditions persist.
The series, edited by Steve Luxenberg, The Post's assis
tant managing editor for
special projects, began Sunday,
Sept. 18 and \vill nUl through Sunday. Sept. 25. The Post
welcomes readers' written comments or phone calls. [f you
~!~h !?,!c::,,-v~"a recorded comment, please call PostHaste at
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THE WASIII~(;TO~ POST
ROSA-LEE'S STORY
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tinkers with a radio
Patty sits after
drugs. Rosa Lee has
said she'd like Patty to
join' her in a
methadone program.
A drug-saturated
community serves as
the backdrop to their
mother-daughter bond.' :"
It was Rosa Lee who
told Patty she could
have her first hit. '
,Rattx's ties to her malher ru. w.~_
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�ROSA LEE. From Al
lee said one day. ,; teU her, 'When you go outside, Patty, don't you
feel those people talking about you? Don't you feel it?' •
And what does Patty say? 1 asked.
Rosa Lee's lower lip trembled, the way it always does when she is
upset. "She says, 'Momma, don't get mad at me. Ain't that the way
you did it?' •
f:{ernarQ?S!UOU':8stae.
on
D~nma
rUlli, t
wu WUlnen ltty Utl ;'tdHlCU.
shcetlesS';;lattrdb
theliving room floor, t~ir bodies limp. We
'~'
had founH Patty ~ PuSsj'cai'f
ft wa~ so hot it-;;as lihrd to:1reathe.'''%,
can go illt~the Ifuck!~:Rosa Lee commaudeirBernard.
She bent dowlltverPattYf'who wore black slacks a red shirt arid
no~MlOes, "Wake'U p, Patty,'"wake up," Rosa Lee' ~id, siapping her
faCe...[ walif youito meet'Someone." Each time Rosa Lee slapped
tl~r. Patty's eyelidS opened 'for a
seconds,
~~
,;:"This isn~t go~ to:,,-orlt:~ Rosa
said. "You'll h.we to meet
.:,Patty anotl]er day:"
:)
, \
"You
.
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Meeting Patty'
ou're gOing to have to take off that damn· tie and jacket tie
fore'we go in there," Rosa Lee said as I parked my car out
side the three tan brick buildings that make up Clifton Terrace, the
'_ '.':.
federally subsidized housing complex.
That was fine with me. It was a hot, humid Sunday aftemoonin May
,
~ 1988, and my shirt was already soaked. We had come to Clifto!1'Ter'
race to look for Patty; Rosa Lee had offered to introduce ber to me.
I had known Rosa Lee for five months at that point. Our~elation
ship consisted of several lengthy interviews at the D.C. jail,. where
she told me in detail about her family. She was sen'rng seyen
months for possession of heroin; I was interviewing the jail's officers
and irunates about drug trafficking inside the jail. She was eager to
share her story, and 1 was interested in learning how her life had af
fected the lives of her eight children. We agreed to get together af
ter her release from Jail. : '
, :):,: '
Rosa Lee wasn't sure of Patty's whereabouts. She" had heard
through the prison grapevine that Patty had turnedo:ve,~,h'er Clifton
Terrace apartment to several New York crack dealers; who were
using it as a base ofo\leration. In return, they were payroll her $50
a day in cash, and $50 worth of crack.
' / />'
Rosa Lee hoped that her sOn Ducky, who lived on the''top floor of
one of the Clifton Terrace buildings, could tell us wliere'Patty was
staying. The last time Rosa Lee had seen Ducky, he Iiai(been work
"''''':'' .
ing for the same New York dealers.
Ducky answered our knock. His slight frame was; sWiJruning in a
badly wrinkled pin-striped, three-piece suit. It was ligliigreen. The
collar of his tan shirt,was open and darkly soiled: .The sag in his
shoulders, the weary look in his eyes, the way he moved; all made it
• hard to believe he was 28 years old.
" ',-i., '
He listened warily as Rosa Lee explained that I was:ihterested in
writing about the family. He said he had just returned from church.
"I'm
religious," he said. "I've been born again.". As .he talked
about
renewed comrriitrnent to Christ, Rosa Lee snook her head
as a warning to me not to~believe him.
' ....
finally;'I interrupted. "Your mother has
powdered cocaine into ,crack for New York
, out of your sister Patty's apartment in this
have been addicted to crack for some time now"
Ducky shot his mother a questioning, alarmed look.
'1 told him everything, Ducky." Rosa Lee said, "so you can stop all
that 'born again' shit."
Ducky's religious cloak fell away, He said that he and the New
Yorkers had sptit. They had accused him of stealing some of the cu
caine and beat him. Now he was trying to seU crack on his own.
Rosa Lee asked if he knew where Patty was staying.
"Pussycat's," he said.
Rosa Lee scowled. Pussycat ran an "allin'
one floor below, a place heroin users .could gather in
'ative safety. Pussycat charged $3 for entry. S
· "works"-a syringe and a hypodernric needle-for $3.
, I asked Pussycat's real name. "I don't know her real name," she
'said brusquely, '1 wish you'd'stop asking me about last names and
real names. People don't want you to know that. You might be set
· ting them up to be arrested by the police or something."
'
: Rosa Lee rapped hard on Pussycat's door. Someone opened it a
crack. "Hello, Mama Rose," a man's voice said.
~ The door swung open. When the man saw me, he quickly began
~to
it. Rosa Lee stopped him.
'
~.
with me, Bernard," she said with quiet authority.
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wo nid~ths later'; I fm:illy tinced with Patty. I rrlet her at the D,C.
jail, where she '\Vas being held on a drug charge. Jailme<1nt a forced
withdra~' from Ii~oin, so Ifgidn't know 'what tet expect:, But she
seemedto,be bearing up well.~he had gained weight and looked noth
ing like tJie emaciated,woman I had seen on that mattress.
She sWke rapidlY;:looking do\vn at the chewed fingernails of her
right haij{fas she deSCnbed soii1e painful or embarrassing incident. I
was not-prepared foi-her candor: Within the first hour, she told me
that a mille relative.llitd raped ner when she was 8. He threatened
to hurt'lier if she toli:fanyone, and the assaults eontinuedover the
years. liater collfirm@her account with the relative, who agreed to
'" ,
'
discuss ii'as long as ti~~was not id~ntified.
Whcin;Patty wasa,~teenager/several of her brothers found out
about thej'elative's behavior and lieat him soundly, they said.
The:iii-st rape haajl\;ned in 1966, while Rosa Lee was in jail.
When R~ Lee was i'el~3sed a few months later, Patty tried to tell
her about it, but she didn't know how. Looking'back. she said she
believesIti~r mother, Should have' known something was wrong,
should have wondered ~hy the man was hanging around her room.
"I feellik'e'she could ha~~ done sornething to stop it," Patty s;:;id.
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,The Unbreakable Bond
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wij;,
y the time Patty
born in JiitlUary 1958, Rosa Lee already had .'
five children, all boys~ Rosa Lee named her Dorma, but no one has '
ever called her that. When she was little, she was kilown as "Papoose,"
RoSa Lee thought the shaRi Of her eyes resembled those of an
n Indian baby. OVer time, PaPoose became
When she was young/Patty had long,
liked to twist into a single braid down her
er's dark skin and her faiher's roundi cherubic face. {).h~~ .. ;"o
father didn't have much'bf a role in her life; when
Patty (Iidn't even consid~r attending lIis funeral.
.
Things might have turned out differently. Rosa Lee met Patty's
father, David Wright; in the mid~ 1950s. They had, a long relation·,
ship that lastei:l until the 'early 1960s, and he fathen;~ three of Rosa
Lee's children. But he never lived with the family: "Back in them
days, the welfare didn't permit no man to live wi!b you," Rosa Lee '
,said. "That's how I lost him. We were going to. try to live together,
but the welfare wouldn't let us."'
The man had a job, but Rosa Lee didn't see
it without welfare. Eventually, the man marri
casionaDy, when RoSa Lee needed money, she would
children and march them over to his house. If he was there-and
wife was not- he would give her $15 or $20.
Home during the 19605 was a sllccession of row houses .and
apartments that never had enough beds for all the children to sleep
alone. The boys shared mattresses, while Patty often slept in her
mother's room and, at times, the same bed. At bedtime, Patty usual·
ly had the room to herself because Rosa Lee worked nights as a
waitress at the Cocoa Cluli and as a dancer at the·821 Club, two
popular spots on H Street NE,
C\U;:wt l..t::t:
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:=!\JUte Vi lUC \"u;:)\.uU";;''',
sejL Rosa Lee didn't try to hide her prostitution from
the older children. Afraid that some of her customers might rob her,
she enlisted the help of her oldest son, Bobby. He was 11 when she
!
started bringing men home. She remembers teHing
"You're Mom
ma's little man. You have to help me. I'm doing this to
She would telephone ahead ~nd instruct Bobby to
at the
door. As soon as she entered the apartment, she demanded that the .
man pay the $20 in advance. Bobby took the money and hid it. '1 didn't
want one of these 'tricks' trying to take the money back or something
like that," ~he told me, 'That was a rough crowd that came to those
Street clubs. It was just me and my kids in that house!"
..
Bobby didn't challenge, his mother's explanation. '1 didn't see it as\
having anything to dO. with sex," he told me. "It was all about making~
to feed us. It was all about us surviving as a family."
is award that RoSa Lee often uses to explaih her actions
rdened shield that she puts up to fend off further discus·
SIan. "You keep talking about prustitution," she said heatedly one
day, "I saw it as survival."
' ~
Rosa Lee had sex with the men in the same room where Patty often \
slept; fronl a, young age, Patty learned the art of pretending to be !
asleep. It could have driven a wedge between mother and daughter, t
but those nights in the dark seemed to forge an unbreakable bond.
In 1969,' w~en Patty was 11, one of her mother's customers
made an unusual request: He asked Rosa Lee if he could have sex '
with Patty.
,
There's no
to: rec.,pture exactly what went through Rosa I
Lee's mind as
coqsidered this request. It is not something that "
she wanted to remeinber or talk about. After Patty told me about it,
I waited a long time'· before. broaching the subject with Rosa Lee'.
When I did, she angriJy:denied that it ever happened and accused
Patty of lying. She was:sure that if I asked Patty again in her presc
ence, Patty would admit, that it was a lie.
Several months later, i ~gingerly raised the issue while the three
of uswere eating lunch.' . ,
'
':
Rosa Lee .turned to Patty aild waited in silence for her daughter
to answer,
'
Patty looked her mother in the eye and named the man.
RoSa Lee began questioning,Patty, as if getting more facts might
help jog her memory, "How 'old 'was 'you, Patty?" and "Was I on
L .. - - ' ~hen?" and "Did he approach me, or did he approach you?"
annrnachPd VOn aoont it n. Patty. said calmly. "Cause 1 was a '
said, 'Yeah, I want to help (
you.' Remember
everybody and doing it all J
j
on your own."
Rosa Lee turned toward me. There was pain in her eyes. "Okay," !
shesaid. '1 just feel so shamed.",
.
\
Piece by piece, the story'came out. Patty said her mother asked "
he! to have sex with the man, who was then in his mid·forties. Patty )
agree.d. Rosa Lee told the man it would cost $40-twice as much as \
she had been charging him. The man then drove Patty to his Capitol'
Heights home. When Patty returned, she put two $20 bills in Rosa'
Lee's hand,
There were other men after that,
The men offered to pay inuch more
$100 or more, amounts that made Pat
mother always asked her if she was willing. Patty never
mother down, "I went with 'tricks' for my mother," :!he said. "I saw
how hard it was for her to take care of all of us. I love my mother, so
I would do it all over again.... At times I wanted to hate her, but I
couldn't see myself doing that 'cause my mother's too sweet for'
that."
I
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~S:r'\imil#tll!il1llM
Trouble'at School
ft s a third-grader at Shadd Elementary School in the fall of 1969,
" Patty stood out for all the wrong reasons. At 11, she was three
years older than nlOst of her classmates. She couldn't read. Her at
tendance ,was spotty, She was headed for trouble, and her teachers
didn't know what to do about it.
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FRIllAY, SEI'TfJIBER 23, 1994 A13
ROSA LEE'S STORY
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DAY-TO-DAY: Above, Rosa Lee cleans up as $he tends to do when she is upset,
parliCularly about Patty. Below, Patty playfully spars with her brother RiChard, who
taught her the basics 0/ boring. She is one 0/ two daughters out 0/ eight children.
MONEY ISSUES: Above, money often is a point 0/ tension between Rosa
Lee and her daughter. After a disagreement in the winter 0/1992, Rosa Lee
gave in to Patty's request/or money though she/eared her plans /M it.
'.
•
Photographs by lucian Perkins-The Washington Post
t
�l'fancy
fl.
IvrC1UWSler, a SOCJ.al wOrKer wnQ nao an QUlCe at ::;'oadd
tmit year, tried to intervene. McAllister already knew the family.
She had !lein assigned to work with Patty's older brother, Richard,
1~;' he had j~t ~etllI'iiedhome afier'serving
in a juvenile !Jeten
ti(jn faciJi~y for burglary. McAllister ,established relations)lips with
four of Rosa Lee's children. Eric; who was 13 when he inet McAllis
credits -her with helping him to make something of his life and
d drug use and ~riminal behavior.
,
"',
'.
,:'McAllister.made f~equent visits to Rosa Lee's apartment during
'the'd3y, and she often found Patty there, Rosa Leewould tell her
that Patty W<1S sick; but McAllister didn't believe it. "I'd see her just
Iaying 'around in bOO: she said:,"1 would get her, to' go to schooL~
But what concerned McAllister most was the way Patty 'dressed
on ,Fridays>'frermimber being so affi.lzed at this girl: McAllister
said. "She uSed'to ~nie to my officein a wig. .. She always wore
tight, short skirts. At II, she was very shapely,"
McAlliSter ask~ Patty why she dressed the way she did.
"Oh, this is my evening to do my thing," McAllister remembers
Patty saying.
,
"What thing?" McAllister asked.
"Oh, you know: is all Patty would say.
"She Was really beyond her years: she said. "The kinds of things
that she would,talk about were not kid things: McAllister suspected
something was wrong, but she hitd no conclusive evidence that she
coUId report to authorities. Besides, Patty wasn't the only student
whose home life seemed troubled. "The teachers probably had 10 to
12 other kids with the same kind of background. It was just over·
wlielming:
Rosa Lee didn't even enroll Patty in school until she was 7 or 8.
The other children teased her because she couldn't read. "Girls used
to do it aU the tirile in front of boys who might like me. 'Spell cat!
SpeD It'"
"
Change the name and go backward 20 years, and it's hard to tell
the difference between Patty's'school record and Rosa Lee's. Both
feD behind at an early age. Both began skipping school regularly,
Neither one had a parent who believed education was important.
Neither one learned to read by the time she 'dropped out.
There's one more parallel: Rosa Lee was 14 when she gave buth to
Bobby, her first child, Patty was 14 when her son, Rocky, was born,
ArID like her mother, that's also when she dropped out of school.
tinie,
f'.ilJi.iSldIWiAi3 jlm.-a
.
\.
Ties That Bind
D, atty learned about drugs
IF about sex.
much the same way that she learned
,
She was about 11 years old. She had noticed that her older broth·
er, Ronnie, 17, and his girlfriend would lock themselves in his room
in the afternoon: Patty wondered what they were doing"One'day,
when she should have been at school, she hid in the bedroom closet.
Ronnie and his girlfriend hurried in. They took out a bag of white
powder, cooked it into a liquid and filled a hypodermic needle. Patty
had a clear view through the slightly open door. "I watched Ronnie
put the needle in his arm," she said.
• After Ronnie had pushed the liquid into his vein, she watched as
her brother'S worried frown changed to a look of pleasure.
. She stepped from the closet. Neither Ronnie nor his girlfriend
showed any reaction until she told Ronnie she wanted to try it. "You
better not," he said, "but then again, if you're going to try it, let me
hit you fust."
Ronnie re~sed to inject her that day. But, Patty told me, "T knew
then', 'Well, I'm a g(jnna, try that one day.' •
That day came in late 1973, just a few weeks before Patty's 16th
birthday. Early one morning, as the gray-light of dawn seeped into
the bedroom where Patty lived with her infant son, she woke up to
find Rosa Lee and another woman huddled in a corner. Patty pre
tended to be asleep and watched,
She saw the woman prepare some sort of liquid, draw it into a hy·
podermic and inject Rosa Lee, Then, using the same needle, she in·
iected herself. Patty wasn't sure what drug they were using, but she
was sure that she wanted to try it.
:..
The drug wa,s "bam," slang for an amphetamine-like stimulant
that prod~ce~ a. feeling of euphoria and high energy. Rosa Lee and
hcr friend had Deen us;ing bam for months. J"hey ha~ tried to hide it,
from Ro".·Lee's'children by shooting up early. in the morning, be·
fore'anyone was awake.
.
Patty sat
in bed, startling the two women, "I want a hit: she,
said.
RoSa Lee refused, "You're too Y0)lng to start drugs." she said"
Patty told her mother, that if she couldn't have a hit, she would
',find Som~ne in the haUways'of Clifton Terrace who would pay her
for 'sex and u~ the money to buy the drug on her own,
As Rosa Lee tells me' about this critical moment, ~he, looks
pained. Slie.says she did to<? much "dirty living," that if she hadn't
used drugs"her children wouldn't mlve either: But at the time, she
felt' as if she had choice, that she had nO'way to stop Patty from
traveling the,same road she had.
'
. "Give her'a hit: she told her friend,
, ,
A year later, Patty 'graduated to heroin. A year after that, so did
Rosa Lee, For the next 15 years; they shared heroin and needles,
Now, there is yet another tie that binds: Both are carf}~ng the vi
rus that causes AIDS.
"
up
no
ill$Be:Wiii#il'il:mi-
Life With Patty
t is a July morning in 1992; and Rosa Lee has Patty on her mind.
We are having breakfast at McDonald's, as we 'often do after Rosa
Lee's visit to the methadone clinic, Rosa Lee is upset: Her latest
urine sample was, "djrty'!"-the second time she has tested positive
for heroin in reCent months. One more strike and she would be re·
quired to appear before a team of counselors, \vho could decide to
suspend her from the program, '
i
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"Mr..Dasli:,she says, "I can't go back to the way I used to be."
For more than a year, her urine samples had been clean; she had
such a good record that a market developed for her urine among the
other methadone patients. In the bathroom; someone would whis·
per, "Rosa Lee, you d~an?" andhand over a dollM or two. The clinic
didn't monitor the bathfooins 'cloSely, so the
of getting caught
was low
",
,".
Then: for some reason,she. bega~ to slip\Over the next six
montns, she used heroin siX, tnnes. Every tinie, Patty was involved.
Six times is not the same asa daily habit, but it's still not good
enough.
" ;, ";', "
" .'
Patty is part of the pro.blem; Rosa L",e te~ me, If only Patty
weren't addicted to heroin; if only Patty didn't bring heroin into her
apartment, if only, sh~ coit!d'get Patty into methadone treatment-if
only she could do something about. Patty, thenshe wouldn't be fac
ing the risk of getting throWn' ourof the program'.
She teUs me that she plims to take Patty to the methadone clinic
the next Monday and, enroll her. Monday comes and goes, without
Patty enrolling, and r hear nothing more about· it.
A few weeks later, on Aug. 11;1992. Rosa 'Lee is arrested for
shoplifting Several expensive scarves from the downtown Hecht's
store. After spending a night in jail, she called 'the next day to tell
me about it: She needed money, she said, to payoff one of Patty's
drug debts: The dealer had threatened to hurt Patty.
Rosa' Lee is planning to plead guilty. I rerriind her that the last
time she appeared in court, in early 1991, the conunissioner had
warned !ler that another shoplifting charge would Iaod her in jail for
a long time.:
',' '
S
On Sept: '2, 'she' tells COllllTussioner John W. King that she is
guilty. King listens intently as her criininal recoid is outlined-a to
tal of 13 convictions for shoplifting and drug-related charges-and
then pronounces sentence: two years probation.'
Rosa Lee decides to celebrafe. On the way ba<;k to her apartment
in Washington Highlands, we pick up a pizza. Lucian Perkins, a Post
photographer who has been working with me since the beginning of
the project, arrives,
Patty is happy to hear the good news, As we eat, I notice a flurry
I
ri*
of activity. There's a knoek at the door. It's a drug dealer who U,es
on the first floor. He and Rosa Lee talk quietly and the dealer
leaves. I assume thal Patty has persuaded Rosa Lee to buy her a
bag of heroin. Sure enough, Paity brings out a metal bottle cap, mix·
es some powdered heroin with water in the cap, and heats it with a
'.Ii
match. She injects herself in her abdomen,
Patty motions to Rosa Lee to lie down, To my surprise; she does.
Using the same needle, Patt)' inject.~ her mother in the leg. Her
eyes flutter for a brief second, and our eyes meet.
Patty has allowed Lucian to photograph her before while injecting
heroin, but this is the first time that he has seen Rosa Lee do it.
Over my left shoulder', I can hear the whir and click of his camera,
When we leave, neither Patty nor Rosa Lee say anything about what
has happened, and neither do I.
When I return from a few days of Vacation, there is an urgent
message on my answering machine from Rosa Lee, I caD her. As
soon as she hears my voice, she interrupts. "1 want to apologize. I
know you didn't like what you saw, and I wanted you to know I'm
sorry. Very sorryl"
"You don't have to apologize to me: I tell her.
"You can try that on someone else, buddy," she says. "J saw your
face when Patty hit me, You were in front of me. I saw your eyes!
I'll never let you see me take another hit!"
I hadn't realized I had shown any reaction, even though it was dif
ficult for me to watch, Nor was I prepared for her apology. After all,
she had told me about other slips, Why did it matter so much if r saw
it rather than heard about it?
But it did matter. To Rosa Lee. it mattered a great deal.
Over the next several months, the slip-ups stopped. She began
badgering Patty once ,more about having unprotected sex with
Priester and other men. She talked about moving again-this tirile
to a senior citizelL" housing comple£-to get away from the drug
traffiC in her apartment. !
Rosa Lee had tried to cut ties with Patty before, without much
success. Thistirile, she told me, would be different: She would make
arrangements for Patty to take over her apartment; Patty would
pay the $64 rent out of her welfare check.
I asked Rosa Lee wik,t she would do if Patty spent the money on
and lost the apartment.
Dash. that's her business," she said. "I don't care."
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About This Series
B
IIJ n 1932, in the midst of the Great Depression, Rosa Lee
Il Cunningham's grandparents and parents gave up their
(:.L
North Carolina sharecropping life for an uncertain joumey
north. Rosa Lee is the link betVl-een past and present, be
tween a world that has disappeared and the one that her chil
dren and' grandchildren face today in Washington, Her life
spans a half-century of hardship in blighted neighborhoods
not far from the majestic buildings where policy-makers have
failed in periodic efforts to break the cycle of poverty.
I of Rosa Lee's relatives, including two of her eight
children, managed to secure footholds in the mainstream of,
American society; their relative success makes it all the more
important to try to understand Rosa Lee's life, Although her
story is discomforting and disturbing, she wants it told, "May·
be I can help somebody not follow in my footsteps," she says,
That, story-of the choices she had and the choices she
made--offers a chance to understand what statistics only
suggest: the interconnections of racism, poverty, illiteracy,
drug abuse and crime, and wlty these conditions persist.
, The series, edited by Steve Luxenberg, The Post's assis
tant managing editor for special projects, began Sunday,
Sept. 18 and will run through Sunday, Sept. 25. The Post
welcomes readers' written comments or phone calls, If you
wish to leave a recorded comment, please call PostHaste at
202·334-9000, Category 4646.
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SATUIIDAY, SEI'i'OIBER 24,
1994
... R
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THE WASIII"GTI).~ POST
ROSA lEE'S,STORY
SOPERIOR COtffiT OF ::nU:;DI6TRICT or COLox.aU.
~,I\'ISION
CRIKI):AL'
Agrandson
in trouble
Junior was born when his mother was 14. By
~
------------------------x
UNITED STATES
:.:-.
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·DOCK!:'!" NO:
F-01S6S-92
the time he was 2, she was using heroin.
1
ROCJ\"Y L. BROWN I
.~
One of his earliest memories is of police
---_____________________ x
Defend-an1:.
.JUNE 7, 199)
Washing1:on, C.C.
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raiding his grandmother's apartment.
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Junior was convicted as an adult lor the IIrst time last year.
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AFAMILY VISIT: Left. Rosa Lee visits her son Bobby and
grandson Junior at Lorton prison inJ992. Below.:she
embraces Junior at her apartment in June 1991.
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Photographs by Lucian Perkins-The Washington Po~t
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TilE W,ISlIIl'iGTO:"i POST
24, 1994 A13
ROSA lEE'S STORY
.'-:
KEEPING
WATCH:
lAljt,Junior
stands in
front ofan
apartment
complex in
&utlieoSt
Washi~gton,
where lie
occasiGnatly
sold crack,
Junior says he
wOuld never
use drugs
himself. "The
people who use
leave their
minds on the
street, " he said
in 1991.
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For 7 vears~ juvenile system was home
~
'/
�~ce over thehe"<:,oded uph~ ca~e,t~ He was caught ina~ro,ed
next,year,
Washington for
:~ts. Both tunes
in trouble.
a stolen
~ '. He '1'n' away, from the counselor who was supposed to escort
him on the return'trip to Pittsburgh. He was arrested by police for
yv;~="'"
of a handgun.
,:
,.
summer of 1987, the juvenile authorities'
mOre discipline if he was ever
out. They sent him to Vision
for teenage delinquents who
take. the
Terrace in the 1970s. He says Ihe police might iJe confused because
he and Cheeks had a fistfight not loug before the night in question.
Junior is upset because no one in his family has come to bail him
out. "I don't like this," he tells me. "' have never ""'en locked down,
I've just been in group homes and Vision Quest. This is the first time
I've ever been iii a-SecUre jail~"
His hail had been set ,at $1,000, which meant under court rules
that he needed to post $100':"'W percent-to be released. He's
ticuJarly mad at his mother and her crack habit. If she wasn't so
dicted to that "little nasty stuff. she could have got me out of here,"
he tells me.
But
.: -.;:".
Junior won't give up. He reminds me iliat Pat~ has tried,to'ii;'Irimit,
suicide several times, and that's proof iliat she's a dangei:, _',,;~, ... ,:
"She just needs someone to pun her in."_Juniqr says.; "1'Iiat's tire
only thing that's going to help my mom now."
"lVhat I Have Done'
abOut the
attack. On June
i,q called for sentencing
.
Rosa Lee, two
grandchildren and' take a seat near the front.
do you have anything to say before I pass sentence?"
!ayly asks Junior.
I do, Your Honor. I want to say ('m sorry, you
what I have done .... I'm asking you to, you know, give me a
so that I show that' am sorry for what I have done, Your Honor." ,
says nothing in response. No lecture about the lure of the
no threats about what he .night do if Junior comes hack to
his court On a new charge. Bayly sentences Junior to two to six years
in prison. but suspends it because Junior has been locked up for 16
months awaiting trial. Then Bayly gets tough: He puts Junior on pro
bation for three years, orders him to work 200 hours of community
service, requires him to seek a job and fines him $500.
"Does he have $500 to pay today?" Bayly asks Junior's lawyer,
Fred Sullivan.
"No, Your Honor, actually he's been on a $1,000 bond since Feb
ruary of '92, unable to pay that bond, so it is going to take him a
while to accumulate that kind of money:
Bayly backs 0(( a little. "Well, I'll make the $500 due by the third
of June of 1994 in its entirety."
The prosecutor in the case, G. Michael Lennon, takes note of Ju
nior's trouhled background in telling the judge that Junior must be
held accountable for his actions.
"No one could fail to recognize the problems that he had as a child
and as a teenager," Lennon says, "but what's troubling is all the in
tervention so far appears to have very little positive effect. And (
think that SOme of the responsibility for that has to be Mr. Brown's."
Later. I ask Junior what he thought of Lennon's remarks. Junior
replies in a voice edged with anger.
"He's saying they gave me a lot of help but that I ain't respond to
none of it," Junior says. '1 say they didn't give me no help,"
~
The teenagers
lind u,us, the I
that 'will turn
The different'quests
modeled after American Indian rites of
passage, Noyes said; and
strUctured "to prO\~de the opportunity
for'the kids to refle~t,o.ri past" behaviors and future
Junior hada 'difficUlt time adjusting to the strict (
iis. He went on 1O-day hikes with nO eating during
i~nt a year' on a hor&e-drawn wagon train quest to Florida
:.. 4,000.mile round-trip with 75 other teenagers, The trek itself
arduous, and the counselors impose a work ethic lhat matches, The
y,quths work with animals, prepare meals, set and break camp, all in
'an effort to fOster a'sense of cooperation and self-discipline.
':~'~'You chop wood.":junior said, "You stay in tepees, Then you go on
a quest. A quest is if you want to starve yourself for three days, you
can, Hiking, to meet your destiny. After the quest, you go on the
You Clean the wagon. You clean the horses. And you move,
mOVe; ni~ve. .. , When it gets cold one place you mOve 'somewhere
wHere it is hot, (n that period of time, you're suppose to change in all
that ,time. Then you're out."
'. " 'As' far"as he was concemed, the counselors and wagon masters
~~lfnothing but contempt for black kids like himself. "There's a lot of
p{~jtidice there," he said. "They used the word, 'nigger: A lot of
them are from G<:'Orgia, and a lot of them are from Tennessee,"
....,He said some tobacco-chewing counselors would get so close to
hi.ffi iliat they would spray brown spittle on his face as they yelled at
I:tfrl!. He got into a fight with a wagon master for choking him and
le.\lving marks on his neck.
::~ (s this a fair description of what he experienced? There's no way to
Know. Vision Quest officials don't think so. This much is certain: Ju
'i!ibj! completed his quests but changed little. He went back to the
.!'i~tsburgh group home in 1989 and immediately landed in trouble,
I}(and several friends from the Pittsburgh home stole a car, went
joy riding and were caught. Junior spent the next nine or 10 months
.i:!,.the home's "lockup," its most restrictive living quarters.
".In July 1990, the home's officials decided he had been there long
enough. "They gave me a bus ticket hack to D.C.: Junior said.
ifam.
~ij:!;1jA!*U"j~
'A Nomadic Existence'
to know each other when I hear that
Rosa Lee's apartment complex with a
found him in a hanway with Rosa Lee's
handcuffed him and took him to the D,C. jail.
Two weeks Mer, on Feb. 25, 1992, I am interviewing him in a
sman conference room at the jail. He is wearing an orange jumpsuit,
.\he standard garb for a new prisoner awaiting trial. There's an irony
to the scene: I first interviewed his mother, Patty, in the jail in 1988,
when she was awaiting trial on a drug charge.
Junior doesn't want to say much about the case. ( know from court
records that he is charged with attacking Deoit Cheeks, 18, on Nov,
30, 1991, at Clifton Terrace NW. According to the records, Junior
surpriseq Cheeks in a corridor about 11:30 p.m., stabbed him and
Oe<! with $100 that Cheeks had in his pocket. Cheeks was treated for
a cut at a hospital and sent horne. Junior says he doesn't have any
iflE;~wliy he's heen charged. lie says he wasn't anywhere near Clif
tqn.Terrace that night. He remembers spending the evening at Rosa
Le€'s apartment in Southeast Washington.
. He:says he knows Cheeks-the two grew up together at Clifton
•
not appear to be a stable member of the com
Long wrote. "He is 19 years old, has virtuaUy no record of
employment and has lived intermittently with his mother and his
aunt, and with other undisclosed persons
to his residence with
for a person of his
his aunt. This is an extremely nomadic
age.'"
~8:Wi!!~i"ii~
Reunion althe fail
.",
rosecutors held Junior's case for';p:and jury action, which meant
it would be months before he would stand trial. While he was
waiting, he was transferred from the '6:~wded jail to the Modular Fa·
cility at Lorton.
He made collect calls to Rosa
often that she slopped accepting
One day she hands me a letter
to her. The letter has capital letters
spots, an indication of Junior's writirlli',;kills
he reads at about 'a fourth-grade lD .. o];.;.. ",'eh
between the ages of 18 and 24,
"Hi how is the family?" Junior
"fine I hope. Me I am thinking like
good with some 'Help: , mean I will
"my mom I hope she give up coke
men!. you ~top the coke from taking
mom needs that feeling .. , I will
cause here make me see it."
Then he returns to his own plight.
for the thing , did .... Love you all.
Him. He will help the ones who love
lnior~s concern about his mother
Modular Facility a few months
a few
Lee and' have come to
Bobby, who is alSo
)sa Lee embraces Bobby
der. Rosa Lee and Bobby. mother
for a long time. Bobby's thin arms
of his
P
was
for
listen
use and her prc.stitutiion,
but when Rosa
begins to make',."ruses
explodes. "' don't want to hear'
letting you know how far it's
She turns to Junior. "I'm just Ie
,Junior. I'm sorry, but! have to ten
,
Bobby is worried ,that Patty's luck is going ,to run out, that one day
she won't payoff her'debt and someone_Patty or Rosa Lee or Ju
nior-is going to'get hurt.
"
"Let Patty start dealing with her problerii:,Bobby says, agitated.
Juniorjumps in. "When I get out of here ;1 wish to put my mom in a
program. The one where you are locke<1 doWn. You can't go out:
Junior wants to have his mother committed to a psvchiatric hospi
t.1L ( point out that the courts can't force'sqineone into this kind of
treatment unless they are a cle¥ danger to themselves or society,
About This Series
8 n 1932, in the midst of the Great Depression, Rosa Lee
I'i Cunningham's grandparents and parents gave up their
North Carolina sharecropping life for an
north. Rosa Lee is the link betwe
tween a world that has disappeared
dren and grandchildren
1S a half-centurv
far from the
failed in
/ of Rosa
, childre~, managed to secure footholds in
American society; their relative success makes it
important to try to understaud Rosa Lee's life, !
story is discomforting and disturbing, she wants it told,
be I can help somebody not foUow in my footsteps,~ she
That story-of the choices she had and the choices
made-offers a chance to understand what statistics only
suggest: the interconnections of racism, poverty, illiteracy.
dnlg abuse and crime, and why these conditions persist.
The series, edited by Steve Luxenberg, The Post's assis
tant managing editor for special projects, began Sunday,
Sept. 18 and will run through Sunday, Sept. 25. The Post
welcomes readers' written comments or phone calls. U you
wish to leave a recorded comment, please call PostHaste at
202·334-9000, Category 4646.
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;:!oor. It was Tllrk. hlti t'",u friends and ~nnth"'r'm'lrl
in. "The tan jjude ~p·ve me $22 for
lhe videntape.
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t\lld wh:lt wns Priester's reaction n'hen
1;'
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. tiescnJ-:;fd the murder ~jf Steve P~ies,ter.
#On Frit,lay, Dec. ,*, 1992. at about" 2 p_m.," the warrallt hellan. "of~
. ficers - at' the Metropolitan Police Department w('re
, "part,nent at 425,Atlantic Street SE [or a complaint
When pOlice entered theapartinerit, theidi:;eo\,ered the
~f the victim. Steve Priester, harid~uffe{hmd gagg{:d. inSI(le a
. of Hie 3partnient .' He had suffered a bullet wouitd to thE: ht"ad."
- According -to the warrant, police had arrested two suspects and
we·re~(ociking (or three others. Police had learned about Prie;iter'~ re
lationship with Patty' from talking to his neighbors
the last person seen with him before his dC'ath.
. Ten days later, in Judge C~eryl.Long's sofrly lit cnuftro~im. Ihe'
videotaped im.1ge of Patty Cunninghnm appenrs I)n a television mQoi
.
,. tor;'The.screen is pasittoned to give the judge ~he hest view; she has
-to qed,Jc: ~vhether .the videot,lpe pr~vides enollgh e ... idence 10 hold
ratty for trial. ..',.
" Patty. iswatching too, [rom the ile[endant', t.hle.
,Qn)he ,ide?tape, Patty, is sitting at a desk.
slacks and 'a red blouse. A white scarf is tied
, "date and time flicker briefly, then disappear:
p,m."
.:., "
A detective, identified as Det. Vi"ian Washington, asks Patty i[ ,he
unde_rst-lmds_ why..~er an~wers are being vid~)b.j:.ed. Normally.;) sus~
peet is interviewed i,vith04t a.camera prest!nl 'Ind tllE:n is Jciked to re
vi~w 3: typed transcript for aec~rt1cy (lnd '3ign it.
"l r.an'lre-.d," Patty tells Washington,
As ttie videotape'roUs,j! is dear, that Pattl' "I ready h.s told
story. to the pOtice and is rc'peating it for the ('.;tnlera, She speaks
idly afld stanimersJepeatedly. l1er aC~(JUnt is cOllfusing. hut it ~m)
vidCs the basi.:; outline of how she became mixed up in the robbery
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rught.'Dec. 3 i 'whe'J soJneone knocked 0
~.Rs_Tur~, a 16-year-old who Ii\'ffi in the IIflUUUlK u~"'
, Turk .;aid two frienus were thinking at>
h.ad'seen Priester <lrOtmd tHe complex and
money ,on Patty. Uid P~tty know If PrieSter had any mOflp.yon
right now?'
Patty saJd ~ne' went
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Rosa Lee had been planning to move for"';',er.rmontlts, Imig
fore Patty's arre.st. but" her new apartme'ot, hadn'~ bten re;:!dy l
now, Rosa Lee ",;)shappy to leave; theold'apartment hOld too iTh1ny
painful "reminders of the.deterlor"tion lJf h~i- family. It had ~cemcd so
chaotic when Patty was there; noW it just see-metf Clltpty. '.
Her new place is a one~~dtoOm- unit in ltle senior dtiztll',a wlng of
~
a building on North Capitol Street NW; slie had 'applied for it after
one particularly bad weekendo[ fell(ling:oIf Patty',,,nd Ducky's re
quests for mont:y ,to huy drugs. She, qualified riot because of her
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tlge-she was only·56 at the time she a'ppJ.led-but because of her
medic,,' di""bility.~? ,.
The nt?~ apartment still smells of fresh-paint when I arrive a few
weeks later for my first visit. We sit in ROsa Lee>$ 1.J('ilroom bec;luse
her son Richard is !:ileeping on the'living -room ,couch; he ·r~~ently got
out of jail, 'lnd Rosa Lee has Jet him sfay' with her.' ..
Her bedroom tele\1sion is on. as usUa1. it is .lnnl!gilnltiOIl Day. On
the screen, crowds <lre gathering <l,t th~ Capitol ,to see .Bill Clinton
take the o.. th of uffke. Rosa Lee pays nC) attentiun:.She h:lS no inter
poUtiC's or goveinrnent. She has never,vf)te<i."It's'not going to
one difference in my li.fe/, she tol~ tne'.one day_'
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In her mind, white people still had
the, pOwer and they didn't
care about blacks. "I 'WOUldn't gu Twcfblockslo vote," she said, "I
have ""en too much and hasn't nothfug' changed, The.only uling
that's ch.1ngcd is we don't" have to dde in the back of the bus,"
Ther'e is-;llrnost no connection betw~en- Rosa'Lee's',wurld and the
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\!orId of Was~gton:s poJicy-rnakers and politidflllS. (jne day !;oon
:lfter the election, I mentioned Clinton during:n cO~l\'ersation with
Rosa Lee; she dirlnrt seem to ~now Iris rlame or that an electioil had'
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I ever let her grow up.'"
Rosa l.ce's tears·run down her face in unhroken streams, soaking
te blouse,
wouldn't h.ave hurt Steve:' she say~. "That man tOl)k care of
so good."
would be mouths hefoft~ we would know how the courts viewed
on the videotape. She
"
HtI3:!@3;AllIiI3a~
doesn't realize what she did!"
'
Her lo",.r lip is trembling,
Patty when ,he gets drunk,
. on him. ' .
A pklO was t~iltdied to rob Pri~~ter
SUffi3.bIY he kept some cash. It wOllld lJt!
in.
.
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ii
On the television. Cijnton is making his ;vay to the platform for the.
swearing~in. RQS3 Lee is showing' me some or PaUis Iptters'from
jail. The letters are in someone else's handwriting. .
.
"She sounds like a child in her letters,"· Rosa -Lee says, "All she
talks about is coming home! Com~ng, hOIU.e! It's .,imo5t like she
her cheek." I
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n New Year's O.y 1993, ,bout two weeksa[ter Long held Patty
for trial, Rosa Lee moved out of the federally ",hsidizcd apart
ment complex in Southeast Wa~hlngton" w~ere she and Patty had
been held,
"taU, dark"skiruled dude" and a
mole on
" "
. , . '.
thiHkine about that tlL'lIl!"
LijeWithoutpqtty
rull ""ne weekend; pOlice f~'ed" wamint in courl that more fully
. ::\Cherne.: ':" "
!lot
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,The 'Videotape
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Patty loa,ing?
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atme.~' PnUy tells W:aspington.
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t~lItion, ."iI0re C'nllle3 :-Gur,j}r~<Gv.lcnt;· (say, pointing to me U::le"l~
had threatened
sh~' h'Ui f:aUed me dozens tJf timt's, !;(;.;:king advice 1)[ ju:;t a shouider
. : tll.:£Y i~n. But after a sieepless night, she t:<111cd no one~-'I1Of c"en
~ . Al~ Of Eric. t1)e ul}lY two Qf her ~;;fght..(hildrt'u who) havi~ never used
":'"'. drugs ~r broken the Jaw, !he only two of ht:r dtildren
~C,~,1Jl truly rely,
'9n tHe night when her'daughter was ticclIsrd of first-dt'~ree mur'
~er. Rosa Lee l:~~ose to be alone.
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RENEWING TIES: Rosa Lee shMes amo'ment with her
aunt, Rosa Jacobs, 81, lift and COttSitl, Daisy Debreaux,
90, outside Chapd Hill Baptist Church ill Rich Square.
Relatives from fou, generations belong to the church.
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Photographs by Keith Jenkins-The Washington Post
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congregation in a song she learned as a child. The
minister had asked her to come forward. When she
began singing, people sat transfixed, then joined in.
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Lee's Story'
r [Ombudsman, your readers too, fail to see
· As ~y of Sept. 25], I, have indicated
,"
the reason or need for your paper to write
about Rosa Lee Cunningham's life [front
page, Sept. '18-251, It has no 'newsworthy
, value and perpetuates the negativity that
your paper has been 'aCcused of, especially
a\lOut its coverage of the African American '
community. While you may have printed
11 positive stories in the past six weeks,
none received the magnitude of coverage
as,Cunningham'$.
In aU likeIih~, the'article will not deter
anyone headed down the path Cunningham
fonowed because these individuals are gen
erally not readers of your paper. Nor will it
result iii legislation or additional funds.for
programs and resources to help people like
Cunningham make wiser 'choices in their
lives. And, last, most people, like me, will
not understand how and why CIU1llinghiun
felt she.had to make the choices she did:,'to
suIvive,·
'
:-Marilyn Mitchell
~--':""-''''~---
,
Rosa Lee's' age, I have a son and six
siblings in California, and I plan to share
this series with them, I can see in tllis
series why, I betieve, that four of us have
been modeStly successful and why my two
brothers have had problems in their
lives-cine is in prison for using and selling
drugs and the other is in and out of jail for
the same reasons. The verdict is still out
on my younger, coUege-educated sister.
I have a master's degree from UCLA
and am a Department of the Anny dviliari
who has attained the grade of GS/GM-14
, and retired as a lieutenant colonel from the
Army Reserves after more than seven
years on active duty. But we aU' came from
a background similar to Rosa Lee's. I want
Rosa Lee to know that her story will make
a difference in how my grandson and my
siblings' grandchildren are raised. ',:.
II
II' E Ba.m,es
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.II
Leon Dash is to be congratulated for his
;~ series o~ Rosa ~.~t,2!~
problefi!, not the solution, Ever since Roo-. she did whatever it took to ensure her
sevelt, we have been" throwing money at family's swi1val: To the contrary, Leon
the pOverty-stricken, The able-bodied take '. Dash's account of ROsa Lee demonstrates
.the money and work the system for even that she did whatever it took to feed her
more.,
base pniclivities, regardless of the inunea- .J.
When will we realize that there are surable cost to the children who depended
millions 'of Rosas out there and that we upori her. Moreover, she imbued most of
don't do them or society any good by her offspring with the same sense of
letting them' produce successive genera- indifference to familial and societal respon- ..
tions to follow in their footsteps? 'sibilities,
.
Luxenberg notes the articles' focus on
-Joseph L. Hudson the interconnections of racism, poverty,
II
illiteracy, drug abuse and crime. An obviTIuJu shalt not steaL Most law-abiding, OilS addition to that list is our failing 1\
dtize.ns live by this motto. Rosa. Lee does welfare system. ROS,l Lee and her family
'not, Leon Dash's articles seem" to disre~ clearly have received an abundance of our s~
gard this societal norm and,in fact glamor- government's generosity in the form of q
ize the. art of ·shoptifting. As I read about welfare checks, food, subsidized housing, U
Rosa Lee's efforts to support her drug free or discounted medical care and medi- £
habit and her successful ploy:t'o stay out of' cation, job training etc, Indeed, it would be ~,'
jail', I became ill. This woman" should not
,
interesting to 'c.llculate the srun that we
'
,
have been given a page and'a' hall.of print ha'
ve spent on this' family so far. D'esplle
each day to f1aWlt her illegal activities,
and perhaps because of all the~ welfare
If th
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'
programs, only two of Rosa Lee s children
I';t".~~~~h"~~;~,,,Z.".t~_r~<~~;::2ted themselves,out of the Qcep;;ning pi!
__
PHOTocoPY
PRESERVATION
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lPHorOCOP'V
PRESERVATION
�ROSA LEE
ME
What One Family Told Me-and America.:-About the Urban Crisis
By Leon Dash
F
OR FOUR intense years, I followed, Rosa
Lee Cunningham. her children and five of
her estimated 32 grandchildren. I became
absorbed by Rosa Lee's story-and deeply
troubled. I also realized that the series that fol
lowed-on the inter generational nature of under
class poverty, crime and drug use in one family
would disturb and anger some readers.
Although the great majority of responses were
positive. it did not surprise me that many of those
the series angered mo'st are middle-class African
Americans. They felt that The Washington Post,
by devoting eight days to a three-generational
family of weJfare-dependent petty criminals. had
given this growiilg urban crisis the ·wrong kilid
ofattention. WIly;' many asked, didil.'t I write a
"positive" story about the many honest single black
mothers whose children went on to lives of Ameri
can success and achievement?
The answer.is simple. Stories about successful
individuals who have overcome societal barriers
Leon Dash
member 0/ The Washington Post's
special projects reporting unit.
have a place in journalism. but these individuals ments. Nearing his West 122nd Street heme. Min
and families are not part of the crisis in urban cy passes through a street -corner t',~g market
AmeriCa. I was interested in writing about the eri- brazenly operated by the newest male generation
sis. Every one of us should be alerted to it. I want- of Harlem's underclass.
'
"As I round the corner. there are drug deals
ed readers to be uncomfortable and alarmed.
Others feel the same way-Ronald B. Mincy. happening on the corner." says Mincy. The kids at
for example. Ron Mincy is himself a "positive" suc- tending the nearby junior high school "are coming
cess story of an African-American man who over- in and out of that all the time."
came tremendous odds. He and his two brothers
This scene is replicated on street corners in ev
were ,raised by their single mother. irl the South, _;gry_ n!~)vl,;.";iY.~~J·Atlle~i<?!,""Th,t::!,dolescentCdrug~
Bronx in the Patterson public housipKP,rojeCt; not", stUers'andtherrdestJtute'ado!t c~ents are J~st the
far from the East Harlem neighbOrhood' where' I observable symptoms of contmumg mner-clty de
'grew up. An expert on urban poverty. Mincy cay. This decay is intricately inte~oven with ot~. earned a doctorate in economics from the Massa- er dead..end mgredients of hfe Within Amenca s
chusetts Institute of Technology. He, his wife and
bottom" tier of poverty: adolescent childbearing;
two sons live in Harlem today out of a comrilitment child abuse' and neglect, foster care, droppmg out
to making a change where change is most needed.
of school, welfare dependence. smgle parenthood,
Mincy' also believes the crisis of poverty and chrome unemployment and neighborhood cnme
,
.
crime in our cities needs to be written about in a and \~olence.
way that people can understand it. He understands
"In most ,~ases, there ,~s not a father m [these]
that this problem is growing not receding.
households, said ~mcy .. Th:re IS not even a poSIEvery evening Mincy leaves his Ford Founda- tive older brother. That IS a, slt~atlon that IS tragtc.
tion office in mid-Manhattan and travels north four It IS an mtergeneranonal thmg.
miles into a large swath of real estate with rows of
Reams of poverty statist.ics cross Mincy's desk
See R.OSA LEE, ca, Col. 1
boarded-up and deteriorated 19th century tene-
----
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PRESERVATION
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"", ,H~IWCF;~.T::~ig~~~p,~~{;s~rie~rQP~t1j.e<~,At~t);l~~rIWg~~J,ik~~~c~;;,~t:i~'~~~. th~usarids:(?f District
,":',of Rosa LeeO~gfupn':by"Po.st~repqr:ter;i~" 'wom,~n',9n.\Ve]fare; aJl~:tlVled.ic;y.d;most,don't lead
, ": ":'~~Q~J)liSP;~sed' on< yea~.::Qf:~t?seiy~;ti~I)z,::,:·~v~s]~~~\R()~~,~~~~;,.~~y,dcin~t. stealortea,ch their
: ,and "mtervtews,:',was,' an ,~xtraor,~, j(l~sqc. ,children"and gr<l!ldchildren, to nlH>ff·others. They
achievement., But it was also', a' 'deeply 'diAturbing: ,< don't prostitute!' themselves 'or' their' daughters.
, "and' ta~~rating'PQrtr~yali~f ,:i:},pi~tp(:t~~:J~mili, :;' ,~:: , ; :~t~~y~d9l'i',tY~elEo;r;:~q::wgs::or~artX>i" criminals or
m9the.~;"her' chilo/e~~apa~gr~qp~dr~ ;',~a~~~~':~if:<.ieach):~e~r ~!rilPr¢n:tP' ~~:;Th~y:liaven't ~one' to jail
" "~ ~n~o~enF. m :whjch~~~S;):',¥D~;:,:(;npte;J~usf,:!::~:'1:?'~e~"o.~\;~e!yed,Y~~:':~llln~:b~s(or'theft and :
tlwg and, ~e ,~~c;lb':lr~:"ve~~(t,hEl'~pmmqn'<4I!9.:,,: "clnt~ab~~.,:r~~y,arE!n:t.~IV:pOSl~V~~ ,To,·conclude
: ,9cceptabl~ ~Den~. ,T.~s;,.was,:,as;wen,,;,ap:enVli.>' : from;'~~" ~eI]e!),~t~~~~:Lee~s life)~ "t;he W(iY ~e
,":' rOnm,e~t;m\V~cQ ,'pub~~::~~~~~~e,tpe~t.J~~{~:help0\ :~r;,liv~~~~, t,o ,~~~)UsI~::~~~r¢,ad;~d,~stake ,what"
,; "th~;-:c:-~d,n? 'Q<?ub~, ,msoIll,~ ~gen:y:~q {t.9n.!~, ha~d:~ee~,~t~~m,':Mrl. !~~~,:,;~er~:lSP1~ch,to, leaI!.l
\' taxe.~' o~' working,: pepple. not· mllch:,b¢.tt~r: off,; tharii ~< '~Qm ,thesen~s,;,' :-"
:,', :':~~'" ' .. : ' " , '
,,',tl1eyc:-:was 'qabit1Ja,llY~J.landeie(roriLmore.9rugs:" ,:':':';Within,t}i~,nation'~;Capii?!;':(ls,iIhinnt:r:cities across, '
, '14d.gingfrom, ~e' ,thou~ds' of :resPQr:I~~(r~~fred,:i,i,the~tiQn,: tf:le,:¢' :¥~f pleQty~o~ '~O?3 ~eC1lii$g::'
, ' ,'thus;f~",mo~t readers say'the: series bas' left :them , "' h3;IDs~and.peOp'le ~ qer qaughter, ,Patty, her sons,
with 'a ~,tter 'uncJerstanding',of,the'stiong ~ti~{ 'Bobby (~ho,'qi~), ,Ducky',ait,d Richard;',and her
, be~een"'margin:aI'~uca,tion;',:we]farede~n~~~cY,,:;':'grani:1soil;' lUnioi~whoa:re 'tli~:real .stories ~hind
, ",~9nic'j9b~~ssn~s;,~giabuS$.;a.:vQ;S~i~di~J:l,'~eljarq~te\~g;':;f'ljm~' ~(ts()cial~~lfare ,statis-.:
',Vlsm, and, how;--,-as:."'1, :"Rosa',;Lee, Cunnmghairi~s:' 'f tics'- ,,we " \read ,or,; - . ' , " " '" ,.'.". ,-.:" next time' a
"m ':".','-·':',;':.r'· ..
,hear·, about: . The'
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,: ,C;38efrthose~conditi9ns C<Jll;persu~t :frQmgeper~tiqp.;\,;,~WscpSs~()n, g~ts ;sWted on,:;ilie,.devastating,lIDpac;t· of .
. 'ito :generation;:, iIi' Part::a,s<a:coriseq4enteoqf, s&:i~ta,k:,:"J~acK·,oo.<:ain:¢: oi1\famili~'.OIi/~; ',cOmmunity; or the'
'. '.':ifailure,' m. .p~ as: a;c,i:mseQuenS~9f, ,IieisOnM, f<wui:e~t~~(~(f~,ure'qf,;pIis,ons\a,ndjuveriil~ ,~<;ilities to rehabilitate
" Tqa( was what the 'seri~~, set ~1.1t to 'acdnnpjish.:: c·,<: '·repeat ,6ifenders;,:oi". 'Scl1oo1,systf!rI)S :that ,callously
'. ,')\):SIIiallt:r ,bu~ ,siwllficant illim~( ;ofreii,~er~:;,,:' :PY~::PJfougll;~dthf;~'iP!1sh out ~tu4ents, whQ Can't
•' .how:~ver, have been 'Ciel,U'ly ihcepsed',bY~:har,th~Y'i: .reaqth~it. QWD' nam~s;Qr ,the next. time you hear talk
, .':, ;ha,-:e,r~ad.. , To.~then1; ·~i.ght,.' COQ~c~ti.ye;j:day,s,t,of:: :'"about {secr~t;: .sins'efcJ:ildsexual 'abuse, or 'the,power "'
". . 'tro~t-:~ge, s~on~~ al>09t IDtergen~r~~~n~l~.dete.nQ:;:;\~, ..of ~e ~ f~r,;(or;,t;he':~~~r~epen4e~~,oLthepath?"ration m.. a' DlStriCtJamily perp:etua,tes raq~t stereo-: :lom~)-::-::-t:ipil,kof R~ L¢e CUIlQlIlgham, her, chil
~s'ofAfti~Ariie.ricans. and,plclys'into' t~epands' i;':c:lren:iilnd"~dChildren;,Butdori'(~top,there~,. " .
.of~t,hose ~ho would 'hav~'govequnent:r~4~t'froriii:: '<.Thipk~ tociiof lier tw~)sons'AlviIblndEric, who set
.:its~~"re~pOnsi~Uiti~s; ~hefe!~;'alWa~:~;~9~ce;;,<, :tllE~~ve~;'apart: 'from: the: fami!y; anq ,~~ed :the ,
that ,will, hap~n m, ,~s :~d,;of:Jo1JI11Clijstic:;,ept~!:~j' ()thE;r ~~y.,;JTh~re 'Cife.ot,her.A1ym,s:apd ::En~ who
prise;, B.ut' ;th.ose:: seekiIig, t<;l, ,use: this 'series' ;' to';'" 'pee<!)to ,know ~ :;they, llave chokes, . that there is
supw,rt"their'tacW: prejtJ.dices.WiI1 ;haye,~to' 190~Jor"'" \, $()Iil~tliing~b¢tter tllan hl,1stling .and manipulation of··
'comfort :som~where :i:!lse:"".'.:<:';' " ,:':" :';: .::"'",'. ':~L':;()th,~, Wi$in 't:heiI:'~rea~h; ·thatJif,e, ,despite it all, can
, . RoSa: LeeCunningharii'!(pei"SQruiF stoiy:"isi':not"
>better:':'The"senes' 'show~that 'AIviIi and Eric .
repr~nt:ative of :,allAfrisall'Ariu!ricaq~;,' '~~; h~r;~ .j\y,~t::h~~,:~y,: thi:!'~interVentip~ qf,teachers 'and
~Qparents and, parents ~~ed,P'te, expenen~ 'of i ,m~~tors,.who could. ,channel' thi:!Ir' r~matkableand
the ,. ~oris::,of:'African,:AIrierica.Qs,'who.',migr;,it¢dj':',stubJ:iorn:':;Will~; to:'frt:.e ,them~ves~ap.d;·'now':their,
from ,th~ ,South to Uf~ a,reas ~veral decades<ago,. :,(QWD;f~esTfrom 'the ,terrible'qcle of de~ndency
most children of migrant f~es did not'end ,upJike ",an~, desolation in 'whi<;h the reSt of their siblings were
R~' Lee.,; But, then; neither: did::mose, Q.f. h~( 11 .' caught:' In ,that there is, sUrely a lesson,. '
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Carol Rasco - Issues Series
Creator
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Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
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2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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Clinton Presidential Library & Museum
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92 folders in 7 boxes
Text
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Original Format
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Paper
Dublin Core
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Pending - To Discuss [5]
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Domestic Policy Council
Carol Rasco
Issues Series
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2010-0198-S Segment 2
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Box 125
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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2010-0198-Sb-pending-to-discuss-5
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PDF Text
Text
WithdrawallRedaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECTffITLE
DATE
RESTRICTION
001. letter
Dr Joe Crawford to Rasco (5 pages)
08/15/1994
P6/b(6)
002. letter
Michael Reardon to Dr Crawford (I page)
0811111993
P6/b(6)
003. letter
Michael Janis to Dr Crawford (2 pages)
03129/1994
P6/b(6)
004. letter
James Jordan to Dr Crawford (I page)
03111/1994
P6/b(6)
005. letter
Ruth Brooks to Dr Crawford (I page)
03/09/1994
P6/b(6)
006. letter
Gordon Ovington to Ruth Brooks (I page)
03/3111994
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Counci.1
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Pending - To Discuss [4]
2010-0198-S
kc232
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)1
Freedom of Information Act· [5 U.S.C. 552(b)]
PI National Security Classilied Information [(a)(l) of the PRA]
P2 Relating to the appointment to Federal offtce [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between tbe President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 ~elease would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(1) National security classified information [(b)(I) of tbe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) oftbe FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(h)(6) ofthe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance witb 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
S{}BJECTITITLE
001. letter
Dr Joe Crawford to Rasco (5 pages)
DATE
08/15/1994
RESTRICTION
P6/b( 6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Pending - To Discuss [4]
2010-0198-S
kc232
RESTRICTION CODES
Presidential Records Act - [44 US.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(I) of tbe PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such ad,;sors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRAI
bel) National security classified information [(b)(I) orthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted inyasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) oftbe FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document 'will be reviewed upon request.
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. letter
SUBJECTITITLE
DATE
Michael Reardon to Dr Crawford (I page)
0811111993
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAiBox Number:
8505
FOLDER TITLE:
Pending - To Discuss [4)
20 I 0-0 198-S
kc232
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)]
Freedom of Information Act· [5 U.S.c. 552(b)]
PI National Security Classified Information [(a)(1) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(I) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIAJ
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. letter
SUBJECTffITLE
DATE
03129/1994
Michael Janis to Dr Crawford (2 pages)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Pending - To Discuss [4]
2010-0 \98-S
kc232
RESTRICTION CODES
Presidential"Records Act - [44 U.S.c. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information [(b)(I) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b )(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(I) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
. AND TYPE
004. letter
SUBJECT/TITLE
DATE
James Jordan to Dr Crawford (l page)
03111/1994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Pending - To Discuss [4]
20 10-0 198-S
kc232
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information [(b )(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would ·violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. letter
SUBJECTrrITLE
DATE
Ruth Brooks to Dr Crawford (l page)
03/0911994
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ON Box Number: 8505
FOLDER TITLE:
Pending - To Discuss [4]
2010-0198-$
kc232
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act· [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(l) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006. letter
SUBJECTrrITLE
DATE
03/31/l994
Gordon Ovington to Ruth Brooks (l page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number:
8505
FOLDER TITLE:
Pending - To Discuss [4]
2010-0198-S
kc232
RESTRICTION CODES
Presidential Records Act - [44 U.s.C. 2204(a)1
Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information [(b)(I) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA]
b( 4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRAj
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�~~ ,
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1
IN THE CIRCUIT COURT FOR MONTGOMERY COUNTY, MARYLAND
JOE D. CRAWFORD, M. D. ,
CIVIL No.
vs.
37592
MARYLAND DEPARTMENT OF HEALTH
and MENTAL HYGIENE,
ORDER OF REMAND
-.717
It is this
'--)"':"---day of November,
Circuit Court for Montgomery County, Maryland,
ORDERED, that the above referenced
1992,
by the
i
i
mat~er
be, and is
hereby remanded to the State Board of Medical Examiners for
further proceedings in accord with opinion of the Court of
Spe·~ial
//
Appeals.
~
"1V
\
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.()KL· ,.... *t£t&'<!_J;41~(
~eLAWRENCE /BEARD
/'
~..
:
Circuit .Court for Montgomery
COllnty, Maryland
I Judge
I
�·'
IN THE
MONTGOMERY COUNTY CIRCUIT COURT
.
In re:
JOE D. CRAWFORD, M.D.,
Civil No. 37592
VB.
MARYLAND DEPARTMENT OF HEALTH
and MENTAL HYGIENE (Board of Physician
Quality Assurance)
Judge Beard:
You entered a November 1992 Order in Civil 37592
requiring the Maryland Board of Physician Quality Assurance
to comply with the Medical Licensing Statute and to comply
within the framework of the Opinion of the August 1991 Court
of Special Appeals decision which overturned and reversed
the refusal of the State of Maryland to grant licensure to
me. Despite your Order, and the Order of the Court of
Special Appeals; that Board and its members have refused or
failed to comply with your Court Order.
For the members of the Maryland Board of Physician
Quality Assurance to simply refuse to obey your order and
valid Orders of this Court is hardly discretionary.
1 need
to get my career on-line.
1 would be more than happy to
listen to any remedies to any circumstance which might exist
which would perhaps make this Court incompetent to enforce
its' own Orders.
Otherwise, -I expect that this Court will
devise it's own response to effect prompt and considerate
compliance with Orders of the Court, and compliance with
your own orders.
rUl Y, / ) .
jJ I.
.~.
oe D. Crawford, M.D.
August 15, 1994
Post Office Box 3851
Gaithersburg, Maryland 20878
CLERK OF THE CIRCUIT eOURl
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MONTGOMERY COUNTY MD
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THE WHITE HOUSE
OFFICE OF DOMESTIC POLICY
CAROL H. RASCO
Assistant to the President for Domestic Policy
To:
~<'
4'
Draft response for POTUS
and forward to CHR by: _ _ _ _ _ _ _ _ _ _ _ _ _ __
Draft response for CHR by: _ _ _ _ _ _ _ _ _ _ _ _ _ __
Please reply directly to the writer
(copy to CHR) by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Please advise by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Let's discuss:
--Iv-:::"c--_ _ _ _ _ _ _ _ _ _ _ _ _ _ __
__
For your information: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Reply using form code: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
File: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Send copy to (original to CHR): _ _ _ _ _ _ _ _ _ _ _ _ __
Schedule? :
o Accept
o Pending
o Regret
Designee to attend: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Remarks:, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
~UN 'W. L,ot"~RY PHOTOCOPY
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FROM:
,RICKI SEIPMAN
,ASSISThNT'TO THE PRESIDENT,
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,'Yt-bpl-C wdw V6tl.h,1 i H"es " ,
Joan Baggett '
Leon Panetta
, ..Rebecca' Cameron
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"John Podesta
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Lloyd Cutler
Jack Quinn
'Carol Rasco}
, ,Rahm Emanuel
Mark Gearan
Bob, Rubin
David Gergen
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'Patti Solis
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Cindy Gire'
G. Stephanopoulos,
,
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,Ann ,S i:ock
Pat
St~phariie Strecitt
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Jack Gibbons
,
Griffi~
.
'MarCia' Hale'
, Christine V?lrney
Alexis Herman
Joe Velasquez
,,Mel anne Verveer
..
• Maggie Williams
Nancy HeFnreich
,
. '
Harold Ickes
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,~hil Lader'
, , , Tony Wilson' ,
Antl1ony,Lake
Anna,Winderbaum,
,Bruce Lindsey
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,'Mack, McLarty
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SCHEDULE PROPOSAL"
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94 JUL2
.iREGRET· \ "
S~:i.dman/ Assisrd~nt
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·.As~ist~nt' '~~the:
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Me~t~~glfOr~~a~d' pre'se~tati~n .
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;pr~sidJntialpresentation of:~
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·'ca.rol : H/.' Rasco',
President
.f()r... Domestic, PC?1iCY~ ...•.,.
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. REQUEST:',
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FROM:
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Ricki'
to the p.re;'ii!nt anci
Director of Scheduling and Advance
TO:. :.
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th~
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an award by
.....;:Presid$nt! se-·Committee on' Employment of~ peopl'e.,
:. ': withD.isabillties.,··'This:-:award. is' considered.:·-· . ,'....,.. : .., .
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, "America's.highest'.honor,·g,1ven, to the ·pers,on. '.'
···who ha~done the. most:: to enhance the l ;·
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with .d '.l.sabi'l'itie's '•.,".....,: ". . .....' ' . . . .,'
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';.' A;'~:briE7f'. presentatio~ ...~t:~hei;:.White ~()use. is
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, '.• ·'·'.·?~<:;:':":;;.~··anothe,r··opportunity::.to'r:hig~lfgl:lt:
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The reason for this. request 'now is that the
. Presidents I '. Committee would . . be' able' .
like to
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to·advertise,. in its call for nomination, the .
award. pre'sentation:
Whitla .House veriuefor the. . ' '
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,to enhance' both .the quality.of the nominati~m .
, and/to: publicize 'the: .President' s commitnient .'
, to the' disabili ty issue.' .
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. PREVIOUS
'. J?ARTICIPATION:'
. DATE AND' TIME:'
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DURATION: .
LOCATI,ON:, .
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.. October 1995 (National Disability Employment
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·,,:;'·,Tony. Coelho'; "Chairniari·:.of:'this comm:l'ttee,. w1:1l:: :, .' c': ':1
:.•.. be ori~.: of::th~'att8rid~e~: at;';thi's', 'presentationt""':;:;~~;0:;::':'
.and sees it as. another ,chance "foi::,'. the .""
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. ' . r~Co9nition .for 'suPP9rtof:'disability.issues •.
In previous' Administrat4.ons,; Presidents,.·have·.
, .
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PARTICIPANTS:
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The President, Representative Tony Coelho,
the Awar.d'recipient 'and immediate family
, menibers L,
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OUTLINE OF EVENTS:
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p:teside~t"
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,wh:lte,House'photog~apher
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"Brief' presentation of'the award by 'the,
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. RICKI SEIDMAN.
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. ASSISTANT' TO .THEPRESIDENT
FROM: -
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. Lloyd .Cutler>
'. Rahm' ~manuei
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.' Marcia Hal..
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' .. 'Chr·ist~ne· Varr1E!Y'
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.. Joe.· Vel~squez
Nancy' Hernreich '
'Melanne' Verveer . ' '
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Harold Ickes .
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Phil Lader
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Anthony . La~e '.
'. Tony 'wilson
'. Anna Winderbaurii
Bruce' .' LiI.ld~~y
Mack M.cLarty
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For 'Your .
Information. '.
. Action
, Comment's:
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THE WHITE HOUSE
OFFICE OF DOMESTIC POLICY
CAROL H. RASCO
i
Assistant to the President for Domestic Policy
~: ~~~I---------porus
Draft response for
and forward to CHR
Draft response for CHR by: ->-;~J.IL_ _ ~_ _~_ _ _~~_ __
Please reply directly to the writer
(copy to CHR) by: _ _ _ _ _ _.
Please advise by: _.~~ _ _ _ _ _ _ _ ___
Let '5 discuss: __ ~~~_~_~~~.~~~.~_~~~~~ __~ __ ~_~ __ ~.~~~_. _ _ ._~~~_~. _ __
For your information:
Reply using form code: ___~__
File:_~~ _ _ _ _ _ _ .~_.~_. __
Send copy to (original to CHR):
Schedule? :
o Accept
o Pending
o Regret
CLINTON LIBRARY PHOTOCOPY
�•• <
JUL 2 2 REC'O
Scheduling Advice Memorandum·
RICK! SEIDMAN
FROM:
TO:
JOAN BAGGETI
LLOYD CUTLER
RAHM EMANUEL
JOHN EMERSON
MARKGEARAN
DA VID GERGEN
JACK GIBBONS
.. PAT GRIFFIN
MARCIA HALE
KAREN HANCOX
ALEXIS HERMAN
NANCY HERNREICH
HAROLD ICKES
WILL ITOH
PHIL LADER
ANTHONY LAKE
BRUCE LINDSEY
RE:
ALMALDON
KATIE MCGINTY
MACK MCLARTY
LEON PANETTA
JOHN PODESTA
JACK QUINN
CAROL RASCO
BOB RUBIN
ELI SEGAL
PATTI SOLIS
GEORGESTEPHANOPOLOUS
ANN STOCK
CHRISTINE VARNEY
MELANNE VERVEER
DANNY WEXLER .
MAGGIE WILLIAMS
TONY WILSON
~i)0r fAtJ{jjLOJ ~fV 1 (~Jv!L-Jk Y~id~+5 (-U1:"I1K-c all frnfl?J~
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The Scheduling Office is considering the attached invitation.
Please advise us:
POTUS should attend.
POTUS should/need not attend.
POTUS should/need not attend but should send a representative.
,
~
If you think POTUS should attend please submit a proposal ASAP.
Your Additional Comments:
PLEASE RETURN TIllS MEMO TO ANNA WINDERBAlJM IN ROOM 185.5 BY
$/3J9 ~
�10# 070892
THE WHITE HOUSE
CORRESPONDENCE TRAC~ING WORKSHEET
INCOMING
DATE RECEIVED: JULY 18, 1994
NAME OF CORRESPONDENT: THE HONORABLE TONY COELHO
SUBJECT: REQUESTS THE PRESIDENT HOST THE ANNUAL
PRESIDENT'S COMMITTEE ON EMPLOYMENT OF PEOPLE
WITH DISABILITIES AWARDS PROGRAM AT THE
WHITE HOUSE DURING THE NATIONAL DISABILITY
ACTION
ROUTE TO:
OFFICE/AGENCY
P
L
ACT
DATE
CODE YY/MM/DD
(STAFF NAME)
ANNA WINDERBAUM
~p
c....REFERRAL NOTE:
efts
WEX!- REFERRAL
NOTE:
REFERRAL NOTE:
, REFERRAL NOTE:
DISPOSITION
ORG
~K
.K
Q.
v--
TYPE
RESP
94/07/18
-
_/_/
~fl/ib<
__/_/
1!JJQ4/t2~
__7_/_
-,-,_/_/-
REFERRAL NOTE:
C COMPLETED
0 YY/MM/DD
-,-,
__/_,
_
COMMENTS: EMPLOYMENT AWARENESS MONTH IN 95
*PRESIDENT'S COMMITTEE ON EMPLOYMENT OF
PEOPLE WITH DISABILITIES
ADDITIONAL CORRESPONDENTS:
MI MAIL
MEDIA:L
INDIVIDUAL CODES:
USER CODES: (A) _________ (B) _ _ __
(C) _ _ __
***********************************************************************
.*ACTION CODES:
*DISPOSITION
*OUTGOING
*
*
*
*CORRESPONDENCE:
*
*A-APPROPRIATE ACTION *A-ANSWERED
*TYPE RESP=INITIALS
*
*C-COMMENT/RECOM
*B-NON-SPEC-REFERRAL
*
OF SIGNER
*
*C-COMPLETED
*
CODE = A
*
*D-DRAFT RESPONSE
*COMPLETED = DATE OF
*
*F-FURNISH FACT SHEET *S-SUSPENDED
*I-INFO COPY/NO ACT NEC*
*
OUTGOING *
*
*
*R-DIRECT REPLY W/COPY *
*S-FOR-SIGNATURE
*
*
*
*
*
*
*X-INTERIM REPLY
***********************************************************************
REFER QUESTIONS AND ROUTING UPDATES TO CENTRAL REFERENCE
(ROOM 75,OEOB) EXT-2590
KEEP THIS WORKSHEET ATTACHED TO THE ORIGINAL INCOMING
LETTER AT ALL TIMES AND SEND COMPLETED RECORD TO RECORDS
MANAGEMENT.
SCANNED
�,'
President's Committee on· Employment
of People with' Disabilities
, June 24, 1994
The President
The White House
Washington, DC 20500
Dear Mr. ,President:
The Pres'ident' s Committee on Employment of People with
Disabilities sponsors an ...qnnual awards p:£,9.gJ:9.nt.- In this program
is The President's Award, described as "America's highest honor
given to the person who has done the most to enhance the
empowerment and employment of individuals with disabilities."
When the award was .originally established, it was given to the
recIpient personally by the President at the White House.
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As the process evolved, the award presentation was moved to the
annual conferenee, and given personally by the President only
when he was able to attend the conference. ,As currently
presented, the award does rec,ognize an'individual, generally,from
the grass roots disability communitYt who has made significant
contributions to increase public awarenes& of Americans with
disabilities in the work force, but ,the President fails to get
appropriate v'fsi)Jility, ?ind recog.nit10n for his support of
disability issues~"
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',\.'
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Because of your-strong committrt'ent t~.~hese issues, I would like
to see you get the credit you p.eserve'fn every possible way.
,
Xour Rersonal Rresehtation'of this award at the White House would
give you another oppoftuhitytohtghlight that commitment.
We can work with White Ho.use staff to a'rrang~n a}2}2ro}2riate date
. 'and ceremony, .possibly·'ar.ound ':the ADA annivers•.;ry- or~uring
~ational D'fsal5"i~-itTEffiPToymerit" ~wareness Month, to begin in 1995.±
-k
If we can advertise' in our call' 'for,nomiriations that this award
will be present'ed at the' WhiteHouse, at your direction or
request, 'thatwouldcertainiy, ,ent:lance the percepti.on of your
1331. F Street, N.W.
• Washington, DC 20004-1107'· 202-376-6200 (Voice) • 202-376-6205 (TDD) . ' 202-376-6219 (Fax)
�page two
level of commitment as well as increase the national interest
among our state partners and disability leaders in recommending
outstanding individuals for the honor.
I look forward to your response.
Sincerely,
""I
Tony Coelho
Chairman
�.
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MENTAL HEALTH ASSOCIATION OF MARIN
_}:!:;'
199 Greenfield Avenue
San Rafael, California 94901
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waiver Summaries as of July 18 ~ '1994
AUGUST 1, 1994'
FLORIDA
·qovernor.Chiles
"
-Section 1115 Medicaid' Waiver
. -Received'· February '10 , 1994
',-OOS has shar~d dl;'aft special terms and, conditions, with
the state and received their commentS. 'OOS is,' ~
negotiating the •remain irig, outstanding' issues" ,
including budget neutrality and the roi~ ofagen~s.
OKLAHOMA
Governor
W~lters
-Welfare Waiver ,Request '
,
- Received February 24, ,1994
-ooS provided no., status report to the White House
, (:Kathi Way, who ,is, at' NGA, is' seeking to get ,status.)
'MISSOURI
Governor Carnahan,:
.
\.
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'I.. ;
-Section, 1115 ,Medicaid Waivel;'. '
" -Received June 30, 1994.
-·OOS .fn: early stages of. review
,:CALIFORNIA
.C?overnor wilson
:-califor~ia WOl;'k Pays Demonst.ration project,
-Received March 14, i994 ' ' .
,
:
.
.
Department ot Social8ervices a
list of issu,es and. questions which arose 'out of the'
federal review of thatapplicati6n~.
~OOSrecentlysent .'~he.
CONNECTICUT
Governor'Weicker
,
'
. ,
...IIA Fair' Chance" Welfare Demonstration, project
. J~Received December 30, 1993.
.'
.. ;
,v,-HiIshar:l been working with ,the' Co;a:tnecticut· Department
, 6fSocial Services to resolve a number of issues and
.questions.
..
.
-ooS is 'in. the process of developing draft terms and
·condltions.to send to the connecticut.Department6f
Social Services in'the next couple 'of weeks.
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.GEORG:rA
, Governor Miller
'-Project'Fulton Welfare Waivei- .
/.
,·Rec:eived october 21" 1993
,. ,
.'
·HHS has been working with theqeorgia Department of ,
'. Human Resources' (OHS). to, resolve' a , number. <;If. issueS,'
. and questions'
,'.
,'
:' . . . ,
·HHS, havirig resolved the key is,sues. of concern, are in:'
the· process of developing 4raft terms and, conditions
t'b send to DHS in,the next couple' of . ,
. weeks.
MASSACHUSETTS
Governor Weld
-Employment, Support ,Program,
-Received March 1, 1994
-HHS expects to send the Massachusetts Department of
Public Welfare a list ,of issues, and) questions wliich
. have arisen out of 'the federal review within the next
2 w'eeks.
'.
'
'-Child Care Co-Payment proj ect "
-Received JanuarY 14,: 1993
,
-HHS recently, identified a potential legal difficulty
·HHS expects to' complete' analysis and ,contact, staff of,
this project by the end of the'month. '
K:rCH:rGAlf
Governor, Engler
,
,,1"
,:"S,trengthen Michigan Families 'Demonstration
. -Received March 8,1994 ,
.
"
-HHS has been. working with the Mlchigan Department of
" sociai Services' (DSSJ to 'resolve issues and,concerm;.
- Significant issue has arisen in· ,C~mgress regarding the.
"federal funding,of Food stamp cash~out~ in state
, demqnstrations. . Until ,co~gress .re,solves this
questions, HHS will continue to work'withDSSto
address all other non-Food stamp· cash-out. iss,ues· in an'
expedit'ious manner~
.
K:rSS:rSS:rpp:r
,Gov~rnor
Fordice
....
'::'we'ifar~ waiver: ~'New Direction Demonstr~tionprogram
"-Received December 1'0, 1993
)
\
·HHS has been working'withthe Mississippi Department,
of Human Resources to resolve issues and concerns'
based on a' federal review of the waiver application.
'. - Food stamp cash":'out problem (see' Michigan) , , ,
Y,
�MONTANA
Governor ,Racico,t '
,
'.
-Achieving Independence for;Mqntanalts'Project '
·Receive~April 19, 1994'
"
-,
·HHS· expects to send the Montana 'Department ,of Social
and Rehabilitation serVice a list of issues and'
"
questions' by tile end of next week.,
,,'
'-Food stam:r;:> cash-out 'problmen (see Miqhigan)
Governor voinovich .,' ,
i :
-"A state of opportunity",project
•Received May 28', 1994' '
-HHSexpects'to send the Ohio 'Department ,of Human,
Seritices'c1, list· of issuesaild questions by the 'end of
the mont~. "
"
,
~Food, stamp problem (see Michigan)
":'Welfare Reform "Automobile'Assets Di~regard ,Project..
, -Received October ·13, 19',93 "
,"
,
·HHS·understands that Ohio may' choose. to withdraw this
waiver,request'as it has since beert included under the l
, II A State.of :.OpI>0~uni ty"
proj ect ..
'-Section' 1115 Medicaid Waiver .
-Received March 2, 199,4
"
,,
·HHS is looking forward, to meeting with staff
l'21s~ to discuss "the proposal ~n more depth.'
o~
July
'- .
PENNSYLVANIA
Governor Casey
,
\'
~Pathways
to ,Independence Demonstration
, • Receive'd February '18,1994
, ,'·HHS has be,en working ,closelY' with the Pennsylvania
,Department of Public Welfare' (DPW) to answer questions
and concerns based on a federal review of the waiver
applicat'ion. '
-Food stamp cash~o~t problem (see Michigan)
I
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,'.
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'. Waiver summaries as ,of: July. 18, 1994
I
AUGUST 15,_199.
'
CALIFORNIA'
, Governor Wilson,
('AFDC and' FOO~ stamp compatibility'De,moni;stration :Project
. -Received MaY,23, 1994 .. ·
'
,,'
-HIlS' expects to send the California Department 9f.·
. Social 'Services. COSS) ~ list 'of issues and. questions
which result from a federal review' of the application',
by the' end of August.
MARYLAND
Governor
Scha~fer
. , :-Maryland w.elfare Reform'~roject \.
,.. ',-RecEdved March 1, ,1994 ..
·HIIS sen~ alett~r:on'July 1, ·1994.toth~
Maryland Department of Human Resource,s addressinq
certainleqal andfundinq concerns'applicable to this.
,project."
'
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MASSACHUSETTS
Governo:r;'.Weld'
-MassHealth Proqram
-Received April 15,< 1994'
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. -On, May 1'9, 1994, the state provided. an informativ~_ .
briefinq for the Department.'
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',-On, June 24th, HIlS askedth.a state to provide
, additional information"abut.their proposal and.looks
forward to receivinqandreviewinqthe'respons~;,.
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,80UTHCAROLINA
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Governor. campbel'l
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-s'elf-sufficlency and Parental Respoh~Jb'ility Proqram
. -Received June 13,' 1994
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'~HIIS ,expects to send the South Carol ina Department of
.Social Servic~sa list of, issues and questions which
result 'from a'federal review of, tlie a,pplicationby
mid-August.
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:":south CaroLina's 'Palmetto Health Initiative
-Receiv~d March'l, 1994
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-HIlS is now reviewing' the materi!ll submitted by the ,
. ,state on May .13,' 1994 'in response to, HIlS' request. for
: additional' information.· , .'
....
-HIlS; and South, Carolina staffs are working toqeth~rto
set upa meeting within the, next two weeks to discuss,
. outstanding 'issues following a meetIng held in ,last 10
day~.
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�NEW 'YORK
CUomo
~~overnor
-Jobs First 'Demonstration"
iR.eceived J.une 7,' 1 9 9 4 ,
,
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-:mis expects to send the New'York'DepartIiient of Social
services a list of, issues and questions by mid-August. '
WASHINGTON
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Governor, Lowry
-waiver which provides home and community-based services 'to
developm~ntal'disabledindividuals in n~rsingfacilities.
, . -Received· June 28,:1994'
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-HHS is cur+ently reviewing the, request and believes' .
th,t ,.any outstanding issues can. be, resolve9- withil1 the.
current 90-day period. . ." ".
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CAL'IFORNIA
,
~8,1994
'
SBPTEMBER, 1 \
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, Governor, wilson '
l
. -Two additional waiver requests were'rece,ived by, HHSJulyl
, and July ,8' , .
'GEORGIA
Gpvernor
,
,f
Mill~r,
0,
-Work for Wel':fare project Application·
,-Received June j
199,4·
-HHS expects to sendthe'Georgia,Oepart~ent of: Human
Resources·a list of issues ,and 'questions by the end of'
, 'August~ ,
'
INDIANA
'Governor Bayh .
-Manpower, pi~cement ~nd.comprehensive'Traininq Program
-Received Jur:-e 21, 1~94 , " , '
"
'
, -HHS' fi!xpects to send the, Indiana Family . and SQcial
'Services Admiqistrationalist of issues and questions'
',which ,result" from a federal review of the application'
'by the end of, August.;
, '
;NEW 'HAMPSHIU
Governor Herril
-section 1115 Me'dicaidWaiver
"-Received June 14,' 1994' '"
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-HHS is currently in the, very early st~ges of review'
"-HHS,expects,to contact the state in the next few,weeks
,,to discuss issue's' relating to t;:.he waiver reqUest ..
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waiver Summaries' as of J'u'ly 113',' 1994,
NOTE:CIm· to check on the status otthe'following:,
NEW MEXICO
,, 'NEW YORK
" Governor, Cuomo,
,
;
, -Jobs' First, Demonstrat'ion
~Received June 7, 1994',
,,'
-HHS expects to send the New York Department of Social
Services a list of issues and ~estionsby ',mid-August."
/
WASHINGTON
Governor Lowry
~Waiverwhich provide~ home, and,com;munity;"based serVices to
deYf!!lopmentally dis,abled' individuals in nursing facilities.'
, ',,' ~Received June 28, '1994 '
' , '
-HHS is currently r~viewing the request and be,lieves
that anyoutstanding,isslles can be 'resolved ~ithin the,
',current 90-day pel;'ioq.
, NEW', HAMPSHIRE
Governor Merril
, , \ WASHINGTON
,
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Governor Lowry
-Success Through'Employment Project
-Received November 16, 1993
- In January ,.1994, HHS. sent the Washirigton Department of
Social and,Health Services a list of issues and
'quest~ons which arose' o~t of'the federai'review'of~the
application.'
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-When' response is received, 'ims should be able to
promptly submit draft te:rms and conditions to staf~,
if jt' provides sufficient clarif'i'cation and resolves
sign~ficant issues'. .
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�OREGON
'Governor Roberts
-~elfare·waiver
,-Received October 28, . 1993
-Nfilth, Circuit' CQurt'Decision problem
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�Waiver Summaries as of July 18, 1994
AUGUST 1, 1994
FLORIDA
Governor Chiles
-Section 1115 Medicaid Waiver
-Received February 10, 1994
-HHS has shared draft special terms and conditions with
the State and received their comments. HHS is
negotiating the remaining outstanding issues,
including budget neutrality and the role of agents.
OKLAIIOg
Governor Walters
-Welfare Waiver Request
-Received February 24, 1994
-HHS provided no status report to the White House
(Kathi Way, who is at NGA, is seeking to get status.)
MISSOURI
Governor Carnahan
-section 1115 Medicaid Waiver
-Received June 30, 1994
-HHS in early stages of review
CALIFORNIA
Governor Wilson
Work Pays Demonstration Project
-Received March 14, 1994
-HHS recently sent the Department of Social Services a
list of issues and questions which arose out of the
federal review of that application.
-~alifornia
CONNECTICUT
Governor weicker
-IIA
Fair Chance" Welfare Demonstration Project
-Received December 30, 1993
-HHS has been working with the Connecticut Department
of Social Services to resolve a number of issues and
questions.
-HHS is in the process of developing draft terms and
conditions to send to the Connecticut Department of
Social Services in the next couple of weeks.
CLINTON LIBRARY PHOTOCOPY
�\'-
GEORGIA
Governor Miller
-Project Fulton Welfare Waiver
-Received October 21, 1993
-HHS has been working with the Georgia Department of
Human Resources (DHS) to resolve a number of issues
and questions
-HHS, having resolved the key issues of concern, are in
the process of developing draft terms and conditions
to send to DHS in the next couple of
weeks.
MASSACHUSETTS
Governor Weld
-Employment Support Program
-Received March 1, 1994
-HHS expects to send the Massachusetts Department of
Public Welfare a list of issues and questions which
have arisen out of the federal review within the next
2 weeks.
-Child Care Co-Payment Project
-Received January 14, 1993
-HHS recently identified a potential legal difficulty
-HHS expects to complete analysis and contact staff of
this project by the end of the month.
MICHIGAN
Governor Engler "
-Strengthen Michigan Families Demonstration
-Received March 8,1994
-HHS has been working with the Michigan Department of
Social Services (DSS) to resolve issues and concerns.
-Significant issue has arisen in Congress regarding the
federal funding of Food Stamp cash-outs in state
demonstrations. until Congress resolves this
questions, HHS will continue to w,ork with DSS to
address all other nqn-Food stamp cash-out issues in an
expeditious manner.
MISSISSIPPI
Governor Fordice
-Welfare Waiver·: New Direction Demonstration Program
-Received December 10, 1993
-HHS has been working with the Mississippi Department
of Human Resources to resolve issues and concerns
based on a federal review of the waiver applicat~on.
-Food Stamp cash-out problem (see Michigan)
�t.
MONTANA
Governor Racicot
-Achieving Independence for Monta~ans project
-Received April 19, 1994
-HHS expects to send the Montana Department of Social
and Rehabilitation service a list of issues and
questions by the end of next week.
-Food Stamp cash-out problmen (see Michigan)
Governor Voinovich
-"A State of Opportunity" Project
-Received May 28, 1994
-HHS expects to send the Ohio Department of Human
Services a list of issues and questions by the end of
the month.
- Food Stamp problem .(see Michigan)
-Welfare Reform "Automobile Assets Disregard project"
-Received October 13, 1993
-HHS understands that Ohio may choose to withdraw this
waiver request as it has since been included under the
"A State of Opportunity" Project.
-section 1115 Medicai.d Waiver
-Received March 2,- 1994
-HHS is looking forward to meeting with staff on July
21st to discuss the proposal in more depth.
PENNSYLVANIA
Governor Casey
-Pathways to Independence Demonstration
-Received February 18,1994
-HHS has been working closely with the pennsylvania
Department of Public Welfare (DPW) to answer questions
and concerns based on a federal review of the waiver
application.
-Food stamp cash-out problem (see Michigan)
�·.
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waiver summaries as of July 18, 1994
AUGUST 15., 1994
CALIFORNIA
Governor Wilson
-AFDC and Food stamp Compatibility Demonstration project
-Received May 23, 1994
-HHS expects to send the California Department of
Social services CDSS) a list of issues and questions
which result from· a federal review of the application
by the end of August.
MARYLAND
Governor Schaefer
-Maryland Welfare Reform Project
-Received March 1, 1994
-HHS sent a letter on July 1, 1994 to the
Maryland Department of Human Resources addressing
certain legal and funding concerns applicable to this
project.
MASSACHUSETTS
Governor Weld
-MassHealth Program
-Received April 15, 1994
-On May 19, 1994, the state provided an informative
briefi,ng for the Department.
-On June 24th, HHS asked the state to provide
additional information abut their proposal and looks
forward to receiving and reviewing the response.
SOUTH CAROLINA
Governor Campbell
-Self-sufficiency and Parental Responsibility Program
-Received June 13, 1994
-HHS expects to send the South Carolina Department of
Social services a list of issues and questions which
result from a federal review of the application by
mid-:-August.
-South Carolina1s Palmetto Health Initiative
-Received March 1, 1994
-HHS is now reviewing the material submitted by the
state on May 13, 1994 in response to HHS' request for
additional information.
-HHS and South Carolina staffs are working together to
set up a meeting within the next two weeks to discuss
outstanding issues following a meeting held in last 10
days.
�.
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HEW YORK
Governor Cuomo
-Jobs First Demonstration
-Received June 7, 1994
-HHS expects to send the New York Department of Social
Services a list of issues and questions by mid-August.
WASHINGTON
Governor Lowry
-Waiver which provides home and community-based services to
developmental disabled individuals in nursing facilities.
-Received June 28, 1994
-HUS is currently reviewing the request and believes
that any outstanding issues-can be resolved within the
current 90-day period.
�waiver summaries as of July 18, 1994
, SEPTEMBER 1
CALl:PORNl:A
Governor Wilson
-Two additional waiver requests were received by HHS JUly 1
and July 8
GEORGl:A
Governor Miller
-Work for Welfare Project Application
-Received June 30, 1994
-HHS expects to send the Georgia Department of Human
Resources a l.ist of issues and questions by the end of
August.
l:NDl:ANA
Governor Bayh
-Manpower, Placem~nt and Comprehensive Training Program
-Received June 21, 1994 .
-HHS expects to send the Indiana Family and social
services Administration a list of issues and questions
which result from a federal r~view of the application
by the end of August.
NEW HAMPSHl:RB
Governor Merril
-section 1115 Medicaid Waiver
-Received June 14, 1994
-HHs·is currently in th~ very early stages of review
-HHS expects to contact the state in the next few weeks
to discuss issues. relating to the waiver request.
�i~
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,
waiver summaries as of July 18, 1994
NOTE: CHR to check on the status of the following:
NEW MEXICO
NEW YORK
Governor Cuomo
-Jobs First Demonstration
-Received June 7, 1994
-HHS expects to send the New York Department of Social
Services a list of issues and questions by mid-August.
WASHINGTON
Governor Lowry
-Waiver which provides home and community-based services to
developmentally disabled individuals in nursing facilities.
-Received June 28, 1994
-HHS is currently reviewing the request and believes
that any outstanding issues can be resolved within the
current 90-day period.
NEW HAMPSHIRE
Governor Merril
-Earned Income Disregard Project
-Received September 20, 1993
-In October of 1993, HHS sent the New Hampshire
Department of Health and Human Services draft terms
and conditions. A final decision should be reached
promptly after receiving this response.
WASHINGTON
Governor Lowry
-Success Through Employment Project
-Received Novembe.r 16, 1993
-In January 1994, HHS sent the Washington Department of
Social and Health Services a list of issues and
questions which arose out of the federal review of the
application.
-When response is received, HHS should be able to
promptly submit draft terms and conditions to staff,
if it provides sufficient clarification and resolves
significant issues.
�OREGON
Governor Roberts
-Welfare Waiver
.
-Received October 28, .1993
-Ninth Circuit Court Decision problem
�, .
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THE WHITE HOUSE
,,
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OFFICE OF DOMESTIC POLICY
,~
CAROL H. RASCO
Assistant to the President (or Domestic Policy
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Draft response for'POTUS
. and for~ard ~o CHR by: _ _ _ _ _~ _ _ _ _ _ _ _ _ _ __
Draft response ior CHR by: _ _ _ _ _ _ _ _ _ _ _ _ _~-Pleasereply directly to the writer'
(copy to CHR) by: -:-~_ _ _ _ _ _ _ _ _~_ _ _ _ __
Please advise by: _ _~_ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Let's discuss: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
For your information: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
, Reply using form LV"",._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
File: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _-,--'-_ _-'-_ __
Send copy to (original to CHR): -:-,_ _ _ _ _ _ _ _ _ _ _ _ __
OAccept"
CJ Pending
u Regret'
�WithdrawalIRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001.
correspondence
DATE
SUBJECTrrlTLE
08/15/1994
Dr Crawford package (15 pages)
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Pending - To Discuss [4]
20 I 0-0 198-S
kc232
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)J
Freedom of Information Act· [5 U.S.C. 552(b)J
PI National Security Classified Information [(a)(1) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PM]
b(I) National security classified information [(b)(l) of the ForA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIAJ
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
----------------------
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TH E WH ITE HOUSE
OFFICE OF DOMESTIC POLICY
CAROl H. RASCO
Assistant to the President for Domestic Policy
To:
Draft response for POTUS
and forward to CHR by: _ _ . _ _ _ _ _ _ _ _ _ _ _ __
Draft response for CHR by: _ _ . .~_ _ ._ _ _ _ _ _ _ __
Please reply directly to the writer
(copy to CHR) by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Please advise by: _ _ _ _ _ _~_ ._ _ _ _ _ _ _ _ _ __
Let's discllss: _ _ _..._ _ _ _ _ _ _ _ _ _ _ _ _ _ __
For your information: _ _ _ _ _ _ _ _-'-- _ _ _; -_ __
Reply uSing form code:
File: _ _ _ _ _ _ _ _ _ _
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Send copy to (original to CH R): _ _ _ _ _ _ _ _-""""""'<....
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o Accept
o Pending
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Designee to
Remarks: --''''''"~-----:~''''''''~---;-'l~----'''--.'''''''"H!~*'''":'!I:;;'\::<>M'T'r-
CLINTON lIBR<\RY PHOTOCOPY
�'.
Mountain View
College
August 23, 1994
4'849 W. Illinois Ave.
Dallas, Texas
75211-6599
f2tJ,o
214-333~{600
Carol Rasco
The White House
1600 Pennsylvania Avenue
Washington, D. C. 20500
Dear Carol,
This is a follow-up letter to my earlier letter inviting President
Clinton to speak at Mountain View College in celebration of the
college's 25th Anniversary.
You had suggested that if I communicated with you that you would then
forward our request to Ricki Seidman, Assistant to the President for
Scheduling and Advance.
Carol, if for any reason you or Ricki feel that the President will be~
unavailable, I would very much '"'appreciate it if you could recommend
someone else in the Administration.
I
look forward to hearing from you.
of Instruction
'Cllgb
Dallaa County Community
College District .
�fe/Ala 0
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Mountain View College
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Dallas, Texas 75211-6599
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The White House
1600 Pennsylvania Avenue
Washington, D. C. 20500
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�SENT BY:Xcrox Tclccopicr 7020 :11-26-61
912024562878-52264:# 2
2143336708~
22:26
June 9. 1994
Carol Rasco
The Wh1te House
1600 Pennsylvania Avenue
- Washington, D. C. 20500
IIp.~r
Caro 1,
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The purpose of thiS letter is two' fold. 'F1iT;S~ldl would 1ike to s~y
hello and commend you for the outstand1ngil'!ol:e:~:you have I'IlaYAd ;n
hel~1n9 President Clinton put in place his domestf~agenda. You should
be very proud, as I know you are, of what, thQ administration has
accompl ished in a ver.y short per10dof time.
,
Second. I would like to SQr.lJr9 ynur help in an et]fort to have Prasident
Clinton speak during Mountain View College's 25th Annivernry
Celebration. We are expecting an attendance of six thousand plus. The
attendance waul d most certainly refl ectour student body and our servic.e
area. Hounta1n View College has a total enrollment of 5,839 students
lwh1te - 2.932. black. - 1,325, and hispanic· 1,271) and dividQd almod
equally ill rniSle and female representat1on.
,
Our college represents the face of Amer; c:a; It. rp.presents the very poor
and the very prosperous. It 1s an i deal 1oc.at i on for Pres tdent el1 nton
to extol the virtues of programs that would lift thapoor out of their
,plight as well as show the benef1ts of a nat1ona1 health care plan to
middle and upper middle class Americans.
,
I
Even though the President's appearanceh~re' would not be a parLinn
polittcal ~vent, it should be pointed out;tha~ Mountain View College is
the onlY college in this region whose servllceiarea 1$ representgd by two
Democratic U.S. Representatives, Martin Fro~t i~'I'I~'!Eddie Bernice Johnson.
.
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Carol. if in your Judgement th1s may be a :difftc,u:1It one to pull off. I
would bo'most appreciative if you could sU9gest'so~e possible options.
.
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Again, I hope thing$ ire goi.(lg will for you and LhilLYlIu ilre not working
too hard. However, knowing you, I'm sure you are still going non-stop
at what has to be a tremendously tough job. Nevertheless, I wish you the
best and I look forward to heari ng from you.
1
.,
Pl ease 51.y hello to the Pres 1dent forme" and 1et h1m know that 01 a and
I arc pr~ying for his continued success.
SincQrQly,
Curt is l. Ivery
Vice Prasident of Instruction
,Cl/gb
�SENT BY:Xerox Teleeopier 7020 :11-28-6?
22:14
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PROPOSED DATES FOR
MVC 25TH ANNIVERSARY CE~EBRATION
PRESIDENTIAL APPEARANCE
Any time between 9: 00 AM and 2: 00 PM on any of the, fo" owi"9 ,datos:
1994
Sept. 1 or 2 (R or F)
Sept. 29 or'30 (R or F)
Oct. 10 or 11 (M or T)
1995
Apr. 6 or 7 (R or F)
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SENT BY:Xerox Teleeopier ,7020 ;11-26-61 ; 22:14: ;
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DALLAS COUNTY COMMUNITY COLLEGE
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D~srRICT
FAX'SHEET:·'::::.
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SENT BY:Xcrox Tclccopicr 7020', :"-28-61 : 22:25
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DALLAS COUNTY COMMUNITY COlL'E~E DIS,TRICT
FAX SHEET
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MOUNTAIN VIEW COllEGE
4849 W. ILLINOIS AV:~:~U~
DALLAS, lX' 7521~i;::i " :.
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�THE WH IT''t11ot:1sE
OFFICE OF DOMESTIC POLlCY
CAROL H. RASCO
Assistant to the President for Domestic Policy
To:
Draft response for POTUS
and forward to CHR by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Draft response for CHR by: _ _ _ _ _~'--_ _ _ _ _ _ _ __
Please reply directly to the writer
(copy to CHR) by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Please advise by: _ _ _ _ _ _ _ _ _ _ __
Let's discuss: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
For your information:
-----------------c-
Reply using form code: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
File: _ _ __
Send copy to (original to CHR): _ _ _ _ _ _ _ _ _ _ _ _ __
Schedule? :
o Accept
o Pending
o Regret'
Designee to attend: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Remarks: _ _ _ __
�"
August 29, 1994
Mountain View
College
SEP - 6 REC'O
Bi·ll Clinton
President of the united states
1600 Penpsylvania Ave.
Washington D.C.
Dear Sir:
4849 W. Illinois Ave.
Dallas, Texas
75211-6599
214-333-8600
We are pleased to join our Vice President -of Instruction,
Dr. curtis Ivery, a former member of your Arkansas
administration and your friend, in inviting you to speak
at Mountain View College during the celebration of our
twenty fifth year ',of providing quality education.
We
know that Dr. Ivery has conveyed to you the fact that
Mountain View is the only public inst;it:ution of higher
education in the southwestern area of Dc,:.llas County, an
area that represents the face of America because of its
racial, ethnic and socio-economic diversity .
We know
that you are flooded with requests such as this, but as
fellow members of your generation and as people who still
believe in the dream of a better world, we urge you to
accept the invitation extended to you by Dr. Ivery to
speak at Mountain View College.
Thank you for your consideration and be5t of wishes in
your struggle to bring true and meaningful change to this
nation.
Sincerely,
of~f~
Larry Pool, Professor of History
?{~ ~.~
Dr. Kenneth G. Alfers, Professor of Hist,ory
Richard Means, Professor of History
,~~f4tf~-
Dallas County Community
College District
�r-,'.
Mountain View CoUege
~
IiiII
4849 W. Illinois Avenue
Dallas, Texas 75211-6599
~
8
b
Carol Rasco
The White House
1600 Pennsylvania Avenue
Washington, D. C. 20500
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Text
MarylandBeats W. ffi.;Virginia, lfl. j
lYeather
rodar. Partly sunny, mild.
'
1igh 77. Low 56. Wind 8-16 mph.
ilonday: Sunny. High 75.
..ow 55. Wind northwest 8-16 mph.
festerdar. Temp. range: 69-88.
\QI: N/A. Details'on Page B2.
I 17TH YEAR
, SUNDAY, SEPTEMBER 18, 1994 '
No. 287
ROSA LEE'S STORY
, PoVERTY AND SURVIVAL IN WASHINGTON'
I
n 1932. in the midst of the Great De
pression. Rosa Lee Cunningham's
,grandparents and pa,rents gave up
their North Carolina
sharecropping life for an
uncertain journey north.
Unable to survive on a
rural Maryland farm.
they abandoned the
countryside for the,
nation's capital.
Rosa Lee is the link
, between past and
present. between a world
that has disappeared and ,
the one that her children
and grandchildren face
today in Washington.
Her life spans a
half-century of hardship
, inblighted
neighborhoods not far
from the majestic '
buildings where policy-makers have
largely failed in' periodic efforts to break
the cycle of poverty that has'trapped her
and so many other Americans for so long;
Many of Rosa Lee's relatives. including
two of her eight chilcken. managed to
the obstacles they faced and
secure footholds in the mainstream of
American society; their
relatlvesuccesS makes .
her story all th~ more
importantio understand.
,'Rosa Lee'talks about
her experience in ways
that are som~times
discomfortiIig and
disturbing. She wants it
told anyway. "Maybe I
can help somebody not
follow in myfootsteps,..
she told Washington Post
reporter ~nnash in
giving hin:l permission to '
chronicle her life.
, Her stoIy~the
choices she had and the'
choices she made -'
" offers a ch3nce to
understand what statistics oilly suggest:
the interconnections of racism, poverty,
illiteracy. drug abuse and ermie,and why
these conditions often perSist from
generation to generation',J\':"::':"
overcom~
PHOTOCOPY'
PRESERVATION
�'!t sbeen rough. Lord knows, it's been rough!'
ROSA LEE, From Al
Lee's calls for help, whether it's to take in a grandchild suddenly left
homeless because his mother has gone to jail or to help Rosa Lee
with one of her many medical emergencies.
My interviews with Rosa Lee and her family grew out of a report
ing project exploring the interrelationships among racism, poverty,
illiteracy, drug use and crime, and why these problems sometimes
persist from generation to generation. r first met her in 1988 in the
D.C. jail, where she was serving seven months for selling heroin; a
jail counselor who was aware of my project had suggested that I talk
to her. "She was arrested for selling drugs to feed three of her grand
children; he told me.
As Rosa Lee answered my initial questions, it was apparent that
her life was an intricate tapestry, each thread reflecting issues that
have absorbed and frustrated experts on urban poverty for years.
She grew up poor on the fringes of Capitol Hill, the daughter of
North Carolina sharecroppers. At 13, after getting pregnant, she
dropped out of school without learning to read. At 16, she married to
get away from her mother. Within months, she moved back to her
mother's after her husband began to beat her. Most of the men she
met, including the five who fathered her children, came from the
same poor D.C. neighborhoods where she lived; some of her preg
nancies were the result of a desperate' but futile attempt to hold on to
the men.
She raised her children by herself, supporting them as best she
could by waitressing in nightclubs, selling drugs, shoplifting and
working as a prostitute. Uncertainty and instability became a fact of
everyday life: Since 1950, when Bobby was born, Rosa Lee has
moved 18 times, always within. the District of Columbia, twice to
shelters for the homeless. Since 1951, when she was flt'st arrested
for stealing, she has gone to jail i2 times, serving a total of five years
for theft or drug convictions. Now, some of her children were cycling
through the D.C. prison system, repeating the pattern set by their
mother.
The more I learned about Rosa Lee and her family, the more I felt
that spending time with her offered a cbance to get beyond the stere
otypical notions that seem to dominate discussions about poverty in
America. Some friends and colleagues doubted that I would learn
much that was new. But I had written extensively about the Dis
trict's poorest communities since the late 1960s and had found that I
learned the most by forgetting what I thought I knew and immersing
myself in the subject as deeply as I could.
Poverty is a phenomenon that has devastated Americans of all rac
es, in rural and urban communities, but it has disproportionately af·
fected black Americans living in the nation's inner cities. As someone
who grew up in a black middle-class family in Harlem in New.York,1
have always been perplexed by the differing outcomes of Mrican
Americans who had migrated in massive numbers in the flI'St baH of
this century from fields of rural poverty in the South to cities across
America, looking for factory jobs and a better life. How is it. I won
dered, that many children and grandchildren from migrant families
had prospered against considerable odds while some, like Rosa Lee,
had become mired in lives marked by persistent poverty, drug abuse,
petty and violent crime and periodic imprisonment?
All of them carried out of the South the debilitating history of ra
cial oppression and segregation. Once in the city, they still faced per
vasive racial barriers in employment, housing and education. Many
managed to' overcome these roadblocks, while others remained
locked in desperate circumstances. Why did Rosa Lee and six of her
children take one path, while her sons Alvin and Eric took another?
When I asked Rosa Lee for permission to spend time with her and
write about her life, she was eager to cooperate. "I'm not saying I'm
going to change; she told me. "But maybe I can help somebody not
follow in my footsteps if they read my life story. There have been
some good times. Some real good times. But it's also been rough.
Lord knows, it's been rough!"
I told her I was skeptical that her story would reach those who
might follow in her footsteps.
"That's all right; she said. "You never know who you may help.
You write it like I tell it.»
Her children were more wary, but they eventually agreed to talk
with me too. So in the fall of 1990, two years after we first met, I be
gan to make regular visits to her apartment. It was the beginning of
a relationship unlike any other in my 27 years as a Washington Post
reporter.
.
..:r!l:n:C:lml
A Survival Network
Lee and are sitting on a
her
room on this
trying to decide what to do.
warm
Rosaleft Sept. 5Imorning in 1990, couch inback toliving bedroom,Bob
by has
us alone to talk, ratty has gone
her
and
Ducky is still asleep on the other sofa. I had planned to take Rosa Lee
to the methadone clinic and then to a restaurant so I can interview
her for several hours in relative quiet. Rosa Lee has other ideas.
She wants to go to the Pepco office so she can talk to someone
about restoring the electricity; it's been off since June 12 because
Rosa Lee has fallen behind in her payments. Patty has been cooking
meals on a neighbor's stove, and she's tired of bringing the food back
and forth. And now that summer's almost over, it will be getting dark
sooner and they will need the lamps again.
Rosa Lee pulls from her purse a set of tattered, rolled-up papers,
slips off the rubber band and leafs through them. They are her most
important papers-her apartment lease, medical records, Medicaid
documents and bills of all sorts. Rosa Lee hands me the pile. I fmd
the electric bill, and we drive to the Pepco office on Martin Luther
King Jr. Avenue SE.
,
r' r
:NIAlV
. "
,..
~
~
.J
Rosa Lee is eager for me to come with her. My suit and tie, she
believes, might give her greater authority with the bureaucracy. I
tell her that I'm a reporter and can't get involved in her;affairs. But I
see from her puzzled expression that she doesn't understand what
I'm talking about.
.
.
It's hard to imagine Rosa Lee having trouble getting someone's at- :.
tention if she wants to. She has learned how to bring smiles or tears ..
to her long, handsome face whenever it's necessary. Her .hips are'
broader than they once were, but her 145 pounds settle easily on her
5-foot-l-inch frame, and she likes to boast that her narrow waist still
turns heads. Her hands are f!I'm and strong, the result of washing
countless baskets of laundry on a scrub board when she was a child.
I wait in my car while she goes inside. Half an hour later, she
comes out with a Pepco employee. Rosa Lee has told her that a "Mr.
Dash" is waiting outside. And the somewhat exasperated clerk tells
me that Rosa Lee doesn't understand the bill. The clerk explains the
situation: Rosa Lee owed $528 when the electricity was cut off. She
had applied for emergency aid, and the D.C. Emergency Energy Of
fice had paid $150 and the D.C. Department of Human Services had ,
paid $238, but Rosa Lee needed to pay half of the remaining $140 to:
get the electricity back on.
.
Rosa Lee says she doesn't have $70. We drive downtown to the
D.C. Energy Office, but an official there says Rosa Lee isn't eligible
for another emergency grant until 1991.
Over lunch at a Chinese restaurant, another crisis emerges. Rosa :
Lee needs a refill for medication she's been taking and slie can't fmd .
her Medicaid identification card, which allows her to pay 50cetlts for '.
a prescription.
•
Suddenly, she begins to cry.
Through her tears, she tells me that she has the AIDS virus; HIY.
So do Patty and Bobby. Rosa Lee says she doesn't remember exactly
when she found out":'six months ago, maybe longer. So far, she says,
none of them has tbe disease.
She doesn't know for certain how they got the virus. But they fit
the profile of those most at risk for my: All three have shared nee
dles while injecting heroin. And all three have engaged in prostitu
tion.
I
"Why didn't you tell me you were HIY-positiver I ask.,
"I was afraid to teD you; she says. "Because I felt you wouldu't
come around me:
No, I assure her, I have no intention of staying away .. She seems
relieved.
Sfveral questions pop into my head: Is she still shooting heroin?
Are Patty and Bobby taking precautions with their sex partners? But
Rosa Lee is so wound up, so emotional that J decide to save them for
another day.
We drive to a pharmacy in Northeast, where the pharmacist
knows her and has a record of her Medicaid card. He agrees to fill
Rosa Lee's prescription for AZT, a medication that sometimes delays
the onset of AIDS. A monthly supply of 100 pills costs $147.95, so
�I,'
occasional "speedbaU; a mixture of heroin and cocaine that she lets
Patty inject into her hand. "The dope [heroin) I don't need," she says.
"It's that 'caine. The 'caine gives you a rush. It stays with you a little
while, and it makes you want more. You want that rush again. U I go ,
get a $10 bag of 'caine and shoot it all by itself, ZOOM!"
She says these infrequent lapses don't make her an addict, but I
don't think she's being candid with herself. For the first time sirice I
became a regular visitor six weeks ago, her eyelids have drooped no
ticeably during our conversations and she constantly'rubs the backs
of her swaDen hands. When I ask her about these symptoms, she in
sists she hasn't gone back to fuD-time drug use.
By now, Rosa Lee is comfortable with me, putting up with my tape
recorder and agreeing to let a Washington Post photographer, Lu
cian Perkins, accompany me on some of my visits. Her background
could not be more different from mine: When Rosa Lee was strug
gling to take care of eight children in the early 19605, I was a teen
ager attending high school in Manhattan. When she was serving her
flIst prison term for theft in 1966, I was earning a coUege degree at
Howard University and working for The Post as an intern. When she
was seUing heroin on the streets of Northwest Washington in the
mid-1970s, I was writing about the devastating effects of heroin traf·
ficking on some of those same streets.
She doesn't understand why I ask so many questions about her
childhood and her family, but she does her best to remember details
that are important to me but not to her. She knows that her grand
parents, Thadeous and Lugenia Lawrence, picked cotton in North
. Carolina before coming north sometime in the mid·1930s, but she
doesn't know much else.
• In fact, she has no keepsakes, no mementos, no record of her par
ents or her grandparents-except for a single black-and·white photo
graph of her mother and grandmother that somehow has survived
over the years. When I first saw it, it was lying loose atop a bureau in
Rosa Lee's bedroom, unframed and unprotected. its edges tom, its
emulsion cracking.
Her mother, Rosetta Lawrence Wright, dominates the photo,
much as she seems to have dominated Rosa Lee in her youth. Roset
ta is sitting on a chair that is too smaU for her large body, dressed in
what appears to be a white unifornl, probably Something she wore in
her job as a domestic worker. She dwarfs her own mother, Lugenia,
who is sitting in an overstuffed flower-print chair that seems to swal
low her slight, almost frail body.
The memory of her mother, who died.in 1979, stirs feelings of an
ger in Rosa Lee, not tenderness. There was the time, Rosa Lee re
members, when her mother accused her of stealing a welfare check
out of the mailbox. Rosa Lee was about 9. She ran to her grandmoth
er's house, a block away. "She came around to my grandmother's
house and whupped me. I mean reaUy whupped me! ... The next
morning the mailman brought the check. My mother didn't say noth
ing. She just got mad at the mailman:
Most of Rosetta's other children don't share Rosa Lee's view of
their mother. They remember her as a woman working hard to keep
· she coUld not possibly afford them without Medicaid. She shares
· them with Patty, who has. let her own Medicaid eligibility lapse.
, When we fmaUy return to Rosa Lee's apartment late in the after
, noon, she asks me to look through her papers to see if she is behind
in her rent. I realize that she is drawing me into her survival net
work, but I offer to sort the thick sheaf of papers at home.
" The next fiight, I return them, divided into oversized envelopes
·with bold, printed capital letters to help Rosa Lee recognize the
words~ WELFARE, MEDICAL, RENT, PATTY, BIRTH CERTlFI
, CATES, and so on.
. Patty, Rosa Lee and I sit on the bed in Rosa Lee's bedroom. A cru
cifllds on a table next to her bed; often, when she is upset, she holds
the crucifix close to her chest as she prays for relief or forgiveness.
. Patty points to an envelope marked RICHARD. "What does that
say?'"'
, "Don't you know your own brother's name?'" Rosa Lee says in dis
belief.
, Patty shrugs. Her reading skiUs, it tUrns out, are no better than
Rosa Lee's.
They decide to draw up a plan to straighten out their tangled fi
nances, and they ask me to write it down. Patty, who hasn't received
welfare or Medicaid benefits for eight years, will reapply_ Rosa Lee's
situation is more complicated. She has been receiving $350 a month
in welfare and $280 a month in food stamps for herself and two of
her grandchildren; now that her daughter is out of jail and caring for
her own children, Rosa Lee will lose some of that income. So she's
,going to fwd out if she's eligible for other assistance.
It sounds good, but it's impossible to ignore this fact: Welfare pay
ments and food stamps don't begin to account for all the money that
, comes and goes in the apartment.
·1:
f.'
I
lj":I!n'I~
,. ", I
;Jaw.
The Tom Photo
"M "Why is it IRosa Lee says one daynoindrugs?'" October 1990.
r. Dash,"
early
can't find a place with
·,
She is standing in her living room, her hands spread in a gesture of
frustration and resignation, her voice competing with the sound of an
afternoon soap opera on television.
Within a week of moving into a federaUy subsidized housing com
plex in Washington Highlands in March 1990, Rosa Lee ran into sev
· era! drug dealers she had known for years. As broken ties were re
pewed, heroin and cocaine began to flow into her newly renovated
'. apartment, just as they had flowed into her apartment on Blaine
Street NE in 1989 and into various apartments on Clifton Street NW
for years before that_
In recent months, she teUs me, she has cut back her drug use to an
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4.
her family together under difficult conditions. "She taught me, 'If you .
want something, work for it!' " said Jay Roland Wright, one of Rosa
Lee's seven brothers. "I've always lived by that."
Jay Wright is 15 years younger than Rosa Lee; her memories go
back before he was born. As a little girl, she says, she became devot·
ed to her father, Earl Wright, an alcoholic who died when Rosa Lee
was 12. Her father doted on her, but he also took his fists to Rosetta,
much as Rosetta took hers to Rosa Lee. "He'd go upside her head,
bam, all the time. He'd be drunk. She'd take it dead out on me. I nev
er did nothing. I was too scared:
We look again at the photo. Rosa Lee has no idea when it was tak·
en or why she has it. She knows only that her mother and grand
mother are sitting on the screened-in back porch of her grandmoth
er's house at 204 17th St. NE and that her grandmother bought the
house in the early 19605.
This seems curious. Buying property is a sign of prosperity, not
poverty. How had Lugenia Lawrence scraped together enough mon
ey to become a homeowner? And why, two generations later, was
her granddaughter Rosa Lee a permanent resident of public housing,
with drug dealers never far from her door?
tr.r!u.JlfIim~
Sharecropping Days
~right
Rosa Lee's older
He
the family his
tonan.
Ben have toisask Ben," Rosa Leebrother.say toalso isquestions about
"You
would
my
her parents and grandparents: "Ben is the one who knows about
that:
For years Ben had organized family reunions, large gatherings
that brought together descendants of the Lawrences and the
Wrights, four generations that trace their roots to fertile farmland
along the northern bank of the Roanoke River in eastern North Caro
lina and the tenant sharecropping system that served as the back
bone of Southern agriculture until World War II.
The reunions brought together relatives from up and down the
East Coast. Branches of the family have put down roots in New Jer
sey, Philadelphia as well as Washington, and many have secured a
foothold in working-class and middle-class communities. Rosa Lee
had little in common with these more successful relatives, so after
attending two reunions in the 19605. she stopped going.
She kept in touch with Ben, but their relationship had soured in re
cent years. When I asked Rosa Lee why, she was uncharactensticaUy
vague, hinting that it was Ben's fault. Later, Ben told me that there
was nothing vague about their faUing-out: He told her that he would
never set foot in her apartment as long as she was dealing drugs.
See ROSA LEE, A34, CoL 1
l
'I
'.
.!'
�She hafi jw;ione memento
of nermother
ROSA LEE, From AS3
, When Rosa Lee was jailed ill New York on a theft' charge in 1964,
'Ben bailed her out. But when she started shooting heroin, he drew
,the line. Ben's world~good job" steady income, retirement bene
fits-had no place for Rosa Lee.
So when Rosa Lee and I knock on the door of a trailer at the D,C.
Department of Public Works storage yard,where Ben worl!M, I'm
not sure what to expect. It is a raw, cold day, and I can feel the bite
of the wind as I explain my project to Ben. He listens, looks at Rosa
Lee, and then invites us to come inside to talk during his lunch break.
Over the next severa!' months, Ben and others provide bits and
pieces of the family history .
. Ben Wright was Rosetta and Earl Wright's first child, born ,on the
first,day of summer in 1932, the year the Great Depression forever
changed the lives of the Lawrences and the Wrights. Rosetta was 15
at the time, and living with Lugenia and Thadeous on the cotton farm
where they worked as sharecroppers, about four miles south of the
market town of Rich Square, N.C.
Thadeous was the second generation of Lawrences to sharecrop
on the property, known as the Bishop and Powell plantation. By the
time Rosetta became a teenager, she had already helped with several
cotton crops. The countless hours she spent in the fields changed her
body and shaped her soul, and taught her the importance of discipline
and stamina. She developed quick, powerful arms and a tough, stern
demeanor-a younger version of the grim, brooding woman in the
'
photograph in Rosa Lee's bedroom.
There is no available record on the Lawrence ·share" in 1932, no
way to know whether the family earned enough to repay the white
landowner for the money be had advanced them over the course of
the year. According to family lore, Thadeous had a hidden source of
income that kept the family 'from falling into debt: a moonshine still
that he kept going even after the family moved up north. "My grand
mother said my grandfather did a lot of bootlegging; said Ben.
Many sharecroppers, however, remained perpetually in debt, unable,
, to make their share, yoked to the same landowner year after year. Most'
could not read or write, add or subtract, so they had no way to challenge;
the landowner's tally at harvest time. It was a harsh life, made even:
hlirsher by the effect the Depression was having on the cotton farmsi
around Rich Square. The plice of cotton dropped from $500 a bale to:
$25 a bale. Joe Purvis, who owned the land where the Lawrences were;
fanning, was forced to close down the farm after the 1932 harvest. So,
when a Maryland tobacco fanner came through Rich Square looking for;
sharecroppers, the Lawrences decided to leave their friends and rela-'
~es and the land they knew sO well.
i;
.: .They packed their meager belongings.and headed with their four;
children to Maddox's farm in St. Mary's County, Md. Rosetta, her in-'
'failt son Ben and her new husband, Earl Wright, joined the Law-'
, rences on the journey north.
, Benand his brother, Joe Louis Wright, vividly remember the sto-,
ries that his mother and grandmother told them about their harsh life
in Southern Maryland. They had almost no money. Meals frequen~
consisted of whatever they could pick or trap. "They were I'..ating a;
lot of muskrat and watercresst Joe Louis said. Watercress grew,
abundantly in the clear springs nearby, and muskrat was ther. a popu~
Jar Southern Maryland dish that the family never got use<'. to. "M;',
mother would say, if she ever got aj<ib and made any money, she waS,
never going to eat another muskrat; Joe Louis said. "Had to eat it;)
.\Jecause that's all they could trap."
, '. "
After the 1935 tobacco harvest, like thousands of other shlirecro '
'pers during the 1930s and 19405, Rosetta and Earl Wright gave up
'iWallife and headed for the city. The Lawrences stayed behind with
.3'-year-old Ben, afraid that the boy might starve if his parents
cOuldn't find work in Washington. Within a year, they too moved tq
the District. Their sharecropping days were over.
" ,.':f,
$egre.gated City
W
.:~
ashington in the 1930s was not a land of opportunity for black,
migrants from the South, especially
sharecroppers. It waS
a segregated city, but within the black community was a
. lished. and educated middle class that traced its roots t
s1ayes. who stayed here after the Civil Wi.e. Over the years, these lO;
cal black families had built an extensive network of churc~es~J
schools, theaters and other institutions. It wasn't a closed SOCIety,
, . but neither did it reach out to embrace the rural migrants.
'
, " Some of the more fortunate newcomers had friends or family
,to help them through the resettlement. Others, like the Lawr
and Wrights, were on,their own. Finding a job, any job, was a
lenge. Most of the government jobs then open to blacks-the
and messengers and cafeteria workers-went to middle-dass b
who had connections or education. "Those jobs were very com
ti~ .. Portia James, the chief researcher at the AnacOstia Muse~4
S31d when lasked ber to put the family's history into pers~~
poor
PHOTOCOPY
PRESERVATION
�"['hose weren't considered regular working-dass jobs. Those were
considered highly desirable jobs."
Like hundreds of other rural black women who migrated to Wash
ington, Rosetta became a domestic worker. Earl found work as a ce
ment finisher for a paving company. This fit a familiar pattern, ac
cording to Elizabeth Clark-Lewis, a Howard University professor
who has interviewed domestic workers in her study of the period.
"['he middle class was not standing waiting for these people with
open arms," Clark-Lewis said. "Very few men could come in and get
a govemment.jOD.~ For most poor, rural women. she said,"domestic
work was the reality. ~
Thadeous and Lugenia found work too, but it was' Thadeous's
bootlegging that kept the family afloat. He would disappear for sev
eral months· at a time; only Iater'did Ben learn that he was going to
North Carolina to tend the still.
.
. , Rosetta arid Earl settled in the neighborhood just north of the Navy
Yard, within a mile of the Capitol, renting a series of·houses that had
'outdoor toiletS and no electricity. Rosa Lee remembers the smell of the
kerosene Iamps,theylighted each night. As theJamily grew-Rosetta
gave birth to 22 diildren, 11 of whom died before reaching adulthOOcl Rosa Lee became accustomed to bedrooms crammed with too manY
people and living rooms with no place for private conversations..' , .
Ben has no way to prove it, but he's certain that Thadeous's moon
shine sales provided the money that enabled Thadeous and Lugenia
to become'homeOwners. The house in the photo, the one on 17th
Street NE. turned out to be the third of three houses owned by the'
Lawrence family.
.
.
Tbadeous and Lugenia bought their first property, a decaying twoo storY,.~e house on the outskirts of Capitol Hill, for $1,400
in 1949: FOll!: years later, they bought a second house nearby ·for
. $8,OOOIThe Seller.gave them a mortgage so they could make the
, '\, ,purChase~:l:~\~·~t~:tif. '.,\.. .: .>' ".''' ,,':' ~;: <;.;".;, -":.~. -.' • ",
',.
";:. ,. ·Thefiis( bOUSe went to Rosetta; two years later, however{':the .
.:"XcitY candeniDed.the property and Rosetta's family had to move.·,,~;~;,·,
;,';'- ". ,"TbadeOiiSdiiida few years later. Lugenia lived in the second
;{r<:" ,:untilthi!icity:claiined. it for the SouthwescExpressway
$U;500iIii:Ompensation. She bought the third hOuse,
died in 1985;-she owned it free of debt. An appraiser
,.'
value at $56,000. .
..
", .. ·f.~.
In her Will, Lugenia directed that the house be sold and the pro:
reeds divided among five grandchildren. Rosa Lee was no~ 3J!,l0ng
. them. I asked her why. "Because I was an addict when she died, she
said,. and Lugenia was determined not to squander this asset that had
taken a lifetime to build.
.
The house wasn't sold immediately. Instead, the grandchildren de
cided to use it as collateral to borrow $55,000, whic~ was divided
among the five grandchildren after expenses. That l;l3tisfied the con
ditions of the' will, and left one granddaughter With the house, a
monthly mortgage payment and a place to live.
".
But it didn't work out as planned. Within a few months, the grand
daughter fell behind on the mortgage payments. In late 1987. Lawan
Wright Rosa Lee's youngest sister. moved in after serving a two
month ~ntence for drug dealing. For the next two months, Lawan
says, she used the house to sell crack.
The mortgage holders decided to foreclose. So in February 1988,
Lugenia Lawrence's house passed out of the famil.y's hands for good.
0
Emergency
t is Wednesda~ afternoon, Nov. 28, 1990, and Rosa Lee i.s
stretched out on a bed in emergency room 63 at Howard Umversl
ty Hospital, telling me about the seizure·that has landed her there.
Actually, she's not telling me much, because she blacked out and she
can't remember exactly what happened.
The room is cool, and she has pulled the blank~ts up to her chest,
exposing only the shoulders of her white hospItal gown and her
. . .
drawn, tired face. She looks awful.
This is her second seizure in two days, her third m SIX months.
The doctors don't know the cause of the seizure~, so th~y have been
putting Rosa Lee through a series of tests, which dOD t bother her
nearly as much as the telephone calls from Patty and Ducky.to s;t~e
minor squabbles. "Why are they worrying me, Mr. Dash. while I m m
.
the hospital?" she says.
The doctors suspect that Rosa Lee's drug use has something to do
with triggering the seizures. On Monday afternoon, Rosa Lee and
Patty shared a "billy" of heroin-a sma1l bag that seDs for about $20.
Inunediately afterward, she had a mild ~e that sent her to the
emergency room but didn't require a hospital stay. Still, she seemed
shaken enough by the experience that I thought she would stay away
from heroin for a while.
' .
.
'.
Not shaken enough.
On Tuesday afternoon, she and Patty boug~t another herom billy
at an "ollin' joint" for heroin addicts on Georgta Avenue: Patty gave
herself a hit, then Rosa Lee. As they went outSIde. to bail a taxi, Rosa
Lee suddenly went limp and her eyes roDed back m her head.
I
,
Pa~ty struggled to keep Rosa Lee from falling, and heard a man ".
shoutmg from across the street. It was Alvin her brother. He was on .-< :,' ,
duty, driving a Metrobus north. on Geor~ Avenue, when he saw ~.' "
Patty trying to h~ld R~ Lee. ,:'Get Momma to .the hospital: he
yelled from the driver's wmdow of his packed bus•.. :,.;' '.' ,. .',
,.' .
Patty, still high from the heroin, maneuvered RoSa'Lee into a taxi:
At the hospital, Rosa Lee's doct!)r; Winston Frederick, was furious.
.,
"If you suffer another one of these seizures. we' may not be able to '/.(j~.
bring yon hack," she remembers·himsaying./:
>;.0
.•. :;:)"
When she goes home on Dec. 10, she vows to herself that her her, ., M'
oin days are over. But home is still
same apartment in
',
l
ton Highlands in Southeast, where
• Patty
much of their time in pursuit of
Rosa Lee 1;.
,;",',
"'
\r,
"B oy.my aonnight," Rosa morning 1990""for ainto the"the seat""','"".'
what
Lee says, settling
front
of
Christmas
trip to
~;
car
metha~".
done clinic.
. ..• " " ..
Recovering drug addicts don't get holidays off. If Rosa Lee wantS.:. ~<
her daily dose of methadone, she still has to make the cross-town' ~-:
trek from her apartment in Southeast to the clinic on N Street NE, .
not far from the Capito\. On the best of days, it's a 3~minute trip r:
Quiring two buses; the holiday bus schedule makes It an uncertain
journey that can last more than an hour.. She's still weak from her
hospital stay, so I have offered her a ride;';;; . '
When I arrive at 8:30 a.m., Rosa
is
one else is asleep, including her gnmdlchilldR~n.
waitingJlnder
"It'
brolight'home $270irom
$150 to Rosa.LeeJor·his share
ties and left to buy crack with the
, '
",
Ducky owed Patty $20, so Rosa Lee gaye it to
off a
reaction that lasted all night long. Patty spent the $20 on crack,
it and wanted more. She begged Rosa Lee for another $20, . .'
"I just·gave her $10," Rosa Lee says"::'".d.. 't~. ,'"
.
As soon as the $10 was gone, Patty was pleading for more. Instead
of saying no, Rosa Lee asked Patty to buy her so~e ice cream and
handed over another $20.
...
'.
A few hours later, Patty returned with one of her. regular
"tricks"-men who trade her drugs for sex. Selling sex proVides Pat
ty with a steady source of .drugs, and oth~r things seem secondary,
including the risk of sprea~g the AIDS Vl11lS. • •
,
The "trick" prepared a nux of powdered cocame m Rosa ~ s bed- .
room gave himself a hit and offered some to Rosa Lee. She saJd no. "I
didn't even hesitate, Mr. Dash," she says. "I was so proud of myself:
After Patty left, Rosa Lee fell asleep with the TV set ?n. A~ut 2
a.m.• she heard someone banging on the door. It was Patty s ~yfriend,
Howard. demanding to know where Patty was. Rosa Lee didn t know.
At 6 a.m., Ducky woke Rosa Lee to say that Howard and Patty
were fighting in the hallway. Ducky pulled Patty, strung out from
smoking crack and drinking liquor, into Rosa Lee's apartment. Pat
ty's left forearm was bleeding. She told Rosa Lee that she had cut
herself with a knife during an argument in Howard's apartment.
Two paramedics arrived and bandaged Patty's arm. Moaning that she
still loved Howard, she cried herself to sleep as Rosa Lee held. her.
:
As I drop Rosa Lee off at her apartment, I try not to think about:
what awaits her inside.
"Merry Christmas, Rosa Lee," I say softly as she opens the car :
door. "I'll see you next week."
.
.
.
"Merry Christmas, Mr. Dash."
About This Series
his series of articles grew out of Washington Post
Leon
of rac
Terpoverty,Dash's reporting on the interrelationshipsreport
ism,
illiteracy, drug use and crime, and why these
problems sometimes persist from generation to generation.
The series was edited by Steve Luxenberg, The Post's assis
tant managing editor for special projects. The articles will be
published daily through Sunday, Sept. 25, and The Post wel
comes readers' written comments or phope calls. If you wish
to leave a recorded comment, please call Post-Haste at
334-9000, Category 4646.
r
__
___
h~
~
________________________________________________________________________________________
PHOTOCOPY
PRESERVATION
~
__________
~
�i
,.1
Stealing Became
.A JTizy of Life \,,'
For Rosa Lee
osa Lee Cunningham guided her
10-year-old grandson through the narrow .
aisles o.f the Oxon am thrift shop, past the
crowded rack&' of secondhand pants'and
shirts, stopping finally at the row of
children's jackets and winter coats.
'" :
The boy picked out a mock flight jacket, with a big, ",
number on the back and a price tag stapled to the. . .
collar.
'.",
"If you want it: Rosa Lee said, "then you're going
to have to help me getit.n
. '. "
·Okay, grandmama; the boy said nervously. "But do
. it in a way that I won't get caught. n
"
Like a skilled teacher instructing a new student, the
54-year-old Rosa Lee told the boy what to do.
,'
. "Pretend you're trying it on. Don't look up! Don't look,
around! Don't laugh like it's some kind of joke! Just put
it on. Let Grandma see how you look."
.
The boy slipped off his old coat and put on the new '
one. It was too big. Rosa Lee whispered,"Now put,the
other one back on, over it." She pushed down the new
jacket's collar so that it was hidden.
"What do I do nowi'" the boy asked.
"Just walk on out the door: Rosa Lee said. "It's
Your coat."
Four days later, Rosa Lee is recounting this episode,
for me, re-creating the dialogue by changing her voice
to distinguish between herself and her grandson'.!t is
'. January 1991, and it has been five months since she
agreed to let me spend time with her as part of a
R
.--~,-
.. - - ,
THE RIC~f P~iCE:
,.;/ntkaSt Wa:;ii~ngtot!fast100d restaurant in March 1992,
RosaJ-4punn~nghO,m ': . MY: s,on lJ#!ly,,{iisagreil over what price to charge for shirts and
sweaters DUcky had stOiert Stealing has ~~: a way to supplement the family's income.
reporting project on how ,sev~al generations of one.
, Washington family have lived with poverty. crime arid
drug abuse.
.:
"
By now, I have spent enough time with her that her
shoplifting exploits no longer.surprise me. One day
before Christmali, Rosa Lee was searching for
;
something in a large shopping bag in her bedroom and
. dumped the contents onto the bed. Out spilled dozens '
of bottles,of expensive men's colague and women's
perfume, as well as leather gloves with their $60 price
i
tags still attached. She leaves the tags on when she '
i;eUs the goods to prove .that the merchandise is new.
"Did you get all this in one trip?" I ask.
''Oh, no," she says. "This is a couple of weeks'
worth."
In Rosa Lee's younger years especially, shoplifting
was,a major source of income. sUpplementing her
welfare payments aiid the money she made during 15
years of waitressing at various nightclubs. She had eight
,
See ROSA LEE, AS. CoLI
-------_._---- .._.,
PHOTOCOPY
PRESERVATiON
�ROSA LEE, From Ai
children to feed and clothe; stealing, she says, helped her to survive.
Later on, when she became a heroin addict in the mid-1970s, she paid
for her drug habit through her shoplifting.
She stole from clothing stores, drugstores, grocery stores, stuffing
the items inside the torn liner of her winter coat or slipping them in
to the oversized black leather purse that she carries wherever she
goes. Her favorite targets' were the department stores. One of her
older brothers, Joe Louis Wright, joked with me one day that Rosa
Lee "owned a piece" of Hecht's and had put Lansburgh's out of busi-,
ness. "Man, she would get coats, silk dressest he recalled. ·She got
me a mohair suit. Black. Three-piece. I don't know how the hell she'd
get them out of there."'
,.
Her stealing has caused divisions and hard feelings in her family,
and is one reason why Rosa Lee has strained relationships with sev
eral of her brothers and sisters. They see Rosa Lee's stealing as an'
extreme and unjustified reaction to their impoverished upbringing.
Two of her six sons, Alvin and Eric, always have refused to partici
pate in any of their mother's illegal activities; today, they are the on
ly two of Rosa Lee's eight children who don't have prisop records.
ROsa Lee has served eight short prison terins for various kinds of
stealing during the past 40 years, dating to the early 1950s. Her
longest stay was eight months for trying to steal a fur coat from a
Maryland department store in 1965. She says that she went to pris
on rehabilitation programs each time but that none had much of an
effect on her. "I attended those programs so it would look good on
my record when I went before the parole board," she says.
. Nothing seems to deter her from shoplifting, not even the specter
of another jail term. On the day that she stole her grandson's coat,
she was awaiting sentencing in D.C. Superior Court after pleading
guilty in November 1990 to stealing bedsheets from the downtown
Hecht's store.
"I'm just trying to survive: she says.
ADay in Court
R
osa Lee had choSen her clothes carefully when she appeared two
months earlier before Commissioner John Treanor on Nov. 13,
1990. She wanted to look as poor as possible to draw his sympathy.
She had worn an ill-fitting winter coat, gray wool overalls and a white
wool hat pulled back to show her graying hair. She had removed her UJr
per dental plate, giving her a toothless look when she smiled. "My hom
ey look; she ca1led it. "No lipstick. No earrings. No nothing!"
,
Her lawyer's statements that day matched her downtrodden look.
Rosa Lee's life was a mess, he told Treanor. She was addicted to heruin,
a habit she had developed in 1975. She had the HIV virus. She was car
ing for three grandchildren because their mother was in jail.
, Rosa Lee told Treanor that she was trying hard to turn herself
around. She was taking methadone every day to control her heroin
addiction and bad turned again to the church. "I got baptized Sunday,
me and my three grandchildren; she said, her voice breaking. "And
I'm asking you from the bottom of my heart, give me a chance to
prove that I'm taking my baptize seriously, 'cause I know I might not
have much longer."
Tears ran down her cheeks. "I'm asking you for a chance, please,"
she begged Treanor. "I know I have a long record."
Rosa Lee was stretching the truth. Yes, she had been baptized,
and yes, she was taking methadone. But no, she wasn't caring for her
grandchildren alone. Their mother's jail term had ended several
months earlier, and she had returned to Rosa Lee's two-bedroom
apartment to take care of the children, with help from Rosa Lee.
Treanor hadn't seemed moved by Rosa Lee's tearful performance.
He glowered at her, and Rosa Lee braced for the lecture she knew
was coming. Both had played these roles before.
''Every time you pomp yourself full of drugs and spend money to
do it," he said,"you're stealing from your grandchildren. You're
stealing food from their plates, clothes from their backs, and you're
certainly jeopardizing their future. You're going to be one of the
youngest dead grandmothers in town. And you're going to have
three. children that will be put up for adoption or going out to some
home or Some junior village or someplace."
That bad been Rosa Lee's opening. "Can I prove to you that my
life has changed?"
,
"yeah, you can prove it to me, very simply," Treanor answered.
"You can stay away from dope. Now I'll make a bargain with you. ...
You come back here the end ofJarlllary and tell me wbat you've been
PHOTOCOPY
PRESERVATION
�"
·.•1' doing; and ilien we'll think about it. But you're looking at jail time.
(Vou're looking at a cemetery."
.'
.
'1 Rosa Lee had won. Stay out of trouble until january, Treanor had
j suggested, and she would stay out of jail.
.
i Rosa Lee came over to me, her cheeks still tear-stained but her
.
1face aglow.
"Was I good?" she asked.
"Yeah,n I said, startled at her boldness.
"Thank you; she said, smiling.
.Trans/ormation
W
hen she returns for sentencing on jan. 22,1991, a transformed
Rosa Lee stands before Treanor. She looks good. She has a
clean report from ,the methadone clinic. She seems to have done ev
; erything Treanor has asked.'
.
She usually dresses well, but I think she has outdone herself today:
• two-piece, white-and-gray cotton knit suit, tan leather boots, tan
i pocketbook..,
.
, "What would you like to say, Mrs. Cunningham?" Treanor says.
"Well, your honor, I know I haven't been a good person. I know it,n
she begins. '
'
Treanor cuts her off. His demeanor is softer, his words more sympa'
thetic than ili November. "Wait a minute, now. Why do you say that? ...
Vou're taking care of those three grandchildreri, isn't that right?",
"Yeli,sir,n Rosa Lee says, keeping up the pretense.
"AIL right; he says. "Now you've raised one family, and now you
have another one."
'
"Yes,sir,n she says.
"Which is really too much to ask of anybody•. SO I don't think you
should sell yourself short. You're doing the Lord's work. Your daugh
te~s in jail for drugs, righan'
.
"Yes, sir," Rosa Lee says:
",
..
.• ·."And you ~ve or haveh3d a bad drug problem yourself."
, ':',"";'7\'es', sir.~·,-·
_.",'
.
'~;.1;,:( .
."
. ~'Then' Treanor launches into another lecture' about drugs. "He
,doesn't ask Rosa Lee why she steals. "Vou steal to support your hah- ,
'; it," he says.·"It's as plain as the nose.on your face.~:"
,
But it isn't that plain. Rosa Lee began stealing long before she be
:came a drug addict.
'..,:' •
'
Finally; Treanor announces his.decision: no j;iil.Instead, he gives her
a suspeilded sentence and ooe year of probation with diug counseling.
"Now,.don't you come back here," he says: . 1':,
'·}:>Ai·~·
"
".,-,,
R
.Lunch Mon{ff
Osa Lee sometimes puts on a public mask, the way she wants the
world to see her. She fudges a little, omits a little there, even when
she is trying to be candid about her behavior. By her aecount, her steal
ing started when she was a teenager. It was an older brother, Ben
Wright, Who told rile tPat Rosa Lee's stealing started when she was 9
years old. Her target: the lunch money that her fourth-grade classmates
at the District's Giddings Elementary School kept in their desks.
"jesus,. Ben!" Rosa Lee shouts when I ask her about it.
':'What's the matter?" I say. "You said I could interview Ben."
It is a late afternoon in january, not long after her court appear
ance. We are talking in my car, which is parked outside Rosa Lee's
apartment. We watch the teenage crack dealers come and go, mak
ing their rounds of the low-income housing complex in Washington
Highlands, a Southeast Washington neighborhood near the D.C.
Prince George's County line. Rosa Lee's grandson and granddaugh
ter are playing nearby on a patch of dirt where the grass has been
worn away. The sun is beginning to sink behind the buildings as she
tells me about her first ·theft.
,
The year was 1946, and Giddings's imposing red-brick building at
Third and Gstreets SE was a bustling part of the District's then-segre
gated education system. The school, now an adult. education center;
served black children living in Capitol Hill neighborhoods; some, like Ro
sa Lee, came from poor sharecropping families who had moved to
Washington during the Depression, and they did not have the new·
clothes and spending money that their better-off classmates did.
Rosa Lee's father, Earl Wright, was an alcoholic who worked for a
paving contractor until drinking became the primary activity in his
life. He died of liver disea~ just after Rosa Lee turned 12. Her moth
er, R?setta Lawrenc7 Wnght, brought in most of the family's money,
working as a dom7s~c 0!l Capi~ol Hill during the day and selling din
ners from the family s kitchen In the evening always for cash so the
~elf~e officials woul~'t know about the additional income. Tbey
lived In a. rented hou~ In the 800 block of Third Street SE thathad
no electriCity and no mdoor toilets
.
Other ~Is came to school with change to' iiuy' .,;r:awUi~tw;;~·~
penny-a-piece cookies that the Giddings teachers sold with the free
milk at lunch. Rosa Lee's family was too poor to spare.even a few
pennies. She knew it was wrong to steal from her classmates' desks,
she says. But she couldn't stand being poor, either.
Rosa Lee soon found that she had plenty of opportunities to steal,
if she were daring enough. Selling the Afro-American newspaper .
. door-to-door on Tuesday and Thursday evenings during the summer
of 1948, when she was 11, gave her a chance to slip into neighbor
hood row houses and rifle through the pocketbooks that women often
left on their dining room tables. Washington was a safer place in
those days, and Rosa Lee discovered that many families would leave
their front screen doors unlatched while they chatted in their back
yards, trying to cool off on hot summer rughts.
.
In the fall, she found a new source of money. the coatrooro at Mount
Joy Baptist Church, a nearby chUrch where her family had worshiped for
many years. She had started ushering during Sunday services and was.
assigned to help in the coatroom. She noticed congregation members of
ten left money in their coat pockets. "1 felt like if they wanted (the mon
ey], they wouldn't have left it in their damn pocket," she said.
'
Rosa Lee said she Would wait until the "singing and praying" started
before going to the racks of coats, patting the pockets and listeniJ)g for
the jingle of coins. Once in a great while she would find dollar bills.
Her coatroom thefts continued undetected until one Sunday, when
Mount joy's minister, the Rev. Raymond M. Randall, announced to
the astonished congregation that someone had stolen several dollars
from a member's coat pocket during the previous Sunday's service.
Randall offered forgiveness and asked the culprit to come forward. If
the thief was hungry, the minister said, the church would try to help.
Rosa Lee could not b~g herself to confess in front of her mother,
her family and her friends. "My mother would have KILLED ME! Do
you hear me? KILLED ME!" she shouted at me as she recalled the
scene. ~And who is going to go up there and tell him that you're bun
. ' gry? That.would only embarrass the hell out of you!"
.
. For.the next few weeks, she stayed away from church. When she
returned to her ushering duties, she was careful to steal only change. '
, She often did not know what to do with the money she stole. Her im
mediate. needs were small and simple: 35 cents for the Saturday
movie matinee at the old Atlas Theater on H Street NE, or a dime
for theS;llow cones that she loved. She gave away small amounts to
brothers and .sisters and friends, but never enough to attract her
'5, .. ,.: '
mother's attention.'
Rosa Lee hid her stolen coins from her mother. "I would roll'itup
in a stocking," she said, and put the stocking under a rug, or under
' ;,
, her mattress or in her underwear.
Forty years later, Rosa Lee still hides her money every nighi-.:.
not from her mother, but from her five drug-addicted' children. '
Sometimes she goes to bed with a wad of bills stuffed into her sock. '
"If I don't hide it, they'd steal it," she said:
'
Outo/Style
I
f Rosa Lee felt bad about not having a few pennies to buy cookies
in fourth grade, she felt even worse about not haviog a stylish
wardrobe to match those of her friends in seventh grade. She hated
the secondhand clothes that her mother bought for her; they were al
most always out of style.
Rosa Lee already felt .at a disadvantage in attracting boys, and
thought fashionable clothes might help. "1 was dark-skirmed," she
said. "I wasn't like the girls with long hair and light skin. The boys al
ways went for them."
'
One mOrrllng, a girlfriend lent Rosa Lee a new gray skirt with "two
pockets on the hip," one of the newest fashions. "My mother would
never buy me one; Rosa Lee told me, her voice still smoldering with
resentment. Rosa Lee loved how she looked in it.
,
During lunch, the girlfriend asked Rosa Lee in front of some class-'
mates to share her 35-cent meal. "I wouldn't give it to her," Ro
Lee said. "I was hungry!"
The girlfriend blurted out, "I didn't say that when you borrowe
my skirt!"
[PHOTOCOPY
PRESERVATION
�•
-
'.~;
~
•
-!
,:.
"
-".
.
,_.
..~ ..... ~ .. -.,
..... : . -
,
'
~-
Rosa Lee's classmates howled with Iauihter at her embarrass
ment. As she retells the story, 1 can see that time'has not healed her
wound. Her voice hardens, her eyes narrow, her expression conveys
the raw ,power of the memory. "That hurt," Rosa Lee says. "I
thought/GOd, this-will never happen again to me.' •
Days later Rosa Lee walked into a five-and-dime store in the 600
block of Pennsylvania Avenue SE. She picked out a gray skirt and a
wliite lace blouse, folded them into two tight Ilundles, slipped them
under the skirt she was wearing and slowly made her way out of the
state. As she turned the romer, she cruShed the Skirt and blouse to
her chest in glee.
She hid the Skirt and blouse from her mother. Emboldened, Rosa
Lee branched out to other stores in the Capitol Hill area. "I was de
termined to have what other girls had,· She said,
- Ata party in early 1950, she met a light-skinned boy who was at
tracting attention from the other girls; And Rosa Lee wanted .to im
press her friends Ily getting his attention; she enjoyed the other girls'
envious looks when he asked to walk her home.
-She thought having sex would cement their relationShip. She be
came pregnant. "1 haven't seen him since," She said.
-, When school officials found out she was pregnant, they told her
She would have to leave school until the baby was born. She never
went back. In November 1950, she gave birth to Bobby, naming him
Robert Earl Wright.
- 9'
Not long after Boblly was born, Rosa Lee decided .to dress for
church in one of her stolen outfits. She knew it was risky, but She
,was tired of wearing hand-me-downs when the other uShers usually
came in stylish clotheS. As soon as her mother spotted the gray
pleated Skirt, She confronted Rosa Lee.
"Where did you get this from?" Rosetta demanded.
"1 stole it out of a store. Please don't make me take it back to the
store, Momma!"
' -
Rosetta was furious. "1 ain't. going' to say nothing to you now be
cause you told the truth, but don't bring nothing else in here that
you've been stealing! DO YOU HEAR ME?"
, -"Yes, ma'am," said Rosa Lee, tremi)ling as She waited for her
mother to hit her.
-, But her mother just said: "Put it on. Let's see what you look like in
- it."
The Stolen Scarf'
osa Ile ignored Rosetta's order to stop ShOplifting. Whenever. her
mother questioned her about some new item, Rosa Lee just denied
that She stole it. "My mother would tell me, 'Stop that lying,' and then
let it go," Rosa Lee said. '
. But a judge wasn't so kind when Rosa Lee was caught Shoplifting a
few months later at a downtown department store, her first arrest. He
sent her to a facility for juveniles for 19 days in early 1951. But the les
son seemed lost on the 15-year-old Rosa Lee; after her release, She
went right back to shoplifting,
_- _
When Rosa Lee was away, her mother cared for l-year-old Boblly.
Rosetta, wbo had her first child at age 15 in North Carolina, had accept
ed Rosa Lee's first pregnancy;but She was'angry because Rosa Lee was
pregnant again. The father was another teenager in the neighborhood.
"What do you think you doing, bringing all these babies in here?" Rosa
Lee remembers her mother saying. .
Rosetta demanded that Rosa Lee have an abortion, but Rosa Lee
wasn't about to let her mother tell her what to do-about babies, or
Shoplifting, or anything else.
Anxious to win her lIIOther's affection, Rosa Lee decided to steal
something for Rosetta. One day after Rosetta came home from work,
Rosa Lee took a multicolored, cotton scarf from under her coat and
handed it to her mother.
Rosetta took the scarf, turned it over in her hands and looked ques
tioninglyat her daughter. Rosa Lee waved both her hands, a sign to her
mother not to.ask where she had gotten the scarf.
Her mother didn't. "Rose, 1NEVER had something like this!~
Rosetta threw her arms around Rosa Lee. "She grabbed me, and I
grabbed her,~ Rosa Lee recaIls. "1 couldn't believe it!"
But the stolen scarf, and other stolen gifts that followed, did not bring
Rosa Lee the close relationstlip that she wanted. Rosa Lee says her
mother didn't like her Shoplifting and continued to badger her about it.
The tension between them was always there, waiting to explode. One
day, when Rosa Lee was 22 and raising five children in an apartment
next door to her mother's, it did.
Rosa Lee and a neighbor had a shouting match after the neighbor had
R
PHOTOCOPY
PRESERVATION
�. '
-_.
\
"';'. ,~~':.~_ '
.
.
-'
.
.
.
"-::it~~!-) . . ~ ~,:;::'~,~:~ .', ."
. hit one of Rosa. Lee's children. When Rosetta heard about it, she was
angry/She stormed into Rosa Lee's home.
"She told me:that all I am 'is a troublemaker," Rosa Lee recalled. "I
told her that ·[the neighbor) shouldn't .have hit my child. Momma said,
'Youoothing but a damn nuisance: and pow, right in my mouth."
Rosetta's blow left her daughter with one visible legacy of their re
lationship: an upper denture to replace the front teeth that Rosetta
knocked out.
.
It also left,a lasting impression on Bobby, who saw the confronta
tion. He was 8. "It.was spooky; he told me. "Ain't nobody supposed
to beat up Mom. As much'as she went to get food for us and clothes
, for us. I don't,care who it was."
R:U1Q i 3ili£
'we Started Grabbing ,
n the babny Thursday night of April 4, 1968, a few hours after
the assassination of civil rights leader Martin Luther King Jr.,
looting and arson erupted in several of the District's,major commer
cial corridors, overwhelming the city's police force.
Rosa Lee watched as looters carried hags, boxes and portable tele
visions past the ramshackle house she was renting at 149 L St.SE.
"Where ya'U get that stUff?" Rosa Lee called out from her porch.
"H Street; folks shouted.
Rosa Lee, 31 at the time, had a vague. idea of King's efforts to
improve life for' AfriCan;Americans. StiU, the destruction did not
disturb her. She did oot believe the torching and trashing of busi
nesses had any connection to her. The shops, she said, were run by
"greedy" merchants who gouged customers and took "whatever lit
;
,
tle money I had!· ,
So when her son'Bobby,then 17, drove up in a Buick that Rosa
Lee instinctively knew had been stolen;she didn't hesitate.
She turned to berseven' other children and said, "All right! Who .
wants to go?" As usu.aJ.Alvin and Eric, .then 15 and 12, held hack.
On H Street, Rosa"Leesaid, "everYbody was grabbing everything
they could gettheir.. bands on. We started grabbing too. Didn't know
what we were takin.g. Just grabbing, grabbing, grabbing."
,
The next !iay,'wben the looting began again, Rosa Lee kept her
children at home~,~e already had so much stuff; she said. "There
~s no need ~o:go Out:.
;.,
O
".;" :~;:.,~.,":~: '~~~';"~~;df~:~~~-'
Shopping for Bread
"M r. Dash," Rosa Lee saysatasthat High's so Itocan get a loaf of
I am driving her her apartment in
, "February 1991, "stop
Jread.
"..' .
".
.I glance at her, and she knows what I'm thinking. "I'm not doing
my shoplifting," she says.
,
• I have told Rosa Lee that I cannot be a party in any way to her
;hoplifting. So when we pull into the parking lot at High's, she makes
I big show of leavmg her oversized black bag on the seat. Wallet in
land, she heads for the store.
Fifteen minutes go by. My feet are getting numb from the cold, so I
lecide to see why she's taking so long. Her head is visible above the dis
,lay counter of canned goods. She is putting something into a large
'roWn paper hag, too busy to notice I've come inside the smaU store.
"ROSA LEE!" I shout.
'
She jumps at the sound of her name. She spots me standing near
ae smudged glass door. She crumples the top of-the hag and walks
')ward me. I feel her cold anger as she breezes past.
"That's the last time 1 wait for you outside of a storer I yell as we.
'alk to the car. "You told me you weren't going to steal anything!"
She fires hack, her words coming out in a steamy vapor from the
Jld. "I'm trying'to feed my family and I don't have any money.
le're just trying to survive!"
"That's dead!" I say. "Save that for the judges at Superior Court.
ou just threw away several huniired dollars buying dope and crack
Ir your children."
"You know so goddamn much!" she snaps as I start the car. "I
'lght to go upside your head!"
.
"You threaten 'to go upside my head' every other day," I say.
She laughs, and the tension evaporates. She shows me what's in
!r bag: a loaf of bread that she bOught, and the items she stole
10 cans of spray starch and a can of baked beans.
~
,
. ,
.
. .-
';.
-
.
.
-
,.
. .'"
- ..
' ~
--'
I am angry with Rosa Lee for violating my trust, and I am angry
with'myself. The incident is a lesson to me: Why did I think that she
would behave differently around me?
'Second Thoughts
A
few Weeks after the shoplifting incident at High's, Rosa Lee and
I are talking in her apartment. Aiter spending so much time with
her, I realize I don't always ask the questions that need to be asked.
"Rosa Lee; I say, "there's something I want to work out 'with you
about how you look at the world."
I remind her of the time she took her granddaughter to steal a
coat. They were on their way to church, but Ro:;a Lee thought the
girl's coat looked ragged, so they went to the thrift shop to shoplift.
Rosa Lee nods.'
"How do you put those two together?" I say. "One Sunday going to "
church to be baptized, and the next Sunday going to shoplift a coat?
"1 don't know; she says. "I didn't like to take her to church with
that dirty-looking coat."
"But how do you take her out stealing thenr' I say..
She protests that the thrift shop's white owner takes advantage of
his customers, who are mostly black. "1 don't understand how a thrift
shop can charge so much for things," she says. "Do you know that he
charges $8.95 for stuff that don't cost that much brand-new?"
"That's a rationalization, and it doesn't dance: I say.
That night, I am surprised to find a message from Rosa Lee on my
answering machine in the newsroom, telling me that she had had
"second thoughts" about taking her grandchildren to shoplift. The
next day, she explains. "You gave me something to think about; she
says. She told her grandchildren that our conversation had made her
see that it was wrong.to steal coats for them.
Her granddaughter immediately went to the closet and got the
pink coat .that Rosa Lee had helped her steal.
"What you want me to do with the coat?" she asked Rosa Lee.
"Keep it. Keep the coat. But we're not going to do any more steal
ing." Rosa Lee replied.
"Are you going to stick to that?" her granddaughter asked.
. ·So help me to God; Rosa Lee said. "I'm going to stick to that."
Rosa Lee looks at me, waiting for my reaction. I study her face.
She isn't promising never to shoplift again, !lnly that she won't in·
valve ,the children. Nonetheless, she seems sincere.
"You have a powerful influence on those children; I say.
"I know it; she says.
About This Series
In
n 1932, the midst of the Great Depression,
Lee
up
grandparents and
I Cunningham'ssharecropping life forparents gave Rosatheir
an uncertain journey
North Carolina
north. Rosa Lee is the link between past and present, be
tween a world that has disappeared and the one that her chil
dren and grandchildren face today in Washington. Her life
spans a half-century of hardship in blighted neighborhoods
not far from the majestic buildings where policy-makers have
largely failed in periodic efforts to break the cycle of poverty
.
that has trapped her and so many other Americans.
Many of Rosa Lee's relatives, including two of her eight
children, managed to secure footholds in the mainstream of
American society; their relative success makes it all the more
important to try to understand Rosa Lee's life. Although her
story is discomforting and disturbing. she wants it told. "May
be I can help somebody not foUow in my footsteps," she says.
That story-of the choices she had and the choices she
made-offers a chance to understand what statistics only
suggest: the interconnections of racism, poverty. illiteracy,
drug abuse and crime, and why these conditions persist.
The series, edited by Steve Luxenberg, The Post's assis
tant managing editor for special projects, will run through
Sunday, Sept. 25, The Post welcomes readers' written com
ments or phone calls. If you wish to leave a recorded com
ment, please call PostHaste at 334-9000, Category 4646.
PHOTOCOPY
PRESERVAT!ON
�{-'.
'ji
ROSA· LEE!SSTORY. ;)' .: .
.,oVERTY AND SURVIVALIN W~HINGTO~/;;~.li;l'
Rosa Lee Pays a Heavy '!bZZ for RZiteracy
Thin:J of eight articles
By Leon Dash
W""'""at. . Poot SWlWriter
osa Lee Cunningham is so weak
she cannot get out of bed.
.
I cradle one of her limp arms
i
. while Richard Cunningham, 36,
one of her eight cJ:iildren, grips
the other. Gently, we lift her up and
support her as she tries to stand. She rocks
unsteadily. groaning and whimpering from
the exertion. We slowly lean her back
against a tall wooden chest of drawers to
brace her, but she slumps against it.
banging the chest into the wall. We hastily
return her to bed.
It is clear she needs immediate medical
attention. I teU Richard that I am taking
R
'"0
:D"'O
m:E:
m~
~~
~O
5~
z
I
RoSa Lee to the Howard University
.
Hospital emergency room. "An excellent
idea,w Richard declares,
Later that moming-Tuesday, March
12, 19.91-doctors began searching for the
cause of her dangerously weak condition.
The next afternoon, with Rosa Lee resting
comfortably in Room 5N9, the mystery
unraveled.
. Rosa Lee was a victim, it turned out, of
. her inability to read.
The first clue came from a blood test. It
showed that she was overdosing on
Dilantin, a medication that helps prevent'
seizures. She had twice the recommended
level in her system.
She had been taking Dilantin only a few
weeks. Doctors had prescribed it for her.
after another seizure-her fourth since the
fall of 1990-had bnded her in Greater
Southeast CommW'lity Hospital. When they
sent her home, they gave her a written
schedule of the four medications she was to
take each day. Under Dilantin, it said "100
mgs 3Xdaily,"
.
"The nurse didn't ask me if I could read
the instructions; Rosa Lee said. "I
wouldn't have told her if she had asked. w
Rosa Lee didn't know that "100 mgsW
meant 100 milligrams, or that she was
supposed to take one lOO-milligram tablet
three times a day. She thought she could
take more than one pill if she wanted, as
long as she took them three times a day.
·Sometimes I would take two of them,w she .
said. .
'.
It became an unending cycle: The extra
See ROSA ~ AS, CoL 1
•
,
BY ll.laAN P£RtOIoCS-lHE WASiHtHGTOfiJ POST
CHANCY: For Rosa Lee, who can't read, taking medication can be risky.
/
�She vowed nevef toreveal hef secret
ROSA LEE, From Al
Dilantin doses made her feel disoriented and weak; as she grew
weaker, she would add another pill, thinking it would make her feel
better.
"I didn't know, Mr. Dasb; she said, her voice reflecting pain and
embarrassment. '1 was trying to get well.»
Breaking the Code
R
osa Lee cannot read these words I have written about her life. '
She is aware that I planned to use intimate details from her past :
and present for this series of articles about bow several generations i
of one Washington family have lived with poverty, drug abuse and ii- ,
literacy. We have spent hours discussing what I intended· to write.
But she will have to rely on someone else's eyes to find out just what
I have written.'
.
She can recognize certain words--enougb to fool strangers-but
the newspaper itself is like a long string of indecipherable code:
Here's a word she knows, and here's another. but together they
make no sense.
,
She often asks me to break the code for her. One 1991 morning at
McDonaId's on New York AvenueNE, where we often have break
fast after her daily visit to the methadone clinic nearby. she asks me
to explain a letter she has received from the D.C. public housing
agency.
'
' ,
She rifles through a rolled-up sheaf of tattered papers she always.
carries in her pocketbook, scrutinizing each piece of paper for the
housing agency's recognizable letterhead. The bulky stack is her por
table filing cabinet, the place where she keeps all her documents,
some dating hack years. Sbe never throws anything away, because
she can't read weU enough to decide what she needs and what she
can discard.
.
'
Finally, she finds what she is looking for and bands it to me.
, "This is the wrong letter: hay.
'
"No, it isn't!~ sbe retorts. "Read the letter. It's from public hous
ing!"
,
'
I shake my head and point to ¢e date at the top of the letter:
1989. "This refers to public housing you lived in on Blaine Street NE
two years a,.go," I say, "not to the application you have filed for a new
apartment.
"
"Are you sure, Mr. Dash? Read it and make sure."
,
.
"This is not the letter. I've read it. In fact, you can throw this
away."
"Don't you dare!" she says, snatching it. '1 might need it."
It is infuriating that someone with such a sharp and quick mind is
shut out from much of the world around her. She cannot find an unfa
niiliar street on a D.C. map, but she skillfuUy navigates the compli
cated bureaucracy of D.C. public housing, repeatedly securing apart
ments for herself and her family jlbead of other applicants on the
waiting list. Balancing a checkbook is out of the question. but she
successfully handled large sums of money when she was dealing
drugs in the 19705 and 19805, satisfying customers and suppliers not
known for patience.'
,
She tries to hide her illiteracy by going on the offensive. Anyone ,
spelling a riame for her is ordered to slow down while she prints each
letter in big, blocky capitals. Sometimes, she casually hands over pen
and paper and asks the person to write it for her, as if she were too
busy to be bothered. She's so good at covering up her illiteracy that I
find myself forgetting that she can't even read the few words on a
medicine bottle label.
"
On the afternoon after her release from the hospital-a blustery'
March day that makes us welcome the warmth of her apartment...,..
Rosa Lee and I are sitting on the plaid couch in her living room. The
hospital has given her a new prescription schedule. and she has asked
me to help her take the medicine correctly this time.
I pick up one of the amber-£Olored plastic containers. "This is the
phenobarbital. I noticed they reduced the amount down to 30 milli- .
grams. When you left Greater Southeast, they had you up to 60 milli
grams."
I shake several into my band. "Now, do you recognize this tablet?
What do you see it as?"
Rosa Lee squints at it. "The little white pill. That's the kind that
makes me drowsy."
I print "little white pill" on a sheet of paper and hold up a different
pill. "Tell me what you see this pill as. This is the Dilantin."
'1s that one of the seizure pills?"
"Yes."
"A white and orange pill: she says. "That's the one I took so many
of."
"Right,".1 say. ~t's what made you sick." I write "white and or
ange" on ,the list: "':',""
•
"Now this one: I say, displaying a folic acid tablet that she takes as
part of her mY treatment.
Rosa Lee studies it. "Little white pill," she says tentatively.
"No, no, no. lbat's the phenobarbital. This pill is the yeUow pill.
Here, look at it again."
'
"The yellow pill: she repeats. staring at the tablet.
"AIl right: I say, moving on to the last container. "This is the re
trovir, the AZT. This is for your condition of being HIV-positive.
Now, you tell me how you see this pill."
"My blue and white."
I show Rosa Lee what I am writing.
"Okay," she says, "but please put the p.m. and the a.m. for me."
'1 am. Now read this to me."
She reads each word slowly, carefully, like a rock climber ascend
ing a cliff. "Little white pill: 8 a.m., 1 p.m. and 6 p.m. The white and
orange pill: 8 a.m:. 1 p.m. and 6 p.m. The yellow pill: 8 a.m." '
I interrupt. "You only take that once."
..
, "Once. Okay. Blue and white pill: 8 a.m., 2 p.m. and 8 p.m."
"Right: I say: "Now, will that work for you?"
"Yes,· she says.
Rosa Lee taped the list to the wall outside her bedroom so that her
grandchildren, who read better than she does, could help her. Asher
strength returned and she spent. more time away from home again,
she stuck it in her pocketbook. After several weeks, she memorized
the routine and the list became just one more out-()f-date item in ber
portable filing cabinet.
The Lessons Learned
'Vi
osa Lee .has no trouble remembering when she began hiding her
illiteracy.
'
It was 1953, imd she was 16 years old, separated from her hus
band of a few months and raising three children in her mother's
hOuse near Capitol Hill. It was the last place she wanted to be. Living
in Rosetta Wright's house meant living by Rosetta Wright's rules,
and those rules were choking Rosa Lee.
. Rosetta and hedamily had come to Washington in 1935, seeking
refuge from their harsh lives as sharecroppers in North Carolina and
Maryland. Her husband, Earl Wright, worked intennittently on con
struction jobs until his death in 1948, but Rosetta's domestic work
brought in money more regu1arly. .
Just as Rosetta's mother had prepared ber to be a sharecropper, Ro
setta .schooled RoSa Lee in domestic work. Long before Rosa Lee
turned 10, her mother taught her to scrub laundry on a washboard, to
wash a floor so it shined, to make a bed so it looked crisp and neat. Rosa
Lee's apartment is a monument to those lessons; no matter how many
people are living there, it is always tidy and weU organized.
As the oldest girl, Rosa Lee was expected to do laundry for every-
R
PHOTOCOPY
PRESERVA-riON
�.
one in the house; by the time she was in the third grade, she was
spending hours at the Scrub board every week, washing sweaters and
shirts for her parents and their 11 children. "My mother didn't ask
me did I have my homework done," Rosa Lee said. "School wasn't
important to her, and it wasn't impOrtant to me."
Rosa Lee remembers asking her mother why she had to do so
many chores. Her mother told her, "You're going to find out. This is
the only kind of job we can find for black people."
Rosa Lee isn't sure how she made it as far in school as she did.
Each year, she was promoted to the next grade, despite her reading
problems. In the seventh grade, not long after her 13th birthday, Ro
sa Lee became pregnant and was forced to drop out of school. She
was supposed to return after the baby was born, but she had a sec
ond child at 15' and then, at 16, she married. the father of her third
child.
Rosetta had insisted that Rosa Lee marry 2o-year-<>ld Albert Cun
ningham. Rosa Lee didn't love Albert, but she was thrilled anyway.
Marriage meant she could leave her mother's ho~ forever. Four
months later she was back; her husband beat her after he found out
that Rosa Lee had been sleeping with a neighborhood boy. Rosetta
told Rosa Lee to come home.
Those few months of independence made it hard for Rosa Lee to
return. She and her mother argued often about Rosa Lee's welfare
checks; Rosa Lee wanted the money to come to her, but Rosetta said
she was too young. "What are you going to do with it?" Rosa Lee re
members her mother saying. ''You don't even know how to pour piss
. out ofa boot."
Rosa Lee craved her mother's love and affection, but she also
feared her. She looked at her mother's broad back and powerful
hands, and could think only about how to avoid the stinging slaps Ro
setta often delivered during their arguments. Forty years later, she
has almost nothing good to say about her mother. "My motherclassi·
fied me as very dumb," Rosa Lee told me one day. "It was almost as if
.
she was making fun of me." .
Rosa Lee saw public .housing as her escape. With the help of
friends, and without telling her mother, she found her way to the
public housing agency one afternoon.
..
She asked a clerk there for help, telling him that she could not fill
out the application by herself. The memory of.his sneer still causes ,
her mouth to tighten and her voice to thicken. "Back in those days, .
they didn't give you any sympathy when you said you couldn't read,"
she said. "It was like, 'So what? It ain't my fault: "
Hwniliated, she trudged back to her mother's house. She vowed
never again to reveal her illiteracy to someone she didn't know.
"Can you read?" she asked her then-current boyfriend that day. Of
course he could read. Couldn't she?
No, Rosa Lee said defiantly. She sat next to him, brooding silently,
while he filled out the application to switch the welfare payments.
The showdown with Rosetta came four days'later.
Rosa Lee was relaxing on the front porch, fecling good that she
had completed her chores for the day, when she felt Rosetta's strong
fingers jab her in the shoulder:
.
"Why didn't you tell me that you went and applied for welfare?"
Rosetta demanded.
.
Rosa Lee had forgotten to check the mailbox. Now it was too late.
She decided it was time to stand up to her mother. '1 wanted to get
me and my kids out of your hair; she remembers saying. "It seems
like my kids were getting on your nerves."
Her mother's questions were tinged with anger: Who helped her?
How did she know where to send it?
"I got somebody to help me! You wouldn't help me!" Rosa Lee re
torted.
.
"Who are you talking to like thatr' Rosetta said in the tone that
Rosa Lee knew so well.
"Momma," Rosa Lee pleaded, "you would not help me fill it out."
"How am I going to help you fill it out when I can't even read my
self?" Rosetta shouted.
Rosa Lee was stunned. "Why didn't you tell me you couldn't read?"
" 'Cause it wasn't none of your damn business!" Rosetta said.
'She Was Teaching!'
he first-grade
that welcomed 6-year-<>ld Rosa
the fall of 1942 was a
way
of
TCunningham in classroomhad attended long yearsfrom theinkindLee
school that Rosetta Wright
20
earlier rural
North Carolina.
Rosetta's school year didn't begin in September and end in June. It
was geared to the rhythms of the cotton fields; from the spring
through the fall, the sharecroppers had to work the crop, leaving the
winter months as the primary time for school. The harvest came
first, the classroom second.
The white landowners had no interest in encouraging the black
sharecroppers to send' their children to school. Education was a
threat to the sharecropping system that dominated much of North
Carolina and the South when.Rosetta was growing up in the 1920s;
sharecroppers who could read and write might take their labor else
where. Rosetta's parents, Thadeous and Lugenia Lawrence, had no
formal education; Rosetta went to school, but when she reached pu
berty, she went to work full-time in the fields.
There was one similarity between the schools that Rosetta and
Rosa Lee attended: Both were part of segregated school systems.
Rosa Lee's difficulty with reading and writing began in fLfst grade..
soon after she enrolled at Giddings Elementary at Third and G
streets SE.. She does not remember getting any special help from her
teachers. "If you didn't learn it, you just didn't learn it," she said.
. Then one morning at the beginning of fourth grade in 1947, she
saw that school could be something more than a place of frustration.
She was talking with a girlfriend in her girlfriend's classroom when
the teacher appeared and shut the door before Rosa Lee could leave.
Trapped, Rosa Lee decided to take a seat rather than draw attention
to herself. Besides, she was curious about the teacher, Miss White
head; Rosa Lee had heard Miss Whitehead did things differently in
her second-floor classroom.
Within a few hours, Rosa Lee felt as if she had stumbled into a new·
school. On the first floor, where Rosa Lee had always been assigned,
she and her cJassrnates rotated among four classrooms every day.
But Miss Whitehead's students stayed all day in the same classroom,
and Miss Whitehead handled all the subjects.
On the ·first floor, the teachers seemed to spend a lot of time in the
hall, talking to each other, while Rosa Lee and her first-floor class
mates played "and meddled with each other." By contrast, Miss
Whitehead's class seemed calm, orderly and exciting.
For three straight days, Rosa Lee climbed the stairs to Miss
Whitehead's classroom and sat there, undetected. For the fLfst time
in her life, she found school fascinating. "She was teaching!ff.she told
me. "She made you feel like you were learning something." Rosa Lee
planned to stay upstairs forever.
.
Why weren't the children downstairs taught like that, she asked
her girlfriend? The friend told her that the fLfst-f1oor class was an
"ungraded class for slow learners."'
.
No one had told Rosa Lee that she was "a slow learner." She re
members angrily cutting her friend off.
It seems difficult to believe, but Rosa Lee went urmoticed in the
class for three days. On the fourth day, she raised her hand to ask a
question. Miss Whitehead appeared to notice her for the first time.
She asked Rosa Lee to stay behind during recess.
After the other students left, Miss Whitehead asked Rosa Lee
where she was supposed to be, and then told her that she would have
to return to her assigned classroom.
"But I like the way you teach up here," Rosa Lee said. "Why won't
you let me come up here?"
.
"You're not supposed to be up here," she remembers Miss White
head saying. "You're supposed to be downstairs.
ff
!PHOTOCOPY
PRESERVATION
�.,
..
"
till
"Why?" Rosa Lee asked.
"Because you're a slow learner!" Miss Whitehead replied.
Rosa Lee retreated to the first floor. Her teacher, who seemed not
to have missed her, told Rosa Lee never to go upstairs again.
Later that school year. Rosa Lee began skipping school frequently.
On many mornings, she left the house as if she were going to school,
but she spent the day roaming the streets of Capitol Hill instead. De
spite her unexplained absences. she was promoted to the fifth and
sixth grades.
In the spring of 1949. after being held back twice, Rosa Lee was
called to the principal's office. It was the end of her sixth-grade year,
and a school official told her she would be allowed to graduate to ju
nior high. "She told me I was being passed on account of my age,"
Rosa Lee said, "not because I had passed any of my classes."
e:ra1j4 i a;liu'J;
'Read It for Me'
orty-three years
on January morning 1992, Rosa Lee is
Ffretting overout later, herabillbill. Shebestares inatwhen eightmonthly
her telephone
the
pages,
trying to figure
how
could
her
$241
seivicecosts $15.38.
.
She thnists the bill into my hands. "Read it for me, Mr. Dash,~ she
says, her lower lip trembling as it always does when she's upset.
. As we talk, Ronnie, Ducky and Richard are in the living room.
They are watching a movie on cable, which Rosa Lee had installed
for them. Patty is asleep on the couch. None of them is working at
the moment, and.no one is helping to pay the $64 monthly rent, the
electricity and phone bills. or the cable.
Rosa Lee has the only steady income, not all of which is legal. She
receives $437 a month from the Supplemental Security Income pro
gram for the disabled poor; the government considers her disabled
because her medical problems and lack of skills limit her job pros
pects. The rest of her money cqmes from selling shoplifted goods.
Money never lasts long in the Cunningham household, so when the
phone bill.·arrived in late December,' Rosa Lee was frantic. The,
words on the first page-"Message Units" and "Federally Ordered
Subscriber Line Charge"-meant nothing to her. The subsequent
pages, each showing totals and subtotals, confused her even more.
She can~t add or subtract, so she couldn't check the numbers, much
as her sharecropping grandparents could not check the landowner's
math when he added up their "share",after each harvest.
She put the bill aside. Three days after Christmas, the phone com
. pany disconnected the line. When her disability check came after
New Years, Rosa Lee paid $140 and the service was restored. But
with $101 unpaid, Rosa Lee is worried:
I wasn't eager to get caught up in her personal affairs again. 1 sug
gested she call her son, Alvin, .who is literate and willing to help when
his· mother calls. Alvin and his brother, Eric-who live on their .
ovro--are the only two of Rosa Lee's children who have never used .
drugs.
"NO. NO, NO: Rosa Lee screamed at me. tears trickling down
her face. "Alvin's going to be angry and fuss at me for letting these
grown-ass children live off of me! No! You've got to help me! You've
got to call the phone company. If I call them, I'll only get flustered,
and they'll find out I can't read. These bills are kicking my butt, and
I'm not getting any help to pay them. PLEASE? PLEASE?"
"Okay, okay, okay," I reply, my head pounding,."but they won't be
able to hear me if you're crying."
I scan the bill, which shows a balance of $137 from November, and
quickly notice several problems.
Someone has been making calls to "900" numbers that charge $4 a
minute for sexually explicit conversations. After checking with Rosa
Lee, 1 ask the C&P billing office to put a block on the line that would
prevent any more calls to 900 numbers.
.
There also are 38 calls to directory assistance, at a cost of $9.88.
That made sense: No one in the house can read well enough to use
the printed phone book, so everyone uses directory assistance to find
phone numbers.
And there are 511 "message units" for local calls outside the Dis
trict-tophone numbers in Maryland and Virginia. This is a mys
tery: Rosa Lee, who didn't realize that she had to pay extra for such
calls, says she doesn't know who might be making so many calls.
As I get an explanation of the bill from C&P, I look at Rosa Lee ac
cusingly. The 511 "message units" were all calls to the same number
in Prince George's County. This was on top of 340 calls made to that
number in November. What is going on? I ask.
Rosa Lee looks both surprised and sheepish. She had been letting
a young woman down the hall use the phone to call her boyfriend in
Prince George's County. The woman's phone had been disconnected
for several months. But Rosa Lee had no idea the woman had been
making so many calls.
It didn't make sense. Why would the woman caU her boyfriend 511
times in one month, nearly 20 calls a day? And how did she do it with
out Rosa Lee's knowledge?
The answer, it turned out, was drugs. The woman's boyfriend was a
crack dealer, and the woman was relaying orders for neighborhood cus
tomers. She made most of the calls early in the day, when Rosa Lee was
out. One of Rosa Lee's children would let her in. •
Rosa Lee is upset that the woman has taken advantage of her. But
she is reluctant to cut off her use of the phone.
"What?" I say. "Why?"
. "Sometimes I need some bread," Rosa Lee says. "Sometimes I
need some sugar, or something ... and I ask her to get it for me."
When Rosa Lee's arthritic knee is too painful to walk to the store,
she would rather send the woman than one of her children. "They
spend my money on crack and don't come back with my change or
my food; Rosa Lee says.
I get up to leave. "NO!" she shouts. "Don't leave! Stay with me a
little while!"
She picks up the large brass crucifix that she keeps on tQP of her
television, clasping it to her chest.
"I need somebody to stand by me!" she says, her voice reverberat
ing off the walls and into the second-floor hallway outside. '1 don't
have nobody. I don't have nobody. I can't do it by myself:
About This Series
.I Cunningham's grandparents Greatparents gave Rosatheir
n 1932, in the midst of the
Depression,
Lee
and
up
North Carolina sharecropping life for an uncertain journey
north. Rosa Lee is the link between past and' present. be
tween a world that has disappeared and the one that her chil
dren and grandchildren face today in Washington. Her life
spans a haU-century of hardship in blighted neighborhoods'
not far from the majestic buildings where policy-makers have
largely failed in periodic efforts to break the cycle of pOverty.
Many of Rosa Lee's relatives, including two of her eight
children, managed to secure footholds in the mainstream of
American society; their relative success makes it all the more
important to try to understand Rosa Lee's life. Although her
story is discomforting and disturbing, she wants it told. "May
be I can help somebody not follow in my footsteps," she says.
That story-of the choices she had and the choices she
made-offers a chance to understand what statistics only
suggest: the interconnections of racism. poverty, illiteracy,
drug abuse and crime, and why these conditions persist.
The series, edited by Steve Luxenberg, The Post's assis
tant managing editor for special projects, hegan Sunday,
Sept. 18 and will run through Sunday, Sept. 25. The Post
welcomes readers' written comments or phone calls. If you
wish to leave a recorded comment, please caU PostHaste at
334-9000, Category 4646.
PHOTOCOPY
PRESERVATION
�~t
p
ROSA LEE'S"StoRY,
..... ".. - ... * .. _ ••••• _.
POVERTY AND SURVIYI\L ,... """"'''''' V"
\
. \
e&f1e6dav .~,tJ1
She Jrfestles WlthRecovery in a Changing Drug Culture
:: Fourth 0/ eWhl arliclu
"'. By. Leon Dash
. . . . __11_
,
"
,
m:J:
m~
~S<
~o
-"0
0«(
Z
A
'.
Lee Cunningham's apartment "
building. The midday Sun is warni
on this spring day in 1992, and my car ,
window is open as Rosli Lee and I pull into
the parlWlg lot
.
'.'.
. "Has the mailman rome yetr Rosa Lee
shouts to her neighbors.
'
, "No,8 oomes the reply.
Ordinarily, the mailman's whereabouts
don't generate much interest at the
Southeast Washington housing complex
where RoSa Lee liVeS. But tOday is the first
,
-0
:D'lJ
THE CLINIC: ROStl Lee Cunningham receives her daily dose 0/ methadone.
crowd is milling around the bank
maluminum rriailhoxes that sits
~n a grassy island outside Rosa
of the month, the day when government
checks are due to arrive.
Standing off to the side, surveying the
scene, is a group of teenage boys who sen
crack cocaine in the Washington Highlands
neighborhood that surrounds the federally
subsidized complex. They too are walting for
the mailman. As soon as the checks are
cashed, they will begin their rounds; making
new sales and collecting old debts. .
Even before Rosa Lee reaches the door to
per second-floor apartment, it flies open.
.Her 34-year-old daughter ,PattY, sticks out
her head. "Momma, have the checks rome
yet?" Patty says urgently in a loud voice.
"Patty. you don't have to shout: Rosa Lee
says. "You know the checks don't rome until
i o'clock.
We step into, the living room and the
ft •
&e ROSA LEE, Ais. Col..
�'.
ROSA LEE, Prom Al
reason for Patty's nervousness becomes clear: Seated on the couch
are two teenage crack dealers, known to me only as Two-Two and
Man. Between them is Ducky, 32, another of Rosa Lee's eight chil
dren. All three are staring at the television, watching an afternoon
soap opera.
Two-Two and Man have come to collect from Patty and Ducky. The
teenagers know they have a better chance of getting their money if they
show up early, before Rosa Lee and Patty have cashed their checks. I
have seen this ritual many times since I began spending several days a
week with Rosa Lee to learn how several generations of one family have
lived with poverty, crime and drugs. Even so, Two-Two and Man barely
acknowledge my presence.
Rosa Lee greets them. The boys nod, their facial expressions
masks of cool indifference~ They are dressed in hip-hop style: over
sized jeans, baggy shirts, expensive sneakers and baseball caps. Rosa
Lee has asked'Two-Two and Man several times not to seU crack to
Patty and Ducky on credit, but they ignore her. I once asked her
why. "Because they know Momma is going to bail her children out,"
she says.
There is no hint of sarcasm or irony in Rosa Lee's voice, just a
simple statement of fact by someone trapped in a drug culture she
helped perpetuate. For years she sold heroin to addicts who would do.
almost anything for a fix; now her own children beg her for money to
feed their habits. She herself is a recovering heroin addict who didn't
quit until the fall of: 1990, when an injection sent her into a Iife
threatening seizure. But Patty and Ducky haven't quit, nor have
three of her other .children.
. .. .
It's the kind of environinent that Sociologist William J. Wilson has
studied in his work on urban neighborhoods that have become domi
nated by.what Wilson calls "a concentration of poverty.~ Wilson said
it is "extremely difficulr for family members living in close quarters
with drug users to come away unscathed. Rosa Lee and her family,
he told me, reflect "the effects of living in neighborhoods that are
overwhelmingly impoverished with all the opportunities for illegal ac
tivities, with limited opportunities for conventional activity.w
Illegal activity swirls around Rosa Lee every day. She resents hav
ing to protect her adult children from drug dealers, but she always
comes to their rescue. With some pride, she tells me about the time
she saved Patty and Ducky from Two-Two's wrath.
It was Labor Day weekend in 1991. The checks had come early,
on Friday and Saturday, because Sept. 1 fell on a Sunday. Before
. Two-Two and Man could find Patty, she had cashed her $252 wel
. fare check and spent it all in a few hours;' She paid Rosa Lee the
$100 that she had borrowed for crack the month before, paid off sev
.• eraI of the other dealers who found her first and then spent the rest
on more crack.
So when Two-Two showed up Saturday afternoon to collect $30
from her, $80 from Ducky and $150 from Patty's boyfriend, Patty
hid iit Rosa Lee's bedroom and Ducky hid in the hall closet. "I want
my goddamn money," Two-Two yelled, banging his fist on Rosa
Lee's apartment door. "Mama Rose, I don't mean no harm. If we let
them go, everybody will think they can do it. Would you rather I
.knock on the door or do you want me to knock them on their ass?"
Rosa Lee knew Two-Two and Man meant business. Though she
called them "young'uns; they were tougher and less patient than
many of the dealers she knew in the 1970s and 1980s, when she
made a living seUing heroin in Northwest Washington.
She didn't want. to pay them out of her $422 monthly disability
check. "I didn't see any way to make it through the month if I paid all
my bills and paid off their debts too,8 she told me.
"All of a sudden; she said, "my mind started working." She decid
ed to become a crack seller, just for the weekend. She asked Two
Two to introduce her to a crack supplier.
"What can I make with $300?" Rosa Lee asked the supplier, a man
in his late twenties.
"You can double it,n he said. Later that evening, Rosa Lee handed
over $3008 return for 30 plastic bags of crack, each containing one
in
"$20 rock. She then sent Patty and Ducky to round up customers.
·As .the supplier prepared the packages, Rosa Lee's 14-year-old
granddaughter walked in. She understood immediately. "I don't want
you to go back to jail, grandma," she told Rosa Lee.
Buyers trooped up to' Rosa Lee's apartment until 5 a.m. Sbe ~!d
some bags at a discount and gave in to Patty's and Ducky's pleas i(Jr
free samples. When it was all over, she hadn't made enough to co'ier
her $300 outlay. She ended up paying off the debts out of her .own
funds.
"I could have made more if I hadn't given Ducky something now
and then, and Patty something now and then," she said.
\
Exhausted from being awake all night, she washed up and got
ready for church.
Since that weekend, Two-Two and Man have looked to Rosa Lee
whenever Patty or Ducky can't pay up. This particular afternoon is
no different. The mailman finally arrives, Rosa Lee agrees to cover
the debts, the checks are cashed at a nearby liquor store and the
money changes hands.
.
PHOTOCOPY'
PRESERVATION
�As soon as Two-Two and Man leave, Patty and Ducky are off in
search of more cmck.
'Mama Rose'
t 8:15 one
slams the brown
AmetalstairsJanuary morning in 1992, Rosa Leeand walks slowly .
door to her one-bedroom apartment
down the
to meet the government-run van for the six-mile ride
to the city methadone clinic.
She steps out into a biting wind, but is glad to leave her crowded
apartment. Inside, her sons Richard, Ronnie and Ducky are asleep on
makeshift beds in the living room. Patty is in Rosa Lee's double bed,
which they have been sharing for weeks.
Rosa Lee looks forward to this part of her day. At the methadone
clinic, she sees old friends she has known since she lived at Clifton Ter
race in the 1970s and early 19805. They greet her with affection.
"Hi ya doing, Mama Rose?"
"Ya' looking good, Mama Rose."
"Nice to see you, Mama Rose.w
"Mama Rosew is what they called her at Clifton Terrace. She likes the
name and the respect it implies. She drifts to the back of a line that
stretches down the corridor toward a counter encased in plexiglass. A
sign on the plexiglass sets the rules: "Attention ... Your methadone'
will be in 3 ounces of water. Please do not ask the nurse for less." Some
patients believe the. methadone works better if less diluted.
The line moves forward methodically, dozens of people from dif
ferent neighborhoods and different backgrounds, all bound together
by their addiction. Behind the glass, the nurse measures out the
blood-red methadone into a plastic cup, places it on a revolving tray,
then spins it so the patient can take the cup through the opening.
The patients r~ve different doses, depending on their weight and
how much they need to effectively curb their craving for heroin.
. The nurse measures out Rosa Lee's dosage. Following the rules,
Rosa Lee drinks it down as a nurse watches. The glass between.
them doesn't encourage conversation. The transaction over, Rosa
Lee heads for. the door. .
.
.
On many weekday mornings, I meet her outside. at the clinic, a
modem two-story coCfee-colored building at 33 N St, NE, and we
ride two blocks to the McDonald's on New York Avenue NE.
The McDonald's is Rosa Lee's preferred spot for breakfast. She
spends several hours there each day, chatting with other patients
from the methadone clinic and "regulars" who hang out there. Her'
routine is the same: She orders Cheerios or the breakfast special of
pancakes, sausage and scrambled eggs.
. This particular morning, she settles on Cheerios. She tears open
seven packages of sugar, dumps them in her coffee and then rips
open several more and empties them onto her cereal. She can't stand
to eat anything until she drinks her methadone, so this is her first
food of the day.
A woman approaches. She hands Rosa Lee $3 in a folded lump.
"More Darvon sales?" I ask.
.
"Yeah, Rosal.ee says.
.
Darvon is a prescription Painkiller that some methadone patients
use for a cheap high. They like Xanax, a prescription tranquilizer,
,ven more. Rosa Lee often has a supply of Darvon and Xanax to sell.
)he was prescribed both drugs after she injured her back slightly in a
lUS accident in August 1991. She has used the injury as an excuse for
~etting refills. As a Medicaid patient, she pays just 50 cents for the
iO pills that come in each prescription. She resells Darvon at $1 a pill
,nd Xanax at $2.
She can't refill them too often without drawing suspicion, so it's
'ot something that brings in a lot of money. But it gives her a certain
tature with the McDonald's crowd.
Some days, she will bring in clothes that she has shoplifted to sell .
r give away. One time, she brought a toddler-sized yellow sweat suit
lat her sons stole in a burglary; she gave it away to a homeless
oman who was there with her 3-year-old daughter. ''I just felt guilty
')'ing to sell it to her," she told me.
A few months after I began visi,ting Rosa Lee regularly in the fall
'1990, she told me that several of her McDonald's buddies couldn't
lderstand why she was allowing me to write about her. "They told
e, 'Stay away from reporters. They put people's business in the
reet: •
I smiled and told her it was true. "We're nosy and intrusive. I want
'ur permission to follow you for a long time. There will be many
ys when I will ask you about the same thing over and over again, .
d then come back months later and ask you again. You might end
cussing me out."
She laughed. 'That's all right. You look like you could handle it."
Jur relationship has evolved from those early days. I have tried to
nain an impartial observer, but, inevitably, I have become a vital
t of her life. Sometimes I am her driver, ferrying her to the meth
W
~.
adone clinic or the welfare office. Sometimes I am her translator,
helping her to decipher paperwork that baifles her because she can't
read. More often, I am her confidante, listening to her painful re
criminations about her life and her children.
Staying at arm's length is difficult. My refusals don't deter her
from trying to get me involved.
"Mr; Dash," she says, tilting her head and softening her voice, "tell
me, what should I do?"
''I'm not in it, Rose," I'll say.
" 'I'm not in it, Rose: " she mimics. "Why do you always say thatH
need your help. I don't have anyone else to talk to."
That's why she enjoys her McDonald's visits. There, she can escape
her problems for a while. One day, as she ranted about her children's
drug habits, she broke down in tears about how trapped she felt.
"Mr. Dash; she said, "I don't have no friends. The only friends you
know I got is up there."
"At McDonald's?"
"McDonald's. That's aU. And they're not what you call friends, but
that's aliI got."
The Cocoa Quo
ost the
crowd a
younger than ROS\!
in a while,
runs into one her old hero
MLee.ofOnceMcDonald'sthough,isshegenerationtablesofat the Cocoa
in Customers from the days when she waited
Club, a nightclub that once operated at the comer of Eighth and H
streets NE. 'That's way back," she says. "Not too many alive from
those days."
"Those days" were the 1950s and 1960s. In the world that Rosa
Lee knows, in the neighborhoods where she grew up, in the places
where she raised her children, on the streets where she once bought
and sold drugs, there are many penple whose lives ended too early,
cut short by too'much heroin or too much alcohol or just simply too
much misfortune.
.
One day at McDonald's, Rosa Lee puUs an old photograph out of'
her pocketbook. It is a Polaroid, and it shows a younger Rosa Lee, in
her early thirties, dressed in a sleek black outfit, with matching pants'
. and top. 'Behind her is the dance floor of the Cocoa Club.
The photo was taken sometime in the late 1960s by a regular cus
tomer at the club. Rosa Lee had run into the nuin recently, and here
membered the photo. He·ran home to get it, and insisted that Rosa
Lee keep it.
It is. the only photo I have ever seen of Rosa Lee at this age; she
looks smashing.and vibrant. She looks as if she belongs.
She never planned to work at the club. As a teenager in the early and
mid-1950s, Rosa Lee often went with her girlfriends to the Cocoa Club
to dance and. drink. The club's owner noticed her and asked her if she
wanted to wait tables. It was her first job. She was 20, and had just giv
en birth to Eric, her fifth child. The year was 1956.
The pay was good, and it was in cash, so she could hide it from the
welfare office. She worked at night, leaving her mother to take care
of her children. It was fun and exciting. There was live music and
flashy customers.
One was a heroin dealer. Soon after she started working at the .
club. he took her aside and offered her a chance to make a little extra
money: If she would sell heroin to cus~omers that he sent her way,
she could keep $25 of every $100 she sold.
.She concealed the heroin, which was contained in small capsules,
inside her bra. The capsules sold for $1 each, and customers usually
bought three. "Friday nights was when I would sell them," recalled
Rosa Lee. "Friday nights, I would sell hundreds in there. The owner
never knew I was selJing heroin, but he was always asking me why
my tables would be full with customers when the other tables were
empty. I told him, .. 'Cause I take care of my customers!' •
The heroin business, she said, was nothing like the crack business
today. She never treated her customers the way Two-Two and Man
now treat Patty and Ducky. She thought of herself as several cuts
above the '1ugglers," the dealers who sold their heroin on the streets.
She was a high-class dealer with high-class customers; they paid
promptly and in cash.
. She resisted the temptation to take a hit herself. She saw the pow
erful grip that heroin held on her customers, and it frightened her.
Besides, she couldn't afford a heroin habit. By 1961, she had eight
children to support. She took a second job at another H Street night
club, the 821 Club, as a "shake dancer"""':slang for strip tease. Soon,
she was engaging in prostitution with club customers.
"The men would ask if they could take me home; Rosa Lee said.
''I'd come right out with it. 'Yeah, you can take me home. I got eight
children at home. We need some money for food!' "
.
.
She also picked up additional things by shoplifting: shoes for little
Patty, pants for one of the boys. She. was caught occasionally, but the
\ i
PHOTOCOPY
PRESERVATION
I
,
,
~
�judge always gave her probation and sent her home. Then. in OctO'
ber 1965, her luck ran out.
She was arrested as she tried to steal an expensive coat from a
Maryland department store. Two security guards spotted her as she
went to the coat rack. took off her raggedy brown wool coat, slipped
into the plush new coat and hung the old one in its place.
She pleaded guilty. On Christmas Eve, the judge sentenced her to
a year in prison.
Her mother was sitting in the first row of spectator seats. "You're
not going to forget this!" yeUed Rosetta Wright, waving her right
forefinger at Rosa Lee's face. "You hear me? Leaving aU those god
damn children! You're not going to forget this'"
'Are lou JJoing It?'
R
osetta took care of Rosa Lee's children for the eight months that
Rosa Lee spent in jail, but Rosa Lee felt little gratitude. The ten
sion betWeen them was as bad as ever. Rosetta told the'welfare of·
fice that Rosa Lee's prison term showed she was an unfit mother;
this convinced Rosa Lee that Rosetta would like nothing better than
. to have custooy.of the childt:en and the welfare payments that came
with them. Their battles only deepened Rosa Lee's resolve to re
trieve her children and move away from her mother's apartment as
quickly as she could.
After her release, she returned to her waitress job at the Cocoa
Club and resumed her heroin sales. Within a few months, she found a
'one:bedroom apartment on Bates Street NW, near North Capitol
Street. It was small and roach·infested, but it meant that she was no
.longer under her mother's thumb.
The children, especiaUy the older ones, remember these years as
a time of constantturmoil: Between 1966 and 1968, they moved four
times before ending up in a public housing complex in the Marshall
Heights area of Southeast Washington. The apartments had one
.thing in common: AU were 'Iocated in areas known for illegal drug ac- .
tivity.
.
Heroin was available to anyone who wanted it, including teeruigers.1n
1967, Ronnie became the first of Rosa Lee's children to try it. He was
151nd in the seventh grade,
.
As he remembers it now, his best friend offered him a capsule at.a
party, suggesting that Ronnie snort .thewhitish powder. He had been
searching for something-that would give him more confidence, help him
to overcome his fear of girls and to control an embarrassing stammer
that took over whenever he·was under stress.
, "I tried some; Ronnie said. "It stopped my stammering." Within a
few months, he and his new girlfriend were "sldnpopping" the drug in
their arms.
He tried hard to hide his addiction from Rosa Lee, but there was a
trai1 of evidence: He needed money to pay for his habit, so he would seU
household items or steal from Rosa Lee's purse. He skipped school of·
ten and finaUy just dropped out in the eighth grade.
Rosa Lee didn't connect any of this to a heroin habit. She had never
paid much attention to her children's performance in school, much as
Rosetta had never paid much attention to hers. Then, one day in 1969,
she found empty heroin capsules and syringes in Ronnie's room.
MAre you doing it?" she asked him in a soft voice.
.
"yeah," Ronnie said, ashamed. "You want me to get out?"
Rosa Lee shook her head. Ronnie was surprised by what she said
next.
'
·She told me, just
she told me when I started smoking ciga
rettes, 'You got to take care of your own habits!' "
.
like
'Get Outta Bed!'
n
neighborhocxl where Rosa
in
that she
to sell. Addicts flocked
her
I gotthearound 57th Placehad heroinLee livedthatthe latein1960s,toword
apartment on
SE, a long street
ends a cul-de-sac
near the Prince George's County line. Some were banging on her
door before the sun rose.
·Some of them would be shaking," Rosa Lee told me. "Some said
their stomachs hurt. Some said their backs hurt. And they were aI·
ways begging, begging, begging. They did not have the foll price. I'd
sell to them at a discount because I couldn't stand the begging and
sniffling and wiping their noses.... I wanted them to come back.
They'd pay full price when they. came back that afternoon, after they
had a chance to steal something or hustle up some money."
She sometimes let them use her bedroom to inject the drug. Her'
youngest drildren often were getting ready for school, so Rosa Lee
told her customers to make sure the door was closed.
PHOTOCOPY
PRESERVATION
�"Aft~r f·!w.mi~utes,
a
they come out of there comPlet:ly changed;'
she srud,. "Ther Wlere relaxed, not worried about anything. They'd
tell me now good the dope made them feel. I was curious about what
dope could do for me, if I could feel good all day.... But I was still
too scared to try it. ~
It wasn't long before police also heard about Rosa Lee's business.
That's when the raids began.
One night in 1969, the police battered down the door and the cbildren
wnke up to find officers, their guns drawn, waving flashlights and
shouting, "Get outta bed! Get outta bed!" Rosa Lee!s youngest daugh
ter, then 8, remembers she was so afraid that she wet her bed.
.The police never found anything. Rosa Lee kept her stash at a
friend's house nearby. But the raids continued, sometimes as often as
once a month.
The younger children had no idea why the police kept breaking
down the door. But the older children knew too well what was going
on. "They raided us so often; Ronnie said. "We were.so hot."
Rosa Lee sFirst Hit
R
osa Lee's first drug use started with her desire to lose weight.
It was 1973, and the family was living in a four-bedroom apart
ment at Clifton Terrace. The pOlice had battered the door at the'
57th Place apartment so many times that D.C. housing officials grew
weary of fixing it. In the summer of 1972, they ordered Rosa Lee to
move. Rosa Lee said she gave $100 to sOmeone in authority and her
name went to the top of the waiting list at Clifton Terrace,
One day, Rosa tee found out that Lucky, a cluse friend, was regu
larly injecting something called "bam; the street name for Preludin,
an amphetamine-like stimulant. Lu~ told her that bam helped re
duce her weight by curbing her appetite.
Bam didn't frighten Rosa Lee the way heroin did, Lucky had been
using it for months, and, Rosa Lee hadn't noticed any change in
Lucky's behavior.
Rosa Lee's weight-had been creeping up, She asked LuckY for a
hit. "Lucky wouldn't hit me," she said.
Rosa Lee asked one of Ronnie's girlfriends if she knew anything
about bam, The friend, a school-crossing guard at nearby Eugene
. Meyer Elementary School, told Rosa Lee that she used bam in the
morning before she went to her post.
Every morning for the next year, the woman brought bam to Rosa
. Lee's apartment. In the pre-dawn darkness, she would prepare the
.
.
solution and inject Rosa Lee and herself.
"I liked the feeling; Rosa Lee said. "I could feel it all in my stom
ach. That's the first thing that shrinks. Your stomach. I would go the
WHOLE DAY without eating, with a WHOLE lot of energy! I woUld
clean up. the whole house. Nothing was clean enough. I'd take two or
three baths. 1 was on top of everything. In three weeks, I lost about
20 pounds!. '''.
'.
.
By 1975, two more of her children had joined Ronnie as drug us
ers. Bobby, then 25, began smoking opium wbile serving in the Army
in Vietnam. And Patty, who had watched Ronnie shoot up when she
was 11, became a regular user when she was 17.
Rosa Lee had plenty' of opportunities to try something stronger
than bam, but she still resisted. Then, at her 39th birthday party, she
gave in. .
It had been a difficult month. She was going through a breakup of a
. three-year relationship. At her party, all she could do was cry. Patty
suggested "a shot of dope" might help her get over her pain.
After that October night in 1975, mother and daughter became
daily heroin users. Rosa Lee was never able to inject herself. U Patty
or Ronnie or Bobby weren't available, she went to a Clifton Terrace
~oilin' joint," and paid $3 for someone to give her a hit.
For 19 years, she had resisted the lure of the drug she sold. Now,
she feU to the same depths as the addicts who had knocked on her
door and begged for a fix: Her eyes were red and watery. Her stom
ach hurt when the heroin wore off. Her body quaked and shivered as
it waited for the next hit.
.
Over the next 15 years, nothing motivated her to stop. In 1983,
she survived a misplaced injection that caused a bone in her neck to
become infected, and went right back to using heroin. In 1988, she
learned that .she, Bobby and Patty had HIV, the virus that causes
AIDS. She continued to shoot up. Then a series of seizures nearly
killed her in the fall of 1990, and a doctor warned her that her next
injection might be her last.
Now her life is a daily struggle to stay on methadone and stay away
from the drug use that spins around her. Mostly, she succeeds. There is
no evidence that she took-a single hit in all of 1991; she was doing so
well that the clinic invited her to speak to a group of addicts about her
experience. That's why 1 am startled one day in early 1992 to notice
that the back of her \eft hand is swoDen and red. It looks like the traces
of "skinpopping," a method of injecting heroin.
"What are you looking at?" she demands, hiding her hands in the folds
of her winter coat.
"I'm looking at your swollen left hand," I say.
'WOuld It Kill Me.? '
osa Lee isn't pleased that I have noticed the tell-tale sign ofher
oin use, but she decides to tell me the story anyway.
Earlier in the week, she had been sitting in McDonald's with sev
eral of her methadone buddies. Everyone was chattering excitedly
about the Christmas gifts they had received from their cbildren. Ev
eryone except Rosa Lee.
Most of Rosa Lee's children hadn't given her anything. "I couldn't
say aword,",Rosa Lee told me. '1 just sat there and looked, and.be
fore I knew it, I went into the bathroom and started crying.!..-:.
To cheer her up, one of her friends suggested they ~e a "billy"
or two of heroin, the quarter-teaspoon package comlnonly sold on
the streets of Washington. Ordinarily, Rosa Lee wo.qJd have dismiss
ed the idea. Not this time.
.- .
She wondered if it would be dangerous. "WhatWOuld happen if I
did some?" she asked her friend. "Would it kill me?", Her friend told /
- ~.
her not to worry. Rosa Lee decided to risk it.
As soon as Patty heard about the plan, she was eager to join in. It .
would be like old times: Patty would give Rosa Lee the hit, then hit
herself. Patty and the friend went looking for a neighborhoOd dealer.
A short while later, Patty sat on Rosa Lee's bed and stuck the nee
dle in the back of Rosa Lee's hand.
"Momma,.can you feel it?" Patty whispered.
Rosa Lee shook her head.
Patty was worried about giving Rosa Lee too much at once. She
remembered Rosa Lee's first seizure, and the panic she felt as Rosa
Lee's eyes rolled back in her head.
.
"Are you ready to take it all?" Patty asked.
.' '
"If you stay here with me," Rosa Lee said.
.
Patty pushed the rest of the milky liquid into Rosa Lee's vein. Ro
sa Lee waited for the familiar rush. But it never came. The metha
done seemed to be blocking the high.
"I didn't feel anything 1 used to feel," she tells me,
"Why did you take a chance on dying?"
.
She wriggles uncomfortably in her seat. "I didn't see it that way,
taking a chance on dying. I thought I might have a seizure, but I
didn't think I was taking a chance on dying;"
I remind her of the doctor's warning. She mutters something and
averts her eyes. We spar for a few minutes, and it becomes clear that
the conversation is going nowhere. She completes my next question
.
before 1 can finish i t . .
"You really don't have a ... ?" 1bCgin.
"A good reason for why 1took it?" she said. "No, I really don't ..
R
About This Series
n '19~2,
midst of the Great D~pression,
Lee
grandparents and
up
I Cunnmghamt!tsesharecropping life forparents gave ~osatheir
an uncertain journey
North Carolina
in
north. Rosa Lee is the link between past and present, be
tween a world that has disappeared and the one that her chil
dren and grandchildren face today in Washington. Her life
spans a half-<:entury of hardship in blighted neighborhoods
not far from the majestic buildings where policy-makers have
largely failed in periodic efforts to break the cycle of poverty.
~ny of Rosa Lee's relatives, including two of her eight
cbildren, managed to secure footholds in the mainstream of
American society; their relative success makes it aU the more
imPO~~ to try t~ unders~d Rosa Lee's life. Although her
story IS discomforting and disturbmg, she wants it told. "May
be I can help somebody not follow in my footsteps," she says.
That story-of the choices she had and the choices she
made-offers a chance to understand what statistics only
suggest: the interconnections of racism, poverty, illiteracy,
drug abuse and crime, and why these conditions persist.
The series, edited by Steve Luxenberg. The Post's assis
tant managing editor for special projects, began Sunday,
Sept. 18 and will run through Sunday, Sept. 25. The POst
welcomes readers' written comments or phone calls. U you
wish to leave a recorded comment, please call PostHaste at
334-9000, Category 4646.
I
PHOTOCOPY
PRESERVATION
�, ] hU§da~ c ~
ROSA LEE'S STORY'
t
a :21'19'-1
-,
•
*
-
-
~.
*
•
~.
~J..
_
*. _ _. _ .
'_ _ '_
POVERTY AND SURVIVAL IN WASHINGTON
!
ROSA LEE, From Al
!
!
j
"
,A LIGHT MOMENT: Eric
.
.
jokes with his mother, RoSa Lee Cunningham.
so hard to escape. By the time he reached Rosa Lee's apartment in '
the low-income neighborhood of Washington Highlands, he was
. steaming. He strode into the living room and stood in front of Ducky,
, who was lounging on the couch after a nightlong crack binge.
, "You've got to go,# Eric shouted.
"This is Momma's house,n Ducky said. "1 ain't got to go nowhere!"
"You're going out of here!" Eric said heatedly.
, Ducky looked at Rosa Lee. She refused to intervene, so Ducky,
, rose from the sofa with a resigned shrug, shoved some clothes in a
plastic bag and left.
Still smoldering, Eric turned to Rosa Lee. Recalling the scene for,
me later, Eric said that he felt Rosa Lee was playing the victim to"
win' his sympathy. But he had no sympathy for her at that moment"
,only 3Oger-the same, anger that has burned within him since he Was
5 years old and learned that he was wearing clothes shoplifted by, his
mother.
"You never instilled any kind of values in us that were worth 3oY
thing!" he raged at her.
, "What do you mean, Cheetah?" she remembers shouting, using the
nickname she gave him as a little boy because of his tree-climbing
skills. "I'm not a good mother?"
Eric shouted louder. ''You never made it a point to see that we
went to school! The things that you have taught us is that manipulat- ,
ing is good, if you can do it. Stealing is good, if you can do it 30d get·
away with it. Using someone is good, if you can get away with it.n
But Rosa Lee gave as good as she got; shouting louder still that
she had taught all her clilldren "to survive!"
Eric stormed off. He had heard it all too many times. Survival was'
always his mother's excuse. Well, he didn't buy it. He had survived
too-without resorting to drug dealing, prostitution or stealing.
:;Two Sons Surmounted the Hurdles
\:'.
Fifth of eight arlicles
.. :r:'
,',/,"'
lives, and they have taken care of themselves and
their families. Both are Army veterans; both have
worked primarily in government jobs since leaving
W~PoetStallWriter
the military 20 years ago.
As adults, they have defined themselves in ways
ric Wright hung up the telephone in his "
that set them apart from the rest of the family. Eric
. ,,'
Prince George's County apartment and
has maintained a lifelong passion for music, hosting
cursed out loud. He couldn't decide what
occasional talent shows and hiring himself out as a
.'
angered him more-that his 33-yearoQld
disc jockey for local parties. Alvin and his wife saved
brother Ducky was badgering his'mother
enough money to buy a comfortable two-story
, , again for money to buy crack cocaine or that his
red-brick bungalow in a middle-class neighborhood.
mother was calling him once more to eject Ducky
, '.He is the only one of Rosa Lee's children who owns
from her apartment. '
his own home.
As Eric, then 35, drove his white Jeep through the
Both men have made it through rough
suburbs toward his mother's apartment in the
passages-both were teenage fathers and dropped'
District, he steeled himself for the impending
, confrontation. He didn't mind getting mvolved. It just out of school-but neither one let those events
knock him off the path to responsible adulthood.
didn't do any good. No matter what he said, no
"Ducky reminds me of myself at one time,#Eric told
matter what he did, nothing seemed to change.
me, "but I caught myself:
.
Of Rosa Lee Cunningham's eight children, only
His mother's phone call on this June night in 1991'
Eric and his older brother Alvin have never used
was just another reminder of what Eric had worked
drugs. They are the only ones who have never been
in prison. Both have worked for most of their adUlt
See ROSA LEE, AIO, CoL I
'E
Motivating Forces
By Leon Dash
O
n a spring night in 1991, not long before Eric's confrontation'
with Rosa Lee, Alvin Cunningham is struggling to explain why.
he, like Eric, had turned out differently from his brothers and sisters.
We are sitting at his kitchen table in his Northwest Washington:
home. A lawn service tends the grass; an alarm system protects the:
house. He and his wife have government jobs; Alvin drives a bus for
Metro, where he's worked since 1981. It's the kind of stability that
was missing from Alvin's childhood; Rosa Lee moved the family nine
times before he turned 16.
'
Alvin leans back in his chair, contemplating his response. His face ,
is small and angular, and he looks much younger than 38. He is self
effacing and slow to anger. When he loses his temper-as he some.'
times does when he visits Rosa Lee's apartment and finds his sister
Patty or his brother Ducky engaged in drug activity-everyone
knows it is best to scatter.
"It's not very complicated," he said finally. "For one, I don't like
drugs because I saw what they could do to you,n
I press him to say more, but he's not given to long, introspective
statements. Initial1y he didn't want to be interviewed. Eric too was
unwilling at first. Not only would my questions open some painful and
personal chapters that they would rather forget, but they were con
cerned about being associated with the family's troubled history. ,
, As they learned more about my efforts to understand how pover
ty, criminal recidivism and drug abuse had affected their family, they
concluded that there was some value in discussing the contrast be
tween their lives and those of their ,brothers and sisters.
Over the course of several interviews, it slowly became clear that
. Alvin and Eric began to set themselves apart from the family during
) their first years of elementary school. It was not something they co
ordinated. Nevertheless, both somehow came to recognize that they
had real alternatives within their reach, that they had the power to
make something of themselves if they didn't give up.
, Their reactions to their upbringing became motivating forces in
; their lives, For Alvin, it was the shame and hwniliation that he felt as
a young boy; for Eric, it was the anger and disgust that he has car
ried to adulthood. At critical points, they benefited from an outsider's
intervention-a teacher in Alvin's case, a social worker in Eric's.
By the time they reached their late teens, both decided that sepa
ration was the best way out. Alvin joined the Army at 18, married
the mother of the daughter he had fathered at 16, received his high
school general equivalency degree and took some college courses.
, He has been steadily employed since his discharge from the Army 17
years ago. Divorced from his fll'st wife in 1978, he has since remar
ried.
Eric followed Alvin into the Army, spent a year in the Job Corps
learning the fine points of wallpapering and then tried to make a liv
ing as a singer. When that didn't work out, he bounced from one job
to another before landing a contract as a street sweeper with the
_l2i!.tIi«~.'.sPub)j~Works Department.He worked his way up, earning,
PHOTOCOPY
PRESERVATION
�several promotions and, pay raises; he learned to operate heavy'
'equipme9!,and se~ed a good job,at.the District's Blue Plains .T~eat
ment Pla.ilt. T!)enlll 1992, he was laid off because of the Dlstnct s fi
nancial woes. Since then, he has taken several temporary jobs while'
looking for something permanent. ' '
He'nas raised his son on his own; his rocky relationship with the
boy's mother ended in 1982, when he discovered that she was.using ,
heroin-and that Rosa Lee had introduced her to the drug. Enc has
never forgiven his mother for that. "She would do things that made
me turn totally away from her." he told me.
In their family, drug abuse has become the dividing wall that no
one can scale. Alvin and Eric don't spend holidays with their broth
ers, and neither one can remember the last time that Bobby, Ronnie,
Ricbard or Ducky came to their bomes for a visit. If they see each
other at all, it is usuaJIy when Alvin or Eric comes to straighten out a
problem at Rosa Lee's apartment.
Rosa Lee can't explain the different outcomes for her children. :'1
didn't do anything more for them than I did for any of my other chil
dren." she said during one of our many interviews on the subject.
1'hey always acted ,different, like they were shamed by it all. Even
when they were little:
Alvin in particular, showed his independence early, she said.
1'bere ~asn't any what you call 'role model' for him to copy." she
said. "His father only came around a couple of times when he was a
boy, and Alvin didn't see him again until he was an adult. No, he just
sort of grew up like he did all by himself."
:'J6ung Alvin
lvin Cunningham beard the hom of the green "welfare truck" and
bolted out the back door of his mother's apartment as fast as his
8-year-old legs would carry him. Whenever the flatbed truck arrived
at the public housing complex for its monthly distribution of food, Al
vin would make himself scarce.
,
Alvin still remembers the contents of those bags: tins of canned
meat and corned beef, rice, powdered eggs, cheese and pinto beans,
along with other bulk items. Rosa Lee saw these staples as a godsend
in ber daily struggle to feed her eight children, including a baby girl
born just a few months earlier. Alvin saw the handouts as an embar
A
rassment.
His brothers and uncles noticed his tendency to disappear when it
came time to unload the surplus goods that the government gave to
poor families. They assumed he was avoiding work. "He was embar
rassed?" Eric said••All these years, I thought he refused to go to the
truck because he was lazy!"
·Sometimes I did go." Alvin said. "But it would bother me. I HATEDit!"
,
It annoyed Alvin that the truck's driver beeped his born wben he
pulled into the small courtyard near the sidt:~y-side, ap~en!-S
where Alvin's mother and grandmother were raJS\lIg thel!' families III
1961. Alvin had a crush on a girl who lived across the courtyard; she
was a year older than Alvin and a grade ahead of him at Richardson
Elementary School. Both her parents had jobs, and although they still
qualified for, public housing, they made enough money that they
didn't receive any surplus food. He was afraid the girl would shun
him if she saw him carrying the sealed bags into his home.
Alvin didn't uilderstand why the family needed to take the free
food. His mother Was working every night, waiting tables at the
nightclubs on H Street, and she often came back in the afternoon
with new clothes for the family. "We had the best of shoes." he re
members. "Foot-Joys. She picked up expensive things for us. On Sun
day or Easter, we looked real nice. Extra nice! It never dawned on
me that she was shoplifting."
Rosa Lee didn't know what to make of her thirij-bom son. Even as
a toddler, he had behaved differently from his older brothers. He
would foDow her around the apartment, observing 'everything she
did. If she stopped to do something, he sat nearby and watched.
Some of Rosa Lee's friends noticed his quiet behavior; Alvin over
heard them telling Rosa Lee that he would grow up to be a "good
person." He liked the sound of that.
,
He didn't like the things he overheard at school. Some of his
better-off classmates at Richardson Elementary, where he was a
third-grader in early 1961, made fun of children from "the 'jects'
the Lincoln Heights public housing community where Alvin's family
lived.
'
Alvin managed to escape much of this "Jone'in'," or teasing. Maybe
it was because he didn't respond to the taunts: maybe it Was because
he befriended some of the boys who lived in the private homes along
nearby East Capitol Street NE. Whatever the reason, the things he
saw and heard while visitiilg his new friends opened his eyes to a new
way of life.
,
He took a close look at the weD-kept furniture at his friends'
homes. comparing it with the worn secondhand furniture at his own.
.
.
His friend~ had a bedroom and a bed all to themselves; he shared a
bed with one. sometimes two of his brothers.
Alvin made other comparisons. His friends' parents were teachers,
office secretaries. Post Office clerks: his mother left her children at
night to wait tables at nightclubs. His friends' farnilies ate their meals
at a dining room table set with flatware; his family's meals were hap
hazard'at best.
"You look at the way they were living and you knew there was a
difference: Alvin told me. :'You'd see that difference. That's what I
picked up on, and I started to pick up on that more and more."
rH',',.,.,...4.,.-..,....,.'.~'~-'.~~-...
16ungEric
E
ric has never had Alvin's quiet temperament, not even as a little
boy. :'1 was a bad·aS5 child!" he says. "You couldn't make me do
nothing!"
.
He Says this with the conviction of a man who knows' himself and
the forces that shaped him. We are seated at his new dining room ta
ble; the shiny black top gives the room a sleek, modem look. Eric
leans forward as he speaks, making sure the tape recorder catches
his words. :'1 remember my mother saying I wasn't going to be noth
ing!" he thunders.
He is unaware of how often he raises his'voice when he taJks about
Rosa Lee. "My mother makes me feel like lowe her something, and I
don't think lowe her anything!" he says. He focuses mostly on her'
mistakes; he's too angry to see any of the obstacles she faced.
Evictions forced Rosa Lee to move the family in 1961 and 1962,
and Eric attended three schools for kinderganen. first and second
grades. He fell behind; some days, he didn't go to school at all.
Soon after the faffiily moved to Ninth and F streets NE in the fall
of 1961, the principal at nearby Goding Elementary School spotted
Rosa Lee's children playing in the street one day during school' .
hours. Rosa Lee hadn't enroDed them yet. The principal knocked on
Rosa Lee's door and told her, :'1t's not pennitted to let your kids run
around without being in school." She registered them the next day.
Eric was assigned to second grade and Alvin to fourth.
Halfway through elementary school, Eric told one of his teachers
that he was having trouble learning to read. He remembers the
teacher telling him, "Don't worry, you'D get it in the next grade." i
Rosa Lee wasn't much help. She had dropped out of school in the
seventh grade and couldn't read weD enough to help her children
with their school work. On many days, she wasn't home when Eric
and the other children returned from school, so she wasn't there to
check on their homework.
Eric often found himself the target of taunts at school. Rosa Lee
was selling some of her shoplifted goods to the parents of Eric's
classmates. Word got around. "Your momma steals!" he remembers
some of his new classmates yelling.
Eric couldn't shrug off the teasing as easily as Alvin. :'1 fought
quite a bit." he said. :'1 fought boys, girls. It didn't matter. If they
were too big, I'd throw bricks at them."
Worst of all, he suspected the taunts were true. "My mother would
leave the house empty-handed in the morning and cOme back with
four shopping bags of anything you can name." he said. ·Clothing. Ap
pliances. Curtains."
One day, he remembers saying to Rosa Lee, "People say that
you're stealing stuff."
Rosa Lee didn't deny it.
"Why do you do that?" he asked.
"So you can eat!" his mother said.
"But Ma, we're eating every day!" he said.
Rosa Lee said her welfare check was too little to feed and clothe
aU eight of them. but that didn't satisfy Eric. '1 just never understood
why she had to do that, but I think I was really affected the older I
got." he says now. "I really started feeling and knowing the meaning
of embarrassment."
Disillusionment
A
mid the constant tormoil, Bobby represented stability and order.
Rosa Lee often left her oldest son in charge when she went out,
and he did his best to make sure the children did the dishes and went
to sleep at assigned hours. Although Bobby was just 13, Alvin and
Eric saw him as the father they never had.
That began to change in 1964. Police caught Bobby breaking into
a drugstore at 11th Street and Constitution Avenue NE. He was sent
off to the city's institution for juvenile delinquents on Mount Olivet
Road NE. At the time, Alvin and Eric didn't know that Bobby and
�·seYeiiii of his friends had been bUfglarizirig stores and schools for
· months..
· A schoolmate taught Bobby how to break into stores. "The first
r store we got was Circle Music. if you remember that on 11th and H..
Bobby told me dllfing an interview at Lorton prison, where he has
serVed several sentences tor theft and parole violations since 1974.
~. "I went in there from the roof and got about two or three thousand
· dollars worth of musical equipment. Lord knows I didn't know what
to do with it.... I took it back up to my Morn and said, 'We'll have
some money now!' •
.
The family was living in a row bouse at 11th and C streets NE,
along with Rosa Lee's mother, Rosetta, and nine of her children-I9
people in all. Rosa Lee was looking over the equipment in the base
ment when Rosetta appeared on the stairs.
.
Rosetta immediately understocxl the scene. She kicked off one of
ber slippers, grabbed it and smacked Bobby on his backside. She
: screamed at Rosa Lee to get the stolen equipment out of the house.
That night, Rosa Lee passed the word to several musicians at the
club. They bought everything tor $275. Bobby remembers that Rosa
" Lee gave him $200. It was the most money he had ever seen. He
'. gave her $50 and split the remainder with two friends who had
, helped in the burglary. Over the next several years, he broke into
• more than a dozen stores. schools and chllfCbes.
· Then, six months after Alvin's 12th birthday, Rosa Lee was ar
rested. for stealing a coat from a Montgomery Ward's in Prince.
• George's County and jailed in a Maryland prison for eight months.
, Uponber. release, she collected ber children from her; mother and
~ began a series of moves that took the family to five apartments over
.
the next three years.
Finally, in 1968, the family settled into a two-story apartment on
: 57th Place SE, part of the sprawling public housing complex in Mar
shall Heights near the District-Maryland line. Alvin enroUed at Evans
· Junior High School, where he met a teacher who saw something in
~ Alvin-'and he set about to help Alvin see it too.
·'------.••Eg~:,~·'~g[i!~iJlii'~9~••r----
'G
Alvin ~ Friend
artreU Franklin remembers the exact date that he met Alvin
"
Nov. I, 1968, Franklin's first day as a history teacher in the D.C.
,;public schools.
~ Both were newcomers to Evans Junior HighSchool, an imposing
: red-brick building on East Capitol Street in Southeast Washington.
Gartrell was 23. fresh from Howard University and bUfsting with en
· ergy and idealism. Alvin was 15. an eighth-grade transfer.
· Alvin wasn't Franklin's best student that first year. But Franklin .
, was drawn to him. "He seemed more mature than children his age:
Franklin recaJled as we taJked about Alvin at Franklin's subUfban
Maryland horne. They have been friends now for 25 years. "He
would ask you things after class. Students didn't normally do that~
Just as the 8-year-old Alvin studied the differences between his life
,and that of his middle-class friends, now the teenager Alvin soaked
· up the guidance and friendship of Gartrell Franklin. His conversa
· tioos with Franklin revolved around black history and the black: c0n
sciousness movement that had gotten started in the 19605. Franklin
organized an after-school Black History Awareness group; Alvin
joined and brought along three of his friends.
It was an exciting and difficult time to be young and black: in Amer
ica. Six months earlier, civil rights leader Martin Luther King Jr. had
been assassinated. His death sparked civil disorders in many major'
cities, including Washington. Stores were looted, buildings bllfned.·
Only a month before King's death, a presidential commission had
:issued its findings on similar disturbances the previous summer in
·Newark, Detroit and other cities. The commission's conclusion was
:stark. "Our nation is moving toward two societies, one black:, one
:white-separate and unequal,· its finaJ report stated. "Discrimination
and segregation have long permeated much of American life; they
now threaten the future of every American.·
. In this atmosphere, Frankiin preached against drugs and pushed
Alvin and his friends to make something of themselves. Alvin re
members Franklin saying over and over: "Get that education. You
need that education!" Franklin was the first person in his life to em
phasize the importance of education, Alvin said.
The boys regarded Frankiin as more than just a teacher. "He said
all the things that a father, if he were there, would say and do; Alvin
said. None of the boys had much, if any, contact with their father.
The boys wanted to know everything they could about every black
leader, living or dead, in America. The boys even visited Franklin at
horne on Satllfday afternoons. They talked about the Black: Panthers,
Malcolm X and the Nation of Islam and King's Poor People's Cam
paign. They hung on Franklin's every word, Alvin said.
He listened to Franklin because he was educated and forceful. "He
always carried paperwork around with him; Alvin said. "He looked
like a professor. Upright! Strong!"
Then, on a spring night in 1969, Alvin put his futUfe in jeopardy.
�lilin
prostitutes who lived near Rosa Lee's apartir';ent offered
'a d~' "
Would Eric like to work for them. procuring customers? Eric agreed:
"l used to set them up with old guys," he said, his voice conveying
a tone of wonderment at his owo behavior. "I didn't fully understand
what I was doing. They liked me because they said I did not treat
them badly:
After several weeks, he bragged to McAllister about what he had
been doing. He was not prepared for the blistering lecture that fol
lowed. He doesn't remember her exact words. but he remembers
how humiliated he felt. "She just said. 'What do you think you are da
ing!' " He stopped working for the prostitutes soon after.
Eric and McAllister have stayed in touch. Eric credits her and
Hank Wilson with steering him away from a life of crime. "I was on
my wa~ to jail, he said. "They showed me a better way of ~ving.
They showed me the positive side of life: I already had the negative.
They showed me what was possible if I just cared about myself."
Bobby invited him along on a school burglary; for reasons he can no
Imfger fathom, Alvin said yes.
A1Vir, waited outside while Bobby and another boy broke into the
. S€hOOl. In the still night air, he heard the wail of a po~ce siren. Some
,lone had spotted them. Bobby and his friend emerged from the build·
ing, empty-handed, and they all ran.
Alvin eluded the police by hiding in the bushes of a nearby back
yard, where he found himself face-to-face with a stanled German
shepherd. Even in his terror, he was angry at himself. He hadn't sto
len anything. He hadn't even gone into the building. Yet here he was,
fleeing ·the police. "l knew I would have been charged if the police
would have caught us." Alvin said. "From then on, I knew I had to'
.inlIke a drastid:hangein ipy life to stay away from this atmosphere:
Eric~
Mentor
'That~ My
he 196&-69 school year also marked a turning point for 12-year
old Eric.
Until: then, Eric had found school an exercise in frustration and
anxiety: He prayed every day that teachers wouldn't ask him to read
aloud. If they did, he would create a diversion "by saying something
smart and getting in trouble." He often ended up in the principal's of
T
fice;,.
.;",
.
n a July afternoon in 1991. Alvin and I are talking at his house,
reflecting on all that has happened to his family in the last 20
years. He and Eric went into the Army after their 18th birthdays,
served two-year stints and came back to Washington to find the fami
ly in the grip of drug addiction.
"l didn't let drugs grab me," he says softly. "They were there. My
friends were using drugs. I'd seen them shoot needles into their
arms. Heroin. Cocaine. See, I was around it. I've seen them wrap a
, belt around their arms and pump the veins up. 1saw it. I ignored it. I
couldn't see myself doing it. My friends respected me. They would
say, 'He don't do it!' ~
He is pleased that Rosa Lee, after years of heroin, has enrolled in
a methadone treatment program and is sticking to it. Like Eric, he is
tired of Rosa Lee's calls for help, tired of rushing over to her apart
ment to act as a referee in a game that never ends, tired of holding
money for her so that Ducky or Patty or Richard won't be able to get
their hands on it.
There is a story that Eric tells about the divergent paths that he
and Alvin took from the rest of the family. It happened in 1982, while
Eric was working brie/ly as a D.C. correctional officer.
Getting the job made him feel good. Not only had he established
himself as a law-abiding citizen. he was DOW being entrusted with the
responsibility of guarding those who had taken the path he had avoid
ed. "I felt great," lie said. "l was in the government!"
He was assigned to one of the Lorton prisons, but he often picked
up additional money by taking an overtime shift at the understaffed
D.C. jail. One night, he saw Rosa Lee. She was locked up on a shop
lifting charge.
She spotted Eric in his navy blue uniform and shouted out excited
ly to the other prisoners.
"That's my son'" she said in a voice filled with pride, as Eric stood
by, embarrassed. "That'SJIlY son!"
O
.
Then he transferred to Shadd Elementary, where he met sixth
grade teacher Hank Wilson. "He worked with you all the way to the
point that you could understand what he was teaching.~ Eric said.
Eric confided in Wilson tluit he had trouble with reading and spell
ing. Wilson gave EriC specia1 exercises to create sentences using the
words Eric knew; When Eric accomplished the task, Wilson took him
out for pizza as a reward.
Wilson told Eric that the exercise demonstrated that Eric had an
. aptitude for learning_ No other teacher had ever said that. "l felt
. great about myself: Eric said. his voice still reflecting his excitement
25 y~ later. "I even went to school! I'd get up early and go to
sc:hooIl" . " ."" ,,',. .."
.
Eric's sudderi enthusiasm for school ended when he graduated
from Shadd and entered. seventh grade at Evans Junior High School.
No teacher encouraged him or worked with him as Wilson had the
year before. He remembers being placed in an ungraded class with
unruly, slower learners. He stopped going to school, and Rosa Lee.
didn't intervene.. .; .•
About this time, social worker Nancy H. McAllister wa1ked into
his life. She came to Rosa Lee's apartment one morning to check on
15-year.old Richard, who had just returned home after three weeks
at the juvenile detention center for burglarizing a Marshall Heights
home. ,
As a frequent visitor to Washington's poorest neighborhoods.
McAllister wasn't, surprised to find several of Rosa Lee's children at
home during school hours. "For three or four families on that street
at that time, school was not a priority," McAllister told me during an
interview. "The children knew that their parents wouldn't bother
.
them too much if they didn't get up."
McAllister asked Eric why he wasn't in school.
"He carne out with some flimsy excuse." McAllister recalled.
Then Rosa Lee chimed in. "They won't listen to me. I try to get
them up. Maybe you could do something."
McAllister did not believe Rosa Lee's protestations. She sent Eric
back to Evans Junior High that afternoon.
Eric latched onto her as a mentor, frequently dropping by her of
fice at Shadd, his former elementary school. She gave him books; he .
eventually told her that he had trouble reading them. She arranged
for him to be tested and found the results significant: They showed
that Eric had no apparent learning disabilities.
She persuaded him to accept tutoring on Saturdays. Over the next
18 months, she drove him to the tutor's house. Gradually his reading
improved, although it never became easy for him. Still, McAllister
was pleased.
,
It wasn't McAllister's job to keep up with Eric. She did that on her
own. She saw something in him-a strength of character-that she
wanted to preserve. But she was fighting against forces outside of
her control.
One force was sexua1 activity. In the spring of 1970, Eric learned
that he was about to become a father. He was 14-the same age as
Rosa Lee when she gave birth to Bobby. As soon as the pregnant
girl's mother told him, he went to Rosa Lee. "My mother had no
problem with it," Eric said. "Alvin had already gotten someone preg
nant."
Alvin's daughter and Eric's son were born about 10 months apart.
Eric now thought of himself as a father and too "grown" to go to ju
nior high. McAllister implored him to stay in school, but Eric had
made up his mind. Alvin already had dropped out; at the end of the
school year, he quit too.
He passed the time by hanging out on 57th Place. Three female
.. ::
Son!'
~~"---
"
About'This Series'
n 1932, in the midst of the Great Depression.
Lee
grandparents and
up
I Cunningham'ssharecropping life forparents gave Rosatheir
North Carolina
an uncertain journey
north. Rosa Lee is the link between past and present, be
tween a world that has disappeared and the one that her chilo
dren and grandchildren face today in Washington. Her life
spans a haIf-centurY of hardship in blighted neighborhoods
not far from the majestic buildings where policy-makers have
largely failed in periodic efforts to break the cycle of poverty.
Many of Rosa Lee's relatives, including two of her eight
children, managed to secure footholds in the mainstream of
American society; their relative success makes it aU the more
important to try to understand Rosa Lee's life. Although her
story is discomforting and disturbing. she wants it told. "May.
be I can help somebody not foUow in my footsteps," she says.
Thilt story-of the choices she had and the choices she
made-offers a chance to understand what statistics only
suggest: the interconnections of racism, poverty, illiteracy,
drug abuse and crime, and why these conditions persist.
The.series, edited by Steve Luxenberg, The Post's assis
tant managing editor ~ for special projects, began Sunday.
Sept. 18 and will run through Sunday. Sept. 25. The Post·
welcomes readers' written comments or phone calls. If you
wish to leave a recorded comment, please call PostHaste at
202-334-9000, Category 4646.
�-.
"
ROSA LEE'S STORY
Frida
POVERTY AND SURVIVAL IN WASHINGTON
. ~3
Daughter Travels the Same Troubled Path as Rosa Lee
, Suth of eight arlicles
By Leon Dash
W~Poot_WriW
atty Cunningham is sitting up
in her mother's bed, dressed '
,
. in her mother's white
nightgown and surrounded by
,
her mother's belongings. At
34, she is very much Rosa Lee
Cunningham's little girl. Rosa Lee
bustles around the bedroom,
straightening this and dusting that, '
although the room is as clean as ever.
Patty's feeling r,nuch better today
than she did yesterday, when she ran
,out of money and went into heroin
withdrawal. Yesterday was a day to ,
forget, a day of sweating, watery eyes
and a runny nose. When Patty awoke
this mild morning, June 16, 1~92, she
was ready to face the world again.
, Later on, she hopes, her friend Steve
Priester wiII give her money that she
can use to buy drugs.
Priester is lounging in a chair,listening
,as I interview PattY. He is one of Patty's
three "boyfriends,~ as she caUs them.
They've known each other for about nine
mOilths, ever since he moved into an
apartment on the ground floor. When
Priester's roommate kicked him out in
, December 1991, Patty invited him to
stay with her for several weeks in Rosa
,', Lee~s~oom!lpartment:
';
P
AN EMBRA~E: Patty q~~ ,
adulthoOd living UJith'lier
",
' :'\
,)
..
'"
PHOTOCOPY
PRESERVATION
Patty knows little about him, except
that he is 57 and comes from West
Virginia. He receives some sort of
monthly check, which he is eager to
spend on her. In some ways, their
relationship is simple enough: She sleeps
with him, he gives her money. That is
Patty's relationship with many of the men
she brings to Rosa Lee's apartment.
But Priester wants more than sex.
He tells Rosa Lee that he loves her
daughter and that he intends to break'
Patty of her drug habit. His declarations
seem odd because he knows that his
money ends 'up fmancing Patty's drug
use. Still, his concern for her seems
genuine.
More than once, Rosa Lee has
complained to Patty about her
prostitution. She can't understand why
Patty, who is carrying the AIDS virus,
makes no attempt to protect herself or
anyone else. Patty doesn't tell anyone
that she is HIV-positive, and it angers
Rosa Lee that Priester and one of
Patty's other boyfriends don't know.
Rosa Lee engaged in prostitution
herself when she was younger, before
anyone ever heard of AIDS. She did it,
she said, primarily to feed her children,
not her drug habit. There is a
difference, she said. Now. at 56, it kills
her to see her daughter travel this road.
"Patty inakes me so shamed: Rosa
See ROSA LEE, AI2, CoL I
�'.
Patty's ties to her mother run deep
Lee said one day. "I tell her, 'When you go outside, Patty, don
feel those people talking about you? Don't you feel it?' "
And what does Patty say? I asked.
Rosa Lee's lower lip trembled, the way it always does when she
,upset. ·She says, 'Momma, don't get mad at me. Ain't that the
you did it?' "
CHAPTER ONE
"Y
Meeting Patty
ou;re going to have to take off that damn tie and jacket
fore we go in there," Rosa Lee said as I parked my car
side the three tan brick buildings that make up Clifton "l"PI""""" "I~h.>!
federally subsidized housing complex.
'That was fine with me. It was a hot, hwnid Sunday afternoon in
1986, and my shirt was already soaked. We had come to Clifton
race to look for Patty; Rosa Lee had offered to introduce her to
I had known Rosa Lee for five months at that point. Our '
ship consisted of several lengthy interviews at the D.C. jail,'
she told me in detail about her family. She was serVing
months for possession of heroin; I was interviewing the jail's
and inmates about drug trafficking inside the jail. She was
share her story, and I was interested in learning how her
fected the lives of her eight children. We agreed to get to~:etllet!af~
ter her release from jail.
Rosa Lee wasn't sure of Patty's whereabouts. She had
through the prison grapevine that Patty had turned over her
Terrace apartment to several New York crack dealers,
using it as a base of operation. In return, they were paying
a day in cash, and $50 worth of crack.
Rosa Lee hoped that her sOn Ducky, who lived on the
one of the Clifton Terrace buildings, could tell us where
staying. The last time Rosa Lee had seen Ducky, he had been
ing for the same New York dealers.
'
Ducky answered our knock. His slight frame was swimmling
badly wrinkled pin-striped, three-piece suit. It was light
collar of his tan shirt was open and darkly soiled. The
shoulders, the weary look in his eyes, the way he moved, all
hard to believe he was 28 years old.
_ '
He listened warily as Rosa Lee explained that I was
writing about the family. He said he had just returned from
"I'm very religious," he said. "I've been born again." As he
about his renewed commitment to Christ, Rosa Lee shook her
as a warning to me not to believe him.
'
Finally; I interrupted. "Your mother has told me that you
powdered cocaine into crack for New York City dealers opE'~ratmg'.:n
out of your sister Patty's apartment in this building and
have been addicted to crack for some time now."
Ducky shot his mother a questioning, aIalmed look.
"I told him everything, Ducky," Rosa Lee said, ·so you can
that 'born again' shit."
Ducky's religious cloak fell away. He said that he and the
Yorkers had split. They had accused him of stealing some of the _
caine and beat him. Now he was trying to sell crack on his own. ',"
Rosa,Lee asked if he knew where Patty was staying.
"Pussycat's," he said.- "
Rosa Lee scowled. Pussycat ran an "oilin' joint" in an apartment}
one floor below, a place heroin users could gather in privacy and rel~,;'r
ative safety. Pussycat charged $3 for entry. She also rented)!
"works"-a syringe and a hypodennic needle-for $3.
',.,
I asked Pussycat's real name. "I don't know her real name," she'-_
said brusquely. "I wish you'd stop asking me about last names and,
real names. People don't want you to know that. You might be set
ting them up to be arrested by the police or something."
'
Rosa Lee rapped hard on Pussycat's door. Someone opened it a
crack. "Hello, Marna Rose," a man's voice said.
The door swung open. When the man saw me, he quickly began
to close it. Rosa Lee stopped him.
-";'.:(;
"He's with me, Bernard," she said with quiet authority.
.';::\,~;
PHOTOCOPY
_ _ _ _ _ _ _ _ _ _ _ _~_ PRESERVATiON
�. Bernl!id"stood aside, Behind him, two women lay on stained,
sheetless mattresses on the living room floor, their bodies limp. We
:,(had found Patty and Pussycat
.,
" It was so hot it was hard to breathe.
"You can go into the back!" Rosa Lee commanded Bernard.
She bent down over Patty, who wore black slacks, a red shirt and
no shoes. "Wake up, Patty, wake up," Rosa Lee said, slapping her
face. "I want 'you to meet someone.' Each time Rosa Lee slapped
her, Patty's eyelids opened for a few seconds.
"This isn't going to work," Rosa Lee said. "You'll have to meet
Patty another day."
A,Conversation in fail
'Two'months later, I finally talked with Patty. I met her at the D.C.
.
jail,where she was being held on a drug charge. Jail meant a forced
, withdrawal from ,heroin, so I didn't know what to expect. But she
. seemed to be bearing up well. She had gained weight and looked noth
. ing like the emaciated woman I had seen on that mattress.
. She spoke rapidly, looking down at the chewed fingernails of her
right hand as She desCribed some painful or embarrassing incident. I
was not prepared for her candor: Within the first hour, she told me
that a male relative had raped her when she was 8. He tlrreatened
to hurt her.if she told anyone, and the assaUlts continued over the
yeara. I later confirmed her account with the relative, who agreed to
discuss it as long as 'he was not identified.
.When Patty was a teenager, several of her brothers found out '
about the 'relative's behavior and beat him soundly, they said.
The first. rape happened in 1966, while Rosa Lee was in jail,
When Rosa Lee was released a few months later, Patty tried to tell
'her about it, but she didn't know how, Looking back, she said she
believes her. mother should have known something was wrong,
should have:wondered why, the man was hanging around her room•.
'''I feel like she could .have done something to stop it; Patty Sdid.,
~," ~,,;ld.'::~;{k;)~~~;}:;;'·~"·'
: '.
~: ,:{>t;""'I, ,.,"~' ".~.
H:ft1:; i3111:1;1#
,
.
'::":n~-Uiibreakable Bond
the time Patty was
in
1958. Rosa
boys.
Lee named
but no one
Byfive children, all When RosawasJanuarysheher Donna,Leeasalready has ..
ever blIed hei that:
she
little,
was known "Papoose,"
born
had
becauSe Rosa Lee thought the shape of her eyes resembled those of an
American Indian baby. Over time, Papoose became Patty.
When she was young, Patty had long, straight hair that Rosa Lee
liked to twist into a single braid down her back. She had her moth
er's dark skin and her father's round, cherubic face. Otherwise.. her' ,
. flither didn't have much of a role in her life; when he died in 1982;
' .
Patty didn't even consider attending his ~eral.
Things might have turned out differently. Rosa Lee met Patty's
father, David Wright; in the mid-1950s. They had.a long relation-,
ship that lasted until the early 19605, and he fathered tlICee ot'Rosa
Lee's children. But he never lived with the family. "Back in them
days, the welfare didn't permit no man to live with you," Rosa Lee
.said. "That's how I lost him. We were going to try to live together,
but the welfare wouldn't let us."
The man had a job, but Rosa Lee didn't see how they could make
it without welfare. Eventually, the man married someOne else. Oc
casionally, when Rosa Lee needed money, she would gather up the
children and march them over to his house. If he was there-and his
wife was not-he would give her $15 or $20.
Home during the 1960s was a succession of row houses :and
.apartments that never had enough beds for aU the children to sleep
, alone. The boys shared mattresses, while Patty often slept in her
mother's room and, at times, the same bed. At bedtime. Patty usnal
Iy had the room to herself because Rosa Lee worked nights as a
waitress at the Cocoa Club and as a dancer at the' 821 Club, two
popular spots on H Street NE.
.
On many nights, Rosa Lee brought home some of the customers,
who paid her for sel(. Rosa Lee didn't try to hide her prostitution from
the older children. Afraid that some of her customers might rob her,
she enlisted the help of her oldest son, Bobby. He was 11 when she
started bringing men home. She remembers telling him, "You're Mom
ma's little man. You have to help me. I'm doing this to feed Y'all!"
She would telephone ahead and instruct Bobby to meet her at the
door. As soon as she entered the apartment, she demanded that the
man pay the $20 in advance. Bobby took the money and hid it. "I didn't'
want one of these 'tricks' trying to take the money back or something
like that; she told me. "That was a rough crowd that came to those H
Street clubs. It was just me and my kids iII that house!"
Bobby didn't challenge. his mother's explanation. "I didn't see it as
having anything to do with sex," he told me. "It was all about making
money to feed us. It was all about us surviving as a family."
Survival is a word that RoSa Lee often usee to explafu her actions, I'
a hattle-hardened shield that she puts up to fend off further discus- .
sion. "You keep talking about prostitution," she said heatedly, one· !
day:"I saw it as.survival."
'
I
Rosa Lee had sex with the men in the same room where Patty often
slept; from a young age, Patty learned the art of pretending to be
,
asleep. It could have driven a wedge between mother and daughter,
but those nights in the dark seemed to forge an unbreakable bond.
In 1969, when Patty was'U, one of her mother's customers
i'·
made an unusual request: He asked Rosa Lee if he could have sex
with Patty.
t
There's no way to recapture exactly what went tlrrough Rosa
Lee's mind as she considered this request. It is not something that
1,\
she wanted to remember or talk about. Mer Pattr tOld me about it,
I waited a long time before broaching the subject with Rosa Lee.
When I did, she angrily denied that it ever happened and accused
Patty of lying. She was sure that if I asked Patty again in her pres·
l
ence, Patty would admit that it was alie.,
.'
Several months later, I gingerly raised the issue' while the three
of us were eating lunch. .
_
-. :
j
, Rosa Lee,turned to Patty and waited in silence for her daughter
to answer. .
. ' ,
Patty looked her mother in the eye and name(fthe.man.
.
Rosa Lee began questioning Patty, as if getting more facts might '
help jog her memory. "How old was you, Patty?" and "Was I on
'
drugs then?" and "Did he approach me, or did he approach you?"
"He approached you about it," Patty said calmly. "Cause I was a
I
little girl. You asked me about it,and,1 said; 'Yeah, I want to help
1
you: Remember,that? You were feeding everybody and doing it all
j
on your own."
Rosa Lee turned toward me. There was pain in her eyes. ·Okay,"
~
'she said. "I just feel so shamed."
\
Piece by piece, the story ,came out. Patty said her mother asked
l
her to have sex with the man, who was then in his mid-forties. Patty:
agreed. Rosa Lee told the man it would cost $40-twice as much'as ~
, she had been charging him. The man then drove Patty to his CapitoI-}
•
~
Heights home. When Patty returned, she put two $20 bills in Rosa' 1 . 1
Lee's hand.
.
. '"
_.','1
There. were other men after that, perhaps as many as' a dozeri;.
.[
The men offered to pay inuch more than Rosa Lee's usnal rate;' I ,I
$100 or more, amounts that made Patty's head swim: Patty said her' i i i
mother always asked her if she was willing. Patty never turned·lier'
mother down. "I went with 'tricks' for my mother," she said. "I saw
how hard it was for her to take care of all of us. I love my mother, so:
I would do it all over again.... At times I wanted to hate her, but I
couldn't see myself doing that 'cause my mother's too sweet for
that."
. ,,'
!
t.
I
l.,.··.
1
I
I
1
r
i
i
'f ';
Trouble at School
~{
s a third-grader at Shadd Elementary School in the fall of 1969, ",I
Patty stood out for all the wrong reasons. At 11, she was tlrree
"II
years older than most of her classmates. She couldn't read. Her at
tendanrewas,spotty. She was headed for trouble, and her teachers
didn't know what to do about it.
.
A
!
�~.'
.
.
-
-
... -
.
-
~
."
-
- .._
..
_
'. -, ... ......
~
~.
-:
.
,
,Nancy H. McAllister, a social worker who had an office at Shadd
that year" tried to intervene. McAllister already knew the family.
She had been assigneq to work with Patty's older brother, Richard.
, 15; he had just returned home after serving time in a juvenile deten
tion facility for burglary. McAllister established relationships with
four of Rosa Lee's children. Eric, who was 13 when he met McAllis
ter, credits her with helping him to make something of his life and
avoid drug use and criminal behavior.
'McAllister made frequent visits to Rosa Lee's apartment during
the day, and she often found Patty there. Rosa Lee would teD her
that Patty was sick, but McAllister didn't believe it. "I'd see her just
laying around in bed," she said. '1 would get her to go to schoo!."
But what concerned McAllister most was the way Patty dressed
on Fridays. '1 remember being so amazed at this girl: McAllister
said. "She used to come to my office in a wig.... She always wore
tight, short skirts_ At 11, she was very shapely.~
McAllister asked Patty why she dressed the way she did.
. '·Oh, this is my evening to do my thing," McAllister remembe'rs
.
Patty saying.
"What thing?" McAllister asked.
'''Dh, you know," is aU Patty would say.
"She was reaDy beyond her years," she said. "The kinds of things
that she would talk about were not kid things." McAllister suspected
something was wrong, but she had no conclusive evidence that she
Could report to authorities. Besides. Patty wasn't the only student
whose home life seemed troubled. "The teachers probably had 10 to
12 other kids with the same kind of background. It was just over
whelming."
" Rosa Lee didn't even enroll Patty in school until she was 7 or 8.
The other children teased her because she couldn't read. "Girls used
to do it aU the time in front of boys who might like me. 'SpeD cat!
Spell II' ~
,
'Change the name and go backward 20 years, and it's hard to teD
the ,difference between Patty's school record and Rosa Lee's. Both
fell behind at an early age. Both began skipping school regularly.
Neither one had a parent who believed education was important.
Neither one learned to read by the time she dropped out.
'
There's one more parallel: Rosa Lee was 14 when she gave birth to
Bobby, her first cbi1d. Patty was 14 when her son, Rocky, was born.
And like her mother, that's also when she dropped out of school.
l."
Ties That Bind
P
atty learned ,about drugs much the same way that she learned
, about sex.
,She was about 11 years old. She had noticed that her older broth
er, Ronnie, 17, and his girlfriend would lock themselves in his room
in the afternoon: Patty wondered what they were doing. One day,
when she should have been at school, she hid in the bedroom closet.
Ronnie and his girlfriend hurried in. They took out a bag of white
powder. cooked it into a liquid and filled a hypodermic needie. Patty
had a clear view through the slightly open door. '1 watched Ronnie
put the needle in his arm,n she said.
" After Ronnie had pushed the liquid into his vein, she watched as
her brother's worried frown changed to a look of pleasure.
: She stepped from the closet. Neither Ronnie nor his girlfriend
showed any reaction until she told Ronnie she wanted to try it. "You
better not," he said, "but then again, if you're going to try it, let me
hit you first. ~
Ronnie refused to inject her that day. But, Patty told me, '1 knew
then, 'WeD, I'm a gonus try that one day.'"
That day came in late 1973, just a few weeks before Patty"s 16th
birthday. Early one morning, as the gray-light of dawn seeped into
the bedrOOm where Patty lived with her infant son, she woke up to
find Rosa Lee and another woman huddled in a comer. Patty pre
tended to be asleep and watched.
'She saw the woman prepare some sort of liquid, draw it into a hy
podermic and inject Rosa Lee. Then, using the same needle, she in
jected herself. Patty wasn't sure what drug they were using, but she
was sure that she wanted to try it.
PHOTOCOPY
PRESERVATION
.
�" .
an. aJinphetalliline-like
that produces:a feelirig of
and high energy. RoSa Lee' .
her frienq.ha<lbeen using bam for months. They had tried to hide it
froIl}Rosa·Lee's.children by shooting up,early in the moming, be
roreljllyone was awake. .
.
.
, .Patty sat up in bed, swming the two women. '1 want a hit; she
Bald.
,
.Rosa Lee refused. "You're too young to start drugs," she said.
Patty told her mother. that if she couldn't have a hit, she would
find someone in the hallways of Clifton Terrace who would pay her
for sex and use the money to buy the drug on her own.
As Rosa I:.ee teDs me about this critical moment, she looks
pained. She says she did too much "dirty living." that if she hadn't
used.drugs, her children wouldn't have either:.But at the time, she
felt as if she had no choice, that she.had no way to stop Patty from
traveling the Same·road she had.
.
"Give her a hit,? she told her friend.
A year later, patty graduated to heroin. A year after that, so did
Rosa Lee. For the next 15 years, they shared heroin and needles.
. Now, there is'yet another tie that binds: Both are carrying the vi
rus that causes AIDS.
;
"
~ife'Wzth
Patty.
t is a July moming in 1992, and Rosa Lee has Patty on her mind.
We are having breakfast at McDonald's, as we often do after Rosa
Lee's .visit to the methadone clinic. Rosa Lee is upset: Her latest
urine sample was "d,irty"-the second time she has tested positive
for heroin in recent months. One more strike and she would be re- .
quired to appear before a team of counselors, who could decide to
suspend her.from the program.
~. Dash,"..she says, "I can't go back to the way I used to be."
For more than a'year, her urine samples had been clean; she had
such a good record that a market developed for her urine among the
other methadone·patients. In the bathroom, someone would whis
per, "Rosii Lee;'you'cleim?" and hand over a doUar or two: The clinic
didn't monitor the bathiooms closely, so the risk of getting caught
was low. ';'.'~:;/;" . . . , .
.
,- Then, for Some reason,"she began to slip. :Over the next six
months, she used heroin six times. Every time, Patty was involved.
Six times is not' the same.. as a daily habit, but it'sstiU not good
enough.:
.
Patty is part of. the:probIem, Rosa Lee teDs me. If only Patty
weren't addicted to heroin, if only Patty didn't bring heroin into her
apartment, if only.she could get Patty into methadone treatment-if
only she could'do something abOut Patty, then she wouldn't be fac
ing the risk ofgetting:thrown out of the program..
She teUs me that she plans to .take Patty to the methadone clinic .
the next Monday arid.enroD her. Monday comes and goes, without
Patty enrolling,and I hear nothing more about it.
A few weeks later, on Aug. 11, 1992, Rosa Lee is arrested'for
shoplifting several expensive scarves from the downtown Hecht's
store. After spending a night in jail, she caDed the next day to teD
me:about it: She needed money, she said, to payoff one of Patty's
drug debts. The dealer had threatened to hurt Patty.
'
Rosa Lee is planning to plead guilty, I remind her that the last
time she appeared in court; in early 1991, the commissioner had ..
warned her that another shoplifting charge would land her injail for
a long time;
.
- .
On Sept. 2,She 'teUs COmmissioner John W. King that she is
guilty. King listens intently as her crimina1 record is outlined-a to
ta! of 13 convictions for shoplifting and drug-related charges-and
then pronounces sentence: two years probation.
Rosa Lee decides to celebrate. On the way back to her apartment
in Washington Highlands, we pick up a pizza. Lucian Perkins, a Post
photographer who has been working with me since the beginning of
the project, arrives.
Patty is happy to hear the good news. As we eat, I notice a flurry
I
activity. There's a knock at
door.
a drug
,on the first floor. He and Rosa Lee talk quietly and the dealer
leaves. I assume that Patty has persuaded Rosa Lee to buy her a
bag of heroin. Sure enough, Patty beings out a metal bottle cap, mix
es some powdered heroin with water in the cap, and heats it with a
match, She injects herself in her abdomen.
Patty motions to Rosa Lee to lie down. To my surprise, she does.
Using the same needle, Patty injects her mother in the leg.'Her
eyes flutter for a brief second, and our eyes meet.
Patty has aUciwed Lucian to photograph her before while injecting
heroin, but this is the first time that he has seen Rosa Lee do it.
Over my left shoulder, I can hear the whir and click of his camera.
. When we leave, neither Patty nor Rosa Lee say anything about what
has happened, and neither do I.
When I return from a few days of vacation, there is an urgent
message on my answering machine from Rosa Lee. I caD her. As
soon as she hears my voice, she .interrupts. "I want to apologize. I
know you didn't like what you saw. and I wanted you to know I'm
sorry. Very sorry!".
.
"You don't have to apologize to me; I teD her .
·You can try that on someone else, buddy," she says. "I saw. yone
face when Patty hit me. You were in front of me. I saw yone eyes!
I'D never let you see me take another hit!"
I hadn't realized I had shown any reaction, even though it was dif
ficult for me to watch. Nor was I prepared for her apology. After aU,
she had told me about other slips. Why did it matter so much if I saw
it rather than heard about it?
•
But it did matter. To Rosa Lee, it mattered a great deal.
Over the next several months, the slip-ups stopped. She began
badgering Patty once more about having unprotected sex with
Priester and other men'. She talked about moving again-this time
to a senior citizens' housing complex-to get away from the drug
traffic in her apartment. "
Rosa Lee had tried to cut ties with Patty before, without much
success. This time, she told me, would be different: She would make
arrangements for Patty to take over her apartment; Patty would
pay the $64 rent out of her welfare check.
I asked Rosa Lee what she would do if Patty spent the money on
drugs and lost the apartment.
"Mr. Dash, that's her business," she Said. "I dOn't care.".
About This Series
n 1932, in the midst of the Great Depression,
~
I Cunningham'ssharecropping life forparents gave Rosatheir
grandparents and
up
North Carolina
an uncertain journey
north. Rosa' Lee is the link between past and present, be
tween a world that ·has disappeared and the one that her chil
dren and grandchildren face today in Wasbington. Her life
spans a haif-century of hardship in blighted neighborhoods
not far from the majestic buildings where policy-makers have
largely failed in periodic efforts to break the cycle of poverty.
Many of Rosa Lee's relatives, including two of her eight
children, managed to secure footholds in the mainstream of
American society; their relative success makes it aU the more
important to try to understand Rosa Lee's life. Although her
story is discomforting and disturbing. she wants it told. "May·
be I can help somebody not foDow in my footsteps," she says. .
. That story-of the choices she had and the choices she
made-offers a chance to understand what statistics only
suggest: the interconnections of racism, poverty, illiteracy,
drug abuse and crime, and why these conditions persist.
The series, edited by Steve Luxenberg. The Post's assis
tant managing editor for special projects, began Sunday,
Sept. 18 and will·run through Sunday, Sept. 25. The Post
welcomes readers' written comments or phone calls. If you
wish to leave a recorded comment, please caD PostHaste at
202-334-9000, Category 4646.
�'SetJw,daYl &pt. ~4,
ROSA LEE'S STORY
I.:
POVERTY AND SU~VIVA~ IN WASHINGTON
I
:.A Grandson'.Y Problems Start Early ..
Seventh ofeight articles
By Leon Dash
W-....IUtSllllWriIer
' R o s a Lee Cunningham sensed
,,
that something was wrong
, ' as soon as she stepped off
.. .,
the A-6 bus and started to
.'
walk up Fourth Street SE.\
',On most swmy afternoons, the drug
: market outside her apartment building
, ,:' is in full swing. But on this Saturday,in
,jwte 1991, the crack dealers who
., usually congregate on the parking lot
,'" and sidewalks were nowhere to be
, "seen.
Squinting in the midday son, Rosa
',,' Lee scanned the street. To her
, , surprise, she spotted two of her "
grandsons, 11 and 12 years old,
standing at the entrance to the parking
lot One was looking up Fourth Street,
the other down. Across the street, in a
cluster of teenagers, stood another
,
grandson, 18-year-old Junior. Rosa Lee
knew that Junior occasionally sold
crack, but she didn't know why his
, yOWlg cousins were hanging aroond.
"What are you doing?" she demalided
of one of. her, grandsons.
"I gotJunior's back," the ll-year-old
said.
'
"What do you mean, 'You got
Junior's back?' • Rosa Lee sputtered.
Before the boy could explain, Junior
sprinted over.
"Grandma," Junior said. "They ain't
duing nothing. All they doing is earning
a few doUars."
'
"yeah, and earning a little time in
jail," Rosa Lee said.
Later, when I interviewed Junior, I
fOWld that his behavior that day was a
striking example of the dangerous tests
of manhood that occur on the streets of
See ROSA LEE, Al2, CoL 1
REFLECTIONS: Rosa Ute Cunningham sgrandson
Junior ~;in Lorton prison in the spring of 1992. '
PHOTOCOPY
PRESERVATION
1m
�'Don 'tletth~m take mel'
ROSA LEE. Ftom Ai
some Washington neighborhoods and take the lives of so many YOWlg
black men.
JWlior said he had paid the boys $10 each to keep watch for a
neighborhood drug dealer who had been selling crack to his mother,
Patty. JWlior 6elieved the dealer was planning to kill him to settle a
grudge. He told the boys to warn him if they saw the dealer's white
car.
The previoUS day, JWlior had "stepped to· the dealer. "It was a
beef about my mom, at first: JWlior told me. "My mom owed him
money and never paid him. .My mom wasn't ever going to pay him.
So he said that he was going to hurt her. I said, 'Hey, if I catch you,
I'm going to have to hurt yoti.' •
Rather than hide, JWlior had decided to bring the confrontation to
a head. He had to be on the street or lose face. He borrowed two
gWJS from a friend and hid them in bushes nearby; first sign of the
dealer's white car and JWlior would retrieve either the .44 with the
extended clip or the Tec-9, whichever was closer.
Word of the possible shootout had spread through the Washington
Highlands neighborhood, clearing the street of all but the fearless,
the foolish and the unsuspecting. But the dealer never showed up; he
later decided to let Patty's debt go.
Rosa Lee didn't know any of this when she confronted her three
grandsons. She knew only that the drug culture had worked its way
into a third generation of her family.
Junior~
Mask·
nlike his mother and grandmother, Junior has never used drugs.
'"The people who use leave -their minds on the street: he tells
me one day ill September 1991. "I'm not going for that."
The idea .scares him, just as it scared Rosa Lee when she started
se11in& heroin in the late 1950s. For more than 19 years, Rosa Lee
shwmed the drug while selling it to others; when she finally tried
it-at Patty's suggestion-she got as hooked as her customers. Now
she is on methadone, which satisfies her craving for the drug. Patty,
however, is a regular user of heroin and crack. .
As a young boy living in the Clifton Terrace housing complex, Ju
nior watched the stream of men and women come to his grandmoth
er's apartment to buy heroin and inject it. He saw how heroin de
stroyed his mother. Drugs were a fact of life at Clifton Terrace, and
he decided at an early age that he wanted no part of it. "I wasn't in
terested in drugs at all: he says. "When I heard about pot and all
that, I wasn't with that...• I wasn't with all that smoking and get
ting high."
He says this matter-of~fact1y, as if we might be talking about yes
terday's weather. It is our third interview, but I have yet to break
through JWlior's mask. He only lets people see as much of himself as
he wants them to. If someone shouts at him, he rarely shouts back.
His doelike eyes remain blank, his voice stays level, his facial expres
sion reveals nothing.
He smiles, though, when I challenge his reputed ability as an ex
ceDent boxer and an above-average basketball player. "I don't beat
up on old men," he says, offering instead to take me one-on-one in
basketball "any time and any place."
JWliors controUed demeanor resembles that of the teenage "en
forcers· who come by Rosa Lee's apartment once a month to de
mand that Patty and Ducky pay their crack debts. It is the demeanor
that psychologist Richard G. Majors calls "cool pose."
Majors, a researcher at the Urban Institute, has studied the atti
tudes of teenage boys in poor urban commWlities. "The emotionless
ness is nothing more than the notion of masculinity" Majors said.
'"These youths are obsessed with issues of pride and dignity. Never
lose your cool, even when you are fighting. All they have is this enol.
All they have is this mask.n
JWlior's WIele Ducky, one of Rosa Lee's six sons, knows better
than to cross JWlior. Ducky once tried to steal some of JWlior's mon
ey so he could buy crack; when JWlior {oWld out, he wasted n~ ..time
U
PHOTOCOPY
PRESERVATION
�.
." ...:,.'
_~:,:,..:.:...:;, . .: . .~.:o.,;."M:
+~"
t~,
n
....
,
. '
-
.-
."
-.
~
..
__
.
,,
___
,
~
~~
___
~
___
A
.
_._.
~
___
'
__
'__
( ' . '
_
~
in Setting his 6ncle straight. Using boxing techniques that he learned
duririg his years in juvenile detention, he pummeled Ducky until he
had to be poRed away. As his fists flew, his face remained impassive.
'Afterward, 'he showed no sign of anger or satisfaction. Ducky may
have been family, but this was business.
1 don't know how extensively Junior has become involved in deal
ing crack. He tells me that he is working occasionally as an enforcer
for.some of,the neighborhood's top dealers but that he isn't selling
right now because his new 15-year-old girlfriend has asked him to
stop. "She felt it might take me away from her," he says. "I was mak
ing money. I was making over $600 a night. n
Earlier in the week, I had suggested that we go together to see
"Boyz N The 'Hood.n the John Singleton movie about three boys
growing up in south central Los Angeles. Doughboy, played by rap
star Ice Cube, deals in drugs and sees no future for himself; Dough
boy's brother, Ricky, has a chance at a football scholarship if poor
grades and test scores don't get in his way; the third, Tre, has the
brightest prospects thanks to a strict father who has raised Tre with
strong ~ues. An argument over a girl and turf ends with a gang of
boys hunting down Ricky and killing him in a drive-by shooting.
Junior seemed interested in my offer, but before we could make
plans to go, he saw the movie on his own. He doesn't trust me yet. I
may, be brown-skinned like him, but I grew up in a middle-class sec
tion of Harlem and graduated from college. I expect he'll always see
me as just 'a middle-aged man with a graying beard and a good job.
He liked the·movie, he said, because it was real. It reminded him
of Clifton Terrace and Washington Highlands, the two neighborhoods
he knows best. He has seen "guys bumping you just to get some at
tentionff'and then pulling out a gun.
He says he 'identifies more with Doughboy than with Tre. Dough
boy wouldn't back down from a fight; Tre did.
, "I grew up like that,n he tells me. "Tre didn't. Ice Cube was like
"!lie." ..".1::... '.
':,
.
.
··M
"':'::?q:~l!0w He
Grew Up'
,
.Hewas using heroin.Patty.·was 14.she says,time he was 2, histhat·she
was bOrn when
By the
mother
Some days,
she was so high
has a hard time remembering how she performed even the simplest
tasks-changing his diaper, feeding him, getting him ready for bed:
One of Junior's earliest memories is of police br:eaking doWn the
door of RoSa Lee's apartment looking for drugs. He was ~o months
shy of his fourth birthday. "I just remember them knocking on the
door," Junior says. "We all woke up. They hollered, '()pen the door or
:we're going.to chop it down!' "
He remembers the sounds more than the sight: the sound of ax on
wood, then shoes, then the shouts of the officers. One image stays
with him: his grandmother, her hands cuffed behind her back, being
led outof the darkened apartment. Police found 60 bags of marijuana
.that day in Rosa Lee's apartment. She served seven months in jail, ,
records show.
At the time of the raid, on Aug. 18, 1976, Rosa Lee was selling
heroin and marijuana from the four-bedroom apartment, where she
was living with Patty, Junior and three of her other children.
By the time he was enroUed at Meyer Elementary School at age 6,
Junior already had a reputation for being hard to handle. Patty says
she was summoned to school several times during Junior's first
grade year because he was threatening classmates with a knife and
demanding they pay him a dollar.
That same year, 1979, Patty and Junior moved into another Clif
ton Terrace apartment with a man she refers to as her common-law
husband. His nickname was Joe Billy, and he sold heroin on 14th
Street NW. Patty and Joe Billy lived together until 1985, when Joe
Billy died of a stroke while in custody at the D.C. jail.
Junior has always blamed Joe Billy for his mother's heroin addie
tinn, although he knows now that Patty had her first hit three years
before she ever met Joe Billy. "He brought my mom down." junior
says. "That's why I hated him."
Junior remembers the first time that he saw joe Billy and Patty us
_______,. ______..____
._'.=--~~
__
'_'._.~
___
~.
ing heroin together. They had just moved to the new apartment, and
he was walking past their bedroom. He saw two needles on the
dresser and Patty and Joe Billy hunched over a "bright light." They
looked up, saw him and shut the door.
.
,'I Canl Control Him".
. By age 9, junior had a reputation at Clifton Terrace. He hung out
with the older boys in the housing complex-teenagers whob3d
dropped out of school and already spent time in juvenile institutions.
The older boys liked him, Junior says, because "I was vicious Iia.Ck
then. I'd take you out in a minute, whether you were grown or not.
'Cause growing up aronnd Clifton, you grew up like that. Everybody
was wild around there'"
,~..
Occasionally, Junior would do something to annoy Patty and .she
would use her fists to let him know. uJ unior mostly had his way, .but
when I did hit him, I was mostly high," she told me one day at ROsa
Lee's apartment. "I would whale on his ass with my fists!"
, .
To fend off her beatings, he threatened to use his knife on het. He
now says his threats were justified. ·She was trying to hurt me! Sne
was using her fists. I remember she blacked my eye. That was child
abuse, what she was doing....That's my mom and everything, but I
wasn't going to let her hurt me."
. .
By the fall of 1982, when Junior was 10, Patty had lost what iittJ~
control she had over him. He began to commit burglaries with sOme
of his teenage friends; he shared some of his take with Patty and she
used the money to support her heroin habit.
'
Junior was arrested six times betWeen October 1982 and the:fol
lowing swnmer, mostly for committing robberies with a knife. Su~
denly, the outside world became intensely interested in Patty, Junior
and their life at Clifton Terrace.
' . .:
One social worker concluded that Patty was afraid of Junior ani:!
rarely attempted to discipline him; another social worker said the' 24
year-old Patty seemed to treat Junior more like a brother and did'not
take his delinquency seriously. Junior skipped school about half·the
time, missing 87 days of the 1982-83 school year.
:- .
The breaking jxJint came at a September 1983 hearing in juvelu!e
court.
'..
'.
.
.. '
. Patty sitysshe didn't realize until she arrived that the jUdge, ~ii~
was aware of her drug problem, was considering taking Junior away
from her. When the crucial moment came, she found herself giving
up rather.than fighting. "There's nothing else I can do," she remem~
bers telling the judge. "I can't control him. Go ahead and take him.~ .
The judge ordered a U.S. marshal to take custody of Junior, who
remembers the scene vividly. "I went off; he told me. "Started cuSs~
ing, throwing chairs."
. I
A second marshal was called to help. Junior kicked at them, des..
perately trying to work himself free. "Momma," he cried, "don't let
. ' '"
them take me! I'll be good!"
He turned toward Rosa Lee. "Grandma! Grandma!" Rosa Lee
shrugged her shoulders in a show of helplessness.
Junior screamed obscenities as the marshals wrapped their arms
around his chest and legs. Years of anger about his mother and her
relationship with Joe Billy began to spill out: "You let that [expletive]
MAN IN OUR HOUSE! HE MESSED UP EVERYTHING!"
&ile
F
or the next seven years. the government was Junior's parent and
the juvenile system was his home.
His first stop was the D.C. Receiving Home, where officials quick
ly concluded that he needed a highly structured program to help him
overcome his severe educatinnal deficiencies and emotional difficul
ties. He made progress during his two years there, then was sent to
a foster home in Virginia. Within a few weeks, however, he was ar
rested on theft charges with two older boys. After his conviction in
1985, he was shipped off to a juvenile group home in Pittsburgh.
A few months after arriving in Pittsburgh, Junior ran away. Still
only 13, he made his way back to Washington and showed up at Pat
ty's Clifton Terrace apartment. After five days, Patty notified the
city's human services agency. He was shipped back to Pittsburgh.
__________.__ ...
.
_~.
___._______ __., ___
~
~".'_.
__...
_l__ _ _ _ _ _ ••
~
••
'
-.
-'.
~
...
�°For 7years, juvenile syst~m was home
".' .TWice over the next year, he came to Washington for approved
.;viSits. Both times he ended up in trouble. He was caught in a stolen
,Car: He ran away from the counselor' who was supposed to escort
him on the return 'trip to Pittsburgh. He was arrested by police for
possession of a handgun.
By the summer of 1987, the juvenile authorities decided Junior
-tleeded more discipline if he was ever going to straighten himself
out. They sent him to Vision Quest, a program in rural Pennsylvania
for teenage delinquents who have washed out of more conventional
group homes.·"We take the toughest of the tough," said Michael
Noyes, a Vision Quest spokesman.
Developed in the 1970s when pressure began building to do more
'.!tIiaD. .just warehouse delinquents in decaying urban facilities, Vision
!'QUest symboliz'.es the evolution of society's thinking about juvenile
-mine. The program seeks to take troubled youths out of their urban
iittvironments and teach them a new set of values in the wilderness,
'The teenagers learn to "master any environment; Noyes told me
'lInd,thus, the theory goes, build a sense of self-sufficiency and self·
esteem that Will turn their lives around.
~ i' The different quests are modeled after American Indian rites of
·tpaspge, Noyes said, and are structured "to provide the opportunity
'for the kids to reflect on past- behaviors and future goals.
. Junior had a difficUlt time adjusting to. the strict discipline and lim·
!~, He went on l(k!ay hikes with no eating during the day, then
~t a year on a horse-drawn wagon train quest to Florida and back,
itJ~OOO-mile round-trip with 75 other teenagers. The trek itself is
atduQUS, and the counselors impose a wnrk ethic that matches. The
ypuths work with animals, prepare meals, set and break camp, all in
an effort to foster a sense of cooperation and seJf~scipline.
~':"You chop wood,~ Junior said. "You stay in tepees. Then you go on
:a,:quest. A quest is if you want to starve yourself for three days, you
can. Hiking to meet your destiny. After the quest, you go on the
train. You clean the wagon. You clean the horses. And you move,
fi.io.ve, move••.. When it gets cold one place you move 'somewhere
Where it is hot. In that period of time, you're suppose to change in all
!hat time. Then you're out.~.
:::','As far as he was concerned, the counselors and wagon masters
JiltC:l.nothing but contempt for black kids like himself. "There's a lot of
F~judice there," he said. "They used the word, 'nigger: A lot of
them are from Georgia, and a lot of them are from Tennessee. ~
..);le said some tobacco-chewing connselors would get so close to
'hlitl that they would spray brown spittle on his face as they yeUed at
~ He got into a fight with a wagon master for choking him and
~ving marks onbis neck.
.
\:'ls this iI fair description of what he experienced? There's no way to
ij{OOw. Vision Quest officials don't think so, This much is certain: Ju- .
'r\}br completed his quests liut changed little. He went back to the
Pitisburgh group home in 1989 and immediately landed in trouble.
1:I~'. and several friends from the Pittsburgh home stole a car, went
JOyriding and were caught. Junior spent the next nine or 10 months
.iA. the home's '1ock:up," its most restrictive living quarters.
~~:In July 1990, the home's officials decided he had been there long
·enough. "They gave me a bus ticket back to D.C.." Junior said.
C1jj"!
'T!)r'
t·:' ,
'A Nomadic Existence'
-J two police Iofficers came to Rosa Lee's apartroentwhen I hear thata
unior and are stiU getting to know each other
complex with
warrant for his arrest. They found him in a hallway with Rosa Lee's
11-year-old grandson, handcuffed him and took him to the D.C. jail.
Two weeks later, on Feb. 25, 1992, I am interviewing him in a
small conference room at the jail. He is wearing an orange jumpsuit,
,the standard garb for a new prisoner awaiting tria1. There's an irony
to the scene: I first interviewed his mother, Patty, in the jail in 1988,
when she was awaiting tria1 on a drug cbarge.
: Junior doesn't want to say much about the case. I know from court
records that he is charged with attacking Deon Cheeks, 18, on Nov.
30, 1991, at ·Clifton Terrace NW. According to the records, Junior
surprised Cheeks in a corridor about 11:30 p.m., stabbed him and
fled with'$100 that Cheeks had in his pocket. Cheeks was treated for
a cut at a hospital and sent home, Junior says he doesn't have any
j~lla why he's been charged. He says he wasn't anywhere near Clif
ton"Terrace that night. He remembers spending the evening at Rosa
~'s apartroent in Southeast Washington'.
. He says he knows Cheeks-the two grew up together at Clifton
PHOTOCOpy
PRESERVATION
�Terrace in the 19705. He says the police might be confused because
he and Cheeks had a fistfight not long before the night in question.
Junior is upset because no one in his. family has come to bail: him
out. "I don't like. this," he tells me. "I have never been locked down.
I've just been in group homes and Vision Quest. This is the first time
I've ever been in a secUre,jail."
His bail had been set .at $1,000, which meant under court rules
that he needed to post $100-10 percent-to be released. He's par
ticularly mad at his mother and her crack habit. If she wasn't so ad
dicted to that "little nasty stuff, she could have got me out of here,"
~~~
.
Junior won't give up, He reminds me that Patty has tried to commit
suicide several times. and that's proof that she's a danger.
"She just needs someone to pull her in," Junior says. "That's the
ouly thing that's going to help my mom now."
,
But Junior has learned not to rely on his mother·for money. If she
doesn't pay her debts to an impatient crack dealer, there's no reason
to expect thatshe is going to come up with $100 for Junior's bail.
His lawyer tried to get the court to reduce his bail. But Judge
CheryL Long looked at Junior's juvenile record and decided that Ju
nior was "likely to f1ee~ before his trial.
"The defendant dOes not appear to be a stable member of ~ com
munity," Long wrote: "He is 19 years old, has virtually no record of
employment and has lived intermittently with.his mother and ,his
aunt, and with other undisclosed persons prior to his residence with
his aunt_ This is an extremely nomadic existence for a person of his
age.".:,. ',. ,.,'
i.
.
.ReuTiion at the Jdil
'.'
' .
rosecutors held Junior's case for grand jury action; which meant
, it would be, months before he would stand trial. Whi1e he was
waiting. ~ was transferred from the crowded jail to the Modular Fa
cility at Lorton. '.,~'.
"
. , . ,
, He made i::ollect cans to Rosa Lee, pleading for ~lp; he called so
often that ~ stoPped accepting them.
. One day she hands me a letter from Junior and asks me to read it
to her. The letter has capital letters and commas missing in crucial .
spots,.an indication of Junior's writing skills. One test indicated that
he reads at about 'a fourth-grade level, which' is typical for inmates
between ~ ages of 18 and 24, according to a Lorton study.'
;
"Hi how is ~ family?" Junior wrote in a neat and legible script.
"fine I hope. Me I am thinking like this. When I come out I will do
good with some :Help: I mean I will do better with Help!!", '
"my mom I hope she give up coke so she can get her own apart
ment. You ~top the coke from taking your life and you feel good. my
mom needs that feeling.... I will make my mom see the light be-'
cause here make me see it."
Then he returns to his own plight. "I hope God see to forgive me
for the thing I did.... Love you all. God will help the ones who need .
Him. He will help the ones who love him so I will try and help me.·
Junior's concern about his mother is still evident when I see him at
the Modular Facility a few months later. It is early August, and Rosa
Lee and I have come to spend a few hours with Junior and ~r oldest
son, Bobby, who is also locked. up there. '
Rosa Lee embraces Bobby and reaches out to touch Junior's shoul
der. Rosa Lee and Bobby, mother and son, hold each other tenderly
for a long time. Bobby's thin arms rest on Rosa Lee's broad back, a
stark reminder of his recent battle with pneumo~. "I had one foot in
the grave," Bobby murmurs to Rosa Lee.
Doctors feared that Bobby's inunune system had succumbed to
full-blown AIDS. He was diagnosed in 1989; Rosa Lee and Patty also
have tested positive for HIV.
Bobby and Junior listen quietly as Rosa Lee complains about Pat
ty's crack use and her prostitution. Bobby and Junior don't sayany
thing, but when Rosa Lee begins to make excuses for Patty's behav
ior, Bobby explodes. "I don't want to hear it!" he tells her.
"I'm just letting you know how far it's gone, Bobby,~ she snaps.
S~ turns to Junior. "I'm just letting you know how far it's gone,
Junior. I'm sorry, but I have to tell the truth."
Bobby is worried that Patty's luck is going to run out, that one day
she won't payoff her debt and someone-Patty or Rosa Lee or Ju
nior-is going to get hurt.
"Let Patty start dealing with ~r problem," Bobby says, agitated.
Junior jumps in. "When I get out of here, I wish to put my mom in a
program. The one where you are locked down. You can't go out.~
junior wants to have his mother committed to a psychiatric hospi
tal. I point out that the courts can't force someone into this kind of
treatment unless they are a clear danger to themselves or society.
P
'What IHave'Done'.
, ' fterm~ths saying that he knew nothing aOO~t theOn June 7,
'A Dean Cheeks, Junior pleaded guilty to the attack. stabbing
.
of
of
u.s.
1993, the case of
v. Rocky Lee Brown Jr. is called for sentencing
in Courtroom 210 of D.C. Superior Court. Rosa Lee, two of her '
. grandchildren and I take a 'seat near ~ front.
"Mr. Brown, do you have anYthing to say before I pass sentence?"
Judge joho H. Bayly asks junior.
'.
"Yes, I do, Your Honor. I want to say I'm ,sorry, you know, for
what I have done.... I'm asking you to, you know, give me a chance
so that I show that I am sorry for what I have done, Your Honor:
Bayly says nothing in response. No lecture about the lure· of the
streets, no threats about what ~,might do if Junior comes back to
his court on a new charge~ Bayly sentences Junior to two to six years
in prison, but suspends it because Junior has been Ipcked up for 16
months awaiting trial; Then Bayly gets tough: He puts Junior on pro
bation for three years, orders him to work 200 hours of community
service, requires him to seek a job and fines him $500.
"Does ~ have $500 to pay today?" Bayly asks Junior's lawyer,
Fred Sullivan.
'
, "No, Your Honor, actuaUy he's been on a $1,000 'bond since Feb
ruary of '92, unable to pay that bond, so it is .going to take him a
while to accumulate that kind of money."
.
Bayly backs off a Iittle:"Well, I'D make the $500 due by the third
. of June of1994 in its entirety.w .
, .
'T~ prosecutor in the case, G. Michael Lennon, takes note of Ju
nior's troubled background in telling', the judge that Junior must be
held accountable for his actions. '
,
"No one could fail to recognize the problems that he had a child
and as a teenager,W Lennon says, "but what's troubling is all the.in
tervention so far appears to have very little positive effect. And I
, think that some of ~ responsibility for that has to be ·Mr.' Brown's,'
Later, I askJunior what he thought of Lemton's remarks. Junior
replies in a voice edged with anger. ,
"He's saying ~y gave me a lot of help but,that I ain't respond to
none of it,~ Junior says. "I say they didn't give me no help.w
as
About This· Series
n 1932, in ~ nrldst of the GreatDep~n,
I Cunningham'ssharecropping life forparents gave Rosatheir
grandparents and
up
North
an uncertain journey
Lee
Carolina
north. Rosa, Lee is the link between past and present. be
tween a wnrld that has disappeared and the one that her chil
dren and grandchildren face today in Washington. Her life
spans a haif-century of hardship in blighted neighborhoods
not far from ~ majestic buildings where policy-makers have
largely failed in periodic efforts to break the cycle of poverty.
Many of Rosa Lee's relatives, including two of her eight
children, managed to secure footholds in the mainstream of
American society; their relative success makes it all the more
.important to try to understand Rosa Lee's life. Although her
story is discomforting and distUrbing, she wants it told. "May
be I can help somebody not foUow in my footstepst she says.
That story-of the choices she had and the choices she
made-offers a chance to understand what statistics only
suggest: the interconnections of racism, poverty, illiteracy;
drug abuse and crime, and why these conditions persist.
~ series, edited by Steve Luxenberg, The Post's assis-,
tant managing editor for special projects, began Sunday,
. Sept. 18 and will run through Sunday, Sept. 25. The Post
'welcomes readers' written comments or phone calls. If you
wish to leave a recorded comment, please call PostHaste at '
202-334-9000, Category 4646.
�ROSA LEE'S STORY
POVERTY AND SURVIVAL IN WASHINGTON
-----.:---------:----:------~--------- ...-
-
..
8Y t..UC!AN p[Rfi!JHS..-..,THE. WA$HJNGTON POST
'":t ;.
SAYING GOODBYE: Rosa Lie·hOlds a portrait of her sfm Bobby, who died ofAIDS complications, as
she sits in a limousine after h.isfuneral. He had been released from prison shortly before his death.
. gave her money so she wouldn't have to
engage in prostitution, but the money
only fed her drug habit.
Rosa Lee told me that Patty had
admitted to participating in the
robbery. The police had her confession
on videotape. Even if Patty had no role
in the murder itself, she could expect a
substantial jail term.
In the past. whenever something had
gone wrong in her family. Rosa Lee
always fell back on the same litany; I did
the best I could. I did what I had to. I
surviVed.
Not this time. After Patty's phone
calI from police headquarters, Rosa Lee
didn't know what to do. Ordinarily, she
would have called someone for help or
consolation. During the years I have
been interviewing her about the family.
. See ROSA LEE, A20, CoL 1
PHOTOCOPY
PRESERVATION
�"
-
~
-.
. - .
-
-..~---" ~~~-
,~~
_.
~
~
.
.
..
ROSA LEE, From Al
she has called me dozens of times. seeking advice or just a shoulder
to cry on. But after a sleepless night, she called no one-not even
Alvin or Eric. the only two of her eight children who have never used
drugs or broken the law, the.only two of her children upon whom she
can truly rely.
On the night when her daughter was accused of first-degree mur
der, Rosa Lee chose to be alone.
The Videotape
hat same weekend, police filed a warrant in court that more fully
described the murder of Steve Priester.
"On Friday, Dec. 4. 1992, at about 2 p.m.," the warrant began. "of
ficers at the Metropolitan Police Department were called to an
apartment at 425 Atlantic Street SE for a complaint of a burglary.
When police entered the apartment, they discovered the lifeless body
of the victim, Steve Priester,handcuffed and gagged, inside a closet
of the apartment.... He had suffered a bullet wound to the head."
AccOrding to the warrant, police had arrested two suspects and
were looking for three others. Police had learned about Priester's re
lationship with Patty from talking to his neighbors and that she was
the last person seen with him before his death.
Ten days later. in Judge Cheryl Long's softly lit courtroom. the
videotaped image of Patty Cwmingham appears on a television moni
tor. The screen is positioned to give the judge the best view; she has
to decide whether the videotape provides enough evidence to hold
Patty for trial.
Patty is watching too, from the defendant's table.
On the videotape, Patty is sitting at a desk. She is wearing red
slacks and a red blouse. A white scarf is tied around her head. The
date and time flicker briefly, then disappear: "Dec. 4. 1992. 10:10
p.m.~.
.
A detective, identified as Det. Vivian Washington, asks Patty if she
understands why her answers are being videotaped. Normally, a sus
pect is interviewed without a camera present and then is asked to re
view a typed transcript for accuracy and sign it.
"I can't read; Patty teUs Washington.
As the videotape roUs, it is dear that Patty already has told her
story to the police and is repeating it for the camera. She speaks rap
idly and stammers repeatedly. Her account is confusing, but it pro
vides the basic outline of how she became mixed up in the robbery
scheme.
She and Priester were at Rosa Lee's apartment on Thursday
night, Dec. 3. when someone knocked on the door about 10 p.m. It
was Turk, a 16-year-old who lived in the building next door.
Turk said two friends were thinking about robbing Priester. They
had seen Priester around the complex and knew that he spent a lot of
money on Patty. Did Patty know if Priester had any money on him
right now?
Patty said she went outside, where sbe met Turk's friends-a
"tall, dark-skinned dude" and a "short, brown-skinned woman with a
mole on her cheek." IT Patty knew their names, she didn't use them
on the videotape. She told them that Priester didn't have any money
on him.
.
A plan was hatched to rob Priester. at his apartment, where pre
sumably he kept some cash. It would be Patty's job to let the robbers
in.
:
T
PHOTOCOPY
PRESERVATION
�.
,l
. .
; .... ,. ,.", ~
,..'
Fatty tells WaShington that she:agreed to the scheme but only.be-
cause the "tall dude" had threatened to hurt her if she didn't.
About 11 p.m., she says, she walked with Priester to his apart
ment a (ew blocks away. Minutes later, there was a knock at·the
door. It was Turk, his two friends and another man. Patty let them
in. "The tall dude gave me $22 for opening the door," Patty says on
the videotape.
And what was Priester's reaction when he saw the four come into
his apartment and Patty leaving?
"He just looked at me; Patty tells Washington.
Patty's involvement in Priester's death. I try to divert Rosa Lee's at·
tention. "Here comes your president; I say, pointing to the televi·
sion.
"I'm not thinking about that man!" she replies.
The ceremony begins. "/ do solemnly swear . ....
Rosa Lee listens to Clinton repeat the oath. then gets up heavily
from her bed and goes to the bathroom to wash her face.
Life Without Patty
Osa Lee can see my excitement. It is April 1993, and 1have ju~i
returned from a trip to Rich Square, N.C., to research her fami·
Iy's history as sharecroppers. Through census records at the court~
house, I was able to trace her ancestors back to the turn of the cen·
tury. Her family tree has many branches, including several in· the
Rich Square area; I looked up two of Rosa Lee's relatives-cousins
she didn't know-and told them about my study of Rosa Lee and he~
family. They gave me a message for her: Please come for a Visit.
Rosa Lee.has never shown much interest in her family's history,
but she is.eager to do something other than sit around her apartment
and· worry about Patty. The case seems to drag on and on. Police
have arrested three more suspects, and aU five have been indicted on
first-degree murder charges. Patty is willing to plead guilty to lesser
charges and testify against the others, but negotiations are on hold
for reasons that Rosa Lee doesn't understand.
For weeks now, Patty has been calling her coUect nearly every
night. Frustrated at the slow pace in the case, Rosa Lee is grateful
for a reason to leave town.
':: .
She had been to Rich Square only once, when she was 9, !IlIdshe
didn~t have fond memories. She showered me with questions. Did
they still live in those gray, weathered wOOd shacks with the rusty
metal roofs? Did they have indoor plumbing, or were they still using
outhouses?
I laugh. Many sharecropper shacks still stand, 1 tell her, but no one
lives in them. They were abandoned years ago, after the sharecrop
ping system had faded away. Her relatives, 1assure her, have indoor
plumbing.
In early June, on a Thursday morning. the two of us are rolling
along Interstate 95.through Virginia. The methadone clinic has given
Rosa Lee enough doses for a four-day trip. As we cruise along, Rosa
Lee is reminiscing about Rich Square in the summer of 1945.
'. She is fixated on plumbing. The two-room shack where she stayed
didil't have an outhouse. During the day, people walked into the
nearby woods to relieve themselves; always watchful for snakes that
lay in tlie grass. At night, the family used a tin "slop jar." Every
morning, the slop jar was emptied into a freshly dug hole.
"It smeUed!" recalls Rosa Lee with an upturned nose and a shud- .
. der.
The shack resembled the typical dwellings that white landowners :
built throughout the South for black sharecroppers. There was ;I.e
front door, but no front window. In the center of the main room was.
a wood-burning stove. The shack's wooden planks were the only bar:
riers to the outdoors; there was no insulation. Rosa Lee could feel'
the wind when it blew through the spaces between the planks.
The house had three windows, one on each side and one at the '
rear. Rosa Lee remembers rubbing dust and moisture from the: .
thick, yellowed plastic in the windows so she could see outside. Gla~
kerosene lamps provided light at night. There were crates and boxe~
to sit on, but not one chair. Ahand pump outside supplied water. '
Rosa Lee sTrip
R
n New Year's Day 1993, about two
Long held Patty
OforcomplexRosaSoutheast Washingtonweeks aftersubsidized apart
Lee moved out of the federally
ment
in
where she and Patty had
trial,
been living.
..
Rosa Lee had been planning to move for several months, long be-
fore Patty's arrest, but her new apartment hadn't been ready until
now. Rosa Lee was happy to leave; the old apMtment held too many
painful reminders of the deterioration of her family. It had seemed so
chaotic when Patty was there; now it just seemed empty.
Her new place is a one-bedroom unit in the senior citizen's wing of
a building on North Capitol Street NW; she had applied for it after
one particularly bad weekend of fending off Patty's and Ducky's re
quests for money to buy drugs. She qualified not because of her
.age-she was only 56 at the time she applied-but because of her
medical disability.
The new apartment
smells of fresh paint when I arrive a few
weeks later for my first visit. We sit in Rosa Lee's bedroom because
her son Richard is sleeping on the living room couch; he recently got
out of jail, and Rosa Lee has let him stay with her.
Her bedroom television is on, as usual. It is Inauguration Day. On
the screen. crowds are gathering at the Capitol to see Bill Clinton
take the oath of office. Rosa Lee pays no attention. She has no inter
est in politics or goveniment. She has never voted. "It's not going to
make one difference in my life," she told me one day.
In her mind, white people still had all the power. and they didn't
care about' blacks. "I wouldn't go TWO blocks to vote;. she said; "I
have seen too much and hasn't nothing changed. The only thing
that's changed is we don't have to ride in the back of the bus."
There is almost no connection between Rosa Lee's world and the
world of WashinSt0n's policy-makers and politicians. One day soon
after the election, 1 mentioned Clinton during a conversation with
Rosa Lee; she didn't seem to know his name or that an election had
been held.
On the television, Clinton is making his way to the platform for the
swearing-in. Rosa Lee is showing me some of Patty's letters from
jail. The letters are in someone else's handwriting.
"She sounds 'like a child in her letters," Rosa Lee says. "All she
talks about is coming home! Coming home! It's almost like she
doesn't realize what she did!"
Her lower lip is trembling. "She didn't kill him! She was drunk. I
know Patty when she gets drunk. She's just like a little child. I don't
think I ever let her grow up. ~
Rosa Lee's tears run down her face in unbroken streams. soaking
her white blouse.
"She wouldn't have hurt Steve:: she says. "That man took care of
her so good." ' .
It would be months before we would know how the courts viewed
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Rosa Lee recalls asking her mother,"Momma, how did ya'U LIVE
down here?"
She remembered Rosetta Wright looking at her with a pained ex
pression and turning away.
Forgotten Memories
W
e reach Rich Square in the early afternoon. As I turn into Hilda and
Bud Tann's driveway, Rosa Lee stares in amazement at the large,
modem tan-brick house where her cousin lives. Big Bud, as everyone
ca11s him, answers our knock. Hilda welcomes Rosa Lee with a big hug.
Hilda, 63, is a large woman with a light-brown complexion and an
infectious, high-pitched laugh. Arthritis has locked up her left hip and
knee, requiring her to lean heavily on a cane or a walker-"depend
ing on how I'm feeling," she says.
She has prepared a big dinner, and Rosa Lee and I help ourselves
to chicken and dumplings and collard greens, After the meal, Hilda
and Rosa Lee settle into the two overstuffed couches in the living
room. I sink down in the upholstered high-back chair to listen.
Hilda tells Rosa Lee that one of the couches belonged to Rosa
Lee's maternal grandmother, Lugenia Whitaker Lawrence. Lugenia
was a sharecropper here until she and her family, including Rosa
Lee's mother, left during the Depression. In 1985, Lugenia carne
back to Rich Square after 50 years in Washington and stayed with
Hilda for a few months before her death at age 88.
Rosa Lee and Hilda swap tales of the family, and Rosa Lee begins
to open up about her life of crime and drug addiction. I knew that Ro
sa Lee was nervous about revealing too much, fearing rejection. But
Hilda already knows some of the story from other family members.
"You needn't worry about it now, Rosa Lee," Hilda assures her.
"That's all behind you now."
"Yes, you're right," Rosa Lee says in a quiet voice. "Praise the Lord!"
They talk until the shadows darken the living room. The only light
is from the television. I say goodnight and leave for my motel. Rosa
Lee is so busy talking that she hardly notices.
The next morning, we pick up another relative, 90-year-old Daisy
Debreaux, at her white-and-green wood-frame house and go off in
search of the land that Rosa Lee's mother and grandmother once
farmed. Daisy lived on the plantation until the early 1950s but hasn't
been there for 40 years.
Daisy is a thin, brown-skinned woman with a head of thick, white
hair. She speaks in a deliberate cadence, barely parting her lips when
she smiles. When something strikes her as funny, she lets loose with
a deep, body-shaking chuckle. She and Rosa Lee's maternal grand
mother were first cousins.
,
We tum east onto the dirt-and-gravel Benthall Cook Road and
\ head toward Bull Neck Swamp, a fertile piece of land on the north
; bank of the Roanoke River. Daisy sucks in her breath in surprise.
! Where generations of Lawrences once toiled stood aU the compo
nents of the modem farm: a two-story office, large hangers for huge
farming machinery~ two large gray-metal silos. No matter which way
we look, there is no visible evidence of the life that Daisy once knew.
"There used to be dozens of houses on both sides along here; Daisy
says, pointing to fields of young cotton and tobacco.
As we walk through the cotton fields, Rosa Lee is overcome by
• emotion. A forgotten memory reemerges: Every day for two weeks
in that summer of 1945, Rosa Lee's mother woke her before dawn .
and took her to the cotton field. They worked for three hours before
breakfast, returned to the fields for several hours before lunch and
then again in the late afternoon.
PHOTOCOPY
PRESERVATiON
�After ~ few days of this regimen, Rosa Lee remembers asking her
"Momma, why do I have to pick cotton?"
.
what I brought you down.here for," her mother said. "To
you what we've had to go through in life to .take care of you and
you."
A Songo!Redemption
n Sunday moming, we attend services at Chapel Hill ~p.tist
Church, founded the year after the Civil ~ar ended. T~e ongmru
wood-frame building was replaced With a red-bnck one ill
Three generations of Rosa Lee's ancestors belonged to the
including her grandparents and her mother. Four genera·
her living relatives are active members today.
the end of thetwo-bour service, the Rev. Franklin D. Williams
Rosa Lee· to say something to the 125 or so worshipers. He
about her visit from one of her relatives. Rosa Lee beams. AU
her as she walks quickly to the front. She is wearing a pink,
suit with a wine<olored blouse and a string of white pearls.
shoes match her long red fingernails. .
was 9 years old .the last time I was here," she says. Until this
she had not understood the difficulties that grandparents and
had faced wben they sharecropped on the nearby plantation.
looked back over her own life, she tells them, and is not
much of what she has done.
you change the way you've been living all your life, any
possible,". she :says. '1 thank God for giving me another
life."
.
Lee shuts her eyes, pushes her prums together and belts out
verse of a gospel song she learned as a child at Mount
Church in Washington.
me, LtwdJ·., .
me,Ltwd.
. .
from heaven on my soul
anything that slwuldn't be
out and strengthen me. "
.
join in:The Rev. Wil1iams rushes to the piano and
play. Even the small children, who moments before
with impatience, ,sit transfixed. The entire congregation
in the pews. . '..
in wonder at the power of Rosa Lee Cunningham. She steps in
people who have·never seen her before and inspires them to
song of redemption. I can't help but think that if circum
had been different, if she hadn't faced so many obstacles in
her drive and her charisma might have created a different
her children and grandchildren.
to be right.
.'
to be $Ilued.<'.. '
•
to be whok. "::'
".'. 'I":
: :.
Painful Delays
investigaltion of Steve Priester's slaying takes a turn in Patty's
1993. Prosecutor Heidi Pasichow accepts Pat
"',
L
ty's statement that her role in the robbery was to open the door for
Turk and the other three. If Patty will agree to testify against .the
others, Pasichow will drop the first-degree murder charges agamst
Patty.
As plea bargains go, it's not a bad deal. Patty still faces a substan
tial prison term, but at least she doesn't have a life sentence hanging
over her head. On Oct. 22, in Judge Long's courtroom, Patty pleads
guilty to first-degree burglary and conspiracy to commit robbery.
She won't be sentenced, however, until she is finished testifying. If
all the defendants go to trial, that could take months.
The delay is excruciating for Rosa Lee. Whenever she sees me,
she badgers me for details about the case. She thinks of little else.
Then, in mid-December, a late-night telephone call gIVes her some
thing else to worry about.
.
It is 11:45 p.m. and she has just fallen asleep. The caller IS the se·
curity guard in the lobby of her apartment building. A Robert Cun·
ningham is here, the guard says. Do you want him to come up?
Rosa Lee is confused. Bobby is supposed to be in jail. What's he
doing here?
. .
A few minutes later, she opens the door and draws back m disbe
lief. Standing in the hallway, dressed in a prison-issue blue cotton
jumpsuit·and a thin windbreaker, is a shrunken version of her oldest
son.
His breathirig is labored and heaVy. He tells. her thqt he has ~st
walked from the jail, a distance of about three miles. He nas been giV
en a medical parole because he is dying of AIDS. His weight. has
dropped from 160 pounds to less than 100.
Two days later, Bobby collapses on Rosa Lee's bathroom floor.
Rosa Lee can't lift him. She calls 911. and.soon her tiny apartment is
filled with paramedics and equipment. They take Bobby to Howard
. University Hospital, where he deteriorates quickly. When he dies on
Jan. 18, 1994, he weighs 72 pounds.
Bobby is the first of Rosa Lee's children to die. and she has no
money to give him a funeral. Because she is poor and Bobby has no
estate, the city's Department of Human Services agrees to pay' the
funerru costs and, later. the cremation.
Death in the Family
Osa Lee is standing
a lavendar-colored
arrive
Funeral Home in
Rhode Island
Rat Frazier'scasket lidnearclosed.the 300 block ofcoffin when IseeAve
nue NW. The
is
'1 didn't want anyone to
the
way he looked when he died," she whispers.
I take a seat in the second row, next to one of Bobby's cousins. Ro
sa Lee's son Eric comes into the parlor. He looks around the room,
sees Rosa Lee in the first row then decides to sit next to me. He has
never resolved his anger at his mother for the way she raised him.
Severru family members are late for the 11 a.m. service, so the Rev.
R.E. Dinkins decides to wait a few minutes. Finally, Rosa Lee mo
tions to Dinkins to go ahead anyway. Dinkins leads the dozen mourn
'ers in prayer, then asks anyone who wants to speak to come forward.
Richard rises. "Bobby has taken care of me and all my brothers.
He had a good life, and he did \he best that he could. I'll never forget
him."
Afemrue relative delivers a more pointed message.
"To the family, I would like to say, be not ashamed of your son or,
your brother. God had him here for some reason, some purpose m
his life." She looks toward Rosa Lee. "As he sleeps away, it is time
See ROSA LEE. A22, CoL 1
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ROSA LEE, From A21 ' ,
for you all to get your act toge'ther. Get your act together, acknowl
edge the Lord and serve Him!"
A hush falls over the room. Now it is Rosa Lee's turn.
"First, I'd like to say, thank God for giving me the strength to be
and to get up here."
She pauses, then cries out: "Bobby!"
His name echoes through the silent parlor.
"I love you son," she says, "and so do your brothers and your sis
ters. But I know now that you are in a better place. All of us will al
ways love you. Take care of him God, 'cause he was my oldest.
Thank you."
Patty ~ Apology
R
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osa Lee has a plan for persuading Judge Cheryl Long to release
Patty on probation. The day before the sentencing, she delivers
two letters to Long's chambers-one from her doctor that details
her deteriorating medical condition and a personal plea that her 17
year-old granddaughter wrote for her, imploring the judge to let Pat
ty come home to take care of her. When I remind her that she left
her old apartment to get away from Patty's drug-addicted lifestyle,
she waves me away.
'
When I pick up Rosa Lee on the afternoon of May 10,1994, she is
nervous, almost shaking. She is still weak from her latest bout with
pneumonia, which put her in the hospital for two weeks, and she uses
a cane to walk from my car to the courtroom.
It is close to 5 p.m. by the time Patty's case is called. Patty is
brought from the lockup. She looks healthier than she has in years.
Eighteen months in jail, away from regular drug use, has given her
body a chanCe to recover. She has lost the sallow, drug-induced pal
lor that I remember. She sees Rosa Lee and breaks into a big smile.
I whisper to Rosa Lee that the prosecutor's recommendation
could be crucial in deciding Patty's sentence. The judge will want to
know if Patty has held up her end of the plea bargain.
All the defendants in the case have pleaded guilty before trial, so
Patty never had to testify in open court. Prosecutor Pasichow tells
Long, "I feel absolutely compelled to let the court know that she's
been cooperative."
Patty's role in Priester's murder, Pasichow says, "really comes
down to, in part and to a large extent, Ms. Cunningham's greed in
terms of her addiction, in tenns of her need for money and in terms
of the type of. lifestyle that, unfortunately, Ms. Cunningham was liv
ing at the time."
That doesn't eltcuse her actions, Pasichow says. "What she did was
- set in motion something that she now regrets, but something that
she really could have stopped."
As prosecutor's statements go, this is a pretty mild one. Pasichow
could have asked Long to sentence Patty to the maximum time in
prison, but she asked only for an "appropriate" sentence.
"Ms. Cunningham; the judge finally says, "this is your opportunity
to speak to the court."
Patty stands. The words rush out. She tells Long that she agreed
.to let the robbers into Priester's apartment only because she was
afraid that they were going to hurt her. "I'm really sorry for what
happened to Mr. Priester. Because I loved him too. A lot! And I ask
him every night to forgive me for what happened. And if I could have
changed it, I would....
"This is the first time-this is the fIrst time that I ever been with
out drugs this long: And it feels really good to me. It gives me a
chance to get my life together, make my life much better. So I'm
asking to be put on probation.~
But Long is in no mood for redemption. She is too troubled by the
statement of facts on Priester's murder.
After Patty left Priester at the apartment that night, the robbers
repeatedly asked Priester, "Where is the money at?" Priester pleaded
.with them to leave him alone. The robbers gagged him, handcuffed
him and bound him at the knees and ankles with belts and ropes. All
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four robbers t.:x;i turns hitting Priester in· the face with a heavy wine ' .
bottle and.a brassi:ornament. The robbers then tied a hood. tightly
over his "iace. and shot him in the head. As far as police could deter
mine, the assailants left without finding any money in Priester's'
apartment. ",
"What they did was just completely unnecessary," Long says to
Patty. "Completely unnecessary. But they did it anyway. And } think
that when you decided to let them in the house and made it possible
for them to get into the house, you knew that you were doing a favor
for some pretty bad penple....
"It's bad enough that penple do this to total strangers; Long says,
"but there is' no real way to excuse what you did to someone who is a
friend to you."
Long announces Patty's sentence: one to three years for the con
spiracy conviction and seven to 21 years on the burglary conviction,
to be served consecutively. She will be eligible for parole in October
1998.
"You should pay a price for what you did, and you should not basi
cally just get off the hook simply because you and your mother are in
bad health," Long says. "
,:',,'
Last WOrds
few ho~s later, we sit in my car in front of Rosa Lee's apart
ment building and rehash the sentencing. Rosa Lee is distraught.
She wanted a chance to speak to the judge. As Patty's mother, she
says, shouldn't she have had the opportunity to explain?
} had been warning her for months that Patty's lawYer might not
let her say anything in court, that he might decide it would do Patty's
cause more harm than good. But Rosa Lee kept rehearsing her
speech, as if this were her trial, not Patty's. One day, months before
Patty's sentencing, she gave me a preview of what she would say to
the judge if she got a chance.
"I want to say, 'Judge Long, my name is Rosa Lee Cunningham.} .
just want to clear my conscience and my mind the way} feel about
my daughter being in jail on account of } feel that } brought my child
up wrong 'cause I didn't know better. I didn't know no other way.
Not only Patty, all'of them children .
.. '1 don't feel too good about it, Your Honor. } never have.... I
wasn't thinking right and 1 wasn't thinking clearly. I just didn't want
her to become hurt like me. I didn't want her to want things and
couldn't get them like me....
" 'Your Honor, I love my children very much, but somewhere
down the line, I didn't· raise them right, and it is hurting the hell out
of me... .'.
,
It was a harsh assessment, and undoubtedly designed to elicit
Long's sympathy. Yet, it was direct and honest in a way that went far
beyond our first interviews six years ago.
But then, Rosa Lee's not the same woman as she was when we
fIrst met. In 1988, she still shoplifted regularly, scild heroin on the
street, used heroin and cocaine frequently while sharing dirty nee
dies with Patty. Somehow,' she also was taking care of her young
grandchildren because their mother was strung out on crack.
Then Rosa Lee found herself paying a heavy price for her past.
She learned she was carrying the virus that causes AIDS. She suf
fered a series of seizures after injecting heroin. She came close to dy
mg from an overdose of seizure medication because she couldn't read
the dosage instructions. Then came Patty's arrest for murder, fol
lowed by Bobby's death. Now she spends hours praying for herself,
Judgmg herself, endlessly asking questions for which there are no
easy answers. She wants more than survival at this point; she wants
peace from a life with almost none.
There are many ways to look at Rosa Lee's story. Some may say
that Rosa Lee is a thief, a drug addict, a failed parent, a broken wom
an paying for her sins. Others may see her as a victim of hopeless cir
cumstances, born to a life of deprivation and racism.
.
There may be truth in both views, but neither extreme reflects
the complexity of her life, or the complexity of the crisis in the na
tion's inner cities. Rosa Lee's story shows the immense difficulties
A
.-
,--,~-
..-
.. _.....
that await any effort to bring an end to poverty. illiteracy, drug abuse
.and criminal activity. In the poorest neighborhoods, white and black,
these problems are knotted together; there's no way to separate the
individual strings, especially in those communities overwhelmed by
drug abuse. Reforming welfare doesn't stop drug trafficking; better
policing doesn't end illiteracy; providing job training doesn't teach a
young man or woman why it's wrong to steal.
But complex is not the same as intractable. Rosa Lee's fate was
far from foreordained; her sons Alvin and Eric. both of whom reject
ed the lure of the street, are testament to that. So are many of her
brothers and sisters. They, like many others who grew up poor,
learned the importance and value of personal responsibility, and it
gave ~em the edge they needed to invent a different way to live.
. For now, Rosa Lee has adjusted to life without Bobby and Patty.
Her apartment remains a haven for those children with nowhere else
to go. Richard and Ronnie are staying with her; Ducky,. however, is
back in Lorton serving time for theft.
Rosa Lee keeps herself busy by helping to take care of the family's
. newest generation-her great-grandson. The baby's father is her
grandson Junior, 21: the boy's mother is a 15-year-{lld girl, a 10th
grader at a District high school. Rosa Lee looks aftel\ the infant on
weekdays so the mother can go to school. Junior can't help out; he's
in jail, awaiting sentencing on new armed robbery charges.
On school days, the haby's mother meets Rosa Lee at McDonald's,
near the methadone clinic; On a recent Thursday morning. she hand
ed Rosa Lee a still-warm bottle of formula, quickly washed down a
sausage sandwich with soda, kissed her son and left for school.
"You're a good-looking boy, you know that?" cooed Rosa Lee as
the eight-week- old infant sucks his bottle. He finished the milk, and
his eyes began to droop.
She gently rocked the haby on her lap. "He's such a beautiful baby
and so easy to look after,n she said, stroking his cheek as he feU
asleep.
About This Series
19~2,
~e
n
in
midst of the Great Depression,
Lee
I Cunnmgham ssharecropping life forparents gave Rosatheir
grandparents and
up
North Carolina
an uncertain journey
north. Rosa Lee is the link between past and present, be
tween a world that has disappeared and the one that her chil
dren and grandchildren face today in Washington. .
~y of Rosa Lee's relatives. including two of her eight
children, managed to secure footholds in the mainstream of
American society: their relative success makes it all the more
important to try to understand Rosa Lee's life.
Although her story is disturbing, she wanted it told. "May
be I can help somebody not follow in my footsteps.n she said.
That story-{)f the choices she had and the choices she
made-<!ffers a chance to understand what statistics only
suggest: the interconnections of racism, poverty, illiteracy.
drug abuse and crime, and why these conditions persist.
The series, edited by Steve Luxenberg, The Post's assis
tant managing editor for special projects, ends today. Since
the senes began last Sunday, The Post has received more
than 3,000 telephone calls from readers. Readers who wish
to leave a recorded comment can call PostHaste at
202-334-9000, Category 4646 until Tuesday at midnight,
when the number will be discontinued.
Many callers have asked about organizations that work
with troubled families. A partia1listing appears on Page A23.
-.
'
". ,-""
,.
~
�" ".
,
•
ORGANIZATIONS THAT CAN HELP
•'y he following metropolitanlist oforganizations in services.
is a partial
the
:
Washington
area that offer social
Several are umbrella agencies that could provide referrals to
, neighborhood-based organizations. The white pages ofthe
, 1994-95 District ofColumbia telephone book also lists
, community services on Pages 41 and 42.
,
,
•!iii~!~ilif~
-D.C. Hotline, 202-223-2255
Provides information on free or low-cost services relating to mental
health. housing, financial assistance, medical treatment, social'
services and support groups,
, - SeIf·Help Clearing House, 703-941-5465
A project of the Mental Health Association, Self-Help Clearing House
is connected with more than 18,000 support groups in the'O.C. area ..
~!~§:1'
- National AIDS HoUine, 1-800-342:AIOS
_Whitman-Walker Clinic (main facility), 1407 SSt., NW,
202-797-3500
A comprehensive outpatient AIDS service organization in the D.C.
area.
;riit(~t~:i1
I_Alcoholics Anonymous, 202-966-9115 in the District and Maryland,
: 703-281·7501 in Northern Virginia
,
· -Cocaine Anonymous, 202-725-1.717 .
-Cocaine Hotline: 1·800-COCAINE.
A 24-hour national information service,
-Narcotics Anenymous, 202-399-5316
,National Clearinghouse for Alcohol and Drug'lnfonnation,
1-800-SAY-NO-TO
, - National Fede..ation of Parents for Drug-Free Youth,
1-800-554-KIDS
- National Institute on Drug Abuse HoUine, 1-800-662 -H ELP
-WACADA (Washington Area Council on Alcohol & Drug Abuse),
202-783-1300.
.
A hotline for drug- and, alcohol-related conce~ns.
"
::-'
-AianonlAiateen, 202,882-1334 in the District and Maryland,
~
703-241-2011 in Northern Virginia.
Support groups for friends and families coping with alcoholism.
~
.ii
d
, - Naranon, 301-876-4316
:~'
Support groups for families of drug a~dicts.
r.
-c
t
, Local governments offer literacy classes through adult education ,'~ "':;,;i;;~'" ~
, programs. Contact them or these umbrella agencies for informatioh:"
;
.
-LHeracyVolunfeersofAmerica, 1325 WSt., NW,
,
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Metro Are~ Inc:,
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'-Big Brothers of Nat~al Capital Area:~30!1-587-0021'
, -BlgSlstel'$ of the Washington
~~,~:;'
202-387-1;~j.::
-Washington Uteracy Council, 1799 Swan SI., NW, 202-398-9029
~f~!~8~[~~~~
202-244-10 12
:-Bora and Gins Clubs of Grea~r Washington, 301-587:43 '15
'
f
.'~'!-::i -~
~
-Coneenied Black Men Inc., 202-783-5414
)
~
• Arflngton County Volunteer Office, 703-3 58-3222
, -Fairfax County Volunteer Action Center, '703-246-3460
: -Greater D.C. Cares, 1201 New York Ave. NW, 202-289-7378
; Connects volunteers with community-based service organizations.
!
.
,
, • Montgomery County Volunteer ServIce, 301-217 -4949
,
,- Prfm:e George's County Voluntary Action Center, 301-699-2800
!'H£ WASHIf't010N PO:
VIRGINIA TECH presents
M410R SHORT COURSES . ..'
3
:
�Rosa Lee Cunningham ~ Story
HE RECENT eight-part series on the life siblings. Likewise, there are thousands of District
of Rosa Lee Cunningham by Post reporter women on welfare and Medicaid; most don't lead
Leon Dash, based on years of observation lives like Rosa Lee's. They don't steal or teach their
and interviews, was an extraordinary journalistic children and grandchildren to rip-off others. They
achievement. But it was also a deeply disturbing don't prostitute themselves or their daughters.
and lacerating portrayal of a District family-a They don't sell or do drugs, or harbor criminals or
mother, her children and grandchildren-wasted in teach their children to lie. They haven't gone to jail
an environment in which drugs, AIDS, crime, hus . 12 times, or served years behind bars for theft and
tling and time behind bars were the common and drug abuse. They aren't mv positive. To conclude
acceptable experience. This was, as well, an envi from this series that Rosa Lee's life is the way the
ronment in which public assistance meant to help poor live is to Seriously misread and mistake what
them-and, no doubt, in some part derived from' has been written. And yet there is much to learn
taxes on working people not much better off than from the series.
they-was habitually squandered on more drugs.
Within the nation's capital, as in inner cities across
Judging from the thousands of responses received the nation. there are plenty of Rosa Lee Cunning
thus far, most readers say the series has left them hams-and people like her daughter, Patty, her sons
with a better understanding of the strong ties Bobby (who died), Ducky and Richard, and her
between marginal education, welfare dependency, grandson, Junior-who are the real stories behind
chronic joblessness, drug abuse and criminal recidi the hard-core drug, crime and sociaI welfare statis
vism, and how-as in Rosa Lee Cunningham's tics we read or .hear about. The next time a
c.ase-those conditions can persist from generation discussion gets started on the devastating impact of
to generation, in part as a consequence of societal craCk cocaine on families or a community, or the
failure, in part as a consequence of personal failure. failure of prisons and juvenile facilities to rehabilitate
repeat offenders, or school systems that callously
That was what the series set out to accomplish.
A smaller but significant number of readers, push through and then push out students who can't
however. have been clearly incensed by what they read their own names, or the next time you hear talk
have read. To them, eight cOnsecutive days of about secret sins of child sexuaI abuse or the power
front-page stories about intergenerational deterio of the family (or the interdependence of the patho
ration in a District family perpetuates racist stereo logical)-thlnk of Rosa Lee Cunningham, her chil
types of African Americans and.plays into the hands . dren and grandchildren. But don't stop there..
Think, too, of her two sons A1vin and Eric, who set
of those who would have government retreat from
its social responsibilities. There is always a chance themselves apart from the family and turned the
that will happen in this kind of journalistic enter other way. There are other AIvins and Eries who
prise. But those seeking to use this series to need. to know they have choices, that there is
support their racial prejudices will have to look for something better than hustling and manipulation of
others within their reach, that life, despite it all, can
comfort somewhere else.
Rosa Lee Cunningham's personal story is not be better. The series showed that Alvin and Eric
representative of all African Americans. While her were helped by the intervention of teachers and
grandparents and parents shared the experience of mentors who could channel their remarkable and
the millions of African Americans who migrated stubborn will to free themselves-and now their
from the South to urban areas several decades ago, own families-from the terrible cycle of dependency
most children of migrant families did not end up like and desolation in which the rest of their siblings were
. Rosa Lee. But then, neither did most of her 11 caught. In that there is surely a lesson.
T
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PHOTOCOPY
PRESERVATION
�'t"Rosa! Lee'S-Story'
Ii.
As ~y of you;. ~ders :have indicated
, (Ombudsman, Sept. 25J, I, too, fail to see
, the reason or need for your:paper to write
about Rosa Lee Cunningh3m's life (front
, page, Sept.' 1&-25]. It has no newsworthy
, value and, perpetuates the 'negativity that
you;. paper has been accused of, especially
about its IXlverage of the Abican American
.\
,!
commwrity. While you may have printed
11 positive stories in the past six weeks,
neue received the magnitude of IXIVefage
as Cunningham's.
,
,"
In alllikeJihood, the article will not deter
anyone headed down the path Cunningham
followed because these individuals are gen
erally not readers of your PaPer. Nor will it
result iii legislation or additional funds for
programs and resources to help people like
Cunningham make wiser ;choices in their
lives. And, last, most people, like me, will
not Ullderstand how and Why Cwmingham
fell she,had to make the choices she did ~o
Rosa Lee's age. I have a son and six
siblings in California, and I plan to share
this series with them. I can see in this
series why. I believe. that four of us have
been modestly successful and why my two
brothers have had problems in their
lives-One is in prison for using and selling
drugs and the other is in and out of jail fur
the same reasons. The verdict is still out
on my younger, IXIDege-educated sister.
I have a master's degree from UCLA
and am a Department of the Anny civilian
who has attained the grade of GS/GM-14
and retired as a lieutenant colonel from the
Anny Reserves after more than seven
years on active duty. But we all came from
a hackground similar to Rosa Lee's. I want
Rosa Lee to know that her story will make
a difference in how my grandson and my
siblings' grandchildren are raised. '
-HollisE. Barnes
';.Ii
Leon Dash is to be congratulated for his
H
,....
'
'-
: ,~""!,,
.i-Marilyn J!itchell e_t-partsenes on Rosa Lee and"1lC1
. 'H.·:.'·,;:~~;,-}.'.1
:-'7;', II
family. It gave readers a painfu1100k at
how poverty, drug use and crime. can
LeoDDash's series
Rosa Lee Cun
,01
ninghani did more to harm the image of
. devastate a family. Eight children is more
G, ' 'poOr black: people' than ianything I have
than any single mother should be expected
read in a long time. I trifd desperately to
to be able to discipline, supervise, nourish
<1"
'find some redeeming qUality about Rosa
and educate. How I wish Rosa Lee had
",J.ee througbaut most of the series. What
known about Planned Parenthood and its
!.
, 'ever hope I bad·waSgone when I read that
subsidized birth control services, AIDS
prevention and abortion, facilities. I .was
"she ~ aoIdher:,daUgbter into presti
, ,Mien at ,the age of 11 under the guise of
disappointed that it was not listed with the
, needing money to feed her: children. Rosa organizations that can help at the end of
Lee is 8, moraIIy',banknlpt individual who the final essay on Sept. 25. Planited .Par
refuses to take: respoIlsibility for her ac- ' e.ilthood clinics in the District and inYl!'
tiona even to tbiiiday: She perpetuates the ginia and Maryland are listed in the.,tele
phone directories;. , '
stereotypeS' tha(,; so many black people
have worlredso bard to erase. There are, '
";"'Samh G. E]J!tein
numerous poor' people' who would never
, resort to theft, drUg using and selling and
'_ , " ' . .
Reading Rosa .Lee's "memoirs" shOws
prostitution as a way of.:life.
'
, me what a stupid life I have led. Why did I
The image of Poor' blacks would be
much better !letVed With more articles work and slave so hard to make a living
such as Dorothy Gilliam's Sept. 24 account when I, lXIuld have had .the easy life, on Shavar Jeffries. Here is a young man stealing, selling drugs and working, the
who has faced more ailversity than Rosa numerous social welfare systems as de
Lee, yet he not only survived but is tailed in the articles.
Too late for me at 82. but younger
striving for
in all that he does.
That, story deserved to be on the front types may well be inclined to take a tip
from Rosa and live off us taxpaying suck
I
life, is
."~!::i'-Rita A. Still ers. And if,bysuch a period ininterrupted
occasionally a rest
the hoose
.r--':';:;',...
,~'lio.;
gow, so what? Society pays for that,aIso.
" Your series ,"Rosa', Lee's Story" was
No doubt deep thinkera like psychoto
powerful-a story that needed to be told. I gists and social reformers will think of
could ,hardly wait until the next install
even more ways to throw money at social
ills such as those portrayed here. They will
ment. ' :
I am a 53-yearoQid black male, about never realize that they are part of the
'0
~.~"
.
.
on
excenence:
problem, not the solution. Ever since Roo
sevelt, we have been throwing money al
the poverty-stricken. The able-bodied take
the money and work the system for even
more.
When will we realize that there are
millions of Rosas ont there and that we
don't do them or society any good by
letting them produce successive genera
tions to follow in their footsteps?
-Joseph L. Hudson
_
T1wu shalt
steal. Most law-abiding
citizens live by this motto. Rosa Lee does
'11(1/
not Leon Dash's articles seem to disre
gard this societal norm and in fact glamorire the art of shoplifting. As I read about
Rosa Lee's efforts to, supP!JI1 her drug
habit and her successful plofio stay out of
jail, I became ill. This woman should not
have been given a page and'a half of print
each day to flaunt her illegal activities.
If the original intent of Dash's series
was to deter future thieves, the result so
far has not been achieved. Only twice in
,the first article did a negative word appear
concerning the ramifications of stealing. I
hope Washington's impressionable youths
do not read this series; if they do, the
District's crime rate will soar.
I recognize the plight of the poor and
sympathize with their struggles in life. But
many welfare programs and organizations
(i.e.• Salvation Anny) exist and are willing
to chip in if an honest job does not bring in
enough cash. Rosa'Lee's situation is not
uncommon. People strive to overcome
every day. But some do not resort to
crime. A hard-working, honorable woman
should have been chosen as the subject of
'this series. Her triumphs and failures
would have earned a reader's reapect and
touched his/her heart. Unfortunately, Rosa
Lee deserves no respect.
-
A
1 k
nnette J ur onie
_
,To describe Rosa Lee Cunningham's
story as "discomforting and disturbing"
as Steve LlIXenberg does in a postscript to
each article-is a tremendous understate
ment. One must read the entire series to
grasp the fun depth of the Cunningharns'
depravity. To me, the most abhorrent
example (of which there were many) was
in the Sept. 23 article in which Rosa Lee
'admits to recruiting her ll-year-<>ld
daughter to join her in prostitution. Rosa
Lee excuses her actions by claiming that
she did whatever it took to ensure her
family's survivaL To the contrary. Leon
Dash's account of Rosa Lee demonstrates
that she did whatever it took to feed her
base proclivities, regardless of the inunea
surable cost to the children who depended
upon her. Moreover, she imbUed most of
her offspring with the same sense of
indifference to familial and societal respon
sibilities.
LlIXenberg notes the articles' focus on
the interconnections of racism. poverty.
illiteracy. drug abuse and crime. An obvi·
ous addition to that list is our failing
welfare system. Rosa Lee and her family
clearly have received an abundance of our
government's generosity in the form of
welfare checks, food, subsidized housing,
free or disIXIunted medical care and medi
cation, job training etc. Indeed. it would be
interesting to calculate the sum that we
have spent on this family so far. Despite
and perhaps because of all these welfare
programs, only two of Rosa Lee's children
!ifiIed themselves out of the deepening pit
that their mother burrowed.
Those two succeeded because they per
ceived the difference between right and
wrong, understood that they would define
themselves every day by the choices they
made, and accepled responsibility for their
actions. In IXIntrast. Rosa Lee and her
dysfunctional children choose ,10 seek in
stant gratification regardless of the cost to
themselves and others.
•The series leaves me convinced that the
current welfare system breeds and perpet
uates this self-defeating conduct. At some
'point, we must say, "You have enough
money for drugs (as well as other so-called
'necessities' such as television and Jong
distance phone service); you obviously
don't need our money for food, clothing
and rent!" By cutting off the exploiters and
reevaluating how we distribute charity,
funda IXIu1d be redeployed to people who
may truly need and appreciate the assis
tance.
In the final article, Dash leans too heavi·
lyon the concept of, redemption. That
Rosa Lee regrets her ways toward the end
of life and sings in church (once!) is hardly
the work of a redeemer. Redemption is a
process of,actively correcting past wrongs,
and nothing in the finaJ article indicates
that Rosa Lee is doing anything to pay
back the conunwrity for what she took or
to save her childien from the disastrous
lifestyle that they learned from her.
PHOTOCOPY
PRESERVATION
-Kenneth
�23unclay/ () e:J;
ROSA LEE .• &;:ME
#
~I
,qq tf
'"
What. One Family Told Me~nd America~About the Urban Crisis
·.
F
.
:'
B Leo D sh
have a place in journalism, but these individuals ments. Nearing his West 122nd Street home, Miny
n a
and families are not part of the crisis fu urban cy passes through a street-comer c!"ug market
.OR FOUR intense year.s, I foUowed Rosa. Am.'erica. I was interested in writing about the cri~ .brazenly operated bY. the newest male generation
Lee Cwmingham, her children and five of sis. Every one of us should be alerted to it. I want-· of Harlem's underdass.
.
her estimated 32 grandchildren. I became ed readers to be uncomfortable and alarmed.
. "As I round the comer, there are drug deals
Others feel the same way-Ronald B. Mincy,
happening on the comer," says Mincy. The kids at. .' absorbed by Rosa Lee's story-and deeply
troubled. I also realized that the series that fol- for example. Ron Mincy ishlmself a "positive" suc- tending the nearby junior high school "are coming
lowed--on the intergenerational nature of under- cess story of an Afriqrn-American man who over- in and out of that all the time."
<;1ass poverty, crime. and drug use in one family- came tremendous odds. He and his two brothers
This scene is replicated on street comers in ev
would disturb and anger some readers.
were raised by their single mother in. the South ," \ ery major city in America. The adolescent drug
;'ilH~u~~e great fIl;<ljority IOf re,spo~~ ;W~~~5';i.Bromf ~ the Patterson pu,bUi; ~o~~ing,m~oj~(:t, ,not':: seUers and their destitute adu~t ~en~s are j~st the
tlVe"lt·<lid not s~nseme t;hat many of ~O~;'.>farfromthe East~lem nelghoorhOOd where I observable symptoms of continwng mner-clty de
;ne,s angered most aremlddle-<:lass Afncan "gteW up. An expert on urban poverty, Mincy cay. This decayjs intricately interwoven with oth
.. ',"
1~. They ·felt. that, ;rheWashington ~ost, "earned a doctorate economics from the Massa- er dead-end ingredierits of life within America's
~bf'·?evotingeightdays to a three-~e~erational .'. cbuSetts Institute of Technology. He, hlswife and bottom til!rof poyeity: adolescent childbearing;
~y o~ welfar~epend~nt ~tty ~s"J!ri~'. two so~s live in Harlem today out o.f comriUtment' child abuse and neglect, foster ~e, dropping out
Sls e ;~ong.
gIVen t:!?s groWIng . urbail skcned
. to making a change where change IS most needed.
of school, welfare dependence, smgle parenthood,
ofat~~b~n. Why, many a
,
t. wnte a
Mincy also believes the crisis of poverty and chronic unemployment and neighborhood crime
"positive story aoo.ut the many hone~t smgle blac~ crime in our cities needs to be written about in a and violence. .
en wen~ on to lives of Amen- way that people can understand it. He understands
"In most cases, there is not a father in [these]
}Il?thers Wh~
__ that this problem is groWing not reCeding.
households," said Mincy. "There is not even a posi
can. success an ;ac, eveme.QtL. ___ .. __ . ..
.• ":~e answer IS sunple. Stones (i6?ut succe:;sful
"Eveiy- everungMincy .leaveshls Ford_F9unda- tive older brother! That is a situation that is tragic.
mdividuals who have overcome societal barriers
tion office in mid-Manllattan and travels north four --IUsan"intergenerationalthjng~
Lion Dash is a member of The Washington Post's
miles into a large swath of real e,state with rows of
Reams of poverty statistics crosS Mincy's "desk
sp8ciaJ projects reporting unit.
boarded-up and deteriorated 19th centUry teneSee ROSA LEE, ca, CoL 1
m
dfdn
cru:t
."
a
z
~o
o~
8ft:
b}j5
:J:W
[La:
tL
�/
, TiI~ WAsIiINGTONPOsT.'i
"
ROSiLI1e's Story:
SUNDAY~ OcroBER 2~ 1994Ca'
educate tWo kids. My 'sister and 1have never ~n in ~y
kind of trouble. This woman' issimplY:,.in'espOnsible •.••
It~s not a black thing. (t's an irrespOnsji)le ,\;I,Iing.
,,
-Janice Dodd, A'.tIlngton, Va.
of
I'm the executive director the House of Ruth. I was
greatly impressed with Mr. Dash's repOrting, I think we '
have a lot in common in terms of the eXperiences we've
all shared, and what Rosa Lee's story exemplifies in a lot "
of the women we're seeing. I thought it was extremely;
in-depth with a lot of wannth.,
;
-Christel Nicllols, Northeast Washington.'
The···Readers React
, In response to Leon Dash's series, "Rosa Lee's s~l
ry," the Washington Post received more than 4,6(0)
phone calls to a special line set up: to al/Ofueatiers toj
leave reconled comments. About halfof the callers a}J:;
proved of the publication of the story while about a',
quarlet' were critical of the Post for running it. An-;
other 20 percent ofthe callet-s offered obseroations that;
were neither critical nor suPporlive; the remainder o/- '
fered judgments that were both positive and negative.!
This was not a scientifIC survey of reader reaction. '
Here is a sompling ofthe comments:
It was an extremely weU-done article and extremely;
interesting. Each day I waited for the next installment of'
the story. Right under our noses, there are people who':
are living this way. The type of life they led is completely
foreign to me, unlike anything I've ever read. Mysug
'gestion to The: Post would be to do an article abOut an
other family that came from similar, background. My
great grandparents were sharecroppers and came to '
Washington in 1946 from South Carolilla. Our lives were
not at all like Rosa Lee's. No one went' to jail, nobody on
drugs, everybody's working, everybody got an educa
tion. I think we should see the other side of this story.
, ,-Gwendolyn Aughtry, Landover, Md.
!
'
i
I
i.
tare
AU people
problems:theq;;;ti~~ i;h~; do they ~
solve their problems. This is where the black church':\
should have come in and helped these peOple, if not inj. 'i
tiaUy when'they came to Washington. then when they ,j
got on drugs. When people leave rural areas to go to the
city it seems like they leave religion out of their lives.!
This exodus is a pOint that I think should be developed. J
,
-A. Mills, Upper Marlboro '\
ri
I
;;
"
[Dash) dnesn't seem to explain .•. how the racist '!
structure of our society allows a situation like this to hap-I
pen in the first place. The information on her life so far is ';1
beginning to show how pOverty and education impacted :!
them-but not racism. But it's The Washington Post so I
wouldn't expect that part. So I hope that, unlike in most
Post stories, you will work hard explaining how the racial
structure has impacted on their lives and given them the
number of choices that they had and didn't let them ben,
efit fully from the contributions they have made.
"
-Wayne Young, Southeast Washington.
As a black person I find this story very troubling but I
gueSs it's kind of necessary to leU this story. It's very in- '
teresting and ver-y compelling; ,
"
-Alan Patterson, Columbia, Mel,
"
lam tired of 'reading stories about black people and
pOverty; When are you going to do a story about a wbite'
person who'moved from Appalachia and is still in a trailer
park three generations later? This is an 'old story; a tired
stOry. We're waiting to see the story of the two children
who made it into middle and working class . . . .so a child
who's in high school, struggling to get out of that circum
stance understands what positive steps can be niade.
This is why people hate The Post. , ;
-CeeeJie Counts.Blakey.North~ast Washington
I don't understand why The Washin~d~ Post is trying ,
to engender suPpOrt or sympathy for this woman: Her
problems don't have anything to do with 'racism, she's
drug addict. She's enabling her children to become drug'
addicts. The only thing that pOverty has 'to do with it is
that it allows her to use government money to suppOrt
her drug habit and her children's drug habits.
-:-,Denise Kenogg, Arlington
a'
I am a 52-year-old black woman who has gone through
some of the same t:bings that Rosa Lee cUnningham did.
I've been keeping up with the story aU' week. It has '
touched me so deeply, the things that she has endured. I
started having children at 15 and it has bcien ,a struggle
with raising them. I've never taken any drUgs, but 1 was
abused and I can relate to so many things that she went
through. It just moved me. I'm praying for Rosa Lee.
..:...Mimde Barnes, Northeast Washington.
.I thought it was truly excellent. I am ru;, upper white
class, middle class,'let's say, girl, used to be' a very pret
ty girl, and I am a heroin addict. I'm on methadone now.
And reading your story reaDy breaks my heart. I am'so
impressed with this I'm cutting it out and taking it to the
clinic tomorrow to hang up because no one seems to un
" derstand and I think that you somehow in yoUr heart do.
.:-candace Ricks, Crownsville, Md.
·
"
;
I reaDy sincerely hope that other people ar,e' as an- '
gered at this person's justification for all of her irrespOn
sible behavior as I am. This is ,disgustiug. My parents
were pOOr Oklahoma farm kids that worked and never ,
stole and ~ver took anything and never did drug~. My
father' came from a family of alcoholics and he himself
battled with it but still manaRed to hold down a job and "
'Rosa=,Lee& Me
ROSA LEE. hom Cl
every week, ,but the tales that drive his search for solu
tions are the stories he reads every day in newspapers. A
Washington ,Post story about a 14-year-old boy who an
ticipates dying by age 17 still haunts him.
This, Mincy says, is "usually the only picture· the pub
lic gets. But he argues that in reading the life stories of
Rosa Lee Cunningham and her family, some readers ·will
realize that in addition to sort of being horrifying, this is
, also tragic. Some will be struck bya sort of compassionn
for, the growing number of persons trapped in patterns of
repeated criminal behavior, '
'
That's why I wrote about Rosa Lee Cunningham. Ron
Mincy and other experts say that, among those living in
, extreme pOverty. her family is not unique. Consider the
statistics:
'
• In the past generation, America's urban underclass
population has tripled in size-to an estimated 2.7 mil
lion persons (according to Urban Institute studies): By
the time of the 1990 census, the underclass was growing
at a rate of 8 percent per decade. America's history of
'racial discrimination has had a disprOpOrtionate impact
on black Americans, who make up 57 percent of the un
derc1ass. Whites and Hispanics compose 20 percent
each. The remaining 3 percentis made up of Asians and
Native Americans.
• Members of families like Rosa Lee's, in which criminal
behavior. is "a continuation from generation to genera
tionn make up 15 to 20 percent of Washington's priSon
pOpulation of about lO,OOO, says jasper Ormond, who di
rects Washington's substance abuse treatment for in
mates. Ormond estimates that this pOpulation is "respOn
sible for 60 to 75 percent of the criminal activity."' '
"That's why it's such a significant group to focus on,·
PHOTOCOPY
PAESEAVA-nON
As an African American woman who was born in the '
North and educated in the South in coUege I was so '
moved by it that I almost cried. It's one of the best histo
ry lessons ever. It should be published in every history
book across America.
-Erica Simpsoll, HYattsville, Md. ,
I know as an African-American woman, I feel eyes up
on me in stores, and this story I think perpetuates this
myth-that if I come in with my kids and a diaper bag,
I'm going to steal something. Also, if you're going to
write a story about pOverty, why don't you talk about the
flip side, the great nomber of people who work more
than one job to try and take care of their families. I know
that's how it was in my family ... ; So, congratulations
on perpetuating a myth.'
-Susan Smith, Annandale Va.
I'm glad The Post has done something in-depth on
JOverty and racism and abuse. My only concern is I wish
:he underlying causes could be explored, the why more
.:e::an me wnatOlittle further. _.'
to
to look at a
U!Ot1l.13S11·15
De commetllll!lt,' bUtwe '
,
"
' - J o h n L Moore, Northwest Washington
, ~'.
"' lAP
"
" I'm a di~~~~ young' black fe~e. Too often this type
of stuff goes on in the, black community. . .. People
think I'm avery strict parent when it comes to my chil- ,
dren, but stories like, this cause me to be even more
strict . . . . It just baftles me to find out how people can
turn out like this •..• Apparently they didn't have a vi
sion or hope ... in life. Without a vision, you suffer.
'~i'
-':"'Doris Rainey, Laure~ Md.
, It's one of the moSt pOignant, emotional experiences
I've gone through in reading. I read all kinds of articles
and books ..• but this one just kept drawing me in ... ,
Any journalist who takes six, years needs to be listened
to, I think. I don't understand how some of her children
did turn out all right: That's the real heroism,
"; }··.;~·:.1·
..
.
.
"; :!"'"J"-
:, .',;:
-Ruth Worth~Dt Ros!yn;Va.
"·,~\··'·i:; ,~J::'~;~. :-::~f);"~>'-'1:';
. I'm a middle :aged,white housewife in suburban Vir
ginia and I think this haS been a reaDy interestiug article
to reallBeing a person ,that sometimes judges people
without thinking, J.,was·able to stop and see a different
perspective-to oot·beso quick to judge the lifestyles of
people. It's hard toilnagine people ~ving like that but
when you descnlle:the: circumstances around, thedecj
sions they made, it just, shines a different ijght on it.
, '.' ~ ,"'if'':"' ' ":';;'Debbie Miller, Sterling, Va.
I didn't like 'the'ai:t:icleS:tiecause the recurrent message
was that society is at Iaiilt; as in so many of these types of
articles. The seiies~g1osSes over individual respOnsibility.
My grandmOther'was Ii s1ave-:-the term was serf in Rus
\ -,i'.i
'!;
,
-.j ';' -i.'!""~;'J'
.' ./)~~t\~ :'/~!"~~?~(':'~:': ..
:
".
'.
says Ormond; a clinical psychologist. "Poverty is the un
derlyingforce. ,Crime,has been seen as a way out of (pov
erty].~. .,':;, :i··tFt'~~~·'~~~~·i~;,ifl~:"
.,
• HaH of LortOn's PrlsoDpOpulationcan be classified as
::riminaIrecjd!vist~~and women repeatedly arrest
~ for new cnme9, a short time after being paroled. The
l~erage inmate i~ between 18 and 24, grew up in ,the
.:lty's pOOrest'neJghb.orboods and reads just above the
Jtird grade level. " ",\:":,
• ~e ~easure of ~de~cJ3ss growth is teenage child
Jeanng m pOOr urban communities. Nationally, the teen
Ige birthrate in 1991 of 94.4 children per 1,000 girls
'.8-19 years' of age "waS higher than in any year since
',972; according to the-National Center for Health Sta
istics. The rates for teenagers ages 15-17, stable at
;t-33 births per 1.000: mothers between 1977 and
_986, "have risen sharply since, by 3 to 8 percent annuUy." ,.
,'; ",,;"S" :";"'. '
'
Washington's'teenage birthrate in 1990 rose to 87 ba
ies born for every 1,000 teenage girls from a rate of 70
abies born to every' 1,000 teenagers 10 years earlier. In
lard6, which jncludes parts of Anacostia and Capitol
:m, 15 percent of households live in pOverty. There the
.!enage birthrate more than doubled to 139 babies born
) every 1,000 girls ages 14 to 19 compared to a birthIte -<;>f 63 a decade earlier. Wards 7 (far Northeast
'ashington) and 8 (far Southeast Washington) have the
ghest percentage of households in pOverty-18 per_
:nt and 26 percent, respectively. Their increases in
rthrates were 95 percent and 73 percent, respectively.
Foster care is becoming increaSingly dominated by mi.
irity children,because African American and Hispanic
~dren are entering and being retained in foster care at
~er rates than whites. Moreover, increasing numbers
physically and sexually abused children from pOOr ur- i
n communities are ending up in foster care, which is !
safe haven.
,
. " .,
In the decade since 1982, the number of children in 1\',
Jter care nationwide has climbed from 260,000 to ~~
,2,0()()-.ca 70 percent. increase, according to Toshio !li
I
�f. sia-and she came here as a teeriager. and workedin,a'
i shoe mcnory all ofller life. She never learned, to read and
, write in any language. Her husband worked in a shoe faCto
ry all of his life and they managed to squirrel away money
and raise their children. She made sure that, her children
took advantage of the educational opportunities here.
That's the key to escaping poverty:!The lack of education
and the values system in poor families, that's the common
denominator that keeps the poor poor. It's not society, it's
broken value systems within families.
"'" ,
-Amiemarle Bro~n, Falla ~hurch, Va.
\
"
.
I
I
I'm a judge in Superior Court. I've been reading your
story about Rosa Lee. I've been assigned to a drug court
here now for almost three years. I am so caught by your
capturing the essence of what this :whole problem is. I
think this' is a story that deserves a Pulitzer Prize .•..
This is the kind of thing that may aCtually change some
people's lives, if they take it to heart:
-Bruce Beaudin, Northwest Washington
,
It',s a phenomenal story, one of the! best things I've ev
er seen in the newspaper. It tells what the real story is
and how people get trapped in these ',cycles. Getting out
is not quite as easy as comfortable middle class folks like
me have been led to believe. Mr. Dash was very even
handed-neither overly sympathetic nor overly harsh.
,
-Maria Wheeler, Ashburn, Va.
,
'
I'm concerned that you don~t maJ{e' it clear enough ,
that Rosa Lee isn't typical of most women on welfare and
that most women on welfare don't conimit crimes and do
drugs. You risk perpetuating a stereotype unfairly.
_:::-~usa,nJ~!II.!!!!!!!g,J,Vheaton, Md._
As a black person who started out ill the ghetto and
now lives rather comfortably in the suburbs, I have a
huge sense of guilt and of obligation, for people like her
whom nobody seems able to help. Someone should do a
cost-benefit study of her and her children, the cost from
all sources, that goes to maintain Rosa Lee and how
,much positive is coming out of that. The point being, as
Jesse Jackson says, that it may cost us'more money to
keep people in jail than it ever does to educate them and
keep them out. Maybe that's not all of the solution but at
least if the Caucasian public would understand that lock
ing up people ... may not be the best public policy.
-Calvin Young, Fairfax Station, Va.
,
Being an African-American male and 37 years of age, I
keep getting negative images of AfricancAmerican pe0
ple in the newspaper. This disturbs me. It's on the.front
page, I'm not learning anything from it, I don't see
where the racism has perpetuated the dnig use or the il
literacy of the family and I think that they perpetuated it
themselves. I think that the story should hi! ve been more
geared to the children who made a succesS of their lives,
how they were able to escape. what people could learn
from them and how they got around the pOverty.
-Ailthony Frizzell, Northeast Washington
This is a deeply moving series .•• the American 20th
century version of Oliver Twist.
,
-Ken Kerle, Northwest Washington
The thing that impressed me most about the series
Tatara. director of research for the' American Public
Welfare ASsociation. For 1993, Tatara forecast another
5 percent increase (to 464,000 children) when all the fig
ures are in.
"
,;
"There is no single answer to account for" the-in
crease, says Tatara. But after 1986. he adds, "parental
drug abuse" caused,by the crack cocaine epidemic "is one
factor" in children being taken away from their parents
and placed in foster care.
!
"You also find a lot of [child abuse) in the!foster care
system,~ says the Ford Foundation's Mincy.;"The num
ber of black children in foster care is extremely high. and
they tend to remain in foster care because' of the low,
rates of adoption. One of the real dirty little secrets of
the foster care system is that those children are often
victims ofrape:
"
;
In Washington, the number of children in foster care
jumped from 1,760 youngsters in 1992 to 2,218 by last
'June-an increase of 26 percent, according to Human
Services Department spokesman Larry Brown'.
"Rosa Lee's Story: Poverty and Survival in: Washing
ton" ran from Sept. 18 through last Sunday. It told how
the repeated imprisonment of Rosa Lee, six of. her eight
children and a 21-year-old grandson had no :effect on
their willingness to engage in new crime. Two teenage
grandsons have begun dealing drugs, even though
they've seen their 21-year-old cousin go in and out of
prison.
,!
"L
ike successful African Americans, familieJ like Ro
sa Lee's are not difficult to find. At the start of the
project, I interviewed 20 men and 20; women.
heads and members of recidivist families in Washington's
jail, called the Central Detention Facility. Every family
contained the same histories of drug abuse, repeated im
prisonment, c/lronic unemployment and marginal educa
tions extending over three generations. I selected four
families to follow. From this small group, I gradually fo
cused on Rosa Lee's family alone. Just keeping up with
three living 'generations in her family occupied :ine full
was the two success stories of Rosa Lee's children-the
two that made it. And what really helped them was the
intervention of two people in their Iives--one was, a s0
cial worker and one was teacher-and the other children
'did not have exposures to people that could help them
and act as role models. It seems to me that all the re
sources that we spend on crime prevention and drug pre
vention we really need to be spending on children.
,
, -Donna Labadie, Gaithersburg, Md.
, As an African ArDerican and an honors graduate ,of '
Stanford University, I'm totally disgusted with this am
'c1e because you're reinforcing every negative stereo~
, about African Americans. I think it would have been ill
your best interest if you had focused on he.art transplant
surgeons or business people, peopl~ dOillg vol~teer
work in the community, and run an elght-~ senes on
,them, something positive instead, of something so nega
tive. I think that the editor, Steve Luxenberg, should be
horsewhipped. This is frustrating and it is un~ely espe
cially with all the racial division in this commuruty.
-Kim Metters, Arlington, Va.
, It'~ a'Sham. this article about this womanwho should
have been in jail, who should have been incarcerated a long
time ago 'who's now teaching the third generation to steal.
I thiIik it's a shame that the guy who,wrote this article
made her out to be a hero. She's a fine example of whatso
ciety has to look forward to. I don't know that you're not
partially culpable as an accessory for some of her thieving.
'1 ' ,,' "
-Thomas A. StaUone, Bethesda,Md.
I appreciate you writing the story on Rosa Lee. She.is
my aunt. I'don't know too much about my fraternal family
because,of the breakup of my family, the lack of closeness
and unity after my grandmother's death.' My grandmother,
Rosetta Wright, was a strong loving woman who did e~
erything to keep herfami1y ~ogether ~d ~ loved~erfor It.
I am a yolirig African Amencan, and It s I!Iterestmg that I
never knew this about this side of my family. "
'
,
-Ms. Wright, Prince Georges County; M~
time for four years. Above all,I realized that most recidi
vists, men and women, become parents as teenagers. but, "
that we never hear about what happens to their offspring ,
as the parents cycle through repeated incarcerations. I :
wanted to know what these children face as their parentS"
are sent off to jail.
: '
Among the callers Who complained about the series, ' '
there were those who said the articles were ';racist" be- .
cause they perpetuate American stereotypes about'
blacks living on welfare and engaging in criminal ~nter, l
, prises.
' '
' :! '
In fact, the stories were about human poverty at the un-"
derclass level. Tragically, many families caught in thesej
circumstances and having a restricted vision of what their i
oppOrtunities are make the same had choices as Rosa Lee J
did. Many more do not.
,
People often asked me, 'What is the solution?" The~el
isn't one clear answer-the many problems in families like :
Rosa Lee's are too intertwined. ,The third-giade reading,;
levels of Washington's criminals, however, do offer onel
clue: They tell us when the criminals stopped learning. ':'
Intensive work with children in the first six years of ele- :
mentary school can begin to make a differenoe. Many of
these prisoners went on to junior high school without the!
academic foundation to do junior high-level work much less ;
be able to function academicaIly at the high scboollevel.
These men and women are not stupid. They know,:
they do not have the academic skills to be employable in :
the American job market; they see crime as an alterna- '.
tive source of income.
'
Of course, providing a hasic education won't save all of
them. But it will give many more of them an avenue into
stable employment and conventional American life. After' :
that, you can see the connections just as you can see the '
connections to a life of crime-and society should see why ,
it needs to make sure they acquire that basic ability, There
are, after all, very few high school graduates in 'prison,
<,",
" , J have mixed feelings about this story; Wh~ I rea? ~
story, I think: Why is The Post sPO!lighting. ~ family m
'stead of spotlighting African-Amencan families who have
made it? It makes 'me wonder what's going on with Tbe
Post. Because oithe climate in D.C., if you 'Yalk do~, the
street and you're black, everyone ~s you re a~.
I come from a family of II, have been ill and out of pnson,
I have a master's degree and make over $5~,OOO a Year;:
The question you ask, you want to know why ill some fanu-'
lies in D.C., some people make it and some people don't..
It's elementary-you want to.
'
,
-Conice Washington, La\1le~ Md.
Never before has a newspaper article affected me in
such away. This past week, I fee1like Rosa u;e has be
come a part of my life, and it's so easy for us to disregard ~
person in Rosa Lee's situation. But because of these arb~
des, I've become much more compassio,nate to the. dr- '
cumstances of such despair. We are losmg g~eratlon~"
and I hope that Rosa Lee's story will make a ~erenceill ,
educating others in her situation, and more Importantly, '
changing the way America regards such people.
"
-'-Toni-Marie Chieffalo, Northwest Washington
-
~~-. --~~
_.
~
~---~
;:;::""'1 think ttiserles'IS reany ... educational in terms of
showing exactly how messed up the family can be. By go
ing into a lot of detail, instead of just making genera1iza
tions, you can see the inner workings of this family and
how the cycle repeats itself. I think it's useful especially
because 'it seems like there is a racial divide in the city,
that a lot of people don't understand the issues that the
poor faoe and don't understand why Marion Barry got re
elected. The white people basically are just clueless about
what poverty really is • • • .
-Gail McGrew, Silver Spring, Md.
I read all eight installments before I called because I didn't
want to make a hasty judgment. My concern is that I think
everyone has this image of the African-American commu
nity. I would like to see an eight-part series devoted to
something equally positive that's going on in the African
Americ3n community. I would like to see struggles of mid
dle class people who go to work every day, who wor~ hard,
who practice Christian values, who raise their childr!?n,
whose kids don't end up on drugs and who go on to nuse ,
normal, stable families where education and Christianity is '
the cornerstone of family living.
"
-Yvette Lewis, Silver Spring, Md.
,
, When I first begim to read the story, I had a different
opinion altogether. But at the end of the story, my opinion '
had really changed. I think Rosa Lee is a very brave wom
an, she's been through hell I pray for her, her daughter.
Patty and all her children. If there's anything I could do for
her, I would. I am constantly praying for her to keep the
faith that she will overcome and everything will work out
with the help of God. The Post would be doing the public a
favor if they ran more stories like this.
-Doretha Parb, Northeast Washington. ,
PHOTOCOPY
PRESERVAT~ON
�The Rosa Lee Story...
Of Rosa Lee cUnningham's eight
children, five have different fathers
and all but two hav~ been to· jail.
CW'IIlingham berseH. a 57-year-old
grandmother, has ~n a prostitute,
thief, drug pusher and drug addict. As
a parent. she has been an, impeded
mentor, She never cared if her chil
dren did their homework or even if
they attended school. But she did
instruct them-and some of her 32
grandchildren-in the craft of shop
lifting, For three generations. ROsa
Lee's family has been feeding the
jaiJs.
Cunningham's life .was reantly
,f I chronicled in a Post series. and her
story had me in the throes of mood
swings: Sometimes I'wanted to take
~ Cunningham into my arms and say.
.: "Oh, you poor woman:" At other
times, I wanted to punish her in some
way, To put it mildly, She made me
furious.
What's to be dODe with someone
..".
0
'" like Cunningham? The woman's close
0to amoral. Stealing, scams and rip-offs
..,,;
have almost always been the way she
. made money.,
She's been an incOmpetent mother
and only fleetingly a wife. WhlIe she
,.:
exhibits a certairi canniness. she con
~
ducts her· life in a seH-destructive
manner-drug addiction (she's now
on methadone) being only part of it.
She rips off the public and in turn
she's ripped off by some of her own
children. They steal from ber, using
what money they earn-and what the
government provilles ,the family-to
buy drugs. Cimningham herseH is
HIV positive,
There are two ways to see Cun
_rPlJgham. _The first,is to say that-Itere
is a woman who is the sum total and
consequence of racism and poverty so
severe that it has left her outside the
main culture, In other.words, she is a
victim-and we owe her. The other is
to wonder whether what we feel we
owe her-the various weHare pro
grams that help sustam her-'-has riot
t::
f.
J
~
1"
~
"
~. ~
Richard Cohen
Is Anybody Listening?
Richa;·dH"~I~'()od.~
crippled her and made things, worse- ,The money for these and (lther'" • American jo~alists have rarely enthat their ,role in American life, is vital.
cable television., including MTV ,and to
~ shows, than to the traditional mefor society in general. Cwmingham,
programs comes from OUr taI doHars.' .' JOYed great public esteem" They have ~ a third of them "s~ongly, agree"
after all, is not some statistical rarity, We're all getting ripped bft and no' ; ~ stereot~, over the, years as
~th the.sta!ement:(~ithout journaI- dia.
one is domg anything about it, A week' ~ ~cks, ltiner~t,~, rob Ism the public wouldiJ t kno,:" wha~ to
We may have become disenchanted
,She's ,aU too typical a member of the
criminal and dysfunctional underclass after the Post series' ooncluaed ,I
Sisters and pr?pagandlsts, the kind of ~pporL" ~ quarter of the .JOurnalists with the increasing acceptance of "tab
that lives, more or less, on our buck.
asked the series' author, Leon Dash,
PE;Ople who--:-like Charles Golson of the
disagree With the statement "strongly"
loid-ism" as an acceptable joumaIi.stic
• .
Among other things, she lives in
if Rosa Lee had been visited by a ' ~~on ga~g, m ~e White tlouse-:-e~- or :'~,\TIew~at," Only 9 per~('nt, of the form, More than 30 cable and netwoJ:k
• '
publicly subsidized housing ($120 a
single federal or local agency. Not' hiM a wiIIl~f!!lCs,s to rul! .over thclr
pohtlclans strongly agree With :the programs fill both daytime and prime-. ...
'
'd
'"
Das'h sal. an d he s pea ks t 0 ' grandmothers In SI.!.m:h of a slory, I, '. statement, and more, th.1l1 half of ,them time huurs with lurid tales from the
one,
Th'; ,'I "I'
"
I.
"
,
"
Cunningham on a daily basis.'
. t'tr ,SOt 13 ,stam mg, as am t, I~S
di~gn'(' ill ,whole orm part. Surpnsmgnethcrworld. the supermarkets are IuD
'/1
'I p' t " k: M' '. " been as marginal as theIr' L'C::OlloIIIIC
Iy, the pubhc "strongly agrees" with the of newspapers in the same .......... and
~~ ,
When Sen, Darue· a riC, oyru~
W ....:_gt'
" ,
" I I'
.'
,
&--~,
h (D-N V
'ed th hr' "i:i fi' _. crondiu'?D., a"'WI on IS onc,of the f"
.
eW
statefllent s Ig It Y more . than JOumaJthe establishment press has begun to
r'!,
com .. h e p Idaseha' ,ehm,,exceptions to that rule.' JJUL. lIs jllllrnal-, isnfs practitioners' 34 to 32 percent
,and' , ' ')d
find this fare tempting The media ......,.,
mg evtancy own, e cou
ve a, : ,.... ~ ha'
d
bl
f th '
"
""
'
,
"
_•..,
R
Lee C
' ha i ' 'd A 'd' 'R>'" ve unage pro ~~s 0
elf Olllll.
These lIumbers are contamed ma over the O. J. Simpson case resumes
They are often seen as amut'lit and
report on "Politicians and the News
this week is that what :.I__ Il_·:c ne"';';'
osa
. hounn:~~ ,m:n minh': h Sl e
s
.
"
.'
,,'
,
~
....
from the;'. pwtmg lor w IC she, arrogan t !lISI'ders alld.' I'ke th ~ cltys
..
."
I
Media" prepared by the Freedom Fo""""Ie want '0 be ..Q.....M.. ted ....th?
'
was conVIcted 12 times for: a total of
' Ii " ,
d d 'h
' d " , , ' , ,,;
.< ,
u'
po tlaa~s~ are reg~r e Wit eOIlSI er·
rum's First Amendtrient Center at VanVet another discoura' fact Iw '
•
five years m )ail, the rest of Cunnmg~
able cyruclsm and dIstrust
.I-rb'l U' ,. t k .
, ' ,
gmg
or.
~
bani's iUegal activities elicit a virtual,
. ,
" : :
'.It'
It
mverslty, lie report IS to be
reportef!l and editors may be a Sense ofl 'II.
.shfu from officialdom-a ~ of
But also,like the ~lit~clans •..we have
relea~d 011 Oct. l~at the annual ~tility about their work. We provide
..,
., . g,
, .
been sustamed by faith III the Idea Ilmt mcetmg of the ASSOCiated Press Man- ample information on which voters em
cnmes becommg so or~mary they are ,what:we do matters, In that sense, we
aging Editors Association The report's att but as fteD
t the . '
'"
,no longer treated as cnmes. , . , " idealists ' , believe that ill gatherare
as no
•
.'
, We
'
e I'" I"Ion on"t' fi'mWllgs••ww be' rnade 'or '_1_:_ 0
3",lra
I s . .I:':: ' "m
JIlll:illlterpret ,what we y ~ US
are doiaJ.
"!'
Even afte,r she coruei§ed to chme
and presentmg the ne;vs ,honestly public then
Ov ".L."
t 18' ' ths, the _1_ _ " ,
•
,
W
.I
perf
bli".
"
er· UIC pas
mon
C<lII:II.OWl-"':.
aftercnmeon~ge.ont:,of Theash- ,and f~ywel' .0~,a,puc;;eTVIl:e.
'TJiereare,seVeraJphssible exp1aria- ; ate has ~n·inundated\with infQl1lJlloo
,
mgton Post. even aft~r. her ,c~en. w"e ~ ,that democ~acy C.1O;t wor~
tions for ..the lukewarm attitudes of tion about health care reform: iasteid
i,
~ere.photographed USUfI ~8s; nd~ a
Without aocess to ,the Iruonll:1tlon CII,I' ,jolUTIalists toward, the work they ,do,
of action we have 'otten legislative
law~
'!.~
' It nia be that man ,of us 'have
"dlock.
g
,
SIngle member.o~'tlie vas'tcl~y~~edeial" zeJ)S need to govern the~~selves, That s
.' .
" "
.'
bureaucracy droPPed by het bdme to" , WhlIt we try to do, Th~t s what presulJII' ' . ~ k' 'cal
gn
' , ' .'
t"
montb Uf ~ent) and ,h3~ ~ped m and, enforce the law: DeVlanC1'(jf Whlclt
ably gives oUr, vocation moral st:1ndillg
a wa~s
II s ~pti
twe ar~ indis, The ~ost ~ JUst conclu~ a stuD
out of V3J10Ul1 public ~lStance ~~o- 'ROSlI .Lee is the vi.rt:Ua1 ....sonifiCa~" arid rationalizes the piivileses we .:lIjllY
pensa~le to SOCIety and the w?rkings of ~lg soclOlogtcal report on ~ mt~- ' :1
grams-welfare, food stamps. Medic'!la'
, '~..: d" pe.U d'
", .. Wider the First f\mendmellt
demO( racy and that our atlltudes 1& lions between poverty. anne, 19no'
,
'
tion
s not J\Jst u.;q. efineu awn
' .
d ' k ha . h .'ed
'
"
ald, emergency grants of one sort ,or
't ha' bee d" f:.;ea,' ut f ;', 't':' ' , , '
Whether this idea has bro.ld public
war our wor
ve c ang
very
ranee and dependence. Four years of
'
I
S
nell. " ' " "nee. . . a.........., - been debatable (or
0
0 eXlS
httle '
k went mOlt, and' IS. certain to,
't '
,
,
another and, a ,
,
Of
',;
"
tance has
wor
at
",
Social 'Secunty pro,
course government agenCles........,
'I
el
L __'
"
_r
r
gram for the disa bled tha t now gives
.'
"
"
years. A lot of evidence has <I('('ulllllht. I may L_ thatwe lee a sense ,0f
ute
""",ome a majOr work'0 f laerence lor ' '
ers .
" '
, '. ,',
,
d'· I_· n . e'nt a' s,othe r nled'Ia' e!ode our
fut ure s u s 0 f the Arne'
t die
.._.......;,.
from the CO"", to weHare w o r k' e d -Ulat ill certam nrCtllw'talln~s"
.
:r, "
,
IS~l(Il"m.
.
ncan WIUCl'
her $437 a month .
..,:
Much of her money has gone for
are ha~d.pre~-:-and Ro~ Lee IS
wars, nationat security aJlairs and ill...a- audiellces, A Jn3jOnty of Amenc<lns say classes. The author is a brilliant black
illegal drugs for her or her children.
nota Violent crumnal: But if g?vernsions of privacy. for ~xalllple-;-the peoth('y.n?w get most of their n~ws from' joWllalist who ,wrote with great sympa
pie want the press COli trolled by the~clcVlSIOII, And there are other competthy. compassIOn and understandin,g.
Under Medicaid. for instance, she
ment cannot enforce Its ,laws. It cart1\,
pays 50 cents for 60 pills of either
no~ then enf9rce ,mor8hty-~ome
'goverrunent. H a constitutiollai,collvclIItors. In th~ ,', New..YorkReview of abou~ the. black family of Rosa Lee
II.
Darvon or Xanaxand re-seUs them
the~rent that.Uf. many respects,
600 'were held tOday, would tlie ,First
~ks, the .JOurnalist, Thomas Edsall
CWlI1I!:Ighani.
.
for either;' $1 or $2 to methadone
CWlfUngha?Jhas neyer
Tbe 'Amendment survive in its prbscnt
wnles: .
,,' __ T~e_ ~des has been highly praised, -_•.••
,
patients who use them for a cheap
practical differ~n~e ~tweenmdiffer-" fomi? There is reilr~thill the _!leWS- -' ~For the past tWo' years; RuSli tUn- --- according to The POst's ombudsman.
but has also brought 00wn on The Post
.....
high. She may be illiterate. but ~e'~_ ~'!Ce_an~ ~rl1t~l?n becom.es.\mJrr~-btiSmesS tliirtit might not. A recent poD baugh III has done; more to shape the
_. something of an entrepreneiii,
and .government ItseH becomes dis- . taken fpr Tune. magazine and CNN
tone of national political discussion than charges of racism for perpetuating "the
'. •
It's hard to know what to do with
credited.
'. •. .
reports that 83 perrent of adult AtIl('ri7 any member of thct House and Senate,
notion that black people are a problem."
Cunningham and, by implication, othThJs is what's ~ppened to·welfare· 'Olnsthink ~ press has acquired "too than any Cabinet appointee •. than the
The conjunction of these develoP.- ..
ers like her. But I do know that
and associated. programs. Vou. can 'much influcnce Oil gmwilllll'Ilt." We! ('hairlllen orlxlth the Democratic and
menIs-erosion of audience, a sense ci' I
Cunningham has been a thief-she
blame Rosa Lee-and she is, hardly· ' are at the top of thaI lis! alollg wilb
,Repuhlican parties or the an('hors of ineffectli.11ily etc,-is all in the day's'" :;,
blameless-but .;you can blame gov- . "the weAlthy" and !'Imge corp',nliol)s,"
the major Iietwork news broadcasts,"
work, of course, but provides no an- " '.'
says she no longer steals-and the
money she took is ours. It's our welern.rilent as' wen, Like Rosa, Lee, it
Last week we wt'Te givt'n a glimpse
In the eler,tion for president in 1992. swers or reassurances for people in tile
of a poD suggesting thilt jnulli;llists
it was widely concedlld in the press that
news business who have begun.to woofare payment and our public houSing,
has its own morality-and in this case'
,
It's our Medicaid and food stamps,
• it amounts to none at all,
themselves are nol l'/ltirely COIlVill(cd
Bill Clinton's Victory owed more to der what it is all about.
Even after she
confessed to crime
after. crime on page
one of The Post,
nobody from
.
government dropped
by her home to
,enforce the
o
,.
,
•
1"'-... ..........-...
"
ma
..
u:
.'
..
bef:d.,
..
..
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Dublin Core
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Carol Rasco - Issues Series
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c9b2ecf9cbb77d3051cced02077da027
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Clinton Presidential Records
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&H*'
�I
CAN NATO BE REINVENTED? II TAXICAB SCAMS IN 10 CITIES
I
JANUARY 10, 1994 .
& WORLD REPORT
·THESECRET
.UFEOF
SIBUMGS
Why we love, hate and '
compete with our
.
"".. . ,brothers and sisters
'
'
$2.50
�
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Carol Rasco - Issues Series
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Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Carol Rasco
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<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
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Text
For Your
\ ATTENTION
j
With
Our Compliments
Staff
Response
UNITED METHODIST WOMEN
CLINTON LIBRARY PHOTOCOPY
�AI
!2M&L'M&MIWM'UIM!!tI!WWM'MMM'!6'M EI'M. .
Clinton Presidential Records
"Digital Records Marker
,':,
'
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..',
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This is not a presidential record. This is used as an administrative
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This marker identifies the place of a publication .
Publications have not been scanned in their en'tirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
10. .' , . . . .» . . .'••··wu·
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"SM..
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'm
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leg
��
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Carol Rasco - Issues Series
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Carol Rasco
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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.
Talking Points
NGA Resolution on Welrare Rerorm
February 6, 1996
As the President said in his speech to the NGA this morning, real welfare reform must
require work, promote family andresponsioility, arid protect children. The governors'
resolution reinforces what the President has said all along -- that the conference report he
vetoedfell short of real welfare reform, and must be improved.
The Administration is pleased with the NGA's recommendations in several areas of
promoting work and protecting children -- substantial increase in child care funds, a better
contingency fund, a substantial performance bonus, equal treatment for recipients, red'uctions
in the overall level of savings, provisions o~ SSI children's disability programs. increasing the
hardship exemption. improving the work requirements, and making the family cap a state ,
option. The Administration continues to have serious concerns about other important issues -
including child welfare, Food Stamps, school lunch, maintenance-of-effort, and benefits for
legal immigrants.
The NGA resolution suggests valuable improvements over the conference report and
. the Senate bill in several key areas that are priorities for the President:
~hild
Care -- The NGA resolution calls for adding $4 billion for child care to the
conference report,which is $5 billion more than the Senate bill. Semitor Dole acknowledged
the need for more child care money in his speech to the NGA this morning. The
Administration believes, however, that states should match this additional child care funding,
and maintain current quality standards.
Contingency Fund -..: The NGA called for doubling the contingency fund to $2
billion, and providing an additional trigger, based on Food Stamps population. The
Administration has made additional suggestions to strengthen the countercyclical mechanism
of this provision.
Performance Bonus -- The NGA endorsed additional funding for a 5% performance·
bonus to reward states tha,t meet the work requirements -- a key provision that the President
has long championed and that was a centerpiece of the DaSchle-Breaux-Mikulski bill. This is
a significant improvement over both the conference report and the Senate bill.
Equal Treatment -- The NGA resolution incllldes an important requirement that was
not in either the conference report or the Senate bill, to ensure that states set forth objective
criteria for the delivery of benefits and fair and equitable treatment.,
SSI Disabled Children -- The NGA resolution adopts the SSI children provisions of
the Senate bill, but moves back the effective date a year, to 1998.'
�The NGA resolution recommends other important changes that are similar to the
Senate bill:
, Work Requirements ~- The NGA resolution adopts work requirements and state
flexibility similar to the Senate bill, which will somewhat reduce state' costs of running work
programs.
'.
Hardship Exemption -- The NGA resolution endorses the 20% hardship exemption in
the Senate bill for recipients who reach the five-year limit. The conference report had
reduced this provision to 15%~
'.
Family Cap -- The NGA resolution endorses the Administration policy that states
should decide for themselves whether to limit benefits for additional children born to parents
on welfare. Like the Senate bill, the NGA would make the family cap a state option -- rather
than a mandatory provision with an 'opt-o~t, as the conference report included.
Overall Savings -- The NGA resolution cuts more deeply into Food Stamps than the
Administration's balanced budget plan -- at levels deeper than the Senate bill. ' Because the
NGA resolution calls for additional sp~nding on child care, the contingency fund, and the,
performance bonus, its overall net savings are slightly below the Senate bill but still
considerably higher than the Administration's balanced budget plan.
The' Administration continues to have serious reservations about som'e other provisions
in the NGA resolution:
Child Welfare :-- The Administration has strongly opposed block granting child'
welfare. The Senate bill maintained current law In this ,area. The NGA resolution would
allow states the option to block grant certain programs.
Food Stamps -- The NGA resolution fails to criticize certain Food Stamp provisions
of the conference report which the Administration has strongly opposed, including the state
option to block grant Food Stamps' and the arbitrary cutoff of able-bodied childless adults.
School Lunch -- The Administration has strongly opposed block granting the school
lunch program. The NGA resolution would maintain the entitlement for children, but block
grant administrative costs.
'
Maintenance-of-Effort -- The NGA resolution is silent on the issue of maintenance
of-effort. The Administration strongly favors the Senate provision of 80% maintenance-of
effort, rather than the 75% requirement in the conference report. In addition, the
Administration opposes the Conference provisions that enable states to transfer funds out of
the block grant for other purposes.
Immigrants -- The NGA resolution is silent on the question of benefits for legal
immigrants. The Administration's balanced budget plan requires.deeming until citizenship.
The Administration strongly opposes the level of immigrant cuts in the conference report and
,
.
�the Senate bill.
Medicaid -- While details have not yet been provided, the NGA resolution on Mediaid
suggests that welfare recipients should continue to be guaranteed health coverage. The Senate
bill maintains this link between welfare and medicaid, but the Conference report broke it.
�FEB-06-1996 09:36
FROM OFFICE OF CHIEF COUNSEL
TO
456555'(
P. 02
..-;;' '.
SUSPENSION
(Policy Position offered by Governor Thompson and Governor Bob Miller)
WELFARE REFORM
TIu Governors believt tIu1l DU1nation's lel1tlos art
and momr.ou.s responsibility
needy fo.mil!eJ. ,We, the
reform llQ:!£.
10
faced with an hutoric opportu.niry
IIDW
risrruclJln' the ftd.er.al.sriue parmmhip inpro'lliding services co
IUlrUm's
Govemo,n, are committed
10
achie1lmg meaningful welfare,
Th.e conrimultion of tht cunenr welfare JYStem ii ulUlccl!]Jcable.
mo.de significant ejfr:nts ,oward ma/dng cJwngrs that will allow
Sl/lleS
Congress
the flexibility
10
has
build'
upon me 'lessons stJUes have lea:rrt«l rhtough, a decade of aperimenracion in, welfare reform.
'The President has o.uo voiced his commitment to achi.e!.'ing welftur reform and has continued
to granr waivers
W lfIJIes
We urge' Congress and lhe Presidmt
to facilbfJle expuimeirtariDn.
w join. wich the'1I.IJ1ion'J Govemon in ~pcn of a bipartisan agreemenl that will reallocale
,responsibilities among levels of fIOVemmenr, mtUimize
mJte
jialbility, and rtSlP'UClW'e welfare as
a lralUitional program, with a f«won work and self-su.fficiency.
children mUSl be protected throughout 1M
TU~auri.n.g
process.
Slale experience in we.lfare riform" has demonrtrated
cnicilll for "su.ccessfui welfare
rqu,m:
tMl
t!vee elements are pa"icuiar/y
welfare must be lempor01Y and linked co work: bOlh
parems musr support datir c/rildlvr.,· and child care
ntWt
be avai.lable
families. with childrm toworlc, A.I:ldi.tion.a/ly, we believe lh.atblock
10
We believe, however, lhat
grtmU
10
enable low-income
should be entitlementS
SlfJleS 0J1.I.J enable states broad disc:recion in 1M duign of theiT own prog;,am! based upon
mutually figreed·· upon gotIls.
We also bdieYe thai sialu should have access ro supplemenrary
marching federal fu1u:U for their c.ash assisrance programs during perioids of economic downturn.
.
The conference agreemenr on 'HR 4, the Pmono./ Responsibility and Work Opporrunity Ace.
[
'
incorporaled mariy of these elementS,
ow
We also believe further changes mUSI be made ro
erearea'souNi and w01'1cable welfare reform bUL
The NarionaJ GOllemors' Association woult1
SuppOl1 lhe HR 4 conference agreement wilh thL changes listed below with the exception of
lite alien prollisions.
The absence of recommendari.onr on the resrmrion of benefits for aliens
.
should nor be Uut1p1'eted as, supporr for the alien. provisions of lite HR 4 conference agreemen.T:
,.
Ct>re Emp/oymj:nl, Suppon Senb:s.
• Add $4 billion
not requiTe
;n
funding
'/2 stale
marCh.
10
che general ellmieme"" for child care.
This funding would
�FEB-136-:1996
139:38
FROM
• 'cJum~
OFFICE OF CHIEF COUNSEL
TO
4565557
P.131
the paniciparion. rme calculatiOn 10 tala. into account those who leave cash
assistance for work as long as they remain emplayuI.
• Reduce the number of hours of panidparion re.qu.iTed in {ur:urt Yf!ars
• ,Pmnit I1IMS rhe opriotl 10 limit the requi1ed houn
EO
25.
C1f work to'1O Mun a week for
;parentS with a child under age si:c.
• Allow job search tmt1 job readiness 10 count as a work aai\liry for up to 12' ~eeks.
• Add $1 billion 10 the contingency
• Slates can meet
()nt!
fund.
of two triggers to access .Ehe contingency jiuuJ.'
the unemp/oymenr
rriggu. in rhe confl!1Vrce agreemtm or· a. new trigger bcpe,d on food Stamps.
food stamp trigger, states would be eJigibk for thI! con.tingenc:y
children in their food $ramp caseload
Under the
fimd if lhe numbu of
inaeasei by 10 percent ovu FY ]994 or FY 1995
levels.
, PirrfDl'lftlllla Int::l1llliws'
• Provide cash bonUles of 5 pueellE annually to nates lhat exceed specified
,emplOyme1'lMeloJed ~rfonnD.r/.U
lurget
percentages.
These bonuses would nor be funded
out of the block grtlnt base.
• Maintain the bonus for states that reduce our-of-wedlock births c01lfained in the
conference agreement
• Provide
SUIteS
.<
wiIh the opdon
10
,-
restrict beMjil.$ ,to adduumm c.hildren bom or conceived
•
while the fllmUy is on welfare.
• Ro.istthe 4dministrfmllt cap on child can: jiuuJs to 5 percent·
• Raise the eremprion to the five-year iiferime limit
case.load.
-2•
011
brnefitJ
10
20 po;cenr of the
�...
FEB-06-1996 '09:38
FROM OFFICE OF CHIEF COUNSEL
4565557
TO
P.02
.....
• Add a statt pltm requirtmeru
~hIJ.l
the It&lU!' sel forth objective criteria for the delivery
· of ben¢n qnd fair and equitDble treatment.
Child Pro1«fim& Block Grant
.• MailuoUl the ofJOJ-endtd e1llillemenl· for [oSIP care and adoption assistance.
• Provuu
a state option l() take fostu core, adoption assisrance, and independent [ivi7lg
funding as a capped mrirJi!nIt!lt1 wtrh aMUDl growth
IU!ju~nnm'
based
071
average
narional ClJSeload growth TaU!.
Srmu may utJJ1Sfu any portion inl() a Child PrOltcrion
Block Gram for acrivws such
III
early intervention, child abuse prevention, and family
Srims musr continue to nuzitttain ejfon ar 100 percent based ~n stare
preservation.
spending in the year prioI' l() accepting
w
protections and sUlN1tutls undo
law.
C'lU'ft!IU
capped en.rillemOll.
Stares must main/am
Statts can revuse their decision on a
yearly basis.
• Create an enri.tlemtlll Child. ProU!criDn Block Grant of the remaining child welfare,
family p,eservalion, and child. abuse prevention and treatment programs.
These
programs an IIOr aurt!lttlY individual enlillmwus. Sr.aus must mlJmtain protections and
standards under current law.
SupplemenJaJ Set:IIrily IIlCltHlfe (551)
10;' Children
• Accept the proVisiollS in the Senate-passed welfare bill
• Change effective dI1.le for ~ and new applicaJUS to January 1, 1998.
FtJ04
StlZmps
• Accept the provisit:m in the Senate-passed welfore bill IhIJ.l reauthorize the Food Slamp
program in its
CUl"fe.nt U1ICapped
• Modify the income deductions
• Mainto.i1f rhe
t:IJ1'IVIt
e1llirlDntnt forllt
as outlined in the Sentl1e-passed welfare bill.
etUitltmeru for childrOL.
.• SChools wou.1d cOnrinut'lo 'ff!c~ivl! per meal federal subsidies for all lunches and
breakf~
under amelll eligibilily criIeriD.;
• Additional subsillies for schools Wilh high proponions Of free OT reduced-price
pani.cipams will be, mouftf.li1u!d.
I
·3·
�FEB-06-1996
09:39
~
fRUM
U~~lC~
lU
Uf CHIEF COUNS~L
Srares would continuero receive lhe proportion of administrative costs based on currenr
law bur in a block' grant.
• The state
I7ULfr
dLve/Qp a SlQte-based plan thaI Vlcludn pub/k VlP'lt aM describes how
the state will optTllte the program..
• AI/ocher sategumds
desa1btd 'in
the
conferrnCl repon will be fnauUained..
• The, National GoVernors' A!socialiDn suongly encourages Congreis to work wUh the
GoYemon of Pueno Rico, Guam,. tWi other territories towards allocating equilable
,
fedoal j'u.If.di.ng for their wel/Q}'t program.
• This is only an
issue' within
the conte:a· of blldgrt rt!!concilio.tion.
• Limil the savings from riMMg 1M EITC
, • AdIi a SlDle option to tlIivance the EITC
to
110 biJ/iol!.
�" i
l
II
H',
",,'
.'.
PHOTOCOPY
PRESERVAtrON ,.
" .
.~
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Carol Rasco - Issues Series
Creator
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Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
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2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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Clinton Presidential Library & Museum
Extent
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92 folders in 7 boxes
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
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NGA/Welfare
Creator
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Domestic Policy Council
Carol Rasco
Issues Series
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2010-0198-S Segment 2
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Box 125
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
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Adobe Acrobat Document
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Clinton Presidential Library & Museum
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Date Created
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12/4/2013
Source
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2010-0198-Sb-nga-welfare
-
https://clinton.presidentiallibraries.us/files/original/dbd40db989fadff00297b296a90565cd.pdf
4584cbbb29b689bdc8fc0ee6d57e5273
PDF Text
Text
,
,,-
',"
.
,
,"
THE PRESIDENT'S MEDICAID REFORM PROPOSAL
1.
Overview
2.' Financing
o
Responsive and Responsible Federal Financing --
o -
Per Capita Cap: What Is It .
o
Per Capita Cap: How Does It Work and Adapt to Enrollment Changes
o
Per Capita Cap: Adapting to State Spending
, o'
3.
Disproportionate Share Hospital (DSH) Changes and Pool ,Payments
'
-Flexibility
o
Managed Care Flexibility
o.
Eligibility and Benefits Flexibility
o -
.)
-Provider Payment Flexibility
0'
..
.. .
Administrative FlexiQility
�.~
1. OVERVIEW
"
The President's Medicaid pr?posal achieves significant refonn and, offers: .
•
•. *
Responsive and"responsible ' . fu.nding:
Federal
.
.
o
•.
Federal funding is not fixed b'ut responds to unexpected costs due to. recessions or increases in the number of aged or
disabled beneficiaries.
.
o
.
F'ederaI reductions are responsible, providing states with s,ufficient funds to mai~tain coverage for the millions of
Americans who rely on Medicaid ..
State flexibility: The top concerns of the Governors have been addressed, including:
.
\
'
"
o
'.
Repeal'of the Boren Amendment regulating provider payments;
o
End to the burdensome waiver process for managed, care and home and. communi,ty-based waivers;
. .
.
o
Eligibility simplification and expansions witho'ut waivers; and .
0'
Elimination ofmany unnecessary and duplicative administrative requirements.
2
�...•
,.-.
,~
;
2. FINANCING
The President has propose4 to'refonn Medicaid financing through a Per Capita Cap apd Dispr0I?0rtionate Spa~e Hospital (DSH)
payment changes.
..
.
•
ResponsiY~mess: A per capita cap maintains the responsiveness of Fedenll fundingto states' unexpected costs.·
0 ...·
•
. Under
the President's proposal, the Federal governrilent shares.in the unexpected costs due to recessions or increases in
.
the number of aged or disabled beneficiaries.
Responsible: The per capita cap and Disproportionate Share Hospital payment reductions achieve responsible lev~ls of Federal
savings.
.
o
. .
.
The President's proposal provides states witli sufficient Feder~l funds to main.tain coverage f~; the millions of
. Americans .who rely on Medicaid.'
.
..
.
The following .section reviews:
o
:Responsive 'and Respopsible Federal Financing .
o
Per Capita Cap: What Is It .
.
oPerCapita Cap: How Does It Work and Adapt to Enrollment Changes
o
o
Per Capita Cap: Adapting to State Spending
. Disproportionate Share Hospital (DSH) Changes and Pool Payments
3
�..
Responsive and Responsible Federal Financing
....
'The President's proposal maintains 'the Federal commitment to share in states' Medicaid costs:
•
Protection from recession. During a period of economic recession, enrollment will increase, cauSing state costs to rise. The
Center on Budget and Policy Priorities estimates that Medicaid costs could increase by at least' $26 billion over seven years if
there is a recession similar. to the one experienced in the early 1980s~ ,Under a per capita cap, the Federal government shares in
these unexpected costs.
•
chan2es in Medicaid caseload, States ~ay find themselves with greater proportions of co;tly persons such as
Protection
seniors or people with disabilities. The per capita cap adapts to shifts in the types of beneficiaries covered by a state,
.
increasing Federal payments to ,states~ftheir patient population becomes sicker;
from
'The President's proposal also takes a responsible and nota radical amount of savings from the tyiedicaid pnjgram.
•
President's plan saves the Fe'derat government $59 billion over seven'years, '
•
Republicans' plan saves the Federal 20'vernment '$85 billion over seven years; .
IS $26 .billion -- or 44 percent -- higher than the . ' proposed by the President.
. savings
o
This
o
Under the Republican plan, spending growth per beneficiary' ~ould average 2 percent over the period-- less than
,
intlation and significantly, below private spending growth per person (7 percent). By 2000, the rates are very low sin~~ .
the Republican'cuts are backloaded,.taking effect after the tum ofthe century.
.'
~.
"
,
o
,
By 2002, Federal funding to states will be inadequate and states wiV be forced to reduc~ payments, benefits and deny
coverage for millions 'of Americans.
.,
4
�Per Capita Cap: What Is It
•
A "per capita cap" is a policy that limhsFederal Medicaid spending growth per beneficiary. Un,der this policy> Federal
payments automatically adjust to a state's enrollment: ira state has an unexpected increase in enrollment, the F~deral .
needy persons
governrnent will share in these increased costs. Inother words, Federal money will flow with the number of . a
-
.
'
.
state serves.
There are three components to the per,capita limit on Federal funding:
o
o
<Bast( spending: :Each state's 1995 spending per beneficiary is calculated, excluding spending items such as paym~nts
for Medicare premium!? and cost;.sharing and Disproportiona~e'Share Hospital payments..The spending per beneficiary'
is separated for·the f~ur major groups ofMe~icaid beneficiaries: seniors, people with disaqilities, adults and children.
.~: . Future year spending limits will be calculated by growing the averag~ 1995 'spendingper beneficiary by a pre
set "index". The index updates the 1995 spending in proportion to the growth inthe gross domestic product per person.
.
In th~ President's proposal, t4e<lndex averages approximately 5 percent between 1996 ind 2002,'
0,
Actual enrollment: This indexed spending pet beneficiary is then multiplied by the number of beneficiaries in each
category ina given year. The category-specific limits are then added together to yields the maximum spending that the .
, < '.
<,
'
Federalgovernrnent will match. '
Each state will have a single total limit, so it can use sa,vings from one group to support expenditures for other groups or to
expand benefits or coverage. '
t "
.
•
5
�"
Per' Capita Cap: How Does, It Work and Adapt to Enrollment Changes
.
To 'give an example ofliow the fonnula works, take a hypothetical sta~e:
•
'.
1995 Spending per
Beneficiary ,
'.
'
2000,Limit per
Beneficiary ..
Enroilment in 2000
$11,487
1,000
' $11.5
Elderly .'
$9,000 .
Disabled
$8,000
"$10,210
Adults·
$2,000
:$2,553
3,00p"
Children
$1,000
$1,276 -
,
2,000 .
6,000 ."
.
Total
'.
,
$20.4
-
..
$7.7.
"
$7.7 .
.
'
,
•
••
Federal Limit
. ' (MilJions)**
Total Limit
. . (Millions)
$23~6
$47.2
.
i
Index is 5% per year, or 28% growth between 1995 and 2000.
Assuines that the.Federal medical assistance rate is 50%.
In the' year 20QO"the maXimum Federal matching payments f~r thi~ state \Vould be'$23.6 million.
The cap adapts automatically to state enrollment changes
-
•
•
.
....
If enrollment in these categories increases above"fue levels noted above', the,totatand Federalli~it would increase
automatically -- because the limit is calcl1.lated ona per person basis.- .'
" .If enrollment shifts to more expensive populations or enrollment grows faster than expected, then the'totallimit would increase
automatically.
o
'
,"
: For example, ifthe~e are 500 more seniorsth~ noted above, then the total limit would i~crease
$5.7 millIon (500 "
seniors times $11 ,487 limit per senior), and the'Federallimit would increase by around $2.85 million." -
by
6
�.'
.
.
Per Capita Cap: Adapting to State Spending
•
If the state'keeps spending per beneficiary below the limit for one or more categories_ofbene£1ciary, it has a number of options.
For example,assume that the state kept speriding for the elderly to $10,376 per elderly beneficiary ($1 ,000 below the limit per
, beneficiary). That would,free up $1-million within the state's aggregate limit ($1,000 per enrollee times 1,000 seniors). The,
. ,state could:
'
.
'
v
o
o
0,
Spend above its per,beneficiary limit for another group. For example, the state could spend $150 more per child -- a
total of$I,426 per child -- for a total cost of $0.9 million ($150 per child times 6,000 children) and still remain within
,its aggregate limit. ,
'
.
'
.
Use'the funds.to expand eligibility to new groups who~e incpme is within the 150 percent of poverty level (see"
, Eligibility Flexibility).
. .
,
Save the state share of the funds.
7
�,
,
Disproportionate Share Hospital (DSH) Changes and Pool
P~yments
Disproportionate'Share Hosphal Payments Changes:
•
Dlsproportion~te Share Hospital (DSH) payments would pe reduced and retargeted.
o
Financing: The current (1995) Federal paymen~s,to states would be grad~ally phased out, and a new DSH paym~nt
method w~uld be phased in. Funding fro~ a fixed Federal pool w~uld be allotted to states onihe basis of their share of
low-income days for' eligible hospitals.
"
o
Prograrri Design: States would use the funds for hospitals that servea l1igh nUmber of uninsured and Medicaid patients;
',and would have the flexibility to cove~ additional hospitals that they deem needy.
Pool Payments:
•
Three pools of grant funding would be cr~ated to ease the tran;ition to th~ refornied' Medicaid progr~. '
o
:,-
Undocumented Persons Pool: A $3.5 billion pool to help the 15 states with the largest numbers of undocumented
persons would be created. This 100 percent Federalpool would be in effect from 1997 t02001, and would be allocated
to states in p~opoition to their share of the nation's undocumented, persons. It would be used by states for emergency
care for these persons.
.
.
.,
o
Federally Qualified Health Centers and Rural ,Health Clini~s Pool:' As part of the proposed changes to-promote
-state'Jlexibility, the mandate for states to pay Federally Qualified Health Centers (FQHCs) and Rural Health Clinics
(RHCs) on a cost basis would be repealed. To ease the change in funding for these facilities, a program would be
created with $500 million in Federal funds in each year begirming in 1997. .
o
. Transition Pool: For 1997 through 1999, $3.5 billion in Federal funds.wouldbe given to states to enable·a smooth·
transition to the reformed Medicaid program.
"
)
.
8
�3. FLEXIBILITY
-
'
'
.
.
The President's Medicaid propo~alsignificantly incre?Ses states' flexibility to design and managed their own Medicaid programs.
•
The President's plan addresses the top concerns of the Govem9rs: _
o
Repeal of the Boren Amendment regulating provider payments;
o
End to _the burdensome waiver process for managed care and home- and community-based waivers;
o
Eligibility simpiification and expansions without ~aivers; and
o
Eliminationof many unnecessary and duplicative admini~trative requirements .
. -i,
The following section describes new state flexibility in the
o -
following~ areas:_
_Provider Payment Flexibility
o
Managed Care Flexibility
o _
Eligibility .and Benefits Flexibility
-0 .
Administrative Flexibility
.~
9
�Provider Payment Flexibility
The President's plan gives states greater flexIbility Tri setting provider payment rates: '
.
;
.
•
Boren Amendment is Repealed: (NGA Recommendation) The prop~sal repeals the 'Boren Amendment, allowing states
greater discretion in establishing their provider payment rates. Underthe Boren Amendment, states were required states to pay'
. hospitals and nursing homes "adequate" and "reasonable" rate~. Because ofit~ ambiguitY,this requirement led to many costly
lawsuits for states.
•
Cost"'Based Reimbursement-for Clinics is Repealed: (NGA Recommendation) States will no longer be required to pay
Federally Qualified Health Centers(FQHCs) and Rural Health Clinics( lliICs) that are not Indian Health Service facilities on
. a cost basis beginning in FY 1999. "
.
•
Burdensome Standards for Obste.trician and Pediatrician Payments are Eliminat.ed: (NGA Recommendation) States
~urrently miJst file extensive doc~entation relating their payments for these providers ... Undetihe p;oposal, states could set
"their own payment standards for obstetricians 3l1d pediatri~ians arid wquldbe freed from the paperwork burden that can range.
from 30 pages to_ 300 pages.
•
Requirement to Pay for Private Insurance When Cost Effective is Rep'ealed: (NGA Recommendati~n) Under currerit
law, states are required to enroll indiv.iduals in private insurance in certain situations, when private insurance is more cost
effective. States will:Qave the option to continue purchasing gr~up insurance·and negotiate their own tates.
to
10
�.'
Managed Care Flexibility
U~der the Presideni's proposal;states'will have new flexibility to implementand operate Medicaid m~aged care programs. '
.
:
Elimination of Need for a Waiver: (NGA Recommendation) States will 'be able to implement managed care programs.
without the need for Federal waivers, soiong as beneficiaries have a choice ofplans, except in rural areas. States will be
permitted to enroll Medicaid beneficiaries into their health phms for up to six months and to guarantee Medicaid eligibility .
during this ,enrollment period.
.
,
\."
•
,Outdated Quality Standards are Repealed: (NGA Recommendation) The 75/~5 enrollmentcompositiori rule will be
eliminated. : " ,
'
Q~alitY of care will be assured through. state~designed quality. improvement progr~s ~- which follo~ Federal guidelines ;.- that
ensure that managed care providers maintain reasonable access to quality health care:"
,
•
Federal ContractReview is EUminated:The Federal gove~entwill no long~r review states' contracts with managed car~
plans that exceed $100,000.
•
HMO Cop~yn:ients are Allowed: (NGA Recommendation) States will be able to require HMO enrollees to make nominal
copayments, consistent with their ability to requiie,copayments in fee-for-service settings:
(
, I
II
�"
.
Eligibility and Benefits Fle'xibility
The Presiqent'~ proposal maintains the Fe~eral entitlement and keeps Medicaid basic benefits intact. It builds upon thi~ base to offer
states options for simplifying and expanding eligibility and designing corruriunity-basea long-tenn care programs.
.
'.
Eligibility Expansions are Allowed Without Waivers: If states are able to manage costs below the,ir per capita lim~ts, they
may. add any new eligibility group at their discretion.' This means that ifstates want to expand coverage, they may do so
without a waiver and to any group of low-income people. The, only limits on this flexibility are that the new beneficiaries'.
income is less than 150 percent ofthe poverty level, and the expansion does not result in spending above the per capita Hmit.
o
o
. •
•
1.n the example of the ho:w a per capita cap would work, the state could, under one scenario; spend $ i,ooo less than its
limit per senior ($10,476). 'Wit111,OOO senior enrollees,thatwould free up $1 million within the state's aggregate limit
',($1,000 per enrollee times 1,0,00 seniorenrollees): "
.' ,
'.
.
.
With this $1 million, the state could choose to add 500 individuals with spendingof$2,OOO.per person and still o·e '
within their limit.
. .
Eligibility Expansions can beScaled Back: (NGA Recommendation) UndercurrenHaw, a state that chooses to cover
pregnant women and children. above the mandatory levels cannot reverse that decision. This mandate is repealed, so states can
return to the minimum level.
. Honie and Community-Based Care Programs are Allowed Without Waivers: . (NGA Recommendation) States wiU be
able to provide home and community-based services to their elderly and disabled Medicaid enrollees without the
administrative burden of seeking Federal waivers."
,
.
-.
.
12
�-
~
,.
Administrative Flexibility
The Pre,sident's plan repeals and simplifies Fedenil'admiIristrative requirements forthe Medicaid program.
•
Certain PersoDnel and Program Requirements are Repealed:, The,current Federal ,mandates to documenqhe
establislunerit and mainte'nance of merit-based personnd s~dards,and to use professional medical personnel in admiiustration
and supervision, are duplicative and are repealed. ,Also repealed is the obligation to; eil:ter into cooperative agreements 'with
other state agencies.
, . , '
•
Data Requir~m~nts are Streamlined: Medicaid ManagementInformation System (MMIS) requiremeD:ts for the use of
standardized clairp.s formats and standardized HCF A reporting requirements will be simplified
reduced., The Medicaid"
Eligibility Quality Control (MEQC) system will also be reformed. States will no longer have to go through the entire
determination, adjudication, and cost accouhting process every six months.
•
Nursing Home Resident 'Duplicative Reviews are Eliminated: (NGA Recommendation) Required annual resident review
in nursing homes will be repealed., States ~ill conduct reviews when i~dicated:
'
'
•
Permissible Sites for Nurse-Aide Traming a~e Broadened: (NGA Recommendation) 'States will be able to conduct nurse
aide training in certain rur~ nursing homes, which currently are not cQnsidered pennissible training shes.
•
and
Certain Federal Provider Qualifications Requireinent~ are Repealed: (NGA Recommendation) Special minimum
quaiifications for obstetricians and pediatricians will be repealed.
13
....... ' . :;"'" .!.
t1)
.
.,
g
=
!II'
""
.~ fh ·!Jnh. HU ·h~
(1)
&1..Q
~'l :5 Ji
~ 11'
.5
.
liI ....
�r~
r"
.
-'<"".
EXAMPLES OF FLEXIBILITY IN PRESIDENT CLINTON'S
PER-CAPITA CAP MEDICAID PLAN
OVERVIEW
L...
IMPLEMENTING MANAGED CARE
•
Repeal of Requirement for Federal Waivers for Managed Care
.•
Rep~al of Managed Care Contracting Rules
•
Elimination of Requirement for Federal Review of HMO Contracts overSl00,OOO
DRAFT
ILFLEXIBILITY IN -PROGRAM PAYMENT
.
•
Repeal of the Boren Amendment
•
Elimination of Special Reqlliremepts for Obstetricians and Pediatricians
IlL
IV.
FLEXIBILITY IN PROGRAM ELIGIBILITY.
• ". Income Levels for Infants and Pregnant Women
FLEXIBILITY IN PROGRAM BENEFITS
•
Enabling States to Require Nominal Copayments for HMO Enrollees.
.•
.Elimination ofRequir~ment for Federal Waivers for Home and Community-Based Waivers
.
.
-'
"
Y....
(p-
;;.\~.
~
~.:
~
FLEXIBILITY IN STATE ADMINISTRATION
. Reforming Medicaid Eligibility Quality Control (MEQC) .
•
Revise and Simplify Medicaid Management Informatf~)I~ System Requirements
•
Provider Qualifications for Obstetricians and Pediatricians
'
•
. Elimination of Requirements to Pay for Private Health Insurance
•
Elimination of Personnel Requirements
•
Elimination of Requirements for Cooperative Agreements
•
Elimination of Requirements for Preadmission Screerling and Annual Resident Review (p ASARR)
•
�EXAMPLES OF STATE FLEXIBILITY IN PRESIDENT CLINTON'S
PERCAPITA..C AP ME1)ICAID PROPOSAL
I.
IMPLEMENTING MANAGED CARE .
REPEAL OF REQUIREMENT FOR FEDERAL WAIVERS FOR MANAGED CARE'
Administration Proposal:
The Administration's proposal would allow ~tates to implement managed care progranlswithout the need for Federal waive,rs .. States
could implement managed care programs with a state plan amendmenL'
\
.
•
43 States will no 10Ilger need to apply for waivers or waiver renewals. These States have initiated 162 requests -- either initial
waivers or renewals -- over the last three years.
.
•
States can implement managed Care by submitting state planameridments.
•
This simplified process will save states the considerable administrative burden associated with preparing freedom-of-choice .
. waiver requests.
Background:
Currently, states must apply for Federal waiver approval to implement Medicaid managed care programs. Waiver requests are
administratively· burdensome and repetitive -- freedom-:of-choice waivers must be renewed every two years., States generally spend
three to six months preparingfreedom-of-choice waiver requests, although this effort varies widely depending on the scope and
complexity of the program .. All but five states with freedom of choice waivers have more than one such waiver. each of which
requires separate processing. HCFA's review and approval process must be completed within 90 days; however, this time period may
be.extendedsubstantially if the State must provide additional information. See attached table for affected states.
,~,;,
�FREEDOM OF CHOICE WAIVER ACTIVITY
(1993-1996)
Arkansas
I
I
Caiiforriia
5
3
Oregon
3
Pennsylvania
5
I Rhode Island
,
I
Michigan
-
3.
3
7
2'
South Carolina
2
4 -
.South Dakota
3
4
Tennessee
Montana
2
Texas
Nebraska
2
Utah
Nevada
I
Vermont
Minnesota
Mississippi.
D.C.
2
Florida
4
Georgia
5
Hawaii
2
Idaho
.'
-
New Hampshire
7
.I
3
14
I
Washington
2,
I
I
3
Virginia
I New Jersey
I New Mexico
3
West Virginia
4
INew York
8
Wisconsin
2
I North Carolina
5
Wyoming
I
Indiana
TOTAL
The numbers indicated inciude appr~ved and pending new waivers, renewals, and mQdifications.
·3
"
"
Missouri
I
,
Delaware
Kansas
Oklahoma
I Massachusetts
18
5
Colorado
Iowa
3
. IMaryland
I
Illinois
Ohio
Louisiana
Arizona
Connecticut .
2
IMaine
Alaska· ;
5
I
4
�RErEAL OF MANAGED CARE CONTRACTING RULES
Administration Proposal
.Under the Administration proposal, States will be able to contract with Medicaid-only managed care plans. States will also be able to .
enroll Medicaid beneficiaries into managed care plans for up to six months at a time. Some States -- Hawaii and Rhode Island -- have
developed demonstration programs in order to-implement managed care programs with these features.
.
,
.
.
. .
•
Stat~s will no longer need to apply for demonstration authority to re~eive waivers of these statutory provisions .
.
!
States will be able to contract with a broader range of managed care entities.
•
Six-mo.q.th lock-in provisions will attract more managed care plans to contract with Medicaid programs._
Background
Currently, Medicaid managed careplansmust maintain a commercial enrollment base of twenty-five percent. This requirement ..:-Jhe
"75/25 rule" -.,. prohibits States from contracting with Medicaid-only managed care plans. In addition, .Medicaid beneficiaries must be
.
.
• able to disenroll from most managed care plans on a month-to-month basis, thus disrupting enrollment stability.
If these provisions were repealed, the programmatic elements (but not eligibility expansions) of some demonstration programs (Hawaii
and Rhode .Island) could 1:>e operated without demonstration waivers. Other demonstrati'on States, such as Oregon, require more
complicated waivers of Medicaid law and w~uld therefore still need waiver authority to operatetheirdemonstration programs.
,
~
4
�".
ELIMINATION OF REQUIREMENT FOR FEDERAL REVIEW OF HMO CONTRACTS OVER$100,OOO
Administration Proposal:
"
"
Under the Administration's proposal, states will no longer need.to seek Secretarial approval for HMO Contracts over $100,000."
,
•
All States with pre-paid managed care programs will avoid Unnecessary and duplicative Federal oversight of their contracting'
and rate-setting procedures.
•
This new flexibility will save states time and effort.
Background:
,
Currently, states must obtain HCFA'sapproval of all contracts with HMOs that exceed $1.00;000 in expenditures. This prior approval
"requirement represents an unnecessary double-check on the state's"contracting andrate~setting procedures. -riCFA approval generally
takes between two and forty-five days.,
'
'".
(
,
,
See attached chart for state-by-state contract numbers.
<"
5
'.
�FEDERAL PRIOR APPROVAL OF MANAGED CARE CONTRACTS
Annual estimate of State-by-State contract approvals:
0.00
Alabama
Alaska
I
0.00
Arizona
7
Arkansas
0.00
California
I
16
7
Colorado
Connecticut
11
Delaware;!
4
D.C.
4
Florida
30
Georgia
Hawaii
. I
0.00
5
Idaho
0.00
Illinois
7
Indiana
2
6
�Iowa
8
Kansas
6
Kentucky
0.00.
Louisiana
0.00
0(6-8 next year)
Maine
Maryland
6
" 11
Massachusetts
Michigan
Minnesota
Ni;ississippi
I
12
9·
0.00 ~ ...
Miss.ouri
6
Montana
2
Nebraska
7
Nevada
New Hampshire
o (4 next year)"
. 3.
NewJersey
25
New Mexico
0.00
7
�New York
130
1
North Carolina
North Dakota
Ohio
Oklahoma
0.00
. 14
.
·12
Oregon
36
Pennsylvania
9
Puerto Rico
2
Rhode Island
5
South Carolina
0.00
South Dakota.
·0.00
Tennessee
12
Texas
1 (8 next year)
Utah
5
nt
0.00
10
30
8
�,,;
o
o
o
_
-
,0
~
o
o
~
0\ ,
~.
~
0
~
.
s::
. .
on s::
.' s::n
'" e
>
~
~
.....
en
0
~
~
Q)
C)
en
r.::l
on
s::
·s
,0
~
~
-<
~
~
~
rJJ
r.::l
�,
.
'.
II.
FLEXIBILITY IN PROGRAM PAYMENT
REPEAL OF THE BOREN AMENDMENT
Administration Proposal:
The Boren Amendment will be repealed, and replaced with a process for notifying the public abouffacility rates. Thus, states can
establish hospital and nursing home payment rates without federal requirements.
•
States will have flexibility to negotiate payment rates with providers.
•
,States would no longer be required to submit assurances ofthe adequacy oftheir payment rates to HHS.
•
States will no longer face law suits from providers demanding hIgher payments.
'
,
,
Backg~ound:
Under current requirements, states are required to assure that payment rates for institutional facilities are reasonable and adequate to
meet the costs that must be incurred by an efficiently and economically operated facility.
'
Since 1984, plaintiffs have filed at least 173 cases alleging that States have failed to comply with th~ Boren Amendment. Under the
Administration's proposal, these suits would not be possible.
''10
"
�ELIMINATION OF SPECIAL PAYMENT REQUIREMENTS FOR OBSTETRICIANS AND PEDIATRICIANS
Administration Proposal:
The current burdensom.t! requirements for data collection to document that states are meeting special payment rate requirements for
obstetricians and pediatricians will ~e repealed.
.
"
.
.
• .
States will no lo~ger have t6 collect and submit data on payment. rates for obstetrical and pediatric services.
•
States will no longer have to submit state plan amendments for the OblPeds information that can range from 30 pages to over
300pages in size.
Background
States are required to report the following information by'April 1
•
•
ot each year:
payment rates for obstetrical and pediatric services for the coming year;
data to document that the st{ttes':rates are sl,lfficient to ensure access·to these services is comparable to the access enjoyed by
, the general population;
.
,.
•
data that doc~ent that payment rates to HMOs take into account fee-for service payment rates for ob/ped services;
•
data on the average statewide payment rates .
.The data collection and ~alysis required to fulfill these requirements involve, on average, at least 5 people in each state Medicaid
agency. In addition; staff from State licensing boards and provider offices are called upon to.help states review and define data.
Preparation of the final report alone takes, on average, 2 weeks. State plan amendments for the OblPeds information range from 30
pages to over 300 pages in size depending on the state.
11
�· .'
III. 'FLEXIBILITY IN PROGRAM ELIGIBILITY
INCOME LEVEL FOR INFANTS AND PREGNANT WOMEN
Administration Proposal:
The 33 States that choose to cover pregnant wom~nand infants above the minimum l33% of the Federal Poverty Level (FPL) will be
given the option to lower this income eligibility threshold back to the minimum level. Currently, once a State chooses to expand
'
Medicaid coverage to include populations, at an income level above l33% FPL, they are prohibited from lowering the income
threshold back to 133% FPL.
'Background
States that used' a percentage of poverty for eligibilityJevel for pregnant women and infants that was above the minimum percentage
required before OBRA 89 are currently prohibited from reducing thaf percentage.
The attached chart provides additional details on the affected states.
12
�INCOME AND ELIGlBILITY LEVELS: INFANTS AND PREGNANT WOMEN
Alabama
-I
133
Alaska
133 -
Arizona
140
Arkansas
133
California
x
x
- 200* «.
Colorado
133
Connecticut
185
x
Delaware
185
x
D.C.
185
x
Florida
185
x
Georgia
185
Hawaii
300**
Idaho
133
Illinois
..
133
Indiana
150
x.
Iowa
185
x
Kansas
150
x
I
13
x
�Kentucky,
185
Louisiana
133
Maine
185
x
Maryland
185
x
Massachusetts '
185
Michigan
185 '.
x
I
x
. I
x
Minnesota
275*
x
Mississippi
185
x.
Missouri .
185
x
Montana
133,
-
Nebraska
150
Nevada
133
New Hampshire
185
x
New Jersey
185
x
New Mexico
185
x
New York
185
x
North Carolina
185
x
North Dakota
..
133
14
�Ohio
133
Oklahoma
150
Oregon
x
-133
:~~
x
Pennsylvania'
185
Rhode Island
250**
South Carolina
185
South Dakota
133 .
Tennessee
J85
x
Texas
185
'x
"
x
"
Utah:
- 133
Vermont
225*
Virginia
' 133
Washington
200*
x
- 150
x
Wisconsin
185
x
Wyoming
133
x
West Virginia .
x
* 'States with effeCtive income levels above the nominal statutory maXimum use the authority in section
1902(r)(2) to disregard higher than usual amounts ofincome.
** States using higher income level as 'part of demonstration under ,section 1115. _
-15
�IV.
FLEXIBILITY IN PROGRAM BENEFITS
ENABLING STATES TO REQUIRE HEALTH MAINTENANCE ORGANIZATION ENROLLEES TO MAKE NOMINAL
.
COPAYMENTS
.
.
Administration ProRosal:
The Administration's proposal would allow States and health plans to require nominal copayments from Medicaid beneficiaries who
. are enrolled in HMOs to the extent that copayments could be imposed if the beneficiary we!e not enrolled in an HMO. Forex~ple,
states could not require children to make copayments, not charge cppayments for pregnancy-related services or emergency services.
o
States and health plans would have the flexibility to control unnecessary utilization better,
o
States could reduce their capitation payments based on plans' anticipated copayment revenues, and
o
Plans would still be requir~d to provide services, regardless of enrollees'. ability to make acopayment.
.
~ackground:
.
.
. Currently, states cannot require categorically-eligible Medicaid beneficiaries who enroll in HMOs to make any type ofc~st-sharing
payment, including copayments. This restriction prohibits States and Medicaid-contracting health plans from using all available tools
to control unnecessary utilization of and paymentJor services.'
..
16
�ELIMINATION OF REQUIREMENT FOR FEDERAL WAIVERS FOR HOME AND 'COMMUNITY BASED SERVICES
PROGRAMS
"
Administration Proposal: '
States will b~ able to. pro.vide'ho.me and co.mmunity-based services'to. their elderly and disabled Medicaid enro.lle~s witho.ut the
. administrative burden o.f seeking Federal waivers.
'
•
49 States with a to.tai o.f 517 ho.me and co.mmunity-baS¢d waiver pro.grams will no. lo.nger need to. o.btain federal approva] and
renewal autho.rity.
•
States can pro.vide tailo.red ho.me and co.mmunity-based services
'.
~imply
by submitting a state plan amendment.
This simplificatio.n will save states appro.ximately 6 mo.nthspreparing new and renewal ho.me and co.mmunity-based waiver'
requests.
Backl!round:
Currently, states must apply fo.r Federal waiver appro.val t~ pro.vide ho.me:and co.mmunity~based seivi~es to. elderly a..qd disabled
, Medicaid beneficiaries. Waiverrequ~sts are administratively burdenso.me and repetitive because initial waiverappro.valso.nly last
three years and must be renewed every five years. States spend approximately. 180 ho.urs to. prepare each new and renewal ho.me and
co.mmunity-based waiver request and appro.ximately fo.rty ho.urs preparing an amendment to.appro.ved waivers. All 49 states with
HCBS waivers have mo.re, th~ o.ne such waiver, with separate,pro.cessing requirements fo.r each.
See, attached chart fo.r affected states.
17
�HOME AND COMMUNITY-BASED WAIVER ACTIVITY
(1993-1996)
I Kentucky
6
Louisiana
Maine
Alaska
12
12
I
Alabama
Arizona
10
Arkansas
I
California
.-
10
Ohio
I
13
Oklahoma
I
9
8·
Oregon
I
2
3
I
4
12
I Massachusetts
I
12
Maryland
North Dakota
Pennsylvania .
12
. 6.
Rhode Island
17
14
South Carolina
18
Michigan
Connecticut
7
Minnesota
Delaware
7.
Mississippi
6
South Dakota
Missouri
11
Tennessee
15
Texas
22 .
Colorado
D.C.
I
Florida
17
Montana
5
Georgia
7
Nebraska
12
Hawaii
4
Nevada
Idaho
4
New Hampshire
Illinois
I
15
Indiana
I
24
Iowa
I
. 23
Kansas
I
7
13
I
8
7
Vermont
I
7
7
Virginia
I
7
Washington
I
16
West Virginia
I
18 .
4
New Mexico
15
New York
..
North Carolina
I
9
I New Jersey
Utah
I
13
Wisconsin
I Wyoming
I
I
3
16
8
aanauo
I TOTAL
I
517
The numbers indicated include approved and pending new waivers, renewals, and modifications.
18
�V.FLEXIBILITY IN STATE ADMINISTRATION
REFORMING MEDICAID ELIGIBILITY QUALITY CONTROL (MEQC)
Administration Proposal:
The Administration's proposal reduces the complex accounting and.individualized cost accounting currently required under MEQC,
by reqll:iring that states address only the numbers of ineligibles and the. average cost per ineligible in the appropriate group.'
.
"
o
"Details of speridingon" each ineligible case will not have to be documented, and
,
o
Disallowances will not be distorted and excessively inflated when the ineligible sample includes a very few very high cost
cases.
All states will benefit from' this' reduction in individualized tracking. Though onlya few States· have excessive error rates (the national
average has hovered around 2 percent for several years), all states are cUrrently required to go through the entire detennim1.tion,·
.
adjudic~tion, cost accounting proc:ess every sixmonths.
Background:
.
"
Federal matching funds are disallowed to the extent that a State makes excessive errors in detennining ineligible perSOJ;lS to be eligible
for Medicaid or understates the amount of medical bill that a-person inustbe responsible for before becoming eligible. "Excessive"
means erroneous payments in excess of3 percent of total payment.s. In certain circumstances, disallowances may be waived (e.g., if
excessive errors are explained by events beyond the State's control).
.
19
�;
REVISE AND SIMPLIFY MEDICAID MANAG~MENT INFORMATION SYSTEM (MMIS) REQlJIREMENTS
Administration proposal:
States would have new flexibility to design, structure, and operate their Medicaid Management Information Systems within general
fed~ral parameters rather being required to comply with the detailed systems design requirements and planning docUmentation
requirements iIi effect today.
•
All states will be ablfe to operate MMIS sys'tems th~t are more tailored to State circumstances and thus more cost-effective.
•
-The SecretaIy will retain appropriate oversight authority and the ability to enforce general Federal parameters, but the States
will not be hamstrung by, a Medicaid equivalent of "mandatory sentencing."
•
' Because current financial penalties for non-compliance will be repealed, HCFA's on-site reviews of State MMISsystems
would be less frequent and less intrusive. States would no longer need to dedicate several staff members t6 month-long
preparations for these reviews.
'
, Background:
Currently, as a requirement for, federal administrative matching, all States must operate a Medicaid Management Information System
, thatmeets highly detailed Federal requirements. Compliance is continuously and rigorously monitored. Non-compliance results i:q.
financial penal tie's, which are elaborated in considerable statutory detaiL'
'
20
�:
PROVIDER QUALIFICATIONS FOR OBSTETRICIANS AND PEDIATRICIANS
Administration Proposal: .
,
.
'
The administration proposal would eliminate the detailed minimum provider qualifications that,specify requirements that must be met
by physicians serving pregnant women and c h i l d r e n . '
,
The requirements that would be eliminated are difficult for practitioners in large urban and underserved rural states to meet. This
proposal wO,uld make state licensure requirements the only qualification requirements practitioners serving pregnant women and
children would have to·meet.
Background:
Section 1903(1) establishes provider qualifications for physicians serving pregnant women and children. Physicians must-be certified
in family practice or pediatrics, affiliated with an FQHC, have admitting privileges at a hospital participating in a State plan, a member
. ofthe National Health Service Corps, or ~ertified by the Secretary as qualified to provide physicians' services to pregnant women.
Implications ofthe current p~licy are significant.
New York estimated that only 113 of its physicianp~ovider population would remain eligible to tr~at pregnant women and
children.
'Rural states e.g., Montana have indicated that the only source of physidancare in some counties is from physicians who do not
me.et one of the qualifications.
.
.
. New MeXICO conducted a quick ~eview of disciplinary actions unde'r licensure and found that all of the involved physicians met,
the Medicaid standards.
'
.
The AMA estimates that approximately one third of the nation's physicians are not board cer:tified.
21
�ELIMINATION OF REQUIREMENTS TO PAY FOR PRIVATE HEALTH INSURANCE
Administration proposal:
The current Fedenil requirements in this area would be repealed .. States will have the option to purchase health insurance for their
Medicaid population under flexible terms of negotiation with insurers. " States will be free to negotiate "benefit packages, premiums,
and cost sharing rates (deductible and co-payments). States would continue to have the option to continue such "buy-ouf' kinds of
programs -- particularly cost-effective "buy-out" arrangements.
.
Background;
Currently, states must pay premiums and all other cost-sharing obligations for a private insurance plan for Medicaid eligibles when
" .
. this strategy provides cost-effective coverage.
.
Free of federal restrictions, states should ·b~ able to do a better job of restraining costs by moving people into private insurance. This is
because Federal requirements require states to consider all cost-sharing related tQprivate insurance. Because private plan deductibles .
and coinsurance amounts typically exceed the Medicaid rate for the same services, this requirement restricts the number ofcases
where a "buy-out" would be cost-effective. Also, the requirement is virtually impossible for states to administer since every plan may
nas different payment rules.
.
.
" 22
�ELIMINATION OF PERSONNEL REQUIREMENTS
Administration proposal:
.,
·Prescriptive Federal personnel standards and requirements that currently must bernet by states would be replaced with.a simple
.requirement that states provide methods of administration which are necessary for the proper and efficient operation of the plan. The
-detailed state plan requirements and documen~tion currently required would be eliminated .
Background:
Federal statute and regttiatlons-'-mandate in some. detail that states must pr<?vide m~th()ds of administration for the establishm,ent and
maintenance of merit system-based personnel standards, and states must use professional medical personnel for administration and.:
supervision.·_ Many of these federal requirements are duplicative of state requirements alid processes. States are required to provide
.
.
considerable documentation forthi~ portion of their state,plan.
->
"
. 23
.
�,.
ELIMINATION OF REQUIREMENT FOR COOPERATIVE AGREEMENTS.
Administralion Proposal:
The current require!ll'ehts for entering into cooperative agreements with numerous other state agen,cies would be repealed. Also
repealed would be any requirements that states provide dOClimerttation, as a part of their state plan, that the agreements are in place and
current.
, The repeal of these requirements would alleviate considerable administrative burden for states, and would allow flexibility to pursue
management of Medicaid withing the circumstances within each state's administrative practices and circumstances.
Background:
Section 1902(a) requires that a State Plan must "provide for entering into cooperative arrangements" with other State agencies. ,Some
. States have interpreted this to mean they must submit state plan amendments with the actual agreements every time an agreement is
esuiblish~d or there is a change to an existing agreement. The requirement, however, is for states only to indicate in their State plan '
that,agreements exist and id~ntify which agencies the agreements are with. States are not required to submit the actual agreements.
24
�..
ELIMINATION OF REQUIREMENTS FOR PREADMISSION SCREENING AND ANNUAL RESIDENT REVIEW
(PASARR)
,
.
Administration proposal:
Replace the requirement for an annual resident review for all residents, with a requirement that States conduct an annual. resident
review on an exception basis. Under the Administration proposal, reviews would be conducted only when the NF r,esident assessment
indicat~s a significant change in the physical or mental condition of the resident.
..
.
This would provide·considerable administrative flexibility to focus scru-ce resources on those residents whose condition iridicaies there
is a need for additional intervention and assessment: This proposal relieves the states of burdensome, costly, annual reviews of every
resident which duplicate, in. large part, ~e required evaluations aDd add little value to meeting the needs of residents.
Background:
States are required ~o perreform resident aSsessments promptly after admission, after a significant change in physical or mental
condition and n~ less often than ~ually thereafter for all mentally retarded or mentally ill individuals residing in, facilities.,
Although each state adniinisters their reviews differently, the state of Washington can be looked to as a case exainple. In 1991,
Washington conducted 400 annual resident reyiews at a cost of $750,000. Under the administration's proposal, the State of
Washington's burden would be reduce9. significantly because duplicative reviews 'jNouldbe eliminated. However, the actual reduction
c~ot be quaritified.·
.
25
�TLe f' \..( 101/ ('~ . . . . .
lv\
'\
<:: cl
ire. i
Pt-OV('
II
;0
o
:1
cP
o
:1
Z
s.; OVl,.S
II
~:S~QJ auf
-+0
])
X
6-over lA Otr$
<!-=
rl'J
100s+ rzi3&-,,1:-,
''0
MEDICAID SPENDING
AS A PERCENTAGE OF TOTAL STATE SPENDING
-I
0
. 1987
1988 1989 1990 1991 1992 1993 1994
oj)
A
U1
IJ)
-.J
(')
c::
:z:
Medicaid
Spending
Non-Medicaid
Spending
A
(,oJ
.....
d
:z:
10.20
10.80
1 t .30
12.50
t 4.20
17.50 18.40 19.40
c:
CD
~
~
-0
::r:
0
89.90
89.20
88.70
87.50 85.80, 82.50 81.60 80.60
d
(')
0
~
II
m
tIl
.....
.....
Source: National Association of State Budget Officers, 1994'State Expenditure Report
oj)
oj)
IJ)
oj)
.....
U1
'1)
:1
'1)
IS)
I\J
�11
;0
,0
3.
o
SECTORAL PROGRAM SPENDING
ASA ,PERCENTAGE OF TOTAL STATE SPENDING
,
,
1987
Elem.lSec.
Education
22.80
3.
Z'
11
1)
X
1.988 1989 1990 1991" 1992 1993 1994
,23~40
,,23.00,
22.80 22.00
2 1. 10 2 'I .20
20.30 '
-;
0
U)
" b.
Ul
.0'
""l
Higher·
Education
12.30
I t.80
12.00
Welfare
5.20
5.30
,5.10.
A
12.20 '11.50
10.90
10.60
10.50
5.30
5.00
4.90
4.50
14.20
17.50 18.40
w
t-'
5.00
,
Medicaid
10.20
10.'80 ' 1"1.30 '12.50
19.40
11
rn
w
.
t-'
Transportation
'
,10.60:'
'10.30
1.0.109.90
9.40
9.10
.
9.00
8.90
'
t-'
U)
U)
0"
..
U)
t-'
Ul
\J
3.
Source: National Association o~ State Budget Officers, 1994 State Expenditure Reporf
\J
!S:)
w
"
�I
'
, State ,Per Capita Funding Allotments "
Comparison of FY96 ,Per' Capita, Allotments '
, "FY96'PerCapita
Per Capita Federal
Funding Level$,,'of
IIBlu~ Doglf States,
" ' Federai Allotment
'
,
Percent of
U.S. Average
"
Dollars
"
.
$1,505
" '$1,668'
Oklahoma
California "
"
"
' 59.5
65.9 '
,J"
, ,Virginia ',' ,
" $1,872
73.9
Mississippi ,..
"$1,936"
76~S
,'rexas
78~3"
' , '$1,981
" Alabama, "
,
'
$2,050, '
Dlinois
79.8
$2,Oi9'
.
"
Sl.O
$2,1.36
85.0·
'Kentucky
;$2,167',
' 86.3'
" Utah
' $2,325
92.6
, $2,342
' ' $2,448
' 93.2,
97.4 .
' ,$2,464
98.1
I
$3,038
" $3,095',
120.9 '
' 123.2
I
I
Arkansas, "
,
,
,
Missouri
North Carolina,
TenneSsee
" Minnesota
Pennsylvania
-_.. _....
.
I'
..
, 'I,
p0'd
WdSl:6
9661~1
833
, U::t>L9St>6:01 '
Xtj.::lINWO:WOi'j.::l
,
~
�States w.ith High.·
Disproportionate Share Payments
DSH as·3 Percentage
of Non-DSH
State
. ~~:.-.
<: :('a····:b···am':'·a· ..
"~
. :':.:::.;~~: . , -:::
,,'
. ,,:.::.. ::,::
..
'
28.4% .'
.
:
.
:··€alifotma.
I:.'iT·;·.
.Colorado'
25.6%
Connecticut·
r
14.4·% .
20.5%
'h'-~'oroia
13.7%'.:
:~e"'.·
"Indiana..
....
:
,
16.2% .
Louisiana
41.9%
·Maine·
. 20.4.%'
. Montana
36.6%· :....
New~~;~pshire .
N~wJ~t:~ey
57:0.%':
',:..
28..··1%...··
.
-
..
"
.
,~:
.
'
-,
2I~:~.%}i};::': . . .
1:5E:~''.;t.f;'~~::.'':::··:::·
26~rZ:%:.~::· ....
.
South Carolina .
,
· ..,'.' .:::
20:e'3··m:'::·····
. TeXas:.'
83;:l
:.:,:."
"""
.. .'v .....: "::':.
.:P~nnSYlyania·. ·
Wd91:6'9661'1
,.
.13 :7'·...,J".:... ,., .. .
• : Ot:.:~:"
New"york··
.Nevada;.
S0'd
....
'.
1[17,,%176:01
:;." ......
V'::"':-",
-
.
Xt;l;:l I NWO: WOCl;:l
,
�-----.:....-----------------.-.~--
"
MediGrant II Expands Special Protection Provisions
::u
"
a
:::I
a
:::I
z
"
D
X
Coverage Guarantees -- MediGrantn guarantees cov~r~ge bf: . .
Pregnant Women with raniiiy Utcome b¢low 133 ~r;ce~\ ijrpoverlY'
Children Und,er 6 with family income below 13~ ~rcenJ. 9t pov~tty( \ ....
Children Ages 6-12 with family income below 100 Percetil of pove~~\ ..
Disabled Individuals (as defined by the State) who meet S8I standards
Elderly IndividualS who meet
sst income and resource standards
-I
a
j;..
Ul
~
b
.VJ
. Benefits Guarantees -- MediG:rant. n .guarantees
certain benefits:
....
Ept Low-Income Families: .Inpatient andOlltpatient HOspital Se~~~i .1 .. . ..
Pb}:sichms', SurgicaJand Medical.Services I .DiagJiosti~/tests I Ctilldhodd
it)1h.tlt.ikti~hs I PrepregWillcy PbHnibg sehi~'Jhl1d Silppli~ "
.
..
For
klJe~ly JrtJ D~bleJ lridivfduals: .Long-Tel'nl. C~re Services
m
"
. :','
trJ
....
.....
ill
ill
(]'I
ill
....
~
:::I
.,? • ~
-.~
.
'.~
~:-
..
.....
'1J
IS)
(]'I
�11
AJ'
a
MediGrant II Protects
Nursing Facility Residents and their Falllilies
,
LllilitatiollS onF~nuiy
3:
~
Z
'
Responslbiliu: .
. . ' ~'" "<>
. . ",
11
~
'..... .
Me&Gi-aniJi ~~~Wblts th~ s6t~H-h.tl tequirtI1gJl~~ailil·'cWid:;.~r;lt·:\;
institutionaliZed parent to contribute tQ the cost of, ri~rs~g facility
other long..tenn care services covered under. the State . pJaJi.
.
:":.'
.
:
.
~.
-
alitl
.
--I
.
"'"
~ -;.
a
\.D
A
~
--J
A
W
.,
-:
Limitations on' Liens:
"
....
,MediGrant.tI strictly limits the ability of tbe siate~;'~~ ~j.~~'~
the. pr~perty ~r a recipient to only those instatic~ i"'~~m:}:t
1;3ccb•
/:::
.
... -:::":
-
~
.'. . .
neb ,~~,: .
:.' ,',:; .
',
11
m
tIl
....
....
...
:
\.D
\.D
(J'I'
,NUrsiHg WttUty XUiillSsl<»!ts PoiitJ-
Restores clft.t~hi
law protectlotls.
\.D
....
=tl
3:
'1J
~
�"
§i
;Q
'MediGrant II
Increases Medical Assistanc'e Funding
.'~"
,Base Allotn1ellts
, ·iH the:Slllies:
~~.;~:
';}"
MedlGrant
,
~.
~ ~"1 : . :~.
l: '
:. i: i ~ ~. ~ ~
MediGrant n
::; Z.
o
t
"
D
X
'.,·~tm~'·····"···ij~}~I~~ft~'~~~~\
-l
o
\.D
A
Per Capita Allotments
to the States:
":
bittiG~ ,
MediGrant I:
Outlays = $0
MediGrant 11:
~W~~~" <~!,~:~I~~;(~~;~·,
;"'.<:'
.
lJ1
~
A
W
I-'
.
" ,<'.> ~'~ ',~> ,~';
1 t _, ", ,'>, .~ \. :~:;.=;/ /:, '(}
"<. \~,,:;.::~:!':~i:~~~lC:t,:,·,~; :>~ ':~
,.' MedIGrant:l;. ',' ' . ', ~~t~ys ,= $3.~'J)I,lJi~~;:;,::;.,
:,: '.,'
..:.
•.
··M~alijflillrlit· ··+';~~rrt $%J~'~lmAAl(~'~J) 'm
.... ': ..... .
m
"
II)
I-'
I-'
;";"lr~GS
, ,M~aiGraiUt:
-'
;."
..
MtdlGhlrii ii: ,
. ::; ,,:
:~
, S~villgs =
Savings =
$133.l bil'i~rl
$8~.O billion (est.)
tE
(J\
\.D
I-'
'm
\J'
::I
\J
IS)
m
�---------_..-.:..-----------:-:---,------
-MediGrant II Establishes a
Per-Capita Supplemental Allotment Fund '
-
~
~
~
."
D
)(
The Per-Capita Suppielnelltal AllotlnentFund ensures
that States will have additiollal funds iftlleir recipient
populatioll _exceeds their State MediGrant growth rate. '
d
ill
A
UI
~
A
W
....
-
~
,Supplcnlcntal
Amount
$8 tUtlWH .
-
"~
"
:,
,
,:
"
Mandatory ,~(jyerage
,
~.:,
" ~:; ', '~tll" L\ ~'",
o~f' E"1" 19lu es
,
'<"
i'·.f\~'\ ~V::;~\.:):,:x::.: , .' .:' .'
1"
1-
•
."
,m
tIl
".
': "1" ",: R':"'" ,H .•: .·•. c:: ; ~
, oCutartt:
B
;i
. . $825.~U.~~.H ..
.. ,".:
....
....
ill
ill
(J'\
ill
....
ill
'-0
::l
-0
ffi
�-n
iU
,Calculating the
Per-Capita SuppieDlental AllotDlent Fund,
~
o
~
-n
D
X
-I
o
Pec·Capita.Supplemental Allotmertt Amount
, equals
Ex~e~is ,. ' ) " ~,AP'Plicable",
Nu,~~~~ ,,~f , ' X, state P~r~~pib
IndIVIduals,
Amount
.~
IJ)
A
U1
(]'I
..,J
A
W
I-"
$
'T1
m
ttl
,
"
-'.:
.....
I-"
I-"
IJ)
l5<
IJ)
I-"
IJ)
-u
::I
-u
I-"
IS)
�1\
:;0
,Calculating the Per-Capita Allotment
'Anticipated Percent Growth of Individuals
o
:r
o
:r
z
1\
~
Based on MediGrant Growth Rates
;;,.
State
'MediGrant
Growth .Rate
Anticipated
Percent Gro\vth::
of Individuals
-
~ercen~gt;,
cpt Increase
-l
o
lD
.t>
V]
~
.t>
W
....
For Example: '
Y""s:~'
U ;SLi'I)~'\TLE;'" .
..
'. .
.'
.. :: :.:.;';= .,' ':, :,.' . • " .: '.' ': :; '.
.
' .. ,
MediGrant Gro"vth Rate of 50/0 '
McitiGt~~f. di()\:vtitIta~e: 5% .
,~·.:~;i<~';,;S~'~;.:'::;ll;Ji;~:::·:,·,~ ,~E: <l~:::··,.::;j.'L6X;I~:i;',:;' ~.... '.. ,. c,';"."
'Afr~';
i;':f{l'I't (fd\r..r{\r\.f~U~ rJl:: :
j'lli,
rUltic.
700 .
•
<
~.
:
~
- ~ : ::
:--'.
1:'1' IVluuaJS:
::
.
•
.'
:".
'.
';-.
5%' .. 3%
. '.:. ~ .
,
~
2%
1\
::.,
m
In;1IU5
CPI rate of 3.0%
tIl
....
....
lD
lD
(]'I
equals
lD
Anticipated Percent Gro\vth Rate of 2%
.....
lD
'lJ
:r
'lJ
....
.
�I]
:;u
0
,
:1
.,
Caiculatingthe Per-Capita AllotlDent
. Excess
Pe~cellt
Growth oJ.Individuals
0
:1
Z
.,
I]
D
X
C•• "
.,
.
:
"
Excess
Percent Growth
of Individuals
.GrowtJi of
State Actual
FfEs .
~ .:.;:.~
.:c- ;::: -:;::
-
-I
o
ill
~
Ul
~
~
w
.....
.For Exa'mple:
/l!,B~~'i:.
u.. s. S..Yfi..''Lh .
i
~
- .. ,:.
I]
111;11 us
",:
'
."
State Actual fTE Growth Rate of 60/0
m
to
.....
~
. Exc~sJ.%·Hf'ltl~HUals:
.. 6% .2%~4~
Anticipated Percent Growth Rate of 2.00/0
.....
tiS
IJ'I
equals
ill
Excess Percent Growth Rate of 4%
I\.)
~
:1
1)
.....
I\.)
�---~------~-----.---- ..
-~---------
"
~
;u
Calculating the Per-Capita. AllotlTIent
o
::I
Z
D
"
Per Capita Allotment Amount
X
".
.
...
Per Capita
Allotment .=:
Amount
Excess
Number of
Individuals
X
Applicable
,I State Per, Capital
Amount
.
X
-I
o
1..0
.~
:V1
()'I
.-'J
~
w
....
For, Example:
Excess Numberof Individuals,
based on population of 10Q (4% of 100 = 4)
O.s. sTAtE
. :::- ..'. '....
..
til1lCS
IJj
. ". ;
~
'
rn
"
Applicable State Per Capita Amount ($2,500)
".'
.tinles
....
......
~
()'I
Applicable FMAP (60%)
1..0
"
. equals
, Per Capita Allotment Alnount of $6,000.00
f\J
IS)
lJ
::I
lJ
.....
w
�"
~
The Per-Capita Cap Funding Formula
Locks In. Current Inequities in 'Federal, Funding
WAW
wo
DB
o
::r
z
."
~
_
The Losers,: States with high rateS of recipient population growth
but low current per capit~ funding levels.
"
-i
Federal
poUars
o
\.D
A
ifl
..J
ti "
.....
High-Benefit
States
, tbw~ii~hefit
$t\l~~\
."
rn
,"
trl
... .
1-'
",
1-'
\.D
\.D
(]'I
\.D
I\J
:,
': ~"', }~
'\:
;l:~ .!.~~; ".~ :..,!:.;;.:". ; ~ ~ .;~'! ~ ~! .: .:.:;: ': ~ !*:~:.
....
-n
•. ';:;
. •":
,,~~.·.·,,:w;
:,~.
: .... ~
,':
::r
;
~:·.:·.~~~;r~:..~~ :-'~~~':;,,:i;.~.:-:.~
' .... ~;s~~~~·5~·
~'.~;~~ ~':;:
-n
.....
A
�-------
..
'11
;u
~
The MediGrant Funding Fornlula
Removes Current Inequities in Federal Funding
by Utilizing a Differential Rate Formula
o
~
11
D
X
All States grow and the current inequities are erased over time.
Federal
.. ,
....
-l
o
DoUars
U)
A
~
..J
A
W
I-'
High-Benefit
States
····~i~fi~At
11
rn
tIl
I-'
I-'
tB
(]'I
0,;'
','
','
Yeats
..
U)'
,
f\)
I-'
lJ
::I
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lJ
I-'
!Jl
/
�~i.
~
.
, ,..,...,....,. ,
~
·4
"
..'
7·YEAR STATE TOTALS
Including Aliens fund Allocations and non-Per Capita Supplemental Allocations
.
House
Senate
Conference
MediGrant II
MediGrant 1I
Floor
Floor
Formula
Formula
minus Conference
. 12.86{348,427·
13,665,345,135
800,996,708
1,659,800,474
1.762,503,840
102,703,366
11.511,439,455
11,658,336,443
12,451,658,925
793,322,482
g, 117.060,109
8.573.602,836
8573,602,836
9,107,436,919
533,834,083
CA
78.706,11'5,491
77.693.216.737
80)10.282,158
86,349,397,134
.6,039,114,976
CO
6,236.058,035
6)42,964,250
6,862,650.788
495,195,444
CT
11.093,676.363
10.649.830,019
11.093,676,363
11.277,686,075
\84,009,712
1.342.469.608
I. 719,690.612
1.719.690,612
1.826.099.795
106,409,1 83
3.629.369,813
3,802.091.067
3.802,091.067
.3,865,155,975
63,064,908
FL
30.869,381.269
31,262.055.451·
33.045,129.389
35,333;353.698
2.288,224,309 .
GA
20.314.358.936
. 20.239,809.189
20.348.284,125
21.850.792.059
1.502.507,934
HI
:.~88.2·HI.065
:.~50.176.852
,~.450.176,852
2;490,817.693
40,640,841
10
:.41 O.<)~7 .953
:::.~~.l.84 5.871
2.448,490,433
:!,600,716.892
152.226.459
IL
27.:::73.~J3.J90
:!H.850.80J,39 I
29;056,303,8.t7
31.614.009,361
2,557:705.514
I~
I (,.OM(69·U~ I:::
I :'.84 1.3~5.652 .
16.068.694.811
16.719.1~5.0::?'0
650.550,208
IA
(dno.Kg4)n7
o.873'<)·H.016
h.873.944.016
7.152.239.5.1 I
278,295.5 15
~.X,28.74:'.OI-'
~.873.717.6?O
5~813.117.650
6.132.506.975
,258.189325
KY
1J . .n-l.-13~.:~g::
1];:97.903.704
13.374.434.382
14,207.191.515
832.757,133
. LA
2lS. 7:8.5:;5.:33
18.817.999.188
18.817.9.99.188
19.619.896.0i:JO
201.896.902
5.155.030.527
5.264.114.507
.5,351.429,853
87.315,346
AL
12.668; 142.23.0
.AK
1,480,117,901
AZ
AR
11,589,517,898
DE.
DC
h:S
'.
12,864,348,427
1,659,800,474 '
6.367,455.344 '
, .
-,
'IE
~.164.11-I.507
'ID
I O.9~4,:!63.1 e)<)
11.192.882.451
.1 1,.166.050,649
11.180.454,388
S14.403,739
MA
MI
MN
i\lS
11.765.171.500
19:835.170.224
.: 1.815~266,920
21.212.066,1 II
396,799.191
27.900,043.998
28.518.258.518
28.518.158.518
" 29,913.528.014
1.395.269,496
12.72:.300.80-'
13.1 :0.993. \08
13.601.788.179
13.827.399.694 .
225.611.515
1U.942.91 0.965
IO,81.9.809.J54
11.100.000.018
11.790.104,287
mO,104.269
'10
MT
15.192.679.647
I ~.337.876.193
15.337,876.1 93
16,477.169.838
1.139.293.645
2:602.779.931
2.781.874.,199
179.094.268
NE
NV
3.552.378.091
.. 2.589.524.929
.1.66:;.386.215
3,662,386,215
3.751.844.814
89,458.599
2.168.7J7.513
2.021.779.281
1.538.737.513
2.679.788.454 '
141.050.941
:.479.)59.424
.
xtJ3INWO:WOCl3
c0'd
wd[c:6
9661 '1
833
�-:.
.~'
Q,
'M~""""
.
Senate
House
floor
NH
NJ
NM
NY
NC
NO
OH
OK
Conference
Formula
Floor
McdiGrant II
MediGrant II
Formula
minus Confcrence
4.260.,317,982
2.54/.744.000
. 2,541,744,000
2,552.124,000
21,487,598.. 282
21.645.927.777
21,775,062,6F
22,226.340,687 .
5.280,952.628
. 5,576,877.642
5,605,163,411
5,967,438,267
97.115,702,068
97,831,290,654
98.331,131,620
100,310,878,826
1.979,747.206
20,418.103,739
. 21.298,136,897
21,298.1 36,897
22,515,745,600
1.217,608,703
1.979,474.902
1,984.803.587
1,984.803.587
2,065.159,484
80,355,897
32.641.759.233
32,948,194.248
33,20Q.00O.033
34,544.120.832
1..344,120,799
8,015.894.810
7,895.692.023
8,015,894,810
8,514,255,460
498,360,650
OR
7,330.985.186
8.959.695.944
8.981.960.575
9.360,602.246
378.641.671
PA
35.303,479.533
35.910,431.644
36.174-,447.057
37,956,085,328
1,781,63.8,271
RI
SC
3.915,115.700
4.137,811:786
4.137.811.786
4.206,445.261
13.735.849.428
13.554.847.197
13~740,558.833
14.596.112,650
855.553,817
SO
::.005.501.364
~.161.869. 900
2; 162;869.900
2.302.067,441
139,197,54,1
TN
1~.15::.506.1 ~I
·20.738.915.886
~0;738.915.886
22,080.3 75.2,)0
1,341,459.344
TX
l'T
'.I.7R 1.5S2:369
:'·U 50. 9 02.513
.55.272.604.685
59.809.760.919 ...
4,537,156,234
.J.OII.9()O...HC
.l.{196J51.789
·U03.175.964
. <1.360,534.513
. 257.358.549
\'T
I.b 17 )6I.bO:
I.M67 .(l 10.068
1.919.' 75,467
~.004.690.075
Q.7(}5)iS3.0(17
().n9.787.744
9.834,846.171
10.645.918.844
811,072.673
WA
,WV
1.~.Ob 1.603.79 1
13.1 ~ 1.913.869
13.405.310.816
13.650.96~.J90
145.653;574
l/;~6.l.(l58. 7..J I
<)520.506.641
9.520.506.641
1),905,949.743
385.443,102
\\'1
I J.5':8.9~-lJ:: I
1..1.069.093.279.
14.069;093.279
14.638.688:486
569.595,207
1.067.31 9.~75
1.076.51 1.828
'1.143.123.080
66.611.252
\':\
.
Wy
. <}RJ.684.9:2
,
10,980,000
.,
451,278,050
362.274,856
;
,
'
68,633.475
85.514,608
..
TOTALS
I
780.650 ...11 1.30
II
777.8·10.0QO.00J
I 790.003.442.944 1
830,212.344.434 1
I E\c1udes
40.208.901.4901
funding for territories.)
"
£0'd
Wdvc:6
9661 '1
83~
XI::::I.:JINWO:WO~.:J
�-
.
.
.
CorI~
Fedt!nll
Federal
Medlc.ltd
C;;:":;;:;-io,A
~f'I
Distrd 01 CoIlnTIOO
~.
-
ConT~
Conf~
Federal
Federal
Tederal
204.933.213
f .370.781.297
1.011.457.933
a,9«J.9J8,461
. 757.49.2.'079
1 463.01 I 63S
112.3:77.763
:501.412.091
3.715.62'1.t60
.,.,
Federal
Modbtd
.,.,
~d
'lI.
~1CaId
0ift0f".
. Gr.Int
FV 1998
Olffgt.
.(;.r;rt.
O1tter·
Enoe
rv 2000
FV 1997
1.6S4,140,9()3
212.105.815
Enoe
9.00
1.791..292.445
719.678,550
350
1.4~.151.613
90Ci
900
1.10'2.489.1 47
9,162.JJ 1,048 .. tn i
6Z:i~691 ,021,)
900
1,514,217.042
350
21A.7~.2'35
350
518,961,515
350
4.05-4.298.-449
.
I.6t7.~.980
1.19::).626.827
10.732,.00:;.517
004,Q12.375
1S6:3.4:29 .096
Zl1.Q55.S60
!'>35,817.1'64
fY 1999
1.9J7.0JS 505
Et'lQe
628
82S
e 28
b26
6 14
II 14
:>43 Jf,;6 011
1,749 581.453
1.2'90 96) 016
11. roo 80'S. 443
9'S6 817.351
I .610331 969
1573']7 lYi
')5.' 001 591
9~
82tl
:l:'5
Il:7tl
J~
4.692~71 ~
e. 14
b '"
9 '6
a I ..
... -
--.
~i
knIOO
nnae
II~
"1.457;300.900
2:86JJ~.L(U
9.904
8"2&
--- 3.~.aon~
.e f <I
3304.43'3.728
345,302.814
32S
994
355561909
300
3,783,31.1,648
3.50
9.11
911
2 '28.189.321
900
~u.4J7.17.:l
.900
9.00
83!>,7J5.8"J'5
II<JI'.-a
713.100,6'69
Kafl&a1l
1.sn.8ze.BJ2
KeniucKy
lo<Ji&ia n.a
2.622.000.000
694,Z20190
1,369,699.647
2.!r'O.348 86J.
::1.465.162.006
1,793.776.356
1.261.7'81.33:>
~
Mai"yiand
~rl~
~
MII'l~
~MPpi
.
~
1.~.24894;)
~
311.117472
463.900 417
251696 4SJ
3€0 ,OOO.1Xr.l
I'oklb! as)o,a
Nef&d;a
~~f1!
fk'WJ~
"'17.933.947
1.719.833.427
2.6Z.2 .000.000
118.S18,518
t ,~92.972 .834
2,910.609.002
.3,m,049.346.
1.956.568.528 .
. 1 376,79' 043
2.0'\5,001.)5(1
340.311."i61'5
490.1392.894
W1 ..m.377
300.000.000
~9-4
4:544209317
2,~' 14'9900
IH
!) 91
!j
No!11 Dako!a
CihiO ---'--)r{l(lOl'l
.~'-&Il
'{ho!je !$Iaod
5000th Ca-roIin:j .
rexas
f'-J'6
91\
9!.04
'J19~1t16'
000
3160,000.000
000
J6() tlOO
000
J.14:L 1)11
900
S82
1.914.40J 561
Hlal
450 .
'] w.o X,/\ )1:;1
19a4JU<91 ...
~:?CS: J:'O
4r.a
994
875
3~
I J. JS.l.35S. 195
3SO
000
137e7 ,;).D.858
3019.670~2
{ (l!\
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26'2,813,7:))
1100
.
1~11---'''-''--
.6.g:)O.en,545
S27 ,658.937
. --246.156723- ...·-~,644.284
1 .144.002.5(JI;)
'l1l· nia
'\(as~oo
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V-~n'
Vyorning
'. uttOlal: Sta1I.>s & 0
:Ul:t.o!al: CIT a~
I. S. TOIill
L.
1.763,400.9ro
1.156.013.151
1.709.500642
132.91SJ9'.')
96.246.087 .89~
1.39.9.50.00>
96,386.031,894
1,249.324,339-
~
9:
t~.964.696
1 lO.OO9.CXJ1.500
159961500
I 10.169,000.000
.
940
J~O
eoo JOO
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f--'*
W
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570.400.556
4-4.l.es9.)77
. 38'.92.11.000.
J.4JJ 4'~.lH2
1.00:'.469.:-.00
1-:' ~1}.71'1.4f7
. 5MlfG5a 012.l
940
1.~.211.6()(j
~86
I.~t!"::~
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57'::0113700
61(\ 554 :>16
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9(31),4
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1 41i::'.I~1 ');8
6.042.807 ~,o
6J7.1t31oo
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" 7.100 6..."5 396
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3 '00 7(j(:. 9()4
137.567.429
,ro, 170.980l~.!.!. -.?J~.
'50019,383
7 '9
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103.321,000.000
iJ.'~.j34 '1l
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fhl B-1S)OO
111i114!JiJ
., jf)J 916
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l.SO
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2966.006.424
S97
597
628
663
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7 61~,933.7JO
51'.5.Q1,310
265.191.724'
1373.5;)0.063
1684.500.550
100
7/!!{l
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4.:"9~
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1.336.141,&47
I 974.500.713
'io44)41~
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350
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1913.300.IOS
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9.00
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1..987.7'&4 .l96
J ti61 0;9 i li',
4..'>J.1'IJO ::";"I'i
5,062.522 .557
2.15i .484.t02
, 171.670.395
311 4.10 J64
900
1,625.,e2.131
!;~
3:x:l
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1260,926.:>42
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S 91
004
300
i
t~OG~.198 ',~,
1257,4;):,.674
S "6.273.132
S83, 1410.003
828
300
9 ;'3
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3.045A07.650 a
5:14,981,637 1.0
- I.9~240:00:r l>.
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•
300
633
900
839
350
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;).4'17 .J41.0:l5
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l.4}') o:r. 1:'1
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600635021
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iii 10
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V66.913.1I9
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'
,
'THE PRESIDENT'S MEDICAID POlley,
The President's plan achieves $59 billi~n (vs: $8S'billion for the Republicans) in Federal
, Medicaid savings from a per capita, Cap mechanism, combined wit" savings from
Disproportionate Share' payments. He retains the individual guarantee, enforced '
through tbe Federal courts, to a set ,of meaningful '(and nationally, defined) benefits, and
be provides for unprecedented flexibility for Governors in administering/delivering these'
health :care services.
' , "
"
'
"Bottom-Line" Essentials for Aoy Deal on, Medicaid, '
.
:.
"
to
(1)
Dollars need to follow people. ' As we are committed re'duce Medicaid per person
, costs and' constrain the overall growth of the program, the' Federal Government must
, maintain its .shared financing partnership with the, states. When a. state faces an .
economic downturn, it must have an immediate and, reliable Federal finandng partner
to help pay for unanticipated enrollment' increases. Such an approach will assure that,
Federal dolim follow the increasing number 'of covered people;
(2)
There ~ustbe' a workable enforcement mechanism that guarantees eligibility to
Medicaid coverage.' We,believe that preservation 'of the Federal court right of action,
for recipients (no,t providers, since the President is repealing all vestiges of the Boren
amendment) assures this guarantee: Any alternative to this approach must satisfy the
President that the' enforcement o,f the Federal guarantee is not un.dermined.
'
.
"
' .
_.
(3)
'
!.
There '~ust be a meaningful and Federally-dtfiried benefits package for all eligible
populations' . .:. . :. regardless of what state they live in. ' This means that states must still
ensure that their mandatory benefit packages,must'not only be' consistent with a.
"
meaningful and, nadonally-defiri~d mandatory benefit, ,but that they also meet current
comparabilitr (non-discriminatory protections across popul~tions) andstatewideness
requirements~
,
, (4). There must be real, workable and significant flexibility for states to administer' their
programs. Our repeal of Boren, elimination.of waiver requirements for managed care,
and elimination of the cost-based reimbursement requirement for health clinics are just
a few of the many new and unpreCedented flexibility provisions that we are committed'
to ~nacting.
'
�MAJOR CONCERNS OF YESTERDAY'S N<:;ADOCUMENT
~
'I • •
'.
Package' of flexibility provisions went well, beyond discussiQn with 'the Pr~sident.
. (Items not mentioned in yesterdayis porus meeting, with the Governors are
'.
itaiicized). The summary of flexibility provisionS mirrors 'the many provisions of the
Republican Medigrant II'bill that our base Democrats and groups would find totally'
,unacceptable. Taken together with the, write-up of the financing provisions, the new
proposal might well be label.ed by the outside world as a block grant with a
contingency ~nd.
•
Eligibility 'concerns include: The repeal of the CUrrent law's phase-in for coverage of
, about 3 million childr~n age 13-17; the devolution of the "di~ability" defiriition to the
states; ,and the elimination of the required coverage of premiums for lo~-:-income
Medicare beneficiaries betWeen 100-120 percent ofpoverty is repealed.
•
Benefit concerns include: ' The total discretion given to states to alter the
amount/duration/scope of services; the repeal of the current law's comparability and
statewideness requirement that ensure, that recipients in particular groups or locations
are not discriminated against; the apparent elimi'nation of any' defined benefit
package for currently optional populations; ~nd the vague redefinition of the ~'T" in
the EPSDT 'children's health benefit.
•
Enforcement concerns include:, The state":"based rigl:tt of action process advocated
by 'the Governors (and whether orhow it will work to effectively ensure the
guarantee).
, .,
Finllncing concerns include: The ~xclusion of pregmint"women and, children,as well
asthe:medically needy, from the'Federally:":financed "umbrella~' pool payments; the
inclusion in the, baseformulaofthe all~wance that states can reduce their matching
, Medicaid rate - - the result prodi.tcing an additional $200 biliion reduction in ~tate '
Medicaid spending over sevenyears"bringingthe totaIFeieral/State cut to $290 ,
billion; the allowan~e for states'to" (jnce again" tax health ,care providers to help ,
finance their state match; allowing for provider taxes will likely push up the cbst of:
the program that CBO scores, since CBO remembers what happened in, the late 80's
, and early 90's when states used this creative financing scheme to access more Feieral
, dollar's and to reduce their state burden. .
•
Quality concerns include: The' adeqdacy 0/ the quality protections for plans under
Medicaid, such as HMOs ,and other managelicqre 'plan; the state-based enforcement
of Ronald Reagan's Federal nursing.horrie standqrds. (The'difference between them'
and us has always come down to ,definition and ,enforcement.) ,
�
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Carol Rasco
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Carol Rasco
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Box 125
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
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2010-0198-Sb-nga-medicaid-2
-
https://clinton.presidentiallibraries.us/files/original/dea4a41faba4a69a6fa9a6a7dd8e6a00.pdf
b41afe7d64747a7a317e824a953d0687
PDF Text
Text
\
!
j'
(
\
,
MEDICAID
AND THE NGA RESOLUTION:
)
I,
DISCUSSION POIN\
1\
\
\
Status Update On: Meetings with the Governors/Congre~sional Hearings n
;\
\1
•
Administration Proposal and Commonground with the NGA Resolution:
11
II
I
(1)
The establishment of a new financing mechanism th~t links and constrains\
~}
federal financing to enrollment;
:
(2)
The repeal of the Boren amendment; and
i\
(3)
The liberation of states from the waiver process.
\
I
Outstanding Issues Relat~d to NGA Res~lution:
(1)
(2)
Second Tier. But Critical Issues; and
(3)
..
The "quarantee;"
The Title XIX Debate.
The NGA Resolutfion and the Guarantee:
(1)
Financing;
(2)
Eligibility;
(3)
Benefits; and
(4)
Enforcement
Congressional and Interest Group Response to the NGA ResoBution
•
Discussion of Medicaid Negotiating Positioning/Strat,egy
PHOTOCOPY
PRESERVATiON
,
\
�/.
"
, .
THE WHITE HOUSE
WASH INGTON
I
'/
, Fe~ruary 19, 1996
MEMORANDUM FOR THE PRESIDENT
FROM:
Carol Rasco, Laura Tyson and Alice Rivlin
,
,SUBJECT:
,
National Governors' Associatipn Medjcaid
Resolut~on
..
;
'nismemo highlights 'our major conCerns with,the Na~ional GoVernors' Association (NGA)
'Medicaid resolution. It summarizes these concerns, outlines our current positiQn with regard
to each issue, suggests some possible fall-back positions, and p}ovides you with a reading of
, .the Democratic Governors' positions on' each of these issues. Iti also includes a summary of
the Hill and Interest Group reaction to the resolution. We thought you' might find this to be
uscful'backgro~nd information for our Medicaid meeting with you tomorrow morning:
,
i
Background
The six Governors will also meet fo~ three hours tomorrow evening to prepare for their
,Wednesday hearing., The Democratic GovernorS want to con~inue to work closely with us
and will meet withus tomorrow before meeting with the Rep'ublican Governors. TheY,rightly
believe they achieved a significant victory by getting. the Republicans to agree to a new
financing mechanism that ensures. that "dollars follow, people:",' They also believe that there
ar~ a number of provisions that were vaguely drafted, whic1i!have been interpreted by many
as extremely problematic (such as the NGA benefits section), that can be ~'clarified" through
the nornial NGA policy .development process. Having said this, the Democratic Governors
also acknowledge th(it they are a number of signifiCant flaws in the NGA agreement that
should be addressed.
.
:
1
�i'
"
Where W e Agree with NGA
Before outlining our differences and cOncerns with the NGA resolution" it is important to
summarize~brieflywhere we have significant agreement.' Your Medicaid refonns include at
Jeast 12 NGA-endorsed flexibility recommendations,inCluding arguably the three most
important structural changes:
'
I
(1)
'.
•
The establishment of a new financing mechanism that: Iinks,and constrains
federal financing to, enrollment through Jhe use of an open-ended "umbrella"
that assures that "dollars follow people" ~d that states ~e protected from
, economic downturns;
I
"
,
,
'
1 ,
I
(2)
The repeal of. the Boren amendment and other federal' provider'
reim~ursement requirements; a n d '
(3)
The liberation of states from the waiver process for: •
i
•
Managed care',
•
Home and community-based care '
•
Coverage expansions up to 150 percent
of poverty
I
,
Outstanding Iss,ues Related toNGA Resolution
There are three sets of issues that will be debat~d in ,the, legislative' p~ocess: (1) the
"gu~antee"; (2) second tier issues; and (3) the Title XIX de,bat,e.
.
The "Guarantee." Those issues that are directly related to the Medicaidnguarantee"
(financing, eligibility, benefits' and enforc~ment) will: demand ,most of your attention,
and are the focus of this memo.
"
J
,
'
'
Second Tier, But Critical Issues. There are "second tier" 'is~ues, such, as nursing
home standard enforcement, financial pr<stections for, families (like spousal
impoverishment), and managed care quality assuraIlCe, that
require Administration
attention should negotiations progress., These issues helped us perSonalize the
Republican Medicaid cuts and they are view.ed as, critical by:mosfDemQcrats.
(For example~ Senator pryor feels ,strongly about the nursing home enforcement issue.)
will
Th~ Title XIX
Debate.' Finally, the Republican desire to repeal title XIX and
substitute a new Medi~aid title raises a host of conCerns; D~ftinga brand new title
for Medicaid in the limited time we have left in this Congress' would inevitably lead to
unforeseen legal, policy and political consequences. This wbuld inClude having to,
detennine how to, deal with case law' --,- such as what is the: definition of "medical
, necessity" --that has developed over the past 30 years. Per.haps, most ~mportantly,
, ,taking this route would place us in an untenable bargaining position; we would have to
,give "chits" just to "reinstate" provisions that are current law.
"
, . ' "
j
2
J
I '
I
�"
THE NGA' RESOLUTION AND
,
THE GUARANTEE:· ADMINISTRATIONPOSITIONS
I
.
, I
','
I"
_There are four elements that make up the Medicaid guarantee: financing" eligibility, benefits,
and enforcement. Each of ~hese elements is inextricably linked to the orhers and changes to
anyone of them must be carefull y ~onstructed to avoid undermining' the. foundation of the
guarantee and the program. The following outlines the primary conceIl!s'we have with the
proposal and' summariz~s current and possible fall-back' Administration, positions on these
'.J
,
, issues.
, j.
!
(1)
Financing Concerns:
"
!
"
The NGA proposal uses a financing mechanism that is different; from ours but that
also assures that dollars follow increases in enrollment. Howev,er, it has the following
problems:
•
states are guaranteed their base formula allotment even it they choose 'to
reduce coverage. This provision ._.... drafted for states like Michigan~..,. is a ..
significant departure; from the historical Medieaid federaVstate partnerShip,
. where federal financing support rises and falls with changes in coverage.
, .
.
'
. .~ ..
•
' .
Many states can reduce their state Medicaid matchi~g requirement•
This provisio~ -- hastily inserted .for Govem<;>r Pataki. i- would signifiCantly
decrease overall Medicaid spending OR sign~ficantly increase Federal spending.
. It would reduce the m~imumstate"match fr~m 50 percent to 40 percent. If
., federal spending is capped and alLstates matched at their minimum levels. the
, matching rate change wouid reduce total Medicaid spending by an additional
$140 billion over seven years (on top of. the already asSumed $85 billion iiI ..
federal savings and $65 billion 'in state savings). ThtS could.:/ead to'large
estimates of coverage loss unless the major eligibility and. benefit protections
mentioned later in' this memo are assured. If federal spendirig were not
capped, the cost-shift resulting from the lower state match would totally offset
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the $85 billion in federal savings.
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States could substitute state tax dollars with revenue raised through·
, provider taxes and donations. Since this is "borrow~d!lmoney. it W9uld
effectively reduce states' real spending on Medicaid. :Because this would make
it~ier to raise state matching doHars, CBO (and OMB) would 'likely conclude
that this provision 'would also significantly reduce Federal savings.
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Administration Position: 'Our CB9-scored per capita cap ~pproach to Medicaid cost
containment has a "dollars follow peopl~" mechanism that is more direct than the, ,
NGA umbrella and does not include any of the problems mentioned above:, We would
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keep the current matching formula, but propose th(it a nation,al commission be
established to make recommendations on how to addre,ss pe~ceived' inequities. '
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Possible Fall-B~ck Position: The RepubliCan- Governors are li~elY to refiIse an
Administration-like per capita cap fina'ncing mechanism. 'We may be able to live with
a NGA-like, fina~cing approach if, as the Democratic Governors; intended, it truly
allows dollars to follow people and. if the state matching reduction and the provider
ta,x/donation provisions 'are. fixed. Govetno~ Chiles, Romer, apd Miller all have
:' indicated they share our concerns with these provisions and support our position.
an fact, the six. "Medicaid," Governors never discussed the ~rovider tax and state
matching reduction isSues; they were added as last second amendments to-.the .
. resolution.)
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Eligibility Concerns: ,
, '1 Repeals current law that phases-in coverage for 1.S ~iIIion poor children '
i \betWeen the ages of 13 and 18.0MB estimates a maXimum of $6 billion in .
: \federal savings if all states do not phase-in coverage. (This would overturn a
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. ' Jaw enacted by President Bush in 1990;)
Allows states to define. disability, subject to HHS approval, instead of
,requiring all states to meet a minimum federal definition. This proposal .
. could result in widespread variation in eligibility dete~inations among, states:
and could threaten the eligibility guarantee for people with.disabilities.
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Administration Position:' We retain the kids phase':"in and u~ the welfare reform'S ,
a~pr~ach to address the Gqvernors' concern about di~ability ,eVgibility 'abuse. This
~y '(. <-gIves Governo.rs the option not to designate as "disabled" those persons who ~re
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alcoholics and chemical· ~nd substance abusers, as well as tigl;Itens the eligibility
~' « ~, definition for children under S S I . . .
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Possible Fall-Back Position: No, fall-back for the, kids covf!rage expansion. On
disability. we could limit eligibility for other groups if the G9vernors can' demonstrate'
that there have been eligi~ility abuses. If this compromise is still not acceptab~e,we
could consider allowing states to define disability, but with much stricter criteria that
the Secretary must use'to e~aluate designations. (This latier!approach needs to be
politically vetted.) The Democratic Governors :would probably be fine with either
of these, positions, although Governor, ~omer thi,nks, the states should not be
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defining disability eligibility."
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Benefit Concerns:
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" Eliminates the current "'adequacy"' requirement for benefits and gives
, states unlimited discretion to determine tbe amount, duration and scope of
: I services within benefit categories.,' Under, these provisions, the HHS
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;' i Secretary would have no legal basis for concluding that a one-'-day hospital '
benefit, was insufficient to. m~et the federal re'quirenient for a hospital benefit.
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'May repeal the statewideness and compar~bility requirements for, " '
mandatory benefits., Ift,hiS is the case, states could offer 5 months of hospital
services for children and 2 weeks for, the disabled. '
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Repeals current statewideness and comparability requirements for optional
benefits. Without these p~ovisiC:>ns, states could offer different' benefits to
different groups of recipients or provide different, benefitsiil different areas of
the state, ' For example, states could decide topro~ide a nOf":deductible/no c;lp
. prescription drug benefit for a disabled person who had ~ stroke, and a drug
,benefit with a $500' deductible and a $1,000 cap for (i'person with MDS:
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Redefines the
treat~ent portion of EPSDT ~arlY a~d Periodic Screenin~, ,
Di~gnosis an~ Treatme?t) so that ~tates nee,d not, cover all Medi~id '
optional serv.ces Cor children.
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, Administration Position:, The Adm'inistration maintains that these concerns m~st be
addressed or the national' guarantee to benefits.is legitimately, ~lled into question.
Your proposal retains the current 'benefit, package and protections., On EPSDT, it
clarifies that benefits provided to children llnder the treatment' requirement need not 1.;Ie
given to, any other population (under the cOmparability requirements.)
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Possible' F~II-Back Position: M~intain the b~nefits adequacy standard. ,Maintain, '
\ current protections for mandatory benefits, but negotiate significant changes'in the
'I \ requirements on t~~ optional ben~fits, Includi,ng elIminating o~'significantly li?eral~ng
l \ current comparablhty and statewldeness requIrements. Negotlatefurther m<?dlficatlOns
1\ \ to the "treatment" requirement within EPSDT, including that; the requirem,ent need not
, \extend beyond a certain age group OR the possibility that the benefits provided need
, \not exceed the states', optional packag~", (These are "hot-btit~on" options that would no
rolled out
The Democratic Governors.~
I Idoubt have to be'carefully "adequ~cy if pursued.) but --' like theN-GA, ~- have not
:) Isupport retention of the
standard,"
lyet finalized their position on the other benefit issues. I.
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. Enforcement Concerns:
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Eliminates any federal, cause of action under Medicaid by ·beneficiaries,
health care,providers and health plans. ',Claims brought by, individuals to
enforce their rights under ~edicaid ~ould be limited to state courts and state
law. Only the Secretary of Health and Human Services could bring an action
in ,federal court on behalf of Medicaid beneficiaries', '
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There are four maj~r concerns with this proposal. :First, the ~ligibility w~uld
vary betwe~n states pecausestate courts would interpret the ,law differently; ,
the same person 'could be covered in one'state but not in another. Second,
fewer remedies would be available under state law: than under federal law.
, Third, Medicaid would be' the only federal statute ihat, confers individual rights
that could not be enforced in federal courts by its .'intended beneficiaries.
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Finally, the HHS Secretary would be unable to 'litigate adequately on behalf of
individuals because there would be significant new administrative burdens
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placed on the Departmept and because the Qnly remedy aviailable to the
Secretary ~ould be the withdrawal of funds to the state. .'
Administration Position: We repeal the Boren amendment arid :make it clear that
providers have no right to sue over payment rates. We retain current law for
eligibility .and benefit claims brought by individuals.
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.. Possible Back-Up Position: IIi addition to the outright repeal qf the Boren
Amendment, .we could also eliminate the private right of action by providers and'
health plans completely (so that they could no longer sue over provider qualifications
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. or other issues not related to' r~imbursement).
On causes of action brought by recipients, we could follow up on a suggestion made
by Governor Chil'es and propose separating eligibility Claims, frdm some benefit
claims. Under this approach:
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' There would, be no. suits by providerS health plans over I '
reimbursement rates or
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any other issue:
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' Ev'eryone filing a claim would be required to ~xhaust a~ministrative remedies.
A recent survey of state Medicaid agencies 'found that in the 40 states that
. responded, less than 5% of fair hearing decisions were 'appealed to a court. In
California, for example. 4,600 fair lieanngs were held and less than 1% were
appealed.. In Wisconsin, 376 fair hearings were held,'¥1d 8 (2%) were
appealed. (Texas Legal Services Center; 1994.)
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. Most disputes over benefits w0l!ld be heard 'in state court. Benefits claims, .
would only ,be heard in federal court if there :were an allegation that the state'
plan or a contract betWeen the state and a provider viqlated federal law.
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aaims brought by individuals over eligibility. would be heard in federal court.
Across the country, there were 6 reported cases ov~r eligibility in 1994, 8
in· 1993, 6 in 1992 and 8.in 1991; (Nation~l Health t,.aw Program, Inc., 1995.)
This is not ~' high 'priority issue. for the Demo~ratic Govetnors, and we believe '
that they would support our approach. However, th~y h~ve reported that the
Republican Governors have a philosophical aversion to any Federal right of,
action. What is clear from our conversations with the NGA staff, though" is that'
the Governors have not focus.ed on this issue in ~any grea!t detail.
Conclusion "
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We hope this information is helpful to'you in deciding hciw the Administration should
position itself on. the Medicaid front. Attached is a. background document'on the
congressio~al and, interest group response to the NGA pr~posal. .
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�CONGRESSIONAL AND INTEREST GROUP RESPONSE TO NGA
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Hill Response to the,NGA Resolution: Most .Republicans, through the B,NC and
comments by the Speaker, are strongly embracing the NGA proposal.' They claim' ,
that it is a virtual mirtor"':image'o(their Medigrant, proposal. Th~ RNCis literally
passing out paper declaring "victory." ' The only exception to a bomplete endorsement
from the Republicans is related to their perception of the financing mechanism. They
.are sending signals that they oppose the open-ended nature of it; and are suggesting ,
that they may push for some type of cap." (The Democratic Governors have already ,
indicated that they would "walk" 'from the deal if .this occuI'!ed.),
Republicans appear to want to push a "bipartisanly-s~pp0l1ed t-fGA" bill out and dare
us to criticize it. It is for this'reason that they hav~,so quickly scheduled hearings for
this Wednesday and Thursday, and have invited'Secre~ary Shal~la to testify next week
before the Finance Committee. Having said this, they·are reportedly being responsive
to NGA calls to not prematurely unveil a Republican '''NGA Medicaid~' bill and risk a '
meltdown of the bipartiSan agreement. There is no question, ,however, that they are "
,(behind the scenes)draftiriglegislatio~ and attempting to get cao to scoreit an~ it is '
not inconceivable that they may' introduce something prior' to Secretary Shalala's '
, testimony.
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The Republican reaction has f\leled the suspicions of the Democrats and; with
extremely few exceptions, there has been a generally: negative reaction to the NGA
proposal. The "base" Democrats, like HenryWaxm~n, have ~een extremely criticai 'of
the proposal antI' have, charged that it offers no guarantee and may, even be a block
grant in sheep's clothing.'
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Congressman Stenholm and cingres~manDingell were apparbiltly quite disappointed
in the lack of state accountability, the reduction lq state ma~ch, and raised concerns
about 'the adequacy of the legal enforcement provisions.' They argue that it is not
unreasonable,to expect a federally-~nforced, national eligibili:ty and standards floor in
return for a large federalinvestment. To back up their pointi theirstaffs have been
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circulating chart that shows' how the coalitio~ proposal wo~ld provide $840 billion to
state Medicaid' programs, 'at :the ,same time the states aretryiIig to, sigriificantly
, decrease their, ~edi2aid expenditures. '
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On the Senat~ side, Senator Breaux' distanced himself a bit and called for hearings so
he could fully understand the implications of the proposal. ' ins staff reports that'
, Senator J?reaux thought the Democratic Qovernors'weregoi~g to be able to "cut a
better deal than they did~", On the moderate Republican sid~ ,of the ~isle. Senator, ,
Chafee privately raised concerns about the proposal and suggested it appeared to be
something akin 'to a federal maintenance of effprt with too little account~bility.
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�Clearly, h~wever, ~th Senators' Breaux and Cliafee want'to keep the Medicaid
discussions alive for the sake of a 'budg~t deal and 'wilL continue to avoid being overly',
critical in public. According to Senator Bre~ux's,staff, ,the prim~ry authors of any'
,alternative, Medicaid bill will likely be Senator Chafee and Senato~ Graham. Lastly,
there ,are also reports'that'Senator Roth's staff'is working with the House Commerce
Committee to draft 'up their own version of the "NGAresolution." Since,t"hey have
fairly "green" Medicaid staff who have previously worked at the House COmmerce
COmmittee, it is likely that their bill will largely m,irror the House Republican. bill.
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. ' interest Group Response to the NGA R.esolution: We have received only
negative reactions from the groups, includirig the unions, 'the Alnerican Hospital'
Association, the American Academy of Pediatri~, the' Childre~'s Defense Fund, the "
Alzheime~' Association and the ,Consortium for Citiiens with Disabilities: The groups,
particularly those' who represent children a~d the 'disabled, feel that enactment of a
proposalli.ke the Governors' resolution would significantly increase the number, of
unirisured and renege on what they believe is a jointly":"lield commitment with the
Administration to expand,or at least not reduce,the number qf insured. The AIDS
groups are particuiarly'concernedbecause they greatly fear the benefit changes and the
, s~ate-by-state definition of disability provision. ,"
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The other inter~st groups are largely staying quiet and waitin~ to see how we respond
to the likely IIclarifying" changes expected to emerge, from the NGA over the next
week or so. Some of them are taking this position because, they do not want to
undermine our position. Others are holding off because they,' want to be perceived as
IIplayers" in the upcoming n~gotiation.
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, The Office ofPublic Liaison believes that your strong stand, on Medicaid has b~jlt
.bridges that extend far beyond the traditional Medicaid constituencies. ,Public liaison
believes that siinificant changes' from 'these groups' perq!ption of our past Medicaid'
position may damag~ this strong alliance and may.I be difficult to repair.
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�CONCERNS/OUTSTANDING ,QU'ESTIONS
ABOUT THE NGA MEDICAID RESOLUTION.
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Eligibility concerns include: '. The repeal of the cum:nt law's phase-in for coverage of
about 3 million children age 13-17 and the devolution o~ the "disability" definition to
the states.
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Benefit concerns include: The total discretion given to i states to alter the
amount/duration/scope of services; the repeal of the current law's comparability and
statewideness requirement that ensure that recipients in particular' groups or locations
are not discriminated against; the apparent elimination of any defined benefit package
for currently optional populations; and the vague redefinition of the treatment
requirements under the Early, Periodic, Screening, Diagitosis and Treatment (EPSDT)
children's health benefit.
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Enforcement conCerns include: The state-based right of action process advocated.
by the Governors (and whether it will work to effectively ensure the guarantee).
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Financing concerns include: The exclusion. of pregn3nt women and children, as 'weIr
as the medically needy, from the Federally-financed. ":umbrella" pool payments; the
inclusion in the base formula of the allowance that states can reduce their matching
Medicaid rate -...:. the result producing an additional $200 billion reduction in state
Medicaid spending over seven yeats, bringing the total FederaVState cut to $290
billion; the allowance for states to, once again, tax he,alth care providers to help
finance their state match; allowing for provider taxes. will likely push up the cost of
the program that CBO scores because it will be easie,r for the State to access Federal
matching funds.
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. Quality concerns include: The adequacy of the qu3.Iity protections for plans under
Medicaid, such as HMOs and other managed care plan; the apparent repeal of the.
Federal-:-based enforcement of Federal nursing home standards. (The difference
between them and us has always come doWn to definition and enforcement.)
Accountability concerns include:
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MEMORANDUM
February 9, 1996
TO:
Carol Rasco and Laura Tyson
FR:
Chris Jennings and Jennifer Klein
RE:
porus Medicaid Memo
Attached is the current draft of the Medicaid memo we promised to get to you. We
attempted to draft it in a way that reflects our best understanding: of the status of the NGA
Resolution, as well as Capitol Hill's and the interest groups' respOnse to it.
It is my understanding through Nancy-Ann Min that Alice Rivlin would probably like
to sign this as well. Do you have a problem with ine sharing utis memo with her and with
making it available for Alice to sign?
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Please feel free to call me 6-5560 with any edits or directions. Thanks.
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MEMORANDUM TO TIlE PRESIDENT
FROM:
Carol RaSco and Laura Tyson
SUBJECf:
The Medicaid "Guarantee" and Issues Rais~di Surro~nding the NGA
Resolution
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The National Governors' Association (NGA) Medicaid resolution passed on Tuesday has
received a great deai of attention from the' media, the Hill, and the health care provider and
advocacy community. As a whole, the "right" has given this proposal Widespread praise and
raised concern only about the resolution's financing provisions. The' "left" ,has been extremely
critical of the proposal, charging that the provisions on benefits, ~ligibility and enforcement
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strip the Medicaid program of its "guarantee."
This memo briefly analyzes theNGA proposal as it relates to the Medicaid "guarantee."
(While there are numerous issues related to the NGA resolution; including how it addresses
quality standards, nursing- home standard enforcement, and spousal h:i1poverishment, we '
thought it was most important to focus on the fundamental structural issues first.) The memo
also describes reactions from the Governors, the Hill and the, interest groups.
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, BACKGROUND
From the beginning of the Medicaid debate, the Administratiori has cOnsistently taken the
position that, it is possible to constrain program growth while' ~till maintaining Medicaid's
guarantee of coverage to the elderly, the disabled,~hildreri arid pregnant women; Your latest
proposal, incorporated into your balanced budget proposal, provides unprecedented flexibility
to the Governors while maintaining the guarantee and saving ~59 billion over seven years.
In response to you and the Republican Leadership, the Governors attempted to hammer out a
compromise Medicaid position to further the budget negotiations. The Democratic Governors
worked tirelessly to move the Republicans from their insistence on a block grant. The
Republicans hesitantly agreed to a new funding forrilUla that .'assures that federal dollars
increase with enrollment increases during 'economic downturns. ,
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The Democratic Gqvemors rightly beiieve that'their success in' gettingi·the Republicans to
agree to a guaranteed funding stream represents 'a significant step fOIWard. To' achieve this
victory, however, the outnumbered Democrats were, apparently forced: togive'in on provisions
that may well undermine other aspects federal guarantee; , , :- . .
of the ,
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FOUR PARTS OF THE GUARANTEE UNDER MEDICAID
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There are four elements,tha, milke~p the Medicaid guarantee:finan~ing, eligibility, 'benefits,
and enforcement. Since the clebate has so .focused on the "guaranteet i,t is likely that any
compromise will be ,twaluat,ed in this context.· It is with this in mind; that we review the NGA
proposal, understanding that it is somewhat of. a moving target subject to future clarification: '
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Financing Guarantee. As m~ntio~edal?Ove, the NGA prop~sal Seems to achieve the
financing guarantee by eliminating the block grant financing approach and. substituting
a so-called "umbrella" financing mechanism. "This mechanism automatically provides
additional federal support as economic downturns produce erirollmept ~ncreases. Over
the weekend, the Republicans agreed that the umbrella would cover the increased costs
of optional (J.S well as mandatory benefits and populations. This 'was an important
breakthrough' for the Democratic Governors.
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Interestingly, the Democratic Gove'rnors could'only securet~eir recession protection
provision if ,they agreed ,that states (like Michigan and Wisconsin) would be '
guaranteed their base alt'otment even if theycho~e ,to reduce coverage and spending. '
This is a significant departure ·from the historical Medicaid federallstatepartnership,
where federal financing support rises and falls withchaIige~ 'in coverage and state
contributions. Additionally, the reduction of the required state match permitted by the
NGA ,resolution (and inserted at the last second for Governor Pataki) could
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significantly decrease' overall Medicaid spending., In fact, estimates from HHS
indicate that the $85 billion in federal savings would trarisl:ate i'nto $290 billion, in total
spending reductions if all states matched at the minimum level. Lastly, the state. may
be able to substitute, state tax dollarS with revenue raised through provider taxes and
. donations~ Since this is "borrowed" money, it would effectively reduce states' real
spending on Medieaid. ,These provisions may have an impact on how CBO scores this
proposal and, if it does,estlmat~s of fe~eral savings may deCline.
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Eligibility Gua~antee. The NGAproposal, with some notable exceptions, seems to
retain most of,the currently eligib.1e populations. The NGA.proposal repeals
provisions, of the 1990 law, signed by President Bush, that phases-in coverage for
about three million poor children between the ages of 13 :and 18. In addition, the
. proposal allo\vs'states to define disability, subject,to 'federal approval, instead of
,requiring all states' to meet a minimum federal definition,: as is' now the law. As
currently drafted, this proposal has 'potential to result in ~idespread variation in
eligibility'determinations among states and, in the minds ;of some, could threaten the
eligibility guarantee, for people witli, disabilities.
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Benefits (Coverage) GUarantee. The, NGA proposal leaves in place the cUrrent,
nationally defined list of Covered benefits for mandatory coverage groups. ' At first ,
glance, one.might conclude that the benefits guarantee was assured. However, the
proposal seems to eliminate the currentrequii-ement that med~Cally necessary benefits
be provided and gives states unlimited discretion to determine the amount, duration
,and s~pe ofservices within benefit categories. It also 'seems to pennit states to offer
different benefits to different groups of beneficiaries or in di(t'erent areas of the state.
For example, under these provisions, states could limit the number ,of hospital days per
year provided to children, even if a doctor decides that the c3te is medically necessary,
States could also decide to cover five days of hospital services for disabled children
but only two days for people with ArDS. Finally, they could chose ,to cover a
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particular benefit in some' ~eas of the state, but not for exa~ple, on an IIldian
reservation. Although the resolution's language seems fairly: clear, it is hard tO,believe
that the Governors, particularly the Democrats, really intended to go this far on both
mandatory and optional benefits.
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The proposal also redefines the treatment portion of EPSDT; (Early and Pe,riodic
Screening, Diagnosis and Treatment) so that "states need nqt cover all Medicaid
optional services for children." They' have. not yet resolved; what treatment would be,
covered.
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Enforcement of the Guarantee., The NGA proposal dimi'nates a federal Cause of
action by Medicaid beneficiaries. Claims brought by individuals to e~force their :rights
under Medicaid would be limited to state courts and state law. Dilly the Secretary.of
Health and Human SerVices could bring an action in federal court:on behalf of
Medicaid beneficiaries.
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Attached is a more detailed description of the' issues raised, by the NGA, proposal' to
eliminate the federal cause of action. The most significant problem is that, under this
proposal, eligibility will vary between states because state: courts wili interpret the law,
differently. In addition, fewer remedies are' availableund¢r state 'law' than under
f~derallaw. The Secretary of Health and Human SerVice,s will be unable ,to litigate
adequately on behalf of individuals because the significant new administrativeburd~n
. , that will be placed on the Department will likely cause delays and, because the only,
remedy available to the Secretaryisthe,withdI?walof furds (which will make matters,
worse. for the recipients in the state).'
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REACTION TO THE NGA' PROPOSAL
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Governors Position: As
this writing, the 'Governors :are working with NGA staff
to clarify the intent behinq their Medicaid res~lution and to write up the back-up
details.. Based on conversations that we have had with :the Democratic Governors and
their staffs, as well as NGA staff, it is clear that .there are a.great deal' of unanswered
questions regarding the intent and substance behind the resolution. NGA staff will
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work with the 6 Medica~d-designated Gove'~ors(Romer, Chiles, .Miller;Thomps(j~;.,
Engler and Leavitt) in the up-coming two weeks to try to furth~r clarify this issue.
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As with any hastily-~rafted document, we h~ve found that the,re were a number of
provisions that Democratic Governors either did not know abqut or are uncomfortable
with. For example, .Governor Chiles was apparently unaware ;that the resolution'
provided f9r the reinstatement of provider taxes and donation~. Governor Romer has
told us he is uncomfortable with the dIsability langUage. and t~e 'state matching
reduction provision. ,And it seems' that all the Democrats are ;uneasy with dropping the .
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Phase-in o.f the kids.:
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Hill Position: Most Republicans, through the RNC and comments by the Speaker,
are strongly.embracing the NGJ\. proposaL They claim that ~t is' a virtual mirror
image of their Medigrant proposal. TheRNC is literally pas~ing out paper declaring
"victory" and the House Republican staff are drafting up language that they are touting
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will incorporate theNGA recommendations. Repub~icans' appear to want to push a
. bill out and dare us to criticize it. In fact, there, are now rumors that they may attach
their interpretation of the NGA resolut'ion to, th~ debt ceilini bill.
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The Republican reaction has fueled the suspicions of the D¢mocrats ~d, with
extremely few,exceptions,there has been a generally negatlye reaction to the NGA
proposal. The "base" Democrats, like Henry Waxman, hav~' been extremely critical.of
the proposal and 'have charged'thatit offers no guarantee and may even be a Qlock
grant in sheep's clQthing. Congressman Stenholmand Congressman, DingeU 'were
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apparently quite disappointed in 'the lack of state,accountability; the' reduction in 'state
match" and raised concerns about the adequacy:of the 'legal; enforcement provisions. '
They argue that it is not unreasonable to expect,a federally'-enforced, national
eligibility and standards floorjn return for 'a large federal i~vestment. To back up
their point, their staffs have been' circulating a chart that shows how, the 'coalition
proposal would provide $840 billiori to state Medicaid programs, at the same time the
states are trying to signifiCantly decrease their Medicaid expenditures.
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On the Senate side,' Senator Breaux distanced' himself a bit and' called for hearings so
he could fully understand the, implications of the proposalf' On the moderate
'Republican side of the. aisle, Se:nator Chafee raised'significant concerns about the
proposal and suggested it appear~d to be something akin: to a federal maintenance of
effort with little to no accountability. Clearly, however, both Senators' Breaux and
Chafee want to keep the Medicaid.discussions alive for 'the sake of a budget deal and
will continue to avoid being overly critical in public. . "
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Interest Groups:. We have received only negative reactions from the groups~
Including the American Hospital Association; the AmeriCan Academy of Pediatrics, the
Chidren's Defense Fund,.the Alzheimers' AssoCiation and the Consortium for Citizens
with Disabilities. The groups, particularly those who re~resent children and, the
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disabled, fe~l that. enactment' of a proposal like 'the Governors; ,:resoltition' would
significantly, increase the number of uninsured and renege on what they believe is a
'jointly-held commitment with the Administration to expand, drat least not reduce, the
number of insured. The AIDS groups are particularly, concerned because they greatly.
fear a state;"'by-state definition of disability., '
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The Office of Public Liaison believeS that your strong stand on Medicaid has built
bridges that ext~nd far beyond the traditional MediCaid constituencies. Public Liaison
believes that significant changes from the~ gro~ps' perception of 'our 'past Medicaid
position may damage this strong alliance and may. be difficult to repair.
CONCLUSION
This morning, Carol, intergovernmental Affairs and Legislative Affairs met .with Ray
Scheppach to discuss ,the NGA Welfare and Medicaid resolutions and the process to move
forward. We will be following up this meeting ,with ~ briefing by NGA for White House, .
OMB, and DepartmeI,lt staff to seek clarification of the intent behind ,the resolution's language.
We will keep you informed of these discussions and would be happy to meet with you to
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disCuss any of these issues further.
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�PRIVATE RIGHT OF ACTION
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A Federal Private Right of Action is Important to Maintaining the Guarantee. The
NGA proposal (and the Congressional conference report) have eliminated any federal cause of .
action by Medicaid beneficiaries. Claims brought bymdividu~ls ,to enforce their rights under
Medicaid would be limited to state courts and state law. Only the Secretary of Health and
Human Services could bring an action in federal court on behalf; of Medicaid beneficiaries.
Both Republican and Democratic Governors want to reduce the number of Medicaid cases
filed. In addition, they do not want court deCisions from federal courts in other states to have
any effect on how they run their Medicaid programs. While, under their proposal, cases
heard in other states' courts would no longer have precedential i value, it is not like! y that
fewer cases would be filed; they would simply be filed in state court.
Since the inception of 'the Medicaid program, a person eligible for Medicaid has had both' a
guarantee of access to certain services and the right to enforce this commitment. We believe
that preservation of the federal' cause of action for individuals to enforce Medicaid eligibility.
assures this guarantee.
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Consistent Interpretation. Those aspects of the Medicaid program that are common
to all states -- like eligibility -- .should be consisteptly interpreted and administered.
The basic guarantee of who is covered should be uniform ·across the country; without
a federal cause of action, it will not be. For example, under current interpretations, a
woman who has a miscarriage is considered "pregnant" and therefore eligible for
services for complications arising from the miscarriage. Under the NGA proposal, if a
state improperly denied those services, she could no longer go to federal court to
enforce her right. The issue would instead be ,litigated in fifty states; in some states,
she would receive .care while in others she might not.
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Significant Limitation of Remedies. Most state ,laws establish higher hurdles for
plaintiffs and provide less relief than federal law.. Under most state statutes that allow
courts to review administrative actions, there is no de novo review (the record before
the court is limited to information considered by the agency) and relief is granted only
when a claimant can show that the agency action was arbitrary and capricious, not
merely wrong. In addition, most state laws do not allow beneficiaries to recover
attorneys' fees, making it more difficult for theI?1 to afford legal counsel.
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�The NGA proposal (and the conference report) maintains a right to sue in federal court
through the Secretary of Health and Human Services. However, this poses three
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problems: (1) the Secretary can sue only if a state is in "substantial noncompliance"
-- a much higher standard than exists today; (2) the Health Care Financing
Administration will become involved in greater numbers oflawsuits and face
significant new administrative burdens; and (3)' it is unclear what remedies are
available. If the only remedy that the Secretary can seek is the withdrawal of federal
funds, this would cause significant harm to the beneficiaries lthat the Secretary is
supposed to represent (and might even make this remedy unus~ble).
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Departure from Other Federal Statutes. Eliminating the federal cause of action
would single out Medicaid as the one federal. statute that could not be enforced in
federal court by its intended beneficiaries. Such ari unprecedented step would be seen
as a signal of second-class status and would set off a massive reaction· from
beneficiary groups and their allies.
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Elimination of Remedies under Civil Rights Law. Whil~ it is not clear that the
NGA intends to go this' far, the conference agreement precludes the right to enforce
civil rights laws. Protection against discrimination in state' programs has been
established under the Civil Rights Act of 1964, the Rehabilitation Act of 1973, the
Age Discrimination Act of 1975 and the Americans with Qisabilities Act of 1990. If
this is what the Governors intended, the civil rights community is likely to be very
concerned.
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Your Proposal Incl,"eases Flexibility While Maintaining the Guarantee. Under your plan,
you eliminate causes of action by providers over payment rates by repealing the Boren
Amendment. This removes state officials'greatest source of concern over litigation and the
most frequent basis for cases filed in federal court.
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Your proposal maintains current law on private enforcement of beneficiary rights under
Medicaid. You could take steps to address the Governors'. concerns by separating eligibility
claims from some benefits claims. On eligibility issues, which ~re most closely linked to the
concept of a guarantee, individuals would retain their current right to bring suits in federal
court. However, individuals would be required to exhaust a stat¢ administrative process
before filing in court. Most claims involving benefits would be' heard only in state courts. A
benefits claim could be heard in federal court only if there were an allegation that the state
plan or a contract between the state and a provider violated a provision of federal law.
2
�M EM.O IlAN DUM
February 7, 1996
TO:
Carol Rasco
FR:
Chris Jennings
RE:
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Medicaid Repeal of Expansion of Kid's Coverage
Attached is the final copy of the memo· we sent to the Pres~dent last Saturday. I have
tabbed and highlighted the section of this memo that mentions the:repeal of phased in
expansion of kid's coverage. I thought you might want to have this reference and perhaps
show it to Leon to inform him that he was also made aware of this provision in this memo.
I hope this information is helpful. Please feel free to call me at 6-5560 with any
questions or comments.
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THE WHITE HOUSE
WASHINGTON "
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Februafy 3, 1996
INFORMATION
MEMORANDUM FOR THE PRESIDENT
FROM:
RE: ' '
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Carol Rasco andLa~ Tyson,
Status of Medicaid discussions
P:URPOSE:
To provide an uPdate on the status of the Meaicaid discussions with t)ieGovemors and the
,Hill, as well as to provide backgroun9 infopnation on,),our Medicaid1reform initiatives. "
BACKGROUND:
Status of Governors Meetings
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'For weeks, in response to reqUl~ts made by the Hill aDd us, the Democratic
and Republican Governors havl~ ,been meetmg to see if they could produce a'
bipartisan agreement on Medicaid.' The lead Governdrs for, the Democrats have '
been R<?mer, Chiles, 'and Miller; for the'Republicans, ;it has been Thompson,
Engler,and Leavitt. To date, :although there is widesPread' agreement on the
need for significant expans~ons in,flexibility, no agreement has 'yet been forged
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on how to structure and financ:e a reformed Memcaid program.
On Thursday evening, and y~;te~day'aftemoon and evening"~ the Governors met
for ,countless hours to review the latest of the Republican Meru.caid.
restructuring propos31s. During their meetings, the RepUbliCans o~tlined their
'new financing (ormula that, f;)r the first time, outlines' how they would allocate
the' downsized '$85 ,billion (fro~ $117 billion) reduction in Federal dollars, " '
amongs~ the states.
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In their new. plan, the Repuhlica~s apparently 'h~ve 1tte~pted to blend their
.blocicgrant with a new contingency fund that is distributed through a per capita
. formula. Their plan would lock·in stat~s; Federal ~~ allotme~ts and grow
them at differential rates. The use of differential rates is meant to address the "
�widespread spending and grO~h I1lte variations between State 'Medicaid
programs. States would be guaranteed thCse.illotnl~nts even If they
signifiCantly decreased the number of Medicaid recipientS tJIeir programs
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served as long as they spent Savin!gs on health care.,'
To address the major policy shortc.oming of a block graxit (no ,
protection), the Republican Go~ernorS have' established a
new contingency poOl of $8 billion that states could apparently tap if they
experienced unexpected enrollment'increases .. Unlike past contingency funds
that have been capped, the Republican ,Governors are claiming that the pool
. " would increase as much as necessary to meet newancl ~eXpected population
growth. If true, this approach could be characterized as a back-up per capita
cap protection. (It is importaDft.o note ~hat we have not been given any ,
statutory.
,language or accompanyiilg CBO scoring of this concept)
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'~sion/inflation
Upon eloserexamination, however, there appears to be: a numbbr of notable
and potentially quite serious shortcOmings with the contingency fund. First, the
dollars are only available to help' pick up the.costs of'higher than projected ' .
, enrollment of mandatory benefits and populations. Siij.ce over 50 percent of
prograln expenditures are for optional services/populati~ns, this does not
provide'anywhere near the level! of "insurance" protection your per capita cap .
does. Moreover, since'their new pool does not inClu~~ the disabled in their .
, calculation (since they allow the States to define disab,ility), the, recession
'. protection provided is probably clOser to 30-40 perCeht of the program costs
for most states. This lack of protection is totally unabceptable to the
. DemocraticGovemo~, particularly Chiles,· and would be inconsistent with your
current policy.
: In. response to criticisms of tluis shortcoming 'byDe~ocratie Governors, the
,Republican Governors areno~~ saying that they would tJe willing to: consider
the establishment of a separat:;~ contingency fund forfoption~ services.
.. Apparently Ray Scheppach is· trying to develop such; ail option. As of this
writing, we ha~e yet'to see or. hear anything specific, about this proposal. If
~y develops somethihg that is workable and is financed without hurting other,
aspects of their allocatioitformula,sOmeDeniocrati~ Governors may' well be '
quite, interested:
State-by-State Fonnula
By releaSing their new state;-by~stateMediCaid fu~ding distribution yesterday, ,
the Republicans have forced us into releasing ours. We had purposely resisted
'until we saw theirs first and could modify ours to ensure it was better for
almost every state. (Not ev.ery state does better because the Republicans are
closing in on our savings number and beCause we '<;QuId not deVelop a
defensiblepplicy rationale to do '''rifk-shot'' policy fixes:)
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, The revised "draft" formula, which we finished this moinjng, will be handed
out to the Democratic Governors tex!ay. It is attached fo~ your revie'Y and, '
includ~ one additional category aimed to show the adv~tage of a per capita
cap during a projected recession. ',As 'you know, because:of the intense politics
and economics associated with· M(:dicaid, this fO,rmula will', change' countless
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" times before ~y final, policy is enacted.
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State Flexibility and 'Preservation of Federal Guarantee
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At least as important as the formula is the need t<> get al sense of where the.
Governors stand on the, basic stril.cture of the program. ,Althou&b the
Governors have' yet to take up these issUes' this week, there is no indi~tion that
, the Republicans have, for ex~ple, retracted their insist'ence. that there nQ ., '
longer be a Federal court right of actio~ for enforcement of eligibility and '
benefit guarantees. The DemOCIatic (iovemors tell us that the Republicans
view this issue as their "holy grail" and that they do not believe Republicans
will settle for anything iess than state court enforcement of eligibility and
benefits.
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It is also clear 'that the Republicans will insist on si~ficantly altering the':
Federally-defmed benefit pack<lge,including dropping,the treatment
requirement. from the EPSDT benefit. Moreover, while we have confidentially
, disciIssed with the Democratic Governors the po~ibility of removing the
comparability and stateWideI.less requirements for some optional benefits, the
Republicans Want to drop thes4! protections for all benefits, ,including
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presCription drugs.'
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In response to the Democratic Governors and after reviewing the flexibility
recommendations by the NGA, we have incorpO-rated an unprecedented number
of provisions explicitly aimed at freeing' the' ,Governo~' hands iIi administering
Medicaid. As you will note frolll the, attached summary of your proposal, it is
. an, impressive list' by any me<lSure. ,In 'fact, you sho~ld know th?t your ,
proposal provides for' far mOle flexibility than does the "Blue J:?og" Coalition
proposal. (They haye not repealed Boren, they have not dropped the cost- .
'based reilnbursement requirements for community~ealth centers, etc.)
The Democratic Governors ~!Clmowledgethat we have, come a long way in their
direction on flexibility. They would like to negotiate some'.rnore provisions,
, particUlarly relatiDg to benefitS. flexibility. We believe there is some room to
move, but probably not as IJ,iuch,as they would deSire. Having said this, no
Medicaid reform package that preserves the Federally-enforcedeligipility
guarantee to a nationally-defined set of benefits ~ match a block grant in
terms of flexibility.
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The Corigress , '
The Co~gress is all over the plaa: when' it comes to MediCaid..
In general,
though, the vast majority of the Democrats, including such Members as
Stenholm' and' Exon"stand squardy behind your Medicaid approach and are'
unified in opposition to anything that appears ,to be a blOck grant. There are
exceptions to this getJeralization on the Democradc side and, in the case o.f
" Members like Chafee, there are exCeptions to. the generc¥ly unified support by ,
, Republicans for a block grant and very little Federal oversight.
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, Officially, the o.nly plan that does not have a'per ~pitajcap approach that
, preserves, a, Federally'~efined benefit pack3ge is the Republican package. The
Breaux/Chafee, the Q>alition, the Daschle and yourplap. all include some
.. version of 'your per capita cap proposal.
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Having said this,a number o.f conservative Democrats,; like Breaux, Condit and
Peterson, are much more interested i.iJ. a budget "deal" ~han in complicated
policy implications. That is why they constantly tell the Go.vernors how easily
,they can deliver COngressional !Democrats on a Medicaid deal if the Governors
can delivero.n a bipartisan compromise~ In an effort t~ push this along, these
Members ,have all indicated the:jr interest in the Republican plan' in the last 48
ho.urs. 'Governo.r Engler is using these statements to maccurately suggest that
there is widespread "Blu~:-Dog"Democraticsupport for their revised plan.,
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, Congressmen Sterihohii and most ,of his followers, as well as' Senator Chafee, '
appear to have no. interest in sigiting onto a "cloaked": block-grant approach. '
They, 'as well as Dingell and ~is'followers (DingeU voted for the coalition bill)
have strong' policy concerns about' the direction they ihink the' Republica~ are
headed. The Democratic base. ,anchored by Henry Waxman, are extremely'
nervous ab9ut the Republicans and our position. There is little doubt that vie •
arebeing'do.sely sciUtinized by themore'liberal Democrats (and,by the way,
the press) on thi~ issue.. '
The Advocacy and ,Provider Organizations
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The groups are quite, impress,xl by, and appreciative'o.f, yo.ur defenS¢ of the
Medicaid pro.gram. ,They definitely have problems wit~ our flexibilitypacl'age.
(For exaniple,the advocates illlhate o.ur'provision tQeliminate the wajver
process for man~ged care;' tb~ providers hate our provisio.n to repeal the Boren
Amendment.) Ho.wever, with the exception of perhkps a few hard core,
Medicaid protectio.nists, they probably will live witJioui position if we do not'
stray too far from our current position. If we mov~ too far in the diI:ection o.f '
, the ~epublicans; though, we may well be the target: of sOme hard-hitting
mticisms.
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We have, already received within'the iast 24 hourS a critique of the Republican'
Governors' proposal by the Childn:n's Defense, Fund. They accurately pointout
that the elimination of the, current'law'phase-in,of low ~come kids from 13
through 17 would result in "more than 3 million children" losing "gUaranteed
health coverage" in 2002 alone. A coalition of provider 'groups, including the
American Hospital Association arid the aCademic health penters', also sent a
letter to the Hill yesterday strongly opposing a block ~tapproach and the
elimin(ition of the Federal guarantee for Medicaid eligibfiity.
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Conclusion
Leon is' meeting with the Democratic Governors this afternoon to attempt to
, ensure they don't go in any directi()n you are not cOmfortable with. ' We
continue to update you on major developments with the Governors and the
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Members.
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Should there be a sudden and unexpected,bipartisan Governors' agreement, we
would recommend that you delayin providing a directJresponse for a short
period of time. A slight ,delay: would give you (and us) some time to get a
sense of what would be the policy/political implications of supporting such a '
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�CONCERNS/OUTSTANDING QUESTIONS'
ABOUT THE NGA'MEDICAID RESOLUTION
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Eligibility concerns include:' Thelrepeal of the cUrrent la~'s phase-in for coverage of
about ~ million children age 13-)$.,and the ievolutLQfl...QUb.e....:.djsabiJj!Y.,"_definition.t0 .
~estates.
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I'"\.Q.W'
lh,e.-.T \:'~,,~~
'~'eMSSI~1
J\f DC pop. .
Benefit concerns include: The total discretion given to states to alter"the
amount/duration/scope of services; the repeal of the current law's comparability and .'
statewideness requirement that ensure that recipients in particular' groups or locations
are not discriminated against; the apparent elimination of any defined benefit package
for currently optional populations; and the vague' redefinition of the treatment
requirements under the,Early, Periodic, Screening, Diagnosis and Treatment (EPSDT)
children's health benefit. .
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Enforcement copcerns include: The state-based right Of action 'process advocated
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by ,the Governors (a~d'whether it will 'York to effectively ensure the guarantee).
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Financing concerns include: .The exclusion of pregnant women and children, as well .
as the medically needy, from the Federally-financed "~mbrelb\" pool payments; the
inclusion in the base formula of the allow~nce that sta~es can reduce their matching
Medicaid rate -- .the result prooucing an additional $200 billion reduction 'in state .
Medicaid spending over seven ,years, bringing the total FederaVState cut to $290
billion; the allowance for state:) to, once again, tax healtli care providers to help
. fi~ance their state match; allowing for provider·taxes
likely push up the cost of
the program that CBO scores because it will be. easie,r 'for the State to access Federal
matChing funds.
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Quality concerns include: 1'!1e adequacy of the qu~lity protections for plans under
Medicaid,
s~ch
as HMOs and other managed care plan; the apparent repeal of the.
Federal-ba~ed enforcement of Federal nursing home standards. (The difference
between .them and us has alwaysconie down to definition and enforcement.)
Accountability concerns
in/~Iude:
�.February 6, 1996
The Honorable William J. 'Clinton
Presidentofthe United States
The White House
1600 Pennsylvania Avenue N.W.
Washington, D.C.20500,
Dear.Mr. President,
On behalf of the members ofthe Serv:lce Employees International Union, AFL-CIO,CLC
and the Americ.an Federation ofState, County and Municipal Employees; AFL-CIO, we are
writing to urge you to reject the Medicaid retorm proposal that has been adopted by the National
. Governors Association. It is clear to us that this proposal represents significant step backward
forthe 35 million Americans who depend on Medicaid for their health instmtnce coverage.
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The proposal would significantly restrict the. number of individllals who could be
guaranteed health insurance coverage. Mothers receiving AFDC bertefits would no longer be
guaraJ;lteed coverage unless they were pregmmt. States would be able to deVelop their own
definition of disability and deny coverage to those who did not meet the hew standard. Only the
.' elderly wh() met SSI income and resource standards would be covered, putting millions of '
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elderly beneficiaries at risk.
While the proposal outlines a benefits package of sorts, the categories are quite vague. It
does not appear that .there would be a floor as to amount, duration, and scope of coverage for
various benefits, as there is inthecurrent Medicaid program. An entitlement to coverage means
little if the benefits are ~o sparse as to provide little real protection. :
We are aiso concerned that this proposal would slash $ i 23biliion from' the Medicaiu
program over seven years. While an improvement over the conference agreement, these cuts are
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still far too large to be abs.orbed by the state:s without significant cutbacks in eligibility and
services, Safety-het providers, who provide the bulk ofcare to the :Medicaid population and the
uninsured, would be at risk of closing their doors, imperiling acces~ in urban and rural areas. We
. are particularly concern~? that the prop,osaJ makes no, mention of the importance bfmaintaining
Disproportionate Share Hospital payments to safety-net hospitals. :
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. Finally, we feel that it is extremely important that beneficiaries be able to enforce their
rights in federal court. Even the limited federal safeguards that do exist in the proposal could
prove meaningless in practice withouuhis basic right. ..
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We are not strongly opposed to thi:, proposal because we ~:elieve that the governors are
necessarily out to hurt Medicaid beneficiaries. But as unions that ~represent state e.mployees
�. across the United. States, we are. well aware ofthe fiscal pressures that :states are under.
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For these reasons, we'urge you to stand by your current propo~al which preserves a .
. federal guarantee of coverage, a federally defined benefit package, adequate federal and state·
providers,
financing, DSH payments to safety:.·net , . , and a' guaranteed federal right of action.
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,Very truly yours,
Richard W. Cordtz
International President
SEIU
International President
AFSCME
RWC:GWM:jpn
opeiu2
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�FEB-07-1996
19:05
FROM
94562878
TO
WHITE HOUSE AIDS ROLICY
P.02
, .,
;f
THE WHITt HOUSE:
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WASHINOTON
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i'ebruary "
MEKOnANDUM TO CAROL FAS(';O
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NGA Medicaid rroposal
I want to bring to your iuediate ;'Uention 't.he very stroner
conccrns boinq rai~~d by thQ Al~S community to the N.4l1on~1
Governors' ACGocia't.ion proposal to restruceure 1'lCctiCilid. I hAve
attached a copy ora lett:er sene to the President tuUClY by a .
coalition of na't.ional groups; pn-llf.s releases trom the AID:J Action
Council And Hum... n Rights campa1qri on th~1S subject, and ,m..t'.4?rial
provided by Tim Westmoreland o{ Georgetown university Law Center.
As you know, the President has displayed enormous political'
!,:
courage in standing against the tide for dbmantUntj' of Medicaid.
He hac .been particulal'ly t!!ffectlve in communicllt:in9 to the AIDS
cOJllll'lunit.y and. eo the nation as a whole tht:l critical importance of
.Medioaid to Al'nericam'l Hving wi't.h A1DS. For this, the Pl-esiutmt
and his Administra't.ion have 9arnered ~t:lry ~trontj' suppore from the
cOJlllllu:nity for his IId.lons.
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Patsy
SUSJF.CT:
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FROM:
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In that liqht, Lh@ proposal by tho NGA has many in tllt:l commun1.ty
quite alarmed. They have rais~d several key issues:
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)I.4i",•.J.l1' Beody. I3ecAuse of tlu;:lr high m91"1lcal coges, :many
people with AIO~ who are Medicaid boneficiaries are
classifiod. as "medically net!dy." tJnd~r the HGA plan, cuch
individuals c:ould be Cleniecl both mandatory and optianlll
benefit3, includin9 prescription drugs.
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Definition of Dls&bility. By dropping ~o ourrent fcderal
derlnltion of ~isability and allowing stot~~ to decide Who
ie disllbled, the NGA plan could create erel!l.endoue inequities
for. people wit:h lIlV and AIDS. Bec~llse of the high cost of
t:hoir care, people with MTV/AIDS ar,.e an unattraotive
population to cover.
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8~a~.wi4eae.a of DeDefits.
8y e11mina't.ing requiremcnt3 that
benefIt" :b9 provided stato'Wide 'With comparable Illl['at.lan and.
ccope, the NGA plan would alloW' states to arbitrarily limit
or Rliminate coverage of certain services -- i.@.,
prescription druys -- to certain cate90rioG of beneficiaries
-- i.Q., people with HIV/AIDS.
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FEB-07-1996 , 19 :~
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FROM
WH 1TE HOUSE,' FlI DS POll CY,
94562878
TO
P.03
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Right
hava
,
of private Action. A!'> you know, people with,HIV/AICS
I:).een and continue to be subject to Mxtraor<.'llnary l.eve1e
of di!;crimination. In fac.t~ AIDs,Srelated. discriminatiun ,i ~
the, lec.d.inq l"'f.:l.ason for biaG investigat-ions' by the HHS
"
'tnspect,or Ceneral. The tiGAplan repl.aces the federal
ght
of private iu.:tion '\l1th a Gtate-ba.sed system., .I:Iy the time '
aueh a c,onvoluted' SyStAl1l ,were completed, a person with ,AIDS
"'i
could very well be dcoCQsed..
•
,Cost-sharing. 'Aqain. because or the hlqh, ooc,t of $c.rvice,s
- eepociallydrugs,-- theimpo3ition of percent~~9 eost
shi'lrlng ,'can be, prohibitively @xpens:1Ve tor peoplew,ith
HIV/AIOS. CUl"n~nt rUles limiting s\.1ch cu::st-f'haring to ,
"nominal" amounts has prot.f:lcted these individuals fl.'oltl thi~
impact. The N~A plan,ho~cveri would 411010' ~or 1~r90r
cl!ar.g es •
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�FEE-07-1996. 19:06
WHITE HOUSE AIDS POLICY
FROM
----·"cij.
to
94562878
P.04
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AIDS 'ACtion Council
1875 Conneoticut Avenue. Nw'Suito 700
WlIihirigton, DC 20009
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.For iiif~r'r:riIition contEt:
,:1. Zuniga. aDZ) 986·1300, EX[, ~.
GO\lUtNORS' MEDICAID REFORM PLAN -UNACCEPTABT.E,'
DOiS NOT PROTECT IIEAT.TH CARE GUARA..Vl'EE FORPWAs
StalemeiJt of Chd~t.i.lle Lubinski
DePu.ry ExeCutive Dira:tor, AIDS AcrIoa CoUDCil
.' .., >
February 6, 1996
, "I
'President Clinton today cxpl'eMCd siJppotr in cornmeala dcli'iered bcfure the N"tional GOvemom
Assioc.l.itioll for i Medieai4n:form 1'181111131, siray' widely ,'com his l'q)ea.ted pro.lllisfls to prole~.t
lbe pa'ruitee to b.ic ~a1th care a.nd life-savlDg 4N;S thi:ltMc:d~4icl has ·come. to repre~.nt to .
al111W>1balt of all.Americans living with HIVIAIDS. While PNiiclent Clinton (Xpr:uti:dan
,interest ia seelnS Itle CongreUion:aJ lludjet 01Ti&:e's aruiiysiS oflhe plan presented 'by a bipartisan .
,rOup ,o( C'JOvemors. he, caUeci the plan 'a step in the j'ig!Jt di~Clloll.· AIDS Action. howc:.vcr,
finds tlla Governors' )¢I'diciici NStrl.l.CtUrillB plan, a pIBl)si1!J.ilar to tile GOP ~'Med.igiamft
prop!)Ml Veined by the President laSe Ial ~. i!a s1ep in the ,vrong direction. lbis ill
coaccived plan is unacceptable 1114 iaise&tivc' particular, COllCems ror peOple., livinS with
HIV/AlDS!
.
,,
,'.i:IigIbiWy. The Sraies are ,nmied complete aUthority to cieftrie disability forMedic:aid
eligibility putp05es: In the name of "state: 1'le;dblIlty," peopl.81iving with HIY and AIDS
eit/ler be deemed mcli1i~le for Ixiul!1ils or cOUld be tUgib!e tor completely
. ~Uld
.i:nadeClUaze benefits.
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AIm
for the seate.'
.,
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. • QW&Ji.ty•. StAtes WO~d. be a.tlawedto ~rce' Mediedd' ~nef1cu:nG8 mio,' rnanagcci care
plans w,!l'hoUt federnl overii.!?bt to ensure that qualily pm~ti;~Tlom are in place. With lower,
.paymemi aDd ltls o".l'!liSht, qwit)' of cans will btl: jeDpardb:@d.
-MOllK
...-'-'_.
,
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• A.1TordabDlty•. The prOposal elitnlnatts federal p~'inrill thAr.,ecst.Ile c:ost;.sharlng
, requirements are nor. Insunnou.ntable barriers to health clre.·Tt' !lures reqUmt co
payments 10 receive St!rviees, people with, HIV could. be foreed to chouSe between
physiciari.yiJjts ana p~ril)li4JlI drujs. at pal cOst totheirovt,;rall health.
... ,
,"'.""
,, '• .Berieftts.UDder the GOvernors' ptoposal. people Jiving with
who are c~ntly
, tcccivini bencllL'I undermedieall.y needy: provisions. could be deniliri acuess to bom
manda1OQ' (doI:;lUr's viRitS) M4 optional' (presoription clru,s) bCCllllflts. ' People with
ffiV IAlDS ,coulci be denied 0.' liwited access to btneiits titlor4cd other MediQlld
.beneflCi.aries purely bqcause they have a !l~ter need - UltNfore will incur greatcr costs
,
�FEB-12!7-1996
19: 1216
FROM
WH IrE HOUSE A I OS POll CY
TO
94562878 ' '
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fit.
111
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ii AcCOllDtabtllty. MIChsltwns nOw in place that allow eO~ume~arui.providen to hoic1
, " sta'tC~ accmmtable fot obeying tM laW, woul~ be c:lilUinated:Insrea4 of 5uea.ml.ining
Medicaid. enfprcemimt by fitly differem SUite coUrtS with 5(1 differentc,rlreria. ,"'ouId
oreAte a ~jU1alOI'Y qUlIgmile. Tht elimillll.tion of virtJJ.ally .all federal ~ardG
undeni:lirAthe fl.lndallwldal priII:1ple of MeI1icaid ~ an entitlement prosram.
"
A Uttle over cWo inoritba aBo" the AIDS community breathed I collective siab at retid' 2i
President ClImon Vt'lCleGI1 budget reconcili~ion bill thll' Inc:luded (Jevastating cuts and disruptive
stnlcturaJ changes to the Medi~id proeram. The 'AlDS community app!o.udc4 Insident
Clinion's VOW [hen In prmeet Mec1icaic: :md other vital f'ed.erJlL.A1DS progmns frOm thOBe who,
Wc:JUld. b4lance the federal budget on Qlt Dub of this ,nationt':i,nosr ~ulmrable citi2em:. Today.
iii .he appearS ready to take a step in Ille wrong cia;ction. :Wc urge Ihe Presldem tok.ef:1' a,
promiee he
inadc~lO
tIDs
rouillry's 1IlO$f
vulnerable '~i1izcful1)y
~jcct.iJ.@ "'I)'
plan thllt pUts at
. jeOpanly Elle emitlemcClJ aatus of thi~ viral he..alth CaN, piOgI'QRl. Contrary to wl1ltl PRSi4ent
, CliIl10n !D14 thil notion' s Govc~rs earl ier 1Od~ ,he pIaa !isw on the nc,oliatilli table does tJOt
guaram:ee b.ieh~alth oa.re to Ib;'" COJ.littry's lI.lOSt· vulnerable oit~n;. but instead ,il; a
pre.seriptlnn !tIr diS2Stet for which there can be nO/lJuidote.
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AIDS Aaion 'QQUlicU i.t the ()I'll]' ruztio'lIll (l~gtini:rPrjon devoted IDklly If)
'shtiping fetll':ml AmSpiJllry (11uJ 18gistlltion, multo tUivocarillg for itu:rem',.d AIDS jPllullng,
IJJDS Acti<m repllYelll..\ more than 1. 000 r:omM1iit'j-btti«i AlDSsemce ~rZ(llli1J1lioIfS throughnll.!
�FEB-07':"1996
19:06 FROM
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94562878
. WHITE HOUSe:·i=lIDS PoLICY
-' " ....,... v.., J
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Ftlbruary 1. 1998
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The President
''The White HOUle
Washington, DC 20500 .
Dear Mr. President:
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We 818. writing to express our extreme cQncem regarding the National GovernOrs
Asaocllrtlo" (NGA) Medicaid reform propoial. We are appalled at the implication from your
reeent commentS that you may support thi, plan.
" OWlr the past few montns, we haV8 wrttten to you on numerOus QI,;CIJSiDnS fegSrdh10 the .
. aed for .etro"9 federal commitment to protectirig the guarantee to tlighquanty health
m
care for fQW·lriccme Medicaid benefiOiaries-and we have frequently recognized your Strong
leadership 10 lSdvOCi1lng fortnle program. "he NGA plan would b9 devas.tatins to people
with AIDS and other Medicaid beneficiarfes. Th. govem0f'8', plan repeals Title XIX-the
backbOnG ot a meaningful gUlrantee to neaUhcoverage for eligible oenefioiaries--and it
does nOt meet any of the crlWia you.have eetabliahed for acr-.eplab!e Medicaid reform,
The NGA propo&alia nathin9 more thin a block grant. Which you have oppoAAd. d/'eS8@d
up In language maanttc provide assurances cllld guarantees that are, in feet. meaningless.
"yOu we", to auppO" ~18 plar", it would betray thecommib'MmbJ ~u have made to peoplo
witt'! AIDS at your ~mbEtr summIt a~d on sevei'al oth8r ocCasions.
.
We ,b8I1.W that tl10re are three critical questions you mu~t lu&k youreelf in assesstna any ,
refOrm plan:· ~.
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lM10 ja coveie,,?
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'The governors' plan
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f.na. the ~eMfiliiiary becauae It WOLild .al/oW .taUII& to define
. disability f'cr purposes of Medicaid eligibility. The NGA plan contains .assurances that the
· dismbled would'receive coverage. 8y Iltmovlng the aJClstlng federal dl'abifny definition.
· however, current disabled beneficIaries ire yulnerable,:to becomIng Ine1l911)1e. Indeed.
· before we h8d tns cUrrent flaeral dIsability definition there were 9rftAt inequIties in aC~.iI '
to Medicaid IImong the diSabled. It /. easy to ImaAinethat some states would ~k to
dellne dlaaCllity in a way that intentionall)l excludes SCfT18 or all paaple with HIV/AIOS.
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WhBt HMel1i 1m cOyerCd?
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The governors' ,Jan flila the beneficiary bEK.:suse it would "epeal current law provisiOns
related 11;1 atateWldeneG&, comparabilitY and amount. duration and scOpe, It ii not enough
simply to state Chat a spoc::ific b9rieflf will be provided. Beneflta end services mlJst be
prov/deG equally In an parts of Ii state, benP.f'ltsmust be provided equally to on cateGories
of bentftciarfee. and they mutt be s:lrovided in;amounts determlnl!!Cf by, a heal1tt cere
.provider to be effective a"d medleally r:'eeeeesry. Statc~ ohould not i;)e free toarbit.unily
·lImlt a<:eess to services. "
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�FEB-07-1996
19:07
FROM
WHITE HOUSE RIDS POLICY'
94562878
'TO
I
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I.
. t1bw'r8 jndi¥iduals oo.y¥ gfrecsMng th@ ;gyerage fpr Whleb they gUauta
The DOv.mors' plln fails the ban.flchu., beeause it takes away an individual's private
right of action. Thi&proVisionofthe law Ii absolutely ri~ce88al')' to enlure that individUQI~'
have recourse If a state clo" not I)roVido them with a service for which they qualify. A
guarantee to coverage or beneflla is relatively meaninglessunleis there Is., Ml!lan$ to
en~rCe it. Peoole with AIOS have ueeci,a private riyhl of action to 1Jght diecriminatlor'l and
tn gain Ul811ilmW acoast; to pr8iCription drugs and other services ats ulher MedICaid'
beneficiaries withrn their st.::.tes.· If these provlslone are lost, people with AIOS could find
that, on paper. they are guaranteed access to. Inedlcatlon or a S8NlCG, ~ut inreslity it is
. d9n;~ tathem. .
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It it aaeential that anyrefofm plan be abl. to provide satisfactory anlwGr1. to aUd these
Clueationa. Failina even oRe.lhen'the proposal should be rejected. Medicaid I)ayments
, ntprelent the federal government's largest form 01 financier sllpporllo lnu statas, totaling
nearly $100 billiOn per yelilr, We !'laliev" that you and the Congress awe it to the American
people to 'nsiatthat States are held accountable for the federal money they receive.
W•. urge you t6 stand firm, 88 younaVfJ ClQn,C to ci8te. i~ opposiOg the curtent NGA
MedIcaid proposal and any other plan tHat could threaten' heeM care for millions gf
wlnerable lOw-Income Americans. .
i:;'
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Sincerely.
'1
ArDS ActIon Council
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AIDS Policy Center for Children, Vo'lIth and Families
Cities AdvOcaiin; fOr E",ergency Ales RilUIf
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Gay McniiHealth Cr~1s
Housins Works
Humsn Riglit!; Campaign
.
National Association
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of People with AIDS
National Mlnortty AIDS Council
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ProJe"t, I"fOrm
Sa., FranciSco AIDS FoUndation
Taxas AIDS NetWOrk '
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�FEB-07-1996
WHITE HOUSE AIDS POLICY
19:07. FROM
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SEN'r BY;
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94562878
liRe
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4··~WS
HUMAN
RIGHTS
.CAIlPAJOIf
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P.08
~1896 D.I.A.P.
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WcdnCllday, Pob.7. I"'
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COVDNOIS'MED(CAJ1) PUN PtrTS PEOPLE WITH AIDS AT IUS~
·H
Hie c..u.-.Cihu.a ;.. llci:ain
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Cu_. a-:...a....
; .: .rBAIldaUd by IN. 111,. CI.lf"lnc i'edf!nd _da.r:da
shaiJlcl rCtlwn m~ac:e, SIQdt~lbuc Mid.· .
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objeca co
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to
tnewrr milt ..ollid
ir. -cli.Ulcl' itt
_ ..iDia, Medieald f'liJi'/)iliry. H~C c:alled 0.11
l'...ickftc amlDft '" ftic« m;, plan UDJ.. cba .
ptMiIiOll it ft'1IV'I'Iiid.
.,.
1.
dcIinc •
'"'l'bi. ~ • • IM 40Dr 10 61laS lEt ad\l4e
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.
HRC. dIC RI!Ib',Iatpa natioulletbiaD aa4 "..,
people '4IIho
i·
ha~
nprn~i\'c
or poIicil.3!ly
uD~ 6rab~ida, inGrludingAIDS IoIlci HIV. ~
III1d 'WIa!\'" !Ilach~lhrt;. HltC'r RUm t-ldl
pgliq ad.YiX:In:. -1& me Il&I1Ie ofpins 'Il..IJility
m du! 1!'Qcn.' ~~. ~rrlO'llS apprex W'l11i.t~ (0.
enc1.r.Dpt 1M.. '11$ C\IIl'c risk tAt posiItility of~O
4ll1'ereJtr dtSl'I iMAlI ortiimhility."
.' . '
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HRC eaUe6 GIl Oiatoft m riud 6n:a _PM '.hi' '
of
~mctJ' p~ ain. hu
spCbA poeldU!ly shOUt dw Mer.all £II:an but 2M
aid he "cecil _~ mil ptoplt·who ~
porQall
currel'ltly eligiMl!f'or Mcdlaid .a.lMtmCII wou(c! '
ItIlialA
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.
plaA .'WOIIJ,J iii", dlminllR
Ie p'ace.that itoM mnoc
-:-"11lablr r..,r plClVidlnaMcdiaid CClYCnic IS
T1u:
pa'1I.0a·
~_ ftO'IIIr
-.~--------
ARC a\!II'> ftftll dIf presidcl11: 10 CDlUf(: WI! "if
Modid ,.fo:1Il P:OIICl! cbc 1eYO of lMJWtls
.aYllll3.ble fur. pcopJc wah lilV or AIDS. "ad
Pt~ ch. ql.lalj~ or cste for Meciieaid
henddllllCs.
.
. Nculy hUf of .,,)J Airleric:iW lima; with AIPS IU\')
.~1'1cd 11,. MtdM;:a,id - )ududlnC mon: diM 90
perQCiI, ofc:l'lildten with the Alseu•.
The H\i~al1 lli/lltllJ Campaip is ~e Ju~
gay pnlltIaJ nrp.nb.adoll.
with. IIKJIlb,~ duQUGhoul she. ~DtJ1. 1t
effccijvely lobbits ('.o",,~ prmfdu CIllIIp:&igxl
euppglt !II1Q cd\IQta d!.;. puillio to CuIU. ~
. lesblllll :and SZ1 MefiQ1M ean he open. honea:
iIld SoIfie a.t ba,lIIC. <II .wOrlr atid in th~ l»!DmuAity.
. Iluio,w lesbilll and
.:~:
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FEB-07-1996
~19Sb
19:08
FROM '
WHITE HOUSE I=1IDS POLICY
94562878
TO
P. 09 '
P;OOl
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FederaI Lei:jslatloD Clinic'
'111 F Street, S~W.
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WashtDEtoD. DC 10001,
,
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Phune (l01) 662.'595 '
Fn(202) 662-9682 '
.
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UXCOYEB MEMORANDUM
DATE:
,,' NuMSEROf PAGEStlNCLUD1NG1~HIS SHEET:
TO:
FAX NUMBER:
FROM:
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COMMENT:
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�'FEE-07-19go ,,19: 08
FROM
94562878
TO
WHITE 'HOUSE AID!? POLICY
P.10
P.0Z!2
FEB4a7-1S 17:30
"
,Medialld MU$t Retain A Standard Definition ofDisabUity
'
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·-"Flexibility" to defjne'~disabiiity" for Medicaid is just "qUibtlity" to eliminate the Medieaid
safety net Cur people witb disabWties who are currently eligible. There is no other reason for
such flexibility.
'
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'-Under eurr:ent law, iri order to quality for Medicaid a ~erson with a disability must meet ~
critma:
The perSOn must be poor. ADd.
The person must meet the SSDfiSSJ definition of total disability.
_·the'SSDIISSI standard is bSsi~aUy an inabilitY to work (i.e.• 8 ~on is unable to maintain
substantial gainful activity). but it
developed signitlcant precedents and. refinements.
has
'fhcSSI standard has &eea developed aDd fine-tuned through regulation and precedent
over'the years to addreSs eomplex disability ca., ~uci1 as '
'
~onditjons that are. sometimes disabling
A
and sometimes not (so-called
"intermittent disabllitiesj that may make a. person unemployable but not
rie(;essarily permanently disabled (e.lf-, mu.ltiple sclerosis; epilepsy. asthma);
, ...:disev.ses that ate progressive (e.g. Parkinson's diseaSe, HIV/AlDS);
-disorders ~·ith non-apparent ,symptoms, or effeCts (e.g.• severe f-atigue associated
with lupus or with Lymedisease)j
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•..il1nt!sses without standard mediCal profile's or that do not stlow upon Jab tests
. (e.s., high...functioning develop!nental disabilities other m.e~tal and emotional
disablltties);· or
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-diseases that have cliffeteat nianifestations,Jn different groups (c.g., cervical
~ancer in women with iDim.u.n.e deficiencies). i' .
--Without such a well-defined arid uniform Federal standard, people with disabilities will be cut
ontfrom tbe Medi~l1id program aDd~ iQ most Qt.!!es, fromhealtb care altoJether.
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States.wiU have in"nttVes to Urbit or eliminate coverage for those people with
dinblUttes who require mOre compl,ex medical care.
-(Note: ,While some' have ...gued 1bat peop~e Iliay fake disabmti~s to claim eligibility for
.Federal cash assistanoe, it wo'Uld be inationaI.for peOple to fake disabilities so'eJy to have those
disabilitiM treated. Even assumins the fraud t..'lkes placo in the pasb programs, cash poSes
incentives tharmtd.ical care does not.)
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�FEE-07-1996
19:09 .FROM
FEB-e?-lsr31S
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94562878
TO
WH ITE HOUSE AIDS POll CY
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1=1.003
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PeOple· with intermittent, progressive, .or other ,omph~x disabilities will have no
reliable p~cdent on which to rely and will be forced to re-defiite aDd re-litigate
'their disability for ¥edicai.d; .
states will seek ine.ic:pensive health)'people,to count tOwalu their f~dinls formulae'
and'neglect to find rhdse,With chronic and wstly needs. .
"
WithOut uniform stai:ldards, people with .disabilities will be foreed to m~ve to find State·
.
Medlcaid prolnlD'U that meet their needs.
If some states provide eliaibiiity and ben~fitsand neighboring States dono!,. people
have to move to get neeessaiy health ~.
'
.For eXample. in the early days of the AIDS epidemic, many people ,moved
, . to California to get, access to health care denied them elsewhere.
~iU
This, in turn, will create a "nee to the' bt.ttom~'inwhich no Siate will want to
provide benefits that might attr~ more poor, disabJ~ people their program.
to
This ~6mpetiti~nto provide tbelca.\1wHl
uUim~tel)' JiJidi b~ndiu to people with
, aiiabilities na'ionwide.'
.
WithOut uniform standards, people with disabilities In statesprovidillC care wiD
, "perienee "Medlcaid·loek." similar the job--lock ofemployc,d ,people with insunm<:e.
to
If a person with disabilities is eligible for health care in one Slate and not in
another. theiJersonwiIl not be'~ble t'O move to be with his or het famny~ to seek
appropriate suppOrt Se~'i~ or to retire.
Without uniform standards, people \l,ith disabiJjtie~ ~d their famiJieswill be caught in ,
confwlng bureaueratic delays.
,
,., "
.
..,
'
, The Social Seeurity Act will continue to' have a definition of disability for purposes
, of its Social Security Diubilf~ Insurance and;~upplcinentaISec:urity Income
programs. ,
.
.
In addition, each State
Medicaid.
,
. . . .
,.
will have a'. . , definition ofdisability for p\ipOses of
different
,
People' With ciisabUities and their families will be forced 1.0 u.ndergo duplicative
',. State and Federal tests. processes, arid paperwork--often aHimes wheD they most
. . need immediate belp.
.
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TO
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.... WithOlrtco~eragc under Medicaid, poor pCQpJe witbdis~bilities wnI b" shut out of the health
care 'ayatem altoMether.
8irice Medicaid is currently. by defmition. limited'to people whom poor and who ~ot '
work. if a State finds a person to be ineligible for the new program, that person will have
,no empJoymcnt-relatedinsurariceand no pefsorWl incorne or assets to u~e for health c:are.
'I,'·,
These Ire the pcople wleb'Do place etscto·go•
....The elimination of a Federal definition of "disability" eliminates the gu'arantee
'oChealth care to poor people with disabilities.
'1
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MEDICAID FLEXffiILITY PROPOSAL
Our Medicaid plan: maintains the guarantee of Medicaid coverage for eligible poor women and
children, people with disabilities, and the elderly. while offering states increased flexibility in
meeting the health care needs of these populations. The plan protects states by providing
adequate funding that responds to unexpected increases in need due to recessions or demographic
chattges such as growth in the number of aged or disabled beneficiaries. In addition, the plan
gives states new flexibility by repealing the Boren Amendment and other provider payment laws,
eliminating the waiver process for managed c.are demonstration projects, enabling states to
simplify and expand their health insurance programs without waivers, and removing many
unnecessary and duplicative administrative requirements.
Maintaining the Federal Financial Partnership
Our proposal continues the shared federal/state partnership and controls growth in federal
Medicaid spending without putting states at risk. Under the plan's per capita cap, federal
spending will increase modestly over time, with Jirnits set on a per beneficiary basis, while
federal Medicaid payments will continue to"automatically adjust to a state's enrollment increases.
In this way, the plan limits federal Medicaid spending while maintaining the federal commitment
to protect states in the case of economic downturn, demographic changes, and other
circumstances beyond states' control. The plan also reduces Disproportionate Share Hospital
(DSH) payments while increasing state control by phasing in a new, more targeted payment
program. along with new payment pools to meet special needs. Our plan provides $25 billion
more in federal Medicaid funding to states over seven years, compared to the Republican plan.
While we save $59 billion under Medicaid, the Republicans cut $85 billion in Medicaid funding
to states.
Increasing State Flexibility
The Clinton Administration has already given 12 states the flexibility to develop comprehensive
health care reform demonstration projects through the Medicaid program. Over 657,000
individuals otherwise not covered under Medicaid have been enrolled in the program through
these state demonstrations. By comparison, there were no statewide health care reform projects
approved between the years 1988 and 1992.
Our Medicaid plan builds on the Administration's proven commitment to state flexibility. It
offers states new options in the areas of provider payments, managed care, eligibility and
benefits, and program administration, while giving states continued opportunities to reduce costs
and increase health care coverage.
o
Flexibility to establish provider payment rates. By repealing the Boren amendment,
the plan gives states greater discretion in establishing their provider payment rates. It
also eliminates the requirement that states pay federally-qualified health centers and rural
health centers on a cost basis. In addition, states will be able to set their own payment
standards for obstetricians and pediatricians.
CLINTON LlBP~RY PHOTOCOPY
�•
o
Flexibility to use managed care~ The plan enables states to implement managed care .
programs without the need for. federal waivers. The plan also repeals burdensome
managed care rules, including federal contract approvals, and the requirement that 25 .
percent of all enrollees in a plan be private patients. In addition, states can require HMO
enrollees to pay nominal copayments.
o
. Flexibility in eligibility and benefits. The plan maintains the Medicaid entitlement and
keeps basic Medicaid benefits intact, while giving states· new. options for eligibility
simplification and expansion. States will also be able to provide home and community
based services to the elderly and disabled without having to seek federal waivers.
o
Flexibility in administration: The plan repeals a· number of federal admirilstrative
requirements, including special. minimum qualifications for pediatricians and
obstetricians, federally-mandated administrative requirements for state· personnel
standards and' cooperative agreements with other state programs,. and duplicative
requirements for annual resident review in nursing homes.
�
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NGA/Medicaid [1]
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6f947b9452feffa9a2c4c6a77347eaf6
PDF Text
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REWARDING WORK: TIlE CASE FOR INCREASING
k
TH€IN;~
The President's proposal would increase the minimum wage from $4.25 to $5.15
over two years, through two 45 cent increases. The last increase, passed by an
overwhelming, bipartisan vote in 1989, and implemented in 1990 and 1991, was
also a 90 cent increase in two 45 cent 'stages. For; a full-time, year-round
worker at the minimum wage, a 90 cent increase would raise yearly income by
$1,800 -- as much as the average family spends on groceries in over 7 months.
MAINTAINING THE HISTORIC VALUE OF WORK: If the minimum 'wage were to stay at
its current level ($4.25), it would fall to its lowest real level in forty years. Indeed, the value of
the minimum wage is now 27% lower than it was in 1979, and has fallen 45 cents in real value
since its last increase in April of 1991. The first half ofthe President:s 90' cent proposal simply
restores the minimum wage to its value from the last increase.
I
I
,RAISING THE MINIMUM WAGE PRIMARILY HELPS ADULT WORKERS -- MOST
OF WHOM RELY ON THEIR MINIMUM WAGE .'JOBS ~TO SUPPORT THEIR
HOUSEHOLDS: Nearly two-thirds of minimum wage workers are adults (63%); over one third
of all minimum wage workers (36%) are the sole breadwinners in 'their families; the average
minimum wage worker brought home over half of his or her family's earnings. 'Thus, a rise in the
minimum wage is a significant boost to the standard of living to millions of households.
,
REWARDS WORK OVER WELFARE: The minimum wage increase provides another crucial
measure to reward work and ensure that there isa strong incentive to choose work over welf¥e.
' .
.
BETWEEN 11 MILLION AND 14 MILLION WORKERS WOULD BENEFIT FROM THE
PRESIDENT'S PROPOSAL TO INCREASE T~E MINIMUM: WAGE: An estimated 11
million workers, paid by the hour, earn between $4.25 and $5:14. ; Research indicates that\an
increase in the mi'nimum wage to $5.15 could have a "ripple" effect ori another 3.5 million workers
who earil within 50 cents of the new minimum wage.
' .
EMPIRICAL EVIDENCE SHOWS THE PRESIDENT'S' PROPOSAL CAN INCREASE
WAGES WITHOUT COSTING JOBS: Over a dozen empirical stuqies have found that moderate
increases in the minimum wage do not have a significant impact on employment. These studies
':", 'ip.clude state-specific research that shows that high~r state increases in the minimum wage did not
r~sult in significant job impacts. As Nobel Laureate Robert Solow s~ated: "[T]he evidence of job
loss is weak. And the fact that the evidence is weak. suggests that tre impact on jobs is small."
A 90 CENT INCREASE IN THE MINIMUM WAGE WILL LIFT A FAMILY OF FOUR
OUT OF POVERTY: !The dramatic extension of the Earned Income Tax Credit helped lift
hundreds of thousands of working families out of poverty. Yet, by 1996, even the EITC is not
enough to lift above the poverty line a family of four. makillg the :qtinimum wage. With the 90
. cent minimum wage increase, food. stamps, and the EITC, a family of four with a year-round
minimum wage worker would be .lifted above the poverty line.
THE LAST MINIMUM WAGE -- ALSO 90 CENTS
GARNERED STRONG
BIPARTISAN SUPPORT. In 1989, the minimum wage was passed by votes of 382 to 37 (135
Republicans) in the House, and 89' to 8 in the Senate (36 Republicans) and was supported by.
Senator Dole and Rep. Gingrich.
.
(
.
�
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Title
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Carol Rasco - Issues Series
Creator
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Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
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Clinton Presidential Records: White House Staff and Office Files
Publisher
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Clinton Presidential Library & Museum
Extent
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92 folders in 7 boxes
Text
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Original Format
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Minimum Wage
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Domestic Policy Council
Carol Rasco
Issues Series
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2010-0198-S Segment 2
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Box 125
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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Adobe Acrobat Document
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2010-0198-Sb-minimum-wage
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https://clinton.presidentiallibraries.us/files/original/9371b6644f566e67e1c9697e691f90a9.pdf
9fcf1c65509aa1c683d05bddb7bdb5ad
PDF Text
Text
MEMORANDUM
To:
Carol Rasco and Bob Rubin
From: Chris Jennings
Date: November 18, 1994
Re:
Background ERISA Materials for Map Group Meeting 11/21
Attached are the background briefing materials on ERISA, developed by Labor, HHS,
Treasury, OMB, DPC, and NEC. You may find this information useful for· the Map Group
meeting on Monday. A general outline of the options, without discussion of the issues and
concerns, will be included in the handout at the Monday meeting.
I
I
If you have any questions prior to the meeting, please do not hesitate to call me.
�f
I
I
I
r"
ERISA PREEMPTION
ERISA OVERVIEW
•
ERISA applies to all private employment related group health plans, of which
there are currently more than 3 million covering over 120 million Americans.
ERISA does IlQ1 apply to church plans, governmental plans and most worker's
compensation plans.
•
ERISA contains extensive rules for pension plans but few substantive
requirements for health plans. Remedies generally provide for only the benefit
denied.
•
ERISA has no eligibility or funding rules for health plans. The discrimination
rules for health plans are not as comprehensive as the rules for pension plans.
•
The limited reporting and disclosure rules do not provide for timely notice of
pertinent plan changes. Currently ERISA only requires that enrollees be
notified of material changes within 210 days of the end of the plan year.
BACKGROUND ON PREEMPTION: WHAT PURPOSE HAS IT SERVED?
•
ERISA allows states to regulate health insurance carriers and the group health
policies they sell to employers but prevents states from regulating self-insured
employee benefit plans.
\
"
•
When ERISA was enacted in 1974, states regulated a far larger share of their
health insurance market because more employers bought health insurance from
state licensed insurers and it was primarily only the largest companies that
were self-insured.
•
'ERISA preemption was intended to aid large multi-state business and labor
organizations by protecting them from being subject to as many as 50 different
state regulatory schemes.
•
The roadblock to health care reform at the state level lies with single-state
small and medium size employers who self-insure and use ERISA preemption
to avoid state mandates and other state requirements. According to a 1991
HIAA survey on self~insurance it is estimated that 76% of all firms that self
insure have less than 500 employees and 67% have less than 100 employees.
These are not the type of large multi-state plans ERISA preemption was
intended to protect from state regulation.
�I
RECENT PREEMPTIOt'WAlVER DEVELOPMENTS
•
•
•
This year Washington, New I¥ork, Oregon, Maryland and Minnesota sought
legislation to exempt their individual states from ERISA preemption. Hawaii
has sought to have its waivdr expanded.
At the end of the last legiSILiVe session several proposals contained ERISA
I
waivers for a number of individual states along with an administrative process
through which DOL could ~rant additional state waivers.
The Administration has pahicipated, through an amicus brief, in the naveler's
Insurance Co. case which /was granted certiorari by the U.S. Supreme Court on
October 7, 1994. This case involves the application of three separate
surcharges added to hospiibl rates by the New York State legislature. The
Second Circuit Court of ~ppeals held all three surcharges were preempted.
The Administration'S position in its brief is that the surCharges are not
1
preempted <l:s applied to insurance carriers and the policies they sell to
employers. Preemption ~s applied to self-insured plans is not explicitly at
issue in this case, althou!gh the Court may nevertheless express its view on the
.
subject. This case may Inot be heard by the Court until June 1995.
.
I
.
2
.
. ,,
�DRAF(:I~
ERISA ISSUES FOR INSiURANCE MARKET REFORM
I
I
.
.. REQUIRE MULTIPLE EMPLOYER ;WELFARE ARRANGEMENTS (MEWAs) [i.e.,
ASSOCIATION PIANS] TO FILE COPIES OF THEIR STATE LICENSES WITH
THJ;;FEDERAL GOVERNMENT.
I
What Are MEWAs?
•
•
. A multiple employer welfaL arrangement (MEWA) is defined by ERISA as an
, '
•
arrangement offering healtH benefits to employees of two or more employers.
Small employers, who oftJn find it difficult to secure affordable health
. insurance for their employ~es, find MEW As attractive because the premiums
, y mexpensIve.
J,
are comparatIvel '
.
A 1983 amendment to EJISA allows states to regulate the financial solvency
I
of MEW As while at the s'anie time permitting DOL to have oversight with
respect to fiduciary standt'ds.
Why There Are Problems With ME'('As
•
•
I
These arrangements can i1ack financial stability since they often do not have a
stable funding source, maintain inadequate reserves and charge actuarially
unsound contribution le~els. However, the insurance market has not served
s~all businesses well, aJnd, in many places, self-funded MEWAs (sponsored by
stable trade associationJ) are an important alternative source of coverage.
~
.
.
Sorne 0 f th i expenence rapl'd growt h an d"It IS m th'IS expanSIon
ese arrangements .
phase that they begin
resemble a ponzi scheme with more premiums coming
in but benefits not bei~g paid out.
tb
.
•
•
I
Such MEW As do not bomply with state law and when caught challenge the
state's authority in fed~ral court, using ERISA preemption as a defense. This
period of non-compliJnce and then time consuming litigation is sufficient for
the MEWA to enroll thousands of participants, collect large amounts of
premiums and then abandon the operation.
Minimum federal
current abuses.
rep~rting requirements would fill time gap and prevent the
I
I
.
�"
Example of Problems Involving MEWAs
•
•
•
I
I
I
According to a 1992 GAO Riport MEWAs were operating in 46 states. The
report estimated that from 1~88 to 1991, unpaid claims by MEWAs totalled
over $123 million and affected almost 400,000 enrollees.
In addition to being left witJ unpaid bills and no health coverage when a
MEWA goes out of busines~, enrollees may be precluded from purchasing
coverage elsewhere if they tlave any pre-existing conditions.
J
The Department of Labor currently investigating 70 MEW A civil cases and
36 criminal cases. Since tHe Department began its nationwide criminal MEW A
effort in the late 1980s, it has obtained 77 criminal indictments and 70
convictions.
I
I
The Solution
•
•
•
This initiative would require that MEWAs provide copies of their state licenses
!o federal authorities priori to beginning operation. This information would then
be shared with the states to help them ensure compliance with their laws.
lllOW
New federal authority to
the federal government to cease the operations
of a.:MEWA that did not !file the required license would enable federal
authofities to prevent abuses before the MEW A's operations became
widesr,read.
I
This is the least intrusive federal solution. Essentially, it allows regulators to
enforce current law by ~roviding a mechanism to notify them that a MEW A
exists while there is stilF time to prevent the damage an insolvent MEW A could
cause. (.c~rrently, the ~uthorities are often unaware of a MEWA's operation
until they begin to recei!ve complaints from employees covered by the
MEW A.) The new requhement will enable authorities to identify arrangements
that are not licensed ana act quickly to force them to comply or cease
operations.
•
•
I.
..
Legitimate association plans may complain that they cannot meet state
requirements. This, h6wever, is already required under the current law and has
been for 10 years. Udder the suggested solution states and associations would
continue to be free as ithey are now to work out any special arrangements to
accomodate certain associations that may be less financially risky.
Existing MEWAs thJ are complying with state solvency requirements would
I
not be significantly areeted by :is new requirement.
�.. REQUIRE ALL INSURERS (INCLUDING SELF-INSURERS) TO ADHERE TO
I
ENHANCED UNIFORM BENEFIT CLAIMS PROCEDURES AND REMEDIES
j
I
Current Problem Involving Remedies
•
The only remedy for enrollees in ERISA plans (whether self-insured or fully
insured) whose benefit clain1s are denied in bad faith is recovery of the initial
cost of the benefit denied.
I
•
•
I
Thus, unlike other legal relationships, no other additional recovery is allowed
even where the bad faith ddnial resulted in further medical harm, economic loss
or even death.
I
l
Under current law, insurers, including managed care organizations and self
insurers, may have a finantial incentive to deny claims because even if they
lose in court they will be l:iable only for the original benefit and possibly some
costs, even if the denial was in bad faith and resulted in further medical harm.
I
Current Problem Involving Benefit cLms Procedures
I
•
.
timefra~es
ERISA's existing
and standards for benefit claims review are not
timely for health care berlefits and give deference to any decisions made by the
plans. For example, enrdllees need only be notified of material modifications
to the plan within 210 ddys after the end of the plan year.
Possible Options
•
Expand remedies availali)le to participants for "bad faith" claim denial:
Permit recovery for bconomic losses (e.g., lost wages);
-- Permit recovery for !non-economic damages (e.g., pain and suffering);
•
•
.Alternative dispute resdlution procedures could be offered or required.
I
Provide for federal civil penalties for cases of bad faith denials.
Make state law remedils available to ERISA plan participants.
I
I
-- Could be applied to insured plans regulated by states or to all ERISA plans.
I
I
I
.
3
�•
Apply new federal requirements and/or remedies to all ERISA plans (insured
and self-funded) ..
4
�DRAFT
STATE FLEXIBILITY / ERISA
November -- , 1994
OUTLINE OF POSSIBLE OPTIONS
The three possible options for dealing with the issue of increasing state flexibility to regulate
employment-based health insurance, in order of increasing flexibility, are:
OPTION 1: To continue the present structure of having federal and state regulation of
health insurance bought from insurance companies and only federal regulation of self
insured employment-based health plans.
POSSIBLE INITIATIVES
... RETAIN CURRENT ERISA PREEMPTION: STATUS QUO
In this scenario states would continue to regulate health insurance companies but self
funded plans would remain subject only to ERISA's limited requirements. In this
system states are limited in achieving reform as employers hav~ the option of choosing
to self-insure, thus escaping state regulation entirely.
OPTION 2: To apply minimum fe.deral insurance reforms to all health plans with.
options for additional state regulation. .
POSSIBLE INITIATIYES
A. APPLY HEALTH INSURANCE REFORMS THROUGH FEDERAL
REQUIREMENTS FOR ALL HEALTH INSURANCE PLANS, INCLUDING
SELF-INSURED PLANS
State laws in these areas would continue to be preempted but new federal insurance
reform could help to expand coverage and.reduce costs thus solving some of the
problems states currently suffer. This initiative, however, does not solve the problem
of an increasing number of employers self-insuring to escape state mandates nor will
. it satisfy every state's individual needs for consumer protection (e.g., additional ERISA
reforms including expanded remedies, timely and uniform claims procedures and
expedited review for urgent requests).
�B. MINIMUM FEDERAL HEALTH INSURANCE REFORM APPLIES TO ALL
HEALTH PLANS, INCLUDING SELF-INSURED PLANS. STATES WOULD
ALSO BE ALLOWED TO IMPOSE ADDmONAL REGULATIONS ON PLANS
BELOW A CERTAIN THRESHOLD NUMBER OF EMPLOYEES (i.e., 5000,
1000, 500, etc.)
This initiative essentially resolves the issue whether only federal rules apply according
to the criteria of plan size; currently the determining factor is whether the plan is
fully-insured or self-insured.
C. ADOPT THE FEDERAL INSURANCE REFORMS BUT REQUIRE STATES
TO REQUEST WAIVERS TO IMPOSE FURTHER REQUIREMENTS ON
PLANS BELOW THE THRESHOLD NUMBER
Under this initiative states would only be able to regulate small employers by
requesting an administrative waiver from the federal government. This initiative may
accomplish more uniformity among state programs by requiring states to meet certain
criteria before a waiver is granted.
OPTION 3: To allow states to implement their own health care reforms by promoting
express legislative waivers of ERISA preemption.
Many of the initiatives discussed below would permit states to institute laws
concerning the financing of health care. It is important to remember that in any such
ERISA waiver approach, the waiver could ~e structured in a way that would make it
more acceptable to the affected parties. For example, the permissible financing,
options could be limited to specific mechanisms -- e.g., provider taxes but not
mandates. Alternatively, certain sized firms could be exempted altogether from state
financing regulations as long as the firms provided a suitable benefit package for their
employees.
POSSIBLE INITIATIVES
A. RETAIN CURRENT ERISA PREEMPTION WITH A LIMITED
EXCEPTION FOR STATE LAWS ON COST CONTAINMENT
This initiative is limited and thus would cause less disruption of the current market. It
will, however, also be less effective in expanding coverage and other reforms.
Financing will be improved only to the extent that cost savings are used to extend
coverage.
2
�B. RETAIN CURRENT ERISA PREEMPTION WITH AN EXCEPTION FOR
CERTAIN STATE FINANCIAL LAWS RELATING TO FINANCING AND
COST CONTAINMENT
Under this initiative state laws financing health care and promoting cost containment
would apply to plans whether self-insured or fully-insured. This would allow states
to do financial regulation to contain costs, expand coverage, raise revenue or achieve
other health care reform goals. This initiative alone does not advance insurance
reform or administration issues.
c. RETAIN CURRENT ERISA PREEMPTION BUT GRANT A LIMITED
NUMBER OF INDIVIDUAL STATE WAIVERS THROUGH A LEGISLATIVE
OR ADMINISTRATIVE PROCESS
Under this initiative specific statutory criteria would need to be established against
which the states seeking waivers would be measured. Granting individual state
waivers could be done on a limited basis, such as for a certain number of states for a
period of 5 years. The waivers could be granted as part of a research or
demonstration project and an executive branch interagency commission could be
established to grant the waivers.
D. RETAIN CURRENT ERISA PREEMPTION WITH A LIMITED
LEGISLATIVE EXCEPTION FOR STATES THAT ENACT LAWS WITH
BROAD COVERAGE EXPANSION
This initiative would allow states to enact more comprehensive reforms (e.g., "payor
play" taxes, single-payer systems, etc.). This initiative essentially exempts from
ERISA preemption state laws that are part of a comprehensive reform system that
would not be exempt under the more limited exceptions for cost containment and
financing listed in initiatives 3(A) and 3(B).
3
�DRAFT
STATE FLEXIBILITY / ERISA
November -- , 1994
The three possible options for dealing with the issue of increasing state flexibility to regulate
employment-based health insurance, in order of increasing flexibility, are:
1. Status Quo: To continue the present structure of both federal and state regulation of
health insurance bought from iIisurance companies and only federal regulation of self-insured
employment-based health plans.
2. Insurance Reform: To apply minimum federal insurance reforms to all health plans
with options for 'additional state regulation.
3. State Waivers: To allow states to implement their own health care reforms by
promoting express legislative waivers of ERISA preemption.
Note: This paper outlines several initiatives involving state flexibility on health care issues
and ERISA preemption of state law. It is important to recognize that more than one initiative
may be chosen as several of these efforts could work well together. This paper does not deal
with Medicaid waivers or other federal laws where state flexibility might-also be increased.
For the past several years the National Governors' Association (NGA) has adopted a policy
promoting ERISA reform in order to allow states to implement their own health reforms to
improve access to quality and affordable care. The NGA has stated that they are aware of the
concerns of large multi-state employers and that they are looking for solutions that balance
the needs of the states and the business community.
The NGA has identified the following four major considerations where state flexibility is
important to them: Coverage Expansion/Financing, Cost Containment, Insurance Reform and
Administration. Provided below is a general discussion of these four considerations as
presented in a recent NGA report and how state laws could address them under each of the
three options:
Coverage Expansion/Financing
States could attempt to expand coverage through employer mandates and taxes on
employers (including payroll taxes), plan contributions and/or health care providers.
�Cost Containment
States could set provider rates (either uniform or varying) and require all health plans
to participate in overall spending limits.
Insurance Reform
States could limit pre-existing condition exclusions, impose other market reforms and
create reinsurance pools for high risk cases. States could also be allowed to require self
funded plans to comply with open enrollment and community ratings, risk adjustment
mechanisms and assessments.
Administration
States could require self-funded plans, in the same manner as insured plans, to:
• Report services utilized, cost and quality information
• Use uniform claims procedures
• Participate in purchasing pools
• Meet quality review organization standards for fair review
RECENT DEVELOPMENTS:
•
This year, Washington, New York, Oregon, Maryland and Minnesota sought
legislation to exempt their individual states from ERISA preemption. Hawaii
has sought to have its waiver expanded. As many as 26 other states may also
be considering requesting exemptions from ERISA preemption.
•
The Administration has participated, through an amicus brief, in the Traveler's
Insurance Co. case which was granted certiorari by the U.S. Supreme Court on
October 7, 1994. This case involves the application of three separate
surcharges added by the New York State legislature on hospital rates. The
Second Circuit Court of Appeals held all three surcharges were preempted.
The Administration's position in its brief is that the surcharges are not
preempted as applied to insurance carriers and the policies they sell to
employers. Preemption as applied to self-insured plans is not explicitly at
issue in this case, although the Court may nevertheless express its view on the
subject. This case may not be heard by the Court until June 1995.
2
�OPTION 1: To continue the present structure of having federal and state regulation of
health insurance bought from insurance companies and. only federal regulation of self
insured employment-based health plans.
PQSSIBLE INITIATIVES
A. RETAIN CURRENT ERISA PREEMPTION: STATUS QUO
In this scenario states would continue to regulate health insurance companies but self
funded plans would remain subject only to ERISA's limited requirements. In this
system states are limited in achieving reform as employers have the option of choosing
to self-insure, thus escaping state regulation entirely.
Considerations:
Coverage Expansion/Financing
Under this initiative states would continue to be generally barred from imposing taxes,
mandates, premium assessments, etc. on any ERISA plan whether self-insured or
fully-insured.
Cost Containment
It is unclear whether states can presently set provider rates. States are prohibited from
setting global budgets for. self-funded pl~ns.
Insurance Reform
States insurance reform measures would continue to have limited effect as they would
only apply to insurance companies and employers who purchase insurance but would
not apply to self-insured health plans.
Administration
States would be able to continue to require insurance carriers to report data, etc. but
they could put no requirements on self-insured plans.
3
�OPTION 2: To apply minimum federal insurance reforms to all health plans with
options for additional state regulation.
POSSIBLE INITIATIVES
A. APPLY HEALTH INSURANCE REFORMS THROUGH FEDERAL
REQUIREMENTS FOR ALL HEALTH INSURANCE PLANS, INCLUDING
SELF-INSURED PLANS
Examples of possible reforms:
• Prohibit pre-existing condition exclusions
• Require guaranteed issue and renewal of insurance
• Prohibit disease specific caps
Considerations:
Coverage Expansion/Financing, Cost Containment
State laws in these areas would continue to be preempted but new federal insurance
reform could help to expand coverage and reduce costs thus solving some of the
problems states currently suffer.
Insurance Reform
In this initiative federal reforms would help with some basic rules and states would be
free to add requirements on insurance companies. This initiative does not solve the
problem of an' increasing number of employers self-insuring to escape additional state
mandates.
Administration .
Federal insurance reforms may solve some of the problems in this category but it may
not satisfy every state's individual needs for consumer protection (e.g., additional
ERISA reforms including expanded remedies, timely and uniform claims procedures
and expedited review for urgent requests).
4
�B. MINIMUM FEDERAL HEALTH INSURANCE REFORM APPLIES TO ALL
HEALTH PLANS, INCLUDING SELF-INSURED PLANS. STATES WOULD
ALSO BE ALLOWED TO IMPOSE ADDITIONAL REGULATIONS ON PLANS
BELOW A CERTAIN THRESHOLD NUMBER OF EMPLOYEES (i.e., 5000,
1000, 500, etc.)
This initiative essentially resolves the issue whether only federal rules apply according
to the criteria of plan size; currently the determining factor is whether the plan is
fully-insured or self-insured.
Considerations:
•
This option would allow the states to move ahead with reform efforts and also
protect national uniformity of plan administration for medium and larger
business and labor organizations. The higher the threshold cutoff, the greater
amount of state flexibility results.
•
This structure has an arguable policy basis as it seeks to balance the goal of
national uniformity of structure for those larger plans that need it most and
increases state flexibility by expanding state regulation over smaller plans.
Coverage Expansion/Financing, Cost Containment
Would allow states to extend requirements to small employers (e.g., an employer
mandate, a "payor play" tax, etc.) that would increase the number of enrollees
covered through their employers or give the states a larger base for obtaining revenue
to operate their own programs to provide coverage. The impact of this new flexibility
will vary according to the number of small versus large employers in each state.
Insurance Reform
This initiative would allow the states to regulate employers below the threshold level
who are presently self-insuring.
Administration
This initiative will permit states to require better data collection and higher quality
standards from a larger group of employers which should produce a more level
playing field for participants.
5
�"
C. ADOPT THE FEDERAL INSURANCE REFORMS BUT REQUIRE STATES
TO REQUEST WAIVERS TO IMPOSE ADDITIONAL REQUIREMENTS ON
PLANS BELOW THE THRESHOLD NUMBER
Under this initiative states would only be able to regulate small employers by
requesting an administrative waiver from the federal government. This initiative may
accomplish more uniformity among state programs by requiring states to meet certain
criteria before a waiver is granted.
OPTION 3: To allow states to implement their own health care reforms by promoting
express legislative waivers of ERISA preemption.
This option could be achieved with or without federal insurance reform. If federal reform is
adopted then the states, including those granted waivers, would not be allowed to drop below
the federal minimum standards.
Many of the waiver approaches discussed below would permit states to institute laws
concerning the financing of health care. It is imponant to remember that in any such ERISA
waiver approach, the waiver could be structured in a way that would make it more acceptable
to the affected parties. For example, the permissible financing options could be limited to
specific mechanisms -- e.g., provider taxes but not mandates. Alternatively, certain sized
firms could be exempted altogether "from state financing regulations as long as the firms
provided a suitable benefit package for their employees.
POSSIBLE INITIATIVES
A. RETAIN CURRENT ERISA PREEMPTION WITH A LIMITED
EXCEPTION FOR STATE LAWS ON COST CONTAINMENT
This initiative is limited and thus would cause less disruption of the current market. It
will, however, also be less effective in expanding coverage and other reforms.
Considerations:
'Coverage Expansion/Financing, Cost Containment
This initiative improves financing only to the extent that cost savings are used for
those specific purposes.
6
�Insurance Reform, Administration
This initiative does not expressly advance insurance reform or administration
considerations although if cost savings are achieved other reforms may follow.
B. RETAIN CURRENT ERISA PREEMJYfION WITH AN EXCEPTION FOR
CERTAIN STATE FINANCIAL LAWS RELATING TO FINANCING AND
COST CONTAINMENT
Considerations:
Coverage Expansion/Financing, Cost Containment
Under this initiative state laws financing health care and promoting cost containment
would apply to plans whether self-insured or fully-insured. This would allow states
to do financial regulation to contain costs, expand coverage, raise revenue or achieve
other health care reform goals.
Insurance Reform, Administration
This initiative does not advance insurance reform or administration considerations.
C. RETAIN CURRENT ERISA PREEMJYfION BUT GRANT A LIMITED
NUMBER OF INDIVIDUAL STATE WAIVERS THROUGH A LEGISLATIVE
OR ADMINISTRATIVE PROCESS
Under this initiative specific statutory criteria would need to be established against
which the states seeking waivers would be measured. Granting individual state
waivers could be done on a limited basis, such as for a certain number of states for a
period of 5 years. The waivers could be granted as part of a research or .
demonstration project and an executive branch interagency commission could be
established to grant the waivers.
Consideration:
•
Any state receiving a waiver would be able to regulate all health plans in that
state to the extent allowed under the statutory criteria, including in the areas of
coverage expansion/financing, cost containment, insurance reform and
administration. Those states not receiving a waiver would remain in the same
position as they are today.
7
�D. RETAIN CURRENT ERISA PREEMPTION WITH A LIMITED
LEGISLATIVE EXCEPTION FOR STATES THAT ENACT lAWS
PROVIDING FOR COMPREHENSIVE HEALTH CARE REFORM
This initiative would allow states to enact more comprehensive reforms (e.g., "payor
play" taxes, single-payer systems, etc.). This initiative essentially exempts from
ERISA preemption state laws that are part of a comprehensive reform system that
would not be exempt under the more limited exceptions for cost containment and
financing listed in initiatives 3(A) and 3(B).
8
�NATI()~ '94
08:55~M NG~
202 624 5825
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'~GOWRNORS'
~CD:IATION
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RJ,l"IlIIlnd C.
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Sd":pp,,~i1
I::.~~'\j!i,,~ l>ir~'h'r
Chair
Tamflly G, Thompwn
Governor ofWiscoftlill
Vice Chair
Hall of lh~ ~mC&
444 Noreh Capilnl Sllcel
Washinttlon.l'>.C. 2001l1·151.l
Telephone (202) C'14·5.~OO
,NOV 1 6 1994
DATE:
~().l.
\'5
TELECOPIER TRANSMISSION FORM
TO:
Co.(O\ ~~CQ
TELECOPIER NUMBER: _ _ _4.....;,.5{p;:;.z._...;:;:~:..::~......;.1....;;.~_,_ _ _ _ _ _ _ _ _ __
•
FROM: ___
~=~~~~,-~~Ch~~~~~~h~,----------------------------
NGA TELECOPIBR NUMBER: _ _ _.....ro."s2..wO""'",ol--'6wo2A4::o-S""B;w2iooio11S_ _ _ _ __
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(Including this cover sheet)
REMARKS:
IF YOU HAVE ANY PROBLEMS WIlH TInS TRANSMISSION, PLEASE CALL:
at (202) 624-5320
�NOV 15 '94
08:55AM NGA 202 624 5825
'I'
DRAFT - FOR COMMENT ONLY,
11/14/94
.
,
JlMLIH CUU!: REFORM .. THE NExT ROUND-
Now that the negative ads are gone and the November election results are known, it is time to
turn from partisan politics to the agenda for the l04th Congress. That agenda will run the
spectrum from welfare reform to a balanced budget constitutional amendment to the farm bill to
clean water. In health care, however. there is a belief in Washington and elsewhere that due to
last years failure the battleground will shift to the fifty state capitols. While it is clear that states
will continue to enact incremental changes, there are a number of obstacles to comprehensive
reform at the state level. Consequently, this issue must remain on the agenda for Congress as
they convene next 1anuary.
Obstacles to State Reform
State action on health this coming year will be limited by a number of political and structuraJ
problems. First, there are twenty-two new Governors who will be inaugurated in December and
January. It takes time for new Governors to appoint their cabinets, senior staff, and to develop
policy proposals. Yet, most will be in legislative session within one to two months of taking
"
office-too early to push for new health care proposals. Second, health care has not been a
major campaign issue. Few Governors will have a political mandate to propose major health
care reforms. Crime, welfare, taxes, efficiency of government, and immigration have been tlte
major campaign issues. not health care. Third, Governor,s are reluctant to raise taxes to expand
health care access. Most state budgets have been strained over the last few years by the
• By Raymond C. Scheppach. Ph.D., Executive Director of the National Govemors' Asaociation. The
views expressed here are those of the author anel do not neGe&sarily represent the National Govemors'
Association.
- 1•
�NOV 15 '94
08:56AM NGA 202 624 5825
DRAFT. FOR COMMENT ONLY
11/14/94
explosive growth in Medicaid and the slow growth in revenues. To maintain baJanced budgets.
states have had to raise taxes by over 530 billion over the 199()"1994 period. This has caused a
voter backlash against taxes and thus few Governors are willing to ask for additional taxes to
fund a major expansion of health care for low and middle income individuals. Finally, the
Employee Retirement Income Security Act (ERISA) exempts most firms from state insurance
regulation. This means that in most states the health plans of 50 to 70 percent of all employees
are exempt from state regulation. Until the U.S. Congress modifies this law rew Governors will
be willing to expend the political capital required since refonn would affect such a small number
ofemployees in a state.
This is not to say that states will not continue to make incremental improvements in their health
care systems. such as refonning insurance to increase portability and access, reform malpractice
laws, create purchasing eooperativea, and implement various cost control strategies. However,
their ability to solve the larger health care problems are limited .both politically and structurally
in the short-run and perhaps in the long-run as well.
The Congressipnal Climate
The next heaJth care reform proposal should have as. its basic theme a strong federal-state
partnership. The federal government can assist the states in overcoming some of the obstacles
and the states can help the federal government in forging a national consensus on reform.
However. the climate olthe congressional debate has changed dramatically and therefore any
new proposal by the administration must reflect the new poUticallandscape and fiscal concerns.
-2
�NOV 15 '94
08:56AM NGA 202 624 5825
DRAFT. FOR COMMENT ONLY
11114194
First the proposal will require bipartisan support. During the l03rd Congress, the Democrats
held substantial margins in both the House and Senate and since they already controJled the
White House, it was possible to pass a "DemoCrat-only bill." Now that the Republicans control
both the House and Senate, it is critical to have a bipartisan proposal. Second. the proposal
needs to reflect the new fiscal concerns. Deficit reduction Will be a major focus of the 104th
Congress, especially given that the Klmy Commission will release its report on reforming
entitlements in mid-Decomber and there will be a vote early next year on a balanced budget
constitutional amendment. In this climate it may be difficult to reserve Medicare cuts to fund
hoalth care - instead they may go to reduce the deficit as part of reconciliation. In addition to
this> Congress will be unlikely to seriously consider the creation of a new low-income
entitlement in 'health care until the growth in Medicaid and Medicare is checked. Third, the
proposal needs to reflect the fact that the debate last year showed that there is little national
consensus on health care reform. Lack of consensus is not unusual given that most of the
concepts in the various bills. e.g., purchasing coopera:dves. global budgets, community rating
areas> and others, have very limited real world experiences. There is little empiricaJ information
upon whic:h to base the projected behavioral responses and related market chanles.
A BipartiSan Proposal
Given these changes in the congressional climate coupled with the fact that the states will be
unable to make very much progress next year, the administration might wish to considllr the
following structure for any new proposal.
-)
�NOV 15 '94
08:56AM NGA 202 624 5825
DRAFT· FOR COMMENT ONLY
11/14194
1. Include in the proposal only those components of refonn for which there is national
consensus. This would likely include several items such as:
• Insurance market reform to increase access to and portability of benefits. This would
include limiting medical underwriting and guaranteeing issuance of coverage. It couJd
also include new rules for how premiums are set for policyholders.
• Federal preemption of selected state Jaws that impede competition in health care
markets.
• Expansion of the federal tax deduction for health insurance premiums of the self
employed.
• Development of a system of medical quality and ouicome measures that states could use
to certify accountable health plans.
• Uniform billing forms and streamlined claims processing protocols for health care
providers and payers.
• Development of one or more model benefit packages, including a prevention-oriented
package.
2. On issues where there is no consensus, the states, acting as a testing ground, should be given
incentives to demonstrate what works. This wilJ build an information base which wi1l help
build the consensus for comprehensive national reform at a later date. Also, it will increase
access and enhance state capacity to ensure an efficient health care delivery system. Such an
approach would include:
-4
�NOV 15 '94
08:57AM NGA 202 624 5825
DRAFT - FOR COMMENT ONLY
11/14/94
• Eliminating Federal Restrictions. First, states should be allowed to use managed care
for the Medicaid population without a waiver. More than 40 percent of the U.S.
population, but fewer than 1S percent of the Medicaid population, receive care through
some type of managed care. Making it easier for'states to expand the use of managed
care would produce a savings for both the state and the federal government that could be
used to fund expanded access. Second, a new waiver process should be established so
that states could tailor their programs to their Jow-income populations. For example,
states may want to reduce the benefits to existing population groups if the funds are used
to expand access to new population groups. Third, there should be a waiver process for
the Employee Retirement Income Sec.urity Act (ERISA) to allow states to implement
various reform packages. This ERISA ,restriction has stopped in their tracks the efforts
of many states, like Oregon and WashingtOn, to implement previously enacted
comprehensive health care reform.
A waiver process could be c.reated within the
Department of Labor that would have the federal government impose requirements on
ERISA firms consistent with state requirements enacted for non-ERISA firms. Waivers
would only be approved if a state had already enacted a major reform package that meets
certain ,cost-control and access criterion.
• Providing Incentive Grants. One to two billion dollars in one-time state matching grants
could be used to build state capacity for health care. These could be either competitive
or non-competitive planning and implementation grants to create smaJl business
cooperatives, reform malpractice systems" reform insurance laws, create community
rating areas, or even to develop cost control strategies such as all payer rate setting or
• S•
�NOV 15 '94
P.7/8
138:57RM NGR 2132 624 5825
DRAFf - FOR COMMENT ONLY
11/14/94
premium budgets.
This would greatly accelerate the rate of reform within states,
enhance state capacity to ensure an efficient health care delivery system, and also build
an information base of what wor~s best.
• Providing Challenge Grants. "Nhile Congress may be reluctant to create a new health
care entitlement for low and middle income individuals, it may be willing to create a
new discretionary grant program to expand access.
Such a· program would provide
matching grants to states, e.g., a I to 3 state/federal match. States would have to apply
for the funds to the Secretary of Health and Human Services by submitting a plan that
outlines how access will be expanded for low and middle income individuals. States
would be allowed to require individuals to pay a share of the premium depending on
I
income. States might want to contract with clinics in urban or rural areas, provide
vouchers, or offer subsidies directly to smalilow-wage firms that are willing to provide
health care to their employees.
• Creating Budget Neutral and Controllable Financing. Both tne incentive and challenge
grants would be financed through a new trust fund 'of about $10 billion a year over the
next five years. Revenues for the trust fund could come from some combination of
Medicare savings and cigarette taxes. In order for states to fully participate in the
program it would be important to have stable and predictable funding over a five-year
period. This financing mechanism would be deficit neutral and controllable over the
long-run, Le., the financial exposure would be limited since it does not create an
individual entitlement.
·6
�NOV 15 '94
08:57AM NGA 20? 624 5825
.
DRAFT - FOR COMMENT ONLY
11/14/94
Such a proposal would not be comprehensive reform and it would not attain the administration's
goal of universal aecess. But ultimately it may represent the most realistic path to attaining that
goal in the Jong-run. It does, however, also have a significant number of other advantages. First,
it would he1p build state capacity to ensure that an
efficje~t
delivery system is created in each
state. Second, it would start helping people now by increasing access. Third, the risk of failure
is low and it meets the important criterion to first do not harm. Fourth, it would develop an
important information base on which a national consensus on comprehensive reform could be
developed. Fifth. the incentive grants would be predictable budget neutral, and not create a new
entitlement. Last, and most importantly. it could develop bipartisan support-which means it is
enactable.
-7
�
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8884ae6e60fd4cc3407f3b3878c613c4
PDF Text
Text
.,
;;
it. -'
.?
Facts On The Republican Medicare Premium Increase
October 5, 1995
Republicans Can't Hide Their Premium Increases. No matte( what the Republicans say" the bottom line
always remains the same:
•
•
The President's proposal maintains premiums at 25 percent of Medicare program costs.
The Republicans' proposal increases premiums to 31.5 percent of Medicare program costs.
Medicare premiums are based on a percentage of the total Medicare Part B costs. No matter how
much you shrink the Part B program, the above percentages always' remain the same. If you apply. a
25 percent premium (our plan) and a 31.5 percent premium (their plan) to the same Medicare program,
the 25 percent premium will always be smaller. And the difference ~ill always be, around $20.
The Republican Plan Raises
Premiums by $18. When the
Republicans claim that their
. 31.5% premium amounts to
only $4 more than the
. P,resident's proposal, they are
being deceptive -- they are
comparing apples to oranges.
They are not applying the
25% premium and the '31.5% .
premium to the same' size
Medicare program. If they
compared apples to apples
, and applied the President's
25% policy to the Medicare
program they are calling for,
the difference would be $18.
Premium Increases Under the
House Republican Plan;
Premium
~O~--------------------------------~_
$80
$70
$60
$50
~O~----L-----~--~----~----~----~
1996
1997
1998
1999
2000
2001
2002
Republican Plan Presidenfs.Proposal
The Reality is That Under The Republican Plan: Older Americans Pay More and Get Less -- In Order
To Finance Tax Cuts For The Wealthy. Any way you slice it, the Republican $270 billion Medicare cuts -
three times larger than any cuts in history -- will force you to pay more to get less -- just to fund a tax cut for
the wealthy.
•
Increased, Out-of-Pocket Costs. The GOP plan will increase out-of-pocket costs for all seniors
.
- regardless of their income or health.
•
Increased Premiums and Deductibles. Both the House and Sen;;tteplans increase premiums, and
the Senate plan aiso cuts benefits and doubles deductibles from $100, a year today to $210 a
year in 2002.
•
Reduced Spending. Medicare benefits per beneficiary will be cut $1 ~ 700 in 2002, forcing
spef!.ding to grow about 30 percent slower than in the private sector..
.
•
Taking Money From Seniors To Pay For Tax Cuts. Not one penny of the increased premiums
will go to the Medicare trust fund. Instead, seniors will pay more out-of-their-pockets to fund a
huge'tax cut for the wealthy.
•
Raising the Eligibility Age. The Senate plan would gradually delay the Medicare eligibility
age from 65 to 67 beginning in 2003. Tens of millions of Americans would have to work
longer and pay more taxes to get fewer years of Medi/?are.
.
I
�.,
,-:r
CBO ANALYSIS CONFIRMS:
REPUBLICAN MEDICARE PLAN WILL
MAKE BENEFICIARIES PAY MORE TO GET LESS
October 3, 1995
,
'
A leaked September 27th memo from tbe Congressional Budget Office (CBO) confirms that under
tbe Republican Medicare plan beneficiaries will have to pay more to get less.
Tbe Republican Plan is Based, on Price Controls. The CBO memo confirms that $43 billion in savings
from the Senate Republican plan comes not from managed care efficiencies but from price controls-
caps on Medicare payments for managed care set 31 percent below private sector growth rates.
Therefore, the benefitsthese. plans provide would have to be reduced over time. Simply put, beneficiaries
will have to pay more in premiums to get less services.
Medical Savings Accounts Increase Medicare Costs. CBO confirms that MsAs don't save money as
the Republicans would have you believe; they cost money. CBO says MSAs "would cost about $2.3
billion as a result of adverse selection." This means that CBO projects that primarily healthy and wealthy
beneficiaries will opt for this high deductible option, leaving less healthy and more expensive
beneficiaries in the, traditional plan.
Medicaid Block Grants Force Low Income Elderly Out of Fee-For-Service Plans. At the same time
as Republicans are cutting Medicare by an unprecedented $270 billion, they are block granting Medicaid
and cutting it by $182' billion; CBO reports that most State Medicaid programs would ~o longer be able
afford to pay for low-income Medicare beneficiaries' premiums, deductibles, and copayments. As a
lit, many beneficiaries would be forced out of their fee-for-service plans. CBO conCludes,
eliminating the entitlement to cost-sharing for Medicaid eligibles and QMBs' would inc,rease enrollment
as those beneficiaries sought out plans with lower cost-sharing requirements."
,
.
,
.
,
• ANY WAY YOU SLICE .IT, THE REPUBLICAN MEDICARE cut IS:THREE
TIMES LARGER THAN ANY CUT IN HISTORY ANUMEANS YOU WILL,
PAY MORE'TO GET 'LESS.
• MEDICARE RECIPIENTS WILL PAY MORE OUT~OF~POCKET
A TAX BREAK FOR THE: WEALTHY:,
$1;700' lessp~r beneficiary in 2002
•.",
•
Double, Deductibles
• "'
Double Premiums
•
Raise the Medicare eligibility age to 67
,.-TO FUND '
• MEDICARE RECIPIENTS WILL PAY MORE" YET THE CUTS WILL MEAN
AN INFERIOR, SECOND-CLASS, MEDICARE PROGRAM:"
•.
Private health, premiums increased by cost.;;shifting
•
Hospital Closings threatened,
• ""
Doctors driven out of the program and turning ,away' recipients
�REPUBLICAN MEDICAID MISTAKE
WILL LEAVE ELDERLY SPOUSES IN POVERTY
October 2. 1995
The Repu blican .Medicaid'plan'repeals'the,common g~ound) ,
law'sig~ed/by': President'R~agari,(lrotectirigelderly' sp~tlse'S,,'
ffom.havirigJo,give'ul!:evelythinglheY:.h~ve--ih(Hrcar,th~ir.;i • .'
homer and all their,saviiigSc'-"iriordertopayforiDursing:h6me,:
, care,f~r/their"sick' sp()use~'
..i'>,,':{::'> "
,"':;',-.'
. ,"'\=:
.::.~.\:~, i·' ,:,>;.
:):::::'.:.:;i,><"·;'<·"
»','
.
ttCongressishould strip:th~se outragf!OUSPfOvisiOns, from:!lte
budg~t,bilh They'rejriconsisteritwjth:~~"corej;alues~' •., "";;> "i:·"· '
,Theylre.Dot,what,"Americais•• antaboqt,and,theYare.certai#ly
not,he~essary. to' balancetllc" budg~t~n'>.
'
,':'::
.... '--presidentCliritoll,September30,J995·
:
i ..
,
'"
,
,
Gingrich's .Plan Will Force Elderly Spouses 'into Poverty. The Speaker's Medi~aid plan
repeals nearly all federal requirements, including those that protect seniors from going broke
paying for their spouse's nursing home bills. There would be no federalasstirancethilt spouses
could keep a minimum, amount of their income and assets.
.
I
.
.
Yesterday, Speaker Gingrich Refused To Back'Down From His Proposal.
•
Appearing on ABC's This Week With David Brinkley, Speaker Gingrich defended
his position:
SAM DONALDSON: "The House Bill would put Medicaid back to the states,
taking away a federal mandate.· On nursing homes, for ins,tance, a state
could do it right, a state could do it wrong:
GINGRICH: "That's right."
•
When as~ed why he would erase the bill signed by President Reagan, Gingrich
said: "We believe that you can, frankly, run most of these programs less
'
expensively at the state level."·
"
Chief of Staff Pan,etta Leon Panetta Blasted Gingrich For His Continued Support Of This
.. "Unconscionable" Provision. "The Speaker~s wrong. House Republicans· must drop this
provision and must drop it now because it defies our deeply held values that our parents and
grandparents should be able to live with independence at:ld dignity. Valuing familles means
doing what we can to keep them together, not tear them apart.' House Republicans must change
their Medicaid bill now so that no elderly woman will ever again have to fear that her house will
be taken or that she will be reduced to poverty so that her husband of fifty years can get nursing
horne care."
�THE REPUBLICAN MEDICAID MISTAKE
September 29, 1995
The Republican Medicaid Plan Eliminates Vital Health Care Coverage For Millions
of Americans.
Medicaid
". .
CoverageEliritin~ted. Under·:TIl~RepublicanPl~ri: • •.
'. '/, ".
: ..
;,:. _.
:
:
.",::
"'
·4~4>lDiliion
e:<.
.
,;,
.
,
. -;. ,','::";.;.:-;."; > .
children;:
:M6:re::::~h:an.: 900,OO~r:::elde'rly; .and";:·
·L4lllillion'.' peopl~;withdisabilities~
The Republican Medicaid Plan Will Wipe qut Quality Standards For Nursing Homes
And Institutions Caring For The Disabled And Mentally Ill .
. ,TIi~'Republi~an M~clic~id:plan .throws away decades~i~rogr~ss .'by,/ ".
rep¢aiing thecommon'~()und .Iawsig'nedby Preside~tR~agan,>
' .'
eSta.blishing ,.quality·· standards for nUrSinghomesand,instiiutions
dlringJor the mentally retarded.
'.,
.
.'.
TbeRepublican message to iniddle. classfamilies'issilIiple . andcle'ar:
Don't put your parents' in a nursing home, we bad tOitakeawaysafety
precautions to pay for tax cuts.
'
..
'
The Republican Medicaid Plan May Force Elderly Spouses Into Poverty.
The Republican .Medicaid plan would ,repeal thecommomground.law
'si~ed by President·· Reagan, protecting.elderly" spousesfi'om·.:having>to ..
give 'up everything. they have - their car,' their /,ome; and all the;r,,'
savings - in· order··to p=tY'for Dursinghome' care:'.for their sick . spouse•.
Common sense Americans know that itiswrong>to. bahince,the; budget
by<forcing elderly,spousesintopoverty~ It's wrong~. It':iunnecessary~
There"s a better way to' balance. tbebudget~
.
.
.
�,
,
. ""
.
THE REPUBLICAN MEDICAID MISTAKE COSTS MIDDLE-CLASS' FAMILIES,
,"Would, beMedicaidreforlDer~tell yo~.:not.to.>~orry~,.",. Th¢;S~y.'<':
their phtn to>turnMediblid over to tlie . states.is'soimd and safe :
and sensiblei D(m~tbelievethem~ Itendang~rs>thehealth> , '
security, ofmillions"ofolde~Americansand>thefirianciaLsolv~ncY,·
of millions <'ofwage:,'earners ,\vho rely on Medicaif:i to, helpdeffay".,
the rtiinouscostofcaringfordisabled\andaging"rehltiVes.r< "."".
>
-USA,Tdday Ediiorial;S?PJember'28; 1995
Republican Medicaid Plan Will Force States to Eliminate Coverage for Millions of Americans.
Medicaid currently covers 36 million Americans and provides middle-class families with protection from
the high costs of nursing home care for their parents. ' In order to pay for their huge tax, cut for the
wealthy, Republicans propose slashing Medicaid by an unprecedented $182 billion -- cutting funding to
states by 30% in 2002.
States' will be forced to raise taxes, reduce Medicaid coverage, and cut services. According to data from
the non-partisan Urban Institute, the GOP cuts will force states to eliminate Medicaid coverage for as
many as 8.8 million Americans in 2002, including:
•
•
•
4.4 million children
more than 900,000 seniors
1.4 million people with disabilities
Republican Medicaid Plan Will, Force Families to Choose Between Nursing 'ijome Care for Their
Parents and Education for Their Children. Medicaid is currently the largest insurer of long-term care,
covering over two-thirds of all nursing home residents. Without the guarantee of Medicaid, families of
elderly and disabled individuals needing long-term care could be stuck with nursing home bills, currently
averaging $38, 000 a year. ,This extra charge to middle-class families may force them to choose between
nursing home care for their parents and education for their children. That's a false choice for millions of
hard working families. ,And that's the wrong way to balance the budget.
Republican PI~n May Force Elderly Spouses Into Poverty. Republicans are turning their backs on the
common ground protection that President Reagan signed into law to ensure that seniors do not have to
give up everything they own -- their car, their home, and all their savings -- in' order to pay for nursing
home care for their sick spouse. The GOP plan repeals this protection, putting seni'ors at risk of losing
their homes and being driven into poverty by the cost of their spouse's nurs,ing home care. The GOP
plan also means that parents of mentally retarded children may be forced into poverty to pay for their
children's care in an institution or at home.
Rep~blic::an Plan Will' Wipe Out Quality Standards for Nursing Homes and Institutions Caring for
the Mentally' Retarded. The Republican plan throws away a decade of progress by repealing another
common ground law signed by President Reagan that established quality standards for nursing homes and
institutions for the mentally retarded. These standards restrict the use of drugs and restraints and require
that nurses' aides are properly trained: Under the guise of reform, Republicans would repeal this law and
throwaway these fundamental protections -- just to pay for their tax cut.
�..
.,
THE REPUBLICAN MEDICAID MIST AKE
WIPES OUT QUALITY STANDARDS FOR NURSING HOMES AND
INSTITUTIONS CARING FOR THE DISABLED AND l\IENTALLYILL.
-,,'
"
"
.'
TheRepublicanM~dicaidplant~tows.awaydeca~~sof.
progress by repealiDgJhec(jrnmonground·lawsigped·. by'
.presidentReaganr.e~*~blishing/.qijalitY standards (Or. nursing
htnnesand institutio~~cari~gfofthe·mentallY r~~~l"ded.
The.. R.ep.~ blican.• •··rri;~~~g~. :·.to•.• •middle·•.:CI~SS •.•.·families•• • • i·~.• • s·im pie.:..·
and/Clear:. Don 't:p1:ltYm.lrp~rents·ilianursirig,fic)rne, we .•.
had.t~.ta~eaway>~aj'ety precautionstop~y f()r.tai . ;uts•..
.
.. ...
.
,,--"',.'.,
',;,,',.,
"","
,"
,.
,"
.
".",',".',
Medicaid Currently Ensures Quality Nursing Home Care and Fundamental ProteCtions. In response
to deplorable conditions in some nursing homes, President Reagan signed into law federal minimum
standards for nursing homes that:
'
•
•
•
•
•
Protect nursing home residents from abuse and neglect
Limit the use of drugs and restraints
Prohibit nursing homes from "dumping" seniors -- evicting, them when they've run out of
money and qualify for Medicaid
Give nursing home residents the right to appeal decisions without retribution
Ensure that nursing aides are trained and do not have a history of abuse
The Republican Medicaid Plan Repeals These Fimdarnental Protections•. Under the guise of reform,
Republicans propose to repeal these federal Medicaid quality standards, as well as the requirement that
Medicaid cover nursing home care at all.
.
•
•
As many as 350,000 elderly would lose nursing home' coverage in 2002.
O~ce again, nursing home residents would be vulnerable to abuse and neglect, to being
inappropriately restrained and drugged, and dumped onto' the streets when they run out of
money and qualify for Medicaid.
President Clinton Questions The Values' of The Republicans' Medicaid Plan. "Do we really want to
eliminate all quality standards for nursing homes? ... can anybody remember what it was like to go in those
places when there were no quality staildards?"
-- President Clinton, Septembe'r 26, 1995
.Revoke tbe Republican Medicaid Plan and Continue The American Commitm~nt to Older and
Disabled Americans. We have federal quality standards for airplanes, cars, and drinking water, and we
should certainly have. them for our nursing homes and institutions caring for the disabled and mentally ill.
We should not balance the budget by reducing the quality of. their health care. We. should instead honor
our parents and grandparents, and improve nursing home care.
�;."
It's The
THE REPUBLICAN EDUCAtION AGENDA:
Putting the' Special Interests Over The Students' Interests
October 5, 1995
'
Stud~nts'
vs. Special 'Interests..
•
The majority in Congress is so busy looking out for the middlemen -- with their guaranteed profits
from student loans-- that they have lost sight of the middle class.
•
Killing or gutting direct lending means giving in to powerful special interests and punishing
students who' are trying to realize the dream of a college, education.
,
'
•
That kind of partisan, political move is the last thing if we are to help more American students go"
to college.
•
The assault on direct lending is a prime example of how Congress is out of touch.
Republicans are taking away choice and will not let the market decide.
.
,
•
Even as they profess devotion to competition, Republicans are abandoning competition with their
attack on direct lending
They are taking away from the schools the choice e to decide what works best for the school and
students.
•
The Republicans, would actually kick out of program students and schools that are enthusiastic
about direct ·lending~
Colleges and students like, it.
•
•
Direct lending is highly popular with students, families and colleges. Surveys have shown
. overwhelming support for direct lending among those participating in it.
Borrowing is easier and faster for students. For schools, processing is eas,ier and service to
stUdents is improved.
'
DirectLen~ing
•
Saves Money for T,axpayers
Contrary to the special interest arithmetic applied by the Congressional majority, direct lending
saves taxpayer money. As Lawrence Lindsey, a member of the Federal Reserve Board who was
appointed by President Bush has written, "As long as it is necessary to provide a profit to induce
lenders to guaran'tee student loans, direct lending will be cheaper."
."
�10/10/95
·11:02
~ 002/007
. 1
OCT I 0 1995 .'
October 10, 1995
TO:
Laura Tyson
Cuol Rasco
FROM:
Chris leIUlings
"
r'
Attached is a draft memorandum to the President on Medical Savings, Accounts. We've been
working on this for a few days, but it seems particularly timely now because of the mark-ups
occuring in the House this week and because of last night's CBS story on the subject.'
I appreciate your reviewing and providing'me with your changes. If you have questions,
please call me.
Thanks.
'
�10/10/95
I4J 003/007
11:02
October 10, 199.5
MEMORANDUM' FOR THE PRESIDENT
FROM:
LAURA TYSON AND CAROL RASCO
RE:
Med'ical Savings' Accounts
PURPOSE:
To reach a decision on an Administration position on the use of Medical Savings
Accounts for the private insurance market and the Medicare program.
OVERVIEW AND BACKGROUND:
Last night, CBS News broadcast a scathing attack on Medical Savings Accounts
(MSAs), suggesting that their popularity was due largely to the financial contribWions of their
backers rather than their actual merh. Yet, while concerns about the concept have' also been
raised by the elite print media, by CBO, and by Lewin-VHi, MSAs continue to ride a wave -of.
support in the Congress.
.
Both the I-louse and Senate budget bills contain some version of an MSA option. The
concept has also received strong support from certain elements of the insurance industry,
particularly those finns that once excelled at· the traditional underwriting method of "cherry
picking" beneficiaries from low-risk popUlations. While these methods· have been rejected by
the public and by policy makers, MSAs offer a subtle; way of accomplishing much the same
. effect. Given the depth of financial and Congressional support behind this concept, some form
of MSA proposal likely will be included in any reconciliation bill that reaches your desk.
Medical Savings Accounts,. as their name suggests, are special accounts' used primarily
to pay personal medical expenses. Typically, these accounts offer tax benefits or other
financial incentives. But, in return, they impose one basic requirement: Participants must
switch their health insurance from a "comprehensive" plan to a "catastrophic" . phm with a high
. .
'9.eductible, sometimes as high as $10,000.
. Supporters in Congress contend that. by forcing individuals to bear more of the direct ~
costs of health care, MSAs discoutage the use of urmecessary or excessively costly medical
. procedures, thus reducing medical expenditures. Opponents counter that the plans simply
anow healthy and well-to-do populations toself-select~:out of the traditional insurance pools _.
thereby increasing costs for those left behind. Other criticisms are that.MSAs: .(1) are
untested; (2) are difficult to administer; and (3) may discourage use of cost-effective
preventive care.
.
. .
�,.
10/10/95
11: 02
~ 004/007
DISCUSSION:
In general, MSAs have been proposed for both the private health insurance market and
the Medicare system. These two options are· described briefly below. The pros and cons of
the MSA concept are then examined in greater detail.
Private Market MSAs
Various MSA proposals have been introduced'for the private (under 65) insurance'
market. One of the most significant, Representative Archer's proposal (H.R 1818), allows
individuals' to open an MSA whenever they enroll in a health plan, with a minimum deductible,
of $1,500 for a single plan and $3,000 for a family plan.
.
'
H.R. 1818 provides a significant benefit for individuals who open an MSA: Not only
are employer and employee contributions into an MSA deemed tax exempt, but withdrawals
from an MSA for medical expenses are also tax free. By comparison, under current law, an
individual.must generally spend after-tax dollars on medical expenses (with a few exceptions).
Medicare MSAs '
Both the House and Seriate Medicare plans allow beneficiaries to withdraw from the
.traditional fee-for-service system and set up a Medicare MSA account. When a beneficiary
opens an MSA, Medicare gives the subscriber a voucher equal to the amoWlt of money' that
the Medicare program spends on the average benefiCiary per year _. roughly $5,200 per
beneficiary in 1995. (Under some proposals~ this average, would be "risk adjusted" to take into
account the beneficiary's demographic characteristics,: like ageo! gender). This voucher can
be used only for the purchase of a high deductible in~urance policy -- with deductibles ranging
from up to 53,000 in the Senate version to up to $10,000 in the House version. Any
remaining credit, is then deposited into the Medicare MSA.
MSA funds can be used to pay for both medical and non-medical expenses. When
used for medical expenses, withdrawals from the account are tax-free. However, when used
for non-medical expenses. the withdrawals are taxed' as income and, under the House plan,
subject to an additional penalty whenever the MSA balance falls below a specified threshold
.(60% of the deductible amount).
GENERAL PROS AND CONS
Pros -- Private Market and Medicare MSAs
The advantages of the MSA concept for the Medicare and private market system are relatively
straightforward:
•
More Choice. MSAs may offer new options. for private health insurance consumers
and Medicare beneficiaries.
'
2
�10/10/95
•
11: OJ
~005/007
Ideolo£ical appeal. MSAs reSonate ,with the anti-government mood of the l04th
Congress. Medicare MSAs, for example, appear to eliminate the federal middle-man in
the Medicare system -- replacing a government-run insurance program vvith what seems
to be a more market-oriented one. Moreover, MSAs in general enable individuals to
decide how to cut costs, rather than imposing institutional rules such as those fOuild in
managed care programs.
~;
co
..
Incentives to reduce unnecessary procedures. ' By requiring individuals to bear more of
the direct cost of medical expenses, MSAs probably lead to a reduction in the use of ' '
unnecessary procedures. As such, MSAs provide an initial attraction to some
conservative academics. Nonetheless, the effect on medical expenditures is unlikely to
be dramatic: MSAs do not address the principal cause of increased spending -- the
rising costs of catastrophic illness. Roughly 20% of individuals 8,ccOunt for 70% of all
medical spending. MSAs would do little to reduce spending on the small number of
,very sick individuals responsible for most medical expenditures,
Popular among certain segments of the population. MSAs appeal particularly to the
healthier and wealthier segments of the popUlation. and their inclusion in a final budget
package would avoid confrontation with their fierce supporters on Capitol HilL
(:
Cons -- Private Market MSAs
,i
The MSA concept raises a number of concerns when applied to the private insurance market.
o
•
co
Untested. The MSA concept is a largely untested concept. It makes little sense to
implement the idea nationally· without better understanding its implications.
Adverse Selection. Adverse selection is, one of the most significant defects associated
with MSAs in general. Adverse selection refers to the fact that MSAs will likely
attract wealthier and healthier beneficiaries •. those rich enough to risk a high
deductible and healthy enough to be confident that they will do better with their own
catastrophic policy than in a comprehensive poor of riskier and sicker individuals.
Adverse selection could lead to a situation where the pool of people left in
co~prehensive insurance coverage are sicker than average, leading to increasing costs
for such coverage as the risk pool shrinks and becomes less favorable, However, it is
unclear how severe the adverse seIectionproblem would be in the private market
because employers who provide MSAs as part of a benefit, package would have some
flexibility to adjust an employee's wages or other fringe benefits in order to limit the
amount of adverse selection that occurs.
Possible' reduction in preventive care. High deductible policies may' discourage families
fTom spending funds on' certain services, like preventive' care. that have short term
costs. but long-term benefits. In many cases, providers may be better pOSitioned to
recognize the benefits of cost-conscious and medically effective preventive care.
3
�10/10/95
11:03
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•
Administrative problems. According to the Treasury Department, private market MSAs
will lead to significant administrative problems, increase the paper-work burden on
taxpayers, and create the potential for Sigllifica.?t non-compliance.
'
'
•
Loss of federal revenues. Since private market MSAs allow individuals to pay for
medical expenses with tax-free dollars, a significant revenue loss for the Treasury can
be expected. The Joint Tax Committee projects that H.R. 1818 will cost $1.8 billion
over 7 years. The Treasury Department estimates that the seven- year loss would be
$3.5 billion.
'
•
No significant increase in coverage. Private market MSAs are unlikely to expand
insurance coverage to any significant extent. Although some individuals who are
currently uninsured may participate in an MSA plan, others who are currently in
comprehensive health insurance plans may drop coverage because of changes in the
risk pool. Moreover, by encouraging healthy ~d wealthy individuals to self-select into
segregated insurance groups, MSAs will proba,J>ly make it more difficult in the future to
achieve comprehensive health care refonn thai'depends on large community-rated
insurance pools.
Cons -. Additional Concerns about Medicare
While the Medicare MSA has many of the same drawbacks as the private market version,
most health policy analysts (including Alain Enthoven and others with influence with the
Democratic Leadership 'Council) have pointed out that adverse selection problems will pose a
particularly serious problem for the Medicare system:
•
Under both the House and Senate~edicare plans! an MSA subscriber receives a
voucher equal to what the average beneficiary, costs the Medicare system each year -
even though these healthy subscribers cost th~' system far less than average. In this
way, MSAs boost spending on healthy penefitiaries, thus increasing costs. . The only
way to address the adverse selection problem is by adjusting the Medicare contribution
,to more accurately reflect a subscriber's cost. As Lewin-VHI notes, however, such
, "risk adjustment" methods are "still under development and largely untested."
Moreover, modifying Medicare contributions based on factors like gender or age would
likely face serious· obstacles in the political process. Because it is skeptical about the
development of an effective risk-adjustment method, Lewin-VHI projects that Medicare
MSAs will cost between $15 and $20 billion.
•
The GOP Medicare plan imposes an overall entitlement cap on Medicare expenditures .
Asa result, the higher cost of Medicare MSAs must be offset by cuts of an equal
magnitude in Medicare's pay-for-service program.
.,
.. !,
~,:..
Th~
GOP Medicare plan allows MSA~holders to transfer back into the traditional pay
for-service system on an annual basis. As a result, subscribers will be tempted to
enroll in MSAs during their ,healthy years, and then opt back into the traditional pay
4
�10/10/95
. '.
11: 03
!4l 007/007
, ' ~.
for-service program when their health declines. This featl1re exacerbates the adverse
selection problem. To address this problem, some have suggested extending the "lock
out" period beyond one year, but such proposals obviously would prove very unpopular
with beneficiaries.
Taken together, the negative effects of MSAs should be a concern for the overall health
,
insurance market. But adverse selection problems raise particularly serious questions for the
Medicare system. Even Senator Dole has expressed some misgivings about Medicare MSAs.
Acknowledging reports' about the cost of M$As, Senator Dole recently said,
"I picked up the paper this morning, the New York Times said the Medical
,
-\
Savings Accounts are a rip-off, when it costs $2.9 billion. They're only for
healthy people. Well, should we spend $2.9 million (sic)? I don't think so.
We're going to check it out." (quoted at the Business Week Symposium of
Chief Executive Officers, 9/28/95).
CONCLlJSION AND RECOMMENDATIONS
\
There is opposition to the concept of Medicare· MSAs throughout the Administration
(NEC, CEA, DPC, Ol\1B, HHS, Treasury). Similar concerns have also been raised about
MSAs for the private market, but with the exception of the Treasury Department diviSIon with
responsibility for administering MSAs, the depth of this opposition is not as great.
'In all likelihood, some form of the MSA conc,ept will likely pass the Congress. The
.,
question arises how best to position the Administration on this issue to ensure that the final
compromise is acceptable. There are a range of options available to the Administration,
including the following:
.
.
OPTION A: Oppose MSA concept for both Medicare· and private industry and suggest that
proposals might attract a veto. At most, suggest 'possibility of establishing a demonstration
project for the priv~te market.
OPTION B: Oppose Medicare MSAs and raise concerns about private market MSAs, but
leave open the possibility of compromise -- perhaps a demonstration project for MSAs in
either the Medicare or private market.
.
OPTION C: Indicate need for more i~onnation to~v~luate proposals, but express preliminary
interest in MSAs as a c o n c e p t . .i
DECISION:
OPTION A
OPTION B
OPTION C
5
DISCUSS
�'t\
.
,.A,~r
~\
. .
.
I
ARKANSAS DEPARTMENT OF HUMAN SERVICES
Of eeer•••llte . '...MEDICAL SERVICES
~~IVISION
~
Ocr
3/995
, FACSIMILE TRANSMISSION COVER SHEET
FAX (501) 682-8013,
TO:
FAX#(~OA)
lfSr2f'?(
PHONE NUMBEA
,:(t>~--,'fS'-2.2~ .
REMA~:
\JJ'
i
If you
hav~ any problems rer:eiving~this message, please call:
At:
. Name'·
':'<
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.
TUESDAY,OcroBER3,199S.'
GOP's rosy scenario ~ disaster
•
Medicare-
R
·caid bill is unworkable
epublicans presume bJ cutMedicare
by a rosysceDal'io. They presume to
. mann Med1caid by ditching the
idea tbatthe tederal government should at-. .
. tach strings to the money it ships to states.
Pres,tdent CliDton . it's all quite sauy.
Re's quite right
.S1O"S
The peace ofmind otpoor elderly pe0
ple nationwide may depend on the veto of
a man who once in Arkansas vetoed a bill .
.and then mwetoed it. Im't it remarkable the
ehallenge and opportu:rlUy. that h1story·ean
offer a mortal being who happens to eross
its path? . . .
.'
.
The ~ubnc8D8 want to take fl70 bU·
lion from projed:ed Medicare spendiDg
over the next seven. years largely by as
suming tbat40 pereent of old folks an be
enticed intD joiDiDg health maiDtenance or
ganizations (HMOs). This. would be purely
John
Brummett
,.
If the Republicans were determined to
avail tbemselves ofHMOs as budget..atUing
measures; they might baYe considered them
for Medicaid, the _program for the poor,
rather than for MedIcare. Some states have
=bad tentative success by moving Medkaid
to Duniaged eare systems.
transcended his usual moderation to Wi
positively frightful about all oCthis.
He explained that the House versic
contains no provision preserving the cu
rent p~n 3Dinstse1zureofhome, ~
and furniture tram spouses ofpersous l'l
ceiving Medlcaidto stay in nursing home
Whether to do that would be lett to tb
virtues ot Alabamans. Arkanli\BmJ. Moi
tanans, Californians and all the rest. ;
Bouse Speaker Newt Gingricll says ~
mocrats are morally bankruptto fl8htbu(
get cuts by sca.ring old people by raisiD
such issues. As usual Newt's rhetoric is UI
acceptably overheated Once again his vi~
ofmorality is confused.
•
B~ no, the Republicans propose to cut
$l~;billion over seven years in Medicaid
. Budget cutting carries moral currene
because it shows a responsibility to fuf,wl
maip]y by sending block grants to the states generations. But suggesting that the red~
and te1.11ngthe states to dp with the money al government impose itselfon the states t
voluntary, you understand·
..
wbattheywlsh in the ww of~al aid tor assure a safety net Cor old people inDUl'SiQ
. I~ :sUreJy is the G~. Canyon ot as the poor.
homes is hardly the stutr of moral bam
sumPt:ion.s,
.':/...).:. ...~.
.
This BepuPlican concoction that the ruptcy..
.
·'.At the risk of stereOtYping, inay We stip. state.sknow best-that the real virtue lies in
Memo to Newt Caring tor the sick h$
ulllte that senior citizens tend bJ cling to 6,.: states baviD,g autonolllY over the spending . bibJ.i:cal ~edent.
miliarity and certainty in the one seniee of federally collected D1tlIlq-i.s a mostcuGingrich seems to provide yet anotb4
.'
.
example of the Republican preference ta
most vital to them-bealth eare-and to be MUS thing.
It assumes, for example, that the poor those unbom over those actualJy living auc
set in tb.eirwa.l'S about the doctors they see
and the procedures they are willtngto en
and the aged in.Arlamsas are better off if encountering iDevitable misfbrtune. :,
dure to see those doctors? .
their lives are p1acedin the hands of the . IfGingrichmeaosbJ~thatCllnton~
Perhaps the wealthiest, healthiest, bold
solons ofthe Arkansas LegI.slature than in the Democrats are morally bankrupt to O{I
est and most progressive among those over the bands or Congress. I de& anyone to sit pose budget cuts,' I would cite the factthi
65 will embrace HMOS as cost-saving mea through a m.eeting ottheJoint Budget Com
Clinton and the Democrats already havecu
sures requiring a smaller contribution.·But mittee at the state Capitol and declare that . nearly in balCtb.e.federal budget de4cltex
.
ceed.ing $300 billion that they lDherited.;.
40 percent? 1t1l be more like a b.aDdtu1., ru view;:with a straight face.
wager. How st:range that Republicans want
litusnotforgetthatlfwehadlefteyery-·
Clinton vows a veto of the Medieare
to the suppOSed virtue of the states, ·Medicaid bill as written by tbe aepubli
. to do to millions or old people wbat they _
claim to have saved all orus from las.t year slavery migbt siill be a supposedJyvirtuous cans. largely in secret. Uhe's immpral. 8D(
in defeating the Clinton health care ref<mn pradite in a couple of places. There's no liD not passing any judgments,. it ~
plan. By that I refer to alternative methods . need to DaIIle names, but the states ofthe . have to ~ on some other b~is.
of h~alth insunm.ee that might limit the Southeastern ConfereI!Ce somehow come to
•
choice of a physician witho~ a higher pre
mind.
John Brummett's coN'ITtft (/.]:Ip£aft er:my 7WJ.
mium
In his radio address Saturday, Clinton q 1'h:tmdcl#. StltImip,y a:n4 ~
:.
President's comnritment in Bosnia.~
.
·
D
.
-
Selling public on his· decisions a problem
efending his annolinced lnteDtion to
assign up to 25,(0) American troo 8
to peacekeeping operatiODS
Bosnia lfpeaee is ever achieved there, Bill
Clliltqn said theAmericaD people were just
"gODDa haVe to understand" that this coun
try is the world's only remainiDI super..
power and as such hal a role that it must
play on the intematiooal stage.. .
Despite B'rerBill's pronouncement, the
American people are given to understand
lna lIThot t'h~\t n/DY'\f . "
...:1""' ....... """""' __ ...J ....
0£:9! £6, E0 1JO
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John R.
Starr'
,
.
..
.
he would c:oatinueto speak out~ ~e:s bti
coP8iders Important.
:
The Qmstitution gives him that rigbt,bUl
he will be w~ bJs breath. Nobody li~
tened to him while he was a candidate. No
body is golngto listen to hini now,·
It is generally believed that Wi1son~
campaign foundered because Ca.1.itorniam
were augry with him fur breaking a promisE
made when be wu a candidate for g0ver
nor that he would serve out his four-year
Ei08c8910£
.
�Arkansas Department of Human Services
Division of Medical Services
O.onaghey Plaz~ South
P.O. Box 1437 &
Little ROCk. Arkansas 72203-1437
Telephone (SOl) 662-829,2
TOO (501) 682-8275
FAX'(501) 682-8013
MEMORANDUM
TO:
Governor Tucker
Tom Dalton
Rich Howell
DHS Executive Staff
Sandra Nichols, M.D.
:::e::::~~l
I
Dire-ctor, Department of Health
Care Advisory Committee
PR.OM~
199J)
DATE:
October 3,
SUBJ:
Briefing on D.C. Meetings
spent four days in Washington D.C. last week, first as an
invited participant at the State Mental Health Director's an~
Substance Abuse Director's conference, and then at the fall
Medicaid Director's conference. The latter meeting b>;ought horne
the point that, with the collapse of health care reform, Medicaid
is the "only game in town" and is drawing renewed attention and
respect. Among the several hundred attendees were reporters from
CNN, the New York Time~, U.S. News and World Report magazine, and
National Public Radio.if It is very likely that the changes in the
Medicaid program over the next few mOllths will be greater-than
has occurred in it's 30 "year exi'stence up to this time.
I
I would like to take this opportunity to brief you on what I
learned from the meetings, whicp for purposes of brevity, I will
combine here.
MENTAL HEALTH
It is clear that the ~nner in which states pay. for mental health
services and substance abuse-treatment is going to chang~, in
some cases dramatically. The historical providers of publicly
funded services, i.e. ~ ;'community health cente:r:s, ,E:tc. face two
major challenges; (l) ~LOSS of and reduction of various block
grant funding sources are a real possibility in the Congressional
drive to balance the federal budget and (2) The drive to·
transform Medicaid programs to managed care, especially capitated
care, will, to some degree shi.ft patients from these traditional
. providers and reduce fees for' others. Historically these
providers have served the bulk of Medicaid patients, often at
guaranteed cost or greater,rate~. It was apparent thato these
providers e~ect to be negatively impacted by managed care but
"The Arkansas Oepanment of Human Serviees is in compliance with Titles VI and VII of the Civil Rights Act and Is operated
manage<! and delivers services without regllrd to age. religion, disability. pOlitical affiliation. veteran statu,. sex. race.
color or nlltional o_rigl","
. ,
£0d 61v
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�MAmn • October 3, 1995
Po.Yf:! 2
that €omc arE) working hard to·rludways 'Co be a player in the new
care delivery ~y~tems . .
There was underot;;:mdilJ:he concern tllaL luss of t:unding and at
least: some Medicaid p4:t. ; ents will negatively impa.ct the ability
to treat those patiellJ::l .who w111 cont:inue to prp.sentwith no
payment source some through court ordel.:"s, and .Lu emergency
·::;ituaCions.· The weltare r.nanges will deny SSI to Gome aupstance
a.bu:Jcra. now their qualirl~i::ltion tor Medicaid, whir.h could
inr.r~a8e the number of uninElurcd seeking such trea.Llilf:!ut.
I
· Much of the capitated managed ~i::lI·e discussion centered flrOl.md the
merit.!': nf either carving out menti2l health treatment [0.[: i::l
separd.Lf:! delivery syst.em or inb.Lllc'ling it in a .glob~l capiti2tion
fee that would purport to· cover Cill t.he healt.h needs ot a
Medicaid P;:IT:.; !?nt . Clearly the mental health providers pret:lE:ut
favored a t:lf;tJi::I.I·ate carve out. I li.~t".Amed to a debate between
Indiana. Medic.:lid staff and mental hf;i::I.lth providers from that
state. ~ndianfl'~ Medicaid program will·offer the patient a
choice of eithsL' c:U1 aljl inClusive HMO prH~l<';::Ige or a primary care
physician (PCP) "gatek,rpeper " fee fOl; sSL"vh;e system. The
cap1 tat.ion tee would hJI11 d in dollars for mental health care. In
reaponl3e to the menLal healt.h providers' concern that the HMO
would opt for extra profit by not affording L.he yatient Cidequate
lllE:utal health or substance ahllse treatment, the Medicaid staff
countered that the patient wuuld be tree to leave thp. HMO and
instead ·l=mr.oJ,.l with a PCP in the event he or she fell they were
· not 9t::Lllu!1 the care they neenen" Th.g significance here is that
in hrkanElao we a.re etrongly cou::ddering a similar gygl"'.~m of
choice hetwAI!;\n the two types of managed care plans. We will need
to addreS:i:l t);1e separat.e carve nut. questions on. mental health.
CONGRr;SSIONAL AIm 'PRESIDEN'l'IAI. PLAN POn. MEDICAID/MEDICARE
While in D.C. we heard from Vice Pre:i:lluent Gore, HH~ SeCrp.r.Ary
Shalala. the .NGA and st.aff from the Senate Pinance Commit-Lee
which was ·wrapping up ~nend.ments to. the Mt=;!dicaid block grant
· alr~ady passed out of ~hc· Houee. The COllH:t"e66 is still intent on
rsuu<.:ing projected spending between 1996 and 2002 on Medicaid lJy .
$182 billion and 011 Medi<.:are by some $270 bi.llion.
The President
renewAO his commitment to veto a.budget cuntaining these
redu<.:l:.ions conr..ending they ar9 excessive and will damage the
nation1o health care in[L~~trucr..ure and thp. persons served by the
two progr~ms. That showdown over thi~ is u~layed unt.il mid
NovembeI: VE:cause of a contimlt=;!d rQsolution on tha budget.
E£;9i
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�Memo. - October 3; 1995
Page 3
Secretary Shalala's
1.
commenes-~-*---
The Republican congress is trying to t'cue the aid out of
Medicaid and the ~ out of Medicare .in order to pay for a
tax,cut for' che wealthy who don't need it anq who have not
asked for it."
(
.,{:
2.
Under the Republis;an plan· even if states closed 50% of the
reduction in Medi6aid funding by increased efficiencies!
managed care they would lIbe forced to either raise
,
additional state general revenue or to eliminate coverage
for 8 million recipients; 4 million of· which would be
children. II
3.
The Republican plan would result in an "Unprecedented
assault on the nation's liealth care. system. 11 "Medicaid
would be replaced by 'Medigrant' which ·would be an
underfunded, unworkable mess. II
Quite clearly the Secretary shared the President's view that the
federal government shotlld continue to play a larger role in
Medicaid than envision~d by the current Congress and explicitly
that Medicaid should r$.main a guaranteed entitlement to low
income perso.ns.
'
HOUSE VERSES SENATE MEDICAID
PL~S
While agreeing on the $182 billion Medicaid spendi~g reduction
target it became increasingly clear last week that the Senate
will be hesitant co go as far as the House in granting states
flexibility to run the Medicaid program or it;s replacement under
whatever block grant name, i.e., IIMedigrant. 1I
SENATE FINANCE COMKITT~E -- This powerful committe,e finished the
work of voting out amendments in the early hours of last Saturday
morning to the "Medigrap.t II proposal voted out of the House
earlier. This amendediplan will be voted on by the full Senate
in October and then go'~o a joint conference between the two
houses of Congress. The end product will go to the President who
. may sign or veto it.
I will detail a listi,ng of what I consider key amendments debated,
in the Financ.e Committee, with deno'tion on whether or not they
passed:
.
1.
.
equal to 1% of a state's federal block grant
must be set aside under one successful amendment for
gran·ts to states for services rendered at community.
hear'th clinics, rural health clinics., etc.' This is an
item of concern for several reasons; (l) Such a
decision should be left to the states (2) While the
non-profit co~unity health centers, Le., FQRe's
An
amou~t
~'
50d 61v
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E108c89105
�Memo - October 3,' 1995
Page 4
provide uncompensat.ed care, the ,inclusion of the for
profit. rural health centers (often a private physician
practice given the HHS designation, is regrettable.)
Some states will advocate that this provision be
stricken, or at least be amended to include all public
health clinics, i.e., those operated by the Arkansas
Department of Health.
2.
A successful amendment by Senator Chaffee will increase
the state's maintenance of effort (MOE) funding
obligation by focusing on expenditures for FY 95
instead' of a;\i 3 year average as had been proposed by the,
House.
'}
3.
States are mandated to cover pregnant women and
children to age 12 when below 100% of poverty. States
may define the benefit package.
4.
States are required to cover the disabled. Still to be
defined is "who is disabled? ". Likely this' will be the
SSI population. The state defines the benefit package.
Under changes made in welfare presumably fewer people
will qualify for S5I in the future for behavioral
disorders and substance abuse.
5.
A passed amendment would allow states to establish a
drug f orrnulaty;. "
,
6.
Retroactive Boren lawsuits would be prohibited.
7.
.An
8.
By a vote of 13 'to 7 an am~ndment to reinstate the
attempt tQ restore federal nursing horne quality of
care enforcement standards failed on a 10 to'lO vote.
r believe this will be restored by ,the fu}1 Senate.
There was major interest on this issue by the' press
covering the Medicaid Director's conference.
Boren amendment failed. Senator Pryor voted with the
losing side to restore Boren.
9.
The corn:mittee;, voted to restore current spousal
impoverishmeti;t regulations to the earlier house bill.
Clearly the action by the Senate Finance Committee'indicates less
,flexibility for states than th~ House envisioned when it passed
out a largely unfettered plock grant bill. Additional rules will
likely be instated by the full senate.
[[:91 £6. £0 1)0
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�Memo - October 3, 1995
Page 5
PUNDING FORbroLAS
Nothing will draw as much attention as how the Congress would
write the formula for distributing the I)M~digrant"· dollars among
the states. I have attached the table to show the base and
allowed annual growth allowed among states as'passed out by
Senate Finance. Changes were clearly made over what had passed
the House, in large part to address the concerns of moderate
Republican Senators from ten or so states. Surprisingly Arkansas
fares somewhat better as will be noted on the attachment -- t:.he.
first year's growth, based on a 1995 base, being 7.25%, the :qext.
year (1997) 8.44%, andtthen S.53%- each year through 2002.
YO~ will note 0% growth for Louisiana for some three years which
is expiained only if you know a d~al was cut to allow them to .
keep hundreds of millions of dollars in their base for
disproportionate hospital share that was to be lost under the
earlier house plan.
FROM ANALYSIS OF SENATE
PRESENTATIONS THE
FI~ANCE
FOL~OW~NG
AND ROUSE ACTION AND OTHER
ISSUES ARK KEY, I BELIEVE:
Unused federal allocations under the Medicaid block grant
could be carried over from, ye~r to year, Le., retained in
Arkansas' Medicaid trust fund.
.
1.
.
.
2.
The current floor }for federal funding is 50%, i. e., for
higher per capita!:;income states like New York, California,
et:.c.' This would change to 60%, but supposedly not othe,r
state's expense but rather New York could draw the same
share of capped Federal dollars but put up less of it's own
.general revenue than is required under current federal law.
3.
States could keep current Medicaid waivers after t:he block
grant but would have to continue to abide by any conditions
that had been attached to the waivers. In my estimation,
Arkansas would have little need to maintain it's existing
waivers under a block grant, .we could provide the same
services without the federal reporting. now required, etc.
4.:
It,is very possible that the final 'block 'grant; . with its
federal 1996 fundipg limits, may not be passed and
implemented before\March of 1996. HOWEVER, the limit could
be retroactive to October 1, 1995. If states spend at a
higher rate in the October to December quarter for example,
than turned up in the final bill this could have an enhanced
negative impact on the budget for the final months of the .
fede+,al year ending September 30, 1996.
-------_ --
..
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Page 6'
5.
Medicare
premium and deductible increases will apparently
be 'income graduated, not appearing until recipient income
reaches $50,000. " If this holds it will spare Medicaid what
could have been ~ major i~crease.
1;
6.
Abortion -- it is likely the current Hyde language will be
inserted by the Senate, federal funds could be used only for
life of mother, rape or incest.
7.
The Vaccines for Children program is gone although states
will still be able to buy at least some vaccines at the
discounted CDC price. It is likely less free vaccine will
be available to the uninsured children, however.
8.
The current confining rules on tax and donations states may
use to raise their share of ,the Mec;iic~id budget will be
retained -- a reg~ettable departure from the promised state
flexibil ity.
~;
9.
HCFA would be required to reduce it/s federal Medicaid staff
by 75% after passage of the Medicaid block grant in language
passed by the House and by the Senate Fin~nce. ,In that HCFA
would 'still have to review and approve state's Medigrant
plans, give technical advice, etc. this seems somewhat
excessive.
'
\'
COMPROMISE?????????????????????????????????
I ,do not believe the President will sign a bill that reduces
projected funding of Medicare'and Medicaid by some $500 billion
over seven years, and I believe the Republ ican lea,dership in the
Senate know this. I a~so believe the President will push to
maintain some entitlement status under Medicaid for at least low
income mothers a~d children. This compromise may well be built
around an amendment offered in Senate Finance by Senator John
Chaffee, a moderate Republican from Rhode Island.
The amen~ent
was withdrawn without a vote ,in the committee. Senator Chaffee
lacked the votes and wanted to retain it for later action in the
full Senate and/or conference with House.
,
\'"
":.'
,:./"
,
, ';
~ "
',"',
Senator Chaffee did succeed in maintaining some semblance of an
entitlement with a succeSSful amendment, to require states to
cover children under 100% of poverty but did not require any
guaranteed benefit package. The withdrawn amendment would retain
the current Tit.le XIX program as opposed to replacing it wic.h a
new Title XXI Medigrant. 'Instead ofa bl,ock grant to states it
would impose an individJlal recipient cap similar to the
President's proposal. :iBoren would be repealed and states could
v£:9t £6. £0 1JO
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�Memo
October 3, 1995
Page 7
do managed care without a waiver. The fate of this amendment
later this month bears watching as I believe 'it may contain the
genesis of the final compromise.
In s~rYI' it is going to.be a challenging next few months.
, Please advise should you have any questions.
RH/dls
Attachments
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,
\
.
AN~UAL
yROWIH RATES UNDEB
'
ElNANCECQMMIUEE MEDICAID FORMULA
STATE
1996
1997
19.98
1999 - 2000
c==.=,a.=·=:a:.~=QIII!==~~====IiI.c=;ae:.:::r~=,:z-=;=:
Alabama·
Alaska.
Arizona
."-7Arkansas
Califomia.
Colorado
Connecticut .
Oeta:wara
DC
F1or1da
.Georgia
M~i
Ahadal~
SOuth.Carolina
South Dakota
Tennessee
Texas
,Utah
01d 51?
2.00
5.53
5.53
5.53
5.53
5.53
5.53
5.53
5.53
·0.00
4.20
4.20
2.00
5.53
4.20
5.53
5.53
5.53
5.53
5.53
5.53
0.00
4.20
4.20
2.00
5,53
4.20
5.53
8.44
8.44
8.448.44
8.44
8.44
8.44-
:;~
2.00
8.44
7.'2$:1
2.00
7.25
8.44
8.44
7.25
7.25
5.53
8.44
2.00
5.53
2.00
5.53
·5.53
5.53
5.53
4.42
5.53
0.00
4.20
5.53
2.00
5.53
5.53
4.2D
5.53
,4.67
4.20
2.00
5.53
5.53
5.53
5.53
5.53
2.00
5.53
2.00
5.53
5..53·
5.53
2OIJ2
5.53
4.42
5.53
5.53
4.42
5.53
1.25
6.75
4.42
5.53
5..53
5.53
5.53
4.20 . 4.20 .
2..00 2.00 2.00
4.42
4.42
4.42/
2.00
2.00
2.00
5.53
5.53
5.53
5.53
5.53
5.53
2..00 2.00 2.00.
5.53
5.53
5.53
5.53
5.53
5.53
·5.53 ·5.53
5.53
5.53
5.53
5.53
5..53
5.53
5.53
5.53
5.53
5..5 3
5.53
0.00
5.53
420
4.20
4.20
4.20
4.20
4.20
2.00
2.00
2.00
4.20
4.20
5.53
··20 4.20 4.20
5.53
5.53
5.53
5.53
5.53
5.~
5.53
5.53
5.53
4.42
4.42
4.42
5,53
5.53
5.53
2.00 ·2.00 . 2.00
4.20
4.20
4.20
5.53
5.53
5.53
2.00
2.00
2.00
5.53
5.53
5.~
420 4.20
5.53
4.20
420
4.20
5.53
5.53
5.53
4.20
4~ . 4.20
4.20
4.20
.:20
2.00
2.:00 .. 2.00
5.53
5.~
'5..5 3
5.53 5.$3
5.53
5.44- .5.10
5.53
5.53
5.53
5.53
5.53
5.53 ·5.40
2.00
2.00
2.00
5.53
5.53
5.53
2.00
2.00
2.00
4.2Q, 4.20
5.14
4.20
4.20
5.53
5.53 5.53
5.53
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,
MEDICARE AND MEDICAID:
KEY ISSUES
October 10, 1995
�TABLE OF CONTENTS
1.
SECURING THE MEDICARE TRUST FUND ......................... 1
2.
MEDICARE "LOCK BOX" ................................... .- ....3
.3.
SPENDING UNDER THE REPUBLICAN MEDICARE PROPOSAL:
INCREASE OR' CUT? .................•... ." .................... 4
4.
THE PRESIDENT'S MEDICARE SAVINGS: $124 OR $192 BILLION? ..... 5
5.
PREMIUM INCREASES UNDER THE REPUBLICAN PLAN ............. 6
6.
REPUBLICAN MEDICARE "CHOICES" DON'T SAVE MONEY .......... 7
7.
HIDDEN BENEFICIARY COSTS IN THE REPUBLICAN PLAN ...........8
8.
REPEALING PROTECTIONS FOR LOW-INCOME MEDICARE
BENEFICIARIES ~ ..... '..........................................9
9.
ENDING MEDICAID PROTECTIONS AGAINST SPOUSAL
IMPOVERISHMENT ...................•....................•..10
10.
ENDING NURSING HOME QUALITY STANDARDS ...................12
�SECURING THE MEDICARE TRUST FUND
THE CLAIM:
Republicans claim that they are cutting $270 billion from Medicare in order to save the
program from insolvency.
THE FACTS:
The Republican $270 Billion Medicare Cut Is Not Necessary
More than half of the cuts in the House and Senate bills have nothing to do with
Part A and will not extend the life of the trust fund one day.
Under the House plan, only about $130 billion of the $270 billion Medicare cuts come
from Part A. The remaining $140 billion in Part B cuts go to general revenues ..
•
•
•
They raise premiums -- and none of that money helps the Part A trust fund.
They lower payments to physicians and other providers of outpatient services -
and none of that money helps the trust fund.
Under the Senate plan, only about $120 billion of the $270 billion Medicare cuts come
from Part A. The remaining $150 billion in Part B cuts go to general revenues.
•
The Se~ate plan raises premiums, doubles deductibles and lowers payments to
health care providers
•
It imposes a new Part B premium-on beneficiaries with incomes above $50,000
($75,000 for couples) -- and none of that money helps the Part A trust fund.
•
. It gradually raises the eligibility age for Medicare from 65 to 67 -- and very
little of that money helps the trust fund.
The President's Plan to Secure the Trust Fund
•
The President's balanced budget proposal shows that we can balance the budget
and secure the Medicare Trust Fund without cutting benefits or increasing costs
for people on Medicare.
�Part A of Medicare, which pays mostly for hospitalization, is financed through the
Hospital Insurance Trust Fund. In April, the trustees of the fund reported that the trust
fund would be unable to cover its expenses by 2002. The trustees have reported nine
times that the fund would be insolvent in seven years or less. Each time, Congress
has taken steps to extend the solvency of the trust fund.
The President has acted three times since taking office to extend the life of the trust
fund.
In 1993, the Medicare trustees projected that the trust fund would be exhausted
in six years. The President offered a package of reforms -- opposed by every
Republican in Congress -- that pushed back that date by three years.
•
•
•
In 1994, the Administration proposed a health reform plan that would have
strengthened the trust fund for an additional five years.
Under the President's balanced budget proposal, payments from the trust fund
would be reduced by $89 billion over the next seven years. According to
career actuaries, this would secure the trust fund until 2006.
The President's plan secures the trust fund without imposing any new cost increases on
beneficiaries.
2
�"
THE MEDICARE ttLOCK BOX If
THE CLAIM:
Republicans claim that their Medicare cuts are not being used to pay for their $245 billion tax
cut. House Re}!)ublicans say that to prove that Medicare cuts are for Medicare alone, they
plan to vote on Medicare cuts separately. Senate Republicans passed an amendment in the
Finance Committee creating a so-called "'lock box" to P.ut all of the Part B beneficiary savings
into the Part A Trust Fund.
THE FACTS:
Both of these proposals are merely gimmicks.
The Republicans could lower their Medicare cut by $150 billion -- take away every
penny of extra premium increase, extra deductible -- by simply lowering their tax cut
by $150 billion. No accounting gimmick or separate account can hide that fact.
Their reasoning is like a person who spends $5,000 less on health care for his family
to pay for a $5,000 Las Vegas vacation but denies that he is cutting health care to pay
for a vacation because he promises to put that $5,000 in a special trust account to pay
for food and rent. Anyway you slice it, if he didn't have to pay for a $5,000 vacation,
he wouldn't have to spend $5,000 less on health care for his family. And, anyway you
slice it, if the Republicans didn't have to pay for a $245 billion tax cut, they wouldn't
have to cut $270 billion from Medicare -- $150 billion more than is needed to secure.
the trust fund.
•
The Senate Finance Committee amendment is also a gimmick. They create a so-called
"lock box" to put all of the Part B beneficiary savings into Part A and claim that this
means they will use Medicare cuts to save the trust fund, not to pay for their tax cut.
•
By doing this, they are admitting that about $150 billion of their Medicare cuts go to
general revenues to pay for the tax cut - not to strengthen the Medicare Trust Fund.
Then they say that they will transfer that $150 billion from general revenues to the
trust fund.
•
One could just as easily say that revenue from the income tax, for example, should go
into the Medicare Trust Fund, but that would leave the government with nothing to
pay for defense, education or the environment.
•
This gimmick can not hide the fact that RepUblicans need $270 billion from Medicare
because they want to give a $245 billion tax cut. If they simply lowered their tax cut
by $150 billion, they could lower their extreme Medicare cuts by the same amount.
�SPENDING UNDER THE REPUBLICAN MEDICARE PROPOSAL:
INCREASE OR CUT?
THE CLAIM:
The Republicans say that they are not cutting Medicare because they will spend $6,700 per
beneficiary in 2002 as compared to the $4,800 that is spent today.
THE FACTS:
•
Under current law, the Congressional Budget Office (CBO) projects that Medicare
spending per beneficiary will grow from to $4,800 to $8,400 by 2002. Even by their
own assumptions, the Republican plan would cut spending per beneficiary from $8,400
to $6,700 in 2002 alone. That is $1,700 less per person than Medicare is projected
to spend.
•
If Medicare spending were constrained to the projected rate of growth in private sector
spending, Medicare would spend $7,700 per person in 2002. Under the Republican
plan, Medicare will spend $1,000 less per person.
•
This is a cut because spending in Medicare will not keep up with the private sector.
According to data from CBO, annual spending per person in the private sector is
expected to grow by 7.1 % per year between 1996 and 2002. The Republican plan
allows Medicare spending per person to grow by only 4.9% per year. That means that
the increase in per person spending under .Medicar.e will be 31 % lower than the
increase in spending in the private sector.
•
The real question is whether $6,700 will allow Medicare beneficiaries to keep the
benefits in 2002 that they have today. It will not. Because spending in the Medicare
program will not keep up with rising health care costs, Medicare will buy less than it
does today. People on Medicare will either have to pay more out of their own pockets
or get less.
4
�THE PRESIDENT'S MEDICARE SAVINGS: $124 OR $192 BILLION?
THE CLAIM:
Rep~blicans claim that the $124 billion in Medicare savings in the President's balanced
budget proposal amounts to $192 billion off of the Congressional Budget Office (CBO)
baseline.
I
THE FACTS:
•
The President's balanced budget proposal includes $124 billion in Medicare savings as
scored by the Office of Management and the Budget (OMB).
CBO and OMB have consistently scored specific Medicare savings proposals almost
the same. For example, OMB determined that the Medicare savings in the Health
Security Act would be $118.3 billion; CBO scored them at $117.6 billion. OMB
concluded that the Medicare "extenders" would save $28 billion;CBO found that they
would save $30 billion.
•
CBO's only analysis of the President's balanced budget proposal (June 16, 1995)
said that the Administration's Medicare savings would be $128 billion over seven
years.
•
Despite CBO's analysis, Republicans claim that if the President's Medicare savings
were taken from the CBO baseline, the President's proposal would equal $192 billion.
They reach this number by: (l) subtracting the projected growth in spending over
seven years under the Administration's (OMB) baseline from the projected growth in
spending over seven years under the CBO baseline; and (2) adding the difference to
the President's $124 billion in Medicare savings.
The Administration baseline assumes that Medicare spending over the next seven years
will be $70 billion lower than the CBO baseline. However,the baselines are different"
.
because CBO and OMB make different economic assumptions. It is not accurate
simply to subtract the Administration's Medicare baseline from theCBO baseline and.
add that number to the President's Medicare savings number.
.
•
To measure the President's savings off of the CBO baseline,the President's savings.
can be calculated as a percentage of the OMB baseline and that percentage can then
be taken off of the CBO baseline. Calculated this way, the President's $124 billion in
Medicare savings equals $130 billion on the CBO baseline.
5
�PREMIUM INCREASES UNDER THE REPUBLICAN PLAN
THE CLAIM:
The House Republicans claim that the Republican plan to raise Medicare premiums would
cost beneficiaries only $4 more per month in 2002 than the President's proposal.
THE FACTS:
•
Under the House plan, people on Medicare would pay $18 more each month than
they would if premiums stayed at 25% -- ,as under the President's plan. That is
nearly three times the amount that the Republicans promise.
•
Medicare beneficiaries pay premiums to receive Medicare Part B (which covers doctor
visits and other outpatient services). Those premiums are calculated as a percentage
of the total spent on Medicare Part B. Under current law, beginning in January 1996
Medicare beneficiaries will pay 25% of program costs.
Republicans are proposing to: (1) raise premiums permanently from 25% to 31.5% of
program costs; and (2) cut spending in Part B.
When Republicans claim that their 31.5% premium amounts to only $4 more than the
President's proposal, they are comparing apples to oranges. They are not applying the
25% premium and the 31.5% premium to the same size Medicare program. To
compare the true premium increase - apples to apples - they must first take into
accounttheir spending cut and then apply the 31.5% premium and the 25% premium.
•
Under the House plan, people 'on Medicare would pay $87 per month in 2002. If
premiums were maintained at the current 25% level as under the President's plan,
beneficiaries would pay $69 per month in 2002. That means that under the House
plan people on Medicare would pay $18 more each month.
•
The President's balanced budget proposal extends current law and keeps premiums at
25% of program costs. Throughout the 1980s and early 1990s, Congress kept
premiums at this level. However, in the early 90s, Congress became concerned that
keeping premiums at 25% of program costs would make premiums too burdensome
and voted to set a dollar level in law. The dollar level for fiscal year 1995 was
$46.10., But because health care costs have slowed, that amount was actually 31.5%
rather than 25% of program costs. The Republicans would force beneficiaries to
continue to pay this higher percentage. The President would leave current law in
place, which automatically returns premiums to 25% of costs in January 1996.
6
�REPUBLICAN MEDICARE "CHOICES" DONtT SAVE MONEY
THE CLAIM:
Republicans claim that new Medicare private plan choices will save money for the Medicare
program and its beneficiaries. Specifically, the Republicans say that by making more
managed care and medical savings accounts (MSA) available to beneficiaries, they will save
$30 to $50 billion over seven years.
THE FACTS:
Both House and Senate Republican Medicare plans include new managed care options and
medical savings accounts (MSA) for beneficiaries. They claim that these options will
produce Medicare savings through competition and efficiency. However, the plans they are
establishing are paid within the context of an arbitrarily set and capped Medicare budget.
Republican Plan Achieves Savings Through Use of Spending Caps
•
CBO confirms that the $43 billion in "managed care" savings from the Senate
Republican plan come from spending caps -- caps on Medicare payments for managed
care set at 31 percent below private sector growth rates (September 27, 1995).
The House Republican plan also relies on payment caps to reach their savings.
Under both plans, if the cost of Medicare benefits exceed the tight price caps, then
beneficiaries will either pay higher premiums or get fewer benefits. There is nothing
in the Republican bills that protects people on Medicare from plans shifting costs to
them.
Medical Savings Accounts Increase Medicare Costs
•
MSAs use the savings from the reduced cost of a high deductible plan to fund a tax
deferred grant to an individual which can be used to purchase health care. They are
theoretically designed to encourage individuals to be more cost sensitive in using
health services. However, they tend to attract healthy individuals who believe they
will not need health care. As a result, when Medicare pays a fixed contribution for
those beneficiaries (based on average Medicare payments), Medicare is likely to
overpay.
•
, CBO has concluded that Medicare MSAs don't save money, they cost money. CBO
says that MSAs "would cost about $2.3 billion as a result of adverse selection" -
approximately $1,000 per person per year for each beneficiary in an MSA (September
27, 1995). A Lewin-VHI Inc. study also just released says that MSAs cost between
$15 and $20 billion.
7
�HIDDEN BENEFICIARY COSTS IN THE REPUBLICAN PLAN
The Republicans have admitted that their plan will force people on Medicare to
pay more:
•
Both the House and Senate plans will increase premiums.
The Senate plan also cuts benefits and doubles deductibles from $100 a year
today to $210 a year in 2002.
•
The Senate plan also gradually delays Medicare eligibility from age 65 to 67
beginning in 2003.
But there are hidden costs as well. Republicans have said that they will not
retain financial protections that exist today for those people on Medicare.
Today, when Medicare pays for physicians' services, it sets the Medicare payment rate
for the doctor:. Medicare also limits the amount above the Medicare payment rate that
the doctor can charge the beneficiary. This limitation on so-called "balance billing"
protects Medicare beneficiaries from excess charges that so many of them can't afford
to pay.
Republicans have said that they will continue current limitations on balance billing for
traditiomil fee-for-service Medicare providers. However, beneficiaries in "Medicare
Choice" -- many of whom will join these plans because they can't afford more
expensive fee-for..;service -- will not be protected. Republicans will allow "Medicare
Choice" plans to charge beneficiaries these extra amounts. With deep cuts in federal
Medicare payments, plans may respond by lowering their reimbursements to doctors.
Doctors will in tum be free to charge people on Medicare more to make up their
,.
losses.
.
8·
�·.
REPEALING PROTECTIONS FOR LOW-INCOME MEDICARE BENEFICIARIES
The Republican Medicaid plan would repeal the requirement that states pay cost sharing
(premiums, copayments and deductibles) for low-income Medicare beneficiaries.
Current Law Protects Medicare Beneficiaries Who Can't Afford Cost Sharing
Under Medicaid, states pay Medicare premiums; copayments and deductibles for people with
incomes below 100 percent of the federal poverty level -- about $7,500 per year -- and
minimal assets (known as "qualified Medicare beneficiaries" or QMBs). Medicaid also
requires states to pay premiums for people on Medicare with incomes below 120 percent of
the federal poverty level and minimal assets (known as "selected low-income Medicare
beneficiaries" or SLMBs).
This year, typical Medicare beneficiaries paid about $550 to cover Medicare Part B premiums
and about $1,460 for all additional cost sharing under Parts A and B. There were
approximately 5.4 million low-income Medicare beneficiaries with Medicaid.coverage.
Medicaid paid about $9 billion (including both the federal and state share) to cover premiums
and cost sharing for these people.
Background and Legislative History
These protections were enacted as part of the Medicare Catastrophic Coverage Act of 1988,
and were one of the few provisions retained when the Act was repealed in 1989. The Senate
voted 99-0 and the House voted 349-57 to retain them as well as a few other provisions.
Republican Medicaid Block Grant Ends Protection for Low-Income Medicare
Beneficiaries
The Republican Medicaid block grant repeals the requirement that states pay cost sharing for.
low-income Medicare beneficiaries. Because the Republicans will cut Medicaid by $182
billion, most states will no longer be able to afford to pay for low-income Medicare
beneficiaries' premiums, deductibles and copayments. As a result, these beneficiaries will be
forced out of their fee-for-service plans into managed care. According to the Congressional
Budget Office: "... eliminating the entitlement to cost-sharing for Medicaid eligibles and
QMBs would increase enrollment as those beneficiaries sought out plans with lower cost
sharing requirements.
II
I
9
�ENDING MEDICAID PROTECTIONS AGAINST SPOUSAL IMPOVERISHMENT
The House Republican Medicaid plan would repeal the common ground law signed by
President Reagan to protect spouses from having to give up everything they have -- their car,
their home, and all their savings -- in order to pay for nursing home care for their sick
spouse.
Current Law Protects Spouses and Their Families from Poverty
j
Current' federal law ensures that spouses of people needing nursing home care do not have to
lose everything they have in order for their spouse to qualify for Medicaid:
•
States must let spouses ikeep income equal to 150% of the national poverty
level - about $15,000 per year.
•
States must let spouses keep a minimum amount of their assets. The minimum
is set by the state and may range from about $15,000 to $75,000. The value of
the spouse's home and car are not counted toward the asset limit, which
protects spouses from having to sell these items to qualify for Medicaid.
,
Since this federal law went into effect in 1989, it has protected about 450,000 spouses of
nursing home residents. Most of these spouses are women. It also protects their families
from being forced to pay the nursing home costs and from having to support the spouse not
needing nursing home care.
Background and Legislative History
Most Americans must pay for nursing home care with their own funds for as long as they
can. Medicare provides minimal long-term care coverage, and Medicaid only covers nursing
home care after one has "spent down" and meets Medicaid's eligibility requirements. Prior to
enactment of the protections against spousal impoverishment in 1988, spouses, most often
wives, of people needing nursing home care, were often forced into poverty before they
qualified for Medicaid. To avoid poverty, many elderly couples were forced to take desperate
steps, such as divorcing or suing their sick spouse for support.
These current protections against spousal impoverishment were enacted as part of the
Medicare Catastrophic Coverage Act of 1988, and were one of the few provisions retained
when the Act was repealed in 1989,' The Senate voted 99-0 and the House voted 349-57 to
retain the spousal impoverishment and a few other proviSIons,
10
�..
.~
Republican Medicaid Block Grant Ends Spousal Impoverishment Protection
.The House Medicaid block grants as introduced repeal the protections against spousal
impoverishment. 'When House Democrats offered an amendment in the Commerce
Committee to restore these protections, the amendment was defeated on a party-line vote.
Senate Democrats offered a similar amendment in the Finance Committee and the amendment
was adopted.
Medicaid is the largest payor of long-tenn care, covering over two-thirds of all nursing home
residents. Without the current federal protections against spousal impoverishment, there
would be no federal assurance that spouses could keep a minimum amount of their income
and assets. The spouses and families of nursing home residents could be faced with the costs
of their sick relatives' nursing home care -- care which now costs an average of $38,000 a
year. Nursing home costs could once again ruin the lives of spouses and their families.
Because Republicans also propose to slash Medicaid by $182 billion over seven years, cutting
federal Medicaid payments to states by 30% in 2002, states may be forced to offset the loss
of federal funding' by not protecting the income and assets ·of spouses of nursing home
residents. Spouses could be forced to sell their home, car and other essential assets, and to
spend everything including their Social Security check on their spouse's nursing home care.
I1
�,.
ENDING MEDICAID,NURSING HOME QUALITY STANDARDS
The Republican Medicaid proposals repeal the common ground law signed by President
Reagan that established quality standards for nursing homes and institutions caring for people
with mental retardation.
Background and Legislative History
President Reagan signed federal, nursing home quality standards, into law as part of the
Omnibus Reconciliation Act of 1987. A 1986 report by the National Academy of Science's
Institute of Medicine had documented an epidemic of substandard care in nursing home
facilities around the nation. In 27 states, at least one-third of the facilities had:care so poor
that it jeopardized the health and safety ofresidents. Nursing home residents were sometimes
found lying in their own waste, injured by rough handling, suffering with bed sores while tied
to their beds at understaffed homes, verbally intimidated, and summarily evicted when their
nursing home found a prospective patient willing to pay more for their bed.
Current Federal Quality Standards
Current federal law provides minimum standards for nursing homes that protect residents
from abuse and neglect including:
•
•
•
•
limiting the use of drugs and restraints
prohibiting nursing homes from "dumping" residents -- evicting them when
they've run out of money and qualify for Medicaip
giving nursing home residents the right to appeal 'decisions about their care
ensuring that nursing aides are trained and do not have a history of abuse
The 1987 law and subsequent amendments have led to dramatic improvements in the quality
of nursing home care. The use of physical restraints and psychotropic drugs has dropped
sharply. The number of registered nurses on duty in nursing homes has increased, as has the
training of nurses' aides. Nevertheless, more progress is needed. Inspectors from the Health
Care Financing Administration continue to find substandard care at some nursing homes. For
example, one resident was hospitalized after maggots and larvae were found in a foot wound
- the nursing home said it did not have enough staff to give baths. Repealing the federal
quality standards would undermine the progress we have achieved and set us back.
Republican Medicaid Block Grant Repeals These Fundamental Protections
Under the guise of reform, Republicans propose to repeal the federal Medicaid quality
,
'standards, as well as the requirement that Medicaid cover nursing home care at all. Medicaid
is now the largest payor of long-term care, covering over two-thirds of all nursing home
residents. As many as 350,000 elderly and disabled Americans would lose nursing home
coverage in 2002, and nursing home residents would be vulnerable to abuse and neglect, to
being inappropriately restrained and drugged, and dumped onto the streets when they run out
of money.
12
�Goal: Give states new options in coverage of acute care and long term care benefits for Medicaid
eligible individuals while preserving individual entitlement to a defined contribution for medical
assistance as well as state entitlement to FFP for per capita payments for eligible indviduals.
1. Eligibility: Maintain individual entitlement to benefits for all mandatory coverage
groups as well as groups that states opt to cover under their plans.
la. Eligibility for inpatient mental illness services: Eliminate IMD exclusion for those
inpatient mental illness and substance abuse services offered by plans under standard benefit
package.
lb. Coverage of former AFDC recipients and welfare to work: Require that states
maintain coverage for persons who would have qualified for Medicaid under prior AFDC and SSI
programs as well as a 12-month transitional benefit for welfare to work.
Ie. Optional coverage for' non-categorical poor: Revise federal DSH program
(discussed below) and distribute funds to states to permit states to revise coverage rules to extend
benefits to some or all low income persons with incomes at or below 100 percent FPL or lower
level. Iflower than FPL, require coverage of children and pregnant women at FPL. Normal FFP
rules would apply.
Id. Eligibility for immunizations: Require states to cover immunization services for all
children without insurance, as well as children covered by Medicaid. Clarify that for children not
otherwise entitled to Medicaid; state agency can carry out this obligation through interagency
agreement with state health agency under which payment for cost of immunizing uninsured
children is made to health agency. Require that as condition of participation in state Medicaid
programs, pharmaceutical companies extend to state Medicaid programs same price for vaccine
purchased and distributed by state for same price as that paid by CDC.
Ie. Eligibility for non-low income children and pregnant women. PIape 200 percent
of poverty upper limit on coverage of children and pregnant women.
If. Treatment of community spouses. Limit maximum asset retention for non
instiutionalited spouses to three times the minimum level.
2. Benefits: Allow states to convert existing defined benefit categories i~to a defined
contribution (per-capita cap) and to purchase coverage for beneficiaries from managed
care plans meeting minimum federal requirements. Establish minimum general
requirements for coverage that include the following:
•
periodic preventive health exams for children under 19 that meet professional standards
for periodicity and content.
1
�•
immunizations for children
•
vision and hearing exams for children <19 and treatment
•
denta1 care for chi1dren < 19
•
pregnancy related care
•
medical, hospital, diagnostic and other services covered as standard benefits under state
employee health benefit plans
3a. Supplemental required EPSDT benefits: Permit states to provide additional
benefits for children covered under EPSDT that are in addition to standard benefits either
through wrap-around benefit arrangements or as direct grants to qualified providers. In
the event that additional benefits are included in premiums paid by states to managed care
plans, require plans to meet supplemental requirements applicable to the management of
children with special health care needs.
3b. Coverage standards for children: Require that in covering children (whether
through purchased insurance or direct benefit) that states require payment for covered
benefits needed to promote growth and development and the attainment of optimal
functioning.
4. Cost-sharing and premiums: Prohibit premiums for persons and families with
incomes at or below the FPL and for pregnant women and children under 6 with incomes
below 133 percent of poverty. Prohibit deductibles but allow nominal copayments for
services for persons with incomes above the federal poverty level. Prohibit copayments for
preventive services for children and ambulatory pregnancy-related care, services for
persons in long term care facilities, and emergency services not denied as inappropriate by
health plans or by state.
5. QMBs: Require that states continue to pay premiums, deductibles and
coinsurance for QMBs.
6. Long term care: Permit states to convert LTC coverage for NF, ICiYMR, home
health care, case management and other benefits into.a defined contribution (per capita
cap) that provides a continuum of institutional and home and community based care
services to elderly and disabled persons. Services would include nursing facility, ICFIMR,
home health care, case management, and services now included in Section 1915(c).
Eliminate need to obtain waivers for 1915c programs and permit states to offer this
continuum as a state option.
7. Managed care: Incorporate Chafee bill standards and require HCFA approval on
2
�contracts in excess of $1 million in annualized expenditures for managed care enrollment.
8. Treatment of ~SB: Require states to maintain DSB payments to hospitals
, meeting Medicare requirements and to make DSB payments to ambulatory DSB programs
including at a minimum Section 329, 330, 340 grantees and rural health clinics. Permit
states to use the excess toward the cost of covering some or all low income persons (see #1).
9, Fraud and abuse: Retain federal authority to enforce fraud and abuse
requirements.
10. Quality: Preserve federal NF standards and authorize Secretary to develop
standards for continuum ofcare long term care programs.
3
�· ..
'; ';;:'OCT 18
'95
12: llPM GWU CHPR
, P.2
CENTER 1101. HEALTH POLIC';" RESEARcH '
'October is, i9~i5
'
MEMORANDUM
TO: Carol Rasco
FR: Sara Rosenbaum
RE: Follow up issues
As promised here are my thoughts on a per capita cap:
,.
'
1. Include all services, all enrollee groups in a single per-capita cap that reflects thif'euiTent state
by state mix ofbeneflciaries and services.
2. The' cap would increase by the MCPI (CPI?) for two years.,
3. During the two year period the Secretary would develop a methodology for updating the per
capita cap (i.e., rebasing the cap) every three years in accordance with a formula that takes into
account demographics of the Medicaid population, service rhix changes, tec1ulblcigy, intensity of
care, price, and other factors that would affect spending levels for Medicaid popuhitibns.
I just do not think that the information captured by HCF A is eitb:er fast eriough'Or good
enough to support a different system. For example, states might get per capita paymentS in a year
based on their estimates of how many persons they would cover underwhich sub.;categoriesand
would then reconcile these estimates withtheir actual expenditures (nuinberbfpersons 'enrolled
and served. by sub-category of enrollee). The amount oftime that it woUld take toaccura1:'ely
calculate not only the number ofpersotis served but services by eligibility sub-categorY seems to
be more problem than it is worth. If a blended per capita rate were calculated for each 'state, the
only reconciliation task would be to finalize the actual number ot'persons served.
With respect to coverage for AFDC beneficiaries, I do not see any answer other than
requiring states to maintain the old AFDe rules for now, as called for in the "velfate bill, for
Medicaid purposes (the question also is whether you can get the same agreement for some or all
ofthe persons losing SSI benefits). Ideally Medicaid would be· provided tn accordance With a
straight poverty measurement, and welfare receipt would not matter. 'This "win be'expensive,
however. If you use a grand fathering rule with a sunset for the'fkst i years follOWing e~tment
of welfare refonn and require a new and simpler system to be in place by the third year, this
would allow time for development of a Medicaid reform plan that simplifies eligibility and ties it
,2021 K STREET,
N.W.,
SUITE 800 • WASHINGTON,
DC 20052
• (202) 296.6922" FAx (202) 785.0114
�~~·OCT
18 '95
12:12PM GWU CHPR
to a straight poverty measure.
Let me know if you need anything else.
P.3
�E X E CUT I V E
OFF ICE
o
F
THE
PRE SID E N T
01-Nov-1995 09:22pm
TO:
justice
FROM:
owner-justice
SUBJECT:
FYI: Dart to Clinton: Veto Budget!
Justice For All
jdart@tsbbs02.tnet.com
I don't want my taxes cut at the expense of human health and human
lives, at the expense of my grandchildren's ability to live the
American dream.
October 30,1995
Hon. Bill Clinton:
President
The White House
Washington, D.C. 20500·
Dear Mr. President:
I JOIN THE GREAT MAJORITY OF 49 MILLION AMERICANS WITH DISABILITIES
AND THEIR FAMILIES in congratulating you on your pledge to veto the
Budget Reconciliation Act. It violates the most profound moral,
economic and structural values of our nation. It abdicates federal
responsibility for U.S. citizens to the states. It weakens federal
guarantees of Medicare, Medicaid and other essential citizen
services in order to lower taxes for the well-to-do.
WE KNOW THAT YOU WILL NOT AGREE .TO ANY .COMPROMISE - on the budget
bill or any other measure - that cuts essential investments in the
health, productivity and security of our people, that reduces taxes
for the wealthy in a time of escalating debt,or that weakens the
dynamic citizen-state-federal partnership which has created the
most successful culture in history.
WE URGE THAT YOUR VETO MESSAGE INCLUDE SPECIFIC REFERENCES TO THE
INTERESTS OF THE DISABILITY COMMUNITY.
�WE OPPOSE WEAKENING THE FEDERAL ROLE in guaranteeing the basic
services, benefits and rights that are due to American citizens.
These guarantees were set out in law precisely because many states
were not meeting their fundamental responsibilities, especially to
citizens with disabilities. The necessity for such guarantees now
is emphasized by the recent request to the Congress' from 24
governors that they not be required to provide Medicaid services
to 'certain groups, including people with disabilities.
WE OPPOSE CUTTING FEDERAL GUARANTEES AND FUNDING OF MEDIcARE AND
ESPECIALLY MEDICAID services. In states with severe budget '
problems health care will be rationed. Ordinary sickness will
become'acute illness. Primary and secondary disability will
increase. Loss of, Medicaid funded community based long term care
will increase homelessness and institutionalization. Total medical
costs will soar. Many Americans will not live their potential life
span. People with disabilities will be among the first to suffer
and to die.
WE OPPOSE CUTTING THOSE BASIC INVESTMENTS IN EDUCATION, jobs,
transportation, housing, the environment and welfare which
form the foundation for a responsible culture. While most
programs can and must be improved, many of the proposed reductions
will severely limit the ability of our people - with and without
disabilities - to be productive, to pay the national debt, to
participate in their families and communities, to compete in an age
of exploding technological complexity and intense international
commerce.
I HAVE THE GREATEST RESPECT FOR ALL WHO INSIST ON BALANCING THE
BUDGET. When governments run out of money, community
responsibility crumbles. It's devil take the hindmost. People with
disabilities are the first victims. I agree with those who say
that almost anything is better than letting this great democracy go
bankrupt. But we are not talking here about sacrifices necessary
to save America from bankruptcy. We are talking about sacrificing
the health, productivity and welfare of America's most
disadvantaged citizens to the short term enrichment of those who
are already benefiting from record highs for the stock market, for
corporate profits and in terms of income for the upper middle class
and the very wealthy.
WE CAN FULFILL OUR FUNDAMENTAL SOCIAL OBLIGATIONS and at the same
time balance the budget and reduce the debt - if all of us in the
public and private sector carry our fair share of the load. If a
responsible deficit reduction plan is adopted, I would be proud to
pay temporarily higher taxes and a Medicare premium which is
commensurate with my income. I would be proud to relinquish my
Social Security benefits to those who truly need them.
I SPEAK TO YOU FROM THE DEPTHS OF MY CONSCIENCE - as a Republican,
a grandfather, a disability rights advocate, as an American. I
don't want my taxes cut at the expense of human health and human
lives, at the expense of my grandchildren's ability to live the
American dream.'
�"
.
.
MR. PRESIDENT, I CONGRATULATE YOU on your pledge'to stand and 'fight
for fundamental American values. I congratulate you on your
pledges to support the ADA, the IDEA, community-based long term
care, including consumer driven personal assistance services, and
many other initiatives that. enable people with disabilities to move
from welfare to work, from institutions to full participation in
their families and communities. I congratulate you on your
unprecedented inclusion of disability community leaders as
appointees in your administration, and as participants in the
administration's decision making processes.
I am proud to have served under your leadership.
God bless you and
Justin Dart
yours~
�
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2010-0198-Sb-medicare-medicaid-3
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5f32bde420116b163e2ccc59adac9ac1
PDF Text
Text
THE WHITE HOUSE
Offic'e' of Media Affairs
September 14, 1995
Contact: 202/456-7150
THE UNITED STATES
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduce Medicaid Payments to States by 30 Percent in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20 percent over seven years and 30 percent in 2002. Even if
states absorb half of the cuts by reducing services and provider payments, they would still
have to eliminate coverage for 8.8 million people in 2002, according to the Urban Institute.
Over 40 percent of all people losing coverage would- be concentrated in five states: California,
Florida, New York, Texas and North Carolina. The 8.8 million who lose coverage includes:
•.
920,000 older Americans; ,
.
•
1.4 million people with disabilities; and
•
6.3 million children and their families.
The Republican proposal .would force states to eliminate coverage for about; 350,000'
nursing home residents and another 330,000 people needing home care in 2002. '"
Medicaid is the largest insurer of long-tenn care for all Americans, including the middle class.
Currently, Medicaid covers 68 percent of the nation's 1.3 million nursing hom~ residents.
Medicaid also serves about 1.4 million older Americans and people with disabilities using
home care. Without Medicaid, families could not afford nursing home care that costs an
average of $38,000 per year.
Tbe Republican proposal would force states to eliminate coverage for 4.4' million children
in 2002.'" Currently, over 20 percent of the nation's children rely on Medicaid for their basic
health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case
of emergencies for about 18 million children.
States could avoid these difficult choices only by increasing their Medicaid spending by 40
percent in 2002 -- by raising property or sales taxes, or cutting other critical state spending.
The President I s Balanced Budget P r o p o s a l .
.
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant 'contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to ,
unexpected changes in the number of people covered. It does not put states at risk and
. dismantle a program that has served as a. critical safety net -- as would happen under the
Republican proposal.
* u.s. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
�The Republican Budget Resolution Conference Agreement:
Estimated ~umber of People Losing Health Coverage, 2002
STATE
U.S.
TOTAL
8.8 million
Alabama
'102,000
Alaska
22,000
Arizona
110,000
Arkansas
122,000
' 1.2 million
California
Colorado
97,000
Q:>nnecticut
74,000
21,000
Delaware
District of Columbia 20,000
Florida
706,000
Georgia
383,000
36,000
Hawaii
Idaho
34,000
274,000
Illinois
112,000
Indiana
Iowa
69,000
40,000
kansas
Kentucky
171,000
154,000
Louisiana
'Maine
34,000
116,00'0,
Maryland
210,000
Massachusetts
215,000
Michigan
88,000
Minnesota
Mississippi
141,000
. Missouri
83,000 "
27,000
Montana
41,000
Nebraska
26,000
Nevada
1,100
New Hampshire
166,000
New Jersey
, New Mexico
80,000
645,000
New York
455,000
North Carolina
18,000
North Dakota
292,000
Ohio
125,000
Oklahoma
118,000
Oregon
308',000
Pennsylvania
51,000
Rhode Island
Continued.;.
Aged
Disabl,ed ' Families:
Adults & Kids
920,000 1.4 million 6.3 million
12,300
1,200
na
16,200
'95,000
10,700
7,500
1,400
1,500
78,900 "
41,200
3,400
3,100
22,000
11,800
8,700
4,500
17,700
16,600
4,300
10,600
24,100
15,200
11,300
18,200
10,200
3,000·
4/700
2,900
na
15,300
8,000
66,400
79,300
2,700 .
32,200
14,000
8,900
3],600
7,800
25,500
1,900
64,500
19,200
na
na
29,200
76,900
145,800
918,100
16,800
70,000
12,300
54,200
3,200
i6,800
4,400
14,400
532,]00
94,900
63,900
277,800
5,600
27,500
5,500
25,500
55,900
,196,100
17,400
83,200
11,700
49,100
29,200
6,100
43,200
110,600
26,800
111,000
7,200
23,000
22,200
83,290
43,600
142,200
157,000
42,400
12,100,
64,300
92,900
29,900
13,000 '
59,600
5,600
18,300
5,500
31,000
19,000
4,1~0
na
29,000 '
'17,100
100,400
64,000
-i,300
50,100
16,400
15,400
67,300
11,200
na
121,600
55,300
478,200 '
312,300
12,600
209,800
94,200
94,ioO ,
209,400 '
32;100
Long-Tenn
Care Users
' Children
I
680,000 4.4 million
11,000
na
na
45,800
12,700
na
13,300
53,100
34,400
571,700
9,200
48,000
11,800
37,100
12,100
1,900
1,500
10,100
49,100 . ',423,000
]88,900
24,600
1,500
18,700
2,400
17,800
25,800
137,9pO
.56,800
11,000 ,
8;500
32,800
4,500 .
19,700
22,400
73,400
3,900
79,000
15,400 '
3,500
58,900
7,400
22,900
94,700
22,900 .
100,7,00
47,000
43,900
5,700
67,300
7,900
39,300 ,
2,100 '
10,100'
4,200
23,100
12,900
1,800
na
16;700
4,200
71,300
40,900
.2,300
28,000
3,700
'8,600
22,200
12,000
na
79,600
37,500
343,700
204,600.
8800 . '
,,
143,]00
65,800
. 62,700
' 150,800
21,600
�Methodology' for the Medicaid State Estimates .
The following describes the sources for the estimates in the September ,14, 1995 White House
Medicaid document.
'
Most of the estimates come from the July 1995 report by the Urban Institute entitled: "The
Impact of the Budget Resoiution Conference Agreement on Medicaid Expenditures" (July 1995).
This report and supplemental analyses by the Urban Institute are the source for:
•
Dollar and percent reduction in Federal Medicaid payments by state;
•
Number of total people losing coverage, number of people in families, elderly, and
disabled losing coverage under the proposal.
The estimates for the number of children 'and nursing home residents and home health users
losing coverage were calculated by the Department of Health and Human ServiceS based on the
Urban Institute data. Both sets of estimates were derived by: (a) calculating the number of
children and nursing home residents and home health users in 1993 as a percent of people in
families and the aged and disabled, respectively; and (b) applying those percentages to the
number of people in families and aged and disabled losing coverage in 2002. For example, in
California, 62.3 percent ofpeople in families were children in FY 1993. It was assumed that
within families there is no disproportionate reductions in coverage of adults or children ~- people
are cut in proportion to their representation the group~ This percent of children was multiplied by
the Urban Institute estimate of the number of people in families losing coverage -- 918,095 -- to
estimate that about 571;700 children in California could lose coverage, in 2002.
The estimated increase in state spending to offset the loss of Federal funds was also calculated by
the Department of Health and Human Services based ori the Urban Institute data. This
percentage increase waS based on the Urban Institute's estimates of Federal baseline spending in
2002 and the reduction resulting from the proposal. Using the 1996 FMAPs,the state share in
2002 was estimated. Then, the reduction resulting from the proposal was added to the estimated ;
state share to calculate the percent increase in state share if the state:increased its spending to
.
offset the loss of Federal funds.
Other facts in the document come from secondary sources. The percent of children covered by
Medicaid by state comes from the March 1994 Current Population Survey. The number of
children and home care users covered by Medicaid by state comes from the 1994 Health Care
Financing Administration tabulation of2082 data, submitted by states. The data on nursing
home residents come from Harrington, Thollaug and Summers' report: ~'State Data' Book on
Nursing Facilities, Staffing, Residents; and Facility DeficienCies, 1991 - 1991" (January 1995).
�,
"
, The Republican Budget Resolution Confere~ce Agreem~nt:
Estimated Number of People Losing Health Coverage, 2002
..
Continued
,
STATE
U.S.
South Carolina
South Dakota
.Tennessee
Texas
Utah
Vennont
Virginia
Washington
West Virginia
Wisconsin
Wyomirig
TOTAL'
8.8 million
149,000
19,000
246,000
687,000
53,000
20,000
236,000
. 183,000
140,000
94,000
15;000
Aged
Families:
Disabled
Adults & Kids
920,000 1.4 million 6.3 million,
21,300
2,300
27,800
66,800
3,200
2,400
32,400
12,900
13,200
12,800
1,000
24,700
3,300
61,000
68,500
6,200
3,500
36,400
29,500
26,100
23,000
1,700
102,600
13,300
157,000
551,600
43,800
14,200
167,100
140,500
: 100,300
58,000
12,200
. Long-Tenn
'Care Users
.Children
680,000 4.4 million
7,800
2,100
5,800
43,100
3,100
1,900
. 17,800
8,200
.5,400
11,300
1,600
73,300
9,690
112,000
.394,100
29,000
9,000
117,000
91,200
60,200
42,600
8,500
NOTES:
Numbers are rounded to the nearest hundred or thousand; as a result nUmbers may not sum to totals due to rounding.
"Long-tenn care users" include residents ofskilled nursing facilities and users of home care. The "aged",
"disabled" and "families: adults & kids" columns sum to the total recipients. The number of long-tenn care
recipients and children losing coverage are subsets of the "aged", "disabled" and "families: adults & kids" estimates
and thus cannot be added to these estimates. The frrst four columns are from the Urban Institute's Medicaid
Expenditure Growth Model. The last two columns are U.S. Department of Health and Human Services' estimates
based on the Urban Institute's estimates. All are based on the assumption that states could achieve approximately
half of the savings target through reducing their growth rate per recipient to inflation plus 1.9 percent. Data for
Arizona, Alaska and New Hampshire were insufficient for these analyses.
�THE WHITE HOUSE
Office of Media Affairs
, September 14, 1995
Contact: 202/456-7150
ALABAMA, '
, The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Cover,age
Republican's Proposal; Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Alabaina would
lose' $2 billion over the seven years,a 22 % reduction in 2002 alone~ Even if Alabama' could
absorb half of the cuts by 'reducing services and'provider payments, it would still have to
eliminate coverage for 102,000 people in 2002, according to the Urb~n Institute, including:
•
12,300 older Americans;
•
25,500 people with disabilities; and
•
64,500 children and their families.
The Republican proposal would force Alabama to eliminate coverage ,for about H,Ooo
people needing long-term care in 2002. til Medicaid is the largest insurer 'of long-temi care
for all Americans, including the middle class. Currently, Medicaid covers 72 % o~ the 19,500
nursing home residents in Alabama. Medicai4 also serves about 37,400 older Am~ricans and
people with disabilities using home care in Alabama. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an,average of $38,000 per
year nationally.
The Republican proposal would force Alabama to eliminate coverage for 45,800 'children
, in 2002. lie Currently, 16% of the children in Alabama rely on Medicaid for 'their basic health
needs. Medicaid pays for immunizations; regular check-ups, and intensive care ini case of
emergencies for about 244,000 children in Alabama.
,
Alabama could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 51 % in 2002 -- by raising' property' or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and sti.11 a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share'
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This' policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at ris~ and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
• U,5, Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to to~sdue to rounding,
�-
THE WHITE HOUSE
Office of Media Affairs
September 14,1995
Contad:202/456·7150
ALASKA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in'2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Alaska would lose
-$429 million over the seven years, a 32% reduction in 2002 alone. Even if Alaska could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 22,000 people in 2002, according to the Urban Institute, including: '
•
1,200 older Americans';
•
1,900 people with disabilities; and
•
19,200 children and their families.
a
The Republican proposal would force A.laska to eliminate coverage for significant
number of people needing long-term care in 2002~'" Medicaid is the,largest inSurer of long
term care for all Americans, including the middle class. Currently, Medicaid covers 86% of
the 500 nursing home residents in Alaska: _Medicaid also serves about 1,000 older Americans
and people with disabilitic;s using home care in Aiaska. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs, an average of $38,000 per
year nationally.
The Republican proposal would force Alaska to eliminate coverage for 12,700 children in
2002.'" Currently, 20% of the children in Alaska rely on Medicaid for'their basic: health
needs. Medicaid pays for immunizations, regular check-ups, Cl;nd intensive care in case of
emergencies for about 39,000 children in Alaska.'
'
'
Alaska c'ould avoid these difficult choices forced by the Republican proposal only:by
'increasing its Medicaid spending by 32 % in 2002 -- by raising property or sales taxes, or
cutting other critical state- spending.
'
'
The President's Balanced Budget Proposal ~
,
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
.
Medicaid policy produces savings by reducing and retargetting d,isprop'ortionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicai4 spending
per recipient. This policy constrains Federal spending but 'allows states to respond to
unexpected changes 'in the number of people covered. It does not put'states at risk and
dismantle a program that has served asa critical safety net -- as would happen under the
Republican proposal.
. . u.s. Depanment of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rouUding.
)
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
. '. ARIZONA
. The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
,
..
Republican's Proposal: Reduces Medicaid Payments to States by 30% ip2002'
Republicans are proposing to cut more than $182 billion from FederalMedicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in i002. Arizona would .
. lose $3 billion over the ~even years, a 33% reduction in' 2002 alone. Even if Arizona could
'absorb half of the cuts by reducing services 'and provider payments, it would still have to .
eliminate coverage fQr 110,000 people in 2002, according to the Urban InStitute. ':.
'Ille Republican proposal would force 'Arizona to elimin~te coverage for a significant
nwnber of people needing long-term care in 2002.11& Medicaid is the largest insurer of long:..
term care for all Americans" including the middle class. Currently, Medicaid cov~rs59% of
the 10,500 nursing home residents in Arizona ... Medicaid also serves about 11,700 older
Americans and people with disabilities using home care in Arizona. Without Medicaid,
families of the elderly and disabled could not afford nursing hom~ car:e that costs an average of
$38,000 per year nationally.
.
The Republican proposal would force Arizona to eliminate coverage for a significant
nwnber of children in 2002.11& Currently, 15 % of the children in' Arizona rely on Medicaid
for their basic health needs. Medicaid pays for immuniZations, regular check-ups, and
intensive care incase of emergencies for about 310,000 children in Arizona. .
,
Arizona could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 63 % in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
.
'
.
.'
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
th~ Republican cut ~d still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility; and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected. changes in'the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net --'as would happen under the
Republican proposal;
Note: Due to data limitations, specific estimates (or Arizona are not available.
,
• U.S. Department of Health & Human Services estimates based au the Urban Institute data; numbers may not sum to totals due to rounding.
�,
"
THE WHITEHOUSE
Office of Media Affairs
September 14, 1995
,
'
Contact: 202/456-7150
ARKANSAS
, The Republican Budget Resolution Conference Agreement:
Medicaid Cuts, Will Force States' to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending,
between 1996'and.2002: a cut of 20% ov~r seven'years and 30% in 2002. Arkansas would
lose $2 billion over the seven years, a 33% reduction in 2002 alone. Even if Arkansas
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 122;000 people in 2002, according to the Urban Institute, including:
.' '.
16,200 older Am~ricans;
'.
29,200 people with disabilities; 'and
•
76,900 children and their families.
The Republican proposal would force Arkansas to eliminate coverage for about 13,300
people needing long-term care in 2002. • Medicaid is the largest insurer of long-term care
for all Americ;ans, including the middle class. Currently, Medicaid covers 78% of the 19,800
nursing home residents in Arkansas. Medicaid ,also serves about 19,500 older Americans arid
people with disabilities using home care in Arkansas. Without Medicaid, families of the
elderly and disabled couid not afford nursing home care that costs an average of $38,000 per
year 'nationally.
The Republican proposal would force Arkansas to eliminate coverage for 53,100 children
in 2002.· Currently, 20% of the children in Arkansas rely on Medicaid for their basic health
needs. Medicaid pays for immunizations; regular check-ups, and intensive care in case of
emergencies for about 112,000 children in Arkansas.
Arkansas could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 93 % in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced 'Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Rep,ublican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting dispropo~ionate share .
payments: increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This poli¢y constrains Federal spending but allows states to respond 'to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program thai has served asa critical safety net -- as would happen under the
,
Republican proposal.
;
• u.s. Departnlent of Health & Human Services estimates based on the Urban instilUte data; numbers may not sum to totals due to rounding.
'
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
CALIFORNIA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Califo[nia would
lose $18 billion over the seven years, a 31 % reduction in 2002 alone. Even if C~lifornia
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 1.2 million people in 2002, according to the Urban Institute,: including:
•
95,000 older Americaris;
•
145,800 people with disabilities; and
•
918,100 children and their families.
The Republican proposal would force California to eliminate coverage for about 34,400
people needing long-term care in 2002.· Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 66% of the 90,400
nursing home residents in California. Medicaid also serves about 56,400 older Americans and
people with disabilities using home care in California. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per.
year nationally.
The Republican proposal would force California to eliminate coverage for 571,700
children in 2002.· Currently, 26 % of the children in California rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups, and intenSive care in
case of emergencies for about 2,260,000 children in California.
California could avoid.these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 31 % in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, .less than one-third
the Republican .cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces 'savingsby reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy c.onstrains Federal spending but allows s~tes to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under, the
Republican proposal.
• u.s. Deparunerit of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
. Contact: 2021456-7150
COLORADO
The Republican Budget Resolution' Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's PrQposal: Reduces Medicaid Payments to States by 30% in 2002·
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Colorado.would
lose $2 billion over the seven years, a 31 % reduction in 2002 alone. Even if Colorado
could absorb half of the cuts by reducing services and provider payments, it would"still have to
. eliminate coverage for 97,000 people in 2002, according to the Urban Institute; inCluding:
•
10,700 older Americans;'
.
•
16,800 people with disabilities; and
•.
70,000 children and their families.
The Republican proposal would force Colorado to eliminate coverage for about 9,200
people needing long-term care in 2002. * Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 62% ofithe 16,100
nursing home residents in Colorado. Medicaid also serves about 12,000 olderAm~ricans and
people with disabilities using home care in Colorado. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
.
.
.
The Republican proposal would force Colorado to eliminate coverage for 48,000 children
in 2002.* Currently, 14% of the children in Colorado rely on Medicaid for ~eir basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in ,case of '
emergencies for about 142,000 children in Colorado.
.
Colorado could avoid these difficult choices forced by the Republican proposal only by'
increasing its Medicaid spending by 34% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending ..
The President's Balanced Budget Proposal
.
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share .
payments, increasing stat~ flexibility. and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to .
unexpected changes in the number .of people covered .. It does not put states at ~isk and
dismantle a program that has served as a critical safety net -- a's would happen under the
Republican proposal.
.
• u.s. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to.tota)s due to rounding.
�THE WHITEHOUSE
. Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
CONNECTICUT
The Rep':lblican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002·
Republicans are proposmg to cut more than $182 billion from Federal Medicaid' spending
between 1996 and 2002: a cut of 20 % over seven years and 30 % in 2002. , Connecticut
would lose $1 billion over the seven years, a 21% reduction in 2002 alone. Even if
Connecticut could absorb half of the cuts by reducing services and provider payments, it
would still have to eliminate coverage for 74,000 people in 2002, according to ,the Urban
Institute, including:
•
7,500 older Americ~;
•
12,300 people with disabilitie~; and
•
54,200 children and their families.
The Republican proposal would force Connecticut to eliminate coverage for about 11,800
people nee4ing long-term care in 2002.· Medicaid is the largest insurer oflong-tenn care
for all Americans, including the middle class~ Currently, Medicaid covers 68% of the 25,800
nursing home residents in Connecticut. Medicaid also serves about ~2,100 older ~ericans
and people with disabilities using home care in Connecticut. Without Medicaid,. faInilies of
the elderly and disabled could not afford nursing home care that costs an average of $38;000
per year nationally.
'The Republican proposal would force Connecticut to eliminate coverage for 37,100
children in 2002.· Currently, 14 % of the children in Connecticut rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
.
case of emergencies for about 166,000 children in Connecticut.
Connecticut could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 21 % in 2002 -- by raising prop~rty or sales taxes, or
cutting. other critical state spending.'
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid; less than one-third
the Republican cut and still a significant contribution toward deficit reduction: The: President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes III the number of people covered. It does not put-states at risk and
dismantle a program that has served as a critical safety net -- as' would happen under the
Republican proposal.
.
• u.s. Department of Health & Human Services estimates'based on the Urban Institute data; numbers may not sum to totals due to rounding~
,
.
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact:' 202/456-7150
DISTRICT OF COLUMBIA
,The Republican Budget Resolution Conference Agreement:
Medicaid .Cuts Will Force States, to Reduce Health Coverage
!
Republican's Proposal: Reduces Medicaid Payments to States In' 30% in 2002,
Republican$ are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. District of
, Columbia would lose $863 million over the seven years, a 31 % reduction in 2092 alone.
Even if District of Columbia could a~sorb half of the cuts by reducing services and provider
payments, it,would still have to eliminate coverage for 20,000 people in 2002, according to the
Urban Institute, including:
•
1,500 older Americans;
•
4,400 people with disabilities; and
•
14,400'children and their fa~i1ies.
The Republican proposal 'would force District of Columbia to eliminate coverage for
about 1,500 people needing long-term' care in 2002. * Medicaid is the largest insurer of
long-term care for all Americans, including the middle class. Currently, Medicaid covers
91 % of the 2,700 nursing home residents in District of Columbia. Medicaid also serves about
2,900 older Americans and people with disabilities using home care in District of Columbia.
,Without Medicaid, families of the elderly and disabled could not afford nursing home care that
costs an average of $38,000 per year nationally ..
The Republican proposal would force District of Columbia to eliminate coverage for
10,100 children in 2002.* Currently,' 45 % of the children in District of Columbia rely on
Medicaid for their basic health needs. Medicaid pays for immunizations, regular check-ups,
, and'intensive care in case of emergencies for about 67,000 children in District of Columbia.
District of Columbia ,could avoid these difficult choices forced by the Republican proposal
only by increasing its Medicaid spending by 31 % in 2002 -- by raising property or sales taxes,
or cutting other critical state spending .
. The President's Balanced Budget Proposal'
The President's proposal saves $54 billion over seven years from Medicaid~ less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing wd retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This ,policy constrains Federal ~pending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle' a program that has served as a critical safety net -- as would happen under the
Republican proposaL,
,
II< u.s, Department of Health & Human Services estimates based on the Urban Institute data; numbers may.not sum to totals due to rounding.
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
FLoRID~
. The'Republican Budget Resolution Conference. Agreement:
. Medicaid Cuts Will Force States to Reduce Health Coverage,
Republican's Proposal; Reduces Medicaid Payments to States by 30% in 2002 .
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002:· a cut of 20%'over seven years and 30% in 2002. Florida would
lose $10 billion Qver the seven years, a 35% reduction in 2002 alone. Even if Florida could
absorb half of the c~ts by reducing services and provider payments, it would still have to
eliminate coverage for 706,000 people in 2002, according to the Urban Institute; including:
• . 78,900 older Americans;
•
94,900 people with'disabilities; and
•
532,100 children and their families.
The Republican proposal would force Florida to eliminate coverage for about 49,100
people needing long-term care in 20Q2.* Medicaid is the largest insurer of long-term care
for all Americans, including 'the middle class. Currently, Medicaid covers 62% of the 59,000
nursing home residents in,.Florida. Medicaid also' serves about 70,500 older Americans and
people with disabilities using home care ,in Florida. Without Medicaid, families of the elderly
and disabled could not afford nursing home care that costs an average of $38,000 per year .
nationally.
.
I
'
The Republican proposarwould for~ Florida to eliminate coverage for 423,000 children
in 2002.* Currently, 23% of the children in Florida rely on Medicaid· for their basic health
~eeds. Medicaid pays for immunizations, regular check-ups, and intensive care incase of
emergencies for about 991,000 children in Florida.
, ,
Florida could avoid these difficult choices forced by the Republican proposal only by
.increasing its Medicaid spending by 44% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
,the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
,payments, increasing state flexibility, and.1imiting the growth in Federal M~dicaid spending
per recipient. This policy. constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen und~r the
Republican proposaL . .
.
.
" ,
.
II<
U.s. Department of Health & Human Services estimates based on the Urban Institl!te data; numberS may not sum to totals due to rounding.
'"
.
.
,
\
�THE WHITE HOUSE
Office of Media Affairs
September 14! 1995
.Contact: 202/456-7150
GEORGIA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States .to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Paym~nts to States by 30% in 2002;
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Georgia would
lose $6 billion over the seven years, a 35% reduction in 2002 alone. Even if Georgia could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 383,000 people in 2002, according to the Urban Institute, including:
•
41,200 older Americans;
.
•
63,900 people with disabilities; and
•
277,800 children and their families.
The Republican proposal would force Georgia to eliminate coverage for about 24,600
people needing long-term care in 2002. III Medicaid is the largest insurer of long-term care
for all Americans, including the middle class .. Currently, Medicaid covers 82% of the 34,700
nursing home residents in Georgia. Medicaid also serves about 21,700 older Americans and
people with disabilities using home care in Georgia. Without Medicaid, families of the elderly'
·and disabled could not afford nursing home care that costs an average of $38,000 per year
nationally.
The Republican proposal would force Georgia to eliminate coverage for 188,900 children
in 2002. III Currently, 17% of the children in Georgia rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and interisive care. iIi case of
emergencies for about 543,000 children in Georgia. .
- Georgia could avoid these difficult choices forced by the Republican proposal orily.by
increasing its Medicaid spending by 56 % in 2002 -- by raising property or sales taxes, or
cutting other .critical state spending;
The President's Ba]anced Budget Proposal'
.
The President's proposal saves $54 billion over seven years from Medicaid, less th~n one~third
the Republican cut and still a significant contribution toward deficit reduction.- The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in -Federal MediCaid spending
per recipient. This policy constrains Federal spending but allows states to tespond·to
unexpected changes in the number of people covered. It does not put states at ri~kand
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
• u.s. Deparonent of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to tota.ls~due to rounding.,
.
.
�','
THE WHITE HOUSE
Office of Media. Affairs
Contact: 202/~56-7150
September 14, 1995
HAWAll
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
. Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Rc.::publicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of20% over seven years and 30% in 2002., Hawaii would
lose $572 million over the seven years, a 32% reduction in 2002 alone. Even if Hawaii
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 36,000 people in 2002, according to the Urban Institute, including:
•
3,400 older Americans; ,
.
•
5,600 people with disabilities; and
•
27,500 children and their families.
The 'Republican proposal would force Hawaii to eliminate coverage for about 1,500 people
needing long-term care in 2002.* Medicaid is the hirgest insurer of long-ter:ql care for all
Americans, including the middle class. Currently, Medicaid cove~s 72% of the 1,500 nursing
home residents in Hawaii. Medicaid also serves about 900 older Americans and people with
disabilities using home c,are in' Hawaii. Without Medicaid, families of the elderly and disabled
could not afford nursing home care that costs an average of $38,000 per year nationally.
The Republican proposal would force Hawaii to eliminate coverage for 18,700 children'in.
2002. * Currently, 15 % of the children iri Hawaii rely. on Medicaid' for their basic health
needs. Medicaid pays forimmuniza~ions, regular check-ups, and intensive care in.case of
emergencies for about 60,000 children i~ Hawaii.
Hawaii could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spendIng by 32 %. in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.'
,
The President I s Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less th~m one':'third
the Republican cut and still a significant contribution toward deficit reduction. The,President's
Medicaid policy produces savIngs by reducing andretargetting disproportionate share
payments, increasing state flexibility ,and lim.iting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond, to
unexpected changes in the number ofpeopie covered. It does not put states at risk:and
dismantle a p~ogram that has served as a critical safety net -- as would happen under the .
Republican proposal.
'.
.
• u.s. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not suni to totals d~eto rounding..
�,THE WHITE,HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
IDAHO,
"
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
i
Republican's Proposal: Reduces Medicaid Payments to States by 30%in 2002,
RepUblicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and30% in 2002. Idaho ~would lose
$542 million over the 'seven years, a 29% reduction in 2002 alone. Even if Idaho could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 34,000 people in 2002, according to the Urban Institute, inCluding:,
•
3,100 older Americans;
•
5,500 people with disabilities; and'
•
25,500 children and their families.
The Republican proposal wotiId force Idaho to eliminate coverage for about 2,400 people
needing long-term care in 2002.· Medicaid is the largest insurer of long-term care for all
Americans, including the middle class. Currently, Medicaid covers 61 % of the 4,200 nursing
home residents in Idaho. Medicaid also serves about 4,000 older Americans and people with
disabilities using home care in Idaho. Without Medicaid, 'families of the e~derly and disabled
could n()t afford nursing home care that costs an average of $38,000 per year nationally.
t
•
I,
The Republican proposal would force Idaho to eliminate coverage for 17,800 children in
2002.· Currently, 15 % of the children in Idaho rely on Medicaid for their basic health needs.
Medicaid pays for immunizations, regUlar check-ups, and intensive care in case of'
emergencies for about 59,000 children in Idaho.
Idaho could avoid these difficult choices forced by the Republican proposal only by increasing
its Medicaid spending by 65% in 2002 -- by raising property ,or sales taxes, or cutting other
critical state spending.
The President I s Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. 'The President's
, Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexib'ility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered., It does not put states at risk and
dismantle a program that has served as a critical safety net -;- as' would happen under the
Republican proposal. '
.. u.s. Department 'of Health & Human Services estimates based on the Urban ,Institute data; numbers'may not sum to total~ due,to rounding.
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
ILLINOIS
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's PropoSal: Reduces 'Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30%'in 2002. illinois would lose
$6 billion over the seven years, a 30% reduction in 2002 alone. Even if Illinois could
absorb half of the cuts by reducing services and provider payments, it would still ~ve to
eliminate co\;erage for 274,000 people in 2002, according to the Urban Institute, including:
•
22,000 older Americans;
•
55,900 people with disabilities~and
•
196,100 children and their families.
The Republican proposal would Corce lliinois to eliminate coverage Cor about 25,800
people needing long-term care in 2002. III Medicaid is the hugest insurer of long-tenn care
for all Americans, including the middle class. Currently, Medicaid covers 64 % of the 77,800
nursing home residents in Illinois. Medicaid also serves about 40,500 oider Americans and
people with disabilities using home care mIllinois. Without Medicaid, families of the elderly
and disabled could not afford nursing home care that costs an average of $38,000 per year
nationally.'
.
,
The Republican proposal would Corce Illinois to eliminate coverage Cor 137,900 children
'.
in 2002. III Currently, 21 % of the children in Illinois rely on Medicaid for their basic health
needs .. Medicaid pays for immunizations, regular check-ups, and intensive care iIi case of
emergencies for about 719,000 children in Illinois.
Illinois could avoid these difficult choices forced by the Republican proposal only by ..
increasing its Medicaid spending by 30% in 2002 -- by. raising property or sales taxes, or
cutting other critical state spending.
. .'
The President's Balanced Budget Proposal
. The President's proposalsaves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
.per recipient .. This policy constrains Federal spending but allows states to respond. to
unexpected changes in the number of people covered . .It does not put states at risk :and
dismantle a program that has served as.a critical safety net -- as would happen under the
Republican proposal. .
• u.s. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sUm to totals'due to rounding.
�THE WHITE HOUSE
Office of Media Affairs
,September 14, 1995
Contact: 202/456-7150
INDIANA
The, Republican Budget Resolution Conference Agreement:
'Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal; Reduces Medicaid Payments to States by 30%. in 2002,
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 20Q2: a cut of 20% over seven years and 30% in 2002. Indiana would
lose $4 billion over the seven years, a JO% reduction in 2002 alone. Even if Indiana could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 112,000 people in 2002, according to the Urban Institute, including:
.
•
11,800 older Amer~cans;
•
17,400 people with disabilities; and
•
83,200 children and their families.
The Republi~an proposal would force Indiana to eliminate coverage for about 11,000
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 66% of the 28,500
nursing home residents in Indiana. Medicaid also serves about 7 ,600 older Americans and
people with disabilities using home care in Indiana. Without Medicaid, families of the elderly
and disabled- could not afford nursing home care that costs an average of $38,000 per year
. nationally.
The Republican proposal would force Indiana to eliminate coverage for 56,800 'children in
2002. * Currently, i 8 % of the children in Indiana rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check;.ups, and intensive care 'in case of
emergencies for about 319,000 children in Indiana. '
Indiaria could avoid these, difficult ~hoices forced by the Republican proposal only by
increasing its Medicaid spending by 50% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
.
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
, per recipient. This policy constrains Federal' spending but allows states to respond to
'unexpected changes in the number Of people covered. It does hot put states at risk and
,dismantle a program that has served as, a critical safety net -- as would happen under the
Republican proposal.
• u.s. Department of Health & Human Services estin:ates based on the Urban Institute data; numbers may not sum to totals due to rounding.
�THE WHITE HOUSE
Office of Media Affairs
Contact: 202/456-7~50
September 14,-1995
IOWA
, The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal; Reduces Medicaid Payments to States by 30% in 2002',
Republicans are proposing to cut more than $182 ,billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. ',Iowa would lose
$1 billion over the seven years, a 27% reduction in 2002 alone. Even if Iowa could absorb
halfof the cuts by reducing ,services and provider payments, it would still have to eliminate ,
coverage for 69,000 people in 2002, according to the Urban Institute, ~cluding:'
it
_8,700 older Americans;
• ,
11,700 people with disabilities; and
•
49,100 children and their families.
The Republican proposal would force Iowa to eliminate coverage for about 8,500 people
needing long-term care in 2002. * Medicaid is the large~t insurer of long-term care for all '
Americans, including the middle class. Currently, Medicaid covers 49% of the 29;300
nursing home residents in Iowa. Medicaid also serves about 15,100 older Americans and
people with disabilities using home care in Iowa. WIthout Medicaid, families ,of the elderly.
and disabled could not afford nursing home care that costs an average of $38,000 Prr year
nationally.
The Republican proposaLwould force Iowa to eliminate coverage for 32,800 children in
2002. * Currently, 8 % of the children in Iowa rely on Medicaid for their basic heaith needs.
Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 136,000 children in Iowa. '
'
Iowa could avoid these difficult choices forced by the Republican proposal only by increasing
its Medicaid spending by 48 % in 2002 -- by raising property or sales taxes, or cutting other
':
'
critical state spending.
The President I s Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less, than one~third
the Republican cut and still a significant contribu~ion toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share ,
payments increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes iDthe number of people covered', It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
,
'
• u.s_ Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due'to rounding:
I
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
" KENTucKY
, The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to lteduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Kentucky would
lose $4 billion over the seven years, a 32% reduction in 2002 alone. Even if Keptucky
could absorb half of the cuts by reducing services and provider payments, it would ,still have to ,
eliminate coverage for 171,000 people in 2002, according to the Urban Institute, including:
•
17,700 older Americails;
•
43,200 people with disabilities; and
•
110,600 children and their families.
The Repubiican proposal would force Kentucky to eliminate coverage for about 22,400
people needing long~term care in 2002.· Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers, 76% of the 19,400
nursing home residents in Kentucky. Medicaid also serves 'about 52,000 older Americans and
people with disabilities using home care in Kentucky: Without Medicaid, families of the
elderly and disabled could not afford nursiilg home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Kentucky to eliminate coverage for 73,400 children
in 2002.· Currently, 26% of the children in Kentucky rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 273,000 children in Kentucky.
Kentucky could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 77 % in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
'
.',
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third'
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savii:J.gs by reducing and retargetting disproportionate share'
'
payments, increasing state flexibility" a~d limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to '
unexpected changes in the number of people covered. It does not put states at risk and,
dismantle a program that has served as a critical safety net -- as would happen under the
, Republican proposal.
'
,
• u.s. Deparnnent of Health & Human Services estimates based on the' Urban Institute data;' numbers may, not sU,m to totals due to rounding.
�THE WHITEHOUSE
Office of Meqia Affairs .
. September
14~
1995
Contact: 202/456-7150
LOUISIANA
The Republican Budget Resolution Conference. ~greemei1t:
. Medicaid ~uts Will Force States to Reduce Health Coverage
.
.
Republican's Proposal; Reduces Medicaid Payments to States·by 30% in 200Z:
Republicans are proposing to cut more than $182 billion from Federal Medicaid s~ending
between 1996 and 2002; a cut of 20% over seven years and 30% in 2002..Louisiana would
lose $5 billion over the seven years, a 25% reduction in 2002 alone. Even if Louisiana ,
could absorb half of the cuts by reducing services and provider payments, it would still have to
.eliminate coverage for 154,000 people in 2002, according to the Urban Institute, including: .
•
16,600 older Americans;
,
•
26,800 people with disabilities; and
•
111,000 children and their families .
•1~ •
The Republican proposal would force Louisiana to eliminate coverage for about 3,900
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
. for all Americans, mcludingthe middle class~ Currently; Medicaid covers 82 % of the 28,900
nursing home residents in Louisiana. Medicaid also serves about 15,200 older Americans and
pe~ple with disabilities using home .care in Louisiana. Without Medicaid, families: of the ,
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.·
, . ·The Republican proposal wO,uld force Louisiana to eliminate coverage for 79,0~0 children
in 2002. * Currently, 30% of the children iJ;l Louisiana rely on Medicaid for their basic health '
needs. Medicaid pays for immunizations, regular check-ups, and intenSive care in'case of
'C,
emergencies for about 376,000 children in Louisiana. '
Louisiana could avoid these difficult choices forced by the Republican prop~sal only by
increasing its Medicaid spending by 63 % in 2002 -:- by raisirig propertY or sales taxes ,or
cutting other critical state spending. ..
.
.
The President's Balanced Budget Proposal
,
The President's propos~l saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significantcoritribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility; and limiting the growth in Federal Medieaid!spending
per recipient. This policy constrains Federal spending but allows states to respond to
'unexpected changes in the number of people'covered. 'It does not put states at .risk, and
dismantle a program that has. served as a critical safety net -- ~s Would happen und~r the
Republican proposal.
:
• u.s. Deparnnent of Health & Human Services estimates based on the Urban Institute data; n~bers may not ~ to total~ due to roundipg.
�TIiE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 2021456-7150 '
,MAINE
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
i
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans 'are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2062. Maine would lose
$675 million over the'seven years, a 22% reduction in 2002aione. Even if Maine could
absorb·half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 34,000 people in 2002, according to the Urban Institute, mcluding: '
•
4,300 older Americans; ,
. .
"
•
7,200 people with disabilities; and ,
•
23,000 children and their families.
The Republican proposal would force Maine to eliminate coverage for about 3,500 people
, needing long-term care in 2002.· Medicaid is' the largest insurer of long-term care for all
Americans, including the middle class. Currently, Medicaid covers 78 % of the 8,000 nursing
home residents in Maine. Medicaid also serve~ about 8,00<) older Americans and people with
disabilities using home care in Maine. Wi~out Medicaid, fanulies of the elderly and disabled
could not afford nursing home care thatcosts an average of $38,000 per year nationally;
The Republican proposal would force Maine to eliminate coverage for'15,400 childreq in
.2002.· Currently, 19% of the children ,in Maine rely on Medicaid for their basic ,health needs.
Medicaid pays for immunizations, regular check-ups, and interisive care in case of
emergencies for about 77,000 children itl Maine.
. '
Maine could avoid these difficult choices forced by the Republican' proposal only by increasing
. its Medicaid spending by 37% in 2002 --by raising property or sales taxes, or cutting other
. critical state spending.
The President's Balanced Bud2et Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit red\lction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constraips Federal spending but allows states ~o respond to .
unexpected changes in the number of people covered. It does not put states at risk and
disinantlea program that has served as a critical safety net -- as would happen under the
Republican proposal.
* u.s. Department of Health & Human Services estimates based on the Urban Instirute data; numbers may not sum to totals due to rounding.
�THE WHITE HOUSE
Office of Media Affairs
Contact: 202/456.;.7150
September 14, 1995
MARYLAND
Tbe Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996' and 2002: a cut of 20% over seven years and 30% in 2oo~. Maryland would
lose $3 billion ove~ the seven years,:a 32% reduction in 2002 alone. Even if Maryland
could absorb half of the cuts by reducing services and provider payments, it would still have to
. el,iminate coverage for 116,000 people in 2002, according to the Urban Institute, mcluding:
•
10,600 older AmericanS;
•
22,200 people with disabilities; and
•
83,200 children and therr· families.
The Republican prQpOsal would force Maryland to eliminate coverage for about 7,400
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care .
for all Americans, including the middle class. Currently, Meqicaid .covers 67% of the 21,900
nurs~ng home residents in Maryland .. Medicaid also'serves about 14,200 older Americans and
people with disabilities using home care in Maryland. Without Medicaid, families of the
elderly and disabled could'not afford nursing home ,care that costs an average of $38,000 per
year nationally.
.
The Republican proposal would force Maryland, to eliminate coverage for 58,900 children
in 2002.* Currently, 14% of the children in Maryland rely on Medicaid for their basic health
needs. Medicaid pays for irnlnunizations, regular check-ups, and intensive care in case of
emergencies for about 198,000 children in Maryland.
.
,
Maryland could avoid these difficult choices forced by the Republican proposal only by
increasing its'Medicaid spending by 32% in 2002 -- by raising property or sales taxes, or .
cutting other critical state spending..
i
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less :than one-third
the Republican cut and still a significant contribution toward·deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and 'limiting the growth in Federal Medicaid, spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a criticill safety net -- as would happen un.der the
Republican proposal.
'
• U,So Department of Health & Human Services estimates based on the Urban Instirute data; numbers may not sum to tOtals due to rounding,
�THE WlllTE HOUSE
Office of Media Affairs
September 14, 1995
.:.
Contact: 202/456-7150
MAssACHUSETIS
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20 % over seven years and 30 % in 2002. Massachusetts
would lose $4 billion over the seven years, a 28% reduction in 2002 alone. Even if
Massachusetts could absorb half of the cuts by reducing services and provider payments, it
would still have to eliminate coverage for 210,000 people in 2002, according to the Urban
Institute, including:
.
•
24,100 older Americans;
•
43,600 people with disabilities; and
•
142,200 children and their families.
The Republican ,proposal would force Massachusetts to eliminate coverage for 'about
22,900 people needing long-term care in 2002.· Medicaid is the'largest insurer of long-term
. care for all Americans, including the middle class. Currently, Medicaid covers 73 % of the
44,400 nursing home residents in Massachusetts. ·Medicaid also serves about 38,900 older
Americans and peopl~ with disabilities using home care in Massachusetts. With9ut Medicaid,
families of the elderly and disabled could not afford nUrsing home care that costs an average of
$38,000 per year nationally.
,
,
The Republican proposal would force Massachusetts to eliminate co:verage for: 94, 700 '.
children in 2002.· Currently, 19 % of the children in Massachusetts rely on Medicaid for
their basic health needs. Medicaid pays for immunizations, regular check-ups, an4 intensive
care in case of emergenc~es for about 304,000 children in ,Massachusetts.
,
,
Massachusetts could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 28 % in 2002 -- by raising property or sales ta~es, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward defiCit reduction. Th~ President's
Medicaid policy produces savings by reducing and retargetting disprpportionate share
payments, increasing state fle~ibility, and limiting the growth in Federal Medicaid' spending
per recipient. This policy constrainS Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -"" as would happen under the
Republican proposal.
'
• u.s. Department of Health & Human Services estimates based on the Urban Institute data;'numbers may not sum to total~ due to rounding.
�THE WHITE HOUSE
Office of Media Affairs
, September 14, 1995
Contact: 202/456-7150
MICHIGAN,
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force 'States to Reduce Health Coverage
•
~.
if~
Republican's Proposal;, Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. 'Michigan would
lose $6 billion over the seven years, a 30% reduction in 2002 alone. Even if Michigan ,
could absorb half of the cuts by reducing ,services and provider payments, it would still have to
eliminate coverage for 215,000 people in 2002, according to, the Urban Institute, including:
•
15,200 older Americans;
,
•
42,400 people with disabilities; and
•
157,000 children and their families.
The Republican proposal would force Michigan to eliminate coverage for'about 22,900,
people needing long-term care in 2002. * Medicaid is the l~rgest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 67% of the 38,700
nursing home residents in Michigan. Medicaid also serves about 76,000 older Americans and
people with disabilities using home care in Michigan. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
.
The Republican proposal would force Michigan to eliminate coverage for 100,700 children
in 2002.* Currently, 23% of the children in Michigan rely on Medicaid for ,their' basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 571,000 children in'Michigan.
Michigan could avoid these difficult choices forced by the Republican proposal only by
'increasing its Medicaid spending by 39% in 2002 -- by raising property or sales taxes, or
'
cutting other critical state spending.
'. J
,
The President's Balanced Budget Proposal
,< ,
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limitmg the growth in,Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows. states to respo:Qd to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program !hat has served as a critical safety net -- as would happen under the
. Republican proposal.
.
,
* U.S. Department of Health & Human Services estimates based on the Urban Institute data;' numbers may not sum to totals due to rounding. '
.
,
�THE WHITE HOUSE
Office Df Media Affairs
September 14, 1995
Contact: 202/456-7150
MINNESOTA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002' .
Republicans are proPDSing to. cut mDre than $182 billiDn from Federal Medicaid spending
between 1996 and 2002: a cut Df 20% Dver seven years and 30% in 2002. Minnesota would
lose $2 billion over the seven years, a 25% reduction in 2002 alone. Even if MinnesDta
CDuid absDrb half Df the cuts by reducing services and provider payments, it WDuid stilll1ave to.
eliminate cDverage fDr 88,000 peDple in 2002, accDrding to. the Urban Institute, including:
•
11,300 Dlder Americans; .
•
12,100 peDple with disabilities; and .
•
64,300 children and their families.
The Republican proposal would force Mimiesota to eliminate coverage for about 47,000
people needing long-term care in 2002.· Medicaid is the largest insurer Df IDng"-term care.
fDr all Americans, including the middle class. Currently, Medicaid CDvers 64% of the 41,500
nursing hDme residents in MinnesDta.· Medicaid also. serves abDut 187,800 Dlder Americans
and peDple with disabilities using hDmecare in MinnesDta. Without Medicaid, families Df the
elderly and disabled cDuld nDt affDrd nursing hDme care that CDStS an average Df $38,000 per
year natiDnally.
The Republican proposal would force Minnesota to eliminate coverage for 43,900 children
. in 2002.· Currently, 16 % Df the children in MinnesDta rely Dn Medicaid fDr their' basic health
needs. Medicaid pays fDr immunizatiDns, regular'check-ups, and intensive care incase Df
emergencies fDr abDut 193,000 children in MinnesDta.
M
. innesDta cDuld aVDid these difficult choices fDrced by the Republican propDsal Dnly by·
increasing its Medicaid spending by 30% in 2002 -- by raising property Dr sales taxes, Dr
cutting Dther critical state spending.
The President's Balanced Budget Proposal
.
The President's prDpDsal saves $54 billiDn Dver seven years from Medicaid, ·less than Dne-third
.. the Republican cut and still a significant cDntributiDn tDward deficit reductiDn. The President's
Medicaid'pDlicy prDduces savings by reducing and retargetting dispropDrtiDnate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This pDlicy cDnstrains Federal spending but allDws states to' respDnd to'
unexpected changes in the number Df peDple cDvered. It dDes nDt put states at risk and
dismantle a prDgram that has served as a critical safety net -- as wDuld happen under the
Republican propDsai.
• u.s. Department of Health & Human Services estiInates based on the Urban Institute data; numbers may not sum to totals due to rounding.
�THE WHITE HOUSE
Office ofMedia Affairs
. Conm,ct:· 202/456-7150
September 14,.1995
. MISSISSIPPI
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage .
Republican's Proposal: Reduces Medicaid Paym¢nts·to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Mississippi would
lose $2 billion over the seven years, a 30% reduction in 2002 alone. Even if Mississippi
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 141,000 people in 2002, according to the Urban Institute.; ¥tcluding:
•
18,200 older Americans;
•
29,900 people with disabilities; and
•
92,900 children and their families.
The Republican proposal would force Mississippi to eliminate coverage for about 5,700
people needing long-term care in 2002.· Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 82 % df the 14,600
nursing home residents in Mississippi. Medicaid also serves about 5,300 older Americans and
people with disabilities using home care in Mississippi; Without Medicaid, families of the .
elderly and disabled could not afford nursing home care. that costs an average of $38~000 per
.
year n a t i o n a l l y . ·
The Republican proposal would force Mississippi to eliminate coverage for 67,300
children in 2002.· Currently, 28 % of the children in Mississippi n!ly on Medicaid for th~ir
basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 258,000 children iIi Mississippi.'
.
Mississippi could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 107 % in 2002 -- by raising property or sales; taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid poliCy produces savings by reducing and retargetting disproportionate ~hare
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
~nexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen uQ.derthe
Republican proposal.
.
• u.s. Deparunent of Health & Human Services estimates based on the Urban Instirute data; numbers may not sum to totals due to rounding.
,
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456·7150
MISSOURI
The Republican Budget Resolution Ccinference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage,
Republican's Proposal; Reduces Medicaid payments to States by 30% in 2002
Republicans are proposing to cut more
$182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of20% over seven years and 30% in 2002. Missouri would
lose $1 billion over the seven years, a 17% reduction in 2002 3Ione. Even if Missouri could
absorb half of the cuts by 'reducing services and provider payments, it would still have to'
eliminate coverage for 83,000 people in 2002. according to the Urban InStitute. ip.cluding:
,•.
10.200 older Americans;
.
•
13,000 people with disabilities; and
•
59.600 chil~ren and their families.
than
The Republican proposal woul~ forc'e Missouri to eliminate coverage for about 7,900.
people needing long-term care in 2002.· Medicaid is the largest insurer of long-term care
for all Americans. including the middle class. Currently. Medicaid covers 65% of the 33,500
nursing home residents in MissourL Medicaid also serves about 26.700 older Americans and
people with disabilities using ·home care in Missouri. Without Medicaid. families ofthe
elderly and disabled could not afford nursing home care that costs an average of.$38,000 per
year n a t i o n a l l y . '
I
"
The Republican proposal would force Missouri to eliminate coverage for 39,300chUdren
in 2002.· Currently,. 22 % of the children in Missouri rely on Medicaid for their basic health
needs. Medicaid pays for,immunizations, regular check-ups, and intensive care:in case of
emergencies for about 328.000 chiidren in Missouri.
Missouri could avoid these difficult choices forced by the' Republican proposal only by
increasing its Medicaid spending ,by 25 % in 2002 -- by raising property or sales taxes. or
cutting other critical state spending.
'
The President t s Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from MedIcaid. less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility. and limiting the growth in Federal Medicaid spending
per recipient. .This policy constrains Federal spending but allows states to respond to
. unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical 'safety net -- as wouldh~ppen under the
Republicanpr9Posal.
,
,
.. u.s. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
�THE WHITE HOUSE
. Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
MONTANA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage·
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to'cut more than $182 billion from Fede~al Medicaid spending
between 1996 and 2002: a, cut of 20% over seven years and '30% in 2002. Montana would
lose $766 million over the seven years, a 33% reduction in 2002 alone. Even if Montana
,could absorb half of the cuts by reducing 'services and provider payments, it would still have to
eliminate coverage for 27,000 people in 2002, according to the Urban Institute, including:
•
3,000' older Americans;
•
5,600 people with disabilities; and
•
18,300 children and their families.
The Republican proposal would force Montana to eliminate coverage for about 2,100
people needing long-term care in 2002. * Medicaid is the largest insurer of long-term care
. for all Americans, including the middle class. 'Currently, Medicaid covers 62% of the 6,000
nursing home residents in Montana. Medicaid also serves about 0 older Americans and people
with disabilities using,home care in Montana. Wi!4out Medicaid, families of the' elderly and
disabled could not afford nursing home care that costs an average of $38,000 per year
nationally.
The Republican proposal would force Montana to eliminate coverage for 10,100 children'
'in 2002. * Currently, 15 % of the children in Montana rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 34~000 children in Montana.
,I
Montana could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 75% in 2002,-- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth irlFederal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to ,
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that haS served as a critical safety net -- as would happen under, the
Republican proposal.
'
,
• u.s. Department of Health & Human Services estimates,based on the Urban Institute data; numbers may not sum to totals due to rounding.
•
•
•
",
•
I
�THE WHITE HOUSE
Office of Media Affairs'
September 14, 1995
Contact: 202/456-7150
NEBRASKA
The Republican Budget Resolution Conference Agreement: .
Medicaid Cuts Will Forc~ States to Reduce Healt~ Coverage '
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Nebraska would
lose $728 million over the seven years, a 27% reduction in 2002 alone. 'Even if Nebraska
;could absorb half of the cuts by reducing services and provider payments, it would, still have to
eliminate coverage for 41,000 people in 2002, according to the Urban Institute, including:
•
4,700 older AmericanS;
. ,
•
5,500 people with disabilities; and
•
31,000 children and their families.'
The Republican proposal would force Nebraska 'to eliminate coverage for about 4,200
people needing long-term care in 2002. * Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 53% of the 15,200
nursing home residents in Nebraska. Medicaid also serves about 4,900 older Americans and
people with disabilities using home care in Nebraska. Without Medicaid, families of the
elderly and disabled could not afford nUrsing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Nebraska to eliminate coverage for 23,100 children
in 2002.* Currently, 14% 'of the children in Nebraskarely.on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, anq intensive care in case of
emergencies for about 74,000 children in Nebrask~.
Nebraska could avoid these difficult choices forced by the Republi~anproposal only by
increasing its Medicaid spending by 40% in 2002 -- by raising property or sales taxes,or
cutting other critical state spending.
'
. he President's Balanced Budget PrQPosal
T
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significa~t contribution toward deficit reduction. The President's
,Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medica~d spending
per recipient. This policy constrains Federal spendfug but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a P!ogram that has served as a critical safety net -- as would happen under the
Republican proposal.
• U,S, Department of Health & Human Services estimates based on the Urba,n Institute data; numbers may not sum.to totals due to rounding.
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
NEVADA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
J
•
'.
I
Republican's Proposal: Reduces Medicaid PaYments to States by 30% in 2002
- Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Neva~a would
lose $516 million over the seven years, a 29% reduction in 2002 alone. Even if Nevada
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 26,000 people in 2002, according to the Urban Institute, including:
-•
2,900 older Americans;
•
4,100 people with disabilities; and
•
19,000 children and their families.
The Republican proposal would force Nevada to eliminate coverage for about 1,800
people needing long-term care in 2002. * Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. ~urrently, Medicaid covers 65 % of the. 2,700
nursing home residents in Nevada. Medicaid also serves about 2,600 older Americans and
people with disabilities using home care in Nevada. Without Medicaid, families of the elderly
and disabled could not afford nursing home care that costsan average of $38,000'per year
nationally.
J
-
-
The Republican proposal would force Nevada to eliminate' coverage for 12,900 children in
2002.* Currently, 9% of the children in Nevada rely on Medicaid for their basiC health needs._
Medicaid pays for immunizations, regular check-ups,. and intensive care incase of
emergencies for about 46,000 children in Nevada.
Nevada could avoid these difficult choices forced by the Republican proposal only by
increasing-its Medicaid spending by 29% in 2002 -- by raising .property or sales taxes, or
cutting other critical state s p e n d i n g . '
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less .than one-third
the Republican cut and still a significant contribution. toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
- unexpected changes in the number of people covered, It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.'
.
_
i
• u.s. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
�THE WHITE HOUSE
Office ofMedia Affairs
September 14, 1995
'Contact: 202/456-7150
NEW HAMPSHIRE
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. New Hampshire
would lose $51 million over the seven years, a 6% reduction in 2002 alone.' ,Even if New
Hampshire could absorb half of the cuts by reducing services and provider payments, it would
still have to eliminate coverage for,l,loo people in 2002, according to th~Urban:Institute.
The Republican proposal would force New Hampshire to eliminate coverage for people
needing long-term care in 2002. III Medicaid is the large'stinsurer of long-term ,care for all
Americans, including the middle class. Currently, Medicaid covers 72 % of the 5,700 nursing
home residents in New Hampshire. Medicaid also serves about 4,800 older Americans and
people with disabilities using home care, in New Hamp~hire. Without Medicaid, families of
the elderly and disabled could not afford nursmg home care that' costs an avenlge ,of$38,OOO
per year nationally.
The Republican proposal would force New Hampsh;re to eliminate coverage for children
in 2002. III Currently, 13 % of the children in New Hampshire rely on Medicaid for their basic
.
.
health needs. ' Medicaid pays for immunizations; regular check-ups, and intensive care in case
of emergencies for about 41,000 children in New Hampshire.
'
"
New Hampshire could avoid these difficult choices forced by the Republican proposal only by
increasing its Me,dicaid spending by 6 % iIi 2002 -~ by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
,
•The PresidenCs proposal saves $54 billiori over seven years from Medicaid, less thanone~third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces' savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth'in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respo~d to
unexpected changes in the number of people covered. It does not put states at ri~k and
dismantle a program 'that has served as a critical safety, net -- as would happen under the
Republican proposal.
'
Note: Due to data limitations. specific estimates for New Hampshire are not available.
'" U.S, Department of Healtb & Human'Services estimates based on tbe Urban Institute data; numbers may not sum to totals due ,to rounding.
�THE WHITE HOUSE
Office of Media Affairs.
September 14, 1995
Contact: 202/456-:7150
NEW JERSEY
The. Republican Budget Resolution Conference Agreement:
Medicaid Cuts ,Will Force States to Reduce Health Coverage
. Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
~epublicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% overseven years and 30% in 2002. New Jersey would
lose $4 billion over the seven years, a 23,% reduction in 2002 alone. Even if New Jersey
could absorb h~lf of the cuts by reducirig· services and provider payments" it would still have to
eliminate coverage for 166,000 people in 2002, according to the Urban Institute, including:
•
15,300 older Americans;
•
29,000 people with disabilities; and
•
121,600 children and their families.
'"The Republican proposal would force New Jersey to eliminate coverage for about 16,700
people needing long-term care in 2002.· Medicaid is the largest insurer of long-term care
.
.
for all Americans, including the middle class. Currently, Medicaid covers 69% of the 36,300
nursing home residents in New Jersey. Medicaid also serves about 39,200 older Americans
and people with disabilities using home care in New Jersey. Without Medicaid, families of the
elderly and di~abled could not afford nursing home care that costs an average of $38,000 per
year n a t i o n a l l y . '
.
,
,
The Republican proposal would'force New Jersey to eliminate coverage for 79,600
.. children in 2002.·. Currently, 17 % of the chilqren in New Jersey rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case 'of emergencies for about 364,000 children in New Jersey.
.
,
New Jersey ~ould avoid.these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 23 % in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced BUdget Proposal "
The,President's'proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid pqlicy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting thegrowtb in Federal Medicaid spending
per recipient. This policy constriliru Federal spending but ailows states·to respond to
.
. unexpected changes 'in the number ofpeople covered. It does not put,states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
. ' ,
'" u.s. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totli.ls due to rounding,
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
NEW MEXICO
The Republican Budget Resolution Conference Agreement: '
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. New Mexico
would lose $1 billion over the seven years, a 34% redudion in 2002 alone. Even if New
Mexico could absorb half of the cuts by reducing services and provider. payments, it would
, still have to eliminate coverage for 80,000 people in 2002, according to the Urban Institute~'
includiilg:
:
•
8,000 older Americans;
•
17, 100people with disabilities; and
•
55,300 children and their families.
The Republican proposal would force New Mexico to eliminate coverage for about 4,200
people needing long-term care in 2002.· Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 72% of the 5,700
nursing home residents in New Mexico. Medicaid also serves about 5,100 olde~ Americans
and people with disabilities using home care in New Mexico. Without Medicaid, families of
the elderly and disabled could not afford nursing home care that costs an average 0[$38,000
per year nationally ..
The Republican proposal would force New Mexico to eliminate cov~rage for ~7 ,500
children in 2002.· Currently, 17 % of the children in New Mexico rely on Medicaid .for their
basic health, needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 152,000 children in New Mexico.
New Mexico could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 91 % in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal'
The President's proposal saves $54 billion over seven years from Medicaid, le~s than one-'third
the Republican cut and still a significant contribution toward deficit reduction. The president's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipieilt. This policy constrains Federal spending but allows states to respond to
unexpected changes in the, number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety' net -- as would happen under the
Republican proposal.
'
. . u.s. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
.,."
..
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
.
Contact: 202/456-7150
.
NEW YORK
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. New York would
lose $19 billion over the seven years, a 27%. reduction in 2002 alone. Even if New York
could absorb half of the cuts by reducing services and provider payment~, it would still have to
eliminate coverage for 645,000 people in 2002, according to the Urban Institute, including:
•
66,400 older Americans;
•
100,400 peop~e with disabilities; and
•
478,200 children and their families.
The Republican'proposal would force New York to eliminate coverage for about 71,300
people needing long-term care in 2002.· Medicaid is·the largest insurer of long-term care
for all Americans, including the midctle class. Currently, Medicaid covers 79% of the 84,500
nursing home residents in New York. Medicaid also serves about 241,800 older Americans
and people with disabilities using home care in New York. Without Medicaid,' families of the
,
elderly and disabled could not afford nursing hom~ care that costs an average of $38,000 per
year nationally.
,
The Republican proposal would force New York to eliminate coverage for 343,700
children in 2002.· Currently, 25 % of the children in New York rely on Medica~d for their
basic heal~ needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 1,300,000 children in New York.
.
New York could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 27% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget pfoposal
The President's proposal saves $54 billion over seven years from Medicaid"less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicai~ spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen un,der the
Republican proposal .
. • u.s.
Departtnent of Health & Human SerVices estimates based on the Urban Institute data; numbers
may not sum to tOrals due to rounding.
�"
"
THE WHITE HOUSE
Office of'Media, Affairs
September 14, 1995
Contact: 202/456-7150
NORTH CAROLINA
The Republican Budget Resolution Conference Agreeme~t:
Medicaid Cuts Will Force States to Reduce Health Coverag'e
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002 .
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002: Nortb Carolina
would lose $7 billion over the seven years, a 34% reduction in 2002 alone. E~en if North '
Carolina could absorb half of the cuts by reducing .services and provider payments, it would
still have to eliminate coverage for 455,000 people in 2002, according to the Urban Institute,
including:
•
79,300 older Americans;
•
64,000 people with disabilities; and
•
312,300 children and their families.
'The'Republican proposal would·force North Carolina to eliminate coverage for about"
40,900 people needing long-term care in 2002. III Medicaid is the largest insurer of long-term
care for all Americans, including the middle class. Currently, Medicaid covers 76% of the .
31,600 nursing home residents in North Carolina., Medicaid also serves about 3l,300 older
Americans and people with disabilities using home care in North Carolma: Without Medicaid,
families, of the elderly and disabled could not afford nursing home care that costs an average of ,
' : '
'
$38,000 per year nationally.
The Republican proposal would force North Carolina to eliminate coverage for 204,600
children in 2002.'" Currently, 19% of the children in North Carolina rely on Medicaid for
.
their basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive _
care-in case of emergencies for about 491,000 children in North Carolina.
..
,
'
North Carolina could avoid these difficult'choices forced by the Republican proposal only by
increasing its Medicaid spending by 62% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
"
The President's proposal saves $54 billion oyer seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution towar<l: deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Fedenil Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and '
dismantle a program that has served as a critical safety net'-- as would happen urder the
Republican proposal.
• U,S. Departtnent of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rOUnding.
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
'Contact: 202/456-7150
NORTuDAKOTA
The Republican Budget Resolution Conference Agreement:.
Medicaid Cuts Will Force States to Reduce Health Coverage
.
.
Rel)ublican's Prol)osalj Reduces Medicaid Payments to States 'by 30% in 2002
.Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. North Dakota
would lose $382 million over tJ:1e seven years, a 26%. reduction in 2002 alone. : Even if
North Dakota could absorb half of the cuts by reducing services and provider payments, it
would still have to eliIpinate coverage for 18,000 people in 2002, according to the Urban
Institute, including:
'
•
2,700 older Americans;
•
2,300 people with disabilities; and
•
12,600 children and their families.
i
The Republican proposal would force North Dakota to eliminate coverage for about 2,300
people needing long-term care in 2002.· Medicaid is the largest insurer or long-tenncare
for all Americans, including the middle class. Currently, Medicaid covers 57 % of the 6,700
nursing home residents in North Dakota. Medicaid also serves about 3,600 older Americans
,and people with disabilities using home care in North Dakota. Without Medicaiq, families of
'the elderly and disabled could not afford nursing home care that costs an average' of $38,000
. per year nationally.
The Republican proposal would force North Dakota to elim~nate coverage for 8,800
children in 2002~· Currently, 12% of the children in North Dakota rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 27,000 children in North Dakota.
N()rth Dakota could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 58 % in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
'
.Ihe'President's Balanced Budget Prol)os31
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant c'ontribution toward deficit reduction. The President's
Medicaid policy produces savings by.reducing and retargetting disproportionate .share
payments, increasing state flexibility, and liiniting the growth in Federal Medicaid spending
per recipient.' This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered,. It does not put states at risk -and
, dismantle a program that has served asa critical safety net -- as would happen under the
Republican proposal.
.
• u.s. Department of Health & Human Services estimates based on ,the Urban Institute data; numbers may not sum to totals due to rounding.
I
�T~
WHITE HOUSE
Office of Media Affairs
September 14, 1995
. Contact: 202/456-7150
OIDO
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal; Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Ohio would lose
$7 billion over the seven y~ars, a .28% reduction in 2002 alone. Eyen 'if Ohio could absorb
half of the cuts by reducing services and provider payments, it would still have to elimin:ate
coverage for 292,000 people in 2002, according to-the Urban Institute, including:
•
32,200 older Americans;
"
•
50,100 people ,with. disabilities; and
•
209,800 children and their farnili~s.
"
•
I
The Republican proposal would force Ohio toelimimite coverage' for about 28,000 people
needing·long-term care in 2002.* MediCaid is the largest insurer of long-term care for all
, Americans, including the middle' class. Gurrently, Medicaid.covers 69% of the 70,600
nursing horne residents in Ohio. Medicaid also serves about 51,500 older Amer,icans and
people with disabilities using horne care 'in Ohio. Without Medicaid, families of, the elderly
and disabled could not afford nursing horne care that costs an average of $38,000 per year
,.
nationally.
The Republican proposal would force Ohio toeli~inate coverage for 143,100 children in
2002. * Currently, 20 % of the children in Ohio rely oIl: Medicaid for their basic health needs.
Medicaid pays for immunizations, regular, check-ups, and intensive care in case of
emergencies for about 785,000 children in Ohio.
' . ,
Ohio could avoid' these difficult choices forced by the Republican proposal only by increasing
its Medicaid spending by 43% in 2002 --by raising property or sales taxes, or cutting other-'
critical state sp~nding.
'
"
,
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years frOII1 Medicaid. 'less than 'one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy 'constrains Federal spending but allows s~tes to re~pond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net-..: as would happen under the
Republican p r o p o s a l . '
.'
.
, ... U,S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum tot?tals due to rounding,
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
,
OKLAHOMA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal; Reduces l\fedicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending'
.between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Oklahoma would
lose, $2 billion over the seven years, a 31% reduction in 2002 alone. ' Even if Oklahoma
could absorb half of the cuts'by reducing services and provider payments, it would still have to',
eliminate coverage for 125,000 people in 2002, according to the 'Urban Institute, including:
•
14,000 older Americans;
•
16,400 people,with disabilities; and
•
94,200 children and their families. '
.
.
'
!
The Republican proposal would force Oklahoma to eliminate coverage for about 3,700
people nee~!ng long-term care in 2002. ill Medicaid is the largest insurer of long-term care
for all Americans. including the middle class. Currently, Medicaid covers 66 % of the 21,900
nursing home residents in Oklahoma. Medicaid also serves about 12,300 older Americans and
people with disabilities using home care in Oklahoma. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
'
.
The Republican proposal would force Oklahoma ;to eliminate coverage 'for 65,800 children
in 2002. III Currently, 15 % of the children in Oklahoma rely on Medicaid for theii- basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 198,000 children in Oklahoma.
Oklahoma could' avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 72 % in 2002 -- by raising property or sales taxes, or
cutting other critical state spending. ,
' .
:
The President's Balanced Budget Proposal
.
. The President's proposal saves $54 billion over sevenyears from Medicaid, less than one-third
th~ Republican cut and still a significant' contribution toward deficit reduction. Th,e President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in 'Federal Medicaid spending
per recipiertt. This policyconstra:ins Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- .as would happen under the
Republican proposal.
,
• u.s. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding,
.,.,
�THE WHITE HOUSE
Office of Media Affairs
Contact: 202/456.:.7150
September 14, 1995
OREGON
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States, to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Oregon would
lose $2 billion over the seven years, a 31 % reduction in 2002 alone. Even if Oregon could
absorb half of the cuts by reducing services and provider payments,' it would still have to
eliminate coverage for 118,000 people in 2002, according to the Urban Institute, including:
•
8,900 older Americans;
•
15,400 people with disabilities; and
•
' 94,100 children 'and their families. ,
The Republican proposal would force Oregon to eliminate coverage for about 8,600
people needing long-term care in 2002.· Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 61 % the 11,300
nursing home residents in Oregon. Medicaid also serves about 25 ,200 older Americans 'and
people with disabilities using home care in Oregon. Without Medicaid, families,of the elderly
and disabled could not afford nursing home care that costs an average of $38,000 per year
nationally.
'
of
The Republican proposal would force Oregon to eliminate coverage for 62,700 children in
2002.· Currently, 13 % of the children in Oregon rely on Medicaid for their basic health
needs.' Medicaid pays for immunizations, regular check-ups, and intenSive care ,in case of
emergencies for about 172,000 children in Oregon.
'
Oregon could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 49% in 2002 -- by raising property or s,ales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less' than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy, produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility , and limitiJ:lg the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
'
unexpected changes in the number of people covered. It does not put states ~t risk and
dismantle a prograIl1 that has served as a critical safety net -- as would happen u,nder the
' , , '
Republican proposal.
,
,I
.,
.. u.s. Departtnent of Health & Human Services estimates' based on the Urban Institute data; numbers may not sum to totals due to rounding.
i
'
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
PENNSYLVANIA'
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force. States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% 'over seven years and 30% in 2002. Pennsylvania
would lose $6 billion over the seven years, a 27% reduction in 2002 alone. Even if
Pennsylvania could absorb half of the cuts by reducing services and' provider payments, it,
would still have to elimlnate coverage for 308,00 people in 2002, according to the Urban
Institute, including:
•
31,600 older Americans;
•
67,300 people with disabilities; and
•
209,400 children and their families.
The Republican proposal would force Pennsylvania to eliminate coverage for~ about
22,200 people needing long-term care in 2002. * Medicaid is the largest insurer of long-term
care for all Americans, including the middle class. Currently, Medicaid covers ~ % of the
75,700 nursing. home residents in Pennsylvania. Medicaid also serves about 22,300 older
Americans and people with disabilities using home care iri Pennsylvania. Without Medicaid,
families of the elderly and disabled could not afford nursing home care that costs: an average of
$38,000 per year nationally.
The Republican proposal would force P~nnsylvania to eliminate coverage for' 150,800
children in 2002. * Currently, 18 % of the children in Pennsylvania rely on Medicaid for their
basic health needs. Medicaid paysfor immunizations, regular check~ups, and intensive care in "
case of emergencies for about 581,000 children in Pennsylvania.
Penrisylvania could avoid these difficult choices .forced by the Republican proposal only by
increasing its Medicaid spending, by' 30 % in 2002 -- by raising property or sales taxes, or
. cutting other critical state spending.
.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less 'than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate ~hare
payments, increasing state flexibility, and limiting the ,groWth in Federal Medicaid spending
per recipient. This .policy constrains Federal spending but aJlows states, to respond to
unexpected changes in the number of people covered. It does not put-'states at risk and
dismantle a program that has served as a critical safety net -- as would. happen under the
Republican proposal. ,
• u.s. Department of Heal!h & Human Services estimates based on !he Urban Institute data; numbers'may not sum to totals due to rounding.
,
�THE WHITE HOUSE
Office of Media Affairs
Contact: 202/456-7150
September 14, 1995
RHODE IsLAND
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican'sProposal: Reduces Medicaid PaYments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Rhode Island
would lose $861 million over the seven years, a 26%· reduction in 2002 alone ••. Even if
Rhode Island could absorb half of the cuts by reducing services and provider payments, it·
would still have to eliminate coverage for 51,000 p~ople in 2002, accordmg to 'the Urban
IristitUte, including:
"
•
7,800 older Americans; ,
•
11,200 people with disabilities; and
•
32,100 children and their families.
The Repu~lican proposal would force Rhode Island·to eliminate coverage for1about
12,000 people needing long-term care in 2002. * Medicaid is the largest insurer of long-term
care for all Americans, including the middle class~ Currently, Medicaid covers 75% of the
7,200 nursing home residents in Rhode Island. Med~caid also serves about 12,000 older'
Americans and people with disabilities using home care in Rhode Island. Without Medicaid,
families of the elderly and disabled could not afford nursing home care that costs :an average of
$38,000 per year nationally.
The Republican proposal would force Rhode Island to eliminat~ coverage for 21,600
children in 2002. * Currently, 23 % of the children in Rhode Island rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups,. and intensive care in
case of emergencies for about 44,000 children in Rhode Island.
Rhode Island could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 31 % in 2002 ,-- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and lirnitipgthe growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond t9
unexpected changes in the number of people covered. It does not put s~tes at risk and
dismantle a program that has served as a' critical safety net -- as would happen under the
Republican proposal.
.'
., u.s. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum.to totals due to rounding.
�THE WHITEHOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
SOUTH CAROLINA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force' States to Reduce Health Coverage
Republican's Proposal; Reduces Medicaid Payments toStates by 30% in 2002
. Republicans are proposing to cut more than $182 billion from Federal Medicaid ~pending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. South Carolina
wOldd lose $2 billion over the seven years, a 24% reduction in 2002 alone. Even if South
Carolina could absorb half of the cuts by reducing services and provider payments, it would
. still have to'eliminate coverage for 149,000 people in 2002, according to the Urban Institute,
including: .
• '
21,300 older Americans;
•
24,700 people with disabilities; and
•
102,600 children and their faririlies.
The Republican proposal would force South Carolina to eliminate coverage for about
7,800 people needing long-term care in 2002.* Medicaid is the largest insurer'of long-term
care for all Americans, including. the middle class. Currently, Medicaid covers 74 %. of the
12,400 nU.rsinghome residents in South Carolina. Medicaid also serves about 13,100 older
Americans and people with disabilities using home care in South Carolina. Without Medicaid,
families of the elderly and disabled could not afford nursing home care mat costs an average of
$38,000 per year nationally.
.
The Republican proposal would force South Carolina to eliminate coverage for 73,300
children in 2002. * Currently , 24 % of the childr~n in South Carolina rely on Medicaid for
their, basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive
care in case of emergencies for about 232,000 children in South Carolina. '
'
,
South Carolina could avoid the~e difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 59 % in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years froni Medicaid, less than one-third·
the Republican cut and still a .significant contribution toward deficit reduction. The President's
.Medicaid policy produces savings by reducing and retargetting disproportionate share
.
payments, increasing state flexibility, and liiniting the growth in Federal, Medicaid spending
per recipient. This policy constrains Federal spending but allows states' to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under· the
Republican proposal.
. '
:
• u.s, Depamnent of Health & Human Services estimates based on the Urban Institute data; numbers may not sum 10 totals due 10 rounding.
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
SOUTH DAKOTA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
, 'Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. South Dakota,
would lose $396 million over the seven years, a 28% reduction in 2002 alone. ' Even if
South Dakota could absorb half of the cuts by reducing services and provider payments, it
would still have to eliminate coverage for 19,000 people in 2002, according to
Urban
Institute, including:
'
•
2,300 older Americans;
•
3,300 people 'with disabi1iiie~; and
•
13,300 children and their families.
the
The Republican proposal would force South Dakota to,eliminate coverage for about 2,100
people needing long-term care in 2002.· Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. ClJrrently, Medicaid covers 56% of the 7,,600
nursing home residents in South Dakota. Medicaid also serves about 2,200 older:Americans
and people with disabilities using home care in South Dakota. Without Medicaid, families of
the elderly and disabled could not afford nursing home care that costs an average of $38,000
.per year nationally.
.,
The Republican proposal would force South Dakota to eliminate coverage for 9,600
children in 2002. III Currently, 15 % of the children in South Dakota rely on Medicaid for their
basic health needs. ' Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 37,000 children in South Dako~.
South Dakota could avoid these difficult choices forced by the Republican propos~l only by
increasing its Medicaid spending by 56 % in 2002 -- by raising property or sales taxes, or '
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-thi~d
the Republican-cut and still a significant contribution toward deficit reduction. The President's
, Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility; and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served. as a critical,safety net -- as would happen under the
Republican proposal.
,
• u.s. Department of Health & Human Services ,estiniates based on the Urban Instirute ~ta; numbers may not sum to totals due to round!ng.
�THEWmTE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
TENNESSEE
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Foree States to Reduce Health Coverage
Republican's Propo~al; Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Tennessee would
lose $5 billion over the seven years, a 32% reduction in 2002 alone. Even if Tennessee
could absorb half of th,e cuts by reducing services and provider payments, it would still have to
eliminate coverage for 246,000 people in 2002, according to the Urban Institute, including:
•
27,800 older Americans;
,
•
61,000 people with disabilities; and
•
157,000 children and .their fainilies.
The Republican proposal would force Tennessee to eliminate coverage for about 5,800
people needing long-term care in 2002. III Medicaid is the largest insurer' of long~term care
for all Americans, including the middle class. Currently, Medicaid covers 77 % of the 31,800 ,
nursing home residents in Tennessee. Medicaid also serves about 9,300 older Americans and
people with disabilities using home care in Tennessee. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs ail average of $38,000 per
year' nationally .
.
'
. , The Republican proposal would force Tennessee.to eliminate coverage for 112,000
children in 2002. III Currently, 27 % of the children in Tennessee rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups, and Intensive care in
case of emergencies for about 452,000 children in Tennessee.
"
Tennessee could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 61 % in 2002 -- by raising property or sales taxes, or
cutting othefcritical state spending."
'
The President's Balanced Budi-etProposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-thiJ.:d
the Republican cut and still a significant contribution toward deficit reduction. The President's
,Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This 'policy constrains Federal spending but allows 'states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has' served as a critical safety .net -- as would happen under the .
Republican proposal.
.
. '
• u.s. Deparnnent of Health & Human Sc;rvices estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
TEXAS
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts WiU Force States to Reduce Health ~overage
Republican's Proposal; Reduces Medicaid Payments to States by 30% in 2002
Republicans ar~ proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Texas would lose
. $11 billion over the seven years, a 29% reduction in :2002 alone. Even if Texas could
absorb half of the cuts by reducing services and provider paymeI)ts, it would still have to
eliminate coverage for 687,000 people in 2002, according to the Urban InStitute, :including:.
•
66,800 older Americans;
•
68,500 people with disabilities; and
•
551,600 children and their families.
The Republican proposal would force Texas to eliminate coverage for about 43,100 people
needing long-term care in 2002. * . Medicaid is the largest insurer of long-term care for all
Americans, including the middle class. Currently, Medicaid covers 76% of the 63,700
nursing home residents in Texas. Medicaid also serves about 85,900 older Americans and
people with disabilities using home care in Texas. Without Medicaid, families of the elderly
and disabled could not afford nursing home care that costs an average of $38,000 per year
nationally.
The Republican proposal would force Texas to eliminate coverage for 394,100 children in
2002.* Currently, 20% of the children in Texas rely on Medicaid for their basic health needs.
Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 1,407,000 children in Texas.
Texas could avoid these difficult choices forced by the Republican proposal only by increasing·
its Medicaid spending by 48 % in 2002 -- by raising property or sales taxes, or cutting other
critical state spending.
'
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
.dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
4< u.s. Deparanem of Health & Jluman Services estimates based on the,Urban Instirute data; numbers may not sum to totals due to rounding.
�TJIEWHITE HOUSE
Office of Media Affairs
\
September J~, 1995
Contact:. 202/456-7150
I
UTAH
The Republican Budget Resolution Conference Agreement:
MediCaid Cuts Will Force ~tates to Reduce Health Coverage
Republican's PrOposal; Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending.
between.l996 and 2002: a cut of 20% over seven years and 30% in 2002. Utah would lose
$1 billion over the seven years, a 31 % reduction in 2002 alone. Even if :Utah could absorb
half of the cuts by reducing services and provider payments, it would still have to eliminate
coverage for 53,OOOpeople in 2002, according to the Urban Institute, including:"
•
. 3,200 older Americans;
•
6,200 people with disabilities; and
•
. 43,800 children and their families.
The Republican proposal would force Utah to eliminate coverage for about 3,/100 people
needing long-term care in 2002. * Medicaid is the largest insurer of long-term care for all
AmericanS, including the middle class. Currently, Medicaid covers' 65 % of the 5,500 nursing'
home residents in Utah. Medicaid also serves about 3,200 older Americans and people with
disabilities using home care in Utah. Without Medicaid, families of the elderly and disabled
could not afford nursing home care that costs an average of $3~,OOO per year nationally.
,
•
.
I
The Republican proposal would force Utah to eliminate coverage for 29,000 children in
2002. * Currently, 8% of the children in Utah rely on Medicaid for their basic health needs .
. Medicaid pays for immunizations, regular check-ups, and intensive care in case of.
emergencies for about 86,000 children in Utah ..
Utah could avoid these difficult choices forced by the Republican proposal only by increasing
its Medicaid spending by 86% in 2002 -- by raising property or' s~les taxes, or cutting other
critical state' spending .
"
The President's Balanced Budget 'Proposal
,
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still' significant contribution toward deficit reduction. The President's
, Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexib~lity, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal'spending but allows states to respond to
unexpected changes in the number of people covered.' It does not put states at risk and
.dismantle a program that has served 'as a critical safety net -- as would happen under the
Republican proposal.
a
'" u.s. Department of Health & Human Services esrlinates based on the 'Urban Instirute data; numbers may not sum to rOf1ils due to rounding .
.
'
�THE, WHITKH0:USE
Office of Media Affairs
September 14, 1995 .
Contact: 202/456-7150
VERMONT
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut.more than $182 billion from FederafMedicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% iIi 2002. Vermont would
lose $318 million over the seven years, a 27% reduction in 2002 alone. Even if Vermont
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 20,000 people in 2002, according to the Urban InStitute, including:
.
•
2,400 older Americans;
•
·3,500 people. with disabilities; and
•
14,200 children and their families.
The Republican proposal would force Vermont to eliminate coverage for about 1;900
people needing long-term care in 2002. *. Medicaid is the largest insurer of long-term care _
for all Americans, including the middle class. Currently, Medicaid covers 68 % of the 3,300
nursing home residents in Vermont. Medicaid also serves about4,600 older Americans and
people with disabilities using hOfile care in Vermont. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
. '
year nationally. .
The Republican proposal would force Vermont to eliminate cover~gefor 9,000 children in
2002.* Currently, 18% of the children in Vermont rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 47,000 children in Vermont.
.'
Vermont could avoid these difficult choices forced by the Republican.proposal only by
increasing its Medicaid spending by 42 % in 2002 -- by raising property or sales taxes, or
cutting other·critical state spending.
The President's Balanced Budget-Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a sig.nificant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility,. and limiting the growth in Federal Medicaid spending
per recipient.· This policy constrains.Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at ri~k and
dismantle a program that has served as a critical sa(ety net -- as would happen under the
Republican proposaL
• u.s, Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding..
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995,
Contact: 202/456-7150
VIRGINIA
, The Republican Budget Resolution Conference Agreement:
MediCaid CutS Will Force States to Reduce Health Coverage
Republican's Propos'at; Reduces Medicaid Payments to States by 30% in 2002
Republicans are-proposing to cut more than $182 billion from FederalMedicaid spending
between 1996 and 2002: a cut of20% over seven years and 30% in 2002. Virginia would
lose $3 billion over the seven years, a 33,% reduction in 2002 alone. Even if Virginia could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 236,000 people in 2002, according to the Urban Institute, including:
•
32,400 older Americans;
.
•
36,400 people with disabilities; and .
•
167,100 children and their families.
The Republican proposal would force Virginia to eliminate coverage for about 17,800
people needing long-term care in 2002.· Medicaid is the largest insurer of long:-term care
for all Americans, including the middle class. Currently, Medicaid covers 70% Qf the 25,400
nursing home residents in Virginia. Medicaid also serves about 17,600 older Americans and
people with disabilities using home care in Virginia. Without Medicaid, families of the elderly
and disabled could not afford nursing home care that costs an average of$38,000'per year,
nationally~
The Republican proposal would force Virginia tO"eliminate coverage for 117,000 children
in 2002.· 'Currently, 14 % of the children in Virginia rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 334,000 children in Virginia.
Virginia could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 35% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
,
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
.
.
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, ~d limiting the growth in FederalMedicaid sp~nding
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put. states at risk and
dismantle a .program that has served as a critical. safety net -- as would happen under the
Republican proposal .
,
... u.s. pepartment of Health &
,
Human Services estimates based on the Urban Institute data; numbers may not sum to totals due
,
to
rounding.
�THE WHITE.HOUSE
Office of Media Affairs .
Contact: 2021456-7150
. September 14, 1995
WASHINGTON
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Med'icaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% 4t 2002. Washington.
would lose $4 billion over the seven years, a 31 % reduction in 2002 alone. Even if
Washington could absorb half of the cuts by reducing services and provider payments, it '
would still have to eliminate coverage for 183,000 people in 2002, according to the Urban'
Institute, including: '
•
12,900 older Americans;
•
29,500 people with disabilities; and
•
140,500 children and theirfamilies.
The Republican proposal would force Washington to eliminate coverage for about 8,200
people needing long-tenn care in 2002. III Medicaid is the larg~st insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 67 % of the. 23,600
nursing home residents in Washington .. Medicaid also serves about 4,300 older Americans
and people with disabilities using home care in Washington. Without Medicaid,Jamilies of
the elderly and disabled could not afford nursing home care that costs an averag~ of $38,000
Per year nationally.
The Republican proposal would force Washington to eliminate coverage for 91,200
children in 2002.* Currently, 12% of the children in Washington rely on Medicaid for their,
basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 328,000 children'in Washington.
Washington could avoid these difficult choices ..forced by the Republican proposal.only by
increasing its Medicaid spending by 31 % in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President'.s proposal saves $54 billion oVer seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward defici~ reduction. The President's
. Medicaid policy produces savings by reducing and retargetting disproPQrtionate,share.
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -.:. as would happen under the
Republican proposal.
II< u.s. Department of Health & Human Services estimates basedon the Urban Institute data; numbers may not sum to totals due to rounding.
"
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150'
WEST VIRGINIA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002·
. Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% iri 2002. West'Virginia
would lose $3 billion over the seven years, a 35% reduction in 2002 alone. Even if West
Virginia could absorb half of the cuts by reducing services and provider payments, it would
still have to eliminate coverage for 140,000 people in 2002, aCcording tO'the Urban Institute, .,
including:
•.
13-,200 older Americans; .
•
26,100 people with disabilities; and
•
100,300 children and their families.
The Republican proposal would force West Virginia to eliminate coverage for about
5,400 people needing long-term care in 2002.* Medicaid is the largest insurer :of long-tenn
care for all Americans, including the middle class. Currently, Medicaid covers 75 % of the .
6,300 nursing home residents in West Virginia., Medicaid also serves about 3,300 older
Americans and people with disabjlities using home.care iri West Virginia. Without Medicaid,
families of the elderly and disabled could not afford nursing home care that costs an average of
$38,000 per year nationally.
.
.
.
,
The Republican proposal would f~rce West Virginia to eliminate coverage for 60,200
children in 2002. * Currently, 24 % of the children in West Virginia rely on Medicaid for
their basic health needs. Medicaid pays for immunizations, regular cheek-ups, and 'iIltensive
. care in case of emergencies Jorabout 161,000 children in West Virginia .
.
,
West Virginia could avoid these.difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 97 % in 2002 -- by ,raising property 'or sales taxes, or
cutting other critical state spending.
,
"
The President's Balanced Budget Proposal
,
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward defidt reduction. The.President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in' Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
.
unexpected changes in the number of people covered. It does, not put stites at risk and
dismantle a program that has served as a critical safety net .:- as would happen under' the
Republican proposal .
. . u.s. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding,
�THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150'
WISCONSIN
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts W~l Force States to Reduce Health Coverage .
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Wisconsin would
lose $3 billion over the sevenyears, a 29% reduction in 2002 alone. Even if Wisconsin
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 94,000 people in 2002, according to the Urban Institute, including:
•
12,800 older Americans; .
•
23,000 people with disabilities; and
•
58,000 children and their families.
The Republican proposal would force Wisconsin to eliminate c0l'erage for about 11,300
people needing long-term care in 2002.· Medicaid is the largest insurer of long-term care
for all Americans, including the'middle class. Currently, Medicaid covers 68 % .of the 43,100
nursing home residents in Wisconsin. Medicaid also serves about 13.200 older Americans and'
people with disabilities using home care in Wisconsin. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
.
The Republican proposal would force Wisconsin to eliminate coverage for 42,600 children
in 2002." Currently, 15 %. of the children in Wisconsin rely of!. Medicaid for their basic health
needs. Medicaid pays for immunizationS, regular check-ups, and intensive care in case of
emergencies for about 141,000 children in Wisconsin.
'
Wisconsin could' avoid these difficult choices forcedbytbe Republican proposal only by
increasing its Medicaid spending b~ 43 % in 2002 -- by raismg property or sales taxes, or
cutting other critical state spending.
',
,
The President I s Balanced Budg-et Proposal
The President's proposal saves $54 billion' over seven years from Medicaid, less than one-third'
the Republican cut and still a significant contribution toward deficit'reduction. The President's
.Medicaid poljcy prOduces savings by 'reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Fed,eral Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond' to .
unexpected changes in the number of people covered. It does notput states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
,
• U,S, Department of Health & Human'Services estimates ,based on the Urban Instirute data; numbers rna)' not sum to totals due to rounding,
�THE WHITE HOUSE
Office of Media Affairs
Contact: 202/456-7150
September 14, 1995 '
, WYOMING
The Republican Budget ~esolution Conference Agree~ent:
, Medicaid' Cuts Will Force States to Reduce Health Coverage
Republican's,Proposali Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Fed~ral Medicaid, spending
, between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Wyoming would
, lose $245 million over the seven years, a 30% reduction in 2002 alone. Even if Wyoming
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 15,000 people in 2002, according to the Urban Institute, including:
,•
1,000 older Americans;
•
1,700 people with disabilities; arid
•
12,200 children and their families.
The Republican proposal would force Wyoming to eliminate coverage for about 1,600
people needing long-term care in 2002.'" Medicaid is the largest' insurer of long-tenn care
for all Americans, including the'middle class. Currently, Medicaid covers 66% of the 1,700
nursing home residents in,Wyoming. 'Medicaid also serves about 3,300 older Americans and
people with disabilities using home care in Wyoming. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
:year nationally.
The Republican proposal would force Wyoming to elimInate coverage for 8,500 children
in 2092. III Currently, 13 % of the children in Wyoming rely on Medicaid for their basic health
needs. ' Medicaid pays for immunizations; regular check-ups, and intensive care in case of
emergencies for apout 26,000 children in Wyoming.
'
,
Wyoming could avoid these difficult choices forced by the Republican proposal only by
'increasing its Medicaid spending by 45% ,in 2002 :-- by raising property or sales taxes, or'
,cutting other, criticai state spending.
The'President's BalanCed Budget Proposal
The'President's proposal saves $54 billion over seven y<;ars from Medicaid, less than one-third
the Republican cut and still a sigriificant contribution toward deficit reduction. ,The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibi~ity, and limiting the growth in Federal Medicaid' spending
per recipient. This policy ~onstrains Federal spending but allows states to respond to
unexpected changes in the number of people cov~red. It does not put states at'risk and
d'ismantle a program that.has served as a critical safety net -- as would happen under the
Republican proposal.
,
'
,
,
. . u.s. Departtnent of Health & Human Services estimates based on the Urban Institute ~ta; numbers may not,sum rorotals due to rounding.
�• SEP';"27-1995
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Admjnistration on Children, Youth, and Families
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Facsimile Cover Sheet
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Organization:
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RecipiemYs ,FAX number:_ _ _ __ _ _ _ _ _ _ _.......-_ _ ~'~
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~umber of Pages Including this sheet: 2
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DEPARTMENT OP HEALTH .. HUMAN SERVICEs
~,
ADMINISTRATION FOR CHILDREN AND F_UES
370 L'Enfant Promenade. S.W:
SEP 27 1995
Washington, D.C., 20447 '
Ms. Carol H. Rasco
Assistant to the President
for Domestic policy
Executive Office of the President
Washington, D.C. 20500
...
..
"
Dear Carol:
Julie Demeo asked that we review a proposal which Dr. Bettye
Caldwell sent to the First Lady for funding ideas, and make some
sugqestions for how you might respond. Bettye is seeking funding
for Phase II of a training program for persons who will work with
infants and toddlers in child care. The first year vas funded by
a combination of foundation grants and an award from the Arkansas
Early Childhood Commission.
..." , '
Bettye has made significant contributions in early childhood
education, as you know, and recently served as a member of an
advisory group which assisted us in la~nching the expansion of
Head start to infants and toddlers. Since she fOllows our work
closely, she is probably aware that werare unable to fund her
proposal at this time. ' However, you might suggest that she
contact the following organizations:
.
The National Institute on Early Childhood Development
and Education
u.s. Department of Education
555 New Jersey Avenue, N.W., Room 522
Washington, D.C. 20208
.. " \ , '
.
The Robert MCCormick Tribune Foundation
435 N. Michigan Avenue
Chicago, Illinois 60611
~
hope that this is helpful.
information.
I
,
Let me'knbw if you need additional
r
Olivia A. Golden
Commissioner
Administration on Children, Youth
arid Families
','
,. ',.
�~-=-=--~.,..,.
THE WHITE HOUSE
OFFICE OF DOMESTIC POLICY
CAROL H. RASCO
Assistant to the President for Domestic Policy
To'
_
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-;]+-----4'lI;J)~. JiQ [ PQutJ
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Draft response for POTUS
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and forward to CHR by: 1---''':-t---A.-J.M'}~r:-- ~--=:..
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Schedule 7 :
CLINTON LIBRARY PHOTOCOPY
1
�THE WHITE HOUSE
. WASHINGTON
FAX COVER SHEET
OFFICE OF THE ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
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TO:
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(p'10 - 7'155
FROM: JULIE DEMEO
NUMBER OF PAGES'(including'cover sheet):
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reader of this message is not the intended recipienfor the employee or agent responsible for
delivering the message to the intended recipient,you are hereby notified that any' disclosure,
dissemination, copying or distribution, or the taking of any action in reliance on the contents
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�~"
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", i
,
THE WHITE HOUSE
WASHINGTON
August 24, 1995 .
Dr. Bettye Caldwell
Arkansas Children is' Hospital ,
·800 Marshall Street
Little Rock, Arkansas 72202-3591
Dear Bettye:
. I am sorry it has taken so long to. respond to your
letter of July 14. Mrs. Clinton has asked me to explore your
request about funding for the Educare. Training Jlroject and I
will.get back to you as Soon as I:possibly can. I hope my
letter finds you well and enjoying the summer. I will be
"back from a two-week vacation on the. 12th.
Sincerely yours, .
Pam Cicetti
Executive Assistant
to the First Lady
�·800 Marshall Street, Little Rock, Arkansas 72202·3591, (501) 320·1100 or TOD (501) 320·1184
.
.
·C.A.R.E.
CENTER FOR
July 14, 1995
(501) 320·3300
(SOl) 320-1552 FAX
Pam Cicetti
Office of the First Lady
The White House
1600 Pennsylvania Avenue
Washington, DC 20500
EMAIL
care@belab.ach.uams.edu
Dear Pam:
Patrick H. Casey, MD
Director
James M. Robbins, PhD
Associate Director
I am en~losinga draft of a proposal that I hope to get funded within the
next few months for what lam calling Phase II of my Educare Training
Project. Mrs. Clinton is very familiar with the model (which is adapted
from the French model which she and I had a chance to observe at first
hand) and is aware of the fact that this training was offered in Arkansas
during the past academic year.
APPLIED
RESEARCH &
EVALUATION
Adolescent Research Program
Patrick D. Snlith, PhD
Arkansas Reproductive
Health Morutoring System
Russell S. Kirby. PhD, MS
Biostatistics
Paula K. Roberson, PhD
Complex Brain Function Lab
Merle G. Paule. PhD
Health Services Research
Debra H. Fiser. MD
James M:Robbins, PhD
Sarah H. Scholle. DrPH
Peggy A. Sissel. EdD
John M. TIlford. PhD
Infant Health & Development
Patrick H. Casey. MD
Bettye M. Caldwell. PhD
Vaughn I. Rickert. PsyD
Janine E. Watson. PhD
Nursing Research
Judith A. Vessey, PhD, RNC
I know how busy she iS,but I thought she might have some ideas about
where I could submit this for funding for Phase II. The proposed budget is
very modest is relation to the products I hope to make available for future
training along these lines.
If you have a chance to show this to Mrs. Clinton and then relflY to me any
ideas she might have about funding, I would greatly appreciatedt.
Sincerely,
i;;j}r#/£
'-Bettye Caldwell
.Professor of Pediatrics
Child Development and Educat~n
University of Arkansas for Medical Sciences
BMC/ap
Enclosure
"arenting Research Program
Nicholas Long, PhD
Psychophysiology Lab
Roscoe A. Dykman, PhD
Joseph E. O. Newton. MD
Donna M. Mooney, PhD
Depflriment DfPediflirics
Uni'Dmily of ArbnsflS fur Medicfll Sciences
�•
I
Educare Proposal Narrative PU--Draft--06-30-95--1
proposal for Years Two and Three for
A Training Program for People Who will
Work in Infant/Toddler Educare<
Bettye M. Caldwell, ph.D.
Professor· of Pediatrics-
Child I:'leVelo:fX!1ent and. Education
Department of pediatrics
University' of Arkansas for Medical Sciences
Arkansas Children.' s Hospital
Little.Rock, AR 72202
a
In September of 1994, after
10-nonth planning process with local and
national colleagues, the Department of Pediatrics launched a neN training:program
for persons 'Who plan to 'IhOrk prirrerily with infants and· tcddlers in child care.
This was done in colla1::oration with QJ.apaw Technical :I.ru?titute in Hot Springs,
Arkansas. . AS I have for years urged adoption oC the term edncare as a label
for corrprehensive programs of care and education; the 'IhOrd was used to describe
the training and the term educa.regiver used as a title for the graduates. The
planning process and the curriculum 'Which resulted is enclosed as Appendix A. As
the societal need for such. a training p:rogram and the theoretical rationale for
its cCll1'TfXll1ents are provided in the original document, these details will:be
repeated here minimally. Instead, this proposal will concentrate on progress
during this pilot year, plans for the next two years, and f:uture dissemination
and exp:msion.
pilot Year Progress
Funding and Staffing
Funding for a one-year pilot was secured from a :rrurriber of sources-:--the
Harris FOllIldation ($39,695), the Kellogg Foundation ($25,000), and the Rp1::ert
W:x:rl Johnson Foundation ($15,028). With these funds, 15% of the PI's salary was
paid, a full-time Site Coordinator (Carolyn Schulte, M.A.)· was hired to
coordinate the program at Q..J.apaw and to serve as liaison with the PI, and two
highly qualified professionals (M3.ry Hendricks, Frl.D. and Paulette Johnson, M.D.)
were pai¢J..·for teaching special courses in the ·Educare sequerice. The re:rainder of
the· funds was to be applied to video production, 'Which has been delayed Until the
1995-96 period of the project .. At the end of the project year (August 31, 1995),
there will still be a small arrcunt rare.ining in 'the Kellogg grant and a1::xJut
$10,000 in .the Robert W:xxl Johnson award. Permission has been obtained to carry
these funds into the second year of the project. In this carry-over,. they will 1
be used to help cover the cost of videotape production, as was called for in the .
original request.
In addition to the awardS secured by ~ PI, Q..J.apaw Technical InStitute
. received an award of $60,118 fran the ArkarlsasEarly Childhood. COrmUssion to help
ftmd program changes necessa:ry at their site. Most of this was expended in .
adding personnel to the Institute s on-site child care center in order to meet
state standards for infant-tcddler care. The remainder was used to p..lr¢hase
equi:fX!1et1t and teaching rraterials necessary for infants and tcddlers.
I
;Cooperation between QJapa.w and UAMS was excellent. In aadl'~ion Ito the
support provided by Ralph Pinkerton, President of QJapa.w, and Audrey Ann
Atherton, Director of Instruction, two Quap.a.w faculty' members (Julie Williams,
�'Educare Proposal Narrative PU--Draft--06-30-95--2
M.S. j' and Ann Wright, B.S.E., of the Child Care Guidance and Management' seiquence)
p:rrticiJ::)ated in all the planning sessions and taught sane of the courses or
sections of the courses. And, of course, Q..lapaw was delighted to add the,
services of Mrs. Schulte to their training activities. cpen-m:indedness and
flexibility characterized all ,individuals, 1t.Drking on the project, and we all
occasionally adapted qur original' plans to the realities of the trpining ,
situation. All 'have expressed a desire to rerrain with the project in the' future.
In fact, Q,Japaw plans tocontirrue the program regardless of ymether funds, are to
be forthcoming for the .i.r!Plementation described in this proposal. The Inst-itute
has already suhnitted a pIq;X:)sal to the Arkansas Early Childhood Cornnission for
the extra funding needed on their site in order for them to offer the training,
and they have received assurance that the requested funds will be available.
Program Progress Report
student Progress. Timing of this proposal pre~ludes a full report on
the academic andernployrnent achievements of the students Who enrolled in the
program in August, 1994, as a, full year, has not yet;. transpired. However, all
students--their ability, 'rrotivation, interference due to life proble:ns, etc. --are
sufficiently well-knc:wn to the on-site faCUlty nr::J.rV that 'We can predict with a
high degree of certainty, their academic progress in the rronths ahead arid their
e:tployment future.
,,
Nine students enrolled in the educare, sequence in the fall of 1994. Of
that rurriber, t1t.D dropped out shortly after the program began. One of these
transferred to another sequence within the InStitute, so preSl.lITBbly that student
, was dissatisfied with some aspect of theprc:>QraIn. The other stude,rtt left Q..lapaw
because of personal problems., Q..lapaw's Director of Instruction, Audrey Ann
Atherton, indicated that this IEtternis fairly typical of students in the
Institute', regardless of the :[Erticular training program in which they are·
enrolled.
'
Of the r€m3.ining seven students, one (the 'only male in the ,program)
dropped outsl1ortly before mid-term, finding the course 1t.Drk difficult and having
other job responsibilities. One other dropped at mid-term because of a job offer
she felt she could not turn down. This 'student intends to corrplete the program
on a part-time l::::ssis.
I,
students graduated in Jurle, rut these were obviously students Who were
already in the Child Care Guidance and Management sequence and, therefore, had
already had some of the child develop:nent courses in the educare sequence. We
confidently anticiJ::)ate that the r€m3.ining four will graduate in January, 1996.
'IW:)
In the fall, focus interviel.A1S will be held with all students (including
those'ltvtlo left the program prerraturely if they can be found) to get a$ndid
opinions ab:::rut the training. ' we k::rla.N fran inforrre.l interviel.A1S students have had
with Mrs. Schulte during the year t.h.:;t init~ly they thought the courses were
"too hard" and required too much reading. ' Because of this, Mrs. Schulte spent a
good deal. of time during the fall semester rnentoring students experie:i1cing
academic difficulties, helpmg them to understand the written assi~ts and to '
express the:nselves orally and in Writing. Also, to our surprise, seVeral
students initially carplained a1::xJut sane aspeCts of the practicum-"":acomerstone
of this rrexlel. With these corrplciints in mind, 'We revised the prqctieum schedUle,
making certain that each student spent sane time with the chilaren each week and
had' one of the educare flacultyavailable for either rrOcieling or instruction When
�Educare Proposal Narrative'PU--Draft--06-30-95--3
he or she was in the center. After those revisions were rna.de, students appeared
to find the practicum more fulfilling.
\
"
J
Although we meN fran data supplied by Mrs. Atherton (Director of
Instruction at QJapaw) that 'general reading lev:el of the students would require .
careful attention to' any reading ,assignments made in the classes, we did not
adjust sufficiently to this reality at the beginning of the training. This was
especially important in the \:w:) rrajor health courses, where often there was a big
and totally new vocab..llary to be assimilated. Dr. Johnson, who has had
experience teaching health courses to secondary students, was incredibly
resourceful in adapting her rre.terials to the prepcrration level of the students.
Even so, this need to adapt written rraterials to a different level remains a
problem. It also rrekes thenee::l fora carpl\':!te set of videotapes. and specially
prepared reading rraterials even more essential.
,"
,
The pilot year ,provided a marvelous
opportunity to ascertain' the appropriateness of not only the entire rrodel rut of
individual courses in the sequence. First it should be said that: reactions of
faculty, students, and representatives of variouS social agencies in Central
Arkansas VJho have either attende::l presentations al::out the educare training
program or have ];::i:I.rticipated in sane wa:y in the training have been uniformly
eri.tlrusiastic and positive. A typical agency executive s response is, ":H'oN I wish
our staff could have had this t.raini:ng." ·The PI has made presentations at
several national meetings (including the Advisory Carnnittee on Services :for
Families with Infants and Toddlers--the group VJhich helped to design Early Head
Start), and several states have asked' to be included in any e:xp:msion plans. In
vieN of such indications of, encouragement--plus our o.NI1 conviction that' the type
of training we are providing is exactly 'What is needed--we have no plans to
change any major aspect of tfle ove:;alIITOdel.
'
CUrriculum Adaptations.
I
We have, however, had to rrake scme adaptations to the realities of
vocational students' lives. OUr one-year ITOdel, with a carefully ~gl1t-out
progression through the various courses, does not fit perfectly the edUcational
t=a.ttern of many vocational students (or college students in today's \4X)rld, for
that rratter) _ Many of them can attend school only part-time, as they combine
school with multiple family responsibilities and outside arployment. Because of
this we have had to give up sane of our ideas ab:Ju t the ideal seq:uence. of classes
and accept the fact that each course has to stand on its o.NI1 and not rely on
prior corrpletion of prereq:uisites. The best exarrple of this is in the \:w:) rrain
health courses, 'ru:.jw sirrply calle::l Health Issues I and Health Issues II .
. Instruction in Heal th Issues II will· not presup[X)se successful carpletion of
Health Issues I, as students may have to reverse the sequence in order to enroll
in either of the. courses,_
.
At the individual course level, we have continuouslyattarpted to craft
the courses so that they convey the necessary information by means of. classroom
presentations (lectures, discussions, tapes. ~t>rojects) properly geared to the
students level of academic readiness. A meticulous content analysis of any
academic seq:uence (for 'Whatever level) is extrenely time-consuming, aI1d. we have
of necessity devoted rrore time to some of the courses than to others .: Two
'exarrples will be cited:
I
Heal th Issues I and Heal th Issues II. The PI' S original idea ab:Jut these
courses assUmed that we could essentially take the courses in Anatomy and
Physiology and in Principles of Pharrn3.cology right out of the LPN training
program and that they could, in fact, be taught by the person in charge of that
�Educare Proposal NarrativePU--Draft--06-30-95--4
r::e
program at QJ.apaw. This prov~ to
infeasible,. as a great deal of the c6ntent'
of the existing courses dealt with the elderly (the main ffiployment category for
LPN s) and minirrally covered the first few years of life and developmental
processes . Accordingly, ·the courses in theeducare sequence have been totally
reorganized to fit the early years. In this process, we have been extremely
fortunate in having a Board-certified pediatrician, Dr. Paulette Johnson, :teach
these courses--prol:::ably a rarity on vp-tech Carrp..lSes. As so ruch change and new
organization proved to be necessary, we have not yet videotaped the courses.
This is to be done in. the fall of 1995- and the, sprmg of 1996.
I
kbrking with Parents. A great deal of time and effort has gone intb the
planning of this course. .This was necessary because the course conceived. by the
PI involved training students to \',Ork with txrrents in the heme' as well as in
centers. The Child Care Guidance and Manage:nent program at Quapaw contained a
course sinply entitled Parenting, and the faculty 'Who were to teach the,neN
course s~ it as something of a replication of the older one. To be sure, the
existing course covered sC:rne of the topics planned for the new course (such as
Understanding m:dern families) rut did not intrcx:lu.ce students to the ideas of
programs sUch as Parents As Teachers, HIPPY, the~ Carprehensive Child Developnent
Program, and Farly Head Start. Nor did the old course involve making any actual
heme visits. Administrative personnel at Q..laJ;law were reluctant to allON. such
visits, fearing that their insurance did not cover activities conducted off
carrp.J.S. Dealing with these realities has required adaptatiop at roth levels, rut
it has been possible to \',Ork out meaningful adaptations that will not coIrpromise
the quality of the training or the insurance arrangements at QJa:paw. '
This kind of course content rrodification is occurring constantly. - Mrs.
Schulte,provideS immediate feedl::ack relating to student reactions and to the
reactions of the QJapaw administration, and these are always considered. as course
syllabi are reforrrulated. A big :part o~ faculty effort has been, devoted to
finding print rraterial appropriate for vocational -students iI1
of these areas.
In this effort, we have been more successful than might have been antici:pated.
Future
P~ans
There are tv.o rrajor goals for the .next tw:J years of the Educare Training
Project. The first is to develop'~ conplete set of distance learning materials
for all the courses in the trai.ni.ng sequence. The second is to launch a
replication of the training in Little Rock. Each of these will be discussed in
turn.
'
Distance Learning Materials
.
this effort into other states and
regions, we feel that it is necessary to p.lt to:.;;rether a carplete set of distance
learning materials covering all the topics included in the training. These
rraterials will include:
_
,
As :part of the preparation for
~g
1: Five 30-mirrute videotapes' covering the major topics to be dealt with
in each course. As a l1l..lIlU::er of other groups have produced or are prqjucing
videotapes dealing with sane of our topics, there' is no intent to disregard. these
and duplicate the effort that has gone into their prcduction. Instead we. Will
pre,t::ere tapes that SUWlEm2I1t those already available arid that will properly
orient students to the principal ideas of each ~ourse. A gcxxI'€xample of this
can be found in the area of health and safety. The .Arrerican Academy of
Pediatrics has produced a series on health, and safety in child' care, and we plan
to reccmnend these as :part of our training . Hcwever, to the best of our
knowledge, no one has prcduced a set of videotapes introducing prospective
�Educare Proposal Narrative pu--Draft--06-30-95--5
educare workers to Basic anatomy and physiology.
concentrate on this aspect of the heal th series .
Consequently
I
ours will·
. , 2. Teacher'S Manuals for each course. In addition·to presenting full
syllabi for each course, the Manuals will contain (a) suggested reading materials
for faculty, (b). a reading list for students, and (c) classroan activities to
extend and supplement the main ideas presented in the course.
'
..
3. Books of readings for the students. ':j:hese will contain approximately
10":12 assignments for the students for each course. They will be short, clear,
and at the appropriate reading level for the students.· Sane of· the articles will
be in the already published literature; sane will be adaptations cifpublished
material (with permission from authors, obviously); and sane will be pre.pared l::y
project staff.
'
It is the PI's conviction that it is essential to assemble a set of such
materials in a "package" before the m:xiel is e:xp:>rted to other states. As a huge
arrount of v..:orkis involved in these t.h.!-ee p:rrts of the distance learning package,
we want to keep our o,.;n instruction closer to home-for the next two year~.
Concretizing the Didactic Model
As indicated previously, the PI s rappJrt with persormel at Quapaw
Technical Institute has been most gratifying. Prior to launching this project,
vmat I knSIJ about vocational education was essentially nil. Yet there has been a
pleasing syrril::>iosis between the ideas I brought to this project and the real 'nQrld
of vocational education. And ·vmat has been continually amazing is the W1iY the
practicalities of the Quapaw guidelines have brought sane of the original ideas
doNn to earth and have given them enough flexibility to fit into. a variety of
p)ssilile future educational settings ~ The best e:xarrple of this is the course
entitled Children with Special Needs, which was offered during the first summer
tenn of 1995.
I
There was nothing like this course in the Quapaw catalogue, and there was
no one on the Quapaw faculty especially qualified to teach it (except for Dr.
Johnson, vmose time had been reserved for the health courses). But the course
was crucial for the educare training, as early intervention for children with
disabilities represents a major arployment area and a major arena for social
action in the early childhood field. In a stroke of good fortune, I was able to
arrange to have Dr. M3.rY Hendricks of the university Of Arkansas at Little Rock
teach the course. Dr. Hendricks is the coordinator for Early Childhood Special
Education at UALR and is extremely carpetent and highly regarded in the field.
Fran the stan.dpoint of the collal::xJration, the only thing· Wrong with the
Q...la:P3W Technical Inst:i,tute
that Hot Springs is 65 miles fran Little: Rock! In
the sumner session of 5+ weeks, the students rmlSt attend each class 9 hours per
week, a requirement which is. generally haridl~ l::y having class each. day for
slightly under 2 hours a day. Had it been necessary for Dr. Hendricks to drive
back and forth ·to and fran Hot Springs every day, she could not have taught the
course. In a display of flexibility that does not always characterize higher
education, the QJapaw administration agreed to the follc:Ming schedule for the 5
week session:
.
Monday: 10:00--12:00
01:00--03:00
Presentation l::y Dr. Hendricks'-"'·'''"
.Presentation l::y Dr. Hendricks
'j
�Educare'Pioposal Narrative PU--Draft--06-30-95--6
Tuesday through Friday: Follow-up activities (reinforcf31leI1t, reviev,
class eXercises, assigned observations, short tests) of 1 1/4 ,hours per day
,
conducted by Mrs. Schulte, the Site Coordinator.
.
This schedule worked beautifully and has given us the format which will be
followed by and large in all future teaching. It will be recognized in the al::xJve
plan to "produce five videotapes" for each topical area. That is, we plan to
\ have one tape which will introduce the major topic for each week (or each major,
time division). This four-plus-five fornula (four hours of somewh.a:t didactic
material plus five hours of fallON-up) has been found to fit into the syllimi for
all our major cOurses. we realize, incidentally, that other schools which may
later want to use the rrodel might not be bised on a five-week nine-hour schedule.,
Adapting our materials to a different weekly time table will not be difficult.
Certainly the "five major ,topic" pattern will fit canfortably into a semeSter
schedule.
Before leaving this discussion, a word rrust be written a1::put heM the
Special Needs course affected our planning in ways_other than the schedule.
perhaps a first statement should sinply be that it was an excellent course.,
Frequently, as I sat in on sessions, I found myself wondering whether our
students had any appreciation of how fort:u:nate they were to study this irrp)rtant
area with a teacher of Dr. Hendricks' k:na..vledge and ability and to have to share
her with only ,al:::xJut a dozen other students! Hopefully they did; certai.n.J,y their
ratings of the course were positive. Because of Dr. Hendricks' rer,:utation in the
state, we felt that people other than our educare students would like to take the
course. The Quapaw administration agreed to this, and a I1l.III'tb2r of persons .
\'.'Qrking with young children with disabilities in the Hot Springs area (plus
several Qu.at;aw faculty members as auditors) took the course. we plan to do this
in the future with several of our courses--i.e., alloiJ individuals other'than ,
educare students--to sign up for specific courses. In fact, when we get all the
other courses to the level of excellence achieved in the Special Needs Class, we
plan to make individual lecture/discussion sessions available as training
opportunities required for child care workers by the Arkansas licensirig •
statutes.'
,
'
,
videotape Production
As indicated above,· our goal is to produce 5 videotapes for, each course in
the' educare sequence. There are 10 courses in the training program unique' to the
educare sequence; other courses repres;ent requirements for a vocational
certificate regardless of specific field, and no tapes will be made for these.
This represents an ciunbitious goal of 50 tapes altogether. That is clearly
,
unrealistic for a 2-year period. For the next ~ years, our goal is to produce
10 tapes per year for a total of 20 tapes. Additional funds will be sought to,
earplete the series. For 1995-96 the tapes produced will be based on five of the
courses in the sequence: Health Issues I and II, Children with Special Needs,
WJrking with Parents, and Fducare I. In addition, an introduc;tory tape will be
made which introduces students to the rodel and orients than to What they can
expect in the course. ,For each course, one tape will be made which offers an
overviev of What will be covered in the course. The second will be the
introductory tape to one of the five major areas to be covered. IUring the
second year we will rnake the introductory tape' for
the rerraining courses and
fill in with others where the instructors feel that an audiovisuq]., presentation '
\'.'Quld be rost helpful. . The major headings of the SpeCial NeedS and the rM:rrking
with Parents courses will illustrate this plan:
�Fducare Prq:osal Nai:Tative PU--Draft--06-30-9S':"-7
Special Needs
I. Children with Special Needs
Likenesses and differences in children
•
•
Causes and classification of developmental disabilities
II.
•
•
•
Farly Intervention and Public Policy
Historical perspec"tive
FederalI State "laws
HaN the system ~rks in Arkansas in terms of
identification
assessment
individualized programs
III. A Connunity of Care: Families and Caregivers
•
Family systems
•
w:>rking with family rnanbers Who have a disability
•
Calling for help
"
4_
N.
•
"•
•
V.
•
•
•
Developnental "Disabilities
Sensory" inpairments
Orthopedi~" and health issues
Eehavior
Inclusion and Integration
Teacher attitudes
Arranging the" environment
Understanding and using equipnent
The first videotape for this cOurse will touch up:m all the rrajor pJints covered
in the five rrajor headings. The second one will deal with Point IV in the
outline.
~rJd.ng
with Parents "
I. Today s Families
•
Tradition3.l. and non-traditional families
•
Imp3.ct on children
I
II.
•
•
v
Before Educare: w:>rking with parents in the hane
Models of hane-l:ased intervention (HIPPY PAT etc.)
Fitting intervention to the family and the child
I
I
".
III. Canbination Programs: Heme Visits plus Group Experience
•
Models in which this approach has been used
•
Pros and cons of the different rrodels"
N.
•
•
•
Cooperation with Parents in SociOEm:)tioilal and Character DevelopneTIt
"Ideal" erotional relationships with parents
"Ideal" erotional· relationships with caregivers
Discipline in home Cl11d: center
V. When Environments Collide (Rivalry or hostility between hare and center)
Causes of dissension and d i s a g r e e m e n t · " · .
•
w:>rking together for the benefit of the child
Parents are clients too
"
•
".
�Educare Proposal Narrative PU--Draft--06-30-95--8
The ti-.o videotapes planned for 1995-96 for this course' are the overview covering
all five rrejor headings am. Point II (as our students have less experience with
home visiting programs) .
A Word about Distance Learning. What I have written thus far about
haN the tapes and print rreterials will be used--as part of classroom leam,ing
experiences--is obviously not what is usually referred to as distance learning.
It is my hape (and conviction) that the Educare model fortraining'personnel to
WJrk with infants and toddlers will eventually become: institutionalized in
, America--i.e., will seem so logical and so necessary that different stat~s will
want to offer it under different auspices. For exarrple, ccmnunity colleges, as
well as vo-tech schools, represent a likely setting for the training. And, as
, already indicated, hospital training for such WJrk \\OUld be eminently practical.
An analogy rray be offered to nurse's training, whiCh today involves several
'different levels and rrey take place in a vo-tech school, a hospital, or a college
or university and rrey lead to differing levels of professional autonomy. , I
visualize eventual levels of recognition for infant/toddler specialists. :
Although we are beginning at a basal level, we aFlticip3.te future differentiation
and leveling.
IIi a similar vein, persons already WJrking in the field and unable, to go
to school even half-time migh~ want to obtain part or all of the course WJrk via
independent study. ~le I was WJrking on this proposal, we received an
interesting phone call that illustrates this possibility. ,The rreg~ine W:Jrking
IDther recently devoted a brief p3.ragraph to the Educare Training Program in a
report on states that were doing something innovative to improve child care
quality. As Arkansas Children's Hospital was mentioned in the citation,' a WOITBIl
called the' hospital switchl::xJard asking for infomation about the training. After
being shunted to two or three wrong settings by the operator , she finally reached
our office. With considerable excitement, she indicated that she had wjrked in
child care for 10· years and had never felt properly trained for what sh~ did.
'The brief description in the rregazine convinced her that the educare training was'
exactly what she needed, and she wanted to enroll! There are m:my others like
her out in the field, and we ,fervently hope that our training model will be of
help to them. '
'"
It is with these possible variants in mind that i especially wan~ to
produce the videotapes and assemble print rraterials that v.ould enable others to
adopt the model and implement it in their 0Nl1 settings, 'possibly without having
the full faculty needed for such' implementation. For exarrple, a state Dep:rrtment
of Vocational Education might desire to offer the training rut not have faculty
that WJUld exactly "fit" the entire program. 'In such instances, the rreterials .
could be rrede' available in a central location and then distrihlted to
participating institutions as needed. Once we have the syllabi organized so that
each course can stand alone, distance learning can become rrore of a reality.
Similarly, with today's technology, interactive satellite participation by our
0Nl1 faculty v.oul.d be feasible in such an arrangement.
During 1995-96" plans will
be fO:rrrnllated for developmg these training neThDrks. ,The prospect is very
'exciting.'
videotape Consultation
As the rudget request for this project is fairly ri'odest,.,:arid as the oft
cited minirral cost for a carmercial-quality tape' is $1; 000 per mirrute of Jinished
tape, one might legitirretely 'question our ability to produce tapes of high enough
I
�EdUcare Proposal Narrative PU--Draft--06-30-95--9
quality that other schools might want to use them for training. In this request,
we have requested only $50, 000 per year (plus $5, 000 for equipnent the first
year) to enable the production of' 10 tapes. 'This rray turn out to be unrealistic,
causing us to" reduce the nurriber sern&ihat. HoNever, in the three small grants
that I currently have, I anticipate having approximately $25, 000 of uncorrm,itted
funds at the end of the grant year (August 31, '1995). Each granting agenCy has
agreed to allow me to carry these funds forward and use the carry-over on the
tape production. Even so, I am hoping to make the tapes for arout $6, 000 'a tape
rather than $3 0, 000 .
'
I am, confident that we can make high quality tapes within this rudget. We
.are not aiming for ,slick corrmercial products; nor will we settle for herne, video
levels.' 0Jr goal' is to produce teaching rraterials which can supplement local
talents when this program is adopted in other areas where we cannot provide
direct consultation--tapes which will be interesting to classroom groups land
which will be' available for check-out for individual use for students who miss
class for one reason or another.
In the tape production I will be working with two groups:
the
instructional Media Dep3rt::rnent of DAMS and the Production Division of AEI'N
(Arkansas Educational Television Network) . I have worked closely with AEI'N
personnel in the past (see bela....) and have their full support in the planning of
this project. They have a 'fully equipped rrobile van with excellent camera and
sound equipnent that can be used, for taping actual educare scenes to use, in the
tape and all necessary equipnent and personnel for final editing. Also we can
use their studio facilities for rrore formal. presentations and for narration.
,
,
,
o
Persorial video Caapetency. As the PI is certainly not mown as a
media specialist, her corrpetency to supervise this part of the project could well
be questioned. Actually I have been rrore involved in this type of activity than
I ever bother to indicate on a CV. With the exception of my very first effort--a
film for parents called How Babies Learn, which was rrade to be an integral part
of a research project on which I was working' at the'time--my efforts along these
lines have often slitply been fun activities that were a by-product of rTly rrain
professional efforts. Even so, r,have developed skills and contacts that will be
extremely, useful in this ,endeavor.
In addition to, HaN Babies Learn, which I wrote, narrated, edited, and
"distrihlted, I have also co-scripted and riarrated 3 tapes for the Davidson Film
Corrpany-- In' the Beginning, Nurturing, and 1tdd1erhood--all of which 'ha,ve been
widely used in child developnent and care settings for training purposes. In
addition, during the time I was president of the National' Association ,for the
Education of Young Children, I participated in the production of a mmiber of
tapes (using mainly the ,facilities of the South Carolina Educational Television
Network) which are distrihltedby the organization for training purposes.
Most relevant for skills needed on this project is a video series entitled
caring. . . Ab:Jut Children which I wrote, narrated, and produced, with funding
from the Arkansas Erldo.o.rnent for the, Hurranities. I rrade 3 ccmplete fi:lms' (later
transferred to tape): caring Ab:Jut Child care, 'Children Caring Al::xJut Children,
and Children's Rights. 'This project was done in collaboration with personnel at
AEI'N (the Arkansas Educational Television Network). Mr. Earl Robinson, a camera '
rren at that time, is rlOJl Production Coordinator at) AEI'N and is enthusiastic arout
working With me on the Educare tapes.
." .
�Educare Proposal Narrative pu--Draft--06-30-'95--10
.
' Ncm that the syllabi are 'lADrked out for nost of the courses in the Educare
training sequence, I will l:::e devoting more and nore of IT!:{ time to the production
of the videotapes. We anticip3te having the orienting tape and the two tapes on
the Children with Special Needs course corrpleted during the early fall. Frc:im
this effort we will 'lADrk out a .rrodus operandi that will hopefully' lead to l:::etter
and better products as we nove forward.
Replication of the Model
T~e second major goal for the 1995-97 period is to replicate the Educare
Training MJdelin Little Rock. As indicated earlier, I had originally plarmed to
l:::egin disseminating the rrodel to different ,states in 199~, in part 1:ecause of, the
timeliness of the training for the infant/toddler program expansion occurring
throughout thecount:ry and in p3rt 1:ecause of interest eXpressed in it by other
professionals. As an example of program expansion, Early Head Start prq;:osals
are currently under revieN, and am.,mt:er of sites will receive funding in the
. f all of 1995. Likewise, a neN program for children in the birth to three-year
age range within ax:: (the Centers for DiseaSe Control> called Project BmIN
(Bringing Education and Grc::lv.1th Into Neight:orhood.s1- has just issued an RFA for
programs operated under this auspice. Personnel in these programs .will.nost
certainly need the type of health/education hybrid represented in the Educare
rrcdel.
Hcwever, although personnel in p.ililic and private agencies in several
states have either written or called me to indicate interest in having the model
replicated in their states, my colleagues and I considered this step prenature at
this tline.· Instead, we wanted to offer the program a second time, using' our
experience from the first year .and t:.aJdI:lg advantage of this second round to
inprove our syllabi for all the 'courses and to begin serious preparation of the
videotapes under controlled conditions.
The ideal solution was replication, not dissemination, and the logical
site was Little Rock. Although travel between Little Rock and Hot Springs has
not been too b...rrdensome, it is time-cof.lSl.U'Oing. Al,though Mrs. Schulte frequently.
canes to Little Rock for our conferences, it is often essential for me ~o go to
Hot Springs in order to meet simultaneously with other Q..1aI,::e.W personnel:.
As there is a vocational-technical school in Pulaski County (Pulaski
. Technical College), my first thought was to 'lADrk out' arrangements to offer the
course there. Another option was to have the certificate offered by Arkansas
Children s Hospital--a solution ....nrtch several of IT!:{ advisers and colleagues still
favor. But our eventual solution did not ,use either of these options. Instead,
we are offering the course in Little Rock at Arkansas Children's Hospital with
students enrolled at Q..1aI,::e.W Technical Institute. That is, Quapaw will be
offering the program on an extension tasis. Students will take the three
required courses that are not in the Educare sequence (Technical conmmication,
Technical Mathenatics, and Canputer Applicat¥'ns) at Pulaski Technic.a.L College.
I
The Little Rock course will not begin until, mid.:...sane.ster (January, 1996).
'!he Site coordinator for Little Rock. cannot l:::e hired until grant funds are
secured, and, with a Septanber 1 anticip3ted starting date, we sinplycould not
l:::egin the program until later in the year. That will l:::e the ideal arrartgement
arr:JWC£Y, as it will give the neN Site Coordinator time to become familiar with the
rrodel. to 'lADrk out all the necessary arrangements for practicum;" and to
.
participate in the preparation ofo tapes and print materials~,
.
�Educare Proposal Narrative pu--Draft--06-30-95--11
There will 1:.e considerable overlap in faculty at the two sites. I will
teach {:art of Educare I and Educare II, with the rerrainder taught by the Little
Rock Site coordinator. Dr. Johnson will ccmrute to Little ,Rock to teach the
Health Issues courses, and Dr. Hendricks will offer the Little Rock course'in
,
Children with Special Needs. with ,the four-plus-five model descri1:.ed earlier, it
nay 1:.e possible to offer these' courses which truly need special faculty (like
Special Needs and Health Issues) at only one of the two sites. That is, using
the Quapaw van, students might 1:.e able to ccmrute to Little Rock for the rrBin
lectures in the courses, with the follow-up and supplementary activities carried
out at roth sites by the two Site Coordinators. All of these possibilities are
teing explored at the present time.
.
Practicum facilities are abundantly available in Little Rock, and T have
already v..orked out arrangements with two that will 1:.e used--the child Enrichment
Center located in Arkansas Children s Hospital,. and the Child Developnent Center
of the First united Methodist Church, located abJut a mile fram' the hospital.
Both have fairly large infant/toddler enrollments, and roth offer excell~t
programs. The Child Developnent Center (which has a !TUch larger physical
facility) operates a sick child care 'program for ~Arkansas Children 's' Hospital.
Both programs are in the. process of trying to ,receive accreditation fram'the
National Association for the Education of Young Children.
I
Postponement of the' start-up for the replication allows us time to market
the program rrore aggressively and to advertise it rrore completely than was
:p:Jssible last sunmer in Hot Springs. At that time, we could not annOunce the
availability of the prcgram until funds were in place, and that did not happen
until practically the· day the students reported for class. We are confident that
we will have far rrore students (plan for 20) enrolled in this Little RoCk
replication.
.
.
.
'
Finally a word needs to te said abJut the advantages of a Little Rock site
from the st..aI1d[:oint of employment prospects. Little Rock is a !TUch larger city
than Hot Springs and has rrore infant/toddler programs already in place.
Furthe:rm:::>re, neW programs are under developnent in this area all the time.' The
Little Rock Head Start, program has suhnitte:;1 a proposal for Farly Head Start and,
if funded, hopes to .hire sane of the personnel we will 1:.e training . . The
Depart:ment of pediatrics is applying for one of the Project BBJIN grants and, in
its proposal a request is teing nade for a variance from the RFA which will allow
'. the hiring of personnel trained according to the Educare rrodel.
Evaluation
,
.
I'Uring the pilot year, our evaluation haS been entirely fornative,
designed to help us adapt the rrodel and :i.rrprove. it. I'Uring the next two cycles
. (1995-96 in Hot Springs and January to Decenl:er of 1996 in. Little Rock) the
evaluation will 1:.e roth fornative (prior to any further dissemination)' and
surmative (in relation, to student k::z1o..lledge,,::-carpetencies, and attituqes) .. As I·
am so emotionally involved in this project', it seemed wise to arrange :for a
carnpletelyindependent Outside evaluation.
.
Arrangements have 1:.een nade with Dr.' EleanOr Stokes' Szanton to conduct
this' evaluation. Dr. Szanton's \\Ork in the area of infant developnent and in
training personnel to \\Ork with infants 'and toddlers is well-lmCMn. The'
.
evaluation will include interviB<JS with faculty' and studerit.$,.knt:1.\7ledge and
attitude tests administered to students, imd on-the-job observations of
�"
Educare Proposal Narrative pu--Draft~-06-30~95~-12
graduates . Deta.lls of the evaluation will, re prep:rred. by Dr. Szanton and
appended to the fomal application.
,
'
"This proposal requests support for a 2-year period for the replicatiOn of
a training rrodel for personnel Who will specialize in infant I tcddler, educare and
for the prep:rration of print and videotape training rraterials that can re
dissaninated to other states. The rrodel blends training in child developnent,
health, early childhood education, and social \\Ork into one ornnib.ls package.
For this grant period we are requesting funds to (1) hire staff to enable
us to replicate the training in Little Rock and, (2) to prep:rre 20 videotapes '.
highlighting rrajor topics in the ten courses in the sequence. And, finally, it
should be stated. that one goal of this phase of the program will be to identify
and bring into the endeavor a well-trained and carmit,ted. individual Who can
continue to develop and disseminate .therrodel after the PI"s planned retrranent
in the Year 2000!
,
.......
.
,
�,
,
Educaregiver Budget
1995-97--Draft~~1
, EDUCARE TRAINING BUDGET
September 01, 1995--August 31, 1997
'1995-96
1996-97
Personnel
Project Director
(Bettye M.Caldwell, 20.%)
20.,0.0.0. +5,0.0.0.
25,0.0.0.
26,250. '
Site Coordinator,Hot Springs
30.,0.0.0.
+7,50.0.
37,50.0.
39,375
Site Coordinator, Little Rock
30.,0.0.0. + 7,50.0.0.
37,50.0.
39,375
Project Editorial Assistant (50.%)
12~5QQ
15,0.0.0.
15,750. "
+ 2,50.0.
115,0.0.0.
120.,750.
Total Lecturers/Consultants
14,50.0.
14,50.0.
Evaluation
10.,0.0.0.
12,Qbo,
5,0.0.0.
6,0.0.0.
50.,0.0.0.
50.,0.0.0.
Total Personnel
Lecturers/Consultants
~-
I
Pediatrics/NUrsing
Special Education
Nutrition
Early Education
Social Work/Parenting
5,0.0.0.
2,50.0.
1,0.0.0.
5,0.0.0.
1,0.0.0.
Travel
video Production
video/Computer Equipment
5,0.0.0.
Office Expenses
2,50.0.
Total Direct Costs
20.2,0.0.0.
20.2,250.
84,710.
Indirect Costs
Total Costs
2,80.0.
84,818
286,710.
. .....
"
287,0.68
�~caregiver
Budget 1995-97--Draft--3
trainees.) For year 1 the $10,000 requested is l::ased on 6 days on site @
$600/daY for a total of $3;600, $3,000 for travel and expenses, and $3,,400 for
a:i1a.lysis and write-up of findings.
Travel
considerable travel retween sites for various faculty and administrative
staff will ,be required. In addition, travel for one professional meeting for
the Project Director and each Site Director is reqUested.
video Production
Although relatively little (is requested in this area, video production
is a major activitiy of this project. A small arrount of carry-over miley is
likely to be available at the end of the pilot year (Septerrit:er 1, 1995), and
. the granting agencies (Harris Foundation, Kellogg Foundation, and Robert W:xJd
Johnson Foundation) have given permission to have these funds used for.
videotape production. I:Xlring the first year covered by this request, all
major faculty presentations will be videotaped:- '!his was done during the
pilot year only with the Children with Special NeedS Course (taught by Dr.
Mary Hendricks). Because of extraneous noises and unanticipated
'
interl:uptions, the tapes are not of good quality. The lectures/discussions
are to be repeated during 1995-96 at the Little Rock Site, with neN tapes made
under studio conditions. .Arrange:nents have been made to have trained '
persormel in the Instructional Media Department at UAMS work with the' Project
D:j.rector in the production of these tapes. Also, arrange:nents have been made
with Mr. Earl Robinson, Production Coordinator of the Arkansas Educational
Television Network, to use,AETN persormel and facilities for the production of
, , the videotapes at m.i.n.:i.nal cost.
'
video/~omputer Equipmen~
The editing of professional quality videotapes requires same E:!Qill.pnent
, Which may not be currently available. , Instructional Media has instructed me
to request a small amount for editing i special soUnd, and camera equipnent
that might be needed to su:pple:nent available resources. '!his item is not
included in indirect costs.
.
"
i
,
,
Office Expenses
'!his will cover the Project's portion of paper, telephone and fax
service, and photocopying within the PI's unit (CARE--Center for Af:pI:ied
,Research and Evaluation) in the Department of Pediatrics.
Indirect Costs
'!his is l::ased on our institution's lJegotiated' assessment' of 43% of all
direct costs exceptS contracts over $25, ono and equipnent..
'
......... .
,
1·
�
Dublin Core
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Carol Rasco - Issues Series
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Domestic Policy Council
Carol Rasco
Issues Series
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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2010-0198-S Segment 2
Description
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Clinton Presidential Records: White House Staff and Office Files
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Clinton Presidential Library & Museum
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92 folders in 7 boxes
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Paper
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Medicare/Medicaid [2]
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Domestic Policy Council
Carol Rasco
Issues Series
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2010-0198-S Segment 2
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Box 125
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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2010-0198-Sb-medicare-medicaid-2
-
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White '=Iouse
Medicare Briefing Document
-,
Outline
I.
The Two Parts of Medicare and the History of the Part A Trust Fund
II.
Clinton Administration Response to Trust Fund Problems (1993, 1994)
III.
The Current Financial Status of the Part A Trust Fund (1995)
IV.
The New Republican Congress and the Trust Fund (1995)
V.
Clinton Administration Response to Trust Fund Problems (1995)
VI.
The Republican Budget Resolution
VII.
Current Clinton Efforts Compared to the Republican Efforts
VIII.
The Republican Budget Resolution -
IX.
Why Increase In Per Beneficiary Spending is a Cut
X.
Republican Vouchers and Overly Tight Growth Rates
XI.
Republican Vouchers vs. The President's Plan
Overly Tight Growth Rates
rJ
�The Two Parts of Medicare:
Hospital and P·hysician Services
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The Medicare program has two distinct parts:
• 1. Hospital insurance [HI] or Part A
.~ p'art A pays for mostly inpatient hospital care.
II
2. Supplemental Medical Insurance [SMI] or Part B
.
•
~
Part B covers physician services, along with outpatient hospital
services, laboratory services and durable medical equipment. '
.'
•
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�•
,
I.
[
The Two Pa\rts of Medicare:
•
The HI priogram -- Part A
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• T he HI program is funded through the HI trust fund .. The
Fund receives most of its income from the HI payroll tax .
(2.9% of payroll, split between employers and employees) .
. . The HI or Part A Trust Fund is the fund that is characterized as
"going broken by the Congressional Majority.
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�The two Parts of Medicare:
The SMI program -- Part B
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• Part B is funded through the SMI Trust Fund. The Fund
receives income from two primary sources: a general revenue.
transfer and premiums paid by enrollees .
. . Part B premiums are directly deducted out of the monthly checks of
Social Security beneficiaries. Therefore, increases in premiums
decrease total dollar amount of .the Social Security check .
. . . While SMI or Part B Trust Fund growth effects deficit spending, it
does not threaten SMI solvency and the SMI trust fund could never
become insolvent (unlike the HI trust fund) .
•
•
.EJ
�• History ,of 'h~ Part A . Fund
. , Trust •
The
,
.
,
. Financial Status .
,.
,
• As the table on the following page demonstrates, the
Medicare Part A trust fund solvency challenges are
not new.
,
• On nine separate occasions, the trust fund has been,
projected to be insolvent in 7 years or less.
[]
�FUND INSOLVENCY
Report
Year
1970
1971
1972
... 1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
Projected Year
of nsolvency
1972
1973
1976
. None Inciicated
None Indicated
Late 1990s
Early 1990s
Late 1980s
1990
, 199& ..
; 199"4
1991
1987
1990
1991
1998
1996
2002
2005'
No Report
2003
2005
2002
1999
2001
2002
\
•
Years Untie
Insolvency
2 Years
2 Years
4 Years
.
N/A
N/A
N/A
N/A
N/A
··12 Years
13 Years
1.4 Years
10 Years
5 Years'
7 Years
7 Years
13 Years
10 Years
15 Years
17 Years
. No Report
13 Years
·14 Years
10 Years
6 Years
7 Years
7 Years ..
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.'
�•Clinton Administration Response to
•
•
•
Trust Fund Problems (1993)
• At the beginning of the Clinton Administration, the Trust
Fund was projected to go insolvent by 1999.
• The President's 1993 five-year deficit reduction package
(OBRA '93) extended the life of the trust fund by an
additional three years -- to 2002.
_No members of the current Congressio/7al Majority
supported the 1993 deficit reduction bill.- -. .
)
rJ
�Clinton Administration .Re~ponse to
Trust Fund Problems (1993)
"
The extra three years were derived from:
1. Constraining the growth of Medicare, primarily through specific
provider cuts.
2. Repealing the maximum earnings cap for the Medicare HI payroll
tax.
3. Increasing the percentage of Soc-jal Security benefits of well-off
seniors subject to taxation and dedicating that revenue to the HI trust
fund.
4. Economic growth partly spurred from the deficit reduction bill
"
•
•
.
• F~_.
�·t·-
·el- t on A'd mlnlstra Ion Response to
~', •
In
Trust Fund Problems (1994)
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• The Clinton health reform plan would have delayed
insolvency an additional five years past the current date of
2002.
• In addition, the Clinton health reform package would have
addressed the Trust Fund problem in the context of the
,entire health care syst~rl1~
t
"
l:J
�The Current Financial Status.
of the Part A Trust Fund (1995)
.
,
.
.
~~Et~i-i·::~j;~~~:lfI~~-.2i~fiJ~£L~p~li~~;ffi~
• The Medicare Trustees, using intermediate assumptions, concluded
that the HI Trust Fund will be depleted in 2002.' .
, ~ The projected year of trust fund, exhaustion measures how long
financial Tesources exist to pay bills. In other words, as long as the
trust has sufficient resources, bills are paid. The trust fund has
never reached exhaustion.
• The program faces a long term insolvency crisis because of the
demographic shift that will occur with the aging of the baby boom
population. The first baby-boomers will reach 65 in the year 2010.
• Neither Democrats or Republicans resolve th·is issue in their .balanced
budget proposals, but both agree that a bipartisan approach is essential
for addressing this challenge .
•
•
.~~
�•
•
The New Republican Congress
and the Trust Fund (1995)
•
.. The only thing that changed between the 1994 Trustee Report
and the 1995 Trustee Report is that th,e 1995 report showed a
one year improvement from 2001 and 2002.
• The only specific component of .the Contract with America that
addressed the Trust Fund made it worse .
... The Contract called for repeal of the increase in the Social
Security benefits tax for high income seniors -- a provision
that .helped -improve the financial status ~f the trust fund.
The repeal passed the House on April 5, 1995 .
... If this provision is enacted, the trust fund will become
insolvent 8 months sooner.
·r~
�Clinton Administration Res,ponse to
Trust Fund Problems (1995)
• The Clinton balanced budget would extend the life of the
Trust Fund through 2006. This proposal reduces HI Trust
Fund spending on providers. [See attached letter from the
HCFA Chief Actuary confirming 2006 Trust Fund status.] .
• With the trust fund secure for better than 10 years from
today, we are in the same situation we have been in before,
many times, since 1970. This provides significant time for
a bipartisan approach to address the long term Trust Fund.
Issue-..
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•
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DEI'ARTMENT Of IIEAI.Tlll... IIUMA.VICES
•
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The MnllnJstutOt
Wuhln!;'\On. D,C,
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August 3, 1995
111(! Honoraule Richard A. Gephardt
United Slates Senate
Washington, D.C. 20510
Dear Congressman Gerhardt:
,"
1llis is in response to your request for infonnation about the effect of the Medicare savings
in the President's balanced budget initiative on the exhaustion date of the Hospital
Insurance (HI) Trust Fund.
Attached is a memorandum that I havc received from the Chief Actuary of the Health Carc
Financing Administration (HCFA). The ~emo ip(ffcatesthat the year-by-year savings in
the President's plan would extend the Iifej of the fIl Trust Fund from 2002 to the: .fourth
quarter of calendar year 2006 (the lirst quarter of fiscal year 20(7). This estimate is based
on the 1995 Annunl Report of tIle Board of Trustees of the Federal Hospital Insurancc
Fund intermediate assumption baseline.
Please let me know if I can provide any further information.
,Si IIccrcly.
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I3ruce C . Vl:ldeck
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DEPARTMENTOF HE,H.TH &. Hu"iAN SERVICES
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Rnandng IAdmlnhtnrtion
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Memorandum
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::!.1995
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Chief Act U4 1)'. HCf A
:"l.;r01 d ct
Estimated Year ofExhau5lion for HI Trust Fund under Administration's
Balanced Budget Proposal
""
Adfllinislrntor, HCFA
TIle purpose of this memorandum is 'to respond 10 the requests from Senator D~hle and
Representative Gephard! for the estimated year orexhnustion for the Hospital Insurance trust
fund under the Medicare provisions in the Administration's balanced budget propo~. Based
on the intermediate set of assumptions in the: J995 Trustees ~port. we estimate thitthe assets
of the HI trust fund would Ix: depleted.in the fourth;quartei:, of calendar year 2006 under the
Administra!ion~s proposal (or, equivalently, in the fIrSt quarl& oftiscal year 2007).
In the absence ofcorrective legislation, trust fund depletion would OCGUr in the fourth quarter
of calendar year 2002 (first quarter offiscal year 2003)'under the intermediate, assumptions.
Thus. the Administration's proposal would postpone the year of.~xhaustion py aboO! 4 years.
The financial operations of the Hi trust fi.md will depend heavily on future e.cooomiy and
demographic trends. For this reason, the estimated year of depletion is very sensitj~e to the
underlying assumptions: In particular, under adverse conditions such as those assumed by the
Trustees for their "high cost" projections. asset depletion could occur roughly 2.to ;I years
cai'l:er than the intermediate estimate. Conversely. favorable trends could delay the' year of
(;xhaustion significantly, The intermediate assumptions represent a reasonable basid for
planning,
1 he estimated yea! of el(,hauslion is only one of a nu~bcr of measures and (em usej:l to
\!·.. a1uate the financial status of the HI lrUst fund. If Senator OaschJe or Representative
G.:;:,hardl would-like additional iriformaiion on the ~stiimltedimp3cl of the AdrrUnistration's
;\ k ..i:care proposals. we would be happy to provide it.
'j7'<-L.cI
S',~,
Richard S, Ft)ster. F S.A.
•
•
IL/
•
�•Clinton Administration Response to
•
•
Trust Fund Problems (f995)
• The Clinton Balanced Budget calls for $124 billion in savings -- less
than 112 of the Republican Balanced Budget.
• Twenty percent of these savings are simply from extension of current
laws -- which both the President and the Congressional Majority
support.
. • All new· saVings are from providers, and $89 billion goes to Part A
Fund, pushing the insolvency date back to 2006.
EJ
�The Republican Budget Resolution
• The Republican budget resolution would cut the Medicare
program by $270 billion.
.
• The Republican 'budget resolution would also extend the life of
the Trust Fund through at least 2006, and likely somewhat longer.
.. However, it is impossible to project for much longer without
more detail about the allocation of cuts between Part A and
Part B.
• The size of the Republican cuts are excessive, and drafts of
their plan confirm that they are considering substantial
out-of-pock~t increases through higher premiums, co-pqyments,
and deductlbles.
.
.
•
•
El.. ..
.~
�"
•
The
•
Republica~ ~udget
•-
Resolution
Beneficiary 1m pact
The Republican Medicare working document provides a preview of
what is in store for beneficiaries who want to keep their fee-for-service
plans. Specifically, preliminary estimates indicate that:
• The average Medicare recipient of skilled nursing home services will pay at
least $1,400 more in 2002.
• The average beneficiary receiving home health care services wi" pay at
least $1,700 more in 2002.
• The average beneficiary choosing to stay in the fee-for-service plan would
pay at least $2,825 more in premiums and copayments over 7 years;
couples would pay at least $5,650. ,
r]
�The Republican Budget Resolution _
..
Harming Vulnerable Elderly
• The cuts shift costs to seniors who on average, a~e already
spending 21 percent of their income out-of-pocket on health care.
II
II
'I"
•
Since 75 percent of these beneficiaries have incomes below
$25,000, it is hard to see how they can afford to pay more.
The Republican cuts exceed the extenders on which we all agree
by $240-billion ~~ just about the amount they- needtofinante their.
tax cut.
•
•• El
�• Reputllican •
The
B~dget
•..
Resolution
Part 8 Cuts Don't Help the Trust Fund
.. A substantial portion (most likely more than $100 billion) of their Medicare
cuts come from Part B of the. program. Savings from Part B savings do
nothing to strengthen the Part A trust Fund .
.. More specifically, the Republican Working Document calls for significant
ihcreases in Part B premiums, deductibles, and co-payments.
• So, for example, not one penny of the Part B Premium increase alone of
$1650 ($3300 for couples) would contribute to strengthening the Medicare
Trust Fund.
~1J
�Current Olinton Efforts Compared to
the Republican Efforts·
.
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The real jssue is how much more is needed to shore up the trust
fund and responsibly manage the program'.
..
.
.
,
..
The President's proposal is a responsible approach to achieving
these objectives:
v F.irst, better than ten years of trust fund security is consistent with
many periods in our history and adequate to allow Medicare's
adaptation to the future.
v Second,
more than this level of cuts might buy a few more years, for
the trust fund but would endanger the protection Medicare provides
and the institutions and caregivers that serve Medicare's beneficiaries .
I
"
•
• While greater reductions might help for a few years, they are not
real solutions and will cause long-term damage to the structure of
the Medicare program.
•
,.
.
•
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�•
The·
Repu~lic~n
• Resolution•...
Budget
Overly Tight Growth Rates
t:tt~~tf~D]1tV~€i"1:I:t~1::jil~"~t[~~~lt¥j1:'~iit~j
• The Republicans claim they want to emulate the health care cost
containment successes of the private sector. They suggest that
vouchers be used to increase current Medicare beneficiary participation
in Managed Care plans.
'.
'" The expectation is that this will result in reduced Medicare
expenditures and growth rates.
• Emulating the private sector and permitting Medicare to grow at a 7.1
percent pace -- the projection of the per person growth rate in the
private sectorof the CSO baseline -- would save significant federal
dollars.
• However, the Republican $270 billion in cuts would constrain Medicare'
to a much tighter and unrealistic 4.9% per beneficiary growth rate.
r-J
�Why Increase In Per Beneficiary
Spending is a Cut
~~'f~t41i~~i!I!lli~:j:~il~~Wljllliit';1';\11
The Republicans say they will increase Medicare spending by $1,900,
from $4,800 per beneficiary now being spent to $6,700 in 2002. Yet,
this amounts to a cut.
'
- This is a cut because you cannot buy today's Medicare benefits with this amount
of money in 20'02. Beneficiaries will pay substantially more or get less benefits.
- $6,700 is about $1,000 less per person than what it would be EVEN IF Medicare
spending were constrained to 7.1 percent private sector per person growth rate.,
-And remember, the' Congressional Majority wishes to constrain the growth rate
well below the private sector even though Medicare beneficiaries are, by any
definition, a much more difficult to manage and expensive population than those
with private insurance .
.
'"
•
•
.El
�,
• Republican Budget Resolution•.....
•
The
Vouchers and Overly Tight GroWth Rates
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• Under the Republican Medicare restructuring plan, beneficiaries who wish to
keep their fee-for-service plan and a guarantee of their choice of doctor, will.
have to pay significantly more .
.. In order for a voucher system to achieve savings, beneficiaries who go into
managed care plans will either have their current benefits reduced or will be
forced to pay more for the same benefits. This is because the Republicans'
overly tight growth rates will over time diminish the value of the voucher and
the type of coverage it can purchase .
.. In this environment, there would-be overwhelming pressure on plans to avoid
the elderly and sick, and "cherry pick" young, healthy beneficiaries.
l~
�The
Republic~n
Budget Resolution -
Vouchers and Overly Tight Growth Rates
!:~1iJ1:2~~~~~~:;';;;j~:~ ~L.~,l: L~>:":r.I~~~n!~:;·!!wrl:gill:~j
• Addressing these problems would take significant regulatory interventions
such as risk adjustment to pay for elderly, sick individuals. It would also
require a more realistic growth rate. Both needed changes would increase
costs and decrease managed c~re savings.
II
,
\
,"
Respected health care economists such as Robert Reischauer and Henry
Aaron, as well as the Congressional Budget Office, have consistently stated
that managed care that adequately protects beneficiaries are not likely to
produce significant federal savings over the short term.
•
•
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�'i-':
•
,~--
•
•
Republican Vouchers vs. The
President's Plan
• The President's approach shows that you can strengthen the
Medicare Trust Fund, offer more choice of plans, and provide new
benefits without imposing new Medicare beneficiary cuts.
• The President's balanced budget also expands chioce for
beneficiaries by providing for a new Preferred Provider Organization
option and authorizing HMOs to offer chioce of doctor options
through Point of Service plans .
. . However, it does this without financially coercing beneficiaries
into plans ..
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White House
Medicaid Briefing Document·
. Outline
I.
II.
III.
IV.
V.
VI.
VII.
. VIII.
IX.
. X.
Overview
State and Federal Partnership
Health Care for Children
Health Care for People With Disabilities
. Long-Term Care and nMedigap'~ for the Elderly
Medicaid Coverage and Spending
What Medicaid Covers
Medicaid Spending Growth
The Republican Budget Resolution
The President's Plan .
Page
2
3
4
7
8
10·
13
17
·20
32
1
�•
'I'
Overview
-Medicaid covers over 36 million Americans.
- Medicaid provides three types of critical health
protection:
.
.a'
.tJI"
Health insurance for low-income families and people
with disabilities.
'
Long-term care for older Americans and people with
disabilities .
./ Medigap coverage that helps low-i'ncome elderl.y fill in '
the gaps of the limited Medicare benefit.
'
2
�•
·f'
State and Federal
Partnership
• In 1995, Medicaid will spend $156 billion: states .
will pay an estimated $67 billion and the federal
government will pay $89 billion.
-c.
• States administer Medicaid under broad federal
guidelines, and receive federal matching
..payments related to each state's per capita·
Income.
3
�•
T'
Health Care for Children
• Medicaid currently covers over 18 million children: one out of
every five. children in the nation .
.• About 1/3 of all babies born in the United States are covered
by Medicaid.
• Over 90 p·ercent of children with AIDS are covered by
Medicaid.
• It is important to note than an August, 1995 study has found.
that the U.S. leads the advanced world in the percentage of
children in poverty. It also points out that poor children in
America are poorer than poor children in almost all other
industrialized nations [note chart on next page].
0
••
4
�•
"
Child Poverty Rates in 18 Countries
Finland
Sweden
Denmark
Switzerland
Belgium
Luxembourg
Norway
Austria
Netherlands
France
Germany (West)
Italy
United Kingdom
Israel
Ireland
Canada
Australia
United States
o
5
10
I
15
20
25
Percent of Children in Poverty
Source: Center for the Study of Population, Poverty, and Public Policy. August 1995. Poverty is defined as percent of chifdren living in families with
adjusted disposable incomes less than 50 percent of adjusted median income for all persons. Income includes all transfers and tax benefits. Year
for each estimate is most recent data available.
.
5
�..
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Health Care for Children
• Children can be eligible for Medicaid if.
they are:
.. In a family receiving Aid For Families and Dependent
Children (AFDC).
.. In a family with
inco~e
at or near poverty (varies by state) .
.. Disabled and poor enough to qualify for Suplemental
. Security Income (SSI) .
.. In some states, impoverished by medical' expenses or
'living in a medical institution.
6
�•
'r'
Health Care For People
With Disabilities·
• Medicaid will cover 6 million people with disabilities in 1995.
• Medicaid is the primary insurer for people with disabilities,
since private insurance is not affordable for people with
pre-existing conditions.
• Persons with disabilities can get Medicaid if they:
. . In some states, have been impoverished by medical expenses .
. . Reside in an institution and cannot afford the full cost of care .
. . Are poor enough to qualify for SSI .
. . Are entitled to Medicare as a Social Security beneficiary and have
income at or slightly above poverty.,
'
7
�.
or'
"
Lon -Term Care and
"Me igap" for the Elderly
• Over 4 million older Americans will be covered by Medicaid
in 1995.
• Although most elderly are covered by Medicare, its benefits
are limited. Because of high deductibles and copayments
and no prescription drug coverage, the Medicare benefit is in
the 20th perce<ntile of benefit packages in the country. '
,
• Medicaid pays for the services not covered by Medicare by
paying for premiums and cost-sharing for all elderly at or '
, slightly above the poverty threshold.
• Medicaid also covers long-term care for older Americans
who have spent most oftheir resources and 'income on ,
health care.
8
�•
f'
Lon -Term Care and
"Me igap" for the Elderly
• Older America'n,s can get Medicaid if they:
~
In some states, have been impoverished by medical
expenses.
~
Reside in an institution and cannot afford the full cost of
care.
~
Are poor enough to qualify for SSI.
~
Are entitled to Me-d~icareand have income at or slightly
above poverty.
9
�.
"
Medic~id
Coverage and
Spending· ..
. .
• States and the federal government will spend an
average of $3,700 per person on Medicaid in
1995.
,
• However, spending varies for the different people
and types of coverage in the program. Medicaid
$pendsabout:, "
'
,-$1,400 per child.
"
'
• $8,300 per person with disabilitie,s. ,
,. $9,800 per elderly recipient.
10
�•
t'
Medicaid Coverage· and
Spending
.
• Only 28 percent of the people enrolled in
Medicaid are elderly and disabled, but they
account for 69 percent of the spending.
• Conversely, while 72 percent of the people on
Medicaid are children and their families, they
account for only 31 percent of the, spending.
• These contrasting statistics are due to the fact '
that health care costs for the elderly and the
disabled are much more~xpensive than' costs for
children and their families.
I
11
�•
·'
Medicaid Beneficiaries
and Expenditures: 1995
Beneficiaries
Expenditures
Millions of People Percentage
Billions of Dollars Percentage
,
51%
18
Children
$25
Children
18%)
-
Elderly
4
12%)
Elderly
$43
320/0
Disabled
6
16%
Disabled
$50
37%)
8
21%
Adults.
$18
13%
---
---- 1--
Adults
i
i
36
TOTAL
---
.......
-.-~
1
$136
TOTAL
.......- . - -...... -..
-~
Source: eSO estimates for fiscal year 1995.
* Excludes disproportionate share and administrative costs ($20 billion).
~.-.-
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-.~
....... -.
---
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....... -..
-~
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�•
What Medicaid Covers:
States' Flexibility
• All states cover a minimum set of services, including
hospital, physician, and nursing home services.
• States have the option of covering an additional 31 .
services, including prescription drugs, hospice care and
personal care services.
.
.
• States' flexibility in designing their Medicaid p.rogram is .
highlighted by the fact that over 50 percent of Medicaid
benefit payments in 1993 were for optional services and
populations selected by the states ..
. .
,
13
�"
What Medicaid Covers:
Long Term Care
• Medicaid is the largest insurer of long-term care for all Americans,
including the middle class. Medicaid covers 68 percent of nursing
home residents and over 50 percent of nursing home costs.
• Medicaid covers skilled nursing facility 'care, intermediate care
facilities for the mentally retarded and developmentally disabled,
.
and home~and-community-based services.
• Although most long-term care spending is for ,institutional care,
Medicaid has made great strides in shifting the delivery of services
to home and community settings .
.
.
• Cost-effective community-based long-term care increased from 13 .
to 21 percent of long-term care spending between 1990 and 1995.
.
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14
�,.
A Critical Safety Net
• Medicaid has slowed the rapid increase in the number
. of people without health insurance.
• Medicaid cover.age is especially important since
.
employer coverage has been declining. Between 1988
and 1994:
,g!'
,g!'
a/
The percentage of Americans covered byemployer.;.sponsored
health insurance fell from 67 percent to about 61 percent.
Medicaid coverage increased from 9to 13 percent.
If Medicaid coverage had not increased, there would be
more uninsured, more uncompensated care, and l1lore
cost-sh ifti ng.
15
�,.
Changes in Insurance
Coverage: ·1988 to·.1994
1988·
1994
Employer 610/0
Employer 67%
'.
. Other g%
*
Other 10%
Medicaid g%
Uninsured 15%)
Uninsured 16%
Source: The Urban Institute, February 1995. Includes only the non-elderly, non instutionalized population.
* Includes individuallv purchased insurance and other public insurance.
Medicaid 130/0
*
�••
Medicaid Spending
Growth
.
..
• eBO projects thataggreg-ate Medicaid spending will
grow at an average rate of 10.2 percent between 1996
and 2002 .
. . This is lower than the growth of expenditures in the early
1990s, when the average rate was cl-oser to 20 percent.
• Medicaid spending growth results from three different
pressures: increases in the price of health care, utilization
and intensity of health care, and the number of people
-covered.
I
17
�..' Enrollment Growth Drives·
Medicaid Spending
Growth
..
• Medicaid .growth is largely driven by enrollment growth, especially
among the elderly and disabled. According to GSO, about 45
percent of the total spending increases results from a rising number .
of people in the program.
• The number of Medicaid beneficiaries is projected to grow by 3.0
percent a year between 1996 and 2002 -- more than three times .
the general population growth, and twice the growth in the number
of Medicare beneficiaries.
• Medicaid enrollment growth reflects the fact that the population is
aging. The number of aged and disabled beneficiaries is growing
at 4.6 percent per year -- almost twice the rate for adults and
children, whose proJected average growth rate is 2.4 percent.
18
�'.
. edicaid Spending
M
Growth Per Person is Low·
• Since Medicaid enrollment growth is high, it distorts the .
overall Medicaid spending growth. Thus, when
comparing Medicaid to other health programs, it should
be done using Medicaid growth per beneficia~.
• Medicaid spending 'per beneficiary is .projected fo
. grow at 7 percent per year between 1996 and 2002.
• This growth rate is the same as the projection of the
private health insurance spending per insured person
under the esa baseline.
19
�The Republican Budget Resolution:
Unprecedented Cuts .
,
• The Republican Budget Resolution would cut Medicaid
. by 20 percent -- $182 billion over the next 7 years.
• The Republicans would achieve these savings by .
imposing a 4.5 percent average annual growth rate cap
on aggregate spending. That is less than enrollment
growth plus inflation ..
• ·Taking enrollment growth into account, the
Republican Budget would limit growth in Medicaid
·spending per person to only 1.4 percent annu.ally.
·20
�"
. The Republican Budget:
Unprecedented Cuts
• Republicans say their Medicaid proposal is not a
cut. However, a 1.4 percent cap on growth per' .
beneficiary is a cut in real terms. It is:
... 80 percent below the projected private health spending
. per person (7.1 percent) .
... 75 percent below projected medical inflation (5.3
percent) .
... 50 percent below the projected consumer price index (3.3
percent).
.
.
21
�t.
Medicaid Growth Per Beneficiary:
Effect of the Republican Proposal
.:
1996-2002
10.0%i~--------------------------------------------------~
. 7.0%
7.1% .
8.0%
6.0%
4:0%
2.0%
0.0
%
'
Current
Medicaid
Source: eBO Projected Baseline for Fiscal years 1996-2002.
Private
Sector
Republican
Medicaid
22
�-"'.
Republican Medicaid Spending Limits
Don't Keep Up With Inflation
~I
G
rowth Rates
12% I
i
\
M MI
' " __ __
M
I •
i
1i _ I -
"'ap
10%
8%
6%
4%
2%
0%
1996
. -1997
1998
2000
1999
2001
2002
Enrollment and CPI Medical CPI GOP Budget
I
csa projected annual increases, fiscal years
1996 - 2002.
I
--t
23
�"
. The Republican Budget Resolution:
Options for Reaching this Level of Cuts·
• There are three ways for states to cut this much (20
percent) from Medicaid: ..
... Reduce benefits or provider payments .
... Eliminate coverage for people on Medicaid .
... Find savings through increased efficiency and productiv·ity.
24
�'I
,.- . . .
,,'
The Republican· Budget
Resolution:
Efficiency Can Only Go So Far
• States have already constrained the growth of Medicaid
spending per beneficiary to the same growth rate as the .
- private sector.
• While states can improve productivity and efficiency,
savings from these' activities do not come close to $182
billion that the Republicans are seeking.
25
�.
'
r;,..O.
.'.
..
The Republican Budget Resolution:
Managed Care Savings Are Limited
• eBa estimates a one-time, 5 to ·15 percent savings from managed
care for non-disabled~ non-elderly adults and children.
• States· have· already aggressively pursued managed care. ··About .
one-third of·Medicaid adults and children are currently enrolled in
managed care. -And,under current law, states are expected to
. enroll 50 percent of this population in .managed care by 2000.
• There is little Medicaid experience with managed care fqr the
elderly and disabled -- who account for almost 70 percent of
Medicaid spending. Ther~fore, it is unlikely that eBa will score
significant savings from this part of the program.
...
.
-
.
- • THus, managed care cannot be expected to achieve the 1.4
percent growth cap per beneficiary in the·Republican Budget.
26
�...
->'
The Republican Budget Resolution:
People'Wil1 Lose Coverage
• The Urban Institute estimates that even if states were able
to achieve half the needed savings from reducing services
and reimbursement to providers, states would still be
. forced to eliminate coverage for 8.8 million people in 2002 .
alone, including:
... Families: 6.3 million adults and children.
_ ... Elderly: 920,000 older Americans.'
... Disabled: 1.4 million persons with disabilities.
• This translates into a 19 percent cut off of current
projections. In other words, almost one in five'
.beneficiaries would lose coverage.
27
�II
The Republican Budget Resolution:
Children Will Lose Coverage
• Currently, 20 percent of the nation's children rely on
Medicaid for their basic health needs.
• Medicaid pays for immu'nizations, regular check-ups,
and intensive care in case of emergencies for over 18
million low-income children.
, • Under the Repu'blican Budget, 4.4 million children
would lose Medicaid coverage in 2002.
28
�,
.'
0"
The Republican Budget Resolution:
Nursing Home Residents Will Lose Coverage··
• Over two-thirds of nursing home residents rely on
Medicaid to pay the staggering costs of nursing home
care.
.
• On average, families pay $38,000 .per year for nursing
home care. .
• A deep cut in Medicaid would mean that about 350,000
residents of nursing home could lose c'overage in 2002. ,
• For many of these residents, there is nowhere to turn.
Two-thirds of nursing home residents are elderly
women, 'and a. majority have no spouses.
29
�,.
.
,,,
""
Nursing Home Care Exp.enditures:
.
By Payer, 1993 .
.
Medicaid . 52%
Private
Medicare
40/0
9%
Other Public
Out-Of-Pocket
330/0
SOURCE: Health Care Financing Administration
30
�·.
.~,,'
A
The Republican Budget Resolution:
States at Risk
,
• States could on'ly avoid these' actions by ,increasing
,their spending by 40 percent in 2002 -- by raising taxes
.or cutting other critical state spending.
• States At Risk From Inflation And Recession. When a recession
occurs, the number of working people who lose health insurance-and
apply for Medicaid can rise dramatically, increasing program costs. An
aggregate growth cap would not respond to this change in state need ..
• S.tates At Risk For Cost Of Aging Population. As the population
continues to age, the growing need for long-term care services will put
increased stress on the Medicaid program. Under an aggreg~te .
growth cap, states with large elderly populations will bear a .
disproportionate burden.
31
�* ..
••
Q'
The President's Plan.
• The• President seeks $54 billion in Medicaid·
savings over seven years.
• The President's plan results in a more realistic
growth in spen,ding 'per beneficiary of 6.3 percent.
• This rate is much closer to the private sector
growth rate of 7.1 percent'.
.
• .The President's savings from M·edicaid are less
than one-third of the reductions called for by the·
Republicans.
.
32
�.-
..
.:.,:/"'
,
,
.ll
The President's Plan
, • The President's plan constrains Medicaid growth
,through a mix of policies, including:
Eliminating unnecessary federal strings on states by allowing
states to pursue service delivery innovations without seekin~
, federal waivers and by restructuring the Boren Amendment.
III'
• Re9ucing and better targeting, federal payments to states for
hospitals that serve, a high proportion of uninsured people.
, III'
Limiting the growth in federal Medicaid payments to states for
each beneficiary (Le., a per capita cap), so that states do not
need to reduce coverage to achieve savings.
33
�",
.. 'v'
\.
\
The President's Plan
• The President's Medicaid plan is preferable to the
Republicans' plan because:
... It protects states from changing economic and demographic
conditions.
.
, ... It gives states flexibility to manage their programs efficiently and
.
responsively ~
- ... It protects against increases in the number of uninsured, thus
avoiding increases in uncompensated care and cost-shifting .
... Together with the President's health reform initiative (insurance
reform, small business purchasing cooperatives, and insurance
assistance for the temporarily unemployed), it protects and expands
health care coverage. .
'34
�JlA. a. rc rk. G.. 4".s'<;.:)
9/Z_'1'/9r
Comparison of the House & Senate Republican Medicaid 'Block Gran
(Dollars in Millions, Federal Spending, Fiscal Years)
~tares
House Republican
Reductlon In Medicaid
Redudion (2)
Percent
Reduction
954,338
$182,366
19%
Alabama,
Alaska
Arizona
Mansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Geor9ia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
MiSSissippi
Missouri
Montana
13,823
2,001
12,903
11,081
' 95,663
8,163
12,990
1,728
4,511
40,720
26,050
2,732
2,933
33,242
23,100
7,807
5,962
18.353
33,991
5,999
13,478
25,516
32,153
14,665
12.640
14,871
3,409
4,448
2,899
3,728
28,038
6,066
119,527
29,014
2,491
40,586
11,074
8,884
38,448
5,465
15,252
1,155
554
1,328
2,964
18,693
1,953
2,145
415
963
10,531
5,776
443
8%
28%
10%
27%
20%
24%
17%
24%
21%
26%
22%
16%
20%
18%
32%
12%
2%
27%
16%
14%
19%
17%
13%
14%
15%
-2%
28%
21%
,23%
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
, Utah
Vennon!
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Based
00
2~
61,167
5,128
1,982
13,022
18.21i: I
13,72
16,484
1,269
575,
6,1
7,
936
133
4,979
5,269
853
2,516
4,239
4,253
2.072
1,938
(321)
943
932
680
(437)
7,032
902
24,588
8.596
511
7,944
3,235
1,596
3,153
1,638
1,516
378
6,424
7,001
1,116
401
3,300
5,434
4,460
2,935
305
-12°1
21%
30%
21%
20%
~
8%
30%
10%
16%
26%
11%
22%
20%
25%
30%
32%
18%
24%
Difference
Pen;ent
.; -stnalfi( Loss l.Inder Senate
Reduction
Reduction
unltea !States
I
~"f'""e....,
Senate Republican
Medicaid Siock Grant
Baseline (1)
~
:..
$186,733 '
-: La~ loss lJrnOer Setlttt:
20"1.
2,607
19%
394
2()l>/o
2,517
2,860
13,801
1,297
3,544
115
734
8,944
5,904
267
581
2,902
8,624
1,082
704
4,928
15,352
946
1,536
5.652
4.692
1.019
1.251
2.043 .
948
692
850
1.164
7.172
615
21,450
8,319
540
6,683
3,423
35
2,422
1,141
2,954
240
4,165
12,187
1,052
205
3,079
5,579
4,615
2,639
264
20%
26%
14%
16%
27%
7%
16%
22%
23%
10%
20%
9%
37%
~
27%
45%
16%
11%
22
15
1;%
14%
28%
16%
29%
31%
26%
10%
18%
29%
22%
16%
31%
0%
6%!
21%
19%1
10%
17%
20%
21%
10%
24%
31%
34%
16%1
2"%1
(1,452)
160
(1,188)
104
4,892
656
(1,400)
300
1~
(128)
176
(6)
3,233
(1.337)
(146)
(571)
51
(10,082)
(93)
980 ,
(1.413)
(439)
1.053
688
(2.364)
(6)
239
(170)
(1,601 )
(141 )
287
3,138
277
(29
1,
(1.438)
137
2,259
(5,185)
64 .
196
220
(146)
(156)
296
me Commerce Commfrtee'.s focmula,as ot Septemoer 18.1995; Senate Finance Committee 'ormu!a as Of Sepf€:r.':ttt7 27. i995
(1) From The Um;;n 'r."r.~,~'S Medic.oic Expenditure GrOWlh Model
~~~::m ~~G;::;' ACGOuming Ol;,<;€s S Sena,e
2;,S.:p-95
Finance Commlt1ee's est<m:;ICS or the
spenoing bYClWNU~FiA'RY PHOTOCOPY
"1
�I
.... I
.
.
.
....
,
,.
, ,REPUBLICAN' PLANE'NDS 'MEDICAID':('",;:<::· '-:.
PUTS 'MIDDLE-CLASSFAMILIES AT'RISK
~
.'.
,
I
1. ,The Republican Medicaid' Plan Will Force
States to Eliminate Coverage for, Millions of
. Americans, including:
• 4.4 .million children,
,
• More than 900,000' elderly, and.
'. 1.4 nlillion people witi) disabilities.
,
"
2., The Republican Plan Will Force 'Families ·to
Choose Between Nursing Home Care for
Their Parents and Education for Their
Children.
3. The Republican Plan May Force Elderly
Spouses Into Poverty. '
,.",<>
,
,
4. The Republican Plan Will Wipe OU,t'
Quality'Standards for Nursing Homes and.
Institutions Caring for the Mentally
, Retarded.
Medicaid 'Talking Points 9/26/95 -- 1:00 p.m,
�,
..
. REPUBLICAN PLAN ENDS MEDICAID:
PUTS MIDDLE-CLASS FAMILIES AT RISK
Republican Plan Will Force States to Eliminate Coverage for Millions of Americans. Medicaid
currently covers 36 million Americans ,and provides middle-class families with protection from the
high costs of nursing home care for their parents. In order to pay for their huge tax cut for the
wealthy, Republicans propose slashing Medicaid by an unprecedented $182 billion --' cutting
funding to states by 30% in 2002.
States will be forced to, raise taxes, reduce Medicaid coverage, and cut services. ,According to data
, from the non-partisan Urban Institute, ,the GOP cuts will force states to eliminate Medicaid
coverage for as many as 8.8 million Americans in 2002, including:
•
•
•
4.4 million children'
more than 900,000 seniors
1.4 million people with disabilities
Republican Plan Will Force Families ,to Choose Between Nursing Home Care for Their
.Parents and Education for Their Children.. Medicaid currently is the largest insurer of long-term
care, covering over two-thirds of all nursing home residents. Without the guarantee of Medicaid,
families of elderly and disabled individuals needing long-term care could be stuck~th nursing
home bills, currently averaging $38,000 .a year. This extra charge to middle-class families may
force them to choose between nursing home, care for thdrparents and education for their children.
That's a false choice for millions 'of hard working faniilies. And that's the Wrong way to balance
the budget.
Republican Plan May Force Elderly' Spouses Into Poverty. Republicans are tufIling their backs
on the common ground protection that President Reagan signed into law to ensure' that seniors do
not have to give up everything they own -- their car, their home, and all their savings -~ in order to
pay for nursing home care for their sick spouse. The GOP plan repeals this protection, putting
seniors at risk of losing their homes and being driven into poverty by the cost of their spouse's
nursing home care. The GOP plan also means that parents of mentally retarded children may be
forced into poverty to pay for their children's care in an institution or.at home.
Republican Plan Will Wipe Out Quality Standards for Nursing Homes and Institutions Caring
for the Mentally Retarded. The Republican plan throws away a decade of progress by repealing
another common ground law signed by President Reagan .that established quality standards .for
nursing homes and institutions for the mentally retarded. These standards restrict the use of drugs
and restraints and require that nurses' aides are properly trained. Under the guise of reform,
Republicans would repeal this law and throwaway these fundamental protections -- just to pay for
their tax cut.
Medicaid Talking Points 9/26/95 -- I :00 p.m.
�... ,.' ....
. REPUBLICAN MEDICARE PLAN:
PAY MORE FOR SECOND-CLASS HEALTH CARE
1. ANY WAY YOU SLICE IT, THE REPUBLICAN
MEDICARE CUT IS THREE TIMES LARGER THAN
ANY CUT' IN HISTORY AND MEANS YOU 'WILL
PAY MORE TO GET LESS.
2. MEDICARE RECIPIENTS WILL PAY MORE OUT
OF-POCKET -- TO FUND A TAX BREAK FOR THE
WEALTHY:
• $1,700 -less per beneficiary in 2002
• .Double ·Deductibles
• Raise Premiums
• Raise the Medicare eligibility. age to ,67
·3.
MEDICARE,RECIPIENTS WILL PAY MORE, YET
. THE CUTS WILL MEAN AN INFERIOR, SECOND
CLASS MEDICARE PROGRAM:
• Private health premiums increased by cost-shifting
• Hospital closings threatened
• . Doctors driven out of the program and turning
away recipients
�"
O<c
",
REPUBLICAN MEDICARE PLAN:
,
.....
PAY MORE FOR SECOND-CLASS HEALTH CARE
Pay More and Get Less -- For Tax Cuts for the Wealthy. Any way you slice it, the
Republican Medicare cuts will force you to pay 'more to get less -- just to fund a tax cut for the
wealthy. The GOP plan will increase out-of-pocket costs for all seniors -- regardless of their
income or health. Medicare benefits per beneficiary will be cut $1,700 in 2002, fordng spending
to grow 33 percent slower than in the private sector. Both the House and Senate plans increase
premiums, and the Senate plan also cuts benefits and doubles deductibles from $100 a year today
to $210 a year in 2002. And not one penny of the increased premiums will go to, the Medicare
trust fund. Instead, seniors will pay more out-of-their-pockets to fund a huge tax c~t for the
wealthy.
Pay Taxes for Two More Years and Wait Two More Years for Benefits. The Senate plan
would gradually delay the Medicare eligibility age from 65 to 67 beginning in 2003. Tens of
millions of Americans would have to work longer and pay more taxes to get fewer years of
Medicare. For someone working a desk job in Washington, that may not seem too bad, but to
millions of Americans with physically demanding jobs, it is ,not just bad -- it is unfair.
,
, Everyone's Premiums Will Increase From Cost Shifting. Lewin-VHI, an independent research
firm, found that the Republican $452 billion cut in Medicate and Medicaid will lead 'doctors and
hospitals to raise their fees on private patients by at least $90 billion -- essentially a new $90 _
billion tax on everyone with private health insurance. This cost-shifting will increase the cost of
private health insurance, which would effectively reduce wage increases by 2.7%, and by as
much as 10% for lower-wage workers.
Gambling with Medicare to Benefit the Healthiest and Wealthiest. Republicans would
experiment with Medicare by creating Medical Savings Accounts (MSAs) under which the
healthiest and wealthiest could gamble at the expense of everyone else. Under' the MSA
proposal, healthy seniors who could afford to risk paying a high deductible would have incentives
to elect catastrophic health insurance with a very high deductible. This- would leave the less
healthy seniors with higher average health care costs -- and who cannot, afford "to gamble' with
deductibles starting at $3,000 -- in the p'aditional Medicare program. A new study-by LewinVHI found that MSAswould substantially increase traditional Medicare program costs. '
,
,
Hospitals Will Close and Doctors May Refuse ~edicarePatients. Many rural and urban
hospitals depend on Medicare for a large share of their income. By making the deepest cuts in
health care provider payments in history, the Republican plan would force many rural and urban
hospitals to close. Lower payments to'doctors also would create huge incentives for physicians
to refuse to take Medicare patients.
Raises Taxes on Working Americans. The Senate plan imposes new payro,ll taxes on many
state and local government employees at a time when the Republicans are cutting taxes for the
wealthy. Medicare does not currently cover government workers in many states who, began work
before 1986 and they therefore are not subject to the Medicare payroll tax. Republicans would
require all state and local workers' to pay Medicare payroll taxes~ raising taxes on workers and
,imposing an "unfunded mandate'" on state government in violation of the unfunded mandates law
that Congress enacted earlier this year.
' "
Medicare Talking Points 9/26/95 - 1:'00, p.m.
�
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Text
MEDICAID FACTS
THE
KAISER
COMMISSION
ON
THE
FUTURE
OF
MEDICAID
December 1995
THE MEDICAID PROGRAM AT A GLANCE
What is Medicaid?
The diverse Medicaid population is comprised of:
Medicaid is the nation's major public financing program for
providing health and long-term care coverage to millions of
low-income people. Initially designed to pay for the health
care of recipients of welfare assistance and certain other
needy people, by 1994. 33.5 million people-more than 1
in 10 Americans-were covered by Medicaid at a cost of
$137.6 billion.
Authorized under Title XIX of the Social Security Act,
Medicaid is a means-tested entitlement program financed
by the state and federal governments and ~dministered by
the states. Federal guidelines place requirements on
states for coverage of speCific groups of people and
benefits. States that meet the federal eligibility and
benefit guidelines receive federal matching payments
based on the state's per capita income. The federal share
ranges from 50 to 80 percent of Medicaid expenditures.
Because states establish their own financial eligibility
criteria, there are large state-ta-state variations in income
eligibility thresholds and coverage.
Who is Covered by Medicaid?
Being poor does not automatically qualify an individual for
Medicaid. Only persons who fall into particular
"categories" such as people receiving cash assistance or
low-income children and pregnant women are eligible.
Although Medicaid has increasingly been used to expand
coverage to the low-income population, it covers only 55
percent of poor Americans. Millions of uninsured low
income Americans are beyond the program's reach.
• 3.8 million elderly persons
• 5.4 million blind and disabled persons
• 7.5 million adults in families
• ,16.9 million children
Although adults and children in low-income families make up
nearly three-fourths of beneficiaries, they account for only 28
percent of Medicaid spending. The elderly and the disabled
account for the majority (59 percent) of spending because of
their intensive use of acute and long-term care services.
Disproportionate share hospital (DSH) payments account for
12 percent of Medicaid spending (Figure 1).
What Services are Covered Under Medicaid?
Medicaid covers a broad range of services to meet the
complex needs of beneficiaries. Because of the limited
financial resources of beneficiaries, few or no cost-sharing
requirements are imposed. Federally mandated services
include:
• inpatient and outpatient hospital
• physician, midwife, and certified nurse practitioner
• laboratory and X-ray
• nursing homes and home health
• early and periodic screening, diagnosis, and treatment
(EPSDT) for children under age 21
• family planning
• rural health clinicslfederally qualified health centers
States have the option to cover additional services and still
receive federal matching funds. Commonly offered optional
services include prescription drugs, clinic services,
prosthetic devices, hearing aids, and intermediate care
facilities for the,mentally retarded.
Flgu",2
Flgu", 1
Medicaid Beneficiaries and Expenditures
by Enrollment Group, 1994
::_---"'"
Elderly 11%
Medicaid Expenditures by Type ofService, 1994
Other" 1%
DSH"*Paymenlll
12%
Blind &
Disabled 16%
Elderly 27%
Adullll 22%
\,
Blind & Disabled
32%
Children 51%
Adullll 12%
/'
Beneflclarl.s
Total" 33.5 million people
Children 16%
· _...... _COSH)
ICFIMR
'
G ST
w
~
SOURCE: ~
8cM.rae:: UIbIn ~~ofHCFA diN, . . ...,.. t98!
1 450
7%
Total" $137.1 billion
·"Oi:NI"'~~.u, ........... ~.aif'Id~ ,
-~ .... '-t*I ('08Hl~"hMpbiIt . . . .
......,..,~,...,....
p,.mluma
Expenditures
Total" $137.6 billion
R E'r: T,
TEL
N.W.
C.,. FIICIJItiM
1M
R.wdIId
for
u.ntaUy
1rIItItI.D..,.,.._tiCFA data, Ncwwnbtr ,M.
S LJ I T E 250
WAS H I N G TON,
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D.C.
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�Of the $137.6 billion Medicaid spent in 1994 (Figure 2):
• Acute care services comprised less than half (45
percent) of spending.
• Long-term care services accounted for 35 percent of
expenditures. Medicaid pays for half of total nursing
home care (52 percent) and 13 percent of all home
health spending in the United States.
• Payments to hospitals with a disproportionately
large population of indigent patients (DSH)
comprised 12 percent of total expenditures.
• Payments for Medicare Part B for the elderly and
disabled and HMO premiums for Medicaid
beneficiaries enrolled in managed care accounted
for 7 percent.
'''Yntl
Medicaid Beneficiary Growth by Enrollment Group,
1988-1994
.Eldefly
cBllnd & Disabled
cAdulta
.Chlld..n
1988
1889
1990
1991
1992
1993
19t4
... 'Medicaid has become a major budgetary commitment for
both the federal and state govemments. Medicaid
As states try to expand insurance coverage to low-income
expenditures escalated rapidly between 1988 and
people, improve access, and contain costs, many are
1992-more than doubling (Figure 4). The rise in spending
adopting new care delivery and financing arrangements
in that period was attributable to a combination of health
under Medicaid. While traditional fee-for-service still
care inflation, state use of altemative financing mechanisms,
predominates, an increasing number of states are
and a rise in enrollment. Only a small fraction of spending
enrolling their Medicaid populations in managed care
growth was attributable to the expansions in coverage of
programs.
low-income pregnant women and children.
How is Care Delivered Under Medicaid?
As of June 1994, 7.8 million Medicaid beneficiaries were
enrolled in managed care, up dramatically from 2.7 million
in 1991. Medicaid managed care models range from
HMOs using prepaid capitated care to loose networks
contracting with selected providers for discounted services
and gatekeeping to control utilization. States have initially
targeted low-income families for enrollment rather than
aged or disabled beneficiaries.
Recently, states have been using Section 1115 of the
Social Security Act to obtain waivers of federal statutory
requirements to undertake statewide, mandatory managed
care demonstration programs and broaden coverage.
Presently, 14 states (AZ, DE, FL, HI, KY, MA, MN, OH,
OK, OR. RI, SC, TN, and VT) have been granted waivers,
one state has been denied (LA), and seven more have
applied and are awaiting approval from HCFA.
Long-term care is a major component of Medicaid.
Presently, over three-fourths of Medicaid spending for
long-term care is on institutional services. States can
provide long-term care services in the community.
Increasingly, Home- and Community-Based Services
(HCBS) waivers are being used by states to shift service
delivery away from costly nursing home care to
community-based care. Although all states have HCBS
waivers, most projects are limited in scope and the
population served remains small.
Recent Beneficiary and Expenditure Growth
After remaining relatively stable for many years, Medicaid
enrollment has recently risen dramatically, reaching 33.5
million beneficiaries in 199+::-up considerably from 21.8
million in 1988 (!:lgurt:r3r Growth has been mostly
attributable'to""expanded Medicaid coverage·of low-income
pregnantwomen and young children and'increases in the
number of blind and disabled beneficiaries.
The rate of growth in Medicaid spending has now dropped
down to histOric levels-10 percent from 1993 to 1994-for
the second year in a row. This suggests that legislation
enacted to limit states' capacity to raise funds through
provider taxes and donations has had a substantial role in
slowing Medicaid spending growth.
,_
Medicaid Spending by Enrollment Group,
1988-1994
·"'OItM('~Mz-.llJj.,~,~,WId~
"C*pr'G~atw.HnpItaI~
BOU~CE:
Urt.\IMd\nMltt*ofHCFA ....,
~1.~"
,/'
Since its enactment in 1965, Medicaid has improved access
to health care for the poor, pioneered innovations in health
care delivery and community-based long-term care services,
and stood alone as the primary source of financial
assistance for long-term care. Medicaid has been
consistently shown to improve access to health care for the
population it serves. Low-income people without insurance
coverage use care at considerably lower levels than those
with Medicaid coverage. As Medicaid struggles to meet '
multiple responsibilities under severe fiscal pressure, it
continues to playa critical role in providing acute and long
term care services to our nation's most vulnerable people.,r
The Kaiser Commission on the Future of Medicaid was established by the Henry J. Kaiser Family Foundation in 1991 to function as a Medicaid policy institute
and serve as a forum for analyzing. debating and proposing future directions for Medicaid and other health reforms affecting low-income Americans.
The Kaiser Family Foundation is an independent national health care philanthropy and not associated with Kaiser Permanente or Kaiser Indusuies.
. ". ,
"
�MEDICAID FACTS
THE
KAISER
COMMI~SION
ON
THE
FUTURE
OF
MEDICAID
MAvl996
MEDICAID AND MANAGED CARE
OVERVIEW
In 1995, Medicaid provided health and long-term care coverage
to approximately 36 million low-income Americans at an
estimated cost of $156.3 billion. In its role as a purchaser of
health services for low-income families, Medicaid increasingly
relies on managed care to deliver services. Almost one-third of
all Medicaid beneficiaries, predominately poor children and their
parents, now receive health care services through a broad array
of managed care arrangements, including Health Maintenance
Organizations (HMOs) and less structured primary care case
management systems.
Fig..... 2
Percent of Medicaid Beneficiaries Enrolled in Managed
Care Plans, by State, 1994
MEDICAID MANAGED CARE ENROLLMENT
Medicaid's use of managed care has grown especial Iy
dramatically in recent years in response to pressure to contain the
growth of State and Federal Medicaid spending while
maintaining access to care for low-income individuals. In 1983,
750,000 beneficiaries-3 percent of the Medicaid
population-were enrolled in managed care. In 1994, this
number had grown to 7.8 million, or 23 percent of the Medicaid
population. .
By 1995, there were 11.6 million Medicaid managed care
enrollees, representing about one-third of all beneficiaries. The
most significant growth occurred between 1993 and 1994, when
Medicaid man~ged care enrollment grew 63 percent, from 4.8
million to 7.8 million beneficiaries (Figure 1).
Today, virtually all states are pursuing managed care. In 1981,
FIgure 1
·lnch.tdl'ltll'lOOllltIC1(1ICOlumtll,
SalJn:tI: HeFA. 19904: Urllin 1,.1111.1111 IInll1'l' of HCFA Otll,
HI9~.
MODELS OF MEDICAID MANAGED CARE
"Managed care" includes a broad array of health financing and!
delivery arrangements designed to reduce costs by eliminating}
inappropriate and unnecessary services and by relying more"
heavily on primary care and care coordination. Managed care
arrangements are characterized by Ihe formal enrollment of
individuals in a managed care organization, contractual
agreements between the provider and a payer, and some degree
of gatekeeping and utilization control performed by a primary
care physician, a separate administerif.lg arm of the health plan,
or both. The major Medicaid managed care models include:
Growth In Medicaid Managed Care EnrQllment, 1983-1995
14.0
.MJ!1!l1!!!..!!!.!!!I!!!S!!!!.l!!!!!!I!!!i!!!!!!!L_ _ _ _ _ _ _ _ _ _---,
12.0
10.0
6.0
4.0
2.0
H~H~H"1~H~HMH"H~HMH~m3~~H"
CHoelth MuinloMnca OrganizationJ
Prepaid HfIoatth Ptan
.Primary Cata Case Mdnaoemoni
SOURce" HCPA 1992 ""';1995
85 percent of all Medicaid managed care enrollment took place
in four states-California, Maryland, Michigan, and New York.
Today, these states account for less than one-quarter (24 percent)
of the Medicaid managed care population. As of June 1994, 18
states and the Districl of Columbia had more than one-quarter of
their Medicaid population enrolled in managed care (Figure 2).
I 450 G
S T R E E T,
TEL
N.W.
SUI T E
(202) 347-5270
• Fee-jor-Service Primary Care Case Management (PCCM):
In a PCCM, a specific provider, usually the patient's primary care
physician, is responsible for acting as a "gatekeeper"-Io
approve and monitor the provision of virtually all covered
services to beneficiaries assigned to him or her. These
gatekeepers contract directly with State Medicaid agencies, do
nol assume financial risk for the provision of services, and are
paid a per-patient monthly case management fee, plus fee-for
service payment for medical care.
• Full-Risk Plans (RMOsor RIOs): Under a fully capitated
plan, a health plan is paid a fixed monthly fee per enrollee for the
delivery of a comprehensive range of services. The plan assumes
the full financial risk of providing all medically necessary
services. The major types of full-risk plans are Health
Maintenance Organizations (HMOs), in which the contracting
entity and the providers are integrated into one plan, and Health
Insuring Organizations (HIOs), which operate as fiscal
intermediaries and are not integrated with the providers.
,.\,
'
250
WAS HI N G 0 N, D.C.
• FAX (202) 347-5274
20005
..
I
�• Limited-Risk Prepaid Health Plans (PHPs): A PHP is an
entity that either contracts on a prepaid, capitated-risk basis to
provide services that are not risk-comprehensive (often
ambulatory care only) or contracts on a non-risk basis. These
plans, usually clinics or large group practices, do not assume full
financial risk for a comprehensive service package.
As of June 1995,403 Medicaid managed care plans were in
operation; two-thirds were full-risk HMOs or HlOs, 25 percent
limited-risk PHPs, and 12 percent PCCMs. The predominance
of full-risk contractors is reflected in the distribution of
enrollees: 46 percent of all Medicaid managed care beneficiarieS
were enrolled in HMOs or HIOs, 23 percent in PHPs, and 31
percent in PCCMs (Figure 3).
A_'
Statewide Medicaid ~nstratlons Under Section 1115
the SOcial Security Act. as of March 1996
-Appnlyod and Implemented: AZ.: DE, OC, HI, MN, OK, OR, RI, TN, VT
E Approved: FL, KY, MA, OH
51 Under Review: AL, GA (behavioral health). IL, KS, LA. MO, NH, NY, lX, U'f, SC
CI
• lmpft!m.nt.~lll nln,
SOURer:. HCf~, 111116,
FlgutO :I
Medicaid Managed Care Plans and Enrollment,
by Type of Plan, 1995
HIO
2%
IMPLICATIONS AND ISSUES IN MEDICAID MANAGED CARE
HIO
1%
HMO
44%
HIIO
82%
ToIIIlNumberolPlans: 403
ToIIIlEnron....' 11.6miNion
STATE ENROLLMENT OPTIONS
To establish Medicaid managed care programs, states usually
must obtain one of two types of waivers from HCFA-Section
1115 research and demonstration waivers or Section 1915(b)
freedom-of-choice waivers. Waivers of Section 1915(b) of the
Social Security Act allow states to implement managed care
plans that require mandatory managed care enrollment or to
implement managed care in only part of the state or for certain
categories of beneficiaries. As of September 1995, 42 states and
the District of Columbia had Section 1915(b) managed care
waiver programs.
States interested in testing new methods of administering
Medicaid and other Social Security Act programs apply for
waivers of Section 1115 of the Social Security Act. With 1115
waivers, the Secretary of the U.S. Department of Health and
Human Services authorizes states to undertake statewide
managed care demonstration projects that do not meet federal
statutory requirements. Besides shifting the traditional Medicaid
population into mandatory managed care, many recently
approved 1115 waivers have extended coverage to additional
low-income individuals and families not currently eligible for
Medicaid. Since the liberalization and revision of the waiver
review and approval process in 1993, the Secretary has granted
1115 waivers for statewide demonstration projects in 13 states
and the District of Columbia. Ten of these demonstrations are
already under way (Figure 4).
Managed care is not an instant solution to problems concerning
access to care and rising costs for the Medicaid population.
Medicaid beneficiaries are economically disadvantaged,
frequently reside in medically underserved areas, and often have
more complex health needs than do higher-income
Americans. As states move to implement managed care and
cost-containment programs, attention must be given to
safeguarding the quality of care and access to care for poor and
vulnerable populations that do not have the financial resources to
go "outside the Medicaid system" to obtain care.
The move to managed care is an attempt to establish a network
of primary care providers for Medicaid beneficiaries, but the
success of managed care depends in large part on the future
adequacy of the capitation rates and the ability to maintain access
to care. As a public program, Medicaid has operated under tight
budget constraints, resulting in provider payment rates that are
often substantially below market rates and that have contributed
toward access problems.
Broadened use of managed care is unlikely to accomplish big
overall savings for Medicaid unless extended to the elderly and
disabled populations, both groups with limited managed care
experience. Acute care services for low-income children and
adults, the target of most managed care initiatives, only account
for one-quarter of program spending, whereas 60 percent of all
Medicaid spending is for the elderly and the disabled. Even if
managed care can achieve savings of 5 to 10 percent over fee
for-service, overall savings of more than 5 percent of total
Medicaid spending are unlikely without the aggressive and
untested implementation of managed care for the low-income
elderly and disabled populations.
Changes in the delivery system can be made to accomplish
savings but, in order to be effective and preserve access to
needed services, these changes will require time to implement,
the development of an adequate infrastructure to deliver care,
oversight of program implementation, and more experience with
enrolling the elderly and disabled. Ensuring that plans have
provider networks in place, educating both providers and
beneficiaries about managed care, and responding to the unique
needs of the Medicaid population will require increased effort as
the share of beneficiaries enrolled in managed care continues to
grow.
The Kaiser Commission on the Future of Medicaid was established by the Henry J. Kaiser Family Foundation in 1991 to function as a Medicaid policy institute
and serve as a forum for analyzing, debating and proposing future directions for Medicaid and other health reforms affecting low-income Americans.
The Kaiser Family Foundation is an independent national health care philanthropy and not associated with Kaiser Permanente or Kaiser Industries.
�'IHE MEDICARE PROGRAM
December 1995
WHAT Is MEDICARE AND
How Is IT FINANCED?
WHAT SERVICES ARE COVERED UNDER MEDICARE?
Medicare is the nation's health insurance program for almost
38 million aged and disabled persons. Enacted in 1965
under the Social Security Act, Medicare covers virtually
everyone ages 65. and older, based on eligibility for Social
Security benefits. Medicare was established because many
older persons were unable to purchase health insurance
coverage on their own. The program was expanded in 1972
to persons under 65 who receive Social Security Disability
benefits for at least two years and to those with end-stage
renal disease (ESRD).
Medicare covers hospital, physician, and other acute care
services. Part A, which accounts for nearly two-thirds of total
program spending, includes:
Medicare consists of two parts: Hospital Insurance (Part A)
and Supplementary Medical Insurance (Part B). Although
Part B is voluntary, 97 percent of Part A beneficiaries enroll
and pay the monthly Part B premium ($46.10 in 1995). Part A
is funded by a payroll tax of 1.45 percent on both employers
and employees. The revenue from this tax is held in the
Hospital Insurance Trust Fund. Part B is funded by general
revenues and beneficiary premiums.
Part B, which requires 20 percent coinsurance after the $100
deductible, covers the following:
Medicare provides health insurance coverage to more than
33 million aged, 4. million disabled, and about 200,000
persons with ESRD. The Medicare population has nearly
doubled since the program began, growing from 19.2 million
in 1967 to 37.7 million in 1995. This increase reflects the
aging of the population and the rising number of disabled
beneficiaries. The oldest-old (ages 85 and older), the under
65 disabled, and those with ESRD are Medicare's fastest
growing groups .. The Medicare population is projected to
increase by an average 2 percent annually through 2015.
Medicare represents 17 percent of total personal health
expenditures in the U.S. Medicare outlays are estimated to
be about $177.8 billion in fiscal year 1995, which represents
12 percent of the federal budget.
• Hospital inpatient services, subject to a deductible
($716 in 1995) and coinsurance after day 60
• Home health services
• Skilled nursing facility (SNF) care, limited to 100 days and
subject to a coinsurance after day 20 ($89.50 in 1995)
• Hospice care
•
•
•
•
•
Physician services
Hospital outpatient care
Laboratory services
Durable medical equipment
Other ambulatory care
Medicare Spending by Type of Service
Other Psrt B
Benefits
HMOs SNF
8%
5%
Home Health
8% Hospice
1%
[iii]
Part A
'0
PartB
HMOs
(PartsA&B)
•
Total
=$177.8 blillon*
• Exdudes admmistratlve 84'6OSes.
SOURCE: Cong",..lonaI8udget 0IIIce. 1995 projections.
Medicare Beneficiary Growth, 1967-2015
SDlsabled and ESRD
52.0
_Aged
1967
80URCE;
1975
1995
1985
_l1li eo.. Financing Admlnl_oft, 11111.
WASHINGTON OFFICE:
CALIFORNIA OFFICE:
2005
2015
The distribution of Medicare expenditures for different services
has shifted over time, partially because of greater reliance on
ambulatory, rather than inpatient, medical care. Between 1980
and 1995, Medicare spending for inpatient hospital services
declined from 66 percent to only 44 percent, while home health
spending increased from 1 percent to 8 percent.
Medicare payments to health maintenance organizations (HMOs)
under Parts A and B constitute 8 percent of total program
spending. Today, 3.7 million beneficiaries (almost 10 percent of
all beneficiaries) are enrolled in Medicare managed care plans.
Of this total, 3 million are enrolled in fully capitated, risk-bearing
plans, and the others in plans that cover some sen::ices on a cost
basis. The number of beneficiaries in HMOs is increasing rapidly.
In fact, the rate of growth of Medicare risk contract errollment
now exceeds private-sector HMO enrollment.
.
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,
�A relatively small portion of the Medicare population consumes a
significant share of total Medicare spending: 10 percent of
Medicare beneficiaries account for 70 percent of program
expenditures.
Distribution of Medicare Spending
For QMBs, Medicaid pays all of Medicare's premiums,
deductibles, and coinsurance. An estimated two million Medicare
beneficiaries, fewer than half of those eligible to participate.
receive these benefits. For an additional group of beneficiaries
with incomes between 100 and 120 percent of poverty, Medicaid
covers only the Part B premium.
Medicare Beneficiaries with Supplemental Insurance
Individual Pollcle8
37%
Medicare Only
11%
Employer &
Individual
5%
Percent of Beneficiaries
Percent of Expenditures
33%
SOURCE: Healn C.... Fln.nelng Administration. Oflloo of lhe Actuary. 199~.
Medicare is less comprehensive than many employer-based
plans: It does not, for example, cover outpatient prescription
drugs, and it has a higher deductible than. those imposed by many
employer-based plans. Moreover, Medicare does not offer stop
loss protection, which means that there is no upper limit on
beneficiaries' out-of-pocket expenses.
Since Medicare's cost-sharing requirements are relatively high,
and neither outpatient prescription drugs nor long-term care is
covered, the program finances only about 45 percent of all health
care spending on the elderly. Beneficiaries pay directly (or
through supplemental insurance) for 49 percent, with the
remaining 6 percent of total spending covered by public sources.
HEALTH INSURANCE THAT SUPPLEMENTS MEDICARE
Fully 89 percent of elderly Medicare beneficiaries have
supplemental insurance to fill in the gaps that Medicare does not
cover. More than one-third receive such insurance from a former
employer, while another third buy supplemental insurance
(Medigap) for themselves. Eleven percent lack supplemental
insurance altogether, and 12 percent are covered under Medicaid,
the major public financing program for low-income Americans.
Medicaid provides supplemental coverage for about 4 million low
income Medicare beneficiaries. For these "dually eligible"
individuals, Medicaid pays Medicare's premiums and other cost
sharing requirements. For some, Medicaid also provides benefits
that are not covered under Medicare, such as prescription drugs
and long-term care.
MEDICARE EXPENDITURES
Medicare outlays have grown rapidly in recent years, primarily
because of technology, the aging of the population, and medical
price inflation. Already one of the fastest growing programs in the
federal budget, Medicare's costs are projected to rise by about 10
percent annually in the future. Higher spending rates. coupled
with slower growth in Trust Fund revenues, are prOjected to
exhaust the Part A Trust Fund by 2002, according to a recent
report by the Medicare Trustees.
Medicare has low administrative costs and a growth rate that, until
very recently, has been lower than private sector health spending.
On a per capita basis. Medicare has grown at a slower rate than
the private sector for eight of the ten years ending in 1993 for
services covered by both Medicare and private insurance plans.
Changes in payments for hospitals and physicians adopted by the
Congress throughout the 19808 helped to lower the rate of growth
in Medicare spending over the past decade.
Medicare beneficiaries may qualify for Medicaid if they:
• Qualify for Supplemental Security Income cash benefits
• Have such high medical or long-term care expenses that they
"spend down" to Medicaid eligibility levels (an option in 36
states)
• Have incomes below 100 percent of the federal poverty level
(such individuals are known as Qualified Medicare
Beneficiaries, or QMBs)
The Kaiser Family Foundation is an independem national health care philamhropy and not associated with Kaiser Permanente or Kaiser Industries.
�'!'HE MEDICARE PROGRAM
MEDICARE AND MANAGED CARE
May 1996
Overview
The Medicare program was established in 1965 to provide
health insurance and economic security to elderly
Americans, many of whom were unable to purchase health
coverage on their own. Today, more than 97 percent of the
elderly are covered by Medicare. The program provides
health benefits to more than 38 million Americans,
including 33.4 million elderly and 4.8 million disabled
individuals and persons with End-Stage Renal Disease
(ESRD). The majority of Medicare's beneficiaries report
that they are satisfied or very satisfied with the quality of
their care, and have higher levels of satisfaction than any
other insured group.
Total Medicare expenditures in 1996 are estimated to be
$199 billion, which represents 13 percent of Federal budget
outlays and 21 percent of Federal entitlement spending.
Sy the year 2002, program expenditures are projected to
reach $332 billion. Given the projected growth in
expenditures, and pressure to reduce the Federal deficit,
there is increasing interest in proposals to restructure the
Medicare program by expanding enrollment in managed
care plans. The philosophy of managed care is to
emphasize primary and preventive care and control costs
by using the most cost-efficient treatment and eliminating
unnecessary care.
The Federal government has supported enrollment of
Medicare beneficiaries in HMOs since the early 1970s.
During the early years of the Medicare program, plans
were paid on the basis of their costs rather than on a
capitated-risk basis. In 1982, Congress enacted the Tax
Equity and Fiscal Responsibility Act (TEFRA), setting forth
the terms and conditions for risk- and cost-based contracts
with health maintenance organizations (HMOs). Today,
payments to HMOs are made either on a capitated-risk
basis, or based upon reasonable costs. Risk contracts
place the health plan at full risk for the cost of providing
Medicare benefits. Cost contracts are reimbursed on a
reasonable cost basis.
Enrollment Trends for Managed Care
Figure 1
Medicare Managed Care Enrollment,
1985-1995
Millions of Medicare Beneficiaries
5.0 I--~=====;;;:===:;----'
_Cost-Sued Pla"s. HCPP" G3Risk·Based PI3ns
4.0
3.7
3.0
2.0
1.0
0.0
1985
1987
1989
1991
1993
1995
• Health Cere Prepll'flTlent Plans and Social Hea!lh MllinienanC9 OIQ8tlIZOnOns
Source. HC!=A, Office of Man8ged Cere, ApflI199S
number of Medicare risk enrollees has more than doubled,
increasing by about 70,000 new enrollees per month since
January of 1996. The CSO projects that the share of
Medicare beneficiaries enrolled in risk plans will grow from
9 percent in 1996 to 17 percent by 2002, and to 24 percent
by 2006.
The recent growth in the number of risk enrollees has been
uneven across the states (Figure 2). Almost one-third of
all Medicare beneficiaries living in California
(33 percent) and Arizona (31 percent) are enrolled in risk
contract HMOs, compared to 19 percent of all Medicare
beneficiaries in Florida and 8 percent of beneficiaries in
Texas. There are virtually no risk HMO enrollees in 22
states. As a result, the 3.5 million Medicare risk-contract
enrollees are concentrated within a small number of states,
with 35 percent residing in California, 14 percent in Florida,
and 7 percent in Pennsylvania. New York and Arizona
each account for about 6 percent of the nation's risk
contract enrollees.
Figure 2
Medicare Risk-Plan Enrollees as a SharEDf Total
Medicare Beneficiaries,by
1996
Managed care is available as a choice for the majority of
Medicare beneficiaries. Three-quarters (74 percent) of all
Medicare beneficiaries live in an area with a Medicare
managed care plan available to them. The proportion of
beneficiaries enrolled in managed care plans has almost
tripled over the past decade, increasing from 4 percent of
beneficiaries in 1985 to 11 percent in 1996.
Medicare managed care enrollment has increased rapidly
in recent years, particularly in risk-contract plans. As of
April 1, 1996, 4.2 million Medicare beneficiaries were
enrolled in managed care plans offered by 289
organizations (Figure 1). Of these, 3.5 million beneficiaries
were enrolled in 202 risk-contract HMOs. Since 1991, the
WASHINGTON OFFICE:
CALIFORNIA OFFICE:
• IllC'i.DIslhe[)stnctolCoIumbIB
Source HCFA, Office of Managed Care, 1996
1450 G STREET, NW, SUITE 250 WASHINGTON, DC 20005 (202) 347-5270
2400 SAND HILL ROAD MENLO PARK, CALIFORNIA 94025 (415) 854-9400
FAX
FAX
(202) 347-5274
(415) 854-4800
"
,
�Medicare Managed Care Benefits and Cost-Sharing
Two attractive features of HMOs are the relatively low cost
sharing requirements and the coverage of services that are
not included in the standard Medicare benefit package.
Most HMOs provide some additional benefits although, in
the case of cost-based plans, beneficiaries pay the full cost
of any additional services. Today, 97 percent of all risk
contract HMOs provide annual physical exams and 39
percent cover dental care. Since 1993, the proportion of
plans providing outpatient prescription drug coverage has
increased from 49 to 61 percent (Figure 3).
In addition to the monthly Part B premium ($42.50 in
1996), some risk plans charge an additional premium.
Nearly two-thirds (64 percent) of all risk-contract plans do
not charge an additional premium, while 19 percent charge
more than $40 per month (Figure 4). Since 1993, the
Figure 3
Percent of Medicare Managed Care Risk-Contract
Plans That Offer Additional Benefits
Foot Care
Dentel Care
Outpatient
Prescnption Drugs
~:=~ii.~~
rf
payment for providing all Medicare-covered services,
based upon 95 percent of what Medicare would typically
spend for beneficiaries if they were not enrolled in an HMO.
This county-specific rate, known as the Adjusted Average
Per Capita Cost (AAPCC), is set prospectively and is
adjusted for geography, age, sex, Medicaid, and
institutional status of the Medicare beneficiary. Medicare
payments based upon the AAPCC vary widely throughout
the country. For example, in Dade County, Florida, the
AAPCC is $687 per month, compared to $368 per month in
Clackamas County, Oregon.
A number of studies have established problems with
Medicare's payment methodology for risk-contract HMOs.
A 1993 evaluation conducted for HCFA by Mathematica
Policy Research, Inc. found that payments to risk contract
HMOs were 5.7 percent more than they would have been if
enrolled beneficiaries had received services under the
traditional Medicare program. This overpayment was
attributed to enrollment of relatively healthy beneficiaries
who are less likely than non-enrolled beneficiaries to use
covered health care services. As a consequence, the
Medicare risk contractor program has not achieved
anticipated savings, and there is widespread agreement
that more predictive measures of health status should be
incorporated into the payment formula.
Ear Exams
Immunizations
EyeExams
Annual Physicals
~iiiLJ
~
0%
20%
40%
60%
80%
100%
120%
Source HCFA. Office 01 Menaged Care, ,996
average premium charged by risk-contract HMOs has
declined from $22 to $14 per month. According to the
Health Care Financing Administration, premiums charged
to risk-contract HMO enrollees tend to be lower than
premiums for individually purchased Medigap policies.
Medicare Payments to Risk Contract HMOs
In addition to any premiums paid by beneficiaries to risk
contract plans, Medicare pays the plans a capitated
Figure 4
Percent of Risk-Contract Plans Charging Additional
Monthly Premiums, 1996
Over $40 per month
19%
$40 per month or less
17%
No Premium
64%
Total Risk Plan Enrollment, 1996
=3.6 million
$ou"ce HCFA, OLIGA Survey 01 Medicare HMOs, ,996
The Kaiser Family Foundation is an independent national health care philanthropy and not associated with Kaiser Permanente or Kaiser Industries.
�
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"
ADMINISTRATION POLICY ON ILLEGAL IMMIGRATION
.. .
'.1
Executive SUlIImary
'.
.
The Clinton Administration h~ a four-part strategy for addressing illegal inimigration.
Details of this strategy can' pe found in the following pages. '
I. Enforcement
. 1 ..
.
.
This Administration has launclied the toughest fight ever to deter illegal immigration through
, a comprehensive set of enforc~ment strategies. This includes:,
Significantly expanding the Border Patrol (45% increase from FY93 ;to FY95)
Adopting a new border/ strategy designed in coordination with the Defense Department
Reforming asylum rules
,
'
,
I
Expanding anti-smuggling initiatives
increasing the number iOf .megal aliens deported annually.
II. Worksite Enforcement -- Verification
Enforcing prohibitions against ,employing illegal aliens is the second piece of the strategy,
since employment is the majdr incentive for illegal immigration. To this end, we will:
'Endorse the Jordan c6mmission's proposal to initiate pilots, to ' test Social Security
I
'
:N'umber and INS database methods to improve verification of employment
authorization
Reduce the number off work authorization documents and increase their fraud
resistance
,Increase enforcement
against employers who flaunt sanctions by hiring illegal aliens.
,I
'
'
III. Assistance to States
Deterring illegal immigratiorl over the long run i~ the bnly way to keep the cost of illegal
imniigration to states from growing. The Administration recognizes that the states need
federal help. We are the first Administration to obtain funding from Congress to reimburse
states for a share of the costs of illegal aliens.
'
IV. Benefits '
Illegal aliens should not be leligible for public benefits or services, with limited exceptions:
e.g. emergency medical services, children's right to an' education, temporary humanitarian
disaster assistance, and to drotect certain public health and safety interests. The
Administration defends the rights of legal immigrants who may be eligible for public benefits
or services like citizens, but will support strengthening sponsorship obligations to prevent
legal immigrants from bec6ming public charges.
I
V~ Budget
I···.
We will support our illegal immigration strategy with an unprecedented budget commitment,
including: $1.5 billion mdre ~n FY1996 than the Bush levels for the INS (primarily for
enforcement)and State co~t reimbursement and, assistance (excluding Medicaid
reimbursement and general education programs) and more than $9 billion over the Bush
I
'
levels for the 5 year peri1 of 1996-2000.
I
�INTRODUCTION: A PRINCIPLED FRAMEWORK .FOR IMMIGRATION POLICY
This· Administration inherited JriOUS illegal immigration problems because previous'
Administrations dedicated neithkr the resources nor the enforcement tools to deter illegal·
immigration adequately. ,As a tesult, a small number of States shouider a high proportion of
the costs of illegal immigrationl.and anti-immigrant sentiment is growing, against not only .
illegal immigrants, but potentiaily also against those who are here legally and contribute to
the wealth and fabric of the uriited States. '
' .
TQ reverse this course, the AdJinistratiOn has. moved boldly to implementa tough, yet
compassionate, comprehensive I:immigration policy. The goal of our overall policy is to: deter
illegal immigration, welcome ,legal immigrants and protect refugees from harm.
Principles and priorities underl~ing this, goal include:
g~als
Deterring illegal immiJation reflects the national arid economic security
of a
nat!on's need to c.ontrol/ its borders. I~ also reflects the Administration's vision Of. a
cnational commumty where people stnvenot only to work hard, but also to contnbute
their fair'share and play by the rules. An individual's illegal entry by definition defies
this vision. And an mdgal crosser's undocumented status virtually ensures some level
of social marginalizatioh and risks, growth of an underclass rather than integration into
and full participation id society. Emphasizing worksite enforcement, in addition to
border control, address~s the largest. magnet for illegal immigration and recognizes that
those who flaunt immibation laws include employers attemptirig to gain' competitive
advantage by hiring ill~gal aliens.
voic~
We should
our ,lcognition of the contribution of legal immigration to our
country and Qur immigbtion priorities should reinforce immigration'S role in
strengthening families rnd communities (through reunJfication of close family . .
members) and strengthening the economy (by supporting needed employment-based
immigration when that/ does not compete with Americans for jobs). These are our'
core interests in immigration that benefit our national, State, an,d local communities.
Our policy should refllct'a commitmentto bringing legal immigrants into our national
community. They havf been invited to enter our country, to invest their skills and
energy, to join with us in the pursuit ofa shared American dream. Our policies
should thus reinforce dur vision of a national community whose members -- citizens
and noncitizens alike
work hard, contribute their fair share and play by the rules
for this is part of our societal contract with legal immigrants as well as citizens.
f-
stron~er
Concurrent with
enforcement we must dedicate our efforts to protecting
citizens and legalimrrligrants from discrimination and harassment. .
.
And finally, we will Jdvocate shared responsibility for immigration costs with States
and localities by suppbrting (within budgetary realities) fair fiscal relief for State costs
of immigration -- legal and illegal -- and opposing additional cost-shifting to'States
and localities.
.
�,
.
The balance of this memorandum focuses on four central areas of the Administration's
. immigration policy: Enforcemerlt, Work Verification: Benefits, and Assistance to States.
I. ENFORCEMENT
Basic policy message: We 'are Going more to deter illegal immigration .through
comprehensive .enforcement stra't~gies than any Administration in history. '_
Border Control -- Through ORerations Gatekeeper (California), Hold the Line (Texas), and
Safeguard (Arizona) we have ddployed a massive increase in the number of agents at the
.
border, equipped them with hi~ technology including infrared night scopes, put them in all
terrain vehicles with new radios l built miles of fences and placed sensors and lighting in
,
strategic locations. We also ard fingerprinting illegal crossers for the first time.
.
.
I
.
.
We have deployed a new strategy of border control ("Prevention Through
Deterrence") which was ~esigned in consultation with the Department of
Defense,. and endorsed b& the Jordan Commission.
.'
,
bur
We will have increased
overall Border Patrol strength by 1560 new and redirected
agents along the Southw~st border by the end of 1995. (A 45% increase from 1993
through 1995 overall and nearly a 60% increase in the San Diego sector.) 800 of
these new agents are beihgassigned to the California and Texas borders where 65% of
illegal crossings occur. .
The budget was enhanced for border control in 1994 by' . in. 1995 by
$45 million and
I
$236 million. About .2/3 of the 1995 budget increase of $357 million for 'immigration
initiatives -- the largest increase in history -- will go to border control.
There has been a significant level of deterrence and a drop in local crime. (We'
should avoid relying updn the problematic measure of "apprehension" rates, '.
although FYI.it has beeA reported that apprehensions have dropped 72% since
Operation Hold the Linel began at EL Paso and 32% in California since October
'
1994 when Operation Ghtekeeper began in comparison to the same time in
1993. And crime is rep~)fted down at both locations.)
.
'.
I
.
.
We are developing Border Patrol response capability that can move quickly to
locations along the bordbr' tocQunter build"':ups of smuggling activities and .
illegal border crossers.
Anti-Smuggling -- The Administration drastically reduced l;lfge ship-based, smuggling. The
.'
"
.
Crime Control Act enhances pe~1alties for alien smuggling.
~-
The Admidistr,ation enacted comprehensive reform of the asylum system
Asylum Reform
to prevent illegal aliens withou~ Iperitorious .asylum claims from remaining in the U.S.
�through fraud and abuse of asylum procedures.
Th~
'
p~ogram
AdministrJion has expanded its
to deport criminal aliens and
Deportation -will continue these efforts with 1$54 million appropriated for 1995. (We expect to almost
double the number of criminal aliens removed directly from prisons to their home countries
annually from 20,000 to 40,ooOi.) The Crime Control Act enhances penalties for failing to'
depart, or for reentering, after a~orderof deportation and provides for administrative
,
deportations, a new legal proce~s that will greatly enhance INS' ability to deport aggravated
felons.
'
Controlling Illegal Immigration At Legal Ports-of-Entry -- The Administration has
improved significantly its ability to catch aliens who attempt to enter illegally at JFK and
other international airports.
International -- The Administr~tion continues to work with foreign governments, especially
the Mexican government, for bilateral solutions to, illegal immigration.
B. What We Will Do --
BdrderControl -
We will continue the training and deployment of new Border Patrol agents to
stabilize the gains in det6rrence capability being made at the Southwest border.
We will seek funding to add 700 new Border Patrol agents in 1996, 1997, and
1998, with ,a goal, of haying at least 7,000 Border Patrol agents guarding the
'
Southwest border by, January 1, 2000.
stre~gthen
The'1996 BUdget' ProvidL over $490 million in additional resources to
border and interior enforbement($380 million of this amount goes to INS for these
enforcement purposes).
.
$150 Million More For Enfo'rcement -- In:addition to the $380 million provided already in
the INS 1996 budget for enforcJment purposes, the Department of Justice proposes to use a
further $150 million 1996 enharicement (shifted from Medicaid reimbursement) for the .
following enforcement activities~ (1) approximately $110 million and over 1,000 a,dditional
staff for a National Detention arid Removal Program to double the number of deportations
(from 52,000 in 1995 to more t1~an 100,000 in 1996); and .(2) approximately $40 million and
400 additional staff to expand ,orkplace enforcement programs and pilots for computer
based employment verification systems.
'.
I
.
,
Anti-Smuggling -...: The Administration will adapt anti-smuggling initiatives as criminals
change smuggling routes and schemes. We will enhance smuggling intelligence gathering and
target organized crime operation~. And we will seek expanded legislative authority to catch
and prosecute smugglers.
�Visa Overstayers --' We will be the first Administration to develop a strategy (through a .
combination of worksite enforc6ment, visa issuance and verification procedures) to begin to
deal with the 40-50% of illegal aliens who. are visa overstayers.
Detention and Removal -- In the past, apprehended illegal aliens often were released because
of lack of local detention space rather than detained and deported. We will develop a
.
national detention and removal policy, including seeking legislation as needed, to correct this.
We also will streamline deporta~ion procedures through new legislation and regulations and
seek enhanced exclusion authority. We will begin to deport gx:eater numbers of failed asylum
I
applicants pursuant to new aSY1rrn prOcedures. . . .
.. .
Targeted Deterrence Zones -...: For the first time, we will initiate a comprehensive and
.
coordinated (interagency and intergovernmental) program of targeted enforcement activities,
particularly worksite and employer sanctions enforcement, in selected metropolitan or .regional
areas of high illegal immigratioh.
.
. . I
C. - - - - Budget (Over - ,..- - Enforcement...;;Related)
INS Total
7,0% is
\
Historical
($ in millions)
1993
1994
1995
1996
1993 to 1996
----
INS ,Resources.
1,514
1,650
2,031
2,552
+69%
Out years
($ in millions)l
1997
1998
. 1999
2000
2,800
2,800
J
INS Resources
2,800
out year estimates
. ,1996 to 2000
TOTAL
13,752
II. WORK VERIFICATION
Basic policy message: Employm~nt is the primary incentive for illegal immigration. The
best way to deter illegal immi~ation is through an effective combination of border and
worksite enforcement. This is Ithe first Administration to take substantial steps to enforce,
employer sanctions law and is bommitted to building national systems that will verify
. employment status. The Admibistration will test several large-scale pilot programs including
.
I
testing the buUding blocks of the Commission on Immigration Reform's proposed national
registry.
A. What - - - - - -
- - We Have Done
Began to reduce the number of acceptable work authorization documents to
.
I
.
achieve the goal of establishing only 2 acceptable documents for noncitizens
and a small number (4)ifor U.S. citizens, while making those documents more
tamper-proof and counterfeit resistant.
�Committed to expanding INS' Telephone Verification System pilot to a
significant number of errtployers.
'
I
•
I
.
Began overhauling the I~S. and SSA records database and infrastructure to
greatly improve their reliability and usefulness. This database improvement is
crucial to any verificatidn system,
'
.
Initiated tests of the tecLical feasibility of verification system proposals.
B. - - - - Will Do
What We - - Call for improved meth0ds for employers to verify, the legal status of those
they hire:
Endorse the proposal made by the Commission on Immigration Reform (the'
Jordan Commission) to itest a variety of methods to improve verification of
employment authorizati0n. Recognizing the Commission's proposal for a
registry will take at lea~t five years to prepare 'for testing; the Administration
will move immediately to initiate three to five large pilot projects. They will
include: 1) expansion of the INS Telephone Verification System from 9 to
1000 employees; 2) si~ulation of an INSISSAd~tabase to test database
integrations; and 3) dev1elopment of a two-step process to cross-check INS and
SSA files for all job applicants.
.
.
Barba:ra Jordan will puJUclY support the Administration's response,'
Propose legislation to rlduce the number of work authorization documents and
continue efforts to mat them more countcrfeit- and fraud-resistant.
C.Verification Budget (INS Only)
I
($ in millions)'"
Workplace
Enforcement!
Verification Costs
1993
36
1994
36
1995
--
1996
49
124
1993 to
--1996
.+244%
*Rough estimates
-~
,
.
�,
.
ITI. ASSISTANCE TO STATES
co~trol,
Basic policy message: Deterribg illegal immigration (by border
worksite
.'
enforcement, and removal of d6portable illegal aliens) is the only longtermsolution to keep
State costs from growing far btyond that which States face today as a resulr of failed policies
of the past. This is the first A8ministration to address its primary responsibility of controlling
illegal immigration squarely add we 'are targeting most of our Federal dollars to those
initiatives which address the rdot causes that lead to increased burdens on States.
Still, this Administration has a vision of shared (esponsibility for the costs of illegal
immigration an? is the fi~st to lobtain f~n~ing fr?ri1 Congress. to reimbu:se States for a s~are
of these costs (mcarceratIOn costs of'cnmmal aliens). We wIll work wIth States to conVInce
Congress to provide more feddral help for certain State costs and will oppose inappropriate
cost-:-shifting to the States.
The 1995 .budget contained about $25 billiOll in resources for immigration and
.
I
•
.
.
Federal programs which help and provide services for immigrants, (both legal
and illegal). 'A signifidant portion of this amount is for States. This is a 32%
, increase over the prior Administration's budget request for the same 'programs.
The Crime Control Act provides authorization for reimbursement to States for
criminal alien incarcedtion costs at a level of $1.8 billion over 6 yearS (1995
2000).
.
.
,
,
'
The Federal governmept reimburses States for 50 to 79 percent of total'
Medicaid costs, including emergency care for illegal aliens.
The Federal governmehthelPs with the costs ·of educating illegal immigrant
children through gener,~l education programs: Title· I program for the
.
disadvantaged ($7 billion); bilingu41 education program ($195 million); .and the
.
.,:,
immigrant education p~ogram ($50 million).
. i
J
..
To respond to the neck for more,reliable·data, the Administration asked the
Urban Institute to pro~ide the be~t estimate to date of costs and revenues of
illegal, immigration fof education, health and welfare.
B. What We Will Do (FY 1996 Proposal)
~-
$300 million will be available for reimbursement to States for criminal alien
incarceration costs.
I·
(
$150 million in Medicaid reimbursement for emergeilcy medical service to
.
. I
'
un d ocumente d .ImmIgrants.
. ' '
�·
,
A 100% increase ($50 tpillion) will be proposed for additional Immigrant
Educational program funding.
.
,
, I
'
C. Budget to Provide State (Cost Reimbursement and Assistance
,
I
Historical
($ in millions)
1993
1994
1995
1996
1993 to 1996
----
Cost
Reimbursement
and Assistance*
0
0
130
550
nla
Out years
($ in millions)
1997
,
1998
1999
2000
1996 to 2000
TOTAL
2,930
580
580
580
Cost
580
Reimbursement
..
and Assistance
* Includes the State, Cnminal Alien Assistance Prog. (SCAAP), Medlcaid Dls cretionary
rain
,
Grants, and Immigration Edubttion (program funaing,not'reimbursement)
IV. BENEFITS
Basic policy message:
1) Illegal aliens shoulo not be eligible for public services or benefits, with
limited exceptions. nese limited exceptions itlclude, emergency medical
services, children's ridht to an education, temporary humanitarian disaster
assistance (e.g., earthquakes), 'and to protect certain public health and safety
interests (e.g. immuniZations).,
, I ,'"
,'
2) Recognizing that legal immigrants, like citizens, pay taxes and contribute to
society, they may be bUgible fora number of public benefits or services. We
will strengthen spons6rship obligations to prevent legal immigrants from
'
becoming public char1ges.
A. What We Have
D~ne _1'
The Administration's Welfare package contained a number of proposals to
reform immigrant benefit eligibility, particularly as it regards legal immigrants.
(Federal law already prohibits illegal aliens from receiving most fyderal
benefits.)
The Administration publicly, opposed Proposition 187.
�The Administration will introduce legislation to make sponsors sign affidavits
of support that are legallY binding.
We will support a lengt;hened uniform "deeming" period of at least five yearfi
for Food Stamps, AFDC, SSI, .and Medicaid. During the "deeming" period a
sponsor's ~ssets are de~med available to the immigrant for the purpose of'
determining eligibility for benefits;·We will.work with the Welfare Reform
Task Force to agree onl the proper period of time if over five years (most likely
10 years or until citizehship).,
'
'11
.
'f
We WI, propose rnak·1 . .
mg ImmIgratIon statuses standard and UnI orm 'f'
or
.
, I
eligibility purposes and eliminate the catch-all PRUCOL category.
.
.
I"
'
.
We will propose that States be given; the ability to use the same eligibility
criteria for immigrant~ as used by the Federal govemment.
. .
•
I
.,
We will restrict benefits to illegal aliens in "mixed households" (families with
illegal immigrant meritbers) by determining benefit. a pro rata basis
levels. on '
,
,I
'
that excludes the illegal alien members of the household:
OU~.POSition
We will advocate
as the better policy compared to a complete bar
on services or benefits for legal and illegal immigrants. and the type of
.teacher/doctotreporti!ng requirements contained in Proposition 187~
.
c.
~enefifs
throu~
We will strengthen
eligibility verification
Improvements 'in the
INS records, the INS benefit eligibility verification system,and other steps
under consideration.
I ..
.. '...' . ..
Savings From Reducing the Levels of Benefits to Non-Citizens
-~
I
t
996
1997
1998
1999
2000
Administration Welfare 1'-180
Proposal 2
-360
-750
-1,130
-1,420
($ in millions)l
.
1996 to
2000
TOTAL'
;
-3,840
Republican Welfare
-2,600 -5,700
-6,200
-6,800
0
-21,300
Proposa1 3
..
EstImates are based on the 1/94 baselme and the AdmInIstration! s proposal dated 6/21/94,
Republican proposal is baked on a preliminary CBO estimate using its ·1/?4 baseli~e
2 Includes Deeming for AFDC, SSI and Food Stamps programs.· PRUCOL programs include
AFDC, SSI and Medicaidi '
.
3 CBO pricing is for AFdc, SSI, Medicaid, and Food' Stamps
. I
�ADDITIONAL SPENDING TO SECURE THE BORDER AND MAN~GE IMMIGRATION "
,AND TO ASSIST STATES WITH COSTS OF ILLEGAL IMMIGRATION·
(Budget,authority; dollar amounts ln' millio~s)
.?
-.
-,.;
1993~
.'Actual
1994
Actual
1996
1995
Estimate
I,mmigration
.Law. Enforcement
Pro~osed
.\
INS.·...... :.....·.......... :.........
1514
"
INS-Border Patrol:
Funding...:...........
Agents ....: ..; ..... ;....
,354
,3;991
. 1,650 .
Percent
Change
93 to 96 .
Percent
Dollar
Dollar
Change ' .- Change . Change.
95,td 96 .' 93 to 96
95 to 96
. ,
2,588'
:2,031
557
27%,'
"1;074
71%
.-: 219,
1,637
62°A,'
41%
385
.' 4,282 .-
459
4,928 '.
. 573'
5,E)28
1'1-4
700'
'25%'
14%
·387
104
.37%
-
117
43%
1'6
16%
,'22,
23%
Treasury/Customs
'270'
275
283'
LaborNiage and ·Hour' .
·95
100
101
1,819
2,025
117 .
/
,
Subtotal'
--,
2,415
,3,092
.677
28%
~1,213,
130
j
~
300
_,170
131%
_300.
~6.5.%
..
,AssistanCe to States
SCAAP*........................
,
-
300 .
Medicaid........ :.........:.... ;
300,
n/a
nla
'300 '.
.
nla
'.
Immigrant education..... :. . . '
.
SO
50
50,
100
50
100% .
100%
50
~.
~
Subtotal
50
50
,
TOTAL
.1,929
180
700
2,595' .
3,792 .
289% .
520
650
.1300%
. 1863
,.
97%
~
2,075..
'1,197
46%
~ State Criminal Alien Assistance PrOgram, Department of Justice
~.
J.
�."
,"
.'
{"'
.,.
,"
ADMINISTRATION POLICY ON ILLEGAL IMMIGRATION
Executive Summary
2
The Clinton Administt:.ation has a four-part strategy for addressing illegal immigration.
Details of this sfiategy can be found in the following pages.
I.
Enforceme~t
. This Administration has launched the toughest fight ever to deter illegal immigration through
a comprehensive set of enforcement strategies. This includes:
Significantly expanding'the Border Patrol (45% increase fr0m.fX9~.to FY95) ,
Adopting a new border strategy designed in coordination with the Defense Department
Reforming asylum rules I
Expanding anti-smuggling initiatives
Increasing the number of illegal aliens deported annually.
II. Worksite Enforcement -- Verification
. Enforcing prohibitions against employing illegal aliens is the second piece of the strategy,
since employment is the major incentive for illegal immigration. To this end, we will:
Endorse the Jordan Commission's proposal to initiate pilots to test Social Security
Number and INS database methods to improve verification of employment
authorization
Reduce the number of work authorization documents and increase their fraud- '
resistance
Increase enforcement against employers who flaunt sanctions by hiring illegal aliens.
III. Assistance to States
Deterring illegal immigration over the long run is the only way to keep the cost of illegal
immigration to states from growing. The Administration recognizes that the states need
federal help; We are ~the first Administration to obtain funding from Congress to reimburse
states for a share of the costs of illegal aliens.
IV. Benefits
Illegal aliens should not be eligible for public benefits or services, witb limited exceptions:
e.g. emergency medical services, children's right to an educatio!l, temporary humanitarian
disaster assistance, and to protect cer:tain public health and safety interests. The
Administration defends the rights of legal immigrants who may be eligible. for public benefits
or services like citizens, but will support strengthening sponsorship obligations to prevent )
legal immigrants from becoming public charges.
V. Budget
We will support our ille'gal immigration strategy with an unpreced~nted budget commitment,
including: $1.5 billion more in FY 1996 than the Bush levels for the INS (primarily for
enforcement) and State cost reimbursement and assistance (excluding Medicaid
reimbursement and general education programs) and more than $9 billion over the Bush
levels for the 5 year period of 1996-2000.
�INTRODUCTION: A PRINCIPLED FRAMEWORK FOR IMMIGRATION POLICY
This Administration inherited serious illegal immigration problems because previous
Administrations dedicated neither the resources nor the enforcement tools to deter illegal
immigration adequately. As a result, a small number of States shoulder a high proportion Of
the costs of illegal immigration, and anti-immigrant'sentiment is growing~ against not only
illegal immigrants, but potentially also against those who are here legally and contribute to
the wealth and fabric of the United States.
To reverse this course, the Administration has moved boldly to implement a tough, yet
compassionate, comprehensive immigration policy. The goal of our overal,l policy is to: deter
illegal immigration,welcome legal immigrants and protect refugees from harm.
Principles and priorities underlying this goal include:
•
Deterring illegal 'immigration reflects the national and economic security goals of a
nation1s need to control its borders. It also reflects the Administration!s vision of a
national community where people strive not only to work hard, but also to contribute
. their fair share and play by the rules. An individual's illegal entry by definition defies
this vision. And an illegal crosser!s undocumented status virtually ensures some level
of social marginalization and risks growth of an underclass rather' than integration into
and full participation in society. Emphasizing worksite enforcement, in addition to
border control, addresses the largest magnet for illegal immigration and recognizes that
those who flaunt immigration laws include employers attempting to gain competitive
advantage by hiring illegal aliens.
•
We should voice our recognition of the contribution of legal immigration to our
country and our immigration priorities should reinforce immigration!s role in
strengthening families and communities (through reunification of close family
members) and strengthening the economy (by supporting needed employment-based
immigration when that does not compete with Americans for jobs). These are our
core interests in immigration that benefit our national, State,and local communities.
•
Our policy' should reflect a commitment to bringing legal immigrants into our national
community. They have been invited to enter our country, 'to invest their skills and
energy, to join with us in the pursuit of a shared American dream. Our policies
should thus reinforce our vision of a national community whose members -- citizens
and noncitizens alike -- work hard, contribute their fair share and play by the rules
for this is part of our societal contract with legal immigrants as well as citizens.
•
Concurrent with stronger enforcement we must dedicate our efforts to protecting
citizens and legal immigrants from discrimination and harassment.
•
And finally, we will advocate shared responsibility for immigration costs with States
and localities by supporting (within budgetary realities) fair fIscal relief for State costs
of immigration -- legal and illegal -- and opposing additional cost-shifting to,States
and localities:
'
(
�,
,
The balance of this memor~ndum focuses on four central areas of the Administration's
immigration policy: Enforcement, Work Verification, Benefits, and Assistance to States.
I. ENFORCEMENT
Basic policy message: We' are doing more to deter illegal immigration through
comprehensive enforcement strategies than any Administration in history ..
A. What We Have Done , -
Border Control -- Through Operations Gatekeeper (California), Hold the Line (Texas), and
Safeguard (Arizona) we h~ve deployed a massive increase in the number of agents at the
border, equipped them witp high technology including infrared night scopes, put them in a11
terrain vehicles with new radios, built miles of fences and placed sensors and lighting in
strategic locations. We also are fingerprinting illegal crossers for the first time.
•
We have deployed -a new strategy of border control ("Prevention Through
Deterrence") which was designed in consultation with the Department of
Defense, and endorsed by ,the Jordan Commission.
•
We will have increased our overall Border Patrol strength by 1560 new and redirected
agents along the Southwest border by the end of 1995. (A 45% increase from 1993
through 1995 overpll and nearly a 60% increase in the San Diego sector.) 800 of
these new agents are being assigned to the California and Texas borders where 65%
of illegal crossings occur.
•
The budget was enhanced for border control in 1994 by $45 million and in 1995 by
$236 million. About 2/3 of the 1995 budget increase of $357 million for immigration
initiatives -- the ,largest increase in history -- will go to border control.
•
There has been a -significant level of deterrence 'and a drop in local crime. (We
should avoid relying upon the problematic measure of "apprehension" rates,
_although FYI it has been reported that apprehensions have dropped 72% since
Operation Hold the Line began at El Paso and 32% in California since October
1994 when Operation Gatekeeper began in comparison to the same time in
1993. And crime is reported down at both locations.)
,
•
We are developi~g Border Patrol response capability that can move quickly to
locations along the border to counter build-ups of smuggling activities and
illegal border crQssers. ,
Anti-Smuggling -- Th~ Administration drastically reduced large ship-based smuggling. The
Crime Control Act enhances penalties for alien smuggling.
Asylum Reform ...,.- Th~ Administration enacted comprehensive reform of the asylum system
to prevent illegal aliens without meritorious asylum claims from remaining in the U.S. '
�through fraud and abuse of ,asylum procedures.
Deportation --:- The AdminIstration has expanded its program to deport criminal aliens and
will continue these efforts with $54 million appropriated for 1995. (We expect to almost
double the number of criminal aliens removed directly from prisons to their home countries
annually from 20,000 to 4Q,000.) The Crime Control Act enhances perialties for failing to
depart, or for reentering, after an order of deportation and provides for administrative
deportations, a new legal process that will greatly enhance INS' ability to deport aggravated
felons. .
,
Controlling Illegal Immigration At Legal Ports-of-Entry -- The Administration has
improved significantly its ability to catch aliens who attempt to enter illegally at JFK and
.other international airports.
.
"
, International-- The Ad~inistration continues to work with foreign governments, especially
the Mexican government, for bilateral solutions to illegal immigration.
B. What We Will Do --:
Border Control -
•
We will continue the training and deployment of new Border Patrol agents to
stabilize the gains: in deterrence capability being made at the Southwest border.
!
•
\ ;
We will seek funqing to add 700 new Border Patrol agents in 1996, 1997, and
1998, with a goal' of having at least 7,000 Border Patrol agents guarding the
Southwest border: by January 1, 2000.
•
The 1996 Budget; provides over $490 million in additional resources to strengthen
border and interior enforcement ($380 million of this amount goes to INS for these
enforcement pUlP,oses).
$150 Million More For Enforcement -- In addition to the $380 million provided already in
the INS 1996 budget for enforcement purposes, the Department of Justice proposes to use a
further $150 million 1996 enhancement (shifted from Medicaid reimbursement) for the
following enforcement ~ctivities: (1) approximately $110 million and over 1,000 additional
staff for a National Det~ntion and Removal Program to double the number of deportations
(from 52,000 in 1995 to more than 100,000 in 1996); and (2) approximately $40 million and
400 additional staff to expand workplace enforcement programs and pilots for computer
based employment verification systems.
Anti-Smuggling -- Th~ Administration will adapt anti-smuggling initiatives as criminals
change smuggling routes and schemes. We will enhance smuggling intelligence gathering and
target organized crime operations. And we will seek expanded legislative authority ,to catch
and prosecute smuggle~s.
�Visa Overstayers -- We will be the first Administration to develop a strategy (through a
combination of worksite enforcement, visa issuance and verification procedures) to begin to
deal with the 40-50% of illegal aliens who are visa overstayers.
.
Detention and Removal --' In the past, apprehended illegal aliens often were released because
of lack of local detention space rather than detained and deported. We wiil develop a
national detention and removal policy, including seeking legislation as needed, to correct this .
. We also will streamline deportation, procedures through new legislation and regulations and
seek enhanced exclusion authority. We will begin to deport greater numbers of failed asylum
applicants pursuant to new: asylum procedures.
Targeted Deterrence Zones -- For the first time, we will initiate a comprehenSIve and
coordinated (interagency and intergovernmental) program of targeted enforcement activities,
particularly worksite and employer sanctions enforcement, in selected metropolitan or regional
areas of high illegal immigration.
.
I
C. INS Total Budget (Over 70% is Enforcement-Related)
,
lm'
INS Resources
1,514
Outyears
($ in millions)l
1224
l225.
l22!i
1223 to 1226
1,650
2,031
2,552
+69%
1998
Historical
($ in millions)
1999
2000
1996 to 2000
TOTAL
2,800
2,800
2,800
13,752
I
,1997
,
2,800
INS Resources
Kough outyear estImates
II. WORK VERIFICKfION
Basic policy message: ~mployment is the 'primary incentive for illegal immigration. The
best way to deter illegal 'immigration is through an effective combination of border and
worksite enforcement. '(bis is the first Administration to take substantial steps to enforce
employer sanctions law and is committed to building national systems that will verify
employment status. The Administration will test several large-scale pilot programs including
testing the building blocks of the Commission on Immigration Reform's proposed national
registry.
. ,
I
A. What We Have Done -
I
•
Began to reduce I the number of acceptable work authorization documents to
achieve the goarof establishing only 2 acceptable documents for noncitizens
and a small number (4) for U.s. citizens, while making those documents more ,
tamper-proof a~d counterfeit resistant.
.
�•
Committed to expanding INS' Telephone Verification System pilot to a
significant number Qf employers.
•
Began overhauling ~he INS and SSA records database and infrastructure to
greatly improve the~r reliability and usefulness. This database improvement is
crucial to any verification system.
.
•
Initiated tests of the technical feasibility of verification system proposals.
B. What We Will Do -
.'
Call for improved ~ethods for employers to verify the legal status of those
they hire.
•
Endorse the proposal made by the Commission on Immigration Reform (the
Jordan Commissioh) to test a variety of methods to improve verification .of
employment authorization. Recognizing the Commission's proposal for a
registry will take ~t least five years to prepare for testing, the Administration
will move immedi~tely to initiate three to five large pilot projects. They will
include: 1) expansion of the INS Telephone Verification System from 9 to
1000 employees; 2) simulation of an INS/SSA database to test database
integrations; and ~}development of a two-step process to cross-check INS and
.
SSA files for all jbb applicants.
aarbara Jordan
•
w~ll
publicly support the Administration's response.
Propose legislatiop to reduce the number of work authorization documents and
continue efforts to make them more counterfeit- and fraud-resistant.
C. Verification Budget: tINS Only)
($ in millions)*
1223.
,
1224
l225.
1.22{i
12Q3 tQ
J.22(i
!
;
Workplace
Enforcement/
Verification. Costs
. *Rough estimates
36
!
36
49
214
+244%
�ill. ASSISTANCE TO STATES.
I
Basic policy message:· Deterring illegal immigration (by border control, worksite
enforcement, and removal of deportable illegal aliens) is the only longterm solution to keep.
State costs from growing f~r bi::yoI)d that which States face today as· a result of failed policies
of the past. This is the fir$t Administration to address its primary responsibility of controlling
illegal immigration squarely and we are targeting most of our Federal dollars to those
initiatives which address the root causes that lead to increased burdens on States.
Still, this Administration has a vision of shared responsibility for the costs of illegal
immigration and is the first to obtain funding from Congress to reimburse States for a share
of these costs (incarceration costs of criminal aliens). We will work with States to convince
Congress to provide more .federal help for certain State costs and will oppose inappropriate
cost-shifting to the States;
.
A. What We Have
Don~
,
-
•
The 1995 budget Gontained about $25 billion in resources) for immigration and
Federal programs which help and provide services for immigrants (both legal
and illegal). A significant portion of this amount is for States. This is a 32%
increase over the prior Administration's budget request for the same programs.
•
The Crime Contr61 Act provides authorization for reimbursement to States for
criminal alien incarceration costs at a level of $1.8 billion over 6 years (1995
2000).
'
•
The Federal government reimburses States for 50 to 79 percent of total
Medicaid costs, including emergency care for illegal aliens.
•
The Federal government helps with the costs of educating illegal immigrant
children through general education programs: Title I program for the
disadvantaged ($7 billion); bilingual education program ($195 million); and the
immigrant education program ($50 million).
•
To respond to th~ need for more reliable data, the Administration asked the
Urban Institute to provide the best estimate to date of costs and revenues of
illegal immigrati?n for education, health and welfare.
B. What We Will Do (FY 1996 Proposal) -.:..
•
$300 million will be available for reimbursement to States for criminal alien'
incarceration costs.
•
$150 million in ;Medicaid reimbursement for emergency medical service to
undocumented immigrants.
,
�•
A 100% increase ($50 million) will be proposed for additional Immigrant
Educational program funding.
C. Budget to Provide State Cost Reimbursement and Assistance
Historical
($ in millions)
1223
1224
1225.
Cost
Reimbursement
and Assistance*
0
0
130
550
Outyears
($ in millions)
l221
1223 to 1226
l226
n/a
.
0
l22B
1222
2QOO
1226 to ZQQQ
TOTAL
Cost
580
580
2,930
580
580
Reimbursement
and Assistance
Includes the State CrImmal Allen Asststance Program (SCAAP), Medicaid DI scretionary
Grants, and Immigration Education (program funding, not reimbursement)
IV. BENEFITS
Basic policy message:
1) Illegal aliens should riot be eligible for public services or' benefits, with
limited exceptions. These limited exceptions include emergency medical
services, children's right to an education, temporary humanitarian disaster
assistance (e.g., earthquakes), and to protect certain public health and safety
interests (e.g~ immunizations).
2) Recognizing that legal immigrants, like citizens, pay taxes and contribute to
society, they may be eligible for a number of public benefits or services. We
will strengthen sponsorship obligations to prevent legal immigrants from
becoming public charges.
A. Wbat We Haye Done -
•
The Administration's Welfare package contained a number of proposals. to
.. reform immigrant benefit. eligibility, particularly as it regards legal immigrants.
(Federal law already prohibits illegal aliens from receiving most federal
(
.
.benefits.)
,
•
The Administration publicly opposed Proposition 187.
�,)
,B. What We Will Do
•
The Administration will introduce legislation to make sponsors sign affidavits
of support that are legally binding.
•
We wil~ support a h.mgthened uniform "deeming" period of at least five years
for Food Stamps, AFDC, SSI, and Medicaid. During the "deeming:' period a
" sponsor's assets are, deemed available to the immigrant for the, purpose of
determining eligibility for benefits. We will work with the Welfare Reform
Task Force to agree on the proper period of time if.over five years (most likely
10 years or until ci~izenship).
•
We will propose making immigration statuses standard and uniform for
eligibility purposes and eliminate the catch-all PRUCOL category.
•. We will propose that States be given the ability to use the same eligibility
criteria for immigrants as used by the Federal go~ernment.
•
We will restrict benefits to illegal aliens in "mixed households" (families with
illegal immigrant members) by determining benefit levels on a pro rata basis
.
that excludes th~ illegal alien members of the household.
•
We will advocate our position as the better poljcy compared to a complete bar
on services or benefits for legal and illegal immigrants and the type of
teacher/doctor reporting requirements contained in Proposition 187.
•
We will strengthen benefits eligibility verification through improvements in the
INS records, the INS benefit eligibility verification system, and other steps
under consideration.
.
,
C. Savings From Reducing the Levels of Benefits to Non-Citizens -'
1996
1997
1998
1999 .
2000
1996 to
2000
TOTAL'
-180
-360
-750
-1,130
--1,420
-3,840
($ in millions)l
Administration
Proposal 2,
Welfar~
-6,800
-21,300
-6,200
Republican Welfare
0
-2,600 -5,700
3
Proposal
EstImates are based on the 1/94 )aseline and the AdmInIstratIon's' proposal dated 6/21/94.
Republican proposal is based on a preliminary CBO estimate using its 1/94 baseline
2 Includes Deeming for AFDC, SSI and Food Stamps programs. PRUCOL programs include
AFDC, SSI and Medicaid
3 CBO pricing ,is for AFDC, SSI, Medicaid, and Food Stamps
�EXECUTIVE OFFICE OF 'THE PRESIDENT
OFFICE OF MANAGEMENT AND BUDGET
WASHINGTON, D.C. 20503
THE DIRECTOR
January 12, 1995
MEMORANDUM FOR THE PRESIDENT
FROM:
Alice M. Rivlin"
Carol Rasco (~,~( {,-- '
c·
FY 1996 Budget for Immigration Initiatives
SUBJECT:
BACKGROUND
Your budget decisions inc~uded $300 million to reimburse for States' medicaid costs. We,
with the Attorney General,now recommend using this money instead to fund a major
, investment in Jordan Commission-style worker verification pilot projects, and a major
investment in detention and deportation activities. The latter would more than double the
number of annual deportations, targeted in the six key states.
The 1996 budget currently contains major INS increases (see attached table):
•
+$381 million (21 percent over 1995) for INS law enforcement, including 700 new
agents and a 25 percent increase in Border Patrol funding;
,
•
+ $170 million to, reimburse States for the cost of incarcerating criminal illegal aliens,
. increasing that assistance from $130 million in 1995 to a total of $300 million; and
•
+$300 million in· a new. program of discretionary appropriations to distribute
supplemental, Medicaid funds to immigration-affected States.
DISCUSSION
In recent days your advisors have debated the merits of a new reimbursement program for
Medicaid costs cOlnpared to an even more aggressive enforcement p~ckage than what is
already planned in the i 996 budget (+$381 million). We present three options:
.
,
,
Option 1:
,
\
,
I
Retain the current 1996 budget proposal for a $300 million Medicaid .
'.
.
discretionary grant program
Modeled after the State Criminal Alien Assistance Program (SCAAP) we proposed last
year, which Congress funded at $130 million, this proposal would help reimburse Stales for
the costs of providing emergency medical services to undocumented, aliens, as required by
�,<
•
<,
the Medicaid program, Currently, the Federal government reimburses from 50 to 79
percent of States' total Medicaid costs. This proposal is similar to the $400 million
program requested by the Administration' in the 1994 budget, which Con'gress rejected.
Pro:
The $300 million Medicaid grant program would allow the Administration to
respond positively to complaints about unfunded mandates and demands for
reimbursement by the Governors of immigration-affected States. ' Governor Wilson
has made this a major theme of his attacks on Washington, and a key element in his
explanation of California's budget gap. Every Democratic leader in the State
supports his position.
•
The General Accounting Office (GAO) has compared the States' Medicaid,
education and incarceration costs to revenues from undocumented immigrants. GAO
estimated that the "net burden" for California is $1.3 billion, of which approximately
$400 million are for Medicaid costs. A $300 million MediCaid grant program would
direct approximately $200 million to California, a 50 ,percent contribution to their
Medicaid bill for undocumented aliens. Together, with the over $200 million from
the State incarceration assistance program in the 1996 budget, California could
receive a tot,il reimbursement of about $400 million, or 30 percent of the $1.3
billion "net burden."
•
In addition to the positive impact on California, OMB staff estimate that this
program could reimburse approximately half of the State share of Medicaid costs for
undocumented aliens for the remaining immigration-affected States.
<
•
Con:
•
The Jordan Commission proposed temporary Federal reimbursements to States.
<
Fiscal relief to States is not the most appropriate use of limited Federal funds. It
would fill gaps in State budgets but would not contribute to specific program goals.
The Federal government may have already fulfilled its "shared responsibility" for the
Medicaid share of immigration costs.
•
This new progra,m, assisting only seven to nine States, has shallow and narrow Hill
support. But if adop~ed, it may be difficult to end.
•
May not appreciably diminish States' complaints. We have received little political
credit for prison reimbursements. States will continue to press (and sue) for more.
2
<
�Option 2:
Provide an additional $300 million in the 1996 budget to support a super
aggressive immigration enforcement program (35 percent over INS' 1995
.budget level) instead of Medicaid reimbursements
A further $300 million 1996 enhancement for immigration' enforcement 'would provide: (a)
about $150 million and over 1,000 additional staff for a National Detention and Removal
Program to more than double ,the number of deportations (from 52,000 in 1995 to more
than 100,000 in 1996); arid (b) about $150 million and 1,700 additional staff to pilot
electronic employment verification systems and expand workplace enforcement programs.
(See attached Department of Justice/INS draft: paper on tentative spending plan.)
Pro:
•
Focuses resources' on our primary responsibility: immigration law enforcement,
which cannot be devolved to the States. The Administration's accomplishments and
leadership on border enforcement are impressive, but we have made only modest
improvements in workplace and removal programs.
•
Without these additional pieces, INS believes that both the magnet effect and the
"culture" of illegal immigration will continue, Proposition 187 in California, was
very much about the presence of illegal immigrants in local communities and. INS'
inability to remove them.
•
Rather than limited fiscal relief, a dramatic improvement in deportation and bold
progress in building towards a "national registry" to screen for illegal workers are
likely to be far more responsive to grass-roots sentiment around illegal immigration.
•
Immigration enforcement has strong Congressional support beyond the border States
because it also touches upon the fundamental principle of National sovereignty.
Can:
•
•
Some members of Congress and Governors of affected States will continue to berate
the Administration for failure to provide adequate reimbursement. In California,
many newspapers and elected officials of both parties will strongly criticize the
President for failing to address a legitimate and compelling need.
INS has already; experienced unprecedented growth under this Administration (+59
percent since 1993). Greatly expanded resources risks management chaos.
Option 3:
Divide the additional $300 million between enforcement and Medicaid
reimbursements
Alternatively, the enforcement enhancement could be scaled back to $100 milliQn for
detention and a near-doubling of deportations, plus $75 million to pilot electronic
3
�· employment verification systems and expand workplace enforcement programs. This would
leave $125 million to reimburse States for the costs of providing emergency medical
services to undocumented aliens, as required by the Medicaid program.
The lower enforcement number will be easier for INS to absorb effectively. Providing a
down payment on Medicaid reimbursement might mollify some State and Congressional
critics, but the would shrink the amount of fiscal relief to little more than symbolic levels.
Under any scenario we will be criticized for doing nothing new concerning the estimated $2
billion in education-related costs.
DECISION
Option 1_ _
Retain $300 million Medicaid discretionary grant program.
Option 2_ _
Provide $300 million for a super-aggressive immigration enforcement
program at INS. Do not fund Medicaid discretionary grant program.
Option 3_ _
Increase INS enforcement by $175 million and
Medicaid discretionary grant program
Attachments
4
re~ain
$125 million for
�Attachment
Department of Justice and Immigration and Naturalization Service
Draft Spending Plan for a Balanced Immigration Enforcement Initiative
,
.
,
.
.
This package focuses on further reducing the incentives that draw' unauthorized aliens
to the United States. It builds upon the Administration's 1994 and 1995 ,immigration
initiatives, as well as the program increases already planned in 1996. This represents a
balanced immigration enforcement effort, the focus of which is identification and ultimate
'
removal of those who are not legitimate immigrants.
Option 2:
Provide an additional $300 million in the 1996 budget to support a super
aggressive immigration enforcement program (35 percent over INS' 1995
budget level) instead of Medicaid reimbursements
INS is requesting $300 million and 1,400 FTEs to expand interior enforcement efforts
'by increasing enforcement of employer sanctions laws,' enhancing its capability' to provide
verification of status, and expanding the capacity to locate and remove those who are in the
United States illegally. The message must be clear: those persons who are illegally residing
in the' United States will, be located arid removed. Furthermore, employers and others who
benefit from these illegal activities will be identified and penalized:
Strengthen Interior Deterrence: $155 million, 850 FTEs
INS will expand employer sanctions activities in the seven states with the largest
illegal immigrant populations. Additionally, INS will increase the investigation and
prosecution of fraudulent document vendors and facilitators, as well as violators who use
fraudulent documents to obtain unauthorized employment. INS and the Social Security
Administration will further expand the Administration's proposed pilot~ which will be
recommended by the Domestic Policy Coilncil by testing the concept of a national
employment verification system.
Detention and Removal: $145 million, 550 FTEs
In FY 1995, INS will remove approximately 53,000 illegal immigrants. With these
resources, INS will have the capacity to more than,double the number: of removals .. Other
efficiencies which will be implemented may result in an even greater number of removals.
INS will increase its detention capacity to reduce the number ofabscondees, provide
resources to facilitate the legal process of removal, and locate and remove those, who have
absconded. This initiative will focus on removal of criminal and administrative cases,
including those identified and located through employer sanctions enforcement efforts, as
well as those who have attempted to seek asylum who lack legitimate ,basis.
Specifically, this proposal provides abscondee removal teams, additional detention
capacity (both Service :and non-Service), administrative deportation of aggravated felons who
are not legal permanent residents, expanded use of the NCIC Program to include warrants of
�deportation, and resources to create an automated decision support system to ()ptimize use of
detention space and the detention transportation system. This will also provide additional
vehicles in support of the transportation network, and. resources to provide immigration·
judges, U.S. Attorneys, and trial atto~neys for the Civil Division.
Option 3:
Divide the additional $300 million in the 1996 budget between an ag:g:ressive
immigration enforcement program (detention/deportation and verification) and
Medicaid reimbursements
.
Provide an additional $175 million and 1,120 FTEs in 1996 for immigration enforcement and
an additional $125 million to help reimburse States for the costs of providing emergency
medical services to undocumented aliens, as required by the Medicaid program.
Strengthen Interior Deterrence: $75 million, 650 FTEs
Same initiative as discussed above but reduced by half in terms of resourc~s.
Detention and Removal: $100 million, 470 FTEs
Under this funding scenario, INS will increase the number of removals In 1996 by
approximately 60%, compared to more than doubling of the number of removals under
Option 2.
.
'''''',.'
,
,
�~--'
ADDITIONAL SPENDING TO SECURE THE BORDER AND MANAGE IMMIGRATION
AND TO ASSIST STAlES WITH COSTS OF ILLEGAL IMMIGRATION
(B':.ldget authority; dollar amounts in millions)
"
1993
. AQWfll
1994
Aciu£L
1995
Enacted
1996
Proposed
Dollar
Change
95 to 96
~
Percent
Change
95 to~§
Dollar
Change
93 to 96
Percent
Change
93~to 9§
Immigration'
Law'Enforcement...
..
----~,
--------.---~~--
--~
INS...........................
1,514
1,650
2,002
2,413
411
21 %
Border Patrol:
Funding ..................
Agents ....................
354
3,991
385
4,282
459
4,928
573
·5,628
114
700
25%
14%
130
300
170
13·1 %
300
n/a
300 .
300
n/a
300
n/a
50
100%
899
219
1,637
59%
.62%
41%
Assistance to States
---------
SCAAP* ...................
Medicaid ...... :............
Immigrant education ...
50
50
50
100
50
100%
·12-Jan-95
01:46 PM
* State Criminal Alien Assistance Program, Department of Justice.
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MEMORANDUM TO.JUDGE MIKVA'" '
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Counsell to the President
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·Christ~Pher Edley, Jr.
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Incar~eration of Aliens Abroad ~- Action
'SUBJECT: '
Needed
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In the Rasco Immigr.ation \Vorki'ng Gr6upmeetlng this.,'morning you nijsed the, ,
question qf mo'virtg illegal Mexican ,imniigrants inGarcenited in't.he Uriited States to Mexican
, ,prisOIi~,~!1(;1 I made the pointihatif this is' to:be pressed seriously', it should 'be readied
part of the,r6110ut of the Pt:esjdenrs irim~i'griltion strategy in ,early ,FebniafY for maximum',
domestic political benefit., The,discussion hazily identified the'two'c'omponents of fashionipg
adiriitiative':, '(1) a ,decision to, negotiate a treaty arhendmeptwiththe~Mexicans, a~d (2), a ,
cOlnplementary set,pfdoil1estjc actions atlec'ring sentencing' statutes,.funcling, and pr6~edur.es,
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Issues 'related t,osovereign~y and to e'lirriiriaiio,~ of the voluntaiiness req'u i red, undel" current' '
laW<- presumably this can b'eh~mdled by statutory changes insentencihg: -- and,,(b),Eighth
Amendment concerns related to tlie conditiorisiq Mexican prisons. I',ve asked Seth Waxm~n' .'
. and Merfic:k Garland to explore"immediately the feasibility' Of getting to dcisurewith
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DeJIi'nger on these. q\lestiohs ill order to meet rh¢, Stephiriopolqus' rollout s<.;hedute, .
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on a treaty .amendment.' According to 'Seth. Waxman, DOl sent a letter .to!the State' " '
, ' Depart,m~,nt over' tne wee~e~d r~conimenJing 'that prisoner policy be'linked to,' the p'eso "
. stabiliiation jnitiqtive, .Seth will :get the letter to' you. '. I assume tlie State Departrhe~lt is' ,
, g~nerally unreceptiv~ to~ linkage, ideas"pr~fe.rring a :'clean"'l:Mhind Httleinfoi:maf baggage'.':
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I thii1k you 'ha,:e 'an assignment: This idea of annoul1:cing in February a mqjor shift.'i)f
criminal aliens back to Mexico is going nowhere until and' unless you win a decision to
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, pursue reneg9tiation of the:'treaty --' whether 01: not tied to the peso plan. If you pursue ,this
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. with the' NSC a,nd .s.tate Department;' please beal' in inind that we also have the related"
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bilate'ri prablen) pf the border 'crossing ·fee, which Traised thismprriing,'Uyou want to
drop ~he matter, let-me and/or Seth 'Waxmq.h know:::Otllerwise; let us know who, on ,your.
staff DPC and. OMB.shouldwork with ,1£1l1laking sure,the pieces cOme toget.her 1'0',: the'
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20503
'JAN 'I 8,'/994
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OFFICE ;OF. MANAGEMENT .AND BUDGET '.
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EXECUTIVE OFFICE . OF THE PRESIDENT'
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�THE WHITE HOUSE
Office of the Press Secreta.ry
For Immediate Release
July .19, 1995
REMARKS BY THE PRESIDENT
IN SATELLITE FEED TO LA RAZA CONVENTION
IN DALLAS, TEXAS
2:16 P.M. EDT
Thank you, ,Irma Flores Gonzalez, for that warm
introduction. And thank, you, ladies and gentlemen, for your warm
welcome.
I'm glad to see so' many of my friends out there, and I
want to say a special hello to your president, Raul Yzaguirre, and
Irma's predecessor, Dr. Audrey Alvarado. The Firs~ Lady sends her
regrets at not being able to be with you today.
I' hope you won't be
too disappointed that I'm going to be her stand-in.
I'm also sorry I
can't be with you in person, as I was last year in Miami.
Just a little over an hour ago, at the National Archives
herein Washington, I announced the. results of our administration's
review of federal affirmative action programs, and my convictions
about what we ought to do with affirmative action.
I made it clear
that an essential part of our search for common ground in the
exercise ,of our freedom is an unwavering commitment to genuine equal
opportunity for all Americans. Affirmative action is simply a tool
in the pursuit of that enduring national interest -- equal
opp'ortunity .
Hispanics are making huge strides in ways we cannot have
even imagined just a generation ago.
I don't want any Hispanic child
. in America to feel that his or her race is an impediment to full
achievement.
Every' child has a right to the American Dream, and all
of us have a responsibility to nourish that dream.
But until this country has achieved equality of
opportunity, until we have stamped out discrimination, we will still
need the remedy of affirmative action.
It must be done the right way
-- it must be flexible; it must be fair; and it must work.
Let me be
clear: our administration is against quotas. We're against
guaranteed results. But we, do need to guarantee genuine equality of
opportunity for all Americans.
(Applause.)
,
We want to support the programs that are working, and we
want to get rid of the ;ones that aren't.
If you ask me in a sentence
what we need to do I'd say we need to mend, but not to end
affirmative action. We ought to stay with our prinCiples and fix
whatever practices we need .to fix.
. Our study showed that, indeed, affirmative action has
been an effective tool in expanding opportunity for those who have
suffered discriminatiori -- in the Aimy, in education, in small
�~
the
mo~t
important thing .
.1 have to keep working on these appointments because
that empowers people who, in turn, send ripples all across the
country. A lot of these judges, for example, will serve for 20 or 30
or more years and will make decisions that will, together, affect
millions and millions of people in positive ways.
But while I am here, your feeling of access and
involvement and participation in this administration is perhaps the
single most important thing that I can give you. So I want to say
again, I would like to invite you to make a proposal about how you
think we should do it, what the right way to.do it is.
I ~ill do my
best to accommodate it and, in any case, we will make sure that
people feel that we are moving thi~ issue forward.
(Applau~e.)
Q
Mr. President, we accept your invitation, and you
will have a proposal on your desk Monday morning.
(Applause. )
We have one last question of extreme urgency and
.
importance to many of the people in this room today that we'd like to
ask. You have spoken out, Mr. President, eloquently against the
forces of hate that led to the Oklahoma City bombing and the need for
greater civility .in public debates.
We could not agree with you more. We live in a time 'of
almost unprecedented immigrant bashing which we, in our co~munity,
view as a manifestation of these forces of hate. All Latinos,
including the majority of us who are native-born citizens, feel we
are targets of this riding tide of hate. You clarified this morning
the need for all of us to come together in a united front.
How do
you plan to include those of us who are immigrants, those of us that
look like immigrants in this plan to unite America? (Applause.)
THE PRESIDENT: Well, first of all, let me say that I
think there is a rising tide of -- it's sort of the same -- I view
the immigration issue rather like the affirmative action issue.
In
the case of affirmative action, I think there were legitimate
questions raised about the way the programs work and whether they
need reform.
There were even some who asked honestly whether
affirmative action was the right or wrong thing for America. And
then there were a whole lot of people that were using affirmative
action to drive a political wedge in this country as a false excuse
for the problems of the American middle class and the economic
anxieties broadly felt by Americans.
I think the immigration issue has sort of flared up'
again, in my judgment, driven by two factors.
One is the general
economic anxiety of Americans and the feeling that we are at an
all-time high in the number of immigrants we let in every 'year, and
that that may be depressing wages and causing economic difficulties.
But I think the far more important problem is the sense
that this country has been very undisciplined in its handling of
illegal immigration in ways that have cost the taxpayers an awful lot
of money and undermined our sense that our laws matter. And so, I
think we need to have the same attitude about immigration, that I have
about affirmative action.
This is a country of immigrants. The fact that we have
so many immigrants in this country and that they come from so many
different places~from so many different racial ethnic and religious
�backgrounds is a mother lode of opportunity for us. The fact that
Hispanics are fast-moving to become our largest minqrity population
is a God-send, given the fact that for the next 20 to 30 to 50 years
our greatest opportunity for growth and trade will be in Mexico,
Central and South America, and in the Caribbean. So I see this as a
positive force.
And I think we have to do several things.
Let me just
some of the things we are trying to do., I think we have to
examine our immigration policies in a factual, calm, nonpolitical way
just as we try to do with affirmative action.
I think we need to do
whatever we can to reduce the burden of illegal immigration without
unduly hurting innocent children.
m~ntion
As you know, I opposed Proposition 187 in California.
I
was unsuccessful, but I did my best -- (applause.) And I did it
because I thought it was unfair to children and counterproductive and
self-defeating. On the other hand, I noticed'that the post-election
polls showed that significant percentages of Hispanic Americans voted
for it -- not a majority, but a significant percentage. And I think
the reason is that a lot of people don't like having people who
deliberately violate our laws spend our tax money.
I think that is a
very -- it is very hard to defend that practice and I don't intend to
defend it.
So I have tried to keep America open as an
immigration-friendly society while toughening our ability to enforce
our own immigration laws and, to deport people who are here illegally,
especially those who come in contact with the criminal justice
system.
I also believe, however, it's very important that legal
immigrants be encouraged to pursue their citizenship and that we do
what we can to accelerate it.
I would like to look at this note here. We naturalized
in 1994 half a million people. That's a 50-percent increa,se over
1992. And we're trying to break that record this year.
T have
directed the INS to get an extra almost $10 million to help to
process people for naturalization. We're trying to get volunteers.
We're doing everything we can in that regard., And I have repeatedly
spoken out against immigrant bashing and negative feelings.
So I think that what we need to do is to have a sensible
approach to immigration. It needs to be open.
It needs to be
�nondogmatic and nonbigoted. We need to be firm· but reasonable in the
way we deal with the problem of illegal immigration. And we need to
try to get as many of our immigrants who want to do so to become
citizens as quickly as possible so that the American people will all
see that this is a part of the process of .American history which is a
good one for our country.
(Applause.)
Q
Mr. President, we thank you very much. And you'll
have our proposal on Monday. And we're hereto help you with advice
if you need us.
Thank you very much.
THE PRESIDENT:
I always need it.
I. thank you.
For 'the
members of the Hispanic community who gave me advice and h~d input on
the affirmative action speech, let me thank you especially.
This was
a very important day for America.
I hope that what I said and the
way it was said will reach the hearts and minds of the vas~ majority
of .the American people. . I believed it very deeply. And I thank all
of you who have had any input on that directly or indirectly.
Thank you very much.
(Applause.)
END
2:48 P.M. EDT
�
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Carol Rasco - Issues Series
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Domestic Policy Council
Carol Rasco
Issues Series
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Clinton Presidential Records: White House Staff and Office Files
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92 folders in 7 boxes
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Immigration
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Carol Rasco
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Box 125
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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12/4/2013
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2010-0198-Sb-immigration
-
https://clinton.presidentiallibraries.us/files/original/cb16fed64249105377388f5dfc378fe5.pdf
c479bfa2e4fc0aa7ba8dc408fff5b5fa
PDF Text
Text
NATIONAL' GOVERNORS' ASSOCIATION
Working Paper
PROPOSAL TO ESTABLISH STATE FLEXIBILITY IN THE
EMPLOYEE RETIREMENT INCOME SECURITY ACT
Background
In the late 1980s, states began to look seriously at refonning their health care systems.
Their Mediciud budgets were growing at intolerably high rates, more and more of their citizens
had no health care coverage or insufficient cOverage to pay for care, Congress was establishing
new Medicaid eligibility and service mandates with only partial funding, and national health care
'~
reform was only a distant1possibility.
In response to these conditions, a number of states began to experiment with modifications
to their health care systems. Some attempted incremental refoIm such as improvements in the
small business market while others attempted comprehensive health care refoIm for their states.
The more comprehensive approaches included universal insurance coverage, unifonnity in the
insurance market, unifonnity in benefits, and a stable and lUlifOIm financing system to pay for the
reform efforts. Soon,' however, states realized that c:wen if the legislature passed the legislation
and the Governor Signed the law, their efforts were thwarted by federal law:
The Employee Retirement,Income Security Act (ERISA) was enacted in 1974 and applies
, to employee benefits plans, including employee health plans. ERISA provides for a complete
federal preemption of state laws that "relate to" employee health plans. State:S do retain the
ability to regulate some employee health plans indirectly, through an exception to ERISA that
Jtermits states to regulate insurance carriers. (such as indemnity plans and health maintenance
organizations). However, states are powerless to regulate or otherwise .affect employee health
plans that "self-insure" rather than buy insurance.
.
\
Self-insurance was very rare when ERISA was enacted, but DOW covers almost half of the
employees in the U.S. who receive health benefits. This proliferation of self-insurance, coupled
with the federal courts' broad interpretation of ERISA preemption, has made ERISA an
insurmountable barrier to states wishing to implement health care reform.
,
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In 1991 and again in 1993 and 1994, the National Governors' Association adopted policy
that calls for reform of ERISA so that states can design and implement health reforms that will
improve access to quality and affordable care. These policies call for comprehensive national
health care reform bu{recognize that the ERISA statutes are an impediment to states thal have a
need to act now. States are limited in their ability to bring health care costs under control without~
modifications 10 ERISA
It must be noted however, that in calling for ERISA flexibility in 1994, the Governors
indicated,their extreme sensitivity to the concerns.of large multi-state employers who feared the
prospect of 50 different plans. That sensitivity remains, and they'look for solutions that balance
the needs of both the state and the.business community.
.,
NGA 7/26/94
�Areas ofERISA Relief
The range of interests among states in seeking relief from ERISA is quite broad. For the
sake of completeness, the following is an inventory of areas where states woUld like flexibility in
the ERISA statute. It is pr~ted to demonstrate the breadth of the problem that states now face.
This list does not indicate that any individual governor wishes to pUISue any or all of these
options.
Financing
• Permit states to establish a mandate that employers offer ~urance with a defmed
minimmn benefits package and pay a portion of that coverage.
• Permit states to impose a tax on !mY employers not offering a health plan that meets
conditions such as specific standards or benefits and contribution levels.
• Permit states to impose apayroll tax on all employers to fund universal health ~care
coverage.
• Permit states to tax all employee health plan contributions to· fund a universal health
coverage system, to subsidize care for the poor, or share the risk of uninsurable
individuals,
• Permit states to tax health care prov~ders to finance care, even if some tax burden
explicitly or implicitly falls to self-funded plans.
Cost Control
• Permit states to set provider rates and have those rates apply to all health plans
including thOse that are self-funded. .. This option includes setting uniform rates, or
having rates vary by payer category.
• Permit states to require all health plans, including self-funded plans, to participate in
overall spending limits.
\
Insurance Reform
• Permit states to limit preexisting conditions exclusions, or impose other appropriate
insurance market reform on ~th insured arid self-funded plans and to create
reinsurance pools to share risk of high cost cases that might raise costs to insured
'i,t
employee health plans.'.
•. Pennit states to define what coverage is true "stop-loss" coverage, and permit states to
regulate "stop-loss" carriers even if it imposes indirect effects on self. funded plans.
• Permit states to require insurers covering self-funded plans, including HMO's, to·~
comply with open enrollment and community ratings, including riSk adjustment.
mechanisms, and assessments to expand or improve the availability or affordability of
coverage.
Administration
• Permit states to require self-fWlded plans to report use, cost, and quality information in
the same manner as required of insured plans..
NGA 7/26/94
2
�• Permit states to require self-funded plans to use uniform claims procedures in the same
manner as required of insured plans.
• Permit states to require self-funded plans to participate in purchasing pools in the same '
.
.
manner as required of insuredPians.
• Permit states to require that. self-funded plans meet quality review organization
standards for fair review.
• Permit states to require that self-funded managed care plans use alternative dispute
resolution, for malpractice disputes.
• Permit states to require self-funded plans that purchase care from managed care
organizations to do so on the same basis as insured plans (e.g. adjust payments for risk,
use a defined grievance procedure).
Strategy'!
A multi-dimensional approach to reform could be taken that includes flexIOility for states
.1. directly in the ERISA statute, and
2., through new waiver authority.
Statutory FlexibiUty
. Congress may act quickly to help states by including flexibility directly in statute. This
may be accomplished through. statutory directives to the federal executive branch regarding
national uniformity. Specifically, states would be permitted to impose requirements on self
funded plans if the state was willing to adopt existing and accepted national ~dards.. The
federal executive branch would be instructed to work: with states to identify and define those
standards.
(j
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This approach' has the potential for broad applicability but is most relevant to,
administrative simplifications and insurance reform. For example, states and the business
community generally agree on the need for uniform' claims and data reporting procedures. In ,.
order to encourage uniformity in health plan administrative requirements, the Secretary of Labor,
in consultation with the Secretary of Health and Human Services and states, could be directed to
compile, publish, and publicize existing national standards for claims processing formats and
procedures for data reporting. If a state. selected one of the existing standards, it would bi
permitted to implement that standard in the state and include self-funded plans. This type of
directive could also be extended to quality and utilization review, and possibly stop-loss
standards.
To facilitate the process, the legislation should be structured to rely on existing nationaL
standards. Where none exist, the legislation could direct the executive branch to develop them.
However, if the executive branch found it necessary to develop a national standard, states could
be given limited flexibility during the development period so that they could move ahead with
their innovation..
Waiver Authority
In addition to direct statutory flexibility, Congress should establish direct waiver authority
in ERISA· Waiver authority would be most applicable for states that wish to develop alternative
NGA 7/26/94
3
�·.
fmancing and cost control strategies that are now precluded by the statute. Waiver authority
could have the following parameters: .
.
• ' The Secretary of the Department of Labor would have authority to review and grant
ERISA waivers.
,
,
• There would be no prohibition against replicating other state ERISA waivers.
However, each state would have to submit a waiver application.
• Waivers would be approved Jor an initial five year period with five year renewals
thereafter.
• Waiver applications would be submitted by the Governor.
• As a condition for waiver approval, the state must demonstrate that the strategy has the
support of the state's legislature.
A
•
For states making requests for exemptions in the areas of fmancing or cost control, the
state's waiver application must include:
• a plan for expap.ding coverage, and
• a strategy for documenting the state's progress toward achieving that goal.
NGA 7/26/94
4
�No. 656
I
BRI
ERISA and State Flexibility:
Exploring the Options
from a State Perspective
Tuesday, October 18, 1994
8:30 to 9:00 am - Continental Breakfast
9:00 am to noon - Discussion
Quality Hotel Capitol Hill
415 New Jersey Avenue, NW
Federal Ballroom North
A discussion featuring
Patricia A. Butler, J.D.
Attorney and Health Policy
Consultant
"taoulder, Colorado
William J. Hagens
Senior Policy Analyst
Mary Jo O'Brien
Commissioner
,,.
Minnesota. Department of Health
James R. Tallon, Jr.
President
United Hospital Fund of New York
Health Care Committee
Washington State House of
Representatives
with comments from
L. Carl Volpe, Ph.D.
.
.Director for Health Legislation
National Governors' Association
Joy JohnSon Wilson
. Director, Health Commitiee
National Conference of State .
Legislatures
Registration: Please call Dagny Canard at202j872-1392 as soon as {X)SSible.
-;,NATIONAL
HEALTH
POLICY
F
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�2
ERISA and State Flexibility:
Exploring the Options
from a State Perspective
The disintegration of the recent campaign for
comprehensive health reform at the federal level has
left many states in the familiar position of seeking
permission from Congress to engineer changes them
selves. Virtually all state initiatives to finance care for
the uninsured and many designed to contain costs face
barriers posed by the federal Employee Retirement
Income Security Act of 1974 (ERISA). Before Bill
Clinton won the presidency and placed health care
reform at the .top of his domestic policy agenda,
several states had been demanding waivers from
ERISA in order to impk~ment a variety of reforms.
The prospect of sweeping changes at the federal level,
however, led many state officials to put demands for
greater state flexibility on hold, while hoping that
federal reformers might lay a foundation upon which
they could build.
The collapse of the drive for major health reform in
the current session of Congress no doubt will have a
variety of impacts on reform efforts at the state level.
Having witnessed the political fallout generated by
federal reform efforts, some state legislators might well
be more cautious. In some states, the political will to
advocate bhange seems to have ebbed. State officials in
Vermont have backed off from a plan to implement
universal health insurance coverage. Yet other states,
such as Washington and Minnesota, remain committed
to comprehensive reforms that raise ml'jor ERISA
issues. Meanwhile, a host of ERISA:'-related cases have
made their way through the courts, with some decisions
coming down against state flexibility and others tilting
toward greater state latitude.
'
Many corporations and unions have, adamantly
opposed state efforts to win ERISA exemptions or
waivers from Congress on the grounds that having to
comply with a checkerboard of disparate state em
ployee benefit 'regulations would be onerous. As evi- .
denced in many of the court challenges listed later,
there is heated opposition to state 'efforts to subsidize
care for the uninsured and indigent by taxing em
ployee benefit plans, either directly or indirectly.
This Forum session will re-examine the problems
that ERISA poses for state health policymakers in
light of both recent court decisions and events in the
nation's capital. Requests for ERISA exemptions and
states' policy options with,or without such exemptions
also will be discussed.
PERILOUS FOOTING
In a recent analysis prepared for the National
Governors' Association, Patricia Butler,J.D., identi
fied some state reform strategies that are clearly
prohibited under ERISA as well as several whose
status is unclear, given recent case law (see Road
block to Reform: ERISA Implications for State Health
Care Initiatives), For example. an employer mandate,
such as the one Washington state is scheduled to
begin iInplementing next July, is clearly prohibited, as
are taxes on' health plans per se. It is unclear whether
financing strategies such as employer pay-or-play
proposals, universal health systems based on income
taxes or taxes on employers, and taxes on health
providers would be permissible under ERISA if
challenged in ,court, according to Butler. In the area of
cost containment, it is clearly off limits for states to
impose a global budget on self-insured plans. Given
conflicting. decisions in recent cases, it is unclear
whether state rate-setting programs might withstand
ERISA challenges and in what form.
ORIGIN AND IMPACT OF ERISA,
A brief review of ERISA's content and history is
helpful in understanding its effects on health policy.
The .primary reason for the paSsage of ERISA was to
ISSUE BRIEF/No. 656 .
Writer/Researcher:
Karl Polzer
National· Health Policy Forum
2021 K Street, NW, Suite 800
Washington, DC 20052
202/872-1390 'Pax 202/785-0114
Judith Miller Jones, Director
Karen R. Matherlee, Co-Director
Michele Black, Associate Director/Editor
NHPF is a nonpartisan education and informa
tion exchange for federal health policymakers.
�3
insure the solvency and equity of the nation's private
(HMOs>-:-were in self-insured arrangements, while 42
percent were covered by an insurer operating under
pension plans (see NHPF Issue Brief No. 609, "The
state regulation, according to Health Insurance Associ
Role of Federal Standards in Health Systems Reform:
ation of America' (IllAA)data. Assuming that all
How Much Leash Should ERISA Give the States?").
HMOs were fully insured, the HIAA estimated that 40
In drafting the law, Congress included fiduciary and
disclosure standards governing employee· welfare, . · percent of all employees in employer-sponsored health
benefit plans, including health plans, but intentionally
plans were in self-insured arrangements in 1991,
did not adopt the kind of substantive requirements
down from 45 percent in 1990 (with the decline of
that it applied to pension plans, because at the time
those in self-insured plans reflecting the growth of
HMO enrollment),
there appeared to be little or no need to do so. (Also,
many policy makers thought national health insurance
Health plan sponsors face many incentives to avoid
would .soon, be passed.) Thus, ERISA pre~cribes
state regulatioJ;1. These may include mandated benefit
minimum participation, vesting, and funding standards
requirements, premium taxes, contributions to 'risk
'~ for private-sector pension plans offered by employers \;
pools, payments to guarantee funds, requirements to
or employee organizations but does not apply these
participate in community-rated insurance pools, and
standards to health plans. ERISA does not establish a
standards governing reserves and contributions.
minimum standard for benefits offered under a health
plan, just as it does not set a. minimum level of
Intentionally or otherwise, ERISA's preemption
benefits for private pension plans. ERISA does
clause has facilitated a substantial erosion of the sphere
establish a grievance procedure and remedies for
· of state. health insurance regulation,a process that
fiduciary breaches and wrongfully denied claims, but·
increasingly smaller companies seek to
continues
some would argue that court interpretations of these
self-insure with the creative use of stop-loss insurance.
safeguards have left 'employees and their families
The shrinking number of workers in fully insured health
without adequate protection.
plans poses a problem for states seeking to finance
coverage of the uninsured; in recent years, some states
In the health care ,arena, ERISA's greatest impact
have taxed insurers to help finance limited programs to
results not from what it requires, but rather from what
cover the uninsured, such as insurance pools for high
it prevents the states from doing. The McCarran
risk individuals. States also have mandated systems
Ferguson Act, passed in 1945, .established the regula
under which some health plans subsidize others through
tion of insurance as an area of exclusive state jurisdic
price differentials, community rates, risk adjustments, or
tion. In its preemption clause, ERISA, in tum, "super
"reinsurance" pools. Some states have levied taxes on
sedes" all state laws relating to employee benefit\
providers to fund uncompensated Care rather than
plans, .thereby. placing the regulation of such plans
concentrating the.burden on the narroWing base of fully
under exclusive federal jurisdiction. ERISA stipulates,
insured plans. All such taxes and subsidy, mechanisms
however, that states can continue to regulate insur
have been challenged or are open to challenge under
.ance. Therefore, states indirectly can regulate fully'
. ERISA because they
~.tinsured employee benefit plans by, regulating the,.
. ultimately affect the Costs of health
>l,.
plans.
.
. insurers from which employers or unions purchase
insurance, but they cannot regulate self-insured· plans.
If ERISA constrains states from financing modest .
The net effect is that-without there having been
attempts to cover the uninsured and from having some
serious congressional consideration of the possibil
plans subsidize others, it certainly presents a barrier to
ity-ERISA has ended up providing' a mechanism
more sweeping health systems reform proposals. Some
through which health plan. sponsors can unilaterally
benefit experts argue that it is within the power of .
escape state insurance regulation by deciding to.self
state legislators to finance universal health insurance
insur¢. ERISA also stipulates thai neither an employee
programs through. income or corporate taxes without
benefit plan nor any trust established under such a
· running afoul of ERISA, but that state lawmakers
plan shall be deemed to be engaged in the business of
simply lack the political fortitude. to do so; state
insurance for the purpose ,of any· state insurance Jaws.
govemmerits would run the risk, of taxpayers' viewing
as
When ERISA was passed, only a small fraction of
health plans were self-insured, but the situation has
changed dramatically. In 1991, 58 percentof Ameri
can workers in traditional insurance plans:.-plans
other than health maintenance· organizations
such visible new taxes as an unnecessary burden
heaped on . a' health care system. that already is too
expensive. Other legal experts argue that even broad
· based taxes, such as· income and corporate. taXes, .
would violate ERISA if they werepart of a reform
�4
that had a significant impact on employ~ benefit
plans. For example, under some reform plans 'a broad
based tax is used to finance an insurance system that
would displace private health plans. An argument can .
be made that a state refonn package making private
plans go away or providing a strong incentive that
would lead to their disappearance would have an
"impact" on plans, thereby violating ERISA.
.
In a general sense, ERISA has its origins in common
law pertaining to trusts and fiduciaries. Under this area
of law, a person responsible for assets held intrustfor
someone else has a duty to handle and invest them
prudently and· solely for the benefit of the person for
whom the assets are being held. Both ERISA and the
Internal Revenue Code cOntain an exclusive benefit rule
requiring that plan assets be used exclusively to provide
benefits and pay administrative expenses for the partici
pants and beneficiaries in the plan. Even assuming the
ERISA preemption issue were overcome, unless ERISA
were. amended in other respects, it is open to question
whether any legislation requiring pooling among plans
would violate the exclusive benefit rule.' As health care
costs continue to rise faster than genenil inflation,
sponsors of health plans with average or below-average
costs will arguably be more. likely to use the ERISA
preemption argument to resist state government efforts
to have them subsidize plans covering disproportionate
numbers of sick people requiring relatively higher
medical expenditures and to help finance care for the .
uninsured.
RECENT CASES
While some state actions are clearly illegal, recent
court decisions concerning hospital rate-setting laws
(some involvinglong-stan~g practices only recently
challenged) provide an example of the uncertainty that
states face in navigating ERISA waters, according to
Butler. Two federal appeals courts'--()ne covering New
Jersey and the other New York-have come to con
flicting conclusions about whether hospital rate-setting
laws violate ERISA. In addition, a lower federal court
has invalidated Connecticut's hospital rate~setting law.
In 1993 the federal court of appeals forNew Jersey
upheld the state's hospital rate:"setting law, which had
been invalidated by a lower court. In 1992, a federal
district court had barred New Jersey from enfordng
state. hospital rate-setting. regulations that required
,
'
.
'
, The federal court of appeals for New Jersey recently ruled
that a state hospital rate-setting system that pools costs does
not violate ERISA's exclusive benefit rule.
self-insured plans to pay charges exceeding a hospi
tal's actual cost of care. In a suit brought against the
state and 70 hospitals by 14 self-insured" jointly
administered union health and welfare funds, the
lower court had· held that ERISA preempted state
regulations allowing hospitals to include in their
charges costs they incurred to cover the uninsured, to
'subsidize the Medicare program, and to give discounts
to other types of benefit plans. Notwithstanding the
appeals court's upholding of the rate-setting law, the
New Jersey legislature abolished the state's long
standing system of regUlating hospital rates and now
allows hospitals to set their own rates.
~
In 1993 another federal appellate court. invalidated
New York's hospital rate-setting law. In the original
ERISA-related lawsuit filed in the U.S. District Court of
Manhattan, theFiIAA andTravelers Corporation argued
that New York State could not require employee benefit
plans (fully insured and self-insured) and non-Medicaid .
HMOs to pay surcharges on inpatient hospit3I bills. At
issue were a ,13 percent price differential given to Blue
Cross, an 11 percent surcharge on commercial insurers
that goes into the state general revenue fund, and a 9
percent surcharge for patients covered by HMOs that
also goes into the state general revenue fund. The state
has petitioned the U.S. Supreme Court to hear an
appeal, but 'the Court has yet to decide 'whether to
accept the case.
For all intents and purposes, the impact of the New
York appeals court's invalidation of the state's rate-.
setting law was postponed for two years by an amend
ment to the federal tax code in the 1993 budget act that
would deny New York employers a tax deduction for
the cost of providing group health benefits if they fail to
participate in the rate-s~tting program, The Connecticut
General Life Insurance- Company and Equicor, Inc"
have filed a legal challeqge to what they referred to as
the "Moynihan Amendm'ent." They argue, among other
things, that the tax code revision encourages behavior.
violating fiduciary duties required under ERISA and
that it is' unconstitutional because it applies. oniy to
employers based in and near New York State (that is, it
does not apply uniformly throughout the country),
In Connecticut, a federal district court in March 1994 '
ruled that the state's uncompensated care pool was
preempted by ERISA. The pool was used to help
finance hospitals serving a disproportionate share of
government-financed, low-income, and uninsured
patients, In response to the court decision, the Connecti
cut General Assembly passed a law terminating the
uncompensated care pool and replacing it with a general
�5
fund appropriation for uncompensated care. The legisla
tion maintains the state's sales tax on patient care
services provided by hospitals and establishes a new tax
on hospital gross earnings; revenues from both taxe~ go
into the general fund. Consequently. the Connecticut
Hospital Association (CHA) has gone to court to
challenge what state officials characterize as a broad
based tax to finance uncompensated hospital care; the
CHA is arguing that sections of the new law are pre
empted by ERISA. (Generally speaking, the more
broad-based a tax, the more likely it will withstand an
ERISA challenge.) From the state's perspective. a key
... question is how to structnre provider taxes as pennitted
under the Provider Specific Tax Amendments passed by
Congress in 1991, while not violating ERISA,. according
to Donald Pogue, Connectic:ut commissioner of hospi
tals and health care;
In. 1994, Minnesota's tax on hospital and physician
revenues was upheld by a lower court after a self
insured union plan had sued on the grounds that the cost
of the tax was passed along to health plans, thereby
violating ERISA.
Meanwhile, a lower court in New York has invali
dated a state risk-pooling arrangement that required'
insurance carriers and HMOs to share the burden of
higher-cost enrollees. The court held that, because
HMOs are governed by separate New York licensure
laws, they are not "insurers" and the state cannot
regulate them under ERISA's insurance exemption to the
law's preemption clause. In. an ironic twist, "any willing
provider" laws have been upheld against ERIS",?- .chal
ienges on the grounds that such la~s are a legt.tlmate
exercise of state insurance regulation" according to
Butler. It is regrettable, some analysts argue, that the
,i. legal foundation of much of the nation's heal~ policy~s
being haphazardly developed by the courts, mstead of
being consciously designed by the legislative and
administrative branches of government.
appellate court ruled that the law violated ERISA; in
1981, the Supreme Court upheld the appellate court's
decision, forcing the issue back to Congress, which
then granted the limited exemption. In recent years,
Hawaii has been seeking to broaden its ERISA exemp
tion in order to engineer further reforms.
. With several states pushing for ERISA waivers, in
1992 a General Accounting Office report outlined a
possible compromise whereby states migh.t be granted
more flexibility to implement reforms If they met
certain conditions, including minimum standards
governing benefit packages, extent of coverag~, and
terms under which waivers might be revoked Several
legislative proposals to give states limited exemptions
from ERISA failed to pass in 1992. Although many
reform advocates sympathized with states' demands, the
prospect of the major federal health ~form, given a
Clinton victory in the fall, solidified the hesitancy to
grant more latitude until the issue was decided at the
federal level.
. '
.THE FORUM SESSION
'At this Forum' session, independent health policy
analyst' Patricia Butler will provide a legal analysis of
ERISA, discuss its impact on state health policy, and
provide a summary of recent ERISA cases. James
Tallon, Jr., former majority leader of the New York
State Assembly. will analyze the significance of ERISA
related issues and describe their impact on New York
State. Mary Jo O'Brien, commissioner, Minnesota
Department of Health, and William Hagens, senior
policy analyst for Washington State's House of Repre
sentatives Health Care COmmittee, will discuss the
barriers that ERISA pOses for their states' ~form
packages as well as how issues were addressea wi~
employers and unions when the states crafted then
reforms. Carl Volpe, of the NGA, and Joy Wilson, of
the National Conference of State Legislatures, will
coIriment on concerns of their respective constituencies.
STATE ERISA EXEMPTIONS
SO far, Congress has granted only one exemption to
ERISA. In 1983, it gave Hawaii a limited exemption
allowing the state to continue requiring employers t?
offer health insurance. A reform proposal that PresI
dent Richard Nixon had made to Congress in 1974
was the model for the employer mandate enacted by
Hawaii that same year. While the plan passed at the
state level interest in federal health reform ebbed in
the nation:s capital. In 1976, the Standard Oil Com
pany challenged Hawaii's employer mandate. An .
Issue Questions
Among the questions to be· addresse<:i are the
following:
• Assuming the ab~ence of major federal reforms, what
problems does ERISA pose for states? What kinds of
waivers or exemptions from ERISA would be needed
to allow states to engineer major health reforms?
• If Congress again declines to. grant additional
ERISA exemptions, what will be the options open
�'1
6
to states that have passed reform legislation? What
might .be the outcome in terms of access to health
care, the number of uninsured. and the growth of
health care costs?
• If states' ability to subsidize the uninsured and
indigent is blocked (or perhaps even cut back by
the courts), what would be the impact on provid
ers? Would some states be pressured enough to
consider broad-based taxes to cover the medically
indigent?
• In light of business and union concerns that too
much state-to-state variation in health plan regulation
is undesirable, what conditions might the federal
government require in granting ERISA waivers to·
ensure an adequate degree of uniformity?
• Given the growth of enrollment in HMOs and
variation in managed care contracting practices
from market to market. how much uniformity
really exists within health plans offered by self
insured employers operating across several states?
• To what degree should employee benefit policy be
made by the courts as opposed to the legislative
and executive branches of government?
Speakers and Discussants
Patricia A. Butler, J.D., is a self-employed health
policy analyst in Boulder, Colorado. For more than 10
years she has worked on issues of he'tlth care financ
ing and delivery with state legislative and executive
branch officials as wen as with associations represent
ing state governments. In 1983 in Colorado, she direct
ed one of the first statewide studies of the medically
indigent. She is currently ,Cl.Pew health policy fellow at
the University of Michiga1h School of Public Health.
where she has completed course work toward a doctor
ate in health policy and has begun research· for her
dissertation. Among her many publications is Road
block to Reform: ERISA Implications for State Health
Care Initiatives, published by the ~GA in 1994,
Since September 1993, Mary Jo O'Brien has
headed the Minnesota Department of Health, which is
responsible for developing· state health care policy as
well as preventing and controlling disease, promoting
healthier behavior choices, controlling environmental
health hazards, protecting the health of mothers and
children, and regulating health care providers. She also
recently was part of an NGA team advising President
Clinton's Health Care Task Force. From 1991 to 1993,
she served as Minnesota's deputy commissioner of
health, assuming primary responsibility for the devel
opment and implementation of the state's health care
reform initiatives, following the passage of Minnesota
Care in 1992. She has worked closely with the Minne
sota Health Care Commission to develop a health care
cost containment plan for the state.
'
James R. Tallon, Jr.,. is president of the United
Hospital Fund of New York, thenation's oldest
federated charity, which addresses critical issues
affecting hospitals and health care in New York City.
Previously, Mr. Tallon was the majority leader of the
New York State Assembly~ where he served for 19
years beginning in 1975. As majority leader from
1987 to 1993 and as chair of the Assembly Health
Committee from 1979 to 1987. he was a leader in
efforts to increase acCess to quality health care and
address health care financing issues. A national leader
in health care policy development. Mr. Tallon is chair
of the Kaiser Commission on the Future of Medicaid
and is widely recognized for his work on. issues
affecting the poor and disadvantaged.
William J. Hagens has been staffing the Washing
ton State House of Representatives for 20 years.
Presently. he is the senior policy analyst for the
Health Care Committee. In that capacity. he has been
the lead House staff member for numerous health care
matters, including AIDS. rural health care. prenatal
care, trauma care systems. mental health services, and
public health system reform. For .the past five years,
he has been working on comprehensive health care
acceSs and cost control reform, which culminated in
the passageof the Washington I:Iealth Services Act of
1993. He also teaches health policy and politics at the
University .of Washington's School· of Public Health
and Community Me~.!=ine.
L. Carl Volpe, Ph.D., is director for health legisla
tion at the National Governors' Association (NGA).
He has, lead responsibility for working with state
governors and their staffs in the development and
implementation of health care policy. He also has
responsibility for advocating governors' policies to
Congress and the administration. Dr. Volpe recently
served as .a consultant to President Clinton's Health
Care Task Force and served as a member of the
National Task Force on Medicaid and Managed.Care.
Before joining the NGA, he worked at the Texas
Department of Human Services.
I
" Joy Johnson Wilson is director of the Health
. Committee of the National Conference of State
Legislatures (NCSL). NCSL represents the legislative
.•
�~.
7
\
bodies of the nation's 50 states, its commonwealths
and territories, and the District of Columbia. The
NCSL Health Committee guides the development of
conference policy on all health care issues and designs
and implements lobbying strategy on these issues. Ms.
Wilson has been with NCSL since 1978, taking a
leave of absence in 1989 to serve on the staff of the
U.S. Bipartisan Commission on Comprehensive
Health Care, better known as the Pepper Commission.
\
�'.
,
.
,.'
�THE CRITICAL ROLE
'OF ERISA
~ INSTATE
HEALTH REFORM
Abstract: Despite p
Health Security ACI
of state legislation t
by the U.S. Suprerr
otherwise preempts
. lower courts to find,
(PPOS), and medic
Several isSues with
ofERISA preemptir
by Mary Ann Chirba..Martin and Troyen A. Brennan
Prologue: During the 1993 sessions ofstate legislatures, tlirtu..
\
ally every state considered proposals that, ifapproved, would
have changed the way mediad care is financed and delivered in
their jurisdictions. Of the states that have acted,.both in 1993
and in pretlious legislative sessions, eight states (Florida, Ha~ ,
waii, Maryland, Massachusetts, Minnesota, Oregon, Ver...
mont, and WaShington) have enacted Laws with the ultimate ob,
jective of ensuring access to medical care for all of their citizens.
With the exception of Hawaii, none of the states that have en...
acted uni~ersal coverage Laws have fully implemented them. As
authors Mary Ann Chirba.. Martin and Troyen Brennan dis,
cuss here,' states have been prevented from implementing health
care {iiaancing reform measures because of federal preemption
by the Employee Retirement Incorru: Security Act o£ 1974
(ERISA)., While the Clinton administration's Health Security'
Act, by its very nature, underscores the need to reform ERISA
to grant states greater flexibility, it fails to address each of the
preeemption problems raised by the federal Law . Chirba~
Martin, a Lawyer, lectures at Boston College's Law School. She
is also seeking a master's degree in public health at the Harvard
. School of Public Health. Her particular research interests re,
valve around health law and product liability,. Brennan is a pro'
fessor of law and public health and an associate professor of
medicine, both at Harvard. He holds degrees in law, medicine,
, and p;Wlichealth from Yale University and a master's degree in
political economy from Oxford University. His research inter'
ests focus on the legal aspects of health care reform, quality im'
provement, and medical ethics.
W
hil~
pen
rela
increasingly tt
ing measures '
Income Seeur
to preserve ar
oversight of J
simply cannol
relate to heall
ERISA's pi
the U.S. SUP!
sions. In effe·
Court's decis
, ameliorate d
bate regardin
real and virtt
. only exceptio
ERISA curb
overlook pel
manner in w
by states.
The Hea"
nature of ET
5ively addre
paper we n
financing a
appears tha'
further refo
'tration the
bcete
'
�ERISA AND STATE REFORM
143
Abstract: Despite prominent roles for employers and state regulation in the Clinton administration's
Health Security Act, relatively little attention has been accorded to the impact offederal preemption
of state legislation through the Employee Retirement Income Security Act (ERISA). As interpreted
by the U.S. Supreme Court, ERISA permits state regulation of insured employee health plans but .
otherwise preempts analogous regulation relating to self-insured benefit plans. This has prompted
lower ~urts to find that h~ital rate-setting legislation, regulation ofpreferred provider organizations
(PPOs), and medical malpractice suits for utilization review decisions are preempted by ERISA.
Several issues with majorimplications for health reform remain unresolved, such as the availability
ofERlSA preemption to self-insured health alliances and health maintenance organizations (HMOs) .
.
hile eagerly awaiting federal health care reform, states have ex,
perimented with various reform measures to addresS the inter·
. related problems' of health care cost and access. Yet states are
increasingly thwarted in implementing more generalized health care financ,
ing measures because of federal preemption by the Employee Retirement
Income Security Act of 1974 (ERISA).! The Health Security Act promises
to preserve and, indeed, encourage state-flexibility. It also envisions state
oversight of health alliances to implement managed competition.. This
simply cannot be accomplished, however, unless the aspects of ERISA that .
relate to health care are thoroughly rewritten.
ERISA's prominence in health care has grown over the 'past few years, as
the U.S. Supreme Court has broadly construed ERISA's preemption provi,
sions. In effect, federal district and circui,t courts, follOWing the Supreme
Court's decisions, have prohibited almost any state legislation designed to
. ameliorate the .current 'health care crisis. Remarkably, in the ongoing de·
bate regarding health care reform, little attention has been paid to this very
"real and vytually insurmountable, federally imposed barriet to change. The
• only exceptions to this silence have been several recent papers discussing
ERISA curbs on state-mandated benefits. 2 Yet these papers completely
overlook perhaps the most important aspect of ERISA preemption: the
manner in which it blocks any sort of structural reform of health insurance
by states.
The Health Security Act demonstrates a recognition of the critical
nature of ERISA reform, but, as currently stated, it does not comprehen
sively address each of the preemption problems raised by ERISA. -In this
paper we review ERISA preemption as it pertains tq state health care
financing arid delivery refonTI efforts, summarize the manner in which it
appears that the Health Security Act will change matters, and suggest some
funher refonns that may be necessary. We agree with the Clinton admini
Stration that state experimentation is integraL to any solution to the multi
faceted and deeply complicated health care crisis. Achieving this laudable
g?al is not possible, however, unless the ramifications of ERISA preemp
tion an~ C::1rf'flll1v ::lcldressed.
.'
.
W
.
'"
:!
�144
HEALTH AFFAIRS I Spring (II) 1994
ERISA Preemption Of State Law
ERISA was enacted by ,Congress, in an effort to protect participants in
employee pension and benefit plans and their beneficiaries from abuses by ;
those who invest and manage such plans. As defined by the statute, these "
include benefit plans that "through the purchase of insurance or otherwise" , '
provide medical, surgical" or hospital care, or benefits 'in the event of
siCkness, accident, disability, or death.
As set forth in Section 1001 Ca) of the statute, Congress perceived ERISA
as a form of redress for specific kinds of problems, which it thought could
best be remedied through uniform federal standards. Congress was particu
larly cognizant of the need for "equitable standards of plan administration;
" .•. minimum standards ot plan design .•. [and) fiscal responsibility" as well ,,',
as the need to insure the vested portion of unfunded liabilities against' •
premature plan termination and expand and increase participation in pri-' ,
vate retirement plans}
,
Legislative history evidences congressional cOncern over the absence of
any substantive fiduciary standards in previous federal regulatory laws. The
availability of "traditional equitable remedies of the common law of trusts"
was deemed inadequate since, fot the 'same set of facts, interstate plans
could face differing standards from state to state~" In contrast, Congress
hoped that ERISA's uniform standards would enable "administrators, fidu~
ciaries and participants to predict the legality of proposed actions withom
the necessity of reference to varying state laws.us
,
,
Although promulgated for the purpose of protecting employees, ERISA
is favored by employers-especially interstate employers-because of its
preemption of state law. 6 Despite its broad preemption ()f state law, ERISA
, imposes virtually no substantive requirements regarding employee benefit
plans. Moreover, the ·Department of Labor," charged with administering
ERISA, has not promulgated any meaningful regulations pertaining to the
substance of employee benefit plans, and has focused instead on pension
plans-which inspired Congress to enact ERJSA in the first place~
The "relate to" requirement. A three~part analysis is used to determine
whether ERISA preempts state law, First, preemption is presumed if the
state law "relate[s] to" any employee benefit plan. ERISA's p'reemption
provision was originally drafted to "relate to" the subject matters regulated
by ERISA. Thus, only state laws pertaining primarily to fUnding and disclo~ ,
sure requirements would face preemption. The broader language of relating
to "any employee benefit plan" was characterized by ERISA's prinCipal
sponsors as intended to avert "the threat of conflicting or inconsistent State
and local reguhltion of employee benefit plans.'~7
The "relate to" requirement has, been construed not to preempt laws
having only a
ernphasized th(,
,
drafting proces~
anY state law ~,
how attenuatea
even state laws
Opponents c
, adopted the rE
virtUally any st<
, Ian 11 Thus ,i
p'
.'
Congress mten
not target ERI
judicial interpr
, The "saVIn
benefit plan IT
insurance, ban
legislation, re,'
,whether a stat<
McCarran,Ferj
practice as "tht
risk, is integral
within the inst
.rendered susce
been the focus
The "deem
co~cerns the ",
to the extent
contracts. As;
be an insuran.
would not otl
"deemer" dau
conventionall
A self~insU1
the policyhol,
than the poli
insurance con
context, the
ministrator pl
not simply de
saved from E
Thus, thro
and "deemer'
�ERISA AND STATE REFORM
·145
having only a remote impact on ERISA plans. 8 Yet most courts have.
emphasized the expansion of the "relate to" clause during the statute's
drafting process as indicative of congressional intent that ERISA preempt
any state law having any impact on an ERISA#qualified plan, no matter
how attenuated the impact.9 Under this extremely inclusive interpretation,
even state laws that are consistent with ERISA have been preempted. 10 .
Opponents of such broad preemption have argued that when Congress
~. adopted the revised "relate to" language, it· did not intend to preempt
virtually any state law having any tangential impact on an ERISA#quaHfied
plan. 11 Thus, it is not at all clear from ERISA's legislative history that
Congress intended, directly or indirectly, to preempt state statutes that do
not target ERISA plans. Yet this is precisely. what has occurred through
judicial interpretation of E R I S A . ' · ·
..
The "savings" clause. Second, a state law relating to an employee
benefit plan may be saved from preemption under ERISA if it regulates
insurance, banking, or securities. Obviously, with regard to health. care
legislation, regulation of insurance is most pertinent to determining
Whether a state law is "saved" and, therefore, not preempted. Invoking the
. McCarran,Perguson Act's antitrust criteria, the courts will characterize a
practice as "the business of insurance" if it involves the transfer or spread of
risk, is integral to the insurer/insured relationship, and is limited to entities
within the insurance industry. What qualifies as "the business of insu~ance"
rendered susceptible to state regulation by virtue of the savings clause has
.. been the focus of ongoing and ever,intensifying judicial inquiry. 12
The "deemer" clause. The third step of the ERISA preemption analysis
cpncerns the "deemer" clause. State insurance regulation may be saved only
•
to the extent that it regulates genuine insurance companies or. insurance
contracts. As a result, a state may not "deem" an employee benefit plan to
be an insurance phin in an effort to avoid preemption if the benefit plan
would not otherwise qualify as an insurance company or contract. The
"deemer" clause therefore limits the application of the "savings" clause to
conventionally insured employee benefit plans.
A self,insured plan does not carry on the "business of insurance" since
the policyholder does not transfer risk or .spread risk across a pool larger
than the policyholder itself. Self;insured plans frequently contract with
insurance companies to render administrative services to such plans. In this,
context, the insurance company acts only as a noninsurer/third,party ad~
ministrator providing managerial functions. Consequently, a state law can~
not simply deem a self,funded plan to be insurance for the purpq$e of being
saved from ERISA preemption. 13
, .
Thus, through the intricate three;step dance of the "relate to," "savings,"
~n,.1 ",.1",,,,.....,0'1''' ,..1",,,,,1"" FRTSA nprmits stMes to ree'Ulate insurancelans but
!.
�146
HEALTH AFFAIRS, I Spring (II) 1994
preempts any such regulation of self, insured or noninsured plans. Perhaps
the Supreme Court's most compelling ground for adhering to this interpre
tation of the interaction of these provisions is that, at least since the 1985
case of Metropolitan Ufe Insurance Company v. Massachusetts, Congress
has been aware of the distinction or "disunifonnity" between insured and
self, insured plans and, whether through design or neglect, has not amended
the statute to alter its preemptive effect. However, this may simply be a
function of congressional gridlock or a measure of the success of various
employer..sponsored interest groups in resisting smte regulation, rather than
a reflection of legislative intent or approval. 14
Still, judging from its recent decision in District of Columbia v. Greater
Washington Boord of Trade, the Supreme Court remains undaunted in its'
expansive reading of ERISA's preemption provisions. IS There, workers"
compensation legislation required employers who provided health insur..
ance for their employees to provide equivalent coverage for injured employ..
ees. The statute did not regulate the ERISA plan itself or impose any
'standards ,regarding how those plans should be administered or what such
plans should provide. Instead, the state law simply stated that employers
providing benefits through ERISA plans must make equivalent benefits
available to workers' compensation claimants. Nevertheless, ERISA
preempted this as "related to" an ERISA employee benefit plan that was
not otherwise "saved" from preemption.
Consequently, the statute was overturned because it expressly tied the
\ mandated workers' compensation benefits to employer,provided health
insurance coverage--even if it did so simply to give the employer a straight
forward index for calculating benefits or to ensure parity of treatment for
both work, and nonwork..related health problems. Thus, any' attempt by
states to rationalize various employment,related,benefits seems destined to
fail ~y virtue of ERISA preemption, regardles; of how beneficial to the
empioyee such efforts might be.
.
The net effect of this tripartite analysis is to preempt states from regulat
ing self-insured plans. This creates an almost irresistible incentive to em
. ployers to self,fund in order to escape state regulation, while all but denying
states the ability to develop effective reforms to improve health care access
or to modify conventional insurance risk pooling.
Initially, only organizations with relatively large and healthy employee
populations opted for self,funding since their large size facilitated risk
spreading. However, as ERISA preemption has been used to provide an
ever,expanding shield from, state regulation, self,funding is growing in
popularity among employers irrespective of size. 16 Our conversations with
private,sector human relations administrators indicate that employer pref
erence for self..funding continues to increase dramatically; it now accounts
for about
pans. 17
I
Steady El
In the ;
states hav,
To date, s
dates to el
des create
such as N
regulate tl
cost contr<
but also to
for poor pc
As the :
began to (
benefit pIa
ees-some
. Company
~
to cover r:
problem 0:
persons arc
coitsists of
Adverse se
.', genous poe
Noting t
the su'bstar
, ruled that
qualify as t
the McCar
exhaustive
clauses ane
worth notil
Me tropoliu
the state's
that impos,
Metropo
Sight. Beca
maintaine(
Without tt
amend mer
�ERISA AND STATE REFORM'
147
(or about 65 pe~cent of 'all ERISA~qualified employee health benefit
17
.
,
plans.
---
Steady
."
,
Erosion Of State Health 'Care Financing Reform Efforts
In the absence of any meaningful federal efforts over the past decade,
states have formed·the vanguard~ trying to reform health care financing.
To date. states have relied.upon rate~settingmeasures and employer'man~
dates to e~ce Coverage 'while overcoming some of the financing obsta,
des created by conventional insurance tisk pooling. By ,the 1970s states.
such as New York, New Jersey. Maryland, and Massachusetts began to
regulate the rates that hospitals could charge various insurers. 18 Hospital
cost controls were meant not only tO'moderate the rise of health care costs,
but also to ensure that there was some system of subsidizing the cost of care .
f
. or poor patients. 19
. As the access and cost problemS \vDrsened in the 1980s, several states
began to consider employer mandates as a ·means of requiring employee
benefit plans to provide certain kinds and/or levels of benefits to employ,
ees-wmething that ERISA does not do. 20 In, Metropolitan life Insurance
Company.,. MassachUsetts, a state statute required "insured" benefit plans
to cover mental health services. It was designed in part to teduce the
problem of adverse selection in mental health insurance. Since healthy
persons are less likely to purchase insurance coverage~ the remaining pool
consists of high,risk individuals more likely to use services and file claims.
Adverse selection results in the inability to distribute risk over a f\etero,
genous pool and therefore drives up the cost of coverage for the sick. '
Noting that a majority of states use mandated benefit statutes to regulate
, the substantive content of insu~ce contracts, the Metropolitan Life court
ruled that suc.h laws are "saved';"from preemptlon to the ,extent that they'·
. qualify as permissible state regulation of the "business of irlsurarice" under
the McCarran,Ferguson Act criteria.
court's ruling came only after an
exhaustive analysis of the relationship between the "savings" and "deemer"
clauses and their relationship to the insured/self,insured distinction. It is
worth noting the inhibitory impact ofERISA preemption as exemplified by
, Metropolitan Life. What really "saved" the Massachusetts legislation was
the state's decision· not even to attempt. to enforce the part of the statute
that imposed the same mandate upon s,elf:;'insured plans. '
Metropolitan Life essentially frees the self,insured plan from state over,
sight. Because ERISA does not mandate that benefit plans be provided or
maintained at any particular level,·. an employer can revise such a plan
Without the consent of the employee. ERISA only requires that' a plan
amendment not discriminate against participants or interfere with or retaB,
The
\
�148
•
HEALTH AFFAIRS ,I Spring (II) 1994
ate for a participant's exercise of rights under the plan. Absent a contract of
assurance that benefits will continue, an employer is free to increase or
reduce benefits without notice to or consent of the employee. 21
Thus, in Vasseur v. Halliburton Company, an employer could modify a
benefit plan to limit inpatient cbverage to licensed hospitals rather than
rehabilitation facilities. 22 Similarly, in McGann v. H&H Music Company,
, ail employer was permitted to reduce lifetime medical benefits of $1 million
. per participant to $5,000 for acquired immunodeficiency syndrome
(AIDS)-related claims after learning that one of its employees had AIDS.2l
Because the reduced coverage would pertain to any employee who devel
oped AIDS rather than to just the identified individual, the modification
was not unlawfully discriminatory under ERISA. McGann, ,recently af
firmed by the Supreme Court without comment, could be logicallyex
tended to permit "after-the-face' termination or reduction of benefits for
other "high-ticket" health problems such as cancer, while leaving states
powerless to halt such activitief. 24
With the growing awareness of the extent ofERISA preemption, em..
ployee benefit plans now are asserting their right to be completely free of
states' health care financing regulation. State attempts to redress adverse
selection by employing traditional hospital rate-setting schemes to cross..
subsidize uncompensated care and high-risk pools are being challenged and
overturned on ERISA preemption grounds. In Bricklayers Local No. I
Welfare Fund v. Louisiana Health Insurance Association, ERISA preempted
aLouisi~ statute that created a state health insura~e assoc~tion to fund
and 'administer a catastrophic health insurance program. 25 Funding would '
have occurred through service charges of $1.50-$2 per patient per day to be
assessed against hospital and outpatient surgery visits. The statute required
payment from the patient's "insurance arrangement," "insurer,'!a.or "self,
insurer" as a "manda'ted benefit." The federal district court found that the
law could not be applied to ERISA plans, whether or not such plans were
self· insured, because it effectively' required plans to pay for persons who
were neither participants in nor beneficiaries of such plans.
New York's hospital rate-setting scheme was struck dO\l{n for similar
reasons in Travelers Insurance Company v. Cuomo. 26 That statute imposed
a series of surcharges over the basic diagnosis-related group (DR,O) rate
based on the patient's kind of coverage'. The surcharges were intended to
reduce hospital rate disparities among commercial insurers and Blue
Cross/Blue Shield plans and preserve the Blues plans' economic viability.,
The Blues were required by state law to cover anyone who applied and to
employ community rather than experience rating. Consequently, they were
less able than commercial insurers to exclude unhealthy persons from the
risk pool or to increase rates to reflect increased claims. In contrast, com
.
'
merciaI im
healthier p
pectedlyhi
carried a di
were intenc
Invoking
surcharges i
and HMOs
the surchar€
plan resour(
state plans t
The appL
uncompensa
Daniel Patti
setting sche
Basically, sel
taX deductic
underscores '
obtaining it.
New Jerse
rate-setting (
deemed to be
Machina..Hea
'employed a rc
Jersey law gra
DRO rate to:
bursement. A
and did not (
" plans, the tri;
plans. Since t
further decide
legislature sub
In a remark
tion cases, h(
, United Wire tr
did not "relar
, Supreme Cou
. definition ofv.
found that a
specifically de
special treatm.
eXistence of su
�ERISA AND STATE REFORM
149
mercial insurers, operating largely through ERISA .plans, tend to insure
healthier pools and can use experience rating to reflect the cost of unex;
pectedly high claims. There was no dispute in the case that the Blues
c:arried a disproportionate share of high,risk persons or that the surcharges
were· intended to help spread this risk more symmetrically.
Invoking ERISA preemption, the court in Travelers reasoned that the
surcharges imposed a substantial economic burden on commercial insurerS
and HMOs providing coverage or services to employee benefit plans,since
me surcharge would be passed through to participants and curtail the use of
rlan resources. ERISA preemption thus was warranted to prevent multi,
gate plans from facing inconsistent obligations in differing states. 21
The application of New York's payer differentials and surcharges for
uncompensated care have come under renewed attack. 28 Recently, Sen.
Daniel Patrick Moynihan (D,NY) managed to rescue New.York's rate..
setting scheme throur:h a special amendment to the federal tax code.
Basically, self.. insured employers now must pay the surcharge or lose their
laX deduction for health insurance costs. 29 This stop..gap measure only
underscores the need for relief from ERISA and the extreme difficulty of
obtaining it.
New Jersey provides another example of ERISA's curtailment of state
rate«tting efforts. The state's then..current rate ..setting legislation· was
deemed to be unenforceable by the trial court in United Wire, Metal, and
Machine Health and Welfare Fund v.Morristown Memorial Hospital, which \
employed a rationale quite similar to tAat of the TraOi!lers court. 30 The New
Jersey law granted discounts to certain payers while including charges in the
DRO rate to subsidize uncompensated care and inadequate Medicare reim,
. burseme4lt. Although this rate,setting legislation was the oldest of its kind
and did not explicitly regulate the terms or conditi't>ns of ERISA b~nefit
plans, the trial court still found it to be preempted for "relating to" such
plans. Since the law did not purport to regulate insurance, the trial court
funher decided that it could not be saved from preemption. The New Jersey
legislature subsequently passed new legislation that abandoned rate setting.,
. In a remarkable departure from th~ clear trend of recent ERISA preemp,
lion cases, however, the· Third Circuit Court of Appeals reversed the
United Wire trial court's decision and found that the rate;setting legislation
did not "relate to" ERISA plans. 31 While purporting to rely on recent
Supreme Court rulings, the appeals court effectively articulated a new·
definition of what satisfies the "relate to" criterion of ERISA preemption. It
found that a state statute relates roan ERISA benefit plan if it is (1)·
spedfically designed to affect such plans; (2) singles out such plans for
. ~dal treatment; or (3) creates rights or restrictions predicated on 'the
eXIStence of such plans.,
..
�. 150
HEALTH.AFFAIRS I Spring (II)' 1994
While the United Wire appellate decision is a bit too facile in dealing
with "binding" precedent, the court should be commended for attempting
to protect a state's ability to regulate and improve health care financing
mechanisms. It also created a direct conflict between the Second and Third
Circuitsconceming the appropriate interpretation of the "relate to" clause.
Nevertheless, the Supreme Court has denied further review of United Wire
and thus continues its refusal to address, ERISA's growing' role in, the
nation's health care crisis. 32
'
, , ' ,
Currently pending in Minnesota is an ERISA challenge to that state's'
efforts to finance health care (9r the unInsured through a 2 percent tax on~
the gross revenues of hospitals and other health care providers.33 The
general trend of recent case law (United Wire notwithstanding) indicates
that,the state would do well to consider alternative financing mechanisms.
State Health Care Delivery Regulation,
As -damaging as the SupremeCo~rt's' preemption apalysis has been to
state health care financing efforts, there is potential for evengreater harm,
depet;lding on the'court's disposition of several unresolved questions con
cerning hea\th care delivery. It is not now clear whether state regulation of
health maintenance organizations (HMOs) and preferred provider organi. .
zations (PPOs) will beundermined'byERISA preemption; whether permis. .
sible state insurance regula~ion will include the ability to regulate relations
between insurers and providers; or whether state,common law ca~ses of
\action challeng4ng 'ttilizadon review determinations will be preempted.
Early indications from lower courts indicate that ERISA's influence will
grow. ERISA preemption was recently invoked but ultimately failed to
block Virginia's efforts to regulate PPOs. Stuart Circle Hospital Corporation . . ..
v. Aetna Health Managemerttilinvolved Aetrla's challenge of a Virginia"· .
statute regarding tarious requirements in negotiating with providers to
participate . in PPO contracts. 34 The tr~al court found. that the statute
_."related to" ERISA employee benefit plans because it regulated insurer
" established PPOs, _
which served as' a vehicle for delivering health care
. services to employees covered by such plans. Yet the statute could not be
"saved" from preemption because it did not regulate "the business of insur
ance"-.the insurer's relationship with the insured-but focused instead on
the relationship between the insurer and prpviders.
',_
The Stuart Circle decision was later re~ersed on appeaI.35 The Fourth
Circuit Court characterized the statute as the kind of insurance regulation
properly saved from preemption because it was part of Virginia's. overall
insurance code and also regulated "the business of insurance." In this
regard" the court reasoned -that' while the statute did focus on, the
insurerlJ
litionsh
ofprovi( .
the risk
Curre
Virginia,
Supremt
ingly bre
statutes.
HMOs, 1
to reach
ers subje(
The in
unclear.
intended
services..
review d.
plaintiff ,
participat
pendent 1
'Caredeni
nancy d~
vigorous 1
retained e
stant fetal
ten hours
distressed
. claims aga
taBzation .
itself.
Nevertl
the state 1:
benefit pIa
in fact "in.
actionable
availabilit)
ting such,
undermine
-to secure tl
an ERISA
preemptior
regulation'
�ERISA AND STATE REFORM
151
insurer/provider relationship, it indirectly regulated the insurer/insured re,
lationship. Moreover, because the law sought to protect an insured's choice
of providers, it affected how the insured's cost or "risk" w~:)Uld be spre~d over
,he risk pool and, as such, deserved to be saved from preemption.
Currently, Virginia is one of twenty,eight states regulating PPOS. While
Virginia's PPO legislation has managed to survive preemption thus far, the
Supreme: Court's continued allegiance to giving ERISA such an exceed..
mgty broad preemptive effect could portend the eventual overturn of such
statutes. Since the'Supreme Court·has not resolved the ·insurer status of
HMOs, PPOS, and other managed care entities, lower courts will continue
.to reach conflicting results.in determining whether such entities are insur..
ers subject to the ERISA preemption savings clause.36 ..
The impact of ERISA preemption on utilization review decisions also is
unclear. Utilization review is a common feature of employee health plans
intended to contain costs by requiring review and authorization of medical
services. ERISA preempted an employee's ability to challenge a utilization
review decision in Corcoran v. United Health Care, Iilc. 37 There, the
plaintiff was covered by a self..funded employee benefit plan that required
participants to obtain precertification from United Health Care, an inde..
pendent utilization review organization hired by the· plan. United Health
Care denied plaintiff precertification of hospitalization for a high..risk preg..
nancy despite the plaintiffs history of similar problems, her obstetrician's
vigorous recommendation of hospitalization, and its own independently
\ttained exptrt's opinion that hospitalization was necessary to permit con,
stant fetal monitoring. Instead, United authorized in,home nursing care for
ten hours per day. At atime whe~ no nurse was on duty, the fetus became
distressed and died. The plaintiff attempted to assert state common law
claims against Unit~d, arguing that its medical d~cision in den'ying hospi,
talization was negligent. There was no attempt to sue the self,funded plan
itself.
Nevertheless, the tort action was deemed preempted by ERISA because
the state law that might have permitted such a claim "related to" ERISA·
. benefit plans. Acknowledging that utilization review determinations were
in fact umedical decisions," the court found that such decisions were not
actionable because they were made in the context of determining the
a~ailability of benefits under self,funded plans. In the court's view, permit, .
tlng such decisions to be challenged through state· tort remedies would
undermine the uniform regulation of benefit plans that Congress intended
to secure through ERISA preemption. The court observed that the lack of
an ERISA remedy could not alter the seeming inevitability of ERISA
preemption. It noted, too, that while an area traditionally accorded to state
regulation will typically escape federal preemption, this is not the case with
.
�'.
152
HEALTH AFFAIRS
I' Spring (II) 1994
ERISA. Rather, "the fact that states traditionally have regulated in a
particular area has functioned as no impediment to .ERISA preemption."38
The Corcoran court was obviously disturbed by its decision, which left
the plaintiff with "no remedy, state or federal, for what may have been a
serious mistake."39 As interpreted by that court, ERISA preemption immu
nizes utilization review dete~inations from generally applicable liability
rules, thereby fostering substandard decision making and decreasing a bene- .'
fit plan's incentives to "seek out the [utilization review] companies that can
. deliver both high quality services and reasonable prices."40 Feeling con..
strained by the congressional goal of uniform regulation to rule as it,did, the
court did not overlook the irony of applying a statute designed to safeguard
workers in a manner so obviously detrimental to the plaintiff employee.
The Supreme Court refused to review Corcoran, but it is likely to face
repeated challenges to ERISA preemption of utilization review decisions:u
The Health Security Act And Congressional Legislation
ERISA preemption has been used to eviscerate state attempts to regulate
both health care financing and health care'delivery. Preemption has under~
cut efforts to implement employer mandates and to cros.s~subsidize uncom~
pensated care and high1risk pools. It is now being invoked to deny the states
any meaningful role in regulating HMOs, PFOs, and insurer/provider rela~
tions. All of this is occurring despite the absence of any countervailing
federal substantive regulation of such entities and their activities.
While the Supreme Court's liberal use of ERISA preemption is clearly
wreaking havoc on the ability of states to respond to the constantly inten,
sifying need for health care reform, only Justice John Paul Stevens, the lone
dissenter in recent ERISA preemption cases, has called for a reexamination
o(:preemp!:ion analysis, arguing that Congress never intended such far'
reaching'eradication of state law. 42 Not surprisingly, he finds strong support
among state legislators. 43 A few reform measures even have been attempted
within Congress itself, but these attempts have been highly controversial
and unsustained.
Today, however, all bets are off. A House subcommittee recently fe'
ported out a bill that would grant ERISA waivers to four states. 44 None of
these waivers were eve,ntually granted in large part because of the vigorous
opposition of the recently formed Coalition for the Preservation of ERISA
Preemption, consisting of over 100 self, insured employers -and trade
groups.45 New York managed to obtain some relief from ERISA preemption
of its rate,setting scheme-not by a waiver but by Senator Moynihan's
"display of sheer political powee'jn obtaining a limited-amendment to the
federal tax code. 46 Those states involved in thoroughgoing reform all recog,
nized the n
So, toO,
srrates a ref
finanCing r
needed by:
competitiol
,5,000 empl
, ance could
alliance is (
anee also Cc
It is imp( ,
terized by 1
reform. Col
very well d,
corporate al
protections
forming a c<
preemption
With reg:
with some I
approach fo'
would qualil
they are pro
,terminate, n
prehensive 1
such coveral
fits as long a
In aontra,::
delivery of r
act requires
from regula 1
alliances. T1
states are to
is beyond t
injured by L
bringing m~
Act's revisi(
effectively (
the Health
H&HM~
including C
health refa
�ERISA AND STATE REFORM
153
nized the need for ERISA revisions.
"
'
,
So, too, the Clinton administration in its Health Security Act demon~
',trates a reasonable grasp of the critical role of ERISA reform in health care
financing regulation. Unfortunately, it does' not provide all of the relief
needed by states to implement health care delivery reform and to manage
competition effectively. UndertJ:te proposal, employers with more than
S,OOO employees could elect to form: corporate alliances~ A corporate alli~
anee. could self..fund and thus assume insurance risk, while a regional
alliance is expressly forbidden frOm bearing such risk. The corporate al~i.."
~ anee also can take advantage of experience rating.
It is important to note that the Health Security Act has been chara~..
terized by Hillary Rodham Clinton as a place to begin federal health care '
refonn. Consequently, the 5,OOO.,person iimit on corporate alliances may
very well decrease in the legislative' process. This will be critical, 'as the
corporate alliance will be able to take advantage of many of the preemption
protections now offered under ERISA. Any lowering.of the thresJ101d for
fonning a corporate alliana; will lead to greater prevalence of ERISA..type
preemption of state regulation.
With regard to financing issues, the Health Security Act provides states
with some ERISA overrides. For example, a state may adopt a single..payei
appro~ch for all employers and individuals"including those who otherwise
. would qualify for corporate'alliances. The act also states that even though
they are protected by ERISA, health plans in corporate alliances may no\
terminate, restrict, or limit applicability of the nationally guaranteed com..
prehensive benefit package. By requiring corporate alliances to provide
such coverage, the act should preclude McGann~type restrictions on bene~
fits long 'as the benefit package is reasonably broad. '
In contrast, the act does little 'to curtail ERISA preemption regarding the'·
delivery of medical care under corp~rate alliances. Thus, even though the
act requires states to manage competition, ERISA would preempt states
from regulating managed care operations under contract with corporate
alliances. The act therefore creates and then' ignores' the dilemma of hqw
states are to manage competition when a significant portion of t,he market
is beyond their control. ERISA also, would continue' to prevent those
injured by utilization review decisions under corporate alliance plans from' "
bringing malpractice litigation. These omissions from the Health Security ,
Aces revisions of ERISA impair the abilityof states to manage competition.
effectively and, thus, undercut the act itself. Clearly, then, the authors of
the Health Security Act,had a re:}sonable understanding of McGann v.
H&H Music, but their grasp of the other important cases in the field,
including Corcoran, Stuart Circle, and Travelers, was less firm. As national
health reform evolves, those, 'who favor state reguhition and reform of"
as
'1.
�154
HEALTH AFFAIRS I Spring (II) 1994
health care delivery will be well advised to inform their congressional
representatives of the importance of more comprehensive ERISA revisions.
Like most of the more controversial elements of the Clinton plan, the
details of amending ERISA are quite sketchy, and competing proposals pay
even less attention to this complicated and politically contentious issue.
The Clinton administration undoubtedly recognizes that the availability of
self~funding and ERISA preemption will be important bargaining chips.
. But it also knows that permitting too many employers to opt out of regional
health alliances and/or unduly limiting state flexibility to regulate health
caredelivery·will jeopardize the·entire reform effort. Whether these inter..
ests can be accommodated remains to be seen. However, one thing is clear:
The problems of ERISA preemption are likely to endure for some time.
It is highly questionable that Congress really intended to make health
policy when it chose to enact ERISA's disclosure, reporting, and minimum
reserve requirements almost tWenty years ago. Rather than protecting em..
ployees from fraud and abuse in the investment and management ofbenefit
plans, ERISA has assumed the dubious. function of creating a roster of
"haves" and uhave~notsn in the health benefits game while preempting
states from leveling the playing field. Stili, the U.S. Supreme Court has not
wavered in its insistence that only Congress can alter the preemptive effect
of ERISA on health care reform. Thus, as' Congress finally confronts re..
form, it must address the appropriate role of ERISA preemption in the
regulation of both health care financing and delivery.
\
NOTES
1. P.L 93-406,88 Stat. 832, as amended 29 U.S.C.,Sections lOOI-1461,paragi-aph 1144.
Space limitar.!0ns preclude complete legal citations here. These ar~available from the
authors at Harvard School of P~bHc Health, Department of Health Policy arid Mart
agement, 677 Huntington Avenue, Boston, MA 02115.
2. See, for example, W.K. Mariner, "Problems with Employer-Provided Health Insur
ance-The Employee Retirement Income Security Act and Health Care Reform," The
New England Journal of Medicine 327 (1992): 1682-1685; and La. Gostin and AI.
Widliss, "What's Wrong with the ERISA Vacuum?" Joumol of the American Medical
Association 269 (1993): 2527-2532. , .
.
3. H. Rep. 93-533 (Education and Labor Committee), 93d Cong., 2d Sess., reprinted in
1974 U.S. Code Congressional and Adm inis tTative News, 4639-4670.
4. Ibid. See also S. Rep. 127, 1974.
5. Ibid.
6. Congress's preoccupation with ensuring uniformity of regulation from state to state was
obviously intended to protect interstate employee benefit plans. Yet, ERISA preemp
tion does not distinguish between inter- and intrastate plans and protects both from.
state regulation.
'.
7. Remarks of Sen. Harrison A WiHiarns (R-NJ), 22 August 1974, Congressi6nal Record
120, S15737, reprinted in 1974 US.C:;.C.AN.Sl77-5190; accord remarksofRep. John
H. Dent (D-PA), 20 August 1974, Congressional Record 120, 29197, reprinted in Senate
Subcomm it(·
ment Income
8. See Shaw v.
9. See. for exan
(1992); lnge
Ins. Co. v. D
. to interpret t
10. MetropolitaI
v. Lanier Co
11. Remarks ofS
Legislative Hi
12. See Union L
471 U.S., 74
13. See FMC Cc
14. Our discussk
and organize(
and broad. S
Groupsand~
15. Dist. of Colu
16. E. Felsenthal
11 Novembe
17. See, for exan
the Crisis of
18. A.R. Somers
. madc .Beginr
19. C.Eby and 1
Politics. Polk
20. R. Blendon, .
267 (1992): .
21. See Shaw, 4(
1991); and L
sity of Penns)
22. Vasseur v. H
23. McGann v. J
• S.Cc. 482 ( 1(
App. no. 35
1031 (empl(
actionable u
24. As elsewher t
but its impac
Health Insur
The McGan
Remarkably,
discussed he
ERISA is.
; 25. Bricklayers I
F.supp.771
26. Travelers In
27. In findingd
court rejecte
(2d Cir. 198
case had fou
�ERISA AND STATE REFORM
155
Subcommittee on Labor and. Public Welfare, Legislative History of the Employee Retire'
ment Income Security Act of 1974 (1976),4670-4671.
8. See Shaw v. Delta Air Lines, Inc., 463 US. 85 at 100, no. 21.
,
9. See, for example, Dist. of Columbia v. Greater Wash. Brd. ofTrade, 113 S.Ct. 580, 583
(1992); Ingel'OOll,Rand Co. v. McClendon, 498 US. 133, 139 (1990); and Pilot Life
Ins. Co. v. Dedeaux, 481 US. 41, 46 (1987). In recent months a few cases have dared
[0 interpret the "relate to" clause more narrowly. See discussion at Note 31.
10. Metropolitan Life Ins. Co. v. Massachusetts, 471 US. 724, 739 (1985). Accord, Mackey
v. Lanier Collection Agency and Serv., Inc., 486 U.S. 825 (1988).
II. Remarks ofSen. JacobJavits (D-NY), 22 August 1974, Congressional Reeord 120,29942,
, Legislative History, 4770-4771.
.
.
".11. See Union Labor Life Ins. Co..v. Piteno, 458 US:' 119 (1982); and Metropolitan Life,
471 US., 743.
13. See FMC Corp. v. Holliday, 498 US. 52 (1990).
14. Our discussions over the past six months with various representatives of both business
and organized labor indicate that support for ERISA within these constituencies is deep
and broad. See also D.M. Fox and D.C. Schaffer, "Health Policy and ERISA: Interest
Groups and Semipreemption." Journal of Health Politics, Policy and Law 14 (1989): 239.
IS. Dist. of Columbia v. Greater Wash. Brd.ofTrade.
16. E. Felsenthal, "Self, Insurance of Health Plans Benefits Firms," The
StTeet}ou:rnaI,
11 November 1992, 1.
17. See, for example, R.A. Padgug and G.M. Oppenheimer, "AIDS, Health Insurance. and
the Crisis of Community," NotTe Dame Journal of Law and Ethics 5 (1990):35-57.
18. A.R. Somers, "Sounding Board: Moderating the Rise in Health Care Costs-A Prag
matic Beginning." The New England Journal of Medicine 306 (1982): 944-946.
19. C. Ebyand D. Cohodes, '''What Do We Know about Rate Setting?" Journal of Health
Politics. Policy and lAw 10 (1985): 299-327.
20. R. Blendon. "Making the Critical Choices," Journal ofthe American Medical Association
267 (1992): 2509-2520.
'
'
21. See Shaw, 463 US. 85; McGann v. H&H Music Co., 946 F.2d 401,405-408 (5th Cir.
1991); and L.P. Francis, "Consumer Expectation and Access to Health Care," Univer
sity of Pennsylvania Law ReView 140 (1992): 1881.
22. Vasseur v. Halliburton Co., 950 F.2d 1002 (5th Cir.1992).
. ,/3. McGann v. H&H Music Co., een. denied sub no~ Greenberg v. H&H Music Co., ,113
.' S.Ct. 482 (1992). See also Westhoven v. Lincoln"Food Service Products, Inc., Ind. Ct.
App. no. 35 A02-9206,CV-260, 6 July 1993, DNA's Health Law Reporter 2 (1993):
1031 (employer's reduction of health benefits for employees with AIDS was not
actionable under state antidiscrimination law due to ERISA preemption).
24. As elsewhere in health policy, ERISA has been evaluated through the leris of AIDS,
but its impact is really much broader. See Mariner, "Problems with Employer-Provided
Health Insurance;" and Gostin and Widliss, "What's Wrong with the ERISA Vacuum?"
The McGann case has been relatively widely discussed in the health policy literature.
Remarkably, however, neither of these recent articles even mentions the case law
discussed here. This is yet another indication of how underappreciated the impact of '
ERlSA is.
25. Bricklayers Local No.1 Welfare Fund v. Louisiana Health lnsurance Association, 771
F.Supp. 771 (E.D.La.1991).
26. Travelers Ins. Co. v. Cuomo, 14F.3d. 708 (2d Cir. 1994).
27. In finding the surcharge statute to "relate to" an employee benefit plan, the district
court rejected the Second Circuit's earlier decision of Rebaldo v. Cuomo, 749 F.2d 133
(2d Cir. 1984), which had employed a narrower reading of the "relate to" clause. That
case had found that a New York statute did not relate to and thus was not preempted
wau
�156
HEALTH AFFAIRS
Spring (II) 1994
by ERISA because it did nO[ "purpOrt to regulate . '.' the tenus and conditio~ of
employee benefitplans"Obid., 137). The broader interpretation of the "relate to" clause
.was supported by the Court of Appellis for the Second Circuit in Cuomo as well as Smith
v. Dunham~Bush, Inc., 959 F.2d 6 (ld Cir. 1992) at 9, n. 3, citingh:lgersoll~RandCo. •
v. McClendon, 498 U.S. 133, 111 S.Ct. 478, 484 (1990).
28. Trustees of Hosp. Ben. Plan of Electric Industry v. Cuomo, E.O.N.Y., CV92~5589 (25 .
November 1992).
.
"
29. M.M. Kahn, "Budget Translated: Tough Sledding forSelf~Insured, Medicare Funds .
Skimpier," Health Care Competition Week 10 (1993): 46..
30. United Wire,.Metal, and Machine Health and Welfare Fund v. Morristown Memorial
Hospital, 793 F.Supp. 524 (D.N.J.1992), rem-sed and remanded, 995F.2d U79 (3dCu.
1993), cert. denied 114 S.Ct. 382 (1993).
31. Ibid., 995 F.ld. 1179 Od. Cir. 1993). While the appeals court reversed the lower coun',
ERISA ruling, it affirmed other portions of the trial court's decision that were unrelated
mffi~
. .
..
32. A petition for a grant of certionlfi was filed with the U.S. Supreme Court 22 July 1993.
33. Boyle v. McClung, no. 3·92·CY602 (O.Minn. filed 2 September 1992).
34. Stuart Circle Hosp. Corp. v. Aetna Health Management,'8CO p.Supp. 328 (E.D.Va.
1992), mcated,remanded, 995 F.2d 500(4rh Cir. i993), Ceft. denied 114 S.Ct. 579 .
(1993).
. . . . .
35. Ibid., 995 F.2d 501 (4th Cir. 1993). Accord, Blue Cross and Blue Shield v: St. Mary's
Hosp. of Richmond, Inc., 426 S.E. 2d 117 (Va. 1993 ). Supreme Court of Virginia also
. finds PPO statute to be saved from preemption. .
36. See.for example, Travelers, 813 F.supp. at 1007. n. 14 citing O'Reilly v. Ceuleers, 912
F.2d 1383, 1389 (11th Cir. 1990); Physicians Health Plan, Inc. v. Citizens Ins. Co.,
673 F.Supp. 963; 907-908 (W.O. Mich. 1987); and Besser v. Hosp. ofPhila. College,
802 F.Supp. 1286 (E.D. Pa. 1992).
37..,Corcoran v. United Health care, Inc., 965 F.2d 1321 (5th Cir. 1992). cert. denied, 113
S. Ct. 812 ( 1 9 9 2 ) . '
.\
38. Ibid., 1334.
39. Ibid., 1338.
40. Ibid.
41. Ibid.
'
42. See. for example. Oisl:;,.ofColumbia v. Greater Wash. Brd. ofTrade (JusticeJ!P. Stevens_
dissenting); and FMC'Corp. v. Holliday.
43. BNA's Health La~ Reporter (17 September 1992): 15.
44. BNA Health Care Po/icy, "House Panel Includes ERISA Waivers in Markup of Recon
ciliation Bill" (17 May 1993): 484.
.
45. "State ERISA Waivers Threatened," Medicine and Health (26 July 1993): 3.
46. Kahn. "Budget Translated."
<
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ilEALTH. CARE uPDATE
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�Q&A FOR WHY INCREASE IN PER BENEFICIARY SPENDING IS A CUT
How can you consider an increase in Medicare spending a Hcut? The Congressional
Majority will pay $6,700 in 2002 per beneficiary, relative to the $4,800 per beneficiary
now being spent~ How can you' characterize this as a cut? .
•
This is a cut because you cannot buy today's Medicare benefits with this .amount
of money in 2002. Beneficiaries will pay substantially more or get less benefits. '.'
. Nothing the Congressional, Majority can do or say can dispute this fact.
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Sure the per beneficiary spending would be $6,650 in 2002, but that is a
staggering $1,000 less per person than what it would ...,e EVEN IF Medicare
.. spending were constrained to the private sector:growth rate:*
•
And .remember, the. Congressional Majority wishes to constrain the growth rate well
below the privafe ~ec~or even though Medicare beneficiaries are, by any definition, a
much more difficult to manage and expensive population than those. with private
insurance.
•
To denylheir propOsal is a cut is like saying that reduci~g the Social Security
(COLA) is not a cut. To' deny their proposal is a cut is· like telling workers who get
a3% raise that their salary will remain sufficient to maintain their standard of living
in an economy that has an inflation rate of 5%.
.
•
The real question is whether the $6,650 advocated by the Congressional Majority
would be sufficient to pay for the' same benefits hi 2002 that Medicare
'beneficiaries have today. Clearly, it is not.
*
(NOTE: The 1996-2002 private sector per capita growth rate projection of 7.1% -.,..
calculated from Congressional Budget Office data -- is 40% higher than the 4.9%
growth rate the Republican budget allows for Medicare. Constraining the Medicare
program to the 7.1% growth rate would reduce per beneficiary spending from. its'
currently projected $8,400 to $7,600, arid would produce substantial federal savings.
However, the Republican budget's 4.9% growth rate would reduce Federal spending
per beneficiary by $1,700 to $6,650; This is $1,000 per person less than even the
private sector growth rate would allow and could only be achieved through
unprecedented cost-sharing increases on beneficiaries.)
"
Upda!ed: 01195 joe
�Q&A FOR WHY INCREASE IN PER BENEFICIARY SPENDING IS A CUT
\
, How can you consider, an increase in Medicare spending a cut? The Congressional
Majority will pay $6,700 in 2002 per beneficiary, relative to the $4,800 per beneficiary
now being spent. How can you characterize this
a cut? .
as
•
,•
•
•
•
*
This is a cut because you camiot buy, todaY's MediCare benefits with, this amount
ormoney in 2002. Beneficiaries will pay substantially more or get less benefits.
Nothing the Congressional Majority can do or say can dispute, this fact.
Sure the per beneficiary spending would be $6,650 in 2002, but that is' a
staggering $1,000 less per person than what it would be EVEN IF Medicare
spending were constrained to the' private sector growth rate. * ,
And remember, the Congressional Majority wishes to constrain the growth rate well
b~low the private sector even though Medicare beneficiaries are, by any definition, a
much more difficultto manage and expensive population than those with private
insurance.
-
.
, To deny their proposal is a cut is like saying that reducing the, Social Security
(CO LA) is not a cut. To' deny, their proposal is a cut is like telling workers who get
a 3% raise that their salarywill reinain sufficient to maintain their standard of living
in an economy that has an inflation rate of 5%. '
The real question is whether the $6,650 advocated by the Congressional Majority
would be sufficient to pay for the same benefits in 2002 that Medicare
beneficiaries have today. , Clearly, it is not.
'
(NOTE: The 1996-2002 private sector per capita growth rate projection of 7.1 % ~
calculated from Congressional Budget Office data -- is 40% higher than the 4.9%
growth 'rate the Republican budget allows for Medicare. Constraining the Medicare
program to the 7.1 % groWth rate w()Uld reduce per beneficiary spending from, its
currently projected $8,400 to $7,600, and would produce substantial 'Federal savings.
However, the Republican budget's 4.9% growth rate would reduce, Federal spending
'per beneficiary by $1,700 to $6,650. This, is $1,000 per person less than even the
private sector growth rate would allow and could only be ac4ieved thro~gh
unprecedented cost-sharing increases on, beneficiaries.)"
UpdaIcd: 6/31195
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. the 1993 forecast .. Ti)(~:pre.sidentaddr,e·ss~d the pr~blem 'in1993and has,
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, '. kn.ows Medicare is dying, but he lias. doheno~hingto. save it.. Apparently his: pl~ls ....
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$70,000 ad in USA Today will fool AtrteficaI{s into believing that Republicans ~~e 'n~t"' .
using the.ir $270· billiori,in MediCare ClitS.toh~lp pay for their $245 bi~lion 'in' tax ch~~:L:·:'.,.·,·
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�TH E WH ITE HOUS E
WASHINGTON
July 7, 199"
MEMORANDUM FOR TIIE PRESIDENT
~,
FROM::
Carol Il. Rasco
SUBJECT:
Lynn Etheredge's Report on Medicare
.' Lynn Etheredge has just completed the attached report that provides solid recommendations about
how the Medicare program canbe modernized. It is a well-written and researched analysis that .
documents the current shortcomings of Medicare and provides specific suggestions about how we Can
move the program into the 21st century. Irishort, he advocates utilizing the best of private sector
. competition, quality and accountability innovations without undermining the program.
As you may recall, Lynn is a consultant wh9 has worked closely with both Republicans (OMB career
under Reagan) and Democrats (your health care transition team and as a consultant last year to
Kennedy's Labor Committee.) Most ,recently, he has been associated with the Jackson Hole group.
He is well respected by all sides and is shopping the concepts outlined in this paper to moderate
RepubliCans' and Democrats.
.~
The good news is that much of what Lynn is advocating is consistent with the Medicare
restructuring/managed care enhancement package you explicitly and/or. implicitly included in your
balanced budget alternative. His recommendations would empower beneficiaries and the Medicare
program itself, without fundamentally destroying the current system that has gained the
overwhelming support of the public. They would contribute to your goal of providing more efficient
options without financially coercing'beneficiaries into plans they otherwise would not choose. Most
importantly, they represent an alternative to the status quo that can be used to counter Republican
voucher proposals. In short, your proposal has choice with security, whereas the Republicans are
financially coercing beneficiaries into capped managed care plans. The approached' outlined by Lynn
would likely have the added benefit of being well' received by the business, the managed care, and
the aging a9vocacy communities. '
While w~ would probably have to push HHS on some of Lynn's recommendations '-- particularly
with regard to a timely implementation schedule -- we believe the current enyironment has made
the Department much more receptive and encouraging of movement in this direction. Donna Shalala,
in particular, would probably love to embrace them.
.
,
I wanted to share this with you now because I thiIik it is particularly timely relative to the inevitable'
upcoming Medicare reform debate. I have asked Chris, Jennings to stay in close touch with Lynn
and to continue to have appropriate White House and Department representatives review our
substantive and political positiqning strategy vis a vis Medicare. Unfortunately, because of the
perception that we (and HCFA in particular) are not sufficiently open to the types of suggestions .
Lynn has raised, we must be careful about how and when we move this type of agenda to ensure that
the Administration gets its due credit. , Attached is a one-page summary of Lynn's recommendations.
cc: Alice Rivlin
Laura Tyson
�HIGHLIGHTS OF ETHEREDGE'S MEDICARE REFORM RECOMMENDATIONS
Medicare's mission philosophy needs to be revised to emphasize Medicare as a
health plan. Most importantly, Medicare needs to become accountable, not just for
insurance to pay bills and protect financial assets, but for improving the health of its
enrollees, by providing preventive health measures and quality. medical care ..
Medicare should have new authorities to purchase health care on the basis of
explicit quality and other criteria and competitive performance. To improve
Medicare's performance, Congress needs to provide authority to move beyond the
limits of regulatory rule-making and price-setting so that Medicare can adopt the
, same types of successful purchasing techniques pioneereq by private-sector pay.
(This is very similar to the Clinton Administration PPO and point of service options.)
Report cards that assess Medicare's performance on the basis of cost, quality,
outcomes, and service need to be utilized so that the program can be held
accountable by enrollees and policymakers. These measures need to reflect a wide '
range of criteria; including preventive care, quality of care, consumer satisfaction, and
'
health outcomes, and should also apply to competing private health plans. Report
cards should show national, state-level, and market-area performance.
Medicare needs to adopt competitive'purchasing of standardized services and
supplies, including durable medical equipment, laboratory testing, radiology, and
outpatient surgery.
'
Medicare needs to significantly expand its use of centers of excellence and
specialized services cQntracting; Medicare now uses such concepts in its coverage
for transplant services; private-;-sector plans use selective contracting even more widely
for many forms of surgery, cancer care, and mental health. Intelligent purchasing by
Medicare would produce b,etter quality, cost, and service competition among providers,
.to the benefit of Medicare beneficiaries and taxpayers.
A national strategy for clinical effectiveness and outcomes stUdies for the
Medicare population needs to be implemented by analyzing the Medicare data to
identify procedures with wide variations that seem likely to renect overuse and
underuse.
'
\
Medicare needs to be better empowered to drop providers'who are contributing
'
to a significant fraud and abuse problem in the program.
�.
,
June 1995
Reengineering Medicare:
From Bill-Paying Insurer to
Accountable Purchaser
'Prepared by
Lynn Etheredge
Consultant
.
,
Prepared for the Health Insuranee' Reform Project, George Washington
University, with funding from the Robert Wood Johnson Foundation
�"
,
In this new purchasing en~ir~nment, private
Reengineering . . , is the fundo.mental rethink
ing and radical redesign of business processes
to achieve dramatic improvements in critical
contemporary measures of perfonnance; such
as cost, quality, [and1 service.
sector employers and consumers are increas
ingly ahle to m~ke informed choices-to hold
providers (and the plans that contract with'
them) accountable-through the use of tools such
as the National ComInittee on Quality Assur'
ance's (NCQA's) "report cards/' which are
based on the Health Plan Employer Data and
Information Set (HEDIS), and other quality'
measures, such as health outcomes. The HEDIS
data set includes more than 60 quality, service
access, patient satisfaction, outcomes, and other
performance measures, including preventive
care (s~ch as immunizations, mammography
screerung, and eye exams for diab~tics) and
signal indicators for poor quality (such as inpa
tient admissions for asthma and treatment fol
lowing heart attacks).'
,
-Michael Hammer and James Champy,
. Reengineering the Corporation
"
At the time of its enactment 30 years ago,
Medicare was patterned on the health insur
ance models widely used by prIvate employ
ers and insurers for the under-~5 population.
In this model, the primary administrative
function of insurance companies and of the
Medicare program was simply to pay bills.
Today, Medicare remains essentially a bill
paying insurance program, with the addition
of national formulas for hospital and physician
payment rates.
. In the current political climate, there is great
mterest in the federal government's making
available to the MediCare population a broader
choice of co~peting private health plans that
use. such purchasing technologies. Today, health
mamtenance organizations (HMOs) and other
private plans enroll only about 10% of the
Medicare population. Among the many mea
sures that could open up more plan options are
an FEHBP-type "managed competition" ap
proach that would allow Medicare beneficiaries
to make informep choices among a wide range
of HMO, preferred provider organization
(PPO), Medicare Select, medigap, and other
plans during an armual open season. Other op
ti~ns being discussed involve workers staying
WIth employer/association planS after turning
age 65 or some use of medical IRA accounts
and catastrophic coverage. Much of the atten
tion in Congress now centers on the policy
questions involved in structuring new options '
for Medicare enrollees.
In recent years, the private sector has
moved beyond this traditional insurance mod
el. Private ..sector_ payers are no longer simply,
paying bills but are using a variety of evolv
ing purchasing techniques, in a competitive
marketplace, to restrain costs and improve
quality and service. Among these purchasing
s~ategies are many forms of selective, compet
itive contracting; capitation and risk-sharing
arrangements; provider performance stan
dards, with incentives, penalties, and continu
ous quality improvement goals; management
of high-cost cases; centers 'of excellence for '
transplants, heart surgery, cancer care, and
other treatment; prevention and chronic dis
ease management initiatives; consumer infor
mation and incentives; specialized contra:cting
for pharmaceutical benefits, substance abuse,
mental health, and other services; and special
ized claims-auditing firms to deal with fraud.
Individuals with benefits offered by large
employers-including, through the Federal Em
ployees Health Benefits Program (FEHBP), the
nation's political leaders and federal workers-"
are usually able to make choices among a num
ber of health plans on the basis of provIder
networks, cost, quality, service performance,
and other features.
As a complete reform, strategy, such options
would fall short. They do not reform the basic
Medicare program. Over 90% of Medicare's
spending is through the fee-for-service model.
As of January I, 1995, 19 states had no Medi
care HMO enrollees and 32 states had 1% or
fewer of their Medicare-eligible populations
-2
�(
•. A revised mission philosophy t/wt empJuisizes
Medicare as a health plan. Most unpoitantly,
Medicare would need to become accountable,
not just for insurance to pay bills and.protect
financial assets, but for improving the health
of its enrollees, by providing preventive
health measures and quality medical care':'
enrolled in HMOs. A handful of states
, including California (42% of Medicare HMO
enrollees) and Florida (17% of Medicare HM9
enrollees)-accounted for most of the Medicare
HMO membership.l Even with an FEHBP-type
arrangement and optimistic growth assump
tions about private plan enrollments, many fac
tors make it likely that most Medicare eligibles
in most states will still be in the program for the
rest of the decade and beyond.2 In its traditional
b'm-paying mode, the Me<?icare program has
very fe~ tools for dealing with the volume, ,
intensity, and quality issues that are its major
cost-drivers. Thus, devising a strategy for fun
damental re,forrn of the basic Medicare pro
gram-nreengineering" Medicare--is essential
not only to deal with budget issues but also to
achieve improvements for the 37 million people
who depend on the program.
• The adoption of "report cards" t/wt assess Med
icare's performance on the basis of cost, quality,
outcomes, and service so t/wt it can be held ac
countable by enrollees and poIicymakers. These
measures need to reflect a wide range of
criteria, including preventive care, quality of
care, consumer satisfaction, and health out
comes, and should also apply to competing.
private health plans. Report cards should
show national, state-level, and market-area
performance.
The measures that could be used by a refor
mulated Medicare can be illustrated by com
paring current official data reports with new
health-related data that could be a basis for
the above:-described report cards. The most
extensive public Z!ccounting for Medicare's·
operations is the Medicare and Medicaid Statisti
cal SupplemeY!t published in February 1995.4 Its
more than 370 pages are filled with statistics
that emphasize financial, workload, and
claims-paid data, such as hospital days of care
and expenditures, that are appropriate to a
traditional health insurance program. No
where are there measures of quality of care
and improved health status or reports on en
rollee satisfaction.
What should be doI"ie about the basic Medi
care program? What would be in the best in
'terest of its 37 million elderly and disabled
enrollees?
This paper considers the question of wheth
er Congress should give Medicare the same
types of authorities that are available to its
private-sector competitors-particularly au
thorities to use new purchasing techniques
and require performance accountabilities for
their use through HEDIS-like quality and
health outcomes measures. Should not the
nation's elderly and disabled, as well as tax
payers, ask for and expect a state-of-the-art
Medicare program? If this approach were
adopted, Medicare-eligible individuals would
be able to enroll either in a Medicare program
that is working, hard to provide the best econ~
omy, quality, imd serviees or in competing
private-sector health plans that are paid equiv
alent ·(risk-adjusted) capitation amounts. One
mi'ght expect that, over the long term, both
taxpayers and Medicare-eligible persons
. would benefit by such competition.
Two recent studies highlight the kinds of
health-related measures that might be used to
assess Medicare's future performance as an
accountable health plan. The Physician Pay
ment Review Commission (P~RC) and the
RAND Corporation have recently developed a
set of approximately 5Q quality measures that
can be, implemented, using claims data, for the
current Medicare program. Several measures,
"
which have been run against Medicare's na
tional claims data, are shown below in Table
1. A number of them are similar to the
At .the most general leveL reforming the
Medicare program in this way would start
wi th three fundamental changes:
-3
�NCQA's HEDIS· measures used for private
sector health plans. In the view of the physi
Cian consensus panels developing the mea
'sures, these are "necessary care" indicators;
that is, professionally acceptable practice
should be near 100% compliance.
as mammography and eye exams for diabetics,
for which there should be failing grades, "D"
or "F," as well as many indicators in the 60%
to 85% range where care falls well below pro
fessional standards. The study also highlights
. particular problems for minority populations
'
and for rural and underserved areas,s
Another recent study, by Lewin-VHI for the
National Institute for Health Care Manage- '
ment, analyzed Medicare hospitalization rates
for three diagnoses that are sensitive to good
ambulatory care and preventive measures. For
1992, the study reported Medicare hospitaliza
tion rates for asthma to vary by more than 3:1
among states, hospitalization rates for diabetes
by more than 5:1, and hospitalization rates for .
hypertension by more than 8:1. Even after
statistical adjustments for demographic charac
teristics, several-fold variations still remained. 6
'. ABLE 1
T
Clinically Based Indicators of
Quality of Care for the Elderly
Medicare Claims Data, 1992 and 1993
Breast Cancer
For patients with breast cancer,
interval from biopsy to surgery
less than 3 months
.
"
64%
'Mammography every year for
patients with a history of
breast' cancer
61%
Mammography every 2 years
in female patients
39%
Given such statistics"any presumption that
Medicare has already become the "gold stan
dard" of quality care and that it is up to its
competitors to prove their superiority should
be put aside. Medicare's performance needs to
be measured and accountable on the same
basis as its competitor plans, so its enrollees
can make informed choices.
Diabetes
Eye exam every year fo,r patients
with diabetes
38%
Heart Problems
Visit within 4 weeks following
discharge for patients hospitalized
with MI
84%
EKG during ER visit for
unstable angina
The third fundamental change that would' .
need to occur for Medicare to become more
like a state-of-the-art accountable health plan
.is the following:
81 %
• Medicare should have new authorities to pur- .
chase health care on the basis of explicit quality
and other criteria and competitive performance.
Within the many statutory constraints Medi
care has to operate under as a government
program, it has generally been run effec
tively, efficiently, and with contir\u~ng im
provement and innovation. Given its con
straints, Medicare is now about as good a
program as it can be. But, in nearly every
area-:-suchas three-year;-long rule-making
processes,volume increases and quality
assurance issues, fraud and abuse, and rap
idly rising budgetcosts-'-it is clear that
Medicare cannot deal a's effectively as it
Mental Diagnosis
Visit within 2 weeks foHowing
discharge of patients hospitalized
for depression
95%
The PPRC-RAND study shows several. qua
lity indicators on which the care received by
,
Medicare elderly patients merits an "Alf
(95%+) on a nationwide basis. But it also high
lights a number of prevention indicators, such,
-4
�needs to with the complexity and pace of
change in today'shealth system, nor can it
hold physicians; hospitals, and other provid
ers accountable for improving their perfor
mance. To improve Medicare's performance,
Congress needs to provide authority to
move beyond the limits of regulatory rule
, making and price-setting so that Medicare
can adopt the same types of successful pur
chasing techniques pioneered by private
sector payers. Such evolution could build
incrementally through many Health Care
Financing Administration (HCFA) initia
tives, but, if fully reengineered, the Medi
care program would be quite different a
decade hence. Such changes will require a
new bipartisan political consensus.
The next section elaborates on management
challenges for the Medicare program's future if
it is to be an effective health care purchaser.
Following that is a discussion of specific legisla
. tive changes needed to allow Medicare to be an
effective purchaser and competitive health plan.
A third section sketches a research agenda for
developing a Medicare management strategy to
use these new statutory authorities. A final sec
tion discusses issues related to competition be
tween a reengineered Medicare program and
competing private-sector health plans.
THE CHALLENGE OF MEDICARE
, MANAGEMENT
For the federal g~vemment, serious efforts
to manage Medicare as an accountable health
plan would be among the most enormous and
complex tasks it has ever undertaken. To put
the task on the scale of private-:-sector enter
prises, the Medicare program, with $160 bil
lion of spending in 1994, has passed General
Motors-with' $154 billion in revenues, the
nation's largest private company-to become'
-the nation's largest business-type operation.'
In 1994, only three privately managed U.s.
corporations (General Motors, Ford, and Ex
xon) had more than $100 billion in revenues,
11 h~d $50 billion or more in revenues, and
110 had $10 billion or more in revenues. To
day, 37 million persons depend on the Medi
care program, Within 30 years, as the baby
boom generation retires, Medicare will be pur
chasing health care for about 70 million per
sons, and its annual spending will be many
times greater than it is today.
, An understanding of the challenges of chart
, ing Medicare's,future begins with an under
standing of the scale involved. Nevertheless, '
there is a widespread misperception about the
, Medicare program that must be dealt with to
understand just how difficult it will be to
manage the program. That is the myth of uni
formity, predictability, and gradual change.
Medicare can seem to be a deceptively sim
ple and easy-to-reform program. Its enroll
ments, financing, and benefits are defined in
statute. It has a centralized administrative
structure (DHHS/HCFA); a uniform set of
regulations; payment rates for hospitals, physi
cians, and other service$ that are specified by
national formulas; and a national quality as
surance/peer review structure, the Profes
sional. Review Organization (PRO) system.
Individuals who are not health services re
searchers also tend to presume that health
care is enough of a science that area-to-area
rates of service use will be roughly uniform
and that clinical practices change gradually,
primarily as' a result of the steady accumula
tion of scientific data. A misperception that
the health care system is evolving in gradual,
uniform ways is also reinforced by national
health expenditure and Medicare actuarial
data that aggregate a vast number of complex
changes and variations into single categories
such as "intensity."
::rhe following selection of data illustrates
how far assumptions of UnifOrmity and steady
change are from the Medicare program's reality.
.• Hospital use. Even on a regional basis, Medi
care enrollees' use of hospital care varies by
a ratio of 2:1-from 1,735 days/1,OOO en
rollees in the western states to 3,455 days/
1,000 enrollees in th~ northeastern states in
1992. As they have for years, hospital
�lengths of stay continue to average about
50% longer in the northeastern states (lOA
days) than for the western states (6.7 days).B
expenditures rose at a national average of
8.8%. Here again, substantial national diver
sity, rather than uniformity, is the dominant
pattern. The rate of increase varied more
.RIltes of change in hospital use by diagnosis
than 3:1 among states-from 4% to 5% an
related groupings (DRGs). In the 1988-1992
nually in California and Hawaii to between,
period, hospital discharges for Medicare
13% and 16% annually in South Carolina,
enrollees rose by 8.3%. Of the 65 leading
Delaware, Kansas, Nevada, and North Caro
DRGs, however, only 12 had increases be
lina. 12 ,
tween 0% and 20%. Seventeen- DRGs had.
increases of 20% to 40%, 9 rose by 40%,to
• Growth in physician procedures. Over the
'60%, and 5 increased by more thaI) 60% in
19~f.1994 period, the growth rate of Part B
. the four-year period. The most rapid in
,services. avera'ged 3.5% annually. Behind
these averages, however, were quite differ
creases were reported for DRG 88 (chronic ,
obstructive pulmonary disease), 219%; DRG
ent and rapidly changing patterns for: differ
462 (rehabilitation), 103%; and DRG 214
ent services. Echocardiograms increased at a
(back and neck procedures with complica
19:3% annual rate, angioplasty at 17.1% an
tions and/or comorbidities), 75%. Dis
nually, MRIs at an 11.9% rate, arthroscopy
at 9.1%, coronary artery bypass grafts at
charges declined for 22 DRGs. Eleven DRGs
had declines of between 0% and 20%; 8 de
8.8%, and joint prostheses at 7.3% per year.
clines were in the 20% to 40% range; 3 de
Among the declining procedures were trans
clined .by over 40%. The DRGs that de
'urethral prostate surgery, falling 9.9% annu
creased most were DRG 90 (simple pneumo
ally, and cataract lens replacements, falling
2.3% annually.13
nia and pleurisy) and DRG 96 (bronchitis
and asthma with complications and/or co
A common-sense view might be that high
morbidities), which had declines of 52% and
use areas would probablya,lso be areas of
58%, respectively.9
high overuse. This a~sumption was rigorously
tested by RAND researchers using 1981 data
• Nursing home use. Rates of nursing home use
varied by 6:1 across states. Minnesota resi
for three procedures: carotid endarterectomy,
dents used 1,364 days/1,OOO enrollees, Con
coronary angiography, and upper gastrointes
necticut residents 1,235 days/1,OOO enrollees,
tinal tract endoscopy. The rates per 10,000
elderly varied among three sites by 3.8 times
and Indiana residents 1,067 <?ay~/l,OOO en-
for carotid endarterectomy, 2.3 times for angi
rollees in 1992. Among the low-use states
oplasty, and 1.5 times for uppergastrointesti
were Maine (248 days/1,OOO enrollees),
Oklahoma (326 days/l,OOO' enrollees), and
nal tract endoscopy. Their findings were that
" rates of inappropriate use were not much dif
New Hampshire (327 days/1,OOO enrollees).10
ferent between low-use and high-use areas.
• Home health use. The rate of home health
However, rates of inappropriate use for all
visits per 1,000 enrollees varied by ,more
three procedures were significant, ranging
than 17:1 among states in 1992. The high
from 17% to 32%.14
use states included MississippL with 11,786
One might be skeptical about some of the
visits/1,OOO enrollees and Tennessee, with
Medicare-reported trends. (Were there really
11,717 visits/1,OOO enrollees. At the other
major e'pidemics of chronic obstructive pulmo
end of the range were Hawaii, with 668
nary disease and complicated back and neck
visits/1,OOO enrollees, and South Dakota,
problems requiring hospitalization of t~e el
with 969 visits/1,OOO enrollees.ll
derly that escaped the national media atten
• Growth rate in part B spending. Over the
tion in 1988-92?) But Medicare has spent a
1986-1992 period, Medicare parr B annual
I
I
,
-6
,
�great deal of effort arid money to improve its
data systems. To the extent that Medicare's
payments do not accurately reflect the services
being provided to its beneficiaries, then far
.more is wrong about provider billings (and
. Medicare administration) than data errors.
cost, and service, and it should also be avail
able for Medicare ad~nistrators.
Among the areas for possible use of such
authorities are:
• Competitive purchasing of standardized services
and supplies, including durable medical .
equipment, laboratory testing, radiology,.
and outpatient surgery
REENGINEERING MEDICARE
MANAGEMENT
.• Establishment of explicit quality and service
performance standards and refusal to do business
with providers that do not measure up. For the
welfare of its beneficiaries, Medicarene~ds .
to m?ve! beyond the minimal participation .
reqUlrements that are now set in legislation.
New standards for providers should include
the HE DIS-type "report card" and health
outcomes measures for whiCh the Medicare
prog:a,rri will be accountable (for example,
phYSICIans who fell below certain standards
in ~rovi~ing mammography screening for
theIr patIents would be dropped' from the
program).
The only way we're going to deliver on the
fulf. promise of reengineering is to start reen- .
gineering management.
-James Champy
If Medicare were to be operated in a more
business-like way, what important changes
should Congress consider making in the Medi
care program's authorities? Many government
sponsored activities do have flexibility similar
to that found in private-sector businesses;
these activities include the Tennessee Valley.
Authority and other power marketing authori
ties, the Government National Mortgage Asso
ciation, and the Federal Reserve Board. But
granting Medicare, with $175 billion ift pur- ,
chasing power and 37 million enrollees, a freer
rein will need to be done carefully and
watched v:igilantly.
• Development and use of centers of excellence and
specialized services contracting. Medicare now
uses such concepts 'in its coverage for trans
plant st:;rvices; private-sector plans use selec
tive contracting even more widely for many
forms of s~rgery; cancer care, mental health,
In general terms, .Medicare needs the authority
a~d so forth. ~ajor expansions may be pos
to select providers based on quantifiable measures'
SIble to develop disease management and
of quality, outcomes, and service and to'use com
preventive services for patients with chronic
petitive purchasing. The heart of a private-sect~r
or high·expense illnesses and for disabled
plan's ability to improve quality and assure
enrollees. Intelligent purchasing by Medi
accountability is its capacity to decline to do
care could call forth better quality, cost, and
business with poor performers and to move
service competition among .providers, to the
. business toward better performers. In contrast, '
benefit of Medicare beneficiaries and tax
Medicare is the pri~e remaining example of
payers. To 'preserve Medicare's role in as
the traditional insurance "any willing pro
suring a broad chOIce of providers, Med'i
vider" philosophy. To be certified as a Medi
care enrollees might still be able to 'go to
care provider usually requires little more than
non-preferred providers, but with higher co
state licensure or accreditation by certifying
payment rates.'
,
'.
organizabons that are provider-dominated.
• Use of case management for high-cost patients.
Congress has created a virtual entitlement for
,Most private-sector health plans have the
health care providers to participate in Medi
flexibility to work with high-cost patients to
care. Competitive procurement is a standard
develop service packages, such as home
business method for assuring good quality,
-7
f
�care, that can better meet their needs. The
Medicare statute does not permit such fl~xi
bility, even when it would be in the best
interests of the patient and the program.
With so many frail elderly and disabled
patients, Medicare might be able to make
good use of such authorities.
Medicare might also be allowed to engage
private-sector law firms to recov~r on behalf
of the government.
• Authorization for Medicare to organize and con
tract for quality assurance at its discretion. Since
1965, the major initiative to improve Medi
care quality has been enactment o(the PRO
• Elimination of notice of proposed rule-making
system. It is an expensive program (costing
process for purchnsing. Like Gulliver tethered
some 5325 million in 1994), deals almost ex
by many bonds, the Medicare program's
clusively with inpaqent hospital care, and has
effective use of its purchasing' power is held
been of questioned effectiveness. The 53 '
back by numerous technical constraints,
PROs are provider-dominated organizations.
some' of which are appropriate to a rule
Most are'physician-sponsored, for example,
making admin'istrative style but not to a
by local medical societies, and typically have
bUSiness-type operation. Most important of
a board of directors composed primarily of
these is the Notice of Proposed Rule Making
physicians and other provider representa
requirements that now involve at least a
tives. Medicare ~art B senrices are largely
, three,.year process for major Medicare policy
subject to quality review by the claims-paying·
initiatives or changes. Such rule-making is
carriers. As noted in an Institute of Medicine
frequently, in essence, simply a stat~ment of
report on Medicare quality improvement, the
contractual terms, that is, what Medicare
implementation of a new health,-o'riented mis
will and will not pay for, under what terms,
sion for the Medicare program will'r~quire
and in what circumstances: A private busi
far-reaching administrative, contractual, and
ness that had to go through a three-year
other changes that include reconsideration of
process any time it wanted to write or re
PRO, carrier, and HCFA roles. 17 Would a pri
vise a contract with its suppliers would '
vate-sector purchaser, intent on improving
probably be in the same financial predica
quality of care, want to be constrained to con
tracting with a medical society or provider:
ment as the Medicare program.
dominated organization?
• Authorization for Medicare simply to drop provid
ers in the best interests of the' program to deal
• Publicity about data on quality and service.
with fraud and abuse. In recent testimony, a
With the advent of HEDIS and buyers in- ,
G()vernment Accounting Office (GAO) official
sisting on accountability, provider secrecy
about quality problems is being replaced by
noted that the Medicare program is "over
publicized reporting in the! private sector.
whelmed" by fraud and abuse and that it is a
Statutory change should also allow this ap
"particularly rich environment for profi
teers."15 Among Medicare's many problems
proach to be adopted by the Medicare pro
gram. Such publicity abput where physi
are the difficulties of kicking providers out.of
cians and hospitals stand compared to pro-'
the program and the limited resources made
fessional benchmarks and gUidelines can be
available by the Department of Justice. A'
important acts in themselves to encourage
recent GAO study based on studies of claims
better patterns of care and senrice.
denial rates for 74 senrices across 6 carriers
noted that one-half of denied claims were
• Improvemeni of customer service. The Medicare
submitted by between 2% and 11 0/ 0 of provid
program has never had a strong customer
ers.16 Acting as a business-type purchaser, ,
orientation. As an adjunct to the Social Se- '
Medicare would have authority to simply
curity Administration (SSA), it started with
stop.doing business with any supplier, at its
representatives in SSA's district offices, but
discretion. In areas of widespread fraud,
-8
�.due process and to judicial review for claims
denials. Much of the needed research will be
useful for competing private-sector health plans,
since these plans will face the same issues and
few yet have much special expertise in manag
ing care for the Medicare populations .
it lost these community-level staff when
HCFA was established. Customer servic~ is
an area in which Medicare is at a competi
tive disadvantage vis-:-a-vis competing pri
vate health plans.
• fnnctment of special authorities for Medicare in
the 'hiring, promotion, and cO,mpensation of em help Congress, the executive
Research might
branch, and other interested parties in the
ployees. There is no activity which is of larg
following five basic areas:
er budgetary consequence or greater man
agement challenge for the federal govern
• A nntionnl strategy for clinical effectiveness and
ment over the next half century than the
outcomes studies for the Medicare populations,
Medicare program. Today, Medicare is
This strategy could be built by analYZing the
bound by government-wide civil service
Medicare data to identify procedures with
procedures, promotion, firing, compensation
wid~ variations that seem likely to reflect
levels, and personnel ceilings. In' business
overuse and underuse or excessive rates of
type operations, such as the Federal Reserve
. increase and by prioritizing a research agenda
Board, Congress has been willing to make
by potential payoffs in enrollee health and
exceptions so that federal activities can be
program costs. It also needs to include recom
carried out with the required 'professional
mendations concerning funding for the effort,
expertise. In particular, the Medicare pro
the appropriate methodologies to assure use
gram may need such flexibility if it is to
fulness, and an ongoing system to automati
compete with private-sector ·plans.·
cally evaluate new technologies and clinical
Certainly some health care providers-and
practices. The serious shortCOmings of much
of the published literature on medical treat
competing health plans-will question the
ment, well-known to clinical effectiveness
wisdom of such new Medicare authorities. But
why would beneficiaries and taxpayers want
researchers, was highlighted in a recent Ne:w
to keep Medicare from being as good a pro
York Times story of a Canadian assessment of
treatment for whiplash injury that found only
gram as it can be? If. Medicare is expected to
62 of 10,382 studies met the evaluators' crite
compete with private plans for enrollees, why
ria for solid. scientific evidence. IS
should it not have comparable purchasing
flexibility?
• Development of HfDIS-type "report card" mefl
sures for quality /health ou~comes, consumer
satisfaction, and service. These data need to
be collected at the state and market-area
. level, so that HCFAcan manage its carrier/
PRO contractors accountably and so that en
rollees have comparable data to private-sec
tor plans for making their enrollment deci-
sions. These report card measures need to
be selected for their validity and reliability
and should include information that is im
portant to consumers for making choices
among health plans. .
.
A STRATEGIC PLAN FOR'MEDICARE
MANAGEMENT
If the Medicare program, as an accountable
health care purchaser, is to begin to use these
authorities to deal with .quality, service, and
cost issues, where should it start and what
should it do? Given the program's scale and
complexity, a great deal of work will need to be
done to devise an intelligent purChasing strat- .
egy before that question can be answered in a
way that has wide professional and political
support. As a matter of law, Medicare cannot
deal with such problems in an arbitrary or ca
pricious manner. Beneficiaries have rights to
_• Studies oj "best practices" in all major areas of
costs, quality, and serVice. Medicare is a vast
program that has not been very amenable to
-9
�centralized, conunand-and-control manage
ment. Political decision-makers and the
Medicare program have rightfully been
extremely wary about trying to use govern
ment coercion to change medical practices.
Perhaps the best way to foster desirable .
change in a competitive-choice market system
is to make sure that patients, providers, and
competing health plans are well-informed
about the best practices and performance
benchmark standards that they should look
for in making purchasing decisions or should
offer to be successful in the marketplace. The
private sector's new purchasing techniques,
and their applicability to Medicare's popula
tions, need to be carefully assessed.
have also argued that managed competition
will not work well in rural areas. If Medi
care competition is opened up to a wide
,variety of options more attractive than'
HMOs:"-for example, PPOs, point-of-service
(POS) plans, Medicare Select options, and
other arrangements-market research on
their comparative success can yield insights
about how the Medicare program may need
to be changed to better meet the needs and
preferences of its enrollees.
In addition to these areas, th~re are a number
of special study topics that could prove useful
for devising a strategy for Medicare to, operate
as an accountable health plan.
• Special studies of needs and service for Medicare's
disabled populations. Medicare's 4 million dis
abled enrollees have been badly'neglectedby
health policy analysts and in Medicare policy
discussions. Medicare publishes very little
data on their characteri~tics, needs, and ser
vice use. Nevertheless, this is an important
group for analysis, as its rate of growth (4.0%
annually in the period 1982-1992) is more
than twice that of the elderly population (a
1.9% annual increase during the same peri
od); the under-45 disability group has been
growing even faster, almost 11% annually
over this period. With a benefit package fo
cused on acute medical care, the Medicare
program is not well-designed for totally and
permanently disabled per?ons. Since this
• Assessment of where both Medicare and compet to be attractive to private
group is unlikely
health insurance plans, it is particularly im
ing private health plans do and do not work
portant that the Medicare program, as an
well, and why. One of the important open
accountable health plan, make speaal efforts
,issues for health policy is to identify market
to be sure that they are being well served.
conditions where health plan competition
Separate HEDIS-type measures may be need
can improve health care and where such
,ed for disabled subpopulations.
competition does not work well. In today's
market, for example, while the Twin Cities
• Special studies of high-use elderly populations.
area has one of the highest riational rates of
,As is the case with the under-65 population,
HMO enrollment for the under-65 popula
Medicare's spending for the aged is,highly
tion, only 9% of Medicare eligibles are en
skewed, with about 5% of enrollees account
roll,ed. A possible reason is that HMOs can
ing for about 50% of expenditures on care,
not make much money or provide many
10% for about 70% of expenditures on care,
additional benefits for 95% of the Medicare
and about 20% accounting for about 80% of
expenditures in tNs area. Some analysts
• Effective communication strategies. The devel
opment of a national research effort for ef-:
fectiveness and outcomes studies, report.
card data, and identification of best prac
tices need to be matched by strategies to be
sure the information is effectively conununi
cated and that it takes into accountthe
, range of sociological and other factors that
need to be addressed for effective change.
Good clinical research data on outcomes
and effective conununication seem to have
been an effective strategy in the recent de
clines in prostr~te operations and cataract
, surgery, two procedures that had been in- '
creasing rapidly until better information was '
made available to clinicians and patients.
-10
�expenditures on care. Among the high~ex
pense populations are important subpopu
lations With chronic illness. Trying to iden
tify these groups and analyze potential im
provements in their care will be of particu
lar importance for dealing with Medicare
spending issues. To the extent that such
high-use groups remain with the Medicare
program, it will be even more important for
Medicare to have a scientifically strong clini
cal basis for assessing their needs and care.
• Better risk-adjustment mechanisms and proce
dures. It is 'predictable that the basic Medi
will
care program
continue to have a less
healthy population than competing private
health plans, at least for the foreseeable fu
ture. This will be an ongoing area of re
search and policy analysis. Perhaps an inde
pendent or quasi-independent organization
. should manage the annual "open season"
competition between Medicare and private
health plans to help assure fair, well-in
formed choice by eligible individuals.
• Special studies of disease management and pre
This is an outline for a very broad and multi
vention initiatives. It may seem unusual to.
think about prevention and long~term dis
ease management for Medicare enrollees;
but its elderly enrollees are in the program,
on average, for over a decade, with some.
enrolled for up to 40 years; its disabled en
rollees receive benefits for even longer.
Among 'prevention initi~tives reported by
HMOs for the over-65 are activities to re
duce falls, a leading cause of hospitaliiation
in the elderly, and to identify inappropriate
. prescribing and potential drug-drug interac
tions. As an increasing number of pharmacy
benefit management and other firms de
velop disease management expertise, it will
be important to assess the potential of these
developments for the Medicare population,
particularly in light of the many studies that
show rnisprescribing for the elderly.
year research agenda. But such an effort is
needed, by both public and private sectors.
Over the past 10 years the primary focus of
Medicare policy has been to design, implement,
and refine its price controls-using DRGs and a .
resource-b,asedrelative value scale (RBRVS).
Today, there is very little that is "on the shelf"
that can be implemented in the short run.
. CAN MEDICARE COMPETE
SUCCESSFULLY?
Given new accountabilities, new' management
authority to purchase health care, and a strate
gic plan for its future, can Medicare compe~e
successfully with private health plans for the
benefit of the elderly and disabled? Why not
just leave Medicare alone as a traditional bill
payer and hope that it will whither away as
beneficiaries choose better-managed private'
health plans? There will be those who believe
that privately managed health care plans will
out-perform any new-model, government-run
Medicare program in head-to-head competition
and that trying to manage Medicare as a com
petitive health program is hopeless or unwise.
• Policy development for,post-acute hospital care..
A particularly rapid part of Medicare's re
cent growth has been in post-acute hospital
care. Between 1992 and 1993, Medicare
spending for home health and skilled nurs
ing care each gre\y by about 40%, to a total
of nearly $17 billion. Rehabilitation therapy
'claims are growing about 30o/~ a year. 19 This
entire policy area needs careful review, in
. conjunction with the Medicaid program,
which is the nation's largest financerof
long-term care, to rationalize the service
efforts. Standards of appropriateness of care
are more difficult to come by in this area'
than for clinical effectiveness and outcomes
studies of acute care.
Nevertheless, the Medicare program is still
the choice of over 90% of its eligible popula
tion (and, in a majority of states, of 99% or
more of eligibles), and it seems premature to
predict Medicare's demise or to make an un
challengeable case about private health plans'
interest and ability to compete, on a nation-.
\vide basis, for the Medicare population,.
-11
�"
particularly its high-expense frail elderly, chro
nically ill, and disabled populations. Given the
current &ituation, it would be a high-;stakes
risk to ignore upgrading Medicare and place
all of the nation's Medicare budgetary bets on
presumptions about t~e success of private
sector plans that may prove to be wishful
thinking. In addition, the federal government
has a number of strengths to build on in try
ing to make Medicare a better program.
Among these strengths are: .
actually pay claims. Federal employees
oversee system of some 74.private contrac
tors (called intermediaries and carriers
mostly Blue Cross/Blue Shield plans or
commercial insurers) that actually run the .
program on a day-to-day basis. These pri
vate-sector insurers-themselves now in
volved in developing and managing private
health plans-bring administrative flexibil
ity, staffing and subcontracting capabilities,
and expertise in local markets. When Medi
care was first established, its contractor sys
tem offered administrative capabilities the
government did not possess and could not
develop on the scale and in the time frame
that was needed. A well-managed Medicare
program might be able to take advantage of
this flexibility, in new relations with its con
tractors. 'As discussed in a recent c'ompanion
. piece,20 the Blue Cross Blue Shield Federal
Employees Plan managed pharmacy benefits
program offers a model for how state-of-the
art managed care programs can be devel
oped and offered in a government-financed
framework for public beneficiaries. Medicare
might be able to cross-fertilize between
HCFA's rule-making and bill-paying culture
and the private payers' purchasing culture
to produce hybrid plans through joint ef
forts with its primary contractors.
a
• Good track record. It is fashionable to dispar
age government competence, but, compared
to much of the private insurance industry,
the Medicare program has an excellent track
record f9r innovation and efficiency, within
its statutory constraints. Through the use of
. DRGs and RBRVS, Medicare has led private
payers in reducing payments for overpriced
procedures and using purchasing power to
restrain inflation and rationalize payment
rates. Medicare has also led in investing in
medical' ,efficacy studies and protocol devel
. opment to improve clinical practices reflect
ing outcomes research (through-the Agency
for Health Care Policy and Research
[AHCPR]); publicizing information on com
parative provider quality, for example, hos
pital mortality rates and nursing home re
views; setting up standardized data systems;
establishing electronic submission of claims;
and overall administrative efficiency. In all
of these areas, Medicare ' still betters the pri
vate insurance norms. Among recent inno
vative steps are beneficiary surveys, a con
sumer information strategy (immunizations,
ma~ography), a coronary artery bypass .
surgery demonstration with bundled pay
ment rates, Medicare Select demonstrations,
and perfomi.ance contracts with PROs. With
a new statutory mandate and authorities,
Medicare mayalso excel in new competition
vis-a-vis private health insurance ·plans..
• Public trust and freedom of choice. While gov
ernment, in general, may be viewed with'
distrust and suspicion by many voters, the
Medicare and Social Security prograrris re
tain strong senior citizen support. Medicare
remains the program of choice of the el
derly. In the Medicare program, enrollees
have much broader freedom to choose a
provider than in private managed care
plans. They also have legal rights and due
processes that help to guarantee their 'bene
fits-and an ability to appeal to their mem
bers of Congress for assistance.
• fleXible administrative structure. Medicare is
normally thought of as a government-run
program, but, in fact, no federal employees
• Enormous purchasing power. Medicare is the'
nation's largest health care purchaser, with
an estimated $175 billion of spending in
-12
�1995. In 1993, it accounted for 19% of
personal health care expenditures, including
28'%' of hospital care expenditures, 20% of
physician care expenditures, and 39% of
home health expenditures. The price dis
counts, Medicare has been able tO,achieve
through DRGs and RBRVS alone-although
now undercut by HMOs in some markets--':
and its high assignment rate (over 96%)
suggest a reasonable amount of optimism
should be in order about the success of fu
, ture purchasmg strategies. If managed pur
posively, Medicare should be able to strike
economic terms that are at least as favorable
as its competing health insurance plans, as
well as use its purchasing discretion for
upgrading quiltity and service standards.
• Data.and research capacity. Finally, Medicare
has an unsurpassed data system, including
claims records on medical services use by
some 37 million enrollees and a potential for
service-profiling and quality-auditing most
ofthe nation's health care providers. This is
a unique resource for developing national
management strategies and for rapid. learn
ing about the effectiveness of these provid
ers. Medicare and AHCPR also have a
strong tradition of health services research
and can work with many professional
'
groups in developing clinieal quality indica
tors and improvement strategies.
How best to manage competition between
competitive Medicare and private-sector plans,
all trying their best to enroll Medicare eligibles
with the most attractive benefits, costs, qual
ity, and service, is a complicated topic in its
own right. If reengineering Medicare; as de
scribed in this paper, is a primary challenge,
another ongOing challenge of daunting com
plexity will be to assure that competition .
among Medicare and competing health plans
works well. Congress is now in the midst of
debating many major policy questions, includ
ing enrollee financial incentives and the poten
tial for budget savings; and there are numer
ous questions which will require long-term
learning agendas.
Thirty years after Medicare's enactment, a
.much-needed debate about Medicare's future is
taking place; its (ocus is whether (and how) the
Medicare program should be rethought in light
of the private sector's transition from bill-pay
ing insurance accountable health care pur
chasing. Whether one favors Medicare reforms
alone, more private plan options alone, or a
"tWo-track" strategy that includes both
approaches (the possibility raised in this P?per),
there are good reasons to proceed with caution
in use C?f either Medicare's new business.;type
authorities or new competitive arrangements.
The welfare of 37 million elderly and disabled
individuals is at stake. While it is attractive to
. '
envision improving the Medicare program, it is
als() important to realize that discretionary au-·
thority c')-n also be misused, and competitive
forces can go awry. The Medicare program'
could be made worse if it is subjected to unreal
istic budget pressures and its new authorities
are used to ration services, or if competing
plans "skim" the Medicare enrollment. As well,
the American tradition of public management
-based on the view that .government officials
should not be allowed to act in ways that are
arbitrary, capricious, and unfair-has usually
insisted on "(1' government of laws and not of
men." But protection of Medicare enrollees in
private plans from poor HMO practices'should
, be no less an issue. 21 With broader administra
tive discretion for political appointees also co
mes increased possibility for the application of
political pressures, from Congress and other '
sources, and the pursuance of personal agendas.
Perhaps the Medicare program is unmanage
able or will prove to be so; perhaps private plan
enthusiasm about the profit potential of.Medi
care enrollees will abate. For many such rea- .
sons, there will need to be a great deal of
oversight and vigilance about Medicare and its
. competitors. Just as Congress established .the
Prospective Payment Assessment Commission
and PPRC to advise on development of Medi
care price regulation, it may also wish to estab
lish a similar advisory commission for an imple
mentation period of market-oi'iented Medicare
reforms.
'
to
-13
�16. Medicare Part B Factors That Contribute to Variations
in Denial Rates for Medienl Necessity across Six Carriers,
GAO/T-PEMD-95-11. .
.
1. Medicare: Opportunities Are Available to Apply Man
aged Care Strategies, statement of Janet Shikles,
17. Lohr, Medicare:.A Strategy for Quality Assurance.
GAO/T-HEH-95-81, February 10, 1995 (Appendix I).
18. ·Study Finds Most Treatments 'for WhiplashAre
2. About 77% of Medicare eligibles already have med
Ineffective," New York Times, May 2, 1995.
igap, Medicaid, or other supplemental coverage, so
switching enrollment to an HMO may provide them
19. !0edicare: High Spending Growth Calls for Aggressive
few additional benefits. Individuals may also be de- /
ActIOn, Statement of William Scanlon, February 6,
terred from enrolling in an HMO because they would
1995', GAO/T-HEH5-95-75.
have less freedom of choice of physicians and other
20. Lynn Etheredge, Pharmacy Benefit Management: The
providers and would not be able to re-enroll in their
Right Rx? Research Agenda Brief, Health Insurance .
current plans if the HMO were not satisfactory. Insur
Reform Project/George Washington University, April·
ers' ability to compete with Medicare is also lessened
1995.
.
because Medicare pays providers well b~low average
private market rates.
.
21. Complaint rates vary by more than 25:1, from '
1.8/10,000 enrollees for Group Health of Puget Sound'
3. An Institute of Medicine committee has also recom
to 45.8/10,000 enrollees at Humana (Florida).
mended that Congress make quality assurance, in
cluding improved patient health outcomes, a funda
mental program goaL See Kathleen Lohr (ed.), Med
icare: A Strategy for Quality Assurance, National Acad
emy Press, 1990. The study, chaired by Steven Schroe
der, M.D., was requested by Congress in OBRA 1986.
ENDNOTES
4. Health Care Financing Review: Medicare and Medicaid
Statistical Supplement, HCFA Pub. No. 03348, February
1995.
5. Physician Payment Review Commission, Monitoring
Access of Medicare Beneficiaries, Report No. 95-1 (forth
coming); S. Asch, et aL, Access to Care for the Elderly
'Project, Final Report, RAND Corporation, April 13,
1995 (photocopy).
6. National Institute for Health Care Management,
Health Care Problems: Variation across States, December
1994, pp. 34-36 (exhibits 4.4, 4.5, 4.6).
7. "The Fortune 500 Largest U.S. Corporations," For
tune, May IS, 1995, p. F-l.
,
8. Medicare and Medicaid Statistical Supplement, p. 199
(table 25).
9.
Ibi~.,
pp. 208 (table 28).
10. Ibid., p. 232 (table 37).
11. Ibid., p. 252 (table
4?).
12. Physician Payment Review Commission, Expendi
ture Limits, July 1993 (~taff paper), p. 62.
13. Physician Payment Review Commission, Anniull
Report to Congress: 1995, p. 20 (table 1-1).
14. M. Chassin, et al., "Does Inappropriate Use Ex
plain. Geographic Variations in the Use of Health Care
Services?" 1.A.M.A., November 13,1987. Ja.ck Wenn
berg has been among the pioneers in Medicare area
variation studies.
.
.
15. Statement of Sarah Jagger, March 22, 1995 (cited in
BNA Health Care Policy Report, March 27, 1995, p. 479).
-14
�SEP - 8 1995
MEMORANDUM
".
September 8, 1995
TO: Carol Rasco and. Laura Tyson
FROM: Chris Jennings
RE: Potential Academic Center Op Ed Piece.
In response to the President's desire to do outreach to the
academic health center community and to request their "eciitorial"
support, we have drafted the attached Op Ed piece.
I would
appreciate your reviewing and making any edits or suggestions.
'I
We've attempted to construct this draft to enable individual
authors to personalize it to their own situations and
experiences.
We will suggest to Marilyn Yager that she provide
this draf.t to likely supporters of the President and combine it
with state and local impact analyses we have already produced.
Hope"you find this to be helpful.
questions.
Thanks.
Please call with any
�DRAFT EDITORIAL
When one of our family members is ill, what do we want ,for
them?
The answer is simple: the best medical care possible,
provided by highly trained professionals, and supported by state
of-the-art research.
And who educates those professionals,
conducts that research, and provides care ,and service in
communities like
----- ? .It is academic health centers and
teaching hospitals [like
----- ].
of these institutions is at risk.
But today, the unique mission
Proposed Congressional cuts in
Medicare and Medicaid, coupled with, changes in the. private
market, threaten the funding that academic health centers need to
continue to serve as the cornerstone of our nation's health· care
system.
The Congressional Budget Proposal
Let's look first at the federal budget.
The Congress
proposes reductions of $452 billion in Medicare and Medicaid over
the next seven
in Medicaid.
years-~$270
billion in Medicare, and $182 billion
Those are staggering. numbers--fourtimes larger
than anything ever enacted.
But to understand their true impact,
it is useful to lOOk at what those cuts will mean for the growth
in spending per person in each of these programs.
Private health
insurance spending per person will increase by about 7.1 percent
annually over the next seven years, according to the
Congressional Budget Office (CBO.)
The Congressional Medicare·
cuts would bring Medicare spending per beneficiary down to a
growth rate of about 4.9 percent annually--or 30 percent below
the private sector growth in
spendi~g
per person over the next
�seven years.
The Congressional Medicaid cuts are even worse-
bringing the Medicaid growth rate down to about 1.4 percent per
beneficiary annually--or 80 percent below the private sector
growth rate.
The result?
The purchasing power of these two essential
health programs will lag significantly behind the private market
each year for the next seven years.
The beneficiaries and their
families will pay more and, most likely, get less.
Specifically,
each Medicare beneficiary will pay about $2,825 more ($5,650 per
couple) over the next seven years, assuming that 50 percent of
the Medicare cuts comes from beneficiaries [Replace with state
specific data for area in which provider. is located.]
And, the
federal Medicaid cut would force states to cut services, reduce
provider payments, and eliminate coverage for about 8.8 million
children, elderly, and Americans with disabilities in the year
2002, alone.
Impact on academic health centers
What does all this mean for academic health centers and
teaching hospitals like _____?
We intend to continue to take a
leadership role in research and the education of professionals
needed for the future.
innovations?]
[Insert local example of some
Weare also striving to remain competitive as the
health system changes and becomes more cost-conscious. [Insert
exampleof.cost cutting]
But the fact remains that it costs more for us to provide
care because our education and research mission adds to our
patient care costs.
Medicare has historically been a major
�source of financing for medical education.
Medicaid has served
as a payer for poor and sick populations who would otherwise
strain hospitals' ability to both provide quality health care and
education.
In addition, we provide a substantial amount of .
indigent care for individuals who do not have health insurance.
[Insert local indigent care $ or #.)
The reality is that while private payers have borne some of
these costs, they are now seeking the lowest cost services for
their enrollees.
In the increasingly competitive health market,
they are not likely to pay the extra costs of facilities that
also provide education and research.
The support of Medicare and Medicaid for the unique
miss~on
of academic health centers will be reduced dramatically by the
Medicare and Medicaid cuts proposed by Congress., Combined with
the private sector cost-cutting pressures, the magnitude of the
cuts means that academic health centers will face great
pressures.
This lessens the ability of academic health centers
to train professionals, conduct research leading to future breakI
throughs, and absorb the costs of 'providing care to the rising
number of uninsured Americans.
Will the results,be immediate shutdowns, or quick, visible
declines in the quality of care?
Probably not: slow, steady
disinvestment in education and research are never very visible at
first.
But they have delayed effects that may be even more
depilitating in the long run--because today's education and
research directly affects tomorrow's care.
When your family--and
your children's families--need health care ten, twenty, or thirty
�years from now, do you want the health professionals then in
practice to be the product of excellence in education or of a
slo~ly defunded education and research system?
[provider] is committed to maintaining
a~d
enhancing the
quality of our education, research, and service.
That is our
core mission--and reflect's the needs and aspirations of our
community and our patients.
Deep budgetary reductions that
prevent us from meeting your needs--now and in the future--must
be opposed.
The President has made clear that he strongly opposes the
scope and magnitude of the cuts being proposed by the
Congressional majority.
Although his plan does achieve savings
from both Medicare and Medicaid, they are about one-third the
total currently being considered by the Congress.
We agree with the president and the Congress that we should
move forward to balancing the federal budget.
But we.also
support the President's contention that it is unnecessary to
decimate the health care delivery system, and'the patients it
serves.
We all must do our part in addressing the fiscal needs
that challenge this nation.
We look forward to working with the
President and the Congress to insure that goal is not met at the
expense of the vital research and training we have all .come to
rely on and
expect~
�••
SEP 14
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. THE MEDICARE PRESERVATION. ACT OF 19.95
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A .bill tc? 'preserve, ,protect.and ,strengthen Medicare'
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A.n outUM released by 1M House Republican Leatkrship
�5EP 14 '95 15:12 FR.
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INTRODUCTION
According to the Meru:;Slfue Board ofTrustces, which iD:~.nndes three Clinton Administratio!
cabinet secretaries, Medicare ?mIt A next year begins speDding om:t more than it takes in for the 6m
time m. the PIO~'S 30 y~ ilmstory. By 2002, the Trust F~ ~VPll be barJlaupt.
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. If the Pt:Ogram is insa:w=n1, the Treasury can not issue cbn:::cks to pay hospital biUs. IfnoDiD.g.=
is done, the health care ofrrrjl'jcwms oCcurrent beneficiaries amiiillioos' more nearing retiremCDt who
have paid into the system an tb=ir working lives will be thxeate ,!,,!A . Bankrupting Medicare is .
unacceptable public p,3liCY~ .
Republicans proposeto~e, protect and sbet:tth::DMJicdicare \1IIith the Medicare
Preservation. Act of 1995. lqi:rislative language and budgetmys=oringa:re not presently available,. bum
the following outline covers tbe.e-po~cy options contained in _ btiill.
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THE. !rSEDICARE PRESERVATION i.:ACf OF 1995
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The Medicare PtesexyaaiioD Act of 1995 (MPA) will p:c::s=:tve the Sy$tem for cur:tent
.beneficiaries, protect it for iaume beneficiaries, and strengtbc:J. it:tlbrough. reforms thait bavewod:d i.r.in
the private sector.
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Legislation to save 1rrCe:mcare from bankruptcy reYOhJ:s amoUDd ~ key components:
1. Keeping our govemmezrs c:x:ommitment to traditional Meiictac'e. 2. Allowing semoIS the sane
health care choiceS aVailable tao other Americans. 3.. ROCJtini omIt rampant :waste, fraud and .abU£.
4. Max.imi:zing the taxpaye:r hl1ea1th Care dollar. S. Aftl:acac:: ~ for taxpayer subsidized pmmtimns
6. Guaranteeing solvez;lCY imrougb a budgetary "fail ~ew pr-:NiSsioD..
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[policy proposals t:IT trin italiCS). .
'I. TRADITIONAL MEDICARE: KEEPING OUR ~M:Mr1lTMENT..
Just as Republicampm:om.ised throUghout the sum""==, tmaditional Medicare will c:ontinu:-to rile
an option for all current am fi:iD1ure beneficiaries, with four ill:paortant aspects:
Average per 1H:ne~ spending will rise from S4,EOO.? ill 199610.$6.700 in 2~02.
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No change in aJ~nJs.
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. No change in deibCrifibles..
No change in the etrr"TeTJI ratelor premi...mu.
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Today, premiumslI'C:'i31.S percent of Part B t:osts..Prc=miums will continue to be calctiateed. that
way. so that they wiUi.nr::=9se slightly every year, just as 1.br.:r'r.have done since the inception «thee
program,
�SEP 14 '9515:12 FR
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P.04/21
The bill exposes the shameless i=.at taaics of the past few mac .'S.:l11ld'tbe lie·that premium
:::- ': '\ill.auld rise by $2,000 per year. A=cordingto the CongJ"essioul B1I&1ldgd Office, the difference
'W"eal President Clinton's propaa1:1 to drop the current 31.5% I'R laO 15-1. at current spendiq
~15 and maintaining the eunar r.rate at lower level. of inc:rea.seCl tpaald.ing amounb to only $1
:::';10 per month, per benefid.a.ry. Annd beneficiaries will not facc.ltC'! i!:r.a.crease in deductibles and
~ in contrast to the mom!Js ODr demagoguery.'
FOI" ..l Jedicare beneficiaries ../tao want to remain In 1M uisrblg s:;;:n;uem. keeping it Is as simple
==iJecking a box every year. JndNJ." :':;I'S os simple as PlDt checlQng Q :iu.x::r every ;year, since jallllTe 10
::::t:1DSfl ,t:S1lirs in a bene/iclarys tDM11fff11J11ic DrTollme.nJ in lraditionDlltktiitii.CD1'e..
: I H K BEl I'ER MEDICARE: Gl1VING SENIORS MORE CBOICCES
. . The MPA would root om ~~.and bring private sector efticif:u:n' to the system. First, the
=::: le.ts ~\lediCQFe benefictariu dtJome bel'ween lTaditiona/ Med~Core DItZUl several priYa~es~ctor
-=:tOm in a new Medicare Plus pm ~v.ery year. beneficlmies wiI1 re:::r:r:rive a booldeitkscribing the
~owdplans available In their tna..:. Any private 11Lf18erwhoat lez:irr::..r:.overs lhe Medicare benejia
::.=.:: ~ets COllSUmel' protection stawtiaDrds am. mbmit IDI applica#onfir r:::rbe .Medicare Plus booldeL .
~es will simply cheel off. FpllDl o/their choice. Ifa ~ m.aJ:es 1JD choice. he is
:::r:z:rmu:rtic eMolled infoe...fi.:N..~e Medicare.
, The. Mediaue ·.PIUspt:O~ ~ offer: awide 'range oc'choices:ti ~OIS.
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..-,nlinated Care. Coordinated c:m:ue companies are likely to ofRr ~ options for. seniors. In
:i:cosing a coordinated·aue plan,. s=morlD,ight agree t9 a.limited ch~ ofphysician:i or other
~ders in return for more benefits thiwi Medicare now offers. Such ~ts ClJuld include less 0111
7tJOCut expensesfor COinsvroNz ant:Ul ded:uctiblu.· and/or added biftltiiJdJs like outpatient prescriptioc
::::::pp. pt>evenlive care,. eyeglasses r.znti.:J. hBoring aids.
All coo1'di1ll2ted core plans -=at meet solvency requirenpmts, :lIitZ:.d offer a minimum benefit '
==:::.:tage equal to that 01MemcorL.
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.:.redicaJ. Savings Accounts.. The Mc:di~ Plus program will also a!i::::I a Medical Savings AecolUl!S
~It:!edisave) option to all seniors. .A 1l!.'enl0l' choosing Medisave wcn.dJi:tr:I a high..deductible insu:rt117l2
-=z:Ub:y along with a cash deporiJ iI a l Medit:aJ Savings Accoll1ll that w:rD.u:id ctJVer a significant portior.
tiedzlcfible. The high-dedw:tibUie policy would have no copaym!!'ti:r.;. so lhatseniors would be
---:rUTed a limit on their O'Ul-o/-por.ier. t costs~ quality manY are lil:eJ.t :c .:7lind attractive.
.'-;:-me
Seniors choosing this op6l:n ~ould have complete control ov= t:::I:.De dollars they spend on
.c:mine medical care. They could maiake important medical decisiom"lri:ti::h their doctors, without
~ about an insurer's or Mtdicr.are"s payment poUcies. They Cllfs;:spend their funds/or whatew:r
~"cal needs they 'have 01' uSe thDn ~.,o purchase long-term care insIraz:mce.
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�SEP 14 '95 15:13 FR
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A beneficiarycQuld IOU funds out 0/her Medisave accoUnt/or non-health related purposes as
long as she maintains a minimum balance 0/60 pe.rcent ofh~r calasrrophi'c insurance deduc(ible. If
the fonds are usedfor non-health care expenses. rhey cue taxed as income. All interest earnings would
be considered taxable income.
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The maximum deductible would be capped to insure consumer protection.
Provider Service Networks. Doctors and hospitals will be allowed to form provider service networks
to cover Medicare benefits, wl/hout the insurance company or rnantJged care company as
intermediary. .A. group ofdoctors or hospitals thatforms a netWork would be required to meet
solvency and marketing req~irements.
Per beneficiary contributions wUl be adjustedfor age and otherfactors. so that Medicare is
providingfunds according 10 need EDch yeDl'.,lhe per benefiCiary contribution 'will increase
according to specljiedgrowth rates. established to ensure 'h.at Medicare, remains solvent. Every plan
participating in Medicare 'must agree to taJce all applicants 'and allow everyone 10 'Stay in the plan as
, long as they want - no one will be shut out due to Dn illness or a pre'-existing condition.
3. ROOTING OUT WASTE, FRAUD AND ABUSE.
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Ask just about any senior who has used the Medicaie'system and they can tell you why
Medicare spending is out oecontrol.The sy~em is riddled wiUt waste, abuse and outright fraud. In
huildteds of town hall meetings and tens ofthousands ofletteafIom an~ seniors~ Republicaris '
listened this sprinS; and summer to story after story of a Medicare system that needs greater scrutiny.
, Whether it was th~ stot)' ,of a. woman who went into the hospital'for eye surgery and was charged for an '
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autOpsy, or the gentleman, who was charged S14~OOO for a ~ee a.nd a half hour hospital stay, the
message from seniors over American is ,the same: Get gd of the fraud and abuSe..
all
The General Accounting Office notes "Since Medicare was enacted in 1965. the delivery of
health care services has become more complex. but Medicare's fraud and abuse controls have not kept
pace." In other words, like much of1he Medicare program, the enforcement component has not
adapted to the !lew realities of the hwth care market.
Market incentives and private sector competition,as described above are not enou&h, to clean up
fraud and abuse.· The Medicare PreserVation Act will enhance the enforcementsy~tem and give
patients incentives to scrub their bills, for mistakes. 'The Medicare Preservation Act provides the
Departmenl ofHealth and Human &rvlces the authority to reward benefiCiaries who report incidences
of waste, fraud and abuse.
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'The bill would require sldlled nursingfacilities ahd homehlalth agencies to provide cost
patient, beel/nUIl makingpricing publicly available guards against later bill·
estimates up fronlto
padding. The plan also imposes significant penaltieS on anyone who defrauds Medicare.
any
�SEP 14 '95 15:13 FR
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The Medicare Preservation Act
Myths, Facts, Questions and Answers
THE PROCESS
MYtH: You're ramming'this bill through without any real hearings.
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• Since the Trustees' report came outin April we've had dozens of hearings and heard
thousands o£pages oftestimQny.· Outside Washington, Representativesh,ave been talking to,
seniors. providers, hospitals and insurance companies, explaining the problem abd looking
for advice and solutions.
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, • This h~ been an open process,. and win continue to be as we work through the bill in
commIttee. on the floor. and WIth the Senate.
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Presiclent Clinton is going to veto this bill. Why go. through all this?
• President ClinlOn admitted Medicare is going broke and it must be changed if it's to be '
around for our seniors. I truly hope he doesn't choose politics over securing Medicare's
future solvency. '
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What's wron~ with Ross Perot's idea to'try some1ofthesereforms as ·pilot projects?"
• Medicare is in cntical condition. And unJess we enact these reforms, Medicare wtn be
bankrupt.
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• We aren't t forcing new ideas on anyone; instead of bureaucrats deciding what I· best. we re
letting 37 million seniors and disabled Americans make their own choices. And for those
who don t want to cbange, traditional Medicare Will remain as an option and seniors will
always be able to switch back to it. .
Q.
HOW SENIORS WIll BE AFFECTED
MY'rH: You ate forcing people into HMOs.· .,:
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• Senion will have the option to stay in the aurent program. move into a private fee·for
service or ;Dlanaged cace plan..' or pur.cbase a MediSavc Account No one will be fmancially
pushed into any plan - it's up to each senior to decide what's best for him or her.
MYTH: If premiums ina-ease. the practical effect will be to force people inti> D1B1l~ged' care,
whatever their choice. ' .
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• In 7 years, seniors will pay between 57 ·and S10 amooth more than they would under the
President's budget We believe this is a reasonable aM practical cost to ask from seniors tQ
save the program Crom bankruptcy.
Q.
Will seniors get a better benefit package than they have right DOW?
' . Seniors will be guaranteed the same benefits they have now, no matter what plan they.
choose. But they will have the option ,10 choose a plan that may offer, (or example,
prescription drugs or eyeglasses, or preventative care or better hospital coverage in addition
to tradItional Medicare benefits. Or. they may choose aMediSave account with a
1
�SEP 14 '95 15:14 FR
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P.07/21
catastrophic policy that will allow themtotal control over their health care dollars. It's.upto
seniors to decide what's best for them. .
MYTH: Manageq care doesn't work in areas like rural America.
• Thars why seniors will have choices of many types of plans. We know that what works in
Los Angeles won't work in rural South Dakota.
• .We're also going to make it easier for doctors and hospi~ls to network together, to provide
health care at a better value.
MY'ni:
lJle poorest and most wlnerable seniors won't be assured Medicaid will cover their .
nursing care.
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• Rather than relying on Medicare and Medicaid interacting properly, we are streamliningtbe
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programs $0 Medicare provides direct relief to low-income seniors. . .
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MYTH: Seniors' out-of-Pocket costs are going to skyrocket.
• Because Medicare is a top-dO'W'D., govemment-designed program, seniors are getting a taw
deal. For example. their bospital - Pan A - deductible is more than S700, and after 2
months, it's about S180 a day.. That's far higherthaa private insurance. And too many dlings .
aren't covered, like prescription drugs and bearing aids, meaning 70010 of seniors have to
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purchase Medigap insurance. at about SI, 200 a year.
• We're offering choices so seniors can choose a plan that offers low copayments and
deductibles.. And we're not increasing co-payments and deductibles for those who wish to
remain in traditional Medicare.
Q.
Will seniors be guaranteed they caD keep their 09111 doctor'?
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• A senior choosing traditional Medicare will continue to have complete choice over what
doctors they see. If'their physician is affiliated with a plan they like. they can choose that
plan. If a senior opts for a MediSave account, he or she can contin.ue to see whatever doctor
he wants.
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MYrH: President Clinton's plan doesn't affect ~~ors, and it makes Medi~e·solvent. Why do
seniors have to pay Cor the government's screw-upa?·
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• President Clinton has never submitted a,Medlcare reform plan. His original budget simply .
let it go broke. We don't know what he plans to do - he talks a good game, but we've never
seen any b i l l . '
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• And President Clinton has used some funny math. If he used the same figures we do, which
are more conservativeabout.gIowth rates and inflation rates, his savings work.out to be S192.
billion -not the SI28 billion he claims. In seven years, that means the difl'erencc b~tweeD
his plan and ours is about a dime on the dollar.
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How will Semors,sign up for these netll plans? .
• Every year, the $ovcroment will send seniors 'I brochure that ouJlines the different options .
. available. This as how federal employees make insurance choie:es each year. Beneficiaries
who do nothing will automatically be enrolled in traditional Medicare. If they want to
choose one oCthe new private plans, they just fill out a form in the booklet and mail it in.
.• After youlre enrolled in the new plan. you have a short time frame to change your mind.. .
And then every year after that. you have the option to switch to whatever plan you choose.
Q.
Q.
What if the voucher isn't enough to buy any plan?
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• Thi~ ;~ not Q voucher program. The federal government is not simply going to give each
elderly a coupon and tell them to fmd their own iD.surance. Every plan that participates in
Medicare will have a contract with the federal government.. assuring they meet consumer
protection standards. Every participating plan must agree to take all appli<;ants. They can t
differentiate between older and younger seniors. or.between healthy or ill seniors. .
�TO
SEP 14 '95 15:14 FR
94562878
• Righ.t now, ~{edic;are spcno:ri..s about $4.800 per benefi~ary, L::m se"<o-en )'ea,rs under our plan.,.
~fedlcare will spend about.:: $6.700. Vlc'vc worked Wlth P£'C't",-iden and doctors, and they
. assure us that's plenty of nmoney for high.:.quality health are.
Q,
Will you increase eo-j:'-.oI)'lDe'nts?
• So.
Q. ,
Will you increase &:d.llUcuDles?
No.
~
Q.
Scniors like the coave::nience of Medicare - there's DO l1eeed to deal with insurance agcms.:s.
Now theylJ have to buy I plum. file claims forms with insur'am:=e companies. and deal with all
tha.t hassle. won't they?
• Seniors don't have to dloaose a private plan if they wish 10 sCitly in traditional Medicare..
• But anyone who has CNecr:llled a claim with Medicare 1a:tovnn it's QOt exactly user.friendly.
Arld if you have Medipp:r', you have to deal with two bun::mu:iaacies instead of one. Many a£f
the private plans etimin:rree a lot of the paperwork for'sen itl \1 s_
.
MYTH: Fly~by.o..ight c:rDDW -will set up scams to rip off 5tAricl!" $, ta.king their vouchers &
ruriniog off with the money. - ieaving them without-health CO\-e:;::age.
. • Seniors will never recavtr.e a check from the government"lllriri:th which they have to buy
insurance_ They'll get a l:oookJ~' make their choice. and m:a:tail'in a form~ Medicare ",ill .
directly reimburse hc:aItb:rplans. And Medicare will only aWlow plans to participate in .
Medicare if they meet st:r:Iric::t co~er protection and othet-! standards. That will prcvCDl
seniors and taxpayers fmmn .gening ripped off- .
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HOW OUR eLAN SOL'Pt:£$ THE'·fROBLEM
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Wbat does this mean::l.for·Medie.are's, binkJuptcy? .
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• Our plan makes Mediame solvent until 2014, just before me baby-boomers retire. We're
'ensuring that Medicare iSs there for todaY's CUtTent and fimwte seniors. ~'e will also appoim:t.a
commission to look beyG:Dnd 2014, and recommend poIidc:cs to address ~e buge demographitic
shift coming then.
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Q.
What abou, Wask:, fifraud.. and abuse?
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• Evelywhere every ~an wea~ ~ver the sUmmer. b.t:e or she heard horror stories abouut,
waste. fraud. ~d abase::. They heard about aoVerDmeut bua:D eaucratswho simply didn~ cmre
about their complaints.. ::mey heard abobthospi1a1s that dicmn-r. YNOrty about correcting mi:s1D.kcs
becai.Lse ·seniors m:o't p:aaying Cor it auiyway.· .
' . .
• Tbey told us about mm~ tests and procedures bet lt81'SC unsaupulous providers Ie
trying to make a quick.t:1luek. They told us about n::ceh~ medical devices they don'toee::d
because someone got u::ilold of their Medicare number. VJ;II e'-l. flx that by giving bene6c:iaaries
,who stay in tJaditiODal~'Medicare a reward for reportingfr:a.:aud. We 11 also require all privaIte
Medicare plans tomainmaia a 1.800 number to receive biIUiingcomplaints. . '
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And most importa:mly, ~'re bringing this system into thee'21st century. By introducing
competition and making providers and insurers com.pea: thor seniors business. seniors willli be .
assured the best bug facr their buck / And that means JXllWViders and insurers will lose
business if they coatim:me to waste m?ney - they '\1II'On t ~ able to afford to tolerate wastr: UD.d .
fraud_
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Q.
Experts believe dlaIz.t options like! coordinated care mci:i Medisave will attract only the
bea1lhiest seniors, leaving t.a sicker and sicker population in. tc:raditional Medicare. How wiD. tf::tD.at
solve the bankruptcy ~:
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�SEP 14 '95 15:14 FR
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• They're wrong. Those seniors with higher health costs will find several attractive private
sector options. The fact is. Medicare leaves seniol'l exposed to far more out-of·pocket risk
than the average priv~te insurance plan.' Beneficiaries .with major illnesses, who are those .
generaUy on fixed incomes, face the prospect at the beginning of each year of a S718 Part A
deductible, a S100 Part B deductible, and,20 percent copayments on most additional medica!
services, along with no coverage for prescription drugs.
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• The only way to avoid these possibly unlimited costs right now is to spend $800 to SI,400
on Medigap insurance. Our Medicare Plus oprions likely will, as is me practice in private
insurance for those under age 6S, offer explicit limits on out-of-pocket liability. mat will be
very appealing to a senior on a flXedmcome who is wonied about mauring large medical
bills during the year.
Q.
HCFA right QOW claims that the Medicare risk contract program actuaJly costs more than
traditional Medicare. How will managed care solve the bankruptcy'problem?
.
• Other studies have shown mat Medicare risk contracts save money. But it's available in only
certain areas, not across the counuy and with major restrictions, so we simply c.aa:itt compare
'today s limited program to the new Medicare Plus system.
HOW DOCTORS & HOSPITALS·WILL BE AFFECTED
MYTH: Cutting doctors' fees means they won't want to see seniors ... that will ration care.
. • Doctors and hospitals must contribute to saving Medicare.. But under a more efficient
. Medicare system, Medicare dollars will go a lot farther tha.tlmey have in the past
fi . If the system gOes ba.nkJ1Jpt. the government cantt pay biUs~ That's what will ration care. ana
we won't let that happen.
..
.
,'.
,.'
Q:
Doesn't cutting doctor and hospital fees for'Medicar.., mean they'll j ust 'pass on tl;lose COSli
to the rest of uS? It sounds like a hidden tax increase..;.
' .
• We are making' the system more efficient and giving doaors and bospitalsmorefle.x:ibility s!
they can better treat patients at reasonable c o s t s . '
.' '
'..
.
Q;
..
'
Ale you doing anything about malpractice reform?
.
.'
,
.
We ve already passed a limit on non-economic damages in our Conna legal reform bill.
Q.
Won', these cuts mean some ruralhospitalswill.have·to close?
,
• Hospitals are going to have to change, to beco.me more efficient. That's happening ill
around the country, because Medical technology has changed. Surgeries that once r~ired
four and five days in the hospital are not outpatient procedures. We tb.in.k rural hospitals'm
as able to achieve efficiencies as W'ban ones.
Q. ' Are you cutting fwiding for graduate medical education?'
, .
'.
• We are making modest reductions in funding and at the same time improving the wgeti.ngu
medical education funds toward ,their best use - training primary care physiCians rather tha:t
, highly specialized doctors who treat fewer patieots. ~.
.
Q.
Will the fail safe mechanisms mean hospitals aDd dOcton won't see me if Medicare n.ms
. over budget?
. .'.
.
. • No. The fail safe is deSigned to make minor adjustments in payments for medical services.
In fact. if providers donI overspend, the fail safe won I even be triggered.
.
.
'
4
�SEP 14 '95 15:15 FR
TO 94562878
P.10/21
GEl\rmQ QUESnQNS
Q.
It's only Part A that's gal:Jing·bankrupt. Wby do you hr.·e~ to increase Pan B premiums and
make reforms to that proguaz?
,
.
• Pan ~ pays hospital bills.. F Pan B pays doaor bills. But its: 5 doctors who put people into
, bosPltalS - you can' Sepii3!HI e the two. And the same repc>crt that warned us about Pan A's
bankruptcy also said that Pl:::3.ttB was gro'WiJtg at uns:u:staiaanble le"'els - 12.1% a year for the
rest of the decade, "'ilile pcrivate insurance costs actua.l~y dm'opped last yeas:.
M:Yl.lf Right now. the gewe r , "meat speads oruy pennies 011 time dollar for administering
Medicare. Private insurers .,."d. far more mODey - meaning !Ser.Uors'Will get less bang for the
'",
• Today. we spend billiOl'5 taO contract out administering}fe=dic:are. and it's impossible to know
exactly how much Mec£i alec spends on paperwork md blm=aucracy.,
'
• Seniors will get a bettcrvaUlue by opening up Medicare 1D a::ompetitiolL Insurers will have
real incentives to· keep ~ overhead down. and that tratcrislates into more money being speat
oa. health care, and less aa:n-pa.~rk. ArJ.y plan that C"2m1!D()t keep its co5tS;down simply will
not be able to compdC b::.Y seo.iors business.
' .
.
• Seniors will compare p'btmS and see which plan is spendin.g~ more on paperwork and
overhead. and which 0l'.III: igsspending more on health ~
buck.. and pay more in papaWWDrk costs.
Q.
I've heard horror mi. 5 S about insurers canceling poIic:ci.es if someone gets very sick.
They also deny or limit c:ow=::m:ge if'someone is alreadysict mnd wants to purchase coverage.
Will that happen to seniol'1i wiIJ:Do choose to buy from privm iimsurers?
"
• No. If a setUor cbooscsta:-;:,.purcbasc a private pl~ they wmIl be guaranteed coverage and
renewability of their pSicides each year. No Medic:a.rcPhms participating insurer can deay
any seoior a plan.
" .
,'
Is this like what thrcrJintonstried to do last year?
• The Clinton bealth C'.aR pi:Jian 'proposed to take everyone's q:nivate health insurance and turn it
over to the government. T;::We're going to take a go:Vera.m.~t insurao.ce program and apply the
,lessons of the private 50 U " I f . '
"
• We're increasing choices Dor Medicare beneficiaries..tb:y·r.:proposed to decrease choices for
everyone. and their pla. ~Id have let Medicare go baniraupt.
Q.
I
MYTII: Your plan is goi%!! 'I!:lO chase dodors out of tradition;pl Medicare.
• Doctors today are ~z away new Medicare patients. beec:ause the bureaucracy is so
overbearing. HCFA a:a:pmloyees with DO medical1raiDing}: regularly overrule doctors
judgments. and dec~ biWled services medically tm1"Wll"J;'l:S$ry. That means the doctors and
patients get stuck with bii:iiJJ.s Medicare won t pay. Our plaiim will give doetors the flexibility to
work with benefic:i.aries ttm determine the besttrean:nem fcior given circumstances. without a
government bureaucrc locokipg over ~ shoulder.
'
.
• Doctors can choose to pa:mnicipate in Medicare Plus plmt..., so they have the freedom to put a
. patient's needs fll'St.
5
�~
What the Clinton .Trustees Said· This Year
About Medicare's Hospital Program:
~
A
\.0
U1
~
U1
~
U1
;:j
.uUnder all the sets ofassumptions, the trustfund is projected
to become exhausted even· before the major demographic shift
begins. " (page 3)
• UThe fact that exhaustlan would occur under a broad range of
future economic conditions, 'and IS ~xpected·to occur in th.e
relatively' near future, indicatesth.e urgency ofaddressing the
ffllfH§I/Hnfl\/iYfmf;{!{ !mbalance.~' (page 13) .
d
\.0
A
~
f35
a1
Source: 1995 Annual Report ofthe Board of Trustees of the Federal Hospital InsW'8llce Program,
signed by Secretaries Rubin. Shalala and R e i c h '
.
:0
~
~
page 1
"
I\J
~
�MEDICARE HOSPITAL TRUST FUND
EMPTY IN SEVEN YEARS"
(f)
qj
t'""
A.
-
(Trust Fund Reserves)
\D
"U1
~
U1
~
U1
Sblillons
;B
$150
$100
r
$50
$0
(§§O)
d
($100)
Y1.
U1
(J'\
($150)
1993
~
1995
1997
1999
2001
2003 .
Source: 1995 Annual'Report of the HI Trustees, April 1995. p_ 13
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" page 2
r
~
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.....
~
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If We Don~t.ReformMedlc~fe, .
Payroll Taxes Will Have i~ .
. .. Doubleby2020
I
..
toAvoid BaIlkruptcy
-I
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Source: 1995 Annual Rcpor1 of HI Truslees. page 20
1]
.....
~
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. page 3
,
�Private Sector Has Made Improvements
that Can Help Medicare
(j)
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I-"
A
U)
VI
I-"
VI
I-"
en
(1994 Spending Growth)· .
;a
- 12.0%
10.0%
-8.0%
"c'_
6.0%
4.0%
2.0%
- 0.0%
·2.0%
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~
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Medicare
Part A
~
large-
OJ
employer
health
spending
lJ
I-"
Sourc..: 1996 Annual Report of HI Truataaa and HCFA actuaries
page 4
~
I-"
�SEP 14'95 15: 16 FR
.
TO 94562878
..
Tradittional Medlicare
. Keepin~ theComnnitment
.
. .
.
'CopaYllnents: No Change
. '. Deducttibles: ·No <Change· .
Premiums;:· Current J;1~5% Rate
..
,
.
,-
.
.
In 2002, tfue premium forr an average
retiree wrlll be $7 more, -:than under .
. Presidlent Clinton's J!lroposal..
page 5
"
.*, •
�CIIOICE IN MEDICARE
(J)
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Medicare~lus
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ounts' "
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�Monthly Part B Premium: .
. Beneficiary Costvs· Taxpayer. Cost
(J)
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(J'\
(portion ofpremium paid by beneficiary vs. portion ofpremium paid from general revenues)
;a
250
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150
100
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Clinton
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1995
premlulJ}
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page 7
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~
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.....
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• includes a Medisave option
·~l1ows creation of provider
sponsored networks
• empha~izes' previously' passed'
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Hospitals Will Be More Efficient
(f)
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.•
r~peals
Stark I and II excessive regulations'
• e§tRbli§l1e§un ndvi§ory eommi~~i9n on·
-Medicare -:
• establishes a commission to recommend
Medicare policy changes to prepare for
retirem@nt of the bElby boom·~enerfltipn
page 11
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.....
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�
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Carol Rasco - Issues Series
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Carol Rasco
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Health Reform [4]
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Carol Rasco
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2010-0198-Sb-health-reform-4
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https://clinton.presidentiallibraries.us/files/original/a0c8dfbf108a544cbabc2600079e1399.pdf
7cf0f4cad59c29cddb1cee4d783c40a0
PDF Text
Text
tH.EWHIT~ HOUSE
WAS HI NGT,o N
!
.....
March 28,1995,
MEMORANDUM FOR THE PRESIDENT
FROM:
SUBJECI':
" CC:
, C~OL RASCO~
•
,;I
"
,
~,
.
Families USA Prescription Drug'Price Incre~~ Repo+t Analysis and Update'
J
Laura Tyson
.
'
.,
'.
'",
" . You asked for an analysis of the recently released,Families USA report on manufacturerS'
. prescription drug price inflation and a' more general .update on this issue. the following
attempts to be responsive to your request and cOncludes with brief sunuilClryof potential
pO~icy option~.
.
a
'4
'
"
,
•
' .
Background
kIiow,.inadequat~: prescriptio~ drug coverage represents one of our most difficult,
,
expensive, and unsolved health policy challenges, particularly as it relates to older Americans.
As you
Facts that illus,trate this' point include:
.
. rescripth:~n drug costs remain, the highest out-of-pOcket healt~ expenditure for
P
'.
, .,
'.
three out of four semon.
Although they represent only 12 percent of the ,populat~on, older Americans
.' consume 34'pemnl of all retail preScriptions.
.',' , ' ,
.
A im Urb~n Institute study foUUd tJiat 13 percent or' senlon are foreed to
choose b~tween purchasing food, or need~ medications.
", ~ AARP 1994 study found that fully 46 percent of older Americans (13.8
. miilion) had DO prescription drug coverage whatsoever (no Medicaid, no Medigap~
or no private retiree health coverage that covered medications.) : Having said this, most
of the "influential" elderly, i.e., those that contributed to, the repeal of the Medicare
CatastrophiC Coverage Act, ~ave some type.of drug coverage and may not be
interested in helpi;ng pay. for something they already. have.
1 :
. ','
�,
.
-'.I.
.
'
,
,
Although not a"'required benefit, 'every state 'covers prescription drugs in their
Medicaid programs~· It is an expensive benefit, however, al1C;1 there is little doubt ~hat
these drug coverage programs will be vulnerable to' major cuts ortola.·
,.
·
. elimination if Medicaid cuts of the magnitUde tbat some Republicans in the . .
~~',I" .'1~~ :UQ::;;,':'> <".:' ~:.:~':;~" :. ·Can~~ esi ::u·e·'::i:'~ co~sidcrlng·'~~e . ea~ded;;·{the':'pioh!e:!ln with this. hljdg~t--driv~n·~·, .•. .,. .
'. . '.
strategy i~ that the ~hort-termsavings wo~ld be much'more than offset' by subsequent .
cost increases in hospitalization and mental'he~lth care.)
. Families USA Report
The Families USA report, "WorthlesS Promises: Drug COmpanies Keep Boosting Prices,"
alleges that drug ma~ufacturers have not been living up' to their "voluntary" price constraim
pledges. It acCurately charges that the manufacturers continue. to i~crease 'prices faster than .
'. the rate of general inflation for drugs that are sold to retail community' pbarmacies; as a
result, out-of-pocket drug costs continue to grow even more bu~densQP1e, particularly for low
income seniors., .
·
.
~
'.
The study reports that prices of the top. 20 drugs used by all Americans increased in
.
'" price 4.3 percent in 1993, or 1.6 timeS the 2.7 percent increase in general inDation (CPl).
'It also reports that tbe prices of the. tOp 20 ..rugs uSect by older AmeriCans increased by
4~0 percent in 1993, or 1.S times the increase in. general inDation.
"
The .Families'USA report also examines the ·profitabiiity· ~f tht ~rug industry. It reports
· tbat from, 1989 through 1993, the median profitability of all industries was 2.9 percent,.
.
.
while drug industry profitability was IS percent -- S·.times blgher•.
Analysis ~f'Families USA.Rep~rt
". ·1. "InDation
The Families USA report chose to focus on inflation :increases solely to-:retail. pharmacists
because they fill about 8S PerCent of311 out-patient prescriptions:.However;"had tbe"
Families USA analysis: surveyed all purcbaSers, Including HM Os, hoSpitals~ mail order"
pharmacy,as well as retail pharmacists, it would. have reOect~d price increases rougbly
· equal to tbat of the general inDation rate. (In 1994, e.g., the drug manufacturer's inflation
.
· rate was 2.6 ~r~nt compared with tlie 2.7 'percent general 'inflation rate.)
T
· h~, manufacturer's infl~tion rate drops when one inco~rates the non:...retail' purchasers
because the industry gives these purchasers deep discounts and restrains pric'e increases.
·The manufacturers say they give these deals because the non.:..retailer purchasers ....;.- unlike
the retailers .....- move drug produ~t market share, primarily through the use of formularies.
TIle retailers strongly believe they are being" victimized by class of trade discrtm.il!~tion and
have filed a class adion suit alleging RobiDson-l:'atnianAd'anti-competitive violations.
•
'"
',1,.,
2
,
•
f,
" .
I
�,
"
,Regardless of w,hich analytical model'is used, t~ere is no question tbat drug price
inOation has\'significantly moderated ~ince tbe days i~ '·tbe late 1980s 'and early 1990s
when it frequently tripl~ tbe:general inOation rate~ However, since the vast majority of
, "AmeriCans purchase their prescriptions at retailphafmacies, theyrightlyperceivc: that the,
"
::,:,:::",'i': ,,!,:\~;.:,~:'(::;'V!;prlc~s"of' thei¥~fuEdicati(jri "putt;hast~ 'attb ' coriHiluiilgU/i ke':abdVe" the 'iilfl;itior;, rateP'ffhis "tii.aY'" '~'r;;";;~'; ",:;,;,;,:.,
,
help explainwby the Families USA report has received such receptive response.)
a
2. Profitability
J
,The report's Jindhlgs ,on drug profitability' appe~ 'to ~e generally accurate. ,As you know, the
,drug manufacturers have always claimed that their high profits 'are nec:;essary to attract
invesfment in risky and expensive reSearch. I,n the face of market pressures (through
managed care, which now, represents about 35-40 percent of the total outpatient drug market)
and political pressures (through the Whiteijouse, David Pryor, Bill Cohen, the media, etc.) to
constrain price increases, the industry QaS been'able 'to, maintain its, high profitabili~y for
'
several, reasons. They include:'
'
"
Significant mergers, which hav~:increased effici~ncy and eliminated duplication;
The growth of managed care and the accompanying centraliiation of drug,
purchasing, ~l1ich has enabled ,diug manufacturers to reduce, tfie' numbers of
pe~onnel utilized to sell ,(or "detail") new drug prOducts; and, ' ,
,I
"
,
~essive' movement into the 'generic drug marketplace by the ~am~ brand
manufacturers, which has enabled them, to benefit from recent generic drug sales '
growth and to Compensate -for faci that, mailydrugs' are coming off patent.
"
.
Outstanding Questions
1.,. Inflation Moderation: Short,or Long-Term Trend?
"
,
The ob~ious outstanding question relatmg to dluginflation is whether the recent positive
trends represent a short or 'long-term phenomenon. 'Largely because the managed care market
is" expanding at unprecedented levels, it> seems reaSonable t() assume that a recurrence of the, .
price escalation the nation experienced in tlie late 1980s and early 19908 is. unlikely. ---at,
least for the immediately foreseeable futUre.' .
'
.
. One threat to an inflation moperated era might he an attempt by s'ome in the drug industry to
~aJce uncompetitive actions to confront the':current competitive pressures. Some allege that the
seeds of this problem are,already being layed, with the recent purchases of 'Pharmacy: Benefit
Management (PBM) companies (drug cost/management firms wider contract with insurc:rs and '
HMOs) by drug manufacturers. The purchase:of three of,the large~t of these PBMs by
Merck, Eli. Lilly, and SmIth ·Kline means that manufacturers control 63 percent of thePBM
market. . The fTC has indicated that it is' mQilitoring this. trend very closely .
'
.
\,'
3.
�,
"
, ,
,
,
·2. Retail Pbarmacy ~s ,! Purcbaser: ,Wbat is tbeir'Status and Administnition Position?
In the last Congress, in response to conC¢ms rClised by the reta,it ph~acy community, w~,
,.
,': inco, pOi'dteua:;provlsitjr1" HilO' Hi~~'H~alth=Seclifii~'~Att ,(hit '~xplidHy' pr(Jhigitt:(i:'ti~ss:,~o f'U'iidit'" :"i,/:,',~""~:,!,::,:",:>~;
priCing distinctions. Under HSA, as long as the retailers could prove they were providing the
same economic benefit to the manufacturers that other purchasex:swere, the manufacturers,
would have tp provide equal access to disCounts., The enforcement ,stick VIas that the industry,
could nofparticipate iIi out proposed new Medicare' pro~ if'a violation was found.
, The, retail pharmacists strongly supported HS.A largely because of the, "equal aCcess"
provision; to their credit, though, they:stuck with us (and the employer mandate) even in the
worst of times. Predictably; the manufacturers hated this provision and lobbied extremely'
hard against it. (As a result, even in the last COngress, there was not a great likelihood that
the provision would 'have 'survived even had some version of health reform passed last year.)
. '
'.
,
In tbe environment of'a more drug manufacturer-fri~ndly' Congress and In' a session '
'... that ls' highly unlikely to produce a tradi~ion~1 Medicare prescription drug benefit,the.
,potential for passing an enforceable "equal. access" ' provision appears to be' dubious at ,
best. In fact, 'the retail pbarmacists' may well decide they prefer their fate, to be, decided
at tbe State level, in the courts, ,and tbrough tbe development of tbeir own competitive' " '
alternatives. (They may prefer this track rather than riSk a lopsided defeat in the Congress.)
On the competitive.,front, the chain drug stores just recentlyestabli~hed their own Pharmacy.
Benefit'Management company. ' This week we will be, meeting' with theretajl pharmacy :, ' ,
representatives (including Charlie West of NARD) to get a sense of their current positio~ on • "
this issue;
"
"
, ,
3. Lack of Adequate Prescription Drilg Coverage: What are ,the Options?
1be problem .that will not go away is that the millions, of low to middle income class" "
Ani~ricans who ~ave little or no prescnption drug insur~ce coverage'smlply cimD.<>t afford
their medications. TheHSA provided 'for a prescription drug benefit in its basic insurance '
benefit for all Americans. It also 'included a Medicare drug benefit for' all the elderly and:,'
'disabled. However~ a required standard benefit paCkage and a $50-75 bMion 5-year '" " ,~.
Medicare drug benefit is obviously not a politically or economically viable option at this, time;
.
.
.
;,
,
",
'
In-response to your in~rest in tbls area, '~e have been working oD,th~ealternative drug',
coverage options. De fint would require all MediCare managed' care plans to offer a .:~
drug benefit. De second ,would create a Federally-fllnded drug benefit through tbe ': '
, MediCaid prognmfor t,ttose who are eligible for the Qualified Medicm:e Beneficiary (QMB)' ,
program. De third option would pro,vide for a new Federal Matching ~nt program to '
" 'encourage States to setuppbarmaceutical assistancepr.~ms for low:-mcome '
beneficiaries.. Attached are some se~ected pros and eons,of each. If you have any
preferences, please let us know.
'
1
,
,',
�:' ,Require Medicare, Man~gedCare, Plans to Offer Drug ,Benefit
Option ,I:
Pros:
,
.
.,.;'
No cosfio Federal Government.
,,-,'j-:,. ,'",.""
."
"
.:
""'l~'·:)·"
"$0
",
,
.~~'l.\..r.-"",;'''''''''''''~;J'~'~'''' .,.... ,~jO';...- ... :•. ~~!·.~~.-!:-, ...~,~.~l' ..' ......~):,.'~,··'''~,,.·"';" . . ~, .•.
:'f\,
" " ' , ' - " , ' ...
,:;:;:,;';'::1.. ~r':';'~"'''·'W6ula::'-inCi'~asi·'f(6rri'3S:petc~ilt"t<fl00"percel1t-~aie'nun15cl;' ur' Ijian~~d;' ,,',..
,
care plans that offer prescription drug benefits. '
,
"
, ,Provides 'additional incentive for enrollment into managed care. :,
.
.
'
,
'i,'
•
•
I
,'"
Cons:
A required offering could be Perceived.as overly regulatory. '
,
Could lead' to adverse selection of sick people mto managed care plans
arid discourage managed care plans from entering market.
,Could be viewed by some advOcates as presenti,ng a Hobson's choice to
,the' ~lderly: Choosing between keeping aCcess to ~ll doctorS and, need
'to have prescription drug coverage.
Option 2:
Create a Federally' Funded Prescription Drug Benefit through the
Medicaid Program for Qualified.Medicare B~neficiaries(QMBs).' '
"~:'
Would cost 'su~tantially less than a full blown Medicare out-patient
program (this option would cost abo1,1f $9 billion over 5 years) and
would better target the benefit to those who 'aie~most in need.'
Would use the established Medicaid program to expand cove~age' rather
than set up a new funding/administrative' mechanism.
"
.
'
~
•
~'I
I
' ,
•.
•
Cons:
Although States would not pay' for, the new drug coverage, they would
likely face increased costs associated with greater use of the rest of the
QMBbenefit (because the drug coverage would attract more people.)
/ Frequent changes in' the eligibility status will, make it difficult to
distinguish between those 'who get the drug 'benefit because of their dual
eligibility status or their QMB status. (In other words, it ,could well
create administrative hassles and fimmcing disputes with States.)
,
"
' ' ' ' ,
,Option 3:
Develop a New Federal Matching Gr~nt,Program for State-Run
Pharmaceutical Assistance Programs for the Low Income
,"
Pros: '
,
"
,States would have discretion todetennine eligibility and coverage.
ConS:
,
.
.
'
.,
I
Questionable that many States would- opt to partiCipate iIi 'an optional
and po~entially expensive new health program.
,.
,',
"
.
5.
,
�JUL 27 1995
MEMORANDUM
TO:
Carol Rasco
FR:
Chris Jennings and Jen J(lein
RE:
Medicare and Medicaid State by State Analysis
July 27,'1995
Attached is the complete set of state by state analysis on the Republican Medicare and
Medicaid cuts that we are releasing tomorrow. We are coordinating closely with
communications within the White House and HHS to get widespread distribution, particuhirly
in regional press. In addition, we are coordinating closely with Legislative Affairs,
Intergovernmental Affairs, Public Liaison, Political Affairs, and Ca~inet Affairs to distribute
this document.
Highlights of this state by state report include:
t~e
next seven years
.
•
Total Medicare beneficiary out-of-pocket increases over
for individuals. and couples
•
The number of people who would Ipse their Medicaid coverage
•
The combined effect of loss of funding resulting from Republican Medicare
and Medicaid cuts
•
Over one-third of these combined cuts will come from just four states:
California ($54 billion), Florida ($38 billion), New York ($37 billion), and
Texas ($28 billion) .
. If you have any questions, please do not hesitate to call me at 6-5560.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
THE UNITED STATES
The Republican Budget Resolution Conference Agreement:
Impact of Medicare and Medicaid Cuts on States
Republicans are proposing to cut more than $450 billion from health care between
1996 and 2002·-- $270 billion from Medicare and $182' billion from Medicaid. Over one
third of these cuts would come from just four states: California ($54 billion), Florida
($38 billion), New York ($37 billion), and Texas ($28 billion). In combination, these cuts
are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay
at least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
These cuts will affect all states, but some states more so than others. States such as
Florida and Texas, where there are high numbers of beneficiaries, will be particularly hard
hit. California, Florida, Texas, New York and Pennsylvania, for instance, will bear more
than 40 % of all the Medicare cuts. On a per beneficiary basis, Massachusetts,
Tennessee, Alabama and Rhode Island would also have higher than average increases in
the out-of-pocket costs.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services,
provider payments, and eliminate coverage for 8.8 million children, elderly, and disabled
individuals in 2002, according to the Urban Institute. The only way to avoid these reductions
in coverage would be for states to increase their spending by 40% -- by raising property or
sales taxes, or cutting other critical state spending.
The Medicaid cuts have enormously different impacts on states. While all states will
see about a one-third reduction in their Federal Medicaid spending, states with high growth -
for any reason, including recessions or an increase in their elderly population -- will be
particularly hard hit. New York and California alone will bear 20% of the total Medicaid
cuts, while West Virginia, Florida, and Georgia will see the largest reductions as a
proportion of their current Federal grant.
,
'
The President's Balanced Budget Proposal
, The President shows how it is possible to balance the budget, assure, that the Medicare
Trust Fund remairis solvent for at least another decade, and expand benefits and choice of
. plans without imposing any new Medicare beneficiary cost-sharing increases. His Medicare
savings, which are less than half ($124 billion) of the Republican proposal ($270 billion),
come from health care providers and through a major new fraud and abuse initiative.
�Effects ofthe Republicans' .Balanced BudgetProposal (Conference Agreement)
Loss of Medicare and Medicaid Funding by State
..
(Dollars in Millions, Fiscal Years)
2002
Medicaid
Combined
71,000
51,150*
122,150*
1,661
42
1,247
525
9,893
959
1,042
235
1,197
7,789
1,737
362
125
2,218
1,312
414
697
809
1,330
193
891
2,569
1,827
1,264
563
1,280
131
283
533
244
1,940
208
4,481
1,810
133
2,161
633
844
3,785
.403
923
128
1,989
4,539
277
88
879
818
394
765
41
542
121
792
696
5,477
475.
486
98
259
2,704
1,692
161
, 160
1,847
1,290
384
228
1,121
1,511
236
800
1,305
1,778
687
705
433
. 211
224
157
40
1,188
389
·5,863
1,830
118
2,124
642
516
1,906
264
672
123
1,455
3,316
302
99
798
1,053
919
883
72
2,203
163
2,039
1,221
15,371
1,434
1,528
334
1,456
10,493
3,429
523.
285
4,065
2,602
798
925
1,930
2,841
429
1,691
3,874
3,605
1,951
1,268
1,714
342
506
690
284
3,129
598
10,345
3,640
251
4,285
1,275
1,360
5,691
667
1,594
251
3,444
7,855
580
187
1,677
1,870
1,313
1,648
112
Medicare
U.S.
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska'
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
, Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
II Texas
Utah
Vermont
Virginia
Washington.
West Virginia
Wisconsin
Wyoming
Medicare
270,000
-
5,890 .
166
4,626
2,108
36,371
3,434
3,968
865
3,778
28,098
6,519
. 1,253
520
9,078
5,092
1,751
2,650
3,227
5,062
807
3,664
9,464
7,540
4,534
2,232
5,073
538
1,126
1,861
924
7,727
844
18,058
6,749
537
8,868
2,558
3,092
15,053
1,451
3,361
516
7,248
16,991
1,061
356
3,625
3,289
1,586
3,182
179
1996-2002
Medicaid
Combined
171,803*
441,803*
1,733
429
2,672
2,444
18,032
1,654
1,423
331
863
9,691
6,093
572
542
6,120
4,269
1,235
663
3,828
5,151
675
2,702
4,291
5,935
2,134
2,457
1,235
766
728
516·
51
3,701
1,352
18,924
6,764
382
7,088
2,250
1,838
6,123
861
2,281
396
5,090
11,135
1,035
318
2,844
3,719
3,321
2,903
245
7,623
595 ,
7,297
4,553
54,403
5,088
5,391
1,196
4,641
37,789
12,612
1,825
1,062
15,197
9,361
2,986
3,313
7,056
10,213
1,483
6,366
13,755
13,476 '
6,669
4,689
6,308
1,303
1,854
2,377
975
11,428
2,196
36,982
13,513
919
15,956
4,808
4,930
21,175
2,312
5,642
912
12,338
28,126
2,096
673
6,469
7,008
4,907
6,085
424
MEDICARE ESTIMATES; Source: US DHHS. Savings estimates from Conference Agreement. as scored off of the CSO Medicare baseline.
Sased on historical sta~e share of Medicare outlays. trended forward with growth in the states' share of outlays.
Estimates based on Medicare outlays by location of service delivery. Thus. certain state estimates may be affected by
part-year residency and state border crossing to obtain care (e.g., Florida & Minnesota).
.
.
MEDICAID ESTIMATES: Source: The Urban Institute: Assumes growth rates of 7,2% fn 1996, 6.8% in 1997, and 4% for 1998 and subsequent years.
Estimates do not correspond exactly to the CBO estimates of .this propoSals since ihe Urban Institute has 'independently constructed the states' baselines .
• Because the Medicaid estimates are not based on the CSO baseline. the totals are no! equal to those in the Conference Agreement·
�Effects of the Republican Resolution Agreement's Medicare Proposal On States'
Losses by State Under the Proposal Relative to the President's Proposal
(Excluding Premium Extenders in President's Budget, Fiscal years)
Ilncreasea Uut-ot-t"ocket I,;ost t"er ~enetlclary
(Increase in dollars per beneficiary)
1996·2002
$2,825
US
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
lIIinois
Indiana
Iowa
Kansas
Kentucky
louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey ,
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon,
Pennsylvania
Rhode ISland
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
3,775
1,350
2,775
1,875
4,100
3,000
3,250
3,350
NA
\
"
4,400
3,025
3,050
1,075
2,200
2,400
1,300
2,850
2,075
3,575
1,350
2,275
4,300
2,100
2,900
2,175
2,425
1,425
1,700
3,000
2,175
2,625
1,225
2,825
2,400
2,025
2,000
2,000
2,525
2,975
3,650
2,425
1,625
3,850
3,125
1,925
1,475
1,500
1,675
1;800
1,500
aoo
875
Source: us DHHS, Savings estimates from Conference Agreement, as scored off of the CBO Medicare baseline, Rounded to the nearest $25,
Variation in the costs per beneficiary across states reflects factors suCh as: (1) practice pattem differences,
(2) cost differences; (3) differences in heaHh status and the number of very old persons in a state;
and (4) differences in the supply of heaHh care providers,
NOTES: Assumes that increases in beneficiary out-ol-pocket costs (e.g" premiuims and coinsurance) are equal 10 50% of the total cuts,
Based on historical state share 01 Medicare Ou1lays & enrollment, trended forward with growth in the states' share of outlays & enrollment.
Estimates based on Medicare outlays by location of service delivery, Thus. certain state estimates may be,aflected'by
part-year residency and state border crossing to obtain care (e.g .• Florida & Minnesota).
State border crossing makes the District of Columbia estimates unreliable.
REVISED: July 12,1995
�States' LoJses,Under a Medicaid Block Grant, 1996 - 2002
Republicans' Balanced Budget Proposal (Conference Agreement)
(Dollars in Millions. Fisc~1 Years)
Losses in Dollars (1996-2002)
U.S.
. (171,803)
New York
California
Texas
Florida
Ohio
North Carolina
Pennsylvania
Illinois
Georgia
Michigan
Louisiana
Tennessee
Massachusetts
Indiana
Kentucky
Washington
New Jersey
West Virginia
Wisconsin
Virginia
Maryland
Arizona
Mississippi
Arkansas
(18,924)
(18.032)
(1.1.135)
(9.691)
(7,088)
(6.764)
(6,123)
(6.120)
(6.093)
(5.935)
(5,151 )
(5.090) .
(4.291)
(4,269)
(3,828)
(3,719)
(3,701)
(3.321 )
(2.903)
(2,844)
(2,702)
(2,672)
(2,457)
(2,444)
(2.281)
(2.250)
(2,134)
(1.838)
(1,733)
(1,654) .
(1,423)
' (1,352)
(1.235)
(1.235)
(1.035)
(863)
(861 )
(766)
(728)
(675)
(663)
(572)
(542)
(516)
, (429)
(396)
(382)
(331)
(318)
(245)
(51)
Oklahoma
Minnesota
Oregon
Alabama
Colorado
Connecticut
New Mexico
\
olumbia
d
Montana
Nebraska
Maine
Kansas
Hawaii
Idaho
Nevada
Alaska
South Dakota
North Dakota
Delaware
Vermont
Wyoming
New Hampshire
Losses as a Percent of Spending in 2002
U.S.
West Virginia
Florida
Georgia
New Mexico
North Carolina
Arkansas
Montana
. Virginia
Arizona
Kentucky
Alaska
Tennessee
Hawaii
Maryland
Utah
Oregon
Colorado
Oklahoma
Washington
District of Columbia
California
Delaware
Wyoming
Mississippi
Indiana
Illinois
Michigan
Idaho
Texas
Nevada
Wisconsin
Ohio
Massachusetts
Nebraska
Vermont
Pennsylvania
Iowa
New York
Rhode Island
North Dakota
Minnesota
Louisiana
South Carolina
New Jersey
Alabama
Maine
Kansas
Connecticut
Missouri
New Hampshire
Source: The Urban Institute., Assumes growth rates of 7.2% in 1996, 6.8% in 1997, and
-28.9%
-35.5%
-35.2%
-34.5%
-33.9%
-33.8%
-33.4%
-33.2%
-32.8%
-32.5%
-32.4%
-32.3%
-31.7%
-31.7%
-31.6%
-31.5%
-31.3%
-31.2%
-31.2%
-31.1%
-30.7%
-30.5%
-30.5%
-30.3%
-30.1%
-29.9%
-29.8%
-29.7%
-29.4%
-29.2%
-29.0%
-28.8%
-28.3%
-27.8%
-27.7%
-27.3%
-27.0%
-26.8%
-2p.6%
-26.6%
-26.3%
-25.8%
-25.4%
-24.6%
-24.4%
-23.3%
-21.8%
-21.6%
-21.1%
-20.7%
-16.5%
-6.3%
4°,4, for 1998 and subsequent years.
Estimates do not correspond exactly to the CBO estimates of this proposals since the Urban Institute has .
independently constructed the stales',baselines.
�THE WIDTE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28,1995
Contact: 202/456-7150
ALABAMA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Alabama
Republicans are propo'sing to cut more than $4,50 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Alabama by $8 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing hO.me would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $},700 in 2002.
Each of Alabama's over 630,000 Medicare beneficiaries would pay as much as
$3,775 more in premiums and copayments over the seven years; couples would pay at least
$7,550 more. Overall, the state of Alabama would lose $2 billion in Medicare funding in
2002, and $6 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8,8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Alabama would lose $542 million in Federal Medicaid funding
in 2002 and $2 billion over the seven years, a reduction of 22% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
544,000 recipients. According to this study, these cuts would mean that Alabama could
have to cut off coverage for 102,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
\
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Offic'e of Media Affairs
FOR IMMEDIATE
July 28, 1995
I.'-CIJl..Jl.!.tr~...::>1.!.t
. Contact: 202/456-7150
ALASKA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Alaska
Republicans are proposing to cutmore than $450 billion from health care between 1996.
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut forwell-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
. would reduce Federal health care dollars to Alaska by $595 million.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiafy would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Alaska's over 32,000 Medicare beneficiaries would pay as much as $1,350
more in premiums and copay~ents over the seven years; couples would pay at least $2,700
more. Overall, the state of Alaska would lose $42 million in Medicare funding in 2002, and
$166 million over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Alaska would lose $121 million in Federal Medicaid funding 1n
2002 and $429 million over the seven years, a reduction of 32% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current·
69,000 recipients. According to this study, these cuts would mean that Alaska could have to
cut off coverage for 22,000 recipients in 2002, likely adding them to *e ranks of the
uninsured.'
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
'.
FOR IMMEDIATE RELEASE
July 2~, 1995
Contact: 202/456-7150
ARIZONA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Arizona
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
"' would not 'be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Arizona by $7 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002 ..
l
Each of Arizona's over 577~000 Medicare beneficiaries would pay as much as $2,775
'more in premiums and copayments over the seven years; couples would pay at least $5,550
more. Overall, the state of Arizona would lose $1 billion in Medicare funding in 2002, and
'$5 billion over seven y~ars.
'
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, 'elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in ~overage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
'
,
Overall, the state of Arizona would lose $792 million in Federal Medicaid funding in
2002 and $3 billion over the seven years, a reduction of 33% in the year 2002 alone,
accord~ng to the Urban Institute. This will have a devastating impact on the state's current I
510,000 recipients. According to this study, these cuts would mean that A,rizona could have
to cut off coverage for 110,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiatiye.
�THE WHITE HOUSE
,
.
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
ARKANSAS
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Arkansas
Republicans are proposing to cut more than $450billion from health care between 1996
. and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
'would reduce Federal health care dollars to Arkansas by $5 billion;'
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
average
least another $5,650. Under a recent House Republican proposal, in 2002 alone
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
an
Each of Arkansas's over 416,000 Medicare beneficiaries 'would pay as much as
. $1,875 more in premiums and copayments over th,e seven years; couples would pay at least
$3,750 more. Overall, the state of Arkansas would lose $525 million in Medicare funding in
2002, and $2 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes,or
cutting other critical state spending.
Overall, the state of Arkansas would lose $696 million in Federal Medicaid funding'
in 2002 and $2 billion over the seven years, a reduction of 33% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
340,000 recipients. According to t.,is study, these cuts would mean that Arkansas could
have to cut off'coverage for 122,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solyent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a. major new fraud and abuse initiative.
,
�THE WHITE HOUSE
Office of Media Affairs,
FOR IMMEDIATE RELEASE
July 28,1995.
Contact: 202/456-7150
CALIFORNIA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on California
Republicans are proposing to cut more than $450 billion from health care'between 1996
and 2002 -- ·$270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to California by $54 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1.700 in 2002.
I
Each of California's over 3.6 million Medicare beneficiaries would pay as much as
$4,100 more in premiums and copayments over the seven years; couples would pay at least
$8,200 more. Overall, the state of California would lose $10 billion in Medicare funding in
2002, and $36 billion over seven years.
Medicaid .
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of California would lose $5 billion in F,ederal Medicaid funding in
2002 and $18 billion over the seven years, a reduction of31 % in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
- 5.0 million recipients. According to this study, these cuts would mean that California could
have to cut off coverage for 1.2 million recipients in 2002, likely adding them to the ranks
of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact:
202/456~ 7150
COLORADO
The Republican Budget Resolution Conference Agreement:
Impact ofthe Medicare and Medicaid Cuts on Colorado
Republicans are proposing to cut more than $450 billion from health care between 1996
, and 2002 -- $270 billion from Medicare and $182 billio11 from Medicaid. In combin,ation, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for weIr·off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Colorado by $5 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would .face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1 . 700 in 2002.
Each of Colorado's over 409,000 Medicare beneficiaries would pay as much as
$3,000 more in premiums and copayments over the seven years; couples would pay at least
$6,000 m~re. Overall, the state of Colorado wOlild lose $959 million "in Medicare funding in
2002, and $3 )jillion over seven years.
"
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Colorado would lose $475 billion in Federal Medicaid funding
in 2002 and $2 billion over the seven years, a reduction of 31 % in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
289,000 recipients. According to this study, these cuts would "mean that Colorado could
have to cut off coverage for 97,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR
July 28, 1995
IlTIITII".''''Ino.
RELEASE
Contact: 202/456-7150
CONNECTICUT
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Connecticut
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts ofthe Republicans
would reduce Federal health care dollars to Connecticut by $5 billion.
Medicare '
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care seryices would pay on average an additional $1,700 in 2002.
Each of Connecticut's over 497,000 Medicare beneficiaries would pay as much as
$3,250 more in premiums and copayments over the seven years; couples would pay at least
$6,500 more. Overall, the state of Connecticut would lose $1 billion in Medicare funding in
2002, and $4 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals iri
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Connecticut would lose $486 million in Federal Medicaid
funding in 2002 and $1 billion over the seven years, a reduction of 21 % in the year 2002
alone; according to the Urban Institute. This will have a devastating impact on the state's
current 354,000 recipients. According to this study, these cuts would mean that
Connecticut could have to cut off coverage for 74,000 recipients in 2002, likely adding them
to the ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains, solvent for at least another decade, and expand benefits and choice ()f plans
without imposing any new Medicare beneficiaty cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
, DELAWARE
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Delaware
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Delaware by $1 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments overseven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alo~e an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Delaware's over 98,000 Medicare beneficiaries would pay as much as $3,350
more in premiums and copayments over the seven years; couples would Play at least $6,700
more. Overall, the state of Delaware would lose $235 million in Medicare' funding in 2002,
and $865 million over seven years.
Medicaid
The Medicaid. cuts proposed by Republicans would force states to' slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in .
. 2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Delaware would lose $98 million in Federal Medicaid funding in
2002 and $331 million over the seven years, a reduction of 30% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
75,000 recipients. According to'this study, these cuts would mean that Delaware could
have to cut off coverage for 21,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
'
\
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiarY cost increases. His Medicare savings, which are
less than half ($ 124 billion) of the Republican proposal ($270 billion),come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
DISTRICT OF COLUMBIA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on the District of Columbia
.
.
Republicans are proposing to cut more than $450 billion from health care between 1996 ,
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to the District of Columbia by $5 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1.700 in 2002.
I
Overall, the District of Columbia would lose $1 billion in Medicare funding in 2002,
and $4 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in '
2002,'according to the Urban Institute. The only way to avoid these reductions in coverage
, would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the District of Columbia would lose $259 million in Federal Medicaid
funding in 2002 and $863 million over the seven years, a reduction of 31 % in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the
District's current 127,000 recipients. According to this study, these cuts would mean that
District of Columbia could have to cut off coverage for 20,000 recipients in 2002, likely
adding them to the ranks of the uninsured.
The President's Balanced Bud2et Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiarY cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28,1995
Contact: 202/456-7150
FLORIDA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Florida
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Florida by $38 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at'
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average .
beneficiary in a nursing home would face an increase of a~least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Florida's over 2.6 million Medicare beneficiaries would pay as much as
$4,400 more in premiums and copayments over the seven years; couples would pay at least
$8,800 more. Overall, the state of Florida would lose $8 billion in Medicare funding in
2002, and $28 billion over seven years.
Medicaid.
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled indjviduals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be,for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Florida would lose $3 billion in Federal Medicaid funding in
2002 and $10 billion over the seven years, a reduction of 35% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
1.7 million recipients. According to this study, these cuts would 'mean that Florida could
have to cutoff coverage for 706,000 recipients in 2002, likely adding them to the ranks of .
the uninsured.
.
. The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28,1995
Contact: 202/456-7150
GEORGIA
The Republican Budget Resolutio~ Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Georgia
. Republicans are proposing to cut more than $450 billion from health care between 1996 .
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare.cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period; the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Georgia by $13 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pavon average an additional $1,700 in 2002 .
. Each of Georgia's over 811,000 Medicare beneficiaries would pay as much as $3,025
more in premiums and copayments over the seven years; couples would pay at least $6,050
more. Overall, the state of Georgia would lose $2 billion in Medicare funding in 2002, and
$7 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending .
. Overall, the state of Georgia would lose $2 billion in Federal Medicaid funding in
2002 and $6 billion over the seven years, a reduction of 35% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
1.1 million recipients. According to this study, these cuts would mean that Georgia could
have to cut off coverage for 383,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budeet Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28,1995
. Contact: 202/456-7150
HAWAII
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Hawaii
Republicans are p:roposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care .dollars to Hawaii by $2 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing horne would face an increase of at least $1,400. Beneficiaries using
horne health care services would pay on average an additional $1,700 in 2002.
Each of Hawaii's over 146,000 Medicare beneficiaries would pay as much as $3,050 .
more in premiums and copayments over the seven years; couples would pay at least $6,100
more. Overall, the state of Hawaii would lose $362 million in Medicare funding in 2002,
and $1 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
OveraH, the state of Hawaii would lose $161 million in Federal Medicaid funding in
2002 and $572 million over the seven years, a reduction of 32% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
121,000 recipients. According to this study, these cuts would mean that Hawaii could have
to cut off coverage for 36,000 recipients in 2002, likely a~ding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiatyco'st increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billiori), corne from health care
providers and through a major new fraud and abuse initiative.
.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
IDAHO
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Idaho
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts.
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the· seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Idaho by $1 billion.
o
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Idaho's over 146,000 Medicare beneficiaries would pay as much as $1,075
more in premiums and .copayments over the seven years; couples would pay at least $2,150
more. Overall, the state of Idaho would lose $125 million in Medicare funding in 2002, and
$520 million over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state ofIdaho would lose $160 million in Federal Medicaid funding in
2002 and $542 million over the seven years, reduction of29% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
110,000 recipients. According to this study, these cuts would mean that Idaho could have
to cut off coverage for 34,000 recipients in 2002, likely adding them to the ranks of the·
uninsured.
a
The President's Balanced Budget Proposal
The President sho~s how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28,1995
Contact: 202/456-7150
ILLINOIS
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Illinois
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
'.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Illinois by $15 billion.
(
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an·increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Illinois's over 1.6 million Medicare beneficiaries would pay as much as
$2,200 more in premiums and copayments over the seven years; couples would pay at least
$4,400 more. Overall, the state of Illinois would lose $2 billion in Medicare funding in
2002, and $9 billion over seven years.
\
Medicaid'
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Illinois would lose $2 billion in Federal Me_dicaid funding in
2002 and $6 billion over the seven years, a reduction of 30% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
1.4 million recipients. According to this study, these cuts would mean that Illinois could
have to cut off coverage for 274,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a majo! new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs '
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
INDIANA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Indiana
Republicans are proposing to cut more than $450 b,illionfrom health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Indiana by $9 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each ofIndiana's over 813,000 Medicare beneficiaries would pay as much as $2,400
more in premiums and copayments over the seven years; couples would pay at least $4,800
more. Overall, the state of Indiana would lose $1 billion in Medicare funding in 2002, and
$5 billion over seven years.
Medicaid
The Medicaid cuts ,proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Indiana would lose $1 billion in Federal Medicaid funding in
2002 and $4 billion over the seven years, a reduction of 30% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
605,000 recipients. According to this study, these cuts would mean that Indiana could have
to cut off coverage for 112,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains.solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�.THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
.Contact: 202/456-7150
, IOWA
The 'Repub'Ucan Budget Resolution Conference Agreement:
Imp:;lct of the Medicare and Medicaid Cuts on Iowa
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from MediCaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off AmeriCans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Iowa by $3 billion.
Medicare
.Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average 'an additional $1,700 in 2002.
Each ofIowa's over 472,000 Medicare beneficiaries would pay as much as $1,300
more in premiums and copayments over the seven years; couples would pay at least $2,600
more. Overall, the state of Iowa would lose $414 million in Medicare funding in 2002, and
$2 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only.way to avoid these reductions in coverage
would be for states to increase their spending by 40% -~ by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Iowa would lose $384 million in Federal Medicaid funding in
2002 and $1 billion over the seven years, a reduction of27% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on' the state's current
303,000 recipients. According to this study, these cuts would mean that Iowa could have to
cut off coverage for 69,000 recipients in 2002, likely adding them to the ranks ofthe
uninsured.
The President's Balanced Budget Proposal
.
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing anv new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major hew fraud and abuse initiative.
�THE WHITE HOUSE
Office bf Media Affairs
Contact: 202/456-7150
FOR IMMEDIATE RELEASE
July 28, 1995
KANSAS
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Kansas
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans .
. Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
wquld reduce Federal health care dollars to Kan'sas by $3 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on a~erage an additional $1,700 in 2002. .
.
Each of Kansas's over 380,000 Medicare beneficiaries would pay as much as $2,850
more in premiums and copayments over the seven years; couples would pay at least $5,700
more. Overall, the state of Kansas would lose $697 million in Medicare funding in 2002,
and $3, bilJion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, ~d eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Kansas would lose $228 million in Federal Medicaid funding in
2002 and $663 million over the seven years, a reductionof21% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
252,000 recipients. According to this study, these cuts would mean that Kansas could have
to cut off coverage for 40,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced
Bud~et
Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiarv cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media' Affairs .
·j
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
KENTUCKY
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Kentucky
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars. to Kentucky by $7 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven ye~s; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Kentucky's over 575,000 Medicare beneficiaries would pay as much as
$2,075 more in premiums and copayments over the seven years; couples would pay at least
$4,150 more. Overall, the state of Kentucky would lose $809 million in Medicare funding
. in 2002, and $3 billion over seven years.
Medicaid
The Medicaid cuts proposed by. Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% ~- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Kentucky would lose $1 billion in Federal Medicaid funding in
2002 and $4 billion over the seven years, a reduction of 32% in the year 20.02 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
638,000 recipients. According to this study, these cuts would mean that Kentucky could
have to cut off coverage for 171,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
,I
I
The President's Balanced Budget Proposal
The President shows. how it is possible to balance the budget, assure thatthe Medicare
Trust Fund remains solvent for at least another deca.de, and expand benefits and choice of plans
without imposing anv new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
LOUISIANA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Louisiana
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. ,Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Louisiana by $10 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican'proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care service~ would pay on average an additional $1,700 in 2002.
Each of Louisiana's over 572,000 Medicare beneficiaries would pay as much as
$3,575 more in premiums and copayments over the seven years; couples would pay at least
$7,150 more. Overall, the state of Louisiana would lose $1 billion in Medicare funding in
2002, and $5 billion over seven years.
Medicaid
,
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avo'id these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Louisiana would lose $2 billion in Federal Medicaid funding in
,
2002 and $5 billion oyer the seven years, a reduction of 25% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
778,000 recipients. According to this study, these cuts would mean that Louisiana could
have to cut off coverage for 154,000 recipients in 2002, likely' adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent-for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficial)' cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
)
�THE WHITE HOUSE
Office of Media Affairs .
FOR IMMEDIATE RELEASE'
July 28, 1995
Contact: 202/456-7150
I MAINE
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Maine
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts ofthe RepUblicans
would reduce Federal health care dollars to Maine by $1 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using·
home health care services wOuld pay on average an additional $1,700 in 2002.
Each of Maine's over 198,000 Medicare beneficiaries would pay as much as $1,350
more in premiums and copayments over the seven years; couples would pay at least $2,700
more. Overall, the state of Maine would lose $193 million in Medicare funding in 2002, and
$807 million over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and dislibled individuals in
2002, according to the Urban Institute. The o,nly way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or ,
cutting other critical state spending, .
. Overall, the state of Maine would lose $236 million in Federal Medicaid funding in
2002 and $675 million over the seven years, a reduction of22% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
177,000 recipients. According to this study, these cuts would mean that Maine could have
to cut off coverage for 34,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
'.J
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
MARYLAND
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Maryland
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Maryland by $6 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alon~ an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Maryland's over 591,000 Medicare beneficiaries would pay as much as
$2,275 more in premiums and copayments over the seven years; couples would pay at least
$4,550 more. Overall, the state of Maryland would lose $891 million in Medicare funding
in 2002, and $4 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban'Institute. The only way to avoid these reductions in coverage
would be for 'states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Maryland would lose $800 million in Federal Medicaid funding
in 2002 and $3 billion over t~e seven years, a reduction of 32% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
415,000 recipients. According to this study, these cuts would mean that Maryland could
have to cut off coverage for 116,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
. The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud ~d abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150 .
MASSACHUSETTS
The Republican Budget Resolution Conference Agreement:
Impactofthe Medicare and Medicaid Cuts on Massachusetts
Republicans are proposing to cut more than $450 billion ~om health care hetween 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid.' In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Massachusetts by $14 billion. '
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay atleast $2,825 more in premiums and copayments over seven years; couples would pay' at
, least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
, beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services wo~ld pavon average an additional $1,700 in 2002.
Each of Massachusetts's over 923,000 Medicare beneficiaries would pay as much as
$4,300 more in premiums and copayments over the seven years; couples would pay at least
$8,600 more. Overall, the state of Massachusetts would lose $3 billion in Medicare funding
in 2002, and $9 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Massachusetts would lose $1 billion in Federal Medicaid
funding in 2002 and $4 billion over the seven years, a reduction of 28%) in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the state's
current 710,000 recipients. According to this study, these cuts would,mean that
Massachusetts could have to cut off coverage for 210,000 recipients in 2002, likely adding'
them to the ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows' how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) ofthe Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July'28,1995
Contact: 202/456-7150
MICHIGAN
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Michigan
J
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Michigan by $13 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
_home health care services would pay on average an additional $1.700 in 200~.
Each of Michigan's over 1.3 million Medicare beneficiaries would pay as much as
$2,100 -more in premiums and copayments over the seven years; couples would pay at least
$4,200 more. Overall, the state of Michigan would lose $2 billion in Medicare funding in
2002, and $8 billion over seven years.
MedicaidThe Medicaid cuts proposed by Republicans would force states to slash services, 'provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
:
Overall, the state of Michigan would lose $2 billion in Federal Medicaid funding in
2002 and $6 billion over the seven years, a reduction of 30% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
1.2 million recipients. According to this study, these cuts would mean that Michigan could
have to cut off coverage for 215,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the-budget, assure that the Medicare
Trust Fund remains solvent for at .least another decade, and exp3;Ild benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($1 24 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
MINNESOTA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Minnesota
Repu~licans
are proposing to cut more than $450 billion from'health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
.cuts are more than four times anYthing ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well~off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Minnesota by $7 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means'that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each ofMinnesota'.~ over 623,000 Medicare. beneficiaries would pay as much as
$2,900 more in premiums and copayments over the seven years; couples would pay at least
$5,800 more. Overall, the state of Minnesota would lose $1 billion in Medicare funding in
2002, and $5 billion over sev\en years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Minnesota would lose $687 million in Federal Medicaid funding
in 2002 and $2 billion over the seven years, a reduction of 25% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
426,000 recipients. According to this study, these cuts would mean that ·Minnesota could
have to cut off coverage for 88,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
.
providers and through a major new fraud and abuse initiative.
\
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
MISSISSIPPI
The Republican Budget Resolution Conference Agreement: .
Impact ofthe Medicare and Medicaid Cuts on Mississippi
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts'
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Mississippi by $5 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at [east $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Mississippi's over 390,000 Medicare beneficiaries would pay as much as
$2,175 more in premiums and copayments over the seven years; couples would pay at least
$4,350 more. Overall, the state of Mississippi would lose $563 million in Medicare funding
in 2002, and $2 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in .coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Mississippi would lose $705 million in Federal Medicaid
funding in 2002 and $2 billion over the seven years, a reduction of 30% in the"year 2002
alone, according to the Urban Institute. This will have a devastating impact,on the state's
current 537,000 recipients. According to this study, these cuts would meari .that Mississippi
could have to cut off coverage for 141,000 recipients in 2002, likely adding them to the
ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
MISSOURI
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Missouri
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times' anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republkans
would reduce Federal health care dollars to Missouri by $6 'billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health car~ services would pay on average an additional $1.700 in 2002.
Each of Missouri's over 823,000Medicare beneficiaries would pay as much as
$2,425 more in premiums and copayments over the seven years; couples would pay at least
$4,850 more. Overall, the state of Missouri would lose $1 billion in Medicare funding in
2002, and $5 billion over seven years.'
Medkaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Missouri would lose $433 million in Federal Medicaid funding
in 2002 and $1 billion over the seven years, a reduction of 17% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
669,000 recipients. According to this study, these cuts would mean that Missouri could
have to cut off coverage for 83,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal'
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without 'imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28,1995
Contact: 202/456-7150
MONTANA
The Republican Budget Resolution Conference Agreement:
Impact ofthe Medicare and Medicaid Cuts on Montana
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything. ever enacted. ,Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts ofthe Republicans
would reduce Federal health care dollars to Montana by $1 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means thatthe average beneficiary would
p~y at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House 'Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1.700 in 2002.
Each of Montana's over 127,000 Medicare beneficiaries would pay as much as
$1,425 more in premiums and copayments over the seven years; couples would pay at least
$2,850 more. Overall, the state of Montana would lose $131 million in Medicare funding in
2002, and $538 million over seven years.
Medicaid
The Medicaid cuts proposed by Republicans ~ould force states to slash services, provider
payments, and eliminate cove,rage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
. cutting other critical state spending. .
.
Overall, the state of Montana would lose $211 million in Federal Medicaid funding
in 2002 and $766 million over the seven years, a reduction of 33% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
96,000 recipients. According to this study, these cuts would mean that Montana could have
to cut off coverage for 27,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
'
The President's Balanced Budget Proposal
The President shows how it is possible to balance the hudget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the ,Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
NEBRASKA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Nebraska
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts ofthe Republicans
/ would red~ce Federal health care dollars to Nebraska by $2 billion.
.
Medicare
Nationally, the $270 billion in Medicare cuts means. that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another.$5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Nebraska's over 247,000 Medicare beneficiaries would pay as much as
$1,700 more in premiums and copayments over the seven years; couples would pay at least
$3,400 more. Overall, the state of Nebraska would lose $283 million in Medicare funding in
2002, and $1 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million chiidren, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by '40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Nebraska would lose $224 million in Federal.Medicaid funding
in 2002 and $728 million over the seven years, a reduction of 27% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
164,000 recipients. According to this study, these cuts would mean that Nebraska could
have to cut off coverage for 41,000 recipients in 2002, likely adding them to the ranks of the
uninsured:
.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solv~nt for at least another decade, and expand benefits and choice ofplans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�· THE WHITE HOUSE
Office of MediaAffairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
NEVADA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Nevada
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over th'e seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Nevada by $2 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Nevada's over 182,000 Medicare ,beneficiaries would pay as much as $3,000
more in premiums and copayments over the seven years; couples would pay at least $6,000
~ore. Overall, the state of Nevada would lose $533 million in Medicare funding in 2002,
and $2 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force sta~es to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Nevada would lose $157 million in Federal Medicaid funding in
2002 and $516 million over the seven years, a reduction of29% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
95,000 recipients. According to this study, these cuts would mean that Nevada could have
to cut off coverage for 26,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) ofthe Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
, July 28, 1995
Contact: 202/456-7150
NEW HAMPSHIRE
The Republican Budget Resolution Conference Agreement:
Impact ofthe Medicare and Medicaid Cuts on New Hampshire
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare an4 $182 billion from Medicaid .. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts.
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to New Hampshire by $975 million.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years;' couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1',400. Beneficiaries using
home health care services w~)Uld pay on average an additional $1,700 in 2002.
'Each of New Hampshire's over 152,000 Medicare beneficiaries would pay as much
as $2,175 more in premiums and copayments over the seven years; couples would pay at
least $4,350 more. Overall, the state of New Hampshire would lose $244 million in
Medicare funding in 2002, and $924 million over seven years.
.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of New Hampshire would lose $40 million in Federal Medicaid
funding in 2002 and $51, million over the seven years, a reduction of 6% in the year 2002
alone, according to the Urb?ln Institute. This will have a devastating impact on the state's
current 88,000 recipients. According to this study, these cuts would mean that New
Hampshire could have to cut off coverage for 1,100 recipients in 2002, likely adding them'
to the ranks of the uninsured.
The President's Balanced Budget Proposal
. The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proPQsal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
Contact: 202/456-7150
FOR IMMEDIATE RELEASE
July 28, 1995
NEW JERSEY
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts'on New Jersey
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 'billion from Medicaid. In c9mbination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the R,epublicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to New Jersey by $11 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1.700 in 2002.
Each of New Jersey's over 1.2 million Medicare beneficiaries would pay as much as
$2,625 more in premiums and copayments over the seven years; couples would pay at least
$5,250 more. Overall, the state of New Jersey would lose $2 billion in Medicare funding in
2002, and $8 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% --. by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of New Jersey would -lose $1 billion in Federal Medicaid funding in
2002 and $4 billion over the seven years, a reduction of 23% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
790,000 recipients. According to this study, these cuts would mean that New Jersey could
have to cut off coverage for 166,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
.
I
.
.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28,1995
Contact: 202/456-7150
NEW MEXICO
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on New Mexico
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billio'n from Medicaid. In cOI:nbination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health caredollars to New Mexico by $2 billion.
Medicare
.
Nationally, the $270 billion in Medicare cl:lts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
,
Each of New Mexico's over 205,000 Medicare beneficiaries would pay as much ~s
$1,225 more in premiums and copayments over the seven years; couples would pay at least
$2,450 more. Overall, the state of New Mexico would lose S208 million in Medicare
funding in 2002, and $844 million ov~r seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to' avoid these reductions in coverage
would be for states to increase their spending by 40% :-- by raising property or sales taxes, or
cutting other critical state spending.,
Overall, the state of New Mexico would lose $389 million in Federal Medicaid,
funding in 2002 and $1 billion over the seven yearS, a reduction of 34% in the year 2002
alone, accorping to the Urban Institute. This will have a devastating impact on the state's
current 268,000 recipients. According to this study, these cuts would mean that New
Mexico could have to cut off coverage for 80,000 recipients in 2002, likely adding them to
the ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to baJance the budget, assure that the Medicare'
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
, less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fr~ud and abuse initiative.
�tHE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE'
July 28,1995
Contact: 202/456-7150
NEW YORK
, The Republican Budget Re~olution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on New York
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four tiines anything ever enacted. Most ofthe $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well~off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to New York by $37 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health Care services would pay on average an additional $1,700 in 2002.
Each of New York's over 2.6 million Medicare beneficiaries would pay as much as
$2,825 more in premiums and copayments over the seven years; couples would pay at least
$5,650 more. Overall, the state of New York would lose $4 billion in Medicare funding in
2002, and $18 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid thes)'! reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of New York would lose $6 billion in Federal Medicaid funding in
2002 and $19 billion over the seven years, a reduction 'of 27% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
2.9 million recipients. According to this study, these cuts would mean that New York could
have to cut off coverage for 645,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half($124 billion) of the Republican proposal (~270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
NORTH CAROLINA
The Republican Budget Resolution Conference Agreement: .
Impact'ofthe Medicare and Medicaid Cuts on North Carolina
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the RepUblicans
would reduce Federal health care dollars to North Carolina by $14 billion.
Medicare
Nationally, the $270 bi)lion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at '
least another $5,650. Under a recent House Repu,blican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of North Carolina's over 999,000 Medicare beneficiaries would pay as much as
$2,400 more in premiums and copayments over the seven years; couples would pay at least
$4,800 more. Overall,'the state of North Carolina would lose $2 billion in Medicare
funding in 2002, and $7 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
.\
'
\
Overall, the state of North Carolina would lose $2 billion in Federal Medicaid
funding in 2002 and $7 billion over the seven years, a reduction of 34(% in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the state's
current 985,000 recipients. According to this study, these cuts would mean that North
Carolina could have to cut off coverage for 455,000 recipients in 2002, likely adding them
to the ranks of the uninsured~
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 2021456-7150
NORTH DAKOTA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on North Dakota
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to North Dakota by $919 million.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of North Dakota's over 102,000 Medicare beneficiaries would pay as much as
$2,025 more in premiums and copayments over the seven years; couples would pay at least .
$4,050 more. Overall, the state of North Dakota would lose $133 million in Medicare
funding in 2002, and $537 million over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in .
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state'spending.
Overall, the state of North Dakota would lose $118 million in Federal Medicaid
funding in 2002 and $382 million over the seven years, a reduction of 26% in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the state's
current 63,000 recipients. According to this study, these cuts would mean that North
Dakota could have to cut off coverage for 18,000 recipients in 2002, likely adding them to
the ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing anv new Medicare beneficiaty cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
OHIO
'The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Ohio
I
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medic~re and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Ohio by $16 billion.'
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pavon average an additional $1,700 in 2002.
Each of Ohio's over 1.6 million Medicare beneficiaries would pay as much as $2,000
more in premiums and copayments over the seven years; couples would pay at least $4,000
more. Overall, the state of Ohio would lose $2 billion in Medicare funding in 2002, and $9
billion over seven years ..
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash s~rvices, provider
payments" and eliminate coverage for 8.8 million ch.i1dren, elderly, and disabled individuals in
2002, according to the Urban Institute.. The only way to avoid these reductions in coverage
would be' for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Ohio would lose $2 billion in Federal Medicaid funding in 2002
and $7 billion over the seven years, a reduction of 28% in the year 2002 alone, according to
the Urban Institute. This will have a devastating impact on the state's current '1.5 million
recipients. According to this study, these cuts would mean that Ohio could 'have to cut off
coverage for 292,000 recipients in 2002, likely adding them to the ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major'new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
OKLAHOMA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Oklahoma
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessafy without the Republicans' $245 ,billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Oklahoma by $5 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each ofOklahoIg.a's over 479,000 Medicare beneficiaries would pay as much as
$2,000 more in premiums and copayments over the seven years; couples would pay ~t least
$4,000 more. Overall, the state of Oklahoma would lose $633 million in Medicare funding
in 2002, and $3 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states'to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
, Overall, the state of Oklahoma would lose $642 million in Federal Medicaid funding
in 2002 and $2 billion over the seven years, a reduction of31 % in the.year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
391,000 recipients. According to this study, these cuts would mean that Oklahoma could .
have to cut off coverage for 125,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing anv new Medicare beneficiarv cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
OREGON
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Oregon,
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 --$270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars t? Oregon by $5 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiUms and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone a!1 average
ben~ficiary in a nursing home would face an' increase of at least $1,400. ,Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Oregon's over 460,000 Medicare beneficiaries would pay as much as $2,525
more in premiums and copayments over the seven years; couples would pay at least $5,050\
more. Overall, the state of Oregon would lose $844 million in Medicare funding in 2002,
and $3 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to iilcrease their spending by. 40% -- by raising property ,or sales taxes, or
cutting other critical state spending.
Overall, the state of Oregon would lose $516 million in Federal Medicaid funding in
2Q02 and $2 billion over the seven years, a reduction of 31 % in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
411,00() recipients. According to this study, these cuts would mean that Oregon could have
to cut off coverage for 118,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade', and expand benefits and choice ofplans
without imposing any new Medicare beneficiarv cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and tQ,rough a major new' fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
PENNSYL VANIA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Pennsylvania
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare arid $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for weH:-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the RepUblicans
would reduce Federal health care dollars to Pennsylvania by $21 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average ,
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1.700 in 2002.
Each of Pennsylvania's over 2.1 million Medicare beneficiaries would pay as much
as $2,975 more in premiums and copayments over the seven years; couples would pay at
least $5,950 more. Overall, the state of Pennsylvania would lose $4 billion in Medicare
funding in 2002, and $15 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and· eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to, avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state ofPeDlisylvania would lose $2 billion in Federal Medicaid funding
in 2002 and $6 billion over the seven years, a reduction 'of 27% in the year 2002 alone,
according to the UrbaQ Institute. This will have a devastating impact on the state's current
1.3 million recipients. According to this study, these cuts would mean that Pennsylvania
could have to cut off coverage for 308,000 recipients in 2002, likely adding them to the
ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
RHODE ISLAND
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Rhode Island
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. ' Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Rhode Island by $~ billion~
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples ,would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1.700 in 2002.
Each of Rhode Island's over166,000 Medicare beneficiaries would pay as much as
$3,650 mO,re in premiums and copayments over the seven years; couples would pay at least "
$7,300 more. Overall, the state of Rhode ISland would lose $403 million in Medicare
funding in 2002, and $1 billion over seven years.
Medicaid
The Medicaid cuts-proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critiCal state spending.
Overall, the state of Rhode Island would lose $264 million in Federal Medicaid
funding in 2002 and $861 million over the seven years, a reduction of 26% in the year 2002
alone, .according to the Urban Institute. This will have a devastating impact on the state's
current 115,000 recipients. According to this study, these cuts would mean that Rhode
Island could have to cut off coverage for 51,000 recipients in 2002, li,keJy adding them to the
ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) ofthe Republican proposal ($270 billion), come from health care,
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28,1995
Contact: 202/456-7150
SOUTH CAROLINA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on South Carolina
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most ofthe $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to South Carolina by $6 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples 'would pay at,
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an addit~onal $1,700 in 2002.
\
,
.
I
Each of South Carolina's over 495,000 Medicare beneficiaries would pay as much as
$2,425 more in premiums and copayments over the ,seven years;, couples would pay at least
$4,850 more. Overall, the state of South Carolina would lose $923 million in Medicare
funding in 2002, and $3 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of South Carolina would lose $672 million in Federal Medicaid
funding in 2002 and $2 billion over the seven years, a·reduction of24% in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the state's
current 486,000 recipients .. According to this study, these cuts would mean that South
Carolina could have to cut off coverage for 149,000 recipients in 2002, likely adding them
to the ranks of the uninsured.
The President's Balanced Budget Proposal
,
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
\vithout imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs·
Contact: 202/456-7150
FOR IMMEDIATE RELEASE
July 28, 1995
SOUTH DAKOTA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on South Dakota
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cutfor well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to South Dakota by $912 million.
I
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of South Dakota's over 116,000 Medicare beneficiaries would pay as much as
$1,625 more in premiums and copayments over the seven years; couples would pay at least
$3,250 more. Overall, the state of South Dakota would lose $128 million in Medicare
funding in 2002, and $516 million over seven years.
Medicaid
.
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute, The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
\
Overall, the state of South Dakota would lose $123 million in Federal Medicaid
funding in 2002 and $396 million over the seven years, a reduction of 28% in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the state's
current 72,000 recipients. According to this study, these cuts would mean that South
Dakota could have to cut off coverage for 19,000 recipients in 2002, likely adding them to
the ranks of the uninsured.
The President's Balanced Budget Proposal·
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiarv cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
. FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
TENNESSEE
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Tennessee
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than fourtimes anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Tennessee by $12 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Tennessee's over 753,000 Medicare beneficiaries would pay as much,as
$3,850 more in ·premiums and copayments over the seven years; couples would pay at least
$7,700 more. Overall, the state of Tennessee would lose $2 billion in Medicare funding in
2002, and $7 billion over seven years~
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
.
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -:- by raising property or sales taxes, or
cutting other critical state spending.
;
.
.
Overall, the state of Tennessee would lose $1 billion in Federal Medicaid funding in
2002 and $5 billion over the seven years, a reduction of 32% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
939,000 recipients. According to this study, these cuts would mean that Tennessee could
have to cut off coverage for 246,000 recipien~s in 2002, likely adding them to the ranks of
the uninsured.
.
.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expapd benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from ~ealth care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
TEXAS
The Republican BudgetResolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Texas
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination; these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the co~bined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Texas by $28 billion.
.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
. beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pavon average an additional $1,700 in 2002.
Each of Texas's over 2.0 million Medicare beneficiaries would pay as much as
$3,125 more in premiums and copayments over the seven years; couples would pay at least
$6,250 more: Overall, the state of Texas would lose $5 billion in Medicare funding in 2002,
and $17 billion over seven years.
Medicaid
The MedIcaid cuts proposed by Republicans vyould force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Texas would lose $3 billion in Federal Medicaid funding in 2002
and $11 billion oyer the seven years, a reduction of 29% in the year 2002 alone, according
to the Urban Institute. This will have a devastating impact on the state's current 2.5
million recipients. According to this study, these cuts would mean that Texas could have to
cut off coverage for 687,000 recipients in 2002, likely addingJhem to the ranks of the
uninsured.
.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are·
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
JUly 28, 1995
Contact: 202/456-7150
UTAH
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Utah
Republicans are proposing to cut more than $450 billion from health .care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
"
would reduce Federal health care dollars to Utah by $2 billion.
o
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home'would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Utah's over 182",000 Medicare beneficiaries would p~y as much as SI,925
more in premiums and copayments over the seven years; couples would, pay at least $3,850
more. Overall, the state of Utah would lose.$277 million in Medicare funding in 2002, and
$1 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property' or sales taxes, or
cutting other critical state spending.
Overall, the state of Utah would lose $302 million in Federal Medicaid funding in
2002 and$1 billion over the seven years, a reduction of 31 % in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
157,000 recipients. According to this study, these cuts would mean that Utah could have to
cut off,coverage for 53,000 recipients in 2002, likely adding them to the ranks ofthe
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
Without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) ofthe Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
VERMONT
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Vermont
Republicans are. proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary withoutthe Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Vermonfby$673 million.
,
,
Medicare
,
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay ,at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing horne would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Vermont's over 81,000 Medicare beneficiaries would pay as much as $1,475
more in premiums and copayments over the seven years; couples would pay at least $2,950
more. Overall, the state of Vermont ,Would lose $88 million in Medicare funding in 2002,
and $356 million over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in co~erage
would be for states to increase their spending by 40% -- by raising property o'r sales'taxes, or
cutting other critical state spending,
.
Overall, the state of Vermont would lose $99 million in Federal Medicaid funding in
2002 and $318 million over the seven years, a reduction of27% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
90,000 recipients. According to this study, these,cuts would mean that Vermont could have
to cut off coverage for 20,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), corne from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
-Contact: 202/456-7150
FOR IMMEDIATE RELEASE
July 28,1995
VIRGINIA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Virginia
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Virginia by $6 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay -at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
(
Each of Virginia's over 798,000 Medicare beneficiaries would pay as much as $1,500
-more in premiums and copayments over the seven years; couples would pay at least $3,000
more. Overall, the state of Virginia would lose $879 million in Medicare funding in 2002,
and $4 billion over seven. years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to _slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Virginia would lose $798 million in Federal Medicaid funding-in
2002 and $3 billion over the seven years, a reduction of 33% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
643,000 recipients. According to this study, these cuts would mean that Virginia could
have to cut off coverage for 236,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
WASHINGTON
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Washington
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. 'Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Washington by $7 billion.
Medicare
, Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couplesw~)Uld pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing hOqle would face an increase of at least $1~400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Washington's over 671,000 Medicare beneficiaries would pay as much as
$1,675 more in premiums and copayments over the seven years; couples would p~y at least
$3,350 more. Overall, the state of Washington would lose $818.million in Medicare funding
in 2002, and $3 billion over seven years.
Medicaid
The Medicaid cuts proposed by Repuplicans would' force states to slash services, ,provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage,
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Washington would lose $1 billion in Federal Medicaid funding
in 2002 and $4 billion over the seven years, a reduction of 31 % in the year2002 alone,
according to the Urban Institute. This will ,have a devastating impact on the state's current
668,000 recipients. According to this study, these cuts would mean that Washington could
have to cut off coverage for 183,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
!
�THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
WEST VIRGINIA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on West Virginia
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary ~ithout the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to West Virginia by $5 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400 .. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of West Virginia's over 325,000 Medicare beneficiaries would pay as much as
$1,800 more in premiums and copayments over the seven years; couples would pay at least
$3,600 more. Overall, the state of West Virginia would lose $394 million in Medicare
funding in 2002, and $2 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of West Virginia would lose $919 million in Federal Medicaid
funding in 2002 and $3 billion over the seven years, a reduction of 35% in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on t~e state's
current 367,000 recipients. According to this study, these cuts would mean that West
Virginia could have to cut off coverage for 140,000 recipients in 2002, likely adding them
to the ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE WHITE HOUSE
Office of Media Affairs.
FOR IMMEDIATE RELEASE
July 28, 1995
Contact: 202/456-7150
WISCONSIN
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Wisconsin
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, t,hese
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 b~llion tax cut for well-off Americans .
. Over the seven-year period; the combined Medicare and Medicaid cuts of the RepUblicans
would reduce Federal health care dollars to Wisconsin by $6 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Wisconsin's over 753,000 Medicare beneficiaries would pay as much as
$1,500 more in premiums and copayments over the seven years; coupleswQuld pay at least
$3,000 more. Overall, the state of Wisconsin would lose 5765 million in Medicare funding
in 2002, and 53 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending .
. Overall, the state ofWisconsiri would lose $883 million in Federal Medicaid funding
in 2002 and $3 billion over the seven years, a reduction of 29% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
474,000 recipients. According to this study, these cuts would mean that Wisconsin could
have to cut off coverage for 94,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal .
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which.are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�."
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE"
July 28, 1995
Contact: 202/456-7150
WYOMING
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Wyoming
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over t~~ seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federa"l health care dollars to Wyoming by $424 million.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1.700 in 2002.
Each of Wyoming's over 59,000 Medicare beneficiaries would pay as much as $800
more in premiums and copayments over the seven years; couples would pay at least $1,600
more. Overall, the state of Wyoming would lose $41 million in Medicare funding in 2002,
and $179 million over seven years ..
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children,elderiy, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending. (
"
Overall, the state of Wyoming would lose $72 million in Federal Medicaid funding
in 2002 and $245 million over the seven years, a reduction of 30% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
51,000 recipients. According to this study, these cuts would mean that Wyoming could
have to cut off coverage for 15,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
�THE SECRETARY OF HEALTH AND HUMAN SERVICES
WA$HINCTON,O.<":, 402'0}
FEB I 7
~
Paul M. Ellwood Jr., M.D.
President
Jackson Hole Group
P.O. Box 350
Teton Village, WY. 83025
Dear Paul:
Thank you· for the opportunitY to review the new draft proposal of "Responsible Choices. I
am looking forward to meeting with you and others in Jackson Hole to discuss our respective
ideas for improving the nation's health care system. ,
It
I have appreciated the opportunity to work with the Jackson Hole Group in the past, in large
part because we' share- a co~on commitment to improving both efficiency and fairness in'
the heallh care system. I think we all agree lhat health reform. requires three elements to b~
effective -:- expanded coverage, lower costs and improved quality - and that a restrocrured
marketplace is essential to achieving these elements. Our ultimate goal must be universal
coverage in an efficiently operating marketplace.
You and your colleagues have·made a significant contribution to the health care debate in this
country by recognizing ~e critical role lhat consumer. choice and private innovation can play
in our health care system~ I think that we both agree that choice is a critical element in
improving qtiality and efficiency,
"
~
was surprised, then, by. the direction reflected in "Responsible Choices." The draft proposal
seems to abandon your previous commitment to addressing the problems of the over 40
million u.niilsured in this nation. I understand that the political envirorunent has changed, and
that our strategies may need to change as a result. However. that does not alter, the
underlying fact that middle class people who lose their jobs, or working families, struggling
to get by, need some assistance to be able afford adequate health insurance.
The/Jackson Hole Group has recognized this fact in the past, and has advocated substantial
subsidies to assist.the uninsured in purchasing private insurance. It deeply troubles me that
the "Responsible Choices" proposal fails even [0 mention the need to move towards universal
coverage, let alone suggest, policies (short or long-tenn) to do so.
,
.
m
In fact, the arbitrary cap on funding for the Medicaid program proposed
"Responsible
Choices" would actually decrease coverage. Over the pas[ few years, enrollment, in
employer-based inSurance has. fallen by almost six percentage points (from around 66 % [0
around 60% of the nonelderly population), while the percentage of the population covered by
Medicaid has grown significantly. Between one-third and one-half of the projected annuaJ
growth in Medicaid spending results from project.ed growth in enrollment.
�Page 2 - Paul M.EUwood Jr.,
M.D.
.
-
Furthermore, I am perplexed and disturbed that you would propose an arbitrary cap on me
Medicare program .. Like- Social Security, Medicare is an inter-generational compact.
Placing an arbitrary, pre-detennined cap on Medicare spending, while at the same time
eliminating itS starus as an entitlement, would put services to the elderly at risk and wauld
violate that compact.
A cap on Medicare puts the elderly and disabled at risk. The vast majority .of Medicare
beneficiaries have modest incomes. Over 75% of beneficiaries have incomes belaw$25,OOO;
30% of beneficiaries get 80% .or mare .of their incame from Social Security. Sa while a
voucher pragram like that praposed in "Responsible Chaices" may expand chaice far same
beneficiaries, it would in fact diminisQ. choice for many by effectively forcing them inta a
law-cost plan and away fram the providers .of their choice.
This does not mean that we oppase improving Medicare - quite the contrary. We are
pleased that, during the Clinton Administratian, projectians far the average aIUlual rate of
grawth for Medicare spending far the periad 1996 - 2000 have decreased - by mare than a
percentage point a year - just in the period between the Mid-Session Review Jast spring and
the President's Fiscal Year 1996 Budget. We are pressing ahead with impravements in
Medicare management, data pracessing, contractor .oversight, aIfd program integrity
activities.
.
Amang the other improvements we are making in Medicare, I believe that we share a
commitment to expanding and impraving the managed care choices available to Medicare
,beneficiaries. Today. abaut 74 percent .of Medicare beneficiaries have access to a managed
care plan. and 9% of beneficiaries have emalled iIi one. Enrallment is increasing rapidly
by over 1 % per month: We alsa are working on ways to make .our existing managed care
program wark bener. Examples include our work with the industry to imprave quality
measures and the AAPCC methodalogy far the Medicare risk contracting program, and our.
collabaratian with- Alain Enthoven ta design a campetitive bidding demonstratian. And, as
we have testified in recent weeks. we are in the process of developing new managed care
options under Medicare. including a PPO aptian.
a
While managed care appears now to be reaching critical mass in private sectar health
programs, at least in same areas, it has taken many years to achieve this state. _Many
employers that have embraced managed care have maved cautiausly ta avaid disruptian, by
maintaining a fee-for-service aptian at affardable levels. or by offering out-of-netwark options
thraugh point-of-service plans or PPOs. Most Medicare beneficiaries - and particularly the
most elderly among them -have not had the benefir of a gradual exposure to managed care.
I amsIrongly cammitted ta expanding the managed care options available in Medicare, but
the emphasis must be on choice. We should learn from the private sector and recagnize that
we need to move prudenrly if we are to foster understanding and acceptance .of managed care
approaches among beneficiaries.
�Page 3 - Paul M. Ellwood Jr.,'M.D.
I look forward to the upcoming discussions at Jackson Hole. We need to focus on how. we
can improve both the private insurance market and public programs. And we must discuss
ways to expand coverage for vulnerable populations. I believe that there are many points on
which we can agree. To me, making responsible choices means rmding ways to improve
what we have, not making arbitrary cuts in important programs that can leave the elderly.
disabled, .and poor at risk. I hope that we can work together over the coming months. to
accomplish meaningful healrh care refom.
Sincerely,
~·f~
Donna E. Shalala
�February
(House)
DRAFT
M.R. 831
,
~995
NOT FOR RELEASE.
Permanently Extend the Tax Deductibility for Health
Insurance Costs for Self-Employed lndividuals
(Archer (R) TX and,3 others)
[NOTB POSSIBLE ADDITIONAL LANGUAGE IN BOLD.]
The Administration supports the primary purpose of H.R. 831 -- to
extend permanently the 25. percent tax deduction for health
insurance premiums £or self-employed individuals -~ and believes
that the cost must be fully offset.
(NOTE--Les Samu~ls' staff is
co~siderin~ whether the word "permanently" should 'be taken out.]
The Administration oppo~es one of the bill's offsets -- i.e., the
repeal of the current tax treatment for the sale of radio and
television broadcast facilities and cable television systems tQ
minor i ty-owned businesses.
("However" the Administration is
aware of concerns about possible abuses ot this program and is
reviewinq what steps might be taken to prevent abuses.ttl
The Administration looks forward to working with the Congress on
identifying appropriate offsets to extend this importarit health
insurance tax deduction (permanently). ["Examples of possiblo
alternative offsets are the provisions in the Gibbons sUbstitute
-- wbiob are identical to proposals in the FY 1996 Budget -
relating to taxation of inoome fro. foreign tru8t~ And tAX
treatment of renouncers of oitizenship."]
Scoring for Purposes of
PaY-As~You-Go
H.R~
831 would affect receipts; therefore, it, is subj~ct to the
pay-as-you-go requirement of the Omnibus Budget Reconciliation
Act (OBRA) of 1990.
The Administration's preliminary scoring estimates of this bill
are presented in the table below.
Final scoring of this
legislation may deviate from these estimates.
If H.R. 831 were
enacted, final OMB scoring estimates wquld be published within'
five days of enactment, as required by, OBRA •. The cumulative
effects of all enacted legislation on direct spending and
receipts will be reported to Congress at the end of the
congressional session, as required by OBRA.
�..
2
PAY-AS-:-YQ!.!-GO ESTIMATES
(Recei12ts in milJ,ions)
~
l..2.2§.
1997
ll2.§.
1999
,2000
-'493
+399
-474
+213
+277
+ 34
-516
+220
+295
+ 37
-563
+226
+309
+ 40
-613
+'233
+332
+ 43
+ 50
+ 36
+12
5
SE Tax
FCC
EITC
other
+ 12
-437
+449
+ 14
+ 31'
Totals
- 82
+ 57
1925-2000
-3,096
+1,740
+1,227
+ 197
+
68
(Not.e:
SE Tax = 25 percent tax deduction for self-employed persons.
FCC ~ Repeal of current tax treatment ~n sale of brpadcast
facilities to minority-owned businesses.
EITC = Modification of the Earned Income Tax Credit.
other =- Change in Section 1033 of the Internal Revenue Code.)
* * * * * * *
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:, , 'October 25, 1994 '
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,objeCtiv~s of ref9jm~ng, the, insurance market "'~. in order ,of increasing
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'PORTABILrfY: ,To ;imp~ovethi abi,lity:~f the curre~tlyi~sured tomaintalrt coverage;'
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AFFORbABILI1:'Y:,To guariuiteeaccess to coverage for 'everyone and
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INTEGRATE 'INDIVIDUAL PuRCHASERS AND SMALL BUSINESSES 'INTO A,
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• ,Integration may be, n~~ssafy ,to'~ak~, cOr,TIprehensive, i,nsuran* '~efbiins viable in the','
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' . ,Integration could, increase' premiums fOf' small'husin~sses a:na: increase' their desire to, leave
the commuiiity ri~kpool." This 'effect incr~ses in the p,resefice of 'generous 'subsidies.
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, ':OBJEC~ 13: ' ,To: restructure the', maiket ' to' promote competition among ,
,insurers based 'on, efficiency: ,and' 'service and to reduce'
',,; opportunities for risk selection by Jnsu(ers~ , ",' ,
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PROMOTE"ESTABLISHMENT 'oF PURCHASING' COOPERATIVES,FOR
INDIVIDUAL PuRCHASERS'ANUSMALLBUSINESSES~",'
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F~eralla~ is riot abaci~r t~ the esta~llshmeritofpur~hasi~g cooperativ'es,
,could promote their' establishm~nt: " \ ' "",
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:t>ut'F~eral i~itiatives
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Po~ible· Opti~Ds: , ' Th~' Fed~~l govemin~nt cO,uld: ,
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'2. 'Require the ~stablishment (e~'g., ,by states) of cooperatives.
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, 4.' Make FEHBP ,the health program for Federal employees' 'available
, ~d individ.uals."
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to other businesses'
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Purchasing ICOQperatives. are not like~y. to be:'.ri~blewi~Q~t so~prehel1~ive insurance ',market'
r~forms, because healthy people wIll choose to buy u:tsurance at lower costs outsIde the
cooPeratives, leaving' only'the'sick :inside the pooL
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. SrANDARPIiE BENEFIT PACKAGEs..
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Benefits' could be standardized t~ a, single package,'
to' se~eral. packages . (with some more
,comprehensive than other$)~ ". Standardization of a"defmed set of ben4:!fits, makes it, easier for ' ,
'appliCants .to ·compar-e"premiums:across .insuiers,which increases competition. It also limits th4:!
. ability of insurancecompaniesto'avoid sic~ people throllgh the design of their benefits package~.'
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' . Establishing theootripositiori
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of th~~~ckage ~ g~n~rn:te signifi~t controversy .. ,
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' . Some people wquld be required to change their:exisdng'coverage '(though they could'stilLb!JY
supplel,llental cOyerag~):' "
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_~ __ ..:..,_,_._ _'_4IP...:: Some:::~y-pe-ot.standardizationTmaY~be~necess3.ry. to' a((t:as;a.. benchrriark~.ir,substantial" premium- .~ .~'.;" .., ~- ;:: ,.,
subsidies are ,to be offered to low income people.,
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',:INSuRANCE 'ANDMARKE~r'REFORMs
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, Preliminary Review , , '
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, ,'October 25, 1,99~:
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Three possib~e objectiv'~s for reforming t~e insur~ce market -- in ordt;r, of inc~easing, '
comprehensivenes~ --, are:
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PORTABILITY: Toimprove the'ability of the currently insured tonlaintain' \','
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cov~rage:
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ACcESs AND AFFOJ,IDABILITY: To g~~tee' acCess to' coverage f~~
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everyonep.nd li~itvariation~ in premiums acrossind,ividuals and busin~sses.' "
O[Thest; ,reforms' are essential to coverage:eiwnsions through private
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OBJECnyE 1: To improve the aQility of the currently insured to
maintain coverage.
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3. ' '.' ENCOURAGECOMPET~TION: To promote coriipetiti:on, among in~~rers "
, based' on 'efficiency and' 'service ~d to red uce 'opportunities for: risk, selection
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POsSmLK INITIATIVES
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PROHmIT 'PRE:-EXISJ:ING CONDITlON EXCLUSIONS FOR THE
CURRENTLY ~SlJ1lED.
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, Most inSurance', reform proposals prohibit insurers, from. imposing pre-existing , , '
" condition:~xclusiOJ;iS Q,n'people with coverage ~hochafigeinsurers (e.g.; when th~y
change jobs):: , ',"
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" 'Lin#ti~g the useo! pre-existing condition e~clusions co'uld r~ise '
, premillmssomewhatina V91untafy' ihsurand.~ market; ,The effect,'on .
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,Most states have'limIted pre-existing condition exclusions in the small ' ,
business maiket,'tiutdnly"some have done sbforindividuCll purchasers. "
Stfttes' are limited 'in their ability to limit exclusions for larger \ , " ' , '
busine~se~ because niostof tfH;~mself-insure, and'pR,ISApreempts stat«(
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regul;ltion: of self-insured arrangements:,
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.. "premiums'wouldbe bigger with respect to individual purchasers '(e.g:,
r, the self·emploYed) than' ep1ployergroups, because employer groups .afl<f
pool risks .across mix ofbotlt'h'ealthy and sick employees.'. ,:/
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Som~ assert that pr~hlbiting pre:"e~rstirig condition, ex~lusion:s' for the "
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. c~rrently' insured would guarantee portability of coverag~: However,
P9itability of coverage is not assured without guaranteed access to. "
coverage and rating reforms because,withoutthem, people cQuid be .
. dehied coxerage .or·charged .high prem,iu~s when trying to c~ange
inslirers.
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However, as lorig asjnsurersru:e permitted to deny'coverage 'or charge
. ' .' higher 'premiums basect on health status, limiting the use of, prt:-existing ,
.' 'oonditionexch.lsions 'would'likely increasepremiunis for thosewJlO 3!.e '
sick and would benefit from the liffiitooexc1usions~buf leavep)."emiums.
'largely ~nchanged for those who are healthy.'
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.. ' , . . REQUIRE INSURERS TO RENEW COVERAGE REGARDLESS QF .
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SOIlle' r~ting reforins (e. g~ ; .limiting: discrlminatoiyrate, ,in,creasesj ar¢,'
.necessary t9' make guarant~ renewal meaningfuL, Otherwise, i~surers
, ~. effectively canCel coverage for people who becoine siGk by'rrusin£
their premiup1s to umiffordable levels. '
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The ,effect on overalt" premIums: .of guaranteed renewal is' likely' to be :
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The, vast majority of states have ~ssured rene~abi,lity fQr smaIl ,
businesses, b'ut only several have done: SQ f<:>r' individual, pm'chasers
(e'.g., th~' self-,employed)~' States pave generally itnplemeQt~ ....
guaranieedrenewalfor"small busines,sesin conjurlctiQil' with 'rating
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; ..... ··GUARANTEEACCESS TOINsURANCE'FOR NEW EMPLOYEES IN
.uUSINESSESTHAT.OFFE~ COVERAGE.', '
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In some states, insurers cah decide to, reject specific e~pioyees in, a busines~ be~~use .
~f their health status.' Tf:lis initiativ.e,would' require insurers "to accept new employees
" of any employer group that. they insQre:'
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For very smill groups,' there' is' some"dangerthat,employ~rswill hire'
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• ',This, initiative would help solve', '~"job iOck" for the vast majority of'.
, 'employees; since they could change 'jobs without
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"'coverage becaus~ of-pOor heal,th'status.:i However, some "job.lock"
: ' 'would'.remain",because'not all employers.contribute towards coverage
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~".,ROHmIT INSURERS'(AN1JSELF-INSURED EMPI,.OYERPLANS)FRQM "~
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IMPOs~G CAPS"ON nE~FITS FOR-'SPECIFIC"DJS'EASES.
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, , " would raise premiums (or·costs for self-insQre<lplans)"a small amount'.'
" In theabsen<i of rating reforms like comm-qnity rating,- premIums '.
, , wouldlikelyrise, primarilyfor'those employers with employees who
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disease-specific, ~ps;ERIsA preempts states from doing 'so for self~'
insured plans. . '
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This jnitiativewQuld prohibitpl~s fro~,pla,.9irig:a cap 'o~ beQefitsfor~
dis~se, . parti<1ularly afiera 'p~ison-has'becorrie i l L , , ' ,
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Thi~,initiative is a' m~re limited form ora guarantee, that everyone 'has ,'"
'access' to.insurnnce:It would'guarantee access for new brriploy~s of'
, 'businesses that already have'insu'rance. But, itwould'oot guarantee'
" that a,smhlL:business or individual purchaser could get. insurance to '
begin with.,'
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rl'se fo~employers who hiresolTIeone';.vtio ordinarily ;would 'have been
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insurer bec,ause,: of poor health' ~tatus'. "
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, ,OBJECTIvE 2: to guara.ntee a:cce~s to coverage for ev~ryone 'and to '
, ' , limit Variations inptemiums across individuals and'
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POSsmLE 'INITIATIVES
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, ~. REQUIRE INstJ:iiERs to ~KE 'COVERAGKACCEsSmLE'TO '
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""Rating reformsare,neeessatY to" riw.ke", guar:anieedaceepmnce and
: ,',rene~al by insurers roeani,ngfuL 'Otherwise, insurers could simply .
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· program, that provides subsidies for'the purchase ofprivate heaJth , ,"
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purchasers (e.g., the self~e'mployed)., ~for very small busineSSeS, or for
· bU,sine~ses with mO(~ :than 25 employees.',:
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Unl~s' insurer~'are allo~edto impose' s~nie pre~existingcondition.
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· excJtisioris'~(generally 6ri16nths) on'the previ'euslyuninsured,
, individuals who: were - ' . previously insured. may tend to w3.it u.ntil they ,
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,t:· Guarari,t~ access to. insurance would,raiseoverallpremitims 'somewhat'
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as sickeipe6ple enter,t~e insurance market(Partic}Jlarl)r'if significant,'
subsidies are offered; allowing,grcaterrihmbers' of the.uninsured to buy
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· According to ~ an~ysi,s'hy' Lewin:: VHI. for, the Catholic Health
.. ,Association, comprehensive insurance reforms without any"
· subsid~es to:make coverage more obtainable ,would rais~
. pr~miums by about $4 per person per month 'on ,average .'; . . '
· (assumingcommunity"rating withpremiurit,· " for age).~.
adjustments
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Insurance reforms atong ~ith significant subsidies would '~aise ,;, .
,premlup1s by ;about $10 perper~on per m()n~h on ~\ierage." 4nd '
" with uriiversal coverage --Which wO,uld bring healthy :as well as:
sick peOple -into the system ~- preQiiums would' rise by about $3
per person ~r' mortth. ,"" ',' . " :,,' , , ' '"
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'Experience wWl'COB~-~ whi~h allows"emplo;ees who leave' '
,,' .'their jobs tocontimie buying ihsuraOeefora limiteq Period of "
, tim~ alab,out lhesame rate, as the' employer paYs-:.'also offers',
, evidence that premiums would likely rise~' Generally, people \
"who'opt,to continue cQverage through COBRA (at fllU ,cpsUo
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,Limit the extent to which ip.~l!rers ,can vary ,premium'i'llcrea.ses 'due to health" ," "
"status. : For,example,:an' irisurer could be required to give tlie same percentage
, premium increa$e to, 'smc,tll' business upon reri'ewal: of:,coverage;
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, This' option would 'not ifumediately'increase of d¢Crease premiurtl~ 'for the '
. currently insured, but would tend to narrow variations,in premIums' bver time:
'Insurers would,' overtime, 'likely give newly'insuring businesses similar'
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, premi~ms; ,beCause.' they could no longer giveheaIthYi groups, low premiums to,
'begin 'with, and theIi'increaSe, their premiums significantly over time, if someOne.
in the ,group gets! sick.,"
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Permit limited' pie~i"'~ v~aclons'f~f ~pecified rati~g "characteristics.' For
, exarriple,~nsurerscould :~epermitted to charge sick~r empJoyer groups up to',
',one ,and ahaIf ti'mes what they charge heaIthie:t: groups; and to'charge
-,,'
, , busil1esses~ in certain "high risk" industries 'up:to',one and a',half ttmeswhal:;
',', ' ,they charger, businesses in "lower risk" i~dustries.' The bill spon~oroo by'"
Secretary ,Bentsen in the Senate contained provisions similar to these and to the
,,option '<described1above.
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Eli~inate experienc~ 'rating, :permitti~g ~re~iu'm ,variations" in a geographic
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area only for benefit differences,age, and'family ~tatus (i.e.,~
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.' '~age/demo~raphic rating;'). Vanations for ',age could
li~llited (e.g., an "
insurer could, charge 'older ,individuals no more than twice what it charges
, younger individuals, 'rather than four'orfiv~ times as is cpm'mon"tqday). '
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,Eliminate experience' apdage rating, ,permitting premium variations in a
'geographic ar~ only" for benefit differences 'andfam~ly status (i.e., "pure'
community rating, "asin New.York) .. " \ '. . . ( , " ,,',.. .','
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The,'more that'prerhiums are ci>mpressed'(Le.,.the greater the.'
. restrictions on how'much insurers
vary premiums from one 'group
to anoth,er), the" greateithe disruption the market:' '.' " - ", ,,';
can
to
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Busin~s~s" with;hea1thyworkers would pay ,more" than they do
todaYrandbusinesses with 'sicker workers" would pay less':' In '
; gener3.I, more husinesses would likely see,prelTlium-increaseS ,
·:,t~ari dei;reases, although the'increases would,. on average', 'be '.'
, sI1}aller.. than· the' decreases: ,
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Inrlivldualsanrl :businesses with workers \vho ,?Ie. younger and
healthjer would,' be: less' likely't'? maintain their insurance
. (particularly, if age rating is' signifiGafitly' limited Of prohibited)..
'The pool of insured people would CQflSequentlx become older' .
,and sicker, "which wo~ld raise average :pr~miums:.,' ' . , ' . ,
... A~analysis ~ondudedbY'the'AI1}erican Academy of Actuaries looked;..
: ' at lheeffect of <llfferent .rating ,'re~oqns. . '
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,. " '. According' to 't~~ analysis~,inov(ng to pur~'c6mmunitytating
.. would·require little or no. change for 39% o(individuals and'
small'e~ployers ,with 'fewef, than 25"employees. One-fiftp of
.individual purchasei~ and small ~inploy~rs ,would see pre.mium '
.increases of more than. 20 %, 'and, 12 % wbuld,see premium . / ..
'q,ecrease~ of more than 20%., ' •. , .;,
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• "," Per~itting' prein'iumvariatio~s' for-age 'would lessen ,the'l~pact, ""
" of pr~mium increases, according to the an'alysis. ,6~ % o'f
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individuals would'see little or'rio change, 9% would see
.increases of'more than 20'%, and 6% would see premi~m
. / ',decreases of more than 20 %; ,
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'Th~' analysis
makes a nu~ber~fsimplifying,assumpti6ns (it' "
does'n:ot, for.'example"accouht fOr,'aily"adrni~i~trat~ve'cost ",
'savIngs or'for the cost of covering siCker people by, ~xpanding, '
,access)~
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'M~~eover, tll~study d~~s not look ,at:irnpacts over' tl~e. -Por
exarnple; with:out reform,' a' small-business, w,ith a 10\'/ premium'
today ,could' See, its premium'rise significantly if ail employee
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In-mosLoflast"sessi~n's Congr~ssional reform bills" the largest'
businesses to which comm~nity ''rating applied generally ranged'
frolniOOto 1,000 employees. _, " : , ,,-,: - '- '
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Businesseshuge~ than' the threshcild for communityratihg, may
, \,Vaflt the Qption to- purchase, cpmmunity~ratect coverage;,
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particularly in geographic areaswh~re they, have a small numper
of employ~s. If they'are -Permitted tq do ,so, premiums for '
'small employeeswould likely rise, beca'usesitker large';__ :
" businesses would be more' likely to purchase com~llI1ity-rated
, 'coverage than heruthier large businesses: 'Employer-specific risk
'adjustments designed' to prevent this behavior are dIfficult to
impl~mrnt.' '
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• '" ~ There was --, and, wil1'hkely ,<;ontiVijeto b,e ~~ pr~ss\}re from,
'associations of smail employers -to" separate themselves from the, ' ,
,.larger cotnmunity nsk:pooU 'This separatIon would- reduce ,the, '
effectiveness of-pooling-, potyntially leaving, the coml1}uhity" pool
tpan average 'population,andhigher.ptemiums.,-
{' 'with 'a sicker,. , : 1
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'Many, b~sinesses':: especially larg~r _e,nployers'. that are 'part of '
, the pool. '--, believe that they w~)Uld be_' better off negotiati'ng , _
separately with'insurers instead of-being:pariofone large - '-c"
community risk,p66i with other busiriesses~' '," :", -: , ,
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: 'Permitti~g l,imited'experie~ce rating (e,.g: ,'permitting an insui~r
,- to' charge a- sick employer group one ,andahalf times wQat it '
, charges'a he8Jthy group) would, tend to mitigate'this disruption.
" . ' ,'To .limit premium varIations; .it is n~ssMy to define a fisk pOoL For
\., example, ' ,is necessary - to define the size, Of business, tq whiCh the - ' ,
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Comprehe~sive federaJ:insuran~e r~forinsl,raise, Ule i~sue of whethe~, '
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',and to,wi1at extent, to permit'sta~s to,enaCt,reforms that are m?re ,
, compreliensive. '
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"In,the' last Congressibnaf session, some suggested >(~.g." In 'th'~,
, "Senate Mai~stfeam propOsal) that federal reforms shQuld ': ~,_
preempt'further state,reforms. _ Larg~ insurers gener~ly' " -,'
." advocate -national ul1iformi~y arid preemption of 'further-state
reforms. '
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'Allowing s~iesto enact more compr~hen'siY~ reforms' also raises
techniC<jl issues. Ifis,~ometimes,difficu1t to determine'whether
,a r~forin ,is more' co~prehensive or, less corriprehensiv~.
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,: '\' particularly difficult are;t of federal p~eemption cOh~erris
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self-,
insured plans 'offered ;by associations of small employers. States
currently have the,authbrity:'to :r:estrict· or prohibit sClf.;.insvred
~assOciatio,n plans (and some have done, s.o)~'but t~erewouldbe ' '
'" pi~ssure in ,the ,context of· federal reforms to grandfather-in these'
piaris (some of which are now9perating illegally);
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-:-----.~Ra:ttQg, reforms a~e ~ore piUkulnc)" e~forceWit~6Urstandatdii;itibh'6f' '
, , ,"'benefits. " ,
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Permitting insurers to vary be~efits ,significantly' gives :them
greater opportunities ,to usebenefitdifferen~es to segment '"
, h~lthy' ~ple 'from sicker people, ,and to 'charge the benefit
packages~hosen by" the sickt?rpeopl~ high~r', premiums. '
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" Forexample~ abe~efitplan with 'prescription drug cove~age'.wm' ,
,", attract, sicker people (and l)avehigi1er premiums) than a bemifj.t
,plan without'drug coverage. ~imilarly, l)~thy people\vould '
t~ndto"prefera ta!,astrophi<::'package if tney were offered a"
',~(~hoice6f that or more comprehensi"e package;,
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' . , " :i>foviding for ,multiple, stan~ardized paclalges makes' reforms ,
easier than, with multiple; uwstarld~lfdized p~<;ka:ges. With :', '"
standardized 'packages\, itis 'easiet: to preventjns'urers, from'. ,",'
varying, premi~ms ,across the packages: for risk' selection~' '" '
•. ~atirig tef9rms ih conjunction withguaranteOO accesstocoyerage may'
,iequire'someniechanism to e~sure that insurers are not penaliz~,f~r
,at~ractingsicker ~ple o(rewarded for,attraCting,h~thy people.
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s~ch mec~anism is "risk~adjustme~f'-- where iimds~e
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~ransferred from plans: thaCattract healthY' people to plan,s that,' .
i_attract sick~r people ~~ htitthere.islittleactual experience with' ,
risk adjustment.. . , ' "
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. spread across ail insurers -- is an ,alternative approach that has
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'.' ,:Tomakerating refOrms effective,'self-ihsi.l'r~ce~ould have t~ be
pro,hibited,amongthe busirtesses
which the reforms apply '(e.g.;, '
busin~ses witt) fewer ~han 100 ~J1lPloyees).'Otherwise,hea1thiet
businesses would tend to self-insure, leaving'nigher premiums for the
siek~r businesses'that,do not. ' ,
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However" itis generally belie\;,ed,that smaller firmS ~ave increasingly'
, b~n choosing,,'to self-insure, 'and there will likely bepres~ure ,to 3l10w
, ' them .~odo,'so. ~'
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IS 'necessary oi-desirable to' allow smaller firms
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'The majority of sllltes have impletriented, at
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, , 'alternative, to rating reforms like community rating would be to permit'
,': ' busiqeS'S'eitoc-self::in'sure-;-bur:only'ihhtWbuy"mairdatory"stop-:loss~'"':-"--":' ':":"
, coverage (w~ich limits the/emplOyer' s ~nancial' exposure, lr'iexchange'
, fora small premiupl)., ,Thi~ would limit variations across employers to
some extent, 'but w0tlld, requir~ new ~ regulat~on' of stop loss coverage. ' ,
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the amount by which premi\lmscan vary' from 'one business to
another.' :,,' '
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"(e,g., those with up to 25el!lployees). They have generally' ", ,
exciuded from reforms individual :purcbasersand' the smallest'Qf ",:,
, busfn¢sses (~.g. ,thosewith'one or two 'employees);
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to INTEGRATE INI)lVIDUALPURCHASERS AND'SMALL BUSINESSES·
'-INTOAS~GLE COMMUNITY:RISK POoi.~"
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'An' insurer' 'Y0u1d'charge,an: in9ividuaJ :u,n~ffiliated'with an, employer (e. g. , 'a self- •' '
'employed, person) the saine:premium,: that it would ~harge ~o a'small business,','
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IntegratIOn' may be necesSary to make comprehensive insurance reform'S,
" ,vIable in'the individual market;'
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In a voluntary'market, insurance reforms inevitably lead ~ s6me
'adyerse' seleCtion' (Le., :higher' premiums as a:'resqlt,of sicker peOple
tending to buyinsuranc~: nwre 'often than h'~thier IX:Ople)~' :1n: the ,
, , employer ' market; adverse selection is mitigated' by the factthatmost v'
" employer groups 'have arnixhire,
healthy and, SIck indiv~duals;' ,:, ,
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In the individ~al market, however,' adverse! selection could be (seve~e "
(l~ding to very high premium,S).' The effect on premiums for
individuals could be smaller if it were: spread more broadly, such as '
, acr~sssmall and,m~ium sized 'employers,as .long' as, the groups could.
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not Self-select ,themselves' <;>ut of the market," " , ' ,
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, This integrati6rf would increase premium~ for small, businesses,: and' '
'increase.their desire to,leave the commiinlty risk pool (e.g., through
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,'plans 'servin'g ,asso~iations of small;employers).",'
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Tne effeCt 'on '~ma1r(j~siness Pre'ffiiTI.ms~aeperia$· n€a"Vily'oir'the~exterirto _..
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which Goyerageof indlvidu,als ~ls,expanded i~rough broad-based,
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supsidies.Without SIgnificant subsidies, fe~' individuals are lil.cely, to ,
purchaSecOverage'e,venwith insu;rance ref()tms, so, the overall effect oh
.' :premiu~swould )ikely be'ls~all~r;:"
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, OBJECTIVE 3:, TO'proinQte competitjon'amo~g;'insurers based ,~n.
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efficiency and service, and to reduce ,opportunities for \
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" risk selectiQn, byillsurers., "
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,:POssmLE INITIATIVEs ,,'
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.. PROMOTE ESTABLISHMENT OF PURCHASING ,COOPERATIVES FOR' "
iNDIVIDUAL,PURCHASERS' AND SMALL BUSINESSES. "
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,Federal law is not a barriet tottIe establishment of purchasi,ng cooperatives" but '
'fCdl!ral in;tia'tives could protnote:'their·establishrnent. " "
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' Provide administrative, (undi~g and 'technical assistance:, "
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Effectively requir~ the' esfublishment ofpur~hasing cooperatives (e.g., by ,',
providing incentives for states to do so, ,and/or disincentives. for them, not to
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3. -,,' ",En(iCt uniform standards,·forc~Pera:tives.
Make FEHSI' -- the,healthprogiam for federal~mployees :'_, available t~ other
businesses or individuals.",
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'; Purchasing cOOpbratives for small businesse.sor; individuals (i~cluding
the'use of FEHBP) are. not likelyio be via!:>le without comprehensi~e'
insurance J;eforms~(e.g., guaranteed access and· rating re-tormsj.
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Otherwise, cooperatives ~il1 attract sicker individuals while' in:surers' ,
, outside 9f cooperatives ,cover. ,healthier ,people.:"
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In California, for example, the Hea1th'Insurance'Plan of,Caiifomia "
•(RIP C) o~tates O~l a generall}" level playing, field with the re~t of the,
':small'businessinsurance'market." "", ,',: :" , "',, ,".
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',',' ", pu'rcha:sed'thr~u~h .the ~OOpCrative} OfvoluntarY (i.e:" where insurance' , "
; ,",' "
" 'can be,purchased inside or ,outside the 'cooperative).Jn gereral, ,
',": voluntarY cooperatives have attracted '!:>ioader support. '
-.--eoop"etatives:1:an-:be-'rhanoat6ry(i::-e;~-Wn~rei~surance· cair-O,fiI)Toe"-'~
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.' 'B~'nefIts'co~ld be standardized t~i~ingle pac~ge; ~r to ~v~ral package~ (with,s~ine •
, more comprehensivethail others)., Insllrers coul9 b~ ieq~~red' to offer a'st$dard:, ,','
package, but permitted to'offet"oth~r '.package~ as welt'
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Standardizing ~enefits requires' the estabJishm~nt of the pac~ge(s), ' '
,(either through legislation o,r:regulation), with 'significant controversY- t,.,
, , ,'" ov«r what tq include ill, the package. ',:, ' " -, .' ,/' , , , ' , ,~, :, ,,'
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'Stan~ard b~T1efit packageS I)lake it, ~sier' fora~p]icants, to compare',
premiums across'insurers, which ili~reases competitiofl.
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If insurers' can offer only:the ;tandard ben~fit package(s), some .people,
would 'pe iequir~ 'to change ,theireiisting cpverage(though they could •
, s,ti11 buy supplemerital:c{>verage).,· The greater th~ number of '
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standardized packages, the fewer the '~umber of people, who would have'
to ,change coverage (and the ,more ~inplicated the systern):
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'Opti~ns to standarQize the !'levei of coverage' by permitting insurers to
, design benefit packages that meet a spCcifiedi'actuarial vatue"' do not': ,
achi~ve the'advantages,of standardization. They do not,. provide the"
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ability to compare p~ckages, nor do theypreyent insurers: f~om' ", 1 :"
designing packages attract the healthy and' avoid the'sick. '
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'Standard 'packages: he,lp to prevent ~nsurers from avoiding sick "
individuals through the' design of their cpverage .•' For example,. not'
-\offering coverage of prescrjpti'on drugs helps to'dissuade people who,
,. are'sick from joiriing particular plan; ',,:' ,',
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stamiardization':may: benes~sary; toad ~s a benchmark if, , "
, substantial premium subsidies are' provided' to 10~er 'income 'people.
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. which' insurers are , . , to offer., ..</
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'CENTER,ON" BUDGET' .
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'. TO: .Members ,of t::ongr~ss' and health care L.A.s:
FR: EllEm..Nissenbaum·' .'
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RE:' M'edicai Savings Accourtts and' Health Care Reform';:
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"1\1ostbf the II1ajof' health care 'prop()si:tlsuncier consider:at;ioIl incl t1 de provisions'
; . allowing in~ividuals to establish special Medical Sav:ings A~counts (MSA,s); yet the'se "
provisioJ)~ ~ave received little careful }nalys~s or attention. This'important issue js, '; ,
likely tob,e deQated' on, the Senateflo9,r :aJ;1d 'eventually in conference. .' I have
enclosed ,the Center's new' rep-ort· on. the issl!~§,. iI).YQlY~.9jJL,M$t\s.:~,... ,:,' ...". "" ...,'
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,/ . , ..•. S~pport' ib~,thisanalysis was ,provided byth~ ,Henry J',Kaiser Family; " '!
Foundation, wl;Uchis ,not affiliated· with Kaiser Perman~nte 9r l(aiser Industries~
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We' hop~ ym~find' t~s' iriforinati~n useful.· , Please' contact' Iris Lavof David' /
Super for. .nrrJ:h~r information..
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777,North.capltolSt:reet NE, sUlte'705,wa~tllngto~,
OC'20007 'Td:,202-40S-1080
RObeitOreenstehi,.ExeoJtive Director' .
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' Var~pus:h~alth carep~?posalS,irtclu~,esomeform o~ an:J:v1SA;· Th~, Gephardt '
...... ' ·and ~owland-Bi1irakis bill~ would establish MSAs th,atwould only ~ccept.
, ... contribut~ons-fromemplo¥ers: The Michel and'Qofe-Packwoodbills \.voulel establish"
. 'MSAs'to which ei~her individuals o'r employers',co'u~d 'conqibute. The Mitchell bill ' i '
does not create MSAs. "
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. The arialysis"examilies:.,how benefits' 9f indivi~ual con~ibutiori ¥SAs wo~d,'
, flowoverWhelmingly,tQllPper-inGometaxpayers inu~h like indivldualr~tin~ment" ,'.
accounts did lJefbre theiruse'was linlitedto rhoderate-incbmetaxpayers.in'1986~In
; .' .,addition,:MSAs are likely to prm:lllce)arge"fI?v'enue losses over time,.,
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The,pape'r di~cus,ses s~'me ofthe '.hiqden,dang~rs of incl~ding'MSAs in 'lleaith,
'care reform legislation" It addresses both. MSAsto which'indf'viduals woulc;l '.
contribute: and ,those designed to accept contri~u~i6p.s from employers~: "Although, '
these two 'nlo,dels of MSAs prese.p.t 'so+riewhat different problems.~ b.oth, could result i~.
increase(:lhe~lthcare '~osts' (regardless of the presence, of an, eit:tplpyer ma~d~te) and
'could j~opardize efforts to acNeve uitiv,ersal health c'are coverage.
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202-408~l056
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The ·'New York' Times
~e~York"NewyC;;rk
AugUst 16, 1994
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'Don't Be Se(illCedbyJV[edi~ave
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, Medisave,' the propOsal' for medica,I' savings', vary with their medical' condition. The combination
, accounts, is a bad idea that has crept into thehealth-,.,: ,qf Medisave and reform invites a scheme: healthy
car,~ bills proposed by th~ Democratic leadership in' peqple buy catastrophiC policies until they become
, , ~the House'a.nd by Bob Dol~.the minority lea~er; in sick ,or pregnant; 'then theys\\'itch~o' ordinary ",'
',the Senat~. Medisave would/allow people to, !ii,ave cOverage"The,scheme,would destroy the elemen
money: by purch~singhealthin~urancepolici~swi~ '. tar'y need of insurers tl) charge/healthy custom~rs,
very hIgh deductible!; and then mvest ~he~avmgs l!l " premiums when they are well to, cover. their costs'
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A~vocates 'say ,Medlsave .can help control"
'Medisave will not work for another "reason:
, hE7illth-care costs through consumer cho~ce rather",' Most healtb.-care' costs are ac~ounteQ .for by pa- , " .
than h;eavy-ha~~ed go~emmen~ regulation. Cat~~ tients who exceed the. $3,000 annual threshold. If \ ,
strophiC c~v~ra~e requ1r4;:s consumer~ to:pay .ordl-, these high-cost patients oWn f~for-service policies,:
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,., na~: medlc~l bllls·out o~ ~ket.leavmg msuranc~, ,"they lose 'any,reason to search for 10w4::ost provid~, ,\. "
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_" ."....~_,. ;___to_pICk;..up,,-only_large_blils:..that_exceed_an_annual_ .-- ~- ~ , " , . '." ....... ' --. __._,......_.._,_.,. ...-----.,-....--'...., -,_ .... '
, ," thh, "Id f' , . $3 000 Th "t' ' ,'d' "'t d' _ . ers. Stu(iles show that s~rglcal costs among compa. ,
" , " "res 0 o. say, , . a , accor mgo avo, ".rable hospitals can vary',by tens 'of thousands of
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cates. will compel consumers' to monitoi:' physician' '
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and hospital fees ca,refully.,'But what advocates do , dolIa~s; un~er cata,strophlc c~verage.:patlents wIll
. not say is that Medisave would'hurt the poorand'the Jose mcentlVe to.re;w~rd ho~pitals that, charge low
/ chronically ill and' ~nadvertently 'disrupt private , fees: Catastrophic coverag~ can also drlv~ consum·
. insurance markets. "
' ',ers away from low-cost p~lmary care, which would
" Meqical savings acco~ts would, attra~t the' , c~me ,outof their pockets. toward ~igh-tech, costly
'riCh, because they get the biggest benefit from tax- ,fixes' wh~nthey let a prev~ntabJe problem fest~r. .'
. free investments. And the accounts would attract'
,'Medlsave'advocate,s are correct whel'! they say ,
,healthy 'people .I>ecause they would not expect to, " con~1.im~r' choic~ ciu:J hel~ co~1trol costs. But 'the
s~nd much money out of pocket for health care. ,C?OlCe that consutner~ ~:nch ~nd ~r, healthy and
But as healthy' pe6ple~, ,gravitate JO,wardcata:.J " SIck - should ha~e !O m~ke IS between sta~dard
strophic coverage, the, Pool of applicants fot regular '" packages of benefits. That way health plans would
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coverage would consist increasingly of people who: be forc~d ~o :attra~t' applicants 'by Offeri~g high
'are more chronically ilJ and more costly ,to insure; . quality care and ~attractiv~ prices ;....' rath~r than
th~t would.drive premiums higher.'
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,', .pickingoff low-risk applicants with ¢atastrophfc
',' The problem grows' worse under.,health~care" .policies and leaVing the h~gh-cost patients forsorl:te
reform~ .Every' bill would t;!'!quire' health plans 'to ' other plan to co,,:~r. Medisave is a needless payoff tQ
" cover n~lilrly a":y applican~ at rates ,that would not 'rich families ,and a bQdy blow to market reform. '
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'f9 94 '. b~.·T~e ,~ew' York Ti~es, 'Comp~~y,. reprinted by" p-ermission.
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CENTER .OrtBUDGET/ ,,~'"
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, Thursday, August 11, 19?t4"
(Revised Augu$t 1,8, '1994)
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'CONTACTS: Iris Lav',
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An iaeger' '
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,'SPECIAL :MEDICAL SAVINGS ACCOUNTS COULD JEOPARDIZE ,',',
UNivERSAL COVERAGE AND PUSHUP HEALTH COSTS; ANALYSIS: SAYS
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iitii'e-f\oticed' provisions 'allowing individuals 'to set' l,lp special Medicru' Sa~ii1gs Acc~u~ts '-', "
"includ~d in several of theh~alth,ieform 'bill$ now 'before Congress '-',',could jeopardize the
'goal 9fu~iv~rsal or,near-universal coverage and 'push up health costs for families; ~mployers, '
and gov:ernm~nt,'according to art analy~is'issil~d today by theCenter onBudget and Policy,
,pn9rities.·
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~~dvari:aged' M~dicai, ~aYing~ Ac~~~n6;.
,,the ,proposals' for't:p:
Aredfound ,in different 'forn1s:in, " ,
'several Sen~te bills ,~d: 'in yet ano~her fOi1n, in the House leadership om: Although the' , " , ,
leadership bill now on the Senate floor does not include an MSA proyision, an amendment
"', provi~ingone maybe ,offered.d~ring ih~. de~at¢.
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AccQrding to, the analysis by the non'profit research organization, MSAs' in plans without,
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, . ,way; these MSAs are similar to,individuaI,retireme~t,accoimts before their use was limited to
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Un,der all the' MSA plans, individuals. with: catastrophic health i~suraIwe cOJ.l:ld d~positPart of.' \ '
, their income' in speCial accoimts witl:wut payi~g, tax'and use the m,meyto ~elp meet their
" deductibl~ ,or other healthcare\.'
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'While6n the s~rface these'propos~lsh~ve,sorrie appeal,the analys'iss~id they pose seriobs,
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MSA ' - in the hopes 8r keeping their tmspent deposits as tax~l,ldvaritage'd investments -", the " :~ ,
pool of those covered by comprehensive heal'th plans will 'become qlderand sicker; pushing,
up the cost,these plans, the analysis 'found~'
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,'Gaming"
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,According to 'the' analysis, ,'people al'so arelikely to, "gaine" the,system
using¥SAsto '
accumulateiax-advantaged 'savings when they,e~pecqow,health C'9~ts andshif,ting, to,: "
comprehensivy covera:g~"when they'anticipate 'higher:costs.: I:"
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"Gaming" could result, the analysis said, 'because most penoing health care reform plans do
, not include "pre~existing conditiori" provisions that 'prevent switch,ing from minimal to ,higher
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777 NOrt:hCapltol ~ NE, Sultei05, washlngton,OC20002', Tcl: 202-408-i080 ,
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Ro'bertqreenstdn~
Executlve,Dlre:c:t:Qr
Fa,~'202-408-1056
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coverage. Witho~t such barrier,s, individuals would, b~ free to choose' catt:/.stmphic cove~age',
" WlieIl they are healthy and switch" to~comprehensive' coverag~, w.hen they; begin aJainily or',
face surgery. '
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The'result would ~~, upward .'pressure on the~'prite of compreh~n$ive' insurance',plans" which '
would increase :the cost to 'employers and families for, premiums and ,to the federal , " ,'"
government for health care ~tibsidiesfor. low-income ,(amilies, the analysis, sajd. ' ,
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MSA pr()pos,als fall into two general categories, but both are tied to us~ of catastrophic, health ,
care', plan,s, or, insl;lrance cov~nigethat.quTIes' a ,high year!y deductible." ",' ',,: ' '~
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The propos'als found iri most health .ref6~ .bills'th~t~,do,nQtinciude m!illdat~s requiring;,
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employers to contribute to health instirance for their employees' allow taxpayers:to make MSA
r contributions, up to ;ill aiuiual ceiling, and to deduct those amounts from their income for tax~
pUq)oses.Several;Senate bills fal(into'this,category. ::,',
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.,' Most of'thesepropos~s requite .MSA funds ;tQ :be uSyd for expenses thiit cou~t toward a
.' d~ductible . . undercatastrophicjnsurailce plans.,'~ome: als9 permit.use .0(. the 'money for other ' ,
'~----'--:-:--' -:rneoical expenses mat migntnorDec-o-ve-reltlTmjenh~'7ptans,sITch-a:S-eyeimn-dental-care-.-,--, - < ' , - - -
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, , . ' , -$ome proposals ;uso, allow deposited,' funds to be used,lor any purpose after. the employee " '" ,_ ,
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, MSA fu~ds, used:to paY"permitted types of 'medical bills 'are never taxed. Ataxpaye~ in the
'highest income taX bra~ketwould~sa'Ve nearly $700'in federal'taxes for eyery' $l~OOO spent on'
medical, care 'llnder an. "individual-deposit" Medical Savings Account. ',!"unds withdrawn 'for' 'c
, " , non:-p~rrn.issibleptirposes ,~e tilxed' as income wh¢nwithdrawn and'also are generalJisubject
, to penruties:'i\ccording tethe analysis, however; taxpayers who ,withdraw frindsfor non- '
,peimissible purposes can still come out ahead, even after paying the taxes"an<l penalties. , As"
a result,' high-in~'ome taxpayers who expect to ,remain' healthy can use this form pf MSA to '
accumulate savings atreduced tax rates.
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,,' '~added;the net value of $3,000 of gross income after fiyeyears in the MSA wopldbe 'nine
"'percent'more'than $3,000 .of gr6s~ :income' saved in the tradition8I ' way., ~This assumes the
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, taxp~y~r is in the 36 ,percent federal income taxbracket and a seven percent state income tax
. : bracket arid that t,he account ~a!ns 'only minimal, thfee ,percent rate of interest. The Gramm . '
, , ,plan allows taxpayers to use MSA deposits for, any j,mrpose' \Vithout p~na,lties, ,so long as/ t~e '
there is enough leftin~, theaccouqt to cover the yearly·insuranc~deductible. "'~",," , ,
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,If held' fOr 20 years,' the. $3,0,00' MSAdeposit ~nder the 'G~amm plan'would have ,a ~~t value: ", ,
, , :nearly a third greater than a depos,it that did, not enjoy such tax advantages, the aI}alysis "",
,added. 'A:rid -if the interest rate ,'were' five p~rcent rather than three percent, the MSA deposit,
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m,~de u'nder' theGra~fn: plan ~ter ,20, years would'be w~rth:50 percent'mo;e than
lacking such,tax advantages; "
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," Other"'individual-deposit"MSA proposals have more restriCtive provisions ,that 'would lessen
, , the' value of MSAs fpr investlllent purpo,ses, but' they' woti.1d~ not eIlnllnate, the tax advantages
altogether,the' analysis said.'; A~ a result, l1igh'-income taxpayers could still use th~ accounts'
" ,'as a tax-advantaged way to accumulate;sivingS. ,
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"flndividual-deposit MSAs generally would ,afford a substantial new tax break to 'healtJ:ty, high- ,
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, incort;tepeople that wOilld' he' unavailable t()the vast: majority ofmoderate~income.families
, " , ' that fall inth~' 15 p~rcent tax bracket," the an~ysis concluded; 'adding that the tax break '
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, ','In this respect,' MSA usage is likely to be similar to ,usage Of Individual Retirement' "
, ,Acco,imtsbeforerRA use waS' tiniitedto'lo\V~ and rnoderate'-incoine taxpayers ',in' the'T~',
Reform Act of 1986," the analys~s said. Before >1'986, itnoted, 82 'percent of IRA deductions
were, takeF1,hy th~'of.le~thIrdof individuals with, the highest incomes:.'"
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' . Also, the ahalysissaid, since. virtually, all those who would benefit catl afford ~xcellent health·
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- ,- '; ,,,',- -..... ~~-th-e~-g'0-al-ohrr~n-g-affO'rda:l1le4realth-care;c6venige-avail~ble -to 'every ·Anierican:'---Rathe~;'it-~-:-·-:,·· ::-,~ -:-~ ~-"'.
. ) sai,d, they are. likely.. to make the(goal ~arder to reach ,by driving up the cost of c:,omprehensive \
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health insur:;mce:
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'Employet~DepoSit"MSA Provide -Tax~Advantaged Savings
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;Bil~s proposed by'~epre~entati~e Gephardtand by RepresenUttives Ro~iand and ~ilirikis '~'.
. "would ct:eateJv1SAs thatwould 'only accept contribu,tions from employers( 'Under'these " . ' "
. propos~ls;. employ~~s couldo~fe6( cphibination ofan MSAand a hlgh:-'d~ductible insuraricy , .
plan as,an (il~mative t9 cotnprehensivc!insurance'j coverage .. Employers are required to ~pe~d ;'
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Jlnder tne"einployer-depo~it'.': MSA .in the: House_leade~ship's', health refo~plan, deposited
, ,funds must be' used forhea]th,earecosts or remain in the account until the employee reaches
age 59Y2. . Under the Rowlarid-Biliriikis bill, unspeJ;l(funds would be ,retained \lntil the' .
empJoyee reached age 65. Atthat poin't, theybec'omeavailable foCanypufpose without .' ,
penalties~" For en;IplQyees {who areielatively healthy and accumulate bal.ances in their, . ..
'. accoun~; the'''employer-'deposif''MSA provides' tax:-advantagedretiremen(savings.· Less ....
. ",healthy emp,loyees,however; are likely tofindthe. combination o(:catastrophic insurance arid .'
, :. -an MSA inadeq~ate.to· meet,their h!!Ii1th:~are. ,ne~ds, the analy~is found..:,"
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'Because the' employer rat~ei than the eIpployee ~akes :the deposits,:"emplpyer"deposit"MSAs
would avoid ~he, pote'ntial: for ~arge federal ahdstate revenue losses. Like "indiv.idtial-deposiC: ' '
MSAs, however, they wpuld create incentives for gaming the system that ultimately would . ,::'
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l~ad to increased costS fprtieal'th insurance. For example,: th~analysis found, a 'young, single:
person 'whose employer deposits $2,509' anriually in an "individual'-:-depo$it" MSA,and who,
withdraws no funds for medical' expenseswoul<;l acc,umuiate, $28,000 over ,10 years. I{ the ' ,
, . same; person, ~ook $2~590 01 e~ings, paid"tax;~s o~ 'it" and ,saved the aftec'-taxearnings ea9)l'"
" year for 10 years, the accumulatIOn would ,be o'nJy ' . . ' '
$16,600.,
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, "There would' be strong incentives to accumulate tax-a~vantaged savin'gs attiin~s when few, '
, 'health care expenses are ,anticipated~" the analysis said.' 'When high' medical expenses became ' ,
,more probable, the individual could,simpIY,switch,t,o comprehensive coverage and keep, the
;MSAaccl:1mulatio~as savings~' ',"
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If the cen'centration' of l\ess:-healthy w~rkers)n ~om'pretiensive,plans' drove uppremiumsf?r
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, 'that type of coverage, the an:al~sis, ~ai~; employe:s' Wpuld, f~ce ~ncre~ed :costs ~or. all, types of.
"health coverage. Under th~ DemocratIc ,lea,dership pIll, for example;'employers would pay 80
, ,percent of ilie''incieased cost 'Qf cOrnpreheilsiveplans for 'their employees. 'Eve~ if the cost of,
" covering employees under catastrophic, plans did not'increase', employers would still have to, ,
'make larger' payments into MSAs" (or' their employees with cataStrophiCIMSA plans' iri order to'
, complyv.;lth the requirement t~at the same am01int per employee 'is spent regardless of which
option is chosen.,Unde.r.the Rowlahd-Bilirakis"bill; 'eith~remployers or workers would have, ,
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"In addition, the ~atYSi~ said:fam!ll~swould' fac6' incre~e~ costs for'theirshare of '
, compre~ensive insurance pre IIIiurris; and the, federal government"YoulQ pay more for , "
, subsidizing lo~-income' households that buyinsutance and sin all ,busm~sses that must provide
, insurance for employees. Thes~ added,costs would require implen:J:entin'g o,ther me~u~es ,to,'
hold down ,costs to ,avoid ,swelliI)g, the qeficit 'For example"under the' Rowland-Biliiakis bill~ ,
these added cos~ 'could tp:gger reductions in 'eligibility for Premium Subsidies, 'leavrng ,more' ,
peopl~' uninsured. 'V nder the Den;locratic,leadeiship bill, payments to providers' could ,be cut. '
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No G90d Way, to' Desig~ MSAs.. ', ' "
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,':"There ;does no~ appear, to,b~ a way 'to designan',1\1SAthat is not detrimental to the goal ,of'
',achieving universal or ne'ar-univ~rsal' ~eaith. ca:recoverage a1 a reasona,ble cost,'~. $e, analy~is
,concluded: . "TIie ultimate, cos~of allowing Medical' Sav,ings Accounts, with or without" , "
employer 'mandates, is .lik~ly tei: be fewer benefi1;S with higher co-payments in comprehensive
insurance plans used by middle.. and lower-income. farnilies. In additIon, -in the absence',of an ,,' ,
employer.: nianda~, a IC,lwer proportion of the, population' is ~ely .to be covered by adequate "
he31th 'instirance"-,' $ince'incre~d cost ofcomprehensiye ,insurance: would lead som~ . ' ,
, employers to drop' insurance 'coverage, ~nd ascale..,back,of subsidies would cause some low
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':.income ;families tC,l fal! to purchase health insurance."· :
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The Center 'on B'~dget '<lJid' Policy' Priorities con~ucts reSearch ~d analysis on a rangeo£.
<government polide~, and programs, willian emphilsison those affecting low-inco~~,' '
, Americans.,' Support for this analysis was pro\!~ded by the Henry I, Kais~r F~ily , "
,'Fo,undatiol1 : .The foundation is not affiliated with Kaiser Permam!fiie or Kaiser Industries.
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"CENTE'RON BUDGET.'
........,....' AND·,·POLICY'PRIORITIEs.
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A number of healthcare 'reform bills iri~lud~:provisio'I1sfor tax-advantaged ,.. '
'Medic'a1 Savings Accounts. 'All of these billS: tie use, -ofsuch accounts to ,catastrophic,
~ealt~,care cQverage,' that Is,a health insurance planthat carries a high yearly '.
de?u~tible a~ount. .~unds'placed in a meciical' ~avings acco-qritin~y be used to pay, . '
health care costs' that'count' . , .the·insuraricedeductible. ,Under some. bills, fund$
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'Oil: the surfa¢~, MSAs have ~ppe~l. An,MSAcan ei1ablep~ople who are, young .
.and ~ealthy, a'long with people ,who· have, enough discretion~ry income to set aside'~or ' "
.. --contirigen~ies,'-to-fee.l-the.y-a.r,e-keepif-l.g-their-ow-f-I.-money -rather-,than· Gontributing-iH0~-:-'-' ,.." ".- ;" .... '-, ,
. insl;1rance cornpa~y,piofit$:. In 'addition, proponeI\ts ofinjecting'plore'free':'market ' ,
.disciplim~, into hea~th, carepeli,eve~a(cQnslln1ers:,cap: be made ,more prke-sensitive -.. '
arid will con~unie fewer health ~ate services',~ ifthey pay medical bills out of their' ,
own accounts. "
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~ Neverthele~~, 'the;e'a~eserious problemswith,MSAs.: The~e probie~s)g~e~tly
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'MSAs'are iikelyto jecipardizethe national goal6f aChieVipg·unhrersal health car,e ' , : . '
coverag~,at.a reasonable.cost: .. :" "
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, If you:nger,JieaIthier people <:h06se' catastrophic: insurance, with MSAs in~the!
hop~ of ke~pingtheir unspeh~ deposi~s'I'thepopl t;>f.people covered'bYcomprehensive.,
, health inSurance will tend'to be older and sicker. Since most ofthe.health care reform /
, proP9sal$ allow tree .thovem~nt pmong,heaith ~nsuranceplans, ~itho~t regard to' pre
existing condiHons, people are likely to "game~' the s.ystem. Peoplewotild be able to;
u$e MSAs to accumulate tax-advantaged savings, at times, whenthey expect 'low health'
care costs and then shift. into' 'coinprel:}ensive helUt}:lcare. pl~mi at times when they" <"
, anticipate high healt.h care costs~such as ~ "
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':,', ,surg~ry.As.a resUlt; the price of 'a basic'
, tompreh~nsive health insurance pl~n
, Will' be' higher thanitwt>uld be, ifall . \
" people participated in a~o1}1prehensive
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.' " , 777 North Capitol Street' NE', SUite 705,'\Vashlngton, DC 2(X)()2' Tel: 202-408-1080 Fax: 202·408-1(;>56 '
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" " 'The up~ard p~ess~~e,~n'the pri~e o(a~omprehenSiveins~ran~eplat;lW~~ld
" in<;:rease the cqslto employers and familiesofor pre~himsarid to th~ federal,
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goyernment forsubsidies, In apdition, ifindi,viduals are permitted to depo~lt funds
'into theMSA ~naddition t6,'orinsteaq of, employers, MSAs dm be ~sed in part 'as a
. n~~, 'ri?n-pf'odudive tax: break: this couldincr~ase thelfeder:aLdeficit and ca~se"
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revenue losses forJ!larn~ states, 'Several pending health tare reform proposals 'would
, 'create MSAsof this type:Like Individual Retirement Accounts befor~, their use was "
ijmit~,d 'byth!= Tax RefbrmAc~ of 198b;,~SAs are' Hkely to yielctlarge'revenue losses"
'that disproportionately-benefit high-i.ncom~ taxpayers~
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" ~lnciividua:I-Deposi't',and' 'Employer Deposit' MSAs "
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di~tingtftshJw'obroad types of proposals, both of ~hich ate calle~',.
,Medical Savings Accounts,,' The twotypes of proposals haves<?mewhat :ctiffer~ritpolicy,,!
, implications. One type maybe calted "indiyidual-dep<?sit" MSAs, while, 'the,other'Jnay
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" _"Individu~l~de'Pbsit"MSAs +,~uChJsthqse propos~d by Senators Phii-Gran'u:h;
"Bob Dole>andJohn Chafee and, also in 'two' separate:pr9posals by Representative:J?ob
'Michel'-,' are included inbiUstIlat aortot require emprOyer~' to contriD~teto h~a1th
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iri~ur~mce for their employees:' UndeJ'thes~ proposals, qualified taxpq.yers(either
, directly or,through their:employe~s) are. ClnOwe~:I.~o contribute'yeadyamount$ to,an
, , MSA,· up to .a,specified c;~iling.;, To b~ qualifi~df taxpayers, must have~ ~s~ance' '.
"coverage thr(;)Ugh a,tatastrophicplan.'
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','CQritril?uti~rts to lIindi~idual-'deposit" MSAs may b~,p'educted on an"" ': :'
Individual's income tax when: determining adjusted gross'income~ which means they.
'" " may be,deducted ;wh~theroI; not the individ~al it~rtuz~s'othe{deductiorts,Ji'M,SA
,contri};mtions ar~ withheld from income by an employer, the ,withheld amountalso5s.
.. hot countedas;wages of;sal~ry'fdr purposes'ofcomputmgincoI?eo! FICA(Social:,":!,'
'Sectirityand Medkare)taxes> In some propo~als, contributions Illadeby a , ,,:,"
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"self.:·employed individual or persort whoseem'ployer qoes not p~ovide ipsurance are
'shnilarly exempt from income and FICA taxes. 1 ,
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The Dole biII allows, irydividuals to. make depOsits in ~SAs if they are not eligibl~ to. participate in' , '
, an em ployer-:-subsidized healtl!'pian or do n'ot receive em pl6yer ~ono:ibut!0ns to a medical, sayings account: ' ' :..
, 'If an employer does make contributions:for'anemploy'-e~ to an MSA,·the MSA deposits 'l-re tax-,free to the ,,,'
, " 'exte9qh~ydo not exce~d the differe\\ce betWe~n th~ premium cost oft~e catastrophic 'plan the employer,
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"MbstQf t~e propo$alsrequif'e person$holding MsAs tQ' us~ funds in'qh ¥SA I
. account to pay medical expenses that COUJ:lt' toward the deductible amount of their.'
';c, 'catasl:(Ophicinsurance. Individuals who incursuch"expenses but do notreimburse
. " themselves from their M'$As are subject to a tax penalty'. Some; proposals, ho~~ver
such as Senator Gramm's -' simply per,mit sl.!-ch reimbursE:!ments fro,m MSAs to ,be
made: .
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medical exp,enses'that are not covered l:>Y catastrophic insurance ,and thattherefore .
would not ,count to.ward thedeauctible. Depending, gn the'plan, expenses 'that ,do not,
count towardthe deductip1E~ might ~nc1udecosts for eye caie,:dental, care, or m'ehtal
h<=:a1th's~rvises.' Funds withdrawn frpm MsAs ~at ar~used to.payperrriitted types of
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pu~poses, th~yar~,'
'subject to income taxes !is 'ordinary incdme in the year tlley are withdrawn. The
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various proposals gene~ally also. apply Renalties to 'such withdrawals, but differ i,n the
, : circuJllst,mc~s to.whidi the penalties apply. Some bills}lso ~llowpenalty-free'
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, '.' wit~drawal 0'£ f~nd~ after the holde.r,reache~ a'specified age.,
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'EmplOyer~O~posit~MSAs ,:"
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"Em'pI6yer":deposif'MSA'proP9salsa.11ow'e~plbyerstooffer their eIllpl~ye~s al!- ,~' ,
option of a'combination MSA and high-deductible insur~nce plan as'an alternative 'tQ' "
_comprehens,ive ins4fance coverage. They contain some mechflnism fo~, requirir:tg ,
, ,employers to spe~d' the same (lmout:Lt -per' empl9yee regardless of ~hich option the' " , ,"
'" ~mployee 'chooses; fhemech,anism may either be, compon,ent of an 'employer mandate,
as ili the Jacobs amep.drilent, or a non":discrimination r~guir'ement, as in the Rowland-' .
·Bilirakis prop'osaL In either case, parity is accompfished ,by requiring the emplQy~t to
!depo~.it'intdtheMSA the 4ifference be~~eri the ernployer~~ share dfthe premium cost'
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, for t~e higl1~deductible cov,er:age emdthe'erhployeri,s ,~ostfor,~omprehe:ns~ve coverage;.'
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ci,ffers and the premium coSt-of· a comp'rehe'nsive plan fo(the individuak . .
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.<Representativ'e' Anqrew'Jacob's amendmenttotheWays'and MeanS Committee bill: '
(which is inch.ided'in the'House Democratic leadet:;Ship bill), the substitute 'amendment
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" proposed by'~epreseritatives R~y, Rowland, and Michael Bilirakisi and a sense..of-tJ;ui!
, Senateamend,menfoffered by Senator,Harris,Wofford in the' Semite Labor and Hfu.D.ari: ',' \'
Res~:)Urces,Comm:ittee'all indude"ernployer,deposit" MSAs.. The bill recently'advanced '," ,
bySenator:,george Mitc~~l1 does not ihcl~d~ an:MSA p,rovision." • ',' " ' ,: < >. ' "',' ,'
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Fpr example, under the Ways and Means bili, an.employer would,be ~equired to '
'contribute an amount equal 'to 80 percent 'of. the ,cost of a comprehensive family plan for
'. each worker. If a comp'rehensiveplanco,st'$5~500; the employer's requir~d ~ontributi01!
would be ,$4,406. ,If an employee, ~hos~ the, ~atastrophic/MSA optiori instead a'nq. the:'
'.' catastpophic'plantost $2,000, the,employe~ w,ould contribute 80 percent -"- or $1,600-;:
. toward that plan,and deposit the difference of $2~800 ($4,400iniriu$ $1;600) iil.the, , ,
,ep:lploye~' s MediCal Sayings Account. Once an, employeF elected to makeacontrib~tidri
'\ towards its workers'health insuqince ~ostsunderthe"Rowland-Bilirakisproposal, the. '
; pioc;ess would bes~ilar.2 UndeF this approach, emplpyeesmay not.make additional
cpntributions to the MSA. ' .
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.c0Sts~ there are no pr~visions for withdrawal with pe~alty ,for other ,purposes. Unused,
.funds r:nu~t 'remain in the:,h:;coUJ:lt. T~e only exception occur~ aft¢r'th~ emp~oyee
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:,. reaches age 59¥..· After age 59¥'i the funds in the'MSA become aVailable for 'any,
:pu~pose~ without a'pe~al!y being hrip6sed.·· TI:eWo£ford.a~eI.1dment was. np~
accompanied by detailed provisions; but it was understood that provisions similar to"
:' tpose in the Jacobs amend~ent were in~ended. The Row lahd-Bilirakis prop'osal would
,allow penalty-free withdrawals, after the employee reach~s age 65.
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"lndividu~I';deposit' MSAs: Healt.hy, H,igher-Income Taxpayers have:lncentives to
,Maximize Use ~
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, , Many high-income taxp'.ly~rs will garner s'ubstantial t'.lx be,nefits from using'an '
,"individual-deposit" MSA and would be likely to'view these'MSAs as 'an advantageo.us
"waY~Q'paymeili:cal ~xpens:es. Fdrhigher:'income taxpayers who expec~ to reI11ai~>
healthy, individtial-depositMSAs woulabe particularly advantageous because the'
acc~mulated .deposits would, repre.sent anew,. tax:..aCivantaged way to accUffiula te ,
sayings: , As a ,result" highet-income taxpayers who anticipate:remaihing l;l.ealthY woitlq ','
. ,,~-eJikely to 'use MSAs ana to contribute the maxiIl}uIn perm:issibleamount to th~ii .
- ',' MSAs. " ' ": . '. .
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, ' , ConsIder a 'taxpayer in~e Nghest federa'l inc.orne tax brack,et ':Eiti1er topay
, $1,000 in (mt':of:·pocket m~dical experi.s~s'ortodeposit$(600 In'a savings account
umier current law/a, taxpayetiri'the3~.6 percent federal income t~x brq~ket would
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' 2Vnder th~ Rowlanct-Biiiralds propo~al,'deductibl~s for ~~tastropliic pla~s ~ould set so that these,
" 'plans would have act\,iariai values'equal to eighty percent of the actuarial v,alueofcoinprehensiveplans,
Hence if comprehensiv~ co,:,erage ~ost $5,500 as in this' example, catastrophic.plan would be expected)o:
cost about $4AOO. If an employer had chosen to make $4,400 contributions towardsits workers' heaI'th care
coSJ:S~ a w~rker choosihg the catastrophiC;MSA option would,rec~ive a':$l,lOQcontiil:j~tion to risor her',
MSA and -have $3,3000f the catastrophlcplan's premiup1'paid by the employer. . , ". (" '. " ' , '
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MSAs. Do Not Help, But May Adversely
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Affecl~ Low-:lnco.me' Fami!'ie~
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· M~dic~l Savings Ac~ou~ts offe'r no ad~an'tage fcir.low-in~~me families.· In fact, inclusion of MSAs ina,'
· heaHh care niform bill 'woule! likelY, disadvantage such families,bec,ause MSA usage is likely to
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.':increase th~ cost of comprehensive (nsu'rancEi.' The' increased costs'could make insurance unaffordablE:!'
. for some low-i~come fani~lies that db not qualify for ful1:s';~sidies. :(n addition~ the cost to the federal· ..
.. government of providing subsidies would be higher,. increasing the likelihood that subsidies would be
scaled back for btid'getary re'(lsons aDd the.reby furtherred~ce' the affordabiIi ty ofinsu~ance for low- .
income families." . i . . '
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. 'Dedu'ctions:NoVa'lu'e to- Poor Households'
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MSAs s;ubsidize the purchase 'of ,h~alth car~ services through providing ta.xdeductio~s for depositsip.to
the accountS; Thi~~anbe of considerable benefit to high-income ~axpayers(as isrexplained starting on ";
. i'page 9)., ,But such tax'deductions'are of no.value to poor families that dpnot owe Income tax, and ,thus .'
MSAs ,cannot be used tosubsidi~e the pUl:chas~ of fnedieid services, by sll:ch families. M~deriite~incpme '
faniilies inthe 15 percent federal incometcixtiracket wOuld ,receive some subsidy from using 'an MSA,
'but arelikely tci'hav~ insufficie~t resources or discretionary. . take advantage'of these b~nefjts. '
i'ncome to
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MSAs Will Increase the Cost of Insurance,
. for Lb~-incomeFa.thlli~s
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~4!!..Rrop6sals fo~ MSAs include some drc~msta~ces u~derj;'hichfunds in .the.accounts:~ay.b~_used·..-:. __
for no~~medical'purpo~es: In some cases, funds maybe withdrawn without penalty if.thebalances '. '
remainitlg in the acc¢lUnt meet a speci fiee!, threshold; in ,other cqses, a modest penalty is applied to' ,
,funds witi1qrawn fcir:non-medical purpoSes. In some bills, funds may be witi1drawnwithout pen~lty
,when the holder reaches a specified age. These.'piovisions invite youi}ger, healthierpeopie to choose
.catastrophic insufance,'with MSAs in the' hq'peof keeping ,their t:Jnspent deposits as tax-advantaged . ,
'investments, leaving an ol<;ler and sicker pool of p~ople to be co~ered by comprehensive health ' .
insurance. As a result, the, price of a comprehensive health insurance plan will be higher'than it would
,be if all people p~rt:icipatep, in a comprehensive plan.·
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. For, persons with incomes modestly above the poverty line,.the increased cost. of comprehensive ,:,"
irisurance-:- resulting"fromthe.concentration of'healthier- people in catastrophic iI!surance~ could '.
represent a substan~ialbu~deri. Since the various health care .refor,m proposals begin to .phase out \'
· :si.Ib~idi~.fo~ purchase'of health'insurance:at orJust above the p()verry-line, Il1any low~income' familieS, ,
.arelik~ly to b~ar directly'a share of theSe higher premium tosts. Some low-incbmefamilies could find,
, insurance unaffordable and, in the absence ofa 'requirement to p~rchas~instirance, fail to purchase it.
MSAs ~illIncrease the Gov'emmenl C~st' of Sub~idie~
• .and Squeeze Funding Available f~r Subsidies:
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, lfthe cost. of comprehe~Sive insurance rises, the .~osttb th~ feder~l govern'ment ofpfpviding subsidies ..
tq low~iricoine households will increase along with it., As result, 'ov.er the long run; inclusion of
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· Medical SavingsAccoun~jn ahe~1th care, refbrmbiU t6~ld resuitinthe sealing ba,ck oflo'w-incof!1~
subsidies for buageta,ry.reasons; Thi~,. too, would cause insurance to be' less afforpal;lle for low-in~o~e
· families.and. could lead some to fail to purchase irstirance. In ,addition,the cost from MSAs ii:tforegone '
, tax rev~nues, much of which isJikely to subsidiz~ high~~ncbme taxpayer'tax-advantaged investments
. not related to medical ~are, may be substantiaL A large revenue loss from I\:1SAs would maRe a scale- .'
back10f subsi.dies particularly likely. .
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have t'~ ~arn ,$1,696 before fed~r~linc6p1t~ ta~ :and payroll ~a'xes aresu~tiacted.' (T~e
,39.6,percent' inco'me: ta~ phis the lAS percentM~di'care, tax eqiials 41.05 percent. 'Taxing'
'away'4L05 percell t of $1,696 leaves $1,000. 3) Using an MSA, r.0wever, wOllIn allow ",
, ' ,such a taxpC1yer'to 'd~posit $lj69prather than$l,OOp:: If the f6nds' are used for,inedical-' ,
~.~ \ payments, the:t~xp'ayer sav:esnearly' $700 for'every $l,OqO,he otshe spends on'medical
care., !f the funds ,ap~ not Ile~d~,d for medical care but ipsteacf are viewt;d a~ an' ,~; ,,' ,
,investment, the taxpayer will eaih,intere,st ,ona~depositof $1,700 ratner than on$l,OOO.
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pgrmissiblt; arriountthr6~ghan' '{ indiYid~ai.,.
, 'deposit" MsA would increa~e with th~ length of time the: ftinds remain~d' on depo.sit. ::
"T~,s may beillustiat~dby c6nsideringa deposit of $3!000 t,o an, MSA in' a, single year
,that,remains 'iIi. th~ account in subsequ~nt years~,For purposes of illustration, the' ,
, taxpayer, is assumed ~p be in the' 36, pt;rcerit federal income tax J:?rac1:<etand in a seven' - '
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, ,'percent ,state' income ,tax bracket. 4 A trret;' percent rat~, of ihterest i$a~suI?ed ,to be',.< ,:', , ' , ' : , ,:":- ; \' " , "
, . earned on,the deposits. ':" ,"
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If.th~'MSA'depo~it were made under the provisions' of the Grammpi6posal;,'.", /
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interest on'the'$3,000 d~posit would accumulate withoutbeing taxed on y~arly basis.
, ," Aiferfive,years, the first yp,ar'~ d~pos~t'of $3,QOO would:hav~ grorvn to $3:480;, The '
" ,:", ,Gramm proposal does'not impose'apenalty for wIthdrawals,for non:"medi~al p'urposes
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~-'7 sp_I,ong~asJ:lle..a.m,ount..rern:c;liningjn'"the.c:tccoW:lt~is~equal-to~the-y:eatl.y--d@d.uGtig~e'-'---'-~--'.'....}-
..'an:tountofthe catastrophic iJ}S,urance plan: 'i?O,assuming that the taxpayer-made
" ,: deposits in subsequ~nt:yearsanda,suffich~nt baiance,remam~d, the individual c'ould
,~,' withdraw..the ,entire'$3,480'as,orclinary incom~~ F~d~raiand,state inCOII\f taxes,would,
reduce the proceeds to appr6xirpa~ely$2,070." This cap: be compared to aninvestmen\
th~ taxpayetcoUld have qlCid~ from orcllnary'after-tax-'earnings;': Theiniti;Hmvest:n:lent
. made from ,$3)00 jn;grossjncome onwhichintoine ta"es and payroli-taxes 'rust ha<;l to
': be.paidwoul.d haveb~enmuchless'-'
,'$1;742: In,addi1;ion, theinter,est pIl'tl)e savings, "
in the n<;>Il-MSA investptent would hav~lbeen taxed on a yearly ba~hi So af~er ~ve. "
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A taxpayerin this intom'~ tax'br~~~et has incom'eth~t far exceeds the'm~ximum:earnings on'
, -. which ~ocial Security payroll taxes mustbe paid and 'so would .receive an exemptiorithrough using,an' ,
',' MSA -:- orily,from the Medicare tax,,~hich is, paid on all earnings. This sirr\}llified exampie' does'not': ' " ,
. include t~e impact,?f state income' tax: As discussed below~ this ta)(pay~r is likely alsq to owe state income
tax, and thus, "to have to earn, more than $1,696 to retain $1,000 under current law., .
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4 ,Til:e 36 p~rcent bracket applies to individuals with taxable incomes over$115,000,and married "
file,rs with taXa}:>leincbmes oY,er $i40,oob. Taxable income is gross inco~e less ali pe~missibleexdusions
and'd~d.uctiOIiS from -income. Thus"a taxa,ble income of:$140,OOO generally would correspond' toamuch
, 'higher'gross;:income~ perHaps in the $170,0(~Ho'$200,600,range. In this and the fo.llowing comparisQn,
. th~ taxpayer is assumed to live in a state with,cinincometax thiH conforms,to1federal treatment of MSAs.
ThirtY-seven of the 42 stah~sthat-Ievy a 'personal incoPle tax generally define a'djusted gro~s income in ,the ,
same way as ~t isc;lefin'~d rorfederal'th purposes. Thesest('ltes would be highly Iikely'to'conform to a " , ,
change' in ·federal' t~x lawS relating to MSAs'. rhe'assumed marginal, state tax (ate'is seven percent, which is
the rate at this income level in the median state.
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Value of $3,000 of Grossfucome Saved Under'Gramm afld Dole MSAs
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:5. $2.500
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Afie~ 15 Years~iter 20 Years
Alter!? Years' .. 'Altei 10 Ye~rs .
, I_curreni ~~wtAPOIe.'[}] Gram~
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Taxpayer is in the 36 percent federal income tax bracket.·and .a 7 percent·slate. incoril'e tax bracket
The sI~te conforms to federaltre,!iment of MsAs, Interest'rate is th~ee percent. .'
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y~ar~;the ~rtiqaI'investment~utsid~o{:theMSA WOUld hav~gio~n to approrimately
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$1,903. 'Conseq'uehtly, the $3,000 of gr<Jsslncome putfn.to the MSA vv9ulq~~ wqrth'9 ,
perce~ti:nore th~i) $3,000 of gIoss in~ome saved in \he norinal~ay.Jrthose initial' .
. deposits were. held for 20 years,the MSA deposit under the Gr~rhm proposal wo.wd be
,worth:30 percent ,more ~ah·a·nop:naldepositthat did not enjoy 'such tax adva·htag~s ..
(See,PigureJ). '. . .
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Bpt wh~re, these restrictipI,lS lessen the value of M5As fOr'ordinary iiwestmenf. ' "
pUrposes,' they' would not c~mpletely elimirJ,ateHthis tax advantage. ' For ~xample, ' .
'Sena tor Dole' s propos~ftaxes,the interest earned ,on MSA deposits on a .yearly basis:
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..,The Dol.eproposal'alsoapplies a .10 perceJ:\tpenalty.toa witfldra~aFfor non': .
peirrllttedpu.rposes;.nq matter wh~t balance remain&'in the account. ,qnder the Dole .:,
prop'osal~ ttte after-tax-and-penalty value, of anJv1SAwithdrawai made by 'a ta~payer in
•the3~ percent fedei-ca ihcomefa;x ofCicl<:etwould be sligtttly gre~ter thanthe'v:alue of a .
. comparable investment mad~ with 'after-ta~ dollars if the investments were:,held at least.
14 years..
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"Theseex~mples~ howeyer, 'assume' ainodest three percenfrrate oj interest earned on
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the ,savings: If interest rat~1; rise i~thefll:tur~, the. valUe ofretaiI:tingta~:'advantaged', .
'. savingsin an MSA woUld increase substantially), If afive percent r,ate ofinterestwere,
, earn~don thesavings,Jor example,' ?fter20 years the $3,000 of gross incoqle ¢eposited .
:a'nd held.in an MSA'would be w.orth ,51 percent 'n;:t6r~ \ffld~r-the Gramm prC?posal , '
, arid 16 percent more under th~. Doleproposal-. than a deposit made from after-tax!
income.·..
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If the, taxpayer inth~ example used ~boyeweie iIi. the :28 percent federal tax. '
36 percent bracket, savj!1g through a GramIn.:.style MSA would
, 'stiIFcoh.fer substantial advantage- albeit somewh,at less advantage than;that~e~ured'. '
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by the high~r-inc~me t~xpayer.5 Under the Gramm'proposal, an MSA'deposit'
. withd{awn after'five 'years for non-medica,l use? would be ,worth 7 percent more to a "
·taxpayer in the 28 percentfe,deral tax bracket tha,n a deposit based, on the same amount ' , .
·Pf grpss, income made, i;nto a norinalaccount,1;>ased'ona three pett~nt rate of iflterest in \, . ,
eaCh case~ After the 20th year, the MSA depo~it wO\lld beworth:24 percent more. ,
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since virttiaUyaU'of th~ taxpayerswhp would benefit fmm M§,As'
,', can aff6rdexcellent h~p.lth care inSurance 'under the current system, the establislurient
. 'of MSA-s' would' not coritribute to,the goal of making affordable health ,care coverage "
:' availal;)le to'every American., As dls~ussed bel~w/ MSAs are Hkely'tb detraCt froin'the
· ability to reach 'that goal;bidrivingup the cost of comprehensive'health inSurance.
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5: The 28 perc~ntfederann~a~e' ta~b~acketapplies to single inciivid~als~ith til;qlbleincome
" between approximately $23,000 and $55,pOOand rnarried,couples with taxableincbmebetW~en .'
, ap'proxi~ately $38,000 and $92,000. Taxable 'income is gross income less all permissible ex?lusi0l1S af).d
\ 'dedu~ti9ns from 'income.'Fh'us( a taxable income of $60,000, for example, ",auld correspond to p1uCh .
; : higher a'cljustedgross iI1 come-.on a~erage, betWeen $75~000,and $100,000 ip. adjusted gross income:,
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", In ~~m, the value of the tax break that MSAs ~onfer increases with the incume -'
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, ), anq t,he income tax br~c~~t'-" of the user and is,greatest for the heal,thiest, highest' ,
. in~ome taxpayers: 'JJIrdividual-deposit"MSAs would afford a substantial new tax,
. bre'ak healthy... high:'incoflLe_p-e_Qple_thaLw_duld_h~unaY-ailable_to-the_v.ast..majoi"ity-of-.---,-..,...-~
m6<;lerate:-iricome families/that-fall in the 15 percen.'t tax bracket. In'thisiespect"MSA .
usage, is likely tc:' be,similar to usage 'of ~ndividual Retirement Accounts before IRA use
, was limited to low- and 'moderate-income taxpayers in the Tax Reform Act of 19'86. ,
, ,Prior to the 1986 Tax Act, 82 percent oORA deductions were ,taken bithe one-third of
" individuals with ~e highest,inc~me~. (See box on nex't p~ge.)' .'
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""lndi~idual~Dep~sit' MS'As Similar to Pre-;.1986 IRA'
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The pattern of usage oflndividual Retirement Accounts befor,e 1986' gives an indicatio~ of what might
be expected under the MSA proposals'. Prior'to the Tax Reform Act of 1986"taxpayers at,all income '
,levels could deposit/up to $2,000' per year in Individual Retirement Accou'ntsan'ddeducrthe'
contribution from their taxable income. Interest onfundsdeposited'in.IRAs accum,ul<ited free from
taxation., Funds could be ~i'thdrawn'after age59~ ,and were subject to taxation as~rclinary income at
thaftime. As,a result; the ,
benefits from lRAscame from the deferralbf taxation on, the annual deposits'
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and, the 'interest build-upand'from,the expectation thaUaxpayers would be in a'lower tax bracket after'
retirement than d~ring their working years. IRAs, were ~advantage6us savings vehiCleS for soine" ,
l1igher-inc()me tll.xpayers, however ,even if they intended to pay the penalty for early withdrawaL
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Even though taxpayers atany incoine level could use lRAs, actual usage was concentrated among
'upper-if).co~e,taxjJayers. IRS tax retutn data show that irll9.86, the last year inwh1ch IRA tax
,
deductions wereavailable-to all,taxpayers, 66 percent of the tax units in the top foilr percent of, the
inc,omesc'aie m~de I,RA contiib~tions. By contrast, only 13 pen;ent ofta~paye~s in the middl~, thir'd ?f' '
the income scale made,suchcontribU'ticiiL Arid only four, percent of'those with adjusted gross incomes ~
below $.15,000 participated."
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upper-i~'com~ ~axpayers terld~~ to have, ~he fi.md~ton:take the'ma,drnum~pe~~itted
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contri~)Ution, while othertaxpayersmade,more:rri.o~est contrioutions:: As a result, the cpstribution of .'
'the amount of IRAdep1..lctions,was ev~n more, tilted to the upper end of the income scale. According to
_
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Congressioi1al R~search ServiCe expert Jarye Grav~lle;' ".. .I~s, c~nnot be characteriz,~d as a subsid y to
th~ miq.,dle Class., In 1986, 82 percent of IRA deductions wer~~~~!l bYJ.l}~!lpp~~ . tbi.\~:LQ.Lind_LY..i9J:l. ~l~~ .. ~ _
filing tax ,returns '(based on adjusted gross income). 'Since these higher~income individuals had higher' .
, marginal taxrates, their .share of the tax benefits w'as eve~ larger:"!' " . '
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~ MSAs may have distributional ,effects tl1at are shniIarly skewed in favor of upper-incom~ ta~payers as
those ofpre-1986 lRAs. As,discussed in the,text, few low- or middle-income taxpayers are likely to '
haye suffic:ient savings to bear the~,risk of high uninsured he,al th care costs. And' the benefits, t~ savings ,
through an MSAinc.r~ase wit11increas~s in iric?me,~nd margiflal tax r~tes'I""
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Statement of J~ne G. Gravelle, Congressional Res~ar~h Service, Senate Committee on Finance, Ma,y
,16, 199L,
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, 'Individual-Deposit' MSAs MaY,Leave Moderate-Income Ta~payers,
" , ,'" ", " ('. Expo'sedto Unaffordable MedicalBiUs' \ , ' ,
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In additiop. to qeing unable to take advan,tage of thehlcrative tax br~aks MSAs
,can offer"tJ:lereis another re,clsonthat MsA,s are nota benefit for ordinary; ql.oderate
income, ~axpayers.; For inod'erate~ihc6me taxpayerswho have.famili,es and for th'Ose
who antiCipate norma,l-to-1:righ medl~aLexpenses, ;using'an ~SA 'with a catastr,ophic
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. in~urance pl,~n may pose a 'signific,ant financial risk. "
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, -Pers,ons covered by catastrophic health insurance must have the yearly
thqusarld dolt'ars -:,av~ilable at the
, " :deductible:~lIh~~n.t '-, whic,hrtlay be several '
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'beginPing 6feach new;ear' to which the deductibleClP~lies i~ case l~rge'~xperises are
'.incUrred e,a'-rly in"th~,year. Jrtaddition; ,:catastrophic insurance plans may cQver.fewer
types of mediCal ser:vices than 'compreh~:nsiv~ plans/,ancl'onlypayment~for ,covered ":
, " ' serviceswoilld count toward fulfillmg theye~rly deductible. Asa reslllt,a person with
~iIl)ited financial resources wilo chboses catastrophic r,ather tllan'comprehensive" ," '
, coverage might'risk incurring large medicalbill~that ar~hQl aovered,by iI!Surance'anq" .
th~t th~inc!ividual caI1!l0tafford~ ::(See box ~n'ne,xtpag~) ,
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" 'IridiYiduciI:-Dep~sieM~As'Iilcre~se Cost of Co,,~pr~h~nsiv:~';'
, , ' », ,Insurance and May R~suU in ,Fewer bl~ured'
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As noted; ma~imizing MSA:deposits would be particularly adv,mtageous to '
high-incoine 'taxpayers, an~ to some n\oderate-incom~ taxpayers, at times in their lives',
, , when they anticipated relatively loW, medical expenses~ ,At'time~ whe(trugh rrledical
"expeI)Ses mig~t be anticipated,hbwever, persons with Il"l:odestfinancial reserves would
'}?e better offusing'coinprehe,nsiveinsUrance.: ,", " " ' "
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, ,'Unqer. ~he'c~rrenth~a:lth i~urance sy,st~m; a sfgruficant bar to keepirlg.'mi~~ai
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, ( cover'i3.geuntH s\lbsfp,ntial costs areimticipated is a w,orry'thata'''pnieXistingcondJti6h'' i
,"; " , willd~ve19P aridfotever preClude the,abilityfo~9btairi insurance. Such b~rriers would""
...:.,..__-,~.>:._~~~_eliminated'by-man~of the refoim_pl~QP.eopk.w_quldb.e:allo.wedJo-choose-tb~b.e-,-'--_,-'--
, ','co,vered by catasttophicinsurancewh~n th~yareh~althy; arid then opt to buy,
"
, compiehenslv~ inS\lI:~ri.ce'wh~nthey kriow~ for~xample: tl}at theywillb~ startiriga
'family or requiring ~Urgery;? ':~fthis, occurs,' the pooiofpeople using comprehensive" '
, lnsurqncewill tend ,to have higher health care utilization ~md a: higher per..:person cost,' '
, of health care thariwoqld be'the case,if everyone wor!9rig for a compapy orJiVirigi~an
area were~overed,by c()mprehensive5ns~anc~. '
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"To'th~~x~eflt th~ttheco'st of basic, comprehensi;e ~urance pla~ip.c~eas~
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because they,are covering less l)¢althy people, the costs to employers and'individu~ls
,for preI1liulns and the'costs t6 the'gov'ernmenHodow-income subsidies also w,ill
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in:cr~'ase: In the absence of an ~mploy~r, m~ndate, this: cost presslJIe eould, ca'lc;e 'some,
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employers.t6 dtop insurarice:cover~ge. ~taIso could res~finthe sc;almgback of i.' ,
, subsidies for budgtTtary reasons, causing some low-tncome familiesJto fail to pur~hase ", . ,',
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If a reformed, system uses a similar preexisting'condition ba(rier to shifting fro~,catastrophlc to, "','
, comprehensive cov~rage,mahy people would be stutkforeverwith deductible amounts tl")at are ' '
, umi(fmdable in their cha'nged c~tcums,~ances. Some of the ,bills thatindude "itldiv~dual-deposit" MSAs
,continue to allow insurance cornpan'ie~ to. deny inSurance coverage bas~d on pre-exisp.ng' cond!tions under
,'some circumstances.: , ,
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iMo,derate:"lricomeFamilies Choosing MSAs Risk,
UnafforclableMedica( Expenses
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Soine rrioderate~incorrie'faniilie~ :Who ~se a,combination '~individ~al~dep~sit" MSAwith a catastropNc, '
insurance planmaynot.,ha\ie sUfficjentresourcesto'cover their exposure to healtlJ'care costs. Consider",
for example,. the Jores 'faniily,~hichcard~s a catastmphic insurance plan 'with a $3,000 deductible'
, t,hrough the husband'sem'ployer.tike many moderate-;iricome families, mortgage and living expenses
, consume alJ. of th~ Jones' income and they are mildly over-e~tenged on.credit-<:ard 'consumer debt. The,
'Jon~' keep $5,000 for emergencies in a money~market fund, but have'no other Iiquiq assets.' :' j ." .'
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Ass~me th~ Jones' had $1,000 inMSA savings going into the year Zlnd made additional depos,its, ,
,thro'ugh thN~mpioyer,of $250 mortthduring the year~:'By early November, the 'family had paid, ",
$2,500 into th~ accouritfrom ~e .\TIonthlydeposits,andhaq paid $2,000 from the account fOfV'arious '
mediCal bills tha~ counted<toward the deductible, leaving $1,500 in the account: In mid-November, .the
Jones' teen~ages'on broke two teeth ina sports gam,e: The $1,000 cost ofnecessaty dental work did not ,
count toward thed~&uctible: amount of their ca'tastrbphic insurance, but it was a permitted use of MSA
funds. TneJonE~s; decided tp pay the bill through.'their M$A, bringing the. balance dow,n to $500. 'Then
in late-November; Kk:Jones became m,and required emergency surgery. The familY,added $500 from,
their ~o'riey-rnarket,fund't6 theirMSA balance to, cover their remaining $1,000 dedtictible for that year:. ,
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, In early January, as Mr.Jones prepared to, resur:ne,work, complications developed and further surgery
, was required. No funds were ayailablein theMSA to pay the '$3,000; deductible for the new calendar
year~ In add.ition, Mr, }O'nes faced seyeraladditiomil weeks before he could ,retJ..1rn to,work arid dtdnot .
, have'sU:fficientsic~ leave toreceive,rus salcu.y for the period'ofanticipated abse,nce~ Paying the $3,000 '
deductible 'wou)d reduce the family'smoneYimarket savings to $1,500; causing the family serious" '
concern about meeting living expenses during tl;le unpaid le<;l.ve.'
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In, ~dd,iti~n to 'increasing the cost of comprehensl'{e insuranc,e (lnd fed~r,a1 subsiqies, fliridivid~~i1~ " "
~deposit"MSAs could result in substantial federal and'state revenue lOsses: If MSA~users'with high, .;' ,"
in~omes deposit the maximum-permitted amounts in order tc)secu;etax-adviultaged savings (above ~nd
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beyonq amounts i'n MSAaccounts that are used for medical costs),)t is po~sible that greater tax deductions
, , " would be taken :for MSAicatastrophic insurance combinations than for ,comprehensive insurance:
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Assume, 'for exaPiple;,th~t'a comprehensive family pl,anhas a premiurrt ~f $5,500 which 'c,m be
paid ~ith pre-tax income either by an employer o~ ,an individual. For coqt parison, aS5u,me that a "
, 'catastrophic family plan has a premium of $2,500 and that the maximum pefmitted contribution\to the
.MSA is $4;000; bringing'the total that can be paid qrd'eposited with pre'-tax income 'to $(),500. In this
scenario,;the Treasury and state goverriments could lose tax revenuefrom,ah additionai $1,000 of , ' "
,poteritiallylaxable income i~a taxpayer~hose the MSA/catastrophiccorribination and 'maximized MSf.,
contributions. A substantial revenuelosswoul,dbeparticularly,likely if the enaCted MSAdeposlt iimits '
werehigh ,they are $5,009 in:Rep. Michel's origin~l h~alth care' reform bill; for tlxampley-and' som~'
catast;rophkinsurarice plans had higllpreq"iums (which could o'Ccur if a plan offered full coverage for
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hea.1th ~nsurarice. Ascal~-b~c~ of subs~dies WCH,lld be particularly likely if the cosfin·
foregone. tax reyenue ofMSAsJurns out to be high? StIch pres~;ures are .likely to
in¢rea$e the propor~on of the populafio~ that is uninsured~
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The'additional revenue loss cOilidbe avoided by,limitingthe MSA deposit to the difference', , '
.' between an individual's catastrophic insurance premium'af.lfa co~prehensive insutance premium, as the" ' ' ,
"employer deposit" MSAs db. The.Pole, bill attempts to address this issue by requiringthatany individllal..
wh9?e employer subsidizes insurance costs may deposit funds,intoan MS,A only through the employer,- ,
, " and by ,liin,iting the amount of tax-freeMSA 'deposits in such cas~s to the difference .between th.e cost of a
,comprehensive plan.for thadndividual and the coSt of ~isor her c~tastrophicplan.·
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, " '~Emp16yerrlieposit'~, MS,As:do rtot allowinqividuals to make deposits to th~ir
accounts. s ' I~tea'd, the,employerw~)Ulctdeposit into the MSAth'e diff~renc(,:betwe~n '
what the ei"nployei wouid,otnerWise contriblltetowards the premiUm for, a comprehen
sive.bla'n an? theemployer's.shar~ <;>f the premium for a catastr6phic"pla~. By' ,:',
equalizing 'the employer p'ayment and tax dedq.ction fqr each option,' the potential for
" large, federal and st~te'revenue ldssesjs avoided: But" ~mployer-dep'osW', MSAs c,reate ",
',-,:, incentives,for gaming the 'system ,similari to those induced by "individual'-d,eposlt": ",' '
, ' MSAs: These incentiv~s wtimately wouldlead to increasecH;ost~ for'healthinsurance.', '
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Consider,~ for ex£~ple~ a yo,~ng/'~ingle person earniI!g $35,000 a ye~r'~~ose, ~
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deposits $2,500 each year for 10 years into the employee's'MSA. If the per~on
withdraws no funds' fer,medicalexpenses, the accountwouldtotaljusfunder $28,000 at
the end ,of the 10-:-year period.Byconti:ast~ if the, same person took$2,500 ofear,nings, • "
paid federahmd state income taxes and payroll taxes ,ahd theDsaved the after~tax , ,
earnings eafh.year for 1Q years, he or she would have justunder $16,600 &ayed at the
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:__ :~,~:..~,~_:~!i~.n ,few health care eX,f2enses are' anticipated:' When' the individ:uaLc,aIDi.trLa_p-oirithi,~',_'_ _-,-,---:---
. ' ,," lif~' whenhighmedfca,r~xpenses b'eca~e more pro!?ablei s.uch;as wh~n pi or she,
'
, married and starteq a family, he or shewQwd,p'fesumablyc;hange to comprehensive:
caver age and siinply retain the MSA accumul,ation a~ "retiremenf.savings." In this ' " '
':,,'"
1 e).'ample, the taxpayerwithdtawing
~'ccllIIiulatedfunds aftef age 59lh' (tinderthe ' '
Jacobs amendmen1) ,or age 65(under. the Rowland-Bilirakis pro'posal)'woUld'receive ~rl
"
advaJ1tage over,h~lVingsay:erl: thefundsin the normalway if his or h~r:combined"'
federal and state marginal income tax: rate at the tune ot-withdrawal was l~~s than'41,'
", 'percent, ~ very likely scenario for .all Qutthehigh~st-in:come- fax'payers:
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Asis th~ ca'se VY,ith"individuat:'geposit" MSAs,y6ung~r,heaHhleremploy~e's',
\ w,Ould be likely to, ch?S'se the, catastrophic/MSA combination, while employees at .
greater risk of high h~alth care costs would,choose comprehenSive coverage. ,As a
"
,result,' the cost of healt~ insurance to employers, individuals, and the federaL
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.~ , government'would go up: Premhmls for comprehensive coverage,wowd have to . "
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, , 8 If "einplby~r-d~posi't'; MSAS',did! allow iIld';idualsto~akegeposits to their
would be similar to "individual-d~posit': MSAs in tneir ~ff~sts: " '. "
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This calculation assumes a three perc,ent rate-of interest on' the deposits and current taxation'of
. yearly interest earnings in both caseS. The individual,iS assumed to'be in the28p~rcent federal in,come tax~ , :'
: 'bracketand a seven percent state in<:.,orne)ax bracket; " ,
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Cumulative Valueof$2r500Gross Income Saved ·EachY~ar for,lO Years
Jacobs J\rnendm~nt Compared with Current
Sav~ngs' ,
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, the requirement thatthe same amotiJ;lfbe spet:\fori ~a~h option. In bills, .
: wIth no mandates,th~ :e,mployer ,wo\ildeither have: to increase its. '
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costs peyond p, leyelthateqtployers would Jo~er_a~e; benefi~s underthe,' '
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( measures 'used to offset the increase. in, cost included ieductio~'iIi
subsidies, insurance could become imaffordable for some iow-ii\come
households ~m9- s~all busim~s~es .. 'Mandates to purchase ihSurance co~ld; "
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.
, " 'c~mprehensiv~ insurance plans used bY,middle- and lower-in,come families. In .
adciifion, ifl the'absenc'e'of anerrlpI6yet'mandat~, fl)lowerproportion.of thepopulMion ....
is likely to be covered'by adequate health insurance,-. since the incr,eased ~ost'of '.' ,. : '.
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�NATIONAL
GOVERNORS'
A5S<D:IATION
Health Policy Studies
Contact: Randolph Desonia, 202-624-5319
July 21, 1994
ERISA: ROADBLOCK TO STATE HEALTH CARE REFORM
Introduction and Background
/
Since the late 1980s, states have been actively seeking solutions to the problems of rising health care
costs and declining numberS of residents with health insurance. An explosion in state spending on
Medicaid has increased the percentage of state budgets deVoted to this program to 18 percent-only 3
percent less than the 21 percent states currently spend on elementary and secondary education.
Furthermore, large finns that historically have offered health insurance continue to downsize, and many
small businesses are reluctant to offer health coverage because of its high cost. This has caused states to
enact health care reforms both incrementally and comprehensively.
\
To accomplish the multiple goals of controlling medical care cost inflation, improving residents' access
to health care, and maintaining the high level of quality in the medical system, Governors must be able to
implement and monitor specific strategies designed to address these concerns. Yet states' ability to fund
and administer a universal access program or even to enforce more incremental insurance reform efforts
is inhibited by federal law - namely, the Employee Retirement Income Security Act (ERISA). Enacted
in 1974 in response to pension plan mismanagement, the law applies to all employee"benefit plans,
including health plans.
In effect, this ERISA qualification allows a company to be exempt from state insurance regulation and,
through court interpretations, from many other state mechanisms necessary to control health care costs
and improve access. Although under the McCarran-Ferguson Act states are still delegated the
responsibility to regulate traditional insurers, plans that are self-insured under ERISA provisions are
exempted from state oversight. (Nationwide, nearly two-thirds of the population insured through
employment participates in self-insured plans.) To. achieve universal coverage within a state, or
implement even a less ambitious effort that affects all state residents, states must hav(: the option to
include every resident receiving health benefits. Without such flexibility, states will be unable to achieve
the objectives of increasing access while controlling costs.
IIAll
OF
TilE
STA.TES
I
444
NORTII
CAPITOL
STREET!
VI.'ASIII~(;TON
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2.0001-1<;72
I
l02-624-S300
�Page 2
ERISA: ROADBLOCK TO STAlE HEALm CARE REFORM
For example, three states well into the implementation stages of their health refoRD laws are
encountering ERISA problems. It is unlikely that Oregon's ')day or pay" option, which requires
employers either to contribute to a minimum health benefit plan for their workers or to pay a tax, would
survive an ERISA court challenge. Minnesota is limited in its ability to make health insurers
aecountable for providing care to high-risk and special needs populations or to realign health plan
incentives. The state ofWashington's universal coverage plan is based on an employer mandate coupled
with a program to assist low income families. Partial funding for that program, which 'comes from a
provider tax, could be jeopardized in the absence of a removal of the ERISA barrier.
oJ.
Provisions of the Statute
When originally debated by Congress, the impact of ERISA on health benefit plans and on state health
policymaking was not widely anticipated. Congress enacted ERISA in 1974 to remedy severe problems
of pension fraud and mismanagement, such as inadequate funding of pension plans, theft, and poor
investment practices. The law established a comprehensive system to regulate employee pension
requirements. The statute, however, also applies to employee benefit plans, including 'welfare benefit
plans." The statute defines 'welfare benefit plans"as including not only programs to provide benefits
such as vacation, child care, and prepaid legal services, but also programs to provide medical care
"through the purchase of insurance or otherwise."
Unlike its specific provisions regarding pel)Sion programs, ERISA imposes few standards on welfare
benefit plans such as health plans. It requires only that administratqrs disclose infonnation to employees
and operate the plan as a fiduciary, and it prescribes a limited remedy - recovery for costs Of services
denied - because of problems with the plan.
\
Although it is common practice for Congress to permit states to regulate in areas in which federal law is
silent, ERISA prohibits such state authority through its preemption clause. Section 514 of the act states,
;Ii "'The provisions ofthis [law] shall supersede any ~ all state laws insofar as they may now or hereafter, ,
, relate to any employee benefit plan...... Although ,,"
state laws regulating traditional health insurers are'
exempt from the federal preemptiOn, ERISA forbids a state to consider a self-insured employee benefit
plan to be an insurer in order to bring that plan under state jurisdiction.
'.
It is clear from the language of Section 514 that states cannot enforce law~, other than those regulating
traditional insurance carriers, that have an intended and direct impact on self-funded employee plans. It
is less certain what types of indirect effects are permissible. Without clearly delineated principles set
forth by court ruling, such areas of uncertainty hamper states' health care financing and delivery refORD
efforts as much as those areas in which ERISA directly forbids state regulation.
�Page 3 ERlSA.: ROADBLOCK Tel STATE HEALm CARE REFORM
ERISA Impediments to What States Would Like To Do
ERISA poses a fonnidable hurdle to many activities that states would like to undertake as part of health
care reform. 1bese strategies, which may be part of comprehensive universal access programs or more
incremental steps, can be grouped into four categories: financing, expenditure controls, insurance
reform, and adm.i.nistr8tion.(A more extensive list of state strategies affected by ERISA is presented in
the attached table.)
State Financing. The most challenging decision facing a state seeking to expand health care coverage is
hOw to pay for it and who will bear the financial burden. Popular funding sources such as tobacco taxes
can provide only some resources to finance care for currently uninsured populations. States may need to
find. revenue sources, impose obligations on employers to cover workers, ,or impose obligations on
individuals to insure themselves. Yet many of the options states are considering as a source of financing
employer mandates (e.g., employer '\>lay or pay," premium taxes on health plans, or assessments on
providers) are not applicable to employer and employees under ERISA plans or it is not clear whether
they are pennissible because of conflicting or unclear court decisions.
Expenditure Controls. States exploring health care reform recognize that containing costs is a critical
objective. Governments, businesses, and individuals need relief from the continual onslaught of medical
cost increases. Excessive growth in medical spending, which make insurance ,unaffordable, also
exacerbates aCcess problems. Health care cost containment strategies that raise court challenges
include provider ratesetting and global budgets. (Global budgets set an annual cap or target for either all
public and private spending or selected categories of such spending in order to reduce inflationary health
expenditures.)
\
Insurance Refomi. The impact of ERISA is so broad that it even effects less ambitious state reform
efforts such as insurance reform. A majority of states are attempting to reform the insurance market by
requiring guaranteed renewability, eliminatiDg medical underwriting, or instituting mandatory
C9J1U1lunityrating. Such efforts are rendered in~ve becauSe a sizable proportion of a state's :;:~
insurance plans are exempt from state insurance laws. .
,,"
Program Administration. Most state and national reform proposals under discussion en.vision some
administrative role for public agencies. Even the market-oriented competition models, both 'hlanaged"
and '\mmanaged," are premised on the availability of current, detailed, and accurate data on health care
use and expenditures. Yet the ERISA preemption for self-insured plans prohibits such relatively benign
activities as collecting uniform data on health care use and expenditures from third-party payers and
requiring the use of uniform claims forms and procedures such as electronic billing.
Because of both the breadth of the federal preemption clause and the fact that the U.S. Supreme Court
has not ruled on most ofthe health care regulatory and taxing strategies states might want to use, few, if
any, activities can be undertaken with the' confidence that they will not face an ERISA challenge. If
�Page 4 ER1SA: ROADBLOCK TO STATE HEALm CARE REFORM
So hard to enact, they must have relief from the
ERISA constraints. Because ERISA is a federal statute, only the federal courts or Congress can stop
ERISA from being a roadblock to reform.
states are to implement the refonns they have worked.
Judicial Approaches to Allow State Health Care Reform
The judicial branch of the federal government is the final arbitrator of the meaning of federal law. Its
interpretations thus have detennined much of the policy impact of ERISA's preemption clause.
Unfortunately, the combination of the vague nature of the clause, the many health plan provisions
impacted by ERISA, and the different levels of federal courts invites differing interpretations that are
inconsistent or even conflicting.
"
There have been two effeds ofthe numerous judicial decisions. First, there is a lack of principles to
guide state policymakers. States must assume considerable political risk when enacting health care
reform, yet without assurances that their strategies can be tested. Second, the rulings by federal courts
have generally narrowed the scope of state authority with respect to state oversight of health plans and
the health care delivery system. This has. resulted in a perverse incentive for states not to address a
pressing and complex public policy issue despite the obvious need to do something.
The judicial approach has tended to create additional barriers for states wanting to implement health care
reform efforts. The judicial route. is neither an effective avenue to resolve the ERISA dilemma nor a
desirable way to make health policy. Judges consider and decide on the facts of individual cases,leading
to numerous and different narrowly defined interpretations throughout the country. In contrast to
legislatures or administrative agencies, courts are not designed to entertain policy analysis or public
input. By failing to reexamine ERISA's impact on health policy development, Congress has forced the
judiciary into an unsuitable and inappropriate policymaking role.
Legislative Approaches to Allow State Health Care Reform
•
•
Although states could attempt to craft financing legislation to try to circumvent judicial interpretations of
ERISA, they could avoid the significant delays associated with defending litigation and remove
substantial uncertainty in the minds of citizens and policymakers if Congress would modify the law.
Moreover, for many proposed health reform initiatives, states need explicit legislative relief from
ERISA.
Assuming Congress would not simply repeal Section 514 or exempt all state health reform initiatives,
there are at least three other basic approaches to amending ERISA to pennit greater state flexibility to
finance and regulate health care.
�Page S ERISA: ROADBLOCK TO STATE HEALlH CARE REFORM
Exempt Categories of Approaches. The most generic way to permit states greater flexibility under
ERISA would be to identify categories of activities that states could undertake without a formal waiver.
For example, ERISA already exempts several categories of.state law from preemption, including laws
regulating insurance, banking. and securities; Medicaid secondary payer laws; and the Consolidated
Omnibus Reconciliation Act (COBRA) continuation requirement that pennits former employees and
their dePendents to pay group premiums and to remain in the plan for eighteen months. Thus, Congress
could reverse the Supreme Court interpretations of ERISA preemption to permit states to tax self-funded
plaDs to the same extent as insured plans; require participation in purchasing pools; require compliance
with overall cost containment strategies, or require all health plans to participate in data collection and
unifonn billing procedures. Amendments also could clarify issues the Court' has not addressed. such as
provider taxes. '.
~
,
Institute a Waiver Request Process. A somewhat narrower mechanism to permit state health care
refonn would be to authorize a federal administrative agency to evaluate individual state requests for
preemption waivers. Such a waiver process was discussed.in 1992. A General Accounting Office study
of state refonn efforts recommended an ERISA waiver process conditioned on congressional standards,
such as defined benefits, extent of coverage, and tenus Ullder which the waiver could be revoked. There
was also a legislative proposal to create a national commission' to grant waivers from certain Medicaid,
Medicare, and ERISA provisions for up to ten states qualifying for five-year grants to demonstrate
universal health care financing programs. The bill would have amended Section S14(b) of ERISA to
.permit states to impose a tax equitably across all types of plans and to establish unifonn administrative
systems.
To provide control and accountability, this approach could outline permitted strategies and impose
conditions on the granting and renewal of waivers. The advantage to a waiver process is that it
implicitly acknowledges that health policy should be established nationally. Moreover, sta\e efforts to
experiment with different regulatory and financing models can move ahead while national policy is being
developed ..
Waive Only EnaCted Programs. The most restrictive model for state~elief from ERISA is the current
exception for Hawaii's law. Section SI4(b)(S) exempts the Hawaii Prepaid Health Care Act in effect as
of September 2, 1974. This approach was proposed in the 1993 federal budget bill. As drafted, the bill
would have permitted four states to continue several existing programs: 1983 amendments to Hawaii's
Prepaid Health Plan Act; Maryland's all-payer hospital ratesetting law; Minnesota's provider tax, data
collection, and uniform claim fonus requirements; and New York's hospital ratesetting law that includes
provider surcharges and charity careJbad debt pools. In proposing these 'harrowly crafted, temporary
amendments"to ERISA's preemption clause, the House Budget Committee noted that ERISA has made
it difficult '\:0 evaluate the workability of key elements of the various reform proposals." These
exemptions were passed by the House of Representatives but deleted from the budget reconciliation
legislation before final passage to comply with Senate rules forbidding the inclusion of nonbudgetary
items in such legislation.
.
'
�Page 6
ERISA: ROADBLOCK'TO STATE HEALlH CARE REFORM
A major drawback to waivers of only enacted state programs is that the uncertainty about congressional
willingness to grant flexibility may inhibit states from passing reform laws. Furthermore, the Hawaii
experience suggests that Congress might prefer to exempt laws only as they exist at a specific date,
thereby limiting a state's ability to modify and refine its program over time.
Conclusion
States are a major force in health care reform, both within their borders and as a partner' in any national
effort. They are at the forefront in experimenting with new strategies to increase access to health care,
control health care costs, and' maintain quality medical care. The strategies being tested range from
incremental changes to improve the availability of health insurance to more, comprehensive efforts to
ensure universal coverage. Many of these efforts were initiated prior to the recent federal interest in
reforming the health care system. Some states are well past their design and development stages and are
actively implementing their plans. These' states are at a critical juncture because they must be able to
include all of the state's payers of health care and insured residents in order to make the strategy work.
, Rather than encouraging state experimentation of new approaches to the financing and delivery of health
cafe, ERISA is stifling innoVation. It is blocking state efforts to test' str.ategies to finance universal
coverage, control runaway medical costs, and track total health care expenditures within the state. To
test and evaluate the effectiveness of these strategies, states must receive some type of relief from
ERISA. Just as states are obtaining waivers under the Medicaid program to make services more
efficient and cost-effective, a similar process is needed for ERISA so that states can complete, the
ambitious efforts they have initiated. Such a waiver strategy is consistent with the role of the federal
government in setting a national framework to ensure some uniformity across state borders, while
providing sufficient flexibility for states to develop new models appropriate to their unique situations and
to provide lessons that can be sharCd with others, both in the private and pubic sectoI1. "
'
, -The information in the Issue Briefiis drawn from a recent National Governors' Associatio,\}report authored by
Patricia Butler. J.D.• Roadblock 10 Reform: ERISA ],i,plicalionsfor Slate Health Care Initiatives.
�State Hulda Care Reform Strategles~ Judldal Restrictions aDd PoteDUaI LegIslative Solutions
Curnnl Authority
Lffis/ativt Ammdmmt Ntttud
Financing
Employer mandate
Prohibited.
Employer payor play tax
Unclear.
Permit sates ro mandate mat
offer insurance with
d ed minimu'm benefits and
pay a proportion of ptemium.
Permit sateS ro impose tax on
employers not offering a heah:h
plan mat mem conditions such lIS
specific sranda.rds or benefits and
~ntriburion levds.
Permit sares ro impose payroll taX
to fund universal system.
,
Permit sates ro impose income tlllt
to fund universal system.
,'
None needed.
Permit sates ro tax all employee
health ~Ian conrriburions (insured
or self· nded) ro fund universal
system.subsidizt care for the poor.
or share risk of uninsurable
individuals.
Permit sares ro tax health care
providers to finance care, even if
some tlllt'burden explicitly or
im[!licidy falls to [!al:'!:rs.
, Start Straugy
EmployertaX.bas~ universal
Unclear.
system
\
Income taX-based universal system Unclear.
~
Excise raxes to cover unemployed
Health plan premium tlllt'
Authorized.
Prohibited. '
Health care provider taX
Unclear.
~Oyers
, GmControl
Provider rate setting
Unclear.
Permit sares ro Set provider rates
even if they raise some health
plans' com.
Global budget enforcement
,Prohibited for self·funded plans.
"
Permit sates to r:lfire all health
pIans: including se ·funded plans,
to parricipate in overall spending
limits.
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AliminirtTation
Insurance market reform
')
5ropcloss insurers
Uniform dac coUection
Uniform claims procedures
AuthorimHor insurers, prohibired
for self·funded plans; authoriry to
impose reinsurance pool cosa on
insu~plans unclear.
Permit sates ro limit preexisting
condition exclusions. or impose
other appropriate insurance
market reforms, on self·funded
plans and to create -reinsurance , ilt
pools to share risk ofhigh-cosr
cases that might raise cosa ro,
insured employee health plans.
' Clarify sate authority to define
Unclear.
what coveraje is tr'.1e stop-loss
coverage an Eermlt Stares to
,
regulate St!; oss carriers even if it
imposes in . o::t effects on plans.
Authoriud for insurers; prohibired Permit sates to require self·funded
for self-funded plans.,
..
plans ro report use, COst. and
quality information in the same
manner as required of insured
plans.
Aurhoriud for insurers; prohibited Permit sares ro require Self-funded
plans m' use uniform claims
for self-funded plans.
procedures in me same manner as
required of insured plans.
~
(onri~d oil
ruxt pal!
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Start Straltg)'
Currmt Authority
Purchasing pool participation
Permir stares ro require self-funded
Can requin: insurers r~ offer
firms ro participate in purchasing
coverage only rhro~h pools;
cannor :x::,e self- nded plans ro pools in me same manner as
required of insured plans.
purchase r ugh pools.
Aurhorizcdfor providers; undC2I ,Permir stares ro require rhar
for managed care fONrcs of plans. managed care plans use alremative
dispute resolution for malpractice
dispurcs.
Aurhorizcd for insurers; prohibircd Consider oVClTiding State·any
wiUing provider" laws. pcrmir
for self-funded plans.
StalCS ro r~ate self-.fun~ed plans
ro meet rcvlcw orgaruzaoon
srandards for fair ~cw. and
pcmUr stalCS ro r~te
self-insured plans r r purchase
care from managed can:
organizations ro do so on same
basis as insured plans.
Aurhorizcd for insurers; prohibircd Permir stares ro require self-funded
for self-funded plans.
.
blans ro use rnan:l4;ed care on same
asis as insured klans. adjwr
payments for ris • and use defined
grievance systems.
Medica1liabiliry arb,rrati~n and
mediation
Managed can: orgaruz:;uion
regulation
Ltgislativt Ammdmtnt Nttdtd
,~
oj)
Hcahh plan requin:ments
<managed care. risk adjwtInenr.
grievance mechanisms}
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�
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Carol Rasco - Issues Series
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Carol Rasco
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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Clinton Presidential Records: White House Staff and Office Files
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Health Reform [3]
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2010-0198-Sb-health-reform-3
-
https://clinton.presidentiallibraries.us/files/original/da6e6c4c0d777e89295add4d7d0cc911.pdf
e1cf27c5de79d43d62e012e7989b867f
PDF Text
Text
i
'
/
Il{(~
;
/
,
PROPOSED PRESENTATION FOR ~ MEETING
I
L
i
TRANSITION FROM COVERAGE DISCUSSION
• More details on kids and
une~ployed
options
II.
REPUBLICAN HEALTH INITIATIVE; LIKELY MENU
III.
,
REFORM IN THE ABSENCE OF UNIVERSAL COVERAGE
Dramatic Premium Increases Will be Minimized Due to:
1. More limited subsidies
2. No Medicaid integration
3. Age rating
4. Issue of integrating the individual market
N.
BACKGROUND ON STATE REFORMS
• Where are the States now?
. :v.
I
VI.
OBJECTIVES AND OPTIONS PRESENTATION ON INSURANCE
MARKET REFORM
PRESENTATION OF POLLING DATA
�REPUBLICAN HEALTH INITIATIVE LIKELY MENU
1. : Insurance Reform --Including Self-insured Expansions for Associations (ERISA changes)
,
,
;
I
2. I Self-employed Tax Deduction
3. , Tax Clarification for Long Term Care Private Insurance
4. ' State-based Reforms, Focusing on Medicaid Flexibility and/or Federalization
,
5.; Tax Caps
I
6.' MSAs
7. i Medical Malpractice
8. i Anti-trust Reforms
I
I
,
9., Fraud & Abuse
10. Simplification (Electronic Claims Processing/etc.)
1r. Medicare Restructuring of HMOs/Medicare Select Policies
12. Product Liability
�'DRAFT
Federal Costs of Programs to Extend Health Insurance, Billions
of Dollars, 1997-2005
!
Program
Costs
% of Total Costs
Low-Income
Subsidies
$781
800/0
Unemployed
Uninsured
$ 66
7%
Kids
$ 90
9%
Transitional
Medicaid
$ 50
5%
Total
$987
100%
I
i
,
--------------------------~--------------------------- -------~ow-income subsidies exclude the Medicaid population, but include enrollment outreach designed
~o maximize participation. Totals may not add due rounding.
,
to
�DRAFT
Program for Children. Federal Costs
Between 1997-2005--$60-100 Billion
IAnnual Household
Percent of Federal
Subsidies
Percent and
Number of
Participants
(Millions)
Less Than $6,500
15%
10%
$6,500-$17,800
33%
220/0
$17,800-$31,700
40%
$31,700-$53,600
. Income
$53,600 +
Total
Federal Subsidy
Per Enrolled Child
Per Year(1997$)
0.6
$1293
1.4
$1312
27%
-
, -
-
1.8
$1180
12%
20%
-
1.3
$ 465
0%
21%
-
1.4
$ ---
100% -
6.5
. $ 817
100%
�DRAFT
Program for the Temporarily Unemployed
Federal Costs Between 19,97-2005--$66
Billion
Annual Household· Percent of Federal
Subsidies
Income
Percent and
Number of
Participants
(Millions)
Less Than $6,500
23%
15%
-
1.6
$1256
$6,500-$17,800
350/0
31%
- 3.2
$1034
$17,800-$31,700
28%
33%
3.3
$1025
$31)00-$53,600
12%
190/d
-
-
2.0
$ 895
2%
5%
-
0.5
$ 695
100% - 10.7
$1040
$53,600 +
Total
100%
Federal Subsidy
Per Family Per
Year(1997$)
�DRAFT
Coverage for the Temporarily Unemployed
Option 1. Income defined as monthly cash income less
unemployment compensation, AFDC and SSI. Federal costs
total $66 Billion between 1997-2005.
Option 2. Income defined as monthly cash income less AFDC
and SSI. Federal costs total $53 Billion between 1997-2005.
�RUBIN_S@OPD
NOVEMBER 1994
11 :30a Princi pals' St aff
Meeting on Coverage
Options
3:00p Health Care Policy
Options Meeting
~()~J'9,4}"'"
?'>:',S)ln'i'Nov,6":199,,,
;'
lW
l'1,O~.:";:l~
9:30a Principals' Staff
Meeting on Coverage
Options
4:00p Health Care Policy
Options Meeting
,
3:00p Map Group Meeting
Sll,n,:Nov,13~:I!
10:00a Presentation of
Polling Data
l:OOp lnsurance Market
Reform Presentation
Meeting
1.2(),l!
l1:00a Map Group Meeting
on Cost Containment
"N,or,27;I?~,i
'oday(1l/15/1994 2:07p)
'.:
/Oy~,'
10:OOa Principals' Staff
Meeting on ERISA
Presen ta tion
(TENTATIVE)
1:3Op ERISA Meeting at
Labor
2:3Op Proposed Agenda
Meeting with Rasco
& Rubin
4:00p Map Group Meeting
ll:00a Map Group Meeting
on ERISA
4:00p Principals' Staff
Meeting on Cost
Containment
Presentation
(TENTATIVE)
~;s()~;:
V::!2;J"~FW
Meetmg wI po'tus
(2 hours )/Four
Meetings Requested
Between Nov. 22 Dec. 25
::}'I'll~;No:v;:2!JH994/'
10:30a Principals' Staff
Meeting on Cost
Containment
Presen talion
(TENTATIVE)
HOLIDAy
THANKSGIVING
'
::JU
Onl'lmetR) Copyrlglif
II Services,lnc. 19!
�THE PROBLEM
PEOPLE WITH INSURANCE
Security: Even people with insuraP.ce can't be s~e that they can
keep it over any extended period of time.
Premiums can go up when people get sick.
:
~
People can't be sure that they can get insurance if they have to move
or change jobs.
The'terms of insurance can change -- an employer can limit coverage
for serious illnesses or treatments.
PEOPLE WITHOUT INSURANCE
Access:
People with health problems can be denied coverage or
charged very high premiums.
Individuals with health problems who want to buy coverage may not
be able to find an insurer that is willing to sell to them.
Insurers and employers can impose long waiting periods for coverage.
Without coverage, people often do not get medical care when they
need it.
'
MARKET STRUCTURE
Too much energy is spent on avoiding sick people instead of
managing health care delivery.
Insurers use benefit design and marketing strategies to target
healthier risks and avoid poorer risks.
As long as the focus remains on risk selection, the market will not
adequately encourage organizations to efficiently manage care.
�.
Federal Costs of Programs to Extend Health Insurance, Billions
of Dollars', 1997-2005
Program
Costs
0/0 of Total Costs
Low-Income
Subsidies
$781
80%
Unemployed
Uninsured
$ 58
6%
Kids'
$ 90
90/0
Transitional
Medicaid
$ 50
50/0
Total
$979
1000/0
-------------------~-------------~-------------------- --------
Low-income subsidies exclude theMedicaid population, but include enrollment outreach designed
to ma.xi.mize participation.
i
..
I
�~
.
,
Portability
General
Rating Limits
AK
X
AZ
X
State
.. Tight
Rating
Limits
Guaranteed
Renewal
Guaranteed
Issue
Reinsurance
·X
X
X
X
X
X
X
X
AL
X
AR
CA
X
CO
X
CT
,
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
DE
X
X
X
X
X
FL
X
X
X
X
X
ID
X
X
X
X
IL
X
X
X
X
X
X
GA
HI
IN
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
IA
X
X
KS
X
X
KY
X
LA
.X
ME
X
MD
MA
MI
.
X
X
X
X
MN
X
X
X
MS
X
X
X
MO
X
X
X
X
MT
X
X
X
X
NE
X
X
X
X
NH
X
X
X
X
X
NJ
X
X
X
X
NM
X
X
X
X
NY
X
X
�NY
X
X
X
X
NC
X
X
X
X
X
ND
X
X
X
X
OH
X
X
X
OK
X
X
X
X
X
OR
X
X
X
X
X
X
PA
RI
X
X
X
X
X
SC
X
X
X
X
X
X
X
SD
TN
X
X
X
X
X
TX
X
X
X
X
X
UT
X
X
X
vr
X
VA
X
WA
X
X
X
X
X
X
X
X
X
X
WV
X
WI
X
X
X
X
WY
X
X
X
X
X
�..-,.,
News Release
.THE.HENRY.J.
EMBARGOED FOR RELEASE:
12:00 p.m. EST
Tuesday, November 15, 1994
·~Irli~:
·FOUNDATION
For further information contact:
2400
Matt James or
Tina Hoff
SAND HILL ROAD
MENLO PARK
CALIFORNIA
94025
TEL
415854-9400
Among Issues, Voters See Health Ref0np.AX 415 854-4800
As Top Priority For New Congress;
But Reject Major OVerhaul of System For MOre Modest Approach
National Election Night Survey ALso Finds:
Voters Support Spending cuts to Reduce Deficit in Theory,
But Not In Practice When Specific Budget Areas Are Proposed
Menlo Park, CA -- A Kaiser/Harvard election night survey of Americans
nationwide who voted in the 1994 election has found that health care continues
to be a key concern, but the voters are rejecting a major overhaul of the
system.
Instead, they strongly favor approaches to solving this national
problem that are incremental and do not significantly expand government
control of the health system.
When voters cast their ballots, candidates' stands on issues are just one of
many factors that determine their votes.
Economic insecurity, values and
ideology, attitudes about government and incUmbents, and the perceived
personal qualities of the candidates themselves all also playa major role.
Among issues, however, health care (33%) was number one for voters in deciding
who to vote for in the Congressional election, ahead of crime (29%) and taxes
(23%) .
In addition, it was named as the top; priority issue for the next
Congress to deal with.
[Tables 1 and 2]
In the survey, the voters also made it clear that they want Congress to take
the lead in health reform next year,
rather than the White House.
[Table 3]
The survey shows that the voters' vision of health care reform has shifted
toward that held by many moderate Republicans and Democrats.
Thirty-one
percent of those surveyed said they were less supportive of major health
reform than six months ago, with half of those citing as their reason that
they did not think the government would do it right. More voters now want
Congress to make modest changes in the health care system (41%),
to enact a maJor reform bill (25%).
rather than
In addition, one in four voters favor
leaving the system as is: [Tables 4 and 5]
-- more -
WASHINGTON OFFICE:
1450 G
STREE·T NW, SUITE
250
WASHINGTON, DC
20005
202347-5270
FAX
202 347-5274
�"
"These results say that voters want the new
~ongress
to place health care high
on their legislative agenda," said Dr. Robert Blendon,
Professor and Chairman
of the Department of Health Policy and Manag,ement at Harvard university.
"But
what the public means by health reform now comes closest to a more moderate
vision: one which is more limited in scope, incremental, and that involves a
much more limited role for government."
A majority of voters (55%) believe that it is better to have the health
insurance system run by private health insurance companies than by the
government.
This is especially the case among those who voted for Republican
House candidates (66%).
(Table 6]
When asked what worries them most about health care reform, a plurality said
they worry that there will be too much government bureaucracy (36%) or quality
will decline (22%).
When asked who they would like to take the lead in
health care reform, more than one half indicated a preference for state
leadership (54%), a change from previous
sur~eys.
(Tables 7 and 8]
Voters are split over whether the priority should be guaranteeing universal
coverage or making an incremental start.
Rep'ublican 'voters favor starting
with coverage for some groups who do not have health insurance, but not
attempting to cover everyone right away (45%).
Democrats more strongly favor
guaranteeing health insurance coverage for all Americans as part of whatever
legislation is passed (52%).
[Table 9]
If health insurance cannot be provided to all Americans, voters favor covering
children first (40%) and working people who are uninsured (24%).
When asked
how the Congress might improve the private insurance system, 29 percent favor
requiring employers who offer insurance to provide a choice of at least three
health plans, and 27 percent favor requiring all employers to contribute part
of the cost ,of health insurance for their employees.
[Table 10 and 11]
In order to see these changes made in the health care system, a slight
majority (51%) of voters are willing to pay more in health insurance premiums
or taxes.
[Table 12 J
-- 2 -
�The Deficit, Taxes, and Entitlements
The survey shows that the outcome of the election was also affected by the
federal deficit and voters' desire not to have their taxes increased.
These
were named as the third and fourth highest priorities for the next Congress.
When asked what Congress should do about the federal deficit in the next
session, two thirds of voters (67%) preferred cuts in major spending programs
to raising taxes (10%) or "not dealing with the deficit problem now" (10%).
[Tables 13 and 14]
Survey results reveal a dilemma for the new Congress.
Voters support general
cuts in government spending in principle, but not in practice when they relate
to specific current government spending programs.
When presented with a list
of 25 selected policies to reduce the deficit, a majority of voters supported
only four:
Having people over age 65 who earn more than $50,000 a year pay
more for Medicare than other seniors (71% favor);
Decreasing spending on food stamps (55%);
Decreasing agricultural price supports (53%); and
Decreasing defense spending (53%).
Voters expressed very low levels of support for spending cuts in Social
Security (17%), Medicaid (17%), Medicare (8%), and veterans' benefits (7%).
Even when told that one in three dollars spent by the federal government go to
Social Security, Medicare, and Medicaid, two thirds of voters (65%) still
prefer to see the biggest spending cuts corne from other areas, while only 10
percent believe the biggest cuts should 'take place in these three major
spending areas.
[Table 15 and 16]
These results pOint to a major obstacle facing the new Congress in its effort
to reduce the federal deficit.
Voters want Congress to address the deficit,
but they do not want their taxes raised.
They want spending cuts in
principle, but are not willing to support major cuts in the programs that made
up the largest part of the non-defense bUdget.
The poll results show sharp contrasts between Democrat and Republican voters.
Democrat voters are willing to cut defense spending further in years ahead,
while Republicans are less willing.
Republicans are more willing to cut AFDC
-- 3 -
�(welfare payments); Democrats are less so.
Voters in both parties are willing
to cut spending on food stamps and agricultural price suppo.rts, and support
asking those seniors who earn more than $50,000 per year to pay more for
Medicare.
[Table 15]
This situation is not aided by voters' general lack of knowledge of what makes
up the federal budget.
They know what entitlement programs are, but they do
not have a very good idea of what are major areas of spending in the federal
budget.
Asked which of five areas consumed the largest share of federal
spending, only 15 percent correctly named Social Security and 30 percent named
defense.
One in four voters (27%) thought the most federal money was spent on
foreign aid, which accounted for only 2% of the 1993 Federal Budget.
said welfare accounted for the largest share.
budget.
And, 19%
It was actually 3% of the 1993
[Tables 17 and 18]
"The public's misconceptions about the Federal Budget is the Achilles heel in
deficit reduction," said Matt James, Vice President, Kaiser Family Foundation.
"What the public is willing to embrace will not result in meaningful spending
reductions.
Policymakers need to do a better job in explaining which areas
need to be addressed to achieve.real savings or there will be a political
price to pay when small-time redu·ctions fail to result in big-time savings."
Methodology
The Kaiser/Harvard Election Night Survey was a random sample, telephone survey
of adults nationwide who said they voted in the November 8, 1994 election.
The national sample consisted of 1,200 voters.
The survey was designed by the
Harvard University School of Public Health's Department of Health Policy and
Management and the Kaiser Family Foundation, and was conducted by KRC
Communications Research, a national opinion research firm located in Newton,
Massachusetts.
The margin of error in the national sample is plus or minus 3
percent.
The Kaiser Family Foundation, based in Menlo Park, California, is an
independent national health care philanthropy and not associated with Kaiser
Permanente or Kaiser Industries.
main areas:
health reform,
development in South Africa.
The Foundation's work is focused on four
reproductive health, HIV, and health and
The Foundation also maintains a special interest
in health care in its horne state of California.
The Foundation does not
support any particular proposal or approach to health reform.
30 -
�THE HENRY
J.
KAISER
FAMILY
FOUNDATION
Kaiser/Harvard/KRC
NATIONAL ELECTION NIGHT SURVEY
* The Voters' Health 'Care Agenda for the 104th Congress
* Public Understanding of the Major Entitlement Programs
and the Federal Budget
November 1994
EMBARGOED FOR RELEASE UNTIL:
12:00 P.M. EST, TUESDAY, NOVEMBER 15,1994
Contact:
Robert J. Blendon, Sc.D.
Professor and Chairman
Department of Health PoliCY and Management
Harvard University School of Public Health
(617) 432-4502
Matt James, Vice President
Communications and Media Programs
Henry J. Kaiser Family Foundation
2400 Sand HIli Road
Menlo Park, California 94025
(415) 854·9400
Fax: (415) 854-4800
�TABLE 1
MOST IMPORTANT ISSUE IN DECIDING 1994 U.S. HOUSE VOTE
Voters Nationwide
VNS
. KaiserlHarvard
Total
Total
Voters
Voters
1.
H~thcare
1. Health care
2. Crime
3.Tues
4(t). Education
2. Crime
3. Emn./johs
4. Taxes
S. Def"lCit
4(t). Aboctioo
6. Emn./jobs
6. Clinton job
Source: Voter News Servke and Kaiser/lIaryard Sw-veys 1994
TABLE 2
WHAT VOTERS SEE AS TOP PRIORITIES
FOR TIlE NEXT PRESIDENT AND CONGRFSS (1992)
AND FOR TIlENEXTCONGRFSS (1994)
1992 for the
next President
1994
for the
nextCo~
andCo~
1. Economy/jobs
2. Def"lCit
3. Health care
4. Taxes
S. Education
6. Foreign policy
1.
2.
3.
4.
S.
6.
Health care
Crime
Tu.es
Def"JCit
Education
Economy
�TABLE 1 (a)
MOST IMPORTANT ISSUES IN
DECIDING 1994 U.S. HOUSE VOTE
Total Voters
HEALTH CARE
33%
CRIME
TAXES
0%
Source:
5%
Kaiser/Harvard Survey 1994.
10%
15%
20%
25%
30%
35%
�· TABLE 2(a)
VOTERS· TOP PRIORITIES
FOR NEXT CONGRESS (1994) AND
FOR NEXT PRESIDENT/CONGRESS (1992)·
40%
HEALTH CARE
-.~ ",.;.~g-.-:
,
,.,
CRIME~2%
TAXES
1 .(
£
£
t
f
~...
'\'
~
-
'
31%
17%
£!
1
7%
DEFICIT~
~23%
-1994: NEXT CONGRESS
[2]1992: NEXT PRESIDENT!
CONGRESS
EDUCATION-- 11 %
~%
ECONOMY
~
L
I' I' I ' I ' I ' I ' "
I' I ' I' ,
,
I' I ' I' I' ,
£ £ £ ,
I' ,
('
£ £
£
£
£
£
£
£
£
,
r £ r £ r ......,
77 %
FOREIGN POLICY
Source:
Kaiser/Harvard Surveys, 1992 and 1994.
-.--- ,_.
- .....
�TABLE 3
VOTERS' VIEWS ON WHO SHOULD TAKE THE LEAD IN DEVEWPING
A HEALTH CARE REFORM PLAN NEXT YEAR
Total
Voters
Voted for
Voted for
Republican Democrats
in House
56%
Members of Congress
Insidmt Clinton
Neither/Other (vol)
Both together (vol.)
18S
os
8S
6S
Don't know
in House
70S
9S
llS·
2S
7S
45S
lOS
lOS
OS
3S
TABLE 4
CHANGE IN VOTER SUPPORT FOR CONGRESS ENACTING
A MAJOR REFORM OF THE HEALTH CARE SYSTEM
Compared to six months ago •••
Position hasn't changed
43S
Less supportive of major reform
Reasons for being ~ supportive:
The govemmeot wouldn't do it right
The reform alternatives were worse
than the way the system is now
Health care reform is too expensive
Less wonied about your family's own
health care now
There's ~ of a health care crisis now
Other (vol.)IDoo't know
31S
More supportive of major refono.
Reasons for being more supportive:
More worried about my family"s own
bealth care now
.
There's more of a bealth care crisis now
Other (vol.)fDon't know
49S
19S
lOS
9S
3S
lOS
18S
SSS
3Ilf,
14lf,
8%
Source: Kaiser/Ilarvard Survey 1994
�TABLES
VOTERS' VIEWS OF WHAT THE NEXT CONGRESS SHOULD 00
ABOUT HEALTH CARE REFORM
Total
Voters
Eoad • iWUor reform bill
Make modest cbanges in the health tare system
Lea"e the health tare system alone
0tIia- (,,01.)
Don't know
Voted for
Voted for
Republican Democrat
in House
in House
25S
4lS
25S
3S
SS
17S
4(;S
3lS
IS
SS
4SS
28S
14S
7S
6S
TABLEt;
VIEWS ON WHETHER IT'S BETTER 10 HAVE THE HEALTH
INSURANCE SYSTEM RUN BY THE GOVERNMENT OR
PRIVATE INSURANCE COMPANIES
November 1994
March 1993 Total
Adults
Voters
Pri"ate i.osuraDce companies
Go"ernment
NeitherlNo differeoce (,,01.)
Don't Imow
Voted for
Republican
in house
39S
4lS
9S
US
66S
US
13S
lOS
SSS
24S
ISS
7S
Soun::.e: Marttilla" KileylHanardlRoberl Wood Johnson Survey 1993
KaiserlHanani Survey 1994
Voted for
Democrat
in house
33S
.us
19S
'S
�TABLE 7
WHAT WORRIES THE VOTERS MOST ABOUT
REALTII CARE REFORM IF CONGRESS TAKFS ACTION
Total
Voters
40'11
25'11
24'11
24'11
17'11
21'11
9'11
7'11
6'11
Don't know
36'11'
2O~
The quality of health care ror you and your
ramily wiD not be as good
You wiD not be able to choose the doctor or
hospital you want
You wiD haTe to pay higher taxes
None/Other (vol.)
Democrat
22'11
There wiD be too much govermneot bul"eaucracy
Voted for
Republican
in House
9'11
3'11
8'11
10'11
15'11
5'11
Voted for
in House
Source: KaiserJHaryard Survey 1994
TABLES
VOTERS' VIEWS ON WHETHER THE FEDERAL GOVERNMENT OR
STATE GOVERNMENTS SHOULD TAKE THE LEAD IN
CHANGING THE REALTII CARE SYSTEM
Total
Voters
State governments
Federal government
Neither/Other (vol.)
Both togetba- (vol.)
Don'tlmow
54'11
32'11
~
3'11
3'11
Voted for
Republican
in House
Voted for
Democrat
in House
62'11
24'11
9'11
2'11
3'11
46'11
44~
5'11
1~
4'11
�TABLE 9
VOTERS' VIEWS ON WHAT CONGRESS SHOULD DO ABOUT
HEALTH INSURANCE COVERAGE
Total
Voters
Guan&11la! health insurance COyerage for
all Americans
Voted for
. Republican
in House
Voted for
Democrat
in House
38411
26411
52411
36411
45411
33411
20411
6411
Make a start by covering some groups who
do not haye health insurance
Don't try to see that more people haye
health insurance
Other (yol.)IDon't know
21411
9411
12411
J4I1
Source: KaiserlHarvard Survey 1994
TABLE 10
VOTERS' VIEWS ABOUT WHICH GROUP SHOULD BE COVERED FlRST
IF WE CANNOT PROVIDE HEALTH INSURANCE TO ALL
Total
Voters
Children
Working people who are currently uninsured
PmpIe wbo need Ioog-teno care
AIllow-i.naMne people
Other (vol.)
None (vol.)
Don't know
Source: KaiserlHarvard Survey 1994
Voted for
Republican
in House
Voted for
Democrat
in House
40411
24411
12411
9411
J4I1
J4I1
10411
J7411
27411
17411
S4I1
2411
J4I1
9411
38411
18411
10411
17411
S4I1
1411
12411
�TABLE 11
VOTERS' VIEWS ON WHICH WAY OF IMPROVING THE PRIVATE REALTII
INSURANCE SYSTEM IS MOST IMPORTANT FOR CONGRESS TO ENACT
Total
Voters
Voted for
Republican
in House
Voted for
Democrat
in House
Require every employer who offers health
iosura.oce to proride a dJoire of at
least t:IIree health insunmce plans
29%
31%
21%
Require every employer to contribute p8rt
of the cost of health insurance for all
of their employees
27%
26%
31%
OutJa.w pre-exNiDg modilion dallSt5
IS%
IS.,
IS%
Require every employer to make health
insunmce available to all of their
employees, without requiring that the
employer rontribute part of the cost
15%
10%
19"
Other/None (vol.)
3%
4%
3%
U%
8%
Don't kilo.
,.,
TABLE 12
VOTERS' WllLINGNESS TO PAY MORE IN PREMIUMS OR TAXES
TO GUARANTEE REALTII INSURANCE COVERAGE 1FOR ALL AMERICANS
Total
Voters
Voted for
Republican
in House
Voted for
Democrat
in House
Would personally be willing to pay more,
either in higher health insunmce
pnmilJlm or higher taxes
51%
43%
6'"
Would not be willing
3'%
48.,
22.,
Don't Imow
Soun:e: Kaiser/Il.ananl Survey 1994
,.,
,.,
8%
�TABLE 13
WHAT VOTERS SEE AS TOP PRIORITIES FOR THE NEXT CONGRESS
Total Voters
1. Health care
2. Crime
3. Taxe;
4. Deficit
5. Education
6. Eamomy
Source: Kaiserlllananl Survey 1994
�TABLE 14
WHAT VOTERS SAY CONGRESS SHOULD
DO TO REDUCE THE DEFICIT
CUT SPENDING ON
MAJOR PROGRAMS - 67%
OTHER (VOL.)!
DON'T KNOW - 13%
RAISE TAXES - 10%
Source:
Kaiser/Harvard Survey, 1994.
DON'T DEAL WITH THE
DEFICIT NOW - 10%
�TABLE 15 a
VOTER SUPPORT FOR 2S SELECTED POLICIES
TO REDUCE THE FEDERAL DEFICIT
% of voters who favor the proposal
Total .
Voters
STRONG TO MODERATE SUPPORT
BaYing people over age 65 who atnI more
than $50,000 a year pay more for
Medicare than other seoiOl"S
Decrease spending on food stamps
Decrease agricultural price supports
Decrease defense spending
MODERATE OPPOSITION
Paying doct.ors and hospitals ~ for the
care they provide to smiors under
Medicare
Decrease spending 011 public housing
Decrease spending on UDmlploymeot
aJlllpensation
Increase the proportioo of Social Security
benefits subject to federal income taxes
Decrease federal aid to cities
Decrease spending on AFDC
Iocrease the retinmeot age for Social
Security from 65 to "
Iocrease Social Security or employer taxes
Limiting the tax deduction for employers'
contributiom to their employees'
health insurance
Requiring people to pay a larger share of
nursing home costs before federal
JW>istance begim
Voted for
Republican
in House
Voted for
Democrat
in House
71%
55%
53%
53%
69%
60%
50%
40%
73%
54%
56%
64%
48%
45%
44%
50%
55%
43%
43%
44%
42%
42%
39%
39%
40%
47%
49%
47%
33%
27%
39%
35%
44%
27%
28%
44%
32%
38%
27%
32%
38%
24%
(rootinued)
Somtt: KaiserlHarvard Survey 1994
�TABLE 15 b
VOTER SUPPORT FOR 25 SELECTED POUCIES
TO REDUCE THE FEDERAL DEFICIT, (continued)
% or voters who ravor the proposal
Total
Voters
SI'RONG OPPOSITION
Decrease or eliminate tax deduction for
charitable giving
Decrease or eliminate tax deduction for
home mortgages
Reduce the annual mst of living increase
in Social Security
Decrease fedentl aid for ooIkge student
loans
Increase the fedentl income tax
Increase taxes on gasoline·and beating oil
Decrease fedentl aid to education
Decrease spending on Social Security
Decrease spending on Medicaid for the poor
Decrease spending on Medicare for the elderly
Decrease Teterans' benefits
Source: KaiserlHananl Suney 1994
Voted ror
Voted ror
Republican . Democrat
in House
in House
29%
29%
29%
27%
32%
24%
2(t%
34%
IS%
24%
23%
20%
19%
17%
17%
S%
7%
2(t%
20%
15%
IS%
21%
17%
5%
S%
22%
31%
25%
21%
13%
15%
10%
S%
�TABLE 16
VOTERS' PREFERENCFS ON SPENDING CUTS AFTER BEING TOLD THAT
ONE IN THREE OOLLARS SPENT BY FEDERAL GOVERNMENT GO TO
SOCIAL SECURITY, MEDICARE, AND :MEDICAID
In onIer to reduce the federal def"aci4 the
biggest spmding am should come in areas
other thaD Social Security, Medicare, and
Medicaid
In onIer to reduce the federal def"aci4 the
biggest spending am should come in Social
Security, Medicare, and Medicaid
We should leave the federal def"acit alone and
DOt make DU\ior spending am in either area
Don't know
Source: Kaiser/lIanard Survey 1994
10~
�TABLE 17
"
VOTERS KNOWLEDGE OF WHICH
PROGRAMS ARE ENTITLEMENTS
SOCIAL SECURITY
~
MEDICARE
liil~
VETERANS BENEFITS
82%
_1_ 82%
MEDICAID
UNEMPLOY. COMPEN.
AFDC
FOOD STAMPS
AGRICULTURAL PRICE
SUPPORTS
0%
Source:
Kaiser/Harvard Survey, 1994
20%
40%
60%
80%
100%
�TABLE 18~1
WHAT VOTERS SAY IS THE LARGEST
FEDERAL EXPENSE TODAY
DEFENSE
30%
FOREIGN AID
27%
WELFARE
19%
SOCIAL SECURITY
HEALTH
DON'T KNOW
0%
Source:
5%
Kaiser/Harvard Survey, 1994.
10%
15%
200/0
25%
30% .
350/0
�TABLE 18-2
1993 FEDERAL BUDGET
SOCIAL SECURITY 210/0
DEFENSE 21%
FOREIGN AID 20/0
WELFARE 30/0
TEREST RECEIPTS 70/0
HEALTH 16%
OTHER MANDATORY 140/0
DOMESTIC DISCRETIONARY 16%
TOTAL = $1 ,408 BILLION
Souroe.: Congressional Budget Office, 1994
._.__
~_
··_r··· .... _.. __
~
•.._
�TilE HENRY J.
KAISER
FAMILY
FOUNDATION
Kaiser/Harvard/KRC
NATIONAL ELECTION NIGHT SURVEY
* The Voters' Health Care Agenda for the 104th Congress
* Public Understanding of the Major Entitlement Programs
and the Federal Budget
November 1994
EMBARGOED FOR RELEASE UNTIL:
12:00 P.M. EST, TUESDAY, NOVEMBER 15, 1994
Robert J. Blend on, Sc.D.
Profeaaor and Chairman
Department of Health Po.llcy and Management
Harvard .Unlveralty School of Public Health
(617) 432·4502
Contact: Matt Jamea, Vice Pre81dent
Communlcatlon8 and Media Program8
Henry J. Kaiser Family Foundation
2400 Sand Hili Road
Menlo Park, California 94025
(415) 854·9400
Fax: (415) 854-4800
�TABLE 1
MOST IMPORTANT ISSUE IN DECIDING 1994 U.S. HOUSE VOTE
Voters Nationwide
VNS
KaiserlHarvard
Total
Voters
Total
Voters
1.
2.
3.
4.
5.
1. Health care
2. Crime
3. Taxes
4(t). Education
4(t). Abortion
,. Econ./jobs
Health care
Crime
Econ./jobs
Taxes
Del'"Cit
I
,. Clintoo job
Source:
voter News Service and KaiserlHarvanl Surveys 1994
TABLE 2
WHAT VOTERS SEE AS TOP PRIORITIES
FOR THE NEXT PRESIDENT AND CONGRESS (1992)
AND FOR THE NEXT CONGRESS (1994)
1992 for the
next President
1994
for the
nextCo~
andCo~
1.
2.
3.
4.
5.
Emoomy/jobs
Del"'lCit
Health care
Taxes
Education
,. Foreign policy
Source: KaiserlHarvanl Surveys 1992 and 1994
1.
2.
3.
4.
5.
Health care
Crime
Taxes
Del'"Cit
I
Education
'.Eoonomy
�TABLE 1 (a)
MOST IMPORTANT ISSUES IN
DECIDING 1994 U.S. HOUSE VOTE
Total Voters
HEALTH CARE
33%
CRIME
TAXES
0%
Source:
5%
Kaiser/Harvard Survey 1994.
10%
15%
20%
25%
30%
35%
�TABLE 2(a)
VOTERS· TOP PRIORITIES
FOR NEXT CONGRESS (1994) AND
FOR NEXT PRESIDENT/CONGRESS (1992)
40% .
HEALTH CARE
.
:.-~~~ "~~---",
".,
'.
-..
t
•
J
.
t
t
f
I'~r~
31%
17%
-1994: NEXT CONGRESS
0
1992: NEXT P RESIDENTI
CONGRESS
11%
6%
•
~
ECONOMY
14%
FOREIGN POLICY~ 5%
Source:
Kaiser/Harvard Surveys, 1992 and 1994.
77%
�TABLE 3
VOTERS' VIEWS ON WHO SHOULD TAKE THE LEAD IN DEVEWPING
A HEALTH CARE REFORM PLAN NEXT YEAR
Total
Voters
Voted for
Voted for
Republican Democrats
in House
Membersof~
56%
President Clinton
Neither/Other (vol)
Both togetbfr (vol.)
Don't know
1841.
1341.
841.
641.
in House
7041.
941.
1141.
4541.
2041.
1041.
2111
13111
741.
341.
TABLE 4
CHANGE IN VOTER SUPPORT FOR CONGRESS ENACTING
A MAJOR REFORM OF THE HEALTH CARE SYSTEM
Compared to six months ago•••
Position hasn't cha:oged
4341.
~
3141.
supportive of lW\ior reform
~ supportive:
The govemmeot wouldn't do it right
The reform alternatives Wel'e worse
than the way the system is DOW
Health care reform is too expensive
~ worried about your family's own
bealth care DOW
There's ~ of a health care aisis DOW
Other (vol.)/Don't know
Reasons for being
More supportive of major reform
Reasons ror being more supportive:
More worried about my ramily's own
bealth care now
There's more of a health care crisis now
Other (vol.)/Don't know
Don't know
Source: Kai'ief"fIlarvard Survey 1994
49111
1941.
10111
941.
341.
1041.
18111
SS~
3141.
14~
8~
�TABLES
VOTERS' VIEWS OF WHAT THE NEXT CONGRESS SHOULD 00
ABOUT HEALTH CARE REFORM
Total
Voters
Enact a major ref'onn bill
Make modest cbaDges in the health care system
Leave the bealth care system alone
Other (vol.)
Doo~t
know
Voted For
Republican
in House
Democrat
25%
41%
25%
3%
5%
17%
46%
31%
1%
5%
45%
28%
14%
7%
6%
Voted For
in House
Source: Kaiser/llarvard Survey 1994
. TABLE 6
VIEWS ON WHETHER IT'S BEITER TO HAVE THE HEALTH
.INSURANCE SYSTEM RUN BY THE GOVERNMENT OR
PRIVATE INSURANCE COMPANIES
November 1994
March 1993 Total
Adults
Voters
Private insurance companies
Government
NeitherlNo difference (vol.)
Doo~t know
3'%
41%
,.,
11.,
55%
24%
IS"
7%
Source: Marttilla &: KiJey/HanardJRobert Wood Johnson Survey 1993
Kaiser/llarvard Survey 1994
Voted For
Republican
in house
66%
11%
13.,
10%
Voted For
Democrat
in house
33%
.,.,
42.,
6%
�TABLE 7
WHAT WORRIF.S THE VOTERS MOST ABOUT
HEALTH CARE REFORM IF CONGRESS TAKES ACfION
Voted for
Total
Voters
There will be too much government bureaucracy
The quality or bealth care for you and your
family will not be as good·
You will not be able to c:boose the doctor or
hospital you want
You will bave to pay higher taxes
NooeIOther (vol.)
Don't know
Republican
in House
Voted for
Democrat
in House
36%
40%
25%
22%
24%
24%
20%
9%
7%
6%
17%
9%
3%
8%
21%
10%
15%
5%
Soun:e: KaiserJllaryard Survey 1994
TABLE 8
VOTERS' VIEWS ON WHETHER THE FEDERAL GOVERNMENT OR
STATE GOVERNMENTS SHOULD TAKE THE LEAD IN
CHANGING THE HEALTH CARE SYSTEM
Voted for
Total
Voters
State govemmeots
Federal govenaneut
Neither/Other (vol.)
Both together (vol.)
Don't know
Source: KaiserJllaryard Survey 1994
Republican
in House
Voted for
Democrat
in House
54%
32%
9%
3%
3%
62%
24%
9%
2%
3%
46%
44%
5%
1%
4%
�TABLE 9
VOTERS' VIEWS ON WHAT CONGRESS SHOULD 00 ABOUT
HEALTH INSURANCE COVERAGE
Total
Voters
26%
52%
36%
45%
33%
20%
6%
Make • start by covering some groups who
do DOt have health insurance
Don't try to see that IDOI'e people have
health insurance
0tID:' (vol.)IDon't know
Voted Cor
Democrat
in House
38%
Guanmt.ee bealth insurance coverage for
aU Americans
Voted Cor
Republican
in House
21%
9%
12%
3%
Source: KaiseI'/Barvard Survey 1994
TABLE 10
VOTERS' VIEWS ABOUT WHICH GROUP SHOULD BE COVERED FIRST
IF WE CANNOT PROVIDE HEALTH INSURANCE TO ALL
Total
Voters
Children
Workiog people who are currently uninsured
People who need loog-tam care
All Iow-income people
0tID:' (vol.)
None (vol.)
Don't know
Source: KaiseI'/Barvard Survey 1994
Voted Cor
Republican
in House
Voted Cor
Democrat
in House
40%
24%
12%
9%
3%'
3%
10%
37%
27%
17%
S%
2%
3%
9%
38%
18%
10%
17%
S%
1%
12%
�TABLE 11
VOTERS' VIEWS ON WHICH WAY OF IMPROVING THE PRIVATE HEALTH
INSURANCE SYSTEM IS MOST IMPORTANT FOR CONGRESS TO ENACT
Total
Voters
Voted for
Republican
in House
Voted for
Democrat
in House
Require evuy employer who offen bealth
i.osunmce to provide a choice of at
least three bealth insurance plans
29'J,
31'J,
21'J,
Require f!'fUY employer to contribute part
of the cost of bealth insunmce for all
.of their employees
27.,
U'J,
31'J,
Outlaw pre-existiog moditioo clauses
18'J,
18'J,
18'J,
Require nuy employer to make bealth
insurance available to all of their
employees, without requiring that the
employer contribute part of the cost
15'J,
10'J,
19"
OtberlNone (vol.)
3'J,
4'J,
3'J,
12.,
8'J,
Don't know
,.,
Soun:e: Kaiser/Barvard Survey 1994
TABLE 12
VOTERS' WILLINGNESS TO PAY MORE IN PREMIUMS OR TAXES
TO GUARANTEE HEALTH INSURANCE COVERAGE FOR ALL AMERICANS
Total
Voters
Voted for
Republican
in House
Voted for
Democrat
in House
Would personally be willing to pay more,
either in higher bealth insurance
pnmitans or higher taxes
SI'J,
43'J,
"'J,
Would not be willing
3''J,
48'J,
22.,
Don't know
Soun:e: Kaiser/Barvard Survey 1994
,'J,
,.,
8'J,
�TABLE 13
WHAT VOTERS SEE AS TOP PRIORITIF.S FOR TIlE NEXT CONGRFSS
Total Voters
1. Health care
2. Crime
3. Taxes
4. Delicit
5. Education
,. Economy
�TABLE 14
WHAT VOTERS SAY CONGRESS SHOULD
DO TO REDUCE THE DEFICIT
CUT SPENDING ON
MAJOR PROGRAMS - 67%
OTHER (VOL.)!
DON'T KNOW - 13%
RAISE TAXES· 10%
Source:
Kaiser/Harvard Survey, 1994.
DON'T DEAL WITH THE
DEFICIT NOW - 10%
�TABLE 15 a
VOTER SUPPORT FOR 25 SELECTED POUCIES
TO REDUCE THE FEDERAL DEFICIT
% of voters who favor the proposal
Total
Voters
SfRONG TO MODERATE SUPPORT
HaYing people over age 6S who earn more
than $50,000 a year pay more for
Medicare than other seniors
Decrease spending on food stamps
Decrease agricultural price supports
Decrease defense spending
MODERATE OPPOSITION
Paying doctors and hospitals ~ for the
care they provide to seniors under
Medicare
Decrease spending on public housing
Decrease spending on unemployment
oompeosation
Increase the proportion of Social Manity
beoelits subject to federal income taxeo
Decrease federal aid to citi~
Decrease spending on AFDC
Increase the retirement age for Social
Manity from 6S to 67
Increase Social Manity or employer taxeo
Limiting the to deduction for employel"S'
cootributiom to their employees'
beaIth imunuxe
Requiring people to pay a larger share of
nursing home costs More federal
aWstance begim
Voted for
Republican
in House
Voted for
Democrat
in House
71%
55%
53%
53%
69%
60%
50%
40%
73%
54%
56%
64%
48%
45%
44%
50%
55%
43%
43%
44%
42%
42%
39%
39%
40%
47%
49%
47%
33%
27%
39%
35%
44%
27%
28%
44%
32%
38%
27%
32%
38%
24%
(rontinued)
Sow-ce: KaiserlBanard Survey 1994
�TABLE 15 b
VOTER SUPPORT FOR 2S SELECTED POUCIES
TO REDUCE TIlE FEDERAL DEFICIT (continued)
% of voters who favor the proposal
Total
Voters
STRONG OPPOSITION
Decrease or eliminate tax dedudion for
charitable giving
Decrease or eliminate tax dedudioo for
home lDOI1gages
Reduce the annual cost or 6ving increase
in Social Security
Decrease federal aid for coIkge studeot
loaDs
Increase the federal income tax
Increase taxes on gasoline and beating oil
Decrease federal aid to education
Decrease spending on Social Security
Decrease spending on Medicaid for the poor
Decrease spending on Medicare for the elderly
Decrease yeterans' benefits
Voted for , Voted for
Republican Democrat
in House
in House
29.,
29"
29.,
27.,
32.,
24.,
26.,
34.,
18.,
24.,
23.,
20.,
19.,
26.,
20.,
15.,
31.,
17.,
17.,
8.,
7.,
22.,
25.,
18.,
21.,
17.,
21.,
5.,
10.,
8.,
8.,
13.,
15"
�TABLE 16
VOTERS' PREFERENCES ON SPENDING CUTS AFTER BEING TOLD TIlAT
ONE IN THREE DOLLARS SPENT BY FEDERAL GOVERNMENT GO TO
SOCIAL SECURITY, MEDICARE, AND MEDICAID
In order to recIuce the federal def"1Ci~ the
biggest spending cuts should oome in areas
other than Social Security, Medicare, and
Medicaid
In order to recIuce the federal def"1Ci~ the
biggest spending cuts should oome in Social
Security, Medicare, and Medicaid
We should kaye the federal def"Hit alone and
not make lW\ior spending cuts in either ........
Don't know
Source: Kaiserlllarvard Survey 1994
10~
�TABLE 17
VOTERS KNOWLEDGE OF WHICH
PROGRAMS ARE ENTITLEMENTS
SOCIAL SECURITY
82%
MEDICARE
VETERANS· BENEFITS
82%
I·J·xl<·~"<-ItIl·N:>;.;.;.'I.,:'<>;·;~I:.;;"X«..:;..xI»:""?I;:.eyxl·«?~.'
v;..~
MEDICAID
UNEMPLOY. COMPEN.
AFDC
FOOD STAMPS
AGRICULTURAL PRICE
SUPPORTS
0%
Source:
Kaiser/Harvard Survey, 1994
20%
40%
60%
80%
100%
�TABLE 18-1
WHAT VOTERS SAY IS THE LARGEST
FEDERAL EXPENSE TODAY
...
DEFENSE
~T':;~~.:.:.:.:.::.:.:.:.jf~~::::~.;..,.
30%
FOREIGN AID
WELFARE
!
,~
'. ..:;,
" '1:<1'
•
f~:·~::::Jf@f:ifffi~:~:~:~::.:-~. .
19o/c
0
•
"';, ~ "
SOCIAL SECURITY
HEALTH
0%
Source:
5%
Kaiser/Harvard Survey, 1994.
10%
15%
20%
25%
30%
35%
�TABLE 18-2
1993 FEDERAL BUDGET
SOCIAL SECURITY 21%
DEFENSE 21%
FOREIGN AID 2%
WELFARE 3%
TEREST RECEIPTS 7%
HEALTH 16%
OTHER MANDATORY 14%
DOMESTIC DISCRETIONARY 16%
TOTAL
= $1 ,408
Souroe: Congressional Budget Office, 1994
BILLION
�TOP 10 RESPONSES FROM KAISER POLL
1. Priority issue for Congress? (Open-ended question) -
Number one answer -- 40% health care (table 2a)
2. Who should take the lead -- President or Congress?
56% Congress vs. 18% President (table 3)
3. Incremental or Major?
41 % incremental vs. 25% major -- (Democrats still at 45% for major) (table 5)
4. States or Federal Government take lead?
54% states vs. 32% Federal (table 8)
(Pollsters say completely switched in last 2 years)
5. If incremental, who should be covered first?
40% kids, 24% workers who are uninsured, 9% low income (table 10)
6. What is the largest Federal expense today?
Top three choices: Defense, Foreign Aid, Welfare (table 18-1)
7. After being told how many Federal dollars go to Social Security, Medicare, and Medicaid,
support for cuts in these programs to reduce the deficit?
10% say yes vs. 65% look elsewhere (table 16)
8. Support for reducing spending on Social Security to reduce the deficit?
17% say yes (table 15b)
9. Support for reducing "Medicare for the elderly" to reduce the deficit?
8% say yes (table 15b)
10. Support for reducing "Medicaid for the poor" to reduce the deficit?
17% say yes (table 15b)
�SMALL GROUP INSURANCE REFORM
State-by-State Analysis
/
•
40 states require Portability
•
34 states have set General Rating Limits
•
18 states have set Tight Rating Limits
•
42 states require Guaranteed Renewal
•
34 states require Guaranteed Issue
•
20 states have established Reinsurance Programs
�INDIVIDUAL INSURANCE MARKET REFORM
State-by-State Analysis
•
] 2 states require Portability
•
11 states have set Rating Limits
•
9 states require Guaranteed Renewal
•
8 states require Guaranteed Issue
•
4 states have established Reinsurance Programs
�SMALL GROUP INSURANCE REFORM
General Rating
State
Portability
Limits
Tight Rating
Limits
Guaranteed
Renewal
Guaranteed
Issue
Reinsurance
,
i
AL
AI<.
X
X
X
X
X
AZ
X
X
X
X
X
X
X
AR
CA
X
CO
X
CT
·X
X
X
X
X
X
X
X
X
X
X
X
X
X
DE
X
X
X
X
X
FL
X
X
X
X
X
ill
X
X
X
X
IL
X
X
X
X
X
X
GA
HI
IN
I
!
IA
X
KS
X
X
KY
X
LA
X
ME
i
X
X
MD
MA
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Ml
MN
X
X
X
MS
X
X
X
MO
X
X
X
X
MT
X
X
X
X
NE
X
X
X
X
X
X
X
X
NV
NH
X
X
�General Rating
Limits
Tight Rating
Limits
Guaranteed
Renewal
Guaranteed
Issue
Reinsurance
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
OK
X
X
X
X
X
OR
X
X
X
X
State
Porta bility
NJ
X
NM
X
NY
X
NC
X
X
ND
X
OR
X
X
X
FA
Rl
X
X
X
X
X
SC
X
X
X
X
X
X
X
SD
TN
X
X
X
X
X
TX
X
X
X
X
X
UT
i
i
X
X
X
VT
X
VA
X
WA
X
X
X
X
X
X
X
X
X
X
WV
X
WI
X
X
X
X
WY
X
X
X
X
X
TOTALS
40
34
42
34
20
..
Source: Blue Cross and Blue ShIeld AssocIatIOn 7/94
18
i
�INDIVIDUAL INSURANCE MARKET REFORM
I
General Rating
Limits
Guanmteed
Renewal
Guanmteed
Issue
Reinsurance
X
X
X
X
X
X
X
X
X
X
X
State
CA
KY
I
X
ID
I
Portability
LA
I
ME
X
X
X
X
MN
X
X
X
NH
X
X
X
X
NJ
X
X
X
X
X
NY
X
X
X
X
X
SC
X
X
,VT
X
X
X
X
WA
X
X
X
X
TOTALS
12
1\
9
8
ND
Source: Blue Cross and Blue Shield Association 7/94
4
�..... ,.",....,
"
...
("'" 7
,JI.:....."'...i'
~,.".
r""
..;~~::; ..4·a
~
PHOTOCOPY
PRESERVATION
�'"
.
'::iNlQrut.~
+o...~
....... . ....~.~..('ILDS. , _.-. . . . . .-""
IZW;iJ--· .....
PHOTOCOPY
PRESERVATION
:'i.,'1
�r?HOT<)C()PV
PRESERVATION
�NOU-14-1994
18:11
FROM
WHITE HOUSE AIDS POLICY
TO
RASCO
P.02
THE WH.ITE HOUSE
WASHINGTON
November 14, 1994
MEMORANDUM FOR CAROL RASCO
FIemiD~
FROM:
Patsy
SUB.J'SCr:
Meetings with Community Groups
Attached is a list of the invitees to the community meetings scheduled for the next two days.
The following is anout1ine of the meetings. Given the time pressures you are facing, we
will keep this· flexible - aDd at the time that you are able to be there, we will break to·
discuss any specific issues they have to raise with you, espedally regarding health c:are
refonn.
.
1. Welcome and introductions
• PF expn:sses thanks for their support and encouragement,. in part what made her
.teCOnSider when the President asked her to stay Oft.
• This· is the first in a series of regular meeting with the commUDity ~ sometimes of
a gene:nU nature, someWnes will be on very specifIC issues.
• Apologize for the short notice: the alternative was waiting until mid-December. and
it is more important to demonstrate the commitment to col.1aboration by meeting on
short notice.
2. The job ahead
• Express the authority the President has given
• Expr:as the imponance, given the change in the Congress, of using the full
a.uthority of the executive branch to assure that the best possible progtanls and
policies are in place.
4. Issues for discussion
~
• FY 1996 budget as a top .priority
• Reauthorization of Ryan White as other top priority - get sense from groups if
their strategy/pluposals will change in light of Congressional elections.
• Inte.nJepartmental task force as vehicle for creating national plan
• AdviJory Council to be named shortly
.• Report 00 adolescents requested by the President - bisis for overview of all
aspects of federal progr.uns; no specific outline yet - seek input now in geAeral terms
about what should be covered.
• health care refann n - PF will be working closely· with CR to assure mv issues
�NOU-14-1994
18:12 FROM
WHITE HOUSE ~IDS POLICY
are addressed; ask groups what their bottom lines
• Other issues of c:ona:m'1
TO
R~SCO
are~
S. Next steps - is this mec:banism a useful one for gaining input - are there changes in
format, etc. that woukl be preferred?
Handouts:
President's saatement
Patsy's statement
P.03
�NOU-14-1994
10:58 FROM
WHITE HOUSE AIDS POLICY
RASCO
TO
c:D.0tJP 1 - TUesday, R'ovEllllber 15th at 11.30-12.30
Art Ammaml, PAP'
Paul Boneberg, GAN
Dan Bross, MC
Keith Cylar, Housing Works
Jim Graham, Whitman Walker
Larry lCessler, Me/letA
Tim McFeeley, HRCF
Colin Robinson, Gay Men of African Descent
Alexander Robinson, NTAP
Julie Scofield, NASTAD
BJ Stiles
Mike Shriver
GJto'O'P 2 • Tuesday, Itovamber 15th at 4a30-S.30
Regina Aragon, CAEAR Coalition
Bill Freeman, NAPWA
Lettie Gomez, LLEGO
Ben Schatz, AAPHR
Jane Silver, AmEAR
Stephen Smith, 'ACTUP DC
ICen South, ANIN
Paula Van Ness, NCAP
Ellen Weber, Legal Action Center
Hank Wilson, Ar:r UP Golden Gate
GROUP 3 - WedDesClay, llovaber 16th at 10:30-11:30
Val Bias, NHF
Mary Boland, National Pediatric AIDS Resource Center
Ruth Eisenberg, NGLTF
Gregg Gonsalves, TAG
David Harvey, AIDS I'olicy Center
Michael MarSico, ACT UP I'hiladelphia
Stephen Michael,Ar:r UP DC
Jeff Richardson, GMHC
Margaret Skelley, ASTRO
Phill Wilson, APLA
~
QRotJ'P 4 - .edDasday, Hovaber 16th at 11.:30-12.30
Pat' Christen, SFAF
Tom Coates, UCSF
Marty Delaney, Project Info~
Ivy Duneier, Mothers Voices
Debra Fraser~Howze, Black Leadership Cmsn.••
Paul Kawata, NMAC
Terry McGovern, HIV Law Project
Ron Rowell, Native American ••.
Brie Sawyer, AC:r UP NY
Edna Viruel, CWPS
Terry Stone, NW1F
P.02
�',,,'
E X E CUT I V E
OFF ICE
o F
THE
PRE SID E N T
25-Nov-1994 11:18am
TO:
Carol H. Rasco
FROM:
Christopher C. Jennings,
Domestic Policy Council
CC:
Jennifer L. Klein
SUBJECT:
RE: Freedom of choice
Carol:
Most people do not view there to be any difference between the
terms:
"any willing provider" laws and "freedom of choice~' laws.
Freedom of choice terminology is used interchangeably by providers
who think it is a more powerful phrase than any "willing
provider."
Technically, however, you could make the following destinction:
Usually, freedom of choice laws are applied to how states regulate
fee for service plans. The states, through their licensure boards
and other oversight bodies, generally limit which providers are'
eligible for reimbursement through training and licensure
requirments.
So, e.g., a chiropractor would not be reimbursed for
the same service provided by an M.D.
Freedom of choice laws
generally are used to open up benefit packages to all providers
who provide the same service.
(However, as you saw yesterday, the
term of art is now used by everyone -- even pharmacists -- who
aren't concerned about competition of people providing the same
service, rather they are concerned about selective contracting
with particular pharmacists.)
Generally, any willing provider laws are applied to help remove
closed panel restrictions used predominantly by HMOs.
In this
case, providers -- like retail pharmacists,-- get upset by the
selective contractihg HMOs employ to achieve discounts. Any
willing provider laws essentially say that any provider who is
willing to play by the reimbursement rules layed out by the HMO
cannot be excluded from participating.
BOTTOM LINE:
I would not worry about destinctions. Relative to
your question about freedom of choice in HSA: We in fact overrode
state's authority to pass freedom of choice laws for HMOs and
PPOs. But to balance this out, we required a fee for service plan
in every service area -- so that all providers would have access
to at least one plan. This fact, along with our equal access
�.'
provision (which allowed group phamacy purchasers to get access to
the same type of discounts that HMOs and hospitals now have), made
our bill acceptable to the retail pharmacy profession.
It also
assured that, for the most part, we were still able to retain the
support of the HMO industry (at least as it related to this
issue) .
Lastly, to answer your question how did we answer the freedom of
choice question: We usually said we expanded choice of plans to
every American.
Since consumers would be choosing plans (rather
than employers choosing for'their employees) consumers would now
be in the true driving seat and plans were more likely to be
responsive to consumer desires. As a result, we concluded, plans
would ensure that the providers consumers wanted would be
contracted out with OR they would have no customers.
(Not all
providers bought this argument, particularly the chiropractors.)
Sorry for the long explanation. It can be a difficult topic.
Hope this helps. Happy to further clarify..
Have a great TURKEY
DAY! ! !
�.,
,
,
'
INTERESTING HEALTH CARE POINTS*
Interestingiy, contrary !o the popular perception (myth) that public sector programs~ are
inflating at much·greaier levels than the private sector, CBO says that Medicaid is
growing at the s~'-me ~capita growth rate (7.2%) as is the private sector;"
. (OMBsays Medicaid's growth rate is actually2% points less than the private sector).
Medicare's, per capita growth rate,accQrding to CBO, is only 1% higher-(8.2%)
.than the~private sector's growth. rate .. (Notably, the Medicare per capita growth
rates from 1982-1993 were less than those,of the private sec~or).' .
\
. . . .-.J.
Keeping the abov~ in mind .-- while the Federal Government needs to do a'much .
better job of slowing the' rate oLgrowth -- cuts of the magnitude the Republicans in
.the House and Senate ~re'floatingseem extremely'unrealistic:(particularly those'
relating to the Medicaid program); Even if implemented, they woulq Jikely hurt in
terms of co~t-shiftirig to small husinesses and/or in terms of reducing coverage, which .
would lead to . even more uncompensated care.'
.
'
'Republicans are currently considering proposals.to ,cap' Medicare and M~dicaid growth
rates at (or about) 5 percent. Current OMB/GBO growth rate projections for both
programs for the next five.years hover around.9-'10 percent. 5 percent growth caps
. produce 'about $150 billion in' savings from the Medicarepro'gram and about $100""
billion from the Medicaid program over 5 years .. (Over? years, cutting both programs
would produce over· $500 billion in savings)
,
Senator Gregg, reportedly with Senator Dole's blessing, recently floated a proposal that "
would produce about $100 billion in cuts from the Medicare program and $115 billion
from the Medicaid program; for Medicaid, he assumes a 4% growth cap: .(The House
isapparentiy considering much higher aggregate Medicare sav.ings numbers.)
..
*
When one evalu~tes a 4-5 % cap, it is important to keep in mind how much of
that is population growth. While Medicare's population'growth is about 1-2 .
. percent, Medicaid is projected to' grow by an average of 3.8% a year. As such, a
4-5 % block grant wouid allow for only a .2. to. 1.2 % growth in Federal Medicaid
payments per person. (It is eX,tre~ely difficult to see how thiS would be'
accomplished, considering the fact that it is' far Jess than the 5~3% projected
annual growth in nuidical inflation).,
'
Back-up materials on ..MedicarelMedicaid primarily use OMB baselipe numbers, which
are slightly lower than CBO's numbers.
....,
�MANAGED CARE
Managed ca~e has potential to achieve savings'o,y~r time, but few believe it can
, produc.e ~nyW}Jere near the level of savings the Republicans need.
'
Ironically, trying to save inoneyand attract more beneficiaries into Medicare managed
care ruris at cross-purposes. (This is because managed care currently costs the
Medicare' program rather than produCing savings; evaluations have determined that thIs
.. is due largely to favoiab~e s~le~tjQn). To .remedy this situation -- while still retaining
incentives to go into managed care ,..-- would be very difficult. See attached rriemo to '
the President.
.
For Medicaid, mu~h of the provable managed care savings' is ,already assumed in the
baseline; the only exception to this is that there is no managed care savings assumed
for the elderly and disabled population." While these vulnerable populations represent,
almost two':"thirds of Medicaid expenditures, even the Republican's Gail Wilensky
acknowledges that there currently is very little evidence to suggest that these
._.,.,,"., ..""" .". populatio~scan be easily,and cost-effectively managed:·~,
."~, .., , . , ......,,'
,,'
,
'.
.
"I·
',--;:
.
�..
"
,',
THE WHITE HOUSE.
WAS'\-1'j'N GTO N
March 15, 1995
.•
.
.
".
~
...
~
"
MEMORANDUM FOR TIIE PRESIDENT
.
.
,FROM: .
C~bL AASC~')\~_/'
LAURA TYSO
.
,
.. _......
t-.
,.~.
SUBJECT:'
Medicare Managed Care
.
..
,~,
.
",'
know, the most recentHHS proj~ctions for the Medicare and Medicaid baseline
between 1996 and 2000 were $94 billion lower than the estimates in the August 1994
Midsession l{.eview. Of this $94 billion, $40 billion of the savings w~r~ for· Medicare
, spending.
.( . '
..
AS 'you
You mentioned in your March-3rd p'ress·co~ferenCe that,Medk'Me-managed tare contributed
to this reduction in the baSeline. Secretary Shalala has made similar suggestions in the' past,
although she now understands that M~dicare managed Care as' currently structured is not
producing Medicare, savings. The reduction in' the .HHS Medieare baseline was actually the
result of other factors, including.programmatic changes. impl,emented during ·your .
"'AdmInistration that have improyed ~fficiency and reduced frau9 and abuse, 'and the lowering
of ov~rall inflatiordn the economy.'"
.
BACKGROUND
,
.
. As cUrrently designed, Medicare·managed care actually: increases program spending. While
the ihdustry argues persuasively that tvey 'are able to red~ce costs with managed care, the .
Federal Government is not enjoying comparable savings. Instead, the savings achieved by
Medic,are HMOs are largely passed along to beneficiaries in the' form of. Medigap benefits,
e.g., prescription drugs,. hearing, vision, and/or. retain~d by, the HMOs themselves in the form
of higher earnings/profits. There are two features'· of cui-rertt Medicare managed care programs
.. 'that explain why t~.ey·do provide inadequare savings .for the Federal government.
t"-
."
'
First; CBO and' OMB now believe that Medicare'S" currtnt reimbursement rat¢..fGr, HMOs is
too high ..and actually loses money on each beneficiary enrolled. lytedicarenow pays
participating I:lMOs'a capitated paYfl1ent rhat is .calculated, 95 percent
the cost of
'providing care to 'fee~for-s~rvice beneficiaries ina~ area. At the time of the enacrment of
the Medicare .HMO 'la~ (TEFRA :- 1972),. there ~astoo little experience in the program to
know what level of reimbursement was appropriate, The"95 percent number was chosen to
provide an incentive for HMO participation in the program while capturing some sa'v'ings for Medicare.
at
of
�'.
"
The current reimbursement formula,doe,s not· adequately control .for the fact that, on'average,
people who e~oll in HMOS are healthier (their ~osts if they had remained in fee-for-service
Medicare are often less than 95 percent Of the average), ,and subsequently Medicare overpays
HMOS for the, cOst of providing care to them. In 'fact, CBO estimates that Medicare pays 5.7
percent more for beneficiaries in managed care than it would if they had remained in the fee.:..
for-service sector. in regions where fee-for-~ervice costs are, disproportionately higherthail . ,'"
managed care ,costs -~ whic.h happens in areas'with very competitive managed care markets
- the paymentfonnula overpays HMOs even more.
'.1>*1> • -
,
,
• :;f'!' .~ ..::
,
The second characteristic in the"M~di~iiemanaged care program that may increase co'sts -is' c. •• \
the option for, beneficiaries t&diseruoll·ev,ery 30 days. There is, anecdotal evidence indicating
that beneficiaries disenroll from an HMO and seek care in the fee-for-service sector once
they get seriously ill. The underlying theory behind managed care savings, however, is that
capitated payi11en.ts prQvide incentiv~s to keep costs down wheneruolleesbecome sick., Wpen.
enrollees'Em ,leave managed care arrangements when~ th~y' get ,seriousl y.,ill;, the', incentives
faced by HMOs to manage care effectively are minimized':,.Undcr thiS scenario, managed
, care could potentially further 'increaSe Medicare costs.
"
,
,
, Many, Republicans in the Congress have suggested that significant savings can be achieved
through the utilization of manag~d care in thcMedicareprograin. Whil~ they have yet to
release details, proposals that could guaran'tee savings of the magnitudetha! are being
discussed would restrict choice, particularly 'for lower income beneficiaries. It is therefore not
surprising that elderly advocates ,are particularly
of proposals for capped 'vouchers that
have been suggested by Republican analysts. '. The HMO -industry also 'is not likely to, lead the
charge'toward initiating any significant changes to the program since, for the te'asonsou~lined
.above, ,they are generally. quite ,satisfied with the 'current Medicare payment arrangement. '
wary
,
,
'
'
, 'FUTURE ADMINISTRATION ACIlONS
We are' conducting an intensi~e' review ~f managed care options to develop, an Administration
position on this issue. There isa strong commitment to moving forward on the managed- care
front by OMB and HHS, and the Department has 'testified to this effect in recent weeks. In
, contrast to the approaches being advocated by some Republicans,' the managed care models-.:.. '
such as a new Medicare PPO model;-that have been referenced in Administration testimony
would increase the use of managed care by expanqing the choice of plans available to . '
,beneficiaries. But the Adminlstr<ition proposals would not restrict beneficiaries' ability to
remain in the fee-for-service system. Without modifications in the reimbu'i:sement
methodology, however, such proposals would probably cost money-:- at least over ~he short
te'nn'--We are ciirreritly studying the political and poli~y feasibility/advisability of alternative
managed care options that would signific;:antly reduce the growth of Medicare spending .
.I'
...
••
We are 'also s~l.jcitin'g input from private sector managed care firms (such.as FHP), and \~e
believe this relationship has the potential toyield some intcr,es~ing r~~ults'. While any viable
managed care proposal is unlikely to generate significant Medic~e savings in the short term;
we believe· that:-movemcnt toward managed care'in the Medicare program has. the potential to
. produce savings over the'long term. We will keep you apprised of the status o( our work
this area.
'
,
'
in
-,
�HEALTH CARE REFORM
. "Our families will never be secure, our· businesses •..,ill n~ver be strong, and ,
, ourgollernment will never again be fully .solv~nt untilwe tackle the health care
crisis. ." [president Clinton, Joint Session.of Congress, 2/J7/931
. ,
-
"
THK.,C.LINTON APMINISTRATIONCONTINUES TO fIGHT FOR'REAL,I:IEt,\LTH
,CARE REFORM.
•
As you know, last year the Clinton Administration fought hard for health care rdoml,
While we could not reach agreement on legislation, theredm be little disagreemen't
'lhat the problems remain. Nearly forty million· Ameficans nayenO h'eal,ih'insurance
and' millions mor~ ar~jl,lstone 'pinkslip or illness away from losing it. Eighty-four:-:
percent of the uninsured in 1993 were in working families, and Jilore-ihat 55 percent
"liv.ed in'families headed by full-tIme workers. And w.hile health care costs_have
begun to slow ~own, they are continuing to rise at three times the rate. of inflation,
•
As the President ~aid in his State of the Union address and in his December letter to,.
,the Congressional Leadership, we remain firmly committed to guaranteeing health
security to all Americans and to containing health care costs' for families, businesses'
and Fe'deral, state and local governments. . ' "
..
•
The President belie~es that we should take a step-by-step approa~h. This year, we
can take the fi~st steps. The Congress can and should:
,"
.
.
,
•
Reform the insurance market :...- so that people 'don't lose their insurance when
they lose 'their job or change jobs or a f~mily 'member falls ill, and so that
small businesses can afford to buy insurance for their' workers.
,"
•
.
~-
Make coverage affordable for and '~vailable to children.
. ..
Help w?rkers Who lose their jobs keep their health insurance.
•
Level thcplayingfield forthe self-employed by giving them
treatment as other businesses.
•
,Help
f~milics
tax
provide long-term care.: for a sick parent or a disable-d child,
.
•
the:s~me
.
Beca\1se thcir constituents arc' demanding action, some Republic'!I~s'have begun to
rcspond to 'the prcsidcnt's challenge by coming forward with proposals and bills. ' Wc
.
look forward tl? working with thcm to take the first steps, this year,
�, I
',.
THE CLINTON i\DMINISTRATIONIS FIGHTING BACK TO PROTECT HEALTH
CARE FOR MOTHERS, CHILDREN, THE DISABLED AND AGED AMERICANS.
•
Unfortunately, for;'too many RepubliC<,lns in Co~gress, "health reform" has turned into '
the code word for slashing Medicare and Medicaid to pay for tax cuts for ~he w~althy .. '
Republicaris in, .the House and the Senate have talked about cutting both Medicare and
Medicaid by hundreds
biHions:of,dollars: ..
of
:;
•
Ri~ublicans have signaled,their intention'to cut Medieare by about $300 biIlign
between now and ;2002.
' .','
; ..
...
~.
• '
•. '
~
~
Republicans have suggested cutting Federal Medicaid spending .b y at least $180
to $190 billioh.betwcen,now. and 2002. ' ,
'
It's not ,hind ,to figure out what that means for the doct~~~a.n.d hospital~.:vh() treat
patie'nts receiving, benefits under these programs, andJor .th6 patients 'thcmsel ves,
. ' .
.
•
It rilean's shif~ing a staggering financial burden t6 elderly and disabled Medicare
beneficiaries. Or to smail businesses and families who will pay higher,
, premiums and fees.if these programs are slashed without overall reform,
.
.
,
.
•
It means dropping coverage or shrinking benefits for mothers ,and chifdren on '
,Medicaid. Or it means aSking:States to, pick up the tab to preserve the
" Medicaidgrografl,1" aggjg.doing SQ•.J9X9ing' ~hem t~ raise taxes or slash
'
spending for services like education a~d public safety. '
.
It means significant cuts 'in p~yments to hospitals, physicians and other
providers.
•
•
. :
",
The President presented a responsible budget to Congress
a, budget that made tou'gh '
choices to get our rising deficit under control, but a 'budget that protected hard
working Americans and investments in our children: Now it is Congrpss'tu~: to act',
To detail where they will get the cuts they need to pay for their tax cuts for the
wealthy. To'step forward 'with their plan .for deficit reduction. '
.
·
,
~
..
,
.
.
..::..",.
•
The President has consistently said that we cannot get,? hold, of the deficit \vithout
passing meaningful health reform. Over the next five 'years alone, almost 40 pcrccnt
, otthe growth in total Federal spending will come fr()m rising costs in Federal health
care programs, We must contain costs inthesc programs~ But we mllst do it as \\;c
reform oUf health carc system as a whole -- not by arbitrarily cutting programs that
serve thc mosi viJlncrable Amcricaris':',
.:,
'
March 6, 1995
'. Staff Contact:· Jennifer Klein (6-2599)
�MEDICAID BLOCK GRANT PROPOSAL
,
I
•
Republicans are proposing t~ ,cap federal payments to states under the
Medicaid program ,as part of their effort,to balance the federal budget. '
.
.
. ' . , '
.
.'
. ~::;
.
..... '-
House leaders have discussed 'a target of $180, - 190 billion in .
reduced federal pontributions for Medicaid betWceen 1996 and 2002.'
This is, approximately equivalent to capping annual growth in 'federal
,Medicaid payments at 5%,begirining in 1996.
,
'
~
Senate 'leaders have discussed a' target of about $75 billion inredu~ed
" federal Medicaid contributions between 1996 and 2000 (which would
correspond approximately_,to,a §.S:Yo" ,gap);:
a
'.
On 'March' 14th; Senator Gregg'releas'ed document that outline~ a
,4% growth cap on Medicaid -- $115 billion over 5 years, well over
'$200 billion over the 7 year window (using eBO baseline numbers).
•
While th(3re are, no specific Coo'gressional block grant proposals for
'Medicaid,. thepresumptioAis,that states would be given broad--flexibility ".-,. -,,-,' ,
to determine eligibinty, benefits,~nd provider paymentJevels.
\
"
1
/'
�BASELINE ENROLLMENT GROWTH
Comparison of Recipient Growth
& Total Growth in Medicaid Block.'Grant
6%~--------------------------~
- ..... . . ... . . .... ...... . . ... .............................. " .......
,'
.'
4%
. .
.................... .....
~
~
~
,Residual for Price arid Use: 1.2"10
' "",:,":":/" ...."'." ..:,:..:...:....:......:,',.....,...".,...,w............, .•., •..••.•••••••.• , •••...••• : ••,.,.,.,.,.,.:.•.,.,.,.,w....,:,.,.,.,.,.,.•.,:,.••,.,." .
...:...:..:...:...:...........
.
_.,-,.!
.3%
2%
.1%
O%~----------~--~~--------~
" . 1995:'1'996' . 1997i
I·.. · Total Block Grant Growth . . .
e
'1998
.J.•.•.
.,1999
. 2000·
Recipient Growth '
'j':' :-'
The number of people covered by Medicaid is projected to, grow by an
average6f 3.8% . a year frori11996. to 2000.
'
, "e""'" If states di'd not rE3d'uce coverageLind~r MSdic·aid.·a bl'ock-gra'nt
,growing at 5%' per year wOLild allow only 1.2%, growth in federal '
Medicaid' payments'per person. This is far less than the 5.30/0
. prOjected annual growth in medical inflation.
'
2,
�.
I
GROWTH .IN .MEDICAID .ENROLLMENT··
Medicaid &' Private 'Health Insurance
Growth: '1996'·2000
12%r----:--~----'-:----______,
10%
Tolal Growth:
6.1%
Total Growth:
9.3%
•Enrollment Growth:
0.2%
6% .'
2'"
.•
•
Contrary to popular perceptibn,percapita private sector groWth ra~es .
. are actyally running at or above those of the .Medicaid· p~ogram ..
a
On per. person' basis, Medicaid actually is projected to grow at a '
slower rate~than·priv.at(3,health.sp~oding -''-.-.. , about 5.3% 'annu~lly peL ..._.,
recipient as compared to about. 7.9% annually per insured person~
.
The CBO baseline just released concludes that per capita growth rates
are e.xactIY. the same for private sector and the Medicaid program.
e· Medicaid enrollrre~t- increases are respon.sible for the relatively high
rates. in Medicaid expenditure .growth.
•
Medicaid is project~d to cover an additional 10 million peqple by 2002
(for a total of 47 .million people).·'
.'
.
. .'
..
.~
,
"
. Between 1996 and 2000, the n'umber of. AFDC Tedpi.ents covered
by Medicaid is projected to grow 2.3% pnriually
..
~.
. ~ . The' number. of' aged and disabled recipients is 'pr()j~cted to grow
.:,.:
.
.
by 4.7% annually during the period. .
"
,
of,
....
�CHANGES IN MEDICAID ENROLLMENT
..Changes In Insurance Coverage
.
. .
,
1989 to 1994 '
1989
,
".
,Employer 59%
Uninsured '16% .
. - .. . .
Uninsured 16%
....Other 9%
M~dicaid 9%' .
Medicaid'l~%
I·
i
I
.
SOURCE: The Urbanln'stitute analysis of the TRIM2·edited March ,1993 Current Population Survey.
.
. .
.
.
.• ,'.' Medicaid h~iS'been ·.asi'gnificant and growing' soUrce
insurance for many people ..
~
of hearth'·'
Between 1989 and'1994, the percentage of the population
covered by Medicaid grew from '9% to 6v~r"14%, 'while the
pe'rcentage cover.ed· by private .healthinsurance fell from 660/0' to
about 59% .
. '
,
Without this, growth in Medicaid, the number of uninsur~~f would
likely have increased significantly.
•
•
This trend could be partially' reversed by Republican welfare reform
proposals, which could eliminate Medicaid eligibility for up to 2, million, . ,
people (over 6 million irall AFDC adults lose eligibility for Medicaid»
.Additional Republican proposals to Significantly cut federal Medicaid .
•payments through a block grant would likely exacerbate the loss of
, Medicaid coverage. The magnitude of the suggested cuts would leave
s,tates with little choice but to reduce eligibility and benefits.
4
�I .
.CAPPING MEDICAID SPENDING "
.
'
" .
.
,
Reduction of Federal Spending Under' a 5o/~ Growth Cap,
. . .
(Billion.s of Dollars, Fiscal Years)
...-
. 1996~2000 ' .
,
1996-2002
1996-2'005 .
.'
.....
__ rr.T::."
CBO
,.:.
Baseline..
$614
. $955
$:1,593.
5% Growth
$518'
$763
$1,178
Baseline
$576
" $890
$1,477
5% Growth
$513
$756·
$1,168
. Administr~tion--'
••
Under the· President's baseline~ Medicaid is projected to· grow at ~.3%
through 2002. This' is a dramatic reduction from the over. 20% annual
average growth rate during the Bush Administration. ' ,
•
Under the CBO.baseline, Medicaid is projected to 'groYf 'at 10.2%,
through 2002. ",
".
,
•
Due to the' c~mulative effect of the' an~ual reductfons' under ,a 5% rate
of growth cap, the reduction .in federal payments to states doubles
(from $97 billion to $1'92 'billio~ under theCBO baselfnef betwe~n -'.
FY2000and FY2002..
,
1
. J.
".
.
'.
'.
,
5
�CAPPING MEDICAID SPENDING .
. Federal Medic~lid 'Payments ,1996-2()05
- Baseline & Capped Federal Payments
$220
'-
Federal
Payments
'Reduce'o by
32% in 2005
(CBO:37%)
1/1
.~ $180
ii5 $160
£:
$140
.!!!
.~ $120.
.~
$100
$80 - ' - - - - , - - - , - - - - - - - - - - - - - ' - - - ' - -
, _1997
1999.
~QQJ
..
I~ Baselin'e Gro~ ..·...·:5% Growth
I ...,
.
,'This wedge illustrates thecuinulative effect of capped expenditures.
Over time, the size of the federal payment reduction grows.
.,'
.'
•
Over five years (1~96to 2000), .federal payme~ts to states would be·
11 % below the baselin'e projection (16% ~nder the eBO .ba~eline).
•
Over ten years (1996 to 2005),the cumulative'reduction in federa.l
:payments is 21 % (26% under eBO baseline)~·.
'.
.
•
: In FY 2005 alone, federal p'ayments to stat~s 'would be 3'2% below the
baseline projections (37% under th~ .9BO basefine).
. .
6 .
,
,.
..
.. :.-
;.;;:
�.
,"
.
POTENTIAL STATE RESPONSES
TO ,OFFSET FEDERAL PAYMENT REDUCTIONS .
"
•
Medicaid Managed Care
.
.•
'.'
.
"Reduction in Payments to Providers
•
Reduction "in Benefits
•
Reduction.Jn Eligibility/Recipients.
Increase :or
' . Decrease in State Medicaid Spending"
. .
.•
. '
i
.
.'
.'"
• tr~ .
,
7.
"',
~
",
"
�MEDICAID' MANAGED CARE
.
•
,
While', many point to managed care asa·source of significantsavings
under Medicaid, studies (including one'by eBO) have generally found·
that it produces a one-time savings of about 5 to 15% over baseline
-'
. costs without slowing the rate of growth. .. .-~
StatesJaave applied managed,care primarily ·to children and AFOC~.adults, who accoun,t Jor less than .0ne-thiJd of Medicaid spending.:..
Applying managed care techniques 'to the serv,i~es-.typically used by . '
. the elderly and disabled (such as long term care) is largely untried and.
difficult, making the potential for' .
achieving savings hard to predict.
.
.
.
,
' •..... -~ Baselin.~ projections' already assume that-a ~ubstanti(;lJ.P[qportion_ 9f
. --, ,.-:, .
_~ed!9aid reCipients will be in managed care'arrangements, (;33~ of
AFDC and non-cash children currently ,growing -to over SO% by the .
. end of the decade) .
• '
r',
'Therefore, the percentage ·of Medicaid spending for which' there is
some evidence that managed care could produce' saving is relatively
small, and varies signi'ficantly by state (e.g., the percentage of state·
Medicaid enrollees that- are-agedor'disabled ranges from 15% to
40%).
.
'
.'.
8,
�, COMBINATION OF MEDICAID SERVICE, PROVIDER,
AND RECIPIENT CUTS: CASE EXAMPLE
'
.
•
.;
....
~
A state 'could react to the reduced federal Medicaiq payments by'
combining Medicaid 'managed care, benefits reductions, p'rovider
paYrnent-reductions and .r~Cipient cuts. . '
,
I .. "
•
"','
The following ,scenario illustrates one way:,that states,coufd offset the
federal Medicaid cut in payments 01.$39.4 billion in 2002.
.... Enrolling all adults arid children through Medicaid managed care
would reduce costs ,by about $1 billion.'
'
Eliminating homebealth, personal care services and prem'ium
and cost=sharing'support 'to'r':Medicare dual eligibles' would, '
'reduc~;r'costs, by $17A billion.' ~". ,':'-',
"
... 'A'5% acrqss~the'-board'reduction in provider payments would'
, reduCEi' costs by $11;5 billion.
'
..
,Cutting eligibility f¢r. a little over 4 million. non-disabled adults and
,,' .. ," ",,·children·wouldreduce"costs by $~.5 billion..
"",""",,,,,",
','
"
,
"
.:..~.
."
9
,
.,
"'",'
�CAPPING MEDICARE SPENDING
. •.
".,:., .••0,••.', .
Republican efferts to. balance .the federal budget may, also. 'Iead to.
prepesals to. cap federal spending fer the Medicare preg'ram: 'Fer
.. ' example, Senater Dele has suggested a reductieninMedicare
.spending ef abeut $150 billien between 1996 and '2000: This is
'appreximately equivalent to. capping annljalgrewth"'inMedicare
. spending at abeut.·'5% beginning in 1996. (Senatqr Gregg suggested
reducing ~edicare spending by abeut $100 .billien ·er abeut a 6-7%
.. capped growth rate)..
' .. , -.
'
•
Medicare is currently prejected·tegrew at an average. annual rate ef
9.3%· between fiscal years 1996 and 2002 (9.8% underCSO
baseline).._....·
.
On a per person basis, Medicare actUally'ls projected to. grew"at abeut .,
thesame rate (abeut 7.6% as cempared to. 7.8%) as private health
prejectiens, per
spending fer peeple w'ith insurance.' (Under
capita Medicare expenditures is grewing at'a slightly faster rate than
private, health spending ~~ abeut .1-2% faster).
eso
,
...., ''''.
.
,
esa
Using
budget estimates, a 5% grewthcap weuld redtJce ·federal
Medicare spending"belew baseline' prejectiens by almost $328 billien
frem fiscal years :1996 to. '2002, and by $720 billien frem 1996 to. 2005.
I
•
.
The fellewing.table shews the petential effects ef a 5% grewth cap, en
, a state....;by-state basis. This analysis assumes that Medicare spending
'in each state under the"status que weuld grew at same "rate as'
prejects everaIiMedicare.,spending to. grew.' .
eso .
.... ;- ..
10
�Illustrative Effect of'Medic!;'re Capped
Expenditu~e~
Reduction in Federal Payments Assuming 5% GroWth Cap
.(Dollars in millio,ns, fiscal years)
1996 - 2002
s·
(328,328)
. labama_
.Iaska
.-.
, (5,647)
:~
,'./"-
--.;-:"
'-.;,:
(223) .
rizona
(4,999)
rkansas
(2,997)
alifornia
(37,838)
olorado
.,
onnec\icut
(3,281 )
(4,711 )
elaware.
(822)
District of Columbia
(2,552)
Florida
(~6,901
Georgia'
)
(7,577)
'. Sl :085.)
Hawaii
. (784)
Idaho
Illinois.:
Indiana.
(14,083)
(6,599)
Iowa
(2,996)
Kansa's
(3,099)
,. Kentucky
(4,495)
louisiana
. Maine
(5,983)
(1,289)
Maryland
(5,668)
Massachusetts
(10,298)
Michigan"
-
(11,868)
Minnesota
(4,834)
Mississippi
(3,047)
Missouri
Montana
(7,165)
(848)
.)
Nebraska
(1,582)
Nevada
(1,523)
New-Hampshire
(1,061 )
New Jersey
(10.899)
New Mexico
(1,277) .
New York
(26,272)
North Carolina
(7,441 )
North Dakota
(797).
Z (1:3:'967")
Ohio
. Oklahoma
(3,549)
Oregon,
'-(3,313)
Pennsyivania
(21, 27 6)
Rhogelsland
(1,443)
South Carolina
(3,305)
South Dakota
(761)
(7,462)
(18,376)
(1.356)
(5?3)
irginia '
(5,554)
ashington'
(4,972)
est Virginia
(2,334)
isconsin
(5.290)
(318)
Federa!
p~';'ment reductions are allocated across slates in proportion;o the states' FY
•
. Stales' losses do
not
•
j
•
sum 10 U,S. losses due to the exclUSion of territories.
.
.11
1993 share of
Medic~re spending.
�POTENTIAL RESPONSES ;TO
_
,
ACCOMPLISH. REDUCED MEDICARE SPENDING GROWTH
•.
Medicare Managed
Car~
:-:; -. '" . Reduction in 'Medicare Payments toProviders,,,-_ ;:~:":.'
•
.,;:.
Redu'ction in Medicare Benefits
;
-•
Increases in-Medicare Premiums
-
,
.:-
-
...
. .. .- ..
..• ".1,-,-"
.
~.
-
. . . .<
"
1?
>
_.~.,
.....n._
�',MEDICARE MANAGED CARE
.The potential for achi~ving 'scorable savings in Medicare thro.ugh managed .
care is uncertain;
(
. Currently, 74 % of 'Medicare bEmeJic:iarieshave access tbamanaged
care option and 9% of· Medicare beneficiaries have chosen to enroll in
. '>a managedj::areplan. Of this 9%,' two-thirds are 'enrolled in an HMO. ,.,
By the year 2000,. we project that about '160/0"
beneficiaries will be .
enrolled in HMOs. ..
. ...
•
of
,C<.
.
• .
M'anaged care currently costs the Medicare program rather than
.. achieving 's·avings·;Evaluations:have determined that due to favorable
. ,_,_ selection, Medicare pays 5.7% more for every enrollee in risk-based
.....~:.,o.;_ ..,.......- ...~':': .... m'anage9 care'thanwc;uld have beer) paidi'(the-benefidary·hac{·stayed .......
.....
,... in fe'e'~for'::'serVice~
.
'. ..:':.:~ ........:. _., ..'
'.1,
.
'. . . -....
.......
•
eBO has testified that expanding enrollment fn managed car'e plans
under the current system, would be unlikely to reduce federal costs',
, and that the changes that would be necessary' to the current payment
system ·for managed carE3 would be "difficult to specify.II ..
., •
The Department has a number of·efforts underway' to 'improve 'and
expand the managed care"cho!ces available to benef'iciaries, including
developing a PPO option. and evaluating methods to improve the
current paymentmethoqology for Medicare managed care plans.
.
.....
-
. .
. .....
~
'
-.
,,--~-
,
~4
.
. . . . . . . ~..
"
•
';
. ,.", .. ,,'
..........
, 13
-
-,. ,
-,
.
�. ,
.COMBINATION OF REDUCED' PAYMENTS TO PROVIDERS AND
. 'BENEFICIARY PREMIUM INCREASES
•
Under the.Mainstream Coalition bill,' Medicare cuts were distributed'
across.providers and beneficia~les so that proyicjers bore about three-.
quarters of ~~~ ..reductions and beneficiaries. bore about one-quarter: .
Using: this- same distribution,the following wQuld be necessary to offset
, the effects of a 5% sap 'on Medicare:~'
., , . , .
..
_.
I
."".
, ....
. .. ~
.'
~
• ."" Provider ,Cuts:· 'If cuts .were distributed proportionately across'
providers: .
. .
Hospitals:,
8%: reduction in 1997;
in 2002; and_..
....
-. -.23% reduction..... _.-.....
-...
.
...... - .... _
.' 30o/O"reductiorr in 2005 ..
"._
Physiciclns:
.
.
",
Other Providers:,
•
,.- ... ·.c.·,·,,)
-.:.-.
.8% reductionfn 1997;:,..
24% reduction in 2002; and
34% reduction in 2005. "
. 7%· reduction in 1997;
",1,·7% ·reduction in 2002; and .
'22% reduction in·2005.,
"'-'
.,
A relatively large' percentage of rural hospitals are heavily
dependent on Medicare as a source of revenue.' Rural, hospitals
also are more likely to have negative Medi6are margins than
urban hospitals... ' c " .
~.. .. ..
"
' , ",
.
..
'.
.".
Increases in Medicare Premiums:. .Ifthese savings were achieved by
_:increasing Medicare premiums, the ,premiums would rr,crease by: "
~::...
•
....
,
_
;"_
•
•
•
c'
•
,
..~-=-- ....
....
$142"per year- 'ih 1997;
$53~ per year in 2002; and
$89ff per yegr :in2005....
--
.
• ", Medicare beneficiaries already spend 'almost 12% .of their,
'"
household incomes on health care, as cQ_n1pared,to less than 4%
for nonelderly families.
';'
..,
14
j
)
I
�.
--.-.....--~---
EFFECTS ON ACCESS AND PRIVATE PAYERS'"
, Between .1 ~96and 2002, 5% ca:ps on the growth In Medicaid,and
Medicare would reduce federal health payments, by over $500binion~
•
.
.
.." ...
,
•
Reductions of this magnitude raises questions ap.9lJtDow providers
, '_"., would respond. With the number of uninsureet 'projectedto rise over
.,,' the decqde, hospitals and, otherj:>roviders will be face 'th.~ s~~?lin of '
,., '" - :","pro\lider more Liricompensat~d carewith"fewer"resource's.·Cuts 'in .
Medicaid enrollment would exaGerbate the strain.
'
.'
Recently, it appears'that private pay'ers ,-' particularly large employers '
-, have. intensified thefr cost containment efforts.'· These efforts have
forced hospitals and other providers to reduce expenses, further
, :,diminish'in~fthe'ITcapacitY to absorb~ redi.Jetlons'in M,edlcClre' ah,(f"~·:::'~~~
--<,.' Medicaid paYr'!"lentsand'Thcreas9s In' unc9mp,eniiated,car.e;" :,' ,
•
-
Given the magnitude of the, proposed cuts, providers 'may' no't be able
to respond to the reductions in 'payments entirely through increased
efficiency.'
'
,'
.
'
,
.'
"
.'
, .... ~.,., Access to care for Medicare beneficiaries and 'uninsured patients
.
may be jeopardized. Understandably, providers, may be less
willing to see these patients as their sources of payment shrink.
,
~
,
,Private payers may also'bear a porti.cm ,of this burden through
, cost shifting. Small employers and individual' purchasers who '
have'less leverage in the: marketplace, mctY be particularly
.
vulnerable to costshifting~"
j ,
...
-~
..,...... ., ...... - .
.. ,........ -- .
-~.'
-"'
_._.. _
...
~,'...'.o;"•.
.rN.
15
�
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WithdrawallRedaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
DATE
SUBJECTfJ'ITLE
Walter Zelman to Rasco re Personnel Matters (1 page)
10/13/1994
RESTRICTION
P61b(6)
COLLECTION:
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Domestic Policy Council
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ONBox Number: 8506
FOLDER TITLE:
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2010·0198·8
kc226
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P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
.
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bel) National security classified information [(b)(l) of the FOIA]
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2201(3).
RR. Document will be reviewed upon request.
�11/08/94
12:02
IaI 002
Health care Qs and As - November 8, 1994
,
,
Q. Congress failed to enact your'bealth care, pI31l1asfyear and expectations are that
with a more conservative Congress next year, it will even be more difficult to pass health
care'refofmleglslation. Will you produce a 'modified approach, perhaps something that "
will gamer more Republican support - or will you introduce sf.)mething that C31l be used "
as • campaip issu, Ut19"?'
'
A. The,re have not been any decisions made on how we will approach health care next ·year.
The only decision made is that we are not going (0 give \1P ,the battle. Another million,
Americans 19St their health insurance last year and costs continue to escalate.. We Cannot
walk away just because the road to 'ref~rm IS diffIcult.
We o,bviously· want h~alth care to be handled in a bipartisan fashion. We always have. We
tried repcatedIyduring the last session to work with Republicans. They threatened to
filibuster in September and it put health care reform on the shelf for now.' But I think there
is a 'good' opportunity ~o provide people 'with the health securitY that they want - with quality,
affordable health'~ 'and private insurance coverage. And it is au 'opportunity that can be a
reality if we work together.
Q. The RepubUl'!8ns, with massive speela) interest help, successfully labeled your plaD ,as
'government-run aDd stated It would lead to rationing and ,massive job .losses. '. Will the
Adnlinis.tration do something belp change thiS public perception? WiD it abandoD
alliances, move at a slower pace, back away from unl'l'enal coverage?
.
.
to
"
'
,
A. Again, no decisions have been made .. We will obvio~ly try to better explain to the
American people that we are talking ~bout preserving what is good in our system and fixing'
what isn't working. And when we .talk. about preserving what is good; we mean preser:ving
the prlv~te insurance system. Providing Americans wi~ priva~ health insurance that can't be
taken away if a loved one g~ts sick or a job ,is loSt.
.
.
scare
,
I
Special interests spent bundieds of millions of dollars to
aud mislead the public. Yet, in
spite of their success in creating confusion, the American people still overwhelmingly believe
that we must act to provide health security to American families and make health tare more
, affordable.
'
Q. Reports from senior White House omclals last week stated that y~u were removing
the First Lady: and Ira MSgaziner as the leaden ill developing health care. legislation
aDd replacing them with Carol Rasco, and Bob Rubin. Istbis mov~ a recogn'ition that '
last year's process was a failure?
'.
:
,A. First, let me' state that reports that the First Lady will Dot be involved iIi health care are
ridiculO1J$. The First Lady. will play ·an ~ctive role in policy strategy and development,and
she will re~ the Admini~tion'spublic advocate on health care. At my request, Ira will'
,
'
�11/08/9412:02
III 003
also remain involved, in health
~e.
We are entering a different phase iIi the health care debate. The 'last two, years were sPent'
doing an. enormous amount of research and policy development. We arc now entering a .
phase that will aUo..v us to move health care through the same policy process that we USe for
, other major dom~1ic policy issues. The Domestic Policy Council (DPe) and the National
Economic Council (NEC) will coordinate our future health tefOInl efforts.
, Q. Given the ·dimculty iD enacting 8 bill with universal coverage last yea~, will·you .
pledge ODc.e again, in a more conservative Congressional environment, to veto a bill that,
does not adtieve universal coverage? . . , .
.
A. We still believe that every American deserves heaith care coverage. Our goal is univers3.J.
coverage. And. we're. going to do everything possible to assure that Americans have health
care coverage when, they need it. ~d we're going to' do everything po!;sible to control
escalatin,g heatth care costs .
. The American peoplc still overwhelmingly suPP9tt lJniversalcoverage. We mu.~t continue to
work toward achieving,'what the American people want and 'deserve.
.
.
Q. There is speculation that the Administration will be presenting recommendations to
CODgress on bealth care reform and that these recommendations will be part' of tbe'
budget. Are you going to submit a new plan and, if yes, have you given ·tbought to wbat
these recommendations will iD~fude?
. ,
we
or
A. We hav~ ·not had a chance to thi~ exactly about where
will go even in, what form
any such proposal would be presen[ed. Could recommendalions be submitted as part of the
budget? Yes, but it i~ also possible they won't be part of the budget.
.
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D R AFT - FOR YOUR COMMENTS
I
I
HEALTH CARE ISSUES
,
1)
,What can we do within the likely exLting budget;. e.g.,
within HHS, welfare reform, or other budgets?
.
I .
2) How does the pressure for additional deficit ·reduction
I
.
relate to what we might do on healtj care reform?
3) What would be a realistic list of alternative health care
I
reform proposals?
4) If the decision is made to continue using health care reform
as our an~wer to the pressure for mpre deficit reduction,
and if our '95. program consists of ,a large long-term vision
and a relatively moderate program, how can the latter
accommodate the former?
/
5) What ideas do we have about private sector cost controls
that might be congressionally real~stic?
. I
6)
,
i
Can we have Medicare and Medicaid cost reduction without
. private .sect9:i:' cost control?'
/
.
7) What are possible programs for reducing Medicare and
Medicaid? .
i
!
8) What's the relationship of health care reform to welfare
reform?
I
,
I .
.
9) What vehicles do we use for healtn care reform -- one bill,
I
or additions to the·HHS budget and the welfare plan and
other budgets? In other words, dd we have one bill or
several bills attached to other m~asures?
-'
.
10)
I.
Do we propose a program, or work jointly with Congress to
propose a program, or wait and respond to Congress?
.
11)
i ..
.
How do we pro,actively manage the message all through this
. process, including positioning oUf effort appropriat~ly now,
·putting.out a proactive message t~ counter leaks, and
characterizing whatever conclusions we reach?
.
. '. .
I
12) In a constructive mode, what lessons should be drawn from
~he health care effort thus far?/
.
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. " .framework for'evruUating the.ch9ices :tQ' beConsidered.Thls·memo~suggestS·a;possible': .
. JramewQrk fot begiimirig 4iScussioris.of how'to pt~ with a h~th policy. initiative for'
.' next year~ .Much"of"the' necessary ~hlYtic work was. pr~uce4.ovei~.~e,Past year·. tp .~tipport .
tlie~on~ressiona1'pr~s, 'anq ~~~ea~y av.ai1ab~e'1ous~·1 Assu~g wear~:.no. l?~g~r' :,,:.' .... .' .
.lookingat a'plan . which leads drrectly ro.uruverSal coverage; the challenge IS to rethink our. ..
approa~~ to .design ',jh~ ,~o's~ .ef(eCti~~ reform ~~ur¢ to ,?e1p' th~, most p~p~e, and cause ili.e
least dlsx:uption. ,To a conSIderable exte~t, the challenge.Is t9'~s~: sy~tematica1ly the . ~ . '.
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(4) Enhance health security through incremental insurance refoim,-- ~ven if we
do not reach universal coverage, the plan should still make the most progress
possible to maint3.m coverage when people change or lose jobs' or .suffer a' .'
medical Catastrophe.
.
The health care proposal must not:
(1) '. Be
compl~ --
A health care proposal ;'sho~id be easy to explain, to Congress,
,the press and the public~
.'
care initiative must build to the maximum
extent possible on existing institutions', keeping to minimum any new
bureaucracy. If any new entities must beestal>lished, incentives for new
institutions should be favored over mandates that new institutions be created.
(2) Be overly bureaucratic,-- A health
a
,
(3)
Contain any mandates.
(4)
,
Contain, price controls.
Fundamental Components of H~h Care Reform
The building blocks which mone form or another are likely to be included 'in any
health care reform bill are familiar at this point. While most were addressed ina similar
manner in the end of session compromiSe efforts, inUght of our shift to developing.an .
incremental approach, there are significant issues that ~e may choose to reexamine. .
(1)' Insurance refomi-- In.order to substantially expand access to health insurance,
some.degree of insurance reform would be'necessary. An early decision will
be the extent to which 'any community rating is feasible'. If so,policy options
must be considered, whi~h would have the least disruptive impact on the
market.
..
.
,
In the context of a bill designed to achieve universal coverage, broad .
community rating' was essential, because it made affordable coverage, and a
mandate -- even if as a back-up-- feaSible. If the objective of insurance
. reform is more narrowly defmed, it might be preferable to take more modest
steps to close coverage· gaps when, people change jobs' and to have a high' risk
pool for people who would otherwise not be instJrable. Any insurance reform
will have winners and losers, but a more modest approach' would have less
dramatic redistributive consequences.
.
. In order for a more competitive health care system ,to evolve, consumers will
have to be presented with more standard options forcomparisol),. ,We will need
to consider whether there should be a single standard package or a range of
options. We will also need to reconsider whether standard benefits should be'
defined 'in law, or administratively based on actuarial values.'
�ord~r for individuals and small businesses to have access to ' '
affordable health insurance, some level'of risk,pooling is necessary.
(2) Risk pooling -- In
If risk pooling is voluntary, how can we ensure that all health individuals and '
low risk small businesses leave the pool, leaving only high risk people in the
pool? What rules can be developed to prevent adverse selection and how
would such a risk pool be administeroo without creating a new bureaucracy.
(3) Financing -- We will need to review all of the financing alternatives that were
considered last year -- including the tobacco tax and the various forms of tax
caps that were on the table. Since realistic funding and deficit reduction are
essential for even a scaled back plan to be successful, estimates of feasible
financing may well define the scope of what can be achieved overall.
(4) , Cost contaimDent :-- In the absence of universal coverage, and with premium
caps and price ' controls off the table, we will need to develop an alternate
credible plan for cost containment. I am inclined to review different tax cap
scenarios, much as, Senator Bradley did. ,
(5) Expanded coverage -- We need to consider various options for expanding
coverage -- including low-income families,children, etc. The
, availability of funding may well dictate a more modest subsidy scheme,
or a phased in approach. We should review additional options which
~ould be less expensive, but still make real progress towards expanded
coverage.
Additional 'building blocks likely to be included in any plan include information and
quality and access in underserved areas. I would suggest that we establish a second tier of
issues to discuss as we proceed in this process.
Next Steps
"
I propose that we spend some time over the next several weeks exploring these and
other questions. In order for the 'staff to have time to prepare option memos for our review,
we should meet early next week to define the ~pe of our policy review and set a timetable.
After we have the opportunity to review these options within each area, and possible
'
packages; it may make sense to block out some time, perhaps on a weekend, to make,
decisiqns on Qurrecommendations."
�(c) 1994 Detroit Free Press Inc. All rts. reserv.
07535699
WELCOME, CLINTON GOALS ARE SOUND; PURSUE THEM WITH STEADY CONVICTION
Detroit Free Press (FP) - TUESDAY October 11, 1994
Edition: METRO FINAL section: EDP Page: 6A
Word Count: 639
MEMO:
IN OUR OPINION
TEXT:
Bill Clinton's visit to Michigan today comes at a critical time in his
presidency. The Republican Party already is saying benediction over his
presidency.
The president mayor may not be able to cut his party's losses in November.
But we're. convinced .his goals are still sound and deserve ,to be put forward
with more clarity and vigor.
. '
Here's how that can be. done:
Foreign poliby: The perception of the president as a waffler began with
last year's ignomlnlous turna~ound of the US~ Harlan County in Haitian
waters 'in the face of a mob, and the dithering . afterward.
It was
exacerbated by the'.contrast between tough talk and mild or limited actions
in Bosnia, and confusion about tactics vis-a-vis North Korea~ The reverse
on China's most-favored-nation trade status was neces~ary but costly.
These things have obscured achievements: facilitating the'Middle East
peace process, aiding the transition in $outh Africa, helping Russia and
Eastern Europe deal with staggering challenges, pushing the British on
Northern Ireland.
'
The president finally has grabbed hold in Haiti, and his policy shows
clear signs of working. His unambiguous response to Saddam Hussein shows
he's learning ,how to act· like the commander in chief. If the president
could build on Haiti and devis~ a more creative strategy to end Cuba's long
nightmare and isolation, he might change the whole character of the
Caribbean basin.
Mr. Clinton also should refuse to let his Balkans p6licy be set ei~her
by the New York' Times or by his European allies; The realistic course
probably is less heroi~ than the morality play of press legend, and more
committeq to change than Europeans imagine.
. '. .
In short, the -president must remember the basic truth that his
interests,and. the' country's, are best served when he behaVes like the
commander .in ,chief, with both the cautions and the boldness that job
d~mands.
.
.
.
. Domestic policy:' The president's goals :"-expanding the .ecohomy, rf1!forming
.the . health care 'sy:stem" changing .welfare, cleaning"llP institutions, of
, government.. --:- are on target·. 'What obscured real aqhi;e'vements 'was the way he
set --or didn'tset'-';" priorities, and the way the: administration acted as
�if health or welfare
are technical rather than political questions.
Approach health care incrementally. Have a master plan and insist that
the pieces conform to it. But go for insurance reforms. Move to cover
children
first.
Borrow, . with appropriate safeguards, . the favorite
Republican gimmick of this year, the medical IRA, which has dangers but may
also have promise. Give the states more flexibility. Build gr~dually ..
Push welfare reform and political reform to the top ~fthe ag~nda.
Bring. the Republicans into the process of finding answers •. Hang onto such
basics as the need to eliminate disincentives and build in incentives in
welfare.
Put together a credible next-st~ge plan on deficit ~eduction_ Include a
middle-class tax cut,butpair it with tradeoffs such as finally protecting
federal assets such as mining rights and grazing lands. Accept a real
line-item veto. Get on with reshaping the courts expeditiously_ Shape up
your operation on the basics.
Finally, the president can show that, imperfect being though he is, he
has deeply held principles and will keep pursuing them. Sponer or later,
people will look around and say, hey, maybe the man really is trying to do
the right thing.
If he show~ steadiness, he 6an s~t a lot ~fthings
straight.
It's a . big mountain Mr. Clinton has to climb. But some of our better
presidents -- Abraham Lincoln and Harry Truman come to mind -- were beaten
up pretty badly at this stage of their presidencies. They figured out what
they had to do to be leaders, and they did it .
. Tough asssignment? Sure. But President
country will be better off if he does.
CAPTION:
PHOTO
Clinton: Priorities
Clinton
can do it, and the
�'.
E X E CUT I V E
OFF ICE
o F
THE
PRE SID E N T
20-0ct-l994 02:59pm
TO:
Carol H. Rasco
FROM:
Linda J. McLaughlin
Economic and Domestic Policy
CC:
Sylvia M. Mathews
SUBJECT:
Comments in Press
Carol,
I read the attached to Bob when he called from the airport. He
wanted me to ask you if you have any thoughts about how we can
deter the Secretary from such extensive comments?
�Date: 10/20/94
Time: 14:41
Shalala: Government to Scale Back Health Care Reform Plans in 1995
WASHINGTON (AP)
The Clinton administration, facing a public
fed up with government, will scale back its approach next year to
reforming the country's health care system, Health Secr~tary Donna
E. Shalala said Thursday.
Shalala said Americans feared that president Clinton's original
plan would have ushered in a government-run health system.
~~Whatever we propose in the future, it seems to me, cannot have
that handicap, '.' the Cabinet officer told health reporters.
~~We're going to try to be shrewder and more strategic about
what things need to be done first," said Shalala, who took a back
seat to Hillary Rodham Clinton and White House aide Ira Magaziner
in framing the original, 1,342-page Clinton health care proposal.
Next time, the administration likely will make its main health
recommendations as part of the regulatory budgetary process, with
the president making key decisions by mid-December on what changes
he will seek in 1995, Shalala said.
~~We are still enthusiastic about going back in and fighting the
good fight on health care reform," said the secretary of health
and human services.
~~You get another kick at the cat and hopefully we've learned
some things over the last couple of years," Shalala said. ~~We'll
try to refine our strategy this time around."
She said the president won't abandon his goals of expanding
health coverage and containing medical costs.
~~We have to layout for the president some options that will
get where he wants to get, but not necessarily with the same road
map that we used before, " Shalala said.
~~People in the United States told us ... they were very gun shy
over taking on the whole system, every aspect of it" in health
reform, she said. ~~They would like it to be in stages and see what
the implications are of each piece as we move along."
The Clinton proposal would have guaranteed health care for all
by forcing every employer and individual to buy coverage starting
in 1998, steering most Americans into huge, new
insurance-purchasing pools, and imposing standby controls on
premiums.
Democrats and Republicans alike picked apart Clinton's plan and
eventually killed health reform entirely for this year.
Shalala said jawboning may have persuaded physicians, hospitals,
drug companies and other providers to hold down increases, but
medical prices are still rising twice as fast as inflation, and
working Americans are still losing their health coverage.
~~The problems are still out there,"
said Shalala.
Clinton has not decided yet whether to try again for an employer
mandate, she said, ~~but I think the public has spoken out on that
issue and we have to take their views into account."
~~The public was against a government-run health care plan"
and
~~they interpreted employer mandates as the government imposing a
pOint of view on how the whole system should be financed," she
said.
Other options for expanding coverage include ~~using cigarette
tax money and anything else you can scare up to extend the Medicaid
program" to the working poor, she said.
Already passed is a law expanding Medicaid to cover all children
in poverty by 2002, she noted, adding, ~~One possibility is to
accelerate that.' I
Instead of a socialized health care system, she said, the
�government could regulate the health insurance market the way the
~ecurities and Exchange Commission oversees financial markets.
Shalala said she has found in her travels around the country "a
very anti-government feeling that government can't get anything
right."
It applied to government at all levels and was based on people's
real experiences, not "something that some (radio) talk show host
had fed," she said.
~~With all of our good intentions, we walked right into that
with health care reform," she said.
APNP-IO-20-94 1440EDT
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
DATE
SUBJECT/TITLE
Walter Zelman to Rasco re Personnel Matters (I page)
10/13/1994
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8506
FOLDER TITLE:
Health Reform [1]
2010-0198-S
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THE SECRET~RV ~F HEALTH ANO H,I.)M'AN'SERVICES,
WA$.. INGTpN, C.C, 20201
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NOTE, FOR ALI~E RIVLIN " ~,J~'
Donna Shalala'Y',,'
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our heatth'
b:!forn(:¢liscUssio~s' arid basical'ly 'agree, orithe critical set, of'
iss~es'You, put 'forth. ',However, we':needa ,shift. in p~rspec,tivethat."
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Crit;i.cs'oft>ur heCll1:.h refo:r:m proposi'll/emphasized d-istressw!th'
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anything, that lookeq, like ,flbiClgovernl\,le~t~ tl, We ',werechar~cterized' "
as . stifling.i: 'riot, 'fa,cilita.:ti~9i' ,change.s·that, ,we. ,and others: '\
re'cOgnized '.as,:already·'~ndetway·in/,th~ "ltla:~-:~e.tplace,~·, ,A~though, we,
,'knOW. that :those~lianges, may ,be lim:itec;l or..even 'problematic without;
s9me, government :role, 'we' ',must f6c~s.' bur attention " on, ~how~-in' ,
substapce'andinfo.rD,l;;;'-to be helpful topriyate' secto.ririitiatives~:";
Th~t ',s.. w~a~ (~e'"n~ed ,',t(),'learn : from ~he' last :,two: ye~rfi". 'exp,eriericre~~
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.",' " ·~'l'o. ,tal,:){' o.f '~/" 'ttrtE!W . pi6poS~1,'" 'with' all' th~, tQ,Pi.~· ,are~s, , '~f . pur,
,····prevlous;. ·proposal. implies~that we ar.e continuing 'anapproachthat
, ·dictates'to',the . private . sector,' rather' tha'n, helping guide its
, " .d.e:v~19Pinent,~ Yo~'r.aof'feriI'lg·ac~earer :and smaller version of wha~1 "
i v e 'did befor.e."Ou:r·,jobistoget the rules straight for a mature" '
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.we:'snpuld
'task in' a' vet-y, :' "
different.way:proposingbui'lding .blocks.that'llelp,move an already
" ,ev91V,irig', priyate:system toward, ourg6als?f" .t;1niv:er~al coverage for,'
effici~ntly-deli~ered ,'care~
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,'This.persp~ctiv~:sh;ouid explicitly effE!ct ~he.,waywe' appr9ach
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.Insurance 'reform. . In: the 'currEmt"environment,,' '~ithout':·
.urii vtarsa1;:c,overage, 'h'o'v/ ,'can we . move 'toward .end.ing
'di,scriniination intheihsurancemarketJwhile'li:tinimizing
. tp.e ':r;isk 'o~disruption.?.'· How cariweshape,a, phased-in.
. :approach" to narrow 'gaps 'whiletransitionally retaining'
' . some dif'¥erenticils"(by age a.nd other factors)?
wp,at arl\i',
··.. the'.be.ne·fits· arid -risks qf, rnovingstep,-.by-step to. 'improve ' ..
. the .small "business an.d them ,the' individual market rather "
than.·a: combin~d app'~oach?,;..
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' Cos,t' 'con~ailUDent." "Given :resistanc,e', to aggressive,
",promotion otl'llar~et 'competition;, (tax,',caps) ~s ',wefl' , a s ' "
're9ulatiori~ how can "wehelp,the marketplc;lcemove' ,in the:
, direc~ions '"ne,eded' ,t~. ,llli:t~e .:competitio~ w?rk?, "Market,
, refonn~ ~o, supP?r1; compet:,l.tJ.on(prom,otJ.on' 'of, vol~J)tary
cooper~tives, , pomparison" sh.opping" across
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, plans) d~nb~' promoted"as the basi's ,fOl; cost containment,
'everiif :not',immediately nscorabik~ """ ., ',~
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'~ '"and Ildok.forwprd'to the ',an~lys1s to com:e~
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th~ni~"'substance
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, ,pursue, expanded, coverage, in!?urapce' and' market reform
ah'~a4 of' the' nation?:" Can, 'WE!, re'solve,the' conflicts,
,between" big' business ,,;'and' .labor who ,want ,no. state,
:, , regulation', (want ,to r~ta'in, the,l!:RISApreemptlo'n'of I3tate
, ,'regulatioll'L ~nd states' seeking ERISA waiverst'o,achiev~'.
, flexi~i'lity for broadscale or specific reforms? ',How can
,Medica.id policy encourage, 'exp~nsions of' 'coverage?
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$tat.~fl'e~ibility. ',HOW 'can 'we help 'states >that , :want:to co"~
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'," ':Furthe:r;:,','Iw6uld~add toyour< list:"
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, To: - - Bob Rubin ruidtaroll~asco,
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Date:, October 19,1994
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. Agenda and Talki~g Points- for ~qr)PC Meeting \
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Bill Galston - '"
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Jeremy BeIl'::'Arrif'
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: Attached 'is a'o~e page' agenda' for'today's ~eeting. Also enclosed is a',tbree"page:sJocun'tenl':
of'talki~g points f<,lr yoUr ,usc. :
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As we discussed yestt~~day, I am prepared' to ,~ddies$ the issuts and r~tionale beh~nd the Six
key i~ues' within"ourworkplan. 'Rle~.review ,this document and·.retum 'it to m¢'with your
comments befor~,:our3pmmeeting.\
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'Welcome, Update on Process, Appre~iation for ,Assistance
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B. ,;'I)~finition of Structure of 'Roles 'and Resptnisibilities for Staff,
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'ID:sutance ,r~fo~' OPtiO~~" '
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Discussion of Spedficlssues'WithinWorw1an-•
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• Second ,tier non':"core issues
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(RETURN TO CAROLAND/ORBOB),OutlineNee~ for Intense'and Quiet Staff
Work on Background In(onnatiQn, rolicy'Options, and Quantitative' (numI)Crs- ~,
run) Analysis
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R~iterate Sensitivity of Any, LeakS About this ,Work ~etting Out,,~, . ,
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,Wlll.Keep, InToucb~ Thank ')'ou,Closti~e of Meeting.
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.' . . .AGENDA AND TALKING POiNTS' ,FOR 11/19 NECjDPC'MEETING
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Will be :avery .open process whereallviews/approach~s/altematives are ~ired'
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~ _Pleas~d 'with e'arlY cooperation,., assistance, '(lI1d ad~i~. Wefee.1 it has been, and' will
continue to" be 'constructive. (Cite, for' example, Alice's memo and perhaps Donna's '
further elaboration, of President:s, HRC's, LeoQ's, and your, feeling that, propos'als .be "
viewed in cpntext of hlying foundationfof: acltiev~ng Pr~s,idenfs eventual goal.) ,
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Ap~reciation of pnncipl'e~"'dedi~ti6n :~f' seii9f,staif res~urces,to helprwith this e~iori:'
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Their and, YO,ur (the, p,rinciples') ipvolyement _ already been' immeasiuably helpftil (in
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terlnsof helping struc~reis~ues:'~dbackgrourid intormati()n th~t should' rece~ve ' ' '
priority ~nsideration.);' Such!help will be requested"and needed throughout the,',
,process. (Detailed disc~ssi'on re ,this' to follow).,
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a moment, . . ' should be getting first....:cut iilfoQ11ation oii sOllIe ~of. .issues" ,.' . ,
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R~ponsibilities for.~~,fT,
, Definition ofStructure of,Roles and
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Ro.1e' o(Chrls as defined and implemented with regard to: Bob and' Carol, and '
-disc~~sion ,of _
how. you ,want -him'to in,teract with the 'Departments;aS'~ell 'as ,OMS;
CEA, etc.' ,
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Role of Jennifer Klein"...,- analogous to Sylvia apd Jeremy, i.e:; is~empowered to,:_, .
·facilItate 'and direct pOlicy' work in' a m'annerconsistent 'with desires and discussions 'of
, you, the· principles!, and Chrl~: FUI:ther c~arifi~tion of :aI1yone dse,'s, r<~le that you',
, , , (Carol or Bob) feels is necessary/advisable!
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'~As we've s,tatidprevi'ously, Bil~ and' Geri~, will' play ,a~ inf~grarroll' in helping Chris'
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and us focu'son~ealth policy issues within the contex(ofthe'budgetand other,
domestiC policy priorities.:' ',They ~illalso;pclrtiCipate i'n and' c()ntribtite to all
: discussions "regarding health care' policy i options , -~ both in terms of-the s'~bstance and' "
· theprocess"of developiiig.t'hese options. We and or Chris \vlll' keep you,appraise~ 'of.
other staff roles on this subject. ,"
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Very little time leftbefo~e significant policy/politiCal meetipgstake pl,ace'immediately
/ after' the: election. (Perhaps outline other liiglr'priori'ty sclieduling/policy ooriflicts?) ,; ,
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'Hope to h~vepackage op~ions olltlii;I~dfo~ f~rs( p~rusal for this ~~up, with input and, ,
politicaVstrategic direction from Pat, ,George and others oDor 'abOut Noyember ;lOth: '
, ~(bbviously; no final decisions or i~Commendations wiWbe 'Wade at this tlme,b~t will ;
,help set the stage, on what and how n;c6mniendationS-are'iiiade/presented.) ,,'
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',As'a result" ~e' may want to' have further 'dis~ussions .to ddemiinehow' we want some
,of these options'layed o~t qefore such a meeting takes place:' If \Vethihk this ;
advisable, we think that'we should tentativelytarget'Noveinber1th for',such a " ,
, discussion to talee place. Because of the sensitivity to .the political tinieframe; we do '
nqt plan on'circuiating paper at 'this time. ' Ho~ever, it d~es see~ advisable·to get' ,
di~ectiOIi, particufarly with regard tq presentation 'of' options, from this' group before'
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"fuiimy everi~,: aft6r tli~ November 'lO~hkeeting~:w~'\Yill need to 'move quicklyi'n '~'
, tight ealendar'before and immediat'tly after Thanksgiving tp m(lke any policy,option,
, presentations, tliat;'in 'particular, haveanyiJIlpact\vith .regard to'ongoing budget,
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, priority discussions~'
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l/Bob ~- do'you want to ~,'" ·s~ tht:m~ tha(:you, are alre~hinkirtg abo~t,~timing,
and pr ess issues' with regard to sc ,uling tbe Presiqent, albeit,
'no decisions, ,/
and sche '·rig having'yeno Occur? ' , ',,"
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Discussion of" :
Specific Issues Within W ~rkp'lan ,.--: Turri to' Chris'
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cpverage'
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state flexibility ,
' costcontainmerit ,
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regul~tory, options
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(RETURN TO CAROL'AND/OR BOB) Outline 'Need for'Intense and QUiet'Staff
Work,on Background Infon,nation;P~Ii~y Option~, and-Quallti~tive (numbers"7
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'In <:mle( for us to get this infonnation prep~ed anclcirculated arnongstou'rselves for
, consideration ~iid discussion"in a timely manfler~ the, staff work wHl need to get it. '~'
, done quiCkly and' quietly. ' Thi~ 'is,'particularly t,he case ~ith regard
any options'"
ielatiIjg ~-o numbers/Cost~rev~nueissue~;:" ',:
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\. "",onsomefronts we can move quickly:and, bliild on, the ,information' base we have ,
,- : either thf9ughour own work 'or those: of the alternatives that ~ave:be~t:t outlined in'
t~eCbngress.However, there most dCfinitelY~ill,be exceptions to'~his that will entaiL _,'
,'new and detailed work,analysis arid.conslderatipn. The targeting and, admInistration '
,'of subsidies and the advisaoility and fe~lbility of providirig for s!at'e.flexibility 'in, a ' , ,',
n9n-universai cov,erage,proppsal serve as two p~icul~rly good ex3.m~les.
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Reiterate Sensitivity, of AIiy Le~ks Ah?ut this Work GeUing Out,"
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At the risk of beating,~'deaq hOrSe"we must 'continue to_reiterate' the 'importari~ of
hQiding this inforlnation-close:· If..anyofthese, options get outinto,press\ or ortto the
. Hill prior to 'early consultation, ,w~ have major problems that ,could underInin~ whoie ,: ,
proCes~ -:-- even)f a leak' occurs after'the election.
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MEMORANDUM FOR CAROL RASCO
FROM: KATHI WAY
RE: HEALTH CARE AND THE STATES"
You are aware that 36 Governors races are to be decided this
November. Ray estimates 20 new Governors with a possibility'of
even more. If the election really goes "down the tubes" the
largest state with a Democratic Governor could be North
Carolina. I include this for the following reason. The Health
Care policy we implemented in Seattle (will yo~ ever forget that
fiasco) is due t9 sunset this year. That means the January
meeting could include a full blown discussion of ,the Policy with
MANY new Governors. I met with Democratic leadership governors
earlier this week to discuss their strategy for that policy
discussion and the one likely to take place on welfare reform.
They will try to make the case for continuing current policy
BECAUSE the many new Gover:nors'will not have time to really
consider new policy prior to the meeting. At best we will delay
the conversation'until the summer meeting. Ray is not optimistic
this can be held off. I am,not certain but do believe we need to
continue to follow that discussion. If we can not hold off that
discussion, we should make certain our friends are up to speed on
the direction of the Administration so they can be as helpful as
possible in framing the policy.',
One more overarching issue. 'Ray indicates the end of the
session on Health Care was not helpful' for states and it seems we
need ,to do some damage control ,work with the states before we .
even talk' about new directions with Health Care Reform. Senator
Mitchell" s bill was a potential disaster for the states and
'.
Governors and their staff were locked out ofmo~t of th~
discussiops. (I always knew are triend Crittendon would come
back to haunt tis.) On the other hand, Dble plajed to Campbell
and the Governors felt the, Republicans were more sympathetic to
their concer,ns.
There are t'wo parts to the states concerns on heal th care
reform, substance and process. With regard to the substance I
will layout Ray's thoughts. He believes the mood of Congress
and people in general will not support a comprehensive, universal
proposal. The components that follow are based on a Federal
framework with state/local flexib~lity.
�INCLUDE:
PORTABILITY: There is a basic understanding and acceptance on
this issue.
It is importa:n~·to citizens and to businesses that
operate across stat~ lines.
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COMMUNITY RATING:
Propose "a wide-band" that allows for
deviation for risk factors.
States.could be offered the "option"
of narrowing the bands. True community rating, one rate for all,
is too costly for the young healthy 'low cost population. ·This
provides a way to begin the process.
STANDARDS: Legislation from last session was loaded with
mandatory standards. Ray recommends breaking those in three
groups, mandatory--small number generally associated with quality
of care and outcomes, guidelines that provide suggestions to
states on standards they may' want to implement .and.optional-
those least important! He believes the various interested
parties may be willing' to sit down and categorize standards in
these three groups.
FINANCING:
In the "new" Congress, with conversations about
balanced budget, deficit reduct.;i.on, etc. it will be increasingly
difficult to produce dollars·for health care. Ray suggests ( I
think,this is one of the best suggestions) creating two "block
grants" for states. The first relatively small dollars, $1/$2
billion for infrastructure would allow states incentives to ,
create alliances, additional managed care for medicaid, etc. The
second $8/$10 billion allocated by state and available to
encourage states tb extend coverage to those currently uninsured
without expanding the medicaid program--either through the use of
subsidies, vouchers, etc. Actual dollars could be raised through
. the cigarette tax.
Three issues 'are conspicuously absent--ERISA, BASIC BENEFIT
pACKAGE and MEDICAID.
There are two ways to apprOach ERISA,
through legislation or regulation. We are not going to win
through legislation, business wil~ line up against us.
We may
have a chance to deal with the issue through regulation. Ray
indicates health care providers are increasingly concerned about
the lack of protection available through self-insured businesses.
Employees are dropped with no' notice or their·benefits are
substaritialiy changed. Ray belie~es the providers mai-be able to
buiid·enough support on this for regulations to be put in place.
Without the encouragement/support of outsiders it is really
.
unlikely we can get this one done ..
Achieving agreement on a BASIC ·BENEFI.T. PACKAGE is· unlikely.
Ray and most others bel'ieve this is a long term goal.
He
suggests we may want to put three "packages" on the table. One
that is just .catastrophic, one more comprehensive, one ideal.
�We know what a patch work the current MEDICAID program has
become. Ray suggests we just leave it alone initially.
Increase
the ability of states to use managed care for medicaid,but
otherwise keep hands off. We talked about the possibility of
"capping medicaid". Capping just the Federal portion won't fly
(big surprise)~ Evidently NGA worked out a deal with Dole to
include a cap on state expenditures also with the states having
the ability to reshape services to ,fit under the cap. That is
the only scenario that will fly with capped entitlement for
medicaid.
How we go about putting together this vers'ion of health care
reform may be as important as what we include in substance. Ray
suggests we think about development of a few white papers that
are shopped around at hearings, on the Hill and with states.
Clearly, whatever we do has to be bi-partisan and include the
Hill as well as states. Once the ideas are circulated, Ray
,suggests the President invite a representative group to Camp
David to hammer out the details and achieve agreement. He
believes, and so do most that know the President, this is, his
strong suit and the forum in which he excels. One additional
note--the intergovernmental process, John Hart" did not work well
last time.'It was very partisan and weighed in only
sporadically. This effort wili r~quire an ongoing dialogue with
a broadly representative group.
I think Ray is on targe,t with his direction. His views
certainly parallel information I hear from the states.
It does
not do it all but certainly heads us in the right; direction,.
It
is very similar to the ideas we talked about ,3-4 years ago.
I
will continue to have "casual" conversations with folks at the
Hall of the States 1:;0 get a read on their individual state
direction.
I w.ould also like to have a conversation with you at
some point ,about the advanta~es/disadvantages of s~lecting a
group, children, for government focus.
Let me know if you need
additional information.
�TO:
FROM:
DATE:
Carol Rasco
Jennifer Klein
October 21, 1994
Attached please find the Health Care Qs and As for the
President's press conference and a transcript of Shalala's
comments.
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H~alth,. Car~Qs and As '- October
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Q. IS' th~ 'new health car~process a recognition tliat the TaskForce was a Caiiure?
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A.,We are simply moving health care through the same policy 'process', that we' use for other'
major:domestic policy issut?S. The Domestic Policy C6~n~il (DPC)and the Nationa(
, Econdmic" CounciL (NEC) 'will, coordinate oUr ',futUJ;e health reform'efforts. 'We are just
beginni~g thi~ process 'and ,it'will be a' while before decisions 'are reached.,
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,Q.Secretary S)Ialahl saJd yeste~day that you will'be presenting ~ecommen~ations to, ,",
, Co-Iigress on health carel reform and that these 'recommendations will be part ,of yout
'budget.' Are.'you going to submit a new plan and; if yes, have ,you' gi~e!1 thought ~o' ~hat
',these reco,mmendatio,'ils: will inchlde?" ' , ' , ' "
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'A.:lhavenot-'had a chance to'think,exactly about where we will ,go'or evertinwliatform, any , ,
such' proposal, would be presentecL Cpuld r~coriunendatio'nsbe' submitted as'pan:' of the,
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, "Q. So,'S~cret~ryShalala '~;isspoke~yesterday? ,,'
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, decisions ha~e 'not been made. , " '
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, Q. Secretary Shalala also sa'id that obviousrevenue s'o~rces will be cuts in Medicare and
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, a tobacco tax. Are these yo~r options that 'youare-~on~idering g~ven that tliey, were in '
your: original plan?,'
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first say tha't t4is'Administr~ti~n,wiltnot ~iash Medi6are:' In ~y"original prop9s~1; ,
we took the Medicare savings ~d used them to provide benefits to.older Americans. We -,' ,
like ¢very bill that'came,'out of Corrimittee ,- liad~ tobacco ,tax. ' Again, however, no
,decisions on any 'fi~ancing options for any proposal has even beeh discussed 'let alone
"decided.,
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Se~retary, Shalala i~dicat~d tli~tyouwould~~'produciQgascal,~d back 'health c~re
plan~ D~es this,meanthatY01i w~li give, up on your goal of univer:s'al covehlge?
Throughout this debate on liealth c¥e"r~forln,rhav~repe~ti':dlY'\stated that' coveiingeve~y ,
, Arrieri~all andc~ntrol1ing esca~atingh~alth care costs should be our goals!' My co~itment '
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. , , to this' mission has nor changed. 1 still believe that every Allerican, deserves health care
,covenlge. Every ~onth that we' don't act to' reform oUr system" 100,OQO l1}ore Americans wil!
lose their insurance. And, if we ,want to ensure that the deficit that we have worked'so hard "
to contain does not palloon again over t~me; we ,need to 'add;ess riSIng health 'care 'costs.' '
,Americ~nl!
spend $982 bi1.lion on/health care s,etyicesin, 1994- pearly 14 p~rcerit of our.
gtoss qoinestlc product. ,If this trend contirpies, we !~ill spend $2)trlllion on, health care in '
2001 - ,20%
our 'GDP.
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There are 9bviously, decisions that neep to Qe made on how to proceed on health care reform. '
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Q. Will 'you veto a bill that does ,not ,achieve universal coverage? ",'",
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A. ,r stillbeli,ev~ thate,very American deserves health care coverage. 'Our/goal is universal
, coverage. 'Ahdw~'re going to do everything possible to assure that Americans have health
, c'~e c~\verag~ when 'they 'need it. "J\ricl we'~e goi~,g to. do' everythirigp~ssibl~ to "control" '
escalatmg J1ealth care costs. ,;
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The Americ~ people still ove;\Vhelmingiysupport univ~rsalcov~rag~.,
latestNYT/CBS
, .News poll (September8-11)stated that nearly 70% of'the,publi y believes' that every.
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the American people wanUind deserve;'
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'Q. Secretary Shalahl said that you have:,no't d'e~ided if you
will
canior ~n employer
mandate next yea~. ',Y~u li~lVe re'peat¢dlY stated ,that ~n employer,:mandate is ,the best:
way to provide coverage for every AmeriC.an.,:Are you backing away from requiring'
employers to ,share in, their ,employees heait,h care ,costs? "
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,all Americans have health coverage.'As I have :repeatedly said 1 a'rri open to any' kind of new'· ."
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FROM· 0A5PA "IEWS D1.1,1
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.9"1567"131
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Not.estram Secretary Sheila-la'c pet. 20 meeting with the Health
communicatorc' Braak£agt ..
[Discu8sion of charts]
The problelltS are stlll.out there. The Clinton Ad:m.inictratian will.
have to comeback. Time ran out; comeone rang the bell. We will
pick up the momantwn' again,.
Q:
What format?
. A:
We I re thinking thrauqh' our strAtegy on - the. budget, welfar:ca
re!onr, health . care . roform.We get another. IC1ck a:t. 'Cbe Cilt.
Hopefully we learned. some thinqs in, the 'last. 2 _. years' that· will
Qn~ble us to retineour strategy.
Q:
What have you
le~rned?
usth~
idea o·f taking an every piece ort:he
A ,1:)1g' target creates .problems•. '
rt • s . the same as with the Republican contract; it creates a lot of'
negatives. 'We need to ,.dcoide what needs to b:edpne f1rst~
We·
haven • t decided which.' The public perceived it as', too. much '. and .
cant us: a messaqe that they want reform. but they want it in stag~.
A:
1l.\1blic clearly told
system,makQIi them· v~ry nervous.
Q:
Reconciliation?
will have to J?9.done wi~ th~ budgat. The Presiden~"
will submit proposals on Medicare, Medicaid.,. welfare, etc.. . This·
. wil.l not 1uatbe a discretionary budget. It'is l:1 natural vebicl.~ .
it has discipline in terms of ,timaf~s. The'bUdqet will 'i.ook' a'C'"
entitlements.· The Entitlement Commission will demand that •.
A; . Something
Q:
Insurance reforms'?
A:
GOtto think about how -t.o do it'without disrupting the. syaUlm'..
.Q:
,Are·you 'sayinq costs.aT.1! your focus not coverage?
A:
Both. ,We, will emphasize both. WQ· can't: do velfarerefor.m'
without expanding coverage for welfare 'recipients ana working
peop.l.e. '11iey need cost conta.lJUlltSnt '0.8, much O~ any;one.
QI.
Reconciliation could take financinq. away?
A; . 'We hAven't 'made those' deoi~ione ,'yElt.· Doficit reduction 19"a
priority but. we also want to qet going on health-care retorm.
Q:~
Question still is how do you pay for it?
There are no. trick.s here. There ~e two obvious sourcos:J ofrevenue:
Medioare aavinqs andciqar~tte taxes.
They are on
eVQryonetg list. No reason to l>elleve we won't go back. :r don't...
kid. myself tnat the pOlitic5 of the moment,on Medicare ~y change.
A~
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OCT-20-199'1
18:38
J=ROM . OASPANEWS 0 I1.I
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9'156?'131 . p.e3
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The question 1s what size of cuts will be proposed.
Q:
Hec:Uoare pays;: less than costs now?
A: Hetve to talk about both privatosector and pUblic sector costs.,
No yay to back away from that. d1scussion .. ' What's qovern:m.entts .
contribution to helping- private se~or got more diQc1plined. Not
. a top down discussion of what qovernlllent can do 'to the privAte
sootor.·' to chanqe ~.havior •
We have it Cull-blown health·· caro
system, not llke30 years aqo when we, croated Ked:lcare. and.
Medicaid. The private sector wants 'help. They d.on't want to .. pick
up th'" cos:ts of 'the. uninspr.ed.
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Elements of reform?
A: There's no new analys,1s beinq done here. The question is how
much you bite off. Our at,titudeis to find our approprl~te role in
co~tcann
Q:
rnvAraqe.
Employer mandate?
A: still a stumbling block. opti-ons include axpanding Hedi~id t.o"
cover the workinq poor. Conqregs· already passed. legislation for
kids and it I s boinq phased in' over a lOD9 period of time'. The Kicis
First. proposal would accelerate that. Another option is ·to cx:eate
larqe pools.
Like tho SECt qet the ma"t"ket: strai,qht and. en:torce
rule9.
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Q':'EIIlploycr mandate?
A:
president hasn't made !il, dcoisionon that.'l'he public hiuJ ..
spoken and we will. take that discussion into' account 1nproviding,
. options for the President. Perhaps we c;:an qet' 'Vbere we .want to go;,
but. take 'a. different, r9ad..
Thcpublio, viewed'. the.mandato as a,,';
proxy for, a government run syst:.om•. Perception was the Pres1dent's;",·
plan was a qovernment-run system. ::t: l(Quld ar9ue. that.· it· wasn't but c"
taltinq 'on every aspect of the system fed that .... Reshould do things-,
that, would be helpful.Ra~ources are more ,limited. now than When we;
.started.,
Q:
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Universal cover ago?
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Comprebensive raform?
Comprehensivereform can be taking stronq' Qteps in. tho right'
We're, not qoinq to drop our overall O'oals. A:\way for.~ ,
everyone to qe't qoOCi 1nsurance; s\..rttU\jU.lEsn the -privo.t.e eynca.'
, Huge plans ilre difficult to qetthrough Congress. Need. avisiQn Of':
where you want to 90. The health care system is dift~rent than two .
year,; aqo.
A:
direction.
Q:Koynihan's opinion?
A;, We'll talk to him after tho eloction about his insights on--'
health care' and w@lfat'p. reform. Ploynihan alwa.ys had large goal's
and moved toward them.
�OCT-20-1994
18:38·
FROM.OASPA·NEldS DIU
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94567431
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Q:Lonq term care?
A: states want to do more exPerimentation. ppint of reform is you
can •t leave state experimentation. out. Have to look at 8tates ".
role.
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Would. California need a waiver if 1t· passeS single payer?
A:
Probably. We'd .have tq see what they ask fori it has to be
budget' neutral. . I. make i t a habit not· to talk abOut. waiver'.:
.requests ,par~icular ly those that. haven r t been made.
~Q:.
Have . you beencampa19l1inq? .
A: Doing a-.lotof campaigning- Kini~ of 2 .. daysaweek~nd all ..
of next. . week.. . About 10 st.11tes: NY I :rA, CA, WA, TXt· MA.
L!.m.:.
finding the same thinq I. 'did. during health ~are reform. A.very
anti-gQvernment feeling. A feelinq that the government can't::qet.. ·
.anythinq riqht~· It's . consistent.. Not.just with Washington' .bUt.
with pol!ticia.ns . in' .qtme,ral, , 'bureauc.l"ats, state, and' local"··
officials. It·s a challenqe.lt's ,pre~ty rig-ide So much so-that·
most· people .think that Social securit:y ..·is,a. privClte system.
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; r.alsohear t:hat mo~peopl~.have ·had.n~qativeexperiences with
government. Thl$may be:reinforced~ytalkshow hosts but they,' re,
; not shaping public opinion. We~alked into that wi1:b health,care.
reform..
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same~i~. welfare refO~?;
A:
No.
Thatts . s~
reducinq .. the amount· of"· government:
involvement in people's lives., Instead of' health~rereform.::that
navcrleavos you it· a.a t:r.ans..itionalproqram.
as·
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A.- VlacieCk.isworkinq onaHedi~ strateqy.. ' Some ·things tOiDake:.:
it- more efficient;· Same new approaches. Ac~major:integrity, effort::~
to eombat:waste; fraud,
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Is·n't· most waste overutilization?
A: Not. only.We have
off.
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to
make sure the syste'Jll is not beinq r.ipp!d
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. Ar
No
excuses abOut not. doing' something'
~ut
that.
Make .i't:;·"a·'
priority. for carriers. . OIG is 'underfunded because of 'discretionary
caps.
Medicare underpaying isanlnterestinq argum~nt·;. We're. accused of·
unaerpaylnq and they 1 re accused' of '. overutilization; EVerybody t S :
making money. .
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Q:
18:39 . FROM
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More managed care under "Medicare?
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want to offer a wider. range. Have to work on pricing •. ' We.
clearly would~ike a lot more flexibility.
A:
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Don't Hl'ios shift cOsts to fee for service?
A:' You can cost shift only. as lonqas someone is willing to pay
the. bill.
There .is tremendous cost shifting going on in the
system.
~loyers are shiftinqcosts . to their- emp;Loyees. arid
shifting people. to . managed. care. Some of those costs. are' being"
shoved back and some efficiencies.' are resu~tinq. "Q~estion is are
,we getting quality under managed. care.· ..-JUst starc1ng to qet
informat.ionon that.;
'Q:
Underutilization? .
is so' fraqm:enteawe. cantt answer': that.
Governors are
desperate to slow costS; employers too. Trying to stabilize costs.
:HKOsare 'leaning on ,drUg companies for price discounts. with all
,this: 9'oinq on,'8TR pQople qettinqbetter care or'as good care?, We
.have a genm:ation used,to fe~for service and. one used to'managed
care.
;Oata
Q:. What do' 1.00 mean by "ran out~'of, ti1ne?'"
The .mainstream bill was ,out: there~
ItW8S different .but it. had
ConqresswoU.ld have. passed something if' they
Ididntt.,run out of tlme~ . Not.because·.tb:ey . lacked 'interest. Not'
· elements.
I;.~ink
because they: ran into a-br.iek.wallof opposition.
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On quality, ~(;m·t,.the:9'overnm.ent be'inte;-ferinq in medicine?
Informationandchoi.ces.
Quality comes from a competitive·
system' with consumer information.
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Budqet :'veIlicle?
A: Have to'· identify financinq. GO throuqh the same committees.'
Timinq. Tradeoffs withi~'the pudget,.
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Will the President present a;plan this yoar?
, A: . Yes, he will present a pl.-an.
Q:
What if Republicans
contr~l.
the Senate?
. A: I.~ra .. not even thinking abou.t it..
sure of it-~
Q: . .
Are.p~oviders
I tmworking like ma.d. to make
driving up costs?
A:.
Not" necessarily because they're' evil.
They want to' do
everythinq .for ',their patl.nts. Pe~ple demand the very best' of care'
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18:39
FROM
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94567431
P.06
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,and they push the professionals. A .cul~ure ot health care in this·
·country to push to the maximum. We're all paying .the bill •
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White House staffing changes?
Ira?
,A: Most of the analytical work has been done. The question is
pickinq amonq the basic elements'. Financial and polltical choices.
Wetre·havinqa collegial discussion of the strategy. Ira is·yery
much part .of that discussion. Chris Jenninqs. is on my payroll and
. he' s coordinatinqthis. Most· of· the work has been done.· We neetl
: a financial and a political 'strategy. HoW much to ,bite off with'as
much public support and bipartisan support~ More' of astrateqic
, discussion.
Q:
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Why December?
That's when the President-'makes his decisions on the. budget •..
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Q:,. Hedicare spendinq?
'!'he iricraasQs may bQ a little lower than expected. That's not
new. It will red\lce the deficit a bit but it limits our options on'
financinq.
A:
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Bipartisan?
A: I'ai:tiaU1ar~y in tbe Senate. Process is· important. It', sets'
tone and attitudes. ~esident will talk to the leadership after
the elections. senator. Dole says ·he wants to do health care 'reform '
next year~President will talk to the leaders about the agenda.
Q:
Will GOp· by willing to, bargain?
A: It's realistic to a-ssume that~no me'Diber of' conqress· is asking
to be elected to do,· nothing --, except the Congressman· from
'Califbrnia who's, runnincj 'for theSonate.
The. public wants'·
something .done... They lye. told us what they don't want' now we need
to make a case ,for what- needs to be done. Our. goals remain the
same:
costs,qui.'llity, coveraqe.,
We want to nudqe the systelD,
, alonq, , not 'rUn' it~
People out there without insurance ,are
Democrats and RepUblicans'.
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Will.the.President,use his veto pen?
A:
Presiden't. wi~1 &peisk. for himself.
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Deficit 'reduction?
A:·
Goinq. to ,be· a ,debate within the Administration on' that.
President· is·" committed to expanding- coverage and it will cost
money.. No newtr1clts out tne:re.'
Q:
GOP contract?
�OcT-20-199-1
18:-10
I=ROM
OASPA "IEWS DlI.I
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P. en
A political exercise,.
Same problelll as Health care refo1:"Jll.·
Negative coalitions. Hit from every direction. liO~ a major vision
. of COP viGW for the futur~.A package of ideas for the elec,tion.
Q;
vaccines for children a Guccecc?
A: Small piece of an overall effort. Infrastruc'Cure expansion,
clinic hours, educ~tion, outreach, physician involvemen~. VFC 1s,
an at:.t:.ampt to qive kids vitnout coverage access. Part of a la.rger
strategy.
Had llQped to siqn all contracts by Oct. 1, . ..Price
contra.cts were done; deliyery contracts veran't; 1 apologiZe for
that_ As soon as tIle'delivery contracts are signed, we will qet'
th1s sy'stem goimf. We're goinq to qet it done a few months late.
Dru'1 "mnl'JI'lni P.S are happy they will qet to deliver the vaccines'.
'l11ey have onqoinq rela.tionships with the' doctors they want to,
proteQt.
.
Q:
Oruq companies say they get sot of theircoata?
AAle thcmt:
Wnat are their costzs?
What do theyche.rge .in'
Canada? We don't know. We ought to pay a fair price and it should
be neqotiat.ed.. If they say the pries1s too low, they have to
provide the d.a~a to congress. Last thinq I want to do is put an
industry out of business.
Layout :their caco, the facts.
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believe drug co~panieG havQ th9 same qoals we have. They want to,
make. a decent income, We have to look at the overall proqram and,
. two' years from now look net. tho reBul ts. We need a system that
Qutomatically vaccinatos each generation of kidS.
A:
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First Lady's profile?
I , don • t
qive hOI' advice on· he:.r: profile.
friend.
Q:
I'1II
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fan and
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IL FDA says tobacco a 4ruq, bow pay for health care?
A:
I,t..d be ecstatic if less, people n.oJced.. particularly younq,
people. We t Ci save a lot' ot, money. l'r 1oim] of cig'arett.. i . "'a..:;.,
piece ot>that~,
Q:
Healtll 'care
on caJDpa1911?
A:' Yes, because it's me. They aSk me ·about health care, welfare,
Head. s't.art, ~oclal security. :t:llvu't get CL lot ofqucationl3 o.bOut-:
GATT or NAFTA'.,
Q:.
w~a't.
are you nearing?
A: Don I t want the government to run health ca're. Horror. stories,
of What thesys~emls doing to people. Tell the Preaidont to keep
going. The t.est of this Adminiatration 1~ hoW ,much we learned in
the first two years. We learne~ a lot.
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Havent.t heard about it toolllUch.
care and flexibility •
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Prescription drugs .for the elderly?
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94567431
Hear more about long tenr
DOf!sn' tLTC a1ternative cost more?
Issue is quality of life. Hy mother '-lsed to take me to nursinq
homes to visit some of her clients. I've seen institu:tion-.l care.
'The key is making people's, lives be'Cter..
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Rumors of yqur leaving?
'A: '
I'm not leaving.
Problems with Social Security transition?
A:
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No.
VertslDooth.
No administrative, problems. '
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"9FFICE ,OF PUBLIC "LIAISON '
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MEMORANDUM ,FOR ,ALEXIS HERMAN
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,Subject:, options fo~ Business,o¥treach for Health\. 'Care Reform
,Date:Oct.ober 18, '199'4
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BACKGROUND
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:You have- requested ,a suggested process for busine~s'
, health care over the next several JDonths. , In light
',that the Businesf? Roundtable 'is meeting on December,
be clear on our activities" before then.
(See their
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outreach ,for'
of the 'fact
6 we should'
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A:s we knew in the c~mpaign, and over, 'this 'past year, many
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businesses have been'inthis battle fot reform for,many'Years.·
Mobiliz ing .them to' supp,ort re~orm~ and getting' t.heir, buy- in to
, '. ,theproces',j; is the c.h~ll,enge.
Businesses, both formerlysuppo:ttiv~' a~d oppos;ed, would like/to.
, : be consulted before, a package 'is ,fully developed. ' ,As ,with most
other' issue~ i~yolving pul;>lic, policy 'and the private sector, they,'
want ·to feel that they" have. had real" input" to policy ,development,
before, ,being' presented ~ith hard;dra,fts of 'legislation whic,h
t
carm'ot be changed significantly. '/ sophisticated business, players
in this ,legislative game realize that they will no,t h~ve'all'
,~he~r ideas accepte4 in' the' drafting "game, b':lt they 'expect ,~ "
certain nlimPer of ,them to be ackllowledged, ,"massaged and
.'. de:veloped,,~"
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, There is 'ceita:in~IY an opportunity for more of a buy~in from,
certa'in companies' and 'perhaps a . few trade associations, ',if we
take into account this desire' for participation and consultation'.,
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Generally:the business community , whether. fri,endly or hostile;,'
appears to be expecting a fairly ,',major i:nitiative from tpe, Whit'e
"House-on health care .ih the coming ,year~Seyeral have .cal1edfor "
advice,. or to ' . input, into what'is belngd.one"
s;eek
here.
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,this'interim .period and next year.
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,small B~siness c~alitio:Jl for Health ,Care Reform ,- , This group has
,', remaine'd .relatively inta'ct',' anCi ,is hoping for continued '~ffortto '
. ,gain he,alth, care coverage, fQr ,small businesses ~; "They ,are. seekil1g
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opportunities to help us on ,other. ''issues" such as urging member:s
,to go to the White House Conference on Small Business in 'their
'states etc. ; ,We must remember'that the sta'ffing for-this ,group
,comes from>' the drug, stores',' and' that they were ver.Y' interested in,',
our ,proposals on this subject.
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National Leadership Coalition 'for ,Health Care 'Reform- ,This'
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,group, most coilllnonly identified with Dr., Henry,'Simmons, contains
many of 'our ,most hard, core manufacturing'supporte~s. ,They ,have"
opinions, of what they b~lieve went, wrorigin' the \process, learned'
,',a few lessons themselves, a~d ,have r:"eceived a grant to conduct
grassroots meetings across the'country with business people to
'describe the n~ed for. universal co:verage. "Their focus is 'cost
conta.:lnment arjd uriiversal- co:verage. ' '
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'Atlti,ns Group -' This group',
in' th~' proc~ss of determining
,'whether it shoul~ cont'inueas a coalition. 'They are planning, a
',retreat in January to, discuss strategy· for next year. Their
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, issues are ' mUlti-state "op~rations:problems aIld, ERISA pre';'emptlon.'
',IBM which is a member of this group, is worried about "its"
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, :reputation' with, tile' administration, and how, much damage, th'ey
sustained in; 'the ',end' of the battle.' "
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'var'iou~ Compa'nies -, Severa~' companies, such as, AlUericzm 'Airlines
are very anxioust~continue ,the ,battle for uniyersa~' coverage:.
Others such as ~RW want some dialogue, having opted out of an
'effective process during 'the debate., So~e large , companies are
'cleariy warning of ,their need tq 'dr~p,' coverageqr a're ,fearful "
,that others" including competitors will do so, placing them at/a
,competitive disad~antage.'
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PAST,ADVERSARIES
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Business Roundtable,- 'The attached'1etter signed by Bob Winters'
of Prudential is 'indicative of where some of the., insurers and,
, sqmeof :the large ,businesses remain -host~leand'l.fearfuL '"
Ho~ev~r, ~n the opinion of'some representing BRTcompanies, there
,is room for movement amoilgthe, rqore ' progressive companies.'
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'Prudential's representative in Washingtcm, ,actually suggested"a,'
, meeting to discu,ss'the future/,but I did not express strong ,
. :interest, in tha,t ~ " I understand, that' Mr. WintersmaynQt continue'
as 'chair qi the BRT'H,ealth, We+fare andRetireni~nt Income Task '
For'ce, and may ,not continue' as CEO ,of, Prudential,' giyen their'
problems.
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" We 'h~vebeen,urged to hold a meeting withsome companies from -the,
BRT, so, that the, December m~et,ing cannot, take place :with ,the
,'statement 'being made ,that the "White House did, not meet and seek
,ppinions.
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'ERIC AND'APPwP,~ The "Erlsalndustry commi'tte~ and the, Associ~tiori
of Private 'P~nsion,and Welfare Plans each had,problemsw.ith the,
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"Clinton, bill} but ,were i~iti'ailysupportive, of condepts.<Their
current" status is unclea,r, but will be, explored~'"
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BcPC - 'This grou~ was" oppC?s~~, to"the ,Clinton' plan'dueto ' it's
", taxation of cafeteria plans: 'and was 'fearful of 'other aspects of
:theorganizational part o'f t.he bill.' It is. primarfly(:made up of
,beneflts managers, o'f,'la'rge manufacturers" with a few other' ,
companies such as Pepsico, which clearly lead the way toward'
,opposition,~ ,,'
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They have,catled,and,'asked what w'e would think of a m~eting,of
groups, to determine what,they ~n live with in,
the future. I, indicated that t;hey ~hou'ldnot' look to us for
,permission to meet, but 'had a', long hard talk with them ,regarding
;firlat\cing solutions, because ,th<:l,t, is the',nub of business 'problems
,of insuring the uninsured now. '
'vario~sbusiness'
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Chambe,rlNF,IB, - "These ',two' grbups 'are soclosel'y' al~iedwith
the Republican Party,<that they, will probably. follow whatever~" '
path the Rep~blicans choose~to 'pursue.
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'National'As~oci~tion",Of Manufacturers-,Th~y have' expressed; an
interest ~in incremental reform 'including s,omething' for chil~ren,
insurance portability ,"a' start toward universal. coverage" and
scaled back ' insurance reform."
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'Hovever'",;th'eir track record wi1;h the administration 'is such that
we ' need to rem~iri ca4tious about their cO'ntJmious 'use of many of
:our legislative'initiat,ives to'develop new, membership 'based' on
{' crit,iques' fo1.lowedby .promises to members to "save them from th~
'Clinton adniinistratiol1,."
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We understand that:
few manufactur,ers did '~esign frc::,m NAM during
the, l1ealth care debat,e, ,arid, t have been forthright with other,:
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, :,manufacturers about their' :being the losers'to the retailers, '
insurers' and some 'of their 'pth'er suppliers of servicesi 'inste'ad
",:6f more, effectively :influencing'the deba~eiritheir, fa~or.
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, 'Special'ized Trade Ass'ociations-, Dependent on the ,financing,
:, formulas, and any {adverse' impact: on ,certain ,industrie~ "of, any,
-",reformpackage, we'may be able ,to attract ,quite 'a mimQer' of' thes,e;',
assoc'iations ,to 'a modified pac,kage. "
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'BaA - The'PJ:"in~ipal Fin~nciaiGro~pandtwoo~~hz:-eeother
companies in HIAA real;lze how counter productivetheir ef,forts
were. It may be possible to have': a dialogue with some' o'f them.
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National Restaura'nt' and Ret~iler~l; __ 'There -are < members ,in these, "
,orga'nizatigns, with whom 'there' cou]\d'~be, dialogue, 'but, the"
associations~l:lemsel "es,'should' not be 'expecte,~ 'to support much., ,I
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OPflONAL RBCOMHBNDA'l'IONS,PORIMHBDIA'l'B,OU'l'RBACH
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:The 'st,ruct,ure for' the ,out,reach would ,.incl~d~' continuing busine~s
': constituency political otitreachfrom jOPL a,nd; 'cooperatively with
'appropr~ate business l~aisons ',' :in ,varl,ous departmf,i!nts ~ ',OPL, would
facil'itate meetings'.an~policy ,exploration' discussions with,
,outsid¢ groups in, coordination with" individualsfrom Ithe 'NEe and
'D?C.:,
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:' There are()ptions-a~ itO \ the: "leve'l anq ·timing ofoutreajchto the
"business', community, '~lld 'tne i4entity of 'those included in the
',";outreach. ,possibilities incluc:ie:,,';( "~
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, 1. " 'convene a 'meeting, of wasbinqton representati.f:e. from
'previousbar4core 'suppor~i ve ',~ompanies. 'Ask thei,r advice,
what, they are 'hearing fromstaff,on,the Hill an$i from o~her
, busin'esses. What, kind -of ,'a 'new package 'would they. like to
see,?
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, ,Ask ,their, advice" what ~hey:ar~ ,hearing' fromqlient,s,'Hill
anc:i colleag~es. ,What kind'of a,packagedotheY,think,is
realis~ic?
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3. -. Ask a: . few CEO,S, who were m'ost, visibly and ,continuous'ly,
,,'sqpportive Qfthe:administrationto meet with senior ,"White ,
- ' HoU;se staff ~and' possibly t~e First· Lady ,after: temperature '
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, , taklng-meetings,with their, Washing'tonRepresentat~ves.,
/ Individualssuch as Bob Cran:dal1 , ' Hank· Barnette; David Haag,
'Chuck Corry, Chuck Johnson, and'Bob,Eaton; and'Paul Allaire
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5. Mee~w,ith National Lea4e,rsbip Coalitlon fotJlealth-Care,
Reform and·discuss. wha,t:(they are hearing in thefield,at' ,
their: meetings and, what they ,would like,to~see in -a package.
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'7. ',FollOwingthes~' me~tings ~ith 'ma:!iY BRT' companies,,'
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8 •. "Consider small meet'ings. 'with some friendly companies-in
unfrien4lyassoeiations' ,or· in4us'tries.:,. '.
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: . k~y ,swing group in thebusine'ss community, with, very'
" influential, members in the BRT. ,what elements of reform:.
wouldth$Y- like to "slee ina Pilckage? A n\lJlll}er of their' CEOs
should be consulted 'after we determine where this "group is
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,Healtb Care Reform, to det,ermine their' aspirations for a new, ,
'effort.'
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9 •. 'Evaluate, 'dependent on,' package being developed', whether,
,uieetingspan be'heid with pharinaceutical~omp.Die8, 'some
larqe iDsur~r.etc.
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.,coordination.'
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This' meeting' has been arranged forF:riday," October' 21 at 5· Ii .\m ..
in iyour office, 'following~ ~ , Panetta's meeting,and iittend~es ~t
this time include:,' ,Robert Rubin, Carol Rasco, Erskine Bowles,'
Marilyn Yag~r, sy~ via Matthews ,and myself., .
cc: 'Robert, Rubin
, Carol. Ra'sco,
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, Er~kineBowles"
"Marilyn.Yager·
. ; Sylvia,Mattpews .
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�THE WHITE HOUSE
WASHINGTON
october 25, 1994
MEHORABDUK TO CAROL RASCO, BOB RUBIN, AND ALEXIS BER.MAH
FROM:
MARILYN YAGER
cc:
Chris Jennings, Jennifer Klein
DISCUSSION OUTLINE FOR INTERIM OUTREACH ON ~TH
I.
CLOSEOUT ACTIVITIES FROM LAST CONGRESS
A.
Thank you letter from the President to supportive
groups and individuals (OPL).
B.
Health Care additions to White House Holiday Card List
(OPL).
C.
Thank you Reception with the President and First Lady.
A reception has been scheduled for November 10 at
4:00pm in the state Dining Room. OPL health staff will
submit a list to the Social secretary's. office by .
October 28 for invitations.
II. 104TH CONGRESS PLAHHING
A.
OPL health care staff liaisons are informally calling
contacts on health care to learn what. they are hearing
from both their membership and around town.
B.
Tentative consultative list has been compiled
(attached). This list of 22 meetings includes 'must
see' health care supporters, as well as key players in
the health care debate. The breakdown for Carol and Bob
is seven meetings and six meetings respectively. The
rest are to be handled by·the OPL health staff lead.
C.
Schedule consultative meetings (tentative schedule
attached) •
1. We suggest beginning these meetings late next week
and spreading them over five weeks (A potential
schedule has been attached).
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2. Either ,Ghris Jennings or Jennifer Kleinwil1 ,staff, '
the ,consultative, meetings ,from a ,policy'.perspect i ve
and, ,wher~ ,th~y deem it appr,op,riate, they will include
other policy, staff.
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',process thanotp.ers.: Al't;hough 'sbm~ meetings will need,'
to be individual gr.oupmee:tingsi whet'e possible"
meetings will comprise ~everal like-minded
associatiohs~, " ,,' , '
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To 'listen to their thoughts and' :reco~E!ndatio'nsJ
prior to.the beginning'of Administration policy
an~strategy development.
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. M,ore speC!f l.Caliy to learn '~h~t' f6rms 'of, ( "
,incremental reform they would' support',' :and what'
incr~mental provisions' woiltdt~ey oppose. \,' "
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3'., Since most of'these groups are allies' it wouJd
pro~a:bJY be: ;he'lpful if ,the meetings' w~re begun by ,
outlining the new health care strudture at,the
W:hite House, and touching 1;>riefly orithe"other key'
, , Pl;'esidential' initiatives' for the' next .Congress,
, Le.,. welfare reform" deficit reduct'ion" ,etc.' '
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Followup toCbnsultative . Meetings
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1.0PL health '~taff wiil'draft summary of'"
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'recominendatii::m5\ ,mhde at each meeting to ,c,irculate
,', among .. ,appropriate' staff~
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OPL:health',staff, wi'li ~~nd tharik you letteJ;:'S
, (dep~nding on who ',led t:tle me~ting)," to each group,
, thanking,. them for.the~r ,input. , " , , ' : :' , "
O~L heaith stfiff wili also· ,follow-up' wi:th phone
call to each group,inqicating hpw'helpf-ql the'
meeting w,as . for, ,the White House team ..
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F.R~quests for meetings with',Bobior Carol ;from groups' not
listed' on,the, 'atta'ched ", sdiedule. " \'le_ suggest," '
,
, forward,ing these' to OPL ,Healtli,staff for' quick'
recominendations: 1:0 either -:inime~iately schedule with,
Bob or: Carol/ or scl'\edule: with tbris,'Jennifer, 'Gene,
or ,Bill,' or 'hold for l~ter scheduling,
refer, toOPL
,staff to :;handl~, 'or·finally, regret.,' ;",
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C,?NSU~TATIVE MEETINGS
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Summary of Suggested Leads,- For the' 22" meetings outlinedbe;Low
,tpe breakdown of, meetings for ~ob and Carol over the next five
weeks is:, Bob - 7 mtgs i , Carol ..:. 7 mtgs,.
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Busin~ss:
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, 'Individual BusinessAllies'(Lobbyists), Bob'Rubin '
,BRT ' B o b Rubin' or Alexis
HIAA " ,
Bob "Rubin
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'Grp. :Health Assn. ofAM~ ,Bob RubiI1;
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,Other Bus. '('lmtg) ',',:Bob 'Rubin""
,
ECFC,' APPWP, ERISA Industry Cbmm.
Pharmaceutical' Man.
' Bob Rubin
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'Small Business, Coalition Alexis Herman,
simmons 'Bu'siness\ Grotip , Alexis Herman
NAM
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Alexis Herman
Chamber 'of commerce/NFIB Alexis Herman
Atkins 'Group , " ' "
Caren Wilcox
Gen~ Sm. Bus. (i mt.g)' ,
Phil Lader
, S m . Bus.,f'United,; Sm. BlJ,s.
"Legislatiyecpuncil" etc •
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Bob'Rubin
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AFL-CIO ,AFSCME', SEIU" CWA,
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'Seniors (One Meeting):
Carol Rasco
AARP, NCSC, NCOA, AJzheimers
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Hospital'Groups (1 mtg),' Carol Rasco
CHA', ,NAPH, NACHRI, :AAMC,
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ACP" AAP, AA}:"P, 'ACOG,
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, ,Nat. Assn.': of Homec,are
Carql' Rasco, ,
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Marj,lyn Yager
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"AMA,', ' , \ '
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Marilyn Yager
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Allied, Health (l',mtg,) '" $kila Harris,
NASW, Mental Health"
Substance A~use
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Carol Rasco
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" " ,carol;. 'Rasco
Children's, Defense Fund; ,AIDS
'Actic;:>h council" Citizen~' Act'ion
NFU, Nat. council, of Churches, ,
Religiou's Action
'Women's G!OUps( 1 mtg)
~elanne Veryeer
MUW, 'NARAL, League, of Women",
Voters, Women's Le'gC'!-l Defense
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CAROL.
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November 4
Fami'lies, USA
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11
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AFSCME, .BEIU,
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Caren Wilcox
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November 14'
November 18
S'enior Groups! .
AARP, NCOA, , NeSC,
Alzheimers'
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:Atkins Group
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Ca.rem Wilcox
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CHA" NA~H,
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exceptions.
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OPL STAFF, ,'.
Although not:
POLICY STAFF
'Usually' Chris
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Jennifer Klein
will staff
th~y will
invite' other
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Physician Groups
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Yager
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AMA'"
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Skila
NA5W, Mental' " , 'Harris
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Debbie Fin~
Marilyn'I\,U ,.
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Melamle'
"Verveer
Women's Gr9uPS
AAUW, NARAL, ,,' '
League' of 'Women
v6ters~ Women's:
Legal Defense
Furid ,
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General Base
'Groups -'
Children's: , "
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, ,AIDS Action
'Council, Citizen
Action,NFU, ,Nat".
council ,of,
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Churches,
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Re'ligious Action'
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Novem))er 28
December 2
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other Busiri~ss ,..:.. 'Bob' Rubln,
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'AinericaQ' 'people .want real health security'a:ndw~nt heaith.care· costs br~)Ught under cont'rol.
'This President ,wiil.'no.t walk awciy' from the ~hallenge. We will ret~m' next year in.Congress
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"':~an't l~a~e for fear
losing their ,insurance:. Famiiies cfn'tget coverage \~eca~se of "pr'e- '.
, :existing cO,nditioris" arid 'other fO,mis of'insurance discrimination. ,Small'pusinesses face :.
health c~lTe premiums 35, percent higher than those· of large· corporations.~ a~d. those .'
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toll as welL This'Administration has worked hard to contain the deficit. But if we' wanUo
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" . ',month, y'ear after. year;' health care costs ar~ ~rthen~roding our savings, our investment, . . , '
capital'0l:lr public treasury, and our-ability to crea.tenewjobs in the ·pr~vatesecto~.. In ~994, :
.I.we will spend. nearly 14% of our ODp'on' .health care services. If this tr,end; <;6ntinues,' we wili.
'spend nearly 20% of our' GDP on he~lth care by,2001,:
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are :notgoing, to stari~. still '~hile moieandriloreArrJeticans ~ee .~ealth care costse,ating away,
:,'at 'theh>family, budgets." And' we'·are.:not going ,to' standstill 'while 'American fa,milies live iIi:'· , "
:; fear' of behig one illness or job 16ss away' from losi~gthdr insurance.'
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,commitment ,to' this' mission has not;chaIlged.· WestIll/belie~e .that' every 'American deserves
:' healthcar~ coverage.' Every .month 'that, we\don't act to reform our system,' 100,000' morc;
'Americ'ans win lose ,their insurance,. And, if we want to. ensure that' the deficit that we ,have
, .worked so harq tq contaiQ' does 'not "balloon again over time, we need;to address rising health ,
.' , , . ' care Costs.· Americans will spend $982 billion ,on health care 'services 'In: 1994 .:-:-' nearly 14' .
, '. percent'-of our gross domestic product.· I{ this.trend co~tinues,
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escai'atin.g health.- ~are costs.
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From:', LotrieMcHugh' , ' '
Re:' HealtI:t, care talking points
Date: October ~8, 1994,
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I diq' n,pUnclude a 'talking point involving ~ personal story. As yo,u know, we found,.'
dtiring' t,he ,firstroluid'of this: ~ffort .that: persOIial' stories really 'brought'lIte point hori;te that our
~nation's 'health 'care probl~ms are riQt:goingaway: ': Ifyou.~n~d any ,up-"'-dated examples,'" I '
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�E X E CUT I V E
o
J' J' ICE
03-Nov-l~94
o J'
T if E
PRE SID E
07:27pm
TO:
Carol H. Rasco
J'ROK:
stacey L. Rubin
Domestic Policy Council
CC:
CC:
CC:
Jennifer L. Klein
Sylvia M. Mathews
Jeremy D. Benami
SUBJECT:
Follow-up
KEMORANDUM
I
To:
, From:
Carol Rasco
Ch~s
Jennings
Date:
November 3, 1994
Re:
Follow-up with Bruce Vladeck
I just spoke with Bruce Vladeck regarding Sheila Burke's presentation on Tuesday night.
Bruce reported that Sheila went through the usual presentation about why health care failed
last Congress. Interestingly, she was generally soft in her critique of the Administration
--although she did have some implicit slaps at the First Lady and Ira (eg. the secrecy issue,
etc...). However, Sheila did say that Republicans did not get their act together:either and
contributed to its demise as well. Bruce characterized Sheila's presentation as conciliatory.
With regard to specifics, Sheila said that Senator Dole would generally approach state
flexibility issues as someone who is sympathetic to the Governors. She stated that there would
likely be many changes at the state executive level and Senator Dole would most likely be
responsive to Republican Governors interested in state-based reform. In that vein, Sheila
spoke about state-based managed care reform initiatives as well as some possible ERISA
changes. On the latter point, she acknowledged that Republicans would have a problem with
this issue, but implied that Senator Dole might be more sympathetic than some people may
think. Other than that, it was a pretty general presentation.
If you have any additional questions, please call me.
�E X E CUT I V E
OFF ICE
o
F
THE
PRE SID E N T
05-Nov-1994 07:36pm
TO:
RASCO C
FROM:
John Gilmour
SUBJECT:
health care proposal
Dear Ms. .Rasco:
It would 'be good policy -- and even better politics -- for the Clinton
Administration to offer as its health care plan the same health care plan
Nixon pr~posed in the 1970s.
Nixon proposed requiring employers to pay 75% of the cost of employees'
insurance; employees were not required to accept. This plan would not
solve all problems in health care, but it would be a big improvement, for
it would· increase the number of p·eople with insurance and reduce cost
shifting.
.
,
Politically this proposal would be unbeatable. Richard Nixon and Caspar
Weinberger were its major proponents. Republicans could not label it a
nutty plan. Perhaps even Weinberger could be persuaded to endorse the
plan anew.
Whatever happens, the Administration wins. If the plan passes, the
American people will win, and the President will look good.
If
Republicans refuse to accept even the plan proposed by Richard Nixon, the
American people will clearly see that they are opposed to broadening
access to health care, and that will help Democrats in 1996.
Embracing the Nixon proposal would be a bold stroke.
else it.could break the logjam on health care.
More than anything
Cordially,
John B.· Gilmour
Assistant Professor of Political Science -
*-----------------------------------------------------~--------------------*
John Gilmour
Voice: (314) 935-5817
Department of Political Science, Campus Box 1063
Fax: (314) 935-5856
Washington University
One Brookings Drive
st. L'ouis, Missouri 63130-4899
gilmour@wuecon.wustl.edu
*-----~-~------------------------------------------------------------------*
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�-_.
THE WHITE HOUSE
WASHINGTON
�~
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4208 Evergreen Lane, Suite 222
Annandale, VA 22003-3264
(703) 642-1070
FAX (703) 642-1075
CHRISTIAN
c>-O-----<1 LEGAL
1 SOCIETY
i
®
NOV I 5 1994
By Facsimile and First Class Mail
November 10, 1994
Joel!. Klein, Esquire.
Deputy Counsel to the President
Office of the Counsel to the President
The White House
Washington, DC 20500
Dear Joel:
On behalf of Christian Legal Society, we would like to express our gratitude for the recent
opportunities you have given us to provide input on matters of importance to America's religious
communities. The Adn:~inistratioll's actions.in Crystal and Chipkevich are truly encouraging.
.
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, .. ,. ,'J Desp-ite their significan,c~, the, political, religio1.l§ @g,moral sensitivity. of these matters does not
eve.n: begin;,tq.~p.p~oach:.tlie ·volatilitY.btYet.anQt4er.ifi:~~e::)llE(tt~a:tin~nt';dt hbortion in health care
reform:P!9P'OSEllS.,. ,...."_:" '.;:~.' ;., . ,.. ' .... '.:::: '... ,., ·'··r ,', ....;......., ... ;., ..... ,.... :.'i.'.'.;" ":. ',::"::.,'.':"'.1::: :.;'.).;.: '.. ::»:,
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Milli~~; ~f '~~ri~,'~'oti~~ted 'b~' b~th' ;'~ligiotis ~d n~~-t:eliwollirnotions' of moriility; ae~~ly
oppose the taking of innocent human life through abortion. With regard to abortion, future proposals
are likely to resemble last term's unsuccessful initiatives. If enacted, such legislation would compel
sin,cerely conscientious citizens to do something that haS never been asked of them before: pay for
abortions and the construction of new abortion clinics. We believe that it is our duty, as an
organization familiar with and part of evangelical Christianity, to warn you of the grave political
dangers associated with such legislation. A fll'estorm of controversy almost certainly will erupt as the
enactment of such legislation comes close,to fruition.
We oppose any proposal that dermes a basic benefits package to include abortion. Such a
pt:ovision would increase access to abortion and therefore increase the number of abortions performed
in this country. This would frustrate President Clinton's stated goal that abortions be rare in America.
Moreover, many Americans committed to protecting the unborn would be required, through their
premiums, to fund abortions. The high visibility of health care reform, as such legislation neared
enactment, would galvanize religious communities and engender avoidable hostility towards the
Administration.
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We also oppose any proposal that: subsidizes abortionS .. Certainof'last term's tiriSuccessful; •
.init4ttives.41clu<ied large health care subsidies, yet there was no indication that such subsidies would
riot r~ach ,abortion. Again, t~ .propo!?al ,woul4in~re.~e the numper of abortions and force all
taxpaying"cit.iz~~tosuppor~a i>ractic<tl~an riUUiy.X~dm<?raUy,.t~~t,e0hi~~s~bie..: li":.~~:'·:,·
(;',:'~:.
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We also
~ehement1y
oppose any proposal that might result in the construction
,'.
9f Dlore abortion
Equipping For Service
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Lette~
to: Joel 1. Klein, Esquire
November 10, 1994
Page Two
clinics. Requirements regarding the availability of benefits arguably would mandate the establishment
of more such clinics. Millions of Americans will be horrified ,at the prospect of the federal government
I
using their tax dollars to construct facilities that are, to them, the moral equivalent of Auschwitz gas
chambers. Although one may not agree with this perspective, this characterization is no exaggeration.
The innocence of and consequences for their victims were and are the same. ,
In sum, the prospect of unquenchable political controversy looms, and almost certainly will
come to pass as such legislation approaches enactment. Such legislation represents a radical departure
from, the status quo in the abortion arena. Inciting vigorous and hostile opposition can be avoided.
We strongly recommend that any health care reform legislation proposed or signed by the
President be abortion-neutral. In other words,legislation should explicitly: (1) exclude abortion from
the basic benefits package; (2) deny subsidies for abortion; 'and (3) disclaim any mandate for the
construction of new abortion clinics. Legislation that ignor~s these recommendations will elicit the
passionate ire of the millions of religious and non-religious Americans who sincerely and fundamentally
oppose abortion.
:
,
Again, we thank you for the opportunity to alert the Administration of situations important to
this nation's religious communities. Please do not hesitate to contact us if there is any further input
we may provide on this or any other matter.
Steven T.' McFarland, Director
Center for Law & Religious Freedom
STM/bh
�Carol R. Rasco - Call List
CALLER
MESSAGE
DATE/TIME
Congo Pete Stark
225-8626
11-10
2:50pm
FOLLOW-UP
DISPOSITION
please calIon Monday
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Title
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Carol Rasco - Issues Series
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Domestic Policy Council
Carol Rasco
Issues Series
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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2010-0198-S Segment 2
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Clinton Presidential Records: White House Staff and Office Files
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92 folders in 7 boxes
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Health Reform [1]
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Domestic Policy Council
Carol Rasco
Issues Series
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2010-0198-S Segment 2
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Box 124
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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2010-0198-Sb-health-reform-1
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b66f9ab3e3215096bc0566ddae70f397
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��THE WHITE HOUSE
�NATIONAL ASSOCIATION FOR HOME CARE
519 C STREET, N .E., STANTON PARK
WASHINGTON, D.C. 20002-5809
(202)547-7424, FAX (202)547-3540
KA YE DANIELS
HONORABLE FRANK E. MOSS
CHAIRMAN OFTHE BOARD
SENIOR COUNSEL
VAL J. HALAMANDARIS
STANLEY M. BRAND
PRESIDENT
GENERAL COUNSEL
Staff
Val J. Halamandaris, President
Bob Hoyer, Vice President for Public Policy
Dayle Berke, Director of Government Affairs
Lucia DiVenere, Deputy Director of Government Affairs
Jeff Kincheloe, Associate Director of Government Affairs
Eric Sokol, Assistant Director of Government Affairs
Jill White, Director of Policy Analysis
Christopher Laxton, Vice President of Communications
Ronald J. Kolanowski, Vice President of Membership
~Deborah McNeal
It(
Arrindell, Executive Director
Home Care Aide Association of America
:f:t:~
Bill Dombi, Esquire
Director, Center for Health Care Law
Bill Halamandaris, CEO
Foundation for Hospice and Homecare
REPRESENTING THE NATION' S HOME HEALTH AGENCIES, HOME CARE AIDE ORGANIZATIONS AND HOSPICES
�NAnONAL ASSOCIAnON FOR HOME CARE
519 C STREET, N .E., STANTON PARK
WASHlNGTON, D.C. 20002-5809
(202) 547-7424, FAX (202) 547-3540
KA YE DANIELS
HONORABLE FRANK E. MOSS
CHAIRMAN OPTHE BOARD
SENIOR COUNSEL
VAL J. HALAMANDARIS
STANLEY M. BRAND
PRESIDENT
GENERAL COUNSEL
NAHC OPPOSES FURTHER REDUCTIONS IN MEDICARE COST LIMITS BECAUSE:
...
Cost limits act to keep home,health agency visit costs low. That is their sole function.
But, unlike other kinds of providers, horne health agency costs have increased little over
the years. For example, between 1988 and 1993, Medicare horne health costs per visit
have increased only about one-third as fast as medical prices and two-thirds the rate of
overall inflation.
NAHC believes that the cost limits are already set too low. In July 1983, they were
lowered despite an industry-wide average increase of 5 % in costs. Congress then froze
the new rates in place for an additional two years. It is estimated that by 1995 about
55 % of the Medicare certified agencies will be adversely affected by the exiting cost
limits. Switching to 100% of the median in 1997, as proposed in the Administration
plan, would reduce the cost limits further to 85 percent of the July 1993 level.
The difficulty of coping with lowered cost limits will become more difficult if the
government calls on horne health agencies to shoulder new costs, such as the costs of
tracking and billing coinsurance amounts, complying with electronic billing
requirements, and paying mandated health insurance premiums.
If reimbursement rates are further reduced, many horne health agencies may be forced to
be more selective about the patients they accept, especially those in rural or inner-city
areas and those who have special needs and require more intensive care. Especially
vulnerable are individuals who need therapy services to restore their ability to care for
themselves and inner-city residents for whom caregivers may require security escorts and
language translators.
Agencies in rural areas would be particularly hard hit by any reductions. Their costs
tend to exceed national averages because of longer travel times between visits and higher
wages resulting from the lingering personnel shortages in rural areas.
REPRESENTING THE NATION'S HOME HEALTH AGENCIES. HOME CARE AIDE ORGANIZATIONS AND HOSPICES
�November 14, 1994
MEMORANDUM FOR CAROL RASCO
FROM:
Debbie Fine, Office of Public Liaison
SUBJECT:
Meeting with National Association for Home Care
DATE/TIME:
Tuesday, November 15, 1994
1:00PM to 2:00PM
WCATION:
Room 476, OEOB
BACKGROUND: The National Association for Home Care (NAHC) represents both
. . home care providers and consumers. Their constituency includes
home health agencies, home care aide organizations, hospices, and
those that these serve, including older Americans and people with
disabilities. The mission of NAHC, as the name suggests, is to
make available "humane, cost-effective, high-quality home care
services to all individuals who require them," in both acute and long
term care settings. As you know, the administration, has been a
strong advocate for home and community-based long-term care
services.
Although the central goal of NAHC is to ensure access to home
care services, the organization recognizes the importance of
universal coverage and the group has been a strong advocate for
reform that achieves universal coverage and includes long-term care
services. Val Halamandaris, NAHC President, contributed hundreds
of thousands of dollars to paid media that conveyed a pro-reform
message consistent with the administration's,· to Health Security
Express, to grassroots organizing and to national free-media events.
In addition to financial contributions, Val dedicated significant
personal time as an advocate for the administration's approach to
health care reform. .
NAHCis also a principal sponsor of HealthRIGHT, which
conducted several video tours across the country. Each· tour
concluded with a forum in Washington D.C. with individuals from
each state telling personal stories that highlighted the need for
universal coverage that includes home and community-based long
term care services. These forums received extensive and favorable
coverage in the press.
�.;
I would note that although NARC was supportive of the Health
Security Act because of both its general goals and its specific
provisions on home care, it strongly opposed both Mitchell's and
Gephardt's bills because they did not include coverage of home care
services.
PARTICIPANTS: National Association for Home Care
Val Halamandaris, President
Robert Hoyer, Vice President of Public Policy
Dayle Berke, Director of Government Affairs
Lucia DeVenere, Deputy Director, Government Affairs
Eric Sokol, Assistant Director, Government Affairs
Janet Neigh, Vice President of Administration
Jill White, Senior Policy Analyst
Ronald Kolanowski, Vice President of Membership
Christopher Laxton, Vice President of Communications .
Jeff Kincheloe, Attorney
Deborah Arrindell, Director, Home Care Aide Association of
America
Bill Dombi, Director, Center for Health Care Law
Bill Halamandaris, President, Foundation for Hospice & Homecare
Staff
Carol Rasco
Ira Magaziner
Chris Jennings
Marilyn Yager
Debbie Fine
AGENDA/TALKING POINTS:
•
Introductions
•
Thank them for coming and for their tremendous work and
active support for the Health Security Act.
•
Overview Comments
1. Briefly comment on the administration's legislative/policy
priorities for the coming year.
2. Describe/comment on the new health care team structure.
3. Describe the process you anticipate for outreach, in
addition to the time-frame for decision-making, to the extent
, you are comfortable.
�.
4. Open it up for discussion, reiterating that the purpose of
this meeting is to listen and learn from them.
(NOTE: As Marilyn Yager indicated on previous
memoranda, the NARC should be prepared to (1) give their
assessment of the new political environment and its impact
on reform; (2) describe what, if any, incremental reform they
would support and which incremental reforms they feel would
be detrimental; (3) de-brief on what they have learned about
the capabilities of their. own membership from the last two
years, in addition to which reforms would find support on the
grassroots level and which would not.)
�Home care agencies should be exempt
from Medicare cuts in any form: data
show that home care is a "good buy."
Data collected from various sources arid analyzed by the National Association for Home
Care (NAHC) show that from 1987 to 1993 the cost of living or consumer price index (Cpn
increased by 27.1 %, the cost of phy~icians' services increased by 48.5%, and hospital costs
soared by 73.4%. By contrast, home care costs increased by only 17% during the same period
about 60% of the increase in the CPI, and far below the rates of increase for other health care
providers.
Consumer Price Index Compared with Price Increases for Home Care,
Physician, and Hospital Services, 1987-1993
180
170
160
150
140
Index of Prices
1993
Source: The National Association for Home Care Research Department
�NATIONAL ASSOCIATION FOR HOME CARE
519 C STREET, N.E., STANTON PARK
WASHINGTON, D.C. 20002-5809
(202)547-7424, FAX (202)547-3540
KA YE DANIELS
HONORABLE FRANK E. MOSS
CHAIRMAN OFTHE BOARD
SENIOR COUNSEL
VAL J. HALAMANDARIS
STANLEY M. BRAND
PRESIDENT
GENERAL COUNSEL
NAHC OPPOSES IMPLEMENTATION OF A PER-VISIT PPS SYSTEM
The National Association for Rome Care (NARC) strongly opposes any amendment which
will establish a per-visit prospective pay system (PPS). NARC does support the per-episode PPS
demonstration currently being conducted by RCF A and recommends that Congress carefully
evaluate the results of this demonstration before legislating any changes to the home health care
reimbursement formula.
The per-visit PPS is unacceptable to both the home care industry and the government for
the following reasons:
A per-visit PPS cannot achieve significant Medicare savings. A per-visit PPS would
cut deeply into home health agencies' payment rates just to reduce Medicare expenditures by
relatively small amounts. The Penny-Kasich per-visit prospective payment amendment, whose
payment rates were set at only 83 percent of the cost limit amounts, saved a mere $1 billion over
5 years.
A per-visit PPS would establish a reimbursement system that would create incentives
to provide visits. This comes about because the profit that is offered is proportionate to a home
health agency's visit volume. A per-visit PPS, therefore, will do nothing to address Congress'
concerns over home health utilization.
A PPS system that pays a flat amount per visit fails to take account of the costliness
of an agency's patients or its operating environment. Surveys of home health agencies have
shown that, on average, nurses make five visits per day. Some agencies, however, had nurses
that average one to three visits per day. In addition, costs vary between agencies and if the same
rate applies to all home health services, those with high-cost patients will be underpaid and those
with low-cost patients will reap excess profits. For example, agencies in inner cities, that serve
medically, economically and socially disadvantaged patients, will incur higher costs; under a per
visit PPS, these agencies would not be fully reimbursed. Similarly, agencies in rural areas that
require exceptionally long travel times will be adversely effected under a per-visit system. On
the other hand, there are opportunities for excessive profits for those home health agencies that
serve low-cost, relatively healthy patients.
NARC strongly urges your support to defeat any amendment to the health care reform bill
which would establish a per-visit PPS system for home health providers.
REPRESENTING THE NATION'S HOME HEALTH AGENCIES. HOME CARE AIDE ORGANIZATIONS AND HOSPICES
�NATIONAL ASSOCIATION FOR HOME CARE
519 C STREET, N.E., STANTON PARK
WASHINGTON, D.C. 20002-5809
(202) 547·7424, FAX (202) 547·3540
KA YE DANIELS
HONORABLE FRANK E. MOSS
CHAIRMAN OF THE BOARD
SENIOR COUNSEL
VAL J. HALAMANDARIS
STANLEY M. BRAND
PRESIDENT
GENERAL COUNSEL
NATIONAL ASSOCIATION FOR HOME CARE OPPOSES A HOME CARE
COINSURANCE REQUIREMENT BECAUSE:
~
Home health copayments would create substantial financial burdens on Medicare beneficiaries.
A 20 percent coinsurance would require the average Medicare home health beneficiary to pay
copays of over $900 in 1996. About 15 percent of the estimated 4.6 million home health
recipients would incur copays of more than $3,500.
~ A home health coinsurance is regressive, inefficient and falls most heavily on millions of the
poorest and oldest Medicare beneficiaries. For example, individuals over age 75 account for
less than half of the total Medicare population, but comprise nearly three-fourths of the home
health beneficiaries. A coinsurance for home health services, therefore, would fall most heavily
on the oldest group of Medicare beneficiaries.
~
Most home care recipients cannot afford to pay the coinsurance. They are older and have
fewer financial resources than the general Medicare population. About 12 percent of the elderly
live below the federal poverty level, whereas nearly half of home health recipients are low
income. Nearly three-fourths of the poor elderly do not own Medigap to help cover the costs
of copays, and the Medicare Qualified Medicare Beneficiary (QMB) program, which is designed
to help pay Medicare cost-sharing requirements for poor Medicare beneficiaries, does not
provide adequate protection from these costs.
~
A coinsurance requirement for home health would create strong barriers to care for those in
need of home care. Home health was exempted from the Part B coinsurance in 1972 to
encourage use of less costly, noninstitutional services. Reimposing a coinsurance would
dramatically undermine that effort.
~ Home health copayments are inefficient. The collection of copayment amounts would create
additional paperwork burdens. Many home health patients receive only a few visits (26 percent
received fewer than 10 visits in 1992). Yet agencies would have to set up billing and tracking
programs even for these relatively small amounts, increasing administrative costs.
~ The Office of Technology Assessment (OTA) recently found that making patients responsible
for copayments will keep them from seeking necessary care and could be especially harmful to
those with low incomes.
REPRESENTING THE NATION'S HOME HEALTH AGENCIES, HOME CARE AIDE ORGANIZAT10:-.1S AND HOSPICES
�NATIONAL ASSOCIATION FOR HOME CARE
519CSTREET,N.E.,STANTONPARK
WASHINGTON, D.C. 20002-5809
(202) 547-7424, FAX (202) 547-3540
KAYE DANIELS
HONORABLE FRANK E. MOSS
CHAIRMAN OFTHE BOARD
SENIOR COUNSEL
VAL J. HALAMANDARIS
STANLEY M. BRAND
PRESIDENT
GENERAL COUNSEL
November 14, 1994
Recommendations from the
National Association for Hom~ Care
on FUture Directions for
Health Care Policy in the l04th Congress
The President should clearly
and quickly set out universal
coverage as a long-range goal of health care reform. The goal
should have a clear date by which universal coverage should be
accomplished and should include measurable benchmarks that could
be objectively applied.
The following items should be among the first steps taken toward
more comprehensive reform.
Extend coverage to pregnant women and children under 18
through private insurance vouchers, Medicare, Medicaid or
other means. At the close of the last legislative session,
there was growing consensus that this "kids-first" approach
was a good place to begin any health care coverage
expansions. Pediatric home care should be included as a
vital element in any expanded maternal and child health
benefit.
In addition, there is broad general agreement on a number of
insurance reform measures. These include limitations on
preexisting condition exclusions, ensuring portability of
insurance, and requiring a standard benefit package
(including coverage for home care and hospice services) to
be included in all insurance plans. There is a precedent for
doing this in the Medigap standardization legislation.
No health care reform plan can be complete or successful
without coverage for a full range of long-term home care
benefits. The long-term care benefits should be offered
(preferably through Medicare) to all individuals -
children, disabled, seniors -- regardless or income, and in-
REPRESENTING THE NAnON'S HOME HEALTH AGENCIES, HOME CARE AIDE ORGANIZATIONS AND HOSPICES
�horne caregivers should be appropriately trained and
supervised to meet the client's care needs and level of·
acuity.
It is critical to keep the Medicare program intact. The
Medicare program will corne under attack in the l04th
Congress and the President should rally public support for
the preservation of Medicare benefits. Specifically the horne
care community opposes beneficiary copayments for horne
health services; reductions in horne health cost limits; and
the premature imposition of a prospective payment system for
horne health providers (see attachments). Further the
President should press for a Medicare expansion to cover
long-term horne care.
until universal health insurance coverage is achieved, it
will be important to see to it that Medicaid is not only
preserved but also changed as may be necessary to assure
that it serves as a viable safety net for the uninsured
poor, including the working poor. Moreover, the increased
use of managed care, with its incentives to economize,
should be carefully monitored at the federal level to ensure
that the eligible recipients get the care to which they are
entitled.
The above recommendations represent the first steps that should
be taken toward more 'comprehensive reform and could be
incorporated into an Administration bill. As for the larger goal
of universal coverage, the Congress has a responsibility to
continue the task, initiated by the President last year, to find
the most palatable and doable solution and to act accordingly. To
do nothing is not acceptable. A prime opportunity to .convey this
message is the State of the Union address, during which the
President could clearly articulate health care reform as a top
priority of unfinished Congressional business from last year, and
challenge the Congress to act first on the above outlined issues
while continuing their work toward comprehensive reform.
�
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Title
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Carol Rasco - Issues Series
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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Clinton Presidential Library & Museum
Extent
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92 folders in 7 boxes
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
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Paper
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Health Care Meeting: 15 Nov. 1994 Nat'l Assoc. for Home Care 1-2pm
Creator
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Domestic Policy Council
Carol Rasco
Issues Series
Identifier
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2010-0198-S Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 124
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
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Adobe Acrobat Document
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Reproduction-Reference
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12/4/2013
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2010-0198-Sb-health-care-meeting-15-nov-1994-natl-assoc-for-home-care-1-2pm
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https://clinton.presidentiallibraries.us/files/original/72979b919f4d33cfc1027d59b7a54101.pdf
888b3e71cae0847a2b05b34abeb10f49
PDF Text
Text
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THE WHITE HOUSE
-
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�..
THE WHITE HOUSE
�EX E CUT IV E
OFFICE
o
THE
F
PRE SID E N T
14-Nov-1994 06:22pm
TO:
Rosalyn A. Miller
FROM:
Marilyn Yager
Office of Public Liaison
CC:
Jennifer L. Klein
SUBJECT:
Thank you notes
The following are the names and addresses for the "thank you for
coming" notes Carol wishes to send to the individuals we met with
today:
Monday, November 14, 10:00am Seniors Meeting
'
John Rother, Director, Legislation and Public Policy
American Associat10n of Retired Persons
601 E. Street, NW,A6....300
Washington, DC
2.0049'
(also attending from AARP were Tricia smith and Marty
Corry)
~.
Larry Smedley, Executive Director
National Council of Senior Citizens
1331 F. street, NW
Washington, DC 20004-1171
(also attending from NCSC were Dan Schulder and Jon
Lawniczak)
steve McConnell, Senior Vice President, Public Policy
Alzheimer's Assn.
'1319 F. Street, NW, suite 710
Washington, DC
2000~
.
(also attending from the Alzheimer's Assn •. were Judy Riggs
and Mike Splaine).
Debra Shollenberger
National Council on the Aging, Inc.
409 Third Street, SW
Washington, DC 20024
(Note: Debra was attending on behalf of Dan Thursz, and for
that reason she did not speak. She plans to share with Dan
and others at NCOA what was discussed, so that we may
continue the dialogue with them).
Monday, November 14, 3:30 pm meeting with Families, USA
�,
Ron Pollack, Executive Director
1334 G. street, NW
Washington, DC 20005
(also attending for Families, USA were Judith Waxman and
Phyllis Torda).
�November 11, 1994
MEMORANDUM TO CAROL RASCO
FROM:
Marilyn Yager
MEETING:
SENIOR GROUPS
American Association of Retired Persons (AARP)
National Council of Senior citizens (NCSC)
Alzheimer's Association
National Council on the Aging, Inc. (NCOA)
DATE/TIME:
Monday, November 14
10:00pm - 11:00pm
LOCATION:
Room 476, OEOB
AGENDA/TALKING POINTS:
•
Introductions
•
Thank them for coming and for their
unbelievable work and support for the Health
Security Act.
Overview Comments
1. Comment briefly on the broader
Administration priorities for next year,
i.e., welfare reform, etc.
2. Comment on the new health care team headed
by you and Bob Rubin.
3. Describe how we plan to proceed on health
care, i.e. meetings with allies and key
health players before any decisions are made.
4. Indicate that we are using the next three
to four weeks to listen and learn from our
allies, hence the purpose of this meeting.
Open it up for discussion.
NOTE: When inviting groups to these meetings
I have asked them to come prepared to give us
their assessment of the new politicat
environment and what it means for health care
reform. To tell us what incremental reform
would they support (if any) and what
incremental reform do they think would hurt
the system.
�And finally, to be prepared to tell us what
they learned about their own membership
during the past two years on what could be
sold at the grassroots level and what could
not.
You are likely to. be asked whether we are
planning to propose health care reform as a
part of our FY96 budget and whether we are
planning to propose Medicare cuts.
The most important message'we can send, is
that we consider these folks friends and
allies and we are demonstrating that by' being
as frank as possible regarding what we are
thinking.
BACKGROUND:
Long term care was the number one· priority for all
senior groups. They often voice their strong
support for the prescription drug benefit, but the
commitment behind the drug benefit was far less.
Other issues of concern to these groups is
potential of continuing age discrimination on
community rating, the early retirees provision of
large companies (they supported), and whether
Medicare should be folded into local alliances
(voluntary or not).
Although all of the senior groups were supportive,
their support was demonstrated in different ways
and to different degrees as outlined below.
Founded in 1958, the AARP is the oldest and
largest senior organization, representing more
than 33 million Americans 55 and older.
It is
important to note that over a third of their
membership is still in the work force, many small
business owners. Their members also tend to be
middle and upper income seniors. These biases
likely influenced their ability to specifically
support the Health security Act versus suppOrt in
general for health care reform.
.
Although the AARP started out with strong support
(and significant financial contribution) to the
health reform project, their ongoing support was a
key disappointment to us and in fact hurt their
credibility with other health care constituencies.
Despite their lackluster performance, we stiLl
consider them an ally and hope they will play a
more signiticant role in incremental ~eform.
�NCSC has a base· membership that is largely retired
union worker (80%) and are often identified as
having been spawned by the Democratic party.
Their activities during the early months of the
debate was centered on pushing the single payer
approach. However, once they came on board the
Health Security Act they remained dedicated
supporters.
NCaA represents the people who administer the
Older American's Act programs, i.e., senior
centers, foster grandparents, senior housing, etc.
Federal law restricts the amount direct lobbying
they can do, but they were very effective in
educating their members and the public. Because
Dan Thursz could not come to this meeting they
will not be speaking, Debra Shollenberger is
attending only to listen.
.
Alzheimer's Association were in a bigger league
regarding their active support for the Health
Security Act. St~ve McConnell chaired the Long
Term Care Campaign and they committed significant
resources in support of the Health Security Act.
If there is a chance at the end for you to have a
private word with steve McConnell, you might want
to reemphasize how much we appreciate all that
they did. They recently sent a letter to the
President (copy attached) suggesting we launch a
broad based Alzheimer's initiative.
ATTENDEES:
John Rother, Dir. Legislation and Public Policy,
AARP
Marty Cor·ry, Dir., Federal Affairs, A.AIiP
Patricia Smith, Senior Coord., Health Team, AARP
Dan Schulder, Dir. of Legislation, NCSC
Larry Smedley, Ex. Dir., NCSC
Jonathan Lawniczak, Senior Leg. Asst., NCSC
Steve McConnell, Senior Vice President, Public
Policy, Alzheimer's Association
Judy Riggs, Alzheimer's Assn.
Mike Splaine, Alzheimer's Assn.
Debra Shollenberger, Nat. Council on the Aging
Carol Rasco
Chris Jennings
Judy Feder (tentative)
Mike Lux
Marilyn Yager
ATTACHMENTS:
I have attached several documents to give you a
flavor for their positioning on health care
reform.
�Bri".lli".n ilj"tri",ts o((.'cpcrim,c a"d leadcrship to Strf'C al(R"'trarions.
AMERICAN ASSOCIATIOH OF' RETIRED PERSONS
BOARD OF DIRECTORS
November 10, 1993
America needs comprehensive health care reform.
bold, not timid, steps now.
comprehensive health care reform
Americans need
m~ans:
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A guarantee that all individuals have access to and
coverage for health and long term' care:
*
System-wide cost containment that slows the explosive
growth in health spending:
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--- .··: .. :....:. .t:~: .
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·Compreh.ensive bene~i ts" ·from .prenat&l,;:care ... all(f.;:-,~;~~,:~~;=~ ..
prevention to prescription drugs"an(f'l'ong~teni' ·caFe1c!'.'~"'"
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Broad-based, fair and affordable financing, so that·
government, businesses, 8,Jld individuals all pay their . . "', .
share and everyone is protected aqainst the high.:~Sts ...
of care : and.::":~. ~~.·,..,,·,·
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consumer-centere(t~~:~e~ance
Of' 'tb:¥h~al th care "':~'?:2~Y
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re~~:::'i.~:':;.~.\
While AARP has not yet endorsed any specific -i:healtb care
.
plan" we belleve the President's proposal provides the strongest';:"
and most realistic blueprint to date for achievillC) our,goals.;: At .
the same time, we commend ~e 'members of congress. inbO~.~~~~s '.
wbo have int~C>,d~c;:ed proposa)s that would achi~e 'universal "'\.::-~~:'" .
coverage. . WS'recOgni ze truit· Congress, . ori~li'''':Bipirtlsanbajlli'~':~'''';:;:
will consider a range of legislative .proposals asi t moves;< .~~:;: ::..... .
towar~s enactment of health care reform •. Th~ final legisl~~f?!i-.i:;:
may d1ffer from any of the proposals now under discussion."·:P::-·':·~;.~~':-
we
especially appreciate
the
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Pr.esident's including in the .Health .
secur i ty Ac,tr:- ~ .~" ; " , ~
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the vital provisions for home and eommunity-based)~9.ijq~··'
term care for disabled persons ofallv(lges: .:::.:(c,;~·::.,';"':·, . .
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* coverage of prescription drugs on \similar terms for '.-:
Medicare beneficiaries as for all \other Americans: and,·
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protection for pre-65 retirees in.the Health Secur.ity
Act.
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:\mcncm ;\ss<xiaoon
or R.c:tircd rersons
Lovola W. Burgess Prtridenr
001 E Sucet. ~.W.
Washington. D.C. 10049
,102) 434-2277
Horace B. DeetS &eCUhPt DirtCUlf'
.,
�For DOre than three decades, AARP has taken a leadership role on
issues of health and long-term care. The Association's draft
health care reform plan, "Health Care America,· was developed
with the extensive involvement of AARP members across the
country. It reflects the Association's commitment to improving
the quality of life for all generations -- a commitment we
believe is shared by President and Mrs. Clinton, members of
Congress, and the American people.
While the debate will be complex and emotional, ve urge every
American not to be misled. We call upon all citizens to ask
their elected representatives to enact a plan that assures every
American comprehensive benefits -- including long-term care and
prescription drugs -- that can never be taken away. We also urge
Americans to demand that effective, system-wide cost controls.be
enacted to keep health care affordable for our children and
qraildchildren.
'.
AARP will work with the Congress in a bipartisan way to ensure
that these important and comprehensive benefits are guaranteed to
Americans of all ages in a final health care plan.
We' ask every~;Americanto joIn ·~in·:tbe 'effort~;::eo~reform·our .healt:h''i'-;·~~"i.:.;·
care system -- not only for us -- but for future ·generations.·
The time for action is now. We call upon AARP members to
directly,participate in this debate. We stand for.bealth reform,'
and ve will fight to make it a reality in 1994.
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�November 17, 1993
"
Lux
TO:
Mike
FROM:
Steve McConnell
RE:
NATIONWIDE ACTIVITIES IN SUPPORT OF PRESIDENT'S HEALTH
REFORM PLAN
~
In Oc:rober, even before the President sent his health plan to Congress, the Alzheimer'S
Association board of directors voted to endorse with enthusiasm. the long term care provisions
in the plan and supported the intent and direction of the remainder of the plan. In short, our
people are ecstatic about the President's plan and are working very hard to get the message out.
Here's a sampling 'of \VJ!atwe're dOing'nationWide to generate
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sUpport:: "
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Chairing the long term care campaign, a coalition of 133 national organizations
supporting long term care and health reform. We've produced anew video and
an excellent packet of materials that make, the case 'Very effectively for the
President' splan;
....- :
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300 ho~p.3I1.ieson,October 21 by ,gp.r, $aP!ers~OVeIJ:", ,which,ge~l3ted··:".;-: :;,
"'1~~~J~I~;~~f:~;;;:~~:~or~~~pport le~~(::!9.:;P.?~· L~~tn!~i~~,~~'f~8,!~p~~,,~'1 '
o
A ,major article in our national newsletter, which is circulated to 2 million
people directly and through our 221 c1Dpter network (see attached), and quotes
in other articles 'that show strong 'supPort {or ,·the':\President's plan (see'Aging',~;·
.Today article and contrast with quotes from other organization leaders);
o
Testimony before Ways and Means and Senate Laboc"Committees exp~ing
strong support for the President's plan and without the caveats and criticisms
expressed by other groups (see example attached); ':;., ."
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Town meetings, forums,. speeches and rallies ,iIi :F.iorid8, Kansas, California.,··
Missouri, Illinois. Virginia, Ohio, Tennessee, Oregon and New York.
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We are available to'ihelp you to get support and visibility for the plan, especially the long term
care components. We can identify sitfs -- adult day car.,¢ centers, family homes where people
are being cared for, .etc. -- for the President and/or the First Lady to visit which will provide
a positive backdrop for their message on health reform. You're doing a great job and we're
ready to help in any way you need us!
Ai.Z~EIMER'S DISEASE AND RELATED DISORDERSASSOC.INC.
,
.
Washington Office: 1319 F St., NW, Suite 710 • Washington, DC 200~4 .. Phone: (202) 393-7733 • Fax: (202) 393·2109
�August 1994
THE HOME STRETCH IN THE HEALTH CARE DEBATE
Real Reform and Alzheimer Issues Threatened
Washington, DC - Congress has junked its Summer vacation to try to reach
agreement on a health ~are bill. Unfortunately ,partisan disputes and opposition by
powerful special interests have made this extremely difficult and may prevent action
this year.
If Congress fails to act, or if it chooses one of the so-called "alternative"
proposals, it will deal a major blow to Alzheimer families and their loved ones. The
,~2two leadership bills in~the:;House ,and SenatcJS~n;iMitcltell and R~p,~,"~R~i),both '.
include a new program of home and community based care, substanti3I" fUnding for
research, and in varying degrees they achieve or move very far in the :cfirection of
guaranteeing health insurance for everyone and containing health care costs. ,- The
alternatives that have been offered by Sen. Dole and Reps. RowlandlBiJ.iqlkisICooper
do none of these things and would, therefore, ,leave Alzheimer fanillies ruglland dry.
(See summary of bills in this i s s u e . ) '
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;;~ln recent :weeJcs,'tJiedlebate~, has;dividetb:al()Jli'1>artiSaIi linesi~12~" extreme :1 'j"
":, partisanship will 'have"to 'give way in order to move a bill; neither party appears to !
have enough votes to enact.or block something this major on their own~ '):aIks are
underway in the Seitate between the Democratic leadership and a so-called group of
moderate Republicans to try to fashion a workable compromise. The 'key won1 here
·"Z.\!:"is ·•.. workable." 'Healthrefornriliust coniam-'many;'vitaJ and interlocDIigpartS';:.!if they
aren't dealt with appropriately the new system won't work.
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,,' Summary of Key Bills
This issue of He~lth Reform Update reviews the 'two Leadership Bills and the
two major alternatives. The fIrst four· questions we ask of each billjx~rtain. iothe
central issues in health reform for our Association outlined in thft1994 National
Program To Conquer:Alzheimer's Disease and Provide Family Security and approved
by tHe Board of Direttors. These are: universal coverage, long term care. research
funding and health calle cost containment. The remaining two questions .:.:. impact on
Medi~are/Medicaid and impact on chapters -- ar~ issues of interest to the Association
and have been monitored throughout the debate.
, While not perfect, the two leadership bills meet the test established by the Board
of Directors; the alternatives fail.
�Hea1tb Reform Update
August 1994
LEADERSHIP BILLS
SENATE -- Mitchell Bill (S. 2357)
•
Does it provide universal coverage?
Establishes voluntary and market-driven
mechanisms as well as gov't subsidies for low income individuals and small businesses designed
to make inSurance more available and affordable for employees and individuals not in the
workforce. If by the year 2000 fewer than 95 % of the population has insurance, a commission
will be established to recommend ways to reach universal coverage. If Congress' fails to act on
the commission's recommendations a requirement that employers of more than 25 employees
. cover their workers will automatically take effect by 2002 in those states which have not already.
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reached the 95 % goal.
•
Is long term care included?
Creates anew, consumer-driven and flexible, home
and community care. program that is available to people with severe disabilities regardless of age
or ,income. The program would provide $48 billion in long term services over a 7 year period
. beginning in 199~~:~~;,:.Co-:pay'ments oP2a.!:slid.iIlg : scale are reqqrre4dQfJli.~I,L but ~low.~in~~~~$:>~,,":
individuals. Creates a new, self-fmanced, pre-funded and voluntary public .insurance progriini:·..
to cover the costs of extended nursing home stays. Establishes a tax credit of 50 percent o{ijl<:,
employed individual's personal assistance expenses of up to $15,000 per :year. EstablishtS':
federal standards for private long term care insurance and clarifies the tax status of long tenii
care services and insurance premiums.
a
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noes it make' eoIDiriitnienf'tc{researCh :rUridiiig? "'~'.~' C"'Inchfdes" the 'HarkinlHatfield !'.'~ 'l~·';': " '"' ,.
research trust funa~:COi':iceptt:wliidlF~s(~f!a fiictiol1,(.-2'S%)!-of 1iiffuSuranceiipreiilitililtatid:.;1: l::.:'·,· l:J'
dedicates them to NIiI funded research.
" ,.:.,-', ,-, . ':.'" .... -.
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How does it contain health care Costs? Private sector health care costs are conh-oUed
primarily through a 25% tax on high priced health insurance premiums. Also includes voluntary •
purChasing org3riiiaiions, medical malpractice reforins, and admJnisffiltive~iU:nplifiCation~tIiili7i"~z"';",- .
Public sector, the' bill reduces the rate of increase in Medicare costs, eliminates some state
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Medicaid mandates and strengthens protection.against fraud and abuse.
•
What changes occur in the MedicarelMedicaid programs? .' Medicare is preserVed.
Spending is reduced by $54 billion over fiv.f:Years. A portion of the savings are directed to pay
for new prescription drugs and long termc&re,programs. Most ofthe savings come in theform
of reduced payments to providerS•. • There are additional costs for the elderly:. 20% copayment
for home health services (with low income protection); income-related premium increase for Part .
B of Med;icare for very high income individuals ($90,000+ income per year). A new Medicare
prescriptibn drug benefit would be provided with a 20'Jf copayment, anannual deductible and
financed ,n part by a small increase in Part B premiums. Medicaid nursing home coverage
remains as is. The acute care portion of Medicaid is eliminated.
�Health Reform Update
August 1994
(Mitchell Bill, Cont'd)
What are the implications for chapters and other small employers? Employers are
•
not required to pay for health inSurance during tJ:1e phase-in period. sman employers would be
able to join purchasing organizations that would make insurance more affordable for both
employer and employee, and provide bener benefits than most small employers are able to offer
DOW. For those employers who expand coverage to aU their employees, a subsidy is available
to make premiums more affordable. If employers are required to pay a portion of aU employees
health premiums by 2002, the requirement would apply only to employers with 25 or more
employees and they would only have to pay 50% of the cost of health premiums with employees
paying the other 50%.
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HOUSE -.;. Gephardt BiIJ (Substitute Amendment to H.R. 3600)
•
Does it provide universal coverage?
Sets a goal of covering all Americans by Jan.
1, 1999 by requiring employers to help payJ()~employees il1SU~:,(80% of prenriYJi\.~tS) 7.
aDd
by setting up a 'new Medicare
choose to join.
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part C. for those, not workmg-iiiiifor' small employets"";ho'
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Is long term care included?
Creates 'a new ._COI~~
and community care program that is available to people with severe ~lbilitieis,:re:2al
or income. The program would begin with $1. 7 billion in feder3J fuiKiiog in
",=;-1004 funding would reach $22.6 billiQll annually-:' Total~expenditures
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,:r~~~ven years ::f~c$68:iF~il1i~rij::Co--:pa~ts ;Ifslia~#g~ej_aie ~ueai'oi;81FblJ'FJCtw;ihC'6ihet-lt::'I',;;r~-=: i r, ~
'-:.-imdividuals.· ":E:stiiblishes"a'-tax"'creoit'of'50 pereenF'ot~ari'empJoyed iDdividuai's personal
assistance expenses of up to $15,000 per year. Establishes 'federal standards for, private long
tenn care insurance and clarifies the tax status of long term care services and insurance
premiums.
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Does it make a commitment to research funding?
Includes the HarkinlHatfield
research trust fund concept, which assesses a fraction (.5 %) of all insurance premiums .and
dedicates them to NIH funded research.
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How does it contain health care' costs? Sets limits on provider charges for ,n.~W J)art
C program. For the .private sector; cost controls don't ,take effect until 2000,'\when a
,commiSSion will detern:li.ile whether health spending in each state is exceeding a national ~gro\yth
target tied to the growth of the gross domestic product. If so, re~bursement limits similar to
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those in Medicare will be ,applied to providers in the state.
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What changes occur in the MedicarelMedicaid programs?
Medicare benefits do
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not change, except for the addition of a new prescription drug benefit,·new preventive benefits
and the enhancement of mental health benefits. A 15% rebate would apply to single-source and
innovator multiple-source drugs. Growth limits would be established for the Medicare program
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�,.~~i.~~::}~!~~
August 1994
Health Refonn Update
(Gephardt Bill Cont'd)
(parts A, B and C), resulting in savings of $UO billion over five years. There are additional
costs for the elderly: 20% copayment for home health services (with low income. protection);
income-related premium increase for· Part B of Medicare for very high iilcome individuals
($90,000+ annual income). Medicaid nursing home coverage remains as is, and states are.
required to continue current levels of Medicaid spending for home and community based care
in order to receive .funds under the new' program. 1be acute care portion of Medicaid is
eliminated.
•
What are the implications for chapters and other small employers? Employers with
50 or fewer employees would be eligible for a tax credit to.offset a portion of the·~st of
premiums. Firms with 25 or fewer would receive an amount equal to 50% of the empioyet
share of Medicare part C premium. The maximum credit would be available at an average
payrol1 of $12,000 or less and would phase out between $12,000 and $26,000.
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ALTERNATIVE BILLS .'.
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Is long term care included?
No new long ·~terin
. . . " . 'on tax
incentives for those who can afford it, to purchase private long .. care '~~'~Medicaid .
,borne and ,community.,based serviceS'· can be providedto:those·~~lth. Jowincome .~".!-oftheE)'~,',"··
state plan option (Le., does not require a waiver). AllowspubIic/private@:fships to
encourage the purchase of private long term care insurance. Establishes insura.hCe'industry .
approved standards for long term care insurance and clarifies the tax treatment of exPenditures .
for long term care services and insurance premiums. Like all other bills, establishes ~ ,tax credit
of 50 percent of an empJoyed individual's personal assistance expenses of up to.,~J~;OOQ per
year.
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Does it make a commitment to research funding?
Ailows 'for a voluhtary check
off on federal income tax. returns to c~ntribute dollars to a.~tional research
fu1...'
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How does it contain health care costs? Reduces Medicare spending
over five years by lowering reimbursements to hospitals and other providers ..
b~$
60 billion
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�Health Reform Update
August 1994
(Dole/Packwood Bill, Cont'd)
Medicare . remains a
•
What changes occur in the Medicare/Medicaid programs?
separate program. No expansion in. benefits, though it directs the Secy of HHS to make
recommendations re: allowing Medicare beneficiaries the option of establishing Medical Savings·
Accounts. Medicaid nursing home benefits remain as in current law.
•
What are the implications for chapters and other small employers? No -employer
requirement to pay any portion of health premiums and no assistance available to employers who
cover all their workers. Conununity rating will apply. to small group markets (50 or fewer
employees) and every health plan must offer at least one fonn of die federal employees health
insurance package.
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HOUSEALTERNATIVE Rowland/Bilirakis/Cooper (Substitute Amendment
. to H.R. 3600)
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Does it provide universal coverage?
Does not establish a universal
Provides tax deductions for self-employed and subsidies for low income .
insurance.
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Is long term care included?
No new ,program for borne and
It eliminates home and community based care under Medicaid for the
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directly- un4ermining:innoyative_~ .state: ~ffortS,,, tO~ . :JD.Ove'=iawaJ,"s-fromthe:." ' .
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_.UUI,UV'...... bias,in:the:curreOt;:Medicaid system;::: Clarifies taX~.rof-rong·;tennJCare·:ke~::t,i~;·,:·,·,
establishes federal, standards for long tenn care insurance.
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Does it make a commitment to research funding?
No.',
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-How (foeS it contilinhealthcire"coStS?' ' Includes only'-::iiiliiiiilcil provlSiom';'(iiietiicaf: - . ,
aJP:racltlte refonns, some administrative simplifications). .
Medicare savings of $61
What changes occur in the MedicarelMedicaid programs?
over 5 y~. Provides optional drug benefit under managed care plans? , Eliminates
.acute care program. Medicaid 'long tenn care remains as is.
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What .are theimpJications rorchapters and other small employers? Emp16yeis'mUst
not pay for, at least two options, for standard coverage (one must allow for unlimited
provider) and one high-deductible plan; medical savings aCcounts are optional.·, .
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�THE WHITE HOUSE
WASHINGTON
Novenmber 10, 1994
XEHORANDtJK
TO:
Carol Rasco,~~~~ Gene Sperling
FROlI:
Mike Lux
aB:
Attached letter
fI t
with the Reagan anouncement drawing new attention to Alzheimer's
disease, I think doing what the attached letter suggests
(launching a full-scale administration effort to conquer
Alzheimer's) is both good policy and good politics. I know that - .
every penny 7in··.tbe .federal:bUdget-.;~is : tight;~':'but::it:::seems ~;to~;.~· .......
that a relatively ·modest .investment of $100 :.:million.::over:otVO,·':'-~:-:"'~·:;i;~··'"·'.~
.,-~- ..
years does an enormous amount of good for people,.:,aswell as::!:"",<:"~;
buying an enormous amount of non-partisan goodville 'We
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even call it the -Ronald Reagan initiative to conquer
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Alzheimer's." . It would also have the advantage of addinq;on8~.~.~
more concrete accomplishment. to talk about vh~ .. people
on the health care issue. :;~iJ::;:\-"'~' ·.-:;:.:<,?l~ti:
.FYX. the Alzh'el,1tiex::'s: .assOeia~lon,!.1ias.~_erie· QL:~'St.r-onqest,· :;*,!b~~1;;~~(.S+'
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�October· 4, 1994
......
'Iba Pmsidem
The '9f'b.itc House
Wadlington. D.C. 20m
Dear Mr. PIesideDt:
I am writf.n: about an Issue tballt ODe dme or muthI:r win lOUCb "'life ofew;ry
American. On behalf of the 4 m.Ulion persons who. suffer from A1zheimer"s disease as well
as tbc "19 million family members Who care for ttxm.. I urge yon to romnrillhe powen or
your office to an alI-ou: effort to conquer ~s ~.
.
.
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.The l1fet1me COSt
or AlllJeImcr". ~ tur r.J.wsc alread)" It::ictaI it ~atr4 •.....
$1.75 aillion. That makes Alzlleime(s already·tbe third most e:.qcmite ~ in 1IIe
.
United States, &"ter heart disease and ea.tX:C. But this is only the Up tL tire kebetJ. 1be .
N'stioml InStin:rtBS of Heald!. estimate that, unJP.ss !dence f!in& I 'Vnr1 SOOB to ewe or preve.al
.the disease, the number of Amer.ieaDs with A1zhelmet's will mushroom fmm 4 miDioo ~
.to more 1ban 14 m1IJf0ll1D. our lItedma.
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If we do not act DOW, Alzheimer's disease. will be the 1l1.lDlber oue public heaWl'crisit .. .
of tba 21st ceor.uty. For that reason, we argeYoo. to make conQ.U.etiDi Alzheime(S;~i :. . .
a high priority of your adtnitistratioa.;
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Health Care Qs and As - November 8, 1994
Q. The Washington Post this morning cited a White House official as saying that you
may be doing more by executive order, including giving states waivers to experiment on
health care reform. Given the Republican control of both the Senate and House and
fierce Republican opposition to your original plan, will you consider abandoning federal
health care reform efforts and promote reform through state waivers?
A. I have repeatedly stated that I am flexible on health care reform. I have already granted
waivers to states to pursue health care reform efforts. But we as a nation must confront the
fact that in spite of having the :l5est health care system in the world, another million
Americans lost their health insurance last year and costs continue to rise. I will not abandon
my commitment ot the American people to provide health security and make health care
affordable for American families. And I hope that the new Republican majorities in the
House,and the Senate will work with me to achieve these goals.
Q. Congress failed to enact your health care plan last year and expectations are that
with a more conservative Congress next year, it will even be more difficult to pass health
care reform legislation. Will you produce a modified approach, perhaps something that
will garner more Republican support - or will you introduce something that can be used
as a campaign issue ill J996?
A. There have not been any decisions made on how we will approach health care next year.
The only decision made is that weare not going to give up the battle. Another million
Americans lost their health insurance last year and costs continue to escalate. We cannot
walk away just because the road to reform is difficult.
We obviously want health care to be handled in a bipartisan fashion. We always have. We
tried repeatedly during the last session to work with Republicans. They threatened to
filibuster in September and it put health care reform on the shelf for now. But I think there
is a good opportunity to provide people with the health security that they want - with quality,
affordable health care and private insurance coverage. And it is an opportunity that 'can be a
reality if we work together.
Q. The Republicans, with massive, special interest help, successfully labeled your plan as
government-run and stated it would lead to rationing and massive job losses. Will the
Administration do something to help change this public perception? Will it abandon
alliances, move at a slower pace, back away from universal coverage?
A. Again, no decisions have been made. We will obviously try to better explain to the
American people that we are talking about preserving what is good in our system and fixing
what isn't working. And when we talk about preserving what is good, we mean preserving
the private insurance system. Providing Americans with private health insurance that can't be
taken away if a loved one gets sick or a job is lost.
�Special interests spent hundreds of millions of dollars to scare and mislead the public. Yet, in
spite of their success in creating confusion, the American people still overwhelmingly believe
that we must act to provide health security to American families and make health care more
affordable.
Q. Reports from senior White House officials last week stated that you were removing
the First Lady and Ira Magaziner as the leaders in developing health care legislation
and replacing them with Carol Rasco and Bob Rubin. Is this move a recognition that
last year's process was a failure?
A. First, let me state that reports that the First Lady will not be involved in health care are
ridiculous. The First Lady will play an active role in policy strategy and development and
she will remain the Administration's public advocate on health care. At my request, Ira will
also remain involved in health care.
We are entering a different phase in the health care debate. The last two years were spent
doing an enormous amount of research and policy development. We are now entering a
phase that will allow us to move health care through the same policy process that we use for
other major domestic policy issues. The Domestic Policy Council (DPC) and the National
Economic' Council (NEC) wiUcoordinate our future health reform efforts.
Q. Given the difficulty in enacting a bill with universal coverage last year, will you
pledge once again, in a more conservative Congressional environment, to veto a bill that
does not achieve universal coverage?
A. We still believe that every American deserves health care coverage ..Our goal is universal
coverage. And we're going to do everything possible to assure that Americans have health
care coverage when they need it. And we're going to do everything possible to control
escalating health care costs.
The American people. still overwhelmingly support universal coverage. We must continue to
work toward achieving what the American people want and deserve.
I
Q. There is speculation that the Administration wiH be presenting recommendations to
Congress on health care reform and that these recommendations will be part of the
budget. Are you going to submit a new plan and, if yes, have you given thought to what
these recommendations will include?
A. We have not had a chance to think exactly about where we will go or even in what form
any such proposal would be presented. Could recommendations be submitted as part of the
budget? Yes, but it is also possible they won't be part of the budget.
�Q. Are you going to do tbis all at once or are you going to pbase it in?
. A. No' decisions have been made.
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their future and what changes they want, not necessarily about
whether the parties are 'ideal or perfect or whatever.
We're going through a period of change. The American
people are not satisfied either with the rate of change or with the
certainty that it will occur. And they, like everybody else --I
mean, after all, you can't -- the people are of more than one mind on
more than one issue. That is, all these interest groups that
everybody reviles when they want campaign finance reform or lobby
reform are the same p~ople that have the money and the organized
communications ability to change the attitudes of the people out
there on issue after issue after issue.
So the impqrtant thing and the message I have to say iSI
what is the direction you want? Do you want continued progress in
the economy? Do you want a government that takes on tough problems
like crime and welfare reform and health care? Do you want a
government that does things for'ordinary people, like the Family
Leave law or making colleg,e loans more available to middle class
people? Or do you want ;this contact, which says clearly, give us
power and weill take you! back to ,the '80s; we'll give you a trillion
dollars worth of promises; we'll promise everybody a tax cut; we'll
explode the deficit; wei'll cut Medicare; we'll never fund the crime
bill; but we will have told you what you wanted to hear?' I think the
American peopl,e will vote for the future and not the past, and that's
my hope and" belief.
Q, Mr. President, a question about bipartisanship.
Looking back on the heal:th care reform effort, is there anything you
think you could have done differently to forge a consensus? For
instance, do you think'it would have helped if you'd brought
Republ ica,ns earl ieron in the process up to the White House to
negotiate the way you did at the end of the crime bill fight? And
looking ahead to next yearwhen'you're going to be pushing health
care reform and other issues through a more Republ ican Congress, is,
there anything that you plan to do differently to forge a coalition
for governing?
'
THE PRESIDENT: Well, let me say, I'm sure that there
are some things I could ,have differently. You know, I never dealt
with Congress before las~ year and I'm still learning all the time.
I would point out that the Congressional Quarterly said that last
year that the Congress and the President worked together more
successfully than at any time since World War ~I except in President'
Eisenhower's first year and President Johnson's second year. So I
felt that we accomplished quite a great deal.
When we wer~ putting this health care 'bill together,
there was a lot, of conSUltation with R~publicans. When we wanted to
present a proposed bill and say, now, how would you like to change
this, we were told that they had their own group working on health
care and they wanted to present a bill and then we would get
together. So I said, that's fine; I understand that. Then Senator
Chafee, to his everlasting credit, carne up with a bill that had two
dozen Republican senators on it that would have covered all Americans
and controlled costs. By the time we got down to serious,
negotiations, instead of~two dozen senators for universal health care
and controlled costs, there were zero. They all left. I mean,
Senator Chafee was still there, but everybody had abandoned his bill.
We had one Republican congressman saying they'd all been instructed
not to work with us.We.had one Republican senator quoted in one of
your papers saying that they had killed it, now they had to keep
their fingerprints off of it.
So I am more than happy to work with them in any way I
can. I do not believe we have a monopoly on wisdom. Let me give you
some evidence of my good faith on being flexible about changing. I
have given state after state after state waiver from federal
regulations, to pursue universal coverage and health care costs
control on their own. Tennessee has done some very exciting things,
�- 12
and by the way, gotten some very impressive results I understand. We
just· approved .Floridato do this. We're in the process of approving
more states.to move forward~I am very flexible on how we get this
done. And if the Ainerican people are worried that the federal
.
government has too much emphasis and they want more for the state~,
fine, let's talk about that •. But if there's going to be a· bipartJ.san
effort, it has. to be 9~od,faith on both sides.
.;::
I 1
I like working with Republicans •. I proved that in the
NAFTA fight, proved it in the crime bill fight •. I will prove it in
the health care fight. ,But it can't be a kind of situation where
every time I move to them, they move further the other way. That's
the only thing I would say.
Q
Yes ,'sfr, last question.
Q
Mr. President, for secretary of Agriculture, will
you be looking for someone with farm experience, or will you be
looking for somebody like Secretary Espy, who has heavy congressional
experience? '
.
THE PRESIDENT: Well, the most important thing, I think,
is someone who really understands how to deal with the agriculture
community, understands the interests and is committed to agriculture
and to farmers and fo ruli:"al development. And let· me say, if I might,
in closing, that I also·want somebody who will faithfully implement·
the reforms th'at Secretary Espy. has started.
.
.
\.
We passed a:dramatic restructuring of the Department of
Agriculture. We're going to take down the number of employees by at
least 7,500. We have seen an Agriculture Department that has. been
extremely. active in helpi~g farmers deal with disasters; that" has
tried to help'thefarmers,in the l:fiddleWest with their production
,problems;.that has given :an enormous amount of emphasis to rural
development •. So this Agriculture Department, under this·secretary of
Agricultp,re, has established a lot, of credibility·with the American
':people who ar.eiriagriculture, including selling rice to Japan for
the· first time, selling·apples f;rom Washington to Japan for the first·
time,. doing things thatlraven'tbeen done fora long time for
hardworking, grass-roots ;farmers, whether they're 'Republicans or
Democrats or independent~.
.
"
.
,;
,'.
, And when I qamehere, out of a rural background, out of
. a farming backgroilnd ,tb.atl.s what I desperately wanted to do for the
agricultura1 communitY.lmd so when I pick another Agriculture
.
'Secretary, :that is a stan'q.ard that Mike Espy set that must be met for
the next AgrAculture Secretary.
Thank ypu very much.
END
MORE
2: 46 P.M. EDT
�
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Carol Rasco - Issues Series
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Carol Rasco
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Health Care Meeting: 14 Nov. 1994 Senior Groups 10:00-11:00
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Box 124
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https://clinton.presidentiallibraries.us/files/original/737e1b5db5cfc842970dcb8b575e676c.pdf
f0c045faba37a0472397094ed660f0b2
PDF Text
Text
'.
.
..
PHOTOCOPY
PRESERVATION
��November 11, 1994
MEMORANDUM TO CAROL RASCO
FROM:
Marilyn Yager
MEETING:
Families, USA
DATE/TIME:
Monday, November 14
3 : 3 Opm - 4: 3 Opm
LOCATION:
Room 476, OEOB
AGENDA/TALKING POINTS:
Int:roductions
Thank thein for coming and for their
unbelievable work and sUpport for the Health
Security Act.
OVE~rview
Comments
1. Comment briefly on the broader
Administration priorities for next year,
i.e., welfare reform, etc.
2. Comment on" the new health care team headed
by you and Bob RUbin.
3. Describe how we plan to proceed on health
care, i.e. meetings with allies and key
health players before any decisions are made.
4. Indicate that we are using the next three
to four weeks to listen and learn from our
allies, hence the purpose of this meeting.
Open it up for discuSsion.
No~rE:
When inviting groups to these meetings
I have asked them to come, prepared to give us
thl~ir assessment of the new political
environment and what it means for health care
reform. To tell us what increinental reform
would they support (if any) and what
incremental reform do they think ~ould hurt
thl~ system.' And finally, to be prepared to
tell us what they learned about their own
membership during the past two years on what
could be sold at the grassroots level and
what could not.
�You are likely to be asked whether we are
planning to propose health care reform as a
part of our FY96 budget and whether we are
planning to propose Medicare cuts.
ThE~ most important message we can send, is
that we consider these folks friends and
allies and we are demonstrating that by being
as frank as possible regarding what we are
thinking.
Families, USA, founded in 1982, has served as
a convener of consumer groups and allied
organizations on health and long term care
(formerly the Villiers Foundation). They
issue numerous reports on health and long
term care issues, and are often asked by
Congress to testify and by the media to offer
a (~onsum:er perspective. '
BACKGROUND:
For their size and revenue, their support for
the Health Security Act was unmatched. They
established 30 state health care coalitions,
and in many states hired field staff to build
grassroots support for health reform. They
also published key reports that.we often used
to describe the problem and what the Health
Security Act do to address the need.
Ron Pollack has been executive director of
Families USA since its inception and has been
a committed Clinton supporter since the early
days of the campaign.
Their issue priorities were long term care
and universal coverage. I have attached an
example of their early correspondence with us
on Long term care to give you a flavor of
their detailed knowledge and pragmatic
approach to health care reform. I have also
attache an example of one of their press
releases regarding building support.
ATTENDEES:
Ron Pollack, Executive Director, Families, USA
Judith lNaxman, Director, Government Affairs
Phyllls Torda, Public Education
"'
Carol Rasco
Chr is Jtennings
.lili~
Fede!
(ctmCac:t"Ve)
Mike Lux
Marilyn Yager
�,
.
eONFleEN"FIAl:
TO
.
Mike Lux
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DETERMINEDTO BE AN
ADMINISTRATIVE MARKING
INITIALS: ®< DATE: b'6/05/IO
FROM:
Ron Pollack
RE
Seeking a Bottom Line on Long Term Care
:
DATE:
April 29, 1993
You asked me to give you a re~ding about an approximate bottom
line for various senior organizations that you specified concerning
long term care in the President's health proposal. In response to
your request, I held sE:!veral off-the-record conversations and -
while none of them were precise 'about their bottom line -- several
key points can be gleaned:
1.
Due to the President's and First Lady's comments on the
subject, there':'::cis
unanimous expectation t~at~:prescriptionZl'idr,ugs!':_~.~J
will be in the benefit package and in Medicare. While prescription
drug coverage is not their top priority -- long. term care is -
there would be major disappointment if drugs are not in the
package. I am unable t:o glean a bottom line, however, concerning
drug deductiblesand co-payments -- but, given previous experience
on this issue in the Cat:astropl1ic Health Care legislation, it is an
,aspect of drug coveragE! that will be looked at -,carefully.
a
2. There is unanimous agreement that the fIrst long term care'
priority is home and'community-based care, not institutional care.
The senior groups, more than the disability organizations, however,
are looking for' some recognition about the need for protection
against expensive nursing home care. Whether phased-in coverage
.. (over a more prot-racted, period of time ) for .P.llx:§i:t:lg.homecaJ;'~~ust
be in the bill, or whet;her it suffices to recognize the need 'with
a promise to deal with it sometime in the future, is unclear. For
the senior groups, however, it seems clear that they need at least
a big enough rhetoriccll fig leaf on nursing 'home protection to
assuage their memberships.
It would -be' very helpful to enact
·nursing home coverage, even if the implementation schedule is far
in the future .. '
.
.
.
3. -There is every expectation that the new' home care coverage
will be phased -in over a period of time.
I . have not heard a_
specific bottom line about the length of the 'phase-in period,"
but the typical response assumes a five-year range.
(These,
assumptions, however, .~re not based on an adequate sophistication
about
the
fiscal, difficult.iesthe Administration has ,in
constructing the overall package, or the,Administration's possible
decision to complete clcute care universal coverage in more than
five years.)
No one expects completion of home care phase-ins
prior to acute care coverage.
"
1334 G STREET, NW • WASHINGTON, DC 2000S • 202-737-6340 • FAX 202-347-2417
�Memo to Mike Lux
April 29, 1993
- 2 -
4.
There isa willingness to see coverage phased-in on an
income needs basis. There is a very strong antipathy, however,
to an ultimate des ign that results in a poor people's program.
This should be clear in the legislative proposal.
I believe,
however, that a progies:sively graduated set of co-payments and/or
deductibles -- perhaps (although I'm not sure) even a fairly steep
graduation based on economic circumstances -- might be acceptable.
5.
It would be very helpful if there was·a modest start on ,',
long term care at the earliest stages. I believe that respite care
could work as the likely candidate for sucha.first step.
I have not seen the long term care option paper currently
before the TaskForce, nor have I seen the cost estimates of the
options. From the accounts I have read, however, I believe that
.- -the option ..tp.~~.·9raduallyp~~se.s..-,,~ .. home care~£~~~f:it_for all j,,_~L~.J:l_e...:~._.._..,_
right direction to go for securiri~f-the organ1.zatrdiial-support':':froiii;:'Sl'~~ .,'
the groups you identifiE~d. (And, if I may editorialize rather :than:'
just report: I would add mandatory spend down protection ~tQr
nursing home care undeir Medicaid for the 19 states that don'i't
currently provide it together with modestly. upgraded spousal
prote.ction --' joined wi th an oral conunitment .to .future nursing
home reform.) .
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�Families
FOR IMMEDIATE RELEASE
WEDNESDAY, SEPTEMBER :~2, 1993
LEA1)ING HEALTH CONSUMER' GROUP
VOICES ENTHUSIASTIC SUPPORT
FOR CLINTON HEALTH REFORM
"It's great for American familie$! The President's Reform
will absolutely guara:ntee that you'll never lose your health
insurance, no matter what," according to consUmer ,advocate Ron
Pollack, '·executivedirector,:~f.:=Families USA.=-,,,_=_,-,",,. _ _ , _., __ ~__ '''-'~'' ,,"
The health consumer group" came out strongfy"-'in suppcift~6f:~~~~""
the President's Health Reform.
' 'f
"This plan will restore peace of mind to ,American families
who worry they'll be among the two million Americans who 'lose" ,
coverage every month," Pollack said.
,
'' ,
"President Clinton's Health Reform will barithe fine print -~ ,
that insurance compan.ies, use to dump you or deny you benefits' "
you've paid for. ~.Ij:,.wj.ll_,cJ;:'~qk .. gQwn on ins\lranc~_ a,.ud',qI"U,g',:-::,:;;o,: ",;,::~~
company overcharcjes~"-"Weire'-very"eiithusra:s-'Fic"In' 'our"support,"'for'-
the reform, It--Pollack 'said." ~,:~.,~,: ...:,-.. ,
, 0"':>"- -'~'-_"r' i'~'"
-:.;h0
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- 30
FOR IMMEDIATE RELEASI~
WEDNESDAY I' SEPTEMBER 22, 1993
HEALTH CONSUMER GROUP RELEASES ANALYSIS
SHOWING ,FAMILIES HELPEDay CLINTON HEALTH REFORM '
Families USA today released ananalysissbowing how'
Americans would:be helped by Clinton's Health Reforin.
[NOTE TO EDITORS: THE FULL TEN PAGE REPORT TEXT (WITH STORIES OF
REAL PEOPLE IN EACH CATEGORY) IS AVAILABLE BY FAX OR MAIL.]
- more
CONTACT: ARNOLD BENNETT OR AVIVA SHLENSKY (202) 628·3030
1334 G STREET NW • WASHINGTON DC 20005 • FAX (202) 347·2417
•..g.."
�'Page 2 of 7
The report looks at the impact of reform on ten groups:
1. Insured Americans at risk of losing their health
insurance.
2. Americans with inadequate insurance.
3. Americans with high prescription drug costs.
4. Americans 'whol retire early and lose health benefits.
5. Americans who are job-locked.
6. Americans who own small businesses--and their families.
7. Americans who need long term care at home.
S.· Americans whoseemp;J.~yers :cut:back, o.l'!:~~~~~~h})er:te!~~~.:;':.::~,t.;. . ,.·"c~":' ":
.
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9. Businesses with skyrocketing premiums.
10. Americans on Medicaid who can't
geth~a~th care • •. ~::.~f;;~~'
INSURED AMERICANS WHO WOULD LOSE THEIR ·INSURANCE.,._ .....:"-',""-'~~c.
,
":',7.
.
,',~~::.~r~~., ..... :,.-.
For the mOr.$;i?than;two Ullil1ion::insured~:America:nS 'Who·.:.losec0"~;~·i::;~·,:, '.:
.
\.
their health insurance each month, the Clinton Health
>\. ~
Reform',~":;:"' .
.
'
.. ftquarantees. that no Amt:!rican can lose health insurance, no matter'
.:••
__
.~. -
~~;.. ,
what.
-
-'.)'
. ' +";i::::.....
;.
__,'
•
'\-".'~'~,;.::~ :.;::.:.:~
-.:~:"":".... ~C::::"\.,."
~
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A health security card will guarantee all Americans
comprehensive health benefits, even if they lose or change jobs/
move out of state, .get divorced, start a small business, or'
....
.
'-"
";.*.' :' •
someo.ne in the family gets sick •. FAMILIES USA RATING:
.
reason to support plan.
,
,
"
I
,
. I
I
.I
\
.- more
J:
VL
�Page 3 of 7
INSURED AMERICANS WITH INADEQUATE INSURANCE
Millions of Americans have inadequate insurance that can
leave them with many th.ousands of dollars in medical bills.
About 18 million insured Americans will have to spend at least
one-tenth. of their incomes on out-of-pocket health costs in 1993;
CI int.on 's
comprehensive
pocket costs.
Health Reform guarantees all Americans
~ealth
benefits, with strict iimits on out-of
It bans all lifetime limits on benefits such as:
hospital care, emergenc:y services, doctor visits, pre-natal care
and . home healtjl-:;:.care·fc)r
~IHG:
th~ _::~lqf!r.1Y:
:and_dJ~~~l?.J.:~!~~~~~AMI.~!!!~r;~7·,:: :..;.~;;e_
<__ •.
, .""'V'.'. .
."
;._....,.;:.~" ,~,,~,
Important new protection for insured Americans; savings
.
.
for. families hit by illness.
_
...Oi".,.:AMERlCAHS WITH, HIGH PRESCRIPTION' ·DRUG··COSTS "~~ , .
..;".~;.
,
..... ,.,.
','7" '
'.
About· 72 million ;/\mericans now
lack ~rnsul:'ance, covel:'ageh.:t,QI:'ih·
prescription drugs, and skyrocketing drug prices make it more and .
. more
diffic~lt . .for
Americans to afford their medications •
• ";3;::
" __
,'"
:
","",":'~'t~~j3a;~.-t_~~t: .•:-'
The Clinton Health Reform includes an important new drug
benefit for Americans.
No elderly American'will ever again have
to pay more than $1,000 a year for drugs, and most· will pay far
less. . After mCi!eting a $250 annual deductible, Americans· ~f-:'ari~;;:
- .....
.- .
age will have to pay no more than 20 percent of· their
prescription drug costs.
"'
Americans under 65 w"ill have a$li,50~··; .'
I
.
annual limit on what they can be charged, or $3,000 per famaly.
FAKILIES USA RA'l'ING: l:mportant step forward.
- more
�Page 4 of 7
AMERICANS WHO RETIRE EARLY AND LOSE HEALTH BENEFITS
Many companies have cut back or eliminated health coverage
for their early retirees,
protection.
le~ving
many Americans without health
Clinton's Health Reform will guarantee health
coverage to early retirees, with the federal government paying 80
percent of premiums for retirees between the ages of 55 and 65.
The former employer or the retiree will pay the remaining. 20
F~ILIES
percent of the health premium.·
USA RATING:. Protects
retirees while taking pressure.off businesses.
AMERICANS WHO ARE "JOB-LOCKED"
One in five worlce:r:'s
rep~rt
can~:{'
they or a familymeInber
-' ..: t'\'
switch jobs because ne'flir workol·fers limited
•
insurance.
-
or.'no~health
.~~"
""<'h ,"
.
The . ,.ClintorlHealth Refprmwill"absdititely:ban:,., .,-....,.'' ','".,;"..~'''
,
'.
::1.:'".
.
:"'.,.
'f,
..':'
0
insui:cimce ,companies' Ero:ra(.,exclud.'ingc;'anyone~n or:any:~ health::::,,:, '.'
condition, from coverage under any circumstances by·1997 •.
. FAKILIES USA RATING: El~cellent.y~o~~tion~o.~~,~i,~~~.,,~~p'ro]):!~::Ii':"~~'_:f:::;;,~"",':
,
.
AMERICANS WHO OWN SMALL BUSINESSES--AND THEIR FAMILIES
Small'business owners pay si911ificantlymo:re for heal:t:h
'
.
. insurance for their ·f~u{\ilies ,and' wor,kers thanlarge'businesses:
pay.
Their
premiums'~an
skyrocket if, an
empI~~ee
"
-:
or'a 'famii'i,i'>
...
,'
'
i
member gets sick or injured.'
-~
.
Insurance companies bften refuse to '
' \
'.
.
cover an individual whc).worksfora smallbusinesslbecause of a
'.
health condition,. or
.
rE~fuse
coverage6f a business bec;:ause of the
nature of the industry.
- more
..,
,,'
"
�'.
Page 5 of 7
The Clinton Health Reform will guarantee that small business
,~wners
can buy insurance at'the same--or lower--price as big
business.
The Reform will also limit insurance company premium
increases, putting an end to health premium increases of 20
percent, 30 percent and more that small businesses have suffered.
Also, insurers will no longer be able to reject businesses or
individuals for any reason.
In addition, small businesses will be eligible for
significant new discounts.
c
:~insurance:companies,
FAMILIES USA RATING: Tough on
helps,most':$mall
bus,i~,~sse~~q.;~_a~!y!~.:p2~~~l'::'-;:-
AMERICANS NEEDING LONG TERM CARE ATBOME
Almost every American family eventually faces a long tem :;;'.;.
.
~~~~~:'~'
,
care crisis,i-...and ,"most AIpericans'want "theiI?-elderlyparents_tC!.;. be,
cared forat"·lrome,ratber·:'than in'Cl',;:;nursing home •.' But, many
\
American families who need long term care at homez:eceive no
professional home care services, often because they can't .:....
afford
"
':-:.~
:-~.'"j~~:,:?~~\~:.,~
The Clinton Reform will provide home care help to Americans'
who most need the help..
By 1996, Americans who need long term
,
c~re
,
,
will begin to be t!ligible for services that can keep' them at
home; the program is tc::> be. fully phased in by the year 2000 •
i
. .'
-'
PANXLIES USA RATING: Valuable. first step!, an important new
~
\
benefit for· older Americans.
- more
,
�Page 6 of 7
AMERICANS WHOSE EMPLOYERS CUT BACK ON THEIR HEALTH BENEFITS
About 40 percent of employees and their families are covered
by employer health plans that are self-insured.
Self-insured
companies do not purchase health insurance from a private
insurance company, opting instead to pay.the cost of their
employees' medical care directly.
Self-insured compa.nies are now allowed to limit or eliminate
health insurance benefi.ts at 'any time.
Some self-insured
employers have,limited employees' health coverage after sickness
str!kes. '. - .':
The Clinton ReforIll will absolutely prohibit all employers
and insurers ·from imposing caps or' exclusions on coverage for
specific medical conditions, 'and will ban lifetime limits 'on
benefits.
.Comprehensive coverage will be required.
,
FAMILIES DSA
RAYING: Excellent new protection.
BUSINESSES WITH SKYROCKETING PREMIUMS
Health costs are eating away at
employee wages.
~usiness
profits and
Today, business spending for health care nearly
equals after-tax profits, up from 40 percent in 1980.
The Cl inton Health· Reform, will strictly 1imit .the amount·.,
insurance companies .can raise premiums.
not be allowed to increase
.By 1999; premiums
w.~ll·
inflation. FAMILIES DSA
\
RATING: Tough on insurance companies, good for families and D.S.
fas~erthan
economy.
- more
�Page 7 of 7
AMERICANS ON MEDICAID WHO CAN'T GET HEALTH CARE
Last year, almost one of five adults on Medicaid were turned
away by a hospital or doctor.
emergency ,room for
carE~
Another 20' percent had to go to an
because they did not have a regular
physician.
Under the Clinton Health Reform, Medicaid recipients will be
enrolled in the same
hE~alth
same high quality care..
plans as other Americans, and get the
FAMILIES USA RATING:
Ends the scandal
of Uedicaid failure.
Families USA is the health consumer group fighting for'
health and long term care reform.
- 30
�
Dublin Core
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Title
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Carol Rasco - Issues Series
Creator
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Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Clinton Presidential Records: White House Staff and Office Files
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92 folders in 7 boxes
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Health Care Meeting: 14 Nov. 1994 Families USA 3:30-4:30
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Carol Rasco
Issues Series
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Box 124
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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2010-0198-Sb-health-care-meeting-14-nov-1994-families-usa-3-30-4-30
-
https://clinton.presidentiallibraries.us/files/original/b786d4b95bb917f6c263e7f947436baf.pdf
79919c0827deaefc75d14a0a802071e6
PDF Text
Text
The prohibition on future contributions to section 401(h) accounts would be effective
January 1, 1995 (or, if later, at the end of the current collective bargaining agreement, but in
no event later than January 1, 1998).
The am~ndment to the welfare benefit fund rules requiring a ten-year funding period
would be effective January 1, 1995. The other amendments to the welfare benefit fund rules
would be effective with respect to additions to the reserve after enactment. No inference
should be drawn as to whether these other amendments represent changes from current law.
Title VII
254
�SUBTITLE E - COORDINATION WITH COBRA CONTINUING
CARE PROVISIONS
(H.R. 3(,00 and S. 1757 p. 1157)
Section 7501. Coordination with.COBRA Continuing Care Provisions. Under
current law, a group health plan that does not comply with the continuation coverage
requirements under section 4980B of the Internal Revenue Code is subject to an excise tax of
$100 per day for each violation. In general, a. plan satisfies the continuation coverage'
requirements, which are commonly referred to as the "COBRA" requirements, if the plan
continues to provide the opportunity for employees and their beneficiaries to purchase health
coverage after a qualifying event. For this purpose, a qualifying event includes the death of
the covered employee, termination of employment, certain changes in family or marital
status, or entitlement to benefits unde:r Medicare. COBRA coverage generally must continue
for up to 18 months (or, in some cases, up to 36 months) after the qualifying event.
However, COBRA coverage terminates if the employee or beneficiary is covered under
Medicare or another group health plan before the end of the required time period.
The enactment of health care reform will make COBRA coverage unnecessary
because health care coverage will be made available to all individuals. Therefore, the Health
Security Act would repeal section 4980B of the Internal Revenue Code as of the earlier of
January 1, 1998, or the fIrst day of the fIrst calendar year following the calendar year in
which all States have in effect plans under which individuals are eligible for comprehensive
health coverage described in the Health Security Act. For the transition period between
enactment and full implementation of health reform, COBRA coverage would not be required
to be offered, or to continue, once an individual becomes eligible for such comprehensive
health coverage.
Except as described above,the provisions would be effective on the date of
enactment.
Title VII
255
�SUBTITLE F - TAX TREATMENT OF ORGANIZATIONS PROVIDING
HEALTH CARE SERVICES
(H.R. 3(.00 and S. 1757 p. 1159)
Sections 7601, 7602, and 76021. Tax Treatment of Organizations Providing Health
Care Services
(a) Nonprofit Health Care Organizations and Regional Alliances
Internal Revenue Code section. 501(a) currently provides that certain organizations,
including those described in Internal Revenue Code section 501(c), are generally exempt
from income taxes. Among the organizations described in section 501(c) are organizations
that are organized and operated exclusively for charitable purposes (section 501(c)(3)) and
organizations not organized for profit but operated exclusively for the promotion of social
welfare (section 501(c)(4)). Section 501(m) disqualifies an organization from exemption
under section 501(c)(3) or (4) if it provides "commercial-type insurance" as a substantial part
of its activities. The definition of commercial-type insurance does not include incidental
health insurance of a type customarily provided by a health maintenance organization
(HMO).
Revenue Ruling 69-545 holds that a nonprofit hospital is a tax-exempt charitable
organization if it promotes the health of a class of persons broad enough to benefit the
community and operates to serve a public, rather than a private, interest.
An HMO that provides health services predominantly at its own facilities through the
use of its own staff may qualify as a tax-exempt charitable organization under the same
standards that govern nonprofit hospitals. Sound Health Association v. Commissioner, 71
T.C. 158 (1978). By contrast, an HMO that does not provide health care services itself may
be denied exemption as a charitable organization under section 501(c)(3). Geisinger Health
Plan v. Commissioner, 985 F.2d 1210 (3d Cir. 1993). A non-provider HMO may qualify
for exemption, however, as a social welfare organization described in section 501(c)(4).
Private foundations are sut~ect to certain excise taxes. In general, private foundations
include tax-exempt charitable organizations other than churches, schools, hospitals,
organizations that normally receive more than one third of their financial support from the
public, and "support" organizations that are organized and operated exclusively for the
benefit of an organization that is not a private foundation.
Present law provides no l1Jle that applies specifically to regional alliances.
A nonprofit health care provider should not qualify for tax exemption unless it
provides services that are beneficial to the community. Therefore, the Health Security Act
Title VII
256
�would adopt new rules to provide further assurance that nonprofit health care providers are
responsive to the needs of their communities.
The Health Security Act would provide a new standard that nonprofit health care
providers must meet to qualify as tax-exempt charitable organizations. A provider meets this
standard if, at least annually, and with the participation of community representatives, it
assesses the health care needs of its community and develops a plan to meet those needs.
This standard would apply in addition to the community benefit standard of current law.
The Act would also clarify the: tax treatment of nonprofit HMOs. First, consistent
with the Sound Health Association and Geisinger Health Plan cases, the Act would clarify
that an HMO can qualify for exemption as a charitable organization described in section
501(c)(3) only if it provides health care services to its members at its own facilities through
health care professionals who do not provide substantial health care services other than on
behalf of the HMO. In addition, the HMO must also meet the community plan and benefit
standards.
Second, for HMOs qualifying for exemption under sections 501(c)(3) or 501(c)(4),
the Health Security Act would provide rules regarding the treatment of certain types of
insurance provided by an HMO as commercial-type insurance under section 501(m). Under
these rules, "point-of-sef\!'ice" benefits relating to care provided outside the HMO's provider
'network are treated as commercial-type insurance. However, tax-exempt status should not be
jeopardized unless point-of-service benefits comprise a substantial portion of the HMO's
activities. / This is likely to occur only if the. HMO's network of providers is inadequate or
unresponsive to the needs of the me:mbers. In that case, the justification for continued tax
exemption would be questionable.
Insurance would not be treared as commercial-type insurance if it relates to (i) care
provided by the HMO to its members at its own facilities through health care professionals
who do not provide substantial health care services other than on behalf of the HMO, (ii)
primary care provided by a health care professional to a member of the HMO on a basis
under which the amount paid to the professional does not vary with the amount of care
provided to the member, (iii) services other than primary care provided within the HMO's
provider network, or (iv) emergency care provided to a member of the HMO outside the
member's area of residence. These rules codify the Internal Revenue Service's current
interpretation of section 501(m). See General Counsel Memorandum 39829 (Aug. 30, 1990).
Many hospitals are part of reorganized systems that are under the control of a parent
organization that serves essentially as a holding company for the system. To clarify that
these parent organizations are not private foundations, the Health Security Act would provide
a new exception from the definition of that term. The new exception would apply to parent
organizations that are organized and operated for the benefit of a hospital (or other
organization described in Internal Revenue Code section 170(b)(1)(A)(iii» that is directly or
indirectly controlled by the parent organization.
Title VII
257
�The Act would add a new paragraph to section 501(c) to specifically exempt regional
alliances from tax. The Act would also provide that regional alliances are treated as not
described in any other paragraph of section 501(c).
The proposal regarding nonprotit health care providers would take effect on January
1, 1995. The proposals regarding insurance provided by HMOs and the treatment of parent
organizations would take effect on the date of enactment of the Health Security Act. The
proposal regarding regional alliances would apply to taxable· years beginning after the date of
enactment.
(b) Taxable Health Care Organizations
Under current law, it is uncertain whether an HMO should be taxed as an insurance
company or as a regular corporation. If taxed as an insurance company, the HMO is entitled
to deduct an estimate of the liability for services rendered to members prior to the end of the
tax year but for which a claim has not been received by the HMO. These are referred to as
incurred-but-not-reported (IBNR) claims. Revenue Ruling 68-27 held that an HMO that
provides medical care through its own provider-employees was not an insurance company.
However, the issue regarding deductibility of IBNR claims is less important for this type of
HMO because generally all services that have been rendered by the HMO's provider
employees prior to the end of the tax year would be known and no IBNR liability would
exist. It is unlikely that regular corporations can sustain a tax deduction for IBNR claims
due to the Supreme Court's decision in General Dynamics.
Treasury Regulations provide that in determining whether a contract constitutes an
insurance contract for medical care, it is irrelevant whether the benefits under the contract
are payable in cash or services.
There is little distinction between the operation of most HMOs and insurance
companies. Whether a for-profit HMO capitates its providers or reimburses on a fee-for
service basis, the HMO assumes a risk when it agrees to provide medical service to its
members in exchange for a fixed premium. It is irrelevant for purposes of determining the
insurance status of the contract that medical care benefits are delivered to members of the
HMO in the form of services rather than cash. Accordingly, the HMO can be viewed as an
insurance company. Taxing HMOs as insurance companies matches income and expense.
Premiums would be recognized over the period that coverage for medical services is
provided. Corresponding liabilities would be accrued and deducted to the extent the HMO is
liable to provide services. Accordingly, a deduction would be allowed for accrued IBNR
claims at year end, a reserve for unearned premiums would be permitted (subject to the 20
percent reduction under current law), and 15 percent of certain tax-advantaged income would
be taxable.
Under the Health Security Act, for-profit HMOs and similar prepaid health care
Title VII
258
�service entities would be taxed as' insurance companies other than life insurance companies
under the provisions of Subchapter L of the Internal Revenue Code. Also, any organization,
other than a life insurer or exempt organization, would be taxed as a property/casualty
insurance company if its primary and predominant business activity is the issuance and/or
administration of accident and health insurance contracts or reinsurance of such contracts, but
only if the issuance or reinsurance of such contracts represents a material business activity of
the organization. Cost-plus contracts of the nature typically issued by Blue Cross/Blue
Shield organizations would be treated as accident and health insurance contracts for this
purpose. The proposal would replace the current section 833 (dealing with Blue Cross/Blue
Shield organizations).
The proposal would be effective for taxable years beginning after December 31,
1996. Any accounting method changes required by the proposal for taxable entities would be
made in the fIrst taxable year beginning after December 31, 1996.
(c) Blue CrosslBlue Shield Organizations
Under current law, Blue Cross/Blue Shield organizations (Blues) are generally taxed
as property/casualty insurance companies, with exceptions. The Blues are entitled to a
special income tax deduction, calculated as the difference between 25 percent of their health
claims (including claims expenses) and their adjusted surplus. This special deduction is not
permitted as a deduction in determining alternative minimum taxable income. The Blues are
also exempt from a rule that requires other property/casualty companies to include 20 percent
of the change in their unearned premium reserves in taxable income.
The special deduction was provided in recognition of the fact that the Blues write
health insurance policies for individ.uals and small groups for a reasonable premium, without
excluding persons with pre-existing medical conditions. The Blues generally charge
community-rated premiums.
.
The Health Security Act would prevent any insurance company from denying
enrollment to an applicant because of health, employment, or fInancial status. It would also
prevent insurance companies from charging higher premiums to persons more likely to incur
higher medical costs because of pre-existing conditions, age, or other factors related to risk.
The Act would effectively require all plans receiving premiums through health alliances to
charge community-rated premiums for the comprehensive benefIts package. Accordingly, a
subsidy to Blue Cross/Blue Shield companies would no longer be needed to make
community-rated premiums available to the public. However, uniform tax rules for
insurance companies selling community-rated policies would be needed to provide a
framework for effective market competition between the Blues and other health insurers.
The Tax Reform Act of 1986, which revoked the Blues' tax-exempt status," required
other insurers to include 20 percent of the change in their unearned premium reserves in
taxable income to provide better matching of premium income and policy acquisition
Title VII
259
�expenses. The companies were also required to include 20 percent of their existing
December 31, 1986 unearned premium reserves in taxable income ratably over a six-year
period, starting in 1987. (No modification to the amount of income inclusion was allowed
for companies, such as mutual property!casualtyinsurers, that had been exempt from tax at
some time in their history.) The Blues were originally exempted from the 20-percent rule
because any mismatching of currently deductible premium acquisition expenses and deferred
premiums had no significant tax impact since the Blues were exempt from tax. The
exemption from the 20-percent rule was also designed to ease the transition from tax-exempt
to taxable status. Now that the Blues have been taxable for several years, continued
exemption from the 20-percent rule is unnecessary, regardless of whether the 20-percent rule
reflects the actual acquisition expenses of health insurers. The elimination of the exemption
from the 20-percent rule should follow the same transition rules that were provided in the
1986 Act.
After enactment of the Health Security Act, it is anticipated that Blues organizations
would remain taxable as insurance companies other than life insurance companies under the
provisions of Subchapter L of the Internal Revenue Code. However. the special deduction
would be generally repealed for regular tax purposes (as it currently is for alternative
minimum tax purposes). A moderate phase-out of the special deduction would be available
for Blues that meet special eligibility criteria in both 1995 and 1996. The eligibility
standards are identical to the standards under existing section 833(c)(3) for organizations
desiring to qualify as Blues. The allowable deduction for Blues that satisfy the standards
would be 67 percent of the current special deduction in 1997, 33 percent in 1998, and
nothing thereafter. .
Blues would be required to include 20 percent of the change in their unearned
premium reserves in taxable income. Under a transition rule, 20 percent of any existing
unearned premium reserve balance would be included in taxable mcome ratably over a six
year period.
The proposal would generally become effective for taxable years beginning after
December 31, 1996.
Title VII
260
�SUBTITLE G - TAX TREATlV£ENT OF LONG-TERM CARE INSURANCE
AND SERVICES
(H.R. 3t,00 and S. 1757 p. 1171) .
Section 7701. Qualified Long-Term Care Services Treated as Medical Care.
Internal Revenue Code section 213 currently provides a deduction for medical care expenses
subject to a floor of 7.5 percent of adjusted gross income. Expenses for medical care
include expenses for lithe diagnosis, cure, mitigation, treatment, or prevention of
disease... [and] those paid for the purpose of affecting any structure or function of the body
or for transportation primarily for and essential to medical care." Under regulations, medical
care expenses are "confined strictly to expenses incurred for the prevention or alleviation of
a physical or mental defect or illness," and do not include expenditures that are IImerely
beneficial to the general health of an individual." The authorities generally indicate that the
cost of personal services, including custodial care, is a medical expense if there is a direct
connection between the service and a recognized, specific medical condition. Old age is not
a sufficiently specific medical condition for this purpose.
The authorities also indicate that services must be perfonned directly for the
individual. By contrast, services such as housekeeping, cooking, gardening, etc. which are
not performed directly for an individual are not considered directly related to a specific
medical condition. Where services qualifying as medical care are provided in addition to
services not qualifying as medical care, an allocation is generally required.
Regulations provide that the entire amount of an expense may be treated as medical
expense if the expense is incurred primarily to provide medical care. Under this rule, the
entire cost of services provided in a nursing home or similar institution may be a medical
expense if the principal purpose for the individual's presence is the availability of medical
care at the institution.
The Health Security Act would provide necessary guidance in establishing the
deductibility of long-term care expf~nses incurred by an incapacitated individual. The
definition of medical care under Internal Revenue Code section 213 would be expanded to
include qualified long-term care services. Services performed for an incapacitated individual
would be treated as deductible medical expenses subject to the 7.5-percent floor. An
incapacitated individual is a persorl who is unable to perform without substantial assistance at
least two activities of daily living or suffers from severe cognitive impairment. No inference
should be drawn as to whether ~s amendment represents a change from current law.
Medical care service expenses incurred by an individual who is not incapacitated
under this definition would be deductible, as provided under current law.
The provision would apply to taxable years beginning after December 31, 1995.
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�Section 7702. Treatment of Long-Term Care Insurance. Generally, the treatment
under current law of benefits provided under a long-term care insurance policy is unclear.
To the extent that long-term care is not treated as medical care, employer-provided long-term
care coverage would not be excludable accident or health coverage under Internal Revenue
Code section 106, and the value of the coverage would be taxable to the employee.
Generally, benefits paid under a long-term care plan or policy would not be treated as
amounts received through accident and health insurance on an excludable basis under Internal
Revenue Code section 104 or 105, unless the amounts received for long-term care represent
reimbursement for medical care.
I
Favorable tax treatment would be provided by the Health Security Act to encourage
the purchase .of qualified private long··term care insurance to assist with the fmancial
protection of an aging population. Following the design of the health reform plan, which
provides for a comprehensive benefit package, the Health Security Act would establish
favorable tax treatment for a qualified long-term care insurance policy. Supplemental long
term care insurance policies could be purchased but would not receive the same tax benefits
as a qualified policy.
Under the Act, premiums paid for a qualified long-term care policy would be
deductible as a trade or business expense or as an itemized deduction subject to the 7.5
percent-of-adjusted-gross-income floor; the value of employer-provided coverage under the
policy would not be taxable to an employee; and benefits under the policy would not be
taxable to the recipient. However, funding the purchase of the policy on a tax-favored basis
through a cafeteria plan would not be permitted.
A qualified long-term care insurance policy would be required to:
(a) satisfy certain regulatory standards set forth in the Health Security Act;
(b) condition eligibility for benefits on being unable to perform at least two activities
of daily living or on suffering severe cognitive impairment;
(c) not allow immediate prefunding or cash values; and
(d) limit benefits to $150 per day (indexed for medical inflation) without regard to
actual incurred long-term care expenses.
Any long-term care coverage provided by rider on a life insurance contract would be
treated as a separate contract. The addition of a long-term care insurance rider would not be
treated as a modification or material change of the contract for purposes of Internal Revenue
Code sections 7702 and 7702A.
The provision would apply to policies issued after December 31, 1995. A transition
rule would permit existing long-term care insurance policies to be exchanged for qualified
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�long-term care insurance policies without recognition of gain or loss.
Sections 7703 and 7704. Tax Treatment of Accelerated Death Benefits
(a) Accelerated Death Benefits Under Life Insurance Contracts
Payments made under a life insurance contract other than by reason of an insured's
death are generally taxable under CUITI!nt law. However, the tax treatment of payments made
under certain circumstances is not entirely clear.
Recognizing the benefits tosodety·of life insurance protection, the tax system
encourages the purchase of life insurance by allowing tax-free "inside buildup" and the
payment of tax-free benefits upon the insured's death. Other tax provisions limit the extent
to which the tax-favored nature of the insurance contract can be abused as a tax-favored
investment vehicle.
Terminally ill individuals face: varied needs in their last months of life. Gaining
access during these months to a portion of the death benefit under their life insurance
contract can ease some of the fmandal burden of the terminal illness. However, there is also
a need to balance the fmandal protection of the beneficiaries under the life insurance
contracts (which is the primary purpose of life insurance) against the needs of the terminally
ill.
While the tax system supports the purchase of life insurance as a means of providing
financial protection .for the insured's beneficiaries, the tax system should also support the
purchase of an accelerated death benefit rider on a life insurance contract as a means of
providing fmancial protection for the insured who becomes terminally ill. However, the
system should not permit abuse of the tax-favored nature of life· insurance by allowing
unlimited access to death benefits prior to death. The insurance feature would be
undermined if the insurance contract were to become a generous tax-favored investment
vehicle. Recognizing this potential for abuse, the accelerated payment of death benefits
should ~ permitted on a tax-free basis only if the death of the insured is imminent. The
insurance element of the contract would thus not be undermined.
The Health Security Act would provide insurers with standards needed to design and
market insurance contracts that provide for payment of benefits prior to an insured's death
without subjecting policyholders to taxation on the additions to cash value within the life
insurance contract. In recognition of the needs of individuals who become terminally ill, the
proposal would allow an accelerated death benefit received by an individual on the life of an
insured who is expected, due to te:rminal illness, to die within 12 months to be excluded from
taxable income as a payment by reason of death. No inference should be drawn as to
whether this amendment represents a change from current law.
The provision would apply to taxable years beginning after December 31, 1993 .
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�(b) Companies Issuing Qualified Accelerated Death Benefit Riders
Under current law, insurance contracts have been developed that provide for payment
of death benefits under a life insurance policy, as a result of terminal illness, prior to an
insured's death. Generally, the accelerated death benefit is equal to all or a portionof the
death benefit, discounted for the remaining life expectancy (generally 12 months or less) of a
terminally ill individual. Internal Revenue Code section 7702 defIDes a life insurance
contract as any contract that is a life insurance contract under applicable law, but only if the
contract either (1) meets the cash value accumulation test of section 7702(b), or (2) meets the
guideline premium requirements of 7702(c) and falls within the cash value corridor of section
7702(d). For- purposes of section 7702, the accelerated death benefit could be viewed as an
amount paid upon surrender of a contract and accordingly would be included in the cash
surrender value of the contract. The impact of this characterization would be to disqualify as
life insurance under section 7702 contracts providing accelerated death benefits.
As discussed above, it is desirable that the tax system support the purchase of an
accelerated death benefit rider on a life insurance contract as a means of providing financial
protection for the insured who becomes terminally ill. Accordingly, the proposal allows an
accelerated death benefit rider to be sold in conjunction with a life insurance contract without
causing disqualification of the contract as a life insurance contract. This protects the
policyholder from taxation on the inside buildup in the life insurance contract.
The Health Security Act would expand the defmition of a life insurance contract to
include a qualified accelerated death benefit rider on the contract and would treat the rider as
a qualified additional benefit under section 7702(f)(5)(A). Also, the addition of an
accelerated death benefit rider to a life insurance contract would not be treated as a
modification or material change of the contract for purposes of sections 7702 and 7702A.
No inference should be drawn as to whether this amendment represents a change from .
current law.
The provision would apply to contracts issued after December 31, 1993.
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�SUBTITLE H - TAX INCENTIVES FOR HEALTH SERVICES PROVIDERS
(H.R. 3600 and S. 1757 p. 1192)
Sections 7801 and 7802. Tax Incentives for Health Services Providers. Since the
early 1970s, the problems of shortages of health care professionals in certain geographic'
areas have been the target of the National Health Service Corps (NHSC) program. Pursuant
to that program, participating health care professionals who agree to practice in "health
professional shortage areas" (HPSAs) may receive scholarships or amounts that are used for
the repayment of educational loans.
There -continue to be significant shortages of health care professionals in a number of
urban and rural areas. Tax incentives would encourage health care professionals to locate in
underserved areas and thereby help alleviate these shortages. The current NHSC program
has not been sufficient to eliminate these shortages.
The Health Security Act would provide two tax incentives: (i) a nonrefundable credit
for certain primary health services providers (section 7801), and (ii) increased expensing
under section 179 for certain medical equipment (section 7802).
(a) Non-refundable Credit for Certain Primary Health Services Providers
This proposal would provide a $1,000 per month tax credit for physicians (and a $500
per month credit for physician assistants, nurse practitioners, and certified nurse-midwives)
who provide primary health services on a full-time basis in HPSAs. To be eligible for the
credit, the individual must first apply for certification, and be certified, by the Department of
Health and Human Services in a manner similar to that currently in effect under the existing
NHSC program. An individual would be eligible for the credit for up to a maximum of 60
months. Previously claimed credits would be subject to complete or partial recapture if the
individual works in the HPSA for less than 60 months. The credit would not be available to
health care professionals who begin work in the HPSA before 1995. In an effort to
coordinate this tax incentive with NHSC programs, individuals who have previously
participated in NHSC programs would not be eligible for the credit.
(b) Increased Expensing of Medical Equipment
Under this proposal, an additional $10,000 of expensing under Internal Revenue Code
section 179 would be available for certain medical equipment owned and used by a physician
in a HPSA in the active conduct of the physician's full-time trade or business of providing
primary health services in the HPSA. As the Omnibus Budget Reconciliation Act of 1993
increased the general section 179 annual limit from $10,000 to $17,500, the combined limit
would be increased to $27,500. This expanded level of expensing would apply to-equipment
used in the screening, monitoring, observation, diagnosis, or treatment of patients in a
laboratory, medical, or hospital environment.
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�The credit would generally be effective for taxable years beginning after
December 31, 1994. The increased expensing would be effective for medical equipment
placed in service after December 31, 1994.
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�SUBTITLE I - MISCELLANEOUS PROVISIONS
(H.R. 3600 and S. 1757 p. 1199)
Section 7901. Credit for Cost of Personal Assistance Services Required by
Employed Individuals. The Internal Revenue Code currently provides tax credits to assist
certain categories of workers and disabled taxpayers. For example, the earned income tax
credit is available to low-income workers. The dependent care credit is available to
taxpayers who incur household and dependent care expenses in order to be able to work.
The elderly and those who are totally .and permanently disabled are entitled to a credit
regardless of whether they are employed.·
Individuals with disabilities who are capable of working face a number of special
challenges in the daily activities that are associated with gainful employment. The incentives
provided to these individuals will assist them in their efforts to become, and remain, part of
the work force.
A nonrefundable tax credit would be made available to individuals who work and
who, by reason of a medically determinable physical impairment that has lasted (or can be
expected to last) for at least 12 months, would be unable to engage in substantial gainful
activity without personal assistance services. The amount of the credit would be based on (i)
the level of specified personal assistance expenses, (ii) the individual's earned income, and
(iii) the individual's (and his or her spouse's) adjusted gross income. For taxpayers with
adjusted gross income of less than $50,000, the credit would be equal to 50 percent of up to
$15,000 in personal assistance expenses (or 50 percent of earned income, if the individual's
personal assistance expenses exceed his or her earned income) -- for a maximum credit of
$7,500. The rate of the credit, and accordingly the maximum possible credit, would be
phased down for taxpayers with adjusted gross income between $50,000 and $70,000 (with
no credit available for taxpayers witb adjusted gross income over $70,000).
The credit would be effective for taxable years beginning after December 31, 1995.
Section 7902. Denial of Tax-Exempt Status for Borrowings of Health Care
Related Entities. State and local governments generally may issue tax-exempt bonds to
finance their activities. Except in the case of certain qualified bonds, however, under current
law, the interest on private activity bonds is not tax-exempt. Private activity bonds include
bonds issued as part of an issue if: (1) more than 10 percent of the proceeds are to be used
for any private business use (the "private business use test"), and (2) the principal of, or
interest on, more than 10 percent of the issue is either secured by property used in a private
business use (or payments in respect of such property) or to be derived from payments in
respect of property used fora priva.te business use (the "private security or payment test").
The Internal Revenue Code defmes qualified bonds to include certain bonds for section
501(c)(3) organizations ("qualified SOl(c)(3) bonds").
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�Generally, the Federal tax laws are designed to limit the ability of State and local
governments to issue tax-exempt bonds to be used for other than traditional governmental
purposes. Health care alliances and Sttate guaranty funds described in section 1204 of the
Health Security Act would perform functions that have traditionally been performed by the
private sector. Regardless of who the operator is, each alliance would be organized for the
benefit of, and would be fmancially supported by, the individual members of that alliance.
Similarly, Sttate guaranty funds would be operated for the benefit of those covered by the
fund. It is inappropriate to provide the indirect Federal subsidy implicit in tax-exempt bonds
to the individuals who benefit from the alliances and guaranty funds.
Where appropriate, the Health Security Act would provide more efficient, direct
subsidies to individuals in need of Federal assistance in obtaining health insurance, and
would prevent State and local governments from substituting tax-exempt debt for taxable debt
in these situations. If alliances ·and guaranty funds were allowed to benefit from tax-exempt
fmancing, there would be a significant revenue loss to the Federal government and an
increase in the interest rates that State and local governments are required to pay to finance
their activities.
The Act would provide that the use of bond proceeds by a health care alliance or
State guaranty fund would be private business use. Therefore, issues of bonds more than 10
percent of the proceeds of which are used to fmance the activities of health care alliances or
State guaranty funds would be private activity bonds the interest on which would not be tax
exempt (unless the issue failed to meet the private security or payment test).
The amendment would apply to obligations issued after the date of enactment.
Section 7903. Disclosure ojf Return Information for Administration of Certain
Programs Under the Health Security Act. The Internal Revenue Code currently prohibits
disclosure of tax returns and retum information, except to the extent specifically authorized
by Code section 6103. Unauthorized disclosure is a felony punishable by a fme not
exceeding $5,000 or imprisonment of not more than .five years, or both (Code section 7213).
An action for civil damages also may be brought for unauthorized disclosure (Code section
7431). In general, no tax information may be furnished by the Internal Revenue Service to
another agency unless the other agency establishes procedures satisfactory to the Internal
Revenue Service for safeguarding the tax information it receives (Code section 6103(p».
The Health Security Act provides for several assistance programs, such as premium
discounts for low-income individuals, that would be income-based. The States would verify
income information provided by individuals to ensure that they qualify to receive the
assistance. Federal tax returns provide the only comprehensive source of information for
such verification.
The Act would permit disclosure to Federal and State agencies of certain return
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�information with respect to assistance provided under the Act. The Act would extend the
current-law restrictions on unauthorized disclosure to Federal and State agencies and their
employees. Those employees would not be permitted to redisclose tax information to any
third party.
The amendment would be effective on the date of enactment.
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�TITLE VIII - HEALTH AND HEALTH-RELATED
PROGRAMS OF THE FEDERAL GOVERNl\1ENT
SUBTITLE A - MILITARY HEALTH CARE REFORM
(H.R. 3ciOO and S. 1757 p. 1207)
Section 8001. Uniformed Services Health Plans.
(a) Chapter 55 of title 10, United States Code, is amended by inserting section 1073a
after section 1073. Section 1073a provides:
(a) The Secretary of Defense may establish one or more Uniformed Services
Health Plans. The Secretary of Defense must issue regulations to carry out this
section. Uniformed Services Health Plans must conform, to the maximum extent
practicable, to other requirements for health plans under the Health Security Act.
(b) A Uniformed Services Health Plan may rely upon the use of facilities of
the uniformed services for the provision of health care services, supplemented by the
use of civilian health care providers or health plans under agreements. entered into by
the Secretary of Defense. An agreement with a civilian health care provider or a
health plan may be entered into without regard to provisions of law requiring the use
of competitive procedures. An agreement with a health plan may provide for the
sharing of resources with the health plan that is a party to the agreement.
(c) A Uniformed Services Health Plan must provide ,the items and services in
the comprehensive benefit package to persons enrolled in the plan. In addition, a
Uniformed Services Health Plan must guarantee to those members of the uniformed
services on active duty for a ]period of more than 30 days as of December 31, 1994 or
any person who is a covered beneficiary as of that date who enroll in a Uniformed
Services Health Plan those he:alth care services that the person would be entitled to
receive under chapter 55 in the absence of this section.
(d) In carrying out its responsibilities under the Health Security Act, a state (or
state-established entity) may not impose any standard or requirement or deny
certification to a Uniformed Services Health Plan because of a conflict with this
section or any regulation prescribed pursuant to this section or other Federal law
regarding the operation of this section.
(e) Except as authorized by an administering Secretary, each member of a
uniformed service on active duty for a period of more than 30 days must enroll in a
Uniformed Services Health Plan available to the member. After enrolling active duty
members, Uniformed Services Health Plans may enroll first spouses and children of
members of the uniformed services who are on active duty for a period of -more than
30 days, and then individuaJ.s described in subsection 1086 of title 10. For all
enrollees, participation in a Uniformed Services Health Plan is the exclusive source of
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�health care services available to the member or person under chapter 55.
(f) If person is eligible to enroll in a Uniformed Services Health Plan but does
not enroll, the person is not entitled or eligible for health care services in facilities of
the uniformed services or pursuant to a contract entered into under chapter 55.
However, the person may receive a premium payment from the Secretary of Defense
as described in paragraph (h).
A person who is eligible to enroll in a Uniformed Services Health Plan but
enrolls in another health plan may receive the items and services in the comprehensive
benefit package in a facility of the 'uniformed services only if:
. (1) the Secretary of Defense authorizes the provision of a particular item or
service in the package to the person;
(2) the Secretary detemlines that the provision of the item or service will not
interfere with the provision of health care services to members of the uniformed
services or persons enrolled in a Uniformed Health Services Plan; and
(3) the health plan in which the person is enrolled agrees to pay the actual and
full cost of the items and services provided. An individual who is eligible to enroll in
Uniformed Services Health Plans but is not offered the opportunity to enroll in a
Uniformed Services Health PI:m and is not enrolled in,an alliance health plan may
enroll in a Uniformed Services Health Plan.
(g) If a person enrolled in the supplementary medical insurance program under
Medicare part B enrolls in a Uniformed Services Health Plan, Medicare is responsible
for making a premium payment on behalf of the person. Medicare must pay the
Uniformed Services Health Plan on the same basis as it pays other eligible
organizations with a risk-sharing contract under section 1876 of the Social Security
Act. This premium payment is the person's exclusive benefit under Medicare.
(h) If an individual eligible to enroll in a Uniformed Services Health Plan
enrolls in another alliance health plan, the Secretary may make a premium payment.
In determining the amount of a payment, the Secretary considers the amount of any
retiree discount payable under the Health Security Act on behalf of the person and the
amount of any premium credits attributable to employer payments with respect to the
person. The Secretary will not make a premium payment for any person enrolled in a
health plan of the Department of Veterans Affairs or a health program of the Indian
Health Service.
(i) An active duty mc~mber enrolled in a Uniformed Services Health Plan pays
no premiums or cost sharing other than subsistence charges authorized by section
1075 of Title, 10.
Spouses and children of active duty members and retirees may be required to
pay the family share of premiums and cost sharing as established by regulation by the
Secretary of Defense. These payments may not be higher than those charged by other
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�health plans. In addition, these payments in 1995 must not be higher than die lesser
of the out-of-pocket costs owed by this group of individuals on December 31, 1994 .
and the amount charged by othf~r health plans. The limitation on out-of-pocket costs
may be adjusted for years after 1995 by an appropriate economic index, as
determined by the Secretary of Defense.
(j) A fmancial account is established in the Department of Defense for all
premium payments and other receipts from other payers and beneficiaries made in
connection with any person enrolled in a Uniformed Services Health Plan. The
account will be administered by the Secretary of Defense, and funds in the account
may be used by the Secretary for any purpose directly related to the delivery and
fmancing of health care services under chapter 55, including operations, maintenance,
personnel, procurement, contributions toward construction projects, and related costs.
Funds in the account remain available until expended.
(b) The term "Uniformed Services Health Plan" means a plan established by the
Secretary of Defense to provide health care services to members of the uniformed services on
active duty and other covered beneficiaries under chapter 55.
(c) If the Secretary of Defen<;e chooses to establish any Uniformed Services Health
Plans, the Secretary must submit to Congress a report describing the Plans. The report must
be submitted not later than 30 days before the date on which the Secretary first issues
proposed rules to establish any Plan. .
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�SUBTITLE B - DEPARTMENT OF VETERANS AFFAIRS
(H.R. 3600 and S. 1757 p. 1218)
Section 8101. Benefits and Eligibility Through Department of Veterans Affairs
Medical System (DVA).
.
(a) DVA as a Participant in Health Care Reform. This section amends Title 38,
United States Code by inserting "Chapter 18 - Eligibility and Benefits Under Health Security
Act" after chapter 17.
Dermitions. Adds section 1801. that defines the following tenus for the purposes of
this chapter: .
(1) . A 'health plan' is an entity that has been certified under the Health
Security Act as a health plan.
(2)
A 'VA health plan' is a health plan operated by the Secretary of
Veterans Affairs.
.
(3)
A 'VA enrollee' is an individual enrolled in a VA health plan.
Subclilapter n
- Enrollment
Enrollment: Veterans. Adds section 1811 which states that each veteran who is
eligible under the Health Security Act may enroll with a VA health plan. A veteran who
selects a VA health plan must enroll.
Enrollment: CHAMPVA Eligibles. Adds section 1812 which states that an
individual who is eligible for CHAMPVA and who is eligible under the Health Security Act
may enroll in a VA health plan.
Enrollment: Family Members. Adds section 1813 which states that the Secretary
may authorize a VA health plan to enroll members of the family of a veteran or CHAMPVA
eligible enrollee and may charge premiums and cost sharing as required under the Health
Security Act. An enrollee's family is the enrollee's spouse and children (and, if applicable,
the spouse's children) if they are eligible individuals under the Health Security Act.
Subchapter ill - Benefits
Benefits for VA Enrollees. Adds section 1821 which states that each VA health plan
must provide the comprehensive benefit package to each enrollee.
Chapter 17 Benefits Described. Adds section 1822 which states that in addition to
the comprehensive benefit package, the Secretary must provide the care and services
authorized to be provided under chapter 17 according to current eligibility rules far those
benefits.
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�Supplemental Benefits Packages and Policies. Adds section 1823 which states that a
VA health plan may offer supplemental benefits policies for health care services not provided
under chapter 17 and cost sharing policies consistent with the requirement of part 2 of
Subtitle E of title I of the Health SecuritY Act.
Limitation Regarding Veterans Enrolled With Health Plans Outside the
Department. Adds section 1824 which states that a VA health plan may provide items and
services in the comprehensive benefit package to veterans enrolled in non-VA health plans if
the VA health plan is reimbursed for the actual and full costs of the care provided.
Subchapter IV - Financial Matters
Premiums, Copayments, etc. Adds section 1831 which provides that the Secretary
may not impose premiums or cost sharing for the comprehensive benefit package on the
following veterans who enroll in VA health plans:
(1) any veteran with a service-connected disability;
(2) any veteran whose discharge or release from the active military, naval or
air service was for a disability incurred or aggravated in the line of duty;
(3) any veteran who is in receipt of, or who, but for a suspension pursuant to
section 1151 of this title (or both such a suspension and the receipt of retired pay),
would be entitled to disability compensation, but only to the extent that such a
veteran's continuing eligibility for such care is provided for in such section;
(4) any veteran who is a former prisoner of war;
(5) any veteran of the Mexican border period or World War I; and
(6) any veteran who is unable to defray the expenses of necessary care as
determined under section 1722(a) of this title.
The Secretary must charge premiums and cost sharing to other VA enrollees. Rates
for cost sharing are established by the VA health plan based on rules of the health alliance.
Medicare Coverage and Reimbursement. Adds section 1832 in which VA health
plans and Departmental facilities are deemed Medicare providers or eligible organizations
under section 1876 of the Social Security Act.
The Secretary of Health and Human Services must reimburse a VA health plan or
Department facility providing servict!s as a Medicare provider or eligible organization under
section 1876 on the same basis as other Medicare providers or eligible organizations for care
provided to veterans other than veterans described in section 1831(b). The Secretary of
Veterans Affairs must require that veterans other than veterans described in section 1831(b)
.pay any deductible or cost sharing that is not covered by Medicare.
Recovery of Cost of Certain Care and Services. Adds section 1833 in which the
Secretary of Veterans Affairs has the right to recover or collect charges for care or services
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274
�provided to an individual covered under a supplemental insurance policy or a Medicare
supplemental health insurance plan (but not including care or services for a service-connected
disability) if the individual would be eligible to receive payment for such care or services if
the care or services were not being provided by a department or agency of the United States.
The provisions of subsections (b) through (f) of section 1729 of this title apply to claims
under this section.
Revolving Fund. Adds section 1834 in which the Secretary of Veterans Affairs must
establish a revolving fund. Any amount paid to the Department for the provision of health
care by a VA health plan or the enrollment of an individual in a VA health plan must be
credited to the revolving fund. The Department may not retain amounts received for care
furnished to a VA enrollee in a case in which the costs of the care are covered by
appropriations. Amounts in the revolving fund are available to the health plan for delivering
the comprehensive benefit package and any supplemental benefits policy.
(b) Preservation of Existing Benefits for Facilities Not Operating as Health Plans.
This section amends chapter 17 of title 38 by inserting section 1705 after section 1704.
Facilities Not Operating Within Health Plans; Veterans Not Eligible to Enroll in
Health Plans. Inserts section 1705 :in which the provisions of this chapter apply to: (1) any
facility of the Department that is not operating as or within a health plan certified as a health
plan within the Health Security Act; and (2) any facility providing care to any veteran who is
living abroad and is therefore not an eligible individual under the Health Security Act.
Section 8102. Organization of Department of Veterans Affairs Facilities as Health
Plans.
(a) In General. This section amends chapter 73 of title 38 by redesignating
subchapter IV as subchapter V and by inserting after subchapter III the following new
subchapter:
Subchapter IV - Participation as Part of
National Health Care Reform
Organization of Departmellit of Veterans Affairs Facilities as Health Plans. Adds
section 7341 which states that the Secretary of Veterans Affairs must organize health plans
and operate Department facilities as or within health plans. The Secretary must establish
standards for the operation of Department health care facilities as or within health plans that
conform, to the maximum extent practicable, to the requirements for health plans.
Health care facilities of the Department within a geographic region may be organized
to operate as a single health plan c::ncompassing all facilities or as several health plans.
In carrying out its responsibilities under the Health Security Act, a state (or stateTitle VIII
275
�established entity) may not impose any standard or requirement or deny certification- to a VA
health plan because of a conflict with this section or any regulation prescribed pursuant to
this section or other Federal law regarding the operation of this section.
Contract Authority for Facilities Operating as or Within Health Plans. Adds
section 7342 in which the Secretary of Veterans Affairs may enter into a contract (without
regard to laws requiring the use of competitive procedures) for the provision of services by a
VA health plan if the Secretary determines that contracting is more cost effective than
providing care directly through Department facilities or when contracting is necessary
because of geographic inaccessibility.
Resource Sharing Authority: Facilities Operating as or Within Health Plans. Adds
section 7343 which states that the Secretary of Veterans Affairs may enter into agreements
for the sharing of resources of the Df:partment through facilities of the Department operating
as or within health plans.
Administrative and Personnel Flexibility. Adds section 7344 in which the Secretary
of Veterans Affairs is given authority to carry out administrative reorganizations of the
Department, enter into contracts for the performance of services previously perfQnned by
employees of the Department, and establish alternative personnel systems or procedures for
personnel at facilities operating as or within' health plans, except that the Secretary must
comply with applicable veterans preference laws. The Secretary may also carry out
appropriate promotional, advertising, and marketing activities to infonn individuals of the
availability of facilities of the Department operating as or within health plans. The Secretary
must use only nonappropriated funds.
Veterans Health Care Investment Fund. Inserts section 7345 which states that: if
amounts appropriated for each of the fiscal years 1995 through 1997 provide new budget
authority for the Department of Veterans Affairs Medical Care account of no less than the
amount requested by the President, the Secretary of the· Treasury must credit to a special
fund of the Treasury an amount equal to $1,000,000,000 for fiscal year 1995, $600,000,000
for fiscal year 1996, and $1,700,000,000 for fiscal year 1997. The amounts in the fund may
be used only for the VA health plans authorized under this chapter.
By March 1, 1997, the Secretary must provide to Congress a report concerning the
operation of the Department of Veterans Affairs health care system in preparing for, and
operating under, health care reform during fiscal years 1995 and 1996. The report must
include a discussion of the adequacy of amounts in the investment fund for the plans, the
quality of care provided by the plans, the ability of the plans to attract new patients, and the
need for additional funds for the investment fund in fiscal years after fiscal year 1997.
Funding Provisions: Grants and Other Sources of Assistance. Adds section 7346 '
in which the Secretary may apply for and accept, if awarded, any grant or other source of
funding intended to meet the needs of special populations that but for this section is
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�unavailable to facilities of the Department or health plans operated by the Government if
these funds will be used by a facility of the Department operating as or within a health plan.
(b) Clerical Amendment. The table of sections is amended at the beginning of
chapter 73 to insert a table of contents for subchapter IV.
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�SUBTITLE C - FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
(H.R. 3600 and S. 1757 p. 1233)
Section 8201. nermitions. This section defmes the following tenns for this subtitle:
(1) The tenn "abroad" means outside the United States.
(2) The tenns "annuitant", "employee", and "Government", have the same respective
meanings as are given such tenns by section 8901 of title 5.
(3) The tenn "Employees Heal1h Benefits Fund" means the fund under section 8909
of title 5.
(4) The tenn "FEHBP" means the health insurance program under chapter 89 of title
5.
(5) The tenn "FEHBP plan" has the same meaning as is given the tenn "health
benefits plan" by section 8901(6) of title 5.
(6) The tenn "FEHBP tennination date" means the date (specified in section 8202)
after which FEHBP ceases to be in effect.
(7) The tenn "Retired Employees Health Benefits Fund" means the fund under section
8 of the Retired Federal Employees Health Benefits Act.
(8) The tenn "RFEHBP" means the health insurance program under the Retired
Federal Employees Health Benefits Act.
Section 8202. FEHBP Termination. Chapter 89 of title 5 is repealed effective as of
December 31, 1997, and all contracts under such chapter will tenninate not later than that
date.
Section 8203. Treatment of Federal Employees, Annuitants, and Other
Individuals (Who Would Otherwise Have Been Eligible for FEHBP) Under Health
Plans. This section sets forth rules applicable after the FEHBP tennination date for eligible
individuals who would have been eligible to enroll in a FEHBP plan before tennination.
Federal employees will be treated as other employees (as defmed in section 1901)
under the Health Security Act, including for purposes of any requirements relating to
enrollment and premium payments. Any employer premium payment required on behalf of a
Federal employee must be paid from the appropriation or fund from which any Government
contribution on behalf of such employee would have been payable under FEHBP.
The Federal Government shall offer to Federal employees one or more FEHBP
supplemental plans.
The Office of Personnel Management (or other applicable Government entity) may,
on the request of an annuitant enrolled in a health plan, withhold from the annuity- of the
annuitant any premiums required for enrollment. The Office (or other entity) must forward
any amounts withheld to the appropriate fund or as otherwise indicated in the request.
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�In the case of an annui1:a.Q.t whose liability to the regional alliance is not reduced by
employer premium payments, a Government contribution must be made to reduce the
employee's liability to zero.
The Office of Personnel Management will develop one or more FEHBP supplemental
plans that meet the requirements of supplemental health benefit policies or cost sharing
policies under the Health Security Act and that reflect (taking into consideration the benefits
in the comprehensive benefit package) the overall level of benefits last generally afforded
under FEHBP. The Office of Personnel Management will also develop one or more
Medicare supplemental plans that offer benefits which include the core group of basic
benefits identified under section 1882(p)(2) of the Social Security Act and reflect (taking into
consideration· the benefits provided under the Medicare program) the overall level of benefits
last generally afforded under FEHBP.
Each annuitant who was an annuitant or family member of an annuitant on December
31, 1997 is eligible to enroll in a FEHBP supplemental plan and is eligible for a Government
contribution to premiums for a supplemental plan in an amount that reasonably reflects the
portion of the Government contribution (last provided under FEHBP) attributable to the
portion of FEHBP benefits which the plan is designed to replace.
The Federal Government shall offer future annuitants one or more FEHBP
supplemental plans.
The Federal Government may, but is not required to, offer one or more FEHBP
supplemental plans to any individual who would have been eligible to enroll in a FEHBP
plan before termination, but would not have been eligible for a Government contribution.
The Federal Government will not pay a Government contribution for these individuals.
Each Medicare-eligible annuitant who was Medicare-eligible on December 31, 1997 is
eligible to enroll in a Medicare supplemental plan and, if that individual would have been
eligible for a Government contribution'under FEHBP, is eligible for a Government
contribution to premiums for a Medicare supplemental plan and for a contribution that
reasonably reflects the portion of the government contributions (last provided under FEHBP)
attributable to the portion of FEHBl? benefits which the plan is designed to replace.
The Federal Government may, but is not required to, offer one or more Medicare
supplemental plans to any individual who was Medicare-eligible on December 31, 1997 and
to make a Government contribution to the premium for the plan.
A Medicare-eligible individual may elect to have the amount of the Government
contribution applied toward premiums for enrollment with an eligible organization under a
risk-sharing contract under section 1876 of the Social Security Act. The amount of the
Government contribution will be determined without taking into account this election.
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�The Govenunent contributions authorized by this section on behalf of an annuitant
(including payments to Medicare-eligible annuitants) must be paid from annual appropriations
authorized to be made for that purpose and which may be made av~ilable until expended.
All contributions relating to any FEHBP supplemental plan, FEHBP Medicare
supplemental plan or health insurance program covering FEHBP eligible individuals residing
abroad must be paid into a fund established in the United States Treasury. The fund will be
administered by the Office of Personnel Management and monies in the fund must be used
for these plans and programs.
Section 8204. Treatment of IndiViduals Residing Abroad. After the FEHBP
termination date, individuals residing abroad who would have been eligible for FEHBP
continue to be eligible for health insurance under a program that the Office of Personnel
Management will establish by regulation. Coverage and benefits under this program will, to
the extent practicable, reflect the level of benefits available to individuals in the United
States. Any Govenunent contribution payable to a Federal employee under this program
must be made from the appropriation or fund from which any Govenunent contribution
would have been payable under FEHBP.
Section 8205. Transition and Savings Provisions. The Employees Health Benefits
Fund will be maintained, and amounts in the fund will remain available, after the FEHBP
termination date, for a period of time that the Office of Personnel Management considers
necessary to satisfy any outstanding claims.
After the end of this period, any amounts remaining in the Fund will be disbursed
(between the Govenunent and former participants in FEHBp) in accordance with a plan
prepared by the Office of Personnel Management, consistent with the cost sharing ratio
between the Govenunent and plan enrollees during the final contract term. The details of the
plan must be submitted to the President and the Congress at least one year before the date of
its proposed implementation.
Chapter 89 of title V will be considered to remain in effect after the FEHBP
termination date for the purposes of any liability incurred or violation which occurred before
termination.
The Retired Federal Employees Health Benefits Act is repealed effective as of the
FEHBP termination date. After the FEHBP termination date, the Retired Employees Health
Benefits Fund will remain available temporarily and will then be disbursed in the same
manner as the Employees Health Benefits Fund. Retired employees who would have been
eligible for coverage under the Retired Federal Employees Health Benefits Act will be
treated as if they were annuitants (subject to any differences in the level of coverage and
benefits provided under FEHBP and RFEHBP).
Regulations concerning the disbursement of monies in any fund must make necessary
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�provisions for individuals residing abroad.
Section 8206. Regulations. The Office of Personnel Management must prescribe
regulations to carry out this subtitle.
Section 8207. Technical and Conforming Amendments. The following technical
and confonning amendments take effect on the day after the FEHBP tennination date:
(1) The section of title 5 requiring the Office of Personnel Management to prepare an
annual report on FEHBP is repealed.
(2) Any reference to a health insurance program under chapter 89 of title 5 will be
considered a reference to the health insurance program under the Health Security Act, subject
to clarifications and except as provided in regulations.
(3) Effective as of the date of the enactment of this Act, section 11101(b)(3) of the
Omnibus Budget Reconciliation Act of 1993 is amended to substitute December 31, 1997 for
September 30, 1998.
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�SUBTITLE D - INDIAN HEALTH SERVICE
(H.R. 3600 and S. 1757 p. 1249)
Section 8301. Definitions. This section defmes the following tenns for the purpose of
this subtitle:
(1) The term "health program of the Indian Health Service" means a program which
provides health services under this Act through a facility of the Indian Health Service, a
tribal organization under the authority of the Indian Self-Detennination Act or a self
governance compact, or an urban Indian program.
(2) The tenn "reservation" means the reservation of any federally recognized Indian
tribe, fonner Indian reservations in Oklahoma, and lands held by incorporated Native groups,
regional corporations, and village corporations under the provisions of the Alaska Native
Claims Settlement Act.
(3) The tenn "urban Indian program" means any program operated pursuant to title V
of the Indian Health Care Improvement Act.
(4) The tenns "Indian", "Indian tribe", "tribal organization", and "service unit" have
the same meaning as when used in the Indian Health Care Improvement Act.
Section 8302. Eligibility and Health Service Coverage of Indians. An eligible
individual is eligible to enroll in a health program of the Indian Health Service, and may
elect a health program of the Indian Health Service instead of a health plan, if the individual
is: (1) an Indian, or a descendent of a member of an Indian tribe who belongs to and is
regarded as an Indian by the Indian community in which the individual lives, who resides on
or near an Indian reservation or in a geographical area designated by statute as meeting the
requirements of being on or near a reservation notwithstanding the lack of an Indian
reservation; (2) an urban Indian; or (3) a Indian living in certain counties in California as
described in section 809(b) of the Indian Health Care Improvement Act.
An individual described above who elects a health program of the Indian Health
Service must enroll in the program. The individual is not required to pay any health
insurance premiums or other cost sharing. If an individual chooses not to enroll in a health
program of the Indian Health Service and instead enrolls in an alliance health plan, the
Indian Health Service does not pay the premiums and cost sharing required by the health
plan.
Section 8303. Supplemental Indian Heallth Care Benefits. All individuals described
in section 8302 remain eligible for supplemental benefits offered by the Indian Health Service
at no charge. $180,000,000 for fiscal year 1995 and $200,000,000 for each of the fiscal
years 1996 through 1999 are appropriated for supplemental benefits.
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�Section 8304. Health Plan and Health Alliance Requirements. Beginning on
January 1, 1999, all health programs of the Indian Health Service must provide the
comprehensive benefit package. The Secretary of Health and Human Services will determine
which other health plan requirements will apply to health programs of the Indian Health
Service. Beginning on January 1, 1999, all health programs of the Indian Health Service
must meet the health plan requirements that the Secretary determines apply to Indian health
programs. Before January 1, 1999, all health programs must, to the extent practicable, meet
these requirements. The Secretary must also determine which requirements relating to health
alliances apply to the Indian Health Service.
Section 8305. Exemption of Tribal .Governments and Tribal Organizations from
Employer Payments. Tribal governments and tribal organizations under the Indian Self
Determination and Educational Assistance Act or a self-governance compact are not required
to make employer premium payments.
Section 8306. Provision of Health Services to Non-Enrollees and Non-Indians. A
health program or facility of the Indian Health Service may contract with a health plan to
provide services to individuals enrolled in that health plan if the program or facility
determines that the contract will not result in a denial or diminution of health services to
Indians enrolled in a health program of the Indian Health Service. The health program or
facility is reimbursed as an essential community provider based on an alliance fee schedule or
Medicare payment methodology and rates, as determined by the Secretary.
A health program of the Indian Health Service may open enrollment to family
members of individuals described in section 8302. If the health program opens enrollment to
family members, family members who choose to join a health program of the Indian Health
Service must enroll. Family members must pay premiums and other cost sharing. The
Secretary of Health and Human Services must establish and collect premiums for family
members enrolled in health programs of the Indian Health Service.
The Secretary must provide for a process for premium reduction which is the same as
the process used by regional alliances for the areas in which family members reside, but in
computing the family share of the premiums the Secretary must use the lower of the
premium quoted or the reduced weighted average accepted bid for the reference regional
alliance. The Secretary must pay to each health program the amounts that would have been
paid to a regional alliance if the individual had enrolled in a regional alliance health plan
(with a final accepted bid equal to the reduced weighted average accepted bid premium for
the regional alliance).
If a health program or facility of the Indian Health Service elects to be an essential
community provider, an individual described in section 8302 or a family member of the
individual may receive health services from that essential community provider.
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�Section 8307. Payment By Other Payers. Indian Health Service programs will
continue to receive payments from other Federal programs and third party payers. The
Indian Health Service continues to be the payer of last resort for Indians eligible for contract
health services under a health program of the Indian Health Service.
Section 8308. Contracting Authority. The Indian Health Care Improvement Act is
amended to permit contracting for personal services for the provision of direct health care
services.
Section 8309. Consultation. The Secretary must consult with representatives of
Indian tribes, tribal organizations, and urban Indian organizations annually concerning health
care reform initiatives that affect Indian communities.
Section 8310. Infrastructure. The Secretary may expend funds appropriated under
section 8313 for the construction and renovation of hospitals, health centers, health stations
and other facilities for the purpose of improving and expanding these facilities to deliver the
comprehensive benefit package. In order to enable health care facilities to deliver the
package, the Secretary will establish a revolving loan program to provide guaranteed loans
under terms and conditions determined by the Secretary to providers within the Indian Health
Service.
.
Section 8311. Financing. Each health program of the Indian Health Service must
establish a comprehensive benefit package fund. All employer premium payments, family
premium payments and premium discount payments, appropriations for the purpose of
delivering the comprehensive benefit package to enrollees in a health program of the Indian
Health Service and any other amount received for the. provision of the comprehensive benefit
package must be deposited into the fund. _Each fund is managed by the health program.
Expenditures may be made from the fund for the delivery of the comprehensive benefit
package. Amounts in the fund remain available without further appropriation and remain
available until expended for payments for the delivery of the comprehensive benefit package.
Section 8312. Rule of Construction. Unless otherwise provided, no part of this act
rescinds or modifies any obligations, fmdings or purposes contained in the Indian Health
Care Improvement Act and in the Indian Self-Determination and Education Assistance Act.
Section 8313. Authorizations of Appropriations. For the purposes of carrying out
this subtitle, there are authorized to be appropriated $40,000,000 for fiscal year 1995,
$180,000,000 for fiscal year 1996, and $200,000,000 for each of the fiscal years 1997
through 2000. These appropriations are in addition to any other authorizations of
appropriations that are available for carrying out this subtitle.
Section 8314. Payment of Premium Discount Equivalent Amounts for
Unemployed Indians. The Secretary determines for each fiscal year beginning in fiscal year
1998 an amount equivalent to the total amount of premium discounts that would have been
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�paid to an individual described in' section 8302 who is unemployed. The Secretary certifies
this amount to the Secretary of the Treasury who pays the amount to the Indian Health
Service.
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�Section 8403. Amendments Relating to Continuation of Coverage. (a) Amends
section 602(2)(D) of ERISA to specify continuation coverage under a group health plan until
health security act eligibility is established. Qualified individuals under section 602 shall not
include any individuals eligible for coverage under the Health Security Act, and continuation
coverage provisions are repealed as of the earlier of January 1, 1998, or the first day of the
first calendar year in which individuals are eligible for·coverage under a comprehensive
benefit package.
Section 8404. Additional Amendments Relating to Group Health Plans. (a)
Amends section 601(c) of ERISA to specify that regulations by the Board supersede ERISA
rules with respect to adoption cases.
(b) The pediatric vaccine program under section 601(d) of ERISA shall not apply to
any group health plan that becomes a corporate alliance plan under section 1311 of the
Health Security Act.
Section 8405. Plan Claims Procedures. Section 503 of ERISA is amended by
requiring group health plans to comply with the Health Security Act plan claims procedures
under section 5201 of the Health Security Act.
Section 8406. Effective Dates. Except as otherwise provided, the effective date is
January 1, 1998 or the date prescribed by the National Health Board in connection with plans
whose participants reside in a state th.at becomes a participating state before the general
effective date.
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�SUBTITLE F - SPECIAL FUND FOR WIC PROGRAM
(H.R. 3600 and S. 1757 p. 1274)
Section 8501. Additional Funding for Special Supplemental Food Program for
Women, Infants and Children (WIC). This section establishes a special fund, in addition to
regular appropriations otherwise available for WIC, to help ensure that the WIC program
reaches full funding status at the end of FY 1996 and then remains at full funding levels.
The President's budget submitted earlier this year set forth a path to full funding that
included an appropriations level of $3.564 billion in FY 1995. This section provides that if
in years after FY 1995, discretionary appropriations are provided equal to the $3.564 billion
level adjusted for inflation, additional amounts from the special fund will be made available
to provide the remaining amounts estimated to be needed for full funding.
This section appropriates for the WIC program the amounts necessary for the
Secretary of the Treasury to credit to a special fund of the Treasury the following amounts:
$254,000,000 for fiscal year 1996, $407,000,000 for fiscal year 1997, $384,000,000 for
fiscal year 1998,$398,000,000 for fiscal year 1999 and $411,000,000 for fiscal year 2000.
These funds, which are to be financed from "pay as you go" savings, are available only for
the WIC program, exclusive of activities authorized under Section 17(m) of the Child
Nutrition Act of 1966, and must be paid to the Secretary of Agriculture for that purpose.
For each fiscal year, the arrlOunt credited to the fund is available only if discretionary
appropriations for that year (that is, funds appropriated exclusive of amounts provided for the
special fund) provide new budget authority for WIC of no less than $3,660,000,000 for fiscal
year 1996, $3,759,000,000 for fiscal year 1997, $3,861,000,000 for fiscal year 1998,
$3,996,000,000 for fiscal year 1999, and $4,136,000,000 for fiscal year 2000. The sum of
these discretionary spending levels and the amounts from the special fund equals the amounts
estimated to be needed for full funding of WIC.
In short, the Secretary of the Treasury is required to place specified amounts in a
special fund each year and to pay these amounts to the Secretary of Agriculture for use in
WIC, and Congress is authorized to provide the necessary appropriations for the Secretary of
the Treasury to fulfill this requirement. These funds are available for use in WIC in a fiscal
year only if regular discretionary appropriations for WIC in that year at least equal the levels
specified in this section.
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�TITLE IX - AGGREGATE GOVERNMENT PAYMENTS
SUBTITLE A - AGGREGATE STATE PAYMENTS
(H.R. 3600 and S. 1757 p. 1277)
Subtitle A describes state maintenance of effort payments associated with Medicaid
recipients not receiving cash assistance and state premium payments to regional alliances
associated with persons receiving cash assistance.
PART 1 - STATE MAINTENANCE OF EFFORT PAYMENT
PaIt 1- describes state maintenance of effort payments associated with Medicaid
recipients not receiving cash assistance.
Section 9001. State Maintenance Of Effort Payment Relating To Non-Cash
Assistance Recipients. Participating states are required to make maintenance of effort
payments based on current Medicaid expenditures for the comprehensive benefits package
associated with recipients who are not receiving cash assistance.
For the first year of participation by a state, a state's payment is calculated as the sum
of:
(A) The state's non-cash, non-disproportionate share (DSH) baseline amount (as
determined under section 9002(a)(1», updated under 9003(a)(1); and
(B) The state's non-cash, DSH baseline amount (as determined under section
9002(a)(2», updated under SC".ction 9003(a)(2).
.
For a succeeding year,the state's payment is equal to the payment for the first year,
updated under section 9003(b).
If a state has more than one regional alliance, the state's payments are divided among
the state's regional alliances.
Section 9002. Non-Cash Baseline Amounts. The baseline amount is calculated in
two parts: a non-cash, non-DSH amount and a non-cash, DSH amount.
The non-cash, non-DSH amount is the sum of:
(A) state Medicaid expenditures in fiscal year 1993 for the comprehensive benefits
package for non-cash assistance children.
(B) state Medicaid expenditures in fiscal year ·1993 for the comprehensive benefits
package for non-cash assistance adults.
Title IX
�(C) state Medicaid expenditures in fiscal year 1993 for items and services that are not
in the comprehensive benefits package and are not long-term care services for
qualified children (under 1934(b)(1) of Title XIX, section 4222) who are AFDC or
SSI recipients.
The non-cash, DSH amount is equal to the state share of disproportionate share .
expenditures in fiscal year 1993 (under section 1923 of the Social Security Act), multiplied
by the proportion of state Medicaid expenditures for hospital services associated with
recipients not receiving cash assistance.
Section 9003. Updating Of Baseline Amounts. Baseline amounts are updated
separately to the first year of participation by a state, and then to subsequent years.
Updates from fiscal 1993 to the first year are as follows:
(1) The non-cash, non-DSH baseline amount is updated by the following percentages
depending on the first year of participation by a state:
(A) 56.6 percent if the first year is 1996.
(B) 78.1 percent if the first year is 1997.
(C) 102.2 percent if the first year is 1998.
(2) The non-cash, DSH base:line amount is updated by the following percentages
depending on the first year of participation by a state:
(A) 45.9 percent if the first year is 1996.
(B) 61.8 percent if the first year is 1997.
(C) 79.0 percent if the first year is 1998.
These percentages represent the projected increases nationwide in the relevant
category of expenditures from fiscal year 1993 through the first year of participation.
For subsequent years, the non-cash baseline amount is updated by the general health
care inflation factor (described in section 6001(a)(3)) plus projected U.S. population growth
for the under-65 population.
Section 9004. Non-Cash Assistance Child And Adult Defined. Section 9004
defmes child and adult Medicaid recipients who are not receiving ·cash assistance.
A non-cash assistance child means a child described in section 1934(b)(1) of the
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�Social Security Act (as inserted by section 4222(a» who is not Medicare-eligible ..
A non-cash assistance adult means an individual who is:
(1) Over 21 years,
(2) A citizen or national of the United States or an alien who is lawfully admitted for
permanent residence or otherwise permanently residing in the United States under
color of law, and
(3) Not an AFDC or SSI recipient·or a Medicare-eligible individual.
PART 2 - STATE PREMIUM PAYMENTS
Part 2 describes state premium payments to regional alliances associated with persons
receiving cash assistance.
Section 9011. State Premium Payments Relating To Cash Assistance Recipients.
For each year, each participating state makes a premium payment for cash assistance
recipients equal to 95 % of the state medical assistance percentage times the sum of the
following:
(1) The AFDC per capita premium amount for the regional alliance for the year
(determined under section 9012(a» times the number of AFDC recipients residing in
the alliance area in the. year (as determined under section 9014(b)(1».
(2) The SSI per capita premium amount for the regional alliance for the year
(determined under section 9013) times the number of SSI recipients residing in the
alliance area in the year (as determined under section 9014(b)(1».
A participating state's payment under this section is increased by the state medical
. assistance percentage times amounts attributable to AFDC and SSI recipients for cost sharing
subsidies (under section 137(c)(1) and for increased premium discounts where an at-or
below-average cost plan is unavailable (under section 6104(b)(2».
Section 9012. Determination Of AFDC Per Capita Premium Amount For
Regional Alliances. The AFDC per capita premium amount for a regional alliance for a
given year is equal to:
(1) Per capita state Medicaid expenditures for the year for the state in which the
alliance is located, multiplied by
(2) An adjustment factor (determined under section 9015) for the year for the regional
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�alliance that is related to health care expenses in that alliance relative to the state as a
whole.
Per capita state Medicaid expenditures for a state for a given year are equal to the
state share of fiscal year 1993 Medicaid expenditures for the comprehensive benefits package
associated with AFDC recipients, updated to the year as below.
Updates from fiscal year 1993 to the year before the first year of participation by a
state is as follows:
(1) 32.2 percent if the first year is 1996.
(2) 46.6 percentif the first year is 1997.
(3) 62.1 percent if the first year is 1998.
These percentages are projected increases in per capita expenditures for AFDC
. recipients for services in the comprehensive benefits package from fiscal year 1993 to the
calendar year before the first year of participation.
The Secretary of HHS shall estimate the rate of increase in per capita state Medicaid
expenditures between fiscal year 1993 and the year before the first year for a state, ·adjusting
the estimate to eliminate any change in expenditures that results from a reduction in the
scope of services, arbitrary reduction in payment rates, or a reduction in access to high
quality services. If the estimated rate of increase is less than the percentage amounts
specified above, then the Secretary shall update the fiscal year 1993 per capita expenditures
by the estimated increase for the state rather than the percentages specified above
Updates from the year before the first year of participation by a state to a subsequent
year are equal to the general health care inflation factor for the year (as dermed in section
6001 (a)(3».
Section 9013. Determination Of SSI Per Capita Premium Amount For Regional
Alliances. The SSI per capita premium amount for a regional alliance for a given year is .
determined in the same way as the AFDC per capita premium amount, except with respect to
SSI recipients instead of AFDC recipients and with different update percentages.
Updates from fiscal year 1993 to the year before the first year of participation by a
state with respect to the SSI per capita premium amount are as follows:
(1) 29.4 percent if the frrst year is 1996.
(2) 43.7 percent if the first year is 1997.
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�state payment levels, taking into account the revenue base in each state.
Section 9023. Special Rules For Puerto Rico And Other Territories. Subject to
guidelines described in this section, the Secretary may waive or modify financial
requirements for participating states with respect to Puerto Rico, the Virgin Islands, Guam,
American Samoa, and the Northern Mariana Islands to accommodate their unique geographic
and social conditions and features of their health care systems.
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�SUBTITLE B - AGGREGATE FEDERAL ALLIANCE PAYMENTS
(H.R. 3600 and S. 1757 p. 1296)
Subtitle B describes payments by the Federal Government to alliances for the federal
share of premiums for AFDC and SSI recipients and for business and family discounts.
Section 9101. Federal Premium Payments For Cash Assistance Recipients. The
Secretary of HHS must make payments each year to each regional alliance for the Federal
share of premium payments and certain discounts for AFDC and SSI recipients. The
payment is calculated in the same manner as a state's payment (described in section 9011),
except that the Federal medical assistance 'percentage (defmed in section 1905(b) of the
Social Security Act) is used instead of the state medical assistance percentage.
Federal payments must be made on a periodic basis, reflecting the cash flow
requirements of regional alliances. Each regional alliance must provide the Secretary with
information necessary to make these payments.
Federal payments are reconciled based on information provided by states, subject to
audit by the Secretary.
Section 9102. Capped Federal Alliance Payments.
(a) CAPPED ENTITLEMENT: Beginning January 1, 1996, the Secretary must
provide to each regional alliance payments for family and employer discounts ("capped
Federal alliance payment amount," as defmed in this section). The total amount of these
payments is a capped entitlement.
(b) CAPPED FEDERAL ALLIANCE PAYMENT AMOUNT: The capped Federal
alliance payment amount is determined on a quarterly basis, and is equal to the payment
obligations of the alliance minus amounts receivable by the alliance subject to the cap as set
forth in subsection (e). Payment obligations include payments to plans, payments for cost
sharing reductions, and alliance administrative expenses. Amounts receivable by the alliance
include premiums owed by families and employers (not taking into account amounts that are
owed but not paid) and amounts payable by Federal and state Governments for maintenance
of effort and for per capita premium amounts for AFDC and SSI recipients.
The Federal Government is not responsible for amounts owed to an alliance but not
collected, for administrative errors in providing discounts that exceed maximum permissible
error rates (specified in section 1~61(b)(1)(C», or for misappropriations or other regional
alliance expenditures that the Secretary fmds are attributable to malfeasance or misfeasance
by the regional alltance or the state.
For a single-payer state, the Secretary must pay an amount equal to what regional
alliances in the state would have received under this section if the state were not a singleTitle IX
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�payer state.
(c) DETERMINATION OF CAPPED FEDERAL ALLIANCE PAYMENT
AMOUNTS: Before the beginning of each year, the Secretary must estimate the capped
Federal alliance payment amount for each regional alliance. The Secretary must report to
Congress an estimate of the total capped Federal alliance payment amounts owed for all
alliances.
(d) PAYMENTS TO REGIONAL ALLIANCES: The capped Federal alliance
payment amount must be made on a periodic basis, reflecting the cash flow requirements of
regional alliances. Each regional alliance" must provide the Secretary with information
necessary to make these payments.
(e) CAP ON PAYMENTS: The total amount of the capped Federal alliance
payments for a fiscal year may not exceed the caps specified in this section.
For fiscal years 1996 through 2000, the caps are as follows:
(1) $10.3 billion for fiscal year 1996.
(2) $28.3 billion for fiscal year 1997.
(3) $75.6 billion for fiscal year 1998.
(4) $78.9 billion for fiscal year 1999.
(5) $81.0 billion for fiscal year 2000.
If the CPI is projected to be significantly different from what was projected by the
Council of Economic Advisors to the President as of October 1993, the Secretary may adjust
the caps so as to reflect the different inflation assumption.
For subsequent fiscal years, the cap from the previous year is updated by a formula
that is based on increases in the CPI, U. S. population, and real per capita Gross Domestic
Product.
"
If total capped Federal. alliance payment amounts are less than the cap for a fiscal
year, the surplus is accumulated and made available for future years.
If the Secretary anticipates that the amount of the cap, plus any amount carried
forward from a previous year, will not be sufficient for a fiscal year, the Secretary must
notify the President, the Congress, and each regional alliance of the anticipated shortfall and
when the shortfall will first occur.
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�Within 30 days of receiving notice from the Secretary, the President must submit to
Congress a report containing specific legislative recommendations for actions which would
eliminate the shortfall.
The President's report is considered under an expedited process. If a joint resolution
is introduced that contains the President's recommendations, that resolution is considered in a
manner described in the Defense Base Closure and Realignment Act of 1990.
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�SUBTITLE C - BORROWING AUTHORITY TO COVER·CASH-FLOW
. SHORTFALLS
(H.R. 3600 and S. 1757 p. 1308)
Section 9201. Borrowing Authority To Cover Cash-Flow Shortfalls. (a) Authorizes
the Secretary to make loans available to regional alliances in order to cover temporary
cash-flow shortfalls attributable to:
(1) estimation discrepancies,
(2) administrative errors,
(3) the relative timing during the year in which amounts are received and payments
are required to be made.
(b) Requires that loans made to regional alliances under this section be under terms
and conditions specified by the Secretary, in consultation with the Secretary of the Treasury,
that take into account Treasury cash management rules. Loans under this section are
repayable over a period of no more than 2 years. Alliances pay interest on the loans at a
rate of interest determined by the Secretary of the Treasury. The Secretary takes into
consideration the current average rate on outstanding marketable obligations of the United
states in determining the interest rate.
As a condition of receiving a loan under this section, a regional alliance must agree to
make appropriate adjustments (as described in subsection (f) to future premiums or
collections to assure the repayment of the amount so borrowed.
(c) Sets forth the manner for repayment of loans under this section. Loans to regional
alliances for shortfalls that result from estimation discrepancies of timing or receipts are
repaid through a reduction in the payment amounts made to regional alliances under section
9102. Loans for shortfalls that result from administrative error are repaid through a
temporary increase in the amount of the state maintenance-of-effortpayment required under
section 9001.
(d) Requires the Secretary to make annual reports to Congress on the loans made (and
loan amounts repaid) under this section.
(e) More precisely describes the purposes for which loans are available under this
section.
The estimation discrepancies referred to iIi this section are discrepancies in estimating
the following:
(1) the average premium payments per family under section 6122(b).
(2) the AFDC and SSI proportions under section 6202.
(3) the distribution of enrolled families in different risk categories for purposes of
under section 1343(b)(2).
Title IX
�(4) the distribution of enrollment in excess premium plans.
(5) the collection shortfalls (used in computing the family collection shortfall add-on
under section 6107).
The administrative errors referred to in this section include the following:
(1) an eligibility error rate for premium discounts and liability reductions that exceeds
the maximum permissible error rate established for the alliance.
(2) misappropriations or other regional alliance expenditures that are determined to be
attributable to malfeasance or misfeasance by the regional alliance or the state.
(f) Describes the estimation adjustment provisions that an alliance must agree to
follow as a condition of receiving a loan under this section:
(1) adjustments for average premium payments per family under section 6122(b)(4).
(2)
(3)
(4)
(5)
adjustments in the A,FDC and SSI proportions under section 6202(d).
adjustments pursuant to methodology described in section 1541(b)(8).
adjustments in excess premium credit pursuant to section 6105(b)(2).
adjustment in the collection shortfall add-on under section 6017(b)(2)(C».
(g) Authorizes the Secretary of the Treasury to advance to the Secretary amounts
sufficient to cover the loans made under this section. The amount of advances outstanding at
any time may not exceed $3,500,000,000.
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�TITLE X - COORDINATION OF MEDICAL PORTION
OF WORKERS COMPENSATION AND AUTOMOBILE INSURANCE
SUBTITLE A - WORKERS COMPENSATION INSURANCE
(H.R. 3600 and S. 1757 p. 1314)
Section 10000. nefmitions.
The term "injured worker" is defmed to mean an individual enrolled under a health
plan who has a work-related injury or illness for which workers compensation medical
benefits are available under state law.
The term "specialized workers compensation provider" is defined to mean a health
care provider that specializes in the provision of treatment relating to work-related injuries or
illness (including specialists in industrial medicine, specialists in occupational therapy and
centers of excellence in industrial medicine and occupational therapy).
The term "workers compensation medical benefits" is defmed to mean the
comprehensive medical benefits for work-related injuries and illnesses provided for under the .
workers compensation laws of a state to an injured worker.
The term "workers compensation carrier" is defmed to mean an insurance company
that underwrites workers compensation medical benefits, including an employer or fund that
is fmancially at risk for the provision of workers compensation medical benefits.
The term "workers compensation services" is defmed to mean items and services
included in workers compensation medical benefits and includes items and services (including
rehabilitation services and long-term care services) commonly used for treatment of
work-related injuries and illnesses.
PART 1 - HEALTH PLAN REQUIREMENTS RELATING TO
WORKERS COMPENSATION
Section 10001. Provision Of Workers Compensation Services. (a) Requires each
health plan that provides services to enrollees through participating providers to enter into
contracts and arrangements to provide or arrange for the provision of workers compensation
services to such enrollees. Payments for workers compensation services are made by workers
compensation carriers under section 10002.
Services may be provided or arranged by the health plan through:
(1) A participating provider in the plan;
(2) Another provider with whom the plan has entered into an agreement for the
provision of such services, or
.
Title X
�(3) A specialized workers compensation provider (designated by the state under
10011).
'
Individuals who are entitled to workers compensation medical benefits generally must
receive workers compensation services through the health plan in which they are enrolled.
This requirement applies without regard to whether the health plan uses participating
providers to provide health benefits to its enrollees. This requirement does not apply in the
case of an injured worker who needs emergency services or to certain electing veterans,
active duty military personnel, and Indians as described in section 1004(b).
I
(b)' Permits an injured worker and' a workers compensation carrier to agree to the
provision of workers compensation services in a manner other than by or through the health
plan in which the worker is enrolled.
(c) Requires each health plan to employ or contract one or more individuals with
experience in the treatment of occupational illness and injury to provide case management
services to injured workers enrolled in the plan. The case manager is responsible for
ensuring that:
(1) there is a plan of treatment (when appropriate) for each enrollee who is an injured
worker designed to assure appropriate treatment and facilitate return to work;
(2) the plan of treatment is coordinated with the workers compensation carrier and the
employer;
(3) the health plan (and its providers) comply with legal duties and requirements
understate law; and
(4) the injured worker is referred to appropriate providers (when necessary).
Section 10002. Payment By Workers Compensation Carrier. (a) Provides that
payment for workers compensation services by workers compensation carriers generally will
be made in accordance with the applicable regional alliance fee schedule established, under
section 1322(c) or the state fee schedule established under section 10013.
(b) Permits an alliance or state to establish an alternative payment methodology (such
as payment on a negotiated fee for each case) for payment for workers compensation
services. Workers compensation carriers and health plans also are permitted to negotiate
alternative payment arrangements.
(c) Provides that this subpart may not be construed to require an injured worker to
make any payment (including payment of any cost sharing or any amount in excess of the
applicable fee schedule) to any health plan or health care provider for the receipt of workers
compensation services.
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�PART 2 - REQUIREMENTS OF PARTICIPATING STATES
Section 10011. Coordination Of Specialized Workers Compensation Providers. (a)
Requires each participatIng state to coordinate access to specialized workers compensation
providers on behalf of health plans providing coverage to individuals residing in the state.
(b) Authorizes states to designate specialized workers compensation providers to
provide workers compensation services with respect to one or more .types of injuries or
illnesses for a geographic area that are:
(1) not included in the comprehensive benefit package; or
(2) specialized services that are typically provided (as determined by the state) by
specialists in occupational or rehabilitative medicine.
Injured workers and health plans are authorized to use providers designated under this
subsection.
Section 10012. Preemption Of State Laws Restricting Delivery of Workers
Compensation Medical Benefits. (a) Provides that no state law will have any effect that
restricts the choice, or payment, of providers that may provide workers compensation
services for individuals enrolled in a health plan.
(b) Preserves the authority of state law to provide for a method for resolving disputes
among parties related to:
(1) an individual's entitlement to workerS compensation medical benefits under state
law;
(2) the necessity and appropriateness of workers compensation services provided to an
injured worker; and
(3) the reasonableness of charges or fees charged for workers compensation services
(subject to the requirements of this subpart related to the use of alliance and state fee
schedules).
Section 10013. Development Of Supplemental Schedule.
Each participating state is required to develop a fee schedule for workers
compensation services for which a fee is not included in the applicable regional alliance fee
schedule.
Section 10014. Construction. (a) Provides that this subtitle should not be construed
as altering:
(1) the effect of a state workers compensation law as the exclusive remedy for
work-related injuries or illnesses;
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�Section 10031. Authorization.
This section authorizes the Secretary of Health and Human Services and the Secretary
of Labor to conduct demonstration projects under this part in one or more ~tates with respect
to treatment of work-related injuries and illnesses.
Section 10032. Development Of Work-Related Protocols. (a) Authorizes the
Secretary of Health and Human Services and the Secretary of Labor, in consultation with
states and others, to develop protocols for the appropriate treatment of work-related
conditions.
(b) authorizes the Secretaries to enter into contracts with one or more health alliances
to test the validity of the protocol.
Section 10033. Development Of Capitation Payment Models.
This section authorizes the Secretary of Health and Human Services and the Secretary
of Labor to develop (using protocols developed under the previous section) methods of
providing for payment by workers compensation carriers to health plans on a per case, per
capita payment for the treatment of specified work-related injuries and illnesses.
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�SUBTITLE B - AUTOMOBILE INSURANCE
(H.R. 3600 and S. 1757 p. 1326)
Section 10100. Definitions.
The term "injured worker" is defmed to mean an individual enrolled under a health
plan who has an injury or illness sustained in an automobile accident for which automobile
insurance medical benefits are available.
The term automobile insurance medical .benefits is defined to mean the comprehensive
medical benefits for injuries or illnesses sustained in automobile accidents.
The term "automobile insurance carrier" means an insurance company that
underwrites automobile insurance medical benefits and includes an employer or fund that is
financially at risk for the provision of automobile insurance medical benefits.
The term "automobile insurance medical services" means items and services included
in automobile insurance medical benefits and includes items and services (such as
rehabilitation services and long-term care services) commonly used for treatment of injuries
and illnesses sustained in automobile accidents.
PART 1 - HEALTH PLAN REQUIREMENTS RELATING TO
AUTOMOBILE INSURANCE
Section 10101. Provision Of Automobile Insurance Medical Benefits Through
Health Plans. (a) Provides that an individual entitled to automobile insurance medical
benefits and enrolled in a health plan will receive automobile insurance medical services
through the provision (or arrangement for the provision) of such services by the health plan.
(b) Requires health plans to make necessary referrals for automobile insurance
medical services as may be necessary to assure appropriate treatment of injured individuals.
(c) Provides that the requirements of this section do not apply to certain electing
veterans, active duty military personnel, and indians as described in section lOO4(b).
(d) Permits an injured individual and an automobile insurance carrier to agree to the
provision of automobile insurance medical services in a manner other than by or through the
health plan in which the worker is enrolled.
Section 10102. Payment By Automobile Insurance Carrier. (a) Provides that
payment for automobile insurance medical services by automobile insurance carriers
generally will be made in accordance with the applicable regional alliance fee schedule
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�SUBTITLE C - COMMISSION. ON INTEGRATION OF HEALTH BENEFITS
(H.R. 3600 and S. 1757 p. 1331)
Section 10201. Commission.
This section establishes the Commission on Integration of Health Benefits.
The Commission will consist of 15 members appointed jointly by the Secretaries of
Health and Human Services and the Secretary of Labor. Members of the Commission will
serve without compensation. The Secretaries provide that each member shall receive travel
expenses, including per diem in lieu of subsistence, in accordance with sections 5702 and
5703 of title 5, United States Code.
The Commission is directed to study the feasibility and appropriateness of transferring
financial responsibility for all medical benefits (including those currently covered under
workers compensation and automobile insurance) to health plans. Staff support for the
Commission is provided by the Secretaries.
The Commission must submit a report to the President by not later than July 1, 1995.
If the Commission recommends the integration of fmancial responsibility for all medical
benefits in health plans, the report must contain a detailed plan as to how (and when) such an
integration should be effected under this Act.
The Commission shall terminate 90 days after the date of submission of its report.
Appropriation of the amounts necessary to carry out this section are authorized under the
section.
SUBTITLE D - FEDERAL EMPLOYEES' COMPENSATION ACT
(iI.R. 3600 and S. 1757 p. 1333)
Section 10301. Application Of Policy.
This section makes technical changes to the Federal Employees' Compensation Act
(Chapter 81 of title 5, United States Code) to conform it to the changes made to state
workers compensation systems under subtitle A.
SUBTITLE E - DAVIS-BACON ACT AND SERVICE CONTRACT ACT
(H.R. 3600 and S. 1757 p. 1333)
Section 10401. Coverage Of Benefits Under Health Security Act.
This section make tec,hnical changes to the Section 1(b)(2) of the Davis Bacon Act (40
Title X
307
�U.S.C. 276a(b)(2)) and to the second sentence of section 2(a)(2) of the Service Contract Act
of 1965 (41 U.S.C. 351(a)(2)). The amendments insert after "local law" the following:
"(other than benefits provided pursuant to the Health Security Act)".
SUBTITLE F - EFFECTIVE DATES
(H.R. 3600 and S. 1757 p. 1334)
Section 10501. Regional Alliances.
The section provides that the provisions of subtitles A and B of this title will apply to
regional alliances and regional alliance health plans in a state 2 years after the state's first
year (as defined in section 1902( 17»).
Section 10502. Corporate Alliances.
The section provides that the provisions of subtitles A and B of this title will apply to
corporate alliances and corporate alliance health plans on January 1, 1998.
Section 10503. Federal Requirements.
The section provides that the provisions of subtitle D of this title will take effect on
January 1, 1998.
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�TITLE XI - TRANSITIONAL INSURANCE REFORM
(H.R. 3600 and S. 1757 p. 1335)
Section 11001. Imposition Of Requirements. (a) Provides that the purpose of the
title is to assure, to the extent possible, the maintenance of current health care coverage and
benefits during the period between the enactment of the Health Security Act and the dates its
provisions are implemented in the various states.
(b) Provides that the Secretary of Health and Human Services will enforce the
requirements of the title with respect to health insurance plans and that the Secretary of
Labor will enforce the requirements with respect to self-funded health plans. Each Secretary
is required to promulgate regulations to carry out the requirements under this title.
Regulations for carrying out section 11004 must be promulgated within 90 days after the date
of the enactment of the Act.
The Secretaries are authorized to enter into arrangements with a state to enforce the
requirements of this title with respect to health insurance plans and self-insured plans
providing coverage in the state.
(c) Provides that the requirements of the title do not preempt any state law unless
state law directly conflicts with such requirements. State laws that provide additional
protection to consumers will not be considered to directly conflict with the requirements of
the title. Each Secretary may issue letter determinations with respect to whether this Act
preempts a provision of state law.
(d) Provides that regulations issued to carry out this title may be issued as interim
fmal regulations. The Secretary is authorized to consult with states and the National
Association of Insurance Commissioners in issuing regulations and guidelines under this title.
(e) Provides that this title will be construed, to the greatest extent practicable, to
assure the continuity of health benefits provided under health benefit plans in effect on the
effective date of this Act.
(f) Authorizes the Secretary to issue regulations relating to the application of this title
when health insurance plans are transferred from one insurer to another insurer through
assumption, acquisition, or otherWise.
Section 11002. Enforcement. (a) Provides that a health insurer or health benefit plan
sponsor that violates a requirement of this title-is subject to civil money penalties of not more
than $25,000 for each such violation.
(b) Authorizes the appropriate Secretary to bring a civil action to enjoin any act or
practice which violates any provision of this title or to obtain other appropriate equitable
Title XI
�relief to redress violations or enforce any provision of this title.
Section 11003. Requirements Relating To Preserving Current Coverage.
(a) Generally prohibits health insurers from terminating (or failing to renew) coverage
under a group or individual health insurance plan except in the cases of:
(1) nonpayment of required premiums;
(2) fraud; or
(C) misrepresentation of a material fact relating to an application for coverage or
claim for benefits.
The provisions of this subsection take effect on the date of enactment and,apply to
coverage on or after such date.
(b) Requires health insurers that provide group health insurance plans to provide
coverage to new full-time employees (and their eligible dependents) of any employer covered
under the plan. Premium rates for new employees must be consistent with the provisions of
section 11004(b) and any exclusions imposed for preexisting conditions must meet the
requirements of section 11005.
Section 11004. Restrictions On Premium Increases During Transition.
This section establishes requirements relating to premium increases by health insurers
during the transition period.
(a) Requires health insurers to divide their health insurance business into three sectors
for the purpose of calculating rate increases: a large group sector (which applies to groups
with 100 or more covered lives); a small group sector (which applies to groups with fewer
than 100 covered lives) and an individual sector.
(b) Establishes requirements for changes in premiums relating to changes in individual
or group characteristics. The subsection applies to changes in premiums for:
(1) changes in the number of individuals covered under a plan;
(2) changes in the demographic or group characteristics (including age,
gender, family composition or geographic area but not including health status, claims
experience or duration of coverage under the plan) of individuals covered under a
plan;
(3) changes in the level of benefits under the plan; and
(4) changes in any material terms and conditions of the health insurance plan
(not related to health status).
Health insurers that increase premiums are required to calculate a reference rate for
each such sector. The reference rate for a sector is calculated so that when applied to the rate
factors (specified in the subsection) it would approximate the average premium rates charged
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�individuals and groups in the sector as of the effective date of this title.
Health insurers that increase premiums are also required to develop a single set of
rate factors for each sector. The rate factors are used to calculate changes in premium that
relate to changes in group or individual characteristics, changes in benefits or material
changes in the terms of the plan.
Rate factors developed by insurers must relate to reasonable and objective differences
in demographic characteristics, in the design and in levels of coverage, and in other terms
and conditions of a contract and may not relate to expected health status, claims experience,
or duration of coverage of the one or more groups or individuals.
Changes in premiums are calculated using the rate factors developed pursuant this
section.
For changes in premium rates that relate to a change in the number of people covered
under a health insurance plan, the premium change is calculated by applying the reference
rate (for the sector) to the rate factors applicable to the people who joined or left the plan.
For changes in premium rates that relate to changes in group or individual
characteristics, changes in benefits or material changes in the terms of the plan, the premium
changes are calculated by applying the rate factors developed pursuant to this subsection
applied to the current premium charged for the health insurance plan.
In applying rate factors under this subsection, resulting changes in premium may not
reflect any change in the health status, claims experience or duration of coverage with
respect to any employer or individual covered under the plan.
The provisions of this subsection apply only:
(1) to changes in premiums occurring on or after the date of the enactment of
this Act to groups and individuals covered as of that date, or
(2) for groups and individuals covered after the date of enactment, to changes
in premiums after the date coverage begins.
This subsection does not require the application of rate factors related to individual or
group characteristics with respect to community-rated plans.
(c) Establishes limitations on changes in premiums related to increases in health care
costs and utilization.
.
.
.
In general, health insurers that increase premiums because of increases in costs or
utilization must apply the same percentage increase to all plans in all sectors. Health
insurers may vary the percentage increase among plans in the large group sector, based. on
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�the credible claims experience of particular employers, as long as the weighted average of
increases for all such plans in the sector is equal.to the percentage increase in other sectors.
Premium increases under this subsection may be applied on a national level or may
vary based on geographic area. Area variations may be applied only if the areas are
sufficiently large to provide credible data on which to calculate the variation and the variation
is due to reasonable factors related to the objective differences among the areas in costs and
utilization of health services.
The Secretary is authorized to grant exceptions to the limitations on rate increases
contained in this subsection to accommodate state insurance reform efforts if necessary to
pennit a state to narrow the variations in premiums among health insurance plans offered by
health insurers to similarly situated groups or individuals within a sector.
The limitations on rate increases contained in this subsection do not' apply to premium
rates that are subject to prior approval by a state insurance commissioner (or similar official)
and are in fact approved by such official.
The Secretary is authorized to specify other exceptions through regulations that the
Secretary determines are required to enhance stability of the health insurance market and
continued availability of coverage.
Premium increases must be applied in a consistent, even manner so that any variations
in the rate of increase applied in consecutive months are even and continuous during the
year.
A health insurer may petition for an exception from the application of the provisions
of this subsection. The Secretary may approve grant an exception if the health insurer
demonstrates that the application of this subsection would threaten the fInancial viability of
the insurer and the health insurer offers an alternative method for increasing premiums that is
not substantially discriminatory to any sector or to any group or individual covered by a
health insurance plan offered by the insurer.
(d) Requires health insurers to obtain prior approval for proposed premium increases
for the individual and small group sector if the proposed premium increase exceeds a
percentage specified by the Secretary.
In specifying a percentage under this subsection, the Secretary must consider the rate
of increase in health care costs-and utilization, previous trends in health insurance premiums,
and the conditions in the health insurance market. The Secretary must specify a percentage
within 30 days after the date of the enactment of the Act.
(e) Requires that premiums for each health plan be conformed in a manner that
complies with the provisions of this section within one year after the date of enactment of the
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312
�Act.
Health insurers are required to document the methodology used in applying limitations
to premium increases under subsections (b) and (c). The documentation must be sufficient to
permit the auditing of the application of the methodology used to determine consistency with
the requirements of the section.
Health insurers must file a ceJ1ification with the Secretary every six months certifying
compliance with the requirements of the section.
(f) Requires the Secretary to establish regulations to carry out this section. The
regulations may specify the permissible variation that results from the use of demographic or
other characteristics in the development of rate factors. The guidelines may be based on the
guidelines currently used by states in applying rate limitations under state insurance
regulations.
'
(g) Provides that the section will apply to premium increases occurring during the
period beginning on the date of the enactment of the Act and ending on the date a state
implements universal coverage through alliances under the provisions of the Act.
Section 11005. Requirements Relating To Portability. (a) Limits the period of
exclusion that a group health benefit plan may apply with respect to services related to
treatment of a preexisting condition to a period of not more than 6 months. An exclusion of
coverage for treatment of a preexisting condition may not apply to services furnished to
newborns or in the case of a plan that did not apply such exclusions as of the effective date
of this title.
A group health benefit plan must reduce any period of exclusion applied with respect
to treatment of a preexisting condition for individuals that were previously covered by health
insurance. The amount of reduction is one month for each month of previous coverage. The
previous coverage must have been continuous (with no more than three consecutive months
without coverage).
(b) Provides that self-insured plans and employers sponsoring group health insurance
plans may not discriminate among employees in the establishment of waiting periods for
health insurance on the basis of health status or related factors.
Section 11006. Requirements Limiting Reduction Of Benefits.
The section prohibits a sponsor of a self-insured benefit plan from modifying benefits
under the plan in' a manner that reduces or limits coverage with respect to any medical
condition or course of treatment for which the anticipated cost is likely to exceed $5,000 in
any 12-month period.
A modification of benefits includes the termmation of a plan if the sponsor establishes
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�a substitute plan that reflects such a reduction or limitation.
A modification made in violation of this section is not effective and the self-insured
sponsor must continue to provide benefits as though the modification (described in subsection
(b» had not occurred.
Section 11007. National Transitional Health Insurance Risk Pool.
(a) Authorizes the Secretary to establish a National Transitional Health Insurance Risk
Pool ("national risk pool") during the transition.
(b) Authorizes the Secretary to administer the national risk pool through contracts
with state health insurance risk pools, private health insurers, or other contractors as the
Secretary· deems appropriate.
The Secretary is authorized to enter into such arrangements with existing state health
insurance risk pools to coordinate the coverage under such pools with the coverage under the
national risk pool.
(c) Provides that coverage under the national risk pool may be provided to individuals
who are unable to secure health insurance coverage from private health insurers because of
their health status or condition (as determined in accordance with rules and procedures
specified by the Secretary).
(d) Provides that the benefits and terms of coverage provided through the national risk
pool will include items and services, conditions of coverage, and cost sharing (subject to
out-of-pocket limits on cost sharing) comparable to the benefits and terms of coverage
available in state health insurance risk pools.
Payments to providers by the national risk pool for covered items and services will be
made at rates specified by the Secretary based on payment rates for comparable items and
services under the Medicare program. Providers who accept payment from the national risk
pool must accept the payment as payment in full.
(e) Provides for premiums for coverage in the national risk pool to be set in a manner
specified by the Secretary. Premiums vary based upon age, place of residence, and other
traditional underwriting factors other than on the basis of health status or claims experience.
Premiums charged individuals must be set at a level that is no less than 150 percent of the
premiums that the Secretary estimates would be charged to a population of average risk for
the covered benefits.
(f) Requires the Secretary to estimate each year the extent to which the total
premiums collected by the national risk pool are insufficient to cover the expenses of the
national risk pool with respect to the year. The Secretary of the Treasury is authorized to
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�advance to the Secretary amounts sufficient to cover the amount estimated.
The Secretary must repay such amounts, with interest at a rate specified by the
Secretary of the Treasury, from the assessments made on health benefit plan sponsors.
Assessments on health benefit plans in a year may not exceed 112 of 1 percent of the total
amount of premiums (and premium equivalents in the case of self-insured plans) for health
benefits under the plan for the previous year.
Section 11008. Definitions.
The term "applicable Secretary" means the Secretary of Health and Human Services
with respect to health insurance planS and insurers and the Secretary of Labor with respect to
self-insured plans and self-insured plan sponsors.
The term "covered employee" means an employee (or dependent of such an
employee) covered under a group health benefits plan.
The term "covered individual" means an individual insured, enrolled, eligible for
benefits, or otherwise covered under a health benefit plan.
The term "group health benefits plan" means a group health insurance plan and a
self-insured plan.
The term "group health insurance plan" means a health insurance plan offered
primarily to employers for the purpose of providing health insurance to the employees (and
dependents) of the employer. The term includes arrangements offered through associations
and trusts, and includes a mUlti-employer welfare arrangement (as defined in section 3(40) of
the Employee Retirement Income Security Act of 1974), whether funded through insurance
or otherwise.
The term "health benefits plan" means health insurance plan and a self-insured health
,
I
benefit plan.
The term "health benefit plan, sponsor" means the insurer offering a health insurance
plan or the self-insured sponsor for a self-insured plan.
The term "health insurance pLan" means any contract of health insurance, including
any hospital or medical service policy or certificate, any major medical policy or certificate,
any hospital or medical service plan contract, or health maintenance organization subscriber
contract offered by an insurer.' The term does not include any of the following:
(1) coverage only for accident, dental, vision, disability income, or long-term
care insurance;
(2) Medicare supplemental health insurance;
(3) coverage issued as a supplement to liability insurance;
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�(4) worker's compensation or similar insurance; or
(5) automobile medical-payment insurance.
The term also does not include any aggregate or specific stop-loss insurance or similar
coverage applicable to a self-insured plan. The Secretary is authorized to develop rules
determining the applicability of this subparagraph with respect to minimum premium plans or
other partially insured plans.
The term "health insurer" means a licensed insurance company, a prepaid hospital or
medical service plan, a health maintenance organization, or other entity providing a plan of
health insurance or health benefits with respect to which the state insurance laws are not
preempted under section 514 of the Employee Retirement Income Security Act of 1974.
The term "individual health insurance plan" means any health insurance plan directly
purchased by an individual or offered primarily to individuals (including families) for the
purpose of permitting individuals (without regard to an employer contribution) to purchase
health insurance coverage. The includes any arrangement in which coverage for health
benefits is offered to individuals through an association, trust, list-billing arrangement, or
other arrangement in which the individual purchaser is primarily responsible for the payment
of any premium associated with the contract.
.
The term "self-insured plan" means an employee welfare benefit plan or other
arrangement insofar as the plan or arrangement provides benefits with respect to some or all
of the items and services included in the comprehensive benefit package, (as in effect as of
January I, 1995) that is funded in a manner other than through the purchase of one or more
health insurance plans. such term shall not include a group health insurance plan (as defined
in paragraph (5)(B)(ii».
The term "self-insured sponsor" includes any entity which establishes or maintains a
self-insured plan.
The term "state commissioner of insurance" includes a state superintendent of
insurance.
Section 11009. Termination. (a) Provides that this title will not apply to a health
insurance plan provided in a state on and after the time a state implements universal coverage
pursuant to the provisions of this Act.
(b) Provides that, for self-insured plans sponsored by corporate alliance eligible
sponsors, the provisions of this title will not apply as' of the effective date of the sponsor's
election to be a corporate alliance. For self-insured plans sponsored by a sponsor that is not
such an eligible corporate alliance sponsor, the provisions of this title will not apply in a
state on and after the time a state implements universal coverage pursuant to the provisions
of this Act.
Title XI
316
�
Dublin Core
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Title
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Carol Rasco - Issues Series
Creator
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Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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Clinton Presidential Library & Museum
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92 folders in 7 boxes
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Paper
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Health Care Materials [11]
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Domestic Policy Council
Carol Rasco
Issues Series
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2010-0198-S Segment 2
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Box 124
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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12/4/2013
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2010-0198-Sb-health-care-materials-11
-
https://clinton.presidentiallibraries.us/files/original/2103dae476f87e1cdae80016e66ea208.pdf
bd81485de10b585dfd0049d6f862c6c9
PDF Text
Text
SUBTITLE B - INFORMATION SYSTEMS, PRIVACY, AND
ADMINISTJUTIVE SIMPLIFICATION
(H.R. 3600 and S. 1757 p. 859)
PART 1 - HEAl.TH INFORMATION SYSTEMS
Section 5101. Establishment Of Health Information System. (a) Within two years
of enactment. the National Health Board must establish a system for collecting. regulating
and disseminating certain health care information.
(b) The information system mUlst be consistent with privacy security standards in the
Act.
(c) The system must be consistent with reducing the costs of health care and providing
health care information to state and Federal governments, health alliances and health plans.
(d) Health care information must be collected and reported in a manner that facilitates
its use for the following purposes:
(1) health care planning, policy consideration and research by Federal, state
and local governments and regional and corporate alliances;
(2) establishing and mQnitoring payments, by Federal and state governments
and the alliances, for health se:rvices;
(3) assessing and improving the quality of care;
(4) measuring and impmving access to health care;
(5) evaluating the cost of clinical or administrative functions;
(6) supporting public health functions and objectives;
(7) improving the capaCity of health plans, providers and consumers to
improve and make choices about health care; and
(8) managing and containing costs at the plan and alliance leveL
(e) Health care information to be collected includes data on:
(1) enrollment and dist:nrollment in health plans;
(2) clinical encounters and other items and services furnished by health care
providers to plan members;
(3) administrative and fInancial transactions of states, alliances, plans,
providers, employers and individuals as are needed to determine compliances with this
act or related laws;
(4) characteristics of regional alliances including· the number and demographic
characteristics of alliance residents;
(5) characteristics of corporate alliances including the number and
demographic characteristics of enrolled individuals.
(6) terms of agreement between plans and participating providers;
(7) benefIt payment information;
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�(8) utilization management by health care plans and providers,
(9) information collected and reported by the Board or disseminated through
the National Quality Management Program;
(10) grievances filed 'against alliances and plans and their resolution; and
(11) information needed in order to determine compliance with health care
fraud statutes.
Section 5102. AdditionafRequirements For Health Information System.
(a) In
developing the health infonnation system, the Board must consult with the following agencies
and entities:
(1) Federal agencies that collect information, furnish health care, pay for
health care or enforce one or more provisions of this Act;
(2) the National Quality Management Council;
(3) participating states;
(4) regional and corporate health alliances;
(5) health plans;
(6) representatives of providers;
(7) representatives of employers;
(8) representatives of health care consumers;
(9) experts in public: health and health care infonnation and technology;
(10) representatives of organizations furnishing health care services, supplies
and equipment.
.
(b) The National Board must establish standards for uniform collection and
transmission of data. The standards must specify both the form and manner in which
information is to be collected and transmitted and the frequency of transmission. To the
extent practicable, standards must:
(1) require uniform. paper forms containing standard data elements in cases in
which electronic transmission is not specified;
(2) require the use of uniform data sets in the case of electronic transmission;
(3) require unifonn presentation; and
(4) require electronic data interchange among automated systems.
(c) The Board's standards shall preempt inconsistent provisions of state law, unless
the Board determines that the state law is needed to prevent fraud and abuse, or is related to
controlled substances, or for other purposes.
Section 5103. Electronic Data Network. (a) The National Health Board, in
consultation with certain entities must develop and administer an electronic data network
consisting of regional centers that collect, compile and transfer information.
(b) The
Boar~
must consult with Federal agencies that collect health care information
or provide or pay for health care, participating states, the National Quality Management
Council, regional and corporate alliances, health plans, consumer, provider, and employer
Title V
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�representatives, experts in public health and health information and representatives of
organizations that provide health services and supplies.
(c) The Board shall test the electronic data network prior to full implementation.
(d) Individual information may be released only in accordance with the Board's
privacy standards under section 5120.
Section 5104. Unique Identifier Numbers. (a) The National Health Board must
establish a system for assigning unique identifier numbers to the following persons:
(1) eligible individuals;
. (2) employers;
(3) health plans;
(4) health-care providers;
(b) In establishing unique idlentifiers the Board must assure that a unique identifier
number may not be used to connect individually identifiable information in the health
information system with such 'identifiable information from any other sources, except where
the Board determines that a connection is needed to carry out duties under the Act.
(c) The Board shall establish rules for the permissible use of unique identifiers.
Section 5105. Health Secwrity Cards. (a) Health Security cards may be used only
for obtaining benefits under:
(1) a health plan,
(2) a supplemental benefit policy or cost sharing policy (as defmed in subtitle
E of title I),
(3) a Federal employee benefit plan supplemental policy (defmed in Title VIII)
(4) a FEHBP Medicare supplemental policy described in Title VIn, or
(5) other program specified by the Board.
(b) The Board must issue regulations establishing standards for the use of cards and
for the information to be encoded in the cards. The section requires that encoded
information include
(1) the identity of the card-holder;
(2) the applicable health plan in which the individual is enrolled;
(3) supplemental policies which the individual maintains; and
(4) other information the Board determines is necessary.
(c) The unique identifier shall be encoded on the card.
(d) The Board must register the name and other features of the security card as a
trademark.
.
Title V
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�(e) Misuse of the card is a criminal offense under section 5438.
Section 5106. Technical Assistance In The Establishment Of Health Information
Systems. The Board must provide information and technical assistance on automated health
information systems to participating states, alliances, health plans, and providers. Assistance
must promote community-based health information systems that collect information at the
place where the patient receives the care, or as a byproduct of providing care to the patient.
PART 2 -- PRIVACY OF INFORMATION
Section 5120. Health Infonnation System Privacy Standards. (a) Within two years
of enactment, the Board shall promulgate standards for the privacy and security of
. individually identifiable information within the health information system. Standards must
assure security. The Board must periodically revise the standards in consultation with
Federal health agencies, the National Quality Management Council, participating states,
regional and corporate alliances, ht:alth plans, and consumer representatives.
(b) The standards apply to individually identifiable information collected for or by,
reported to or by, or the dissemination of which is regulated by, the Board.
(c) Standards shall incorporate the following principles:
(1) disclosure is prohibited unless:
(A) the enrollee discloses the information;
(B) the enrollee authorizes disclosure in writing;
(C) the disclosure is to a Federal, state or local law enforcement agency
for the purpose of enforcing this act or a related act;
(D) disclosure is consistent with the Act, under rules of the Board.
(2) authorized disclosure is limited to the amount of identifiable information
needed for the purpose for which it is disclosed.
(3) health plans may not transmit the identifiable information to regional or
corporate alliances for purposes of setting premiums on the basis of risk-adjustment;
(4) individuals and entities that maintain, use or transmit such information
must safeguard its security;
(5) individualsenr()l1ed in health plans have the right to know what types of
identifiable information is being maintained on them and why;
(6) enrollees or the:ir representatives may see and copy information (subject to
appropriate procedures) and have amendments or corrections noted;
(7) individuals must be notified in writing of the purposes for which
individually identifiable irtformation may be used or disclosed and the right of access
described in paragraph (6).
(8) transmission of individual information shall use individuals' unique
identifiers.
(9) individually identifiable health care information may not be used in making
employment decisions.
Title V
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�Section 5121. Other Duties With Respect To Privacy. (a) The Board may sponsor
research on privacy and security of individually identifiable health information, the
development of disclosure consent forms, and the development of technology to implement
the standards relating to such infomlation.
(b) The Board must establish programs for training of personnel with access to
individual information about their S(:curity duties, as well as public education programs for
individuals and employers about their rights and protections.
Section 5122. Comprehensi.ve Health Information Privacy Protection Act. (a)
Within three ¥ears of the date of enactment of this Act, the Board must submit to the
President and Congress a detailed proposal for privacy protection legislation that includes an
easily understood code of fair information practices regarding individually identifiable health
information, as well as enforcement provisions.
Section 5123. Defmitions. (1) the term "enrollee" means an individual enrolled in a
health care plan;
(2) the term "enrollee representative" means an individual legally empowered
to make health care decisions for an enrollee;
(3) the term "individually identifiable health information" means any oral or
recorded information that identifies or can be connected to an individual enrolled in a
health plan, and that conce:rns his or her mental or physical health, health care, or
payment for health care.
PART 3 --INTERIM REQUIREMENTS FOR
ADMINISTRATIVE SIMPLIFICATION
Section 5130. Standard Benefit Forms. (a) Within a year after enactment the Board
must develop and publish in the Federal Register standardized forms for :
(1) enrollment and disenrollment;
(2) clinical encounters; and
(3) benefit claims.
(b) Forms must include instructions for completion and standardized codes and data
sets.
(c) Within 270 days of publication the forms shall take effect, and health providers
furnishing items and services in the United States must use the forms to file claims for
payment. Health plans are also required to use the standardized enrolment, claims payment,
and clinical encounter forms.
(d)( 1) Affected health plans include any public or private entity or program
providing for payment for health care services, including plans that are group health
Title V
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�plans under the Internal Revenue Code and any other health insurance arrangement or
service contract. Plans that are accident only, credit, disability, liability supplement
policies, or other types designated by the Board, shall not be required to use the
fonns. Workers' compensation and automobile medical insurance are covered by the
standardization provision. F:ederal and state programs providing for the direct
provision of health care to patients are not covered.
(2) Affected health service providers include any person or entity furnishing
health care and includes Federal and state programs that support the direct provision
of health services.
(e) The Board may modify or update any standardized fonn.
PART 4 - GENERAL PROVISIONS
Section 5140. National Pri.vacy And Health Data Advisory Council. (a) A National
Privacy and Health Data Advisory Council is established to advise the National Health Board
on health-care infonnation systems, infonnation privacy and security, and other matters. The
Council is appointed by the Board and consists of a I5-member board that includes
representatives of consumers, employers and other purchasers of health care, plans,
providers, alliances, public health agencies, participating states and experts in data collection
and protection, law, ethics, medical and health services research, and other specified matters.
Members serve three-year staggered tenns, and individuals appointed to fill a vacancy shall
. serve out the remainder of the pre:decessor's tenn. The Council shall meet three times each
year.
Section 5141. Civil Money Penalties. Establishes civil penalties of $10,000 per
violation for non-compliance with. the standards for the health care infonnation system and
for privacy and security of system information, or for using a health security card or unique
personal identifier for unauthoriz(!d purposes.
These penalties are in addition to other penalties that may be imposed by law. The
process for imposition of a civil money penalty under this part shall be the same process used
under subtitle E of title V (all-payer fraud provisions).
Section 5142. Relationship To Other Laws. Stipulates that the title may not restrict
or invalidate the authority of any court with jurisdiction over health care infonnation. The
section also stipulates that the title neither restricts nor invalidates laws requiring reports of
disease, child abuse, birth or death.
Title V
188
�SUBTITLE C - REMEDIES AND ENFORCEMENT
(H.R. 3600 and S. 1757 p. 887)
PART 1- REVIEVV OF BENEFIT DETERMINATIONS
FOR ENROLLED INDIVIDUALS
SUBPART A - GENERAL RULES
Section 5201. Health Plan Claims Procedure. (a) A claim is a claim for payment
for, provision of, or authorization before receipt of, benefits under a health plan; an
individual claimant is a person who submits a claim to a health plan in connection with
enrollment or on whose· behalf a claim is submitted; a provider claimant is a provider who
submits a claim on behalf of an enrolled member.
(b)( 1) Plans must notify claimants in writing, within 30 days after an
individual or provider claimant submits a complete claim, whether it is approved or
denied. The notice must be understandable by a typical plan member and must take
into account accessibility to the information by persons whose primary language is not
English. If the plan denies a claim, it must provide a notice within five days of the
determination to deny the claim. The notice must state the reasons for denial, and of
the claimant's right to appeal the denial. A claim for which a plan fails to meet these
requirements will be consid.::red to have been approved by the plan.
(2) Plans must review written claimant requests for reconsideration of a claim
denial, if the request is made within 60 days of receipt of written notice of the denial.
(3) The plan must re:view the denial and provide written notice of its decision
within 30 days after receiving the request for reconsideration.
(4) The review must: be de novo and the reviewer must be a person who did
not make the initial denial decision and who is authorized to approve the claim. If an
issue to be reviewed requir,es medical expertise, review by a qualified physician must
be included in the process.
(c)(1) Plans must approve or deny within 24 hours after submission an
"urgent" claim for pre-authorization of items or services (other than emergency
services under section 1406, which may not be subject to pre-authorization), if the
claim is submitted with a statement that failure to provide the requested benefits can
reasonably be expected to seriously jeopardize the health of the claimant (including
an unborn child of a pregnant woman), or result in serious impairment of bodily
functions or serious dysfunction of any bodily organ or part. A decision within 24
hours is also required if the claimant has made or is at risk of making an attempt to
. harm himself or herself or another person.
(2) In the case of an urgent claim, a health plan must approve or deny the
claim within 24 hours of submission. Failure to comply within the time limits shall
be treated as approval.
Title V
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�(3) An urgent claim which is denied must be treated as a claim for which all
internal plan grievance procedures have been exhausted.
(4) Plans are prohibitc!d from later denying a claim that has been initially
approved under the 24-hour pre-authorization. For any such subsequent denial,
internal plan grievance procedures will be considered to have been exhausted.
(d) For purposes of this section, a complete claim is one submitted by an individual
and accepted by a provider in a hea.lth plan, or any complete individual or provider claim,
unless the plan notifies a claimant in writing, within 10 days of receiving a claim, that
additional information is needed in order to complete the claim. The filing of such additional
material will be treated as an initial filing of the claim.
(e) A plan's denial must be accompanied by certain information as follows:
(1) the factual basis of a determination that a claimed benefit is not covered
under the comprehensive bt:nefit package, or exceeds applicable payment rates;
(2) the medical basis for, and a description of the process used in, determining
that a claimed benefit is excluded as an experimental treatment or investigatory
procedure;
(3) the medical basis for, the guidelines used, and a description of the process
.used in determining that a claimed benefit is not medically necessary or appropriate or
is inconsistent with the plan's practice guidelines.
(0 A plan may not require any party to waive any right under the plan or the Act as a
condition of approval of a claim tmder the plan, except as specified in a formal settlement
agreement.
Section 5202. Review In Regional Alliance Complaint Review Offices Of
Grievances Based On Acts Or ('ractices By Health Plans. (a) Each state must establish and
maintain a complaint review office, under rules prescribed by the Secretary of Labor. Such
offices will also serve as complaint offices for residents of the regional alliance area who are
enrolled in a corporate alliance.
(2) In cases in which a state is not a participating state, the Secretary of Health
and Human Services must assume these state duties, under regulations of the
Secretary of Labor.
(b) A person may file a complaint in the appropriate alliance complaint review office
with regard to the following actions by a health plan:
(1) actions resulting in the delay or denial of payment or provision of benefits
under an alliance plan;
(2) an act or practice by any plan involving the denia.l of payment or benefits
under a cost sharing plan.
(c) Individuals may· not file complaints until all plan remedies have been exhausted.
Title V
190
�(d) The complaint and administrative and judicial review system in section 5202, 5203
and 5204 are the exclusive means of review for the delaying or denying actions described
above by a corporate alliance health plan or cost-sharing policy.
(e) Complaints must be written, be sworn under oath or affmned, and must include
information required in regulations of the Secretary of Labor.
(f) The complaint review office must notify the person(s) complained against of the
alleged violation within 10 days afu~r the complaint is filed.
(g) Complaints may not be filed later than one year after the alleged violation occurs
but may be amended.
Section 5203. Initial Proceedings In Complaint Review Offices. (a) At the time a
. complaint is filed, the review office must offer the complainant the right to elect one of the
following forms of relief:
(1) to forego further proceedings in the review office and seek whatever
judicial remedies may be available (except in the case of grievances involving
corporate alliance plans, for which the review process is the exclusive form of relief)
(2) to submit the'complaint to an early resolution program (thereby suspending
further review); or
(3) to proceed with. a hearing (with regard to the original complaint, or to
matters unresolved by the early resolution process).
(b) Matters that are part of a dispute for which early resolution has been selected shall
not be assigned to a hearing unless the resolution process has terminated without settlement
or resolution of the dispute. Submitting a complaint for early resolution does not affect the
applicability of the review process except to the extent required by terms of a settlement or
other formal resolution that is reached.
Section 5204. Hearings Before Hearing Officers In Complaint Review Offices.
(a)(1) A complaint review office must assign a complaint to a hearing officer
empowered by the state. The hearing officer must have the power to issue and serve
the complaint on the health plan and to furnish notice of a hearing scheduled no
earlier than 5 days amr the complaint is served. Hearing officers must meet
standards prescribed by the Secretary of Labor with regard to experience, conflicts of
interest and other qualifications.
(2) A hearing officer may amend the complaint upon the complainant's motion
or at the officer's discre:tion, prior to the issuance of an order.
(3) The party complained against has the right to file an answer to the
complaint (and any amendments), and to appear in person or otherwise present
testimony at the hearing on the complaint.
(b) The hearing officer at the officer's discretion may permit other parties to intervene
Title V
191
�and present testimony at the hearing.
(c) Hearings shall be de novo. Testimony must be reduced to writing, and the officer
has the discretion to hear argument or take further testimony. The officer has the right to
issue subpoenas, and the appropriate Federal district court has the power to enforce the
subpoena. In the case of an urgent claim for benefits, a hearing shall be scheduled within 24
hours of the receipt of the complaint by the hearing officer.
(d) A hearing officer's decision must be based on a preponderance of the evidence,
include the officer's fmding of fact, and must constitute the officer's fmal disposition of the
matter. If the officer decides in favor of the complainant, the officer must order the party
complained against to halt the complained-of activities, provide benefits due under the plan
and applicable requirements of this Act, pay the complainant interest up to the time of
judgment, on the value of the contested benefit, and to pay reasonable attorney fees and other
costs. If the officer decides that the: party complained against has not improperly denied
benefits or engaged in other prohibited activities with regard to the complainant,· the section
requires the officer to dismiss the charge. The officer must also require the complainant to
pay attorney's fees and other costs of the party complained against, if the officer fmds that
the complaint was frivolous. The review office must issue copies of the officer's decision to
the parties to the proceedings.
(e) A hearing officer's decision is fmal and binding on all parties. However, except
for "urgent" complaints receiving an expedited hearing, a party to the complaint may file an
appeal of the decision to the Federal Health Plan Review Board. The appeal must be filed
within 30 days after the review oftice has served the decision on parties.
(f) If the decision in favor of a complainant is not appealed, a party to the proceeding
may file for enforcement of the decision with any court with jurisdiction. In such an
enforcement action, the court may not review the decision of the hearing officer and may
award reasonable attorney's fees and costs.
Section 5205. Review By Federal Health Plan Review Board. (a) The Secretary of
Labor must establish a five-member Federal Health Plan Review Board, which must operate
under rules established by the Sec:retary. Board transactions must be recorded, and Board
hearings and records must be ope:n to the public.
(b) The Board must provide for reasonable notice of each appeal and for consideration
of arguments by any party to the hearing on which the appealed decision is based. The
section authorizes the Board, at its discretion, to permit any other person to intervene and
present written argument. The National Health Board also may intervene in such
proceedings.
(c) The Board's review shall be only for the purpose of determining:
Title V
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�(1) whether substantial evidence in the record, considered as a whole; supports
the hearing officer's determination;
(2) whether the officer's determination is supported by a preponderance of the
evidence if the hearing issue was interpretation of contract terms (regardless of the
extent to which the officer considered extrinsic evidence);
(3) whether the officer's determination exceeds statutory jurisdiction,
authority, limitations or violates a statutory right; or
(4) whether the determination was made without following proper legal
procedures.
(d) The decision of a hearing officer, as approved, modified or reversed by the
Board, is the-final, binding order of the Board, subject to judicial review. The Board must
serve parties with copies of its decision no later than five days after it is reached.
(e) A person who is aggrieved by a Board's fmal order may seek review of the order
in a Federal court of appeals for the circuit in which the violation is alleged to have occurred
or in which the complainant lives. Such appeal must be med within 60 days after the
Board's fmal order is entered, and the amount in controversy must be more than $10,000.
The court's jurisdiction over the appeal is exclusive once the record is filed, and its judgment
is final, except as reviewed by the United States Supreme Court. The court may enforce the
order by decree if it does not reverse the Board.
(f) The Board and the reviewing court may award a prevailing complainant reasonable
costs and attorney's fees.
Section 5206. Rules Governing Benefit Claims Determinations. Determinations
made under this part or by any state court in connection with a complaint under section
5202(b) shall be in accordance with the provisions of this Act, the comprehensive benefit
package under the Act, and rules, regulations, and decisions of the National Health Board.
Subject to this section, the rights and remedies available in state court against a health plan
based on complaints under section 5202(b) shall be governed by state law.
Section 5207. Civil Money Penalties. The Secretary of Labor may assess civil
penalties against persons for actions involving corporate alliance health plans, or any other
plan in connection with a cost-sharing policy, for unreasonably denying or delaying payment
or provision of benefits. The section authorizes penalties of up to $25,000 per violation; but
up to $75,000 per violation if bad faith on the part of the plan is found; or up to $1,000,000,
in addition to the total amount of the foregoing penalties, if a pattern or practice of such
violations is found. Each violation with regard to a single individual is a separate violation
for purposes of assessing penalties. The section authorizes the Secretary to enforce the civil
penalties in any court of competent jurisdiction.
Title V
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�SUBPART B -- EARLY RESOLUTION PROGRAMS
Section 5211. Establishment Of Early Resolution Programs In Complaint Review
Offices. (a) Each state must establish and maintain an Early Resolution Program in each of
the state's complaint review offices. Each resolution program must establish and maintain
forums for dispute mediation as described in this subpart, and any forums for other forms of
alternative dispute resolution (including binding arbitration) that the Secretary of Labor may
require by regulation. A state must ensure that the same requirements with regard to
qualifications of personnel and confidentiality are observed in dispute mediation as are
required by the Secretary of Labor for other types of dispute resolution.
(b) A complaint review office must administer its early resolution program and recruit
and train attorneys to be resolution facilitators according to regulations of the Secretary of
Labor. The office must provide sites, records, staff and attorney referral panels for
resolution proceedings. The office must also inform a complainant of the complainant's
options upon the fuing of a complaint and monitor and evaluate the resolution program on an
ongoing basis.
Section 5212. Initiation Ok' Participation In Mediation Proceedings. (a) A dispute
may be submitted to an early resolution program only if the dispute involves an individual
health plan enrollee's claim against a plan or a cost-sharing policy for the denial of payment
or provision of benefits alleged to be covered by the plan or policy. A claim may be either a
claim for payment or benefits, or :a request for information or documentation that is required
by the Act to be disclosed.
(b) An eligible complainant may choose to submit the dispute to mediation under the
early resolution program no' later than 15 days after filing the complaint with the review
office. Submission of a dispute to mediation must be by written agreement (including
complainant's agreement to comply with program rules, and consent for the complaint review
office to contact the health plan); a complainant must also release plan records to the
program, for exclusive use of the facilitator assigned to the dispute. The section requires
each party designated by the complainant to participate in mediation to fully participate in the
mediation; a party must provide to the claims review office a copy of a plan's written record
of its claims procedure, and all relevant plan documents, with regard to the dispute.
Section 5213. Mediation Proceedings. (a) The facilitator assigned to a dispute in an
early resolution program must prepare parties for a dispute conference and serve as a neutral
mediator to settle the dispute.
(b) Before the conferenc{~ the facilitator must determine if the case needs to be further
developed or if additional information and documents are needed.
(c) During the conference the facilitator must help parties identify issues not in
dispute, explore settlements, and help prepare a written agreement reflecting any settlement
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�reached. If there is no settlement, the facilitator must assess the parties' positions and the
likely outcome of additional administrative action or litigation and suggest how to narrow the
issues in dispute.
(d) The facilitator must ensure that mediation of a dispute conclude within 120 days
after a complainant chooses mediation. Parties to mediation may agree to one extension of
the mediation, of up to 30 days, if tlIle mediation is suspended in order to obtain an agency
ruling, or to reconvene the mediation for another session.
(e) Formal rules of evidence do not apply under an early resolution program, and all
statements and evidence may be admitted.' The facilitator acts as ,the sole judge of the proper
weight to be given to each submission. The facilitator may not require parties to a
proceeding to make their statements. or present evidence under oath.
(t) Parties may proceed pro se or be represented by an attorney.
(g) Mediation proceedings under an early resolution program are subject to the
Federal confidentiality rules that apply to dispute resolution proceedings (section 574 of title
V, U. S. C), and the Secretary of Labor may assess a civil penalty of three times the amount
of the claim involved against a person who discloses information in violation of appropriate
.regulations. The Secretary may enforce the penalty in any court with jurisdiction.
Section 5214. Legal Effect Of Participation In Mediation Proceedings. (a) The
fmdings and conclusions of mediation proceedings of Early Resolution Programs shall be
treated as advisory and nonbinding and, except to the extent foreclosed by a settlement
reached in the proceedings, without effect on the rights o'f parties to the proceedings.
(b) A facilitator must assist parties write an agreement reflecting a settlement. Such an
agreement, if signed by the parties, constitutes a binding and enforceable contract between
them.
(c) A settlement agreement does not have the effect of waiving or otherwise affecting
the rights to review under subpart A of this Part with respect to any person who is not a
party to the settlement agreement:.
Section 5215. Enforcement Of Settlement Agreements. (a) A party to a settlement
agreement resulting from mediation proceedings may enforce the agreement through a court
with jurisdiction. The order of the hearing officer is not subject to review in an enforcement
proceeding.
(b) The court in which enforcement is sought has a duty to expedite a party's petition
for enforcement.
(c) The prevailing party in an enforcement action is entitled to attorney's fees and
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�costs.
PART 2 -- ADDITIONAL REMEDIES AND
ENFORCEMENT PROVISIONS
Section 5231. Judicial Revif~w Of Federal Action On State Systems. (a) A state or
alliance aggrieved by a detennination of the National Health Board with regard to the
Board's review and approval of the state's system (subpart B of part 1 of subtitle F of title I)
may seek judicial review of the dett!nnination.
(b)(l) The courts of appeals of the United States have jurisdiction to review
the detennination and to affinn the decision or to set it aside in whole or in part. A
judgement under this section is subject to review by the United States Supreme Court
upon certiorari or petition.
(2) A state or alliance that desires judicial review must file a petition for
review in the court of appeals for the circuit in which the state or alliance is located,
within 30 days after the state or alliance has been notified of the disputed National
Board detennination. The Board must file with the court a record of the proceedings
on which its detennination or action was based, as provided under section 2112 of
Title 28 of the U. S. Code.
(3) The fmdings of fact by the National Board shall be considered conclusive if
supported by substantial evidence, but the Court may remand a case to the Board for
further evidence and the Board may make new or modified findings of fact and certify
the record of further proceedings. New or modified findings shall be considered
conclusive if supported by substantial evidence.
Section 5232. Administrative And Judicial Review Relating To Cost Containment.
There is no administrative or judicial review of any National Health Board detennination on
any matter under subtitle A of title VI.
Section 5233. Civil EnfoJrcement. Except as provide otherwise in the Act, Federal
district courts have jurisdiction over civil actions by the Secretaries of Labor and Health and
Human Services to enforce fmal orders of or civil money penalties assessed by the
secretaries.
Section 5234. Priority Olf Certain Bankruptcy Claims. Certain claims for monies
owed to regional and corporate alliances or to the Secretary of Labor are given priority in
bankruptcy proceedings.
Section 5235. Private Right To Enforce State Responsibilities. The failure by a
participating state to carry out its responsibility under the act constitutes a deprivation of
rights secured by this Act under section 1977 of the Revised Statutes of the United States (42
U.S.C. section 1983). A court must exercise jurisdiction over the claim regardless of
whether the person bringing the: action has exhausted any administrative or other remedies
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�provided by law.
Section 5236. Private Right To Enforce Federal Responsibilities In Operating a
System In a State. (a) The failure of the Secretary of Health and Human Services to carry
out the Secretary's responsibility to operate an alliance system in a non-participating state
under section 1522 of the Act confers an enforceable right of action on any person aggrieved
by the failure.
(b) Action may be brought tn an appropriate state court or Federal district court
regardless of whether the person bringing the action has exhausted his or her administrative
or other remedies provided by law.
(c) A court may award compensatory and punitive damages and, at the discretion of
the court, other appropriate relief if the court fmds a failure in the Secretary.
(d) The court may also award reasonable attorney fees to a prevailing party but not
to the United States as a party, and the United States is liable for costs as a private person
would be.
Section 5237. Private Right To Enforce Responsibilities Of Alliances.
(a) Individuals aggrieved by the failure of a regional or corporate alliance to carry out
its responsibility under the Act have an enforceable right of action and may commence action
in an appropriate state or Federal district court.
(b) An action may be brought in an appropriate state court or Federal district court
only if, with certain exceptions, the person bringing the action has exhausted his or her
administrative or other remedies provided by law. Exceptions to the exhaustion rule include
actions relating to determinations of a person's eligibility under the Act for health benefits
(section 1001(c», a premium discount (subpart A of Part 1 of subtitle B of title VI), or a
reduction in cost sharing (subpart D of part 3 of subtitle D of title 1. A court must also
exercise jurisdiction regardless of exhaustion of remedies in actions relating to enrollment or
disenrollment in a health plan.
(c) If the court fmds a failure, it is authorized to award compensatory and punitive
damages and any other appropriate relief.
(d) The court may allow the prevailing party reasonable attorney's fees, and the
United States shall be liable for costs as a private person.
Section 5238. Discrimimlltion Claims. (a) Individuals aggrieved by the failure of a
health plan to comply with section 1402(c) may commence a civil action against the plan in
an appropriate state or Federal court. The standards to be used to determine whether
discrimination on the basis of age or disability has occurred shall be the standards that are
applied under the Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.) and the
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�l
Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) If a court finds that the
plan has failed to comply with the Act, it may award compensatory and punitive damages
and order other appropriate relief. The court may also award reasonable attorney fees to a
prevailing party (but not to the United States as a party), and the United States is liable for
costs as a private person would be.
(b) If the Secretary of Health and Human Services fmds that a health plan has failed
to comply with the anti-discrimination provisions or applicable regulations under section
1402, the Secretary must notify the plan of its failure. The Secretary is authorized to refer
the matter to the Attorney General with a recommendation to commence an appropriate civil
action, to terminate a plan's participation in an alliance or to take other action as provided by
law, if the health plan fails or refuses to comply with the anti-discrimination provisions or
regulations within a reasonable time after the notification.
(c) The Attorney General may bring a civil action in a district court on matters
referred by the Secretary with recommendation for such action. The action may be for
appropriate relief, including injunctive relief. A court may grant equitable relief as
appropriate and other appropriate relief, including compensatory and punitive damages. The
court may also assess a civil money penalty against the plan of $50,000 for a first violation
and $100,000 for each subsequent violation.
Section 5239. Nondiscrimination In Federally Assisted Programs. Federal
payments to regional alliances (under part 2. of subtitle C of title VI of the Act) constitute
Federal fmancial assistance for purposes of section 504 of the Rehabilitation Act of 1973 (29
U.S.C. 794), section 303 of the Age Discrimination Act of 1975 (42 U.S.C. 6102), and
section 601 of the Civil Rights Act of 1964 (42 U.S.C. 2oood).
Section 5240. Civil Action By Essential Community Provider. (a) An electing
essential community provider (as defmed by section 1431(d)) that is aggrieved by the failure
of a health plan to comply with section 1431 requirements for the community provider's
participation in the health plan may commence a civil action against the plan in state or
Federal court.
.
(b) The court may award compensatory damages to the provider and order any other
appropriate relief if it fmds the health plan failed to comply with a duty imposed by section
1431. At its discretion the court may award reasonable attorney's fees to a prevailing party
(but not to the United States as a party), and the United States is liable for costs as a private
person would be.
Section 5241. Facial Constitutional Challenges. The United States District Court
for the District of Columbia has original and exclusive jurisdiction over constitutional
challenges brought against the Act or any provision of it, on its face and for every purpose.
The court is prohibited from issuing a temporary order or preliminary injunction restraining
enforcement, operation or execution of the Act or any provision of it, in connection with
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�such a constitutional challenge. A constitutional challenge must be initiated no later than a
year after the enactment of the Act.
Facial constitutional challenges must be heard and determined by a district court of
three judges (under section 2284 of title 28, U.S.C.). The court must consolidate any such
constitutional challenges that are pending before the court and that involve a common
question or law or fact. Appeal is authorized directly to the U.S. Supreme Court of any
flnal judgment, decree or order in which the district court invalidates the Act or a provision
thereof and determines that the holding will materially undermine application of the Act as a
whole.
This section should not be read to limit the right of a person to bring litigation
regarding the Act or a part of the Act, or to petition the Supreme Court for review of a
district court holding at any time before judgment is rendered in a court of appeals, nor does
the section limit the authority of the: Supreme Court to grant review of such a petition.
Section 5242. Treatment Of Plans As Parties In Civil Actions. A health plan may
sue or be sued as an entity. Summons may be served on a plan and other legal process of a
court in connection with such a suit. Any money judgement against a plan shall be
enforceable only against a plan as an entity and shall not be enforceable against any
individual person.
Section 5243. General Nonpreemption Of Existing Rights And Remedies. Nothing
in this title shall be construed to deny, impair or otherwise adversely affect a right or remedy
available under law to any person on the date the Act is enacted, except to the extent that the
right or remedy is inconsistent with the title.
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�SUBTITLE D _. :MEDICAL MALPRACTICE
(H.R. 3600 and S. 1757 p. 933)
PART 1 - LIABILITY REFORM
Section 5301. Federal Tort Reform.
(a)(1) The provisions in this part apply in any malpractice liability action
brought in any state or Federal court, with the exception of cases involving claims or
actions for damages arising from a vaccine-related injury or death, to the extent that
title XXI of the PublicHeath Service Act applies to such a claim or action.
(2) This subtitle preempts any state law to the extent that such a law is
inconsistent with the limitations contained in such provisions, except state laws
providing for additional defenses, limiting liability, placing greater limitations on
attorneys' fees, or otherwisf! imposing more restrictions than those contained in this
part.
(3) The preemption in this part shall not be construed as a waiver of any
defense of sovereign immunity asserted by any state under any provision of law, or
.by the United States. The preemption may not be construed to affect the applicability
.of any provision of the Foreign Sovereign Immunities Act of 1976. It shall not be
construed to preempt state choice-of-Iaw rules with respect to claims brought by a
foreign nation or citizen of a foreign nation, nor to affect the right of any court to
transfer venue or apply the law of a foreign nation, or to dismiss a claim of a
foreign nation or a citizen thereof on the ground of inconvenient forum.
(4) This part shall not be construed to establish jurisdiction over medical
malpractice liability action') in the district courts of the United States on the basis of
section 1331 or 1337 of title 28, Unites States Code.
(b) For purposes of this subtitle:
(1) "Alternative dispute resolution system" (ADR) means a system for
resolving medical malpractice claims in a manner other than by medical
malpractice liability actions.
(2) "Claimant" means any person who alleges a medical malpractice
claim and any person on whose behalf such a claim is alleged, including the
deceased individual when such an action is brought through or on behalf of the
individual's estate.
(3) "Health care professional" means any individual who provides
health care servicc::s in a state and who is required by the state's laws or
regulations to be licensed or certified by the state to provide the services in the
state.
(4) "Injury" means any illness, disease, or other harm that is the
subject of a medical malpractice liability action or a medical malpractice
claim..
(5) "Medical malpractice liability action" means a civil action brought
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�in a state or Federal court against a health care provider or health care
professional in which the plaintiff alleges a medical malpractice claim. This
defInition applies to any such civil action, regardless of the theory of liability
on which the claim is based.
(6) "Medical malpractice claim," with two exceptions, means a claim in
a civil action brought against a health care provider or health care professional
in which a claimant alleges that injury was caused by the provision of (or the
failure to provide) health care services. The term "medical malpractice claim"
does not apply to any claim alleging an intentional tort, or to any claim based
on an allegation that a product is defective and that is brought against an
individual or entity that is not a health care professional or health care
. provider.
Section 5302. Plan-based Alternative Dispute Resolution Mechanisms. (a) No
medical malpractice liability action may be brought by an individual enrolled in an alliance
health plan (regional or corporate) for services covered until a fmai resolution of the claim
under the plan's alternative dispute resolution system.
(b) Each regional or corporate alliance plan:
(1) must adopt at least one· of the alternative specifIed dispute resolution
methods for resolving medieal malpractice claims arising from the provision of health
care services to individuals enrolled in the plan.
(2) must disclose to enrollees and potential enrollees the availability of, and
procedures for, consumer grievances under the plan, including the alternative dispute
resolution method or methods adopted under this part.
(c)(1) The National Health Board must develop alternative dispute resolution
methods for use by alliancf: plans (regional and corporate in resolving the medical
malpractice claims. The methods are to be developed by regulation and must include
at least the following: arbitration; required mediation; and a process requiring parties
to make early offers of settlement.
(2) In developing the required alternative dispute resolution methods, the
Board must assure that the methods promote resolution of medical malpractice claims
in a manner that:
(A) is affordable for the parties involved;
(B) provides for tirnely resolution of claims;
(C) provides for the consistent and fair resolution of claims;
(D) provides for reasonably convenient access to dispute resolution for
individuals enrolled in plans.
(d) After final resolution of an enrollee's claim under an alternative dispute resolution
method applied under this section, an enrollee dissatisfIed with the resolution may· bring a
cause of action to seek damages or other redress with respect to that claim, to the extent
permitted under state law.
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�Section 5303. Requirement for Certificate of Merit. (a) Any medical malpractice
liability complaint must be accompanied by an affidavit declaring that the individual (or the
individual's attorney) has consulted and reviewed the facts of the action with a qualified
medical specialist. The affidavit must also include a written report by the specialist that
clearly identifies the individual and that states that the specialist, after reviewing the medical
record and other material, has· determined that there is a reasonable and meritorious cause
for filing the action against the defendant. The affidavit must also state that the individual or
the individual's attorney has concluded, on the basis of the qualified medical specialist's
review and consultation, that there is a reasonable and meritorious cause for filing the action.
(b)(l) The requirement of subsection (a) does not apply if the individual
bringing the medical malprac:tice liability action cannot obtain the affidavit before the
applicable statute of limitations expires. The requirement also does not apply if at the
time the individual brings the action, the individual has not been able· to obtain
medical records or other information necessary to prepare the affidavit pursuant to
any applicable law.
(2) The action of an individual that is brought without the required affidavit
must be dismissed unless the individual submits the required affidavit within 90 days
after the action is brought or 90 days after medical records or other necessary
information has been obtained.
(c) For purposes of the affidavit, a "qualified medical specialist" means a health care
professional who is knowledgeable of, and has expertise in the same specialty area of,
medical practice that is subject to the action. The medical specialist must also be one whom
the individual reasonably believes to be knowledgeable in the relevant issues in the action, to
practice or teach in the same area of health care or medicine at issue in the action within the
preceding 6 years, and to be qualified by experience or demonstrated competence in the
subject of the case.
(d) On a motion by any party or on its own initiative, the court in a medical
malpractice liability action may impose a sanction on a party, the party's attorney, or both, if
any information in the affidavit is submitted without reasonable cause and is found to be
untrue. The sanction may include an order requiring that the sanctioned party reimburse the
other party to the action for costs and reasonable attorney's fees.
Section 5304. Limitation on Amount of Attorney's Contingency Fees. (a) An
attorney who represents on a contingency fee basis a plaintiff in a medical malpractice
liability action may not charge, demand, receive or collect more than 33 and 113 percent of
the total amount recovered by judgment or settlement in the action. This limitation applies
also to resolution of the claim that is the subject of the action under any alternative dispute
resolution.
(b) In the event that a judgement involves periodic payment, the amount recovered for
purposes of computing the limit on the fee shall be based on the cost of the immunity or trust
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�established to make such payments or on the present value of the payments in cases in which
there is no annuity or trust.
(c) For purposes of this section, "contingency fee" means any fee for professional
legal services that is partly or completely contingent on recovering any amount of damages,
whether through judgment or settlement.
Section 5305. Reduction of Awards for Recovery from Collateral Sources. The
total amount of damages that an individual recovers in a medical malpractice liability action
must be reduced by the amount of past or future payment that the individual has received, or
is eligible to receive from other sources for the injury that is the subject of the claim. These
sources include:
(1) Federal or state disability or sickness programs;
(2) Federal, state or private health insurance programs;
(3) private disability insurance programs;
(4) employer wage continuation programs; and
(5) any other program, if the payment is intended to compensate the claimant for the
same injury for which damages are awarded.
Section 5306. Periodic Payment of Awards. At the request of any party to a medical
malpractice liability action, the defendant shall be permitted to make such payments
periodically, based on a schedule that the court considers appropriate, taking into account the
periods for which the injured party will need medical and other services.
PART 2 - OTHER PROVISIONS RELATING
TO MEDICAL MALPRACTICE LIABILITY
Section 5311. Enterprise lLiability DemonStration Project. (a) Not later than
January 1, 1996, the Secretary of Health and Human Services shall establish and fund a
demonstration project in one or more states to demonstrate whether making the plan in which
a physician participates, rather than the physician, liable for the physician's medical
malpractice will improve the quality of health care provided under the plan, reduce
defensive medical practices,. and improve risk management. The funds for such
demonstrations will be in the amount that the Secretary considers appropriate.
(b) A state is eligible to participate in the above-referenced demonstration project if
the state submits an application to the Secretary that contains the following assurances:
(1) the state has entered into an agreement with a health plan other than a fee
for service plan under which the plan assumes legal liability for malpractice claims
arising from the provision or failure to provider services under the plan by any
participation physician;
(2) the state provides that participating physicians in such plans may not be
liable for damages and may not be required to indemnify the plan;
(3) the state will provide periodic reports as required.
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�(c) Such sums as are necessary to carry out the demonstration are authorized-to be
appropriated .
. Section 5312. Pilot Program Applying Practice Guidelines to Medical Malpractice
Liability Actions. (a) No later than one year after determining that appropriate practice
guidelines are available, the Secretary must establish and fund state demonstration projects
to determine the effect of applying practice guidelines in the resolution of medical
malpractice liability cases.
(b) A state is eligible to participate in the pilot program if the state submits an
application to the Secretary containing:
(1) Assurances that under the law of the state, in a medical malpractice action
alleging that the defendant was negligent in providing (or failing to provide) services,
it is a complete defense that the defendant followed the appropriate practice guideline
with regard to providing (or failing to provide) the services that are the subject of the
action. The "appropriate practice guideline" is the guideline (for the services at issue)
established by the National Quality Management Program under subtitle A.
(2) Other information and assurances as required by the Secretary.
(c) The Secretary must submit annual reports to Congress on the pilot program. Such
reports must be submitted no later than 3 months after each year in which the pilot program
is in effect. The reports must describe the operation of the program during the previous year
and make such recommendations a.s the Secretary considers appropriate, including
recommendations on revising the laws governing medical malpractice liability.
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�SUBTITLE E - FRAUD AND ABUSE
(H.R. 3600 and S. 1757 p. 948)
PART 1
ESTABLISHMENT OF ALL-PAYER HEALTH CARE
FRAUD AND ABUSE CONTROL PROGRAM
Section 5401. All-Payer Health Care Fraud and Abuse Control Program.
Requires the Secretary of the Department of Health and Human Services, through the Office
of the Inspector General of the Department of Health and Human Services, and the Attorney
General to establish a program to coordinate their programs and facilitate the enforcement of
laws with respect to fraud and abuse; and-to conduct investigations, audits, evaluations and
inspections relating to the delivery of and payment for health care. Requires the Secretary
and Attorney General to consult and share data and resources with law enforcement and other
relevant public agencies, and to consult with and arrange for sharing data with health
alliances and plans. Authorizes the Attorney General, the Secretary, and the Inspector
General to carry out their duties under the program and to have access (including on-line
access where available) to all records of health plans and health alliances to carry out their
duties. Provides for qualified immunity for persons providing information to the Secretary
or Attorney General. In addition to any other amounts authorized to be appropriated for
health care anti-fraud and abuse activities in a year, authorizes the appropriation of such
additional amounts as necessary to carry out the program. Authorizes the Inspector General
to exercise all powers under the Inspector General Act of 1978 in carrying out this part.
Section 5402. Establishment of All-Payer Health Care Fraud and Abuse Control
Account. Establishes an all-payer health care fraud and abuse control account in the
Treasury, to contain gifts and bequests, criminal fmes imposed for health care offenses,
penalties paid to the government under the False Claims Act, administrative penalties and
assessments imposed under the Social Security act, civil monetary penalties imposed under
Section 5412, and amounts resulting from forfeiture of property by reason of a health care
offense. Provides that amounts in the account shall be available without appropriation and
may be used to cover the costs of carrying out the program established under section 5401 as
detennined by the Secretary and the Attorney General. States that such funds are intended to
be supplementary to appropriated operating budgets of the agencies. Requires the Secretary
and Attorney General to submit an annual report to Congress on the revenue generated and
disbursed by the account. _Defmes a " health care offense" as a violation of specified
sections of title 18 of the United States Code, of the Social Security Act, of ERISA, arid of
the Food Drug and Cosmetic Act, including certain sections as amended in the Health
Security Act.
Section 5403. Use of Frmds by Inspector General. Authorizes the Inspector
General to retain and use any funds paid to reimburse for the costs of conducting
investigations. Establishes in the Treasury the "HHS Office of Inspector General :Asset
Forfeiture Proceeds Fund, to be administered and continually available to the Inspector
General for investigations. Requires that funds transferred from the Department of Justice
It
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�from forfeitures be deposited in the fund.
PART 2 -- APPLICATION OF FRAUD AND ABUSE AUTHORITIES
UNDER THE SOCIAL SECURITY ACT TO ALL PAYERS
Section 5411. Exclusion from Participation. Requires the Secretary to exclude
from participation in an applicable health plan for not less than five years an individual or
entity convicted of health care crimes or patient abuse (described in section 1128(a) of the
Social Security Act, as amended under section 4044, supra). Permits the Secretary to
exclude from participation in an applicable health plan for periods of different duration an
individual or entity convicted of health care crimes (described in specified subsections of
section 1128(b) of the Social Security Act, as amended under section 4044, supra). Requires
the Secretary to provide notice of exclusions to sponsors of health plans, entities
administering state health care programs, and state licensing agencies. Provides for notice,
hearings, and judicial review of exclusions, with prior hearings except where the health or
safety of individuals warrants exclusion prior to such a hearing. Provides terms for
termination of the exclusion by the Secretary and for requests for exclusion by a health plan.
Prohibits payments for items and services (other than emergency care) furnished by, or under
the 'direction of, an excluded person (in situations in which persons working under the
direction of an excluded person knew or had reason to know, of the exclusions.
Section 5412. Civil Monetary Penalties. Provides for the imposition by the
Secretary for the following actions: actions with respect to health plans that are similar to
those that would subject a person to a penalty under paragraphs (1) through (12) of section
1128A of the Social Security Act; terminating enrollment of a person in violation of subtitle
E of title I or state law; discriminating on the basis of perceived need for medical services;
inducing enrollment in a health plan under false pretenses; or providing fmancial incentives
to enroll in a particular health plan. The provisions of section 1128A shall apply to
imposition of penalties. Civil monetary penalties for actions similar to those that would
subject a person to a penalty under the Social Security Act are as provided in that Act, and
for other offenses are up to $50,000. In addition to the civil monetary penalties, the
Secretary may exclude persons committing such offenses from participation in all applicable
health plans. Generally requires the Secretary to follow procedures and provide for appeals
as would be required for similar proceedings under section 1128A of the Social Security Act,
except that the Attorney General must take action within 60 days. If no proceeding to
impose a civil monetary penalty has been initiated within 120 after the Secretary has
presented a case to the Attorney General, the state in which the regional alliance is located
, may initiate such a proceeding. Amounts recovered are repaid to a health plan that has made
such payments, with the remainder paid into the All-Payer Health Care Fraud and Abuse
Account under section 5402, supra. Provides for notification by the Secretary to appropriate
licensing agencies or organizations of the inipositionof sanctions under this section.
Authorizes the Secretary of Labor or state to take civil monetary penalty action against
corporate or regional alliance plans if authorized by the Attorney General and the Secretary
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�of HHS. Provides the Attorney General and Secretary of HHS 120 days from date·of
notification by the Secretary of Labor to reach a detennination.
Section 5413. Limitations on Physician Self-Referral. Provides for the application
of the prohibitions, safe harbors, and penalties under section 1877 of the Social Security Act
(dealing with physician self-referral) to similar actions taken with respect to health plans, and
provides the Secretary of Labor and the states the authorities provided under that section to
the Secretary of the Department of Health and Human Services.
Section 5414. Construction of Social Security Act References. Provides that the
references to provisions under the Social Security Act are to that Act as amended by title IV
of the Health· Security Act but otherwise as that Act is in effect on the date of enactment of
the Health Security Act.
PART 3 -- AMENDMENTS TO ANTI-FRAUD AND ABUSE PROVISIONS UNDER
THE SOCIAL SECURITY ACT
Section 5421. Reference to Amendments. Notes that amendments to anti-fraud and
abuse provisions under the Social Security Act are found in part 5 of subtitle A of title IV.
PART 4 -- AMENDMENTS TO CRIMINAL LAW
Section 5431. Health Care Fraud. Amends Chapter 63 of title 18, U.S.C., by
adding a provision providing imprisonment of up to 10 years, or [mes, or both, for anyone
who knowingly attempts to or actually does defraud (or wrongfully obtain the property of) an
alliance, plan or any other person. Provides for imprisonment for life or any tenn of years
if the violation results in serious bodily injury.
Section 5432. Forfeitures for Violations of Fraud Statutes. Amends section 982(a)
of title 18, U.S.C., to provide for forfeiture of property used in or derived from commission
of a health care offense that poses a serious threat to the health of a person or has a
significant detrimental impact on the health care delivery system, in proportionate value to
the seriousness of the offense, from an individual convicted of the offense. Proceeds from
such forfeitures are to be paid into the all-payer health care fraud and abuse control account
in the Treasury.
Section 5433. False Statements. Adds a new section 1033 to Chapter 47 of title 18,
U. S.C., providing for [mes and imprisonment for up to five years for knowingly and
willfully falsifying or covering up material facts, making false statements or representations,
or making or using documents with false entries, and similar acts of misrepresentation.
Section 5434. Bribery ~md Graft. Adds a new section 226 to Chapter 11 of title
18, U.S.C., making unlawful the giving or promising to give anything of value to officials of
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�health plans, health alliances, providl!r organizations, state agencies, or related entities, for
the purpose of influencing decisions by such officials or inducing them to engage in unlawful
activities, and the soliciting and acceptance by such officials of such things of value.
Authorizes fmes, imprisonment for up to 15 years, or both. Bribes relating to health care
officials' actions involving plans and alliances are also subject to fmes and imprisonment.
Section 5435 .. Injunctive Relief Relating to Health Care Offenses. Amends
section 1345(a)(1) of title 18, U.S.C., to include injunctive relief with respect to the
anticipated commission of a health care offense.
Section 5436. Grand Jury Disclosure. Amends section 3322 of title 18, U.S.C., to
authorize persons privy to grand jury information concerning a health law violation to
disclose that information to the Government for use in civil proceedings or civil forfeitures.
Section 5437. Theft or Embezzlement. Adds a new section 668 to Chapter 31 of
title 18, U.S.C., providing for fmes and imprisonment for up to 10 years for theft or
embezzlement of assets or funds of health plans or alliances.
Section 5438. Misuse of Health Security Card or Unique Identifier. Adds a new
section 716 to Chapter 33 of title 18, U. S.C., providing for fmes and imprisonment for up to
2 years for the use of a health security care or disclosure of a unique identifier for purposes
other than those authorized under the Act.
PART 5
.a
AMENDMENTS TO CIVIL FALSE CLAIMS ACT
Section 5441. Amendments to Civil False Claims Act. Amends section 3729 of
title 31, U. S. C .• to provide that false claims for payments by health plans shall be considered
false claims subject to the provisions of the False Claims Act.
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�SUBTITLE F - M.CCARRAN-FERGUSON REFORM
(H.R. 3600 and S. 1757 p. 979)
Section 5501. Repeal of Exemption for Health Insurance. Amends section 3 of
the Act of March 9, 1945 (15 U.S.C. 1013), known as the McCarran-Ferguson Act, to
provide that the business of insurance is subject to the Sherman, Clayton, Trade
Commission, and Robinson-Patman Antidiscrimination Acts, to the extent that such business
relates to the provision of health ben.efits, in addition to being subject to regulation by state
law.
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�TITLE VI - PREMIUM CAPS;
PREMIUM-BASED F1NANCING; AND PLAN PAYMENTS
Section 6000. General Definitions. This section provides definitions for this title, as
follows:
Accepted bid - The bid agreed to between a regional alliance health plan and a
regional alliance for the comprehensive benefits package.
Final accepted bid - The accepted bid, taking into account any voluntary reduction in
the bid made.by a non-complying plan under section 6004(e).
Weighted average accepted bid - For a regional alliance, the average of the accepted
bids for all health plans in the alliance, weighted to reflect enrollment of regional alliance
eligible individuals among such plans.
Reduced weighted average accepted bid - For a regional alliance, the lesser of the
weighted average accepted bid or the regional alliance per capita premium target.
Weighted average premium - For a class of family enrollment, the product of:
--The reduced weighted average accepted bid for the regional alliance;
--The uniform conversion factor for the regional alliance, which converts the
reduced weighted average accepted bid (a per capita amount) to an individual
premium; and
--The premium class factor established by the Board under section 1531 (which
converts an individual premium into a premium for other classes of
enrollment) .
. SUBTITLE A - PREMIUM CAPS
(H.R. 3600 and S. 1757 p. 984)
Subtitle A describes computation and enforcement of premium caps for regional and
corporate alliances.
PART 1 - REGIONAL ALLIANCE HEALTH EXPENDITURES
Part 1 relates to premium caps for regional alliances.
SUBPART A - COMPUTATION OF TARGETS AND ACCEYfED BIDS
Subpart A describes the computation of regional alliance per capita premium targets,
and the process by which plan bids are submitted and reviewed.
Title VI
�Section 6001. Computation Of Regional Alliance Inflation Factors. The Board
computes and publishes each year, not later than March 1, the regional alliance inflation
factor for each regional alliance for the following year. The regional alliance inflation factor
is the general health care inflation factor, adjusted to take into account changes in the
demographic and socio-economic characteristics of the alliance population. The regional
alliance inflation factor is also increased for the year 2001 to reflect the actuarial value of the
increase in the comprehensive benefits package, not to exceed with respect to mental illness
and abuse services the expenditures that states and subdivisions of states would have made
for such services in 2001 if this Act had not been enacted.
For the period 1996 to 2000, the general health care inflation factor is the increase in
the CPI plus:·
•
•
•
•
•
1.5
1. 0
0.5
0.0
0.0
percentage
percentage
percentage
percentage
percentage
points
points
points
points
points
for
for
for
for
for
1996
1997
1998
1999.
2000.
In 1999 the Board submits to Congress recommendations regarding the general
inflation factor for 2001 and beyond. In the event Congress fails to enact a law specifying
the factor, the default general health care inflation factor is the combination of the percentage
change in CPI and the percentage chan&e in the real Gross Domestic Product per capita.
The Board must develop a method for adjusting regional alliance inflation factors for
the following purposes:
•
To reflect material changes in the demographic characteristics of regional
alliance eligible individuals as a result of corporate alliances terminating their
status as corporate alliances, and entering the regional alliances.
•
To reflect changes in the demographic characteristics and health status of those
in a regional alliance. Any SQch adjustments may not result in a change in the
overall weighted average of the regional alliance inflation factors across all
regional alliances.
The Board must consult with states and regional alliances before establishing the
regional alliance inflation factors each year.
Section 6002. Board Determination Of National Per Capita Baseline Premium
Target. By January 1, 1995, the Board must determine a national per capita baseline
premium target, which is the national average per capita current coverage health
expenditures, inflated to 1995.
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�The national average per capita current coverage health expenditures is total covered
current health care expenditures, divided by the estimated population of regional alliance
eligible individuals (not including AFDC or SSI recipients).
Current health care expenditures are total payments for the comprehensive benefits
package in 1993, decreased by the proportion of such payment attributable to Medicare,
AFDC or SSI beneficiaries, workers' compensation or automobile insurance, and other
payments which will not be made by regional alliances.
This amount is increased to include expected increases in utilization by those currently
uninsured or underinsured (at average rates of provider payment), and uncompensated care is
removed. It is also increased to reflect the estimated percentage for administrative costs of
health plans, alliances, and state premium taxes (not to exceed 15 percent).
The total payments are decreased by the amount that will be subject to cost-sharing
(under a high cost sharing plan), and the decrease in utilization from such cost sharing.
The Board shall update the amount determined for 1994 and 1995 based on the
increase in private sector health care spending (not to exceed 15%).
Section 6003. Determination Of Alliance Per Capita Premium Targets. By
January 1, 1995, the Board must determine, for each regional alliance for 1996, a regional
alliance per capita premium target. The regional alliance per capita premium target is the
national per capita baseline premium target, updated by the regional alliance inflation factor,
and adjusted by the regional alliance's adjustment factor.
The Board must establish an adjustment factor for each regional alliance, taking into
account the difference between the national average of the factors used in determining the
national per capita baseline premium target and the amount of those factors for the regional
alliance, including:
.
•
•
•
Variations in health care expenditures.
Variations in the rates of uninsurance and underinsurance in different alliance
areas.
Variations in the proportion of expenditures for academic health centers in
different alliance areas.
The type of information considered by the Board may include information on
variations in premiums across states and across alliances; in per capita health spending by
state; in per capita spending under the Medicare program; and on rating factors commonly
used by actuaries.
The adjustment factors must be determined in a neutral manner, meaning that the
weighted average of the regional alliance per capita premium targets must equal the national
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212
�per capita baseline premium target.
If a state is not a participating state at the time of computation by the Board, the
entire state is treated as one alliance. If a state changes alliance boundaries, the Board
provides for a method for computing a new regional alliance per capita premium target for
each regional alliance in a neutral manner.
For each succeeding year, by March 1, the Board shall determine a regional alliance
per capita premium target, which is the regional alliance per capita premium target from the
previous year updated by the regional alliance inflation factor.
If actual weighted average accepted bid for a regional alliance for a year (based on
actual enrollment in the first month of the year) exceeds the regional alliance per capita
premium target, then the regional alliance per capita premium target is adjusted downward in
each of the following two years to recoup the overage (based on a formula described in this
section),
Section 6004. Alliance Initial Bidding And Negotiation Process. By July 1 of the
first year and by August 1 of each succeeding year, each regional alliance must obtain
premium bids from each health plan that would like to participate in the alliance. Each
bidder must accept the condition that the premium may be reduced under section 6011.
After a period for negotiation, the fmal bid submitted by a health plan is considered
the plan's fmal accepted bid.
Each alliance must report to the Board by September 1 the fmal bids for plans in the
alliance, with information on the likely distribution of enrollment (for the first year), and
, actual existing enrollment (in future years),
Using this information, the Board determines the weighted average accepted bid for
each alliance.
By October 1 the Board must notify the alliance if the weighted average accepted bid
for the alliance is greater than the regional alliance per capita premium target. The Board
must also notify the alliance and each non-complying plan in the alliance of any plan
payment reductions computed under section 6011. Non-complying health plans are given the
opportunity to voluntarily reduce their bids consistent with any plan payment reductions.
Section 6005. State Financial Incentives. Any participating state may elect to
assume responsibility for containment of health care expenditures. For a state that elects to
assume responsibility,' if the statewide weighted average of the reduced weighted average
accepted bids is less than the statewide weighted average of the per capita premium targets,
then one-half of the percentage reduction in health care spending multiplied by Federal
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�payments to regional alliances in the state for discounts is made available to the state by
reducing the state's maintenance of effort payment for the following year.
A participating state, may regulate provider rates charged to private payers. Such
regulation may not cause a corporate alliance health plan to be charged rates different from
those charged other health plans or otherwise discriminate against corporate alliance health
plans.
Section 6006. Recommendations To Eliminate Regional Variations In Alliance
Targets Due To Variation In Practice Patterns; Congressional Consideration. The chair
of the Board must establish, within 60 days of the chair's appointment, an advisory
commission on regional variations in health expenditures. The advisory commission must be
composed of consumers, employers, providers, representatives of health plans, states,
regional alliances, individuals with expertise in the fmancing of health care, individuals with
expertise in the economics of health care, and representatives of diverse geographic areas.
The advisory commission must provide the Board, states, and regional alliances with
information about regional differences in health care costs and practice patterns.
It must also:
•
Examine methods of eliminating variation in regional alliance per capita
premium targets due to variations in practice patterns (but not due to other
factors such as health care input prices and demographic factors), by 2002.
•
Examine methods of reducing by 2002 the variation in state payments for
AFDC and SSI recipients and for maintenance of effort under Title IX, subtitle
A. The advisory commission must examine methods of reducing variation due
to practice patterns, historical differences in the rates of reimbursement to
providers, and the amount, duration, and scope of benefits covered under state
Medicaid plans.
By July 1, 1995, the Board must submit to Congress separate detailed
recommendations for each of the following:
•
Eliminating the variation in the regional alliance per capita premium targets by
2002 (as described above).
•
Reducing the variation in state payments for cash assistance recipients and for
maintenance of effort by 2002 (as described above), in a manner that is budget
neutral with respect to total government payments and payments by the Federal
Goveniment. The Board must consider the fiscal capacity of the states.
'
Congress must consider each of the Board's recommendations separately in an
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�expedited manner, as specified in the Defense Base Closure and Realigrunent Act of-1990.
Each of the Board's recommendations apply unless a joint resolution disapproving the
recommendation is enacted within 60 days.
Section 6007. Reference To Limitation On Administrative And Judicial Review
Of Certain Determinations. Limitations on administrative and judicial review of certain
determinations under this part are described in section 5232.
SUBPART B - PLAN ANU PROVIDER PAYMENT REDUCTIONS TO "
MAINTAIN EXPENDITllRES WITH1N TARGETS
Subpart B describes the calculation of plan and provider payment reductions for non
complying plans in regional alliances where the weighted average accepted bid exceeds the
regional alliance per capita premium target.
Section 6011. Plan Payment Reduction. In order to assure that payments to
regional alliance health plans by a regional alliance are consistent with the regional alliance
per capita premium target for the alliance, each noncomplying plan is subject to a reduction
in plan payment by the amount equal to the plan payment reduction.
A regional alliance health plan is a "noncomplying plan" if the plan is offered through
a noncomplying alliance and the plan's final accepted bid exceeds the plan's maximum
complying bid. A regional alliance is a "noncomplying alliance" jf the alliance's weighted
average accepted bid (computed under section 6004(c» exceeds the regional alliance's per
capita premium target.
The maximum complying bid for a health plan is calculated differently in the frrst
year than in subsequent years.
In the first year, the maximum complying bid for each health plan in a noncomplying
alliance is the regional alliance per capita premium target for the alliance.
In subsequent years, the maximum complying bid for a health plan is the plan's
accepted bid for the previous year (before any voluntary reductions under 6004(e», minus
any plan payment reductions for the previous year, plus the alliance-wide inflation allowance.
The alliance-wide inflation allowance is the dollar increase in the regional alliance per capita
premium target from the previous year (plus any amount by which the weighted average
accepted bid from the previous year was lower than the regional alliance per capita premium
target).
For new plans, the maximum complying bid is the regional alliance per capita
premium target. The Board or a state may modify this rule in order to prevent abusive
premium practices by entities previously offering plans, to encourage the availability of all
Title VI
215
�types of plans in the state, or ~o pennit the establishment of new plans.
Plan payment reductions for noncomplying plans are calculated by multiplying a
plan's excess bid amount by the alliance-wide reduction percentage.
The excess bid amount for a noncomplying plan is the amount by which the plan's
accepted bid (before any voluntary reductions) exceeds the plan's maximum complying bid.
The alliance-wide reduction percentage is calculated so that plan payment reductions
are sufficient to bring the weighted average of bids (after plan payment reductions) down to
the regional alliance per capita premium target.
The alliance-wide reduction percentage is equal to the difference between the
weighted average accepted bid for the alliance and the regional alliance per capita target for
the alliance, divided by the sum (across all noncomplying plans) of the "plan proportion of
alliance excess bid amount." The "plan proportion of alliance excess bid amount" for a plan
is the excess bid amount for the plan, multiplied by the proportion of the alliance eligible
individuals enrolled in that plan.
Section 6012. Provider Payment Reduction. This section provides for provider
payment reductions by noncomplying plans.
Each regional alliance health plan, as part of its contract under section 1406(e) with
any participating provider, must:
•
Include a provision that provides that payments to the provider are reduced by
the applicable network reduction percentage if the plan is a noncomplying plan
for a year.
•
Not include any provision which the state determines is intended to nullify the
effect of such reductions.
The Board may issue regulations relating to these requirements.
The applicable network reduction percentage for a noncomplying plan is equal to the
plan payment reduction amount for the plan divided by the fmal accepted bid for the plan,
and increased by the Board to take into account any estimated increase in volume of services
that may reasonably be anticipated as a consequence of applying a reduction in payment.
For providers that are not participating providers, a noncomplying plan must reduce
payments under the applicable alliance fee schedule (under section 1406(c)(3» by the
applicable nonnetwork reduction percentage.
The applicable non-network reduction percentage for a plan is equal to the plan
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216
�payment reduction amount for the plan divided by the fmal accepted bid for the plan, and
increased by the Board to take into account any estimated increase in volume of services that
may reasonably be anticipated as a consequence of applying a reduction in payment.
Restrictions on balance billing (section 1406(d» and computation of any cost sharing
(part 3 of subtitle B of Part I) are based on the reduced payments by noncomplying plans, as
determined under this section.
.
PART 2 - CORPORATE ALLIANCES HEALTH EXPENDITURES
Part 2· describes computation. and enforcement of caps on corporate alliance
expenditures.
Section 6021. Calculation Of Premium Equivalents. By January 1, 1998, the
Board must develop a methodology for calculating an annual per capita expenditure
equivalent for amounts paid by corporate alliances for coverage for the comprehensive
benefit package. The methodology must permit a corporate alliance to petition the Secretary
of Labor for an adjustment to compensate for material changes in the demographic
characteristics of the eligible individuals receiving coverage through the alliance.
In the year 2001 and each !.'Ubsequent year, each corporate alliance must report to the
Secretary of Labor the average of the annual. per capita expenditure equivalent for the
previous 3-year period.
Section 6022. Termination Of Corporate Alliance For Excess Increase In
Expenditures. If a corporate alliance has two "excess years" in a 3-year-period, then:
•
The Secretary of Labor must terminate the corporate alliance; and
•
Employers participating in the corporate alliance are required to become
regional alliance employers (unless the employers become corporate alliance
employers of another corporate alliance).
This provision first applies to the 3-year-period beginning with 1998.
For large employers whose participation in a corporate alliance is terminated under
this section, employer premium payments are subject to adjustment under section 6124.
The term "excess year" means, for a corporate alliance, a year (beginning on or after
2001) for which the rate of increase for the corporate alliance exceeds the national corporate
inflation factor.
The rate of increase for a year is the percentage amount by which the average of the
Title VI
217
�annual per capita expenditure equivalent for the corporate alliance for the 3-year period
ending with the year has increased over the same average for the 3-year period ending with
the previous year.
The national corporate inflation factor for a year is the average of the general health
care inflation factors (as defmed in section 6001(a)(3» for the 3 years ending with the year.
PART 3 - TREATMENT OF SINGLE-PAYER STATES
Part 3- describes rules regarding premium caps in single payer states.
Section 6031. Special Rules For Single-Payer States.
The Board must compute a statewide per capita premium target for each year in the
same manner as a regional alliance per capita premium target is determined under section
6003.
PART 4 - TRANSITION PROVISIONS
Part 4 describes the monitoring of health prices and expenditures during the transition
period.
Section 6041. Monitoring Prices And Expenditures. The Secretary must establish a
program to monitor prices and expenditures in the health care system in the Unites States.
The Secretary must periodically report to the President on the rate of increase in
expenditures in each sector of the health care system and how such rates compare with the
rate of overall increase in health care spending and the rate of increase in the consumer price
index. The Secretary must periodically issue public reports on these matters.
The Secretary may obtain, through surveys or otherwise, information on prices and
expenditures for health care services. The Secretary may compel health care providers and
third party payers to disclose such information as is necessary to carry out the program under
this section. Non-public information obtained under this subsection with respect to individual
patients is confidential.
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218
�SUBTITLE B - PREMIUM-RELATED FINANCING
(H.R. 3600 and S. 1757 p. 1025)
Subtitle B describes premium payment requirements and discounts for families and
employers.
PART 1 - FAMll.Y PREMIUM PAYMENTS
. Part 1 describes premium payment requirements and discounts for families.
SUBPART A - FAMILY SHARE
Subpart A describes the family share of premium in regional and corporate alliances.
Section 6101. Family Share Of Premium. Each family enrolled in a regional
alliance health plan or a corporate alliance health plan is responsible for paying the family
share of premium. The family share of premium may be paid by an employer or other
person on behalf of the family.
Two methods are used to calculated the family share of premium, one for families
enrolled in regional alliance health plans and one for families enrolled in corporate alliance
health plans.
Regional Alliance: For families enrolled in regional alliance health plans, the family
share of premium is equal to "base amounts" minus "credits and discounts." . The family
share of premium cannot be less than zero.
Base amounts are the sum of:
(1) The (total) premium for the health plan in which the family is enrolled, varying by
the family's class of enrollment (described in section 6102(a».
(2) 20% of the family collection shortfall add-on (computed under section 6107). The
family collection shortfall add-on raises funds to pay for premiums owed but not
collected.
Credits and discounts are the sum of:
(1) The amount of the alliance credit under section 6103(a). This credit is equal to
80% of the weighted average premium in the alliance, for a given class of enrollment.
(2) The amount of any income-related discount provided under section 6104(a)(1).
(3) The amount of any excess premium credit provided under section 6105. This
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219
�credit passes on the benefit to families of any plan payment reductions under
enforcement of premium caps.
(4) The amount of any corporate alliance opt-in credit provided under section 6106.
This credit compensates families for higher premiums in regional alliance health plans
that may result from corporate alliance employers opting into the regional alliance.
(5) For certain low-income families -- SSI and AFDC recipients, and families for
whom the family share of premium is fully discounted -- a credit equal to 20% of the
family collection shortfall add-on is provided, meaning that they are not responsible
for paying the add-on.
CORPORATE ALLIANCE: For families enrolled in corporate alliance health
plans, the family share of premium is equal to the premium for the health plan in which the
family is enrolled for the family's class of enrollment (as specified in section 1384) minus
"credits and discounts." The family share of premium cannot be less than zero.
Credits and discounts are the sum of:
(1) The amount of the alliance credit under section 6103(b), which is equal to the
minimum employer premium payment (under section 6131).
(2) The amount of any income-related discount provided under section 6104(a)(2).
Section 6102. Amount Of Premium. The amount of the premium charged by a
regional alliance is specified in this section. The amount of the premium charged by a
corporate alliance is specified in section 1384.
The amount of the premium charged by a regional alliance varies only by the health
plan and by the class of enrollment, and is equal to the product of:
(1) The final accepted bid for the plan (as defmed in section 6000(a)(2)), which is a
per capita amount. .
(2) The uniform per capita conversion factor for the alliance (established under
section 1341(b)), which converts the fmal accepted bid to a premium for the
"individual" class of enrollment.
(3) The premium class factor for a given class of enrollment (established by the Board
under section 1531). The premium class factors, which are uniform across all
regional alliances, convert a premium for the individual class of enrollment to the
premiums for other classes of enrollment.
Special rules apply in the cases of divided families (as described in section 1012).
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220
�Section 6103. Alliance Credit. Each family enrolled in a regional alliance tiealth
plan receives a credit equal to 80 percent of the weighted average premium (as defined in
section 6000(c» for health plans offered by the alliance, for a given class of enrollment.
Each family enrolled in a corporate alliance health plan receives a credit equal to the
minimum employer premium payment for the family (under section 6131).
Section 6104. Premium Discount Based On Income. Two methods are used to
calculate premium discounts, one for families enrolled in regional alliance health plans and
one for families enrolled in corporate alliance health plans.
REGIONAL ALLIANCE: Each family enrolled in a regional alliance health plan is
entitled to a premium discount, depending on family income and status as an AFDC or SSI
recipient.
The amount of premium discount for a family is equal to 20 % of the weighted
average premium for regional alliance health plans (varying by the family's class of
enrollment) minus:
(1) The family obligation amount (described below); and
(2) Any employer payment towards the family share of premium (Le. an employer
payment beyond the minimum amount required).
A family's premium discount may not be less than zero.
If a regional alliance determines that a family eligible for a discount under this section
is unable to enroll in an at-or-below-average-cost plan that serves the area in which the
family resides, the amount of the premium discount is increased by the minimum amount
necessary to pennit the family to enroll in a regional alliance health plan without paying an
additional amount. An "at-or-below-average-cost plan" is a plan whose premium does not
exceed, for a given class of enrollment, the weighted average premium for the regional
alliance.
The "family obligation amount" is calculated based on the family adjusted income (as
determined under section 1332(a» and marginal rates.
For AFDC and SSI families and for families with income below a specified income
threshold amount, the family obligation amount is zero. The income threshold amount is
$1,000, inflated by the CPI for years following 1994.
For other families with income below 150% of the poverty level, the family
obligation amount is the sum of:
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221
�(1) The initial marginal rate (for the. applicable class of enrollment) multiplied by
income between the income threshold amount and the poverty level (for the applicable
class of family); and
(2) The fmal marginal rate (for the applicable class of enrollment) multiplied by
income between the poverty level and 150% of the poverty level (for the applicable
class of family).
/>
The initial and final marginal rates are calculated separately for the individual class of
enrollment and for family classes of enrollment (Le. couple-only, single parent, and dual
parent), according to formulas specified in this section.
For families with family adjusted income below 150% of the poverty level, the family
obligation amount is capped at 3.9% of income. For families with income above 150% of
poverty (but below $40,000), the family obligation amount is equal to 3.9 % of income. The
$40,000 and 3.9% figures are indexed for years following 1994, according to rules specified
in this section.
CORPORATE ALLIANCE: Families enrolled in corporate alliance health plans are
entitled to a premium discount if the employee through which the family is enrolled is a low
wage employee.
A low-wage employee must be employed on a full-time basis and earn wages less than
$15,000 (on an annualized basis). The $15,000 figure is indexed for years following 1994,
according to rules specified in this section.
For such low-wage employees, the premium discount is the amount (if any) by which
95 % of the premium for the least expensive low or combination cost sharing plan offered to
the employee (for the applicable class of enrollment) exceeds the minimum employer
premium payment for the family.
EXCEPTIONS: The following individuals are not eligible for premiums discounts
because no premium is imposed:
(1) An electing veteran (as defmed in section 1012(d)(I» who is enrolled under a
health plan of the Department of Veterans Affairs and who has a service-connected
disability or who is unable to defray the expenses of necessary care (as determined
under section 1722(a) of title 38, United States Code).
(2) Active duty military personnel (as defmed in section 1012(d)(2».
(3) An electing Indian (described in section 1012(d)(3».
Section 6105. Excess Premium Credit. If enforcement of premium caps results in
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222
�plan payment reductions made for one or more health plans offered by a regional alliance
(under section 6021), a credit to pass on the benefit of these reductions is provided to each
family enrolled in health plan in the alliance .
.The credit is fIrst calculated as a per capita amount -- the per capita excess premium
amount -- which is equal to the amount (if any) by which the regional alliance's reduced
weighted average accepted bid exceeds its per capita premium target.
This per capita amount is then converted into excess premium credits for each class of
enrollment based on the same method that is used to convert the reduced weighted average
accepted bid to the weighted average premium for that class of enrollment.
The excess premium credit is adjusted for under or over estimates of the credit in a
previous year.
Section 6106. Corporate Alliance Opt-In Credit. If a regional alliance is owed a
payment adjustment resulting from a large employer opting into the regional alliance (under
section 6124), then the regional alliance provides each family with a credit based on the
payment adjustments.
The credit is frrst calculated as a per capita amount -- the per capita corporate alliance
opt-in amount -- based on 20% of the total of payment adjustments and the estimated number
of eligible individuals in the regional alliance.
This per capita credit is then converted into corporate alliance opt-in credits for each
class of enrollment based on the same method that is used to convert the reduced weighted
average accepted bid to the weighted average premium for that class of enrollment.
Section 6107. Family Collection Shortfall Add-On. A family collection shortfall
add-on is calculated to raise funds to pay for premiums owed to a regional alliance but not
collected.
The add-on is fIrst calculated as a per capita amount -- the per capita collection
shortfall amount. The per capita collection shortfall amount is based on the regional
alliance's estimate of the total amount of payments which the alliance can reasonably identify
as owed to the alliance and not likely to be collected (after making collection efforts
described in section 1345) and the estimated number of eligible individuals in the regional
alliance. The add-on does not include amounts owed to the regional alliance by the Federal,
state, or local governments.
The per capita collection shortfall amount is adjusted for under- or over-estimates of
the add-on in a previous year.
The per capita collection shortfall amount is then converted into family collection
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�repayment of the alliance credit (reduced through employment and self-employment,- as
described in sections 6111 and 6112) is capped based on the family's wage-adjusted income.
Wage-adjusted income is equal to family adjusted income (as defined in section
13~2(d)(1», reduced by the sum of the following:
(1) Monthly wages up to $5,000 per month (for each month associated with
employment for which an employer premium is paid under section 6121).
(2) Net earnings from self employment (associated with self-employment premium
payments under section 6126).
(3) Unemployment compensation (included in income under section 85 of the Internal
Revenue Code of 1986).
AFDC and SSI families and families with wage-adjusted income below a specified
income threshold amount have no repayment obligation. The income threshold amount is
$1,000, inflated by the CPI for years following 1994.
Other families with wage-adjusted income less than 250% of the applicable poverty
level are eligible for a discount for repayment of the alliance credit. Their obligation is
capped at the following level:
(1) The initial marginal rate (for the applicable class of enrollment) multiplied by
income between the income threshold amount and the poverty level (for the applicable
class of family); plus
(2) The fmal marginal rate (for the applicable class of enrollment) multiplied by
income between the poverty level and 250% of the poverty level (for the applicable
class of family) .
. The initial and final marginal rates are calculated separately for each class of
enrollment, according to formulas specified in this section.
The following individuals are not eligible for discounts because no premium is
imposed:
.
(1) An electing veteran (as defmed in section 1012(d)(1» who is enrolled under a
health plan of the Department of Veterans Affairs and who has a service-cOImected
disability or who is unable to defray the expenses of necessary care (as determined
under section 1722(a) of title 38, United States Code).
(2) Active duty military personnel (as defmed in section 1012(d)(2».
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225
�(3) An electing Indian (described in section l012(d)(3».
Section 6114. Special Treatment Of Certain Retirees And Qualified Spouses And
Children. An individual who is an eligible retiree, or a qualified spouse or child of an
eligible retiree, is considered to be a full-time employee for the purposes of repayment of the
alliance credit, and therefore has no repayment obligation.
An eligible retiree is someone who meets all of the following conditions:
(1) Is between age 55 and 65.
(2) Is ·not employed on a full-time basis.
(3) Has met the work requirements to be eligible for Medicare part A hospital.
insurance benefits.
(4) Is not a Medicare-eligible individual.
A qualified spouse or child is someone who is under age 65 and is the child of an
eligible retiree or is married to an eligible retiree (and has been for at least one year). If an
eligible retiree dies, a qualified spouse (and the spouse's children) remain eligible for the
benefit under this section until the eligible retiree would have turned age 65, unless:
I
(1) The spouse turns age 65.
(2) The spouse is employed on a full-time basis.
(3) The spouse is remarried.
Section 6115. Special Treatment Of Certain Medicare Beneficiaries. Medicare
eligible individuals who are qualified employees or spouses of qualified employees (as
determined under section 1012(a» are considered to be full-time employees for the purposes
of repayment of the alliance credit, and therefore have no repayment obligation.
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226
�PART 2-'EMPLOYER PREMIUM PAYMENTS
SUBPART A - REGIONAL ALLIANCE EMPLOYERS
Section 6121. Employer Premium Payment Required.
(a) Requires each regional alliance employer to pay a premium to the regional alliance
for each qualifying employee employed in the month. Corporate alliance employers must
pay premiums as regional alliance employers for their part-time, seasonal, and other
employees who are not corporate alliance eligible employees.
(b) Describes the amount of premium an employer must pay for a month.
For each class of family enrollment, the employer's payment is the product of the
base employer monthly premium for that class of family enrollment (as determined under
section 6122) and the number of full-time equivalent employees employed by the employer
and enrolled in that class of family enrollment in the previous month.
Default payment rules are established if an employer does not know the class of
family enrollment or the residence of a qualifying employee. If the class of family enroll
ment is not known, the employer's premium is based on the two parent family class of
enrollment. If the employee's residence is not known, the employee is deemed to reside in
the alliance area in which the employee principally is employed by the employer.
Employer payments for the first month after implementation in a state are made on
the first of the month and are based on an estimate of the of the amount that will be owed for
the month. An adjustment is made to the payment in the following month to reflect the
difference between the estimated payment and the actual amount owed (based on employment
and hours worked in the month).
In the case of families whose coverage is divided under section 1012, the employer's
premium obligation is calculated as if the family was not divided and regional alliance
divides the premium payments on a proportional basis to the health plans chosen by the
respective family members.
(c) Describes the how the section applies during the transition (1996-1998) for
employers with employees in more than one state. Generally, the requirements of the
subpart apply to an employer only with respect to qualifying employees residing in partici
pating states. However, in determining whether an employer is a small employer, all of the
employees of the employer (whether or not they reside in participating states) are counted.
Section 6122. Computation of Base Employment Monthly Premium.
Subsections (a) and (b) describe the computation of the base employment monthly
premium.
Title VI
�Each regional alliance calculates a base employment monthly premium for each class
of family enrollment.
For the individual class of enrollment, the base employment monthly premium is
equal to one-twelfth of 80% of the credit-adjusted weighted average premium for the
individual class of enrollment.
The credit-adjusted weighted average premium is the weighted average premium for
a class of enrollment, reduced by the corporate alliance opt-in credit (described in section
6106(b)).
.
For the couple-only class of enrollment, the base employment monthly premium is
equal to one-twelfth of 80% of the total premiums for couple-only enrollments, divided by
the number of covered families and extra workers in the alliance in that class of enrollment.·
Total premiums are calculated by mUltiplying the credit-adjusted weighted average
premium for the couple-only class of enrollment and the total number of covered couple-only
families in the alliance.
The term covered family does not include SSIor AFDC families, families in which
one spouse is a Medicareeligible individual, or families that are enrolled in health plans that
are not regional alliance health plans.
Extra workers are counted where the number of premium payments in a family
exceeds one. Each family counts as at least one premium payment, but may count as more
than one premium payment if both spouses are qualifying employees. In a family where both
spouses are qualifying employees, the number of premium payments is the sum across both
spouses of the number of full-time equivalent employees each spouse is counted as. No
spouse can be counted as more than one full-time equivalent employee.
The base employment monthly premium is the same for the single parent and dual
parent classes of enrollment. It is equal to one-twelfth of 80% of the combined total
premiums for both classes of enrollments, divided by the combined number of covered
families and extra workers in the alliance in those classes of enrollment. Total premiums
and extra workers are calculated in the same manner as described above for the couple-only
class of enrollment.
If the estimate of the average number of premium payments per family for a class of
family enrollment is more or less than the actual number of payments for the class of enroll
ment, the estimated number of premium payments in the second succeeding year for that
class of enrollment is increased or reduced so that the total receipts of the alliance- are in
creased or decreased by the amount of any excess (or deficit) that resulted from the original
misestimation.
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�(c) Sets forth the basis for the determinations made under the section. The determina
tions of premiums and number of covered families are made by alliances, based on annual
ized estimates, in a manner determined by the Board and consistent with estimates used in
applying premium caps under Subtitle A. The determinations of employment are based on
estimates of employment established by the regional alliance in accordance with standards
. promulgated by the Secretary of Labor in consultation with the National Health Board. The
regional alliance may require employers periodically to submit information on employment to
the alliance so that it can make the determinations required in this subsection.
(d) Requires that the determinations under this section for a year be made no later
than December 1 of the prior year (or by 'such other date established by the Board).
Section 6123. Premium Discount For Certain Employers. A discount is provided
to regional alliance employers equal to the amount by which their required premium
payments exceed the limiting percentage of payroll defined in this section.
Subsection (a) provides that, in general, the premium payment required for a regional
alliance employer for any year is capped at the limiting percentage of the employer's wages
for that year. The cap does not apply with respect to the employer collection shortfall add-on
described in section 6125. The cap is phased in for large employers opting into regional
alliances, as provided in section 6124(c).
The cap on employer premium payments does not apply to corporate alliance
employers making payments· to regional alliances on behalf of employees that are not
corporate alliance eligible individuals. The cap does not apply to the Federal Government, a
state government, or a unit of local government until 2002.
Subsections (b) and (c) defme the limiting percentages for regional alliance employ
ers. In general, the limiting'percentage is 7.9 percent of total wages for regional alliance
employers. For employers with fewer than 75 full-time equivalent employees and average
annual wages of less than $24, 000, the limiting percentage is the applicable percentage from
the following table:
firm
size:
< 25
< 50
< 75
Small Business Discounts:
Average Pay: (same categories as before)
<12K
<15K
<18K
<21K
3.5
4.4
5.3
4.4
5.3
6.2
5.3
6.2
7.1
6.2
7.1
7.9
<24K
24K+
7.1
7.9
7.9
7.9
7.9
7.9
An employer is considered a small employer for a year if it does not employ, on
average, more than 75 full-time equivalent employees during the year. Average annual
Title VI
229
�wages in a year for an employer are detennined by dividing the total wages paid in the year
to qualifying employees by the number of full-time equivalent employees of the employer in
the year. The Board may establish rules relating to the computation of the average annual
wages for employers.
Self-employed individuals who are partners in a partnership, 2-percent shareholders in
an S corporation (as defined in section 1372 of the Internal Revenue Code of 1986), or who
otherwise carry on a trade or business as a sole proprietorship are for this section deemed to
be employees of the partnership, S corporation, or proprietorship and any net earnings of the
individual from self employment attributable to the partnership, S corporation, or sole
proprietorship are deemed to be wages from the partnership, S corporation, or proprietor
ship.
Employers claiming a discount under this section must provide notice to the regional
alliance involved when premium payments are made. Employers claiming discounts must
make information available to regional alliance to pennit the alliance to audit the average
number of full-time equivalent employees, average annual wages, and the total wages paid by
the employer for qualifying employees.
Employers who have employees in multiple regional alliances and receive a discount
distribute premium payments across alliances on a proportional basis.
Section 6124. Payment Adjustment For Large Employers Electing Coverage In a
Regional Alliance.
This section provides for an adjustment to premium payments and a phase-in of
employer discounts for large employers who are eligible sponsors of corporate alliances but
whose option to fonn a corporate alliance is not exercised or is tenninated..
(a) Provides that the provisions of the section apply to employer payments for
full-time employees in a state with respect to large employers (as defined in section
13U(e)(3» that are eligible sponsors of corporate alliances (under section 1311(b)(1)(A» if:
(1) the employer's election to fonn a corporate alliance is terminated under section
1313; or
(2) in the case of an employer that is a large employer and an eligible sponsor on the
first day of the first year of a state, the employer fails to provide the notice required
under section 1312(a)(1) (relating to the election to become a corporate alliance).
For large employers whose election to form corporate alliances is terminated under
section 1313, the payment adjustments under this section begin on the effective date of the
termination of the election. For large employers that are eligible sponsors on the first day of
if the first year of a state and that fail to provide notice of their election to form corporate
alliances, the payment adjustments first apply as of the first day of the first year of such
state. The payment adjustment Imder this section continue to apply to an employer for seven
years.
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·230
�(b) Describes the amount of the adjustments to premium payments made to regional
alliances by employers subject to this section. For each employer, the monthly adjustment is
calculated by multiplying 1112 by the product of the following:
(1) the reduced weighted average accepted bid for the regional alliance for the area
for the year;
(2) the total average number of full-time employees (or family members of such
employees) of the employer who reside in the regional alliance area in the year before
the fIrst year in which this section applies to the employer;
(3) the excess risk proportion (if greater than zero) for the employer for the alliance
area; and
(4) the phase-down percentage for the employer for the year.
The excess risk proportion for an employer for an alliance area is a percentage that
reflects, for the year before the fIrst year in which this section applies to the employer, the
amount by which the average demographic risk for the employer's full-time employees (and
family members) residing in the alliance area exceeds the average demographic risk for all
regional alliance eligible individuals residing in the area.
Demographic risk is measured in a manner specifIed by the Board, based on the
demographic characteristics described in section 6001(c)(l)(A) which adjusts regional alliance
per capita premium targets to reflect large employers opting into regional alliances. Each
employer subject to this section must submit information to each regional alliance necessary
to determine the average demographic risk for the employer's full-time employees (and
family members) residing in the a1liance area.
The phase down percentage for an employer is:
(1) for each of the fist 4 years to which this section applies to the employer, 100
percent,
(2) the fIfth such year, 75 percent,
(3) the sixth such year, 50 percent, and
(4) the seventh such year, 25 percent.
(c) Describes the phase-in of employer discounts for employers subject to this section.
The discounts are phased in as follows:
(1) For each of the fIrst 4 years in which this section applies to such employer, no
discounts are available to the employer;
(2) in the fIfth year, the discount available to the employer is 25 percent of the
reduction that would otherwise apply under section 6123; .
(3) in the sixth year, the discount available to the employer is 50 percent of the
reduction that would otherwise apply under section 6123;
(4) in the seventh year, the discount available to the employer is 75 percent of the .
reduction that would otherwise apply under section 6123;
Title VI
231
�(5) in subsequent years, the discounts available under section 6123 apply to the em
ployer without any reduction under this subsection.
Section 6125. Employer Collection Shortfall Add-On.
The employer premium collection shortfall add-on is added to the premiums payable
by employers to raise funds to pay for premium amounts owed to a regional alliance but not
collected.
The amount of the add-on in any year is computed in a manner similar to the
premium payment amount for employers, except that the calculation is based on the per
capita collection shortfall amount (computed under section 6107(b)(1» rather than the
reduced weighted average accepted bid for the alliance for the year. The discounts available
to employers -under section 6123 do not apply to the amount of the add-on calculated under
this section.
Section 6126. Application 1['0 Self-Employed Individuals. Provides that a self-empl
oyed individual is considered to be an employer of himself or herself and to pay wages to
himself or herself equal to the amount of net earnings from self-employment (as defmed in
section 1901(c)(I».
Self-employed individuals are required to pay premiums under this subpart as
employers to regional alliances (subject to the discounts available to small employers) from
the amount of net earnings from self-employment. The amount of employer premium
required in a year is reduced (but not below zero) by the amount of any premium contribu
tions required from regional alliance employers (without regard to any discounts under sec
tions 6123 or 6124) plus any premium contributions required from corporate alliance employ
ers (calculated as if the cOrporate alliance employer were a regional alliance employer) relat
ing to employment of the individual in the year.
For individuals who have a substantial amount of wage-adjusted income and are
substantial owners and who are employees of closely held businesses, the amount of any
reduction attributable to the individual's employment by that business will be reduced (in
accordance with rules prescribed by the Board) to prevent individuals from avoiding payment
of the full amount owed through fraudulent or secondary employment arrangements.
A business is considered closely held under this section if the employer meets the
requirements of section 542(a)(2) of the Internal Revenue Code of 1986 (or any similar
requirements as appropriate in the case of a partnership or other entity).
SUBPART B CORPORATE ALLIANCE EMPLOYERS
Section 6131. Employer Premium Payment Required.
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232
�(a) Requires each corporate alliance employer that employs a qualifying empfoyee to
make a premium payment on behalf of the employee. The employer must make the payment
to:
(1) a corporate alliance health plan, (if the employee is enrolled in a corporate
alliance health plan offered by the alliance); or
(2) the regional alliance (if the employee is not enrolled in a corporate alliance health
plan.
Premium payments to the regional alliance are made in the same manner as if the
employer were a regional alliance employer.
(b) Specifies the amount of premium a corporate alliance employer must make to a
corporate alliance health plan on behalf of qualifying employees who are corporate alliance
eligible individuals.
In general. the corporate employer premium for a month for a family residing in a
premium area (established by the corporate alliance under section 1364(b» is 80 percent of
the weighted average monthly premium for the applicable class of family enrollment of the
corporate alliance health plans offered by the corporate alliance for families residing in that
area.
The Secretary of Labor establishes rules relating to the determination of the premium
for different classes of enrollment and different premium areas in the case of self-funded
health plans offered by a corporate alliance.
For low-wage employees entitled to a premium discount under section 6104(a)(2), the
employer premium payment for a month is increased by the amount of the discount provided
under that section.
(c) Requires the Secretary of.Labor to specify a basis for the determinations to be
made under this section.
Title VI
233
�SUBTITLE C - PAYMENTS TO REGIONAL ALLIANCE HEALTH PLANS
(H.R. 3600 and S. 1757 p. 1086)
Section 6201. Computation Of Blended Plan Per Capita Payment Amount.
(a) Describes the blended per capita premium payment amount paid by the regional
alliance to regional alliance health plans.
(b) In general, each health plan is paid a blended plan per capita payment amount
equal to the sum of the plan bid component, AFDC component and SSI bid component,
adjusted by any factor applied for the year under section 6202(d).
The plan bid component for a health plan is the fInal accepted bid (as defmed in
section 6000(a)(2» for the year multiplied by the plan bid proportion determined under
section 6202(a)(1) for the year.
The AFDC component for an alliance is the AFDC per capita premium amount for
the regional alliance for the year (determined under section 9012) multiplied by the AFDC
proportion determined under section 6202(a)(2) for the year.
The SSI component for an alliance is the SSI per capita premium amount for the
regional alliance for the year (determined under section 9013) for the year niultiplied by the
SSI proportion determined under section 6202(a)(3) for the year.
Section 6202. Computation Of Plan Bid, AFDC, and SSI Proportions. This
section defmes the plan bid, AFDC and SSI proportions used in calculating the blended per
capita premium in section 6201.
The plan bid proportion is 1 minus the sum of-the AFDC proportion and the SSI
proportion.
The AFDC proportion of enrollment is the average of the number of AFDC recipients
enrolled in regional alliance health plans for the year divided by the average of the total
number of individuals enrolled in regional alliance health plans for the year.
The SSI proportion of enrollment is· the average of the number of SSI recipients
enrolled in regional alliance health plans for the year divided by the average of the total
number of individuals enrolled in regional alliance health plans for the year.
These proportions are determined and applied by the state, based upon the best avail
able data, and must be calculated at least 1 month before the date bids are submitted under
section 6004. In determining the AFDC and SSI proportions, Medicare-eligible individuals
are not included.
.
Title VI
234
�The AFDC and SSI proportions are flrst calculated and applied based on an estimate
of the number of AFDC and SSI recipients in an alliance. If the actual AFDC proportion or
SSI proportion for a year determined after the end of the year based upon actual number of
AFDC recipients and SSI recipients is different from the projected AFDC and SSI propor
tions used in computing the blended plan payment amount for the year, the regional alliance
increases or decreases the blended plan payment amounts paid to health plans in the second
succeeding year to reconcile the amounts that were paid with the amounts that should have
been paid. Any adjustment under this section is subject to the provisions relating to the
alliance contingency fund under section 1361 (b)(3).
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235
�TITLE VB - REVENUE PROVISIONS
SUBTITLE A - FINANCING PROVISIONS
(H.R. 3600 and S. 1757 p. 1094)
PART 1
6
INCREASE IN TAX ON TOBACCO PRODUCTS
Sections 7111, 7112, and 71.13. Increase in Tax on Tobacco Products. The
following is a listing of the Federal excise taxes imposed on tobacco products under current
law:
Article
Tax imposed
Small cigars
Large cigars
$1.125 per thousand
12.75% of manufacturer's price,
up to $30.00 per thousand
Cigars:
Cigarettes:
Small cigarettes . . . . . . .
Large cigarettes . . . . . . .
Cigarette papers . . . . . . .
Cigarette tubes . . . . . . .
Chewing tobacco . . . . . . . . . .
Snuff . . . . . . . . . . . . . . . . . .
Pipe tobacco . . . . . . . . . . . . .
$12.00 per thousand (24 cents per pack of 20 cigarettes)
$25.20 per thousand
$0.0075 per 50 papers
$0.015 per 50 tubes
$0.12 per pound
$0.36 per pound
$0.675 per pound
No tax is currently imposed on "roll-your-own" tobacco (Le., tobacco purchased by
consumers for use in making their own cigarettes).
Under current law, certain excise tax revenues on articles brought into the United
States from Puerto Rico and the Virgin Islands are transferred ("covered over") to the
treasuries of Puerto Rico and the Virgin Islands. The cover over of tobacco excise tax
revenues applies only in cases where significant value is added in the possession from which
the product enters the United States, but the full amount of the tax on qualifying products is
covered over. In contrast, only $10.50 ($11.30 during the five-year period beginning
October 1, 1993) of the $13.50 Federal excise tax on rum from Puerto Rico and the Virgin
Islands is covered over.
Numerous studies have suggested that the current price of tobacco products does not
reflect the costs to society of tobacco use. The U.S. Surgeon General and the Department of
Health and Human Services have identified cigarette smoking as the most significant source
of premature death in the United States. In addition, studies have indicated that billions of
dollars of health costs are smoking related. An increase in the tobacco excise taxes would
Title VII
�(a) Assessment on Corporate Alliance Employers
Current law does not provide for health coverage to be obtained through health
alliances and hence does not impose assessments on employers that form corporate health
alliances.
Under the Health Security Act, employers with more than 5,000 full-time U.S.
employees (including the U.S. Postal Service), certain existing multi-employer health plans
established pursuant to. collective bargaining and covering more than 5,000 active
participants, and rural electric cooperatives or rural telephone cooperative associations that
maintain certain existing health plans covering over 5,000 full-time U.S. employees, would
be permitted to form corporate alliances instead of purchasing coverage through regional
health alliances. An assessment would be imposed on employers in corporate alliances in
order to ensure that they contribute toward the fInancing of graduate medical education,
academic health centers, and related activities intended to benefIt individuals and employers,
as well as the costs of providing universal coverage.
The Health Security Act provides that, in general, an annual assessment would be
paid by every employer that has employees who obtain health coverage through a corporate
alliance because they are employees of that employer. The assessment is equal to one
percent of the employer's payroll. ,For this purpose, payroll generally includes all FICA
wages paid by the employer to any of its employees (whether or not they obtain coverage
through the corporate alliance), determined without regard to the FICA contribution base. In
addition, in the case of a sole proprietorship, partnership, or Subchapter S corporation,
payroll also includes the proprietor's and each partner's or shareholder's net earnings from
self-employment attributable to the proprietorship, partnership, or S corporation,
respectively.
To the extent that an employer is a corporate alliance employer because it participates
in a multi-employer collectively bargained plan that sponsors a corporate alliance, the
employer would be exempt from the assessment. Instead, the employer would pay a
different assessment imposed generally on regional alliance premiums under Title I of the
Health Security Act.
The controlled group rules applicable in determining employer premium obligations
under the Act also would apply in defIning an employer for purposes of the assessment. The
assessment would be paid at the same time and in the same manner as in the case of FICA.
Reporting requirements and interest and penalties for failure to make timely payment would
apply in the same manner as in the case of Federal employment taxes.
The assessment under the Act would generally become effective on January 1, 1996.
Every employer that is eligible to be a corporate allian6e employer would be treated as one
as of January 1, 1996 for purposes of the assessment unless the employer irrevocably waives
its rights to ever be treated as a corporate alliance sponsor.
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238
�(b) Temporary Assessment on Employers with Retiree Health Benefit Costs
Under current law, there is no assessment on employers that provide retiree health
benefits.
Other provisions of the Health Security Act (primarily community rating and the early
retiree subsidy applicable to retirees between the ages of 55 and 64) would significantly
reduce some employers' cost of providing early retirees with health benefits. As a result, it
is appropriate to require a temporary maintenance of effort from these employers. Thus,
under the Act, employers that have provided early retiree health benefits would be subject to
an assessment that recovers a portion of the reduction in their liability for early retiree health
benefits resulting from the Act.
The assessment for a year would be defmed as 50 percent of the greater of 1) the
average cost of providing health benefits to retirees between the ages of 55 and 64 during the
years 1991-1993 (whether directly provided by the employer, through a plan described in
section 401(h) of the Internal Revenue Code or through a welfare benefit fund), adjusted for
medical care inflation during the period after 1992 and before the current year, and 2) the
estimated employer savings in the current year for providing health coverage to retirees
between the ages of 55 and 64 as a result of the enactment of the Health Security Act.
The assessment for each year would be paid on or before March 15 of the following
year, but the Secretary of the Treasury could require quarterly estimated payments. The
controlled group rules applicable in determining employer premium obligations under the Act
also would apply in defining an employer for purposes of the assessment. Reporting
requirements and interest and penalties for failure to make timely payment would apply in the
saine manner as in the case of Federal employment taxes.
The assessment would apply for each of the years 1998, 1999, and 2000.
PART 3 - RECAPfURE OF CERTAIN HEALTH CARE SUBSIDIES
Section 7131. Recapture of Certain Health Care Subsidies Received by High
Income Individuals. Under current law, taxpayers who choose Medicare "Part B" coverage
receive a 75-percent subsidy because premiums are set to cover only 25 percent of the
average benefits for an enrollee. The premiums are the same for everyone, regardless of
their income leveL
Generally, there is currently no government subsidy for health insurance premiums
for retired people under 65 years of age.
Under the Health Security Act, beginning January 1, 1998, retired people between the
ages of 55 and 64 would be eligible for a subsidy for the employer share of their health
Title VII
239
�insurance premiums. The Act also would expand the benefits covered under Medicare Part
B.
It is inappropriate for the government -- and ultimately all taxpayers -- to subsidize 75
percent of Medicare Part B premiums, or early retiree health benefits, for high-income
taxpayers who have the resources to pay a greater share of their premiums. Accordingly,
under the Act, taxpayers with "modified adjusted gross income" in excess of a specified
"threshold amount" would be required to pay a "recapture amount" that would recapture the
early retiree subsidy and, in effect, impose additional premiums set to cover up to 75 percent
(Le., an additional 50 percent) of the average Medicare Part B benefits for an enrollee.
Modified adjusted gross income would equal the taxpayer's adjusted gross income, increased
by the amount of tax-exempt interest income, the amount of excluded income from sources in
U. S. possessions, the amount of income excluded by U. S. citizens and residents living
abroad, and the amount of excluded income from higher education savings bonds. The
threshold amount would be $90,000, except in the case of joint returns ($115,000 threshold)
or separate returns by a married couple (generally, a $0 threshold, but $90,000 if the
taxpayer lives apart from his or her spouse for the entire taxable year). The recapture
amount would be phased in (on a straight-line basis) over the first $15,000 of modified
adjusted gross income in excess of the applicable threshold amount (or the first $30,000 of
modified adjusted gross income, if each of the taxpayers filing a joint return receives an
early retiree subsidy or is covered by Medicare Part B).
The recapture amount. would be deductible to the same extent as health insurance
premiums generally, and any employer reimbursement of the recapture amount would be
excludable from income.
The recapture amount would be administered and collected in the same manner as
income taxes imposed by Subtitle A of the Internal Revenue Code, but would not be reduced
by income tax credits and would not be taken into account in computing alternative minimum
tax. Any estimated tax penalties resulting from the Medicare Part B recapture amount in
1996 would be waiVed. Similarly, estimated tax penalties resulting from recapture of the
early retiree subsidy in 1998 would be waived.
The provision would be effective January 1, 1996 with respect to recapture of the
Medicare Part B subsidy. For early retiree health benefits, the provision would be effective
commencing with the effective date of the subsidy (January 1, 1998).
PART 4 - OTHER PROVISIONS
Section 7141. Anti-Abuse Rules Relating to Definition of Wages for Certain S
Corporation Shareholders and Limited Partners.S corporation shareholders are currently
subject to employment tax under the Federal Insurance Contributions Act (FICA) and the
Federal Unemployment Tax Act (FUTA), but only to the extent the S corporation
Title VII
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�characterizes payments to the shareholder-employees as wages. In contrast, general-partners
and sole proprietors are subject to employment tax on all of their "net earnings from self
employment" under the Self Employment Contributions Act of 1954 (SECA), with certain
exceptions. Limited partners pay SECA tax only on guaranteed payments made to them in
exchange for services.
The Health Security Act would require that every employer pay a significant share of
its employees' health insurance premiums, subject to discounts based on the firm's payroll
and number of employees. To minimize the administrative and compliance burdens on firms
and avoid the creation of an additional, unfamiliar set of rules, the computation of "wages"
paid to the firm's employees, for purposes of determining the firm's payroll-based premium
discounts, should rely on the existing employment tax rules with which all firms already
must comply. For this purpose, the "net earnings from self-employment" of owner
employees should also be treated as "wages" (and the owner should be treated as an
employee).
The existing tax rules, however, are subject to manipulation, and would allow firms
to improperly exploit the payroll-based premium discount rules. For example, by treating
compensation for services as non-wage distributions, an S corporation and its shareholders
could reduce the firm's payroll, thereby allowing the S corporation to obtain greater premium
discounts. Limited partners who materially participate in a partnership could similarly
disguise compensation for services as non-wage distributions. The rules for similarly situated
general partners and sole proprietors do not permit wages to be disguised in this manner.
In order. to provide one consistent set of rules for health care and employment tax
purposes for all firms, the Health Security Act generally would follow the existing
employment tax rules in determining a firm's "wages" for health care purposes. However,
because of the importance of determining "wages" consistently for all firms in determining
eligibility for health care premium discounts, the rules would be modified, as described
below, for both health care and employment tax purposes.
Under the modifications, any individual who owns more than two percent of the stock
of an S corporation that has a service-related business, and who materially participates in the
business conducted by the S corporation, would be treated as having "net earnings from self
employment" equal to his or her distributive share of the S corporation's income from the
service-related business. Existing exceptions to this treatment for partnerships would also
generally apply for S corporations. Payments to shareholders that are designated as wages
would continue to be subject to FICA and FUTA. In this manner, all service-related
earnings of two-percent S corporation shareholders who materially participate in the
corporation's business would be treated as "wages" for purposes of determining the
corporation's eligibility for premium discounts, regardless of when and in what manner the
earnings are paid to the shareholders (i.e., as wage payments or as shareholder distributions).
To address the same concern in the context of limited partnerships, the Act would
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�treat any limited partner who materially participates in the partnership's activities as- having
"net earnings from self-employment" equal to his or her distributive share of partnership
income. In this manner, the limited partners' earnings from the partnership would be treated
as "wages" for purposes of determining the partnership's eligibility for premium discounts.
This rule would apply for both health care and employment tax purposes.
The provision would be effective for taxable years of S corporation shareholders and
limited partners beginning after December 31, 1995, and taxable years of S corporations and
partnerships ending with or within sucb taxable years of the individual.
Section 7142. Extension of Medicare Coverage and Hospital Insurance Tax to All
State and Local Government Employees. Before the enactment of the Consolidated
Omnibus Budget Reconciliation Act of 1985, State and local government employees were
covered under the Medicare system only if the State and the Secretary of Health and Human
Services entered into a voluntary agreement. In the 1985 Act, Congress extended Medicare
coverage and the Medicare Hospital Insurance tax on a mandatory basis to State and local
government employees hired after March 31, 1986, for services performed after that date.
Under current law, State and local government employees hired on or after April 1,
1986, are covered by Medicare Hospital Insurance and their wages are subject to the
Medicare Hospital Insurance tax (1.45 percent on both employers and employees).
Employees hired prior to April 1, 1986, are not covered by Medicare Hospital Insurance nor
are they subject to the tax unless a voluntary agreement is in effect. Medicare coverage (and
the Medicare Hospital Insurance tax) is mandatory for Federal employees.
State and local government employees are the only major group of employees not
assured Medicare coverage. One out of six state and local government employees are not
covered by voluntary agreements or by law. However, 85 percent of these employees
receive full Medicare benefits through their spouse or because of prior work in covered
employment. Over their working lives, they contribute only half as much tax as is paid by
workers in the private sector. Extending coverage would assure that the remaining 15
percent have access to Medicare and would eliminate the inequity and the drain on the
Hospital Insurance Trust Fund caused by those who receive Medicare without fully
contributing.
The Health Security Act would require Medicare coverage of all employees of State
and local governments without regard to the employee's date of hire. These employees and
their employers would become liable for the Medicare Hospital Insurance tax, and the
employees would earn credit toward Medicare eligibility based on their covered earnings.
Present law exceptions for certain State and local government employment, such as
temporary emergency disaster relief workers, services performed by certain students, patients
or inmates, and election workers receiving less than $1 00 annual remuneration, would be
retained. Exceptions exist for similar types of Federal employment.
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�In the case of employees who are required to pay the Medicare Hospital Insurance tax
as a result of the Health Security Act, State and local service before October 1, 1995 would
be treated as covered by the Medicare Hospital Insurance tax for purposes of determining
Medicare eligibility. Prior State and local service would be counted regardless of whether
the service was continuous.
Under the Act, the Hospital Insurance Trust Fund would be reimbursed from the
general fund of the Treasury for any additional cost arising by reason of the provision. The
Secretary of Health and Human Services would be required to provide procedures to assure
that State and local government employees are fully informed of their eligibility for benefits
under this provision and related requirements.
The Health Security Act would apply the Medicare Hospital Insurance tax to services
performed by State and local government employees after September 30, 1995. Services
performed after September 30, 1995 would be treated as employment for purposes of
providing the employees with Medicare Hospital Insurance benefits. State and local
government employment before October 1, 1995 by employees required to pay the tax as a
result of the Act would be treated as covered by the tax for purposes of providing the
employees with Medicare Hospital Insurance benefits.
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�based on the average cost of providing such coverage to the beneficiaries receiving such
coverage. To the extent provided by the Secretary, these cost determinations could be made
on the basis of reasonable estimates. The employment tax provisions of the Internal Revenue
Code would be amended to recognize these amounts in the definition of wages for social
security, railroad retirement, and unemployment tax purposes, as well as for income tax
withholding purposes.
In addition, accident or health benefits or coverage could not be offered under a
cafeteria plan. An exception would be provided for coverage providing wages or payments
in lieu of wages for any period during which the employee is absent from work on account
of sickness or injury.
Under other provisions of the Health Security Act, an employee who selected a low
cost plan would be eligible for a taxable cash rebate of the difference between the premium
payment made available by the employer and the cost of the plan. The Act provides that no
inclusion in income would occur merely because an employee had the option to select a plan
that would result in the employee's receipt of a cash rebate.
The limitation on the exclusion for employer-provided coverage would generally be
effective January 1, 2004. The prohibition on provision of accident and health benefits or
coverage under a cafeteria plan would be effective January 1, 1997.
If the employer-provided coverage were provided through a flexible spending
arrangement or similar arrangement, the limitation on the exclusion also. would be effective
January 1, 1997. A flexible spending arrangement is defmed as a benefit program that
provides employees coverage under which specified incurred expenses may be reimbursed
and under which the maximum amount of reimbursement that is reasonably available to a
participant is less than 200 percent of the value of the coverage.
Section 7203. Increase in Deduction for Health Insurance Costs of Self.:.Employed
Individuals. Section 162(1) of the Internal Revenue Code, scheduled to expire in taxable
years beginning after December 31, 1993, provides a deduction to self-employed individuals
for 25 percent of amounts paid for insurance for the taxpayer and the taxpayer's spouse and
dependents which constitutes medical care under Internal Revenue Code section 213. The
deduction is limited to earnings from self-employment and no deduction is allowed if the
taxpayer has other employer-provided accident or health coverage.
In order to provide more equitable treatment for self-employed individuals when
compared to employees who receive health insurance coverage from their employers, the
Health Security Act would make section 162(1) permanent. Further, the 25-percent deduction
would be replaced with a 100-percent deduction for insurance that constitutes comprehensive
health coverage\described in the Act and purchased from a qualified alliance. The 100
percent deduction would be reduced if the taxpayer has employees and does not pay at least
100 percent of the weighted-average premium for this same coverage for the employees.
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�The deduction continues to be limited to the amount of earned income attributable t6 the
trade or business for which the plan is established.
The 100-percent deduction would be effective on the earlier of January 1, 1997 or the
first day on which the taxpayer could purchase comprehensive health coverage from a
qualified alliance (Le., earlier than January 1, 1997 if the applicable State establishes its
alliance(s) before that date). Until silch time as the 100-percent deduction is effective, the
current-law 25-percent deduction would continue in effect.
Section 7204. Limitation on Prepayment of Medical Expenses. Internal Revenue
Code section 213 currently provides individual taxpayers an itemized deduction for expenses
not reimbursed by insurance or otherwise, for medical care of the taxpayer, the taxpayer's
spouse and dependents. The deduction is available only to the extent that those expenses for
a year exceed 7.5 percent of adjusted gross income. Medical care,expenses are statutorily
defined to include payments for diagnosis, cure, mitigation, treatment or prevention of
disease, transportation essential to medical care, and insurance covering medical care.
.
Treasury regulations contain specific examples of qualifying medical expenses. The
regulations also state that, while capital expenditures are not generally deductible, capital
expenditures that otherwise qualify as expenses of medical care will not be disqualified
medical expenses simply because they are capital.
Allowing a deduction for substantial prefunding of medical care undercuts the floor on
deductions equal to 7.5 percent of adjusted gross income for a year. It allows taxpayers who
have the resources to prefund their medical costs to receive' more favorable tax treatment
than other similarly situated taxpayers.
Under the Health Security Act, Section 213 of the Internal Revenue Code would be
amended to provide that if a taxpayer pays a premium or other amount that constitutes
medical care, the benefits of which extend beyond 12 months. after the payment, the amount
.so paid will be treated as paid ratably over the period for which the coverage or care is
provided. This provision would not apply to insurance described in section 213(d)(7) or to
qualified long-term care insurance premiums. No inference should be drawn as to whether
the amendments represent changes from current law.
The proposal would apply to amounts paid after December 31, 1996.
Title VII
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�SUBTITLE C - EMPLOYMENT STATUS PROVISIONS
(H.R. 3600 and S. 1757 p. 1143)
Sections 7301, 7302, and 7303. Employment Status Provisions
(a) Anti-Abuse Rules Relating to Determinations of Employment Status
Under current law, workers must be classified either as employees or as independent
contractors for Federal income and employment tax purposes, as well as for many non-tax
purposes. This determination is made predominantly by analyzing 20 factors derived from
the common law. This 20-factor test essentially requires a facts and circumstances analysis
of each case,- and has been criticized as imprecise and unpredictable. In response to this
criticism, Congress enacted section 530 of the Tax Reform Act of 1978 (not an Internal
Revenue Code provision) to protect certain employers from reclassification of workers by the
Internal Revenue Service. Section 530 was enacted as a one-year "stopgap" measure, but
was made permanent in 1982.
Section 530 prohibits the IRS from issuing any regulations or revenue rulings
regarding the proper classification of workers. Section 530 also prohibits the IRS on audit
from correcting erroneous classifications of workers as long as the employer (i) has
consistently treated all workers with substantially similar positions as independent
contractors, (ii) has filed all necessary returns (including information returns) on a basis
consistent with that treatment, and (iii) had a "reasonable basis" for that treatment. A
reasonable basis can include, but is not limited to, reasonable reliance on (i) judicial
precedent, published rulings, or private letter rulings or technical advice memoranda
regarding the taxpayer; (ii) a past IRS audit of the taxpayer (including an audit in which
workers' classification was not reviewed) in which there was no assessment attributable to
the classification of the worker or of workers holding substantially similar positions; and (iii)
a long-standing recognized practice of a significant segment of the industry in which the
worker was engaged. By its terms, section 530 is controlling only for purposes of
employment taxes and only with respect to the employer. In addition, section 530 does not
apply to three-party arrangements involving technical service workers.
The Health Security Act's requirement that employers pay a significant share of their
employees' health insurance premiums and its provision for premium discounts based on
average payroll and the number of employees will substantially increase the importance of
proper classification of workers as either employees or independent contractors. To
minimize the administrative and compliance burden on firms, the classification of workers
for health care purposes should rely on the existing employment tax classification rules with
which all firms already must comply, and which are clear for the vast majority of firms and
workers. The subjective nature of the common law test for employment tax purposes,
however, makes it difficult to determine with certainty the status of some workers-, and thus
potentially allows misclassification of those workers in order to avoid the obligation to pay
premiums or inappropriately take advantage of premium discounts. Accordingly, health care
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�reform makes it imperative to develop clearer rules for determining the employmenr status of
all workers, which would apply for health care and employment tax purposes.
Presently, proper classification of workers is further complicated by the provisions of
section 530. As long as the underlying classification test is difficult to apply with any degree
of certainty, a provision like section 530 can serve a useful function to the extent it protects
taxpayers from large retroactive assessments. In the context of health care reform, however,
section 530 in its current form could foster manipulation and abuse of both the requirement
that employers pay a portion of their employees' health insurance premiums and the payroll
based premium discount rules.
.
For example, section 530 presently applies only to firms and only for employment tax
(and not income tax) purposes. Thus, "whipsaw" situations may arise where a firm claims
one treatment under the protection of section 530 while one or more of its workers claims
the opposite treatment under the common law test. As a result, without the provisions
included in the Act, a firm could claim that a worker is an independent contractor (and thus
not pay the employer share of the worker's insurance premiums), while at the same time the
worker claims that he or she is an employee and likewise refuses to pay the "employer"
share. While similar incentives exist under current law, the consequences are greatly
increased by health care reform.
Moreover, while the section 530 safe harbors should be retained to protect reasonable
taxpayers from large retroactive assessments of health insurance premiums and employment
taxes, consistent treatment under the existing safe harbors is not always attainable. For
example, the "reasonable reliance" threshold for safe harbor protection is, in practice,
extremely difficult to apply consistently for purposes of the "prior precedent" safe harbor,
due to the large number of cases deciding workers' status. An administrable and fair rule in
this context requires that taxpayers not claim reasonable reliance merely by finding some
support for their position, but that taxpayers make an effort to weigh the authorities
supporting their position against any contrary authorities.
In addition, the permanent prohibition on guidance from the IRS, while perhaps
understandable when section 530 was to apply for only one year, creates unnecessary
confusion because it has seriously impeded the IRS's ability to convey its interpretation of
the law to taxpayers in advance of an audit. This 15-year void in guidance also increases the
risk of inconsistent application of the rules. Again, health care reform makes it particularly
important to address these issues.
On the other hand, the current consistency requirements of section 530 are overly
stringent, discouraging firms from reclassifying workers where it may otherwise be
appropriate and potentially denying protection to taxpayers that make minor information
reporting errors. For example, similarly situated firms could be treated differently under
section 530 simply because one fnm failed to file one Form 1099 with respect to a payment
to a worker.
Title VII
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�Under the Health Security Act, the employment status rules of the Internal Revenue
Code would also govern for health care purposes. In view of the increased importance of
proper classification of workers as a result of health care reform, however, the Act would
amend the employment status rules in two respects.
First, to prevent avoidance of the obligation to pay health care premiums and abuse of
the premium discounts, the Act would authorize the Secretary of the Treasury to issue
prospective regulations for determining the classification of workers for health care and
employment tax purposes. It is expected that the new rules would not result in substantial
reclassification of workers. For example, the Act provides that the regulatory rules would
not override other statutory classification provisions already in the Code (for example,
section 3508), Moreover, under the Act,' the regulations would be required to give
significant weight to the common law applicable in determining the employer-employee
relationship. It also is anticipated that guidance regarding the parameters of the regulatory
rules would be provided by Congress. In addition; it is intended that the standards for
worker classification that are being developed on a cooperative basis between representatives
of industry groups and the IRS as part of the Compliance 2000 initiative would serve as a
model for developing the regulatory rules. Finally, this ongoing dialogue would be
supplemented by the open dialogue with taxpayers and practitioners that would occur
throughout the normal administrative rulemaking process, which includes the issuance of
proposed regulations for public comment and open hearings.
The regulations would be effective no earlier than for periods beginning six months
after the regulations are issued in final form. At that time, the Secretary would also submit a
report to Congress regarding the regulations.
Second,the Act would 'codify section 530 to retain the protection appropriately
provided to employers, but would make revisions necessary to prevent abuses under the new
health care system and to accommodate the regulatory rules to be developed as described
above. To ensure that the employer premium obligation is applied fairly, the rules would be
extended to all fIrmS. and. if a worker's status is determined under the modified provision,
this determination would be controlling for the fum and the worker.
Under the revised rules. the IRS would be permitted to reclassify misclassified
workers on a prospective basis. However, as under existing section 530. the employer
would be protected from retroactive reclassification if the employer met certain requirements.
These requirements would be essentially the same as under existing section 530, with the
following modifications:
(1) Consistency and return-filing requirements. The consistency and retum
filing requirements of section 530 would be essentially retained, but would be relaxed
to (i) allow employers to reclassify workers as employees without losing protection
for their prior treatment of the workers as independent contractors; (ii) protect
employers who promptly correct failures to file timely and accurate information
Title VII
249
�returns for payments to workers; (iii) protect employers who fail to file a de minimis
number of information returns for payments to such workers (for this purpose, de
minimis is defIned as payments totalling less than three percent of the total amount for
which such returns were required to be filed for that period); and (iv) prevent failures
to file information returns from eliminating the protection of the provision for years
other than the year of the failure. These changes are intended to ensure consistent
application of the provision to similarly situated employers.
(2) Safe harbor requirements. The specifIc "reasonable basis" safe harbors of
section 530 also would be largely retained, but would become the exclusive safe
harbors under the provision. These safe harbors would be modifIed as follows to
safeguard against abuse and to accommodate the future adoption of the new regulatory
rules described above:
(a) Under the "prior precedenf' safe harbor, reliance on written
determinations- (Le., private letter rulings, etc.) regarding the taxpayer would
not be changed. Reliance on other authorities would have to meet the
"substantial authority" standard now required of all taxpayers to avoid
penalties for substantial understatement of income taxes. This standard does
not·require that the preponderance of authority support the taxpayer's
classifIcation of the worker, but it does require the taxpayer to give some
weight to any authorities that do not support the taxpayer's position.
Consistent with the applicatiqn of this standard, the types of authorities to be
considered would be expanded (from judicial precedent and IRS revenue
rulings) to include any item that is "authority II under the II substantial authority II
standard, other than private letter rulings issued to other taxpayers (as under
current law). This includes, for example, legislative materials, fInal and
temporary Treasury regulations, and IRS revenue procedures, notices,
announcements, press releases, and other offIcial pronouncements.
(b) The "prior audit" safe harbor would be limited to audits in which
the employment status of the worker (or similar workers) was actually
reviewed. In addition, if the IRS issues general guidance (such as a revenue
ruling under the common law control test or the regulations described above)
after the relied upon audit, then, as to the workers covered by the guidance,
the fIrm would no longer be permitted to rely on that prior audit.
(c) Taxpayers could continue to rely on the existing "industry practice"
safe harbor until the new regulatory defInition of employee is issued (or
guidance is issued by the IRS under the common law control test addressing
workers in that industry). While the safe harbor would terminate as such at
that time, the regulations are expected generally to be consistent with existing
industry practices that in fact are based on reasonable applications of the
existing common law control test.
Title VII
250
�The proposal authorizing a regulatory deflnition of employee would be effectIve on
the date of enactment. However, the regulations would be effective only for periods
beginning no earlier than six months after the date final regulations are promulgated.
The proposal to revise and codify section 530 would be effective for periods
beginning after December 31, 1995, except that the.repeal of the provision prohibiting the
IRS from issuing prospective guidance on worker classiflcation would be effective on the
date of enactment. If a taxpayer were protected from retroactive reclassiflcation of a worker
under existing section 530, but would not be protected under the revised rules, any
reclassiflcation of that worker could be retroactive only to the flrst period beginning after
December 31,1995.
(b) Revised Reporting Penalties for Services
Under current law, flrms are not obligated to withhold any employment taxes on
payments to an indepen<;lent contractor, but are obligated to me an information return (a
Form 1099) reporting payments to the contractor exceeding $600 during any calendar year.
The penalty for failure to me this information retUrn is $50 per failure, subject to annual
limits and to reductions (in the per-failure penalty and in the annual limits) and waivers in
the case of prompt correction of the failure. The penalty is increased to the greater of $100
and ten percent of the amount not properly reported where the failure is due to intentional
disregard.
Under the Health Security Act, self-employed individuals are entitled to certain
premium discounts based on their income. In general, the individual's income tax returns
will provide this information. It is essential that all of an independent contractor's income be
reported for tax purposes to prevent abuse of the premium discounts. One of the most
effective tools for enforcing complete reporting of income by contractors is the existing
information-reporting system. Data show that if the contractor is aware that the flrm has
reported the payment to the IRS, the contractor is more likely to report that payment on his
or her income tax return. But, at least in part because the current penalty for failure to me
information returns for payments to contractors is only $50, there is substantial
noncompliance with the information-reporting requirements. Increasing the penalty to reflect
the magnitude of the reporting failure should enhance compliance with the reporting
requirements.
The Act would increase the penalty for failure to report payments for services
performed by non-employees to the greater of $50 (the current penalty) and flve percent of
the amount not properly reported. The annual limits, reductions, and waivers of current law
would continue to apply. In addition, the new higher penalties would not apply (and the
penalty would equal $50 per failure, as under current law) if the taxpayer properly reported
at least 97 percent of the aggregate of such amounts required to be reported by the taxpayer
for the calendar year.
Title VII
251
�The proposal would be effective for information returns due (without regard 10
extensions) more than 30 days after the date of enactment.
Title VII
252
�SUBTITLE D - TAX TREATMENT OF FUNDING OF RETIREE
HEALTH BENEFITS
(H.R. 3600 and S. 1757 p. 1153)
Sections 7401 and 7402. Post-Retirement Medical and Life Insurance Reserves
and Health Benefits Accounts Maintained in Pension Plans. Under current law, a pension
or annuity plan may contain an account for purposes of paying medical expenses for retired
employees, their spouses and dependents under Internal Revenue Code section 401(h).
Contributions to the account are deductible when made, and may not exceed 25 percent of
the total contributions to the pension or annuity plan (excluding contributions used to fund
past service costs). The contributions are accumulated in a tax-free trust.
Alternatively, under current law, retiree medical benefits can be pre-funded as part of
a welfare benefit fund under Internal Revenue Code section 419 (typically in a "VEBA," a
voluntary employees' beneficiary association). Such a fund can contain an additional reserve
for post-retirement medical and life insurance benefits. Additions to the reserve are
deductible when funded, must be actuarially determined on a level basis over the working
lives of the covered employees, and may not anticipate future increases in cost. Earnings on
contributions for post-retirement medical benefits are generally taxable, unless the fund is for
collectively bargained employees.
In light of the substantial changes that would be made with respect to retiree health
benefits in the Health Security Act, the continued existence of two different funding vehicles
for the same purpose would no longer be justified. Employers should not have to analyze
which vehicle maximizes their tax advantage and should not be able to combine two vehicles
in order to exceed the intended limits on funding. Because the welfare benefit fund is
available to all employers, and is not artificially capped by the employer's pension
contributions, it is the logical vehicle for future retiree health funding. In addition, proposed
amendments, described below, regarding the additions to the reserve for post-retirement
medical and life insurance benefits are intended to curb current abuses.
The proposed changes are the following:
(a) Prohibit future contributions to section 401(h) accounts.
(b) Require that the additional reserve for post-retirement medical or life insurance
benefits in a welfare benefit fund be funded no more rapidly than over a period of ten years.
(c) Clarify that amounts included in the reserve for post-retirement medical or life
insurance benefits must be used for those purposes and cannot be used for other purposes.
Title VII
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�
Dublin Core
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Title
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Carol Rasco - Issues Series
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Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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2010-0198-S Segment 2
Description
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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92 folders in 7 boxes
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Paper
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Health Care Materials [10]
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Domestic Policy Council
Carol Rasco
Issues Series
Identifier
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2010-0198-S Segment 2
Is Part Of
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Box 124
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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12/4/2013
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must as a condition of funding report to the Secretary on the purposes for which grants were
spent and the extent of progress made in achieving measurable outcomes.
Section 3315. Application for Grant. The Secretary may make a grant only if an
application includes each agreement described above and the information required in section
3314; also, the application must be in the form and made in the manner required by the
Secretary. The application must include any assurances, agreements or information that the
Secretary determines are needed.
Section 3316. General Provisions. (a) The Secretary must, in consultation with
states, develop uniform data sets for monitoring core health functions.
(b) The duration of a grant is limited to five years, during which annual approval of
payments by the Secretary are requir,ed. The foregoing may not be interpreted to limit the
number of grants a state may receive.
Section 3317. Allocations fOlr Certain Activities. The Secretary may reserve up to
five percent of grant funds for carrying out the following activities:
(1) provision of technical assistance with respect to planning, development,
and operation of core functions including provision of statistical expertise;
(2) development. and operation of a national information network among state
and local health agencies;
(3) program monitoring and evaluation of core health functions;
(4) development of a unified electronic reporting mechanism. to improve
management of Federal grants to state public health agencies.
PART 2 - NATJ[ONAL INITIATIVES REGARDING
HEALTH PROMOTION AND DISEASE PREVENTION
Section 3331. Grants for National Prevention Initiatives. (a) The Secretary may
make grants to state or local government agencies, private non-profit organizations, and
coalitions of such agencies and organizations for developing and implementing community
based health-promotion and disease-prevention activities and strategies.
(b) Eligible entities are units of state and local government, private non-profit
organizations (including- research institutions) and coalitions that link two or more of these
groups.
(c) The Secretary shall assure that projects under this subsection reflect approaches
that take into account the special needs of the affected populations, are targeted to- needy and
vulnerable groups, examine the link between high priority health problems and potential
community-based action, and establish and strengthen links between public health agencies
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�and health plans, alliances, providers and the health care delivery system.
Section 3332. Priorities. (a) The Secretary· must establish annual priorities for grants
and must allocate funds in accordance with priorities. The Secretary shall publish a statement
of priorities in the Federal Register by January 1 and take comments. A fIna1list of priorities
for the following fIscal year must then be published.
(b) Grantmaking shall be consistent with the statement of priorities and shall give
priority to projects that are potentially replicable.
Section 3333. Submission of Information. Applicants must submit to the Secretary
information describing the activities to be conducted and how such activities will contribute
to a priority health need, as well as descriptions of the total ,amount of funding requested, the
geographic area and populations to be served, evaluation procedures to be followed and such
other information as the Secretary specifIes.
.
Section 3334. Application for a Grant. The Secretary may make grants only if
applications are submitted in a form and manner as the Secretary requires.
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�SUBTITLE E - HEALTH SERVICES FOR MEDICALLY
UNDERSERVED POPULATIONS
(H.R. 3600 and S. 1757 p. 578)
PART 1 - COMl\1UNITY AND MIGRANT HEALTH CENTERS
/
Section 3401. Authorization of Appropriations. (a) Authorizes funds in addition to
other authorized funds for community and migrant health centers.
(b) The additional funds authorized are $100,000,000 per year for each of fiscal years
1995 through 2000.
(c) These funds are in addition to other funds available for the centers.
Section 3402. Use of Funds The additional funds authorized may be used for any
purposes authorized under sections 329 or 330 of the Public Health Service Act as well as to
establish and maintain the fmancial reserves that are required under Title I for providers of
health services.
PART 2 - INITIATIVES FOR ACCESS TO HEALTH CARE
SUBPART A - PURPOSES; FUNDING
Section 3411. Purposes. The purposes of this program are:
(1) to improve access of medically underserved populations to health services
through a program of flexible grants, contracts and loans;
(2) to establish transition to a system in which medically underserved
populations have adequate c:hoice of community-oriented providers and health plans;
(3) to promote the development of community practice networks and health
plans that integrate public a.nd private health providers in underserved areas;
(4) to support linkages between provider of care to underserved populations
and regional and corporate alliance health plans; and
(5) to expand system capacity with additional practice sites and improvements
in health-care facilities in need of repair.
(6) to link providers in underserved areas with each other, regional health care
institutions and academic health centers.
(7) to support activities enabling under served populations to gain access to and
effectively use the health care system.
Section 3412. Authorizations of Appropriations. For the development of
community health plans and networks there are authorized to be appropriated $200 million in
fiscal 1995, $500 million in fiscal 1996, $600 million for fiscal 1997, $700 million for fiscal
year 1998, $500 millio~ for fiscal year 1999, and $200 million for fiscal year 2000. These
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�funds are in addition to other funds authorized for this program. Funds under this part are
also available for use under section 3692 (school health services).
SUBPART B - DEVELOPMENT OF QUALIFIED COMMUNITY
HEALTH PLANS AND PRACTICE NETWORKS
Section 3421. Grants and Contracts for the Development of Plans and Networks.
(a) The Secretary may make grants for developing qualified community health plans
and community practice networks. These plans and networks may be, in this title, referred
to as community health groups.
(b) To be a qualified community health plan, a health plan must be public or non
profit priyate entity whose principal purpose is to provide the comprehensive benefit
package, in areas with shortages of medical personnel or to populations with a significant
number of medically underserved persons; the plan must be a member of one or more health
alliances; and two or more of the categories of providers specified in subsection (d) must be
represented in the plan.
(c) A qualified community practice network means a consortium of health care
providers that is a public or private non-profit entity whose principal purpose is to provide
services to underserved populatioIl5 or in health professions shortage areas, which has an
agreement with one or more health plans and whose. members are governed by a written
agreement. Two or more categori(!s of providers in subsection (d) must be included in the
consortium.
(d) The relevant categories of providers described in subsections (b) and (c) are the
following:
(1) physicians or other health professionals or health care institutions providing
care in a shortage area or to an underserved population;
(2) migrant and community health centers;
(3) entities funded under sections 340 and 340A of the Public Health Service
Act (homeless health care providers and health care providers in public housing);
(4) entities furnishing health services under Section 1001 or Title XXIII of the
Public Health Service Act (family planning clinics and Ryan White program
providers);
. (5) entities furnishing services under Title V of the Social Security Act·
(maternal and child health);
(6) entities that are rural health clinics or federally qualified health centers;
(7) entities providing health services to Indians in urban areas under Title V of
the Indian Health Care Improvement Act or outpatient services to Indians through the
Indian Self Determination Act; and
(8) state or local public health agencies.
The Secretary also may make grants to a health plan that is not a community health
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�plan but that seeks to develop a community practice network with the entities described in
this subsection.
Section 3422. Preferences in J\1aking Grants. In making grants, the Secretary shall
give the preference to those applications in which a maximum number of entities described in
section 3421(d) are represented and added weight if a large group also includes private
physicians, other health professionals or institutions that provide health services in a health
professions shortage area, or provide health services to significant numbers of ilndividuals in
medically underserved populations.
Section 3423. Certain Uses of Awards. (a) Awards under section 3421 may be
spent for the following purposes:
(1) planning the network or health plan, including entering into contracts;
(2) recruitment and compensation of health and administrative staff;
(3) acquisition and expansion of facilities;
(4) acquisition and development of infonnation systems;
(5) other expenditures recognized by the Secretary.
(b) An award that includes funding for capital costs must obligate the recipient to the
United States for the amount of the award, plus interest during the 20 year period beginning
on the date of completion, if the applicant ceases to be a qualified health plan or network or
is sold or transferred to an entity that is not a community health plan or network.
Section 3424. Accessibility of Services. (a) Community health plans and networks
must assure that their services are available to persons seeking care, whether or not they are
eligible individuals under title I.
.
(b) A community health group's providers must be approved as Medicare and
Medicaid providers. A group must seek reimbursement for the cost of caring for persons
entitled to benefits under Title I, Medicare, Medicaid, any other public assistance programs,
or private health insurance plans.
(c) The network or plan must prepare a fee schedule that is consistent with local rates
and a corresponding schedule of discounts to be detennined by a patient's ability to pay.
(d) The plan or network m.ust maximize the accessibility of its services to residents in
its area by eliminating barriers resulting from geographical or demographic characteristics,
including limited ability of patients to speak English. A plan or network also must
periodically detennine the accessibility of its services.
Section 3425. Additional Agreements. (a) Networks and plans must provide enabling
services (as dermed in section 3461(g)) as part of their funding agreement.
(b) Networks and plans must maintain ongoing systems for patient-oriented,
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�community-responsive quality control, and for collecting and making public information on
costs, health-care and fmandal perforrnance, and other matters.
(c) The plan or network must agree to maximize its use of existing resources.
Section 3426. Submission of Certain Information. (a) The Secretary may make
grants only if applicants submit information on the needs (including the need for enabling
services) of the medically underserved population to be served by the applicant.
(b) The applicant must also include a description of how the applicant will design the
plan or network, a description of efforts to secure fmancial and technical assistance, and
evidence of significant community involvement in the initiation, development and ongoing
operation of the project.
Section 3427.. Reports; Audiits. Funded plans and networks must provide reports and
information as required by the Secretary and must submit to annual audits.
Section 3428. Application for Assistance. Applications must include the agreements
and information required in other sections of the subtitle and additional agreements and
information that the Secretary deems necessary.
Section 3429. General Prmrisions. (a) The Secretary may not make more than two
grant awards under section 3421 for the same project.
(b) The Secretary may determine the amount to be granted for any project.
SUBPART C - CAPITAL COST OF DEVELOPMENT OF
QUALIFIED COMMUNITY HEALTH PLANS AND PRACTICE NETWORKS
Section 3441. Loans and I.,oan Guarantees Regarding Plans and Practice
Networks. (a) The Secretary may make loans to public and private entities for capital costs
of dev~loping qualified community health groups, and may also guarantee such loans by
Federal and non-Federal lenders.
(b) The Secretary shall use: the same preferences in making loans that apply to grants
under section 3421.
(c) Funds under this section may be used to fmance facilities, major equipment,
including information systems, to establish finimcial reserves and other capital costs that are
necessary to the purpose of the section (as determined by the Secretary). Priorities shall be
placed on loans to modernize facilities, prevent or eliminate safety hazards, and to repair or
replace obsolete facilities.
(d) The principal of the loan or loan guarantee, when added to other assistanc,e under
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�this section, may cover up to 100 percent of the costs involved.
Section 3442. Certain Requirements. (a) The Secretary may approve loans only if
reasonably satisfied that the grantee can repay the loan, and only if the grantee provides
assurances that additional funds are available to complete the project for which the loan is
made. Also, a loan under section 3441 must be on the terms and conditions that are
necessary to protect the fmancial interests of the United States (as determined by the
Secretary) .
(b) The Secretary may guarantee loans only if the loan conditions, terms and
arrangements for repayment are sufficient to protect the fmancial interests of the United
States. Such· guarantees are also subject to further terms as determined by the Secretary.
(c) An applicant for a loan or loan guarantee must agree to use existing resources to
the maximum extent feasible.
Section 3443. Defaults; Right of Recovery. (a) The Secretary may take necessary
action, including waiver of regulatory conditions, deferral of loan repayments or other
actions as needed to prevent a default on a loan or loan guarantee. The Secretary may also
foreclose a loan in default,or waive, for good cause, any right of recovery from a borrower
who fails to make payments on a loan. A waiver of the right of recovery does not modify
the Secretary's obligation to make payments for a loan that has been sold and guaranteed.
(b) A loan becomes due and payable immediately if a facility for which loan funds
have been used is sold within 20 ye:ars after the federally-financed work on it is completed.
The loan becomes due if sale is to an entity not eligible for assistance under the section, or'
not approved by the Secretary, or if the facility ceases to be a public or nonprofit private
entity eligible for assistance. The Secretary may also subordinate or waive the right of
recovery and any other Federal interest based on a loan or loan guarantee for capital
projects, if such waiver(s) would further the purpose of serving medically underserved
populations.
Section 3444. Provisions Regarding Construction or Expansion of Facilities. (a)
The Secretary may provide loans or loan guarantees for the construction, conversion
expansion or modernization of a facility, only if the applicant describes the facility site,
provides plans and specifications which meet the Secretary's requirements, and demonstrates
that title is vested in one or more of the applicants.
(b) An applicant for a loan must make the following agreements:
(1) Title to the site will be vested in one or more of the applicants;
(2) Adequate fmancial support is available for completing and maintaining and
operating the facility;
(3) The construction contract complies with the Davis Bacon Act (relating to
payment of laborers); and
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�(4) The facility will be available to persons seeking service there, regardless of
their ability to pay.
Section 3445. Application for Assistance. The Secretary may provide assistance only
if the applicant files the applicationirl the form and manner prescribed by the Secretary.
Section 3446. Administration of Programs. The loans and loan guarantees for
capital projects must be administered from a centralized unit in the Department of Health and
Human Services.
SUBPART D.; ENABLING SERVICES
Section 3461. Grants for Enabling Services. (a)(I) The Secretary may make grants
to qualified community health groups (Plans and networks) and to other public and private
non-profit groups that provide services in one or more health professional shortage areas or
to medically underserved populations and are experienced in providing services to increase
the capacity of individuals to use health services. The grants are to be used to provide
enabling services.
(b) Enabling services are transportation, community and patient outreach, patient
education, translation services, and other services that would increase the capacity of
individuals to use the comprehensive benefits to which the Act entitles them.
(c) Grants may be made only if the applicant submits information demonstrating the
need for the services, a proposed grant budget and evidence of significant community
involvement in the project.
(d) Grant applicants must agree not to charge fees for·grant-funded enabling services.
(e) Grant applicants must make maximum use. of existing resources.
(f) Applications must be filed in a form and manner prescribed by the Secretary, and
include agreements and assurances deemed necessary by the Secretary.
(g) Enabling services are services described in subsection (b), when furnished by an
entity described in subsection (a).
PART 3 - NATIONAL HEALTH SERVICE CORPS
Section 3471. Authorization of Appropriations. (a) Funds for carrying out subpart
II of part D of title III of the Public Health Service Act, and section 3472 of the Health
Security Act, are authorized in the following amounts: $50,000,000 for fiscal year 1995,
$100,000,000 for fiscal year 1996, and $200,000,000 for each of fiscal years 1997 through
2000.
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�(b) The authorizations are in addition to funds otherwise authorized.
(c) Funds may be appropriated under this section at any time before the fiscal year
for which they are appropriated.
Section 3472. Allocation for Participation of Nurses in Scholarship and Loan
Repayment Programs. Of amounts appropriated under section 3471, the Secretary shall
reserve such amounts as may be needed to ensure that of the aggregate number of persons
participating in the scholarship .program or loan repayment program of the National Health
Service Corps (section 338A of the Public Health Service Act), the total proportion of
individuals being educated as or serving as nurses increases to 20 percent.
PART 4 - PAYMENTS TO HOSPITALS
SERVING VULNERABLE POPULATIONS
Section 3481. Payments to Hospitals. (a) The Secretary shall make payments to
eligible hospitals from funds made :available under this part. The amounts specified in
subsection (b) must be made available to the Secretary on behalf of eligible hospitals, but
payment is not guaranteed to the state in which an eligible hospital is located or to any
individual receiving services from lhe hospital.
(b)(l) The total amount of the payments is $800,000,000 for the fiscal year in
which the general effective date occurs and for each subsequent year.
(2) For any year prior to the general effective date, the amount specified shall
equal the aggregate disproportionate share hospitals (DSH) percentage of the amount
otherwise available under this section. The aggregate DSH percentage is equal to the
percent of total payments to DSH hospitals in all states represented by the payments
to DSH hospitals in participating states.
(c) Hospitals qualifying for payments shall receive them for five years, without regard
to the first year in which a hospital receives payment.
(d) Payments shall be made on a quarterly basis.
Section 3482. Identification of Eligible Hospitals. (a) In order to qualify for
payments, a hospital must be located in a participating state. However, a qualifying hospital
may continue to receive payments .even if the state in which it is located is no longer a
participating state.
(b) States shall identify for the Secretary those hospitals that meet the qualification
criteria.
(c) In order to qualify, a hospital must have a low income percentage caseload (as
defined in section 1923(b)(3) of the Social Security Act) during the base year of not less
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�than 25 percent.
Section 3483. Amount of Payments. (a) Of total amounts available for payment, 75
percent shall be allocated based on the hospital's low income percentage of the allocation for
the year.
(b) Twenty-five percent of the total shall be allocated to hospitals for services that
are not covered services under the Act. The Secretary shall develop an allocation
methodology .
(c) An eligible hospital's low income percentage shall equal the amount of all low
income days -attributable to the hospital. Low income days equal the total amount of
inpatient days mUltiplied by the hospital's low income utilization rate under section
1923(b)(3).
Section 3484. Base Year. The base year is the year prior to the year of the general
effective date of this Act.
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�SUBTITLE F - l\1E~ AL HEALTH; SUBSTANCE ABUSE
(H.R. 3600 and S.1757 p. 615)
PART 1 - FINANCIAL ASSISTANCE
Section 3501. Authorization of Appropriations. (a) Funds are authorized for the
purposes of this subtitle in the following amounts: $100,000,000 in fiscal year 1995;
$150,000,000 in fiscal year 1996, and $250,000,000 for each of fiscal years 1997 through
2000.
(b) Of amounts made available, the Secretary shall reserve as much as is deemed
appropriate for activities under section 3503. Of the remaining amounts, the Secretary shall
reserve 50 percent for activities des(;ribed in subsection (a) of section 3502 and 50 percent
for activities under subsection (b) of section 3502.
(c) The amounts authorized above are in addition to any other funds authorized for the
same purposes.
Section 3502. Supplemental Formula Grants for States Regarding Activities
Under Part B of Title XIX of the Public Health Service Act. (a) The Secretary shall make
mental health grants to states that have submitted applications meeting the requirements of
subsection (e). The allotment formula shan be the same one used under section 1918(a)(2) of
the Public Health Service Act.
(b) The Secretary shall make grants for substance abuse services to states that have
submitted applications. The amounts of the grants are determined by using the formula
under section 1933(a)(I)(B)(i) and section 1918(a)(2)(A).
(c)(1) The Secretary shall approve grant uses that are consistent with the
mental health and substance abuse activities that are described in this section. The
state must agree to spend grant funds in accordance with the Secretary's approved
uses.
(2) Approved uses are as follows:
(A) transportation and translation, patient and community
outreach, patient education, and such other services as the Secretary
deems appropriate for the purpose of increasing the access of
individuals to services relating to mental health and substance abuse;
(B) improving the capacity of state and local service systems to
coordinate and,monitor mental health and substance abuse services,
improving information systems, and establishing linkages between
mental hea.lth and substance abuse services and primary care providers
and health plans;
(C) providing incentives to integrate public and private systems
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�for treatment of mental health and substance abuse treatment systems;
and
(D) any a.ctivity for which a grant may be made under sections
1911 and 1921 of the Public Health Service Act.
(d) As a condition of grant receipt, a state, may not reduce its funding for mental
health and substance abuse activities below the level spent in the fiscal year preceding the
first year for which the state receives the grant. The Secretary may waive this requirement
if the state agrees to spend the funds that would otherwise be subject to the requirement on
the developing community based care systems for the eventual integration of the public and
private systems for treating mental he:althor substance abuse (as applicable to the grant).
(e) The state's application must be submitted in a form, time and manner and include
agreements and assurances as required by the Secretary.
Section 3503. Capital Costs of Development of Certain Clinics and Centers. (a)
The Secretary may make loans and loan guarantees to public and non-profit private entities,
for the capital costs of developing non-acute, residential treatment centers and ambulatory
clinics.
(b) Priority must be given to loan and loan guarantees for centers and clinics in areas
with a health professions shortage or with significant numbers of medically underserved
individuals.
(c) Loans and loan guarantees shall be made only in accordance with procedures in
subpart C of Part 2 of subtitle E.
PART 2 - AUTHORITIES REGARDING PARTICIPATING STATES
SUBPART A - REPORT
Section 3511. Report on Integration of Mental Health and Substance Abuse
Systems.
(a) As a condition of being a participating state, each state must submit, not later than
October 1, 1998, a plan to achieve the integration of state and local mental health and
substance abuse services with services that are included in ~e comprehensive benefit plan.
(b) The state's report shall contain the following information:
(1) the number of persons served by state and local mental health and
substance abuse systems and the proportion who are eligible persons under title I of
the Act;
(2) services furnished to eligible persons, including each type of benefit
furnished, the diagnoses for which the benefits are furnished, the amount, duration
and scope of cQverage of each benefit fui:nished, applicable limits on benefits, and
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�cost-sharing rules that apply;
(3) the extent to which mental health and substance abuse providers providing
services under a state plan participate in alliance health plans and reasons for any lack
of participation by these providers;
(4) the amount of revenues from health plans received by mental health and
substance abuse providers that: do participate in health plans and that are funded under
one or more state program(s);
(5) the amount spent by the state and its political subdivisions in each of the
two years before it became a participating state, for items and services covered in the
comprehensive benefit package; also, the amount spent on medically necessary care
not included in the benefit package', including medical and other health care and
related supportive services;
(6) an estimate of the amount the state will need to spend on uncovered
benefits and services after mental health and substance abuse services are expanded in
the year 2001;
(7) a description of how the state will assure that all eligible individuals served
by state-funded mental health and substance abuse programs will be enrolled in a
health benefit plan and how mental health and substance abuse services not covered in
the benefit package will continue to be furnished;
(8) a description of the conditions under which integration of mental health and
substance abuse providers into health plans can be achieved and an identification of
changes in provider participation and health plan certification requirements that are
needed to achieve integration; and
(9) if integration is not medically appropriate or feasible for one or more
groups of individuals treated in state programs, a description of the reasons therefor,
and a plan for assuring coordination of care and services covered in the benefit
package and the state program for these people.
(c) Reports shall be submitted in a form and manner prescribed by the Secretary.
SUBPART B - PILOT PROGRAM
Section 3521. Pilot Program. (a) The Secretary shall establish a pilot program to
demonstrate model methods of integrating mental health and substance abuse services with
the mental health and substance abuse services covered in the comprehensive benefit package
under title I.
(b) In establishing the pilot program, the Secretary must consider the following
factors:
(1) the types of items and services needed by patients in addition to those
covered under Title I;
(2) optimal methods of treating persons with long term mental illness and
substance abuse conditions;
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�(3) the capacity of alliance health ,plans to furnish such treatment;
(4) necessary modifications in coverage and services furnished by health plans;
and
(5) the role of publicly funded providers in integrating acute and long-tenn
treatment.
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�SUBTITLE G - COMPREID~NSIVE SCHOOL HEALTH EDUCATION;
SCHOOL-RELATED HEALTH SERVICES
(H.R. 3600 and S. 1757 p. 627)
PART 1- GENERAL PROVISIONS
Section 3601. Purposes. The purposes of activities authorized in this subtitle are to:
(1) support, in kindergarten through grade 12, sequential, age appropriate
comprehensive health education programs that address locally relevant priorities;
(2) establish a national framework for comprehensive school health education
programs, focused on such health-risk behaviors as drug abuse, sexual behavior
resulting in HIV and other sf:xually-transmitted diseases, unintended pregnancy,
injuries and other unhealthy lifestyles; the framework must also allow for integration
of the school health plans with state plans for achieving national education and health
goals for the year 2000;
(3) support planning and establishing the school health programs;
(4) support research, f~valuation, training and technical assistance;
(5) motivate youth to stay in school and strive for success;
(6) improve the knowledge and skills of children by integrating academic,
experiential learning with other elements of comprehensive health education; and
(7) further national education and health goals for the year 2000.
Section 3602. DefInitions. (a) Comprehensive school health education programs
means programs that address locally relevant priorities and that meet the following
conditions :
(1) the program is sf:quential and age and developmentally appropriate;
(2) the program is provided every year for every student from kindergarten
through grade 12;
(3) the program provides comprehensive health education that addresses
community, environmental, personal health, family life, substance abuse, growth and
development, nutritional health, prevention and control of disease, safety and
prevention of injuries, consumer health and health education;
(4) the program promotes personal responsibility for a healthy lifestyle;
(5) the program is eulturally sensitive in the content of its instructional
materials and approaches;
(6) the program includes activities that support instruction;
(7) the program involves families, community organizations and other
appropriate entities;
(8) the program is coordinated with other Federal, state and local programs;
and
(9) the program focuses on the health concerns of students in the state, school
district or school.
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�(b)(l) The tenn local education agency has the meaning given under section 1471 (12)
of the Elementary and Secondary Education Act;
(2) the tenn state educa.tion agency has the meaning given under section
1471(23) of the Elementary and Secondary Education Act.
PART 2 - SCHOOL HEALTH EDUCATION;
GENERAL PROVISIONS
Section 3611. Authorization of Appropriations. (a) For purposes of carrying out
parts 3 and 4 (grants to states and local education agencies respectively), the following
amounts are authorized: $50,000,000 for each of fiscal years 1995 through 2000.
(b) Of amounts appropriated under subsection (a) the Secretary may allocate up to
$13,000,000 of appropriated funds for local education agency grants under part 4, and up to
$5,000,000 for such
national leadership activities as research and demonstration, evaluation, and training and
technical assistance in comprehensive school education. The Secretary may use up to five
percent of the funds for administrative expenses of carrying out parts 3 and 4.
(c) Funds authorized under this part are in addition to other authorizations.
Section 3612. Waivers of Statutory and Regulatory Requirements. (a) (1) The
Secretaries of Health and Human Services and of Education may waive restrictions on the
use of funds under the Federal programs identified below, if the following conditions are
met:
(A) the requirement to be waived impedes achievement of the purposes
of parts 3 and 4;
(B) the Secretary detennines that the requested use (requiring the
waiver) would be consistent with parts 3 and 4;
(C) a State education agency making the request has provided for notice
to and cominent on the waiver request by local education agencies;
(D) a locall!ducation agency or other entity making a waiver request
has submitted the request to the state education agency for review;
(2) The programs subject to waiver are: (i) Prevention, Treatment and
Rehabilitation Model Projects for High Risk Youth under section 517 of the Public
Health Service Act; (ii) State and Local Comprehensive School Health Programs to
Prevent Important Health Problems and Improve Educational Outcomes under Section
517 of the Public Health Service Act; (iii) Part B programs under the Drug Free
Schools and Communities Act of 1986.
(b) A waiver may not exceed 3 years but may be extended if the waiver has been
effective in the purpose for which it was granted, and if the extension is in the public
interest.
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�(c) The Secretaries may not waive statutory and regulatory requirements relating to
the following:
(1) comparability of services;
(2) maintenance of effort;
(3) equitable participation of students in private schools;
(4) parental involvemen.t;
(5) distribution of funds;
(6) maintenance of records;
(7) civil rights; and
(8) the requirements of sections 438 and 439 of the General Education
Provisions Act.
PART 3 - SCHOOL HEALTH EDUCATION;
GRANTS TO STATES
SUBPART A - PLANNING GRANTS FOR STATES
Section 3621. Application for Grants. (a) A state education agency shall submit a
planning grant application in the form and manner prescribed by the' Secretary.
(b) An application must be d.eveloped jointly by state health and education agencies'
and must include:
(1) an assessment of the state's need for comprehensive school health
education, as measured by goals established by the departments of Health and Human
Services and Education and state goals;
(2) a description of how the state education and health agencies will
collaborate in the development of a comprehensive school health education program
in the state, including coordination of existing programs and resources;
(3) a plan to build capacity at the local level to provide for staff development
and technical assistance for local education agency and health agency staff;
(4) a preliminary evaluation plan;
(5) information demonstrating that the state has established an advisory council
with representation from state agencies with principal responsibilities for health,
education and mental health;
(6) a timetable and proposed budget; and
(7) such other information and assurances as the Secretary may require.
(c) A state agency may receive one planning grant annually, and no more than two
such grants may be awarded to a state.
Section 3622. Approval of the Secretary. The Secretary may approve the
applications that meet the statutory requirements of subpart A that are likely to result in a
program meeting the requirements of subpart B.
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�Section 3623. Amount of Grant. A planning grant may not be less than the amount
necessary for the state planning process (as determined by the Secretary), nor more than
$500,000.
Section 3624. Authorized Actilvities. States may use grants under this subpart only
to:
(1) carry out the planning process;
(2) carry out state and substate collaboration and coordination activities;
(3) conduct activities to build capacity to provide staff development and
technical assistance to local education and health agencies;
(4) develop student learning objectives and assessment instruments;
. (5) work with state and local health and education agencies to reduce barriers
to implementation of school health education;
(6) to prepare applications for implementation grants; and
(7) to adopt, validate ~md disseminate curriculum models.
SUBPART B - IMPLEMENTATION GRANTS FOR STATES
Section 3631. Application for Grant. (a) A state must submit an application for an
implementation grant in the form and manner specified by the Secretary.
(b) The application for an implementation grant must be developed jointly by state
education and health agencies and must include descriptions of:
(1) state program goals and objectives;
(2) the state formula for allocating grant funds to local education agencies;
(3) how the state will coordinate programs funded under this subpart with
other local, state and Federal health education programs;
(4) how the comprehensive school health education programs will be
coordinated with other local, state and Federal programs;
(5) how the state has worked with state and local health and education
agencies;
(6) how the state will monitor implementation;
(7) professional capacity development plans;
(8) staff development and technical assistance plans;
(9) the respective roles of state and local education and health agencies;
(10) how programs will be tailored to be responsive to students, including
those with disabilities and from disadvantaged backgrounds; and
(11) the state's evaluation and reporting system.
Section 3632. Selection of Grantees. The Secretary shall establish award criteria for
competitive award of implementation grants; the Secretary may give additional planning
funds (if any are available) to an unsuccessful implementation grant applicant that could
benefit from additional planning.
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�Section 3633. Amount of Grant. The Secretary shall establish grant award criteria
that take into account such factors as the numbers of children enrolled in school and of
school-age children living in poverty, and also the scope and quality of a state's plan.
Section 3634. Authorized Activities; Limitation on Administrative Activities. (a)
State education agencies receiving grants may retain up to 75 percent of funds in the first
year, 50 percent in the second year, and 25 percent in the third year. Funds not retained
shall be granted to local education agencies.
(b) States must use retained grant funds for specified purposes, including the
following:
. (1) statewide and regional coordination activities;
(2) adapting, validating or disseminating models for comprehensive school
health education;
(3) building capacity for staff development and technical assistance;
(4) promoting involvement of families and coordinating program activities with
community groups and agencies;
(5) evaluating program performance and reporting thereon to the Secretary;
and
(6) other activities approved by· the Secretary.
(c) States may use up to 10 percent of the retained funds for administrative costs.
Section 3635. Sub-grants to Local Educational Agencies. (a) Local educational
agencies may apply to states for implementation grants, and must furnish specific information
including
(1) goals and objectives;
(2) how the local agency will target schools with a high need for
comprehensive health education, monitor program performance, and ensure cultural
and linguistic suitability of the education programs;
(3) monitoring actitvities;
(4) how the agency will assure that programs are appropriate for students,
including those with disabilities and from disadvantaged backgrounds; and
(5) how the local educational agency will evaluate and report on attaining the
goals and objectives of (1).
(b) States must select grantees on the basis of evidence of need, as shown by high
rates of poverty, births, sexually-transmitted disease, drug and alcohol use, violence among
adolescents, and other factors.
(c) Grants must be used for comprehensive school health education programs.
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�SUBPART C - STATE AND LOCAL REPORTS
Section 3641. State and Local Reports. State agency grant recipients must submit
infonnation as required by the Secreta:ry; and local grant recipients. must submit required
infonnation to the state agency.
PART 4 - SCHOOL HEALTH EDUCATION;
GRANTS TO LOCAL EDUCATIONAL AGENCIES
SUBPART A - ELIGffiILITY
Section 3651. Substantial Need of Area Served by Agency. A local educational
agency is eligible for a grant under this part if the agency enrolls at least 25,000 students and
serves an area that shows a high need for the program, compared to other areas in the United
States.
SUBPART B - PLANNING GRANTS FOR LOCAL EDUCATION AGENCIES
Section 3661. Application Jfor Grant. (a) A local education agency must submit a
planning grant application to the S(~cretary in the fonn and manner required by the Secretary.
(b) Before submitting an application to the Secretary, a local education agency must
frrst submit it for comment to state education and health agencies.
(c) Applications must include the following:
(1) a needs assessment, using Federal and state health and education goals;
(2) information showing that the local agency has established or selected a
community-level advisory council, with representation from community health,
education, child nutrition and mental health agencies;
(3) a description of expected collaboration among state education and health
agencies and local health and education agencies;
(4) a plan to build capacity in the local agency for staff development and
technical assistance;
.(5) a preliminary evaluation plan;
(6) a planning and budget timetable; and
(7) other infonna1don and assurances required by the Secretary.
(d) A local educationagency may not receive more than two annual planning grants.
Section 3662. Selection of Grantees~ (a) The Secretary must establish criteria for
competitive selection of grante(~s.
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�(b) The Secretary may not approve a local grant application unless the Secretary
determines that the local plan is consistent with the state plan, if any.
Section 3663. Amount of Grant. In any fiscal year, the minimum amount for a
local agency planning grant is the amount determined by the Secretary to be needed for
agency planning. The maximum amount of a grant in any year is $500,000.
Section 3664. Authorized Activities. Local agencies may use grant funds only for the
following purposes:
(1) planning;
(2) joint training, staffing, administration and other coordinating activities
among local education, health and other appropriate agencies;
(3) building capacity for staff development and technical assistance;
(4) developing student learning objectives;
(5) reducing barriers to implementing comprehensive school health education;
(6) preparing an implementation plan.
SUBPART C - IMPLEl\:IENTATION GRANTS FOR LOCAL EDUCATIONAL
AGENCIES
Section 3671. Application for Grant. (a) A local education agency must submit an
implementation grant application to the Secretary of Health and Human Services in the form
and manner, and including information and assurances as required by the Secretary.
(b) The application must be submitted to state education agency for comment.
(c) The application must include specified information:
(1) local agency goals andobjectives for the program;
(2) how the program will be coordinated with other state and Federal health
education programs;
(3) how the program will be coordinated with other state and Federal
education programs;
(4) how the agency will reduce barriers to school health education;
(5) how the program will be monitored;
(6) how the agency will build professional development capacity;
(7) how the agency will provide staff development and technical assistance;
(8) the respective role of state and local health and education agencies in
implementing comprehensive school health education programs;
(9)'how programs will be tailored to meet the needs of students, including
those with disabilities and from disadvantaged backgrounds;
(10) evaluation and reporting plans.
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�Section 3672. Selection of Grantees. (a) The Secretary must establish criteria for the
competitive selection of grantees.
(b) The Secretary may not approve a local education agency implementation grant that
is not consistent with a state plan.
(c) The Secretary must offer p1anning grants to local education agencies whose
implementation grants have been denied, if there are funds available and if the local agency
could benefit from planning.
Section 3673. Amount of Gr~mt .. (a) The minimum amount of a grant is the amount
necessary for- implementation of the program, as determined by the Secretary.
(b) In determining the minimum grant, the Secretary must take into account factors
such as the number of children in the: schools, the numbers of school-age children living in
poverty in the area served by the local agency, and the scope and quality of the plan.
Section 3674. Authorized Activities. An implementation grant may be used for the
following purposes:
(1) implementing comprehensive school health education programs;
(2) coordinating local or regional activities;
(3) providing staff development and technical assistance to schools;
(4) administering and monitoring the program;
(5) evaluation and reporting;
(6) other activities authorized by the Secretary.
Section 3675. Reports. Local education agencies that receive implementation grants
must submit reports required by the Secretary.
PART 5 - SCHOOL-RELATED HEALTH SERVICES
SUBPART A - DEVELOPMENT AND OPERATION OF PROJECTS
Section 3681. Authorization of Appropriations. (a) For developing and operating
school-related health services, the following amounts are authorized: $100,000,000 for
fiscal year 1996; $275,000,000 for fiscal year 1997; $350,000,000 for fiscal year 1998; and
$400,000,000 for each of fiscal years 1999 and 2000.
(b) Funds appropriated under this section are in addition to other funds available for
developing and operating school-related health services.
Section 3682. Eligibility for Development and Operation Grants. (a) Entities
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�eligible to apply are state health agencies that apply on behalf of local community
partnerships, and such local partnerships in states where state health agencies have not
applied.
(b) Local partnerships are entities that at a minimum include a local health care
provider delivering services to adolescents, one or more public schools, and at least one
community based organization. Partnf~rships shall encourage broad participation from parents
and youth, health and social service providers, teachers and school personnel, the regional
alliance serving the area in which schools participating in the partnership are located, and
other organizations and business leaders.
Section 3683. Preferences. (a) In making grants, the Secretary must give priority to
communities with highest level of ne€~d among 10 to 19-year-olds as measured by poverty,
the presence of a medically underserved popUlation, a health professions shortage area, and a
high proportion of children with special health care needs such as disability, adolescent
pregnancy, sexually transmitted disease, injuries and gang violence, and exposure to drugs
and alcohol.
.
(b) The Secretary shall give preference to applicants demonstrating a link to qualified
community health plans and community networks under subtitle E of title III.
Section 3684. Grants for Development of Projects. (a) The Secretary may make
development grants to state health agencies or local community partnerships.
(b) Permissible uses of planning funds include planning for the provision of school
health services; staff recruitment, compensation and training; developing agreements with
alliance health plans; acquiring equ.ipment and information services, establishing local
partnerships (in the case of state applications), and other activities necessary to achieve
operational status.
(c) Applications shall be submitted in a form and manner specified by the Secretary.
A state agency application must include assurances that the agency is applying on behalf of
at least one local community partnership and at least one other community in need of
services (as identified by the state) but without a local partnership. In the latter case, the
application must also describe how the state will aid the community to develop a
partnership. No more than 10 percent of grant awards may be used for administrative
activities.
(d) The application shall contain the following contents:
(1) a plan for assessing need;
(2) a description of how the proposed services will reach the maximum
number of school-aged children and youth at risk for poor health outcomes;
(3) an explanation. of how services will be integrated with other community
health and social service programs;
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�(4) an explanation of how services will be linked to health plans;
(5) evidence of program linkages to regional and corporate alliances; and
(6) a description of quality assurance plans.
(e) No more than one planning grants may be made to an applicant.
Section 3685. Grants for Operation of Projects. (a) The Secretary may make
grants, for the cost of operating school health service sites, to state health agencies or local
partnerships.
(b) The purposes for which an operating grant may be used include:
- (1) furnishing health services;
(2)
(3)
(4)
(5)
(6)
(7)
furnishing enabling services (as defmed under section 3461(b»;
training, recruitment and compensation of staff;
outreach services, to at-risk youth and parents;
prevention and support services;
linkage of individuals to health plans and community and social services;
other activities authorized by the Secretary.
(c) Applications shall be submitted in a form and manner approved by the Secretary
and must include information on the services to be furnished, the amount and sources of
funds the applicant will spend, and such other information as the Secretary requires.
(d) The applicant must also meet the following conditions:
(1) the applicant will furnish the following:
(A) diagnosis and treatment of minor illness and injury;
(B) preventive services;
(C) enabling services;
(D) referral and follow up for illness and injury;
(E) health and social services, counseling and referrals, including
referrals regarding mental health and substance abuse;
(F) other services the Secretary specifies.
(2) the applicant maintains agreements with all regional and corporate alliance
health plans offering services in the applicant's service area;
(3) the applicant participates in Medicaid;
(4) the applicant does not charge for services;
(5) the applicant will periodically review the needs of populations served and
will remove barriers to the use of services;
(6) the applicant will provide a plan to meet the needs of non-English speaking
populations;
(7) the applicant will provide non-Federal contributions; and
(8) the applicant will operate a quality· assurance program consistent with
section 3684(d)(6).
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�(e) Grants will be for periods determined by the Secretary. A grant recipient must
provide reports and information required by the Secretary.
Section 3686. Federal Administrative Costs. The Secretary may retain up to
five percent of funding for development and operation grants for administrative costs.
SUBPART B - CAPITAL COSTS OF DEVELOPING PROJECTS
Section 3691. Loans and Loan Guarantees Regarding Projects. (a) The Secretary
may make loans to and guarantee loans to state health agencies and local partnerships for
capital costs of developing school-related health services.
(b) The provisions of section 3441 (loans to develop community health plans and
networks) shall apply to loans and loan guarantees under this subpart.
Section 3692. Funding. Amounts made available to the Secretary to carry out
subparts Band C of part 2 of subtitle E may be used not only for purposes there authorized
but also for school-related health services under this part.
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�SUBTITLE H - PUBLIC HEALTH SERVICE INITIATIVE FUND
(H.R. 3600 and S. 1757 p. 667)
Section 3701. Public Health Service Initiative. The' total amount authorized under
. subtitles C, D, E, F and G this title and for subtitle D of title VIII (subject to the extent of
funding made available in appropriations acts and subject to authorizations of appropriations
in the foregoing subtitles) are:
(1) $1,125,000,000 for fiscal year 1995;
(2)
(3)
(4)
(5)
(5)
$2,984,000,000 for
$3~830,000,000 for
$4,205,000,000 for
$4,055,000,000 for
$3,666,000,000 for
fiscal
fiscal
fiscal
fiscal
fiscal
year 1996;
year 1997;
year 1998;
year'1999; and
year 2000.
Amounts are available until expended and are available to carry out the specific
programs for which the amounts are appropriat~.
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�SUBTITLE I - COORDINATION WITH COBRA CONTINUATION COVERAGE
(H.R. 3600 and S. 1757 p. 668)
Section 3801. Public Health Service Act; Coordination with COBRA
Continuation Coverage. (a) Amends section 2202 of the Public Health Service Act (relating
to continuation of employment benefits) to provide for continuation of coverage until such
time as an individual becomes eligible for comprehensive health benefits under the Health
Security Act.
(b) Amends section 2208 of the Public Health Service Act to provide that individuals
eligible for coverage under the Health Security Act are no longer covered individuals under
this section.
(c) Amends Title XXII of the: Public Health Service Act by repealing the title upon
the effective date of the Health Security Act (the earlier of January 1, 1998, or on January 1
of the fIrst calendar year in which all states have in effect plans under the Health Security
Act.
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�TITLE IV - MEDICARE AND MEDICAID
SUBTITLE A - MEDICARE AND THE ALLIANCE SYSTEM
(H.R. 3600 and S. 1757 p. 674)
PART 1 - ENROLLMENT BENEFICIARIES IN REGIONAL ALLIANCE SYSTEMS
Section 4001. Optional State Integration of Medicare Beneficiaries into Regional
Alliance Plans. (a) Adds a new section to the Medicare statute that permits participating
states to seek and obtain approval from the Secretary of HHS to integrate Medicare
beneficiaries -and payments into the regional alliance system through enrollment in health
plans. States may obtain approval for Medicare integration whether or not they operate
single payer systems.
State applications must contain the following assurances:
(1) States must cover all Medicare-eligible individuals.
(2) Each beneficiary within a covered class must be enrolled in a regional
alliance for the area in which the individual resides or (in the case of a single payer
state) the state's single system. Each individual must have the same choice among
applicable plans as other persons eligible under the Health Security Act. Individuals
must be offered at least one fee-for-service plan that meets the following
requirements:
(i) The plan's premium rate, and the actuarial value of the premium,
deductibles and coinsurance may not exceed the actuarial value of Medicare
deductibles and coinsurance;
(ii) the plan's payment rates for hospital services, post-hospital
extended care services, home health services, home intravenous drug therapy
services, comprehensive outpatient rehabilitation facility services, hospice care,
dialysis services and ambulatory surgical services must be accepted by
providers of these services as payment in tull; and
(iii) the plan's payment rates for physicians are no less a percentage of
the amounts accepted as payment in full than are payment rates under Part B.
(3) Health plans must offer at least the items and services covered by Medicare
(including the secondary payer program) and coverage rules must be no more
restrictive than those used under Medicare.
(4) Premium rules that apply to other alliance eligible individuals may not be
applied to Medicare beneficiaries. However, states may not vary the premiums
charged different Medicare individuals within the same premium class.
(5) Quality assurance mechanisms are in effect.
(6) Beneficiaries have appeal rights at least equal to those afforded other
alliance eligible individuals.
(7) The state will furnish data required by the Secretary and provide access to
all relevant documents.
(8) The state will use payments made under this section only to carry out the
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�purposes of this provision.
In the first year of integration, the amounts payable to the state for each covered
beneficiary shall be determined at the rate payable to Medicare risk sharing contractors under
section 1876, but at 100 percent rather than 95 percent and without regard to reductions in
payments otherwise applicable under section 1876(a)(1)(G). For each succeeding year, the
amount payable is the base rate adjusted by the alliance inflation factor. Payments shall be
made out of the Hospital Insurance Trust Fund and the Supplementary Medical Insurance
Trust Fund, as under section 1876.
(b) Payment begins on January 1 of the first calendar year of approval and ends either
on December 31 of the year in which the 'State notifies the Secretary that it no longer wishes
to integrate Medicare, or at a time determined by the Secretary in a case involving
substantial non-compliance. No termination is effective without notice to Medicare
beneficiaries and health plans.
.
(c) Payments under this section are in lieu of any other benefits for which Medicare
payments would be made.
(d) The Secretary must evaluate state compliance on an ongoing basis.
(e) Definitions in this section have such meaning as under the Health Security Act.
Section 4002. Individual Election to Remain in Certain Health Plans. (a) Section
1876 of the Social Security Act is amended by adding a new subsection that provides that
each eligible organization under section 1876 with a risk sharing cpntract (or that is eligible
for such a contract) that also is a health plan participating in a health alliance shall offer
continued membership (for the same benefits to which alliance eligible persons are entitled)
to a plan enrollee who is a Health Security Act eligible employee, or the spouse or dependent
of an eligible employee, who becomes eligible for Medicare and therefore loses eligibility
under the Health Security Act. Payments shall be made beginning in the first month in which
the individual is Medicare eligible and no longer eligible under the Health Security Act.
Payments shall end with the earliest of either the month in which the individual notifies the
Secretary that he no longer wants to be enrolled in the eligible organization or the month of
open enrollment or the month in which the individual ceases to meet the requirements of this
section. Payments under this provision shall be the sole Medicare payment to which the
beneficiary is entitled.
Section 4003. Payments to Regional Alliances on Behalf of Certain Medicare
Eligible Individuals. Amends Medicare by adding a new section which provides that
individuals are not entitled .to Medicare coverage if they continue to qualify for coverage
under the Health Security Act under section 1012, because they are qualified employees or
the spouses of qualified employees. The Secretary must transfer to each regional alliance the
amount of the reductions in liability owed the regional alliance under section 6115 of the
Health Security Act. Unless all family members qualify for Medicare, reductions in liability
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�TITLE IV - MEDICARE AND MEDICAID
SUBTITLE A - MEDICARE AND THE ALLIANCE SYSTEM
(H.R. 3600 and S. 1757 p. 674)
PART 1- ENROLLMENT BENEF'ICIARIES IN REGIONAL ALLIANCE SYSTEMS
Section 4001. Optional State Integration of Medicare Beneficiaries into Regional
Alliance Plans. (a) Adds a new section to the Medicare statute that pennits participating
states to seek and obtain approval from the Secretary of HHS to integrate Medicare
beneficiaries and payments into the re:gional alliance system through enrollment in health
plans. States may obtain approval for Medicare integration whether or not they operate
single payer systems.
State applications must contain the following assurances:
(1) States must cover all Medicare-eligible individuals.
(2) Each beneficiary within a covered class must be enrolled in a regional
alliance for the area in which the individual resides or (in the case of a single payer
state) the state's single system. Each individual must have the same choice among
applicable plans as other persons eligible under the Health Security Act. Individuals
must be offered at least one fee-for-service plan that meets the following
requirements :
(i) The plan's premium rate, and the actuarial value of the premium,
deductibles and coinsurance may not exceed the actuarial value of Medicare
deductibles and coinsurance;
(ii) the plan's payment rates for hospital services, post-hospital
extended care services, home health services, home intravenous drug therapy
services, comprehensive outpatient rehabilitation facility services, hospice care,
dialysis services and ambulatory surgical services must be accepted by
providers of these se:rvices as payment in full; and
(iii) the plan's payment rates for physicians are no less a percentage of
the amounts accepted as payment in full than are payment rates under Part B.
(3) Health plans must offer at least the items and services covered by Medicare
(including the secondary payer program) and coverage rules mus.t be no more
restrictive than those used under Medicare.
(4) Premium rules that apply to other alliance eligible individuals may not be
applied to Medicare beneficiaries. However, states may not vary the premiums
charged different Medicare individuals within the same premium class.
(5) Quality assurance mechanisms are in effect.
(6) Beneficiaries have appeal rights at least equal to those afforded other
alliance eligible individuals.
(7) The state will furnish data required by the Secretary and provide access to
all relevant documents.
(8) The state will use payments made under this section only to carry out the
purposes of this provision.
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�In the first year of integration, the amounts payable to the state for each covered
beneficiary shall be detennined at the rate payable to Medicare risk sharing contractors under·
section 1876, but at 100 percent rather than 95 percent and without regard to reductions in
payments otherwise applicable under section 1876(a)(1)(G). For each succeeding year, the
amount payable is the base rate adjusted by the alliance inflation factor. Payments shall be
made out of the Hospital Insurance Tmst Fund and the Supplementary Medical Insurance
Trust Fund, as under section 1876.
(b) Payment begins on January 1 of the first calendar year of approval and ends either
on December 31 of the year in which the state notifies the Secretary that it no longer wishes
to integrate Medicare, or at a time determined by the Secretary in a case involving
substantial non-compliance. No temlination is effective without notice to Medicare
beneficiaries and health plans.
(c) Payments under this section are in lieu of any other benefits for which Medicare
payments would be made.
(d) The Secretary must evaluate state compliance on an ongoing basis.
(e) Definitions in this section have such meaning as under the Health Security Act.
Section 4002. Individual Election to Remain in Certain Health Plans. (a) Section
1876 of the Social Security Act is amended by adding a new subsection that provides that
each eligible organization under section 1876 with a risk sharing contract (or that is eligible
for such a contract) that also is a health plan participating in a health alliance shall offer
continued membership (for the same benefits to which alliance eligible persons are entitled)
to a plan enrollee who is a Health Security Act eligible employee, or the spouse or dependent
of an eligible employee, who becomes eligible for Medicare and therefore loses eligibility
under the Health Security Act. Payments shall be made beginning in the first month in which
the individual is Medicare eligible and no longer eligible under the Health Security Act.
Payments shall end with the earliest of either the month in which the individual notifies the
Secretary that he no longer wants to be enrolled in the eligible organization or the month of
open enrollment or the month in which the individual ceases to meet the requirements of this
section. Payments under this provision shall be the sole Medicare payment to which the
beneficiary is entitled.
Section 4003. Payments to Regional Alliances on Behalf of Certain Medicare
Eligible Individuals. Amends Medicare by adding a new section which provides that .
indiv,iduals are not entitled to Medicare coverage if they continue to qualify for coverage
und,er the Health Security Act under section 1012, because they are qualified employees or
the spouses of qualified employees. The Secretary must transfer to each regional alliance the
. amount of the reductions in liability owed the regional alliance under section 6115- of the
Health Security Act. Unless' all family members qualify for Medicare, reductions in liability
under section 6115 are based on the alliance premium credit amount for an individual.
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�Section 4004. Prohibiting Employers From Taking Into Account Status as a
Medicare Beneficiary on Any Account. Amends section 1862(b)(1)(A) by striking existing
exceptions to the non-discrimination provision (subclauses (ii) and (iii» in order to extend the
prohibition to all health plans ..
Section 1862(b)(1)(B) is amend.ed by extending the prohibition to all group health
plans. Section 1862(b)(1) is further amended by striking the limited time period of
protection against discrimination for persons with end stage renal disease. Section 1862(b) is
further amended to prohibit coverage of items and services for which there is primary
coverage under an alliance plan, except that payment may be made for cost sharing amounts
covered by Medicare. The provisions of this section take effect on January 1 of the first
year in which a state is a participating state.
PART 2 - ENCOURAGING MANAGED CARE UNDER MEDICARE PROGRAM;
COORDINATION WITH MEDIGAP PLANS
Section 4011. Enrolbnent and Termination of Enrollment. (a) Amends section
1876 of the Social Security Act to require uniform open enrollment periods under Medicare
risk sharing plans. Also amends section 1882(s) to require sellers of Medigap policies to
maintain 30-day uniform open' enrollment periods annually during which time issuers may not
deny or condition the issuance or effectiveness of policies for reasons of age, health status,
claims experience, receipt of health care or medical condition. Policies may not contain pre
existing condition limits (except in limited circumstances now provided under section
1882(s», elimination periods or probationary periods.
(b) Section 1876(c)(3)(A) is amended to require Medicare risk plans to provide open
enrollment periods for new residents of their service areas.
(c) Section 1876(c)(3)(B) is amended to permit enrollment through a third party and to
require uniform termination of em:ollment rules governing terminations during annual
enrollment periods, in cases of [mancial insolvency, and when persons move from an area.
(d) These amendments become effective for enrollments occurring after 1995, as
specified in regulations of the Secretary. The Medigap amendments become effective for
supplemental policies issued after 1995.
Section 4012. Uniform Im.formational Materials. (a) Amends section 1876(c)(3)(C)
to require the Secretary to develop uniform informational materials comparing all eligible
organizations. Risk plans are required to reimburse the Secretary a pro rata share for the
cost of preparation of the materials.
(b) Amends section 1882(t) to require the Secretary to prepare informational and
comparative materials about Medigap plans. Plans must reimburse the Secretary a pro rata
share of the cost of preparation.
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�(c) These amendments shall take effect in years after 1995.
Section 4013. Outlier Payments (a). Amends section 1876 to require the Secretary to
make additional payments to risk plans of not more than 50 percent of the imputed
reasonable cost, as determined by the Secretary, (or if requested by the organization, the
reasonable cost) above the threshold amount of Part A and Part B services provided or paid
for in a year by the organization to enrollees. The threshold amount is five percent or less
of total amounts paid to a risk sharing organization under its contract. Payments in future
years must be adjusted to take excess payments into account.
(b) Section 1876(a)(1)(C) is also amended to specify that total amounts paid include
the base rate plus the additional payment.
(c) These amendments apply to services furnished after 1994.
Section 4014. Point of Service Option. (a) Amends the statute to add a new section
authorizing the Secretary to develop a point of service program through which beneficiaries
not already enrolled in risk-sharing organizations may obtain services. A point of service
network must meet such criteria as the. Secretary may establish.
(b) Minimum criteria for networks are as follows:
(1) networks must serve designated appropriate geographic areas to ensure that
the. network has sufficient parti~ipating members to furnish covered Medicare
services;
(2) the Secretary must establish requirements for participating members;
(3) the Secretary must establish payment schedules including a schedule of
bundled payment arrangemt!nts for selected medical and surgical procedures;
(4) the Secretary must delineate permissible fmancial incentive arrangements to
encourage members to join;
(5) the Secretary must establish standards under which carriers administer the
program;
(6) the Secretary must establish procedures for the provision of case
.management services and criteria for determining when case management will be
covered;
(7) the Secretary must establish standards for processing and payment of
claims and for apportioning payments among parts A and B;
(8) the Secretary may establish other standards as appropriate;
(9) the Secretary must establish standards for physician participation based on
practice patterns and demonstrated quality assurance; and
(10) the Secretary must assure that the point-of-service option does not result
in a net fmancialloss to Medicare, taking both medical and administrative costs into
account.
(c) Conforming amendments are added to sections 1812(a) (expanding scope of
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�covered Part A services to include additional items and services furnished through point of
service networks), section 1814(b) (conforming provider payment provisions to point of
service amendment to permit payment of additional items and services plus bonus payments),
section 1832(a)(2) (expanding scope of Part B benefits to include additional items and
services furnished by point-of-service networks), section 1833 (to permit payment for point
of service services plus bonus payments), section 1862(a)(1) (to permit coverage of additional
Part B items and services under a point-of-service network that otherwise would be excluded
while excluding items and services not included in the individual's plan of care). Bonus
payments may be made by the Secretary if Medicare costs are reduced and if the quality of
care is not adversely affected.
PART 3 - MEDICARE COVERAGE EXPANSIONS
Section 4021. Reference to Coverage of Outpatient Prescription Drugs. References
subtitle A of title II.
Section 4022. Expanded Coverage for Physician Assistants, Nurse Practitioners
and Clinical Nurse Specialists. (a) Amends section 1861(s)(2)(K) to add services for
physician assistants, nurse practitioners and clinical nurse specialists.
(b) The effective date for these amendments is for services furnished on or after
January 1, lQ96.
PART 4- COORDINATION WITH ADMINISTRATIVE SIMPLIFICATION AND
QUALITY MANAGEMENT INITIATIVES
Section 4031. Repeal of Separate Medicare Peer Review Program. The peer
review program found at title XI of the Social Security Act is amended to provide that, upon
the adoption of the National Quality Management Program under title V of the Health
Security Act, the peer review program shall terminate.
Section 4032. Mandatory Assignment for All Part B Services. Section 1833 of the
Social Security Act is amended to include a new subsection providing that in the case of
items and services furnished after January 1, 1996, payment shall be made only on an
assignment related basis. The amendment prohibits patient billing except for applicable
deductibles, coinsurance or copayment amounts. Knowing and willful violations of this
provision may result in exclusion from the program for up to five years and the imposition
of civil money penalties. The violator also may be liable for restitution to the beneficiary.
Section 4033. Elimination of Complexities Caused by Dual Funding Sources and
Rules for Payment of Claims. (a) Authorizes the Secretary of HHS to take such steps as
may be necessary to consolidate the administration of the Medicare program.
(b) The Secretary ,shall contract with a single entity to combine intermediary and
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�carrier functions under Parts A and B for each regio~ of the country except in cases ~in which
the Secretary fmds that a national contract is appropriate.
(c) The provisions of section 1816 and 1842 (relating to intermediaries and carriers)
are superseded to the extent necessary to carry out this function.
Section 4034. Repeal of PRO Precertification Requirement for Certain Surgical
Procedures. (a) Section 1164 is repealed effective upon the date of enactment of the Health
Security Act.
(b) The statute is further amended to make conforming changes to eliminate PRO
approval of the following procedures: section 1833(a)(10)(D) (clinical diagnostic laboratory
tests furnished in connection with obtaining a second opinion); section 1833(a)(2)(A) (home
health services furnished in connection with obtaining a second opinion); section
1833(a)(2)(D) (payment rates for clinical laboratory services fuInished in connection with a
second opinion); section 1833(a)(3) (rural health clinic, federally qualified health center and
comprehensive outpatient rehabilitation services furnished in connection with obtaining a
second opinion); section 1833(b)(3) (payment principles for services furnished in connection
with obtaining a second opinion); section 1834(g)(I)(B) (payment for outpatient rural primary
care hospital services furnished in connection with obtaining a second opinion); section
1862(a) (exemption of second opinions from exclusion of coverage); section 1866(a)(2)(A)
(provider charges for services furnished in connection with obtaining a second opinion).
Section 4035. Requirements for Changes In Billing Procedures. (a) Prohibits the
Secretary from implementing changes in billing and processing ·procedures under Medicare
more frequently than once every six months.
(b) Requires carriers and intermediaries' to provide 120 days advance notice to
providers of major changes in billing procedures.
(c) The provision becomes effective with contracts beginning nine months after the
date of enactment.
PART 5 - AMEND:MENTS TO ANTI-FRAUD AND ABUSE PROVISIONS
Section 4041. Anti-Kickback Provisions. (a) Amends section 1128A(a) to authorize
the Secretary to impose civil money penalties for violationS of section 1128(B)(b) (relating to
fraudulent or false statements or material misrepresentations). Amends section 1128A(a) to
authorize penalties up to $50,000 for false or misleading statements. Amends section
1128B(b) to increase the civil and criminal penalties for remuneration offered or received in
exchange for either referring an individual for services or a lease, purchase or order of goods
and services or a recommendation for a lease or purchase.
(b) Amends section 1128B(b)(3)(A) to exempt from the anti-kickback provisions
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�.
.
I
discounts obtained by providers that are not part of tie-in arrangements, are not exclUsive to
certain providers, and are not remuneration in cash. Further amends section 1128B(b)(3)(B)
to exempt from the anti-kickback provisions amounts paid to employees that are consistent
with the fair market value of the service and are not tied to the volume or value of services
(except that employees may, receive productivity bonuses).
Further amends section 1128B(b)(3)(D) to exempt from the defInition of kickback
waivers or reduction of coinsurance if the waiver is made pursuant to a public schedule of
discounts and obligated as a matter of law to apply. Also exempts waivers of coinsurance by
persons who do not routinely waive coinsurance or deductibles and who waive the payment
after determining that the individual is indigent or who fail to collect amounts owed after
making a reasonable effort or who meet other exceptions authorized by the Secretary.
Section 1128B(b)(3) is further amended by providing that the anti-kickback provisions
do not apply to certain federally funded providers and to providers that as a matter of law
must waive or reduce coinsurance for certain individuals pursuant to a public schedule of
discounts. The copayment waiver rules do not apply to these two classes of providers if
remuneration is pursuant to a written arrangement for the use or prOCurement of space,
equipment, goods or services or the referral of patients if there is no private inurement to
any current employee, offIcer, agent or member of the Board, and the arrangement does not
preclude the referral of patients to other providers or interfere with the ability of health
professionals to refer patients to providers they believe are the most appropriate.
'
Section 1128B(b)(3) is further amended by adding a new provision providing that the
anti-kickback provisions any reduction in cost sharing or increased benefIts to individuals
enrolled under prepaid per capita health plans.
(c) Amends section 1128B(b) to defme referrals from employees to employers to
cover referrals for which payments may be made under Medicare or a state health care
program .
. (d) Amends section 1128B(b) to authorize the Secretary to issue regulations to protect
patients from abuse under any of the new anti-kickback exceptions added by this provision.
(e) Amends section B(b) to clarify that in addition to an intent to influence, an
element of a punishable offense under the anti-kickback statute is an intent to be influenced .
Also clarifIes that persons who knowingly and willfully engage in remunerative acts violate
the statute even if the knowing and willful payment of remuneration is only one of the
purposes underlying the individual's actions.
Section 4042. Revisions to Limitations on Physician Self-Referral. (a) Amends
section 1877(a)(1)(B) (relating to physician referral ban) to clarify that physicians may not
avoid the ban on self referrals by billing themselves for items and services for which a
physician-owned entity would not be permitted to bill.
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�(b) Amends section 1877(a)(2) (defining financial relationship) to clarify that
physician ownership is established in cases involving loans, and interest in the entity held by
a physician's relatives.
(c) Amends section 1877(b) (relating to general exceptions) to repeal the exception for
services provided by another physician in the same group practice as the referring physician.
Also amends section 1877(b) to extend the exception to the physician referral ban to clinical
laboratory, x-ray and ultra-sound services that are provided at low cost, as defined by the
Secretary, but not in instances where the referral is to another physician in the same group
practice. Amends section 1877(b)(2) to exempt certain prepaid practices (other than those
reimbursed on a cost basis) from the self-referral ban.
(d) Amends section 1877(c)(1) (relating to the exception to ownership in publicly
traded funds and securities) to limit the exception to securities and mutual funds that are
publicly traded at the time that they are acquired by the physician.
(e) Amends section 1877(d)(2) (relating to exceptions for rural physicians) to specify
that at least 85 percent of the provider's services must be furnished in rural areas in order to
qualify for the exception.
(f) Amends section 1877(e)(3)(relating to physician incentive plans) to clarify that the
exception applies when physicians are placed at risk for services that are not physician
services. Also amends section 1877(e)(3) to clarify that physician incentive plans, as the term
is used in this section, are arrangements that have the purpose (rather than merely the effect)
of limiting services to enrolled individuals.
Section 1877(e) (4) as redesignated (relating to physician recruitment) is amended to
limit the exception to entities located in rural areas, health professions shortage areas, or an
entity in which 85 percent of patients are members of medically underserved populations.
The exception is also limited to the recruitment of physicians practicing in certain specialties
for less than one year. Recruitment plans must be in writing, the new practice location must
be at least 100 miles from the established primary practice area and at least 85 percent of
new physician revenues must be generated by care for new patients. Recruitment benefits
must not be more than 3 years in duration. There must be no requirement that the physician
make referrals as a condition of receiving recruitment benefits. The physician must not be
prevented from establishing staff privileges at other entities in cases in which the recruiting
entity is a hospitaL The value of the recruitment benefit must not vary on the basis of
volume of referrals. The physician must agree to treat Medicaid and Medicare patients.
Amends section 1877(e)(5) as redesignated (related to exceptions for isolated
transactions) to clarify that there may be no financing of the sale between the parties.
Amends section 1877 (e)(7) as redesignated (related to exceptions for payments by a
physician) to exempt physician payments for clinical laboratory services when payment is at
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�the fair market price. Also amends the subsection to permit discount exceptions so long as
the discounts are properly disclosed and reflected in the physician's charges and are not part
of a tie-in arrangement or selectively made available to individuals and entities.
(g) Amends section 1877(g)(4) (relating to civil money penalty sanctions for certain
activities) to allow the imposition of penalties for cross referral and multiple lease
arrangements that have the principal purpose of inducing other referrals.
(h) Amends section 1877(h) (relating to definitions and special rules) to clarify that
the term "remuneration" includes payments, discounts, price reductions, debt forgiveness, or
other in kind or cash benefits made overtly or covertly.
(i) Section 1877(h) is further amended to clarify that the Secretary has the authority to
require physical grouping of group practices in order to prevent the abuse of any applicable
group practice exception. Also clarifies that the members of the group must personally
provide both health services and incidental services.
G) Amends section 1877(h) (relating to the definition of referrals and referring
physician) to strike paragraph (C), which exempts from the definition of "referral" requests
by pathologists, radiologists, and radiation oncologists for laboratory and diagnostic
radiology tests and radiation therapy.
(k) Amends section 1877(h)(6) (relating to the designation of certain health services
under this section) to add both diagnostic services and any other item or service not rendered
by the physician personally or under the physician's personal supervision.
(1) Amends section 1877 to authorize the Secretary to promulgate self referral
regulations .
(m) Incorporates by reference OBRA 1993.
Section 4043. Civil Monetary Penalties. (a) Amends section 1128(A) (relating to
civil money penalties for false claims to add as a sanctionable act the offering or payment of
remuneration to Medicare beneficiaries to obtain Medicare services from certain providers,
practitioners or suppliers.
Amends section 1128A to add as a type of remuneration the waiver of coinsurance
and deductibles unless the waiver is not offered as part of an advertisement or solicitation,
the provider does not routinely waive deductibles and coinsurance, and the provider waives
the deductible or coinsurance after determining that the individual is indigent or after making
a good faith attempt to collect amounts owed or is a provider permitted to waive deductibles
and coinsurance.
(b) Amends section 1128A(a)(1) to add as a covered form of remuneration the
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�deliberate· and medically unnecessary upcoding of items and services or provision of
medically unnecessary items and services.
(c) Amends section 1128A to cover remuneration by excluded persons during a period
of exclusion, who retains a direct or indirect ownership interest greater than five percent, or
who is an officer, director, managing employee or agent of a Medicare participating entity.
(d) Amends section 1128A to cover practices designed to circumvent payment
methodologies that are designed to circumvent bundled payment arrangements, including
hospital diagnosis-related groups (DRG) payments.
Amends section 1128A to cover health plan practices by participating providers that
have the effect of limiting or discouraging (compared to other plan enrollees) the use of
services by Medicare and Medicaid patients, including differential locations and hours of
services.
Amends section 1128A to cover substantial failure to cooperate with a quality
assurance program.
Amends section 1128A to cover the substantial failure by plans to provide or
authorize medically necessary services if the failure has or is likely to adversely affect the
individual.
Amends section 1128A to cover plans that employ or contract with excluded
individuals for the provision of services.
Amends section 1128A to cover plans that submit false or fraudulent data to the
Federal, state or local government.
(e) Amends section 1128A to increase certain civil monetary penalty amounts and
.
fines.
(f) Amends section 1128A(f) to add interest on penalties to the amounts payable and
to add to the amount owed the cost of collection and recovery in the case of late payments.
(g) Amends section 1128A authorizing the Secretary to take action unless the Attorney
General acts within a year of having a case referred.
(h) Authorizes the payment of penalties into the all payer account established under
section 5402 of the Health Security Act.
Section 4044. Exclusions from Program Participation. (a) Amends section
1128(a)(1) (relating to mandatory exclusion of certain individuals from Medicare and state
health programs) to clarify that grounds for mandatory program exclusions include individual
convictions for of criminal offenses related to the delivery of services under Medicare or
state health programs and individual convictions under Federal or state law in connection
with the delivery of a health care item or service relating to fraud, theft, embezzlement,
breach of fiduciary responsibility or other financial misconduct.
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�(b) Amends section 1128(c) (relating to permissive exclusions) to establish a minimum
exclusion period of up to 3 years for convictions of offenses described in paragraphs (1), (2)
or (3) of section 1128(b). In the case of individuals excluded after conviction of offenses
under paragraphs (4) and (5) of section 1128(b), the period of exclusion may not be less than
the period during which the individual's or entity's license is revoked or the individual is
otherwise excluded from a Federal or state health program. In the case of offenses described
under section (b)(6), the period of exclusion shall not be. for less than one year.
(c) Amends section 1128(b)(14) (relating to exclusion of persons defaulting on health
education loan and scholarship obligations to clarify that only reasonable steps must be taken
to secure payment before exclusion may occur.
(d) Amends section 1128(b) to permit exclusion of persons with ownership or control
interest in a sanctioned entity (civil money penalties, exclusions or convictions) of five
percent or more.
(e) Amends section 1128(b) to add as a ground for exclusion under Medicare the
following: actions that violate the all payer health care fraud program under the Health
Security Act; the failure to disclose information needed by the Inspector General in order to
carry out the All Payer Health Care Fraud and Abuse Control Program; the failure to
provide fmancial information required under the Health Care Security Act; the failure to
grant immediate access to entities authorized by law to conduct on-site health and patient
safety inspections under the Health Care Security Act.
. (f) Amends section 1128(f) to provide that appeals of exclusions shall be brought in
the United States Courts of Appeal in the circuit in which the excluded individual or entity
resides or has its principal place of business (or in the District of Columbia Court of Appeals
in cases in which the entity or individual does not have a principal residence or place of
business).
Section 4045. Sanctions Against Practitioners and Persons for Failure to Comply
with Statutory Obligations Relating to Quality of Care. (a) Amends section 1156 (relating
to the general obligation of providers to furnish only care that is medically necessary, of
good quality and economical) to require the Secretary to establish a minimum exclusion
period of one year for exclusions for violations of the section.
(b) Amends section 1156 (b)(1) to repeal the provision requiring a fmding that a
practitioner is unwilling to comply with the requirements of section 1156 before excluding
persons who fail to furnish q2uality, medically necessary and economical services.
(c) Amends section 1156 (b)(3) to increase the civil money penalties to $50,000 for
each instance in the case of violations under this section.
Section 4046. Effective Date. Amendments made under this part become effective
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�January 1, 1995.
PART 6 - FUNDING OF GRADUATE :MEDICAL EDUCATION AND
ACADEMIC HEALTH CENTERS
Section 4051. Transfers from Medicare Trust Funds for Graduate Medical
Education. (a) For purposes of complying with section 3034 (relating to support for the
institutional costs of graduate medical education) there shall be transferred to the Secretary
from Parts A and B of Medicare, the following aggregate amount in any fiscal year:
(1) for fiscal years prior to 1998, the proportion of the amounts spent from the
trust funds during the most recent 'calendar year for payments for the direct cost of
graduate medical education attributed to hospitals located in states that are
participating states;
(2) in fiscal year 1998, the amounts spent from the trust funds for graduate
medical education direct costs in 1997;
(3) in the case of subsequent fiscal years, the amounts specified in paragraph
(2) increased by the Secretary's estimate of the percentage increase in the urban
consumer price index except that for purposes of this subparagraph the increases
provided for in subparagraphs (A) and (C) of section 6001 (relating to subsequent
year payment reductions) shall not apply.
(b) Funds transferred under subsection (a) shall be allocated equitably, in accordance
with standards prescribed by the Secretary.
(c) Section 1886(h) (relating to graduate medical education payments) is amended to
prohibit payments for direct medical education costs after January 1, 1998 (or an earlier date
for hospitals located in states that are participating states at an earlier date). The Secretary
may not recognize direct graduate medical education costs for any cost reporting period after
October 1, 1997, (or an earlier date in the case of hospitals located in states that are
participating states at an earlier date).
Section 4052. Transfers from Hospital Insurance Trust Fund for Academic
Health Centers. (a) For the purpose of complying with section 3104(a) (relating to payment
to academic health centers) there shall be transferred to the Secretary from the Part A Trust
Fund the following aggregate amount:
(1) For fiscal years 1998, the proportion of funds spent on indirect medical
education that is attributable to hospitals located in a state that is a participating state.
(2) For fiscal year 1998, the amount spent on indirect medical education.
(3) In each subsequent fiscal year, the amount spent in fiscal year 1997,
updated by the inflation factor in section 6001(a)(3) of the Health Security Act, but
without regard to the reductions in increases under subparagraphs (A) through (C) of
section 6001.
(b) Section 1886(d) is amended to prohibit indirect graduate medical education
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�payments under Medicare for discharges occurring on October 1, 1997, or thereafter (or an
earlier date in the case of a state which is a participating state at an earlier date).
PART 7 - COVERAGE OF SERVICES PROVIDED BY
FACILITIES AND PLANS OF DEPARTMENTS OF DEFENSE AND
VETERANS AFFAIRS
Section 4061. Treatment of Uniformed Services Health Plans Eligible
Organization Under Medicare. (a) Amends section 1876 (related to payments to certain risk
sharing entities) to provide that Uniformed Service Health Plans shall be deemed to be
eligible institutions for covered services that are furnished to Medicare beneficiaries.
Payment amounts and items and conditions shall be developed through agreements between
the Secretary of HHS and the Secretary of Defense.
(b) This provision takes effect on January 1, 1998.
Section 4062. Coverage of Services provided to Medicare Beneficiaries by Plans
and Facilities of the Department of Veterans Affairs. (a) Amends Medicare to add a new
section authorizing Medicare payments to VA health plans and VA health care facilities as
providers of health services. The Secretary is required to make payments to VA plans under
the same terms and conditions as payments would be made to entities under section 1876 of
the Social security Act (certain risk sharing plans). VA facilities shall be treated as Medicare
providers.
(b) The amendments under this section take effect on October 1, 1997.
Section 4063. Conforming Amendments. A series of conforming amendments are
added to the Medicare statute to carry out this part. These amendments, take effect on
January 1,1998.
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�SUBTITLE B - SAVINGS IN MEDICARE PROGRAM
(H.R. 3600 and S. 1757 p. 752)
PART 1 - SAVINGS RELATED TO PART A
Section 4101. Reduction in Update for Inpatient Hospital Services. Amends
section 1886(b)(3)(relating to updates in inpatient hospital payment rates) by establishing that
for each of fiscal years 1997 through 2000, payment increases will be at market basket minus
2.0 percentage points.
Section 4102. Reduction in Adjustment for Indirect Medical Education. Amends
section 1886(d)(5) (relating to prospective payments for inpatient hospital services) by
revising the indirect teaching adjustment factor to read as follows: c* «(1 +r) to the nth
power) - 1) where r is the ratio of the hospital's full-time interns and residents and' n equals
.405. For discharges occurring after October 1, 1994 and before October 1, 1995, "c" is
1.395 and after October 1, 1995, "c" is 0.74.
Section 4103. Reduction ill Payments for Capital-related Costs for Inpatient
Hospital Services. (a) Amends section 1886(g)(I) (relating to capital related costs for
hospitals under the prospective payment system) by specifying that for discharges occuring
after September 30,1995, in addition to the 7.4 percent reduction in the unadjusted standard
Federal capital payment rate,' the Secretary shall reduce by 7.31 percent the unadjusted
Federal capital rate in effect as of the date of enactment of the Health Security Act and shall
reduce by 10.4 percent the unadjusted hospital specific rate in effect on that date.
Further amends section 1886(g)(l) to give the Secretary authority to establish a factor
for the amount of capital cost recognized per discharge that reflects an appropriate factor
that takes into account amounts necessary for the efficient and effective delivery of medically
appropriate and necessary care of high quality. For payments attributable to portions of cost
reporting periods occurring during each of fiscal years 1996 through 2003 the Secretary shall
reduce the annual update factor to adjust for excessive increases. The reduction shall not
result in an annual update factor of less than 0 but may equal either 4.9 percentage points or
the sum of 4.9 percent and the difference between the update factor and the update reduction
for the previous year in cases in which the factor was less than the reduction.
(b) Amends section 1861 (v) (relating to reasonable cost reimbursement) by providing
that in the case of hospitals exempt from PPS, payment for capital-related costs shall be
reduced by 15 percent for cost reporting periods occurring during each of fiscal years 1996
through 2003.
Section 4104. Revisions to Payment Adjustments for Disproportionate Share
Hospitals in Participating States. (a) Amends section 1886(d)(5) (relating to payments to
hospitals) to authorize the Secretary to pay additional amounts to hospitals located in
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�participating states and that are disproportionate share facilities as defmed under this section.
Four categories of hospitals may qualify for payments under this section: urban hospitals
with more than 100 beds with SSI patient percentage of at least 5.5 percent; urban hospitals
of less than 100 beds with SSI patient percentages of at least 17 percent; rural referral
hospitals or rural sole community hospitals with SSI patient percentage of at least 23 percent;
and other hospitals with SSI patient percentages of less than 23 percent. The SSI patient
percentage is the proportion of all Medicare inpatient days attributable to SSI patients. '
The payment percentage for hospitals meeting the disproportionate share requirements
of this section are 'as follows:
(1) in the case of urban hospitals of more than 100 beds, e to the nth power,
where· "e" is the natural antilog of 1 and "n" is equal to (.5642*(the hospital's SSI
patient percentage for the cost reporting period - .055»;
(2) for urban hospitals of less than 100 beds and other hospitals, 2 percent;
(3) for rural referral centers and sole community hospitals, the sum of 2
percent and .30 percent of th.e difference between the hospital's SSI patient percentage
and 23 percent.
(b) Amends section 1886 (d)(2) (relating to the establishment of national.adjusted
DRG rates) to clarify that in establishing a national standard rate the Secretary shall adjust
the estimate to take to take into account payments to disproportionate share hospitals and
shall include additional payments made to hospitals under section 4104 in setting a standard
amount.
(c) Clarifies that the change in DSH payments relates only to hospitals located in
participating states.
Section 4105. Moratorium on Designation of Additional Long-Term Care
Hospitals. Amends section 1886(d) pertaining to payments to hospitals to prohibit the
Secretary from treating as a long term care hospital any hospital that did not have such a
status as of the enactment of the Health Security Act.
Section 4106. Extension of Freeze on Updates to Routine Service Costs of Skilled
Nursing Facilities. (a) Amends section 1888(a) (relating to payment to skilled nursing
facilities for routine costs) to limit to 100 percent the upper limit on payment for reasonable
routine service costs for services in skilled nursing facilities and authorizes the Secretary to
make such further adjusttnents as are necessary to extend the savings achieved by OBRA
1993.
(b) Amends section 1888(d)(2) (relating to routine payments to skilled nursing
facilities) to limit per diem payments for routine services furnished in skilled nursing
facilities to no more than 100 percent of the reasonable cost and authorizes the Secretary to
make such further adjusttnents as are necessary to extend the savings achieved by OBRA
1993.
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�(c) The effective date of these amendments is October 1, 1995.
PART 2 - SAVINGS RELATED TO PART B
Section 4111. Establishment of Cumulative·Expenditure Goals for Physician
Services. (a) Amends section 1848(t)(2) (relating to use of Medicare volume performance
standard rates of increase) by inserting new performance standard rates of increase for fiscal
years beginning with fiscal year 1994. In fiscal years 1994, 1995, and 1996, the increase
shall equal the rate of increase for fiscal 1993, increased by the product of the calculation set
forth at current section 1848(t)(2)(a).
(b)Amends section 1848 (d)(3)(b) to provide that beginning in fiscal 1997 updates for
a particular category of physician services shall be increased or decreased by the same
percentage by which the cumulative percentage increase for the category of services was less
or greater than the performance standard rate of increase. The cumulative percentage
increase is equal to the product of the adjusted increases beginning in 1994, up to· and
including the year involved, minus 1 and multiplied by 100. The term adjusted increase is
equal to 1 plus the percentage increase in actual expenditures for the year.
(c) Amends section 1842(t) t.o repeal the volume performance standard factor.
Section 4112. Use of Real GDP to Adjust for Volume and Intensity; Repeal of
Restriction on Maximum Reduction Permitted in Default Update. (a) Amends section
1848(t)(2)(B)(iii), as added by section 4111 to substitute average per capita growth in the real
gross domestic product (increased by 1.5 percentage points for primary care services only) in
place of the existing volume and intensity growth factor under current law.
(b) Amends section 1848(d)(3)(B) to eliminate the maximum reduction restriction
beginning in fiscal 1995, which currently stands at 5 percentage points.
Section 4113. Reduction in Conversion Factor for Physician Fee Schedules for
1995. (a) Amends section 1848(d)(1) to specify for 1995 a conversion factor for primary care
services equal to current law, with a three percent reduction for other types of physician
services.
Section 4114. Limitations on Payment for Physicians' Services Furnished by
High-Cost Hospital Medical Staffs. (a) Adds a new section 1849 requiring the Secretary to
develop an annual, hospital-specific per-admission relative value scale and to determine
whether a hospital's specific per admission relative value exceeds the allowable average per
admission relative value applicable to the medical staff for the year. If the Secretary
determines that the rates are excessive, the SecretarY shall reduce payments for the physician
services to hospital inpatients. By October 1, annually, the Secretary must notify the hospital
of it specific relative value.
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�(b) In the case of urban hospitals, the allowable average per admission relative value
equals 125 percent (or 120 percent for years after 1999) of the median 1996 hospital-specific
per admission relative value for all hospital medical staffs.
In the case of rural hospitals for each year beginning with 1998 and thereafter the
allowable per admission relative value equals 140 percent of the median 1996 hospital
specific relative value for all hospital medical staffs.
The hospital specific projected relative value for a hospital (other than a teaching
hospital) is equal to the average per admission relative value for each physician~ s service
furnished to inpatients by the hospital's medical staff (excluding interns and residents) during
1996, and adjusted for variations in case mix and disproportionate share status
The hospital specific relative value for teaching hospitals equals (1) the average per
admission relative value for each physician's service furnished to inpatients by the hospital's
medical staff (excluding interns and residents) during 1996 and adjusted for variations in case
mix, disproportionate share status, and teaching status; and (2) the equivalent per admission
relative value of each physician service furnished to inpatients by interns and residents during
1996 adjusted for variations case mix, disproportionate share status, and teaching status.
The Secretary shall determine the equivalent relative value based on the best available
data for teaching hospitals and shall adjust the relative value to take into account the
additional costs of teaching and disproportionate share hospitals.
The projected excess relative value for a year means the number of percentage points
(as determined by the Secretary) by which a medical staff's hospital specific per admission
relative value exceeds the allowable average per admission relative value.
(c) The amount of payments otherwise due will be reduced by 15 percent for each
service furnished for hospitals whose relative value per admission exceeds the allowable
average per admission.
(d) Not later than October 1, beginning in 1999, the Secretary shall determine each
hospital's actual average per admission relative value using claims forms submitted no later
than 90 days after the last day of the previous year, adjusted by the appropriate case mix,
disproportionate share factor and teaching factor.
In cases in which hospital specific actual average per admission relative value was
reduced and falls below the average rate, the Secretary shall reimburse the hospital up to the
average including interest at an appropriate rate. In cases where the actual average relative
value is less than 15 percentage points above the national average, the Secretary shall
reimburse the hospital a percent of total allowed charges representing the difference between
15 percentage points and the actual number of percentage points by which the staff exceeded
the allowable average per admission relative value, including appropriate interest.
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�If the actual average per admission relative value exceed 15 percentage points, none
of the amounts withheld shall be paid. Hospital medical executive committees shall be given
as one-year advance notice of projected excessive relative values and can designate a
fiduciary agent to receive and disburse amounts witheld by the carrier that are later returned.
Amounts paid by the carrier may be paid directly on a pro-rata basis to treating members of
the medical staff.
(e) Medical staff are defined as individuals who are subject to bylaws, rules and
regulations established by the hospital and who have clinical privileges under which the
individual may provide physician services independently within the scope of those privileges.
Medical staff also include individuals who furnish at least one service to a Medicare
beneficiary in the hospital.
Rural and urban areas have the same meaning as under section 1886(d)(2)(d). The
term "teaching hospital" is a hospital with a teaching program approved under section 1861.
The effective date of this amendment is January 1, 1998.
Section 4115. Medicare Incentives for Physicians to Provide Primary Care. (a)
Amends section 1848(c)(2) (relating to relative value payments for physicians) beginning in
1996, to increase by 10 percent the practice expenses that are allowed in calculating the
relative value unit. Increases must be budget neutral, with anesthesia and primary care
exempted from offsetting reductions. The Secretary is required to develop a resource based
system for determining practice expenses for each physician's service.
(b) Amends section 1848(c)(2) to increase the work relative value units for office
visits by 10 percent beginning in 1996.
(c) Amends section 1848 (c)(2) to reduce the work, practice expense and malpractice
components of office consultations under the RBRVS system for other physicians to offset
increases for primary care physicians.
(d) Amends section 1848(c)(2) to reduce the work relative value components of
procedures or classes of procedures where intensity exceed thresholds established by the
Secretary. The Secretary must apply the savings, from such reductions, to increase the work
relative value of primary care services on a budget neutral basis.
(e) Amends section 1833(m) to increase the uilderserved area bonus payment to 20
percent for primary care services and remains at 10 percent for other services.
These amendments are effective on January 1, 1996.
Section 4116. Elimination of Formula-Driven Overpayment for Certain
Outpatient Hospital Services. (a) Amends section 1833(i) (pertaining to payment for
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�outpatient ambulatory services) by striking 80 percent and inserting "less the amount a
provider may charge under section 1866 (a)(2)(A)." (the provider's applicable charge). Also
(b) Amends radiology and diagnostic procedures under section 1833(n)(1) by striking
"80 percent" and inserting "less the amount a provider may charge) under section
1866(a)(2)(A). "
The effective date of this provision is July 1, 1994.
Section 4117. hnposition of Coinsurance on Laboratory Services. Amends section
1833(a) to strike 100 percent and insert "80 percent of the negotiated rate."
This section is effective January 1, 1995.
Section 4118. Application of Competitive Acquisition Process for Part B Items
and Services. (a) Adds a new section 1847 to the statute to require the Secretary to establish
competitive acquisition areas for the awarding of certain items or services furnished on or
after January 1, 1995. The Secretary may establish different competitive acquisition areas
for different items and services.
Competitive acquisition areas must initially be within metropolitan statistical areas and
must be chosen on the basis of the availability and accessibility of suppliers and on the
probability of achieving savings through competitive bidding for the items and services.
The Secretary must conduct a competition among suppliers for the contracts for each
class of item and service and for each acquisition area. The Secretary may not award a
contract unless the supplier meets quality standards and agrees to furnish sufficient items and
.
services to meet the needs of the area.
Each contract shall specify the quantity of items and services to be provided and such
terms and conditions as the Secretary specifies.
Services subject to competitive bidding include magnetic resonance imaging tests and
computerized axial tomography scans (including physician's interpretation), oxygen and
oxygen equipment, and such other items and services that the Secretary determines can be
cost-effectively and appropriately secured through competitive acquisition.
(b) Amends section 1862 (relating to limitations and exclusions) to exclude coverage
of items and services furnished in a competitive acquisition area unless furnished through a
contracting supplier.
(c) If competitive acquisition fails to achieve at least a 10 percent annual reduction in
the amount of Part B payments that would otherwise have been made for items and services
subject to competitive acquisition, the Secretary shall reduce payment levels by an amount
necessary to achieve such savings.
These amendments are effective January 1, 1995.
Section 4119. Application of Competitive Acquisition Procedures for Laboratory
Services. (a) Section 1847, as added by section 4117, is amended to also cover clinical
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�diagnostic laboratory tests.
(b) If competitive acquisition procedures do not reduce the fee schedules and
negotiated rates by at least 10 percent annually, the Secretary shall reduce payments by an
amount sufficient to achieve such savings.
PART 3 - SAVINGS RELATED TO PARTS A AND B
Section 4131. Medicare Secondary Payer Changes. (a) Amends section 1862
(relating to Medicare as a secondary payer) by repealing the sunset requirement on employer
data matches .. Section 6103(1)(12) of the Internal Revenue Code also is amended by striking
subparagraph (F).
(b) Amends section 1862(b) by repealing the sunset on disabled employees with
respect to coordination with other benefits in the cases of employers of 100 or greater.
(c) Section 1862 is amended by striking the secondary payer sunset for end stage
renal disease beneficiaries with respect to coordination with other benefits.
Section 4132. Payment Limits for liMOs and CMPs with Risk Sharing Contracts.
(a) Amends section 1876 to establish new standards for payments under Medicare to
entities with Federal risk sharing contracts under section 1876.
In the case that proportion of risk payments are made from the Supplemental Medical
Insurance Trust Fund, upper payment levels are limited to 95 percent of the following:
(1) In 1995, 150 percent of the weighted national average of all adjusted
average per capita costs determined under paragraph (4) for that class that are
attributable to payments from the trust fund, plus 80 percent of the amount by which
the adjusted average per capita cost for that class exceeds 150 percent of the weighted
national average.
(2) for 1996, the excess payment shall be limited to 60 percent;
(3) for 1997, the excess payment shall be limited to 40 percent;
(4) for 1998, the excess payment shall be limited to 20 percent;
(5) for 1999 and fiscal years thereafter, payment shall be at 150 percent of the
weighted national average of all adjusted average per capita costs. .
The limits described in this section shall not apply if the portion of the annual per
capita rate of payments for each class of patients that is attributable to payments from the
Hospital Insurance Trust Fund is less than 95 percent of the weighted national average of all
average adjusted per capita costs.
Payments from the Supplemental Medical Insurance Trust Fund are limited as
follows:
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�(1) For 1995, payments are limited to 170 percent of the weighted national
average for all adjusted average per capita costs plus 80 percent of the amount by
which, if any, the adjusted average per capita cost exceeds 170 percent of that
weighted national average.
(2) In 1996, the excess amount of payment is 60 percent;
(3) In 1997, the excess amount of payment is 40 percent;
(4) In 1998, the excess amount of payment is 20 percent;
(5) In 1999 and years thereafter, payments are limited to 170 percent of the
weighted national average.
The payment limitations of this section do not apply in cases where the portion of the
annual per capita rate of payment for each class of payments from the SMI trust fund is less
than 95 percent of the weighted national average of all per capita costs for a particular class
of patients that are attributable to payments made from the Health Insurance Trust Fund.
For 1995 and succeeding y~ars, the portion of payments from each of the trust funds
may not be less than 80 percent of 95 percent of the weighted average of all adjusted average
per capita costs for any class of patients that are attributable to payments from that trust
fund, unless the portion of the annual per capita rate of payment for each such class from the
other trust fund is greater than 95 percent of the weighted national average of all adjusted
average per capita costs for that class of patients.
For the year 2000 and succeeding years, the Secretary may revise any of the
percentages otherwise applicable during a year but only if the aggregate payments made to
risk sharing providers under section 1876 during the year is not greater than they would have
been without the revisions (budget neutrality test). In determining the weighted average of all
adjusted average per capita costs, the Secretary shall not take into account costs associated
with treatment of ESRD patients.
Additional conforming amendments are made.
Section 4133. Reduction in Routine Cost Limits for Home Health Services. (a)
Amends section 1861(v)(1) (relat.ing to reasonable cost payment limits for home health
services) by striking "112 percent" in the case of excess home health costs and inserting a
limit of 100 percent of the mean. for allowable visit related costs. This subsection is effective
on July 1, 1996.
(b) Amends section 1861(v)(1) to strike "mean" and insert "median". This subsection
is effective for cost reporting periods beginning on or after July 1, 1997.
Section 4134. Imposition of Copayment for Certain Home Health Services. (a)
Amends section 1813(a) (relating to deductibles and coinsurance) to impose a copayment
equal to 10 percent of the average of all visit costs as determined by the Secretary on a
prospective basis, unless such services were furnished during the 30 days immediately
following the patient's discharge as a hospital inpatient.
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�Amends section 1833 (a)(2) (relating to payment for benefits) to limit payment for
home health benefits to the lesser of reasonable cost or. customary charges less the amount of
allowable copayment. Public providers and other providers are exempt from the new cost
sharing requirement (other than nominal cost sharing) if they can demonstrate that a
significant proportion of their patients are low income, so long as certain conditions are met.
Confonning amendments are· made to section 1866.
(b) The effective date of this section is July 1, 1995.
Section 4135. Expansion of Centers of Excellence. (a) The Secretary must contract
with centers of excellence for cataract and coronary artery bypass surgery and other services
detennined to be appropriate. In such cases, payment under Medicare shall be made under
contracts on the basis of negotiated or all-inclusive rates as follows:
(1) the center shall cover services in an urban area;
(2) the aggregate to the center shall be less than it would have been had the
agreement not been in effect; and
(3) the Secretary shall make payments based on the following services: facility,
professional and related services related to cataract surgery; coronary artery bypass
surgery and related services; such· other services as the Secretary and center agree to
cover.
(b) The Secretary shall give a rebate equal to 10 percent of the savings to individuals
who receive care at the center.
PART 4- PART B PREMIUM
Section 4141. General Part B Premium. Amends section 1839(e) (relating to amount
of premiums) to continue indefinitely the increase in the part B premium to 50 percent of the
monthly actuarial rate for enrollees age 65 and over. Increases in premium amounts because
of this change shall be taken into account in establishing the monthly premium payment level
each year.
Section 4151. Report on Savings. By January 30,1999, the Secretary shall submit to
Congress a report containing a detennination of whether the average annual rate of growth in
Medicare spending (taking into account savings under this subtitle) in the four-fiscal-year
period beginning with fiscal year 2000 will exceed a rate of growth equal to the CPI plus the
average annual percentage change in the size of the Medicare population plus the average
annual change in the real GDP plus 1.
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�SUBTITLE C - MEDICAID
(H.R. 3600 and S. 1757 p. 807)
PART 1 - COMPREHENSIVE BENEFIT PACKAGE
Section 4201. Limiting Coverage Under Medicaid of Items and Services Covered
Under Comprehensive Benefit Package. Amends the Medicaid statute by adding a new
section to the statute clarifying that items and services covered in the benefit package shall
no longer be considered medical assistance for purposes of Federal fmancial participation
(Federal contributions for program costs); This rule applies to all Medicaid beneficiaries
who are eligible individuals under Title I of the Act but excludes Medicaid beneficiaries who.
also receive Medicare and persons eligible for Medicaid but covered only for emergency
services because they are undocumented persons. This rule applies in any state that provides
payment to regional alliances in accordance with Title VI of the Act.
This amendment applies with respect to items and services furnished in a state on or
after January 1 of the first year in which the state is making payments to regional alliances.
PART 2 - EXPANDING ELIGmILITY FOR NURSING FACILITY
SERVICES; LONG TERM CARE INTEGRATION OPTION
Section 4211. Spend-down Eligibility for Nursing Facility Residents. (a) Adds as a
new mandatory coverage group to Medicaid those individuals who would meet the income
and resource requirements of the appropriate state plan described in subclause (I) of section
1902(a)(lO)(A)(i) of the Supplemental Security Income program, if their incurred expenses
for medical care were deducted from their income.
(b) Benefits for this new mandatory coverage group are limited to coverage for
nursing facility services unless the state has elected the long term care benefit option
described in section 4213.
(c) The effective date for this section is January 1, 1996.
Section 4212. Increased Income and Resource Disregards for Nursing Facility
Services. (a) Amends Medicaid by increasing to $50 per month the amount of funds that an
individual who is institutionalized in a nursing facility or an intermediate care facility for the
mentally retarded may retain for personal needs. The section also allows states to disregard
up to the first $12,000 in assets held by an unmarried, institutionalized individual.
(b) Separate amendments to Title XVI of the Social Security Act increase the personal
needs allowance for SSI beneficiaries who are residents of nursing facilities or institutions for
persons with mental retardation (section 4301).
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�(c) The section also provides that the Federal government shall pay 100 percent of the
difference between the amount of expenditures made by the state for nursing facility. services
and services at intermediate care facilities for the mentally retarded (ICF/MR services)
during any quarter and the amount that the state would have expended had the personal needs
allowance not been increased, based on the state's personal needs allowance in effect on
September 30,1993.
(d) The amendments made by this section are effective as of the month of January,
1996.
Section 4213. Informing Nursing Home Residents About Availability of Assistance
for Home and Community Based Services. (a) Amends the Medicaid statute to require that
as a condition of participation, states inform all individuals residing in nursing facilities or
ICF/MR facilities of the range of home and community based care available at the time they
apply for medical assistance and periodically thereafter. Individuals must be informed about
both the home and community care available under Medicaid and services available under the
new block grant program established under Title II.
(b) The amendments made by this section are effective for quarters beginning on or
after January 1,1996.
PART3-0THERBENEmITS
Section 4221. Treatment of Items and Services Not Covered Under the
Comprehensive Benefit Package. Amends the Medicaid statute to specify which categories
of Medicaid beneficiaries continue to qualify for services that are covered by Medicaid but
are not included in the comprehensive benefit package.
The section adds a new section to the statute specifying limitations on services for
beneficiaries. All Medicaid enrollees, regardless of whether they are classified as mandatory
coverage groups under section 1902(a)(1O)(A)(i) or optional coverage groups under section
1902(a)(1O»(A)(ii) or section 1902(a)(1O)(C), are eligible to receive long term care services
covered under their state's Medicaid plan.
Long term care services are the following items and services, but only to the extent
that they are not included in the comprehensive benefit package:
(1) nursing facility services and intermediate care facility services for the
mentally retarded (and items and services that may be included as part of such
services pursuant to regulations in effect as of October 26, 1993);
(2) personal care services;
(3) home or community based services covered under a waiver granted under
section 1915;
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�(4) home and community care provided to functionally disabled elderly
individuals under section 1929;
(5) community supported living arrangement services provided under section
1930;
. (6) case management services (as described in section 1915(g)(2), for
individuals eligible for Medicaid services (which now, for nearly all beneficiaries, are
limited to services not covered by the Act); and
(7) home health care, clinic services, and rehabilitation services that are
furnished to an individual who has a condition or disability that qualifies the
individual to receive services under (1) through (6).
The section also exempts from the long term care service limitation certain Medicaid
enrollees. These individuals remain entitled to receive all required and optional items and·
services listed in section 1905(a) that are covered under their state's Medicaid plan, as well
as the mandatory items and services. listed under section 1905(r) (the Medicaid Early and
Periodic Screening, Diagnosis and Treatment (EPSDT) benefit package for individuals under
age 21), even if the service in question is not a "long term care" service within the meaning
of the statute. Services that are not long term care include both services described in
sections 1905(a) or 1905(r) that are not described in this section, as well as services that
would fall within the defmition of long term care under this section but for the fact that the
individual receiving the .service does not also require a service described in categories (1)
through (6) above.
The following persons are exempt from the long term care coverage limits:
(1) Aid to Families with Dependent Children (AFDC) beneficiaries (individuals
receiving aid under title I, X, XIV, XVI, or part A or E of Title IV of the Social
Security Act);
(2) Supplemental Security Income (SSI) beneficiaries;
(3) Individuals also receiving Medicare, and
(4) Children under 18 years of age (or, at the option of the state, under age 19, 20 or
21).
.
The section also amends the Medicaid secondary payer program (sections 1902(a)(25)
and 1903(0)) to clarify that Medicaid is a secondary payer to a health plan. The amendments
made by this section apply on or after January 1 of the first year in which a state is a
participating state.
Section 4222. Establishment of Program for Poverty Level Children with Special
Needs. The Secretary is directed to establish a federally financed program for qualified
children under age 19 who are eligible for Medicaid, for those items and services described
in section 1905(a) or section 1905(r) that are not long term care services and that are not
covered under a child's health plan. In this section, a "qualified child" is one born after
September 30, 1983, who is 'under age 19, and who meets the financial requirements of the
section. The financial requirements are as follows:
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�(i) for children under age 1, family income at or below 133 percent of the
Federal poverty level (or in the case of states that established an income level greater
than 133 percent as of October 1, 1993, an income level greater than 133 percent but
at or below 185 percent);
(ii) for children ages 1 to 6, family income at or below 133 percent of the
Federal poverty level;
(iii) for children ages 6 - 19, family income at or below 100 percent of the
Federal poverty level.
The Secretary shall establish procedures for the enrollment of children in the program
which shall assure enrollment in both Medicaid and the new program, shall utilize essential
community providers as outstationed enrollment sites, and shall utilize fonus that make
enrollment as simple as practicable. The Secretary is also required to develop an automatic
system for enrolling qualified children in both Medicaid and the new program at the time
they enroll in alliance health plans.
The Secretary is required to publish new standards for this program that specify the
benefits to which the program applies, procedures for the periodic redetenuination of
benefits, provider qualification criteria, payment amounts for covered services, standards to
ensure the quality of care, hearings and appeals procedure, and other requirements needed
for the proper and efficient administration of the program.
Federal fmancial participation for the program is 100 percent, including administrative,
expenses.
Limits on expenditures for the new program are as follows: the percentage of total
state and Federal expenditures on qualified children for covered services adjusted to take into
account an increase or decrease in the number of qualified children and adjusted by the
applicable percentage applied to the state non-cash, non-DSH baseline (under section 9003 of
the Act).
The program begins in the first year in which a state is a participating state under the
Act.
The section also repeals section 1902(r)(2) for states not using the coverage option for
children as of October 1, 1993.
PART 4 - DISCONTINUATION OF CERTAIN PAYMENT POLICIES
Section 4231. Discontinuation of Medicaid DSH Payments. Section 1923(a)(23)
(relating to payments to Disproportionate Share (DSH) hospitals), is repealed in a state at the
time when it becomes a participating state. ,State allotments and Federal financial
participation are also repealed.
Section 4232. Discontinuation of Reimbursement Standards for Inpatient Hospital
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�Services. The requirement for cost based reimbursement to hospital inpatient services (known
as the Boren Amendment) is repealed at the time when a state becomes a participating state.
PART 5 - COORDINATION WITH ADMINISTRATIVE
SIMPLIFICATION AND QUALITY MANAGE:MENT INITIATIVES
Section 4241. Requirements for Changes in Billing Procedures. Amends the
Medicaid statute to prohibit states from changing billing and claims processing procedures
more frequently than once every 6 months and requires states to notify individuals and
entities furnishing services at least 120 days before a change is to take effect. This
amendment takes effect on January 1 of the first year that a state is a participating state.
PART 6 - :MEDICAID COMMISSION
Section 4251. Medicaid Commission. Establishes a Medicaid Commission comprised
of 15 members appointed for the life of the commission. The purpose of the commission is
to study matters relating to further Medicaid reform, including the use of block grant
payment systems for covered services, the integration of acute and long term care services in
health plans, consolidation of institutional and community based long term care, and other
matters. The Commission shall report no later than one year following enactment of the
Health Security act and shall terminate as of the date of the completion of the report.
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�SUBTITLE D - INCREASE IN THE SSI PERSONAL NEEDS ALLOWANCE
(H.R. 3600 and S. 1757 p. 832)
Section 4301. Increase in the SSI Personal Needs Allowance. Amends the SSI
statute to raise the personal needs allowance to $600 annually for an institutionalized
individual and $1200 annually for an institutionalized couple. The amendment is effective on
January, 1996.
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�TITLE V - QUALITY AND CONSUMER PROTECTION QUALITY
SUBTITLE A - QUALITY MANAGEMENT AND Il\1PROVEMENT
(H.R. 3600 and S. 1757 p. 835)
Section 5001. National Quality Improvement Program. Not later than 1 year after
the date of enacttnent, the National Health Board must establish a performance-based
program of quality management and improvement designed to enhance the quality,
appropriateness, and effectiveness of health care services and access to such services. The
Board oversees the program, to be known as the National Quality Management Program,
which is administered by a National Quality Management Council.
Section 5002. National Quality Management Council. (a) The National Quality
Management Council is authorized to carry out tasks under this subtitle.
(b) The duties of the Council are to administer the National Quality Management
Program, perform any other duty specified in this subtitle, and to advise the National Health
Board with respect to its duties under this subtitle.
(c) The Council is composed of 15 members appointed by the President and its
members must be broadly representative of the population of the United States. Members
must include individuals representing the interests of: governmental and corporate purchasers
of health care; health plans; states; health care providers; academic health centers; and
individuals who are distinguished in the fields of public health, health care quality, and
related fields of health services research.
(d) With the exception of the first appointees (whose terms shall be staggered),
Council members serve three-year terms. A member of the Council may continue to serve
after the expiration of the member's term of that member until a successor is appointed.
(e) If a member of the Council does not serve the full term applicable, the individual
appointed to fill the resulting vacancy must be appointed for the remainder of the
predecessor's term.
(f) The President must designate an individual to serve as the chair of the Council.
(g) The Council must meet not less than once during each discrete 4-month period and
must otherwise meet at the call of the President or the chair.
(h) Council members must be compensated for each day (including travel time)
engaged in carrying out the duties of the Council. Compensation may not exceed the
maximum rate of basic pay payable for level IV of the Executive Schedule under section
5315 of title 5, U.S.c.
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�(i) The National Health Board must provide to the Council such staff, information,
and other assistance as may be necessary for the Council to carry out its duties.
(j) For purposes of this subtitle, "health care provider" means an individual or entity
that provides, to an individual in a health plan (as defined in section 1400), an item or
service that is covered under the plan.
Section 5003. National Measures of Quality Performance. (a) The National Quality
Management Council must develop a set of national measures of quality performance, which
must be used to assess the provision of health care services and access to such services.
(b) The measures of quality performance must be ones that are capable of providing
information on the following subjects:
(1) consumer access to services;
(2) appropriateness of health care services provided to consumers;
(3) outcomes of health care services and procedures;
(4) health promotion;
(5) prevention of diseases, disorders and other health conditions; and
(6) consumer satisfaction with care.
(c) (1) In developing and selecting the national measures of quality
performance, the National Quality Management Council must consult with appropriate
interested parties, including:
(A) states;
(B) health plans;
(C) employers and individuals purchasing health care through regional
and corporate alliances;
. (D) health care providers;
(E) the National Quality Consortium established under section 5009;
. (F) individuals distinguished in the fields of law, medicine, economics,
public health, and health services research;
(G) the Administrator for Health Care Policy and Research;
(H) the Director of the National Institutes of Health; and
(I) the Administrator of the Health Care Financing Administration.
(2) The following criteria must be used in developing and selecting national
measures of quality performance:
(A) Measures must relate to the significance of a specific disease,
disorder or other health condition in terms of its prevalence, morbidity,
mortality ,or the costs associated with preventing, diagnosing, treating or
clinically managing the disease, disorder, or condition.
(B) The measures, taken together, must be representative of the range
of services provided to health-care consumers by health care providers.
(C) The measures must be reliable and valid.
(D) The data needed to calculate the measures must be obtained without
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�unduly burdening the entity or individual providing the data.
(E) Performance with respect to each measure must be expected to vary
widely among the individuals and providers whose performance is assessed.
(F) When a measure is a rate of a process of care the process must be
linked to a health outcome based upon the best available scientific evidence.
(G) When a measure is the outcome of provision of care, the outcome
must be one that is within the control of the provider. The outcome must also
be one with respect to which an adequate risk adjustment can be made.
(H) The measures may incorporate standards identified by the Secretary
of Health and Human Services for meeting public health objectives.
(d) The National Quality Management Council must review and update the set of
national measures of quality performance each year, to reflect changing goals for quality
improvement. The National Health Board must establish and maintain a priority list of
performance measures that, within a five-year period, the Board intends to consider for
inclusion within the set through the updating process.
Section 5004. Consumer Surveys. (a) The National Quality Management Council
must, by periodic surveys of health care .consumers, gather information concerning access to
care, use of health services, health outcomes, and patient satisfaction. The surveys must
monitor consumer reaction to the implementation of this Act and must be designed to assess
the impact of this Act on the general population of the United States and potentially
vulnerable populations.
(b) The National Council must develop and approve a standard design for the surveys,
which must be administered by the Administrator for Health Care Policy and Research on a
plan-by-plan and state-by-state basis. A state may add survey questions on quality measures
of local interest to surveys conducted in the state.
(c) The Council must develop sampling strategies that adequately measure populations
at risk of receiving inadequate care, including persons who fail to enroll in plans, resign
from plans or who are members of vulnerable populations.
Section 5005. Evaluation and Reporting of Quality Performance. (a) In areas
where there is sufficient information and consensus to develop quality standards, the National
Council must recommend to the Board that it establish goals for health plan and health care
provider performance.
(b) The National Council must evaluate the impact of implementation of this Act on
the quality of health care services in the United States, and the access of consumers to such
services.
(c)(l) Each regional and corporate alliance must publish and make available to
the public each year a performance report that outlines the performance of each health
Title V
177
�plan offered by the alliance. The report must present, in a standard format, the each
plan's performance on the set of national measures of quality performance. The report
must also include the results of a smaller number of such measures (of quality
performance) for health care providers who are members of provider networks of
such plans (as defmed in section 1402(f)), if the available information is statistically
meaningful. The report must also include the results of consumer surveys described
, in section 5004 that were conducted in the alliance during the year that is the subject
of the report.
(2) The National Council must report annually to Congress and to each health
alliance a report in a standard format that:
(A) outlines the performance of each alliance and each health plan;
(B) discusses state-level and national trends 'relating to the quality of
health care; and
(C) presents data for each health alliance from consumer surveys
described in section 5004 that were conducted during the year that is the
subject of the report.
(d) Amends the Health Care Quality Improvement Act to require the Secretary to
promulgate regulations by January 1, 1996, permitting health plan enrollees access to data
bank information on physicians and other licensed practitioners. Access must also be given
to point-of-service contractors under medicare.
Section 5006. Development and Dissemination of Practice Guidelines. (a)(I),The
National Council must direct the Administrator for Health Care Policy and Research to
develop and periodically review and update clinically relevant guidelines, that may be used
by health care providers to assist in determining how diseases, disorders, and other health
conditions can be most effectively and appropriately prevented, diagnosed, treated, and
managed clinically.
(2) The practice guidelines must:
(A) be based on the best available research and professional judgment
regarding the effectiveness and appropriateness of health care services and
procedures;
(B) be presented in formats appropriate for use by health care
providers, medical educators, medical review organizations, and consumers of
health care;
(C) include treatment-specific or condition-specific practice guidelines
for clinical treatments and conditions, in forms that are appropriate for use iIi
clinical practice, in educational programs, and in reviewing quality and
appropriateness of medical care.
(D) include information on risks and benefits of alternative strategies
for prevention, diagnosis, treatment and management of a given disease,
disorder, or other health condition;
(E) include information on the costs of alternative strategies for the
prevention, diagnosis, treatment and management of a given disease, disorder,
Title V
178
�or other health condition, where cost infonnation is available and reliable;
(F) be developed in accordance with priorities which the Council must
establish, on the basis of research priorities established under section 5007,
and the five-year priority list of performance measures described in section
5003.
.
(3) The Council must establish standards and procedures for evaluating the
clinical appropriateness of protocols used to manage health service utilization.
(4) The Secretary of Health and Human Services may use guidelines developed
under this· subsection in the pilot program applying practice guidelines to medical
malpractice liability under section 5312.
- (b)(1) The National Council must direct the Administrator for Health Care
Policy and Research to develop and publish standards relating to methodologies for
developing clinically relevant. guidelines for health care providers.
(2) The Council must also direct the administrator to establish a procedure by
which individuals and entities may submit such clinically relevant guidelines for
providers to the Council, for evaluation and certification by the Council using the
standards established above for such guidelines~
(3) The Secretary may use guidelines that have been certified in the practice
guideline pilot program for medical malpractice liability under section 5612.
(c) The National Council must direct the Administrator for Health Care Policy and
Research to establish and oversee a clearinghouse and dissemination program for the practice
guidelines that are developed or certified under this section.
(d) The Council must also disseminate information documenting clinically ineffective
treatments and procedures.
Section 5007. Research on Health Care Quality. (a) The National Council must
direct the Administrator for Health Care Policy and Research to support research that is
directly related to the Council's five-year priority list of performance measures under section
5003. The research related to the priority list must include research with respect to:
(1) outcomes of health care services and procedures;
(2) effective and efficient dissemination of infonnation, standards, and guidelines;
(3) quality measurement; and
(4) design and organization of quality of care components of automated health
information systems.
(b) The Council must also establish priorities for research with respect to the quality,
appropriateness and effectiveness of health care,and the council must make recommendations
concerning research projects. In establishing the priorities, the Council must emphasize
research involving diseases, disorders, and health conditions which demonstrate:
(1) the highest level of uncertainty concerning treatment;
(2) the widest variation in practice patterns;
Title V
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�(3) significant costs associated with prevention, diagnosis, treatment, Or
clinical management; and
(4) high rates of iDcidence or prevalence for the population as a whole or for
particular populations.
Section 5008. Regional Professional Foundations. (a) The National Health Board
must oversee the establishment of regional professional foundations.
(b)(l) The Board must also oversee the membership requirements and any
other requirement for the internal operation of each such foundation.
(2) The membership of each professional foundation must include at least one
academic health center (as defined in section 3101). The following types of entities
may also be members of the foundation for the region in which the entity is located:
(A) schools of public health (as defmed in section 799 of the Public
Health Service Act);
(B) other schools and programs (as defmed in the same section 799);
(C) health plans;
(D) regional alliances;
(E) corporate alliances; and
(F) health care providers.
(c) A regional professional foundation must carry out certain duties for the region in
which it is located, with the boundaries of each region established by the Board, with the
advice of the National Quality Consortium (established under section 5009). Each foundation
must carry out the following duties:
.
(1) Develop programs in lifetime learning for health professionals (as defined
in section 1112(c)(1), to ensure the delivery of quality health care;
(2) Foster collaboration among health plans and health care providers, to
improve the quality of primary and specialized health care;
(3) Disseminate information about successful quality improvement programs,
practice guidelines and research fmdings;
(4) Disseminate information on innovative uses of health professionals;
(5) Pevelop innovative patient education systems that enhance patients'
involvement in decisions about their health care.
(6) Apply for and conduct the research on outcomes, quality of care and other
matters described above in section 5007.
Section 5009. National Quality Consortium. (a) The National Health Board must
establish a consortium, to be known as the National Quality Consortium.
(b) The consortium must:
(1) Establish continuing medical education programs for health professionals;
(2) Provide advice on research priorities to the National Quality Management
Council and the Administrator for Health Care Policy and Research;
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�(3) Oversee the development of the regional professional foundations
established under section 5008;
(4) Provide advice, with respect to funding proposals to establish the
professional foundations, to the National Quality Management Council;
(5) Consult with the quality management council about the selection of national
measures of quality performance under section 5003(c); and
(6) Provide advice, with regard to any other duty of the Board or the Council
under this title, to the Board or the Council. .
(c) The consortium must consist of 11 members, appointed by the Board, as follows:
five individuals who represent the interests of academic health centers, and six other
individuals, who represent the interests of schools of public health and other schools and
programs defmed in section 799 of the Public Health Service Act (including medical, nursing
and allied health professional schools).
(d) The term of a member of the consortium is three years, with initial appointments
on a staggered basis.
(e) The Board must also designate an individual to serve as the chair of the
consortium.
Section 5010. Eliminating CLIA Requirement for Certificate of Waiver for
Simple Laboratory Examinations. (a) Amends section 353 of the Public Health Service Act
to exempt from federal rules clinical laboratories that perform only simple tests and
procedures as defmed by the Secretary.
(b) This section takes effect on the fIrst day of the fIrst month beginning after the date
of the enactment of this Act.
Section 5011. Uniform Standards for Health Care Institutions. Not later than
three years after the date of enactment the National Health Board must develop uniform
standards for licensing health care institutions, that address essential performance
requirements relating to patient care except in the areas of fIre, safety, sanitation and patient
rights. Standards must not undermine nursing home reform. The Council shall conduct and
complete by January 1, 1996, demonstration projects using the standards and evaluate their
impact on quality, costs, and providers. Standards once tested and revised shall replace
existing standards except where changes in Federal statutes are required. The council shall
also undertake efforts to develop a single consolidated annual audit and inspection.
Section 5012. Role of Alliances in Quality Assurance. Each alliance (regional and
corporate) must:
(1) Disseminate to consumers information related to quality and access in order
to aid in their selection of plans in accordance with section 1325;
(2) Disseminate information contained in reports of the National Quality
Title V
181
�Management Council (under section 5005) on the quality of health plans and health
care providers);
(3) Ensure, through negotiations with health plans, that performance and
quality standards are continually improved; and
(4) In cooperation with regional professional foundations, conduct educational
programs to assist consumers use quality and other information in choosing health
plans.
Section 5013. Role of Health Plans in Quality Management. Each health plan
must:
(1) Measure and disclose its performance on quality measures that are used by
the following: participating states in which a plan does business; regional and
corporate alliances that offer the plan; and the National Quality Management
Council.
(2) Furnish the information that is required under subtitle B of this title, and
provide other reports and information on the quality of care delivered by health care
providers who are members of a provider network of the plan (as defmed in section
1402(f» as may be required under this Act; and
(3) Maintain quality management systems that use the national measures of
quality performance developed by the National Quality Management Council under
section 5003. Each plan also must measure the quality of health care that all
providers who are members of a provider network of the plan furnish to enrollees
under the plan.
Title V
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�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Carol Rasco - Issues Series
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
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2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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Clinton Presidential Library & Museum
Extent
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92 folders in 7 boxes
Text
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Original Format
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Paper
Dublin Core
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Title
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Health Care Materials [9]
Creator
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Domestic Policy Council
Carol Rasco
Issues Series
Identifier
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2010-0198-S Segment 2
Is Part Of
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Box 124
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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Adobe Acrobat Document
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Clinton Presidential Library & Museum
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Reproduction-Reference
Date Created
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12/4/2013
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2010-0198-Sb-health-care-materials-9
-
https://clinton.presidentiallibraries.us/files/original/9c9376b3b3b956ee54e01a8800d60d0f.pdf
087319f7757da9370586960a0699ea15
PDF Text
Text
the Act except those delegated to the National Board, any other executive agency or- a state.
(b) The Secretary shall develop standards for the fmancial management of health
alliances.
(c) The Secretary shall periodically audit regional alliances in the areas of:
(1) enrollment of all regional alliance eligible individuals;
(2) management of premium and cost sharing discounts and reductions; and
(3) financial management, including collection shortfalls.
Section 1572. Advisory Council on Breakthrough Drugs. (a) The Secretary shall
appoint an Advisory Council on Breakthrough Drugs that will examine the reasonableness of
new drug pricing in the case of drugs that represent a breakthrough or significant advance
over existing therapies.
(b) At the request of the Secretary, the Council shall determine the reasonableness of
launch prices of breakthrough drugs. Determinations shall be based on:
(A) the price of other drugs in the same therapeutic class,
(B) cost information supplied by the manufacturer,
.
(C) the price of thl~ drug in countries specified in section 802(b)(4)(A) of the
Federal Food, Drug and Cosmetic Act, and
(D) projected prescription volume, economies of scale, product stability,
special manufacturing and research costs,
(E) cost effectiveDl~ss relative to the cost of alternative treatments, and
(F) improvements in the quality of life offered by the new product.
The Secretary shall review and publish the determinations of the Council along with
minority opinions.
(c) The Council shall include 12 members, including a representative from the
pharmaceutical industry, consumler organizations, physician organizations,· the hospital
industry, and the managed care industry. Other members must be recognized experts in the
field·s of health care economics, pharmacology, pharmacy and prescription drug
reimbursement.
(d) Appointments shall be for three-year terms; but the Secretary may provide initially
for shorter terms so that no more than five members' terms expire in anyone year.
(e) Members shall be reimbursed for their travel expenses and per diem in lieu of
subsistence.
(f) Notwithstanding the Federal Advisory Committee Act, the Council shall continue
in existence until otherwise specified by law.
Title I
64
�SUBPART B - CERTIFICATION OF ESSENTIAL COMMUNITY PROVIDERS
Section 1581. Certification. (a) The Secretary shall certify as an "essential
community provider" any health care provider or organization that:
(1) is within any of the categories specified in section 1582(a) or
(2) meets certification standards under section 1583(a).
(b) The Secretary shall develop a certification process that permits providers to be
certified prior to the date of implt:mentation of the Act in a state.
Section 1582. Categories of Providers Automatically Certified. (a) The following
providers are· automatically certified as essential community providers:
(1) migrant health centers;
(2) community health centers;
(3) homeless program providers funded under section 340A of the Public
Health Service Act;
(4) public housing providers funded under section 340A of the Public Health
Service Act;
(5) family planning clinics;
(6) service units of the Indian Health Service, a tribal organization, or an
urban Indian program, as defmed in the Indian Health Care Improvement Act;
(7) AIDS providers funded under the Ryan White Act;
(8) public and private non-profit entities furnishing prenatal, pediatric or
ambulatory services to children, including children with special health care needs and
that receive funding under Title V of the Social Security Act;
(9) Federally qualitied community health centers and rural health clinics;
(10) providers of school health services receiving funding under subtitle G of
Title III; and
(11) community pr.actice networks receiving development funding under
subtitle E of title III.
(b) Certification applies to both recipients and sub-recipients of grants. A sub
recipient is an entity that receives funding under a contract with the principal recipient and
meets the requirements needed to be a recipient.
Section 1583. Standards for Additional Providers. (a) The Secretary shall publish
standards for certification of additional categories of health care providers and organizations
as essential community providers. Such health providers may· be certified only if the
Secretary determines that health plans operating in areas served by the applicant would not l;>e
able to assure adequate access to the comprehensive benefit package without contracting with
the applicant.
(b) Optional categories indude:
(1) health professionals (including physicians, nurses, nurse practitioners,
Title I
6S
�certified nurse midwives, physicians assistants, psychologists, dentists, phamiacists,
and other health care professionals recognized by the Secretary) who either are
located in a health professions shortage area (as the term is used in section 332 of the
Public Health Services Act), or who provide a substantial amount of health services to
medically un4erserved populations (as the term is used in section 330 of the Public
Health Service Act).
(2) Institutional providers meeting the same location and service requirements
as health professionals.
(3) other public andl private non-profit agencies and organizations that meet the
location or service requirements for health professionals.
Section 1584. Certification Process; Review; Termination of Certifications.
(a)(I) The Secretary shall decide on public certification procedures within 6
months of enactment of thils Act and shall describe the form and manner in which
application for certification is to be made.
(2) The Secretary shall act on an application under section 1582 within 15 days
and on an application unde:r section 1583 within 60 days of submission of a completed
application. Certification of entities under section 1582 shall only involve verifying
that the entity falls into one of the automatic certification classes.
(b) The Secretary shall periodically review certified essential community providers to
determine that they meet the requirements of this subpart.
(c) If the Secretary fmds that an entity does not meet certification requirements or
fails to continue to meet such reqlllirements, the Secretary shall notify the entity and permit
the entity an opportunity to rebut such fmdings. If the Secretary continues to find that the
entity fails to meet the requirements of this subpart, the Secretary shall notify the entity and
regional and corporate alliances of the termination and its effective date.
Section 1585. Notification of Health Alliances and Participation States. (a) The
Secretary shall notify participating states and health alliances regarding certified essential
providers. The notice shall include sufficient information to permit each health alliance to
identify the provider; the notice must also report to health plans the location of the provider,
the health services furnished by the provider and other information necessary for health plans
to carry out their duties under subtitle E of title I.
PART, 3 - SPECIFIC DUTIES OF THE SECRETARY OF LABOR
Section 1591. Responsibilities of the Secretary of Labor. (a) The Secretary is
responsible for the following:
(l) enforcement of employer requirements in regional health alliances under
subtitle D of Title I and the administration of corporate alliances;
(2) oversight of the election of eligible sponsors to become corporate alliances
Title I
66
�and tennination of such an election;
(3) temporary assumption of insolvent corporate alliances under section 1395;
(4) establishment of a Corporate Alliance Health Plan Insolvency Fund under
section 1396;
(5) carrying out of other responsibilities assigned to the Secretary under the
Act; and
(6) administration of Title I of ERISA as it relates to group health plans
maintained by corporate alliances.
(b) The Secretary of Labor may enter into agreements with states to enforce
responsibilities of employers and eorporate alliance health plans and subtitle B of Title I of
ERISA.
(c) In carrying out his or her responsibilities, the Secretary shall consult with the
Board.
(d)(1) The Secretary of Labor shall assure that employers pay premiums and
withhold and make payment for the family share of premiums, submit timely reports,
and otherwise comply with the requirements of the Act.
(2) The Secretary of Labor may carry out audits and investigations of
employers and health alliances and may exercise the authorities provided in ERISA,
arrange for collection activities for amounts owed to alliances, and may impose civil
money penalties.
Title I
67
�SUBTITLE G - El\1PLOYER RESPONSmILITIES
(H.R. 3600 and S. 1757 p. 303)
Section 1601. Payment Responsibilities. (a) Employers must make payments as
required under section 6121 (general payment responsibilities) or section 6123 (payment
responsibilities for small employers).
(b) Employer payment responsibilities in single payer states supersedes the foregoing
requirements.
(c) Employers participating in multi-employer plans acting as a regional alliance
employer satisfy their payment obligations under section 6121 if they pay the plan the
required premium amount and the plan assumes the duties of a regional alliance employer.
Section 1602. Requirements. for Information Reporting. (a)(1) Employers must
provide certain information to persons who were qualifying employees during any month of
the previous year.
(2) This information includes the following:
(A) For each regional alliance through which the employee obtained
health coverage, the total number of months of the employee's full-time
equivalent employment (defmed under section 1901(b)(2) as 120 hours per
month), the amount of wages attributable to such employment, the amount of
covered wages, tht~ total amount deducted and paid in as the family share, and
other information required by the Secretary of Labor.
(B) With re:spect to corporate alliances, employers must report the total
number of months of the employee's full-time equivalent employment and .
other information required by the Secretary of Labor.
(3) The required information shall be provided for each regional alliance to
which the employer made premium payments (on behalf of the employee).
(4) "Covered wagl~s" means wages paid during a month in which the employee
was a qualifying employee.
(b)(1) Employers must provide certain information to regional alliances on an
annual, monthly and one-time basis.
(2) Annual inforID.ation includes:
(A) For each regional alliance,
(i) lhe total number of months of full-time equivalent
employment for each employee and for each class of enrollment and the
total amount deducted from wages and paid toward the family share of
the premium for the qualifying employee.
(ii) the total employer premium payment on behalf of all
qualifying employees, and in the case of small employers who have a
discount under section 6123, the total amount that would have been
Title I
68
�owed if there had been no discount.
(iii) The number of full-time equivalent employees for each class
of family enrollment
(iv) in the case of large employers electing to enroll in regional
alliances under section 6124, additional information required by the
Secretary of Labor
(v) amounts to be paid as part of the employer collection
shortfall add-on.
(vi) the amount of covered wages for each qualified employee.
(3) Monthly information includes the following:
(A) information on individuals who changed qualifying employee status
- during the month, the regional alliance in which the individual resides, and the
class of family enrollment.
(B) Individuals are considered as having changed qualifying employee
status if they either became qualifying employees during the month or ceased
qualifying employment during the month.
(4) Initial information, that employers must provide to regional alliances on
behalf of qualifying employees, is to be specified by the National Health Board.
(c)(1) Employers liable for premium payments to a regional alliance (including
small employers with discounts) must provide the alliance with the reconciliation
information needed by the alliance to determine if the employer's payments were
correct.
(2) Reconciliation information shall be provided by February following the
year subject to reconciliation.
(3) Employers shall adjust premium payments in the month in which they
provide reconciliation information. This adjustment must reflect the amount by which
payments were greater or less than they should have been. Employers that cease to be
employers shall make a frnal payment to the alliance if owed.
(4) In the case of self-employed individuals, the family share reconciliation
system under section 1344, shall be used instead of the system described in this
section.
(d) Self-employed persons shall provide information on net earnings needed to
compute the amount payable.
(e) Information shall be provided in a form specified by the Secretary, but in a way
that, to the extent feasible, simplifies administration for small employers.
(t) The Board shall use regional information centers that are part of the electronic data
network under section 5103 to pt:rform information clearinghouse functions. Clearinghouse
functions include the receipt of employer information, transmittal of information to regional
alliances, and other functions specified by the Board.
Title I
69
�(g) Employers must provide annual information to their employees by the deadline in
section 6051 of the Internal Revenue Code of 1986. Employers must provide annual
information to alliances by the same date as used under section 232 of the Social Security
Act.
(h) Employers shall notify individuals on whose behalf they are not obligated to make
payments. These individuals are those who perform more than 40 hours per month of
services, but who are not employc!es of the person to whom they supply services. Notices
shall commence after January 1, 1998 and shall be furnished within a reasonable time after
employment begins. The Secretary shall issue regulations on exceptions to the notice
requirement with respect to individuals performing services on an irregular, incidental or
casual basis, as well as model notice forms.
Section 1603. Requiremelllts Relating to New Employees. (a) When an individual is
hired as a new employee, a regional alliance employer must obtain the following
information:
(1) The individual's name;
.
(2) the individual's alliance area of residence and whether the individual has
moved from another alliance area;
(3) the individual's class of family enrollment (single; couple; couple with
children; or single parent with children);
(4) the individual's health plan; and
(5) if the individual moved from another area, whether the individual intends
to enroll in a regional alli~mce plan.
(b) Employers must transmit employee information to the 'alliance in which the
employee resides.
(c) In the case of individuals who have recently moved, the employer must provide
the employee with information about his or her choice of regional alliance health plans and
how to enroll. The employer must also provide an enrollment form. Alliances must provide
this material to employers.
Section 1604. Auditing of Records. Regional alliance employers must maintain
records, in their principal place of business, that permit alliances to audit them for
compliance with the Act.
Section 1605. Prohibition of Certain Employer Discrimination. Employers may not
discriminate against employees 011 the basis of the family status of the employee or the class
of family enrollment selected by the employee.
Section 1606. Prohibition of Self-Funding of Cost-Sharing Benefits by Regional
Alliance Employers. (a) A regional alliance employer (and a corporate alliance with respect
Title I
70
�to employees enrolled in regional alliance) may not self-fund employee cost sharing benefits
but must instead purchase insurance for such benefits.
(b) Cost sharing rules in single payer states supersede this part.
Section 1607. Equal Voluntary Contribution Requirement.
(a)(l) An employer must treat all qualifying employees as generously as it
treats any full-time employees with respect to voluntary premium payments. The
equal volUJ1.tary premium payment requirement applies to both ,regional and corporate
alliance employments. With respect to regional alliances, a voluntary premium
payment by an employer may vary' only by class of enrollment and alliance area.
With respect to corporate alliances, a voluntary premium payment by an employer
may vary only by class of enrollment and premium area. Part-time employees must
receive a pro-rata share of the voluntary full-time employer premium payment.
(2) Employer voluntary premium payments may not exceed the family share of
the premium for the most expensive health plan offered in the regional or corporate
alliance. The equal contribution rule does not apply in the case of health plans that
do not have material enrollment, as defmed by the Secretary of Labor. Employers
may not discriminate in providing voluntary contributions on the basis of the plan
selected by an employee.
(b) Employers must rebate the difference between the amount of premium
contributions they voluntarily malce and the value of the insurance plan chosen by employees.
Rebates shall be treated as wages for Federal tax purposes. Couples who both qualify for
rebates may elect to have the full rebate furnished for all employment.
(c) Rebate requirements shall not apply when voluntary contributions are made
pursuant to a collective bargaining agreement; however, subsection (a)(2) does apply.
(d) "Voluntary employer premium payment" means payments designed to be used
exclusively (or primarily) toward the cost of the family share of premiums.
Section 1608. Employer Retiree Obligation. (a) Employers furnishing threshold
payments (as defmed in subsection (c) as of October 1, 1993, must pay an amount specified
beginning January 1998 but only for so long as the person is a qualifying retired beneficiary.
(b) A qualifying retired beneficiary is an eligible retiree or qualified spouse or child
(as the terms are defmed in subsections (b) and (c) of section 6114).
.
(c) The threshold payment equals 20 percent of the amount of the premiiun for
coverage under a health plan.
(d) The amount of the payment is 20 percent of the weighted average premium for the
regional alliance in which the beneficiary resides and for the applicable class of family
Title I
71
�enrollment.
(e) This requirement is in addition to any other requirement under the Act.
(t) Nothing in this Act or this section shall be construed as affecting collective
bargaining rights.
Section 1609. Enforcement. The Secretary of Labor may impose a civil money
penalty of up to $10,000, for each violation of this subtitle.
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72
�SUBTITLE J - DEFINITIONS; MISCELLANEOUS PROVISIONS
(H.. R. 3600 and S. 1757 p. 341)
PART 1 - GENERAL DEFINITIONS
Sections 1901 and 1902 provide general deflnitions for the following tenns: employer,
employee, employment, covered child, covered aliens, alliance area, types of health plans
and other elements of the Act.
PART 2 - MISCELLANEOUS PROVISIONS
Section 1911. Use of Interim Final Regulations. To assure timely promulgation of
rules, the Board, the Secretary of HHS, and the Secretary of Labor are authorized to
promulgate rules on an interim final basis that become flnal on the date of publication and
are subject to subsequent public comment.
Section 1912. Social Seclilrity Act References. Except as provided, references to the
Social Security Act are references to the act as in effect on the date of enactment.
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73
�TITLE 11- PUBLIC HEALTH INITIATIVES
SUBTITLE A - MEDICARE OUTPATIENT PRESCRIPTION DRUG BENEFITS
(H.R. 3600 and S. 1757 p. 343)
Section 2001. Coverage of Outpatient Prescription Drugs. (a) This section amends
section 1861(s) of the Social Security Act (relating to the deftnition of covered medical and
other health services) to add cov(:red outpatient drugs, and amends section 1861(t) (deftning
outpatient drugs and biologicals) to defme covered outpatient drugs and biologicals used for a
medically accepted indication to include the following items:
(A) A drug which may be dispensed only upon prescription and
(i) which is approved as safe and effective under section 505 or
507 of the Federal Food, Drug, and Cosmetic Act or is approved under
section 505(j) of such Act;
(ii) which was commercially used or sold in the United States
before enactment of the Drug Amendments of 1962 or which is
identical, similar or related to such a drug and which has not been the
subject of a fmal determination by the Secretary that it is a "new drug"
(within the meaning of section 201(P) of the Federal Food Drug and
Cosmetic Act) or an action brought by the Secretary under the Act to
enforce the Act; or
(iii) which is described under section 107(c)(3) of the Drug
Amendments of 1962 and for which the Secretary determines there is a
compelling justiftcation for its medical need, or is identical, similar or
related to such a drug, and for which the Secretary has not issued a
notice of hearing under the Federal Food, Drug, and Cosmetic Act on a
proposed order of the Secretary to withdraw approval of an application
for such drug on the grounds that it is less than effective for all
prescribed,. suggested or recommended uses.
(B) A biological product which may only be dispensed upon prescription, is
licensed under section 351 of the Public Health Service Act and is produced at a
federally licensed establishment under the Act; and
(C) Insulin certift(~d under the Federal Food, Drug, and Cosmetic Act.
The term "covered outpatient drug" does not include any product which is:
(A) administered through infusion in a home setting unless it is a covered
home infusion drug;
(B) furnished as part of, or incident to, any other item or service;
(C) which is an excludable drug under Medicaid and which the Secretary elects
to exclude under Medicare (other than benzodiazepines and barbiturates).
The term "medically accl!pted indication" with respect to outpatient drugs includes
any use which has been approved by the FDA for the drug and includes another use of the
drug if:
Title II
�(A) the drug has been approved by the FDA; and
(B) such use is supported by one or more citations which are included (or
approved for inclusion) in the following compendia: the American Hospital Formulary
Service-Drug Information, the American Medical Association Drug Evaluations, the
United States Pharmacopoj~ia-Drug Information, and other authoritative compendia
identified by the Secretary (unless the Secretary has determined that the use is not
medically appropriate or that the identified use is not indicated), or the carrier
determines under guidance by the Secretary that the use is accepted based on
supportive clinical evidence in peer reviewed medical literature.
The Secretary may revise the list of compendia that have been designated as
appropriate under this section.
The term "covered home infusion drug" is a covered outpatient drug or an external or
parenteral nutrient dispensed to an individual that is administered intravenously,
subcutaneously, epidurally or through other means determined by the Secretary, using an
access device that is inserted into the body and an infusion device to control the drug flow
rate, that is administered in the individual's home (including an institution used as a home)
and is an antibiotic or other drug that can be administered safely and effectively in a home
setting. The Secretary shall publish a list of covered home infusion drugs by January 1,
1996.
(c) Sections 1861 and 1881 are amended to make additional conforming amendments.
Section 2002. Payment Rules and Related Requirements for Covered Outpatient
Drugs. Section 1834 (relating to special payment rules for specific services) is amended to
add a new subsection governing payment for covered outpatient drugs.
(1) Payment shall be made for covered outpatient drugs only after the
individual has satisfied the: annual drug. deductible of $250 in 1996, and in succeeding
years, an amount that the Secretary estimates will ensure that the percentage of
individuals satisfying the deductible will remain the same as in prior years (excluding
beneficiaries enrolled in Medicare managed care plans). The Secretary shall
promulgate deductible amounts for 1997 and each successive year by September of
the previous year. I~ setting the deductible, the Secretary shall not take into account
expenditures on drugs thall exceed approved payment levels.
(2) The amount payable for covered drugs shall be equal to 80 percent of the
payment basis for individuals who have satisfied their deductible for the year and 100
percent of the payment basis for individuals who have satisfied both the deductible
and out-of-pocket requirement.
The annual out-of-pocket limit is $1000 in 1996 and in succeeding years, an
amount determined by the Secretary that is estimated to ensure that the average
percent of persons receiving covered benefits will remain the same as in the previous
year (excluding beneficiaries enrolled in Medicare managed care plans). The
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�Secretary shall promulgate out-of-pocket limits for 1997 and each succeeding-year by
September of the previous year.
In determining the amount of expenses incurred the Secretary shall not take
into account amounts paid beyond the payment basis for a drug.
(3) The "payment basis" is the lesser of the actual amount charged for a drug
or the applicable payment limit.
(4) The applicable payment limit for drugs is as follows:
(A) For single source drugs or mUltiple source drugs with restrictive
prescriptions the payment limit for a calculation period is the lesser of the 90th
. percentile of the actual charge (computed on a geographic basis) during the
second previous calculation payment period or the amount of administrative
allowance plus the product of the number of dosage units dispensed and the
per unit estimated acquisition cost for the drug product.
(B) For multiple source drugs with non-restrictive prescriptions the
payment limit equa.ls the amount of administrative allowance plus the product
of the number of dosage units dispensed and the unweighted median of the unit
estimated acquisition cost.
(C) The Sel;retary shall determine the estimated acquisition cost for a
drug during a calculation period. The cost may not exceed 93 percent of the
average wholesale price during the period. The Secretary shall impose civil
money penalties against wholesalers who refuse to provide price information,
following the procedures under section 1128A of the Social Security Act.
Information shall not be disclosed except as prescribed by the Secretary.
(5) The administrative allowance is $5.00 for 1996, and for each succeeding
year, the amount adjusted by the percentage change in the consumer price index for
all urban consumers for the 12-month period ending with June of the preceding year.
The Secretary may reduce the amount of administrative allowance for mail order
pharmacies after consulting with pharmacists, Medicare beneficiaries, and private
insurers.
(6) The Secretary shall establish a program to identify (and educate physicians
and pharmacists regarding) patterns and instances of inappropriate dispensing or '
prescribing, instances of substandard care, potential adverse reactions, and appropriate
'uses of generic drugs. The Secretary may require advance approval for an outpatient
drug which the Secretary fmds is subject to misuse or inappropriate use, is not cost
effective, is a multiple source drug with restrictive prescription or is subject to rebate
negotiation. The Secretary must ensure that prior approval procedures do not restrict
patients' timely access to medically necessary drugs, assure prompt determinations of
approval or disapproval and provide an appeal mechanism.
The Secretary may provide for a drug use review program with respect to covered
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�outpatient drugs to assure that prescriptions are medically necessary, appropriate, ana are not
likely to result in adverse medical reaction.
(7) The Secretary shall adopt a standard claims fonn for outpatient drugs
consistent with Title V of lthe Health Security Act.
(8) Phannacies may not receive payment for covered drugs unless phannacy
agrees to answer beneficiaJries' questions about appropriate use, potential interactions
and other matters.
(9) Under this section:
(A) the tenns "multiple and single source drugs" have the same
meaning as under section 1927(k)(7) of the Social Security Act;
(B) the tenn "restrictive prescription" means that the prescription
indicates an appropriate restriction recognized by the Secretary in the
prescriber's handwriting such as "brand medically necessary". In the case of a
telephone prescription the prescriber must state that a particular drug must be
dispensed and follows up with an appropriate hand-written confmnation within
30 days.
(C) The tenn "payment calculation period" means the 6-month period
beginning with each January and July.
(b) Section 1848 (g)(4) (re:lating to limitations on beneficiary liability) is amended to .
require that phannacies submit ChlimS within 90 days in the case of prescribed outpatient
drugs.
(c) Section 1842 (relating to use of carriers) is amended to pennit the Secretary to
enter into contracts with regional carriers and may detennine an appropriate method of
payment. The Secretary may also contract with any other qualified entity. to carry out these
functions. The Secretary must use Railroad Retirement Act carriers to carry out functions
for Retirement Act beneficiaries.
(d) Actions taken before 1996 that affect claims processing functions are not subject
to section 111 of the Federal Property and Administrative Services Act and shall not be
subject to administrative or judicial review.
(e) Adds confonning amendments to section 1833, section 1866 and section 1842.
Section 2003. Medicare Rebates for Covered Outpatient Drugs. (a) In order for
payment to be available under this part for a covered outpatient drug on or after January 1,
1996, the manufacturer must enter into.and have in effect a rebate agreement with the
Secretary that meets the requirements of this section and must give equal access to discounts
in accordance with this section. The following tenns apply to rebate agreements:
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77
�(1) Each calendar quarter, within 30 days of receiving specified inforination,
the manufacturer must pay the Secretary a specified rebate for all covered outpatient
drugs. Drugs subject to the rebate are those drugs dispensed to beneficiaries (other
than beneficiaries enrolled in Medicare managed care plans or state alliances) by
pharmacies during the quarter.
(2) Within 60 days after the end of each quarter the Secretary shall inform the
manufacturer of the total number of units, dosage strength and package size of each
covered drug dispensed based on data furnished to the Secretary. The Comptroller
General may audit the data to assure accuracy .
. (3) Each manufacturer shall inform the Secretary within 30 days after the end
of each calendar quarter the average manufacturer's retail and non-retail price for
each dosage form and strength of each of its covered outpatient drugs. Each
manufacnirer must also inform the Secretary of its base quarter average manufacturer
retail prices (within 30 days of entering into an agreement) of each dosage price for
each dosage form and strength. The Secretary may inspect manufacturers' records to
verify the average manufacturer retail and non-retail price and may impose civil
money penalties in accordance with the provisions of section 1128A of the Social
Security Act on manufacnlrers who provide false information or who refuse to furnish
information. Manufacturers that do not provide timely information (within 90 days of
the deadline imposed) may be suspended .
(4) Agreements may not be in effect for less than 1 year and shall be
automatically renewed unless terminated. The Secretary may terminate for good
cause, and the termination shall take effect 60 days after notice. The manufacturer
may request a hearing, but the termination shall not be delayed pending the outcome
of the hearing. A manufacturer may terminate for any reason, in which case the
termination is effective on the first day of the first calendar quarter occurring at least
60 days after such notice is given. Terminations do not affect rebates due on or
before the date of the termination. The Secretary must notify pharmacies and
physician organizations of a termination no less than 30 days before the actual
termination date.
The manufacturer shall rt::bate to the Secretary in accordance with the following rules:
(1) a basic rebate for each calendar quarter equal to the product of the total
number of units subject to the rebate and the greater of (i) the difference between
the average manufacturer retail price and the average manufacturer non-retail price;
or (ii) 17 percent of the ~lverage manufacturer price;
(2) an additional rebate equal to the product of the number of dosage units
subject to the rebate and the amount by which the average manufacturer retail price
for the quarter in question exceed the average manufacturer retail price for the base
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78
�quarter increased by the percentage increase in the CPI for urban consumers-from the
end of the base quarter to the month before the beginning of each calendar quarter;
(3) the Secretary may negotiate a rebate amount for a new drug first marketed
after June, 1993, which is not marketed in any country named in section 802(b)(4) of
the Federal Food, Drug, and Cosmetic Act and which the Secretary believes may be
excessively priced or which is marketed in one or more of the countries named in
section 802 at a significantly lower price. In the case of drugs that are marketed in
other countries, the rebate may equal the difference between the average manufacturer
retail price in the U.S. and the price available to wholesalers in those countries. In
determining if a price is excessive~ the Secretary shall take into account the prices of
other .drugs in the same therapeutic class, other cost and pricing information, special
manufacturing requirements, prices abroad, and other relevant factors. The Secretary
may exclude a drug for which an acceptable rebate agreement cannot be negotiated.
The effective date for an t:xclusion shall be 6 months after the effective date of
marketing approval (but no earlier than July 1,1996) or the date the manufacturer
terminates rebate negotiations;
(4) no rebates are imposed for outpatient drugs that are generic (Le., neither
single source drugs or an innovator mUltiple source drugs).
The Secretary may not disclose information under this part except to the degree
necessary to administer the program or to permit review by the Comptroller General or the
Director of the Congressional Budget Office.
Manufacturers must offer substantially the same terms to each purchaser of covered
outpatient drugs. Equal access is determined in terms of prompt payment, cash payment,
volume purchase, single site delivery, the use of formularies by purchasers and any other
terms effectively reducing the manufacturer's costs. In determining compliance with this
part, terms given to public programs, the Department of Defense and the Department of
Veterans Affairs shall not be tak(m into account.
The following terms are defmed:
(1) the term "average manufacturer retail price" means the average price paid
to the manufacturer for dJ1lgs distributed through retail pharmacies, including
discounts, prompt payment, volume purchases and rebates.
(2) the term" average manufacturer non-retail price" means the weighted
average price (including discounts, prompt payment, volume purchases and rebates)
paid to the manufacturer by hospitals and other institutional purchasers that purchase
drugs for institutional use and not for resale.
(3) the term "base quarter" means the calendar quarter beginning April .1,
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79
�1993, or if later, the first full calendar quarter that a drug was marketed in the U. S.
(4) the term "covered drug" includes each innovator multiple source drug and
each single source drug, as defined under section 1927(k)(7) of the Social Security
Act.
(5) the term "manu.facturer" means the entity whose National Drug Code
number appears on the label or the individual named in the license or human drug
application to the FDA.
(b) Amends section 1862 to exclude from coverage outpatient drugs for which there is
no rebate agreement or drugs that are e~cluded because no rebate amount has been agreed to.
Section 2004. Extension of 25 Percent Rule for Portion of Premium Attributable
to Covered Outpatient Drugs. Section 1839 (relating to Part B premiums) is amended to
specify that the portion of the premium attributable to outpatient drugs shall equal 25 percent
of Medicare program costs for outpatient drugs~ This provision takes effect after December,
1998.
Section 2005. Coverage of Home Infusion Drug Therapy. (a) Section 1832(a)(2) is
amended to add coverage of home infusion drug therapy services.
(b) Section 1861 is amended to add a definition of home infusion drug therapy
services, which are defmed as itf!ms and services furnished to an individual under the care of
a physician in a residence used as the individual's home by a qualified home infusion drug
therapy provider or by others under arrangements with the provider and under a plan
established and periodically reviewed by the physician. Home infusion therapy items and
services include nursing, pharmacy and related services including medical supplies,
intravenous fluids, delivery and equipment as are necessary to carry out a home infusion
regimen safely and effectively.
A qualified home infusion therapy provider is an entity that is capable of providing or
arranging for items and services needed for home infusion, maintains clinical records on all
patients, adheres to written protocols and policies, makes services available 7 days a week,
24 hours a day, coordinates all services with the patient's physician, conducts quality
assessment activities, assures that only trained individuals provide home infusion, assumes
responsibility for the quality of services and is appropriately licensed or approved by a state
agency as required under state law.
(c) Section 1833 and 1834 (relating to payment for services) are amended to specify
payment rules for home infusion therapy services as the lesser of the actual charge or the fee
schedule established under this section. The Secretary is required to establish a per diem fee
schedule before the beginning of 1996 and to update it annUally.
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�Section 1877 (relating to physician referrals) is amended to prohibit physician
referrals for home infusion services.
(d) Section 1835 is amended to require certification of the need for home infusion
therapy, the provision of services in accordance with a written plan, and that the individual
is under the care of a physician.
(e) Section 1861 is amended to provide that home infusion therapy providers shall be
treated as part A providers and section 1864 is amended to require the Secretary to use state
agencies to determine compliance.
.
Section 1846 (relating to intermediate sanctions for providers or suppliers of clinical
laboratory services) is amended by adding home infusion drug therapy services and by
permitting intermediate sanctions for providers no longer substantially in compliance
(including plans of corrections, civil money penalties, payment for the cost of on-site
monitoring and suspension of payments).
(f) Section 1816 (relating to the use of intermediaries) is amended to provide that the
Secretary may use regional intermediaries to carry out this section.
(g) Section 1861 is amended to add coverage of enteral and parenteral nutrients,
supplies and equipment.
Section 2006. Conforming Amendments to the Medicaid Program. (a) Section
1927 (relating to drug rebates) is amended to prohibit contracts between state Medicaid
agencies and manufacturers that do not have Medicare rebate agreements in effect. Also
provides that covered drugs furnished to dually eligible enrollees shall not be included in the
determination of units of outpatient drugs subject to Medicaid rebates.
(b) The effective date is quarters beginning on or after January 1, 1996.
Section 2007. Effective Date. The amendments made by subtitle A shall take effect
on or after January 1, 1996.
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�SUBTITLE B - LONG-TERM CARE
(H.R. 3600 and S. 1757 p. 389)
Subtitle B establishes a new source of to Federal funds for home- and community
based services and related activities for individuals with disabilities. It sets forth the
conditions of state participation and also establishes basic eligibility criteria for individuals
with disabilities. The subtitle inCludes a defined Federal budget allocation for the new
services and the methodology for determining a state's allocation of that total.
PART 1. STATE PROGRAMS FOR HOME AND COMMUNITY-BASED SERVICES
FOR IN][)IVIDUALS WITH DISABILITIES
Section 2101. State Programs for Home and Community-based Services for
Individuals with Disabilities. Creates a new state entitlement to Federal payments for
home- and community-based services and related activities for individuals with disabilities.
The section entitles every state to Federal payments under section 2108 if a state has a plan
for the home- and community-based services that has been approved by the Secretary.
The benefits conferred by this part do not constitute an entitlement for individuals,
nor are states with approved plans required to spend the full amount of Federal funds to
which they are entitled in any ye:ar.
Section 2102. State Plans. (a) State plans under this part must meet the following
conditions for approval:
(1) Subject to the amount of state and Federal funding available, the plan must
make covered services available to individuals in the state with disabilities (as defmed
in section 2103(a).
The plan must provide for initial screening of potentially eligible individuals.
The plan may not restrict the eligibility of individuals on the basis of income,
age, geography, the nature, severity or category of disability, residential setting (other
than institutional setting)., or other grounds specified by the Secretary.
The plan must also provide assurances that the state will continue to make
available under this plan:, the state's Medicaid plan or otherwise, an appropriate level
of assistance for home and community-based services for individuals who are
receiving assistance for these services under the state Medicaid plan at the time of
enactment of this Act. Such an individual's post-enactment level of assistance, under
the state plan, must take into account the level of aid the individual was receiving on
the date of enactment, and the individual's need for the services.
(2) Consistent with section 2104 (coverage of services), a state plan must
specify the services and the extent and manner of allocation and availability of the
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�services available under the plan. It must specify how services under the state plan
are to be coordinated with each other and with health and long-term care services
otherwise available to individuals with disabilities. Subject to the coverage limitations
in section 2104, services may be delivered in an individual's home, a range of
community residential arrangements, or outside the home.
The state plan must also specify how it will allocate services among
individuals with disabilities both during and after a phase-in period over 7 fiscal
years, beginning in fiscal year 1996. The state plan may not allocate the services on
the basis of income or other financial resources of the individuals.
The state may not require consumer-directed providers of personal assistance
services to be licensed, certified or meet other requirements that the Secretary fmds
not necessary for the' health and safety of individuals with disabilities. ("Consumer
directed" services, defmed at the end of this section, are services provided by an
individual who is selected and managed (and may also be trained) by the individual
receiving the services).
To the extent possible, an individual with disabilities (and the individual's
family) must be permitted to choose the type and provider of covered services.
The state plan must assure the number of low-income individuals with
disabilities who receive home and community-based services under the plan, the
state's Medicaid plan, or both, is proportional to the number of low-income
individuals in the state.
(3) Cost-sharing under a state plan may not exceed the levels allowed under
section 2105.
(4) A state plan mlLst specify the types of providers that are eligible to
participate in the program under the plan, including consumer-directed providers, and
must also specify conditions of provider participation.
(5) A state plan must specify how the state will manage the Federal and state
funds available under the plan to serve all categories of individuals with disabilities
and otherwise satisfy state plan requirements. This information must be provided for
disposition of funds available for each fiscal-year, beginJring with fiscal year 1996
running through fiscal year 2003 and for each five fiscal-year period thereafter.
(6) A state plan must specify the methods that will be used to reimburse
providers for services provided under the plan. The methods may include
retrospective reimbursement on a fee-for-service basis, prepayment on a capitation
basis, payment by cash or vouchers to individuals with disabilities, or a combination
of these methods. If a plan uses cash or vouchers, it must specify how the plan will
assure compliance with applicable employment tax provisions.
A state plan must also specify the methods and criteria to be used to set rates
of payment for plan services (including rates for cash payments or vouchers).
The plan must limit payments to providers to those who agree to accept, as
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�full payment for covered services, payment at rates established under the plan
(including any cost-sharing that may be imposed).
(7) The plan must provide for quality assurance and safeguards for people
applying to and in the plan, in accordance with section 2106.
(8) A state plan must assure that the state advisory group required under
section 2107(b) will be established and maintained.
(9) The plan must designate one or more state agencies responsible for
administering or supervising administration of the plan. The plan must include
assurances that administrative expenditures under the plan will not be more than 10
. percent of total expenditures, beginning in fiscal year 2003.
The state also must specify how the plan will be integrated with specified
public programs and with health plans. The public programs with which a state plan
must be integrated are: the state Medicaid plan, titles V (maternal and child health)
and XX of the Social Security Act; programs under the Older Americans Act of 1965,
the Developmental Disabilities Assistance and Bill of Rights Act, the Individuals with
Disabilities Education Act, and other Federal or state programs providing services or
assistance targeted on individuals with disabilities.
(10) The state plan must provide that the state will make reports and
cooperate with audits on the state's administration of its plan (including claims
processing) as the Secretary determines are needed. The plan must also provide data
required by the Secretary.
(11) The state plan must include assurances that Federal funds will not be used
to pay the state's share of expenditures under the plan. The Section also incorporates
the provisions of section 1903(w) of the Social Security Act (related to prohibited uses
of provider taxes and donations under the Medicaid act).
(b) The Secretary shall approve a state's plan if the Secretary determines that the plan
was developed in consultation with individuals with disabilities and their representatives, and
meets all the foregoing requirements for elements of a state plan. The Secretary is required
to monitor plans' compliance with the eligibility requirements of section 2103, is authorized
to monitor other requirements of the subpart, and must promulgate timely regulations.
Approvals take effect on the fJISt day of the fIrst fiscal year following approval, except that
approvals made before January 1,1996, shall take effect on January 1. The Secretary may
establish submission deadlines.
Section 2103. Individuals with Disabilities Defined. (a). An individual in one or
more of the following four categories is an "individual with disabilities," for purposes of
eligibility under this part.
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�(1) Individuals requiring help with daily living. These are individuals who
need, and who are expected to need for at least 100 days, specified types of assistance
to perfonn three or more activities of daily living. The specified types of assistance
are hands-on, standby, supervision or cueing. "Activities of daily living," (ADLs)
mean eating, toileting, dressing, bathing, and transferring in and out of bed.
(2) Individuals with severe cognitive or mental impainnents. These are
individuals of any age who satisfy the following criteria:
(A) the individual's scores on a standard mental status protocol that is
appropriate for the person's condition (as specified by the Secretary), indicate
severe cognitive or mental impainnent or both;
(B) the individual requires hands-on or standby assistance, supervision
of cueing with one or more ADLs, or requires assistance or cueing with one
or more cognitive-related instrumental activities of daily living (IADLs)(as
specified by the Secretary), or displays symptoms of one or more serious
behavioral problems that create a need for supervision to prevent hann to self
or others; and
(C) The individual is expected to meet these requirements for at least
100 days.
(3) Individuals with severe or profound mental retardation. This means an
individual with severe or profound mental retardation, as detennined by a protocol
specified by the Secretary"
(4) Severely disabl,ed children. These are children under 6 years of age who
have a severe disability or chronic medical condition and who would need to be
institutionalized in a hospital, nursing facility or intennediate care facility for the
mentally retarded if personal assistance, or other "additional services" described in
section 2104 were not provided. The individual must also be expected to have the
disability or condition, and to require the services for at least 100 days.
(b) Disability must be det(!nnine by persons or entities specified under the state plan
and using protocols that inchlde ,m initial screening and assessment specified by the
Secretary. A state may also coll(!ct additional infonnation for purposes of assessing an
individual's need for care and for developing a plan of care for the individual, as required
under section 2104.
A state must establish a fair hearing process for appeals of eligibility detenninations.
An individual's eligibility, as an "individual with disabilities," is effective under a state plan
for no longer than 12 months bm may be effective for a longer period if a significant change
in an individual's condition affecting eligibility is unlikely. If there is such a significant
change, the individual's eligibility must be reassessed.
Section 2104. Home and Community-Based Services Covered Under State Plan.
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85
�(a) A state plan must-specify the home- and community-based services that will be
available under the plan to individuals or categories of individuals with disabilities, and must
also specify limits applicable to stich services. Services must be specified in a manner that
pennits sufficient flexibility for providers to meet individuals' needs in a cost-effective
manner.
Services may be delivered in an individual's home, a range of community residential
arrangements or outside the home, except (under an exclusion in a provision below), the
services may not be delivered in a hospital, nursing facility, intermediate care facility for the
mentally retarded or other institutional setting specified by the secretary.
(b) A state plan may provide services to an individual only if a comprehensive
assessment of need has been mad(! (regardless of whether all needed services are available
under the state plan) and for whom an individualized plan of care, based on the assessment,
has been developed. Only servict!s consistent with the plan of care may be provided.
The individualized plan of care must be developed by qualified individuals in close
consultation with the individual. with disabilities and the individual's family. The care plan
must be approved by the individual (or the individual's representative), and must be reviewed
and updated at least every six months. The care plan must specify which of the services in
the plan will be provided under the state plan and identify (to the extent possible) how an
individual will obtain services that are not provided under the state plan. The care plan must
also specify how the services provided to the individual under the state plan will be
coordinated with the provision of other health care to the individual.
A state must make reasonable efforts to identify and arrange for those services in the
care plan that are not provided under the state plan. Nothing in this section shall be
interpreted to require the state to provide all the services in the care plan, either under the
state plan or otherwise.
(c) A state plan must include in the array of services made available to each category
of individuals with disabilities agency-administered and consumer-directed personal assistance
services.
(d) Additional services that states may cover are case management; homemaker and
chore assistance; home modifications; respite services; assistive devices; adult day services;
habilitation and rehabilitation; supported employment; home health services; and any other
care or assistive services approved by the Secretary that the state determines will help
individuals with disabilities to stay in their homes.
The state plan must specify the methods and standards used to detennine the types
and amount, duration and scope of services covered for each category of individuals with
disabilities, as well as how the state's coverage rules meet the needs of each of the 4
categories of individuals with disabilities.
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�(e) The exclusions and limitations that apply to services under a state plan are the
following:
(1) A state plan may not provide for coverage of room and board, nor for
services provided in a hospital, nursing facility, intermediate care facility for the
mentally retarded, or other institutional setting specified by the Secretary. The plan
may not provide for items and services to the extent that these are covered for the
individual under a health plan or Medicare.
(2)ln determining the amount or types of services to be made available to
individuals with disability, a state plan may take into account the availability of
informal care.
(1) A state plan may provide the following methods of paying for services: vouchers;
direct cash payments for individuals with disabilities; payments per capita to health plans;
and payments to providers.
(g) Personal assistance services, in this section, means services that a state plan
specifies as personal assistance. 'Whether the personal assistance services are delivered by an
agency or by a consumer-directed. provider, they must include at least the following: hands
on services and stand-by assistance, supervision, and cueing with activities of daily living.
"Consumer-directed" means services provided by an individual who is selected and managed
by the individual receiving the services, and if he or she chooses, also trained by the
individual receiving the services. "Agency-directed" means services that are not consumer- .
directed.
'
Section 2105. Cost Sharing. (a) A state plan may not require more than nominal cost
sharing for individuals whose income is less than 150 percent of the poverty level (as defmed
in section 1902(25) of the Act) applicable to a family of the size involved.
(b) A state plan must requ.ire cost sharing in the form of coinsurance, based on the
amount paid under a state plan for a service, subject to the following sliding scale:
(1) The rate of coinsurance is 10 percent for individuals with disabilities whose
income is more than 150 percent but is less than 200 percent of the poverty level
applicable to a family of the size involved.
(2) The rate of coinsurance is 20 percent for individuals whose income is more
than 200 percent but less than 250 percent of the poverty level applicable to a family
of the size involved.
(3) The rate of coinsurance is 25 percent for individuals whose income is equal
to or above 250 percent of the poverty level applicable to a family. of the size
involved.
(c) A state plan must specify a process that is consistent with standards specified by
the Secretary for determining the income of an individual with disabilities for purposes of
this section.
'
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�Section 2106. Quality Assurance an~ Safeguards. (a) A state plan must specify how
the state will ensure and monitor the quality of services, including:
(1) safeguarding the health and safety of individuals with disabilities;
(2) minimum standards for agency providers, and how these standards will be
enforced;
(3) minimum competency requirements for employees of agency providers who
provide direct services, and how the competency of such employees will be enforced;
(4) obtaining meaningful input from consumers (including consumer surveys)
that measure both the extent to which participants get the services described in their
care plans, and their -satisfaction with the services;
(5) participation by the state in quality assurance activities; and
. (6) the role of the long-term care ombudsman (under the Older Americans Act
of 1965), and the Advocacy Agency (under the Developmental Disabilities Assistance
and Bill of Rights Act), in assuring the quality of services, and protecting the rights
of individuals with disabililties.
(b) A state plan must also provide confidentiality and abuse safeguards. These
safeguards must:
(1) restrict the use or disclosure of information about applicants and
beneficiaries to purposes directly connected with administering a state plan;
(2) guard against physical, emotional or fmancial abuse or exploitation.
Appropriate safeguards for individuals receiving program benefits in the form of
direct cash payments or vouchers must be included.
Section 2107. Advisory Groups. (a) The Secretary must establish an advisory group
to advise the Secretary and states on all aspects of the home and community-based services
program. A majority of the advisory group must be individuals with disabilities and their
representatives; the group must also include providers, Federal and state officials, and local
community implementing agencies.
(b) Each state plan must a.lso provide for establishing and maintaining an advisory
group, appointed by the governor (or other state chief executive officer), to advise-the state
on all aspects of the state plan for the program. A majority of the advisory group must be
individuals with disabilities and their representatives; the group must also include providers,
state officials, and local community implementing agencies. Each state must establish a
procedure through which all residents of the state, including individuals with disabilities, may
nominate individuals to serve on the advisory group.
The state advisory group must:
(A) advise the state on guiding principles and values, policy directions
and specific components of the state plan, before the plan is developed;
(B) meet regularly with the involved state officials while they are
developing the plan, to review and comment on all aspects of it;
(C) participate in public hearings to make sure that public comments
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�are addressed to the extent practicable;
(D) document differences between the group's
recommendations and the state plan;
(E) document specifically the degree to which the plan is consumerdirected; and
.
(F) meet regularly with officials of the designated state agency(ies) to
advise on all aspects of implementing and evaluating the plan.
Section 2108. Payments to States. (a) Subject to the limitation for administrative
costs (section 2102), the Secretary must make quarterly payments to a state with an approved
plan from the state's allotment under the Federal budget (under section 2109). The amount
paid to a state must be the total of the following:
(1) the Federal matching percentage (defmed below) of the amount the state
spent during the quarter for home and community-based services under the plan, for
individuals with disabilities (as proven by state claims); plus
(2) 90 percent of the amount that the state spent during the quarter for
detennining eligibility (including preliminary screenings) and assessing individual
needs; plus
(3) 90 percent of the amount spent during the quarter to design, develop and
install mechanical claims processing systems and for information retrieval (but 75
percent of the costs beginning with quarters in fiscal year 2003); plus
(4) 50 percent of the remainder that a state spent during the quarter that are
necessary for proper and efficient administration of the state plan (as found by the
Secretary) .
(b) The "Federal matching percentage" for a state, is the reference percentage (100
percent minus the state percentage) increased by 28 percentage points. The reference
percentage can be no less than 50 percent and no more than 83 percent. The Federal
matching percentage can be no 1c~ss than 78 percent, and may not· be more than 95 percent.
The reference percentage must be 50 percent for Puerto Rico, the Virgin Islands, Guam, the
Northern Mariana Islands, and .American Samoa.
The "state percentage" is that percentage which bears the same ratio to 45 percent as
the square of the state's per capita income bears to the square of the per capita income of the
continental United States (including Alaska) and Hawaii.
(c) States shall receive their payment on a quarterly basis, computed and made as
follows:
(1) Prior to the beginning of each quarter, the Secretary must estimate the
amount to be paid to the state from its allotment for the quarter, on the basis of a
state's report estimating the total amount to be spent in the quarter, and other
infonnation as the Secretary fmds necessary ..
. (2) The allotment paid must be reduced or increased by any amount (not
previously adjusted) by which the estimate for the amount to be paid to the state for
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�any previous period of time was more, or less, than what should have been paid.
(d) Section 1903(w) of the Social Security Act (prohibiting the use of provider
donations and taxes except under certain circumstances, applies to state expenditures under
this part.
Section 2109. Total Federal Budget; Allotments to States. (a)(1) The total Federal
budget, stated in this section, for the state plans for home and community-baSed services is
as follows for fiscal years 1996 through 2003:
(A) Fiscal 1996, $4.5 billion;
(B) Fiscal 1997, $7.8 billion;
(C) Fiscal 1998, $11,.0 billion;
(D) Fiscal 1999, $14.7 billion;
(E) Fiscal 2000, $18.7 billion;
(F) Fiscal 2001, $26.7 billion;
(G) Fiscal 2002, $35.5 billion;
(H) Fiscal 2003, $38.3 billion.
(2) For each fiscal year after fiscal 2003, the total Federal budget for the state
plans is the amount of the total budget for the preceding fiscal year, multiplied by two
factors, reflecting changes for the fiscal year in the consumer price index (" CPI
increase factor") and changes in the number of individuals with disabilities ("disabled
population factor").
(3) The CPI increase factor for a fiscal year is the ratio of the annual average
index of the CPI for. the preceding fiscal year to the same index for the year
preceding that (the second preceding fiscal year).
(4) The disabled increase factor is the difference between 100 percent and the
percentage increase or decrease change in the disabled population of the United States
(as determined for purposes of the most recent update under subsection (b).
(5) States must inform the Secretary of offsets and reductions in the funds that
would have been paid under Medicaid for similar services to individuals with
disabilities who instead receive services under the home and community-based
services program. States must report this information as the Secretary may require
for purposes of monitoring state compliance.
The Secretary must review the state reports and increase the total Federal
budget for state plans by the amount that Federal expenditures for home and
community-based services under Medicaid are reduced. States may not receive
payments under this section for any services for which the state received payment
under section 1903(a) of the Social Security Act. Nothing in this part shall-be
construed as requiring states to determine Medicaid eligibility for individuals
receiving services under this program.
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�(b)(1) From the total amount allotted under this section, the Secretary must
allot to each state, for each fiscal year an amount that bears the same ratio to the total
Federal budget for that fiscal year as the state allotment factor for the fiscal year
(defmed below) bears to the total of such factors for all states for that fiscal year.
(2) The Secretary must compute the "state allotment factor" referred to above
for each state, for each year, using the following method. A state's annual allotment
factor is to equal the sum of its base allotment factor and a low-income allotment
factor for each fiscal year.
The base allotment factor is calculated by mUltiplying the following four
elements: the number of individuals with disabilities in the state; 80 percent of the
national average per capita budget amount for the fiscal year; the wage adjustment
factor for the state; and the Federal matching rate.
The low-income al10tment factor is calculated by mUltiplying the following five
elements: the number of individuals with disabilities in the state; 10 percent of the
national average per capite:! budget amount; the wage adjustment factor for the state;
the Federal matching rate; and the low income index lor the state for the preceding
year.
(3) The number of individuals with disabilities is determined as follows: on the
basis of the 1990 census, adjusted as appropriate by the March 1994 current
population survey, the Secretary must determine the number of individuals in the state
by age, sex and income category. The Secretary must also determine, for each such
age, sex and income' category, the na~ional average proportion of the population of
such category that represents individuals with disabilities. The Secretary may
determine such proportions by periodic surveys .
. Based on these detenninations, the Secretary must establish a 1994 "base
disabled population" in each state by multiplying the state's population of individuals
with disabilities in each age, sex, and income category by the national average
proportion for such population and adding the results. For any fiscal year, the
Secretary must determine the number of individuals with disabilities in a state on the
basis of the base disabled population, increased or decreased by the percentage
increase or decrease in the disabled population of the state (as detennined by the
current population survey from 1994 to the year before the fiscal year involved.
(4) The national per capita budget amount is determined as follows: the
numbers of individuals with disabilities in all the states for the involved fiscal year
(determined as above), are added together, and the Federal budget specified for home
and community-based services for the year is divided by the total (national) number of
individuals with disabilities.
(5) The wage adjustment factor for a state for a fiscal year, referred to above,
is the ratio of the average: hourly wages for service workers in the state to the national
hourly wages for service workers. (The state and national average hourly wages
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�exclude those of household or protective service workers.) The hourly wages used in
the foregoing detenninatioIl must be based on data from the most recent census that
are available.
(6) The low income index for each state for a fiscal year is the ratio,
detennined for the preceding fiscal year, of the percentage of the state's population
with income below 150 percent of poverty to the percentage of the U.S. population
with income below 150 percent of poverty. Percentages shall be calculated from the
decennial census and updated through the most recent current population survey.
(c) This part of the Act constitutes'budget authority in advance of appropriations Acts,
and represents the obligation of the Federal government to provide payments to states of the
amounts described above (section 2109).
PART 2 - MEDICAID NURSING HOME IMPROVEMENTS
Section 2201. Reference to amendments. See Title IV Subtitle C.
PART 3 -- PRIVATE LONG-TERM CARE INSURANCE
SUBPART A -- GENERAL PROVISIONS
Section 2301. Federal Regulations' Prior Application or Certain Requirements.
(a) The Secretary must issue regulations needed to implement this part, in consultation
with the Advisory Council established in section 2302.
(b) Within 120 days after a majority of Council members are appointed, the Secretary
must publish a timetable of the regulations to be published subsequently, at'the end of the
first, second and third years after the appointment of the CounciL All regulations must be
published at the end of the third year after appointment of the Council.
(c)(I) Notwithstanding the regulatory timetable, within 6 months after
enactment of the Act, insurers must comply with the following provisions of this part:
(A) section 2321(c)(standard outline of coverage);
") (B) section 2321(d)(reporting to state insurance commissioners);
(C) section 2322 (preexisting condition exclusion);
(D) section 2322 (c)(limiting conditions on benefits);
(E) section 2322 (d) (inflation protection);
(F) section 2324 (sales practices);
(G) section 2325 (continuation, renewal, replacement, conversion, and
cancellation of policies);
(H) section 2326 (payment of benefits).
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�(2) Insurers will be considered as having met the requirements of these
sections prior to the effective date of regulations if on an interim basis they adopt the
following applicable provisions of the NAIC Model Act and Regulation.
(A) section 6.G(2) of the Model Act and section 24 of the Model
Regulation in the case of standard outline of coverage (section 2321(c));
(B) section 14 of the Model Regulation in the case of reporting to state
insurance commissioners (section 2321(d));
(C) section 6.D of the Model Act in the case of preexisting condition
exclusions (section 2322(c)(I));
(D) section 2322(c) and section 11 of the Model Act in the 'case of
limiting conditions on benefits (2322(c)(2));
(E) section 12 of the Model Regulation in the case of inflation
protection (section 2322(d));
.
(F) section 10 of the Model Regulation in the case of applications for
the purchase of insurance (section 2324(b);
(G) Permitted Compensation Arrangements in the Model Regulation in
the case of compensation for the sale of policies (section 2324(d);
(H) section 21.C of the Model Regulation in the case of sales through
employers or mem.bership organizations (section 2324(g»);
(I) section 5 of the NAIC Model Act, in the case of interstate sales of
group policies (section 2324(h»;
(J) section 7 of the NAIC Model Act in the case of continuation,
conversion, replacement and renewal of policies (section 2325(f).
Section 2302. National Long-Term Care Insurance Advisory Council. (a) The
Secretary must appoint a National Long..,Term Care Insurance Advisory Council made up of
five members.
(b) The Council's 5 members each must have substantial expertise with regard to
providing and regulating long-telm care insurance. At least one member must have
experience as a state insurance commissioner or legislator with expertise in developing policy
for and regulating long-term care insurance. Members of the council serve for no more than
two successive terms of five years each, with shorter, staggered terms for the first
appointees. Members may removed from the council only for cause.
(c) The Secretary of HHS shall appoint a chair from among the members.
(d) The Council must be provided with travel compensation and expenses,
(e) The Council must meet at .least twice a year.
(f) The Council must have a salaried executive director and staff. The Council is to
be provided with information and assistance from Federal agencies to carry out its duties.
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�(g) The responsibilities of the Council are to:
(1) advise and assist the Secretary on long-term care insurance;
(2) collect, analyze and disseminate information on long-term care insurance to
insurers, providers, conswners and regulatory bodies;
(3) develop models, standards, requirements and procedures relating to long
term care insurance for the Secretary's consideration;
. (4) monitor the long-term care insurance market and advise the Secretary on
any needed regulatory changes.
(h) The Council must also make recommendations to the Secretary on:
(1) uniform terminology, definitions and formats for use in long-term care
insurance policies;
(2) a standard format, to be used in long-term care policies, for the outline of
coverage required under section 2321(c);
(3) whether Federal standards should be established for the amounts of
premiums for long-term care policies and rates of premium increases and if so, on'
what factors should the standards be based;
(4) whether Federal standards are needed regarding the conditions insurers
may place on an insured person to improve his or her coverage;
(5) whether "threshold conditions" for payment of covered benefits (i.e. the
degree of impairment required before a benefit will be paid) should be
standardized, and related matters;
(6) what procedures for resolving benefit disputes should be required of
insurers and states;
.
(7) standards relating to sales and servicing of long-term care policies,
including mandatory training and certification of agents, limitations on insurance
agents' commissions or other compensation, sales practices that should be prohibited
or limited, and standards for sales of policies by or through employers and other
entities.
(8) the extent to which the long-term care insurance aspects of continuing
care retirement community arrangements should be subject to regulation (the
Secretary must consider these recommendations and promulgate resulting regulations
with the Secretary of the Treasury.
(h) In carrying out its responsibilities, the Council may consult broadly, conduct
meetings, hearings and research, collect, analyze and disseminate information, develop
model formats and procedures for insurance policies and marketing materials and develop
proposed regulatory standards, rules and procedures.
(i) For the Council's activities, $1,500,000 is authorized for fiscal year 1995 and
$2,000,000 for each succeeding fiscal year.
Section 2303. Relation to State Law. This part may not be interpreted to prevent
a state from imposing standards for long-term care insurance policies that are more
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�protective of individuals, except that state standards may not be inconsistent with tliis part or
regulations issued under the part.
Section 2304. Definitions. For purposes of this part:
(1) "activity of daily living" means eating, toileting, dressing, bathing and/or
transferring in and out of bed;
(2) "adult day care" means a program providing social and health-related
services to six or more adults during the day, in a community setting;
(3) "advisory council" refers to the national council established under section
2302;
(4) "certificate" means a document showing an individual's coverage under a
group· insurance policy;
(5) "continuing care retirement community" means a privately-operated
residential community that contracts with its residents to provide for their future
long-term care;
(6) "designated representative" means the person who represents an
incapacitated insured individual to the insurer (the representative is chosen by the
insured or by administrative or judicial procedure for an incapacitated individual);
(7) "home health care" means medical and such nonmedical services as
homemaker service, assistance with activities of daily living and respite care;
(8) "insured individual" with respect to a long-term care insurance policy
means the individual covered by the policy;
(9) "insurer" means a person (including an agent) offering or selling a long
term care insurance policy under which the person is at risk for all or part of the cost
of benefits under the policy;
(10) "long-term care insurance policy" has the meaning given the term in
section 4 of the NAIC Model Act except that the last sentence of that section does not
apply;
(11) "NAIC Model Act" means the model act as amended through January
1993;
(12) "NAIC Model Regulation" means the model regulation as amended
through January 1993;
(13) "nursing facility" means a state-licensed facility providing skilled nursing
care, rehabilitation services and health-related care and services for individuals
requiring these types of care;
(14) "policyholder" means the entity that is the holder of record of a group
long-term care insurance policy;
(15) "residential care facility" means a facility (including a nursing facility)
providing residents with medical or personal care services in a setting other than an
individual or single-family home, and does not provide services at a higher level of
care than can be provided by a nursing facility;
(16) "respite care" means temporarily providing care to an individual, in his or
her home, to relieve individual's unpaid caregiver for a period of time;
(17) "state insurance commissioner" means the state official with that title or,
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�\
absent the title, with prima.ry responsibility for regulating insurance.
SUBPART B -- FEDERAL STANDARDS AND REQUIREMENTS
Section ,2321. Requirements to Facilitate Understanding and Comparison of
Benefits. (a) The Secretary, after considering advisory council recommendations, must issue
regulations to standardize the formats and terminology of long-term care insurance policies,
to require insurers to provide customers and beneficiaries with information on available
public and private long-term care coverage, and to establish other requirements to promote
consumer understanding 'and facilitate comparisons of benefits. The "other requirements"
must at least .include the following requirements in this section.
(b) The Secretary must require insurers to use uniform terminology, definitions of
terms, and formats in long-term care insurance policies.
(c) The Secretary must require insurers to provide an outline of coverage under a
long-term care insurance policy as part of each policy, to make such an outline available to
each potential purchaser and provide such an outline to each insured individual and
policyholder. The outline must be in the uniform format prescribed by the Secretary, must
reflect the contents of the policy clearly and accurately, must be periodically updated, and
must include at least the following elements:
(A) a description of principal. benefits covered including services in residential
care facilities, terms for obtaining upgraded benefits, benefit "triggers" and principal
exclusions from and limitations on coverage;
(B) a statement of terms under which a policy may be returned with a refund
during a period for initial examination (of the policy), continued in force or renewed,
or converted from group to individual coverage;
(C) 'a statement of circumstances in which a policy may be terminated and if
applicable, a refund obtained including the death of the insured, nonpayment of
premiums, decision by the insured not to renew, and any other circumstance;
(D) a statement of the total annual premium, any right reserved by the insurer
to change premiums, any limitation on annual premium increases, any expected
premium increases, and circumstances for waiver of premiums payment;
(E) a readily understandable statement in boldface type, on the face of the
document, that the outlin~~ is a summary, not the contract of insurance.
(F) information on average costs for nursing facility and other types of care as
specified by the Secretary; information on the value of the policy benefits relative to
such care costs, and a comparison of policies, for a period of 20 years or more, of
policies with and without protection for inflation. The outline must also declare
whether the amount of benefits will increase over time and any limitations on and
premium increases for the benefit increases;
(G) a statement of the Federal income tax treatment of premiums and benefits
under the policy, as determined by the Secretary of the Treasury;
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�(H) other infonnation required by the Secretary of HHS.
(d) The Secretary of HHS must require each insurer to report specified infonnation
each year to each state insurance commissioner in which the insurer sells a long-tenn care
insurance policy. Information that must be reported includes the standard outline of coverage
(above), rates of policy lapses and replacements; the ratio of premiums collected to benefits
paid; reserves; written materials used in selling or promoting the policy; and other
infonnation required by the Secretary.
(e) The Secretary must require each insurer to provide to each individual, before he
or she buys a long-tenn insurance policy from the insurer, infonnation on eligibility and
benefits under the insurer's policy, and on additional benefits available under policies of
other private insurers, and infonnation on eligibility'and benefits under each public long-tenn
care program administered by the state, Medicare programs, and each regional alliance in the
state. The insurer is obligated to provide the above information to the extent that it is
available from the state insurance commissioner.
Section 2322. Requirements Relating to Coverage. (a) The Secretary, after
considering advisory council recommendations, must issue regulations on requirements for
tenns of and benefits under long-term care insurance policies. The regulations must include
at least the following requirements in this section.
(b)(1) A long-tenn care insurance policy may not exclude or limit coverage for
a condition or disability because the insured was treated for or diagnosed with the
condition before the policy was issued; ho:wever, an insurer may so exclude or limit
coverage if
(A) the insurer detennines before issuing the policy that the insured had
the condition during the six months before the effective date of the policy or
(B) the need for or the service benefit begins within six months after
the effective date of the policy.
(2) The effective date of.a replacement policy, for purposes of these exclusion
and limitation rules, is the effective date of the policy being replaced.
(c)(l) A long-tenn care insurance policy may not condition an insured's
eligibility for benefits on:
(A) a requirement for prior hospitalization or the need for any other
type of service;
(B) a particular medical diagnosis or group of diagnoses;
(C) compliance by licensed or certified providers of the benefits sought
with any condition') not required by Federal or state law;
(D) the benefits being provided at a higher level of care thart is needed
by the insured.
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�(2) A long-tenn care insurance policy that provides benefits for home or
community-based services at some other site than a residential care facility
(A) may not limit the benefits to services of registered or licensed
practical nurses;
(B) may not limit benefits to persons or entities participating in
Medicaid, Medicare, or part 1 of this subtitle; and
(C) must at least cover personal assistance with activities of daily living
and home health, adult day and respite care.
(3) A long tenn care insurance policythat provides benefits for any nursing
facility services:
(A) must cover such services provided by all types of nursing facilities
licensed in the state; and
(B) may cover care in other residential facilities.
(4) A long-tenn care insurance policy may not discriminate against certain
medical conditions with respect to the "threshold conditions that detennine whether
an insured will receive benefits and in the amount of benefits. The conditions for
which such different treatment is prohibited are:
(A) Alzheimer's disease or any other progressive degenerative
dementia of organic origin;
(B) any organic or inorganic mental illness;
(C) mental retardation or any other cognitive or mental impainnent;
and
(D) mv infection or AIDS.
It
(d)(l)An insurer selling a long-tenn care insurance policy must offer the
purchaser the option of in11ation protection (annual increases in benefits) if the
purchaser pays higher premiums.
(2) The increases for each year must reflect a percentage of the full value of
benefits for the previous year, but no less than 5 percent of that value (or the rate of
increase detennined by th.e Secretary to be adequate).
(3) The inflation protection described above may be excluded from an
individual's coverage only if the individual objects to it in writing.
Section 2323. Requirements Relating to Premiums. (a) The Secretary, after
considering advisory council recommendations, must issue regulations on requirements for
premiums for long-tenn care insurance coverage. The regulations must include at least the
requirements in this section.
(b) The Secretary, after considering advisory council recommendations, may establish
by regulation appropriate standards· and requirements for
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�(1) mandatory or optional state procedures for reviewing and approving
premium rates and increases or decreases in such rates;
(2) limits on the amount of initial premiums or on the rate or amount of
premium increases;
(3) the factors to be considered by an insurer in proposing and a state in
approving or rejecting rates and increases of premiums;
(4) the extent of consumer participation or representation in rate-setting, and
consumer access to infomtation used in setting rates.
Section 2324. Requirements Relating to Sales Practices. (a) The Secretary, after
considering advisory council recornmendations, must issue regulations on requirements for
the selling and offering for sale long-term care insurance policies. The regulations must
include at least the requirements in this section.
(b) An insurer offering a long-term care insurance policy must meet requirements
established by regulation for the content, format and use of application forms for the policies.
(c) An insurer may not sell or offer a long-term care insurance policy through an
agency who fails to comply with minimum training and certification standards established
by the Secretary .
(d) An insurer may not pay more in compensation to agent(s) for sales or servicing or
renewing long-term care insurance policies than the maximum specified by the Secretary in
regulations.
(e) The following practices are prohibited in the sale or offering of long-term care
insurance policies:
(1) false and misleading representations;
(2) inaccurate completion of medical history of an applicant for insurance;
(3) using force, fright or other undue pressure to induce the purchase of a
policy;
(4) "cold lead advertising," which means any method of inducing an individual
to contact an insurer or agent for the purpose of inducing the individual to buy
insurance, if that purpose is not disclosed conspicuously;
(f) An insurer or agent may not sell or issue a long-term care insurance policy that
the insurer or agent knows (or should know) duplicates coverage that the purchaser already
has (except to replace a duplicative policy).
(g)(l) In sales of long-term care insurance endorsed by or sold through an
employer, organization, association or other entity,
(A) the insurer must not sell through the entity unless certain
requirements are met; and
(B) the entity receiving compensation for the sale or marketing shall be
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�considered the insurer's agent.
(2) The entity that endorses a long-tenn care insurance product must:
(A) disclose prominently to individuals receiving insurance policy
infonnation: the manner in which the entity selected the insurer and the policy;
the extent to which the policy was evaluated by an experienced, independent
analyst; organizational or flnancial connections between the entity and the
insurer (or a related entity or insurer); and the nature and amount of any
compensation for tbe endorsement or sale of the policy.
(B) make counseling available, directly or through referrals, to potential
purchasers of the policy.
Section 2325. Continuation, Renewal, Replacement, Conversion, and Cancellation
of Policies. (a) The Secretary, after considering Advisory Council recommendations, must
issue regulations on requirements for renewal, replacement, conversion and cancellation of
long-tenn care insurance policies . The regulations must include at least the requirements in
this section.
(b) Each insured individual must have an unconditional right to return a policy within
30 days after it is issued and delivered and to receive a full refund of the premium he or she
has paid.
(c) An insurer has the right to cancel a long-tenn care insurance poiicy, or to refuse
to pay a claim, on the basis of evidence that the insured falsifled or failed to disclose
infonnation material to eligibility for coverage but only if
(1) the insurer produces written documentation at the time of application that
the insurer requested the infonnation that was withheld and the individual's response;
(2) the insurer produces medical records of evidence showing that the insured
knew or should have known that infonnation furnished was false, misleading or
incomplete;
(3) the notice of cancellation is provided within three years of the policy's
effective date; and
(4) the insured has an opportunity to refute the insurer's evidence.
(d)(l) Insurers have the right to cancel long-tenn care insurance policies for
nonpayment of premiums,· subject to certain requirements:
(2) the requirements are as follows:
(A) the insurer must give written notice not earlier than the date on
which the payment is 30 days past due and 30 days must elapse to pennit the
insured to respond to the notice;
(B) the notice requirement in the case· of group policies applies to each
insured individual.
(3) the insurer must reinstate the individual retroactively to the date- of
cancellation if the insurer receives within 5 months of the date of cancellation
evidence that the individual was incapacitated and all premiums due and late charges
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�are paid.
(4) incapacitation is defmed as a detennination of incapacitation by a qualified
health professional of a cognitive impainnent or loss of functional capacity which
could reasonably be expected to render the individual pennanently or temporarily
unable to deal with business or fmancial matters.
(5) the insurer must: pennit an individual to designate a representative at the
time of sale for purposes of communication concerning premium payments or to
complete a signed and dated statement declining such representation.
(e) The Secretary, after considering advisory council recommendations, must by
regulation require appropriate nonforfeirure benefits in any long-tenn care insurance policy
that lapses for any reason (including non-payment, cancellation or failure to renew but
excluding lapses due to death) after it has been in effect for a specified minimum period of
time. The percentage of non-forfeiture benefits must increase with·the amount of premiums
paid.
(0(1) Insurers may not cancel or refuse to renew or replace a long-term care
insurance policy for any reason other than fraud or material misrepresentation or for
nonpayment of premiums.
(2) Each policy must clearly state its duration, the insured's rights and
conditions for renewal, the date and manner by which an option to renew must be
exercised, and any applicable restrictions or limitations consistent with this part.
(3) An insurer may not sell a replacement policy to an individual or group that
reduces any individual's coverage as a replacement for his or her more generous
policy. Individuals may knowingly and willfully elect to substitute a less generous
policy as a replacement policy.
(4)(A) Each group long-tenn care policy must pennit each insured
policyholder at the insurer's option to continue or convert coverage with equivalent
coverage (as detennin~d by guidelines issued by the Secretary). Insurers must comply
with other requirements for continuation, renewal, replacement or conversion of long
term care insurance policies that are established by the Secretary.
(B) Insurers must allow continuation in cases in which the relationship
of related individuals covered jointly is tenninated by death or divorce.
(C) Insurance policies meet continuation requirements if the same
benefits are maintained, subject only to timely payment requirements.
(D) Insurance policies meet conversion requirements if each previously
covered individual is entitled to a replacement policy with benefits at least
identical or substantially the same without requiring evidence of insurability
and at premium rates no higher than the initial group policy rate.
(5) The Secretary must develop long term care comparison guidelines for the
purpose of detennining whether policy benefits are substantially equivalent. Prior to
the effective date of Federal guidelines, state insurance commission guidelines for
substantial equivalence shall· apply.
(6) The Secretary may establish other requirements for cancellation,
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�continuation, conversion, renewal and replacement.
Section 2326. Requirements Relating to Payment of Benefits. (a) The Secretary,
after considering advisory council recommendations, must issue regulations establishing
requirements for claims for and payment of benefits under long-term care policies. The
regulations must include at least the requirements in this section.
(b) Each long-term care insurance policy must meet certain requirements with respect
to identifying and determining if an insured person meets threshold coverage conditions:
(1) the policy must specify the level of functional or cognitive impairment
needed (the "threshold conditions") to receive benefits under the policy. The
Secretary may require the use of standardized thresholds. Each policy must provide a
procedure for determining whether the threshold conditions have been met for an
insured individual.
(2) Each policy must apply uniform procedures for determining whether
threshold conditions have been met which:
(A) apply uniform standards, procedures and formats if specified by the
Secretary;
(B) permit an initial evaluation by a qualified independent assessor
(selected by the individual or a representative) of whether the threshold
conditions have been met;
(C) permit the insurer to obtain a reevaluation by an evaluator chosen
and paid for by the insurer;
(D) provide that the insurer will consider the threshold conditions as
having been met in cases in which the insurer does not reevaluate or where
both the initial evaluation and the reevaluation conclude that the conditions are
met.
(E) provide for a fmal resolution by a state agency where the initial and,
reevaluation reach inconsistent conclusions.
(3) a qualified independent assessor means a licensed or certified professional
who meets standards established by the Secretary after consulting with the Secretary
of the Treasury, who has no significant or controlling fmancial interest in the insurer
or is not an employee of the insurer.
(c) Insurers must ·be required to promptly payor deny claims for benefits by
individuals meeting threshold conditions, provide written explanations for their actions on
claims, and provide an administrative procedure for appealing a denial of a claim.
SUBPART C - ENFORCEMENT
Section 2342. State Programs for Enforcement of Standards. (a) A state is eligible
for enforcement grants under this subpart, if the state has a program that meets certain
conditions under rules of the Secretary.
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�(1) the program must include the elements required under this subpart; and
(2) the program must be designed to ensure compliance with the requirements
established under subpart B, both for long-term care insurance policies sold in the
state and for insurers offering such policies and their agents.
(b) A state program must provide for:
(1) monitoring compliance of insurers doing business in the state and of long
term care insurance policies sold in the state with requirements under this part. The
state program must provide for review, certification and annual recertification of each
such policy sold in the state, annual reporting by insurers needed to ensure
compliance, data collection from insurers, service providers, insured individuals and
others, and oversight of insurers' marketing practices, and procedures for monitoring
insurers' administration of benefits including determination of eligibility and actions
on claims for payment;
(2) procedures for providing insurers with information on eligibility and
benefits under public long··term care programs administered by the state, so that
insurers can comply with 1he consumer-information requirements of section
2321(e)(3);
(3) procedures for investigating and resolving consumer complaints and
disputes with regard to long-term pare insurance conduct under this law or other
applicable laws including disputes over eligibility, amounts payable and other issues
involving the rights and responsibilities of insurers and insured persons;
(4) technical assistance to insurers to help insurers comply with requirements
of this part and other relevant state laws.
(c) A state program must ensure that the state insurance commissioner (or other
appropriate authority) has the authority to:
(1) prohibit the sale or marketing of any long-term care insurance policy that
does not comply with requirements of this part;
(2) require an insurer to develop, submit for state approval and carry out in
less than one year a correction plan for practices that do not comply with
requirements of this part as a condition of continuing to do business in the state;
(3) direct an insurer out of compliance with requirements of this part (subject
to appropriate due process) to eliminate the noncompliance within 30 days;
(4) assess civil money penalties for each violation up to the greater of $10,000
or three times the amount of the commission involved, for violations of requirements
concerning compensation or sale of policies, prohibited sales practices, and
prohibition on sale of duplicate benefits, for such other violative acts as the Secretary
specifies in regulation and other cases as the state fmds appropriate; and
(5) other authority that the state finds appropriate or necessary for enforcing
requirements under this part.
(d) A state must maintain the records, make the reports, and cooperate with the
audits that the Secretary fmds necessary to determine compliance with this part.
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�(e)(1) The Secretary must approve a state program meeting the requirements of this
part.
(2) the Secretary must also provide the state official chiefly responsible for
regulating long tenn care insurance with a description of the Medicare programs,
making clear the unavailability of long-term care under the programs, for distribution
to insurers selling long-term care insurance in the state.
Section 2342. Authorization of Appropriations for State Programs. For states
with programs meeting the requirements of this part, the following amounts are authorized:
$10,000,000 for fiscal year 1996; $10,000,000 for fiscal year 1997; $7,500,000 for fiscal
year 1998; and $5,000,000 for fiscal 1999 and each fiscal year thereafter. These funds are
available until spent.
Section 2343. Allotments to States~ A state's allotment for its long-term care
insurance program (if the program is approved under this part) is an amount determined by
the Secretary, taking into account the numbers of policies for such insurance sold in the
state, the number of its elderly residents, and other factors.
Section 2344. Payments to States. A state with an approved program is entitled to
an annual payment of its allotted funds, for up to fifty percent of the cost of the program's
activities. A state may not use funds from any Federal source to pay its share of program
costs under this subpart.
Section 2345. Federal Oversight of State Enforcement. (a) The Secretary must
periodically review state regulatory programs approved under 2341 for compliance with
requirements of this part.
(b) If the Secretary determines that a state program is not in compliance, the
Secretary must notify the state specifically of the problem and permit the state a reasonable
opportunity to correct the' problem (including time' to develop and secure the Secretary's
approval of a correction plan). The Secretary must withdraw approval of the state program
if it fails to eliminate the problem by the date set by the Secretary.
(c) Where a correction plan is needed, the Secretary may permit a state reasonable
time after notice to develop a correction plan for the Secretary's approval and permit the
state reasonable time to eliminate the cause for non-compliance.
(d) The Secretary must withdraw approval in the case of states that fail to cure the
non-compliance problem by the specified date.
Section 2346. Effect of Failure to Have Approved State Program. (a) No insurer
may sell or market any long-term care insurance policy in a state without an approved
regulatory program. A policy shall not be considered sold or offered for sale solely because
it is sold or offered to a resident of the state.
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�(b) An insurer is subject to a civil money penalty of up to the greater of $10,-000 or
three times any commission involved for each instance in which the insurer sells or markets
a long-term car~ insurance policy in violation of subsection (a). The Secretary shall enforce
this provision in accordance with civil money penalty procedures under section 5412 of the
Health Security Act.
(c) The prohibition on sales and marketing in subsection (a) takes effect one year after
the date that the Secretary fIrst promulgates regulations on the prohibition. However, if a
state requires state legislative action to comply, it will not be considered to be out of
compliance until the fIrst day of the fIrst calendar quarter that begins after the fIrst regular
session of the state legislature following promulgation of the regulation.
SUBPART D -- CONSUMER EDUCATION GRANTS
Section 2361. (a) The Secretary may make grants for developing and implementing
long-term care insurance information, counseling and other programs; the grants may be
made to states, regional alliances (at the option of the state in which an alliance is located)
and national organizations representing insurance consumers, long-term care providers and
insurers.
(b) Applications for grants must be in the format and include information required by
the Secretary. The goals of programs under this section are to increase consumer
understanding and awareness of their long-term care options with regard to risks of needing
long-term care and costs of .these services, shortfalls in long-term care coverage under
Medicare, supplementary Medicare ("medigap"), policies, standard private health insurance
and state programs; availability, variations in coverage and common features of private long
term care insurance and pitfalls to avoid when purchasing such insurance.
Grants under this section may fund appropriate activities including coordination of
public and private entities to carry out a grant-funded program; collection; analysis,
publication and dissemination of information; consumer education, outreach and information
programs; consumer counseling and consultation programs and other appropriate activities.
Grants proposing innovative approaches to assisting individuals who might benefIt from or
are considering buying long~term care insurance must be given priority.
(c) Grants may not be longer than 3 years.
(d) Each grantee must annually evaluate its program effectiveness and report on it to
the Secretary and the Secretary must report annually to Congress on program effectiveness.
(e) The following amounts are authorized for grants under this section: for grants to
states, $10,000,000 for each year in fIscal years 1995 through 1997; for grants to eligible
organizations, $1,000,000 for each of fIscal years 1995 through 1997.
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�PART 4 - TAX TREATMENT OF LONG-TERM CARE INSURANCK
AND SERVICES
Section 2401. Reference to Tax Provisions. For amendments to the Internal
Revenue Code of 1986 relating to the treatment of long-term care insurance and services, see
subtitle G of title VI.
PART 5 - TAX INCENTIVES FOR INDIVIDUALS WITH DISABILITIES
WHO WORK
Section 2501. Reference to tax provision. For amendment to Internal Revenue Code
of 1986 providing for a tax credit for cost of personal assistance services required by
employed individuals, see section 7901.
PART 6 -:-- DEMONSTRATION AND EVALUATION
Section 2601. Demonstration on Acute and Long-term Care Integration. (a) The
Secretary must establish a demonstration program to test the effectiveness of various
approaches to fmancing and providing integrated acute and long-term care services for
chronically ill or disabled persons who meet the eligibility criteria in this part.
(b)(1) Except as permitted by the Secretary, each demonstration approved under this
section must offer the following services and benefits:
(A) the comprehensive benefit package under Title I of the Health
Security Act;
(B) benefits relating to the transition from acute to long-term care
including: assessment and consultation; medical rehabilitation; inpatient
transitional care; home health care and home care; caregiver support and self
help technology;
(C) long-term care benefits, including adult day care; personal
assistance services; homemaker and chore services; home-delivered meals;
respite services; nursing facility services in specialized care units and in other
residential settings; and assistive devices and environmental modifications; and
(D) specialized habilitation services (for participants with developmental
disabilities) .
(2) The Secretary may allow a demonstration to omit long-term care services
and specialized habilitation services under sub-paragraphs (C) and (D) or to provide
additional services if the Secretary determines this appropriate, taking into
consideration such factors as the needs of a specialized group of beneficiaries, the
availability of the omitted services under other programs, and the geographic
availability of services. The Secretary must assure that in approving demonstrations
that vary from the benefit list under paragraph (1), the demonstrations as a- group will
adequately test financing and delivery models for all of the required services.
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�(c) The Secretary must establish eligibility criteria for individuals receiving benefits in
the demonstrations. The following groups of individuals may be eligible under the criteria:
(I) individuals with disabilities who are entitled to services and benefits from a
state program under part 1. of this subtitle (home and community care);
(2) individuals entitled to benefits under parts A and B of Medicare (title
XVIII of the Social Security Act);
(3) individuals entitled to Medicare who are also medical assistance recipients
or SSI beneficiaries.
(d)(I) Applications by entities to participate in a demonstration must be in the
format and contain the information required by the Secretary.
-(2) An application must state the services to be provided (either directly or
through participation agreements); and
(A) enrollment services;
(B) client assessment and care planning;
(C) simplified access to needed services;
(D) integrated management of acute and chronic care, including
. measures to assure continuity of care;
(E) quality assurance, grievance and appeals mechanisms; and
(F) other services that the Secretary may require.
(3) The applicant must provide evidence of consumer participation in planning
and conducting the demonstration (including aspects of the demonstration such as
information on self-help, health promotion and disability prevention practices, enrollee
contributions to the cost of care, care planning and decisions concerning treatment,
grievance resolution and appeals procedures, quality assurance and provider
contracting, and consumer satisfaction evaluation).
(4) Applicants must meet eligibility criteria established by the Secretary,
including the existence of adequate fmancial controls, a demonstrated commitment to
the goal of the demonstration, adequate information systems, and compliance with
applicable state laws.
(e) An entity conducting a demonstration is entitled to receive, for each period of
services for each enrollee, such payment amounts as the Secretary provides. These amounts
may include risk-based and non-risk-based payments by government programs, third parties,
program enrollees or any combination of such payments. Amounts paid by the Secretary
may vary by project and by enrollee.
(f) The Secretary must publish a request for applications under this section no later
than a year after the Act is enacted, and must authorize no more than 25 demonstrations,
each to last for 7 years from the date of the award.
(g) The Secretary must evaluate the demonstration projects and make interim and
final reports to Congress. The fmal report must contain recommendations regarding whether
to include some or all of the tested models for integrated services in the benefit package of
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�title I of the Act or in Medicare.
(h) The following amounts are authorized for costs of the demonstration authorized in
this section (including costs of technical assistance and research and evaluation): $7,000,000
for fiscal year 1996 and $4,500,000 for each of the six fiscal years thereafter. Authorized
funds are available until spent.
Of the total authorized above, no less than $1,000,000 must be made available for
studies of the feasibility of systems to provide integrated care for non-aged populations).
Funds are also authorized for costs of benefits for which no public or private program
or entity is legally obligated to pay. The amounts authorized for this purpose are
$50,000,000 for the first fiscal year in which grants are awarded under the section and in
each of the four following years.
Section 2602. Performance Review of the Long-term Care Programs. (a) The
Secretary must make interim and final reports to Congress on the effectiveness of programs
established under this subtitle. The interim report must be made no later than the end of the
seventh full calendar year that begins after enactment of the Act, and the fmal report by two
years later.
(b) Evaluations must address at least states' effectiveness in delivering services,
access to and quality of services, the performance of the private sector in offering affordable
and adequate long-term care insurance, costs of insurance, and the effectiveness of the
programs to integrate long-term, and acute care and social services.
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�TITLE
m - PUBLIC HEALTH INITIATIVES
SUBTITLE A - WORKFORCE PRIORITIES UNDER FEDERAL PAYMENTS
(H.R. 3600 and S. 1757 p. 504)
PART 1 - INSTITUTIONAL COSTS OF GRADUATE MEDICAL EDUCATION;
WORKFORCE PRIORITIES
SUBPART A - NATIONAL COUNCIL REGARDING WORKFORCE PRIORITIES
Section 3001. National Council on Graduate Medical Education. (a) Establishes
the Council on Graduate Medical Education within the Department of Health and Human
Services.
(b) Requires the Secretary to carry out Subpart B (dealing with the allocation of
residency positions among specialties and programs) through the Council.
(c) Specifies the following categories of private sector individuals to be included in
the membership of the Council:consumers; medical school faculty; physicians in private
practice; officers or employees of health alliances; officers or employees of health plans;
others determined to be appropriate by the Secretary. Also authorizes appointment of
Federal officers or employees as ex officio members of the Council.
(d) Requires the Secretary to designate one member as Chair.
(e) Defmes "medical school" as a school of medicine or of osteopathic medicine,
referencing section 799 of the Public Health Service Act.
SUBPART B--AUTHORlZED POSITIONS IN SPECIALITY TRAINING
Section 3011. Cooperation Regarding Approved Physician Training Programs.
(a) With respect to funding under section 3031 (Subpart C), requires that approved physician
training programs enter into agreements that the number of enrollees in their programs will
be in accordance with this subpart.
(b) Defmes an "approved physician training program" as any postgraduate physician
training program participation in which may count toward specialty certification. Includes
programs based in ambulatory settings whether or not they also provide inpatient hospital
services. Defmes "eligible program" as an approved physician training program receiving
funding under Subpart C,. Includes all medical, surgical and other physician specialties and
subspecialties within the term "medical specialty. "
Section 3012. Annual Authorization of Number of Specialty Positions;
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�Requirements Regarding Primary Health Care. (a) Requires the National Council to
designate for each academic year the number of individuals who are authorized to be enrolled
in eligible programs.
(b) Requires that at least 55 percent of individuals completing eligible programs
nationwide be in primary care, beginning with the class entering training in the year 1998
99.
(c) Requires the National Council to designate the number of positions in each
specialty for three academic years at a time, beginning with 1998-99 through 2000-01.
(d) Specifies that the need for additional practitioners in the specialty be included
among the factors considered by the National Council in designating specialty positions.
Requires the National Council to consider the recommendations of organizations representing
physicians in particular specialties and of organizations representing consumers of the
services of such physicians. Requires the National Council to ensure that the total number of
residency positions nationwide bears a relationship to the number of graduates of U. S.
medical schools consistent with the purpose of this subpart, beginning with academic year
1998-99, and is reduced between the years 1998-99 through 2002-03.
(e) Dermes "primary health care" as family medicine, general internal medicine,
general pediatrics, and obstetrics and gynecology.
Section 3013. Allocations Among Specialties and Programs. (a) Requires the
National Council to allocate the designated annual number of specialty positions nationwide
among eligible programs.
(b) Requires that the allocations among programs be done for three years at a time,
with at least one year advance notice to programs, with the first allocations beginning in
academic year 1998-99.
(c) Requires that the historical distribution of specialty positions among different areas
of the country and the quality of each of the programs be included among the factors
considered in making allocations among programs. Requires that the following be included
among the factors considered by the National Council in making an allocation for an eligible
program: the extent to which the program includes training participants who are members of
racial or ethnic minority groups and the extent to which such group is underrepresented in
the field of medicine or its specialties. Requires that the National Council consider
recommendations of organizations representing physicians in particular specialties and of
organizations representing consumers of the services of such physicians in making allocations
among programs.
SUBPART C -- INSTITUTIONAL COSTS OF GRADUATE MEDICAL EDUCATION
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�Section 3031. Federal Formula Payments to Approved Physician Training
Programs. Requires the Secretary to make payments for the operation of approved physician
training programs that submit applications (in accordance with section 3032), beginning in
calendar year 1996.
Section 3032. Application for Payments. (a) Requires that applications for payment
be submitted on a timely basis; contain the described funding agreements and provide
assurances of compliance with those agreements that are satisfactory to the Secretary; are in
the form and manner and contain infonnation required by the Secretary; and contain
agreements by the institution within which the program operates that payments will be made
directly to. the program by the Secretary ..
(b) Institutions operating residency programs must meet these requirements as a
condition of participation as providers in alliance health plans.
Section 3033. Availability of Funds for Payments; Annual Amount of
Payments. (a) Establishes an annual health professions workforce account to contain
amounts detennined by the Secretary to be necessary for making payments to operate eligible
programs and to make transitional payments to programs (under section 3051, dealing with
programs that lose residency positions), within the following limitations for specified
calendar years: $3,200,000,000 in 1996; $3,550,000,000 in 1997; $4,800,000,000 in 1998;
$5,800,000,000 in 1999; $5,800,000,000 in 2000; and in subsequent years, $5,800,000,000
increased by the general health care inflation factor (as defmed in section 6001(a)(3» for
each year.
(b) Payments to each.eligible program shall equal thefull-time-equivalent number of
residents in the program multiplied by the national average of the costs of training residents
(as determined for the academic year 1992-93, trended forward by the consumer price index
for each year, and adjusted to reflect regional differences in wage and wage-related costs).
(c) Payments in any year will be pro-rated if necessary on the basis of available
funds. Under section 4051, payments under Medicare for direct graduate medical education
costs are tenninated for cost reporting periods beginning on or after October 1, 1995.
Section 3034. Additional Funding Provisions. Funds for the annual health
professions workforce account are to come from three sources: Medicare, corporate
alliances, and regional alliances.
Under section 4051, Medicare is required to make transfers from the Part A and Part
B Trust Funds at the rate at which payments for the direct costs of graduate medical
education would have been made, in the amount of $1,500,000,000 in fiscal year 1996 and
$1,600,000,000 for fiscal years 1997 and 1998, and for years beyond 1998 at the- 1998 rate
increased by the consumer price index.
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�After the level of Medicare payments is determined, corporate and regional alliances
pay the balance needed in the annual health professions workforce account, with such
payments coming from the 1 percent corporate alliance assessment (under section 7121) and
the 1.5% regional alliance assessment (under section 1353). For 1996 and 1997, one-half of
such regional alliance payments are available for the annual health professions workforce
account, with the remainder made available from payments by corporate alliances. In
subsequent years, payments into the annual health professions workforce account are made in
proportion to the total payments to corporate and regional health plans by corporate and
regional alliances, respectively.
Beginning in 1996 an additional transfer of funds is made equal to 50 percent of the
amount made available for graduate nurse education under section 3063(b),.
SUBPART E - TRANSITIONAL PAYMENTS
Section 3051. Transitional Payments to Institutions. The Secretary must make
payments to institutions that operate programs that lose specialty training positions as a result
of allocations by the National Council. Applications for payment must be submitted on a
timely basis; contain the described funding agreements and provide assurances of compliance
with those agreements that are satisfactory to the Secretary; and be in the form and manner
and contain information required by the Secretary. The institution requesting payment must
have cooperated with the programs in permitting payments to be made directly to the
programs by the Secretary.
Payments are equal to the number of full-time-equivalent specialty positions lost
(equal to the difference between the positions for which payment will be made under section
3031 and the number of full-time-equivalent specialty positions at the institution for academic
year 1993-94) multiplied by the national average salary of training participants (as
determined for the academic year 1992-93, trended forward by the consumer· price' index for
each year, and adjusted to reflect regional differences in wage and wage-related costs).
Payments may begin in calendar year 1998 or the fIrst year that the programs of the
institution experience a net reduction in specialty positions because of the allocations by the
Council. Such payments are to be made over a four year period. Payments in the fIrst year
are equal to the amount calculated above in the fIrst year, but decline by 25 percent in each
of the three succeeding years.
PART 2 - INSTITUTIONAL COSTS OF GRADUATE NURSING EDUCATION;
WORKFORCE PRIORITIES
Section 3061. National Council; Authorized Graduate Nurse Training Positions;
Institutional Costs. (a) Establishes a program with respect to graduate nurse training that
parallels the program for approved physician training programs under part 1.
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�(b) Such pr'Ograms are 'Ones f'Or advanced nurse educati'On, nurse practiti'Oners, nurse
midwives, nurse anesthetists, and 'Other training in clinical nurse specialties determined by the
Secretary t'O require advanced educati'On. Pr'Ograms must meet the c'Onditi'Ons defined in
secti'Ons 821, 822, and 831 'Of the Public Health Service Act.
Section 3062. Applicability of Part 1 Provisions. (a) The pr'Ovisi'Ons 'Of part 1, ,
apply t'O the graduate nurse training program under secti'On 3061 in the same extent and
manner as they apply t'O the graduate physician training pr'Ograms, except as they are
m'Odified in this part. (b) F'Or the purp'Oses 'Of this pr'Ogram, the c'Ouncil is the Nati'Onal
C'Ouncil 'On Graduate Nurse Educati'On. The c'Ouncil will make all'Ocati'On 'Of nurse training
positi'Ons in the same way as the C'Ouncil 'On Graduate Medical Educati'On d'Oes f'Or physician
residencies.
Section 3063. Funding. The am'Ount available f'Or graduate nurse training pr'Ograms
under this part is $200,000,000 annually, pr'Ovided as direct transfers fr'Om the Treasury
under secti'Ons 3034, and 3104. Under secti'On 4051, payments under Medicare f'Or the c'Osts
'Of appr'Oved educati'Onal pr'Ograms other than direct graduate medical educati'On c'Osts are
specifically c'Ontinued f'Or c'Ost reporting peri'Ods beginning 'On 'Or after Oct'Ober 1, 1995.
PART 3 -- RELATED PROGRAMS
Section 3071. Programs of the Secretary of Health and Human Services.
(a) Auth'Orizes t'O be appr'Opriated $400,000,000 f'Or fiscal year 1994 and each year thereafter,
f'Or carrying 'Out the pr'Ograms described in this secti'On, in additi'On t'O am'Ounts 'Otherwise
auth'Orized t'O be appropriated f'Or such pr'Ograms. Requires the Secretary 'Of Health and
Human Services t'O carry 'Out the pr'Ograms in this secti'On.
I
(b) Establishes 'Or expands existing programs with respect t'Otraining primary care
physicians and physician assistants, including pr'Ograms t'O train additi'Onal numbers 'Of
physicians and physician assistants; t'O retrain mid-career physicians previ'Ously certified in a
n'Onprimary care specialty; t'O expand the supply 'Of physicians with special training t'O serve
in medically underserved areas; t'O expand service-linked educati'Onal netw'Orks f'Or training in
c'Ommunity settings; t'O provide training in managed care, practice management, and
c'Ontinu'Ous quality impr'Ovement; and t'O enhance inf'Ormati'On 'On primary care w'Orkf'Orce
issues.
(c) Establishes 'Or expands pr'Ograms with respect t'O training 'Of underrepresented
min'Orities and disadvantaged pers'Ons, including pr'Ograms t'O increase the number 'Of such
pers'Ons in the health pr'Ofessi'Ons thr'Ough fmancial assistance, recruitment and retenti'On,
enhancing interest at the prepr'Ofessi'Onallevel, and training 'Of additi'Onal min'Ority health
pr'Ofessi'Ons faculty.
(d) Establishes 'Or expands pr'Ograms with respect t'O training 'Of nurses, including
training additi'Onal numbers 'Of nurse practiti'Oners and nurse midwives; baccalaureate nurses
Title III
113
�for careers in teaching, community health service and specialized clinical care; nurse
clinicians and nurse anesthetists; and, school-based community nurses; also programs to
promote research on nursing workforce issues.
(e) Establishes a program to develop and encourage adoption of model practice
statutes for advanced practice nurses and physician assistants, and other to support efforts to
remove inappropriate barriers to practice by advanced practice nurses and physician
assistants.
(f) Establishes or expands programs with respect to training health professionals and
administrators in managed care, cost-effective practice management, continuous quality
improvement-practices, and provision of culturally sensitive care.
(g) Author~es the Secretary to carry out these programs through existing programs in
Titles VII and VIII of the Public Health Service Act.
Section 3072. Programs of the Secretary of Labor. (a) Authorizes to be
appropriated $200,000,000, for fiscal year 1994 and each year thereafter, for carrying out
the programs described in this section, in addition to amounts otherwise authorized to be
appropriated for such programs. Requires the Secretary of Labor to carry out the programs
in this section.
(b) Establishes programs to provide for skills upgrading and occupational retraining
(including retraining health care workers as technicians, nurses, and physician assistants) and
for quality and workforce improvement; to assist health care workers in career advancement;
to develop health worker job banks; to provide for joint labor-management decision-making
on workplace matters; and to facilitate the comprehensive workforce adjustment initiative.
(c) Requires the Secretary of Labor, in carrying out programs under this section, to
provide for specific skill requirements, internal career movement opportunities, employment
during retraining, .evaluation and dissemination.
(d) Requires the Secretary, in carrying out programs under this section, to provide for
joint labor-management implementation and administration and discussion and consultation.
Section 3073. National Institute for Health Care Workforce Development.
(a) Requires the establishment of the National Institute for Health Care Workforce
Development jointly by the Secretary of Health and Human Services and the Secretary of
Labor.
(b) Authorizes the Secretary of Labor to carry out section 3073 through the Director
of the Institute.
(c) Requires the Director of the ·Institute to make recommendations regarding health
Title III
114
�care workforce needs of the system established under the Act and the impact of the new
system on health care workers and the needs of such workers· with respect to education,
training and related career development.
(d) Establishes an advisory board for the Institute, including both Secretaries and
representatives of health care workers, institutions, education and consumer organizations,
and other appropriate individuals. Sunsets the Institute at the end of calendar year 2000.
Section 3074. Requirement for Certain Programs Regarding Redeployment of
Health Care Workers. With respect to plans for State programs for home and community
based services under section.2102(a), and for mental health and substance abuse service
integration under section 3511(a), requires negotiations with labor unions prior to
implementation of such plans, and the inclusion of evidence concerning such negotiations in
such plans.
Title III
115
�SUBTITLE B - ACADEMIC HEALTH CENTERS
(H.R. 3600 and S. 1757 p. 548)
PART 1 - FORMULA PAYMENTS
Section 3101. Federal Formula Payments to Academic Health Centers. (a)
Requires the Secretary to make payments to teaching hospitals and to academic health centers
that operate teaching hospitals.
(b) The payments to the hospitals and health centers are to assist with specialized
costs they incur that are not routinely incurred by other entities in providing health services.
(c) Defmes an "academic health center" as an entity that operates a school of
medicine or osteopathy, operates or is affiliated with other health professional training
programs, and operates or is affiliated with a teaching hospital. Defmes a teaching hospital
as a hospital that operates an approved physician training program (as defined under section
3011).
Section 3102. Request for Payments. Requires that requests for payment be
submitted on a timely basis; contain the described funding agreements; and be in the form
and manner and contain such agreements, assurances, and information required by the
Secretary. Requires that entities involved agree to maintain their status as a teaching hospital
or as an academic health center.
Section 3103. Availability of Funds for Payments; Annual Amount of Payments.
Establishes an annual academic health center account that provides for total payments in each
calendar year of $3,100,000,000 in 1996; $3,200,000,000 in 1997; $3,200,000,000 in 1998;
$3,700,000,000 in 1999; $3,800,000,000 in 2000; and in each subsequent year,
$3,800,000,000 increased by the general health care inflation factor (as defmed in section
6001(a)(3» for such years.
(b) Provides for distribution of such funds among academic health centers in
proportion to the product of their relative gross receipts for patient care and the indirect
teaching adjustment factor (under section 1886(d)(5)(B)(ii) of the Social Security Act)
applicable to patients discharged from the center in the preceding year or in 1997.
(c) Requires the Secretary to report to the Congress by July 1, 1996, with any
recommendations for allocating funds among centers. Under section 4052, payments under
Medicare for indirect graduate medical education costs are terminated for discharges
occurring on or after October 1, 1995.
Section 3104. Additional Funding Provisions. Funds for the annual academic
health center account are tacome from three sources: Medicare, corporate alliances, and
Title III
116
�regional alliances.
Under section 4052, Medicare is required to make transfers from the Part A Trust
Fund at the rate at which payments for the indirect costs of graduate medical education
would have been made, in the amount of $2,100,000,000 in fiscal year 1996 and
$2,000,000,000 for fiscal years 1997 and 1998, and for years beyond 1998 at the 1998 rate
increased by the consumer price index.
After the level of Medicare payments is determined, corporate and 'regional alliances
pay the balance needed in the annual academic health center account, with such payments
coming from the 1 percent corporate alliance assessment (under section 7121) and the 1.5
percent regional alliance assessment (under section 1353). For 1996 and 1997, one-half of
such regional alliance payments are available for the annual academic health center account,
with the remainder made available from payments by corporate alliances. In subsequent
years, payments into the annual academic health center account are made in proportion to the
total payments to corporate and regional health plans by corporate and regional alliances,
respectively.
Beginirlng in 1996 an additional transfer of funds is made equal to 50 percent of the
amount made available for graduate nurse education under section 3063(b).
PART 2-- ACCESS OF PATIENTS TO ACADEMIC HEALTH CENTERS
Section 3131. Contracts for Ensuring Access to Centers. (a) Requires regional
and corporate alliances to ensure that health plans have sufficient contracts with eligible
centers to assure that their enrollees receive appropriate specialized treatment of such centers.
(b) Contracts are ,in compliance with this section if they provide for referrals to the
centers of patients in the plans whose health conditions are within the specialized expertise
of the centers.
(c) Specialized treatment expertise' of academic health centers is expertise in treating
rare diseases or unusually severe conditions, and providing other specialized health care.
Section 3132. Discretionary Grants Regarding Access to Centers. Authorizes
grants to academic health centers for the establishment and operation of information and
referral systems and other activities to provide services to rural health plans.
Title III
117
�SUBTITLE C - HEALTH RESEARCH INITIATIVES
(H.R. 3600 and S. 1757 p. 560)
PART 1- PROGRAMS FOR CERTAIN AGENCIES
Section 3201. Biomedical! and Behavioral Research on Health Promotion and
Disease Prevention. Amends the Public Health Service Act to require the Director of the
National Institutes of Health, in collaboration with the Associate Director for Prevention and
the heads of the agencies of NIH to conduct and support biomedical and behavioral research
on promoting health and preventing disease, and establishes priorities for such research.
Section 3202. Health Services Research. "Amends the Public Health Service Act to
require the Administrator for Health Care Policy and Research to conduct and support
research on the reform of the health care system, as directed by the National Board, and
establishes priorities for such research.
.
PART 2 -- FUNDING FOR PROGRAMS
Section 3211. Authorizations of Appropriations. (a) Authorizes to be appropriated
$400,000,000 for fiscal year 1995 and $500,000,000 for each fiscal year 1996 through 2000 ~
for conducting and supporting biomedical and behavioral research on promoting health and
preventing disease under section 3201.
(b) Authorizes to be appropriated $150,000,000 for fiscal year 1995, $400,000,000
for fiscal year 1996, $500,000,000 for fiscal year 1997, and $600,000,000 for each fiscal
year 1998 through 2000 for conducting and supporting research on the reform of the health
care system under section 3202.
(b) Both authorizations, are in addition to any other authorizations of appropriations
available for those purposes.
Title III
118
�SUBTITLE D - CORE FUNCTIONS OF PUBLIC HEALTH PROGRAMS;
NATIONAL INITIATIVES REGARDING PREVENTIVE HEALTH
(H.R. 3600 and S. 1757 p. 564)
PART 1 - FUNDING
Section 3301. Authorization of Public Health Services Funds. (a) The following .
amounts are authorized for "core" public health functions including surveillance for
communicable diseases and occupational hazards. The amount of the authorization is
$12,000,000 for fiscal 1995, $325,000,000 for fiscal 1996, $450,000,000 for fiscal 1997,
$550,000,000 for fiscal 1998, and $650,000,000 for fiscal year 1999, and $750,000,000 for
fiscal year 2000.
(b) Funds are also authorized for national initiatives regarding health promotion and
disease prevention. Amounts ·authorized are $175,000 for fiscal year 1996 and $200,000 in
each of fiscal years 1997 through 2000.
(c) Funds authorized under this section are in addition to any other authorized
appropriations available for these purposes.
PART 2 - CORE FUNCTIONS OF PUBLIC HEALTH
Section 3311. Purposes. The purposes of activities authorized by the subtitle are to
strengthen the capacity of state and local health agencies to perform the following core public
health functions:
(1) Monitoring and protecting communities from communicable diseases and
exposures to occupational hazards, harmful products and poor quality health care.
(2) Identifying and controlling outbreaks of infectious diseases and patterns of
chronic disease and injury.
(3) Providing information for consumers and providers of health care
regarding preventive health and the appropriate use of medical care.
(4) The testing and development of new public health control and prevention
interventions .
Section 3312. Grants To States For Core Health Functions.(a) Authorizes the
Secretary to make grants to states for one or more core public health functions.
(b) The core functions include the following:
(1) Activities to measure population health and monitor (health) outcomes,
collection of health data, vital statistics. and personal health services data; also analysis
for planning and needs assessments, of data supplied by health plans through the
information system authorized in title V of the legislation;
(2) Environmental protection activities and activities to assure the safety of
Title III
119
�food, housing, workplace and water, including monitoring public health, lead
exposure, sewage and solid waste, abatement of lead hazards, recreation and worker
safety, and enforcement of public health and sanitary codes;
(3) Investigation and control of adverse health conditions including
improvements in emergency treatment preparedness, surveillance and control of
environmental health hazards, cooperative activities to reduce violence, outbreaks of
disease, and exposure to other health threats;
(4) Public information and education to reduce health risks from use of
tobacco, alcohol and other drugs, behavior that increases risk of transmission of HIV
and sexually-transmitted diseases, inadequate diet, inactivity and low childhood
immunization levels;
. (5) Accountability and quality assurance activities including monitoring the
quality of personal health services and monitoring community access to health care;
(6) The provision of public health laboratory services such as assessments of
blood levels of environmental toxins;
(7) Training and educating public health professionals;
(8) Leadership, policy development and program administration activities,
including needs assessment and the setting of public health standards and policies.
(c) States are prohibited from using grant monies to acquire or improve facilities,
land, or acquire major medical equipment, to make cash payments to intended recipients of
grant-funded health services, to provide inpatient services or to assist entities other than
public or private non-profit entities. No more than ten percent of funds may be spent for
administrative expenses.
(d) States are required to maintain the same level of state funding for core activities as
in the year before the first year in which a core services grant is received.
Section 3313. Submission of Information. The Secretary may make grants only if
states submit the following information:
(1) A description of the deficiencies in their current public health systems,
using standards of sufficiency developed by the Secretary;
(2) A description of the health-status measures to be improved through
expanded public health functions;
. (3) Measurable outcomes and process objectives for improving health status
and core health functions;
(4) For each public health function to be undertaken, state and local funding
for the year prior to the year in which the grant is sought as well as a detailed
description of how additional Federal funding will improve the functioning of state
and local public health agencies;
(5) A description of the core health functions to be carried out at the local
level and the amount of funds to be spent in each community.
Section 3314. Reports. Not later than the date specified by the Secretary, states
Title III
120
�
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Carol Rasco - Issues Series
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Carol Rasco
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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2010-0198-Sb-health-care-materials-8
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https://clinton.presidentiallibraries.us/files/original/fc30f0efca63bc0eec63df9095394bab.pdf
05d904b4add6ce153026a5737eef77bf
PDF Text
Text
THE WHITE HOUSE
WASHINGTON
December 16, 1993
MEMORANDUM FOR CHIEFS OF' STAFF
FROM:
DANA HYDE
Cabinet Affairs
SUBJECT:
Health Care Ma.terials
Enclosed is a section by section analysis of the Health Care
Security Act as well as recent economic summaries of the plan's
financing provisions.
Just last week the Lewin-VEI research
group released a study that confirms that the Health Security Act
is fully financed and will reduce the deficit over the period
1995-2000.
I urge you to circulate these reports to members of your staff
involved with health care.
Please let me know if you have any
questions or need any additional information. Thank you.
----I
DF..C I 6 REC'O
�HEAl,TH SECURITY ACT
SECTION-BY-SECTION ANALYSIS
. December 1993
�TABLE OF CONTENTS
TITLE I-HEALTH CARE SECURITY
Subtitle A-Universal Coverage and Individual Responsibility
Subtitle B-Benefits
Subtitle C-State Responsibilities
Subtitle D-Health Alliances
Subtitle E-He3.Ith Plans
Subtitle F-Federal Responsibilities
Subtitle G-Employer Responsibilities
Subtitle I-General Definitions; Miscellaneous Provisions
H.R.
Page 3600,
S.1757
1
5
23
28
48
56
68
73
14
32
95
118
224
256
303
341
74
82
343
389
109
116
118
504
548
560
119
123
131
564
578
615
134
145
146
627
667
668
147
160
169
174
674
752
807
832
TITLE II-PUBUC HEALTH INITIATIVES
Subtitle A-Medicare Outpatient Prescription Drug Benefit
Subtitle B-Long-Term Care
TITLE Ill-PUBUC HEALTH INITIATIVES
Subtitle A-Workforce Priorities Under Federal Payments
Subtitle B-Academic Health Centers
Subtitle C-Health Research Initiatives
Subtitle D-Core Functions of Public Health Programs; National Initiatives
Regarding Preventive Health
Subtitle E-Health Services for Medically Underserved Populations
Subtitle F-Mental Health; Substa.nce Abuse
Subtitle G-Comprehensive School Health Education; School-Related
Health Services
Subtitle H-Public Health Service Initiatives Fund
Subtitle I-Coordination with Cobra Continuation Coverage
TITLE IV -MEDICARE AND MEDICAID
Subtitle A-Medicare and the Alliance System
Subtitle B-Savings in Medicare Program
Subtitle C-Medicaid
Subtitle D-Increase in SSI Personal Needs Allowance
�TITLE V -QUALITY AND CONSUMER PROTECTION .
SiJbtitle A-Quality· Management and Improvement·
Subtitle B-InformationSystems, Privacy, and Administrative.
Simplification
SubtitleC-Remedies and Enforcement
Subtitle D-Medical. Malpractice
Subtitle E-Fraud and Abuse
Subtitle F-McCarran-Ferguson Reform
183
859
189
881
933
200
. 205 . 948
209 ·979
TITLE VI-PREMIUM CAPS; PREMIUM-BASED FINANCING; AND PLAN PAYMENTS
Suhtitle A-Premium Caps
Subtitle B-Premium-Related Financing
Subtitle C-Payments to Regional Alliance Health Plans
·210
219
234
984
1025
1086
236
244
247
253
255
1094
1133
1143
1153
1157
256
261
265
267
1159
1171
1192
1199
TITI.E VII-REVENUE PROVISIONS
Subtitle
Subtitle
Subtitle
Subtitle
Subtitle
Subtitle
A-:Financing Provisions·
.
B:-Tax Treatment of Employer-Provided Health Care
C-Employment'Status Provisions
D-Tax Treatment of Funding of Retiree Health Benefits
E-Coordination of COBRA Continuing Care Provisions
F -Tax Treatment of Organizations Providing Health Care Services
And Related Organizations
Subtitle G-Tax Treatment of Long-term Care Insurance and Services
Subtitle H-Tax Incentives for Health Services Providers
Subtitle I-Miscellaneous Provi~ions
TITLE VIII-HEALTH AND HEALTH-RELATED PROGRAMS OF
TIlE FEDERAL GOVERNMENT
Subtitle
Subtitle
Subtitle
Subtitle
Subtitle
A-Military Health Care Reform
B-Department of Veterans Affairs
C-Federal Employees H~lalth Benefits Program
D-Indian Health Service
E-Amendments to the Employee Retirement Income Security
Act of 1974 .
Subtitle F-Special Fund for WIC Program
TITLE IX-AGGREGATE GOVERNMENT PAYMENTS
270
273
278
282
1207.
1218
1233
1249
286
288
1262·
1274
�Subtitle A-Aggregate State Payments
Subtitle B-Aggregate Federal Alliance Payments
Subtitle C-Borrowing Authority to Cover Cash-flow Shortfalls
289 - 1277
295
1296
298
1308
TITLE X-COORDINATION OF MEDICAL PORTION OF WORKERS
COMPENSATION AND AUTOMOBILE INSURANCE
Subtitle
Subtitle
Subtitle
Subtitle
Subtitle
Subtitle
A-Workers Compensation Insurance
B-Automobile Insurance
C-Commission on Integration of Health Benefits
D-Federal Employee's Compensation Act
E-Davis-Bacon Act and Service Contract Act
F-Effective Dates
TITLE XI-TRANSITIONAL INSURANCE REFORM
300
305
307
307
307
308
1314
1326
1331
1333
1333
1334
309
1335
�TITLE I - ·HEALTH CARE SECURITY
SUBTITLE A - UNIVERSAL COVERAGE AND
INDIVIDUAL RESPONSIBILITY
(H. R. 3600 and S. 1757 p. 14)
Subtitle A describes the he~llth care coverage to which all eligible individuals are
entitled and the date on which coverage becomes effective. It also sets forth eligibility
criteria and describes how individuals and families obtain their coverage by enrolling in
health plans offered through health alliances.
.
PART 1 - UNIVERSAL COVERAGE
Section 1001. Health BeD4~fits. (a) Every eligible individual is eligible to receive the
comprehensive benefit package described in subtitle B. This guarantee is secured through
enrollment in a health plan in accordance with the provisions of title I.
(b) Every eligible individual is entitled to a Health Security card which is issued by
the individual's health alliance or the entity that offers the health plan in which the individual
enrolls.
.
(c) An eligible individual is any person who resides in the United States and who is:
(1) A citizen or a national of the United States;
(2) An alien blwfuilly admitted for permanent residence in the U. S.; or
(3) A long-term nonimmigrant.
Aliens lawfully admitted for permanent residence in the U.S. are defmed under
section 1902 as the following persons:
(A) An alien who is admitted as a refugee under the Immigration and
Nationality Act (INA).
(B) An alien who is granted asylum under the INA.
(C) An alien who Sf: deportation is withheld under the INA.
(D) An alien who is admitted for residence under the amnesty programs
(sections 210, 210A or 245A) of the INA.
(E) An alien who has been parolled indefInitely into the United States or who
has been granted an extended voluntary departure.
(F) An alien who: (1) is the spouse or unmarried child under age 21 of a
citizen or the parent of a citizen over age 21; and (2) has applied for permanent
residence.
(G) Other classes of permanent resident aliens as the National Health Board
recognizes.
Long-term nonimmigrants (defined under section 1902) include:
Title I
�(A) Aliens entering under a treaty of commerce or trade and their families.
(B) Certain temporary workers and trainees (for example, registered nurses).
(d) Medicare-eligible individuals are entitled to benefits through the Medicare
program rather than through the Health Security Act unless, in accordance with Section
1012, they are qualified employees or spouses of qualified employees.
(e) Prisoners (who are imprisoned by Federal, state or local authorities following
conviction as an adult) are not entitled to coverage under the Act during the teon of
imprisonment.
Section 1002. Individual Responsibilities. (a) Each eligible individual must enroll in
an applicable health plan and must pay required premiums.
(b) No individual may be disenrolled until the individual is either enrolled in another
health plan or becomes a Medicar'~-eligible individual.
Section 1003. Protection of Consumer Choice. Nothing in this Act prohibits any
person from purchasing health services or supplemental health insurance (consistent with the
Act) to cover health services not included in the comprehensive benefit package. Individuals
who are not eligible persons under the Act may purchase health insurance other than through
a regional alliance. Employers may provide coverage in addition to that offered through the
comprehensive benefit package (subject to certain limitations set forth in subtitle E, part 2,
relating to provision of supplemental health insurance).
Section 1004. Applicable Health Plan Providing Coverage. (a) In general, a
family's applicable health plan is the plan selected by the family that is offered through the
regional health alliance in which 1he family resides. In the case of families eligible to enroll
in a plan through a corporate alliance (defined in section 1311), the family's health plan is
the corporate alliance health plan except as provided for multiple employment families in
section 10130.
(b) Certain groups have ce:rtain additional types of health plans available to them.
Military personnel and their families may elect to enroll in a .health plan offered by the
Department of Defense, as described in section 800l(a). Veterans may elect to enroll in a
plan offered through the Department of Veterans Affairs and their families may do so if
authorized by the Secretary of Veterans Affairs under section 81Ol(a). Indians, as defined in
. section 8302, may elect to enroll in a health program offered through the Indian Health
Service.
Section 1005. Treatment of Other Nonimmigrants. (a) Undocumented aliens are
ineligible for benefits under the Act.
(b) Diplomats and other foreign officials may enroll in accordance with conditions
Title I
2
�established by the Secretary of State. Other nonimmigrants are subject to reciprocar
agreements established between the United States and other foreign governments.
Section 1006. Effective D13lte of Coverage. (a) In general, individuals become
eligible for benefits when their states become participating states, as defmed in section 1200.
In cases in which a state becomes a participating state before the general effective date
(January 1, 1998), individuals enrolled in an employee benefit plan offered by an employer
that intends to sponsor a corporate health alliance remain with the plan if-the employer so
notifies the regional alliance of the: state in which it is located. In order for employees to
remain exempt from the regional alliance, the employer must offer a benefit plan that
provides the comprehensive benefit package and must pay at least 80 percent of the
premium.
(b) In the case of persons digible to enroll through corporate alliances, January 1,
1998, is the effective date of coverage under the Act:
PART 2 - TREATMENT OF FAMILIES AND SPECIAL RULES
Section 1011. General Rule of Enrollment of Family fu Same Health Plan. (a) In
general, all family members enroll in the same health plan.
(b) The term "family" means an eligible individual, the individual's spouse (if
eligible) and the individual's (and the spouse's, if any) eligible children.
(c) The following each represents a separate class of family enrollment:
(A) Individual coverage is referred to as the "individual class".
(B) Coverage of a married couple without children is termed a "couple only"
class of enrollment.
(C) Coverage of an unmarried individual and one or more children is termed a
"single parent" class of enrollment.
(D) Coverage of a married couple and one or more children is termed a "dual
parent" class of enrollment.
The term "family" enrollment refers to classes (B), (C), and (D). The term "couple"
enrollment refers to classes (B) aild (D).
(d) The term "married" means marriage as defined by the law of the applicable state
in which the couple resides. The term "couple" refers to an individual and an individual's
married spouse.
(e) The term "child" means an eligible individual who is under 18 years of age (or
under age 24 in the case of a full-time student) and is a dependent of an eligible individuaL
State law is used to determine if a person is a child, but the National Board may prescribe
uniform rules for determining who is a child. Under such rules, a child shall include a step
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3
�or foster child, a disabled adult child, the child of a parent who is herself a child and living
with an eligible individual, and a child placed for adoption. Emancipated minors and
married individuals shall not be treated as children.
(f) The Board is required to prescribe rules for families in which members do not
reside in the same area, individua1s who are under 19 and who are not dependents of eligible
individuals, children of parents who are separated or divorced, and enrollment rules for
families whose composition chang';::s during a year.
Section 1012. Treatment of Certain Families. (a) A Medicare-eligible individual
who is a qualifying employee for two consecutive months in a year (and is anticipated to be
one in the next following month), or who is the spouse or family member of a qualifying
employee, shall be treated as alliance eligible for the remainder of the year and not as a
Medicare-eligible individual.
(b) In families that include AFDC or SSI recipients, such recipients are considered
their own families, and remaining family members are considered separate families. Also
considered separate families for purposes of this Act are electing veterans, electing Indians,
and active duty military personnel, unless all family members join in the election. Prisoners
are treated as a separate family.
Individuals eligible for mUltiple coverage options may elect the plan or program of
their choice.
(c) Qualifying students (persons who are children and are full-time students in a
school located in an alliance area different from their parents' alliance area) may elect to
enroll in the alliance in which the school is located. In such a case, the parents' alliance
health plan shall pay the plan in which the student enrolls.
(d) The National Health Board is required to promulgate regulations governing
married couples who live in diffelrent alliance areas.
Section 1013. Multiple Employment Situations. (a) Single adult wage earners and
married wage earners whose spouses are not qualified employees and who work for both a
corporate alliance employer and a. regional alliance employer may elect as their applicable
health plan either a regional or corporate alliance plan.
(b) Where members of married couples work for both a regional and a corporate
alliance, the couple may elect either a regional or a corporate alliance health plan. In cases in
which spouses work for two corporate alliances, a health plan in either alliance may be
selected.
Section 1014. Treatment of Residents of States with Statewide Single Payer
Systems. Special rules, set forth at section 1222 govern coverage in single payer states.
These special rules supersede rules in section 1002.
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4
�SUBTITLE B - BENEFITS
(H.. R. 3600 and S. 1757 p. 32)
Subtitle B sets forth for all alliance health plans requirements regarding the
comprehensive benefit package, benefit limitations and exclusions, and patient cost sharing.
Part 1 lists each covered benefit. Part 2 .describes each benefit in detail. Patient cost
sharing and benefit limitations and. exclusions are described in parts 3 and 4. The National
Health Board's duties with respect to defining or modifying the benefit package are set forth
in part 5.
PART 1-
CO~~REHENSIVE
BENEFIT PACKAGE
Section 1101. Provision of Comprehensive Benefit by Plans. This section describes
each item and service contained in the benefit package. Health plans must provide the
following benefits to all alliance eligible persons:
(1) hospital services;
(2) services of health professionals;
(3) emergency and ambul::J.tory medical and surgical services;
(4) clinical preventive services;
(5) mental illness and substance abuse services;
(6) family planning services and services for pregnant women;
(7) hospice care;
(8) home health care;
(9) extended tare services;
(10) ambulance services;
(11) outpatient laboratory, radiology and diagnostic services; .
(12) outpatient prescription drugs and biologicals;
(13) outpatient rehabilitative services;
(14) durable medical equipment and prosthetic and orthotic devices;
(15) vision care; and
'
(16) dental care.
No scope or duration limitations or cost sharing is permitted except as prescribed in
the Act.
PART 2 - DESCRIPTION OF ITEMS AND SERVICES COVERED
Section 1111. Hospital Services .. Hospital services include (1) inpatient hospital
services, (2) hospital services and (3) 24-hour-a-day emergency hospital services. Hospital
services as used in this section do not include services provided for treatment of a mental or
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�substance abuse disorder (which are separately described at section 1115) except for- medical
detoxification as required to manage conditions associated with alcohol or drug withdrawal.
As used in this section, th~: term "hospital" has the same meaning as in Section 1861
(e) of the Social Security Act (Me-dicare) and the term "inpatient hospital services" means the
items and services described in paragraphs (1) through (3) of section 1861(b) of the Social
Security Act.
Section 1112. Services of Health Professionals. The services of health professionals
are inpatient and outpatient professional services, including consultations, that are provided in
a home, office, or other ambulatory care setting or in an institutional setting.
r
The term "health professional services" means professional services (1) that are
provided lawfully by a physician or (2) that would be lawfully provided by a physician but
that are provided by another person (such as a nurse or physician assistant) who is legally
authorized to provide the services in a particular state.
Section 1113. Emergency ~d Ambulatory Medical and Surgical Services.
Emergency ambulatory medical and surgical services are (1) 24-hour-a-day emergency
services; and (2) ambulatory medical and surgical services, when furnished by a health
facility that is not a hospital (including birthing centers) and that is legally authorized to
provide the services in a particular state.
Section 1114. Clinical Pr,eventive Services. Clinical preventive services consist of
the following items and services:
(1) items and services for high risk populations (as defmed by the National
Health Board) when furnished in a manner consistent with any periodicity schedule
for such items and services promulgated by the Board;
(2) age-appropriate immunizations, tests and clinician visits furnished in
accordance with a specific periodicity schedule set forth on Table 1; and
(3) other immunizations, tests and clinician visits furnished in accordance with
standards established by the Board under section 1153.
The immunization or test and any administration fee is covered if the test or
immunization is administered to ~m individual consistent with a periodicity schedule but not
during a clinician visit.·
For purposes of this section, "clinician visit" consists of the following services
provided by a health professional: a complete medical history; an appropriate physical
examination; risk assessment; health advice and counseling (including nutrition counseling);
and administration of age-appropriate immunizations and tests.
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�TABLE 1: CLINICAL PREVENTIVE SERVICES
Age-appropriate
immunizations for:
• Diphtheria
• Tetanus
• Two blood tests to screen
for blood lead levels for
children at risk for lead
exposure
Eight age-appropriate
visits, including a newborn
visit
• Haemophilus illfluenzae
typeB
• Measles
• Mumps
• Rubella
• Hepatitis B
Age-appropriate
immunizations for:
• Diphtheria
• Tetanus
• Pertussis
• Polio
• One urinalysis
Three clinician visits
Three clinician visits
Age-appropriate
immunizations for:
• Tetanus
• Diphtheria
• Papanicolaou smears and
pelvic exams for females
who have reached
childbearing age and are at
risk for cervical cancer
every 3 years, but annually
until 3 negative smears have
been obtained, if medically
necessary and annually for
females who are at risk for
fertility-related infectious
disease
• Annual screening for
chlamydia and gonorrhea
for females who have
reached childbearing age
and are at risk for fertility
related infectious illnesses
I
Title I
7
Three clinician visits
�Booster immunizations
every 10 years against:
• Tetanus
• Diphtheria
Booster immunizations
every 10 years against:
• Tetanus
• Diphtheria
• Papanicolaou smears and
pelvic exams for females
every 2 years, but
annually, following an
abnormal smear, until 3
negative smears have been
obtained, and annually for
females at risk of fertilityrelated infectious disease
• Annual screening for
chlamydia and gonorrhea
for females who are at risk
for fertility-related
infectious illnesses
• Cholesterol every 5
years
One every two years
Booster immunizations
every 10 years against:
• Tetanus
• Diphtheria
• Papanicolaou smears and
pelvic exams for females
every 2 years
• Mammograms for
.females every 2 years
• Cholesterol every 5
years
One every two years
• Booster immunizations
every 10 years ag:Linst
tetanus and dipthe:ria
• Age-appropriate
immunizations against
invasive influenza and
pneumococcal disf:ase
Title I
• Papanicolaou smears and
pelvic exams every 3
years, but annually,
following an abnormal
smear, until 3 negative
smears have been obtained,
and annually for females at
risk of fertility-related
infectious disease
• Annual screening for
chlamydia and gonorrhea
for females who are at risk
for fertility-related
infectious illnesses
• Cholesterol every 5
years
• Papanicolaou smears and
pelvic exams every 2 years
for females who are at risk
for cervical cancer
• Mammograms for
females every 2 years
• Cholesterol every 5
years
One each year
8
�Section 1115. Mental illness and Substance Abuse Services. (a) Mental ilfness and
substance abuse services consist of the following services:
(1) Inpatient and residential mental illness and substance abuse treatment,
consistent with applicable limitations;
(2) Intensive nonresidential mental illness and substance abuse treatment,
consistent with applicable limitations;
(3) Outpatient mental illness and substance abuse treatment including case
management, screening and assessment, crisis services; and
(4) Collateral services consistent ~ith applicable limitations.
(b)(I) An individual! is eligible for inpatient, residential, intensive non
residential, and outpatient mental illness and substance abuse treatment if the
individual:
(A) has, or has had, during the one-year period prior to the date of
treatment, a diagnosable mental disorder or a diagnosable substance abuse
disorder, and
(B) is either experiencing or is at risk of experiencing, or if untreated
would experience, impaired functioning in family, work, school or community
activities.
(2) An individual is eligible for case management services if a health
professional designated by the plan determines that the individual should receive case
management, and the individual is eligible for and is receiving outpatient mental
illness or substance abuse treatment for a diagnosable mental or substance abuse
disorder.
(3) All alliance eligible individuals are eligible for outpatient screening and
assessment and crisis services.
(4) Family members (as defmed under the Act) who are related to persons
eligible for inpatient and n!sidential mental illness and substance abuse treatment are
eligible for collateral services.
(c) Inpatient and residential mental illness and substance abuse treatment means the
following items and services when provided to a person with a diagnosable mental disorder
or substance abuse disorder:
(1) Inpatient hospital services as defined in paragraphs (1) through (3) of
section 1861 of the Social Security Act, when provided for a diagnosable mental
disorder or substance abuse disorder to an inpatient of a hospital, psychiatric hospital,
or a residential treatment or detoxification center, crisis residential program or mental
illness residential treatment program, or to a resident of a family or group treatment
home or community residential treatment and recovery center for substance abuse.
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�The National Health Board. is required to specify in regulations those health
professional services that are to be treated as inpatient treatment services.
(2) The follOWing l.imitations apply to coverage for inpatient and residential
care:
(A) Residential mental illness treatment when provided to a person with
a diagnosable mental disorder is covered only when provided in a setting that
is not a hospital or a psychiatric hospital and is covered only to avert the need
for, or as an alternative to, treatment in a hospital or psychiatric hospital, as
detennined by a ht::alth professional designated by the enrollee's plan.
(B) Residential substance abuse treatment is covered only if a health
professional designated by the health plan detennines that the individual should
receive the treatment.
(C) Inpatient treatment is covered only when provided to an individual
in the least restrictive inpatient or residential setting, and when less intensive
nonresidential or outpatient treatment would be ineffective ·or inappropriate.
(D) Before January 1, 2001, 30 days each year of inpatient treatment is
covered. A maximum of 30 additional days is covered if a health professional
designated by the health plan detennines that:
(i) the individual poses a threat to his own life or the life of another; or
(ii) the medical condition of the individual requires inpatient treatment
to initiate or adjust pharmacological or somatic therapy.
(E) Inpatient hospital treatment for substance abuse is covered only for
medical detoxification required for the management. of psychiatric conditions
associated with withdrawal from drugs or alcohol.
(d)(l) Intensive nonresidential treatment means diagnosis and therapeutic items
and services provided to an individual with a diagnosable mental disorder or substance
abuse disorder who is either (A) participating in a partial hospitalization program, day
treatment program, psychiatric rehabilitation program, or ambulatory detoxification
program or (B) receiving home-based mental illness services or behavioral aide
mental illness services.
The National Board is required to specify in regulations which health professional
services described in section 1112 must be covered as intensive nonresidential mental illness
and substance abuse treatment.
(2) The following limitations apply to coverage for intensive nonresidential
treatment:
(A) Treatment is covered if a health professional designated by the
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�health plan detennines that the individual should receive the treatment.
(B) Treatment is covered only if necessary to:
(i) avert the need for residential or inpatient treatment,
(ii) facilitate an individual's earlier discharge from an inpatient
or residential setting,
(iii) restore the functioning of an individual with a diagnosable
mental disorder or substance abuse disorder, or
(iv) ltO assist the individual to develop skills necessary for, and
to gain access to the support services that the individual needs to
achieve the maximum level of functioning in the community.
(C) Before January 1, 2001, for every two days of intensive nonresidential
treatment furnished, inpatient coverage for the year is limited by one day, until the
number of available inpatient and residential days is reduced to zero.
An additional 60 days of intensive nonresidential substance abuse and mental
illness treatment may be furnished in a year if a health professional designated by the
health plan determines that the individual should receive the treatment. Cost sharing
for the additional 60 days is 25 percent in lower cost sharing plans and 50 percent in
higher cost sharing plans.
(D) Before January 1, 2001, deductibles, copayments and coinsurance
applicable to intensive nonresidential treatment may not be applied toward any annual,
out-of-pocket limit on COSlt sharing if the treatment is provided for a diagnosable
substance abuse disorder or if the deductible, copayment or coinsurance is paid for
the additional 60 days of 1reatment.
(e)(I) Outpatient mental illness and substance abuse treatment means the
following services providf:d on an outpatient basis, for a diagnosable mental disorder
or substance abuse disordl~r:
(A) screening and assessment,
(B) diagnosis,
(C) medical management,
(D) substance abuse counseling and relapse prevention,
(E) crisis services,
(F) somatic treatment services,
(G) psychotherapy,
(H) case management,
(I) collateral services.
(2) The following limitations apply to coverage of outpatient treatment:
(A) Treatment must constitute health professional services as defined
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�under section 1112.
(B) Treatment for substance abuse counseling and relapse prevention is
covered if a health professional designated by the health plan determines that
the individual shou.ld receive the treatment.
(C) Before January 1, 2001, coverage for both psychotherapy and
collateral services is limited to 30 visits per individual per year. Additional
visits may be covered to prevent hospitalization or facilitate earlier hospital
release. The number of inpatient and residential days is reduced one day for
every four of the additional visits. The number of inpatient and residential
. days available in a year is also reduced by one day for every four days of
substance abuse counseling and relapse prevention. Thirty days of group
therapy for substance abuse are available without substitution if the individual
has received inpatient, residential or intensive nonresidential treatment for the
substance abuse disorder within 12 months (regardless of the length of stay for
these treatments).
(D) Detoxification in an outpatient setting is covered only if it is
provided in the context of a treatment program.
(E) Before January 1, 2001, deductibles, copayments and coinsurance
applicable to outpatient treatment may not be applied toward any annual out
of-pocket limit on cost-sharing.
(F) For purposes of this subtitle:
(i) "Case management" means services that assist individuals to gain
access to needed medical, social, educational and other services.
(ii) "Diagnosable mental disorder or substance abuse disorder" means
a disorder listed in Diagnostic and Statistical Manual of Mental Disorders,
Third Edition, or a revised version of such manual, the equivalent of a
disorder listed in that text as it is listed in the International Classification of
Diseases, 9th Revision, Clinical Modification, Third Edition or revised version
of such text, or is listed in any authoritative text that specifies diagnostic
criteria for mental disorders or substance abuse disorders that is identified by
the National Health Board.
(iii) "Psychiatric hospital" has the same meaning given to such hospitals
under section 1861(f) of the Social Security Act, Indian Health Service,
Department of Defense, and Department of Veterans Affairs hospitals may all
qualify as inpatient psychiatric hospitals for persons electing enrollment in
such plans under Section 1004.
Section 1116. Family Planning and Services for Pregnant Women. Family
Title I
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�planning services and services for pregnant women consist of the following items arid
services:
(1) Voluntary family planning services;
(2) Contraceptive devices that may be dispensed only by prescription and that
are subject to approval un(ier the Federal Food, Drug and Cosmetic Act; and
(3) Services for prc::gnant women.
Section 1117. Hospice Call'e. Hospice care consists of the items and services
described in section 1861(dd)(1) of the Social Security Act as dermed in paragraphs (2),(3)
and (4)(A) of that section (with the exception of paragraph (2)(A)(iii).
Section 1118. Home Health Care. (a) Home health care consists of the following
items and services:
(1) Items and services described in section 1861(m) of the Social Security Act;
(2) Home intravenous drug therapy services described in section 1861(1l) of the
Social Security Act (as added by section 2006 of the Health Security Act).
(b) Limitations on home health care are as follows:
(1) Home health care provided after an illness or injury is covered as an
alternative to inpatient care in a hospital, skilled nursing facility or rehabilitation
facility.
(2) Care may be continued after a mandatory reevaluation at the end of each
60-day period if the care is an alternative to inpatient care in a hospital, skilled
nursing facility, or rehabilitation facility.
Section 1119. Extended Care Services. (a) Extended care services consist of items
and services described in section 1861(h) of the Social Security Act, if provided to an
.
inpatient in a skilled nursing facility or a rehabilitation facility.
(b) Coverage is limited to 100 days per year and is limited to cases in which care is
furnished as an alternative to hospitalization following an illness or an injury.
.
.
(c) The term "rehabilitation facility" means an institution (or separate part of an
institution) devoted to providing services for rehabilitation from illness or injury. The term
"skilled nursing facility" means an institution (or separate part) that primarily provides
skilled nursing care or services for rehabilitation from illness or injury.
Section 1120. Ambulance Services. Ambulance services consist of ground
transportation by ambulance, or air or water transportation by aircraft or vessels that are
equipped for transporting ill or injured persons. Air and water transportation serVices are
covered only if a patient's condition indicates that there is no alternative to such
transportation or the alternative is contra-indicated.
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�Section 1121. Outpatient Laboratory, Radiology, and Diagnostic Services. These
services consist of laboratory, radiology and diagnostic services that are prescribed for
individuals who are not inpatients in a hospital, hospice, skilled nursing facility or
rehabilitation facility.
Section 1122. Outpatient Prescription Drugs and Biologicals. Covered outpatient
drugs are drugs that are covered under section 1861(t) of the Social Security Act (as
amended by the Health Security Act). A drug is covered as an outpatient drug if used as
approved by the FDA or for another use if the drug is FDA-approved and an alternative use
is supported by certain recognized drug compendia or alternative use is supported in peer
reviewed literature. The National Board may revise the list of specified compendia in the
statute. Blood clotting factors are also covered if provided on an outpatient basis.
Section 1123. Outpatient Rehabilitation Services. (a) Covered rehabilitative services
are outpatient occupational and physical therapy, and outpatient speech pathology services
provided for the purpose of attaining or restoring speech.
(b)(1) Coverage is limited to services or items that are needed to restore an
individual's functional capacity or to minimize limitations on an individual's physical
and cognitive functions that are the result of an illness or injury.
(2) Outpatient rehabilitation services may be continued only if the need for
coverage is reviewed at the end of each 60-day period, and if such a review indicates
that an individual's functioning is improving.
Section 1124. Durable M:edical Equipment and Prosthetic and Orthotic Devices.
(a) Coverage. Items and services covered under this section are:
(1) durable medical equipment (as defmed in section 1861(n) of the Social
Security Act), including accessories and supplies necessary for the repair, function
and maintenance of such t~quipment;
(2) prosthetic devices (except for dental devices) that replace all or part of the
function of an internal body organ (including colostomy bags and supplies directly
related to colostomy care), and replacements of such devices;
(3) accessories and supplies used directly with a prosthetic device to achieve
its therapeutic benefit or assure its proper functioning;
(4) leg, ann, back, and neck braces;
(5) artificial legs, .arms,and eyes, including replacements required because of a
change in an individual's physical condition; and
(6) fitting and trail1ing for use of such items.
(b) Coverage is limited to items or services that improve an individual's functional
capacity or prevent further deterioration in function.
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�Section 112S. Vision Care. Routine eye examinations and diagnosis and treatment
for defects in vision are covered, except that eyeglasses and contact lenses are covered only
for individuals under 18 years of age. The National Health Board must develop a periodicity
schedule for eye exams.
Section 1126. Dental Care. (a) Coverage and limitations. Dental care covered
under this section is:
(1) Emergency dental treatment, including simple extractions, treatment for
acute infections, bleeding and injuries to natural teeth and oral structures, requiring
immediate care to prevent risks to life or significant medical complications, as
specified by the National Health· Board.
. (2) Prevention and diagnosis of dental disease, including oral dental
examinations, radiographs, dental sealants, fluoride application, and dental
prophylaxis. Until January 1, 2001, this care is covered only for individuals under
age 18. After that date, all services except sealants are covered for all individuals.
(3) Treatment of dental disease, including routine fillings, prosthetics for
genetic defects, periodontal maintenance, and endodontic services. Until January 1,
2001, these items and services are covered only for individuals under age 18; on and
after that date, these services are covered for all eligible individuals enrolled in a
health plan, except that endodontic services continue to be covered only for
individuals under age 18.
(4) Space maintenance procedures, to prevent orthodontic complications are
covered only for individuals at least 3, but less than 13 years of age. Coverage is
also limited to procedures on posterior teeth that involve maintenance of a space or
, spaces for permanent posterior teeth that, if the space were not maintained, would be
prevented from normal eruption. Coverage excludes a space maintainer placed within
6 months of the expected eruption of the permanent, posterior tooth.
(5) Interceptive orthodontic treatment to prevent severe malocclusion is
covered only on or after January 1, 2001 and then only for individuals at least 6 years
of age but under age 12.
)
Section 1127. Health Education Classes. Health education and training classes in
smoking cessation, nutrition counseling, stress management, support groups, physical
training, or classes that are otherwise intended to encourage reduction of behavioral risk.
factors and promote healthy activities are covered, if a health plan chooses to offer such
classes. Classes covered under t1:ds section neither include nor limit education or training
provided as part of professional health services, as defined in section 1112.
Section 1128. Investigational Treatments. Investigational treatments may be covered
by health plans at their discretion if the treatment is furnished for a life threatening disease,
disorder or other health condition defined by the National Health Board. Items and services
that are routine care and otherwise included in the benefit package are covered when
furnished as part of an investigational treatment. Treatment is investigational if its
effectiveness has not yet been determined and the treatment is under clinical investigation as
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�part of an approved research trial.
PART 3 - COST SHARING
Section 1131. Cost Sharing. (a) All health plans must comply with general cost
sharing principles as a condition of participation in health alliances. In general, health plans
must offer all enrollees the following cost sharing schedule:
(1) lower cost sharing,
(2) higher cost sharing, or
(3) combination cost sharing.
(b) Regional alliances must apply special cost sharing rules for low-income families,
as specified in section 1371.
(c)(1)Deductibles and out-of-pocket limits on cost sharing are based on
expenses incurred for items and services furnished during a year.
(2) Individual general deductibles represent the countable expenses that an
individual can be required. to incur in a year before the plan incurs liability. At the
point at which a family deductible has been reached for a year, no individual member
of the family may be required to incur additional deductibles before plan coverage
begins. A countable expense, for purposes of determining if a deductible has been
satisfied, is any expense for an item or service covered in the benefit package and for
which (but for any applicable deductible or coinsurance) the health plan would be
liable for payment.
(3) Coinsurance requirements apply after individual and family deductible
requirements have been satisfied.
(4) Individual out-of-pocket limits on cost sharing represent the amount of
expenses an individual may be required to incur during a year because of general
deductibles and cost sharing for items and services furnished in the benefit package.
In the case of families, no family member may be required to incur additional out-of
pocket costs-once the out-of-pocket limit is satis,fied for the family. Special rules
apply in the case of mental health services (see section 1115).
Section 1132. Lower Cost Sharing. (a) A health plan's lower cost sharing schedule
may not impose deductibles and must contam individual out-of-pocket limits of $1500 and
family out-of-pocket limits of $3000. No copayment for "in-network" items or services is
allowed except as consistent with Table 2. Plans must impose coinsurance for "out-of
network" items and services at a level to be specified by the National Health Board. The
"out-of-network" coinsurance must be not less than 20 percent and, for those items for which
the coinsurance under the higher cost sharing option is greater than 20 percent, the Board
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�may specify a higher percentage.
Section 1133. Higher Cost Sharing. A health plan's higher cost sharing schedule
must have deductibles of $200 for an individual and $400 for a family for all items and
services in the comprehensive benefit package. In addition, the following deductibles apply:
(1) a separate individual deductible for inpatient residential and intensive non
residential mental illness and substance abuse treatment equal to the cost of one day of
such treatment;
(2) an individual outpatient prescribed drug deductible of $250 annually; and
(3) a separate $50 annual individual dental deductible.
Deductibles for clinical preventive services and prenatal care visits (including one post
partum visit) are prohibited ..
Coinsurance in accordance: with Table 2 is permitted. Annual maximum out-of-pocket
limits must be set at $1500 for individuals and $3000 for families ..
Section 1134. Combination Cost Sharing.(a) Combination cost sharing plans are
required to use the same out-of-pocket limits for individuals and families and must use
different cost sharing requirements for out-of-network, as opposed to in-network, items and
services.
(b) With respect to in-ne~~ork items and services, plans may not impose deductibles
and must follow the same cost sharing schedule required of lower cost sharing plans.
(c) With respect to out-of··network items and services (as the term is defined in
section 1402(f) of the Act relating to health pl~), deductibles and coinsurance not exceeding
amounts described in section 1133 will be applied to individuals and families.
An item or service is "in-network" under section 1402 if furnished by a provider that
has entered into an agreement with the plan that obligates the provider to furnish benefits to
enrollees. The term "out-of-network" applies to items and services furnished by providers
that are not members of the plan network.
Section 1135. Table of Copayments and Coinsurance. Section 1135 sets for the
following table of copayments and coinsurance applicable to low cost sharing, higher cost
sharing and combination cost sharing plans. The applicable payment rate referred to in
Table 2 refers to the fee-for-service fee schedule to be established for all health alliances
under section 1322.
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�TABLE 2
Copayments and Coinsurance for Items and Services
(Sec. 1135)
Benefit
Section
Lower Cost Sharing
Schedule
Higher Cost Sharing
Schedule
Inpatient hospital
services
1111
No copayment
20 percent of applicable
payment rate
Outpatient hospital
services
1111
$10 per visit
20 percent of applicable
payment rate
Hospital emergency room
services
1111
$25 per visit (unless patient
has an emergency medical
condition as defmed in section
1867(e)(1) of the Social
Security Act)
20 percent of applicable
payment rate
Services of health
professionals
1112
$10 per visit
20 percent of applicable
payment rate
Emergency services other
than hospital emergency
room services
1113
$25 per visit (unless patient
has an emergency medical
condition as defmed in section
l867(e)(1) of the Social
Security Act)
20 percent of applicable
payment rate
Ambulatory medical and
surgical services
1113
$10 per visit
20 percent of applicable
payment rate
Clinical preventive
services
1114
No copayment
No coinsurance
Inpatient and residential
mental health and
substance abuse treatment
1115
$25 per visit
50 percent of applicable
payment rate
Intensive nonresidential
mental health and
substance abuse treatment
1115
No copayment
20 percent of applicable
payment rate
lll5(d)(2)
(c)(ii)
$25 per visit
1115
$10 per visit
Outpatient mental health
and substance abuse
treatment (except
psychotherapy, collateral
services, and case
management)
Title I
50 percent of applicable
payment rate
20 percent of applicable
payment rate
-
18
�Benefit
Section
Lower Cost Sharing
Schedule
Higher Cost Sharing
Schedule
Outpatient psychotherapy
and collateral services
1115
$25 per visit until January
1,2001, and $10 per visit
thereafter
50 percent of applicable
payment rate until January 1,
2001, and 20 percent thereafter
Case management
1115
No copayment
No coinsurance
Family planning and
services for pregnant
women (except clinician
visits and associated
services related to
prenatal care and 1
postpartum visit)
1116
$10 per visit
20 percent of applicable
payment rate
Clinician visits and
associated services related
to prenatal care and 1
post-partum visit
1116
No copayment
No coinsurance
Hospice care
1117
No copayment
20 percent of applicable
payment rate
Home health care
1118
No copayment
20 percent of applicable
payment rate
Extended care services
1119
No copayment
20 percent of applicable
payment rate
Ambulance services
1120
No copayment
20 percent of applicable
payment rate
Outpatient laboratory,
radiology, and diagnostic
services
1121
No copayment
20 percent. of applicable
payment rate
Outpatient prescription
drugs and biologicals
1122
$5 per prescription
20 percent of applicable
payment rate
Outpatient rehabilitation
services
1123
$10 per visit
20 percent of applicable
payment rate
Durable medical
equipment and prosthetic
and orthotic devices
1124
No copayment
20 percent of applicable
payment rate
Vision care
1125
$10 per visit (no additional
charge for 1 set of necessary
eyeglasses for an individual
less than 18 years of age)
20 percent of applicable
payment rate
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19
�Benefit
Section
Lower Cost Sharing
Schedule
Higher Cost Sharing
Schedule
Dental care (except space
maintenance procedures
and interceptive
orthodontic treatment)
1126
$10 per visit
20 percent of applicable
payment rate
Space maintenance
procedures and
interceptive orthodontic
treatment
1126
$20 per visit
40 percent of applicable
payment rate
Health education classes
1127
All cost sharing rules
determined by plans
All cost sharing rules
determined by plans
Investigational treatment
for life-threatening
condition
1128
All cost sharing rules
determined by plans
All cost sharing rules
determined by plans
Title I
20
�Section 1136. Indexing Dollar Amounts Relating to Cost Sharing. (a) Deductibles,
coinsurance, copayments and out-of-pocket limits imposed in any year after 1994 must be
indexed in accordance with a percentage equal to the product of the cumulative health care
inflation factor after 1994. Increases in cost sharing amounts owed must be rounded to the
nearest multiple of $1 in the case of amounts of $200 or less, $5 in the case of amounts
between $200 and $500 and multiples of $10 in the case of amounts of $500 or more.
PART 4 - EXCLUSIONS
Section 1141. Exclusions. (a) Th(~ comprehensive benefit package does not contain items or
services that are not medicallY,necessary or appropriate or that the National Health Board by
regulation determines are not medically necessary or appropriate.
(b) In addition, the package does not cover the following items or services:
(1) custodial care «(!xcept in the case of hospice care);
(2) cosmetic surgery (other than to correct congenital anomalies or following
an accident or disease);
(3) hearing aids;
(4) eyeglasses and contact lenses for individuals 18 years of age and older;
(5) in vitro fertilization services;
(6) sex change and related services;
(7) private duty nursing;
(8) personal comfort items (except in the case of hospice care);
(9) orthodontal and other dental procedures other than as described in section
1126.
PART 5 - ROLE OF THE NATIONAL HEALTH BOARD
Section 1151. Defmition of Benefits. (a) The National Health Board is authorized ,to
promulgate regulations and guidellines to assure uniformity in benefits across all health plans.
(b) The National Board must permit health plans to use appropriate providers and
methods to deliver covered services.
Section 1152. Acceleration of Expanded Benefits. Prior to January 1, 2001, the
National Health Board may add benefits not otherwise scheduled for coverage prior to that
year or revise the coinsurance provisions in accordance with rules to take effect in the year
2001, if it determines that such additions or revisions will not cause any regional alliance to
exceed its per capita expenditures.
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21
�Section 1153. Authority With Respect to Clinical Preventive Services. (a) The
Board is required to defme clinical preventive items and services and a periodicity schedule
for high risk populations. The Board is also required to update the periodicity schedule for
immunizations, tests and clinician visits and to establish rules for the provision of
immunizations, tests and clinician visits provided at periods other than the periodic age
ranges. Finally, the Board may modify the clinical preventives service package but may not
modify the cost sharing requirements.
Section 1154. Establishmtmt of Standards Regarding Medical Necessity. The
National Health Board is authorized to establish regulations regarding the exclusion by the
Board of items and services that are not medically necessary or appropriate.
PART 6 - ADDITIONAL PROVISIONS RELATING TO
HEALTH CARE PROVIDERS
Section 1161. Override ofr Restrictive State Practice Laws. No state may through
licensure or otherwise restrict the practice of any class of health professionals beyond what is
justified by the skills and training of such professionals.
Section 1162. Provision of Items of Services Contrary to Religious Belief or Moral
Conviction. A health professional or facility may .not be required to provide an item or
service in the comprehensive benefit package if the professional or facility objects to that
item or service on the basis of religious belief or moral conviction.
Title I
22
�SUBTITLE C - STATE RESPONSmILITIES
(H.R. 3600 and S. 1757 p. 95)
This subtitle sets forth general requirements for participating states and provides
special rules for states administering single payer programs.
Section 1200. Participating State. (a) A state is a participating state if it meets the
requirements of this subtitle.
(b) States that elect to participate must have an approved system in place by January
1, 1998. In states that do not elect to participate, the provisions of subpart B of part 2 of
subtitle F (relating to federal operation) take effect. A state becomes a participating state if it
submits its system for approval by the National Health Board and the Board approves the
state's health care system.
Participating states must submit annual updates to the Board by February 15 of each
year after the frrst year a state has been approved. Annual updates must consist of such
information as the Board requires to determine whether a state health care system meets
subtitle C requirements in the year for which the update is submitted, and whether a state
system was operated as approved by the Board during the preceding year.
PART 1 - GENERAL STATE'RESPONSmILITIES
Section 1201. General State Responsibilities. Participating states must do the
following:
(1) Establish one or more regional alliances, in accordance with section 1202;
(2) Certify health plans, in accordance with section 1203;
(3) Assure fInancial solvency of health plans, in accordance with section 1204;
(4) Designate an agency or official responsible for coordinating the state
responsibilities under Federal law;
(5) Conform state laws to meet the requirements of title X for medical benefIts
under workers compensation and automobile insurance;
(6) Carry out other responsibilities of participating states under the Act.
Section 1202. State Responsibilities With Respect To Alliances. (a) A participating
state must establish and maintain one or more regional alliances and assure that the
alliance(s) comply with the requirements of the Act. A state may not be a participating state
in any year unless it has established its alliance(s) by March 1 of the preceding year.
(b) A state must designatt~ the geographic area (known as the alliance area) that is
assigned to each alliance. The area must have a large enough population to ensure that the
Title I
23
�alliance has adequate market share to negotiate effectively with health plans; no area may be
assigned to more than one regional alliance; all areas of a state must be assigned to a
regional alliance; and the entire portion of a metropolitan statistical area located in a state
shall be included in the same alliance. An area that includes a Consolidated Metropolitan
Statistical Area is presumed to m(!et the establishment requirements. In establishing the areas,
a state may not discriminate on the basis of or otherwise take into account race, age,
language, religion, national origin, socio-economic status, disability, or perceived health
status.
(c) One or more states may permit or require two or more regional alliances to
coordinate their operations (whether or not the alliances are located in separate states or the
same state) by adopting joint operating rules, health plan contracts, enforcement activities
and the establishment of unified fee schedules.
(d) A participating state must assure that amounts owed to alliances in the state are
collected and paid.
(e) A state must assure that determination of families' eligibility for cost sharing
assistance, premium discounts, and cost sharing reductions' by regional alliances are made on
the basis of the best information available to alliances and the state. A state shall use
information available to it under section 6103(1)(7)(D)(x) of the Internal Revenue Code of
1986 to assist alliances in verifying financial eligibility.
(1) A state operating a single payer system must assure that the regional alliance in
which the system operates meets the requirements of section 1224(b).
(g) A participating state is responsible in accordance with section 9201 for
administrative errors by alliances. (These are errors relating to eligibility determinations
which occur at a rate that exceeds an established error rate, as well as regional alliance
expenditures attributable to mal- or misfeasance by the alliance or the state.)
Section 1203. State Responsibilities Relating to Health Plans. (a) A participating
state must establish and publish health plan certification criteria with respect to quality,
fmancial stability, capacity of a plan to deliver the comprehensive package of services in a
designated area, other requirements for health plans in parts 1, 3 and 4 of subtitle E (health
plan requirements) and state requirements that are consistent with the Act.
(b) A state must certify as a regional alliance health plan any health plan meeting the
criteria applicable for regional alliance health plans.
(c) A state must monitor certified health plans for their continued compliance with
the criteria.
(d) A state may not discriminate against a health plan on the basis of the location of
Title I
24
�the entity offering the plan. A state may not regulate premiums except as such regu1ation
relates to the state's cost containment responsibilities under Title VI or assurance of financial
solvency.
(e)(1) A state must assure that each regional alliance eligible family has within
the area in which the family resides adequate access to a choice of regional alliance
health plans in which to enroll. This includes, to the maximum extent practicable,
adequate access to a health plan with a premium at or below the weighted average for
plans offered. The state also must assure that families eligible for a premium
discount under section 6104(b) are provided with such a discount. To ensure access, a
state may require one or more regional alliance health plans to cover all or part of a
regional alliance area, as a condition of entering into a contract under section 1321
with the regional alliance.
(2) A state may also require, as a condition of contracting with a regional
alliance, that one or more certified health plans provide their enrollees with access to
centers of excellence as designated by the state under rules promulgated by the
Secretary of Health and Human Services.
(3) The section also permits a participating state to adjust the risk-adjustment
methodology (under section 1542(c)) and otherwise provide fmancial incentives to
plans for enrolling individuals in disadvantaged populations. It permits a state to
provide for outreach, transportation, interpretation and other extra services to ensure
access for groups facing access barriers because of their location and other specified
factors.
(f) A state must 'also comply with requirements under title X of the Act regarding
workers compensation and automobile insurance.
(g) A state must establish a reinsurance program for health plans consistent with
regulations established by the Board if a mandatory system is developed under section 1546.
(h) A state may not certify as a regional alliance plan any health plan that offers
either a supplemental health benefit policy or cost sharing policy that fails to meet Act
requirements under part 2 of subtitle E, or if the entity affiliated with the plan offers such a
supplemental health benefit policy.
Section 1204. Financial Solvency; Fiscal Oversight; Guaranty Fund. (a) A
participating state must establish capital standards for health plans that meet Federal
requirements established by the National Health Board (under section 1505(1)).
(b) A state must establish requirements for health plans' fmancial reporting, auditing,
and fund reserves. These requirements must be adequate for monitoring the financial status
of plans.
(c) A state must provide a guaranty fund for health care providers and others in the
Title I
25
�event of a health plan's failure. For purposes of this section, plan failure means curlent or
imminent inability of a plan to pay claims. The state may require each regional alliance plan
to pay an assessment to the state of up to. 2 percent of annual premiums paid by regional
alliance members for as long as is necessary to guaranty claims in the case of a failed plan.
The section also requires states to take the following steps to ensure continuity of
coverage for individuals enrolled in a failed regional alliance health plan:
(1) designation of a state agency to assume control of a failed plan;
(2) payments by the fund in the following order of precedence: (1) to health
care providers for care covered by the plan; and (2) operational, administrative and
other costs and debts of the plan. .Payments by the fund are the exclusive remedy for
providers, who may not bring action against enrollees for amounts owed.
Section 1205. Restriction on Funding of Additional Benefits. A state may not use
funds provided under this Act to pay for benefits in addition to those provided through the
guaranteed benefit package.
PART 2 -- REQUIREMENTS FOR STATE SINGLE PAYER SYSTEMS
Section 1221. Single Payc~r System Described. The National Board is required to
approve a state's application to administer a single payer system if the state's application
either meets the requirement for a statewide single payer system or for an alliance-specific
single payer system.
Section 1222. General Rc~quirements for Single Payer Systems. Each state single
payer system must meet the following requirements:
(1) The system is established under state law and the state law provides
mechanisms to enforce its plan requirements.
(2) The system is operated by a state agency.
(3) The state system provides for enrollment of all persons who are regional
alliance eligible individua1s, including enrollment of all Medicare eligible individuals
if the state has received approval from the Secretary of HHS for Medicare integration
and enrollment of all corporate alliance eligible persons if the state has elected to do
so. Single payer states may not require enrollment of electing veterans, electing
Indians or active duty military personnel.
(4) The state makes direct payments to providers and assumes all fmancial risk
(although payments per capita with the assumption of fmancial risk by providers is
permitted).
.
(5) The state provides the comprehensive benefit package to all persons and
maintains cost sharing requirements no greater on any subgroup of individuals than
those permitted under the Act.
(6) The state maintains per capita expenditures within the target established by
the Board and has mandatory enforcement mechanisms to reduce payments to health
Title I
26
�care providers to assure that per capita expenditures do not exceed applicable targets.
(7) The state meets all requirements applicable to health plans under section
1400 but does not limit enrollment based on capacity, as permitted under section
1402. Requirements for plans relating to marketing and plan solvency do not apply.
Section 1223. Special Rules for States Operating Statewide Single Payer Systems.
(a) States operating statewide single payer systems are required to operate through a
single statewide alliance and must meet the basic requirements for participating states. A
single payer state must assume th(~ functions otherwise carried out by regional alliances.
(b) Other requirements pertaining to regional alliances and health plans are waived,
but coordination of health coverage with workers compensation and automobile insurance
continues as a requirement.
(c) Rules for health alliances pertaining to enrollment and issuance of Health Security
cards continue to apply. Similarly, rules applicable to regional alliances pertaining to low
income assistance, non-discrimination, and data collection and quality assurance.
(d) A state using a single payer system must at least in part use a payroll-based
fmancing system that requires employers to pay at least as much as they would be required to
pay under normal rules of operation in non-single payer states.
Section 1224. Special Rules for Alliance-Specific Single Payer Systems. (a) A state
operating an alliance-specific single payer system must comply with the rules applicable to
participating states.
(b) Each regional alliance must meet requirements generally applicable to regional
alliances, except that such alliance: does not have to comply with the plan choice or consumer
complaint resolution process under sections 1322 and 1326 and does not have the authority to
use fmancial incentives to stimulate service by plans in areas of the alliance with inadequate
services.
Title I
27
�SUBTITLE D - HEALTH ALLIANCES
(H.R. 3600 and S. 1757 p. 118)
This subtitle sets forth the requirements for regional and corporate health alliances.
Part 1 describes general rules for regional and corporate alliances. Part 2 identifies the
duties and responsibilities of regional alliances. Part 3 describes the financing and income
detennination requirements of regional alliances. Part 4 describes the duties of corporate
alliances.
Section 1300. Health Alliance Defined. A health alliance means a regional or
corporate alliance (as defmed in sections 1301 and 1311).
PART 1. ESTABLISHMENT OF REGIONAL AND
CORPORATE ALLIANCES
SUBPART A - REGIONAL ALLIANCES
Section 1301. Regional Alliance Defined. A regional alliance is a non-profit
organization, independent state agency or an agency of the state which meets the
requirements of this subpart and carries out the duties of alliances.
Section 1302. Board of Directors. (a) A regional alliance must be governed by a
Board of Directors. The Board of Directors has all of the powers vested in a regional
alliance under the Act.
(b) Board members must include in equal proportion representatives of employers
(including self-employed persons) and individuals (including employees).
(c) Board members are prohibited from maintaining a fmancial interest in health care,
either directly or through a family member.
Section 1303. Provider Advisory Boards for Regional Alliances. Each regional
alliance must have a provider advisory board.
SUBPART B - CORPORATE ALLIANCES
Section 1311. Corporate Alliance Dermed; Individuals Eligible for Coverage
through Corporate Alliances; Additional Dermitions. (a) A corporate alliance means an
eligible sponsor that has elected (in a form and manner prescribed by the Secretary of Labor)
to be treated as a corporate alliance and that has filed documents with the Secretary.
(b) Eligible sponsors include large employers. Excluded employers include employers
whose business is employee leasing, the federal government (other than the United States
Title I
28
�Postal Service), and state and local government agencies, including special purpose units of
government.
Eligible employers also include plan sponsors, under section 3(16)(B)(iii) of the
Employee Retirement Income Se(;urity Act (ERISA), of multiemployer group health plans
under section (e)(4) of ERISA, but only if the health benefit plan was offered as of
September 1, 1993, and has more than 5000 active participants in the United States or is
maintained by one or more affiliates of the same labor organization, or one or more affiliates
of labor organizations representing employees in the same industry and covering more than
5000 employees.
Rural·electric cooperative associations may also sponsor a corporate health alliance,
but only if the cooperative offered benefits on September 1, 1993, and only if the plan
covered more than 5000 full-time employees.
(c) The following employees are eligible to enroll in a corporate alliance health plan:
(1) full-time employees;
(2) participants and beneficiaries of multi-employer alliances, as the
terms are defmed under section 3 of ERISA; and
(3) full-time employees of rural cooperatives.
Persons eligible to enroll in corporate alliances are ineligible to enroll in regional
alliances unless they meet the multiple-employment family requirements of section 1013.
(d) The following individuals are ineligible to enroll in corporate alliances:
(1) AFDC recipients.
(2) SSI recipients.
(3) electing veterans, Indians and active duty military personnel under
section 1004 of the Act. ,
(4) temporary and seasonal workers unless treated as corporate alliance
eligible individuals pursuant to a collective bargaining agreement.
(e) Defmitions are provided for the following terms:
(1) a "group health plan" means an employee welfare benefit plan as
defmed in section 3(1) of ERISA providing medical care to participants and
beneficiaries as defmed in section 3 of ERISA.
(2) the term "large employer" means an employer with more than 5000
full time employees.
(3) the term "multi-employer plan" has the same meaning given the
term in section 3(37) of ERISA.
(4) the term "rural electric cooperative" has the meaning given the term
in section 3(40)(A)(iv) of ERISA.
(5) the term "rural electric cooperative association" has the meaning
given the term in section 3(40) of ERISA.
Title I
29
�Section 1312. Timing of Elections. (a) Large employers must notify the Secretary of
Labor that they intend to sponsor a corporate alliance by January 1, 1996. In the case of
new large employers that are not eligible sponsors as of the general effective date, such
. employers can become corporate sponsors by filing with the Secretary of Labor by March 1
following the year in which the employer becomes an eligible sponsor.
(b) Multi-employer plans and rural cooperatives must file their election with the
Secretary no later than March 1, 1996.
(c) Elections made by large employers or multi-employer and rural cooperative plans
shall be effective for coverage under health plans on or after January 1 of the year following
the year in which the election is made.
Section 1313. Termination of Alliance Elections. (a) A corporate alliance election
shall terminate if the number of full-time employees or active participants falls below 4800.
(b) Termination shall occur if the Secretary of Labor determines that the alliance is in
substantial non-compliance or if the corporate alliance's premium expenditures increase
excessively, as dermed under section 6022.
(c) A corporate alliance may elect to terminate.
(d) Termination under this section takes effect as of the date of the next open
enrollment in regional alliance health plans.
PART 2 - GENERAL RESPONSmILITIES AND AUTHORITIES OF
REGIONAL ALLIANCES
Section 1321. Contracts with Health Plans. (a) A regional alliance must negotiate
with any willing state-certified health plan to enroll eligible individuals. An alliance may not
contract with a plan that is not state certified. Regional alliances must contract with plans
offered by the Department of Vt:terans Affairs and the Department of Defense if requested to
do so by an appropriate official.
(b) A regional alliance may deny a contract to a plan only if the plan's bid exceeds
120 percent of the alliance per capita premium target (as determined under section 6003) or
if the plan failed to comply with prior contracts, including failing to offer coverage for all
services in the plan's entire service area.
Section 1322. Offering Choice of Health Plans for Enrollment; Establishment of
Fee-For-Service Schedule. (a) Each alliance must offer residents a choice of health plans
among those that have contracts with the alliance.
Title I
30
�(b) Each alliance must offer at least one fee-for-service plan. A fee-for-service plan
is a plan that offers all of the items and services offered in the comprehensive package and
pays providers without regard to whether there is a contractual arrangement between the plan
and the provider. Reasonable restrictions that may be imposed on payments under a fee-for
service plan include utilization review, prior approval of specified services, and exclusion of
providers on the basis of poor quality of care. Prior approval authority may not be used to
impose gatekeeper requirements on the use of specialty services.
(c) Each regional alliance must establish a fee schedule for fee-for-service plans or the
fee-for-service component of any other health plan. The fee schedule shall be established
only after negotiations with providers, and providers may collectively negotiate. The
schedule applies to both regional alliance health plans and to corporate alliance plans
furnishing services subject to the schedules in the regional alliance area. A state may elect to
establish a statewide fee schedule for all regional alliances. Fee schedules shall be updated
annually.
The establishment of a fee schedule shall be considered state action, and negotiations
by providers over the schedule (including collective negotiations) shall be considered efforts
to influence governmental action. Nothing shall be construed to permit providers to threaten
or engage in a boycott.
(d) A regional alliance may use prospective budgeting in creating its fee schedule.
Such a fee schedule shall be based on a budget negotiated with providers that contains
spending targets for each sector of health plan spending. If the regional alliance determines
that plan spending will cause the alliance to exceed its budget, it must reduce expenditures
through a withhold or delay in payments. If a regional alliance or the state uses a
prospective budget for fee-for-service plans, then payment for all services under fee-for
service plans shall be in accordance with the prospective schedule.
Section 1323. Enrollment Rules and Procedures. (a) A regional alliance must assure
that each eligible person (residing in its area) is enrolled in a regional alliance health plan.
Procedures developed by the alliance must assure enrollment at the time individuals fIrst
become eligible, including at the time of birth or when they move into the. alliance area and
at the time that they reach the age of individual eligibility as an adult. Alliances must have
procedures for assuring that families select a single health plan in which to enroll.
(b)(l) Alliances must'maintain a point of service enrollment mechanism
enrolling eligible individuals who are not already enrolled in a plan when they seek
health services.
(2) Under the point of service mechanism the following procedures apply:
(A) the treating provider must notify the alliance of the individual's
identity and may request payment from the alliance.
(B) The alliance must then determine· the individual's eligibility and
whether the individual already is enrolled in a plan.
Title I
31
�(C) If the individual is already enrolled in a regional alliance plan, the
alliance shall send the treating provider's claim to the plan, and the plan shall
pay in accordance with the alliance fee schedule. If the individual is required
to be enrolled in a specific plan as a family member, the alliance shall record
the enrollment, notify the individual, submit the treating provider's claim to
the plan, and the plan shall make payment.
.
(D) If the individual is enrolled in a health plan offered by another
alliance, the alliance shall forward the claim and the plan shall pay it in
accordance with the alliance fee schedule.
(E) If the alliance determines that the individual is eligible for
enrollment through another health alliance, it must notify the alliance and
. forward the claim.
(F) The Board is required to promulgate rules for treatment of other
individuals.
(3) The following procedures shall be used in the case of individuals eligible
for point-of-service enrollment:
(A) The individual must be provided with information about alliance
health plans.
(B) If the individual does not enroll within 30 days, he or she is
randomly assigned to a health plan.
(C) The plan in which the individual becomes enrolled must pay the
initial treating provider.
(c) Alliances must have procedures for enrolling new residents. Individuals who
intend to reside in the alliance area for more than 6 months must register with the alliance
and enroll in a plan. Short term residents (those in the alliance areas for more than 3 months
but less than 6 months), may either enroll in an alliance plan, continue coverage with their
plan, or change enrollment in the previous alliance to a plan that provides coverage on a fee
for-service basis for all items and services furnished outside the area of that alliance.
(d) Each regional alliance must maintain an annual open enrollment period and must
have procedures permitting disenrollment for good cause at any time during the year.
(e) An alliance must assure that all family members are enrolled in the same plan.
(f) Each alliance must establish enrollment priorities in the case of oversubscribed
plans that do not have sufficient capacity. Current enrollees are required to have priority.
(g) Alliances must have termination procedures that permit enrollees to terminate
enrollment in one plan and reenroll in another plan without any interruption in coverage for
benefits. Such procedures also must cover enrollment situations involving the failure of a
corporate alliance.
(h) An alliance may not knowingly offer enrollment to an individual who is not
Title I
32
�eligible. However, any health plan may offer coverage and enrollment without fmancial
payment by the regional alliance.
(i) In the case of an individual who fails to enroll, the alliance must enroll the
individual and require payment of twice the amount of the family share of the premiums that
. otherwise would have been payable under subtitle B of Title VI unless the individual can
demonstrate good cause for non-payment.
Section 1324. Issuance of Health Security Cards. A regional alliance must issue a
health security card to all regional alliance eligible individuals .
. Section 132S". 'Consumer Information and Marketing. (a) Before each open
enrollment, regional alliances must provide enrollees with easily understood and useful
information that permits enrollees and other alliance eligible individuals to make valid
comparisons among alliance health plans. Brochures must include information about cost,
the characteristics and availability of the health professionals and institutions that participate
in the plan, any restrictions on access to plan providers , and a summary of the annual quality
performance report published under section 5005 of the Act.
(b) Each regional alliance must review and approve all materials used to market
health plans.
Section 1326. Ombudsm~m. (a) Each alliance must establish and maintain an
ombudsman to deal with problems arising within the alliance and health plans.
(b) At state option the ombudsman may be fmanced through a VOluntary dollar
checkoff arrangement at the time that individuals enroll in plans.
Section 1327. Data Collection; Quality. Each regional alliance must comply with
quality requirements under title V and shall take steps to assure that plans comply with
requirements ..
Section 1328. Additional Duties. (a) In carrying out its activities under this part, a
regional alliance may not discriminate against health plans on the basis of race, sex, national
origin, religion, mix of health professionals, location of the plan's headquarters or (except as·
specified) organizational management.
(b) Each alliance must coordinate enrollment and disenrollment activities with other
alliances to ensure continuous and non-duplicative coverage for eligible individuals.
Section 1329. Additional. Authorities of Regional Alliances to Address Needs in
Areas with Inadequate Health Services; Prohibition of Insurance Role. (a) In order to
ensure that plans are available in all areas of the alliance, an alliance may adjust payments to
plans or use other fmancial incentives to encourage health plan expansion.
Title I
33
�(b) In order to help establish a new health plan in an area with inadequate services, an
alliance may help organize health providers and provide technical assistance.
(c) A regional alliance may not bear m.surance risk.
Section 1330. Prohibitions Against Self Dealing and Conflict of Interest. (a) The
Board shall promulgate conflict of interest standards for any officer, fiduciary or employee of
a regional alliance that shall iden1ify improper ownership and investment interests, the
circumstances that constitute impermissible conflicts of interest or self dealing. The Board is
authorized to seek civil money penalties for violation of these rules in a manner consistent
with section 1128 A of the Social Security Act.
PART 3 - AUTHORITIES AND RESPONSmILITIES OF REGIONAL ALLIANCES
RELATING TO FINANCING AND INCOME DETERMINATIONS
SUBPART A - COLLECTION OF FUNDS
Section 1341. Information and Negotiation and Acceptance of Bids.
(a)(I) Each health alliance must provide to interested plans, by April 1 of each
year, information that the National Health Board specifies as necessary for plans to be
able to estimate the amounts that would be payable to a plan if its premium bid for
the year were accepted.
(2) At a minimum, necessary information includes the following:
(A) the demographic characteristics of regional alliance eligible
individuals;
(B) the uniform per capita conversion factor for the alliance which
converts an accepted bid into a premium for the individual class of enrollment;
(C) premiwn class factors established by the Board under section 1531;
(0) the regional alliance inflation factor;
(E) the risk adjustment factors and the reinsurance methodology and
payment amounts 1.0 be used by the regional alliance to compute blended plan
per capita rates under section 6201;
(F) the plan bid proportion, the AFDC proportion, the SSI proportion,
the AFDC per capita premium amount, and the SSI per capita premium
amount for the year, as computed under subtitle D of Title VI;
(G) the alliance administrative allowance percentage computed under
section 1352.
(b) A regional alliance shall specify its uniform per capita conversion factor by April
1 of each year (beginning the year before the flIst year). SSI and AFOC recipients are not
included in this calculation.
(c) Regional alliances shall compute and publish the risk adjustment factors and
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�reinsurance paynient amounts to be used in computing blended plan per capita
rates~
(d) Regional alliances shall solicit and negotiate with alliance health plans a per capita
payment rate for the comprehensive benefit package for alliance eligible persons in the
alliance area.
Section 1342. Calculation and Publication of General Family Sh~e and General
Employer Premium Amounts. (a)(I) Regional alliances shall compute the following
components of the family share of premiums:
(A) a premium, by class of family enrollment, for each health plan
offered in the alliance (including the amount imposed to offset the alliance's
family collection shortfall);
(B) the alliance credit for each class of enrollment under section 6103;
(C) any excess premium credit provided under section 6105;
(D) the amount of any applicable corporate alliance opt-in credit under
section 6106.
(2) Regional alliances shall compute employer premium payments as follows:
(A) the base employer monthly premium for each class of family
enrollment under section 6122; and
(B) the employer collection shortfall add-on under section 6125.
(b)(1) Before open enrollment each year, regional alliances shall publish the
general family share of the premium, without regard to any premium discounts for
which certain families may be eligible and without regard to the special credit for
AFDC and SSI families under section 6101(b)(2)(c)(v).
(2) Each December, regional alliances must publish the general employer
. premium payment for each class of family enrollment without regard to credits or
add-ons in sections 6124, 6125 or 6126.
Section 1343. Determination of Family Share for Families. (a) Regional alliances
charge the family share in the case of families enrolling in regional alliance health plans.
(b) The family share is based on the general family share , any income-related
discounts, and whether the family receives AFDC or SSI.
(c) The alliance credit repayment amount for each family in the alliance takes into
account the following factors:
'
(1) the number of months of enrollment, the class of enrollment, in regional
alliance health plans;
(2) reductions in liability based on premium payments reflecting net earnings
from self employment under section 6111;
(3) reductions in liability based on months of family employment;
(4) limitations on liability resulting from adjusted family income under section
6113;
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�·(5) the elimination of liability in the case of certain retirees and qualified
spouses and children under section 6114;
(6) the elimination of liability in the case of certain working Medicare
beneficiaries under section 6115.
(d) The alliances shall have access to the infonnation necessary to make the
enrollment detenninations, including:
(1) infonnation needed for income-related detenninations;
(2)infonnation on SSI and AFDC recipients;
(3) infonnation submitted on a monthly and annual basis by employers under section
1602;
(4) inf.onnation submitted by self employed persons under section 1602;
(5) applications for premium reductions under section 6114;
(6) infonnation concerning Medicare eligible individuals;
(7) income related discounts provided to families under section 6104;
(8) whether or not the family is an AFDC or SSI family.
(e) Participating states and the Secretary of Health and Human Services (hereafter
"the Secretary ") must make available infonnation needed to detennine and verify the AFDC
or SSI status of alliance enrollees.
(f) The Secretary must make available infonnation to alliances regarding the Medicare
status of area residents, infonnation on whether they are qualified employees and therefore
subject to special treatment under section 6115, and information on amounts owed to the
alliance. Alliances must notify the Secretary regarding those individuals that would be
Medicare eligible but for the provisions of section 1012(a) (relating to Medicare individuals
who are qualified employees).
(g) Regional alliances shall establish an accounting system that meets standards
established by the Secretary which shall collect timely infonnation for each enrolled
iridividual regarding the applicable premium, families members covered under the
enrollment, premiums paid, employer premiums paid, and government contributions. At the
end of the year the system shall report on total premiums imposed and total amounts
collected.
Sectic;m 1344. Notice of Family Payments Due. (a)(I) Alliances shall notify families
who have paid the family share and are not liable for an additional. payment under section
6111, that they are not required to make additional payments or file additional infonnation.
(2) Alliances must also notify families of amounts owed and not paid. Such
notices shall contain detailed infonnation on amounts owed and the basis for the
computation and the date on which payment is due. Notices must include infonnation
regarding discounts and reductions available to reduce or eliminate liability· and a
worksheet that families can use to calculate eligibility. Notices also must contain
income reconciliation statements for families receiving a premium discount under
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�section 6103 and a deadline for making payment. Families that did not receive a
discount but qualify for one can submit information and receive a rebate. Notices
must be mailed at least 45 days before the deadline for payment.
(b) The Secretary must specify payment deadlines that take into account the date on
which income reconciliation infonnation becomes available during the year .. Amounts not
paid by the deadline are subject to fmes and a penalty.
(c) For families changing regional alliances during a year, the Secretary shall establish
rules which provide that the regional alliance through which the family most recently
obtained coverage is responsible for recovering amounts due and paying other alliances as
appropriate..
(d) Nonpayment shall not result in the loss of coverage under the Act.
(e) Regional alliances must: maintain dispute resolution systems for resolving disputes
over amounts owed.
Section 1345. Collections. (a) Regional alliances are responsible for collection of all
amounts owed (whether by individuals or employers or whether on the basis of premiums
owed, incorrect amounts of discOlmts or cost sharing or other reductions made). The Federal
government does not pay any amount attributed to the failure to collect. Regional alliances
shall use credit and collection procedures including late fees and imposition of interest for
failure to make payment and shall be assisted by states.
(b)(1) In the case of the family share owed by qualifying employees, the
Secretary of Labor shaH promulgate rules for employer withholding of amounts owed.
Families with multiple employers shall select the employer to make the deduction.
Amounts withheld shall be paid to the alliance and the employee's obligations shall be
deemed to be met to the extent that amounts are withheld.
(2) The Secretary of HHS may issue rules governing payment by families that
do not include qualifying employees. Payments may not be made less than monthly.
(c) Employer premiums must be paid not less frequently than monthly. Regional
alliances may require employers to pay by electronic transfer if they have the capacity to do
so.
(d)(1) The Secretary of Labor shall assist regional alliances in order to
promote the efficient collection of amounts owed by employers. The Secretary of
Labor may also assess civil money penalties on employers that fail to pay.
(2) The Secretary of HHS may assist alliances in developing efficient
collection systems for families and may also impose civil money penalties on families
that fail to pay.
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�(e) Additional funds paid to alliances are those paid by states under subtitle A of title
IX and the federal government under subtitle B of Title IX.
Section 1346. Coordination Among Regional Alliances. (a) The regional alliance in
which a family is enrolled in December is responsible for collection of amounts owed
without regard to whether the family resided in the alliance for the full year.
(b) Each alliance must provide to the final alliance information required to determine
liability and reductions attributed to alliance credits (through the National Information System
under section 5101, or otherwise).
(c) The fmal alliance shall distribute amounts collected equitably among the alliances
that provided coverage during the year.
(d) The Secretary may publish rules to expedite alliance coordination.
(e) For full-time students, the alliance in which the parent is enrolled (if different
from the one in which the student is enrolled) shall pay the student's alliance an appropriate
portion of the premium.
(f) In the case of couples enrolled in a corporate alliance and in which one member
isa qualified employee of a regional alliance employer, the regional alliance shall pay the
corporate alliance the amounts received on behalf of the employee from the regional alliance
employer without regard to discounts under section 6123.
SUBPART B - PAYMENTS
Section 1351. Payments to Regional Alliance Health Plans. (a) Regional alliances
must compute, under section 6201(a) a blended plan per capita payment amount for each
regional alliance plan for enrollment for a year.
(b)(1) The amount of payment equals the net blended rate adjusted to take into
account the relative actuarial risk associated with such coverage.
(2) The net blended rate is the blended per capita payment amount under
section 6201, reduced by the administrative allowance percentage and 1.5 percentage
points and any plan payment reduction for the year under section 6011 (relating to
payment reductions to keep alliance expenditures within target).
(c) Regional alliances shall use risk adjustment methodologies developed by the
National Health Board to make payments to plans.
(d) The 1.5 percent of the premium is paid to the federal government for the support
of academic health centers and graduate medical education.
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�(e) In the case of veterans health plans and uniformed services health plans, Title VI,
subtitle A does not apply, except for the requirement to submit a per capita bid, which is not
subject to negotiation or reduction under section 0011 and shall be considered the plan's final
bid. The proportion of enrolled AFDC and SSI beneficiaries is deemed to be zero. In the
case of Indian health progr~s, families enrolled are not taken into account in computing the
blended rate. Regional alliances shall collect employer premiums owed for qualifying
employees enrolled in a program of the Indian Health Service. The family share is deemed
to be zero. Family residence and enrollment class rules shall be developed by the Secretary.
Section 1352. Alliance Administrative Allowance Percentage. Before obtaining
bids, the alliance shall establish an administrative allowance percentage for the operation of
the regional alliance. The percentage is equal to the total administrative allowance divided
by the total of the amounts payable to regional alliance health plans. In no event may the
allowance exceed 2.5 percent of lhe total amounts payable to regional alliance health plans.
Section 1353. Payments to the Federal Government for Academic Health Centers
and Graduate Medical Education. Regional alliances must make payment to the Secretary
annually of an amount equal to 1.5 percent of premium amounts collected.
SUBPART C - FINANCIAL MANAGEMENT
Section 1361. Management of Finances and Records. (a) Regional alliances must
comply with National Board administrative and financial management requirements.
(b) Specific requirements include:
(1) Annual, published fmancial audits, with actions to correct deficiencies
found. Error rate allowances for premium discounts, liability reductions, and cost
sharing reductions consistent with maximum rates set by the Secretary of HHS for
, families and by the Secretary of Labor for employers and alliance error rates shall be
included in the audit.
(2) Procedures for safeguarding funds in accordance with fiduciary standards
and in compliance with rules of the Secretary of HHS in consultation with the
Secretaries of Labor and Treasury, regarding standards for the holding of funds.
(3) Contingency funds to hold surpluses resulting from estimation
discrepancies.
(4) Audits of regional alliance employers to assure proper payment. Regional
alliance audits shall be coordinated in the case of employers with employees living in
more than one alliance area, according to a process established by the Secretary of
Labor, in consultation with the Secretary of HHS. Employers aggrieved by the
results of an audit may appeal to the Secretary of Labor.
SUBPART D - REDUCTIONS IN COST SHARING;
INCOME DETERMINATIONS
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�Section 1371. Reduction lin Cost Sharing for Low Income Families. (a) AFDC and
SSI families and families with adjusted incomes below 150 percent of the applicable poverty
level are entitled to a cost sharing reduction. Reductions in cost sharing apply only to items
and services furnished after application for the reduction. In the case of AFDC and SSI
families, reductions apply only during the periods that they receive AFDC or SS!. Alliances
shall furnish providers and plans with information necessary in order to provide cost sharing
reductions. A cost sharing reduction is only available if there are not sufficient low-cost or
combination cost plans (as defmed in section 6104(b)(3)).
(b) Cost sharing reductions shall reduce cost sharing to the level of a lower cost or
combination plan.
(c) In the case of AFDC or SSI families enrolled in lower or combination cost sharing
plans, health plans shall provide additional cost sharing reductions equal to 20 percent of the
amount that otherwise would be owed under the lower cost sharing plan, adjusted for
inflation as required in section 1136. The additional reduction does not apply to non
emergency care obtained in emergency rooms.
(d) The regional alliance shall pay health plans the amount represented by the family's
cost sharing reduction, except that no payment shall be made for the additional cost sharing
reduction to which AFDC and SSI beneficiaries are entitled. Payments shall be made to
plans based on prospective estimates of amounts owed by the alliance and reconciled on a
quarterly basis.
(e) In the case of Indians, Veterans and active duty military members enrolled in
Indian, Veterans and Department of Defense plans, no cost sharing reduction is available
since no cost sharing is required.
Section 1372. Application Process for Cost Sharing Reductions. (a) Families may
apply to their alliance for a cost sharing reduction. Applications shall include information
prescribed by the Secretary of HHS and shall include information ,on at least family
employment and income.
(b) The family's application may be filed at times specified by the Secretary,
including open enrollment periods, at the time of a move, or after a change in life
circumstances affecting a class of enrollinent or amount of family share or repayment
amount. Alliances must approve or disapprove a family's share and provide notification of
the determination.
(c) Applications shall be approved if the family's adjusted income for the month is (or
is expected to be) less than 150 percent of the applicable poverty level. The alliance shall
use income from the previous 3-month period as well as current wages, consistent with rules
of the Secretary of HHS.
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�(d) Family adjusted income means the sum of adjusted incomes (defined as aajusted
gross income under the Internal Revenue Code) of all family members. Famiiies may include
the income of other individuals who are claimed as .dependents for income tax purposes, but
such individuals are not counted as family members for purposes of determining the size of
the family.
(e) Family eligibility for discounts depends on periodic confirmation by the regional
alliance; also, family income must be reverified at each new filing of income reconciliation
statements. The Secretary is required to issue rules on confirmation and verification of
income. Families must notify alliances of material changes in family income or employment
status. If an alliance learns of changes in a family's income or employment status, it shall
promptly reconfrrm the family's eligibility, whether it learns of the change from the family,
an employer, or otherwise.
(f) The alliance shall promptly terminate cost sharing reductions if it determines that a
family is no longer eligible.
(g ) AFDC and SSI recipients are not required to apply for cost sharing reductions.
states and the Secretary shall notify each alliance of the identity of the AFDC and SSI
recipients.
Section 1373. Application for Premium Discounts and Reduction in Liabilities to
Alliances. (a) Families may apply for a premium discount to regional alliances under 6104
or a reduction in liability under 6113.
(b) Applications for premium reductions and reductions in liability can be filed at the
times that cost sharing reduction applications are filed and may also be filed at the end of the
year to obtain a rebate for excessive premiums paid.
(c) Alliances shall approve applications for a premium discount if the family's
adjusted income for a month is (or is expected to be) less than 150 percent of the applicable
poverty leveL Alliances may grant a reduction in liability under section 6113 if the family's
wage adjusted income is or is expected to be less than 250 percent of the applicable poverty
leveL (Wage adjusted income is equal to family adjusted income reduced by (a) the amount
of wages received from employment, up to a maximum of $5,000 per month; (b) net
earnings from self employment; and (c) the amount of unemployment compensation included
in income). In making the determination, the alliance shall use family income from the
previous 3-month period and current wages from employment, and a statement of estimated
income for the year.
(d) Periodic verification and confrrmation requirements apply to discounts and liability
reductions, as well as to cost sharing assistance.
Section 1374. General PJrovisionsRelating to the Application Process. (a) Regional
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�alliances must distribute applications under this subpart directly to consumers and thi'ough
banks, employers and designated public agencies.
(b) Applications may be filed in person or by mail and may be submitted with a
health plan enrollment form.
(c) Applications shall contain a declaration of annual income for the year involved.
(d) The Secretary shall prescribe the form and contents of the application for a
discount or reduction.
(e) Applications may be filed at any time during the year, including during the
reconciliation process under section 1373. Families may also apply to have premium
discounts and reductions reduced if their incomes change.
(1) Premium discounts and reductions apply to payments required and expenses
incurred after the date of approval. For AFDC and SSI recipients, the date of approval of
the application for financial assistance shall be the date of approval under this subpart.
(g) Verification methods shall be prescribed by the Secretary and shall be separate
from the reconciliation requirements.
(h) Regional alliances shall assist individuals in completing applications.
(i) Penalties shall be imposed on persons who knowingly misrepresent or understate
their income.
Section 1375. End-of-Year Reconciliation for Premium Discount and Repayment
Reduction with Actual Income. (a) Families receiving premium discounts and reductions in
liability must file annual income reconciliation statements. Statements must contain such
information as the Secretary of HHS may specify. Deadlines for income reconciliation shall
be coordinated with regional alliance notifications to families of payments due.
(b) Regional alliances shall compute the amount of premium discount that should have
been provided on the basis of the family's annual income statement (above). If the amount
of discount provided is greater than it should have been, the family is liable for repaying the
excess (either directly or through an increase in future payments). If the amount of rebate
actually provided is less than should have been provided, the alliance must pay the difference
to the family directly or by reducing the family's future premiums or payments.
(c) No reconciliation is required for AFDC and SSI families.
(d) Families that fail to file reconciliation forms are disqualified from receiving
premium discounts or liability reductions.
.
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�(e) Individuals who file false statements shall be subject to monetary penalties.
(f) Regional alliances shall notify families in writing of their obligation to reconcile
their income.
(g) States may use available information to assist alliances to verify family income
claimed on family applications and may be provided by the Secretary of Treasury, income
information from Federal tax returns consistent with section 6103 of the Internal Revenue
Code so long as it is not disclosed directly to alliances.
(h) Nothing in this section shall be construed to permit reconciliation of cost sharing.
PART 4 - RESPONSIBILITIES AND AUTHORITIES OF
CORPORATE ALLIANCES
Section 1381. Contracts with Health Plans. (a) A corporate alliance may offer
eligible individuals either a self insured plan or a state certified health plan or both.
(b) Corporate alliances and state certified plans may contain additional provisions but
may not abrogate the requirements of the corporate alliance to provide health benefits to
eligible individuals.
Section 1382. Offering Choice of Health Plans for Enrollment. (a) A corporate
alliance must offer enrollees a choice of at least 3 health plans. At least one must be a fee
for-service plan, and at least two of the plans must not be fee-for-service plans.
Section 1383. Enrollment; Issuance of Health Security Card. (a) Each corporate
alliance shall assure the enrollment of each alliance eligible individual and shall assure
enrollment as soon as individuals become alliance eligible. A corporate alliance is also
responsible for issuing Health Security cards.
(b) A corporate alliance that is notified of a person who appears to be alliance eligible
at a point of service shall promptly ascertain eligibility and enroll the person if eligible, and
also notify the Secretary of Labor of the enrollment. The alliance shall forward the claim for
payment to the enrollee's health plan.
(c) Corporate alliances shall follow regional alliance rules under subsections (d)
through (f) of section 1323 with respect to annual open enrollment, enrollment of family
members, and procedures in the event of over-subscription.
(d)(I) Corporate alliances shall use the same termination procedures for
alliance eligible persons that apply to regional alliances under section 1323 (g).
(2) Health plans may terminate contracts with corporate alliances that fail to
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�pay premiums, in which case the corporate alliance is responsible for promptly
enrolling plan members in another health plan.
(e) Corporate alliances must cover individuals 'as of the first day of the month in
which the individual becomes eligible for the corporate alliance and must continue coverage
through the end of the month in which the covered individuals loses eligibility.
Section 1384. Community Rated Premiums Within Premium Areas. (a) Premiums
charged by corporate alliances shall vary only by the class of family enrollment and by
premium area.
(b) Cerporate alliances shall designate premium areas to be used to impose premiums
and calculate employer payments. ,Boundaries shall reflect labor market or health service
delivery areas and shall be consistent with rules of the Secretary of Labor so that within such
areas there are not substantial differences in per capita health spending. The rules of sections
1202(b) (relating to anti-redlining and the use of metropolitan statistical areas) shall apply to
corporate alliance premium areas.
(c) Premiums shall be applied based on class of family enrollment and shall vary
based on class factors that take into account the considerations the National Health Board
uses under section 1531 to establish premium class factors, the cost of regional alliance
health plans for different classes, consisten with rules established by the Secretary of Labor.
(d) The Secretary of Labor may exempt multi-employer plans from certain
requirements as may be appropriate to reflect the unique historical relationship between
employers and employees under such alliances.
Section 1385. Assistance for Low Wage Employees. Corporate alliances shall
adhere to rules in section 6131(b)(2) in making additional premium contributions for low
wage employees who qualify for a premium discount.
r
Section 1386. Consumer Information and Marketing; Data Collection and
Quality; Additional Duties. Corporate alliances shall follow the data, quality and
information collection duties of regional alliances under sections 1325(a), 1327 and 1328.
Section 1387. Plan and Information Requirements. (a) Corporate alliances must
provide written information to the Secretary of Labor regarding how they will carry out their
duties.
(b) Corporate alliances must annually report on their compliance with the Act's
requirements.
(c) Each alliance must notify the Secretary by March 1 each year of the number of
full-time employees or participants that obtained coverage through the alliance as of January
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�1. Large employers that are not corporate alliances also must report to the Secretary of
Labor on the number of such employees on January 1.
Section 1388. Management of Funds; Relations with Employees. The management
of funds by a corporate alliance is governed by applicable parts 4 and 5 of subtitle B of
ERISA (fiduciary and enforcement provisions respectively). The corporate alliance shall
comply with rules of the Secretary of Labor on management of fmances, records and
accounting systems.
Section 1389. Cost Control. Corporate alliances must control covered expenditures in
compliance with part 2 of subtitle A of Title VI.
Section 1390. Payment by Corporate Alliance Employers to Corporate Alliances.
(a) Large employer sponsors shall fund benefits in a manner consistent with 6131,
through insurance or otherwise, and shall meet certain solvency requirements in sections
1394, 1395 and 1396.
(b) Other corporate sponsors make premium payments in a manner consistent with
rules of the Secretary of Labor.
Section 1391. Coordination of Payments. (a) A corporate alliance shall make
premium payments to regional alliances in cases in which a married couple has enrolled with
a regional alliance plan, and one spouse is an employee of a regional alliance employer, and
the other an employee of a corporate alliance employer that has made payments for the
employee to the corporate alliance.
(b) Where a couple is employed by two different corporate alliances, the alliance in
which the couple is not enrolled shall make payments to the alliance in which the couple is
enrolled.
Section 1392. Applicability of ERISA Enforcement Mechanisms for Enforcement
of Certain Requirements. Sections 502 (civil remedies) and 504 (investigative enforcement)
of ERISA shall apply to enforcement actions by the Secretary of Labor under this part.
Section 1393. Applicability of Certain ERISA Protections to Enrolled
Individuals. The provisions of sections 510 (relating to interference with rights protected
under the Act) and 511 (relating to coercive interference) shall apply to corporate alliance
enrollees as they apply to participants and beneficiaries in employee welfare benefit plans
covered under ERISA.
Section 1394. Disclosure and Reserve Requirements. (a) The Secretary of Labor
must assure that each self insured corporate alliance health plan reserves in trust sufficient
assets to ensure that the plan can at any time pay. health care providers the outstanding
balance owed by the plan. (The trust arrangement is to be as provided under section 403 of
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�the Employee Retirement Income Security Act of 1974 (but omitting the section 403(b)(4)
exemption of that act.» The Secretary shall prescribe the type of security that satisfies the
requirement of this section.
(b) Self insured plans must notify the Secretary if they do not satisfy the reserve
requirements and are subject to a $100,000 penalty for failing to disclose the lack of security.
Section 1395. Trusteeship by the Secretary of Labor of Insolvent Corporate
Alliance Health Plans. (a) If the Secretary of Labor determines that a self insured corporate
alliance plan will be unable to provide benefits when due or is otherwise in a financially
hazardous condition as defined in. regulation, the Secretary shall apply to the appropriate
United States District Court for appointment as trustee. The Court shall appoint the
Secretary after a hearing if it determines that a trusteeship is necessary to prevent further
financial deterioration or protect the interest of the covered individuals or health care
providers. The trusteeship shall continue until the hazardous conditions are remedied.
(b) The Secretary shall have broad powers to manage the health plan, secure
information and records, collect funds and premiums owed, terminate and liquidate or
preserve the plan, and otherwise protect the interests of plan enrollees.
(c) The Secretary shall notify the plan administrator, enrolled individuals and
employers that are liable for contributions of the appointment.
(d) The Secretary shall carry out other duties specified by ERISA for a trustee.
(e) The Secretary may file a trusteeship application notwithstanding other judicial
proceedings against the plan.
.
(f) The court in which the application for trusteeship is filed shall have exclusive
jurisdiction of the plan and its property wherever located and may stay any other proceeding
against the plan. Venue lies· in the judicial district where the plan administrator resides or
does business or where plan assets are situated:
(g) The Secretary may appoint personnel needed to carry out trustee duties.
I
Section 1396. Guaranteed Benefits Under Trusteeship of the Secretary of Labor.
(a) The Secretary of Labor shall guarantee all benefits of the self-insured plan.
(b) Any increase in benefits resulting from a plan amendment that was made or
became effective within 180 days of the Secretary's appointment shall be disregarded for the
purpose of determining the guarantee.
(c) The Secretary shall establish a Corporate Alliance Health Plan Insolvency Fund to
pay guaranteed benefits. The fund shall receive assessments and funds borrowed and shall
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�make payments needed to cover guaranteed benefits, repay loans, and operate the fund. The
total balance of outstanding fund obligations at any time may not exceed $500 million.
(d) The fund shall have sufficient borrowing authority, in accordance with tenns
established by the Secretary of the Treasury, to carry out its duties.
Section 1397. Imposition and Collection of Periodic Assessments on Self Insured
Corporate Alliance Plans. (a) The Secretary of Labor may impose assessments on self
insured corporate alliances in order topennit the insolvency fund in section 1396, to repay
loans and carry out its duties.
(b) Assessments shall be unifonn but may vary the amount by category or reserve
requirements.
(c) Not more than 2 percent of total premiums paid to plans may be assessed during a
year.
(d) Plans shall pay assessments when due, as detennined by the Secretary. The
Secretary is authorized to impose fmes and penalties for late payment. Plans can obtain a
waiver of the timely payment requirement on a showing of substantial hard~hip.
(e) The Secretary may commence a civil action in federal district court against a plan
for non-payment.
(f) The Secretary shall continue to guarantee benefits even if assessments are not paid.
(g) The designated payer is the employer or plan administrator in the case of a large
employer or the contributing employers and the administrator in the case of a multi-employer
plan. Controlled groups who are treated as a single employer (as defined iIi the Internal
Revenue Code) are jointly and severally liable for payment of assessments.
Section 1398. Payments to Federal Government by Multiemployer Corporate
Alliance for Academic Health Centers and Graduate Medical Education. A
multiemployer corporate alliance must pay the Secretary of HHS an amount equal to the
amount that would have been payable under section 1353 if the alliance were a regional
alliance. The Secretary shall develop rules estimating amounts owed. Such estimates must
be based on the annual per capita expenditure equivalent under section 6021.
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�SUBTITLE E - HEALTH PLANS
(H.R. 3600 and S. 1757 p. 224)
This subtitle sets forth requirements for plans contracting with alliances as health
plans. Part 1 describes plan duties with respect to the comprehensive benefit package. Part
2 sets forth requirements relating to supplemental insurance. Part.3 describes plan duties
with respect to essential community providers. Part 4 relates to workers compensation and
automobile medical liability coverage.
Section 1400. Health Plan Dermed. (a) The term health plan means a plan that
provides the comprehensive benefit package and meets the requirements of parts I, 3 and 4
of this subtitle.
(b) An appropriate self-insured health plan is a self-insured group health plan to which
the applicable requirements of Title I of ERISA apply.
(c) A state certified health plan is a health plan certified by a state or by the Board in
the case of federal administration.
(d) The applicable regulatory authority is the Secretary of Labor for self-insured plans
and the state authority with respect to state-certified plans.
PART 1- REQUIRE:MENTS RELATING TO COMPREHENSIVE BENEFIT
PACKAGE
Section 1401. Application of Requirements. A plan may not be treated as a health
plan under the Act unless it is self-insured or state-certified or if the applicable regulatory
authority determines that the plan is not in compliance with applicable requirements.
Section 1402. Requirements Relating to Enrollment and Coverage.
(a)(I) Health plans offered by regional or corporate alliances must accept
every eligible person seeking enrollment. .Plans may not engage in practices that have
the effect of attracting or limiting enrollees on the basis of personal characteristics
such as health status, anticipated needs for health care, age, occupation, or affiliation
with any person or entity.
(2) Health plans may limit enrollment because of limits in capacity or fmancial
constraints, with the approval of the applicable regulatory authority.
(b) Plans may not:
(I) terminate, restrict, or limit coverage for any reason, including non-payment
of premiums;
,
(2) cancel coverage for any enrollee until the individual is enrolled in another
plan;
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�(3) exclude an individual from coverage because of the individual's medical
condition;
(4) impose waiting periods before coverage begins
(5) impose a rider that serves to exclude certain eligible individuals
(c)(1) A health plan may not discriminate or engage (directly or through
contractual arrangements) in any activity, including the selection of a service area,
that has the effect of discriminating, on the basis of race, national origin, sex,
language, socio-economic status, age, disability, health status, or anticipated need for
health services.
(2) In selecting network providers or establishing terms and conditions for
membership, a health plan may not engage in any practice that has the effect of
discriminating against a provider on the basis of race, national origin, sex, language,
age, disability of the provider or patients, or on the basis of socio-economic status,
disability, health status or anticipated need for health services of a patient of the
provider.
(3) A person may take an action that is prohibited by this section if the action
is required by business necessity but may never intentionally discriminate.
(4) The Secretary of HHS is required to issue regulations implementing these
non-discrimination provisions within a year of the date of enactment.
(d) Plans offering the lower cost sharing schedule (section 1131):
(1) shall apply the schedule to all items and services in the comprehensive
benefit package;
(2) shall offer enrollees the opportunity to obtain coverage for out-of-network
services and items; and
(3) notwithstanding the community rating requirements of section 1403, may
charge an alternative premium to take into account coverage of out-of-network use of
services.
(e) Health plans, in providing the comprehensive benefit package,
(1) must include in payments to providers such additional reimbursement as is
necessary to reflect cost sharing reductions described in section 1371 and
(2) must maintain claims or encounter records as may be necessary to audit the
additional amount of reimbursement paid to providers.
(f)(1) The term "in network" under this subtitle means items or services
provided to an enrollee by a provider who is a member of the provider network of the
plan.
(2) The term "out of network" means items or services provided to an enrollee
by a ·health provider who is not a member of the plan network.
(3) The term "provider network" means providers who have entered into an
agreement with the health plan under which they are obligated to furnish items and
services in the benefit package on a fee-for-service or other basis.
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�(g) Health plans are not required to furnish services to detention facilities for
detainees in the facility.
Section 1403. Community Rating. (a) Regional alliance plans may vary premiums
only with respect to different types of family coverage under section 6102.
(b) Corporate alliance plans may vary premiums only with respect to different types
of family coverage under section 1384.
Section 1404. Marketing of Health Plans; Information.
(a)(l) As a condition of contracting with an alliance, health plans may not
include false or misleading information in their marketing materials and shall submit
materials for prior approval by alliances before distribution.
(2) Regional alliance health plans must distribute their marketing materials to
entire market areas served by the plan.
(3) Plans may not seek to influence an individual's choice of plans in
conjunction with the sale of any other insurance.
(b)(1) Regional alliance. health plans must provide eligible individuals with
information about plan cost, participating providers, utilization control procedures,
quality management procedures, rights and responsibilities, and information on plan
disenrollment.
(2) No health plan may be state certified if it is determined that the plan
provided to consumers contains materially inaccurate information.
(c) Health plans (whether self-insured or state-certified) must provide information on
advance directives for use when a patient becomes unable to consent to care, as described in
section 1876 of the Social Security Act.
Section 1405. Grievance :Procedure. Health plans must establish grievance
procedures that meet the requirements of subtitle C of title V. Enrollees may also seek
assistance from the alliance ombudsman and seek any additional legal remedies.
Section 1406. Health PI3lll Arrangements with Providers. (a) Health plans must
have arrangements with providers as necessary to assure the provision of all items and
services covered by the comprehensive benefit package to enrollees.
(b)(1) Health plans must cover emergency and urgent care services without
regard to whether the provider furnishing the service has a contractual agreement to
furnish the services, and in the case of emergency care, without prior authorization.
(2) Payments for emergency and urgent care services outside the health plan's
service area must be paid in accordance with the alliance fee schedule where services
are provided.
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�(c)(I) Health plans operating on a fee for service basiS must use the alliance or
statewide fee schedule.
(2) If a provider under a health plan voluntarily agrees to reduce the amount
charged to an enrollee, the plan shall reduce payment to the provider under the fee
schedule by the proportion of the provider's discount.
(3) Noncomplying plans (whose expenditures exceed alliance targets) must
reduce payments under the fee schedule to providers that are not participating
providers under section 6012.
(d)(I) Providers may not charge or collect from enrollees amounts in excess of
the fee schedule; neither the plan nor enrollees are liable for any such excess charges .
. (2) Providers may not directly bill enrollees for amounts that are payable by
the health plan (including cost sharing reduction assistance payable by the plan).
(3) Agreements between plans and providers shall provide for a prohibition on
balance billing (provider billing exceeding the scheduled fee above).
(e) Agreements, between plans and providers must provide for reductions in payments
to providers under section 6012 in the event that the plan is found to be in noncompliance.
Section 1407. Preemption of Certain State Laws Relating to Health Plans. (a)
State laws may not be applied against health plans that are not fee-for-service plans (or fee
for service components of plans) if they have the effect of prohibiting plans from:
(1) limiting the number and types of participating providers;
(2) requiring enrollees to obtain care from participating providers;
(3) requiring enrolle~s to obtain referrals for specialty treatment;
(4) establishing different payment rates for network and non-network
providers;
(5) creating incentives for the use of participating providers;
(6) using single source suppliers for pharmacy services, medical equipment,
and other supplies and services.
(b) State laws related to the corporate practice of medicine shall not apply to health
plans that are not fee-for-service plans and their participating providers.
(c) A participating provider is a provider who is a member of a plan's provider
network.
Section 1408. Financial Solvency. Health plans must meet or exceed a state's
minimum capital requirements for such plans, participate in a state's guaranty fund, and meet
other requirements relating to fiscal soundness established by the state.
Section 1409. Requirement for Offering Cost Sharing Policy. Health ptans must
offer cost sharing policies (as described in section 1421 (b)(2» to enrolling families that
cover the cost of out-of-network items and services as well as deductibles and coinsurance
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�applicable to network services.
Section 1410. Quality Assurance. Each health plan shall comply with quality
assurance requirements under title V.
Section 1411. Provider Verification. Health plans must verify the credentials and
licenses of participating providers, oversee their quality and performance of providers, and
investigate and resolve complaints against participating providers.
Section 1412. Consumer Disclosures of Utilization Management Protocols. Health
plans must disclose protocols used by the plan to control utilization and costs.
Section 1413. Confidentiality, Data Management, and Reporting. Health plans
must comply with confidentiality, data management and reporting requirements under Title V
and must assure that health information submitted in electronic form is accurate and reliable.
Health plans must comply with federal privacy requirements.
Section 1414. Participation in Reinsurance System. Health plans must participate in
state reinsurance systems.
PART 2 - REQUIREMENTS RELATING TO SUPPLEMENTAL INSURANCE
Section 1421. Imposition of Requirements on Supplemental Insurance. (a) Health
plans may offer supplemental health benefit policies but only if the policies meet
requirements under section 1422 and may sell cost-sharing policies but only if they meet
requirements under section 1423.
(b)(I) A supplemental health benefit policy means a health insurance policy or
health benefit plan which provides coverage for items and services not covered in the
benefit package or coverage for items and services that are covered but limited in the
amount, duration and scope of coverage. Supplemental health benefit policies do not
include cost sharing policies, long-term care insurance policies, disease-specific
insurance, hospital or nursing home indemnity insurance, Medicare supplemental
policies, and accident insurance.
(2) A cost sharing policy is a health insurance policy or health benefit plan
providing coverage for deductibles, coinsurance and copayments imposed as part of
the comprehensive benefit package under title II, whether imposed on a higher cost
sharing plan or with respect to out-of-network providers.
Section 1422. Standards for Supplemental Health Benefit Policies. (a) No health
plan, insurer or any other person may offer supplemental benefit policies that duplicate
coverage under either the comprehensive benefit packag~ or the Medicare program.
(b) Health plans offering supplemental policies must accept all applicants for
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�enrollment, subject to capacity and financial limits. This requirement does not apply in the
case of supplemental plans offered only on the basis of an individual's employment or
membership in a fraternal, religious, professional, or other organization.
(c) The National Board will develop rules to prohibit marketing abuses by sellers of
supplemental plans that involve tie-in arrangements, financial inducements to purchase
policies, or the disclosure of information about the health status of health plan participants
for the purpose of marketing a policy.
(d) Entities that violate this provision are subject to civil money penalties in
accordance with the procedures of section 1128 of the Social Security Act.
Section 1423. Standards for Cost Sharing Policies. (a) A regional allliance health
plan may offer cost sharing policies only if offered by the plan in which an individual is
enrolled, only if offered to all enrollees in the health plan, only if both standard and
maximum coverage policies are offered, and only if offered during the annual open
enrollment period.
(b) Health plans may not offer insurance against the copayments required under the
schedule under section 1135 (Table 2).
(c) Cost sharing policies must cover items and services to the same extent that the
benefit package covers the items and services. The price of a policy must be the same to
each individual and must take into account an expected increase in utilization rates resulting
for the policy. Policies may not have a loss-ratio (the ratio of premium returned to
consumers relative to the total payout collected in premiums) of less than 90 percent.
(d) States may not certify a health plan if the cost sharing policy does not meet the
standards of this section.
(e) Supplemental plans offered under the Federal Employee Health Benefits Program
(FEHBP) are exempt from the requirements of subsection (a) but only if the supplemental
plans are offered to all persons to whom a comprehensive benefit plan must be offered under
section 8203, both standards and maximum policies are offered, the supplemental plan is
offered only during the open enrollment period, and the price takes into account any expected
increased in utilization resulting from the supplemental plan.
PART 3 - REQUIREMENTS RELATING TO ESSENTIAL COMMUNITY
PROVIDERS
Section 1431. Health Plan Requirement. (a) Health plans must, with respect to each
electing essential community health provider (as defmed in subsection (d» located in the
plan's service area, either
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�(1) enter into a written provider participation agreement with the provider; or
(2) enter into a written agreement under which the plan shall make payment to
the provider in accordance with subsection (c).
(b) A participation agreement between a health plan and an essential community
provider shall include terms and conditions at least as favorable as those applicable to other
participating providers with respect to the following:
(1) the scope of services for which payment is made by the plan to the
provider;
(2) the rate of payment for covered care and services;
(3) the availability of ftnancial incentives;
. (4) limitations on fmancial risk provided to other providers;
(5) assignment of enrollees to participating providers;
(6) access by the provider's patients to the plan's specialists.
(c) In the case of providers electing payment without regard to a participation
agreement, the provider may elect to be paid either in accordance with the alliance fee
schedule or on the basis of the most closely related Medicare payment rate or methodology,
as specifted by the Secretary of HHS in regulations. Payment may be subject to utilization
review, but not to otherwise applicable gate-keeper requirements.
(d) An electing essential community provider is an essential community provider that
is certifted as an essential community provider under section 1581 and that elects to apply to
the health plan. The Secretary of HHS shall specify the form and manner in which election
is to occur; election shall include notice to the health plan. An election may be made once
annually, unless the plan and provider agree to a more frequent election.
(e) In the case of essential providers that are school health clinics, each health plan
shall pay to each school health provider an amount determined by the Secretary.
Section 1432. Sunset Requirement. The provisions of Section 1431 apply to health
plans only during the ftve-year period beginning with the ftrst year that a regional alliance
health plan is offered by the alliance.
(b) The Secretary shall conduct studies of essential providers, how the term is
defmed, examining how payment is made, the effects of the contracting and payment
requirements under this part, and other matters.
(c) No later than March, 2001, the Secretary shall report to Congress with
recommendations concerning the continuation, modiftcation or termination of the special
health plan contracting requirements for essential providers. Congress shall have 60 days
from the date the recommendations are presented to act. In the event that the
recommendations of the Secretary are not disappro:ved, they shall be adopted.
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�PART 4 - REQUIREMENTS RELATING TO WORKERS'
COMPENSi\TION AND AUTOMOBILE MEDICAL LIABILITY COVERAGE
Section 1441. Reference to Requirements Relating to Workers Compensation
Coverage. See part 2 of subtitle A of Title VIII.
Section 1442. Reference to Requirements Relating to Automobile Medical
Liability Services. See Part 2 of Subtitle B of title VIII.
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�SUBTITLEF - FEDERAL RESPONSIBILITIES
(B.R. 3600 and S. 1757 p. 256)
PART 1 - NATIONAL HEALTH BOARD .
SUBPART A - ESTABLISHMENT OF A NATIONAL HEALTH BOARD
. Section 1501. Creation of A National Health Board; Membership. A National
Health Board, composed of seven members appointed by the President and subject to Senate
confirmation, is created to oversee the implementation of Health Security Act. The Board
shall have a chair designated by the President, who serves a term concurrent with that of the
president and who shall also act as the chief executive officer of the Board. The Chair may
serve a maximum of three terms; other members serve terms of four years. Rules on the
staggering of terms and the filling of vacancies are also provided.
Section 1502. Qualifications of Board Members. (a) Each member must be a United
States citizen.
(b )Members will be selected on the basis of their experience and expertise in relevant
subjects, such as the practice of medicine, nursing, or other clinical practices, health care
fmancing and delivery, state health systems, consumer protection, business, law and delivery
of care to vulnerable populations.
(c) Service on the Board shall constitute federal employment and shall be exclusive
employment.
(d) Members of the Board may hold no interest in an affected health care industry.
(e) Members are subject to post-employment restrictions applicable to comparable
federal employees.
(f) Federal pay schedules for the Board members and the Chair are specified at levels
IV and II, respectively, of the Executive Schedule. .
Section 1503. General Duties and Responsibilities. (a) The Board shall interpret the
comprehensive benefit package, make adjustments in the delivery of preventive health
services, and assure national uniformity in coverage standards. The Board also may
recommend to the President and Congress changes in the benefit package that are appropriate
in light of changes in technology, health care needs, health care costs, and methods of
service delivery.
.
(b) The Board shall oversee the cost containment provisions of Title VI.
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56
�(c) The Board shall develop rules for eligibility, plan coverage of certain individuals,
and treannent of families.
(d) The Board shall oversee the perfonnance based quality management system
described in Title V.
(e) The Board shall oversee the development of the national health infonnation system
described in Title V.
.
(f) The Board shall establish standards for participating states, monitor state
compliance and provide technical assistance in a manner that assures access to the
comprehensive benefit package.
(g) The Board shall develop premium class factors under subpart D.
(h) The Board shall develop a risk adjusnnent methodology for premium payments to
plans in accordance with part 3 of this subtitle.
(i) The Board shall establish minimum capital requirements and requirements for
guaranty funds under subpart G.
(j) The Board shall establish standards for health plan grievance procedures.
Section 1504. Annual Report. (a) The Board shall prepare and send to Congress and
the President an annual report addressing overall implementation of the system. The report
shall include infonnation on federal and state implementation, quality data, recommendations
or changes in the administration, regulation, and laws related to health care coverage, and a
full account of Board actions in the preceding year.
Section 1505. Powers. (a) The Board shall have authority, consistent with federal
civil service laws, to appoint officers and employees and may enter into contracts for studies
and analyses. Executive branch employees may be detailed to assist the Board in carrying out
its duties.
(b) The Board may establish advisory committees.
(c) The Board may secure directly (from any federal agency) necessary infonnation to
the extent such infonnation is available to a federal department or agency .
. (d) The Board may delegate functions to officers and employees but may not be
relieved of responsibility for administration of such functions.
(e) The Board may promulgate rules needed to carry out the Act.
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�Section 1506. Funding. (a) There are authorized such sums as may be neces-sary for
fiscal years 1994 through fiscal years 1998. The Office of Management and Budget shall
review the Board's budget annually.
SUBPART B - RESPONSmILITIES RELATING TO REVIEW
AND APPROVAL OF STATE SYSTEMS
Section 1511. Federal Review and Action on State Systems. (a) (1) The Board shall
approve a state health care system unless the Board fmds that the system does not or will not
provide for the state to meet its participation responsibilities under the Act.
(2) The Board shall issue regulations outlining participation requirements by
July 1-, 1995. The Board must take action on states intending to participate before the
date of issuance of regulation.
(3) The Board may not approve a state health care system for any year prior to
1996.
(b)(I) The Board must notify states within 7 days of the receipt of documents
as to whether the document is complete and provides the Board with sufficient
information to approve or disapprove the state's plan.
(2) In the case of incomplete documents, states have 45 days to submit
additional information.
(c) The Board shall act on a state proposal within 90 days after the state has submitted
a complete document. The Board's failure to act within the prescribed time period shall be
deemed to be approval of the state's document.
(d) If the Board does not approve a state's document, the state has 30 days in which
to submit additional information. The Board shall respond to this additional information
within 30 days. If the Board does not meet this deadline, the plan is deemed approved.
(e) If the Board terminates its approval of a state's system, it shall approve the system
in a succeeding year if the state satisfies the Board that the cause of its failure no longer .
exists and provides reasonable assurances that the actions that fonned the basis of the
termination will not recur.
(f) A state may revise its system, but revisions will not take effect until the Board has
approved documents revising the state system. The Board shall act on state amendments
within 60 days of submission. If the Board fails to act within 60 days, the revision shall be
considered approved. A state shall have an opportunity to respond to rejected revisions.
(g) If a state fails to submit documents to become a participating state, the Board shall
notify the Secretary of HHS and the Secretary of the Treasury .
Section 1512. Failure of Participating States to Meet Conditions for Compliance.
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�(a) If the Board determines that a state system fails to meet the requirements- of the
Act, sanctions shall be imposed in accordance with subsection (b).
(b)(l) If the Board determines that the state's failure does not substantially
jeopardize individuals' access to health coverage, it may directly order compliance by
a regional alliance to correct the problem and may, if it determines that the problem
has not been corrected, notify the Secretary of Health and Human Services who shall
reduce payments in accordance with section 1513.
(2) If the Board determines that the state's non-compliance substantially
jeopardizes individuals' access to coverage, it shall terminate its approval of the
state's plan and notify the Secretary, who shall assume the duties described in section
1522..
(c) A state against which a sanction has been imposed may submit information at any
time to demonstrate that the failure has been corrected. Following a determination the Board
may then notify the alliance that has been sanctioned or notify the Secretary in the case of
other sanctions that have been applied against the state under subsection (b).
(d) The Secretary shall exercise authority only in a manner that assures uninterrupted
coverage for individuals in the state.
Section 1513. Reduction in Payments for Health Programs by the Secretary of
Health and Human Services. (a) Upon receiving notice from the Board, the Secretary shall
reduce certain payments that otherwise would be made to individuals and entities in the state.
(b) Payments subject to reduction are:
(1) Payments to academic health centers under Title III;
(2) Payments for health services research funded under the Public Health
Service Act;
(3) Payments to hospitals serving vulnerable populations under Title III.
. Section 1514. Review of Federal Determination. A state or alliance that is affected
by a decision of the Board may appeal the decision under section 5231 of the Act.,
Section 1515. Federal Support for State Implementation. (a) Not later than 90 days
after enactment, the Secretary shall make planning grants available to each state to develop
the system needed to become a participating state. Funds for this purpose will be distributed
according to a formula developed by the Secretary. Appropriations of'$50,000,OOO in each
of fiscal years 1995 and 1996 are authorized.
'
(b) States that have enacted enabling legislation qualify for grants to assist in the
development of regional alliances. Grants shall be allocated in accordance with a -formula
developed by the Secretary. States must expend amounts equal to the amount made available
under this section in order to qualify for federal assistance. Authorized funding levels are
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�$313,000,000 for fiscal year 1996, $625,000,000 for fiscal year 1997, and $313,000,000 for
fiscal year 1998.
SUBPART C - RESPONSmILITIES IN THE ABSENCE OF STATE SYSTEM
Section 1521. Application of Subpart. (a) This section applies to states beginning
January 1, 1998, unless the state submits its documents by July 1, 1997, and the Board
determines that the state meets the requirements of the Act.
(b) In the case of states whose systems have been disapproved, this subpart becomes
effective as of a date that is appropriate to assure that continuity of coverage for the
.
comprehensive benefit for eligible individuals is not lost.
Section 1522. Federal Assumption of Responsibilities in Non-Participating States.
(a) When the Board determines that this subpart applies to a state in a calendar year,
it shall notify the Secretary.
(b) Upon receiving notice the Secretary shall establish a regional alliance system in
the state and shall take other steps required of participating states.
(c) Regional alliances established by the Secretary must meet all of the requirements
of alliances in participating states.
(d) The Secretary shall establish a guaranty fund to provide financial protection for
health care providers and individuals in the event of an alliance health plan failure. The
Secretary is authorized to impose assessments on health plans for so long as necessary to
generate sufficient revenues for the guaranty fund.
Section 1523. Imposition of Surcharge on Premiums Under Federally Operated
Systems. (a) In operating a state alliance system under this subpart, the Secretary shall
impose premiums equal to the amount the state alliance(s) would have imposed, increased by
an additional 15 percent to reimburse the Secretary for expenses incurred in operating the
system.
(b) The 15 percent surcharge shall be treated as part of the premium.
Section 1524. Return to State Alliance. (a) A state may apply at any time for
approval to assume operation of a federally administered alliance system.
(b) If the Board approves the state's application, the state's takeover shall begin as of
January 1, following the date of approval.
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�SUBPART D - ESTABLISHMENT OF CLASS FACTORS
FOR CHARGING PREMIUMS
Section 1531. Premium Class Factors. (a) For each class of family enrollment
under section 1011(c), the Board shall establish a premium class factor that reflects the
relative actuarial value of the comprehensive benefit package of the class of family
enrollment, compared to individual enrollment. The factor for individual enrollment shall be
one, and the factor for a couple-only class shall be two.
SUBPART E - RISK ADJUSTMENT AND REINSURANCE
METHODOLOGY FOR PAYMENT OF PLANS
Section 1541. Development of a Risk Adjustment and Reinsurance Methodology.
(a) By April, 1995, the Board shall develop a risk adjustment and reinsurance
methodology. The Board shall make improvements in the methodology as appropriate in
order to achieve the purposes of the methodology.
(b)(1) The purposes of the methodology are to assure that payments to plans
reflect expected utilization and expenditures for such services by plan enrollees
compared to average utilization and expenditure rates and to protect plans that enroll a
disproportionate share of individuals whose utilization and expenditures are higher
than average.
(2) In developing its methodology, the Board shall consider the following
factors:
(A) demographic characteristics;
(B) health status;
(C) geographic area of residence;
(D) socio-economic status;
(E) the proportion of enrollees who are SSI and AFDC recipients
unless the Board concludes that other risk adjustment factors are sufficient to
adjust premiums to take into account the effects of high AFDC and SSI
enrollment;
(F) other material factors identified by the Board.
(3) The methodology shall assure that the total payment to health plans in the
alliance would be the same after application of the factors as in the absence of the risk
adjusters.
(4) The risk adjustment methodology shall allow for prospective adjustment to
plans, to the maximum extent possible.
(5) The Board may eliminate a special AFDC and SSI adjustment if it
determines that other adjustments are sufficient.
(6) The Board shall give special consideration to payment adjustments with
respect to persons with mental illness.
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�(7) The Board shall give special consideration to adjustment for Indian,
Veterans and Department of Defense health plans.
(8) If total payments by a regional alliance to its health plans either exceed or
fall short of the total of such payments estimated by the alliance using the Board's
risk adjustment methodology, and if the problem results from a discrepancy between
the alliance estimate of the distribution of enrolled families by risk categories and
their actual distribution, the Board shall adjust its methodology in a succeeding year
by the amount of the excess or deficit to take the discrepancy into account.
(c)(I) The Board's methodology may include a system of mandatory
reinsurance, but not voluntary reinsurance .
. (2) If the Board determines that a risk adjustment system cannot be developed
and readied for implementation by April, 1995, it shall include mandatory reinsurance
as a component of the methodology. The Board may eliminate this requirement when
.it determines that a risk adjustment system has been developed and is ready for
implementation.
.
(3) The Board, in developing a reinsurance methodology, shall provide for
health plans to make payments to state reinsurance programs for the purpose of
reinsuring some or all classes of items and services in the comprehensive benefit
package for specified classes of high risk enrollees, and for high cost diagnoses and
treatments. The Board also may specify the structure and operation of the system.
(d) The Board shall assure that reinsurance systems are developed in conformity with
confidentiality requirements.
Section 1542. Incentives to Enroll Disadvantaged Groups. The Board shall
establish standards to permit states to adjust the risk adjustment methodology to create
financial incentives for health plans to enroll disadvantaged groups.
Section 1543. Advisory Committee. The Board shall establish a 15 member
technical advisory committee to assist in the development of a risk adjustment methodology,
which shall include representatives of health plans, regional alliances, consumers, employers
and health providers.
Section 1544. Research and Demonstrations. The Secretary shall conduct research
and demonstrations to aid in the development of a risk adjustment methodology.
Section 1545. Technical Assistance to States and Alliances.
states and alliances implement the risk adjustment methodology.
The Board shall assist
SUBPART F - RESPONSmILITIES FOR FINANCIAL REQUIREMENTS
Section 1551. Capital Standards for Regional Alliance Health Plans. (a) The Board
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�shall develop in consultation with the states, miriimum capital requirements for regional
alliance health plans.
(b) For each regional alliance health plan, there must be at least $500,000 in capital
maintained, regardless of whether a sponsor offers more than one plan in the area.
(c) The Board may require additional capital, based on factors likely to affect the
financial stability of health plans, including the following factors:
(1) projected plan enrollment and the number of participating providers;
(2) market share and strength of competition;
. (3) extent and nature of risk sharing with participating providers and their
fmancial stability;
(4) prior performance of the plan, its risk history, and liquidity of assets.
(d) The National Association of Insurance Commissioners shall develop model
standards for additional capital requirements for the. Board by' July 1, 1995. The Board may
accept or modify such standards.
Section 1552. Standards for Guaranty Funds. (a) In consultation with the states, the
Board shall develop standards for state guaranty funds.
(b) Standards shall include the following:
(1) A fund must be able to generate sufficient resources to pay providers and
others in the event of plan failure, in order to meet obligations with respect to
services rendered by providers for the comprehensive benefit package and any
supplemental coverage for cost sharing. Fund resources must also be sufficient to
meet plan obligations for services rendered prior to and after plan insolvency, before
they plan to enroll in other health plans.
(2) The fund must be liable for all claims against the plan by health care
providers with respect to items and services furnished under the comprehensive
benefit package.
(3) The fund stands as a creditor for payments owed the plan, to the extent of
payments made by the fund for plan obligations.
(4) The fund has authority to borrow against future assessments.
PART 2 - RESPONSmILITIES OF THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES
SUBPART A - GENERAL RESPONSmILITIES
Section 1571. General Responsibilities of the Secretary of Health and Human
Services. (a) Except as specificaJly provided, the Secretary shall administer all provisions of
Title I
63
�
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2010-0198-Sb-health-care-materials-7
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https://clinton.presidentiallibraries.us/files/original/a15253b45634785d2f839b27d8c92abc.pdf
f9b41a4714f47e7f847480a0809ba9d1
PDF Text
Text
Methodological Description of
Health Care Reform Premium and Discount Estimates
�Contributions to this paper were made by:
•
Department of Health Jnd Human Services' OffICe of the Assistant Secretary for
Planning and Evaluatioh
•
The Office of Managelent and Budget
•
Health Care Financing lAdministratiOn' s Office of the Actuary
•
Agency for Health Care Policy and Research
•
The Urban Institute's
I
'
Ienter for Income and Benefits Policy
I
2
�Contents
I.
Background
II.
Description of the Maj0f Models
I
A. The Urban Institute's Transfer Income Model (TRIM2) .
B. The Health Care Finanbing Administration's Special Policy Analysis Model (SPAM)
C. The Agency for HealtJ Care Policy and Research's Simulation Model (AHSIM)
III.
Premium Estimation Under Reform
A. Health Care Financing Administration
B. Agency for Health Care Policy and Research
C.
IV.
Choice of Premium E1Stimates for Budgeting Purposes
Discount Estimates
A. Employer Discounts
1. TRIM2:. Employer Discounts
2. HCFA: Employer/ Discounts
3. AHSIM: EmPloyr Discounts
B. Discounts for the selr-EmPIOyed
C. Discounts to Low Income Families
D. Retiree Discounts
E.
Choice of Discount Estimates for Budgeting Purposes and Distrbutional Analyses
V. National Spending Impacts
Appendix A: Example of tHe Application of an Induction Factor to a Change in Insurance
Status
3
�I. Background
Estimates of premium COS1S, national health spending, and government program costs
under health care reform have been necessary in the decisions leading to a health care reform
bill. During the basic policy development process, exploration of alternative policies required
estimates of the cost impacts df each possible variation. Specific areas included analyses of
premium caps, the impacts on businesses of reqiured employer payments, the effects on
households of required purchase of coverage, and the budgetary effects of the discount
schedules.
The development of estimates of this type is obviously a complex task. Given that no
single authoritative data set e4ists which captures all spending for all services through all
sources of funding, numerous data sources were used in this process. Federal surveys,
especially the National Medical Expenditure Survey (1987), offer the best characterizations of
NatiO~al Health Accounts generated by the Health Care Financing
Administration (HCFA) sum~arize. the best available data on total national spending by type
national spending. The
of service and source of fundl Producing estimated spending under health reform, however,
I
I
requires developing a comprehensive baseline summary for literally hundreds of affected subpopulations, and then estimating the future spending patterns associated with the reform.
Estimates of future costs of reform are primarily derived through modeling transfers of
current spending among the various channels of payment. Estimating the impacts of changing
primary payers is relatively sltraightforward, given a baseline of national health spending.
I
.
More difficult is estimating the net impacts of fee upgrades and paying for uncompensated
care, since reimbursement letels will be set to achieve some amount of recapture of these
increased outlays for current services. Also difficult is estimating the induced spending
attributable to new or enriched insurance coverage. Estimates have been based upon
experiences of government Jnd private insurers as well as the results of academic
the demand for medical carel.
.
4
~tudies of
�Multiple data sources, meiliodologies, and models were needed to produce estimates of
premiums,. discounts, ·and the +ernll effects of refonn options. Major contributors included
the Health Care Financing Administration's (HCFA) Office of the Actuary (OAct), the
Agency for Health Care
POliC~ and Research (AHCPR), the Treasury Department, and other
government agencies. Numerous consultants assisted in the process, with major modeling
.
I
contributions provided by the Urban Institute. This paper provides an overview of the major
models and their ways of
estir~ating premiums, discounts, and overall health spending under
health care reform.
II. Description of the Major, Models
A. The Urban Institute's Transfer Income Model (TRIM2):
The Urban Institute has deleloped a microsimulation model called the Transfer Income
Model (TRIM2). This model has been used to analyze the financing of national health care
reform plans, and has particularly focused on the distributional effects of such proposals.
TRIM2 is based upon the MJch 1992 Current Population Survey (CPS) and combines data
from a number of other sourcks in order to provide a complete basis for assessing acute care
health spending by the non-eJderly in the U.S. popUlation. I The complete model has been
aged to 1994, and all results ke presented in 1994 dollars. The following description of
TRIM2 and its capabilities hds been adapted from Zedlewski, Holahan, Blumberg, and
Winterbottom (1993).
The TRIM2 model simulates the employer-based group health insurance system, nongroup
or individually purchased he1th insurance, out-of-pocket spending, and the Medicaid
program. The model assignS' spending under these programs/systems at the individual and
family levels and adjusts for regional variation in premium levels. It is then possible to
-
IHistorically, TRIM2 bas been/ used to analyze current and alternative tax and transfer programs. See National
Research Council (1991) and Lewis and Michel (1990) for a more complete description of the properties of this
model and its recent applications.
5
�assess the distributional effects of the financing of the current health care system. Detailed
tax calculations allow the
anal~sts to examine health spending on an after-tax basis and to
calculate the after-tax value
0'
I
employment-based health benefits. lRIM2 can also be used to
simulate the di~tribution of hefth spending and health care financing burdens under
.
alternative assumptions about how insurance would be provided and financed. Each
component of the basic model is presented below. 2
1. Employment-Based 9roup Health Insurance. TRlM2 examines reponed insurance
coverage for individuals and families on the CPS to detennine the number of family members
who share coverage under an bmplOyment-based policy.3 The model assIgns an employment
based health insurance premiJm, including the shares paid by the employer and the employee,
to each covered worker based on two 1989 private, employer-based surveys (from the Health
Insurance Association of America and Foster-Higgins) and federal health insurance plan
documents. 1)Iese private SUreyS represent finns of different sizes, in all major industries
(including state and local government), and in all regions of the country. Federal health
I
insurance plan documents include infonnation about premiums for single and family coverage
and how these premiums are
~istributed between the employer and worker.
TRlM2
statistically matches workers lo health plans based on variables that the employer insurance
I
plans and workers on the CPS have in common. These include the type of coverage (single
or family), location, industry, the size of finn, and whether or not the worker has to pay part
of the insurance premium.
2.
Private, Nongroup Health Insurance. TRlM2 estimates premiums for the families
and individuals on the CPS JhO repon insurance coverage through private, nongroup, hea)th
insurance policies. It does Jis by matching these people with plan data collected from Blue
Cross and Blue Shield Plan dffices across the U.S. Plan documents included premiums for
typical health insurance
plan~ covering single individuals, families, and dual (adult and child)
I
I
2Giannarelli (1992) describes the full TRIM2 model.
:!zedlewski (1991) describes
JiS model in more detail.
6
�insurance units in each state. The method does not, however, capture differences due to
families' insurance preferenceJ or income levels. For example, if low (or high) income
non~roup health insurance are more likely to purchase catastrophic
families reporting private,
policies, the
m~del will oversJte their premiums.
Conversely, the model will understate
premiums for families who pJfer broader coverage than that included in the prototypical
plan.
3. Medicaid. TRIM2 uis detailed sets of algorithms. to replicate the rules of state
Medicaid programs.4 These algorithms identify Medicaid eligibles as all persons who meet
the states' categorical, asset, Jnd income criteria in effect July 1991. The model has
procedures for selecting Medibaid enrollees from those who are eligible. The second part of
the model imputes the insurJce value of Medicaid. Separate estimates are made for adults,
children, and the disabled;
es~mates also vary by age, sex, race, urban or rural residence,
reason for enrollment, and nubber of months in the program. The model uses Medicaid state
expenditure data to adjust for differences among states in program generosity and the cost of
health services.
4. Out-or-Pocket Spending. The model uses data from the Consumer Expenditures
Survey to predict out-Of-pocJet spending (other than health insurance premiums) for families
I
on the CPS.s Separate equations were estimated for persons with private insurance coverage,
Medicaid, and for those uninLred.. The equations predict the incidence and levels of
spending as a function of
fa~ilies' socioeconomic characteristics including region of
residence, income, the age-Jx distribution of family members, and the family head's marital
status, education, race, and Jork status.
5. Income and Payroll Taxes. The model calculates family disposable income and
estimates the amount of income and payroll taxes required to fmance health care spending by
.
I
.
I
4See Holahan and Zedlewski (1989) for a full description of this model.
.
I
5See Wade (1991) for a full description of this model.
7
.
�the federal government through. the Medicaid and Medicare programs. Other federal"taxes
(such as corporate, estate, and excise taxes) are not included.6 The portion of Medicaid and
Medicare spending that is fmanced through the federal personal income and payroll tax
I
systems is calculated and can be allocated to families. The model can also calculate income
and payroll taxes under the as1umplion that employer-paid health insurance premiums are
taxable to estimate the tax valLe of this employee benefit.
6. TotaJ Health Care Sprnding for the NoneJderJy. The TRIM2 baseline distribution
of direct spending from various sources accounts for most health spending for the nonelderly.
I
.
The TRIM2 model excludes the institutionalized population. In addition, Medicare benefits
for the nonelderly and miliJ health benefits are excluded. Nevertheless, the model
accounts for nearly all of the Ispending under systems that would be most affected by health
care reform alternatives currehtly under debate.
7. Adjustments to TRIM2 Baseline Output. Two significant adjustments were made to
the TRlM2 baseline health sJending simulations at the request of the office of the Assistant
Secretary for Planning and EralUatiOn (ASPE), Department of Health and Human Services
(DHHS). Both employer health insurance premiums and private nongroup health insurance
+
premiums in TRIM2 were ddwnwardly adjusted to reflect health care reform premiums
estimated by the Office of
Actuary (OAcn. The TRIM2 employer plan data include
employer spending for dental care and a few other benefits that not fully covered by the
I
'
reform package" Without this adjustment for differences in coverage, employer and family
I '
spending under reform as calculated in TRlM2 (using HCFA OACT premiums) would not be
comparable to employer and family spending under the current system according to TRlM2.
Thus, estimated changes in spending under reform compared to current spending would be
distorted without reconcilinJ the spending levels.
'
6However, the TRIM2 modelidoes have the capacity to simulate excise tax payments on alcohol and cigarettes.
8
�B. The Health Care Financing Administration's Special Policy Analysis Model (SPAM):
The Health Care Financing Administration's (HCFA) Special Policy Analysis Model
(SPAM) database is also based upon the March 1992 Current Population Survey (CPS). The
March 1992 CPS acts as the
h~st file, with each person on it being statistically matched to a
I
person on the 1987 National Medical Expenditure Survey (NMES). Health expenditures and
utilization from the NMES peJson record are then linked to the CPS record, and the entire
data set is controlled to be coJsistent with '1994 National Health Account data.
,
The parameters used in the linking the NMES file to the CPS were disability status
(disabled or not), age and
gen~er (male adult < 19, male adult 19-44, male adult 45-64, male
I
adult 65+, female adult < 19, female adult 19-44, female adult 45-64, female adult 65+,
dependent child < 19, and deJendellt child 19+), family income (family under 100% of
poverty, family 100% to 1854, of poverty, family at or above 185% of poverty), and
insurance class of the person lemPIOyer sponsored insurance and Medicare, employer
I
sponsored insurance and Medicaid, other employer sponsored insurance, Medicare and
Medicaid and other private
in~urance, Medicare and Medicaid, Medicare only, Medicaid and
other private insurance, Medihaid only, other insurance, and uninsured).
For a CPS person to be c0nsidered disabled, one of the following situations had to be true:
I
(a) person was a veteran, collecting veteran's disability, (b) person collected over $10,000 in
workers compensation, (c) pJrsonhad disability income, or Cd) person was under 65 and had
SS! income. For a NMES pbrson to be considered disabled, one of the following had to be
I
.
true: (a) person was a disabled veteran, Cb) person didn't work due to disability/illness, or (c)
person was without a job dub to disability/illness.
, , '
The determination of adult vS.· child was made from "insurance families," which were
appended to both the CPS
a~d NrvtES files.
These families were created using staI)dard
insurance industry definitionb. Within an insurance family there can be one or two adults
(single or married couple), kd an.y number of dependent children (or none).
9
�The insurance classifications were hierarchical, and made on the person level usin-g the
appropriate variables on both Je CPS and NMES. NMES insurance classifications were
I
'
converted from round data7 to rever insured" data (for example, if a person had Medicare in
one of the rounds of the NMES survey, they were coded as having Medicare). Poverty
I
.
.
classifications were calculated by adding income of all insurance family members together
and comparing it to the
appro~lriate poverty standard for the year in question (1991 for the
CPS and 1987 for NMES), for the appropriate family size.
Once each CPS person was linked to a NMES record, expenditure data by service
(hospital inpatient, hospital ouipatient, etc.) and source of payment (out-of-pocket, private
I
insurance, Medicare, Medicaid, etc.) were attached. This file was then aged to 1994 through
.
I
two steps. First, the 1992 CPS population was weighted to sum to the 1994 Social Security
Administration (SSA)
non-ins~tutionalized popUlation (about 20 million more than Census
estimates). This was done by age (20 age groups), gender and marital status (single, married,
divorced, and widowed).
Second, the total national health expenditures by this SSA-weighted CPS population (the
SPAM population) were then "benc:hmarked" by service category, channel of payment, and
age category to the aggregate totals. in the projected 1994 National Health Accounts. There
are 13 service' categories: hospital inpatient, hospital outpatient, hospital emergency room,
physician inpatient, physician outpatient, physician emergency room, physician office visit,
+
other professionals, prescription drugs, home health care, dental, vision, and other durable
medical equipment There
eight channels of payment: private health insurance, out of
pocket, Medicare, Medicaid, other federal, other state and local, workers compensation, and
other private. There are threb age categories: under 19, 19 to 64, 65 years and over.
An example of how this oenchmarking worked is as follows. Suppose the ratio of current
·
I
.
.
7NMES-2, described moJe fully in the following section, involves 4 surveys of each family
over a period of 16 months. Each of the 4 interview sessions is referred to here as a "round."
10
�SP AM out-of-pocket inpatient hospital spending for .persons under age 19 to NHA-c6nsistent
spending for the same cell is
1.9.
Then each SPAM person's inpatient hospital spending total
is multiplied by 1.11. The onLy divergence from this logic was that out-of-pocket spending
for the uninsured was
controll~d separately from out-of-pocket spending for the insured
population (which was thOughi to have risen at a rate closer to the rate of inflation in
insurance).
C. The Agency for Health Care P'olicy and Research's Simulation Model (AHSIM):
..
AHSIM is based on AHCjR'S 1987 National Medical Expenditure Survey (NMES-2),
which is the most recent national effort to collect comprehensive, person-level profiles of
I
health care use, spending, and insurance coverage. AHSIM currently is designed only to
analyze the nonelderly (under 65), noninstitutionalized civilian population residing in the
United States. Although the NMES-2 data were collected in 1987, demographic variables
have been aged forward by rJweighting individual records. New weights take into account
changes in the distribution of the population by age, race, sex, insurance status, and poverty
status observed between the November 1987 and March 1992 Current Population Surveys.
Additional demographic agin1 is based on Census projections of the population by age, race,
~rowth in service-specific health expenditures and insurance
and sex beyond 1992. Real
premiums have been incorpo}ated through adjustments based on the appropriate rates of
changes in HCFA's National Health Accounts and its projections.
AHSIM draws primarily on the NMES-2 Household Survey and its two derivative
components, the Health Insu}ance Plan Survey (HIPS) and the Medical Provider Survey. The
Household Survey sample is representative of the civilian noninstitutionalized population of
the United States in 1987. Each family in the Household Survey was interviewed four times
I
("rounds") over a period of 16 months to obtain information about the family's health and
health care during calendar tear 1987. Roughly 35,000 individuals and 14,000 households
completed all rounds of dad
collf~ction.
The Medical Provider Survey obtained information
directly from the PhYSiCians] hospitals, and other providers .used by a portion of the household
11
�sample. These data were used Ito edit and supplement household survey data describing use
of and spending on health services. HIPS data were collected from employers, unions, and
insurers and include premiums paid by all sources and specific provisions of baseline private
insurance coverage. They also provide information about the organizations offering insurance
coverage and include in the case of employers, firm and establishment size, industry, and
location.
Other data sources were incorporated when needed for specific purposes. For example,
survey data from the Health Idsurance Association of America were used to project market
1
shares for fee-for-service,HMO, and preferred provider health plans by region. Annual
survey data from the AmericJ Hospital Association were used to determine the allocation of
hospital spending between inpktient and outpatient services and to identify local areas in
which at least one HMO is opbrating. County Business
Patte~s data were used to impute
average payroll for emPloyersl using a statistical match based on industry, location, and firm
size. The Internal Revenue
S~rvice (IRS) Statistics of Income (SOl) data were used to
expand NMES-2 income data and to calibrate the AHSIM tax module. Further details of the
basic AHSIM Model are presented below.
1. Employment.Based Group Health Insurance. AHSIM does not model employers,
only households and individuLs. IllPS aild Household Survey data measured the scope of
1
employment-based insurance in 1987, as well as the allocation of premiums among
.
1
employers, employees, and other sources (primarily unions). AHSIM assumes that any
1
changes in the pattern of availability, benefits, premiums, or other plan provisions between
1987 and 1994 are controlledl for in the aging process, using CPS and HCFA aggregate data.
2. Private, Nongroup Health Insurance. AHSIM handles people with private, nongroup
insurance in the same way
Jit does those with employment-based insurance.
This means,
for example, that a tendency for people with systematically higher medical expendiJures to
purchase private, nongroup h'ealth insurance will be captured in the model.
12
�3. Medicaid. NMES-2 measured Medicaid program participation directly. Since 1987,
however,
Me~icaid eligibility Jas been expanded to include low-income pregnant women and
children who are not otherwisel categorically eligible. This Medicaid expansion was
incorporated into the ASHIM model by identifying household survey respondents who would
have become eligible for Medibaid benefits by 1994 and modifying their baseline insurance
h~alth spending for new Medicaid recipients was also modified
to reflect the effect of a Chang~S insurance status, using the same methods that were used to
status accordingly. Baseline
•
.
project •
estImates e' the unmsuredaf relorm.
lor
'ter ~
I
4. Out-DC-Pocket Spending.
NMES-2 directly measures baseline out-of-pocket (OOP)
spending on cost-sharing and honcovered services for all household survey respondents.
I
However, because the AHSIM model cannot use actual NMES-2 expenditure data directly,
data on OOP spending repoJd in the household survey are used to develop, a set of estimates
that can be incorporated into Jhe model. 8 In particular, a system of equations was estimated
expe~ses paid out-of-pocket in the baseline as a function of
demographic characteristics, i~surance coverage, health status, and other relevant explanatory
variables. These equations w~re then used to impute baseline OOP spending as a percent of
to predict the percent of
imputed total spending, by tyk of service. While baseline expenditures are imputed in the
AHSIM Model, they are still !intemallY consistent with the rest of the
NMES-2 data because the estimation procedures preserve the pattern of spending observed in
the original household
surve~ data.
5. Income and Payroll Taxes.. The AHSIM model distinguishes between households and
I
tax filing units. The effect
o~ wage changes induced by employer mandates on federal
I
NMES-2 expend~~ure are not used ~ baseline spending in the AHSIM Model for two
reasons. For some people, e.g., those affected by the expansion of Medicaid eligibility, baseline
insurance status is different than what is was in 1987 when the NMES data were collected. In
addition, it is important that teform expenditures only differ from baseline for reasons related to
reform. Because reform e*penditures must be predicted for people based on their "new"
insurance status, it is helpfu~ to predict baseline spending with the same methodology.
8Actual
13
�personal income and payroll taXes can be calculated with respect to the 1991 tax treatment of
employer paid premiums.
6. Total Health Care Spending for the Nonelderly. The AHSIM baseline includes
-
I
most health spending by the civilian, resident population of the United States under the age of
I
65. AHSIM excludes the institutionalized population, Medicare beneficiaries among the
nonelderly, and spending by abtive-duty military personnel.
7. Adjustments to AHSIM Baseline Data. Because the aggregate health insurance
I
.
premiums reported in the HIPS component of NMES-2 are not consistent with the benefits
paid by private health insuranbe according to either the Household Surveyor the National
I
Health Accounts, the NMES-2 HIPS-based premiums are calibrated to these other data
sources. Tax estimates and ,age income are calibrated to SOl data, as described above. In
general, according to extensiie analysis by HCF A and AHCPR staff to account for
differences in definition and coverage, the NMES-2 expenditure data and the National Health
"1
"
.
Accounts YleId simi ar estlmates,
.
III. Premium Estimation Under Reform
Two agencies, the Health Care Financing Administration and the Agency for Health Care
Policy and Research, estimated the cost of health insurance premiums under reform. Their
estimates are in 1994 dollars and reflect the benefits included in the standard benefit package.
The premium estimation methodology used by each of these agencies is described below.
A. Health Care Financing Administration:
The first step in HCFA's simulation process was to determine each individual's insurance
status. The modelers used GPS indicators for this, and considered a person to be insured if
he/she was covered by emplbyer-sponsored insurance, other private insurance, CHAMPUS,
Medicare, or Medicaid.
Ins~ranc~~ could be either in one's own name or through it:lclusion in
a policy held by an adult in the insurance unit. Also, some dependents are covered by private
insurance policies owned by people outside the family (for example, a child of divorced
14
�parents may be covered through insurance carried by the parent who does not live with the
child).
HCFA modelers then adjusted health expenditures to reflect the coverage offered through
Th~t coverage is restricted to hospital care, physician and other
professional services, preSCrip~on drugs, and durable medical equipment other than vision and
I
"
the regional alliance plan.
hearing products. Therefore, the analysts excluded all other National Health Accounts
expenditure categories. The cbst of coverage for mental health, dental, and preventive care in
the standard benefit package las estimated separately, from aggregate data, and added in at
the end of the process. Once expenses were adjusted for coverage differences, the modelers
applied the fee-for-service plan deductibles, coinsurance, and cost-sharing limits to each
person covered through the relgiOnai alliance.
"
An insurance-induced demand adjustment was applied to all those enrolled in the regional
alliance. " The basis for the
in~uced demand was the difference between out-of-pocket
spending under current law ahd that determined by the reform simulation described above.
The induction" factor varied
b~ type of service.
values used are described in
~ppendix A.
The application of the factors and the specific
Post-induction spending is equal to the expenditures
calculated previously plus (JinUS)the induced spending calculated as described.
Following these steps, H<!FA analysts imputed expenses to currently uninsured people.
I
I
Existing patterns of use for the uninsured person were discarded, because those patterns are
insurance. An imputation fIle was created for each
1 To create the file, insured people (excludingservice who
covered under the regional alliance.
people
influenced by the absence
0
received SSI cash payments), wem divided into groups according to gender, four age classes,
and three poverty status c1Jses. Expenditures were tabulated for each group to determine: (a)
the proportion that had no ekpenditure and (b) mean expenditures and use for each decile of
the user distribution.
Expenses were imputed for an uninsured person using these imputation files. For each
15
�type of service, the person was assigned a random number ranging from 0 to 1. If that
random number fell within the nonuser proportion for the service, the person was given no
expenditure for the service. Otherwise, the person was given the mean expenditure and use
for the decile of users into whibh the random number placed them. Analysts assumed that
facility and physician use was borrelated for hospital services, and used the same random
number for hospital inpatient ahd physician inpatient use. They did the same for hospital
outpatient and physician outpahent, and for hospital emergency room and physician
emergency room use.
Analysts performed a fmal simulation to determine which people were covered by the
alliances. Typically, they exduded people who received AFDC or SSI cash payments.
I
Similarly, most Medicare enroUees were excluded; only those who worked or whose spouse
worked were included in the Jremium calculations. The remaining people were divided
between the corporate alliancd and the regional alliance according to the worker status of the
adults in the insurance familyj and were assigned to one of three policies: individuals (and
couples with no dependents), one adult plus dependents, and two adults plus dependents. In a
final pass through the family,l health expenditures, analysts applied the family limits on out
of-pocket spending to
determt~e the, plan benefits.and copayments.
In order to generate an upper-bound discount estimate, whenever a two-earner couple had
one worker in a large firm (5[000 or more workers) and one in a firm that would be covered
through a regional alliance. tJe couple was assumed to choose coverage in the regional
alliance. This maximizes the potential cost of the discounts costs given that no government
discounts are available through the corporate alliances.
After plan benefits had reen determined, premiums were calculated for each of the policy
types and alliance types. An offset was applied to expenses to reflect current-law cost
shifting attributable to uncompensated care. Under the current system, private sector
premiums are higher than thJy would be if there were no uncompensated care in
t~e system
,
'd
I
&'
smce provl ers pass these unpal'd costs on to ' d ·patIents. Under relorm, all
msure • paymg '
16
�persons will be insured; conseqpently, baseline premiums should be reduced to reflect the
elimination of non-payers from the system. A load factor was applied to the (reduced)
benefit cost per policy. The load factor was 15 percent for the regional alliance.
B. Agency for Health Care Policy and Research:
AHCPR's method of generJting premium estimates has seven steps. First, following
conventions in health economiJs, AHSIM estimates a two-part model of expenditures for each
service. The unit of observatiJn is the person. The first equation in· each service's set of two
I
equations estimates the probability of using the service at all as a function of demographic,
income, insurance,
empIOyme~t, and health status measures from the 1987 NMES-2.
The
second equation estimates annbal expenditures on the service for all users of the service, as a
function of the same exPlanatdry variables. Combining the result of these equations (Le.,
multiplying the probability of hse times the coefficients in the second equation) yields an
equation that predicts expendiJures for each type of person. Predicted expenditures are aged
to 1994.
Health expenditures for
.
ea~h
I
person are then predicted for each of the ten services
included in the AHSIM Model using this system of equations. Predictions for both the
probability and the level (givdn any use) of an expense were made for each person based on
I
I
these regressions. The procedure assigns the same expected values to people with private
insurance and similar personal characteristics, based on a hypothetical "average" insurance
policy. Expected values are
~Odifi.ed to take into account specific plan provisions using
.1
information from· the RAND National Health Insurance Experiment about the effects of such
provisions. Reform expenditJres are imputed to all people in the model using a stochastic
process that maintains observbd correlations in expenditures across service types while
controlling for the demOgrapJic characteristics and health status of individual NMES-2
respondents.
Every individual included in the AHSIM Model actually had three types of reform
expenditures assigned to them, indicating their (assumed) behavior under fee-for-service
17
�(FFS), managed care (HMO), and preferred provider (PPO) insurance arrangements.
Expenses for benefits paid, cosLsharing and noncovered services were calculated separately
for each type of plan by
apPly~g claims-processing logic .to the appropriate estimated
expenditure. Premiums for eadh type of insurance plan were computed on the basis of
average benefits paid per insu+ce policy plus an administrative load set at a percent of
benefits paid. In this way, each person was taken'into account in computing initial premium
levels. Premiums were adjUsJd for current regional variations in prices.
Individual choice of health plans under reform was modelled by randomly assigning health
insurance units to one of the tlilree types of plans (FFS, HMO, PPO) described above. The
assumed probabilities of
seleC~ng particular plans were based primarily upon market shares
observed by HIAA in their anhual surveys, trended forward to 1994. These estimates were
modified by assuming a 10 pelcent reduction in FFS under reform as a result of managed
competition. Market shares
Jrre allowed to vary on the basis of region, urbanlrurallocation,
and the availability of discounts for out-of-pocket (OOP) expenses and premiums.
Two passes through the data are made to compute the final set of premiums. The first
pass implements decision
rul~ regarding the distribution of premium payments under reform.
It also computes the cost of +ncovered services and cost· sharing requirements borne by
individual households. Based on these calculations, the model determines the extent to which
I
I
'
a household's direct costs wil[ be offset by supplemental insurance and OOP discounts. In
'
, the second pass through the data, expenditures are increased to reflect additional spending
induced by supplemental insJrance and OOP discounts. Insurance premiums are then
adjusted to reflect these highlr expenditures.
C. Choice of Premium Estimates for Budgeting Purposes:
,
One set of premium estiJates had to be chosen for final budgeting purposes. Although
AHCPR's premiums were usbd by that agency in their estimation of discounts to e!TIployers
and households and those dilcount estimates were used as a check on estimates done by
HCFA and the Urban InStitute, the Administration opted to use the HCFA premiums' for
18
�purposes of final federal budgeting and distributional effects analyses.
This choice was made for two reasons. First, the premiums estimated by HCFA were
higher than those estimated by AHCPR, and it was viewed as desirable to have an official
estimate that was more conservative (i.e., that would lead to higher costs associated with the
program -- see Table 1 belOw)l Second, the HCFA estimates are benchmarked to the
National Health Accounts, the most reliable measure of aggregate spending in the current
health care system. Given that the National Health Accounts are considered to be the "gold
standard" in measuring total hbalth expenditures, it seemed most appropriate to keep the
official premium estimates
co~sistent with that standard.
Table 1
Alliance Premium Estimates
Policy Type:
HCFA
AHCPR
Single
$1933
$1735
Couple
$3865
$3471
One Adult Family
$3894
$3647
Two Adult Family
$4361
$4262
IV. Discount Estimates
The national health care reform plan includes a number of different discounts, targeted at
different payers. There are tlo employer discounts: . one directed at all firms in the regional
alliance, and one directed at small firms with less than 75 employees. There is a discount for
the family share (20 percent of
th(~
actuarial value) of premiums and for out-of-pocket
19
�payments for both working and nonworking low income families. There is also a diScount for
I
'
the 80 percent premium share for those families who do not have at least one full time
worker (or equivalent),
inclUdi~g early retirees.
The major models are similar in how they
estimate most components.
A. Employer Discounts:
The general firm discount consists of a 7.9 percent of payroll cap on all firm premiums,
regardless of fIrm size, ProVid1d the employer is in the regional alliance .. If the cost of
providing 80 percent of the adjusted premium per worker exceeds 7.9 percent of firm payroll,
the share paid by the federal gbvernment is equal to the difference between the two amounts.
or:
[NS<.8Ps)+Nc(.8Pc) +Nsp(·8Psp)+NDP(·8PDP)] -(.079*firm payroll)
where N is the number of wolers of each contract type (S=singles, C=couples without
children, SP=single parent fJilies, and DP=dual parent families) and P is the adjusted per
worker premium for each
con~act type.
The small firm discount schedule provides lower payroll caps (less than 7.9 percent) for
firms with less than 75
emplo~ees JiJ1d average pay below $24,000 per year.
schedule is shown in Table 2.
20
The small firm
�.
Table 2
Small Firm Discounts
Size of Firm' (Number of Employees)
Average Firm Payroll
i
Less Than 25
Less $12,000
I
25 to 50
50 to 75
3.5%
4.4%
5.3%
6.2%
$12,000-15,000
I
4.4%
5.3%
$15,000-18,000
I
5.3%
6.2%
$18,000-21,000
I
$21,000-24,000
I
I
Greater Than $24,000
7.1%
..
6.2%
7.1%
7.9%
7.1%
7.9%
7.9%
7.9%
7.9%
7.9%
~
9Because 75 workers was not fIrm size break included in the data sets being used, modelers were asked to use
a frrm size of 100 for this subsidy' calculation. Given that the subsidies will apply only to fIrms up to size 75, the
results overestimate the subsidy dosts.
21
�1. TRIM:2: Employer Discounts. In the TRIM2 model, employer obligations (either 80
percent of the adjusted premiurh for each worker or a percent of total payroll) are calculated
I
for each worker; there are no firms per se on the CPS, although each worker has employer
information associated with
thJ~.
I
TRIM2 assigns fIrm average payroll information from the
'
County Business Patterns (CBP) data to each worker, using a statistical matching procedure
I
that relies on industry (the 3-digit SIC codes), state of residence, and establishment size.
In addition, an average fIrm premium is imputed to each worker. Take, for example, retail
IAssume that according to the CPS, of the workers who report
fIrms with 100-500 workers.
being employed by that type
o~ fIrm, 40 percent are singles, 20 percent are married but have
no children, 30 percent are rnJrried with children, and 10 percent are single parents. The
weighted average fIrm
premiu~ that an employer of that type faces is equal to
where Ps, Pc, P sp, and PDP are as described earlier.
The employer's payment is proxied by the comparison of average pay times the
appropriate percentage cap (315 percent to 7.9 percent) to 80 percent of the average firm
premium. If the 80 percent
Jthe average firm premium is less than capped average pay, the
employer would pay 80 percdnt of the correct adjusted premium for each
work~r.
If, on the
other hand, capped average pky is less than 80 percent of the average firm premium, the
employer would contribute 7.b percent (or the appropriate percentage less than 7.9 percent) of
total payroll to the alliance.
If the fIrm cap is the less expensive option, the worker's record is appended with an
employer payment equal to the appropriate cap times average pay in the fIrm. The amount
paid by the federal govemmJnt on behalf of the employer is also added to the record in the
amount of:
22
�where P is the adjusted per wGrker premium for the worker's health insurance unit type i
(single, couple,' single parent, kUal parent), CAP is equal to the appropriate percentage cap
(ranging from 3.5 percent to 7.9 percent) and Avg. Firm Pay is equal to the firm's average
payroll as imputed from the OBP data.
If, conversely, 80 percent Gf the adjusted per worker premium is the less expensive option,
the worker's record is
append~d with an employer payment equal to .80*P
j,
where i is equal
to the apprqpriate health insuJance unit type for that worker, and there" is no government
employer discount.
2. HCFA: Employer Discounts. In the SPAM model, the basic calculations of
'
employer discounts are similJr to those in TRIM2, other than the development of firm-level
I
average payrolls. While TRIM2 imputes payroll data from the County Business Patterns data
set, SP AM uses payrolls created by synthesizing firms from employees on the CPS. For each
record of
~ employee on thd CPS, one of the firms created using that employee is linked
back to serve as the firm desbriPtion for that employee. The resulting payroll distribution is
similar to that implied by thd CBP.
'"
3. AHSIM: Employer IDiscounts. In the AHSIM model, the calculations are also
similar to those in TRIM2. AHCPR uses County Business Pattern data for estimating average
payroll. The links to
NMES~2 make use of the Household Survey detailed responses by fum
size, industry, and other variables, confirmed by the NMES-2 Health Insurance Plan Survey.
+
B. Discounts for the Self-Employed.'
Those individuals who
. '
self-employed are obligated to make a contribution to the
alliances based upon the same schedule used to determine small business
paymen~.
Those
with self-employment incoJe between $0 and $12,000 per year, for example, pay the lesser
I
of 3.5 percent of self-employment income and:
23
'
�where Pi is as before and EC is the credit received by the self-employed person due to
employer contributions made In their behalf while doing wage work. So, for example, a self
employed person who is also e1mployed by a firm and who is working a full-time, full- year
job for wages/salaries has no flrther obligation with regard to the 80 percent/employer share.
An individual who works full be for wages for 8 months and then quits that job and
becomes self-employed is
.
onl~ obligated up to a maximum of 4 months of the 80 percent of
the adjusted per worker premium for his/her health insurance unit type.
C. Discounts to Low Income Families.
Low income workers and nrn-workers (those with family income less than 150 percent of
povertylO) are eligible for government discounts to assist in the payment of the family share
of the premium and to assist Jith family out-of-pocket payments (co-insurance and
deductibles). The family preJium share discounts work as follows:
1. Those with family incomes at or above 150 percent of poverty are responsible for paying
the full 20 percent share, sabject to a maximum of 3.9 percent of family income. .
2. Those with family incomes below 150 percent of poverty have their premium obligation
calculated as:
MARG 1(INC l -lOOO) +MARGz(INCz -INC1)
where INC, is equal to the f4ilY income up to the appropriate poverty guideline. INC, is
equal to family income if it exceeds 100 percent but is less than 150 percent of the
appropriate poverty guideline, MARG l is the contribution rate applied to family income below
'<The family size specific poveny guidelines used are as follows:
single -- family size is 1
couple -- family size is 2
single parent family -- family size isI 3
dual parent family -- family size is 4.
I'
24
�poverty, and MARG2 is the contribution rate applied to family income between 100 and 150
percent of poverty.
The two contribution rates are such that families below poverty do not pay more than 3
percent of income for their fJily premium share contribution, those with income below
$100011 have no premium conlribution. Families at 150 percent of poverty pay the full 20
percent share, or 3.9 percent
J family income, whichever is less.
The government payment
is equal to 20 percent of the Jtuarial premium for the health insurance unit type, less the
family contribution calculated above. For purposes of this calculation, family income is equal
to adjusted gross income less unemployment compensation plus non-taxable interest income.
For each marginal rate (MARG 1 and MARG2), there are two sets of rates to be used. The
first set (MARGlSingle' MARGling1J is applicable for single health insurance units and uses the
famil~ of size one.
The second set (MARG lother, MARG2olher) is
I
applicable to all other health insurance units and is based on the poverty guidelines for a
poverty guidelines for a
family of size four.
Set one is calculated as foHows:
I
MARG1si;V1e =(O,03*POVG1)/(POVG1 -lOOO)
MARG2&i11&14 =«O.2*PREMs) -(0.03 *POVG1))/(0.5 *POVG1)
where POVG 1 is based on thl poverty guidelines for a family of size one, and PREMs is the
premium for a single individhal. In 1994, these rates are estimated to be 3.5 percent and 4.8
percent, respectively.
Set two is calculated as follows:
HIn 1994 dollars. The incoJe "disregard" is indexed by the CPI in furore years.
25
�where POVG4 is the poverty guideline for a family of size four, and PREMF2 is the premium
for a dual parent family. In Ib94, these rates are estimated to be 3.2 percent and 5.8 percent,
respectively.
..
These rates result in singles and dual parent families paying their full 20 percent premium
share at 150 percent of povedy. At 150 percent of poverty, singles pay 3.6% of their income
and dual parents families pay 3.9 percent. When the second set of marginal rates are flPplied
to single parents and couples, these families are paying approximately 3.9 percent of their
income at 150 percent of their appropriate poverty guideline (family size set at three for
single parents and two for cOhpleS); however, that amount is less than 20 percent of their
respective premiums. Conse4uently, couples and single parents with incomes in excess of
150 percent of poverty will bb required to pay the lesser of 20 percent of their premium and
3.9 percent of income.
An out-of-pocket spending discount is available for those families below 150 percent of
I
poverty who live in an area that does not provide access to a low cost sharing (HMO) plan.
In such cases, the family is Jnly obligated to pay the cost sharing that would be required if
I
the family had actually enrolled in an HMO (Le., $10 copayment for outpatient services); and
discounts will be available
flr the remainder.
Families without at least one· full time worker or equivalent12 may be required to pay at
least some portion of the 80 percent adjusted premium share that is covered for workers
l2'fwo examples of families 4th a "full time worker equivalent" are:
1. each spouse works balf time for the full year;
2. one spouse works full time fo~ 8 months and the other works full time for 4 months.
26
�through their employers. Families with non-wage income below 250 percent of poverty are
eligible for some subsidization lof this obligation. If eligible, a family's payment for this
portion of the premium is
eqU~ to:
I
MARG3(MWINC l -lOOO)+MARG4(NWINC2 -NWINC1)
where NWINC 1 is equal to the family non-wage income up to the appropriate poverty
guideline, NWINCz is equal t1 family non:wage income if it exceeds 100 percent but is
below 250 percent of the appropriate poverty guideline, MARG 3 is the contribution rate
in~ome below poverty, and MARG is the contribution rate
applied to family non-wage in~ome between 100 and 250 percent of poverty. MARG, is set
applied to family non-wage
4
such that families below povehy do not pay more than 5.5 percent of their non-wage income
for this portion of the
premiu~, and families with less than $1000 in non-wage income have
no required contribution towJdS this portion of the premium. The federal payment is equal
to 80 percent of the approPriak adjusted per worker premium less employer payment credits,
less self-employment
contribu~ions, and less family contributions as defined above.
Non-wage income is calcu1ated as Adjusted Gross Income (AGI) less wages and salaries
less unemployment
compensa~on and less self-employed inco~e.13
Income in this category
includes: rents and royalties, interest (including non-taxable interest income), dividends,
alimony, capital gains/losses, the taxable portion of social security, partnerships, and trusts.
Aside from items mentioned above, other categories of excluded income are: welfare
payments, VA benefits, workbr's compensation, child support income, inherited money, and
proceeds from life insurance.
There are four sets of contribution rates which can be applied to non-wage income: one
each for single, couples, sindle parent, and dual parent families. They are calculated using
the fonnulas shown below, iSing the family sizes of I, 2, 3, and 4 respectively to detennine
-
lJ-yhe actual legislation exclud~s wages and salaries up to $60,000 per year. Wages and salaries in excess of
this amount count towards this c.ucuJation. The $60,000 exclusion cap was not modelled, making the subsidy
estimates somewhat over-stated.
27
�poverty guidelines.
For family type 'i':
MARG3I.=(0.055 *POVGj)/(POVGj -1000)
MARG4,=((0.8*Pj )-(0.055*POVGj ))/(1.5*POVGj)
where POVG j is the poverty JUideline for the appropriate family size, and Pi is the
appropriate adjusted per
work~r premium.
In 1994, these rates are estimated to be as follows:
I .
for singles, 6.4 percent and 10.7 percent; for couples, 6.1 percent and 10.9 percent; for single
I
parent units, 6.0 percent and 9.8 pe.rcent; for dual parent units, 5.9 percent and 7.5 percent.
These rates were calculatea so that families pay their full employer share of the premium
at 250 percent of poverty.
D. Retiree Discounts.
Families with retirees l4 are eligible for a special discount. When fully phased in,
I
.
government discounts cover the full 80 percent/employer share for non-working retirees.
I
Government discounts are offset to some extent by the employers of retirees who work part
time and the employers of Wbrking spouses. For example, a 58 year' old man who is working
half time will have half
Of\hi~ employer contributions made by his employer and half of his
contributions will be made bt the federal government No government discount is necessary
when a retiree has a full timJ working spouse, as the spouse's employer's contributions will
fulfill the coverage responsiJility. However, if a retiree is married to a non-worker, the
government contribution
wil~ cover the couple (or family).
~
'4'[be policy defines retirees
those nonworkers who have' fulfilled a requirement of a minimum number of
working quarters and who are bet~een the ages of 55 and 64, inclusive. However, the models being used to simulate
the cost of the plan do not have (lata on quarters worked. Consequently, all individuals 55 to 64, who are not
working or work part time or part year, are modelled as being eligible for the special retiree subsidy.
28
�E. Choice of Discount Estimates for Budgeting Purposes and Distributional Analyses:
For reasons noted above in the section on premium estimation, the HCFA premiums were
selected as the official Administration estimates. This choice necessitated that a model using
l the official Administration discount estimates. 'For this
the HCFA premiums be used
reason, the discount estimates fused for budgeting purposes are from the HCFA simulation
model. It should be noted however, that all three discount estimates were within 7 percent of
each other. Consequently, all estimates are well within the discount "cushion. 1115
For purposes of distributional analyses, the Administration's official estimates come from
the Urban Institute's 1RIM2 kOdel, which was benchmarked to the National Health Accounts
and which used the HCFA esJimated premiums. The Urban Institute is the most experienced
I
of the three groups in doing the type of complex distributional analyses needed for the reform
process.
V. National Spending Impacts
The change in spending produced by health reform can be summarized in terms of the
I
impacts on businesses, households, and governments. Present business spending is here
I
limited to employer contributions for employer-sponsored health insurance and for active
workers and retirees. Under bform, employers are required to pay 80 percent of the average
worker premium in their areJ (net of discounts) for most workers. Beyond the required
outlays, it is expected that
th~re will be supplementation of the required coverage.
Those
employers currently paying Jore than the required employer contribution percentage, or
buying richer coverage (e.g., lower cost-sharing) are assumed to continue to pay more than
the required minimum.
The calculations of changes in business outlays are similar in 1RIM2 and SP AM. If an
I
15The HCFA discount es~mates were increased by 15 percent in an effort to budget a more
conservative level of discou~ts.
29
�employer currently pays more than 80 percent of premiums. TRIM2 increases employer
spending under reform to matdh the proportion contributed by the employer currently. as long
as this does not exceed currenJ spending. If maintenance of the current proportion would
exceed current spending. it is lsumed that employers increase their spending only to the
point of current spending. WJrker contributions are reduced accordingly. This first part of
supplementation is then
increa~d to add the cost for enhancing the richness of coverage up to
the current level of plan richnbss associated with each currently insured worker. The cost of
matching the current richness 16f benefits is paid by the employer and the worker in
proportion to current premium contributions.
In the SPAM model. additional coverage is assumed wherever current payments are better
f~ture payments under the mandated benefit package.
for the family than modeled
Supplementation amounts are accumulated equal to the difference between current and
required benefits. Employer contributions are assumed to cover the supplement. although
employer payments for the
r~uired coverage are held to the mandated minimum.
The AHSIM Model assumes that both employers and households attempt to hold their
spending on health insurance constant from baseline to reform. To the extent that baseline
spending on employer-sponsored insurance exceeds expenditures required under reform.
employers are first assumed fo buy down their employees' required contributions. If baseline
spending exceeds reform reqhirements for either households or employers after taking this
r
transfer into account. the AHSIM model then allows both households and employers to buy
supplemental insurance.
F01 each health insurance unit in AHSIM, the actuarial value of
supplemental insurance purchased under reform cannot exceed baseline levels. The total
amount ofsupplemental ins+ance is also limited by the level of potential out-of-pocket
expenses (cost-sharing plus noncovered services) under reform. Supplemental insurance is
also assumed to carry a hig1er administrative load than basic health plans, 25 percent in most
recent simulations. Any employer excess that remains after buying -supplemental insurance is
-
.
assumed to increase other tax-preferred fringe benefits.
I
-
__
30
-.
�Household spending is dermed to be the employee contributions for employer-sponsored
health insurance, direct premiJms for non-group coverage (under the current system) or direct
purchase of alliance coverage funder refonn), and cost-sharing payments. In the baseline, the
employee contributions are defined to include employee payments irrespective of tax status;
pre-tax employee contributionl are counted as employee payments despite IRS treatment of
such sums as employer contriJutions. To the extent supplementation implies higher business
payments, household spendinJ is reduced by like amounts. Total changes in cost-sharing are
calculated as the net of reducdd payments due to new and enriched coverage, against
increased cost-sharing attribudble to required purchase of insurance leading to increased
utilization and some personal bayments (rather than reliance on uncompensated care
mechanisms) ..
Government spending changes reflect transfers between the Federal government and other
. levels of government, as well as increased Federal responsibilities (particularly in arranging
discounts for low-wage firmS)!" Baseline Federal spending is primarily Medicaid and
Medicare. Under reform, MeOicaid non-cash populations move into alliance plans, with some
direct business payments.
Si~ilarIY, more Medicare recipients fall under working aged rules,
with direct employer contribuhons reducing Medicare responsibilities.
State and local baseline spending is primarily Medicaid, although significant sums are
currently spent on other
prog~ms. most notably direct payments to hospitals.
Medicaid savings will be
Under reform,
redi~ted under maintenance of effort requirements for use in
paying for discounts for low-income populations in the alliances.
31
�References
Burner, S. and D. Waldo. "U~ing HCFA's Special Policy Analysis Model to Simulate
Benefits in a Health Reform Scenario". Health Care Financing Administration Internal
Memorandum, March 1993.
Doyle, P. "Microsimulation and Health Care Reform." Proceedings of the American
Statistical Association 1993 Annual Conference. Alexandria, VA: American Statistical
Association, 1993.
Giannarelli, L. (1992). An Analysts' Guide
Institute Press.
to
1RIM2. Washington, D.C.: The Urban
Holahan, J. and S. Zedlewski.I (1989). Insuring Low-Income Americans Through Medicaid
Expansion. Washington, D.O.: The Urban Institute.
(1~O). ~icrosimulation Techniques for Tax and Transfer Analysis.
Lewis, G. and R. Michel.
Washington, D.C.: The Urbart Institute Press.
I
National Research Council. (1991). Improving Information for Social Policy Decisions.
Washington, D.C.: National Academy Press.
Wade, M. (1991). "Out-or-Jket Expenditure Model (revised). Urban Institute Research
Memorandum. (October).
Zedlewski, S., J. Holahan, L. Blumberg, and C. Winterbottom (1993). "The Distributional
Effects of Alternative Health Care Financing Options," Washington, D.C.: The Urban
Institute.
Zedlewski, S.R. (1991). Expanding the employer-Provided Health Insurance System: Effects
on Workers and Their Employers. Urban Institute Report 91-3. Washington, D.C.: The
Urban Institute.
32
�APPENDIX A
Example pf the Application of an Induction Factor
To a Change in Insurance Status
Before
Change
$200
x 50%
$100
Current law spending
Multiplied by copayment rate
Out-of-pocket spending
After
Change
$200
x 20%
$40
$60
x 0.7
$42
Initial change in out-of-pocket
Multiplied by induction facuhr
I
Equals change in total spending
$200
42
242
- 48
194
Current law spending
Plus induced demat)d
Equals new total spending
Less new out-of-pocket (20%)
Equals new benefits
Induction lFactors Used in SPAM Simulations
0.3
1.0
0.0
0.7
Hospital inpatient (facility and physician)
Prescription drugs
Emergency room services and DME
All other services
I
SOURCE: Office of the Actuary
I
Health Care Financing Administration
33
�
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Carol Rasco - Issues Series
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Carol Rasco
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Carol Rasco
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2010-0198-Sb-health-care-materials-6
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Text
(
~'i
The Health Security Act of 1993
Documentation of Federal Budget Effects
December 1993
�Table of Contents
MedicaidlMedicare .
Medicaid.....................................................................................................................2
~
....................................................................................15
Medicare............•......••.... ..... J
Other Existing Government Programs
Veterans Affairs ................. ).....................................................................................40
.!.....................................................................................43
Department of Defense...
Federal Employee Health
ene"fits.............................................................;.........46
B
Public Health .............................................................•...............................................50
New Programs
Academic Health Center and Medical Education Funding Pools................72
Wrap-Around Benefits
f1
Long-Tenn care..............
Children...................................................................73
..l......................................................................................75
Net Federal Discount Payments to Alliances (Capped Entitlement)
l.. .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I
Discounts...........................
.
80
Offset for State Maintenance of Effort..............................................................82
Ad.:m.inistrative Costs_............•..........•................•........•...•••..••.•....••••.............•........84
Attachment
Glossary of Acron'fIDs............................... ~ ................................................... ~........88
ii
�BACKUP DOCUMENTATION
This document provides a description of policies in the Health Security Act which involve
Federal costs or savings, the line-by-line numerical estimates, and a brief description of key
assumptions or methodologies used to derive the estimates. The estimates are consistent with the
--:--_ _~C~o~ng!'essional testimony presented by the Director and Deputy Director of OMB. A few minor
variances with the final bill language remain. Revised esfimafes-will-be-provided-wlili-ilie--------_
President's FY 1995 Budget.
.....
�BACKUP DOCUMENTATION
(savings negative, costs positive)
BUDGET CATEGORY
(outlays in $ millions)
Medicaid: Providing Coverage for Medicaid Non;'Cash Recipients through Alliances
BUDGET PROJECTIONS
Fiscal Years
1996
1997
1998
1999
2000
1995-2000
. Guaranteed
benefit package
0
-1,900
-6,500
-18,50.0
-24,700
-27,900
-79,500
Wrap: non-cash
I\)
1995
0
-100
-600
-1,600
-2,300
-2,600
-7,200
Wrap: cash kids
0
-100
-300
-900
-1,200
-1,300
-3,800
Emergency svcs for
undocumented persons
0
100
200
400
500
600
1,800
Net Medicaid savings
0
-2,000
-7,200
-20,600
-27,700
-31,200
-88,700
POLICY DESCRIPTION
Current non-cash recipients of Medicaid (individuals under age 65 who do not receive AFDC or 55I payments) will receive
a comprehensive package of benefits through the health alliances, like everyone else. Medicaid will not pay their premiums.
In addition, Medicaid will no longer pay for wraparound benefits on behalf of non-cash recipients integrated into
alliances or cash recipient children. (Cash and non-cash children will receive wraparound benefits through
a new Federal program, as described in a separate backup document.)
�KEY TECHNICAL ASSUMPTIONS
Estimates are based on projected Medicaid acute care spending for services covered in the guaranteed benefit package as
well as Medicaid wraparound benefits. Pricing based on August 1993 Medicaid estimates. The percentage of aggregate
acute care spending allocated to non-cash recipients is based on data from HCFA-64 and 2082 forms. DSH spending is not
included in the estimates. Assumes that states with 15% of Medicaid spending implement by FY 1996,40% by FY 1997,
and 100% by FY 1998. Estimate includes discount due to payment lag liability for non-cash recipients. Cash kids wrap
estimates based on assumption that new Federal program is created to cover wrap benefits for both cash and non-cash
children. Net Medicaid savings includes estimate for continued Medicaid coverage of emergency services for
undocumented persons.
w
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ millions)
BUDGET CATEGORY
Long.:.term care: Medicaid offset from new community LTC program
BUDGET PROJECTIONS
PiscarYears
1995
1996
19.9.2:
1998
1999
2000
1995·2000
-----~====~--~-----
community LTC offset
4:>
o
-1,500
-2,200
-2,700
-3,100
-3,600
-13,100
POLICY DESCR.PTION
The new community LTC program for people with severe disabilities will serve eligible individuals who were
previously covered under Medicaid.
KEY TECHNICAL ASSUMPTIONS
Estimates are from ASPE/ Lewin-VHI (see "New Programs/Long-Term Care"), based on the assumption that roughly
50% of baseline Medicaid home and community-based spending will be offset by the new program. Data from the
National Medical Expenditures Survey and the Medicaid program support an estimate that 50% of Medicaid home and
community-based expenditures are for individuals meeting the severely disabled criteria of the new community
LTC program. ASPE assumed that States will move these individuals to the new LTC program, where a
higher Federal matching rate and increased program flexibility will be available. Medicaid baseline
spending projected by Lewin-\THi.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ inillions)
BUDGET CATEGORY
Medicaid: Effect of Capitated Payment for Cash Recipients
BUDGET PROJECTIONS
Fiscal Years
. 1996
1997
1998
1999
o
U1
1995
-300
-1,200
-3,900
-6,700
2000 1995-2000
----
-10,2uu
-22~300-----~---
POLICY DESCRIPTION
Under the Health Security Act, a comprehensive benefits package will be provided to cashAFDC recipients through the'
Alliances. States will contribute to the Alliances a premium for cash recipients equal to 95% of baseline spending on
benefits for cash recipients in the year prior to implementation of reform. Baseline spending in the year prior to
implementation is computed by trending forward spending in FY 1993 by the projected national average. Medicaid growth
rate for benefits for cash recipients. Beginning with the first year of implementation, premiums grow at the budgeted
premium growth rate for the private sector. Separate premiums will be computed for AFDC and SSI recipients. States are to
vary premiums across Alliances within a State so that the weighted average premium across aU Alliances is equal to the
premium as calculated on a uniform, Statewide basis.
OACT'S KEY TECHNICAL ASSUMPTIONS
To calculate the premium, actuaries used annual growth rates derived from historical and baseline data. States were
assumed to implement health reform on a Federal fiscal year basis in 1996 (15%), 1997 (25%), and
1998 (60%). It was assumed that full-year cash recipients would total roughly 18 million by FY 1996. The baseline
data used to calculate the savings listed above incorporates State spending estimates from August, 1993.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ hundreds of millions)
BUDGET CATEGORY
Medicaid: Disproportionate Share Hospital Payments and Vulnerable Populations Adjustment
BUDGET PROJECTIONS
Fiscal Years
1995
1996
1997
1998
1999
2000 1995-2000
Disprop Share
Vulnerable Pop Adj
Net
0.0
0.0
: 0.0
-1.4
0.2
-1.2
-4.7
0.4
-13.0
1.0
-12.0
-16.8
1.0
-15.8
-18.6
1.0
-17.6
-4.3
-54.6 *
3.6 ..
-51.1 ..
.. Totals do not add due to rounding.
0"
POLICY DESCRIPTION
Medicaid disproportionate share hospital (DSH) payments are supplemental payments for hospitals
that serve large numbers of low-income, undercompensated, or non-paying patients. The Federal share of DSH payments
totalled about $9 billion in FY 1993, over 12% of medical assistance payments. Hospitals that currently serve a disproportion
share of Medicaid and uncompensated patients will receive large inflows of new revenue when uriiversal coverage
is phased in with health reform. Providers will be compensated for all patients and rates for current and former
Medicaid recipients will be determined through negotiations with health plans. As a result, Medicaid DSH payments
are to be eliminated as States implement health care reform in CY 1996 (15%), CY 1997 (25%), and CY 1998 (60%).
New Federal payments of $3.55 billion will be targeted to hospitals serving a high percentage of low-income individuals
through the Vulnerable Populations Adjustment.
OACT's KEY TECHNICAL ASSUMPTIONS
The baseline data used to calculate the savings listed above incorporates State spending estimates from August, 1993.
August State estimates were not included in HCFA's mid-session review (MSR) estimates. HCFA actuaries estimated
that Federal DSH outlays in FY 1994 will total roughly $10.3 billion -- up from an MSR estimate of $9.5 billion. Actuaries
�assumed that a three-month payment lag would lower potential first-year savings in each State by 25%. Savings were
calculated assuming that States would implement health reform on a Federal fiscal year basis as follows:
FY 1996 (15%), FY 1997 (25%), and FY 1998 (60%).
-....J
�BACKUP DOCUMENTATION
BUDGET CATEGORY
Long-term care: Liberalized LTC eligibility
(savings negative, costs positive)
(outlays in $ millions)
BUD~ET
PROJECTIONS
Fiscal Years
Liberalized LTC elig.
CD
1995
1996
1997
1998
1999
2000
o
500
500
500
500
500
1995-2000
2,500
POLICY DESCRIPTION
Under the Health Security Act, States will establish a medically needy program for all residents of nursing homes
and intermediate care facilities (ICFs-MR). The personal needs allowance (PNA) for nursing home residents may be raised
to $50 per month. (Current PNA levels vary across States, but the national average is $35 per month.) The costs of
raising the PNA are financed with 100% Federal dollars. States have the option to allow unmarried nursing
home and ICF-MR residents to retain up to $12,000 in assets (up from the current $2,000) in determining Medicaid eligibility.
KEY TECHNICAL ASSUMPTIONS
Approximately 1.2 million residents of nursing homes and ICFs-MR are Medicaid recipients. PNA levels would
increase for these individuals in 45 States. 5 States already have PNAs at or above $50 per month.
�BACKUP DOCUMENTATION
(savings negativ'e, costs positive)
(outlays in $ millions) .
BUDGET CATEGORY
Medicaid: Cost-Sharing Discounts Provided in Some Alliances
BUDGET PROJECTIONS
---Fiscal-Years
1995
o
1.0
1996
100
1997
200
1998
600
1999
766
2000
700
1995-2000
2,300,-'--_ _ _ _ _ __
POLICY DESCRIPTION
If a low-cost sharing plan is not available at or below the weighted average premium, AFOC and SSI recipients (as well as
other low-income beneficiaries) will receive discounts to reduce their cost-sharing to the level they would have incurred if
they had enrolled in a low cost-sharing plan. Medicaid pays for these cost-sharing (out-of-pocket) discounts as part
of payments to the alliances.
KEY TECHNICAL ASSUMPTIONS
The total number ofMedicaid cash enrollees (non-aged and disabled) was estimated by HCFA at 18.4 million in FY 96
and grows to 20.2 million in FY 2000.
The percentage of Medicaid cash enrollees eligible for low cost-sharing discounts is estimated at 5.0%, yielding 990,000
enrollees receiving discounts in FY 1999. The average discount cost was estimated at $1050 in FY 96, 57% of which is Federal,
yielding an average Federaldiscount cost of $599. Average discount costs were assumed to increase by 5% per year.
State phase-in schedule assumes States with 15% of Medicaid spending implement 10/1/95; States with 25% implement
10/1/96; and States with the remaining 60% of spending implement 10/1/97. Estimate of cost-sharing discounts calculated
on fiscal year basis.
Act provides Medicaid premium (in addition to out-of-pocket) discounts to AFDC and SSI recipients (§1371 (c) (1»
who reside in alliance areas in which a health plan at or below the average weighted premium is not available.
This estimate only reflects costs associated with these out-of-pocket (not premium) discounts.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
.(outlays in $ m,illions)
BUDGET CATEGORY
Medicaid: Costs associated with paying unpaid Medicaid claims for cash recipients ("Payment lag").
BUDGET PROJECTIONS
Fiscal Years
1996
1997
1998
1999
2000
o
::;
1995
1,040
1,960
5,310
n
o
1995-2000
8,310,----_ _
POLICY DESCRIPTION
States generally pay Medicaid costs (claims) retrospectively. Thus, in the year of implementation, States will be
responsible for "lagged" claims from the previousyear in addition to prepaid capitation payments to plans.
KEY TECHNICAL ASSUMPTIONS
States are, on average, a quarter behind in payments. In the year in which a State implements reform, the State (and
the Federal government) must make up for this lag, which constitutes 25% of spending for cash recipients for
services in the standard benefit package. The costs are incurred in FY96 through FY98 due to staggered State
implementation of 15%/25%/60%. States are assumed to phase-in on fiscal year basis.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ millions)
BUDGET CATEGORY
Medicaid: Administrative Savings Due to Program Reduction and Simplification
BUDGET PROJECTIONS
Fiscal Years
1996
1997
1998
1999
o
I--'
I--'
1995
-100
-300
-800
-l,ro-o
2000 1995-2000
-1";400
-3,700--~---_ __
POLICY DESCRIPTION
Under the Health Security Act, as under current law, State expenditures for administering the Medicaid program will be
matched by the Federal government. State Medicaid programs will include far fewer enrollees, however. Payment for services
included in the comprehensive benefits package will be made via a fixed, pre-paid monthly premium, rather than through
direct, fee.;for-service provider reimbursements .... significantly reducing the volume of claims and the need for provider
contracts, reimbursement specialists, and other State oversight personnel. Thus, with enactment of the Health Security Act,
States will have an opportunity to reduce Medicaid administrative expenses substantially.
KEY TECHNICAL ASSUMPTIONS
It is assumed that States would be able to reduce administrative expenses by about one-third
in response to reduced responsibilities in enrollment, oversight, rate-setting, and claims processing. Because
administrative savings depend on discretionary State action, potential savings were discounted by 25%. Savings
totals assume that States implement health reform on a Federal fiscal year basis in FY1996 (first 15%),
FY97 (next 25%) and FY98 (last 60%), and that full administrative savings are reached 2 years after implementation.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ millions)
BUDGET CATEGORY
Medicaid: Impact of Medicare Drug Benefit on Medicaid Spending
BUDGET PROJECTIONS
Fiscal Years
1996
1997
1998
1999
o
I-'
N
1995
-700
-1,000
-1,200
-1,300
2000 1995-2000
-1,500
-5,700
POLICY DESCRIPTION
The Health Security Act extends a drug benefit to Medicare Part B beneficiaries. Low-income beneficiaries will receive the
same out-of-pocket discounts for the drug benefit as they do for other Medicare services. Individuals eligible for both
Medicaid and Medicare who currently receive Medicaid drug benefits will now be served by the Medicare drug benefit when
reform is implemented. Federal and State Medicaid expenditures will be reduced by the portion of the Medicare drug
benefit financed through Federal Medicare revenues.
OACf'S KEY TECHNICAL ASSUMPTIONS
OACT assumed that the net Federal per-beneficiary cost of the Medicare drug benefit, together with
beneficiary premiums and cost-sharing, would be equivalent to net Federal per-beneficiary costs for prescriptions
drugs under Medicaid. Actuaries also assumed that Federal outlays from the Medicare drug benefit would
reduce current Medicaid spending on dual eligibles (approximately 3.5 million beneficiaries) by 50%, since Medicaid will
continue to pay the premium and cost sharing. Conversely, in a shorthand way, the actuaries assumed that Medicaid would
incur additional costs equal to 50% of the net Federal 'per-beneficiary cost of the Medicaid drug benefit for Qualified
Medicare Beneficiaries (QMBs) and Specified Low-income Medicare Beneficiaries (SLMBs), for whom Medicaid pays Part
B premiums (approximately 1.5 million beneficiaries). The baseline data used to calculate the offset savings listed above
incoporates State spending estimates from August, 1993.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(Outlays in $ hundreds of millions)
BUDGET CATEGORY'
Medicare/Medicaid: Effect on Qualified Medicare Beneficiary (QMB)/Selected
Low-Income Medicare Beneficiary (SLMB) participation and Medicaid payments
BUDGET PROJECTIONS
Fiscal Years
.....
w
1995
1996
1997
Net effects on Medicaid
0.0
0.1
0.1
of Medicare savings proposals
(Drug benefit cost-sharing and premiums assumed in Medicare drug estimates.)
1998
1999
0.1
0.2
20'00-1995-2000---
0.3
0.8
POLICY DESCRIPTION
Under the Health Security Act, working individuals of Medicare-eligible age and their spouses will receive health coverage
by enrolling in Alliances, with the employer as primary payor in those cases when a Medicare enrollee works at least
40 hours in each of the last two months of each year. Those eligible for Medicare and Medicaid coverage of cost-sharing
and/or benefits will retain Medicaid benefits. Medicare is primary payor for all Medicare services under current
law, including drugs for non-working. dual eligibles, with Medicaid paying Part B premiums and, in some cases,
cost-sharing for poor Medicare Part B enrollees.
KEY TECHNICAL ASSUMPTIONS
Full FY 1996 implementation of relevant policies; approximately 3.5 million QMBs and 750,000 SLMBs
in 1996, extrapolated from HCFA data reports for 1993. Assumed no QMBs/SLMBs are working aged.
Medicare is primary payor of drugs for dual eligibles. Drug cost-sharing for QMBs is not in the MOE
calculation, but will be required of States. QMBs and dual eligibles who work would receive coverage
�through the Alliance and may continue to receive Medicaid wrap-around coverage. Medicaid
cost-sharing for drugs assumed in Medicare estimates. Assumed 57% of total additional Medicaid costs would be
borne by Federal government. Effect of package on Part A premium is not calculated and, as a result, effects
on qualified working disabled individuals (QDWIs) are not included in the estimates.
This calculation is, therefore, sensitive to the following variables: Percentage of QMBs working; whether Medicaid pays
the 20% premium for working QMBs/SLMBs; whether Medicaid pays QDWIs' 20% premium in Alliance; effect on Part A
premium for QDWls of Medicare savings package; effect of final Medicare savings package on coinsurance liabilities
(Medicaid pays the Part A premium for QDWIs) .
......
.r::.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ millions)
BUDGET CATEGORY
Medicare: Part B Prescription Drug Benefit
BUDGET PROJECTIONS
Fiscal Years
Drug Benefit
I-'
VI
1995
1996
1997
1998
1999
o
6,600
13,500
14,200
15,200
2000 1995-2000
16,200
65,800
POLICY DESCRIPTION
Under the Health Security Act, Medicare Part B will be expanded for all beneficiaries to include a prescription drug
benefit on January I, 1996. Beneficiaries will pay for their prescriptions out-of-pocket up to $250 each year and 20% of drug cos
between $250 and $1000, and will not incur out-of-pocket costs for prescriptions above $1000 each year. Manufacturers
will be required to pay a rebate for each non-generic prescription sold to a beneficiary equal to at least 17% of the average
manufacturer's price to the retail class of trade. The Part B premium is calculated to equal 25% of the Federal costs of the .
drug benefit (net of rebate revenue). Reimbursement to pharmacists will be capped at 93% of the average wholesale price
for ingredient costs plus $5 per script for the dispensing fee (indexed to inflation). Pharmacists will be expected to answer
questions from beneficiaries on recommended usage, side-effects, interactions, etc. The HHS Secretary is authorized'to require
those administering the benefit to operate a utilization review program for pharmacists and physicians similar to that
required under Medicaid.
OACT'S KEY TECHNICAL ASSUMPTIONS
Listed costs are net of rebate revenue. It was assumed that each dollar of the new Medicare drug benefit would induce an
additional 60 cents of drug spending by beneficiaries. Induced demand is estimated to be about $10 billion annually.
Administrative costs account for about $1 billion per year of gross Federal expenditures. Monthly Part B premiums
, would rise between $10 and $11 in CY 1996 to cover 25% of Federal program costs. It was assumed that, after implementation
�of the drug benefit in 1996, over 36 million Part B beneficiaries would obtain a total of about about 1 billion prescriptions per'
year. It was also assumed that 500,000 high-income beneficiaries would disenroll from Part B due to the combined effect
on the Part B premium of the drug benefit and the proposal in the Health Security Act to income-relate the Medicare Part
B premium. Working beneficiaries in the Alliance (see sepc;lrate description of working policy) were included in the
beneficiary population used to estimate the costs listed above. An offset for working beneficiaries for all Medicare
expenditures, including Part B drug costs, is listed separately.
t-"
(jI
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(ou tla ys in $ millions)
BUDGET CATEGORY
Medicare: Part B Prescription Drug Benefit Administrative Costs (non-add)
Administrative costs are displayed separatelyJor illustrative purposes only and are included
in the cost estimate ofthe Part B prescription drug benefit.
BUDGETPROJECTIONS~------~--------____~________~__~____~~
Fiscal Years
Drug Benefit
~
1995
1996
1997
1998
1999
2000
13
·600
900
1,000
1,000
1,100
1995·20-0-0~----'--------
4,613
POLICY DESCRIPTION
Under the Health Security Act, Medicare Part B will be expanded for all beneficiaries to in~lude a prescription drug
benefit on January 1, 1996. Beneficiaries will pay for all prescriptions out-of-pocket up to $250 each year, 20% of drug costs
between $250 and $1000, arid will not incur out-of-pocket costs for prescriptions above $1000 each year. Manufacturers
will be required to pay a rebate for each non-generic prescription sold to a beneficiary equal to at least 17% of the averag\::
manufacturer's price to the retail class of trade. Pharmacists will be expected to answer questions from beneficiaries on
recommended usage, side-effects, interactions, etc. The Secretary is authorized to require those administering the benefit
to operate a utilization review program for pharmacists and physicians similar to that required under Medicaid.
OACf's KEY TECHNICAL ASSUMPTIONS
Actuaries assumed that, beginning in 1996, over 36 million Part B beneficiaries would obtain a total of about 1 billion
prescriptions per year. It was assumed that electronic claims would account for 90% of all prescriptions and would cost 73
cents each in 1993. Remaining claims would be filed on paper, averaging 1.5 prescriptions per claim, and would cost
about $1.00 each to administer. It was assumed that the weighted average cost per prescription, 72.4 cents, would increase
3% annually through FY 2000. Fixed costs of $100 million annually were also included in the cost estimates.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ millions)
BUDGET CATEGORY
Medicare payments to VA health plans
BUDGET PROJECTIONS.
FiscarYears
19.~5
1996
1997
1998
2000
1999
1995-2000
~~~~~~==~--~
Medicare payments to VA health plans
I-'
(Xl
200
300 .
300
800
POLICY DESCRIPTION
Under the Health Security Act, Medicare will reimburse VA health plans for services to higher-income veterans for
non-service-connected conditions, as defined in 38 USC 1722 (b), eligible for Medicare. VA and HHS will negotiate
application of rules and payment rates.
KEY TECHNICAL ASSUMPTIONS
VA estimates approximately 55,000 veterans that are enrolled in Medicare and that are above the "higher-income" .
. . threshold received VA care in FY 1992. Assumes 1/1/98 start...up date. VA health facilities must meet Medicare conditions of
participation and reporting requirements.
This calculation is sensitive to the following variables: which Medicare payment methodology will be used if VA health
also cover
plans are considered Medicare HMOs; interaction with working aged policy; whether VA health plans
spouses of veterans; rate of increase/decrease in eligible population; whether Medicare pays for a spouse who enrolls in a
VA plan; phase-in schedule used in pricing; whether premiums have been netted out of Medicare expenditures,
including drug premium add-on; whether Medicare will be primary payor for prescription drugs purchased by the VA;
the date for commencement of Medicare payments to VA health plans; additional administrative
costs, if any.
will
�BACKUp·DOCUMENTATION
(savings negative, costs positive)
(Outlays in $ millions)
BUDGET CATEGORY
Medicare payments to DoD health plans
BUDGET PROJECTIONS
FiScal Years
1995
19.9.6
1997
1998
1999
2000
1,400
1995-2000
1,400
~~~~~~~----
Medicare payments to
DoD health plans
~
200
500
1,300
4,800
POLICY DES~RIPTION
Under the Health Security Act, the Secretary of HHS has the discretion to disregard the exclusion in the Social Security
Act on Medicare payments to DoD health facilities. Medicare will pay a capitated amount to military health plans for
services equivalent to SMI benefits for those Medicare beneficiaries who enroll in military plans. The payment will equal
the payment to an organization with a risk-sharing contract under Section 1876 of the Social Security Act.
KEY TECHNICAL ASSUMPTIONS
DoD estimates it will provide $1.268 billion in services to individuals over 65 in 1993. Assumes revised phase-in schedule
of 15% in FY 1996, 40% in FY 1997, and 100% FY 1998. Estimate only accounts for currently projected services to over-65
population and assumes no induced utilization for inpatient or outpatient services. DoD used the DRG workload for the
over-65 population to calculate total services provided Medicare beneficiaries. Assumes Medicare paid for 90% of costs.
Used the CPI-U to inflate estimates in the out-years.
This' calculation is sensitive to the following variables: method of calculation of the capita ted amount; inpatient
induced utilization would appear to be negligible, but there may be an inducement effect on the outpatient (Part B) side;
effective date for Medicare payment -- phase-:-in schedule for such payments not specifically outlined.
�BACKUP DOCUMENTATION
(savings negative~ costs positive)
(Outlays in $ millions)
BUDGET CATEGORY
Medicare: New liabilities for ex-FEHB retiree beneficiaries
BUDGET. PROJECTIONS
FiscarYears
New Medicare costs, net of
premium penalty
~,
:::>
Medicare offsetting receipts from .
monthly premium
1995
1~9_6
1998
300
1999
300
2000
300
1995-2000
0
1997
0
o
o
-100
-100
-100
-300
9()()----
POLICY DESCRIPTION
Under the Health Security Act, retiree health benefits for Federal retirees are covered by Medicare as primary
payor. Federal retirees could then have first-dollar coverage, with OPM filling in the cost-sharing as the
secondary payor. OPM is assumed to be responsible for payments to cover late enrollment fees assessed against
the Part B premium. OPM will offer a Medigap-like policy to protect Federal retirees from cost- sharing.
KEY TECHNICAL ASSUMPTIONS
Assume all Federal employees and annuitants join beginning January I, 1998. Assume cohort equals 115,000 individuals
(OPM estimates). New enrollment is only under Part B, since almost all have Part A coverage now. Assumed average
Part B benefits for aged Part B enrollees. Assumed OPM pays 100% of the Part B late enrollment penalty, including new
drug premium (Beneficiaries who do not enroll in Medicare during their initial enrollment period are subject to a penalty
in the monthly premium). Assumes all new enrollees pay Part B premium of 25%, including new drug premium.
Assumes no drop-outs as the result of the working aged policy or the income-related Part B premium. Assumes no
�.,
balance billing; assumes drug rebate amounts (15%) into net new Medicare outlays.
This calculation is sensitive to the following variables: Effect of wrap-around coverage on utilization; whether
wrap-around policies will cover the Part B deductible; how many will opt to purchase FEHB supplemental
coverage; average number of years subject to penalty; relative health status of this cohort of individuals;
PAYGO consequences; what effect the final policy on working aged will have on these estimates;
interaction effect with income-related Part B premium; design of OPM's supplemental policies;
receipts from drug add-on amount to Part B premium (Estimates do not account for working aged, long-term
care policies).
N
I-'
�BACKUP DOCUMENTATION
(savings negative, costs positive) .
BUDGET CATEGORY
BUDGET PROJECTIONS
Fiscal Years
Medicare Working Policy. Offset for Medicare-Eligible Employed Beneficiaries,
and Medicare-Eligible Spouses and Dependents of Working Individuals
1995
1996
1997
1998
1999
2000
1995-2000
-3,000
-8,000
-8,000
-8,000
-28,000
POLICY DESCRIPTION
Policy is described in detail in the attached specifications.
~
KEY TECHNICAL ASSUMPTIONS
HCFA actuarial estimate is based upon the attached specifications. The Office of the Actuary assumes the Medicare
working policy would result in about 5.4 million beneficiaries obtaining primary coverage in FY 1996 through their
employment (or as a dependent or spouse of an employee) -- up from about 2.2 million who would have primary
coverage from group health insurance under current law. All 5.4 million would retain Medicare Part A for secondary
coverage; about 5 million out of the 5.4 million beneficiaries are projected to retain Medicare Part B secondary coverage.
The remaining 400,000 who would not enroll in Part B are largely high-income beneficiaries who would be required to
pay a higher, income-related premium to receive Part B wrap-around coverage.
Pricing assumes 15% phased into alliances in FY 96,40% in FY97, and fully phased-in in FY98.
Includes Medicare as Secondary Payer (MSP) savings associated with the drug benefit. Does not include
savings from theMSP proposals in the $124 billion Medicare savings package. Interactions with the
income-related Part B premium and savings proposals in the $124 billion Medicare savings package are taken
irito account within the $124 billion package.
�MSP POLICY
o
Medicare beneficiaries ~ho are working or have a spouse that is working or
who are a dependent of someone who is working would be required to enroll
in the alliance if the individual working worked forty or more hours in each of
the previous two calenJiar months and would be working in the third month.
(An exception would b~ provided in the case of a person who retired in the
month prior to the moitth in which Medicare coverage begins.) Coverage in
I
.
the alliance would begln on the first day of the third month..
·
.. 1
Thi s policy IS a varlati0n on the coverage ruI e non-Medi care benef'"
es Lor
IClarles
under which the emplbyer is required to make a payment on behalf of an
individual if the indivrdual worked more than 40 hours in a month.
o
Medicare would make the following payments on behalf of beneficiaries
enrolled in alliances:
+
+
o
Medicare woul<jl fill in all cost sharing if the individual was enrolled in
Part B or cost sharing only for Part A covered services if the individual
did not enroll ih Part B.
Medicare
pay the remaind";' of the employer share that would
otherwise be th'e responsibility of the worker, if the employment was for
less than 30 hohrs per week. (Discounts that would otherwise apply if
the individual raSPaYing part of the employer share would not apply.)
woul~
If the tie to employment is terminated prior to the end of the year, the
individual would stay in the alliance and Medicare would pay the entire
employer share for tHe remaining months. At the. end of the year, the
individual would ha.J.e the' option of Medicare coverage or opting to remain in
the alliance under thJ opt-in rules.
o
ol
Existing limitations
the working aged provisions to firms with at least 20
employees and on t~~ disabled provisions to large group health plans would
be eliminated. The ESRD MSP provisions would be conformed to the revised
aged and disabled ptovisions. The existing limitation of 18 months for ESRD
MSP would be elimihated. (Savings from extension of the authority for the
disability provision, ~eduction of the employer threshold from 100 to 20, and
extension of the 18-dtonth provision for ESRD are included. as part of the
Medicare savings, ra!ther than under this proposal.)
23
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(Outlays in $ millions)
BUDGET CATEGORY
Medicare. Rein~hursements to physician assistants, nurse practitioners, and clinical nurse specialists (Sec. 4022)
BUDGET PROJECTIONS
Fiscal Years
.z:,.
1996
1997
1998
1999
2000
o
I\J
1995
250
450
500
600
650
1995-2000
2;450---
POLICY DESCRIPTION
Sec. 4022 of HR 3600 would expand the sites and areas in which services from Medicare's physician fee schedule could be
furnished by physician assistants, nurse practitioners, and clinical nurse specialists. Separate billing for these services
. (i.e., fee-for-service payment) would be more widely available to these non-physician practitioners or their employers.
Effective January 1, 1996, services furnished by the specified non-physician practitioners would be separately reimbursable
as follows: physician assistants -- services furnished in all settings and all areas; nurse practitioners -- services furnished
in all settings excepfto inpatients of hospitals located in urban areas; clinical nurse specialists -- services furnished in all
settings except to inpatients of hospitals, nursing facilities, and skilled nursing facilities located in urban areas .
. KEY TECHNICAL ASSUMPTIONS
HCFA actuary pricing assumes that outlays would increase because of greater beneficiary access to these non-physician
practitioners' services (predominantly primary care) in more settings and more areas of the country. The actuary also
assumes that some substitution for higher-cost physician-furnished services would occur, reducing the net costs of the
provision.
. Interactions with other relevant provisions of the Health Security Act, e.g., Medicare savings provisions, Medicare
incentives for provision of primary care services, and between Health Alliances and the Medicare beneficiary
population still being considered.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(Outlays in $ millions)
BUDGET CATEGORY
Medicare savings proposals
BUDGET PROJECTIONS
FiscafYears
1994
1995
19,96
1.997
1998
1999
2000 1994-2000
--~~==~----------
Medicare savings proposals
~
-150
-2,480
-9,875
-14,373
-22,815
-33,000
-41,721
-124,414
POLICY DESCRIPTION
HR 3600 contains a package of provisions to reduce the rate of growth of Medicare program costs that will result in
seven-year savings of over $124 billion. The provisions include changes to payment rates, enrollee cost-sharing, and
and other changes to current law. These changes will be made in the context of both universal coverage and slower
growth in private sector health costs, reducing the likelihood of cost-shifting and adverse effects on beneficiaries..
A significant portion of these savings would come from reducing payments originally intended to ease financial
pressures created by uncompensated care, the rationale for which is virtually eliminated under the universal coverage
ensured bythe Health Security Act. The provisions will also strengthen the Medicare Trust Funds and ease upward
pressure on beneficiary cost-sharing.
KEY TECHNICAL ASSUMPTIONS
Provides back-up documentation for estimates in the 1994-2000 window. See attached document.
Estimates are sensitive to interaction with other provisions affecting Medicare; effect and magnitude of Medicare
enrollees opting into managed care plans; net effect of all relevant provisions on Medicare spending.
�MEDICARE SAVINGS PROPOSALS for HEALTH REFORM
($ in millions)
PARrA PROPOSALS
Reduce the Hospital Market Basket Index (HMBI) Update by 2% in FY 1997-2000. Medicare changes the inpatient per
discharge standardized amount by a certain amount every year to reflect input cost changes and Congressional
direction. OBRA 93 reduced the HMBI in FYs 94 - 97 by 2.5,2.5,2, and 0.5 percentage points respectively, to reflect
.greater efficiencies in hospitals. This proposal would reduce the market basket updates by 2% for FY 1997 - FY 2000.
Since the market basket is projected to increase 5% annually, and case mix is projected to increase 2% per year, hospitals
- - - - - .Gan-stilLexpect_an overa1l5% increase per year .
~~~~--~------~--~----
.
Savings
.122j
$0
l.22Z
930
l.22fl
·2,870
-1m
~
5,610
8,750
. 1996- 2000
$18,160
t\.l
0'1
Reduce Indirect Medical Education (lME) Adjustment to 3.0% in FY 1996. A portion of the IME is intended to
compensate hospitals for uncompensated care. Universal coverage, however, will. ensure payment for all patients and
essentially eliminate uncompensated care. In 1996, the IME adjustment will be lowered to 3.0% under this proposal.
Beginning in FY 1997, the aggregate amount of IME payments will be increased by the projected national average
increase in premiums for the under-65 population for those States that opt into the reformed system; by 1998, all
Medicare IME payments will be made in this fashion. These payments will be appropriated to a national pool to finance
. the higher costs of academic health centers. The cash flow effect for IME payments is built into these estimates.
Savings
.122j
l22Z
$2,470
3,110
l.22fl
1222
~
3,470
4,130
4,660
1996- 2000
$17,840
�Adjust Inpatient Capital Payments to Reflect Better Cost Data. This proposal combines three inpatient capital payment
adjustments to reflect more accurate base year data and cost projections. The first piece would reduce inpatient capital
payments to hospitals excluded from Medicare's prospective payment system (PPS) by 15% for FY 1996 - 2000. PPS
excluded hospitals, currently paid at full costs, do not have an incentive for efficiency. The second piece would reduce
PPS Federal capital payments by 7.31 percent and hospital-specific amount by 10.41 percent to reflect new data on the FY
1989 capital cost per discharge and the increase in Medicare inpatient costs from FY 1990 to FY 1992. The last piece
would reduce payments for hospital inpatient capital through a 22.1% reduction to the FY 1996 - 2000 updates of the
capital rates. Current data indicate that Medicare inpatient capital cost per discharge increased 77.5% during the years
immediately before the introduction of prospective payment for capital-related costs (FY 1986 - FY 1991). The
identifiable variables for capital costs only increased 38.2% over the same period. This proposal would reduce the
update to the capital rates by 4.9% each year during FY 1996-2000 to recover excess capital spending.
l22i
$995
~
.l22Z
1,400
l221l
2,005
l222
2,610
200Jl
3,315·
1996- 2000
$10,325
Revise the Disproportionate Share Hospital (DSH) Adjustment. Hospitals that treat a disproportionate share of low
income patients receive an additional payment. Studies show that the additional payment overcompensates for the
higher costs associated with treating low;.income Medicare patients. In the reformed system with uIliversal coverage,
DSH can be reduced. This proposal would replace the current DSH program with a new program as States come into
the new system. The new program would assist hospitals serving the .largest share of low-income patients.
Savings
1m
$430
l22Z
1,330
1m
3,670
l222
4,390
200Jl
4,810
1996- 2000
$14,630
�Moratorium on PPS-Exempt LonR-Term Care Hospitals. Long-term care hospitals, which have an average length of
stay of over 25 days, are currently exempt from the PPS system, receiving cost-based reimbursement from Medicare,
subject to a rate-of-iricrease limit. This proposal would pay new long-term care hospitals under the PPS system.
Alternatively, these hospitals could seek reclassification as psychiatric or rehabilitation hospitals, or become certified as
skilled nursing facilities (SNFs), for example, and be paid, under the SNF cost limit structure.
SavinI'S
l225
l22i
$20
40
122Z
70
1222
122a
100
2!lWl
170
130
1995- 2000
$530
.Extend OHRA 93 Provision; EliiiiinateCitCh-;;Upafte-r-SNF-Freeze-Expires,QBRA-93-established_a_two-y-=ea~r~fr=;;:;e.=;ez:=-,·e=-o.::::.:n~_ _ _ _ __
updates to the cost limits for skilled nursing facilities (SNFs). A ."catch-up," however, is allowed after the SNF freeze
expires on October 1, 1995; new cost limits would be established that do. not reflect the effects of the freeze. This proposal
would eliminate the IIca'tch-up" by recalculating the percent of the mean that would serve as the cost limit. The
recalculation would be calibrated to result in the same amount of savings as a continuation of the freeze.
I\J
SavinI'S
co
192.6
$80'
122Z
160
122a
180
l222
200
2OO.Q
210 .
1996 - 2000
$830
�Graduate Medical Education; Effect of National Pool. Under the legislation, Medicare would pay into two national
pools: one for direct medical education, and one for academic health centers. The projected Medicare spending for
direct and indirect medical education would be transferred to the Secretary for those States that have opted into the
reformed system; by 1998, all States will be folded into the new system. These funds will be transferred out of the Trust
Funds faster than they are cUIrently paid to hospitals. This will result in a slight cost to Medicare. The costs displayed
here are the cash flow effect for direct graduate medical education.
~
l22n
($30)
l22Z
(60)
l22.a
(150)
1222
200Q
1996 - 2000
(20)
(20)
($280)
(730)
($1,650)
Interaction Costs
PART A
($0)
INTERACTION
IV
\P
(110)
(300)
(510)
�PART A REVENUE PROPOSAL
Subject All State and Local Employees to Hospital Insurance Tax. State and local jurisdictions can opt to pay the ill
payroll tax for State and local workers hired before April 1, 1986, but are not required to do so. The proposal would
extend the payroll tax to all remaining exempt State and local workers, who would thus be treated like all other covered
workers. Additional revenues would exceed benefit payments for a long time, since 90% of retired State and local
workers already receive Medicare benefits through other covered jobs or spousal employment; only about 70%,
however, worked in State or local government jobs on which ill taxes were paid.
Sayingti
------------------~
$1,535
l22Z
f,s-r8
~
l222.
2.O!lll
1;470
1-,420
1,366
(Estimates for this proposal were calculated by Treasury Department staff.)
w
·0
1996:-2000
$2',309________________
�PART B PROPOSALS
Base MVPS on Real GOP Per Capita. This proposal would change the statutory formula that is used to determine the
Medicare Volume Performance Standard (MVPS), a target for the rate of growth in Medicare physician expenditures.
Currently, the MVPS is based on the average annual growth in tJ:te volume and intensity of physicians' services over
the preceding five fiscal years. This proposal would substitute the five-year average of growth in real GDP per capita for
this volume and intensity factor and the performance standard factor. This change would directly connect the MVPS to
the growth rate of the nation's economy. The MVPS for all three categories of physician services (surgical, primary care,
and all other) would continue to be adjusted for projected increases in physicians' fees, beneficiary enrollment, and
changes resulting from regulatory and legislative activity. The MVPS for primary care services would be given an
additional 1-112 percentage point upward adjustment. Under current law, there is no upper limit on physician fee
increases, but fees cannot decrease by more than five percentage points. This proposal would eliminate the floor on
physicianfeereducti~o~n~s~.--------~----------~~----~~--------~~------__________________________________
Savings
W
122.&
$0
122Z
l.22a
275
1,075
1222
1,975
~
1996-2000
2,775
$6,100
I-'
Establish Cumulative Growth Targets for Physician Services. Currently, the MVPS for each year is based on the prior
year's actual rate of growth in outlays, without regard to the prior year's target rate of growth in outlays. This process
weakens the ability of the MVPS to serve as a meaningful target for sustainable growth in Medicare physician spending.
Under this proposal, the MVPS for each category of physician services would be built upon a designated base-year
MVPS (FY 1995). This initial target would be updated annually for changes in beneficiary enrollment and inflation, but
not for actual outlay growth above or below the target. Essentially, physician fee changes in anyone year would no
longer distort the MVPS for the follOwing years. The annual process for calculating physician fee updates would not
change from current law.
Savinss
1996
$0
1997
(85)
122a
1,825
1222
2,475
2000
1,600
1996-2000
$5,815
�'\
Reduce the Medicare Fee Schedule Conversion Factor by 3% in 1995, Except Primary Care Services. The conversion
factor is a dollar amount that converts the fee schedule's relative value units (RVUs) into a payment amount for each
physician service. This proposal would reduce the conversion factor by 3% in CY 1995 to account for the excessively
high FY 1992 target and 1994 update that is anticipated, except that primary care services would not be reduced.
Savings
1m
l22.6.
122Z
122!l
1222
1D!m
1995-2000
$250
475
525
550
575
600
$2,975
Eliminate Formula-Driven Overpayment in Hospital Outpatient Departments. Under current law, Medicare pays for
hospital outpatient ambulatory surgery, radiology, and other diagnostic services using a blended payment methodology.
Because of a flaw in the statutory payment formula, which assumes a lower coinsurance payment than is actually made, .
hospitals receive more tllan the int~ded-payment-amount.-'fhis-proposaLwould_elimiDate the flaw in the Eayment
methodology and the resulting overpayment, effective July I, 1994. fu addition, the current payment method g::,-iv;:;::e=s=-------~
hospitals strong incentives to increase charges for these SErvices, t..'lus raisL'1g benefidary coinsurance liabilities. Fixing
the formula-driven overpayment would mitigate the hospital incentive to raise the charges to Medicare enrollees.
S~ing5
w
IV
1m
1226
l22Z
l22.a
1222
z.o.wl
1,050
l22i
. $150
1,300
1,690
2,190
2,750
3,480
199~
- 200Q
$12,610
Contract Competitively for All Part B Laboratory Services. The Secretary would be required to establish the same kind
of competitive acquisition system for Medicare laboratory services as for other selected Part B items and services
beginning January I, 1995. Pricing assumes that competitive contracting will reduce the price of laboratory services by
10%. Medicare laboratory payments currently are projected to grow by 15% to 18% per year. This proposal seeks to
curtail the growth rate by lowering the price of tests and reducing the profit incentive for physicians to order
unnecessary tests. H the competitive system does not result in a reduction of at least 10 percent in the price of all
laboratory services from the price that would otherwise occur in 1996, then the Secretary would reduce Medicare fees for
these selected services to achieve an overall 10 percent reduction in price.
Savings
l22S
l22.6.
122Z
1m
1222
lOOD
$140
220
260
290
320
360
1995 - 2000
$1,590
�Competitively Bid Selected Medicare Part B Items and Services. This proposal would require the HHS Secretary to
.
contract competitively for Medicare services and supplies, based on quality and other standards. The initially planned
items for competitive procurement are MRIs, CAT scans, oxygen services, and enteral nutrients. Pricing assumes a 10%
reduction in price for these services and supplies. H the competitive system does not result in a reduction of at least 10
percent in the price of these selected services from the price that would otherwise occur in 1996, then the Secretary
would reduce Medicare fees for these selected services to achieve an overall 10 percent reduction in price.
Savings
1995
w
1996
l.22Z
1998
l222
2000
1995- 2000
$110
190
210
240
270
300
$1,320
Income-Related Part B Premium. fuJly Phased-in to 75%. Currently, all Medicare enrollees pay the same Part B
premium, regardless of income. This-premium-is-set-at-approximately.: 25% of erogram costs, beginning in 1996; the
balance is paid by general revenues. This proposal would charge high-income enrollees a premium up to 75%of'----------~
program costs. The increase in the premium for si.'1g1e individuals would begin at modified adjusted gross incomes
(plus taxable Social Security benefits) of $90,000 and phase up to 75% for those individuals with incomes equal to or
above $105,000~ The increase for couples would begin at $115,000, with the maximum 75% premium being paid by
couples in which both are eligible for Medicare with a combined income of over $130,000.
C,;...
Sayings Uncludes interaction)
122n
1997
$350
935
·1999
985
1998
900
2000
1996 -2000
1,070
$4,240
Re-establish 20% Coinsurance for Laboratory Services. This proposal would re-establish a 20% coinsurance on all
physician office, outpatient, and independent laboratory tests under Medicare Part B, effective January 1, 1995. Congress
eliminated the required coinsurance on laboratory services for independent labs and those in hospital outpatient
departments in 1984. In 1985, Congress eliminated the coinsurance for physician office laboratory services. Clinical
laboratory services are the only services provided under Medicare Part B for which no coinsurance is now required.
Savings.
122.5.
122n
1997
122a
l222
2000
1995-2000
$650
1,070
1,230
1,380
1,540
1,720
$7,590
�,
Extend OBBA 93 Provision: 25% SMI Premium. OBRA 93 established the Part B premium collections at 25% of
program costs for 1996-1998. This proposal would extend the OBRA 93 provision requiring that Part B premium
collections cover an estimated 25% of program costs.
.
Savings
~
1996-2000
$6,080
l22Z
0
l22a
0
l222
~
1,770
4,310
Interaction ($710)
(1,090)
(2,140)
(2,770)
(3,180)
($9,890)
NET
(1,090)
(2,140)
(1,000)
1,130
($3,810)
$0
w
~
($710)
Limit Payments to High-CQst Medical Staffs. This proposal would establish limits on Medicare pnysiCian Ffayments-per----
inpatient hospital admission, similar to li.mits used i..~ ether parts of Medicare. The proposal would take effect in 1998.
Payment limits would be established based on the median of hospital-specific case-mix adjusted relative vaiue Wlits per
admission. For urban hospitals, the limit would be 125% of the national median in 1998 and 1999, and 120% in 2000
and" thereafter. For rural hospitals, the limit would be 140% of the national median in 1998 and thereafter. Annually, a
hospital-specific per admission relative value would be projected for the upcoming year for each hospital. This
projection would be adjusted for each hospital's teaching status and disproportionate share. At the beginning of each
year, Medicare would establish a 15% withhold for medical staffs projected to be over the national limit. After the end
of each year, Medicare would compare the actual RVUs per admission per hospital to the limit for that year. For
medical staffs above the limit, either none or only a portion of the withhold would be returned. For medical staffs
below the limit, the entire withhold would be returned.
Savings
"1m
$0
l22i
o
l22.'Z
o
l22a
500
l222
780
20rul
1,Q40
1996- 2000
$2,320
�Prohibition on Balance Billing. Physicians and other providers of Part B services are said to "accept assignment" on
Medicare claims when they accept the Medicare approved amount as payment in full for covered services. Balance
billing (also called extra-billing) occurs when providers charge more than the Medicare approved amount -- Medicare
pays 80% of the approved amount and the beneficiary or other payor (e.g., Medigap insurance) is responsible for paying
the balance. Balance-billing is prohibited under current law for most Part A and B services. Physicians may not charge
more than 15% over the Medicare approved amount fo~ their services, and only about 6% of all physician dollars are
billed on an unassigned basis. Elimination of balance-billing remaining in Medicare will make for consistent treatment
of all services within Medicare and between Medicare and the health alliance-approved plans serving the under-65
population. It will also reduce beneficiary confusion, enhance beneficiaries' financial protection, 'and simplify carrier
administration. This proposal will mandate assigrurient and prohibit all balance-billing by providers of Part B services
effective January 1, 1996. The costs from ~s proposal arise largely from elimination of the participating physician
payment differential.
122.&
($130)
Lv
U'I
1991
(250)
4990
1999
2QQQ
(260)
(270)
(290)
_.1
ft
1996-2000
($1,200)
�PARTS A AND B PROPOSALS
Extend OBRA 93 Provision: Eliminate Cakh-Up after Home Health Freeze Expires. OBRA 93 eliminated the inflation
adjustment to the home health limits for two years, FY 1994-1995. This proposal would eliminate the inflation "catch
up" - currently allowed after the freeze expires on July 1, 1996 -- by recalculating the percent of the mean that would
produce the same amount of savings as if the freeze continued. HCFA actuaries estimate this to be 100% of the mean.
Savings
Wi
$0
l22Z
1228
480
600
1222
650
1996- 2000
$2,420
2DWl
690
Lower Home,HeaIDtIJiiiitsto1UO%orMtrdrnn.Home-health-is-prejeeted-to-rise-o:v:er_10~Lo-,-a_y:ear through 1998,
including 33% growth in 1994. This proposal would lower the cost limits to 100% of the median for cost'-.::r:-=e=p=o=.;rt'!::in=-:g::--------
periods beginning on or after July 1, 1997. In other words, lv1edicare would rei.-rnburse home health agencies at a rate no
higher than the costs encountered by half of the agencies.
Sayings
w
C!\
1997
10
~
$0
1998
160
2000
250
1222
230
1996·2000
$650
Require a 10% Copayment on AU Home Health Visits for Visits other than Those Occurring 30 Days after a Hospital
Discharge. Home health is one Qf the fastest growing benefits in Medicare, with a projected increase in home health
outlays of nearly 33% in 1994. Medicare enrollees do not currently pay cost-sharing on home health care. This
provision would charge a copayment on all home health visits except those received within 30 days of an inpatient
hospital discharge; these visits are less discretionary and .more intensively rehabilitative. Enrollees who receive home
health without an inpatient stay would pay the 10% co payment on all services. The copayment would be equal to 10%
of the average cost per visit.
Savings
1225
$230
Wi
1,400
l22Z
1,560
1228
1,680
1222
1,800
2.Wl!l
1,920
1995 - 2000
$8,590
�Expand Centers of Excellence. HCFA has initiated two bundled payment demonstration projects that show potential for
Medicare savings. These projects involve contracting with "Centers of Excellence" that perform coronary artery bypass
graft (CABG) surgery and cataract surgery. By expanding this concept to all urban areas, contracting with individual
centers using a flat payment rate for all services associated with the cataract or CABG surgery, Medicare would be able to
reduce costs. The Secretary also would be granted the authority to designate other services that lend themselves to this
approach. Beneficiaries would not be required to receive services at these centers, but would be encouraged to do so
through rebates representing 10% of the government's savings from the center. Pricing assumes a 10% discount in the
price of services for the 20 percent of beneficiaries who are assumed to use the centers.
SaviDS:i
n ... ~A
... HI .. J.&
PartB
W
-.J
122.&
...
¢.~
~~
$40
122Z
~
70
70
1222
70
40
40
40
199'6-;-2000
2000
70
$340
40
$200
Extend OBRA 93 Provision: Medicare Secondary Payor (MSP) Data Match with SSA and IRS. OBRA 93 included an
extension of the data match between HCFA, IRS, and the Social Security Administration to identify the primary payors .
for Medicare enrollees with health coverage in addition to Medicare. This proposal would extend that provision
beyond its scheduled expiration date of 1998.
Savinss
1996
$0
l22Z
o
~
o
1222
195
2000
330
1996 - 2000
$525
�Establish a Threshold of 20 Employees for MSP for the Disabled. OBRA 93 extended through 1998 an OBRA 90
provision making Medicare the secondary payor for disabled enrollees with employer-based health insurance. The
provision is .applicable to all employers with 100 or more employees. This proposal would lower the employee
threshold from 100 to 20 employees beginning on January 1, 1998. With community rating under health care reform,
small employers will no longer be vulnerable to paying higher premiums for covering disabled or other high-risk
individuals. A separate provision in the Health Security Act addressing alliance enrollment of Medicare beneficiaries
who work or whose spouses work would e1imin~te the employee threshold. The provision would require all
.
employer-sponsored plans to cover workers, dependents of workers and workers' spouses who are eligible for Medicare.
Savings
1m
$0
l22Z
0-
1m
150
l222
240
~
260
1996 - 2000
$650------------
Extend OURA 93 Provision; MSP for Disabled. OBRA 93 extended through 1998 an OBRA 90 provision making
Medicare the secondary payor for disabled beneficiaries with employer-based health insurance. This proposal would
extend this provision permanently.
.
'-"
CD
Savings
1m
$0
l22Z
o
l22.a
o
l222
990
~
1,340
1996 - 2000
$2,330
Extend OURA 93 Provision; Medicare Secondary Payor Provisions for ESRD Patients. OBRA 93 extended through FY
1998 a provision that makes Medicare the secondary payor for individuals with end stage renal disease (ESRD) enrolled
in employer. group health plans for 18 months after they become eligible for Medicare benefits. This provision
permanently extends the MSP provision for individuals with ESRD. A separate provision in the Health Security Act
addressing alliance enrollment of Medicare beneficiaries who work or whose spouses work would provide for coverage
of individuals with end stage renal disease for as long as the individual requires care. The provision would require all
employer-sponsored plans to cover workers, dependents of workers and workers' spouses who are eligible for Medicare.
Savings
~
$0
l22Z
o
l22a
o
l222
75 .
2!lrul
105
1996 - 2000
$180
�HMO Payment Improvement. Medicare pays 95% of the average adjusted per capita cost (AAPCC) for Medicare
enrollees in Medicare-contracted HMOs. This proposal would establish a range around the Part A and Part B
components of the AAPCC that would presumably encourage HMOs to participate in Medicare while establishing
reasonable limits on reimbursement for high-cost counties. The ceiling would be 150% of the national average Part B
component of the AAPCC and 170% for the Part A component of the AAPCC, with a floor established at 80%. The
range would be phased-in over a four-year period, beginning in 1995.
Savings
l22.5.
l22.6.
90
- - -_ _ _ _ _$30
~
165
l22.2
~
250
.l.2.2Z .
350
400
1995 - 2000
. $1,285
TOTAL SAVINGS
w
o..D
l22J
l22.5.
$150
2,480
l22.6.
9,875
.l.2.2Z
14,373
1m
l22.2
~
22,815
33,000
41,721
1994-2000
$124,414
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ millions)
'-BUDGET CATEGORY
Department of Veterans Affairs: Third Party Receipts
BUDGET PROJECTIONS
lm..
Third Party Receipts
1996
1997
1228.
1222
2000
o
Fiscal Year
..;600
-1,700
-4,3nO
-~~500
=4~700
1995-2000
-15;800-------~
POLICY DESCRIPTION
.
.
Under refonn, VA will collect receipts from a variety of sources, including premium payments from Health Alliances.
J:>,
o
KEY TECHNICAL ASSUMPTIONS
The number of veterans currently using VA medical care will not change under reform. Receipt estimates are based
on average premium and copayments projected under health care reform that VA is expected to receive. Based on the
phase-in of health care reform, reimbursements are estimated at 15 percent in 1996,40 percent in 1997, and 100 percent
in 1998 and later years. Detailed VA data on current users relies on a 1987 survey.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ millions)
BUDGET CATEGORY
Department of Veterans Affairs: Reimbursement from Medicare
BUDGET PROJECTIONS
Fiscal Year
Medicare Collections
1995
1222
1221
1998
1999
2000
o
0
0
-225
-300
-300
1995-2000
-825,_ _ _ _ _ _ __
POLICY DESCRIPTION
~
Under reform, VA health plans will collect reimbursement from Medicare when VA care is provided to a Medicare eligible,
non-service connected, higher-income veteran.
KEY TECHNICAL ASSUMPTIONS
The number or'veterans currently using VA medical care will not change under reform. Medicare reimbursements .
to VA are equal to the average actual cost per Medicare beneficiary. Based on the phase-in of health care reform,
collections are estimated at 75 percent in 1998 and 100 percent in 1999. Detailed VA data on current users relies
on a 1987 survey.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ millions)
BUDGET CATEGORY
Veterans Health Care Investment Fund
BUDGET PROJECTIONS
Fiscal Year
Health Care Investment Fund
1995
1996
1997
1998
1m
2000
1,000
600
1~700
-0
0
0
POLICY DESCRIPI10N
These resources will help VA implement and operate under the President's national health care reform~
.t:.
1>-,
KEY TECHNICAL ASSUMPTIONS
nJa
1995-2000
3,300_ _ _ _ _ _ __
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ millions)
BUDGET CATEGORY
Department of Defense health care for dependents and retirees.
BUDGET PROJECTIONS
Fiscal Years
Budget-Gategory
1995
1996
1997
1998
1999
2000 1995-2000
0
-100
-200
-500
-500
-500
-1800
POliCY DESCRIPTION
.I:>
w
Assumes 000 pays all costs for dependents of active duty personnel, retirees and dependents of retirees who enroll in
the 000 medical plan. 000 will pay 80 percent of the premium cost for non-working beneficiaries who enroll in other
.health plans. Employers of 000 dependents and retirees are assumed to pay the normal employerpaymenl. This
.
payment will go to 000 for beneficiaries who choose a military plan.
KEY TECHNICAL ASSUMPTIONS
Average cost per capita for the 000 health plan was determined using data provided by RAND and the 000. We have
assumed that the same proportion of beneficiaries who choose the 000 system today will enroll in the 000 health plan
in the future.
During the transition, savings are estimated at 15 percent in 1996, 40 percent in 1997, and 100 percent in 1998 and later
years.
The cost estimates assume that in areas where there are no military facilities, 000 will use health alliance plans if
running DoD's own plan in those areas would be more costly.
.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ millions)
BUDGET CATEGORY
Savings to the Department of Defense resulting from Medicare paying DoD for care now provided by 000 to
eligible beneficiaries.
BUDGET PROJECTIONS
Fiscal Years
Budget Category BA
1995
~·99·6
1"997
o
-200
-500
1998 .
-t300
1-999
.... "''''
-1"'tUU
2000-1.995-20.0.0
-1400
-4800
POLICY DESCRIPTION
,tl.
,tl.
Beginning Oct. 1, 1995, 000 will be reimbursed by Medicare for care provided to Medicare eligible 000 beneficiaries
who choose 000 health plans.
'
KEY TECHNICAL ASSUMPTIONS
000 estimates that it will provide $1.268 billion in medical services to persons over age 65 in FY 1993. Medicare
estimates it pays 90 percent of costs. Payments are assumed to phase in at the rate of 15 % in FY 1996,40% in FY 1997
and 100% thereafter.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ millions)
BUDGET CATEGORY
Savings to the Department of Defense resulting from payments to DoD for health care of non-working retirees
between the age of 55 and 65.
BUDGET PROJECTIONS
Fiscal Years
1995 .
1-996
o·
U
Budget Category
t'\
1-991
1998.
1999
2000 1995-2000
o
-200
-300
-300
-800
POLICY DESCRIPTION
.I:>
U1
The Government will assume 80 percent of the cost of health care for non-working early retirees.
KEY TECHNICAL ASSUMPTIONS
DoD currently pays the cost of health care provided to its non-working retired beneficiaries. This estimate assumes that
DoD will continue paying twenty percent of the cost of the care. The funds shown are an estimate of 80 percent of the
cost of health care for non-working beneficiaries who would choose to use DoD health care under national reform.
The estimate assumes the same percentage of non-working retirees who choose DoD health care today would choose
DoD health care under national reform.
Payments are assumed to begin Jan. 1, 1998.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ billions)
BUDGET CATEGORY
Federal Employees Health -- coverage for Federal annuitants age 55-65. not yet medicare-eligible.
BUDGET PROJECTIONS
Fiscal Years
1995
0.0
~
1996
-0.0
1997
0.0
1998
-1.1
1999
-1.7
2000
-1.9
1995-00
-4.8*
POLICY DESCRIPTION
. Annuitants without Medicare coverage obtain coverage through the alliances. Annuitants in this group would be eligible
for a Government discount for the employer share of premiums. Savings above result from shifting the empioyer-shaie
of premiums away from the Government as an employer (from the OPM IIGovernment Payment for Annuitants" account)
and onto the broader Government early retiree discount program.
cr·
KEY TECHNICAL ASSUMPTIONS
-- After January 1998, Government. as an employer. makes no contributions to premiums for Federal annuitants in this
group until they become Medicare-eligible (Le., Government subsidy program pays 80% of the alliance premium and
Federal annuitants pay the remaining 20%).
-- Includes savings for non-Postal annuitants and the portion of savings for Postal Service annuitants attributable to
pre-1971 service (savings attributable to post-1971 creditable service would accrue to the U.S. Postal Service;
savings for pre-1971 creditable service would accrue to the Federal Government).
OUTSTANDING ISSUES
-- Cost sharing and benefit assumptions for supplemental plans.
-- Assumptions and costs during the transition period (1996 through 1997) for coverage and premium contributions for
Federal annuitants not currently covered by FEHBP. but who reside in states that become "participating states" prior
to January 1998.
"Row does not total due to rounding.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
.
(outlays in $ billions)
BUDGET CATEGORY
Federal Employees Health -- coverage for Federal annuitants age 65 or older, not Medicare-eligible*, or under age 55,
not yet Medicare-eligible. .
BUDGET PROJECTIONS
--~-Eis_c_al Years
1995.
0.0
1996
0:0
1997
6;0
1998
-0.-1
1999
2000
1995-00
-Q.2""---_ _
-0~._=__3_ _--------:-0=_=_:.6=___ _ _ _ _ _ _ __
POLICY DESCRIPTION
Annuitants without Medicare coverage obtain coverage through the alliances. The Fede·ral Government. as an
employer, makes a contribution toward premium costs .
.t>.
-..J
*In general, the group of annuitants age 65 or older, not Medicare-eligible, is comprised of Federal employees who
retired before January ·1, 1983 and did not have enough employment outside Government to qualify for Medicare.
KEY TECHNICAL ASSUMPTIONS
-- Annuitants under age 55 (not yet Medicare-eligible) or age 65 or older (not Medicare-eligible) are not eligible for the
Government subsidy program. An employer contribution for the alliance premiums would be paid out of the OPM
"Government Payment for Annuitants" account.
-- Includes savings for non-Postal annuitants and the portion of savings for Postal Service annuitants attributable to
pre-1971 service (savings attributable to post-1971 creditable service accrue to the U.S. Postal Servic'e; savings for
pre-1971 creditable service accrue to the Federal Government).
OUTSTANDING ISSUES
-- Cost sharing and benefit assumptions for supplemental plans.
-- Assumptions and costs during the transition period (1996 through 1997) for coverage and premium contributions for
Federal annuitants not currently covered by FEHBP, but who reside in states that become ·participating states n prior
to January 1998.
�BACKUP DOCUMENTATION
(savings negative. costs positive)
(outlays in $ billions)
BUDGET CATEGORY
Federal Employees Health -- coverage for Medicare-eligible Federal annuitants.
BUDGET PROJECTIONS
Fiscal Years
1995
-0.0
1996
-0.0
1997
-0.0
1998
-1.6
1999
-1.8
2000
-2.1
1995-00
-5.5
POLICY DESCRIPTION
Annuitants with Medicare obtain additionai coverage ihrough an OPM..administered supp!ementa! Medicare wrap-around
plan (Hmedigap"). The Federal Govemment, as an employer, makes a contribution toward the premium costs.
"'"
CD
.r
KEY TECHNICAL ASSUMPTIONS
-- Annual premium cost for comprehensive medigap (1994 preliminary estimate): $1,273 single; $2,545 family. .
-- Govemment pays an employer-share of the medigap premium of approximately 72% (the rate· in use today under
FEHB; paid via the OPM "Govemment Payment for Annuitants" account). Annuitants pay the remaining 28%.
(Note: because the Hmedigap" premiums are estimated to be much lower than current FEHBP premiums, annuitants
are still likely to be better off than they are today.)
-- All Medicare-eligible annuitants enroll in Medicare Parts A and B, and elect to be covered by the OPM medigap.
-- Assumes the same benefit levels for current and future annuitants.
-- Includes savings for non-Postal annuitants and the portion of savings for Postal Service annuitants attributable to
pre-1971 service (savings attributable to post-1971 creditable service accrue to the U.S. Postal Service; savings for
pre-1971 creditable service accrue to the Federal Govemment):
OUTSTANDING ISSUES
~- Assumptions and costs during the transition period (1996 through 1997) for coverage and premium contributions for
Federal annuitants not currently covered by FEHBP, but who reside in states that become "participating states" prior
to January 1998.
�BACKUP DOCUMENTATION
(savings negative. costs positive)
(outlays in $ billions)
BUDGET CATEGORY
Federal Employees Health -- Payments to Medicare
BUDGET PROJECTIONS
Fiscal Years
1995
. 0.0
01:>
\0
1996
0.0
1997
0.0
1998
0.1
1999
0.1
2000
0.1
1995-00
0.3
POLICY DESCRIPTION
Approximately 115,000 Medicare-eHgibie annuitants undei FEHBP have declined the optional Part B coverage available
from Medicare. Without FEHBP (or another insurer). these annuitants would lack insurance coverage for physician
services. Annuitants in this group who wanted to be covered by Part B after FEHBP terminated. would have to ·pay a
late enrollment penalty.' This policy assumes that the Government. as an employer, would pay the late enrollment
penalty amount on behalf of these annuitants.
KEY TECHNICAL ASSUMPTIONS
-- Average penalty is 10 years (based on each year the individual could have elected coverage but did not).
-- OPM would pay the late enrollment penalty amount on an annual basis. The payments would be funded out of the
. OPM "Government Payment for Annuitants" account.
-- Medicare has additional costs for benefit amounts incurred by these annuitants once they enroll in Part B. These
costs are absorbed by Medicare (they are not a liability for OPM). The increased costs to Medicare for the benefit
amounts are estimated at: 1994-1997: $0; 1998: $0.3; 1999: $0.3; 2000: $0.3.
-- Note: to the extent that annuitants without Part B coverage decided to elect coverage through the alliances rather
than through Medicare. the estimated penalty and benefit payment costs would be reduced.
OUTSTANDING ISSUES
-- Although for estimating purposes it was assumed OPM would pay the penalty amount on an annual basis. no .
decision has been made regarding whether the penalty would be paid annually or in a lump sum.
.
-- Cost sharing arrangements for the U.S. Postal Service and the Federal Government for penalty amounts for Postal
Service annuitants.
�50
�BACKUP DOCUMENTATION
BUDGET CATEGORY
Public Health Service
BUDGET PROJECTIONS:
(billions of dollars)
Fiscal Years
1996
1997
1998
1999
2000
Budget Authority
Tota! Outlays
U1
I-'
1995
1.1 .
0.4
3-:0
1.5
3:-8
2.6
4.2
3.3
~Ll
3.7
3.8
3.7
1995-2000
19.9
15.3:---------
Details of the Public Health Service initiatives planned as part of health reform are shown in the following tables in this section.
These budget estimates are presentec:t in terms of proposed Budget Authority. Actual outlays will differ somewhat from the BA
because of differences of timing. Total outlays for the PHS ~tiatives are shown above.
�-'
PUBLIC HEALTH SERVICE
H.fth Care Reform Budget
Public Hufth Initiative
(Dollar. In Million.)
FY 1995
FY 1996
FY 1997
FY 1998
FY 1999
FY2000
Six Year
Increment
lnaement
lnaement
Inaement
Ina.ment
Increment
Total
$100
200
0
$100
500
200
$100
Sublotal
300
800
$100
700
300
1,100
$100
500
300
900
$100
200
100
400
600
2.700
1.200
4,500
100
200
200
200
Sublotal
50
20
3
73
4
304
5
405
200
200
5
405
200
100
5
305
200
100
5
305
950
820
27
1,797
100
50
150
275
50
325
350
50
400
400
50
450
400
50
450
1,525
Subtotal
0
50
50
400
150
550
40
100
500
400
900
180
150
500
500
1,000
200
250
500
600
1,100
200
250
500
600
1,100
500
600
1,100
200
250
200
2,900
2,850
5,750
1.020
1.250
12
450
200
650
550
650
750
200
750
200
200
12
325
175
500
850
950
' 2.737
975
3,712
S1,125
S2,184
S3,13O
14,205
14,055
S3.8155
S1I.,854
:IO-Ncw·n
10:38 AM
Program/ACtivity
C.pllClt, Expanalon/Enabllng
Community/Migrant Health Centara
Capacity Expansion
Enabling Servldas
•
600
300
1,000
Workforce
NBuonai Health Service COrpl
Health Professions 1/
Academic Health Centers
V1
tv
SchooI-8aaed H....h
, School Related Health Services
School Health EducatJon
H....h R....roh lnitlatlv. .
Prevention Research (SectIon 3201)
Health Servic:8s Research (Section 3202)
Subtotal
Indian H. .lth Suppillmental Servloea
........ H. .Hh & Subatance Abua.
250
300
1.825
Public H. .lth Servloea
Core
0
Priority
Subtotal
TOTAL
DIlle: Jchn Hefti: HCRFUNOI,WQI
�SECURITY ACT
Public Health Initiatives
The President's Health Security Act includes a $20 billion initiative over the next 6 years to expand Public Health Service
activities that are essential to successful implementation. This initiative begins with $1.125 billion in FY 95, $2.98 billion in
FY 1996, grows to $4.2 billion in FY 1998, and levels off at $3.6 billion in FY 2000. The additional resources in FY 1995 and
FY 1996 represent an increase of 5 percent and 14 percent respectively over the resources available to PHS in appropriations bills
(conference action) for FY 1994.
Tnese PHS initiatives-are-centrai-to-achieving-the-prevention,aeeess,quality-,-and-cost-effectiv-eness_goals_artic,.,..u",la"",t",ed"'---!i",-,n--ct!±h~e,--_ _ _ _ _ _ _ __
President's plan. These initiatives, included in Title III and Title VIII of the Health Security Act, are divided into seven major
elements:
'
•
Workforce Priorities - A new national council on graduate medical education (GME) is established to allocate speciality
positions in a manner that: expands training capacity to support a shift to, training 55 percent of new physicians in primary
care; expands recruitment and financial assistance programs to increase the number of minority students in the health
professions; and supports expansion of priority nurse training initiatives including advanced practice nursing, faculty
development, school nurse training, and development of data systems. ([he AHC and GME funds established in the
Health Security Act are not included in PHS authorizations cited above but are a separate entitlement.)
•
Health Research Initiatives - are expanded to:
U1
Lv
Provide research on prevention and high-cost/debilitating diseases (e.g., Alzheimer's disease) and areas such as
children's health, breast cancer, and reproductive health and translate advancements into the health delivery system to
help control health care costs and improve the quality of life.
To accelerate health services research including quality measurement and improvement, efficiency, and effectiveness of
the health care delivery system.
•
Core Functions of Public Health Programs and Preventive Health - support for public health agencies and community-based
organizations to improve the health of populations and to control health care costs through:
�Core Public Health - to reduce preventable disease and disability and their attendant costs to the personal health
care delivery system by supporting states to strengthening their state and local health departments' capacity to·
carry out core public health functions that protect whole communities from infectious diseases, environmental
hazards, and preventable injury and provide population-based prevention education and community mobilization
regarding behavioral and environmental risks.
National Initiatives Regarding Preventive Health - to achieve measurable reductions in preventable disease,
disability, and death by supporting public and private non-profit agencies at the community level to address
priorities defined through the Healthy People 2000 process with community-based, innovative interventions
affecting special population groups and involving regional and state variations in level of need.
------··~--H:ealth-Ser_vices_IoLMedicallY_
Underserved Populations - Capacity expansion and enabling initiatives are essential to
ensure that underserved populations have access to the services to wfiicnfney are entided-under-the-Health-Security._ _ _ _ _ _ _ __
A
rl.l... l. Activities include support for:
_L
the development of practice networks and community-based health ·plans;
information systems and telecommunications linkages
acquisition, construction, or renovation of delivery sites; major equipment purchases; establishing financial
reserves; and other capital needs of health care providers;
expansion of Community and Migrant Health Centers (C/MHCs); and
the provision of outreach and enabling services to ensure that low-income, hard-to-reach, and culturally diverse
populations are able to use the health care system effectively.
expand from 1,600 to 8,000 by 2005 (when full· effects are felt) the number of National Health Service Corps
(NHSC) providers available to serve underserved populations;
lJl
01:=>.
•
Mental Health and Substance Abuse - support is expanded for wrap-around services for the most vulnerable
populations of our society, which includes over 2.5 million persons in poverty who are homeless, seriously mentally ill,
or diagnosed to have mental health and/or substance abuse problems.
•
Comprehensive School-related health activities - by IT 1999 provide health services for 3.2 million students in 3,500
scho!=>ls with a high proportion of low-income populations. Also, a $50 million health education program will be
implemented for children in grades Kindergarten through 12.
•
Indian Health - expand enabling services to help raise the health status of American Indian and Alaskan populations
to that of the rest of the United States population covered under the Health Security Act.
�HEALTH SECURITY ACT
Public Health Initiatives
(Dollars in Millions)
Title
m, Subtitle E - Health Services for Medically Underserved Populations
Part I - Community and Migrant Health Centers
FY 1995
$100
U1
U1
FY 1996
$100
FY 1997
$100
FY 1998
$100
FY 1999
$100
FY 2000
$100
FY 1995
FY 2000
$6UO
The Community and Migrant Health Center program is a successful program that currently provides a range of primary care, specialty
care, and enabling services to 6.8 million Americans living in Federally-designated underserved areas. Twice as many projects are
approved in this program than can currently be funded. An additional investment of $100 million annually over six years will expand
the reach of this program to an additional 2 million individuals, meeting 7% bf the current unmet capacity needs in underserved areas.
�HEALTH SECURITY ACT
Public Health Initiatives
(Dollars in Millions)
Title III, Subtitle E - Health Services for Medically Underserved Populations
Part 2 - Initiatives for Access to Health Care
Subparts A, B, and C
FY 1:::JFY 1~
IT 1997
$600
r
I
FY 1998
$700
I
I
FY 1999
$500
I
I
FY 2000
$200
I FY 1995-l
I
FY 2000·
$2,700
I
U1
<l'
This transitional program supports capacity expansion in underServed areas in ways that build on existing resources in each community
and that are responsive to local circumstances and needs. With a $2.7 billion investment over six years, the program will fully address
the estimated need for information systems and telecommunications (exclusive of highway costs) in underserved areas; provide all
federally-funded and other practitioners in underserved areas wit.h the skills and support they need to form practice networks or health
plans; meet most of the need for new practice sites in uriderserved areas; support renovations to improve the practice ehvironment for
3800 practitioners working in C/MHCs and other existing sites in underserved areas; and address much of the capital needs of rural
and public hospitals.
�HEALTH SECURITY ACT
Public Health Initiatives
(Dollars in Millions)
Title III, Subtitle E - Health Services for Medically Underserved Populations
Part 2 - Subpart D: Enabling Services
---.£Y 1995
$0
~
FY 1996
$200
FY 1997
$300
FY 1998
$300
FY 1999
$300
FY 2000
$100
FY 1995
FY 2000
$1,200
This program ensures that low-income, hard-to-reach, culturally diverse populations have access to the services to which they are entitled
under reform by providing them with the supplemental services they need to use the health care system effectively. With a $1.2 billion
investment over six years, the program will support the provision of transportation, translation, outreach, follow-up, and child-care
services to 6 million individuals not served by other programs.
�HEALTH SECURITY ACT
Public Health Initiatives
(Dollars in Millions)
Title III, Subtitle E - Health Services for Medically Underserved Populations
Part 3 - National Health Service Corps
FY 1995
$50
FY 1996
$iVO
FY 1997
$200
FY 1995..;
FVT998 -W-t999 -FY-200e--- --FY-2QQO-
$200
$200
$200
$950
...!1
~.
The National Health Service Corps assures the availability of physicians and other health professionals in severely underserved rural and
.urban communities. Of the 72 million Americans who live in underserved areas, 33 million currently lack a regular source of care.
The NHSC provides scholarships and repayment of student loans to health professionals who agree to serve at least two years in these
areas.
The NHSC would be expanded by increasing the number of NHSC scholarships and loan repayments from approximately 800 in 1994
to 1,800 in 1996 and to 2,800 in 1998 and subsequent years.
The NHSC field strength would grow from its level of 1,600 providers in 1993 to 5,300 providers serving over 8 million people in 199B.
NHSC field strength would plateau at about8,000 providers by the year 2005. Placements are prioritized by severity of need and these
providers would .serve the most difficult to reach one-third of underserved communities with providers distributed fairly evenly between
rural and urban sites ..
�HEALTH SECURITY ACT
Public Health Initiatives
(Dollars in Millions) .
Tide III, Subtide A - Workforce Priorities Under Federal Paytnents
Institutional Costs of Graduate Medical Education; Workforce Priorities
IT 1995
. $2()
U'1
IT 1996
$-2eO
IT 1997
$200
IT 1998
$.200
IT 1999
$200
IT 2000
$100
IT 1995
IT 2000
$820
The nation currently trains far too many physicians in specialties and too few in primary care. This distortion of the
workforce contributes to the high costs of care. There are also too few mid-level professionals trained and the workforce
lacks diversity to assure adequate access to care for all groups in the population.
I.D
In a new system with more limited specialty training, the number of new medical school graduates who choose primary care
training programs needs to increase from present levels of 4,000 per year to 9,000, or 55 percent of all new graduates.
Similarly, estimates indicate that the number of mid-level providers should increase from the current 2,500 per year to 5,000
per year. Finally, an estimated 23,000 minority students could benefit from expanded recruitment programs, with about
8,500 students in such programs now.
Funds support the transition of physician training to primary care by increasing Federal assistance for primary care programs
by 50%. These funds help meet the need for more graduates who choose primary care by supporting faculty and curricula
development and expansion of 2,500 additional positions. Mid-level providers will increase to about 4,000 graduates per ye~r
to meet 80 percent of the projected need. Minority recruitment programs will expand to reach about 12,500 students each
year, about 50% of the projected goal. Support for physician retraining programs will begin an effort to redirect physicians
currently trained as specialists into primary care. Expanded support will be provided for a range of nursing programs,
including school nurse training, geriatric nursing, development of innovative education and practice models, and other
priority nursing projects. Public health training support will also increase.
�HEALTH SECURITY ACT
Public Health Initiatives
(Dollars in Millions)
Title III, Subtitle B - Academic Health Centers
FY 1995
I--~
*
()"I
FY 1996
*~
FY 1997
---*
FY 1998
*~
FY 1999
~--*
FY 2000
FY 1995
FY 2000
*
*
The Health Security Act establishes formula payments to Academic Health Centers (AHCs) to assist eligible institutions with
costs incurred by virtue of their training function. These funds will help cover such costs as:
o
reduced rate of productivity of faculty due to teaching responsibilities;
uncompensated costs of clinical research; and
exceptional costs including treatment of rare diseases, treatment of unusually severe conditions, and providing
other specialized health care.
The President's Health Security Act contemplates stronger ties between academic health centers and providers in urban and
rural areas. The Act authorizes grants to assist academic health centers to establish referral networks and educational
~
alliances in such areas.
* A new Academic Health Center account is established (outside the PHS initiative) to fund
these activities as follows:
1996, $3,100 million; 1997 and 1998, $3,200 million; 1999, $3,700 million; and 2000, $3,800 million.
�.'
HEALTH SECURITY ACT
Public Health Initiatives
(Dollars in Millions)
Title III, Subtitle G - Comprehensive School Health EducatioD; School Related Health Services
Part 5 - School Related Health Services
'1":'"<1
.r I
11'\1'\<::
1 ::1::1;)
$0
I·,
'1":'"<1
.r I
1 I'\l'\e
1 ::1::10
$100
. '1":'"<1
r
I
1 1'\1'\"'t
1 ::1::11
$275
~r
r
I
11'\1'\0
1::1::10
$350
~r
r
I
1 r\r\1'\
1::1::1::1
$400
T:"\1 ,,,,,.,,-,
r
I
~uuu
$400
~. ~~~~-.
r
I
~uuu
II
$1,525
0'1
I-'
Only 500,000 children in America's middle and high schools have access to school based or school-linked clinics. Yet, according to a
1992 Department of Education survey, 5.4 million students age 10 - 19 in 9,411 middle and high schools with a high prevalence of
poverty and other risk factors (schools where at least thirty percent of the students are eligible for subsidized meals) are estimated to be
in need of these services. These young people, who frequently engage in high risk behaviors, experience multiple non-financial barriers
to health care. These barriers include reluctance to seek help, lack of parental availability, and lack of knowledge about what help may
be available and how to get it. This initiative will improve access to health and psycho-social services to up to 3.2 million children in
over 3,500 schools (priority will be given to schools with the highest percentage of children in need) by providing health services where
they spend most of their time. As a result of targeting services in high-need areas, there will be a reduction in the preventable morbidity
and mortality that children. and adolescents experience. Grants to states and local consortia will support the provision of services at sites .
throughout the country in areas of greatest need.
�HEALTH SECURITY ACT
Public Health Initiatives
(Dollars in Millions)
Title III, Subtitle G - Comprehensive School Health Education; School Related Health Services
Parts 2. 3 and 4
FY 1995
-FY-I-995 -FY-l-996 -"FY-1-991 -FY-l-998 -FY-l-999 -F¥-2DOO- I--FY-2()OO
$-50
'"
/I..)
$50
$50
$50
$50
$50
$300
The health problems that plague our children and adolescents, and the adults they become, are caused primarily by behavioral patterns
usually established during youth. Research has shown that initiation of these behaviors can be delayed, reduced, or prevented through
school based. health education programs. Yet U.8. Department of Education data show only 12 percent of 10th graders and 2 percent
each of 11 th and 12th graders received any health education credits in school. This initiative will provide grants to every state as well as
20 of the largest Local Education Agencies to enable them to implement comprehensive school health education programs. It contains
waiver authority to leverage existing health education monies. State education and health agencies will be expected to collaborate in
developing plans targeted to students at highest risk while integrating new funding with_ existing categorical funding to provide
comprehensive health education services.
.
�HEALTH SECURITY ACT
Public Health Initiatives
(Dollars in Millions)
Title III, Subtitle C: Health Research Initiatives
Prevention Research
FY 1995
$400
Cl"I
W
FY 1996
$500
FY 1997
$500
FY 1998
$500
FY 1999
$SU-O
FY 2000
$5-00
FY 1995
FY 2000.
$2;900
Prevention research is the foundation for clinical preventive services and public health interventions which are integral components of
efforts to reduce the burden of avoidable disease, disability, and death. A renewed emphasis on prevention research is necessary to
ensure the availability of effective preventive measures against existing diseases, as well as new and emerging threats to the health of
Americans. Progress in preventing disease will help to offset escalating acute health care costs and the disproportionate impact of disease
and disability among women, minorities, and the elderly.
NIH is the Federal Government's lead agency for biomedical and behavioral research and has the expertise to plan, coordinate, and
implement a prevention research agenda to support health care reform. Prevention research findings will be translated into, or
appropriately integrated with personal health services and public health programs to maximize th~ impact of prevention research on
disease reduction and improved health status.
. The Prevention Initiative will contribute to more effective and efficient measures to prevent the onset of diseases and disabilities that now
affect tens of millions of Americans. For example, delaying the onset of Alzheimer's disease by an average of five years would cut in half
the costs associated with this disease, currently estimated at $90 billion annually.
�HEALTH SECURITY ACT
Public Health Initiatives
(Dollars in Millions)
Tide III, Subtide C: Health Research Initiatives
Health Services Research
FY 1995
I FY-I"995- -F¥-1-996- -F¥-l-99i- c-F'Y-1-998- -"14'-1-999- -W-2000--,- --EY-2000--11
I
~
.
$150
I
$400
I
$500
I
$600
I
"$600 ,
$601) , .
$2,850 I!
1
The DHHS supports a broad based program of investigator-initiated and directed research on cost, quality and access issues in health
care delivery. This research will inform practitioners, managers, purchasers, providers, and consumers under the Health Security Act.
The basic principle underlying the President's Health Security Act is that we can provide better quali!J of care to more people at less cost.
To support the achievement of these objectives, DHHS will expand its research program to: 1) develop the science base on what works
best in medical care to identify practice variations with unnecessarily high costs and no added clinical benefit; 2) develop quality and
performance measures and related information to assist consumers, practitioners, and plans in making good health care decisions; 3)
significantly expand medical effectiveness· research and practice guidelines development, dissemination and evaluation to improve the
treatment decisions made by physicians, thereby contributing to cost-containment by reducing unnecessary care; 4) desigri and test
clinical arid administrative data systems and technologies to expedite administrative simplification and lower administrative costs; 5)
investigate and assess the organizational, clinical, and financial alternatives adopted by states during initial reform to refine and improve
subsequent implementation; 6) develop approaches for improving the efficiency and equity of reimbursement and provider payment
systems; arid 7) determine the impact of improved primary care on access to c~re.
�HEALTH SECURITY ACT
Public Health Initiatives
(Dollars in Millions)
Title VIII, Subtitle D - Indian Health Service
,
IT 1995
$40
0'1
V1
IT 1996
$T80
IT 1997
$200
IT 1998
$200
IT 1999
$200
IT 2000
$200
IT 1995
IT 2000
$"1,020
The IHS provides comprehensive medical and public health services to the 1.3 million American Indians living on reservations.
American Indians have among the poorest health status of all Americans: 40%reduction in years of productive life; tuberculosis rate 6
times higher than other Americans; and infant mortality 1.5 times higher than whites. Isolated living conditions, poverty, lack of .
available public health services, and inadequate access to care all contribute to poorer health status.
Historic legal and ethical obligations require that the Federal Government provide health care and public health services to American
Indians and Alaskan Natives. These obligations continue under the Health Security Act. But, health insurance alone will not improve
the health of American Indians. Given existing resources only 45% of American Indians receive the necessary personal, community and
environmental-based public health services. Only about half of American Indians receive necessary enabling services such as outreach,
transportation and translation services.
Additional funding will improve the health status of American Indians to a level closer to other Americans. Funds will increase enabling
services by 2.7 million additional home and other visits, one-half million nursing visits and additional transportation and interpretive
services to an additional 240,000 American Indians by IT 1998. Improved services will be targeter! to lower rates of diabetes,
alcoholism, injuries, and to improve immunization coverage.
�HEALTH SECURITY ACT
Public Health Initiatives
(Dollars in Millions)
Tide III, Subtide F - Mental Health; Substance Abuse
r-F\"-l-995 -EY-t996_ ---.EY 1997
I
.~
$100
I
$150
$250 _I
FY 1998
$250
FY 1999
I
$250
FY 1995
FY 2000
FY 2000
I
$250
I
$1,250
I
While health insurance will cover most direct acute mental health and substance abuse treatment costs, it will not ensure access to
services. Research clearly shows that enabling services, such as outreach, transportation, child care and translation services are necessary
to get persons with serious substance abuse and chronic mental health conditions into treatment. Beneficiaries will include over 2.5
million persons in poverty who are homeless, seriously mentally ill, or diagnosed to have both mental health and substance abuse
problems. This would meet approximately one-quarter of the need nationwide. Funds would be distributed to States using the existing
formula for mental health and substance abuse block grants.
�HEALTH SECURITY ACT
Public Health Initiatives
(Dollars in Millions)
Title III, Subtitle D - Core Functions of Public Health PrograDls;
National Initiatives Regarding Preventive Health
Part 2 - Core Functions of Public Health Programs
FY 1995
$12
0'1
-...J
FY 1996
$325
FY 1997
$450
FY 1998
$550
FY 1999
$650
FY 2000
iI!'.,,,n
.jlIIJU
FY 1995
--YY-2000
$2,737
The Health Security Act cannot meet its national cost containment targets if full advantage is not taken of opportunities to prevent
. unnecessary disease--opportunities largely accessible through public health programs. These functions are necessary to protect whole
communities from infectious diseases, environmental hazards, and preventable injury and to provide population-based prevention
education and community mobilization regarding behavioral and environmental health risks. Yet the resources available to support the
core functions of public health are only about half the level necessary to meet basic responsibilities. Between 1981 and 1993, support for
the basic public health functions fell from 1.2% to 0.9% of national health care expenditures. Concurrently, additional demands were
imposed on public health agencies by problems such as HIV infection, childhood vaccine-preventable diseases, tuberculosis, violence,
and the health and social service needs of young, single mothers amI their children. There is a vital need to assist state and local health
agencies to rebuild and strengthen their capacity to carry out their basic responsibilities for population-based programs, which have the
potential to prevent diseases that otherwise drive up personal health care service utilization and cost billions of dollars to treat. Through
this grant program, the Health Security Act will support states and communities to meet approximately 8% of estimated need to repair
the eroded infrastructure by the year 2000. The returns to this program in terms of cost savings from reduced disease incidence--even
using conservative assumptions--will substantially exceed the investment.
�HEALTH SECURITY ACT
Public Health Initiatives
(Dollars in Millions)
Title III, Subtitle D - Core Functions of Public Health Programs;
National Initiatives Regarding Preventive Health
Part 3 - National Initiatives Regarding Health Promotion and Disease Prevention
FY 1995
$0
g;
FY 1997
FY 1996
I
$175
I
$200
FY 1998
I
$200
FY 1999
I
$200
FY 1995
FY 2000
FY 2000
I
$200
I
$975
I
Prevention opportunities related to behavioral risks, physical and social environment, and appropriate use of clinical preventive services
have been defined and quantified in the national prevention agenda contained in Heal~ People 2000. Through community-based
prevention approaches, it is possible to dramatically reduce premature mortality and chronic disease and disability. The need is to
support public and not-for-profit agencies in devising approaches that mobilize communities to improve health of whole populations,
thus effecting savings to the overall health care system. A competitive grants program will support large-scale, multi-site community
based prevention innovations, with findings from these projects disseminated through public health information networks to other
communities across the Nation. Examples of priorities of this program and prevention of the initiation of Smoking by Children and
Youth, prevention and violence, and reduction of behavioral risks contributing to chronic diseases such as heart disease, cancer, stroke,
and adult-onset diabetes.
�Public Health Service Off-sets
Many current Public Health Service (PHS) programs provide 'gap·filler' health services to uninsured individuals.
Some PHS programs provide direct health services to selected uninsured populations, while others support disease
specific or treatment-specific medical services. For example, PHS grants support State immunization programs.
The Health Security Act assurance of universal coverage and a comprehensive benefits package directly addresses
many of the 'gaps' that PHS fills. The services currentiy provided piece=meal through public health programs will be
covered uniformly under the comprehensive benefits package, such as immunizations. Preventive, mental health
and substance abuse services, and many disease-specific services, are covered under the benefits package.
:I;
As health reform progresses, there will be an opportunity to redirect PHS resources to higher priority programs.
PHS Off-sets
(outlays in $ billions)
FY95
Offset/Redirection
Ot
FY96
0.0
(0.3)
EnZ
(0.9)
FY98
FY99
fl:W!
FY95-00
(1.8)
(2.4)
(2.6)
(8.0)
�BUDGET CATEGORY
Special Supplemental Food Program for Women, Infants, and Children(WIC)
BUDGETPROJECl10NS
Fiscal Years
Increase in regular
appropriations
Special fund
-------Total
(OUTLAYS IN BILUONS)
.l222
1996
!22Z
l228
1222
2000
2001
0
.2
.2
.5·
.2
.4
.6
.2
.4
.6
.3
.4
.3
.3
.4
.7
0.
0
:Z.
.4
.7
"Totai does not add due to rounding.
POUCY DFSCRJPTION
--..I
o
The Special Supplemental Food Program for Women, Infants, and Children (WIC) has been proven to play it key
role in health promotion by providing nutritional supplements to pregnant women and young children. WIC
services to pregnant women have been found to reduce medical costs the first 60 days after birth. WIC also increases
micronutrient intake among infants and children, thus reducing conditions such as iron deficiency anemia. Fully
funding WIC is a strong priority of the President's and builds on our commitment to preventative and primary care.
The bill seeks to guarantee full funding for WIC by the end of FY 1996 by creating a special fund to supplement
annual appropriations. The amounts in the fund will automatically become available for WIC if appropriations bills
. include the amounts shown in the first line in the table below.
.
FYt996
FYt99'
FYt998·
FYt999
FY2000
(BA in millions)
Regular appropriation HCR anticipates 3,660
254
Special fund
3,759
407
.3~1
384
3,996
398
4,136
411
3,914
4,166
4,245
4,394
4,547
Full funding level
�KEYTEOINICAL ASSUMPrIONS
~e
-.J
1-'
cost estimate for the WIC provision in the bill is the difference between current services and full funding.
�BACKUP DOCUMENTATION·
(savings negative, costs positive)
(Outlays in $ billions)
BUDGET CATEGORY
Academic Health Centers and Graduate Medical Education
BUDGET PROJECTIONS
FY
1995
1996
1997
1998
2000
'95-00
Gross
5.93
6.3
6.75
8.0
9.5
9.6
46.08
Medicare
Offset
-5.9
-3.6
-3.6
-3.6
-4.0
-3.9
-24.6
Net New Spending
0.03
2.7
3.15
4.4
5.5
5.7
·1999
.......
·N
21.48
POLICY DESCRIPTION
The "Gross" spending line represents the policy commitment to Academic Health Centers and Graduate Medical
Education support for physicians, nurses, and other health professionals. The Medicare. Offset represents proposed
law IME and current law DME payments for physicians (DME for nonphysicians is assumed to continue to flow to
Academi~ Health Centers).
KEY TECHNICAL ASSUMPTIONS .
The projections of IME/DME dollars are made by OACT consistent with their appraisal of overall health reform and
the Medicare savings package in general.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outla ys in $ millions)
BUDGET CATEGORY
Program for Poverty-Level Children with Special Needs
BUDGET PROJECTIONS
""'lI
.bJ
1995
1996
1997
1998
1999
2000
1995-2000
o
Fiscal Years
264
869
2,453
3,025
3,157
9,768
POLICY DESCRIPTION
A new Federally-funded program will provide certain medically necessary and appropriate items and services (that are
not in the comprehensive benefit package and are not Medicaid long-term care services) to qualified low-income
children.
KEY TECHNICAL ASSUMPTIONS
The estimate assumes that Federal expenditures would be limited to total (Federal and State) Medicaid spending for
these services in FY 1993 in participating States, trended forward through the year of implementation for each State by
the appropriate growth rates in §9003 (a). Thereafter, the annual Federal expenditure limit is trended forward by the
growth rates in §9003 (b).
�lhis estimate includes administrative costs, which are not explicitly accounted for inthe legislation.
The estimate also differs from the legislation in the calculation of the annual Federal expenditure limit: (1) The
estimate trends FY1993 expenditures for wrap-around services by projected spending growth for these services for
children; (2) §1934 (d) (2) (A) (i) requires that FY1993 spending also be adjusted to take into account annual increases or
decreases in the number of qualified children; (3) the legislation requires that FY93 spending for these wrap-around
services be trended forward according to a schedule that does not take into account when States become participating
States. lhis estimate applies the trend factors noted in §9003 (b) for spending in each State in the year following the
----Y-ear-in_wbich it becomes a p-articiL-p_atin_· g,..,_St_a_te_._ _ _ _ _ _ _---:-_ _ _ _ _ _ _ _ _ _ _ _ _ _ _-.:.._ _ _ _ _ _ _ __
----'
-.....l
""
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ millions)
BUDGET CATEGORY
Long-term care: New Federal spending for community-based program
BUDGET PROJECTIONS'
Fiscal Years
community LTC program
~
19'95
1996
1997
1998
1999
o
4,500
7,800
11,000
14,700
2000--1-9-9s,,2000
18,700
56,700
POLICY DESCRIPTION
The new community-based LTC program is a capped entitlement to States to finance community-based care
for the severely disabled (Le., disability with at least 3 ADLs). The program is not means-tested but includes an
income-scaled coinsurance schedule. The Federal matching rate for the program is approximately 28% higher than
current Medicaid FMAP in each State.
KEY TECHNICAL ASSUMPTIONS
Estimates are from ASPE/Lewin-VHI long-term care model, the key components of which are outlined in the attached
document. Figures reflect phased-in funding of total program costs according to the following schedule: 20% in 1996,
30% in 1997, 40% in 1998, 50% in 1999,60% in 2000,80% in 2001, and 100% in 2002. Thereafter, the capped amounts
are trended forward by CPI and the percentage change in the severely disabled population. Absolute capped amounts are
derived from the following assumptions (per Lewin-VHI): 3.1 million individuals are eligible for the program;
80% of eligibles participate in the program; elderly participants receive approximately 120 visits per year; physically
disabled adults and children receive approximately 122 visits per year; mentally retarded participants receive
care 365 days per year. Costs per visit are assumed to be $56 for elderly and physically disabled patients, $85
for mentally retarded (in 1993 dollars). Per ASPE, the capped amounts now include the Federal share of
�administrative costs. No Medicaid offset dollars are included in these capped amounts.
--.J
0'1
�KEY COMPONENTS OF HC)ME AND COMMUNITY-BASED CARE PROPOSAL
NUMBER OF ELIGIBLES
1993 estimates in
1
thousa~ds
total -- 3,090
children --150
adult physi~al -- 420
MAIDO -- 270
I
elderly -- 2,' 50
The estimates are based on a number of different data sources used for
different age groups in an attempt to use the best available data source.
• Children -- For perpons under age 18, both the 1989 National Health Interview
Survey (NHIS) and the '1987 National Medical Expenditure Survey (NMES)
were used to estirrlate the number of children with at least three of five AOLs .
• . Working-Age AdulJs -- For persons age 18 to 64, the 1990 Survey of Income
and Program Partipipation (SIPP) was relied upon to estimate the number of
persons who required h,elp with at least three of five AOLs. SIPP was also
used to estimate t~e number of persons who have severe or profound mental
retardation or dev~lopmental disabilities (MAlOO). Because SIPP does not
have data on levels of MA/OO. we used data from Charles Lakin at the
University of Minn~sota to estimate the total number of community-dwelling
persons with severe or profound MAIDD (approximately 220,000 in 1990).
• Elderly -- The 198h National' Long Term Care Survey (NLTCS) was used to
estimate the numtier of elderly who would be eligible. The NLTeS provides a
large sample of el~erly Medicare beneficiaries with disabilities that have or are
expected to last a~ least three months. The data were used to estimate the
number of person~ with at least three of five ADLs or a similar level of cognitive
impairment. A sirrlilar IBvel of cognitive impairment was defined as: 1) missing
four of ten questiohs on the Short Portable Mini-Mental Status Questionnaire
(SPMSQ); and 2) bemonstrating one of the following: disability in at least one of
. the cognitive Inst~mental Activities of Daily Living (IADLs) of medication
management, mo~ey management, or telephoning; evidence of a behavior
problem; or disability in one or more ADLs.
77
�PARTICIPATION RATE
CURRENT LAW PROGRAMS AFTER REFORM
Medicare - assuied unchanged
Other Federal So~rces (OAA & VA) -- assumed unchanged
State Supported
.
.
~rograms -
ex~nditures
estimated for severely disabled are incorporated
into match rate on an aggregate basis
~
$1. billion current law state-only spending in 1993 for the
elig'ible population has been distributed among the states .
acdording to the estimated distribution of MRIDD state-only
spinding by state
.
state spEmding for other populations assumed to remain
I
unchanged
.
Medicaid -
I
In 1993. we estimate $7.1 billion for Medicaid home and
co munity-based care expenditures; this is less than HCFA
act aries $8.8 billion and more than the annualized first three
78
�Qua1ers of HCFA 64 data at $6.5 billion
.
.
One]half of current Medicaid home a~d community-based care
spending ($3.55 billion) is assumed to be for persons eligible for
the ~rogram.
The bstimate of one-half of current Medicaid home and
com~unitY-baSed care expenditures for the eligible population is
based on NMESdata and HCFA form 64 and 372 data. For
Ho~e Health, Personal Care. and Home and Community-Based
Waiyers, the distribution among all elder1y, adult disabled and
children who are Medicaid home and community-based care
recitients and the subset that would be eligible for the program
is b sed on 1987 NMES data .. These data indicate that
app oximately 50 percent of Medicaid expenditures are for those
me~ting the severely disabled criteria. The split between MRIDD
Medicaid Home and Community-Based Waiver recipients and
oth~rs is Ibased on a Congressional Research Service paper by
Ric~lard Price ("Medicaid Home and Community-Based Care
.
. Pro ram," 92-902 EPW). This report indicated that
app oximately 65 percent of Home and Community-Based Care
Waiyer e)(penditures in 1991 were for persons with MRIDD.
Based on data from the 1987 NMES Institutional sample for
resi~ents of small (beds less than 16) MR facilities, we assumed
thatl47 pl3rcent of these expenditures were for persons with
sev~re or profound MRIDD (those eligible for the program).
I
79
�BACKUP DOCUMENTATION
. (savings negative, costs positive)
(outlays in $ billionS)
BUDGET CATEGORY
Net Federal Discount Payments to Alliances (Capped Entitlement)
BUDGET PROJECTIONS
EY
1995
1996
1997
1998
1999
2000
'95-00
Gross Discounts
0
12.8
35.7
96.3
100.6
103.6
349.0
State Maintenance
of Effort
0
-2.5
-7.4
-20.6
-21.7
-22.6
-74.9
Net Discounts
0
10.3
28.3
75.7
78.9
81.0
274.1
00
0
POLICY DESCRIPTION
Although all Americans will be asked to contribute to the cost of their health care, there are some groups that will not
'be able to meet their full contribution: low income families, individuals who have lost their jobs, and small businesses..
Low income households and all firms in regional alliances are eligible for premium discounts. Low income
households without access to low cost-:-sharing plans are also eligible for discounts on their out-of-pocket expenses.
There are special discounts for early retirees as well. No firm in the regional alliance will pay more than 7.9% of
payroll, and small, low-wage firms will pay less, according to a, specified schedule. These numbers also reflect a direct
grant program for state and local governments as employers ($2B over the period). State maintenance of effort
. payments (detailed documentation follows this page) to alliances offset Federal discowlt payments. The Federal
liability is capped at the Net Discounts amount, to ensure fiscal responsibility.
�Discount eligibility summary:
20% share:
out-of-pocket:
households with AGI less than 150% of poverty, no household pays more than 3.9%
of AGI for this portion;
households with less than at least one full-time worker which have AGI - wages
unemployment compensation + tax exempt interest less than 250% of poverty;
households with AGI less than 150% of poverty without access to an HMO;
7.9% payroll cap:
all firms in the regional alliance;
80% share:
-----~-small-firm-schedule:
ftr-ms-w-ith-fewer--tJ.:\aR-~S-empl().yees--and ..a\':e[age-wages~ess_than_$24,OO=0,-,--._Th",-"-",e~se",,,l,,-f-_ _ _ _ __
employed are treated as a firm of size one for the 80% share.
KEY TECHNICAL ASSUMPTIONS
00
,.....
Discount estimates came from a collaborative estimation process involving HCFA/OACT, AHCPR, Treasury, and the
Urban Institute models. The actual numbers used were from the HCFA/OACT model. An additional 15%
contingency was added to the point estimate of the premium discounts. This 15% is an allowance or "cushion" to
cover potential behavioral responses that are difficult to model.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ millions)
BUDGET CATEGORY
Medicaid: State maintenance-of-effort payments to alliances.
BUDGET PROJECTIONS
OJ
I\.l
Fiscal Years
Non-DSH
Alliance-covered services
State share of new wrap-around
program
Less ER svcs for undocumented
persons
DSH
TOTAL
1995
1996
1997
1998
1999
2000
1995--2000
~1,890
-70
-5,570
-230
.,.15,590
-640
-16,270
-790
-16,970
-820
-56,290
-2,550
·70
180
470
490
510
1,720
-630
-2,520
-1,800
-7,420
-4,880
-20,640
-5,100
-21,670
-5,320
-22,600
-17,730
-74,850
POLICY DESCRIPTION
Each State contributes a maintenance-of-effort (MOE) payment to alliances that is equal to the level previously spent
for services in the standard benefit package for non-cash Medicaid recipients and for wrap-around services for
children who receive AFOC or SSI benefits. Medicaid will continue to provide emergency services to undocumented
persons and current State spending for these services is netted out of the MOE computation.
KEY TECHNICAL ASSUMPTIONS
State phase-in schedule assumes States with 15% of Medicaid spending implement 10/1/95; States
with 25% implement 10/1/96; and States with the remaining 60% of spending implement 10/1/97.
�KEY TECHNICAL ASSUMPTIONS (cont.)
The State contribution is based on the State share of spending for non-cash recipients (comprehensive benefits package
only); cash children (wrap-around services only); and DSH spending attributable to non-cash recipients in FY 93,
trended forward according to national projected growth rates for Medicaid through the first year of implementation.
Projected annual growth rates will be those included in §9003 of the Health Security Act. Following the
first year of implementation, the MOE is trended forward according to the 1 + general health care
inflation factor (§6001) multiplied by 1 + the annual percentage increase in the U.S. population that is under age 65.
States assumed to phase-in on fiscal year basis.
.
en
eN
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in$ millions)
BUDGET CATEGORY
Information Systems and Quality Assurance
. ADMINISTRATIVE COST BUDGET PROJECTIONS
FY 1995
Estimated Cost
to,
"'"
FY 1996
FY 1997
FY 1998
891
248
248
250
FY 1999 FY 2000
250
Total FY95-00
260
2,147
POLICY DESCRIPTION
The Health Security Act specifies that the Federal government would help develop and maintain the new health infonnation
systems and would perform quality assurance activities in the new system.
KEY TECHNICAL ASSUMPTIONS
The estimate includes pricing for the following major administrative functions: support of information systems, support of the National
Quality Management Program, and technical assistance to alliances, plans and states. The estimate assumes that, in addition to new
resources, existing resources could be used to help support the quality assurance and information collection activities of the National
Quality Management Program.
�BACKUP DOCUMENTATION
(savings negative, cqsts positive)
(outlays in $ millions)
BUDGET CATEGORY
Monitoring of Alliances and States
ADMINISTRATIVE COST BUDGET PROJECTIONS
FY 1995
Estimated Cost
FY 1996
63
120
EX 1997 EX 1998 FY 1999 FY 2000
205
240
250
262
Total FY95-00
1,140
POLICY DESCRIPTION
00
U1
The Health Security Act specifies that the Federal government would be responsible for overseeing certain state and alliance
functions. Major monitoring activities would include: overseeing the financial operations of alliances, ensuring that plans
and alliances adhere to applicable regulatory requirements, and overseeing the premium targets.
KEY TECHNICAL ASSUMPTIONS
The estimate assumes a number of Federal auditing functions, and includes costs associated with the hiring and contracting of auditors
needed to carry out these activities.
.
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ millions)
BUDGET CATEGORY
Program Oversight and Financial Management
ADMINISTRATIVE COST BUDGET PROJECTIONS
------------------~------------~F¥~-199~~~FY'9%_~-~~i~--FYl~~
Estimated Cost
301
218
242
293
300
FYWOO·
I~9~~~1~EY~-~9S~~~Ot-----------
300
POLICY DESCRIPTION
~
As reflected in the Health Security Act, the Federal government would be responsible for developing rules/standards for the new
system, and managing existing Federal programs within the new system.
KEY TECHNICAL ASSUMPTIONS·
The estimate includes several oversight functions of the National Health Board, including: updating the comprehensive
~nefits package, monitoring new drug prices for consumers, development of enrollment rules for plans, monitoring of alliance
grievance procedures, development and management of a risk adjustment factor for premiums in the alliances. The estimate also
includes the cost of Federal support for antitrust reform, and fraud and abuse activities.
1 .e;C:;:A
.L,V"""'-X
�BACKUP DOCUMENTATION
(savings negative, costs positive)
(outlays in $ millions)
BUDGET CATEGORY
Transition to the New System
ADMINISTRATIVE COST BUDGET PROJECTIONS
FY 1995
Estimated Cost
~
FY 1996
FY 1997
FY 1998
419
360
393
783
FY 1999 FY 2000
39
Total FY95-00
39
2,033
POLICY DESCRIPTION
As reflected in the Health Security Act, the Federal government would be responsible for helping states make the transition to
the new sytem. The Federal government would help administer planning and implementation grants, issue standards, provide
technical assistance and approve state plans.. The Federal government would also administer a national risk pool for the uninsured
during the period before universal coverage fully phased-in.
KEY TECHNICAL ASSUMPTIONS
The estimate reflects the costs of organizing and maintaining a new National Transitional Health Insurance Risk Pool for uninsured
individuals. The cost of administering the risk pool would phase-down as universal coverage is phased-in. The estimate also reflects the
administrative costs of processing approvals of state plans and waivers for states opting to implement single payer systems; as well as the
cost of state planning and start up grants. '
�,
AAPCC
ADL
AFDC
AHCPR
ASPE
CABG
CBO
CEA
ClMHC
CPI·U
CY
DME
DoD
DSH
ESRD
FEHBP
FMAP
FY
GDP
GME
HCFA
HCR
HHS
HI
HIV
HMO
IADL
ICF/MR
IME
LTC
MOE
MRIDD
MRI
MSP
,MVPS
NHSC
NLTCS
NMES
OACT
OBRA
OMB
OPM
PHS
PNA
QMBs
QDWI
PPS
RVS
RVU
SIPP
,Glossary of Acronyms
Average Adiustt Per Capita Cost
Activities of Daily Living
,
Aid to Families Iwith Dependent Children
Agency for Health Care Policy and Research
Assistan t Secret1try for Planning and Evaluation (HHS)
Coronary Artert, BypilSS Graft
'
Congressional Budget Office.
Council of Eco~omic Advisers
CommunitylM~,rant Health Centers
Consumer Price Index - Urban Area
, Calendar Year
Durable Medic.p Equipment
'
Department of Defense.
Disproportionate Share Payments to Hospitals
End Stage Renal Dislease
Federal Emplo~ees Health Benefits Program
Federal Matching Pelccentage (Medicaid)
Fiscal Year
Gross Domesti, Prodluct
Graduate Medi al Education
Health Care FiJancing Administration
Health Care RtJ£orm
Department of realth and Human Services
Hospital Insurf'ce
Human Immu..,o,;.Delfidency Virus
Health Maintejance Organization
Instrumental Aictivitiies of Daily Living
Intermediate C~re F~lcilitylMentally Retarded (facilities)
Indirect Medicrl Education
Long-Term Ca~e
Maintenance of Effort
Mentally Ret~ded/DevelopmentallY Disabled
Magnetic Resonance Imaging
.
Medicare Secohdary Payer
Medicare'Volulme Performance Standard
I
National Healt~ Service Corps
National LonglTerm Care Survey
National Medical Expenditures Survey
,
Office of the Actuary, Health Care Financing Administration
Omnibus Bud~et RE!conciliation Act
Office of Manfgement and Budget
Office of Pers,nnel Management
Public Health Servic:e
Personal Need~ Allowance
Qualified Me1icare Beneficiaries
Qualified Dis1.bled Working Individual
Prospective Payment System
Relative Valu~ Scale
Relative Valu, Unit
Survey of Inc me and Program Participation
I
i
88
�(continued)
SLMB
SNF
SSI
VA
VPA
WIe
Specified Lo -Income Medicare Beneficiaries
Skilled Nurs~g Facility
..
Social SecuritY Income
Veterans Ad~nistI'ation
Vulnerable Population Adjustment
Women,lnf Its, and Children
89
�
Dublin Core
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Title
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Carol Rasco - Issues Series
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Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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92 folders in 7 boxes
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Health Care Materials [5]
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Domestic Policy Council
Carol Rasco
Issues Series
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2010-0198-S Segment 2
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Box 123
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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2010-0198-Sb-health-care-materials-5
-
https://clinton.presidentiallibraries.us/files/original/ad26af5dbc0012bd25f04ca054fe4152.pdf
f29cc26c341849b93e00c093ed21afd8
PDF Text
Text
i
:
WithdrawallRedaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. press release
SUBJECTfrITLE
DATE
unpublished, Letter Writers to Meet with President in Connecticut
(partial) (4 pages)
02/22/1994
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Health Care Materials [4]
2010-0198-S
kc233
RESTRICTION CODES
Presidential Records Act - [44 U.s.C. 2204(a)]
Freedom ofInformation Act - [5 U.S.c. 552(b)]
PI National Security Classified Information [(a)(1) of;the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of t~e PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
i
P5 Release would disclose confidential advice betweeri the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted inVasion of
I '
personal privacy [(a)(6) of the PRA]
b(1) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b )(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions containlt in donor's deed
I
:
of gift.
PRM. Personal record misfile defined in accordance *ith 44 U:S.C.
2201(3).
'
RR. Document will be reviewed upon request.
�(-
WiihdrawallRedaction Marker
Clinton Library
'I
DOCUMENT NO.
AND TYPE
001. press release
SUB.JECTITITLE
DATE
unpublished, Letteriwriters to Meet with President in Connecticut
(partial) (4 pages) I
02/22/1994
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAiBox Number: 8505
FOLDER TITLE:
Health Care Materials [4]
20 I0-0 198-S
kc233
RESTRICTION CODES
I
Presidential Records Act· [44 U.S.c. 2204(a)]
!
I
Freedom of Information Act· [5 U.S.c. 552(b)]
I
I
PI National Security Classified Information [(a)(I) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential: commercial or
financial information [(a)(4) of the PRA]
I
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA],
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
I
I
I
C. Closed in accordance with restrictions contained Iin donor's deed
of gift.
!
PRM. Personal record misfile defined in accordance with 44 U.S~C.
2201(3).
RR. Document will be reviewed upon request.
I
I·
I
b(l) National security classified information [(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
h(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
h(8) Release would disclose information concerning the regulation of
financial institutions [(h)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
�TH E WH rrE HOUSE
health care az:ena . not ~A~\"'d¥.b~upport for the
seven-term laWmaker in what could be
a difficult e~ection year.
The visit a:lso fits in with a new administration
initiative to ~each out more to senior citizens, the
official said.
Gejdenson will fly to Connecticut with Clinton on Air
Force One and ~ccompany him on Thursday's tour.
Although Gejdenson supports Clinton's plan, which faces
significant opposition including several major vying
proposals on Capitol Hill, he has not been a major player
in the health bare debate.
A Gejdensoniaide, asked whether the congressman invited
Clinton to the \district to help his own re-election
effort, deferr~d comment to Gejdenson's press secretary,
Jamie Shor.
I
,
Efforts to ~each Shor, who was traveling in the
district Tuesday, were unsuccessful.
Clinton is tiot expected to make any new policy
pronouncements.i He is expected to simply reinforce aspects
of his univers~l health care plan, including the fact that
it offers presc~iption drug benefits.
Sen. Robert Dole" R-Kan., the Senate Republican leader,
has said the final health care reform plan will begin to
take shape in about two months, and that a reform bill
will pass Congr~ss this year.
II
\
I
Letter Writers To Meet with President In Connecticut
I
I
Feb 22 -- I Four, Connecticut area seniors will meet with
President Clinton when he visits the Norwich Free Academy this
Thursday. All four wrote to the First Lady about the
problems they w~re having with our. nation's health care
system
I
The president! will meet with the letter writers at the
Norwich Academy before he gives his speech. (Coverage is
POOL PRESS - the: same pool from the pharmacy).
Excer ts of the letters are attached.
·l;lIlrV,\:I,>\'X'.?\",:>,1ltr~~£06"6·/r'("b·~)·
Excerpts from three letters)
"'!<:'}?:W\'''!'.''';~~1,·'~.\liJ?i;v".c ',,", •.
Dear Mrs. Clin on:
My wife and I are senior citizens earning $18,000 to
$20,000 a year including social security. We are having a
hard time making:ends,meet. The doctors, pharmaceutical
and health insur~nce companies keep raising their fees and
premiums. On a fixed income we a having a hard time living.
We have a $2,000 iprescription drug bill a year. Some we
don't order as we just can't afford it. We tried generics
which don't work !for us so we need the name brands that
cost a lot here. ~or the elderly earning less than $32,000
'I
I
I
�,
I
TH E WH ITE HOUSE
I
a year, why ban't we in~~~I~~iption drugs in with
Medicare?
\
Dear Mrs.\Clinton:
If we letlthe rising costs charged by health insurance
companies, doctors' fees and pharmaceutical companies
continue, they are going to bankrupt us.I am sure you and
President Clinton: are aware of this.
In your h~alth plan please include prescription
drug-re~lar ~rand coverage. Generics do not work for me
and myw~fe. We c~n't afford the cost of these name brands
as we need our little money for housing, clothes and
food--so we don't take them. This is a big problem for the
elderly. Please include this in with your health plan. I
and my wife voted for your husband as I think he will take
care of the forgotten American who paid his taxes all his
life. Now he is old and he deserves something better.
Dear Mrs. Clinton:
Please help the,senior citizens to pay for the
medication they need. My wife and I don't take our
medication as ~e need the money for food. Other seniors do
this too. We a.J..l like Medicare. Why can't we include
prescription drugs with it? If your husband puts
prescription d~ugs in with Medicare he will be the
greatest president since FDR and 41 million seniors will
elect him agaiT;l.
I
Dear rs.
i~nton:
I would lik~ to send congratulations to you and
President Clintpn as you begin the tremendous task of
leading this co~ntry back to a position of health--human
and economic. I
Please pay sepcial attention to one of the most glaring
deficiencies in\our health care system-the lack of price
regulation of tqe pharmaceutical supply houses.
Because of s~rious chronic health problems for both my
husband and myself, ages 75 and 77, our medication costs
for 1992 totall~,d over $5,000. Medicare does not pat for
this. Without an: unusual health insurance policy, payment
for which is tak~n from my small pension, we would not be
able to pay thes~ bills. My son, who has paranoid
schizophrenia, i~ being treated with clozapine-- which
originlly costs $9,000 a year, now has been "cut back"
to around $7,000:in Connecticut in response to public
protest, yet is proving effective in restoring many such
clients to productive living. All of our medications have
risen unconscion~bly during these last few years.
Drug companies: cite research as their excuse for
continual extremel rises in price. In many cases research
has already been done. Competition and a desire for
profits ahead of ~ervice are the motives, to my way of
thinking. I think I this excuse of "research" should be
carefully scrutinized.,
�i
THE WHITE HOUSE
One amongmaryy quest~~~I~~~ould the same drug vary
in price by huge percentages between the u.s. and Canada,
or the u.s. andlMexico? Our case is but one of
millions--mpst of whom are much worse off than we are. The
point is--why is this allowed to happen?
Please give this phase of the health care mess your
highest and most serious consideration. Thanks for
listenin ! God ~less ou.·
",~;?';~~,1~jr
ear Mrs.
~n on:
My wife, l,f;~:st;:it!rR61(~).(§j\t~~·\l'~,~:~:i~;~lis so ill with anemia, chronic
asthma, need of IblOOd transfusions, transportation via
ambulance, legally blind, suffering from a fractured leg
which needed me~al bars, tubing and wire to mend the bone
structure-- she jwas a chronic asthmatic for which she was
administered predmison to enable her to breath, which in
turn weakened her bone structure.
She has plen~y oflthe many medications she must take
for her breathing, blood pressure, a diuretic, etc .•• , but
at the nursing nome it was required that residents or
patients, have ~o home order the drugs from a special
source coming bl:ister sealed. ~·:~:R67(b)(~~~1ttl,~ retirement plan,
as a former sch90l teacher, has a service J5y which we can
obtain medications at a very reasonable cost and they are
at home not being used.
We have Medidare and Blue Shield and Blue Cross, and
are disheartenedi knowing that the cost of these services
are taken out of! ~~~~ill~!~ft;[~jlIi6)(~).;~~~~; annuity and in our present
set up we are jus~ sic~fhat'we have to pay extra for
medication, to tpe tune of $800 in July.
We are of limiited means and wonder how long we can
afford this.
~
.
Mrs. Clinton ~e need your help as do many others in
similar situations as ours.
Dear Mrs. C
I admire you : or taking so much time and trouble to try
and equalize the: health care system.
I am 83 years: old and am having a hard time making ends
meet. I get $764[ per .month from social security and have
to payout $126 each month to Medicare and Blue Cross-Blue
Sh1eld. I was paY1ngmore but I downgraded my po11cy to
save a little. But now I forfeit the cost of prescription
drugs 3- 6 months after I return home from the hospital.
I have been .ih the hospital twice in the last month
with blackouts and irregular heart beats. The first time I
went in in an ambulance. They charged me $320 for the
paramedic that rode with me and no one would pay that
amount.
.
I'm telling you this so you will know what is going on.
Thank you fori trying to do something for those who
•
I.
I
I
.
,
�12oj)
THE WHITE HOUSE
Don't ~k~I1rlR;!TON
------------7-------------
I
i
UNION IN
HEA~TH-CARE
:
,
DRIVE AMONG NONUNION WORKERS
BAL HARBOUR, Fla (Reuter)Feb 22-- The United Food and
Commercial Wqrkers union TUesday launched a drive to urge
non-union employees at Wal-Mart and Kmart stores to
support President: Clinton's health care plan.
Union volunteers distributed pamphlets to workers at
60 of the discount chain outlets around the country and
,
over the next: few months w111 target all 750,000 workers
at the 4,000 U.S. Wal-Mart and Kmart stores, the union
said.
.
\
The two r~tail chains were targeted because they
provide health care coverage for less than half of their
employees, require,those who are covered to pay above the
national average for their insurance and are lobbying
against the Cl'inton health care plan, the union said.
"We want kmart and Wal-Mart employees to know that
their employers are on Capitol Hill fighting health care
reform," UFCW:spokesman Greg Denier said.
"We're going t,o take a campaign into the non-union
retail operato~s in this country that do not provide
health insurance for their workers," said union President
Douglas Dority,i who is attending the AFL-CIO Executive
Council meeting here.
The pamphlets urge workers to call a toll-free number
for more infor~ation and ways of contacting their
lawmakers.
Ii
Union officials 'said large retail and supermarket
chains that provide ·employees with little or no insurance
coverage are putting unionized employers that provide
coverage at a competitive disadvantage, resulting in
increased press~re at the bargaining table for
concessions.
I
,
union officfals said their aim is to protect their
contracts with union employers, rather than organizing the
non-union worker:s at Kmart and Wal-Mart.
.
I
----------------1------------
i
STUDY SAYS CLINT~N HEALTH PLAN COULD COST U.S. JOBS
I
I
WASHINGTON, ~eb 22 (Reuter) - Business groups stepped
up attacks on Preside~t Clinton's health care reform plan
Tuesday, as the White,House tried to court Republican
lawmakers whose support will be needed to pass any final
plan.
\
The Employment Policies Institute, a nonprofit group
backed by the hot~l and restaurant industry, issued a
!
�\
. THE eBO ANALYSIS
February 9, 1994
I
1
•
The fundamentkl premise of the President's approach to health reform is that
we can guarant~e private insurance to every American and still reduce the
amount the nation spends on health care. Yesterday, the Congressional
Budget Office cqmpletely validated that premise.
I
.
I
I
•
.
'
.
In fact, the CBO determined that, between the years 2000 and 2004, we
will be able to iguarantee private insurance to all Americans while
spending $413 jbil1i~n less on health care. That's $413 billion that can go
to higher wages for American workers, money that businesses can invest and
. use to create jobk, and increased savings.
I
I
•
I
.
I
I
•
,
The CBO and th~ Administration agree that the President's approach will
save money. In fact, the two estimates of savings in national health
expenditures -- t~at is; total spending for health care in the country -- are
very close. The qifference between the Administration and the CBO analyses
is that CBO predicts that these savings will initially go to businesses and
I
statellocal gover~ments. In contrast, the administration expects these
savings to initially go to the federal government and therefore to immediately
begin to reduce the deficit. The $133 billion "difference" in the CBOand the
Administration dkficit estimates -- which is described as "small" in the CBO
analysis itself -- is a result of these differing assumptions. Nonetheless, the
CBO too projects long-term deficit reduction. [CBO Analysis, p. xiii]
.
!
This issue clearly:can be resolved. Since we are in agreement on the
essential framew4rk, tne deficit issue is something that can be easily worked
out as the proposal proceeds through what will be a very substantive process
in the U.S. Congr~ss. We stress that the President's health reform
. proposal will pa:y for 'itself and reduce the deficit.
,
,
i
I'
I
I
�THE CBO ANALYSIS
A.
VALIDATES THE PRESIDENT'S APPROACH
I
!
•
'.
The President:s approach will guarantee every American private
health insurance and control costs.
I
I
•
"The CBO credited the administration with coming up with a
framework that appears to reconcile what many had considered
irreconcildble: e'xtending health care to all Americans while at the same
time slowing th~ growth of medical costs, which threaten to consumer
20 percent: of the nation's economic output by the end of the decade."
[Pearlstein ~nd Broder, Washington Post, 2/9/94]
•
i
.
:
.
"[The CBq analysis] is a significant acknowledgment that health
reform can do what is necessary; that is, provide health coverage for all
Americansi while containing sky-rocketing health-care costs. " [USA Today,
·2/9/94]
!
'
,
I
•
American families wHI benefit from the President's approach.
I
•
"The Clinton plan, when compared to today's system, would cost
average Americans less money, give them more health benefits and more
choice ofphysicians and medical care, [Reischauer] said:" [priest arid
I
,
Rich, Washin'gton Post, 2/9/94] ,
I
•
The President's\approach will lead to deficit reduction.
I
t
, .
'
!
•
'lCBO Chairman Reischauer said] significant deficit reduction will be
achieved by; 200{ " [!:1fl, 2/9/94]
t
•
i
•
American workers will get higher wages from the President's
.
I
approach .
I
'
,
I
•
the lio~ 's share of those savings would be returned to workers in
the form of lJ,igher cash wages. . . "[ 'jt1n Analysis of the Administration's
It • •
•
Health Proposal ", CBO, 2/9/94, p. 35]
I
•
''First, the p~oposal would increase the cash wages of U.S. workers . .. "
['jt1n, Analysis
?f the Administration's Health Proposal ", CBO, 2/9/94, p. 51]
!
�THE CBO ANALYSIS I
I
Page 2
I
•
National health iexpenditures will be "significantly" reduced under
the President's approach.
,
,
I
I
•
'
"Thus, CBQ projects that national health expenditures would fall $30
billion below the current CBO baseline by calendar year 2000, and
would be$i50 bi~lion (7 percent) below that baseline in 2004." ['~1t
Analysis of th~ Admi~istratio1t's Health Proposal", CBO, 2/9/94, p. xii]
I
•
"Once the a~ministration 's proposal was fully implemented it would
significantly redu,ce the projected growth of national health
expendituref' ['~h Analysis of the Administration's Health Proposal", CBO,
/I
2/9/94, p. 26] iI
'
:
•
Businesses will ~ave substantially under the President's approach .
I
,
•
,
'
''But busine$ses' costs for health care would be'significantly reduced
overall . . For example, the total premiums employers would pay for
active workers would drop by about $20 billion in the, year 2000. " ['~n
Analysis ofth~ Admii;Listration's Health Proposal", CBO, 2/9/94, p. xiii]
I
I
•
.
"[The President's proposal] would sharply reduce the growth of
employer sp~nding for health insurance. By 2004, employers would
save about ~90 bi~lion for active workers and more than $15 billion for
early retiree$. . . "'['~n Analysis of the Administration IS Health Proposal", CBO,
2/9/94, p. 35]
I
I
I
•
All small businesses will benefit.
-
I
I
•
•
'
"[The propo~al] would benefit smaller firms that typically pay much
higher premiums than larger firms. This leveling of costs could benefit
all small bu~inesses -- not just those that provide insurance today. With
access to more affordable insurance, small businesses would be better
I
.
able to attract workers who now demand health insurance as a
condition of kmployment. " ['~n Analysis of the Administration's Health
Proposal", CBO, 2/9/94, p. 54]
I
�I
!
I
THE CBOANALYSIS
I
]>age3
!
B.
WHAT IS OqR RESPONSE TO • ••
•
Reports thatilthe CBO claims job loss:
The CBO analysis specifically states, as do many independent studies, that
the President'~ approach will have a negligible, or positive, effect on
employment. \
,
,
•
liThe Clihton plan, [CBO] concluded, would not significantly slow the
economy\or result in the loss ofjobs, as many critics have charged."
[pearlsteitl and Broder, Washington Post, 2/9/94]
!
I
•
" ... [the\propo.sal] would alter the unemployment rate little. " [CBO, ':An
Analysis of, the Administration',s Health Proposal'~ 2/9/94, p.51]
I
'
!
In fact, some independent studies say there will be job creation.
,
,
,
!
•
Two independent studies -- one from the Economic Policy Institute and
one from the Employee Benefit Research Institute _. predict that jobs
will be cre,ated as a result of health reform. The EPI projects that
258,000 ~anufacturing jobs will be created over the next decade. And
the Employee Benefit Research Institute predicts that the President's
proposal could produce as many as 660,000 jobs. There will also be
health car~ jobs created -- with one health economist at the Brookings
Institution: predicting that the plan will create 750,000 health-related
jobs. [EPI, November 1993; EBRI, November 1993; Reuters, 9116/93]
.
\
The CBO says th~t the :primary changes in the labor market would be a
result of voluntarY retrrement as Americans who have worked hard their
whole lives are lid, long~r locked into their jobs just to keep their health
'
coverage.
,
•
I
:
"CBO estimates that eventually between one quarter of a percent and 1
percent of t~e labor force might prefer to stay at home if the
proposal uJere enacted." [':An Analysis of the Administration's Health
I
Proposal", CB<;>, 2/9/9;4. p, xiv]
I
�i
THE CBO ANALYSIS I
,
,
Page 4
•
Differences in Short~Term Deficit Projections:
The Administratibn and the CBO agree that the President's approach will
create savings. C'BO shows the initial savings going to private sector and
I
statellocal governments, rather than to the federal government as the
~
Administration projects. The difference between the CBO and
Administration dJficit estimates -- which was described as "small" in the
.
CBO analysis; itself -- is a result of this allocation. Nonetheless, the CBO too
projects long-term deficit reduction.
"
.
I
,
I
'
I
"[Reischau~r} also went out of his way to call the differences in financial
•
estimates 'rlelatively small potatoes in the great scheme of
things.'" ~ear, New York Times, 2/9/94]
I
•
.
In fact, the :difference between the Administration's and the CBO
deficit estimates is only about 4% of the projected federal health
expenditures during the same period --and much less than 1% of the
total federal budget (.13%). [internal calculations from CBO, Table 2-1, p. 26]
I
.
I
I ;
" ,
I
•
'lCBO Chairman: Reischauer said} significant deficit reduction will be
achieved byI2004.;" [UPI, 2/9/94]
•
'lThis} diff~rence ,Of opinion may have more political than economic
significance: Both predict that the Clinton plan will begin saving money
for the gove~nment, business, and consumers by the year 2000. "
I
[Pearlstein and Broder, Washington Post, 2/9/94]
.
I
I
!
•
"Focusing on the effects ofproposals in their early years is, therefore, not
very meanirlgful; it is the long-term impacts, when new coverages would
be fully pha1ed in: and the system stabilized, that are important. " ['~n
Analysis of th~ Administration's Health Proposal", CBO, 2/9/94, p, xiii]
C.
OUR PROPOSAL STANDS ALONE IN SPELLING OUT SPECIFICS:
!
.
I
•
"The Healthi Security Act is unique among proposals to restructure the
health care ~ystem ... the proposal outlines in legislation the steps that
would actua:Uy ha.ve to be taken to accomplish its goals. No other
proposal has come close to attempting this. Other health care
proposals inight appear equally complex if they provided the
same level of detail as, the Administration on the
I
implementation ;requirements. " (emphasis added) ['~li Analysis of the
Administrati01+'s Health Proposal", CBO, 2/9/94, p. xv]
I
I
.
�i'
E X E CUT I V E
!
OFF ICE
o
F
THE
PRE SID E
18-Jan-1994 03:33pm
TO:
;(See Below)
FROM:
Jeffrey L. Eller
Office of Media Affairs
I
SUBJEC'Ij: -5~~ternal Use Only
:~
I
_~. __ ~
__ w,_ "
For Internal use! Only
Not for Distriburion
t
1/18/94
I
IS THERE A HEALTH CARE CRISIS IN AMERICA?
I
I
Q: Some
health
Republic~ns, and even Senator
care cris~s in America. Do you
,
Moynihan, say there is no
agree?
A: We disagree, but if they seriously believe that there's no
problem, let's h~ve a real debate. Unfortunately, this is
apparently just ~ political strategy of some Republicans. And
it's very sad because there are many Republicans who are very
committed to a real, bipartisan solution to this health care
issue, and healtn care is not an issue that anyone should be
using to play politics with."
I
[Background:
1
Republican strategist William Kristol has written a
widely-cir,culated, memo saying the only way to defeat the
President's plan :is to flat-out oppose it. And the only way to
justify that oppo:sition is to deny that a health care "crisis"
exists in ~mericai. Dick Cheney and others have picked up this
line in the last few weeks, and Sen. Moynihan repeated it on
Sunday's "~eet the Press." And a recent Wall Street Journal ltem
said that ~ristol(s "follow-up strategy II is to get Gingrich and
Dole to introduce,a IIlimited set of insurance and malpractice
reforms and tax incentives."]
,
!
•
:
I,
i
i
NOW, you can argue over whether or not the current health care
system in ~ stateiof "crisis" per se. But we do know this: our
health care system is seriously broken, and the President is
committed to fixing it. And those who deny there are serious
problems don't understand the lives of middle-class Americans
who live irt fear that their health care won't be there when they
need it.
I
I
;
i
The Health 'Securi~y Act proposes a system of guaranteed private
�"
!
I
;
insurancbe. It builds on the current system of private
I
!
"
~--
.. -
..
"--~----
insuranqe with two :critical changes: first, the guarantee of
I
I
,
-_._._-_
... _.
,
I
I
i
,
i
comprehensive h,ealth benefits that can never be taken away; and
second, ~reate~ power for individuals and small bu~inesses to
choose affordab'le, quality health insurance.
I
'
Q: What about the fact that medical cost growth is as low as
.
~t's
b
I
•
I
eep
s~nce,
,
I
19731
I
;
'
A: Well,! 1973 was the year that President Nixon's bill was also
before the Congress. Leading health economists such as Uwe
Reinhardt of Princeton agree that the prospect of reform always
causes tl!le industry ,to tighten its belts to a certain degree.
But without refbrm, :costs will continue to accelerate.
I
�I
I
I America's Health Care Crisis
The statistics
I
Lastlyear, 2 million Americans lost their health coverage
?
permanentl yi.
I
I
I
i
I
?
Every month" 2 million Americans lose their insurance for
some' period of time. If someone in the family comes down
withl a seripus illness during that time, the family's
savirgs cou~d be wiped out.
?
In 1980, Am~ricans were being charged $2,600 per family
for health care~ This year, between prescription drug
costs, whatl you pay for premiums, Medicare taxes and other
heal~h cost~, we're being charged $8,000 per family.
I
,
I:
I
I
?
The us ranks 19th in the world in combatting fatal heart
disease amo~g adults, 20th in infant mortality, and 16th
in l~fe expectancy.
i
.,
?
Drugicompanles charge American consumers three or four
times as much as they charge foreigners for the very same
drug~.
i
?
I
:
Smalf busin~sses are charged an average of 35% more than
big busineskes for the same insurance.
The storiel
I
;
Tell the f9llowing people that nothing's wrong with our health
care syste~:
Gayle S. of Baton: Rou~e, Louisiana -- who was dropped by her
insurance conmpany when illness struck.
,
Tom M. of kingston, T~nnessee or Patricia G. of Simi Valley,
Californiai-- whose cancer treatment was delayed by insurance
company "fine print."
I .
I
Rick and S~ndy R.I of Waldorf, Maryland -- whose family was
driven int9 bankr~ptcy when a child's illness slipped
I
�,
through an irtsurance company loophole.
I
I
Kerry ~. of T.itusville, Florida -- a small business owner whose
insurapce company told him he'd have to fire two elderly
employ~es if pe wanted health coverage for his company. The two
elderly employees were his own parents.
\
,
I
\
1
,
I:
I
\
If We Do Nothing •••
!
\
?
'
,
E,very A~erican can expect to pay more every year with no
guarante'e that their health care will be there when they
n~ed it.!
,
,
,
?
o~e
?
Atmost $1 out of every $5 Americans spend will go to
he,al th c~re, and American families will be charged $14,000
a year fdr he~lth care.
?
Millions 'of Americans will find that r~s~ng costs will
force their firms to cut back on benefits and limit
ch~~ces o~ doctors and health plans.
of every four Americans will lose their insurance at
some point in the next two years.
\
1
\
\
,
•
,
?
•
I
!
By!the ye~r 2000, workers will lose over $600 in real
wages to iising health costs.
:
,
i
?
the tiext five years, health spending will rise to
consume 20\ percent of the Federal budget.
?
30%iOf sma~l businesses will be forced to drop coverage
for', their employees because of the high cost.
ove~
,
,
:
,
i
Distrib~tion:
,
Te:
TO:
,
TO:
TO:
TO:
TO:
TO:
TQ:
TO.:
To',:
TO~
TO~
TO;
TO:
TO:\
TO:i
TO:!
TO: 'I
I
Daviid Leavy
steven A. Cohen
Vir~ini~ M. Terzano
Arthur L. Jones
Carol H.. Rasco
David B. Anderson
cat~eririe Balsam-Schwaber
Kenneth R Chitester
Jef~rey L. Eller
Ern.st D~ Gibble
Jona~hanp. Gill
Kimb~rly:s. Hopper
Lisa:, Mortman
Rica" F. Rodman
Jess \Sarmiento
Laura, D. Schwartz
Joshua N.' S~lverman
Richard strauss
.
\
'
�JAN
t~
'94
~9
P.t
29AM GWUICHPR
I
Cs)'(tEII. pall Hw.:!'H POL(CY RElI'EIolI'CH
FAX COVER LETTER
N,ueer of .heet. inoluding oover sheet. I
!
'
Carol Bascp
\
1
I
White
1
OF:
Hpuse
Dome.tic Policy
I
PHONE I
456-22;16
FAX,
456-2879
i
Sara
FROM I
RO!enPlA,Um
I
296-6,22
PHONE:
MESSAGE:
,
I
2021
i
k. S'ttliBT, N W., SUITE BOO •
I
'
I
I
WASH[NGTON.
DC 20052 • (202) 296-6922 • FAX (202) 78S-0114
�I
,JAN
:!.13
'94
i39:313AM G;WU CHPR
!
P.2.
'
CWiTEIt POI. HEALTH POLICY RIlsBABCH
January 6, 1993
:MEMORANDUM
i
'To: Carol, I~11, XYmL, Melanne; Christine, Greg and Jen
Fr:Sara
~
;
Re: Ca1cul~ the fln$cial burden on families under the Chafee and Cooper bills
,
"
1
I·
As I mentioned at today! DPC staffmeeting. I thought that it might be useful to
caloulAte the; financial bUrden on families under the Cooper and Chat"" bill&. One of the Center's
research associates and [ therefore dcvUed a. simple method to gauge the level of aasistancc to
families und~r both bills;. We b;ave finished the Chafee analysis and will complete Cooper in the
next couple Of days.;
,
The Chafee analysis shows that while the bill purports to suarantee coverage, the financial
burden placed on fanilli~$ ii often severe. Moreover ~ families' premium burdens increase
exponentiall~ as they try to move out of poverty; thu8 J the bill operates as a major work
dbWncenuve.'
I
ApplYing the Chafee poverty-related subsidy formula ( a 100 percent subsidy for below
poverty families. phased: do'Wll to a 0% subsidy at 240 percent of poverty) to the 1993 poverty
.guidelines and using HerA's premium cost estimates we get the following results:
~
A fan\ily of2 with income at 130010 ofpoverty ($9061 in 1993) would pay 7 percent ofits
..
"..
II'
income in premiums alone.
A fatrM' of3 with income at 150% ofpoverty ($17.83S in 1993) would pay IS percent of
its incPrne in pre;mums alone.
,
A farrilly of2
income at 210 percent of poverty in 1993 ($19,803 in 1993) would pay
1S peroent of its income, in premiums alone.
wi*
A
f"mPY of3 at ~30 peramt ofpOYCrty ($27,347 in 1993) would pay 13 peroent ofits
ineom~
in premiwns alone.
Even this burden :on families does not take into account all of the other out-of-pocket
costs in the bill. We cannot calculate the real burden. since the bUt doesn~ tell Americans what
their coverage will even include.
Even more ,tartli~g perhaps, a family of 3 at 150% of poverty whose wages rise to 210
. percent ofpoveny, WQul<t see 3() percent ofits pay raise ($2000 ofthe $7100 inorease)consumcd
by a premium !increase. I
,
In effebt. the Chafee bill is an unfunded mandate on American families. Moreover, our
esrimtrtes are !;he best ca~ scenario; under the bill subsidies disappear' if there are insufficient
saV'insg in any!given year.: I 'Will forward Cooper as soon as it is completed.
,
,
I
.
00: Hllla.ry Ro~ Clint6n
,
,
i
2021 K STREliT. N.W.• SUITE 900 • WASHINGTON. DC 20052
I
(202)2S!6-6Sl22 • FAX (202) 78S-01H
�..
JAN 10 ;94
09:30AM GWU
I
~HPR
P.:.!
I
I
,I",
!
I
I
I
January 6, 1994 I
!
I.
CYinth'Ja M0nr-s
TO :
I
I
,PROM:
JU~ie Darnelli
,RE:
Adalysis of v6ucher pro&ram in Chafee legislation
ii,
S. 1770,
I
•
I
I
I
The Health! Equity and Access Reform Today Act of 1993 (HEART), introduced by
Senator Chafee on November 22. 1993, creates a fedem11y-administered voucher program to help
low·income indiJiduats PUrthaS8 insurance. All individuals must purchase insurance by the year
2005. This requ~ement is phased in based upon an individual's ability to purcruule the £tandard plan
and will be tied to the gradYa1 expansion of federal assistance for low-income uninsured individuals.
I
I
Table 1
I
~alendar
I
i997
'
I
I
I
:
Year
:
I
I
I
~998
I
110 ~ of poverty
I
I
1999
Phase-in Percentage
90 % of poverty
!
130 % of poverty
I
2000
1SO " of poverty
~OOl
I
• ~002
I
,
~OO3
~
,
I
170 % of poverty
,
:
I
i
,
190 % of poverty
210 % of poverty
230 % of poverty
240 % of poverty
I
I
I
I
Therefore, stattiriS in 1997; individuals with inoomes at or below 90 percent of the poverty level
(and who are no~ elisible for Medicaid) will receive VOUChCIIi to buy in:surance through purcha5ing
groups. Voucher assistance will expand annually up to 240 percent of the poverty line in the year
2005. If the voucher program is implemented on schedule, the subsidy amount an individual should
expect
to
reeeivd toward the ,cost of the premium is calculated helow.
t
' :
I
~
,
�,,,\
.
P.4 .
12l9::31AH GWU CI-lPR
. JAN 10 ":34
"
•
\
"
\
I
Table '2
,
Yeer\
Poverty
Level
Voucher pereeDtage
[100 - «(percentage above 100) X (.1oo/140»J
1997 \
,
1998 ,
,
90
100 percent
110
93
1999 :.
130
79 percent
150
64
170
50 peI'QOnt
,
190
36 perce.nt
I
210
21 percent
!
I
2000·
\
i
'I
2001
I
\
2001
,
,
2003
,
I
I
I
,
2004
2005
\
i 1230
tt
\ ••
24b
I
1
.
~cnt
.
7 percent
;*Tn"2005! at full p
)naSe-1n
,
I
percent
0
e&Cl'l
or me preVlOUi percenta ell would contmue to apply
\
Using the 1993 poverty guidelines1 and HCFA's estimate::! of the annual health insurance
premium for each of fourl family types, I have calculated what a family's contribution is expected to
be based on th~ subsidies \provided in Chafee's bill for families at 130, 150. 210 and 230 percent of
poverty.
"
:'
!
!
I
'
I
The tabl~.s demon~i:rat-: that Chaf:' II individual mandate requires families to contribute as
little as three ~cent up t~ as much as 17 percerlt of their income t depending on their place on the
poverty line. A: couple without children, however, pays significantly more than any other family
size, regardless pf income.; Most', families in these scenarios are required to pay eizht percent or
more of their family inconie on thcit h&1th insurance premium alone,. This finding is significant
given that it has :ibeen sug~~sted that a. fa.mily'~ out-of-pocket maximurn liabilities should not exceed
10 pcn:ent wageSI~
,
'.
or
i
1
See Appendix
,
1
:&
1.:
I
I
See ApPendlx 2. ;
a
I
'\
'
of
For discussion income-related cost-shario,g, see Thomas Rice and Kenneth E.
Thorpe. "Income-Related G08t Sharing in Health Insurance, il Health Affairs, Spring 1993,
pp. 22-39.
3
I
,
2
�i
I
JAN lIZ! "34
09: 31At1 GWU CHPR
,
I
I
P.S
IMPACT OF SUBSIDIES ON
FA'MILIES AT 130 PERCENT OF POVERTY
!
. Table 3
I
I
/I of
Penom
P~verty
~'Ve1
I
l~O %
of
~ove1"lY'
BCFA
Premium
Chalee FamUy
Subsid.y ContrlliuUon
~Unatt
I
Pel'tentaae of
Family
lnco~e
I
1
61~70
I
12,259
,
I
.
3
11;890
15A57.
3.894
3,076
818
0.05
4
141350
18,655:
4,391
3,469
922
0.05
4,391
3,469
922
0.04
5
16~81O
I
2~,853
J~ -=-t-~--:.::;-,~ -~- it-~-+~.;. .:~-:~- ,-!+-:.;...::-:-:--f-:.;...::-::--t-::-:---.J-:-~:-3----I1
I
IMPACT OF SUBSIDIES ON
FAMILIES AT 150 PERCENT OF POVERTY
Table 4
IPoverty
'
Persons . Level
# of
i
I
150 % of
POverty;
I
I
Percentage of
HCFA
Chafee
Premium
Subsidy Contribution Family Income 1
FamBy
Estimate
I
-1
6,970
I
10.455
1
1,933
1,237
696
0.07
2
9,430
14,145
3,865
2,474
1,391
0.10
3
11,890
17!,835
3,894
2,492
1,402
0.08
4
14,3'0
21~525
4,391
2,810
1,S81
0.07
5
16,810
i
25 ,215
,
. 4,391
2,810
1,581
0.06
6
19,270
2~,l905
4,391
2,810
~~5g1
O,OS
7
21,730
32JS95
4,391
2,810
1,581
0.05
,
I
3
�JAN ::'13'94
:
i
09: 32Atr1 Gl-JU IZHPR
i
P.b
I
sUM:MARv OF IMPACT OF STJBSWlES ON
FAMILIES: ,AT 210 PERCENT OF POVERTY
Table 5
# of
Poverty
210 % of
ReFA
PenOI19
Level
Poverty
Premlmn
F&lmate
" 1
,
6,970
14,637.00
1,933
406
1,521
0.10
2
9,43,0
19,,803.00 3,865
812
3,053
0.15
3
11.~90
24>~69.00
3,894
818
3,076
0.12
30,:135.00 4,391
35,:301.00 4,391
922
0.12
922
3.469
3,469
4,391
922
3,469
0.09
4:5 ,i633 .00 4,391
922
3,469
0.08
I
Percentage of
Cbafee Family
Subsidy Contribution Family Ioeome
I
4
14,350
5
16,810
,
0.10
I
6
19,270
II i
121!~30
40,'467.00
I
Table 6
I, # of
i
Persons
IMPAC1' OF SUBSIDIES ON
FAMILIES AT l30 PERCENT OF POVERTY
I
I
,
I
Poverty
23~ ~ of;
Level
Poverty: Premium
Chatee
HCFA
Family
Percentage of
Subsidy Contribution Family Income
Estimate
I
1
6.970
16~O31.00
1.933
135
1!798
0.11
2
9,430
21i689.00 3,865
271
3,594
0.17
3
11,890
27,347.00
3,894
273
3,621
0.13
4
14,350
33;OOS.OO
4~39l
307
4~O84
0.12
5
16,810
307
4,084
0.11
,
38,663.00 4,391
~
6
19,2'70
44;321.00
4,391
lO7
4,084
0.09
7
21,730
49~979.00 4,391
307
4,084
0.08
I
I
,
,
I
I
I
Another look at the Chafee subsidies reveals that as a family moves up the poverty
line, the gains made in incoi'ne are eaten up in health insurance premiums. As shown in
Table 7, fI. family of three fi~ the 150 percent poverty level who increases their wages by
$7,134~ bringing ,them up to 210 percent of poverty, mU5t pay an addirirm.al $2,043 or nearly
30 percent of their increase I,in wages for their health insurance premium. You may refer to
Appendix 3 for a more· complete examination of the impact of subsidies on a family of three.
i
.
4
�JAN
..
1~
'94
<.
:
~9:32AM
I
I
I
GWU CHPR
P.?
!
Table 7
Increase in Poverty
I
Level
:
I
I
i
Dollar Amount of
Inc~ease in Wages
!
!
I
100..,. 150
100 -40 210
1S0 .... 210
,
,
I
Dollar Amount of
Percentale of
AdcUdonal Increase
in Premium
LJabWty tor Family
Devoted to
Wqe Increase
Pnmium
;
5,945
13,079
~
23.5
23.5
2,043
7,134
3,076
29
The subsidies are financed from savings achieved through health care reform. More
specifically. savings arise from means testing the Medicare Part B premiums, phasing out
payments to hospitals for uncompensated care and for enrollee bad debt, and instituting a
managed care program in MCdicai& The voucher program expamJion proceeds only after
certl.t1catlon by the Director of the Ofnce of Management and Budget (O:MB) that
savinas are occurring as anticipated. In other words! the sum of the expenditures under
Medicare and Medicaid plus I the total amount of the vouchers to be provided in that :fiscal year
must not exceed the baselinelspecift.ed in Table 8 below.
I
I
BASELINE FOR FY 1m TO lOGS
I '
I
I
,
!Table 8
~Year
Bue1ID!
1997
$318 billion
1998
$3S2 billion
1999
$391 billion
2000
$43' bllllon
2001
$483 billion
2002'
$535 billion
~OO3,
$;3 billion
2004'
previous FY
baseline + 9b
increase in GDP
200S:
previous FY
basc::line + 95
increase in GDP
5
�I
..
'
JAN 10 '94
.
(ij9::33AM GWU CHPR
P.S
I
I
,
In the event that ;savinss ocCur more rapidly, the phase-in will be accelerated. In the case of
.a aa.vi.ngs shortfall, it will b~e dece1e.ra.ted. The Benefits Commission may make
reoommcDdaiion~ to Congress to reduce the deficit amount by restructuring benefits or
restructuring health care en~tlcment. If Congress enacts such recommendations, the
, deceleration in voucher coverage will be appropriately adjusted.
!
I
I ,
; ,
Effective January 1~ 1995, individuals who enter the health care system uninsured
will pay a tax p~y eq~ to the average yearly premium ot the local area plus 20
I
percent. No taxes are imposed on any individual who would have received a voucher for a
"particular calendar year bU~! for a decrease in the pbase-in eligibility percentage.
6
�.'
..
"
"
"
.. JAN
113 '94
1219j33AM GWU ICHPR
P.9
APPENDIXl
I
POVERTY GUIDELINES, 1993
II of
Peteona
Povert)i
lAvel:I
00 9t
110 9!i
Poverty
l!O %
Pove:'ty
Poverty
150 "
170 %
POVl!rty
190 S$
Poverty
210 %
Poverty
2309E
Poverty
240%
Poverty
7,657
9,061
10,455
11,849
13,243
14,637
16,031
16,728
10,373
12,239
14,l4.S
16,0:31
17,917
19,803
21,689
22,632
13,0'0
15,457
17.835
20.213
22,SSn
24.,969
27,347
28,536
I
I
!
,
i
Poverty!
I
I
1
6,970
6,213
2
9,430 :
8,487
:4
11.190
,
to,701
!
I
I
I
4
14.350
12.915 : 15,785
18,655
21,525
24,395
27,265
30,135
33,005
34,440
5
16,810
15,129 : 18,491
21,853
25,21'
28,S17
31,939
",301
38,663
40,344
2S,05L
28,905
32,759
36,613
40,467
44,321
46,248
28.249
32.595
36.941
41.287
45,633
49,979
52,152
I
(5
19,270
,
I
17,343 : 21,197
I
7
21,730
19,557
!
23.90g
7
i
�I
..
:..
~
•
.
JAN 10 194: 09:33AM GwU CHPR
P. 111} .
1
". l' "
APPENDIX 2
ESTIMATE OF ALLIANCE PR.EMJUM FOR Uga
Pamily Type
,
i
,
,
! BCFA Premium Estimate
I (used' In Cllnton's plan)
\
;
t
i
Lewin/Vm Premium Estimate
$1,933
$2,732
Couple (without childr~n)
$3,865
$5,464
One Adult F:amily
!
$3,894
$5,97;
I
$4,391
$5,172
Single
Two Adult Ramily
,
,
,
I
1
B
�,
I
09: 34A~ GI,,!U i:::~PR
, JAN 10 '9,4
.. ~ .... " ". ~.
P.11.
l
i
APPENDIX 3
IMPACT OJ' SUasIDlES ON
FAMILY OF TIIlt£E
i
% of
\pove:rty
Poverty ',Level
I
,
,
!
HCFA
\
Premium
Estimate
:
,
!
Chafee
. Subsidy
Family
Contribution
Income After
Premium'
• Payment
1
100
I
3;894
3~894
0
11,890
\
3,894
3,621
273
12,806
\
3,894
2~861
1,033
14,424
\
;
3,894
2,492
1,402
16,433
3,894
1,947
1,947
18,266
I
I
3,894
1,402
:,492
20,099
24,969
,
,
3,894
818
3;076
21.893
27,347
\
I
3,894
273
818
26,529
3.894
0
3!894
24,642
-11,890
110
13,079
130
iJ,4~7
,
i
1!50
170
190
17,83'
2.0,213
230
,
,
I
1
I
I
22,591
I
210
I
,
,
,
1
240
28.536
;
,
. ,
I
9
�TO:
FROM:
RE:
CarqI Rasco
Jennifer . Klein
i
Compprison of Health Security Act to Other Health
Reform Bills
1/4/~3
DATE:
\
At~ached ~lease find copies of the. memorandums on the Cooper
and Chafee Bilis. I have also included a Summary of Major Health
Reform Legislation that I find very useful.
;
I
i
I
Please let' me know if there is anything else I can do for
you.
. I
\
"
<~.
�THE COOPER BILL
I
I
I
I
.
The Cooper bill I has serious flaws. Had the President proposed the Cooper bill, it
would have been dead bn arrival.
I
pLC
Coope~ and the
have waged a successful public campaign to convince the press
and others that if universal coverage is added to the Cooper bill .;..- and is phased in more
slowly -- a "qinton Ute", "new Democrat" compromise can be aChieved. In fact, the
Cooper bill ~ot be trlerged :With universal coverage.
!
.
It fails to;
• i:uninsured,.provide health security by leaving 20-25 million Americans
I
,
•
I
lit increas~s taxes by $160-$200 billion (from 1996 to 2000), mostly on
ibenefits of middle class Americans -- people who are satisfied with their
,
I
current health care coverage.
I
I
,
•
I
iu deprives. Americans of choice by forcing them into managed care plans run
,by large i~surance companies or by forcing them to pay for coverage currently
provided by their employers.
:
•
i '
I
~t
!.
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•
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I
Jt increase~ fedet;'al control of the health care system. For example, a federal
board must certify all health plans, and all health plans must meet Medicare
and Feder~l Employee Health Benefit Plan requirements. A federal board
~etermind: benefits. The federal board collects and disseminates all health
quality and cost data.
I
I
I
•
:
allows rationing of benefits at the federal level. The Health Care Standards
Commissi9n can reduce benefits in the future' and, unless Congress rejects the
.
reduction, iit takes effect.
i
Federal control means more federal bureaucracy.
I,
I
...
I
I
I
I
-I
I
.
New federal bodies include the Health Care Standards Commission; the
Benefits. Evaluations and Data Standards Board; the Health Plan
Staridards Board; and the Agency for ainical Evaluations.
In a,'ddition, there will be a massive expansion of the role of existing
agertcies. ,The IRS, for example, must identify the low cost plan in
everY area~ d~termine how much individuals and employers are paying
for health Poverage, and calculate their tax liability above a cap.
!
'
TheibiU requires means testing for subsidies for low-income people, but
the bill does not specify how the enormous task of determining
I
'
i
1
�elig~bility 'for millions of Americans (all those under 200 percent of
povfrty) apross the country will be done.
Analysis
Incompatibility w,ith Universal Coverage
! ,
1
Coo~er
The
bill dJes not,' provide universal coverage. While Cooper claims that his
bill will insure the vast mfljority, of the underinsured, CBO has estimated that 20-25 million
.
people would re~ain uninsured under Cooper's approach.
,
i
I
,
.
By proposing a voluntary system, the Cooper bill avoids difficult issues, such as
financing, mand~tes, and 9<>mm~nity rating. The bill cannot get to universal coverage without
addressing these, question~.
,
,
I
I
•
COmmunity: rating -- Cooper allows age rating -- so that people of different
ages pay different amounts, the old more than the young -- and thereby
,
maintains c~rrent incentives to market to younger and healthier individuals. He
allows insu~ance companies to deny coverage for preexisting conditions for six
months (wh;ich is pecessary in a voluntary system but harmful to those who are
sick and mqst in need of coverage).
I
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,
,
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F~nancing _1-
•
Cooper does not address how to pay for coverage, except for
rovisions onlow.:..income assistance.
P
I
.
•
~e subsidi~s in his bill are inadequate.
Even his "New Republic" allies
believe that Ihis subsidies fall short. If a family earning $20,000-$25,000 per
year must p~y 15 percent of its income for insurance premiums (which does
nQt include out-of-pocket spending), health insurance is simply not affordable.
.
~
I·
.
Taxing tile Middle Class
,
I·
.
' I
The Coo~er plan reimoves. tax deductibility for all benefits above a nationally defined
minimum package, and evbn taxes these nationally defined benefits unless they are purchased
from the low cost. health plan in an area.
:
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;
.
1
This is a huge mid4le class tax. Employers of most Americans with good benefits
today would pay i taxes on their health insurance benefits, either because they provide better
benefits than the (national package or because they do not belong to the low cost health
insurance plan in their area.
This creates insecurity. S~nce the national package of benefits is not defined and can
change under the~ bill, indiJiduals might be taxed in the future if the national package fell
below the level of benefits !they receive through their plan. In addition, enrolling in the low
,
:
I
2
,1
!
�,
cost plan in an area might be difficult, as the plan might have its nearest facility 50-100
miles away, dclude local doctors or the low cost plan may simply change at each enrollment
period.
.
I,
,..
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,
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While simple t* cap ,on deductibility for a comprehensive national benefits package
(with enough l~ad time) :makes'sense, the proposal in the Cooper bill would be an
administrative andpolitieal nightmare.
,
.
Less Cboice
·1
The Cooper bill gives large, national managed care plans a competitive advantage over
community-based plans.:
I
I
•
I
It requiresI , certification of health plans, thereby favoring large plans
national
,
'
with the skills and resources necessary to pursue federal certification. The bill
includes SIgnificant reporting and other requirements for receiving certification .
.I
I .
!
•
,~
j
I
~t promote~ the formation of large multi-employer buying groups that will
~egotiate
;
with hrrge insurers and will limit employee choice.
I,.
i
•
it maintains .antitrust protections for insurers.
i i '
I .
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.
Becaus~
of these ~dvantages -- as well as the limit on tax deductibility of benefits -
more Americans will be forced to join managed care plans. In managed care plans, some
patients may no longer see the doctor of their choice or may be required to go through
"gatekeepers" t9 get care] There are no provisions to support fee-for-service or point-of
service plans. (he Coo~r bill lacks many of the consumer protections included in the
Clinton plan ne,eded to eqsure trat the worst features of managed care do not oveIWhelm the
good features. i i '
Family doctors and small group doctors will be increasingly angry as they are forced
to join managed care netWorks on unfavorable terms. Specialists will see their incomes
increase more ~lowly than today under either plan, but under Cooper physicians would have
less freedom th;m under the Clinton plan.
I
Extensive Federal Control
The federal control in the Cooper bill is extensive.
i
~
~
•
~e Healt~ Care Standards Commission certifies all health plans in the country
and has broad discretion not to approve health plans. Moreover, every health
plan must participate as a Medicare plan and as a Federal Employee Health
Benefit Pla:n, thereby requiring plans to meet additional federal standards.
!'
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3
�\
\
\
\
•
The iICooper Health Care Standards Commission specifies benefits and cost
, '
,
shari~g at some time in the future, subject only to congressional disapproval.
The Commission is therefore free to reduce benefits at any time -- which may
amoJ,nt to federal rationing of benefits.
I
,
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The ~temal Revenue Service (IRS) is given oversight of· a complex taX cap as
well ~s significant enforcement authority over employers with 100 or fewer
workers.
'
I
,
: The Cooper bill requires a vast expansion of the IRS to oversee the
\ complex tax cap it creates. The IRS must determine -- for every
\health plan in the country for every month -- whether, health
;expenditures for the plan's benefit package exceed the low cost plan.
\The t~es of every company and individual that purchases health
Coverage must be adjusted.
I
,
Since small employer participation in health alliances is enforced
through the tax system, the IRS is required to determine whether every
~usiness with 100 or fewer workers is participating properly in the
system. i
\
'
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•
\ A new apparatus would also have to be created to determine eligibility for and
\ to admin~ster subsidies to everyone in the country whose income is 200 percent
',of poverty or less. The eligibility determination cind enforcement process,
,though not spell~d out in the bill, would be enormous.
;
\
,
Increased Feder~1 Bureaucracy
,
I
,
Beyond', the incre~sed federal control by agencies discussed above, the new federal
bureaucracy in Jhe Coop~r bill is extensive. The Cooper bill creates a large and powerful
national commission (the: Health Care Standards CommiSSion) that assumes many of the
functions now performed lat HH~ and DOL and that is given new broad responsibilities not
now performed'~t the fedbral level. Its authority is greater than the National Health Board in
I
'
the Clinton proposal.
•
Al health pl~n may not operate anywhere in the country unless it is certified by
the federal Commission. The plans must meet a whole host of federal
regulations ~stablished by the commission, and the commission has broad
di~cretion not to approve health plans. Plans must:
,
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Provi~e uniform benefits;
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Meet quality: standards established by the commission;
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4
�-'
Eng~ge in Cost sharing adjustments with other health plans;
,
Coll~ct information on enrollees and services electronically;
Meet solvency requirements established by the commission;
-,
Mee~, advanced directive requirements established by the commission;
I
Mee, grievance procedure requirements established by the commission;
,
I
Mee~ agent commission requirements established by the commission;
I
!
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i
Meei physiCian incentive plan guidelines established by the commission;
,Pay
'~Lees establ'IShedby the commISSIOn;
' ,
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~atIon~ ,regIstratIon
,
I
Pay ~ tax to the national medical education fund run by the
commission;
,
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Provide Medicare adjustment payments through the commission;
,
Coo~dinate low-income assistan~ in a manner described by the
com:mission; and
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Be of a minimum size.
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,
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The commission also develops criteria for alliances specifying maximum
overhead levels, payment term requirements, consumer satisfaction measures,
reporting requirements, and requirements for enrollment of at-risk populations.
,
•
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TIle commi~ion defines the nationally guaranteed benefit package and submits
it to the Congress, subject' to disapproval.
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•
rie commiJsion, through another board it constitutes, develops risk adjustment
fOImulas fot the nation.
'
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The commission ~ay direct health plans not to pay doctors or hospitals if the
prpviders fail to provide information the commission deems necessary on
quality or a ,wide variety of other issues.
i
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~e commi~ion defines all
health insurance rules nationally, including age
classes for experience rating of premiums.
,
•
-cle
I'
commis~ion must approve the designation of all areas which will qualify
Ii,
i
5
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as i rural or urban urderserved areas.
•
Tije commis~ion approves the allocation of all federally financed residency
slots and limits those slots to 110 percent of graduates of U.S. medical schools.
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The commission designates medical centers of quality that are eligible for
research and other funding.
!
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The commission, through another board it constitutes, determines what can be
considered *ppropriate medical care.
•
The board, through another board it constitutes, sets information standards for
aN health cAre information.
i
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Shifting :the Burden on :Long-Term Care
,
I :
The bill ~ssumes f~deral 'responsibility for acute care Medicaid and forces the states to
assume full responsibility i for long-term care. This is the opposite of what states would like
since 10ng-teI1'll care needs are exploding. The result would be a serious deterioration of
long-term care :in the cou1ntry. The bill also cuts hospice and home care benefits under
Medicare.
'
Unders~rved POP~lations
!
i
The Cooper bill provides significantly less federal funding than the Health Security
Act for under~rved pop~lations. It eliminates all extra services currently provided for poor
children and all Medicaiq disproportionate share payments for hospitals in underserved areas,
and provides o~ly 5-10 percent of the additional funds we propose investing to upgrade the
health care infr~structure:in underservedareas. It proposes no new public health spending.
i
i
Under the Coope~ bill, there would be a significant likelihood of failure for a large
number of urb~n and rur~1 health facilities during the next couple of years, severely
undermining the health of many urban and rural poor Americans.
,
:
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Constituents
,
'
The na~ional con~tituents of the Cooper bill are:
I
•
•
'''••'''O>''PEU
;urge insvrers and for-profit hospital, chains who will dominate health care if a
;Cooper approach passes, free from the premium caps and consumer and
:provider protections in the Clinton bill.
,
:Small
bu~inesses who will not be subject to mandates.
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Some', big businesses because the bill will make it easier for them to save
money by cutting benefits, because it leaves them more in the "drivers seat" as
big purchasers, and because it is a federal rather thana state-based approach.
i
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!
\
If its contents were 'fully understood, it would be opposed by virtually everyone else,
\'
including: .
,
,
1
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The middle class because their benefits are taxed and they will be forced into
restrictive mcfuaged care plans.
,
,
•
Seniors: because long:"'term care will deteriorate and because Medicare will be
cut but :no new benefits will be added.
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The poqr and ~heir advocates who will see a deterioration in benefits and in the
health iMrastructure now serving them.
•
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Physicia~s,
•
nurses and community hospitals who will be taken over by the
large ins~rance companies.
I
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Low-wa~e workers who still will not be able to afford health care coverage.
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�THE CHAFEE BILL
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Wh~n examin~d cloSely, the 850 page Chafee bill accomplishes much less than the
rhetoric surrounding it suggests. It is described as providing universal coverage; but there is
no requirement that individuals purchase coverage until 2005. It uses the tax code to
. discipline C<?nsumer bFhavidr by denyirig tax deductions for health coverage costing more
than the average of the bottom half of plans in an area. It. maintains many features of the
current insurance system.
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The ~ederalgo~ernment plays a significant role in the proposal, from a Benefits
Commissionlthat devel,ops and interprets the benefit packages and recommends cutbacks in
the event of Cost incre~es to IRS enforcement of the mandate an9. ,a tax cap. HHS would
establish a n~tionwide eligibi~ity determination structure to distribute vouchers to low-income
individuals fqr health insurance.
Overview
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The Chafee bill pas. the following major problems:
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There is no requirement for universal coverage until 2005. Even then,
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unjversal coverage is contingent upon funds being available for
vouchers' for those whose income is less than 240 percent of poverty,
and may 'be expensive for those above 240 percent of poverty for whom
no ;subsidies are available. Some families may be required to pay 15
20 'percent of their income for health care.
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Thd tax cap, set at the average cost of the bottom 50 percent of health
plat1s in a region, will mean increased taxes for millions of people,
mostly middle-class Americans.
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The :individual mandate will provide a significant disincentive for
empioyers:to continue to provide coverage, especially for low-wage
employees '(since the government will provide subsidies, or vouchers, to
indiv;iduals .with incomes less than 240 percent of poverty). This will
incre~se program costs dramatically as companies drop coverage they
now provide.
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The ~enefits: package is not clearly defined.
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e: In the: event:that the costs of the voucher program, Medicare, and
Medi~aid ex~ed a baseline in the legislation, the Benefits Commission
is req~ired to recommend to Congress cuts in benefits, increases in out
of-po~ket c~sts, or cuts.inM~diCare or Medicaid. Either through
rationing beri,efits, increasing consumer costs, or cutting programs for
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the poor or the elderly, the consumer pays for increases in costs beyond
those specified in the legislation.
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There is no financing mechanism for the voucher system. The Chafee
bill contains cuts in the Medicare and Medicaid programs, which make
available some federal funding, and will produce additional revenue
: through the tax cap. But the funding is totally unrelated to the cost of
\ the voucher system, and there· is no other source of funding.
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\There, is a dramatic increase in federal control and bureaucracy .
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A new commission determines benefits and specific cost sharing
, provisions.
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The role of the IRS will be significant. The agency enforces the
individual mandate and oversees the tax cap.
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HHS would have to establish a national system to make voucher
determinations for tens of millions of people.
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Much of the current insurance system is maintained. Individuals may
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still be denied coverage because they have preexisting illnesses, and
in~urance companies will be permitted to continue experience rating
UIi:der certain circumstances.
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Analysis
Failure to Provide Secupty
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No Uni~ersal Acc:ess
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The Chafee bill pU,rports to phase in universal coverage by 2005 -- leaving millions
of Americans uninsured f~r at h~ast the next twelve years.
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Even in ~OO5, univ~rsal coverage will not be achieved. Universal coverage is
contingent upon ~t savings in the Medicare and Medicaid programs -- if savings are not
achieved, federal\ subsidies 1are cut, preventing low-income Americans from affording
coverage. Subsi4ies for cehain categories of people are not adequate, in any event, to make
insurance affordable.
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No Significant Insurance·Refonn
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The Chafee bill iriclddes only minor insurance reforms -- allowing the continuation of
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modified experience rating and some pre-existing condition exclusions. Since the purchasing
groups are vpluntary, ~arketing to low-risk groups and individuals by insurance companies
will continue.
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By allowing in~uran~ companies to charge different prices on the basis of age and
administrativ~ efficien~ies,. insurance companies will continue to market coverage to the
young and h~althy and ito discriminate against older and sicker Americans who need health
insurance thel most.
Further, those i~dividuals with illnesses who seek coverage may be excluded, since the
bill permits insurance companies to deny coverage to individuals with preexisting conditions
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for six months under ~rtain circumstances.
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Comp~ehensive \Benefits Not Guaranteed
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The benefit package is not clearly defined in legislation; the benefits are listed in
thirteen lines Of the bill. \ At b~st it is unclear what the benefit package includes, with no
mention, for example, of vision, dental or extended care services.
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A Ben~fits Commission is charged with clarifying the benefit package through a
recommendation to Congress, which must be affirmatively approved by the Congress. The
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clarification recommendation to the Congress may delete benefits, but may not add them.
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The bill, requires that all' plans cover the listed benefits, through either a standard or a
catastrophic cost sharing policy; The Commission must define covered services; deductibles,
cost sharing and out-of-~ocket Jimits, and submit them to Congress as part of the
clarification report. The ~enefits Commission could, for example, recommend a copayment
or coinsurance payment of 50 percent or more of any payment.
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Because the benefits will' be defined later, there is no guarantee that the package will
be comprehensive or that kll Americans will be able to afford the cost-sharing.
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The Ben~fits ComQIission may also recommend at any point that benefits be reduced.
If health care spbnding for; Medicare, Medicaid, and the voucher program exceed the baseline
amount stated in: the bill, the Commission may recommend benefit cuts, reductions in
eligibility for the, voucher program, Medicare or Medicaid cuts or a reduction in the tax cap.
In the event that :the Commission recommendations are not approved by the Congress, the
funds available for the voucher program are reduced by the amount of any shortfall for the
year, limiting the! availability of cOverage for low-income people.
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Inadequa~e Financi,ng M~chanisms
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The federa,l government is responsible for providing vouchers for low-income
individuals, but tn,e cost to ~he government cannot be calculated without knowing the benefit
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package. 'PIe bill dbes corttain cuts in Medicare and Medicaid, but there is no connection .
with finan~ing of th9 voucher system.
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A baseline ofj federal health expenditures (projected Medicare, Medicaid, and voucher
spending) ~s established. If spending is more than anticipated, the voucher phase-in is
delayed (or benefits reduced) and, after phase-in, the voucher program must be reduced,
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meanmg nQreaI umv;ersaI coverage.
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Taxing
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Middle (;Iass
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The, Chafee plan removes tax deductibility for benefits contributions above the average
cost of the ;bottom 50 percent of health plans in a region. This will mean increased taxes for
millions of:people, rriostly middle-class Americans. We are currently calculating the amount
of the tax ipcrease.!
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Less Cboic~
The :Chafee bill gives large, managed care plans a competitive advantage over
community"':""based pl~s. Because of these advantages, individuals will have less choice of
plans than they do today and may be forced to join managed care plans.
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Heal1th plans n)ust cover an entire "health care coverage area", which may be as large
as an entire, state, may not be smaller than a metropolitan statistical area, and may include no
fewer than 250,000 h:idividu~ls.
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There is no requirement that individuals be offered a fee-for-service plan or a point
of-service ~ption in tVanaged care plans.
Extensive Federal C~ntrol 'and Bureaucracy
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The Chafee bill adds .layers to the existing federal bureaucracy and gives broad new
authorities to federal agencies to regulate the private sector.
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A new federal. commission, the Benefits' Commission, defines the benefit
package: through a long and complicated process requiring that a series of
proposals be submitted to Congress.
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In addit~on, there will be an expansion of the role of existing agencies.
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The De~artmeht of Health and Human Services will have the following new
responsibilities:
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A new apparatus within HHS must be created to detennine eligibility
fhr and ,',to administer vouchers to everyone in the country whose income
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�is 240 percent of poverty or less. The eligibility detennination process,
though not spelled out in the bill, would be enonnous.
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A new office within HHS, the Office of Health Care Competition
Policy, implements health care antitrust policy .
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HHS, with the Department of Labor, regulates large employer plans. It
develops standards to require that large employers: guarantee·
avail~bility to aU eligible employees; guarantee to all enrollees coverage
for services; meet quality assurance criteria; and provide standardized
inforlnation to evaluate the perfonnance of the plan.
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HHSI oversees the quality assurance system by: .
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Developing standards and measurements of quality with which
the quality assurance programs must comply;
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Publishing annual reports on expenditures, volumes and prices
for procedures;
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Developing comparative infonnation regarding the relative
perfonnance of specialized centers of care;
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Stuaying the feasibility of creating an Agency for Clinical
Evaluations; and
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Evaluating and disseminating infonnation on research priorities
and data about effectiveness trials.
HHS develops and certifies models of alternative dispute resolution to
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be used by health plans.
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HHS establishes and coordinates a national health care fraud program.
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HHS' creates a new program to administer grants to the states for low
ine<:?me and medically underserved populations.
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A new office within HHS, the Office of Emergency Medical Services,
proyides technical assistance to state EMS programs.
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HHS develops and submits to Congress a proposal for the integration of
Me~icarebeneficiaries into qualified health plans.
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HIlS establishes a Health Insurance Coverage Data Bank.
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The Department of Labor develops standards for large employer plans, in
addit'ion to .those imposed by 'HHS. Large employer plans must: meet
finan~ial solvency requirements; meet premium payment and collection criteria;
provide mediation procedures for hearing and resolving malpractice claims;
offer :,both the standard and cataStrophic benefits packages; provide an
altem~tive plan if more than 50 percent of the eligible employees so elect; and
proviqe for equitable enrollment criteria.
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The IRS enforces the individual mandate and limitations on tax'deductibility of
benefit,s.' These responsibilities require significant expansion of IRS oversight.
To enforce the tax cap alone,the IRS must measure, for every family in the
count~, the <:ost of health insurance as compared to the low cost plan in the
area an'q calculate the tax status of their health benefits.
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Maintenance
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of Current Insurance Market Practices
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The Chafee bil~ allows, but does not require, small employers (fewer than 100
employees) ~d indiviquals to join purchasing groups and does not permit employers with
over 100 employees toljoin. Because risk is spread across an entire purchasing group, low
risk individu~ls and employers 'with low-risk employees -- who can find less expensive
coverage outside the ptirchasing group -- will choose not to join the purchasing group.
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The purchasing groups: will become insurers of last resort, with a high-risk population
and high pre~iums. n,e higher the premium, the more likely small employers and
individuals wi~l attempt\to avoid joining the purchasing group.
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With the continued ability of insurance companies to market to healthier populations;
the high administrative dpsts in the current insurance system -- including substantial
underwriting ~d marketi,ng costs incurred in attempting to insure only ,low-risk individuals
-- will continue.
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Underserved Populations
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The Chafee bill provides only limited funding for public health initiatives and
investments in ti,nderserved area~. It eliminates current disproportionate share payments under
Medicare and Medicaid, h4rting facilities in underserved areas, at the same time as Medicaid
payments are reduced. These red.llctions take place well before coverage of these populations
can be achieved. \
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�Constituents
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The national constituents of the Chafee bill are:
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~aIler J.....".Who will continue tOlilarket to "good risks",
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Small busmesses who will not be Subject to mandates.
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::me poor imd their advocates who will see a deterioration in benefits and in the
health Infr~tructure now serving them.
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Low-wagb workers who still will not be able to afford health care coverage.
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-SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
(AS OF DECEMBER 22,1993)·
THE HENRY .J.
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.FANtlLY:
FC)UN OAT IC)N
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----.-PREP-AR-EO-FOFi THE-KAISER HEALTH REFORM PROJECT
Prepared by:
Kaiser Commission on the Future of Medicaid
Julie .Darnell
Peter Long
For More Information Contact:
Diane Rowland
Peter Long
(202) 347-5270
�OVERVIEW
American Health Security Act of 1993
IIR 1100/S 491
McDermottiWellstone
Issue
Health Equity and Access Reform Today
Act of 1993 -- HR 37041S 1770
Thomas/Cllafee
Health Security Act
HR 3600/S 1757
President ClintoniGephardtiMltchell .
. Managed Competition Act of 1993
HR 311l1S 1579
Cooper/Breaux
Affordable Health Care Now Act of 11193
HR 3080
Michel
Consumer Choice Health ~urlty Act of
1993 -- S.1743
NlckJes
Mandate 10 individuals not eligible for
Medicare 10 purchase private health insurance,
through system administered by federal
government and financed through individuals
premiums and subsidies for low·income
peraons.
Universal, mandalOry coverage of all
citizens and legal residents by 1995 through
. a "Canadian-style" single ·payer system of·
federal government-sponsored health
insuri·nce administered by states.
Universal, mandatory coverage by 1998 of all
citizens and legal residents who do not receive
Medicare, thrOugh a system of subsidized
private group health insurance administered by
states and purchasing alliances. Financed
through a combination of individual, employer,
federal payments, and state contributions for
low-income peraons and oimall employers.
Universal, mandalOry coverage by 2005 of all
citizens and legal residents who do not receive
Medicare through use of a system of subsidized
private group health insUrance administered by
states and purchasing alliances. Financed
through a combination of individual premiwns,
voluntary employer pmniurns, and federal and
state contributions for low-income ·peraons and
small employers.
Universal, voluntary coverage through group
purchased private insurance for persons not
covered by Medicare through a system
administered by states and regional purchasing
pools. Rnanced through individual and
voluntary employer contributions, state and
federal subsidies avsilable for low-income
persons and small employera.
Improved access 10 private health· insurance .
for peraons not covered by Medicare through
insurance practice and coverage reforms and
through new program of insurance subsidies
for Medicaid beneficiaries and other lowincome persons.
Benentsl
·Cost-Sharlnll
Comprehensive, explicitly defined benefit
psckage coverage primary, acute, and long
tenn care. benefits, with no cost-sharing.
Explicitly defined benefit psckage consisting of
. primary and acute. benefits, with sPecific
permissible cost-sharing levels. Health
insurance benefits supplemented with services
for peraons with developmental, chronic arid
long-tenn care illnesses and conditions through
continuation of Medicaid and a new long~tenn
care block grant.
Broadly described benefit psckage; legislation
indicates several categories of items and
service coverage, with an emphasis on primary
and acute .care benefits. Cost:sharing
permined.
Coverage rules left 10 a national commission, .
which is given broad direction 10 develop
within certain guidelines that assure coverage
of.preventive and diagnostic services. Costsharing permitted. .
Broadly defined minimwn requirements for
standard and catastrophic benefit psckages 10
be offered by employers and 10 individuals,
with authority delegated 10 NAIC to develop
actuarial coverage standards. Benefits not
stated in. tennlI of defined content but rather
. in tennsof actuarial value. Cost... haring
permined.
Flnanclnll
Both insurance coverage and other reforms
fin~nced through a combination of new
taxes, consolidation of Medicare and federal
Medicaid expenditures, state contributions
and premiums for long-tenn care.
Insurance coverage financed through mandslOry
employer contribution, individual pmniums,
state and federal contributions, reductions in
Medicare and Medicaid spending, taxes on large
corporations,and sin taxes. Other provisions·
financed through special taxes on insUrers and
general revenues.
Insurance and other fefonrui financed through
individual contributions, voluntary employer
contributions and Medicare and Medicaid
spen~ reductions. Other reforms financed
through general revenues.
Enforceable federal budget accompanied by
the elimination of private insurance and
. government spending controls over pricing.
Enforceable federal budget for insurance
premiums paid by employers, individuals and
the federal and state government, sUpplemented
with reforms designed 10 increase price
competition among private insllI'Cr!l.
Limitations on the deductibility Or private
insurance.premiums 10 spur competition,
!~psnied by. Medicaid. and Medicare--- _.
spending reductions.
Incre.sed price competition
insures
through market refonns, limits on the
·deductibility of health insurance 10 spur
competition, caps on MediCaid spending,
Medicare cuts and Medicaid -spending
reductions ..
Coverage!
Approach
Cost
Containment·
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Administration
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Federal andstate administration.
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. Federal and sta te administration, with use of
- mandatory" regiiilaland Criiployer purchUifig
cooperatives.
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· Insurance finanCed through individuals and
· voluntary employer contributions and
Medicare and Medicaid spending reductions.
Other refonns financed through general
revenues.
Increased emphasis on price competition
through inSurance mi.rlr.et reform,
accunpsnied by limits on the deductibility of
private insurance costa. In addition, Medicaid
is rqJealed and rqllaced with low-income
assistance capped program. Medicare
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spending ~ reduced,artd .all federal
contributions for state long-tenn care
Medicaid programs are ended .
!,~_~cLsta~ administration,_with.\I8C.of - --Federal andstate·administration;with-use-of small employer and individual pw<:hasing
mandatory purchasing cooperatives for
· individuals and·small firms.
cooperatives.
Insurance ftnanced through individual and
voluntary employer contribution and through
Medicare and Medicaid sPending reductions.
Other refonns financed through general
revenues.
Increased emphasis on price competition
through market reform. Reductions in·
Medicaid spending through caps on the cost
of acute care and the creation of a new
capped health allowance program. Medicare
spending reductions also proposed.
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Broadly defined categories of benefits that
must be offered by participating health
insurance plans, with authority in HHS and
state insurance commissions 10 develop and
enforce coverage standards. Cosi-sharing
permined.
Insurance flnancCd through individual
contributions and through Medicare and
Medicaid spending reductions .. Other reforms
financed through general revenues:
T;"",mation of·employer insurance expense
deductions and employer exclusion, limitations
on the deductibility and favorable tax treatment
of individual tax expenditures. Caps on federal
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psyments for Medicaid acute care coverage
expenses, other Medicaid spending reductic:'"s, . .
- and Medicare -saVings.
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-Fedmliiru.-8i8tC .dlniniltration.
Federal and state administration.
Medicare
Consolidsted with new insurance plan..
Retained, but· with state option 10 consolidate
with new insurance plan.
Retained.
Retained.
Retained.
Retained.
Medicaid
Consolidated with new insurance plan.
Partially consolidsted inlO new system with
respect 10 those Medicaid benefits now covered
by the health benefit plana. Medicaid benefits
not covered by health plans generally still
a.vsilable 10 Medicaid eligible persons..
Consolidsted with health plans at state option.
Medicaid benefits not covered by health plans
still available 10 Medicaid eligible persons.
Repealed and rqllaced by low-income
assistance program. Responsibili1y for
Medicaid services not covered by health plims
relegated entirely 10 states without federal
financial participation.
Revised to give states authority 10 purchase
private insurance for Medicaid benet;ciaries
and ocher low-income people. Medicaid·
spending capped.
Medicaid revised 10 permit states 10 buy
inscinmce for bc:nCIi.ciaries arid low-incane
persons. Medicaid spendiitg capped.
A defmed portion of health budget allocated
Requests funding for resource development for
undersc:rVed.
Requests funding for new reso~
development for underserved.
A defined portion of health budget allocated
Requests funding for new resource
development far underserved.
Requests funding for new resoun:e
development.
- Access to Care
10 resource development for underservCd.
. Kaiser Commasion on the Future of Medicaid (12122J93)
10 resource development for underserved.
�SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
A PRODUCT OF KAISER HEALTH REFORM PROJECT
DECEMBER 22, 1993
LEGISLATION:
American Health SecurHy Act of 1993 (Rep. McDermott/Sen. Wellstone)
Health SecurHy Act (President Clinton; Rep. Gephardt/Sen. MHchell)
Health EquHy and Access Reform Today Act of 1993 (Rep. Thomas/Sen. Chafee)
. Managed COmpetition Act of 1993 (Rep. Cooper/Sen. Breaux)
Affordable.Health Care Now Act of 1993 (Representative MiChel)
COnsumer Choice Health SecurHy ·Act of 1993 (Senator Nickles)
Kaiser COmmission on the Future of Medicaid (12/22193)
CRITERIA:
1. General Approach
2. Coverage
3. Scope of Coverage Pools
4. Benefits
5. Federal Costs
6. Effect on Overall National Health COsts
7. Federal Financing
8. Premiums, COst-Sharing, and Out-of-Pocket Payments
9. Tax Treatment of Health Insurance
10. COst COntainment
11. Federal Administration
12.. Provider Reimbursement
13. Phase-In of;COverage
14. COverage of Older Persons
15. COverage of LOW-Income Persons .
16. COverage of Persons wHh Disabilities
. 17. Treatment oU~9dlca-:e
18. Treatment of Medicaid
19. Reforms In Health Insurance
20~Reformsln-Health-care. Access
21. Reforms In Health Professions -ECiuCBtlijn-
22. Managed care
23. Quality
24. Protections for Individuals
25. Malpractice Reform
�"
SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
DECEMBER 1993
93 In Housal4 In Senata
Publio'Private mixture
Voluntary system
Administered by insurance
companies, States, Federal
government, and large and
small businesses
Voluntary coverage
84% under 65 had
nsuranee coverage In 1991'
••62% employer·related
Insurance'
··8% Individual coverage'
··11% received Medicaid'
··16% uninsured'
One in four Americans'lost
health insurance'in two year,
period between 1987 and
-----
Thomas (R·CA)lChafee (R-RI)
Cooper (0-TN)!Breaux (O-LA)
Mlche. (R-IL)
Nickles (R-OK)
4 In Houaa123 In Senata
52 In Housal4 In Senate
130 In House
25 In Senate
• Individual entitlement to
government-eponsored hllllith
Insurance secured through
mandatory enrollment in Stat..
administered programs and
financed through various taxes
• Individual entitlement to
hllllith coverage secured
though mandatory enrollment in
private health plana offered by
health alilance8 and financed
through a combination of '
Individual and employer
premiums and government
a..lstanee
- Individual entitlement through
mandato"; enrollment in
qualified hllllith plans offered
through purchasing
cooperatlvu, large employer
plans or a government program
• Financed through Individual
and employer prsmlums,
chang.. In tax deductibility and
government 188lstance
• Voluntary program that
establishes cooperative
arrangemsnta to Improve
acce.. to affordabls h..lth
coverage, conditions tax
exemptions for coverage on
enrollment through purctiasing
cooperatives, provides subsldl..
for low Income Individuals and
reforms Insurance practlc..
-Universal and mandatory
coverage of all US citizens and
legal residenUi by 1995
• Covers undocumented
persons If National Board or
States expand eligibility
• Employe,.. ere a....sed a
payroll tax to pay lor program
• Other r"enu.. used to
cover coats of coverage
- Unlverael and mandatory
' coverage of all US citizens and
permanent legal residenUi by
• Promise 01 unlvereal and
mandatory coverage of all lawful
permanent residents by 2005
• Excludes undocumented
persons
• Individual mandate to purchase
coverage in long. term, with
federai subsidies for Iow'income
individuals
• Requires emplOye,.. to oftar.
but not pay for, coverage
• Impoa.. penalty lor
Individuals failing to obtain
covarage equal to 120% 01 the
average yearly premium in a Ioeal
area (Iow·income protected from
,- pemilties) -" ,"
- No coverage mandate
• Expands acc... to health
coverage through, insurance
reforms
• UndoCumented persoris who
do not work are excluded
• Requires employe,.. to oftar.
but not pay lor, coverage
• Government subsidies
available for low-Income
Indlvlduala
• Allows individuals iax deductions
lor their shere of plan premiums
1989'
98% 01 elderly receive
Medicare
3.2 million undocumented
persons in the U.S., heavily
-- concentrated In five-States'
(Prealdent Clinton)
Oephardt (D-MO)!
Mitchell (O-ME)
100 In Housal30 In Senate
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Kaiser Commission on the Future of Medicaid (12122193)
1998
• Excludes undocumented
persons
• Employer mandate to help
pay for coverage by paying
80% of the average family'
premium (divided by the average
number of workers per family
and adjusted by family Iype)
• Individual mandate to
purchase coveraga with
aubsldl.. for Iow-Incoma
individuals through regional
--alliances
.. Imposes penally lor non
compliance equal to double cost
_. ___of.average.premium--- ~--~-
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• Voluntary program that reforms
and standardlz.. group heslth
Insurance 881.. practlc.. and
provides expansion of Medicaid
coverage for low·income individuals
• No coverags mandats
• Expands scc ... to health
insurance coverage through
insurance marketing reforms
• Silent on ,coverage of
undocumented persons
• Requires employers to oftar. but
not pay for, coverage
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--"
---
----
• Voluntary program imposing
financial penaltl.. for
Individuals who fall to enroll In
a private health Insurance plan,
with rastructurl!lg of tax
deductibility of health care
roverage. and redistribUtion of
Medlceld funda to expand access
for low·incOme individuals
• No coverage mandste; but
strong financial penalty
(ellmlnstlon of personal tax
"smptlon) for failing to purchase
catastrophic insurance by 1997
• Silent on coverage of
undocumented persons
• Employers currently offering
coverage must maintain until 1997
and pay difference in wages if
they cash·out their plan after that
date
'Individuals reaponslble for
paying for coverage and health
c:ars '
- Provides peraananncoms to
cradlta to offaat health cenl
coata
----
1
�,:
SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
DECEMBER 1993
companies
• Insurance pOols range from
single persons to large
corporations (5,000+
employees)
• Private insurance regulated
by States
• Medicaid is a separately
administered FederaVState
coverage pool
• Medicare Is federally
administered insurance
• Single pool .dmlnlstered by
e.ch St.te
• Establishes N.tlonal He.lth
Bo.rd to interpret standards for
benefits and to aSsist Stales in
developing budgets
" States must meet Federal
standards
~
- ._
• Requires Statea to eat.bllsh
one or mo.... regional .1II.nces
that are non-profit corporations
or State agencies which oVersee
insurance companies and
providers
--A Metropolitan Statistical
Area may not have more
than one allia nce
--Alliances must be big
enough to negotiate
effectively
--Alliances cannot cross Stale
lines
• Requires employer••nd
Indlvldu.l. to purch••e
In.urance exclu.lvely through
their regional .111.ncea which
negotiate rates, pay premiums 10
plans, and provide consumer
information on price and quality
• Allows Stales to establish
statewide or alliance-wide Single
payer systems
• Allows large corporations
(5,000 employees), Taft Har1ley
Trusts, rural electric and
telephone cooperatives to
c .....te corporate .1II.nce.
• St.te .nd Feder.1 employ...
..... inCluded in regional
81l1a'n098' "
.
• Requl ....s States to eat.bllsh
health cs.... coverage .rea. for
small employers, less than 100
.mploy...
--Allows more th.n one
purch.slng group to operst.
in a geographical ......
..limits the type of State
agencies that may act in an
.1II.nc. role
• Individuals and small employers
may join on voluntary basis
• Requires I.rg.r .mployer.,
more than 100 employees, to
ofter the st.nd.rd or
cat.strophlc benefit. pack.ge
• St.tes may opt out of national
plan to Implement .ltern.tlv.
retonm. if they meet certain
financial requirements
• Requires that States establish
Health PI.n Purch.slng
Coaparatlvea (HPPCs), State
chartered non-profil cooperatives,
for individuals and businesses
with no more thai1100' covered
employees
--limits the type of State
agencies that may act as a
purchasing cooperative
--Requires cooperatives to have
exclUSive service territories
• Raqulrea Indlvldu.ls .nd
.mployera with fewer th.n 100
.mploy... to purch... through
the cooperatlv. to maintain tax
deductibility
• Allows .mploy.ra with mo....
th.n 100 .mploy... to dl....ctly
purch. . . .n Account.bl.
Health PI.n (AHP)
• Allows I.rg••mploy.ra to form
their own group purch.slng
.fr.ng.m.nta
• Allows States the option to
establish volunt.ry In.ur ance
purch.slng cooperatlvea for
small .mploye....
• Allows .xlstlng emplo y.r .nd
group pl.ns to continue
• Allows Individual cons umara to
act .s thalr Own purchasing
.gent• .
• Individual consumara will act
aa thalr own purch.slng sgents
• Allows existing employer .nd
group plans to continue without
tax deduction.
• Changes in tax treatment .lIow
Indlvldu.ls to choose .mong
Insurance pl.n.
• Employers currently offering
coverage are required to add the
value of insurance to their
workers' wages if they decide to
cash-out benefits
• States may increase above 100
as long as no more than half of
employees In the Stale would
purchase through HPPCs as a
result
• Allows St.tea to Include
Medlce.... beneflcl.rlea In
. regional alliances.throj.lglL_,_
Federal waiver
.
-
-
Kaiser Commission on the Future of Medicaid (12122193)
----~-
2
�I~
SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
DECEMBER 1993
• Uses medically necessary and
appropriate as general standard
• Mandates complehenslve
benafi1s package; specified In
the statute
'Indudes inpatient and
outPatient services. professional
services of state-authorized'
practitioners, community-based
primary health services.
outpatient therapy, home
dialysis, emergency ambulance
services, prosthetic devices,
OME, prescription drugs and
biologicals, and prenatal and well
child care
• Family planning aervlces are
Included In benefits
• Preventive services Included
without coat-eharlng
• Mental health services and
chemical dependency
treatment are Included
• Long-term care beneflte
include home and communitybased long-term care, nursing
facility services, home. health
services. and hospice care .
• No ell.clualons of abortion
• Additional benefits and
darificationprovided by National
Health' Board
• Allows States and employers 10
provide additional benefits at
their own expense
.
.-
Kaiser Commission on the Future of Medicaid (12/22/93)
• Uses medically necessary and
appropriate as general standard
• Mandates comprehensive
standard benefits package,
specified In statue
• Includes inpatient and
outpatiem hospir81 services,
emergency and ambulalOry
medical services, services of
physicians and other health
professionals, ambulance
services. laboratory/diagnostic
services, OME,.prosthetics and
orthotics. extended care
services. outpatient rehabilitation
services following an acute
illness. eyeglasses for children
under age 18. prescription
drugs, preventive and .
emergency dental
coverage, and health education
dasses
• Clinical preventive aarvlcaa
withoUt coat-eharlng
• Family planning ..rvlces
Included In'beneflts
• Initially Includes limite on
mental health and substance
abuse aarvlcaa; by 2001,
expands these services
• Creates new long-term care
program (non-antltlement) for
home· and community-baaad
care through grants to States
• No ell.cluslons of abortion
• National Health_Boar.d.IO.. ___
- "iiiierpre! benefits package and
modify preventive benefits
.
• Allows individuals 10 purchase
supplementary insurance
• Preempts State mandated
benefit laws for group health
plans
care
• Uses effective and appropriate
as general standard
• Requires qualified health plans
10 offer standard benafi1s
package or· combination of
catastrophic benefits package and.
medical savings accounts to small
businesses
.• Specific benefi1levels to be
clarified by National Benefits
,CommiSSion, after enactment
• Standard package 10 include
services under the following broad
categories: medical and surgic81
services and equipment.
prescription drugs and biologicals.
rehabilitation and home health
services related 10 an acute care
episode. hospice, and
transportation
• Preventive health ..rvlce8
Included, not established whether
cost-sharing required
• Severe mental hlialth and
substsnce abu" aarvlcaa are
covered
• Lang-term cere ..rvlcaa are
nat Included In standard
pacbge
• No ell.cluslons of abortion
• Additional services and lower
cost-sharing may be offered
separate from standard paCkage
• Preempts State mandated
benefit laws for group health
.plans..__. .--.. - -_.
• Uses medically necessary and
appropriate 'as general standard
• Aequires all plans to offer
Standard beneflta package
; Includes broad outline of
covered services, benefits to be
established, after enactment, by
Health care Standards
Commlaalon
• Requires standard benefits
pack8ge 10 include full rang. of
preventive sarvicas with no
coat-aharlng
• Silent on Issue of family
planning
• Mental health and substance
abuse benefits are not specified
in the bill
.
• Long-term care benefits are
not induded in benefits package
• No ell.cluslons of abortion
• Allows plans 10 offer
supplemental benefits as long
as they are non-duplieative and
offered separately
• Preempts State mandauid
benelit laws for group health
plans
.
• No standard baneflts package
• Insurers. are required to offer
small employere a choice of
thres'plans: standard coverage,
catastrophic coverage, and a
medical savings account
• Establishes broad definitions of
thli three ·types of plans and
requeats National Aaaoclatlon of
Insurance CommlaalOrier to
dstermlne actuarial value of
coversge
• Allows insurers 10 create any •
benefits package for small
employers that fha within 5
percent of actuarial value .
• Silent on Issues of preventive
'care, substance abuse and.
mental health and long-term care
• No ell.cluslons of abortion
• Preempts State mandated benefit
laws for group health plans
• Imposes penalty for not
obtaining at least a cateatrophlc
benefits package
• Establishes broad categories that
benefits package is required 10
meet
• Catastrophic benefits package
must include at least medically
necessary acute care services:
phySician services, inpatient.
outpatient and emergency hospital
services. and inpatient and
. outpatient prescription drugs
• Benefit package nat required
to Include prevenUve ..rvlces.
mental heaHh and substance
abu88, or long-term c8re
..rvlcas
• Explicitly states thatbenefha
package does not have to
InclUde abortion ..rvlCes
• Preempts. State mandated
benefit laws
3
�.',
SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
DECEMBER 1993
.1
• Federal spending on
Medicaid $65 billion dollars in
1992
, Federal spending on
Medicare $130 billion in 1992
, Total health care spending
13.5% of GOP in 1991
• Rechannels approximately
$370 billion per year In current
private spending to the
Federal government through
tax system. replacing most
private spending
• States pay providers. hospitals
and nursing homes
• $213 billion cost of low-income
aubsldles, 1997-2005; only
implemented after savings
raallzad In Medicaid and
Medlcara and tax revenue
increases
• Budgat neutral to the Federal
deficit
• $25 billion In Federal funding
par year or $125 billion over 5
ysars to implement
• Budget neutral to the Federal
, deficit
, Bill sponsors estimate total
spending at $1.47 trillion in 2000
, lewinNHI estimatas total
health care spending to,be
$1.57 trillion in 2000
, NOt specified
~
, Federal financing through
employer payroll tax and sin
tax..
, Detalls of financing are still
under reviSion
, Eliminates employer and
Individual premiums for health
insurance which covers services
in the comprehensive benefit
package
, Es~mates 5 year revenues of
$89 billion from cigarette and
corporate alliance tax..
, Estimates 5 year revenues of
$124 billion from apendlng
reductlona In Medlcara; $65
bUlion from Medicaid
, Estimates 5 year revenues of
$40 billion from other Federal
programa
, Estimates 5 year revenues of
$71 billion as a result of IImlta
on tax exempt health
apendlng, and other changes
, Caps Federal apendlng:
$10.3 billion in 1996; $28.3
billion in 1997;.$75.6 billion in
1998; $78~9 biilion in 1999; and
$81.0 billion in 2000
, Estimates 5 year revenues of
$213 billion from reductions In
growth of Medlcara and
Medlcara spending
, Slows the rate of growth In
Medlcara by $40 bi1lion over 5
years
··Phased·ln elimination of
dleproportlonate ahare
hospital paymenta
-lncraa.e. pramluma for
Medicare Part B for high·
income Americans
• Capa employer tax deductions
to lowest cost qualifying
accountable health plan. raising
$15 billion per year
, Imposes 1% premium tax on
Accountable Health Plans to fund
new GME program
• Repeale Medicaid program,
generating unspeafied'Federal
savings
'lewlnNHI estimates total
spending without health
reform at $1.53 trillion in 2000
• General tax revenues
finance Medicaid, Medicare,
CHAMPUS, Veteran's
Administration and the Public
Health Service
• Treasury Department estimates
, $390 billion in Federal funds
over 5 years to pay for plan
• Estimates $57.7 billion
reduction In the budgst deficit
over five years
-- ,--
---
--
Kaiser Commission on the Future of Medicaid (12122193)
Not speci fied
• $17 billion In additional Federal
costs to implement reforms over 5
years
• Budgst neutral to Federal deficit
• $133 billion in additional Federal
costs to finance tax changes
between 1997·1999
, Budgst neutral to Federal deficit
• Not specified
, Not specified
• Es~mates 5 year revenues of $13
billion by Incrsaaing Federal
ratlramantage from 55 to 62 and
prefunding retirement health
insurance costs
, Estimates 5 year revenues of $4 ,
billion by phaalng out Medlcara
aubsldl.. for seniors with incomes
over $100,000
• Estimates revenues' of $72---"
billion between 1995-1999 from
. reductions In tha growth of
Medicaid apendlng
• Estimates revenues of $87
billion between 1995-1999 from
chang.. In the Medlcara
program
~------
4
�SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
DECEMBER 1993
• Average 1991 premium lor
private insurances:
··Individual, $1,700
··Family, $4,200
• Employers contributions to
Insurance premiums are
voluntary
--Employers contribute lor
75"10 ol.lull·time
employees and 8% 01
part-time employees
·-Average contribution
-~levels-are:"88%-lor
individual and- 70% for
famities .
• Cost-sharing levels:
·-HMO and Point 01 Service
range from $4 to $8
copayments per visit
··Typical coinsurance
amounts in fee· for-service
plans are 20%
• Out-ol-pocket limits range
from less than $500 up to
$5,000 and higher
• In a recent
Kaiser/Commonwealth/Harris
survey, 330/. 01 Americans
reported paying more than
$500 out-ol-pocket last year
lor health care
• Pr.mlum payment. required
• Premium payments requIred
• No pr.mlum payments
• Places no IImh on pramlume
required for acute care
and IImll.dby p ...mlum cape
• Premiums requIred for long
• Mandalea employere In
• Requires employers to offer, but
lerm ca...
regIonal alliance to pay 80% 01
not pay for, coverage
• Phaa••ln Fedaral p ...mlum
• No d.ductlblea, copaymenta,
average family Premium lor full
or colnau ... nce is required 01
time employees and their
aaaistance vouchs ... 10
individuals Iorarote or
lamilies (> 30 hourstweek), with
individuals with incomes 01 below
90% 01 the Fed~ral poverty level
preventive care
pro-rated contributions lor part
• Requlraa copaymems lor
time workers and families (> 10
by 1997; to 110% by 1998; 10
long-term care
hoursfWeek) 130% by 1999; to 150% by 2000;
to 1700/. by 2001; to 190% by
• Providers must accept
• Indlvlduala (other Ihan AFDC reimbursement as payment in full
and SSI ban.flclsrlaa and
- 2002; to 210% by 2003; 10 230%
-and-cannotbill_iJidlvidualsJ2!' __ certaIn ...11 ....a) and famlllea
by 2004; and to 240% by 2005
additional amounts
@iitrlb-uta20%on:ostrOrthe
.-Coat-sharlnglev.lalo ba_
average weighted premium Plus determined by Banefits
_excess, ifthey -choose above
. Commission
average plan
. • Does not apaclfy out-of-pocket
• Non-workere, other than
IImha
• Cost-sharlng aealstance
AFDC and SSI reclplenti;
responsible lor 100% of
provided for Medicaid
premiums wi discounts
ban.flclarlea
• Caali aaaistance walfa ...
reclplenls pay nothing;
FederallState governments
subsidize full payment
• Premium discounts available
lor:
~
...:....-----
--Non-working Individuals
with unearned -income under
250% poverty (80% share)
--Low-income families under
150% poverty (20% share)
·-Low-wage workers in
_corpo@!1! ~Iianoos
• Fainily premiums
3.9"10 lor families with Incomes
under $40,000
• Establishes three cost
shartng schedulea: low cost·
sharing (HMO-type plans). high
cost· sharing (fee-lor-service
plans). and combination cost
sharing (preferred proVider
-organizations)
• Cost-Sharing assistance
offered 10 wellare recipients only
in HMO-type plans
• Providers must accept
reimbursement as payment in
full
cappedat"
Kaiser Commission on the Future of Medicaid (12122193)
• Pr.mlum payments required
- • Premium payments required
• Premium paymenta requIred
• Places no IImh on premiums
• Placea limits on Insurance .
• PlaCes no IImh on p...mlume
• Requires employers to ottar,
premium rate varlatlona charged
·-Establishes maximum IImh-on
but not pay for. coverage
to small businesses
Individual and family
~Full p ...mlum asslatance
• Requires employera-to ottar, but
deductlbl.s of $1,000 and
available for low-Income
not pay lor. coverage
$2,000. respectively, indexed to
populations under 100% of
inflation in future years
• Pnovldes subsldlea for low
poverty lavel whh alldlng scala
Income Individuals to buy Inlo
• Establishes $5,000 IImh on
upto 200%
Medicaid
annual family out-ot-pocket
• Beneflls Commlaslon will
• Individual cost-shartng I.v.ls
costs. indexed to inflation
spaClfycopayment, deductible
a... not apaclfled
• Doas notspaclfy cost-shartng
and out-of-pocket IImha alter
smounts under the aggregate
enactment
limits
~Requires cost-sharing, except
• Asslatanc. lor heahh cs... for preventive servlces-- .--- -, 1·-·---
-~--·----I-costs"provided-th!:QJ.lgtL!n~!lc!ual-IL--~
• Nominal cost-sharing lor lowIncome tax credhs
Incom. Individuals
• Providers must accept
reimbursement from insurers as
payment in full lor services
---------_.
--
5
�.'
SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
DECEMBER 1993
• Employer health
contributions are 100% tax
deductible
• Employee contributions
have 100%, tax exclusion
• Sell-employed purchasers
can deduct 25% 01 insurance
costs
o Long-term care insurance
not tax deductible
o Individuals can deduct
unreimbursed medical
expenses which exceed 7,5%
of adjusted gross income
• Not applicable. prtvate heaHh
Ineurance will be virtually
eliminated
o Program is financed through
new employer payroll tax..
and eln taxee
o Imposes long-term care
premium/tax on persons over 65
of $65 per month (exemptions lor
low-income elderly)
o Ralaes deduction for aelf·
employed to 100"10
• Effective January 1. 2004,
eliminates exclusion from
employoo income of employer
paid health benefits beyond
those required under the Act
• Termlnat.. tax exclusion lor
employee flexible spending
accounts
• Medical savings accounts are
not available
• Provides the same tax benefit
for long-term care Insurance
o Utilization review and other
managed care arrangements
In the private sector
o Prospective payment
system. utilization review.
RBRVS-based foo schedule
under Medicare
o Low provider reimbursement
and movement to managed
care In Medicaid
o Establishes annual global
budgetelor health care, limiting
growth In expenditures 10 GOP
• State eats physician f_,
hospital and nurelng home
budgets
• National HeaHh Board
negotlat.. preacrlptlon drug
prtces with drug companies
o Sets separate budgets for
capHal projects, such as new
equipment
o Admlnletratlve savings
• Sets IImHs on Insurence
premiums paid by Individuals,
employere, State and Federal
goYemments
o Promotes price cuts through
managed competition
• Imposes limits on MSdlcare
and Medicaid spending and
Federal subsidy payments
o Changes in tex Pl'ovlslons to
IlmH tax deductlbllHy
• Medical malpractice reform '
• Admlilletratlvs savlnga
o Medicare Is lederally
,
Establishes National HeaHh
administered by DHHS--- -. -Board to Ht-etandards foro Medicaid is a joint FederaV
benefits and to aealet Stat.. In
State administered program
developing budgets
o Limited Federal oversight of
States must meet Federal
private health insurance
standards
market beyond assuring
solvency
0
0
Kaiser Commission on the Future of Medicaid (12122193)
• Creates a National HeaHh
Board within' Administration'IO--
determine benefits, eat
national and raglonal budgeta
and determine compliance
• Oversight by the National
HeaHh Board and
Departments of HsaHh and
Human Services, Labor and
Treasury
• Federal administration of
regional alliances, lor 15% foo, if
States fail 10 establish
• Permits regional alliances 10
borrow Federal money 10 cover
cash-flow shortfalls
Allows all Individuals to deduct
100% of the coat of their health
Insurance premiums. up a •
specified tax cap
o Tax cap on individual exclusion
is equal to lowest one-half of '
certified plans in an area
o Msdlcal aavlngs accounts are
avallabls and tax deductible
o OHHS determines tax treatment
of multiple employer trusts
o Provides the same tax benefit
for long-term care Insurance as
other health insurance
o Allows all Individuals to deduct
100% of ths coat of their health
Insurance premiums. up to the
tax cap
o Self-employed Insurance tax
deductible up 10 the cap
o Caps deductibility at the lowest
cosl plan in a region which offers
standard benefits package and
moots minimum quality and
enrollment criteria
o Silent on tax treatment of long
term care
• Raleas deduction for aalf
employed to 100%; provides
deductions lor employeas who
purchase own insurance
o Phaaes In deduction lor
pravlously unlneured who are not
offered employer coverage
o Medical saYings accounts and
catastrophic coverage fully tax
deductlbls
o Provides the same tex benefit for
long-tarm care Inaurance as acute
Insurance: gives option 10 use
IRAs, 401(k) plans or lite
Insurance 10 purchase long-term
-care·coveraga------- --
o Ellmlnat.. tax deductibility of
hsaHh Insurance
• Replacea wHh refundable
Income tax credlte lor health
care expenditures on sliding scale:
--25% credit for health
spending under 10% adjusted
gross income (AGI)
--50% between 10%-20%
of gross income
--75% over 20% of AGI
o Allows 25% credit for medical
eavlngs account up 10 $3,000
per individual
• Long-term care would receive
.. preferred.tax.treatmenL___ _
o Personal Incoms tsx
exemption is disallowed as a
penaHy for being uninsured
o No global budgets or premium
limits
o Managed competition among
health plans in insurance
purchasing cooperatives lor
individuals and small businesses
Reductions In Medicare and'
M8dlcald spending growth
o Changes in tax prOvisions to
IImH tax deductibility
o Relorms medical malprectlce
o Admlnletratlve savings
o No global budgets or premium
IImHs
o Managed competition among
accountable health plans
• Reductions In Medicare
spending growth
• Repeal of Medicaid
o Changes in tex provisions to
IImH tax deductibility
o Medical malpractice reform
• Admlnlstretlve savings
No global budgete or premium
I1mHs
o Voluntary managed competition
• Encourages prics competition
among Insurara
o Reductions In Medlcera
spending growth
o Medical malpractice reform
• Admlnletretlve eavlnga
o No global budgets or premium
IImHs
• No managed competition
o Price competition among
insurars lor consumers
o Reductions In Medicare and
Medicaid spending
o Changes in tex Pl'ovlslons to
limit tax -deductlbllHy
o Medical mslpractlce relorm
o Admlnletratlve savlnga
o Creates independent HeaHh
Care _Stan•.rd.l. ~.!!!!!II~I.~to
determine the specific benefits
covered in standard benefit
package. risk adjustment factors
and outcomes reporting
requi rements
o Creates private sector advisory
board 10 advise Commission
o Creates OffIce of prtvata HeaHh
Care Coverage within Department
- orHe8lttiand Human Services ~
o Establishes an OIflce of
Emergency Medical Services 10
coordinate rural access 10
emergency care
• Combines administration of
Medicare Par1 A and Par1 B
o
. 0
o
Creates a HsaHh Standards
specific benefits and cost
shartng levele to Congr_
o Federal govemment monitors
multi-State plans
o Federal govemment will set up
purchasing cooperatives if States
fail 10 establish
o
No new Fedsral admlnlatretlon
Secretary of OHHS, with the
National'Association of Insurance
CommiSSioners, develops
guidelines lor Federaily qualified
health plan, proposes health
insurence market reforms. and
suggests non-binding rating
standards
o
o
6
�I ,
SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
DECEMBER 1993
• Fee-for-service paid at
some percentage of usual
and customery rate'charged
by providers in an area
• Medicare RBRVS fee
schedule established by
Federal govemment
• Medicaid fee schedule
established by States
• Capitated plans negotiate
rates with individual providers
• Medicare and Medicaid
payments are made to
hospitals that care for the
uninsured
'
''In-l992,according to,Match-
Current Population Survey.
39 million Americans were
uninsured
• Pays hospitals and nursing
homes based on global budgets
established annually
• Reimburses other facility-based
services. Including outpatient
services. home- • school- and
community-based services.
through annual operating
budgets, fee eched,ulee,
capitation payments or an
altemative prospective payment
method
_ 'F!elmburses Independent
hsaHh care profeaslonil-s-
basad on fea schedUles
'negotiated at the State level
, Can pay community haillth
sarvlea organizations (HMOs)
an annual capltated rste
• Prohibits balance billing by
providers
Baglns_11,1195__
• Capllated liealth plans
negotiate rates with Individual
provldera similar to current '
situation (anti-trust reforms
permit providar negotiations)
• Alliance or State devillops "e
schedules for "e-for..ervlces
plane
• Allows for relmburaement for
' specified services which WOuld
' be furnished by phvslclan
but could be performed by a
health profaaslonal who is
-licensed'to-perform-!,llm
services in !he State
• Designated ...entlal
providers have minimum
reimbursement protection
• ReimbUrsement for emergency
and' urgent care provided
outside alliance service area
according to FFS schedule in
alliance where services provided
• Replaces Medicaid
dlsprOportlonste ahare COSH) ,
payments with smaller
vulnerable population adjustment
and reduces Medicare OSH
payments
• Prohibits balanca billing'
(both under comprehensive
benefit package and Medicare)
• Provider payment
methodology Is not specified
• OSH paymente toprovldere
for uncompensated care are
phBsad out by 2000
• AI~s_~ci~~gStates to
start in 1996
• Requires States to have an
approved plan by 111198
• Corporate alliances may not,
start until 111198
, • Requires Individuals to have
,. liiiuranca by'2005
• Ph_In Federal premium
assistance to Individuals with
incomes ofbelow 90% 01 the
Federal poverty level by 1997; to
110% by 1998; to,13O% by 1999;
to 150% by 2000; to 170% by
2001; to 190% by 2002; to 210%
by 2003; to 230% by 2004; and to
• Payment methods to
provldere are not specified
• Medicaid DSH payments are
eliminated with the repeal of
the program on January 1, 1995
• Prohibits balance billing by
providers in qualified health plans
• Payment methods to provldera
are not specified
• Medicaid DSH payments to
providers can be used by States to
expand insuran98 coverage
• Payment methods to providers
are not specified
, • Medicaid DSH payments to
providers are converted into
grants to States to expand
coverage
• Insurance reforms begin on
1,,1991
• Implements malpractice reforms
three years after enaClment of
legislation
• T Ql( changes take effect on
~!!t~r 3.!,t~ ~ ' ___
• Grants to States lor low-income
uninsured issued between 1997·
2000 as ',DSH payments are
phased out
• Medicaid and Medicare
reductions begin in FY 1995
a
• Enrollment in HPPCs. Iow
-Income'assistance anQ tQl(
reforms begin on January 1,
1995
-~' I-January
240% by 2005
Kaiser Commission on the Future of Medicaid(12122193)
7
�SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
DECEMBER 1993
• Virtually all (98%) elderly
have Medicare
• Some have supplemental
medigap insurance
• sOme receive supplemental
benefits end premium and
cost-sharing assistance from
Medicaid
• Some have only Medicare
• long-tenn care purchased
out of pocket or financed by
Medicaid after 'spending
down'
• Integrates Medicare
• Folds Medicare beneficiaries
Into State systems
·-Eliminates cost-sharing and
deductibles
··Expands benefit package to
. include prescription drugs
and other benefits not
rurrently offered
• Eliminates need for
supplemental private insurance
for the elderly
• Qualified Medicare
Beneficiaries (OMBys) on
Medicaid would have no cost· .
sharing or deductibles
• Introduces new long-term care
progrem for persons with 3 or
more activities of daily living
(ADls) impairments
------~-.
-Kaiser Commission on the Future of Medicaid (12122/93)
• Maintains Medicare as
uparate program with
individual options to integrate:
--Requires Medlcare..llglble
people who work to atay In
health alliance
--Permits certain Medicare
retirees to remain with their
regional alliance health plans
• Expands benefits to indude'
n_ outpatient prescription
drug benefit
• Imposes a co-insurance on
laboratory services
• Reduces overall Medicare
spending growth
• Provides 80-100% payment of
regional alliance plan premiums
in the case of early ratlre..
(ages 55 to 64)
• OM.Bys remain covered under
Medicaid
• Establishes an expanded
long·term care progrem
(mainly home- and community
based services for severely
disabled persons) through grants
to the States
separate program
--Individuals have option to
enroll in qualified health
plans
·-Requlrement to purchase
Insurence Is mat by enrolling
-In Medicare
• No new benefits; expands
SELECT program to enroll more
beneftciaries in HMOs
• Imposes a co-insurance on
laboratory and homa health
services
• Applies means·tests to Part 8
premiums
• Reduc. . overall Medicare
spending growth
• OM8ys on Medicaid continue as
is
• No long-term care program
separate program
··Allows Medicare beneficiaries
to enroll In AHPs
·-May also remain in current
program
• Expands Medicare benefits to
cover preventive services
• Expands SELECT program to
enroll beneficiaries in HMOs
• Increases Part B premium for
. high-income individuals
• Reduces overall Medicare
spending growth
• Provides cost-sharing subsidies
for low-income elderly similar to
rurrent Medicaid
• No long-term care program
• Maintains Medicare aa separate
progrem
• No n_ benefits: expands
SELECT program to enroll more
beneficiaries in HMOs
• Increa... Medicare Part B
premIums for high· income elderly
• OMBys remain covered by
Medicaid
• No long·term care program
• Maintains Medicare as
uparate program
• No new benefits are added
• Imposes colnsurence for
laboratory urvlces, certain
home health cere urvlces and
skilled nursing facilities
~ Reduces overall Medicare
spending growth
• OMBys remain covered under
Medicaid
• No long-term care program
• Secretary of HHS to conduct
feasibility atudy of allowing
future Medicare beneficiaries to
rataln private health Insurence
coverage In lieu of Medicare
---- - _.
8
�r
SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
DECEMBER 1993
, In 1991. Medicaid covered
46% of persons with incomes
below poverty level'
, 20% of poor have private
coverage'
.
'33% 01 poor are uninsured'
, Uninsured can receive care
at community health centers
and emergency departments
which are reimbursed lor
uncompensated care
, Integrates Medicaid Into State
systems
, low-Income uninsured
. receive coverage without
premium payments
, ComprehenSive benefit
package equivalent to Medicaid
, Provides additional saleguards
and outreach efforts to ensure.
equal acooss to care
., No coat-ahsrlng or
deductlbles
Kaiser Commission on the Future of Medicaid (12122193)
, Acute care Medicaid
replaced with regional alliance
plans for all low-Income
Including beneficiaries who
are "alliance eligible" (All
Medicaid beneficiaries except
undocumented persons and
Medicare beneficiaries)
, Uninsured are also integrated
into regional alliances
, Provides State and Federal
premium assistance lor Medicaid
beneficiaries and low-income
lamilies up to average weighted
premium·
'-Assistance lor 'Iamity
share" 01 premium (20%
share) available for lamilies
with Incomes below 150"10
poverty
--Assistance lor the 80%
share 01 premium available
to non-working lamilies with
incomes <250"10 poverty
--Corporate alliance peys
subsidies lor low wage
employees (un~r $15.000)
--State and Federal pay 100"10
premiums lor AFOC and SSI
; Caps Federsl asslatance for
iow-Income
, Provides coat-aharlng
discounts to poor peaple
enroll8d In HM0-4ype plans,
only if they also receive cash
assistance
.
, Allows States to purchase
private Insurence coverege
from qualified health plans or
retaIn Medicaid
, Provides premium subsidies
for low-Income uninsured
Individuals to purchase private
Insurance (see phase-in
coverage under #13 and #8)
, Federel subsldlea are
contlngenl upon savings In
Medicaid and Medicare
, Benefits in standard package
are less comprehensive than
Medicaid
, All coat-aharlng for current
Medicaid beneficiaries enrolled
In qualified health plans would
be paid by Medicaid
, No cost-sharIng subsidies lor
non-Medicaid low-income persons·
• Repeals Medicaid and
raplaces with a prcigrsm of low
Income assistance for health
coverage by purchasing Into
AHPa through HPPCa
• Provides full premium
subeldles lor people with
incomes leaalhan 100% of
poverty
··Provides subsidies on a sliding
scale for individuals with incomes
between 100% and 200%.ot
poverty
, Cape Federsl low-Income
asalalance subsidy
• Prohibits employers who offer
coVerage to their employees from
dropping coverege lor those
eiigible lor subsidy assistance
• Provides prescription drugs.
eYegla..... and hearing aids il
above basic benefit package lor
persons with incomes below
100% ot poverty
• Assures nominal coat.sharlng
lavels for Indlvlduala with
. Incomes undf!r 200% ot poverty
, R88Iructures Medicaid
to permit States to establish health
allowance program for Medicaid
and other low-income persons
'Caps axpanslon funding of
medical allowance program al
expected spending levels without
program
• Senaflts In private plans muat
at leaat be ictuarlally equivalent
to per capita medlcalanlatsnce
payments lor beneficiaries
• eoat-aharlng may be required of
Individuals with Incomes over
100% of povsrty
, R88Iructures Medicaid
, MedIcaid DSH payments
replaced by Federal grants to
States to establish programs that
provide health care lor low
Income uninsured Individuals
apendlng graater than 5% ot
grosslncoma on health care
through:
--Financial assistance to
purchase health insurance
--Direct delivery 01 medical.
. services
--Funding 01 community and
migrant health centers
--Improvements in
availability 01
emergencyltrauma care
• Seneflta under DsH grant
program may be 1888
comprahanalve than Medicaid
'Anlstlnce with out of pockat
C081a appll.. only to IndividualS
apendlng more Ihan· 5% ot
gross Income
9
�,
SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
DECEMBER 1993
• 15 million persons report
disabilities that prevented
them from working
• In 1992, 3 million low
income persons with
disabilities received Medicaid
coverage because they
qualify for Supplemental
Security Income"
• An additional 1 million
persons with disabilities
receive Medicaid through
"medically needy' programs·
• Medicaid, in many States,
covers rehabilitation, PTIOT
and other services necessary
to treat chronic conditions
• Persons with chronic
conditions can be excluded
from private coverage or
charged exorbitant premiums
• No coverage limitations
based on the cause of illness or
injury for acute care services
under national plan'
• Persons with thrll8 or more
ADLs are covered under new
national long-term care
program
Kaiser Commission on the Future of Medicaid (12122193)
services for persons whose
conditions do not result from an
injury 'or Illness
• Benefits covered by Medicaid
but not covered by health plans
would be available to tow
income persons who qualify for
Medicaid
• Certain Medicaid beneficiaries
(AFDC, SSI, children under 21,
and Medicare eligible persons)
would get more "wrap-around"
benefits than others
• Provides new block grantS to
States for horne- and
communlty-ball8d care for
disabled persons with 3 or more
ADLs
• Retains Medicaid coverage 01·
institutional and noninstitutional
long-term care
• Provides disabled employed
Indlvlduale who require
personal .eelatanca with tax
credits covering 50% of th~ir
costs up to $15,000 per year
• Prohibits discrimination based
on health status or disability
• Standard benefit package
does not discriminate in
coverage based on type of
condition, because benefits are
not specified
• Low-income persons can
continue to be covered under
Medicaid program
• Medicaid children with special
needs remain in fee-lor service
Medicaid program
• Retains institutional and non
institutional long-term care as a
Medicaid responsibility lor
eligible persons
• Prohibits discrimination by
health lnaurera on the basis'ol
health status
• Standard benefit package, has
no specific limitations or
exclusions identified, because
benefits are not specified
• Current Medicaid beneficiaries
with disabilities are lolded into
HPPCs
• Directs Health Care Standards
Commission to determine any
unmet medical needs 01 current
Medicaid populations as a result
of integration
• Repeals Medicaid, leaving
long-term care as a State
responsibility
• Umits. pre-i!xisting condition
clauses
• Benefit packages will be baaed
on actuarial value
• No specific limitations or
exclusions Identified, because
benefits are not specified
• Retains long-term care portion 01
Medicaid
• Limits pr_xlatlng conditions
clauses
• Minimum cataatrophlc benefit
requirements
• No specific limitations or
exclusions identified, because
benefits are not specified
• Current Medicaid beneficiaries
with disabilities remain as is
• Retains long-term care portion 01
Medicaid
.
• Umits PI'_xlatlng conditions
clauses
10
�II
SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
DECEMBER 1993
physicians, but they are
allowed to balance bill
• Medicare does not cover
prescription drugs
• DRG payment system used
to reimburse hospitals
• Has significant deductibles
and co-insurance which Iorce
many elderly to. purchase
medigap insurance.'
• limited coverage of long
term care
• Integrat.. Medicare
• Folds Medicare beneflclarl..
Into State eysteme
--Eliminates Cost-Sharing and
, deductibles
--Expands benefit package to
. include presaiption drugs
and other benefits not
QJrrently offered
• Ellmlnat.. need tor
eupplemental private insurance
'lor, the elderly
• Qualified Medicare
Beneflclarl.. (QMBys) on
Medicaid would have no cost
sharing or deductibles
Kaiser Commission on the Future of Medicaid (12122193)
separate program
--Allows States to get
Medicare waivers to bring
beneficiaries Into ailianc..
--Medlcare-ellglble workeril
remain In alllancea wi1h
Medicare as secondary
payer
--Allows Medicare
beneflclarlea to stay with
their health Insurance plan
If It mests Federal
atandards
• Expands benefits to indude
outpati!lnt prescription drugs
• Imposes 20% co-Insurance
on laboratory eervlcea
'
• ReduC88 Medicare spending
by $124 billion, expecting 10
decrease rate of growth to 7.4%
by the end of the decade
• Secretary has new authority
to develop new health
Insurance products for
Medicare beneficiaries
separate program
--Allows Medicare
beneficiaries to enroll in
qualified health plans
• No expansion of benefits
• IncreaseS Medicare Part B
coinsurance and means tests
premium ,taxes
• Imposes 20% copaymenta on
laboratory and home health
'
eervlcaa
.• Reducaa overall Medicare
spending growth
• Expands SELECT program to
enroll more beneficiaries in HMOs
• Directs the Secretary of DHHS
to conduct a study on the
pha88-ln of current Medlcsre
bensflclarl.. into qualifi8d health
plans
eeparate program
--Allows Medicare beneflclarlea
to enroll In AHPa
--May remain in current
program·
• Expands benefits to indude
. some preventive care
, • Increases Part B premium lor
high-income individuals
, • Reducaa oversll Medicare
spending growth
• Expands SELECT program to
all States to enroll more
beneficiaries ,in HMOs
, • Maintains Medicare as a
. separate program
• No expansion of benefits
• Imposes Medicare Part Btax on
individuals with over $100,000
• Expands SELECT program to
enroll more beneficiaries in HMOs
and eliminates membership
limitations on Medicare HMOs
• COmbin.. administration of
Medicare Parts A and B
separate program
• No expansion of benefits
• Eatabllshes 20% colnsurence
. tor home health care, skilled
nursing facilities and laboretory
eervlcea
• Reducea overall Medicare
spending growth
• Secretary of HHS 10 conduct
feasibility study of allowing
future Medicare beneflclari.. to
rataln private health Insurance
coverage In lieu of Medicare
11
�"
SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
DECEMBER 1993
• Covers low-income welfare
recipients, persons with
disabilities, IIDd low-income
elderly
• Curren~y enrolls only 46%
01 poor
• One-hall 01 spending pays
lor acute care services e
• Integrates Medicaid Into State
systems
• Comprehensive 'acute care
benefits package Is equivalent to
Medicaid
• Long-term care will be
covered under new system for
persons with 3 or more ADLa
• ()Yer one-third (36%) pays
lor long-term care and home
health care e
• 15% 01 spending linances
hospital disproportionate
share payments lor
uncompensated care and low
reimbursement ratese
• Many doclOrs reluse new
Medicaid patients (Highest
refusal rates lor OB/GYN)
• Medicaid reimburses
physicians and hospitals at
approximately 600/0 of private
feese
'
• Many States are moving
toward Medlcald,managed
care 10 improve access and,
Kaiser Commission on the Future of Medicaid (12122193)
beneficiaries except Medicare
eligible persons and
undocumented persons
• AFDC and SSI beneficiaries,
Medicare beneficiaries and
eligible children contln~e to
quality for Medicaid for
beneflta not covered unclar
the health plans
• Coverage 01 institutional and
non-institutional long-term care
remains as is
• Coverage rules lor Medicare
beneficiaries and undocumented
persons remain unchanged
• Estimates eavlngs of $85
billion by curbing rate of
growth
• Repeals Boren amendment
• Repeals DSH program and
replaces it with smaller
Vulnerable Population
Adjustment program lor
hospitals serving large
percentage 01 low-Income
patients
• Mandates medically nsady
coverage for nuralng home
benefits
• Increases asset limits and
living expense allowance for
nursing home residents
• Restructures Medicaid
• Establishes a per-caplta
Federal payment based on
historical Medicaid costs
• Allows States 10 provide
coverage to beneficiaries
through a Private purchasIng
cooperative, managed care
plan, or other aUemstlve
• Allows States to purchase
lOme MedIcaid recipients into
qualified hasUh plans wUh
protectIons
--limited ,to 15% during first
3 years; then phased-in
--Statas wIll pay copayments
and deductlbles
• Medicaid children with special
nsads are exemptlrom enrolling
in HMOs and will remain in
current program
• Institutional and non-institutional
long-term care remain unchanged
• Caps Medicaid spending
growth rate lor acute care at
national health spending level
• Allows States 10 contract for
coordinated care eaMces under
Medicald With managed care
organizations (with protections for
first 5 years)
• Phll888 out hospital
disproportionate share
payments by 2000
• Repeals the Medicaid statute
• Integrates acute care Medicaid
into HPPCs
• Provides prescription drugs,
eyeglaases, and heat1ng aids, il
above basic benefit package, lor
persons with incomes below
100% of poverty
• Aasures nominal cost-sharlng
levels for IndividualS wUh
Incomes under 200% of poverty
• Federal govemment assumes
full responsibility for subsidizing
acute care lor the poor; States
gradually assume responsibility
lor long-term care Portion of
Medicaid
• Caps Federal su"'ldles
• Establishes phase-down
schedule lor Federal, assistance
lor States' long-term care
programs
• Provides coat-sharlng
subsidies for low-Income
elderly similar to Medicaid
• Directs Health Care Standards
Commission 10 submit a report to
Congr... concerning any
transUlonal provisions
concerning the medical needs
of current Medicaid population
• Restructures Medicaid
• Allows States 10 expand Medicaid
up 10 100% of poverty with, an
option 10 expand up to 200% on a
sliding scale using DSH payments
• Caps expansion funding at
expected spending levels without
program
• Medical Health Allowance
Program gives States option 10
enroll recipients and low~ncome
persona Into private health
Insurance plans as long as they
provide a choice 01 plans and other
,qUality saleguards
• Non-institutional and institutional
long-term care remain unchanged
• Imposes maintenance 01 effort on
States
program
--Federal payments
calculated on a per capita
basis for children and
adults
-Allows Stste Medicaid
waivers to pursue cost
effective health care
• Caps Federal payments to
Medicaid on acute care spending
to growth In CPI plus 1%
beginning in FY95
• Non-institutional and institutional
'long-term care remains '
unchanged
• Replaces DSH payments with
Federal grants to States to
establish programs to provide
health care lor low-income
individuals spending greater than
5% 01 gross income on health
care through:
--Financial assistance to
purchase health insurance
--Direct delivery 01 medical
services
--Funding 01 community and
migrant health centers,
--Improvements in
availability 01 emergency!
trauma care
• Provides States wUh broad
latitude in how they delivery
medical care services
12
�II'
SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
DECEMBER 1993
recipients, persons with
disabilities, and low-income
elderly
- Currently enrolls only 46%
01 poor
-One-half of spending pays
for acute care services"
• Over one-third (36%) pays
for long-term care and home
health care"
• 15% of spending finances
hospital disproportionate
share payments for
uncompensated care and lOw
reimbursement rates'
• Many doctors refuse new
Medicaid patients (Highest
refusal rates for OBIGYN)
- Medicaid reimburses
physldans and hospitals at
approximately 60"'" of private
fees"
- Many States are moving
toward Medicaid managed
care to improve access and,
save money
• Integrates Medicaid Into State
systems
• Comprehensive acute care
benefits package is equivalent to
Medicaid
- Long-term care will be
covered under n_ system for
persOns with 3 or mora ADLa
~
Integrataa acute care
Medicaid for all Medicaid
beneficiaries except Medicare
eligible persons and
undocumented persons
- AFDC snd SSI beneficiaries,
Medlcara beneficiaries and'
ellglbie chlldran continue to
qualify for Medicaid fOr
bensflts not covered under
the haalth plans
• Coverage of institutional and
non-institutional long-term care
remains as is
• Coverage rules for Medicare
beneficiaries and undocumented
persons remaln'unchanged
• Estimates aavlngs of $85
billion by curbing rata of
growth
'
, - Repeals Boren amendment
• Repuis DSH program and
replaces It with smaller
Vulnerable Population
AdJustment program for
hospitals serving large
percentage of low-Income
patients
• Mandates medically needy
benefits
• Increases asset limits and
living expense allowance for
nursing homeresldents
Kaiser Commission on the Future of Medicaid (12122193)
~ Restructuras Medicaid
• Establishes a per-caplta
Federal payment based on
historical Medicaid costs
• Allows States to provide
coverage to beneficiaries
through a private purchaalng
cooperative, managed cara
plan, or other alternative
• Allows States to purchesa
some Medicaid recipients into
qualified health plans with
protectiOns
--limited to 15% during lirst
3 years, then phased-in
--Ststes will pay copayments
and deductlbles
• Medicaid children with spacial
needs are exempt from enrOlling
in HMOs and will remain in
current program
• Institutional and non-institutional
long-term care remain unchanged
• Caps Medicaid spending
groWth rete for acute care at
, national health spending level
• Allows States to contract for
coordinated cara HrYlcas under
Medicaid with managed care
first 5 years)
• PhaHs out hospital
disproportionate share
,payments by 2000
• Repesls the Medicaid statute
• Integrates acute care Medicaid
irito HPPCs
• Provides prescription drugs,
eyeglass.., and haarlng alds,iI
above basic benefit package, for
persons with incomes below
100% of poverty "
, • Aesures nominal coet-aharlng
lavels for Individuals with
Incomes under 200% of poverty
• Federal govemment assumes
full responsibility for subsidizing
acute care for the poor; States
gradually assume responsibinty
for long-term care portion of
Medicaid
• Caps Federal subsidies
• Establishes phase-down
schedule for Federal assistance
for States' long-term care '
programs
• Provides coet-aharlng
subeldles for low-Income
elderly similar to Medicaid
• Directs Health Care Standards
Commission to submit a raport to
Congr_ concerning any
transitional provlslona
• Rastructuras MediCaid
• Allows States to expand Medicaid
up to 100% of poverty with an
option to expand up to 200% on a
sliding scale using DSH payments
• Caps expanelon funding at
expected spending levels withoUt
program
• Medical Health Allowance
i>rogram gives States option to
enrotl recipients and low-lncome
persons'lnto private health'
Insurance plans as long as thay
provide a choice ofplans and other
quality safeguards
• Non-institutional and instibJtiona/
long-term care remain unchanged
• Imposes maintenance of effort tin
States
'
program
--Federal payments '
calculated on a per capita
baals for chlldran and
sduHs
-Allows State Medicaid
walvera to pursue cost
effective health' care
• Caps Federal payments to
Medicaid on acute care spending
to growth In CPI plus 1%
beginning in FY95
'
• Non-institutional and institutional
10!l9·term care ramalns
unchringed
• Replaces DSH payments 'with
Federal grants to States to
establish programs to provide
health care for low-income
individuals spending greater than
5% of gross Income on health
care through:
--Financial assistance to
purchase health insurance
··Dlrec1 delivery of medical
services
·-Funding of community and
migrant health centers
in
of currant Medicaid population
trauma care
• Provides States wHh broad
latHude in how thay delivery
medical cars services
12
�,.
:
SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
DECEMBER 1993
• Eliminates the private health
Insurance Industry for benefits
in the national package
• May be continuing role for
private supplemental coverage
and HMOs to operate within the
new system
• Regulates long-term cara
Insurance
• Places caps on premiums In
raglonal alliances based on
global budgsts
_ Applies pure communHy
•
rating within alliances
• Guarantees that plans ara
ranewable
• Guarantees portabllHy of
coverage
• ProhlbHs heaHh plana from
denying coverage based on
health, employment or financial
status
• No premium caps or global
budgets
• Establishes modified
communHy rating for qualified
health plans
• Guarantees that plans are
ranewable
• Guarantees portabllHy of
coverage
• Contains non-dlscrlmlnatlon
clause based on health status
• Limits pre-exlstlng condition
clauses
• 4,200 areas in US are
considered underserved due
to provider shortages 7
• 15% of the population is
underserved 7
• Uninsured are more likely to
go to emergency rooms for
basic care
• Significant differentials in
utilization and patterns of
care exist between poor and
non-poor neighborhoods
• Doubles funding for
communHy and migrant hesHh
centera
• SlgnlHcantly Incraases
funding through the public
hesHh block grants for services
such as maternal and child
health, preventive health, mental
health and substance abuse, and
care for people living with AIDS
• Authorizes a new program to
provide grants to communhy
'. Authorizes n_ hesHh
funding for public heaHh and
access expansion programs
• Authorizes Federal grants and.
loans to support provldera In
. rural and Inner-cHy
communities to form networks
. and health plans
• 'Provides enabling Services
tor cash-aeslstsnce and low·
Income child ran
• Requires health plans to
• Authorizes appropriations for a
new program to provide funds
to allow faderally qualified
heaHh centera and othera to
provide expanded services to
medically underaerved
individuals
• Authorizes appropriations for a
n_ communHy-based primary
heaHh cara grant program to
States to expand acC888 In
underserved areas
Harris survey, 34% of
uninsured reported delaying
needed health care compared
to only 8% of privately
insured individuals and 10%
of Medicaid recipients
faderally qualified heslth
centera to delivery primary
care In underaerved aress
• Allows patients to _k
services from any partiCipating
doctor or medical facility
• Prescribes equal payments to
community providers and
includes services of community
health providers as a specific
benefit
• Geographic distribution of
population calculsted Into
budget and reimbursement
determination
• Increases funding tor NHSC
communHy provldera
• Prescribes equivalent
payment methodologies tor.
communHy provldera
• Authorizes the expansion or
the NHSC
rural heaHh grants and
demonstrations to improve'
access to care
• Requires qualified health plan
to comply wHh any provisions
ralated to services in
underserved areas established by
the certifying authority
• No payment methodologies
specified for community providers
• Establishes rural emergency
access care haspHals
individiJals
• No guarantee of portability
between jobs
• Pre-existing clauses can
exclude coverage for certain
illnesses/conditions
(some States regulate these
practices)
• Large and small companies
are rated based on their
claims experience
• Almost 20% of insurance
costs pay for administration
• No limit on annual premium
Increases
Kaiser Commission on the Future of Medicaid (12/22/93)
• No premiums caps or global
budgsts
• Requires age-adJusted
communHy rating inside HPPC,
and either age-adjusted or pure
community rating outside HPPCs
• Guarantees ren_ablllty
• Guarantees portabllHy of
coverage
• Limits pre-exlstlng condHlon
. clauses
• Provides grant funding and
transitional support for
development of accountable
health plans In. underaerved and
rural aress
• Provides grants to communHy
and migrant heaHh centera to
integrate with Accountable Health
Plans
• Provides transHlonal support
tor safaty nst haspHals
• Specifies payment methodology
for
chronically underserved areas
• HeaHh p1sns may be required
to offar coverage In
underaerved areas
• Establishes rural emergency
access care hospitals
• No premium caps or global
budgsts, but limits maximum
annual premium Incresse tor
small employers to 15%
• Does not establish community
rating, but limits pramlum variation
among small employera
• Insurara must offar hesHh plans
to small employera, including
standard, catastrophic and medical
savings accounts
• Guarant_ ranewablllty of
. coverage
• Guarant_ portabllHy of
coverage
.• Limits pre-exlstlng condHlon
exclusions
• Increases grant funding for
communHy and migrant heaHh
centera by $1.5 billion over five
years to improve access for
underserved areas
• Increases grant funding to
coordlnste primary heaHh care
• Increases fund Ing tor rursl·
heaHh services with emphasis on
emergency care services
• No special deSignation or payment
methodology for community
• No premium caps or global
budgsts
• Does not establish community
rating
• Guarantees ran_ability of
insurance coverage
• Guarantees portabllHy of
coverage
• Prohibits insurers from
terminating policy except for non
payment or fraudulent claims
• Limits pre-exlstlng condHlons
clauses
• Restricts Insurance markstlng
practices to limit discrimination
• States can use Federal
"Medicaid DSH" grants to fund
communHy and migrant heaHh
centera
• No funding increases to promote
access to care
• No special designation or
. payment methodology for
community providers
Access Cara HaspHal (REACHs)
program
13
�1'
,
.
SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
DECEMBER 1993
• Mandatory relonn.
• 50% GME paid for by
Medicare, which favors
• Establishes target of 1:1
primary c.re providers to
tertiary care
specialization
.peclallsta five years after
• Only 14% of current fIl"'UI"Iil~1 enactment of legislation
students are choosing
• Establishes Advisory
_Committee Health Profllaalonal
primary care less than half
-Education
the rate (36%) in 1982
• Reduces payments to States
that hill to meet national goals
for graduate medical education
• Health Board will establish
target numbar of mldlevel
primary care practltlonera by
year 2000
• Incraa... funding to .upport
health profeaalona education
and nuralng education,
including nurse practitioners,
certified registered nurse
anesthetists, certified nurse
midwives, and physician
assistants
- • Increa... funding for NHSC
• Mandatory reform.
• PrOVIde. new entitlement
grsnt funding .cademlc health
centers for medical education
• Replaces GME and IME
payments from Medicare
.. GME payment. to emphasize
primary care training
• Umlta the numbar of
specialty residencies
• Inc rea ... the authorization
for funding for training of
nur.e~prsctltlon8ra and
phy.lclan aaalatanta
• Eatabll.he. Natlon.1 Council
of GME within OHHS
• AuthorizeS expanalon of
NHSC
• Overrides restrictive State
practice laws but health plans
can still decide which providers it
allows to participate in their
networks
• Voluntary rafonn.
• Creates GME demonatratlon
project. which allows States to
pool GME funds and change
specialty mix
• Provides tax Incentives for
primary cal'8_ providers In
under.ervad area.
• Incraaaes the authorization
for primary care phyalcl.na
• Incre.... the authorization
for funding for training of
nuraa-practltloners and
phyalclan aeslatant.
• Increa.es the authorization
fOr funding for PHS and NHSC
• Provides tax breaks for NHSC
loans
• Managed care is not a major
feature ot-plan, but use of
. primary group health practices Is
assumed
• Growth of m.naged care Is a
malor featura of plan
• Requires at leaat one fila-for·
service option in each alliance
• Requires managed care plans_
ID contract with all essential
• Growth of managed care Is
malor featul'8 of plan
• Individual mandate to have
insurance may be met through
catastrophic plan and medical
savings account
• Preempta State laws that
raatrlct development of
managed cal'8
to provide outreach to
• 25% of the population with
employer coverage was
enrolled in managed cares
• In many States. Medicaid is
enrolling benefiCiaries j12%)
Kaiser Commission on the Future of Medicaid (12122193)
underearv8cl communhles
• Enc:OUI'8g88 and fIIcilhates
movement of Medicaid Into
managed cars risk contracts
• M.ndatory I'8fonna
• Establishes National Medical
Education Fund
• Eliminates .eparate medical
- education paymenta under
Medicare
• Umlta the numbar of sPecialty
residencies to 110% of applicants
• Differential funding for primary
care; 25% higher than specialty
slots
• Increases the authorization for
funding for trslnlng of mld·leval
prscthloners, NHSC••nd Area
Health Education Canters
• Override. raatrictlve Stat.
practice laws but health plans
can still decide which providers It
allows to partiCipate in their
networks
• Growth of managed care I. a
malor faatUI'8 of plan
• AlloWs fee-for-service option in
HPPCs
• Provides granta to community
_provldera to Integrate wtth
• Managed ciue is not a major
feature of plan
• Encourages movement of
Medicaid Into managed c.re
• lIfta State laws reatrlctlng
development of managed C.1'8
-
• Managed care is not a major
Jeature of plan • Lift. State lawa reatrlctlng
development of managed cal'8
-
• Uft. State laws to reatrict
development of managed c.1'8 _
"
14
�"
~
...
,,~
SUMMARY OF MAJOR HEALTH CARE REFORM LEGISLATION
DECEMBER 1993
• Individual private insurers
and large corporations have
quality assurance programs
• AHCPR has Issued several
non-binding guidelines for
surgical procedures
• Medicare has utilization
review program
• Outcomes research still in
Infancy
• Promotes use of practice
guidelines and outcomes
research
• Protll.. practice pattems to
identify outlierS on a systematic
basis
• Requires States to establish a
uniform data base for patient
records by 2001
• Establlshea centers of
excellence
• Creates National Quality
Management Council to
develop quality, information, and
accountability programs
• Appll.. parformance
meaaurea to all health plans,
institutions and practitioners
• Dlasemlnatea quality report a
through regional alliances
• Creates uniform licensing
standarda
• Expands AHCPR quality
research
• Requires that qualified health
plans be certlflad by the states
and mest Federal quality
a..urance guidelines
• Createa a nstlonal health deta
system
• Expands federal outcomes
reaearch agenda
• Creates national medical
research lund from overpayments
and contributions
• Individuals and groups can
be systematically excluded by
Insurers (some States
regulate these practices)
• In case of negligencel
discrimination, Individual has
right to bring suit
• Grievance mechanlama to be
developed at State level
• state ombudaman provided
• Appll.. exletlng fraud and
abuaa controla to system and
strengthens them
• Eatabllahea fade rally
administered external
grievance procedures
• Alllancea develop Internal
grievance procedures
• Includes Individual privacy
protections
• Regional alllancea will each
have an ombudaman
• strengthena fraud and abuM
controla and appll.. to all
payers
• Each quallflad health plan
required to have Intamal
madlstlon procedures
• Strengthena fraud and abuM
controla
• Each plan must provide
information about person's right
to self·determination
• Provides Intemsl grtavance
mechanlam for enrollees
• Every HPPC will have an
ombudeman to handle disputes
between consumers and health
plans and consumers and HPPCs
• Silent on fraud and abuse
controls
• Requires notice of advance
directive rights for patients
'entering Medlcere
• No changes
• Requires health plans to
• Requires madlatlon and
altemstlve dispute resolution
eetabllah alternative dlapute
resolution mechanlama
• limits non-economlc
• Noliffiitsptaced-on-non- -damege&-to-$250,O.OO
economic damages
• limits lawyer'a fees to 25
• Requires individual to have a
percent 01 award
certlflcete of merit bafore
• Loaer to pay court and
going to court
lawyere ...., il appealed
• Hold. lawyers fees to 331f3%
of award
damages
• No limit on lawyers lees, 113
01 award is typical .
• High malpractice insurence
costs
• Delensivemedicine
1.
2,
3.
4.
5.
6,
7.
• Silent on practice guidelines
• Grants for development and
distribution of stste and Federal
comparative value Information for
health care purchasing
• Establishment of electronic data
standards for providers
• Provides grants to States to
develop practice guidelines to
be used in malpractice liability
cases
• Accountable H..lth Plana
required to meet Federel quality
and dsta standards
• Applies performance
meaaurea to all health plans,
institutions and practitioners
• Createa Agency for Clinical
R....rch
I.
_L
strangthena fraud and abuM
controla
• Requires madlatlon and
• Requires alternstlve dlapute
resolution
altematlve dlapute resolution
• limits non-economlc
• limits non-economlc damagea
damages to $250,000
to $250,000
• lImit8 lawyei"a-fees-to'25%-o f- -~lImlts-lawy-=s.Jaea_to_20
first $150,000 and 10% 01
percent of award
additional
• Loser would pay court and
lawyers ...., il appealed
• Loser pays court and lawyer
tees, if appealed
• Grants for development and
distribution of State and Faderal
comparative value Information
programs for consumer
information
• Establishment of electronic data
standards for providers
I.
Strengthena. fraud and abuM'
controls
• Silent on a1temative dispute
resolution
• limits non-economlc damages
to $250,000
• Limits lawysra' faea to 25
percent oflirsf$l5O;000-and
percent 01 additional award
• Loser to pay court cost. for
claim if not justified or improperly
advanded
Based on Kaiser analysis 01 the 1992 March Current Population Survey.
"
Bureau 01 the Census, 1992.
United States Immigration and Naruralization Service. unpublished report, 1992.
Clinton Plan is the only plan that has received cost estimates from the Office 01 Management and Budget and the Department of Health and Human Services. Figures for other proposals represent estimates by the authors 01 the bill.
Results 01 the Health Insurance Association 01 America 1991 Employer Survey,
Kaiser Commission on the FuMe 01 Medicaidl\Jrban Institute analysiS 01 HCFA data.
lives in the Balance, 1993.
Kaiser Commission on the Future of Medicaid (12122193)
.,
15
�"
December 9, 1993
ESTIMATING THE
ACT OF HEALTH REFORM ON FEDERAL RECEIPTS
Executive Summary
. The Treasury Department's Office of Tax Analysis (OT A) is responsible for preparing
revenue estimates of proP9sa1s which affect Federal receipts. In general, OTA analyzes
legislative proposals that chi¥lge the Internal Revenue Code. OTA also analyzes the effects of
certain legislative changes which do not amend the Internal Revenue Code but nonetheless affect,
Federal receipts. For example, changes in the laws concerning employer provision of certain.
fringe benefits can affect receipts because of the favorable tax status of such benefits.
p~ides
The tax code also
preferential treatment for certain types of health insurance
expenditures. Health insurance contributions receive preferential tax treatment under several
different provisions. Emplo~er contributions for health insurance are deductible as a business
expense by the employer and are excluded from the income of employees. Through their
employers, some employees bay have the option of contributing to tax-preferred cafeteria plans,
enabling them to pay for t~eir portion of health costs with pre-tax dollars. Self-employed
individuals can deduct 25 !percent. of health insurance costs from adjusted gross income.
Taxpayers can also deduct Iqualifying medical expenses which exceed 7.5 percent of their
adjusted gross income. As a Iconsequence, changes in the financing of health insurance will have
implications for Federal receipts.
'
I
Estimating the effects of pealth reform on Federal receipts has required a cooperative effort
among many agencies. The rndertaking has ,demanded a broad understanding of the provisions
contained in the proposal. Ettimating the revenue impact of the proposal has required many data
inputs from other Federal apencies involved in this process. To maintain consistency while
estimating the costs of the health reform plan, the estimates of the revenue impact of the plan
rely on certain inputs from lother Federal agencies involved in this process. Because of the
interaction among the prOVisions, a change in one or two of the basic underlying policy
parameters could trigger sighificant changes in the revenue estimates.
'
~ntains
many non-tax provisions which may affect Federal receipts
The health refonn plan
by changing the financing 'or health care. Each of these provisions may have very different
effects on revenues, but in f.0mbination the Administration's plan results in a net increase in
Federal receipts over the buaget period. An alternative plan with similar features could yield
very different revenue result~, even if it differed from the Administration's plan in only a few
key non-tax aspects.
This technical note proyides background as to the methods and assumptions underlying
Treasury's estimates of the limpact of health reform on Federal receipts. In preparing these
estimates, Treasury followed long-standing estimating conventions accepted by both.
Administration and Congres~ional agencies responsible for producing estimates of the budgetary
impact of legislative proposhls. In analyzing the revenue impact of non-tax changes in the
financing of health insurancJ, Treasury has used the same methodology and models which are
used to estimate the effects Jf changes in Internal Revenue Code provisions on receipts.
�-2
Individual Tax Mcxiel
The Individual Tax Mcxiel (I M) is one of the most powerful tools developed by OT A to
aid in estimating changes in Federal receipts. The ITM is a large microdata simulation model.
The micrcxiata aspect of the mddel refers to the fact that it contains data on the income,
deductions, health expenditures,!and other characteristics of individual. tax filing units and
families. The mcxiel can simulat the taxes paid under both current law and proposed changes
in law.
Professional economists in OrA construct, maintain, and utilize the ITM. OTA economists
share a broad background in appli~ microeconomics, particularly in public finance. In addition,
OTA economists are also specialists in other fields, such as econometrics, health economics,
labor economics, statistics, and domputer programming. These skills are used to develop the
inputs to the mcxiel and for exanhning its outputs.
Interacti n with Other A
with Interests in Tax
d Health Polic
uestions
,
OTA economists communic~te regularly with their counterparts at the Joint Committee on
Taxation (JCT) and the Congressional Budget Office (CBO), who also use large microsimulation
mcxiels. Such contacts are usef~l both for identifying differences among the models as well as
for developing consensus among the agencies responsible for analyzing the receipts effects of
proposals.
I
In the health area, OTA staf~ maintains regular contact with numerous specialists. Members
of OTA staff routinely discuss health modeling issues with staff from several agencies in the
Department of Health and Humin Services, including the Agency for Health Care Planning and
Research (AHCPR), the Office bf the Assistant Secretary of Planning and Evaluation (ASPE),
and the Health Care Financing tdministration (HCFA). In addition, OTA consults with health
policy staff at the Council of Economic Advisers (CEA), the Office of Management and Budget
(OMB), and theCBO.
OTA's extensive contacts with the staffs of other government agencies and outside experts
provide additional access to dati, research, and other techniques which are generally useful for
model development. In many cases, these contacts are long-standing.
Description of the Individual Tax Mcxie}l
Data: The current version
..
.
~f the ITM was constructed from a sample ofllO,OOO individual
For a more detailed disc¥ssion of the Individual Tax Model, see James Cilke and Roy A.
Wyscarver, The Treasury Individual Income Tax Simulation McxieL Department of the
Treasury, Office of Tax Analy~is, March 1990.
1
�-3
income tax returns filed in 1989. The data base is a stratified probability sample of tax returns
prepared by the Internal Reverue Service's Statistics of Income (SOl) Division. 2 This is the
same sample employed by the SOl to produce the tabulations published in the Statistics of
Income - 1989 Individual Incdme Tax Returns. When weighted, these data represent the total
population of taxpayers in the United States.
Tax returns contain extensive information on the components of taxable income. In addition,
tax returns provide informatioh about taxpayers' marital status and family size. However, tax
returns do not contain inform~tion on other demographic characteristics, on non-taxable forms
of income such as welfare be~efits or earnings on pension and other retirement savings, or on
expenditures made by the taxfayer. Nor do tax returns provide any information on families
outside the tax system.:3 Morel comprehensive information than is provided on tax returns is
needed to analyze the impact of proposals which extend the current income tax base and to
analyze payroll, excise and other taxes.
To add more information, the SOl tax return data are first matched to age data from Social
Security records and then statistically merged with records from the Current Population Survey
(CPS) conducted annually by ~he Bureau of the Census. The records in the ITM are grouped
into family units as well as income tax return units, and are weighted to represent the entire
filing population and noninsti~utionized nonfiling population. The SOl file is also statistically
merged with records from thd Bureau of Labor Statistics' Consumer Expenditure Survey. In
addition, imputations of other tritical income, asset, expenditure, employment, and demographic
measures are made using a vbety of sources (e.g., the Federal Reserve Board's Survey of
Consumer Finances).
The data sources describ~ above contain only limited information on expenditures on health
care. From tax returns, info~mation is available on the amount of health insurance purchased
by self-employed persons who claim a 25 percent deduction. Tax returns also contain
information on certain health +xpenditures, but only for those filers who itemize deductions and
whose expenditures exceed 7.5 percent of their adjusted gross income. The Current Population
Survey provides information
the insured status' of individuals, including whether the insurance
is provided through private ot. public sources .. Lacking from these surveys is information on a
family's total expenditures I<including any employer contributions) on health insurance,
characteristics of their insurance policy, and the health status of family members.
06
Under Section 6103 of the Internal Revenue Code, OTA and JCT have access to tax
return data, including the cofuplete SOl file. A public-use computer tape file is available to
other analysts, but it has fewet data items and taxpayer records and does not contain information
I
.
which might violate the conFidentiality of taxpayers. In particular, the public use file blurs
information on high-income tkpayers.
2
3
Nonfilers are PredOmi+'tly low-income persons who do not have an income tax liability
and do not file a return to claim a refund.
�-4
To supplement these data sources, OTA statistically matched the data from the 1987 National
I
Medical Expenditure Survey tNMES) to the ITM. The NMES is an extensive survey of
approximately 14,000 householtts representing the civilian, noninstitutionalized populatjon of the
United States. It was conductM under the auspices of the Department of Health and Human
Services' Agency for Health CF Planning and Research (AHCPR). The 1987 survey updates
and expands previous surveys conducted in 1977 and 1980. The surveys collected information
about participants' utilization Jnd expenditures for health services, health insurance coverage,
health status, and employment land income. Data from the household survey are supplemented
by information from medical p,roviders, employers, and insurers.
.
I
. ..
Extrapolation: The compiete data file is then extrapolated to future years based on the
economic forecasts used in th~ Budget. 4 The extrapolation is done in two stages. The first
stage adjusts for anticipated ecdnomic growth and inflation. This is accomplished by mUltiplying
the various income, deduction,! and credit items on each return by forecasts based on per-capita
growth rates estimated from tHe economic forecasts. In the second stage, the weights assigned
to the records in the file are Fhanged to hit separately determined targets for key variables,
including the size distribution 10f adjusted gross income.
The growth rates for health data are generally based on projections contained in the Federal
Budget or the National Health IAccounts. Where relevant, the targets reflect significant changes
in participation or expenditure~ since 1987 (the base year for the NMES) or 1989 (the base year
for the CPS). For example, a Imajor expansion in Medicaid will affect participation rates during
the mid-nineties. To ensure cbnsistency with the Administration's Budget estimates, the Health
Care Financing Administrati~n's projections for persons insured by Medicaid are used to
estimate targets in the extra1lation of these items in the ITM.
Tax Calculator: Using the extrapolated files, the tax laws for each year in the Budget period
are simulated. In combinatiort, these simulation programs are referred to as the "tax calculator"
or simply, the "calculator. The calculator takes information from each potential tax filing unit
in the data file, and using d set of specified tax parameters, computes that unit's Federal
individual income tax liabilit1 under the proposed change in law.
II
Two basic revenue estimating assumptions are embedded in the calculator for computing tax
liabilities. First, all filers are assumed to choose tax options which minimize their tax liabilities.
Second, variables such as the level and distribution of total pre-tax income or total expenditures
are held constant when simulating a tax policy change.
The calculator computes the values of a number of variables that are endogenous to the
At the time of the relelse of the Administration's health reform plan, the estimates were
based on the Administration'~ economic assumptions contained in the 1993 mid-session review.
The economic assumptions ~bere extended through the year 2000 .by OMB for purposes of
.
determining the longer-term udgetary impact of health reform.
4
�-5
model -- that is, these are tax v 'ables, in addition to liabilities, which may be affected by a
proposal and which, in turn, can [affect the calculation of tax liabilities. In general, the ITM can
trace through most of the interactions between any income source and the various provisions of
the Internal Revenue Code.
Appropriate behavioral resppnses have been incorporated into the tax model. In addition,
as will be discussed further belbw, off-model adjustments are often made by the analysts to
incorporate other anticipated be'avioral changes in response to a proposed tax change.
Uses and Limitations of Model Output
i
ec·~nomists
. As noted above, the ITM is powerful tool which enables OTA
to better analyze
the effects of various proposalS'i There are several important distinctions, however, between the
output of the tax model and the final analyses prepared by OTA.
First, even in the simplest . ase, output from the ITM does not go unexamined .. Output is
subject to a reality check. U~rs of the ITM check carefully the results to determine if they
appear reasonable. For example, users may compare the extrapolation of a particular variable
with data which has become a~ailable since the initial construction of the tax· model. Such
information may include data ~rom more recent samples of tax returns (e.g., the 1991 SOl
sample of tax returns), other government organizations (e.g., the Bureau of Labor Statistics'
Surveys of Employee Benefit~; the Census Department's Survey of Income and Program
Participation), trade associatiorys (e.g., surveys conducted by the Health Insurance Association
of America), and independent consulting organizations.
I
Second, the ITM is best utilized to analyze the effects of changes in the tax code that affect
broad groups of taxpayers and involve current law tax rules. The tax model cannot be relied
upon exclusively to estimate changes in the tax code which affect narrow populations or
introduce new income tax rule~. In these instances, OTA economists may rely on "spreadsheet"
models to produce estimates of tax changes. Often, these spreadsheet models are, themselves,
quite extensive and sophisticatJd. In many cases, information from the ITM (e.g., the marginal
tax rate faced by a comparabld group of taxpayers) may be used as input into these spreadsheet
models. The ITM is also not ufect to analyze proposals affecting tax units other than individuals.
For these purposes, OTA maintains several other tax models, including a corporate model, a
depreciation model, and an estate model.
Third, subject to certain JUdget estimating conventions, estimates of the revenue effects of
tax changes include assumptiohs about changes in taxpayers' behavior induced by changes in tax
policy. Given the set of mactoeconomic assumptions used to prepare the Budget, major GDP
components -- such as real ~d nominal GDP -- are assumed to be fixed for purposes of
estimating the deficit impact of a proposed change in legislation. Thus, for revenue estimates,
behavioral effects are constdined by this "fixed GDP" assumption. Behavioral assumptions
which affect the composition of GDP, but not its level, are integral to the revenue estimates.
�-6
Off-model adjustments are generally necessary to account for the full range of potential
behavioral effects.
Fixed GOP Assumption
The "fixed GOP" budget estimating convention is a long standing rule and is followed by
the Office of Management an I Budget, Treasury, and all other Executive Branch agencies. The
Congressional Budget Office 4CBO) ~d the Joint Committee on Taxation (JCT) follow a similar
convention, using the econonhc assumptions contained in CBO's budget analyses. The "fixed
GOP" assumption allows poJicymakers to view the effects of proposed change in law on the
deficit, as forecasted in the m6st recent Budget.s Without such a convention, dozens of analysts
in each agency could derive their own independent forecast of GOP each time they estimated the
deficit impact of a proposed thange in legislation. 6
J
I
.
As ~ consequence of the fixed GOP assumption, Treasury, CBO, and JCT assume that total
employee compensation rem,ns unchanged in response to a requirement that employers provide
a new fringe benefit to the,r workers. This identity is derived from the Census Bureau's
National Income Accounts (l'I{IA). Under these assumptions, if employer contributions for health
insurance increase, then oth,r forms of labor income -- wages or other fringe benefits - must
decline in order for GOP to remain constant.' However, if wages and salaries decline, income
taxes and employment taxes must decline as well. This eff~t is sometimes referred to as the
"income offset. "S
S Under the Budget Enforcement Act of 1990, the estimates of legislative proposals are
based on the economic assJmptions contained in the President's Budget. At the time of the
introduction of the Administ1ration's health reform bill in the fall of 1993, it did not seem likely
that the legislative action wduld be completed by the end of the year. As a consequence, there
was an Administration-widd decision to use the recent economic assumptions contained in the
Mid-session review.
The fixed GOP assumption is discussed in detail in Howard W. Nester, "A Guide to
Interpreting the Oynamic Elbments of Revenue Estimates. Compendium Qf Tax Research 1987,
I
C. Eugene Steuerle and Thomas Neubig, eds. Washington, D.C.: Government Financing
Office, 1987, pp. 13 - 41.
6
It
, Some benefits -- sucH as employer contributions for social insurance -- are linked by law
wages change.
to wages and thus change
is
t~e
~d
For a discussion of
"income offset," see George Tolley
C. Eugene Steuerle, "The
Effects of Excises on the Taxation and Measurement of Income," 1978 Compendium of Tax
Research. Washington,
Government Printing Office, 1978, pp. 67 - 78; and Sonia Conly
and Linda Radey, "Changes in Excise and Payroll Taxes and Their Effect on Total Budget
Receipts," paper presentetl at the 1988 Eastern Economic Association Meetings, Boston,
S
o.p.:
�-7
Federal income and emplo, ment tax liabilities are affected by these compositional changes,
as the allocation between taxable cash wages and non-taxable compensation (including the
employer portion of payroll dxes) shifts. Based on observable relationships within the NIA,
wages and salaries would appfar to fall by almost the full amount of an increase in employer
contributions for health insurance. Wages and salaries do not fall by the full amount for several
reasons. First, the reduction in wages automatically causes employer contributions for social
insurance (another form of la~or compensation) to decline. Further, to some extent, employer
,
I
contributions for other fringe benefits, such as pensions and life insurance, will also fall.
Estimating the Effect of Reguired Employer Contributions for Health Insurance, Premium
Di ounts and ost Containm nt on Federal Recei ts
Under the health reform plan, employers would be required to contribute towards the
purchase of a comprehensive Iealth insurance benefit plan for their workers:' This package may
cost either more or less than the health insurance plan currently provided by the firm, and its
scope may also differ mark~ly from the firm's current plan. Employers' response to a'
requirement that they contribJte toward their employees' health insurance will depend, in large
part, on how the guaranteed COli mprehensive benefit package differs both in costs and generosity
from their current plans and the extent to which they may be entitled to premium discounts
under the proposal. 9
Five key pieces of infor ation are necessary to evaluate the impact of the health reform
proposal on Federal receipts. These include:
I
•
•
•
•
Initial cost Ofjhe comprehensive benefit package;
Rate of grow
in the cost of the comprehensive benefit package;
Degree to Whibh employers' costs are offset by premium discounts;
Employees' d1mand for health insurance in excess of the comprehensive benefit
package; and
I
Massachusetts.
9 The health reform Plan affects revenues largely through its impact on ~he allocation
between taxable wages and pon-taxable health benefits. The plan can affect revenues in other
ways as well. As insurance coverage expands as a consequence of the plan, some taxpayers will'
not incur large out-of-pock'et expenditures for uncovered medical expenses, and deductible
medical expenditures willcHso fall. Expansion of the Medicare benefit package to include
prescription drugs may also reduce deductions for medical expenses.
�-8
•
Employees'. abil~ty to negotiate with employers to obtain tax-preferred methods
of paying for supplemental coverage and the employee share of the cost of the
comprehensive Ilenefit plans.
The data sources and the key underlying assumptions for each of these items are described
briefly below.
Costs of the Benefit Package: The Health Care Financing Administration (HCFA) provided
estimates of the costs of the ~enefit package at 1994 levels, assuming that the plan was fully
effective in that year. Their estimates included the effects of moving to a system of universal
coverage.
Rate of Growth in the Costs of the Benefit Package: All agencies involved in estimating the
. budgetary impact of the healt~ reform plan used the same assumptions regarding the rate of
growth in the cost of the benefit package. Under these assumptions, the basic benefit package
'was assumed to grow at a rate/consistent with private health insurance between 1994 and 1996.
Beginning in 1996, the costs of the plan were assumed to grow at the targeted rates of growth
specified in the health reform/plan (CPI + 1.5 percentage points in 1996, CPI + 1.0 percentage
points in 1997, CPI+0.5 percentage points in 1998, and CPI in 1999 and 2(00). These rates
of growth are based on the ass~mption that the cost containment initiatives contained in the plan
are effective.
Premium DiscQunts: Un?er the plan, premium discounts are provided to ease the burden
for some employers. First, sIfall firms with fewer than 75 employees and average wages below
$24,(X)() will be entitled to significant premium discounts. Second, the Federal government will
provide premium discounts fdr other firms within the regional alliance if the cost of providing
the comprehensive benefit pabkage exceeds 7.9 percent of their payroll. Some employers will
receive premium discounts e~en though they provided health insurance in the past. These
employers are expected to paks the discounts back to workers in the form of higher wages and .
other benefits. Receipt of pJemium discounts, then, could affect the estimates of the plan on
Federal receipts.
HCFA is responsible for producing the official estimates of the costs of the premium
discounts. Using Treasury's /Individual Tax Model, it is also possible to simulate the receipt of
the premium discounts by individuals (as passed back to them by their employers). Treasury's
estimates of the premium di~ounts were used solely as an input into the analysis of the effect
of the plan on Federal recei~ts. As a check, OTA's estimates of the premium discounts are
reconciled to those produ1 by HCFA. . . .
.
Demand for Supplemental Coverage:
Workers' demand for supplemental coverage is
estimated largely as a functioh of expenditures on medical services for items not within the scope
of the comprehensive benefit package. Data on reimbursable expenditures on health insurance,
l
as well as current health insu ce expenditures, are used to determine the value of supplemental
health insurance coverage. I stimates of the costs of.administering health insurance (the "load
�'f
•
-9
factor") under the current syst m were provided by HCFA. The estimates also account for
changes in the price and dem1d for supplemental coverage following health reform.
. Cafet ria Plan and th Tax-Preferred· Arran ements with Em 10 ers: Under the
Administration's health plan, i dividuals may be responsible for a portion of the cost of the
comprehensive benefit packagel They may be liable for the difference between the cost of the
plan which they select and eighty percent of the weighted average cost of a plan within their
region. As under current laJ, workers are generally required to pay for health insurance
premiums out of after-tax inco+,e. However, the current system provides workers with several
opportunities to reduce their hefth insurance costs by paying with pre-tax dollars. To the extent
that workers can take advantage of these options, tax receipts will fall. IO
1
Jhe estimates of the required employer contribution (with premium discounts and cost
containment) took into accountlthe likelihood that individuals may seek ways to shelter, on net,
more of their health insurance ~remiums through cafeteria plans and other informal arrangements
with employers. The estimatds also took into account other offsetting factors (such as some
reductions in contributions which, under the current system, cover out-of-pocket
reimbursements).
Under the plan, employer contributions for the comprehensive (Le., standard) benefit
package (up to 100 percent on the costs of the package) would be exCluded from income for'
purposes of calculating indiviJual income and employment taxes. Employer-paid premiums on
supplemental plans would noJ be included in employees' taxable income.
WOUI~
generally become effective January I, 2004, contributions for
While this provision
health benefits through cafeteha plans would be disallowed, effective January 1, 1997. As a
consequence, the seven-year ~stimates of the revenue impact of health reform only show the
impact of the restrictions on dFPloyer contributions through cafeteria plans.
OTA's estimates of the etlrects of the restrictions on cafeteria plans are "stacked" after the
combined effects of the requiroo employer contribution, cost containment, and subsidies have
been taken into account. In bther words, the baseline for cafeteria plans, in these estimates,
I
assume that individuals have a),ready made certain adjustments to other aspects of health reform.
Thus, for example, the baseline would reflect changes in the utilization of the cafeteria plans in
response to the required emp[bYer contribution.
~tributions
As will be discussed fu er below, the Admimstration 's plan would restrict
to cafeteria plans. The estitJates of the effects of the required employer contribution do not
reflect these proposed restrictions. The effects of these restrictions are estimated separately,
under the assumption that em loyee behavior has changed in the ways described in this section.
10
�,
-10
When contributions to cafeteria plans are restricted, individuals may have alternative
opportunities to shelter incom1 through other taX-preferred arrangements with their employers
(e.g., the employer may agree to pay the full amount of the employee contribution and, in tum,
explicitly reduce wages by an offsetting amount). These alternatives for sheltering income are
taken into account in the reve ue estimates for restricting cafeteria plans ..
�
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Carol Rasco
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751aa13b836cb5ac70b8977922c2b58c
PDF Text
Text
i
!
THE: WHITE: HOUSE:
WASHINGTON
I
,
i
I
I,
t-farch 24, 1994
MAR 24 RfCiJ
!
1
!~
MEMORANOtJM FOR SENIOR STUI"
,',
FROM!MARKGEARAN
I
SUBJECT:,
1994 Accomplishments
As we all well know, the first part of 1994 has been
productive for this Administration, a pOint the
President will be making tonight. I have attached,a draft
SU111lD8.ry of some of our major accomplishments this year. It may
be aluseful backgrounder helpful to you in the coming days and
weeks.
enor~ously
I
IAt this point, there are no plans to release this document
to the press, but I welcome your additions or corrections so that
we can build a suitable public record for the future. Thank you.
�,
Ad'ministration Accomplishments 1994'
'.
I.
.
Appointments
o
Since reconvening on Janu8ry 25. the Senate has confirmed 134 presidential nominees.
633 nominees have been confirmed so far in the I03 ~d Congress.
Banking
o
The Senate passed the Community Development Banking Bill on March 17.
Budget
o
The House passed the FY95 Budget Resolution on March 11. The Senate is expected
to vote this week.
o
The Balanced. Budget Amendment was defeated in the Senate on March 1.
Budget: Deficit Reduction .
o
The budget reduces the deficit by $126 billion in FY1995 alone •• a 40% cut from
what it would have been without the plan.
o
The projected 1998 deficit would be S200 billion lower than was projected prior to
passage of the plan.
o
After going up almost unstopped for 12 years. the deficit is now projected to go down
three years in a row:'· for the first time since Harry Truman was in the White House:
o
As a percentage of GOP. the deficit would be cut by more than half, from 4.9% in
1992 to 2.3% in 199,5.
o
The budget follows through on the S500 billion in deficit reduction enacted last year,
with new spending ~uts to meet the discretionary spending caps, as well as to finance
investments.
Budget: Spending Cuts
,
'
o
The budget cuts spending in 60% of all major spending accounts
of 6 3 6 . '
.'
o
.~
The budget calls for completely eliminating 115, programs.
,
.0
379 progiams out
"
"10 of 14 major Dep1artments are cut in real terms. and 7 of 14 are cut even without
accounting for inflation.
I
�Budget Provisions
,
,
o
Includes an 8dditionalS2.7 billion in funding for crime programs to put another,
,100.000 cops on the street, implement the Brady bill, establish community partnerships
against crime, and fight illegal immigration.
o
Includes a SO percent- increase over 1993 in technology and research investment '
programs.
o
Includes a S1.3 billion increase in funding for infrastructure investment programs.
0'
Includes a S3.3 billion, or24%, increase from 1994 in funding for education and
training.
0,
Includes an overall i~cre~eof $1.3 billion in funding for the
Act, childhood immunizations, and drug treatment.
.
.
Nm, the Ryan White
Commerce
-
o
Delivered to Congress the Maritime Security and Trade Act of 1994. calling for a SI
billion program over; 10 years to revitalize the U.S. maritime industry.
o
Made available S30 million in emergency funding to the Commerce Departinent for
assistance to the Northeast fishing industry because catches for key species must bo
reduced to restore th'e supply of fish.
~rime
o
The Senate has passed tough crime 'legislation that include full funding for p~tting
100,000 more cops on the street, and the House is expected to pass a bill this week.
o
The proposed FY 1995 Budget includes an additional S2.7 billion in funding for crime
programs to put another' 100,000 cops on the street. implement the Brady bill. establish
community partnerships against crime, and fight illegal immigration. The budget
includes
increase of more than 300% in funding for state and local law
enforcement, the largest increase ever.
an
o
' Awarded the second round of the SI SO million Police Hiring Supplement to
,communities for cOmmunity policing; federal grants have been award to over ono .
hundred cities thus; far.
o
Began implementation of the Brady Bill on Monday. February, 28.
o
Reclassified the Streetsweeper assault shotgun to keep it off the street.
�o
Introduced the 1994 Nlltional Drug Control Strategy which targets the problem of
haidcore drug abuse and the violence that surrounds it.
o
Introduced Operation Safe Home, a joint effort by HUD, Justice and Treasury which
will bring the federal law enforcement resources, in cooperation with state and local
authorities, to bear on violent crime in public and assisted housing.
o
Designated the Baltimore-Washington corridor as a High-Intensity Drug Trafficing
Area (HIDTA) resulting in more federal money and federal law enforcement support
for local anti-drug efforts.
o
Treasury-ATF Firearms Proposal: Along with reforms of our Federal Firearms
Licensing laws and a pan on· assault weapons,. Secretary Bentsen has proposed
cracking down on gwi tr,afficking in the lOjurisdictions that account for 23% of the
crime; notifying local: police of the gwi. dealers in their area; and expanding programs
'
to work with local police departments to interview all FFL applicants.
Disaster Relief
I
o
Delivered the most cqmprehensive national response to a natural·disaster in history,
. providing over $9.5 billion in aid for California earthquake relief.
o
Signed legislation th~t expands eligible uses of federal 'bridge replacement funds in
response to the California earthquake.
'
Defense
o
Announced the releaSe of $190 million in federal matching grants to help 50 projects
in defense and commercial industry as part of the Technology Reinvestment Program.
The awards bring to ,$605 million the total size of federal matching grants announced
under the program. ; '
'
o
Extended moratori~ on nuclear testing by the United States through September 1995.
Edu1cationtrraining
o
Both houses have passed versions of the President's "Goals 2000: Educate America
Act." The house has passed the final version. "Goals 2000" is a comprehensive
national education reform program based on world-class standards, local school
flexibility through waivers, and a performance-based accountability system.
I
.
o
The House Educati~n Committee approved the "Elementary and Secondary Schools
Act of 1993"
'
o
Passed the "School-to-Work Opportunities Act" in the Senate on February 8.
�o
;Issued an executive order designed to increase educational opportunities for Hispanic
Americans through fed~ral programs, by, in part, by establishing a President's
Advisory CommiSsion pn Education Excellence for Hispanic Americans within the
'
Department of Education.
,
,
Submitted to Congress,: the "Reemployment Act of 1994," which will create a
comprehensive system :of reemployment, training, and income support services
for dislocated workers.: The Administration's FY 1995 budget includes $1.465 billion
for reemployment programs~ when fully implemented in FY 2000, the system will
serve 1.3 million workers.
o
EITC
:--1
Issued a Presidential Memorandum directing heads of all Federal Agencies to take
. steps to publicize the Earned Income Tax Credit and the advanced payment option
among all employees.' This is the first step .in a broad public and private sector
, campaign to educate all workers on the EITC
!
Energy'
o
Issued an Executive Order creating a committee to review the ethical and scientific
'
standards of hUman radiation experiments.'
o
The president issued a written statenient that he is making available as an emergency
appropriations $200 million in fiscal '1994 budget authority for the Low Income Home
Energy Assistance Program.
'
Environment
o
«)
Issued an Executive Order on environmental justice to focus Federal attention on the
environmental and hUman health conditions in minority c9mmunities and low-income
communities.
,
Introduced the Superfund Reform Actin Congress.
Foreian
,0
Poli~y"
Led NATO support iin the creation of an exclusion zone around Sarajevo which
resulted in the longest cease-fire since the onset of the crisis in Bosnia. As a result of
direct US intervention apd intensive work with all parties, an agreement has been
signed between the Bosnia government and Croats and the Government of Croatia
leading to the establishment of a federation for Bosnia ,and eventual confederation with
Croatia. The agreement constitutes a fundamental building block upon which a
comprehensive settl,ement ban be built.'
�,
I'
I ,
o
,
American .leadership provided the necessary impetus for the signing of trilateral'
accords WI~ Ukraine. These accords are initiating the actual transfer of warheads
from Ukrame to RusSia and complete de-activation of nuclear weapons systems on
Ukrainian territory. Some 1800 strategic nuclear warheads are affected. Strengthened
economic aid commitment to Ukraine.
I
o
Proposed the most comprehensive restructuring or roreign aid si~ce the Kennedy
Administration, leavipg behind Cold War baggage and promoting economic growth,
democracy, peace, s~ainable development" and humanitarian reli.ef. Committed to
maintain assistance a,t current levels to Israel and Egypt.
o
One week from today (Thursday), all US troops will be withdrawn from Somalia.
o
Ended the Vietnam Trade Embargo on February 3, 1994, to assist in the recovery and'
return of remains ofiPOW's and 'MIA.
o
Took a tough stand on North Korea and ordered shipment of Patriot mIssiles to South
i
Korea.
Housing
o
Issued an Executive Order establishing the President's Fair Housing Council, a cabinet
level organization devoted to insuring fairness and non-discrimination against disabled
, persons and famili~s with children in Federal housing programs.
o
Issued an executive 'order coordinating and clarifying the leadership of fair housing in
federal programs. The secretary of housing and urban development and. where
appropriate, the attorney gen~ralwill take the lead in developing and coordinating
measures to carry out the new order.
'
,
'
~
'
,
'
,
'
'
Rei~venting Government:
o
The proposed FY95, budget would reduce Federal government employment by 118,000
from where it stood in the beginning of 1993. This exceeds by 18% the President's
, eX,ecutive order req~ring a reduction of 100,000 and puts the Administration ahead of '
schedule for achieving the 252,000 reduction recommended by the Vice President's
National Performan'ce Review.
' ,
,
,
,
I
o
Developed andsigried performance agreements with the Departments of HUD, Interior,
Labor, SBA. GSA, ja rec~mmendation of the Vice President's National Performance
reVIew,
o
Announced the
o
The House passed the final version of the Federal Workforce Restructuring Act
(Federal employee buyouts) on March 23.
co~prehensive
reorganization of OMB.
�Trade/Global Economy
o
o
Convened a 07 ministerial jobs co~ference in Detroit to discuss the global workplace
. for the 21st century. ~
.
Announced the U.S. s~e to Saudi Arabia of 50 civjlian aircraft manufactured by·
Boeing and McDonnell Douglas, worth $6 billion. TI:le sale should result in the
creation of more than 120,000 Jobs in the industry.
.
I
.
.
o
Issued an Executive Order on March 3, 1994 reinstituting Super 301 in order to
eliminate the major tr8de barriers around the world which block market access for our
products and services.'
o
Motorola: On March: 12, 1994, ,the United'States and Japan reached a results-oriented
agreement that will provide U.S. cellular telephone systems comparable market access
in Japan, through a h(ghly detailed schedule of quarterly commitments. After nine
years .and three failed agreements, the Government of Japan will ensure that U.S ..
technology has the saine opportunities to compete in the Tokyo-Nagoya cellular
telephone market as Japanese technologies have..
I
.
o
Superconductor Ma,rket: On March 18~ 1994, the foreign share of the Japanese
semiconductor market reached 20.7 percent, representing more than a two full .
. percentage point gain from the third quarter of 1993.
Other Legislative Initiatives;
o
o
o
o
o
o
o
o
Health Care Reform.
Welfare Reform
.
Elementary and Secondary Education ReauthoriZation
. EPA Cabinet elevation
Campaign Finance Reform
TeleCommunication~ Legislation
Immigration Reform
Clean Water Reform
.
I
�TO: ,
FROM:
DATE:
I
Carol Rasco
Jennifer Klein
3/14/94
Disability, Issues
RE:
Sorry Carol -- ,I meant to send you a copy of the attached
memo. Since Friday, I have (I hope) reached agreement with the
actuaries that we can add a maintenance program to the outpatient
reh~bilitation beneiit for only a small (about .01%) additional
cost.
,
I
I ·
w~th
I am working
Greg Lawler, who coordinates outreach on
care, to figure out how to share this information with
advQcacy groups without appearing to be "negotiating n •
hea~th
�'.
f
TO:
FROM:
DATE:
RE:
'Hillary
8"ennifer
~/11/94
Disability Issues
I just wanted to share some good news with you. We have
been trying to provide technical assistance to committee staff to
eli~inate the language in the outpatient rehabilitation, extended
I '
,
,
,
care and home health care benefits that limits coverage to
treatment after an t~illness or injury." As currently drafted,
this language may exclude treatment for congenital disorders -
whiph, as you know, has been of great concern to disability and
chi1ldren's groups. 'I have finally reached agr~ement with "the
actuaries" that eliminating the "illness or injury" language will
notl increase the premium. I am also making progress on expanding
the: rehabilitation benef:i t to include a maintenance program (it
cur,rently covers treatment beyond 60 days only if functioning is
improving) without ~dding cost.
�'.
THE WHITE HOUSE
WASHINGTON
December 9, 1993
I
I
In~erested Parties
,
TO:
<
i
I
White'House Health Care Team
FR:
I
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I
.
:.
On December Sl1993, the independent research group, Lewin-VHI released
~ study that sho}Vs the sOlUldness of the financing of the President's Health
,~ecurity Act. The study confirms that the Health Security Act is fully
financed and th~t it will reduce the deficit over the period from 1995-2000.
"
i'
Included in this ipacket are:
,
~.
f.
3.
~:
I
5.
I
:'
'
'
,
A copy of the Lewin-VHI executive summary
A copy of the Lewin-VHI press release
Fonnal s~atement by Deputy OMB Director Alice Rivlin
Transcript of briefing conducted by Treasury Secretary Lloyd
Bentsen ~d OMS Director Leon Panetta.
Selected pewspaper articles
'
I
If you need more information, please feel free to contact the Health Care
I
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Delivery RooIniat 20f -456-2566.
i
�I
I
I
The Financial Impact of the Health Security Act
!
.
i
i
EXECUTIVE SUMMARY
I
I
•
President Clinton's health reform proposal, the Health Security Act, would fundamentally
resha~e
:
the United States health care system.
!
The Health Security Act assures that all
Americans have access to comprehensive health insurance coverage and clearly defines the
roles
lot employers, g~vernm~nts, and individuals in financing this coverage.
I
The Act also
.
redefines the role of insurers in providing coverage to all Americans while' realigning the
provi~er incentives tha~ have contributed to the rapid rate of growth in health spending in the
Unite~ States. Moreqver, it would, for the first time, place limits on the growth in health
spen~ing through a coh,bination of price competition and premium growth limits over time.
I
,
I
I
In this analysis, lite focus upon the financing implications of the President's health reform
plan. We present estimates of changes in health spending by employers, governments, and
I
I
individuals under the plan in. 1995 through 2000. We also compare our estimates with those
devJ'oped by the adm~inistration.
j
I
A.
Overview pf the Health Security Act
The
e~tablishes
Act
I
quasi-public
"Hek'th
I
'
entities
called
Alliances" : in
I
each
regiFn of the cou~try wpich
aggregate . consumer
I
I
:
I
buying
1
'
power to negotiate! the best
I
I
premiums with health plans. In
general, all
persons
not
I
I '
otherwise
covered
under
Medicare would select from among alternative plans offered through the Health Alliance.
I
I
These plans would ~e required to offer a uniform benefits package covering a standard list of
se"'llices with standardized patient cost-sharing requirements. These plans are also required to
I
'
accept all applicants and are not permitted to vary premiums with health status ("community
I
;.
I
I
rating·). This market structure limits insurers' ability to target healthier populations, thus forcing
insurers to compete for market share on the basis of price, provider network, and quality of
setvices provided. iAII
st~tes
are required to partiCipate in the program by 1998, although
stJtes are permitted!to participate as early as 1996.
C 1993
I
ES-1
.
Lewin-VHI, Inc.
�The Financial Impact of the Health Security Act
Employers are required to contribute at least 80 percent of the cost of the average plan
in the area for each full-time worker, leaving the employee to pay the remainder.
employer has the option of contributing more.)
. ,AVERAGE ANNUAL.'PREMIUMS IN •.
...• ~ .....••. ,'REGIONALALUANCE IN 1998 '" .'
Non-working individuals also obtain coverage
ia¥~~")"!',":S",".·.···"
through the program. The Act provides premium
subsidies
to
low-income
individuals
(The
O,.;e:.Parent.Fllmil;es:'«·.. · · · . ··;'·,' '$5,172 <;
and
employers (primarily small firms with lower wage
workers). In addition, the Federal government will pay 80 percent of the average cost premium
for early retirees. However, these subsidies are provided only up to an amount equal to the'
average cost plan in the area to encourage consumer price consciousness when selecting a
plan.
Medicaid coverage would be continued for persons receiving cash assistance although
they would obtain coverage through the Health Alliance.
Medicaid coverage would be
eliminated for all other persons not receiving cash assistance (except those on Medicare);
these individuals would obtain coverage through the Health Alliance where they will qualify for
subsidies according to the same criteria that apply to other families. ,However, states are
required to make a "maintenance of effort" contribution to the Federal government to fund
subsidies under the program the amount of which is based upon the state share of savings for
the non-cash Medicaid population. 1
Under the Act, the Medicare program is retained in its current form, although coverage is
extended to cover prescription drugs. Long~term care, coverage is also expanded under the
Act. However, working Medicare recipients would become covered in the Regional Alliance by
virtue of the employer coverage requ,irement.
In addition, the program includes provisions
which limit the growth in health spending for both public and private programs by controlling
the rate at which premium payments could increase.
B.
Change in National Health Spending
National health spending would increase over the 1996 through 1998 period as states
begin to participate under the program and extend coverage to the uninsured (Figure ES-1).
Under the Act, health spending would eventually fall below levels projected under current
I
1 The amount of this maintenance of effort contribution will be based upon current spending for the non-cash
Medicaid population indexed to health spending growth (i.e., reflects budget caps).
© 1993
ES-2
Lewin-VHI, Inc.
�i
Th~ Financial Impact of the Health Security Act
,
199~ as t~e effect of the health expenditure constraints increases over
policy Jeginning in
I
I
time. lLInder the Health ISecurity Act, health care will comprise about 18.0 percent of gross
I
domes~ic
reform{
J'
product (GOP); by 2000 compared with 18.7 percent under current policy (without
I
'
.
I
I
I
FIGLIRE ES-1
CHANGES IN HEALTH SPENDING UNDER THE HEALTH SECURITY ACT IN 1995
;'
THROUGH 2000
1,631.0
1995
11996
1991
I~Current Policy
1998
1 99920 00
___ Under Health Reform
I
Source: Lewin-VHI estirl,ates using the Health Benefits Simulation Model (HBSM).
I
Health spending! in the' first full year of implementation (1998) would be roug hly the same
as uinder current
I
spe~ding
POli~y ($0.6 billion less)
I
(Table ES-1).
.
Ho~ever,
as discussed below, health
by individual payers will change substantially under the Act.
The $0.6 billion
redJction in health spending reflects an array of complex changes in coverage and service
I
I
.
'
delivery under health: reform. This includes increases in utilization of acute care services for
pre~iously
uninsured: persons of $47.0 billion; increased long-term care utilization of $11.6
'billi6n; increased
I
$6.9 billion.
I
fUn~ing fo:r public health of $5.4 'billion; and increased administrative costs of
I
'
These I new costs will be offset by savings attributable to increased use of
maraged care.
I
i
.
'
I
!
C1993
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ES-3
Lewin-VHI, Inc.
�The Financial Impact of the Health Security Act
TABLE ESo1
CHANGES IN H~LTH SPENDING IN 1998 (IN BILLIONS)
{1!;l~;;!ji;;:!~,
HEAL:
.... 'Ge$;;INitfE~utH~$eENoING;i;i\ji~'~'~~i~t;i~l'l~l~~~;\jK#};);';;')tljmii'.;i;~~&~~;f~;tll
Federal Government Health Spending
New Program Costs
Offsets to New Pro ram Costs
State Government Health Spending
New Program Costs
Offsets to New Pro ram Costs
Local Govemment Health Spending
Savings to Public Hospitals
Loss of Disproportionate Share Funds
Local Government Worker Health Benefits
Private Employer Health Spending (Net of Subsidies)
Firms That Now Insure
Firms That Do Not Now Insure
Household Health Spending
Premiums Payments
Out-of-Pocket Payments
Tax Pa ments
$6.0
($12.4)
$3.4
($14.8)
$16.6
$1.6
$28.9
($0.4)
$29.3
($26.5)
($26.2)
($15.8)
$15.5
j';:li·:l;W:j[1:;i·j~¥~f::;;~~~\~~;¥iX~,illl;lj:;jt;i~:::iiili,!\B:i·i~;]~j·NEi;l.CflANGE"N0HEjL:tH1SeENQING\lj~~fE;!~,1;;~~41t~~lli)1;m~~~]~,;:':;;"r;'::'~'8i';1~f~1;i~~1
Net Change in Spending bl
Utilization for UninsuredlUnderinsured
Managed Care Savings
Long-Term Care
Public Health
Administration
Ex enditure Control Savin s
($0.6)
a
Does not include wage effects and resulting changes in tax payments because these values are
not included in tne national health accounts. These effects are estimated below.
b
A detailed analysis of changes in national health spending under the Health Security Act is
presented in Appendix A.
Source: Lewin~VHI estimates. . .
C.
Federal Health Spending Under the Health Security Act
New Federal programs under the Health Security Act would be financed largely with
. savings in existing Federal health benefits programs. The Federal government would p'rovide
premium subsidies to households and businesses, expand long-term care coverage, provide
prescription drug coverage under Medicare, and expand public health activities.
These
programs would be financed with savings under Medicare, Medicaid and other Federal
programs together with other taxes on households and employers. Under the assumptions
used in this analysis, the program would result in a net reduction in the Federal deficit over the
1994 through 2000 period of about $24.6 billion .
. ©.1993
ES-4
Lewin-VHI, Inc.
�T~e Fin~nciallmpact of the Health Security Act
I
.
I
T~tal uses of Fed~ral funds under the Health Security Act would be $342.1 billion over
the 1994 through 2000 period (Figure ES-2). This includes new program spending of $317.5
,
I
billion knd $24.6 billion, in deficit reduction.
I
~
The $317.5 billion in new program spending
includes premium and qost-sh~ring subsidies (net of offsets) of $152.9 billion; net Medicare
drug
b~nefit payments 6f $59.3 billion; and
long-term care expenditures of $64.7 billion. The
program also includes ;$7.9 billion in increased health insurance tax deductions for selfI
I
i
.;
employed persons, and ~unding for public health and administration of $32.7 billion.
I
'
·.
FIGURE ES-2
.
.
SOURCES AND USES OF FEDERAL FUNDS UNDER THE HEALTH SECURITY ACT
1994 - 2000 (IN BILLIO~S)
I
I.
Federal
Misc.
Medicaid
Savings
$66.7
Revenue
Gains
$13.3
Deficit
Tobacco
Taxes
$65.8
Savings
$123.9
Assessments
$45.1
,
I
Public Health!
Self·Employed
Tax Deduction
$7.9
Administration
$32.7
Medicare Drug
Benefit
$59.3
;
I
Sources of Funds =$342.1
Uses of Funds =$342.1
Total funding uhder the Health Security Act would be $342.1 billion over the 1994
thropgh 2000 period.! About two thirds of these funds would be raised through savings in
existing programs suqh as Medicare, Medicaid, FEHBP, Veterans and other programs. These
savihgs reflect the irhpactof the premium cap, shifts in coverage from public programs to
I
I '
private plans and Medicaid savings resulting from the elimination of Disproportionate Share
I
:.
.
PaYiments (DSH) to hospitals. About 36 percent of\ the program would be financed through
I
new tax revenues of/which about half would be attributed to a three fold increase in Federal
I
I
I
excise taxes on tobacco products ($65.8 billion). The program would also be financed partly
by borporate assessh,ents of $45.1 billion. This includes the one percent payroll tax paid by
I
i
ES-5
Lewin-VHI, Inc.
�The Financial Impact of the Health Security Act
employers who elect to form a Corporate ·Alliance and employer savings for early retirees
receiving subsidized coverage under the Act. 2
A major portion of new spending under the Act will be Federal subsidies to businesses
and households of $152.9 billion. Total ,subsidy payments would. be $338.4 billion over the
1996 through 2000 period which includes: employer premium subsidy payments of $142.9
billion; premium subsidies to families of $168.4 billion; cost-sharing subsidies of $12.1 billion;
and early retiree subsidies of $15.0 billion (Figure ES-3). These costs will be offset by: 1)
Medicare savings for working aged persons covered under the Health Alliance ($31.7); 2) the
Federal share of savings for the Medicaid non-cash recipients shifted to the Health Alliance
($82.1); and 3) state maintenance of effort payments· for the non-cash Medicaid population
shifted to the Health Alliance ($71.7 billion).
FIGURE ES-3
SUBSIDY PAYMENTS UNDER THE HEALTH SECURITY ACT: 1996 THROUGH 2000
(IN BILLIONS)
. $338.4
Cost S haring:-:l~;;;~~~~C=12.1
Early Retirees
15.0
Family
Premium
Subsidies
$185.5
State
Maintenance
of Effort
Federal
Medicaid
Employer
Premium
Susbidies
Federal
Medicare
Premium Subsidy
Cost
Offsets
Net Cost
Source: Lewin-VHI estimates using the Health Benefits Simulation Model (HBSM).
D.
Employer Health Spending
Private employer health spending (net of subsidies) would increase gradually over the
.
.
1996 through 1998 period as states participate in the Health Alliance (Figure ES-4). The net
'
.
.
increase in employer spending in the first full-year of implementation would be $28.9 billion.
2 Firms with 5,000 or more workers are permitted to form a Corporate Alliance but must pay a one percent payroll
tax beginning in 1996. We assume that firms with unionized workplaces will elect this option as will other eligible
firms that will find it to their advantage to do so.
© 1993
ES-6
Lewin-VHI, Inc.
�'I
I
,
The Financial Impact of the Health Security Act
I
i
Employer health spendi,:ng would continue to be higher than projected under current law
through the end of the; century.
However, the rate of growth in private employer health
spendi1ng would be substantially lower than under current projections due to the premium caps.
!'
I
Ii'
FIGURE ES-4
PRIVATE EMPLOYER 'HEALTH SPENDING UNDER CURRENT POLICY AND THE HEALTH
J
'SECURITY ACT ( IN BILLIONS)A
$309.2
$293.2
19194
.
1995
1996
1997
l-+-i:Current Policy
1998
2000
1999
-Health Security Actl
a
/lnCludes benefits for workers, dependents, and retirees net of program subsidies.
Sourfe: Lewin-VHI esti~ates using the Health Benefits Simulation Model (HBSM).
i
I
The increase in ,employer spending under the Act reflects the cost of covering workers
I
•
WhO/ currently do not ~ave coverage on their job offset. by cost containment savings under the
Act.. Among employers who now offer insurance, costs would increase initially due to the cost
I
of ¢overing workers; now excluded from coverage in these firms, the cost of upgrading
!
!
coverage to the minimum standard under the Act, and the one percent payroll tax paid by firms
~ Corporate Alliance.
I '
that decide to form
I
Once all states participate under the Act in 1998,
spending for these firms would decline below currently projected levels due to: 1) cost controls;
I
!
2) Federal coverage lof early retirees under the Health Alliance; and 3) the fact that coverage
for I~Orking
depende~ts in ~mployer plans would in effect be financed by hislher own employer
resulting in savings tp firms that now provide insurance (Figure ES-S).3
I
J
.'
;
I,
3. JThe federal government will pay SO percent of the Alliance premium for early retirees resulting in savings to
employers who provide early retiree benefits.
I i ,
I,
@ 1993
I
I
'
ES-7
Lewin-VHI, Inc.
�The Financial Impact of the .Health Security Act
FIGURE ES-5.
CHANGE IN EMPLOYER HEALTH SPENDING FOR FIRMS OFFERING AND NOT OFFERING
INSURANCE
$29.3
1996
1997
$30.6
$32.0
1998
Firms That Now Offer Insurance
~Firms
That Do Not Now Offer
Insu ranee
a
Includes benefits for workers, dependents, and retirees net of program subsidies.
Source: Lewin-VHI estimates using the Health Benefits Simulation Model (HBSM).
Smaller firms that now offer insurance Will tend to see a reduction in health spending due
to the higher level of premium subsidies provided to these groups. For example, insuring firms
with less than ten workers save an average of about $868 per worker under reform. Among
firms that do not now offer insurance, employer spending would increase by about $1,908 per
worker. Among firms that now provide insurance, expenditures will decline in industries such
as construction, manufacturing, transportation, wholesale trade, and finance.
E.
Impact on State and Local Government Health Spending
State and local governments are a major source of financing for many programs that
provide care to low-income and medically indig.ent populations. These programs, especially at
the state level, will generally see substantial savings under the Health Security Act as
coverage is extended to all Americans.
However, the discontinuation of Disproportionate
Share Hospital (DSH) payments under Medicaid will have a significant impact on many
hospitals that are heavily dependent upon DSH payments.
The employer coverage
requirement could also result in a significant increase in expenditures for many state and local
governments that do not now cover substantial portions of their public employee workforce:
@1993
ES-8
Lewin-VHI, Inc.
�I
T~e
Financial Impact of the Health Security Act
State and local go~ernment health spending would be reduced by about $9.0 billion in
I
" .
1998 under the Health ;Security Act.
~12.4
about
!
.
State government expenditures would be reduced by
billion in 11998 due to savings in Medicaid and other indigent care programs
I
sponsrred by state governments.
Local government spending would actually increase by
about~3.4 billion in 1998 largely due to the loss of DSH payments to public hospitals and the
I
I '
cost of conforming to tbe employer coverage requirement for government workers under the
I
.
I
Act.
I '
!
I .
I
F.
I
I
Impact on l1ouseholds
I
iT"he Health
i
,
,
Secu~ty
I
Act' would affect households in four ways. First, the plan generally
I '
would result in substantial changes in family premium payments. Second; expanded coverage
undei the plan would generally reduce family direct payments for care. Third, lower-income
I
hous~holds
~
,
would re,Ceive .subsidies. for patient cost-sharing and household premium
paymients. Fourth, theiAct would result in increased tax payments resulting from the excise tax
I
on tobacco products a~d the exclusion of health benefits from cafeteria health, plans.
I
'.'
lin 1998, overall
~ealth ~pending
unde1r the Act (Table lES-2).
by households would be reduced by about $26.2 billion
Family premium payments would be reduced by about $25.9
billioh and direct payfnents ,for care (copayments, uncovered services) would decrease by
aboJt $15.8 billion.
T~ese savings would be offset by increased tax payments of about $15.5
billiOh. about two-thirds of which would be due to an increase in tobacco taxes under the Act.
I
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ES-9
Lewin-VHI, Inc.
�The Financial Impact of the Health Security Act
TABLE ES-2
IMPACT OF HEALTH REFORM ON HOUSEHOLDS IN 1998 (IN~~~b
Employee Share of Employer Premium
.
Payments to Alliance aJ
Premiums Under Current Plans bl
Worker Premium Subsidies cl
Prem
for
!'ltal Benefits dl
Non-Employment Premiums
Premiums to Alliance" el
Non-Group Premiums Under Current Policy fl
Premium Subsidies el
$62.9
($74.7)
($4.9)
($14.9)
~~~
Medicare Part B Premium gl
Increased Premium for Higher Income Persons
Part·B Spending Cap
Prescri
Direct Payments
Out-of-Pocket Spending for Acute Care hi
Direct Payments for Long-Term Care il
New Copayments Under Medicare jl
Patient Cost Shari Subsidies kI
($15.8)
Tax Changes
Tobacco Taxes
State and Local HI Tax Payments V
Cafeteria Plan Restrictions mI
Reduced Medical Expense Deduction n/
Deduction for Self Em
01
a
b
c
d
e
g
h
Ii:> 1993
The employer is required to pay an amount equal to at least 80 percent of the average cost plan in
the area with the employee paying the remainder.
Premium payments for existing coverage are eliminated.
Premium subsidies are provided to workers below 150 percent of poverty.
Some employers are assumed to continue coverage for services not covered under the minimum
benefits package at the current employee premium contribution level for these benefits (e.g., adult
dental. eyeglasses).
Non-workers not otherwise covered under Medicare are required to purchase coverage through the
Health Alliance. Subsidies are provided for lower..income families.
The subsidized non-worker coverage provided under the Health Alliance eliminates the need for
other non-group insurance payments for this population.
Medicare premiums are increased for higher income persons. The premium is increased to cover
roughly 25 percent of the cost of the prescription drug benefit. This premium increase will be
partly offset by premium reductions due to the budget cap.
Family out-of-pocket payments for health services will be reduced under the program due to: 1)
reduced patient cost-sharing requirements under the plan and 2) expanded coverage for services
often excluded under existing plans.
Footnotes continued on next page
ES-10
Lewin-VHI, Inc.
,
I
I
!
�,
The Financial Impact of the Health Security Act
I
I
i
j
k
I
m·
n
:
Includes tax incentives for long-term care insurance.
Includes increased copayments for home health and laboratory services. .
The program reduceS patient cost-sharing for persons below 150 percent of poverty.
.A!II state and local wqrkers will be required to pay the Medicare HI tax (individual share).
I~creased personal h1comes taxes due to exclusion of health benefits from cafeteria plans.
Reductions in direct payments for care will lead to reduced medical expense income tax
deductions.
:
.
o
The insurance deduCtion for self-employed persons will result in reduced tax payments for some
I
"
persons.
I
'
Sourc~: Lewin-VHI estim~tes usifl9 the Health Benefits Simulation Model (HBSM).
:
L
I
;:
'
The greatest decline in health spending would occur among older persons.
Health
spending for persons age 55 to 64 would decline by about $782 per family, largely due to the
retire~
coverage proJision and prescription drug coverage for the Medicare disabled
I
:'
population. Health sp~nding 'would decline by $487 among families headed by a person age
o~ older, again lar~ely due to prescription drug coverage. Among persons who would
spen~ $10,000 or mor~ out-of-pocket under,current policy, family spending would be reduced
65
by acout $6,093 per family
/The plan would ireduce spending across all family income groups except those with
incorhes of $100,oooi or more.
savi~gS of about $742 per family.
I
Families with annual incomes below $10,000 would see
Average savings would generally decline as income rises.
I
Health spending would increase by an average of $289 per family for families with incomes of
:
I
$100,000 or more largely due to the increase in premiums for high income Medicare
ben~ficiaries and the kxclusion of health benefits from cafeteria plans. 4
I
I
G.
'
The Imporitance of Community Rating
Under the Act, ~II individuals in a given health plan pay the same. premium for their type
,
of family (Le., individyal, two-parent family, etc.) regardless of their age or health status. This
me~ns that younger ihealthier populations will cross-subsidize the cost
sic~er
of care for older and
groups. In P~rticular, it implies that employers and workers will cross-subsidize non
workers. For examp,Ie, the average monthly per capita cost of the uniform benefits package
woilild be roughly $160 for workers and dependents while the monthly per-capita for non
wofkers, would be
WO~ld
a~out $319 (Figure ES-6).
The overall community rated per-capita premium
be about $18;2 per month, which is about 14 percent higher than the actual cost for
workers and
depend~nts.
I
!
I
!'
4 IThe Act prohibits e~ployerS from including employee contributions for health insurance and other health
expenses in tax exempt 'cafeteria plans. resulting in an increase in tax revenues (after adjusting for likely shifts in
compensation to other nbn-taxable forms of compensation).
.
[
@
1,993
I
ES-11
Lewin-VHI, Inc.
�The Financial Impact of the Health Security Act
. FIGURE ES-6
AVERAGE MONTHLY PREMIUM COST PER PERSON UNDER THE REGIONAL ALLIANCE
IN 1998
$319
Firm s That
N ow In sure
Non
Workers
FirmsThat
Do Not
Now Insure
Com m unity
Rate
Source: Lewin-VHI estimates using the Health Benefits Simulation Model (HBSM).
This employer cross-subsidy of non-workers reduces substantially the Federal cost of
assuring universal coverage. This is because the non-worker population, which includes early
retirees and Medicaid non-cash recipients shifted
t~
the Health Alliance, will generally receive
premium subsidies under the Act. However, due to this community rating cross-subsidy, the
Federal government will subsidize premium purchases for non-workers at $182 per month
rather than at their actual cost of $319 per month. Thus, in effect, employers and the Federal
government share in the cost of insuring the lower income non-working population. This is one
of the primary reasons why the Federal cost of assuring universal coverage under the Act is
less than might have been expected. It is also one of the primary reasons why employer
health spending would remain well above currently projected levels into the next century
despite constraints on the rate of growth in health spending.
H. Distributional Impacts
,A comprehensive reform ,of the U.S. health care system such as the Health Security Act
will involve a substantial realignment and standardization of coverage affecting both employers
and individuals.
This will. inevitably result in net changes in health spending for many
employers and individuals.
About 52 percent of all households would see a reduction in annual health spending
under the Act of $20 or more (Figure ES-7).
© 1993
About 29 percent of families would see an
ES-12
.
'
Lewin-VHI, Inc•
�T~ Financial Impact of the Health Security Act
;
I
,
I
FIGURE ES-7
DISTRIBUTIONAL IMP.1ACTS OF HEALTH REFORM ON HOUSEHOLDS AND EMPLOYERS
I
.'.!
IN 1998
.
I, •
Decrease of $20 or Mom
per Family
52.3%
FamilieS Wh~;
:Spending:WOuld:
!:, ,oec~BY:"
1$1 000' or More
$500. 1$1 000
$250 ·1$500
$100 ·1$250
$20· $100
! 7.8%
6.2%
; 4.7%
1
72.3%:
62.3%
58.2%
54.0%1
45.8%
With No Ifllll'Oved
Change of
$20 or Less
per Family
CoV9lage
15.2%
t
$1 oob or More
$500 L $1 000
$250 '. 5500
5100;·5250
$20. 15100
: 14.6% .
! 11.5% .
8.2%
6.5%
3.8%
79.7%
86.2%
77.1%
63.6%
56.4%
3.1%
Witlllflllroved Coverage
29.4%
Decrease of
$100 or More
per Employee
53.4%
1$2 500 or More
$1 000 • $2.500
$500 • $1.000
$250· $500
$100· $250
16.3%
15.8%
11.8%
·7.5%
2.0%
j
1
.0.5%
20.5%
12.5%
: 6.4%
Increase of
$100orMore
per Employee
43.5%
Changeo!
$100orLess
per Employee
3.1%
23% offirms that pay more
currently cover less than 75
percent of their employees.
a
Includes changes in premiums, out-of-pocket expenses, and taxes earmarked to fund health
reform. Exclude~ institutionalized persons.
b
Includes the impact of premium subsidies and changes in retiree expenses. Counts based upon
number of employers so that each employer holds the same weight in this analysiS regardless of
I the number of ~mployees in each firm.
S~Ui'ce: Lewin-VHI e~timates using the Health Benefits Simulation Model (HBSM).
I
ES-13 .
Lewin-VHI, Inc.
�The Financial Impact of the Health Security Act
increase in spending of $20 or more per year due to the fact that their insurance coverage is
improved under the Act; and about 15% would experience spending increases of $20 or more
without improved coverage, notably younger persons, high income persons, and users of
tobacco products. About 38 percent of families would see a change in spending of $1 ,000 or
more, one way or the other. About 80 percent of those who see an increase in spending of
$1,000 or more per family will have improved coverage.
There will be substantial shifts in spending among employers who provide insurance as
well.
About 53 percent of all employers who now provide insurance will see an annual
decrease in spending of $1 O~ or more per worker, while about 43 percent of these employers
. will see an increase in spending $100 or more per worker. However, about 23 percent of
employers who spend more will be firms that currently cover less than 75 percent of their
employees. Overall, about 53 percent of employers will see a change in spending -- either. an
increase or a decrease -- of $1,000 or more per employee.
These wide shifts in household and employer health spending are the inevitable
consequence of standardizing coverage and premium contribution requirements. More over,
shifts of this type can be expected in any health reform initiative that seeks to redress what are
arguably vast inequities in the current health care financing system.
I.
Comparison with Administration Estimates
The primary difference between our estimates and
Administration are the premiums in the ·Regional Alliance.
those
developed
by the
Our analYSis indicates that
premiums in the Regional Alliance would be about 17 percent higher than estimated by the
Administration.
Higher premiums· lead to substantially higher levels of employer· and
household spending than are currently projected by the Administration under the Act. This, in
turn, leads to larger premium subsidies. We estimate that net subsidy payments will be $153
billion over the 1996 through 2000 period compared with the Administration estimate of $116
billion (Table ES-3)
© 1993
. ES-14
Lewin-VHI, Inc.
�The Financial Impact of the Health Security Act
TABLE ES-3
COMPARISON OF ADMINIS"rRATION AND LEWIN-CHI ESTIMATES, 1995-2000
,
(IN BILLIONSt
I
I
Administration, 'I ....... Lewin-VHI; .. '.'" . . . Difference
..
.. .' .
. . j :,1><.:.;'
: .<.':(:;' .. ...,....
." .:. SOURCE OF FUNDS .•.... "
:.1:
,
,
$124
$124
$0
Medicare Savings
:
I
$67
$65
$2
Medicaid Savings
$27
$40
($13) :
Federa.l Program Savinos
I
$65
$66
$1
Tobacco Tax Increase I
$35
$45
$10
Corporate Assessment~
(1'% Rayroll and Retiree)
($18)
$23
($41) •
Tax Effects of Mandate
($6)
$31
$37
Other. Revenue Effectsi
,
($47)
$389
$342
TOTAL
I
"0'.'>: :::;i. ... .•. .' !'.::' :':: ~~ ,:,." :·:i·.~:·:~.·:k.-c':· >\~<;t::·:~ 'USESOF,FUNDSC.")iii f , . .. :; :~:~::::::;::.; ;:; :.::::;::~; :',/: •.:L:.:;,'· :,.,.•:.. ,.,:" .:.' .
','
,
$116
$153
$37
Subsidies
($45)
$0
Contingency Cushion I
($7)
$59
Medicare Drug Benefit i
$65
$65
$0
Long~ Term Care
$29
$33
$4
Public Health/Administration
$10
($3)
Self-Employed Tax Deduction
$7
,
($33)
$58
DefiCit Reduction
$25
I
($47)
TOTAL
$389
$342
:
Source: Presentation by: Alice RlVhn and Lewln-VHI estimates.
.(
,
,/.
",,'1: :
;
'".
:~. ,':'::~.:
~'
In particular, the!higher premium in our estimates leads us to different conclusions about
the Plan's impact on employers. We show a net increase in employer spending through 2000
whil~
the Administration projects a net reduction' in employer health spending by 1999.
Morkover, the
Admini~tration projects an increase in wages due to reduced employer spending
With/ an associated injbrease in Federal income and payroll taxes of $23 billion (Table ES-3).
By 9ontrast, our
proj~cted
increase in employer spending under the Act is likely to result in
offsetting reductions i'n wages which would be associated with a $18 billion loss of Federal tax
I
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rev~nues due to the mandate.
,
:.
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For these reasqns, we show a substantially smaller net reduction in the deficit under the
Health Security Act ;than does the Administration.
I ,
The Administration estimates that total
.
deficit reduction over,'this period would be $103 billion of which about $45 billion is reserved as
a cpshion against
u~anticiPated increases in spending under the Act.
We estimate that this
reserve cushion wou,ld be exceeded and that the net deficit reduction under the Act would be
, abdut $25 billion ove,'r this period.
I
@
1993
ES-15
Lewin-VHI, Inc.
�The Financial Impact of the Health Security Act
J.
Caveats
Like most current health reform proposals, the President's health plan would implement a
program that has never before" been attempted on a broad scale in the United States.
Consequently, there is little data on the likely outcome of such a program that can be used to
estimate its impacts. Although the estimates in this paper are based upon the best data
available at this time, they should be considered illustrative of potential impacts rather than
point estimates of actual policy outcomes.
..
Moreover, this analysis does not consider some potentially important second order
"
effects of the Health Security Act. For example, it does not consider the potential hidden costs
associated with slowing the growth in health spending on technological developments and
quality of care. The analysis does not take into account the potential impacts of reform on
employment, international competitiveness, and general productivity growth. It also does not
consider the potential impact that the early retiree provisions under the Act could have on
retirement behavior and the economy over time. In particular, the study does not consider
some of the potential social and economic benefits of health reform.
Our analysis indicates that the ultimate impact of the plan on the Federal deficit and
employer spending is very sensitive to assumptions on the effectiveness of expenditure
controls. Moreover; these estimates are very sensitive to employer and consumer behavioral
responses under the new incentives created under the Act.
Consequently, policy makers
should recognize "that any major health initiative is likely to require continued refinement in
program financing overtime.
<e)
1993
ES-16
Lewin-VHI, Inc.
.I
�LEWlN-VHI!INC.
a Value fea'th company
9302 lee Highway. Suite 500
Fairfax. Virginia 22031-
(703) 218-5500
(703) 218-5501 (FAX)
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Contact: Janet O~hsWie~er
(301) 652-4389
1
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!
LEWIN-VHI REPORT'FINDS ADMINISTRATION
i
cosr ESTIMATES OVERLY
OPTIMISTIC BUT STILL REDUCES BUDGET DEFICIT
WASHINGTON, D.C., December 8, 1993 -In the first complete independent analysis of
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{
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the financing of President Clinton's Health Security Act, Lewin-VHI says the
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,
administration's plan to provide universal coverage will cost the country and the business
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sector more than ac;tvertised.
However, according to Lawrence S. Lewin, Chairman <i"J CEO of Lewin-VHI, the
internationally recognized ,health care policy and management consulting firm, the report
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,
,
I
"shows that the plan's financing structure works: it meets the President's requirement of
:
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ptoviding universal I '
icoverage, and it does so without , relying or: an increase in broad,
b~sed income taxes.
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'We think itl is time first to focus on the validity of the assumptions underlying the
plan, modify it as
I
n~cessary, and then get on with the passage and implementation of a
I
Health Care ReforT,n Plan, says Lewin-VHI's President Robert J. Rubin, M.D., former
~ssistant SecretarY for Planning and Evaluation in the Department of Health and Human
{
I
Services in the
ea~y
1980s.
"The broader issue - finding ways to control costs while expanding access and
r~taining
I
high quallity cart! - should not be lost in a contest of predicting winners and
'psers." Rubin ad~s, noting that "any restructuring of this magnitude is bound to create
gains for some, and losses for others.
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�2·2·2 LEWIN·VHI ESTIMATES ON HEALTH SECLIRITY ACT
This analysis came as a part of a press conference today at which Lewin-VHI
announced publication of a detailed 196-page study "The Financial Impact of the Health
, Security Act" explaining the Plan's complex financing scheme. The report's findings and
an analysis of its impact on providers of care, federal and state governments, employers,
households. and the pharmaceutical and biotechnology industries will be presented at an
all-day public meeting tomorrow. "Health Care Reform by the Numbers" at the Omni
Shoreham. in Washington, DC. The purpose of releasing these independent estimates.
is "to inject a measure of objectivity into the debate;" ,ccording to Lewin.
"These findings come at a time when there is growing skepticism about whether
the President's plan ~ work. ''This report", Lewin adds. ''validates the logic of the
,
,
plan's financing; it also clearly reveals how critical the underlying assumptions are". The
Lewin-VHI study includes calculations showing the sensitivity of the bottom line to
different behavioral assumptions. The "bottom line" here is the impact the plan's ,
financing has on the federal budget deficit.
The calculations in this report rely on Lewin-VHI's Health Benefits Simulation
Model (HBSM) the most commonly used model for estimating the impact of health care
, reform proposals~
The Lewin-VHI analysis also shows that American families as a group are the
major beneficiaries under President Clinton's health care reform package. with
employers. especially those not now providing insurance. bearing most of the cost of
expanded national coverage.
~'The
'magiC' in the administration's plan, is community rating" says John Sheils.
author of the study and an architect of Lewin·VHI's Health Benefits Simulation Model,
created ten years ago to estimate the impacts of alternative health reform plans.
Community rating is the phenomenon through which the costs of relatively sicker
individuals are spread across a larger population. ''This is quite simply a return to the
way insurance used to work before insurers competed to avoid risk" Sheils said.
(MORE)
LEWlN-VHI, INC.
a Value Health company
�3-3-3 LEWIN·VHI ':ST;MATES ON HEALTH SECURITY ACT
,
Under the Health Security Act, all indivici.k'O:s in a given health plan would pay the
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sJme premium for t,heir typ" 'Jf famiiy, regardless of age or health status. By putting
in6ividuals witr. .,igh
utilizat~~;:i into the larger community pool, younger, healthier
pbpulations ano th~ir employers would share in the cost of their care. While community
r~ting spreads thes~ costs among employers and individuals, the federal government
cbntribute~ ~~ubsidi~S to those employers and families unable to pay.
I
"Our analYSiiS indicates that premiums in the Regional Alliances would b' 3bout
Ypercent ~i:;Jher tran those esti~ated bv the a,dmini.stration a~d this influ.ence:. much .Of
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t~e resulting finan~ing." says Shells. L~~"in-VHI s. ~stl.~ate of higher premiums results In
federal subsidies to employers and families of $1~. J billion from 1996 through 2000, a
!
figure that is $37 billion higher than the Administr"ilon's five-year estimates.
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Because of the higher premiums ~':-:d the expansion",. coverage to the 40 million
uninsured, private ~mployer health spending (after subsidies). will increase graduc!ly
f~om 1996 through: 1998 and will be higher through the end: "ne cen+.ury than under
durrent pOiicies. However, the g~owth r:,'" :: private employer spenc .':J is expected to
!
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decline after 1998.;
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ThE' ,'.ct relies upon price competition among insurers as the primary mt\,:, :,s of
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cost containment. ! As a backstop measure, however, the plan pli:.,:es limits on the rate of
,
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~rowth in premiu"1s to assure that the rate of growth, in health sp.r:nding is constrained.'
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''There is aimpie evidence that the kind of managed carp the Health Security Act
envisions ~ slow health care spending growth, but whether ;( ::til! do so on a national
~cale and to the e~ent the President's plan requires, remains Co ;:;£;t, not a certainty," says
I
I
Lewin. "On the ot,her hand. premium caps. while a sure thing on paper, have to be
~chievable in pra~ice. and will depend on the political will of ~'ected officials and the
toting public; so t~ey are not a sure thing ';;::::ler."
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f,
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The
,
'
admi~istrationestimated a total deficit reduction between 1994 and 2000 of
$103.0 billion Including $45 billion reserved as a cushion against unanticipated increases
i i ,
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in spending. TheiLewin-VHI estimates pre:iict that the reserve cushion will be exceeded
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and that the net d~ficit reduction will be ab::.ut $25 biiiion over the same period.
(MORE)
LEWlN-VHI, INC.
a Value Healtn' company
�4--4-4 LEWIN·VHI ESTIMATES ON HEALTH SECLIRITY ACT
In addition to detailing the financial effects of the plan; Lewin speakers at the all
day workshop will describe their analyses of the effects on key sectors of the health care
economy. Highlights are:
States:
• States will spend less ($f2.4 billion in 1998) under HSA but will have the
responsibility of supervising the Regional Alliances.
• Strong incentives to begin implementing alliances in 1996 will tax,the capacity of
most state governments.
• Alliance budgets will exceed the current state budget in a majority of states.
Local Governments
• Local governments will spend $3.4 billion more in 1998 than 'they would under
current policy, primarily due to the loss of DSH and the mandate to cover local
workers.
• 'The HSA, although, addressing many of local governments historic needs, leaves
gaps: many mental health and substance abuse services, prisoners and
undocumented immigrants.
Providers of Care
• Hospital spending will be $23.8 billion less in 1998, chiefly because of the impact of
reduced utilization due to managed care and cuts in Medicare
• Physicians will see $20 billion more in 1998, due to the impact of managed care and
providing coverage for those currently uninsured, however, there will be distributive
effects among physicians.
(MORE)
LEWlf+VHI,. INC.
a Value Health company
�I
SLS-S LEWIN-VH'! ESTIMATES ON HEALTH SECURITY ACT
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Physipians will face a ban on balance billing and other regulatory restraints if they
remain in a fee :for service setting.
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HSA will accele1rate the current trend of provider integration.
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HSA's effect on l employers is varied and complex. As a group they will pay more
through the year 2000' then under current policy - a finding different than the
,
Administration's.
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•
In general, firms that now offer insurance will see a reduction in spending while those
.
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that do not will see an increase.
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•
Manufacturing, transportation, communications, and utility companies will see a
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reduction in costs by 1.998 while retail trade and service companies will see
increases.
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Plilarmaceytjcal IndUstry
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The HSA expands access to pharmaceuticals and will result in a 6 percent increase
in spending by 1998; tt:Jere will however be an increase in regulation of drug prices
I
especially new products.
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Lewin-VHI.
asubsidiary of Value health, Inc. is a health care consulting firm
i
providing health policy, research and management consulting services to government
ag~nCies. health ca;e prov:iders, health industry suppliers, Insurers and Investors.
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offices in the Washington, D.C. and San Francisco bay areas.
Value
i
Healt~.
Inc. is a leading provider of specialty managed care benefit
programs and health care information services.
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(MORE)
. UWlN--VHI, INC.
a Value Health company
It has
��EXECUTIVE OFFICE OF THE PRESIDENT
OFFICE OF MANAGEMENT AND BUDGET
WASHINGTON. D.C. 20503
.
I
contact: Barry Toiv
FOR iMMEDIATE RELEASE
DeCemDer 8, 1993\
(202) 395-7254
STATEMENT BY DR. ALICE RIVLIN
DEPUTY QIRECTOR, OFFICE OF MANAGEMENT AND BUDGET
I
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The Lewin-vHI study essentially verifies our estimates and
the soundness of ithe financing of our proposal. The study
confirms that th~ Health Security Act is fully financed and that
it will reduce the deficit over the period from 1995-2000.
lour initial:rev1ew of the Lewin-VBI study indicates that it
substantially co~firms our estimates of the financial impact of
the Health Security Act. Because of slightly different
ass~ptions, the; study yields slightly different results. Despite
these differences, the important point i~ that Lewin-VBI's
esti~ates of theicosts of the Health Security Act are roughly the
samelas the Administration's 'estimates; and their estimates of
the savings that:will be realized from the Health Security Act
are roughly the ~ame 'as the Administration's.
I
.Lewin-VBI's i estimates of the cost of the discot::.:-.s for
sma:.. : low-wage 4!!mployers and for low-income worker6.'::.re slightly
lowE:j than our estimates. Therefore, the Lewin-VBI analysis
confirms that th~ entitlement caps we have placed in the Health
Security Act are', not likely to be exceeded.'
.
for~ard
Iwe look
to having an opportunity to review the
Lewin-VBI study more ,thoroughly.
III
Note: The Lewin press release appears to contain an inadvertent
factual error. ~he Lewin estimate of the discounts is $153
bill~on; the Administration's estimate is $161 billion, which is
the amount of funding' assumed in the entitlement caps in the
Health Security Act. Therefore, contrary to a statement in the
Lewiti release, the study actually con~ludes that the cost of the
discqunts for inqividuals and businesses will DQt exceed the
ent': ~~!lement cap ~n the legislation.
��THE WHITE HOUSE'
Qfficf f,r the Press Secretary
December 9, 1993
·For Immediate. Release
I
I
PRESS BRIEFING
!
BY
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SECRETARY OF THE TREASURY LLOYD BENTSEN
D~RECTOR OF OMB LEON PANETTA
I
The Briefing Room
,
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3:12 P.M. EST
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, sr- -: _ETAR~ BENTSEN:
Good afternoon. We've only had a short time to
study this j..;;:win report, but I must say it is most encouraging. There were a lot of people
thatl~aid we couldn't ~ve one of these, that we couldn't have ~ni~ersal coverage. But the
LeWIn report says we :can. It says that we meet the overall ob::, ', : ~lves of the
adrrlinistration's plan. ! And not only that, that we do it without a broad-based tax and then
•
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ak
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tn turn we mea contrl utlon to the defilClt.
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I think it's encouraging -- you know, projections on a new program like of this
I
with this scale, it's a cpaIlenge. We have plenty of experience in government making
estifuates of program ~-. But with this one we're looking at years into the future. So we
had/a number of agenpies in the government work on it -- HCFA, TreasUry, we had our
esti¥1ators, we had ou;r actuaries -- to try to be sure that we weJ;e right in this regard. And
I think that they were Ivery cautious in doing that. Our economists and our estiinators at
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the jfreasury Dep~ent looked at this one with a magnifying glass. We've had actuaries
andlestimators from ~e five'largest accounting firms checking on the methodology -- to
be right -- be sure we :were right in that regard.
I
And the concl~sions;over;.tll buttress each other, reaffirming my confidence in the
estimating job that we've job. We're ftnding we agree on a number of points about the
fimfucing of health care reform. We agree that our plan is paid for. And we agree that
thete will be a deficitireduction. -- we don't come ur'vdth the same deficit number, hut
it's ~ major contributibn on eachon them insofar as cutting that deficit.
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And I better ~int o~t that the estimates in this study of the subsidies that are
required under the pl~ of the government spending, are less than we in the
adIriinistration had, re~ched, which I think shows how cautious and conservative we were
in cbming up with those numbers:
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�Americans deserve a comprehensive health care reform that covers everyone.
And they expect the truth about what it will cost. And, once again, those estimates are
buttressed by the Lewin Report.
DIRECTOR PANETTA: From the beginning of process of developing
comprehensive health care plan, it's been our intent to produce a plan that was fully paid
for and that had the most accurate estimates of costs available so that the American
people could be confident that they could get universal coverage, and that they would get
a plan that is fully paid for.
That has not been an easy process. As I indicated before, we began this year
developing models that did not exist before in temis of determining a lot of the estimates
with regards to cost. We believe we have the most accurate estimates, and we think that
the Lewin Report in effect confirms that. We now have, I think, as a result of the Lewin
Report -- and the people that are associated with that review and that analysis -- the same
judgment that this plan is financially sound. As the Secretary has pointed out, I think, if
there's anything that the American people were asking themselves when the President
kept saying, "We can have comprehensive coverage of health care. We can have cost
controls: We can reduce the deficit, and it doesn't demand a broad:-based tax," we now
have confirmation that, in effect, this can be accomplished. And I just would read for you
a quote from the Lewin Report: This report shows, and I quote, "shows that the plan's
financing structure works, it meets the President's requirement of providing universal
coverage, and it does so without relying on an increase in broad-based income taxes."
Now, if I can, I would like to kind of point to where the areas of difference are,
and generruly how they arrive at their conclusions. This is about a 200-page report with
about 80 pages of indexes, and we are still in the process of reviewing it. But to the best
of our ability, these appear to be the principal differences with regards to the chart on my
left that basically establishes what's in the President's plan in terms of cost, and the
revenues that we will raise in order to cover those costs, and obviously the deficit
reduction that would then result.
If I can draw your attention to the right side of the chart. On that chart there is a
difference here with regards to the proposed premium -- they believe that the premium
will be about 12 percent higher -- I think they say 17 -- but we estimate that using the
right mathematics here it would be about a 12 percent increase in the premium. If you
.combine the $117 billion and the $.44 billion, which is what we project on the premium.
cost plus the cushion, that number would be $161 billion.' The number that the Lewin
. report came out with is $153 billion, so that even with the increase that they project in the
premium ...;- we don't agree with that -- that it would involve that higher premium; we
nevertheless are below the caps that we established with regards to the premium side.
On the Medicare drug benefit, we estimate the cost of that at about $66 billion.
They estimate the cost at less -- $59 billion, which shows again that we tried to accept the
most conservative judgments of the costs in these areas.
2
�On 10m:,' ,':m care they estimated the cost at $62 billion -- we estimated the cost
$62 billion; th~), ,:"stirltate is about $65 billion -- but I have to tell you that they were
wor~ng off a v•.' .jon!that we nrovided earlier that involves a $65 billion number. So, we
think we're very ;;iosei on th~ '~()st estimates with regards to long-term care.
The one area that we i are not sure of what their estimates are, at least in a
preliminary aml;:::;is, fS on the public health part of this where we have public health and
adniinistration costs. :We have estimated that at 5) 53 billion; and this is the one are we're
not Sure how they cOIhe to their costs estimates and that's something we've got to
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contmue to review. I
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revenu~
On the
side, 'thl.1edicare savings are exactly alike. We have said $124
billion on Medicare savings; th~ir judgment is that we're right on the button with regards
t(l :ll' Medicare savings of $124 billion. On Medicaid savings, we projected $65 billion;
th .'estimate is $67 ~i1lion. So, they assume that we will achieve some additional
sr" :.gs, not much, hut in these numbers, but nCJt:rtheless, they show that we will get
abvut $2 billion moreiin savings from Medicaid. '
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On the tobacc~ tax, our estimate on the tohacco tax is $65 billion; theirs is $66
billi,on. So, they're es#mating, again, we're all in the right ballpark here -- about $1
billion more on the tobacco tax.
I Onwhatcorpoolte assessment whichwith regards towe really have not been able
the
is
of this
determine
they
specifically
revenues from the corporate
part
to
~stimate
ass¢ssment. On the f¢deral savings, this is an area of difference -- we're assuming about
$40!billion in savingslfrom various federal programs ~. . , a result of implementing this
plan; they edmate $27 billion. But I have to tell you Iilat at least our sense of this is that
the teason : ',ill're havirg less savings here is because of their higher premium estimate
and iwhat that then does with regards to savings, particularly with regards to federal
emp,loyees.
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Lastly, on other revenue effects on the $86 billion that we estimate, we think there
are differences here ~ well; and we are still in the process of trying to analyze
spedifically what those differences are. But when YO'., add up Where they're at in terms of
revenues versus the c~st, they arrive at a deficit nurnoer of $25 billion as compared to our
$58Ibillio~. ~gain, I think thi~> ~l()int is this --. that ~ev hav~ essentially confi~ed that we
are well WIthin the ballpark th:c' we are working wrL ~lere m terms of the estimates for
'.
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this ,plan; and that the ,plan we have presented is ind(o;ed financially sound as we presented
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. \"hat I hope .Je will do is be able as a result of this -- and I hope there will be
analyses tliat are done of these numbers. We have always said that these are
out best estimates, and we hope that there are additional people who will look and
I
anal~ze the numbers that we presented.
.
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con~inuing
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�But we hope that in this process that the American people will derive as we have a
degree of,comfort here that we are in fact working with the right numbers in terms ofthe
estimates and the costs; and that we can shift the debate here in the health care area to
what exactly should be in the plan. I've often mentioned in the budget battle the
credibility of our numbers was not questioned. It was a question of what should or
should not be in the plan -- should there be additional revenue, should there be additional
cuts. That's a fair debate. But we were right in terms of the numbers. And that's
essentially the kind of debate we'd like to have on the health care plan. And we also hope
that other plans· will be subject to the same kind of review -- that Lewin will look at the
other plans that are on Capitol Hill and make the same kind of analyses that he did with
the President's plan.
I think the bottom line is that we derive a great deal of comfort as a result of this
first analysis that we're on the right track when it comes to health care reform for this
country.
Q
How sensitive are these figures to the current interest rate environment -- I
mean, you know, if the Fed ends up having to be on a tightening path as the economy
picks up steam, how sensitive is this analysis to interest rates staying where they are
now?
SECRETARY BENTSEN: First, let me say that I think you're going to see
certainly long-temi interest rates stay at the same relative level that they are now, because
whatwe are seeing in the way of excess capacity and excess labor gives us some cushion
in that regard. So I'm optimistic on it. Insofar as short-term rates, over a period oftime,
obviously they're going to raise some --they're going to rise some. But I would not
estimate that that would be anything major.
DIRECTOR P ANETTA: Let mejust -- there really is not that much that's
included here that is interest rate-related in the sense of cost estimates with regards to
either the drug benefits·and others. I mean, obviously there would be some impact,
particularly, I think, on-the revenue that might flow in depending on obviously incomes
and earnings and what have you. But other than that, I think that certainly in this interest
rate climate, these numbers are right on track.
Q
Can you tell us what the mechanism for the cushion is? How is that to be
appropriated by Congress? And second, can you tell us how many businesses with how
many employees do you expect --be paying the corporate assessment?
DIRECTOR P ANETTA: Do you have the number on the amount of businesses
that would be paying the corporate assessment?
MR. THORPE: We don't have it with us. Again, the cushion in the -
DIRECTOR P ANETTA: You want to come up here.
4
�I
MR. THORPE! The cushion as we've shown it up here, as you'll know, in the
capped entitlements thkt we Have in the legislation that what we have under the premium
discJunts and the cushion is indistinguishable. So built into the capped entitlements are
,
I
the ~161 billion in discounts,: So they're really indistinguishable in t~rms of the
legisiation,
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Q
So wou'ld Congress appropriate $44 billion or not?
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MR. THORPE1 (Ken: Thorpe, Assistant Secretary, HHS) No -- yes, it is included
-- ab~olutely -- is included within the yearly capped entitlements.
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DIRECTOR P ~ETTA: You need ha~e th: cushion appropriated so that we're
rotected with regard to the cap that's establIshed In this program.
.
P
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Lewin'~ numbers and yours assume you're going to bring health costs
under· .';ltrol in par ~th your premium caps, Levin predicts Ylm'll get $57 billion in
reduL..i health spendirtg by virtue of those caps in '98 alone. But there's a lot of doubt
I
about whether you'll ge~ those caps through Congress. How much confidence can people
have! ~1at your numbers actually will hold up to the political realities facing you?
I
.
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I DIRECTOR pANETTA: Well, you know, as always, v,e present this plan as a
:
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comprehensive plan. ¥d the cap is a part of that plan. And so we intend to go to the
.
Congress and fight forlthat provision because we think it's very important to our ability to
say tb the American people that we're going to control costs. Now, obviously the debate
I
I
in the Congress is going to take place and we're going to fight our way through the
comfuittees and on the!. floor. ' But the position of the administration is to fight to protect
I
that because we think ,t's an important discipline when it COT:1eS to holding down costs.
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Let me tell you'something from just the budget perspective. And I'm right in the
middle of working on the budge~ right now. We are very much on track with regards to
whei:e the deficit is he¥ed. We are now in a situation, having passed the budget plan,
that we expect that we iare going to not only meet but perhaps even exceed the deficit
targ¢ts we're looking aF. But it is absolutely essential if we're going to stay on track to
pass health care refomi. The ,only way you can keep us on track on the deficit so that we
can bring that deficit h~pefuliy below $100 billion and eventually to balance is to pass
cost hontrols on healthi care. And frankly the cap is a part of that process.
Q
Directo~ Panetta, on the deficit issue, the mayors were here this morning,
they told us that the Pr~sident told them that crime is now the number one domestic
agentta issue. They h~ve asked for huge increases in crime spending. Are you going to
be able to do that ~nd ~till meet your deficit targets?
5
�. DIRECTOR PANETTA: We are operating under a hard freeze cap. That
basically means that what we.spent in '93 is what we're going to spend for the next five
years in the federal government. That means that if there are areas in which we are going
to increase spending, we're going to have to find savings elsewhere. And thatis the
process ~e're going through. On crime, essentially what the Congress is doing and I
think what the President envisions is that whatever we commit to pay for the war against
crime in this country is going to come within the caps established by the Congress. And
we will have to find savings elsewhere in order to pay for that priority.
Q
•• said a few minutes ago that you're on track in terms of the deficit and
you may even exceed your target. Now,' as I remember for '94 your deficit number in
your last forecast was like 260, and the '93 figure came in much lower than you had
thought. Can you give us •• I realize you can't give us an exact number -- can you give us
some idea of what the '94 deficit •• what your general ballpark estimate is now for the '94
deficit?
DIRECTOR PANETTA: Right now, we think we'll be below the mid-session
projection on the deficit. I can't tell you how much. We're still getting the projections
coming in. But by '98 we think that frankly instead of looking at $180 billion deficit, it'll
be more like $150 billion.
The President talks a lot about personal responsibility in terms of welfare
reform. There's a lot of talk on the Hill about personal responsibilities when it comes to
health care reform and placing that requirement or the obligation up to the individual to
obtain the health insurance. Would the President accept a plan if it had Universal
. coverage and comprehensive package of benefits if the mandate is up to the individual
rather than the employer to obtain other -
Q
SECRETARY BENTSEN: I don't believe under those conditions you'd get
universal coverage. So we look at the practicality of the application -- what would be
forthcoming. And I think the employe~ mandate isa prerequisite.
Q
So you think. the Chafee approach would be unacceptable to you?
SECRETARY BENTSEN: I beg your pardon?
Q
Does that mean then the Chafee approach would be unacceptable to you
.
because it leaves it up to the individual -SECRETARY BENTSEN: Well, I've already told you what I thought the
administration's point of view is, and we feel that quite strongly, that we think it has to be
an employer mandate to be able to bring about universal coverage. And I think these
things that we'ye seen in the way of estimates are fortifying our position as to be able to
accomplish it without any broad-based tax and end up paying for it in full with some
.
leftover to curtail the deficit
6
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Q
.
Do you:think you are losing a lot of ground lately that there's has been sort
,
of a backsliding in support for the plan in terms of the AMA and the public at large?
•
.
.
1
I SECRETARY ~ENTSEN: I heard that same talk on the budget and on NAFTA.
No, I think we're going to put together one where we accomplish it next year, and we'll
get ai package through that is satisfactory to the administration.
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MS. MYERS: 'Thank you.
!
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END
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3:30 P.M. EST
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Health Plan Funding Passes Muster
Independent Gr~up Says ainto~ Proposal Is Financially Sound
________-+1__
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W_"""""SU/lW_ :
By Spencer Rich
An independent researchl group
that included officials of the Reagan
administration has concluded that
the proposed funding system for
President Clinton's national! health
plan is basically sound.
I
''If the question is whether they
can finance this program with the
revenues they will get under their
plan, the answer is yes, and they
will still end up with $25 billion for
budgetary deficit reductionl: said
Lawrence S. Lewin, chain'nan of
Lewin·VHf, which conducted the
study released yesterday, "It! meets
the president's requirement 'of pro
viding universal coverage, land it
does so without relying on, an in
crease in broad-based income
taxes,~
I
·Our funding estimates are in the
same baUpark as theirs; said Rob
ert J. Rubin, assistant secretary of
health and human services lin the
Reagan administration and now
president of Lewin· VHf. which con
ducts studies to determine the costs
of various health programs. Don
Moran, fonner top aide to Reaganera OffICe of Management and Bud
get Director David A. StoCkman,
also worked on the report. I
The Clinton administration
greeted the study with delight. For
months it has been battered by as
sertions from congressional Repub
licans. IIIIch as Rep. Thomas J.
Bliley Jr. (Va.>. and from nwrierous
groups representing businesses and
providers of medical services that
the fmancing mechanisms fOr the
president's health plan eould'result
, in massive underfunding and per
haps a need for new taxes an~ pre
miums far beyond what the White
House has estimated.
I
Even some Democrats wOO, favor
the plan. including Rep. Henry A.
Waxman (Calif.), have questioned
some of the numbers.
I
Alice M. Rivlin. deputy diiector
of the Office of Management and
Budget, said. "The lewin-VHf stu
dy essentially verifies our estimates '
and the soundness of the fmancing
for our proposal." confuming that
the plan "will reduce the deficit
over the period from 1995 to
2000,·
fn addition to its broad fiilding
that the "fmancing structure
works." tbe study also found tllat:
• Health insurance premilUllS un
der the president's plan in 1998.
used as an example year, would be
about 17 percent higher' than the
administration estimated, requiring
more federal premium subsidies for
businesses and poor individuals.
• In 1998, employers (priniarily
smaU 'fums that do not now msure
their workers) would pay a net of
$28.9 biUion more for health care
than under current law because of
the requirement that they provide
insurance to their workers. I but
households would pay a net of $26.5
billion less because the govenultent
and employers would be pickillg up
mucb more of their costs. The extra!
payments by employers would grad·
ually drop as cost cootrols took ef
fect.
I
• The plan's cost controls eventu
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ally would slow ~ growth of health
spending. By 2000, it would ae
count for 18 percent of gross do
mestie product ulstead of the 18,7
percent figure expected under cur
r,ent conditions. alsaving of $57 bil
lion.
,
•
The study, coiJducted primarily
by lewin-VHf viCe president John
Sheils, was fina.riced by the fum
itself. Lewin said.
Lewin, Rubin and Sheils all em
phasized strongly that no study of
an untested new system can be ta
ken as an absolute prediction or
guarantee that the plan will work as
envisioned. Lewin said the findings
are based on their best estimates
and predicated on the assumption,
which could be optimistic, that the
states. Congress. Ithe proposed na
tional health boai'd and aU, others
will have ~he political will" to adopt
and enforce difficUlt aspects of the
president's plan. I That woUld 'in
dude requiring all emploYers to
insure their workers and limiting
insurance premium increases.
Looking at the federal portion of
the funding for the plan. the study
said the White HOuse had claimed
that it would raise $389 billion in
federal funds from 1995 to 2000 to
cover $286 billion in federal costs
for the basic plan Iplus $103 billion
for contingencies and deficit' reducI '
lion. Sheils said the basic plaA'
would actually cost the federal gOY;
emment $317 billion, not $286 bilt'
lion, and the proposed funding·
would raise $342 billion. That,
would be enough to cover the $317
billion cost with $25 billion left over.
for defICit reduction-but nothing.
for contingencies. the study said.:' :
Sheils concluded that in 1998 tIIfj.
average annual premium for an in-:
dividual would be $2,732; for a coo-'
pie. $5,464; and for a'two-parent
family, $5,975.
.:.
fn a separate development ye$-"
terday, presidential pollster stan:
Creenberg. appearing on an Amer;;
ican Enterprise Institute panel. said
the administration had considered'
proposing a value added tax (VAt,.
to pay for the health care refOlir\
program but found virtually no pu~'
lie support for it in poDs conducte4'
on the issue.
." '
Creenberg said the administra:'
tion looked at the VAT as an alter
native to mandating employers 10:
pay 80 percent of their employ.:
health insurance costs. He .said:l1:
was one of at least two instancel
where polling had been used to 116:
!ermine public attitudes toward:
particula.r tax policies.
::
SIll/! fI1riIn' l/rJ.. &k t:tmIriInUtd 14:
..
tlsu rrport.
::
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II
TIlE WASH~TON PosT
�THE WALL STREET JOURNAL THURSDAY. DECEMBER 9. 1993
Health-Pktn Cost Outlook Is Too Rosy,
But Basic Financing Works, Firm Says
By HILARY STOUT
the lederal budget deficit, Lewin-VHI says
oJTUJ;; WALL STRF:r.T JOURNAL
the shrinkage will be 525 billion.
WASHINGTON - Arespected health-re
The administration's financingesli
search firm said the Clinton heallh-care mates have been criticized by lawmakers
plan will cost emplo\'ers and individuals in both parties, And despite the report's
more than the White Ilouse projects, but it ronclusions. Lewin-VHI officials ex
said the administration's overall financing pre,sed some doubt at a news conference
proposals are sound.
about the feasibility 01 some 01 the admin
The company, Lewin-VH:' a unit of istration 's savings projections.. 'There is a
Value Health Inc.• released a 186'page 10\ of potential fat in the system. Whether
analysis of President Clinton's proposal to you can get it out this way. no one knows."
guarantee health coverage to all Ameri said Robert Rubin. Lewin·VHl's president.
cans. 1\ concluded that the White House "I've been on record saying that I think it
can successfully pay for its plan through its will be difficult. but not necessarily undo
slralegy of wringing savings lrom current able."
public health programs. raising the excise
The report contains a number 01 other
tax on cigarettes and other. tobacco prod eslimates that could cause .political diffi
ucts and holding down medical costs culties for the White House. For exam
through competition and controls on health ple. the administration has been saying
insurance premiums.
that overall employer spending on health
"The plan's financing structure won't rise under the Clinton plan. even
works:' said Lawrence Lewin. chairman though the White House is proposing to
and chiel execulive of Lewin-VH!. "1\ require all firms to contribute to paying
meets the presidenl's requirement of pro· their workers' health premiums. Lew!n
viding universal coverage. and it does VHI estimates that the total cost to em
so without relying on an increase In broad ployers in 1998. the first year the Clinton
plan would be fully phased in. would be
based income taxes."
But Lewin' VHI disagreed with the 529.3 billion higher than under the current
system, Almost all of the increase. how
While House on what premiums would be
required to pay for the health,benefits II ever. would come from firms that currently
proposes. The administration projects that don't insure their workers,
Lewin·VHI offiCials said lhe company
the average premium once the system Is
lully phased in would be 52,388 for an analyzed the Clinton plan on lis own
initiative. and paid lor the project itselr.
individual; the company's estimate Is 52.
The undertaking wasn:t sponsored by
732. The White House projects the pre
mium lor a two-parent family with Chil "any government agency or private
dren would be 55.388; Lewin-VHI puts it at group," Mr. Lewin said.
S5.9i5.
As a result 01 the higher premium
projeclions. Lewin-VHI eslimates that the
subsidies proposed lor businesses and low
income Individuals would cost 537 billion
more during the first five years 01 the plan
than the administration says - 5153 billion
instead of the White House estimate of S116
billion,
However. the legislation that the preSi
dent submitted to Congress adds a 545
billion cushion to the overall subsidy fig
ure. Counting thaI. the Lewin-VHI subsidy
estimales come in SS billion lower than the
White House prujections.
Lewin,VHI, based in Fairfax. Va.• is
one 01 the lew organizations outside the'
government with the computer models
needed to analyze complex health-care
legislation. Administration offiCials. memo
bers of Congress. and numerous publiC
interest groups respect the firm. and be
lieve its evaluations to be credible.
White House offiCials. who had been
nervous aoo!.!t the Lewin-VHI review. said
the;- were pleased by the conclusions. "To
have someone come out and confirm the
fact that our estimate of the Isubsldiesl are
conservativf and that we get substantial
deficit reduction is. I think. really a critical
finding." said Kenneth Thorpe. the De·
partment 01 Health and Human Services
economist who oversaw the administra
tion's number-crunchin. operation.
The White House predicts the savings
in public health spending through the year
2000 will result in a S58 billion reduction in
Staff Reparlf'T
�...
Encouraging checkup for Clinton health plan
But study also disputes
some administration figures
~
____
By,JudUll�S���l�l
_ _ __
USA TODAY
dum th ~ Wh
Bouse Is
~~ =~ a
ann.
was
~~ the Wblte House
beallb policy ftlSeIII'Cb
"Because of slJ&btly dIlfersays some adm1nIslniIion em- ent assumptions, tbe study
cu/at:lons are onlarget.
yields sllgbtly different re"There's a lot of potenllalfat suits." satd deputy budget dIIn !be II)'!Item whldI you caD rec:lDr Alice Rlv11n.
set out," said Lawrence I.I:wIII,
"The Important point Is that
!be Irm's cbaInnIIII.
~ J..ewID.VHl'9 estimates of!be
But the study - the Irst COlIS ••• are roughly !be same
comprehensive outside I1JIIII}'- ~ 88 the admlnIsIratIon's est!sis 01 the OInton p18D - abo mates." she said.
disagrees wltb some Wblte ' Wblte House bealth adVIser
Bouse ligures.
Kenneth 1bcJrpe satd !be adminlstralillD would release Its
The ldudy found tbat
"The average CUlt of pre- own alIIIIIdaI ana1ysIs of the
mlums would be 17% blgher plan today or Friday.
,~
=~~~~~~":am,~ur:nl~~~'=~~~wtth~~~forlhe
-jectJ~g.e Ad~%-Istrau~n -:,::-
c:IaI5 dispute !bat c:onduslon.
The Wblfe House, which bas
.. There would be a dellctt
been a1lidzed tor Its bea1ttH'e- redUdion of $28 billion, about
fonn 1II'I1hmeIIc, was relleved ball the adm1n1slni1ion's $58
WedneSday to set a SIamp of billion projection.
approval from 8D IndepeodeDt
.. It would take unW 2002 becomultlna Inn.
fore employers save money.
Skeptics, many of wbom sup. The admInIstnItIon says emport compeUna bealth bUis In ~ ployen' bealth Insurance COlIS
('.cqj:re!II. have dIaqJed Ibal would decline before 2000.
~-tbe~~admlnIsIratIon"s -reYeDue-- "It-would cost about '153 '
and cost projections cIon't add blllIon In subsldles between
up. They abo argue that !be 1998 and 2000 to belp smaD
Wblte House f!.IpI!dS IIIIJ'eIIIi!r ' businesses Insure low-wage
tic savlnpJn the Medirare and . workers. The admlnlslratlon
MedIcaid JInl&I"8lI1S and under- estimates speIIIIIna '1l6 billion
estimates !be cost of provIdIna In subsidies.
-=:
A compaison of heaIItH:are COSIs under the CinIDn plan
0
~
Adminls!Jallon _ _ -Lewir".YHL----
...... allundl (In bIIIIanI)
Medicare savings [===:J tl24
SIJlsIdIas
1118
_
1124
_
1153
MedIcaid 88IIIngs _
Contingency cushion 0
145
-,
~
Federal pqram savings ~
MadIcare drug berefIi .... : :
-aoun:. aI fIIncII ~~)
c:=J
=
e.
c:J $65
ToI:Iacco IBX Incraase _ . .
D.
CoIponIta IISII8S8I1l8I'I •
' I = : J $65
lJ:ln!t!erm CIII8
~
'l1s
0Iher •
~ TOIaI
137
,
- -- ~, ~ ' - ~-
1342
~!~=--------'1138I
1342
I
.
AnnuIIIlmpad an 1I1~ In 1998
AnnuIII.,..man lmpad an IIouIIIhaIds In 1998
IS2.3'lIo
44.ft,
ecu..: ~VHl.Inc.
The LewIn study cooduded
that nDIt families would pay
less for medical care - IndudIna Insurance premiums plus
all out-of-pocket expeI\!Ies under OInton's plan.
Only 7.1% - those with
bousehold 1nc:omes of more
dum '100,000 - would pay
more. $281 a year. However,
other consumers c:ouId pay
Totai
•
.
Pay at least $20 less
Pay at least $20 mont
Less than $20 c:flanga • 1.1'"
,
OeIIcItrecb:llon . - _
I 1381
I
:
'---11- tlO -1$7
CJ 158
SIiII~taxdeducllon
~~
$31
!
- -
S85
_
0
NlIic: ~ •
,J:] 123
---T8lIeffadBoImandaIa-~"8
0
~ ~
Pay at least $100 less
Pay at least $100 mont
Less than $100 c:flanga
THURSDAY, DECEMBER 9,1993' USA TODAY
• 3.1'"
~.
.
more It they diose optional
b!gher-ccst bealth plans.
J'am111es wltb annual Incomes below 110,000 would
save an average 1742 a year,
the report said.
Others whose total beaJth
spending would go down. ac:mrdIng to the report those age
55 to 64, who would save 1782
per famI1y,1argeIy because !be
~ I-:=====~~ 53A%
43.5'lrt
federal government would
pick up 8O'lb of premium COlIS
tor early retirees. ~ .
The report found
bIUion
morewouldbespentlnl998on
visits to doctors' ofIc:es, because with Insurance, more
people would go to doctors, Indudlna poor peop1e wbo DOW
rely on emergency room care.
Other IDdings:
no
.
e, I t i _ _
USA TODAY
'
•
. ~ .. Employers that Dmently
do not Insure workers would
pay 1161 a month per worker
In 1998 to provide Insurance.
.. The pl8D would save SI5
billion by encouraging more
people to join bealth malntenance of1llUll:Zllliot\! and other
fonns of InIIIIqI!d care.
�," '\
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l!i '~III'II .~
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liijLt !t--
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•
b"hlr~ ·'1..
•
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~ll: Irit 11@1 ." "~:...
~
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, • 11
.::lII.1f
· . i jJr';~iplolniil '-<
. ,.~ lI~rI!h~lll Jih ~
!~!biJifri ~i[~l
tJfJ~J!! ~f.i rIll .
" ~I ~ .1: III f. I!. ,n"
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lIealthpIan passes
fdepen~ent revi~w
~os~ are off, but goal reachahie, saysfinn
Hl.u.TK
CAU. flam PIp lA
!
\ Nonetheleaa, the report is I.ik~ to
provide fodder !vi' botb Iida in the
debete. A.mc:lna iu main conclusions:
• The White HOllIe .iIni!ic:antly 10'11
baIIfd the COlt of Clinton'. comprChtn
live benellt. Plwte. J.eowin "tnllll
the pecka,!! will COlt 12,132 for: indi
vicluale and 15,975 for • t_parem
funil)' in 1998 - LIlt finl yflr durinr
wNrI! ill Arrleritw WOIIkI be tC'I'I!rfd.
Tilt .drnini.tntlon bas eSlimated the
ber\efiu will COlt 120388 far an incIivid·
u.,l and S5.388 for I rwo-parenl fa.'niIy .
• About 26 percent of Amtnc:an
IIoUxbo,dl would PlY at leall 1500
more for health cart In 1998 under the
Clinton plan than they would other·
w Another 15 percent WOUld ply It
•.
leui S100 more. But 34 pm-ent of
IlculeholdJ would UYe at lealt $500,
while 14 pem!IIt would uve I: lellt
1100. Moil of thole PI>'inf r:iort
wouI<! be tettlnl better bentutl tna:l
Ihry Ino'll have.
The White HOIIIt II)'IIw than jO
percent of lIIaured Indlvlduala \\Ic.uJ~
PlY ni,lIer premill:tII, bul bas cffefed
110 flaW'!! COITIPIl'Ibie to I.ewIn'. lor
how the plan would IIfcct iloIIeehoIda.
• Ea\pIoym wOllld lIOt .tAI1 -vitia
money on hialth care CCItI ","til2C02.
venui 1998 in adminimtioD projec.
tiona. IAboul 44 percenl 01 :ompIniei
that now pmide covenI' wOllld Pay
II leul 1100 mare per ..mployle!in
1998:, 53 percem would PlY It 1ei.1
1100 Ie... IDd 3 peram WIIUIC
VinuaUy no chlllie, CJlnmn'. plan reo
QuimiaU emplo)'ll'l to provide I!Ovp,..
ap.
'
• White HOUle projectiiJIU th3 ~ c!iII
ton', bill CIIII the de5at by I!:IS bllhOll
between 1995 and 2000 In! too Qpti.
millie, i The I..rIrin repor. .timatlicl
the bill WOUld reduce Che 0IIfid\ try 125
billion. \but warned tml ...n aliaht
:.iantQ in the rata ot inuuIt 0(
healt.h coati CDIIid To" iii out any piIiI
and :eMllt in mop. red iIIk for til!
petninent,
I
Lewln-VHI PI"$Iled the report ~.
*
_t.
~tIy.not tor • PII"tICIIIar
Marilyn Mor..n, • heaIt.h policy _
cialilf ~h tilt nonpcrtiIrn Urban In
.Iitute in W."*'Iton. Mid Lnin is .
one rJf the
raeardl arpnIratianl
..iU,
f,.,
ilif .:IllICit, 10 _tImaW hMItII
cart CO!>Cf for ~ ... wbo/e.
j
"J ,JQn't . . . tbem .. uYinI to
.rAW the deck - they 11M aood
----,
,
�~
Outside Analysts: Clinton Health Plan Can Avoid Broad Tax Hike
'Eds: This also moved on general news wires.
By CHRISTOPHER CONNELL: Associated Press Writer,
WASHINGTON (AP) An independent analysis of the Clinton health plan
concludes that it can cover everybody without a broad-based tax increase and
still reduce the federal deficit.
But the deficit reduction would be much less than the. White House forecast
and the insurance premiums Americans pay would have to::" higher, according to
the 196-page study issued Wednesday by the health consu~~ing firm of
Lewin-VHI.
'
The White House was pleased, even though the study disputed some
administration calculations.
It "essentially verifies our estimates and the soundness of the financing
of our proposal," said deputy budget director Alice Rivlin. It "confirms
that the Health Security Act is fully financed and ••• will reduce the
deficit.' ,
The report by the respected Fairfax, Va., firm estimated that Clinton's
health reforms could cut families' medical bills including premium~ and
out-of-pocket costs by $26 billion in 1998.
At the same time, businesses would have to spend $29 billion mo::<, for
health care, with virtually all of the ,extra money coming from companies that
now fail to insure their workers.
'
Lawrence s. Lewin, chairman of the Fairfax, Va." firm said, "The bad news
is that there isn't nearly as much cushion as they said there would be. The
good news is that they still haven't crossed the line into requiring new
taxes. "
,I' t
The study estimated that premiums' in 1998 would have to be:
$2,732 for individuals.
'
$5,464 for couples.
$5,172 for one-parent families.
$5,975 for two-parent families.
. Lewin said that is 17 percent higher than the administration is
projecting.
Kenneth Thorpe, a deputy assistant secretary of health, disputed that and
said the gap was only 12 percent.
The Lewin study estimated Clinton's proposal would reduce the deficit
between now and the year 2000 by $25 billion, not the $58 billion the Whi'te
House estimated.
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But assuming that Clinton's proposed caps on health insurance premiuas
work, "then the rest of it plays out," said Lewin. "There is no smok. and
mirrors here.'
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"We think their estimates have been overly optimistic, but they still
achieve deficit reduction," he added.
Clinton would require all employers to help pay for health insurance, and
levy a 1 percent tax on big corporations that self-insure their worker•.
Everyone else would get their coverage through giant new insurance-purchasing
pools.
The White House is counting on big savings in Medicare and other health
spending. Its only major tax hike would be on tobacco.
'-It confirms what we've said all along: our numbers are on,the
conservative side," said Thorpe.
He noted that the Lewin team figured premium subsidies for small
businesses would cost $153 billion over six years" or $8 billion less than,
the White House estimated •.
The study, "The Financial Impact of 'the Health Security Act," also
concluded:
Employers will spend more on health care through 2000, but their costs
will climb at a s~ower rate.
The changes will trigger an $18 billion loss in income and payroll taxes,
not the $23 billion increase the White House predicted.
Total health spending would grow from $912 billion in 1993 to just under
$1.4 trillion ,in 1998. Without reform, the health bill would be $600 million
higher in 1998.
The plan would save $15 billion by 'encouraging more people to join health
maintenance organizations and other forms of managed care.
It said that in 199~ alone:
.
The premium cap would save almost $57 billion.
Families would pay $26.5 billion less.
Businesses would pay $29 'billion more.
Federal health spending would climb by $6 billion.
state 'governments would pay $12.4 billion less in health costs.
Local governments would pay $3.4 billion more.
Hospital spending would be almost $24' billion less.
Physicians would get $20 billion more in revenues.
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FEB 02 '94
10:52AM GWW CHPR'
C'BNl'!J. FOl HEAll'H POliCY RBSIAReH
'February 2, 1994
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ThC Honorable H.emyi A. Waxman
Chtlirman. Subcommittee on. Health aDd the BIlvironment
eofumittee on Eneray' and Commerce
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U.S. House of RepresentatIves
2408 Rayburn HausejOffice:Building
Washington. D.C. 29:H5 ;
oJar Chairman Waxkan:
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~bmit
We wish to
for inclUlion in the Subcommittee's national health reform hearing
record. today pre1imiJuuy iafOnnatiOD from a study we are prepariq for the Henry 1. Kaiser
C6mmission on tile Future of Medicaid and The COmDlonwealth Fund. Tbia ltudy will
as~ss the degree to ~hiCh various national bealth reform prop08W now WIder Congressional
ctinsideration assure I:low and moderate income working fam11!es t1nanclal assistance in paying
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for private health U1$urance.
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The three
rn~asuros we have analyzed are H.R. 3.600 (the Health Security Act): H.R.
3222 (The Manage~ Competition Act); and H.R. 3704 (The Health Equity and Access
Reform Today Act)! We have selected these three measure.!! bcoausc of their similarities and
d~fferences. On ODe hanel, all tlU'ee bills incoIpOrate a premium-based approach to health
cpverage and. Reek to achieve universal health coverage by expanding access to affordable
private. grouppurc~a8ed heaJth insurance. On the other hand, the bills take highly different
approaches to financir.g coverage for working Americans. These differences yield '
4ramatic:ally diffen;nt results for working families. 100=. our l'$S\llts suggest that neither
H.i. 3222 nor H.R. 3704 may Signifwantly reduce the number of uni.n5\J.rcd workers IlIld
their families. This is because, even after fulJ implementation of either btu, coverage 9till
~o'Uld be unaffordable for millions of workina families with modest incomes.
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,ZOZl K STUEl'; N~., SO'T£ 800 • WASHIl"CTON. DC 20052 • (202) 296-6922 • FAX (202) 785.0114
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FEB 02 '94
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10:52AM GWU CHPR'
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1. Relative level, of premium assistance
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TabJe 1 shOws
levei Of premiwn asiUtan&:=c provided to low and moderate income
working famiJies under/the three measures. We have calculated the premium II_stance
impaht of each bill. usQla a family of 3 headed by a full-time worker, 1993 federal poverty
,level! datal and a sroup i bea1th :plan premium whose 1993 dollar price would be considered
average by HCFA.l
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~e cas~
I H.R. 3600:
In
of H.R. 3600, employers bear 80 percent of the premium eost
for full-time workers and their families, leaving low and moderate income workers with out
of-pbcket premium co~ts tbafamount to no more than 3.9 percent of their taxable Income.
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family'~
In the ca8C of H.R. 3704 and H.R. 3222, however, the
potential premium
burden is far greater. This is because thC\ only assured premium iUbsidy comes from the,
pu~lic subsidy system! specified uruler eacb bill and beca~ neither sUbsidy system appears to
be rdequate to assure ;afford~bility ,
.
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'H.R. 3704; Uhder H~R. 3704. individuals receive vouchers to buy insurance through
purchasing groups, Voucher a.ssistance begins for individuals with incomes, at or below 90
percent of the federal poverty leveJ and expands annually up to 240 percent of tM poverty
l~ by the year 200~, In that year, a famUy of 3 with taxable income lIIIlounting to 180
percent of the federaJ poverty level ($21.400 in 1993 dollars) woUld have to pay more than
~100 in premium costs alone for health coverage. This amounts to 10 percent of the
falnily's amwal taxable incOme. A family with taxable income amounting to ZSO percent of
tht federal poveny level wou.ld have health insurance premium costs of over $3700. This
. premium burden ampums to 11.~ percent of the family's cmnual taxable income. This
fdlding is sie:nificani, since economists have. suggeSted that a. family's maximum out-of
pOcket liability for
health costs .- premiums, deductibles, coinsurance and uncovered
'hbulth expenses -- ~bould not exceed 10 percent of wages.
all
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H·R· 3222: n.R. 3222 shows even more dramatic results. Under the bill, subsidies
are available to to~ and moderate income families with taxable incomes up to only 200
Percent of the poverty level,Z Moreover, unlike H.R. 3600, the premium fmanciog Iystem
in H.R.. 3222 does ;not assume a premium payment structure for low'and moderate Income
~rkcl.'s equal to tile price of at least the average cost plan, Instead, health plans would be
reqUired to absorb ;a. significant portion of the premium east through a sizable discounting
i
lin the cas Qf JU~, 322); two ac:Id.i!iO!llll1ll5Umprlcns U'Iliquc to their bill were ncccwlY iII ordllr·to condllOt the analysi,.
r:lr8'l. IIw pAIloMl fUjuid)l Jiercentase'l\'lI.S Dl'Ojectod LO be 90 percem. Seeolldly. the reference premium rate \\IllS lInsumed to be eqwlLO
the aVenll!f.I preMium amOllrtt lI'I both ClSe5. we aaempi=d 10 malt, 1M moll favotllble ul\I1IIptions in onler ttl 4tsp1ay me maxlm1.lm
IIOtDllial .Impact of tbe mQallre.
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measure ~uld also 're\'i&c the federal poverty level 1.0 maIcI ir SlltIiI·'peCllrIG. !tor lIle sue or !l1mpI~ity 1.;1'(;, 'WI': It....o I1SM
the current federal poverty level IIInICIIU'e.
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In our opinion jhJJ
I1'I'IIJFI1Ient WC1llc1 serio1IIly limit the wUlinp:oo of
health plans to market to low and moderate iDcome workers.
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im~act
fJnancial
OfIH,R. 3222 on worker. can be seen on Table 1. Under the
meas'\lfe, a family with ,taxable income no greater than twice the federal poverty level
($23.1780 for a family of 3 in 1993 oollars) would be guaranteed DO discount or subsid.y and
woula pay Sg,709 for health coverage. This premiwn burden amountS to 15.6 percent of the
fllJllUy's annual income!. A famil), with taxable income as Jow as 150 percent of the fede~
pove~ lcvcl would still be required to pay annual premiums amounting to more than 10
perd:nt of annual taxa'tile ~c.
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2. 'l1be
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im.Pact of declitling premium assistance for workers moving out of poverty
.bow. ,be
Table 2
'cliffo" 1hat oocurfor low Income wortdna faJDilles as tbf,y move
l
out rOf poverty IUU1 the already limited subsidies provided under H.R. 3600, H.R. 3704 and
H.R. 3222 as they are phaSed out. These calculat1.o1l5 arc of particular importance, because
the~ show the impact ;of insuffICiently financed premium subsidies 00 the overall wcll..bcing
of low and moderate income workers as they attempt to better their financJal situation..
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In the casc afia worker whORe earnings ~eased from 100 percent to lS0 percent of
poverty. under H.R. ~600 Ihe woIker's annual premium liability would increase by $g~9,
w$e her wages would. grow by $5,94'. 1bus the "price" of heX' salary increase amounts to
only 5.7 percent of her additional eaminSs. Under B.R. 3704, hOwever, the worker would
lo~ more than 22 pe1-cent of her additional earnings to higher health insurance premtums.
uxidcr H.R. 3222, ~e "price" of moving out of poverty would be over 31 percent of her
additiOnal eam.iDls. :Put another way, under H.R. 3222, for each a.dditional dollar our
hyPothetical worker~; more than 30 ccnt~ arc lost inunedill.tely to higher health
inkurance premiums! These cliffs, when combined with the relatively bigh cost of cover-aae
fdr near-poor and mbc:lerate income workers, act as a powerful worle dislncenuve. Mote
.i~POrianlly. perhap~, they would deprive families with modest incomes of they funds they
'need to meet other basic ~ssitieB of life.!
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In the end, the most important question Congress must confront is which plan does
the most for those families who constitute the bulk at uninsured A.meritanS today - full-time
forkers earning lo~ or modest incomes and their famUies. These tables suggest that unless
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~irect publio sub8i~ie; are. fmanced at far hieber levels than those contemplated under either
~.R. 3704 or B,a.; 3222,iBlislation to aid the uninsured may provide little mea.nin,gful help
!lie worklog
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TIed.
wo '1I01llll
wlUcb wollld IIIkIl p~=
wJf't
I!.... for a tunny earuing the medlan income (appmximataly
mat die diff _Id bo l:I.ell II-tar.....,.
-81a 'inoltAlIII,
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we 10 faeto!' in Lile :added loa of
~ eamed incolll{: credit,.
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P.5
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Hil ~ 5:3AM GWU CHPR
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$3O,qaa> !he eost of bt!anrt _
UIIIIer eItbo< bill would .,....,d 10 p....nt of 110 ........
income and would be ~Uy: u11iffomable In the absence of all &Sawed subai4y.
We thank you fC?f lncll.ldiDS tbiA information in the hearing ~.
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R:S;nbauin. J.D.
Senior Research Staff S"ientist
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Slncl:1'Cly,
~ f1,.,,-JR A...o
Julie Darnell. M.ll.S.A.
Researcb Assooiate
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PIlEMIUMASSlSTANCE-FOR-LOW-AND-MODERA1E INC(NE W«JBKJNG FAMlLm 1JNDDl
SBLI:CTF.IJ HEALTH uvoim~
..0
Ff.lmily Ckoose.t Awmge-IWad' Health 1m«RIlICB PIe (l3, 7G9)
OInltm/GepbardtlMtdtd1
HIt l600i S J751
A
'lbmD1IfIChaff.e
Coapel'lBnBmr;
11K 37011 S 1710
BIt 322ZIS 1m
- - - - - - = - -::-I-;,-I~ I
I
~
100 111.1W
I :ns
[1961
-11t
1357
13.0
13"100,
tt
10
10
10
'lU8
10
130
"PJS
:5.1
1137ltl '
I~O
U2S
1.4
1669
I lU'
I IJ_!I
I
0
I 2649
I 11.1
I0
I 370!J
I 12.5
I tJ ,401 I 0
I 2961
I0
'742, I
:zoo I 13.1Bt1 I 0
I 2967
I0
I 142
I 29.-m"' 1 0
I 2967
I0
I 142
llO
250
I 1590
I D
I0
I 3.1
I
I
,
I 2.S
I0
3.~
Jj](i(J
I)
, 0
'
0
1171
10
'12m -I tl~3
lIS
I -r
of
IFaaily
lit
, 7 •2
J85i
II
lOA
I II
I 74
2961
139
I0
I0
I0
lJU9
l.5.6
I0
I
I0
not
n.s
(iii
f)
011 HeFA's estimate of fie 199'4 averap. prernjgm cast ($3.894) of IIealQ plan for 0Ire IIdult tiuBi1.J. deDated to 1991 dall.m. .,. asllllllirW: S% gRIWIh iD. CPI
Fmdy of 1:Imle; full-11m workiDK morher wilh two dependentr; 1fJt receiving .!\FOC m SSI
J PGvc:rty piddines.I993; .adjusted gC055 ilWOflle (umble income)
.. Median income for all hcrusehnlds in 1991 WIS $30,126; S.ltislical Ab6t!1lCt of die U.s.• 1993
5CalCilated asmminJ 90% natimaJ 5UbsiIy ami buc Federal pcmium of
fi NIlIlIl'S 1]0 volU01aJy empbyer tontrfJrution lOWlIld. wst of premiun
1
limed
t
:n.ms
-u
(1'1
~G~W~U~q~
0:JIfA:r r.r Hcaltl RW;v Jil:e.sem::b, Fcbnmy. IIJ}4
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Table 1
-:
,
-,
-.
--
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JMPAC-T-ClF-SUBSIDES_UNDOl SELR:.'I'ED DEALTB REJ'OKM. I'ROPOSAl.S
to
rv.AM1I.JBs
ON LOW AND MODERATE INCOIll..
-
.AS THEY INCREASB EARNINGS
CSl
_ _ IlJ_
'f
Family CIuJostS Avtm,ePricetI' lktJlth lnmmia PI., ($3.109)
,...,.
C1intmiGep.8n1tOO~d1
--
----- -- ------,-JKRaS~
in
Ibvull'
'--
Dollar
AnwunI
of
Illtmlillt
iii
lIB. l ' " S 175'7
---Dollar ABOlDIt of -Pl::R:iDt of Wage
Ad4'Itionnllll.CRll!!e Int.:rea5e De1Imed
to Premium
i. Premium
LinhiJily *,1'
family
- '--------
-._,
~
1'hntnICWce
11K 31U4J 8 17'10
CSl
IRJ2DJS1579
Y!.
:D
-Doillr-Amount&f _ ~_9fWIge
AltIitiol8llnclrase
in Pn:::mium
LiaIJIlil¥ m
Family
I\:ra:at of Wage
DGlbr .ABIIIJut of
Iu.mme omJted"-- JkrdiIitiMlIi1Creae- -Itla:aa:-Dnoted.10 Pn:mi.ulll
inPe:miam
IOPraoiIIm
LiabiitJ for
-- '"
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Family
3:
G)
-----E-
()
:r
lJ
AI
\YIIICS
100- a50
S.94S
D9
S.1
1325
22.3
lK55
31.2
130-181)
~.94S
218
4.7
l:J25
22.3
IISS
31.2
ISO-2m
5,94S
46
.1
nzs
n.]
1155
31.2
lOO-2!D
5.94S
0
1060
11.8
0
0
..
'Based.1I HCFA'seSlimal£oflbe 199411Yaage peDiuDI aKlt($l.I94)oh b~fIb
ilsorani:e,'a k OIHdlil fimtily, ddlatll:d tD ]993 dDIIars by _
. .5" JIR'Ib in.
*
CPI
lJ
--J
'I1:Jt GeIIrg~ Wub.1l UnM:rsiI)I
Center for EluIIh PnIi:y ReIitll.lCb. FelDlary. 1994
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TWO INDEPENDENT STUDIES FIND MEDICARE OUTPATIENT DRUG BENEFIT
WILL LEAD TO'NEW SAVINGS FOR THE MEDICARE PROGRAM
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Two independent istudies have documented the potential savings to the Medicare program as
a result of adding la new outpatient drug benefit to the Medicare program.
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• Commissioned by! the National Association of Chain Drug Stores (NACDS), one study was
conducted by Lewin-VHI, an international, non-profit cost estimating firm, the other by the
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Center for Health Policy Studies in Colombia, Maryland.
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• The studies conclude that the new drug benefit could save the Medicare program .between
$37.2 billion l and $29.2 billion2 from 1996 to 2000. The savings come from three major
areas:
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• The majority of ~avings come from community pharmacist involvement in preventing drug
related hospitali~ations and nursing home stays.
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• Savings also res~lt' from pharmacists monitoring the effectiveness and appropriateness of
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patient drug tpe~apy -- for example, reviewing all the medications a person is prescribed and
catching the fact that the heart medication conflicts with the diabetes medication. This is
referred to as "drug utilization review".
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• Finally, savings ~esult from pharmacist intervention in recommending generic substitutions
for brand name Iimedications where appropriate.
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Medicare beneficiaries, and the Medicare program, stand to gain from the new drug benefit:
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• While the bigg~st winners from the new drug benefit are clearly the older Americans who will
get prescriptiori drug coverage for the first time, these studies document that the Medicare
program will aliso net significant savings that could offset as much as half the cost of the new
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benefit.
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In addition, becau~e the riew benefit is offered through the MedIcare program, older Americans
can continue t9 get their prescriptions filled at any pharmacy they choose, building on the
relationships tAey've established with their community pharmacist.
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Center for Health Policy Studies estimate
2Lewin-VHI estimate
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�-- BACKGROUND -
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OLDER AMERICANS ARE MOST LIKELY TO NEED PRESCRIPTION DRUGS, BUT
FEW HAVE COVERAGE
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• The Medicare program currently does not cover outpatient prescription medications for its
enrolled populatiqn, most of whom are people over 65.
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• Older Americans ,are most likely to be reliant on prescription drugs to manage their medical
conditions or rec0ver from illnesses.
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• People age 6~ and older represent 12% of the population, but consume 34% of all out
patient prescription drugs.
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• People underl 65 purchase an average offour prescriptions a year, while people over 65
purchase, on:average, four times that amount-- 16 prescriptions each year.
• Medicare reqipients with some disability purchase an average 26 prescriptions a year.
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• Those in poor health purchase more than 31 prescriptions a year.
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• In part because they la~k coverage for prescription drugs, older Americans too often take
drugs incorrectly, take:too little or too much medication, and experience dangerous and
costly reactions:or side effects. The doctor's visits and hospital stays that result are paid for
in large part by ~he Medicare program, whose costs have skyrocketed in recent years.
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• Pharmacist review of the medications older Americans are taking can prevent these side
effects and adv~rse reactions, but Medicare recipients lack access to these services because
they don't have! coverage for prescriptions.
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Studies ha\{e shown that more than 60% of elderly drug-related hospitalizations were
preventabl~ or avoidable. 3
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Other studies estimate that 28.2% of hospitalizations of the elderly were the result of
adverse d~g reactions and improper use ofprescriptions.4
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Prescriptidn drugs are the single highest out of pocket expense for three out of four older
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Americans.
Bero LA, Lipton Hi, Bird JA: Characterization of Geriatric Drug-Related Hospital Readmissions. Med
Care 1991; 29(10): 989-1003. Hallas J, Davidsen D, Grodum E, et. al.: Drug-Related Illness as a Cause of
Admission to a DepMtmentofRespiratory Medicine. Respiration 1992; 59:30-34.
4 Col N, Fanale
Kronholm P: The Role of Medication Noncompliance and Adverse Drug Reactions in
Hospitalization oft~e Elderly. Arch Int Med 1990; 150:841-845.
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�To: Distribution
Fr: Health Care Delivery Room
Re: Seniors Week Materilils
Date: February 10, 1994 :
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Attached is a packet of rrlaterials for seniors weekes) to be used by Administration officials.
members of Congress, an,~ surrogate speakers. These materials should address most of the
issues that people will face as we talk about how the President's approach affects older
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AmerIcans.
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The packet contains the following:
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Overview of ho~ the President's approach affects seniors
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Medicare
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Prescription drug' coverage
Long-term care
Medical researcli
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Questions and ariswers
Supportive quotes from seniors advocates
Comparison of ~lternative approaches
AFSCME comp~rison 'of alternative approaches
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Families USAcpmparison of alternative approaches
Sample seniors Iop-ed '
Op-ed by Ron Pollack of Families USA
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The National Health C~re Campaign has also prepared pamphlets that explain the effect of the
President's proposal on' older' Americans. For more information, contact Maureen Atta at 863
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7154.
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HOW THE PRESIDENT'S APPROACH AFFECfS OLDER AMERICANS
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PreselVes Medicare.
Medicare will ibe preserved and strengthened .. Older Americans will continue to
receive the saine Medicare coverage -- with guaranteed security. Seniors can keep
seeing the do~tors they see today, with expanded b~nefits. And doctors and
hospitals willinot be: able to charge more than what Medicare covers.
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Expands Medifare to include prescription drug coverage.
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The plan offers prescription drug coverage as part of Medicare -- providing
desperately n~eded protection for older Americans. For less than $10 a month,
older Americ'ans will get protection against prescription drug prices that represent
their highest ,out-of-pocket medical cost. An annual cap will be placed qn out-of
pocket presciiption'drug costs, and above this amount, drug costs will be fully
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covered.
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Covers home land community-based long-teon care.
The Health Security Act takes an important first step towards expanded coverage
of long:ter~ care by creating a new home and community-based long-term care
program. It ;will help Americans who need long-term care live independently at
home and in their communities -- which most older Americans, people with
disabilities, iand their families and friends prefer.
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Guarantees s~curity to early retirees.
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Under the Health' Security Act, American workers who retire early will never have
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to worry about losing their health insurance. Today many of these Americans are
vulnerable J-- dropped from their coverage and not yet eligible for Medicare.
Starting in! 1998,;early retirees will pay no more than their share of the premium
that they p'aid as :employees, unless they are single and have an annual income
higher thaA· $90,000, or a couple with income of more than $115,000. Companies
must honot . existing agreements that guarantee . that their retirees pay nothing for
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h~thcar~
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Outlaws ins:uranc,e company discrimination against older worl<ers.
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Today, in~urance companies pick and choose whom they cover -- and they charge
older wor,kers more than younger workers. These practices will be outlawed under
the President's approach -- insurance companies must charge older workers the,
same as ~ounge:r workers.
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�MEDICARE
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. Preserves
an~
Strer;tgtlIens Medicare
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Under the Health Security Act, older Americans will see little difference in where,
how or from: whom they receive their health care. And although every health
reform proposal before the Congress calls for significant savings from Medicare,
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the President's plan is the Q!!1y one that reinvests the savings in two new benefits
for older Arrtericans: prescription drugs and a new federal/state program providing
home· and cbmmunity. based long. term care.
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'Provides Prescription Drug Coverage
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. Medicare beneficiaries will have 80 percent coverage for their medications after
they reach a: $250 ,deductible. A $1,000 annual cap will be placed on out-ofI
'
pocket prescription drug costs, with costs above this amount fully covered. Patients
will receive:counseling from their pharmacist on what medications are most
,
appropriate. ~
I
•
Increases Choice for Medicare Beneficiaries
i
I
For Medicare beneficiaries reform will mean more choices among health plans, and
cho~se a plan which may offer lower copays and deductibles than
the ability
traditional Medicare coverage offers today.
tp
•
Protects
I
SeniOl~
Against Fraud and Overcharges
I
The Health: Security Act calls for new penalties to pursue and prosecute those who
order unne~essary tests and procedures to defraud Medicare and senior citizens. In
addition, tHe Health Security Act controls rising costs in both the private sector and
Medicare. I
,
i
•
I
Lowe~ Me~gap
I
,
;premiums
For those who currently buy a Medigap policy to cover prescription drugs and
I
,
overcharges, the Health Security Act will mean significantly lower costs. The plan
stops doctbrs or hospitals fiom charging more than Medicare covers. And it
prohibits ihsurance companies from using pre-:existing conditions to exclude people
from Medigap coverage.
J
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PRESCRIPTION DRUG COVERAGE
I
I
Any doctor who deals with the elderly will tell you that there are many elderly people who
don't get medicine, who get sicker and sicker and eventually go to the doctor and wind up
spending more money arid draining more money from the health care system than they would
I
'
if they had regular treatrpent in the way that only adequate medicine can provide."
II
,
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-- Preside1nt
J
'
speech to a Joint Session of Congress, September 22, 1993
'
I
I
•
Cli~ton,
'
Older Americans are hurt, by high drug prices and no prescription drug
I
coverage.
I
Between 198:0 and :1992, while the general inflation rate increased by 27 percent,
drug prices increased 128 percent. For 3 out of 4 older Americans, prescription
drugs are th~ highest out of pocket health care cost. Nearly two thirds of
Americans ~ver the age of 65 have no prescription drug coverage, and over eight
million older Americans are forced to choose between buying food and medicine.
I
•
Prescription
~rug
cpverage will reduce overall costs in the long-run.
i
Many older IAmericans and others are hospitalized today because their lack of
pr~scriptionl drug coverage means that they can't afford to get the medication they
need. In fac't, one study says that problems related to medication lie at the root of
, I
25 percent of all hospitalizations of older patients -- and costs more than $21
billion a ye~r.
I
•
Medicare recipients will be guaranteed prescription drug coverage for the
tirst time. I
I
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I
Medicare beneficiaries will have 80 percent coverage for their medications after
they reach:a $250 deductible. A $1,000 annual cap will be placed on out-of
pocket pre~cription drug costs; \vith costs above this amount fully covered. Patients
will receiv'e counseling from' their pharmacist on what medications are most
.
I
'
appropnate.
�LONG-TERM CARE
•
I
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Expands Home and Community-Based Care
i
,
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The Health S~curity Act will establish a new home and community based care
program, enabling more, than 2 million older Americans and 1 million
Americans with disabilities who need long term care to live at home,
independently, in their communities, or with family caregivers -- which most
prefer. Servi:ces win be tailored to meet individual needs and could include
such services~ as in-home care, personal assistance, respite for family caregivers,
~d~It day .s~_7ices, rehabilitation, assistive devices, and services in assisted
hvmg facIlItIes.
'
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'
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•
Protects Nursing Home Residents
I
The Health SecuritY Act will improve the quality of life for nursing homes
residents. States will have the option to allow single nursing home residents to
retain up to ;$12,OOO-in personal assets -- up from $2,000 today -- and the
personal ne~ds allqwance for all Medicaid residents would be increased to a
minimum of $50 a month. Older Americans will no longer be forced to "spend
down" their!, entire:life savings to qualify for Medicaid.
!
•
Makes Privatb Long-Term Care Insurance More Affordable
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.
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The Act will improve the quality of private long-term care insurance by
establishing tough national standards that prevent insurance companies from
denying people coverage or choosing only the best risks. New tax incentives,
similar to those available for health insurance, will help make private long-term
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:
care insurance more affordable.
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Encourages feople with Disabilities to Work
Individual~
with disabilities who work will be eligible to obtain tax credits for
50 percent l of th~ costs of personal expenses needed to work, up to $15,000
maximum Iper year. This will provide more opportunity for people with
disabilities! to be further integrated into the workforce .
.
•
Provides
I
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R~spite
i
SelVices to Family Caregivers
The President's ~pproach will help family members care for relatives with
disabilitie~ with the long-awaited support they deserve, giving families a break
when they need: it most.
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MEIlHCAL RESEARCH AND EDUCATION
I
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•
Figbu
Alzhei~er's Disease
!
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The Act incr~ases funding to research into prevention and treatment for
Alzheimer's disease, new drug therapies to treat Alzheimer's, and respite
i
'
services to give those caring for a family member an occasional and muchdeserved bre;aJ<:.
I
•
Expands
I
Res~arch
for Disease Prevention
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!
The Preside?t's approach will substantially increase funding to conduct and
support research aimed at preventing diseases that strike older Americans. $2.9
billion dollars will be dedicated to new prevention research, including research
.
I
targetmg: I
- Alzheimer'sdisease
- osteoporosIs
- cancers, including breast cancer
- heart idiseas~ and stroke.
I
•
•
Emphasizes Research for Elderly Health
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The Nation~l Institutes of Health will give certain areas of research special
,
priority, induding elderly health, substance abuse, and chronic health
conditions (for example diabetes, arthritis, and heart disease). These efforts
will go a lang way to uncovering the root causes of many of the diseases that
afflict older Americans, and discovering new treatments and cures.
•
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Researches Effective Treatmenu
i
The Health Security Act invests an additional $2.85 billion in "health services
research" ~~ evaluating the effectiveness and appropriateness of different
procedure~, and the quality of different kinds of care. ,
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Makes Sure! Older Americans Get the Medicine They Need
I
Under the! President's plan, coverage of prescription drugs is added to Medicare.
As part o( providing this new benefit" pharmacists and physicians will receive
training 'about the appropriateness of certain drugs and their effects, and
pharmacists will answer patient questions regarding the appropriate use of the
drug, pos~ible si,de effects, and potential interactions with other drugs.
!
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�'.
Questio~ About the Health Security Act
i
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'
Q: Will my Medicare! coverage change?
i
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You will receive Medicate benefits exactly as you do today, with the addition of
prescription drug coverage. And you will have more choices. Different kinds of health
plans -- which frequently 'have :lower deductibles and copayments -- will be made more
I
available on an optiona/1basis. '
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Q: H I am covered by Medicare will I still be able to see my own doctor'
under the new plan? ,i
i
Yes. You will always b~ able to choose your doctor, because Medicare will work just like
it does today. After turning 65, they will have the option of enrolling in Medicare, or
staying in the plan theyi are in.
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Q: Won't there be rationing of care after ~fonn?
j
Absolutely not. That's a scare, tactic used by opponents of reform. The President's
approach will give youl the security of knowing that you can get the care you need when
you need it.
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Q: What about long-tenn care? Will I receive help with caring for myself or
my loved one at h~me? ,
,
,
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The President's appro~ch recognizes that older Americans and those with disabilities prefer
home and community ;based'care -- the kind of care not covered today. The plan will
provide greater coverage for'long-term care for people with disabilities, including older
I
Americans, through a IInew home and community-based care program.
'
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Although nursing homes will continue to play an important role in long-term care, the
I
President's approach r:ecognizes that to best serve older persons and people with
disabilities, long-term; care must offer a wide range of social services. For example, the
plan will help famili~s care :for relatives with disabilities by helping pay for respite
services that give farrtilies break when they need it most. The Health Security Act marks
an important first step, mo~ing us toward a more comprehensive system that has a wide
range of options for older Americans and people with disabilities.
,
,
a
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Q: I know many people who need long-term care. How will the long-term
care benefit be distribrited?'.
'
,
,
The new long-term care benefit: will be available to persons with severe disabilities of all
ages, regardless of income. Each state will design a program to best meet the needs its
citizens. Eligible older Ameridms may receive home care, personal assistance or other
services. The plan also sypports family members who often serve as the only source of
care for their loved ones'!
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Q: Will the plan help with the high cost of prescription drugs?
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Yes. The Health SecuritY Act will help cover prescription drugs -- older Americans'
highest out-of-pocket expense.: For less than $10 a month, Medicare beneficiaries will get
80 percent coverage of their medications after they reach a $250 deductible. All out-of
pocket costs above $1,000 will be fully covered. And patients will receive regular
I
counseling from their p~armacist on what prescription drugs are most appropriate.
f
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Q: Will reducing th~ proj~cted rate of the growth of costs in Medicare and
Medicaid affect my ,benefits?
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No. In fact your benefi~s will: be expanded. The reduction in the growth of the cost of
Medicare and Medicaid will happen at the same time as costs are controlled in the private
sector. These changes ito the program will reduce the rate of growth of inflation by one
third and enable us to pontrol the price of health care. But it won't involve any reduction
in services or cuts in qenefits. Fraud and inefficiency have crept into the system, and we
will make a determineCl effort to get rid of this waste, using the money to expand benefits.
I
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Q: I currently have: suppiemental insurance. Will I still receive benefits in
the Health Securi~ Act?
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Yes. If you have supJlemen~al insurance through Medicaid, you will receive the same
Medicaid benefits unQer the, Health Security Act that you do now. If you get supplemental
insurance through a Medigap policy, you can still get that policy. But for those who
currently must buy a :Medigap policy to cover prescription drugs and overcharges, the
Health Security plan ;Will mean significantly lower costs.
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Seniors ,iAdvocates SupPOrt the President's Approach
TIlE AMERICAN AssoCIAnON OF RETIRED PERSONS BELIEVES WE
SHOULD START wtrn TIlE PRESIDEN'TS PROPOSAL:
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John Rother of the AARP says that the President's plan is the "best option for se
nior citizens." He ~so says that alternative plans put forth by conservative Demo
crats and Republi~ans "don't go far enough in improving Medicare." [S1. Petersburg
Times. 1114/93]
:
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OLDER AMERICANS
.
w~
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BENEFIT:
'
"The elderly in g~neral come out winners, partly because of benefits on prescrip
tion drugs and long-term care," said John Rother of the American Association of
Retired Persons (:AARP). [Washington Post, 1112/93]
,
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"When you add p the benefits and the costs, it's a terrific deal for seniors." [James
P. Firman, United S~niors Health Cooperative, 2115/94]
I
"The proposal pr,omises many vital improvements for older Americans, including
prescription drug coveiage in Medicare, early retiree ,coverage that is secure and
affordable, enhariced quality measures, and increased choices for families and indi
.
I
vlduaI S." [Daniel ;Ihursz,Chairman, Leadership Council of Aging Organizations, 10115/93]
I
BROAD RANGE QF ADVOCATES SUPPORT TIlE PRESIDEN'TS APPROACH
. The President's proposal is ..the best thing for older Americans since Medicare was
first created," s~d Dr.. Arthur Flemming, President Eisenhower's Secretary of
Health, Education and Welfare. [quoted in "Rest Assured: The Clinton Health Reform Pro
tects Older AmeriJans," by Ron Pollack of Families USA]
,
.
,
.
,
"It is above all,: a uniquely American plan which seeks to integrate abiding Ameri
can concerns fdr equity and fairness with realistic means of achieving universal
I
coverage, ease pf access, and controls of excessive and inappropriate costs." [Dr.
Paul Kerschner, Executive Director The Gerontological Society of America 9/23/93]
I
.....the NCSC strongly supports the broad thrust of the Clinton plan."
[National Co~ncil of Senior Citizens 10/27/93] .
,
!
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"The National ,Council on the Aging applauds the President's approach to health
care reform." [Daniel Thursz, President National Council on the Aging 9/22/93]
,
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"None of the qther proposals on the table offers families any real long term care
protection." [Stephen McConnell, Chairman, The Long Term Care Campaign 1112/93]
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TIlE ~TON APPROACH PROVIDES NEW BENEFITS
FOR OLDER AMERICANS, TIlE OTIlER PlANS DON'T
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Preserving Medicare vs. Raiding Medicare to Cover the Uninsured
I
Virtually every health! reform proposal being considered on Capitol Hill calls for
slowing the growth i~ spending on Medicare and Medicaid and using the savings as a
source of financing for reform.
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The President's appro'ach reinvests that money in new benefits for older Americans.
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Other approaches us~ Medicare and Medicaid savings to extend coverage to lowerincome Americans, o;r to reduce the deficit.
'
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New Covernge for Prescription Drugs vs. No Help with Costly
Medications
!
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Today, millions of bIder Americans literally choose between medicine and groceries -
Medicare enrollees Ynll not have true health care security until they receive coverage
for prescription medications.
I
The President's app~oach provides Medicare beneficiaries with a new benefit so
important to millioris of seniors-- coverage for prescription drugs. No other approach
gives seniors any hblp with costly prescriptions.
,
.
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New Help with Long Tenn Care vs. No Help with Long Tenn Care.
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The President's approach :creates a new home and community-based long-term care
program, which wi;1l provide needed services to elderly and disabled Americans who
would otherwise b¢ at risk for entering a nursing home.
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Other approaches bontin~e to offer older Americans in need of assistance no choice
but to enter a nurjingh~me, rarely a first choice and alwaysvery expensive.
I
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. Fair Insurnnce Practices vs. Discrimination Against Older WorkelS
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The President's aHProach outlaws the unfair insurance practices that cause older people
to be charged more for insurance than younger people.
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Other approaches! allow' insurance companies to remain in charge-- using age, health
status or previou~ health problems as a reason to charge higher premiums or offer only
I '
barebones coverage.
,
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�Chafee
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,.
The Chafee proposal trims roughly $213 billion from the Medicare and Medicaid
programs, but it earm~rks the savings to pay for government vouchers for the poor.
The proposal does no~hing to provide new benefits to older Americans. It does not
guarantee any help w1th the cost of prescription drugs, though Senator Chafee said in a
recent television broapcast that he thought it was a good idea. It does nothing to give
new options to the millions of older Americans who want to remain at home rather
than move to a nursing home.
,
.
,
Cooper
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,
Congressman Coopei also proposes we pare back spending on Medicare and
Medicaid, saving rotighly $219 billion over 5 years. The savings come in part '
from raising the Medicare premiums many elderly Americans now pay, but
providing no help with costly prescription drugs, no help with iong-term care,
and no greater protettion against impoverishment that now grips too many
elderly in nursing h<?mes. !The biggest source of savings, and perhaps the
greatest risk to older Americans under this proposal, would be· the plan to shift
spending for long-t~rm care services currently shared by the state and federal
governments compl~tely to the states. Governors and other say they are
already being bankrtipted by their contribution to escalating long-term care
I
costs, and could never afford the full burden of long-term care. Nonetheless,
,
that's just what Congressman Cooper proposes, and if his bill became law, it
could jeopardize th~ nursing home care and other long-term care services many
. vulnerable elderly ryow receive.
i
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Testifying before t~e House Energy and Commerce Committee, the National Council
of Senior Citizens ~ummed it up this way: 'The CooperlBreaux bill will eliminate all
federal supporl for; long-term care. "
Nickles
The Nickles bill niakes several changes to Medicare that could make Medicare
services cost older: Americans more and give them no new benefits in return. Under
the Nickles plan, the money saved from Medicare would go to expanding access for
low-income indivi!duals ..
I
Michel
Congressman Mi~hel's health reform plan also calls for significant savings from
Medicare and Medicaid; and uses these funds for expanding access to low-income
. ,
.
individuals.
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Medicare HMOs woul'd be more widely encouraged, as would other Medicare·
managed care plans. A new'tax would be imposed on Medicare Part B premiums paid
by upper income indi~iduals'. As with other plans, not one cent of these savings is
spent on new benefitslI for older Americans.
.
.
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This plan also propos~s capping Medicaid spending, giving states a per-person amount
and no more, regardless of how much care actually costs. Reducing the federal
,
commitment to Medi¢aid could jeopardize access to long-term care services for
millions of older Americans.
I
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The National Council for Senior Citizens predicts: tIle .MicheVLott bill, which simply
cuts reimbursement ~ates for Medicare, will "make it harder for beneficiaries to find a
provider. "
,
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Gramm
I
The Gramm bill callis for an arbitrary Medicare savings figure based on assumptions
that are backed 'up ~y not~ing more than optimistic projections regarding the growth of
health care spending. The plan calls for $6l.5 billion in Medicare savings over 5
years, a figure arriv~d at as: "half the savings from the President's plan." How are
these savings realized? Unlike the President's plan, which spells out exactly how the
savings are achieved with specific policies scored by the Congressional Budget Office,
the Gramm plan do~s not 'say how they achieve these savings.
,
The specifics they do spell out paint a grim picture for older Americans: Medicare
recipients would hive the' so-~alled "choice" of trading their existing Medicare
coverage for enrollhtent iit an HMO or for the purchase of catastrophic coverage and a
Medical Savings Apcount'. If individuals opt for one of these options, they are locked
out of Medicare forever.!
,
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And because the Gramm :bill does nothing to control spending in the private sector, the
difference between' private insurance rates and Medicare rates will become greater and
greater, and many!doctors may decide they can no longer afford to see Medicare
patients, restrictin~ their ,access to the providers of their choice.
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1 'Upon becoming ~Iigible for Medicare (currently at age 65), individuals would have one year to
decide whether or n~t to stay in the current Medicare system. The decision to opt out of the traditional
Medicare program tei employ any private health care coverage arrangement is finaL· Gramm summary,
p. 3
.
�COMPARISON OF HEALTH REFORM BILLS
FOCUS ON RETIREE ISSUES
CooperlBmu!ll (UD)
Olatoa
H.8.36OOI5.1757
tong
Tenn
(!.TC)
Benefits
Care
H.1.5222J5.1579
::r.:
CmIIeS new home md 00IIUIlUIIity
basal are
for disabled
(COSI-shartng IO-Z5%). No
means fell SCales will be able to
I'lIise Medicaid IISSds Iimil up to
$11.000 for disabled In IIlJfSing
homes.
No new benefits. Medicaid would he
pha<;ed-out for long tenn care as.~islance, 1e:Mng all LTC spending to
the states' discretion.
~~;.r).
........
~...
1I.I.501JMUSn
Wells1one/McDermoU (D)
S.491111.8.I200 .
No neW beiIefiIi
Mediadd L'It ClOOIImIes. .
MetllalliI:tIngs IIXXlIOIIIi could be
used for L'It expeIL'IeS.
L'It senIces Would be ca·
deductible medk:aJ expense If IIlOR!
Ib2Il 7.5% or adfusted gross
;
Cmers long tenn care-ln nursing
homes a~ weD a~ home and com·
munity-based care-a~ part of
basic benefits package. People over
6S would pay monthly premium or
$65 (younger people would pay
through payroU tax) for LTC.
.No new benefits. AD LTC smIa!s
.would be IreIted IS 1II«duc:tib1e
medk:JI eJPfiL'Ie!Ilf dtey exceed
7SA> or adjUSled (!roSS Income.
InaIme.
New
No outpatient prescription drug
Benefit.
.
EIpmds ~ 10 IDt::IocII! 0UIpI
tIenl presalpdon drup ($Z50
IIIIIUII dedudibIe a zor, alplJ5 up
to a IDDimum or $J,000 • year).
Medicare/
Medicaid
I.eMs Medic:are InIIItt as FedenIty:
Would iocrea'ie Pal'1 8 premiums hy
$1.40 a month to pay for benefil';
named aboW!.
Medicare
Changes
=r.1ocrases
premkrm'"
admlnislend JII'OtP'B.. FJimbades
Put B
II IDI!IIIb 10 pay for .
.. "',
No new bendits.
Benefit~ package for all· Americans
would Indude prescription dru~.
preventive health and full menial
health coverage.
RqlIaces current Medicare funding
wid! per apIta paymalts to stales.
Intnxluces means-testing
Medicare Part B premiums.
No new
Medicare and Medicaid would he
replaced with universal govern
ment-financed, single-payor health
care syslen1. No balance billing.
benefit Would add roIoredal
screenin~ and some immuniza
lions.
new beoefiIs.
..
or
beoditS.
Would combine MediaIre Pu1s A
Ii. B md continue to aDuw bal
111m
IJiIIio8.
..
F.arly
_
Reti~
__ .__
No coverage or early retirees (bill
does not provide universal cover..age).
___ ~.
zor, (biI jJiOiNIti$iiIdDtmtsI CXJI1"" __ ,,__ .__
.".)
.
ss-65 In IIelIbb
premimD lIfIIIre
CoIIm! redn!es •
_~ •
or
All ~ IlIIIIfi 65 WoUld be . Everyone is cotJered, regardless of
No.~ or early redn!es (bill
required to buy their own heahb
age.
. . fIOI prOVide for ui!hersaI'
imurance, Induding retirees. Low
~).
-lriCOmepeopie would be ru.mpt.. .. - - - --
uotil sutfident sysmn-wide COSI
'--"
~ would permit the gowoem
ment to provide subsidies.
-.--------~
----~-
Private
LTC
Insurance
=
IIIIII6hrs FaIenI
fOr
. . lenD CIn! (L'It iDSIJIace to
SlIIIIIIudia: poIk:ies aad ~
premiums. Also ImpnJIIII!s l\III m..
IIIf!IIl
No morms of private long tenn
care (L'OC) insurance.
Would set uniform stmdmIs fur
privaIe L'It iDsul'llllCl!. aloog with
tu incmtm5 fur purtbaser.i.
Prohibits duplicate coverage. mak
ing private insurance industry largeIy unneeded.
Would iIIIprI:Mllllllrellmeftl or
prMte !.'It lnsul'.lllCe.
or L'It espmses.
-
Note: (D) denotes bill sponsured by Democrats; (R) is sponsored by
RepuhlicmIs; (R & D) is bipartisa" sponsvrsbip.
---~--
................
.........
~.-
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W
ATe
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H
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.HEALTH;
REFORM: IS
. IT GOOD: FOR
GRANDMA?
,
,
Here is how the Pr~sident's Health Reform stucks up against two leading substitutes: The Cooper
Plan and the Chatee; Plan '
I
CUNTON
COOPER
CHAfEE
DOES IT STRENGTHEN MEDICARE?
YES
NO
NO
DOES IT ADD tioNG'TERM CARE
,
PROTECTION?;
YES
NO
NO
YES
NO
NO
YES
NO
NO
DOES IT PROT;ECT OLDER WORKERS'
FROM INSUR4NCE DISCRIMINJlfION? YES
NO
NO
YES
YES
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DOES IT COVER
PRESCRIPTION DRUGS?
,
I
,
I
DOES IT CRACK DOWN ON
DRUG COMPANY OVERCHARGES?
I
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DOES IT PROTECT YOUR
CHOICE OF DOCTOR?
YES
I
Source: Families USA
SENIOR WATCH IS AN EDITORIAl. SERVICE OF FAMlUES USA FOUHDAnOll
!~z,
R~v'
�SAMPLE OP-ED
mE HEALTH SECURITY ACf:
,
AN APPROACH THAT'S GOOD FOR OLDER AMERICANS
!
I
Today. we st~dat a moment of unparalleled significance in U.S. history.
President Clinton hasipresellted an approach to health care reform that will guarantee
health coverage for every American that can never be taken away.
I
I
Our country ~as the finest medical care in the world, that's clear. But
it is also
clear that there is a h'ealth care crisis in America. Our health care system is broken,
and it urgently needs: to be fixed. The President's approach preserves what's right and
fixes what's wrong, Bhasing in reform over a few years to make sure it's done right.
r
We must face' up to this task. Today's health care system is rigged against
families and small b*sinesJes. and the insurance companies are in charge. They pick
and choose whom they cover -- and they've decided that 81 million Americans under
the age of 65 have ~edical problems they label ;'pre-existing conditions" for which
they should pay higlier premiums or be denied coverage, and 58 million Americans
will have no coverage at some point during the year. They use "lifetime limits" to cut
off your benefits -- and although people may not know it, three out of-four insurance
policies have these ~hings hidden in the fine print.
I
,
The President's approach will stop the insurance companies from controlling' the
system, and put peo'ple and small businesses in the driver's seat.
I
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Because. of IMedicare, older Americans have better protection than most today.
But there are still gaps. N,earIy two thirds of Americans over the age of 65 have no
prescription drug coverage. Most older Americans want to stay at home with their
families if they nee,d long-term care. But in today's system, many are forced into
nursing homes beduse they have no way of getting the help they 'need.
,
i
Medicare will be preserved and strengthened. You will continue to receive your
Medicare coverage: -- with guaranteed security for years to come. You can keep seeing
the doctors you' see today. and your benefits will be expanded to cover prescription
drugs, with 80% of all costs covered after a $250 deductible.
I
'
I
The Presid~nt's approach takes an important first step toward covering long
term care, helping/Americans who need long-term care live independently at home and
in their communiti,es -- ~hich most people prefer.
�,
I
I
The President's,' approach also includes several important steps to protect older
Americans from frauq and overcharges. Many older Americans are vulnerable to
providers who order Unnecessary or inappropriate tests and procedures, or bill the
patient, bill the Medigap insurer, and bill Medicare -- defrauding Medicare and senior
citizens and adding billions to our nation's health care bill. But the President is calling
for new penalties to aggressively pursue and prosecute those who abuse the system.
The Health Security ~ct also includes tough measures to slow rising health care
prices, preventing do~tors and hospitals from charging people more than the amount
Medicare covers.
I
And all Ame~icans -- young people, early retirees and Medicare recipients -
will have the, securitY of health care that can never be taken away.
!
Some people!in Washington are offering alternative reform proposals, bilt we
should take a careful look ,at how these other proposals affect older Americans. For
example, the Presid6nt's approach uses Medicare savings to help older Americans buy
prescription drugs and to provide new options for long-term care. Others use Medicare.
as a bank to pay ot~er bills -- an approach which the President strongly opposes.
I
i
!
As the Presi~ent said in his recent State of the Union address, "To those who
would cut Medicare without protecting seniors, I say the solution to today's squeeze on
middle-class worki~g people's health care is not to put the squeeze on middle-class,
retired people's health car~. We can do better than that. ,.
I
There will ~e many attempts in the next several months to confuse and scare all
Americans -- espe¢ially older Americans -- about the possible effects of reform. But
older Americans s~ould know that the President's proposal is a good deal for them -
helping with the c9st of prescription drugs, creating more options for long-term care,
and providing gre~Uer security.
I
I
The bigges~ threat to our health care system is doing nothing. If we do nothing,
our benefits will tie cut. If we do nothing, the cost of care will continue to skyrocket.
And if we do nothing, millions of Americans will continue to live in fear that their
I
health insurance Will be. taken away.
I
,
Now is th~ time ,'to act, once and for all, to guarantee health insurance to every
Americ'an, and tol strengthen the coverage older Americans need and deserve.
I
.
�.~
W
ATe H
REST ASSURED: THE CLINTON HEALTH'
REFORM PROT/EC,TS OLDER AMERICANS
r
By Ron Pollack
.
I
I
r
.
I
II
'm saving that rocker for the day when I feel
as old as I really am," Dwight E;isenhower
used to say-and at 88, Arthur ,Flemming is
the fulfillment of Ike's words.
,
Dr. Arthur Flemming was President Eisenhower's
Secretary of Health, Education and Welfare, and, at 88,
he.'s still saving that rocker for some day in the future ...
Today, Dr. Flemming is working to enact the Clinton
health reform plan, which he sees as "the best
thing for older Americans since Medicare
was first created."
I
"President Clinton's Health Security Act
will guarantee thatlYou can keep your!
doctor-and also guarantee that Medicare
will be strengthened and expanded," Dr.
Flemming says. .
.
After four decades of fighting for synior
citizens, Dr. Flemming now sees the :
realization of a long-sought goal- prpviding
the national community with a health plan
including a strengthened and expant/.ed Medicare.
i
i
'
New Prescription Drug ~enent '
"Older Americans will receive all!the benefits
they do today. In addition, Medicar~ will be,expanded
to cover prescription drug benefits,!and there will be
a new long term care program to cover home and
community-based care," Dr. Flemrrting says.
'"Except for wealthy seniors earning 5100,000 a
year. older Americans will still hav~ to pay ,only 25% of
the total costs of the Part B benefits they receive-and
that includes the wonderful new dtug benefit," Dr.
Flemming reports.
i
t
Long Term Care atl Home '
The new home care benefit resbgnizes the reality
that millions of seniors' have knO\yn for years- it's
nearly impossible to provide roul,1d-the-clock care for
a loved one without some help. i
The Clinton reform strives to cover not just medical
help, but all the other elements decent and proper,
home care: paying for a home nurse, nurse's aide or
other professional caregiver; 'ing y~ur home safer
9f
SE'N
for an invalid; homemaker and chore assistance, and
adult day care and other needed services.
How long did you think it would be before seniors
wouldn't have to worry about being forced into a
nursing home, just because they can't afford long term
care at home? With President Clinton's Reform, that
'
time is finally about to come.
Research to Prevent Alzheimer's
The reform even gives us new hope in the
battle against Alzheimer's disease. That
terrible disease is everyone's nightmare-not
being able to dress or eat without assistance,
losing control over our very bodies and
minds. Being a burden on our children, and
an object of pity to our grandchildren.
But Bill and Hillary Rodham Clinton have
made research into Alzheimer's disease
prevention a top priority for their health
reform plan. It's been agonizing to wonder
what breakthrough is just around the corner, which
scientist is one investigation away from learning
valuable new information about Alzheimer's.
The Clintons don't want any of us to have to wait
any longer for a cure to Alzheimer's and other diseases
that devastate so many American families. That's why
their health reform boosts medical research.
As the health reform debate heats up, you'll see
slick, multi-million dollar commercials aimed at scaring
senior citizens into taking the side of the insurance
companies and drug companies.
Instead of listening to the hucksters, listen to a
fighter for older Americans in the tradition of Claude
Pepper. Listen to Dr. Arthur Flemming:
"Over the next several months, there will likely be
many attempts by those opposed to reform to scare
Americans about the effects of the President's plan,"
Arthur Flemming cautions. "But older Americans
should know that President Clinton's reform will bring
them greater security and expanded benefits."
•
Ron Pollack is executive director of
Families USA Foundation
,'WATCH IS AN EDITORIAL SERVICE OF FAMILIES USA FOUNDATION
�
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Text
THE WHITE HOUSE
MAR 25 REC1t
WASHINGTON
March 24, 1994
P
MEMORANDUM FOR CABINET CHIEFS OF STAFFS
FROM,
DANA HYDE
SUBJECT:
"Health Reform: How It Works"
Enclosed are two copies of our newest packet "Health Reform: How it Works." This is a black-and-white
version of the packets you received at the Chiefs of Staffs breakfast on Tuesday. March 22. and that
members of your staff received at the 5:30pm briefing also on Tuesday.
Due to the costs involved, we are unable to make many more copies of the color version. However, we
strongly urge you to duplicate and circulate this version to members of your staff.
In addition, several of your Deputy and Assistant Secretaries requested Small Business Talking Points and a
Transcript from the President's Small Business event on March 22. Copies are enclosed.
Owt~~
elL '-PVlv~, bONVcw.h~
~~.
1
i2n.
-, '0
CLINTON LIBRARY PHOTOCOPY
�Health Reform:
How It Works
�HEALTH REFORM:
THE PRESIDENT'S APPROACH
Here's how the President's health reform works:
•
Guaranteed private insurance. We want to guarantee private insurance
coverage to every American. Comprehensive coverage that can never be
taken away.
•
Choice. We want everyone to have the right to choose their own doctor and
their own health plan. We want to make sure you get high-quality care by
giving you the choice, not your boss or insurance company.
•
Outlaw unfair insurance practices. We want to make it illegal for
insurance companies to: drop coverage or cut benefits; jack up your rates if
you get sick; use lifetime limits to cut off your benefits; or charge older
people more than younger. That's how you'll ge,t affordable insurance you
can depend on.
•
Preserve Medicare. We will protect and strengthen Medicare. Older
Americans have a right to count on Medicare and. choose their doctor. We
also want to cover prescription drugs under Medicare, and give new options
for long- term care in the home and community.
•
Health benefits guaranteed at work. Every job should come with health.
benefits. Most jobs do today. And yet 8 out of 10 Americans who have no
insurance are in working families. We want everyone to have health benefits
guaranteed at work. The government will provide discounts for small
businesses and help cover the unemployed.
�THE PRESIDENT'S HEALTH CARE REFORl\1:
How It Works
I. Introduction: The Health Care Crisis
II. A Vision of Health Security
1. Guaranteed private insurance for everyone
2. Choice of doctor and health plan
3. Outlaw unfair insurance practices
4. Preserve Medicare
5. Health benefits guaranteed at work
III. Conclusion: The President's Reform ·Works For You
�Introduction: The Health Care Crisis
1. They say there's no crisis, but they're wrong. [Chart 1]
A. Even if you have good insurance today, you can lose
it tomorrow.
58 million Americans go without insurance at some
point during the year. 2 million Americans a month
lose their insurance.
B. Your benefits are threatened by insurance company
fine print.
81 million Americans have "pre-existing conditions"
that insurers can use to raise rates or deny coverage.
3 out of 4 insurance policies -- that's 133 million
people -- have lifetime limits that cut off benefits
when you need them most.
C. You're paying more, and your choices are declining.
The President's refonn will protect you and your
family from a future of being squeezed -- getting
lower-quality care, fewer choices .and higher bills.
2. America faces 3 choices: [Ch~rt 2]
• government insurance
• guaranteed private insurance (the President's approach)
• no guarantee of coverage
3. The bottom line: the President wants to strengthen what's
right about our health care system and fix what's wrong.
�A Vision of Health Security
Here's how the President's health reform will work. [Chart 3]
Guaranteed private insurance
The President's proposal will guarantee every American
private health insurance. Comprehensive coverage that can
never be taken away.
Under the President's approach, everyone will get a Health
Security card that will guarantee: [hold up card]
•
Benefits as good as what America's biggest companies
offer and as good as what members of Congress get.
Your benefits will include prescription drugs and
preventive care - things often not covered today.
•
Protection against the devastating .costs of serious illness .
That means a low deductible and no lifetime lim its on
your benefits •.
�Choic"e of doctor and health plan
You will: [Chart 4]
•
•
choose your doctor
and
choose your health plan.
We want to make sure you get high-quality care by giving you
the choice, not your boss or insurance company ..
lfwe do nothing, rising costs will force more and more
employers to limit your choice ofplan and doctor.
With your Health Security card, you'll be able to follow your
doctor to any plan you choose:
•
•
•
a plan where you can see any doctor in your community
-... they call ~hese "fee for serVice" plans
a network of doctors and hospitals
or an HMO
Let's be clear: we're against forcing people into HMOs. That's
why the President's approach expands your choices.
�Outlaw unfair insurance practices
We need a system of coverage that guarantees affordable
insurance people can depend on.
That's why the President's reform makes sure that insurance
company premiums don't continue to skyrocket. [Chart 5]
And it will be illegal for insurance companies to:
1) drop coverage or cut benefits
2) jack up your rates if you get sick
3) use lifetime limits to cut off your benefits
4) charge older people more than younger
Ifwe do nothing, you will continue to be at the mercy of the
insurance companies. And continue to pay more and get less.
Insurance ought to mean what it used to mean. You. pay a fair
price for security, and when you're sick, your health care is
there for you -- no matter what.
�Protect Medicare
The President believes very strongly that the true test of health
reform is ·whether it's good for older Americans. That's why
his proposal preserves and protects Medicare. [Chart 6]
The American Association of Retired Persons (AARP) says
that the President's approach is the "best option for senior
citizens. "
Older Americans will have:
•
the right to choose their doctor
•
new prescription drug coverage
•
some long term care protection
The President wants to make sure that every penny of
Medicare money is used for seniors. But others want to take
Medicare money away from seniors.
�Health benefits guaranteed at work
We want everyone who works to get health insurance at work,
with employers and employees each paying part of the cost.
This is the easiest, simplest way to make sure everyone has
coverage because:
•
That's where the vast majority of Americans with private
insurance get it today.
•
Eight out of ten people without insurance are in working
families.
Today people on welfare get guaranteed health insurance,
while people with jobs mayor may not be covered. That's
wrong. People who work should have health insurance.
[Chart 7]
So anyone who works will get coverage at work. Employers
will be asked to contribute, as will employees. Small
businesses will get discounted insurance. The government will
cover the unemployed, and will continue to cover older
Americans with Medicare. That's how we make sure that
everyOlJ.e is covered.
�Conclusion: The President's Reform Works For You
1) The President's reform works for you and your doctor.
That's why the doctors, the nurses, the people on the front
lines _. including America's largest associations of family
physicians, pediatricians, nurses and pharmacists -- support it
and believe it will work.
\
2) Opponents will try to confuse the issue by making it seem
more complicated, but it's really pretty simple:
•
You'll get a Health Security card, you'll pick any doctor
you want, fill out one form, and know exactly what's
covered. And your health security can never be taken
.away.
3) So that's how the President's reform works. [Chart 8]
•
•
•
•
•
Guaranteed private insurance.
Choice of doctor and health plan.
Outlaw unfair insurance practices.
Preserve Medicare.
Health benefits guaranteed at work.
4) The insurance companies don't like the President's reform.
But the President didn't design h~s reform for the insurance
companies -- he designed it for you.
5) Now it's up to us to stand with the President against the
special interests. This is the right thing to do, and with your
help, it's going to happen this year.
�HEALTH CARE SPEECH
introduction
President Clinton has been in office for Just over a year now, and we have already
seen him move our economy in the nght direction. start to restore our sense of security and
begIn to rene\\' Amenca's spirit.
This President is dedicated to the proposition that people that work hard and play by
the rules should be rewarded for their work.
That's why he introduced a reemployment initiative to help people get good jobs with
growing incomes. That's why he passed the Family and Medical Leave Act so good workers
can be good parents. That's why he expanded the earned income tax credit to reward work
over wei fare.
And that's why he's dedicatmg himself to fixing this health care system -- to provide
hard-working families v,.;th the health secunty they deserve.
This year we have a magic moment After 60 years of false starts and obstruction, we
have an opportunity to give every American health security. This is an opponunity we must
seIze.
Opponents of reform are trying to teIl you there's no health care crisis, but they're
wrong. [Chart I]
The fact is: Even if you have good health insurance today, you can lose it tomorrow.
Two million Americans a month lose their insurance. And fifty-eight million Americans find
themselves without insurance at so"!e pomt during the year.
Your benefits are threatened by insurance company fine print. Eighty-one million
Americans have "pre-existing conditions" that insurers can use to raise rates or deny coverage.
And three out of four msurance policies -- that's 133 million people -- have lifetime limits
that cut off benefits when you need them most.
Even if you've got insurance, you know you're paying more and getting less. And your
choices are declining. I'm here to tell you how the President's reform will protect you and
your family from a future of being squeezed -. getting lower-quality care, fewer choices and
higher bills.
[Chart 2]
America faces three choices: government insurance for everybody, no guarantee of
coverage for anybody. and guaranteed private insurance _. which is the President's approach.
And the President has told the Congress he will veto a bill which doesn't cover everybody -
because without guaranteed private insurance for everyone, it's not real reform.
�The bottom line is this: the PresIdent wants to strengthen what's right about our health
care system and fix what's ""Tong.
We kn.ow the system is broken. We know that aU of us are at risk of losing our
coverage at any time. Here's how we want to fix it.
We want to guarantee private health insurance for every American;
.We want to protect your right to choose your own doctor and health plan. and
improve the quality of your health care;
We want to outlaw insurance company abuses;
We want to protect and dramatically improve Medicare;
We want to guarantee health benefits through the workplace. because that's the
best way to cover everyone.
Guaranteed Private Insurance For All
[Chan 3]
The President believes that everyone must be covered. Always. That's the only way
to guarantee security. As long as any of us at any time can be denied coverage or dropped
from coverage -- none of us is secure. And as long as Americans who have insurance pay the
price for those who don't have insurance, we'll never get costs under control.
He's also said that the benefits package must be comprehensive. [hold up Health
Security card] Under the President's proposal, every American will get a Health Security card
that \ViII guarantee benefits as good as what America's biggest companies offer -- as good as
what members of Congress get Plus preventive care -- immunizations, mammograms,
physicals -- and prescription drugs. We must keep our people healthy, not just treat them
after they get sick.
And Americans must have protection against the devastating costs of serious illness.
That means low deductibles and no lifetime limits on your benefits. People must have the
peace of mind of kno\Ving that no matter what happens, their health care can never be taken
away.
�Choices Preserved and Expanded
(Chan 4]
The Pr~sident wants to preserve and expand your choice of doctor and health plan,
because that's the best way to guarantee high quality health care.
But choice and quality are threatened today. If we do nothing, rising costs Vvill force
more and more employers to limit your choice of plan and doctor.
Under the President's approach, your Health Security card guarantees your choice of
doctor. Once you get your card, you -- not your boss or insurance company -- choose your
doctor and health plan. It can be a plan that lets you use any doctor or hospital that you
want Or it can be a plan that lets you use a network of doctors or hospitals. Or. you can
join an HM:O. It's your choice.
The special interests are trying to scare you on this issue in order to block reform. But
remember that they're trymg to preserve their profits. And don't let them stand in the way of
your health security.
Outlaw Insurance Company Abuses
[Chart 5]
We want to guarantee affordable insurance that people can depend on. The President's
approach would make it illegal for insurance companies to raise your rates unreasonably ... to
drop your .coverage or take away your benefits... to increase your rates if you get SICk... to use
"lifetime limits" to cut off your benefits... or, to charge you more simply because you are
older or have a pre-existing condition.
If we do nothing, or worse, pretend to do reform, you will continue to be at the mercy
of the insurance companies. And you'll continue to pay more and get less.
Insurance ought to mean what it used to mean. No more fine print. No more insurance
company abuses. You pay a fair price for securi ty, and when you're sick. your health care
benefits are there for you -- no matter what.
3
�Protecting and Expanding Medicare
[Chan 6J
,
The Pr~sident believes very strongly that the true test of health reform is whether it's
good for older' Americans. That's whv his proposal, dramaticallv improves
. preserves and
Medicare. And the American Association of Retired Persons (AARP) says that the President's
approach is the "best option for senior Citizens."
Under the President's approach, if you get Medicare you keep it. You keep your
doctor if that's your choice. PI us, your benefits are expanded. People receiving Medicare will
get coverage for prescription drugs, which costs older Americans more than anything today.
And we also begin to provide coverage for long term care at home or in your community.
The President wants to make sure that every penny of Medicare money is used for
seniors. Some want to take Medicare money away from seniors and spend it on other things.
That's why we must fight with the President for health care reform that protects Medicare and
older Americans.
Insurance Through The Workplace
Finally. if we're going to cover everybody, the best way to do it is to guarantee health
benefits at work. Every job should come with health benefits. Most jobs do today. And yet 8
out of 10 Americans who have no insurance are in working families.
[Chan 7]
We want everyone to have health benefits guaranteed at work, with the government
providing discounts for small businesses and the unemployed. This approach builds on what
works. And it's the easiest and simplest way to accomplish our goal of guaranteed private
insurance for everyone.
Providing health benefits at work not only makes sense; it's also the right thing to do.
Today people on welfare get guaranteed health insurance while people with jobs mayor may
not be covered. That's Mong. People who work should have health insurance.
If we are to guarantee this, we must prot.ect small businesses -- and the President's
approach does just that. The President wants to provide discounts for small businesses, and
full tax deductibility for people who work for themselves.
That's how we make sure that everyone is covered. Anyone who works will get
coverage at work, Employers will be asked to contribute, as will employees. The government
will cover those between jobs, and will continue to cover older Americans with Medicare.
4
�Conclusion: The President's Reform Works For 'You
The President's reform works for you and your doctor. That's why the people on the
front lines -- America's largest associations of family physicians, pediatricians. nurses and
pharmacists --. support it and believe it Vvill work,
Opponents are trying to confuse the issue by making it seem more complicated. but it's
really pretty simple. You'll get a Health Security card, you'll pick any doctor you want, fill
out one form, and know exactly what's covered. And your health security can never be taken
away,
[Chart 8]
Guarantee everyone private insurance. Keep your choice of doctor. Outlaw
unfair insurance company abuses. Protect Medicare. And guarantee health benefits at
work. That's the approach. ' And this is our opportunity.
No wonder the special interests -- the people who profit off today's crazy system -- are
out in full force, One group of health insurers has already spent $14 million -- money from
your insurance premiums -- on TV ads to scare you about reform.
But the President didn't design health reform for the insurance companies -- he
designed it for you. And we must not let the insurance companies stand in the way of real
reform,
Presidents from FDR to Harry Truman to Nixon to Carter have tried to guarantee
insurance to every American, but none have succeeded -- because special interest groups have
been just too powerful to overcome, But this time, if we work together, I am convinced things
Vviil be different.
This time, we will make history and guarantee private insurance to every American, I
ask you to join with me and help do what is right for America~ Thank you.
�QUESTIONS Alvn AiVSWERS
1) Doesn't the Clinton plan add more layers of government·
bureaucracy?
No. The President specifically rejected a government-run system in favor
of guaranteed private insurance. America basically faces 3 choices:
.. government insurance for everybody
• guaranteed private insurance (the President's approach)
o
leaving people without insurance
The President's approach is guaranteed private insurance. Everyone will
have comprehensive coverage that can never be taken away;
2) But what about these so-called "alliances"?
The purpose of them is very simple -- to give bargaining power to small
businesses and individuals and take it away from the insurance companies.
Today, the deck is stacked against small businesses and individuals. Small
businesses are paying 35 % more than big business for the same insurance,
and individuals pay even more.
So we have these consumer-controlled alliances to allow people and small
businesses to band to!Zether and !Zet more consumer clout in the
marketplace. Consumer-controlled -- that's the President's idea, not·
government~controlled.
Now, Congress will figure out exactly how they should be structured, but
this is an idea that has bipartisan support. The insurance companies don't
like it because it means they have less power, but that's what alliances are
intended to do. And ·that's why the insurance industry is spending millions
to weaken or destroy the idea.
3) One of those TV ads says that the President's plan will limit my
choice of doctor. Is that true?·
No, it's not. You'll be able to choose your own ·doctor and health plan.
In fact, to make sure that you get the high-quality care you deserve, the .
President's approach actually increases the choices most consumers will
have. Because you will choose your doctor and health plan -- your boss
�won't and the insurance company won't. So you can choose any doctor
and health plan in your community. Remember who's paying for these
ads: the insurance companies -- who are try'ing to scare you and preserve
their profits.
4) Won't this plan mean that I'll pay more and 'get less?
No. In fact, the indepeFldent Congressional Budget Office (CBO) analysis
that the Republicans praised said that the President's plan would cost
Americans less money and give them more health benefits, Young,
healthy people may pay a little more _. but that's because we're
prohibiting the insurance companies from charging older people more than
younger people.
Under the President'S approach. you'll be guaranteed affordable insurance
you can depend on. We'll make it illegal for insurance companies to jack
up your rates or drop you if you get sick, use lifetime limits to cut off
your benefits, or take away your benefits. The insurance c.ompanies won't
be allowed to bleed you dry.
And the President's proposal calls for comprehensive benefits, including
preventive care and prescription drugs. Under the President's approach, no
one _. not your boss, not your insurance company -- can take those
benefits away.
5) Won't your emplover mandate cause massive job loss and cause
thousands of small businesses to go bankrupt?
There is no credible evidence to support that claim. The independent
Congressional Budget Office (CBO) analysis that the Republicans praised
said that the Clinton plan would not result in the loss of jobs, and would
benefit all small businesses ..
Studies predict that there will, in fact, be job gains as a result of the plan.
The Economic Policy Institute predicts 258,000 manufacturing jobs
created over the next decade, Lewin-VHI, a widely-respected, bipartisan
finn, predicts over one million jobs created by providing long-tenn care,
and the Employee Benefit Research Institute predicts that the President's
proposal could produce as many as 660,000 jobs.
�The President specifically designed his proposal to help small businesses
- the biggest victims of today's health care crisis. Small business owners
will be able to get rock-solid, comprehensive coverage for their families
and employees. And no longer will they be subject to insurers jacking up
their rates: or dropping their coverage when one employee gets sick.
Because those insurance company abuses will be illegal.
6) Why do we need an employer mandate anyway?
If we want to guarantee every American health insurance, we've got to
figure out how to achieve that goal. The President believes every job
should come with health benefits. Most jobs do today because most
employers accept this responsibility to provide worker health benefits.
And yet 8 out of 10 Americans who have no insurance are in working
families. We want everyone to have health benefits guaranteed at work.
And under the President's approach, the government will provide
discounts for small businesses, help cover the unemployed, and continue
Medicare for older Americans. That's how we'll cover everybody.
7) When you try to cut costs and limit the amount premiums can
rise, won't that just lead to rationing?
Absolutely not. The key to this is insurance c0II!pany premiums can't
continue to rise unchecked. Your money will go to buying you the highest
quality of care and service, not padding the insurance company red tape.
That's why there's a limit on how much insurance companies can raise
your rates. In fact, it will be illegal for insurance companies to drop your
coverage or take away your benefits. You'll be guaranteed affordable
insurance you can depend on.
The President'S approach is all about keeping you healthy. You'll have the
right to choose your own doctor and health plan. We want to make sure
you get high-quality care by giving you the choice, not your boss or
Insurance company.
8) I've got good insurance. What's in this plan for me?
First -- and most important -- you'll get something that no amount of
money can buy in today's insurance market: guaranteed private insurance.
Comprehensive coverage that can never be taken away. Second, you, not
�your boss or insurance company, have the choice of doctor and health
plan to make sure you get the high-quality care you deserve.
Third, unfair insurance company practices will be outlawed. 3 out of 4
insurance 'policies -- that's 133 million people -- have these lifetime limits
which mean that your coverage could be cut out just when someone in
your family is sickest. No more. No more jacking up prices when you get
sick. You'll have affordable insurance you can depend on. Fourth, we
protect Medicare. We'll cover prescription drugs under Medicare, and give
new options for long-term care in the home and community. And fifth,
everyone will have health benefits guaranteed at work, with the
government providing discounts to small businesses and the unemployed.
Even if you lose your job, you will never have to worry abQut losing
benefits or being forced to change doctors.
9) Is it true that my doctor can be fined S10,000 for treating me
outside the system?
A: No, that's not true. You can see any doctor you want and pay for any
procedure or treatment. The $10,000 fine refers to the President's
crackdown on insurance company fraud. Fly-by-night insurance companies
will be fined if they try to dupe you by selling you "supplemental"
benefits that you're already guaranteed by law.
.
[Note: By law, you'll be guaranteed the right to pay to see any doctor in
the country, even if you are in an HMO.]
10) What's going to bappen to my l\fedicare benefits?
A: Older Americans who receive Medicare will continue to receive all the
benefits you do today. And you'll keep the doctor you now have. In
addition, we'll strengthen Medicare by adding pre~cription drug coverage.
Older Americans will also benefit from new long-term care options in
their homes and communities, where they want to receive care .
. 11) What happens if the money runs out?
A: Today, when insurance companies go out of business, patients get
struck without health care, and doctors. don't get paid. The President's
approach prevents that. It bans fly-by-night insurers, forcing the insurance
industry to set aside funds to protect against bankruptcy or failure.
�THE CRISIS
People Without Insurance Each. Year
58 million
People With Pre-existing Conditions
81 million
People With Lifetime Limits On Coverage
133 mil]ion
�TEED PRIVATE
.. INSURANCE
- Comprehensive Benefits
-No Lifetime Limits
_. Insurance That Can't Be
Taken Away
�CHOICE
• You choose your doctor
• You choose high-quality plan
• Employers won't pick your plan
;
.
• Insurance companies can't deny
you coverage
�REAL INSURANCE
REFORM
lllegal for insurers to:
• Drop coverage or cut benefits
• Increase your rates if you· get sick
• Use lifetime limits to cut off
your benefits
• Charge older people more
�.e
��HEALTH BENEFITS
Gu
TEED AT WORK
• Employed: Covered at Work
• Small Business: Discounts
. on Insurance
• Unemployed: Help from
Government
�How REFORM WORKS
• Guaranteed Private Insurance
• Choice of Doctor
• Real Insurance Refonn
• Medicare Preserved
.
• Health Benefits Guaranteed
·AtWork·
.
�BACKUP FACT SHEET
People \Vithout Insurance Each Year
58 Million
THE FACT:
"The Bureau of the Census calculated that 50 million Americans
lacked health insurance for at least 1 month during 1987.
Lewin/VHI updated the census estimate, calculating that 58
million people were uninsured for at least 1 month in 1992."
THE SOURCE:
"Dynamics of People Without Health Insurance: Don't Let the
Numbers Fool You," Journal of the American Medical Association
(JAMA), January 5, 1994
People With Pre-Existing Conditions
81 Million
THE FACT:
An estimated 81 million Americans under age 65 have medical
problems for which insurance companies can charge higher
premiums, exclude coverage or deny coverage altogether.
THE SOURCE:
"Health Insurance at Risk· The Seven Warning Signs", Citizens
Fund, June 1991 [with data from National Center for Health Statistics
"Health Interview Survey", further data from the Health Insurance Association
of America" Source Book", and the latest Department of the Census "Current
Population Surveys'1
People With Lifetime Limits on Coverage
133 Million
THE FACT:
The Bureau of Labor Statistics 1991 Survey of Medium and Large
Private Establishments reports that only lout of 4 people have
insurance policies without lifetime limits.
THE SOURCE:
Table 45 .- Medical Care Benefits: "Employee Benefits in Medium
and Large Private Establishments", Bureau of Labor Statistics,
1991
CALCULATION: In 1992, 177.5 million .A.mericans had private insurance, according
to the Employee Benefit Research Institute analysis of the March
1993 CPS. Seventy-five percent of 177.5 million is 133 million.
�"
THE WHITE HOUSE
ottice of the Press Secretary
March 22, 1994
For Immediate Release
REKARKS BY THE PRESIDENT
AT SMALL BUSINESS HEROES HEALTH CARE EVENT
Room 450 ,
Old Executive Ottice Building
10:46 A.M. EST
THE PRESIDENT:
Ladie. and gentlemen, tir.t let me thank
allot you tor coming here. W. have .everal me~er. ot the united
State. Congre•• up here in the tront. We're very glad to .ee allot
them and we thank them tor their pre.ence. And we have small
businesspeople here trom allover AlIIerica, and we thank you tor your
presence. We're here primarily to hear trom the sm.ll businesspeople
who are here on the pan.l, and p.rhape .om. othar it tim. permits.
I just want to make a coupl. ot comm.nts.
First ot all,
I very much appreciate the work that Er.kin. Bowl.. has done a.
Director ot the Small Bu.in... Adaini.tration. I . . proud ot the
tact that I was able to appoint .om.on. to this job who w•• not just
someone who had run un.ucce••fully tor ottic. or was otherwi••
looking tor a patronage appointment. Thi• .an has .pent 20 y.ars
h.lping to tinanc• •m.ll bu. in••• cr.ation. and .xpan.ion.. And
theretore, h. has a clear.r und.r.tanding and gra.p ot what small
businesses are r.ally up again.t and the ditt.r.nce b.tw••n the
rhetoric ot supporting .mall bu.in••• and the r.ality ot it than
perhaps anyone who has held this job in a v.ry long tim••
S.condly, I want to thank my good tri.nd, Congr.ssman
laFalce, tor hi. l.ad.r.hip on small bu. in••• issu•••
Finally, l.t me .ay that ev.rybody, I think, understands
that one ot the rea.on. that the Unit.d State. has not .ucc.eded in
providing h.alth s.curity tor all it. p.opl. while ev.ry oth.r
advanced economy has done
i. the ditticulty po••d by the gr.atest
strenqth ot our .conomy, which i. that an inordinate p.rcentag. ot
our work.rs work tor .mall bu.ine••peopl. -- v.ry small bu.iness -
and increasingly, more and more ot,th. n.w job. are creat.d by small
businesses.
.0
I
So that pr•••nt. us with a dilemma. How.v.r, w. also
know it we look at the r.al tact. that almo.t all the job cr.ators
among small bu.in••• are making .om• • ttort to provide h.alth
insuranc., and that tho•• that do t.nd to have more .tabl. work
torce. and higher productivity and gr.at.r .ucc••••
Ju.t this we.k I had a good tri.nd ot .in. up here with
his tamily. He'. a car d.aler in my haae .tat. and he va. talking
about how he'd alway. in.ured allot hi• •mploy••• and non. ot his
competitors had. And in the laet 20 year., thr•• ot them had com.
and gone and he was atill ther.. And on. rea.on va., he nev.r had
any employ.e turnover becau.e h. alway. took car. ot hia employees
and their health care probl.... But how th.y atruggl.d to get a
bigger pool of insured people ao that he could get hi. insurance cost
down was a continuing on. tor him.
Anyway, that just bringa me to thia point: Thi.
could not in good coneci.nc. have advocated, and I
adm~nistra~ion
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could not support a plan that I thought would be, on balance, bad fer
small business. I believe this plan is, on balance, good for small
business. If I didn't, I wouldn't be supporting it. And I will not
sign any bill passed by the congress that I do not believe is good
for the small business economy because we have to create more jobs in
this country.
Our plan builds on the system we have now; guaranteed
private insurance. It provide. more choices to .mployees than they
now have under mo.t h.alth car. plan., at lea.t thr•• a y.ar, ev.ry
y.ar. It contain. r.al in.uranc. r.form. that ~re very important to
small bu. in••••• -- no di.crimination. tor pre.xi.ting conditions, or
ba.ed on the age ot the work torce. It prot.cts M.dicare. It does
provide tor both M.dicar. people and tor the work torc. and their
tamili•• , pr.scription. ben.tit and a pha••d-in, long-t.rm care
b.n.tit tor .ervice at hom., for .xample, tor di.abl.d p.opl. or
eld.rly people, a. well a. in institutional setting.. And it does
have an .mployer mandat., but with .trong di.counts tor small
bu. in••••• with mod••t payrolle and mod••t protit margin•.
Now, th.r. will b. countl••• di.cu•• ion. about what the
proper d.tails ot that should be, but it .e.m. to me that that is the
only approach that has a r.a.onable chanc. ot b.ing .ucce.stul in
this environm.nt. And a. I .aid, th.r. are p.opl. who will propose
variation. on it, but that, it •••m. to m., i. what w. ought to be
doing.
My purpo.. today i. to .how that th.r. i. a great
ditterenc. in the rh.torical pronounc.m.nt. ot .om. organiz.d groups
and the r.al lit• •xp.ri.nc•• ot a lot ot bU. in••• p.ople. And we
have her. p.opl. who have b••n att.ct.d by the pre••nt h.alth
condition., and I am trank to .ay that wbile mo.t ot the people who
are on this panel who are providing health in.urance today would
actually pay 1••• under our plan. Soae would pay more, and they know
it. But they al.o know that tor the tir.t ti.e th.ir competitors
would as w.ll, putting them on a more even tooting.
So l.t'. get in to the paneli.t., hear their stori.s,
and give them a chanc. to comment.
Q
Thank you, Mr. Pre.ident. We are a 22-y.ar-old
company and through the year., I have .ought out the be.t ot the best
.mployee. and have competed with majority companie.. By that I m.an
I have cov.red our employ••• 100 p.rcent a. an attractive package to
work witb us. Rowever, in the la.t tew year., we'v• •ncount.r.d some
probl.m., and the problem. are that two ot our .mployee. ar
uninsurabl.. Why? On. i. over the w.ight .cale according to the
insuranc. companie.. And I have gotten in.urance policies that are
-- tor six month., renewed them a .econd time and then at the third
time they're dropped. And .0, ther.tore, I have two wond.rtul
.mployee. that are unin.ured.
And what'. happening, th.y teel di.criminated against.
OUr payroll
-- it tak•• about 15 percent ot our payroll, which i. a lot tor a
.mall company. We want to grow. Wh.re do we get the money? As you
all know, .mall bu.in••••• -- the ditticulty i. getting
capitalization tor running your company.
,
I want to continue inauring them, but how can I do it?
So, Mr. Pre.ident, I t ••l that this i • •om.thing that
your program. would hopetully re.olve ~nd would benetit our .ituation.
MR. SOWLES: Mr. Pre.ident, Setty RaIl i. al.o her.,
trom the Hall Manutacturing Company in N.w Hamp.hire. And I think
you've experienced .om. ot the.e .imilar problem.. I think you've
also been ~ropped trom your insuranc. a couple ot times.
8etty, would you like to comm.nt on it?
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.
Q
Yes, I would. Thank you, Mr. President, for giving
us this oppor~unity. I've been in business for 43 years. When my
husband and I started our business we just assumed that we would
provide health benefits tor our employees and tor ourselves. And we,
very shor~ly thereatter, start.d with Blu. Cross-Blue Shield. That's
back in the 1960s. And wh.n the Matth.w Thornton Health Plan HMO
came on board, we also ott.r.d that group to our employees.
'
And th.n about thr.e y.ars ago, both of those companies
decided that th.y couldn't otter health insurance groups to companies
aa small aa mine. Under 25 employees -- they don't even think you're
a business at all. And so, I was very disturbed. I tried to
convince them that they should continue to insure my employees
because I t.lt I was willing to pay my .har. ot their in.urance and I
ought to be allowed to do that.
So Blue Cro••-Blue Shield was unmoved, but Matthew
Thornton did continue to cover my employ.es. But 80me ot them don't
want to be cover.d by Matthew Thorn~on, they want.d to stay with
their own doctors. And ultimately, they had to go oft ot the group
plan that was dissolved and go into a nongroup in.urance.
And I think it'. -- my employe.s have b••n around tor 43
years with me, and I think one ot the r.ason. th.y .tayed with me so
long was because ot otterinq h.alth insuranc.. And I think that's
very, very important to allot u••
So I hop. we can r ••olve thi. problem, and those of us
who want to do it can do it. I think the Clinton health plan will
probably cost m. le•• than what I'm payinq riqht now with my Matthew
Thornton and helpinq tho•• nonqroup . .ploy••• to have insurance.
MR.. BOWLES: And probably ot .qual importance, Mrs.
Hall, is that your . .ploy.e. will g.t choic. and th.y'll have choice
among many ditter.nt providers in thr•• ditter.nt types ot plans.
And they'll be able to tollow th.ir doctor and the hospital they go
to, to the plan that th.y b.lonq to. So that this will really bring
the doctor and the patient clo.er toqeth.r. And many, many people
have said that.
I think w. al.o have here today Sp.nce Putnam, who, Mr.
President, i. head ot the V.rmont T.ddy Bear Company up in vermont.
He was the 1993 winner ot the NFIB award tor company ot the y.ar.
THE PRESIDENT:
(Laughter and applaus•• )
I hope they don't take it back trom him.
MR.. BOWLES: Sp.nce, I think you 'v. experi.nc.d some of
the same problema ot rieinq co.t and lack ot raal mark.t mu.cle out
th.re.
Q
Ye., we have. And, Mr. Pre.id.nt, on. ot the
rea.on. that w. rec.iv.d that award i. that ev.ry Vermont teddy b.ar
comes with a lit.tim.health plan. (Laughter.) w. op.rate America's
only teddy b.ar ho.pital, and .hould any Vermont teddy bear need
rehabilitation, we do it tr•• ot charqe. (Lauqhter.) There i. only
on. insurance company. Ther. ia no paperwork. If it look. like our
teddy bear we will r.place limb., replace eye. -- do••n't matter how
old you are. We truly have universal acc••• tor teddy bears. And
it'. trustratinq that w. have ditficulty providinq that tor our
employ.es.
Our company was a struqglinq company only four -- a
little over four years aqo. We had l.s. than two dozen .mployees,
.and at that time, I would .ay the mo.t v.xing bu.ines. problems was
how to prov~de coveraqe tor our .mploy.... We now have over 200
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employees, and the most vexing business problem we have today, is how
to provide coverage for our employees.
We feel that health care is a national problem and it
needs a national solution. And that's why Vermont Teddy Bear is
supportive of the Clinton plan. (Applause.)
THE PRESIDENT:
Thank you very much.
Let me ju.t try to empha.ize a couple of the points that
were made h~re. Fir.t of all -- becau.e they are different issues.
Mr. PUtnam wants to in.ure all of hi. employee.: today can only
in.ure about two-third. of them. So he would actually pay more if
our plan pa••ed, but he'd get to in.ure of all of hi. employees and
they would al.o have more primarY and preventive care than they have
now and lower deductible.; But he would be, again, on an even .cale
with his competitors.
Betty Hall talked about -- I wanted to make sure you
understand what .he meant when .he talked about her .ituation in New
Hampshire, becau.e she doe.n't have Blue ero•• option. for her
business, but doe. have the matching Thornton option, she has an HMO
option. And the HMO has a very good reputation in New Hampshire and
throughout New England -- I think everybody would admit that. But
the individuals who work for her now don't have the choice that if
our plan pa.sed, every year her . .ployee. would get to choose either
the HMO or one of two other option.. And und.r our plan, she wou~d
pay the same no matt.r what. But if the . .ploy•• wanted to pay a
little more for fe.-for-.ervic•••dicin., the . .ploy•• would have
that right. So that'. how that would work.
If you go back to what Kona .aid about two of h.r
employe•• being unin.urabl., it'. iaportant h.r., I think, to
recognize a c.rtain truth about the insuranc. busine•• ita.lf. While
c.rtainly I have be.n critical of in.urance practic•• of which I do
not approve, I think it i. al.o iaportant or u. to understand that
given the organization of the in.urance bu.ine•• today, it i.
economically impo••ibl. for a lot of the.e health .in.urance companies
to do oth.r than they do becau.e they are dealing with a very small
pool of p.ople.
So if you in.ur., l.t' • •ay, an . .ployee unit the size
of her company and two of- th.. are r.ally .ick or th.y have two kids
who have b••n r.ally .ick, th.n that can double the co.t of whatever
your annual premium. are in a y.ar which i. why we have work.d.•0
hard to find a mechani.m -- and I'll .ay .ore about thi. in a minute
-- to let insurance companies in.ure p.ople the way groc.rie. .tore.
make money -- a little bit of money on a lot of p.ople. And that'.
what all thi. -- and I'm going to .ay more about thi. toward the end
of the hour becau.e I don't want to int.rrupt the flow of the people
talking -- but that'. the dil.mma we face about wh.th.r th.re .hould
or .hould not be a h.alth allianc., a buy.r'. co-op or .om.thing.
You 'v. got to have th••• folks abl. to go into big
.nough pool• •0 that the in.uranc. co.pani•• th••••lv•• do not go
broke. Th.y're in bu.in••• , too. And the .conomic. have to work
out. And the only way the .conomic. can work out i. if the riaks
which all .mall bu. in••••• are .ubj.ct to, can be vid.ly .pr.ad ov.r
a bigg.r pool. So v.'ll com. back to that.
Q
A. a pawnbrok.r, I r.pr•••nt on. ot the mo.t
mi.und.r.tood indu.tri•• in the country. (Laught.r.)
(Laughter.)
THE PRESIDENT:
Want to co.e to work up h.re?
Q
Fortunat.ly, our indu.try i. changing dra.tically.
People don't realize it, but a large p.rcentago ot Am.rican. have no
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credit and have no access to credit. and pa~rokers are the only
source of credit to them. And we try to provide lnsurance for our
employees. And I was one of those people who got a letter from my
insurance company that said, we are happy to say we are only going to
raise your rates 48 percent. And what we're having to do are things
like drastically increase our deductibles, switch companies to find
better policies, but the overriding problem is those employee. that
we have that are not insurable.
'fI1 .•
And we've got a very valued employee right now, an
assistant manager who has preexisting condition., and w. can't get
insurance. We've tried .v.ryt.hing. And" you know, w. don't lose the
employ... And w. sp.nd so much of our productive time, and he spends
so much of his tim. and our staft sp.nds tim. just d.aling with his
health care probl.ms that, you know, it he had insurance, those
problems wouldn't b. th.re.
And we've sat down and we've looked at the numbers and
with your plan, we would be able to insure all of our people which we
can't do now, we don't do, at almost the sam. co~t that w.'re
spending now tor halt of our employ•••.
THE PRESIDENT: Same thing -- 81 million Am.ricans have
preexisting conditions of some kind or other. This is not a small
problem: this is a big problem. Thos. who are in families that are
insured through gov.rnm.nt or larg.r .mploy.r. are okay .xc.pt that
most of th.m couldn't chang. job. and go to work tor any ot you or
couldn't start th.ir own busin.... You know, a lot ot p.opl., that's
a lifetime dr.am -- to .tart th.ir own bu.in.... It tak•••nough
courage, as all of you know, to do that it you don't have to worry'
about this.
So you've got 81 million American., some in the
situation of your .mployee who can't g.t in.uranc., others who pay
very much higher rate., and million. and millions -- no on. knows
exactly how many, but literally, ten. ot millions -- .who are locked
in the jobs they are now in b.cau•• they can't attord to give them up
and losing coverage. So it's a .igniticant i ••u.. Congr.ssman would
you like to say something about any of this. I hav.n't heard from
you sine. the b.ginning.
CONGRESSMAN LAFALCE: I think this is .0 important.
have town meeting att.r town m
••ting, and I go b.tore Chamb.rs of
Commerce all the time, and I usually a.k the bu.in•••men, w.ll how
many of you do provide coverage for your .mployee.? And, not to my
surpris., but maybe to the public' • •urpri.e, a va.t majority ot
small businesses do provide coverage. And the problem. they are
experiencing are their premiums are going up a.tronomically. It's
be.n double-digit intlation tor the la.t halt dozen y.ar. or
with
the possible .xception ot this pa.t year when we had this, sort of,
control. ov.r the head. ot the in.urance compani•• , drug compani•• ,
.t cetera.
T
(
.0
They're limiting their choice., too. aetore, they u••d
to oft.r three or tour option. to their .mploy••• and now, th.y don't
otter an option they .ay, w.'ll cover you, this i. it. or, the co.ts
are getting .0 great that th.y'r• •aying, .orry, w. can't cov.r you
any more. Very often when th.y till job opening., they .earch for an
individual whose spouse gets coverage at a larqer place ot
employment. So tho•• who are di.advantag.dwho don't have spous.s
who are employed and cover.d b.com. more di.advantag.d.
~. o~.r ~hing I tind tha~ .mall bu.1n••• 1. d~lnq 1n
addition to subsidizing through co.t shifting, those small bu.inesses
that don't provide coverage, is they're shifting the taxation more
and more ~n the .mploy.... B.tor. th.r. u••d to bean 80-20 split.
Then it gets to b. 70-30: th.n 50-50 split. And the .mploye. has no
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choice but to pick it up. And these small businesses, too, there's
no negotiation, there's no bargaining power.
But then there's additional premiums above and beyond
the clear premiums that the employees of small businesses have to
pay. There is the deductibles that are increasing constantly.
Before it used to be $50 per person, and then $100, then $150, then
$250 per person. These are enormous. For a family ot four theY're
already at $1,000.
Th. copaym.nts are incr.a.ing. Th••• are the tin.
prints. Betor. it us.d to be, well, w.'ll cover 85 percent, then 80
p.rc.nt, th.n 75 p.rc.nt. And it's not ot whatev.r the charg. is,
it'. what the UCR i. -- what the u.ual customary r.gional t •• is.
And it you look at the tin. print ot the contract., the usual
customary regional t •• has b.en reduc.d while the te.s have gone up,
which means again, your copaym.nt increa••s astronomically.
And mo.t importantly, you're limiting coverag.. Again,
this is the tin. print of the in.uranc. contract, but your ability to
access a mammogram go•• down. Your ability to achieve X ray., CAT
scans, HRIs even wh.n n••ded goes down considerably.
I think w.'r. getting le•• and le•• health care at
gr.ater and gr.at.r co.t. And the chi.t casualty ot all this is not
big business that has a .trong union to n.gotiat. on behalt of the
employees. Th. Chi.f ca.ualty ot this i. both the s. .ll
bu.ines.p.rson and the . .ploy••• ot the ...11 bu.in•••p.rson.
THE PRESIDENT: W. have .om.on. hor. trom your hom.
state, Elaine Ston., of·~.rican Aviation in Nov· York, who has gone
to extraordinary .tfort. to cov.r h.r ..ploy••• at v.ry high co.t.
I'd like to a.k h.r to .xplain h.r .ituation and vhat the
cons.quences have b.an.
Q
Fir.t I would like to thank you, Mr. Pr••id.nt, for
putting the h.alth car. i ••u. right on the front burn.r of the
national agenda and k••ping it th.r., d••pit. the h.at.
w. are a ...11 bu.in.... w xport over••a. aircratt
••
hardware, .mall part. and compon.nt.. w. w.r. a tairly sub.tantial
sized firm and w. have b.en atf.ct.d not only by h.alth care but by
tho rece•• ion -- th. a.ro.pac. indu.try has b••n ••v.r.ly atfected.
But I fe.l that it i •••••ntial for all p.opl. to have ace••• to
health care coverag••
And in that light, v. have don. vithour incr.a.ing
costs, done evaluation.. We u.ed tob. tully in.ur.d through the
in.uranc. company, and aft.r ch.cking into pret.rr.d, into HMO. and
into other plan., ve decid.d to take what r.ally i. an .normou. risk,
but based on our .xperi.nc. rating at th. timo, w. t.lt it vould save
mon.y, and that va. to go into a s.lt-insur.d plan -- split funding,
vhereby the company would a••um. the ri.k ot$5,OOO in m.dical claims
b.tore the in.urance company kick.d in.
Now,
that i. an .normou. ri.k it you have a gr.at nu.mDer
l.n~y, debilitating illn•••••.
We were lucky in the begiMing, and our pr..iwu d.finit.ly have been
contain.d. But v. don't think in term. ot a pr••ium paym.nt, w.
think in terms of what i. it co.ting u. at the .nd ot the y.ar wh.n
w. count in the claia.. And v. have had ••v.ral illn••••• that have
gone -- fallen ov.r into the in.uranc. company, and, fortunately,
they have b.en spr.ad out ov.r the pa.t f.v. y.ar•.
ot p.ople coming down vith ••riou.,
How.v.r, ve are ·tacing new incr.a••• in Blu. Cross and
in our premiums, and v. have to evaluate again vh.th.r w. can .till
attord the plan ve have. I vould b. the la.t on., or I t ••l my
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company would be the last one to take a move of reducing the benefits
that we have. As it happens, our deductible is very low.
Congressman, you mentioned tiqures. We only have a $100
per individual, and $300 per tamily, which in today's marketplace ~s
very good, and we could not replace. We also undertake the 80-20
option, and in todayls marketplace, i t we were to change our plan, we
couldn't -- I mean to other than a Clinton-type plan, health care
plan -- we couldn't do it.
So that I teel that we must, we must continue to try to
reduce -- or to produce a health care plan that all, all people can
attord: that employers -- I also teel it should b. don. through the
workplace because it's something that we are us.d to. Most ot us,
trom the day we started working, have b••n covered through the
workplace. It's what we're us.d to. That would be the least
dramatic Change it th.r. are oth.r chang•• , and I strongly t ••l that
w •hould have univ.r.al h.alth car. op.rating via the workplac. tor
•
ev.ryone.
And, again, w. are v.ry grat.tul that you are taking
this issue to heart. (Applaus•. )
THE
PRESICENT:
Thank you very much.
Let m •ay b.cause ot the uniqu., .ort ot, se.i-selt
•
in.ur.d .y.t•• that Elain. ha., and b.cau•••h.'. had .0• •
signiticant illn••••• in h.r work torc., ah. would actually, at l.aat
baa.d on the last y.ar or two' • •xp.ri.nce, pay con.id.rably le.s
than ah. ia paying b.cau•• ot the ••It in.uranc• •ch•••• kick.d in.
It's works, again, like .verything .1•• -- it .ay work very w.ll tor
large ••ployers, but tor .o••on. with a couple ot doz.n ••ploy••s, it
a vary high-risk atrategy that can work r.al w.ll until it do••n't
anymore.
, I'd like to now talk about p.opl. who are kind ot the
other side ot that .quation -- p.opl. who like to cover all th.ir
employees but can't, and th.retor., only cover a portion ot the., or
have had to give up cov.rage. And I'd like to b.gin with Judith
Wicks who own. the Whit. Cog cat. in Philad.lphia. Becaus., a. I'm
sure allot you know, the p.opl. in the re.taurant busin••• have been
among those .o.t conc.rned about this h.alth care plan b.cau•• there
are BO many people whO work tor r ••taurant. and d.li. and oth.r
.ating establishm.nts who are young, who are .ingl., who don't have
health insurance, and who are still willing workqrs th.r.. But th.re
are an awtul lot ot p.opl. whO want to cov.r tolka.
f
And the pr.s. will r •••mb.r, w. w.re in a .stablishment
in Columbus, Ohio, just a coupl. ot w••ka ago, wh.r. by accident -
w. didn't plan to go th.r. tor h.alth car., but wh.r. w. had a whole
health care seminar b.cau•• only halt the .mploye•• w.r. covered, and
the p.rson cov.ring th•• want.d to cov.r th••. all.
situation?
So, Judith, Why don't you talk a little bit about your
Q
Thank you, Mr. Pr•• id.nt, tor giving •• this
opportunity. I'v. b••n a little .urpri••d at the reaction trom the
restaurant community again.t the health car. retorm plan b.cause I'm
very much in tavor ot it. Th. Whit. Dog cat. i. a v.ry labor
int.nsiv. re.taurant. W. al.o have a little .hop n.xt door called
the Black Cat, and that'. our logo ov.r th.r.. (Laught.r.) And.we
buy directly fro. local tarm.r., so w. have a lot ot p.opl. in the
kitchen picking little l.av•• ott tr••h h.rb., and .aking our own
desserts and our own ic. crea••.
that's the
So we employ 96 peopl., consid.ring part-ti•• p.ople
ot 75 tull-tim• •mploy.... W. cannot attord to
equ~valent
MOR.!:
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8
provide health insurance for all those employees. It would be
impossible for us to do so. We do provide health insurance for
around 15 employees.
The thing that really exc,ites me about the health care
plan is that under that plan we would b. able to provide for all of
our employees without that much of an increa.e. My health care costs
would double, but I am very happy about that because if you look at
the whole picture, we would only have to rai•• our pric•• no more
than around two percent to make up that ditterence b.cau.e of the cap
that this program put. on the p.rc.ntage ot payroll that w. would
have to pay that prot.ct. bu.ine•••••uch asr••taurant. that are
very labor-intensiv., that hire
many peopl., esp.cially entry
level positions.
.0
So the way I tigur. it, it all the re.taurants together
raise th.ir pric•• about two p~rc.nt, w.'r. not an indu.try that's
going to 10•• our custom.r. to'M.xico. (Laught.r.) So I think this
is a grand opportunity. I think the r.mtaurant bu. in••• in g.n.ral
is on. that's b.en und.rvalu.d<by our .conomy. I think that we don't
really now charg. the g.n.ral population what it ~.ally co.ts to run
a restaurant, which should includ. cov.ring h.alth in.uranc. for
every worker. I don't s.. whyl; h.alth in.uranc. is not available to
restaurant workers wh.r. it is'availabl. to mo.t oth.r industries.
So this is a gr.atchanc. tor the r.staurant industry to
really be in comp.tition with oth.r.. So I thank the Pr•• id.nt tor
coming up with thi.. I think it'. a qr.at id.a. (Applaus•• )
CONGRESSMAN LAFALCE: I!d like to just int.rj.ct a tsw
comm.nt.. What you had to .ay" Judy, was au.ic to ay .ars. It .hows
that you're .ocially con.ciou. in addition to being .conomically
consciou••
I think the two chi.t oppon.nt. to h.alth car. r.torm
tor the buSin••• co.-unity ha~e been the N7IB and the National
Restaurant A••ociation. We were able to talk quit. r.a.onably for a
while with the National A••ociation of Manufacturer., the Unit.d
States Chamber ot Commerce, et cetera. I a.an, they chang.d their
rhetoric totally -- th.y talked about shar.d re.pon.ibility of all,
including all employer.. And th.n wh.n pu.h cam. to .hov., they had
their own political con.ideration. dealing with other bu.ine••
associationa, there was .Om. backtracking.
i
But I have the greate.t re.p.ct tor the NFIB, but you
have to und.r.tand, th.y not only oppo••d an incr.a.e in minimum
wage, they oppO••d the concept ot a minimua wag.. Th.y'd like to see
the minimum wage r.p.al.d. And when it co••• to the National
Restaurant As.ociation, again I have nothing but the highest r.gard
tor th.m. But the tact ot the matt.r i., i. that what thi. law would
do is put all r ••taurants in the Unit.d Stat.. in the ....
competitive po.ition. And right now the good guy. are di.advantaged.
The good guys are trying so hard, a. you are doing, to provide tor as
many ot your employ••• a. you can. Oth.r. are not a• •ocially
conscious.
And a r.staurant,' "ould only be co.p.ting against another
re.taurant on .qual tera.. A::Ll r ••taurant. would have to provide the
exact sam. b.n.tit.: there would b. no di.advantag.. And with thia
cap on what you'd have to pay, mo.t r ••taurant., I b.liev., would
wind up paying 1••• or not mUch aore. And the incr•••• that those
would exp.ri.nc. who do get an incr•••• would be con.id.rably less
than a cost of living increa~. in the ainiaua wag. would b., and we
haven't witnessed that tor about thr•• y••r. now.
that?
THE PRESICENT:Co you think h. t ••l. strongly about
(Laughter.) Thank you.
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MR. BOWLES: Mr. President, we also have another
restauranteur here -- who runs the Burrito Brothers chain here.
They're three Mexican tast tood restaurants. tric'~ also experienced
some ot these same problems that small businesses tace in trying to
provide health care coverage. And, Eric, you might want to comment
on how you would react it it was a level playing tield and' you could
provide reasonable coverage at reasonable cost.
a First let me say that, what ~udy said
notwithstanding. I hope jobs are lost to Mexican tood. (Laughter.)
THE PRESIDENT: well. it I'm s.tting the pace, you've
got a good chance ot achieving that obj.ctive. (Laughter.)
a I should tirstmention that the r.staurant industry
has very small protit margin•. ' It mak•• it very ditticult tor us to
attord to insure our employees ,tully. W. d••perat.ly want to do that
because it's good torbusin••s and b.caus. it's the right thing to
do. currently, w. ott.r in.uranc. to our employ••• , but w. can only
attord to pay about SO percent ,ot the premium.. That mean. that most
ot th.m can't attord to go on the plan at all. Only about a third ot
our employees are insured at this point.
We want our employees to b. insur.d and the reason they
say it'. good tor bu.in••• i. that .mploy••• who are on health care
and have health car. in.uranc. ,mi•• t.v.r day. ot work, they are more
productive when th.y are at work, and al.o, it theirtamilies are'
insur.d, that's .v.n mora .0 tq. ca... Th.y ai•• t.w.r day. ot work
and they are more productiv. wh.n th.y are at work b.cau•• th.y are
not Worrying about tamily m.mber. who can't g.t tr.atm.nt.
I would ju.t add that the i ••u. ot rh.toric versus
employm.nt. I can a••ur. you ihat th.r.'. not going to b. a single
job lo.t i t the in.uranc. planrthat you are propo.ing go.s into
ettect. Th. tact is w. will pay mor.. And w.'r. willing to do that
because we want our .mploye•• insur.d. But und.r the plan you're
proposing, we'd still be paying halt ot what it would cost right now
to tully insure our employees.
THE PRESIDENT: Thank you. I just want to .ay that Eric
and ~udy represent an interest:~ng thing that w. have se.n basically
around the country with peopl.' who r.ally are trying to do the right
thing by th.ir employee.. I t ,you are in the r ••taurant business and
you insure part ot your employee., you are in the worst ot all
worlds. You're still at a competitive disadvantage to people who
don't in.ure anybody, and you ,te.l t.rribl. that you can't insure
everybody. That'. ba.ically ~~at th.y tac••
f
MR. BOWLES: Mr. President, untortunately, 80m. ot the
small businesses in this country have .xp.ri.nced such absolutely
skyrock.ting cost. and the cost ot h.alth care .xp.riencing these 20
to SO percent annual ris•• inllhealth car., that th.y simply just no
longer can attord it. Garth Sheritt is here trom Lo. Angeles. I
know h. has had to drop hi. cov.rag. a coupl. ot y.ar. ago when the
cost ju.t w.nt .0 high you couldn't attord it.
a On. point betore -- in the tood indu.try, chances
are your av.rage wag. p.r employe. i. going to b. about $12,000 or
lower. - And you would quality, tor the maximum sub.idy. So you would
prObably have a cap ot around'3.S perc.nt ot payroll, and that is an
unbelieVable bargain and prObably les.than you are paying now it you
are covering even a third ot your .mploy•••.
a I'm an architect in Los Angele., and I've had my
business tor 19 year.. And, Mr. President, tor 16 ot those 19 years,
! cover.d o!very on. ot my employe.s and th.ir .pou••• 100 percent
~rough thick and thin.
The ia.t three y.ar. a. the r.ce•• ion took
over 1.n Los Angeles, costs av~raged 30 p.rc.nt intlation p.r year
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"
until at the end ot that, my payroll percentage exceeded 13 percent
as my employees went from l2 to;6 and threatened to go lower in the
depths of the recession. And in 1991 I was faced with the following
choice: do I drop one more employee or health insurance? 00 I let
one family stay employed and have food on their table or do I provide
health care tor the other five.
So I kept my employee, and I dropped health insurance.
And it hurt me de.ply because I 'think that's a responsibility in this
country and I deeply am appreciative the .upport you've .howed small
business because we provide much ot the engine that drives job
creation in this country.
"
But we have a preexisting condition. It'. a silent
preexisting condition. It's not talked about in the media, and it's
seldom talked about in the corridors ot power. And lilY friend. here
trom the American In.titute ot Architect. and Architect., De.igners,
Planners for Social Re.pon.ibil~ty can tell you that it'. age~ We
have exactly the high technical, high-skilled kind ot po.ition. that
you, Pre.ident Clinton"and tha'Vice Pre.ident have talked about are
so critical for the 2l.t century, but with it co.es experience and
age and the technical skills to', do a job 11ke rebuilding after the
LoS Angeles earthquake or after, Hurricane Andrew in Florida.
The average age ot:my .taft over the years ha. been
between 3S and 60 -- the range :of my'.tatt -- and the average is over
40. The actuarial table. are like a la.er be. . in the in.urance
industry. They show no mercy, and when it got to over 13 percent ot
my payroll, I had no choice.
I would be delighted to have the Clinton health care
plan in eftect. It would cap lily co.t. at 7.9 percent. And 7.9
percent i. not the fiqure I think ot. Like Judy, I would like to
talk about a new figure, and it',. lilY two cent. worth, becau•• mo.t
service profe•• ional.' .alary i. one-third of their gro•• receipts.
And one third of 7.9 percent i~ really two percent of gr~s. and a
little bit more.
:1
So this i . lily two :'cent. worth in endor.ing the Clinton
health security act, and my group feel. the .ame way. We are 3,000
businesspeople strong, and la.t night the board of director. voted to
unanimously endor.e the Clinton health act. (Applau.e.)
.
THE PRESIDENT:
"
T~ank you.
Thank you very much.
I
I'd like to, tir.t of all, thank you and thank your
group and thank you for .haring your paintul experience with us. ,I'd
like to go on and .ort ot pur.ue this theme a little more and call on
Brian McCarthy, who own. the McCarthy Flower., a large florist in
Scranton, and a.k him to tell us a little about hi• • ituation.
Brian.
Q
Thank you, Mr. Pre.ident. I thank you for the
opportunity to be here today. The floral bu.ine•• attracts a great
number ot un.killed worker. in our econolllY, and our particular
metropolitan area where I hail': trom in the Scranton-Wllke.-Barre,
Pennsylvania, market, ju.t on la March 11th .urvey on USA Today,
ranked-tourth highe.t in the h'ighe.t percentage of un.killed workers
in the United State., behind cities that you might under.tand like
Miami and aome other more -- cities that attract more immigrants •.
The problem i. that it the tloral bu.ine.. is to truly
attract people and take them from the weltare roll., e.pecially those
that are un.killed, we have to be able to not .care people into
thinking they're going to be ible to lo.e benefit. to leave the
welfare rolls. That'. been a ,.ignificant problem for u.. We have
families where the head. ot thehou.ehold want to co.e to work for
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us. They have three or four l~vely children, and their problem that
they're constantly facinq is, ~Brian. I can't come to work for you
unless I can have full coveraqe for my children." And, of course, as
many of the other panelists have addressed here today, some of the
problems they are facinq are p:reexistinq conditions which make
matters even worse.
And i t we're truly qoinq to be a source ot job qrowth in
the future, i t the small busil'!ess sector truly is tilled with
talented people like I believe we have in this rOOm today -- and as
they say, if small bu.inesses lare just waitinq to be larqe buslnesses
with qreat idea. -- we bave to be able to qet the.e people to leave
the welfare rolls and come with us.
The other problem that see~ to be a siqnificant one tor
ours -- our company'ha. been in a qreat, qreat qrowth position in the
ratail flower businese -- we, too, have recoqnized the value of
becominq biqqer to qet better'buyinq power. The same principle that
President Clinton's plan is advocatinq today. He's sayinq let's bond
toqether and make small businesses one qroup to be able to qo out and
use 80me muscle in order to be able to employ better buyinq power in
the marketplace.
.
One of the problem. that we face i. that in order for us
to qrow as we've been qrowinq,-- we've qrovn 500 percent, our
company, over the last .even year. in particular -- if we're qoinq to
continue to qrow we have to att:act al.o talented people. And
there's a lot of dovnsizinq in this company, a. you know, so there's
a qreat deal of manaqement people, very, very skilled, seasoned
manaqer. out there, who we can very clo.ely .eet the .alarie. which
they lett in tho.e previous p'0.ition.. The qreatest problem
continues to be the health Caire issue. Once we finally sit dovn, we
match the dollar for dollar, -it COmes dovn to, well, in my last job
we were all covered -- we had: dental, we had eye qla•• , we had
prescription -- my.elf, my family. We can't do that.
First of all, w~ can't discriminate aqainst the rest of
our staff to otfer it 5inqly to one. And next, it would be
absolutely co.t-prohibitive for us to try to do that. So a company
like ours that's poised for qrowth -- McCarthy Flower. is poised tor
qrowth into the next century-- i t we're poi.ed for that type ot
qrowth, I think we nsed to be able to let that health care issue not
be a wall between my.elf and some very, very talented people. And as
I said earlier, I don't want',it to be a wall between those unskilled
workers who are dyinq to qet, into the marketplace and make themselves
skilled workers.
,
So I stronqly endorse this particular health care
security act. In fact, I think the stronqest word of the health
security act ia the word sec~rity. Thank you. (Applause.)
THE PRESIDENT: : Thank you very much. I just want to
emphasize one comment Brian made, and if I miqht, qo back to what our
restauranteurs also .aid there. One of the arquments that the
Restaurant A.sociation make. aqainat our doinq this i. they say,
well, we have a lot of younq sinqle worker. that are healthy, they're
strappinq. They don't want insurance, or if they do have it, they
ouqht to be Lble to qet i~ ~uch more cheaply than older workers.
Because younq s1nqle worker. will pay hiqher per person
premiums under our plan. That'. what community ratinq is all about.
If you put people in larqe pools with older people, and with families
with a lot of kids and the ~ids have been sick, you averaqe it out.
So they will pay a modeatlyqreater amount, and therefore, the
employer contribution tor them will be modestly qreater.
I'd like to make two arqument. in respon.e to that. One
is one Brian made. A lot ot the younq .inqle people we want to be
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workers in this country are on welfare. They all have health
insurance for themselves or their children through the Medicaid
program. which is as generous!as most health insurance programs. And
ye~. we want them to move from welfare to work and take jobs in our
small bUsinesses and give up health insurance for their children so
they can then s~art paying taxes to pay for the health care of people
who made the other decision to stay on welfare.
I mean, it'8 just a -- we cannot reform this welfare
system unles8 w. fix this problem. So th.r. are a lot of young
single potential workers out th.re w. cannot even get in the
workplace unle.. w. deal with;:this.
The second point!: that I'd like to make is that the
fastest growing group of people in AlIIerica are older AlII.ricans. And
people are going to working later and later and later in their lives.
Indeed, the gradual phase-up of the Social Security retir.m.nt age
start. in a coupl. ot years as a re.ult ot the Social s.curity Reform
Act of 1983, rai.ing retir.ment age by a month a year over several
years to go up to 67. And if., you don't want disc:rimination, if we
ne.d older people, it we know" th.y're very good employee. and they're
very reliable, and you don't want di.crimination against them in the
workplace, one sure way to avoid it is to make sure that their health
insurance premium. are not discriminatory.
i
I . . . a lot of older people who work in eating
establishment8, too. So thi. thing, I think, will balance out and it
ultimately fair. I ••p.cially thank Brian tor hi• •tatem.nt because
h. doe. cover all hi. employe•• today. And it ahow. you, I think he
really is thinkinq towards the tuture.
ADMINISTRATOR BOWLES: Mr. Pre.id.nt, we al.o have here
Chris Maa., who has experienc.d .ome ot th. . . . . . . probl... ot trying
to comp.te for labor with ab.olutely .kyrock.tinq co.t. in health
care.
j'
Chri., do you want to talk about it a ••cond?
Q
W.'r. a ••all comput.r con.ultinq tirm h.r. in
washington. W. do .o.t ot our work with Wa.hinqton area lawyers, and
we need prote••ional help. And the one competitive advantaqe that we
have as a little firm -- (laughter.)
THE PRESIDENT: !Ev.ryone ot you has a one-liner tor
that, don't youi (Laught.r.)
Q
W. need profes.ional help. (Lauqhter.) One of the
things that we tound-- I que•• you were .entioning, talking about
the older people -- and my tour partner. and I, w. need to be nimble.
We need to be able to hire people and g.t people and put them to work
tor us. That's our competitive strength. That,.'our only one, in
tact.
A ...11 ex_ple" we set out to hire a r.c.ptionist a
year or.o aqo, and we .et a l 60 year old .al. that we liked. We
spent 15 minute. intervi.wing him, decided we liked hi. and wanted to
hire him: and then w• •pent 'about tour hour. tiqurinq out how to get
him covered with the health ,care plan so it didn't me•• up the re.t
ot us. That's not riqht. And it ju.t .houldn't work that way. We
tound that our premiums were qoing to qo through the root. We still
hired him anyway, and we lov~ old Bob, but that'. qot to .top.
I
On the other end ot the .pectl"'Wl, we're pa•• inq up
bu.ine•• b.cau.e w. want to 'grow and there'. people we want to hire
and we can't hire them. W. :know a per.on in particular we'd love to
hire who's qot a couple of kids: and th.y've qot .ome conqenital
b.irth defects. We cannot t~'lk to this per.on b.cau.e we understand
that it's qOing to de.troy our ability to have h.alth care tor the
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whole company. And that's not right. That's hurting us and it's
hurting our business. And this stuff has got to stop.
'......
Our partners are allover the lot politically. Some of
them didn't even vote for you,iHr.President. (Laughter.) And we
don't see this as a political issue. We see this as a business
issue. And I don't care about this from a political standpoint. I
care about getting my business to run. And the quicker, in my mind,
that you can get this stuff through the political process and get it
back to business where it belongs, and w. can get on with our life,
and we get health car. off the table as an imp.dim.nt to my ability
to do busines., ·the happier I'm going to be and the happier our
bu.ines. is going to b.. (Applause.)
<
THE PRESIDENT: Good for you. S.lieve you m., nothing
would make m. happier than to 'do exactly what you've .aid. It should
not be a partisan political is.u.. And if you get b.yond the fog of
rh.toric to the hard facts of what p.opl.'s actual individual
circumstance. ar., it'. v.ry much .a.i.r for it not to b. a poli~ical
is.ue. Thank you v.ry much. That was v.ry impr.s.ive.
I want to talk a little bit by giving th••• folk. a
chance to talk about how w. g~v. small bus in••• p.opl. th.ability to
have comp.titiv. pric•• in the insuranc. mark.t.
Q
Thank you, Mr. Pr•• id.nt. And I'd like to .tart
out by .aying that having b••n in bu. in••• for about 37 y.ar., I':.
stood on a coupl. ot .hould.r., and I'd like to acknowledge and .ay
h.llo to you from my par.nt. <~- which I . . a ••cond g.n.ration
bu.in••••
W. start.d, and:a. a child, I gr.w up watching
••ploy.... W. w.r. not alway. in the ••dical ti.ld, w. w.r. not
alway. a durable m.dical equip••nt company, w. w.r. in the janitorial
business wh.n w •tart.d out. And w. gr.w into that bu.in••• to
•
wh.re at someti•• w. had up to lSO ••ploy.... On. hundred p.rcent of
them w.re not in.ur.d. Probably mo.t of th.m were te.t.r-tott.ring
between staying on welfare and working 20 -- 1••• than 40 hours per
week.
,
It wa.n't until: about, I want to .ay about 10 year. ago,
that we start.d d.v.loping our company to the d.gr•• that w. w.re
able to provide h.alth in.uranc. and at that point in tim. is when we
start.d to s.. a chang. in the type of p.opl. that w. w.r. able to
attract a. a bu.in.... And until that took plac., until w. were able
to off.r b.n.fit., w. w.re not able to g.t p.ople that would stay.
We w.r. not able to g.t qual:ity p.opl.. And our bu.in••• ju.t b.came
more and more co.petitiv. a.: we w.r. able to provide th••e typ•• of
insurance.
f
,
Now today, out of the 10 full~tim. p.opl. that w. have
that w. provide in.uranc., our in.uranc. i. running us ov.r 14
p.rcent of our payroll. And in addition to that, work.r.' comp is
about 4.S p.rc.nt, but that could b. a. high a•••v.n perc.nt in our
.tat•• And I know how hard: it i. for m. to ••et that in.uranc.
premium .very month, that i t w. had the opportunity to k••p tho••
employ.e. and provide thea the numb.r on. d.t.rr.nt right now being
h.alth in.uranc. -- and I can't .ay .nough that w.ltar. r.form and
h.alth insurance i • • 0 tiedtog.ther wh.n you look at part-tim.
p.opl. being able to leave one thing and go to the other -- I r.ally
f •• l that w.·ar. going to b. able to be aor. competitive becau•••y
couts are going to r.duc. und.r thi.h.alth car. plan. And I ••• it.
And at the .... time, .I . . going to b. able to giv. b.tt.r cov.rage
to cov.rage to my .mploy•••, and be able to attract b.tt.r .mployees.
And I really applaud you for looking at the big picture
·and not just being narrow ahd ju.t ke.ping on .urfac. thing. that
really don't make a diff.r.nce in p.ople'. like my.elt'. liv•• and my
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14 -
community, the African American; community, the people that I see that
are dOing without health insurance allover this country.
Thank you.
THE
(Applause.)
PRESIDENT:
I"d like to now to go to a smal·l family
business.
Q
Thank you, Pr.sident Clinton, and it'. good to be
h.r. in Wa.hington, D.C. today.
There have be.n so many important thing. said this
morning and what I would qu••• :all ot u. up h.r. ar. doing are being
.ponges. We're kind ot soakinq in all this intormation, th•••
comments trom all the various participant. and I r.ally am amazed
that ther.'s two tlorists her.; the v.ry big and the v.ry small.
Brian and I just m.t this morning, and h. has an out.tanding business
and was able to do 80mething we're not and that'. ott.r health care
insurance tor .mploy.... At on. tim. w. did. At the tim. w. had to
drop our benetit tor our employe•• -- w. have leGs than 10 .mployees
-- it waa approximately 20 percent ot payroll. Obviously, w.
couldn't compete in the tlow.r'market at that rat•.
Th. Small Bu.ine.. Admini.tration has b••n v.ry
proactive in the h.alth car. debate. And I think, trom our
viewpoint, what w•••• a. a ma••iv• •ducation probl. . to really
intorm and educate .mall bu.in••• p.opl. b.cau•• , a. I g.t out and.
visit with other p.opl., I u•• the Small au.in••• Adaini.tration torm
that was develop.d tor Congr••• , and wh.n p.opl. can .it down and
crunch their own numb.rs -- moat .mall bu.in••••• are like our.,
there are maybe 8 or 10 .mploy••• -- th.y will tind, I am sur., what
w. tound, that our tamily in.uranc. policy right nov i. 1••• than
$400 per month. w. could in.ur. allot our taaili•• with the Clinton
plan -- all tamili•• in our bu.in••• for 1••• than $400 a month with
the cap and b.cau.. ot the low.r incom. and the .mall.r number ot
employees.
So I would encourage p.ople who have que.tion. to
contact an SBA ottic., to contact th.ir congr•••ional offic. and to
work the number. because I really t ••l that when they work the
numbera they will ••e that this is a win-win .ituation tor amall
business.
r
B.yond that, what we p.r.onally appreciate and why we
have work.d
hard i. the Clinton r.torm legi.lation will do away
with litetim. maximum b.n.tit.. And w. happ.n to b. a faaily who has
a child with a lifetim. illn••• , and w. can actually anticipate the
point wh.r. w. will m.et our llifetim. maximUll b.n.fit and our child
will not be an adult at that tim.. So this i • •om.thing that is ot
gr.at concern to all famili... It your tinancial future i.
threaten.d b.cau•• ot the way :you are tr.at.d in the h.alth care
sy.tem, you will really b. wanting to ••• thi.pi.c. of l.gi.lation
pa•••d.
.
.0
Ther.'. two kind. of p.opl., I figur.d out, that don't
want to chang.. And tho•• are people who have .om.on• •1•• paying
the whole bill tor them, and p.opl. who have n.ver b••n .ick.
Oth.rw ise, pr.tty much acro•• I;th. board, p.opl. want chang•.
(Applau••. )
,
.
Y
••
THE PRESIDENT:
t.rday wh.n I Was in Miami, I m.t, as
I otten do When I'm trav.lingaround the country, with .om. childr.n
and t:he1r t'am111e. t'rom th••• lfak.-A-Wi.h program., wh.r. the kids
are desperately ill and one ot the thing. th.y want to do is meet the
President. And I m.t with a tamily, a v.ry impre•• iv. family ot
three children -- two sons and a daughter -- wh.r. both .on. had a
~ery rare and apparently g.n.~ically-tran.mitt.d prop.n.ity to have a
very rare form of canc.r. And this tamily has a lifetime limit on
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�'- 15
their policy, as three out of four Americans do.
Americans have lifetime limits~
Three out of four
And they're in a real pickle. Secause they are going to
run up against the limit long before the second child -- assuming
that both the boys survive, an~ they've done pretty well so tar, but
it they do both survive their illness and they're plugglng along -
then they'll run up against th.ir limit long before the second child
is out ot the hous.. And th.n'th.y have a third youngest child and,
thank goodne.s, the child .0 tar has not contract.d the disease, and
ot cours., they hop. sh. won't:. But if she do•• , th.n you can just
double whatev.r th.ir problem ts.
Again, I would .ay -- I want to empha.ize, though, the
only way this works with the private health insuranc. bu.in.s. is
that you have to tind a way not to bankrupt private h.alth in.urance.
And a lot ot th••• thing. -- I,,'v. had a lot ot employ.r. -- I had a
r ••taurant own.r I m.ntion.d in Columbu., Ohio, who wa. v.ry
complim.ntary ot h.r p.r.onal h.alth in.urer.. She .aid, th•••
p.opl. are doing the b.st th.y· can tor m. und.r the circum.tance.
giv.n the way th.ir bu.in•••. i . organiz.d and the way the mark.t ia
organiz.d. That'. why you have to r.organize the mark.t and put
p.ople into larg.r unit. and in.ur. p.ople on a community ba.ia.
On. ot the mo.t controv.r.ial thingo -- I ju.t want to
m.ntion thi. -- on. ot the m08t controv.r.ial asp.ct. ot our plan has
b••n the provi.ion tor ...11 and m.diua-.iz.d buain..... to b. in
th.s. big buying allianc... P.opl. have tr••t.d it a. it it w.re
some big n.w gov.rnment bur.a~cracy.
I have .een it, quit.th. contrary, a. a way ot
entorcing community rating. That i., you can -- th.r. are .om.
states -- New York Stat. has a lav mandating community rating. But
it you don't have the .yst. . within which the little quy. can buy
together, the law it••lt won't querant•• co.-unity rating.
,
And y••t.rday --;1 ju.t want to r.ad you aomething -
yesterday in Th. Lo. Ang.l•• Tim.s, th.r. i. this articl., "State
Allianc. Giv.s Work.r. H.alth" Clout. Forty thou••nd work.rs at small
California bu.in••••• will g.t an .xtraordinary pi.c. ot good news on
Tuesday" -- that'. today. "At a tim. wh.n h.alth in.urance costs in
the country are cli.m.blng at s'1x to .ight p.rc.nt a year, their
premiums will actually be r.duced, .tarting July l.t. Th•••
tortunat. t.w are maabar. ot the .tate'. unh.ralded health alliance,
a purchasing agency that give. compani•• with between tiv. and 50
workers an opportunity to band tog.ther to achieve the .... buying
clout the h.alth car. mark.t ~iv•• to giant corporation••
f
,
"!'V.n a. Pr•• ident Clinton'. propooal tor allianc•• is
being denounc.d in Wa.hinqton' a. a blu.print tor a m.nacing new
bureaucracy, a .tatt ot ju.t :,13 .tat. work.r. in Sacr...nto has put
together a working allianc., the fir.t in the nation, and the
customer. . . . . d.light.d."
,:
.
~d in Florida th.y'v. got now buying pool. ot .mall
bu.in••••s -- Congr.....n Gibbon. i. h.r.. And the Gov.rnor told me
la.t night that mo.t ...11 bu. in••••• had .xp.ri.nc.d -- that join.d
th... allianc.. -- had .xp.ri.nc.d d.clin.. in pr••ium co.t. ot
b.tw••n f i v. and 40 p.rc.nt. "
So I ••y this not to b. coabativ.,but ju.t to a.k tht.
A. thi. bill mov•• through the Congr••• , it th.y don't
like the way we reructur.d the allianc•• , you've got to tind .ome
ways to give the little quy. :'big buying pow.r.
qu•• tion:
'.
,
MR. BOWLES: Kr~ Pr•• id.nt, all th••• buying groups do
-- and I wi.h to goodn••• w.,id call.d th. . buying group. in.t.ad of
alliance., but all the•• buying group. do -MOllE
,
�-' 16
THE PRESIDENT: I do, too.
"'ATO an alliance. (Laughter.)
They liked it when we called
MR. BOWLES: -- is, truly, they shift the pow.r of the
marketplace. They change that s~pply and demand equation from
favoring the suppli.r of health car. to favoring us, the consumer and
the small business owner. It'. just id.ntical to what Mr. McCarthy
was here saying about what happen. in the tlow.r busin.s.. It gives
u., the .mall bu.in••• own.r, .om. mark.t mu.cl• •0 that w. can cut a
good d.al for our employ.... That's what it do•••
a Could I a.k a lqu••tion? On. of the big arqum.nts
that I have h.ard in talking to .oth.r bu.in..... i. that .v.rybody is
conc.rn.d about the quality of ~.alth car., what'. going to happen.
Th.y·re afraid -- right now th.y, may have choic•• , th.y have c.rtain
choic•• , and that'. sort of the unknown out th.r.. What is the -
how is the quality of h.alth care going to chang••
THE PRESIDENT: I think th.r. are two conc.rns about the
quality of h.alth car. that I'v. h.ard. On. i., are you gOing to cut
down on how much you .p.nd on health car. so much that th.r. won't be
enough for m.dical res.arch, tor t.chnology, tor thing. to progress?
The other is, if you d.priv. people of choices, i.n't that a back
door way of und.rmining quality?,
all lik.
quality.
don't do
her. and
chOice.
you will
I m.an, p.opl. -- in Am.rica I think people .quat. -- we
to make our own d.ci.ion•• So p.opl• •quat. choic.with
To that I would r ••pond in two way.: Numb.r one, if you
anything, if w. ju.t l.t this alon., if w. walk away from
don't do anything, you!will ••• druatic r.duction. in
And many of you in thi. room will contribut. to that b.cause
have no choic••
That'. what happenid to our fri.nd fro. N.w Hupshire
here. She wished to give h.r ."ploy••• the choic. b.twe.n being in
the HMO or insuring with f ••-for-••rvic. m.dicin. through Blue Cross.
Now she has only the HMO option.. She i. now in the majority of
employer. in Am.rica who cov.r th.ir .mploy.... NOW, a .light
majority do•• not provide any choic. for the employ•• but, in fact,
makes the choic. for the employ•• b.cau•• th.y have no choic.. You
know., on. of our pan.li.t. h.r.,; if h. w.r. able to g.t back into the
health insuranc. mark.t, would have -- probably would have to ju.t
make the be.t d.al h. could andth. employ••s would have to take it
or leave it.
'
So on th. qu••tion'; of quality in t.rms of choice, under
our plan, again b.cau•• of marketing pow.r, w. would give your
obligation aa an .mploy.r would b. conatant. You would pay the same
no matter what. But your .mploy••••v.ry y.ar, b.cau•• of the
cooperative buying pow.r, would b. able to choo•• from uong at l.a.t
three program..
'
And w•••timat. that in mo.t plac•• th.y would alway.
have acc.a. to an HMO. And a. ,I said, many of thea are v.ry good,
but they'll b. b.tt.r if th.y have comp.titiv. pre••ur.. Th.n,
probably there would b. a PPO -,- that i. a prof••uional qroup wh.r.
doctor. get tog.th.r and th.y organize h.alth care d.liv.ry, and
normally tho•• have many more doctor. and .o••ti••• l.t p.opl. in who
are willing to provide the s.~ic. for an approv.d pric., .0 you g.t
.v.n more choice -- andth. f ••-for-••rvic•••dicin.. And that would
com. up .v.ry y.ar. So that' • •y an.w.r.
And the .econd thing is, i t you 'do nothing, you will
continue to see a .qu••z. on the quality of m.dicin. in t.rm. of what
goes into the teaching ho.pital. and m.dical r •••arch. Why do I say
that? I was in Boston laat w••k, and I m.t with the h.ad. of all the
teaching hospitalsaft.r which they c.... out and .ndor.ed our plan.
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And they said -- every one of the~ said, if we don't do anything,
we're going to get less and less money because the people who come
into our hospitals are increasingly in manaJ;ed care plans where they
put the squeeze on us and they cU,t down on the money' we get tor
patient care. So under our plan" we increase medical research, we
increase support tor teaching hOS,pitals, and that's what we have to
do.
So, my arqum.nt is quality will sutter it w. do nothing.
Choic. will be restrict.d if we do nothing. It w. mov., we can
increase quality and choice in a tair and balanced way.
I know w. got to wrap up. W. have on. more p.rson to
h.ar trom, and the Congr••sman w~nts to make a comm.nt.
CONGRESSMAN LAFALCE: I ju.t want to add to what ,you
said, Mr. Pr.sid.nt, about the quality ot car.. Not only would you
have tar more choic. und.r the Pr••id.nt ' • propo.al, but I think you
would have much b.tt.r quality car.. I don't thing w. have a h.alth
care system right now, I think we have a .ick car• •y.t.m. OUr
primary d.fici.ncy, it •••m. to me, is w. don't have primary car••
We don't have pr.v.ntiv. m.dicine. And the .mpha.i. of the
President's proposal is on preventive m.dicine.
It you look to the .tat. of Havaii, Which about 20
years ago, mandat.d the h.alth car. b.n.tit. for all ••ploy••• ,
you'll s•• that bu.in••••• tlouri.h.d in Havaii. You'll al.o •••
that h.alth outcom•• flouri.h.d, too. By virtually any h.alth
statistic you could point to, Havaii i. doing b.tt.r than mo.t any
oth.r atat.. Thi. i. not b.cau•• of the cliaat. out th.r., too,
b.caus. you could compare Havaii'. climat. to Florida'., to Puerto
Rico's, at c.t.ra, .t c.tera. But vh.n you look to birth .tati.tic.,
w.ight statistic., life .xp.ctanci•• , .t c.t.ra, the preventive care
that they're able to g.t in Havaii b.cau•• of the fact that all
.mploy.rs mu.t provide coverag., for th.ir ••ploye.. has incr.a••d the
quality ot health car. imm.a.urably.
THE PRESICENT: I ':d lik. to hUlll.r that ho•• because a
lot ot people say, vell, Bill, :everybody go•• to Havaii on vacation.
It's a rich .tate. Havaii ha.,a v.ry, v.ry large percentage ot
people in it. h.alth car• •y.t•• VhO are lov incom. p.opl. -- native
islanders, people co•• in from .urrounding i.land.,~- about a 20
percent load th.r., quit. a high load. So the h.alth outcom•• tor
Havaii include a very large numb.r ot p.ople vhO have to be paid for
in traditional W4Y. vhO ar.n't.ven in the ••ploym.nt .y.t••• So you
just can't make that argument. I'. ju.t trying to r.intorc. vhat he
said.
I
Our la.t .peak.r '1. John Sor.n.on, fro. the Weco Supply
Company, in Fr••no, California. H. wrote to, •• about on. ot hi.
employ.es.
And I thought itvould be good to kind ot l.t hi. clo.e
becau•• ot the conc.rn that this e.ployer had for hi. employ.e, and
hoV it atfect.d hi. bu.in•••• ,;
.
Q
Well, tir.t,I'd like to thank you tor inviting me,
and thank you tor caring. I ~a. invited here b.cau•• of an ••ploye.
I have by the na.e ot Randy Walk.r. But betore I talk about him, I
wanted to thank the health ca#. industry and the in.urance industry.
Four years ago ttl. month, w. di.covered my fath.r had a
brain tumor about size of a b~ked potato, and it didn't look good.
In fact, if you've .v.r had anybody in your life like that, you'd
know hov scary that vas. About a month or so atter v. discov.red it,
they p.rform.d the operation"and he's tlne. A year later, they had
to do it allover again, and he va. fine again. In.urance paid tor
all of it, and Or. Brian Claiq in Fre.no was Absolutely a .arvelous
surgeon.
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And with that in mind, when this situation happened with
Randy Walker, I was just angry., And what happened was that, as a
salesman for my company, he was !married, had two children, and one of
the children was born premature+y, and the insurance ~ills were 30
some thousand dollars. And they occurred right at the time where he
had left his previous employer and come to work tor my company, and
he thought he had a 60-day grace period that it was going to pay for
the coverage. It didn't, and w~ all advised him to seek advice. And
it came up that the best solution was to tile bankruptcy.
And two year. atter the second child was born, a third
child came along and we had just started a new in.urance plan. And
the new insurance plan -- because ot the co.t ot insurance, and
becau.e ot the complaints I get every time somebody at my company has
a health problem -- they come t'o me as it I wrote the policy -- I
advise them to .ee the inaurance man. And in this case I said, well,
I'm not going to step in the middle ot this,one -- we're going to
pick it collectively.
'
So the employees picked the insurance plan, and we voted
on it. And I repre.ented just~one ot -- at the time, I think it was
18 votes.
I told them that unless three-tourths ot us agreed to it,
we weren't going to pass it. So the employees were real curious:
they asked a lot ot questions/'they wanted to makG 8ure it would
cover certain situation..
i
Randy didn't have the money to go to the doctor, but
apparently his wite wa. already barely pregnant. And they hadn't
been to the doctor to tind out, although I'm .ure they prob~ly
su.pected it. well, the baby wa. born about tive month. atter the
coveraqe had atarted. The in.urance had taken the pr_iwu. The
in.urance company had .aid, ye., it'. covered. They paid tor, I
believe, some ot the doctor vi'.it.. But vhen the baby va. born
premature by tvo month., it incurred $150,000 in medical bill.; and
he was just deva.tated. He va. tryinq to tocu. on a nev baby that
was barely alive. He va. tryi'nq to tocu. on the re.t ot hi. tamily,
and try to do a job tor me and avoid creditor.. And it made it
virtually impo••ible.
So, ~out a year"aqo at this time, ve tried to qo buy
him a vehicle. And hi. credit wa• • 0 bad that the only vay he could
get one was vith .omebody'. help. And I decided that I prob~ly
stood the bigqe.t chance ot helpinq him ot anybody in hi. lite -- I
wa. his bos.. So we vent out;i to a car dealer.hip to try to buy him a
car with the idea that I would co-.ign on it becau.e .y credit was
okay. We picked it out, and we qot all the niceties out ot the way
at the car dealership; and then they looked at hi. credit report.
And his credit report 8aid ev~rythinq terrible that you could i.aqine
and every .inqle one ot the. was a health care expen.e that he
couldn't beqin to pay. We had told thea that ahead ot ti.e.
I
They treated u. ,like we had AIDS. And I had, never been
treated that way. I've never' been poor. I vent ho.e that niqht and
I was just anqry; I knev I c~uldn't help this guy. I've alway. been
~le to help anybody that I really .et torth to try to help.
So
~out 11 p.m. at night, I .tarted to write a letter to Hillary.
eLauqhtar. I
.
THE PRESIDENT:
(Lauqhter and applau.e.)
I've done that .y.elf a ti.e or two.
Q
It took .ei~out three hour. to write it, and I
the fir.t drat~ ott to 1600 Penn.ylvania Avenue vi~~ a :1p
code, tigurinqI'd probably never hear anythinq. And I va. almost
embarrassed that I'd written it becau.e it .ounded a little corny. I
talked about everythinq I've talked ~out today and then so.e: it was
about three page.. By the t,ime it was done, I tel t that I j u.t had
to at least show Randy that I'd written the letter. I thouqht, at
••ftt
MORE
,
�•
,'- 19
least I wanted to show him I was trying. I figured I couldn't do
much, but I could try. And he:made me a batch of cookies the next
morning, so I guess I tOUChed him.
When I heard tromthe White House and actually heard
that it had been read, I was saddened because he had already quit.
He had been chased by people trying to collect trom him. And they
had attached his wages, and we; had tried to dodge that bullet by
calling him a selt-employed salesman and everything we could think of
to try to retain his income. And he finally couldn't take it, and I
can't say I blame him.
So, when the White Hou.e called, he was off in a place
where no one could tind him, avoiding creditors. And one of the guys
that works for me was still friends with him and did contact him.
And Ron Brown trom the Commerce Department came out and met me about
a month and a half ago. And we got Randy on the phone that evening,
and about 20 minute. betore we had that conference, I got a call trom
Randy's wite. And I thought it was icing on the cake ot this story
-- she said, are you aware that we've .plit up? And I thought that
we did everything possible to try to make this event work. We had
health care coverage. We had,-- we did everything we thought
possible, and it still tailed. And I thought that preexisting
conditions was the whole cau.e.
THE PRESIDENT:
It wa••
Q
And it you can accompli.h that, you've got my vote
tor the next 20 time•• (Laughter.)
THE PRESIDENT: Well, let me tell you what the votes -
the vote. that really matter h.re. Fir.t ot all, l.t·. give him a
hand. I think that was quite a moving -- (applau.e).
I want.d to end with that becau.e I was so moved by the
letter that he wrote to Hillary. And it .eemed to .ort ot capture so
many ot these thing. that we ,talk about in kind ot e.oteric terms -
preexisting condition.; people talling in between the gaps: why you
can't change jobs; all that kind ot stuft. And you hear a story and
you realize that this i. the'busin••• ot America.
But the vote. that really matter hore are the vote. ot
the members ot Congr.... So ':betore we leave" I'd like to ask the
members ot Congress who .at through this entire panel to please stand
and be recognized. I .ee Congre••woman DeLauro there and
Congresswoman l.hoo ther., who are .tanding, .0 they can't stand: and
Congres.man Serrano'. in the back. Would all the member. ot Congress
who are here plea.e .tand .0 you can see them.
(Applau.e.)
I
Thank you, Mr. Bowle.. Thank you, Congreesman. And
that you most ot all to the.~ tine members ot our small bu.ine••
tamily in America.
Thank you.
We',re adjourned.
END
(Applau.e.)
l2:00 Noon EST
,
�March 8, 1994
MEMORANDUM FOR THE CABINET
FROM:
GENE SPERLING
MEEGHAN PRUNTY
KIM O'NEILL
I
SUBJECT:
'
~orkplace
Coverage: Information Packet
Please find attached an information packet on "Guaranteed Coverage at Work". It
contains:
•
Guaranteed Coverage at Work: Talking Points
•
A Brief History of Employer-Provided Insurance in America
•
Employer Responsibility: The Hawaii Example
•
Health Reform and Am'erican Jobs
•
"Why Employer Mandate?", Roger Altman, Washington Post, 2/25/94
•
Possible Sites for
•
Guaranteed Coverage at Work: Questions and Answers
1.
Why workplace coverage?
2.
Won't this requirement result in huge job losses?
3.
What is the iID.pact of this requirement on small businesses?
4.
Why don't we just have an individual mandate?
5.
How dare the federal government tell me what I can and cannot do for
my own employees?
6:
Do you agree iwith the CBO decision to put the premiums from this
requirement the federal budget?
7.
Isn't it true that even Laura Tyson said that health care reform will
cost 600,000 jobs?
Aren't the caps to firms the same as a payroll tax on high-wage
8.
employees?
9.
Why do we need universal coverage anyway?
Even~s
on Employer-Provided Insurance
m
•
Possible Topics for Economic Health ,Care Op-eds
�,
;
GUARANTEED COVERAGE AT WORK
,
TALKING POINTS
SUMMARY: The President's bottom line is guaranteed private health insurance
for every Apterican. There are only three ways to achieve this:
government insurance, guaranteed coverage at work, or an
individual/family mandate. The President chose to build upon the
current system and ask all businesses to do what the most successful
American companies do today -- provide health coverage for their
employees.; The critics' claim that this will lead to job loss has been
disputed by independent economists -- and a number of credible
studies have concluded that the plan will actually create jobs.
,
ONLY THREE WAYS TO PROVIDE GUARANTEED COVERAGE:
•
There are only three ways to guarantee health coverage for all Americans.
One is to raise a broad-based tax to finance government-provided insurance.
The second is to require employers to contribute to the cost of coverage for all
of their workers. The third is to require all individuals and families to
purchase insurance for themselves. Whether it's the government, employers,
individuals, or some: combination ... for everyone to have coverage, someone
has to pay.
WHY NOT AN INDWIDUALI FAMILY MANDATE?
•
Some critics of our plan support an individual/family mandate. But, to date,
no one has proposed: an individual mandate that would provide health
insurance for every American without causing large disruptions to the
current system. For example, under the family mandate currently before
Congress, employers across the country would face incentives to drop
coverage -- forcing individuals and families to bear the full burden of health
care costs without help from their employers.
"
EMPLOYER CONTRIBUTION BUIWS ON CURRENT SYSTEM:
•
The best way to acHieve guaranteed coverage is to build on what we know
works. Right now, :hine out often people who have private insurance get it
through employers.'lEBRI with 1993 CPS data. 1/941
•
Excluding the smallest companies -- those with less than 5 employees -- the
vast majority of bm;,inesses (between 75 and 90%) provide insurance. Even
among the smallest companies, more than.halfprovide coverage and many of
the rest say they woul~ if they could afford it. And the most competitive
businesses -- includplg nearly every company on the Fortune 500 list -
provide medical cov,erage to their employees. [Jennifer Edwards et aI, Data Watch,
Spring 1992; NFIB 1990; Daily Labor Report. 3/1/941
�COVERAGE AT WORK: TALKING POINTS
Page 2
•
Eight out often people 'who do not have health insurance are in working
families -- workers or dependents of workers. [EBRI. 1994]
NO COST SHIFTING SAYES MONEY FOR FIRMS THAT NOW PROVIDE:
•
When all employers take responsibility, costs will be substantially reduced
for businesses that currently provide insurance. The CBO confirmed that:
"Universal coverage would mean that those firms that now offer insurance
would not longer need to pay indirectly through higher doctor and hospital
bills for the care giventd uninsured workers and their families. On the other
hand, firms that do not now provide insurance could not longer ride free.
/I
[Reischauer Testimony, Se~ate Finance Committee, 2/9194]
•
This is why the Wall S'treet Journal wrote: "For many small businesses,
saddled with escalating health care costs, President Clinton's health care
package comes as an unexpected windfall" and Henry Aaron of the Brookings
Institution said that" Successful implementation of health care reform is one
of the best pieces of news American business could receive." [Wall Street Journal.
"Small Business Sees Burdens Getting Lighter", 9/13/93]
•
A system of shared re~ponsibility, where all employers and individuals pay
their fair share, will stop the cost-shifting that goes on today when
businesses that provide coverage have to pay higher premiums to compensate
for those that do not. Today, 8 of 10 Americans without insurance are in
working families, and, firms that provide insurance end up picking up the bill
when these uninsureq. individuals go to the hospital and can't pay for it.
I
EVEN WHILE COVERING EVERYONE, BUSINESSES SAVE BILLIONS:
•
Even when new spending from those businesses that do not now provide
insurance is included, the non-partisan CBO concluded that American
businesses as a whole see dramatic savings under reform. "[The President's
proposal] would sharply reduce the growth of employer spending for health
insurance. By 2004, employers would save about $90 billion for active workers
and more than $15 billion for early retirees... I, ["Analysis of the Administration's
Health Proposal", CBO, 2(9194]
JOBS - EXPERTS SAY NEGLIGIBLE IMPACT OR NET CREATION:
•
The non-partisan CBP analysis states clearly that the President's approach
will have a negligible, net effect on employment. "The Clinton plan, [CBO]
concluded, would not significantly slow the economy or result in the loss of
jobs, as many critics have charged." [pearlstein and Broder, Washington Post, 2/9194]
�'.'
COVERAGE AT WORK: TALKING POINTS
Page 3
•
In fact, some experts say there will be job creation. Two independent
studies -- one from the Economic Policy Institute and one from the Employee
, Benefit Research Institute -- predict that health reform will cause a net
increase in American Jobs. The EPI projects that 258,000 manufacturing jobs
will be created over the next decade. And the Emplovee Benefit Research
Institute predicts that the President's proposal could produce as many as
660,000 jobs. [EPI, November 1993; EBRI, November 1993]
•
For example, the health care sector should produce a significant number of
new jobs. One health:,expert at the Brookings Institution predicted that the
plan will create 750,000 home health care jobs alone. [Reuters, 9/17/93]
•
Many small businesses -- those with less than 75 employees and an average
w:age of no more than';$24,000 -- will be eligible for substantial discounts on
the cost of the insurartce they provide their employees. In many cases,
contributions for health coverage will be approximately $1.25 a day per
employee for the small employer whose average worker earns minimum
wage. [Edie Rasell, Roll Call. 3/94]
'.'
HAWAII EXPERIENCE pkOVES MANDATES DON'T COST JOBS:
•
Hawaii's real world e~erience suggests that required employer contributions
do not necessarily have adverse employment effects. Since Hawaii began
asking all employers to provide insurance for their employees in 1974: the
unemployment rate has dropped to one of the lowest in the nation; small
business creation rates have remained high; and the rate of business failures
has been less than half the national rate. In addition, only 2% of Hawaii's
"rainy day" fund, which set up to assist the small businesses provide
insurance, has ever been used. [The Hawaii Department of Health, June 8,1993]
CONSERVATIVE APPROACH PROPOSED BY NIXON 20 YEARS AGO:
•
In 1971, President Nixon first proposed extending the employer-based health
insurance system to all employees. Nixon's proposal was one of shared
responsibility betweep employers and employees -- with the employer paying
75% of the premium and the employee paying 25% -- which is strikingly close
to President Clinton's approach. [8. 2970 "Comprehensive Health Insurance Act of
1974", Congressional Rec~rd (p. 2291), February 6, 1974]
Ii
•
In support of his emp,1oyer mandate, Nixon said: "In the past, we have taken
similar actions to assure workers a minimum wage, to provide them with
disability and retirement benefits, and to set occupational health and safety
standards. Now we should go one step further and guarantee that all workers
will receive adequate :healthinsurance protection." The costs would be
"shared by employers' and employees, much as they are today under most
collective bargaining pgreements. "
�A BRIEF IllSTORY OF EMPLOYER-PROVIDED INSURANCE IN AMERICA
Because A mericans have consistently rejected a government-ron health ccue system.
employer-based coverage has been the route to private health insurance for most Americans
for neculy a century. The President.'s approach is to extend that system to all employees.
Health insunmce started io Dallas,'Texas io 1929.. Unpaid bills at Baylor University Hospital
were traced to school teachers who could not afford catastrophic expenses, so Baylor
instituted a plan in 1929 whereby 1500 teachers could prepay fifty cents a month for twenty
one days of hospital coverage a ye~. This plan is considered the forerunner of what later
became known as the Blue Cross plans.
lbat same year, Los Angeles was 'the site of the fint prepaid cootract betweeo employee
associations and physician groups.;'Employees of the Los Angeles Department of Water and
Power arranged with two physicians to provide comprehensive services for about 2000
workers and their families. Each subscriber paid $2 a month. plus some additional fees, and
the plan was unusual in that it provided for hospital as well as medical care.
Io 1932, the fint citywide, multi-hospital Blue Cross plan was tried out with a group of
hospitals io Sacrameoto, California. And a few months later, hospitals in Essex County, New
Jerrsey authorized a similar joint plan.The plans offered community rates (rates based on
average costs for large groups of people) and guaranteed payments to participating hospitals.
Blue Cross pioneered the sale of health insurance to employee groups rather than to '
individuals. Employer-based coverage helped the health insurance market grow because group
insurance limited risks, and automatic payroll deductions to guarantee payment of premiwns
cut collection costs.
1
Throughout the Great Depression, health insur.mce expanded through both public demand and
hospitals' eocouragemeoL With fewer and fewer patients able to pay hospital costs, hospitals
sponsored insurance plans as a way to guarantee steady revenue. Before the 1930's, 90
percent of medical expenses were paid out-of-pocket. Besides the nonprofit Blue Cross plans,
which offered insurance at community rates, a nwnber of private, commercial insurers
emerged in the 1930s and 1940s. These insurers used "experience rating;" basing rates on age
and medical history. By the 1950's and 60's, the Blue Cross plans were forced to also use
experience rating in order to compete with the commercial insurers.
I
During World War n, wheo wage and price freezes were io effect, the tmditioo of employe...
provided insurance took hold. Offering benefits became a good way for employers to reward
and attract workers, and it was a particularly attractive option because of the tax-exempt
status of health insurance. By the rrud.50's, health coverage through the workplace was
widespread, and commercial insurers dominated a market once ruled by the Blue Cross and
Blue Shield plans.
�Unions negotiated for better he~th coverage. In the late 40's, the Supreme Coun ruled in the
Inland Steel case that benefit plans were considered a pan of "conditions of employment."
This meant that wtions had gained the right to bargain collectively for health care. helping to
spur the growth of employer-provided coverage. The United Mine Workers led the way in
expanding health benefits, and between 1948 and 1950, the number pf workers covered by
negotiated health plans jumped from 2.7 to more than 7 million. In the 50's and 60's, as
wtions placed increasing emphilSis on demanding more untaxed benefits to increase "total
compensation." they successfully negotiated for more "first-dollar coverage': -- health
insurance where employees don't have to pay anything.
In 1971, President Nixon first Iproposed extending the employer-based health insunmce system
to all employees. He proposed: a more comprehensive proposal in 1974, but it failed when
wtions failed to rally around it~ and the President failed to push hard enough for it.
Nixon's proposal was one of shared responsibility between employers and employees -- with
the employer payim: 75% of the premium and the employee payin~ 25%. This proposal is
strikingly close to President Clinton's -- where employers pay 80% and employees pay 20%.
To justify the employer mandate. Nixon said. "In the past, we have taken similar actions to
assure workers a minimum wage, to provide them with disability and retirement benefits. and
to set occupational health and'safety standards. Now we should go one step further and
guarantee that all workers will receive adequate health insurance protection." The costs would
be "shared by employers and employees, much as they are today under most collective
bargaining agreements."
Nixon also made the case that there must be sufficient consumer protection as part of his
reform. He said: "Any time the Federal Government, in effect, prescribes and guarantees
certain things it must take the necessary follow-through steps to assure that the interests of
consumers and taxpayers are fully protected. Accordingly, legislative proposals have been
submined to the Congress within recent weeks for regulating private health insurance
companies, in order to assure' that they can and will do the job, and that insurance will be
offered at reasonable rates."
The passage of the Employee Retirement Income and Security Act (ERISA) in 1974 spurs the
growth of self-insurance by hu~e employers - meaning large employers are playing by a
different set of insurance rules than small employers.
The growth in employer-provided health insurance continued through the late 1970's. Since
then, the percentage of employed Americans who lack health insurance has begun to increase.
This reflects in part the changing job market -- as manufacturing jobs with generous benefits
have given way to service jobs with linle or no benefits during the 1980's. And recent
analysis by researchers at the Harvard School of Public Health predicted that 30% of small
businesses would drop coverage for their employees in the coming years because of rising
costs.
'
�EMPL,OYER RESPONSIBILITY:
THE HAWAII EXAMPLE
"
SUMMARY: Hawaii has moved closer to universal coverage than any other state by
reforming and ~trengthening its traditional system of private, employert
based health care coverage. Its required employer contributions have
leveled the play'ing field for all businesses, showing that universal
coverage can cr~ate a climate in which businesses grow and prosper.
i
•
In 1974, Hawaii passed the Prepaid Health Care Act requiring all employers to
make contributions towards health coverage for their employees. Under the Act,
all employers must provide a defined comprehensive package of benefits, with
costs shared between the' employer and the employee.
•
The majority of insurance is provided by private insurers and providers. The
insurers voluntarily use 'modified community rating to offer small businesses the
same rates as large busirtesses.
i
The Results:
•
Hawaii is a small busine'ss state, with 97% of its businesses employing less than
100 people and 94% employing 50 or less. After the state began asking all
employers to contribute to coverage:
•
Unemployment CJ.ropped: The unemployment rate dropped to one of the
lowest in the nation.
•
Hawaii's rate of business failures was less than half the national average.
•
Small businesses prospered: Small business creation rates remained high
-- with the numb~r of employers growing almost 200% from 1970 to 1991.
•
Only about 2% of the Premium Supplementation Fund -- Hawaii's "rainy
day" fund which was set up to help the smallest businesses provide
insurance -- has ever been used.
•
Hawaii achieved near-universal coverage: Only about 2% of the
population rema~ uninsured -- compared to estimates of 15.3%
nationwide.
•
Costs have been controlled: "Perhaps most surprising to many experts, the
near-universal a¢cess to health care has not led to soaring costs. YVhile
Hawaii ranks near the top of the states in cost of living, its average health
insurance premi~m is near the bottom. For example, a family in Hawaii
pays a premium of $263 a month, nearly half that of other states.
II
Sources:
The Hawaii Department of Health; "Hawaii: Setting an Example for the Rest
of the Nation", The New York Times, 11114/93
�HEAL TH REFORM AND AMERICAN JOBS
SUMMARY: Health reform will save the private sector tens of billions of dollars
that can be~used to create jobs, raise wages, and improve the
competitiv~ness,of American firms. Today's rising health care costs
are a hidden tax on America's employers, robbing firms of profits
that could go to wages for existing or new employees or to reinvest in
their companies. The President's approach will level the playing
field for American businesses by demanding responsibility from all
employers. This will prevent the cost shifting that now takes place
and lower costs immediately for many companies now offering
msurance.
I
RISING HEALTH CARE COSTS BURDEN AMERICA'S EMPLOYERS:
•
In 1990, GM spent $3.2 billion in medical coverage for its 1.9 million
employees and retirees. This was more than the company spent on
steel. Health care costs add $1,100 to the price of every car made in America
-- double the cost added to Japanese imports. [University of Michigan, 1990; TIME,
11125/92]
•
In 1992, American businesses paid almost $4,000 for health care for each
employee -- more than twice as much as they paid eight years before.
[Christian Science Monitor, 11/21191]
JOBS - EXPERTS SAY:'NEGLIGffiLE IMPACT OR NET CREATION:
•
The non-partisan CBO analysis states clearly that the President's approach
will have a negligillie net effect on employment. "The Clinton plan, [CBO]
concluded, would not significantly slow the economy or result in the loss of
jobs, as many critics have charged." [pearlstein and Broder, Washington Post, 2/9/94]
•
In fact, some experts say there will be job creation. Two independent
studies -- one from'the Economic Policy Institute and one from the Employee
Benefit Research Institute -- predict that health reform will cause a net
increase in American jobs. The EPI projects that 258,000 manufacturing jobs
will be created over the next decade. And the Employee Benefit Research
Institute predicts that the President's proposal could produce as many as
660,000 jobs. lEfLNovember 1993; EBRI. November 1993]
•
For example, the health care sector should produce a significant number of
new jobs. One health expert at the Brookings Institution predicted that the
plan will create 7qO,000 home health care jobs alone. [Reuters. 9117/93]
�HEALTH REFORM AND AMERICAN JOBS
Page 2
HAWAII EXPERIENCE PROVES MANDATES DON'T COST JOBS:
•
Hawaii's real world experience suggests that employer mandates -. such as
those proposed in the Health Security Plan do not have major adverse
employment effects. Since Hawaii asked all employers to provide insurance
for their employees in: 1974, total private employment in Hawaii increased by
90 percent, compared ,to 54 percent in the Unit~d States as a whole. [The
_w
Hawaii Department of Health]
•
In addition, the unemployment rate dropped to one of the lowest in the
nation (2.8% in 1991); small business creation rates remained high (the
number of employers grew almost 200% from 1970 to 1991), and the rate of
business failures in Hawaii remained less than half the national business
failure rate. [The Haw~ii Department of Health. June 8, 1993]
LEADING CEOS SAY REl!ORM WILL HELP COMPETITIVENESS:
•
CEOs of some of Ame,rica's leading firms - large and small - have sent
written statements of support for the President's approach because they
recognize that it pres~nts the best opportunity for American firms to deal
wit.q. escalating health care costs that threaten their competitiveness.
•
Prominent business ~eaders expressing support for the Clinton plan include
the CEO's of USX, Bethlehem Steel, American Airlines, Archer Daniels
Midland, Food For Less, Drummond and Company, Anheiser Busch, Ford,
Chrysler, McDonnell'Douglas, and General Motors.
REFORM WILL SAVE BILLIONS FOR AMERICAN BUSINESSES:
•
An end to cost shifting -- As much as 10.5 percent of premiums paid by
firms that now cover;.their employees goes to pay for coverage for the
uninsured. The Health Security Act will end the cost shifting of the current
system, immediately,: lowering costs for many businesses that now offer
Insurance.
•
No more corporate "free riders" - The Health Security Act will make
businesses more efficient by eliminating "corporate free riders" -- the millions·
of Americans who are insured through a spouse's policy. Employers of both
spouses will contribute to coverage, further lowering costs for business that .
currently provide coverage.
�HEALTH REFORM AND AMERICAN JOBS
Page 3
•
Slower growth in costs - Firms that do not provide insurance will pay
more, but at a much lower cost than they currently face when they try to
purchase insurance.!: While the implementation of universal coverage means
that aggregate busi~ess spending will initially increase under reform -- as
employers that do not currently provide begin to, the reduction in the growth
of health care costs:williead to lower aggregate business spending on health
care by the end of the decade.
•
The Congressional Budget Office (CBO) found that the President's proposal
"would sharply reduce the growth of employer spending for health insurance.
By 2004, employers would save about $90 billion for active workers and more
than $15 billion for :early retirees... " ["An Analysis of the Administration's Health
Proposal," CBO, 2/9/94]·
•
An independent stuHy by Lewin-VHI confirmed that the growth of business
spending on health care will be slowed dramatically by the President's
approach. [Lewin-VHI, December 8,1994],
INCREASED EMPLOYMENT IN HEALTH CARE SECTOR:
•
As many as 400,00q net new jobs will be created in the health care sector,
with more providers and fewer administrators and insurance workers,
according to the Council of Economic Advisers. Joshua Weiner at the
Brookings Institution predicted that the Clinton plan would lead to 750,000
home health care jobs alone. [Bureau of Labor Statistics, Council of Economic Advisers;
Reuters. "Health Care Reform Impact on Jobs", 9117/93]
AN END TO "JOB LOCK" AND "WELFARE LOCK"
•
Job lock occurs wh~n workers remain in a job just because they fear losing
their health benefits if they switch jobs. Studies show that as many as one in
five of America's workers stay in their jobs because of concerns about health
benefits. Job lock can create economic distortions if it impedes the ability of
workers to move to:jobs where they may be more productive. [Kaiser Family
Foundation]
•
Research by Brigit~e Madrian at Harvard has found that mobility rates for
married men are depressed by as much as 25 percent because of job lock.
["Employment-Based Health Insurance and Job Mobility", forthcoming Quarterly Journal of
Economics 2/94]
�HEALTH REFORM AND AMERICAN JOBS
Page 4
•
Universal coverage will also eliminate "welfare lock" which arises when
welfare participants do:not seek employment -- typically minimum-wage jobs
that do not offer health: benefits -- because they fear that they would lose
their Medicaid benefits~ Some research indicates that as many as 25% -- 1
million of the 4 million .welfare recipients -- would take jobs if continuous
health care benefits were available to them. [Robert Moffitt and Barbara Wolfe.
"The Effect of the Medicaid Program on Welfare Participation and Labor Supply"]
SMALL BUSINESSES WILL GET DISCOUNTS:
•
Small businesses are often priced out of the market under the current
system. They face disproportionately high premiums and they risk losing
coverage if even just one single employee becomes sick. Under the
President's plan, however, small firms will be able to purchase affordable
private insurance. And if the firm has 75 or fewer full-time-equivalent
employees and average wages below $24,000, it will receive significant
discounts on its premiums in order to make coverage affordable.
•
The CBO states that the President's plan "would benefit smaller firms that
typically pay much higher premiums than larger firms. This leveling of
costs could benefit all small businesses - not just those that provide
insurance today. With access. to more affordable insurance, small businesses
would be better able to attract workers who now demand health insurance as a
condition of employment. ["An Analysis of the Administration's Health Proposal," CBO.
/I
2/9/94, p.54]
•
Those small businesses that now' provide, and pay the highest rates, will save
most dramatically un<;ler reform. That's why the Wall Street Journal wrote:
"For many small businesses, saddled with escalating health care costs,
President Clinton's health care package comes as an unexpected windfall."
["Small Business Sees Burri-ens Getting Lighter". Wall Street Journal, 9/13/93]
�PAGE
1
LEVEL 1 - 1 OF 1 STORY
Copyright 1994 The Washington Post
~he Washington Post
February
SECTION: EDITORIAL; PAGE A21
25, 1994, Friday, Final Edition
I
LENGTH: 845 words
HEADLINE: Why Employer
Manda~es?
SERIES: Occasional
BYLINE: Roger C.
Altman
BODY:
Amid business complaints and fresh controversy over the health care numbers,
assorted commentators have deplared the president's health care reform plan
dead. This is ridiculous. The outlook is actually very good.
That's because the heart of our plan is guaranteed private health insurance.
Eighty percent of Americans want this. The entire congressional leadership says
it does too. But some self-styled reformers in Congress pay only lip service to
this concept. The central question is whether Congress will back a mechanism to
ensure it.
The president has propose4 building upon the present system through an
employer mandate. Businesses would be required to help pay for coverage, and
employees would have to pay their share. Today, nine of 10 Americans with
private coverage receive it this way.
There are only two other ways to do it.
One is a government progr~m in which government would raise the money to pay
all the bills. This is too much centralization, too much tax, and too much
government.
The second is an individual mandate. All Americans would be required to buy
coverage, but would be on their own in doing so, without the benefit of group
rates.
What those pushing an individual
would no .longer have an incentive to
their employees would end up with it
and that would undermine the: bedrock
mandate don't say is that many employers
provide coverage. Why should they, when
anyway? So, many employers could drop it,
of today's system.
It is also doubtful whether an individual mandate would bring a reduction
in health care inflation, which is vital to true reform. Our employer-based
proposal would have all companies buying in volume and benefiting from lower
prices.
Some sayan individual. mandate would be easier to administer. But in fact
it would involve refundable ,tax credits for much of America. This would have the
IRS seeking out millions who are not now on the tax rolls. Who wants that?
�PAGE
2
The Washington Post, February 25, 1994
Then there are the myths circulating about the impact of an employer
mandate. They should be exposed for what they are -- flat wrong, misleading,
or red herrings.
One is that it would cost, jobs. Numerous independent studies, including work
by the nonpartisan Congressional Budget Office, conclude the job impact would be
small.
I
Some claim the mandate would cost businesses money. For the majority of
businesses that already provide coverage for their employees, that is wrong. The
CBO has now affirmed that our plan would produce major savings in national
health spending -- as much as $ 150 billion annually by 2004. Since so much of
that spending is underwritten by businesses, they will realize particularly
large savings.
We're sufficiently confident of this to have proposed an outright cap on
business spending for health care. Most larger businesses today spend 10 percent
to 11 percent of payroll on: it. We would cap that at 7.9 percent.
A third myth is that the ': mandate would crush small busin.ess. Here, there is
an acute misunderstanding. rhose who oppose an employer mandate don't want you
to know that a majority of small businesses already offer coverage. That's
right. Approximately half of Americans employed by businesses with fewer than
500 employees are already covered.
These are the very busin~sses victimized by the present system. They don't
have the purchasing power of large firms, and must pay through the nose for
coverage; on average, they pay 35 percent more. Our plan gives them the volume
purchasing power of bigger businesses. Small business is one of the biggest
winners under the Clinton p~an.
What about those small businesses that don't cover their people now and would
have to do so in the future? Won't they be crippled? In a word, no. The average
wage among firms that don't provide coverage today is very low -- $ 7,.400 a
year. Under our plan, the co.st of covering that average worker would be 70 cents
a day. It's that low because we would sharply discount the cost of insurance
premiums to such small employers. This extra cost is surely not negligible, but
its not crushing either.
':
Another canard is that the required benefits package is a "Cadillac plan" -
too generous to employees. In reality, it's only slightly more generous than
what most large employers ~ow offer. Benefits will be slightly expanded for most
workers, and they will have, for the first time, the security only guaranteed
coverage can provide.
Finally, some sayan employer mandate amounts to a giant payroll tax. No
one in my memory has ever called a payment for private insurance between two
private parties a tax. CBOhas concluded it is not a tax but a miscellaneous
receipt like a fine, a penalty or forfeiture. We don't agree even on this budget
treatment, and these differences can be easily resolved by slight adjustments on
our side.
The employer mandate is the best approach to build on the present system,
ensure national and busine~'s savings, and avoid an administrative nightmare.
That's why we chose it and why we hope Congress will support it.
�The Washington Post, February 25, 1994
The writer is deputy sec+etary.of the Treasury.
LANGUAGE: ENGLISH
LOAD-DATE-MDC: February 25,;' 1994
PAGE
3
�possmLE SITES FOR EVENTS ON EMPLOYER-PROVIDED INSURANCE
Dallas. Texas (Baylor University Hospital) -- site of the first health insurance plan. (late
1929)
Los An~eles. CA -- site of the first health insurance plan between a physician group and a
group of employees. (Los Angeles Department of Water and Power -- 1929)
Sacramento. CA -- site of the first Blue Cross plan. (July 1932)
Essex County. NJ -- site of one of the first Blue Cross plans. (January 1933)
Inland Steel (Chjca~Q) -- the Supreme Court case in the late 1940's that bore its name allowed
unions to negotiate for health care; member of the recently fonned Chicago Business Group
on Health -- which may act as a purchasing alliance.
Yorba Linda. CA -- President Nixon's hometown. to point out the comparison in the two
proposals.
.
We might also have an event .at a small business that has provided insurance for many years.
•
.
�GUARANTEED COVERAGE AT WORK
QUESTIONS AND ANSWERS
Table of Contents
•
Why workplace coverage?
•
Won't this requirement result in huge job losses?
•
What is the impact of this requirement on small businesses?
•
Why are we p'utting the burden on employers? Why don't we just have
an individual..mandate, like we do with auto insurance?
•
How dare the federal government tell me what I can and cannot do for
my own employees?
•
Do you agree :with the CBO decision to put the premiums from this
requirement in the federal budget?
•
Isn't it true that even the Chair of your own Council of Economic
Advisers Lau'ra Tyson said that health care reform will cost 600,000
jobs?
•
Aren't the caps to firms the same as a payroll tax on high-wage
employees?
•
Why do we need universal coverage anyway?
�GUARANTEED COVERAGE AT WORK: Q & A
Page 1
Q:' Why workplace coverage?
A:
Let's start with the President's bottom line: guaranteed private insurance for
all Americans.
While there is more than one approach to universal coverage, building on the
existing employer-based system makes the most sense. Nine out of ten
people who have private insurance get coverage through employers. Except
for the very smallest firms -- those with 5 or fewer employees -- the vast
majority of firms in the U.S. offer their workers health benefits. And many of
these smallest firms say that they would provide if they could afford it. Our
goal is to bring those now getting a free ride into the system -- to lighten the
load of those now providing insurance -- and to aggressively control costs to
make insurance affordable for even the smallest firms.
Requiring all employers to contribute builds on what works and is a proven
means of reaching universal coverage through the private sector. The state
of Hawaii has had a near-universal system based on an employer mandate
for almost 20 years, and the results are impressive: the unemployment rate is
one of the lowest in the nation, small business creation rates have remained
high, and the rate of business failures in Hawaii remained less than half the
national rate.
Every other state that has passed comprehensive legislation calling for
universal coverage unanimously agrees that an employer mandate is the best
and most expedient ;route to full coverage. Two of the three states that
passed comprehensive reform legislation last year -- Oregon and Washington
state -- passed legislation based on an employer mandate. The third state,
Florida. passed a managed competition plan that set up alliances and health
plans, and Florida's governor Lawton Chiles has said that the missing piece
that will bring universal coverage to Floridians is a national system based on
the President's plan.
Combining the goal of universal coverage with the strong belief that
health care can and should 'remain in the private sector means
employers have t~ be involved in providing their workers' insurance.
Q:
Won't this requirement result in huge job losses?
A:
AbS!olutely not. In fact, the CBO refuted these charges, testifying that "The
Clinton plan . .. would not significantly slow the economy or result in the loss
ofjobs, as many critics have charged." [pearlstein and Broder. Washington Post,
2/9/94]
�GUARANTEED COVERAGE AT WORK: Q & A
Page 2
Today, the rising cost of health care is a hidden tax on American workers
and employers -- hurting businesses, limiting job creation, and threatening
,
our competitiveness. That is why we believe that comprehensive health care
reform is a necessary element in a strategy to increase long-term economic
growth, reduce the deficit, and create jobs.
People that make this job loss criticism sometimes cite a few, old studies that
don't take into accou'nt the significant discounts that the President's plan
offers small businesses. In fact, the lobbyist who paid for the most cited job
loss study calls it "outdated and not relevant to the President's plan.
II
The bottom line is this: health care reform will bring down the costs to most
businesses who pro'Vide insurance to their workers -- allowing them to create
jobs and increase wages. CEOs at some of the top companies in America -
companies like Chrysler, Ford, Bethlehem Steel and American Airlines -
have said that they support the President's plan because it will help them
become more competitive. And even a leading health economist who has at
times criticized our plan, Henry Aaron of the Brookings Institution, said that
"Successful implementation of health care reform is one of the best pieces of
news American business could receive."
Two independent studies -- one from the Economic Policy Institute and one
from the Employee Benefit Research Institute -- predict that jobs will be
created as a result of health reform. The EPI projects that 258,000
manufacturing jobs will be created over the next decade. And the Employee
Benefit Research Institute predicts thatthe President's proposal could
produce as many as 660,000 jobs. For example, there will be new health care
jobs created -- with:one health economist at the Brookings Institution
predicting that the ·plan will create 750,000 home health care jobs alone.
Q.
What is the impact of this requirement on small businesses?
A:
Today, small businesses -- the engine of America's economic growth -- are
threatened by a health care system that is stacked against them. Their
health coverage costs more and offers less than it does for large businesses.
Insurers charge them much more than large employers and then raise their
premiums or drop them altogether if even one employee gets sick. And,
administrative costs eat up as much as 40 cents of every dollar small
businesses spend on health insUrance premiums -- eight times as much as
large companies.
I
�GUARANTEED COVERAGE AT WORK: Q & A
Page 3
The CBO analysis said that all small businesses will benefit from the
President's approach:"[The proposal] would benefit smaller firms that
typically pay much higher premiums than larger firms. This leveling of
costs could benefit all small businesses - not just those that provide
insurance today. With access to more affordable insurance, small
businesses would be better able to attract workers who now demand health
insurance as a condition of employment. "
,
"
For the majority of small businesses that currently provide insurance to their
employees. the Wall Street Journal has said that the President's Health
Security Act will be "an unexpected windfall". These businesses will pay
substantially less in a: health care system that puts them -- not insurance
companies -- in the driver'S seat. These small businesses will now be able to
create new jobs and expand their businesses.
,
A lot of small businesses that don't provide insurance want to -- they just
can't afford it. The President's plan will provide discounts for small
businesses, depending on the firm size and average wage of their workers.
When they actually looked at the President's proposal, many small business
owners found that they will save more on their family'S policies -- which they
get today at the highest prices -- than the total amount that it will cost them
to insure all their employees.
When we look at the effect on small businesses, one interesting example is
Hawaii. Since 1974, ~hen Hawaii passed a plan that requires all businesses
to contribute to the cost of their employees' health insurance, Hawaiian small
businesses have continued to thrive. In 1991. Hawaii was the nation's third
fastest-growing state 'for small businesses, and Hawaii's unemployment rates
are consistently among the lowest in the country.
,
Q:
Why are we putting, the burden on employers? Why don't wejust have
an individual mandate, like we do with auto insurance?
A:
Two reasons: first, we don't want to undo something that's working well for
most people; second, we want real, achievable universal coverage.
Number one, the employer based system works well for 9 out of 10 people -
health care coverage comes with employment. That should be built upon, not
undone.
�GUARANTEED COVERAGE AT WORK: Q & A
Page 4
To date, no one has proposed an individual mandate that would provide
health insurance for ~very American without causing large disruptions to the
current system. For example, under the family mandate currently before
Congress, employers across the country would face incentives to drop
coverage -- forcing individuals and families to bear the full burden of health
care costs without help from their employers.
Number two, if you really want to get universal coverage, you need to make
sure the cost of health care is affordable, and you need to make sure everyone
is covered.
.
'
To make sure health'care is affordable under an individual/family mandate
system, there would have to be significant new government spending for
subsidies. We think/it's better for health care to remain in the private sector
as much as possible, ':but an individual mandate could mean millions of
American families relying on the government, not their employer, for h~lp
with health care costs.
We want to build on the system of coverage through work, keep health care
spending private as much as possible, and make sure universal really is
universal. An individual mandate doesn't do that.
I
Q:
How dare the fede'ral government tell me what I can and cannot do
for my own employees? {philosophical small government argument}
A:
The facts are: whenryoudon't cover your employees', other businesses are
forced to. We need to stop the cost-shifting that goes on today when
. businesses that take responsibility and provide coverage have to pay higher
premiums to compensate for those that do not. Today, 8 of 10 Americans
without insurance are in working families, and everyone else gets charged
when they go to the hospital and can't pay their bills. Insurance premiums
for businesses that provide insurance are 30% higher on average than they
would be otherwise because they also have to pay for the added cost of the
uninsured. '
�GUARANTEED COVERAGE AT WORK: Q & A
Page 5
'
Q:
Do you agree with t,he CBO decision to put the premiums from these
employer mandates in the federal budget?
;
A:
We believe that any Iponey the government spends -- whether for long-term
care or discounts for small businesses or whatever -- should be on budget and
fully paid for. Premi~m payments for health insurance, however, are not
government spending; they are payments between one private party and
another. Premiums for private health insurance should not be "government
receipts" any more than payments currently made by employers to private
insurance companies' on behalf of tens of millions of Americans are
government receipts: Thirty-nine states today have requirements that their
residents purchase auto insurance. The resulting payments -- bet\yeen these
people and their insurance companies -- are not counted as part of state
budgets, nor would anyone expect them to be.
Q:
Isn't it true that Laura Tyson said that health care reform will cost
600,000 jobs?
A:
This is a serious distortion of what Laura Tyson said. Her clear statement
was that health care reform, while leading to higher wages and greater
security for American workers. would not have any significant impact on job
creation. When asked what was the range of impact, she said that it was
likely to be negligible -- either down or .Yl! one half of one percentage point of
total employment. Some have translated this into a range between negative
600,000 jobs and positive 600,000 jobs. Therefore, the most accurate
,
description of Dr. Tyson's statement is that it would have a negligible impact
on jobs. Those who assert that this could mean 600,000 job lost must also
recognize that Dr. Tyson noted that it was equally likely that the plan would
create 600,000 jobs.
"
Q:
Aren't the caps to firms the same as a payroll tax on high-wage
employees?
A:
Under a system of universal employer responsibility, the 7.9 percentis not a
tax, but a guaranteed limit on the amount that any company will pay for
coverage. This is not the government requiring firms to pay 7.9 percent, it
the government ~aranteeing firms that they will not have to pay more than
7.9 percent oftherr payroll when they cover their employees. This is a
guarantee that cov.erage will always be affordable for all firms, unlike the
current system where costs can skyrocket from one year to the next.
I;
�·
.
GUARANTEED COVERAGE AT WORK: Q & A
Page 6
Q:
Why do we need universal coverage anyway?
A:
Two reasons. First, until everyone participates, those with health coverage
will pay the hidden co:sts of those without. When people without insurance
get sick and show up at the emergency room, everyone else is charged higher
premiums to compensate for this unpaid care. Second, the American people
have been cle~r that they want security from health reform -- coverage even
if they change jobs, lose their job, move, become ill, or have a pre-existing
condition. The President is committed to providing this security -- guaranteed
private insurance tha,t can never be taken away.
[i: \data\hlthcare\mandate.q&a;'03/08/94 11:29 AM]
�
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Carol Rasco - Issues Series
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Carol Rasco
Issues Series
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Clinton Presidential Records: White House Staff and Office Files
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Health Care Materials [2]
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Carol Rasco
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Box 123
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
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2010-0198-Sb-health-care-materials-2
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https://clinton.presidentiallibraries.us/files/original/5439b64d69c2008bc2f2e7d925e3e6fc.pdf
10c51e6c16c8abf0a4d89f8cbc6be6a7
PDF Text
Text
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This marker identifies the place of a publication.
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��FOR RELEASE 11 AM
MONDAY, JANUARY 31, 1994
FEB" 3
REC'O
NEW REPORT COMPARES IMPACT OF COMPETING
HEALTH PLANS ON TYPICAL AMERICAN FAMILIES
CONSUMER GROUP CHALLENGES
COOPER,BREAUX,CHAFEE
ON THEIR HOME TURF
How will health reform affect your family?
which reform passes.
It may depend ?n
There are dramatic differences between the
Clinton health reform and two leading substitutes in Congress,
according to the health consumer group Families USA.
At press conferences today in Tennessee, LouiSiana, and Rhode
Island, Families USA released a report showing how ordinary families
would be helped by the Clinton reform, but not by the plans put
forward by Tennessee Rep. Jim Cooper, Louisiana Sen. John Breaux, and
Rhode Island Sen. John Chafee.
"American families get real security from the Clinton reform.
But under the Cooper and Chafee bills, the real winners are the
insurance companies, not the American family," said Ron Pollack,
Executive Director of Families USA.
"Every Member of Congress has guaranteed comprehensive employerpaid health insurance.
President Clinton's bill extends that same
protection to America's families.
not," Pollack said.
The Cooper and Chafee bills do
- more
CONTACT: ARNOLD BENNETT OR AVIVA SHLENSKY (202) 628·3030
1334 G STREET NW • WASHINGTON DC 20005 • FAX (202) 34 7-2417
.~"
�Page 2 of 5
The release of the report in Nashville, New Orleans and
Providence is part of a Families USA effort to bring the health
refor.m debate to people beyond the Beltway.
"We're letting the folks back home know what their
representatives are doing in Washington.
lobbyists know what's going on.
The insurance company
We're going to make sure ordinary
citizens know too," Pollack said.
"When you look at the fine print in the Cooper and Chafee bills,
you see they are hollow imitations of refor.m.
They don't guarantee
comprehensive protection and security to middle class families,"
Pollack said.
The Families USA report compares the impact of the Clinton
refor.m and two health refor.m substitutes on problems faced today by
ten families with typical health insurance problems.
The report examines the family impact of three health plans:
President Clinton's refor.m, the Cooper Bill, introduced by Rep. Jim
Cooper (O-TN) and Sen. John Breaux (O-LA), and the Chafee Bill,
introduced by Sen. ·John Chafee (R-RI).
In each of the ten cases, the President's refor.m offers better
protection for the families than the Cooper bill or the Chafee bill,
according to the consumer group.
"The Clinton refor.m is good for American families and bad for
the insurance companies.
The Cooper and Chafee
plan~
protect the
profits of the big insurance companies, but put American families'
wallets and health at risk," Pollack said.
- more
�Page 3.of 5
"When casting their health reform votes, Members of Congress
·need to decide whether they're on the side of big insurance
companies, or on the side of American families," Pollack said.
The report examines the impact of each reform proposal on
families who will lose their insurance in coming months, have
inadequate insurance or high prescription drug costs.
It also
. ,examines the impact on early retirees who lose their health benefits,
working people who are locked into a job for health benefits,
families that own a small business, and older Americans who need long
term care at home.
The report also deals with the impact of reform on Americans who
are vulnerable to arbitrary limits on insurance benefits or who have
skyrocketing insurance premiums, as well as Medicaid
For families who worry that they will lose their
bene~iciaries.
he~lth
insurance, only the Clinton plan offers .real protection.
Neither the
Cooper plan nor the Chafee plan guarantees that families would no
longer have to worry about losing insurance.
Families who have insurance policies riddled with loopholes can
find help in the Clinton reform, .which guarantees comprehensive
protection.
Neither the Cooper plan nor the Chafee plan guarantees
comprehensive health benefits.
One of the most important differences between the Clinton,
Cooper and Chafee plans has to do with the price of health insurance.
For employers who face skyrocketing health insurance premiums
under the current health system, only the Clinton reform absolutely
guarantees relief.
- more
�Page 4 of 5
Under the Clinton reform, health insurance premiums could rise
no faster than inflation.
Under the Cooper and Chafee substitutes,
no limits would be set on how fast insurance premiums could go up.
"The Clinton reform protects consumers by cracking down on
skyrocketing insurance premiums.
The Cooper and Chafee substitutes
protect the insurance companies by letting them boost your premiums
.~
as fast and high as they want," Pollack said.
For elderly Americans with high prescription drug costs, the
Clinton reform offers the only financial protection against the high
cost of medicine.
Under the Clinton reform, older Americans would
have to pay no more than $1,132 a year for prescription drugs.
Under
each of the substitutes, there is no limit to how much the elderly
could be forced to spend for medicine.
For early retirees who lost their health insurance· when their
companies eliminated the1r health benefits, only the Clinton reform
offers major protection.
Under the Clinton reform, the federal government would pay 80
percent of these early retirees' health insurance premiums until they
are eligible for Medicare.
Under the Cooper and Chafee bills, early
retirees who lose their company health benefits would have to pay the
full price of their health insurance premiums out of
~heir
pockets.
The President's reform guarantees that workers will never be
locked in a job for health benefits, because all employers would
offer comprehensive benefits.
Under the Cooper and Chafee bills,
workers could be locked in a job because many jobs will still deny
health benefits.
- more
�•
. I
Page 5 of 5
For small business owners and their families, only the Clinton
reform spells out their benefits and costs.
Under the Clinton
reform, small business owners and their families would get
comprehensive benefits, premiums that won't rise faster than
inflation, and a limit on out-of-pocket costs.
The premiums, other
out-of-pocket costs, and benefits for small business owners are not
spelled out under the other plans.
For Americans who need long term care at home, only the Clinton
reform offers assistance.
Under the Cooper and Chafee plans,
Americans who need help caring for a family member at home would
_ remain ineligible for assistance.
Under all three plans, employees will no longer be vulnerable to
arbitrary benefit limits on their health insurance.
However, what
services will be covered and how much you will have to pay are not
spelled out under the Cooper and Chafee plans.
"The Cooper and Chafee plans are offering us apig-in-a-poke.
-They say 'trust us, we'll. let you know later what you've bought,'"
Pollack said.
Medicaid recipients would continue to get health coverage under
each of the plans.
choice of
h~alth
The Clinton reform, however, offers advantages in
plans available.
Copies of the report are available
b~calling
Families USA.
Families USA is the consumer group working for health and long term
care reform.
- 30
�American Hospital Association
APR I I Rtci}
Place,
#3
Street. N.W.
Suite 1100
Washington. D.C.· 2000\
Telephone 202.638-\100
FAX NO. 202.626·2345
Integ~tion
Statement
of the
American Hospital Association
before the
Senate Finance Committee
on
Medicare Spending Reductions
and the
of Medicare into a Refonned Health Care System
April U, 1994
Mr. Chairman, I am Dick Davidson, president of the American Hospital Association. On
behalf of AHA's 5,000 institutional members, I am pleased· to have the opportunity to testify
here today. The issues we are discussing -- the role Medicare will play in financing health
care reform, and whether Medicare beneficiaries will become part of the reformed health
care system -- are absolutely central to the reform debate.
"
.-,
'
Hospitals strongly disagree with the idea that Medicare reductions are a reasonable way to
finance reform .. We· don't believe there are resources in the system to allow such large -
truly unprecedented -- reductions without seriously undermining both hospitals' ability to
EMBARGOED UNTIL 10:00AM TUES. APRIL U
Page 1
�carry out the changes that will be needed under reform and hospitals' responsibility to
provide high quality care for Medicare patients, and for all patients. Today, we draw on
new data, which we asked the health consulting firm Lewin-VHI to develop.
HOSPITALS SUPPORT FUNDAMENTAL REFORM
, As we begin, however, I want to be very ,clear about one thing. Hospitals are firm
supporters of fundamental health care reform. I couldn't be prouder of the work our
members have done in developing a progressive, practical vision for reform. Our vision is
centered on three core objectives:
o
Guaranteed coverage and access to care;
o
Restructuring the delivery system to
d~liver
more efficient and effective care;
and
o
fair financing.
We use our three goals as a template, against which we measure all other reform proposals.
No 'proposal now on the table would achieve all our goals -- so we do not endorse any single
reform plan. We are, however, working to support elements of proposals that do move us
"
,
,toward our reform vision., And, we are providing constructive'suggestions to strengthen
areas we feel fall short. That is the procedure we are following today ,explaining to you
why proposed Medicare reductions ~d the failure to integrate the Medicare population in
reform undermine achieving our fundamental goals.
EMBARGOED UNTIL lO:OOAM TUES. APRIL 12
Page 2 '
�Many of the congressional health care reform proposals woulQ make unprecedented cutbacks
. in the rate of increase in Medicare spending to pay for reform. The Administration's
proposal would reduce Medicare spending by $118 billion over the next six years in order to
finance health care reform. This is twice the size of any reductions previously taken from
Medicare.. Other proposals, including those offered by Rep. Pete Stark (D-CA), Sen. John
Breaux {D-LA)/Rep. Jim Cooper (R-TN), and Sen. John Chafee (R-RI) also would reduce
Medicare spending by significantly more than ever before.
It's important to remember that these proposed reductions come on top of OBRA 1993
legislation, which cut $56 billion from projected Medicare spending; and on top of $43
billion in reductions approved just three years earlier as part of the 1990 budget summit
agreement. Furthermore, outside of the health care reform debate, many members of
Congress favor limiting future spending on entitlement programs, including Medicare and
Medicaid. Others support a requirement to balance the federal budget on an annual basis -
an approach that would hit hard on the largest federal programs, particularly Medicare.
We should also put these reductions in the context of current inadequate Medicare payment
rates. The Prospective Payment Assessment Commission (ProPAC) -- the independent
. agency set up by
,
..
',.
"
Congn~ss
to oversee Medicare -- has
" .
"
conclud~d
.
, hospitals' already fail to keep pace with h~spitals' costs.'.
'EMBARGOED.UNTll...I0:00AM TUES. APRIL 12
Page 3
that Medicare payments to
�NEW ESTIMATES ON IMPACf OF REDUCfIONS
The Lewin-VHI estimates give us a preliminary forecast of what could happen in the future
with Medicare reductions of the magnitude envisioned in the Administration's reform
proposal. It is important to note that these estimates do not pretend to predict the future with
any certainty -- they are highly sensitive to underlying assumptions about future growth in
hospital costs. They are, however, illustrative of the kinds of pressures that hospitals face if
Medicare spending reductions alone of this size are enacted.
And the magnitude of those
pressures is sobering:
o
By the year 2000, after six years of spending reductions, Medicare could pay
hospitals only 71 cents for every dollar of inpatient care delivered to a
Medicare patient.
o
The spending reductions could make the Medicare program an even poorer
payer than today's Medicaid program, which currently pays hospitals about 82
cents on the dollar.
o
While most hospitals and all states are affected, teaching hospitals, large urban
areas, and communities with hospitals serving a disproportionately large
number of low-income patients would be particularly hard hit.
""
EMBARGOED
UNTIL lO:OOAM TUES.
APR.ll. U
Page 4
.
"'"
�(:)-
... '" .
The study uses Medicare reductions contained in the Administration's plan because it was the
most detailed available at the time the study began. Among the health care providers and
,
,
'Medicare beneficiaries who would be affected by the President's spending reductions,
Administration estimates indicate that hospitals are hardest hit, taking $70 billion of the $118
billion in proposed reductions.
The data show that reductions like these, with no accompanying reform steps such as
, expanding health care coverage, could cause significant financial losses for hospitals. While
arguably losses might be mitigated by reducing the rate of growth in hospital costs, hospitals'
abiHty to squeeze down costs is limited. As ProPAC recently reported, 60 percent of
hospitals' costincreases from 1985 to 198,9 were due to factors beyond hospitals' control -
inflation in the general economy (39 percent) and increasing complexity of patients treated
(21 percent).
Hospitals are deeply concerned that losses of the size estimated by Lewin-VHI
cannot be made up through increased efficiency and will therefore undermine our ability to
deliver high quality care and to participate in health care reform.
One reason for our concern is that the current health care environment, with its growth in
managed care, means that Medicare reductions will be felt by hospitals, patients, and
communities more deeply than ever before. In the past, hospitals have been able to shift
unfunded costs toother non-government payers --meaning higher costs for these patients and
,their employers. Managed care contracts, however; narrow this option. So, too, do the
growing number of private 'insurers who negotiate discounted prices. And, under many of
EMBARGOED UNTll. 10:00AM TUES. APRIL 12 Page 5
�the comprehensive· health care reform proposals that seek',to limit private sector spending, the
ability to cost-shift is reduced even more..
.
'
HOSPITAL CHOICES ARE FEW UNDER MEDICARE REDUCTIONS
This leaves hospitals with unpalatable choices for controlling costs: , reduce the size of the
hospital work force" or reduce services and programs, or both: Hospitals are reluctant to' .
reduce their work force, because doing so jeopardizes their ability .to do their job well -
.
"
, hospitals are very labor-intensive institutions. Similarly, it is often easier to .eliminate certain
services than to restructure' services in order to cross-subsidize care. Hospitals will continue'
"
,
to work to provide care more efficiently. But, given these economic fa:cts of life, additional' .
Medicare payment 'reductions would be· felt more
de~plythan ,ever by hospitals,patierits,' and
the communities they serve ..·
, Such reductions 'also threaten the- ability of hospitals to participate in health care reform.
. .
.
,Expanding the,covered population, restructuring the delivery system, reconfiguringhospitals
and other service~ for the future, and investing'in neW technologies to meet the demands of .
the new system-- all \,ViII need adequate' resources. For example, the infrastructure
.
.
" .
'
.
'
improvements we all endorse in order to reduce administrative costs :..-. electronic billing,
computerized patient records, new information systems -- will require an'up-front
, ..
. :
investment..
EMBARGOED UNTll. 10:00AM TUES. APRIL 12 . Page 6
�..,.
.".
"
'I
~ ...
4
,
. Specifically for hospitals, getting beyond the traditional ac~te ..care role that will be necessary
.
.
,.
"
. " "
"
under reform would be jeopardized by excessive spending reductions ..' For example,
consumer education, wellness, and outreach programs--: not funded by the current system -
are among the most vulnerable when finances are
squeezed~
.
Alternative sources of financing health .care ,reform are available
to spread the cost of reform'
more broadly, beyqnd hospitals, physicians, arid other health care' professionals who will . ,
, ,
already be deeply affected by change." For example, ~Ore than $75 billion could he raised"
by, increasing or imposing federal excise ~es' on handgUns, assault weapons, 'ammunition,
, tobacco and alcohol. Significantly" the use of many of these i'tems often contributes to poor
health and hospital emergency department visits ..
"
.
"
IMPLICATIONS FOR PATIENTS AND COMMUNITIES
Hospitals . Wallt to see reform done right. Many hospitals " " . . . begun to provide care
have already
".
.
.
',~.
,.,.'.'
..
'
.
"
.
.
'<,
in more cost-effectiVe, collaborative ways. ~ For. ' ProPACreports that the number of
example,
"
"
,
\
. hospitals with health maintenance organization and preferred provider contracts increased
from 37 percent in 1985 to nearly 62 percent in'1992. i\nd, Pro PAC also reports that iii'
1993,' more than 30 percent of the
nati~n' shospitals were involved in' collaborative'
.
.
relationships with physicians, whether a formal physician/hospital organization (14 percent),
a inanagementservicesorganization (Tpercent), or
a foundation that negotiated managed,
care c;ontractsfor the hospital and physicians as a unit (4 percent). ~orming collaborative'
provider networks and reconfiguring services for the future, however, present. major financial
.
. .".
EMBARGOED lJNTll.., 10:00AM
TUES. APRIL 12' Page 7
�and organizational challenges for hospitals. .It is unfair to expect hospitals to deliver on
health care reform and
~
for it, too, through deeper Medicare spending reductions.
,
,
We understand that not all hospitals will survive in a reformed health care system. In fact,
the kind of massive restructuring that we propose will result in mergers, consolidations, and
, closures ~- this is the most responsible and thoughtful way to reduce excess capacity and
eliminate, overlap and duplication in high technology and services. ,
'
..
.
.
.'
.
But the kinds of 'indiscri~inate Medicare spending reductions proposed hit hardest on the
most fin'ancially vulnerable institutions -:- those barely breaking even or already operating at a
loss and those treating large numbers of Medicare, beneficiaries. These hospitals may be the
very facilities that need to remain open to assure access and coverage to underserved '
popuiations and achieve the broader goals of health care reform. Hospital closures should be
.
'
'
based on the needs of communities, not on a particular hospital's financial health. Decisions
to merge or close facilities should be made at the local level wi~hin the community.
RESTRUCTURED DELIVERY SYSTEM AND MEDICARE "INTEGRATION"
The size of proposed, Medica;e reductions presents another obstacle for' achieving'
fundamental health care reform -- it creates a greater-than-ever' schism between how we pay
, ,for and provide care for Medicare beneficiaries and for the rest of the population. This is
the opposite direction of when~' we want to go.
EMBARGOED UNTIL lO:OOAM
TUES. APRIL 12
Page 8
�Currently, Medicare beneficiaries are presented with a delivery system that stresses
specialization over primary care; administrative complexity over simplicity; and fragmented
. care rather than coordinated care .. Many of us have had the experience of helping an elderly
friend or family member deal with stacks of confusing bills and forms, or trying to
coordinate their medical care between the physician and the hospital or some other health ..
care provider.
At the same time, some Medicare beneficiaries still face barriers to receiving basic primary
care. According to the Physician Payment Review Commission,the independent
congressional commission overseeing payment to physicians under Medicare and Medicaid,
the lack of availability of primary care is the most common complaint mad~ by Medicare· ..
beneficiaries.
We believe it's absolutely essential that the Medicare population be part of the saIlle
reformed system as other Americans -- that Medicare beneficiaries be "integrated" into
reform. And, just as strongly, we believe that the reformed health care system include the
kinds of collaborative provider networks we touched on earlier. In AHA
I
S
reform vision,
such collaborative arrangements are called "community care networksSM " --locally based,
networks of hospitals, doctors, other health care providers, and social service and community
. agencies, working together to improve the. health of PeQple in the community.
EMBARGOED UNTll... lO:OOAM TUES. APRIL U
Page 9
�Community care networks focus on primary care, prevention, and coordinating care to
ensure that all patients -- young and old -- receive the right kind of care at the right time and
in the most appropriate setting. A capitated payment system -- an upfront fee for. each
enrolled person -- improves efficiency and creates the proper incentives for providers to work
. together to keep patients healthy ..
. Networks would also help patients navigate the complex maze of available health care
services. This is particularly important for Medicare patients, beCause they use more
services·more often.
In addition, if the Medicare and non-Medicare populations are part of the same reformed.
health care system, providers would have the same incentives to deliver appropriate and cost-:
effective care to Medicare beneficiaries as they would for other patients. Imagine hospitals
trying to improve coordination and efficiency' if more than 30 . percent of what they do is·
driven by a set of incentives that represeiltthe inefficiencies of our current fragmented.
system -- which would be the case if Medicare, comprising, on average, a third of hospitals'
patient revenue, remains out of the reformed health care system of the future .
.
..
But it is not clear that these opportunities for better patient care and more efficient case
~
management will be available to Medicare beneficiaries and encouraged under health care
reform .. As a first step, all ~eform plans should encourage Medicare beneficiaries to join
managed care plans where available. . Interest and participation could be increased through·
.
,
"
EMBARGOED UNTIL lO:OOAM TUES. APRIL 12
Page.tO
�education and information about the advantages managed care offers, by providing financial
incentives or increased benefits for joining managed care plans, and by expanding the types
and numbers of managed care plans offered to Medicare beneficiaries to allow them more
We support these and a number of similar
flexibility to choose their o!,n physician.
initiatives
contain~d
in Sen. Dave Durenberger's (R-MN) bill, S. 1996, that work toward
these ends.
Integrating Medicare patients into the reformed delivery system makes good public policy
sense. But more importantly, it makes good sense for the older Americans we serve.
CONCLUSION
Hospitals have been and will continue be a constructive force as our nation moves toward a '
, fundamentally reformed health care system.
We believe our role on the front line of health
care delivery gives us, valuable insight and experience to bring to that process. We are
'c'.'
willing to contribute to the shared sacrifice that will inevitably be part of reform. Our vision
of reform does just that, with its incentives for economic discipline and dramatic changes in
the structure of health care delivery.
What we are ",ot willing to do, however,
.
IS jeopardize the qua!ity of the health care we
.
deliver to our Medicare patients, 3.!ld to all our patients. We firmly believe that the
, Medicare spending reductions proposed in the Administration's plan and in many other
congressional health reform proposals would undercut our ability to deliver high quality care.
EMBARGOED UNTIL 10:00AM TUES. APRIL 12 ,Page 11
':'
'"
�Continued Medicare reductions are likely to result in further staffing reductions, delays in
purchasing new equipment,postponing the upgrading of facilities, closing certain services in
order to maintain other services at peak quality, and jeopardizing the research and education
programs that have kept America's health system on the cutting edge of scientific
development.
In addition, we believe it is absolutely essential that the Medicare population be part of the
same reformed system as other Americans, and that the reformed system expand managed
care opportunities for Medicare patients and for all patients. Only through such Medicare
"integration" will beneficiaries have strong incentives to seek cost-effective care and their
providers have consistent incentives to treat them in the most cost-effective way.
It is for these reasons that we urge' you to reject Medicare reductions contained in the
Administration's plan and in other congressional reform proposals and instead consider the
many alternative sources of financing available as your committee goes about the difficult
work of shaping health care reform. And, we urge you to include Medicare beneficiaries
under the reform umbrella as the best way to work toward more cost-effective delivery of
care for these patients:
m
Community Care Network, Inc. uses the name Community Care Network as its service mark and reserves all
rights.
'
'
EMBARGOED UNTIL lO:OOAM TUES. APRIL 12 Page 12
�NOTICE
This document is not
available for public·
release until 10:00 a.m.
Eastern time, Tuesday,
April 1 2, 1 994
MEDICARE REDUCTIONS:
UNFAIR TO EXPECT HOSPITALS
TO DELIVER ON HEALTH CARE REFORM
AND PAY FOR IT TOO
BACKGROUND:
Hospitals support comprehensive health care refonn centered on three goals: .'
a
Guaranteed coverage and access to care;
a
More efficient and effective delivery of care; and
a
Fair fmancing.
Hospitals understand that extending health coverage to the uninsured will take additional
resources. We cannot, however, support unprecedented reductions in Medicare funding as a
major source of these resources. Such reductions would be counter productive -- they would
undennine our ability to achieve refonn and threaten patient services.
For example, health care refonn -- fonning collaborative provider networks; reconfiguring,
hospitals and other serVices for. the future -- will present major fmancial and organizational
challenges for hospitals. It is unfair to expect hospitals to deliver on health care refonn and •
Wll!.' for it too through deeper Medicare spending reductions.
�Many of the congressional health care refonn proposals would make unprecedented cut backs
in the rate of increase in Medicare spending to pay for refonn. The President's proposal
would reduce Medicare spending by $118 billion over the next six years in order to finance
health care refonn. This is twice the size of any reductions previously taken from Medicare.
Other proposals, including those offered by Representative Pete Stark (D-CA), Representative
Jim Cooper (D-TN), and Senator John Chafee (R-RI) also would reduce Medicare spending by
signifIcantly more than ever before.
Outside the health care refonn debate, many members of Congress favor limiting future
spending on entitlement programs, .including Medicare and Medicaid. Others support a
requirement to balance the federal budget on an annual basis -- an approach that would hit hard
on the largest federal programs, particularly Medicare.
Alternative sources of fmancing health care refonn are available to spread the cost of refonn
more broadly, beyond hospitals, physicians, and other health care professionals who will
already be deeply affected by change. For example, increasing alcohol and cigarette excise
taxes ($86 billion), scaling back nuclear weapons production ($3 billion), and asking host
nations to share in more of the cost of U.S. troops stationed abroad ($10 billion) would raise
nearly $100 billion over five years toward health care refonn fmancing.
STUDY FINDINGS:
New estimates prepared by Lewin-VHI look at the impact on hospitals of Mep.icare spending
reductions. It is important to note that these estimates do not pretend to predict the future with
any certainty -- they are highly sensitive to underlying assumptions about future growth in
hospital costs. However, these estimates are illustrative of the kinds_ of pressures that hospitals
face if Medicare spending reductions alone of this magnitude are enacted.
The Prospective Payment Assessment Commission (ProPAC) has already concluded that today,
payments to hospitals under Medicare's Prospective Payment System do not keep pace with
hospitals' costs. The new Lewin-VHI estimates confmn that this pattern will likely continue.
The study uses the President's plan -- the most detailed available -- as an example, Among
the health care providers and Medicare beneficiaries who would be affected by the President's
Medicare spending reductions, administration estimates show that hospitals are hardest hit,
taking $70 billion of the $118 billion in proposed reductions.
Data show that reductions like these, .with no accompanying reform steps such as expanding.: ,
health care coverage, could cause signifIcant fmanciallosses for hospitals. Losses might be
attenuated by reducing the rate of growth in hospital costs. But hospitals are concerned that
losses of this size' can not be made up through increased efficiency. Medicare reductions could
undennine hospitals I ability to transfonn and improve the health care system for patients and
threaten their ability to continue to·deliver quality care in the communities they serve.
�The Lewin-VHI data show:
a By the year 2000, after six years of spending reductions, Medicare could pay hospitals
only 71 cents for every dollar of inpatient care delivered to a Medicare patient. The
overall Medicare Prospective Payment System (PPS) inpatient operating margins for all
hospitals in the U.S. could be negative 29 percent (see table 3).
.
.a These spending·reductions could make the Medicare program an even poorer payer
than the Medicaid program is today, which currently pays hospitals 82 cents on the
dollar.
a
Coping with the spending reductions already.enacted in the Omnibus Budget
Reconciliation Act (OBRA 1993) will be difficult enough for hospitals. Lewin-VHI data
,show that by the year 2000, the overall Medicare PPS inpatient operating margm for all
hospitals in the U.S. would be negative 12 percent as a result of changes enacted in OBRA
1993 (see table 1). The additional reductions proposed by the President could lower this
margin by an additional 17 percentage points (see table 3),
a Particularly hard hit are teaching hospitals, hospitals in large urban areas, and
hospitals serving a disproportionately large number of low-income patients. By the
year 2000, Medicare PPS inpatient operating margins could be reduced by 22 percentage
points for teaching hospitals; reduced by 19 percentage points for large urban hospitals; and
reduced by 26 percentage points for hospitals receiving both indirect medical education and
, disproportionate share adjustments.
u After six years, regardless of hospital type -- large or small, urban or rural, teaching
or non-teaching -- most hospitals face significant MediCare losses. Under current law,
Medicare PPS inpatient operating margins for various types of hospitals are expected to
. average between positive 4 percent and a negative 18.5 percent (see table 1). If the
President's re4uctions were enacted, Lewin-VHI data suggest these margins could average
between a negative 19.9 percent and a negative 32:2 percent (see table 3).
a All states are negatively affected.
After the enactment of OBRA 1993, hospital margins
varied considerably by state (see table 2). But Lewin-VHI data show that if the Medicare
reductions proposed by the President are enacted, rul states would lose significant shares of
revenue, driving Medicare PPS inpatient operating margins down (see table 4).
r
" IMPLICATIONS:
Medicare spending reductions have serious implications for the future of health care reform,
hospitals, patients, and communities.
�Hospitals may be without the resources needed to achieve comprehensive reform -- to
reconfigure the way in which they deliver care to be more efficient and to refocus on the
health of the patients and communities they serve.
'
Cuts will be felt by hospitals, patients, and communities more deeply than ever before. In
the past, hospitals have been able to shift unfunded costs to' other non-government payers,
meaning higher costs for patients and employers. But this avenue will be narrowed, if not
closed, by the current rapid growth in managed care in the private sector as well as by
many of the comprehensive health care reform proPosals that propo~ to limit private sector
spending. Thus, hospitals will have to cut costs which could mean personnel and service
"
'
,cutbacks. '"
,
.
.. .
~
,
Some communities may see their hospitals close for the wrong reasons --: not because they
are no longer n~ed, but because they are fmancially weak. The kinds of Medicare '
spending reductions proPoSed hit hardest on the most fmancially vulnerable hospitals -
those barely breaking even or already operating at a loss and those that treat large numbers
of Medicare beneficiaries. These hospitals may be the very ones that need to remain open
to assure access and coverage to underserved populations and achieve the broader goals of
health care reform.
'"'
"
�4/4/94
Table 1:
Projected Medicare PPS Inpatient Operating Margins by Hospital Group Under OBRA 93
All Hospitals
All Teaching Hospitals
,----
Major Teaching
Minor Teaching
Non-Teaching
Type of Hospital
Urban
=1;L(]rg e Urban
Other Urban
Rural
Sole Community
.' .
c--: ----
_ Sole Comm and Rural Referral
Rural Referral
Other Rural
Payment AdJusfme,..ts
. IME & Disp Share
c-
IMEOnly
Disp Share Only
None
Medicare Proportion of Rev.
Over 60%
Under 60%
Size
1-50 Beds
50-99 Beds
r-- lO{H99 Beds
200-299 Beds
300+ Beds
Ownership
Church
Voluntary
Proprietary
Govemment
---
-----
* Actual
N
5185
1008
213
795
4177
1991·
-3.3%
1.1%
8.3%
-2.3%
-7.8%
PreOBRA93
1992
-4.0%
-0.5%
7.8%
-4.3%
-7.7%
2914
1545
1369
2271
541
46
188
1496
-3.1%
-1.9%
-4.9%
-4.2%
1.0%
4.1%
-5.9%
-6.4%
-4.5%
-3.6%
-6.0%
-0.7%
1.6%
9.4%
-3.1%
-1.7%
483
774
383
3545
4.1%
-5.0%
-4.0%
-6.9%
1175
4010
1994
-6.4%
-2.1%
7.6%
-6.6%
-10.9%
1995
-8.8%
-4.4%
5.7%
-9.2%
-13.3%
1996
-10.9%
-6.3%
4.1%
-11.3%
-15.7%
OBRA93
1997
-11.7%
-7.1%
3.5%
-12.1%
-16.6%
1998
-11.9%
-7.2%
3.5%
-12.3%
-16.8%
1999
-12.0%
-7.1%
3.7%
-12.3%
-17.1%
2000
-12.2%
-7.1%
4.0%
-12.4%
-17.4%
-4.6%
-3.5%
-6.2%
-0.8%
1.6%
9.4%
-3.0%
. -1.8%
-6.1%
-4.5%
-8.5%
-8.5%
-9.8%
-2.1%
-9.1%
-8.8%
-8.6%
-7.0%
-11.0%
-10.1%
-9.9%
. -5.0%
-12.1%
-9.6%
-10.7%
-9.0%
-13.1%
-12.7%
-12.6%
'-7.5%
-14.5%
-12.3%
-11.4%
-9.8%
.' -13.9%
-14.0%
. -13.9%
-8.6%
-15.6%
-13.7%
-11.6%
-9.9%
-13.9%
-14.6%
-14.5%
-9.1%
-15.9%
-14.5%
-11.6%
-9.9%
-14.1%
-15.1%
-15.1%
-9.6%
-16.3%
-15.3%
- -11.7%
-10.0%
-14.2%
-15.7%
2.8%
-5.5%
-5.4%
-7.0%
3.2%
-6.3%
-5.5%
-7.1%
1.9%
-8.5%
-8.1%
-10.0%
-0.3%
-11.1%
-10.7%
-12.3%
-2.2%
-13.6%
. -12.7%
-14.6%
-3.0%
-14.7%
-13.6%
-15.4%
-3.1%
-15.1%
-13.6%
-15.5%
-2.9%
-15.4%
-13.7%
-15.8%
-2.8%
-15.7%
-13.8%
-16.1%
-6.6%
-2.7%
-7.2%
-3.5%
-7.4%
. -3.6%
-11.2% .
-5.7%
-13.7%
-8.0%
-16.3%
-10.1%
-17.4%
-10.9%
-17.8%
-11.0%
-18.2%
-11.1%
-18.5%
-11.2%
1362
1123
1226
670
804
-4.5%
-6.0% .
-5.8%
-5.6%
-1.0%
-2.1% " -2.4%
-5.0%
-4.7%
-5.5% .
-5.8%
-6.5%
-6.3%
-2.5%
-2.5%
-9.3%
-:10.1%
-------:..---=-:-'-
-9.0%
-8.7%
-4.0%
-10.5%
-11.8%
-11.5%
-11.4%
-6.3%
-13.3%
-14.5%
-14.0%
-13.6%
-14.7%
-16.4%
-17.2%
-15.7%
~8.2%
-15.0%
-14.5%
-8.8%
-15.5%
-16.6%
-15.4%:
-14.8%
-8.8%
674
2327
748
1436
-3.9%
-2.9%
-5.6%
-1.6%
-4.9%
-3.8%
-6.5%
-1.6%
-9:3%
-8.9%
-9.4%
-6.9% .
-11.2%
-11.2%
-11.2%
-9.2%
-11.9%
-12.1%
-11.5%
.-10.2%
-11.9% .
-12.4%
-11.2%
-10.5%
711.9%
-12.5%
-11.2%
-10.8%
1993
-4.1%
-0.3%
8.3%.
-4.4%
-7.9% .
-15.8%
-10.0%
-16.6%
-16.0%
----------
'.
-5.2%
-3.8%
-6.4%
. -1.6%
"7.0%
-6.4%
-7.4%
-4.8%
~15.9%
-17.3%
-17.9%
. -16.1%
~14.9% .'
-15.1%
-8.7%
-8.7%
.
-11.9%
-12.7%
-11.3%.
-11.1~_
Lewln-VHI, Inc.
�414194
Table 2:
Projected Medicare PPS Inpatient Operating Margins by State Under OBRA 93
N
, PreOBRA93
1991*
1992
1994
1993
1995
1996
OBRA93
1997
-5.6%
-13.4%
-0.7%
-8.3%
-2.4%
-5.1%
-16.3%
-14.8%
-9.1%
-10.3%
-9.6% '
-28.8%
-6.6%,'
-10.3%
-15.3%
-10.1%
-10.2%
-8.1%
-11.5%
-16.1%
NA
-1.2%
-3.6%
-3.5%
-6.0%
-9.9%
-8.5%
-7.5%
-14.7%
-2.2%
-10.7%
-4.4%
-7.3%
-20.1%
-16.6%
-11.2%
-12.2%
-11.9%
-32.2%
-8.7%
-12.3%
-17.9%
-12.4%
-12.1%
-9.9%
-13.3%
-18.8%
NA
-3.9% .
-5.6%
-6.1%
-7.7%
-12.0%
-10.2%
-9.3%
-16.5%
-3.3%
-13.2%
-6.0%
-9.3%
-23.3% '
-18.3%
-12.8%
-13.6%
-14.1%
-35.7%
-11.0%
-14.0%
-20.1%
-14.8%
-14.2%
-11.8%
-15.0%
-21.7%
NA
-6.2%
-7.5%
-8.7%
-9.9%
-13.8%
-12.3%
-9.5%
-16.6%
-3.0%
-14.1%
-6.1% '
-9.8%
-25.7%
-18.4%
-12.9%
-13.5%
-14.8%
-37.1%
-11.7%
-15.2%
-21.7%
-15.6%
-14.7%
-12.1%
-15.2%
-24.1%
NA
-7.7%
-8.7%
-9.8%
-10.4%
-14.0%
-12.8%
.....
,
1998
1999
2000
State
Alabama
Alaska
Arizona
Arkansas
Califomia'
Colorado
Connecticut
Delaware
Washington DC
Florida
Georgia
Hawaii
Idaho
illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
r---
Minnesota
Mlsslsslppl
Missouri,
Montana
.'
.. ,
,
'
.
'
,
,
**
-----
**
'.
'
,
,
116
' 16
57
81
437
67
34
7
9
219
160
20
42
204
116
123
131
104
138
39
NA
99
171
149
104
132
,
54
-2.5%
-1.4%
1.2%
-0.1%
-0.1%
-4.4%
-11.8%
-12.0%
-3.5%'
-9.2%
' -7.8%
-14.1%
-0.1%
-7.0%
-11.5%
-6.8%
-5.6%
-4.2%
-11.2%
-9.0%
NA
2.7%
1.1%
2.8%
-1.3%
-4.3%
-0.9%
-3.3%
-3.3%'
-2.6%
-2.7%
0.4%
0.5%
-1.5%
-1.9%
-2.4%
-2.4%
-2.7%
-2.8%
-15.1% • -14.6%
-12.4%
-12.0%
-7.2%
-7.4%
-9.7%
-10.3%
-6.6%
-6.8%
-22.7% '
-22.0%
' 3.2%
1.2%
-9.1%
-8.7%
-11.9%
-:12.0%
-4.8%
-5.1%
-6.3%
-6.5%
-5.2%
-5.3%
-11.3%
-11.6%
-13.6%
-13.1%
NA
NA
0.9%
1.3%
-1.2%
-0.8%
1~4%
0.4%
-0.8%
-0.8%
-7.2%
-7.8%
-0.2%
-0.2%
--~
-9.3%
-16.3%
-2.3%
-14.5%
-9.4%
-16.4%
-1.9%
-15.0%
~5.9%
-5.9%
-9.8%
-10.2%
-26.6%
-27.4%
-17.8%
-18.0%
-12.5%
-12.5%
-12.9%
-12.6%
-15.4%
-14.9%
-37.6%
-38.6%
-12.0%
-12.4%
-15.0%
-14.9%
-21.8% ' -22.2%
-15.9% ' -16.3%
-15.0%
-14.7%
-11.9%
-11.9%
-14.8%
-14.8%
-25.6%
-24.8%
NA
NA
-8.1%
-8.4%
-8.5%
-8.6%
-11.1%
-10.4%
-10.8%
-10.6%
-13.9%
-13.8%
-13.3%
-12.9%
-9.5%
-16.6%
-1.6%
-15.6%
-5.9%
-10~~~
-28.1%
-17.6%
-12.5%
-12.3%
-15.8%
-39.5%
-12.9%
-14.8%
-22.5%
-16.6%
-15.3%
-11.9%
-14.9% '
-26.4%
NA
-8.6%
-8.4%
-11.8%
-11.0%
-13.9%
-13.7%
Projections were not made for Maryland, which operates an 'all-payer rate setting system under a waiver
from the Medicare program.
* Actual
Lewin-VHI, Inc.
�4/f1./94
Table 2:
Projected Medicare PPS Inpatient Operating Margins by State Under OBRA 93
N
State
Nebraska·
Nevada
New Hampshire
New Jersey
New Mexico
New York .
North Carolina·
North Dakota
..
. Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
. Tennessee
Texas
Utah
Vermont·
Virginia
Washington
West Virginia
.
Wisconsin
Wyoming
• Actual
1991·
Pre OBRA 93
1992
1993
1994
1995
1996
OBRA93
1997
89
22
26
88
35
218
126
48
185
115
65
218
12
69
-14.6%
-4.6%
-18.5%
-9.6%
9.4%
7.8%
-6.1%
-4.5%
-6.5%
0.8%
8.1%
. -2.4%
3.8%
-13.9%
-2.5%
-6.9%
-6.8%
7.5%
-10.9%
-6.2%
2.7%
-7.1%
0.6%
-1.8%
-13.0%
-4.8%
-16.6%
-11.4%
9.4%
8.7%
-1.5%
-1.8%
-6.7%
{).1%
4.1%
-3.0%
1.9%
-9.3%
-2.6%
-10.6%
-7.6%
9.2%
-11.2%
-6.9%
2.3%
-5.4%
0.8%
-12.6%
-13.3%
-4.1%
-16.3%
-10.8%
9.5%
8.5%
-2.3%
-1.3%
-6.7%
0.0%
4.2%
-2.9%
4.9%
-9.6%
-2.8%
-10.4%
-9.6%
9.5%
-11.8%
-7.0%
1.6%
-5.4%
0.5%
-10.7%
-12.3%
-3.5%
-13.5%
-12.7%
3.7%
6.9%
-5.0%
-6.7%
-11.3%
-6.9%
-2.1%
-4.9%
0.1%
-11.6%
-8.3%
-12.4%
-9.9%
5.4%
-14.1%
-4.6%
-16.3%
-16.7%
2.3%
3.8%
-8.1%
-8.0%
-13.7%
-9.1%
-4.2%
-7.3%
-2.5%
-14.3%
-9.8%
"14.3%
-12.0%
3.4%
-21.0%
-13.2%
-4.3%
-16.8%
-6.9%
-24.7%
-16.0%
-5.2%
-18.8%
-20.3%
0.5%.
0.7%
-11.0%
-9.5%
-15.6%
-11.4%
-6.1%
-9.2%
-4.7%
-16.9%
-11.4%
-16.1%
-13.9%
1.6%
-24.2%
-15.5%
-6.5%
-19.5%
-8.9%
-26.7%
-16.3%
-4.6%
-20.5%
-22.3%
0.2%
-1.3%
-12.4%
-9.4%
-17.1%
-12.0%
-6.5%
-9.7%
-6.0%
-17.9%
-11.7%
-16.4%
-14.2%
1.3%
-26.7%
-16.1%
-7.2%
-20.5%
-10.4%
-27.1%
53
132
398
39
15
99
92
58
128
26
~18.1%
-10.8%
-1.8%
-14.1%
.-4.7%
-23.7%
1998
1999
2000
-16.1%
-3.5%
-20.8%
-23.7%
0.3%
-2.9%
-13.3%
. -9.0%
-17.0%
-12,3%
-6.5%
-16.3%
-3.4%
-21.0%
-24.3%
0.3%
-2.6%
-14.0%
-8.7%
-17.0%
-12.7%
-6.6%
-9.9%
-6.4%
-18.5%
-11.7%
-16.3%
-14.2%
1.1%
-28.0%
-16.6%
-7.9%
-21.5%
-10.8%
-27.4%
-16.4%
-3.3%
-21.2%
-24.8%
0.3%
-2.4%
-14.6%
-8.5%
-17.0%
-13.1%
-6.8%
-10.1%
-6.6%·
-18.7%
-11.8%
-16.4%
-14.4%
0.9%
-28.6%
-16.9%
-8.4%
-22.1%
-11.1%
-27.3%
~9.8%
-6.3%
-18.4%
-11.6%
-16.2%
-14.0%
1.2%
-27.4%
-16.3%
-7.5%
-21.0%
-10.5%
-26.9%
Lewin-VHI, Inc .
�Table 3:
4/4/94
Projected Medicare PPS Inpatient Operating Margins by Hospital Group Under the Health SeGurity Act
\
All Hospitals
All Teaching Hospitals
Major Teaching
Minor Teaching
Non-Teaching
Type of Hospital
Urban
Large Urban
Other Urban
Rural
Sole Community
Sole Comm and Rural Referral
Rural Referral
Other Rural
Payment Adjustments
IME & Disp Share
IMEOnly
Disp Share Only
None
Medicare Proportion of Rev.
Over 60%
Under 60%
Size
1-50 Beds
50-99 Beds
100-199 Beds
200-299 Beds
300+ Beds
Ownership
Church
Voluntary
Proprietary
Government
Alabama
Alaska -
1991 *
-3.3%
1.1%
8.3%
-2.3%
-7.8%
PreOBRA93
1992
-4.0%
-0.5%
7.8%
-4.3%
-7.7%
1993
-4.1%
-0.3%
8.3%
-4.4%
-7.9%
2914
1545
1369
2271
541
46
188
1496
-3.1%
-L9%
-4.9%
-4.2%
1.0%
4.1%
-5.9%
-6.4%
-4.5%
-3.6%
-6.0%
-0.7%
1.6%
9.4%
-3.1%
-1.7%
-4.6%
-3.5%
-6.2%
-0.8%
1.6%
9.4%
-3.0%
-1.8%
-6.1%
-4.5%
-8.5%
483
774
383
3545
4.1%
-5.0%
-4.0%
-6.9%
2.8%
-5.5%
-5.4%
-7.0%
1175
4010
-6.6%
-2.7%
1362
1123
1226
670
804
674
2327
748
1436
-116
16
N
5185
1008
213
795
4177
OBRA93
1994
-6.4%
-2.1%
7.6%
-6.6%
-10.9%
1995
-10.4%
-7.5%
0.2%
-11.0%
-13.3%
1996
-14.8%
-14.0%
-10.2%
-15.6%
-15.7%
Health Security Act
1997
1998
-17.5%
-23.7%
-24.4%
-16.6%
- -12.6%
-24.9%
-24.2%
-18.3%
-23.0%
-18.4%
1999 •
-26.3%
-26.8%
-27.0%
-26.7%
-25.7%
2000
-28.9%
-29.3%
-29.2%
-29.3%
-28.5%
-
-9.8%
-2.1%
-9.1%
-8.8%
-10.4% _ -15.1%
-9.2%
-14.5%
-12.2%
-16.0%
-10.2%
-13.1%
-9.9%
-12.6%
-5.0%
-7.5%
-12.6%
-15.8%
-9.5%
-12.3%
-17.7%
-17.1%
-18.6%
-16.1%
-15.7%
-10.2%
-18.7%
-15.6%
-24.2%
, -24.1%
-24.4%
-20.3%
-20.5%
-14.4%
-23.6%
-19.1%
-26.7%
-26.5%
-27.0%
-23.3%
-23.5%
-17.1%
-26.5%
-22.2%
-29.3%
-29.0%
-29.7%
-26.4%
-26.6%
-19.9%
-29.3%
-25.4%
3.2%
-6.3%
-5.5%
-7.1%
1.9%
-8.5%
-8.1%
-10.0%
-3.8%
-11.1%
-13.1%
-12.9%
-10.8%
-13.6%
-18.6%
-15.9%
-13.4%
-16.5%
-21.3%
-18.5%
-24.6%
-24.6%
-23.9%
-22.9%
-26.8%
-27.4%
-26.4%
-25.7%
-29.0%
-30.2%
-29.0%
-28.4%
-7.2%
-3.5%
-7.4%
-3.6%
-11.2%
-5.7%
-14.1%
-9.8%
-17.1%
-14.5%
-20.1%
-17.1%
-23.2%
-23.8%
-26.0% -26.3%
-28.8%
-28.9%
-4.5%
-6.0%
-5.8%
-5.6%
-1.0%
-2.1%
-4.7%
-5.5%
-6.3%
-2.5%
-2.4%
-5.0%
-5.8%
-6.5%
-2.5%
-9.3%
-10.1%
-9.0%
-8.7%
-4.0%
-10.3%
-11.8%
-11.8%
-12.3%
-8.9%
-13.3%
-14.7%_
-14.7%
-15.8%
-14.6%
-16.4%
-17.9%
-17.6%
-18.6%
-17.0%
-18.6%
-21.3%
-23.5%
-24.6%
-24.0%
-21.8%
-24.3%
-26.3%
-27.2%
-26.3%
-25.1%
-27.5%
-29.2%
-29.9%
-28.7%
-3.9%
-2.9%
-5.6%
-1.6%
-2.5%
-1.4%
-4.9%
-3.8%
-6.5%
-1.6%
-3.3%
-2.6%
-5.2%
-3.8%
--6.4%
-1.6%
-3.3%
-2.7%
-7.0% -6.4%
-7.4%
-4.8%
-5.6%
-13.4%
-10.4%
-10.9%
-9.7%
-8.9%
-8.3%
-14.7%
-13.8%
-16.0%
-12.0%
-14.2%
-11.3%
-16.5%
-16.3%
-18.8%
-13.9%
-17.0%
-13.2%
-18.4%
-21.5%
-25.1%
-18.3%
-26.4%
-16.9%
-25.7%
-23.9%
-27.7%
-20.6%
-29.3%
-19.3%
-28.3%
-26.4%
-30.4%
-23.0%
-32.2%
-21.8%
-31.0%
~8.5%
"
* Actual
Lewin-VHI, Inc.
�4/4/94
Table 4:
Projected Medicare PPS Inpatient Operating Margins by State Under the Health Security Act
N
~Stat.
Arizona
Arkansas .
California
Colorado
Connecticut
Illinois
Indiana
Iowa
Kansas
Kentucky
louisiana
Maine
Maryland
Massachusetts
Mlchlaan
**
**
57
81
437
67
34
7
9
219
. 160
20
42
204
116
123
131
104
136
39
NA
99
171
149
104
1991*
PreOBRA93
1992
0.4%
1.2%
-1.5%
-0.1%
-0.1%
-2.4%
-4.4%
-2.7%
-15;1%
-11.8%
-12.0% . -12.4%
-3.5%
-7.2%
-9.2%
-10.3%
-7.8%
-6.6%
-14.1%
-22.0%
-0.1%
3.2%
-7.0%
-9.1%
-11.5%
-12.0%
-6.8%
-4.8%
-5.6%
-6.3%
-4.2% .
-5.3%
-11.2%
-11.6%
-9.0%
-13.1%
NA
NA
2.7%
1.3%
1.1%
-1.2%
2.8%
1.4%
-1.3%
-0.8%
-4.3%
-7.8%
-0.9%
-0.2%
1993
0.5%
-1.9%
-2.4%
-2.8%
. -14.6%
-12.0%
-7.4%
-9.7%
-6.6%
-22.7%
1.2%
-6.7%
-11.9%
-5.1%
-6.5%
-5.2%
-11.3%
-13.6%
NA
0.9%
-0.6%
0.4%
-0.6%
-7.2%
-0.2%
OBRA93
1994
-0.7%
-8.3%
-2.4%
-5.1%
-16.3%
-14.6%
-9.1%
-10.3%
~9.6%
-26.6%
-6.6%
-10.3%
-15.3%
-10.1%
-10.2%
-8.1%
-11.5%
-16.1%
NA
-1.2%
-3.6%
-3.5%
-6.0%
-9.9%
-8.5%
1995
1996
-3.3%
-5.9%
-11.1%
-14.1%
-5.4%
-8.4%
-8.5% . -12.2%
-23.7%
-32.3%
-19.2%
-24.7%
-15.9%
-24.6%
-12.7%
-14.6%
-12.9%
-16.5%
-39.7%
-33.6%
-6.6%
-11.4%
-14.3%
-16.8%
-19.0%
-22.7%
-13.4%
-17.2%
-13.3%
-17.1%
-10.6%
-13.5%
-14.1%
-16.9%
-20.1%
-24.7%
NA
NA
-6.6% . -13.3%
-6.2%
-13.6%
-14.7%
-6.6%
-7.9%
-10.4%
-13.6%
-17.8%
-10.2%
-12.3%
Health Securi1y Act
1997
1998 T 1999
-7.2%
-16.8%
-10.2%
-14.5%
-37.0%
-26.6%
-26.6%
-16.3%
-19.0%
-43.4%
-13.8%
-21.9%
-26.3%
-19.8%
-19.5%
-15.6%
-18.9%
-29.2%
NA
-16.9%
-17.0%
-17.6%
-12.8%
-19.9%
-14.6%
-11.0%
-19.8%
-18.3%
-17.7%
-42.4%
-28.8%
-37.4%
-20.1%
-25.6%
-54.7%
-16.3%
-29.0%
-30.5%
-24.0%
-23.9%
-21.4%
-25.5%
-36.5%
NA
-23.3%
-22.8% .
-21.1%
-21.7%
-23.5%
-17.6%
-12.8%
-22.7%
-20.6%
-20.5%
-46.1%
-31.2%
-40.1%
-22.1%
-28.5%
-58.8%
-19.0%
-31.4%
-33.4%
-26.8%
-26.6%
-23.8%
-27.8%
-40.1%
NA
-26.0%
-25.1%
-24.3%
-24.3%
-26.0%
-20.3%
T
2CXXJ
-14.6%
-25.7%
-23.0%
-23.3%
-49.8%
-33.6%
-42.8%
-24.2%
-31.5%
-63.1%
-21.8%
-33.9%
-36.4%
-29.7%
-29.4%
-26.2%
-30.3%
-43.7%
NA
-28.9%
-27.4%
-27.6%
-27.0%
-28.5%
-23.1%
-------
Projections were"not made for Maryland. which operates an all-payer rate setting system under a waiver
from the Medicare program.
* Actual
lewin-VHI. Inc.
�4/4/94
Table 4:
Projected Medicare PPS Inpatient Operating Margins by. State Under the Health Security Act
N
State
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
iOklahoma
Oregon
f>(3nnsylvanla
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
'..
Washington
West Virginia
Wisconsin
Wyoming
.. Actual
/"
,
1991"
89
22
.26
88
35
218
126
48
185
115
-14.6%
-4.6%
-18.5%
-9.6%
·9.4%
7.8%
-6.1%
-4.5%
-6.5%
0.8%
8.1%
-2.4%
3.8%
-13.9%
-2.5%
-6.9%
-6.8%
7.5%
-10.9%
-6.2%
2.7%
-7.1%
0.6%
-1.8%
65
218
12
69
53
132
398
39
15
99
92
58
128
26
PreOBRA93
1992
1993
OBRA93
1994
-13.0%
-13.3%
-12.3%
-4.8%
-4.1%
-3.5%
-16.6%
-16.3%
-13.5%
~12.7%
-11.4%
-10.8%
9.4%
9.5%
3.7%
8.7%
8.5%
6.9%
. -5.0%
-1.5%
-2.3%
-1.8%
-1.3%
-6.7%
-6.7% -=6.7%
-11:3%
-0.1%
0.0%
-6.9%
4.1%
4.2%
-2.1%
-3.0%
-2.9%
-4.9%
1.9%
4.9%
0.1%
-9.3%
-9.6%
-11.6%
-2.6%
-2.8%
-8.3%
-10.6%
-10.4%
-12.4%
-7.6%
-9.6% -9.9%
9.2%
5.4% 9.5%
-11.2%
-11.8%
-18.1%
-6.9%
-7.0%
-10.8%
1.6%
-1.8%
2.3%
-5.4%
-14.1%
-5.4%
0.8%
-4.7%
0.5%
-12.6%
-23.7%
-10.7%
1995
1996
-15.5%
-4.8%
-17.6%
-18.6%
1.8%
1.0%
-9.7%
-8.4%
-15.9%
-9.9%
-5.3%
-9.6%
-5.4%
-15.5%
-10.0%
-15.3%
-13.0%
1.9%
-23.8%
-14.5%
-5.3%
-18.0%
-8.3%
-25.3%
-19.4%
-5.8%
-21.9%
-25.0%
-0.6%
-6.4%
-15.1%
-10.5%
-21.0%
-13.2%
-8.8%
-15.1%
-11.8%
-19.7%
-12.5%
-18.6%
-16.3%
-2.1%
-31.1%
-18.7%
-9.1%
-22.4%
-12.4%
-28.3%
Health Security Act
1997
1998
-21.6%
-6.8%
-25.6%
-29.0%
-2.4%
-10.3%
-18.4%
-12.2%
-24.4%
-15.7%
-10.9%
-17.5%
-15.1%
-22.7%
-14.5%
-20.7%
-18.5%
-4.2%
-35.9%
-21.2%
-11.5%
-25.4%
-15.7%
-30.7%
-26.8%
-9.4%
-28.4%
-35.2%
-7.5%
-22.4%
-28.8%
-14.0%
-29.4%
-20.7%
-14.6%
-23.5%
-17.8%
-33.2%
. -17.1%
-19.1%
-25.1%
-8.0%
-40.3%
-26.8%
-17.4%
-32.0% .
-19.8%
-32.3% .
----_._._._._._._._._._._---
1999
2000
-29.5%
-11.4%
-31.2%
-38.5%
-9.7%
-24.5%
-32.2%
-15.9%
-32.0%
-23.5%
-16.9%
-26.0%
-20.2%
-36.0%
-19.5%
-21.6%
-27.7%
-10.4%
-43.7%
-29.7%
-20.2%
-35.2%
-22.5%
-35.4%
-32.3%
-13.4%
-34.0%
-41.9%
-11.8%
-26.8%
-35.5%
-18.0%
-34.6%
-26.4%
-19.4%
-28.7%
-22.8%
-38.9%
-22.0%
-24.1%
-30.4%
-12.8%
-47.2%
-32.6%
-23.2%
-38.5%
-25.3%
-38.6%
Lewin-VHI, Inc.
�KEY ASSUMPTIONS MADE BY
LEWIN~VHI
a Medicare PPS inpatient operating. margins are dermed as Medicare inpatient operating
revenue minus Medicare inpatient operating costs divided by Medicare inpatient operating
revenue (R-C)/R. .
a
The following provisions of OBRA 1993 have an impact on hospitals and are included in
. the "0BRA 1993" portion of this analysis:
·Reductions in the·PPS updatefactor
Changes in indirect medical education payments
Phase-out of day outlier payments
Hospital protection against cenain changes in the wage index
Regional referral center extension
. Small Medicare-dependent rural hospital payment extension
. Regionalfloor extension
a
The following. provisions proposed by the President would have a further impact on .
hospitals and are included in the "Medicare Reductions Under the Health Security Act"
portion of this analysis:
Reductions in the PPS update factor
Reductions in the indirect medical education adjustment
Reductions in disproponionate share. hospital payments
a Margin estimates reflect Medicare PPS inpatient operating revenues and costs only.
Capital and other Medicare revenues (e.g., direct medical education) are not included.
Margin estimates reflect the impact of the proposed Medicare spending reductions and do
not reflect the impact of other provisions included in the Health Security Act.
a Hospital costs are assumed to grow by the rate of increase in the hospital market basket
index plus 2.9 percentage points, or about 7.3 percent annually over the projection period.
This rate of growth is about 1 percentage point less than historical rates of growth after
adjusting for inflation.
a The Lewin-VHI model is a "static" model, so it does not include behavioral changes (e.g.,
. changes in the organization of hospital service delivery) or changes in industry structure
(e.g., no hospital closings or consolidations). This is because it is impossible to predict
which types of hospitals may restructure, consolidate, or close. Moreover, little
. . information is available to allow experts to model into the future ho}V hospitals and the
. health care system generally might respond to the system-wide kinds of regulatory and
market changes being proposed.
�-2
Q
The proposed change to an "all-payer" pool for indirect inedical education costs is not
included in the Medicare PPS margin estimates because non-Medicare funds (from regional
and corporate alliances) would also be included in the pool, and would distOrt the Medicare
PPS-onlyanalysis. Medicare indirect'medical education payments, reduced as specified by
the Administration, are included and
assumed to continue until the year 2000.
are
Q The Administration's proposal would significantly reduce Medicare disproportionate share
payments as states form health care alliances. Because the timing of states' reform
, activities cannot be known, margin estimates assume that OBRA 1993 disproportionate '
share provisions continue in effect through 1997 and the disproportionate share provisions
proposed by the Administration are fully implemented in,1998~
. Q No estimates were made for the state of Maryland because the state operates under a
federal waiver and has a distinctive rate setting system.
, i
�'.
April 6, 1994
Making the Tough Choices:
Alternative Financing Options for Health Care Reform
OPTIONS ,FOR INCREASING REvENUES, OR REDUCING SPENDING
INCREASE mE
35 PERCENI'
10 PERCENI' EXCISE TAX ON HANDGUNS AND ASSAULT WEAPONS TO
5-YEARVALUE
$1
BILlJON
This option is modeled after legislation, H.R.' 3245; introduced 'by'
Congressman Mel Reynolds (D-ll..), which would increase the current
10 percent excise tax on handguns to 35 percent. Congressman
Reynolds' legislation would specifically earmark 25 percent of the
proceeds for general health care, purposes.
INCREASE mE FEDERAL EXCISE TAX ON CERTAIN ALCOHOliC BEVERAGES
$5.5 BllllON
Alcohol abuse is responsible for over 100,000 deaths and $100 billion
in economic costs annUally. This option would increase the federal
"
excise tax on alcoholic spirits to $16.00 per proof gallon (from
$13.50), and on wine at a concomitant mte.(Source: Reducing the
Deficit.~ Spending and Revenue Options, March 1994, Congressional
Budget Office) "
INCREASE 11lE 24 CENTS FEDERAL EXCISE TAX ON A PACK OF CIGARETTES BY
$1.25, 50 CENIS MORE THAN 11IE ADMINISTRA110N'S PROPOSAL
Cigarette use causes 419,000 deaths each year and $65 billion in
tobacco-related health care costs and lost productivity. This option,
based on the provision adopted by the House Ways and Means
subcommittee on Health during its markup of health care refonn
legislation, would increase the current 24 cents federal excise tax on a '
pack 'of cigaiettes by $1.25. The Administration's plan would increase"
the federal excise tax on a pack of cigarettes by 75 cents, raising $67 '
billion over six years, and $56 billion over five years. (Source: House
Ways and Means Subcommittee on Health, March 1994)
For every $15 bUlion in increased revenue~ or reduced federal spending,
comprehensive health care coverage can be provided to approxinultely 1 ,
miUion people for five years.
$80 BllllON
�LIM" 11lE TAX-DEDUC11BH.JTY OF EMPLOYER-PAID HEAL71l INSURANCE TO 11lE
COST OF AN AVERAGE PLAN
$104.4BI1ll0N
· Currently, employees do not pay taxes on income they receive in the
. fOnD employer-paid health insurance. In addition, employers are
allowed to deduct the full cost of any health coverage they provide to
their employees. Limiting the amount of tax-free benefits that an
employee can receive to $375 per month ($4500 annually) for family
coverage and $165 per month ($1,980 annually) for individual coverage
increases income tax revenues and payroll tax revenues dramatically.
(Source: Reducing the Deficit: Spending and Revenue Options,
March, 1994, Congressional Budget Office)
SCALE BACK 71lE SUBSIDY FOR EARLY RE17REES UNDER 71lE CUNI'ON PLAN
$15 BI1ll0N
The President's proposal would provide a generous benefit to early
retirees (ages 55-64) and those employers who have obligations to
· provide their health coverage, by offerjng to pay the 80 percent
employer share of premiums for those retirees who have paid into the
Social Security system. Some observers question the fairness of giving
· early retiree a subsidy that is greater than those who are either working
or unemployed. (The Health Security Act provides individuals and
families with incomes of less than $40,000 per year a subsidy for their
portion of the health plan premium.) The- Administration's proposal
would reduce the early retiree subsidy only for singles with an income
over $90,000 per year or families with an income over $115,000 per
year. If the administration proposal were scaled back to the same .
$40,000 subsidy level as applies to the working and the unemployed,
. significant savings could be achieved. (Source: The Financial Impact
of the Health Security Act, December 1993, Lewin-VIfl, Inc.)
MEANS TEST 11lE MEDICARE PART B PREMIUM FOR UPPER-INCOME BENFIC/ARlES
Currently, .beneficiaries only pay 25 percent of the Medicare Part B
premium; the remainder is paid by the federal government through
general revenues. This proposal would require wealthier beneficiaries
(individuals with retirement incomes of $125,000 or more and couples
with retirement incomes of $150,000 or more) to pay the full cost of
the Part B premium. (Source: Reducing the Deficit: Spending and
Revenue Options, March 1994, Congressional Budget Office)
For every $15 bUlion in increased revenues or reduced federal spending,
comprehenrive health Ctlre coverage C4n be provided to approximately 1
million peopk for five years.·
$5.4 BI1ll0N
�; ' - ' - ~.'
ACCELERATE 11lE RISE IN 11lE SOCIAL SECURITY RE11.REMENT AGE TO
YEAR 2008
68 BY 11lE
$36 BHllON
When the Social Security system· was established in the mid-1930's and .
the retirement age set at 65, average life expectancy was about 60
years. Today, average life expectancy is 76. In other words, Social
Security recipients receive benefits for many more years than
envisioned when the program was enacted. Under- current law, the age
for full-benefit Social Security retirement will increase gradually from
65 to 67 between 2000 and 2017. This proposal would raise the
retirement age to 68, increasing by three months each year starting in
1995, untint reached age 68 in 2006. (Source: The Zero Deficit Plan:
. A Plan/or Eliminating the Federal Budget Deficit by the year 2000,
. September 1993, The Concord Coalition)
USE 11lE FUNDS TARGETED FOR DEFICIT REDUCJ10N UNDER PRESIDENT eUNTON'S
HEAL111 CARE REFORM PROPOSAL TO HELP FINANCE 111E REFORM EFFORT
$59 BHllON
Under the President's health care reform proposal, .$59 billion in
reduced spending is targeted for deficit reduction over six years (FY
95-2000). It should be noted, however, that the Congressional Budget
Office recently reported that these savings would not be achieved under
the President's health care reform proposal.
IMPOSE A MINIMUM TAX ON FOREIGN-OWNED BUSINESSES OPERAl1NG IN 111E
UNITED STATES
Some evidence suggests that some foreign-owned, multinational
corporations may be attempting to avoid paying U.S. taxes by
manipulating transfer prices and shifting income overseas. When
foreign multinational corporations Operating in the U.S. import·
materials and services from affiliated companies abroad, the "transfer ..
. price" of imports affects the amount of income that is subject to U. S.
- tax. By raising the transfer price of imports, foreign-owned companies
can shift income out of the U.S. to their foreign affiliates and reduce
their U.S. tax. This proposal would impose a minimum tax on all
companies that are at least 25 percent foreign-owned and have
transactions with foreign affiliates in excess of either ·10 percent of their
. gross income or $2 million annually. (Source: Reducing the Deficit:
, . Spending and Revenue Options, March -1994, Congressional Budget
Office)
.
For every $15 bilUon in increased revenues or reduced federal spending,
comprehensive health care coverage can be prol'ided to approximately 1
million people for five years.
$2.6BHllON
�IMPOSE EXCISE TAXES ON WA1ER POlLUTANTS
$17 BHLlON
In 1991, more than 240 million pounds of toxic materials were
discharged by the U. S. manufacturing sector directly. into bodies of
water, and more than 400 million. pounds were discharged indirectly
through sewers. Toxic pollutants generally include organic chemicals
(such as solvents and dioxins), metals (such as mercury and lead), and
pesticides. This proposal would impose varying tax rates based on a
pollutant's level of toxicity.. (Source: Reducing the Deficit: Spending
and Revenue Options, March 1994, Congressional Budget Office)
IMPOSE ONE-l1ME EMISSIONS TAX ON NEW CARS AND UGHT TRUCKS
$13.3 BHLlON
This proposal would impose a one-time tax on new cars and light
. trucks based on the level of harmful emissions from each automobile.
The EPA would determine.the tail-pipe emissions for each new model
light-duty vehicle and the tax would be based on these emissions rates.
The tax would be collected from the purchaser by the auto dealer· at the
point of sale. (Source: Reducing the Deficit: Spending and Revenue .
Options, March 1994, Congressional Budget Office)
PROHIBIT PEOPLE WITH ANNUAL ADJUS1ED GROSS INCOMES OF OVER $100,000 FROM
RECEw/NG FARM PRICE SUPPORT PAYMENTS
$300MHLlON
Current law limits participants in crop price support payments to no more
than $100,000 in deficiency payment benefits from the Commodity Credit
Corporation during any crop year. This option would prohibit those
people with annual incomes of $100,000 or more from receiving farm
price support payments. (Source: Reducing the Deficit: Spending and
Revenue Options, March 1994, Congressional Budget Office)
MEANS 1EST UNEMPLOYMENJ' COMPENSA110N, AT TAXABLE INCOME EXCEEDING
$120,000 .
This proposal would end the federal portion of unemployment subsidies
to any individual who has an after-tax income of over $120,000. (Source:
Kerrey!Brown Senate budget-cutting package)
For every $15 billion in increased revenues' or reduced fedeToJ Spending,
comprehensive health care coverage ctm be provided to approximately 1 million
people for five years.
$361 MHLlON
�,
$580 MIIi.JoN
REFORM PRISON CONSTRUC110N
This option would require that previously appropriated funds for prison
cOnstruction be spent before new amounts could be appropriated. (Source:
1993 House GOP Budget)
HALT NEW ACQUlSmONS OF CRUDE OlL FOR 71IE STRATEGIC PEIROLEUM RESERVE
(SPR) FOR FIVE YEARS
$325 MIlllON
The SPR, a government-owned crude oil inventory stored in Louisiana
and Texas, was authorized in 1975 to reduce the vulnerability of the U.S.
to interruptions in oil supplies. This option would halt new purchases of
crude oil for the SPR. (Source: ,Reducing the Deficit: Spending and
Revenue Options, March 1994, Congressional Budget Office)
EuMINATE FUlwVING FOR mE MAGNEl1C LEVITA110N (MAGLEV)
DEVELOPMENT
PROTOTYPE
$700 MIlllON '
The MagLev is a high-speed rail prototype development program
established by the, 1991 highway bill. 'The' Office of Technology
Assessment states, that the technology is not yet ready to jump to the full
scale operating demonstration as proposed in the highway bill. (Source:
PennylKasich budget package)'
'REDUCE TRAVEL ACCOUNIS BY 15 PERCENT FOR SPECIFIC EXECU11VE BRANCH
AGENCIES AND mE LEGISI..411VE BRANCH
$875 MIlllON
Tne proposal exempts selected agencies because of special requirements
of their' functions that necessitate the use of their full travel budget
allowances. The agencies exempted are the'Department of Defense, the
Department of Veterans Affairs, the Department of the Treasury (which
includes the FBI), and the Department of Justice.
(Source:
KerreylBrown Senate budget package)
EuMINATE mE MARKET PROM0110N PROGRAM (MPP), WHICH ASSISTS U.S.,
AGRICUL1VRAL EXPORTERS IN SEUING mEIR PRODucrsOVERSEAS "
The MPP was authorized by the 1990 farm bill to help U.S. agriCUltural
exporters sell their products overseas. This option eliminates the MPP.
(Source: Reducing the Deficit: Spending and Revenue Options, March '
, . 1994, Congressional Budget Office)
. .
For every $15 billion in increased revenues or reduced federal spending,
comprehensive health care coverage can be provided to approximately 1 million
people for five years. ,
. $500 MIlllON
�IMPOSE A 5-YEAR MORATORIUM ON LAND ACQUISmON Byi1lE; FEDERAL GOVERNMENT
$1.4
BILLION
This option would impose a five-year moratorium on the purchase of land
by the federal government. •The federal government already owns one
third of the nation's land. (Source: The Zero Deficit Plan: A Planfor
Eliminating the Federal Budget Deficit by the year 2()(}(), September 1993;
The Concord Coalition)
REDUCE FUNDS FOR 11IE STRATEGIC DEFENSE INI71A11VE (SDI OR "STAR
WARS")
$1.85
BILLION
This proposal would reduce the star Wars budget by 16 percent.. (Source:
· Amendment to H.R.. 3400, the Reinventing Government bill, offered by
Reps. Barney Frank (D-MA) and Chris Shays (R-CT), November 1993)
.
.
r
IMPOSE A MORATORIUM ON 11IE PURCHASE OF FEDERAL BUILDINGS
$2
BILLION
, '. According to the National 'Performance Review report, "Over the next 5
· years, the federal government is slated to spend more than $800 million
· a year acquiring new federal office space and courthouses .. Under current
'conditions, however, those acquisitions don't make sense." (Source:
,Creating a Goverrunent that Works' Bener and Costs Less, ·.Report of the
National Performance Review, September 7, 1993)
ELIMINATE FUNDING FOR HIGHWAY DEMONSTRATION PROJECl8
$2.6 BILLION
Outside of the normal competitive bidding and selection process, the
Congress will earmark special highway demonstration projects through the
reauthorization of the highway bill or the annual appropriations process.
Often times, these. demonstration projects cannot be justified by economic
criteria. (Source: Reducing the Deficit: Spending and Revenue Options,
March 1994, Congressiorul1 Budget Office)
SCALE BACK NUCLEAR WEAPONS PRODUCTION',TO
.'
.
3,500
WARHEADS
l
The end of the Cold War and recent developments in Eastern Europe, the
former Soviet Union, and elsewhere around the world, raise questions
about the proper nuclear arsenal of the Umted States. This proposal
. would scale back the Department of Energy's weapons production to no
more than 3,500 warheads, the maximum number of strategic warheads
that can be deployed under the Strategic Anns Reduction Talks (START
II) T~ty. (Source: Reducing the Deficit:· Spending and Revenue
.options, March 1994, Congressional Budget Office)'
.
'
.
,
For every $15 biUion in increased revenues or reduced federal spending,
comprehensive health care coverage can be provided to approximately 1 million '
people for five years.
. $2.7 BILLION
�.:.;1.: "
$9.6 BILLJON
INCREASE BURDENSHARlNG BY AIllEDNA110NS HOSl1NG U.S. FORCES
Countries in which U.S. troops are· stationed provide varying amounts of
support as the host nation. In 1991, for example, Japan signed a five-year
agreement with the U.S. that promises to contribute 75 percent of the total
cost of U.S. deployment in Japan, excluding the sa1aries of U.S. anned
forces and civilian personnel. As Congress recommended in' the
conference report accompanying the 1993 and 1994 defense authorization
acts, other allied nations hosting major concentrations of U.S. forces, such
.' . as Italy,. Germany, the United Kingdom, and South Korea" should follow
the lead of Japan in assuming 75 percent of U.S. /stationing costs
(excluding the salaries ofU;S. personnel). (Source: Reducing the Deficit:
..Spending a:nd Revenue Options,. March 1994, Congressional Budget.
Office)
.CANCEL 11IE
$8.4 BILLJON
AIR FORCE'sF-22 AIRCRAFT PROGRAM
The F-22 is being developed to replace the Air Force's current fighter
plane, the F-15. The Air Force plans'to purchase 650 F-22 aircraft.
Given the changing nature of world events, some observers . question
whether the F-22 fighter, the only prototype of which 'crashed jn 1992, is
needed. (Source: Reducing the Deficit: Spending a:nd Revenue Options,
March 1994, Congressional Budget Office)
,
$10.4 BILLJON
CANCEL 11IE NASA SPACE STA110N PROGRAM
Some' observers question whether we can continue to affor the NASA
. space station program. They cali into question its. scientific merits, '
particularly in relation to other vital scientific projects. (Source:
Reducing the Deficit: Spending a:nd Revenue Options, March. 1994,
".
Congressional Budget Office)'
.
.
. '
REDUCE 11IE FEDERAL SUBSIDY TO FARMERS PARl1C/PA11NG IN FEDERAL COMMODITY' .
PROGRAMS--11IOSE WHO PRODUCE CORN AND 011lER FEED GRAINS, WHEAT, RICE,
AND C07TON--BY LOWERING TARGET PRICES BY 3 PERCENT PER YEAR
1.°,'
$11.1
BHLION
Fanners who participate in federal commodity programs receive a
'.. deficiency payment, which is the primary form of ~t government
subsidy: to growers .. The size of the deficiency payment is calculated in
part from the difference between the market price of a crop and a target
price set by law. This option would lower those target prices by '3 percent
per year from 1995 through 1999. (Source: Reducing "the Deficit:
Spending a:nd Revenue Options, March 1994, Congressional Budget
: Office)
TOTAL
$393
BIlLION
'
�
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Carol Rasco - Issues Series
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Carol Rasco
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Carol Rasco
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https://clinton.presidentiallibraries.us/files/original/59fdb8572cf5ec1ecaf8c9084c4b61af.pdf
6070342418216e84ff246d906803678c
PDF Text
Text
Withdl, 'awal/Redaction 18heet
"
Clinton Library
.
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"
"
-D-O-C-U-M-E-N-T-N-O-.---S-U-B-J-E-CT-rr-IT-L-E-------
"",
DATE
AND TYPE
I~
001. paper
Health Care and the 1994
pages)
Ele~tion,
RESTRICTION
I
""
PoIls and Strategy (political) (13
I
"
12114/1994
Personal
~:isfile
I
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAiBox Number: 8506
------------------------------------~----~-----------+---------------------------------FOLDER TITLE:
Health Care [2]
RESTiU::TION CODES
I
Presidential Records Act - 144 U.S.C. 2204(a)1
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P2
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P4
t
National Security Classified Information l(a)(l) of the Pi:AI
Relating to the appointment to Federal office l(a)(2),of tt.e PRtl
Release would violate a Federal statute l(a)(3) of the-PRJ', I
i
Release would disclose trade secrets or confidential commercial or
financial information l(a)(4) "of the PRAI
I
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the P:lA1 I"
P6 R.eIease would constitute II clearly unwarranted invasion of .
personal privacy l(a)(6) of the PRAI
C. Closed in accordance with restrictions contained in d:;nor's"deed
of gift.
• PRM. Personal record misfile defined in accordance with 4{U.S.~.
2201(3).
,
RR. Document will be reviewed upon request.
I
I
20 10-0 198-S
kc732
Freedom of Information Act - 15 U.S.c. 552(b)1
"b(1) National secJity elassified information I(b)(l) of the FOtAI
b(2) Release woul,d disclose internal personnel rules and prac~icesof
an agency 1(~)(2) of the FOIAI
b(3) Release would violate a Federal statute l(b)(3) of the FO[AI
b(4) Release would disclose trade secrets or confidential or financial
information :[(b)(4) of the FOIAI
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financial inJtitutioris [(b)(8) of the FOIAI
b(9) Rclease woJld disclose geological or geophysical information
concerning/lwellS [(b)(9) of the FOIAI
,
I,
________-._i{."'_____------
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JACKSON HOLE GROUP _ _ _---+-_ _ _ _ _ __
Paul M. Ellwood, M.D.
President
Nov.ember 8, 1994
Ms. Carol H. Rasco
Assistant to the President
for Domestic Pol~cy
The White House
Second Floor I West Wing
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear Carol:
Like the Administration. the Jackson Hole Group is rethink.ing its health policy suggestions in
light of private sector success in slowin~ inflation over the past two years and the inability of
the Congress to find a solution upon which they could agree. We are reluctantly persuaded
that comprehensive reform will not be accomplished by one sw~ing piece of legislation, but
by necessity through a series of smallet proposals that build OD bach other.
Jth
You are probably somewhat familiar
the Jackson Hole GrJUP. 1t is an informal and '
fluid group of leatlers drawn from the ~ealth sector. employers,/ and JXllicy makers, who have
been meeting in my living room over the past twenty-odd years. Our focus has always been
on how to make market forces work in'the health system. with Ian emphasis on competition '
and accountability under govemmentally-cstablisb~ ground rulbs. We address specific topics
related to health reform; develop potedtial solutions, persuade e'ach other to appJy them, and
then keep tabs on whether or not they ~ working. This inforinal process of consensus
building fo~tered the dev.elopment of the managed care jndus~ and the so-called managed
competition public policy proposals. Iits participants continue to apply these policies within
their own organizations, and to advoc:1te. refonn based on man~ged competition.
Over the course of the last two years. iwe learned that some oflour original public poJiCJI
proposals either were not politically fc;asihle or were being applied by employers in the
private sector. This in tum lessened the need for aggressive pQlitical intervention. We
further had to acknowledge that we dib nOl have adequate or ti~ely infonnation to project the
cost of various approaches to refonn tnd of universal coveragd, no maner how it is paid for.
The tonuous logiC in the various mailiematical models that wefe used for health care reform
could, be twisted to produce any desirdable, but no believable, bswcrs. To keep the refonn
process moving and jn a search for bi~partisan consensus. we Proposed Managed Competition
II. Men indeed found the middle and formed the ha..~ls for the House Bj~Partisan and Senate
Mainstream proposals.
Mailinj: Acklre$s: ,1'.0. Box 350 1(!loll ViII<lge, WY 83025
Fed·fl\/tJPS: h7tXl
~or1h mm Crt:'t!k Road
)acksoh. wy 83001
307·7,]'1·1176 Fax: ]07·7J9-1177
�.", ,
Ms. Carol H. Rasco
November 8, 1994
Page 2
Now whati' Over the past eighteen months, the pace of reform in the private sector has
increased exponentially and elements of managed competition ~e being widely and
successfullyappJied. Integrated delivetY systems are becoming the norm, and effective group
purchasing through private business coalitions (an estimated 120-140 are currently in
operation) and State·led voluntary purchasing cooperatives is ~ve1oping at a rapid rate. In
addition, the majority of States have afready passed versions of. small group market reforms.
~
There remain, however, deficiencies our health care system, uneven coverage, inequities in
the tax code, a woefully inadequate infonnational infrastructure, and an unsatisfactory
approach for shifting Medicare and M~caid beneficiaries
managed care. To this end,
the Jackson Hole Group is in the process of developing a thirdjphase proposal for health
refonn based on the Original managed bompetition concepts, tentatively entitled -Responsible
Choices".
intol
All of us involved in the recent health .care debate failed to convey to the American public
that achieving our ultimate goal of pr,*ucing a healthier natiod will require everyone's
participation, and to some extent sacrit;ice. The message to th~ American public was that
someone else was responsible for the faults of the system, be they insurers, providers,
pbannaceutica1 manufacturers, employers, or the government. Continuing this painless
pre.-;cription is, I fee1, a gross disservi~e to the public.
Therefore, "Responsible Choices" will focus on the notion of responsibility shared by all
parties participating in the health system -- employers, individrlal consumers, insurers and
providers, and state and federal goverrtment. It will call for l~SS government intervention,
but correspondingly mo~ private sec~r commitment to internal reforms, than either the
Mainstream or Bi-Partisan bills. It will also focus on achievin~ reform in incremental steps.
by which we mean predictable stages, 'with failsafe mecbanis~ in place to anticipate fuLUre .
problems that we have not yet solved, 'and to allow us to modify our approach if it appear~
necessary. One thing J've learned ove~ the years is that changb in the professionally· '
,
dominated, trillion dollar hca1th industty always takes longer than expected, and rarely
I
procedes as planned.
Recognizing that you can't overtly endorse the work of any particular group, I would
nevertheless like to invite you to partidipate in the Jackson Holb Group process in any way
you feel is appropriate. It may involv~ simply an informal exdhange of information or
.actually participating in meetings here iwhen the topics lITe of iitterest to you. Since Donna
Shalala recently partiCipated in Jackson Hole C'JfOUP activities~ ~he might have suggestions on
how best to interface with thix activityl
.
I
Our meetings next year will be held o? Fehroary 17-20 and Aygust 24·27. At the, February
meeting, we are going to critically evaluate the "Responsible Choices" proposal prior to its
being published in late February. We welcome your partiCipation at ejther or both of these
�·
'.
~:
.
Ms. Carol H. Rasco
November 8, 1994
Page 3
meetings, or otherwise in OUT policy development process, to the extent you would fee)
comfortable.
I
1 have sent versions of this letter to five Administration officials, Including yourself (see list
below). 1 am concerned that by conv~ng the same message th so many policy makers, we
may not bear from any of them. car~lt ~use we became ~uainted in the past when you
served a.'l a mediator betw~ myself and others in the White House, please feel free to give
me your informal suggestions on how :we might best collabora~. I intend to do everything I
can to assure that the Jackson Hole Group is more su~ ib coordinating with and
supporting your activities than we werb in the Clinton A~OD'S first attempts at health
refonn. We really want to helpt and Welcome your suggestioris as to how best accomp]jsh
our mutual goal.
I
[ look forward to your input, and
ma~
be reached at 307n39·1l76.
Sincerely,
Paul M. Ellwood, M.O.
A version of this letter was sent to:
The Honorahle Uoyd Bent~n) Secretary of the Department of the Treasury
The Honorahle Alice Rivlin, Directo~ of the Office of Managtment and Budget
Rohert. Ruhin, Assistant to the Presid~t for Economic Policy I
The Honorable Donna ShalaIa, Secr$fy of the Depanment of Health and Human Services
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:.- health reform efforts such as the Rowland/Cooper-B,Illrakls/Grandy proposaL'We.hope:·~hi:'·':;:;i~·~'):':'1~;~~.q!i.·,;.
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futu re 'CI rcumstance demonstrated what we already: knew; .health :care .reform IS'a'tnal' ana]!-ie:~§,~;:.::·t>· .
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'" ::-r:.:.,':: ·..~. .:c·urrentIY in operatio'ri), well as'Statef:leo _voiu·ntarYpu!chasing·co·operative~,.·j{:h'~yri)g~~~~~:~~W~::,~~·:,,,··>-:··
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and priv~te sectc)r initiativ~~.
this ~nd, :theja~k~o.n·H.ole"Group· i~·:id:'t.~.~>tf{~.&:ti~t~~~>·,;.:,,-:,
'. .:,:::: ,'... ' process of developing yet another proposal for health reform 'baseQ on an updated .y'~rsI9~ 0i::};}{.;~i}-:
.. ":,". . of managed competition, er:1titl~d "Resbons'ible Choites";·. ..;. ::,;:~:.
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Mailing Address: ·P.O: Box-350 Teton Villa:ge~ WY 83025 .' .
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�~'(>;~~~:;~::~~I~9~:wt Gingrich..
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on .the.notion of responsibil ityshared by al r parties;?;;....\::if'· .'....
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".. :;:-·',··.·,:·~'participating in the health system-employers, indjvidual consumers,'insurers and :",;::: ::~:";'<~»
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':';":':.-'" but correspondirmly more private sector commitment to internal refOrms, than 'either the :, :"";~:>,,~,'
. <:,":'.. " Senate Mainstream or House Bi-Partisah bills put forth th'is lastt session. We .are..currently> '. :" ~:~J;',.:"'.'-,
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': ~i;~:;~:', '< .~holding a series of meetings ~nd conducting analyses of State and employer experien,ce in :>.;~>:>;:"
'·:/'>,\!:',i:.'~'>,:, QU,Ying econon;ical health care.' Based on initlalrevie'N, RespbnsibleChoices islikel/}6, ~~,~,:};:~:,>~,
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·::.':::Responsible Choices will be based
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',.' ,;,,' ':,~:' ::Pnvate Sector, Voluntary Agreements
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Bfnefits'. Aibasic.set f standard b ne,fits would.. ~~ offere~:d.Qt:·;f.~1j~~~{.,{:: :.
ea t pans, an emp oyers as an option or purposes 1fva l uecomparlSons"~n.',:ii:t~;,,j~t;;~~~~":;':::'.,:
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allowing inv.~stigation and id~l)~ific~tion of-the' effediv~ness of medical s~,rVi~~.~~;~i~·,:~,;q¥¥:~~':;::;"
Heal~h plans and e~ployers ~o~ld be free ~~ offer anyj a~ditional. ~ac~;~ges.j;:;'.:~~~:};~~~J;~~>:
Quality Accountability.· Qu~lltYI accountability systems should be ,~mpr9ye.,d '~:st;~t/ .!:(.~;:-'
through ".standardized . . . to the - public; giving .gr~ater emphasis, to;'theimpact':: ..";" ,iJ:·;'I~>:
reporting
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of health plan 'activities on p~ople's health. Uniform 1easures ,should include'~r\:~~::;·tf:t~~.~·~·.
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Management and Physician -:Relationships, We are'cbncerned 'about the"growih··g:fY:~~,,~f~X'F~'~.
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sch isni" betwee'n physicians/as'represented by organized medic'in'e/ arid the<::- :;,?1i~'1r;~/<:~/;;~\:,:~;;;.::- .
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d Ifferencesand to head, off an. atmosphe~e analogous to 'un lon:-manage~ent.stnf~i i,. ..
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'''':'~S~{''/:~;~::);'r~sOlved and agreements. reinforced. II, addition,we a're . " j into the'possibi'lity'~~6f)t!:'r:~;~~,'f:':, ",.'
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Medicare. Medicare cost~should not ~is~ faster tha~ t~e.rest. <?f the ~co~oniy),~,~;;,-~,;:,~~:;~~,:~/.:
gover~~e~t reve~ues, adJ~sted !or an aging population and increasing n~mb~.~~ ..8r~.":,;.;:;;:~:~·:<
beneflclanes. To accomplish tHIS, the government sho:uld emulate the pnyate "'::;;':, '~;:'{i(>.:~·:~·.""' ..
sector by shifting Medicare benkficiaries into competitive managed care plans::as~.; }t-;I.. ~~ .,':.
quickly as possible.
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Information Needs. As the CBP scoring proc,ess dem?nstrated, current, d~ta, on' th.e ,~...:;~;;;~~~>
health system's performance are Inadequate. rhe government should ta~e the lead .. '.::.' ~.,: ",;
in setting uniform measures for :data reporting and coll:ecting, particularly on cos,t..";. ,:-,~:~" .:':/'
and coverage. We need something analogous to the Bureau of Labor Statistics for )~~'\<::
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health care.
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'" ;The Honorable NewfGingriCh
.' .. December 7, 1994
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Cost Consciousness.' In order to provide greater fairne~s in'th~;'tax code: ~ol'to,·;~{~;·,;q~;~:·-:'·'''~,
pr'omote C9st consciousness on the .part of consumers ~nd health, plans~ t~~?~5~!q.:.!
:hould be instituted a fixed Iimit1 to the ~ax :~dusion fd~ the .cost ~f h¢alth :ben.¢;r~!~",~,
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In e~change.for equal tax treatmrnt for nidl:vlduals' ~ndlt~e self emp'loy.ec.t:~:::~~. .t.f;';:::,'5{?+ .<~.;:'
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.Medical Savings Accounts (MSAs), .We are attempting to develop sOll1e appro~ches ?{,~;.,.~~
. . to MSAs that do not discriminat~ against thos'e with pr~existing coriditi6ns,ancLthat ~~~.:.' \."':'
.have a less damaging'effect on. the djstri~ution ofinsur1nce ~isks.· !~!S ap.pr,6.~sH~rl.i:
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woul~ reward healthy behaviorsl'fo~everyone, and at tfue sam,e·tim.e.aiscou~age~~.:('~
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ReforOl~: Insuranc~~~;or~s' s~quld e;"p~asife'spr~:~df~:g':he,~hb::;!l~t~~"
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what w(;>rks best, and yvill. further advise'on what we have I~arned. '.:'!Ve erijQi,a.
. excellent working relationship ~ith'the Natidnal G'ovehlOrs' ~ssociaffon/and Wi
. continue to consult\vith th~in"bh.how·p.e·st t~f~pp'r,dach'in·sdiahc~·!:¢f9rri1~Z:. ~~~i~:
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sho~ld .retam~anag~ment of t,~f.pr~.g~~n~, :.~~ weJe~I)~~\;1~~~,~):nbr~~8[~~~~},to
keep management at the local level. -:. ~-. ,',
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. These.changes, esp~cially the m~ve t?wards ma~?geo ffue :i.n. tbe 'p~~!.iS ·,~i<?~r~Jn.~.<".
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eat.e a large amo.unt of co~tro~ersy In the me~ Ical cornmun Ity, .Bec;au,s~ ~?! ~he :;~~~r:.:;.);., ;'.::-tg !'·':"
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requirement that States retain a balanced budget, they seem petter able to stand:up :,~~,,8~·;"-j[~· .; .
to the pressures aligning against' managed care.
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~ :- ....": ~nevertheless like to invite the Republican congressional leadership to pal1:icipa~e in the-:'};2)i~;,;.,~'\~.'.
::: ..;'"/:';':" ':. 'iackson Hole Grou'p process in any way you'feel is appropriate.. It m·ay. involve ·~im'pb/:air·~~'x;~·~>·
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;:~topics are <of interest to·you.
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:;~< vye currently have scheduled a meeting for February 17-20, 1995, 'at whiCh time we~yvil.! ):':\<Bf ... :.
".< .. ·critically evaluate the "Responsible Ch6ices" proposal prior to itsbeing pu.blished in'late)i?~::' i'/;\· .
'.: .'.:':~ February. We would welcome the participation of yourself ofa repres~entative of yout-:,:;~:~f·]f~t ..
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.:-,t·~::':.The H6~:~~ab'i~ Ne~t Gingrich":. ·~~~>;~V
'._~:'~":'.:' December"l, ;994'"
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have"had in the past wi II continue;,Fonhe'nextJew' weeksj;;1 can be'reached at '307/73 9": .;;-;.:~:::." , ':
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�STATE OF THE UNION -- HEALTH CARE INSERT
Structuralrrhematic S~ggestions -- Outline
1.
Restate commitment to health security. Important to show that the vision was and
still is right, and that whatever dolitical obstacles there Jre, the President is still
committed to this larger goal.
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Strong restatement of larger goal also provides a way to measure all
Republican health care efforts.
~keresponsibilitY, but ,<10 not dwell on the past: The
Express disappointment and
President should briefly ackno'"[ledge the past -- that there were differences, mistakes
and/or disappointments -- but it should be clear that h~ is not apologizing for having
tried.
3.
Stress that the problem still exists: There are three goals served by stressing that
the problem still exists.
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This is not a matter ofl politics, it is a real problem that won't go away.
Therefore, "we can't give up." We care about riiiddle class families who are
losing their health insur~nce and therefore we hhve an imperative to keep
trying.
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Broad roblem definition: We must define tHe problem broadly 'enough so
p
that we don't give the ifupression that minor in~remental refonn is enough .. We
. 1
I
are not for thmgs that "sound good, but don't solve the problems".
Health car; costs: HJlth care costs still threJen the fiscal security of the
nation (the major causd of future deficit increaJes) and the financial security of
families. Examples frdm OMB:
' .
• .
Health lre costs will rise more than 50% per person by the
year 2000 -- from $3,300 in 1,93 to over $5,000 in year 2000.
•
BetweeJ 1992 and 1993, 1.1 million more Americans lost their
•
84% of the uninsured in 1993 lived in working families and
more than 55% were in familiek headed by full-time workers.
•
As many as 30% of employees say that they are afraid to leave
their job for fear of losing health coverage.
1
•
health irisurance. (PLEASE NiTE: no 1994 statistic available).
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�4.
Make clear that the ultimate legislative vision is still health security for all
Americans, but reach outwith!step-by-step path th~t Republicans and
Democrats should be able to agree on.
Three goals to this point:
•
Define incremental measures as part of step-by-step plan for
.
univ~rsal covera~e: Make clear that any /incrementa.l steps we accept
are vIewed as a s~ep toward the goal of Health secunty for all and not as
..J health reform in itself. When we work tdward or sign an incremental
step, it must be 'seen that we are not sati~fied but that we see this as
only one step in Our path toward our Ultrate objective. .
•
Take
of certain measures: IThe Administration is looking
toward five goals for 1995 and 1996: 1) insurance reform; 2) cover
America's childrbn; 3) help to workers who lose their jobs, 4) long-term
care initiative; ahd 5) self-employed tax: deduction. To the degree we
. reach out and ask for cooperation in pas~ing these five steps, we hike
ownership of th6 ideas, and when they Jre proposed by others, we can
define the ideas las cooperation in movirlg toward our step by step path
.toward universal- coverage.
ownershi~
Rationale: The /paCkage chosen by the President is attractive to many
. key and influential consituencies -- (1)' the middle class who care about
security and res~ond particularly well
the ,insurance reform and the
health insurana? protection for the short-term unemployed, (2) the more
traditional health care reform advocate~ who respond extremely well to
the children's ahd the long term care pi1eces, and (3) small businesses
and their advoCates who love the self....;Jmployed tax deduction, which is
likely to be p~sed by the Republicans Ino matter what happens.
(fncidentally, t~is package is absolutely consistent with the letter the
President sent to the Congressional Le~dership on December 27th.)
tb
~iS
The benefit of
1225. -2fi J1Quurnl ksilliming str.aregy is simple:
It Congress moves on any acceptable land substantive level . they are
lik.ely to move itowards some or most the aboVe-mentioned vision.
It they do. it ~ll appear that they are;respqnding to the President's
clearly Jocuseq challenge: he will clearly NOT be vulnerable to the "me
too charge. It the Republican majority does not pass all or most Q/ the
above. the President and the Democrdts can more clearly contrast his
position to that Qf the unresponsive, upearing Republica;;s: "They could
not even respOnd to a 'modest'set of basic health care priorities that All
Americaris share. /I
JJ
/I
2
�•
Show bipartisan willingness to reach out on these steps: By reaching
out on thes~ step~, we are telling Americrns that we are 'willin~ to look
for those thmgs that we can all agree on ,to make progress. ThIS puts the
pressure on them to do the same or be held accountable.
s.
Draw the line on Medicare: The President must make clear that while we are willing
to reform health. care entitlemeJts in the context of health care reform and expanding
coverage, he will not accept Mbdicare cuts to pay for Republican tax cuts for the
wealthy.
6.
Consider the Health Care that Congress Has Approach: George and others in the
group believe that we may waqt to draft up some lang6age for the President's .
consideration: that says something to the effect that, '\~e should take steps towards
assuring that all Americans ha~e the ability to have ana to hold onto affordable health
insurance. All of us in this robm have that benefit; isb't it time we started to treat our
constituents like we treat oursdlves?" NOTE: This lahguage is very rough and it
needs work; moreover, the prds and cons of using thi~ approach probably merits
further discussion.
3
�M.E M 0 RAN DUM
TO:
FR:
RE:
DT:
cc:
Health Care "Map Room" Pal]licipants and Other Health VIPs
Lorrie McHugh, Chris Jennings and Jennifer Klein
Health Care Talking POints/Qs and As/Daschle Bill
January 4, 1995
Carol Rasco, Bob Rubin
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. Attached you will find talking points/Os and As to help Admipistration officials respond to
questions regarding health care refonn!, in particular, Senator IDaschle's bill that he will be
.
I
introducing today. It is for internal u~e only. Please do not distribute.
Also enclosed is the latest two-page Jummary of the Daschle bill that his office just prepared.
Although I have Monday night's copy/ of his bill language (and have given some of you'
copies), the bill was still being modified late into last evenind and, I think, today. I hope to
. 'have a final version later today for those of you who are interested.
.
doc~ments
We hope that you will find these
helpfuL If you have any questions, please do
not"hesitate to contact either Chris Jebnings (456-5560) or J~nnifer Klein (456-2599).
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For/Internal Use
Health Care Questions and Answers - January 3, 1995
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Q. How is the Achiti.nistration going to proceed on health care
reform?
J
A. -* The President remaiJs firmly committed to providing
insurance coverage for eve~y American and c6ntaining health care
costs for families, businesses and Federal, State and local
governments.
* As he stated in his December 27 letter to Congressional
leadership and during end-9f-the-year interviews last week, he
believes that we should work in a step-by-step manner to achieve
these goals.
- ,
/ . ,
'
* The President wants this Congress tb ~ork with him in
taking the first steps by passing measures/ to address the
'
unfairness in the insuranqe market, making coverage available and
affordable for children a,nd unemployedworlkers, assuring that the
populations served by Med~care and Medicai~ are protected and
reducing the long-term fejeral deficit.
Q. What is the Administration's reaction to Senator Daschle's
I
health care proposal?
I
* Senator Daschle's proposal is consistent with the V1S10n
laid out by the preSident/ in his December/27 letter to the
Congressional leadership. Both the President and Senator Daschle
want to work in a biparti!san fashion on h~al th care reform. The
nation's health care pro~lems have not gohe away and it is
imperative that we move forward.
/
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Q;- Is the Daschle bill effectively the Administration's bill?
sh~~~es Ithe - visi~~'- that- tth~-president ,outlin-ed
---;- No, but' itin his letter to the
Con~ressional
includin~ heal~h
leadeFship last week.
* By
care in his lJadersh{p package,
Democrats are sending ani important signal that, health care reJorm,
remains a high priority for the nation. IWe hope to work with the
Republicans in abiparti,san manner to enact health care -reform
this year.
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Q. Did Senator Daschle cJnsult with the President?
* Senator Daschle
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his staff inf/ormed the Administration
of the proposal and outlined the direction that it would take.
~nd
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�Q. Senator Daschle is challen'ging Senate Republicans to pass his
bill within the first 100 daYis of the 104th Congress . . Does the
Administration support this ~hallenge?
* Everyday, American flamilies are losing health care
coverage ~ This Administration has been worJ.hng hard to ensure
that families have quality, affordable heal tlh care. Every day.
that we wait, more families live in jeopardy of being one job
loss or one illness away fr~m losing their ~overage. We want to
work with Congress to move health care reform forward as quickly
as possible..
.
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Q. What specifically does the Administration feel about Senator
I
. ..
Daschle's insurance reform p1roposals (or any· other specifics in
the bill)?
.
* We haven't yet anal~zed line-by-line every provision
Senator Daschle'~ bill appears t~ be consistent with
the vision outlined by the IPresident last week. What the
Administration feels is imRortant is that tioth Democrats and
I
Republicans work together to move forward on health care.
propos~d~
.
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* As the President said last week, we can and should work '
together to ~ake the firstlsteps necessary to put us on ,the road
to achieving health security and containing health care costs.
Administra~ion
i~surance
Q. Last year the
said that
reform could
not really be achieved in the absence of universal coverage. Has.·
the Administration backed ~~ay from this claim?
A.
* This AdministratioJ has not backed laway from its
commitment to provide Amer.icans with real health security. We
believe, however, that th~s now should be done in a step-by-step
approach. We can put Ame~ica on the' road to universal coverage
by addressing the unfairness in the insurance market and
bevginniTrg by expanding coverage to childr~n· and working families.
But all of this must be done in the broader context of eventually
reaching universal coverage.
.
v
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Q. Last year the Administrktion said that everyone must be
covered by 1997. Now you are saying eventtially.
eventually m e a n ? /
/
What does
A . * We need to focus our energies now on putting America on
the road to health secur~ty. Let's move ~orward in ·a step-by
step fashion to ensure that Americans haVie quality and affordable
health care.
I
Q. Will health care be in the budget?
A.
* There have not been any announcements made on the budget.
�. Q. Will the President introduce health care l,eqislatiOn?
* Everyone knows where the President stands on health care.
His goals have not changed. He believes th~t we must now act .in
a step-by-step manner to achieve these goals.
A.
wo~k
. . * The President is cornkitted to
ih a bipartisan fashion
to begin putting America onl the road to hea~th security. He will
work with Congress as Demodrats and Republibans develop
proposals. . If he feels that adequate stepsl are not being taken,
legislation may be introduqed.The President ,has made it very
clear that he will NOT give up the fight t~ for health security
and affordable health careJ We need to wonk with Congress and
see what develops.
I
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Q. The President says that he believes.that we can make a start
on expanding coverage.
HOW/Will he pay for It?
* The Administration wants to work WiJh Congress to expand
coverage and ensure that apy action taken is paid for and
achieved. without increasing the deficit.
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FAMILY HEALTH INSURANCE PROTiECTION ACT
I
Summary
.
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'This legislation rep~ents a first step toward the goal of en::;uring that all Americans have access to
affordable, high quality coverage in a corhpetitive hl;!:alth care marketplace. While only
comprehensive refonn will achieve all of these goals, this bill tac~es many of the most pressing
problem.1:; plaguing working families andsmall businesses and entourages states to move forward'
with their own reforms. Specifically, rhls bill ensures coverage dumot be lost because of ill health,
loss of employment, or a disability, whilb providing premium assistance to me temporarily
unemployed and children in 10w-incom~ families. Finally, this le~slation (.:alls (or a more
coordinated response to healm care fraud and abuse. reduces health system bureaucracy and red
" I
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tape, en hances access to care U1 run arqas'andaddresses meffi·1 . . our mal prdCoce system.
ClenCles m
,
Title I
-
Insuran£e
I,' '
Reforrn~:
,
,
Ensurinl: Portnble and Affordable Coverage
.Ib Wlthout l ' t h"1
. osmg elf msurance and that' no one qn be
"
· 't!'
Th'IS t1 e ensures workers can ch ' J9
ange
S
denied coverage because of a pre-existipg condition, the birth orla disabled child.; or any other
medical condition. It also prohibits insurers from dropping customers or raising their fates once
they fall ilL Finally. it ensures mat all Americans have available~o mem the same coverage'that
Members of Congress have, with bettd information about the qJality and prices of all health plans.
'
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Guaranteed issue and renewability :for individuals and smaIL group market (1-50 employees)
Prohibition on pre-existing condition exclusions for those with continuous 'coverage
Six-monm limitation on 'Pre-existi~g condltion exclusion fo~ those with coverage lapse
Limits onvariarion in premiums due to age (applies to individuals and small group market)
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Pn;>hibition on lifetime limits
Requirement that insurers ,offer "Benchmark Benefit Plan" that includes all benefits available [0
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Fedc:ral employees (insurers may also offer other benefit paclcages)
,
~, Standards for quality assurance, ~?nsumer information and/consurner protection
,
-Grants to states to establish purchasing cooperatives for businesses and individuals", .. ,__ ','
'-~~ ....---....-'-'-.-'-; Healrh-C~~Cost-C~~ssi~n ~;dated- to m~nilor and ad~i~e Congress on health cost increases
•
•
•
•
,•
•
Title II • Assistance fur SmalJ Businesses and Families
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1S tl
Lor
Th ··t!e proY}'de s tax incentlves c sm al'lb usmesses an d aSSIstance to ..uJ.wles, for th' e pure h ase of
private heahh insurance .
• 100% health insurance premium (J~lllctibility for the self-employed (phased· in by 1999)
• Premium subsidies for shon.te~ unemployed with famil~ incomes up to $35.500 (2400/0 of
poveny) to ensure continuity of c'overage during periods of unemployment
Premium subsidies for children families with family inJomes up to S35,500 '
ih
�Title III -
Imp[Qyjn~
Access to Rural Health Care
I
This title helps rural communities adjust to mc changing ruralheallh care environment through
grants and technical assistance for the esdblishrnent of rural healthl plans and telcmedicine
networks and the establishment of guidelines to clarify the types of collaborative activities
p~ssible under antitrust law .
• Establishmenr of Assistant Secretary,for Rural Health in HHS '
• Grants, for the development of rural ttrlemedicine networks
• Demonstrations for development of health plans in rural areas '
,
Requiremem for FfC and DOl to da'rify "safe harbors" for rural collaborative effons lhat do
not violate Federal antitrust policy
Title IV
Quality and Consumer Protection; Administrative Simplification,
Privacy, Fraud and Abuse Prevention, Bnd Mahiracticc! Reform
.
~OUld
This title establishes new guidelines that
decrease the heall care system';paperwork and
administrative costs through standardi7.ed billing and claims form~ and the electronic transfer of
information. These provisions would alsb protect the confidentiality of individuals' medical
information, strengthen and coordinate fbderal fraud and abuse cdntrol effortS, and make our
mcdiciU malpractice system fairer and m6re efficient
I
• HHS adoption of guidelines to standardize health care financial and administrative transactions
• Establishment of rules for provider J.nd health plan'llCcess to fuedical data while ensuring
"
confidentialitY; of individual medical! records , "
• Establishment of joint HHS-Justice 1p~Pt health care fraud and abuse prevention program
'. Medical malpractice reform through limits on attorney continge.ncyfees. periodic payment of
awards, allocation of punitive damake aw.uds to provider quality improvement effons, and the
use of s[ale-basedalr.ernative dispute resolution systems. "
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�. THE SECRETARY OF HEALTH AND HUMAN SERVICES
I
WArNCWN. D.C. "'"
2 1 1994
MEMORANDUM FOR THE PRESIDENT
We can take considerable pride in t~e progress we have made in slowing spending
growth in the Medicaid program, while enhancing coverage and state flexibility.
•
The annual growth in Jedicaid spending hai dropped from 30% in the
last two years of the B~sh Administration to about 9% today.
•
One-third of welfare reLpients and other covered children are already
in managed care plansland participation is :growing rapidly.
•
.
.
S· States are uSing ~Ical waIvers t t l
IX
0 s ream I'
Ine th' programs
err
and expand coverage; nine States have prdposals in the pipeline.
ML~';d
While we will must continue our efforts to improve Medidaid efficiency and
flexibility, I am deeply concerned about the proposal to tap the Medicaid program
that you are conSidering. Although Iwe expect Republic~ns to propose such caps,
for us to do so is unconscionable. r'e would be abanddning our commitment to
coverage and protection of the nation's children and othkr vulnerable populations.
~he
Medicaid safety net
Declines in employer-based coverabe make preserving
critical to keeping coverage intact. Over the last five ye~rs, the percentage of the
nonelderly population covered by employer-based insur~nce has fallen by
7 percentage points. Had Medicaid coverage not incre~sed by 5 percentage
points, the uninsured population wbuld have grown drarhatically.
i
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Proposals to cap spending put states and beneficiaries at risk. No one would
credibly argue that we can dramati1bally slow growth through efficiency gains alone.
Expansions in managed care are already in our baselinb, limiting future gains.
Caps will simply mean less Fede~1 money for coveragJ.
fl~Xibil~Y.
a Medicaid dap would conflict with our
Despite the appearance of state
current waiver policy. Under this Administration's waiv~rs, states are achieving
savings without losing Federal dollars. In fact, they ar~ using Federal dollars, with
their savings, to expand coverage) .A cap that is designed to generate Federal
savings would reduce Federal dollars and the ability of states to expand.
�Page 2 - The President
Even if the cap were relatively generous, states will be differentially affected.
conti~ue
•
to receive large
States with generous Jrograms· would
amounts of Federal fuhds, while poorer States. even if they were
prepared to expand their programs, could glet no additional funds.
•
States with depressed economies would lole the partial cushion
against economic downturns that Federal rhatching of Medicaid
payments affords.
I
•
.
States that want to expand coverage would lose the opportunity to
obtain a Federal match; e.g., 35 states. haJe exercised the option to
I
cover infants up to 18,5% of poverty.
To live within caps, states would have to cut payrrients to providers, eligibility
levels. or benefits. Some states cOuld negotiate lower payments to providers if
given more flexibility (e.g .• Tennes~ee). Medicaid payrtlent rates are already much
lower than Medicare's and the priVate insurance market. Further cuts either .shift
costs or reduce access.
When it comes to eligibility and services, people too often forget that Medicaid is
not simply a welfare program. TWb-thirdsof its spendirlg goes to the elderly and to
disabled people. Disabled enrolle~s, including children! are the highest users of
the extra services (like rehabilitatidn) that Medicaid cov~rs which go beyond
standard insurance packages. C~ps could be devastating for these groups.
~II
of your professionll lives working to improve
You and Mrs. Clinton have spent
access, benefits and quality in M~dicaid for our most v~lnerable populations. I
urge you to reject any policy that jeopardizes your sign'ificant achievements.
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Donna E. Shalala
�.,."
EXECUTIVE OFFICE OF THE PRESIDENT
I
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OFFICE OF M.ANAGEMENT AND BUDGET
I
WASHINGTON, D.C .. 20503
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December 21, 1994
THE DIRECTOR
MEMORANDUM FOR THE PRESIDENT
~
FROM:
Alice Rivlin
SUBJECT:
Medicare Extenders
There was considerable discussion in pur meeting .on Monday about the various categories of
Medicare "extend,ers" or savings poli~ies that were in OBRA!1993. The. purpose of this
memorandum is to provide a more de~led explanation of the classification of the various
Medicare extenders and briefly descripe each extender. Theie are two main.categories of
extenders: (1) proposals that continue savings that would di~ppear from the Medicare
spending baseline as a provision of cdrrent law sunsets; and (2) proposals that repeat, a
Medicare payment reduction policy that generated permanent Savings, and in ,so doing
achieve additional savirigs during the jfive-year budget windOr as well as in all future years.
As you heard in Monday'~ meeting, ~e first Category; which includes $13.8 billion in
savings over five years, is not in contention. With respect the second category of'
proposals, totalling $5.4billion in fiJe-year savings, there i~ some question about the extent
to which provider groups could argub that the proposals are not extenders but instead
represent deeper reductions.
.
tb
, Category 1: Extensions of OBRA',il993 Baseline Savings
.
,1,
"
The'primary characteristic distinguishing this category of e~tenders is that savings obtained
'
from these proposals are not perm~ent-..they are lost when/the prOVIsion expires. ' If
legislative action in the form of an extender is not taken, the MediCare haseline will increase.
These kinds of proposals have been :part ofthe budget IIgatrie ll for years--a savings provision
'is implemented with a set expiration) date, , so that beyond ilie expiration date Congress can
claim, I~new" savings by ,extending the provision. All of thJse proposals were in the Health
Security Act.
L
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• Extend Medicare'Secondary Payer (MSP) Provisions (-$3.0 billion). Like any,,'
.... ,,,."'. 'responsible insurer, Medicare takes steps to insure ~t does not pay for benefits legally ,
'\ required to be paid by anothbr insurer. These provfsions wW be viewed by providers
'\and payers as simple extension of provisions that will sunset and' have been extended '
p~eviously.
'
'
�-2
"
• Extend Medicare Part B Premium at 25% of Program Costs (:..$4.9 billion).
'
Originally, Medicare beneficiarips were expected to pay 50% of the insurance value
of the M~icare Part B benefit ij>rimarily physician serVices). Medicare expenditure
growth has out-paced the cost of living increases, so th~ percentage of Part Bprogram
costs paid by the beneficiary h~ eroded from, 50 % to 25 % (75 % of the cost is paid
, by general revenues). Because lfurther erosion of the 9bneficiary's contribution would
contribute to the deficit, Congress has enacted this extender in seven reconciliation
bills beginning in 1982.
'/'
, '
I
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• Extend Home Health and SIGlled Nursing Facility ~ost Limits (-$2.5 billion). In
submitting claims to the Medicare program, home health agencies and skilled nursing
facilities are subject to so-calle?tlreasonable cost limi~". ,'Because these services have
demonstrated extremely rapid r;ates of growth, OBRA /1993 lowered the cost limits for
these providers to encourage efficiencies. However,' l:)ecause paymen~ rates are "re
based" periodically, these providers can effectively "dtch-up" and the savings froI11
these OBRA 1993 provisions J,m be lost unless these Iprovisions are extended.
Ibillion). The hospital industry
.' Extend Hospital Capital Payment Reduction (-$3.7
, ", I ,
is characterized by over-capactty (Le., the average oceupancy is 61.5%). Thus,
MedIcare has taken steps to ~ntrol the amourit of pajments to hospitals for capital.
Both OBRA 1990 and 1993 iribluded proposals to restrain capital growth. This
proposal extends a savings prdvision expiring in Fy1995.
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, " Category 2: Extensions of OBRA 1993 Savirigs Policies
,
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These proposals woulq extend four ~edicarepayment policirs enacted,by OBRA 1993. "
, Unlike the above extenders, there was no sunset date in OBRA 1993 for the savings from
, these poliCies. ,Their enactment in OBRA 1993 peimanent1~lowered' Medicare baseline
spending. Thus, this second group df extenders would re~t OBRA 1993 savings policies
, and produce a larger savings stream I~Uring th,e five-year budget window as well as in all
.
future years."
WO~ld
I.
commitmen~
.'
Extending these savings policies
continue the Administration's
to confront
, ,some of the most serious fiscal problems facing the Medicate Trust Funds and the
,
,beneficiaries who depend on theirsdlvency. Policies of thi~ kind are typically included in,
reconciliation bp1s, and have been epacted so many times iliat they are viewed as extending
the previous legislation. For examp,le, restraints on the ho~pital market basket update have
been included in reconciliation bills since OBRA 1990.
, . Extend Reduction of Hospital Market Basket UpOate. OBRA 1993,r,estrained the
inflation update' for Medicare hospital payments by 2.5 percentage points in FY 1994
, and 1995, 2.0 percentagepdints in 1996, and 0.5p6rcentage points in 1997. This
proposal would extend the 0'5 percentage point redtiction beyond F,Y 1997.,
�.,Y
-3
According to the 1994 Trustees' Report on the status of the Hospital 'Insurance Trust
Fund, the HI Trust Fund is projected to become insolvJnt in 2001 -~ just six years
from now. While small, this eitender will help to fordstall, that coming crisis .
• Extend Reduction in PhYSiciL Fee Increases. OBJ 1993 reduced Medicare
physician fee increases by 2.6 to 3.6 percentage points/in 1994 and by 2.7 percentage
points in 1995. Despite these rMuctions. HHS recently announced that Medicare fees
for surgical services will increase by 12.2 percent in dy 1995. This increase is the
result ofa statutory formula, which clearly is in need ~f reform. (The Health
Security Actwould have fixed hus formula.)
/
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Extending the policy from OBRA 1993 would bea sound first step t~ gaining control
over the Medicare spending on/ physician services. niis proposal would restrain the
updates for surgical and non-surgical services by 3.0 percentage points. As in OBRA
'
, '1993, Medicare payments for primary care services wb"uld not be reduced.,
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• Extend, Freeze on Inflation IIncreases for Clinical l!aboratory and Ambulatory
Surgical Center, (ASC) Services. OBRA 1993 elimimtted the inflation adjustments to
,
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, payments for these types of Medicare services in FY [994 and FY 1995. These are
two of the fastest growing ards of Medicare expenditures. The General Accounting
, Office and HHS Office of'the /Inspector General have/ released reports indicating that
Medicare payments for clinica:llab services are excessive compared to the private '
sector. ASCs have proliferatdd since the late 1980s (increasing by 45% between 1987
and 1991). suggesting that Mkicare payments are nil inappropriately low.
.
, Extending the OBRA 1993 rrLzes would reduce payments in real 'terms, while
, allowing time to develop mor~ comprehensive' reforrrls to address the payment'
problems in these two areas df the program.
�..'"
-4
Recommendation
There should be no question about the proposals in Category 1 as extenders. Moreover,
while there will almost certainly be a Inegative reaction from providers to any proposals to
~~trol costs in the Medicare prograIl} the proposals in Categ;ory 2 can be defended on their
own merits. Therefore, I recommend that we propose the entire $19.2 billion package of
extenders~
Decision
Agree
Disagree
Needs further discussion
cc: Carol Rasco ,/
Bob Rubin v
Gene Sperling
. Bo Cutter L---'
Secretry Bentsen
Secretary Ron Brown
Secretary Reich
Laura Tyson v- .
LeOn Panetta v ..
George Stephanopoulos ......
Pat Griffin ,/
.
�.Withdrawa~}R.ed~ction NIIIarker
.
DOCUMENT NO.
AND TYPE
001. paper
ClInton Library
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SUBJECTfflTLE
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Health Care and the 1994 Election, POI1!s and Strategy (political) (13
~~~
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DATE
12/14/1994
RESTRICTION
Personal Misfile
•
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8506
FOLDER TITLE:
Health Care [2]
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THE PRESiDENT HAS SEEN
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. ISSUES RELATING TO THE BUDGET
f0110Win~ areas: turning Medicld Wo a block grant; the'
, This memo covers the
middle..dass tax cut; investments; and thinking strategically! about budget cuts. I have
limited knowledge of what's Under e6nsideration now andthus can't co.aunelll on
other issues.
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Medl..fd Block G .....t
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. An option has been developed to turn Medicaid into a block grant and cap it so '
it grows at ";0 to 8% per year (ratherl than at the higher rat~s at which it is currently
projected to grow). Th.is is a very wiwise idea for both sublstantive and political
reasons.,'
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Substantive Problem"
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.Absent !luang acUon lo I'eciuce Llle ,'ate of gI\;Jwth iUl:u!)u; thruulI'huut the
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U. S. health care syste,pt, this proposaJ would cOJllpelstate5 to make large
cuts in Medicaid eligibility and/ or services, The strong likelihood is that the
number of tmin~u,.ed wbuld rise signijicDntly QS a result. "
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The proposal's proponents apparently argue that the rate of growth in
Medicaid costs - prdjected at about 12% is too high.. and states should
be able to bring it do~n to 7% or 8%. This ;trgument misses several "
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points. Firsl, lhe 12 percent rale ot grow th ;,1.\ Mediuaiu ,-=ost~ Us d.u~ (wt
only to the rise in heaItb care costs through;but the U. S. health care system
but also to growth the Medicaid benefidai'Y population. The number
of beneficiaries is sr9wing at a rate of aboJt four percent per year, for
three reasons: 1) fed~ral requirements that /states cover more poor children
each year; 2) the ste.dy growth in the number of disabled people; and 3),
the steady ina-ease in the number of low-ihcome people who apply for
Medicaid when they lose employer-based/coverage. Many states are .
already moving aggressively to controi the costs of health services ' ,
reinlbwsed.under Medicaid by sh.iit:ing tdmanaged care. To slow overall
growth further So i~ is 7% or 8"0, the !itst ~ep that many states would .
likely take - if heed from fed~a1 Mediciil requirements - would be to
reduce, or slow
increase in, the numb~ of beneficiaries. That would
most certaiNy mea,n more uninsured peo.ple - and in particular more
uninsured children.
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Of particular concern is the fact that the most important advance in health
t;are coverage for childreh over the past decad~ - the federally mandated
extension of Medicaid td cover virtually a..l.lloW-income pregnant women
and yoUnS chil~en ~dl~y. 2002)" virtually aU poor ~dren through age
18 - would be in sen0'1s Jeopardy. The feder~l requirement would .
disappear under the pr9posed block grant, and this would be a likety
place for states to cut baCk.
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Also in jeopardy would be the federal requirement that states provide '.
. Early Periodic Screening, Diagnosis, and Treafment(EPSDT} exams for .
children in M~dicaid atid provide Medicaid c?verage for medical
prnblem!l; unmVPfPn h~ thp 'F.P5nT p.1tams. TlMs requirem~nt, also, would
be dropped under a b1lck grant.'
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Another group likely t~ be adversely affetteeJi would be elderly poor
people who are not on 5S!. Federal law requires that Medicaid help pay
. the ever-mounting Me~care premiums, ded~c:tibleSI and co-payments
.that these low-income ~lder1y face. Under th~ proposed block grant,
many states could be expected to pare back or drop this coverage. ' .
probl~ j thatUnder the covera~entitlement structure, back
Medicaid
would have to be cut
sharply dwing recessibna.
current
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Vet another
increased federal MecUcaid matching funds ~utomatically become
available when state Medicaid caseloads and costs riseduiing recessions.
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Under a block grant, ~F.tate/A federal' Mpnj('~id funding far (4 year wO'llld
be fixedino additional funds would be pro~ided if a recession hit. If the ..
t::cuI1.umy turned down, many states would be forced to put new Medicaid
applicants (such as pJor children in newly Jnemployed families) on .
waiting lists for MedIcaid. '
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.Also, if a formula were developed to allocate block grant funds among
states, still another pfoblem could ariSe. ~me states would be big .'
"losers." while other would be "winners."
. Political Problems
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This proposal woUld be seen as an Admi.nistration flip~flop. '-One year,
the President propo~ universal coverage!' The' next year1 he proposes
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changes that would [swell the ranks of the uninsured.
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As a result, this Wo1d likely be s.en as
Cl~POlitiCai ~POsitiorUng
on the
part ofthe Presiden't.That would intensUy the already too-widespread
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view that he lacks core beliefs and is essentially a vol who dOt!:sn't ~ti1.nd .
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, It would anger the groups that supported the YVhite House on health care
reform. It would antag9nize governors as well. It's hard'to figure out
who would like the proposal., .
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Middlc..cIass Tax Cut
'1 understand the political neeq to propose a ll\iddle*C!ass tax cut. . The question is
how to design it and how to payJor it. Here are some thotights..
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Keep the tax cut as modest as possible
will
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.political goals. The Administration/s tax cut
be a starting point, from
. which the size of the ta;x cut
grow on Capitol Hill. And with the
bal(ll1'\(,E'd budgetconstitutional amendment likely to pass.- and Social
Security and defense ~if-limits - a large tax Icut will make the reductions
in omer parts of the blfdget even more exaufiating as We approach 2002. ' .
(2002 is the vear the-bUdget has to be balanced under the pioposed
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constitutional amend.xltent.)
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D~aw aHouseline so to do this. people don't get the tax cut. I gather the
firm
hi~-income
White
plans
Provide the tax cut in the fonn of a tax credit rather than in the form of an
increase in the pel.'501r'1 exelllpUon or i;U\ e.x.Pi:Uasiuu uf eligibility fur .
Individual Retirement Accounts (IRAs). A tax credit provides the same
amount of tax relief tp a family at $20,000 a~ to a family at $75,000. By
contrast, an increase fr\ the personal exemp~on is worth nearly twice as
. much to upper-mid'¥e income families in tpe 280/0~ tax bracket as to lower
middle and middle-income families in the t5% bracket Expanding IRAs
is the least desirable bf these approaches. I;RA tax breaks are already .
available to families with incomes up to $50,000 (about 70% of families) ..
A proposal to expana the IRA tax bre.ak w6uld principnlly benefit those nt .
higher income levell Moreover, average quddle-ineome families can't
afford to put ~uch i~to 1M accounts, whife moreaftluent tamilles can.
The data showina that the expanded IRA tax bracket would be of little
value to typicallXlidjWe-income families ar~ strong. (There may also be
other tniddle-class tax cut options Under consideration. I'm nOl awa,-e of
the specific tax cut proposals being considbred.)
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For u~th pulitical and pulicy rt:iUiUl'\l')I the Admi.tlistration shouldn't .
propose a tax cut that be~efits upper-middle intorne families more than
families right in the mid~e of the income spectirwn or. hard-working
families in the lower-mid dle class.
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If the tax cut is provided in the form of a tax credit, the credit should
least partially "refunda~le~" A refundable taxi credit is one, like the
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be at
earned income credit, ~at provides a payment to families that qualify for
it but have incomes too low to owe income ta,d A I1Otl·refundable credit
does not provide a pay#tent to those owing nd tax. A substantial fraction
.. of families with childrert owe no income tax aitd would not benefit from a
middle-class tax cut prdvided a~ a non-refund!ahlp. r.rp.ciit. (Thp.y ~Isl)
would not benefit from/an increase in the per*,nal exemption or
e.ll.paUu.~U IR.As.) On tll~ uth~r luuld, may uf tpese families are benefitting
from the expansion of the eamedincome credit.
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Making a tax crecti.t
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refundable
probab~J increases its cost too much,
but there are lower-co$t options that involve partialrefundability. The
Contract with .A.merica is refundable to a very
. children's tax credit
limited degree. If ii'p~oposes a tax credit, thJ White House might·
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consider including at l~ast as much refundabllity as the Contract's tax
in/the
proposlll docs.
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PaYing for the Tax Cut
t:ur~,t:.nt lciw a ta~ cutlutw;t be pilitJ. fur thrlJugb offiiettiIlg cuts in
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entitlements or increases in taxes. I understand that one ~ption now under .
consideration calls for changing the budget laws so that the savings from lowering the
used 10 pay for tax cuts.
cap 01\ discreti~nary (i.e., non-entifemlll\tJ pfograms
can/be
I believe this would be a dangerous route to follow. Once the Administration
proposes changing the budget la~ to allow cuts in discr~tionary programs to be uSed to'·
pay for tax cuts, the Republicans 'rill seize upon it. They are lik!ly to cut discretionary
progta..ms substantially deeper ~ the Administration proposes to do - and to use
the additi.onal savings to. help fun.'ii larger tax cuts. ,ThiS/iS a pattern that could be ,
repeated llt subs~u.ent years. I·
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Since the current budget structure was enacted in 1990, the requirement that a
til. x cut be paid fur by .an entitl!11l.,bt cut ur a tax iOCIt:as1ie.MS wurked extremely well in
restraining tax-cutting. To abaitq.on this procedure just when the Republicans are, .
searching for ways to finance th~ir rather massive tax cuts would, in my view, be folly.
To ba.lance the bildget in seven years without to\tching defense or Soda! Security or,
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raJsing taxes - as the Republicans propose to do - w1lJ. require devasrating reductions
over the next seven yeats in the discretionary side of the budtet. These reductions will
. dwarf the largest cuts Ronald Reagan ~er proposed. Allowmg discretionary cuts to
pay for tax. cuts will likely lead to stiU-larger tax cuts and still-deeper disc:retionary cuts
in the years ahead and make this problbm more severe.
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It is understandable that the
House would feel a stroItg temptation to
follow this route. It makes it easier to pay for a larger middl~-class tax cut But the
long-term consequences for children's!programs and other discretionary programs are
seriOUS.!
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Inveslll\ellts
The Republican Congress is likely to reject many of the Clinton investments. I
would reconunel.'\d having a shorter list of investments tha~ in last year's budget,
choosing the investments cc.rclully, &rid picking severol of the investments proposed in
the budget to fightfor visibly.
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Among the'investments I
keep in the Presidept's budget are Head Start
and WIe. I understand that, the "pa~back" to HHS and USDA shortly before
Thanksgiving included All increcil$e '9f $400 million fo[He~d Starl and $350 mllllan fot
WIe. I think those are very reasonable numbers. I hope tRey have not been reduced
since lateNovember.
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I·don't know enough about 'rhat the budget contaihs for other investments or
children's programs to offer comments on them..'
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Larser Strategy Questions
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. ' One final concern. I hope ~e White House is considering which elements of the
l.ontradit mOAt wan~ tn hpat and.~ what aJ1ie~ it needs tn/dO AO. The question then .
arises of whe~r any of the cuts p,toposed in the budget would undermine such .
a.lUimc~=:i. In.other wur<U;i are ~rl~ any budgt:t l.'Utb wtdlir t:uiu:W.lercstiuu that wuulcJ.
jeopardize larger, more important Administration goals/and priorities? I don't know
whether the White House is purs~ these questions in fashioning its budget cuts.
December 13, 1994
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�THE WHITE HOUSE
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December 21, 1994
MEMORANDUM FOR TIlE PRESIDENT
FROM:
CAROL RASCO
ROBERT RUBIN
SUBJECf:
Health Care/Budget Bribfing
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As you know, the health NEC,jDPC health reform working group has been reviewing a
wide range of policy options. The purpose of this memorand~m is to provide background on
the health care policy options that wei will discuss at our meeting at 8:30 tomorrow morning
and that must be considered and resolved within the budget J.rocess. We will present: (1) the
. new deficit line that reflects changes ito the Medicare/Medicald baseline; (2) potential sources
of financing for coverage expansions land/or deficit reduction; (3) possible options for
coverage expansions; and (4) illustrat,ive packages that pair financing sources with options for
coverage expansion and deficit reduction.
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THE NEW DEFICIT LINE
While OMB and HHS are currently discussing the magnitude of the reduction in the'
Medicare and Medicaid baseline tQatwill be presented to Ydu tomorrow, the changes will
reduce the deficit by tens of billionsl of dollars over the five year budget period.
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. LIKELY SOURCES OF FINANCING
Background
Many: health reform initiativ,es that were introduced in the last Congress by the
Administration as well as by Memqers of Congress (e.g. Health Security Act, Mitchell's bill,
Gephardt's bill, Dole's bill and Chafee's bill) were financed primarily by savings in Medicare
and Medicaid.
In this Congress, the RepulJlicans will be under pressure to usc Medicare and
Medicaid savings to pay for their dommitments in the Con1tract with America. (This is why
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�~any in our base group and Hill health reform coalition are nervous th~t any cuts we put On
the table will be used not for health in~estments, but to pay inktead for the Republican
Contract.) .
The political and policy question is how best to achieve public sector cost containment
through more efficient management of: federal health programd while: (1) avoiding the charge
that we are backing away from promi~es to preserve Medicarel, (2) protecting the Medicare .,
and Medicaid programs and their reci~ients from overly harsh/ cuts, and (3) preserving some
of the savings for coverage expansionlor program improvement.
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Specific SQurces of Funding on Options List
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After long discussions about li,kely financing sources for health care, the NEC/DPC
health policy working group has conc,luded that the current pdlitical environment limits the
consideration of financing options to three (if unoriginal) soutces: (1) Medicare,
(2) Medicaid, and (3) tobacco taxes. Specific options includd:
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(1) Medicare
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Medicare savings were, by faI', the primary source of .funding for all health care
proposals in the last Congress. Even/ the Dole bill had $42 tiillion in Medicare sa'vings over 5
years. Medicare savings will likely r,emain a targeted source of funds for either deficit
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reduction or health care reform in the new political environment.
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The two major categories of Medicare 'savings proposals' are "extenders" and "other·
savings proposals." Beca~se of the Jxtreme sensitivity to Mbdicare cuts and the potential for
Hill Democrats to dispute our charasterization of o~r MedicJre savings, it is essential to
define these categories as well as the areas of disagreement.
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l$19
(a)· Medicare Extenders
billion over 5 years). In the current political
context there is likely to be a discussion about the distinction between what is
a "new" policy and what is simply an extensibn of past policy. In our budget
discussions we have Jsed $19 billion to reprekent the pool of policies that
could be defended as merely an extension of hxisting policies. However, as
you know, both from recent budget discussio~s and from Alice Rivlin's memo,
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there maY,be some di,spute as to whether $5.6 billion of the $19 billion that we
list as extenders are perceived as resulting frtim new policies.
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We list $19 billion
Medicare savings as "Ltcndcrs" in our budget tables.
"Extenders'" have bee~ categorized in two wa!ys in our budget discussions : (1)
proposals that simply! extending existing savihgs that would disappear from the
Medicare spending bkse1ine as a provision o£ current law sunsets; and (2)
proposals that contin~e a trend of Medicare ~ayment reductions,: and in so
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doing achieve additional savings during the five-year budget window as well
as in all future years.
You should consider two political realities. First, it is possible that some
people will consider any new Medicare savings _1- even pure extenders -- as
Medicare cuts. Second, iif provider groups or the! Hill take issue with the
definition of extenders, the protective label of "erenders" quickly wears off.
(b)
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Other Medicare saving Proposals. ($39.3 Billion over 5 years). HHS and .
OMB 'produced a list of additional Medicare savi1ngs proposals that they believe
are defensible, particularly in the context of heal~h care reform reinvestment.
'Of the $39.3 billion, HHS believes that about on~-third of the changes ($12.5
billion) could be categorized as "desirable progr~mmatic changes" -- changes
that would lead to a morb efficient Medicare pro~am without cost-shifting or
benefit cuts. In other w~rds, if you are trying td run an efficient Medicare
program, these cuts (such as competitively biddihg out for lab services) should
be implemented and woJld require statutory chahges. OMB believes that there
are a greater number of pesirable programmatic Fhanges.
The $39.3 billion in cutJ come from providers, beneficiaries and state and local
workers and their empldyers. The provider cutsl account for over 50% (about
$~O. billion) of the. total :savings, the beneficiarylcuts produce 31 % (ab~ut $12
blillon) of the savmgs, ~nd the state and local "l0rkers1employers contribute the
additional 19% (about $7 billion). Of particular note, the hospitals are targeted
for almost 80% of the tbtal provider cuts (about $16 billion) and; if history is
any judge, the~ will be fertai~ to raise. ve~y 10up objections. The beneficiaries
are targeted with cuts mat target the high mcome elderly and people who are
recipients of home health services through a 10% copayment on services.
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Medicaid
A major source of possible funds for health care investments or deficit reduction
would be reducing the growth in Med'icaid. It is almost a ce~tainty that even with the
"dynamic scoring", the extremism of fhe Republican Contract will require a serious assault on
Medicaid. The benefits of our affirm~tively ~Iling for savings from Medicaid are: 1) it is a
serious source of savings that the Republicans will be callingl for anyway; 2) the growth and
perceived generosity of Medicaid may seem indefensible when raised to a high national
profile, and if we do not propose savings, we may be seen a~ the defenders of the "status
quo". This could actually make it halrder for us to draw the line against draconian cuts.
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The downside of taking savings from Medicaid arc: (1) there is a chance that. we
would actually make it easier for Republicans to cut Medicai~ in a way that hurts poor
children and (2) on political grounds; if we propose Medicaia cuts, we may take away
politieal heat that the Republicans wbuld have to take. If oulr cuts were major, we could
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�, alienat,e our base or be accused of taking steps that would reduce coverage,
against our goal of expanding coveragd.
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Cleari y, the negatives would bJ blunted if the savings were moderate or if they were
done in combination with some plap. t6 expa"nd coverage.
(a)
Freeze federalDSH palments at FY 19951eyl· ($17.4 billion over 5).
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The savings policy that iwould appear least connected to benefit cuts and could
be solidly justified on policy grounds is freezirik current DSH payments. This
proposal would save $lVA billion. It would bel more easily justified if we
could argue that we were expanding coverage
and thus uncompensated care.
The main issue is going to be the reaction of Gpvernors -- who will object.
This $17A billion cut, ftowever, will likely be far less than what Republicans
will eventually be fOrCer to propose.
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(b)
Mandatory Managed Care for AFDC Population's (Current scoring: Costs
$1 billion over 5 years; saves $4.7 over 10 ye1ars). The concept of finding
savings through manag6d care is an attractive dne, because the claim can' be
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made that savings are coming through the benefits of managed care and not a
reduction in benefits. , Furthermore, advocates 6f this proposal claim that
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beneficiaries would be better off if they came from a consistent provider, as
they would in a manag6d plan. House Republibans (Kasich) make precisely
this case when theY'ad*ocate this proposal andlclaim $10 billion in savings ,
over five years. Our preliminary analysis, ho~ever, shows that this proposal
may actually cost $1 billion over five years (although it would save $4.7 billion
over 10 years). Nonetfueless, this proposal, to~ether with a proposal under
review to eliminate all iwaiver approval proces~es for states wanting to move
ahead on managed care, could prove an attractive option to states.
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One of the reasons why OMB has scored less savings for the mandatory
managed care option i~ that they already assucle in the baseline that 50% of
recipients will eventually be in some form of rbanaged care. In viewing
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Tennessee as a model for reform, two caveats should be noted. First, the
federal government let Tennessee lock-in its' ~rojected baseline growth at a
maintenance of effort level -- and, given the fecent significant reductions in
the Medicaidbaseline,lthey will be getting
federal aid than they otherwise
would have. Furthermore, Tennessee was better able than most states to
transition to managed bre because they had a jstrong inanaged care system
already in place, and J,ere in a position to reduce provider payments -- a
situation that several,siates are not in.
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(c)
Mandatory Managed Care - A Small Percentage 0.5°/c.
One option would be t,o require states to place: all Medicaid beneficiaries in
managed care, with a ~light reduction ($10 billion) in Medicaid over five years
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as an incentive for states to move quickly to more efficient care. If this is
accomplished as a cappedi entitlement it would be scorable and could be seen
as accepting Kasich's proposal -- while drawing the line on further cuts. As
with any cap proposal, states with higher growth btes might argue that they are
disproportionately hanned by the cap; this would /be particularly troublesome to
those states that did not Have .capacity to estafulish managed care systems.
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Lastly, some would argue that thIs approach opens the door on capped
entitlement fOr' the gain.of only a small amount
savings.
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(d)
Total block grant-like Jap on total program growth -- Medicaid
population plus CPI; in/ other words, Medicaid current funding plus '8
percent ($43.6 billiern over 5 years). Under thi~ proposal, states would
assume full control of Mbdicaid.' One idea would be to give states a capped
entitlement that would g~ow at perhaps 8%. By /doing so, we could save '$43
billion if the cap started in FY 1997 -- or $70 Dillion, if the 8% cap was in
'place by 1996.
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The advantages of this strategy are the following: First, it is a significant
source of funds. Second, from a purely messagd point of view, it may be
difficult for Governors t6 communicate a public Imessage that they cannot
manage an 8% to 9% i~crease per year -- though, from a policy perspective,
this growth rate is not a~ high as it may appear./ Indeed, it is close to the sum
of beneficiary growth arid CPI. Third, by giving this offer to the Governors,
we give them "ownershi!p" of the Medicaid basdine -- they either accept it or
they are the defenders
the status quo baselind.
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The downsides of this cippro;:lch, however, are clnsiderable from a policy'
standpoint. The Goverrtors will ask for considebble flexibility, which could
lead to reductions in behefits or coverage. In addition, we could contribute to
a false perception that Frederal health care aid, t6 the 'poor is more out of control
than we believe to be true. The real policy qudstion, however, is whether this
proposal will blunt the ,Republicans' Medicaid ~ssault (by calling their bluff) or
whether it will make things worse. We must c6nsider whether we end up
,
I
taking the blame for a Medicaid cut that would have been proposeq by the
Republicans anyway arid legitimizing the block grant approach.
, COVERAGE OPTIONS
For the purpose of sciecting options for coverage expansions, the NEe/DPC working
group assumed that all options should be:
(1)
A Serious, but MOdeJt Step Toward Universal Coverage: While we must
stay committed to mo~e towards universal cov1erage, the goal of achieving
5
�universal coverage would best be reached by seeking passage of a more modest
first step.
(2)
Middle-Class Oriented. We focused on investments that either directly
benefit the middle class 0r at least appeal to therlI politically.
(3)
Privately AdministeredJ To extent possible,
privately to avoid the big government labeL
thl policies are administered
'. .
I.
f
h b
h'
..
.
The options or coverage expanrons t at est met t eSI requlfements were:
(a)
Kids Coverage. ($20-$25 billion over 5 yearsl). Children who have been
I
,
uninsured for at least six months would be eligible for subsidies to purchase an
insurance package simil~r to the Blue Cross/Blu~ Shield package offered to
Federal employees. Sinbe low-income children are already covered by
Medicaid, the subsidies lare targeted to higher income families: one option
would reach children w~ose families have incorbe up to 300% of poverty .
,
.
I
($44,400 for a family of four) and the other would reach children up to 240%
of poverty ($35,520 fori a family of four).
I
Temporary Unemploy~d Coverage. ($16.6 billion over 5 years).
.
Individuals who are eli~ible for unemployment Icompensation and who are
uninsured would be eligible to receive an insurance package similar to the Blue
. '
I
Cross package. The subsidy would be phased out at 250% of poverty
($37,000 for a family 6f four), but -- since eli1gibility would be determined on
a monthly basis -:... it ik likely that Americans \vith annual incomes that are
higher than $37,000 wbuld be eligible.
I
,
(c)
Welfare to Work. ($6.2 billion over 5 years~. Consistent with the
Administration's welfare reform initiative, peQ~le leaving welfare for work
would be eligible to continue receiving Medicaid for two years. (Under current
law, only one year of rnt.inUCd Medicaid is arailable.)
.
(d)
Self-Employed Tax Deduction -- 25%/100F<l. ($3.8-$7.5 billion over 5.
years). It is likely tHat any Republican or Democratic health reform bill will
include an extension dr expansion of the sclflcmployed tax deduction.
Treasury .estimated a humber of versions. We chose two to illustrate the
policy. The first perdlanently extends the 25% deduction. The second
phases-in the 100% ~eduction by 1998.
(e)
Long-Term Care plgram. ($6.2 -$8.3 billion over 5 years). If we
consider significant ~edicare cuts, you may. ~ant to reinvest some of the
savings for the elderl~r. (The drug benefit is bost prohibitive.) This policy
option is a moderate iinvestment in state-adm1inistered home- and community
6
�based long-term care. program. (This investment is much less than what was
contemplated in the Health Security Act).
(f)
Long-Term Care Tax ILentives. ($2.8 billion over S years). These
proposals include: (1) ta~ clarifications for long1term care private insurance
policies and (2) a tax credit for personal assistance services for the disabled. If
the Republicans do any s;ignificant Medicare cutJ, they are likely to propose
these incentives to illustrate their commitment to' long-term care. (These
policies were included irl the Contract with Ame~ica.)
(g)
Public Health InvestmJnt. ($1 billion overS tears). Since all Republican
sponsored health reform !initiatives that have invpsted in public health -
generally by expanding funding for community health centers -- we may want
to propose a small investment in order to get crbdit for this type of proposal.
ILLUSTRATIVE EXAMPLES
During the presentation, you will have before you the attached tables on sources of financing
l
and uses of funds to enable you and tne other participants thelopportunity to mix and match
packages. However, to help focus thel discussion, we also have 'prepared several package
examples (e.g. one package includes r~warding workers throu~h subsidies for the temporarily
unemployed, extending Medicaid for i'ndividuals leaving welfare, and increasing and
permanently extending the self-emplJyed tax deduction). Thby are attached for your review.
CONCLUSION
We have limited this discussiqn to issues that must be resolved as part of the budget
process. Subsequent memoranda will describe insurance refo'rm and other issues that have
been discussed by the working group!
Attachments
7
�J
'"
' I
MEMORAN DUM
TO:
BOband~
FR:
ChrisJ'f:?)'
RE:
'Daschle Health Reform Bill
cc:
Bill, Gene, Jennifer, Sylvia, Jeremy
January 2, 1995
,
Attached is a memo regarding the impending introduction of a health reform proposal
by the new Senate Democratic Leader 1_- Tom Daschle. SenJtor Daschle plans on
introducing the bill on Wednesday.
We are going to have a very s~ort time getting people up to speed on the Senate
Democratic bill. Since the press can be counted on to ask for the Administration's position
on it, we will needt~ spend at le?st alli~tle time during the n,~t 48 ~ours deciding on what
we should say. Ukrne McHugh IS draftmg up some draft talkmg pomts/Q's&A's for our '
review on Tuesday.
'
To better assure a prompt and unified Administration response, I have taken the liberty
of forwarding the attached backgrouna information on the D~schle bill to our Map Group
participants. If you have any questiohs, give me a call at 6-.5560.
'
'
�.;
,..
f,
MEMORANDUM
TO:
. FR:
RE:
cc:
Distribution
January 2, 1995
Chris Jennings
Impending Health Ref.orm Bill Introducti.on by Senat.or Daschle
Carol Rasco, Bob Rubin
On Wednesday, January 4th, Senate Democratic Leader Daschle will introduce a
healt? reform bill £:~ ~adetspj£..legislative packag~ (S., 6- ~O). His bill, the
f6~~~ACt, has not yet bebn fmahzed. However,
.
Family Health Ace
.it seems clear that its insurance refomk kids and unemployed subsidies, and 100 percent tax
,'deduction for the self-employed will
within the "first stepJ" vision the President outlined
. in his December 27th letter to the eoAgressional Leadership.
'
fit
. .
J
.
Senator Daschle's staff report that the Senator is introducing this bill "to send a signal
that Democrats do not intend to retreJt from their commitmerlt to reforming the health
system." The health reform initiativel will be purposely smal\ in size (probably around 100
pages) and scope (probably just 4 titles). It will be a Daschle, n.ot an Administrati.on, bill.
Senator Daschle intends to ch+"enge the Republicans Ito act immediately on his bill.
He will suggest there should be broad, bipartisan consensus on this bill, since most of the .
provisions can be found in both Rep4blican and Democrat p~oposals from the previous
Congress. Senator Daschle will apparently call on Republicans to pass ,this "downpayment"
bill within the first 100 days of the ~04th Congress and thenlinvite them to hammer out
agreements on the more contentious issues that he will say must still be addressed.
. .
-
I
.
As .of n.ow, in .order t.o keep his .opti.ons .open and t.o pr.otect the Dem.ocratic
.
"Medicare edge," Senat.or Daschlels bill will NOT includ~ a specific financing package.
. .Attached is a 2-page sumJary of the m,\!or provisions of tbe Senate Democratic
Leader's bill. One provision worth Inoting that is NOT in the summary states: "Nothing in
this Act shall be construed as prohibiting States from enactihg health care reform measures
that exceed the measures established under this Act..." SenJtor Daschle will get more specific
later, but this one provision raises niany questions, includink bilt not limited-to the touchy
ERISA issue .
. There is n.o d.oubt that the press and the Hill will be asking Administration
representatives questi.ons ab.out h6w we feel ab.out the Daschle bill. Some reporters may
suggest that the new Leader ispree~pting the President, m~ch like they said Gephardt did
with his tax cut press conference. We will need to come
with a common set of talking
points/Q's&A's. l.4rrrie McHugh is) working on such a dra~t that we plan on circulating
tomorrow. If you have any questions, please call Jennifer Klein (6-2599) or me (6-5560).
up
�, . ~ Pvu,k-<::::t-r't>v'!,
THE FAMILY HEALTH A€ € E SS
I.
AND AFFOftDABILff¥ ACT
I
INSURANCE REFORMS include:
I
*
Guaranteed Issue and Renewability for Small Businesses and .Individuals:
Insurers would be prohi~ited from turning down any small business (that has
1-50 employees) or individual who wishes to buy or renew insurance.
*
Expe~ence
Rating Phased Out for Small Business (1-50 Employees) and
Individuals: Insurers w'ould be probibited froml charging sick people more
than healthy people (thisl prohibition would be phased in over 3 years),
although premiums could vary by age, family type, and geography.
*
Portability: Would Prolibit use of pre-existiJg condition
for
those changing insurancb (usually through job s~itches) and would severely
limit such exclusions fotI those newly purchasin~ insurance; (this reform would
,
be applied to all plans, including self-insured plans offered by large business).
*
Ufetime UinitsprohiJitiOn: Would prohibit lifetime limits on benefits for
both insured and self-irlsured plans, although limits on the scope and durations
of particular services arb permitted.
'
" 'I
'
/
'
'.
ex~lusions
I
'
*
Standards' for Quanty IAssurance and Consumer Protection. ' Would require
that HHS Secretary establish minimum. guideli~es for states to implement;
(these would include subh things as quality/conkumer satisfaction report cards.)
*
*
Grants t.o States to Es,LbiiSh Purchasing col Pe ratives.
/'
,
.
Establishment of Health Care Cost and Access Advisory Commission.
These reforms, like any insuralce reforms, would reJlt in losers as well as winners.
I
I
Fo~ example, the attempt to providegesirable protections to the individual market as well as
the group market is likely to raise premiums for small busin~sses. This disruption and/or
fear of this dispruption can be expectbd to attract oppostion ftom small businesses and the
insurance'industry -- although the 061e bill had similar pro~isions last year. (This disruption
could be minimized if the higher cos~ of insuring individual purchasers were spread to larger
businesses as well, albeit with signifipnt oppostion from this influential community.
Alternatively, the individual market could be dropped from tfue reforms altogether.)
,
II.
I,',
EXPANDED COVERAGE and ASSISTANCE TO SMALL BUSINESS:
I
*
Insurance for childrln would be provided to/0ugb subsidies on a sliding
scale basis up to 240 percent of poverty ($35,500 for a family of four); the
subsidy ,would be linked to the value of a starldard FEHBP Blue Cross benefit
package.
'
�.
~.
.
*
Insurance for tbe Temp,orarily Unemployed wpuld be provided ~or six
months for those who ha~ lost their ,insurance when they became unemployed;
the benefit would be pro~rided through subsidies :on a sliding scale basis up to
240 percent of poverty a~d, like the ki~s subsid , would be linked to the value
1
of a standard FEHBP BI,ue Cross benefIt package.
,
*
Self-Employed Tax CJdit would be
to assist small businesspersons
to purchase health insurance; the credit would bJ phased up to 100 percent by
1999.
reinstate~
The combination of these subsidies would expand coverage signficantly for politically
appealing populations of Americans. The kids benefit, howev6r, would encourage some
employers to drop dependent coverage!(particularly for low in{x>me workers) under the
assumption that these employees' children could qualify for subsidies for their children. (The
dropping problem could be mitigated by lowering the thresholas for subsidy eligibility and
prohibiting employers from' discrimi l13ling against low incom1 workers,)
j
UI.
QUALITY AND CONSUMER PROTECTION: ADMINISTRATIVE
I
SIMPLIFICATION, FRAUD AND ABUSE, and iRACTICE REFORM
*
Administrative SimpUpcation would be achiered by adoption of HHS
.
guidelines to standardiZe health care financial and administrative transactions.
*
Privacy Protections aslured through establislent'of rules for provider and
health plan access to Itiedical data that ensures patient confidentiality.
*
Fraud and Abuse prelention would be improved though establishment of a
joint HHS-Justice Deptartment health ca~e fra~d & abuse prevention program.
*
Medical Malpractice keform would be aChieLd through limits on attorney
contingency fees, peri6dic payment of awards, allocation of punitive damage
I
awards to help fund efforts to improve quality of care, and through the use of
state-based alternative/ dispute resolution systems.
.
Virtually all of these provisions were included, in sole respect, in the Health Security
Act, the Mitchell bill, the Mainstrearl-t bill, and the Dole bill! The Republican initiatives went
further in their medical malpractice ~rovisions, however (e.g., caps on damage awards).
.
IV.
I
I
IMPROVING ACCESS Tj RURAL HE~TH CiRE
*
Higber Profile/Priority for Rural Healtb would be secured through
I
establishment of Assistant Secretary for Rural Health within HHS and through
grants for rural telem~dicine and other innov~tions. .
*
Additional AntlClarification would be required to be provided from
Justice Dept. and FTC for safe harbors for rural providers.
~t
�·MEMORANDUM
TO:,
FR:
RE:
DT:
cc:
Health Care "Map Room" Participants and Other Health VIPs
Lorrie McHugh, Chris Jennihgs and Jennifer Klein
.
Health Care Talking Points/Qs and As/Daschle Bml·
January 4, 1995
Carol Rasco, Bob Rubin
Attached you will find talking points1Qs and As to help Adnhnistration officials respond to
questions regarding health care refonn, in particular, Senator Daschle's bill that he will be .
introducing today. It is for internal Jse only. Please do not distribute.
I
.
Also enclosed is the latest two-page Isummary of the Daschle bill that his office just prepared.
Although I have Monday night's copy of his bill language (~nd have given some of you
copies), the bill was still being modified late into last evenirig and, I think, today. I hope to
have a final version later today for those of you who are intbrested.
,
.
I'
I
.
We hope that you will find these documents helpful. If youl have any questions, please do
not hesitate to contact either Chris. Jbnnings (456-5560) or Jennifer Klein (456-2599).
�Internal
e
Health Care Questioms . and Answers January 3, 1995
.
. I
Q. How is the Administration going to proceea on health care
reform?
.
A.
* The President remains firmly committed to providing
insurance coverage for evety American and 60ntaining health care.
costs for families, busine~ses and Federalj State and lo6al
governments. .
.
.
I
.
I
.
I
, * As he stated, in hIs December 27 letter to Congressional·
leadership and during end-of-the-year intetviewsrlastweek, he
believes that we should wo~k in a step-by-htep manner to achieve.
these goals.
I. .
I
.
. * The President want~ this Congress to work with him in
taking the first steps by ~assing measures to address the
unfairness in the insurance market, making coverage.available and
affordable for children arid unemployed workers, assuring that the
.populations served by Med~care and Medicaid are protected and
reducing the long-term federal deficit.
..
I'
Q. What is the Administration's reaction to Senator Daschle's
health care proposal?
I
\
* SenatorPaschl~'s ~roposal is consistent with the vision .
laid out by the president/in his Decemberj27 letter to the
Congressional leadership., Both the President and Senator Daschle
want to work in a bipartisan fashion on hEbalth care reform. The
nation's health care probtems have not gone away and it is
imperative that we move forward.
Q. Is'the Daschle
.
~ill
efflctivelY the Admiinistration's bill?
-. -' .._-' I..
"--'--
-,~-~-
...
* NOi but it shares ~he vision that the President:outlined
in his lei~er to the' Congressional leader~hip last week. .
B~
lelder~hiP
*
including healtb care in his
package,
Democrats are sending an limportant signall that health care reform \.
remains a high priority fbr the nation. We hope to work with the
Republicans in a bipartisan manner to enatt health 'care reform
this year.
.
.
I
Q. Did Senator Daschle consult with the President?
.
* Senator Daschle aJd his staff infolrmed the Administration
of the proposal and outl~ned the direction that it would take.
�Q. Senator Daschle is challenging Senate Re~ublicans to pass his
bill within the first 100 days of the 104th Congress. Does the
Administration support this challenge?
* Every day, American families are losing health care
co\("erage. This Administra,tion has been wOFking hard to ensure
tha t families have quali t y', affordable hea!l th care. Every day
l
that we wait, more familie~ live in jeopar~y of being one job
loss or one illness away firom losing theirl coverage. We want to
work with Congress to move health care ref/orm forward as quickly
as ,Possible.
/
Q. What specifically does the Administration feel about Senator
Daschle's insurance reform proposals (or any other specifics in
the bill)?
., . .
.
I
* We haven't yet ana~yzed line-by-line every provision
proposed. Senator Daschle's bill appears do be consistent with
the vision outlined by the Pre'sident last week. What the
Administration feels is i~portant is that both Democrats and
Repu~licans work together Ito move forward on health. care. ,
.
* As the President said last week, we can and should work
I
together to take the flrststeps necessary to put us on the road
to achieving health security and containing health care costs. .
•
I
Administr~tion
Last year the,
said that Jnsurance reform COUld'
not really be achieved in ithe absence ofu~iversal coverage. Has.
the Administration backed away from this claim?
Q.
, A.
* This Administratioh has not backed away from its
commi tment , to provide Ame1ricans with real hea1 th s.ecuri ty. We
believe, however, that t~is now should be done in a step-by-step
approach.. We can put Ameiricaon the road to universal coverage
by addressing the unfairdess in the insur~nce market and
be'gir!:ning by':'expandirig cqverage' to childrlen and ~. .orking-,families.'
But, all of this must be done in the broader context of eventually
teaching universal coverdge. .
I.
'
Q. Last year the Administi-ation said that
~veryone
covered by 1997. Now you 'are saying eventually.
eventually mean?
must be
What does
A.
* We need to focus 9ur energies now on putting America on
the road to health security. Let's move forward in a step-by
step fashion to ensure that Americans have quality and affordable
health care.
.
Q. Will health care be in the budget?
A.
* There have not been any announcements made on the budget.
�Q. Will the President introduce health care legislation?
A.
* Everyone knows wherlthe President Jtands on health care.
His goals have not changed~ He believes t~at we must now act in
. a step-by-step manner to achieve these goals.
* The President is coLmittedto work In a bipartisan fashion
to begin putting America oh the road to he~lth security. He will
work with Congress as Democrats and Republicans develop
proposals. If he feels th~t adequate steps are not being taken,
legislation may be introdubed. The Presid~nt has made it very .
clear that he will NOT giv:eup the fight tb for health security
and affordable health car~. We need to wo~k with Congress and
see what develops.
Q. The President says that he believes that we can make a start
on expanding coverage. Bow will he pay for it?
* The Administration/wants to work with Congress to expand
coverage and ensure that any action taken is paid for and
achieved without increasidg the deficit~
�FAMlLY HEAL TN INSURANCE PROTECTION ACT
Summary
This legislation represents a fIrst step toward me goal of en$uring mat aU Americans have access to
affordable, high quality coverage in a bompetitive h~a1th care rrlarketp1ace. While only
comprehensive refoon will achieve alit of these goals, this bill tkkles rrumy of the most pressing.
problem" plaguing working families and small businesses and bncourages !itates to move forward
with their own reforms. Specifically,l this bill ensures coverag6 cannot be lost because of ill health,
loss of employment, or a disability, Jhile providing premium issistam::e to the temporarily
unemployed and children in low-inco~me families. Finally, thi~ legislation calls for a more
coordinated response to health care fraud and abuse, reduces hralrh system bureaucracy and red
tape, enhances access to care In.ru.ral ~areas and addresses inefficiencies in our malprdCtice system,
Titl~
r -
Insurance Refu[ms:
ensure~
c~
"nsurin~
I
Port.ble and
A[rord.~le CQv~r.ee
This title
workers
changJ jobs without losing theJ insurance and tha[ no one can be
denied coverage because of a pre-ex.i~ting condition, the birth br a disabled child, or any other
medical condition. It also prohibits ~surers from dropping c~slomers or rmsing their rates once
mey fall ill. Finally, it ensures that all Americans have available to them the same coverage that
Members of Congress have. with better information about the quality and prices of all health plans.
• Guaranteed issue and renew.bili!Y for individual, and smill group market (1- 50 employees)
• Prohibition on pre-existing condition exclusions for those Iwith continuoll;s coverage
• Six-month limitation on pre-existing condition exClusion for those with coverage lapse
• Limits on variation in premiums Iidue to age (applies to individuals and small group market)
• Prohibition on lifetime limits
• Requirement that insurers offer ":Benchmark Benefit Plan'i that includes all benefits available [0
Federal employees (insu:rer.) may also offer other benefit {?ackages)
.
• Standards for quality assurance, Iconsumer information arid consumer protection
• GrantS to states to establish pur'ihasing cooperatives for ~usinesses and inclividl.1:'lls
". ,
• Health Care CoSt Commission created to monitor and advise Congress on health cost rncrcases
I.
Title II • Assistance fur Small Businesses ilnd Families
··tl
'de
.
.
r I
al·l b' , ,.
d I.
u~lOesses an aSSIstance
Th IS U e proVl s tax Incenttves lor sm
private heahh insurance .
,
to
f'amiJ'
.
f r.h '··h
f
les or e pure ase 0
• 100% health insurance premiumdedllctibility for the selftemployed (phased-in by 1999)
• Premium subsidies for shon-terln unemployed with family incomes up to $35,500 (24D% of
poverty) to ensure continuity ofcoverage during periods unemployment
• Premium subsidies for children in families with family irlcornes up to $35,500
bf
�Title III -
ImorOYiDl~
Access to Rural Health Care
I
This title helps rural communities adju$t to !.he changing rural herailh care environment through
grants and technical assistance for the dstablishment of rural health plans and telcmcdicine
networks and the establislunent of guidelines to clarify the type~ of collaborative activities
permissible U.nder antitrust law.
•
•
•
•
for
Establishment of Assistant Secret:.ary
Rural Health in HHS
Grants for the development of ruraft telemed.ici.ne nelworks
Demonsrrations for development df health plans in rural areas
Requirement for FTC and DOJ to flarify "safe harbors" for rural collaborative effort'; that do
not violate Fedc:ra.l antitrust polic~
I
Ijtle IV
Quality arid Consumer Protection; Administrative' Simplification.
Privacy. Fraud and Abuse Prevention. and MalprncticcReform
.
.
I
I
This title establishes new guidelines that would decrease the health care system's paperwork and
administrative costs !.hroilgh standardi~ed billing and claims forbs and the electronic transfer of
infonnarion. These provisions would 8Jso protect the confidentiality of individuals' medical
information, strengthen and coord.inat~ federal fraud and abuselcontrol effons, and make our
.
medical malpractice syslem fairer and 'moreefficient
, • HHSadoption of guidelines to s1ardize health care financial and administrative transactions
• Establishment of rules for provid~ and health pJan o.ccess Ito medical data while ensuring
confidentiality of individual medical records
f
.
Establishment of joint HHS-Justide DC!pt health care fraud and abuse prevention program
• Medical malpractice reform throu~h limits on attorney contingency fees. periodil: payment of
awards. allocation of punitive da.tnage awards to provider Iquali ry improvement effans. and the
use of stale-based alternative dispute resolution systems.
-.,.....-..-._'.-._
. . . . ~, . .~~-==~==--I . . ___ .---.:-====--~~
- -
"
..
......--~.-
--
~-.-
..
-.~-
. ...-.",--""-....
"
.
�
Dublin Core
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Carol Rasco - Issues Series
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Carol Rasco
Issues Series
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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2010-0198-S Segment 2
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Clinton Presidential Records: White House Staff and Office Files
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92 folders in 7 boxes
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Health Care [2]
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Domestic Policy Council
Carol Rasco
Issues Series
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2010-0198-S Segment 2
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Box 123
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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"
"
MEMORANDUM
.TO: . :
FR: ..
RE:
· cc:
.7~'
t
"
March 14, 1995 '
Carol and Laura
Chris Jennings.
",,: : ." .
'Managed.Care Memo and Health Care Polling Data
Gene', Bill, Jen,}eremy~ Tom'
I
:
.
.
,
·•.~L_-·
,,~', Attached is the. revised, managed care memo for the P~esident.:. I beli~¥!! it has
incorporated your changes-'aiid'suggesti()ns; but any further thought~: Bl,n be :easily integrated
into the memo .. (Our review ofmanagedcar.~·poli~y pptjonsJocy"qui:consideration should be'
completed by sometime nextweek}.
.
.., .
. ,
..
, Also for your information is ~0I1.1e recent pollingdata--ihatStan Greenberg has given'
out to the political folks in the White House. " [ have pulled out, the health care questions and"
· res~onses for ,your review.,
'
'
A bdef review of the informat'ion documents that health care -reform ,remains at or near
. the top of th~ public's legislative priorities. Arnedcans also consistently report that they not
on!y lose their appetite· f~r de!!':.itreduction when Medicare is thiown on th~Jabre for .
consideration, but that cuts in the Medicaid program: -- defined as the "health program for
the poor" -- 'produces a simihu result. 'More specifically, at least two thirds of those
surveyed respond negativdy to Medicare and Medicaid cuts being used fOf' deficit reduction.
.
.
'.
The polling data,clearly points ,out' the problem the Republicans will have when they
formally propose the level of Medicare and Medicaid cuts (over $200 billion over 5 years to
be roughly divided between the prograp:ts) that they are reportedly considering., [f we chpose
to criticize their proposals~ they will be extremely vulnerable to charges that they are
undermining the pr()grams and the people they serve. (This willpartieularly be the C&~~ when
the aging advocacy groups j()in in -:-- or start -- their own chorus of criticism.)
, '. The likely fig leaf the Republicanshope to stand on is·the public's growing familiarity
and comfort. with managed care (HMOs/PPOsietc). [f the Republicans can sell their approach
as provid~ng' greater, choice, with the ability to retain the option' of fee for service, they may'
have some chance of capturing the media elite, and" at least som~, of the public. The fact is,
however, that the'only way that managed care can produce the level of savings the
Republicans are discussing' is through limiting-choice of'affordable options. [n other words, it
appears that the Republicans ,need us' to providt;~ the cover they need to move in this area.
Conversely, we will need them to take the heat if we also decide to utilize MedicarelMedicaid
· savings for additional deficit reduction .. ' '
., .
�M~lfch 14, i995 '
MEMORANDUM FOR THE 'PRESIDENT ,
"
,··FROM:,
SUBJECT:
,
'.
, CAROL RASCO
LAURA TYSON'
Medicare Managed Care
As you know, the most recent HHS prbj~ctions for the, Medi~re' anel Medicaid baseline
between 1996 and 2000 were $94 billion,lower than the estimates in the August 1994
Midsession Review. Of this' $94 billion, $40 billion of the savings were for Medicare "
, , spending.
,,'
,
,
'
You me~tioned i n' your, March 3idpress confere~ce, that Medicare managed care contributed'
to this repuction in the ba~eline. ,Secretary Shaiala has made similar suggestions in the past,
although she now understarids tliat Medicare managed Care as currently structured is not
producing'savings in the program. The reduction in the HHS Medicare baseline was actually
the result of other fact()rs;including programmatit changes implemented during your
Administration that 'have improved efficiency and reduced fraud and abuse, and the lowering
of overall inflation in the economy:
'
,
BACKGROUND, ,
As currently designed, Medicare managed care aetually increases program spending. While
the industry argues persuasively that they are able,to reduce costs with managed care, it
appears'that the Federal Government ~s ,not shadng i~ these savings. Instead the savings
achieved by Medicare HMOs are largely passed along to beneficiaries in the form of Medigap
benefits, e.g., prescription drugs, hearing, vision, and/or retained by the plan, as higher
earnings/profits. The rea.son why Medicare doe~not' adequately share in the savings is due in,
large' part to ,two' characteristics of the current Medicare managed care ,program.
, First,' CBO and OMB no~ believethar Medi~rets current reimbursement for, HMOs is too'
high and' actually loses money on each beneficiary enrolled .. Medicare' 'now pays' participating
HMOs a capitated payment that is calculated at' 95 percent of the cost Of providing care to
fee-for-ser.vice beneficiaries in an area. At the time of the enactment of the Medicare HMO
law (TEFRA - 1972), there was too little experienc~ "i~ the' program to know what level of
'reimburSement was appropriate; The, 95 percent number was chosen to provide an incentive
for HMO participation in the' program w,hile CaptUring, some savings for Medicare, '
�ff ,~'
~
The current reimbursement formula 'does not adequately control· for the ·fact. that, 'on average"
people who enrol~ in HMOs are healthier (their costs if they had remai!led'in fee:...for-service
Medicare are often less than 95 percent of the average)·and subsequently Medieare overpays
the HMOs' for the cost of providing care-1o them. In' fact, CBO estimates that Medicare pays
5.7 percent more for beneficiaries in managed care than it would if they had remained in the .
fee-for-service sector. In regions where fee..:.;for-s~rvice costs are disproportionately higher
than managed care costs :.....:.. which could happen in' areas with very competitive managed care '
'markets-.- the'paymenLformula .ov:erpays HMOs: even. more.
"
..... >...
The second characteristic in the Medicare managed care program that ~ay increase costs is
the option for beneficiaries to disenroll'every 30 days .. There is anecdotal evidence indicating
that. beneficiaries disenrolLfrom an .. HMO and seek care in the fee-for~serviCe sector once. " .. '
.
....,
...the·y.get seriouslY"ilL The underlying theory behind managed care .. savings;·-however, ·is· that
.. ,capitatedpayments:provideincentivestokeep costs down.when enrollees become.sick. When-' .'-'
.. enrollees can 'leave managed care arrangements at the point when they' get .seriously -ill,:the ..:..:
· incentives:faced by the HMOs. to manage care effectively are minimized. Und~r. this.' "
,,'
-:scenario.. ffi(fnaged ~~reco~ld potentially flirt·her ·increase. Medicare costs:
'
: '
Many Republicans in. the Con~ess have suggested that significant savings can be achieved
through the utilization of managed care in the· Medicare program ... While they have' y~t to
~~lease details, proposals that could guarantee savings of the magnitude that :are being
discussed would restrict choice, particularly for lower income beneficiaries, It is therefore not
.surprising that elderly advocates are partieularly wary of proposals for capped vouchers that.
Republica~ analysts have been s~ggesting: The HMO industry aiso is not likely to'lead the
· charge toward initiating any. significant changes to the program since; for the reasons outlined
above, they are generally quite slltisfied with the current Medicare payment arrangement..
FUTURE ADMINISTRATION ACTIONS
'.~
We are c,onducting an intensive .review ·()f ma~aged care options to devdop an Administration
position on 'this issue. There is a strong commitment to' moving forWard on the managed care
front by OMB and HHS and the· Department has testified to this effect in recent weeks. In .
contrast to the approaches being advocated by some Republicans,' the managed care models-
s,±ch asa -.new .Medicare PPO modd--that have been referenced· in' Administration testimony
would increase the us~ of managed care by expanding the choice of plans available to .
beneficiaries. They would not, however, restrict beneficiaries' ability to replain in the fee..:..
:.. for-service',system: However,. without modifications' in the reimbursement methodology,
which would secure program savings at the~xpense of the plans' and/or beneficiaries' savings, ..
these alternatives would 'likely cost money -- -at le~st over the"short-term. Weare studying
..... thepolitica:l and policy feasibility/advisability of managed care options thatwoilld
significantly reduce the growth of Medicare spendirig;:
We are also soliciting input' from private sector managed Care firms..(such as FHP) and;we
believ.e this relationship has the potential to yield some interesting results. 'While any 'viable .
managed care proposal is unlikely generate significant Medicare savings- in the short term, we
· believe that movement toward managed care in the Medicare program has potential to
.
produce savings over the long term .. We will keep you apprised of the 'status of our workin
this area.
l
'c'
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,
~
Public Polling Update
on'
"
,
Balanced Budget Amendment, Deficit Reduc,tion, Medicare and Medicaid
•
I
'
,
. March, 1995
(provided 'by
.'
Gree~berg
Research)
~
�I'd like to read you a list of seven possible legislative priorities; Please teil me w~ich one or two you fee!
are the most important issues for Congress to address...an increase in the minimum ,wage. a balanced
budget amendment, a middle class tax cut. welfare reform. a revised crime bill, health, care reform. a
capital gains tax cut?
'
,
,. 18%
Increase minimum wage
·24
Ba!anced budget amendment
Middle class tax, cut
·28
, , Welfare reform
. 46
Revised crime bill
. ,21
,. Health car,e reform
". 29
Capital gains tax cut
. 8
·',3,
AILequally important (voL)
QUESTION NOTES: Adds to more than ,100% due to multiple responses
Do you favor or oppose a balanced budget
a~endment to'the u.s.
(United States)Con'stitution?
Favor
'·71%
,Oppqse
• 16
Depends (voL)
. 4
Not sure
'
9
Would you favor or oppose a balanced budget amend ment to the Constitution if thatwould require a
tWenty perc:ent cut in spending on entitlement programs such as ~re.Medicajd.' and vete.@ns
benefits?
Favor ,
Oppose
Depends (voL)
Not sure
28%
65
. 3'
.
,
"
4
,
Many Democrats say that Congress should have to explain which programs they inte,nd to cut before
voting on the balanced budget amendment. so people will understand theconseque'nces. Republicans
say that voting on the balanced budget a'mendment should come first, because without the ,?mendment. '
Congress won't 'really make the spending cuts that it should. Who do you agree with more on this
issue"':'the Democrats or the Republicans?
", , "
'"
,
, "
,
, :
Democrats
·58%
Republicans
- 36
Both/neither (vol.) " . 3
. 3
Not sure
',",
POPULATION:, National adult
NUMBER OF PARTICIPANTS:, 1,003
INTERVIEW METHOD: Telephone
SURVEY SPONSOR: NBC News, Wall Street Journal
'BEGINNING DATE: January 14, 1995·
ENDING DATE: January 17, 1995
SOURCE DOCUMENT: NBC,NEWS, WALL STREET JOURNAL'
DATE OF RELEASE OF. SOURCE DOCUj'v1ENT: January 20. 19;35
ORGANIZATION: HART AND
RESEARCH COMPANIES
�Would' you favor or oppose a balanced budget ame.ndment to the, Constitution that wouid require the
federal government to balance its budget by the year.2002?
Favor
• 77% '.
, Oppose
- 15
Don't know INa answer
- 8
Suppose balancing the federal .budget required' c.uts in Social Security or Medicare-then wo~ld you
. favor a balanced Qudget amendment (that would require the federal government to balance the budget
.bY the year 2002), or'not?
Favor.
- 34%
Oppose
: 62
Don't know INa answer
4
POPULATION: National 'adult
NUMBER OF PARTICIPANTS: 4,943
IN-tERViEW METHOD: Telephone
QUESTION NOTES: Asked 'of those who favored a balance budget amendment (77%), .
BEGINNING DATE: January 10, 1995
ENDING DATE: January 20, 1995
SOURCE DOCUMENT CBS NEWS
DATE OF RELEASE OF SOURCE bOCUMENT:.January 23. 1995
ORGANIZATION: CBS NEWS
�,
.,
,.'
Do' you favor or oppose a ',balanced budget amendrn'ent to the U.S. '(United States) Constitution?
.
"
,
"
",
Favor
- 68%
Oppose
- 19
Depends (vol.)
- 3
Not sure
. - 10
Would you favor o~ oppose a balanced budgetam,endment to the C'onstitutio~ if that would require a
twenty percent cut on ~niitlement programs such' as, ~edicare, Medicaid, and vet~rans benefits?
.
Favor
- 33%
Oppose
- 61
Depends (vol.,)
- 3 '
Not sure
- 3
.'
,;
.J
.
:
.;
. , .
.
I'd like to read you a list of seve'~ possible legisliHive priorities. Please tell me which one or tw~ you feel
are the 1\10st important issues for the next Congress to addr~~s .. ~ job'training programs, a balanced
budget amendment, a revised crime bill, welfare reform.-hl:Jalth care reform, a middl~ class tax cut, 'a .
school prayer amendment?
' , '. ' .'
'
, ,,
.
Job training programs
- 21 %
Balanced budget amendment
- 28· ..
'Revised cri
ill '
~-'.,
- .37 "
.' - 31
.
Middle -c-:--Ia-s"'7-:-tax-c-u-:-t----~
s
School prayer .amendment
- 11
All equally important (vol.) . - 3
Not sure
1
QUESTION I~OTES: Adds to more than 100% due to multiple responses ..
1>3
"'POPULATION: 'National adult
NUMBER OF,PARTICIPANTS: 1,0'00, .
INTERVIEW ,METHOD: Teh3phone
SURVEY SPONSOR: 'NBC News. Wall.Street,Joumal
1994
BEGINNING DATE: December
ENDING DATE: December :13. 1994
. SOURCE DOCUMENT: NBC NEWS, WAlJ.. STREET JOURNAL
DATE OF RELEASE OF SOURCE DOCUMENT: DeCember 16.1994'
ORGANIZATION: HART AND TEETER RESEARCH "COMPANIES
10.
'
�1 ,
Would you,favor or oppose a balanced budget ame,ndment to the Constitution that would require'the
federal government to balance its budget bY,the year 2002?
'.
/
Favor
- 81% '
Oppose
' ,- 12
Don't know/No answer
- ,7
, Suppose balancing thef~deral bu,dget ~equired' 'cuts in .social Security-then would you favor a balanced
. budget amendment (to ,the Constitution that would .reqUire ,the'federal government to balance the budget
by the year 2002),o~·not?
'
',.
Favor
' ,: 37%
Oppose. '
- 60
Don't know INo answer
2
,
,
POPULATION: National adult
NUMBER OF PARTICIPANTS:, 1,147
INTERVIEW METHOD,: Telephone '
"',
,"
QUESTION NOTES: Second question asked
those who favor a balanced budget amendmef)t which
would require the budget be balanced by the year 2002 (81 %)
BEGINNING DATE:.Decemb,er 6, 1994 '
ENDIN~ DATE: December 9, 1994,
,
SOURCE DOCUMENT: CBS,NEWS, NEW YORK TIMES
DATE OF R~LEASE OF SOURCE DocuMENT: December 14, 1994
ORGANIZATION: CBS NEWS. NEW YORK TIMES
of
,
'.,
'"
�,
th~federal bUd9~t
'
tu~s Medicare"':the~ wo~ld
Suppose balancing
required
in
you favor a balanced '
budget amendmel1t. (to the Constitution that would require the'federa,J government,to balance the
budget'bythe year 2002). or.not?
'
','
,"
Favor
- 33%
Not favor
- 64
Don't know INa answer " - 2
,~
,
.
Suppose balancing the ,federal budget, req'uired cuts in spending on education-then would you favor a
, . balanced bLidget amendment (to the Constitution t,hat'Would require the federal government to bali:mce
the budget by'the year 2002). or not? '
'
, favor
Not favor
/
- 27%
- 73
Suppose balancing the federal budget required Increases in the amount you pay in'fec1eral income
tax--then would you favor a balanc'~d bu'dget amenqment (to the Constitution that would require the
federal government to balance the b~dget by the year 2002). or not?
'
Favor
·5·1%
- 47
Not favor
Don't know/No answer
2
POPULATiON: National adlllt'
NUMBER OF PARTICIPANTS: 1,147
'INTERVIEW METHOD: Teleph9ne
.
QUESTION NOTES: Asked of those wh.o favor balanced budget amendment which would require th~
, budget be balanced by the year '2002 (81 %) "
,
BEGINNING DATE: December 6, 1994 ,
ENDING DATE: December 9. 1994
SOURCE·DOCUMENT:' CBS NEWS, NEW YORK TIMES
DATEOF RELEASE OF SQURCE'DOCUMENT: December 14, 1994'
ORGANIZATION: "CBS NEWS. NEW YORK TIMES
a
�Would you favor qr oppose a. balanced budget amendment that would require Congress to balance the
federal budget by the year 2002? .... .
.
.
Favor
. - 80%
Oppose.
- 12
Don't know Ino answer
- 8 .
If a balanced bud. get amendment were passed, to do you think ,Congress would be able to balance the
, federal budget by tile' year 2002. or don't you think Congress would be able to balance the budget by
then?
- 28%'
Will be able
Will not be able
63
Don'tknow/no answer
9
• y
POPULATION: National adult
NUMBER OF PARTICIPANTS: 1,120
. INTERVIEW METHOD: Telephone
BEGINNING DATE: November 27; 1994
'ENDING DATE: November 28. 1994
SOURCE DOCUMENT: CBS NEws
DATE 'OF RELEASE OF SOWRCE DOCUMENT: Novembe~ 29.1994,"
ORGANIZATlON: CBS NEWS
I'd like to read you al\st of six possible legislative priorities. Please tell mewhich one or two you fe~' are"
the most important is~ues for the next Congress to address... welfare reforrrl, health care reform, .' ,
'"
balanced. budget amendri1~nt to the const~ution, Congressional temn limits. a middle class tax cut. job
training progra'ms.
'
"
.
..
, Welfare reform .
-46%·
. ,
.
Health care reform
-.37
Balanced budget amendment
- 26
. Congressional term limits
- 8
Middle class tax cut
<29
.- 25 .
. Job training
All equally' important (vol, )
- 3 '
" '~\'1k (" <2..br tv'
,
"
~t~l;f- ~ ,\~~\~
~~\j >J.(\k ('<.,tn:ry
POPULATION: National,registered voters
NUMBER OF PARTICIPANTS: ,302
INTERVIEW METHOD:. Telephone
SURVEY SPONSOR: NBC News. Wall Street Journal
QUESTION NOTES: Adds to more than 100% due to multiple responses
BEGINNING DATE: November 9. 1994
ENDING DATE: November 9. 1994
.
SOURCE DOCUMENT: NBC NEW$. WALL STREET JOURNAL
DATE OF RELEASE OF SOURCE DOCUMENT: November 11. 1994 .
ORGANIZATION: HART AND TEETER RESEARCH .COMPANIES
..
.
,
,
\
'
~i
�.',
-.
I
Idl-f !1~_
LYV~L»' VVl:Q'~,
0·12
A few questionsaoout priorities for President Clinton and the new Congress .next year.. ~. As I read
, from a list' tell me if you think the item thac I read. should be a priority: First... (READ ANP
ROT ATE) should this be a top priority, important but lo;.ver priority; not too important, or not·
'
.'
done?
Top
Prioritv
lmpcirtarit, ,
but lower
Priority
Not
Too
ImQortant
.
"
Not
Be
Done.
Don't
Know
..
a.
Stricter concrol of handguns
46
25
14
' 13
2=100
b.
Improving the job situation
64
27
5
2
,2=100
c.
Reforming health'care
'9
'7
3=100
d.
Cutting the capiral gains tax
27'
38
16
7
12=100
e.
Reducing crime
78
' 17
2
f.
Reformingthe welfare system .
66 .
~5
5
a
y
Reducing the budget deficit
65
26
5
h.
Reducing feder3J income taxes
f~r the middle class
.
53
32
9
3
3=100
Limiting the number of terms a
member of Congress c3.n s'erve
33
31
23
8
5=100
51
32.
8
'5
4=100
' 19
2=100
I.
J.
~(
Passing a constirutional ainendment
, requiring a balanced federal budget
27.) .
:0
4
2=100
,2
'2=100
3=100
,,'
k.
Passing a constirutional amendment
thac would allow prayer in public
schools
.
27
33
19
".
"1
3I
�~~t."
13. Here are some proposals memOOr.s of Congress have made. For, each
one, please tell ~e whether you think it ,should be the ~ priority for
Congress to pus within the ,first 100 'days, a.lll.9i1 priority, & .tow
priority, or ~ priority at all. First•••• Next, how high a priority
ahou~d conqress give to ••• {ROTATE}'
\\'?
.(IN":tERVn;wER, Na.rE: Ii' REsPOHD~' S.i\YS I:t:!:H, SHoatiD
PRlolUn_l
"'RO~
,
m
BE PASSED" .MARX AS
No
2::d.Qb:;i,,~
No
~
High
34
SO
12
2
"
2
Significant reduCtion in the
Feder!!.l budget .def:"ci t
.
n
Sl
13
3
:2
A 'Constitutional <IJl\endmGnt to
balance the budget
30
47
16
4
3
A cut in taxes for most
i\mQrican :axnilieg'
27
47
20
4
2
44 )
2i
5
2'
Tougher
anti-cr~e,
legislation
.Major reform ,in the. ,country's'
, health 'care system
1
~
i:Qr;;'2S
'\
~
\
\:
,
"~
~,
,Legislation to l.i:nit weifare
payments
26
44
24
'3
SiqnH1cant ciuts in spendinq
for Federal proqr~
22
45
26
S
:2
Legislation which ~ld &ll~
the President to veto indiV'idual
parts ot a' proposed spending or
tax·bill, rather than naving to
accept or veto t.b.a entire bill
2l
43
26
6
4
19,
36
34
8
3
19
' 33
33
14
1
IS .
36
33
7
9
An increase in defense
spending
12
30:
4S
11
2
Making it mora, difficult for
. ,.,omen t.o , get an abortion,
"
"13
21
40
23
3
l
A constit~tionalamen~nt
to limi.t ':..~e number of terms ,
members of congrea,S can serve
A
constitutional amendment
to allowV'Oluntary prayer
.
in schools
A cut in
~he
capital-gains
t.ax
~
,.,,"
.
.
"
.
.
(USA Today(Gallup poll
~2128-30(94
-~-
�';'
"
. f ' ,
,
Among the items Y'o'u. have said should ~eceive .. top .... priority with
Congress
~hich one do.you personally think is the'mo~t important one1
14.
')'
~0~·...:..1_1_____ o~r_r_e_f_orm
M,a_j_'
_c_ou-:n_t-:-ry~._a_h_e_a_l_t_h-:-.~ca_re_'_IJ_y_s_t.:. . -em
__i_n-:-t_h_e-:"
leq~slation
. Tou.ghu anti-crime
II
7.
SiQnificant reduction in' the?ederal budget. deficit
6
Legislation to limit· we,J.fare payments. .~ .
6
11.
6
.,
A cut in
i
COnstit':.1tional amenc1rn.i!n:t to balance the budget
taxes. .fot .most
Americans
·Legislation which would allow the President:. to veto
individual 'p~s of apropoaed spending or tax bill. rather
than having to accept or veto the entire. bill
5
~
,\
,
'
,
"
'
A Cons·tit'.Jtional amendment. t:o allow .....oluntary prayer in
schools;;
5
4
. Significant cuts'in spendi.ng for Federal programs
4
. Mak!.ng it
"
more .di:!'!':'cuit
for women' to get.an abortion
.~
Constit'Utional amendment to limit the number of terms.
members of Congress can serve
11.
in
1
A.' cut
the ':apital-gains tax
.1
An ..i.ncrease .in defense
spen~ing
.No 'opinion
.-lQ.
100
15.
The .Republican leaders in Collg~88 have inadeseveral proposals to·
change the ~ay congress. operates. which they plan to bring to a vote on
the first day of the'newcongress. These change9 include reducing the
number Qf congressionaJ.· conim.i.ttees and statfand requiring all lDe@tings
':0 be made public.
DO' you t.'llnk these changes represent' ::aal refor:tla of
Congress, or are they ju~t a 'political gimmi.ck1
Represent real
37·
57,
ref?~
Just.. <1. politiCal. gimmick
-2.
No
opinion " .
100
'"
'1
CNN/USA..Today/Callup Poll
'.'
'
12/28-30/94
-1,0':"·
�CBS NeWs Poil - November National Survey ',- N()vem~: i7-~ 1994)
~
.
Fagell
'~..:..;:..=-
.
. 24. Have you heard or read anything about
the Republican "Contract with America,"
which outlines proPosals 'the Republicans in
the u ~s. House of Representatives promise .
'to vote on in the first 100 days of. the new .
, . Congress. 'or haven't ,you ,heard or read
, anything aboufit?
I
. Have beard or read
Tot
Oct94B*'
.28 % 35 % 24 %
70
. 63
74
2
2
2
Have not
DKINA
~Varied wording:"
T ota! Respondents
00 • •
wouid work
25-%'
73
2
29 %
70
1
on if
. tbeywin a m.8jority in Congress this fall~
"
In the firSt 100 days of the new
Congress, ,do you think the Republicans will
keep their promiSe to vote on the propbsals
outlined in .theirContraCtwirh AmeriCa, or ..
don't you think they'll keep their promise?"
.25.
47 % 71 % 31 % 39 %
38
18"
53
43
15
11
16'
18
Will keep promise
wm not'- keep promise .
DKINA
of
:76.
With the Republicans in control both
the U.S. House of Representatives and the
U.S~ Senate, do you think your taXes will 'go
,'up, go down, .or stay, about the same?
.
.
42' % 22 % 58 %
2
'9
18 .
Up
. Down
Stay about the same
DKJNA
--'7
.,.
.
.~%
46
5
42
511
3
37
3.
6
4
27. Would you favor or appose a balanced
budget . amendment tha~ wouLd require .
. Congress to balance the fede~ budget by.
the year 2CXY.2?
'
. Favor
Oppose
DKINA.
80 % 85 % 76 % .
79 %
12
11
10
8
1114'
.t
'10
c~nducted in Nii!w Y~rJc State 9f29-f0r.U94; s.p94A W2.I
conducted 918-iU94; Aug94A wa3 conductM lf2J94; iul94C wu conduc:e(\ 71l4-i7/94: Apr94A was condl.l.Ctro 4121-2:3194;
J.a.094C was conducted 1I15-17l'i4; Jan94A wa3 conducted 1/3-5194; Feb9:3A W8.S coaduouxi 2/20-:21193; M.u8:2
conducted 3/11- tSI&2; AprSl wa& coQducted .4/Zl-2hJSl.
Trend Date:s: Oct94B was conducted. IOI29-111l194; NYS94A \lois
�,
'.1
',23. , (Of t...1.osewho support a ,.balanced budget' amendment) Would you support -t:,r
oppose a constitutional, amendJnentto •reqUire a balanced, fede,ral budget if
it meant raising your tederal income ,taxes?
Support
Oppose
No opinion
1/4/95
48
',49
2
,
Q.21/23 NET
Support aIOe.ndment if raise"federal income taxes
Oppose amendment if raise federal income taxes
tio opinion
'
"
-'
1/4/95
38"
55
7
24. Do you think- the president 'of the United- States should or"should not
have the auth'ority to veto individual itel!l.s in the federal budget,
something known as 'the line-item ve'to?
,
L
1/4/95
Yes, pre~identshould have ,the authority
tio, pres~dent should not have, the authority
N"o opinion ' .
.',
,
','
,,
'
•
"
, .1
•
•
64
31
5
' , '
25. ,Turning ,to another ,subject, the death penalty: Do you favor or ,appose
the death penalty for persQnsconvict:.ed a~'murder?
1/4/95 4/26/92* 12)18)82
74
,1.9
5
Favor
'Oppose
(Vol) It depends
No, opinion
'
" ,Word
'It
-
2
75,
-19'
5
-76
19
NA- ,
1
6
1/30/82
69 '
19
8
5/20/81
4
7J
20
5
3
oppose II adde.d to: question ' '
26. Dc you support or oPJ,JOSEl a reduction in the ,federal 'capital gains tax :- '
that ~,s, the tax on pro.f~ts from investments?
1/4/95
Support
Oppose
No opinion
10120/88,
52
44'
40
8
33,
23 '
27. Would you support or oppose, a l,aw' limiting wel£are' recipients to' a
'maximum of ~.oyears of benefits, atter which those who are able to .ark
would have to get a job or docbmmunity service?
,
,support
oppose
No opinion'
1/23/94'
1/4/95
91
,
'
,
"
89
a
, 8'
J
1
28. Do you favor or, OOoose an ,amendment to' t..'e (LS Const'itutiont..'at -...,ould
allow'organized prayer in the public schoal~?
:?avor
Oppose
No opinion
1/4/95
67
32
4/13/87
68
30
2,
or
on
29. Do you favor
opoose a l'imi t~
tIle'number of years a person could
,serve as a IT. S. Represfmtati:ve,inc:mgress?
,
,
. Favor
1/4/95
6/:?6/94
75 '
72
Oppose23
24
No, opinion
2
3
�•Af!:f!/vJP
aa,
11/14/93
4/9/92 :- ','
3/18/92 "
:3/11/92
10/21/91
17
21:
3
3
76
7'4,
21
'3
23,
~
74
24
24
3
16
73 '
10/14/90
LiLt /fS-
),
:30. Now on several 'of these issues I'mgoinq to ask ,you what kL~d of
priority it shoUld'qet in Congress. For each I, name l please tel~me whether
:rou think it/s absolutely critical to ,gat dona. as soon as possible l ,
Important but not, critical, notVlerj important or not important at all.
A.Health care 'reform
critical/important '(llET)
Absolutely critical
Import~nt but not critical
Not important (NET)
,
Not very important
Npt ~ortant at all
No opi~on
,
.~
1/4/95
~4,
45
39
, , 15
,
...
tf)
---
~.-'"
1'0
'5
,1
B,. CUtting the federal, budget deficit'
' .
<
"
1/4/95
93
55
39
5
3 "
2
1
critical/ important (NET)
, Absolutely critical
Important but not Critical "
Not important (NET)
Not very important·
Not important at all
No opinion
c. providin~ a. middle-cla..<is tax cut
Critical/important (NET)
Absolutely critical
'"
IlI1po~t but not 'critical
Not, important (NET) , '" , '
Not very important
" Not ~l?0rtant at <ill ,
No opl.n~on ' ,
'
i/4/95
~2
37, '
46
17
13
<\
1
D. Approving a constitutional ~endment to allow
organized prayer in puplic schools
1/4/95, .
critical/important (NET)
" Absolutely critica:l
60 '
"
Important but not 'critical
~ot import?nt (NET)
.
!lot very important
Not ~l?0rtantat,all
No op1n~on ,
.
22
]8
38 "
,- '19
19
'1
E: Approving a constitutional amendment requiring,a
balancedtederal budget
,..
"
'
. C:-itical/iJuportant (NET)
Absolutely critical
'
Ilnportant but ,not. critical
Not important (NET,)'
Not VQry important
1/4/95
35
41
45
13 ",
.7
. i
.
/1
\.
i.
•
�11.
As you ~nOH'. the President and theCongre.ss will be trying to cut
,
.. federal, programs; Ii order to reduce the budget defi cit. For.e3ch of the
. folla,.ring programs. please tell me whether you think. it is more .
importantta,reduce·the federal budget deficit. or more important to
grevent that program from being significantly cut .. First. (READ lSi
lTEM.RO!AiE); Second.: CREADANO ROTATE .RES! OF ITEMS) -- .
.'
,
Reduce Fed, '
,Sudget .
Pr!:!vent
'Significant
C.ut ; nProgrm
...
GeficH
'h
Medicare-- the. ''''~:
f~era 1 he:! 1th·",,"
,pr-vgram for.tl1e_.
\'1
elderly ..
Medicaid-'- the
federa 1 hea 1tl1:;:~:;:
program .for t::e
, poor
., ..,
.~c.
Sac1 a1 s,ecuri ty
d.
Defense sFendjng,
e
,
.il.D
Food stamps
'
,S.:L
.;:2.~
"3
\
.' t.A~
.'Lot::)
f. , Schoo L i unch:...p,r:,ogram
,
,
35
,
:S
,
~
~~
"3
Grants to cities ,to
put more pol1cEon
.;;2 ~ .
c....,~.
Aid to farmers
Y3
.. . 5"'"
'-\
S
Funding for the~.rts
'~l..
.::l.q
S
the streets "
Loans. to
co 11 ege:: . ,
students '.
F:.
l,oJe 1fa re
prOgrams ~:,:
in genera 1"
.
-.
t.....::;;.
?:J\
~£-
c..\
,
."
~c
'5"
--
.
,,'
.&
.
~.,
�,
., ..........'\ ... .
"
ID:202-395-6148
.
FEB 20'95
:
.. /
STATEMENT OF
.BRUCE VLADECK
ADMINISTRATOR
HEAlTH CARE FINANCING ADMINISTAATlON
BEFORE1liE
SUBCOMUrTTEE ON HEAlTH
COMMfTTEE ON WAYS AND Mf:ANS
U.S. HOUSE OF REPRESENTATIVl:S
FEBRUARV 10,1995
21:05 No.001 P.02
�ID:202-395-6148
FEB 20'95
21:06 No.OOl P.03
Mr. Ch81rman and .emDer. of 1he SuJKgnmtttee
I. am plelMd to be here today to begin a dialogue WIlt1 U11. SUboommittee
about the,curreAt state of the Medicare program and. more Importantly, about its
Mure. More than any other m&mbena oJ this Congress. the membere of this
subcommittee have Jong had an understanding of the complexttles of the Medicata
program and the vulnerable poputatiDn that we serve. and have contributed to maJor
improvements In the program Over the veara. MecIcar. Is a popular and 8uooeesful
program., I believe we need to work together to Improve on the prcgram'.IY008SS
and strengthen It for Its beneficiaries Mel the UPcpGyar'8 who eupPort It.
We in HCFA have been workr-g very hard to make the MadIc8re ,ptogram'.,
effective, affcrdabIe and ·customer fiiendty' program for bentfSdaries. At the Same
time. we have been working to Implement adminlstratlve and program improvements
, which maximize the effldena; and oost tffe=Jven,sa of the program. I want to begin
by reviewing some of our recent etfor18 arw:I SUCQ8SSeS and then provide you wtth an
overview Of our 8Iforts In the .rea Of managed. care, Finafiy. I wouk.1llke to "lieu..
lOme of our initiatives to Improve the administration of the Medicare program.
I. SUCOESSES
MedIClr8 is the world's largest health lnaurance program end by many
measures one of the most aucc:eSsful. It began in 1966 as 8 Federal health insurance
program for the eIdef1y and was expanded in 1972 to cover disabled persons and .
those with End Stag. Renal ctMase (ESRD). 'The Medicare program was estabfiShed
because our vulnerable populationa had dHftoulty obtaining private health Insurance
coversge.
Medicare Is adminIstered largely by private ccntradOr& unCl8r our IUperviIiOn•. In
1004, Mftdieare servec:.t almost 38 mllllo" paraona under Pats A and B of the ,progi'im.
Aged Medicare benefiolariea number 32 million, 3.8 minion are disab,led and 7t I:tXJ
have ESRD. Medicare has agreements with over as oon1raotor; to process .
beneficiary Claims. In FY '994, over 750 million clalma were processed ~ MedIoIt'e
. , ' paid more then 1159 blRton for mecicaI services. treatment and equlpmcmt.
,
' Today, we mafntak1 Madieara's commJtment toserv8 the most ·vulnerable.
M8d1cere Ie the wr;eat payor of 1he elderly's hoaJth 081" e~ns... A8 the
SubCcmmitt8e eXamines the Mur. of the Medicare program. I would urge you to
conlider the ~JoWIng Important facts abOut Medicar. benefia8lies.
o
RelaIIveIy few Medlcar.e beneficiaries can'be conlfdered flnancialty w.,1J..off.
Approximately 83 percent of program ,pending 'n 1992 w.. on bGhaff of those.
with incomes less than $25,(XX). (CHAAT 1)
o
Currenlfy• .20 percent Of 0Wt' btneficiaries are efther lieniora age as and Older,
.
�FEB 20'95
ID:202-395-6148
21:06 No.001 P.04
most 01 whom ar.e women, or paraona with disabilities Inoludlng End Stage
Renal Disease (CHART 2 ) . ·
.
g
ThIrd. per Qlplta·heaIth care spending for aged bBneflcllirles .Is 4 tfme& 1he
average fOr the under S5 population.
Medicare is successfully fuHiBIng Its mlasIon and beneftdarle8 continue to eXpress a
high degree of aatlsfadIon with the progr.n. MIllIo~1 of eIder1y WId dll8lt*Kl
Americans now have hGafth cere oovorego end • quolltY of life· that tnoy would
0Cherwiae lack. tho. to the Medicare program.
Innovltlvi Program AdmlnlltrlUon
Despite the alza of the M8dJcare program. we have maIntained • high lEWlI.at
consumer satisfaction with low administrative COlts, lela than two percent of .program
outlays. In contrast, private Insurance administrative ~nae. are about 25 .percer It in
1tnt amaJl group mark8t tiI1d about ftw percent In the large group market.
Medicare has been a pioneer In strearnilntng program adminiStration ancUs a
world leader In fOstering eJe~ claimS submission: Ninety percent of MecI1care'a
hospital and skilled nursing facUlty claims and 87 percent of its physician claims ara.
GUbmltted el8OIronIc&IIy. In contrast, 60 percent of Blue Oro';" hoepital. oIaiMsiltld 2Q
peroent of its pl?tBician claima are aItotronicaJty submitted. For oommerolaf 0III'1'iera,
the percentage 115 10 percent for alI dalms. {CHART 3)
,
We have focused attention on f8duolng the ~ burden on heafth care
.prcvlders. working closely with the heafth· care ccmmunity to eatabJlah a standard.
uniform netlonal Medioare oIaim form for. physioIans and ~r for hospitals, SkfDed
Nursing FacUJtIes (SNFs) and Hane Health Agehcies (HHAs). Many other ~rn
\De 111.58 fOrms, but attach addnk:Jnaf TOrma as well. ThesI. nowever, are U18' only
hospital and phyalcian claim forma that Medicare rGQuires.
DeclIne'" the
~edlcar.·BasaIln.
During U. Cfinton Administration, the pro~ 10rUlI average anAuaI·'" Of
growth for Medicare have deaeased. In the President's ~ 96 Budget, 1hI prOjected
*
annUlif average rata of growth for 1996 .. 2CKX) 1s.9.1.percent. In contrast,
manlh.
. .ago in the MId-8eetion Review, the .proJected annual ave. . . rate of growth for the
aame period
10.3 percent. The primary contrIbu1ion to.. lower Medicate
w-.
proJecUon& IcJ slQwer growth In Part 14. HOlpitaJ Inaurlilll08 expenditures. 1l18·decIIne In
prOjeCted Pan A··growtt results prim8rHy tern a decr.ase ·in-forecuted. hOlpilWccst
Inflation andslowlt growth in th8 ccmplexity of MecflC8r8 inpatient eases.
IL MANAClED CARE AND THE MEDICARE PROGRAM
2
.'
�ID:202-395-6l48
FEB 20'95
21:07 No.OOl P.05
Today, any discullion of the qUest'to enhanoe 008t effeothreneu, .. WIII~,_tha
accessibility of quality medical cae for: benefidarIes, must inclU!H managed care. We
. . c.unniltted 10 working wtth you to 1mpr0v8 WId ~'1he rnanaQed care chaices
available to our ~Ie& &0 that 1hey hive .... fuR range of mfiI1aged care capUons
, NitabIe to the genarallnsured population. The comerston8 of our polley ts lnfonned
ChoIce In.8· fair markatplace. in which beMflcIIrIIs have Y' and objective InfotmaIion
Md •• not disaimlnated against on the basil tI ralaUve need.
M~
care il not •
new c:cncept for the MtdIcare program.
SJnoe ..
Inception In 1sea.• portion 01 MedIcare blneflcIarIeI have rlOlivld care through
managed care arrangsmentR. Enrollment Is Incr8aslng. and we antIcIpata COIIliIIUIId
svong growth. newty·entftIed ben8ftdarte8, WhO are more:f8miIiar with managect
cere enter fle MedIcare program.
t
I
'';
Currently. 14 percent Of Medicare beneficianes'fiave' 80cetI to a managed care
plan and 9 percent of Medicare beneficlarlea have chosen to enroll 'n 8 rna!INIQ8d' care
. option. 1894 we. • year of hnpressive 'growth In Medicare managed care, we
exportencecI doUble digit Increases bo1h In plan enrollment and the numCor of, plans
per1IcIpatIng In "'program. Plan enrOllment Increased by 18 percent. We rt1N have
11 counties where 40 percent or more or our beneficiaries are enrolled In managed
care, an addttJonal 3:) ccuntlos with enrollment b8tw88n 30 and 40 percent, and mora
than 44 oourrti8C .with enrollment between 20. and 30 percent.
. ' .
,
, " MOrI lmpQrt8nt for futUre enrolment growth I, the number of contrect& witb
managed care pfens. In 1884,·the number or our MedIcare managed care plans
Increased by 20 percent. Many of theae new contraclS are ,in rega..a beyond ,thoSe
that tradltioMJly have had a strong Med1eara managed Cl!lre presence. In our
,
,PhKadeIphia regjQn, 1he number of CQI'1tr~ 1na'lJia.d from 6 'to 16.and In the Io8ton .
. reQlon contra IncrNeed frOm 4to 9. ...... ..
, .
,
AI we wCWtk,to extend and brOaden managed care options for Medlen
beneftcfarin. we·must be aware both of the practJcall1mitations of a rapld expatWIfon
of managed care in, Medica" and of past failures of overly eggressive effottIln ,both
, the Medlcere and Medicaid p-ogrems~ The movement to managed care cannot
owtpBce \he gapec;Ity of l1'l8I1iIgod QIte plans 10 8Of'V'O 18fge' numbera of now enrol. ."
p8r1icularty those ~ 1he expensive and special h8~h needs of the Medioere
'
population.
'
.
,
In addition. for Medlcare to benefit· tom 1he expansloo. Of managed oar't we
need to Impl'OYe',4he way Medioar. p8Y' managed oare piane. Managed oare
currently costs the Medicare program rather ~ achieving ·"Wlga. Our evaluations
hIV. suggested 'that MedJcare pays 5.7 percent mora for every enrollee In managed .
care tha"t would have been paid If 1he beneftciaty had stayed In fee·for-&8t'Vt08. 'The
reason for thl' II thai they attract the healthier members of 1he Medicare population
J
�.\
1D:202-395-6148
FES20'95
21:08 No.OOl P.06
whoM health cere QOSts are Iow.r. £ffot1a are underway to ImprOVe the aurrant
payment methodology 80 it doesn't act as a barrier to the expansion of managed
ewe. We haw iriitiated ..,eral researQh pro}lOC8 and demonstnJUons add...a thIS .
situation and we expect to hove preUmlnary results Ietor thf' YNf.
'0
.
1
I
•
Madicar.· beneflc!aries them. .·must de!8rmine the pace of 1hW ~
to managed cal't. The emphasis mull be on ctlg[gt. Managed car. Ytin succeed •
. managed care plene wo able to prove the value or 1hItIr products and as bellBftcIwln
reco;nI&e the benefit of tNt coordIn~ of CIn and caM management f\at high
quality .managed care plana can provide.
New Manag_
c.... 0pI0M
In adc:IiIiari to our efforts to· Improve current rneii&ged·.care optlons·....
MIdIcJr8. we WWlt to make avaBabkt to beneftdarles • new preferred provkler
or~ (PPO) option. This option has proven to be very popular In the
commerCIal mar1cst. and maPly of
8ccaaS to PPOs. We believe that Mec;Ioai'e
·benaficiariel IhovId have the same range of ohoIces. Under tne PPO option, 0CiI' .
objeCtive would" to aAow beneficiaries to choose to go to any physician at any: ,1Ime,
subject to htgh_ coet-ahIrIng.
""heM
In develop,lng a PPO ~ for MedfOarut W8 hope to learn from cur ~
with the M8dIcaIe SELECT ctemon8tration~Aa you know, Medicare SELECT was
designed to create'. hybrid of managed oare' and ~edigap·that tt W8$ hoped waufd
be ~fklial bo1h 10 beneflQiarie,8 and to Mec:JJcare. However r our expersenoe under
the demonstration has been hit while premiums for tradlttona1 Medlgap benefits 81'8
reduced.' Medicare does nat ahara In, the savIr1gs.
"
The
reason for this apparent anomaly. ;that the tower Medlgap premItmi h·
·MediGare KLECT pona are "ellerally the r..yll ur flUlfplh:Ih;JlSQ'JUI1~ ~
rather than 1he ~. manag~ Of cart or the efRCiency of the SeLECT netWorks•.
The balic problem with Medicare SELECT 11 that there are Rmited incentives for plana
to manage tMJ tQtaI costs. As 8 ,ellA. Medicare d088 not participate in afTi~,
and beneficiaries do not receive the. benefits of coordJnated:·care that they would .
reooIY. in' offiokWIl f'Ietworks. In. fact, If ptOPQeel, 10 IDIp8lld'SELECT ~ ·10
Part B servIcea
.enacted. Mecicare costs WOUld actually;·incr...., as .pihysiciai\s.
1nCreaSe utHizatJcfl to recoup their di$Qounts.
are
. A ~ Iuue with. Medicare' SELECT deals with the Idequacy of b8ne&ciary
patectlon. w. fNf atrongty
IMneftc:Jariea should not hav. to wor¥y about ...
quafty and ~ provisions of Ihelr Medicare choices. W.look forward to ~
Mh the Subcarnrnltl8e on tN. inportanl.i8sU'.
"'et
.
We also hci)pe to "tit . . to workWith'the SUbcOri'll'nlttee.ai the PPOoPtioM In .
-.,.------~
,_ _ _ r.', ,.......
�ID:202-395-6148
.
FEB 20'95
21:09 No.001 P.O?
. .
the months ahUd. In.adcItion, given the impending deadlina far expiration of the
.SELECT authorttV and the need to, examine the c:Sir"noc lStratian experience before 1he
program is eJCPltlCled. to l1li states, CongrRl may wIIh consider a 6 monch
extension of the demonstration for existing pIIna. 1NI WQuId allevkde the unoer18intY
for existing plana. and' provide time to make approprtete ChIngta to SELECT baaed
. on c8nonItratJon upII'I8nca.
.
=
~ry~uodon
, .
. I
. we need to do a better jOb t!f informing 'baneIic:iaria about the managed care
and Medigap ct"oIoeI thatara aV81lable. The cu""" lick mInformation in the faDe of
. 1UdI. variety, (I·ChOICes generates c:onfU8IOn WhIch .,.-ks :agaInst managed on
optIone. To ~d their c:hoIcea. beneficiaries hew to negotiate th~
.
dlfferen6es in benefit peckages, cost-sharing 1tndU'. and premium amounts.
Beyond 1hI' nMCd for tnformation, benefic:iaI1e8 nalao ~ feced with enrdIrnent
oerfods that vary by plan "'d. In the case of Medlgap, with health screenIng enct
unct.rwriting. BerKtficlar;e, who initially enrOl In a· managttd care plan 10_ their one
tim. option for open enrollment An ~edlgap.
'
We wgufd:'lfke to do 1V8~ possible to make managed care optlonl':very
. attraCtive to ~8. We think we can do a ~ar Job of helping them to
und.mand the
~88
of 1hese pI~.
.
Quality' and Ma~g.. car.
Today. managed care OrganlZ:atlons'proyiding services to Medicare and MedIcIIcI
beneficiaries .,..:reQulred to have Internal quality 888ellment and Improvement
programs to ldtw.dIfy ways to tmproV8 the delivery of health care _Men and the .
. ealth car•. Itself. We also requi~e Independent extemal. review of quality of care
h
c:ieliverod to our be~foa.
HCFA II ~In; In collabOration with the industry on along term dcrt of
develOping. single. 98t of measures that could ~ UMd by ·all payers to addreu the
·fuR range of a ~ pian's membershIp end performance.
. The first phaae 'of this effort centers on major performance measuren I8I'1t .proIIgts
underway In both: Medicare and Medicald. Theae are,designed to help us develop
me.urea that are focused on the special need. d our dlvarse populatiot\s:
In MedIcaId. we· are ~lng oolleQgrattvefy with NatIonal Committee for Quality
Assurance (NCCA). State Medk:ald agencaa, consumer advocates and managtd care
organizations to "dapt ~ ccmmercl~ ~'~ stete-of·the-art performance
meaeurwnent 1DaI HECIS (HeaM Plan Emptoyer caw and InfOrmatiOn set) to the
needs of the Medicaid progr.",.
•
-_._--,--
�.
.
21:09 No.001 ~.08
FEB 20'95
ID:202-395-6148
.
'.
.
.
We Chose HI=OIS as the tampa.. for our U.cIloard Ift9rt for 88Y81'AII'888OnB!
a
HEDIS Ie viewed by most of the Ieading·state navJged care progr.n. • "....
·rapproprille mOdel ~ Medtoaid. Some __ . . already adoptirV HEOIS. W.
feel
. 0
~
II Important to prcMde acme naIonIIleIdnhIp.·
,
we wn to ~nate With the privatel8Cla and take advantage of the .
elgnlRolnt III'IeIytJoaI grCM.lndwork eIreIdy produaed by NCaA. 10 . ' to .rnllI*lnIIttrrnt,.
••
potential rapcrtJng burdens on ouf managed care plans. many of whIah . .
&dopang HEDIS~ .
.
.,-oaoh
In Medicare, we are begfnnlng to pIIQt test • new,. performance baSed .
to
Revfe\tl OrganlultJon (PRO) ~CIW of HMO. developed under contrlC.lt Wlln·!he .
Delmarva Foundeltion. These measures reftect 1ha apeoIaI haaIth needs· of an eIdIrty
end d&abIed ~n. for examplel in, management ot chronic condJtions. Thes8
measures wUI them be oon~ed In conjunctIon whh the broader HEOIS Iffcrt,
Paef
. ".yment/COm.,.uuve BIdding
AI5 I Cfi80IIlSsed &batie, concerns &boUt the payment methOdolOgy for rllk
contractors has been long standing. Currentty. we 'deterf11lne rate. on a ytlJ'ly blats,
and plans decide whether or not to enter Into • oontraat etaet. year ~ on the' ......
These rat••, callad the Adjusted AVerage Per Capita Coct (MPCe). are deYeIopeCI for
.each county and ,are based on feHor-llfViCe
In the area. County rates are tIeri
adjwsted for age., aox. InltnutJonal W1d MedicalQ SlaWI; no aaJuaunent 18 made far
haaJth SfatU8 per.. Plans have been eoncern8d with the adequacy, ItabIIty nI
eqUIty of the AAPCC. Earty on. when Ibecarna Admlnistratcr of HCFA, I 1rMttd· the
Industry to come up with alternatives to the AAPCC.. We still have no algnfficant
com
aItaTrativeI.
One ~ that has recentfy reoelved ~dsupport and attention from
IndUMry. acacJemIa and commerCl~ payers 18 that of 'competitive bidding.II ' ..
proponents of competJtive prk:ing models claJm that'the methodology will
In .
payments that more 80CUfately reflect the true costs of doing business. in·addItIon to
,.wIt
promoting .CJffidency ttvough greatoroompetitJon 8lt'1OI1Q hoalth plans.
, We V'tfnk 1b8t this is a pr~iSing idea, and we would like to test variants of ft ..
demonstrations In a· number of geographic araas. In ordar..,for the den10nlb atIcN to .
be uaefuf, we believe that «mpetitivi bidding should become the payment
methodology fOr aI1 Medloal'$ ",;".ged CIte ~ In the d..-nonvtratlon...... ".
always. beneIIcif.Iies wIJ &tiD'have the ability to choose to ~ In managed en.·pIn
We would be Imerested In watkin; wtth the SUbconunlll8e
·on ... R'tJCSture r:I a competitlv, bidding den'lonstratlOn.
or ...",..., in ......kK-eet'Vk;e.
t·
•
_-- __
~.-.-e
,_ _......, .._ _........
_.,,_.~_
',t
�10: 202,-395-6148
ill
FEB 20'95
21:10 No.OOl P.09
lMPROVID PAOQRAM MANAGEMENT
.
,
M~ ger, options 'while of growfng ImportIInoe to the admintantlonOf tne
MedIoare ~ .e not the whole aIory. W. ere aodvely working to improve
management throughout the program end to make continued Innovations In the fee.
for·aarvica ptOgtfarn.
CUtIomtt '8eMc:a lniIIaav_
,"
under IN 1 dtr1hip of Presidant Clinton. VIce President Gore and S8Ctetay
..
Shalela. we at HCFA have fDcused our effonI en making sure that our nearly 10
million bet18ftcIar1iII '(Medlcar. anj Medlcald) rec:eIV8 the h8IItn care 1hIy need ~
they need It. ihIa me&na1hat bonefk:I.-liI corrMt Itat In .. thal we do. HCFA has
undergone sIQnIflcant hternal and external changes 10 Insure that the .~ first"
phHoeophy beOOr'neI. rf8lftY. Throughout the agency. we are working to ,inprove .
communications with beneftcIarIes .. wha1har ,It be one-on«18 in persoo.. on4Ine .
ttIr'cu8h the computer. ov. 1he I8lephone, hough our numerous pubUcaUons or
.
tt'l'ough the
med~.
'
.
.
'
The naU'I Of tI"Ie MedIcare progrem is sUCh 1hat there are numerous other
people and organizallons Ihat have do.... contact whh bene1k:lar'l88 than HCFA. They
... also our cuatomel'1l and our partnere In providing heaJth care services .. .providers
such .. hoIpItabl. nursfng
home IieaIlh agendes. phy8lciGne and ,medfoaI
SUPPliers; contractora (carriere and Intermedtaries) that process and pay Medicare'
~••' WId, Peer Awn OrganizatIonS 1h8t assure the quaJity of health an .viCes.
hom.,
. We have QaIIeIoped 8 sat of c:ustorn8r ~.
~.
thai appfy 10 our'
Interactions with benefICiaries and our partners. Th_ atancJarda apply to ell or our
~, claims processing actMtiea. cUstomer satisfaction, consumer ChOIce,
, health 'GOrO queIitJ f.Ifld P-oQ'tlnl! Willi JIItratlgn. rror. "Xllmpl" we are working Wftn, our
CU8tornet'S to mal<e.our publiCations and notJcIIlUier to undel'lta1d: w
...
sim~ng Medicare claims admjnlstrltlon,80 that clalma dmarmlnatlons will be more,
ccnlatent. W. ar. placing • premiLm on ,measuring and improving oustomet'
88tlsf~ tht~h.1he use of survay&. fcQJ. groups andmNtlngs.
also,~
that the, need for Integ",,"; deDvery· systems wiRbecoma more
and more crttlQal . ' our population becomes Increasingly dIv9rse and ~d.r with mere
cI"IrcniO care neecda. In erdar to meet theaa needs. It Is cIur that HCFA must maintain
a ~ f~ with Its penners In the, provider communtty and assist ,them
We
to Improve their focu. on customer servioe. Several sudl inltSadvOi are 8II'eI8Cy
underway. HCFA Is examining all cj the Jonrrterm ave services provided ,by both
MecIcart and Medioatd ald IS considering ways 'that 1I1ese servk:es can be baUar
, CICOI"dII"MiIled wtth one anocher Wld With the acutB. care system. A similar ravIaw' of
nome helfth car. progrllTlf has also been undertaken.
.
'f
- - _ _ _.. ,_, - ' ' ' - _....._ , , _ - - ' . "w._,_ _ _....
'
�1D:202-395-6148
Fraud
FEB 20'95
21:11 No,OOl P,10
Mel Abu. .
8'I8I1ing • Ihe Office Of 1he AdmlnlltratOr -.d • every level Of HCFA, we nave
e.aparded and strengthened our efforts to root out fraud and abuse agail'l$tMedlcare
end Medloaid end to vtgoroUiIy pursue thole whO cotnmlt such Illegal ectMtIe8. W.
operate In a pat1nerIhip, not Qnty with the Departmri. Office of the lnapeotor
General, but with the Department of Justice, including 1hI FBI, state and loCal law
. enforc::ement agencies. and our contragtcQ. Ft.rther. H(iprA IIInorNlln;ty 8X8rct11ng
Its 8UIhorIty to ..spend paymenta to prOYid11'8 and .uppU.... when eYidenoe of fraud
8XIsts.
.
.
In ~. HCFA Is nMawing and ChangIng progratnl:wd pone. . . . tiM·
been found l110It vuil tel IbIe to IIbwIe. For uarnpie, In ~ to bitter rtQ'lttbr fraud
.-.cf abuae rtllMed to durable mcdcaJ equlpmett (DM&). HCFA has changfd"
procedures for claims processing.. Four carriers are now responsible for DME claims
prOO8S8lng rather than the previOut 33- cattJera, ••~ whloh proYided OME
suppIIn OpponUnltlellO lubmtcc&a1m8 to the carrier who8e payment policy WBI'1TXJ8t
liberal. The new system of using four regIOnal carrlera reduc;es the chance'for
fraudulent bAling because 8U~.must 8ubmlt cIaJrna 10th,·carrier In the re;bn
where hi benetiOIary. teaideI,
"n'Ie use of more sophisticated data proc:I8S8ing sylltema, auGh .. the· MTS
eyatem, that I diIcussed ealiler, further incra" the chance8 of detecting aberrant
pal1trns Nt migttt indicate abusive behavior.. The MTS SYstem wll greatfy improve
HCFA'I ability to lCI'eert Medicare -'clajms for errors and freud,
.
IV. CONCLUSION
. For thirty years, Medicare has been in.llning the nation·. eIderfy and· di8abIed,
we know 1t'Om QUI' fOCUS groups, JlI10 11I1nk you are 811 aware frOm .tnteracuons wnn
your constituents. that beneficiaries feel a certain ownership of the program. ThIs
faaIing is justified~ Through their "payroll ~ionI and thole of their ~. .,
during their wor1<Jni lives. and through their own prerhlum,payments, benet'fc1IrIeI In
fact contribute 70 percent of their -insurance coati. W. went to work wJIh )Ql1O ·make
r_ponlilbl8 ~ In planntng'lIl8 neXl steps for U1e MurBaf ltE MedICare
program.. We look iorward to WClrking with thilSubcxmmittee 88 we expand·choIces
available to benePciaries without compromising quality, eOc888 Dr value.
�.Electronic Submission of Claims
Medicare vs. Private Insurance
"
Percent EJectronic
H
t::1 '
120
I\.)
o
I\.)
100
J
<.N
1.0
80
U1
J
C1'
......
60
.b
00
40
20
o
~
~;
~0
~~~
.
""~
#~ ..
~(J
~
."
;t!J:-
~~'
.~
~JJ .
.tI'
.
eft
,~t::J.
.~
...(1'
<f'"...
.
~0
q;,G
((}Cl
~
(J)~'
(TJ
to
I\.)
o
1.0
U1 .
I\.)
I-"
I-"
1994
Sowce: t-CfAlBPO; Blue Cross Assx.
......
z
o
o
o
P78 HCFACHl2
I-"
-0
I-"
I-"
"
�...
!
I
,of
The Composition of the Medicare Population, 1992
Elderly. Disa~ed and EE.1D
t-I
t:::1
IV
65-74 Years 510/0
o
IV
I
VI
U)
U1
I
en
.a:::.
.......
00
<65
(Disabled & ESRO)
29%
85+ Years
f1
rrI
OJ
IV
0
U)
U1
IV
Total Bereeficiaries=35.6 Million
~
Source:. HCFAlBOtJIS
P78 HCFJ'.CHT4
......
......
IV
:z
0
0
0
......
"
......
IV
�¥
•
•
J
.
.
Share of Program Expenditures by Income
. Of Medicare Individuals or Couples. 1992
1-1
o
tv
o
tv
$15,000 or Under
I
VI
\D
Ul
I
6~
en
.....
b
oo
$15,ooJ to$25,OOO 21%
!I
IT1
t.p
$50.001 or "-4ore 3%
25,001 toJ $50.000 14%
tv
o
\D
Ul·
83% of Expenditures: AI.lual
Income of $25,000 or Less
tv
.....
.....
tv
Z
&aides 2..2% mit repomng j 1'1C01'De.
Afso Exdudes HMO enrolees (9%}.
Sc:Ju1:)e: HCFAJOACT
o
o
o
.....
\J
.....
VI
�:SENT BY:Xcrox Tclccopicr 7021
1- 6-95
7:54PM
HEALTH CARE REFORM· WHERE IS IT? .
OUESTION:
Where i5 the Adminlstr3tion'~ reform proposal?
budqet7 How will you pay tor it?
thr
will it be in
i
ANSWER:
~
The Pre5ident is committed to working in a bipartisan
t3shion to begin putting America on thG road to' health
security. AS he stated in his Decembar 27 letter to
Congre5eional leadership, he believoa that we should work
in A ctep-by~ctep manner to. achieve t.heso goalll. In the
meeting with bi-partisan leadorship on January 5th he
aqain urged Congr~ss to work t0gethar to Addrco~
Americana concerns about the 5ecurity of their hoalth
care. H. will work with Congress a8 Democrats and.
Ropublioane develop proposals.
The President remains firmly committed to providinq
insurance ooverage for every Amerioan and containing
health care cost for families, bu~ine8ses, and Federal,
State and local govGrnments.
He has made it very clear
that h. will NOT give up the right for healthl!leourity
andattordable health care.
.
[on health care in the budget:) The bUdqe~ is thQ
and he will announce it at thG appropriate time.
[A
copy. of the
Pre~ident I
PrQsidant'~
e letter is attached]
A - 15
January 6, 1995
�94567431:# 3
, r 7021 ; 1- 6-95
''\ ~ SENT BY:Xcrox TcicCOP1C
7 : 54PI-I
..
TH.~
wHITE HOtlSE
.....ItUI'fQtClN
,
u'l&r Nevt t
ve .~Qu14 ftot achievo ~~I~.Da •• a agreement 'on A nl&l~n
1"1titt!~e ll'~ year, thc~o ~4n ~e,li~tlc d~iig~oemon~
that ~••till fael,t~1 onQrmo~! prohlem. of incre.g1n~ health
ar., c:o.l:a 4nd. 4Gcrudn,g ClQvulge. WI naeC! to eoaf:cnt these
)
roblema en 1 eipartiaan ~&.i. ano .d~~e~~ the 1neecur1ties that
00 ftlAny ARluiclnS 1\lv, abcti: cheir t1nlth en..
:t 1111 ,.,d\;Lng
~~le
re:crm
~
,0
AU.rata ro.y,ltt'cmg de81ra
tOlrlCr);
with
Y0\l,
11:1
thU ra~:..rc!.
~cnw~tt'c1 to provi4ing insuranc:t ccvuagefcZ'
an4'eoneain1ns b.&l~n care COle. :cr tami11a~,
U81ftlaaa., &ad r~Qe~.l. Stat., .~d lo~&l ~.rnme"ta. In ~ho
poeming e•• ,~cn of Coftgrl•• , WI can 'nd anou14 work togQ~h.r to
aXI chA fi~.t .tep. tcvarc! aehiev1ng ;h.'e goall. we cln pa••
e;1.alat1cn l!hat. i!leluc!t. ",... ~re. coo aw.... tM 1.1ntdrne" 1n
he in.~~an~e mi~kGt, matt ecvera;. mo~8 aftordlbl~ !O~ yo~);ins
k remain
firmly
av.~ ~er1Q~
.1I\1n quallty &ao 1:!!i,iencY in thl
ano Meci1clid pre~r~, &no t~Q~~' the loa~-~'rm pod.4al
'
.
am111eland ehil4reZlo,
ed1e&~.
.£i~lt.
• leek forward ~o t&lk1ng w1tn you ift tho ~pooming WeekA
o~t a bipa.t184n .{tort to 4el1vo. health oape ?fc~ to the
"ice pUblic. U1UIlry &nd I .eno ou but wishua for .. Uti
d. ha.ppy hol1d.J.y U"Oft.
I'
',inc.nl.y,
~'C~'L-~
\'
\
1h. Honor~le
ijou••
'----
Nawe
Qln,~i~h,
o~ RAp~esantat1v.a
If&lh1n~Qn.o.c. , 20$15
�94561431:# 4
, ~
~
!
SENT
By:~crox
..
TclccOplcr
1021: 1- 6-95
1:55PM
HEALTH CARE REFORM - EXPANDING COVERAGE
.You say you want to expand coveraSQ. How will you pay tor it?
Would you support Medioare cute to pay fOr coverage
expansions? particularly .for children?
~
The Administration remains committed to expanding
coveraqe for all Americanll, including children. As you
may remember, when we sent up our bill last year we
provided run4inq to pay for it -- we want to work this
year to oontinuo to search for solutions aDd .e will al.o
VI-At to ahare .:lll the t.spous1bllity of idtUltityiftl1the
r ••ouzae.to pay for it.
As far as Medicare outs are concorned, let me reitorate
what the President has Gaid
he will not support the
use of any new Medicare savings outside the context of
health oare reform.
~
Once we all have a better $en~e of what kind of coverage
expansions we are discussing and what other options might
be there tor tund1ng then we all can digcUQ~ which
options may be the m05t suitable.
FOLLOW-UP QUESTION:
Will the President insist on univQrsal coverage?
~
II'
The President is committQd to providing 1nQurance
coverage for every ~erican and containing ·health care
costs for families, businesses, and Federal, State, and
local governments. He believes that we ehould work
together with Congress to take the firat steps toward
aohieving these qoals.
'together we 'can work to pass legislation that 1ncludQs
measures to address the unfairness in the ineuranc8
market, make coverage more affordable tor working
families and children,· assure quality and e!!1c1&ncy in
the Medicare and Medicaid programs, and r.duce the 10ng
term Federal d$ficit.
.
A - 16
,
January 6, 1995
�·\ ~ SENT BY:Xcrox Tclccopicr 7021
1~ 6-85
7:55PM
84567.4 31 : # 5
LONG TERl\-J CARE • T.AX CREDIT
QUESTION:
The President has 8aid noth1nq lately aboutlons-term care.
Would you 8upportthe tax credit tor carlq1vera wo propose in
the contr~ct? [or--have you abandoned your so-called
commitment to long-term care?)
ANSWER:
..
~
Thi. AClminietrat10n continues to support alllsillltance to
states to develop home-and-community-cAro ~ystema that
help people with substantial ~isabilities, req3rdless of
ago or condition; strengthen families' ability to c~re
tor disabled family Ulemb8rsl ~d allow atatoQ the
flexibili'ty to tailor servioes to their pattlcu13r naedc.
we are delighted that .the Contract too r~coqnizes the
importance Of addressins our citizens' long-term care
needGi. We lihar. the Contract's interest in .xtending
preferred tax treatment to long-term carQ insurance. But
we feel 5tronqly that insurance should inclUde
. information and be marketed in ways that helpaenior5
understand tho benefits and limitations of insuranco
policies.'
.
(It Mrs. Johnson or another member shouldaek about
requirements for insurance policy, answer should
be: We'll be happy to work with you.)
~pecific
~.
We too ahare the Contract's concern about helping
caraq1vers. However, we believe the propoaed tax credits
lUay not be 'the best 'Jay to targot limitlid rGiBOUrCes 'to
oaresivers end their chronically 111 family lllo.mberl5. Wlil
th1nx a bettor lpproach to helping these Americans would
be through grants to Stateg for ~ervice5 tailored to
oommunity needs.
(swn.mary of lonq ter:m care propo15al5 within the contract With
America is attached]
A - l7
January 6, 1995
�94567431:# 6
. 7Q21
".' SENT BY:Xcrox TclccOplcr
i- 6-95
7:56PM
i~
P!uy1IiW:
nere are two propoala tor add.re&'stna loftl term care Deed.a:
•
•
A s"OO a year refundable taX crcd/., for taXPayers who haw :l patQllt or &ralll1parent with a
dlsaoillty living with them 111 their AO=el IDd
A IIIO<1lficat1on of the tu code to pcrm.lt t'avo11ble tax tre&tmcIlt for privlIIO 10112 term ea:t ..
~ pCCllliums.nd
expe!ld.iturlS.
The retwuiablc t.u crc4It Is probltlDlUot
•
The credit Is ll.%l:lltcd to wG w:payon who have ~ par=£ or &nndparent living with them. It ' .
provideS no Wlstanee to older people: livllJi Ilene. to the milIlona of IpOUles WhO 110W care
for a dia&blcd wife or husband, or to the ;&ropv", of disabled chUdren aDd. young adWI.S. :
•
The benefit Is roo small to provide ~ assistance to the fatDilla or old.er peOple with
slgnltic:a.tlt d.babUltloa. who are srruasliDg to· cue for thcl.r loved ones without lIDy help.
The Adml.D1straUoQ c:ontiDues to ad'oeate ror I
pSded by tht toUowtu, prtadpla;;
.•
•
DCW
lODg term care proara= or grants to states wbleb Is
Pcoplo with .ieDifiant disabillu03 IDd their !mllics lbDuld receive 10115 tc:nIl
bIMId on Ihclr nccll /lot on tbcIr aae or ci:lMit!O/l.·
,
C&rC
assiJtance
TQ c:ompltQlC!U aDd I~eo. the Wonnall:aI'O givinl I)'stem we l'.Uust tltl4 wayl to make
wi community long term care aenrlcosav&llable ill every Stale and eomr%lWllty in dW
country: To maP lhia happen we must work in par'ttUIf1hlp with govetnDlOll( II allleve1s aut!
heIDI
wllh me private ~ot and voluntlQ)' &X01lp&,
'.
Public funding fot 10111 term em aIlowd be hlghly Gulblo 110 th&L ,lata and COmtl'lunltles c:aA
tailor !he 4eai&n of th!lr .ervica d.cUvcry I)'au:ml to their UlIique nteda 8AQ ~tanCOII,
Printc louatn c:ar"8liLNruee proposal Dads ImPl"OVfmfllltt
•
. Th1s proposal iI.vary aJmilar to the ad.ml:datraLloc', proposal, We IUpPOrt the IltJfId for
"
nuwtvcr, ..~ bc:J••" t.1:.e:. ~ ~~ pcu \[~ or J;4:.±oi p:!;.;:,e !,,;:.,t 1tr'Q ~e lJj,ltiIiI.llCC
favorable tu ttea1t!ICnt lathe .l4bliahmcDl of SOIIlll m!Jl1murn ~t protcc;tiQtlS ,
taX
Clarifications 10 thal private lOIil termc:.ate inl1.ltaIlce aM prlv&Ull~ !CrIll care ~
cau be dedw::u:d WIder the tI.X code hi the aamcrway tlW medical ~ c;.&ll be dcductcc1.
�9456H31:# 7·
. '<:' SENT BY:Xerox
Telecopi~..r' 7021
1- 6-95
7:56PM
ERISA - PREEMPTION
As you know, 8tate~ are limitad in their ability to pursue
health t:-aform because of ERISA preemption. What i8 your
position on giving states greater tlexlbill~y over employers?
•
states have taken a leading role in health care reform.
They should be encouraged to continue their efforts to
incr.iue coverage. and contain health· CClra COQts. At the
8ame time, ERISA has permitted laros employera to develop
innovative health programs, free from sta~e mandated·
benefits and anti-managed. care law".
•
We are currently evaluating options on the bast ~ay to
proceed in th1s·arQa. We look forward to working with
you on this important issue.
A - 15
January 6, 1995
�94567431:# S
'I;'
SENT BY'Xerox Tc I ccopier 7021
WAIVERS .. MEDICARE SELECT
t.
He.dicdra Select has been succeSsful in l'D.i!lny S'tates. I t
~bout to expira.
would you ~upport not only ita extension but
its expansion to all 50 St~.tes on a permanent r~th.r than a
demonstration b~sig'
'ANSWER;
~
While wo believe that the SELECT damonstration has baen
successful on 4 number of fronts I we believe that boforo
the proqram ia mado per~anent and expi!lnded to all SO
ati!ltee that we should laarn from our oxperionc::e unda,r the
demonstration dnd maXe ~ number of program changes.
We should ba assured that SELECT plans are actively
mana9in9 care and that bonofic::iaries have tho $~me
level of assurance as to the quality ot care and,
access to care that they receive under the other
Medicare ~4n4ged care options.
Por oxamplewhile Medicare SELECT plans are required
to havQ procedures tor evaluating quality and takin9
corrsct1vA actions, th&re is no atter tho ti!lct
determination throu9h Qite visits that the 'plan has
tolloved tham or that they are effective. While we
'roquire that other Medicare managed care plans have
'active quality improvement committees that collect,
analyaeQ and aot on ~ata there iQ no such
requirement for Medioare SELECT.plans.
We look forward to working with the Congree8 to learn the
lQseon from the SELECT'demonstration and to make an
improved SELECT option availahle on a permanent basis in
ail states.
~
In OBRA 90 , Congress authorized a 3-y••r demonstration in
15 atataB tor the sale of a hybrid managed care/Medicare
product oall Medicare AEL!C~. Unlike other Medigap
policies vhich pay benefits vithout regard to where
servic::e5 are providad, Medicare SELECT polioies may limit
benefits to services provided through tha plana'
preterred provider networks.
The demon~tration woul~ have expired in December 1994,
but it was extended for 6 months in the Sooial Seourity
Act Amendments ot 1994, signed into law on October 31,
1994.
1;. - ,19
,january a, 1995
�...
9456H31:# 9
. : SENT BY:Xcrox Tclccopicr 7021
Many mellLbers of Congress support: making
it a permanent,
nationwide proqram; such a provision ~as included in
lIaveral health care reform proposals. However,
congressman 'Stark oppo~ed it. The 6-month extension was
• oompromise to buy additional time to decidQ what to do .
about a program with strong supporter5 and detractors.
A - 19.1
January
(i,
199~
�B4567431 :#10
"
SENT By:Xcrox Tclccopicr 7021 : 1- 6-B5 : 7:58P~ :
WAIVERS - SAVING MEDICAID MONEY?
What are you doing to save money in Medioaid?
~
To da~e, nearly e million Medicaid beneficiaries are
enrolled in managed care plans, which is approxima~ely a
40 peroent increase in enrollment over ~h9 past yellr.
Since, January 1993, HerA has approved SO state
applioation. to establish Medicaid managed care programs
and 18 more appiicat10ns are under rQv1e~. Through the
8~ansion of managod care, savinga will be aChieved
t.hrough et'.ticient program manaqement, foous on primary
and preventiveoare and effective case management. of
Medica1d henefioiaries.
As more st.ates apply and are approved for waivers, HCFA
has Sf:J.t a hudget neutrality cap tor thetive-year lifo of
tho project. This means thet states must stiok to their
projected bUdget and the rederal budqet i5 protectGd from
any unanticipated increases over ~he lifo of the,waivQr.
The end re5ult is savings for the state and the federal
governm.nt if the waiver is managed efficientlY.
A -
20
January 6, 1995
�•
'. SENT BY:Xcrox Tc Iccopicr 7021 : 1- 6-95 ;, 7: 56PM :
..
94567431:#11
MANAGED CARE AND SENIORS
Would you support moving seniora into managed care programs?
Isn't that the· best way to promote efficiency in the Medicare
proqram?
[CONVERSELY" you could. l:le,askAd: How do we protect 5eniora
and other consumers from being forced. into managed care, which
may not be in their best interosts?]
,ANSWER:
II>
This Administration has alwe.ys supported choice. There
is no question that managed oare is 'Workinqto keep costs
down while keeping consumers happy and healthy. Sut
While I support man~qed o~re, I also strongly beliQve
that consumers, 1ncludinq seniors, need to have the
choice as to whether or not to jotn a managed care
proqram.
'
As affective aa managed care can be, it is not for
everyone. As Chairman Archer said to me in October 1993
when I teetitied betore this Committee, thetreedom to
choose one's health care providers,is a "very, very
special ~reasure to AmericanQ today,ll, I could not agree
moro, and giving Americans'of all aqas the ability to
choose their health plan guarantees ,that choice.
11>'
seniors are increasingly
of It per month.
choosln~
A - 21
managed care at a rate
J'i'1nuary 6, 1995
�·
94561431:#12
.
SENT BY:Xcrox Tclccopicr ?021
MANAGED CARE AND l\fEDICARE
What is th. current statue of. manaqed care programs under
Medicare? What specifiC things can We do to promote managed
oare in the Medica.re program?
)
~
As of September 1994, nine percent of oar Me~icarQ
benoficiaries wore enrolled in managed care, which 18 an
increase ot l~ percent over the prevIous year. More
importantly, the number ot plana with Medicare contracts
increased by 2~ peroont. 50 clearly, thie is a' qrowing
asp.ct of tho Medicare prcgram.
There are many ways, either throuqh legislation or
r~9Ulation, which wa can expand and improve Modioare
manaqe~ carQ programs, inCluding:
Our prosent payment mothodology needs to ba improved
and updated, the Department is currently examining
the possibility ot using .a competltiv; bidding
process ~~ establish payment rates.
We believe that Medicare SELECT is a promising· new
option, and would like to work with you to find way~
to expand that program.
.
We nQed to do a. better job educatinq Medicare
benefioiariea about managed care. Current choices
between managed careoptione And Medigap can be
oontusing, .and we'd 11):e t.o move to an annual open
enrollment prOCQse to make these choices more
understandable.
A - 22
January 6, 1995
�,
.,
84567431:#13
'
702 1 : 1- 6-95 : 7:59PM
SENT BY:Xcrox Tclccopicr
MEDICAID ENTITLEMENTtnLOCl\, GRANTS?
Should Medicaid be an ent1tlQmcnt'?
about m4kinq Medicaid a block, grant?
Why
What 0.0 you think
ANSWER:
~
We are committed to protecting thepopulationssrvQd by
Medicaid, While working with states to promote cost
containment and tlexib1lity within Med1caid ' s current
entitlement ~pproach. That approach ae5ure5
states that tederal matching funds Will be availablu
to pay for the health,care. needs of thGir VUlnerable
cititens,so that. they do not llear these coste on
their own;
providers that they ~ill be paid for care to
vulnerable populat10ns~ so that they do .not ~ave to
shirt these cos~s to other payQrQ; and
low income children, pe.ople with diaabilitie.s and
other VUlnerable populations 8CCe.S~ to health oare,
80 that they do not have to go without needed
service.
A -
23
January 6, 1995
�94561431 ;#14
.• " SENT BY:Xerox Te Iccopicr 7021
1- 6-95 : 7:59PM
MEDISAVE PROPOSAL
.QJlESTION:
What i. the adminis~ration'e position on
introduced by chairman Archer?
.
•
~h9
Medisav8 proposal
We support many of ~ho ~oala that underlie MSAe -- we
wan~~o encourage families ~o save moro ana we want to
make the health inaurance market more competitive.
However, we have looked at a number of MSA proposals, and
we are concerned that they could cause serioue problems
in the in.urance market because they mOVe away from the
concepts of pooling ot risk and shared responsibility.
Unlo8G we are careful, we could undercut many of the
insurance market reforms that states have enacted.
'rhese propolials could cauas premiums to increase for many
Americans.
The combination of an MSA and a l'1igh
deductible insurance plane will b~ much more attractive
to younger and healthier families than it is to older or
less healthy·oneal. This would load to adversQ selection
-- premiums for young and healthy people that are ~illlnq
to enroll in high deductible plans will tall, whilo
pramiume for everyone else will ri~G. Ri5k adjustment
oan help some, but they ~re impreCise and would not
eliminate effects or selection.
I know that these propoGllh also raise serious questiomi
related to Administrative comploxity, budget neutrality
and tax equity. 'rheee issues are better addresses by tl'1e
Tre~~ury Department.
A -
24
January 6, 1995
�01,56H3' :#,5
,
'
, r 102'
" ." NT 13Y:xcrox Tc\ccoptC
SE ;-.
~C-22-19i4 . 1S:B2
"i!Iy\lU
,_ 6-05 ; 8:00P~ :
tlQSTAl< tU.l C'I'
,
IQJ OOS
'492 5i2 f1?64
P . es--e6
)
Mcdlc::al Sa'fblp A.ccaDUU
N&~
'Qru;luslpos,
•
Medial Savin,s AccaIUI%S (MSA,s) are po1ltblly appel&&.
•
MSAs may have In adV!t'lt ef!'= OD tha btalib ~ mubL . M a ~.
premiums Of the lUi healthy \\IOuld rise,. ~ pr=tums of ~ hc.althy 1l'out4
faU. '
•
liealth ,.rorm proposals by Dole, Chifco, !.ru:be1. Samctum. and Gcpbatdt
Includ. variants of Medical SlVL=gS, Mcl'll2cra (MSAI). "l'hco, J3lW:1 A4m.b\i.stn.tiO'l1
worked \IIi~h several membtrs of C~SlIO'tlUds'developi.q'lI.D MSA ,proposal.
Miny Rtpubli~ and. loma Democrat!! u.yor WSAl. n. Health Seeurlty Al;t
did nor inelu~, MSAs. but 1M propostl IpProvc:d. by'the Wa)J Ill4 Moaris
Committee did.
"
,•
MSA prcponls allow wtpayers to 1'11C:C t'wld. in lipcQal t:U.-prefmcd atCOUl11.
Funds from MSAs that are used tor IPCdftc6 mc4i.c:&l purposes arc ugt \Ue4,
'while runes 'used rer other purposes mlY or may =at be mxed ~ upon thI·
. proposal.
"
or
•
.The iftt:nt an MSA i.S to ;nc:ouraac employers e.ci employoeS to JWirdt Cram
"cnmprchcnslvc" health insurua te -tat.l.SU'Oph1c- PI~5 tha.t have b.lchet c;oa .
payments and deduc1iblu. thereby livia: employeec tn lnceD1ive to reduce
unnecenary mel1ical CUI.
.'
•
In glnerll~ MSAs 1:01.116 provld'e & mechanism for tIX-prefe1l:'Ot1 Avina for healthy
individuals ....hlle Qluslns pret!\iwns tor lKi hetlthy 1n~vidUals to risl, Advtnc
s.:lc:t:tlon m1Y, r"ult 111 huhh)' and upper i.r.II;ome lndMdllli.ls jolu1ng MSA.t,
k:1"ln~ less heahhy and lower income. iD4lY1duals in tht more cornPrcMus1ve Pee·
F('r..Scrvic\: plw and HMO pl,..al. A'i a rtWlt. ~remluml of tbt leA bWth)"
~I.·"uld riM. whil, 'I'Cmi~lTLs at the heAlthy would fall. 'Ib1s idod or refCC'lll woyld
.unutrminl tommunit)'-t'&tin,. RisK-adjusters Illd taXq cwld be dcvbed to ~uco
the~ efT,'l'. However. Nk adjuster1 a.rc impr=d.se: 'would be dif1l.eult to do
~~>n"eelly~
:tnt.! wO\lld be lIiowcd lS'ldrolni,rtr&tivdy bun1ensortlc.
�94567431:#16
:Xcrox Tclccopicr 7021
199~
.\
1- 6-95 : 8:00PM:
lSlill2
•
~~2 '2::1 8'78.4
P . ~/0G
IR3 Tp')( P!l....ICY
MSAs would
~\lg:
inluranca prenUutl'l.S
tar pal11ciplJ1.DI but expose them to
1a.r&er out-or·poekct costa. Some individuals who un~pa:tcdl)' bt".eOrne _
flnd thel'r\stlvw.s shon of f'wIdsta cover tl'Ielt medical ~sc:a.
mlY
•
A lbnd study of heaJth inlunnc:e. condud!d in ah~ 1910's, IUJPItl mat if an
individual switches ~m , pllll with & 5200 deductihle to a. plan with a 52,000
dmu.ctible thu IndMdlJll '!"Ould, reduce !a1'Jl bealth oxpcndlw.ra by 10 pcr.e1\t.
Tcm pc:rce.nt t, In upper' boun4. Bcca1& mete would be no av!:lgs for
nonpcnidpuus and, for rhoce who I~td\ tram COlt eiftctivc In(Os to MSAS,
IIlre,ltt savinls \ItOuId probahly b. mud! tower tNn 10 ptrcecLt.. daplnding
upon palti~patiQn. (Soma people outsido the AdmirUnntion lI\&y boUM that
cost SAvin,s loR ,realer than 10 pcn:cnt. but lOme ,pa.rtic!PUlta in the NEe
meedn: btUcve ",vines ue close to zero.)
•
Greater p:uti=ipat.ion in caculmphle plans wowd rtduCe costs icm.awhat.
Howev.: thm art bcu.er ""'.YS to eneouZ1gG rM usc of QWU'Ophle pb.Da, Th'-SO
lneludt: (1) ,t.u. QPS on, co-pa.yments ind dcducdblca; or (2) expanded
dedUCtibility or medic:&l coxpcnscss. Other health in'~cc market retorm& mi,bt
also be (1esilned to encourlic l:a~trOphle plans or cost containmant: However,
c:ost containment will rdU be dimc:ult to obtain.
'
•
fo~, thoy should be c:arefully dc:signed to red~
.tfe:u. Diffetlnt ),{SA 4c.sicnl tc:aC1 to d..i.ffe.ront mqnitudO$ of ct!ecu.
, O~i,n (catu.res, to be coaafdBrCd indlldc: (1) lim.lts on ccl\uibutiolUi (l) tax
. treatment of caminc! in the funds; (3) Urnh! on and taX trea.tmeat of withdnwals
for n.onmcdic.eJ purposes: and ('> tigh1cninl tho definition of medleal wtUlclr&Wil.s~
"The limits ilia othor dcslgn fe:a.tUrel sb,?uld depend to some extent on OUlct MSA
desicn featurc.s Sl.ldl as risk l.Ojuston.
•
rf MSA proposals 10
adY~K
I
.-.
e
5
2
&
�THr. SECRETARY OF HEALTH AND I-iUMAN
SER\I!C£~
WAS",,,,CTC,.'1.0.<:' ?0201
March 7,1995
The Honorable Bill Archer
Chairman, Committee on Ways and Means
House of Representatives
Washington! D.C • . 20515
I"
Dear Mr. Chairman:
This letter expresses the Administration's views on H.R. 483, as
reported by the Subcommittee on Health. H.R. 483 would make' the
'Medicare SELECT demonstratio'n program permanent and extend it ~o'
'all 'States.
Our experience with the Medicare SELECT demonstration should be
part of the effort to improve current and future managed care
choice~ under Medicare.
We have previously made' available the
case study portion of the Medicare SELECT 'evaluation. Other
pieces of the evaluation arestil! in process; these include a
survey of SELECT .plan enrollee satisfaction and an analysis of
SELECT enrollee utilization experience. Preliminary results will
not be available until the later part of this summer. We believe
that Congress would benefit from a review of the full evaluation
results before beginning the deliberations on Medicare SELECT as
a permanent program.
The case study portion of the Medicare SELECT ev~luation has
already raised a number of questions about· the Medicare SELECT
demonstration. As managed care options under Medicare are
expanded, we want to ensure that our beneficiaries are guaranteed.
choice and appropriate consumer protections. In addition, many
of the SELECT plans consist solely of discounting arrangements to
hospitals. We would be concerned if the discounting arrangements
under Medicare SELECT were to be expanded to Medicare
Supplementary Insurance (part B) services. Discounting
a~rangements, particularly for part B services, may spur
providers to compensate for lost revenues through increased
service volume. Consequently, we are concerned that such an
expansion would lead to increased utilization of part B services,
rather than contripute to the efficiency of the Medicare program
through managed care. We 'Would therefore oppose such a·change.
�."
Page 2 - The Honorable Bill Archer
Gi~en that the Medicare SELECT demonstration is under ,an expiring
authority with an impending deadline, the Administration supports
a temporary extension of, the 15-State demonstration.' Such an
extension would provide sufficient time to examine what we have
learned from the demonstration and to make needed changes to
SELECT based on our findings.
We are committed to working with the Congress to improve and
extend the available choices to Medicare beneficiaries so that
.they have the full range of managed care options enjoyed by the.
general insured population.
We are ,advised by the Office of Management and Budget that there
is no' objection to the presentation of this report from the
standpoint of the Administr~ti
�Extendinq cur'rent Mldicare Policies
o
The President t s FY 1996~'budget proposes. to extend four
current law Medicare provisions.
+
o
These extenders are provisions that are in effect now but
are scheduled to expire unless they are extended.
+
o
f
1n
th~
Inclusion ot these extender provisions in the budget
will lower the projected FY96 outlays by $140 million,
and the to~~l FY96 through FY2000 outlays by $9.8 bill.
We are concerned that new Medicare cuts outside of
health care reform will impose new costs on
beneficiaries and/or reduce provider payments inducing
them to refuse to taka Medicare beneficiaries, both
without providing additional health· security to those
on Medicare.
'
The President's budget uses the savings from the Medicare
extenders for deficit reduction and explicitly not ,to
finance the president's middle-class tax cut~
+
a
s~ike
The President does not intend to propose any new Medicare
savings proposals outside the context. of health care reform.
+
o
without extension, there will be an upward
Medicare spending baseline.
These extenders do help reduce Medicare spending. But they
are not new Medicare cutSt rather these are policies that
are currently part of .the Medicare program.
+
o
The budget contains DQ new Medicare savings proposals.
The Administration's proposed tax cuts of $63.3 billion
from 1996 - 2000 are financed by $80.5 billion in
reductions to discretionary programs. In addition,
$26.2 billion in savings from the second phase of
reinventing government, $37.4 billion from mandatory
programs, as well as other,initiatives will produce
another $80.6 billion in deficit savings over the next
five years.
Specifically, the extenders cover:
'+
+
Medicare Secondary'payor protections which allow the
Medicare program to collect payments from primary
insurance sources. These expire after FY 1998.
A provision that maintains the Part B premium at 25
percent qf program costs.
This expires after 1998.
�. ·,.
)~
,
page 2
extending current Medicare policies
DRAFT
+
A provision that makGs permanent the savings from a
two-year temporary freeze on payments for skilled
nursing facilities (just like all other freezes in
Medicare have worked). This"··expires:' after FY95.
+
A similar provision 'with rGga~d to home health
services.
\
'J
�:ources of Funds
i\'lcdic~re
Receipt Proposab
Illdin'rt Errect.,
Mcdicare
Oil
Herl'i"t,
S~\'ings
i\lcdicaid 11511 Frce?e
Medic~id
Offset
Uses of Funds
Kids Prol(r:lm (133'10 - 241J';I-,) +
Temporarily Uncrnplo\'cd (100% - 240%)
6.7,81
FQHC
Expaf1.~ion
Erfect
Oil
!'vledicare/i\ledicaid
l.oflg-Il'rm CaI'(' Progral11
Long-term Ca re Ta,
ell" ngl'S
Self-employed T:1.' Decluclinn Phased to 100%
.~\
',·1
\
. WHI
I !.3
12.0
12.8
I ~.6
1451
36.7
5,J
5.5
5.9
6.1
6.5
7 I
19.8
6Jl
68[
5.1
57
5.6
6.1
'u,
02
0.2
0.2
02
0.2
02
n.1
0.1
O.l
0.2
02
0.2
u
1.5
J .6
1.6
1.7
IR
0.2
0.5
OJ>
O.X
0.')
1.0
0.5
0.9
I.~
20
2.2
2.4
00
6.8
9.4
10.0
00
0.0
0.0
0.0
3R
JO
5.2
4.2
101
0.0
0.2
0.2
n.2
III
00
01
aI
121
o.n
0.0
111
0.0
I dl
0.5
Subsidies for Kids (net or ki,h ill TU Program)
Subsidics ror Tcnl(lorarily Unemploycd F~rniljes 91
Puhlic ""-altl! Se~\'ic"'FQIIC Expallsjoll
10.6
0.0
16.9
50.7
50.1
021
1.0
2.0
0.2
OJI
O.S
1.5
I.S
1.9
2.01
6.2
15,4
1.1
1.2
1.4
1.)1
30
92
2.7
30
1.2
3.51
7.5
22.3
7.7
�·s
DRAFT
Footnotes for Package Three - No Tobacco Tax
I estimates are preliminary. Totals may not add due to rounding.
Ie both Sources and Uses of Funds appear in this table as positive numbers, in the budget, Medicare and Medicaid savings would
be indicated in negative numbers as reductions in outlays .
. Similarly, the cost of the self-employed tax deduction would be indicated in negative numbers as a revenue loss. Increased receipts
would be shown in positive numbers.
Administrative costs have not been estimated.
II
21
Includes income-related Part B premium and extension of HI tax to all state and local employees. Includes effects on Part B
. take up and utilization of services. Estimates from HCFA:iOACT and Treasury.
Indirect effects on receipts of the kids subsidy. Subsidies for unemployed cause a negligible effect on receipts under standard
assumptions. Includes on-budget effects only. Estimates from Treasury.
Estimates from HCFA/OACT.
41
Includes 25% behavioral offset. Estimate from HCFA/OACT.
51
Medicaid offset reflects savings to Medicaid as a result of Part B savings. Estimates from HCF A/OACT.
61
These estimates assume some employer or employee dropping of insurance,
revenues.
71
Also assumes that kids and families with access to employer contributions of 50% or more arc ineligible 1'01' subsidies.
Assumes 100% ESI takeup for unemployed program. Assumes durational effects on health insurance subsidies.
February IX. 1995 (.1:40pm)
""
ch would
jn small, increased tax
~'
�\:.
DRAFT
8/
Assumes that unemployed compensation is included in income determinations for the unemployed program. Eligibility for
subsidies based on monthly cash income. Basing eligihility on annual cash income would reduce costs and coverage.
Subsidies to unemployed individuals will have an indirect effect on.the unemployment insurance (UI) program. Such an
indirect effect is estimated to increase the cost of the UI program by approximately $2 billion over five years'and $3 billion
over ten years (net of offsetting UI reccipts).
10/
Estimnle from HI-IS/PHS.
111
Estimate from HCFA/OACT.
12/
Grant program to states to expand home & community-based services for disabled individuals. Estimate from HHS/ ASPE.
3/
] 4/
Includes !ong-'term care insurance tax incentives, personal assistance services tax credits, and accelerated death benefit
changes. Estimates from Treasury.
Five and ten year totals include $0.5 billion cost for self-employed tax deduction in FY 1995. Assumes that self-employed
must provide health coverage to their employees in order to claim a deduction in excess of 25%. Phase-in: 25% in 1994/95;
50% in] 996; 75% in 1997; and 100% in 1998 and thereafter.
Five and ten year totals
8, 199:\ (I AOPll1l
ude $0.5 billion cost for self-employed tax .deduction in FY 1995.
\
�. ":,
DRAFT
Possible Sources and Uses of Funds - Package One (Phased-in Tobacco Tax)
.
J
\ 11)
Fi,cal Ycars. Il illions of Dollars
lUrces of
II
0.0
0.0
39
54
5.4
54
5.:1
5.:1
6'1
(,.R
671
20.2
50.8
,\edicarc Receipt Propos:"s
21
0.0
1.4
2.7
2.(,
2.6
2.<)
1.2
3.5
.1~
:L2
,1.61
11.3
31.4
odin.'d Efft'c.:t.... on i{t,t'l'ipts
11
(j,n
(lO
0.1
0.2
0.2
0.2
0.2
0,2
0.2
0.2
02
0.7
1.9
27.1
115.9
8.9
35.9
0.0
0.5
36.7
100.8
Oh:H"f(l
Tax (pha.'.:t'd-lo)
1
2351
\iedicnre Savings
41
0,0
0,8
4.0
5.4
7.3
9.7
125/
14'.8
17.5
203
\Iedicaid [)SII Freeze
51
0.0
0.6
1.1
1.7
2.4
), I
3&
. 4.6
5.4
6.2
.\ledicnid Offset
61
0,0
0.0
0.0
0.0
0.0
0.0
0.1
0,1
0.1
0.1
7;8,91
0.0
0.0
6.8
9.4
10.0
10.6
11.3
12eO
12.8
. l3.6
Subsidies for Kids (net of kids in TU Program)
Subsidies for Temporarily Unemployed Families 101
00
0.0
0.0
0.0
3.8
3.0
5.2
4.2
5.3
4.6
5.5
5.1
5.7
5.6
5.9
6.1
6.1
66
6.5
7.1
68
7.7 1
19.8
16.9
I II
0.0
0.2
0.2
02
0.2
0.2
0.2
0.2
0.2
0,2
0.21
1.0
'·121
0.0
0.1
0.1
0,1
0.1
0.1
0.2
0.2
0.2
0.2
0.31
0.5
III
0.0
GO
1.5
1.5
16
16
1.7
1.8
1.8
1.9
141
0.0
0.2
0.5
0.6
O.S
0.9
10
1.1
1.2
1,4
1.5
3.0
151
0.5
0.5
0.9
1.4
2.0
2.2
2.4
2.7
3.0
32
3.51
7.5
:~l
)ses of Funds
Kids Program (133%·240%) +
Temporarily Unemployed C100%. 240%)
Public Heallh ScrvicclFQHC Expansion
FQHC Expansion Effect on i\!cdicarcfMedicaid
Lon~·terlll.Cat'e
Program
LO!ll(-lerm Care. Tax Change.,
Sclf-eTT1plo~'cd
\
T:1,\ Deduction Phased
10
100%
14.5,
20/
6.2
�DRAFT
Footnotes for Package One - Phnsed-in Tobacco Tax
I estimates arc preliminary. Totals may not add. due to rounding ..
ile both Sources and Uses of Funds appear in this table as positive numbers, in the budget, Medicare
be indicated in negative numbers as reductions in outlays.
Medicaid savings would
Similarly, the cost of the self-employed tax deduction would be indicated in negative numbers as a revenue loss. Increased receipts
would be shown in positive numbers.
Administrative costs have not been estimated.
'1/
Increases by $0.49 per pack from today's $0.24 level. Specifically, on 1/1/97 increased to $0.60 and to $0.73 on 111/2003.
Estimate from Treasury.
21
Includes income-related Part B premium and extension of HI tax to all state and local employees. Includes effects on Part B
takeup and utilization of services. I Estimates from fICF NOACT imd Treasury.
31
Indirect effects on receipts of the kids subsidy. Subsidies for unemploy'ed cause a negligible effect on receipts under standard
assumptions. Includes on-budget effects only. Estimates from Treasury.
41
Estimates from HCFA/OACT.
51
Includes 25% b.chavioral offset. Estimate from HCFA/OACT.
61
Medicaid offset reflects savings to Medicaid as a result of Part B savings. Estimates from HCF A/OAeT.
71
These estimates assume some employer or employee dropping of insurance, which would result in small, increased tax
revenues.
Fehru"rv 18.1995 (1:40pm)
"
.
'"'
t)
�-,:
families with access to employer contributi-ons of.50%'or more are ineligible for subsidies.
for unerpployed program. Assllmes durational effects on health insurance subsidies.
8/
Also assumes that
Assumes 100% ESI
9/
Assumes that unemployed compensation is included in income determinations for unemployed program. Eligibility for kids'
subsidies based on monthly cash income. Basing eligibility on annual cash income would reduce costs and coverage.
Subsidies to unemployed individuals will have an indirect effect on the unemployment insurance CUI) program. Such an
indirect cfICct is estimated to increase the cost of the Ul program by approximately $2 billion over five years
$3 billion
, over ten years (net of offsetting Ul receipts).
III
Estimate
12/
Estimate from HCF AIOACT.
HHs/PHS.
Grant program to states to expand home & community-based services
disabled individuals. Estimate from HHSIASPE.
'\
141
lSI
16/
Includes long-term care insurance tax incentives, personal assistance services tax credits, and accelerated death benefit
changes .. Estimates from Treasury.
Five and ten year totals include $0.5 billion cost for self-employed tax deduction in FY 1995. Assumes that self-employed
must provide health coverage to their employees. in order toclaim a deduction in excess of 25%. Phase-in: 25% in 1994/95;
. 50% in 1996; 75% in 1997; and 100% in 1998 and thereafter.
Five and ten year totals include $0.5 billion cost for self-employed tax deduction in FY 1995.
rcb,unl}' IS. 1995 (IAOpm)
_
.....
�HEALTH CARE REFORM
"Our families will never be secure, our businesses will never be strong, and
our government will· never again be fully solvent until we tackLe the heaLth care
crisis." [President Clinton, Joint Session of Congress, 2/17/93]
THE CLINTON ADMINISTRATION CONTINUES TO FIGHT FOR.REAL HEALTH
CARE REFORM.
•
As you know, last year the Clinton Administration fought hard for health care reform.
While we could not reach agreement on legislation, there can be little disagreement.
that the problems remain. Nearly forty million Americans have no health insurance
and millions more are just one pink slip or illness away from losing it. Eighty-four
percent of the uninsured in 1993 were in working families, and more that 55 percent
lived in families headed by full-time workers. And while health care costs have
begun to slow down, they are continuing to rise at three times the rate of inflation.
•
As the President said in his State Of the Union address and in his December letter to
the Congressional Leadership, we remain firmly committed to guaranteeing health
security to all Ainericans and to containing health care costs for families, businesses
and Federal, state and local governments.
•
The President believes that we should take a step-by-'-step approach. This year, we
can take the first steps. The Congress can and should:
•
•
Make coverage affordable for and available to children.
•
Help workers who lose their jobs keep their health insurance ..
•
Level the playing field for the self-employed by giving them the same tax
treatment as other businesses.
•
•
Reform the insurance market -- so that people don't lose their insurance when
they lose their job or change jobs or family member falls ill, and so that
small businesses can afford to buy insurance for their workers.
Help families provide long-term care for a sick parent or a disabled child.
a
Because their constituents are demanding action, some Republicans.have begun to
respond to the President's challenge by coming forward with proposals and bills. We
look forward to working with them to take the first steps this year.
.
�THE CLINTON ADMINISTRATION IS FIGHTING BACK TO PROTECT HEALTH
CARE FOR MOTHERS, CHILDREN,THE .DISABLED AND AGED AMERICANS.
•
Unfortunately, for too many Republicans in Congress, "health reform" has turned into
the code word for slashing Medicare and Medicaid to pay for tax cuts for the wealthy.
Republicans in the House and the Senate have talked about cutting both Medicare and
Medicaid by hundreds of billions of dollars.
•
•
,•
Republicans have signaled their intention to cut Medicare by about $300 billion
between now and 2002.
Republicans have suggested cutting Federal Medicaid spending by at least $180
to $190 billion between now and 2002.
It's not hard to figure DUt what that means for the doctors and hospitals who treat
patients receiving benefits under these programs, and for the patients themselves.
G
•
.•
It means dropping coverage or shrinking benefits for mothers and children on
Medicaid. Or it means asking States to pick up the tab to preserve the
Medicaid program, and in doing so, forcing them to raise taxes or sla,sh
spending for services like education and public safety.
•
•
It means shifting a staggering financial burden to elderly and disabled Medicare
benefiCiaries. Or to small businesses and families who will pay higher
premiums and fees if these programs are slashed without overall reform.
It means significant cuts in payments to hospitals, physicians and other
providers.
The President presented a responsible budget to Congress -- a budget that made tough
choices to get our rising deficit under control, but a budget that protected hard
working Americans and investments in our children. Now it is Congress' turn to act.
To detail where they will get the cuts they need to pay for their tax cuts for the
wealthy. To step forward with their plan for deficit reduction.
The President has consistently said that we cannot get a hold of the deficit without
passing meaningful health Teform. Over the next five years alone, ,almost 40 percent
of the growth in total Federal spending will come from rising costs in Federal health
care programs. We must contain costs in these programs. But we must do it as we
reform oUf 'health care system as a whole -- not by arbitrarily cutting programs. that
serve the most vulnerable Americans.
March 6, 1995
Staff Contact: Jennifer Klein (6-2:S9~)
�DRAFT March 7, 1995
FAWELL (DR 995 AND DR 996)
Strengths
J.
Expands access to health coverage, primarily in those states that have not yet
implemented incremental insurance reforms.
• .
•
•
Eliminates pre-existing condition exclusions for those changing coverage
(e:g., when changing jobs), and limits exclusions for those newly purchasing
insurance. These rules would apply to all plans, including self-insured
plans. Due to ER ISA, states have only been able to limit exclusions for
insured plans (generally offered by smaller employers).
Requires health .plans to guarantee access to and renewal of coverage.
This provision applies both to small busiri.esses (those with 50 or fewer
employees) and individuals.
,.
Preempts state anti-managed care laws.
Weaknesses
•
Preempts all state health insurance laws that are .inconsistent with the· bill.
•
•
Preempts state mandated benefits laws without establ.ishing a national
minimum or standardized benefits package.
•
•
States that have gone further in guaranteeing access to coverage or moving
towards community rating would have to scale back reform. States could
choose to continue to enforce insurance laws, but would have no discretion
over the content of the laws.
Appears to preempt state premium taxes for health insurance, reducing
state revenues.
. Continues to permit wide variations in premiums across small businesses and
individuals. Provisions are similar to the NAIC's model law, which many states
have enacted (though some states have gone further).
•
Small business premiums cou Id vary due to age bya factor of 4 to 1
(potentially phased down in the future to three to one). Variations due to
age f~.r individual purchasers (e.g., the self-employed) would be unlimited.
•
Small busmess premiums could vary due to claims experience by a factor
or 1.5 to 1 (potentially phased down in the future. Premiums for individual
�DRAFT March 7,1995
purchasers could vary due to claims experience by a factor of 2 to I All of
the major Republican bills last Congress prohibited experience rating.
•
Health plans could vary premiums by size of business for differences in
administrative costs (up to 15% higher for the smallest businesses).
•
Insurers could establish separate classes of business (based, for example, on .
how coverage is marketed), and charge different premiums across these
classes.
•
Permits assOciations of small employers and individuals to obtain coverage
through self..:insured or insured arrangements outside of the c~mmunity risk pool.
The bill establishes reserve requirements for self-insured associations, but these
requirements are inadequate given the amount of risk mvolved. This provision
would preempt state efforts to restrict or regulate these arrangements.
•
Establishes medical savings accounts, which could further segment healthy and
sick individuals into separate risk pools. (Note that the tax treatment of medical
savings accounts is ·under the jurisdiction o'f the Ways and Means' Committee.)
�MEMORANDUM
TO:
FR:
RE:
cc:
Political Strategy Group
Chris J.ennings
ShortlLong-Range Health care Challenges
Carol Rasco, Pat Griffin, Janet Murgia
March 3, 1995
Attached is a one-month calendar that outlines. some immediate (predominantly)
. legislative even"ts, which will refocus ~ttention on the health care issue. Understandably
enough, it starts with yesterday's balanced budget vote and the attention it focuses on health
care entitlements (Medicare & Medicaid), the deficit, and our position on health reform;
Background on Politics of Health Care and the Budget
The President has consistently said we cannot get a hold of the deficit without
enacting meaningful health reform. As such, we oppose "Medicare cuts outside the context of
health reform.
II,
.
Until we make a more specific statement on the health reform issue, the
Administration will be pressed extremely hard by Republicans and the elite media to provide
oUr'definition of health reform, with speCifics on how much --if any -- deficit reduction
such reform entails. Moreover, a number of very visible Democrats on the Hill (e.g.,
Ranking Budget House/Senate Chairmen Sabo/Exon), responding to this prpssure, will almost
certainly produce their own deficit reduction proposals. There is little doubt that these visible
Democrats' proposals will contain significant MediCare and Medicaid cuts.
"
The Administration's current position is that we stand firm on challenging the
Republicans to produce their budget BEFORE we engage in talking about any specific health
reform package that the Adininistration might support. (This is consistent with the President's
position of not wanting to "push a health reform proposal down the Republicans' throats and
inviting them to work with him to jointly produce a "meaningful" health reform proposal).
Although everyone within the Administration understands and supports our position, the
outside pressures will make it very difficult to implement and will require enormous
discipline.
�Sbort-Term Stra,tegy Recommendation
During the pre-Republican budget resolution mark-up period, we need to continue to
coordinate any necessary responses with the President's health policy development team
chaired by Carol Rasco and Laura Tyson .. As the calenda~ illustrates, the.Republicans are'
already startingJo hold hearings and mark~ups on health bills .. Leon,:George, Pat, Harold,
Erskine, Alice,G~ne,<Bill, the primarf health care j~risdiction Department Secretaries and
others are represented in this work group and, so far, our clearance and policy position
prpcesshasworked quite well.
'..
In addition, we must understand the importance of being better prepared to define our
health care reforn;t/deficit reduction position. Even if we can avoid being specific for now; it
become almpst impossible to not further expand oil our current position after the
Republican budget resolution mark-up. There is no question that the longer we remain silent
on this issue, the more vulnerable we become to criticism that we are being fiscally
irresponsible and playing politics with the health care and deficit reduction issue.
will
Similar to our short, short-term strategy, the DPC/NEC working group needs to
, continue to be the focal point of our political/policy deliberations around a specific health
policy position. We must ensure, however, that its work is running at a parallel and
consistent track to the stragegy being discussed in the political and budget groups that are
now being formed within the White House.
I
?'
�HEALTH CARE
RUBIN_SOOPD
MARCH 1995
Secretary Shalalo testWies
• Senate Approps
Subcommittee(AGy Dr,
full House Approps
- Balanced Budget I/Ote
deteated 6!>-35
test~ies
SubCommittee
Shalala test~ies
House App,ops
Sull<:ommitteeiOr, Lee testWies
. .. Health Professions Senate
LoborlHRlDr, Lee testffies
- Ways&Means H,R483 marl<
upIMedicare Select&Medicare
Extenders for tax package
- GOP ATTACKING OEMS
FOR NO HEALTH
ENTT11.EMENT CUTS TO
REDUCE DEFICIT
Committee hearings on health
,etorm: the problem
Committee hearings on health
reform: the solution
• Possible POTUS release 01
FDA Regulatory RetolTl1s?
- House Approps
Sull<:ommittee(AGY Or,
Kessler, FDA testWies
Shalala testWies
- House Approps
Subcommittees/Or, Chavez,
SMlHSA testWie.
- House Appmps
SubcommitteeiOr Sumaya,
HRSA testifies
- House Approps
SubcommitteeiOr, Graus.
AHCPR testWies
FDA Regulaltlry Reforms?
- GOP ATTACKING OEMS
FOR NO HEALTH
ENTITlEMENT CUTS TO
REDUCE DEFICIT
------+-----------
FY'96 Budget
ATT4(""1o(11IoJr.:
OEMS
GOP ATTACKING OEMS
FOR NO HEALTH '.'
ENTT11.EMENT CUTS TO
REDUCE DEFICIT
Today(3(lII99511:06.)
Onlime(R) Copyrighl CampbeU Services. loe. 1991. 1994
�,,'
EFFECTS OF CAPPING IVIEDICAID
,
0
Medicaid is a safety net for mothers and children, the elderly and people with
disabilities.
>-
Republicans have proposed to cut federal Medicaid funding by at least $180 to ,
$190 billion between now and 2002 -- a 24% cut in 2002 alone.
>-
Medicaid spending per person is already projected to grow at a slower rate than
private health spending. So, with a cut this large, people win suffer.
•
If you want to protect mothers and children, you would have to:
o
Drop coverage for as many as 3 million elderly and people with
disabilities, or
o
Eliminate benefits like home health, hospice, Medicare premium
and cost sharing assistance, dental, drugs, and personal care
services _.- and, by 2005:, begin to limit nursing home services. "
,
•
,
If you want to protect the elderly and people with disabilities, you would
have to:
0
o
Drop coverage for as many as 16 million mothers and children,
or
o
Eliminate all inpatient hospital, outpatient, and physician service$
for mothers and children -- and still not have enough savings to
offset the loss of federal funds.
States could, of course, decide to increase their spending 'by more than $180
billion. But that would mean a 33% increase in state Medicaid spending in
2002 alone, and would force states to raise taxes or sl~sh spending for seIVices
like education and public safety.
In other words, there are no easy choices when you have to cut $180 to $190
billion out of a health care program for mothers ;and children, the elderly and
people with disabilities.
�EFFECTS OF CAPPING MEDICARE
)0-
>-
Medicare is the primary health care program for 32 million elderly and 4 million
disabled Americans.
. Republicans have proposed to cut Medicare funding by at least $150 billion
between now and 2000 -- a .20% cut in 2000 alone ..
\
>-Medicare spending per person is already projected to grow at roughly the same
rate as private sector health spending. So with a cut this large, both beneficiaries
and providers will be forced to shoulder huge burdens.
•
If all the savings come from providers, in 2002 alone a 25 pereent
reduction in Medicare payments to hospitals, physicians and all other
providers would be needed. This would cause serious financial distress to
the nation's medical system, which would still bear the growing burden of
uncompensated care. Many providers could no longer· afford to see
Medicar~ patients. Those that do, would have to shift costs to businesses.
•
If providers are protected, a staggering financial burden would be shifted to
elderly and disabled beneficiaries. 111 2002, beneficiaries would have to
pay $3,640 more for Medicare, a 290% increase over the premiums they
pay today.
�01124195
16:12
ft
~004
. ·1
.. '
,
j
(
DT-STATE OF TBE UNION
BEAL'IH CAllE TALKING POINTS
WJuJt ,... wUllletllth t.'an! p'll;ol ill tits ~brB :llltIW
As he stated in hi8 December 21. 19941et.ter to the C0l1IH8Ii0J1~ Leaciership. tae
President rema.ille firmly committed. to guar8.Dte~r hlait}, inaurA:t1M for every
Americ:all atad to containing health care costa to: f&iznillu,· busineMes and FederaL
State and local ~ve:mDleD.tB, While'we didn't succeed last year. that doa..,'t me81l
tile problem of Wlaflordable health ca.re ud alack 1ha81th I8curity have
cliaappeared. lor millio=a of working families. The Americ:aD people still want ud
lleed health C8.1'8 nfona, and we owe it to them to ~B that it happell8 thi.. year.
Doell tNJ Plvsitlsnl "..,.. NI'Driu.ce ItsrillA care jlqialG&bII
'
The Pre.ai.d.ent wuta tlWl CODifIes to work together to take the :5.ret steps towarde
univeraa1 eoverap. He feell that we Qhould 'be able to pasa meaeuree we 8.P'et all:
reforming the unf'Jlim"8A in tn.e ;nilurance market. =akini coverale ava:ilable for
chndren and people who loas their job., and e!li~1 the quality and efliciencyof
the Medicare Gel Medicaid ~rorrama. The Preside~t iataftd. to work with
CongnN Lo' aea that thee goals are achieved. He h;aa made it very clear that lte
will not &i:ve up the Gght lor health security and affordable health c:are.
Has ,he Presitlt:1II ret,.atetl on unive,.,al 0XIe;.q,e tdllr. the .tc.D8 he I.Gltl oed
flRllgltt,
1'bJ1 :Preaitlent haa not backed. away from his oom~l!lent toprovicio Americans
With 1'611 heiltli CAre security. By Nilizing the goa!l.s laid out tonight in a step-by
step apprOAC'.h, ArntlMca will be Oil the rosa to achieVins univ8Hal coverage..
The Presid.enL will aG.mel that issue when he releases his budget.
Did t1Iie 1Tu~ draw 0 line In the Band on MedJcure'
The President will ftot allow Medicare to be cut 'in Order to pay far ta c~t8 tor 1J1e
wealthy. TAe PrefJideAt has aoneistently aaid that he oppose. new 'Medicare (;:1.1tll '
outaida the c:ontezt of health Gare reform.
,
I
I
't
I
I
I
, -....•..r --:..... ~~~--·."""--"""":--
-_,,"-_0,'"
I
l
�01/03/95
IaJ 002
13;05
"·w
('
.
THE WHITt Hotr!\£
27, 1994.
hile we 'could. not achieve broad-based agreement on a health
cform initiaeive last year, there can be little disagreement
hat we still face the enormous problems of; increasing heal~h
are c;:esta and decrea.sing coverage. We need to confront these
roblQms'on a hipartisan basis and. ad.Qreas .the inseQur1ties that
00 many Arl'Ier1c:ans' have a.bout their healt:haare.
I am writing
o reiterate my streng des,ire to work wich you in
thi~
regard..
remain f1rmlY'committed to providing insurance coverage for
very American and. c:ontain.ing health. care: cose.s for fa.rnilies, .
UIiI ina
anc:l 'clI:iCIIZ'al, , S~at:.e, and local g'Qvsrmnencs. In the
i
i iiii.,,
pc:oming session of Congress,
WI!!
can and should. wo:;k eogether to
ake the fi:ret steps toward ac::hievins these gea.l~. We c;an pass·
.g~liIlation that· 1ncluc:les measures to address the unfairness in .
ho 1nsurancc markee, make coverage more
afforda~le
tor
wor~ins
..mil!e. andch11dren, aesure qu.al,i ty and efficieney in .t.he·
edieare and Medicaid program.. a.nd red.uee the long-t.erm Federal '
ef1e1t.
e look forward to- talking with you in the upcoming weeks
boue a bipartisan effort to deliver healch care re!crm to the '
e.1can pu~l~c. Hi~lary and I send our boet ~iehee for a safe
nd happy ho11~ay season:
ineoroly,.
he Honorable Richard A. Gephardt
Quae of Representatives
&shington, D.~. 20515
�01/03/95
~003
13:05
., .
.
.
. ._ . ··_·t·······- _.- ._--"--'-.' '.._.
.
TK~
IDa~~mber
'KnITl HOlTSE
27, 1994
I
I
loa.lil!'
,
Newt:
I
~ile we c=~ld no~ &chieve brcad.baaed agreement on & health
!reform initiative laar:.yea::, there ean ~CI lit:t::le disagreement
that we still fac~ the enO~OUg problema of increaaing health
.
are costs an4 decreasing coveraqe. we nee4 to confront ~hese
roblems on a bipartisan basis and address the insecurities. 'that
00 many Amliricans have about their health earl!.
I am writing
.
o reiterate my strong des.ire to work with. YOU in t.his regard..
i
remain firmly committed to providing insuranee c~vQrage for
vary American and containing health care cost.1 tor families.
\.Iainesees, and Federal. State, a.nd 100a1 governm.ents. In tho
peoming session of Congress, we can and should work togethgr to
aka the first steps toward achieving-these goals, We can pass
eg1elation that includeD measures to address the unfairness in
hI! ins~rance market, make coverage more affordable fo~ working
amiliea and children, aS8ur. ~&11ty and efficiency in the
e4icare and Medicaid programs, ·and tedu.ce the long.:.t:erm Pederal
efleit.
.
.
,e look forward ~o talking with you in ~he upcoming ~eek~
about a bipa;rtit1an effo:-t to deliver health care reform to t.he
American publio~ R111a~ and I ~end ou.r best wishes for a sate
_nd happy h011day .• eason.
I
·$inc.r~iy •
~-C~~·
I.
I
!
h.e Honoroi.ble. NevtGing't'ich
ouae of Rep~esentatives
.
a8h.1ng~on. D.C.
20515
..
�Q1/03/95
IgJ004
13:05
.
....
.
l
''rUE WHtTE HOUSE
I ecember
"'ASHtNOTON
27, 1994
,
ear
t
aoo;
"
,
hila wa ~Quld not aohieve broad-baeed agreement On a health
e~orm '1nltlative lalt year, thet'e can be little disagreem.ent
, Fhat we still fa~e the enormOI.1&1 prol;;leme of int:reasing health
are costs and decreasing ooverage. We need to confront these
roblems on a bipar~i8an basis and address the insecurities eAat
00 many Americans have about their health care.
Iamwrit.ing
o re.it.er='~Q my strong desire 1:0 work with you in ebia ,regard. '
f
remain fi4mly committed to provid1ng insurance cov~rage,ror
very American and ~ontaining heal~h cars coste for families,
us1neaaes, and ~ederal, scate, an~ local governments. In the
pcoming ee•• ion of CQng~8ss, we can and'should wo.k toge~her to
axe the first at.pa tawara aohieving these goals. We can pass {
eg1s1at1on that 1ncl~des measureS'CQ address the unfairness in
~e insurance marke~, make cQve~age more affordable for wOrking
amilies and ehildrQn, assure quality and effioienoy in the
edicareand. Medicaid programs" and reduee t.h.C!!I ·lortg-toerTTI F'eoe"f:at 1
~
, <leficit.
I
e lOQk forward.
to~alkingwith
you in the upcoming wPoeks
bout a bipartisan cffQrt to deliver healt:hcare l:efcrm to I:he
m@rican public. Hillary and I 8end our best wish.es for a safe
nd happy holiday
1neerely.
,
season.
'
AE~'~
\'
he Honorable Robert Dolo
nited State. Senat8
Washington. D.C.
20510
�01/03/95
•
141 005
13:~6
, ..
•
l. •
THE WHITlt HOOSE
WASHl'Nn'H'l N
oecember
27, t994
Dear Tom:
h1l@ we ceul~ net ac:hieve :t:".t'oe.d.-oased agreement' Ona health
form initiative last year, there ca.n be little ~1Bagreement
hat. ....e still face the enormous problems of 1nere.u1·ng health.
are costD and decreaeins coverage. We need to confront. these
rcblems on a bipart1aaft ~aaiQ and address the. insec~rities t~at
00 many Americans have about their health care.
l am writing
o re1t@rate my st.r~ng desire to work v!th you in this regard.
remain firmly comm1tted to prov1ding insurance coveraga tor
very Ame~1ean and cQn~a1ning he.lth car~ coate for families,
ue1ne5ses, and Federal, State, and loc~l governmenta. In ~he
pcoming session of Congress, ~e.~an and should work together. to
~k~· t.h. first atGpa ~oward achievini t~c.e goals.
We, can pa~a
eg191atiQn that inclUdes measurea to address the unfa~rneee ~n
he ins'U..ra.ncQ market, make COVel"age
affordable tor working'
am1liea an.d. children,aaaure qualiey and e££ic:toeney j"n the
cdica~e and Medi~a1d pro;rams, and reduce the long-term Federal.
e£icit.
.
c look forward to talking. with you in the upcoming w@Qks
ut a bipartisan effort to deliver health care reform co the
merican public. Hillary and I send. our beet wishes for 5 safe
nd happy hc11day season.
more
I
,
he Yonorable Taomas A. Daschle
ited States senate
aehiZ19ton, D.C. 20510
.
�
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Carol Rasco - Issues Series
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Carol Rasco
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Box 123
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2010-0198-Sb-health-care-1
-
https://clinton.presidentiallibraries.us/files/original/8fa9f05c537a455790d4aadc630f25b0.pdf
bfbf4e7dd59606153030d0a629137652
PDF Text
Text
,/
MAR 31'95
15:1~
P.02·
~~
~
The Administration's Response to Draft AO Report, "MEDICAID: '
reS8ures Drive ~tates Toward Program Reinvention!· ,
The Administr~tiQn's budget neutrality methodology'
. There is no such thing asa State-specific Medicaid baseline. Thus, in reviewing State
projections of without-waiver expenditures, the Administration generally compares State .
historical expenditure growth to the benchmark of baseline gro~h in the Medicaid
program for the nation as a' whole. In so doing, the Administration recognizes' that there
has historically been dramatic variation in state Medicaid programs. e.g., differences in
the mix of eligible populations. the mix of services offered. provider payment rates, the
, use of disproportionate share funding, etc. These factors (as well as the geographic
variation in practice styles) have resulted in radically different levels of expenditures and
growth rates across the states.
Further,.it is important to rec~gnize that the Administration determines budget neutrality
on the basis of currentfederalJaw. which is also the basis used in the President's
Budget to .project baseline Medicaid expenditures. Therefore. in its review of waiver
proposals, the Administration acknowledges that under: current Federal law States are
able to engage in program changes.
Waiver reyjew I)olicy changes under this AdministratiOn '
, The GAO report suggests that this' administration's waiver review policies are different
than previous administration's policies. It is important to note that prior to the Clinton
Administration taking office in 1993, only one Statewide section 1115 Medicaidw~iver
had been granted.· Recognizing the desire and the need of States to have greater
'flexibility in reforming their Medicaid systems: upon taking office the Clinton
"
Administration encouraged states to design 'innovative health delivery systems tailored
'to each State's unique circumstances,whUe preserving and enhancing access to
quality care. To facilitate these aims, the Clinton Administration developed a more
flexible approach to reviews of waiver proposals submitted under section 1115 of the
Social Security Act. The Administration.annouricedthe principles that would guide its
,review of such proposals in the Federal Register on September 27, 1994, stating its
desire to "facilitate the testing of new policy approaches to social problems" and
'pledging, among other things, to:
'
•
work with States to develop research and demonstrations in areas consistent
with the Department's policy goals;
.
•
consider proposals that test alternatives that diverge from that policy direction;
Page 1
"
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ID: .
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15:12 No.D09 P.03
consider. asa criterion for approval, a State's ability to implement the research or .
.-demonstration- project;
•
grant waivers to tesUhe same or related policy ~nnovations in multiple States as
a·mechanism bywhich the effectiveness of policy changes can be assessed; .
•
comp~te budget neutrality over the life of,the waiver, since .many demonstrations
involve making "up-front'i investments in order to achieve out-year savings;
•
recognizing the difficulty. of making appropriate basel.ine projections of Medicaid
expenditures, remain open to development of a new methodology in that regard;
~~.
.
•
.
"
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in assessing budget neutrality, the Department will not rule out consideration of-
other cost neutral arrangements proposed by States.
.
.
. The Administration articulated these principles for reviewing waiver requests in part as'
a response to State concerns about arbitrary spending limits, e.g., the Inherent·
limitations in projections of future spending. the lack of consistently reliable data; and
past State experience showing that eventhe best planning can beoverwhelnied by
unforeseen effects.
GAO's use of the natjonal current services baseline to ~~tablish budget neutraljty
The Administration disagrees with GAO's preliminary analysis of the financing
provisions of four Statewide Medicaid demonstrations discussed in the draft report.
GAO applies a uniform budget neutrality methodology to each State, without a
discussion of the advantages and disadvantages of that approach. GAO compares the
"
baseline .costs and growth -rates of the approved projects to a "current se(\tices" .
baseline, and finds that three of the four States may not be budget neutral. We believe·
that each demonstration is budget neutral and take issue with GAOls assumption that
·their rigid methodology is appropriate for all States~ Recognizing that States and their
Medicaid programs vary significantly, as discussed above, we have used a more
flexible approach to ensure that each project is budget neutral.
There are several conceptual and technical problems with the GAO's approach to using
the national current services baseline to establish budget neutrality in all states:
The GAO uses as a· standard for Federal budget neutrality a current services
baseline, which they define to include expenditures needed to finance the.
program assuming laws and policies that are in place at the State level today.
Nevertheless,the GAO applies this current services standard to a current law
baseline {the President's Budget does not differentiate between the two,
Page 2
�MAR 31'95
ID:.
15:13 NO.009P.04 .
essentially applying a current law approach to estirnates of current services
baseline expenditures). The GAO does not construct a true current services
baseline for their analysis.
.
•
Conceptually,·curre·nt services is the wrong baseline to adjudicate budget
neutra.lity. In granting waivers. the federal government determines budget
neutrality on the basis of currentfederalJaw.:· the basis also used to project
baseline Federal expenditures. Undercurrent federal law states are.aQle to
engage in program expansions and contractions. Thu~, establishing a state
specific budget neutrality baseline at a minimum must involve some judgement
regarding states' behavior under current law. (See further discussion of
.hypotheticals below).
.
•
The report spends considerable time (Summary, page 2) relating the dramatic
variation in state Medicaid programs, i.e., differences in the mix·of eligible· .
populations, the mix of services offered, provider payment rates, and the use of
disproportionate share funding. All of these factors (as well and th~ geographic
. variation in practice styles) have resulted in radically·different levels of
expenditures and growth rates across the states. However, this variation is
. ignored in selecting their ~udget neutrality approach.
. ..
..
. The report (Summary. page 3) asserts that the determination ofthe without
waive·r baseline is in .considerable "dispute," Yet in asserting its methodology, .
GAO offers no disclJssion of pros and cons of its approach or alternative
methods. The GAO should at leastattempt an analysis of budget neutrality
using state-specific data. .
.
.
•
' .
. .
. .
Waivers involve subsets of the Medicaid population and s~rvjces. GAO appiies
the President's Budget Current Services Medicaid baseline to establish its
.
. budget neutrality baseline. ·It is unclear.how GAO measured the ,services used
by "populations co·vered by the waiver."
.
. For the four waiver states for Which GAO provided Its estimates of year-by-year with
. and without baselines, based on the President's Budget baseline for FY 1996, we note
that across the four waivers, the Federal government actually realizes a small savings
{O.1 % relative to total' Federal Medicaid outlays for the FY 1994 to FY 1998 period).1
l
lTh~
fOllr ::;lalc::; are Tennessee, Florida, Oregon, and Hawaii.
Page 3
r
",
�ID:
The'lnclusion of 1902(e)(2)expansjon ~OPulations
MRR 31 '95
15:13 NO.009 P.05
in State demonstration baselines
The report criticizes the Administration's decision to allow states to Include in their
demonstration baseline the cost of extending coverage to optional: groups under
§1902(r)(2) ofthe Social Security Act. We believe this decision is consistent with a
current law approach and reflects the priorities of the Administration and Congress to
extend coverage to pregnant women and children. We ~ould also emphasize that, to
be counted in the "without waiver" baseline costs, the expanded populations must also
be covered under the demonstration.
Entitlement growth played minoe (Ole in Medicaid's high growth
We concur with GAO's finding 'that entitlement growth was not the major cause of the
17% cost growth experienced in the Me~icaid program between 1985 and 1993.
However, we believe it is mislea'ding to compare this growth rate with growth in the
federal budget of3.8% over the same time period, as on page 4 oUhe summary.
Waivers used to do more than conta]n co~ts and expand program cOverage
GAO's report suggests that the obj~ctives of section 1115 are limited to containing
costs'and expanding coverage, While these objectives are important ~ and we believe
they are ,achieved in section,1115 waivers discussed in this report,-,:, the Administration
believes this focus is too narrow.
'
First, in addition to containing costs and expanding coverage. §1115 demonstrations
allow states taexperiment with innovative delivery and payment systems for their
Medicaid or low-income populations.
Second. we do not agree whh the statement that"whether the comprehensive scope of "
the demonstrations can be charaCterized as experimental iscohtroversial." HCFA
considers each of the statewide demonstrations as having unique components that are
worth testing under a demonstration and has awarded two contracts to evaluate the
innovative features of each implemented program.
Page 4
�f
04/03/95
"
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,~"-
17: 15.
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_....
...
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~
I4J 0031007
.
_D_E_P_A_R_T_M_E._N_T_O_f_H_E_A_t_T_H_&'
...H_U_M_A_N_S_E_R_V_)_C,...
E-S----.._____
~ OOZIOOIS
-=~===~'.~~.~~:'.~~.:'_Ot'l_.
Ttl. Admi,,,.thJtor
WU/'unllon. D.C. . 2.020:
'!'he Honorable CbarlesA. .Bowsher
. eol'iptrol1er Qeneral of the
unit-eel States
Caneral Aooounting afficA
Washinqt:cn, DC 20548
Dear Kr. Bavsher:
GAO
Bn~ioee4 i5 the AQm!n6~atioD's rOcponse to the draft
report,
"KE:Dlc::AID,
sp.nelilSli' pz-gccuz:es Drive St.ates Toward Program
Reinvention. II We appreciate the opportunity t.o reviaw 1:his.draft.
repo~ ~c1 provic1e CQr ~omments on it•.
8ruce C. Vladeok
Ad.lIlinistrator
Enclosure
�17: 15
• 04103/95
. '6'
.
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" '.
.
,,~
n. AdmInJstratiOD'S Response to.Draft GAO l.eport. "MEDICAID:
,
I(l) 0041007
".
raJ 003/008 .
: ",
SpendlDa: Pressures
' D r i n Sta_ T~rcl Prop.. RaImeution"
111e Admlnls1n.tloD's budp' nmaUty metbodolo# .
There is no such,thiDg as a State-specific: Medicaid bM:liDe. Thus, in reviewiDg State
projection& of wi~out-waiver ezpeadiCDres, the Administration .Ienerally compares State
histmical expenditure srowth to the beOQJ:amatk of baseIiDe 8fowtla in the Medicaid
program for tile Dation ,as a wbole. In so doing, the Administration tceopizc:a that there
bas historically been dramatic variation in State Medicaid ,programs. e.g... cUfferences in
the use ,of disproportiOAate share fundiDg. etc. These £acton (as well as the ,geographic
variation in practice r;tyle) have resultecl in radica.lly differeut levels of expenditures and
growth rate.s SCI"O&."J the s t a t e s . '
,
Further, it is important to feo:JgDize !hat the AdmJnistra'liOD 4etermtaes budget
lieutra1i~ OIl the basis of current federal law. which is also the basis used. in the
President's Budget to project base1iDe Medicaid expenditures. Therefare. mits review of
waiYer pr~ the AdmhUltratio. adalowledges that UDder current Pederallaw States
are able to enpge iD program changes. .
Waiver reView policy changes under this AdministratigD
The GAO report sugges15 that tb. Admiaistratioa's waiver review policies are different
than previous Ad.nrlnistra;ti.on'l po}j:ie&, It is importaDt to Dote that Fior to'the Clinton
~tion tald.ng office In 1993, only ODe comprehensive Statewide sec1idn 1115
Medicaid waiver had beeD graDted. ,RecDgD.i%iDg the desire and die need of StateS
in reformi:D.g their Medicaid systems, upou taking office the
to
have greater flexibility
Cliutw Administr;r.tiaa e.ae.auraged states to design mnovative health deUvery sys'tentS
tai10Rd to cadi SIatC'ls uDiqu.e oirc:umsumces, while preserving alld enhancing .aceess. to
quality care. To faentta'C lbese aim.S. tbe Clinton AdmiDistration ~oped a more
f]eXJole approach to revieWs of waiver proposals submitted UDder seetlonlllS of the
Social Security Act. the Ac:lministration announced the principles that would guide its
review of such propo.als in the Federal llszigerOD September 27. 1994. statiog, its
dairc 'to "facilitale the tcatiDg of new poUcy approaches to social probl,ems" and
pledging. amoagothe.r things, to:
•
wor):: "";'th states to develop research and demonstrations in areas consistent with
the Department's poliQY goals:
•
consider proposals that test alternatives tb.at, di\lerga ·from. that poHo/ direction;
�,.04/63/95
17:16
~005/007
.,'
#~
: ....; , '
-:
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iii 004/008
.....
•
coDsidcr, as a criterion for approwJ, a' State's abilit:, to implemeDt th~ reMarch or
demoDSlTation p r o j e c t '
'
•
grant ft.i¥cn to tat the same related policy innovations in multiple States as a
mecbamsm by which the effectivelless of polley challges am be ilSSC&Sed.;
•
eompllre budlet neutrality over the life of tao waiver, since many demonstratiolls
UaYCIM lDakin, "up-&ont' mvestrDats In order to achieve out-year saYings;
or
.
,
•
tecopizing the difficul1¥ at maki"" appropriate baselme projectiorus of Medicaid
expeDditures, remain opeD to development of a new metbodology In that regard;
ad
•
:in assessing budget neutr:aJi~; the Department "lrill net rule out c:.onsideratiou. of
other budget neutral amtI1SC:mCDts proposed·by Statca.
The AGmjnistrati!=,D articulated thae prillciples far rmcwiag wai\lel request ita part as a
response to State COIlCeI1IS about albitrary spendiDg limits. r..g.• the inhereDt limitations
in projections of future spending, the 1aek of consistently reliable elata, aDd past State.
cxpcrieoc:e .shawiDg that even the DC8t plauninS caD be ~erwhelmed. by umore&eeD
effeets.
GAO'S DR of the national ~umnt semces baseli.n@ to estabUsb budget neutrality
-
The A~ip_atio%l c!bagrees with GAO's prelilniaary ~ of the financiDg , ,
prav:fsions of four StateWide Medicaid dcmgnstntioa d~ in the: draft report.
GAO applies a uniform budget ueutrali1y methodology to each State, without a
discussion of tile advantages and disadvantages of that approach. GAO ~mpateS the
baseli!le eOits and growth rates of the approved projeas to a "eurreDt services" baseline.
avd.liD.ds that three of the foilr States may Dot be buclset neutral We beUeve that each
demODS1l'a'doD is bUdget ncutnU and ~c issue with. GAO's usumpdoa. tbat their ri,id
method.olOl)' is appropriate for all Slates. RecogniziDg that States and thelt Medicaid
programs vary significantly, as discussed above, we'have used a more flexible approach
10 ensure that each proj~t is buqet neutral.
There are several concx:.pta.aieG tulmical problems with the GAO·, approaeh to usmg
the national current services baseUne to establish budget neutrality in an states:
The GAO uses as a standard for Federal budget neutrali1¥ a current services .
baseline, whici. they defble to iaeJude expenditures needed to finance the
program. usumillg laWJ and policies that areja. place at the Stata level t.oday.
Nevertheless. the GAO applies tbis <:urreot ~tvi~ standard to a <:urrcut law
baseline (the President's Budget does Dot differentiate between lbe tWo,
essentially applying a current law approach to estimates of current sel."\'ices
baseJ.me e%pe:D.ditUres). The GAO does not Coustruct a true eummt semces
baseline for their analysi5.
I
.1,
�.04l03!95
Ial 006/007
III 005/008
17:16
.' .
.
..
. CoaceptaaUy. cu.rmat &erYica is the 'MODS bascliDe to aclj'adicatc bucJp'
ucutrality. Ja putiDg wai1rcrs, the federal ~CDt detellllmes budget
neut:raIi1¥ 9n the basis of CIlt:JeDt fe4erallaw ~ the basts aJso used 10 project
baseline Federal expenditures. UDder current federal law states are able to
uSage in program expansions anclc:ontractiolS. nuS. estabJishing a state
specific budget 1l8utrality baseliDe at a miDimua:uDust iDvaJ:ve same jUdgement
n:p.nting _tea' behzMor uDder current law. (See 6lfther diJouuioD of
hypothedcaJs below).
.
.
The report spends considerable time (SUmmary. pace 2) relating the dramatic
w.ri&UOll i:a Itate Medicaid propams. Le.,· differeDtJe mthe mix of eU&t"ble·
popQlati~ the mm of services offered, provider paymeDt rates. and the uSe of
disproportionate share fund.iDs. AU of 1hese faCtors (as 'WIdl as the geosr.phic
wriation in practice styles) have resulted in radically differeJ:It levels of
. elI;Peridi1u.res and growth rates acrc& the states. However, this variation is
ignored. ill se1edin! their budset DeutraUty ipproacb.
The report (Summa!)', pale 3) asscl1s that the dc1c:nninaucn;l oltho without
waiver baseliDe is ill col'lSideJ'lble ItdJspUte..•. Yet in asserting its methodology.
GAO offers DO discu.ssionat. pr04 and CODSof its approach or alternative
methads. ne GAO should at least attempt an ~atysis of budget neutrality using
stam.specific data.
. WaiVers fDvolve subsets of the Medicaid populadoJl and sefvia:.5. GAO applies
the Presidcnt·s Budget Qlueut SeMces Medicaid baseline to·establish its bUdget
ileutrality baseline. It is unclear how GAO meuured the services used by . .
"populatiODIii covered. by the ~."
.
I
Por the four waiver states for w.hicb GAO prO\idccl its e&timatcs of year·byo-year with .
and lVithout baselines. based onthePresidellfs Budget baseline for FY 1996, we note
that across the four waivers. the federal governme.rlt actually ;realizes small savings (0.1 %
relative to total Federal Medicaid outlays for the FY 1994 to:FY 1998 period).!
The IlIclusloD of 190Z(r)(%,) expansion populations , State demonstration baseJiDet
in
.
,
The report criticizes the Administration·s decision to allow states to include ,in their
demanstnt:iDJl baseliJie.s tile eost of extending coverage to optional groups.under section
1902(z')(2) of the Social Securift Act. W. 'believe this decisian .is canastellt ~tb: a
cum:nt lcnv approach and reflects the priOrities eftkc Administration and CoDPess to
extend. ceverage to prepant women and cbildreD. We would also emphasim that, to be
counted in the "without waiver' baseline costs, the exp3.llded populations must also be
covered under the demonstration.
.
(
IThe four states are TeJ;I.Dessee, Florida., OregoD. and Hawaii,
�• 04103/95,
.
,
.
17:16
.... '
,
.
,
raJ 007/007
.
'
•
t',
ri)a08l008
,
-
Entitlement anI. "am' mig mle ia Medicaid'. hi&ln;rmh
We ~C1lr wida GAO', fil:lCimS tltat entitlement erow&h was not the major cause of the
17% case gr09l1h QfCricAce in the Medicaid program between 19&5 and 1993. However,
~ beIi.e¥e it is misleading to cxmparc t1Us growth rate with ~ in the federal budget
of 3.8% over tbe same 'lime period, as 011 page 4 of the N"'mary. '
!!al<ren usec1 lit do
II!!!! tUn coptaln costs aM aDand promm coveraa8
GAO's report SU"~IS that the objectives of seetioll 1115 are Iim&ed to cont.aiDiug costs
,and expanding coverage. While Ibesa objectivC5 are impOrtant - and we believe they are
aclUeved in section 1115 waiYers discussed in this repan - the AdmillistratiOll 'believes
this focus is too 1Wl'ow.
First, 'ill addition to containing costs ud. ElKpUd.inS eoverage. section 1115
demonsfratiODS allow states to experimCDt with imlOYative delivery aDd payment systems
for their Medicaid or Jow-iDcome populations.
SeGon.d, We Go aot apee 'with the statement that -Whether the campreherasive scope of
the 4emoDStrations caa be chuacterized ac experimental is controversial' HCFA
considers each of the stateWide ch:moastratiODS IS having unique components that are
worth testing under a demcmstratiOD and has awarded t.-o oontraCts to evaluate. the' ,
, \ inlloYative features of each implemented progr:a:a1.
'
,
,
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Carol Rasco - Issues Series
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An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
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2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
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Clinton Presidential Library & Museum
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92 folders in 7 boxes
Text
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Paper
Dublin Core
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GAO Report: "Medicaid: Spending Pressures Drive States Towards Program Reinvention"
Creator
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Domestic Policy Council
Carol Rasco
Issues Series
Identifier
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2010-0198-S Segment 2
Is Part Of
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Box 123
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
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Clinton Presidential Records: White House Staff and Office Files
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THE WHITE HOUSE
WASHINGTON
January 10, 1995
A MEMORANDUM FOR CAROL RASCO
MCCOWN~
FROM:
GAYNOR
SUBJECT:
TECHNICAL ASSISTANCE FOR EZs AND ECs
CC: PAUL WEINSTEIN
KUMIKI GIBSON
SHERYLL CASHIN
MICKEY LEVITAN
The purpose of this memo is to give you some indication of
the current status of our plan to provide technical assistance
(capacity-building) for the Empowerment Zones and Enterprise
Communities. Our biggest challenge is that of coordination and
communication, both within the federal government and with
outside resources, to avoid duplication. Therefore, in order to
develop a coherent strategy for helping the zones and communities
realize their visions, we are focusing on the following:
coordination among agencies;
interaction with outside resources; and
mechanisms for communication within the government and
with outside resources.
The Departments of HUD and Agriculture, in consultation with
other relevant agencies, will have the primary responsibility of
coordination and communication. However, the DPC, NEC and OVP
will continue its oversight of the process.
Involvement of the private sector, in general, and the
philanthropic community, in particular, is critical to the
success .of our effort to provide capacity-building. On October
14, we met with a group of representatives from the philanthropic
community and other non-profit organizations regarding how they
could assist us in providing support for the Empowerment Zones
and Enterprise Communities. Since that meeting, the Annie E.
Casey Foundation, the Ford Foundation, the Danforth Foundation
and the Carnegie Corporation have all pledged to make a
commitment. We are planning to convene another meeting with a
larger group of foundation representatives within the next month.
�As you know, a small White House team of agency
representatives will be ,detailed to work exclusively with the
designated zones and communities. While no final decisions have
been made, the hiring process has begun. This team - to be
comprised of representatives from HUD, USDA, HHS, Justice,
Education, Labor and Transportation - will report to the CEB and
the Vice President. In addition to promoting the program and
overseeing agency implementation, they will work closely with HUD
and USDA to facilitate inter-agency coordination and cooperation
for capacity-building.
The types of support that will be needed will vary from
community to community and will change over time. However, after
several discussions with individuals from different federal
agencies and outside organizations, we have developed a list to
illustrate the types of support that the designated EZs and ECs
will most likely need over the next ten years. Please find it
attached.
The Community Enterprise Board Working Group will continue
meeting every Friday to discuss issues of implementation and
capacity-building. We will keep you posted as this process moves
forward. Meanwhile, any comments or suggestions you have would
be appreciated.
�The following is a list to illustra te the types of support tha t
the designated EZs and ECs will most likely need over the .next
ten years:
FINANCING SUPPORT - Assistance with overall cost and
financing support. Types of support would include the
dissemination of various finance models from around the
country (e.g., Center for Social Policy discussion papers,
J. Sugarman Consolidated States Plan), the provision of
expert assistance from nationally recognized individuals,
and the convening of financing seminars on a topical basis.
TECHNOLOGY SUPPORT - Assistance in linking up applicants to
the information superhighway. These linkages would include:
(1) access to the best ideas and programs developed by
cities that participated in the EZ/EC program; (2) access to
information on the range of relevant federal programs and
funding opportunities; and (3) access to information on
foundation resources, including financial resources, and
successful foundation-sponsored community projects.
STRATEGIC PLANNING SUPPORT - Assistance in the formulation
and clarification of goals and outcome measures. Types of
support would include the dissmenination of various
strategic planning models developed around the country
(e.g., Oregon Benchmarks and Urban Strategies planning
system), the provision of expert assistance from nationally
recognized experts, and the convening of strategic planning
workshops on a region -or state-wide basis.
PROGRAM DESIGN SUPPORT - Assistance in the exploration of
(a) specific program design alternatives (e.g .. , early
childhood services, public safety, child abuse prevention)
and (b) service integration strategies and approaches.
Types of support include the preparation and dissemination
of summaries of relevant research and field experience, the
preparation of options papers on specific policy topics
(e.g., job creation, affordable housing), the provision of
expert assistance from nationally recognized experts and the
convening of policy seminars and briefings.
TRAINING AND STAFF DEVELOPMENT SUPPORT - The design,
development and conduct of pre-service and in-service
training for service providers, local agency staff, family
advocates and resident participants. Types of support would
include the preparation and dissemination of summaries of
relevant training activities and field experience, the
preparation of options papers on specific training / staff
development topics (e.g., cross disciplinary training,
licensing and certification), the provision of expert
assistance from nationally recognized experts, and the
convening of topical policy seminars and briefings.
�MANAGEMENT SUPPORT - Includes technical support with respect
to: (a) developing and implementing agreements for
cooperation and collaboration among government, not-for
profit and for-profit organizations, professionals and
consumers; (b) the formulation of policies to simplify
current bureaucratic requirements, unify service eligibility
requirements, and increase service flexibility; (c) the use
of management incentives (e.g., compensation and promotion
strategies), regulations, performance measurement
systems and management evaluation approaches; and (d)
the design of monitoring, auditing, complaint
investigation and non-discrimination systems. Types of
support include the dissemination of various management
models developed around the country, the provision of
expert assistance and the convening of management workshops
on a topical;basis.
EVALUATION SUPPORT '- Includes assistance in the design,
development, and information of evaluation strategies that
effectively measure the investment of human and financial
resources.
�,...,
E X E CUT IV E
o F,F ICE , 'OF
13~Jan-1995
THE
PRE SID E N T
03:25pm
TO:
Carol H. Rasco
FROM:
Michael Levitan
Domestic Policy Council
CC:
CC:
Gaynor R. McCown
Paul J. Weinstein, Jr
SUBJECT:
EZ/EC - Children and Families
I am very enthused about this new assignment.
Thanks.
Per your recommendation, I drafted ,a memo to the CEB' about this
project for your consideration.
It is on the i drive under the
name i:\dpc\data\ezchlfam in case you want to edit directly.
An official ble~sing of this project'in a letter from you will be
helpful.
I am proceeding with informal contacts here in the White
House and with HHS and Education to begin the coordination
process.
Both HHS 'arid Edu6ation appear enthused about the idea.
One important issue - I just learned at a CEB meeting that HUD is
beginning to hold meetings in the zones to finalize performance
agreements.
I spoke with Judy Wurtzel after the meeting and
learned that until today, Education had not planned any
participatio~ in these meetings.
I have a call in to Dave
Garrison to check with HHS. Needless to say, if our concern is
that children and families receive full attention, it is vital
,that such attention be reflected in the performance agreements.
I will follow-up with Dave and Judy to see what can be done.
Please let me know if you have any suggestions.
�E X E CUT I V E
OFF ICE
o F
THE
PRE SID E N T
17-Jan-1995 09:21am
TO:
Carol H. Rasco
FROM:
Michael Levitan
Domestic Policy Council
SUBJECT:
RE: EZ/EC - Children and Families
I checked the i drive and the file can be retrieved as
i:\dpc\data\ezchlfam. Don't know where the snafu is. I'll walk
over a hard copy after the conference call.
If it is easier to work from the draft, perhaps you could try to
bring it up one more time. I re-saved it just in case somehow the
original connection was not made.
So much for high tech ...
Hope you had a good weekend.
�·Dr<-f+
t,r
MEMORANDUM FOR:
(OI'A~+;
January 1'7;1995
;,
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Community Enterprise Board
I
FROM:
-,
Carol Rasco
'.-.-;;tA.'-'.!
Lll n
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SUBJECf:
, ,
EZ{EC Activities for Children arid"Families
."
As we move forward with implementation of the EZIEC program, I want to ensure that~ -aleng.;.With..
,the a~blti011s-alIay of e.conmni~ve!\..activities related to children and families receive the
'
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/
;'appropriate level of attention.
, Two critical questions warrant ajtention
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at thIS juncture:
. What level- of 'progress has been made by communitit~s as they gegin to implement planned
activities related to-ehiilclJ;m.fam'ilies and children?
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2) , ~hat a~dlt10~al support~-em:-the-f~e¥emment-and!er...resour~~D gth@rEZs-and-R -L ,-vv ,~fot
WIll aSSIst theIr e f f o r t s ? ,
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I have asked Mickey Levitart who is serving as ~White House Fe119w.with the DPC ~taff to assist
,with this effort. 'He brings many years of hands-'-oi community development experience to the task .
.Coordinating closely with CEB agencies and the White HOl.!-se Oversight Team, Mickey will visit all
of the EZs, and some ECs to engage comm~ities on the two major questions identified above. After
each visit, he will prepare a memo for the CEB (iescribing his interaction with community members,
local; and regional staff who are~orking on children an~ family issues~ and citirig any areas which
need attention.. In addition to providing us with timely information, these·visits will serve to '
highlight the importance of children and families in' the EZIEC program' and.to encourage all who are
.working on activities, which serve them.
.
, Mickey ~il1 be c;cjntacting many 'of you to make sure that this'effo~ is fully integrated with on..:.going
activities. . YQur cooperation and support will contribute to the success of this important aspect of
the EZIEC program.
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January 17, 1995
MEMORANDUM· FOR:
Community Enterprise Board
FROM:
Carol Rasco
SUBJECT:
EZ/EC Activities for Children and Families
As we move forward with implementation of the EZ/EC program, 1 want to ensure that activities
related to children and families receive the appropriate level of attention.
Two critical questions warrant attention at this juncture:
1)
What level of progress has been made by communities as they begin to implement planned
activities related to children families and children?
2)
What support from the federal government and/or resources in other EZs and ECs as wen as
private sources will assist their efforts?
I have asked Mickey Levitan who is serving as a White House Fellow with the DPC staff to assist
with this effort. He brings many years of hands-on community development experience to the task.
Coordinating closely with CEB agencies and the White House Oversight Team, Mickey will visit all
of the EZs and some ECs to engage communities on the two major questions identified above. After
each visit, he will prepare a memo for theCEB describing his interaction with community members,
local, and regional staff who are working on children and family issues, and citing any areas which
need attention. In addition to prpviding us with timely information, these visits will serve to
highlight the importance of children and families in the EZ/EC program and to encourage all who are
working on activities which serve them.
Mickey will be contacting many of you to make sure that this effort is fully integrated with on-going
activities. Your cooperation and support will contribute to the success of this important aspect of
the EZ/EC program.
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J;1,N - 4 1995
PRESIDENT
·WILLIAMJ.'
CLINTON.
VICE PRESIDENT
ALGORE
BUILDING"·COMMUNmES: TOGE1HER
.
'
EMPOWERMENT ZONES & ENTERPRISE COMMUNITIES
u.s. DEPARTMENT OF
HOUSlNG AND URBAN .
. DEVELOPMENT .
Henry G. Cisneros, Secretary.
U:S. DEPARTMENT OF
, AGRICULTURE
\Iike Espy, Secretary
�PRESIDENT CLINTON ANNOUNCES DESIGNATION OF MORE THAN 100
EMPOWERMENT ZONES AND ENTERPRISE COMMUNrrIES
Wednesday, December 21, 1994
Moving to restore' economic opportunity to America's distressed neighborhoods and .
enable communities to take responsibility for their own futures, President. Clinton will today
announce the desiguatiori of more than. 100 Empowerment Zones (EZs) and EI)terprise
Communities (BCs). The PresIdent, joined by the Vice President; will notify 15 of the
designated communities via a telephone call from the Oval Office. The President and Vice
President will then proceed to OEOB 450 to announce the entire list or designees and deliver:
, - ,
remarks.
Nine Empowerment Zones - six urban (Atlanta, GA;Baltimore. MD; Chicago, IL~ .
D,etroit, MI; New York. NY;' Philadelphia. PA/Camden; NJ) ; and three rural (Kentucky
Highlands, KY; Mid-Delta,.MS; Rio Grande Valley, TX) - will be designated. Each urban
zone will receive- $100 million in flexible social service. block grants and tax breaks for zone
. businesses; each rural zone ~ll receive $40 million in assistance and tax breaks.
,The President will also announce the designation of tw~stippieJ1lental Empowerment
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Zones -- Los Angeles. CA and Cleveland, OH -- which will receive economic development
grants through the Dep8rtment of Housing and' Urban Development. LOs Ailgeles will receive' .
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. $125 million in. grants. Cleveland will receive $90 milliQn.
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ID. ,addition, the President. will name 95 Enterprise CommUilities -- designated to'
receive $3,million each in social servi<;e. block grants and tax exempt bond financing for Ee. .
businesses -- and four Enhanced Enterprise Communities.:A full list ofEC designees is
attached. The four Enhanced ECs ~- Boston; MA; Houston, TX; Kansas_City~ KS/Kansas ..
CityIMO; and O~land, CA -- will receive a total of.$25 million each in .ecOIiomic
development grants and social service grants:,
.
The urban EZsand ECs were,s~lectedby Ho~ing and Urban. Development Secretary
Henry Cisneros; the rurat EZs. and ECs we~e selected by' Agriculture Secretary Mike Espy.
BACKGROUND ON PRESIDENT CLINTON'S EMPOWERMENT
ZONEIENTERPRISE COMMUNITY INITIATIVE
Pr~sident Clinton's Empo~erm~nt ZonelEnterprise Commuriity initiative represents a,
new way of doing business for the federal government. This approach recognizes that
communities know their own needs and is based on a pact between the federal government
and each EZIEC community whereby:
�The federal government, working across agency lines and, in a new partnership with
state and local government and the private sector, will provide distressed communities '
with the tools they need and the flexibility they desire, in the form of block grants, tax
breaks and waivers.
'
In return, EZlEC communities - re~idents, community leaders, businesses, state and
local governments and schools - must demonstrate that they are taking responsibility
for their own fu~res by developing and implementing a plan to utilize these tools.
The EZlEC,program was established in the Omnibus BudgetReco~ciliation Act of
1993. Under the program, HUD is authorized to designate six urban EZs and 6S ECs, USDA
is authorized to designate three rural EZs and 30 rural ECs. In September, 1993, President
Clinton estaQHshed the Community Eilterprise Board to assist HUD and USDA in
implementing the program. Fact sheets on the WEC program,on public-private'
partnerships, on assistance 'to- non-4esignees and on the EZiEC application process ay
attached'
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ANNOUNCEMENT CALL BY THE PRESIDENT AND VICE PRESIDENT
The President and Vice President will notify IS communities of their selection via
telephone calls to their respective mayors or other designated officials. The call will, be closed
'press" but video will be made available via satellite and, audio of the calls' will be available on
of . . . .
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,. the mults and PA ,the White House Press Briefing Room.
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'The President and Vice President are expec~ed to call the fdllowing officials: '
Urban Einpowerment Zones
Atlanta Mayor Bill Campbell, ,Baltimore Mayor Kurt S,chmoke, Chicago Mayor
Richard Daley, Detroit Mayor Dennis Archer, New York City Mayor Rudolph Guiliani, ,
Philadelphia Mayor Ed Rendell and Camden Mayor Arnold Webster
Urban SupplementalZoiles
Cleveland Mayor Mike White and Los Angeles Mayor Richard Riordan
Urban Enhanced Communities
, Boston Mayor, ThomaS Menino, Houston Mayor Bob Lanier, Oakland Mayor Elihu
Harris, Karlsas City, KS Mayor Joseph Steineger and Kansas City, MO Mayor Emanuel,
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Rural Empowerment Zones
, Kentucky Highlands - Official TBA,Mid-Delta Region, MS - Official TBA, The :Rio
, Grande Valley - Official TBA
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�FACT SHEET:
EMPOW~RMENT
ZONES AND ENTERPRISE COMMUNITIES
Selection of EZs and ECs were based on a community's ability to satisfy four
fundamental principles:
•
Economic Opportunity: Creating jobs, attracting 'private partnerships and training
residents for newjob opportunities.
•
Sustainable Community Development: Promoting physical and human development·
such as safe streets, clean air and water, lifelong learning and a commi'lIitent to
personal, family and civi~ responsibility· as part of a long-term strategy of economic
d~velopment.
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Community~Based Partnerships: A strategic plan must involve the entire community,
including residents, community groups, private and non.private sectors, education and
. religious institutions and local and state governments. .
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Strategic Vision for Change: There must be a strategic map that coordiriates a
. response to the needs of a community by integrating economic, physical, human and
.' other strategies.
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Summary of Federal Incentives: The federal incentives offered are: (1) taxincentives; (2)
flexible block grants; (3) waivers and flexibility with existing federal resources; and (4)
priority consideration for discretionary federal programs.
.. .
Overcoming Federal Barriers: A primary goal of this initiative is to renew the commitment
for cooperation among the federal, state and local governments. On September 9. 1993, the ..
President issued a Presidential memorandum creating the Community Enterprise Board (CEB)
and directing, 13 agency members of the Board to identify federal programs that should be·
coordinated in the EZlEC initiative and. to .respond to the waiver requests of all EZlEC
applicants. More than 1200 waiver requests were received and are being processed. The·
CEB will work with all communities that have submitted a strategic plair for change •• even jf
they are not designated as an EZ or EC ·;.·to·overci>me programmatic, regulatory and statutory
impediments and encourage more effective economic, human. physical, environmental and
community development strategies.
,.
Tax Incentives: The program provides for approximately $2;5 billion in new tax incentives.
Both EZs and ECs are eligible for new tax·exempt facility bonds for certain private business
.activities. B~siriesses located in EZs will also be afforded an employer wage credit of up to
$3,000 per year per employee for wages and training expenses for employees who both work
and live in the zone. Zone businesses will also be afforded additional Section 179 expensing
deductions for plant and equipment of up to $20,000 (for an annual total of up to $37,500).
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�Social Services Block Grants: The EZIEC program includes $1 billion in fl~xible social.
services block grant (SSBG) .funds that can be used to promote economic self-sufficiency and
reduce dependency. In EZs, designated areas will receive $100 million for each urban zone
and $40 million for each,rural zone for approved activities identified in their strategic plans.
Each EC will receive approximately $3 million in grant funds.
HUD Supplemental Economic Development Grants: In order t9 enable more communities
to implement their strategic plans, HUD. wiJl utilize grants, under the Eoonomic Development
Initiative (EDI), ranging from $25, million to $125 million to create two supplemental
empowerment zones and four enhanced enterprise communities. The grants will enable
communities to provide financing for economic development, housing rehabilitation and
essential development projects that best meet their needs.
'
Additional Federal P~ograms:The CommunitY Enterprise Board identified approximately
$3. billion in additional federal programs that further. the goals of the EZlEC initiative arid
EZIEC applicants received technical assistance and/or priority consideration ,in compding for
these funds. Where EZs and ECs offered viable, competitive strategies in support oftheir
overall strategic vision, additional grants were made.' Designated EZs and ECs will continue·
to receive such technical assistance and priority consideration during the 10-year initiative.
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�FACT SHEET: LOCAL AND PRIVATE SECTOR PARTICIPATION
Across the country,' from the Mississippi Delta to Detroit, the existence of a common
goal has brought together diverse groups that rarely, if ever, cooperated in the past. Many
communities have for the first time developed a comprehensive approach to economic
revitalization that encompasses both capital formation strategi~s 'and the provision of social
services. such as, child care, job training. education and health care. In short, all the
applicants are winners.
-Whether or not Houston wins an empowerment zone designation, the participation of a wide variety of
community players to prepare the application will result in on-going discussions.... ne procus has
brought pe.ople together who had never worked will. each other before. - Judj Butler, aide to Mayor'
Bob Lamer <Houston Chronicle; May 28, 1994) ,
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-It [the application process] also illustrates that the media's constant focus on Chicago's very:-real
neighborhood problems masks significant physical and human assets in these same communities.
Linking these neighborhood leaders with the resources necessary to act on their plans must be a priority
in the future ..'.. In many respects.... Chicago is meady a winnu.' The empowel"llUnt %One process
is a sl1'ong :rtlltement thllt meliningfu' city govemment-neighbo,hood planning can work iii Chicago." "
Thomas Lenz, Local Initiatives Support Corporation and member of Chicago's Empowerment Zone
Coordinating Council (Chicago Tribune,May 23, 1994)
Examples of Private-Sector Commitment:
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IriDe~it,more than $2 billi~n in private sect~rcc:,mmitments have been pledged.
Major automobile ~mpanies will train and hire EZ residents.\ 'Growing industrieswili:"
locate and expand 'in the Detroit Zone. Banks will invest more than SI billion in
homeownershipand small business. Lawyers and accountants will donate their
services to start-up businesses.
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Baltimore's plan leverages $8 in ou~ide resources for every SI of' federal funds. Six
local banks have committed over S50 million for a variety of business and residential,
loans to the'targeted zone. Seven foundations have committed' 1% of the, value of'
their assets each for the next 5 years for zone.
In St.Louis, major corporations have pledged to hire
'income neighborhoods over 10 years.
~ore'than 3000 residents in low- ,
•
In Boston, seven banks have committed $5 million each, for commercial .lending in the '
proposed zone and will provide S625.000 for minority and small business technical
assistance. Boston Edison will offer deep utility 'discounts to new businesses that
commit to employ 'zone residents.
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Iri Kentucky, the Kentucky Highlands Investment Corporation has attracted $33
million, in commitments from state and local banks to 'create the Development Venture
. Capital. fund and S11 million from local banles for free-range chicken farming.
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�EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES"
Commitments to Non-Designated Communities
The Clinton Administration is determined to Continue working 'with communities that do 'not
'receive EZ or EC designations. We will attempt to grant their waiver and program funding
requests. We will provide technical assistanceto help them implement their strategic visions.,
And, working through the CommUnity Enterprise Board (CEB), we will work to reinvent the
relationship between the federal government and local, communities. '
of
the HUD and USDA EZIEC Task Force - an interagency ,
Immediate Contacts: Members
team C()mprise of approximately 50 officials, from' the 13 federal agencieS! represented on the ,
CEBwill be contacting non-designated communities to inform them about plans for future •
assistance.
Waivers and Federal Program Funding Requests: All communities will receive decisions
on waivers and federal'program funding requests that,they submitted in their EZlEC ,-:
applications, whether or not they receive designations. Where legally permissible, the CEB
will attempt to ensure that allEZ and EC applicants receive priority consideration foc'funding ,
requests submitted in, their ~trategic plans:
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Technical Assistance: The'EZlEC Task Force will maintain a permanent unit charged With
outreach to non-designated communities. HUD will also enter into a $2 million annual
Contract with, expert advisers who will' assist non-designated communities in strategic plan
, 'components such as ecOnomic development,comm~ty participation and 'integrated service
'delivery~ In addition. to assiSt all applicants and distressed communities, HUD and USDA
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will publish a 1995 guide to feder~ programs.
Commitments from Third Parties: The Community Eriterprise BQard and the EZlEC Task.
force will be 'reaching 'out to interested third parties- such as foundations. academic
institutions and national business organizations - to work on special projects that can help all '
EZlEC applicants successfully implement their strategic plans. Ideas for special projects
include assistance with linking communities to' electronic networks so that communities can,
access information 'on best practices. programs and sources of, additional assistance, ,pUblishing.
a best practices'casebook and sponsoringregionaliechnical'assistance'conferences for EZlEC
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applicants. '
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�EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES: '
The Application Process
Balckground: After a nationwide competition thai attracted 520 applications, 104
, , communities are receiving designations either as an empOwerment zones (EZs) or an " "
enterprise communities (Ee). ,h1 order to apply, communities had to meet certain eligibility'
criteria regarding size, poverty, unemployment and general distress. They had to be
nominated by their states and local governments. And, t~ey had to 'submit strategic plans
developed with the input of community residents that described the community's vision for
the future and explains how the vision would be implemented. Communities were given six
, months to develop their strategic plans.
'
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Designating Secretaries: SecretarY Cisneros of HUDis' desigriating 6 urban empowerment
zones, 2 urban supplemental zones, and 65 urbail enterprise communities (4 of which are
enhanced with additional economic development grants). Secretary Espy of USDA is
designating 3 rural empowerment zones and 30 rural' enterprise communities.'
KeY,Evaluation Principles: The strategic plan served as the foundation for each
, community's applications. They were judged on the basis of four key principles: economic
, opportunity, sustainable community development, 'Community-based partnerships, and
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strategic vision for change.
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Number of Applications: By June 30, 1994, the application deadline, HUD and USDA'
received a total of520 applications. HUD received 74 urban EZand 219 urban pC '
'applications. U:~?A received 88 ru~l EZ and 13~ rura~: ~C.,'.~f~licatiOns~:_, ,": : ':" ."
Review ProCesS: Aninteragency review t~ of o~er' 100 federal executives from the
agencies of the Community Enterprise Boaid (CEB) thoroughly analyzed the urban and rural
EZand EC applications. The interagency teaui reviews resulted in extensive written and oral_
'
presentations to separate review panels set up at HUD and USDA. Review panels
considered the input of the federal agencies regarding ,application quality, the results of the
federal waiver and program funding .requests,. and additional analysis by :thereview teams.
Using the information provided by the review panels, the Designating Secretar:tes identified
EZ/EC'finalists; cOnsulted with members of the CEB on EZ fiilalists, and.announced their"
proposed designations for EZs and ECs,at a 'meeting of.the:CEB on' December 19, 1994.
Waiver Requests: Approximately 1,138 requests'made by urbanEZ/EC applicants and 134,
request by rural EZ/EC applicants for federal program"waivers were distributed to the
appropriate. federal agencies represented on the CEB. The EZIEC Task Force will continue to
'
, ,process the waiver requests from each of the, EZ'and EC applicants, whether or not the'
applicants receive designations.
Federal'Program,Fimding Requests:' Approximately 2,322 requests made by urban EZIEC
applicants for federal' program funding have been distributed by the E7)EC task force to,
federal agencies. Approximately 466 requests were.made by rural'E7)EC applicants. The
EZ/EC Task Force will continue to w~rk with designated cOmmunities on these requests.
�EMPOWERMENT ZONES
URBAN EMPOWERMENT ZONES
. Atlanta GA
Baltimore MD
Chicago Il.
Detroit MI
New York NY
,Philadelphia PA & Camden NJ
I,
URBAN, SUPPLEMENTAL ZONES'
los Angeles CA
Cleveland OH
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RURAL EMPOWERMENT ZONES'
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'Kentucky Highlands.,
,
. (Clir:'ton, Jackson, Wayne Counties, KYl
,
"~ .
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.:;: -,
.
. ',', i'~ '-' , " "'Mid-Delta Mississippi
.
(BOlivar'oHolmes, Humphreys;l,efl9re Counties, MS)'
: Rio Grande Valley Texas
(Cameron i Hidalgo, Starr, Wlllaey COunties, TX)
URBAN ENHANCED ENTERPRISE 'COMMUNITIES'- ,
BOston MA"
Houston TIC
Kansas City KS ;..- Kansas City, MO
Oakland CA,
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�URBAN AND RURAL
ENTERPRISE COMMUNITIE-S
URBAN ECs
RURAL ECs'
STATE
Birmingham
Chambers County
ALABAMA
,
,
Greene & Sumter
Counties
II. '
"
I:
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ALASKA '
, - [None Eligible]
II ::
III ",.
,
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'Mississippi County
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;,Eastem Arkansas:
1¢ross~ Lee, Monrow &, '
,St. Francis County
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,City'of Watsonville:
Santa Cruz County',
' Los Angeles (SOuth
,,CentralIHuntington
Patk)
"
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1,~Fn Diego
"
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COLORADO
ONNECTICUT
I
--,
lV
--
; "Scin FrancisCo
'(Hunters Point),
II~~
Denver
,
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f;idg eport
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Imperial County,
CALIFORNIA
:"- .
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',;ARKANSAS
~f"
Phoenix
ArIzona Border Region:
,Cochise, Santa Cruz.& .
Yuma Counties
ARIZONA
'"
, '
'"
'
..... :.,'
'
�STATE
URBAN ECs
RURAL ECs
New Haven
II
II
,Wilmington
DELAWARE
II
II
Washington
DISTRICT OF
,COLUMBIA
I
FLORIDA
Jackson County
Dade County/Miami
1~~--~~----~--4-~------~----~r-------~----~1
:;~,
Tampa
1~==============~=========,=======1:='============~111
",
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HAWAII
~ [No Applicants]
~~:
'F=~~~~~1'~~=='~~11I~2'~,~~~1'1~
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I~I.I=DA_H=O=:-========~I'=~-~'='=='='====_"=='~IF~="[=N=OApPI=ica=n=~==~lt
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~'_ILLIN_O_IS_"______~__-+_--_'_'_______
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'Spring'field .
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IF===============~==============~============~I
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�URBAN ECs'
RURAL ECs
, STATE
Des Moines
--
IOWA
" ~,
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II
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II
III
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RYLAND
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MASSACHUSETTS
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Muskegon
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Minneapolis
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Lowell
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[No AppliCants]
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:-MAINE
,"
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Ouachita' Parish " ' -.
Macon Ridge:
Catahoula, COncordia, .
Franklin. Morehouse &
Ti:!nsas-County
•
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~~:
'New Orleans
Northeast L6ui$lana
. Delta: Madison County
LOUISIANA
"
.Louisville
McCreary County"
KENTUCKY
,q,~
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Illi;'
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�MISSISSIPPI
North Delta:
Panola, Quitman &
Tallahatchie Counties
I
MISSOURI
URBAN ECs
RURAL ECs
STATE
Jackson
I
St. Louis
City of East Prairie:
Mississippi County
I
MONTANA
- [No Applicants]
'NEBRASKA,
Omaha
:
,~
,
I.
NEVADA
Clark County/Las
',Vegas' ~
1F===============m==============ifF===============II
~J'
'':NEW HAMPSHIRE
~,
NEV'.' JERSEY
-
;
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:'Manchester
:~
-Newark,
'~I
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~========~====~==============~============~
\~
..
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-=-,-,-,--.=*'~-c=-----~,IFlli,-=-=-=~,I~,
~~,-,
I~================~==============~~==============~
I -
NEW MEXICO
NEW YORK
I '.
Mora, Taos & Rio Mba " ~buquerque,
Counties
Albany
It--------~__+_'--------~--:;...-~---_n
l ,
,/
Buffalo
Newburgh-Kingston
I~~-------~-~-----------+----~-~---~I
Rochester
..
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..
�URBAN ECs
RURAL ECs
STATE
Charlotte
Halifax, Edgecombe &
Wilson Counties
NORTH CAROLINA
.Robeson County
-
NORTH DAKOTA
-- [No Applicants]
I
OHIO
II
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··Akron
Greater Portsmouth:.
Scioto County
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.Columbus
·OKlAHOMA
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j·Josephine County
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.Oklahoma City (EZ)
.Southeast Oklahoma:
Choctaw & McCurtain
Counties
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Harrisburg
City ,of Lock Haven:,
Clinton County ,.
PENNSYLVANIA
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Pittsburgh
··.I,t
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-,
RHODE ISLAND
'
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I :SOUTH DAKOTA
o·
Williamsburg COunty &'
Lake City: Aorence & .
Williamsburg ,Counties
$OUll-i CAROLINA
.,
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Providence
It:
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"Charleston
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Beadle & Spink Counties· -- .[No Applicants]
.\~::.
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�URBAN ECs
STATE
II
II
"
Fayette & Haywood
Counties
· Memphis
Scott County
TENNESSEE
.
· Nashville
I
-
TEXAS
Dallas
,
EI Paso
,
·San Antonio
..
Waco
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ru;AH
-
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. Northampton Counties
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Ogden"
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Lower Yakima County
Seattle
;.
Tacoma
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.WEST VIRGINIA
.'
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'Central Appalachia:
Braxton, Clay, Fayette,
Nicholas & Roane
Counties
Huntington
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.McDowell County
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�STATE,
URBAN ECs
RURAL ECs
WISCONSIN
'Milwaukee
-
-
I
III
WYOMING
tl
-
-
[No Applicants1
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JAN -:-: 4 't995· '
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\-'PRESIDENT ';,
WILLIAMJ.', , '
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CLINTO'N ,,'
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,vICE; PRESIDENT,
" ALGORE,
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BUILDING,'COMMUNITIES: TO'GETHER:
Ervip~WERMENTZOl'mS&El'nERPRI$ECOM~UNrrIES··
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'wee'W£¥iM
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U,S. DEPARTMENT OF
, HOUSING AND URBAN \
, , , DEVELOPMENT .
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Henrv G.,
Cisneros SecretarY
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U.S. DEPARTrvrENT OF ,
, AGRICULTlJRE
\,
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, Mike ESIJY) Secretary,' , ,
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PRESID,ENT CLINTON ANNOUNCES DESIGNATION OF MORE. THAN 100
, " "EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES '
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Wednesday, Dece~ber 21~ 1994 '
"
'Moving'to restdre, ec~nomic opportunity 'to America's distressed neighborhoods' and : '
enable conlmuriities'to take' responsibility'for their own futures, PresidentCI!nton will today
" aIDloUnce the designation of niorethan 10,0 E,mpowerinent Zones (E2s)' anlEnterprise '';
:,' Communities (ECs). The Presldent"joined by the. Vice President; will, notify 15 of the '
',desIgnated communities via a teleph,one call from the ,Oval Office, The ,President and Vice
Presid,ent. will then proceed ,to ,OEOB '450 to announce the entire list'of desi~ees and deliver
r.
, remarks.
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, Ni~e Empo~erment Zone~ :. six urban (At18.n~ GA; B'altimore, 'MD; Chicago, IL; ,
,Detroit, MI; New York, NY; Philadelphia, PA/Camden, NJ) ; and three rural '(Kentucky
, Highlands, KY;Mid-DeIta, MS;;
Grand~ Valley, tX)..,' will be designated. Each urban
~one'wiU receive $100 million in flexible soCial service block grants andtax'breaks for zone
'businesses;~ach rtual zone~ll" receive I $40 'million in aSsistance and tax breaks.
Rio
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'jb'ePresident win 'also announce the desigTlation of tWo Supplemental Empowerm~nt ,
Zones -~'Los Angeles, CA and Clevelarid"OH which ~ll receiveeconornicdevelopment
graIits through the Department 'Of Ho,usingand Urban' Development. Los Angeles will re,celve
$ 125millioh in. grants, Cleveland will receive $90 million.'
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in addition, the President will name 95' Enterprise Communities .:.- designated to
,
receive $3 million' each in social' servic~ block grants and t~ exempt bond financing for Ee
businesses ;~- and fo,ur Enhanced Enterprise Corptn~itie$.A fulIJist of EC designees is '
'
attached. The four Enhanced ECs .;- 'Boston,' MA; Houston, TX; Kansas City, KSlKans~, "
,
CityIMO; and Qakland, CA -- will receive a totalof$25 million each in :economiC' "
developme~tgrants and social· service grants, ,
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The urban EZs and ECs ~ere selected by Housing and Urban Development Secretary
Henry Cisneros; tlle,rural EZs and Ee; 'were selected by Agriculture' Secretary Mike Espy.
BACKGROUNDiON 'PRESIDENT CLINTON'S EMPOWERMENT
.
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ZONE~NTER~RISE COMMUNITY INITIATIVE
,~
" Pr~sident Clinton~s Empowerment ZpnelEnterprise ComrituIiitYinitiative ,represe~ts a','
, , ,new 'way of doing business for the fed~rai government. This approach recognizes that
'
communities know their own' needs and is based on a pactbetW'een the federal government
and each EZIECcommunity, whereby:
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The federal government, v,rorking' a~rossagencylin;es and in a 'new pa~ership with '
state, and iocal government' and the private sector, 'will providedistressedcoqlmunities
with the tools they need lind the flexibility they' desire, in the fopn of l>lock grant~, tax
'/,,' "
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breaks and waivers.
, In retu~;EZIEC commilhities .' residents, community l~aders, bu~in~sses, state and
,local governm~nts and schools· muSt demonstrat~ that 'they 'are tiking responsibility
, for their own futures by developing and implementing a plan to utiliz~,these tools.' '
.,' , 'The'EZIEC,program was established in the Omnibus BudgetRecopciliation Act of
, 1993. Under the program, Him is~uthorized to desi~atesix urban EZs and 65 ECs, USDA
, is authorized to designate three rural EZs and 30 rural ECs; In September, 1993, Pr~sident '
' . -'
, 'Clinton established ,the ,Community Enterprise Board to assist HUDand USDA in ,
implementing the program. Fact sheets on' the EVEC program, on public-private )
partnerships,on assistance' to- non-tiesiC1:'ees and on ~the EVEC application process aLe
attached.
"
ANNOUNCEMENT CALL BY, THE PRESIDENT AND VICE PRESIDENT
, , The President: and Vice President will notify" 15 communities '~f their selection via
telephone c8Jls to their respective mayors or other designated officials. The call will be closed
'press, but video will be made available via satellite and audio of the '(;allswillbe available o!l,
the mults ,and PA of the White House Press Briefing Room.
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, The President and Vice President are expected to call tile fallowing officials:, ,
UrbaliEinpo~e,rmerit Zones,
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'Kurt
,
Atlanta'Mayor,Bill Campbell, naltimore Mayor
Schmoke, 'chicago Mayor '
Richard Daley, Detrqit Mayor 'Dennis Archer"New York City'Mayor Rudolph Gui li ani,
, Philadelphia,Mayor Ed Rendell an~,Camden Mayor Aniold Webs,ter, , ,
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Urban Supplemental ~Zones ,
Cleveland Mayor Mike WhifeandLos ~geles Mayor. Richard Riordan
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Urban Enhanced Communities "
Boston Mayor Thomas Menino:' Houston Maypr Bob Lanler~ Oakland Mayor Elihu
Harris, ,Kansas City, KSMayor IosephSteinegerandKansas City, MO Mayor Emanuel
, Cleaver
Rtiral Empowerment Zones, '
KentuckY Highlands - OfficialTBA,Mid;.Delta Region,MS - OfficialTBA, The Rio
Grande Valley -: Official TBA
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, .FACT SHEET: EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES
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Selection of EZs ahd ECs were based on a oo~~unity's ability to' satisfy:'four
, fundamental principles:
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, Economic Opportunity: Creating Jobs, a~acting ppvate partnerships and,'trainin'g
, 'residentS for new job opportunities.
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Sustainable Community D~velopment: Prom~ting physical and hUnlWt development •
'such as 'safe str~ets; clean air and water, lifelong learning and acommitrttent to '
personal, family and civic ,responsibility - as partofa long-term strat¢gy of economic,
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, dev~lopme~t.'
Community-Based Partnerships: 'Astrategic ,plan must involve ~e entire cOIJlm'Qnity,
including residents, community groups, private and nbn~private sectors, '~ducatiop and , ,
religious institutions and local ,and, state gov~nlIlients:
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Strat~gk Vision for Ch~ge: There must be a,sttategicmap that coordinate~ a '
response .to the needs o( a community by integrating econoinic: physi9a1, hum~ and,
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, ~iher str~tegies.'
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Su~mary.of FederaIInce~t~ves:' The f~detal incentiv~soffered'are:(1') tax'incentives; (2) ,
" ,flexiblel;llock grants; ,(3) waivers and flexibility with existing federal resources; and (4)"
, I?riority consideration' for discretionary federal programs. "
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O~ercoming Feder~IBarriers: A primary' goal ofthis initiativ~ is to' renew the commitriiertt , '
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for 'cooperationaplong the federal,' ~ate and'locaLgoven:tments. ,On'September 9,1993, the, '
President issued a Presidential memorandum creat~ng the Community Enterprise Board (CEB)
'and directing 13 agency members of the ,Board 'to identify f~deral programs that should be
coordinated in the EZIEC :initiative' and to respond to the waiver requests of all EZIEC '
applicants. More than 1200 waiver requests were received and ~e being 'processed. The '
CEB will work with all communities that ~ave submitted a' strategic 'plan for change -- even if
,.they ate not'designated as an EZ or EC -- 'to, overCOme programm'atic, regu,latory and statutory
impediments and encourage ,more effective economic, human, physical, environmental and
" communitY development strategies.' , ,',
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" Tax Incentives:, The programptovides for app,roxi~ately $2;5 billion inn,ew tax incentives.
Both, EZs and ECs' are eligibie, for new tax-exempt faciIi'ty bonds for ceJ;tain private busines~
,activities. Businesses located in EZs will also be afforded an employer wage credit of up to;
$3,000 per y~ar per employee for wages and training e'Wenses for employees Who both work
an~ live in the 'Zone. Zone businesses wil~ 'also be afforded addition~ Section 179 expensing
deductions for plant and equipment of-up to $20,000 (fQi an annual total of, p, i(),S37,500).\
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Social Services' Block Grants:, The EZIEC prpgram include~ $1 billion i~~ flexible social
services b,lockgrant. .
(SSBG)'fimds:that can be used to promote 'economic self-sufficiency and
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reduce' dependency. In EZs, desi8J1ated areas will receive $100 million for each urban zone
and $40 milli9D for each rural zone for approved activities 'identified in; their Strategic plans.
'Ead~ EC 'will receive approximately $3 miJlion inin~.nt furids. , .
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HUD Supplemental Economic Development Grants: 'In order't~ enable more communities
to impleme~t their sirate~c plans,HUD, will utilize grants, under the 'Economic Development
Initiative (EDI), ranging from $25 million to $125 milliontocn~atetwo supplemental',
'
empowetment zones and four enhanced enterprise communities. The 'grants will enable
communities, to, provide' financing for economic devel9pment, housing rehabilita#on and
essential:-development projects' that best me'ettheirneeds.'
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, A~ditional Federal Pr:~grams: The CommunitY E~terprise'Board' identified approXimately ,
$3 billion in, additional federal programs that fl,lrther the goals of the EZIEC initiative ~d '
EZIECapplicantsreceived technical' 'assistance and/or' priority consideration in competing for
,', these funds. where EZs /arid' ,ECs offered viabl~, c~mpetitiye strategies in, support of their
'overall strategic vision, additional grants' were made .. :DesigOated EZs and ECs will' continue
to receive such technicalassistaD.c~ and priority consideration d~ng the ,IO-year initiative.
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FACT SHEET: LOCAL'AND PRIVATE SECTOR PARTICIPATION'
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Acros~
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Missi~sippi
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exist~~'ce ~ ~ommori
thecountiy, froJti the
Delta Detroit,th'e
o'f
goal' has brought together diverse groups that rarely, i{ ever" cooperated in the past. ¥~y ,
, commuriities have for the first time developed a comprehensive approach to economic
, revit~ization that encci~passes, both' capital fortQ.ation strategies arid' the proVision of social
serVices,' such as child ca:Ce~ job training, education and health care. In s.hort, all ~e
',
"
,applicants are Wi~e~s. ,
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" "Whether or not Houston, wms ari empowerment zone designation, the participation of a wi~e variety ~f
, commUnity playerS t9 prepare the' application will result in on-going ,discllssions.... The process has,
brollght people together who had 'never worked with each other before.· Judy Butler, aide to Mayor'
: ' Bob Lanier (Houston Chroni~le; May 28',1994),'
"
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"It [the application pro~ess] als~ illustrate~ that the media's constant focus' on Chicago's yel".}Y'eal
neighborhood problems masks sigriificant, physical and human assets' in these ~me communities.
Linking ~ese neighborhood leaders :with the resources necessary to act on their plans must be a priority,
in the future. ... In many respects: ... Chicago is 'tllready a winner. ' The empowerment :one process'
is,aiirong statement that meaningflll cit} government-neighborhood planni;ig can work in ChicQio.~ ,
Thomas Lenz, Local,Initiatives Support Corpo~~tion and member of Chicago'S EmPowerment Zone,
'Coordinating,CoUnciHChicago Tribune, May 23. 1994) . ,
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Examples, of Pr.vate~Sector Commitment:
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.. ., " In Detroit, more than $2 billion in private sector commitments have been pledged.
Major automobile companies
tr:ain and hireEZ residentS. Growing industries .,will
locate' and expand:'in the Detroit zone. Banks will invest more than $1 billion in "
homeoWJlership and small business.' LawYers and accountantS will donate their "
, , services to start-up businesses.
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Baltimore's plan leverages $8 in outside resources for' everY $1 of -federal funds. Six
local banks have committed over $50 n,:tillion for variety of'business and residential,
loans to the targeted zone. Seven foundations have comn,:titted 1 % of the value of
, their assets each for the next 5,.years for zo~e.,·
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In Sf. Lo~is, ~ajor corp~rations 'have pledged to hire more 'th~' 3000
income neighborhoods over 10 years~
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~esidents in low- '
'
, In 'B9st~n; seven banks, have oo.mrpitted $5 million ea9h f~r comIl1e~dal,l~nding
the
, proposed zone and wiU'provi~e $625,000 for min9rity and small' business te'chnical
assistanc~'. Boston Edison Will offer deep ~tilitY disco~ts to new businesses that
co'mmit to employ ,zone residents: " , ,
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In Kentucky, the Kbntucky Highlands Investment Corporation haS attracted $33
, million in commitments from state, ahd local banks to create the ,Development Venture
Capital fundand $11 million fro~ local banks for free-range chicken farming, '
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�'EMPOWER'MENT ZONES AND ENTERPRISE COMMUNITIES"
, Com":'itments to Non-Designated <:;ommunities
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',The ClintonAdmini~ation is detenninedto coIitinue wo~king'with comrilllnities ,that do not
'receive EZ or EC designations. ) We will attempt 'to grant their waiver and program funding "
requests. We'will provide technical assistance to help them)mpleinent theirstrategicvisions.'
And, working through the Community Enterpr,ise Board (CEIl), we will work to, reinvent ;the ,
relationship between·ilie federal govemment)lI~d 10cal.cOmmunities:
'" ,
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Immediate ,Contacts: Mempers of the HUD and USDA EZIEC ,Task, Force ..;:- i an interagency~ ,
, team CQmprise of approximately 50'officials/fror~rthe 13' federal agencies represented on 'the ,
, : CBB will be Contacting non-designated cOmmunities to infonn them about plans for future '
assi~tance.' " ,
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, :, 'Waivers and Federal Pr.~gram Fu~ding Reque~ts: All communities will ..eceive decisions,
on' waivers and federal prpgram funding; requests that they submitted iIi their EZIEC -::-, ,
, applications; whether or not they receive designations; Where 'legally, pemiissible, th~e CEB ' '
, will 'attempt to ensure that allEZ and EC aPplicants receive prioritycorisid~rati,on for fliDding ,
"
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,
,'requestS 'sub~itted in their 'strategic plans;,
.
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Tech":i~aIAssistance: ' Th~ 'EZIECTask: For~Will maintain a pennanent unit charged with' '
"outreach to non-d¢signated communities. HUD will alSo e~ter into a $2 'million annual ,
contract with ,expert advisers who will asSi~ noh-designated comm~ities in stratetJic plan ,
components such as' ecOnomic developme~t,comniunitf participation and integrated service
'delivery, In addition, to assi~,all applicants 'and distressed communities, HUD and USDA "
-Will publish a 1995 ,gUide to federal programs., , '
\ '
I
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Com~itmentS rro~- Third Parties: The ,Co~munity Erite'rpnse Board and ,the EZIEC Task: " "
force will be reaching 'out. to interested' third p~es '..;~ ~uch as foundations, academic ' "'"
institutions and national business organizations -- to .work _ -special.projects that can' help 'all
on
, EZIEC applicarits successfully, implement their 'strategic plaris. Ideas for. special projects '
include assistance with linking communities to electronic network~ so that cOmmunities can
'
'access inf~)I1~lation on best p~actices, progrmns and soUrces of additional assistance, publishing ,
a b,est practices caseboo,k and sponsoringregi~~altechnical assistance conferences for EZIEC
,
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',EMPOWERMENT ZONES AND' ENTERPRISECdMM~NITIES:·
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' T h e Applic;'tionProcess " '
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&,ckground: After a nationwide competition' thai' attracted 520' appli~tions, '104 "
oommunitjeS are receiving designations either as an emp~werment zones (EZs) ~r an
enteIprisecommunities (EC), lIn order to apply, communities had to meet ce.rtain eligibility'
criteria regarding size, poverty, unemployment and ge~neraL distress" They had to , b e '
nominated by their states and local gov~riunen~s, An,d, they had to submit, strategic plans,
, developed with the, input of community residents that described ,the community's yision for
" the future arid explains how ,the vision would, be implemented, Communities were given six
'months to develop their strategicplans~
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Designatblg Secretaries: Secretary Cisneros of. HlJD is desi~ting'6 urban eIripowerm~nt
zones, 2 urban supplemental zones, and 65 urban enterprise communities (4 of which are
enhanced with ,additional ecOnomic development grants). ,SeCretaiy Espy of USDA'is
designating 3 rural ~mpowerment- zones and 30rutal enteIpri~e communities.' '
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Key Eval~tioD, Principles: The str~tegiC' plan served as the foundation for each
community's applications. They wer.e j~dged on the basis of four key priilciples: economic,
ppp0I't4nity" sustainable cOmmunity developrtlent, community-based partnerShips, and
'
strategic vision for change.
'
'
Number of'Applicati,ons: By june 30, 1994, the appli~t~on deadline, HUD and USDA
received a t()tal of. 520 applications.,lfl,JDreceived 74 urbaJ) EZ '~d 219 ,urban EC'
applications: USDA'received 88 niralEZand 139 'rural EC'applications.
( ,'
Review ProcesS: An inier~gency revieW team of ov~r 100 fed~ral exeCUtives from, the ,
agencies of the Community'EnteIprise Boald (CEB) thorough~yanalyzed the urban and rural
E~ and EC applications. The interagency te:am reviews result~ in extensive written and oral
pre~ntations to separate revi~w ,panels' set up at HUJ) and USDA. . Review p~els
, conside'red the input of the federal \agencies regarding application quality, the results ofJhe
federal waiver andprpgramfunding requests, and additional analysis by the review teams.
Using'the information provided by the' review panels, the DesIgnating Secretar:tes identified
EZ/EC'finalistsj consulted with members of the CEB on EZfin3lists,and.announced their '
proposCd designat,idnsfor EZs ~dECs at a' meeting of the CEB on Decem~r19, 1994.
Waiver, Requests: Approxiriiately 1,138 request~ made by urban Ei./EC applicants and 134
request by rural EZ/EC applicants (or' fede~alprogram, waivers were distributed to the '
appropriate' federal agencies represented on the CEB. The EZ/EC T~k Force will continue to
process the waiver requests'p:-om each of the EZ and, EC applicants, whether or not. the, ~ ,',
applicantsr~eive designations.,
'
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Federal Program:Funding Request~: Approximately'2,322 requests made by urban EZ!EC'
appl~cants for federal program funding bavebeen distributed by t~e EZ/EC tru;kforce to, '
federal agencies. Approximately 466 requests were made py rural' EZIEC applicants. The',
EZ/EC Task Force will cOntinu~ to w~rk with Qesi~ated commuqities on, these requests:
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, EMPOWERMENT ZONES
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, .URBAN EMPOWERMENT-ZONES
.....
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Atlanta GA "
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" Baltimore MD .
, ,Chicago Il .
, Detroit MI' ,
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New,Yor~'NY
,
,Philadelphia PA &Carnden 'NJ '
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URBAN SUPPLEMENTAL ZO'NES ".
••
Los Ang~les CA
" Cleveland OH
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RURAL EMPOWERMENT ZONES'
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Kentucky Highla,ndS' , ,
(Clinton, Jackson, Wayne Counties,. KY)
!
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,Mid-Delta Mississippi·.
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(Bolivar",Holmes, Humphreys, leflore COunties,' MS) , .
Rio 'Grande Valley Texas, "';
(Cameron, Hidalgo" Starr, Willapy Counties, TX)
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URBAN ENHANCED ENTERPRISE COMMUNITIES
Boston MA.
, ",
Houston TX
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Kansas' City KS-- KanSas City j MO
Oakland CA'
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URBAN'AND, RURAL,'
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STATE
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'RURAL:- ECs '
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Birmingt:Jam,
Chambers CountY
.ALABAMA
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Greene & Sumter.
Counties'
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ARIZONA
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KANSAS
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Pulaski CountY
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Los Angeles (South .
CentraVHuntington'
,Park)
Impe,rial County
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Cit}lc()fWatsonville:
Santa Cruz County ,
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III,
CALIFORNIA
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Eastern Arkansas:' ,
Cro~; ,Lee, Monrow &,'
, St. .francis County
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Phoenix
'Mississippi County
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Arizona Border Region:
Cochise, Santa Cruz &
Yuma Counties '
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ALASKA '
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San Diego
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. ' san FrancisCo
•(H4nters Point)
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COLORADO
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Denver,
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CONNECTICUT,
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Bridgeport
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, URBAN ECs '
RURAL ECs
STATE
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New Haven
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III "
DISTRICT OF
. "COLUMBIA'
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Jackson County
FLORIDA,.
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Dade County/Miami .
,Tampa
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III
GEORGI~',
Albany
",
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Central, Savannah Rivei'
Area: Burke, Hancock,
Jefferson,' McDuffie, ,
Taliaferro & Warren
Counties
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HAWAii
--, [No Applicants]
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IDAHO
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ILLINOIS,
EaSt St. Louis
Springfield .
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INDIANA
,Indianapolis
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IOWA
Des Moines
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KANSAS
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MAINE
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MASSACHUSETTS
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Springfield
"III
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Lowell.
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lake County
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MARYLAND
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Ouachita Parish
'MacpnRidge:
Catahoula" Concordia,
F-ranklin, Morehouse &
TensasCounty, '
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New, Orleans'
Northeast Louisiana
Delta: ,MacU.$On County,
LOUISIANA
MICHIGAN'
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Louisville:
McCreary CountY" ,
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KENTUCKY. '
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Flint'
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Muskegon "
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,MINNESOTA
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MinneapOlis
St. Paul,
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',RURAL ECs, ,
'STATE'
,URBAN ECs
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MISSISSIPPI
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St. Louis'
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: City of East Prairie:
"Mississippi County
MISSOURI
,
Jackson' ,
North Delta: '
Panola,Quitman&
Tallahatchie Counties
I
'-- [No Applicants]
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NEBRASKA
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III '
'-
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Omaha
,
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NEVADA
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Clark County/Las
Vegas
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NEW HAMPSHIRE
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' Mora, Taos ,& Rio" Ari~a
Counties
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,Albany
,,',
Newburgh...;:Kingston ' ,,
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,'Buffalo
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Albuque'rque
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NEW YORK
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NEW MEXICO
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Mancnester ,.
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RSEY
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STATE,
URBAN'ECs "
RURAL ECs"
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Robeson County
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Ch~rlotte
Halifax, Edgeco'mbe:&
Wilson, Counties
NORTH CAROLINA
,
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..;..:. [No App,lic~nts]
DAKOTA,
,II
".,
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,OHIO
'
Greater Portsmouth:, '
Scioto CountY
,
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PENNSYLVANIA
,
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Portland
, I
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, City of Lock Haven: " "
Clinton County
Harrisburg
,
,
, Pittsburgh
-'
II,
: '
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RH~LAND
"
SOUTH CAROLINA
,
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TH DAKOTA
,
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Williamsburg County & ,
, Lake City:! Florence &
Williamsburg 'Counties
,'III
,
Providence
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Josephine County:
,
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Oklahoma Gity(EZ)
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Southeast Oklahoma: '
Choctaw & McCurtain
Co~nties '
OKLAHOMA
'
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I ,Columbus
"
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Akron
I,
OREGON
'
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Beadle & $pink Courities
Charleston,
,
III,
-- '[No Applicants]
','
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.RURAL ECs
STATE,
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TENNESSEE
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Memphis'
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Fayette & Haywood.
, Counties
.Scott 'County
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Nashville.
E
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Dallas·
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EIPaso
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UTAH
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VIRGINIA'
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.Burlington .
Norfolk:
Lower Yakim~ Co""nty
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WEST VIRGINIA
/.
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Central App~lachia:
Braxton, Clay, Fayette~
Nicholas .& Roane
',
COunties'
/
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McDowell County
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Seattle
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Tacoma
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'WASHINGTON' .
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Accomack &
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,NortharriptonCoorities
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-- -,
VERMONT
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. Ogden
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Waco
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WISCONSIN·
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WYOMING
URBANECs
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Mi!waukee
..
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�EMPOWERl\llENT ZONES AND ENTERPRlSE COMMUNITIES
r-----~_. ~----;
URBAN
o Enipowerment Zone
• SUllplemental Empowerment Zone
., Enhanced Enterprise Community
• Enterprise Community
RURAL
• Elr,powerment Zone
• En~erprise Community
_.
--------------------~
EMPOWERMENT ZONE (EZ)
California: Los Angeles
California: Oakland
Georgia: Atlanta
Illinois: Chicago
Kentucky: Kentucky Highlands'"
Maryland: Baltimore
Ml!Ssachusetts: Boston
Michigan: Detroit
Mississippi: Mid Delta'"
MissourilKansas: Kansas City, Kansas
City
New York: Harlem, Bronx
Ohio: Cleveland
Pennsylvania/New Jersey: Philadelphia,
Camden
Texas: Houston
Texas: Rio Grande Valley'"
ENTERPRISE COMMUNITY (EC)
Alabama: Birmingham
Alabama: Chambers County"
Alabama: Greene, Sumter Counties'"
Arizona: Phoenix
Arizona: Arizona Border'"
Arkansas: East Central '"
Arkansas: Mississippi County'"
Arkansas: Pulaski County
California: Imperial County'"
California: LA, Huntington Park
California: San Diego
California: San Francisco, Bayview,
Hunter's Point
California: Watsonville'"
Colorado: Denver
Connecticut: Bridgeport
Connecticut New Haven
Delaware: Wilmington
District of Columbia: Washington
Florida: Jackson County'"
Florida: Tampa
Florida: Miami, Dade County
Georgia: Albany
Georgia: Central Savannah'"
Georgia: Crisp, Dooley Counties'"
Illinois: East St. Louis
Illinois: Springfield
Indiana: Indianapolis
Iowa: Des Moines
Kentucky: Louisville
Louisiana: Northeast Delta'"
Louisiana: Macon Ridge'"
Louisiana: New Orleans
Louisiana: Ouachita Parish
Massachusetts: Lowell
Massachusetts: Springfield
Michigan: Five Cap'"
Michigan: Flint
Michigan: Muskegon
Minnesota: Minneapolis
Minnesota: St. Paul
Mississippi: Jackson
Mississippi: North Delta'"
Missouri: East Prairie'"
Missouri: St. Louis
Nebraska: Omaha
Nevada: Clarke County, Las Vegas
New Hampshire: Manchester
New Jersey: Newark
New Mexico: Albuquerque
New Mexico: Moro, Rio Arriba, Taos
Counties'"
New York: Albany, Schenectady, Troy
New York: Buffalo
New York: Newburgh, Kingston
New York: Rochester
North Carolina: Charlotte
North Carolina: Halifax, Edgecombe,
Wilson Counties'"
North Carolina: Robeson County"
Ohio: Akron
Ohio: Columbus
Ohio: Greater Portsmouth'"
Oklahoma: Choctaw, McCurtain
Counties'"
Oklahoma: Oklahoma City
. Oregon: Josephine"
Oregon: Portland
Pennsylvania: Harrisburg
Pennsylvania: Lock Haven"
Pennsylvania: Pittsburgh
Rhode Island: Providence
South Dakota: Beadle, Spink Counties·
South Carolina: Charleston
South Carolina: Williamsburg County'"
Tennessee: Fayette, Haywood
Counties'"
Tennessee: Memphis
Tennessee: Nashville
Tennessee/Kentucky: Scott, McCreary
Counties"
Texas: Dallas
Texas: EI Paso
Texas: San Antonio
Texas: Waco
Utah: Ogden
Vermont: Burlington
Virginia: Accomack*
Virginia: Norfolk
Washington: Lower Yakima"
Washington: Seattle
Washington: Tacoma
West Virginia: West Central'"
West Virginia: Huntington
West Virginia: McDowell·
Wisconsin: Milwaukee
" denotes rural designee
�I
i
COMMUNITY EMPOWERMENT BOARD
Improving Our Response to EZs/ECs.
i
,
Overview. The~e are 105 deSignated EZs/ECs in 42 states .. The goal of CEBis to
deliver on the promises made to those communities in the Federal Guidebook,
namely to respond favorably to waiver and barrier removal requests and provide
priority consideration for additional federal funds. The CEB Working Group (your
agency contacts) has been working to establish systems at your agency to help us
deliver on specific EZIEC requests and to enable us .totake credit for positive action.
I
"
'!.
Current Work of CEB Agency Staff. Agency staff have jOintly developed a
fram~work for (1) expedited processing of priority waiver and barrier removal requests;
and (2) tracking and capturing information on additional grant awards to EZs/ECs. .
CEB Agency contacts are responsible for ensuring that these revised systems are
.
.
implemented. CEB Agency contacts have been asked to report final decisions on
waivers and program awards to the EZIEC Task Force for recordkeeping and inclusion
in the CEB Newsletter. Agency contacts will also facilitate scheduling of visits to
highlight grant awards and waiver decisions. Finally, agency Chiefs of Staff have
been asked to report positive adions in EZs/ECs to the Cabinet Secretary. .
Suggestions for Cabinet Members: To assist the CEB in fulfilling its mission, we
would like you to consider taking the following steps.
Travel: Travel to at least one EZIEC this summer to announce positive agency
action and encourage Sub-cabinet officials to do the same. Ask your scheduler
to look for opportunities to add EZIEC visits when you will be in an area that
has anEZ or EC.
E
. mpower your CEB Agency Staff: Assign someone to report directly to you
on how your agency is doing on programs, waivers and visits to EZs/ECs ..
*
*
*
Thank you for· the commitments you and your agency have made to the
EZ/EC program. We sincerely appreCiate your continued· interest and
support!
�E X E CUT I V E
o F FI C E
o
F
T B E
PRE SID E N T
13-Jan-1995 12:24pm
TO:
Paul J. Weinstein, Jr
FROM:
Gaynor·R. McCown ,
Domestic Policy council
SUBJECT:
Suggestions of EZs and ECs that Carol may visit
Paul:
I read Peter's memo to you regarding suggestions for place
Carol may want to visit. To begin with, I like the idea of her
visiting both Zones and Communities. I think we should seriously
consider the two communities he highly recommends: Robeson County
EC, on the North - South Carolina line and the Central Savannah
River in Northern·Georgia. In addition, the Greene and Sumter
Counties Rural Enterprise community in Alabama (not JUST because
that is ,\'lhere, I 'm -from, ot cQurse). .-may be 'interest;i.ng because of.
their focus on job skill training programs.
.
I think Carol has indicated she would like to visit four or
five sights. Perhaps the remaining one or two should be
Empowerment Zones. However, since the VP and the Cabinet
Secretaries are visiting the Zones, there may be some value to
Carol's concentrating on the Communities. Nonetheless, I think
the Rio Grande and the Mississippi Delta would be good choices if
she does decide to visit one or two Zones.
I have several questions:
Will Carol's visits be as the result of or in addition to
the work-Mickey will be doing?
Has she mentioned what, if any, the connection would be?
Finally, did you mention to Kumiki that I would help her
with Rio Grande? Should I speak.to her?
Gaynor
�..
E X E CUT I V E
OFF ICE
o F
THE
PRE SID E N T
13-Jan-1995 04:59pm
TO:
Carol H. Rasco
FROM:.
Paul J~ Weinstein, Jr
Domestic Policy Council
. CC:'
CC:
CC:
Julie E. Demeo
Gaynor R. McCown
Jeremy D. Benami
SUBJECT:
Visits to rural ECs
Per your request, I asked USDA to give mea list of rural ECs with the best
. panmting, children, disability, AIDs emphasis .in their applications. ' I asked
GayIlor to review these and her analysis of the USDA recommendations is attached.
I am sending over the USDA analysis through interoffige mail.
�
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Carol Rasco - Issues Series
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Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
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2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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Clinton Presidential Library & Museum
Extent
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92 folders in 7 boxes
Text
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Original Format
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Paper
Dublin Core
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Title
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EZ/EC [Empowerment Zones/Enterprise Communities]
Creator
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Domestic Policy Council
Carol Rasco
Issues Series
Identifier
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2010-0198-S Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 123
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Publisher
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Clinton Presidential Library & Museum
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Reproduction-Reference
Date Created
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12/4/2013
Source
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2010-0198-Sb-ez-ec-empowerment-zones-enterprise-communities
-
https://clinton.presidentiallibraries.us/files/original/fe1de492be4dca17db863913556f8492.pdf
60e89bb89744adee302f95e2c87b1717
PDF Text
Text
DPe MEETINGS
.
October 2 -- ~
october 16
-{0.Lu-0
October 30
November 13
November 27
December 11_
�E X E CUT I V E
OFF ICE
o F
THE
PRE S I,D E N T
13-Sep-1995 12:47pm
TO:
Carol H. Rasco
FROM:
Julie E. Demeo
Domestic policy Council
CC:
Patricia E. Romani
SUBJECT:
Media and Violence Report
Kim Savage called from UCLA to tell you about a study Jeff Cole's
office (Center for Communication Policy) is releasing on Sept
19th.
Tomorrow Jeff will be in Washington to give Rahm a preliminary
report at 10:45am.
The study ~s a qualitiative anaylsi~ of violence with an
"appropriateness rating" for all of the major TV shows over past
one year. Study funded by major networks and sponsored by senator
paul simon.
Kim's number is 310-825-8593 if you have any questions. She is
leaving this message as an FYI in case you wanted to call IIRahm's
office" and invite yourself.
�PAGE: e 1
FROM: UCLA COMM & GOUT RLTHS
... -?
'.
FAX TRANSMISSION
OFFICI! OF COMMUNI'fY AND GOVEflNMBNTAL RELATIONS
llNI VHRSITY OF CALIFORNIA. LOS ANGELES
:1119 l"'VUa
405 HI\.D/tR1:I AVENUE
LOlli AHOEI.&3. c::A 00024-1 ::a1$0
(3101 82S-S61i;J
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131995
To:
. Fax Ii: .
Julie Demeo
Date:
September 13, 1995
202/4~h-2K7K
rages:
3
From:
Kim Savage
Federal Relations Coordinator'
Subjed:
(exc]udilig cover)
;),
Network Violence Assessment
~.
r
COMMENTS:
Following is the background pioce on the Network Violence Study. As we discussed, the relea.~
for tho ropon ;0 ouheduled for Septomber 19 in Los AnseleJ. Jeft" Cole, nirp.r.fnr nf t.he I J(;T~A
Center for Communication Po1i<:y, will meet with R.ahm EmanUElI t.nmnM'ow, September 14, 1995,
at 10:'1 S a.m. to discuss the repoat. Jeff aaked that I let Carol'lhRt'.o know ofthill meeting.
If yuu have any questions about the report relea.~ please call me. If you would like to set-up any
subsequent meetings, left' Cole will be back in Washington, D.C. September 20 and could give a
"
detailed briefing on the ~t.ndy at that time.
f
�FROM: UCLR COMM & GOUT RLTNS
Sep-13-95 Wed 08:36
FRX: 310-206-8207
PRGE: 02
'\
Summary of Network Vif)l~ncf'. Asst'Ssment
by the UCLA Center for Cnmmnnir.at.inn Pnlir.y
The;
as~cssmcm
of violence in nerwork entertainment pl'ogranmling conducted' by (he'
UCLA Center for COlll111l.lui\;i1liuu Pulicy will comist of ~ quaJltatlve evaluation of the violem
contcnt found in the programming broadca.~t by ABC, CBS. FOX auu NBC. TIlt; proj~L wil) also
asscss programming on cable, independent television stations, alld PBS,
iSS
well as lheatrical
movies distributed on home video ond video games, in onlC:rlv pillet; nc:twork progranuning In
the eomcx.t of all oth<:r sourCeS of video that cntcr the b01ll1.:.
The nssessment.will cva]ulltc the following:
1. Network prime time entertainment progrllms., i,neluding scries. made-for-tclc:visi<7n
:i'
movies, miniseries llnd theatrical mOLino pictur~s. including:
* A minim.um of fO\.lrepiuodes of each 3cricli progrnm will bccvalul.\tcdj
where
appropriate. all episodes of a series rnily bc reviewed.
II<
An
made·for·,teJevision movies. mini·~eric~ and theatrical motion pictures
broadcau by the networks.
2. Programs specific.ally designed for children, broadcast by the networks and othe,'
broadc.ast television outlets.
~.
3. I~rimc-time syndicated and locnlly-rrncince-.d entirulinmcnt programming on
independent station~ located in l.o~ AnCr.lr.!\. linn prime-time enterlainment
programming on PBS.
-more
�FROMI
FRXI 310-206-8207
UCLR COMM & GOUT RL THS
Sep-13-95 Wed 08137
PRGEI 03
4. Relevant program matc:ria] from other non-network sources, including entertninm.enl
nnd children's progrnms on n number of basic and pny cable nClworkFl and rorular
home video rental/) and video sames,
~, National
advertisement.'! and promoti~'n6 on network and cable television.
Nature of the Assessment . .
Ea~h
program reviewed will be evaluated within a framework that takes into account
sllch factors as:
III
The
motjv~ti(l.n
for the
vjol~nr.e,
'" The cont.ext, lind manner in which violence i!; portrayed.
'" The relevance of the violence to plot or chara.cter <1evelopmem.
>I'
The consequences of the violence.
.. The time at which the pro~ram was scheduled.
... Whether an advisory was attached to the program.
1'lcse (actun; will cn.::ute un tllltllyticul struclure lhat rel,;ugnif.c:l lhltl Villh:::JIcc:cIlJlb\;
appropriately and be an important· pan of lhe plOl a.nd that
lilill
lrCHll,;~
identifies violcilCC llJilLiL
I2fQhh;matjc in its depicLiQIl.
Process
The directors of the UCLA Center for Communications }'oJicy will both ovcr~cc and be
intimately involved in every facet of the assessment. They will train the evaluators who will
initially view individual programs and wiJ) pcr8on~Uy review any programs found to· contain
pl'oblematic violence. .
�FROMI UCLR COMM & GOUT RLTNS
Sep-13-95 Wed 09:39
FRX: 310-206-9207
The nirec:t('lf'; t.\f the ('~nter will
PRGEI 04
he re~ponsihle for the writing and publication of the final
repOrH:.
Ifinal Repon.e;
Ii
. TIle UCLA Center for Communication Policy ",111 issue writTen annual rep(ln'i on
assessments covering the 1994-'9' and ]99.5-'96 broadcast seasons, The reports will incluuc lhc
.
resull~ of lhe CIIIl)Uitliou of pH)gnullluiug on the networks and other video outlets and also
witt
analyze: trcnds and "banges in the way vio)c:.nt themes arc handled across all media, The reports
will be: available to the public,
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BREAKlt,iGTHE CYCLE:,',
WOMEN MAKING A DiFFERENCE FOR TliEMS~LVES,AND THEIR CHILDREN,
Mentors:' :Remind clients that each oftha w9men in the video has gotten' support and guidance
. from others to.become successful. Who has helped~ each of these women? What sources of'
support do the women !n your program' have in place? Who serv~s to help them meet their goals?
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and COor$ Iir~;;"ing Compa;'y arll p/Ba$tHi to stlJlld, you comP/iiniJntJJ~
copy of DrHlcing thll Cyclll. .WII'worklld t09110- to creatll thi$ -vk[tIO, far U$II in CBr".. Ct/JIIttIr$, 'lob
training program$ aild RtfJl'acy prO/tict$, that.$fJl'VlI WDmtIJII. _'t ha$ btHIII'dllveloptHi to motivlltll'WOmtIJII who
ntlfKi to $tr8.ngthtin th- ballic$ki7l$ and Who arll-intfll'lI$ttHi in mOl(ingitito thll/ob markllt. WII;"o~:YDu'H
U$II it .and that it. w/71 btl II hf!lpfUJ prog,am t o o l : ' .
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RII~Hrch $how$ that II mothfJl"$ BduCiltiOlla/' lev8I i$. -Onll of'thll most'coniidtll'lt' lind powlllftil '
dlltfJl'minant$ of. litll'clu7drfliJ'$ f.utimi $chool-'UCCtI$$., Thereforll,_ wom~';w"D""'provlI the;, IHIUCllifo"al
'IBv8l$ biing impOrtai;tJlcolJomlc lind tHiUf:l!tI!)n.1 IIctVllntaglls' to their f~m/7ie$" MalcingtJ;;$,-cycle of '
$ucceS$- 'lIrt1a1ity 10/(lgr.tfJl' numbtll',_of ~omiJIi -is the goal of. the partnfJl'ship crlJlltlid betwtHIII:,Coor$
ComPany .nd .VJlid.rOpportuniiiil$:foi Wom.n., :WII._lIrll-committ8ct to: iricrlJll$lng fIITIpioymiJni
.i,pPorlunitill$ forw0nl.'" : through litfll'scY1!nd /OJ, training' progrllms, IInd'to increaslI $UPPon from
fimplo yfN,Si thll govlll1Jm~t IInd,othfJl' fUniifJl'$. ~Drft8king. the· Cyclll i$ the fint of $evfJI'al joint ~vtinture. to
.' .timUllltll grlJlltBl' :sttlintion"to';""'m!in~$ Rt.,iit:y iJtIfId$~< WII hopS that you,'g·6I1d it lind thi$acCOnipanying _,.'.
guide ii.efulin your IIffo,,$ to rNch outtowomllil int6n,$teditim.lcing charge-of their. Uve$. . '
, . ~ •. :Motivation::.Talk about what has motiv~ted YQur clients to seek ~ssistanc~ in reaching their goals.
'. " Develop ways for clients to motivate eacli other' andlheir own children.
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'The vid'eo operates on two leveis. First, it is -a motivational piece; teliingsuccess-storieS:;ahd"-" :'
showing the impact that adult education/job trail:1ing prog~ams can have:on w:oinen ~nd their famiiies~. ' .
informational piecel.offer;nginformation abol,lt women's educational programs;' ,
Second, it works as
nontraditional emp,loyment for wom~n:an(i,advice from the three women ~nd,their 'employers about
what it takes to be suc;cessful. By focusing'or, theintergenerational nature of literacy ,transfer, the
video also makes clear statement about the important role' that children carLplayas motivators 'to·
, adult learners 'i:md ttieultimate payoff they receive'whenttieir mothers, enroll iii_ and stick with these
p'rogram_s,.
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.(romthe Washington, C. area employed in nontraiJitional jobs' such 8S amechariic"elecitoriic
technician, 'truck driver and carpenter. ,.' ,.~'
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A claSSic', w.ork examining ,edJ!9ational,.eform_~nd human. resourc;~~!1eve~opmeritin I/ght.~lpa.st
successes:and failuresin'tlie,nation.'sediJcationaf.,outp!it. . :» .':, , " . ' -:',$10" '
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__ a community-based program a~ itutilize~-:'unctional context education. ' " ", '$20
f. • Getting the:JobDOne (1994)· : ,
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, 'One in five women in Ametic!i.is challenged by. barriersoi u'nfinished~du~ation, and low le.velsof
literacy, which lead to low self~~st~Efm'and~a sense of failure.· ,These barrif3 rs'limit the'abilityof these,
, >: wome,;:to obtain quality jobs: ilJose with liveable Wages; health benefits and securitY;lnreceni years,
'. "greater',emphasis has been plac~d oli ,the iiiterginerational nature Of these barriers. Research Shows"
,
that'investing in the education and training' ofwoinenha~ '8 ~doubleduty" impacti -As 'the mother's."
.skilis and employability improve,
too does the educational perlormance' of herchildren;Wcimen with
-low levels of eaucation tend 'to live in povertY and·thelrchildren often ~nter, school two or more years
behind in basicJiteracy skills. Educational andvocation~1 programs for women hold out the, hope' for
breaking,this cvcle. That's what thh{~video and resource guide are about:
,,: ,'Breaking the CYCle tells the stories of three wo:men' Who have moved from undereducatiori, low
, 'paying jobs or·welfare to quality,traditional or nontradit,ional empioymeritthrough women' $·educational
'. " and vocational 'programs. ,The' result~, aregrea.ter lev.elsof ',€;o(lfittence, motiva_tion and 'economic;~.'
isecurity for:themselves, and 'ttieirchildren. The st9ri~s"of ttiese,,~omen provide' clf!ar ~~amplej,ofthe "
intergenerati,onal'impacts whe),'moihers invest in their own 'futures through' education. In teiling their
stories, Mary 'Beard, Kaihy"Burns'8iidGina Chavez descriptions of the'ir own:.obstacleS,·iuccesses,
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of the best knovVnresearchersanrro;gariizations in the field."
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Executive, -Direc~or;. -. ' .',
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, :'. workplace literacY, e.ducati9nal andJob traini.;gprograms for women arid intergenerationaltransfers
'-of literacy and·education.Coors Brewing Company supports two "800" numbnrs: the one listed at the
, end of the video (1 ~80Q,642':6116) provides inforrriati9non Coo~s sponsored:Jiteracy pro'gramS, and'
~the Coors literacy Pays Hotline (1-'800-626-4601; provide$ iilformationon Ibc~lliieracy and workplace
)j;r()grams.for:potential students and volunteers. Thefollowingpublication~ and video are available by ,
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co;niac;ting VVPW'at-(202) ~38~3143, 81515tt1 Street;'~W, Suite-916,Washington~ D.C. 20005.
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• Why would a mother's investment in her own educatioi:'l and job'skills lead to changes in her
children's interests, attitudes and school;successes?
Mary. Kathy and Gina: Three Stories about Overcoming the Odds
• Mary Beard, a resident of Denver, CO, always wanted to work in the field of construction. A single
mother of four who left school at age 15, Mary enrolled in the Colorado: Women's Employment and
, Education Program to improve her educational and job skills. She now works as a labor foreman
for the Mortenson Construction Company in Golden, CO, earning 8 tOper hOLl( plus overtime and
benefits. -, feel wonderful!- Mary states in the video, and her daughter Kamishaagrees. ·We've
gone '8 lot further in life and we're happier than ·w,.,en she (Mary) didn't hav,e a job, and now it's
"all paying off. "
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• At the start of the video, the narrator talks, about turning challenges into opportunities. What
is the difference between a challenge and an opportunity? How can you turn your challenges
into opportunities?
'
• Kathy Burns' story is' one of perseverance and ambition. A single ,mother of four living in
Allentown, PA, she left school in the. 1Oth grade. 'Kathy decided togo back to, school despite major
" obstacles, including the incarceration of her boyfriend and her commitment to care for his terminally
ill mother; A t the Program for Women and Families in Allentown, she took courses and earned her
GED. Today she wOlks as a telesales representative for Day-Timers Inc, earning 816,000 per year
plus profit sharing and benefits. Her success has Inspired her boyfriend to complete his GED, and
her children talk about going to college.' Kathy's hope'for her children has kept her motivated'
throughout this process. ,'., want to see them have a definitely better life than I did.· ,
• Gina ChavI!z left school 1 1 years ago at the age of 1 7 to have her first chikl., Without welfare, she
balanced low,-paying, full-time jobs with her role as mother. But Gina always hap high goals for
herself. She enrolled in a program at the Adult Learning Source, in Denver, CO, which also offers
child care, .and she obtained her' GED. While, working full time as an assistant senior manager for
Healthy Habits restaurant, Gina is attending college. Her goal is to earn a master's degree in
business. Currently, Gina earns 825,000 per year p~us benefits, and she is on her way to a
promotion. She tells other women in her situation to ·take the fear by the horns and toss}t aside
,iUJd',take charge. of your 'life.
a
, Breaking the Cycle: A Guide to Practitioners for' Using this Video
.
,
Breaking the Cycle provides opportunities for discussions and activities reiating to issues of women's,
literacy employment opportunities and intergenerational transfers of attitudes and abilities that result
when women invest in themselves. AithoUgh this guide offers some ideas for activities to parallel the
video, this list is by no means exhaustive. ~ "
'
. '
", '
Talkina about the ,.ob M a r k e t ,
After watching the video, viewers can be asked to'l) list/describe the jobs shown and discuss
or write about what interests them most about these types of jobs;' 2) determine if these jobs are
available in their. communities, and what types of pay and/or benefits women could expect to
receive for these jobs; 3) list the types of skills and interests women would need for these types
,of jobs; and 4) determine which of the jobs are traditional/nontraditional and what the viewers
would like to learn about traditional and nontraditional emploYl1lent. The questions' could lead to
in~ividual assessments of interests, abilities and goals; they also could lead to a discussion about'
, terms like employee profit sharing, benefits and overtime.,
."
.'
.
,
The Intergenerational Transfer of Literacy
The children featured in this video talk about their attitudes and views about education and the '
changes they have undergon,e since their mothers returned to school. Viewers could discuss their
own goals for their children and the impact mothers have on the lives of their children based on
their own experiences. Discussions drawing connections between a mother's investment in her ,
own education and her goals for her children could help make these ideas more 'concrete. A'
discussion about the motivational role that children can play for mothers going back to school also
could come out of this.
''
,:
--4
.-,..:;
'Advice for'Women Seeking Education and Job Training Programs,
The three women and their employers featured in the video offer advice that women could
examine to determine what,employers are looking for and what it takes to be successful, in the
job market. They could identify which suggeslions would be most h~lpful to them, what would
be most difficult for each of them in following this advice and how they could overcome some of '
",
.
"
"
''
these obstacles.
'
I
, Using the Video
,
The video tan be used in literacy class~ in a workshop to·interest single mothers in, exploring
, '.
. careers, in job readiness program teaching job seeking skills or in a program designed to help
'women get their high sChooldlpldmas. It also ,can be used in a one-to-one volunteer tutoring,
experience to 'encourage 'a ·new reader· to talk about her ca~eer aspirations and motivate her to
continue working toward her goals.
. '
,
The video can be used as a stand-alone discussion starter or to introduce a'search for well-paid
jobs. It can be combined with a speaker or panel of local ·success stories,· or can be accompanied
by a presentation by a local employer. Tailor the class or workshop to best meet the needs of your
students.
. '
,
a
a
.t:-!.;
Other Activity Ideas Relating to the Video '
,
• Qvercoming Barriers: After discussing the barri~rs faced by women in the video~ ask viewers to
list what they see as their own barriers to meeting career and/or personal goals and develop plans
to overcome these barrier~.
, ,
.
.~
.~.'
• The IntEnviewing Process: Use the comments of the employers shown in,this video to help women
, : develop a sense of what employers look for in job applicants and then practice portraying these
,
attitudes in job interview role-plays and resume ~riting' activities.' .
• Inspiration' Lists:' Ask clients to create a list of the outcomes' of women;s education and job
training programs for,the women featured in the vide,o, and then suggest savi,ng these lists for
those days when clients, need a little hope.
'
.,~~
:.. ~ ,
Starting the Discussion
. A teacher/facilitator can introduce the video to 'the group, show it and then kick off a
discussion with questions leading to the goals of the ~eminar, Some examples follow:
,"
"Getting the Big Picture" Discussion Questions ,
• What are the women in this video getting from their educational experiences and jobs besides
pay and benefits?
:2
• In-Context Mathematics: Use the salary figures and benefits portrayed in the. video for viewers to
create budgets for their ,own families. 'Determine whether their families could afford to live on
these kinds 'of wages and if not, what kinds of assistance they might need. Viewers also could
use want ads and other publicly llvailable employment information ,resources to research how
much these types of jobs pay'in their own communities.
• Realistic Exoectations: Map out the process and training time involved in reaching the types of
c~reer goals portrayed in the video to help viewers develop realistic expectations about the level
3
'.,
�
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Carol Rasco
Issues Series
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https://clinton.presidentiallibraries.us/files/original/1da863b8115a0524cd006b9cad35f94f.pdf
bce9add168437a06384b4380a159a585
PDF Text
Text
E X E CUT I V E
o
F.F I ,C E
o
F
THE
PRE SID E N T
04-Sep-1996. 04: 42pm
TO:
(See Below)
FROM:
Carol H., Rasco
Domestic Policy Council
SUBJECT:
Health care for people with disabilities
I was as I told you earlier pleased to see that POTUS indicated
interest on the return health care reform memo in learning more
about the insurance for people with disabilities who work/want to
work. I would ask that ,the t.hree of you continue to really look
. at this issue seriously so that we can interject this issue in a
serious way in the upcoming budget discussions. Thanks.
Distribution:
TO:
TO:
TO:
Christopher C. Jennings
Diana M. Fortuna
Jennifer L. Klein
CC:
Elizabeth E. Drye
Jeremy D. Benami
Carol H. Rasco for files
CC:
CC:
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THE WHITE HOUSE
WASHINGTON, D,C. 20500
DATE:
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August 17; 1996
MEMORANDUM FOR THE PRESIDENT
THE PRESIOEN,T HAS SEEN
. tal.2 '2 q ~. ' .
FROM:
,TODD STER:rfL/0>
SUBJECT:
Rasco/Tyson Health Care Policy Memo
Laura and Carol have prepared a lengthy memo that reviews your health care achievements,
discusses pending proposals you have already put forth, and suggests three options for new
initiatives.
Fifteen achievements to date •. Five from Kennedy-Kassebaum:. (1) p'ortability reforms, so
workers won't be locked into jobs for f~ of losing insurance due to pre-existing conditions;
(2) elimination of discriminatory tax treatment of self-employed; (3) 'strengthening fraud and
abuse preventiQn; (4)
incentives for private Ion -term care olicies; (5) reduced
paperwork. Other accomphs ments: (6) extended solvency of Medicare Trust Fund by 3
years;· (7) protected Medicaid against GOP attack while jncreasing state flexibility; (8)
cont.!bbuted to" substantial reduction of health care inflation (1995 rate W(iS lowest in 23 years
~d first half of 1996 is running below 2 %); (9) 16% jncrgse in biomedical research at NIH
in>:1udjng breast cancer (up 76%) and AIDS (up 25 %); (lO)'major increases in funding for
~
Alq.S treatment and ~revention; (11) childhood imiillinization effort contributed to record
~:Io> 75!'/P immunization ICe fOr 2-year olds in 1995; (12) expedited FDA review of new drugs; .
(13) protected kids from tobacco products; (14) increased funding for VA health by nearly $2
billion; (15)"eut regulatory burden of HHS for providers and consumers.
~
. Nine pendin2 proposals. Extending Medicare Trust Fund to 2006 -- provided for in your
FY 1997 budget.·· Modernizing Medicare -- your budget would increase choice of plans; add
, preventive benefits (e.g., for mammography); take first step toward long-term care benefit by
establishing· "respite benefit" for families of beneficiaries with Alzheimer's; include
competitive. bidding initiatives. Increase State flexibility re Medicaid -- your budget would
eliminate waiver process for managed care and for home/community based alternatives to
~
institutionalization and make it easier for states to spend money to expand coverage.
'Workel3" Transition benefit -- proposal would build on Kennedy-Kassebaum by helping~ . \
. those who lose their jobs afford health insurance. Cost: $2 billion/year. Increase small "'1J
business access to voluntary health purchasing cooperatives (HPCs) -- opening up the
FEHBP to outside purchasers would be a bad idea as it would be a magnet for poor risk
employers, increasing FEHBP costs. Your budget proposal is much better. It would require
health plans that participate in the FEHBP in a given region to offer coverage (in a separate
. risk pool) to private or state HPCs. ~rovide mental health parity -- GOP blocked this in
Kennedy-Kassebaum negotiations, b issue may come to Senate floor again in Fall.
.
~.
.
�~ 48 hour rule for new mothers -- on Mothers' Day you en~rule requiring health care
plans to allow new mothers to remain in hospital for 48 hours. Vpen VA to Medicare
eligible vets -- allowing VA to get reimbursement from Medicare. Eradicate global polio -
by contributing to WHO's initiative to end polio by 2000.
.
Three options for new initiatives:
~ncreased oversight of managed care -- In view of rising concern that cost containment may
be coming at expense of quality, (i) support "gag" rule law preventing health plans from
restricting what doctors can tell their patients about alternative treatments. OMB and HHS
support; (ii) establish pUblic/private advisory board toevaluate managed care shortcomings
and .recommend appropriate role for federal government. VP, OMB, HHS, DOL support, as
do Sweeney and McEntee; (iii) host Presidential forum on problem of managed care's role in
declining research and training funds, challenging managed care industry and research
community to work· together on solutions.
..
"'Provide children greater access to affordable insurance -- Four options: (i) legislation for
targeted investments to help community health centers and school-based clinics provide
preventive and other services (wouldn't increase insurance coverage much);.(ii) small tax
subsidy for working families who pay for kids' .insurance if employers don't contribute to
dependent coverage (addresses affordability more than coverage); (iii) provide subsidy to
help low-income families purchase;insurance for their kids (would significantly increase·
coverage, but would be costly, inefficient, duplicative of Medicaid and would create
incentives for employers to drop kids who.have coverage); (iv) increase state flexibility to
Jdesign programs to expand Medicaid coverage to more children. NOTE -- Options (ii-iv)
~would require new spending of $15-20 billion over 7 years.
..
Increase independence of people with disabilities -- (i) to address problem of disabled people
who choose to remain on SSI or SSDI rolls rather than risk loss of health insurance, ~
i bl to urchase Medicaid or Medicare covera e on sliding scale linked to their income;
(ii) evaluate options to a ress problem that home- and community based care services are
"optional" Medicaid services, while nursing home coverage is "mandatory" -- a distinction
disabled community hates.
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THE
PRE~OENT
HAS SEEH
. &-(}4-? f,
TH E WHITE HOUSE
WASHINGTON
96A~ ,tap 3: "
August 16, 1996
. MEMORANDUM TO
~IDENT
,
.•.
FROM:
Carol Rasco and 'Laura Tyson .
SUBJECT:
Health' Care Policy Achie·vement and Initiatives Update
.. ~~
~y~- ~,
'1
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II
~"\
You may want to highlight health care reform achievements and unveil "next-step" initiatives
concurrent with, or soon after, the signing ofthe Kennedy-Kassebaum bill and the
Democratic Convention. This memo outlines: Health Reform Achievements, Pending
Proposals, and New Reform Options. These could be highlighted as part of any major
health message.,
~.
enacted~
Health Reform Achievements: . Because the Health Security Act was not
there
has been a perception that the Administration has had few health care achievements. As the
following summary attests, this perception is a mistaken one. The enactment of the Kennedy
Kassebaum bill and a more forceful effort to highlight our achievements will help tum this
perception around. In the first term, you have:
~. Passed portability, guarantee issue and guarantee renewal insurance reforms.
[n response to your State of the Union challenge, the Congress finally passed long
overdue insurance reforms that will benefit as many as 25 million Americans. As a
result, workers win no longer be locked into "second-choice" jobs because their (or
their families') pre-existing condition make them live in fear of losing health
insurance. Similar insurance reform provisions were included in the Health Security
Act and your balanced budget proposals.
Eliminated the discriminatory tax treatment of the self-employed. Youhave
. advocated eliminating or reducing the 100 perccnt vs. 30 pcrcent disparity between
large employers and the self-employed for years (the 1992 Campaign, the Health
Security Act, and your two balanced budget proposals). The Kennedy-Kassebaum bill
increases the deduction to 80 percent for the 3 million self-employed Amcric~ms now
purchasing hea~th care, (which is close to parity since most employers do not pay for
llfv\l].,\ ~\~l.lI....Ll"".
.
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Strengthened fraud and abuse prevention and enforcemen. initiatives.
The Kennedy-Kassebaum legislation included prov,sions long. sought by Secretary
. Shalala that strengthen· our ability to. target' and. prosecute "bad apple" health providers
who are bilking the system of billions of dollars from Medicare, Medicaid, and private
insurance. The bill expands penalties and provides for permanent funding to ,build on
our already' successful efforts to combat fraud. The Congressional Budget Office
conserVatively estimates that these provisions will save over $3 billion .
Provided tax incentives for private long-term care .poJicies and consumer
protections to go along with them. The Kennedy-Kassebaum bill inCluded the tax
clarifications for private long-term· care policies and many of the basic ,consumer
protections that were in the Health Security Act. These provisions should increase the
sales of private long-term care policies, which should reduce future financial burdens
,
on our public programs caused by an fast aging population.·
•
Provided the tools to simplify the health care systein and reduce p~perwork, while
still protecting the privacy of patient records•. The Kennedy-Kassebaum. bilI
included provisions you have long called for that would modernize; streamline and cut
the costs of insur,ance paperwork by'providing standards for a common electronic
syste~ for paying health claims that' most private insurers would use. The bill' also
provides the Secretary the authority to establish Federal privacy protections that would
.~rohibit inappropriate disclosure of information.
•
Strengthened Medicare Trust Fund by 3 years. Your 1993 economic package
included policy?and structural changes that extended the life of the Trust Fund by three
years and were enacted without one Republican vote.
.
~.
Preserved and .protected the Medicaid guarantee of health coverage, while
providing more flexibility to states to expand coverage. You· successfully defeated
the Republican Leadership's proposal to block gran~ the Medicaid program, thus
assuring that millions of vulnerable Americans would not :lose guaranteed health care
coverage or benefits; At the same time, you presided over the rapid approval of 12
thoughtful Medicaid waivers that, when completely implemented, will provide heal~
coverage to 2.2 million previously uninsured Americans.
.
~ ..
Contributed to getting health care inflation under control. Your efforts to assure
that all Americans have affordable, quality health care focused the nation's attention on
the problem of health costs. This attention expedited the private sector's interest in
implementing approaches to slow cost growth. This, along with the improvements in
the economy, helped slow medical inflationto 3.9 percent in 1995-- the lowest rate in
23' years. In the first 6, months of 1996, medical inflation is running at less than 2
percent and may actually grow below the general inflation rat~ for the year.
.
.
Increased investment in biomedical research at the National Institutes of Health
'(NiH). by an impressive 16 percent at a time when m.a~y other programs were
being cut. Funding for breast cancer res~arch at NIH h~ased by 76 percent and
s~pport for AIDS ,research funding bas increased by 25 perc.,.:nt.
- 2
�•
~
Funding for AIDS prevention and treatment has been increased to historic levels.
Support for AIDS prevention programs has incre~ed by 19 percent, and sURR0rt for
treatment programs, primarily through the Ryan White Care Act, has increased by an
&xtraordinary 95 R~~nt. In addition. earlier this year. the Congress f6sponded to your
'
request to increase the Federal commitment to the State AIDS drug assistance
, programs (ADAP) by $52 million. This funding will be used to help AIDS patients
buy expensive, new protease inhibitor drugs. Combined with, the increases in our
AIDS research investment. total funding for mY/AIDS programs in fiscal year 1996
-wt1S-.$2.86 billion: this repre~Dts a nearly4.2.J!.ercent inc~ase since you t~ce.
Established a comprehensive childhood immunization initiative to ensure
vaccinations and healthy futures for all children. The proposal includes: a major
community-based outreach effort to educate parents and providers about the need for
vaccination~ better detection of vaccination levels and outbreaks of infection~ and a
standardized immunization schedule to make it easier for parents to know when
vaccinations are due. This program contributed to the immunization rate of 75 percent
of 2-year old children in 1995 -~ an historic high. ~W~,~
r't'Z-:
k
',~, Expedited the FDA review and approval of new drug products.
U.S. drug
approvals are now as fast or faster than in any other industrialized nation. Average
drug approval times have dropped since the beginning of the Administration from
almost three years to just over one year. In 1997. virtually all breakthrough drugs will
'be approved within 6 months.
Protected' kids,crom tobacco products and advertising. Issued a proposed
regulat~on to eliminate easy access to tobacco products by children and to prohibit
companies from advertising to make tobacco appealing to kids. The goal is to reduce
smoking by children by, 50 percent within seven years after the plan goes into effect.
~ .. Increased funding for the VA health system by nearly two billion dollars. This
support will provide the resources necessary for the treatment of 94,000 more veterans.
•
Significantly reduced the regulatory ~urden of the Department of H'ealth and
Human Services for providers and consumers. The Vice President's reinventing
goveniment initiative has resulted in the elimination of 1,600 pages of regulations, a
23 percent reduction.
.
II. Currently Pending Health Care Proposals: Unnoticed by much of the public, you
unveiled an extraordinary number of substantive health reform proposals which in any other
Congress would have'been viewed as aggressive and quite ambitious. No other·President haS
put as many public (Medicare and Medicaid) health savings dollars on the table, and no other
President has proposed to so significantly alter and modernize the Medicare arid Medicaid
programs. However, relative to the Republican proposals, your proposals have been
mistakenly viewed by the media (and thus the general public) as modest. Despite the fact
that anyone who knows these programs knows better, the media has either ignored your
proposals or has chosen to classify them as protecting the status quo.
- 3
�We have nev~r strongly promoted the private insurance reform initiatives you advocated that
go beyond the Kennedy-Kassebaum bill because we feared they had the potential to
undermine our Hill negotiations on the hill. The good news about this is that these initiatives
will appear to be new to the public and the media, and --with the exception of the $1 billion
over seven years mental health parity initiative -- they are paid for in the context of your
previous omnibus balanced budget proposals. Your major currently pending proposals
include:
Extending the life of the Medicare Trust Fund until 2006. Your Medicare
savings ($124 billion/CBO estimates it to be $116 billion), combined with the home
health 'care expenditure transfer (previously passed by the House), e~tends the Trust
Fund for ten years from today while also 'making a significant deficit reduction
contribution. It is a responsible savings package that would hold the' Medicare per
person growth ~ate just under what CBO numbers assume is equivalent to, the private
sector growth rate. [NOTE: Because the Medicare baseline is increasing, we may be
able to squeeze more savings from the program in next year's budget.]
,
Modernizing. the Medicare program and beginning to prepare it for the
retirement of the baby boom population. Your Medicare plan would ipcrease
choice of plans for beneficiaries (by adding a new Medicare Preferred Provider
Orgariization option, a new Provider Sponsored Organization alternative, and a new
HMO with a point-of-service option). It also would add important and potentially
cost-effective preventive" benefits (by providing for full coverage of mammography
screenings, adding a colorectal screening benefit, and providing for diabetes case
management.) 71t takes the first step toward providing for a long-term care benefit by
~ablishing a respite beneftt far filfHiJies of Medicare beneficiaries afflicted with
"ooIQo,
A!zbeimer;spis;~e. Lastly. it includes a number of market-reform-oriented.
"competitive-bidding" initiatives that would make Medicare a more prudent and
effective purchaser of health care services.
•
Liberating the states in their desire to have more flexibility to manage Medicaid •
Your Medicaid proposal (which provides for $59 billion/CBO estimates $54 billion in
deficit reduction through a per person cap) would eliminate the burdensome waiver
process for managed care, eliminate the waiver process for home and community
based care alternatives to institutionalization, and eliminate the Boren requirement. It
would also make it easier for states to spend money in an attempt to expand coverage.
[NOTE: Because the Medicaid baseline is declining, the fiscally aggressive policy we
are now advocating would likely be scored lower on both the CBO and OMB baseline
next year; in other words, it will be difficult to get the same deficit contribution from
Medicaid next year.]
••
Building on Kennedy.;.Kassebaum by providing for a "Workers' Transition
Insurance" benefit. This proposal would help assure that previously insured people
who' are looking for a new job could afford to keep their health insurance and thus
retain their portability protections. It would cost about $2 billion a year, would
annually help approximately 3' million temporarily unemployed Americans, and would
illustrate our resolve to still expand coverage within a balanced budget context.
-4
�•
Empowering small businesses to gain market-leverage to access more affordable
insurance through the use of voluntary health purchasing cooperatives (HPCs) by
providing access to FEHBP plans, overriding restrictive state laws, and giving
financial assistance for the establishment and operation of HPCs. We have been
studying a series of options about how best to use the FEHBP and the limited political
and financial resources we have available to empower voluntary HPCs to purchase
more affordable, accessible health insurance for small businesses.
'
Based on extensive conversations with public and private sector insurance analysts, we
continue to believe that, in the absence of universal coverage, the potential for serious
risk selection is too great to recommend that FEHBP'scurrent insurance pool be
opened to other purchasers. Since the Kennedy-Kassebaum bill does not include
rating/price bands, there will continue to be significant premium price variation in the
insurance market. As a result, a health plan that charges average premiums for larger
populations --.like FEHBP-- would become ,a magnet for poor risk employers who are
currently charged higher than average premiums in the market place. This would
increase FEHBP plan costs as well as Federal employee hostility towards us. If we'
held Federal employees harmless, this could significantly increase the Federal costs of
running FEHBP. Whether the Government picked up these costs or not'-open'ing up
the FEHBP insurance pool would attract extremely loud Government union opposition.
The risk selection issue could be addressed by requiring OPM to administer a separate
insurance pool inFEHBP for the non-Government employees. While this could be
done, weare hesitate to recommend this option primarily because we are skeptical that
OPM could administer an effective FEHBP alternative without a significant and
politically risky1 infusion of money· and talent. Second, based on what people in the
field are telling us about what is actually happening in the marketplace, it seems mY§!l
more likely that private, locally-adminIstered HPCs (perhaps certified by the state) ~re
better ositioned to ne otiate more effectively than an OPM employee who has Jittle
. knowled e of plan rates within a particu argeograp IC area. And finally,: without a
arge number of small group enro ees In a pa ICU ar geographic 'area, it is highly
. unlikely that FEHBP would negotiate attractive arrangements· with insurers.
I
Having said this, using FEHBP arid other changes to the law to empower small
businesses can and should. be done. We would suggest that you ~
proposal that would give private or state-run HPCs the ability to reguire that hesUUt
~~..n plans participating in FEHBP (who also operate in the small market) must also offer
..coverage (In a separate flS po
In
s. n a 1 lon, SInce one 0
e greatest
hur es HPCs fate in becoming viable is their difficulty in attracting capital for their'
formation and operation, Federal grants would be made' available to either state or
private run HPCs who met certain standards (including that they are regulated by the
state.) This proposal also would incorporate the Kennedy-Kassebaum purchasing
cooperative provisions, which were dropped in conference, that: (1) Override state
llfictitous group" laws (which prevent non-associated employers from purchasing
insurance together), (2) Allow HPCs to negotiate price, reductions even in states where'
community rating laws would preclude them from doing so, and (3) Allow HPCs to
offer the same insurance packages for small businesses that bypass state benefit
mandates that the state has authorized other insurers to sell.
-5
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Providing mental health parity across health insurance products. The Republican
Leadership rejected all attempts by Senator Domenici to come up wiih a compromise
. on the mental health parity issue and dropped it from the Kennedy-Kassebaum
~. conference. They would not even support an Administration-endorsed Domenici
alternative that dropped all parity provisions other than those related to lifetime
and annual caps. .This approach reduced the proposal's costs by 90 percent and
would have assured that premium increases to pay for this benefit would not exceed
.4 percent. This issue may come before the floor of the Senate again this Fall.
Protecting mothers and their newborn babies from premature discharges from
hospitals. You endorsed this proposal in your Mothers' Day Radio Address. Similar
to legislation sponsored by Senator Bradley, it requires health care pl~s to allow
mothers to remain in the hospital for at least 48 hours. There have been cases where
plans have required a discharge within 8 hours of birth. Premature discharge can lead
to serious health consequences for both mothers and children. Like the mental health
parity provision, this popular initiative may come up for a vote in September.
•
Expanding health care options for older veterans~ This summer you proposed the
"Veterans Medicare Reimbursement Project of 1996," a proposal to open the VA
system to Medicare-eligible. veterans at a number of cities. This measure, sometimes
knoWn as .Medicare "subvention," would allow V A to receive reimbursement from
Medicare, improving access to care for older veterans while lowering VA costs.
•
Contributing to the World Healt... Organization's initiative to eradicate
global Polio by the Year 2000. This proposal -- advocated strongly by Rotary
International -- ?would increase spending on global polio eradication efforts by
$20 million. The Centers for Disease Control (CDC) has estimated that adequate
funding and intervention could achieve the goal of eradication within one or two years.
If successful, the United States alone could save more than $230 million per year after
polio eradication is achieved and vaccinations are no longer needed. It appears that
your request may well be included in the FY 197 Appropriations bill. .
III. Options for New Health Reform Initiatives: There are three additional health care
reform issues that we believe merit particular consideration for possible future Administration
involvement. The initiatives are: (1) Appropriate oversight over managed care and other
health plans; (2) Proposals aimed at providing children with greater access to affordable
insurance; and (3) Initiatives designed to provide more independence for people with
disabilities. With the exception of the managed carelhealth care delivery oversight issues,
these proposals are quite preliminary and have yet to be formally scored and fully reviewed
through normal interdepartmental process.
.
The public, consumer advocates, health care providers (academic health centers in particular)
are increasingly fearing that the cost containment successes of managed care are the result of
cuts in quality care, research and training, and questionable financial incentives between
insurers and providers. The trick for developing politically viable policy alternatives is to
strike the balance between the desire to enhance consumer protections with the need to avoid
micromanagement of the health care system. What follows is a package of proposals that we
believe achieves the appropriate balance.
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Because the House Democratic Leadership and a number of health policy advocates are very
interested in children's insurance coverage initiatives, we are also including a range of
potential policy options. And finally, we believe that there a ,couple of disability
empowerment initiatives that are worth seriously considering. As you know, people with
disabilities have a heavy reliance on public health programs. particularly Medicare and
Medicaid. As a result, since the only way to retain benefits.is to stay eligible for SSI and/or
SSDI cash benefits. they have overwhelming incentives to not seek gainful employment.
In addition, there is a growing frustration within the disability community that the institutional
bias of the Medicare and Medicaid programs are also undermining the potential for people
with disabilities to be more independent.
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Building on your managed carelhealth care insurance oversight record
(mental health parity :provisions, 48-hour rule and a recent MedicarelMedicaid
regulation to monitor excessive financial incentives for physicians to underutilize
'health care), consider becoming active on three visible fronts: (1) sign the
, "gag", rule; (2) further define the appropriate role of the Federal government in
regulating ma'naged care; and (3) develop approaches to protect the academic
health center community in this period of unprecedented cbanges in health care
delivery.
~)
Push for and sign the "gagttrule into law. ' Consider immediately calling on
the Congress to move to pass the "Patient Right to Know Act." In response to
concerns about health care plans prohibiting physicians from advising their
patients about alternative treatments, Congressman Ganske (R-IA) and
Congressman Markey (D-MA) introduced legislation prohibiting any health
plan fro'tn restricting medical communications, oral or in writing~ between
health care providers and their patients. This bill was unanimously reported'
out of the Commerce Committee in late July and may well pass the House
prior to adjournment. If you push,the Congress, you may ensure that they' pass
the bill before they leave. OMB and HHS support this provision. '
The only possible downside of endorsing 'the bill is that it will strain our
relationship with the managed care community, but even they are now
,beginning' to accept the fact that this bill and the 48 hour rule proposal will
likely pass with little to no opposition.
(2)
EstabHsh an advisory board to make recommendations about the
appropriate Federal role in monitoring managed care; assuring quality,
and protecting consumers. Consider establishing a bipartisan working group
of public and private appointees (with representatives of consumers. unions,
providers, insurers, businesses, and the government) to evaluate the
shortco'mings of consumer/quality protections/access.in managed care and other
health delivery systems, and to make recommendations about the appropriate
role of government in regulating these plans. You may recaU that you and the
Vice President discussed a similar initiative with John Sweeney'and Gerry
McEntee earlier this year. (They are particularly concerned about the impact of
managed care on the workforce and would strongly support this proposal.) The
Vice President, OMB, HHS' and Labor support this initiative.
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�There 'are a number of advantages of this route. First, it would be an initiative
that illustrates you want to act, but act thoughtfully in this area. Second, if
,controversial recommendations were made from the perspective of the insurer,
managed care, and business community, there would be policy and
political cover for proceeding. 'Third, the fact is we need better information to
make thoughtful recommendations that do not unintentionally hurt the positive
elements of managed care. And finally, if we are visibly associated with the
IIgag" rule bill and the 48-hour protection measure, we will have shown our
commitment in this area without having togo further at this time.
The disadvantage of this approach is that it may appear we are either ganging
up on the industry or, conversely. delaying necessary. action. Some proponents
'of intervention ·would probably suggest that the delay 'in the report was nothing
more than a stalling mechanism designed to stop necessary intervention.
(3)
Host a Presidential forum. on the impact of managed care on the declining
private sector financial contributions for research and training at academic
health care centers and on possible approaches to reverse this trend. The
managed care communitY is being (fairly) charged with not adequately
supporting its share of the new health care research that is riecessary to sustain
the nation's overwhelming lead in health care technology/research.' We
propose that you consider hosting a "challenge" event to get the managed care
and the research community together to engage in constructive conversations
about an issue that neither is effectively addressing. The event would be
designed to discuss how centers of excellence can produce the type of research
HMOs Knd other managed care plans are interested in seeing and, conversely.
how these health plans can better financially support the work academic health
centers are undertaking.
There are no disadvantages to this proposal as long as it is not the only
managed care oversight initiative you pursue. (If that were the case, it might
'seem too insignificant a s~ep relative to the perception of problems with
managed care.)
•
Consider options that assist children in terms-of access, affordability and/or
coverage. We are looking at four options: (I) investments in community health
centers and school-based health centers; (2) health care financial assistance through
the tax code; (3) premium subsidies; and (4) empowerment of states to.design kid
coverage programs. Cost and coverage, estimates are unavailable, but are expected in
short order. Howe~er, while all four options would increase access to care and -- to
some extent -- affordability, it is clear that only the last two options would
significantly increase coverage. Most importantly, with the exception of the modest
public health investment outlined in option one, they all will require significant
' investments -- probably in excess of $15-$20 billion over 7 years. Unless we drop
some other priority, it is difficult to see "credibly" financing any significant proposal
in the context of a balanced budget.
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�(1)
Introduce legislation to invest in public health initiatives to expand access
to children. This proposal could be pursued on its o~ or in addition to any
,of the other three options. Targeted, investments would be made to community
health centers and school-based clinics to provide preventive and other,services
to children. Health centers participating would aggressively undertake outreach
activities aimed at signing up eligible children for Medicaid.
'
The advantages of this proposal are: it builds on an existing system that serves
many of the most difficult to reach children; it is, cost effective to provide
health services in these settings; and it could be achieved with a relatively
modest investment. The disadvantages are: it does not significantly increase'
health insurance coverage; school-based clinics have been controversial. because
they often provide family planning services, (but any proposal could be
targeted at clinics in elementary schools); and States may oppose circumvent
ing their own outreach efforts and undermining the control of their program.
(2)
Provide tax relief for families purchasing health insurance for their kids. ,
This proposal, fathered by the House Democratic Leadership, would require all
health plans doing business with the Federal government to offer health
insurance policies for uninsured children. Working families with incomes
below a certain level would be given premium assistance through a tax
dedUction or credit if their employer does not contribute toward dependent
coverage. To keep costs low and to prevent substitution of tax subsidized
coveragf) for employer-sponsored coverage, the subsidy would be set ata low
percentage of the premium. As a result, the primary benefactors of this option
would be those who already have insurance. Therefore, this proposal can be
best described as addressing affordability more than coverage problems.
Th.e ~dvantages of this proposal are: it
eXlstmg structure of the tax system and
( most. The primary disadvantage of the
that few uninsured children would gain
is .easyto admini~t.er be~ause it uses the
middle-class famlhes Will benefit the
proposal is that initial estimates show
coverage. ,
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Provide Federal premium subsidy assistance. This proposal would subsidize
families below certain income levels (on a sliding scale) to purchase health
insurance for their children. Eligible populations include 'uninsured and state
optional Medicaid children. Because they would receive a full subsidy, the
primary benefactors of. this program would be lower-income children.
The advantage of this proposal is that it would significantly expand coverage
for children. ,Old estimates projected that 6 million children would receive
benefits, although only 2 million' children would have been previously
uninsured. The disadvantages of this proposal are that it would be costly,
inefficient, difficult to administer, duplicative of Medicaid, and would create
incentives for employers to drop children who currently have coverage.
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(4)
Empower states to design an innovative program that supplements
Medicaid to expand coverage for children. This proposal would give states a
Medicaid per capita amount to expand coverage to children. This could be
done by: (a) giving states more flexibility to use different delivery systems,
including. managed care, without seeking waivers but leaving current benefit
rules in place; or (b) allowing even more flexibility by permitting states to
require contributions from higher income Medicaid eligibles: Using savings
, from these premium and cost-sharing requirements, states could expand
coverage to additional populations of children. Populations eligible to receive
benefits would be uninsured children In low-income working families.
The advantages of this proposals are~ it b~ilds on existing state'structures;
it limits Federal cost to the Medicaid matching amount versus a fun premium
subsidy; and it gives Govemors much desired flexibility' to increase coverage
for children in working families.
The disadvantages of this proposal are: Although limited to lower-income
populations, it will still likely induce some employer dropping of coverage; its
cost-sharing requirements would impose burdens on some b~neficiaries t~at
have none now.
•
Consider options that increase the independence of people with disabilities,
including breaking the health coverage link to public cash assistance programs and
creating more incentives to use home- and community-based services in lieu of
insti tuti onal care.
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(2)
Unveil a proposal to allow people with disabilities the opportunity to
retain, or in return for a sliding scale premium, purchase Medicare or
Medicaid. Because private insurance is often not available or affordable to
people with disabilities, many people choose to remain on the rolls rather than
take. the risk of working and losing coverage. This proposal, which we are
designing with the Sodal Security Administration, would allow disabled social
security clients the opportunity to purchase Medicaid or Medicare on a sliding
scale as their income from employment rises. The primary potential downside
is that this option might create unintended consequences of attracting many
more people W.ith di~abilities to the subsidi~ed ~~dicarelMedicaid prog~ams
than are currently bemgserved. We are stIll waltmg for final OMB estimates
( and will obviously r~think this option if it is cost prohibitive.
"
Consider additional ways to reorient the Medicaid 'program towards home
and community-based care and away from its institutional
bias. The disability community hat~s the fact that nursing home coverage'
within Medicaid is defined as a mandatory service, while home- and
community-based care services are optional. We are currently evaluating
options (that go even beyond your current proposal to eliminate the waiver
process for States who wish to implement a home- and community-based
service option). We will keep you informed of developments.
- 10
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�AMERICANS WITH DISABILITIES
(
Opening Line: People with disabilities have the same aspirations as all Americans:
opportunities for e~ployment, access to education, quality health care, equal rights.
That is why I have fought so hard to protect the Americans with Disabilities Act, the
Individuals with' Disabilities Education Act, and other critical laws that prohibit discrimination
against people with disabilities in schools, workplaces, and public areas across the nation.
I commend Senator Dole for his hard work in helping to enact the Americans with Disabilities
Act., But we do have differences. Senator Dole and Speaker Gingrich passed -~ and I vetoed -
a budget that would have ended the Medicaid guarantee of meaningful benefits to people, with
disabilities and included Medicare cuts that' would have affected 4.9 million disabled
Americans [under age 65].
Key Answer Points
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.•
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In rejecting proposals that would have ended the Medicaid guarantee of meaningful
, health benefits for individuals with disabilities, I have preserved Medicaid coverage for
6 million persons with disabilities, including 1 million children.
•
I have proposed a balanced budget that preserves health care benefits for 37 million
Medic,are beneficiaries, including 4.9 million Americans under the age of 65 with
disabilities. My bud~etwould impose no new increases in Medicare premiums.
•
I am working to protect the civil rights of disabled Americans by including a 3.9 '
percent increase in funding for ADA enforcement andcompliance in my 1997 budget
and I am fighting for strong, national policies that promote inclusion, independence and
empowerment of.ciisabled Americans.
•
In 1994, 800,000 more severely disabled .individuals were working than at the end of
1991 . .I am committed to 'expanding employment options for people with disabilities
and challenging all Americans to understand that having a disability is natural part of
the human experience.
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I am fighting to increase the focus of the Individuals with Disabilities Education Act on
outcomes for children and by cutting unnecessary paperwork. My Administrat~on has
opposed attempts to weaken the guarantee of the right to education for children with
disabilities.
•
At the start of my Administration, I appqinted a h~ghly qualified group of people with
disabilities to high-level, policy-making positions, including many peopie from the
disability community like Judith Heumann, Assistant Secretary of Education for the
Special Education & ,Rehabilitative Services.
1
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I signed the Health Insurance Refonn Act (Kassebaum-Kennedy Bill), which expands
and protects access to health insurance by.limited exclusions for pre-existing conditions
and by allowing indivi~uals to take their health insurance with them· when they'change
ot lose jobs.
Dole Contrast
.•
The 1995 Dole/Gingrich budget's Medicaid block grant proposal. would have reduced
federal Medicaid spending by $163 billion between 1996 and 2002 with a 28% cut in
the year 2002 a](me. This could have forced the r~m{)val of 1 ~2 million disabied people
from Medicaid. The Dole/Gingrich budget's $270 billion in Medicare cuts would have
increased health-care costs for 4 Inillion disabled people whq receive Medicare.
•
Dole also voted to cut Medicare by $270 billion over seven years. I vetoed the GOP "
budget because it would have cut Medicare benefits for 4.9 million disabled Americans
'
under the age of 65. ,
Likely Attacks and Responses
Attack 1: What a're you doing about to enhance employment opportunities for people with
disabilities and to reduce their high unemployment rate?
'
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Response: Education and employment are interconnected. High school graduates who went to
school under IDEA have ail expployment rate twice that of the overall population of individuals .
with disabilities. We ~re seeing progress. For the past three years, I have fought for increased
education funding for people with disabilities. My 1997 budgetreqliest includes another
increase which would bring the total funding for IDEA programs to $3.3 billion --.an increase
of ~ver $1 billion since I took office.
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Carol Rasco - Issues Series
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Domestic Policy Council
Carol Rasco
Issues Series
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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2010-0198-S Segment 2
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Clinton Presidential Records: White House Staff and Office Files
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92 folders in 7 boxes
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Disability Initiatives
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Domestic Policy Council
Carol Rasco
Issues Series
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Box 123
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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2010-0198-Sb-disability-initiatives
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https://clinton.presidentiallibraries.us/files/original/88af7041b1b3b93014617963b5bb887b.pdf
e3551d66aceb297470c2f9601b3fce80
PDF Text
Text
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memoranifumprovides tw~ proposals for the m~ national press ~vent. Congressiorial briefmgs Wfn
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of situations (e.g: the press' evc::nt(s») Congressio~al briefings, ,bne:fl..Dgs for nongovemm~ta1' "
'o'rganizations; internal agency brieHngs, etc.). The whole package l1lay be u~ed for so~eevenfs, such . .
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comprehensive removal and tranSportation program~ We c8n!djscu,ssthi~ further on
Wednesday when"we show you the fucqheets in total. \: .
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White House, Inter<tgsIDcy Event led
the. Fr~sident or Vice President. Lead
, ,officlaJ(s) from 'the white House, e.g.; Leon'Panetta,'.Chief of Staff. :Alice Rivlin
by
.OptiOll . 1;
•• 1
/
I
.1
i
I
.
Option 2: '
.'
~~
Department of Justice Event led by Attorney General Reno and INS
Doris Meissner, There are two variants, on this option: .
Y
,
ComrrJssion~(
,
'
,
.'
-~) Washbgton. D.C, 'Event~ This would besj~i1ar to the immigra;tion 'budget "rollout ....
last FebrUary:'. AS,with Option ',other agency heads shOl~ldbe present to give shan
remarks and answet questions. The advantage ofthis option is that it focuses
the \ .
·agency, DOJ, that is receivihg the)argesf Portion of the imgration, budget :and
chleflyresponsibIe for the enforcement. aspects, : The di!:acI~anta8e is that it-does not '..
provide- th~.emphaSis !,Uld'impression, M well~'Optiortl would, tha(trus is Ii
on
I.
.1
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I
!
"
. comprehensive, interagency White
I '
-:,
1
.
is
House directed and supponed plan fur controlling'
illegal imnligration and prOViding assistance to the states.' \
'I
I
.
.. are
1
:\
I
. (OMB), Carol Rasco (DPC),' and other agency heads involved in immigration'
initiatives sho~!d also be involved, One or more of the following would make brief
·re-marks qn tHe de1.ails oftheinititttives and ansvve; questions:, Attorney General JMet .. ,~
,Reno; INS GommissionerDorls Meissner, the. Secretaries of HHS,Labof. Education, .
,Treasury, and State, .and the ~dministra~or ofthe Social SeCurity Admini!1tration, The
advantage ofthis.option is that it presents the.initiatives al1d the budget as they r~ally
'!':.. a .. comprl!hen~ive) •. Administration-led, hlteragency agenda Jor iri'llniSr~tion' .
·reform.
"
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Page 3 '
,
Memo..a.nd~pl to Chris EdIe)'
"
,
"
"
'. i
Event: Instead of amtOl.!IlCIng the ,p~kage At the ,n'epartment ofJu&tice,
-"the Attorney Gerler'hl and ,COrnrnlSSioner Meissner could travel to 'Los'Ange1~:s (with
, offif-ials from other agencies) 3.lld 'anriounce the package, In lieu ofa White aouse
b} ylitomia
'announqement by th~ President, ,Ron Klain favors this option on t~e,grounds 'that it ' '
',wouid bi::more ofan "event~ ,...and garner mote press attention ..:- ,tltaii yet"another- ,
, announcement atDOJ,panicuJarly in light'of'thcNew York Times"article last'
I,
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, ' ,
'
Sunday- ' '
,,-'
,
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•
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•
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.
,
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Alte~tively~ t1~e an,nou~mentcou1d be mad~ at the Whit~ Ho~se. and the Aitomey ,
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, Gericfid and the INS Conunission~r.cou1d',do'a'fol1ow,:"up eV~(s) the next day, ,,'
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, " Recommendation,' We recommend' Option l,~ an'initial national event at the White Ho~se, led " '
, by either the President or the Vice President~ with'lead agency officials and appropriate member,'s of "
Congreas pteseht:, This woUId,pe followedinUriediately 'by Attorney Gem~fal/Commissioner Meissner' "
'~eVents,in Califurni~ andoth<?I' key states:
F
orany'of these, 9ptiot).s" we 'WoiuQ need,todecide ~heiher 'to:'hlClude kertongressional
,
, IJeaders.antl, if
,
i
I,
I
i
so, wha.t role they ~gbt,play:
"
.', ' '"
,,', ,
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Cc;:
,Carol Rasco
" . Pat Griffin '
''jolID Angell
,
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Tom Epstein:
St~ve Warnath
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�Immigration Core Group Meeting Agenda
January 25, 1995
1.
FY96 Immigration Budget Rollout
Border Crossing Fee Legislative Proposal
3~
Plans for Substantive Immigration Bill
�CONTENTS
1.
Press
2.
Executive
3.
Fact Sheets With Charts
a.
.
~e
d.
4.
Release
Border Enforcement and Management
Worksite Enforcement and Verification
Detention and Removal of Deportable Aliens
Assistance to States and Customer Service
I
Executive
a.
b.
Summary
Overview
Presentation
Series of Color Presentation Charts
Associated Black and White Working Copy
�DRAFT (WH)
January 25, 1995
10:07 AM
Administration Announces $1 Billion Initiative in FY 96 Budget
To Combat Illegal Immigration and Expand Key Programs
The Administration today announced a $1 billion budget increase for 1996 to
further strengthen its commitment to combat illegal immigration through border
enforcement back up by credible interior enforcement and removal of deportable aliens.
Building on initiatives begun in 1993, the President's 1996 budget request
accelerates the momentum already underway by providing additional Border Patrol
strength, expanded worksite enforcement, and improved verification of employment'
status, removal of criminal aliens and assistance to states most affected by illegal
immigration.
In proposing the increased budget for immigration enforcement; President
Clinton called it "essential to carryon the initiatives first begun in 1993 to meet the
immigration challenges now facing the country. We owe the people of this nation a full
commitment to control illegal immigration while maintaining our valued heritage of
immigra tion. 1I
Nearly half of the $1 billion increase, $528.4 million, is earmarked to bolster an
Immigration and Naturalization Service (INS) that was substantially understaffed and
underfunded when the Administration took office two years ago. The 1996 budget
proposal increases INS total annual funding by 22 percent to $2.6 billion to effectively
carry out border control and other immigration enforcement programs.
The comprehensive approach outlined in the President's budget provides
funding across five Executive Branch departments to implement an integrated, broad
based strategy to address needs in four key immigration areas ignored by previous
Administrations:
.
• Border Enforcement and Management - The budget includes $369 million to
support border enforcement and management efforts. This includes resources to
increase Border Patrol agents to more than 5,600 in 1996, an increase of more than 40
percent over a three-year period, towards a goal of 7,000 agents by the end of the
century. The budget also provides improved border infrastructure to facilitate
commercial vehicular and pedestrian traffic. Included in the budget is a border
services user fee to add 680 new INS inspectors and XXX new U.S. Customs
inspectors, and to support improvements at ports of entry.
(more)
�1996 Budget Initiative
Page 2
• Work site Enforcement and Verification - The budget includes $93 million to
address worksite enforcement. Of this amount, $51.2 million supports a 74 percent
increase in the number of INS employer sanctions investigators to 870. The
.
additional staff will increase the number of sanctions "cases that can be handled to
14,650, up 130 percent from the 1993 level. The budget also includes $11 million to
increase the number of Department of Labor wage and hour standards investigators.
The budget includes $28.3 million to initiate pilot projects to improve verification of
employment authorization for job applicants as previously recommended by the
Commission on Immigration Reform (CIR), headed by Barbara Jordan. Test areas
will include the Commission's registry proposal, expansion of the INS Telephone
Verification System, and improvements in INS and Social Security Administration
records and databases.
• Detention and Removal of Deportable Aliens - The budget includes $171 million
for a comprehensive National Detention and Removal Program to expand the
capability to detain and remove criminal and deportable noncriminal aliens.
Funding will double the number of deportations from 49,000 in 1995 to more than
110,000 in 1996 by increasing detention capacity and establishing absconder removal
teams.
The budget supports the Administration's strategy to deal with the 40-50 percent of
illegal aliens who overstay their visas. This will be accomplished through a
combination of workforce enforcement and visa issuance and verification
procedures.
"
Included in this initiative is $42.3 million to expand into New Jersey and Arizona the
Administration's successful Institutional Hearing Program in five states (CA, NY,
TX, FL, IL) that expedites removal of criminal aliens upon completion of their prison
sentences.
• Assistance to States - The budget includes $300 million to reimburse states for the
costs 6f incarcerating illegal aliens, first established in the Immigration Reform and
Control Act of 1986. This funding continues the Administration's commitment to
·extend the $130 million appropriated in 1995 to more fully reimburse states for
incarceration costs.
The budget also increases two assistance programs for states with disproportionate
shares of illegal immigration. The budget includes $150 million for the Department
of Health and Human Services for discretionary grants to cover emergency medical
services, including labor and delivery, for undocumented aliens eligible under
MEDICAID. Help for states also includes an additional $50 million-double FY95
funding-available for grants to school districts with high numbers immigrant
students.
-WH
�DRAFT (AG)
January 25, 1995
9:50 AM
Administration Announces $1 Billion Initiative in FY 96 Budget
To Combat Illegal Immigration and Expand Key Programs
The Administration today announced a $1 billion budget increase for 1996 to
further strengthen its commitment to combat illegal immigration through border
enforcement backed up by credible interior enforcement and removal of deportable
aliens.
Building on initiatives begun in 1993, the President's 1996 budget request
accelerates the momentum already underway by providing additional Border Patrol
strength, expanded worksite enforcement, and improved verification of employment
status, removal.of criminal aliens and assistance to states most affected by illegal
immigration.
In announcing the President's increased budgE:!t for immigration enforcement,
Attorney General Janet Reno called it "essential to carryon the initiatives first begun in
1993 to meet the immigration challenges now facing the country. We owe the people of
this nation a full commitment to control illegal immigration while maintaining our
valued heritage of immigration."
Nearly half of the $1 billion increase, $528.4 million, is earmarked to bolster an
Immigration and Naturalization Service (INS) that was substantially understaffed and
underfunded when the Administration took office two years ago. The 1996 budget
proposal increases INS total annual funding by 22 percent to $2.6 billion to effectively
carry out border control and other immigration enforcement programs.
The comprehensive approach outlined in the President's budget provides
funding across five Executive Branch departments to impl~ment an integrated, broad
based strategy to address needs in four key immigration areas ignored by previous
Administrations:
• Border Enforcement and Management - The budget includes $369 million to
support border enforcement and management efforts. This includes resources to
increase Border Patrol agents to more than 5,600 in 1996, an increase of more than 40
percent over a three-year period, towards a goal of 7,000 agents by the end of the
century. The budget also provides improved border infrastructure to facilitate
commercial vehicular and pedestrian traffic. Included in the budget is a border
services user fee to add 680 new INS inspectors and XXX new US. Customs
inspectors, and to support improvements at ports of entry ..
(more)
�,
~
.,.J I
1996 Budget Initiative
Page 2
• Worksite Enforcement and Verification - The budget includes $93 million to
address worksite enforcement. Of this amount, $51.2 million supports a 74 percent
increase in the number of INS employer sanctions investigators to 870. The
additional staff will increase the number of sanctions cases that can be handled to
14,650, up 130 percent from the 1993 level. The budget also includes $11 million to
increase the number of Department of Labor wage and hour standards investigators.
The budget includes $28.3 million to initiate pilot projects to improve verification of
employment authorization for job applicants as previously recommended by the
Commission on Immigration Reform (CIR), headed by Barbara Jordan. Test areas
will include the Commission's registry proposal, expansion of the INS Telephone
Verification System, and improvements in INS and Social Security Administration
records and databases.
• Detention and Removal of Deportable Aliens - The budget includes $171 million
for a comprehensive National Detention and Removal Program to expand the
capability to detain and remove criminal and deportable noncriminal aliens.
Funding will double th~ number of deportations from 49,000 in 1995 to more than
110,000 in 1996 by increasing detention capacity and establishing absconder removal
teams.
The budget supports the Administration's strategy to deal with the 40-50 percent of
illegal aliens who overstay their visas. This will be accomplished through a
combination of workforce enforcement and visa issuance and verification
procedures.
Included in this initiative is $42.3 million to expand into New Jersey and Arizona the
Administration's successful Institutional Hearing Program in five states (CA, NY,
TX, FL, IL) that expedites removal of criminal aliens upon completion of their prison
sentences.
• Assistance to States - The budget includes $300 million to reimburse states for the
costs of incarcerating illegal aliens, first established in the Immigration Reform and
Control Act of 1986. This funding continues the Administration's commitment to
extend the $130 million appropriated in 1995 to more fully reimburse states for
incarceration costs.
The budget also increases two assistance programs for states with disproportionate
shares of illegal immigration. The budget includes $150 million for the Department
of Health and Human Services for discretionary grants to cover emergency medical
services, including labor and delivery, for undocumented aliens eligible under
MEDICAID. Help for states also includes an additional $50 million-d.ouble FY95
funding-available for grants to school districts with high numbers immigrant
students.
-DOJ
�t
'f
EXECUTIVE SUMMARY
I
"This budget responds to the clear message sent by the American people demanding that the
ihtegrity ofour Nation's immigration laws be restored This will only be accomplished through a
shared sense ofcommunity where the Federal government works in partnership with the states to
r~new this Nation's proud heritage ofimmigration". President Clinto,n
February xx, 1995
I
,
~er
two years of unprecedented efforts, the President's FY1996 budget proposes to
I
further strengthen its commitment to border enforcement and backs it up with expanded
~orksite enforcement, improved verification of employment status, removal of criminal
Jlien, and assistance to states. The President's budget requests an additional $1 billion to
~ccelerate its commitment to combat illegal immigration thereby restoring a credible
immigration system for the nation.
I
In four key areas, the Clinton Administration is addressing imperatives ignored by
previous administrations.
Border Enforcement and Management
,
'When this Administration came to office two years ago, the fNS was understaffed and
underfunded. With this budget, President Clinton has increased the INS budget by a full
71%, expanding its total resources to $2.6 billion. Along the Southwest border, the'
Administration increased the Border Patrol by 50%, projecting over 5,000 agents on-the
border by the end of FY96.
The budget also provides for improved border infrastructure to facilitate commercial
vehicular and pedestrian traffic. The President proposes a border services user fee to
, support investments at the Ports-of-Entry for the Customs Service and INS Inspections.
o
Worksite Enforcement and Verification
This Administration is reversing years of inattention that reduced enforcement of labor
• standards and employer sanctions. The President's budget proposes $51.2 million to
increase the number of INS investigators devoted to employer sanctions by 86%,
expanding the pool from 468 in FY93 to 870 by the end of FY96. These additional
resources will increase the number of sanctions cases by a full 130% by FY96. (14,650).
The proposed budget also halts the decline in enforcement of labor. standards. It proposes
$11 million to increase the number of wage and ho~ standards investigators by 12%.
'
DRAFT
�I
I '
c
The President's Initiatives also finnly endorse the Jordan Commission's proposal for pilot
I
.
projects to test ways to improve verification of employment authorization status for job
applicants. The FY 1996 budget requests $28.3 million to support several projects,
including testing the Commission's registry proposal, expansion of the INS telephone
v,brification system, and improvements in INS and Social Security Administration records
and databases.
I
tJ
~
Detention and Removal ofDeportable Aliens
.
FY1993, only 20,000 criminal aliens residing in the United States were removed. The
President's budget proposes $171 million to expand the capacity to detain and remove
both criminal aliens and other deportable non-criminal aliens. Through a comprehensive
~ational Detention and Removal program, INS will double deportable aliens by
increasing detention capacity and personnel, establishing absconder removal teamS, and
~eeking legislation to streamline deportation and exclusion processes. Of this total, the
1
budget proposal adds $42.3 million to the Administration's suqcessful Institutional
I '
.
~earing Program to extend coverage of criminal aliens incarcerate~ in state correctional
institutions in Arizona and New Jersey.
i
10
.
Assistance to States
For the first time ever, the Clinton Administration proposed to fulfill the commitment
established in 1986 by the Immigration Refonn and Control Act to reimburse states for
the costs of incarcerating illegal aliens. In 1995, the Violent Crime Control and Law
Enforcement Act authorized $130 million of the Admi.illstTation's illihal $300 million
request. In FY1996, the President continues that commitment by requesting $300 million
for the State Criminal Alien Assistance Program (SCAAP), a $170 million increase over
Fy 1995.
The President's budget also enhances two programs for States with disproportionate
shares of illegal immigrants. A discretionary grant program of $150 million will cover
emergency medical services, including labor and delivery to undocumented aliens who
otherwise meet MEDICAID eligibility criteria.
Help for states also includes a proposed $100 million, a doubling of the amount available
in FY95 for grants to school districts enrolling high numbers of immigrants.
DRAF·T
�1996 IMMIGRATION INITIATIVE
FUNDING SUMMARY
DRAFT
07:26 PM
23-Jan-95
I
I
Border Enforcement and Management
Border Control between Ports-of-EntryfTechnology
I
INITIATIVES
.
E~forcementlFacilitation at Ports-of-Entry
Overseas Deterrence
Technology at Ports-of-Entry
Field Intelligence/Anti-Sm ugg ling/I nterior Repatriation
Subtotal:
INS Border Control Subtotal:
Treasury/U.S. Customs Service Subtotal:
Total:
DOLLARS
(millions)
$81.0
119.9
8.9
40.2
19.3
269.3
269.3
100.0
369.3
Wor'ksite Enforcement·and Verification
Curtail job opportunities for illegal immigrants
Verificatiqn Information System/Pilot Programs
I
I
Subtotal:
INS Interior Enforcement Subtotal:
Other: DOJ - EOIR Subtotal:
DOJ - U.S. Attorneys Subtotal:
Department of Labor Subtotal:
Total:
Detention and Removal of Deportable Aliens
I
National Detention and Removal Program
I
Subtotal:
INS Removal of Criminal Aliens 'Subtotal:
,
DOJ - EOIR Subtotal:
DOJ - U.S. Attorney Subtotal:
DOJ - Civil (OIL) Subtotal:
Total:
51.2
28.3
79.5
79.5
1.7
0.8
11.0
93.0
166.2
166.2
166.2
3.1
1.3
0.2
170.8
Assistance to States and Customer Service
Law Enforcement Support Center Pilot
Create Center for Immigration Statistics
INS Assistance to States and Customer Service Subtotal:
Direct Assistance to States
DOJ - Incarceration of Criminal Aliens
HHS - Medicaid. emergency medical Services
DOE - Immigration Education Program
Direct Assistance to States Subtotal:
3.4
10.0
13.4
170.0
150.0
50.0
37
38
SUMMARY OF FUNDING
I
INS Subtotal:
Department of Justice Subtotal:
Customs Service Subtotal:
Department of Labor Subtotal:
Direct Assistance to States Subtotal:
GRAND TOTAL:
528.4
7.1
100.0
11.0
370.0
1,016.5
�Reforming the Nation's Immigration System
1996 Targeted Investment--$1 Billion
DR
~T
i!k..<l1
ID
i.l
�!
"
Imn igration and Naturalization Service
BI dget History - 1980 Through 1996
(Dollars in Thousands)
.usn sa /1 2.5
Salaries & Expenses
(Appropriated)
2.0
Violent Crime Reduction
Trust Fund
I 'ee Accounts
1.5
- - - - - - - - - ....-
'PS"
1.0
05
0.0
1980
*Inclutles $50,000,000 No- Year Construc .. oll Fund.
F; ~r'
.
D~'$f' .":j, ~1,.n ;
~
~i;-"-"~'\~
�BORDER ENFORCEMENT AND MANAGEMENT
The Administration's effective and highly acclaimed border control strategy, "prevention through
deterrence," will receive a $369 million resource enhancement in the President's FY96 budget. With
these funds, INS will build on the successes of "Operation Hold the Line" and "Operation Gatekeeper"
by increasing . the number of new Border Patrol agents on the border, augmenting the number of
inspectors assigned to ports of entry, providing strategic intelligence and investigative information at the
border, and enhancing technological and equipment capabilities that result in greater deterrence of illegal
migration and facilitation of legal migration. This deployment of resources ensures maximum
effectiveness through the appropriate combination of human, technological and physical resources. A
portion of this enhancement will be fmanced through a new Border Services User Fee program at land
border Ports-of-Entry -- a fee of $3.00 per vehicle and $1.50 for pedestrians crossing the land border
ports.
Control at the Border - Border Patrol Agents
•
700 new border patrol agents and 140 Border Patrol support personnel will increase the size and
effectiveness of the Border Patrol and advance the strategy of "prevention through deterrence"
along the Southwest border.
With unprecedented resources provided in FY 1994, 1995 and those requested for 1996, 1,750
new Border Agents will have been added -- a 44 percent increase over 1993. In addition, new
technology and support personnel have provided for the redeployment of 510 agents to front line
enforcement activities. Thus, border enforcement strength on-the-line will have increased by
57% since 1993 or the equivalent of 2,260 agents,
The 700 FY 1996 Border Agents will be assigned to .ar:e,as with the ,Nghest levels of illegal
movement. Allocations will be based on assessments of illegal migration patterns at the end of
1995 using a variety of measures, such as recidivism and apprehension rates, that identify the
areas experiencing the highest levels of new or persistent illegal migration. Resour,ces will be
also be used for rapid redeployment of Border Patrol agents in response to changes that have
begun to occur in illegal entry patterns.
•
Continued technological improvements at the border, including surveillance cameras, fmgerprint
technology, sensors and a new helicopter will enhance the effectiveness of agents.
Control at Ports of Entry - Inspectors
•
680 INS inspectors and XXX new Customs inspectors assigned to high volume Ports-of-Entry
will complement border enforcement activities, provide dedicated Immigration Response Teams
to preempt entry by mala fide aliens, stop cross-border drug smuggling, and facilitate legal
crossings.
•
ENFORCE, the INS enforcement case tracking system, will be deployed at certain land and
airports of entry. Additional Dedicated Commuter Lanes and Automated Permit Ports will be
established to facilitate processing of certain low-risk traffic.
'DRAFT
�•
The Interagency Border Inspection System (IBIS) -- a joint CustomsfINS "lookout" system at
Ports-of-Entry -- will be upgraded to expedite electronic data exchange of information with the
Department of State, and to facilitate traffic through automated arrival and departure information
from airlines.
•
Funds are provided to meet infrastructure needs to collect the new border fee at land border
Ports-of-Entry.
Additional Strategic Border Control Initiatives
•
Pilot testing of a program to repatriate 5,000 illegal aliens from the San Diego area who are
. repeat crossers or serious criminals will begin in FY 1996.
•
Field Intelligence Groups at key southern border locations will be established to collect, analyze
and disseminate information on the migration patterns of illegal aliens and smuggling activities.
•
A 42% increase in domestic anti-smuggling resources will be targeted at smuggling organizations.
in foreign locations and along transit routes. Enforcement resources will be augmented at
overseas locations to work with host country governments to deter alien smuggling and the use
of fraudulent documents in source countries.
1996 Initiatives
(dollars in millions)
Control at the Border
700 BPagentsll40 Supp.
TechnologylMobility
SUBTOTAL
Ports-of-Entry
INS Inspectors
Customs Inspec.
Automation
Infrastructure
SUBTOTAL
Other Initiatives
Repat.lIntell.lOverseas
TOTAL
..
TOTAL
Airport User
Fee . .
VCRTF
S&E
Border
Seryice Fee
16.7
59.4
.Q
..2ll
16:7
81.0
19.3
100.0
14.0
40.3
100.0
68.6
42.7
0
16.J.
5..5.
58.8
5.5
0
..:......Q
0
21.0*
0
14.4
0
0
31.3
0
0
8.9
-1!
~
U
...5.!W
..ll.2
35.4*
31.3
10.1
183.3
260.1
19.3
0
8.9
0
28.2
113.5*
36.S
19.0
200.0
369.3
* Includes $4.3 nulhon for DCLs tn the Land Border Inspections account.
2
R FT
�.'
Immigration and Naturalization Service
Border Control Program
Nationwide Border Staffing Levels
Border Patrol Agents
~ Border Patrol Support
71
1/11 _
Inspections Staffing
6
5
2
1990
1991
1993
1994
1995
1996
Total percent of increase of Nationwide Border Staffing Levels from 1990 - 1996
is 66 percent.
Percents represent year to year
inc~eases
DRt1~FT
�Immigration and Naturalization Service
Border Control Program
Southwest Border Staffing Levels
Thous~nd •
./
8
(7
7F
7'
(1
'"
Border Patrol Agents
~ Border Patrol Support
7
. Inspections Staffing
6
5
4
3
2
o
1992
1993
1994
1991
1995
1990
1996 *
Total percent of increase of Southwest Border Staffing Levels from 1990 - 1996 is 77 percent.
• Assumes area with greatest need will continue to be lJ?e Southwest border.
Percents represent year to year increases
RAFT
�u.s. BORDER PATROL
..'
Border Control Hours
Nationwide
Millions
10
8
6
4
2
o
FY 90
FY 91
... - Estimate (Includes all Trainee Hours)
FY 92
FY 93
FY 94
FY 95*
FY 96*
Percentages reflect year to year increases/decreases.
DRAFT
�u.s. BORDER PATROL
Border Control Hours
Southwest Border
!
Millions
8
7
6
5
4
3
2
....
1
o
FY 90
FY 91
FY 9 2 · FY 93
* - Estimate (1ncludes all Trainee Hours)
FY 94
FY 95*
FY 96*
Percentages reflect year to year increases/decreases.
rr~- ~FT
- i4
. ~,.?'" £1\
D"Iol"" Q-"~tl
tt
�WORKSITE ENFORCEMENT AND VERIFICATION
The Administration's plan for investing $93 million in FY 1996 in interior enforcement efforts is the
next critical step in the multi-year border control strategy that has been successfully underway for the past
two years. To succeed, border enforcement must be backed up by effective workplace enforcement.
Recognizing that employment is the primary incentive for illegal immigration, the Administration's interior
enforcement strategy is targeted at reducing the magnet of job opportunities for illegal migrants. This will
be accomplished in the following ways:
Worksite Enforcement
•
Building on FY 1995 employer sanctions pilot programs initiated in FY 1995 in Los Angeles and
New York City, the Administration will initiate a comprehensive, coordinated interagency program
with INS and the Department of Labor (DOL) for worksite and employer sanctions enforcement in
selected areas of high illegal immigration. The President's budget request will provide for 370 new
INS investigations personnel and 202 new DOL Wage and Hour personnel to establish "targeted
deterrence zones" for enhanced worksite enforcement.
•
. Deterrence zones will include the seven states with the largest number of illegal immigrants:
California, Texas, Arizona, New Jersey, New York, Florida, and Illinois. Enforcement efforts will
concentrate on selected industries that have historically depended on an illegal workforce flfSt.
•
INS investigations of employers are expected to increase by 117 percent, and fraud cases will almost
double. Apprehensions of illegal aliens at worksites are expected to increase by 67 percent.
. Immieration Status Verification
•
FY 1996 resources will be invested in substantial improvements in the accuracy of immigrant
information contained in INS and Social Security Administration (SSA) databases. Improving data
accuracy and the timeliness of status information will make it easier for employers to maintain a legal
workforce and to verify eligibility for entitlements.
•
INS will expand its Telephone Verification System (TVS) Pilot program to between 750 and 1000
employers ,in industries that typically attract illegal workers. The Pilot provides employers with a
simple, automated means of verifying the work eligibility of non-citizen job applicants.
•
The INS and the SSA will initiate several additional large-scale pilots to test a variety of verification
approaches, including the feasibility of the proposal recently made by the Commission on
Immigration Reform. These pilots will include:
Expanding Social Security Number Validation for Employers. Targeting industries that often
draw illegal workers, the SSA will test expanded, automated methods of providing quick
response verification of Social Security cards used as proof of employment eligibility.
�Test of a Two-Step Process to Cross Check INS and SSA Files. Using INS and SSA
databases separately, the agenc~es will test a process for employers I) to verify the validity
of Social Security numbers and claims to U.S. citizenship, and 2) to verify work eligibility
against INS flies jf the SSA check is not conclusive.
Simulate Methods for Combining [NS and SSA Data. The agencies will simulate various
approaches for ensuring data accuracy and combining data from different systems that would
provide for restricted, secure, accurate and non-discriminatory verification of an individual's
work eligibility.
Fraud-Resistant INS Documents and Document Reduction
•
Building on current initiatives to make immigration documents counterfeit-proof, [NS will develop
and iinplement a new, tarnper-proofErnployrnent Authorization Card (EAD) to deter fraud and allow
for easier detection of fraudulent documents. A centralized process for issuing EAD and "green
cards" will lower production costs, increase service to the public and improve employers' ability to
authenticate legitimate documents.
•
The Administration will propose legislation to reduce the number of acceptable work authorization
documents ultimately to two documents for non-citizens and a small number (approx. four) for
citizens. A proposed regulation reducing the number of such documents from 29 to 15 will soon be
published.
1996 Initiative
(dollars in millions)
,
Em 10 er SanctionslFraud - INS
Wa e and Hours Investi ators - DOL
Verification S sternslPilots
Other DO] (EOIRJUSAtt s)
Salaries &
E enses
�DETENTION AND REMOVAL OF DEPORTABLE ALIENS
The Administration's immigration strategy recognizes the need to ensure that those aliens who
have been ordered exc1udedor deported actually depart from the United States. The Violent Crime
Control and Law Enforcement Act of 1994 provides for the expedited deportation of criminal and
illegal aliens and increases penalties for those who fail to depart, or who reenter, following an order
of deportation. The 1996 budget enhancement of $171 million supports resources to increase
detention and removal capacity in the following ways:
Removal of Criminal Aliens
•
Through the Institutional Hearing Program (IHP), enhancements in FY 1995 and FY 1996
will increase removals of criminals identified, processed, and ordered removed in the seven
states with the largest populations of foreign born prisoners (CA, TX, FL, NY, IL, NJ, AZ)
and in the Federal IHP.
•
Resources will be provided for removal of aggravated felons in FY 1996 under administrative
deportation procedures for certain criminal aliens that were provided in the Violent Crime
Control and Law Enforcement Act of 1994.
•
Total criminal alien removals anticipated in FY 1996 will double from 23,250 in FY 1995 to
58,200 in FY 1996.
Removal of Other Deportable Aliens
•
Absconder removal tearns will be established to identify. apprehend, and remove illegal aliens
who fail to appear for their hearings, or who abscond after being ordered deported or
excluded. INS will also expand use of the National' Crime Information Center (NCIC) by
entering the names criminal aliens and repeat crossers aliens who fail to appear for
deportation.
•
To support the objectives of the FY 1995 asylum reform initiative, we will expeditiously
remove aliens whose asylum applications are denied and who appear unlikely to leave
voluntarily. This removal capability is a necessary component of our program to reduce the
number of fraudulent claims to asylum.
.•
As a result of these and other initiatives, total non-criminal alien removals in FY 1996 will
more than double from 25,600 in FY 1995 to 53, 080 in FY 1996.
Increased Detention Capacity and Transportation
•
Without adequate detention space, persons ordered deportable are often released and fail to
appear for deportation. Resources requested will provide an additional 1,836 non-INS
detention beds in state, local and contract facilities as well as 976 beds in INS Service
Processing Centers -- a48 percent increase in bedspace over FY 1995. Resources will also
support a transportation network with new vehicles to enhance an aging fleet and a
computerized decision support system that will allow INS officers to make effective use of
available detention space nationwide, and identify transportation modes for aliens to be
detained and removed from Uniteci States.
DR FT
�·FY 1996 Initiative
(dollars in millions)
S&E
VCRTF
TOTAL
Removal Of Criminal Aliens
29.5
23.2
52.7
Removal of Other Deportable Aliens
18.5
9.9
19.4
Expanded Detention Space
81.3
0
81.3
Legal & Management Support - INS
3.8
0
3.8
Other DOl (EOIR/USAttys/Civil)
4.6
0
4.6
137.7
33.1
170.8
TOTAL
DRAFT
�"
.
ASSISTANCE TO STATES AND IMPROVING CUSTOMER SERVICE
Deterring illegal immigration is the best way to contain the costs 9f illegal immigration to
States. Beyond this clear Federal responsibility, the Administration will target a total increase of
$383 million to assist the States with the costs of illegal inunigration, resulting from failed
enforcement policies of the past. The INS will also assist States and localities through efficient
customer service for legal immigrants and providing much needed quality information.
State Criminal Alien Assistance Program (SCAAP)
•
An increase of $170 million is proposed for the States, bringing to $300 million the full
amount authorized for FY 1996 in the Violent Crime Control and Law Enforcement Act
of 1994. This is the first Administration to request funds from Congress to reimburse the
States for the costs of incarcerating criminal aliens.
Medicaid Discretionary Grants ,
•
$150 million is proposed for grants to States with a disproportionate share of the
undocumented immigrant population in need of emergency medical services, including
labor and delivery.
Immi~rant
•
Education
An increase of $50 million is proposed for grants to school districts heavily impacted by
large influxes of newly arrived immigrant students. This is a doubling of the FY 1995
leveL
Law Enforcement Support Center (LESe)
•
$3 million is provided to support an expansion of the LESC pilot project which assists
State and local law enforcement in determining immigration status of serious felons or
suspected aggravated felons.
Qualify Immifration Statistics
•
$10 million will be available to create a high quality Center for Immigration Statistics to
collect, evaluate, and disseminate accurate and.timely immigration data to Congress, state
and local governments, and the public.
Promotinf and Streamlininr: Naturalization
•
Legal. immigration represents the best of America. The INS will promote citizenship
awareness by effectively disseminating information on the application process for
naturalization. INS will expedite and streamline the naturalization process. Qualified
local educational institutions will be certified to offer English languagy and citizenship
courses. As a result, 602,000 naturalization applications are expected to be approved
and processed in FY 1996 a, 20% increase over FY 1995.
DRAFT
�t' '.
ASK Immigration
•
$10 million of base resources will be used to improve customer service by expanding the
Ask Immigration telephone system. These funds will provide the resources needed to
increase the number of live assistance calls. In addition, a separate 800 line will be created
for those requesting INS forms, facilitating a more direct service. The current taped
telephone greeting 'will be reduced from over 9 minutes to 45 seconds.
1996 Initiatives
(dollars in millions)
\
VCRTF
Salaries &
Expenses
TOTAL
SCAAP
170
0
170
Medicaid
150
0
150
Education
50
0
50
0
3.4
3'.4
0
0
LESC
10
Immigration Statistics
I TOTAL
1
380
..
I
DRAfT
3.41
3
/
�Immigration and Naturalization Service
. Naturalization Program
N-400 Applications Approved
1990 through 1996
(I1J
500
400
300
200
100
o
&timate
Total percent of increase from 1990 - 1996 is 119 %.
Percents represent year to year increases
DRAFT
&itimale
��-.....
~
.
\
\
I
:
i
������'.
����,.
��������•
�".
�
Dublin Core
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Carol Rasco - Issues Series
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Domestic Policy Council
Carol Rasco
Issues Series
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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2010-0198-S Segment 2
Description
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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92 folders in 7 boxes
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Carol Rasco
Issues Series
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Box 123
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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2010-0198-Sb-department-of-justice-immigration-naturalization-service
-
https://clinton.presidentiallibraries.us/files/original/0e85242e57b308cbee32e6b111dd6530.pdf
e46ea1f9efd5c902143e4c747ed0dfec
PDF Text
Text
09/19/94
!''t
17:07
'5'202 514 9077
DOJ
......... CAROL, RASCO
I4J 002/003
" ..........
MAKING. AMERICA SAFE
Implementing the Violent Crime Control Act
On September 13. President Clinton signed into law the Violent Crime Control
and Law Enforcement Act of 1994: This badly needed legislation represents the bi
partisan product of six years of hard work, and will:
•
Provide $8.8 billion in funding to put 100;000 new police officers on
America's streets;
.
.
•
Provide $7.9 billion in funding for prisons to make sure that violent
offenders serve their full sentences;
•
Provide $1 billion in funding for Violence Against Women programs;
•
Provide $1 billion in funding for local drug courts;
•
Provide $4.1 billion in funding for prevention· programs which were
designed with significant input from experienced police officers;
•
Ban military-style assault weapons, as well as ban the possession of
handguns by juveniles; and
•
Expand the federal death penalty to cover 60 new offenses.
The Violent Crime Control Act gives the country an historic opportunity to tum
the tide against crime and violence in our communities. The Clinton Administration
knows that to achieve the full promise of the Violent Crime Control Act, the law must be
quickly and effectively implemented.
To fulfill its promise to the America people, the Administration has already taken
the following actions:
•
The Attorney General directed Associate Attorney General John R.
Schmidt to personally oversee implementation of the Violent Crime
Control Act. As the third-ranking official in the Department of Justice, he
will make sure that accountability remains at the highest levels.
•
The Department of Justice established a Response Center to answer
questions about the Violent Crime Control Act. The phone number for the
Response Center is 202-307-1480 or 1-800-421-6770.
�.
,.
09/19/94
17:07
'5'202 514 9077
DOJ
......... CAROL RASCO
~003/003
;
•
On September 14, the day after the Violent Crime Control Act was signed,
President Clinton met with U.S Attorneys from around the country. He
directed the U.S. Attorneys to work with local prosecutors and develop
plans within the next 100 days to enforce the ban on juvenile possession of
handguns; and
•
. The Attorney General and the Associate Attorney General sponsored
Violent Crime Control Act implementation forums in Denver, Colorado;
Springfield, Illinois; and New York, New York to hear and learn from state
and local officials. Forums will be held in other in cities the coming
months.
Although this is an impressive start, it is not nearly enough. Within the next 30
days, the Administration will:
•
Appoint the Director of the COPS Program. This person will oversee the
Administration's efforts to add 100,000 police officers to the nation's
streets.
•
Announce $200 million in community policing awards to help cities hire or
rehire police officers. More than 2,600 officers will be hired as a result.
•
Announce plans for states to apply for $130 million in State Criminal Alien
Assistance Program grants. These funds will reimburse states for the cost
of incarcerating illegal criminal aliens; and
•
Announce plans for states to apply for $24 million in boot camp grants.
Implementing the Violent· Crime Control Act is a challenge and an opportunity.
The Clinton Administration pledges to work with federal, state, and local officials, and
communities to make America safe.
Response Center 1-800-421-6770
202-307-1480
September 19,1994 11:00 a.m.
�_.
,
'
..
, ,
O~/22194
16:56
I(1J002
TALKING POINTS
,
,
• . The Violent Crime Control and Law Enforcement Act of
1994 is the largest crime bill in the his.tory of the country
and will pr<lvide $8.8 billion for-lOO,OOO ~ew police
officers, $9.7 billion in funding for prisons and ,$6.1
billion in funding for crime preventiori programs. '
Among other things, it:
'.
- Expands the government's ability to deal with
problems "caused by criminal aliens and provid~s
$2.. 6 billion in' additional funding forth~ FBI, DEA,
INS, United S'tates Attorneys, Treasury Department
and other Justice Department components," as well as
the Federal courts.
.
- Bans the manufacture of 19 military-style assault
we,apons, assault weapons with specitic combat
.featUres, "copy-cat fI models, and certain high
. capacity ammunition magazines of more than ten
rounds.
.
"- Expands the Federal death penalty to cover about
60 offenses, including terrorist homicides, murder of '
a Federa~ ''!awenforcement officer, large-scale drug
trafficking, drive-by-shootings resulting in death and
. carjackings resulting in death.
- Mandatory life imprisonment without possibility of
parole for Federal offenders with three or more
. convictions for' serious· violent felonies or drug
trafficking crimes .
�O~/22/94
,16:57
•
Although it is impossible to' quantify our impact, I know
having women at 'senior levels in the Administration (as
well as enlightened men)involved throughout ,the crime.
bill policy process, made a, difference in myriad ways.
Perhaps among the most visibl~ results is the inclusion of
th~ Violence Against Women Act, which was
championed by .Judiciary Committee Chairman Joe Biden
among others,' and and of a number related provisions in
the bilL
. .
,
•
So let me discusss it in somewhat greater detail:
@003
�,09/22/94
. 16; 57
'ft.
141 004
3
VIOLENCE AGAINST WOMEN
•
As part of the President's overall anti-crime strategy, the
Administration supports new federal efforts, including $1
.billion,' in funding assistance aim,ed at curbing gender
motivated violence and improving restitution to victims of
such crime. The Crime Bill's Violence Against Women
Act creates a federal cause of action for violence
perpetrated against an individual because of their gender.
•
Under the Violence Against Women Act, victims ofa
felony crime of violence. may bring a civil suit for
damages'or equitable relief in federal or state court,
provided that the crime they suffered was committed .
because of gender and due" at least in part, to animus'
bas¢ on the victim's gender.
.•. The Act also creates new federal offenses, such as
fleeing across state lines in violation of a stay away or
protectio~ order.
•
The Act also creates new Federal Rules of Evidence for
Sexual Crimes and Child Abuse. Th~ Act establishes
general rules of admissibility in sexual assault and child
molestation cases for evidence that the defendant has'
co~tted. offenses of the sa.ri:le type on othe:r occasions.
(NOTE: The legislation defers the effective date of these
new rules for up to 150 days pending a report by the
Judicial Conference. If the Conference endorses the
enacted rules in its report, they will go into effect 30
�OQ/22194
16:57
~005
4
.days thereafter.. Other\,Vise, their effective date will be .
deferred for an additional 150 days.) These new rules
are critical to the· effective p~otection of the public
against rapist and child molesters. They also incorporate
appropriate and adequate safeguards of fairness for the
defendant.
•
•
The Violence Against 'Women provision is' both fair and
smart.. It's fair because it addresses those situations in'
which victims are without redress due to inadequate state
remedies, and allows victims improved access to federal
courts. The proposal is smart because it does not clog
federal dockets ~y. automatically labelling whole
categories of offenses. as gender~motivated; proof of the
perpetrator's animus is a prerequisite to recovery..
Specifically, other substantive law. Crime Bill provisions
. include:
.
o Domestic Abusers and Fireariits -- Prohibits
"
firearms sales to and possession by persons subject
to family violence restraining.orders~· .
o Registration of Sexually' Violent Offenders ~- .
Requires states to enact s'tatutes or regulations which
require" those detennined to be sexually violent .
predators or who are convicted of sexually violent
offenses to register.with appropriate state law "
enforcement agencies for ten years after release
from prison. Requires state prison officials to notify
appropriate, agencies of the release of such'
�O~/2V94
16:58
'It
I4J 006
5
,
,
'
individuals. 'Requires .states· to criminally. punish.
, those' 'who fail to register • States which, fail to
, , " establish registration' systems will have Federal grant'
, money reduced., "
o· Repeat ~ex 'Qffenders ~-. Doubles the maximum
tenn of imprisorunent for repeat sex offenders
convicted of FederaL sex crimes. "
,
o
0'
.
,"
'
Three Sttike..'i ;... Mandatory life imprisonment
, withoufpossibilityof par~le for Federal offenders
with three 'or more convictions for certain serious '
violent or drug' felonies, inciuding sexual offenses.,
Victims of Crime -- Allo.ws victlmsof Federal
,violent and sex crimes to speak at the sentencing of
'thei.r assailants. S,trengthens requirements for sex
offenders and child molesters to pay restitution to
their victims. ' Improves the Federal Crime"Victims'
,,Fund and the, victim-related programs it, supp<?rts. '
o
Battered Immigrant WQmen -- Statutory authority.
for abused· spou~es and spouses with abused children .
to. petition for permanent 'residency or suspension of
deportation.
'.
This proposal goes further than providing victims of
. gender-motivated violence with Ile~ legal' remedies,'
,however. It also provides funds for programs aimed at
, reducing and preventing .violence against women, . ,such '
.
,
as:
.
�O~/22/94
16:58
ft
@007
.,
. 0 -
6
'Hgtline - Competitive grant program adrWnistered
by the ,Department of Health and Human Services to
establish a National Domestic Violence Hotline. $1
,million authorized in 1995. An' additional $2
million authorized in 1996-2000.
,
,
o Yiolen~e Against Women State Formula GrantS -
to support police and prosecutor efforts and victims.
services in cases involving· sexual violence or
domestic abuse, and for other programs which
strengthen -enforcement and provide services to
victims in such cases. Purposes include to expand
and strengthen victim services and programs, such
as rape crisis centers, battered women's shelters,
and rape an~ family violence programs; train law
enforcement officers to more effectively identify and
respond to violent crimes against women; and
expand law enforcement units (police and
prosecutors) specifically to target violent crimes
against women.
$26 million available in 1995. $774 million for'
formula grants and over $200 million for related
competitive grants authorized in 1996-2000.
o. Battered Women's Shelters ":-Competitive grant
program-administered by· the Department of Health
and Human Services for battered women's shelters
- and other domestic violence prevention activities.
$325 million authorized.
.
,0
Federal Victim Counselors -- to help victims and
�.
Ot!/22194,
16: 58
C
.
@008
"
,
.
,.
,
. 'witnesses in federal sex and domestic violence cases .
. $1.5 milli~n authorized.
,
.
.
Help for the Homeless and Runaways -- provides
.. $10 million' to help alleviate the problem of
homeless "and runaway women and girls through
street-based education an~ outr~ach programs and .
counseling .and' treatment' for runaway, homeless and'
street y~uthwho .are at risk of being subjected to
sexual abuse. .
o Education and Prevention to Reduce Sexual ' ,
Assaults AgaipstWomen -- Competitive grant
'program administered by the Department of Health.
. and Human Services to fund rape preyention and '
"education programs the' form of educational
seminars, hotlines, training programs for
'. professionals
the preparation ·of informational
materials. $205 million authorized.
in
and
' . '
.
�09/22/94
16: 59
ti'.
~009
MAKING AMERICA SAFE
Implementing the Viol~nt Crime Control Act .
"
. September 19, 1994.
•...
The Violent Crime Control Act '
On September 13, Pr~sident'CJinton signed into law we Violent Crime Control·
badly needed legislation represents the bi
and Law Enforcement Act of 1994.
. ,
partisan product of six years of hard work, and will:
nus
•. Provide $8.8 bilUon in funding to put 100,000. new police officers on
America's streets;
.
.•
Provide $7.9 billion in funding for prisoAs to make sure that violent
offenders serve their full sentences;
.
.
•
Provide $1 billion in' funding for Violence Aiainst Women programs;
•
Provide $1 billion in. funding for local drug courts; .
•
Provide $4.1 billion in funding for prevention programs which were
dCligned with significant input from experienced police. officers;
•
Ban military-style assault weapons, as well as ban the possegsion of
handguns by juveniles; and
•
Expand the federal death penalty, to' cover 60 new offenses.
The Violent Crime Control Act gives the country an historic opportunity to tUrn
the tide against crime and violence in aUf 'communities.. The Ointon Administration
that to achieve the full promise of the Violent Crime Control Act, the law must be
quickly and effectively implemented.
.
mows
To fulfill its promise to the America people, the AdJriini$tration has already taken
.
the following actions:
•
. 'The Attorney General directed ~sociate Attorney General John R.
Schmidt to personally oversee implementation of the Violent Crime
Control Act. As the third-ranking official in the Department of Justice, he
will make sure that accountabilitr remains at the highest levels.
�0~/22/94
16:59
III 010
•
The Department of Justice established a Response Center to answer
questions about the Violent Crime Control Act. The phone number for the
Response Center is 202·301·1480 or 1-800-421·6770..
.
.•
On September 14, the day after the Violent Crime Control Act was signed,
President Ointon met with U.S Attorneys from around the country: He
directed. the U.S. Attorneys to work with local proseCutors and develop
pJanswithin the next 100 days to enforce the ban on juvenile possession of
handguns; and
•
The Attorney General and the Associate Attorney General sponsored
Violent .Crime Control Act implementation forums in Denver, Colorado;.
Springfield, lliinois; and New York. New York to hear and learn from state
and local' officials. Forums will be held in other in cities the coming
months., "
Although this is an impressive start, it' is not nearly enough. Within the next 30
days, the Administration will:
•
Appoint the Director of the COPS Program. This person will oversee the
Administration's efforts toad~ 100,000 police officers to the nation's
streets.
.
.
•
Announce 5200 million in commu,l.1ity policing awards to help cities hire or
re.hire :poI~ce officers. More than 2,600 officers' will be hired as a result.
•
Announce plans for states to apply for $130 nu1lion in State Criminal Alien
Assistance Program grants. ' These funds will reimburse states for the cost
. of incarcerating ille~dl critninal aliens; and
.'
•
Announce plans for states to' apply for $24 million itl boot camp grants.
Implementing the Violent Crime Control Act is a cllallenge and an opportunity. '
The ~ton Administration pledges to work with federal, state, 8!ld loCal officials, and
communities to make America safe.
Response Center 1·800-411·6770
202.307·1480
Scptc:mber :1.9, 1994 11:00 a.m.
�OCT 1213 '94 1216:1213PM
OFFI~E
OF DEPUTY SEC
P.l
'f
OCT
o.s. Depart~ent of Education
Michele Cavataio
Office of the Deputy Secretary
400 Maryland Ave., SW • Washington, D.C. • 20202
(202)403.-3.000
Date:
To:
Memo:
/0 -3
..
.
J.~~b (202)403.-3093
Total # of pages Including cover sheet: _
Recipient Fax:
i.lJto - ~ 8' '7
«'
4 1994
�'94 06:04PM OFFICE OF DEPUTY SEC
P.2
UNITED STATES DEPARTMENT OF EDUCATION
THE DEPUTY SECRETARY
.
October 2, 1994
18~c
To: "
Carol Rasco .
cc:
Jose Cerda
From:
Madeleine
Subject:
Youth Violence prevention Strategies and Activities·
~~/
K:n-1h'
Safe and disciplined schools are an integral part of the
Department's school improvement strategy, imbedded in both Goals
2000 and the Elementary and Secondary Education Act. Our
conclusion is that families are primarily concerned about
discipline and safety, making it critical for us to link academic
improvement and violence prevention in all our outreach
activities.
.
The following are some events we are scheduling. The week of
october 16 is celebrated as Safe Schools week in many States.
During this week, we would like to sign our memorandum of
understanding with the District of Columbia schools. This
memorandum provides $1 rnillion to the school system for safe
school activities. In addition. our Elementary and Secondary
Education Act, which contains $482 million in the Safe and Drug
Free Schools and Communities p,rogram, should have passed. Below
have outlined the components of the Safe Schools program and the
timeline for making awards. We would welcome an opportunity to
celebrate any.of these successes with the President.
Safe
Schools
I
Program:
The Safe Schools Act passed as part of Goals 2000. There are
three basic sections to the Act .. One part provides discretionary
funds to LEAs for a variety of violence prevention efforts;
another part provides Slm to the District of Columbia to establish
a "model violence prevention program;" and the remaining part
provides the Secretary with $lm for discretionary "national
leadershipN activities.
The status of each of these three sections folloW's:
~!e
Schools pi~cr~ti9nary GraDts program; The Safe schools
discretionary grants program was announced in the Federal
400 MAIlYI.A!fD AVZ .. S.W. lwoUHUfGTOlf,
D.C. 20202-4800
�OCT 03 '94 06:04PM OFFICE OF DEPUTY SEC
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Register in August. The program closes September 30. ED
expects to make approximately 30 grant awards totaling S18m
by the end of the year. In order to get to 30 grants we
anticipate reviewing 500-600 applications. It is expected
that the awards will be made by the end of the year.
of Columbia MemorAndum Qf ynderstanginqj ED is in
the prQcess of negotiating a Memorandum of understanding with
the District of Columbia. We expect tQ make an award
tQtaling:, Slrn nQ;,later"than next week. The District is using
their grant to target thE:f Marshall Heights area of the
.'
District. Resources will be targeted to schQols and students
in the catchment area (3 elementary schools, Qne k-9 school,
Qne junior high school, and one high school).
g~strict
Funds will be used for activities in five broad areas:
School-based violence prevention activities: neighborhood
based support for students; school security enhancement;
capacity building through cQllaboration; and public educatiQn
and involvement.
More specifically, examples of how the funds will be used are
as follows:
--training teachers. and students in principles of
community of 'Caring, a values-education program designed
to integrate values in schools.
--developing community service' programs.
will be required to participate.
All students
--holding student forums (once a week).
--providing students with an alternative to suspension
and expulsion (an extensive 9-week program will be
developed) .
--hiring school neighborhood liaisons who will work to
link community services, activities, and programs with
the school.
--developing alternative after school programs.
National Activities; Of the total funds appropriated for the
Safe Schools program, ED can use $lm for National Activities.
while no decisions have been made regarding the use of these
funds (except for approximately $175 / 000 that is to be used
for reviewing proposals that are submitted under the Safe
Schools program), we have several ideas on how to use the
funds. Among the ideas are:
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�03 '94
06:04PM OFFICE OF DEPUTY SEC
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--for printing and distribution of material reiated
to violence prevention (we have a lot of material
from the National School Safety Center which we
have not been able to reproduce because we haven1t
had authorization to do anything in the area of
violence prevention).
--support of PAVNET. Justice has requested that
agencies help support this on-line inrormation
system. If we do, it will cost approximately
$80,000.
--data collection. We need more information on the
issue of school violence and are examining ways in
which we can obtain it.
--study on information needs. Report language to
Goals 2000 recommends that we conduct a study on
the information needs of SEAs and LEAs·.
--conflict resolution. ED and Justice are
sponsoring a one-day meeting of conflict resolution
experts~
We will.produce a booklet on how to
select a conflict resolution program. We are
splitting the costs with Justice (they are paying
for development work and we are paying forprinr.ing
and dissemination).
--Other ideas center around: alternatives to
suspension, gun removal, and development of safe
schools study.
We expect to circulate for review and approval a plan for
these funds by the end of October.
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�iOCT 03 '94 06:05PM OFFICE OF DEPUTY SEC
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Other
Safe
and Drug
Yiol,noe
Free
Prevention
Sohools
Aqtivities
and. communities
at
ED
Act:
Overview: The Safe and Drug Free Schools and Community Act
(SDFSCA) just completed conference, and has been
approved by the. full House. Itis.awaiting
approval by the Senate. SDFSCA is part of larger
Elementary and Secondary Act reauthorization and
therefore will have to face several huddles--in
House and Senate--before it actually becomes law.
Comment: Bill would give SEAs and LEAs authority to fund
violence prevention as well as drug prevention
programs. Additionally, prevention is defined
rather broadly, thereby allowing schools to use
funds to develop and operate programs such as safe
havens, conflict resolution, peer mediation/and
anger management. Bill also targets funds at areas
of highest need (as defined by SEA). SEAs must
designate up to 10% of LEAS as high need areas,
these areas will get additional funding (30% of
total SEA funds to go to high need areas) .
Budget:
safe
Schools
The budget for FY 1995 .is slightly higher than FY
1994. In FY 1995 we have been appropriated a'total
of $482M (as compared to $47lm in FY 1994). Of this
total amount $4S7m will be distributed directly to
SEAs and Governors, (this is an increase over FY
1994 when the states received $375m) .
Act:
Overview: The Safe Schools Act passed as part of Goals 2000.
There are three basic sections to the Act. One part
provides discretionary funds to LEAs for a variety
of violence prevention efforts; another part
provides $lm to the District of Columbia to
establish a 'Imodel violenc.e prevention program;"
and the remaining part provides the secretary with
$lm for discretiona.ry "national leadership"
activities.
Comment: The Safe Schools discretionary grant program was
announced in the Federal Register in August. The
program closes September 30. ED expects to make
grant awards totalling $18m by the end of the year.
Approxirn~tely 30 grant awards are anticipated (500
600 applications are expected under this grant
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�OCT 03 '94 06:05PM OFFICE OF DEPUTY 5EC
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announcernenti. ED is in the process of negotiating
a Memorandum of Underscanding with the District of
Columbia. We expect to make an award to the
District no later than early October.
Budget:
Family
S20mhas been appropriated f~r the Safe Schools
program for FY 1995. This is a one year effort. no
funding has been appropriated for F'l 95.
and . Communi ty schools
Bndeavor
Program:
Overview: This program passed as part of the Crime Bill. The
program, is to be administered by the Department of
Education. It calls for a competition among
"eligible local entities to pay for the Federal
share of assisting eligible communities to develop
and carry out programs that are designed to improve
academic and social development by instituting
collaborative structures that train and coordinate
the efforts of teachers, administrators. social
workers, guidance counselors, parents, and school
volunteers to provide concurrent social services
for at-risk students at selected public schools in
eligible communities.
II
.
Comment: The Departments of ED and HHS are working together
in the development of guidelines for these two
programs. It is anticipated that both agencies
will be ready to.make grant awards by Mayor June
of 1995.
Budget:
$llm has been appropriated for the FACES program in
F'i 1995.
Gun Free Schools Act:
overview: The Gun Free Schools Act requires all schools to
establish policies that mandate expulsion for one
year for all youth who bring guns to school.
Comment: This bill was passed as an amendment to the Goals
2000 legislation. As .the Gun Free Bill amends the.
current ESEA it essentially expires when ESEA does
(Sept 30). The ESEA which is stuck on the Hill
contains a similar amendment {Feinstein}. This
amendment also requires that schools pass zero
tolerance polices--polices that require one year
. expulsion for those caught bringing guns to school.
The only difference be eween the amendment pending
and the one originally attached to Goals 2000, is
that the Feinstein amendment gives schools one year
to come into compliance.
s
�OCT 03 '94
,
06:06PM OFFICE OF DEPUTY SEC
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.
Budget:
pro
No funding provided.
Chi ldrens Act:
Overview: The Pro Childrens Act requires all schools to ban
smoking ·inside school buildings (other bUildings
housing children are also covered).
Comment: This Act which was included as an amendment to
Goals 2000, was passed as a reaction to secondary
smoke and the harm it causes children. While t:.he
Act will eventually impact all schools, those
schools with labor agreements permitt.ing smoking
are given some leeway in implementing the ban. We
expect an announcement to be issued in the Federal
~egister in the. fall.
The requirements of the Act
become effective in late December. The Department
of HHS has responsibility for enforcing the Act.
Schools can be fined if they violate the provisions
of the Act.
Budget:
Ounce of
No funding provided.
Prevention
Council:
Overview: The Crime Bill 'establishes the OUnce of Prevention
Council which includes the Secretary of Education,
along with . the Attorney General, the Secretaries of
HHS, HUD, Labor, Agriculture, Treasury, and
Interior, and the Director of ONDCP. The president
to appoint the chair. The Council has
responsibility for coordinating prevention programs
funded under the Violent crime Control and Law
Enforcement Act; for developing a crime prevention
program catalog; providing assistance to
communities seeking assistance in prevention
programming and program integration; and
development of strategies for program integration
and grant' simplification.
The Council is also authorized to make grants for
summer and after-school education and recreation
programs; mentoring, tutoring, and other programs
involving adult role models; programs assisting and
promoting employability and job placement; and
prevention.and treatment programs to reduce
substance abuse, child abuse/and adolescent
pregnancy.
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�OCT 03 '94 06:06PM OFFICE OF DEPUTY SEC
Status:
P.S
President appointed the vice president chair of
the council. The Ofticeof the vice president is
developing an operating plan for the Council.
~he
7
�· ....
VIOLENT CRIME CONTROL AND LAW ENFORCEMENT ACT OF 1994
The Violent Crime Control and Law Enforcement Act of 1994 represents the bi-partisan product
of six years of hard work. It is the largest crime bill in the history of the country and will provide for
100,000 new police officers, $9:7 billion in funding for prisons and $6.1 billion in funding for prevention
programs which were designed with significant input from experienced police officers. The Act also
significantly expands the government's ability to d~al with problems caused by criminal aliens. The Crime
Bill provides $2.6 billion in additional funding for the FBI, DEA, INS, United States. Attorneys, Treasury
Departme~t and other Justice Department components, as well as the Federal courts. Some of the most
significant provisions of the bill are summarized below:
I.
Substantive Criminal Provisions
o
Assault Weapons -- Bans the manufacture of 19 military-style assault weapons, assault
weapons with specific combat features, "copy-cat" 'models, and certain high-capacity
ammunition magazines of more than ten rounds.
o
Death Penalty -- Expands the Federal death penalty to cover about 60 offenses,
including terrorist homicides, murder of a Federal law enforcement officer, large-scale
drug trafficking, drive-hy-shootings resulting in death and carjackings resulting in death.
o
Domestic Abusers and Firearm's -- Prohibits firearms sales. to and possession by
persons subject to family violence restraining orders.
o
Firearms Licensing -- Strengthens Federal licenSing standardsfor firearms dealers.
o
Fraud -- Creates new insurance and telemarketing fraud categories. Expands Federal
jurisdiction to cases that do not involve the use of the mail or telephone wire to commit a
fraud. Provides special sentencing enhancements for fraud crimes committed against the
elderly.
o
Gang Crimes Provides new and stiffer penaltiesJor violent and drug trafficking
crimes committed by gang members.
o
Immigration Provides for enhanced penalties for alien smuggling, illegal reentry after
deportation and other immigration-related crimes. (See Pan II).
o
Juveniles -- Authorizes adult prosecution of those
n
n
13 a~d older charged with certain
serious violent crimes. Prohibits the side or transfer of a fi'rearm to or possession of.
certain firearms by juveniles. Triples the maximum penalties for using children to
distribute drugs in. or near a protected zone, Le., schools, playgrounds, video arcades and
youth centers.
'
o
Registration of Sexually Violent Offenders -- Requires states to enact statutes or
regulations which require those determined [0 be sexually violent predators or who are
convicted of sexually violent' offenses to register with appropriate state law enforcement
agencies for ten years afterrelease from prison. Requires state prison officials to notify
appropriate agencies of the release of such individuals. Requires states to criminally
punish those who fail to register. States which fail to establish registration systems may
have Feder~1 grant money reduced.
�o
Repeat Sex Offenders -- Doubles the maximum term of imprisonment for repeat sex
offenders convicted of Federal sex crimes.
o
Three Strikes -- Mandatory life imprisonment without possibility of parole for Federal
offenders with three or more convictions for serious violent felonies or drug trafficking
crimes.
o
o
II.
Victims of Crime -- Allows victims of Federal violent and sex crimes to speak at the
sentencing of their assailants. Strengthens requirements for sex offenders and child
molesters to pay restitution to their victims. Improves the Federal Crime Victims' Fund
and the victim-related programs it supports.
Other -- Creates new crimes, 'or enhances penalties for: drive-by-shootings, use of semi
automatic weapons, sex offenses, crimes against the elderly, interstate firearms trafficking,
firearms theft and smuggling, arson, hate crimes a~d interstate domestic violence.
Immigration Initiatives
The Crime Bill contains specialized enforcement provisions respecting immigration and criminal
aliens. Those programs are highlighted here:
o
o
$1.8 billion to reimburse states for incarccration of illegal criminal aliens. (See SCAAP
.Grants in Section III).
o
Enhanced penalties for failure to depart the United States after a deportation order or
reentry after deportation.
o
Expedited deportation for aliens who are not lawful permanent residents and who are
convicted of aggravated felonies.
o
III.
$1.2 billion for b'order control, criminal alien deportations, asylum reform and a criminal
alien tracking center.
Statutory authority for abused spouses and spouses with abused children to petition for
permanent residency or suspension of deportation.
'
Grant Programs For 1995
Most of these programs are authorized for six years beginning October I, 1994. Some are formula
grants, awarded to states or localities based on population, crime rate or some other combination of
factors. Many are competitive grants. All grants will require an application process and are administered
by the Department of Justice unless ,otherwise noted. As always, all funds for the years 1996-2000 are
subject to appropriation by the Congress.
o
Boot Camps For Young Offenders Competitive grant program for state
corrections 'agencies to build and operate boot camps for ~on-violent younger offenders
with limited criminal histories. $24.5 million available in 1995.. $300 million available in
1996-2000.
u
SqJtt::mlx:r 13,1994
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1:30 p.m.
�o
Brady Implementation -- Competitive grant program for states to upgrade criminal
hstory records keeping so as to permit compliance with the Brady Bill. $100 million
available in 1995. $100 million available in 1996-2000. .
.
o
Byrne Grants Formula and competitive grant program for states for use in more than
20 law enforcement purposes, including state and local drug task force efforts. $450
,million available for the formula grant program in 1995. $550 million a'vailable in 1996
2000.
.
o
Community Economic Partnership -- Competitive program administered by the'
Department of Health and Human Services for lines of credit to community development
corporations to stimulate business and employment opportunities for low-income,
unemployed and underemployed individuals. $~70 million available.
o
Community Policing Competitive grant program (COPS Program) to put 100,000
police officers on the streets in community policing programs. $1.3 billion available in
1995. $7.5 billion available in 1996-2.000..
o
Community Schools
o
Drug Courts -- Competitive grant program to support state and local drug courts which
u
u
Formula grant program administered by the Department of
Health and Human Services for supervised after-school, weekend, and summer programs
for at-risk youth. $37 million available in 1995. $530 million available in 1996-2000.
u
provide supervision and specialized services to offenders with rehabilitation potential. $29
million available in 1995. $971 million available in 1996-2000.
o
Hotline - Competitive grant program administered. by the Department of Health and
Human Services to establish a National Domestic Violence Hotline. $1 million available
in 1995. $2 million available in 1996-2000.
.
,
o
Ounce of Prevention -- Providesfunding for the Ounce of Prevention Council to
coordinate new and existing crime prevention programs. $1.5 million available in 1995,
$88.5 million available for competitive grants in 1996-2000.
o
SCAAP Grants -- Formula grant program to reimburse states for the cost of
incarcerating criminal aliens. $130 million available in 1995. $1.67 billion available in
1996-2000.
o
Violence Against Women Formula grant program to support police and prosecutor
efforts and victims services in cases involving sexual violence or domestic abuse, and for
other programs which strengthen enfon;ement and provide services to victims in such
cases. $26 million available in 1995, $774 million for formula grants and over $200
million for competitive grants available in 1996-2000.
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Scptt:mbt:T 13, 1994
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1:30 p.f1L
�IV.
Grant Programs For 1996-2000
All programs available in 1995 are continued. All programs are administered by the Department
of Justice unless otherwise noted. Funding for 1996-2000 iS"as always, subject to appropriation by the
Congress.
Battered Women s Shelters --
o
I
Competitive grant program administered by the
D'epartment of Health and Human Services for battered women's shelters and other
domestic violence prevention activities. $325 mil1ion available.
o
Capital Improvements to Prevent Crime in Public Parks --
Competitive grant
program administered by the Department of Interior for states and localities for crime
prevention programs-in national and public parks. $15 million available.
'
o
Crime Prevention Block Grants -- $377 million for a new Lo~l Crime Prevention
Block Grant program to be distributed to local governments to be used as local needs
dictates. Authorized programs include: ,anti-gang programs, sports leagues, boys and girls
clubs, partnerships (triads) between the elderly and law enforcement, police partnerships'
for children and'youth skills programs.
o '
Delinquent and At-Risk-Youth
Competitive grant program for public or private
non-profit organizations to support the development and operation of projects to provide
residential services to youth, aged 11 to 19, who have dropped out of school, have come
into contact with the juvenile justice system or are at risk of either. $36 million available.
o
DNA Analysis --
o
Drug Treatment
o
u
Competitive grant program for states and localities to develop or
improve DNA identification capabilities. $40 million available. An additional $25 million
is available to the FBI for DNA identification programs.
$383 million for prison drug treatment programs, including $270
million in formula grants for states;
,
u
Education and Prevention to Reduce Sexual Assau1ts Against Women
u
Competitive grant program administered by the Department of Health and Human
Services to fund rape prevention and education programs in the form of educational
seminars" hotlines, training programs' for professionals and the preparation of
informational materials. $205 million available. '
.
o
o
Family and Community Endeavor Schools -- Competitive grants program
administered by the Department of Education for localities and community organizations
to help improve the overall development of at-risk youth living in poor and high-crime
communities. This program is for both in-school and after-school activities. $243 million
. available.
Local Partnership Act
Formula grant program administered by the Department of
Housing and Urban Development for localities to enhance education, provide substance
abuse treatment and fund job programs to prevent crimes. $1.6 billion available.
u
St:ptanber 13, 1994
-4
1:30 P.11L
�o
Model Intensive Grants -- Competitive grant program for model crime prevention
programs targeted at high-crime neighborhoods. Up to 15 cities will be selected. $625
million available.
o
Police Corps -- Competitive funding for the Police Corps (college scholarships for
students who agree to serve as police officers), and formula grants to states for
scholarships to in-service law enforcement officers. $100 million available for Police
Corps, and $100' million available for in-service law enforcement scholarships.
o
Prison Grants -- Formula grant program to states to build, expand, and operate prisons
and alternatives to. incarceration such as boot camps to insure that additional prison cells
will be available to put - and keep - violent offenders incarcerated. Fifty percent of
money to be set aside for those states which adopt truth-in-sentencing laws (violent
offenders must serve at least 85% of their sentence) or which meet other conditions. $7.9
billion available.
o
Prosecutors
i
I
I
I
o
o
-~ Competitive grant program for state and local courts, prosecutors and·
public defenders. $150 million. available.
. Rural Law Enforcement -- Competitive grant program for rural anti-crime and drug
efforts. $240 million available.
Technical Automation -- Competitive grant program to support technological
improvements for law enforcement agencies and other activities to improve law
enforcement training and information systems. $130 million available.
o
Urban Recreation For At-Risk~Youth -- Competitive grant program administered
by the Department of Interior for localities to provide recreation facilities and services in
areas with high crime rates and to provide such services in other areas to at-risk-youth.
$4.5 million available.
St:p!.eml:!er 13, 1994
-5
1:30 p.rn.
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understandl.ngwJ. th,: the District.of. Columbia:schools . '.:Tnis· c.'>:. ....,.~"
; .' .mem6randum·prqv~de's ·Si:;million.:t;p.:the',s·chool .,sy;~~~in>f()r·. safe>'~·'·: , ' . " I.~
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·Educa:tionAct{:.which·:contai.ns·:$48~mj;,111on'·in ·the(:Safe.:andDtug, ',,' ..
Free'Schoqls:q,nQ:.c,omro\.1·ri~t/i~sPtp9ram,·.shoul,:d'haye:pa~sed:.i'Belb\<i·t·,.,
•. have, outlined thec;ompo~ep.t$~:·Of J:h'e<Safe 'sc1)ools' ptogr~I:YI~:ari4: :~he. ~
,timeline>f'Q,r 'makipg :awa~ds,' ·~.we¥ould.: ~i~.tcorne;anopporturiity: '.to
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'any. 'of "these~:s:Uccesses. widf :the' president,;,·
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, .,:,,-study. orftn.~orma~ion· n~eds' .. ' ·Report·;::,l~nguage .. ,~9:·'·' ': ,,:,~,t·,·)
Goals, 2000',recomme)~ds th,at we: ,c;:ond~~t,· astudy·'oJ:l..' .', .:'
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.Comment':···.··::,BilJ? wotild';give'~SEAs ··.and" LE~s:::au~p6r~t.y;'tc):,"fund.;:ij>Y. :;.e'.
: ..... ' ..'.. .... violence :'prevention'as;: well~·as\::drug.'lprev~ritl6n '~/.:>:~;':;:";~'
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·,prog,rams·,. >,Addl.tidnailYlprev:en~ion: is:,'defined':<:·,:'·, .'. :'r. ":
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::,furids ,t:o·,develQP:·a~d'.operat.e:programtLsucll;··assa.fe,. ': .. '
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·.:havens" c6nflict:·'resolu~ion'"peet,.mediation. ,-and . ",
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·::an:ger·:manageme~t.~·'BilT'also 1:arge't,S, ~unqs'~ at 'areas'" ,"':: .
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". ,::of:>highest·t1e,ed,:(as~ de'f~ned,CY,·sEA):,.:SSAS.rriu~t.:'" ...... .' ,'. :. \
desigll~te ':up,,·to.10'% Of'LEAsas·hign:.need·areas';./ " .. '
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.: :these :areas':~will' :get'>additioriai fundirig i '(30% . of", ."".;
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'.' ..',: 1994 when the's,t'ates;'recelved $'375rilf . ':' .. ' ,';.' .:'.'
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•.: SEAs 'and Governors ,( this . is>'an'increase~ Over'PY
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�/10/24/94
18:42
.110/24/94
15:44
I4J 002/002
IaJ 0011001
PUBLIC AFF.:.:A.:.:IR:.;.::S:.-_,--~_.
'lt202 616 0904
il·
J.
• I
DRAFT .~ .19123194 7:32pm .
TALKING POINTS ON MOF;FETf, OKLAHOMA'S POLICE HIRING GRANT
Moffett is a smali, poor town where the average incomeIs less than ~5)OOO a year•
. .unemployment is high and the poverty level is 115% below the national average.
It ca.nnot currently afford u police department
.
•
Itscrinie problems are very real, and are·exacerbated by its lack of any poHce
o
force.
...
.
.
It is highly vulnerable to drug trafficking, since it is a mile away from the
worst part of Ft. Smith, Arkansas, a city of 74,000 that is fighting its own
war on drugs, and near the junction.of two.major highways. A dr~g deal
resulted in a shooting just last week.
Its application notes that domesd~ violence' is a chronic problem that goes .'
unchecked because of the lack of policing., .
Moffett applied fOla grant application in the Fall of 1993, and its serious crime
problems and innovative strategy led to its selection for' a b'Tam.
'
,
.
,
"
The grant is in no way a surprise or unwelcome •• the application including 9
percent local match was signed by the Mayor in 1993 and supported by a city
council resol\:ltion.
!
Wh~n Moffett asked the Department of Justice to reduce its 25% match.
requirement to 9 perce.nt, the DepartIflent did so. ·CAP and the Wall Street
Journal in~orrect]y reported that Moffett, Oklahoma wiH have to provide 25
percent, but neIther bothered to check their facts on this or any other part of the
story.) .
.
,
, Moffett officials stated in their application and in private conversations this week
that they are confident that they can provide these matching funds. Payment of
Moffett's Sl1,OOOshare will be stretched over three years, and they can even delay
. ailypayment at all untiHhe third .year.
.
This admjnistratio~ takes small to\Vnandrura] crime serious]y, •• that's why it
made this grant, and that's whyit reserved half of the crime bill's police hiring
money for jurisdictions ot' 150,000 or less.
. OPTIONAL FORM 99 j7.901
FAX TRANSMITTAL
.
. '
To
.
.
�VCCA Implementation Update
(October 26, 1994)
I
1) COPS
• Phase I packages out
• Director Search continues
• Moffett, Oklahoma
• COPS AHEAD invitation out
• COPS FAST out on 11/1
2) Youth Handgun Safety Act·
• The Klain Plan
3) SCAAP
• Interim regs. donIt include locals
4) Brady/Criminal History ReCord Grants
. • Regs nellt week
5) SJV Testing
6) Violence Against Women
• Task force in formation
7) Workshops/Seminars, etc.
• NACO sateWte feed
• NAAG briefing
• Indian Tribes
• Congressionals!
8) Other
�U.S. Department of Justice
u.s. Department of Justice
Fact Sheet
Community Oriented Policing Services
Funding Accelera"ted for Smaller Towns
(COPS"FAS.T) for Populations under 50,000
Program Information:
The cOPS FAST Application is one of several .
approaches developed by the Department of Justice under
the Violent Crime Control and Law Enforcement Act of
1994 to speed the deployment of new officers devoted to
community policing on the streets and rural routes in this
nation.. As directed by Congress,. the FAST Application
dramatically simplifies the task of applying for a federal
grant. The FAST Application may be used by jurisdic- .
Hons with populations under 50,000, while the COPS'
AHEAD approach will expedite the hiring by agencies
serving larger populations.
Funding
~rovisions
o.
The FAST Application -- a fill-in-the-blank, one page
form -- will be available"by November I, 1994. The
application will request basic identifying information
about the agency, the number of police officers currently
on the force and the number of new officers requested,
basic fmancial information, and an agreeIlJent to abide by
standard legal requirements.
o
Completed applications will be due tq the COPS Of
fice by December 31, 1994. The COPS Office will in
form the agency of an authorized hiring level by February
1, 1995. Before funding may begin, jurisdictions desig
nated for funding will be required to submit necessary
budget information and a brief, satisfactory description of
community policing plans. Technical assistance with the
development of policing plans will be provided to juris
dictions in need of such assistance.
o
Up to $165 million, iIi grants will be made under
COPS FAST to state, local and other public law enforce
ment agencies which serve populations under 50,000. If
requests exceed the funds available, the amount or start
ing date of grants may be adjusted to accommodate de-.
mand. '
.
o
Funding will begin once the FAST Application has
been approved and the new officers have been sworn.
Grants will be made for up to 75 percent of the total sal
ary and benefits of each officer over.three years, up to a
maximum of $75,000 per officer.
o
COPS grant funds must not be used to replace funds '
that eligible agencies otherwise would have devoted to
future officer hiring. In other words, any hiring under the
COPS program must be in addition to, and not in lieu of,
previous hiring plans.
o
In hiring new officers, agencies may not reduce the
scope of their customary screening and training proce
dures, and must include community policing principles in
their training curricula. In addition, to the extent practi
cable, tops grant funds should be used to increase the
representation of women and racial and ethnic minorities
within the ranks of sworn officers. '.'
o An award under COPSFAST will not affect the con
sideration of an agency's application for a grant under any
other COPS program. An agency thatreceived funding
under COPS Phase I is eligible to receive additional fund
ing under COPS FAST.
October 15.1994
�u.s.
Department of Justice.
Office of the Associate AttOrney General
Hbshin,gton. D.C ~30
October 25, 1994
Dear Colleague:
The Violent Crime Control and Law Enforcement Act of 1994, signed into law by President Clinton on .
September 13, created a federal~locallaw enforcement partnership and the opportunity to hire 100,000 new· .
officers under 'the ·Cops on the Beat~ program. With community policing as jts base, the program is intended
.to encourage the development of police-citizen cooperation to control crime, maintain order, and improve the
quality of life in America. Attorney General Janet Reno bas establiShed the Office of Community Oriented
Policing Services to expedite the hiring of new police officers and to implement community policing programs.
The Department of Justice and the new Office of Community Oriented Policing Services (COPS) are pleased to
announce the Accelerated Hiring, Education, and Deployment.program (COPS AHEAD). Through this new
expedited grant approach, lawe.nforcement agencies serving populations of 50,000 or more are eligible to hire
new officers to participate in community policing, up to a maximum of 3 percent of their actual sworn officers
subject to the ,conditions contained in the attached Fact Sheet.
.
/..
. . .
.
.
.
.
.
I am enclosing a fact sheet that describes ~OPS AHEAD in more detail. To apply for a share of these funds,
you ltIlUI. return the enclosed response form to lheCOPS Offtct, poSImIJrked or foxed by November 10, 1994.
We recognize that this is a short response period, but one of the goals of COPS AHEAD is to expedite and
streamline the process of making funds available to law enforcement agencies. 'Within
weeks after receiving
·these responses, based upon the num~r of responses we·receive. we will let you know the specific numberof
sworn officers that you may select and train. Before funding is Ultimately approved~and while your new
two
officers are in training- you must still submit qualifying information concerning your community policing plan
and your budget. . .
.
.
The COPS AHEAD program is one part of a multi-faceted effort th!d will bring new officers and deputies to
cities, counties, and towns throughout America. If you do not wish to participate in COPS AHEAD. other
funding opportunities will :he available to hire new officers. Electing to wait for other programs will not
prejudice your funding opportunities under those programs. Si~larly. participatmg in COPS AHEAD ~ll not
prejudice your opportunity to l"t':IOOive funds for officers beyond those authorized under COPS AHEAD.
Announcements will be sent .to you soon about other funding opportunities. We have tried to distribute this
announcement widely and if you received more than one copy of this announcement or if your agency
not
meet all of the eligibility requirements for cOPS AHEAD. please pass the information along to. a colleague.· .
For more information about this program please call the Crime Bill Response Center at 1-800-421~770 .
does
. We look forwatdto working with you in a productive partnership to fight crime· in our country..
sm=e.?;/;
....
~.
ohn R. Schmidt
�U. S. Department of Justice
Office of Community Oriented Policing Services
633 Indiana Avenue N. w.. 3rd Floor
(202) 514·2058
FAX(202) 514·9272
Washinglon. D.C. 20531
Community Oriented Policing - Accelerated Hiring, Education and Development
LETTER OF INTENT TO PARTICIPATE
Yes, we are interested in participating in COPS AHEAD. We understand that by providing the infonna
tion requested below, and returning this fonn postmarked by November 10, 1994, we will receive a fonnal
application kit and confinnation of eligibility by November 21,1994. We also understand that COPS
AHEAD hiring grants provide a maximum federal contribution of 75% of the salary and benefits of each offi~
cer over three years, up to cap of $75,000 per officer, with the federal share decreasing from year to year.
a
. Executive Information'
.
I
I
Law Enforcement Executive's Name
------,----------------------c------,---
Address
City______ ~:__--------~
State ______-'-_ _-'-_
Telephone ___________-,-_________
.
Zip Code _ _ _ _ _ _ _ _ __
FAX
,
Government Executive's Name
~--------------~-~--~--:-----------~--------
Address
_~
__
State ______-,-_ __
Telephone _ _ _ _ _ _ _ _ _ _~_ _ _ _ __
Zip Code. _ _-'--_______
FAX
General Information
Number of Officers Requested Through COPS AHEAD _ _ _ _ _ _ _~_ _ _ _ _ _ _ _ _ _ _ _ _-
Actual Number of Sworn Officers as of October 1, 1994 ________~_ _ _-~----'--___,.~----Entry Level Annual Salary Per Officer
~.,__---
Entry Level Annual Fringe Benefits Cost Per Offi,cer _ _ __
Area of Jurisdiction (square miles) _ _ _ _ _ _ Current Population Served (per most recent U.S. Census data)_ _--'__
I certify thin. the information provided on this fOrln is true and accura~e to the best of my knowledge. I understand that,
. prior to any grant award, the applicant mustclemonstrate compliance with all program requirements of the Violent Crime
Control and Law Enforcement Act of 1994 and other requirements of federal law.
Law Enrorcement Executive's
Date
Government Executive's S ign3ture
Date
Return or FAX this ieller of intenllO:
U.S. Department of Justice
COPS AHEAD
P. O. Box 14440
Washington, D.C. 2()()44
�U.S. Department of J,ustice
,
,
U.S. Department ofJustice
Fact Sheet
, I
I
Community Oriented Policing Services
Accelerated Hiring, Education and Deployment
(COPS AHEAD) for Popul,ations of 50,900 and Over
Program Information
COPS AHEAD is one of several approaches developed
by the Department of Justice under the Violent Crime'
, Control and Law Enforcement Act of 1994 to speed the '
deployment of new officers devoted to' community polic
ing on the streets and rural routes of this nation. COPS
AHEAD pennits interestedage'ncies to begin recruiting
" a nd hiring new officers now in anticipation of later COPS
grant funding, with?ut compromising the quality and
thoroughness of officer training and the careful design of
community policing programs. COPS AHEAD will ben
efit jurisdictions with popUlations of 50,000 and over,
while COPS FAST will be used to expedite the applica- ,
dons agenCies serving smaller populations.
.
of
Funding Provisions
o Law enforcement agencies intending to participate in
, COPS AHEAD may select and train new officers now,
prior to submission and approval of a fonnal grant appli
, cation. Funding will begin once the new officers have
been sworn and a satisfactory grant application has been
submitted and approved, Grants will be made for up to
75 percent of the total salary and benefits of each officer;
, over three years, up to a maximum of $75,000 per officer,
with the remainder to be paid by state or local funds.
o Grant funds, may be used to enable each agency to
hire new officers to increase its actual sworn force up to a
maximufl'\ of 3 percent over actual October I, 1994 force
level.
o
Up to $225 million in grants w,ill be made under
COPS AHEAD to state, local and other public lavi en
, forcement agencies which serve populatiol~sof 50,000
and over. (frequests exceed the funds available, the
. amount or starting date of grants may be adjusted to ac
cOl1il1lodate demand,
o COPS grant funds must not be use& to replace funds
that eligible agencies otherwise would have devoted to
future officer hiring. In other words, any hiring under the
COPS AHEAD program must be in addition to, and not in
lieu of, officers tnat otherWise would have been hired.
"
'
o , In hiring new officers, agencies may not reduce the
scope of their customary screening and training proce
dures, and,must include community policing principles'
and methods in their training curricula, In addition, to the
extent practicable, COPS AHEAD grant funds should be
used to incr~ase the representation of women and racial
and ethnic minorities within the ranks of sworn officers.
o All agencies serving a population of 50,000 and ove,r
will receive an invitation to participate in COPS AHEAD.
In response, an int~rested agency must send a letter of,
intent to the COPS Office, to be received no later than
November 10, .1994. Tile COPS Office expects to con
finn the eligibility of applicants and proposed funding
levels no later than November 21, 1994.. Officers pro
posed to be funded under COPS AHEAD must be hired
ItO later ttEll" the agency's first class starting in ,1995.
o ' At the time that proposed funding levels are con
finned, a fonnal grant application will be sent requesting
infonnatio'n concerning the agency's strategic community
policing plan for the use of the officers that have been
..approved to be hired, budget plans and projections, and
other information to enable the COPS Office to conftnn
compliance with grant conditions,
o
An award under COPS AHEAD will not affect the
consideration of an agency's application Jor a grant under
any other COPS program. An agericy that received fund
ing under COPS PI;ase I is el igible to receive additional
funding under COPS AHEAD if the combined hiring un
der both progranis does !lot exceed 3 percent of the actual
October 1,1994 force level.
Octoher 15, 1994
�leader and a pioneer in public service for most of her life. She has
always followed her mother's rule: "Don't ever rest until good is
better, and better is best."
Ms. Reno's political career began while she was studying at
Cornell University, where she was president of the Women's Self
Government Association. She then attended
Harvard Law School. Of 500 students, she was one
I I
of only 16 women who completed the law program.
I
As Staff director of the Judiciary Committee of
the Florida House of Representatives, Ms. Reno
helped improve Florida's COUrt system. In 1976, she
became a partner in a private Miami law firm, and
later she was appointed as the first female State
Attorney for Florida. In the State Attorney's office,
Ms. Reno prosecuted and worked to prevent
homicide, child abuse, rape, drug trafficking, and
other violent crimes. She focused much of her
attention on prevention programs so that children
could live in safe environments.
One of Ms. Reno's most important programs,
the Miami Drug Court, offers alternatives to prison sentences for
non-violent criminals with drug addictions. A majority of the
people who finish the rehabilitation programs of this court remain
drug-free.
Because of President Clinton's admiration for Janet Reno's great
knowledge of the law and her longtime dedication to justice, he was
honored to appoint her the first female Attorney General of the
United States of America on March 12, 1993.
,
,
• [\.I::uuuug anne ana vIolence oy IOcarceratlng senous, repeat
offenders and finding alternative forms of punishment for first
time, non-violent offenders.
• Focusing on prevention and early intervention efforts to keep
children away from gangs, drugs, and violence and on the road
to strong, healthy, and self-sufficient lives.
• Enforcing civil rights laws to ensure equal
opportunity for all Americans.
~.
~--
-
.
• Using the law to ensure that the waters,
land, and skies of America are protected
from pollution.
• Building a Department of Justice that
reflects a diverse government of the
people, by the people, and for the people,
making integrity, excellence, and
professionalism the hallmarks of the
department.
THE WHITE HOUSE
•
Attorney General Reno lives in
Washington, D.C., and is frequently visited
by her family. She likes to hike and canoe, and she enjoys reading
poetry and listening to music. She often visits her family home,
built by her mother, near Miami, Florida.
On a daily basis, Attorney General Reno confronts the urgent
need to protect Americans from crime and violence. Her mother's
"good, better, best" rule serves her well in her position as our
nation's highest law enforcement officer.
To learn more about crime, you may want to visit your local library or contact a local organization
in your area. In addition, you can write your representatives in Congress and ask their views on this
important topic. You can also contact some of the many national organizations that deal with these
issues. A few of them are listed below.
Alateen
AI-Anon Family Group
Headquarters, Inc.
Post Office Box 862
Midtown Station
New York, New York 10018-0862
1-800·356-9996
America's PRIDE Program
National Parents' Resource
Institute for Drug Education
Suite 340
10 Park Place South
Atlanta, Georgia 30303
404·577-4500
Center to Prevent
Handgun Violence (CPHV)
Suite 1100
1225 Eye Street, N.W
Washington, D.C. 20005
202-289-7319
Crime Stoppers International (CSI)
Suite B4
3736 Eubank Northeast
Albuquerque, New Mexico 871 I I
505·266-2744
Do It Now Foundation (DINF)
Post Office Box 27568
Tempe, Arizona 85285
602-491-0393
Drug Abuse Resistance
Education (DAR.E.)
Post Office Box 2090
Los Angeles, California 9005 I
1-800-223-DARE
Educational Fund to End
Handgun Violence (EFEHV)
Box 72
I 10 Maryland Avenue, N.E.
Washington, D.C. 20002
202·544-7227
Produced by the White House Office
"Just Say No" International
Youth Power Program
Suite 1300
2101 Webster Street
Oakland, California 94612
5 I 0-451-6666
Students to Offset Peer
Pressure (STOPP)
STOPP Consulting Services
Post Office Box 103
Hudson , NH 03051-0 I 03
603-889-8163
National Crime
Prevention Council (NCPC)
Second Floor
1700 K Street, N.W
Washington, D.C. 20006-3817
202-466-6272
Target - Helping Students
Cope with Tobacco,Alcohol,
and Other Drugs
I I 724 Northwest Plaza Circle
Post Office Box 20626
Kansas City, Missouri 64195-0626
816-464-5400
Students Against
Driving Drunk (SAD D)
Post Office Box 800
Marlboro, Massachusetts 01752
508-481-3568
of Presidential Student Correspondence; Debra Wood,
Director.
Youth to Youth International
Third Floor
700 Bryden Road
Columbus, Ohio 43215
614-224-4506
S
hite House
WASHINGTO N
o
gun
Welcome to the fall issue of Inside the White House. This
newsletter is designed to keep you informed about some of the
important issues being discussed here in Washington, D.C.-both at
the White House and on Capitol Hill. The topics featured in this
newsletter are those that young people most often write to me about.
This issue focuses on anti-crime efforts in our country.
As a parent and as President, I am deeply troubled when I hear
stories about crime and violence on our streets in America. Too many
children are afraid of getting hurt on their way to school. Too many
families don't feel safe in their own homes because their
neighborhoods are so dangerous. One of the greatest responsibilities
of any government is to protect the safety and well-being of its
citizens, and we are taking steps to reduce crime and renew
Americans' sense of security.
In September, I signed into law the most significant anti-crime
legislation in our nation's history. The law is a comprehensive attack
on crime-putting more police officers in neighborhoods across the
nation, providing tough punishment for criminals, and supporting
programs designed to prevent crimes.
As your President, I am continuing to address crime and other
issues that affect you, your family, and all Americans. I want you to
be able to look forward to the brightest future possible.
Sincerely,
outb
crease
~~
rl e IS spreading
�these problems affect nearly all American families. Violence
is a threat everywhere. It occurs in fast-food restaurants,
mall parking lots, and schools. Every day, you probably read
and hear about tragedies related to violent crime-in the
newspaper, on television, and maybe from your friends and
family members. And crime is not limited to anyone area
of our nation-it occurs in cities and rural areas, in large
and small communities.
President Clinton is concerned about crime and its
effects on the safety and well-being of Americans of all ages.
H e wants all people to feel safe in their neighborhoods and
in their schools, and he is working to replace people's fear
with a sense of security. As part of his efforts to ensure that
America's neighborhoods are safer, the President recently
signed into law a comprehensive crime bill-the broadest
attack on crime in our nation's history.
The crime bill takes a comprehensive approach to
reducing crime and violence- addressing police,
punishment, and prevention.
POLICE
One way to reduce crime is to increase the number of
police officers in neighborhoods across the country. The
crime bill will make it possible for state and local
governments to hire 100,000 more local officers. They will
take an active role in the communities they serve, patrolling
the streets, listening to citizens' concerns, and building
partnerships with residents to try to prevent crimes before
they occur.
These police officers will
help
bring
community
members together to solve
problems effectively and
efficiently. They also will
encourage citizens of all ages
.... to take responsibility for
/
.!
their own actions and for
...
making their communities
safer. With
the
active
involvement of the people they serve, police can identify
potential problems before they result in crime. In cities and
towns across the country, communities have demonstrated
how important simple steps can be in promoting safety and
avoiding tragedy.
The bill also supports scholarships for police officers and
for students who agree to serve as law enforcement
officers. Providing scholarships for young people who are
committed to serving their communities after graduation
can help produce well-educated police officers who have
trained and prepared for years for their jobs. Scholarships
also will be available to current police officers who want to
further their education and improve their skills.
"{
Y~.r . ~~I '~ '
~,
,.J(\ri.. _~
"-
~\
,. \ ~
(above) President Clinton appeared in a public service announcement with
Alicia Brown, a student In Washington, D.C., to raise awareness about the
problem of crime in America. (below left) On September 13, 1994,
President Clinton signed the crime bill into law.
PUN ISH MEN T
Hiring additional police officers is an important step in
our fight against crime. But once a person is convicted of a
crime, it is important to provide appropriate punishment.
Much of the violent crime in our nation is committed by
a small number of "repeat offenders." Our criminal justice
system imposes the most severe penalties for these
hardened criminals. To make sure that violent criminals are
not free to victimize innocent citizens, the crime bill
includes a "three strikes and you're out" provision. This
means that people will be locked up for good if they are
convicted of a serious, violent felony under federal law after
being convicted previously of two or more violent felonies
or drug offenses. The crime bill also expands the death
penalty to cover the most vicious crimes against society.
Prison and jail crowding is a problem in almost
every state in our nation. Often, prisoners are
released before they have served their entire
sentences because there is not enough space for
everyone who needs to be detained. The crime bill
w ill provide more money for states to use to build
prisons to house violent criminals.
Not all people who commit crimes are repeat
offenders or violent criminals. In fact, in recent years,
more young Americans have become involved in
criminal activities. Too often, the only options for
punishing youthful offenders are probation-which
may not provide adequate supervIsion-or
incarceration with the most hardened criminals.
Locking up youths with adult criminals exposes
them to negative role models who can teach them
how to lead a life of crime.
speCifically designed To r young,
nonviolent offenderS-including
weekend incarceration, community
service, and "boot camps." A boot
camp program is similar to military
basic training. Young people who
participate have a short period of
confinement, followed by intensive
community supervision. Designed
to impose discipline, instill a respect
for authority, and provide physical
conditioning,
these
programs
provide a strict environment in
which youth can be taught to avoid
a life of crime. Participants also are
given an opportunity to receive
education and counseling, as well as
treatment for drug abuse if necessary.
Currently, 28 state prison systems operate 43 boot
camps, and more states plan to follow. Boot camps are far
less expensive than long-term incarceration, and some
states have found that they also are more likely to decrease
criminal behavior. Together with post-release services and
supervision, boot camps can help youth develop skills, learn
values, and prepare for employment.
PRE VE NT ION
While addressing the critical need to hire more police
officers and punish individuals who threaten public safety,
the President also believes it is important to act to prevent
crime from occurring. Because he wanted the crime bill
to be a balanced approach to crime, he supported several
(below) Since taking office, President Clinton has listened to the concerns of
Americans of all ages. (above right) On November 30, 1993, President Clinton
signed the Brady Bill into law. This law is named for James Brady, who was
wounded in the assassination attempt on President Ronald Reagan in 198/.
Many SChOOlS and communities prOVide activities tor
young people to say "yes" to while they say "no" to gangs,
guns, and drugs. The crime bill supports programs such as
after-school, weekend, and summer activities; training to
resist joining gangs; and sports and recreational
opportunities. Many of these programs involve community
organizations and police officers, who clearly understand
the need to keep kids from joining gangs, using drugs, or
illegally using guns.
An important part of crime prevention is reducing the
use of guns for violent crimes. The President has taken
several steps to address this urgent problem. First, he
signed the Brady Bill
into law last year. This
legislation requires a
five-day waiting period
for the purchase of a
handgun, during which
all potential purchasers
~
.
must submit to a
(&
background
check.
Since the enactment of this law, many individuals have been
denied guns after a background check revealed past
criminal offenses.
In addition, the crime bill outlaws the sale of 19 of the
deadliest assault weapons-the types of semiautomatic
firearms that have been used by drug dealers, gang
members, and terrorists. The law also safeguards the rights
of hunters to own guns, protecting 650 sporting rifles for
the use of those who enjoy the sport. And because the
number of young people who have been charged with
illegally possessing a handgun has increased dramatically in
recent years, the crime bill bans the sale of handguns
to juveniles.
~' J
\ .•
~r /l ' {
.
IL
1
The passage of the crime bill was a high priority for
President Clinton.The law provides a balanced approach to
combatting crime-increasing the number of police
officers, ensuring appropriate punishment for crimes, and
supporting effective crime prevention programs.
While the law takes many significant steps that will help
reduce crime, the problems of crime and violence cannot
be solved by legislation alone. No federal program will be
truly successful without the help of Americans like you.
What can you do about crime? You can playa vital role
in the national effort to prevent crime by staying away from
drugs, looking out for your neighbors, walking away from
arguments before they turn violent, and treating others
with respect. Remember that as a student and as a citizen,
you share responsibility for creating a safer community, a
safer nation, and a safer world.
With your help, America can be a more secure place for
you, your family, and future generations.
�United States, has been a
• Reducing crime and violence by incarcerating serious, repeat
leader and a pioneer in public service for most of her life. She has
offenders and finding alternative forms of punishment for first
always followed her mother's rule: "Don't ever rest until good is
time, non-violent offenders.
better, and better is best."
• Focusing on prevention and early intervention efforts to keep
Ms. Reno's political career began while she was studying at
children away from gangs, drugs, and violence and on the road
Cornell Universiry, where she was president of the Women's Self
to strong, healthy, and self-sufficient lives.
Government Association. She then attended
Harvard Law School. Of 500 students, she was one
• Enforcing civil rights laws to ensure equal
of only 16 women who completed the law program.
opportuniry for all Americans.
I
As staff director of the Judiciary Committee of
• Using the law to ensure that the waters,
the Florida House of Representatives, Ms. Reno
..
land, and skies of America are protected
helped improve Florida's court system. In 1976, she
from pollution.
became a partner in a private Miami law firm, and
• Building a Department of Justice that
later she was appointed as the first female State
~
reflects a diverse government of the
Attorney for Florida. In the State Attorney's office,
people, by the people, and for the people,
Ms. Reno prosecuted and worked to prevent
making integriry, excellence, and
homicide, child abuse, rape, drug trafficking, and
~
professionalism the hallmarks of the
other violent crimes. She focused much of her
department.
attention on prevention programs so that children
could live in safe environments.
Attorney General Reno lives in
•
One of Ms. Reno's most important programs,
Washington, D .C., and is frequently visited
the Miami Drug Court, offers alternatives to prison sentences for
by her family. She likes to hike and canoe, and she enjoys reading
non-violent criminals with drug addictions. A majoriry of the
poetry and listening to music. She often visits her family home,
people who finish the rehabilitation programs of this court remain
built by her mother, near Miami, Florida.
drug-free.
On a daily basis, Attorney General Reno confronts the urgent
Because of President Clinton's admiration for Janet Reno's great
need to protect Americans from crime and violence. Her mother's
knowledge of the law and her longtime dedication to justice, he was
"good, better, best" rule serves her well in her position as our
honored to appoint her the first female Attorney General of the
nation's highest law enforcement officer.
United States of America on March 12, 1993.
,
,
-
:1. __
....
America's PRIDE Program
National Parents' Resource
Institute for Drug Education
Suite 340
10 Park Place South
Atlanta, Georgia 30303
404-577 -4500
Center to Prevent
Handgun Violence (CPHV)
Suite 1100
1225 Eye Street, N.W.
Washington, D.C. 20005
202-289-7319
Crime Stoppers International (CSI)
Suite B4
3736 Eubank Northeast
Albuquerque, New Mexico 871 I I
505-266-2744
Do It Now Foundation (DINF)
Post Office Box 27568
Tempe, Arizona 85285
602-491-0393
Drug Abuse Resistance
Education (DAR.E.)
Post Office Box 2090
Los Angeles, California 9005 I
1-800-223-DARE
Educational Fund to End
Handgun Violence (EFEHV)
Box 72
I 10 Maryland Avenue, N.E.
Washington, D.C. 20002
202-544·7227
WASHIN G TON
Cr
"Just Say No" International
Youth Power Program
Suite 1300
2101 Webster Street
Oakland, California 94612
5 10-451-6666
National Crime
Prevention Council (NCPC)
Second Floor
1700 K Street, N.W.
Washington, D.C. 20006-3817
202-466-6272
Target - Helping Students
Cope with Tobacco,Alcohol,
and Other Drugs
I 1724 Northwest Plaza Circle
Post Office Box 20626
Kansas City, Missouri 64195-0626
816-464-5400
00
Students to Offset Peer
Pressure (STOPP)
STOPP Consulting Services
Post Office Box 103
Hudson,NH 03051-0103
603-889-8163
Students Against
Driving Drunk (SADD)
Post Office Box 800
Marlboro, Massachusetts 01752
508-481-3568
Produced by the White House Office of Presidential Student Correspondence; Debra Wood, Director.
e
\Nounde
To learn more about crime. you may want to visit your local library or contact a local organization
in your area. In addition, you can write your representatives in Congress and ask their views on this
important topic. You can also contact some of the many national organiz.a tions that deal with these
issues. A few of them are listed below.
Alateen
AI-Anon Family Group
Headquarters, Inc.
Post Office Box 862
Midtown Station
New York, New York 10018-0862
1-800-356-9996
THE WHITE HOUSE
Youth to Youth International
Third Floor
700 Bryden Road
Columbus, Ohio 43215
614-224-4506
S hiteHouse
-
Welcome to the fall issue of Inside the White House. This
newsletter is designed to keep you informed about some of the
important issues being discussed here in Washington, D.C.-both at
the White House and on Capitol Hill. The topics featured in this
newsletter are those that young people most often write to me about.
This issue focuses on anti-crime efforts in our country.
As a parent and as President, I am deeply troubled when I hear
stories about crime and violence on our streets in America. Too many
children are afraid of getting hurt on their way to school. Too many
families don't feel safe in their own homes because their
neighborhoods are so dangerous. One of the greatest responsibilities
of any government is to protect the safety and well-being of its
citizens, and we are taking steps to reduce crime and renew
Americans' sense of security.
In September, I signed into law the most significant anti-crime
legislation in our nation's history. The law is a comprehensive attack
on crime-putting more police officers in neighborhoods across the
nation, providing tough punishment for criminals, and supporting
programs designed to prevent crimes.
As your President, I am continuing to address crime and other
issues that affect you, your family, and all Americans. I want you to
be able to look forward to the brightest future possible.
Sincerely,
'{outb
crease
~~
rIme IS spreading
�most Americans. In one way or another;
these problems affect nearly all American families. Violence
is a threat everywhere. It occurs in fast-food restaurants,
mall parking lots, and schools. Every day, you probably read
and hear about tragedies related to violent crime-in the
newspaper, on television, and maybe from your friends and
family members. And crime is not limited to anyone area
of our nation-it occurs in cities and rural areas, in large
and small communities.
President Clinton is concerned about crime and its
effects on the safety and welI-being of Americans of all ages.
He wants all people to feel safe in their neighborhoods and
in their schools, and he is working to replace people's fear
with a sense of security. As part of his efforts to ensure that
America's neighborhoods are safer, the President recently
signed into law a comprehensive crime bill-the broadest
attack on crime in our nation's history.
The crime bill takes a comprehensive approach to
reducing crime and violence- addressing police,
punishment, and prevention.
.............
7'11"'"
POLICE
One way to reduce crime is to increase the number of
police officers in neighborhoods across the country. The
crime bill will make it possible for state and local
governments to hire 100,000 more local officers. They will
take an active role in the communities they serve, patrolling
the streets, listening to citizens' concerns, and building
partnerships with residents to try to prevent crimes before
they occur.
These police officers will
help
bring
community
members together to solve
problems effectively and
efficiently. They also will
r\~~ encourage citizens of all ages
.... to take responsibility for
their own actions and for
'making their communities
safer. With the active
involvement of the people they serve, police can identify
potential problems before they result in crime. In cities and
towns across the country, communities have demonstrated
how important simple steps can be in promoting safety and
avoiding tragedy.
The bill also supports scholarships for police officers and
for students who agree to serve as law enforcement
officers. Providing scholarships for young people who are
committed to serving their communities after graduation
can help produce well-educated police officers who have
trained and prepared for years for their jobs. Scholarships
also will be available to current police officers who want to
further their education and improve their skills.
,
~. · -'{I ~. ~
' -~
\
"' :~~; ~~I '~'
.
"-
(above) President Clinton appeared in a public service announcement with
Alicia Brown, a student In Washington, D.C., to raise awareness about the
problem of crime in America. (below left) On September 13, 1994,
President Clinton signed the crime bill into law.
PUN ISH MEN T
Hiring additional police officers is an important step in
our fight against crime. But once a person is convicted of a
crime, it is important to provide appropriate punishment.
Much of the violent crime in our nation is committed by
a small number of "repeat offenders." O ur criminal justice
system imposes the most severe penalties for these
hardened criminals. To make sure that violent criminals are
not free to victimize innocent citizens, the crime bill
includes a "three strikes and you're out" provision. This
means that people will be locked up for good if they are
convicted of a serious, violent felony under federal law after
being convicted previously of two or more violent felonies
or drug offenses. The crime bill also expands the death
penalty to cover the most vicious crimes against society.
Prison and jail crowding is a problem in almost
every state in our nation. Often, prisoners are
released before they have served their entire
sentences because there is not enough space for
everyone who needs to be detained. The crime bill
wil l provide more money for states to use to build
prisons to house violent criminals.
Not all people who commit crimes are repeat
offenders or violent criminals. In fact, in recent years,
more young Americans have become involved in
criminal activities. Too often, the only options for
punishing youthful offenders are probation-which
may not provide adequate supervIsion-or
incarceration with the most hardened criminals.
Locking up youths with adult criminals exposes
them to negative role models who can teach them
how to lead a life of crime.
alternative forms of punishment
specifically designed for young,
nonviolent offenders-including
weekend incarceration, community
service, and " boot camps." A boot
camp program is similar to military
basic training. Young people who
participate have a short period of
confinement, followed by intensive
community supervision. Designed
to impose discipline, instill a respect
for authority, and provide physical
conditioning,
these
programs
provide a strict environment in
which youth can be taught to avoid
a life of crime. Participants also are
given an opportunity to receive
education and counseling, as well as
treatment for drug abuse if necessary.
Currently, 28 state prison systems operate 43 boot
camps, and more states plan to follow. Boot camps are far
less expensive than long-term incarceration, and some
states have found that they also are more likely to decrease
criminal behavior. Together with post-release services and
supervision, boot camps can help youth develop skills, learn
values, and prepare for employment.
PRE VE NT ION
While addressing the critical need to hire more police
officers and punish individuals who threaten public safety,
the President also believes it is important to act to prevent
crime from occurring. Because he wanted the crime bill
to be a balanced approach to crime, he supported several
(below) Since taking office, President Clinton has listened to the concerns of
Americans of all ages. (above right) On November 30, 1993, President Clinton
signed the Brady Bill into law. This law is named for James Brady, who was
wounded in the assassination attempt on President Ronald Reagan in 1981.
community level.
Many schools and communities provide activities for
young people to say "yes" to while they say "no" to gangs,
guns, and drugs. The crime bill supports programs such as
after-school, weekend, and summer activities; training to
resist joining gangs; and sports and recreational
opportunities. Many of these programs involve community
organizations and police officers, who clearly understand
the need to keep kids from joining gangs, using drugs, or
iliegally using guns.
l
An important part of crime prevention is reducing the
use of guns for violent crimes. The President has taken
several steps to address this urgent problem. First, he
signed the Brady Bill
into law last year. This
legislation requires a
five-day waiting period
for the purchase of a
handgun, during which
all potential purchasers
must submit to a
background
check.
Since the enactment of this law, many individuals have been
denied guns after a background check revealed past
criminal offenses.
In addition, the crime bill outlaws the sale of 19 of the
deadliest assault weapons-the types of semiautomatic
firearms that have been used by drug dealers, gang
members, and terrorists. The law also safeguards the rights
of hunters to own guns, protecting 650 sporting rifles for
the use of those who enjoy the sport. And because the
number of young people who have been charged with
illegally possessing a handgun has increased dramatically in
recent years, the crime bill bans the sale of handguns
to juveniles.
P ttI \ ••
'
~I ,( 44!.
1
t·
-
.
-
The passage of the crime bill was a high priority for
President Clinton.The law provides a balanced approach to
combatting crime-increasing the number of police
officers, ensuring appropriate punishment for crimes, and
supporting effective crime prevention programs.
While the law takes many significant steps that will help
reduce crime, the problems of crime and violence cannot
be solved by legislation alone. No federal program will be
truly successful without the help of Americans like you.
What can you do about crime? You can playa vital role
in the national effort to prevent crime by staying away from
drugs, looking out for your neighbors, walking away from
arguments before they turn violent, and treating others
with respect. Remember that as a student and as a citizen,
you share responsibility for creating a safer community, a
safer nation, and a safer world.
With your help, America can be a more secure place for
you, your family, and future generations.
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MEMORANDUM FOR THE ATTORNEY GENERAL AND 'CAROL RASCO"
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COpy, 'TC;>:
, PATGRIFFIN,- JACK QUINN,';RAllM EMANUEl., ,BRUCE ,REED,
MARTHA FOLEY, ,J~IE GORELICK, JOHN SCHMIDT
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FROM:
, CR:U·iE, BILL "'REDOX"
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&y now",' we '~reall' aware' of the, Republi'can proposal to'
revisit:, last year',s hard-Won crim.e BilL '. The pur-pose of, this,
,memorandum is to respond to Carol' Ras,co ··s request, that I outline
,some of the choices we' face in dealing 'with this GOP initiative,
,and offer, some ldeas about how_ to deal, 'with those Challei:i(ies~
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'INTRODUCTION:'
THE REPUBLICAN STRATEGY
'Based on my conversations with key staff people, and a
review'of'the ,draft House GOp:Bill, we know the, basic outline, of
• the ,GQ'p strategy' on ,revisitingtheC,rime Bill::
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They intend to lnovefast'onthecrime'Bill --itwill 'be one
,of'thei-r' very .first' ,items;. , ,
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,As made clearer'belpwitheir major substanti~e,goals are
aboliShing the .100, OD,D cops program; v-riping- out the
prevention ,programs; arid adding ntougher" provisions em,
habeas reform', exclusionary rule,' and crf.minal senten.cing. i
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, The, GOP'.leCldersh~p does ,not; 1ntend to push a repeal of the
Assau,lt Weapon Ban ...;- ,but they ar,e probably unable' to '
prevent their "back-"benchers·t from launching, such an effort.
'other matters',' however I ,remain' unresol ~ed-- ~~d' pose interesting
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They are divided over whether they want, to prod~ce a hill
that the President will (or must) sign -- or w~ether they'
looking to taullt him into ~ politically-difficul,t ve'to;
,Senat!?! - R~publicansdo not. appe~rtobe fully,'s~'gn~don to
the House GOP plan --:-preferring, f.or example, . provisions
that ar,e more favorable. to Governors i '.and'
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'How the GOP leadership' will acconUnodate the press for' ac,tibn '
on an assault wea.pons repeal-:-- perhaps moving ,it as a
separat,e bi) 1 inte;nded to be' vetoed
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still; they havca;ba.sic game pl<;lnthat 'is Clear: they will
attempt"divide our remaining force~' on the Hill with a ·tough-on...,.
cl"ime bi'll that slashes prevention, while also quietlytak~ng.
away one' of ourpes,t victorie.s,· the 100,000 cops program.,.'
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To counter this, we will need ,a clear and.· strong.re$pon~e.·
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' , I t will need tqemphasize'that.:we want to build·upon last year's
bill-- strengthening and improving ,it:-- 'w:ithoutqoing .
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'Arid ;above alI,. :our strategy 'needs to be cognizant.
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fact ·that' t:ttere are ,only two ,possible' 'outcomes:~ the, President
. wiil'· ha.ve, to· sign the' .
bfllthat congress sends :j':'
bim,qr vet.p it:·
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If'thePresident s1gl) 'this b111, it'willoutrage our core
constituency in the CQngress' ....- ,iithis is where we 'are
headed, posturing for'their benefit along.the .way ma,kes
little,sense (and'instead, we should be looking now for ways
to~lose .the· gap. between~sandtheGOP on this" issue).
If, on the 'other hand, 'the' Pre~ident e~ds "up' vetoing ,the
bill, then the fight will· be over wbY he v~toed it .__ ..
requi~ing ,that we be highly disciplined in the 'early stages
in saying 'what will or, will not:; oppose. We cannot
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.. eedlessly' give theG'OPthe 'opportunity to say: that the'
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President ip.veto:i,ng a'lCtough on·crime" bill. for,Usoft on
crimen reasons., .
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The inevitability of ·th'is.choice drives where we should stand on.
certain isspes -- for ,examplE;1, on defending the most hotly
assa~lted:prevention programs.
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THE REPUBLICAN BILL,.
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, while senate Republicans.are. still work:ing~'House
" . Republicans have already producec:t ,(i- draft· bill.' summ'aries . and
. spending .charts are attached; ir.onidally, its price tag of $29'
'billion is about the 'same as the "bloated" 1994 Crime Bill 'that
they 'deemed so vastiy ,ov~rftinded.
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,The major features. ofth~' House Republican bill are:
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Elimination of.tqe lOO~OOO cops/program, to.be replaced by a
"Law EnfQrcement Block.Grant~" that loc~lities canuse.to
. hire .cops, pay' ove'rtime/.buY police equipment,. beef .. up
school security i or fund citizen watch groupS'j , '
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. Elimination of most o'{ the' crim,e prevention programs, wi,th
, SOlne of the fUl")ding' (about $1' billion) moved into the '''Law
'Enforcement 'BloC;k Grant," and another chunk ($2 billion)
reallocated. t~ ~risons~
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Tough habe(ls,COrp~sand exclusionary rule refoi-rn, ~esigned'
,to sharply liniit death row' appeals, and, broaden the use of '
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, ,illegally s(;:iz'edevidenc,e in COUl:"ts;
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Tougher truth in sentencing'standards for states that want
prisori:gr~nts,along with . '
limits,on priso~er . .
lay,rsuits; 'and
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Various other pri::lVisi6ns"6nvi6tim~ right~ and .criminal .
'. alien-deportation (;that we generally' 'support)_ .'
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All, of the ' above, are.' fairly'\)bViousand' self....;explanatory; "except
,perhaps the. first' -;-, the elimination of the ' 100 i 000 cops program.
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. . The Reptiblicans' 'goal, here is purely PQlitical ~nd tactica'l:
to'take ,away the clearest, 'best nClinton'achievement" 'on crime,
and to deprive the Pres'ident'of the~6pportunity to aw~rd
,'communi,ties 'all "over th,iscountry the,ir share of', the 100,000. 'new,
'P91ice 6ffi6ers.,'
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,Their' method'is fairlycl~ver:'by'movingpolice hiring ,funds ,
into anew: blockgraht,'Repuqlicans arese,lliJ1g ,,:the mayors on 1::he
,idea that. they will. 'get'.all.thec.ops' ,money we would gi va them
"put with 'no' r~quir;.em~nt that'it'be.m~tched,', or thci.tthefunds be
used~to'hire p61ice.'
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ThUS, many mayors will support the'GOP'package in lieu of
·,the 1994, crime Bill, because ::the burden 6:n' 1::he, m~yors ~s lesser
.' (no match) , the ,funds more flexible, . and .the· tot,al funqing
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roughly. equal to what they actually expect'to see appropriated,'
'for COPS and, crime preventiori. Police groups may (llso support
'the GOP,astheyprcfer having m,ore money for overtime and
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equipment for .existing, cops I,' rather than 'our pl?rl to hire new' .
.... " 'poli'ee. Many Democratic Members ·o.f Congress," will, in the
absence of -leadership from us, go' the way of the \ Mayors. ' ~ "
Moderate Republicans ,we're p\l,shingthis idea'last:yeari they,' to.o,
are very·likely to lineup behind it now'. .,'
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In 'sum, theioo"ooo ~ops program is'substanti'ally a:trisJ~
,'from the Republican p:r:oposa'l. Our 9Illy ehance to save it is a
strong, publioi' confrontational "~i,l1e in "the sana." message from
the ~resident, of. the, . rol16~ing sort:
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( "Congress passed the 100,1)-00 cops prC?gram last"year, and'!'
signed it: that ',is. l!l:l 'I contract with, i:he ,Am€ ! iican people •. I ,
I will fight. against -~ Twill. v~to --any bill that repea~s
my guar.a,nte'e .. of 100 ,.000 ,new' pOl.ic'e on ours,treets. n
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Towage this, fight, wewil,l,need to attack the. Republican's pard,
f,or playing ,politics with the 100,'0,00 'cops, and 'fo:!:' passing out " '"
"pork" to maydrs --' focusing ,:our efforts on saving the COPS'
,program; as 'oppose~to all of the crime, bil+. prog'rams ,(i.e."
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The natural tendency of the press'corps,wi1l, be toplav the
fight as the Republicanstltough on crime" vs. Democrats
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Ufightingfor prevention", -- they will be· incU,ned to "TIli'ss":,
our stand for the policeprogral'li,and describe us a's ",
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,fighting,for,prevention,onl'y.' In, response, to save the cOPS
program, our rhetoric must focus' cfearly gn that program
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"and to make it clear that weare pushing the tougher on
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This' will be hard. We will have few Congressional Democrat,s" ,few, '
,mayors I ,few police groups r on dur side . But if, we really care
about saving this 'program, it'willtake, a fo<;:used and disciplined
,effort to be successful.
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REPEAL OF THE ASSAULT WEAPO~ BAN
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One 'is~ue not included in the Republi::al1oillis arepea1'of,
the: assault weapon ban: their leadership wants to ge.t the focus "
. off this, issl.l:e; 'wh fch divides theit party as i t ~o,es ours. ' But '
,notwithstanding the desire of the GOP le,adership, to make this"
issue go away I we all know that a large share of their ,'ra~k-and-",'
file --and: some of. their key' cortstituenc,i~s -- are going to' '
demand :action, on repealing the gunban~' ",
,We, can expect floorarnendments ~n the House 'and Seriate' to \'
rep,eal the gun ban -- and those measures 'will probably pass in
both chambers, given their new line-ups., ,While some .Senate'
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particular use' ;of that device might play into' Republican hands.'
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'Given' that, , we ar~, probably iO,oking at an assault weapon
.t::epeC\l 'making it'to,Confer~nce,--,with the Republicans forced to:
'choose between, including it'.in their Crime ,Bill,,!which,presumably
'gives ,th~ President· a solid basis~or vetoing' ,the bill), or,
,sendiIlg , it as a ~eparate bill ,to ,the President(~hich the'NRA
views 'as a sell-out}.' .Rep. Glngricp. fayors, this' second course
1. e.~, l:et, the Members vote, and make" the ,President veto' it, ' ,
without allowing' the 'a!i3sault weapon issue to derail the, GOP Crime
8111 ';"'"~ but where it~li'll, come out" is'stil1'unclea,r'.
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PUR STRATEGIC POSTURE
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's~rat~gici optiorts:
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IntensiveEngaqerne~t.' The,'President could stay a,bove,
the fray, ~ayingthathe supports lastyear'scrime Bill but
does not obj,ect'to Congressional efforts to improve it '-- , '
largely,' staying ,6u,t of, the fight. This strategy w,ould: ! '
envision the, President signingth,e Bill that congress pa'sses
,(assuming 'that this B,ill does n,ot include an a!Ssaul~ ban'
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(1) ,Avoid
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Does not involve taking new positions
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a1ienating' congressional Delnocrats because we, do '
not'affirmativelyback,changes'in the Crime Billi
"Looks presidential" ... .;. the President stays above
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, .on-crimebili in the end.
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If nqt .quite' a ,betrayal, Congressional Democrats"
will,' view'this as an .'abandonment'-'-: a :r;epeat ,of
our, 1993 IIhandsoffli approach'to crime bills;
Means 'that a repeal of lOO,OOO coPS. program and
allprev~nti(m,programs is assured;
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Concedes this issue and the Crim's Bill to theI GOP .
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('2 >. Support "Going ',Forward,;' Contest IlGoing Back" ~ :A second
, approach ¥IOU 14 ,be, to' welcome Republican efforts to build: on,
last year I s trimeBill, but 'to vigorou~vly,'oppose -- even
,with a 'veto thre,at-~proposals that would tear down .what
, has" been accomplishe.d~ , Specif~cally" I would' propose two
. ulines in the., '~andn -- a yeto ,threat of any' bill 'tha,t' would:
. (1) . eliminate the gua'ra~tee of 100,000 new cops ; . and (2)
,eliminate the assault:weapon ban. . .
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" Shows, the Pr.esident· standing up for his, core '
beliefs and his core aCl';lievements;
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'. Stansls behind last :y"eal;' I s ~cJiievernerits;')
• If t~e'billp.ssed by Con~~ess'pres~rves 100,obo
c'ops and the gun ban~ thel'residfant ba'sa "win'"
.when he signs the new'.C'rime-Bill~;
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'con: ' •. 'congressional tiberals w,ill, res,ent.selective use
.of Presidential power -- t.hey, will want: all crime,
bill programs protected"by.ve.to threat.;:' '"
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'. May provoke bitter confrontation with(Republicans
--: they may call our ub1uff'~ just to' see' if the
Pres'ldent wiTl veto: a Il,tough ot;l crime" bill i , '
.', . Conservat.-),ve denlocrats will: probably, resent
another~~gh-profJle 'foc\ts on assault'w~apons.
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(3) Vigorous Defense of Last Year's Bi 1.1. 'The third strategy is
a broader version ,of the ,second -,- to extend the "forward
, only~ 'n,o going back u formulation to the 'whol.~ of' last year IS,
crime bill, inclupingthe prevention prograllls.'"
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Provid:e:s"astrong, full defense of "what we
believ.e in u ,~ ... looks' principled;
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• ,This leaves us defending some unpopular' programs;' '
• ,It ,makes it very hard :Cor moder~tes ':--:,both
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ItIt is certain to provoke a, biter confrontation
w~th Republicans in Congress~,
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(4) Offer, New Crime Legislation Building Upon Last Year· s BilL",
','l'hisfinal possibility is consistent 'with,:the'second; i.e~,
, we ,could draw some "l,ines in the sahd" about what we wIll, '
pppase; 'while also proposing a new b~ll th~t: would indicate '
some ideas ab,out how to' "move forward. 1I
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Allows us to be IIfor" something" and" not just
"against", the,ir proposal;.,
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,'moderates and MaYors to' our causei', " ' "
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,~Makes the,' ultimate p:t:'oduct from congress' (which
wou1d probably reflect a mix: of ,our stuffandl the"
GOP, bill) a IIwintr 'on_ a n'ewbill that the President',
wanted~' rather than a repeal of :last ',year I s bill. , "
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preventionc~ts) will be 'seen as: selli~9 out;
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Ourcen:trist bill may laCK' congr~ssional support:
it. will be too conservative" for Democrats, ,top
, liberal ,for ~epublicans;
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to the right,in an ef'fort, to "outbid" us. '
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personal view is that ~e shOUld colnbine" (2) nan~ It (4) :'~' the
l?res:ld.ent,s~ould' ~~y ~hat,h$will fight any bill t~at 9'o~:;
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back~ards ,(l.ncludl.nq a veto threat on COPS, and assault, weapons),
"'hile offering a constructive proposal for, moving, ahead. ~",'
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Attached is a very', very rough outline of a possible new
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Crime, Bill --one ~that builds, upon the foun,dat~on, of last:. year's,
bill. Alsoattache~,~re:comparisQnCharts of Cay ~ast yeaifs
bi11 to (b) the GOP 1995 Bill, and to ,(c) our possible 199.5 bill.
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Among 'the major feature,s of/our bill',woul'd be:
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Law Enforcement:· We~i:)\ild keep, the 100,. 000 'cops program;
double the Police corps"program; add 4, 000 new 'police for'
schools that want GOps in the hallsj and' allow local "
governments to use crime'prevention funds to pay their share
'of the,,~ocal match for police hiring grants.,
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Prisons! w~ wouid r'equire states,that want. prison grants to
abolish parole and have pre-trial ¢letention for violent
offenders. We would provide $700 million ~o build
f?1c'ili ties to hous,e. vi,olent juvenilE?s~,
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Prevention; Ten 'cr'ime,, prevention programs wou'ld be 'combined,
, into' one 'crime preventIon "block, grant; wei would si~plify the~
'after-school programs;, and mandate a ,review of 'crime.
prevention programs. for further streamlining.',. (Prevention,
'furlding, would be·cut by ,$l'billion to fund the new spending
, pr:op~sed' above) .' '
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,Habeas Reforl1', E~c!usionary Rule: We ~otild proyide ,
alternatives to tbe Republican' p~qp6sals in ,these areas.
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Anti...,Gang'Efforts: ,'In' addition to the violent juvenile'
incarceration'plan,we wO!lIdalso hit at'gangs with neW
, penalties and new, auth6rities to prosecute violent: kids' as
adults. '
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victillis 'Rights., criminal Aliens; We would meet the
Republican proposals ,in both of these areas .
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Drug Court Improvements :','Wbile pres'erving Drug Courts I we,
wouid allocate half of the, fund·irig for drug prosecution ....
at ,present/-'aII of ,the funding is ,for drug ~reatment ~
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Terrorism, publ ic corruption',....sexual 'Assault:· "Unl ike the
R~pu1?lic\3-n bill, ' our bill/would have. provisions attacking
all,three oftheseproble1l'ls~
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(Again,' a brief outline is attaohed (we have a longer, 20-page'
outline available as w~11), along wit,h' .compar,i son charts, and,
,costing' figures. 'Notethat'by' allowing local 'commuhities' to use
crime'pr~venti6n' funds to pay for ',their "COPS match /l f our bill"
may neutralize the appeal of the GOP'S new black grant program to
t,he m a y o r s . '
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COMMUNICATIONS PLAN
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Assuming'internai agreem.ent, on a -proposed,' stiategy, a~d, some
version. of the, legis'lation, outlin~d abOVe, we 'Would begin to·
'quietly rally Hill. Democrats. and moderate Republicans. to ,our
effort; next'we v/ouldrcach out to p·o;I.ice groups, elected
officials (:mayors,' governors), and prosecutors.,
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'Onde necessary corlsultati.ons a~e moving along ,¥e, wou~d
the following coml!l~nications plan·to, "roll out" our new
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·~nde.rtake
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• . ' . EarlY December: 'At the ceremony announcing 'the h'e-ad pf the
COPS' .program and. qrants for the next 4,000 police officers,
(under,COPS.AHEAD), ~he President-'would draw ,the "l~~e in
the sand" -"7' a,pledge to 'fully fight any effort to repeal'
the .1:-00, OO~ cop;; program 'to, th~ as,satilt.weap'on ban.
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Mid, December:'Th~'President would unveil'his proposed 1995
. 'C:rime Bill ata WhiteHouse event'. (, We w01J.ld .~olicit.,
officials from both parties ,to: . in support.
attend
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President to 'receive the U.S. ,Attorney, "Kids' ,and Guns",
pl~ns, remindi,:r,tg, the publ;ic that epforcement of the ,Crime \
Bill is underWay --. and:' that the Bill 'contained ,many useful
',pr,ovisionEi.
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early .. next' year" we will b~ re~dy for the.'
,pre.sident to announce awards of '3,OOO'police to. smaller'
towns under .COPSFAST ~ . (About 12,000 of the,' 100., bOO cops
wi'll ,have', then been, awarded,.. ) .ae would use this event td
';reiterate the, '!-line in. the sand", and his ! support' for his ne~
C~imeBill.
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Earl'y January:
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Late January: . Frot:n, the White HOUSH!,' the Attorney General ..
would br:ief;onth~ status of Crime Billimple.melitation~ The,
'. ,'briefing would" emphasize ,acc,oniplishments' to date on COPS; on
enforcet:nent of, laws l;i.kellthree st:tikes~1I and:on·the·t>ill's.
other pro:v:isi6ns~
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.state·oftheUn.1on:; The ,new Crime Bill would bepart:of the,
President's proPc>sed 1995,legislative'agenda: He 'would call
on cong;j:-essto join' him in ·a.bipartisan effort to build upon,
the'success 'of the 1994 bill ~:-. without going.backwa:l;ds on " ,
the: achievem~rlts' of ,that legislation.···
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Again,,':many more' events'apdpossibilities' ca~, be added. \ But;: the
goal is· clear: t'oassert . ourselves strongly and .affirmatively on
, ,this" issue ;...~ defending our achievements of last year while alse>
building -upon th~m in. ,the year ahead.
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OUTLINE OF
THEI/SAFER STREETS
ACT OF 1995"
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The follQwing is' ~ outline of possibleanti~crll1}e legislation
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for ~ext year:',
STATE AND LOCAL T.iAW,ENFORCEMENT
T.
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. This title wouldstrengtherLaid to state and local law enforcement by: (1) launching an ,
expanded Po!ke Corps prograrll.' with funds transferred from crime prevention; (2) providing ,
'4,000 nevi police to be sent to schools that ~ant officers; and (3) protecting under federal '
'.law all state ,and local copswllo are' aiding'in federal investigations. (State' and locaUaw '
enforcement would also be, aided by a new ,provision, in Title J{{,'to allow crime prevention
. fun~s to pay for the ",localmatching share" 'of police hiring grants.) This seetion would' also
exempt law enforcement agencit;s ITom the mandatory'retirement laws.
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VICTIMS' RIGHTS
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. This title would require all violerlt"criminalsto be ordered to make full fmancial
rc~titution totheit victims~ Such orders Qrresli~ution wou,ld be mandatory in all cases.
J 11. ' ANTI-GANG
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AND YOUTH VIOLENCE ACT'
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Thisproposal steps up the attack on g~gs and youth ,violence, by: (1) authorizing
, , severe periaIties for violent crimes committed, as part of a criminal street gang; (2) lowering'
the threshold to age 13 for discretionary'transfer to adult prosecutionJor violent felonies; (3) "',,'
, adding, seribus juvenile drug offenses as predicate offenses under the Armed CareeiCri,rninal
Act; ,and (4) adding other proviSIons to crack down,on :Yiolent'juvenile offenders. '
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,IV. ' ANTI;;.SEXUAL ABUSE.ANDCHTLD PoRNOGRA'PHY ACT'
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This title would arne~d fecteralla~to make it clear 'that cases i~volving importati~~ 'of
c~ld' pornography by compl;Iter are 'also cover~,L "It would also pro'vide for mv testing of '
sexual abuse defendants (with disc~osureof the test results to the victim)'.,
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, '" , " This title would contains several provisions to i~prove on last~year;s 'Crime Bill:
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Tougher Trinh in Sentencing: .The bill would limits one-half of all prison g~nt ftlnds
to SUites that 'aboiish parole)' and have pre-triardetention foiv161cnt offenders. '. •
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,PRISONS, AND CORRECTJONAT~ FACILITIES
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Violent Youth Incarceration: Like the Repub.lican bill,thi~ bill W041d re-allocate '
$700',mi11ion from .cnm9- prcvtntion programs to prison' programs. But in this bil1~
these reallocated funds would beus~d for/constructing special prison facilities :to
, house vioient juveniles. .
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Limits on' Prisoner Lawsuits:' Th~ bill would imPos~ further
'lawsuits that establish population, for prisons~
cap's
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-No Frms in Prison: ' The bill would alsoprtJhibit'the us~ of fCetera! grant fu~ds t~ ,',
suPPort any'facilities with mm,ate ,accommOdations beyond "bare, bones:-- beyond
,those facilities essential to soundcorrectional rriahageme~t and legal requirements. '
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limits~n prisorier
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VI.
HABEAS' CORPUS ,REFORM '
, , TIlls title wo~ld contain the nabea~ corpus reform provisions endorsed by the'
administration last year -;. provisions' developed mcooperation with the Nati9nall)istrict _
, Attorneys Association and the State Attorneys General. In brief, these'reforms would limit
death rowiIlIllates lo.'a single ha~eas' p~titiOri-- to be filed, within strict tirile limits :- while ,"
, providing such inmates with competent counsyl to assist in prepari,ng this single ,filing., The
goal is to make the,death penalty' appeals process faster; without sacr:ifici~g fairness.
VIll.DRUG CQNTROLqAND DRUG COUR~' ~PROVEMEN'rS
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' This title would: (i) authorize Civil penalties and injunctive ~eliefagainsd;epers 'of
dnlgparaphernalia; and (2) j~prove ',the process fortaking assets seiied from drug dealers,
, and transferring them tO'law enforcement., The' title would,alsoirriprov~, the Drug Courts "
,program by: '(1) devoti'ng,half of all funds to the prosecutiori of dnigoffe"ders -.:.' ,not just for
.
rehabilitation programs, a~d (2) providing funoing to supportrehab'ilitation programs, in
'which:>upervision.is' provided by, prosecutors, in '~ddition tojudge-supervised prograrris~,1
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IX.' 'CRIME PREVENTION IMPROVEMENTS .
This
tit1e~o~ld improve and sffuplifies last year's Crim~ Bill'in,se~eral respects:
'., Consotidation into Block Grants: : The billCo~solidates 10 separatepfogramsfrom
,
last year;s bill into' a sirigl~ block grant criITie prevention program. Total prevention
funding is trimmed ~y $1 billion to fund the expiuided Police Corps; Cops in SchoolS;
'antl,the new Youth Incarce,ration~rogram. A(rer the .consolidatibn, only.' six crime "
prevention programs \Y.ould remain:, the Block Grants~ Violence Against Women, '
After-School Programs; Drug Courts, Drug Treatmenl iIi Prisons" arid tl1~'LOCal
Partnership Act.
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Cops on theJtreei:'The bill a1so'allowslocafgo~emmentS to use hlqck grant funds·
(or: funds under the Local' Partnership Act) for putting' more police on the str.eets.
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• ' 'Simglified Afrer-School ProgT(lm:, T..ast year's.'two after-school p'rogtams would be
" consol~aated into a single, simple program to 'keepschbolsand churches opeo, aft~r
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school and on the ~eekends."
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IX.
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Further Consolidation':, The biUwQuld,also direct the PreSident~s Prevention Council,
chaired by the Vice President, to study all federal crime prevention programs, to
determine where. further consolidation is possible.
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TERRORISM "
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The'bUl would contain a ntlmber of provisions tociack down onterrorism,including:' '.
(1) broad~r jurisdiction over ten;orists .ofFshore; (2) a repeal of restrictions' on FBI
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. investigations of those who provide material support to.terrorists; (3)new'juriscliction over
'terrorist offenses on foreign sl)ips; and (4) procedures to make th~ deportation of alien
terrorists easier and faste:r~ [This, would neeQ to be harmonized with the Anti-Terrorism
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legislative package that is being developed.].
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PUBLIC 'CORRUPTION
. X.'
This title would Incorporate important refo~s to strengthen, federal 'public corruption .
Jaws. The Senate has passed theSe provisioris.'in its 1993 Crime Dill. ,
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XI. CRIMINALALTENS ..
will'
.. This provision
increase the' penalty for smuggling aliens ~nto the, United' States -,and make .it ea~jeT to deport those' aliens who commit crimes here.
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EXCLUSIONARY RULE REFORM'
This, s,ection would i~sure thatther~ c~ be no judicial mmpering with. decisions that
. -provide law enforcement with a "good faith" exception. to the exdusionary rule-,foT cases
.involving reasonab~e reliance on a warrant.
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This section would'strengthen the death penalty procedures enacted in :theCrlme Bill.
It would 3150 make "use-of-a-firearmtf an aggravating factor .indeath 'penalty caseS. .
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xu.. DEATH ,PE;,NALTY'OOROYEMENTS .
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GENERAL CRIMINAL .JUSTICE TMPROVEMENTPROVYSIONS,:
This title will, 'fncltide, a wide array of provisions designed to strerigthen' our attack on
violent.crime.
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VCCA
VS.
'95
CRIME BILL COMPARISON:
GOp:e.tu. va. '95 AOM1NISTftATION SILL.
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19915 REPUBLICAN BILL
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1996ADMIt.4ISTRATlON B1LL
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POLICE
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Vllinq r,"lole Police. on the
PUIS
100,000 c:op~ On Ihe
diviCed
'Syel!l
'Conlbauitlg Ganes
Continues
Ir,clo~sinillllw
of
EnhonciI\9Poli~e'
Recrultmer,!
of .America for community policing; evenlv
Ovme Gtant'flJndinO of gMg task
enlorcameRt altencles in
E.,tolceml!nl "0 P/omOle
, (he Se'curilY
O~I '
Children
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S((,Slm
bEilween 'Mlle and s:na[ltawns,
'
f(lrces'arul cQ(lroloates ledefl.llaw
"gntlno aangs. '
Creates' 4 permanent t.ask force or federal law enforcement agenes to
·dlfl.icultml.ulng ,a'1d 8xpl()lted children cases •....:
assIst In !he
mOS,t
Replaces the community "ollce hirin1}
prol)cl!mwim a new -iaw'enforC4mnt
b!(,:ek orant,;, elimlnlltlng any aSSutBncII
that anv new police will be hired,
No Provision
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hld"~ m,atch.
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federal Jurisdiction ovar
certar" gang·relaied. crImes •. ,_
Creates
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.Allows block gIants to,bll,vsed fOl
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iili.2 h.-ods
Allowa block grants to be used 'or·
achaol safety proorams and
school lately proQrams.
hirIng of 4.0()·:) additional police to '
purolln and around schools.' '
R&talna the Law·En.torcom&i'lt
Allows' sstablisl'iud communitv organizations to help recruit qualified appUcants 10. "
-(hell local police department's.
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Retains & boo,(, 100.000 cop~
program b',..aIJowing I(leal
govemmttl\lS lhe option o/using,
p(e..... n.lon monies fO'r local police
Abol/slle.' the Police Recruitment
ptcgram.
ReCfiJltm~nt prooram and'reallgns
,under the crimepreventico brock
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a scholarshlp.and ualnino prog,am similar to ROTC ellat ptovld8ll'lncendvel I No Provl,loR
fied:c91lege studentS to work In law enforcement alter graduation.
P()lice 90rpi
Police Cotps:
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Plovlde$ that avldence ahallnOl be
ucluded from tJ£G If It wu obtained in
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E.x.;I.J$ionilry Rule
OOl.lbles Ihe five vearfunillno or the
eI'etJmstlnce~ ,uStiOablv belIeved to be
In conformity with the fourth amendment and does rio, allow
evidence to be 6xcluded unleu
No Provision
Codifies the el(ception to Ihe search
and ialtura 1I';le ·for ca.su lnvol\ring '"
raasoiu.blt, reliance cn a warram.
,
exclusIon Is expre$~lvauthodzed bV
statute Ot a rula prescribed bV (hll .
Suprom 8COlJrt~
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'H"bel;5 CCIPI.'S °P.clolm
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. C,.ateulmelimha fDf lutui habeu
. filing; eUlhorlHs 81'J)EI11ate Jl.ldoes to
luuI «rtlnC81~U otp,obllble cause lo( .
. .
appeal In federal habeas cases; ..
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rGllulres a Clfcuit )udoe-issuad
c'ertitlcate of probable causo fot appeal
,
~fore the case may proceed: providB! .
. ~tate. courts discretion to
,ha.beas
.,
applications despite failure to oxllaust
,.I':Ite temediui creates a riling timG"
Jimlt fGr eolia leral remedy .In"fed&ral .
courtslestablishos counsel
.
<::lIIppointmen,;: qualificatior" and
,.
compensatlor\",tandafdslorstate
capital cues: eroa'lesrimtts on·S'·tays of
.ox&<:utlon and su~ce!l$l\le petilions;
, 8sublls.haa ~tandards 'or. the. scope of
federlll habeas ·r6\/le\....
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Estahlish~s\tlme
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"lII:leasing Pilson Space
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limits .s~cl)nd and successive ledm:1
hab&as petitions; 'CIUtes' actual
Il'Ir.oCence a 'claims illandards In lederal
habeas tevier..... III capital uses; ,
'&!,iablishes counsel apP'jinlmenl.
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qUllificaticn, corillicalion and'
~compen$ation standards.tor ltale
capital cases; equalizu funding 101
jlrosecl.;liqn'anc doloos.o '1'1 (,'loelal, ._"
Mbns lidoaiion in capital casas;-and'
.authoriz6~ gram tunds to aid ,stale! J:1,
meolino inclGased ,couosol '
"<lQulrementsiotcapital.cases.
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Establishes'procedur'es t6 e.tfectuate abo'u~.50 new and uisling capital offenses,Calls for ,81orm, In federal dl:lach 'Implovu 8n,:1 'siranotheos fedor31
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penalty procedures •. '
' . deatl1pOl\ahyprocedures,
. Locks up criminal; by Pf~~id~no approximatelyS8 billion I~ new funding fot prison'
and boot camp, consttuc.tlon.
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ha:,eas'raino: Ciliates stalutOfV .
, sl3lldards lor fedBfll1 habus re\iiew;
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),~~11' POI\<llly PloccdulCS
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PUNISHMENT·
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;.:: ~.Ei<';1995 .,.AOMINisTM-1ION81[;;L':":'~'-:
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." ' _ . ~.. VCCA",:'-:.<.1.: ~ ~-#'·.!'*·~r:h~.i:.·.~;. ·01.~·.r'\ .~I.~:':.../.(i\)~ ;:;~~~~\;At996 AEI>UalJCAN·SIWl:;. '''i~'
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.:,'. '~';,'f.': ~::.':<~!,':t';~~"" S·~,";t,,~.uI.t;.1..i1l'! t,...;'«jot-",. ',.,..
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Conditions 1/2 of 1\11\05 ,an meeting Tluth-ln'.SiI_ntenclnQ requirements.
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Mid \(lol6n1 luvenlle olfellders,
Requires abolition 'of pafGlean·j
mandatory prolfieldot'Joclon ,0.1
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dsogeroull delsl\dants u conditiOnJ
for Trulh-ln·Senl&llcII1Qil\Cer.t!ve
grants. ,
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ilgMan. Itandardsfor thll.oeneral
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TM"·Tn~SenlGnclno gnnt ptoOfam Md
nmhs program &!ii)ibility.
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Shl~ overcS2 billion '(ompleliantlon " Adds 171>0 miitio(\ ironto tot peisons 10"
ptOOlema to prl8<11'i etants.·
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. "1.'. ,. :Y·Y:;~'..,'··~Vl"1'A ':"'.~ .;;.:;. :·~.'::~!..;')?:~~f"~ti ;'·~:I-~~(~"~~,~JfI;t~:';1 J;.;ht~q.;·996 l\epU811~AN.8ILI..:.~":.'~t~I:$.;~:,·~~9~· ADM1NI$TMJION 81i..L:.....;·;~:
~ I,.~i . .}.~..~.{ ,.f'!U;···,,,.~:l.:" ~f .. '!J*;."~......... ~,~~~ .... "'c ... ~~~_.~_~"': .......
-¥.~" "y.1 ·.~·.:t' .. ~·· ~"":.""· . . ,.·:I<1; '''.~
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Broadens Inc. range of oHenses 'for_
which IUloIeniles may be Irie:1 as adults;
• makes serious ]ullenlledllJO oHo!\$es
subject to the Armed Cllreer Criminal
S li"~l'ling PunisI1l11ei;: 'Ior
S(!ods a clear meSSll{J1l tovoung would· be t:rlmlnals bV providing funds to states
NoProilisiQA
Act; c,aa~GS- new· $~vere'pen"lties 10/
Ilnd.loca:ities loq:·vnistlment·o[ young offandersj allows children down to age 13
V()l.Jnll Olfel'ldli,~'
. '··to beuied
an adult. fouiertai(! viol.lllt ccime$~ amI c,e a(~s 'supplemental tlanBltles
gang'c/irr,ts; and oasos roslricllons
for uang·rOlalod cfims$_, ,.
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allowinl;:.nll VSG 01 juvenile crimina!
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reco/ds OIl·[i:St od;ud'icallon of a
seri<>u$ violent cri".o 0' dtuo
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trafficking Iilw.
Serious
PUI'lI~hme:rH 101
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Cd'T!u
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penalties-and defines available restitution
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No Provision
Expands vlctim$' riilht to,m'lIndatorv
lutltudon to all offensos under ledet'al
cr1mlnal code.
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PfIJvlde~'ol victim's right of allocution In sentencln·ll.
Allocution 'Ilnd Reslitu lion
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Eases the load on uat~ Frimioallustic& systems bv ploviding OVllr U billIon 'til.
h.mdino for,slBtes. stale courts, local courts, local governmatlts. and ,fibal
governments to cleate. drug courts for noo~violent offenders.
O-'ug Court!
'A.oqulfes HIV lutin·;) of' U,l offline'en
and inv9stioates lou~nor penallies lot
~HIV positive Sill( oHendais',
.,
EKpands victims' ~[l1hi to ma'nda:ory
restitution 10 all oHensa~ under 'odilral
c/iminal code hamel.
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Allows up \0 halfo' dr"JO court mone'(
to be used fOI specialitGd drug
.
Repeal$ Orug Courts,
prosocutio'n courts and alJqw!
prosecuters .10 sUPErliiso drug cou-"1
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type pfoO/ams.
T.olJghcnlnll
OlU9
Abolishes Communiiy-aued 'Justice
Grantc fot Prosecutols
Bans Ihe man.lIfactvrs, transfer, and possesslon'of ctrtllin usault weapons;··
'
continues 'unding fot tlui_BradV Law; and creates'new offenses for tile possessIon
of iI handgun by a!uveniles, " .
,
1-I1~8nrri9ful Gon laws
irbHickl!1Q
~o
AidSOIl$cbucdened slate and .oeai prose·::vtors by -provldioo about $60 million
c9mmunltv·based justi1:eprogtams. . , \
'.
..
' . ' ".
, . .
SUPPofting Stall! lind Local
Proucutors' '
·Stopplng Internall::Hlal
Chilo Pornography
Enhances p~ncliies [or lesser drug·
climes by autMrizirog civil penallle$
Inereasesponalties for using children to distribute drvQ$ nesr Ichools and
,
plavoroundSj Increasas penalties fOf lelling d,ugs near.-publh: 1\0usln1ji and c.eate,
new penalties for advertising i1licle drug l(an.sactions;
.
Calls for mandatory $ontencing'or
certaIn crimes In which a gun'ls u.s~d.
No .Pro'Jision
No-Provision
Tightens loo-plio!es In U.S. Code to
crack down' o~ importation of
laws
I
i , . .
.i
,
i cstablishos(olJQher penalties for persons &ngalling in Internlltionat trafficking
child pornography.
.
/. ..
'11
Provision
drIlQ-,:.arapherc'illia
'
/ Retains t!".is plo<;lranof aid 1:0
prosecutors,
'01
t:1
o
c...
I·
o
t:
C)
eloetronlcally depicted chlle' .
pOUlograpt"iy. ,
..
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. -: :,..
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f
"A'.';('(, ,\'11:': I G95AEPUBLICAN 8IliJ;i;;"I':' "j t"t'\'i~'19S5'AOMINllhRATION BILl.' : .,
Jt •• • .,;";'. I~
::,.".
i. ~..!. t=!,
~I"-' ....., .". • .Ift f ...... ,.?-.~~! !,.,~
/'
Clacking Oowil
) Jor(~rism
oQ
Aids red~tal prosecutors by tlx(endillO ,the statute of lIinltatlons,'or c&rtaln C8Norism
ollllnse! and allows ,the admittance to the U.S. 0' allenswilh tellable Informallon
'N() Provision
':.:
'. ..... 0"'" 1. " ~. \. * .,
Aepeals rGlmlcdol\S 01\ Ma1Bliai
'., SuppOrt of Terrorism Investigations; .
reforms procedure! {or removal 01
arien tenorls.ts 10 avoid compfomlsing
~'~~'.~_~".)I .. ,:. _.
..
I-'
I-'
'
N
N
"
'-,
<:0
f~dlllral terrGrism ~ase$; and era/ifies
"
0
-,
-',
:
CI1.l21es s(ilIEll.pMal(i~s lor~al; climas.
N
U.S, climinall~fisdictjQn -In Ille
-,'
1),1\II;iI9 Hate Crin'-I!ls
"'"
eX1eindod territqrial'.$ea, '
auout (errOrl$1,Oro'anilations.
Makes tlcocadures alnd sla"dslds iOI
hate crimes .sentencino enhMc'cmenl .
',conslstont,'with ottlel soncencirg
er,hanc tI'1lent, ,I ~ic lor,s.
HoProvision
I
c:.>
<:0
tj
N
0
N
P.REVENTION
GIl
I-'
-~,
"'"
.
I-'
.....
Ceneliif Cdmll,P,e.vcnt'on
-'Initi.ative$
Cuts nDarty .6 billion from prevention
-ptogrsml end .hTtts resources to
ptlson.and law enforcement grants,
Aut-horlze! OliO' many new crir1Hl prtlventi,on g~nt proQrams, totl!1IIno$7 bl1tion
, adminisl.9lod by dilferon, feder'al agencies.
Combll1lis t(ln ,sapa/aUI plcven(iOn
programs Into this blc,c:( program I see
balow)andteducu clime pteventl3n
fundlnobv $ I biliil>r\.
, Cc;me·Prevemion and
Coordir81ion
-Altel School Programs
local. Crima Pilll/enticn
Block Gtllnts
IItriou~. pro'Jen crime'prl'lventlon programs
avthoriZlld by the VCCA
furta"
and ooordinatesother prOgrems
.Abolishes Provant;on Council.,
,Cre.lICS tWO new plograms to fund after sch<>01 program-s for young people;
,
. -".
f , .. '
, .',"
.
.
N
'
Manda1l1S Clime Prevention Cou(\cil to
" 8JCamine CO!lsOlidatl?n of ~r9ven[ion'
pro~ran:'s.
'
.
""',
I::'
o
,
COtl$olid at&S the' twolnlo a single
, Establishes:a lormulablock oranlProgram for local go~efnments for specific crime
proYsntio,n, purposes.'
.
"
., ,
Transfer. fundino,lro':n this 'program
Into the nsw law GI\Corcemo,Rt grant
program.
':>
c...
youth supEltvislonieallv i"telv<ll'ltion
'proj}c8111 :' 'tr&smiines procod\jru,
Abolishes chasa prC!iirilms.
o
~,
Rotains [his prooram and consolidUes .
£avoral VCCA prev'eotioi", programs In
(I'.is block grant.
C'l
IMMIGRATION
":.'
IICCA
ISSUE
Sliffens pei\alties lorafien'smugoling, failing to depart or reentetino atter
{j.zlli,":r'TotJgh on IIIe9al
Aliens
cepo(t3tion, and passport lind visa violations.
Dcpotl.Oltion of Criminel
Alien$
-
Creates newdcportatlon procedures", for cilminal aliens.
,
" "
I'"
','
1996 t:\EPUBlICAN BILl.
19S5 ADMINISTRATION BILL
No" Provisions
Inctoins'penalties
. tmllGOling.
. .
Calls for naw dellortation procedures
for
crimInal alle...,s.
.
,
101
alien
Calls lor r,ew deportatlo>np'rocecvres
lor. crirrinJlI aliens Isa.-neJ •
..J
" 't§i
....6
,I-'
'0')
�,
..
11/22/94
20:39,
'll'202 '514 1}24
DOJ-OAAG
,
. C1'1/T118 SRI Comparlalons
I
..
. '
11/22194
.TotaiAut.IlotlDtd Funding
(00114... In Ihouaanda)
05:41 PM
'.'
,
.
"
"
.
tlO~t Crime Control and law Enforc._t Act of 191M
Back Our S'tJvetB Act of
Tekl
1995 ..
Pro.
-
liLII
~ I AIdoaiiaai.i-'
Total '
.; · ....uthorizzrtion TI1I.
OEP~RTMEHI
OF JUSTICE
Public SaNty and P~i!:lng -, '
TmmwU~ ~~~: ,,"Cops on the ~
.
'"
$8;aoo:O<XI Comtr'll.ll'1lty PoIic~: "Caps on '!he Be~·
LAw fEnforcomeC'll Block Gfants
Prisons
'
COrrectionAl FacljViol.Offonder Inc:arcefl!ltion GraM'
I
'
I
t:;'ertllin PufJiahrNnS fot YoUng Offerii:lgra,
7.895.000
, I'
.
. '. . '.
, , O'ime PfovantiOn . ,
.
',
. Cn.ne PreWntion Gratrts (misc.)
.
r
.
,
1.222.3i:Io Crime Prawntfon Grt:It'ItB (mite.) . .
'112.500
. 270,000
5,000 ..
I
i
'
.'
,.,'._
I
1.010.200
(1,000,000
13.000
:
a: Immigration Enforcement
<
,"
Corps"
I
241.000
.
la,
644.000
Eriforc::ament Off. Trng. and
,.
'.'
State CLI'Id LoCal Law Enforcement
'I
200,000
'
.1.5Z7.1CO
"
(
'20.000
20.000 ,
SubtO'lal. Oep6rtrnGnt of ~c:e
I
200.000
1.527.700 '.
'
Senior Cltlm~ AgiiUnat Marketing Sauna
I
13.000 .
, '
f;edara11.!1.w,Enfurcement
.I
'.'
','.,
~ollc.
o
1.Un.400
O1her'Law"Enforcement
I
o
, "112.soo
. 270,000,
, 5.000
'
,1.000,000 DNJ Col.Ins
.
...
Criminal Aliens
(1.222.500
,
U)10.200
.
0'
10,499.6i:o
150,000
,1.800.000
,
Ccudo
, (7.895.000
10.499.600
1.a~.OOO
.
Substanc9 AbcJM TrN'lment In federal Priacina
i
F,Ie.~ Subldanc:e Abuse Tre4trNm br State PriGOnGl'IJ
Treatment of TubIIiI~lase., in CorrectIoMlll'1lS1itutio/"dl
,Viol.,.ee Ag4inst Women
.
Co~or:a. F~a,JV1ol. OffafI!Jer It'IC4rcarallon,Gr4l1bJ
TrUth In Sentencing ~antIs.
150,000
.
·
,
Ircatca,amn of Undocumented Criminal Aliens
. ($8.800.000;
, ,0
. 10,OOO.0<XI $10.000.000
.
1,595.300
27.6&4,40:)
"
.'
'."
OTHER DEPARTMENTS:
Caurts
. ' .' "
.
.,'
El:luc:.IltiOn & Training for Fedaral Judges: .
AdditianaJ Appropriatiom .
.
/
'J':'
'
J
• .
I
'700
•
Ed~onJHHS
.
.'.
. ,
,IF4milY41 Co~m. End~..;or ,&,hoo,18,~rant Prog~lirn.
,
810,000 Family & Comm. End80.¥OI'SchOoI. Giant Ptogram
.
HHS/HUDJlnterior
,I Pr8Y8ntion Grants
•2.408.000
,
Intotior{Tranaportation
.' .
1 ~~itAUmpra... ment
,PrOWlnt Crime , . ,
'0
:
. '~ate Justice Inst'itu~e
,.'
Equal Jus~c;~~f Women in ~ ~ur'tS: Tro.lnir'lg GniJ
.I
','
".
'II
Pre~ Grants
~tler ~~s,
Total. Crime 6il
(1.894,500
1.000 .
1.000
I
600
,600
. "
45.000 GangRGsistAnce Education &. Training Projoc:t&
,5 000
550:~
--:;4~,1:71"'S,"'300=1I
• (45.000
Sub1ot41..
Otne;Dep>!is1~
o
5.000
'
30 204 400 Total. Crime Bil
'"
o
35:000·"
Additiala! A p p r o p r i a t i O n : s i •
Subtotal
(810,000
.
I Gang Resbtance ~duc:istion &. Training Projects"
~, Rural Drug Enfcrcement Training: . FlETC,.,
'"',
35,000
i~t'f Commiuion On Crime Control.&. Prewntiol
Tteasucy
700
200,000
200,000
550.000
(2.749.500
.1;365.800
154200
29.050.200
(1
.. ,.,
,
I
·1,
-"':
'/
�D\J~I<kf\noN
~~
CLlNTON,~\BRARY PHOTOCOPY
�
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Carol Rasco - Issues Series
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Carol Rasco
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Crime Talking Points
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2010-0198-Sb-crime-talking-points
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https://clinton.presidentiallibraries.us/files/original/b6ca2e27da3e32acf172fa32b53c671a.pdf
dabd0d144d68669319e5a7712717644c
PDF Text
Text
-A- STUDY OF SCHOOL-ASSOCIATED VIOLENT
DEATHS IN THE UNITED STATES, 1992 ~1994
Executive -Summary
April 8, 1995
The Centers for'Disease Control and Prevention (CDC) is today releasing this advance
executive summary of its study of school-associated violent deaths. ,According to the CDC,
this is the first attempt to gather national information on school-associated-deaths as there is
no national reporting system for such incidents. The data being made available today indicate
that the problem of violence in schools is much more serious and potentially life-threatening
than previously believed. These findings highlight the extent to which violence in
communities has crept into schools, once viewed by parents as "safe havens" for children.
The key findings of the Study include:_
o The CDC has identified 105 violent, school-associated deaths in the -last two school
years (1992-3 and 1993-4) across the ~ountry.
o Twenty-nine (28%) of the fatal injuries happened inside a school building, another
thirty-seven (36%) occurred outdoors on school property, and the remaining thirty-six
-(35% j occurred off campus
o These deaths included 84 homicides, 18 suicides an4 3 unintentional firearm-related
deaths
o 65.3% of the victims were students and 11% were teachers or staff. The remaining
victims (23%) were community members killed on school property
-
.
-
While the study is still underway, early findings suggest that violent deaths can occur in
schools and communities of all types and sizes.
As researchers continue to analyze the data collected for this study, they hope to
identify risk factors for school-associated violent death and ultimately prevent other fatalities.
Violence has long been recognized as an important public health and social issue, especially
for young people. This study underscores the degree to which violence has crept into
students' lives and into' their schools. The result is students who are so frightened by 'the
possibility of violence, they feel compelled to find new and "saf~r" routes to school and home
again, or· to avoid school altogether. Others feel the need to carry a weapon for protection, \
unaware that this will put them at greater risk.
I
The/IDS deaths are, of course, only the most startling example of the growing
epidemic of school violence. A full report on this study is expected in early 1996. The study
was conducted by the CDC, in conjunction- with the United States Departments of Education
and Justice and the National School Safety Center. '
-
�CRIME TALKING POINTS .;..- HQUSE REPUBLICAN ,CRIME BILLS
HR 728 -- Law Enforcement
Blo~k
Grants -- Oppose
•
Not a single new cop on the beat. HR 728 scraps the President's 100,000 more
police initiative (and every prevention program) and replaces it with a b~ock grant that
wouldn't guarantee a single new cop on the beat. Instead, HR 728's funds "to reduce
crime and improve public safety" could go for almost <,lny public safety purpose. The
President is strongly opposed to HR 728 -- and he will veto it.
•
Ignores lessons of the past. Congress should have learned from the past. Under the
LEAA, a giveaway grant program established in the 60's -- and killed by President .
Reagan in the 80's -- waste and abuse ran rampant. Scarce law enforcement
resources paid for gadgets and gizmos that went unused, and it is estimated that
. perhaps as much as one third of LEAA's funds went to consultants.
•
Learn from the present. The. President's 100,000 cops initiative is under budget and
ahead of schedule. It's been implemented in a simple, non-bureaucratic manner and
has already helped thousands of communities put nearly' 17,000 new officers on the
street.
•
President's program is. flexible, but focused. We wa~t state and local officials to
have more flexibility, and that's why the President's plan allows police departments to
use their funds in a variety of ways (training, hiring, redeploying, technology, etc.),
but its focus is clear: more police on the street in community policing. HR 728 has
no such articulated national' purpose.
HR 667 -- Prison Grants -- Oppose
,
•
Too restrictive. HR 667 only allows for grant funds to be used for incarcerating
specific, limited categories of "serious violent offenders -- and conditions eligibility
of funds on States first spending money to increasing incarceration rates for broad
categories of offenders. Also, it deletes the Drug Courts program. We oppose it.
•
Fewer violent criminals behind bars. Frankly, with such burdensome requirements,
HR 667 will do less to put criminals behind bars than last year's crime bill. In fact, as
originally introduced, the Justice Department estimated that under HR 667 no states
, would be immediately eligible for prison funds, and only 3 states would be eligible for
funds in the near future. That means only one thing: fewer prisoners behind bars.
•
Support reimbursements to States for criminal aliens. HR 667 proposes
reimbursing states for the costs of incarcerating criminal aliens, which we generally
support. Under last year's crime bill we already helping states pay for the costs of
incarcerating criminal aliens -- $130 million this year, $300 mjllion next year, and
$1.9 billion over the life of the crime bill. However, HR 667 proposes spending even
more, and this is inconsistent with out budget.
�I'
;,.,
HR 665 -- Victims Restitution -- Support
•
We support. The Administration supports --. and has supported since -last year -
-the mandatory restitution provisions included in HR 665, which requires all federal
offenders to compensate their victims. HR 667 illustrates how powerful bipartisan
support can help us move forward on crime -- and do more to make our communities
safer.
HR 668-- Criminal Aliens Deportation -- Support
•
Support streamlining deportation process. We generally support ...,.- .and supported
last year _ HR 668's provisions to streamline the deportation process for criminal
-aliens. Again, this is an -example of a new public safety issue on which we look
forward to working with the New Congress.
HR 666 -- Exclusionary Rule Reform
~-
Support with Modifications
•
Support certain "good faith" exceptions. We support a "good faith" exception to
the exclusionary rule in cases where a warrant has been obtained. Where the polic~
officer does his job and obtains a warrant, evidence shouldn't be thrown out on a
technicality. We would support HR 666 if amended in this fashion.
•
Warrantless searches more difficult. We also recognize that there are exigent
circumstances when an officer may not have time to seek a warrant. And in such
cases, we have got to work with law enforcement to help them do their job. That's
why we worked with the police and community in Chicago's Robert Taylor homes, so
that they could continue conducting certain searches and sweeps immediately after
shootings -- without violating anyone's constitutional rights.
•
HR 666 puts politics over policy. Some members of the House were more concerned
with politics than law enforcement when voting on HR 666. Members actually voted
down the text of the Fourth Amendment in favor of HR 666. They also tried to curry
favor with the special interests, the NRA, by voting not to grant ATF agents the same
search authority they are willing to give the rest of law enforcement. That's a slap in
the face to the federal law enforcement officers who are charged with the difficult and
life-threatening duty of enforcing our gun laws.
HR 729 -- Habeas Corpus Reform -- -Support with. Modifications
•
Support strong habeas corpus reform. We are committed to strong habeas corpus
reform that cuts back· on the delays that plague the current death penalty appeals'
process. These unnecessary delays undermine the death penalty's deterrent effect and
corrode the public's confidence in the criminal justice system. We'will work with the
new Congress to reconcile the differences between HR 729 and the habeas proposal
_developed by Senator Biden, the nation's prosecutors and the Justice Department last
year, which we support (S. 1607 in the 103rd Congress).
�,
\
'
THE WHITE HOUSE
WASHINGTON
January 15, 1994
MEMORANDUM FOR JACK QUINN/KUMIKI GIBSON
'
FROM:
RAHM EMANUEL/BRUCE REED/JOSE CERDA
SUBJ,ECT:
Crime Tour Ideas
<: e~ CNLDL f:Te;~f
.'
. .
.
In response to your previous draft memorandum, we have prepared an outline for you
of our ideas for the President and Vice President's Crime Tour and Summit. Given the new;
post-election challenges we face, however, we have repackaged the specific forum topics to
correspond more directly with some of the debate we anticipate from Republicans on the Hill.
I. Crime Tour Goals
Borrowing from some of the long-term strategic decisions that have been made since
the election, we would suggest that the following four goals serve as our guide in putting
together the Crime Tour:
(1)
Passing the Leon Panetta Test. Potential Crime Tour events should -- from
the outset -- meet the Chief of Staff's three-fold test for getting on the schedule:
(1). raising the stature of the President, (2) demonstrating the Administration's
commitment to fighting for the middle class, and (3) furthering the President's
image as a reformer. Certainly, speaking to the violence issue in broad terms
and beyond our crime programs is presidential. However, we must also go out
of our way to ensure that our forums cast the President as pro-middle class and
as a reformer, not as a Washington insider or an ac~demic elite.. Our forums
need to have real meaning for real people.
.
(2)' Taking the Offensive. At a time when all of Washington will be buzzing with .
wholesale change and unprecedented activity, we feel strongly that the
President and Vice President need to beon the offensive, not merely in
listening mode. As the President stated in his speech to the DLC, we need to .
have ", ..a contest of ide'as.'~ Thus, our forums must be part of the battle of
ideas that is to take place. They will need some sort of action component.
(3)
Getting Credit for the Crime Bill. Republicans fought against the crime hill
-- and continue to want to r~peal it -- for one simple reason: they do not want
President Clinton to get any credit for fighting crime. That is why we have to
fight especially hard to make the crime bill work and to highlight its successes.
�-2
If we are not aggressively defending our crime bill (and its core principles -
police, punishment and prevention), we will play right into Republican's hands
on the need to revisit and improve the Dill.
(4)
Making Peopie Feel Safer. Ultimately; the American people will give the
President credit for fighting crime only if they feel safer. Remember, former,
Mayor David Dinkins put 3,000 more pohce on the streets of New York and
helped drive the crime rate down in every major crime index for the first time
ih 30 years, but New Yorkers did not feel any safer -- and Dinkins lost the
crime issue and his re-election bid. To help the middle class feel safer, our
Crime Tour needs to reach beyond the crime programs and crime rates, and
speak directly to communities' crime concerns -- not problems in the abstract.
We must be willing to embrace the bold, new crime fighting solutions to which
many communities have turned.
While it may' not be easy to ~tructure forum's that meet all four of these criteria, we
strongly believe that the Crime Tour must achieve a balance between three goals.
II. Structure and Content of the Forums
We enthusiastically support the forums you have suggested on the breakdown of the
family and the use of illegal drugs, and have included som~ suggestions on how to repackage
the others so that they respo'nd more directly to the crime debate we expect on the Hill. .
Specifically, we would propose forums on the following three topics: (1) Youth Violence; (2)
the Criminal Justice System; and (3) Building Communities. We have also included some
brief suggestions on the actual structure of the forums.
A. Specific Forums
1.
Youth Violence
,"-,.'
At the very heart of America's current crime crisis is the multi-faceted problem of
~uth violence., While overall crime rates have been dropping, kids today are increasingly the
perpetrators and the 'victims of some of the most violent crimes. As one prominent
criminologist put it, "...there are 2 opposite crime trends going on: The baby boomers are
getting older and less violent, and the young are getting more ruthless.
II
o
Americans know this. When property crimes of all sorts are on the rise, Americans
could respond with increased security -- more locks, alarm systems, the club, etc. But society
-- especially its working families who .depend on the government to keep them safe -- do not
know how to respond to a crime epidemic that is fueled by a small percentage of gun-toting,
violent youth who are just as likely to shoot a stranger or an innocent bystander as they our a
rival gang member. As a result, we believe the Crime Tour must first address the problem of
�-3
youth violence. In' fact, we would even go so far as to suggest that youth violence could be
the subject of more than one forum.
Here are some of the issues that could be address within the context of a youth
violence forum:
.. The young violent offender. We know that a very small percentage of youth (about
6 percent) will commit a majority of the serious crimes committed by youth, and that
these individuals have become even more violent in recent years. We also know more
and more about the characteristics of these violent youth -- criminal parents, broken
families, problems in school, drug and alcohol abuse, etc. However, our juvenile
justice system remains ill-equipped to deal with these offenders.
- Gangs. For many at-risk youth, gangs have taken the place of strong families. In
our urban centers -- and increasingly in suburban and rural areas -- gangs are a major
part of the crime problem.
.
- Kids and guns. Kids today are 2 112 times more likely than adults to be victims of
violent crimes, and firearms kill more people between the ages 15 and 24 than all
natural causes combined.
" .
- School safety. Nearly 3 million thefts and violent crimes occur on or near school
campuses every year-- or about 16,000 incidents per school day, one every 6 seconds.
Schools should be part of the answer to youth crime, not part of the problem.
2. .
the Criminal Justice System
Crime has remained such a volatile issue for millions of Americans because they have
little faith in the criminal justice system's ability to protect those who work hard and play by
.the rules, or to punish those who do not. Americans from all segments of society long ago
embraced the notion that the system is in crisis. For instance, influenced by countless stories
about repeat offenders who don't serve their full sentences and go on to victimize again, the
rfiiddle class has turned to a series of increasingly punitive laws and more prisons for
answers. Working families in distressed communities -- society's most likely crime victims -
continue to see their public safety needs go unmet and view'the system itself as the problem;
suburban and well-to-dQ families begin to give up on government's ability to ensure public
safety and invest large sums of money on private security, gun ownership and other measures.
Here are some things we'would consider discussing:
- Victims rights. While the stories of vic~ims such as Polly Klaas can mobilize
communities to take action on crime, millions upon millions of Americans have been
victimized during violent crime's 30-year rise. And, in 1993, someone was victimized
'
�-4
every year 16 seconds. Very few of these crimes will galvanize communities into
action, but they will directly shape the perceptions and expectations that so many
Americans have of our criminal justice system. We must be ever vigilant of the needs
of victims.
.
,
- Certainty of punishment. Although much public attention is focused on the severity
of punishment? it is certainty of punishment and likelihood of apprehension that
ultimately will deter crime and drive down the crime rate. However, the criminal
justice system will only punish a small percentage of serious criminals -- about
500,000 of 25 million -- most of whom will have already gone through the criminal
justice system's revolving door.
- Truth-in-sentencing. Even when criminals receive stiff sentences, prison
overcrowding and it patchwork of outdated parole policies often result in serious
criminals serving less than half of their full sentences,
- Reinventing the "Criminal Justice System." While we refer to the criminal justice
system as a single entity, it is not. It is an amalgam of tens of thousands of
components, including -- state and local law enforcement agencies, federal law
enforcement bureaus, state and criminal justice agencies and court systems, etc. How
can we make sure that the public's needs are met with such a complex system?
3.
Building Communities
There is little disagreement that, to have an impact on crime and its related social ills,
we need to both empower and encourage communities to confront their problems. The way
to start doing that is not by bringing Washington's dead-end debate on crime to communities,
but by learning from communities. Communities long ago stopped talking about'the violence
problem and started working toward solutions. Washington needs to do the same.
Equally important, however, communities have stressed that, more than new laws and
what they want from the President and Vice President is leadership. They want the
President and VicePresident to use the bully pulpit to "build community will," and help them
create consensus and move forward. We could not agree more and we suggest the following
'topics for such community-focused forums.
re~o.urces,
:. Community policing. In many communities, community policing has served as the
linchpin for neighborhood organization efforts. With the President's expansive
community policing program, we could playa huge leadership role in helping
communities get together with their police to take on crime problems and improve the
quality of life in America's neighborhoods.
�-5
- Involving the. private sector and professional associations. To achieve long-term
success, communities need the support of the private sector and of its local leadership.
institutions.
- Local media. All too often, lodd media exacerbates a community's crime problem.
Crime stories lead the local nightly news night after night, but successful anti-violence
efforts of all types go unreported.
- The faith community. Churches, synagogues and mosques can playa key role in
reducing violence.
4.
Illegal Drugs and Violence
With the strong exception of any discussion on the topic of legalization, we strongly
favor a forum on illegal drug use and trafficking. We would suggest a special focus on why
kids today are using more drugs and perceiving them to be less dangerous. During' the mid
eighties, the middle class's concern with increases in adolescent drug use made the drug issue
America's number one concern.
5.
Breakdown of the Family
Again, we strongly support such a forum.
B. Structure of the Forums
Here are some general recommendations for you to consider oil the actual structure of
the forums. Actual participants, locations, etc., we assume can be worked out later.
First, we would focus much less on "thinkers" than on real people making a
difference. Generally, we believe it will be more difficult to capture the public's attention
wit,h. the same "thinkers" who have exhausted the anti-violence speaking circuit over the past
t",o years, than it will by highlighting those on the front lines of violence. Moreover, such
participants make it easier for the President and Vice President to show leadership and talk
solutions. We need to develop the right mix of "thinkers" and front line crime fighters.
Second, we believe that the point of departure for each forum should be some
Administration action or anti-violence solution -- not merely a rehashing of the problem.
During the past two years, every major interest group and Federal agency has held a forum of
some sort to size up the violence problem, so a large body of information on the extent of the
. problem already exists. Our forums should build on this existing body of knowledge -- and
. on the crime bill -- and show that we are moving forward to do everything we can to make
communities safer..
�-6
Third, we prefer that the forums take place at a school, community-based organization,
a police department, or some other location that would show the President as trying to
directly understand the very real concern that many Americans have with crime and viol~nce
in their communities. A .university, we fear, may be viewed as detached and aloof.
And fourth, in the hope of making these events look and feel less staged than they
have in the past -- as well as possibly increasing their odds of getting on the President's
schedule -- we would suggest that you consider ready-made forums or asking some of the
more friendly groups to sponsor certain forums for us. For instance, Mark Klaas has been
after the President to attend a violence forum he is sponsoring. This could serve as an
opportunity for the President and Vice President to focus on "Fixing the Criminal Justice
System. Also, groups such as Community Anti-Drug Coalitions (CADCA) and the National
Crime Prevention Council (NCPC) could help us develop forums on "Illegal Drugs," and
"Building Community WilL"
tI
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�January 10, 1995
MEMORANDUM FOR THE ATTORNEY GENERAL AND CAROL RASCO
FROM:
SUBJECT:
RON KLAIN1~ NYtrI~O
CRIME BILL \).~~~EGrl \j
~
With the first congressional hearing on the 1995 Crime
Bill just about one week away (January 18), we still lack
closure on an overarching strategy for dealing with this
legislation. Here is my. latest attempt, building upon my
previous memorandum (November 22), to offer a proposed
strategy.
REPUBLICAN STRATEGY and TIMETABLE
The Republicans in both the House and the Senate are
moving ahead toward early February floor action on a revised
Crime Bill; Committee action will start later this month.
While there is a chance that this early Republican effort will
entail only a subset of the crime ·issues (both Hatch and Hyde
have talked about a preliminary Crime Bill that addresses only
habeas reform and death penalty procedures), we need to be
prepared for dealing with the full-scale Republican proposal
within the next few weeks.
To refresh your recollection, the Republican Crime Bills
(now introduced in both the House and Senate, and substantially
similar), change the 1994 Crime Act, by:
(1) Eliminating the 100,000 cops program, to be replaced by a
"Law Enforcement Block Grant,lI that localities can use to
hire cops,·pay overtime, buy police equipment, beef up
school security, or fund citizen watch groups;
(2) Eliminating
some of the
Enforcement
realloc.ated
most of the crime prevention programs, with
funding (about $1 billion) moved into the IILaw·
Block Grant," and another chunk ($2 billion)
to prisons;
(3) Adding tough habeas corpus and exclusionary rule reform,
designed to sharply limit death row appeals, and broaden
the use of illegally seized evidence in courts;
(4) Federalizinq all crimes committed with guns, coupled with
stiff mandatory minimum sentences for those offenses;
�(5) Toughening truth in sentencing standards for states that
want prison grants, along with limits on prisoner
lawsuits; and
(6) Adding various other provisions on victims rights and
criminal alien deportation (that we generally 'support) .
As you can see, it is no exaggeration to say that the
President's program to put 100,000 more police on the streets
is in substantial danger. And, as I pointed out in my November
22nd memo, there is a sUbstantial risk that constituency groups
who supported ~s last year -- Mayors, county offi6ials, law
enforcement officers -- will not be with.us this time.
PROPOSED REVISED STRATEGY
As you may recall, in November, I proposed a strategy of:
(1) Promising to work with the Republicans on "going forward,"
but vigorously opposing any efforts to "go backwardi ll
(2) Thereby supporting a 1995.Crime Billj 'but,threatening to
yeto proposals to repeal the assault gun ban or the
100,,000 cops program; and
.
(3) Offering our own version of a 1995 Crime Bill as an
alternative to the Contract Bill.
While I still would prefer to see us pursue this course, based
on the negative reaction it received, I have prepared this
alternative strategy instead. Under this new plan, we would:
(1) Drawing a tough line around core principals. The
President 'would make ~ public statement that he strongly
opposes any efforts to repeal the tough penalties, assault
weapons ban, or 100,000 cops program included in the Crime
Bill. There will be no going back on these achievements.
•
We would criticize their plan for Block Grants in
lieu of 100,000 cops as "Super Porki"
•
We would seek a close alliance with law enforcement
on the three core points (protecting penalties, the
gun ban, and th~ COPS program) outlined above.
(2) Taking a lower-key admini~tration stand on the 1995 Bill.
DoJ would -submit for clearance a formal~tatement on the
legislation.
(This will be ready by Friday.)
In it, we
would announce our support for some elements of the new
Cri~e Bill (e.g., victims'rights, alien deportation,
tougher truth in sentencing), our opposition to other
proposals (such as cuts in prevention and eXClusionary
rule reform), and our very strong opposition to any
efforts to cross the "tough linell discussed above.
�(3) Authorizing DoJ to engage on the 1995 Bill -- but keeping
the President out of the fight.
With (1) and (2) in hand,
DoJ would take the lead in engaging on the bill -- but the
White House would largely be spared involvement.
•
The Attorney General would begin meeting with pivotal
House and Senate moderate Repub~icans.
•
We would conduct strategy ~eetingswith House and
Senate Democratic leaders.
•
We would attempt to rally constituency groups and key
outside leaders in our cause.
(4) continuing to implement the 1994 Act. We would pontinue
·to implement the Crime Act, which will continue to build
support for its current formulation.
Events.and
announcements consistent with sound implementation of the
Bill would be conducted.
.
(5) Highlighting Crime Fighting as Part of the President's
Middle Class Agenda~ While the day-to-day engagement on
the Crime Bill would be left to the Attorney General and
other surrogates, the President would step up his public
profile on the crime issue, by doing more "crime events"
and by emphasizing crime fighting as part of the middle
class agenda:
.
. W e have already submitted eight possible Presidential
events for the next eight weeks; .
•
Several of the events relate to the 1994 Crime Bill,
without putting the President directly int6 the 1995
debate (e.g., swearing-in police paid for by the
Crime Bill);
•
Other events will not be Crime Bill related -- for
example, issuing executive orders, meetings with
federal prosecutors, and the like.
Our middle class message cannot be complete without an
aggressive Presidential focus on this leading concern of
middle class Americans.
ANALYSIS OF PROPOSED STRATEGY
The above strategy is a middle ground between a more
aggressive approach (on the one hand), and two more limited
options (on the other).
A. More Aggressive Posture
The more aggressive approach would have more appeal to
liberals· in Congress, by putting our defense of prevention on
an equal plane with our defense of the rest of the Bill.
It
would also be a frontal assault on the whole idea of an
additional Crime Bill, as unnecessary in light of the 1994
Bill.
3
�Of course, the most aggressive approach is a full-scale
stand for principle, and most likely to have elite opinion
support. And, as long as we care little about the final
product emerging from the Hill -- or care little about having
the President veto a highly-popular bill -- this is an issue on
which we could side with Congressional liberals whom we will ,
cross on other matters.
But this more aggressive approach is untenable in terms of
winning in the current Congress, and out of step with the
middle class agenda. Moreover, it would require far more
extensive Presidential involvement to have any prospect of
success.
B.
More Limited Defense
On'the other hand, if we were single-mindedly concerned
with protecting the 100,000 cops program, than a more limited
approach would be better; this approach would invest all of our
resources in protecting the 100;000 cops, and would not make an
effort to defend the prevention programs as well.
Such an approach would address the natural tendency of the
press corps to play the fight over any Crime ·Bill as the
Republicans being "tough on crime" vs. Democrats "fighting for
prevention l1 - - they will·be inclined to"miss" our stand for
the police program, and describe us as fighting for prevention
only. In response, to save the COPS program, we could focus
our rhetoric clearly on that program -- making it clear that we
are pushing the tougher on crime position on that issue.
However, by doing so we would abandon the crime prevention
programs that we fought so hard to get, so quickly after we won
them. We would be accused of lacking principles or
convictions. And if we give the COPS program heightened'
emphasis in our effort to fight for both it and prevention, we
may achieve some of what this, more stark strategy, aims at as
well.
.
C.
Remaining Detached
Fin~lly, we could stay above the fray, saying that we
supports last year's Crime Bill but do not object to
Congressional efforts to improve it -- largely, staying out of
the fight. This strategy would envision the President signing
the Bill that Congress passes (assuming that this Bill does not
include an assault ban repeal).
4
�On the plus side, this approach does not involve taking
new positions -- and the~eby avoids alienating Congressional
Democrats because we do not affirmatively back any changes in
the Crime Bill. And it "looks presidential," because the
President stays above the fray.
But if not quite a betrayal, Congressional Democrats will
view this as an.abandonment -- a repeat of.our 1993 "hands off"
approach to crime bills -- and it means that a repeal of
100,000 cops program and all prevention programs is assured.
Finally, and perhaps more unsatisfactorily, this approach
concedes the crime issue and the Crime Bill to the GOP -- and
ends with an embarrassing reversal, when the President
ultimately signs the Crime Bill that Congress passes.
RECOMMENDATION
I recommend that we pursue the policy outlined above, and
that a Justice Department working group be assembled.to
implement this strategy -- subject to coordination with the
White House Domestic Policy, Legislativ~, and Communication
offices.
.
5
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DEBUNKING THE MYTHS: mE 100,000 COPS PROGRAM WORKS U!
,
FEBRUARY 10, 1995
There are a number of myths being disseminated about the 100,000 COPS programs. Here
are some of the facts:
Myth:
The COPS program will not pUl100,Ooo new officers on the street.
Fact:
Myth:
The 100,000 COPS program beneJUs smo114own and rural Amerka. This
week's COPS FAST awards went only to towns and communities with '
populations under 50,000. The $433 million awarded under COPS FAST will
enable over ~ such jurisdiction to hire over 7...100 new community police
officers.
Myth:
./
Crime is only a big city problem, so the COPS prog1'Cim only help, big cities.
Fact:
\
The 100,000 COPS program WQRK~. Wim this week's COPS FAST'
,awards; the President has provided gnmts to ,hire almost 17,000 new police
officers in just four month$. He is well on his way to his goal of putting'
100,000 new community police officers on the streets of America. We cannot
. afford to retreat from this coal.
The COPS programs is yet another bureaucTrllk /ederol program that
imposes too many restrictions on cities and towns.
Fact:
The COPS program is one 0/ the least bureallcraJic programs ever created
tmd, as a result. thousands, 0/ jurisdictions have IIpplied lor funding •
Jurisdictions that were awarded COPS' FAST grants this week had only to .
complete a gne-page' application. Due to the ~se of the application process, '
OVer half gf all the small jurisdicticms in America applied for-COPS FAST
tungs. The Department of Justice announced the COPS FAST gral;lts ks! than
six weeks after the apj)lication deadline.
Myth:
law enforcement officers oppose the COPS proglTlm• ..
Fact:
Police officers ttrongly suppOIt the COPS program. From big city chiefs to
small-town sheriffs, law 'enforcement professional fro~ across, the country
have praised the 100,000 COPS program and the President'S commitment to
community policing. Here's what some of them have to say:
VlWestrongly support you in your resolve to fight ... any diversion of
�02/10/01>
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funding earmarked for the 'hiIing of 100,000 police officers. D
Letterfrom Dewey Slokes. Nilliana/. Presidenz; FrQlc11"I41
Order ofPolice io Presilknl Qi1Jl()ll. 2/6/95.
"[O]ur ."esident in 1992 said he would not forget the people in small
towns and c:our:aties throughout America. fie lias more than kept his
, p,romise to, US all,· '
,
Clark County. OhioSheri,ffGer14 Kelly, COPS FAST
Arl1lQllIICemenr, February 7. 1995.'
-Because of President ClintOn's and AttOrney General R.eno'sefforts,
we will soon see 100,000 new police onlhe streets, without. smoke and
min'Ots. On behalf of my colleagUes here and across Aroma. thank
you,"
'
Galrhersburg, Maryland Police Oticf Mary Ann
Vivereue. COPS I<'AST A1I1lOWenumI, February 7, 1995.
n. COPS progl'tllia is only /or pulice htrlng.lt doel not prol'ide polke
departm'nts Jluibility to bu, equip",eRl or invest in oth" reSOUTCilS.
,'FflCl:
1M COP.~ progTtD'll is Aotjust/or hiring new officers - COPS MO'NH
(-MlIklnt Olficer Rl.dtplDym,nt EJ/llmve") will soon plrJviJe "1110 1200 ,
II.illIon Jur equipment t:UUl technicallJ3lUUuacc to enable tl" reilepw:vmelll oJ
ezisling o/ficen. Under the COPS MOIm program, for which the applh:alion
, process is already underway. all state and 'local police departments are eligible
for grants' to purchase cquil'ment and technology and to .procure support
services to take police officers from behind de.~o· and put them on the streets
wheze they belong. And law enforcemen~ will,Dot have to wait long to begin
redeploying officers -- the deadline for COPS MORE ~1iQOltions is March,
17 and grants ~ be in the hands o.f . " . by late-Spring.
police dc;partmentS
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�02/13/95
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PRESIDENT CLINTON WILt VETO ANY BILL THAT ABOLISHES
THE 100,000 COPS PROGRAM
'February 13, 1995
In his radio address on Saturday, the President said:
. "1 mode a commitmDll. a promise to pwlOO,txXJ more police on our streers. because
. there is simply 110 better crime fighting toOl to be found. An4 1 intend to keep that
promise. Anyone on Capitol Hill who wa1US 'to play partisan politics wilh police
ojJicers for America should lislen c'areflilly: 1 will velD any eJ!on to repeal or
undermine lhe 100,000 police commitment. period•.,
K,R. 728
•
TURNS THE CLOCK BACK ON CRIME FIGHTING
No Guarantees that eyenone new police officer will be hired: The 1994 Crime
Law guarantees 100,000 new police on the streets of America engaging in community
policing. Already, grants for nearly 17,000 new officers have been 'awarded, in cities
and towns across the country. Indeed, as a sure sign of its need, virtually half of all
police departments in the country have already applied for COPS grants! Law
Enforcement and ,the American people want more pOlice.
The only thing H.R. 728 gUarantees is fewer new police OD the streets of
America ... there will be fewer police to build partnerships with communities;
, fewer police to work with' residents to reduce and control crime; fewer police
, to keep our streets safe for law-abiding citizens.
'.
,•
•
Taking a Walk on Accountability to the American Taxpayer: Under H.R. 728,
money would be distributed with no strings anache4. It is super-pork of the highest
~. While the bill has been amenqed to prohipit the use of funds for the purchase .
of tanks or airplanes, how many thousands of ridiculous uses have not been explicitly
prohibited - how much money will be spent on thousands of wasteful pUrposes rather
than on more police officers? Who knows -- the bill provides for no accountability of
the use of $10 billion!
Police versus Pork. The 1994 Crime Act is paid for by reducing the size of the
Federal Government. The President said on Tuesday: "I didn't .tight to cut 100,000
bureaucrats so we could trade them in for mold-fashioned pork barrel program. "
Hoops, Hurdles and FIts for Local Governments~' Rather than forging a partnership
bCtween Federal~ ,State and loCal governments to effectively and efficiently ,fight crime
-as has been done under the 1994 Crime Act - H,R, 728 builds rQi!dblQClcs to crime
fighting.
.
• <
"
\:
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�02/13/95
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'The creation of-lOcal advisory boards required under,H.R. 7Z8,
designed to review appliCations, would add anotl)er .layer of ,
bureaucracy' and would delay Fe4eral dollars from getting to the front
quickly.
' ,
,
lines
Mayors would ,hav~ to,defer to Go~emors on criine ftghting, s,tr.ategies,
even though mayors, P'?lice clUefs and community leaders already know
~t what works for th~ir commu~ty,~
,
'
Rather than receiving grants directly' to meet their particular needs,
sri:tall towns and rural ,communities would have to ,seek their porti~m of
federal doll3.rs froin a pool distributed by the Governor of their State.
.
"
•
RepJaclng Crime F'agbters with AdministI1ltOrs. The COPS' Program under the
1994 Crime Act is eff'lclent and centralized. In distributing grants for nearly 17,000
police officers in just four months, the COPS office is under budget and 'aJ:1ead of
schedule. Yet ,the proposed block grant would move,slowly, delay crime fighting
efforts and would shave off more of the taxpayers money to pay for its adminislIative
costs.
Wbereas the COPS Office has admlnistrative costs of just .08% of the
grant funds in'FY' 19,9~, the block ~t permits'2.S" of the funds to
be'spent on federal adJD,inistiation.,' A yirtually no=stDn,gs-ittached.
, ; prt barrel program that costs'the .Ain~rican JlUblic more at eyen' tum.
No' thanks.
' ; "
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�02/13/95
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FEDERAL LAW ENFORCEMENT OFFICERS ASSOCIATION
)
··A Profnslonal Association for F.d",ol Law Enforcement Offfeelll"
February 10, 1995
The Honorable Janet Reno
Genera+
U.S. Departmcane of Justice
Washington; D • C • ;a aS3.0
A~torney
Dear Me ~
Reno I
On beha.lf of the lO, 000 members of
t.he Fed.eral Law Enforoement: Officera A".oeiation
(FLEOA) I l.he largest: representat tve of. Federal
la.w enforoement ~ffieere and 5pe~ial agentS! in
the nation, I want to exprQ~gour deep concern
and oppoasition to H.R. 728. entit.led the "T..oc:al
Government LiilW Enforeemcnt:. nlock Grants Act of
1995. fl
The broad languoge contained inH,R.
·728 does not assure that. the funda obtained
through the block grant,1iI will be used. to hire
more ~"PQ.
In the pa.st. ma.ny well intend.:d
gl."ant. ~rograms ha.ve failed hec.a1.\se such broa.d
language 3110wed funds to be dlverted.
Th~ COPS program 1s world.ng, it !o
putting more police off.icera in our communit1es.
The speed in wh1~h the arant Q under the cor>s
program are being awa,,·c3.ed should cont 1nue arid
not he interferGc1 ...,i tho
If Congre.:5~ is truly
serious about. fighting crime, hiring more cops
is t.he moet direct wa.y Clf Cl(;(;omp11sh1ng tha.t
goal.
FLEOA ~an~e to oec t.he COPS proqram
to contin\le and 15 opposed to any legiQlo.tion
that would ohange It .
./
HI20 hL" STREET N.W•• SUITe 11602. WASIOIINGTON. DC 20036·7<:212
1'ELEPJ.lONE: 202·2;8·7222 FAX: 20:"~9IH220
�02/13/95 12:41
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FROM
17~4
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[.U.P.~ .• ~FL-CIO
fgJ 005/005
TO
,
INTERNATIONAL UNION
OF POLICE ASSOCIATIO,NS
AFL-CIO
,/
THE ONLY UNION FOR LAW (;NFORCEMENT OFFICERS
P.02
ROBERT S. k1.IESMET
.'11f1tma1ionJi P/Uidl:flf
SAM A. CABRAL
1f/1'f(rIa~
Srar:/'Jry·Tl'lWllteI
ARlliUR J. REDDY
IIItamatlo1l!/1 V'tQ1.J>ras1dr:trl1
---
.--."
February 10, 1995
. The Honorable William E. Clinton
President ofthe United States
The White House·
WashiDgtO%L D.C'. 20500
Dear Mr. President:
......-.....
The Executive Board ofthe Ii:nemational Union of Police Associations. AFL-CIO meeting
in Las Vegas, Nevada. during Janu,ary 20-22, 1995, discussed the continuation of discretionary
grants for law enforcement. The Executive Board unanimously supported the 100,000 COPS
initiative which has already put more:than 17,000 ne'J{ police on the streets to make big city
communities safer. In addition, 7,100 ne-;:v community policing officers are now working in
smaller jurisdictions throughout this nation. The 100,000 COPS program is a strategy that has
just begun to work and must be eontinued untillhere are 100,000 more police on our streets. The
Executive Board also lauded the fact that this 100,000 COPS initiative not only makes our
communities safer through communi~ policing efforts; it also makes the job of street police safer
because of the interactions of police ~d their communities.
The COPS progran:i muSt no~ be diminished or abolished. On.behalfof our national
membership. we thank the President!and the Department ofJustice for their continued support
and we pJedge ours to their efrOM.
: Sincerely,
.
.
~fLL--J
: Robert B. Kliesmet
: International President
cc::
Sam Cabral
Atrhur J. Rc:d~'
�02/17/95
.f
17:51
ft202 514 1724
III 002/003
DOJ-OAAG
THE ADMlNISTRATlON HAS CONSISTENTLY SUPPORTED
A BALANCED APPROACH TO HABEAS AND EXCLUSIONARY REFORM
February 17, 1995
,
•
,
The Adminktration bas long been "on the record" in its can for balanced Habeas
and Exclusionary Rule reform. Three years ago, President-elect Clinton stated that
he was in favor of balanced monns that speed justice and assist law enforcement
without compromising the fundamental Constitutional rights 'of all Americans. The
Clinton Administration has never deviated from this position.
HABEAS REFORM:
•
,Giving defendaDts "one-bite-at-the-appleli and imposing striCt riling deadlines will'
reduce delay. The Adniinistration favors a "one-bite-at-the-apple" approach to
habeas corpus that would require petitioners promptly to bring all their claims in one
federal habeas corpus petition and impose strict filing deadlines for the first time ever
in federal habeas corpus, in both capital and noncapiial cases.
•
Effective habeas refonn means targeting' aU' sources' of delay. The excessive
delays in Capital cases result not only from manipulation of habeas corpus procedures
but also from a high rate of constitutional error' in capital trials. In a significant
percentage of capital cases, the federal courts, on ha~ review, find some form of '
error in the original proceedi ngs that necessitates reversal of the conviction. Effective
habeas corpus reform must target both sides of the problem -- manipulation and
Ci9mpetent counsel.
'
.
•
Habeas Reform must provide for competent trial counsel. The Administration
supports an approach that pro~c:ies for gualified counsel·in.state trials to ensure that
the trial is done right the first time, keeping the trial "the main event" in the system.
Defense counsel and prosecutors agree that competent counsel is essential to a well
functiamng habeas process..
-EXCLUSIONARY RULE
•
•
The Department of Justice haS
consistently supported the Biden Amendment which calls far a good-faith exception to
the exclusionary rule. Under, that exception, which the Supreme.Court has
recognized, evidence will be used at trial if it was obtained in "good faith" -- meaning
~e police officer conducted the search in objectively reasonable reliance on a search
wmant.
"Good Faith" Exception for Warrant Searches.
The good·faith exception to the exclusionary rule makes good policy sense when
the police have obtained a search warrant. The exclusionary rule is designed to
. deter police misconduct; but where the police obtain 'search warrant from,
�02/17/95
...
,
17:52
'ff202 514 1724
DOJ-OAAG
~ 003/003
magistrate. and the magistrate is latctr determined to baye erred, there is no reason to
suppress evidence -- and risk allowing a guilty person to go free.
"
•
Under our'proposal, effective law enforcement is 1;Jalanced with protection of
Constitutional rights. We agree with Senator Biden and other law makers that police
should be encouraged to obtain search warrants. The good-faith exception to the
exclusionary rule, since it applies only when' police obtain a search warrant, does not
reduce, an officer's incentive to obtain a warrant where required py the Constitution.
At the same time, it reduces the possibility that the guilty will go free. It is' a
balanced approach.
•
The House approach to exclusionary reform puts politics over pollcy. Some
supporters of H.R. 666 were more concerned with:politics than law enforcement.
Members actually voted down the text of the Fourth Amendment in favor of H.R~
666. They also tried to curry favor with speCial interests like the N.R.A. by voting
not ,to grant ATF agents the same search authoritY they are willing to give the rest of
lawenforcement. That's a slap in the face to the federa11aw enforcement officers
who are charged with the difficult and life-threatening duty of enforcing our gun laws.
�02/21/95
, _,;,._ _~,~02/00J
DOJ-OAAG
'0'202 514 1724
18:07
THE PRESIDENT'S 100.000 COPS PROGRAM
THE NUMBERS CRUNCH: FACTV. FICTION
February 21, 1995
Fiction: lOO,OOO,Cops Doesn't" Add Up
. •
~:
Since passage, of the 1994 Crime Act, Republican members of Congress charged
that the COPS initiative would fund only 20,000 new cops over the next, six years.
'The Numbers Prove It: This is Not -New"Math
-
\
•
The COPS Program earmarks almost $9 billion for hiring or rehiring of .
community police officers. That money will help put 100,000 additional cops on
the street .~ an almost 20 percent increase in the nation's 504,000 local Jaw
enforcement officers. '
•
The 100,000 cops pledge is based on a simple formuli:
I
•
The 1994 Crime Bill authorizes $8.8 billion for hiring or rehiring community
policing officers and programs.
a.
Total funds = 58.8 blllion
• With 3% set aside for technical assistance 'and training, $8.54 billion will
remain.
** Remaining funds = $8.54 billion
• Of the remaining $8.54 billion, I/nomore than" 15% is available for non-hiring
purposes ,li.k:e equipment and overtime., If 14% .is allotted for these -other'
purposes "(Sl. 195, billion), 86% is available to hire more cops. '
aa 86% of the remaining funds
=·57.345 billion
will be used for hiring and rehiring. of cops
..
II The COPS Program will provide 3 year grants of up to 575,000 to pay up
7S % of the cost of salary and benefits for each new or rehired offiCer.
*.
to
$7.345 billioD in remaining funds divided by $75,000 per officer :;
97,920 cops
,
�02/21/95
...
18:08
'6'202 514 1724
'
··.Number
97,920
ot COpS projected to be funded through the COPS Program ==
• 2,080 cops were funded under the earlier Police Hiring Supplement program.
"" Adding these to the 97,920 officers funded under. the COPS Program brings the
total number of cops to be funded to 100,000.
•• 97,920 plus 2080 cops hired under the Police Hiring Supplement =
100,000'
•
With grants for nearly 17,000 Dew officers aIreadyawarded, the COPS awards are
. on target. As promised, the COPS program is proceeding efficiently and non
bureaucIatically. As promised, instead of "red tape" the American people are
getting more cops. Andtliis is happening with a minimum of administrative
overhead. Whereas the COPS office has administrative costs of just .08% of 1995
gmIlt funds, the Republican block grant proposals pennit 2.5% of funds to be
spent on administration.
""1"
Fiction: Republican critics have .long .claimed that the COPS Program would produce the
equivalent .of only one new police officer for every police department in the country.
Fact: Vnder the COPS Program, cities like Chicago have hired 321 new officers.
Anchorage, Alaska has added 15 new officers to its force and Fresno, California received
funding for 11 new offiCers.
2
�
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Carol Rasco - Issues Series
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Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
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2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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92 folders in 7 boxes
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Crime
Creator
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Domestic Policy Council
Carol Rasco
Issues Series
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2010-0198-S Segment 2
Is Part Of
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Box 123
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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12/4/2013
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2010-0198-Sb-crime
-
https://clinton.presidentiallibraries.us/files/original/bc99af0abe5a702a942189ad8b9c63c2.pdf
27a1a30c47614c7a4d030dad65f0d0dc
PDF Text
Text
WithdrawallRedaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECTfI'lTLE
RESTRICTION
00 I. schedule
Rasco, Saturday, July 9 through Wednesday, July 15 (partial) (3
pages)
07/09/1994
P61b(6)
002. itinerary
AmEx Travel for Rasco from Nashville TN to WDC, 07113/94
(partial) (I page)
07/05/1994
P61b(6)
003. itinerary
AmEx Travel for Rasco from Nashville TN to WDC, 07/13/94
(partial) (I page)
07/0511994
P61b(6)
004. schedule
Rasco, Saturday, July 16 (partial) (I page)
07/161l994
P6/b(6)
005. memo
Romani to Clarissa Cerda re Speech by Carol H. Rasco (partial) (I
page)
06/15/1994
P61b(6)
006. schedule
Rasco, Friday, July 29 (partial) (1 page)
0712911994
P61b(6)
007. letter
Betty Guhman to Rasco re visit (partial) (1 page)
07/2111994
P61b(6)
008. schedule
Rasco, Friday, July 29 (partial) (1 page)
0712911994
P61b(6)
009. note
handwritten re Fayetteville trip on 07129/94 (partial) (I page)
nd
P61b(6)
010. memo
Rasco to Romani re Flight Information (partial) (l page)
0711211994
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: Travel Schedules
2010-0198-5
kc224
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)J
Freedom of Information Act - [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(1) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
bel) National security classified information [(h)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would \iolate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
or
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
00 l. schedule
DATE
SUBJECTITITLE
Rasco, Saturday, July 9 through Wednesday, July 15 (partial) (3
pages)
07/09/1994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Schedul ing per 10-11: Travel Schedules
2010-0198-S
kc224
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a»)
Freedom of Information Act - [5 U.S.C. 552(b»)
PI
P2
P3
P4
bel) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b )(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
. information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of the PRA)
Relating to the appointment to Federal office [(a)(2) of the PRA)
Release would violate a Federal statute [(a)(3) of the PRA)
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
C. Closed In accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�SCHEDULE
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
TRAVEL SCHEDULE
SKYPAGE NUMBER:
1-800-SKYPAGE
PIN::... 2074765
CHR WILL TAKE TAXI TO AIRPORT FROM RESIDENCE
SATURDAY, JULY 9
I.
LV NATIONAL
AR DALLAS
SEAT 19D.
11:26 A.M.
1:26 P.M.
AMERICAN AIRLINES
FLIGHT 1997
LV DALLAS
AR LR
SEAT27F
2.23 P.M.
3:31 P.M.
AMERICAN AIRLINES
FLIGHT 1132
PICK UP RENTAL CAR
CONFIRMATION NUMBER:
LODGING:
' 0950177865
NATIONAL CAR
IN TERMINAL
�Carol H. Rasco Travel Information Schedule Continued:
Return Rental Car.
SUNDAY, JULY 10
LV LR
AR TN
SEAT 14'D
6:35 A.M.
7:42 A.M.
AMERICAN AIRLINES
FLIGHT 1330
CHR will take taxi to Hotel:
HOLIDAY INN CROWN PLAZA
615-259-2000
CONFIRMATION NUMBER: 64864575
Upon arrival: CHR will have room available per Cynthia Morin
(Nashville Conference Co-ordinator)
UPON ARRIVAL AT HOTEL
Any problems call Cynthia Morin
615-259-4000 (0)
12:15 P.M.
CHR MEET AT LOBBY/INFO. DESK
CATHY-WOOD DOBBIN IS
TN. TASK FORCE MEMBER AND EX. DIRECTOR
TN. PRIMARY CARE ASSOCIATION
CATHY WOOD-DOBBIN WILL ACCOMPANY/TRANSPORT
CHR TO CONFERENCE SITE'
.
TENNESSEE STATE UNIVERSITY
1:00 -5:00
Family ReUnion III:'
IIExperts' Forum"
Vice Presiden't Gore will ~ost Family Reunion III Conference:
The Role of Men in Children'S Lives
Tennessee State University Students' Center
3500 John A. Merritt Boulevard
Contact: Kathy Robinson
615-320-3173
Main University Number:
615-320-3131
CATHY WOOD-DOBBIN WILL TRANSPORT CHR BACK TO HOTEL
5:30 - 7:30
RECEPTION (DRESS CASUAL)
TN STATE MUSEUM
(WALKING DISTANCE FROM HOTEL
LESS THAN ONE BLOCK)
Tennessee State Museum
Tennessee Performing Arts Center
505 Deaderick Street
Nashville, Tennessee
�Contact:
T. Greg Anderson
615-741-2692
Carol H. Rasco Travel Infor.mation Schedule continued:
7:00
9:00
PRIVATE DINNER (50 PEOPLE - POLICY/FUNDERS
WITH VICE PRESIDENT AND MRS. GORE
CUMBERLAND CLUB (DRESS IS UP TO CHR)
CHR WILL HAVE TIME TO CHANGE IF SHE WISHES
(CUMBERLAND CLUB IS ALSO WITHIN WALKING
DISTANCE - LESS THAN BLOCK FROM HOTEL)
Cumberland Club
511 Union Street
Nashville, Tennessee
Contact: Kathy Davis
615-254-3451
�Carol H. Rasco Travel Schedule Infor.mation continued:
MONDAY, JULY 11
'Bill Galston will attend White House Management Meetings
8:00 A.M.
CATHY WOOD-DOBBIN WILL MEET CHR AT
LOBBY/INFORMATION DESK OF HOTEL
AND ACCOMPANY CHR TO CONF. SITE
8:30-5:00
Vice President Gore Hosts Conference
Family Re-union III: The Role of Men in
Children's Lives
12: 30
LUNCH
HOLIDAY INN CROWN PLAZA
CHR SEATED BETWEEN GOV. MCWHERTER (R) AND
REV. JESSE JACKSON (L)
3:15 - 4:00
Vice President Gore and Carol H. Rasco
Lead Panel Discussion regarding Policy Issues
(Representatives of federal agencies, state
governments, local governments)
CATHY WOOD-DOBBIN WILL TRANSPORT CHR TO AIRPORT FOR P.M. FLIGHT
LV TN
AR LR
SEAT 6B
8:15 P.M.
9:23 P.M.
PICK UP RENTAL CAR
NATIONAL
CONFIRMATION #
THE CAPITAL HOTEL
111 WEST MARKHAM
LITTLE ROCK, AR 72201
501-374-7474
CONFIRMATION NUMBER:
002697
AMERICAN AIRLINES
094504571
FLIGHT 665
(IN -TERMINAL)
�Carol H. Rasco Travel Information Schedule continued:
TUESDAY, JULy 12
Bill Galston will attend White House Management Meetings
9:00
10:00 - 12:00
Arkansas People for Inclusive Communities
Open House
Pyramid Building, 221 West 2nd, Suite 401
Little Rock, Arkansas
Contact: Sydney Padgett 501-372-2747
12:30
1 :,00
Meeting with Arkansas Department of Human
Services Officials in preparation for
Wednesday speech
�Carol H. Rasco Travel Schedule Information continued:
WEDNESDAY, JULY 13
Bill Galston will attend White House Management Meetings
CHR WILL DRIVE FROM LR TO HOT SPRINGS
9:30 - 6:30
Arkansas Department of Human Services
1994 County Administrators Association
Conference
1:30 -2:30
KEYNOTE SPEAKER:
1994 County Administrators
Association Conference, Department
Human Services
Lake Hamilton Resort
2803 Albert Pike Road
Hot Springs, AR
501-767-5511
CHR WILL DRIVE FROM HOT SPRINGS TO LR
RETURN RENTAL CAR AT AIRPORT
5:08 p.m.
'6:16 p.m.
SEAT 18D
LV LR
AR TN
AMERICAN AIRLINES FLIGHT 860
6:50 p.m.
9:23 p.m.
SEAT 24D
LV TN
AR DC
AMERICAN AIRLINES FLIGHT 1022
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. itinerary
DATE
SUBJECTITITLE
AmEx Travel for Rasco from Nashville TN to WDC, 07113/94
(partial) (I page)
07/05!l994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-1 1: Travel Schedules
20 I 0-0 198-S
kc224
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)]
Freedom of Information Act· [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(1) ofthe PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
bel) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(h)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
conc!!rning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�"
1hwe1
~~ Management
American Express ,
Travel Related Services Company, Inc:.
White House Travel Office
Old Executive Office Building, Room 87
Washington, D.C. 20500-0001
Phone: 202 456·2250
Faxi 202,456-6670
Services~
INVOICE / lT1NERARY
In Emergency After Hours CallI
1 800 847·0242 (Toll free In the U.S.,
YourcoJle number is: KC52
,[lATE: O~I JlIL 94
SALES PERSON: 74
ITINERARY/INVOICE NO. 0007275
CUSTOMER HEIR: 1695000023
SJZPST
PAGE: ()2
TO: WHITE HOUSE TRAVEL
1600 PEHNSYLVANIA AVE
WASH DC 20500
FOR: RASCO/CAROL MS
REF: KC5SXD4LR1
13 JUL 94
- WEDNESDAY
AMERICAN AIRLINES
FLT:1022
'LV NASHVILLE
AR WASHINGTON HATl
RASCO/CAROL MS SEAT-24D
AIR
,
ECOHOMY
6S0P
SI~AC.(
EOP: SUPER 80
NON-STOP
923P
01 JAN 95, .;. SUNDAY,
OTHER WASHINGTON
HAVE A GREAT .TRIP
AIR'TICKETS
AAll13286847/48
610.00
610.00*
SUB TOTAL
NET CC BILLING
\
0.00
TOTAL AMOUNT DUE
• TOTAL AIR FARE USD766.00
FOR AFTER HOUR EMERGENCIES,
CALL aOO-847-0242/YOUR HOTLINE CODE IS S-KC52
.•......•.........•..••••••••••••••••.•......... -...
••••••••••••••••• RE"INDER •••••••••••••••••••••••••••
ALL FREQUEHT FLYER BENEFITS EARNED ON OFFICIAL TRAVEL
ARE THE SOLE PROPERTY OF THE U.S. GOVERNMENT AND CANNOT
BE REDEEMED FOR PERSONAL USE •
.
....... ............................................ .
'
ALL UNUSED TICKETS ARE TO BE RETURNED TO AMERICAN
EXPRESS OR YOUR TRAVEL COORDINATOR IMMEDIATELY UPON
RETURN,FROM TRAVEL OR WHEN TRIP HAS BEEN CANCELED •
. ...'" ................... '" ......... " .................
THANK YOU FOR TRAVELING WITH AMERICAN EXPRESS.
TR 6450 (12190) PAINTED IN U.S.A.
ORIGINAL
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Clinton Library
DOCUMENT NO.
AND TYPE
003. itinerary
DATE
SUBJECTfflTLE
AmEx Travel for Rasco from Nashville TN to WDC, 07113/94
(partial) (1 page)
07/05/1994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: Travel Schedules
2010-0198-8
kc224
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)]
Freedom of Information Act· [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would \iolate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b )(9) of the FOIA]
National Security Classified Information [(a)(I) of tbe PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would \iolate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his ad\isors, or between such ad\isors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift. '
PRM. Personal record misfile defined in accordance witb 44 U.S.C.
2201(3).
RR. Document will be> re\iewed upon request.
�1t'ave1
.:;=~ Management
Services
Am.';,"" Exp''''
@o
!J
Travel Related Servlcel Company, Inc.
White House Travel Office
Old Executive Office Building, Room 87
Washington, D.C. 20500-0001
Phone: 202 456-2250
Fax: 202 456-6670
In Emergency After Houri Cali!
1 800 847-0242 (Toll Free In the U.S.,
INVOICE / ITINERARY
DA t~~r t°t,eJ1rt~~ is: KC52
PAGE: 02
SALES PERSON: 74
ITINERARY/INVOICE NO. 0007275
CUSTOMER NBR: 1695000023
SJZPST
TO: WHITE HOUSE TRAVEL
1600 PENNSYLVANIA AVE
WASH DC 20500
FOR: RASCO/CAROL MS
REF: KC5SXD4Ua
13 JUL 94 - WEDNESDAY
AIR . AMERICAN AIRLINES
FLT:l022
LV NASHVILLE
AR WASHINGTON NATl
RASCO/CAROL MS
SEAT-24D
ECONOMY
650P
923P
SI~ACf{
EOP: SUPER
NON-STOP
BO
01 JAN 9S - SUNDAY
OTHER WASHINGTON
HAVE A GREAT TRIP
\
AIR'TICKETS
AAlll~286847/48
. 610.00*
S,UB TOTAL
NET CC BILLING
TOTAL AMOUNT DUE
610.00
610.00*
0.00
· TOTAL AIR FARE USD766.00
FOR AFTER HOUR EMERGENCIES
.CALL 800-847-0242/YOUR HOTLINE CODE IS S-KC52
·.................................................. .
••••••••••••••••• REMINDER ••••.•••••••••••• ~ •••••••••
ALL FREOUENT.FLYER BENEFITS EARNED ON OFFICIAL TRAVEL
ARE THE SOLE PROPERTY OF THE U.S. GOVERNMENT AND CANNOT
BE REDEEMED FOR PERSONAL USE.
·..................................
~
............... .
ALL UNUSED TICKETS ARE TO BE RETURNED TO AMERICAN
EXPRESS OR YOUR TRAVEL COORDINATOR IMMEDIATELY UPON
RETURN FROM TRAVEL OR WHEN TRIP HAS B~EN CANCELED.
THANK YOU FOR TRAVELING WITH AMERICAN EXPRESS.
TR 6450 (12190) PRINTED IN U.S.A.
ORIGINAL
�PHOTOCOPY
PRESERVATION
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
TRAVEL
CHECKLIST FORM
COMMENTS/
PROBLEMS
INITIALS OF
DPC STAFF PERSON
FUNCTION/
ACTIVITY
\ DATE(S) OF TRAVEL?
\v
..~
DESTINATION?
TRAVEL AUTHORIZATION
FORM COMPLETED?
MODE OF TRAVEL?
RESERVATIONS MADE?
IF AIRLINE, WISH
AISLE SEAT.
\\i
TICKETS OBTAINED FROM
TRAVEL OFFICE?
HOTEL RESERVATIONS
MADE?
\-J
CONFIRMATION NUMBER?
NOTE: FOAM .PILLOWS
NOTE: NON-SMOKING
\
J
COMPUTER SET-UP
AVAILABLE AT HOTEL?
DEDICATED LINE?
HOTEL FAX NUMBER?
CAR
RENTAL READY?
RESERVATION NUMBER?
MATERIALS FOR TRIP
(MTG. FOLDERS/SPEECH
MATERIALS) READY?
,
CHR SCHEDULE FAXED
TO WH OPERATORS,
SIGNAL & STAFF?
CAR RESERVATIONS
MADE WITH WH GARAGE?
CHR DEPARTURE:
1) TICKETS PACKED?
2) ITINERARY PACKED?
TRAVEL SCHEDULE TO MARY-MARGARET?
"
-,
F(iX
(t.'J)
DATE: _ _ _ INITIALS:
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�E X E CUT I V E
OFF ICE
o F
THE
PRE SID E N T
18-Jul 1994 01:37pm
TO:
TO:
Rosalyn A. Miller
Patricia E. Romani
FROM:
Carol H. Rasco
Economic and Domestic Policy
SUBJECT:
. expenses from Boston
I've put my receipts in outbox. As I understood it from Pat, the
.ticket was purchased by the Nat. Ed. Goals Panel. AS to room:
the room fee itself I believe we are eligible to send to Nat. Ed.
Goals Panel (Pat has the scoop on all of that); the meal (Room
Service $13.55) on the hotel ticket can go to Panel; the phone
calls should be submitted to White House for reimbursement; and no
one has to repay me for the movie I watched (Pay Service $7.95).
The taxi I took
garage to get .a
the taxi fee as
as well.
I did
them I wouldn't
Saturday afternoon as there was not time to call
car since I left Boston on the spur of the moment;
I understand it can probably be submitted to Panel
call garage upon my return to White House to tell
need the car that evening.
�•. I'"
SCHEDULE
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
TRAVEL SCHEDULE INFORMATION
SKYPAGE NUMBER:
1-800-SKYPAGE
PIN:
2074765
FRIDAY, JULY 15
3:45
WH Car enroute to National
Airport
4:30
·Northwest Flight to Boston
Flight 38
Arrive in Boston
6:05
AT AIRPORT CHR WILL BE MET BY UNIFORM
STATE TROOPER OR AIRPORT REPRESENTATIVE WITH
CHRiS NAME ON SIGN:
PERSON WILL ESCORT
CHR TO BOSTON COACH SEDAN (TRANSPORT TO
HOTEL)
CHR WILL THEN HAVE TO GO BACK TO BAGGAGE
AREA TO RETRIEVE BAGGAGE IF SHE HAS OTHER
THAN CARRY-ON (this according to Susan
Ade,: 617-954-2528)
PHONE NUMBER FOR TRANSPORT:
617-954-2537
Contacts: Bob Burnette or Roger Spelta
LODGING:
Sheraton Boston Hotel and Towers
39 Dalton Street
Boston, MA 02199
Phone:
617-236-2000
Fax:
617-236-1702
Confirmation: #30RA07151132G
(STANDARD CHECKOUT TIME IS 12:00 NOON
IF YOU WILL NEED LATER TIME, INFORM
DESK PERSONNEL AT TIME OF CHECK-IN)
CHR will have to pick up credentials
at Hines Convention Center (for NGA)
Registration Desk Open Saturday,
July 16, 9:00 - 5:00 (final program
will be included in
materials CHR
will pick-up) Third Level
(Walkway from hotel to Convention Center)
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. schedule
DATE
SUBJECTrrITLE
0711611994
Rasco, Saturday, July 16 (partial) (l page)
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Schedul ing per 10-11: Travel Schedules
20 I 0-0 198-S
kc224
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom ofinformation Act - [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(I) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute ((a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
bel) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(bX9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�SATURDAY, JULY 16
8:30 - 11:00
NEGP MEETING
Sheraton Hilton and Towers
Republican Ballroom A
39 Dalton Street
Boston, ,Massachusetts
Telephone: ,617:-236-2000
1:00
DGA,Van departs from main Entrance
(39 Dalton Street) of the Sheraton
enroute to Meeting
(Seating confirmed with Katherine
Whelan 202-479-5153 on 7-,14)
1:00- 4:00
DGAGOVERNORS'-ONLY MEETING
Residence of Tom & Nicole Hynes
Contacts:
Carol Sullivan and Kaliope Poulianos
Phone:
4:00
DGA Van departs Meeting enroute
to Sheraton
6:30
Northwest Airlines Flight #39
Departs Boston
.
(If CHR wishes to use Boston Coach, Sedan
for transport back to airport: 617-954-2537)
8:11
8 :15
,
'
Northwest Airlines Flight #39',
'Arrives DC National
WH Car enroute to White House
(
\
/
�(,J"
-'.
I, ;:
-(; U.S. GOVERNMENT PRINTING OFFICE 1993·341;.776
\.
,
.~
EXECUTIVE OFFICE OF THEPRESIDENT
OFFICIAL TRAVEL AUTHORIZATION
1. TYPE OF AUTHORIZATION
(Pril'acy Act SlIlIement and instructions on back)
XJ .TDY
Amendment
(Show items amended)
o Invitational
2. Traveler (First name, middle iniJial, last name)
Carol H.
0
Relocation
(Non EOP Employees Only)
Rasco
3. Title of Traveler
4. AGENCYIDIVISION
Assistant to the President for Domestic P plicy
5. Office Phone
7. fJ Per Diem
Actual SUDsistence (unusual circumstances) *
6. Official Duty Station
456-2216
Washington,
OPD/DPC
DC
Rate(s):
(1) To. participate in Vice-President I s Family Reunion
Conference in Nashville, TN and (2) speak to Department of Human
PURPOsEServices City Mmi oj strator I ASsoci at j on Meet j ng . j n AR
(3) attend other Official meetings in AR
8. TRAVEL INFORMATION
1-.9...1 --9.4
DATE(S): Travel Begin On
Travel End On
~/-l-J/--9.4
ITINERARY: Point of Origin (City. State) _W_a_s_h_i_n-=g::...,t_o_n...:,_D_C _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_
Place(s) of Official Visitation (City, State)
Nashville, .TN,
Hot Springs, AR, Little
Rock, AR
Washington,
p.
.omtofR etum (C'ty, State)
I
:i:: ('.,.
'·9;...
< ~\':'. ·t., ;,ilkESTIMATED COST
';:~'.;;£··.y:>~'tMQDE··QF;TRI.\,YEL
(a)::i::·j;('j'r:.~N,~i·(~;~{~€o~·~riatioD!:\l,.d:G;:··,:
Rail
Coach
Extra Fare"
Coach Tourist
Air
Business *
First Class :j:
Rate auth
per mile
$
..
-
99.00
Miscellaneous
242.00
TOTAL
$
1357.00
0
Detennined more advantageous
10 government ..
" li:':SPECtAI;E:x:PENSE'AtITiloiUZED
0
For convenience of traveler
NTE common camer cost
0
Registration Fees (meeting, training, etc.)
KJ
Commer\=ial Rental Car
0
Excess Baggage not to exceed
(c)'D'fiOv!t OWDedVebide
.
.. .
.
-
250.00
766.00
Transportation
Rental Car
i::First;CIass muSiiItaveappn;v8Lof-AlePcY,Head or. Deputy
'-'.. ~' r~:;j:~" ·'frlvatdy 'OWij~;Vehide .
(b),',"
Other
AMOUNT
'. ::.':;';\13;::11 . Per Diem/Actual Subsistence
X
Auto
DC
.
D Other (Ple~e iden(ify)
(dj OOther (speclry)
.J2:' ADVANCKREQUESTED.
$
(mabmul miscellmulou.s expenses DillyJ
13. * Special ProvisionslRemarks (Ju.stifU:alion lorfirst class /business lextrolare trovel, anntuU leave enroute, t:u:tuo:l subsistence, etc.)
Air Travel on 9 July
heeds of traveller.
1994 (government rate) did not meet schedule
IS. Accounting data (Appropriation, dMsion, project, I'endor number)
1.4(b) I certify that the trave.1 herein was reviewed and determined
to be essential for the accomplishment of agency programs
and missions
Approval ~fficial ~reand Title)
O~t'AJ
17.
,
te
,,-OJ....
Xl)
�WithdrawalIRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. memo
DATE
SUBJECTffITLE
Romani to Clarissa Cerda re Speech by Carol H. Rasco (partial) (1
page)
06/1511994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: Travel Schedules
20 I 0-0 198-S
kc224
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(I) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(!) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�[005]
,~
",(
~
/~<d(!'I(£
tf-7V
4:/(0 /~d~
)'7 /,/
June 15, 1995
MEMORANDUM FOR CLARISSA CERDA
WHITE HOUSE COUNSEL'S OFFICE
r
FROM:
Pat Romani
Office of Domestic Policy
SUBJECT:
Speech by Carol H. Rasco
I have appended a copy of an invitation Carol has accepted
to speak before the Arkansas Department of Human Services,
County Association Annual Conference in Arkansas on July 13,
1994.
They have offered to pay for Mrs. Rasco's expenses.
portion, if any, is acceptable?
What
Please advise.
We need an. answer by June 21 at the latest per the folks in AR.
.
'
5'·'..,A
Thanks for your assistance.
Please phone (6-2216) or e-mail with decisi
~
!).~ .c..
Pay~'<;Z;
.. fi,17
.
,:1Zfl-u.r ,.., b»-A.4-e-
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1">LA .(
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-
�Contact person: Pat Romani
Phone, number: 6 - 2 216
Date of request: 6-15.;. 9 4
ACCEPT~CE
OF TRAVEL EXPENSES FROM OursI,DE SOURCE
'In order to consider whether the Government may accept from aD. outside source payment of
your trave4 subsistence and related expenses under the GSA travel- rule. you m~t complete the
informationbelow. The outside source need not be a 501(c)(3) organization. but if it is. please
state so on this form and include the IRS dete~tion letter.
Please include a copy of the letter of invitation if one was received.
Your mime and position:
Carol H. Rasco, Assistant to the Presiden't for Domestic Policy
Nature of meeting or similar function and how it relates to your official duties:
Carol Rasco wiil be attending conference in Nashville, TN and
then travelling' to AR to give a speech orJIr~~K>efore' the'
Department of Human Services County Administrators Meeting Association.
Date and plac~(s) of travel~
.'
*Welfare Reform
From Nashv~lle, TN· (Leaving VP Family Reunion Conference)
To: Little Rock, AR, (Speech in AR July 13)
"
Return: to DC
(Return to DC)
.
Persons or entity making the payment (please also note any tinancial.interests of the person or '
entity known to you that may be affected by tJ:ae exercise of your -Government responsibilities):
Nature of expense(s) paid for:
Hotel
Air Fare
Method and approximate amount of payment (payment may' be made either in-kind or by
check made payable to U.s. Treasury; you may not directly receive payment in cash or check
, made out to you):
'
This form and any accompanying memorandum of approval must be attached to your travel
authorization. You must complete a travel voucher following the trip. Please send completed
form to Room 128, OEOB, at teast 3 days before commencement of travel.
�(0 NLR
TEL:1-501-375-2846
Feb 16
February 16, 1994
tMlJL,
Dear~o:
On behalf of the Arkansas Department of Human Services, County Association,
we would like to extend an invitation to "come home" and be the Keynote
Speaker at our annual conference sched\ued July 13, 14 and 15 at the Lake
Hamilton Resort Center at Hot Springs.
extremely busy schedule, ,.,e will gladly be flexible and adjust
our activities to accomodate you on any time frame, in order for you to,
address our group. Any information you can shar.e \J,ith us regarding "Welfare
Reform" we would greatly appreciate.
Due to your
We would, be very honored to have you as our guest and hope that your~
would permit it. Please let us know at your earljest convenience, if you
will be able to visit with us. Best wishes!
With kindest regards,
~
Randy 1£wson, Program Co-chair
Arkansas DHS.Courity Administrators Association
,02
�DHS P..!"LLAS~ IN. CONLR
TEL: 1-501-375-2846'
Jun 23 94
12:00 No.007 P.02
~\e.{lky
~--Le
June 22, 1994
Le-·J:x2,
Ms. Carol Rasco
Assistant to The President for Domestic Policy
The WIlite House
West Wing, Second Floor
Washington, D.C. 20500
eoL-'~
Q~
Dear ..MB--. RaSC;tl:
~
~
Thank your for the recent correspondence from Ms. Romani in preparation
for your visit. I spoke with Lerone Thomas, President of the County
Administrators Association and he authorized me to guarantee reimburse
ment for the following items that were reQuest~d=
(1). Airfare
at government rates fr9J1l Nashville to Little Rock and the
return flight from Little Rock to Washington.
(2) One night accomodations at a Little Rock hote1..,
(3) One day car rental.
(4) One day government per diem.
If there are any' details in which we can assist you, please call me at
501-372-4080. We thank you for your assistance and look very forward to
your homecoming!
With kindest regards,
Randy Lawson,
Program Co~air
. .
Arkansas DHS County Administrators Association
�Jun 23 94
DHS PULRSK IN. CO NLR . TEL: 1-50 1-3.75-2846
.11:59 No.007 P.01
JUN 2 3 REC'[J
REMARKS:
..
... ' _!
_. .
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'
,." - - - . ..."
-
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_ _ _ _-
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June 15, 1995
tJ~Jj
MEMORANDUM FOR CLARISSA CERDA
WHITE HOUSE COUNSEL'S OFFICE
FROM:
SUBJECT:
r ~p ,7j~'dP_
A~ ~
lF/~SL
Pat Romani
Off
lo\LP
r
of Domestic Policy
~~
Speech by Carol H. Rasco
I have appended a copy of an invitation Carol has accepted
to speak before the Arkansas Department of Human Services,
County Association Annual Conference in Arkansas on July 13,
~'~.~
1994.
They. have. 0fffered. to pay fobrlMrs. Rasco's expenses.
port1on, 1 any, 1S accepta e?
What
~- .. ~'
~
'~~
~
()
U
(u
Please advise.
We need an answer by June 21 at the latest per the folks in AR.
Thanks for your assistance.
Please phone (6-2216) or e-mail with decision.
CLINTON LIBRARY PHOTOCOPY
\'j/1...-
�;,i~
f
"
\'
Contact per;son: flat Romani
Phone number:, 6 - 2216
Date of request: 6-15-9.4
ACCEPTANCE OF IRAVEt EXPENSES FROM OIITSIDE SOURCE
In order to consider wh~ther ,the 'Government may' accept' from an outside source payment' of
.your trave~subsistence and related expenses l:lnder the GSA travel rule; you must complete the
information below. The outside' source need not be a 501(c)(3) orgaD.ization, but if it is, please
state so on this form and include th~ IRS determination letter.
Please include a copy of the letter of invitation if .one was receive~.
Your name and position:
. Carol H. Rasco,
'A~sistant
to the' President for Domestic Policy
Nature of meeting or similar function and how it ~Iates 'to your official duties:
Carol Rasco will be attending conference in Nashville, TN and·
then travelling to AR to give a speech orP~~~x:>efore the
Department of Human'Services County Administrators Meeting Association.
,
,.;
.*Welfare Reform
From Nashville ,TN. (Leaving VP Family ,Reunion Conference)
To: Little Rock, AR
(Speech. in AR ·.July 13)
Return: to DC
.
.
(Return to· DCl
Date and place{s) of travel:
'
'.'
.
Persons or entity making the payment (please also note any financial interes~s of the person or
entity known to you that may be atTect~d by the exercise of your .Government '. responsibilities):'
Nature of expense(s) paid for:
Hotel
Air Fare
Method and approximate amount of payment (payment may be made either in-kind or by
check made payable to U.S. Treasury; you may not directly receive. payment in cash or check'
made out to you):
'
.
This form and any accompanying memorandum of approval mus't be attached to your travel
authorization. You must complete a travel voucher following the trip. Please send completed
form to Room 128, OE9B, at 'least 3 days before, commencement of travel.
�co
NLR
TEL:1-S01~37S-2846
Feb 16
February 16, 1994
bUlJ.i.,
Dear~o:
on behalf of the Arkansas Department of Human Services, County Association,
we would like to extend an invitation to· "come home" and be the Keynote
Speaker at our annual conference sched\ued July 13, 14 and 15 at the Lake
Hamilton Resort Center at Hot Springs.
Due to your extremely busy schedule, 'We will gladly be flexible and adjust
our activj.ties to accomodate you on any time frame, in order for you to
address our group. Any information 'you can shar.e w.ith us regar.ding "Welfare
Reform" we would greatly appreciate.
. We would be very honored to have you as our guest and hope that your sdB.iule
would pe;m.it it. Please let us know at your earl-jest convenience, if you
will be able to visit 'With us. Best wishes!
'
With kindest
reg~rds,
.~
Randy r£wson, Program Co-Chair
Arkansas DHS County AdndJlistrators Association
,02
�.'
.J
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
TRAVEL SCHEDULE
1-800-921-7576
PAGE NET NUMBER
MONDAY, AUGUST 22
1:00 pm
Depart West Basement enroute to National
WH Car
1:25 pm
Arrive National
1:45 pm
Depart USAIR Flight 1759
3:53 pm
.Arrive Orlando
Lodging:
Orlando Marriott World Center
8701 World Center Drive
Conf. #: 80664482
Phone:
407-239-4200
Fax:
407-238-8777
TUESDAY, AUGUST 23
1-800-921-7576
PAGENET NUMBER
Bruce Reed will attend WH Staff Meeting at 8:15a.m.
7:30 a.m.
Breakfast Meeting
9:00 a.m.
SPEECH
National Association of Chain Drug
Stores Conference
LV Orlando Northwest # 957
12:20p.m.
1:15 p.m.
AR Memphis
1:50p.m.
4:27p.m.
LV Memphis Northwest #987
AR Seattle
�Lc;>dging:
Westin Hotel
1900 5th Avenue
Seattle, WA 98101
Phone:
206-728-1000
Fax
206-728-2259
I
4:30 - 6:00
General Meeting Between representatives from
the Federal Government and Roundtable Participants
concerning Future ADA Implementation
WEDNESDAY, AUGUST 24
1-800-921-7576
PAGENET NUMBER
Bruce Reed will attend WH Staff Meeting at 8:15
8:45a.m.
SPEECH
National Council on Disability Quarterly Meeting
1:00p.m.
LV Seattle/Tacoma
8:36p.m
AR Washington Dulles
WH Car pick up enroute to West Basement
United Airlines Flight
1576
�PHOTOCOPY
PRESERVATION
�;Y~ ~~~_p0_10/? - J-:;;
.'
EXECUTIVE OFFICE OF THE-PRESIDENT
OFFICIAL TRAVEL AUTHORIZATION
r--.-TY-P-E-O-F-A-U-T-H-O-R-IZ-A-T-IO-"N-'- - - - - -
1
(Privacy Act Statement and instruction's on back)
XJ
(Show items amended)
o (Non EOP Employees Only)
Invitational
2..Traveler(First :
. .. ' . ' , name, .middle initial,iast name).!:
.
~
Amendment
TOY
,
Relocation
'Carol H. Rasco
3. Title or TiaveIer '
4. AGENCYIDIVISION
Assistant: to the President for D0mestic Pol icy
5. Office Phone:;:~' ,
•.•..
,"
.1,
6. Official Duty'Station';
7.
OPD/DPC
~PerOiem
Actual Suosistence (unusual circumstances) * ,
o,Rate(s): ,
.
"8. TRAVEL INFORMATION
,'.
.
"roP)TO
P~~,
E.,
, ".,
~.
;,..:.
.
~; ~:.~
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,
deliver Speech at Univ. of AR (Fayetteville), Fulbright School of
Public AffaiI~ ;r;e~ :q. i,S.~,~pw.Ef:st:::bc~,P01..ic:;y.l,,.(2L:Site ~isit Fighting Back
Drng 'i':r:eatmelit Cehters 'eihdtileeLwith'officfalswho di::i:ecL pIogIallt,
OATE(S}:(~lve~~irntonwi ~h1~~:~?}.~r.i~?r~7.~J5yeWfna>8n~~~i?~4 Fo~pq~t"io.~ ,
Dir~ctor,. N~:w ,F.u:t;:,gr,E1~,LJ,O:r;:
, , ' ,.. ,."
ITINERARY: PomtofOngIn(Clty, State)·· ..'
Place(s} of Official vi~it~tiO~ iCily, State)
,
Litt,leRock Youth
,,',
'"
(4) meet with
Washington, DC
"
_'i_'.....F-"-a;. .r.y_'e:. 't. : . . :tc. .:'~=-v-'-'.: i"'-l. .:l: .e.=:. J.'~_:'. .:A:.:': .R.:.,.'-"'-'- - - --,.,-------'-.
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Washinton, DC
'-' ,
" .</ _.....
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$ 23EXEE 317.00
701. 00
.:
.....
Auto
Other
Rate auth
per mile
'0
X:gltx~~
TOTAL
$~Uai1a~OlJa 1142.00
Determined more advantageous
to government * "', "' ..
o For convenience of traveler
NTE'common carrier cost
124.00
o Registration Fees (meeting, training, etc.)
~~~~~~~~~~~~----7--"-'---:--:-:---:---1 ~ 'Cornrni~~ial Rental Car
o Excess Baggage not to exceed ---,_____-,-.,...-_____
..
'.
'
"
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'.
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13. * ~pecial ProvisionslRemarks (JustifICation for first class /business lextrafare travel, annual leave enroute, actual subsistence, etc.)
15. Accounting data (Appropriation, division, project, vendor number)
/I'-/--.:?~ :::7/0.A
14(b) I certify that the travel herein was reviewed and determined
to be essential for the accomplishment or agency programs
and missi
Appr: al 0 lcial (Sigtua,lll1f!"r1
REVISED ffBRlIARY 1993
ORIGINAl (RETURN WITH TRAVEL VOUCHER)
�~\\~
lo3...o PT~'~~~L[eUe_": It=-.
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QJJ,-~ --t:.~c ~~L- --CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
PHOTOCOPY
PRESERVATION
TRAVEL CHECKLIST FORM
INITIALS OF
DPC STAFF PERSON
FUNCTION/
ACTIVITY
DATE(S) OF TRAVEL?
J u.J.l.{ 'd- t3 I
DESTINATION?
F~e~lf~
I
COMMENTS/
PROBLEMS
\.k=..
LK,
TRAVEL AUTHORIZATION
,
FORM COMPLETED?
i
o.l (C.
eLv..~_ ~_(LkJ
MODE OF TRAVEL?
RESERVATIONS MADE?'
IF AIRLINE, WISH
AISLE SEAT.
V
TICKETS OBTAINED FROM
,
TRAVEL OFFICE?
I
y~:;>
&V
l(es ~eJ.kD\t ~ tuL·
\.i-v' ~~
<2--~
HOTEL RESERVATIONS
MADE?
,
~:~\-L-e ~l~t~ L0lCA*~
CONFIRMATION NUMBER?
NOTE: FOAM PILLOWS v/
NOTE: NON-SMOKING, V
COMPUTER SET-UP i / '
AVAILABLE AT HOTEL?~
DEDICATED LINE?
LHOTEL FAX NUMBER?:
bb\.a'\ i"'"
V
CAR RENTAL READY?,
V'
RESERVATION NUMBER?
MATERIALS FOR TRIP
(MTG. FOLDERS/SPEECH
MATERIALS) READY?'
CHR SCHEDULE FAXED
TO .WH OPERATORS, :
SIGNAL & STAFF?
tbv6Dtt t-
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,
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CAR RESERVATIONS;
MADE WITH WH GARAGE?
CHR DEPARTURE: :
vrf'TicKETS-PAcKED?_____
2) ITINERARY PACK~D?
~'~
.~
~
.
�,
,
.
'
RA~CO
CAROL H.
'\
,
ASSISTANT ."TOTHE PRESIDENT FOR DOMESTIC pbLICY
,C,'
THURSDAY, JULY 28
PAGENET NUMBER: ,:1'';'''800-921-7576,
NOTE:
PAGER SERVICE WILL NOT BE
AVAILABLE IN FAYETTEVILLE, AR
.
;,.'
PAGER SERVICE WILL BE AVAILABLE IN
LITTLE ROCK, AR'
'/
-
,WH ,Car ,from West basement enroute'
12 :15
National Airport
.
,Amer:-ican Airlines' Flight i741 (LV National)
Arrive, Nashvill~.
'
Amer1can,Airlines Flight 4529 (LV Nashville)
Arrive' Fayetteville, ,AR
12:59
1:52
2:40
4 (40
Fayett~vilie Hilton
Lodging:
"
)
Square
Phone:
5017442-5555
.Fax:
501-442-2105
To~n
'
"
,
,6: 30'
,
"
8,,: 0,0
Keyno1;:eDinner Speaker
nUnited States Domestic Policy" Issues'.'
Uri~versityof'Arkansas '
Fu'lbright School of PubliC Af
Futra,ll Hall; 531 Lindeli St.
and Douglas Street)
(corner· 'of Lindell.
Fayetteville,'AR '
Contact number:
50i~575. 3033 (message mach~ne)
'Main University Number:
501 57'5-2000 is
avairable ~ntil 11:00 p.m.,
I,
, I
i,;
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE·
SUBJECTITITLE
DATE
RESTRICTION
,
006. schedule
Rasco, Friday, July 29 ~(partial) (l page)
07/2911994
I
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol·Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: Travel :Schedules
20 I 0-0 198-S
kc224
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b){6) of the FOIA]
b(7) Release would disclose Information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b )(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(l) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confid~ntial commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�/
I
'
FRIDAY« JULy 29 .' .
us A~i Flight 5631 LV Fayetteville
Arrives LR
8:42
9:30
l!0:00
,
Lodging:
'The:Capitol Hotel
.. 111 :West .Markham
Phone: 501-374-7474
Fax:
501-370-7091
Rob~rt Wood Johnson Foundation
Rock Fighting Back project:
Meeting with Officers of Robert
Wood Johnson Foundation and
Officers, Little Rock Fighting Back Project
Of(icers of Robert Wood J;ohnson Foundation
will be travelling to Little Rock for
mee'tings and presentations.
.
Site Visits: Drug Treatment/Neighborhood
Support Centers
.
12:00 - 3:00
~Lit~le
SATURDAY, JULY 30
Meeting: Don Crary, Director
New Futures'for LittleRock Youth
Project.of the Annie'E. Casey Foundation
9:30 - 11:30
SUNDAY « . JULY .31
3:59
American Airl.ines Flight 604
D~pa:tt LR
Arrive Nashville
American Airlines Flight 1574
Depart Nashville
.Arrive Washington National
4:00
WH Car pick-up ertroute' to "WH
11:45
12:51
1:25.
�TEL:
15=13 No.004 P.Ol
Jul 25.94
: UNIVERSITY~ARI<ANSA~
n 1 Old Main
Arkansas 72701
(501) 515:50.39
(SOl) 575·7981 (FAX)
F..lb!'lgh~ Collcge 01 A~ end ScieneoM
Deparanent of SOc:iolOll'\'
$oct,,1 Work Program
fayttW/llle,
Telofacimile Transmittal Cover ~h~et
Date
TO.
CITY.
M fumttn;
J I'J S
, tq 'i
.Joe wo{ Kqsco
Wat})in~ D. C,
FAX NUMBER:
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FAX NUMBER (501
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Number of pal)(=!f:I ; nr.] llding this
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Travel
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Services
,. INVOICE /Il-INERAF~Y
Aml:!rican Express
. Travel Related services Compal'!Y, Inc.
.. White House Travel Office
'" '
Old Executive Office Building, Room 87 .
Washington, D.C. 20500.,0001
Phone: 202,456-2250.
Fax: 202 456-6670 '
In Emergency After Hours Call:
1'800 847-0242 (Toll' Free in the U.s.)' .
;ALES PERSON: 50
, ;l)STOMER, NBR: 169500002':3 '
Your: code number!s: KC52 '
ITINERARY
aCTLVF
DATE: 25 JUL 94'
PAGE: 01,
TO:,WHITE HOUSE TRAVEL
160~ ~ENNSYLVANIA AVE
WASH DC 20500
"
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:OR: RASCO/CAROL'
'?8 JU( 94 'THURSDAY,
ECONOMY
LUNCH
AIR' AMERICAN AIRLI,NE'S
FLTH741
HlP: SUPER 80
LV WASHINGTONNATL
~259P
152P
NON-STOP
AR NASHVILLE
RASCO/CAROL
SEAT~15D
ECONOMY
FLT~4529
AIR ~MERICAN AIRLINES
OPERATED BY FLAGSHIP AIRLINES
240P ~
~ EOP~ SAAB 340 TPROP
LVNASHVI~LE , ,
'. 'NON-STOP
440P .
AR FAYETTEVILLE , AR
RASCO/CAROL
SEAT-6B, ,
BUDGET RENT A CAR ',l-INTER'CAR 'AUTO A/C
CAR FAYETTEV,ILLE AR
, ,CO~P JD-414000046**
PICK UP-440P
RETURN-29JUL/830A
RATE:IS GUARANTEED
DAILY R~TE~USD3~:ob
UNLIMITED MILEAGE
93455935,
'CONFIRMATION NUMBER
'!
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29 JUL 94 '- FRIDAY
AIR
USAIR
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COACH
'FAYETTEVILLt AR~LITTL~'ROCK ciP~RATED BYUSAIR E~PRESS
LV FAY~TTEVILLE
AR
,842A
EOP: BEECH~RFT Bl00
, " AR' LI TTLE ROCK
9 3 0 A ' NON-STOP,
. RASCO/CAROL
SEAT-3A
CAR LITTLE ROCK
,.NATIONAL CAR ,RENTAL i-INTER CARAUtO~/C
. , .!:'ICKUP-0930
CORP ID-:-5000:300**
RETURN-31uUL/11A
RATE rS\~UARANTtED.'
DAIL~ RATE-USD30.00
:UNLIMtTED MtLEAGE
CONFIRMAr'ION NUMBER'
I 0,953802162COUNT
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A.IRAME,RICAN AIRLINES
FL:T:604 , ECONOMY
1145A "
LV LITTLE ROC~
AR NASHVILLE
12511='
RASCO/CAROL
, SEAT-f9D
AIR ,AMERICAN AIRLINES' FLT:157~ ECONOMY'
125P
·LV NASHVILLE
, 359P
, \'
ARWASHINGTON NATL
" ,
RASCO/CAROLSEAT-~OD '
EOP:' Fmq<ER 100
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[R 6450 (12190) PRINTED IN U.S.A.
ORIGINAL,
.
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1tave1
Management
services~
INVOICE IITINERARY
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iALES PERSON: 50
:USTQMER NBR: 1695000023
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PAGE:' 92 '
'QCTl'VF
TO: WHITE HOUSE T~AV~L
1600 PENNSYLVANIA AVE
WASH DC 20500
c
American Express
"
, Travel Related Seivl~s C:ompcmy, Inc::.,
White House Travel Office
'
,
Old Executive Office' Buiidirig, Room 87
Washington, D.C. 20500-0001'
'
Phone: 202 456·2250
Fax: 202 456·6670
In Emergency After Hours Call:
1 ~OO 847·02.42 (Toll Free In the U.S.)
DArf~r~eJlH..~~" Is: KC52 '
'
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REF: .KC5SX[I4LN6
~B JAK 95SA~URD~Y
OTHER WASHINGtON,
'
TOTAL AIR FARE USD446.00 ~
,
FOR AFTER HOUR EMERGENCIES
:ALL BOO-B47-02~2/YOUR HOtLINE CODE
'r • • • • • • • • • • • • • • ' • • ' •
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~LL FREQUENT FLYER, BENEFiTS EARNED. ON OFFiCIAL T~AVEL ,
~RE THE SOLE PROPERTY OF THE O.S. GOVERNMENT AND CANNOT
)E REDEEMED FOR PERSONAL USE.
• • • • • • • • • ' . It • • III
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~XPRESS'OR YOUR TRAVEL COORDINATOR IMMEI!IATELY UPON'
~ETURNFROM TRAVEL OR WHEN TRIP ~AS BEEN CANCELED.
lLL UNUSED
,
TICKET~ARE-TO
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................••..••.••••• •••...................
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TEL:
:.
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, UNlVERSlTII¢'ARKANSAS,
WI.
'
.
, l'ulbright CoJIc:ae of Art~ and Scltrl4:c,&
Fulhright S,hwl o(Puhlic Affair.;,' "
, 2t 1 Old Main
F':'yetLevillc:, ArkansaS 1l'rOl,
(501) 575·50)9
(SOl) 515·79Rt (FAX)
. July 21,1994"
Dear C:uol,
Here are a tew things i!lpreparation fur your visit next Thursday.... :
Enclo5ed:, ' Copy of full ttireewcck schedule'
,
LiSl of speaker!>, participants
..'
.
, Compilation uf discussion issues identified by students on first day .
Coopy of editorial:; ill Frlday's paper
.So~ "hot
','
topic:>" currently ~in9 discussed by students..... '
.
Sheffield Nelson's ideas abOut getting tough <;In juvenile! crime (see Iocaleditorial),-He
spoke ,with FSPA sludents lastweek ancfoffended most of them. He W3!=l opposed to'
!=lpedal treatment programs for Juveniles, suggesting we expand adult
corrections to· handle juveniles;, called RB, Friennlander a liar and disputed all tne
facts she presel)tM on jwenile justice; thought we Should NOT all schools to offer'
. content on "black ·h'story·~ (only in those with large ulack student populations'
didn't see the need forilelsewhere).A.nyway, you get thedlirt! [Weirein big
, ' , trOubl,p. (he ANDlor Huckabee win In November.]
.
Welfare'Refurm (Tomnalton will talk with,them un, Tues!1ay....), .
Health care Reforl1l (they're still trying to figure out the issues andoptionG • like most
of the general public!) . . '
. .
.' ,
Education rAform (the "otandar:ds director" fofArkansas Educa~ion deparlrnent speaks
,em Wednesday. will be talking a bout new stanaards for Arkansas studen~ • also
how this cumpares ar.ross US . . . . .
"
,
/ '
~
"The favored' format for this year's sessions' involves:
,. Speaker visits with small group of "student hOStS" during tho meal:, Ilostspruvide
speaker withastuc1A",t's p8l'ipective on the plugram and 'the issues to be '
discussed. Hosts wlllintrodllce speaker to full group,
"
.,
, 2'; A br~ef (10-'5 minute) .presentatlon by the speaker (some things abOut yourself,
your joh, what you seo as the critical publiC: poUey issueD you are
iddressing....etr.
'.,
l'
. "3- ~tudent and speaker reaction to '3-5 of contrOversial QuestlonSlissues , " ,
I Te2d a statement (such as "Juve,.,ile off.nders should not be place,d In rsgul.r
adult r:orrections but should bt: treated in'secure spBci:ll;zed progillms. e.g.
.' wilderness or hoot camps". Students tlJt!n phySically DO to one of four comelsof
the room, each cpmer marked as 1/Agree, Mildly Agree, Disagree, or Mildly
Disagree. BRIeF comments am 5Olicited'from eechgroup; then reacrionS and
comments from the speaker (YOUI).I his glvesstudcnts lin active part in the
discusSiOn ;md giv8s you a good idea ofw~r thRY are thinking.
'
You and I can discuss the j!l:SU9S be presented lateI', .as late as after your visit .
.
with student hOsts.
.
\ '
. , '
.
~~ ~J~h'.rl1,,,ol A.bn581l. '.~ f'QWlI oPllorNl\lty/.ffl""allvo Qed;";" h...lll1laon.
"
. "
I
I
I
,
i
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007. letter
DATE
SUBJECTfflTLE
Betty Guhman to Rasco re visit (partial) (I page)
I
07/21/1994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: Travel Schedules
2010-0 198-S
kc224
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)]
Freedom of Information Act· [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(I) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
,
b(l) National security classified information [(b)(I) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade s~crets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions con~ained in donor's deed
of gift.
,
PRM. Personal record misfile defined in accorda~ce with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request. '
�Ju 1 ~~ 94 "
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16:48 No.002 P.02
4- Break the fullgl'OUP, alloWing 5t'l1'rl8 students to leave and those whO are
" particularly I~telested to ask questions. and vl,lt with you personally.
I
If yuu've got a different Idea, wo're very flexlblell!
I am really looking forward to liieelng you next week. I'd like to check your calendar for August
and maybe sepwmber, since I have to be In Washington at least once during tad. month.
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EULBBIGHT SCHOOL OF PUOLICAFEAIRS
University of Arkans8s, ,Fayelteville '
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, Summer. ,1994,',
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AASTRACT
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The Fulbright School of PubliC Affairs wi!1 provide st~dents with it unique,
opportunity to EXAMINE current social, economic and, political concerns.
Issues and attitudes
America at)dthe World today; to, EXPlbRt: the
meaning of ciViC responsibility in a dernocr~tlc SOCiety; to CONSIDER the
,influence of cultural values and 'tra'dl,tlo;,s on pOlitics', and "PUblic: opinions;
_ to MEEt and OlAlOGUE with pollti~ians, state officials" profeSSional. and,
, citizen lobbyists, UnIversity ofArkans~s faculty and other concerned high
school students in Arkansas; to DISCOYEB how to bttcome more informed 1,
, and'-involved In policymaklng .which affects ttu;lm; to LEARN how concerned
citizen8, In~ludlngstudents" have shaped policies, and imp~oved tho quality
of life ,in their communities: and. finally. to PARTICIPATE 'in simulation
games, smail' group discussions, video productions and field trips r~lated
"to public' affairs.
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OVERVIEW,.
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The ':ulbright, School' of PubliC; Affairs 'Is an, intensive' summer: program .for' ,
a selec;t group 6f gifted' and talented, high school students In Arkansas.
The three 'we,ek residential program'ls a cooperative effort between the
, University of 'Arkansas at Fayetteville 'and the Arkansas Depi,lnment of
Educations's A~GiS Program (Academic Enrichment for Gifted In Summ.r).
,FSPA is dosigned to expalid'\the students', awareness 'and understanding of
currentsocial" political. and econom,ic I,ssues, facing our communities,
nation and thew,or1d tOday. The program places heavy emphasis on
,
, ,increasing the' stUdents', personal Intorest and Involvement In social' and'
political' action as' a means'of 'MAKINQ A DIFFERENCE-'In one's,own
envlron'mant. . FSPA will also explore the effect of cultu(al values' and
trQditlons, ecOnomic forces andtoday'~ powerful media on public opinions ;
and poUcymaking. 'The 'program is very studsnt orionted wi~h numerous
, simulation games,dialogueopportuniti,c$ and participatory learning
, , formats.
'
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" The program 'is designed fQrstudents who are concerned about the, world
theyUve in~ :Interesled in becomino '!lore i"formed and Involved 8S
citizens, and, future leaders, and' are looking for an exciting and .
stlmulatlno way to spend, three wecks of their summerl '
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lJNIVERS~f ARKANSA
. WAA
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. Ofret1 a Unique Opportunity foi
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'EXAMINE
'C\llTcnr3oCial, economic.
, and political concerns.,..
. i"uos & AttiNdes in Amcri"
and Ihe \Alorld·tOday.... itnd
uac reid mcaning yC civic .
responsibility in I .
.
,
July 10-30
CONSIDER
'I'hc WlUCIltC) of ,ultural
values and traditions on .
polidcli &:. public policic:s...~
and the rote of today'.
'. mcdill in shapinSpublh: '
opinion. and soCial
. policies.
'. democrali~ society
I
. 40 high school KNon;
'1994
.LEARN
, . ElcclCd politicilU13•.80VL
,
agency repre~tat1ves. .
. lobbyists, ,iuzcn ac:livisl.ll•.
, University of Mansas .
faculty. and ulhcr
, sNcients ftOm
around the
How c:oacSned c:jtlz.ens
4
, .bavcshapcd social and public
DISCOVER
How 10 become more intonned
. 'a.nd mvolvtcl in policymakinS
• whieh affects you; and how to
slllle.
" policies IU1d hGye improYcd
, Ihe quiJity ot ute in America.
. •ind how you c:an do
the ..me in your
community•..
influence dccbionmakcra
in pnlitie.< and publie '
. PARTICIPA~
, ' polic:ymaking . .
1\refI1I.
For applications. conl8c:1 ", .
iii simulation RImcs (uade
YQurlocli1 31:0001 c:o~c1or. '
.<iined &£ Talented coordinator or·:
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DllSOtillllOllS. aciversllriat '
coon. CIe.). media projects
,
(vidc:o. ftCwspapci-. radio.
phOtography) and. ~ trips
rela&cdto publk ,[Calrs,
- 'pht.. n>.c:reabnnal
.BellY Gu~m8n~ FSPA Direc:wr. '
DlileClildweU· ProlP"anI C;=oordinator
Room 211. Old Main .
Univcrslty Arkansas
. Phone
."'ayeUeville~ AK 7%701 (SOl) 575·3105
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,PUBLIC SERVICE
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1 27,; 94
13~15
No.003 P.02
CAA~ERS
, whflt, can nigh school 5tudenta do
about
experience necessary,
caruef& In' public affairs
'
most re!$vant career to dew with Issuas that affect
what can you do With, a political sciencedQgree
'job availabllltv
,-
tee,nagert ,
'
affect of public careers on' family and social life
educationSJ .r9quirement3" need advanCeo degree?
,-
pay.ben(lfit5, job &ecurilY
,
majora other than pOlitical science
• other flelas·· ,haw they relate to public services
MEDIA'
'
when do you stop prossil'!Ciillhequ8stlon"
2.
how to quest'Qn, affectival'l
, experience and e£!iJCatlon
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m~edad
for media jobS
voice lessons? accents'
'm80ia bias '
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,f9&&aroh and. report objectIVeS
responsibility 01 jOurnalists
how.ar does 'Irgf amendm~mt go
" who decides' media ethIcS '
hOw much, research does a broadcaster, anch~Qt"&on actually ,do
neutralizing bias personnel
pfivf.lCY
3.
VS.
PUbllc's right to know
COURT SYSTEM
how 00 you go from lawyer to judge.,
deronaGiprosooutlon guiltyvs. ,Innocent,
rlow chariot court ' sYStem
I
why stat9'JUClga& are Glected
Difference' In curr'3nilpast Suoreme Court- womEtn &, rriin(:~rity
-4. ,
Appeal PrOq9OS- slow process'
'
" How judges' know" if it Is, constitutional if ita not
"How public opmlon affects court opinion
,"
the affects of personal biaeof the judge',
THe ',CONSTITUTION '
,
freo speeCh- how far ,
t9&nag,~
,rlgtrts
gun coiltrOI wltl'lln Constitution '
, COnStitutional, rights- refugees, immigrants
Medlamanipulate$ 'politicians '
Politicians man,IPurate media '
,$oarch and seizure represented in, Comnitutlon
Constitutional manipulated OV6r Il 'year
Cl1urch and stats separated In school
• ,
curfew- Constitution.
written in the" ,Constitution
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�7 ,
Ju 12, , 94'
13:,15 N6.003 P.G3
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INfLUENCING
,
what can'we dO to prevent satellite learning ,
.'
who 'really influencIng policymakere?
corruPtion and ~mrol inv./ooal politic~
•
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manipulatiOn " '
:
"
, ways ,fortoena to bo resp'ected by and exert influlmco with scl100t bOards
checks and balances (lOcal)',
"
ARKANSAS GAME, AND FISH COUMISSION,
what is being done to clean up'parks
wh6re dOSs. fines and revenue'money go
,poaching; (reduced) ,
change Image of 'Ar1<ansas tourism'
'
mercury and laka"
Penalties, for violations ,
'
How'penaltiQS are$et and by whom,
7 •
PARKS AND YOUR ISM
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how money mgenerater:t and sPOOl
, where do fees for 'state parks go '
',anempu~
to
change perception'
lourismprofitable , '
, '
"'
hi; Day, U:te Fete discouraging use of the park
Negative sides of tourism
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NATIONAL POLICY ISSUES
how Is thQ ordinQryperson heard at tho national Jewel
term limits
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national health care
domesticvs. foreign issues
on pfotQsts at abortion clinics
,' PUbliC physical punishment
, ban
. expensive executions
g•
Priorities for funding' exporiments
POLITICAL PARTIeS
.
party platforms
.most effective types of IODoylng
politicians changIng parties while in office
vote of! .bllls lor content or parties '
is the 2.party syatem enough?, " ,
,"
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tioWArkansas d,emoctatlC ,party has b,een affected bY Clinton gOing to Waahington
othor parties, platforms OOSidG$ Oem &. Rep
,
, what is the middle ground between dorriOcrat and republican'
. cori$ider rrustb9Tween partf65 lind candidates
'" '
'how would third' major party effect, system?
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�] J 1 27. 94
. TEL: ' .
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LAW ENFORCEMENT
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how can laiN Gnforooment Offic8f$ 'ael respept. back
Get Tough-. will be etf~iY8 In deJinQUGnl. ¢rimo?
POlice jm8ges~ how 10 Improve'
Police power restriCtions
,Effect or cops prssenco in public Ilfea~ ,
age for teens to be oonvicted
adults .
Polleo r90ognition .of gangs
Legal problems in speecJ trap$
discrepancy' In penalties
.
as
. Perote .Standa~ds
Victim rights V8. Defendant rights liS. authority rights ,
Preventive measures- keep pri$OnS from overcrowding
Jail as lUXUrY> free' ride
.
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Alternative pUnl$hmentB
rehabilitation?
Whatever happ9Md
Money spent', on convicts vs.. eaucatlon
to
. '
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11. CORRECTIONS .
how to I«)ep ClfUgs, an<' weapons out of prison
wnat kind' ot ~ucation and job trahiing to De provided In jail
Length' of sentence served· full term
TalCpayor dOOlde what' "luxuries" .
Capital punishment movEt!'nent
"
Gen6r~"conalUons in Ark prison. '
Cit/zen involvement'in crime control'
·UII'Q$ str.ikee arid out- explain ?
Weight lifting In. jail
why It is $0 expensN6 lO (un prisons ..
why higher Jail standards than publichOU8lng'
,
has prISon ploved effective
, 2.
ARKANSAS' ATTORNEY OENeAAL
,
what office is responsible for..:
rip off$ and cori8l.1m~r protoctlon
see all
law enforcemeOt!cortectlons QueStions
13: . CHILO WELFARF:t FAMILY: Sef'VICES . ,
Hea(iatan: . Program- fulf fur\dlng
..
RewardlngAFOC mOthers for more chlldr8ll
family suppon In Rural area "
,Prevention for
child, showing tendency. towards. violence
WhO decides i,f child should be taken "way
Child AbuBeand discipline '(line)
,
Natural parent rlghr's· vs; ChUd. aafoty
Adoption' by Parents'
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JUVENILE JUSTICE
· judged by. peer' jury·
· tIme Sefv8d same as aOullS
· wilc:Hlrll8s& b~ot camp effaaiveness
cUr18w effects' on juvenile crime
Conviction, bY'mentalitv or age
. , pubHc use of private boot' camp
. teenagors: hava rights
'
1 5 •. ARKANSAS' POLITICS
. lOtlSrV' Ballot- . aChoranlh!pS .
I=r9Ghmen acadernlc SchOlarships .
, Gamblin9lmpl~memea
· srate campaigns. politics
u~ployment in Arkanstis and, new jobs .
1
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ENVIRONMENTAL·
.
how do companies get away with dumping in othercountties
jObs vs. enVironment
..
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community planning' and the environment
· Why 18 Arkansas behioo in recyCling
Why.not natlonalmanaatory recycling I
Press print artlClac saying' law ok
envIronment laws affect industry
.
c:rump'lng toxiC waste in other. counu'~
local preparations i.or. population growth'
landfill "alternstlvell
'.....
'
·COmmunities grow and law$ chaOge fe: landfill
,enfOrce pollution laws
super f.undlng r6newed
wa&te mllllagemem systems.
national 3.tanaards. for recycling
1i
.. . INTERNATIONAL.LAW
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, balancet(ade with other countries
NAFTA
I
.GATT ./
.internatlonal
~ntrol
no governmenLlnterventlon, fet rule
Amorican: protection. Of Cltlze,ns of other countries'
how tariffS are oetermlnod
UN-Boinla Haiti
· Nortn Korea8tatU8
now
18. FII R
involved In other' countries affaIrs
. ,
US fUntler actlo~ • KorCfI • d.eath of KS ,
'nvol"~ in FUR
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youth opportunities
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�Jul 17.94
'TEL:
13:16 No.bo3 P.06
19. HEALTH
current billS and proposals
what is Clinton's
plan
all employees • worker's comp
research and funding ,
Canada and Hawaii progrill118 '
fund abortions And pills'
emplOyee ripoffs
hospitals
,,!"I'.tlona' nealttl care funding abOrtions
"
and
welfare system and the, impact of health cars plan
,
affect
ot
immigration'
'
, limits on h,ealth, Insurance', '
, "urefor ,AIDS likely?
pre:el(iStinG conditi9r1S, - NHR
2,0.
EDUCATION
' :
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nationai pay scale for tea¢ners (ben~fits)
home :schQOung ,
grade pelnt: and standardization
year round ,school and day c a r e " ,
,
redistributing nlUTlber of school diitricta to improve' educarlon
0'
"
looal contfol over number
houre &pent In clasSes'
year round 'school affect families
",
',
wnat'do politiCians and teachers [hint,< anaut year round school
, ' quatity of eduoat.ion;n small or'large achoole, is It OQUill
prevent [mplementatIOnOf· satellite learning.'
. upgrade speCial education grading'
21. Human., S.rvlee./WELFARE
JOb traIning,
..
eliminate, welfare1
limit amount .of time
how are we :g(atting peopl6 Off, welfare
state funding for after hour, program
,who qualifiej; tor welfare,
.
. famitieG on welfaro for years· '
other weltare systems
rhswelfare ,trap
welfare system goals for clients
. "\
IIrnit number
ot
peopiecn .welfare
22. DOMESTjC POLlCV,..
.. ,
.
domestic violence • Whito· House s~port.
etay home and work ·9nOomestic policy' rather than
voting ag('! low~raCI ,
. gun contrOl
.
·ltIegai Illlen~ ,
priority
for dpmastic pr~ram$ ra: money
,
'
wofldng on foreig" policy
.,
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1994 FSPR -·lUEEK ,
J Sun 1/10
!
.
-
. Ttoes 7112
Thurs '7114
Wed 7/13
'
Fri 7115'
aat 7116
.
Br·eakfasl
I
Breakrasl
B~eakfa$l
Brea~fast .
(optIiOOaI) Ul1lon
(op'lmal)Ulion
(OSltlcnal) \Jn~)I'I
(ofll'onal) Ui,.o"
FuR GIOup
7:3·)·
6:30
.,
Mon 7i11
Full Grcup
Breakfasl .
(ope; Unim
Br:dst
(FwalI)
..
9:00- .
9: t 5
. FulJ Group
Check h
12:0:>·
...
.
lun;:h (Union 311NJ
VA FacultY/Statl•. , B. BLAGG' ,
. 1111'0 to, Corr.., Pre',edS Mom;ng NeM'S
Welccrre Luncheon
. -,Fli.a"J '.
.
J- .
i,
s:, 5
'D
Opening
'ReceptioJl
"Free
r
ACLU
. meetings
(Futrall)
Simu'alion
..
Free "me .
o·
. .(FUt:r6/1) .
Work
P.uks
& Tou:iSill
(Fulra.li)
..
Hee time
, (F~t,ajJ)
Fre~
Regroup, (futraP.)
(Futrall)
Aegoollp (FlJtntJI)
Regroup (FlJtnf#)
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.Ohner (fUlrall.:<FJ;)
N. ROYSTER
. UA Career S8W
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Oinrer :&O'..,h)
w. .MILLER
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RE9~OuP
QEH
SlATE
PARK
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3:008:00
.to
DEVIL'S
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OUTING
. Free time
tiMe
.
;0
.
.
lur.ch ;BIo4l
REP TIM
. fluTcHi'NSO.
.Stmt.dallor .
\York
. 10
City Council Sim
,
Re9ro~p
~r
"
( unpeclt) .
5:30
J~ HENORON
(l.a w School)
In~l'oducn(Jn
Proj9Ct'
Flee time
UIT.8
" lure, (t.:n1::l1r1 3t1NI lurich(~).
C. 'JOHNSON
R.OAVlES
lI.:n:::h \Sel"le:y'l
R. SP1LLlNGER
.
Cards
HPERTour
iFJllall)
3:30
City
CO:JJlcii .
0
,.
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AOVO-='A.C~ rECHN USAGRIPOLC Simul
PISCUSSICN OUeSTlC1'l ' '::;RITlCAl THINKING ' CONST. ISSUES
.
.
.
P•. A.~DeflSON
iI. BERRY
'lash Coonl1
S. aUHMAN
Co' BAILEY
RJR SPEAKERS
.UA LAw School (:"sw) . •ague ", W.Vot (rw) W!)ite H~use Adv, ~~C:r
: iJA Soc Work r.:utl)
,
,.,
1-):30·
11 :30
2:00·
m
Small Group6:,
Small Gr:lU~'s: " . Small Grps: ' C:msti;ulior.al Flig'lIs . Polilical Actio.n . JS Agri Polio!
IFIIlI3I)
,
1:30
-I.
Sma I Groups:
Com"TluniC'sti'::I1l S.<Hs
Sman Grcu:>s:.
Rublb Policy Issu~$
.,
.
Full GroUp
Meeting tFlllnll)'
(Fut~al)
Meeting
-
Meethg
MeetinS(Fu:.all;
. 'Meel'rg(Fulrall,.
.9:30:-'
ID:OO
Full Grocp ,
Dimer
UA PO:it Science
A: GSmB & Fish'
(Fu!rar.)
i.Wins
(FLlral·
Oinrlef at
NWA MALL
U~ry)
>.D
~
."-,,,
0"1
&
PICNIC
00
..
Z
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'f'IIb'aII-PIna) .
RfVIS:Dml94bi;
t-.>
t-.>
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�'994 FSPR
Sun 7/17
;1
I
Mon '-7/18
7:3'0
8:30
FuHGroup ,
Meeting (Futrall)
,
.
-2:00-
(BrGUgh)
.
3:,.5
~
Free Time
(Futralf)
~eeting (Futrali)
Small. Groups:
., Sma" Groups;.· .
-CHILDRE:N & FAMILIES' CRIMINAL JUSTICE
Dill arCh &. Faro Sf!tV
lunch (Union 31 IN
W. BRYANT·
. AR Attomey Gen.
.Free time
Regroup.
-I
Full Group,
Meeting (Fun-all)'
ENVIRONMENTAl
I.CULTURAl
ISSUES'
. AWARENESS
A. HOBSON (F(Jtrall) .INTERNArL
eTlJn~IUTc!
1L- ••• '
rn
r
II. JOHNS(
~81
Atlomt
,.,.
.-~--,
lunch (Ser-y)
JUVENILE JUSTICE
. R.B. ,FRIEDLANDER
I
~ Dht. .D! Y1J1l1b ~<:imI.
Simulation work
(Lawyers}Futrai.
-
Small Groups .. Smail-GroupS, LEGAL
GL~ CONCERNS CUtruRAL D'VEils S4MUL
(Futrell)
5:30
6:00
Brkfst
(opliOriltJ) Ullon
. Full Group'
Full Group
Meeting (Ftllrall)
~. BASSETT
3:30
5:30.
6:00
8:00
(optional) Union
LA.WENFORCMT &
<XlRAECT"CNS
I
Bteakfssl
(Optional) Union
. Breakfast
~
lun~
12:00
1:30
Breakfast
.Thurs 7/21
Rep & Oem Parties fHILDREN & YOUTH
A; HUTCHINSON, B. JONES
. Free time
or Church
Sat 7/2~
Wed 7/20
Full Group
. Meeting (Futrall)
POLITICAL-PARTIES
10:30
.11:30
Fri 7122
Tues 7/19
(optional) Union
'9:30 Small Groups
~O:OO
WEEK. 2
Breakfast
Breakfast
(optional) Union
9:00
9:15·
.~
Simulation work
,I.~;
" ,"W",'
(Police}FiJtrall
Free time
lunch (8I\lugt1)
LunCh (Union 311H)
~TERNATlONAL LAW
J. LOONEY
I..t COl.. II. RAIL
Ar Stale Police .
I
Simulation work
(Corrections}Futrall
"
I
JJA
112l1li
I'
'Project Work
Flltrall'
Free.time
Free time
Lunch (Union tM'2) IlUnCh"
. W.F:ULBRIGHT (Brougll)
R. WOODS
$."..
I
t:"Ih..:"'111 In!:rit
~mU.b -rILSOI
(rrial ~r,jp)FUlrall ~~
Free trme
.&
PICNIC
(KFe)
Regroup
(~traJ')
I
(Futrall)
Regroup
Dinner (Futral.) Dinner (Unio~)
INTROTO
. N. ·WlI..I..IAIfS
I..EGAI.. SIIf UA History.
(Futral'-KFC).
Regroup
Regroup
(Futral!)
i
(Futrall)
. (Futrall)
w
. s::.
IV
IV
i..O
.P>
Regroup·
(Futrall)
t-'
(T\
•
Dinner (Or MI SmolcetlOuse)
$ .. NEI..SON
Candidate for GOlf.
Dinner (Futratl-W8$)
GILLEAN
Comm. Corrections
Governors Office
-!.
.
Dinner (Union)
Or. R. A. ,KING
Oin~r (Brough)
.P>'
00
_ Night Outf '
US State Dspartment
FutiaA-Piz
Z
o
o
o
IV
, REVISED 7f1/94 bg
--0
a
.t::>
�WEEK 3
"94 FSPII
"
Su~
7124
.Tues 7126
Mon 7/25
,
7:90 ,
8:30
Breakfast 'ilion
'
,
, '9:00
9: 15'
:'
Break'asl
(Fulrall,
, lopli::onall
'
,
'
l.klan ,
i
,141='Al TH
Small Groups
"
Full Grcup
Meetin!;(Fetrai') ,
LUIUI.N ........................
(".Am:
I~nl
_ .............
r.u=nIA
.
,
'
C'lurch
IWELFARE SIMLlATION
Iv. MILLER
AIDS AWAFENESS
E.. Minlr?
,
IJ~,
HatIIftI EWart.oil
"
'
E. BASS
(fVI.... fII
\
Lunch
lii0i.9')
Jhn.
8~I».r.
BUnE.R
Ark f1e9.Jth Dept
(Fvt,.n)
, Lunch f~311N)
T. 'PAL TON'l)HS '
,
Lunctl (8n!ugt(,
H. ,Pun/I.
"
Ark (Jgpt Hurria:, Sel\! ' (FIIR)
-I
IT1
r
Fut'. I
r:1=I='RACK "
,
'BRO~,OCAST JOURN ' ACTIO\! PLANS
J. FULFORO
D. BEBEE
KUA,r::-Radro
AJ1c Act,rccatss
Cfleck
out
F/r,./
PTOg,,,.":' ,
AI' Ds'3#. '/:,., t._ti"n
Lunch tUition 311'1)
, or.
EClL\llON
tER)FN"
BrIGs!
-UAO",
S"sl':;roups
"
"
11 :30
12:0C
, 1:30
Full Group
, lVeelinQ (FloCrall'
Small Gro~
Small Groups
OJ
~ O~30-
pa.::M up
(cpl<m")
(oplfc.nal)
Full Gr.o~
Mee-fha( FU:n.ll'
Fult Grot'P
Meetina (FlAr.1I I
"
amaD GroupS
Free titre
Sat ir.!O
SreaJdas1 Union )
Breakfas' U,"lioc1)
.,
(optional;
,
9:30
1n·r.n
=ri 7129
'Thurs 7!28
,
Full Grour;
. 'M~ifi~ (Funlr.
.
Braak1~~
Bre.aklast : Jnion )
'(oplioll3. )
7/~7
Wed
1Ft
bnch cs-~)
M. BRANTLE.Y
Ark'
Tirr.~
LEG/SLAnVE
LUNCHEON' ..
(J=utral/}
,V'livn 412)
~
UA Reaid.nce Ute
Fin Aid; Adml..ions
·2:00
3:15
3:30- "
5:30
5:30
6:00 '
ALUMNI
REUNION
"
Free time
&
FSPA
GAMES
,
'Ap:l1s wi
Project work
'
'
UA Faculty (opt)', ,
(F....u)
&
,
,
Free time
'
,
Regroup
PB;Jf()UP
(FloCr_111
',8:0:)
"
;F:aL"lIIIl-Wes;
,
P,oje<:\ wor<,
UA Faculty (opt) "
&
Free \me ,
(Fumil,
, Li
C
(FQh'al1)
t,J
U1
Tafentr&hearsall
, Free Time
"
Aegr:>up
(FlI1rari)
PICNIC
6:00·
,FrEe time
,
' ADPts 'wI
I.D
-""
, Regroup
,
DINNER
(Br:Jugt)
iFutlal)
.....
<
Dinner
(Unon)
'II. HUCKABEE
tt GCNefTIor
Dirn~r
rJrion I
C. COLE CHAFRN
Ca.'ldidate for Lt Gov
U1
Dinner FlIJiIIl . OMS,
JUsncr: HOLT
Ark SUOI'9'Pf1 Crt
fes)
'Jstk:
WI
.....
TALE.Nr, SHOW
& AWARDS
<tJ'
Z
(FU1filt-Piln) ,
a
PO/iel AdVIS8~
FE'oflSED 7.71&4 tg
,
o
o
-""
"0
o
VI
�TEL:
),'ulhright
P.04
School of ,Publk 'AffHlr~
Student 1.lst
<
t 994
\ "
Student
Nltm&)
Allen. 'Marci
Bcanl, ' Katherine
BeckhAm.:' JA,nfl<' Ann
'Benllon,
Donny
BIllino,
Martin'
Brumfield. lbn,1 II II
CIUtpUlIln; Mary
Co(.k. Chorll!
Uona,lIy, Sarah
'Dou, Climmu
Olovc.r, leui,IlIl',
Ht!l!l!e. Candee!:
Hicka. "fAra "
Hill. FionA
liughes. Ericil
, J eff"tDOn;, II, J •
Johnson, M~lirutll
JUIICIS,
No~004,
Jul 25.9415:15
/
,Chri~IY
Kelnp, ~&hl.y
Kirkc'onnell.' Molly
Kordlif\loicr" GiDn y
Lillng, pennia
Mascagni., ,Jeffrey
Malllll;Y. "Cit
,
lliLm..eJ~
J n'np.l1.hnro,,"
,Hot Springs
J aSl',er
Ullfdon
I.ittlc ROCk
,R,o"."
Little Rock
Hoxie
JOftuboro
, Mallncilia
Omaha
W .. intlr
BaUlilc
WinaJow
MuveJI
Hllrrhon
Crolis"Ue
hyettevi11c
Roehl" "
Ruuellvill~
Morrilton
"
StAr City
- Occed) ..,
,
BI Dotadn
Mt'Ad. ,MArlin
Whito Han
Miller, Scon
Hot
'Morphia",
Nadin,.
:Nguyen,!
NguYlln; ,
De",
Mary
G,osnell
Pu,t Swith'
TOllY
t'enqulto. " Angie
<rhiHip6, Ki~1I '
'PTivett, MelillNa
Purifoy. Kanan
R()cd, L~III ie.. ' '
Tllylor, R.ltch.1
Tlndoll. Cherleli'
Todd, <Laura ,
U1re'y',lnr.;h
Wailon, : Olivia
W mey. Jltll"~
,Wi11iam~.
AJiI>OIl
<
SI\ringtol
Betsy
Kfo!nneth
R08er!'l
,I>
Harrison,
While Hall'
lIoxic
ArkadelphiA
,Walnut Kida:e,
nc;!"na '
'
Pl'lrryvilJe
PayencvllJe
Fljl,pin
Fort'Smilh
Cunway
'Cabut
~j/07.14;94 :
: /'
(,
�16:4~ No.002 ~.05
Jul 22.94
TEL:
I,
FSPA 1994 t
GUeST 'SPEAKE~S.F=ACULTY SCHEDULE
'Qu.
Speaker
1. Dr.' Noyla RnYRter :\
2. Ms,_ Beny Gunman
'3. Ms. Brenda Blagg
4. JUstice David Newbern
_6. Mr. Carlton Bailey
, 6. Ma.· Rita Spillinger,
7: Dr: Will Miller,
8'. Ms. Peg Anderson
Q. ,HendronJJohnson
" O. 'Mr. MarianB,rry!
11. Mr. RlcnardDavles '
12. Rep; Tim,.. Hutchision
13.
1 4.
1!)
1"6;17.
A. Hutehlneon/W. SaMett
Atty. Gen., Win~on. Bryant
Dr. Nllnie, Williams
Ms.Severly Jones
Ms. R.' B., Friedlander
18.
,Mr. Sheffield Nelson
Lt: ·CoL ,Richard RaJI
20. Mr. JSck Gi/lAR!J
21. Or. Art Hobson'
22. Dr. Jake Looney
23. ,Or. Robin A. King,
'24'. Dr. Randall Wo~s:
25. Mr. RufuS Jonnson'
2 G. ,Mr. Ed Millit.
1 9.
27. Mr. Tom /Jutler
28. Lt. Gov. Mike,Huck3bee'
2Y. Dr. Will Miller'
.30: Mr.' Tom Dalton,
31. Sen. Charlie Cole Cluiffln
. 32. ,Or. Emma 8QS3
33., ~1i'. Hoyt Purvis
34 . Chief J ustlee ., R~k , Holt
35. M~. Jennifer Fulrord
38. Mr. Max Brantley I
Ms. Carol Rasco
3~. Mr. Don Rebee
, 39. Leg. Luncheon
u...
Mon
,Tues
Tues
Tues
Wed
Wed
7.11
7.1',
7-12
lime
f
7~12
7"13
7·13
Wed ~,'3"
Thurs 7-14
Thurs 7·14
"Fri 7·16
Frl 7~1S
Sat 7'16
Mon 7-18,
'Mon 7-10
Man 7·18
TUA!4,7·19
Tues 7-19
Tues' 7-19
Wod 7-20
Wed 7-20
'I:Iurs '7-',1
Tllurs 7·21
Thurs , 7·21'..
Frl 7·22"
Sat 7.23
Mon t-:r!!)
MOl" ,7·25
,Mon 7·25,
,TU667·26
'Tues 7·28
iues 7·26
, :' Wed 7·27,
Wed 7·27
" Wed. 7~27
ThurlO 7·?8
Thurs 7-28
Thurs" 7·28
Fri 7·20
·Frl 7.29
Place
6:00 pm
, 10:30 am
Futrall
, Futrall
. Union" 311N
;2 noon
6:00, (JUI
'10:30 am
'12 noon.
R:OOpm'
'10:30 am
12
11001'1
'0:30' am ,
12 noon
12 noon
10:30 am,
,12 noon
-6:00 pm
10:30 am
12 noon
6:00 'pm'
12 noon
.6:00 pm
10:30 am.
,12 noon,
6:00j,lrn -:'
12 "oon
9:30 am
'10:30 am
12 noon,
6:00 pm
10:30 am
"
,Servery/FuUall
UA Law School 328
SorvcryJLaw '320
Brough/Fulrall
Futnlll
Union 311N
Main, GUfels,
,Brough
Brough
foutrall
Union 311N
Union/Futr.all
Law 328
ServeryJLaw 328
'OMS'
Brouyfl
Futrall
Futrall
Union' 311 N/Law 328
\
Servery
, . Union M412 '
Wash Co CourtroOm
. F,uuall i.,
Union 311 N '
, 'Servery
FUlI'al1 .
1'2noon
Union, 311N
6:30 pm
UnionS,rvery
10:30 am
"ulrall
12 noon"
Brough
6;00 PI')'!
Futrall
10:30 am·
Enginoerlng,
"12noon ~~ "ServeryJFutrali .
6:00 Din
'
Furrall
Fuli all '
10:::10 am
12.noon '
Union M412
'·OMS - Oz.;;u1( MOUi"ltaln' SmOkehou~e,
(CIl07.07.!I4)
"
, !
\
�TEL:
\ Jul 22;94
16:50 No.002 P.06"
1994 FULBRIGHT SCHOOL OF PUBLIC AFFAIRS
JU~ Y 11, 199'
\ ,PARTICIPANT/STAFF E,XPECTATIONS
Hogeto gain·,' froinproq,sm '
•
,
,
.
,
..
•
devel9P;' listening, 'skills
see uther 'viewpofnts "
make friends
develOP' 'interpersonal qommunication 'skills
,learn 't~debate objectively
.
become more aware of public policy issues, ideas and 'options'
polish comm unication skills and' political ideas
'
-,
,dAvelop' better understanding of , ~tiliUcat system in Arkansas'
meet a'1d explore POlitical philosophy of current policymakE!rs
' \
'talk· about· current events,"
learn how to talk in fro~t' of people
"
practice clear expression of ide8s j positions
learnQlscussiori. persuasion' and argumentation skills,
'.
.
become more ,open-minded'"
"earn ',~ays .to make a difference (individually,' as teens, etc)
discuss CQreer prospects,: and 'related 'academ,ic fields ,of study
learn ways to influence othe'rs
develoP' community leadership Skills
increase, awareness of local, state, a'nd national' Issues
,
'Atmosphere for IIvlnqand learnlag
•
•
"
\. ~
'casual yet busy .
inumS,AhpI fun
reapectfui
heated debates., with time to wind dow'n,
lots. of group interaction
relaxed. open.. trusting
comfortsbl,9
,friendly
, hrgh:, energy,: low pre•• ",r.
involved
"
'
I. ' .
"
)
"
.
,
�,
"
TEL: ,
,
tJul 22.94
,
,
16: SO , "No. 002 P .07
c
, 'j
"
,:Expectat/ons ' of, both gartlelp;nts' and ' sUlU" ,
t~oilitate dlsculSions, interactions among al/ participants
bA pA'iAnt.' remember what " waS/is like for ot~ers
some entertalnmeill
be cool. relaxed, flexible
1,,
" aware a~ sympathetic to others
informed, unde~stan(1lng, ,
"
,
I
. ,
all
balanced interaction among
participants
3~l gootl examples for' each other
high energy', low prcq~ure
'
,
reliable. trustworthy, and courteous
be tner,e anCl De, alert. on time and prepared tor all meetings:
resptJCt sp811k~rs
,,'
alert'to health conditions
responsible for self'
enthusiasm for IAArnlng,
,
Speak, up· ,VOiCe concerns. Q8nlcuiarlYIIsgilUve, feeling:;
open to alternative views ,
follow rul98 , sugge8t ohanges l{neeeAary
keep open minds
'
,
'
('
have fun ,
btl resPurl~itJle, lUI self, and lhe group
, be cooperative and Involvod
,!
promote poSitive image of FSPA
,
,
1
•
,
\
,(IRiCtaC/ons ofSta'" (from students)
1
;
answer quc~tlons. offer helpful information
serve as mentor
'
8C1 as friend, not pa(ent
'trf:lal as eqUid wilhco,nmOIl sense
Suggestions. Ideas
,
,
I
Field trips e.g. canoe floaltrlp. little RoCk. ,TulSi:I; Wttdlngturl
•
Intramural $port$competltlon
Dinner at O.P.O., other restaurants around, town
don't repeat restaurants
put
Out fruit for snackS.
I"ent movies '
swimming?
cameraa?,
:
fun fiAld frips- parks, and
mailS
triPs 10' Wal·Man1"
campu$' tours, meeting' professorS:
autograph party at Gnd
group piOtt/re
..
-,'
"
,couple Of ClayS
COOkoul'
t~
sleep.1n .
.. someono to tCQch Judo
,
I
,
! '
�Nels()n oesctibesJuvenile CampsaSiC~~J1trtClubs' .
."
"
" ,
' " : , , " , . ' ,: ' "
Ftiedfan,derDefends':Camps:
I'
'"J' N'" ed 5' . '5 ',.
Jl!~~n_',es'
, e , ' -,',:"';' .. '.> ;"., ;"'.'
tnet ,~f!.~'!8.,
'ReI:!e(:caJtder:' ~. ,,'
, ~ ~A'BU",au ;'. " ' ,
• ..J
:1"
Rebtec. ltder'
The Mor.ringNews
",'; ' : ',:"
",
::ait.pi did rd ~~
With'' ' pro1~ iotbe
Rcp.Wcan -gubematorW c:aridicbu: Sbef·
AIIauIsU' DepartrDent of HIIRIaD, ,Se.JYices.
,=:=~tT~-;:=:~,':'U:="::fJ~=~i::irc!~):::'
"sUll\1eSday t:'leSC '"badacttlB'", are beiog".,.l~',"3SIU,tne..Hcsaiddllltl.~arcoce
'bellCd cD I
"c:ot:Jl'I!"ciI'~'!eCling., '
, :: :,~'.bcm t..ilt.ili ihat)"Caf' ~ haclllecn DO
, "
"
, N e l c o o wu U1 Fa)'eneviUe ~ adJJess S!U. ' 'CSC:.lfCS of which he was 1\'I'IR. F~
: • ~endUtg dteSlate'i'lioleal
~)i~~is .0.' "c:iy,
~~ lIUCItcfing 1IiC. fU~gJll ScbOoI ~ PJbliC" :"iiaid, 1Je'numbci'of eScapes beforclS92 wu "
~ sr:r;uctured e:nri..mll"la~ SIIdI as the p10JlClSed ~·vriIdemess·
Af."aiB at Ilte Umvemty of ~'. " ,272~butlhe6fureha4droppJd1J)60aftcr[1e
'c:'tDIps"rnay()fmayl'K't'lflllCt.SlIid,IL1UlriedlaJMlef.~orlbcdi"j..
''1htse a.e rot babes to lbC woods ,,-c:re .. fence was builT..
' "
,',',
'
,m.or~se1:vjoesDfIlae.Arka.ils:.u.~c:niu~S-...rn:.es.
de:d.iDg widl,.- Nelson said ol tbc j~c:PiJe ' NebolllWoa.idbebad~!lltfcralu.nslic-:
but SOlMIJjr.g hu to be dale CD proTide
~es fordH:lse
ofI~ w3t)' ~ te plac:at in the:amps '. ~fDl anuop.s 10 gel peopk ~JYCd UI me ,
oIIenk:n 10 Ieara .the 41ference beIweco ngtit and-wrong,'
ror reIlabiJiWioll. '¥rilb a sm.moDtl1 follow-up ",ilkmesl<llIDP prognm 10 adIod dBt bald·
, ~~J 10 stulkQts of tbe Fulbrig"~dv>d ofPu.btic Affairs at ~
p-ogram.
,,
,"
"
,axe CJiInm:als, s~ as mwdtft:D 8;.Id r;'J'ms.
t1ruvemty or ~ ~ ,[~e&ily. F~~ ~ Ihc amps 1!(it,
'Nel<.Qll ~tod dull tlejD,milcoO'el1de.rJ· ,'~ be ~ gibe taIn)lS. He said Ibis ~
dIer ao aI~uve ~ J~ iJ!C:Ua.'.I1tiDB Ibc ~vertileoff~.
' be piaoed in IRa! wbm curectioo faciljlie$' 'c Yided tie brced.il1g pound for ~8S deYe~
. Tt~. S1aIeU,~ ax of lIle camp' ~ DlIpk:atelll:d iDltDUy.
, aI.reaIy exisI instead or inllle
Do
tlu'oItgb, I~denllip of the
seROUS
. iDdudiog ':me m Sebl~ Ccu.nSy ncar,MaD~Jd. The c:aq:lS ~c
.toikI camP'. he said, "but provide e.uericw '~'.
"
".,
'
~ ~oda" rue from res:hlen1S 01 ~ SIlIJ'CIW'Ki.Dg dI~ proposed camp
~ons'iD OC' aloDod editing prison '
Earlia", 1!It. day.Ri«l1aDda- told lite sW
,81ItS;;~udoglbe~~),~,:~~ludge o,oJI1~~ IS"
~ 1hal are already equipped co, ~ ,', *:m.Slballbe~JoII't'.DdenNels",!re~cn.cd ,
" ",'.~.L'#, ,; "",;"''''''';. See,FItIEOLAND.P.f/. p' .~:: ",baid ' .. ,'"
' . . ID WOIld be parlor !be camps. Slae iocIk:aTed
_f
r
:,~e:=di~J~~~
bell«.
camJ!S.
!itt:
mm:c
:., ";--':"~~~::'~',-:~"~:-~ "":"," . ':' ~':-~.~'. :;':~~:~~;,:"::"::.r~~ :~~,·~~~:~~::·~~~;~~~~:1.{~~;;~i?~::~~i.~E,~W/~~:' !:";:I:
c..,
c
t..>'
t..>
\D
J:;l.
....
0)
1.11'
o
, :z
o
"
o
o
t..>
"'0
(
o
(,0
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�.,
/
'.
'
.' Nelson (rolll,1A
.
,\
,
one uf the reasON for &he C'~mp. was ting." This :lellillg, he said. will do
, to try 10 provide botlel'rchabiUulI.luo nothing but cnenll"'g!! them to want
rohard-corojllvcnlleuhrou,nartgid.' 10 stay. "Man~ofthcaekld.a hllvc ney..
, closely wa~helI program. She ~bo . c:t ~ anylhmg like th!~. Il~d Ihey
,aid Juveftl~ wirh lC3Xl o.rr~ses . wan (wan.uo.leave•.Bul. ~r Ubave
; wuuld less likely he swayed by Ihe: co, bUl wlthOllt any 1kiJ1s.
. seriolls offellden in a ~1lin8lhat pro- . Nelson said he 1oob4 mco &he cclu, ,; '!tIded ~ldye diversions. .
. ' cadonal budget for each uf me camps
1::'·:.NI;ISll~describedth..ettingaub~ and round onlY S17,OO) designa=
Jllvenile Wildemeu, Camps. alullg
wil.b uther area residents.
'Th~ Mansticb.t~/Up is belnJl built
oa the former Jol)nny Cake thnch
SOllrh of ~1IJI$neld. The project hiS
. arollled opposition' from some 1I1'f'..lI
. redd~nts:
'
' The Camp is 1M ne>.ar the homes of
residenu
NelsonsaJd
andJiedoesn'l
;. St Franc::u Couulyw1lCletnCSS camp. for each. . , . . .
..' .
..' t
.' " die fmt esrabll.htd bylh. SIAIC, AI. :"ThaL~ a tarce."~e sai~. ~ebon; lib ~lans !O omlt~, f.nC.!S and
. bivinB no fence•• where 1110 juveniles .said be did nat plit. much fairh m the. lpcoc ~ uniforms fot mma~ ~f IlIC1
. I ":"'areDoc JeQu1red 10 wear unifurmt aM· Ability ol1hc "Illlp. co pm'iide VOQ. camp.
.
. '.
, \ ;!here are 110 armed
He Aid danaf or. any other kInd of lrainirlg., , leff Holumg". (!.\~uuvc d1reclO!
. rhaehavc IlQ:n 12runaways. and one emphuising that oa.1I 'WoWd be .,0( the camp. said hiS, seven yeslI
:. ~P, ~mp~oyee was aaacked by a.'.' "'fl'~u~ln."and hWnUI pan of (taeir experienc6 .wilh c.h.c; ~mpany ~1Il' i
..:)il~enilc ~11h. an .lVtc. .
.. punishment..
.: .
' . wUI,nan Ihecamp. AsSOCiated~ne
: ;::}~Rererrinl tn . tbe. propolled·· ... Nelson 1OII.raI.1he Mansfiejd camp r~tlfute of Tal!'I' Fla..' Jed him to
: ,~)~!ldemo&s·OAII'Ip 'he nc:ar Mansfield. M~)' llonl wadi Mansfield Moror. expect Lhat (ew JIl~CI would IZY 10
. ~. #(.Sebasllan County, schedilled for Olen Hurt, former Ouv~ PmIt White. escape~ from the CIll'!'p.
.'
-' openil'li in August. Nelson wei. "IL and Paul Wilsnn. chairman ofIlJ'Ollp The A.aoclo&ccl, Pre. wDtr.bu&cd
. ,:,"':~~
"reminds me uC a counay-cluIHet. : called ConCemed Ci&b:ens AplOSl to ibis story.
.
';
'.'
~
sun.
,',
'
,
..
. 0
;l31
�If an}1.bIng.~g·Juvenl.le oflenders' as adultsls a
fundamental and cu1te serious 'mJstalre we often make in .
:;
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the sliety .at' lbelr property and themselves. though vie
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see there IS no real threat bd.ng posed...
What we na'\'e qua...-reled with amJd allWshas, been'
state's a}>proach 'iO sUing lhe 9*lPS . . :. ofl.m, ~U:-out
teal p·.lbJlcnotJccf and· iDO'ltng wtihtL'le: sort of stealth that
a1\\-ays makeS 'one suspiciouS. 1h1sbappened
Eun:
ita Springs.. MountaJnburgand 'Wlrlslow.· .and the loeai '
'. popclat1Oi1 wasjuStiftablylllifrei:l'when tt:\\ClS surprised,
by the new!ithata C!'.DP might. be COr::tJng to thelrarea.
'rus'::s
the state~n~ to'Nork on; and we
bdie-.re ,J! they:d~ openly ~ ~:'1rorif ~U,1 Jhe cfUzenS
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~t .go1rig.!6a:·.wu~s camPl~t~d·ola:.prlson rnJght ....j..~ .
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CAROL·H. RASCO
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. ASSISTANT, TO THE- PRESIDENT F,OR DOMESTIC POLICY
,
:,
. THURSDAY, JULY 28
,.
PAGENET NUMBER: 1-800-921-7576
NOTE: PAGER SERVICE WILL NOT.BE
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12 :59'
'. ,1: 52
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WH Car' fro~,West~asement ~nroute'
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. American Airlines· Flight 1741 (LV National)
. Arrive Nashville
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',' American Airltpes Flight 4529 (LV Nashville) "
-,~,":>.:A'rrive Fayetteville'>',AR '.' '
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"United States Domestic. Policy Issu~e;rn.
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Universi ty. of:'Arkansas '
, , ' . ;', ',:
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�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
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DATE
SUBJECTffITLE
07/29/1994
Rasco, Friday, July 29 (partial) (I page)
RESTRICTION
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Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
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�FRIDAY" JULy 2 9
8:42
9:30
US Air Flight 5631 LV Fayetteville
Arrives LR
10:00
Lodging:
The Capitol Hotel
111 West Markham
Phone: 501-374-7474
Fax:
' 501-370-7091
12:00
Robert Wood Johnson Foundation
LittleRock Fighting Back Project:
~eeting with Officers of Robert
~ood Johnson Foundation and Leaders
of the Little Rock Fighting Back Project.
Officers of Robert Wood Johnson Foundation
will be travelling to Little Rock for
meetings and presentations.
Site Visits: Drug Treatment/Neighborhood'
:Support Centers
4:30
".<,
,
SATURDAY, JULY,,30
9:30 - 11:30
,
Meeting:' ' Don Crary, Director
New Futures for, Little Rock Youth
Project of the Annie E. Casey Foundation
,
SUNDAY, JULY 31
11:45
3:59
American Airlines, Flight 604
Depart'LR
Arrive Nashville
American Airlines Flight 1574 .
Depart Nashville
Arrive Washington National,
4:00
WH Car pick-upenroute to WH
12:51
1:25
/
.1,'!
�J.~L~22-94
FRI 10:25
LR FIGHTING BACK
'\T~P,92
. UITLE ROCK FIGHI1NG BACK
CAROL RASCO VISIT
July 29, 1994
: TENTATIVE AGENDA
PRESENTATIONS
12:00 noon
Welcome, Invocation and LWlCh
-Wendy Thamani Salaam
-Reverend David EmeJY
12:30 p.m.
Opening Remarks
-Vice Mayor Jesse Mason, Ir.
:City Manoger Charles Nickerson
12:40 p.m.
Figbting ~ack Documentary
~Pamela Smith. K.ATV Reporter
1:00 p.m.
1:)0 p.m.
Women'.8 Treatment At Child Care Recruitment
Women~ TreQtmentIWomen~ & Children" Recovery Center
-Gail Harber (S minutes)
, 'Child Core Rec11IitmentiArlcalUQ.f Early ChiJJhood Comm;sslon
:
-Glenda Bean (5 minutes)
1:20p.m.
Small BusinesslDRUGS DON'T WORK Program
, -Stott Bellingratb. Small Business Owner (5 minutes)
1:25p.rn.
Funding Initiatives througbthe HaIf-Cent Sales Tax
-Wendy Salaam
1:35 p.m.
1:45 p.rn.
2:00p.m.
TOUR OF FACILITIES
3:00p.m..
Stephens/Oak Forest Neighborhood Alert Center
3924 West 12th :5ZJ1"':' 0to¢-5'(;,'i-9
-Zandalisa Ward. Alert Center Facilitator
..code EnfOItleJl1ent Officer
..COPP Officer
3:30p.m.
�JU~7"22-94
c,
FR I 10: 24
LR FIGHTING BACK
FAX NO, 5013993425
P,01
JUL 22 REC
Little.Rock Fighting Back
500 W. Markham
Little Rock, AR 72201
(501) 399-3420
Fax: (501) 399-3425
FAX TRANSMISSION COVER SHEET
Date:
July 22, 1994
To:
Pat Romani'
Fax:
(202) 456-2878
Subject:
Tentative Ai,enda for Carol Rasco
Sender:
Judy Butt~orth
,
YOU SHOULD RECEIVE 2 PAGE(S), INCLUDING THIS COVER SHEET. IF
YOU DO NOT RECEIVE ALL THE PAGES, PLEASE CALL (501) 399-3420.
�P.03
AUTOMATIC COVER SHEET
DATE:
JUL-22-94 FRI 10:26
TO:
FAX #:
9120245628780016·
~
FROM:
~ ~.~
LR FIGHTING BACK
. ~~. '1
FAX #:
5013993425
I
03 PAGES WERE SENT
(INCLUDING THIS COVER PAGE)
CUNTON USRARY PHOTOCOPY
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THE U PRE SID E N T
11-Jul-1994 03:17pm
H.
,TO:
Carol
Rasco
FROM:
Patricia E. Romani
Domestic Policy Council
SUBJECT:
Upcoming Fayetteville
& LR trip
Carol,
I 'm working on trip and need some, advise.
fa
"r~:%
I have a rental car reserved in Faye~
Do you also wish one reserved in LR.~
~
I am continuing to try to get in touch with Don
Crary reo a site visit. He will be in his off
tomorrow and will call ba~k.
Another question: The folks at tqe Fighting Back program
wanted to know if you wished to visit City Hall and
view videos reo their program and ,talk w/some folks or
actually make a site visit to a neighborhood center.
They are so happy you are:coming they will do WHATEVER
YOU WISH TO DO.
~
~
~
~
~
your preference for lodging in LR. We have you
booked at the Fayetteville Hilton,. Have you finalized
your thoughts on lodging ~or LR. ,Please advise.
O,,~ r, /'
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Thanks,
Pat
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Clinton Library
DOCUMENT NO.
AND TYPE
009. note
DATE
SUBJECTffITLE
handwritten re Fayetteyille trip on 07129/94 (partial) (l page)
nd
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAfBox Number:
8505
FOLDER TITLE:
Complete Schedul ing per 10-11: Travel Schedules
20 I0-0 198-S
kc224
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)]
Freedom of Information Act· [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(1)!of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate Ii Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrel~ or confidential commercial or
financial information [(a)(4) ofthe PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of tbe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile derined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
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WISHES AN APPOINTMENT
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CLINTON LIBRARY PHOTOCOPY
�July 28,. 1994
Trip·to
Fayetteville, AR
10'3- 5;)8- (5/1+
AMERICAN AIRLINES
LV DC .1:00 p.m.
Arrive Nashville 1:?2 p.m.
Change planes
LV Nashville 2 :40 p:.m.
AR Fayetteville 4:40 p.m.
Govt • ,rate one way $172.00
Aisle Seat 15D
AA # 1741
Aisle Seat
AA #4529
6B
Car Rental (In-terminal)
Budget
Mid-size
$34. unlimited
,
Confirmation Number:
93240487
Hotel: Fayetteville Hilton
single occupancy
501-442-5555
\ non-smoking
Town Square
non-feather pillows
I
AE Creqit Card number given for confirmation
confirmation number: 174631210
NOTE:
,
MAX. GOVT. RATE FOR HOTEL ALLOWED:
MEALS, ETC.
TOTAL
$45
26
$71
Room rate at Hilton is $60.00 per nite - government
rate not available' for that nite due to conference ong.oj,ng.
talked with Demitii at 1:55 p.m., June 21
F~{{-:-r-({~--.,
F~-
�. LV
1: 52
. Governmen t rate:
.
,
703
~1II.
$144
522:~~1~lizabet~
spoke
Wl
s Travel In
Expres
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one . way
Rossalyn, VA
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�IIJUL94 13:29 FROM 62029160 4499636M
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EASYLINK 4499838M001 11JUL94 13:29/13:29 EST
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PAGE 1 OF 3
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�l1JUL94 13:29 FROM 62029160 4499636M
SALES PERSON: 50
CUSTOMER NBR: 1695000023
TO 2024562676
ITINERARY
QCTLVF
UIA AT&T EASYLINK
DATE: 11 JUL 94
PAGE: 01
TO: WHITE HOUSE TRAVEL
1600 PENNSYLVANIA AVE
WASH DC 20500
FOR: RASCO/CAROL
28 JUL 94 - THURSDAY
FLT: 1741
AIR AMERICAN AIRLINES
ECONOMY
'1259P
LV WASHINGTON NATL
152P
AR NASHVILLE
RASCO/CAROL
SEAT-15D
AIR AMERICAN AIRLINES
FLT:4529 ECONOMY
OPERATED BY FLAGSHIP AIRLINES
LV NASHVILLE
240P
AR FAYETTEVILLE AR
440P
RASCO/CAROL
SEAT-6B
CAR FAYETTEVILLE AR
BUDGET RENT A CAR
PICK UP-440P
RETURN-29JUL/830A
RATE IS GUARANTEED
~ DAILY RATE-USD34.00
UNLIMITED MILEAGE
93455935
CONFIRMATION NUMBER
, LUNCH
EQP: SUPER 80
NON-STOP
EQP: SAAB 340 TPROP
NON-STOP
1-INTER CAR AUTO A/C
CORP ID-414000046
29 JUL 94 - FRIDAY
AIR USAIR
FLT:5631
COACH
OPERATED BY USAIR EXPRESS
LV FAYETTEVILLE AR
EQP: BEECHCRFT B100
842A
AR LITTLE ROCK
930A
NON-STOP
RASCO/CAROL
SEAT-3A
NATIONAL CAR RENTAL 1-INTER CAR AUTO A/C
CAR~ LITTLE ROCK
'., PICK UP-0930
CORP ID-5000300
" .! RETURN-31 JUL/11 A
RATE IS GUARANTEED
DAILY RATE-USD30.00
UNLIMITED MILEAGE
CONFIRMATION NUMBER
0953802162cOUNT
31 JUL 94 - SUNDAY
AIR AMERICAN AIRLINES
FLT:604
LV LITTLE ROCK
AR NASHVILLE
RASCO/CAROL
SEAT-15B
FLT: 1574
AIR AMERICAN AIRLINES
LV NASHVILLE
AR WASHINGTON NATL
RASCO/CAROL
SEAT-22D
. J'
COACH
11.45A
1251P
EQP: FOKKER 100
NON-:STOP
COACH
1.25P
359P
SNACK
EQP: SUPER 80
NON-STOP
CONTINUED ON PAGE 2
,
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PAGE 2 OF 3
�IIJUL94 13:29 FROM 62029160 4499636M
SALES PERSON: 50
CUSTOMER NBR: 1695000023
TO 2024562676
UIA AT&T EASYLINK
ITINERARY
QCTLVF
TO: WHITE HOUSE TRAVEL
1600 PENNSYLVANIA AVE
WASH DC 20500
FOR: RASCO/CAROL
FOR AFTER HOUR EMERGENCIES
CALL 800-847-0242/YOUR HOTLINE CODE IS s-Kc52
••••••••••••••• • •REMINDER •••• •••••••••••••••••••••••
ALL FREQUENT FLYER BENEFITS EARNED ON OFFICIAL TRAVEL
ARE THE SOLE PROPERTY OF THE U.S. GOVERNMENT AND CANNOT
BE REDEEMED FOR PERSONAL USE.
ALL UNUSED TICKETS ARE TO BE RETURNED TO AMERICAN
EXPRESS OR YOUR TRAVEL COORDINATOR IMMEDIATELY UPON
RETURN FROM TRAVEL OR WHEN TRIP HAS BEEN CANCELED.
THANK YOU FOR TRAVELING WITH AMERICAN EXPRESS.
DATE: 11 JUL 94
PAGE: 02
PAGE 3 OF 3
�Jun 17,94
TEL:
F'IoIlbrighc COIJII'~ of Am and Sc;ic;mas .
o...plfcmp.!\t of Sociology,
15:1S No.OOS P.Ol
Zit Old ~bin
itlc:. Alic,aruas 7!701
(S.:'1) SiS S~]I)
(;,j!) .H5·796l (FAX)
f'a~'I:~'C"
Social Work Pr02fI::\
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CO~ANYI /.,;Jh; h
CITY..
FROM:
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FAX NmtBER;
FAX
~R~m~t!i~VQr Sheet
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711 .
1)~ G~A' - A;t'it
NUM3E~
(50l)575-7981
Number ot,pagQ!li jnr.:lndinlj this cover:
7.-'.
If there is a probl&m receiving this FhX, please call \
. (501)575-5039.
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�E X E CUT I V E
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THE
PRE SID E N T
20-Jun-1994 04:50pm
TO:
Carol H. Rasco
FROM:
Patricia E. Romani
Domestic Policy Council
SUBJECT:
FYI Items
i'\9'
'\'9Pofe\ witr~p.rCi~ '\~~rtin{s'\~ffiC~ \~e. ~tti'
Carol,
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rnteragen~y WQr~ing \Group on, Hou~in~\ - ~~ as Q~ 0
howeve~~, ..,I lef't"mesS~9,~)we w~:".,torkt:r1g on···'schedu e,
reo
I also called Travel office reo Fayetteville AR travel:
LV DC at 2:10
Arrive Dallas 4:16
AR Dallas 4:16
change plans
LV Dallas 5:20
Arrive Fayetteville 6:45 p.m.
Another option:
CLINTON LIBRARY PHOTOCOPY
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1600 Pennsylvania Ave. NW
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Dear Ms. Rasco:
We are. writing to requestyourpa.rticipaliori iti the 1991 FulbrighiSchool of Public Affairs.
FSPA is a three-week summer program for gifted and talented Arkan~a~ high school students
which is co-sponsored by thc University of Arkansa."l, fayetteville and the: ArkauliasDepanment of
fllucrltion. As yonwillseefrom the attached program infonn.,tion, this program is designed to
expalld lh~ :slullC:IlI.8' awareness and understanding of current social. political, and economic '~!i:IIP-!'
facing their communities, the stote, the nation, and the world today. At rSPA. heavy cm"lulsis is
placed on increa."jng the studen'!l' ~~onlll interc$t. involvement, and sense of responsibility for
the world around thelll.Thepl'U~llllll will 00 held on Ihe lJA Fayetteville campus from Sunday.
July lOth through Saturciay.July 30th.
F.ach year we offer students tbe opportunity t.o meet wil h rli~tingtlished leaders luch as
yourself. because, as government officials, you ilre ill a uui(.juc posatiun tu provide a "real life"
perspective. to the sludents' awareness and understanding of public issues.
Over the years, we have round that the most effective way to present !lpedrll gup-sts such as
yourself is to schedule the visit around the lunch or dinner meat: This gives a few sLull~nl.S the
chance to vi~it infonnally and personally with you during the meal and allows for an hour or so of
Jiah)~ue/(.j~slioll·(Ul8wering with the full group. After tbe meal, we encourage our guests to make
a few short rema.rks, followed by open discussion and question:s from the students.
If you will come, and we ~incerely ho~ thafyou do, we will make the necessary program
scheduling arrangements. Ag~illl we: hOI"; lltHl you will (Iccepllhis invitatioll and challenge [,?
'D,
address some of Arkansas' brlghtost and most concerned students. We look forward to hearing
f~'
from you regarding your interest and availability to participate. Ple:l~e. con'ilc:t either ofus at ' , - - -
575-3205, UA Sociology Dc:partT1lcnt. Old Main Room 211 so lhal we \:ltulliscuss more details. _. ':...L
We hope to be hearing from you very s o o n . '
, L i 2."1J.J,_~__
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,Sincerely.
~Dire""'r *~
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Jun 17.94
TEL:
.JUN I 7 REC'O
UNlVERSITYlfARKANSAS
Wii.
rulbrlebt CoUeee 01 Arb> and ~IM".P&
fun" Il;llal &hool tlf rubllc: Affairs
Favell~\lIII\!.
Zit Old Main
ArbNll& 72101
(:>01) 575·5039
(501) 575·7931 (FAX)
June 16, 1994
Ms. Carol Rasco
Dome~tic Polir.y Council
1600 PcnllsylvanUt.· Ave.· NW
Washington, DC 20500
Dear Ms. Rasoo:
We are writing to try finn up R nate for you to join us at Fulbright. Indeed I we would like for
you 10 give the "keynote address" at FSPA '94. Of wurse. health care reform, welfare reform, and
crime are some of the moSt important issues (acjng the United States toda~. ConscquenUv, we at
FSPA will be concenll'aling heavily on 1he~ il\~ul",~. frankly, we do not think there could be a
better informed or morc influent~al person than ),?urscJfregarding US Domestic Policy. That. is
why we t.hin\c you would be the Ideal person to give our )(eynote address.
Last year, 1111: sludents were really impressed with yon and likf.d the presentation that you
gave. IndCed, it was one of the highlights of PSPA t93.
lralked to Pat Komani on June 16, and she said that you may be able to come on ~, at
~m CST. TIw would be perfect. It is near the end ofour proeram and the time. is StiIf()pen on
OUfSCheaure. Pat also suggested July 29 as a possible alternative. We have a I...tlgislative Luncheon
scheduled for 12:(x) - 2:00 pm CST on that day. However, we wilJ aocomodate your coming on
that day jf you wOldd like to s~ al 10:00 or 10:30 am CST or at 2:30 or :~:(fJ pm CST.
Pfease give us a call at 501 75..· 3 to confinn a date. We could look at oUlC~r dates and
limes if none of lhese will ork-for QU.
Thanks for supp«?rtinB PSPA and'we are Joukiu~ forward to you joining us again th1S year! .
rinally. Betty ;i in little Roc~ tod&~\' said to send you her best.
but Sh\e
.
Sin;!t~ ~~.
~We11. Pm m Coordinator
Fulbright School 0 Public·Aff.i"
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The UniversitY
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of Arlran .... t, an equal opp"n\O"hy/af/lmu.ti"" ACtIOft WIiNdel".
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THE
PRE SID E N T
12-Jul-1994 01:17pm
. TO:
Carel H. Rasce
FROM:
Patricia E. Remani
Demestic Pelicy Ceuncil
SUBJECT:
Re. Fayetteville and Schedule
care~
Yes, the cemmuter flight leaving Fayetteville at 8:42am is the
earliest flight
Friday.
(I checked alse with last departure
en. the 28th
last cemmuter frem Fayetteville te LR in pm
departs at 7:45 p.m.)
Wednesday,
July 27
Aspen Inst. is squiggled until 1:00
(Yeur speech at ASPEN meeting is July 26 at Embassy Rew Hetel
time slet:
6:00
9:00 pm)
Jeremy phened yesterday te FYI yeu: White Heuse Ceuncil en
Aging is meeting Wed/July 27 frem 1:00 - 4:00. He is requesting
your ·at·tendance frem 1: 00 - 2: 00 that date
Thursday,
July 28
Regular a.m. Management Meetings and DPC call
12:00 DPC Pregram Staff Meeting
FYI: Yeur flight departs DC Natienal at 12:59 p.m.
Prebably have te Iv WH by 12:10 .or 12:15
Pat
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
010. memo
DATE
SUBJECTfflTLE
Rasco to Romani re Flight Information (partial) (1 page)
0711211994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: Travel Schedules
20 I 0-0 198-S
kc224
RESTRICTION CODES
Presidential Records Act • [44 U.S.C. 2204{a)]
Freedom of Information Act· [5 U.S.C. 552{b)]
PI
P2
P3
P4
b(1) National security classified information [(b)(I) of the FOIA]
b(2) Release would disclose Internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b){3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b){7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA] "
National Security Classified Information [(a){1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a){3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�E X E CUT I V E
OFF ICE
o FT H E
PRE SID E N T
12-Jul-1994 12:55pm
TO:
Patricia E. Romani
FROM:
Carol H. Rasco
Economic and Domestic Policy
SUBJECT:
RE: Flight information
.. the other thing you should check out is the question:
a.m. the earliest I could fly out of Fayetteville to come
to LR? Also, what do I have that Wed,. and Thursday before flying
to Fayetteville? Thanks. '
L
�E X E CUT I V E
OFF ICE
o
F
THE
PRE SID E N T
\
12-Jul-1994 12:51pm
TO:
Carol H. Rasco
FROM:
Patricia E. Romani
Domestic Policy Council
SUBJECT:
Flight information
Carol,
Your flight arrives from Fayetteville into Litt
9:30 a.m. on Friday, July 29.
Pat
Rock at
�i ",'
"
". "
E X E CUT I V E
OFF ICE
o
F
THE
PRE SID E N T
12-Jul 1994 12:45pm
TO:
Patricia E. Romani
FROM:
Carol H. Rasco
Economic and Domestic Policy
SUBJECT:
RE: DON' CRARY
Before I go further with this: What time does my flight get into
LR from Fayettville that Friday?
�-~-J'~'-l. .9.".\...('-.)
l ( ~..,
'-..
(.?
0
501 -.
.. B99k me on that 1 p. m. flight to Fayetteville get me hotel roo:==-"'''\
at! Fayetteville Hilton ( I think that is the hotel on the town
\ \
' square - Guhmanis office will know). Get rental car. You and I
can look later at a time I will go from Fayettevil
to LR on
Lriday a.m. and remainder of details. Let Guhman's office know
I'll hav#~ rental car, will plan to be at dinner at 6:30 e.m.
unless they let me know differently and of course we'll need a
contact name for that night in case my plane runs late into
Fayetteville.
I
Thanks.
<.-.
.,,)
(~("""
.)
!
II ) :
... i., ../
CLINTON LIBRARY PHOTOCOPY
�CLINTON LlBHARY PHOTOCOPY
�universi~~
Arkansas
1994 FUlbrig~~ChOOl of Public Affairs
spoke with Dale Caldwell in Betty Guh anls office:
THEY ARE DELIGHT '\ CHR MAY BE .ABLE
DO DINNER ON THE 28TH
DINNER IS SET FOR ~'OO P.M.
AFTER DINNER SPEECH. D DIALOG
WITH STUDENTS
THEY WILL SEND DETAI /PLACEI. TC.
Flight Options:
Northwest
LV DC
AR Memphis
LV Memphis
AR LR
TWA
LV DC
. AR ST.
LV ST,..
AR LR
AMERIC
LV DC
ARRI
DALLAS
LV D LLAS
I
ARRIIVE LR
LV DC
ARRIVE DALLAS
.LV. DALLAS
ARRIVE LR
on 28th of July
(CONTRACT CARRIER)
a1:40
{Hot Lunch}
~r
3:
(CHANGE PLANES)
~\
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10:05
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12:20
1:32
9:50
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12:51
1:59
11:26
1:26
2:23
·3··: 31
\ l\
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{CHANGE PLANES}
(CHANGE PLANES)
{CHANGE PLANES}
THEY ARE DELIGHTED AT THE POSSIBILITY OF YOUR COMING TO SPEAK AND
WILL DO MOST ANYTHING TO ACCOMMODATE YOUR SCHEDULE.
THE ONE THING THAT COULD NOT BE CHANGED WAS LUNCH ON 29 JULY.
IT IS A LEGISLATION LUNCHEON. THEY ARE OFFERING OPTIONS OF
SPEAKING EARLIER IN DAY 10:00 OR 10:30 OR AFTER THE LUNCHEON
2:30 OR 3:00.
~L
�'RANDUM
.F CAll .
; CALL.·.
Previous editions usable
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CLINTON LIBP~~R'f PHOTOCOPY
.
�'E X E CUT I V E
o
F ,F I C,E
0 F
THE
04-Jul 1994 05:14pm
TO:
Patric
E. Romani
FROM:
Carol H. Rasco
Economic and Domestic Policy
SUBJECT:
options for site visits on July 29
1. Please call Paulellinek, (spelling?) or Frankie Sarver with the
Robert Wood Johnson Foundation's Fighting Back program (I think
Roz should have a card on Frankie in rolodex and Paul was at the
,recent Lee Brown luncheon on drugs that I did) and ask them whom
we should contact about me visiting a "Fighting Back" program site
in Little Rock on July 29.
2.
Call Doni Craxy in
tIe Rock (Roz has in rolodex) and tell
him I would love=to sit and visit with him or some group he feels
I should visit with on July 29 if he is available.
~ ~
'<.{:'
rO
The two times to give these folks as options are:,~_ rl~~'\
1.
30 minutes after scheduled arrival until 11:30 or 12 noon.
2.
2 3: 30 p. m .
~c----:--::-':-7-=-~-/-
'f e(ci,
0-.___
L
L
r-
~ 'U~ - - 0
d
0.
\
\~.
C?t:{
~
This will leave two hours for me to have lunch with someone or go ~-'~
to hotel ... we'll decide on the noon slot later.
~~
I'd say give the Fighting Back program site the first option on
the time slots.
Keep me posted.
Thanks.
~
�~~JUL-22-94
~
FRI 10:24
LR FIGHTING BACK
",<.:;'''
FAX NO. 5013993425
P.01
JUL 22 REC'O
Little Rock Fighting Back
500 W. Markham
Little Rock, AR 72201
(501) 399-342()
Fax: (501) 399-3425·"·
FAX TRANSMISSION COVER SHEET
Date:
JulY 22, 1994
To:
Pat Romani
Fax:
(202) 456-2878
Subject:
Tentative Agendafor Carol Rasco
Sender:
Judy Butterworth
YOU SHOULD RECEIVE 2 PAGE(S), INCLUDING THIS COVER SHEET. IF
YOU DO NOT RECEIVE ALL THE PAGES, PLEASE CALL (501) 399·3420.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Carol Rasco - Issues Series
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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92 folders in 7 boxes
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Paper
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Title
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Complete Scheduling per 10-11: Travel Schedules
Creator
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Domestic Policy Council
Carol Rasco
Issues Series
Identifier
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2010-0198-S Segment 2
Is Part Of
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Box 122
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Format
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Reproduction-Reference
Date Created
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12/4/2013
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2010-0198-Sb-complete-scheduling-per-10-11-travel-schedules
-
https://clinton.presidentiallibraries.us/files/original/17560bd5cee8c3c70f2b04b2ce77f259.pdf
f825a7a8ba48686ff535d91c75ca5b6c
PDF Text
Text
WithdrawallRedaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECTffITLE
DATE
RESTRICTION
00 I. schedule
Rasco, Friday, September 9 (partial) (I page)
09/09/1994
P6/b(6)
002. itinerary
AmEx Travel for Rasco from WDC to Little Rock AR to Cincinnati
OR and ret, 09/07-09/09/94 (partial) (1 page)
08/31/1994
P6/b(6)
003. schedule
Rasco, Thursday, September 8 and Friday, September 9 (partial) (l
page)
09/08/1994
P6/b(6)
004. schedule
Rasco, Thursday, September 8 and Friday, September 9
page)
09/08/1994
P6/b(6)
(parti~1)
(l
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: Travel-Misc Extra Documents
20 [0-0 \98-S
kc223
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(I) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of thePRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [aXS) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
bel) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of tbe FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b )(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�I
-'
(
,
\
v
Contact person: Rosalyn Miller
Phone number: x 62216
Date of request: f'tlarch 7, 1994
'
ACCEPTANCE OF TRAVEL EXPENSES FROM OUTSIDE SOURCE
In order to consider whether the Government may accept from an outside. source payment of
your travel, subsistence and related expenses under the GSA travel rule, you must complete the
information below. The outside source need not be a 501(c)(3) organization, but if it is, please
state so on this form and include the IRS determination letter.
Please include a copy of the letter of invitation if one was received.
Your name and position: .
Carol H. Rasco
Assistant to the President "for Domestic Policy
Nature of meeting or similar function and how it relates to your official duties:
Date and place(s) of travel:
August, 15, 1994 --- Island of Kauai
Persons or entity making the payment (please also note any financial interests "of the person or
entity known to you that may be atTected by the exercise of your -Government responsibilities):
Hale Opio
Nature of expense(s) paid for:
Travel expenses
Method and approximate amount of payment (payment may be made either in-kind or by
check made payable to U.S. Treasury; you may not directly receive payment in cash or check
made out to you):
This form and any accompanying memorandurri of approval must be attached to your travel
authorization. You must complete a travel voucher following the trip. Please send completed
form to Room 128, OEOB, at least 3 days before commencement of travel.
�THE WHITE HOUSE
WASHINGTON
March 7, 1994
MEMORANDUM FOR CLARISSA CERDA .. nA~
Miller~l
FROM:
Rosalyn
SUBJECT:
Travel Expense Approval
Carol Rasco has accepted an invitation to address the Annual
Conference of Hale Opio on August 15, 1994. I have attached
background information about this company and am seeking guidance
as to whether we can accept their offer to cover her travel
expenses. For planning purposes, we would like to respond to
this request as soon as possible. Y our pro mpt attention is
appreciated.
Thank you.
�OFFICE OF DOMESTIC POLICY
TilE wHITE ilOUSE
;
::,;':
lJl!AFT RESPONSE I
PI.EASE REPLY
(C
PLEASE
B~
ADVIS~
. ~.
I.ET'S DISCUSS;
FOR YOUR INfORm
REPLY USIUG fORM
fILE:
RETURN ORIGINAL
SCIIEDULE:
CLiNTON LIBRARY PHQ~OCOPY
�~'
~------------------------------------~;'--~,~~--------------------------------~
THE UNIVERSITY OF PENNSYLVANIA
SCHOOL OF SOCIAL WORK
CENTER FOR THE STUDY OF .v~~
Judge Frank A. Orlando (Ret.)
Director
Nova University
3305 College Avenue
Ft. Lauderdale, FL 33314
(305) 452-6239
FAX (305) 452-6241
Ira M. Schwartz
Dean and Director
4200 Pine Street, 2nd Floor
Philadelphia, PA19104-4090
(215) 898-2229
FAX (215) 573-2791
January 27, 1994
Russell K. VanVleet
Director
The University of Utah
Social Research Institute, Room 126
Salt Lake City, Utah 84112
(801) 581-3439
FAX (801) 585-3702
Carol Rasco, Domestic Affairs
2nd Floor, West Wing.
The White House
1600 Pennsylvania Avenue
Washington, D.C.,20500
Dear Carol:
I hope writing is easier than trying to call. I hope that you have
time to at least reap your mail and consider this offer.
I have been working for the last four years in Hawaii.
We have
made some nice changes in the system there and in the process of
-that· I' ,became acquairited with a private provider on the Island of
Kauai, Hale opio which has,' with our assistance , developed some'
fairly innovative and effective programming for kids.
It is a fairly small program but given the population of Kauai
(about 50,000) it has an amazing array of quality programs. Ira
Schwartz and I have both served on the Board and feel that it is
a program worth supporting.
They hold an annual conference each August and invite a guest
speaker.
I realize your schedule. is packed but I hoped that a
chance to go to Kauai, do some work and get a little R & R might
be appealing. Hale Opio, of course, will pick up the cost of your
attending the meeting and pay an honorarium if you desire.
I told the Hale Opio Board it was a long shot that you would be
available but the lure of Hawaii might be enoug~.t9 get you to
consider it.
.'
.
�'I invited Rosemary Barkett, President Clinton nominated her for the
Federal Court recently, to -go 'last summer and' she really enjoyed
the trip_
Let me know if you can consider it.
It would be good to see you
and also be quite a boost to that community. Most of the damage
from hurricane Iniki is gone but the Island people still need an
occasional boost and your attending this meeting would certainly
be one.
r'n'l stiTl working iI'i'Arkansas. - Speht last week with the Youth
services Board and with Dept. staff _ They intend to close the Pine
Bluff Youth Services Center to youth, convert it to an adult
facility and develop work camps/boot camps to replace the lost
beds.
Due to the "crisis" in juvenil~ crime our work seems to be changing
rapidly _
We still try to help states to reduce reliance on
training schools and develop community programming but we have to
spend a great deal of time looking at violence, gangs, and the
public reaction to ·the whole system.
Hope your work is going well.
Vleet
.Look forward to hearing from you.
�03/01/94
16:29
'8'801 585 3219
UofU ~OCI~b.~~.~~,._. _ _ _ _ _ _ _ _ _ _ ~_0_2~~17
141.:;;;;..,
March 1, 1994
. To:
r
From:
Re:
Hale'opioAnnual Meeting, August 15, 1994
I have faxed materials that should explain Hale opio to you and
Carol Rasco.
Hale opio is a private provider, under several contracts from the
state of Hawaii to provide an array of services to youth on the
island of Rauai.
Hale opio has been in existence for many years and is in the
process of improving their programs.
There is one area of controversy that perhaps Carol should be made
aware. I included information regarding the relocation efforts of
Hale Opio but let me give a brief explanation.
Hale opio was located in an old Coast Guard Building on the Poipu
side of Kauai, Hale opio having occupied this building with the
Governments permission. The Federal Government decided to sell the
land and Hale opio had to relocate. As part of this relocation
effort Hale Opio was given a relocation settlement and ten acres
of Hawaii land for program development.
Since Hale Opio is dealing with troubled youth the efforts to
relocate the program became very difficult. Attempts are being
made to develop three different s1tes but the NIMBY (Not in my
backyard) factor is alive and well in Hawaii~ The state has been
unwilling to provide the land and public hearings have not resolved
the issue.
Hale Opio was advised to file a claim with HUD. That did happen
and HUD ruled in Hale opios favor and turned the case over to the
Fair Housing Division of the Justice Department, where it currently
sits.
There is no intention to involve Carol in this issue. It is being
resolved, hopefully, through the proper channels although I must
admit the Justice Department has basically sat on the claim for
several years and this has caused feelings both from the Board of
Directors of Hale Opio as well as the State of Hawaii.
�O~/01/94
16:30
'5'801 585 3219
UofU SOCIAL WORK
-"------,. ._--,
"
~ 003/017
The Annual Meeting has nothing to do with this issue. It is to
give a message to the Board and staff of Hale Opio as to the issues
facing youth in our country today_
Please call me if I can give further information. I have advised
Hale epio of Carols willingness to attend. August 15 has been
confirmed as the date.
�---
03/01/94
16:30
'6'801 585 3219
UofU SOCIAL WORK
~004/017
BOARD OF DIRECTORS
Hartwell H. K. Blake
. Amy Parungao
Jean Holmes
Allan Smith
Rilli Smith
Charles Malley .
Norman Akita
Carol Furtado
Melody Canales
Robert Yotsuda ...................................................................President
David Nekomoto ......................................................Vice President
Ceorgia Mossman .....................................;.........................SecretaIY
Robert H. Rask.....................................................................Treasurer
Mary Lou Barela..................................................Executi\le Director
laVerne Bishop .....................................................Program Director
Community Ad\lisory Committee
Inspector Howard Carvalho
kauai Police Depaltment
Rex Couch. M.D.. Director'
Kaual Medical Group
Sherwood Hara. Director
Family Court Afth Circuit
Ryan Jiminez. Prosecuting AMrney
County of KWili
Gail Takasugi-Ignacio. Administrator
Oepr.. of Human Services
PubliC Welfare Division
Ira M. Schwal't2. Director
Russ Van Vleet, Associate Director
Shiney Akita. Superintendent
Kauai School District
University of Michigan
Center for the Study of Youth Policy
Christobal kealoha
Deputy Attomey GenelOl
Wayne P. Law. Chief
Kaual Mental Health Center
Member of
Hawaii Youth Se~jces Network
Honolulu. Hawaii
Western States Youth Se~ices Network
Petaluma, California
The National Network of Runaway
& Youth Se~ice5, Inc.
Washington, D,C.
Hale 'Opia Kauai, Inc.
1645 Pe'e Road, Koloa.kauai, Hawaii 96756
(808) 742-1524
FAX 742-:211 ~
2955 Aukele Street, Suite #6, lihue. Kavai, Hawaii 9&76&
(808) 245-2873 FAX 245-6957
A United Way of Kauai Agency
8nx;hure made possible by American Saying,; Bank.
Tax deductible COI1tributions are Gratefully 3Ge6ptcd.
This brochure is printed on rec.yGltd paper stock.
Hale 'Qpio
Kauai, Inc.
In-community programs for
children, youth and families
�0"3/01194
16: 30
raJ 005/01'7
UofU SOCIAL WORK
'6'801 585 3219
Hate 'Opio Kauai, Inc.
Article
II
Purposes
( a) To engage in charitable and educational activities of any and all
kinds;
( b) To fill a community and State need tor neglected. homeless. pre
delinquent, and delinquent boys and girls ages 13-17. No
preference to be given to race. background, or religion.
( c) To offer remedial education. vocational education, professional
counseling, sports conducted by trained an caring adults, in a home
setting, removed from the usual influences the above-mentioned
boys and girls have encountered and lived with.
( d) To develop self-confidence and self·respect. and an appreciation
of their own worth as individuals.
( e) To take pride in self and abilities.
( t) To recognize the influences that have affected their lives and how
to deal successfully with them.
( g) To develop an ability to return to the community as a worth·while
member.
( h) To acquire skills which will enable them to be gainfully employed.
( i) To attain academic progress to the point where they can
successfully compete with their peers in a scholastic situation.
(written in 1975)
�03/01/94
16:30
'6'801 585 3219
UofU SOCIAL WORK
HALE 'OPIO KAUAI, I NC., a private, non-profit organi·
zation incorporated in 1975, is committed to provid
ing a continuum of services for children, youth and their
families, of any ethnic. religious or racial background, to
preserve and strengthen individual and family function
ing by providing mUltidisciplinary assessments of
casework, homebased services, individual, group. and
family counselin& and placement options ranging from
temporary shelter. long-term residential services and
therapeutic foster care. These services are expected to
.prevent out-of-home placement. lead to reunification
with the tam ily/extended family. a permanent alternate
placement, or interdependent living.
Kauai Multidisciplinary Team
Hale 'Opio coordinates a panel of experts who consult
v.:ith the Department at-Human Services to offer dis
cipline-specific input to facilitate casework in
cases of child abuse and neglect. The team is composed
of a physician, a psychologist, a psychiatrist, a nurse with
a specialty in maternal and child health, a substance
abuse social' worker, and the. Oeputy Attorney
General.
Emergency and Long-Term Services
Emergency services, also available to self-referred youth,
and long-term' residential services are provided to '5
boys and girls ages' 2-17 in one of three homes, each
housing five youth. A team of Resident Counselors, on
duty 24 hours a day, 365 days a year, utilize behavior
managementtechniques which reinforce the concept of
accepting responsibility for one's actions in highly in
dividualized treatment plans. It is Hale 'Opio's philo
sophy that providing services in community-based
programs is to' the advantage of the youth and fam! Iy and
to this end.a special counselor is assigned as an advocate
to each youth in matters of education, job placement.
and meeting individual goals. Residents remain in public
schools with daily on campus monitoring provided by
Hale 'Opio·s· School Liaison. After dasses the youth
attend the learning Resource Center of Kauai Com
munity College where each works on a computer
managed program designed to assist in attaining grade
level competency, vocational skills and employment If a
youth is eligible for and would benefit from taking the
GEO, Hale 'Opio will work with the Department of
Education, Adult Education Departmer:'t. to insure the
141 006/017
youth's success. A Fine Arts program, including
ceramic~, photography and music is part ofthe resident's
regular SChedule. Hale 'Opio works with other
community-based private and public agencies and pro
fessionals to augment seOlices provided to the young
people by the staff. Medical care is p~ovided on a 24
hour basis through a Physician's Agreement for emer
gency treatment with Kauai Medical Group.
Therapeutic Foster Home Program
Hale 'apia's Therapeutic Foster Home Program differs
from traditional foster care in its emphasis on the pro
fessional parents who provide [he youth with the on
going family based treatment and daily opportunities for
success. One parent is considered d,e primary profes
sional parent and does not work outside the home. Both
parents must have the same level of commitment,
receive the same extensive training, clinical consultation
and are provided 24-hour a day support from Hale
'Opio's parent supervisors. These "professional parents"
receive respite services, a tax-free stipend, and room and
board payments for taking a youth into their own home.
Services are also provided to the youths' birth family
through weekly support groups and 'Ohana outings.
Homebased Services
Hale 'Opio's Homebased program provides prevention
and intervention services to Kauai's children and their
families by immediately responding to a family's crisis
and within 24 hours providing in-home intervention ser
vices to strengthen family functioning. These services, in
collaboration with the public and private sector, aim to
identify and prevent further acting out, truancy, runaway
or other behaviors compromising the well·being of the
child within the family setting. Regular in-home visits for
up to three months are scheduled attimes convenient to
family members. including evening. holidays or
weekends, and allows for therapy teams to go into the
home frequently and for long periods of time to provide
services aimed at teaching the family anger manage
ment, problem solving, coping skills, stress-reduaion
exercises, "hard" services, such as providing linkages for
the basic needs of food, medical care. transportation,
housing. and long-term counseling needs referrals for
such issues as substance abuse, marital therapy, etc.
Therapists are available to the family 24-hours a day, and
follow-up at three and six months and annually.
--_.-_.--
HALE OPIO KAUAl, INC.
BALANCE SHEET
DECEMBER 31, 1993
ASSETS
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flJ007/017
HALE OPIO KAUAI, INC.
BALANCE SHEET
DECEMBER 31, 1993
LIABILITIES AND CAPITAL
CUrrent Liabilities
Accounts payable
Note payable - bank
$
41.28
27,793.13
Total Current Liabilities
$
Total Liabilities
capital
Fund balance - endowment
Fund balance - general
Fund balance - relocation
CUrrent Earninqs
'27,834.41
27,834.41
200,000.00
68,213.28
78,752.45
54,618.38
Total Capital
TOTAL LIABILITIES AND CAPITAL
.See Accountant's Compilation Report
401,584.11
$
429,418.52
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UofU SOCIAL WORK
'0'801 585 3219
MALE OPIO tAUAI, INC.
COMPARATIVE BUDGET INCOME STATEMENT
fOR TME SIX MONTHS eNDEO DECEMBER 31, 1993
CUll R e Ii T PERIOD
alodget Varlanee
Actual
Revenue
OYS contract reye~e
JUdiciary eontr. reve
DOH contr.ct revenue
OKS contract revenue
Inccme INItnUl'llnce
Federal H8 re~enue
federal FSS revenue
Department of Educati
federal Youth Sves Bu
Donations
Weinberg foundatton
United Way Pro,ram
Intarollt .'!ncOlDl
Mlac. II'ICCIIIIt
Total Revenue
S
9,426 S
7,900
66,587
19,904
3,752
13,500
9,364
310
500
°
0
667
47
°
133.957
13,958 S (4,532)
31,313 (23,413)
SO,564
18,023
9,591
10,313
(3,760)
7,512
(3,847>
17,341
(219)
9.583
417
(107)
Q
500
(3,358)
3,358
a
0
667
0
47
0
57, '55
4,373
0
329
0
3,381
1.366
1,647
2
548
380
175
40
978
1,833
236
900
31,6
1,009
113
0
(54)
209
3,1M
460
St.1
0
"
2,n]
0
138
0
S
140,830
79,925
174,197
68,958
25,443
97,196
60,672
1,61'
2,500
5,500
,
a
3,675
50
T 0 OAT E
Budget Variance
131.742 S 9,088
187,8'15 (107,950)
66,062
108,135
15,667
53,291
(19,628)
45,071
104,082
(6,886)
57,500
3,172
(889)
2,500
(500)
3,000
20,147 (14,647)
0
a
(325)
4,000
50
0
873
0
BUDGET
Annulll
Unexperldud
S
7',655
295,826
42,075
41,875
64,698
110,968
54,328
3,389
3,500
34,194
13,500
4,325
(50)
(873)
0
0
873
11Z,269
21,688
661,430
717,343
(55,913)
743,010
65,068
4,978
',299
230
344
4,815
1,254
819
20
380
538
126
(7,913)
(60S)
(1,299)
349,299
26,T.!3
2,981
3,513
416,769
3',883
B,339
1,458
2,212
30,843
20,838
5,220
485
2,458
3,770
(67,470)
(5,160)
(5,358)
2,055
(1,324)
(12,700)
457,866
35,025
13,163
(689)
3,390
41.587
33,293
3,583
595
2,605
5,021
329
6.765
5,133
20,323
(113)
8,370
(945)
8,160
10,973
5,229
2,914
, ,291
18,496
',845
6,667
1,877
236
(4,018)
191
991
1,000
Expenses
Salarlo.
Errployar FICA
Wor~'8 compensatio
State unemployment
TOI
Health Insurance
Retirement
Office expense
Medfcat." program
EdiJeottonet - pro,ram
Motor vehlcte - 'I.,l
Recr.atlonal • proore
Program (cloth. & ell
"ous.hold &sundries
Food
Postage &delivery
Tel.phone
Printing &publlcotlo·
Mllea,e .
airfare, Interisland
Airfare, out-of-.tete
Subsistence, per diem
Ground transportacion
Leaso/rental of apace
Leese/rental of equip
Electricity
Woter
GI'
Bldg' ,rds '. rep &m.
Ofc furn , oq- rep & m
Motor vehicle-rep & ~
Other repair' maine
YEA II
Actual
681.
99
(l44)
0,434)
(',888)
828
(18)
168
(158)
49
(644)
259
719
2,493
70
, ,203
41
1,249
954
607
418
187
3,188
326
767
200
114
(226)
(200)
80
(66)
201)
2,523
(48)
9
(83)
48
'29
83
(660)
166
(103)
105
(240)
(841)
(607)
(472)
22
0
ass
18,141
7,065
6,557
15
2,131
1,979
1,351
1,613
3,497
9,677
947
6,630
1,445
6,840
467
2,041
2,086
940
26,948
2,067
2,533
523
72'
6,418
392
559
0
Seo Accountant'S compilation Report
930
4,280
',315
15,041
416
7,787
251
7,501
5,720
3,635
2,500
1,115
22,721
',956
4,600
1,200
480
1,200
292
775
500
(13,773)
1,337
(470)
(327)
(1,191)
421
(2,667)
(818)
(5,364)
531
(1,157)
1,194
(661)
(5,253)
(1,594)
(414)
(175)
4,227
,,,
(2,067)
(677)
244
5,218
100
(216)
(500)
•
215,484
375,'151
216,211
"0,833
90,141
Z08,164
115,000
5,000
6,000
40,294
13,500
8,000
0
0
1,404.438
807,165
61,748
16,144
2,824
4,278
59,730
40,358
10,140
610
4,nS
7,000
1,680
8,378
8,630
30,000 •
834
15,000
SOD
15,000
11,440
7,270
5,000
2,231
45,444
3,912
9,200
2,400
960
2,400
585
',550
',OOD
�0'3/01194
16:32
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VoiV SOCIAL WORK
IilI 009/017
HALE OPIO KAUAI, INC.
COMPARATIVE BUDGET INCOME STATEMENT
FOR '~E SIX MONTHS ENDED DECEMBER 31, 1993
YEA R T 0 D ATE
Budget Variance
Actual
C IJ RitE iii T PER 101)
Budget Yarlanee
Actual
1,267
0
6,879
2,839
2,218
420
0
Insurance
OUtalde CPA
'Olter famft i et
Contrlct services
Clerical/bookkeeping
Theraplat
Paychtecrt8t/Paycolog
program Con8ijltant
Stiff trainfng & reer
"fscellaneoua
Interest expense
0
1,109
21
217
0
960
(522)
217
(1,21"
(3,989)
(5,452)
3.661
5,143
(14,199)
(331)
(3,000)
10,064
, .261
2,533
113,045
(14,845)
606,813
726,231
(119,418)
791,626
54,617
(8,888)
63,505
(54,616)
0
54,611 S
(8,888) S 63,505
(54,616) S
0
(SOO)
98,200
IncODl fram Operatfons
35,757
(n6)
36,533
35,751 s
(716)
s 36,533
S
8,103
6,150
40,350
12,191
6,749
28,9CoZ
331
3,000
4,495
3,250
0
Totel E.lpel\tes
Net IncCIIIII
8,683
7,472
2,161
34,898
16,452
12.492
14,743
0
0
14,559
4,511
2,533
1,150
724
6,72S
532
1,125
4,824
56
500
749
SO
117
(724,
154
2,307
1,093
(',404,
(56)
8 U D GET
Unexpended
Annual
$
See Accountant's CompIlation Report
-
8,339
45,802
,471 )
1,008
43,141
662
6,000
(5,569)
1,989
(2,533)
S
15,515
10,500
80,700
15,981
13,500
57,884
662
6,000
8,990
6,500
0
1,404,438
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16:32
"a'801 585 3219
UofU SOCIAL WORK
141 010/017
HAL E 'OPIO KAUAI, INC.
ANNUAL MEETING OF THE BOARD OF DIRECTOR'S
Tuesday. August 24.1993
5:30 p.m.
Hyatt Regency Resort
AGENBA
Welcome • . . . . • • . . • • . • . • . . . • • • • , . . . . • • • • • • ,.
Report of the Board of Directors
Introductions. • • • • • . • . • . . . . • • . . . • . • • • . . . . . . .•
Chuck Malley
Chuck Malley
Meeting Of the Board of Directors . . • • • . . . . • • • .• Robert
Minutes
Motion to approve minutes Of the annual meeting held August 27,
as circulated
Treasurer's Report. . • • • • . • • • •. . . . . . . . . . . Robert H.
Motion to approve Financial Statements for year ending June 30.
as circulated at the July meeting of the Board of Directors
K. Yotsuda
1992
Rask
1993
Old Bustness
New Business
Repon of the Nominating Committee. . . • • . . • • .•
Carol Furtado
Election of Officers for FY 1993/1994 , . . . . . . • •• Robert K. Yotsuda
Election of Board members
Appointment to Community Advisory Committee
Introduction of Guest Speaker••.•. : . . . . • • . • . • . • • . Russ Van Vleet
The Honorable Rosemary Barkett.
Chief Justice
Florida Supreme Court
CloSI ng . . . . . . . . . . . .
I
•
•
•
•
•
•
•
•
•
•
•
'.'
•
•
•
Motion to adjourn
Cocktails and Pupu's
Ka a'j Ballroom Promenade
•
•
•
•
•
.Robert K. Yotsuda
�03/01/94
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..
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16:32
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141011/017
IHALE OPIO KAUAI, INg.
"
Projected Budget &Income Statement
For the year ending June 30,1993
.'
.'
..
,~
I
AMOUNT
FVE93
I
ISalaries:
..
Executive Director
Program Director
Fiscal Director
Office Manaser
HBS Pr~ram Coord.
TFH Program Coord.
Schoolliason
Office Assistant
Resident Counselor
Resident Counselor
Resident Counselor
Resident Counselor
Nutritionist/Cook
Relief Cook/Cotto SU2r,
Cottage Sueervisor
Su ervisor
C
Fine
Instr./Sul2' .
Fine Arts Instructor
Fine Arts Instructor
ResEite Counselor
Resr;2ite Counselor
Parent Sueervisor
Parent Sueervisor
Parent SUr;2ervisor
Parent Sueervisor
Thera2ist
Theraeist
Theraeist
Thera(2ist
Theraeist
Clinical Coordinator
Subtotal
\ Em21~ee Benefits
[TOTAL PERSONNEL COSTS
48,082
37,000
27 1000
17,244
32,500
30,000
24.150
20.000
24 1561
24,291
24,129
24.561
15,540
12,499
8 1380
8,880
12,000
4.997
4,997
21,500
22 1101
27,000
27.540
27.540
13.392
28.000
28,000
28,000
27,500
27,500
15,000
693 1884
137,402
831.286]
�63/01/94
16:33
D801 585 3219
UofU SOCIAL WORK
~012/017
AMOUNT
FYE93
[Su2~lies:
I
Office Expense .
Medical - Program
Educational - Program
Motor Vehicle - gas/lease
Recreational - Program
Program - {cloth. & allow.}
Household & Sundries
250
2,824
13 1614
4,383
5,426
8,000
[TOTAL SUPPLIES
44,020]
9,523
:
IMisc. 02erational:
30.000
Food
Postase, Delivery
Telephone
Printing &Pubs
Mileage
Airfare, inter- island
Airfare, out-of-state
$ubsistance, eer diem
Ground trans~rtation
7,886
1.500
ITOTAL MISC. OPER.
.. 74.015]
','29
9,467
1,500
8,500
5,084
8.949
ILEASE RENTAL OF SPACE
.16.3761
ILEASE RENTAL OF EQUIP.
4,3211
IUtilities:
Electricit~
10,698
1,708
1.248
Water
Gas
/TOTAL UTILITIES
[Aeeair & Maintenance:
Building & Grounds
Office fum. & eguiQ.
Motor Vehicles
Other
.,.~
.
. ..,
~
,,'
""
.
.:.;~;.:
,13.654] .
12,000
912
1.995
1,500
$
(TOTAL REP. & MAINT.
16.4071
�03/01/94
I• •
16:33
U801 585 3219
Voiv SOCIAL WORK
IaJ 013/017
'
AMOUNT
,
FYE93
IINSURANCE
.1-:.
..
[Contractual Services:
CPA
Foster Families
KMT
95,604
4.673
12,000
5,000
ITOTAL CONTRACT SVC.
126,4621
Igther:
Staff Tralnina
Miscellaneous
ITOTAL FYE 93 BUOGgT
11.378
5.638
:
17.01[j
:·1,159.0571
{BUDGET BREAKDOWN BY CONTRACT:
OYS LONG-TERM GROUP HOME
OYS STAFF SECURE
JUDICIARY EMERGENCY
JUDICIARY LONG-TERM GROUP HOME
JUDICIARY THERAPEUTIC FOSTER HOME
DOH THERAPEUTiC FOSTER HOME
DOH HOMEBASED SERVICES
DHS MULTIDISCIPLINARY TEAM
DHS EMERGENCY
FEDERAL HOMEBASED SERVICES
OTHER HALE OPIO
ITOTAL FYE 93 BUDGET
I
9.185
Bookkee~in~/Clerical
Ps~chiatrist or ~s~cholo~ist
ITOTAL OTHER
:::"j ";·.:::j5,500
145,'30
72,200
28.838
154,976
176,660
194,000
95.000
18.433
28,838
200,000
44,982
:
�03/01/94
16:33
1992
,,,n
_.11_0' .......
.10,...
w..
I4J 014/017
uofU SOCIAL WORK
'5'801 585 3219
1MWAM W. 'An. CIWIIPNOII
BCARe OF I.ANC "NO NATURAL REscuFICn
"
STATE OF HAWAII
(C©ffi"~~~~::
OEPAATMENT OF L.AND AND NATURAL RESOURCES
P. O. 10J 121
I!IOHOLUW. HAWAII ..101
. APR - i 1992
P
AQUA
til
IInQuIlC(I
.
~Q .. llllv" flON
...,.0
&'f&lll,
<:O".'""""'ON 'NO
IIUOuIlC" I .. ,O.C."'",
CO..vl'''NCU
(NVI"OIl"III'''~
.OIlESTAY 1... 0
lIIIIU)~"E
...SfOIIiC '1I1Slllv"TIOjj
PI\OGR,U'
"""I) .....,
1"'" "'''"''0''''''''ClEWiI.O....I ..T
..AtEIl 'III:) I,.IoHCI
I<A-90:0803
Mr. Robert K. Yotsuda, President
Ms. Mary Lou Barela, Executive Director
Hale Opio Kauai, Inc.
1645 Pee Road
Koloa, Hawaii 96756
Dear Mr. Yotsuda and Ms. Barela:
Subject: Housing Discrimination complaint Filed
~~ Hale 0E~o Kauai, Inc.
This is in response to your letter of February 25, 1992 to
the U.S. Department of Housing and Urban Development regarding
your subject complaint-.
We believe it is appropriate to clarify some of the
statements made in your letter as well as bringing you up to
date on the matter.
In October 1989, the lOOth Congress.of the United States,
by provisions of public Law 100-400 under the heading -Real
Property Relocation W appropriated $1.5 million to Hale Opio
Kauai, Inc. for relocation of its facility on the former Loran
Station at Makahuena Point on Kauai. In a formal Memorandum of
Understanding and Agreement between the U.S. General Services
Administration and the State of Hawaii dated June 20, 1989, and
in an agreement between the Department of Land and Natural
Resources and Hale Opio Kauai, Inc. dated May 24, 1990, the
State agreed to assist in the relocation by providing public
land.
Originally, Hale Opio's request was for a single 5-acre
site. Your current request is for the conveyance of three (3)
sites for residential use, and a fourth site for administrative
office and suppor~ facility purposes following the philosophy
that smaller units are more successful than a central
institutionalized facility.
�03/01194
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141 015/017
Mr. Robert ~. Yotsuda
Ms. Mary Lou Barela
~~e_ 1992
r
A request authorizing the conveyance of state land at
Hanapepe and Wailua on the island of Kauai to Hale Opio was
scheduled for submittal to the Board of Land and Natural
Resources at its April 27, 1990 meeting. However, because of
concerns voiced by substantial number of residents from the
affected areas, the matter was deferred to the Land Board's May
24, 1990 meeting.
On May 17, 1990, the Hanapepe Bay Community Association
presented to the Department of Land and Natural Resources a
petition signed by 1,755 Kauai residents opposed to locating
Hale Opio in the Hanapepe area. Then, on May 22, 1990, a
petition signed by 572 Kauai residents opposed to Hale Opio
locating in Wailua was received by the Department. The matter
was again deferred.
Subsequently, a Citizens Advisory Task Force was formed in
June 1990 to involve community members in the planning process
and to review a list of thirty-five (35) state-owned sites
offered by the Department of Land and Natural Resources.
On January 7, 1991, the Board of Directors of Hale Opic
submitted to the Department of Land and Natural Resources a
list of five (S) sites it selected from the eight (B) sites
chosen by the Citizens Advisory Task Force for conveyance to
Hale Opio.
Due to the sensitive nature of this program, public
informational meetings were held in the communities affected
starting with Kapaa, January 22, then Koloa, January 24, and
finally, Hanapepe, January 29, 1991.
The input from residents attending the meeting was,
overwhelmingly, against Hale Opio moving into their
neighborhoods. We continue to receive letters from residents
and politicians in the affected communities who are opposed to
the selected sites for Hale Opio.
On April 12, 1991 at a meeting held on Kauai in the County
of Council Chambers at Lihue, the Land Board considered a staff
recommendation to provide Hale Opio with three (3) sites. TWO
(2) sites, one in Rapahi and the other in Hanapepe, are for
youth education/residential purposes. The third site, located
in Xapaa, is for youth education/administrative office and
support facility purposes.
I
�63/01/94
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flI 016/017
Mr. Robert K. ¥otsuda
Ms. Mary Lou Barela
Page 3
APi< -
II~J2
After considering testimony, the Board decided to approve
the sites at Kapahi and Kapaa, but deferred action on the
proposal to issue a lease for a one (1) acre portion of Tax Map
Key: l-8-08:17, Hanapepe Site, for youth
educational/residential purposes until its next Kauai meeting
scheduled for July 19, 1991. During the interim, the Hanapepe
community and Hale Opio Kauai, Inc. were charged with the task
of resolving differences and coming to agreement.
On May 17, 1991 a meeting was held to allow the Hanapepe
community and Hale epio an opportunity to resolve their
differences. Attendees included representatives from Hanapepe
community, Hale Opio, the Kauai Humane Society, the Mayor's
Office and the Hanapepe Business Association. After nearly two
(2) hours of dialogue, the meeting ended with the Hanapepe
people clearly in opposition to the idea of Hale Opio moving
into their community, preferring instead that the Board drop
Hanapepe as a considered site, substituting instead parcels at
emao and Wailua Houselots.
On July 19, 1991 at the Board meeting on Kauai, the
Department requested that the Board authorize the issuance of a
direct lease to Hale Opio for the Hanapepe site.
This Department will be the first to admit that the
Hanapepe site is not the perfect site. Even after extensive
discussion at the various community informational meetings, no
community has stepped forward to welcome Hale epio.
Thus, given the few alternatives, plus the opposing views
expressed by Hale epio and the community, our Department felt
the Hanapepe sites to be the property best suited for the
proposed use under the circumstances.
However, at the July 19, 1991 meeting, Mayor ¥ukimura
formally requested that the County be given until March of 1992
to find a suitable place for Hale Opio. Based on this
representation, the Board denied the staff recommendation to
authorize the issuance of a direct lease for youth
educational/residence purposes to Hale Opio Kauai, Inc. for
State-owned land on Kauai identified as Tax Map Key:
1-8-08:17, the Hanapepe site.
To date, we understand that discussions have occurred
between the County of Kauai and Hale epio on alternatives
sites.
In light of the March 1992 deadline set by the County,
this Department will be contacting them to determine the status
of of their efforts. Be advised that the Department is still
�63/01/94
16:34
U801 585 3219
voiV SOCIAL
WO~.._.
~017/017
Mr. Robert K. Yotsuda
Ms. Mary Lou Barela
page 4
AfJR - i
19~2
prepared to request the Board's authorization to issue a lease
to Hale Opio on the Hanapepe Site. The Board's action of July
19, 1991 was effectively to defer action on the Hanapepe site
to allow the county an opportunity to find a more acceptable
site.
Given the county's on-going efforts to secure Hale Opio a
site, the Department was not prepared to entertain your request
for additional sites. By letter dated January 7, 1992, we
informed you that rather than consider any other sites at this
time, we would prefer to honor the Land soard's commitment to
Mayor yukimura to allow the County of Kauai until March 1992 to
find Hale Opio a site.
We understand and share your desire to attain a quick
resolution on your relocation sites. HOW ver, part of the
process involves public participation. C munity concerns
raised during this process must be consid red in the decision
making. Ideally, the Board would prefer hat both Hale Opio
and the affected communities reach mutual agreement on the use
of a site before taking action. This is ot always the case,
however, and the Board is faced with the ifficult task of
weighing the needs of Hale Opio .and that f the affected
communities.
We will notify you of our progress 0 the matter after we
have contacted the Mayor. In the fnterim, should you have any
questions, please feel free to contact eit er Mr. Sam Lee on
Rauai at 241-3326 or Mr. Dean Uchida in Honolulu at 587-0414.
Attachments
cc: Mr. Herbert Apaka (wI attachments)
KDLO (wI attachments)
Mayor JoAnn Yukimura (wI attachments)
U.S. HUD (wI attachments)
�03/01194._
16: 29
'6'801 585 3219
~001l017
VofV SOCIAL WORK
FAX TRANSMISSION
TO
ORGANIZATION_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
AOORESS_________~-~-------------
PHONE
~.5&-~1f..
(J,02.J
FROM
RUSS VAN VLEET
(801) 581·3439
The Center For The Study Of Youth Policy
University of Utah
Graduate School of Social Work
Salt Lake City. Utah 84112
DESCRIPTION
61'"
.61k41n;= /!h.J,;4.iJ
U,HL
.
t:-v {a, .
FAX (801) 585-3702
~t': Ikk ~~
.'
:!fit;,
.
J .
�,MAY 3 I REC'O
\
Contact person: Rosalyn Miller
Phone number: x 6 2 216
Date of request: Narch 7, 1994
ACCEPTANCE OF TRAVEL EXPENSES FROM OUTSIDE SOURCE
In order to consider whether the Government may accept from an outside source payment of
your travel, subsistence and related expenses under the GSA travel rule, you must complete the
information below. The outside source need not be a 501(c)(3) organization, but if it is, please
state so on this form and include the IRS determination letter.
Please include a copy of the letter of invitation if one was received.
Your name and position:
Carol H. Rasco
Assistant to the President for Domestic Policy
,
Nature of meeting or similar function and how it relates to your official duties:
Date and place(s) of travel:
August, 15, 1994 --- Island of Kauai
Persons or entity making the payment (please also note any financial interests of the person or
entity known to you that may be affected by the exercise of your ,Government responsibilities):
Hale Opio
Nature of expense(s) paid for:
Travel expenses
Method and approximate amount of payment (payment may be made either in-kind or by
check made payable to U.S. Treasury; you may not directly receive payment in cash or check
made out to you):
This form and any accompanying memorandum of approval must be attached to your travel
authorization. You must complete a travel voucher following the trip_ Please send completed
-:'\
form to Room 128, OEOB, at least 3 days before commencement of travel.
~~~ ~ ~ {ro~ ~ ~f>,,"\-\.'-\.L\.5. (,,(\b~~
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�THE WHITE HOUSE
WASHINGTON
March 7, 1994
MEMORANDUM FOR CLARISSA CERDA
~
Miller~
FROM:
Rosalyn
SUBJECT:
Travel Expense Approval
Carol Rasco has accepted an invitation to address the Annual
Conference of Hale opio on August 15, 1994. I have attached
background information about this company and am seeking guidance
as to whether we can accept their offer to cover her travel
expenses. For planning purposes, we would like to respond to
this request as soon as possible. Y our pro mpt atte ntion is
appreciated.
Thank you.
�.THE UNIVERSITY OF PENNSYLVANIA
SCHOOL OF SOCIAL WORK
CENTER FOR THE STUDY OF
Judge Frank A. Orlando (Ret.)
Director
Nova University
3305 College Avenue
Ft. Lauderdale, FL 33314
(305) 452-6239
FAX (305) 452~6241
V~~
Ira M. Schwartz
Dean and Director
4200 Pine Street, 2nd Roor
Philadelphia, PA 19104-4090
(215) 898-2229
FAX (215) 573-2791
January 27, 1994
Russell K. VanVleet
Director
The University of Utah
Social Research Institute, Room 126
Salt Lake City, Utah 84112
(801) 581-3439
FAX (801) 585-3702
Carol Rasco, Domestic Affairs
2nd Floor, west Wing
The White House
1600 Pennsylvania Avenue
Washington, D.C.,20500
Dear Carol:
I hope writing is easier than trying to call. I hope that you have
time to at least reap your mail and consider this offer.
I have been working for the last four years in Hawaii. We have
made some nice changes in the system there and in the process of
'that I became acquairited with a private provider on the Island of
Kauai, Hale Opio which has, with our assistance, developed some
fairly innovative and effective programming for kids.
It is a fairly small program .but given the population of Kauai
(about 50,000) it has an amazing array of quality programs. Ira
Schwartz and I have both served on the Board and feel that it is
a program worth supporting.
They hold an annual conference each August and invite a guest
speaker.
I realize your schedule is packed but I hoped that a
chance to go to Kauai, do some work and get a little R & R might
be appealing. Hale Opio, of course, will pick up the cost of your
attending the. meeting and pay an honorarium if you desire.
I told the Hale· opio Board it was a long shot that you would be
available but the lure· of Hawaii might be enough to get you to
consider it.
�I invited Rosemary Barkett, President Clinton nominated her for the
Federal Court recently, to go last summer and she really enjoyed
the trip.
Let me know if you can consider it. It would be good to see you
and also be quite a boost to that community. Most of the damage
from hurricane Iniki is gone but the Island people still need an
occasional boost and your attending this meeting would certainly
be one.
I'm still working in Arkansas.
spent last week with the Youth
Services Board and with Dept. staff. They intend to close the Pine
Bluff Youth Services Center to youth, convert it to an adult
facility and develop work camps/boot camps to replace the lost
beds.
Due to the "crisis" in juvenile crime our work seems to be changing
rapidly.
We still try to help states to reduce reliance on
training schools and develop community programming but we have to
spend a great deal of time looking at violence, gangs, and the
public reaction to the whole system.
Hope your work is going well.
Look forward to hearing from you.
ly,
Vleet
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CLINTON LIBRARY PHOTOCOPY
�03/01/94
16:29
'Zt801 585 3219
UofU SOCIAL WORK
._----------------=_0021017
.,
March 1, 1994
To:
r
From:
Re:
Hale apio Annual' Meeting, August 15, 1994
I have faxed materials that should explain Hale apio to you and
Carol Rasco.
Hale apio is a private provider, under several contracts from the
state of Hawaii to provide an array of services to youth on the
island of 1<auai.
Hale apio has been in existence for many years and is in the
process of improving their programs.
There is one area of controversy that perhaps Carol should be made
aware. I included information regarding the relocation efforts of
Hale apio but let me give a brief explanation.
Hale apio was located in an old Coast Guard Building on the Poipu
side of Kauai, Hale apio having occupied this building with the
Governments permission. The Federal Government decided to sell the
land and Hale apio had to relocate. As part of this relocation
effort Hale Opio was given a relocation settlement and ten acres
of Hawaii land for program development.
Since Hale apio is dealing with troubled youth the efforts to
relocate the program became very difficult.
Attempts are being
made to develop three different sites but the NIMBY (Not in my
backyard) factor is alive and well in Hawaii. The state has been
unwilling to provide the land and public hearings have not resolved
the issue.
Hale apio was advised to file a claim with HUD. That did happen
and HUD ruled in Hale apios favor and turned the case over to the
Fair Housing Division of the Justice Department, where it currently
sits.
There is no intention to involve Carol in this 'issue. It is being
resolved, hopefully, through the proper channels although I must
admit the Justice Department has basically sat on the claim for
several years and this has caused feelings both from the Board of
Directors of Hale epio as well as the State of Hawaii.
�03/01/94
16:30
US01 585 3219
UofU SOCIAL WORK
141 003/017
The Annual Meeting has nothing to do with this issue. It is to
give a messaqe to the Board and staff of Hale Opio as to the issues
facing youth in our country today.
Please call me if I can qive further information. I have advised
Hale apio of Carols willingness to attend.
August 15 has been
confirmed as the date.
�03/01194
16:30
trS01 5S5 3219
UofU SOCIAL WORK
~004l017
BOARD Of DIRECTORS
Amy Parungao
HartWell H. K. Blake
Jean Holmes
Allan Smith
Billi Smith
Charles MaUey
Norman Akita
Carol Furtado
Melody Canales
Robert Yotsuda ...................................................................President
David Nekomoto ......................................................Vice President
Georgia Mossman .....................................;.........................Seaetary
Robert H. Rask.....................................................................Treasurer
Mary lou Barela ..................................................Executive Director
laVerne Bishop .....................................................Program Director
Community Adlti50ry CommiUee
Inspector Howard Carvalho
i<auai Police Department
Rex Couch. M.D.. Director
Kaual Medical Croup
Sherwood Hara. Director
Family Court Fifth Circuit
Ryan Jiminez, Prosecuting AttOmey
County of Kauai
Gail Takasugi.lgnacio. Administrator
Ira M. Schwartz, Dir@ctor
Russ Van Vleet. Assoaate Director
University of Michigan
Center for the Study of Youth Policy
Dept. of Human Services
Public Welfare Division
Shirley Akita. Superintendent
Kauai School District
Christobal Kealoha
Deputy Attomey Ceneral
Wayne P. law. Chief
Kauai Mental Health Center
Member 01
Hawaii Youth Senices Network
Honolulu, Hawaii
Western States Youth Services Network
Petaluma. California
The National Network of Runaway
" Youth Services, Inc.
washington. D.C.
Hale 'Opio Kauai,·lnc.
1645 Pe'e Road. Koloa.kauai. Hawaii 9&756
(808) 742·1524
FAX 742-2113
2955 Aukele Street. Suite 16, lihue, Kauai, Hawaii 96766
(808) 245·2873 FAX 24506957
A United Way of Kauai Agency
BI'ochure made possible by Americun SilYinp Bank.
Till! deductible cOrttribution5 lira gratefully aCCClplod.
Thi. brochure is printed on recycled pilpot slOCk.
Hale 'Qpio
Kauai, Inc.
In-community programs for
children, youth and families
�OJ/01/94
16:JO
~005/017
UofU SOCIAL WORK
'6'801 585 JU9
Hale 'Opio Kauai. Inc.
Article
II
Purposes
( a) To engage in charitable' and educational activities of any and all
kinds;
( b) To fill a community and State need for neglected. homeless. pre
delinquent, and delinquent boys and girls ages 13-17. No
preference to be given to race, background, or religion.
( c) To offer remedial education, vocational education, professional
counseling, spons conducted by trained an caring adults, in a home
setting, removed from the usual influences the above-mentioned
boys and girls have encountered and lived with.
( d) To develop self-confidence and self-respect, and an appreciation
of their own worth as individuals. '
( e) To take pride in ,e11 and abilities.
( f) To recognize the influences that have affected their lives and how
to deal successfully with them.
( g) To develop an ability to return to the community as a worth·while
member.
( h) To acquire skills which will ena,ble them to be gainfully employed.
( i) To attain academic progress to the point where they can
successfully compete with theJr peers in a scholastic situation.
(written in 1975)
�OJ/01/94
16:JO
'5'801 585 J219
ttl 006/017
UofU SOCIAL.,!ORK
HALE 'OPIO KAUAI, INC., a private, non-profit organi
zation incorporated in 1975, is committed to provid
ing a continuum of services for children, youth and their
families, of any ethnic, religious or racial background, to
preserve and strengthen individual and family function
ing by providing multidisciplina~ assessments of
casework, homebased services, individual, group. and
family counseling, and placement options ranging from
temporal)' shelter, long-term residential services and
therapeutic foster care. These services are expected to
.prevent out-of-home placement, lead to reunification
with the family/extended family, a permanent altemate
placement. or interdependent living.
Kauai Multidisc;iplinary Team
Hale 'Opio coordinates a panel of experts who consult
With the Depanment of Human Services to offer dis
cipline-specific input to facilitate casework in
cases of child abuse and neglect. The team is composed
of a physician, a psychologist, a psychiatrist. a nurse with
a specialty in maternal and child health, a substance
abuse social . worker, and the. Deputy Attorney
General.
.
Emergency and Long-Term Services
Emergency services, also available to self-referred youth,
and long-term'residential services are provided to 15
boys and girls ages , 2·17 if'! one of three homes. each
housing five youth. A team of Resident Counselors, on
duty 24 hours a day, 365 days a year, utilize behavior
management techniques which reinforce the concept of
accepting responsibility for one's actions in highly in
dividualized treatment plans. It is' Hale 'Opio's philo
sophy that providing services in community-based
programs is to' the advantage of the youth and family and
to this end.a special counselor is assigned as an advocate
to each youth in matters of education, job placement
and meeting individual goals. Residents remain in public
schools with daily on campus monitoring provided by
Hale 'Opio's' School Liaison. After classes the youth
attend the Learning Resource Center of Kauai Com
munitY College where each· works on a computer
managed program designed to assist in attaining grade
level competency, vocational skills and employment If a
youth is eligible for and would benefit from taking the
GED, Hale 'Opio will work with the Department of
Education, Adult Education Departme,:,t, to insure the
youth'S success. A Fine Arts program, including
cerami~, photography and music is part ofthe resident's
regular schedule. Hale'Opio works with other
community-based private and public agencies and pro
fessionals to augment services provided to the young
people by the staH. Medical care is Provided on a 24
hour basis through a PhYSician's Agreement for emer
gency treatment with Kauai Medical Group.
Therapeutic Foster Home Program
Hale 'apia's Therapeutic Foster Home Program diHers
from traditional foster care in its emphasis on the pro
fessional parents who provide the youth with the on
goin g family based treatment and daily opportunities for
success. One parent is considered the primary profes
sional parent and does not work outside the home. Both
parents must have the same level of commitment,
receive the same extensive training, clinical consultation
and are provided 24-hour a day support from Hale
'Opio's parent supervisors. These "professional parents"
receive respite services, a tax-free stipend, and room and
board payments for taking a youth into their own home.
Services are also provided to the youths' birth family
through weekly support groups and 'Ohana outings.
Homebased Services
Hale 'Opio's Homebased program provides prevention
and intervention services to Kauai's children and their
families by immediately responding to a family's crisis
and within 24 hours providing in-home intervention ser
vices to strengthen family functioning. These services, in
collaboration with the public and private sector, aim to
identify and prevent further acting out. truancy, runaway
or other behaviors compromising the well-being of the
child within the family setting. Regular in-home visits for
up to three months are scheduled animes convenient to
family members. including evening. holidays or
weekends, and allows tor therapy teams to go into the
home frequently and for long periods of time to provide
services aimed at teaching the family anger manage
ment, problem solving, coping skills, stress-reduction
exercises. "hard" services, such as providing linkages for
the basic needs of food. medical care, transportation;
housing, and long-term counseling needs referrals for
such issues as substance abuse, marital therapy, etc.
Therapists are available to the family 24·hours a day, and
follow-up at three and six months and annUally.
--_.--,--
HALE OPIO KAllAl, INC.
BALANCE SHEET
DECEMBER 31, 1993
ASSETS
�03/01/94
16:31
t;t801 585 3219
tal 007/017
Uotu SOCIAL WORK
HALE OPIO KAUAI, INC.
BALANCE SHEET
DECEMBER 31, 1993
LIABILITIES AND CAPITAL
current Liabilities
Accounts payable
Note payable - bank
$
41.28
27,793.13
Total Current Liabilities
$
Total Liabilities
Capital
Fund balance - endowment
Fund balance - general
Fund balance - relocation
CUrrent Earnings
27,834.41
27,834.41
200,OOO.OQ
68,213.28
78,752.45
54,618.38
Total Capital
TOTAL LIABILITIES AND CAPITAL
See Accountant's Compilation Report
401,584.11
$
429,418.52
�03/01/94
16:31
VofV SOCIAL WORK
B801 585 3219
I4J 008/017
HALE OPIO lAUAl, INC.
COMPARATIVE BUDGET INCOME STATEMENT
fOR THE SIX MONTHS ENOEO DECEMBER 31, 1993
YEA R T 0 D ATE
Actual
Buclget Variance
CUlt R E II T PERIOD
8!.dget Variance
Actual
Revenue
OYS contract revenue S
Judtct.ry contr. reve
DOH contr.ct revenue
OKS contr,ect reVef'I!..Ie
Inca. ...'ntenence
federal H8 reYenue
federal FSS revenue
Department of Educlt;
federal Youth Ivea Bu
Donations
Velrarg Foundatton
United III.y Protram
Intereu 'Inc...
..llc. IncClllO
Toe.l Re"enue
Expensel
Sllarlea
E,.,lov.r FICA
Workmen'. compensatio
Sta'e un~loymen'
TDI
Health Insurance
.etlrelNmt
off Ice e..pense
..edlcll • program
Educetiona1 . progrom
Motor "ehicle - g.8,l
Recree'ional - progre
Program (cloth. & oll
"GUSehold & sundries
Food
POI tag. &deli"ery
Tel.one
Printing & publlc.tlo
MHe"e .
Ilrf.re, Interisland
Ilrfare, out-Qf-Itate
Salatence, per diell
Ground tran.por'e,lon
L.ale/rental of aplce
~e'I./rent.l of equip
Electricity
Water
Gil
9,426 S
7,900
68,587
'19,904
3,752
13,500
9,364
310
500
0
0
667
47
13,958 I (4.532)
31,313 (23,413)
50,564
18,023
9,591
10,313
7,512
(3,760)
(3,847>
17,347
(219)
9,583
417
(107)
0
500
3,358
(3,358)
a
S
140,830
79,925
174,197
68,958
25,443
97,196
60,672
1,611
2,500
5,500
,
131,742 S 9,088
18'7,875 007,950)
108,135
66,062
53,291
15,667
(19,628)
45,071
(6,886) ,
104,082
57,500
3,172
(889)
2,500
(500)
3,000
2Q,147 (14,641)
0
0
(325)
4,000
50
0
87'3
0
8UDGET
s
74,655
295,826
42,075
41,875
64,698
110,968
54,328
3.389
3,500
34,194
13,500
4,325
(50)
(873)
a
a
3,675
0
,47
0
87'3
133,957
l1Z,269
21,6&8
661.<.30
717,343
(55,913)
743,010
57,1SS
65,068
<',978
1,299
230
344
4,815
3,254
819
20
380
538
126
(7,913)
(605)
(1,299)
99
)<.9,299
26,723
2,981
3,513
8B8
(67,470)
(5,160)
(5,358)
2,055
(1,324)
457,866
35,025
13,163
(344)
(1,434)
18,143
7,065
6,55'7
15
2,131
1,979
, ,351
1,613
3,497
9,677
947
6,630
1,445
6,840
467
2,041
il,086
940
26,948
2,067
2,533
523
724
6,418
392
559
0
416,769
31,883
8,339
1,458
2,212
30,843
20,838
5,22P
485
2,458
3,770
930
4,280
4,315
15,041
416
7,787
251
7,501
5,720
3,635
2,500
1,"5
22,721
',956
a
4,37'3
0
329
0
3,381
1,366
1,647
2
548
380
175
40
978
1,833
236
900
346
1,009
113
0
(S4'
209
3,788
460
541
0
14
Bld; &,rds • rep &m
2,723
Ofe furn , eq- rep & ..
Motor "ehlcle-rep &m
OCher repaIr &matnt
0
138
0
667
a
684
719
2,493
70
1,203
41
1,249
954
607
418
187
3,788
326
767
200
80
200
48
129
83
(1,aea)
828
(18)
168
(158)
49
(644)
259
(660)
166
(303)
:SOS
(240)
(841)
(607)
c472>
22
0
134
(226)
(200)
(66)
2,523
(48)
9
(83)
0
50
See Accountant'l compilation Report
(12,700)
(15,77'3)
1,337
(470)
(327)
C1,791 )
421
(2,667)
(818)
(5,364)
531
(1,157)
','94
(661 )
(5,253)
",594)
(I.,,)
(175)
4,227
,"
',600
(2,067>
1,200
480
1,200
292
775
500
(6n)
244
5.218
100
(216)
(500)
Annual
Ut\lllpended
(689)
3.390
41,587
33,293
3,583
595
, 2,605
5,021
329
6,765
5,133
20,323
(113)
8,370
(945)
8,160
10,973
5,229
2,914
1,291
18,496
, ,84S
6,667
1,877
236
(4,018)
193
991
1,000
,
215.'84
375,751
216,271
110,133
90,141
208,164
115,000
5,000
6.000
'0,294
13,500
8,000
0
0
1,404,438
807,165
61,748
16,144
2,824
4.278
59,730
40,358
10,140
610
4,735
7,000
1,680
8,378
8,630
30,000 _
834
15,000
SOO
15,000
",440
7,270
5,000
2,231
45,444
3,912
9,200
2,400
960
2,400
585
1,550
1,000
�03/01194
16:32
'6'801 585 3219
l!ofl! SOCIAL WORK
raJ 009/017
HALE OPtO lAUAl, INC.
COMPARATIVE BUDGET INCCME STATEMENT
fOR THE SIX MONTHS ENDED DECEMBER 31, 1993
CURllfNT
A.:tual
Y I A R T 0 bAT Ii
PERIOO
Bur.:jget variance
Actual
34,898
16,452
12,492
14,74]
0
D
14,559
4,511
l,S33
(1,211,
(3,989)
(5,452'
3,661
5,143
(14,199)
(331,
(3,000)
10,064
1,261
2,533
(14.845)
606,813
7Z6,231
( 119,418'
797,626
36,533
54,617
(8,888)
63,505
(54,616)
a
S4,617 S
(8,888) S 63,505
(54,616) S
0
217
117
(724)
154
2,307
1,093
(4,404)
(56)
(500)
960
(522)
217
Toul E&penaes
98,200
113,045
IncOle fran Operations
35,757
(n6)
35,757 s
(776) S ]6,533
lIet Income
Q
0
1,709
21
S
BUD GET
unexpended
AlVUll
8,683
6,150
40,350
12,791
6,749
28,942
331
3,000
4,495
3,250
0
',150
721,
6,725
532
1,125
4,824
56
500
749
SO
0
1,267
0
6,879
2,839
2,218
420
1l'l8l.lrlnce
OUtllde CPA.
'olter fllllliliea
tontrl.:t ,ervlce.
Clerical/boOkkeeping
Therapl"
P,ychfetrfat/Plycolog
progr.. Consul tint
Stiff training , reel"
,n,cellaneout
Interest e.pense
Sudaet Varlanc:e
7,472
2,161
s
See Accountant's CompIlation Report
8,103
8,339
45,802
(471 )
1,008
43,11,1
60l
6,DOO
(5,569)
8,990
1,989
(2,533)
,
10,500
80,70D
15,981
1l.5oo
57,884
662
6,000
6,500
15,515
0
1,404,438
�03/01/94
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HALE 'aPia KAUAI, INC.
ANNUAL MEETING OF THE BOARD OF DIRECTOR'S
Tuesday, August 24,1993
5:30 p.m.
Hyatt Regency Resort
AGENBA
Welcome • . . • • • . • • • . • • • • • • . • • . • • . . . . • • • • • • •• Chuck Malley
Report of the Board of ~irectors
Introductions. . •• . • . • . • • . . . • . • . • • • • . • . . . . . . .. Chuck Malley
Meeting Of the Board of Directors. . • . . . . . . • • • .. Robert
Minutes
Motion to approve minutes of the annual meeting held August 27,
as circulated
Treasurer's Report. . • • • • • . . . .. . ......... Robert H.
Motion to approve Financial Statements for year ending June 30,
as circulated at the July meeting of the Board of Directors
K. Yotsuda
1992
Rask .
1993
Old Business
New Business
Report of the Nominating Committee . . . .. • . • • • .
Carol Furtado
Election of Officers for FY 1993/1994 • • . • •. • . • ••
Election of Board members
Appointment to Community Advisory Comminee
Robert K. Yotsuda
Introduction of Guest Speaker•••..• : • . . • • • . • • . . • . • Russ Van Vleet
The Honorable Rosemary Barkett.
Chief Justice
Florida Suprema Court
Closing . • . . . . . . • . . .
Motion to adjourn
I".
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Cocktails and Pupu's
Ka a'i Ballroom Promenade
•
•
•
•
•
.Robert K. Yotsuda
�03/01/94
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16:32
ft801 585 3219
UofU SOCIAL WORK
~011/017
\
[HALE OPIC KAUAI, INC.
"
Projected Budget & Income Statement
For the year ending June 30. 1993
~:
r
I ~OUNT I
FYE93
ISalaries:
..
Executive Director
Pr29ram Director
Fiscal Director
Office Manager
HBS Pr!:?,Sram Coord.
TFH Program Coord.
School Uason
Office Assistant
Resident Counselor
Resident Counselor
Resident Counselor
Resident Counselor
NutritIonist/Cook
. elief Cook/Cotto Suer.
R
Cottage Sueervisor
Cottase SUE!ervisor
Fine Arts Instr./Sue!:.
Fine Arts Instructor
Fine Arts Instructor
ResEite Counselor
Reseite Counselor
. Parent SUEervisor
Parent SUEervisor
Parent Sueervisor
Parent SUEervisor
TheraQist
Theraeist
Thera2ist
Theraeist
TheraEist
Clinical Coordinator
Subtotal
\ Erne/ayee Benefits
[TOTAL PERSONNEL COSTS
48.082
37,000
27 1000
17.244
32.500
30,000
24,150
20,000
24 1561
24.291
24.'29
24,561
15.540
12,499
8 1380
8.880
12,000
4.997
4,997
21,500
22,101
27.000
27,540
27,540
13.392
28,000
28.000
28,000
27,500
27.500
15,000
693 1884
137,402
P831 ,286 I
��03/01/94
16:33
fr801 585 3219
lToftJ SOCIAL WORK
~013/017
'-
'
,AMOUNT
I
FYE93 "
.I:,
ONSURANCE
[Contractual Services:
CPA
Foster Families
KMT
Bookkeeping/Clerical
Psychiatrist or psyChologist
ITOTAL CONTRACT SVC.
'" "','15.500 I
9,185
95,604
4.673
12,000
5,000
126.4621
[9ther:
Staff Training
Miscellaneous
ITOTAL OTHER
..
11,378
5.638
17,01[]
ITOTAL FYE 93 BUDGET
1,159,0571
IBUDGET BREAKDOWN BY CONTRACT:
OYS LONG-TERM GROLIP HOME
OY$ STAFF SECURE
JUDICIARY EMERGENCY
JUDICIARY LONG-TERM GROUP HOME
JUDICIARY THERAPEUTIC FOSTER HOME
DOH THERAPEUTIC FOSTER HOME
DOH HOMEBASED SERVICES
DHS MULTIDISCIPLINARY TEAM
DHS EMERGENCY
FEDERAL HOMEBASED SERVICES
OTHER HALE OPIO
(TOTAL FYE 93 BUDGET
145,130
72,200
28.838
154,976
176,660
194.000
95,000
18,433
28,838
200,000
44.982
:
�03/01/94
16:33
UofU SOCIAL WORK
'6'801 585 3219
ial014/017
1992
W1WAM W. 'An, C~POIIOII
JO"IIi "'''I"U
. GOW,.-oa Of
BCARD OF LANe ANO NATU~L AESOURaS
tc~ •• 11
STATE OF HAWAII
(C©~ii;:··
OEPARTMENT OF !..AND AND NATURAL RESOURCES
II. O. 101 12'
.. ()NOLV~U. H........II tllW
. APR - i 1992
I:C)I,I"'V .. TION_
("VIIllON"I"'4~
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lIuaU'''lS III'Olll:.....'t
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"0. Est SlY • • 0 ,,",11\,111
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...
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OIyt~O""I""
KA-90:0803
Mr. Robert K. Yotsuda, President
Ms. Mary Lou Barela, Executive Director
Bale Opio Kauai, Inc.
1645 Pee Road
Koloa, Hawaii 96756
Dear Mr. Yotsuda and Ms. Barela:
Subject: Housing Discrimination complaint Filed
~y Hale Opio Kauai, Inc.
This is in response to your letter of February 25, 1992 to
the u.s. Department of Housing anc Urban Development regard-ing
your subject complaint.
We believe it is appropriate to clarify some of the
statements mace in your letter as well as bringing you up to
date on the matter.
In October 1989, the lOOth. Cdngress:of the United States,
by provisions of public Law 100-400 under the heading -Real
Prope~ty Relocation- appropriatec $1.5 million to Hale opio
Kauai, Inc. for relocation of its facility on the former Loran
Station at Makahuena Point on Kauai. In a formal Memorandum of
Understanding and Agreement between the U.S. General Services
Aaministration and the State of Hawaii dated June 20, 1989, and
in an agreement between the Department of Land and Natural
Resources and Hale Opio Kauai, Inc. dated May 24, 1990, the
State agreed to assist in the relocation by providing public
land.
originally, Hale Opio's request was for a single 5-acre
site. Your current request is for the conveyance of three (3)
sites for residential use, and a fourth site for administrative
office and support facility purposes following the philosophy
that smaller units are more successful than a central
institutionalized facility.
�03/01/94
16:34
'a'801 585 3219
UofU SOCIAL WORK
[aJ 015/011
Mr. Robert K. Yotsuda
Ms. Mary Lou Barela
~~e_ 1992
r
A request authorizing the conveyance of state land at
Hanapepe and Wailua on the island of Kauai to Hale Opio was
scheduled for submittal to the Board of Land and Natural
Resources at its April 27, 1990 meeting. However, because of
concerns voiced by substantial number of residents from the
affected areas, the matter was deferred to the Land Board's May
24, 1990 meeting.
On May 17, 1990, the Hanapepe Bay Community Association
presented to the Department of Land and Natural Resources a
petition signed by 1,755 Xauai residents opposed to locating
Hale Opio in the Hanapepe area. Then, on May 22, 1990, a
petition signed by 572 Kauai residents opposed to Hale Opio
locating in Wailua was received by the Department. The matter
was again deferred.
Subsequently, a Citizens Advisory Task Force was formed in
June 1990 to involve community members in the planning process
and to review a list of thirty-five (35) state-owned sites
offered by the Department of Land and Natural Resources.
On January 7, 1991, the Board of Directors of Hale Opio
submitted to the Department of Land and Natural Resources a
list of five (5) sites it selected from the eight {B} sites
chosen by the Citizens Advisory Task Force for conveyance to
Hale Opio.
Due to the sensitive nature of this program, public
informational meetings were held in the communities affected
starting with Kapaa, January 22, then Koloa, January 24, and
finally, Hanapepe, January 29, 1991.
The input from residents attending the meeting was,
overwhelmingly, against Hale Opio moving into their
neighborhoods. We continue to receive letters from residents
and politicians in the affected communities who are opposed to
the selected sites for Hale Opio.
On April 12, 1991 at a meeting held on Kauai in the County
of Council Chambers at Lihue, the Land Board considered a staff
recommendation to provide Hale Opio with three (3) sites. TWO
(2) sites, one in Kapahi and the other in Hanapepe, are for
youth education/residential purposes. The third site, located
in Kapaa, is for youth education/administrative office and
support facility purposes.
I
�03/01/94
16:34
'5'801 585 3219
UofU SOCIAL WORK
~ 016/017
, .~
Mr. Robert K. Yotsuda
Ms. Mary Lou Barela
Page 3
APi'< - \ IJJL
After considering testimony, the Board decided to approve
the sites at Kapahi and Kapaa, but deferred action on the
proposal to issue a lease for a one (1) acre portion of Tax Map
Key: 1-8-08:17, Hanapepe Site, for youth
educational/residential purposes until its next Kauai meeting
scheduled for July 19, 1991. During the interim, the Hanapepe
community and Hale Opio Kauai, Inc. were charged with the task
of reso1ving'differences and coming to agreement.
On May 17, 1991 a meeting was held to allow the Hanapepe
community and Hale Opio an opportunity to resolve their
differences. Attendees included representatives from Hanapepe
community, Hale Opio, the Kauai Humane Society, the Mayor's
Office and the Hanapepe Business Association. After nearly two
(2) hours of dialogue, the meeting ended with the Hanapepe
people clearly in opposition to the idea of Hale Opio moving
into their community, preferring instead that the Board drop
Hanapepe as a considered site, substituting instead parcels at
Omao and Wailua Houselots.
On July 19, 1991 at the Board meeting on Kauai, the
Department requested that the Board authorize the issuance of a
direct lease to Hale epio for the Hanapepe site.
This Department will be the first to admit that the
Hanapepe site is not the perfect site. Even after extensive
discussion at the various community informational meetings, no
community has stepped forward to welcome Hale epio.
Thus, given the few alternatives, plus the opposing views
expressed by Hale epio and the community, our Department felt
the Hanapepe sites to be the property best suited for the
proposed use under the circumstances.
However, at the July 19, 1991 meeting, Mayor yukimura
formally requested that the County be given until March of 1992
to find a suitable place for Hale Opio. Based on this
representation, the Board denied the staff recommendation to
authorize the issuance of a direct lease for youth
educational/residence purposes to Hale Opio Kauai, Inc. for
State-owned land on Kauai identified as Tax Map Key:
1-8-08:17, the Hanapepe site.
To date, we understand that discussions have occurred
between the county of Kauai and Hale epio on alternatives
sites.
In light of the March 1992 deadline set by the county,
this Department will be contacting them to determine the status
of of their efforts. Be advised that the Department is still
�03/01/94
16:34
'6'801 585 3219
UofU SOCIAL WO~K.._.
~017/017
Mr. Robert R. Yotsuda
. Ms. Mary LOU Barela
page 4
AtJR - i
19~2
prepared to request the Board's authorization to issue ~ lease
to Hale apio on the Hanapepe Site. The Board's action of July
19, 1991 was effectively to defer action on the Hanapepe site
to allow the county an opportunity to find a more acceptable
site.
Given the county's on-going efforts to secure Hale apio a
site, the Department was not prepared to entertain your request
for additional sites. By letter dated January 7, 1992, we
informed you that rather than consider any other sites at this
time, we would prefer to honor the Land Board's commitment to
Mayor Yukimura to allow the County of Rauai until March 1992 to
find Hale apio a site.
We understand and share your desire to attain a quick
resolution on your relocation sites. How ver, part of the
process involves public participation. C munity concerns
raised during this process must be consid red in the decision
making. Ideally" the Board would prefer hat both Hale apio
and the affected communities reach mutual agreement on the use
of a site before taking action. This is ot always the case,
however, and the Board is faced with the ifficult task of
weighing the needs of Hale apio and that f the affected
communities.
We will notify you of our progress 0
have contacted the Mayor. In the interim,
questions, please feel free to contact eit
Kauai at 241-3326 or Mr. Dean Uchida in HO
the matter after we
should you have any
er Mr. Sam Lee on
01ulu at 587-0414.
Attachments
cc: Mr. Herbert Apaka (wI attachments)
KOLa (wI attachments)
Mayor JoAnn Yukimura (wI attachments)
U.S.HUD (wI attachments)
�r'HE WH ITE HOUS E
WASHINGTON
TRAVEL SCHEDULE
CAROLH. RASCO
ASSISTANT TO THE PRESIDENT ,FOR DOMESTIC POLICY
WEDNESDAY, SEPTEMBER 7
,PageNet Number:
1-800-921-7576
12:15
'12:59
1:54
3:08
4:18
Lodging:
WlI
LV
AR
LV
AR
,
car enroute to' National Airport
American Airlines Flight 1741
DC
Nashville
American Airlines ,Flight 1833
Nashville
LR
Capitol Hotel
111 W. Markham Street
'Little Rock,AR 72201
Phone:
501~374-7474
Fax:
501-370-7091
THURSDAY, SEPTEMBER 8
Bill Galston will attend 8:15 Senior Staff Meeting
Itinerary:
Site Visit
Phone Number at NCTR:
9:30
501-543-7516
501-540-3003
Depart Little Rock
10:00
Arrive National Center for Toxicological Research
'10:15
Overview of THE BIOPLEX
11:00
, Tour of NCTR Facilities
11:45
Luncheon, NCTR Conference Center
12:45
Tour Pine Bluff Arsenal
1:15
Review of The Action Agenda
2:00
Depart, Pine Bluff Arsenal
,2:30
6:30
Arrive LittleRock
SPEECH:
General Meeting of
Little Rock Junior League
�WithdrawallRedaction Marker
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DOCUMENT NO.
AND TYPE
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00 I. schedule
Rasco, Friday, September 9 (partial) (I page)
DATE
09/0911994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: Travel-Mise Extra Documents
20 I0-0 198-S
kc223
RESTRICTION CODES
Presidential Records Act • [44 U.S.C. 2204(a)]
Freedom of Information Act· [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(1) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such ad"isors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
bel) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b )(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b )(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�"
FRIDAY, SEPTEMBER 9
Bill Galeton will attend 8:15 Senior Staff Meeting
11:00
1:00
(
Easter Seals Meeting
LV LR
Delta Airlines Flight 1224
3:00
5:25
AR
6 :.17
7: 35
AR DC National
7:35 'I
WH Car pick up enroute to West Basement
Cincinnati
LV Cincinnati
Delta' Airlines Flight 848
j
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. itinerary
DATE
SUBJECTrrITLE
AmEx Travel for Rasco from WDC to Little Rock AR to Cincinnati
OH and ret, 09/07-09/09/94 (partial) (I page)
08/31/1994
RESTRICTION
P61b(6)
COLLECTION:
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Domestic Policy Council
Carol Rasco (Issue Papers)
OAiBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: Travel-Misc Extra Documents
20 I 0-0 198-S
kc223
RESTRICTION CODES
Presidential Records Act· [44 U.S.c. 2204(a)]
Freedom of Information Act· [5 U.S.C. 552(b)]
Pl National Security Classified Information [(a)(I) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
bel) National security c1assilied information [(b)(l) of the FOIAI
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIAJ
b(3) Release would violate a Federal statute [(b)(3) of the FOIAI
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
be?) Release would disclose information compiled for law enforcement
purposes [(b)(?) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA].
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�1hNe1
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Services~
INVOICE I ITINERARY
. SALES PERSON: 50
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CUSTOMER NBR: 1695000023
QSKSHZ
American Express
Travel Related Services Company, Inc. (
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.
Old Executive Office Building, ROom 87
Washington, D.C. 20500-0001
.
Phone: 202 456-2250
Fax: 202 456·6670
In Emergency After Hours Calli
1 800847-0242 (Toll Free in the U.S.) ;
Your code number 151 KC52
DATE: :31 AUG 94
PAGE: 01
,
\
TO: WHITE HOUSE TRAVEL
1600 PENNSYLVANIA AVE
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FOR: RASCO/CAROL
I
REF: KC5SXD4L.P8
07 SEP 94 - WEDNESDAY
ECONOMY
FLT:1741
AMERICAN AIRLINES
AIR
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LV WASHING~ON NATL
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SEAT-14D
RASCO/CAROL
ECONOMY
FL T :18:;r::~
AMERICAN AIRLINES
AIR
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SEAT-18B
RASCO/CAROL
.NATIONAL CAR RENTAL
LI TTLE ROC.{
CAR
PIC.{ UP-1618
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RETURN-09SEP/IP
RATE IS GUARANTEED
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DATE: :31 AUG 94
PAGE: 02
�TRAVEL SCHEDULE
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
WEDNESDAY, SEPTEMBER 7
PageNet Number:
1-800-921-7576
7:30 - 8:15
Staff Meeting, COS Office
8:15 - 8:45
WH Senior Staff Meeting
9:30 - 9:45
DPC Conference Call
10:00 - 11:00
Crime Bill Meeting
(CHR's office)
12:15
WH car enroute to National Airport
12:59
1:54
Seat 14-D
LV DC
AR Nashville
American Airlines Flight 1741
3:08
4:18
Seat 18B
LV Nashville
AR LR
American Airlines Flight 1833
National Car Rental: Pick-up in-terminal
Confirmation #0969822063
Lodging:
7:00 - 8:30
Capitol Hotel
Confirmation #5002
111 W. Markham Street
Little Rock, AR 72201
Phone:
501-374-7474
Fax:
501-370-7091
Meeting
Mount St. Mary Academy
3224 Kavanaugh Blvd.
664-8006
Cafeteria
�THURSDAY, SEPTEMBER 8
Bill Galston will attend 8:15 Senior Staff Meeting
Contacts: Pine Bluff
Jack A. McNulty 501-534-5532
Derrill Pierce 501-535-7189
Preliminary Itinerary
Phone Number at NCTR:
501-543-7516
9:25
Depart Little Rock
(MAP ATTACHED)
10:00
Arrive National Center for Toxicological Research
CHR will be met at SECOND SECURITY GATE ENTRANCE:
Art Norris, Deputy Director, NCTR
Pete Attwood, Ass't. Dir., NCTR
Col. Samuel Mims, Commander, Pine
Bluff Arsenal
Jim Bacon, Executive Assistant, PBA
Jack McNulty, Jefferson County Industrial
Foundation
Derrill Pierce, Jefferson County Industrial
Foundation
10:15
Overview of THE BIOPLEX (NCTR Conf. Rm.)
11:00
Tour of NCTR Facilities
11:35
Pine Bluff Commercial Reporter: Brett Talent
(ten minutes) NCTR Conference Center
11:45
Luncheon, NCTR Conference Center
Meet:
Community Leaders of Pine Bluff
and Little Rock (List of
Attendees attached)
12:45
Escorted Tour Pine Bluff Arsenal via Van
See: Vaccine Production Facility Site
Technology Center
Demilitarization Site
Biotech Production Site
Flexible Manufacturing Center Site
Hazardous Waste Landfills
1:15
Review of The Arsenal Capabilities
Arsenal Admin. Bldg., Colonel's Conf. Rm.
1:30
Concluding Discussions
Rationale for Administration Support\Review of Agenda
for Future Action
2:00
2:30
Depart Pine Bluff Arsenal
Arrive Little Rock
�Notes:
CHR car will be transported from the NCTR to the
Arsenal Administration Building to facilitate timely
departure. An escort car from the Arsenal Admin.
Bldg. to the U.S. 65 Expressway will be provided
upon conclusion of discussions.
Emergency Communications Cohtacts:
Jefferson County Industrial Foundation
501-535-7189
Rhonda Dishner
National Center for Toxicological Research
501--543-7516
Linda Vetsch
Pine Bluff Arsenal
501-540-3033
Maxine Miller
Attendance List
Luncheon
Peter Attwood, Assistant Director, NCTR
W. E. Ayres, Chairman, Simmons First National Bank
Jim ,Bacon, Executive Assistant, Pine Bluff Arsenal
Bill Bowen, President, Health Source AR
Dr. Lawrence Davis, Chancellor, University of AR at PB
State Senator Jean Edwards
Pat Hayes, Mayor, North Litt
Rock
Robert Hoffman, President, Hoffman-Henry Insurance
Jack McNaulty, Attorney, Pine Bluff
Col. Samuel Mims, Commander, Pine Bluff Arsenal
Art Norris, Deputy Director, NCTR
Dr. Tim O'Brien, University of AR for Medical Science
Derrill Pierce, Jefferson County Industrial Foundation
Louis Ramsey, Attorney, Pine Bluff
Dale Robertson, President, AR Southwestern Bell Telephone
Pete Ross, Mayor, White Hall
Bill Sanders, Chairman, Greater Pine Bluff Chamber of Commerce
Alice Smith, University of AR for Medical Sciences
Tom Spillyards,. President, Worthen National Bank of PB
Dr. Alan Sugg, President, University of AR System
Jerry Taylor, Mayor, Pine Bluff
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. schedule
DATE
SUBJECTITITLE
Rasco, Thursday, September 8 and Friday, September 9 (partial) (I
page)
09/0811994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: Travel-Misc Extra Documents
20 10-0198-S
kc223
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)J
Freedom of Information Act - [5 U.S.C. 552(b)J
PI
P2
P3
P4
b(1) National security classified information [(bXI) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(bX3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(bX8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(bX9) of tbe FOIA]
National Security Classified Information [(a)(1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(aX3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�,r
6:30 - 8:30
SPEECH/General Meeting/JLLR
Place:
Pulaski Heights United
Methodist Church
Grand Hall (CHR enter Main
Entrance, to Hall - familiar
face will be there to greet her)
4823 Woodlawn Avenue
Church number:
501-664-3600
(Eve has scheduled CHR's remarks
for 6:45 - 7:15 pr 7:30
Time Frame: entirely up to CHR
Q and A's after remarks
Eve Yancey's number:
0
(0)
(h)
FRIDAY, SEPTEMBER 9
Bill Galston will attend 8:15 Senior Staff Meeting
11:00
1:00
Easter Seals Meeting
)
3:00
5:25
Seat 16D
LV LR,
AR Cincinnati
Delta Airlines Flight 1224
6:17
7:35
Seat 29 C
LV Cincinnati Delta'Airlines Flight 848
AR DC National
\
7:35
WH Car pick up enroute to West Basement
(According to Garage Personnel, Delta
is located at Interim Terminal, have
CHR go ,out door of Terminal and wait
for WH car to arrive near second sidewalk)
�:;,.
TRAVEL SCHEDULE
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
WEDNESDAY, SEPTEMBER 7
PageNet Number:
1-800-921-7576
7:30 - 8:15
Staff Meeting,
8:15 - 8:45
WH Senior Staff Meeting
9:30
DPC Conference Call
9:45
COS
Office
10:00 - 11:00
Crime Bill Meeting
(CHR's office)
12:15
WH car enroute ·to National Airport
12:59
1:54
Seat 14-D
LV DC
AR Nashville
American Airlines Flight 1741
3:08
4:18
Seat 18B
LV Nashville
AR LR
American Airlines Flight 1833
J
National Car Rental: Pick-up in-terminal
Confirmation #0969822063
Lodging:
7:00 - 8:30
Capitol Hotel
Confirmation #5002
.111 W. Markham Street
Little Rock, AR. 72201
Phone:
501-374-7474
Fax:
501-370-7091
Meeting
Mount St. Mary Academy
3224 Kavanaugh Blvd.
664-8006
Cafeteria'
�THURSDAY,. SEPTEMBER 8
Bill Galston will attend 8:15 Senior Staff Meeting
Contact~: Pine Bluff
Jack A. McNulty 501-534-5532
Derrill Pierce 501-535-7189
Preliminary Itinerary
Phone Number at NCTR:
501~543-7516
9:25
Depart Little Rock (MAP ATTACHED)
10:00
Arrive National Center for Toxicological' Research
CHR will be met at SECOND SECURITY GATE ENTRANCE:
Art Norris, Deputy Director, NCTR
Pete Attwood, Ass't. Dir., NCTR
Col. Samuel Mims, Commander, Pine
Bluff Arsenal
Jim Bacon, Executive Assistant, PBA
Jack McNulty, Jefferson County Industrial
Foundation
'
Derrill Pierce, Jefferson County Industrial
Foundation
10:15
Overview of THE BIOPLEX (NCTR Conf. Rm.)
11:00
Tour of NCTR Facilities
11:35
Pine Bluff Commercial Reporter: Brett Talent
(ten minutes) NCTR Conference Center
11:45
Luncheon, NCTR Conference Center .
Meet: Community Leaders of Pine Bluff
and Little Rock (List of
Attendees attached)
12:45
Escorted Tour Pine Bluff Arsenal via Van
See: Vaccine Production Facility Site
Technology Center
Demilitarization Site
Biotech Production Site
Flexible Manufacturing Center Site
Hazardous Waste Landfills
1:15
Review of The Arsenal Capabilities
Arsenal Admin. Bldg., Colonel's Conf. Rm.
1:30
Concluding Discuss~ons
Rationale for Administration Support\Review of Agenda
for Future Action
2:00
Depart Pine Bluff Arsenal
Arrive Little Rock
. 2: 30
�--FF . • • ·INDUSTRI~L Fdn TEL: SOl-S35~1643
-J
. M
Ji:.
Sep 02.94 10:30 No.002 P,02
To Reach NCTR
TO MEMPHIS
•
N.e.T.R. Rd
·*Clf~
(;JiLL
90
-t-hrv- aVe
qA-Te MD·
R::e. it1eT
Tlravel U.S. Highway 65 S.
batWeen Utua Rock and
PIns Stun 10 1ne JefferSon
exll (#24) and follow the
cc)unty road 1.2 miles to
JGfferscn. At the atop algn
tum left 0.4 mile. on High
way 365 to N.C.T.R. Rd,
tum right and follow It 5.5
lXJT~
HER~
mileato NCTR Pilr1dng lot.
It-T~IJO Parking spacas for vlolters
alt! near the entrRnc::e gate.
-
(34rel.t
All to All
<>
�'Notes:
CHR car will be transported from the NCTR to the
Arsenal Administration Building to facilitate timely
departure. An escort car from-the Arsenal Admin.
Bldg. to the u.s. 65 Expressway will be provided
upon conclusion of discussions.
'Emergency Communications Contacts:
Jefferson County Industrial Foundation
501 535-7189
Rhonda Dishner
National Center for Toxicologiqal Research
501--543-7516
Linda Vetsch
Pine Bluff Arsenal
501-540-3033
Maxine Miller
Attendance List
Luncheon'
Peter Attwood, Assistant Di~ector, NCTR
w. E. Ayres, Chairman, Simmons First National Bank
Jim Bacon, Executive Assistant, Pine Bluff Arsenal
Bill Bowen, President, Health Source AR ,
Dr. Lawrence Davis, Chancellor, University of AR at PB
State Senator Jean Edwards
Pat Hayes, Mayor,North, LittleRock
Robert Hoffman" President, Hoffman-Henry Insurance
Jack McNaulty, Attorney, Pine Bluff
Col. Samuel Mims, Commander,' Pine Bluff' Arsenal
Art Norris, Deputy Director, NCTR
Dr. Tim O'Brien, University of AR for Medical Science
Derrill Pierce, Jefferson County Industrial Foundation
Louis Ramsey, Attorney, Pine Bluff
Dale Robertson,' President" AR' Southwestern Bell Telephone
Pete Ross, Mayor, White Hall
Bill Sanders, Chairman, Greater Pine Bluff Chamber of Commerce
Alice Smith, University of AR for Medical Sciences
Tom Spillyards, President, Worthen National Bank of PB
Dr. Alan Sugg, President, University of AR System
Jerry Taylor, Mayor, Pine Bluff
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. schedule
DATE
SUBJECTffITLE
Rasco, Thursday, September 8 and Friday, September 9 (partial) (1
page)
09/0811994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: Travel-Misc Extra Documents
2010-0198-S
kc223
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)1
Freedom of Information Act· [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified Information [(b)(l) of the FOIAl
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIAl
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIAJ
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial Information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�6:30 - 8:30
SPEECH/General Meeting/JLLR
Place:
Pulaski Heights United
Methodist Church
Grand Hall (CHR enter 'Main
Entrance to Hall - familiar
face will be there to greet her)
4823 Woodlawn Avenue
Church number:'
501-664-3600
(Eve has scheduled ~'s remarks
for 6:45 - 7:15 or 7:30
Time Frame: entirely up to CHR
Q and A's af~er remarks
Eve Yancey's number:
(0)
, (h)
FRIDAY, SEPTEMBER 9
Bill Gal s ton will attend 8:15 Senior Staff Meeting
11:00
1:00
Easter Seals Meeting
3:00
5:25
Seat 16D
LV LR
AR Cincinnati
6:17
7:35
Seat 29 C
LV Cincinnati 'Delta Airlines Flight 848
AR DC National
7 :35
WH Car pick up enroute to, West Basement
Delta Airlines Flight 1224
~
(According
is located
CHR go ,out
for WH car
to Garage Personnel, Delta
at Interim Terminal, have
door 'of Terminal and wait
to arrive near second sidewalk)
\
/
�National Economic Council
. Domestic Policy Council
Office on Environmental Policy
Travel Expenses. Worksheet
Name of Traveler:
Dates/Destination
--------------------------------~--------------------Advance Received:
Exchange Rate: _ _ _ _ _ __
---------------------------------------------------------------------
Travel Schedule
(Continued on reverse)
Date/Time
Departed From
Date/Time
Arrived At
Taxi/POVlAir
Mileage
Oth,er Expenses
(Continued on reverse) .
Date
Lodging Expense
Other
Be sure to attach the following: copies of all tickets for transportation. (return unused tickets
to 'the Travel Office for refund); all receipts for taxis, lodging, airport parking, hotel
parking, rental cars, etc. that are in excess of $5.00 (if receipts are not available, please
provide an explanation); and the original copy of the travel authorization and a copy of
Counsel's Office approval if expenses were accepted from an outside organization.
�Travel Schedule
Date/Time
Departed From
Date/Time
Arrived 'At
Taxi/POV /Air
Mileage
,
Other Expenses
Date
Lodging Expense
Other (rental car, parking, etc.)
�Travel Schedule
Date/Time
Departed From
Date/Time
' At
I Taxi/POV/Air
Mileage
Other Expenses
Date
Lodging Expense
..
Other (rental car, parking, etc.)
�National Economic Council
Domestic Policy Council
Office on Environmental Policy
Travel Expenses Worksheet
Name of Traveler:
------------------------------------------------------Dates/Destination
------------------------------------------------------Exchange Rate: _ _ _ _ _ __
Advance Received: --------------Travel Schedule
(Continued on reverse)
Date/Time
Departed From
Date/Time
Arrived At
Taxi/POV/Air
Mileage
Other Expenses
(Continued on reverse)
Date
Lodging Expense
Other
Be sure to attach the following: copies of all tickets for transportation (return unused tickets
to 'the Travel Office for refund); all receipts for taxis, lodging, airport parking, hotel
parking, rental cars, etc. that are in excess of $5.00 (if receipts are not available, please
provide an explanation); and the original copy of the travel authorization and a copy of
Counsel's Office approval if expenses were accepted from an outside organization.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Carol Rasco - Issues Series
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
Clinton Presidential Library & Museum
Extent
The size or duration of the resource.
92 folders in 7 boxes
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Complete Scheduling per 10-11: Travel-Misc. Xtra Documents
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 122
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Publisher
An entity responsible for making the resource available
Clinton Presidential Library & Museum
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
12/4/2013
Source
A related resource from which the described resource is derived
2010-0198-Sb-complete-scheduling-per-10-11-travel-misc-xtra-documents
-
https://clinton.presidentiallibraries.us/files/original/9e4d0a51474a66dd7c4c1992630ce1e2.pdf
d9344739cb953404880e2f605f3b7245
PDF Text
Text
WithdrawallRedaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECTrrITLE
RESTRICTION
00 I. schedule
Rasco, October 12 (partial) (1 page)
10112/1994
P61b(6)
002. schedule
Rasco, October 12 (partial) (I page)
10112/1994
P61b(6)
003. envelope
Arkansas Advocates for Children and Families to Rasco w/handwritten
notes (I page)
07/15/1994
P61b(6)
004. letter
personal to Rasco (3 pages)
07/13/1994
P61b(6)
005. letter
personal to Rasco (I page)
09117/1994
Personal Misfile
COLLECTION:
Clinton Presidential Records'
Domestic Policy Council
Carol Rasco (Issue Papers)
QAlBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: October 12- 13, 1994 AHSEA Conference
2010-0 J98-S
kc222
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a))
Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
bel) National security classified information [(b Xl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(I) of the PRA)
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�Contact person: Pat Romani
Phone number: 62216
. Date of request: ~4 q~,
...
..
ID1
31?
ACCEPTANCE OF TRAVEL EXPENSES FROM OUTSIDE SOURCE
In order to consider whether the Government may accept from an outside' source payment of
your travel, subsistence and related expenses under the GSA travel rule, you must complete the
information below. The outside source need not be a 501(c)(3) organization, but if it is, please
state so on this form and include the ms determination letter.
Please include a copy. of the letter of invitation if one was received.
Your name and position:
Carol H.Rasco
Assistant to the President for Domestic
Policy
Nature of meeting or similar function and how it relates to your official duties:
Speech (Keynote) to Arkansas Department of Human Services
Employees Annual Meeting re.: Health Care Issues and other
Domestic Policy matters
.Date and place(s) of travel:
October 12 - 13, 1994
Little Rock, AR and
Hot Springs, AR
Perso'ns or entity making the payment (please alsO note any financial interests of the person or
entity known to you that may be affected by the exercise of your ,Government responsibilities):
Arkansas Human Services Employees Association
Nature of expense(s) paid for:
Round-trip airfare: lodging, rental car
Method and approximate amount of payment (payment may be made either in-kind or by
check made payable to U.S. Treasury; you may not directly receive payment in cash or check
made out to you):
Reimbursement to U.S. Treasury
This fonn and any accompanying memorandum of approval must be attached to your,travel
authorization. You must complete a travel voucher following the trip. Please send completed
form to Room 128. OEOB, at least 3 days before commencement of travel.
�THE
WHITE
HOUSE.
sept. 17, 1994
LEON Carol Rasco had already
accepted the attached speech
requests requiring travel
prior to YQu becoming Chief
Staff.
01
She would like to know as sooru
as possible if you have any
problems with any of them
since it would be difficult to
cancel.
I recommend you approve
attached list.
.1
�THE WHITE HOUSE
WASHINGTON
September
~6,
1994
MEMORANDlJM FOR Jodi Torkelson
Assistant to the President for Management
and Administration
FROM:
Carol H.· Rasco ~
Assistant to the President for Domestic Policy
SUBJECT:
Accented Invitations/Out-of-Town Travel
As we have discussed earlier, I have accepted engagements prior
to Leon Panetta's new procedures relating to' travel.
I have attached a memorandum prepared by my staff which lists
out-of-town commitments, meeting site, and other pertinent
data pertaining to these events.
It is rare I would accent invitations so far in advance
as the two listed for 1995. However, these were very special
circumstances:
1)
April 3, 1995
Keynote Speaker'
Annual Meeting: Society of Hospital
Epidemiologist Association (SHEA)
The Health Care Reform Team recommended this acceptance.
2)
May 17, 1995
Keynote Speaker
President's Commission on Employment of People
with Disabilities Conference
This was accepted at Tony Coehlo's insistence as this is the
group he Chairs.
I would appreciate your help if you anticipate any difficulties
in honoring the commitments listed in this memorandum.
Thank you.
�TH e: WH ITE HOUS E
WASHINGTON
Sepcember 14, 1994
MEMORANDUM FOR CAROL H. RASCO
. ASSISTANT TO HYRESIDENT FOR DOMESTIC POLICY
From:
Subjece:
Accented Tnvitati'ons/Out-of-Town Travel
Following are cue-of-town commitmenes on your schedule through this
date. The inviting organization, meet:ing site, and other pertinent
data are included. .
.
Date:
Purpose:
Organization:
September 23, 1994
Meeeing Site:
Travel Paid
by:
Minneapolis, MN
Keynote Speaker
National East:er Seal Society and the
University of Minnesota's Center
fer Citizenship and Democracy Launch
Program.
Inviting group
************************************************************** ••
Date:
Purpose:
:Organizat:ion:
October 13, 19.94
Meeeing Site:
Travel Paid
:by:
Hot Springs, AR
Keynote Speaker
50th Annual Training Conference:
Arkansas Human Services Employee
Association.
Inviting group
.************************************ •• **-******************* ••••
Date:
Purpose!
Organization:
October 25, 1994
Meecing Site:
Travel Paid
by:
Summit, NJ
Keynote Speaker
Summit, New Jersey Junior League;
Combined Stat:e Meeeings.
Inviting group
***********************************.*.*********************.* ••
�Page Two
Travel :::lates
Carol 2. Rasco
Date:
Purpose:
Organizat:ion:
November 5, 1994
Keynote Speaker
Meet:ing Site:,
Travel Paid
by:
M0:r.:gant:own,
West Virginia Rural Health Conference.
'iNA'
OPD/DPC
(This was a co:mmitment made over a year ago at the request of the
Health Care team in the White House.)
***********************************************~***************
Date:
Purpose:
. Organizat:ion:
Meet:i:lg Site:
Travel Paid
by:
November 18, 1994
Keynote Speaker
American Speech, Language, and
Hearing Associat:ion National
Convent:ion.
New Orleans, LA
Inviting group
*************************************************************
Date:
Purpose:
Organizat:ion:
April 3, 1995
Meet:ing Site:
Travel Paid
by:
San Diego,
lteynote Speaker
Annual Meeting: society of
Hospital Epidemiologist
Association (SHEA).
CA
Inviting grouF
************************************************************
Date:
Purpose:
Organizat:ion:
Meet:ing Site:
Travel Paid
by:
May 17, 1995
Keynote Speaker
President's Commission on
Employment of People with
Disabilities Conference.
Portland,
OPD/DPC
OR
�DHS DIRECTOR'S OFFICE' TEL:1-501-682-8650
Oct 05'94
15:49
No~022
Arkansas Department of Human 'Services
Office of the Director
329 Donaghey Building
P.O, Box 1437
Little Rock, Arkansas 72203..1437
Telephone (501) 682:-8650
FAX (501) 682-6836
Jim Guy Tucker
Guw.,rnur
october 5, 1994
Date:
To:
Pat Romani
From:
Pam
Burne~
Pat, as we discussed, attached is a ~opy of the ~rkansas
Human services Employees Association Program OVerview. If
Carol would like to stop by any of the Wednesday evening
activities, she is oertainly welcome. " We all look forward
to seeing he.r.
I understand from the,Conference.Program committee that they
listed both President Clinton and Governor Tucker as having
been invited as this is the. 50th year anniversary of "the
Association. The Committee has received follow-up from your
scheduling office and understands the President will not be
attending_
Pat, I appreciate your assistance. Please let me know if.I
can provide you any other information •
. Thanks.
"The Arkansas Oepartment of Human Servioes is in compliance with Titles VI and VII of the Civil Rights Act and is operated.
managed and delivers services without regard to age, religion •. disability, political affiliation, veteran status. self, race,
.
color or national origin,"
".
P.02
�DHS DIRECTOR'S OFFICE
TEL:1-501-682-8650
Oct 05'94
ABIlA PROGRAM OVERVIEW
"
15:50 No.022 P.03
/D),~. Ck4W~
"'~e"cr a '~ '~~J
UJ
rc,
CON'lapea: TBDB
D
nso Year. of People Se%'viee" epartrnentof '
",
,
"ec5De.4ay,OctoJ:)er. 12, 1994
3:00p ,. . 7:00p
'lOOp - B,OOp
7:00p .. 8:00p
Registration , Membership
~i~ector'.
Reeaption
Retire.'. Reception
(All Rmploy•••
8:30p - 12:30p Weloome Party
P.atu~ing:
lnv!~.d)
Hum
ans ,
- erllICes
'Exhibit Cent.er
Magnnlia Room
Magnolia Room.
CryatalBallrm
Diac Jockey J.R. Staek.
, !bur.day, October 13,
7: OOa -8: lOa
~:OOd • 6:00p
5 ISS; . ,
1".
Continental Breakfast
Regiltraeion & Member.hip
,Crystal Ballrm
Exhibit Cenc8:
9: OOa·, 12: OOp OlDING 8BSSIOH
. •. . . . . . .. Conf . Ctr B, C
1lInvocat1oll ...•.•••.•••...... Jamea Thema.on
.Presentation of Plags ....... Army Reserve
·Vledge of Allegiance ....... Cheryl S~uart
"'National Anthem .............. Malvie Giles
*Acc:ompan1st .....•.....•••.. ,.Samh.• W"lters
Weleome/Ilirector's Remarks, ........ Tom Calton, .DRS Director
Introduction or sena.tor canaOa ...• Tom Paleon. DKS D.b,ec.:t.or
Welcome ..... 1..................... Sen. Bud Canada, Dist., 13
Mayor Helen selig'
Presentation of the, Governor ...... Tom Deil ton, DHS :Directol'
I
'
Governor's Remarks ......... ~ ...... HonoraDle Jim Guy Tucker
Governor (Invite~)
' r•••ntatioA of the Pre.idant of theUnit.d statea ..•..
President's Remarks .....The llonorabl e Bill Cl inton, . Pres ident
(Invited)
,
Introduction of Speaker ...."....... Tom. Dalton, DHS Director
Jeeynote Speaker ........ ·Carol Ralco, Domestic Policy Advisor
................. ~ ...... ottice of Assistant to the presi4ent
Busi~ese
Door PT'i
Meeting ......
~'
P' • • • •
••••
IIAA
~
•
President Christine Brown
.
12 ~ OOp .. 1; lSp .................... Lunch
1: J.5p .. 2 f 4 $p . '.......••..•. ',' .•.•. Concurrent Workshops
2 : 4 Sp ·3 lOOp. . . . . . . . . . ........ ~ . . . . Break
. .
J100p - 4:10p ...... , ..........• : .• Concurrent worleshops
4:l0p· ,:OOp ..........•.......... Dinner . Blues in the Park
(Provided)
.
'lOOp· 7:00p ..................... Presigenc'. Reception
, , .
,.
M~gn"'lia
Room.'
,'
1 : O()p • 9: OOp ..•.••..•.•.•.••••••• Entertainment Show
'~OOp, -
:1;000 ••••.•..•••••••••.•.. Dance
''', -.
~~----~~--~~
C",nf.Ctr. A,B,C
tH.se Jockey, J. B. Stacks
�11'U~
.
NU.UUO
'
,Arkansas Department of Human Services
Office of the Director
Jim Guy Tucker
G_rno,
329 Donaghey Building
P.O. Box 1437
Little Rock, Arkansas 12203.:.1437
Telephone (50') 682-6850
FAX (501) 882-6836
August 26, 1994
. Ms. Carol Rasco
Assistant to the President
for Dom~stic Policy
Second Floor, west Wing
The White House
Washington, DC 20500
.Dear Carol:
On behalf of the Arkansas Human services Employees
Association, I want to thank you for acceptinqthe
invitation to be the keynote speaker at our annual meeting
on October 13, 1994 in Hot Sprinqs, Arkansas.
The Association will reimburse you for roundtripairfaro,
lodging, rental car, and other incurred expenses.
I look forward to seeing youl
TD/pc
Caring People. .. Quality Services
"The Arkansas Department 01 Human Service. io in compliance wilh Tille. VI lind VII of the Civil Rights Act and II operated,
managed and delivers services Without regard 10 age, religion. disability. political aHlllatlon, yet8tan statuI••ex, rllee,
color or national origin."
r.u~
�DIRECTOR·S OFFICE
TEL:1-501-bS2-Sb~U
Arkansas Department of Human Services
Office of the Director
329 Donaghey Building,
P.O. Box 1437
Little Rock, Arkansas 72203"'1437 '
Telept'lone (501) 682-8650
FAX (501) 682-6636
Jim Guy Tucker
Gov,'no,
Hay 17, 1994
Carol Rasco, Domestic policy Advisor
Office of the Assistant to the President
Second Floor, West Wing
The White House
Washington, DC 20500
Dear Hs
Rese8,~
I'
on behalf of the Arkansas Human Services Employees Association, I
would like to invite to you to be our keynote speaker at our 50th
Annual Training conference on Thursday, october 13, 1994 at· the
, Arlington Hotel, Hot Springs, Arkansas.
As you are 'aware, the AHSEA officers, bOard, and members:work
diligently each year planning the array of training activities
designed to enhance our skills, stimUlate our minds and enrich
our hearts.
carol, I know from my conversations with Alexis that these are
bUSy times. for all of you, but we would consider your presence an
honor. In my opinion, the President is the only other person who
knows the challenges Arkansas Human Service workers face daily
and unders~ands our commitment ,to provide quality services to our
citizens, as well as you do. Please let me ,know by June 1st if.
your schedule will allow you to participate.
Thank you and best regards to Alexis and Rosalind.
Sincerely,
9~
Pearl Herman
DHS Advocate
PH:lae
cc: chris Brown, President, AHSEA~Z~-t5'75t)
Tom Dalton, Direc'tor
Caring People. .. Quality Services
"The Arkansas Department 01 Human Services i8 in compliance wltn Titles VIand VII of the Civil RIght8 Act and 1& operated.
manageCl and deliver. Servic;es without regard to age. religion. disability. politie&1 aftilhUion. veteran status, 8ex. race.
color o~ national origin.:'
c
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
00 I. schedule
DATE
SUBJECTfflTLE
10/12/1994
Rasco, October 12 (partial) (1 page)
RESTRICTION
P61b( 6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Complete Schedul ing per 10-11: October 12-13, 1994 AHSEA Conference
20 10-0 198-S
kc222
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)]
Freedom of Information Act· [5 U.S.C. 552(b)]
PI National Security Classified Infonnation [(a)(1) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
bel) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b )(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) or.tbe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose infonnation compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(B) Release would disclose information concerning the regulation of
financial institutions [(bleB) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�,........
SCHEDULE
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
OCTOBER 12
PageNet Pager Number:
1-800-921-7576
11:00
11:40
12:57
WH car departure from West Basement
Northwest Airlines Flight 855
Arrive Memphis
Seat:
17-C
2:20
3:16
Northwest Airlines Flight 1546
Arrive Little Rock
Seat:
13-D
Lodging:
The Capitol Hotel
111 W. Markham Street
Little Rock, Ar 72201
Phone:
501-374-7474
Fax: .
501 370-7091
Confirmation # 1779
4:00
7:30
Dinner:
Sue Gaskin
�OCTOBER 13
CHR will Drive to Hot Springs (50 mi
slone hour drive)
Arlington Hotel
Conference Center Room, 2nd Floor
239 Central Avenue
2nd Floor, Meeting Rooms
Phone:
501-623 7771
Fax:
501-623-6191
9:00
Openi.ng Session
9:45
CHR introduced Tom Dalton
9:50
CHR KEYNOTE ADDRESS
(20 or 30 min. presentation)
Per Pam Burnett CHR can. PLAN on departing if she wish~s at
10:30 a.m.
CHR will drive back to Little Rock
3:00
5:22
Seat:
LV LR Delta Airlines Flight 1214
AR Cincinatti
15C
6:21
7:35
Seat:
LV LR Delta. Airlines Flight 848
AR DC National
13C
7:35
WH car pick up enroute to West Basement
�~
V
;':
~HS~D-'IRECTOR • S
·
.
'
O'FF ICE
.: A~~: 26' 94
TEL:1-501-682-8650
.
I"
t
:'
Arkansas Department
Office of the Director
Jim Guy Tucker
Goye,I\Ot
11:O~ No.006 P.02
,.
of HiJjm an Services
:1
I
I
. ,
'
329 Donaghey Building
P.O. Box 1437
Little Rock; Arkansas 72203.. 1437
Telephone (501) 882-8850
FAX (501) 682-6838
August 26, 1994
To:
From:
Pat Romani
Pam
~~
Burnet~
I:
'
t
i;.:: .
"I'
'·r
~\
I:
:1 ,. ,
Pat, as \!Ie discussed, attached is the P,t'!~,~~~m overview for
the Arkansas Human Services EmployeesAs)!:;,q:~~;~tion conference
on octQber 12-14, 1994.
" ,. ,1 .
.
, 'Il
, 't
Carol is scheduled to speak at the opening 's~ssion on
October 13th. This session begins at 9:00 a.m.' As I
mentioned to you, Carol will probably 'begin her presentation
at approximately 9:40 or 9:50 a.m. We hav~ not received
confirmation fr·om Governor TUcker regarding his attendance.
If he is there, he will make remarks and then introduce
Carol; If he is unable to attend, Tom Dalton (DHS Director)
will introduce her.
Carol should plan on a 20-30 minute presentation. Atter her
presentation (which I would estimate will be somewhere
between 10:15 and 10:30) we will take a break before
beginning the business session. So, Carol can plan on being
finished by 10:30 a.m.
If there are other meetings Carol woul:<i1 like to have while
here, I will be glad to assist in arr~nqing those. Also, if
she needs someone to pick her up at t:ri~:li:t:i;rport or assist
with any travel arrangements, just le~lm:~L;k:now.
II ,,; I
Ii":' I
..
,
I
Thanks for your assistance!
:;
:.,',
·1
)
Caring People. .. Quality Services
."The Arkansas Depanment of H!Jman Ser"t'lces Is In compliance with Titles VI and VII of the Civil Rights Act and is operated.
managed and delll/ers serylces without regard to age, religion. disability. political affiliation. veteran status. sex. race.
color or national otlgln,"
�....
"
EXECUTIVE OFFICE OF THE PRESIDENT
OFFICIAL TRAVEL AUTHORIZATION '
1. TYPE OF AUTHORIZATION
(Privacy Act Statement and instructions on back)
ex TOY'
,0
.. 0 I~vitational '
:. Traveler (First name, middle initial. last name)
Amendment
(Show hems amended)
0
Relocation
(Non EOP Employees Only)
col H. Rasco
.t AGENCYIDIVISION
\. Title of Traveler
sistant to the President for Domestic
I6. Official Duty Sta.tion
;. Office Phone
7. ,131 Per Diem I.lU§.lX
, 0 Actual Suosistence (unusual ciicumsiallces)*
Washington, DC
6-2216
OPD/DPC
Polic~
Rate(s):
.
it TRAVEL INFORMATION
PURPOSE: __ T~o d_e~l_1_'ve~r__
~ __
__ K_e~y~n~o~t~e~s~p~e_e_c_h_'__
t_o~A_r_k_a_n~s~a_s~D~erP~a r_tm~e~n~t~o=-f__ __ __________~
__
H_uma_n
Services Annual Meeting reo Domestic Policy Issues
DATE(S): Travel Begin On
-1:..0,. 14~ 4
Travel EndOn1~/13, 94
__________________~-_LittleRock, AR and Hot Springs, AR
,mN~AA~~~~~~(~~~~W~a~s~h~i~n~g~t~o~n~,~D~C~
Place(s) of Official Visitation (Cicy. State)
9.
(a)
Rail
Coach
. Washington, DC
Pomt 0 f Return (Cicy, State)
. MODE OF TRAVEL
COmmertial Transportation
Air
Exira Fare· ..
Business ,.
Coach Tourist
,X
.'
,AMOUNT
10. ESTIMATED COST
$
Per Diem/Actual Subsistence
FII'Sl Class
I
:j: First OaBs must have approval ofAgency Head or Deputy
(b)
Privately Owned Vehicle
Auto
Rate auth
Other
Determined more advanlageous
10 government'"
.
per mile
*
(c) D Gov't Owned Vehicle'
(d) DOtber (specify)
~tJ·
. Rental Car
'
,
t7Z)"
.,
Miscellaneous
1$$lD.-oD' ,
TOTAL
11. SPECIAL EXPENSE AUTHORIZED
D
Registration Fees (meeting. training, etc.)
~ Commercial Rental Car
D
.,
,
Excess Baggage not to exceed
D Other (Please identify)
11. ADVANCE REQUESTED.
.
$
(meals turd miscellDMoua upenses onlyl
13. • Special ProvisionslRemarks (JustiFICation for first closs /business lextm fare trallel, annualltralle tmroute, tu:lUlll subsisulICe, etc.)
note:
Lodging authorized at 150%: nogovt. rate available
athoteli'bnly conference rate available
IS. Accounting data (Appropriation, division, project, vendor number)
/1J7- ;).::LO()
certify that the travel herem as reviewed and determined
to be essential for the accomplishment of agency programs
and misSions
Approval Omcial (Signature and Title)
OAFORM22
-
~O.O"D·
Transportation
o.
o, NTEconvenience of traveler
For
common carrier cost
60.00
-'IO~·
'
�WithdrawalfRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. schedule
DATE
SUBJECTfflTLE
10/1211994
Rasco, October 12 (partial) (I page)
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: October 12-13, 1994 AHSEA Conference
2010-0 J98-S
kc222
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)]
Freedom of Information Act • [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(I) National security classified information [(b)(I) of the FOrA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate it Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
National Security Classified Information [(a)(I) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PR.t\1. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request
�l
THE
WHITE
HOUSE
Carol H. Rasco
OCTOBER 12
PageNet Pager Number:1-800-921-7S76
11:00
11:40
12:57
Seat:
WH car departure from West Basement
Northwest Airlines Flight 855
Arrive Memphis
17-C
2:20
3:16
Seat:
Northwest Airlines Flight 1546
Arrive Little Rock
13-D
Lodging:
The Capitol Hotel
III W. Markham Street
Little Rock, Ar 72201
Phone:501-374-7474
Fax:501-370-7091
Confirmation' # 1779
4:00
7:30
�OCTOBER 13
CHR will Drive to Hot Springs (50 miles/one hour drive)
Arlington Hotel
Conference Center Room, 2nd Floor
239 Central Avenue
2nd Floor Meeting Rooms
Phone:501-623-7771
Fax:501-623-6191
9:00
Opening Session
9:45
CHR introduced Tom Dalton
9:50
CHR KEYNOTE ADDRESS
(20 or 30 min. presentation)
Per Pam Burnett CRR can PLAN on departing if she
wishes at 10:30 a.m.
Cl-jRwill drive back to Little Rock
3:00
5:22
Seat:
LV LR Delta Airlines Flight 1214
AR Cincinatti
15C
6:21
7:35
Seat:
LV LR Delta Airlines Flight 848
AR DC National
13C
7:35
WH car pick up enroute to West Basement
PHOTOcoPY
PRES~AVATrON
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. envelope
DATE
SUBJECTffITLE
Arkansas Advocates for Children and Families to Rasco wlhandwritten
notes ( 1 page)
07/15/1994
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAJBox Number:
8505
FOLDER TITLE:
Complete Scheduling per 10-11: October 12-13, 1994 AHSEA Conference
20 I0-0 198-S
kc222
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information [(b)(I) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordanc'e with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. letter
DATE
SUBJECTrrlTLE
07/13/1994
personal to Rasco (3 pages)
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAf Box Number:
8505
FOLDER TITLE:
Complete Scheduling per 10-11: October 12-13, 1994 AHSEA Conference
2010-0198-S
kc222
RESTRICTION CODES
Presidential Records Act • [44 U.S.C. 2204(a)]
Freedom of Information Act • [5 U.S.C. 552(b)]
PI
P2
P3
P4
bel) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose Internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIAj
b(7) Release would disclose information compiled for law enforcement
purposes [(b )(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geopbysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(l) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(ale 4) of tbe PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [aleS) of the PRAj
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.c.
2201(3).
RR. Document will be reviewed upon request.
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. letter
DATE
SUBJECTITITLE
09117/1994
personal to R!J.sco (I page)
RESTRICTION
Personal Misfile
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: October 12-13, 1994 AHSEA Conference
20 I0-0 198-S
kc222
RESTRICTION CODES
Presidential RecordsAct· [44 U.S.C. 2204(a)]
Freedom of Information Act • [5 U.S;C. 552(b)]
PI
P2
P3
P4
b(l) National security classified Information [(b)(I) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIAJ
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will he reviewed upon request.
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THE WHITE HOUSE
1
OFFICE OF, DOMESTIC POL
Y
CAROL H. RASCO
Assistant to the President for Domestic Policy
To:
Draft response for POTUS
and forward to CHR by: _ _ _ _ _ _ _ _ _ _ _ _ __
Draft response for CHR by: _ _ _ _ _ _ _ _ _ _ _ _ __
Please reply directly to the writer
(copy to CHR) by: _ _ _ _ _-,-_ _ _ _ _ _ _ _ __
Please advise by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Let's discuss: _--'_ _ _ _ _ _ _ _ _ _ _ _ _ _ __
For your information: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Reply
:
u~for~ code:
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Schedule? :
o Accept
o Pending
o Regret
Designee to attend: _---'-_ _ _ _ _ _ _ _ _ _ _ _ _ __
Remarks: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
CLINTON LIB~R'tPHOTOCOPY
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
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Carol Rasco - Issues Series
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Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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92 folders in 7 boxes
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Paper
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
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Complete Scheduling per 10-11: October 12-13, 1994 AHSEA
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Domestic Policy Council
Carol Rasco
Issues Series
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2010-0198-S Segment 2
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Box 122
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
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Clinton Presidential Library & Museum
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Reproduction-Reference
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12/4/2013
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2010-0198-Sb-complete-scheduling-per-10-11-october-12-13-1994-ahsea
-
https://clinton.presidentiallibraries.us/files/original/e3efe67244391761a89838b381704587.pdf
ed59403041f62f631ff55e91d37b39f8
PDF Text
Text
•
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E X E CUT I V E
o P PIC E
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P
THE
PRE SID E H T
26-Jan-1994 11:42am
TO:
FAX (9-703-836-4869,Phillip Schneid
PROM:
Carol H. Rasco
Economic and Domestic Policy
SUBJECT:
Invitation
Phillip schneider:
My sincere thanks to you and NACDS for the invitation to speak on
February 12 to your membership. I apologize for this rather
impersonal method of responding, but I wanted to get an answer to
you quickly and without the usual phone tag we can all play for
hours. I deeply regret I will be unable to accept this invitation
as I am already obligated for an event that day. I hope you will
give me a raincheck for another time .•. as you know, I especially
like to visit with audiences of pharmacists!
I have notified Marilyn Yager that I must regret the invitation,
and she assures me and asked that I share with you that she will
immediately go to work on obtaining another speaker for you.
Again, thank you for the invitation. Please know we are all
deeply appreciative of all the work NACDS is doing in support of
the health care reform effort.
�I
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.
01/24194
1aI002
15:44
THE WHITE HOUSE
WA.'.:,1-I1NGTON
3anuary 24, 1994
'1'0.
FROM I
RS:
carol Rasco
Marilyn Ya9'er
Invitation to Speak on February 12
The National Association of Chain Druq Stores has
invit~d you to speak at their annual conference on
Fab~uary 12 In LQJolla, California.
As you may know,
the NACDS has been one of our
~Srgngest
business
organi~ation~ ~upporting
the Health Security Act. Five
of their company CE05 have been active members of Mrs.
Clinton CEO 5upporter meetings over the past five
month5, ana they are working closely with the DNe on
the gra.55roots a.ctivity.
They especially want you because of your father's
relationsh1p w1th retail pharmacy business.
Your schedule perm!~~in9, ~h!s is an
would strongly recommend accept.
Please advise.
even~ ~ha~
we
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Nationa! A.$$oclatiOIl of Chain Drug Stores:
J.obetr: W. Hannan
i
I CiJa.'muJ1I qf thl1kltlrrl
!
K01W4 1.. :l.u:glcr
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J8IllU\.ry 14,
1994
'The Rononble CarOl H. Rasco
AUiit:l.t't to tbi PtB$idem
for
Dglllf.Sti~
Second
~,
Policy
West WLr!g
The Whit! House
WashillltO.n. D.C. 20SOO
R.~:
Deat Ms.
As you know, the N:niooaJ. A£SOQiation of ClWIl Drug Stoles (NACDS) is I. srmng suppon~ of Pres14ef1t .
Cliacon', bMl~ ~iI reform..tforto. Along with the i'tlin:iQI\al Assac1:u.lOIl· uf R.e~ail Drumlilim, NACllS
formed the Community Retail Pharmacy lIQ:iJth Cae Refi;um Coalition. ThtoUBb this COalition 'lie are
pbarmaclsu 1n OVf:lllO.OOO oommuruty phitlDilCiea lO promote
ul!;ltJll~iJJ! 111. 112,000 colIUuunity .,qij
the p~m~iple$ ohhe. PrelildlElE'i plan.
On behalf Of Rollild L. Ziegler, NACDS PresideDt and CEO. \Nt ate iDvitinj you to addtr!SS an ilrlportant
element of the NACDS membetibip. On Februal)' 12, approx.lm3tely 150 executiVeB whO are the CE05
and owners of chain drue stores will 2i1her for a three-day comerence ill LaJolla. California.
A major portion of me ron(aram:e deals with health care taCoI'm. 00 thll attlJtI100ll of Febn.r.Atj' 12, wt
~ n~ptesentative Of the
seek
Admlnlstruioll to addre&'i the audience on the eurrent IWuI add outlook for
me Prcsldenr:'s pliiD. Our dOl,;l:n: hup.! is Wal you will be 'hilL 1l:l-'1"1AA:ul"••
personal associatiop. wilD. eo~nity reWl9hvma.cy.
~~i,)JI)' uocauilO of )'91.11
is a S\lmm.at:Y of the activities NACDS hAl; iDitiated w demonsuate and build support tor the
President's plM. Of plltliwlar imp(lrtarlCC is the laum:b of Ii oatlClDai petition dt1v~ Ulrougll retail
phanual;iea to gaerate p"bl1~ ;uPPOEt Gat can be demo.1Ub'1!e4 to tlle CClngtei.li. You would bl! talking
direCtly 10 me ohain drug store exec\lliVes we are mobUiting for this obj~ti.ve.
~l(l~
we lOOk forward 10 YOllr acetptanee of our invitation. 1 will contact your offic~ shortly to discuss your
POSSible InvoJVement at our contor~n,e,
Sincerely,
'?Lu.~ l.. /1.U--Plaillip L,
.
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bir~o[
of Plablk: Atrlll'S
04::: Matilyn
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�NACDS
National Association of Chain Drug Stores
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2
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h~~'!}
Robert W. Hannan
Chairman oj the Board
RonaldL. Ziegler
President & CEO
January 14, 1994
The Honorable Carol H. Rasco
Assistant to the President
for Domestic Policy
Second Floor, West Wing
The Wbite House
Washington, D.C. 20500
Dear Ms. Rasco:
As you know, the National Association of Chain Drug Stores.(NACDS) is a strong supporter of President
Clinton's health care reform efforts. Along with the National Association of Retail Druggists, NACDS
formed the Community Retail Pharmacy Health Care Reform Coalition. Through this coalition we are
mobilizing the 112,000 community retail pharmacists in over 60~000 community pharmacies to promote
.
the principles of the President's plan.
On behalf of Ronald L. Ziegler, NACDS President and CEO, we are inviting you to address an important
element of the NACDS membership. On February 12, approximately 250 executives who are the CEOs
and owners of chain drug stores will gather for a three-day conference in LaJolla, California.
A major portion of the conference deals with health care refprm. On the afternoon of February 12, we
seek a representative of the Administration to address the aU(lience on the current status and outlook for
the President's plan. Our sincere hope is that you will be that representative, especially because of your
personal association with community retail pharmacy.'
,
'\\,
Enclosed is a summary of the activities NACDS has initiat~ to demonstrate and build support for the
President's plan. Of particular importance is ~e launch -of a national petition drive through retail
pharmacies to generate public support that can be demonstrated to the Congress. You would be talking
'.'.
directly to the chain drug store executives we are mobilizing for this objective.
,
We look forward to your acceptance of our invitation. I will contact your office shortly to discuss your
possible involvement at our conference.
Sincerely,
....-v~:;: t.. I~"----,
A 1\,',"
{ "
Phillip L. chneider'
,
Director of Public Affairs
cc: Marilyn Yager
Enclosure
413 North Lee Street, P,O. Box 1417-D49, Alexandria Virginia 22313-1417
Phone: 703-549-3001
FAX: 703-836-4869
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, NACDS Activities Supporting, '
Presid~ntClinton's Heal~h Care Reform Initiative
Ljste4 below are just a few of the filany ac,tivit,i~suIidertaken by NACDS and its member
companies to demonstrate and develop support of t,he President's health care ,reform efforts
'siJ)ce March, 1993:, ' "
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, :
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Letters of support from CEOs o,f NACp~ member ,companies
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Public press releas,es
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anno~ncing
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support of the President's health care reform plan,
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Two news conferences expressing support of the Pr~sid~~lt's health care reform plan
•
Letters to every membe~, of Congress urging'them to support the President's Health
S,ecurity Act.' '
• •
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Development of a chain member grass roots network to co~unicate'support ofthe
'p~esident's plan to members of Congress
',
•
Close involvement with and ,coordination with the National Health Care Campaign
an,d its Initiatives '
'
,
/' ,
,.
Aggres~ive
interaction with key members' of jurisdictional 'coriunittees to
commurucate' our support for the President's H~alth Security Act (its principles a,nd
the value of the prescription benefit)
,
•
'Implementation of specialized monthly newsletter sent to ,112,000 community retail
pharmacists to communica~e to them the merits of the President's plan
•
Outreach to numerous' public interest/elderly and disease organizations (diabetes,
arthritis, ,etc,.) to communicate merits ofthe President's program and to build support
•
Sponsorship of two independent studies' to document the cost savings of extending
prescription coverage to Medicare recipients :
,.
.
.
,
,
-
,
, - , .
-
Sponsorship with the National Health Care Campaign of a state-wide petition drive,'
"(December 4) ill Florida tpbuild public support
'
,
,
Additionally, NACDS and the Coalition will be implementing:
." ,'AnationaI petitiondrive through aU community pharmacies,
• ' Distributing presc~iption bag inserts which are, designed to motivate consumers to
express support for the' principles of the' President's plan ,and inclusion: o~ the
, prescription drug benefit,
'
•
' Continuing 'outreach activities to elderly/consumer groups and others,
,
•
Continuing interaction with key' members of Congress, and;
'.
Testifying at Congre,ssional hearings
,
"
.
--,-~--~----~~-.--
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marker by the WillialTI J. Clinton Presidential Library Staff.
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,
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Publications have not been scanned in their en'tirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
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�NACDS
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National Association of Chain Drug Stores
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413 North Lee Street
P,O, Box 1417-D49
Alexandria, Virginia 22313-1417
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Assistant to the President
for Domestic Policy
Second Floor, West Wing
The White House
Washington, D.C. 20500
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Carol Rasco - Issues Series
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
Clinton Presidential Library & Museum
Extent
The size or duration of the resource.
92 folders in 7 boxes
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Complete Scheduling per 10-11: National Association of Chain Drug Stores
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 122
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Publisher
An entity responsible for making the resource available
Clinton Presidential Library & Museum
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
12/4/2013
Source
A related resource from which the described resource is derived
2010-0198-Sb-complete-scheduling-per-10-11-national-association-of-chain-drug-stores
-
https://clinton.presidentiallibraries.us/files/original/d94c4d7f8159140581fe882b47f9b7eb.pdf
bb9a9b48b4f09a2ed35954b3877957a4
PDF Text
Text
WithdrawallRedaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECTffITLE
RESTRICTION
,
001. form
OA Form 22, Rasco Travel Authorization TA000015 from WDC to
Seattle W A and Orlando FL and ret, 08/22-08/24/1994 (partial) (2
pages)
09/19/1994
P61b(6)
002. form
OA Form 22, Rasco Travel Authorization T AOOOO 15 from WDC to
Seattle W A and Orlando FL and ret, 08/22-08/24/1994 (partial) (2
pages)
09/19/1994
P61b(6)
003. itinerary
AmEx Travel, WDC to Orlando FL to Seattle W A and ret, 08122
08/2411994 (partial) (l page)
0811711994
P61b(6)
004. itinerary
AmEx Travel, WDC to Orlando FL to Seattle W A and ret, 08122
08/2411994 (partial) (l page)
0811911994
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-\\: NACDS Aug 22-24 [1994]
20 I 0-0 198-8
kc22 1
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)]
Freedom of Information Act· [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information [(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) ofthe FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIAj
b(4) Release would disclose,trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of tbe FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(aX3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. form
DATE
SUBJECTfflTLE
OA Form 22, Rasco Travel Authorization T AOOOO 15 from WDC to
Seattle W A and Orlando FL and ret, 08/22-08/24/1994 (partial) (2
pages)
09/19/1994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: NACDS Aug 22-24 [1994]
2010-0198-S
kc22 I
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(1) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would ~iolate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential ad~ce hetween the President
and his ad~sors, or between such ad~sors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(I) ofthe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would ~olate a Federal statute [(b )(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.s.C.
2201(3).
RR. Document will be re~iewed upon request.
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,
Funded by
Non-Federal Sources
POlitical
CAR.oL H. RASC.o
6. SOCIAL SECURITY NUMBER
Ameildment
(Show itefl/s emended} ,
7. AGENCY
~ ,.' 0 Per Oiem,
" ,'
..
IXl Actual Subsistence (unusual circumstances} •
WASHINGT.oN
DC
, Rete($J:
See Below
12. TRAVEL INFORMATION
PURPOse:
.orlando- S12eech on health care & Welfare reform;," Seattle -speech, on
disability is~ues. '
, ,
OATE(S): Travel Begin On
Travel end On JL.:.12 4/..JJ194'
JL(2 2,-JJl94
".
ITINERARY: (Point of Origln/Plsco(s} of OfrlClal VJsitlltionlPolnt of Retum} ,
From:WASHINGTQN
To:SEATTLE, WA
To:
To:
To:
To:
I
DC
,
To: .oRLAND.o I
To:
To:
To:
To:
79/,34
Retum to:
o
,'IX] Com~rcial Ail
o
o
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Private Vehicle
FL
:
,.'
66/30
WASHINGT.oN, DC
0 ~ 00 0 'Mileage Rate
MiliteryAir
Registration F_ '(~t/ng, tTIIlnlng, etc.) ": '
'Commercisi Rental Car
'
'0 Excess 'Baggage not to exceed
'0 Other lPlllBSB ~ntlfy}_':--'---,_ _ _~'--_ _ _-'-'--..,......_..,-_
; .
ACTUAL EXPENSES,'
Actual expense reimbursement is authorized as shown.
Conference sponsors will pay logding in .orlando.
" 08/22/94 L.oDGING $114 ' , , : . ' , "
,
"
:::>rlando-Seattle-WDG will be at the government's expense. .orlando
conference sponsor will reimburse government for cost of WoC-Orlando trip.
,'8. ACCOUNTING DATA (Appropdlttlon, dM8/on, project, WJndor numbtn1
94J103E
20. I certify the lravel'herelll was reviewed alld detennlnad . ""~" '
21..
".",
'. ,'>'.:. '"
,,'
'riglnal
lEVlSED juNE 1994
_,4.
iRetum with voucher'
TeletlcketingOfflce
Ii. Funds M~neger copy
.
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..
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~
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============~============~=======~===~~===================~~?====6==============
ACCOUNTING CLASS CODE
-----------~--~---~------
LODGING-DOM-210601
M&IE-21060*
TRANSPORTATN~210100
-":'...:.:'"
ENV POL/REM
94J103E
6.00
--
- --'
0.00
193.00
'82.00
,699.00
974.00
�American Express
Travel Related Services Company, Inc:.
White House Travel Office
Old Exec:utive Office Building, Room 87
Washington, D.C. 20500-0001
Phone: 202 456-2250
Fax: 202 456-6670
In Emergency After Hours Call:
1 800847-0242 (Toll Free in the U.S.)
Your code number is: KC52
1hIve1
Management
~~~
Services~
®
-;:-
INVOICE / ITINERARY
SALES PERSON: 50
ITINERARY/INVOICE NO. 0007895
CUSTOMER NBR: 1695000023
QUESAJ
DAlE: 19AUG 94
PAGE: 02
TO: WHITE HOUSE TRAVEL
1600 PENNSYLVANIA AVE
14ASH DC 20500
REF: KC5STA000015
FOR: RASCO/CAROL
FARE~-iJSD416--::-09~' ".~ ~
. TOTAL AIR
'-t<..leelc:?
FOR AFTtR HOUR EMERGENCIES
CALL 800-847-0242/YOUR HOTLINE CODE IS S-KC52
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.....
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..
ALL FREQUENT FLYER BENEFITS EARNED ON OFFICIAL TRAVEL
ARE THE SOLE PROPERTY OF THE U.S. GOVERNMENT AND CANNOT
BE REDEEMED FOR PERSONAL USE.
.. .. .. .. ...... w ..
til
..
III
......
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...........
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.... 1'1 D . . . . . . . . . . . . . 'II .. 'II
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ALL UNUSED TICKETS ARE TO BE RETURNED TO AMERICAN
EXPRESS OR YOUR TRAVEL COORDINATOR IMMEDIATELY UPON
RETURN FROM TRAVEL OR WHEN TRIP HAS BEEN CANCELED •
. . . . . . . . . . . . . . . . . . . . . . . . . II
••••
"
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............
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THANK YOU FOR TRAVELING WITH AMERICAN EXPRESS.
TA 6450 (12190) PAINTED IN U.S.A. (12190)
\
. ORIGINAL
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. form
SUBjECTffITLE
DATE
OA Form 22, Rasco Travel Authorization TAOOOOl5 from WDC to
Seattle WA and Orlando FL and ret, 08/22-08/24/1994 (partial) (2
pages)
0911911 994
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Schedul ing per 10-11: NACDS Aug 22-24 [1994]
20 J0-0 J98-S
kc221
RESTRICTION CODES
Presidential Records Act • [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(1) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(1) National security classified information [(b)(l) of the FOrA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the ForA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�. '/ 'EXECUTIVEOf,FIC~,OF~T~~~RESII)Ef.l1";;;;;;:i;~'
,',;,f <':'~;OFFICIALTRAVEt' AUTfiORiZATION, . .
;\;C!:';t~1\;':;:'\\
?,"~'tJ'Y::~I:f:'
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3. TYPEOF,TRAVEI.>'
.
~
!Xl Official,
o Relo~atiori
Ame'ndment
. (Show ~ms amended} .
OFundedbv
Non-Federal Sources
Political
CAROL H. RASC
7. AOENCY
11.' 0
WASHINGTON
"
"", •
(Non.EOP Employees Only)
o
.'
Mixed
6. SOCIAL SECURITY NUMBER
.': ....:
Initlta~io~al :
.0
8. DIVISION
"',
Per Clem
.'
"
!Xl Actual Subsistence (unusual circumsnmcesJ'
. Rllte(si: See Below
DC
12. TRAVEL INFORMATION
PURPOSE:
Orlando -speech on health care §i: welfare reform;' Seattle - "speech· on
(jisability issues. ' .
OATEtS): Travel Bogin On
JL/22/,,» 94
Travel End On 1L:.t24 (..JJ194'
.
ITINERARY: (Point of OrlgWPi/lce(s} of OfrlClaI Vl$itationlPoint of Return}
From:WASHINGTON, DC . ,
To:SEATTLE, WA 79/ 34
, To:
To:
To:
..
To:
To:
To:
~,
Rewm to:
o
"IX] Coml)"8rclal Air
o
Private Vehicle
WASHINGTON,
0 ~ 0 0 Q .Mileage Ratll
.tJ Govemme~t Owned Vehicle
Military Air
"'CAB '
Registratlon F_ '(meeting, trainIng, etc.,:': .
Dtommerclai Rental Car'
.0
.0
66/ '30.
To:
To:
o
ORLANDO, FL
To:
Excess Baggage not to
Other
. ', .
e~ceed
iPteBSB lde~tlfyJ_':-:-'_ _-:--_-::-'_~_ _-'-_'_..,.....,_..,___
; .
ACTUAL EXPE~SES,'
Actual expense reimbursement is authorized as shown.
Conference sponsors will'pay logdingin Orlando,
,
08/22/94 L()DGING $114 "
,
'
::>rlando-Seattle-WOC: will be at the ,government's expense. Orlando
conference sponsor will reimburse government for cost of WOC-Orlando trip.
,18. ACCOUNTING DATA (ApptopdlltJon, d1vI8/Qn. project, vendor numberl
94J103E
20. I certify the tmvef'hereln was reviewed and detennlned
"
1£VISEDjUNE 1994
. _,,' 4. Teletlckedng ,office'
J'
,,
. 2: FMD c:opy ,
3.. Advence :of funds
"
6. Funds Manager copy
.
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.
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iCCO~ING OE~~tL:':~';:!):·"'~ ...
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===========-======~======~==~====~====~==~==F====~========~=?==~=~=======~======
ACCOUNTING CLASS CODE
.
------------------------
LODGING-DOM-210601
"
.
M&IE-21060*
TRANSPORTATN~210100
ENV POL/REM
94J103E
.
--------.
--------
,
0.00
0.00
.'
193.00
82.00
699.00
--------
974.00
,
'
�THE WHITE HOUSE
WASHINGTON
August 1, 1994
From: Florence Champagne, x7900, Rm. 128
Office of Counsel to the President
0::, -
(&? L/ =t-
Upon completion of pre-authorized invitational
travel, please return the attached Travel
Voucher indicating any amounts associated
with trip.
If you have any questions, please do not
hesitate to co~
-'{~ -- d IL-f~)
£a.& 'L'C~~
'1~-
CLINTON LIBRARY PHOTOCOPY
�'SEfn BY:Xer,ox Telecopier 70207':'tlJ-94 : 11 :37
,
'
The White House~,
2024586423:# 1
THE WHITE.HOUSE
'W/Io,SI-I'NGTON
.
,
VAX COVER SHEET
.tA~pu~,p:~.b.l_8
r~' , ,
ave aA'fI
Yl1t:h the faa: translII:i.s.:i.on, pleas8 call .".'
"
.
a't (202)456-2216..
,
'
The docwaen1: acca;patly:i.ng ,. this faclrUatl" translLi. total sheet is
intended oaly 'leI: the us. of tM'iAcl!vid.ual or entity to whom .it
. is address.d. This m sage conta1ns informat!oa ~hich may ba
••
pI:'1v.ileged. cClof.idan-,:1al or exeurp1: frOID di.c~Qsw:. under
applicable law. If ;;ne re.elu of tbJ.. 1II• • • •ge i . n.at tha
'iateDcied raa1picu.t" or the employ••' 01:" a9.-n:'I: re.spoDsil:Jle for
del.ivar:Lngtha ....aga to tba iD~lID.ded. rac1p:Leat, you 8Z'19 henaby
na't1f1eci that aD)~ c1:L:lclo,=e. di••eaination# copying or
,4i8tri~ut1oft, or the taking~ofsny action in reliance on th.
contents ofth:1a c:c'DltlUD.:Lcat1en is str:lctly prch.tb1ted.
-------------------.~.----------------------~-----------------
�'.
,
\
.·SEN'f BY:Xerox .
Telecopier, ' 7020 t;
.
":37
7-~:1)-94
;
The White
2024566423:# 2
House~
Contact person: Pat Romani
Phone number: ·6- 2216
Date of request:",i.7-20-94
ACCEPTANCE OF 1]lAYEL EXPENSES FROM OUTSIDE SOURCE
In order to consider whether the Government may accept from an outside source payment of
'. your travel,. subsistence and' re:late:Id!' expenses under the GSA ,p'avel rule" you must complete the
information below. The outside SC)ur~ need not be a SOl{c){3) organization, but if it is, please
state so on this form and include tile IRS determinatiqn letter..
Please include a copy of the l(~ttelr of invitation if one was received.
,Your name and posidoRI, .
CarC)l·H. Rasco
As~dstant to the President for Domestic Policy
Nature ot meeting or stmllar Iwnc~Uon and bow it rebates to your official duties:
,
,
, ••r
Speech, before. Convention c)f Na,t;'ional: A~s6ciation of Chain Drug Stores
re'. Health Care Reform and HelfareReform
Date and pJace(s) of traveh
August 22 and 23, 1994
Orlando, FL
.
.
Persons or entity making ·the :p8ylnrl.ent (please also note any 'nnanclallnterest~ of the person 'or
entlty known to you that may be Ilffec:tedby the exercise of your .Govemm.ent responsibilities):
'National Association of Chain Drug Stores
Nature or expense(s) paid for.:
..
,
Airfa~e and 'one .ni~ht
lodging
Method and approXimate. amount j()f payment (paYnient may ~ made ~!ther In,,ktnd or by
cheek made payable to -U.S. Trea!lury; you may not directly' reCeive payment ,in 'cash or ,check
:made out to you):
.
." This form and any ,accompanying J[Jlemorandum of approval must be attached to your, travel
authorization. Y9U must complete: a travel voucher folloWing the trip. Please send completed
form. to ~oom 128, OEOB, .at: leas't 3 days before commence,ment of travel.··
,
,fWp~ K1AuU~ <tV GS~,et6) §~ 6<1~tA-;1.~ ~ I~
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TP4VEL VOUCHER
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2. TYPE OF TRAVEL
3. VOUCHER NO.
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PERMANENT CHANGE, 4. SCHEDULE NO. '
OF STATION
BUREAU DIVISION OR OFFICE
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NAME (L.t. Ii,..,. middl(l inititl/}
b. SOCIAL SECURITY NO.
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b. TO
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TRANSPORTATION
REOUeSTS. OR
TRANSPORTATION
nCKETSWf f'UR·
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12. GGVERNMENT
11. PAID BY
CASH PAYMENT RECEIPT
a. DATE RECEIVED
a. Ouu\lftdlnt
b. Amoun. 10 be lIPfIiIIieGI
C.
b.
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PAYEE'S SIGNATURE
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I hereby lSsi9n to me United StatlS Iny fight I may hive eoainst any parties in connection. with reimhurubl~ . . TrwM(lr', 'niti••
trlmpoMltion chat91'S dncrib«t tielOlN. pUfchllMd undet' cash ~ment procedur" IFPMR 101·71
.
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AGENT'S
VALUATION
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ISSUING
CAR·
RIER'
POINTS OF TRAVEL
SERVICE
AND ACCQM·
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DATE
ISSUEO
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13. I c«tify that dtis voudwtf.is tfue and CIOlTect to thl best of my knowledge and belief. and thlt payment or credit hat 1101 been
received by _ . When
,this voucher.
TAAVELER. .·
SIGN HERE
IPC)Ij~ble,
per dilf!! cllimed is based on the aver. cost of lodging incurred during the period covered by
CLAIMED"
NOTE: Ftllsif;c.tion of." item in MI ttICpensiI l/CCount IIIIOrk,. forfl1itlllTl of c/"im (28 U.S.C. 2S14J MId mtly ",suit in
thtln $10.000 or imprisonmtlflt for
mOrll thIIn S Yfltll'l or both (18 U.S.c. 281: i.d. 1001/.
.
not
,APPAOVING
OFFICIAL . .
SIGN HERE
.
..
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11. FOR FINANCE OFFICE USE ONL Y
..
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fiM of not mort!
COMPUTA TION
1
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I
lb.
0,.0. SYMBOL
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YE~R
b.
&
TOTAL VERIFIED CORRECT FOR
CHARGE TO APPROPRIATION
(HIS VOUCHEA IS CEATIFIED COAAECT AND PROPER FOR PAYMENT
OFFICIAL
SIGN HERE
18. ACCOUNTING CLASSIFICATION
I
I
c. APPLIED TO TRAVEL AOVANCt
(Appropriation symbol}:
.
,HORIZEO
~cATIFYING
I
S
Cenifier's in/till/s:
....
S,
I
. fEICp/llin .
lind show
"mount)
liS. LAST PRECEDING VOUCHEA PAID UNDER SAME TRAVEL AUTHOAIZATION
VOUCHER NO.
I
AMOUNT' ,
. ,DATE .. '
14. This voucher is approlled. Long distlnCe tel~one eells, jf Iny. Irll certified as
necessary in the interest of the Government; (NOTE: If long distance telephone calfs
'",.. included. tilt! ""prOffing officilll muft h_ bttftn IIIItlloiind in '_itin, by tllfl '
hHd of tilt! ~(ll'ft'Mnt 0' ~ to 10 certify '" U.S-c. 6BO.J.J
.
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d.
NET TO TRAVELER"
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of uPllft,.1
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LODGING
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m-.
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TOTAL
SUBSISTENCE •. NO, OF
MILES
EXPENSE
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flO Compll,..c. wllh tti. ',h'Ky Act 0' "7., "he 'ollowln, In'o,m,tlon I, p,o.
vidld: Solicllliion 0' the In'o"",lIo" on ,,,,, 10'101 I, .ul"o,I'M by I U.S;C:
Ch,p, " •• Impl....
by the ' . . . . . T'e"" " . .ul.tlon, IP'''MR
1.0. UI01I 0' July 22. ' ' ' ' , 1,0. 11012 0' M.,ch 27, 'H2, 1.0, ':lt7'01'
"'o".mber 22.
d 21 U.S.C.
IftGI
Th, prim.,y purpOll
0' Iha 'loqu..,M 'n'OfmatiOfl " 10 cIIetenIIlN N Y - I Of "lmbVI'Mmenl to
,Utlb" I"dlvldu." 'or .lIow-"e t,"'" ..",. . 'tIIoeetlOfl ,.pen_ IncU"M
uncte· apprOPf'et. admln'''''tl... "'.......... IIfttI to ,ecord .nd m.l"t.ln
COIU 0' euch ,......bvr_Ift..· '0 .... 0 ...._ . . Th, j"torm'tlO" will be
ulld bY ollie_ Iftd -lIfoY_ .................. tOf the I"to,metld" I" the
per'orm_e of theW ofllel" Clut..... Tile "" . ._tlon ..,..y be dltcla.td to
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pOrter" elc. Cothe, .Ihan 10,),..01"..
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TRAVel. AUTHORIZATION NO,
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IiICQn:tpIe•• 10' pe, diem end Klu.1 upenlil!
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Show tot.llubsi"tnce expenle incuned '0' .ctu.1 •• penll ...vel:
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(nl Show ex.,."",. such II: tlxi/limou,inll.,,,, .ir I.i. IiI purCh.ild with clihI. local or TRAVEl£R:S LAST ~AME
10ne,di'I.nce telephonl c.lI, for Gov.rnment bu. in....! c".',nta'. ,.Iocalion Olher .'han
subsISt.nc•• Itc.
t,_leuthotllltioftJ
DATE
Compl,re mi,
informltion
INSTRUCTIONS TO TRAVELf;R (Unli't«lirtlms are self·explanatoryl
Col. leI If. the vouchIf IMiudII
Com. [C.~ (dl). Show .mounC.inCu"ld
'" 'SCHEDULE
OF
EXPENSES
AND
AMOUNTS
CLAIMED
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�NACDS
JUN 2 8 REC'O
National Association of Chain Drug Stores
Jack Futterman
. Chairman ofthe Board
Ronald L. Ziegler
President & CEO
June 23, 1994
The Honorable Carol H. Rasco
Assistant to the President for Domestic Policy
Second Floor, West Wing
The White House
Washington, D. C. 20500
Dear Ms. Rasco:
As you know, the National Association of Chain Drug Stores is a strong supporter of President
Clinton's health care reform efforts. Along with the National Association of Retail Druggists,
NACDS formed the Community Retail Pharmacy Health Care Reform Coalition. Through this
Coalition we are mobilizing the 112,00 community retail pharmacists in over 60,000 community
pharmacies to promote the principles of the President's plan.
On l?e~~!Jl.f RqJ1ru~t L. Ziegler,
NACDS-.I!resident-and-GEQrwe-are_plea~
to invite you L"6
,a~9lI~~,~It!wIW~,~l~m~.ntoJ:, the N~CDS-meinbershiI>. OI!_Tu~sday.,_August23.'_over_L,OO.Q;J
.executlves_who.=.are. the~ CEOs ~d selllOLlev.eLmanagemenLoLcllam drug stQr.es_wIILgather.JOiY
[a ~-day_~harmacy_C_Qnference in_Orlando,...-Elorida;:> A major portion of the conference deals
with health care reform and the changing marketplace. On the morning of August 23, we would
like you to address this audience on the current status and outlook on a variety of domestic
issues, including health care reform.
By way of background, at this same meeting in 1993, The First Lady was able to join us via a
live satellite feed, and for that we are most appreciative. This year, we have invited Vice
President Al Gore to be with us at this Conference and to review for the participants the current
status and outlook for health care reform. It would be a great opportunity for you both to be
with us....and perhaps, with such a large elderly population in Florida, if desired, we would be
happy to work with you to also conduct a tie-in senior citizen event which would support the
President's objectives.
413 North Lee Street, P.O. Box 1417-D49,Alexandria Virginia 22313-1480
Phone: 703-549-3001
FAX: 703-836-4869
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Page Two
June 23, 1994
We look forward to your acceptance of our invitation. I will contact your office shortly to
discuss your possible involvement at our conference.
Sincerely,
~'::rs~n~
Director of Public Affairs
cc: 'Alexis Herman
Ronald L. Ziegler, NACDS
Enclosures
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'" : . NATIONAL COUNCIL ON, PIWIUTY ,.·AUG - 5 REC'O
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: An independent -fed~al agency working with the President and the Congress.to increase the .
:. inclusion, independence, and empowerment orall Amencanswithdisabilities.
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; August.3, 1994
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: The Honorable Carol Rasco, .
~ White House DOIIleStlc pOlicy CQuncU'
: White Bouse
.,..l Washington,, DC 20500
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Dear Ms. Rasco:
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?n behalt of the National Counc~ on Disability, I wouldtlike to, invite you 'fo pa~iCipate .
In our next quarterly meetina whIch wUl be held Auaust 22-24" 1994 at tbe_WestllL '
!!'te~900 FiIlhAven.ue, Seattle,' Washington~ (206) .,28--1000., Jllis~ting ~lU be "
atten, ed by the Councll's current Members and staff, leaders of Federal a,eocles
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: serving people with disaiJilities, 'leaders from the disab~tycommunity, arid the public~
The meetin, ageoda will include 8~ orientation for the President's recently coDflimed '
Members of the Council, a Couoen business meetinl~ a strategic pJaD.Din& session, a day.
loog roundtable session on the 'Am.erical,lS"ith Disabilities Act,' and presentations on the
current statUs ofFederally supported programs serri.ng. people ,,,ith disabilitit\s.'
\.
This would be. an exceUent opportunity f~r lIS to hear about the (urre~t and planned .
activities of the White .House Domestic, Policy Council regardinc Americans with
,
" ': disabilities. It "ould also afford' you an opportunity ,to identU'yareas in "hieb tile'
CouDcil might be abl~ to assist the J)omestic l!oHcy Council in its impOrtant work. As'
; ,you might reCall, we b8d a general discussion regarding this later issue during our'
: ' recent meeting_ YOUI" 'attendaace at our upcomlng meeting would:provlde,us, with aD
" opportunity to foDow-up in tchis area and engage in sub~ntlve work that llVoQldbenefit '
all Americans with disabilities;
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I ' with disabilities and express my "ish that you "ill be able to jom tis iII Seattle. Thank
, you for your attention.to this request.
...
,!ce
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Chairperson
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1331 FStreet NW.• Suite 1050 • Washing'ron, D.C. 20004-1107
(202) 272-2004 Voice _ (202)272-2074 IT • (202) 272-2022 Fax
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SENDER FAX'NUMBE~:
(312) 226·0487'
. SENDER TELEPHONE,NUMBER:
(312) 226-5900 voice
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DATE:~2> 1- 9
(312) 226-1687 ttd .
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1331 F,Street N.W.•. S~ite 1050' • Washington,D.C20004-1107
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(202).272-2004 Voict!. (202) 272-2074 IT. (202) 272-2022 Fax
�Aug. ·jl8.1 994
4:38PM
NACDS
NA€ B S
. No...9.097
P. 1/1··
National AssociarlonofChain Drug Stores
M E M 0 R A.N D 'U M
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Aug~st
18, 1994
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FAX T&V~SMlnALFQRM
TO.~
Pat Romani, The White House
. 202-456-2878 .'
FAX:
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~ Laura Cranston, NACDS
V~703/836.4869
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FROM:
FAx:·
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NVMBEROF PAGES (including cover sheet):
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MESSAGE:
~s per our discussion today, we would be pleased if Carol could join us on. two separate occasions while
s~e is in attendance at the Pharmacy Conference. .
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1he fIrst is for a brief meeting with our Senior V~ce President of Public Policy and General CounselL~~~
Waspe. This would provide' .Rob all opportunity to answer any questions she may have ~ut the
;.. ~udience she..v.:iU be spealdQg;tc!~ .Thi~.~~b~ .~ged.afte.r she has checked iritothe hotel and ~uld
f?e done over dtnner that evenmg, If Carol IS In at tha,t .time. '.'
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. .~dditiODallyt.~ I mentioned we have a P?litlCalP.oint~ounterpoint ~~akfaston Tuesda:y ~~~~gt
·~)\ugust 2lnd at 7:30 AM. We would be,most pleased If Carol would JOIn us at the head table. Th~se
, iwho will be seated at the head table. are: "
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iRon Ziegler, President &: CEO, NACDS
INancy Ziegler
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Jack Futterman, Chairman oflhe Board, NACDS and
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Cha;rmtZ11 & CEO of Palhmark Slores, Inc.
Estelle FUllerman
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Marlin Filzwater, speaker at thebreaJifasl
ChriJ Matthews. speaker at lhe breaJifast
.,.,
Stew Turley, Chairman and CEO, EckerdCorporalion
Frank Newman, Eckerd'j President
EDrl HeiSey Zeneca Pharmaceuticals, sponsor of the breakfast .
Kalhy Taylor. McNeil PharmaceUlical
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My a.ssistantl~~ll forward to me the flight arrangements for carol, when they are finalized. Rob
Waspe will be here both Friday and Monday. If you or Carol have any additional questions, please'feel
free to call them. or contact me at the Marriott in OrJando. Thanks again for all of your assistance.
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
ANDTYPE I
003. itinera)y
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SUBJECTrrITLE
DATE
AmEx Travel, WDC to Orlando FL to Seattle W A and ret, 08/22
08/24/1994 (partial) (I page)
08/17/1994
RESTRICTION
P6!b(6)
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COLLEGTION:
ClintoA Presidential Records
Dome~tic Policy Council
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Carol ~asco (Issue Papers)
OAlBox Number:
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8505
FOLDER TITLE:
Complete Scheduling per 10-11: NACDS Aug 22-24 [1994]
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2010-0198-S
kc221
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RESTRICTION CODES
Presidenti~1 Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
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P2
P3
P4
National Security Classified Information [(a)(1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Releas~ would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Releas~ would disclose confidential advice between the President
and hi~ advisors, or between'such advisors [a)(5) of the PRA]
P6 Releas~ would constitute a clearly unwarranted invasion of
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personal privacy [(a)(6) of the PRA]
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C. Closed in accordance with restrictions contained in donor's deed
of bft.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
22~I(3).
RR. DO,cument will be reviewed upon request.
I
b(1) National security classified information [(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
�[ooiJ
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SALES PERSON. 59
CUSTOMER NBR; 169500~023
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DATE I 17 AUG 94
PAG!, 01
ITINERARY
QUESAJ
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• TOTAL AIR FARE U8D416.00
FOR AFTER HOUR EMERGENCIES
CALL 8B0-847-0242/YOUR HOTLINE CODE IS S-KC52
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• •••••••••••••• • •REMINDER •••••••••••••••••••••••••••
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ALL FREQUENT FLYER BENEFITS EARNED ON OFFICIAL TRAVEL
ARE THE SOLE PROPERTY OF THE U. S. GOVERNMENT AND CANNOT
BE REDEEKED FOR PERSONAL USE.
·...................................................
ALL UNUSED TICKETS ARE TO BB RETURNED TO AMERICAfi
au c:....1 o_Q.,..JL.<.-'
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EXPRESS OR YOUR TRAVEL COORDINATOR IMMEDIATELY UPON
RETURN FROM TRAVEL OR WHEN TRIP HAS BEEN CANCELED.
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PHOTOCOPY
PRESERVATION
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CAROL H .... RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
TRAVEL SCHEDULE
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1-800-921-7576
?AGE NET NUMBER
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~ONDAY,
AUGUST 22.
a..:00 pm
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1:25 pm
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Depart West Basement enroute to National
WH Car
Arriv~National
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Depart USAIR Flight 1759
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Arrive Orlando
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Orlando 'Marriott World Center
8701 World Center Drive
Conf. #: 80664482
Phone:
407~239~4200
Fax:
407 238-8777
;Lodging:
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TUESDAY, AUGUST 23
,1-800-921-7576
PAGENET NUMBER
Bruce Reed will attend WH Staff Meeting at 8:15a.m.
7:30 a.m.
19:00 a.m.
r
(15
,12:20p.m.
p.m.
1:50p.m.
4:27p.m.
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Breakfast Meeting
SPEECH
National Association of Chain Drug.
Stores Conference
LV Orlando Northwest # 957 ,
AR Memphis
LV Memphis Northwest '#987
AR Seattle
�DRAFT
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todging: .
Westin Hotel
1900 5th Avenue·
Seattle, ·WA 98101
Phone:
206-728~10QO
Fax
206-728-2259
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.4: 30 - 6: 00
General Meeting Between representatives from
the Federal Government and Roundtable Part ipants
concerning Future ADA Implementation
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:WEDNESDAY , AUGUST 24
I
11-800-921-7576
I PAGENET
NUMBER
,
;Bruce Reedwi11 attendWH Staff Meeting
"-
8:45a.m.
at
8:15
.SPEECH
Natiorial Council on Disability.Quarterly Meeting
1:00p.m.
'8:36p.m
LV Seattle/Tacoma
AR Washington Dulles
WH Car pick up enroute to West Basement
United Airlines Flight
1576
�Speaker Response Form
Plea~ provide
~
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NACDS with the following information by
Mond~y, July 24,
1994:
D 0...~
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Brief Biography (1-2 Paragrnphs in length)
_ .. ;:};
Black and White Photo
~2JJV-f) \ ~
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Completed Complimentary Registration Form
• :
Hotel Requirements
Arrival Date and approximate time: _ _ _ _---'-_ _ _ __
Departure Date and approximate time: _ _ _ _ _ _ _ _ __
(Note: NACDS is pleased to provide complimentary lodging for one night)
•
Special Requirements for Sleeping Room (please circle all that apply)
Smoking Room
Non-smoking room
King-size bed
•
NACDS Closing Reception and Dinner on Tuesday, August 23, 1994 (6:30 PM-I0 PM)
I will be able to attend this function.
I will NOT be able to attend this function.
•
Transportation: if travelling by air, NACDS will reimb.ur.se-~ou..foI:..Jl.Ollr co.aclLtr3.,vel. Please
indicate if you will be using your own travel agency or using the NACDS
Travel Agency, which is McNair Travel Management (Ellen McNair is our
contact)
Phone Number is 1-800-433-1790, or 703-836-1100.
MacNair Travel may ask for the following budget number #77220.20
I will be using our personal travel agency.
I will be using MacNair Travel agency.
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Contact, person: Pat Romanl.
Phone nu.mbor:, ' 6-2216',
Date of reque,st: 7- 20 - 94,
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ACCEPTANCE of TRAVEL EXPENSES FROM OUTSIDE ,SOURCE
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In ord~r to "consider whethert~c' Government may a~pt' from: ~anoutside so~ce payment'of
your tiavel, subsistence andre:iatedl expenses under the GSA trav~ rule,youmusf complete the
.information belOw. The' outsii~e sCluICe need riot be a SOl(c)(3) organization., but if it is, please
, state on thisfoml aDd include theIRS detenpiriation letter. ' , ' ",,'
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Please include
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awpy of the ic:ttcrof invitation ~.,~ne'was received.
"YoUr ~ame and posidoDl
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Carol ,H. Rasco
Assistant to "t.he Presidemt for'Domestic Policy
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spa~ch
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Auqust;22 and 23, 1994
Orlando " . FL ,
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entity known to youth.t- may be a,reeledby' the exercise ot your'.Government responsibilities):
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~EMORANDuM' FOR CHRISTINE HEENAN'
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,
.
Pat ,Romani
FROM':
.
'
•
RE. :' :,
Briefing M~ter{~ls fo~ CHR
Per
our c~nversation,I'n.ave attached materials relevant
:to. Carol's pres,enb3.tion
2.3 August 1994 . .
on
'Carol wished also for you to work 'with War Room to provide
imaterialsand updat;es,".
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prov~de
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byC.O.B. 18 August 1994.'
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NACDS
28
National Association of Chain Drug Stores
I
Jack Futtcrma:n
Chairmau ofthe Board
I
Ronald L. Zic:glcr
Prcsidcut & CpO
I
I
I
June 23, 1994
I
The Honorable Carol H. Rasco
A~sistant to the President for Domestic Policy
SeCond Floor, West Wing
T~e White House
Washington, D.C. 20500
,
1
Dear Ms. Rasco:
As you know, the National Association of Chain Drug Stores is a strong supporter of President
Clinton's health care reform efforts. Along with the National Association of Retail Druggists,
NACDS formed the Community Retail Pharmacy Health Care Reform Coalition. Through this
Coalition we are mobilizing the 112,00 community retail pharmacists in over 60,000 community
pharmacies to promote the principles of the President's plan.
I ..'
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...."..,;':-,',," '.' -'-, "', ,". ~ '.' , . ''', ...."
..
Oribehalf of Rpnal,d.L.: ~~gler, NACDSPres~dent and CEO, we are pleased·toinvi~:Y9u:'.to
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a44t~~~,~ imw~~,~J~me,Jlto( $~. NACDS mem~t:Ship. On ~uesday, August 23; over 1,OOO~
exeCutives who are~the:,CEOs and ~nior level management of cham 'drug. stOres will gather for,;lil
a i4-day Pharmacy Conference.in Orlando, Florida':: A major portion of the conference deals
with health care reform and the changing marketplace. On the morning of August 23, we would
like you to address this audience on the current status and outlook on a variety of domestic
issues, including health care reform.
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gy way of background, at this same meeting in 1993, The First Lady was able to join us via a
li;ve satellite feed, and for that we are most appreciative. This year, we have invited Vice
President Al Gore to be with us at this Conference and to review for the participants the current
status and outlook for health care reform. It would be a great opportunity for you both to be
Vfith us....and perhaps, with such a large elderly population in Florida, if desired, we would be
happy to work with you to also conduct a tie-in senior citizen event which would support the
~resident's objectives.
I
413 N6rth Lee Street, p,O, Box 1417-D49, Alexandria Virginia 22313·1480
I
,
Phone: 703·549·3001
FAX: 703·836·4869
�lelecopier 7020
7-~!)-S4
'1 : 39
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2024566423;# 6
House~
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page TWO
June .23. 1994
I
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.
.
.
We l\>Ok fOfWaid to your acce.ptance' of our
1 will contaet your ofll<:e ohQrtly to
discuS! your possible involvement .t our _!$nee. .
.'
. ' ..'
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.Sincerety,
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.
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<J~"';L lRJ-."'"
ptillhp . Schneider
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DiJ.ctor of Public Affairs
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.!
Alexis HermlP .
Ronald L. Ziegler•.NACDS
'
Enclosures. .
I .
I
I
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
i
AJljDTYPE
DATE
SUBJECT/TITLE
RESTRICTION
I
I
004. itinerary
!
AmEx Travel, WDC to Orlando FL to Seattle W A and ret, 08/2208/24/1994 (partial) (1 page)
08/19/1994
P61b(6)
COLLEGnON:
Cl intoniPresidential Records
Domesfic Policy Council
Carol Rasco (Issue Papers)
OAlBo~ Number: 8505
FOLDER TITLE:
Compl~te Scheduling per 10-11: NACDS Aug 22-24 [1994]
!
!
I
2010-0198-S
kc22 1
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)J
Freedom of Information Act· [5 U.S.C. 552(b)]
Pl National Security Classified Information [(a)(1) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Releaseiwould violate a Federal statute [(a)(3) of the PRA]
.
P4 Release' would disclose trade secrets or confidential commercial or
financi~l information [(a)(4) of the PRA]
P5 Release' would disclose confidential advice between the President
and his ~advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
person~1 privacy [(a)(6) of the PRA]
b(1) National security classified information [(bXl) of the FOIA]
h(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regUlation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geologieal or geophysical information
concerning wells [(bX9) of the FOIA]
I
I
I
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
220,1(3).
RR. Document will be reviewed upon request.
i
�@:DE
Ame,;'an Exp"'..
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~~~ Management
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INVOICE / ITINERARY
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SALES P~~SON: 50
ITINERARY/INVOICE NO. 0007895
CUSTOMER I ~IBR: 169500002:3
QUESAcJ
Travel Related Services Company, Inc.
White House Travel Office
Old Executive Office Building, Room 87
Washington, D.C. 20500-0001
Phone: 202 456-2250
Fax: 202 456-6670
In Emergency After Hours Call:
1 800847-0242 (Toll Free In the U.S.,
Your code number 'SI KC52
nATE: 1.9 AUG 94
PAGE: 01
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TO: WHITE HOUSE TRAVEL
, I 1600 PENNSYLVANIA AVE
WASH DC 20500
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REF: KCSSTA000015
FOR: RASCO/CAROL
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CONTINUED ON PAGE 2
6:39.00
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ORIGINAL
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7-20-94; ":38 ;
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-
The.White
2024566423;# 3
House~
NACDS
~ion~LAssodation of Ch!!!! Drug Stor~s ...
i
Jack Futterman
ChairmAn o}j the Board
July 14, 1994
I
Ronald L. Ziegler
Prendent &I CEO
I
The Honorable Carol H. Rasco
Auista;nt to the President for. D'Imestic Policy
Secon4 Floof, West Wing· ...
The White House .
Washington, D.C.20S00
Dear
I
(!arol~
.
I
We are pI.eased you have accepted Qur invitation to address the NACDS Pharmacy Confe,fence· on
Tuesd~y, August 23; 1994, in Orlandi:>; Florida" The 4·day conference will be attended by ove.r 1,000
senior iand mid-level executives of c:hain drug stores- and supermarkets with pharmacies as well as
suppll~rs of pharmaceutical. products ~Uld services;
.
i
' . .
.
A majpr focus of theConferent;c:will be on health care reform .and the changmg marketplace. The
_
morniDg of Tuesday, August 2:5rd is when you have agreed to give your remarks. We Would like
... you adctress this audience on health care refonn, and plans for welfare reform (speeifica1ly
Mediclald) from' AM·5h30 A l V [ . ·
.
to
!
The a~dience has been closely nionitoring the latest twist and turns Congress has beim taldnS in an effort
to get ,I bill passed in this sessicln. If you could comment on where the process is at the time of this
meeting,.and the Administration:'$ pc:rspectiveon where the legislation is headed, if not passed by late
August, we' would greatly appreciate your time and your' unique perspective. As there will be niany
pharmacists in management positions in the'audience. your unique per5peQtive of having grown up with
your father in the busines$, will' be of particular interest to the attendees. .
'
I :
.
.
I
.
.
.
.
Carol.f would you, or someone on yo~t staff, kindly complete the attaChed form and send your bio and
. a black and white photo by July 24th to the attention of Laura Cl1UlSton for our final program book.
Lauraj he.rself a pharmacist, coordina~~s all arra."'1gements for this meetirig and looks forward to working.
with ypu. .She will contact you .IaterdUs month to answer any additional questions you may have and·
to assist you in the preparation of your. .
remarks.
.
I
.
Thanks again for your willingneSs to p~cipate. Ron Ziegler and all of us ~t NACDS look forward to
seein, you in Orlando on August: 231:dl •.
I
I
1
S'
11
a!Pr:~
.
.~
- tibilll'tf ScJineider .
..
Director, Public Affair$ .
co:
,.,
.
I Ronald L.. ·.·~fegler, ·Laura ~~====-- ~:,,' =.~ ';
: :,' - .
: CraJ1st~n;, V;p,i, Health care·programs·
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....
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�NACDS
~ ati()nalAssociation ~(!f Ch~
Drug Stor:s
I
Jack Futterman
Chairma~ ofthe Board
.
July 14, 1994
I.
Ronald L; Ziegler
President & CEO
I
The IHonorable Carol H. Rasco
Assi'stant to the President for Domestic; Policy
Sec6nd Floor, West Wing
ThelWhite House
Wa~hington, D.C. 20500
I'
i
Dear Carol:
I
Wei are pleased you have accepted our invitation to address the NACDS Pharmacy Conference on
Tuesday, August 23, 1994, in Orlando, Florida. The 4-day conference will be attended by over 1,000
senior and mid-level executives of chain drug stores and supermarkets with pharmacies as well as
suppliers of pharmaceutical products and services.
I
.
!
A tnajor focus of the Conference will be on health care reform and the changing marketplace. The
m~rning of Tuesday, August 23rd is when you have agreed to give your remarks. We would like
yo~ to address this audience on health care reform, and plans for welfare reform (specifically
Medicaid) from 9 AM-9:30 AM.
I
.
I
Th'e audience has been closely monitoring the latest twist and turns Congress has been taking in an effort
to Iget a bill passed in this session. If you could comment on where the process is at the time of this
meeting, and the Administration's perspective on where the legislation is headed, if not passed by late'
AJgust, we would greatly appreciate your time and your unique perspective. As there will be many
pHarmacists in management positions in the audience, your unique perspective of having grown up with
your father in the business, will be of particular interest to the attendees.
I
carol, would you, or someone on your staff, kindly complete the attached form and send your bio and
a black and white photo by July 24th to the attention of Laura Cranston for our final program book.
!lura, herself a pharmacist, coordinates all arrangements for this meeting and looks forward to working
w,ith you. She will contact you later this month to answer any additional questions you may have and
t~ assist you in the preparation of your remarks.
I
Thanks again for your willingness to participate. Ron Ziegler and all of us at NACDS look forward to
s~ing you in Orlando on August 23rd.
I
I
sinclFe~11
0P~
',',
,
~illip L. Schneider
~
I
Director, Public Affairs
I
,
I
cc:
I
l
Ronald L. Zie ler Laura Cranston, V.P., Health Care Programs
I
4!13 North Lee Street, P.O. Box 1417-D49, Alexandria Virginia 22313·1480
I
!
.
.
Phone: 703·549·3001
FAX: 703·836·4869
�i
I
Page,lTwo
Junei23, 1994
We ilook forward to your acceptance of our invitation. I will contact your office shortly to
disCuss your possible involvement at our conference.
I
!
Sincerely,
I
<flLLL~
Phillip il'Schneider
director of Public Affairs
I
Alexis Herman
Ronald L. Ziegler, NACDS
I
Enclosures
I
,
I
!
I
1
I
J
Phone: 703-549-3001
�
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Carol Rasco - Issues Series
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Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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2010-0198-S Segment 2
Description
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Clinton Presidential Records: White House Staff and Office Files
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92 folders in 7 boxes
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Complete Scheduling per 10-11: NACSD Aug. 22-24 [1994]
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Domestic Policy Council
Carol Rasco
Issues Series
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Box 122
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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2010-0198-Sb-complete-scheduling-per-10-11-nacsd-aug-22-24-1994
-
https://clinton.presidentiallibraries.us/files/original/e4122370f00f2ec59d614b6272d9ef3e.pdf
220d96ce0e06b9b600f48841196511f2
PDF Text
Text
WithdrawallRedaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
SUBJECTrrITLE
Rasco to Miller and Romani re
DATE
GOY'S
Phone Number (partial) (I page)
08/2211994
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAiBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: [Loose Documents J
20 10-0198-5
kc220
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)]
Freedom ofInformation Act· [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(1) of the PRA]
P2 Relating to the appointment to Federal oflice [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [aX5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
.
b(I) National security classified information [(b)(I) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3):
RR. Document will be reviewed upon request.
�-
August 15, 1994
To:
m, /J ...
L?
. K~l~/)C.~,
~cU
From: Florence Champagne, x7900, Rm. 128
Office of Counsel to the President
Upon completion of pre·authorized invitational
travel, please return the attached Travel
Voucher indicating any amounts associated
with trip.
If you have any questions, please do not
hesitate to contact me•
.
CLINTON LIBRARY PHOTOCOPY
�June 21, 1994
To:
From: Florence Champagne, x7900, Rm. 128
OMce of Counsel to the President
Upon completion of pre-authorized invitational
travel, please return the attached Travel
Voucher indicating any amounts associated
with trip.
•
If you have any questions, please do not
hesitate to contact me.
QlL
~
L--V~f'J,Jj ~d_<;;
CLINTON LIBRARY PHOTOCOPY
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WAS SENT.
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COMMENT
6
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TH E WH ITE HOUSE
WASHINGTC~
FAX COVER SHEET
OFFICE OF THE ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
SECOND FLOOR. WEST t'IING
THE \-lHITE HOUSE
WASHINGTON. DC 20500
(202)456-2216 PHONE
(202)456-2878 FAX
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COMMENTS:
~easE; b~Ve So~onc MvI'~-e12&, ~ O-~ ed· . 'Th~ '::[Ov--I.
problems with the fax transmission. please call
at (202)456-2216.
The document accompanying this facsimile transmittal shee~ is
intended only for the use of the individual or entity to whom it
is addressed. This message contains information which may be
privileged. confidential or exempt from disclosure under
applicable law. If the reader of this message is not the
intended reCipient. or the employee or agent responsible for
delivering the message to the intended recipient. you are hereby
notified that any disclosure, diss~nation, copyinq or
distribution, or the takinq of any action in reliance on the
contents of this communication is strictly prohibited.
�i
'
Contact person: Pat Romani
Phone number: 6 - 2216
Date of request: 7-20-94
ACCEPTANCE OF TRAVEL EXPENSES FROM OUTSIDE SOURCE
In order to consider whether the Government may accept from an outside source payment of
your travel, subsistence and related expenses under the GSA travel rule, you must complete the
information below. The outside source need not be a 501(c)(3) organization, but if it is, please
state so on this form and include the IRS determination letter.
Please include a copy of the letter of invitation if one was received.
Your name and position:
I
Carol H. Rasco
Assistant to the President for Domestic Policy
,
Nature of meeting or similar function and how it relates to your official duties:
Speech before'Convention of National Association of Chain Drug Stores
reo Health Care Reform and Welfare Reform
Da,te and place(s) of travel:
August 22 and 23, 1994
Orlando, FL
Persons or entity making the payment (please also note any financial interests of the person or
entity known to you that may be affected by the exercise of your -Government responsibilities):
National Association of Chain Drug Stores
Nature of expense(s) paid for:
Airfare and one night lodging
Method and approximate amount of payment (payment may be made either in-kind or by
check made payable to U.S. Treasury; you may not directly receive payment in cash or check
made out to you):
This form and any accompanying memorandum of approval must be attached to your travel
authorization. You must complete a travel voucher following the trip. Please send completed
form to Room 128, OEOB; at least 3 days before commencement of travel.
�NACDS
National Association of Chain Drug Stores
---
-----=-
Jack Futterman
Chairman ofthe Board
July 14, 1994
Ronald L. Ziegler
President & CEO
The Honorable Carol H. Rasco
Assistant to the President for Domestic Policy
Second Floor, West Wing
The White House
Washington, D.C. 20500
Dear Carol:
We are pleased you have accepted our invitation to address the NACDS Pharmacy Conference on
Tuesday, August 23, 1994, in Orlando, Florida. The 4-day conference will be attended by over 1,000
senior and mid-level executives of chain drug stores and supermarkets with pharmacies as well as
suppliers of pharmaceutical products and services.
A major focus of the Conference will be on health care reform and the changing marketplace. The
morning of Tuesday, August 23rd is when you have agreed to give your remarks. We would like
you to address this audience on health care reform, and plans for welfare reform (specifically
Medicaid) from 9 AM-9:30 AM.
The audience has been closely monitoring the latest twist and turns Congress has been taking in an effort
to get a bill passed in this session. If you could comment on where the process is at the time of this
meeting, and the Administration's perspective on where the legislation is headed, if not passed by late
August, we would greatly appreciate your time and your unique perspective. As there will be many
pharmacists in management positions in the audience, your unique perspective of having grown up with
your father in the business, will be of particular interest to the attendees.
Carol, would you, or someone on your staff, kindly complete the attached form and send your bio and
a black and white photo by July 24th to the attention of Laura Cranston for our final program book.
Laura, herself a pharmacist, coordinates all arrangements for this meeting and looks forward to working
with you. She will contact you later this month to answer-any additional questions you may have and
to assist you in the preparation of your remarks.
Thanks again for your willingness to participate. Ron Ziegler and all of us at NACDS look forward to
seeing you in Orlando on August 23rd.
:i~~
liP
,
L Schneider
Director, Public Affairs
cc:
l
Ronald L. Zie ler Laura Cranston, V.P., Health Care Programs
413 North Lee Street, P.O. Box 1417·049, Alexandria Virginia 22313·1480
Phone: 703·549·3001
FAX: 703·836·4869
�Speaker Response Form
Please provide NACDS with the following information by Monday, July 24, 1994:
""
.,.
Brief Biography (1-2 Paragraphs in length)
_ ~ J-t\\~O '~
. /'
V""
. }lJ-IV'-'1 M \gJj CS I{
fl." .....+-- l
Black and White Photo
~
Completed Complimentary Registration Form
•
Hotel Requirements
Arrival Date and approximate time: _ _ _ _ _ _ _ _ __
Departure Date and approximate time: _ _ _ _ _ _ _ __
(Note: NACDS is pleased to provide complimentary lodging for one night)
•
Special Requirements for Sleeping Room (please circle all that apply)
Smoking Room
Non-smoking room
King-size bed
•
NACDS Closing Reception and Dinner on Tuesday, August 23, 1994 (6:30 PM-tO PM)
_ _I will be able to attend this function.
1 will NOT be able to attend this function.
•
Transportation: if travelling by air, NACDS will reimburse you for your coach travel. Please
indicate if you will be using your own travel agency or using the NACDS
Travel Agency, which is McNair Travel Management (Ellen McNair is our
contact)
Phone Number is 1-800-433-1790, or 703-836-1100.
MacNair Travel may ask for the following budget number #77220.20
1 will be using our personal travel agency.
1 will be using MacNair Travel agency.
�.NACDS
National Association of Chain Drug Stores
lack Futterman
Chairmall ot'tlle Board
Ronald L. Ziegler
Prcsidcut.:3 CEO
June 23, 1994
The Honorable Carol H. Rasco
Assistant to the President for Domestic Policy
Second Floor, West Wing
The White House
Washington, D.C. 20500
Dear Ms. Rasco:
As you know, the National Association of Chain Drug Stores is a strong supporter of President
Clinton's health care reform efforts. Along with the National Association of Retail Druggists,
NACDS formed the Community Retail Ph~macy Health Care Reform Coalition. Through this
Coalition we are mobilizing the 112,00 community retail pharmacists in over 60,000 community
pharmacies to promote the principles of the President's plan.
On behalf of Ronald L. Ziegler, NACDS President and CEO, we are pleased to invite you fb
address an important element of the NACDS membership. On Tuesday, August 23, over 1,000·..
executives who are the CEOs and senior level management of chain drug stores will gather fw
a 4-day Pharmacy Conference in Orlando, Florida. A major portion of the conference deals
with health care reform and the changing marketplace. On the morning of August 23, we would
like you to address this audience on the current status and outlook on a variety of domestic
issues, including health care reform.
By way of background, at this same meeting in 1993, The First Lady was able to join us via a
live satellite feed, and for that we are most appreciative. This year, we have invited Vice
President Al Gore to be with us at this Conference and to review for the participants the current
status and outlook for health care reform. It would be a great opportunity for you both to be
with us....and perhaps, with such a large elderly population in Florida, if desired, we would be
happy to work with you to also conduct a tie-in senior citizen event which would support the
President's objectives.
413 North Lee Street, P.O. Box 1417·D49, Alexandria Virginia 22313·1480
Phone: 703·549·3001
FAX: 703·836·4869
�Page Two
June 23, 1994
We look forward to your acceptance of our invitation. I will contact your office shortly to
discuss your possible involvement at our conference.
Sincerely,
7';;::;rS;hn~
Director of Public Affairs
cc:
Alexis Herman
Ronald L. Ziegler, NACDS
Enclosures
Phone: 703-549-3001
FAX: 703-8
_
�: SENT BY:Xerox TeleCopier 702Q
7-~O-94
The White
,':37
2024~66423:#
House~
,
.\
Contact person; Pat Romani
Phone number: 6- 2 216
Date of request: i - 20 - 94
ACCEPTANCE OF TRAVEL ExpENSES FROM OUTBIDE SOURCE
.
\
~
. .
.
,
, InordertcJ ~nsider whether the Govcmment.may acceptfromanoutside,soutce pa~ntof
your travel,' subSistenCe
rdated expenses under'the GSA travel r1l1e, you must complete the
, information below. The outsi.:ie sourcerieed not be a 501(c)(3) orsanization, but if it iltplease
.
state soon this form and include the IRS determination letter.
and
Pleaseinc1ude a copy of the lc~tter of invitation if one was received.
Your name and positioa:
Carol H. Rasco
Ass~Lstant
to the President for Domestio Folicy
'Nature or meeting or,shrtllar !~nC1t:ton and'bow it relates to your onkiat dpties:
Speeoh before Co~vetition 9f National ,Association of Chain Drug Stores
reo Health Care Reform anCl,t-ielfare,Reform
, Date and place($) oftrawb '
August 22 and 23, 1994
Orlando, FL
'
Persons or entity. making the .payment (please also note aD)' Onuc:lallDterests 'of the person or
,entity known to you that may beaJ'tected by the exercise or your .Government responiibiliUes): .
National Ass~cia'tiori
;i
Chain Drug Stores
Nature of expense(s) paid for::
,
,
,
Airfare' ano, one night
~od9in9
Method and approximate amount ,of payinent (payment may be made either In..k1nd or by
check made payable to' iT.s. Treasury; you may not directly ~iye payment in cash or check
,made out to you):
'
.
.
!
i ".
.,
, ' , .
,
.
This form and any accompanying memorandum of approval must be attached to your travel
authorization. You must complete a travel vO\lcher followin& ~e trip. Please send completed
form to ~oom 128. OEOB, at least 3 days before commencement of travel.
','
'
; iliJP~, ~~1{)"GJ~ ~6) §~ ~~L+; (,S-,~ I~"
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_ SENT BY:Xerox Telecopier 1020
I,
1-,0-94: ":38
:
The
W~ite ho~s~~
NACDS
---_________________
,'.
~---------.I
Nat,~on~ Association ofCh~ Drug Strjr~s .
Jack Futterman'
Chairman of the Board
July 14, 1994
Ronald L. Ziegler
. P,enlient C!I CEO .
The Honorable carolH~·Ra.sco,
. Assistant to the President for Domestic Poli~y
Second Floof, West Wing
The White House .
Washington, D.C. 20500
.
Dear Carol:
We, are pleased you have accepted .4JU! invitation to address the NACDS Pharmacy Conference on
Tuesday, August 23 1 1994, in Orlandc), Florida. The 4-day conference will be attended by o'/er 1,000
senior and mid·level executives of chain drug stores and supermarkets with pharmacies as well as .
suppliers of pharmaceutical -products and .services. '
.A major focus of 'the Conferent:e will be on health care reform and the changing marketplace. The
morning ot Tuesdayi Aupst 2:~rd bl when you have agreed to give your remarks. We would llke
you to address this audience nn bE!81th care refonn, and plans' for welfare reform (specifically
Medicaid) from 9 AM-9:30 A}.[. ,
The audience has been closely monitOring the latest twist and turns·Congress has'been taking in an effort
to get a bill passec:l in this sessie'n, U' you could comment on where the process is at the tlme of this
meeting, and the Adrninistration"s perspective on where the legislation is headed, if not passed by late
August, we would greatly appreciate your time and your uruque pers~tive. As there will be many
pharmacJsts it:' management positions in the audienCe, your unique perspective of having grown up with
'your father in the business, will be of particular interest to the attendees.
Carol, would you, or someone on your .staff, kindly complete the attached form and se~dyour bio and
a black and white photo' by July 24th to the attention of Laura Cranston for our final program book.
Laura, he.rself a pharmacist, coordinates all aITa.'lgements for this meeting and looks forward to working
with you. She will contact you .later this month to answer any. additional questions you may have and
to, assist you in the preparation of your remarks.
.Thanks again for your willingness to participate. Ron Ziegler and all of us at NACDS look forward to
..seein, you in Orlando on August: 23ra.
..
,
.
Sincerel~
!r]
..' .
.
SeM"""."ei\loder-..".......-
....
Director, Public Affairs .
cc:
Ronald·L&..Ziegler. Laura Cranston, V.P., Health Care Programs
= .----
�Howse~
The white
; ~ *"
SptUlker Response Form
: Pie.ueprovidc NACDS with the following information by Monday, July 24, 1994:
~
-• . ; '
,
/I •••• ..}.
Brief Biography (1-2 Paragrjphs in length)
j'tJ-/""'"
r-1 \ ~,
l
,
~ {f
'f, '''''''Black'and W h i t e P h O t D ' , ~ M\~ 1~ ,
,-_._"
Completed Complimentary Ref:istration Form
• '
Botel Requtremeats ",
Arrival Date and approximate time:...._______
•______
•
Departure Date and approximate time:_._'_.____ _____
.
.
.......
(Note: NACDS is pleased to provide complimentary lodging for one nlg1:l)
•
Sleel~lng
Special Requirements fer
,Smoking Room
" Non-smoking room
King"size bed
Room (please circle all that apply)
NACDS Closina Reception and Dumer OD Tuesday, AullJ,St 23, 1994(6:30 Pl\1·10 PM)
I will be able to attend tris function.
''
•
-
'
_ I will NOT be able to at:cnd this function. "
'
,
,
,
,
.'
'
Transportation: if travelling',y ait t NACDS will reimburse you for your coach travel.' Please
indicate'if you will be using ,your own travel agency or using the NACDS
~,
,
,', Travel Agency, which-is McNair Travel Managemci\t (Ellen McNair is' our
contact)'·'"
' .
-.
':
'
..'
, Phone Number is 1-8Q0-433-J790,or
"
..
"
"
703-83~llOO.',
, ,MacNair Travel may ask (01' the CollowiDl budaet number #77220.20 '
'-,
I will be using our personal travel agency.
, I will be using MacNair Travel agency.
I
I
�Iha White
..
House~
,·····NACDS
,
.
>l
: ..
8
N atio:lal,,~\.ssQciation of Chain Drug Store! .
I
;
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h"kF\lttcrm:ln .
. CiJa,r11WJI .ot'tht Board
Ror.ald L ZkSl:kr
l'r.lidwt U r;EO
,
;
.
June 23,1994
The Honorable Carol H. Rasco .
Assistant to the President for Domestic Policy
Second Floor,West Wing
The White House
. Washington, D.C. 20S00
Dear Ms. Rasco:
As you know, the. National Associ;iltion of Chain Drug Stores is a strong supporter of Prcsident
Clinton's health care reform efforts. Along with the National Association of Retail Druggists,
NACDS fonned the Community R.etail Pharmacy Health Care Reform Coalition. Through this
Coalition we are mobilizing the 1t"OO comm~nity retail pharmacists in over 60,000 community
pharmacies to promote the p:rinciples of the President's plan.
On behalf of Ronald L. ZJea;ler, NACDS' President and CEO, we are pleased to invite you I)
addteu an importan~ clement of the NACOS membership. On Tuesday, August 23, over 1,000 "
executives who are the CE().I and senior level management of chain drug stores will' gather fOfi: .
. a 4-day Pharmacy Conferall:e in .~, Florida.·· A major pomonof the conference deals
with health care refonn and thech,uigirig marketpIace.On the morning of August 23, we would .
like you to address this auchence on the current status and outlook.on a variety of domestic
issues. includi~g health care reform. ". .
.
By way of backaround, at this san'le mectirig in 1993. The First Lady was able to join us via a
live satellite feed, and for filat we, are most. appreciative. This year, we have invited Vice
President Al Gore to ,be with us at this Conference and~ to review for the participants the current
status and outlook for health car:ercform: It would be a great opportunity for you both to be
with·us....and perhaps, with such a largc elderly population in Florida. if desired, we would be
happy to work with you to also'cunduct a tie·in senior citizen event which would support the
President's objectives. .
i .
j
.
,j
.,
! .
oil ~ "J""~h T.ep. S~p.I'.
po.
n()~
1417,D49. Aleltlndrill VirQ:inia 22313·1480
Phone: 70~·549·3001
FAX: 703·83t4i·4869
�"'J
!,
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-.;1"
I
I 1 ; ;jl;j
Ine Wlllte MOuse'"
'Page Two "
'June 23. 1994'
We look forward to your acceptaJ'ice' of our invitation. I will contaCt your office shortly to .
discuss your possible involvement at our conference.
,
,
Sincerely, .
' .., "
·7~~(~··
, PhilliP~" Schneider
'
"'"
Director of Public Affairs '
CC:,
Alexis' Herman
.'
Ronald L. Ziegler. NACDS
Enclosures .
,
-,'
:'"
�..
".
.~:.
Ine Wnlte House.. .
"
:.
,
.
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'FAXCOVD "SUft' ,
.
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rOR DoMEsTIC 'POLICY
SECOND FLOOR. WEST WING
.
OrFI.CE OI'THE ASSIS'!t'AK'1' '1'0 TU PRES%EJDrl"
, THE WHITE HOUSE
WASHINGTON, DC
TO:
E\oet=:~g
C \r-o.M ~9§n ..
ta-l0±st~A
FAX'#:
,FROM: CAROt H.
DATE:
20500
, '(202)456..2216 PHONE'
(202)456-2818.rAX
RAS~Ct&+; tiOfY'9:4;J
~
1Jd:P I qiL____·--0:------------
NUNDa,o; PAGES. (tnc:l'I,u:1J.ng caver sheet): __
&_,_______
COMMEN'rS:
~eQ:2.§: hQVE S€tY'eOf'k'!' "/4d v)';;SZ'- -'
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The dacu=ent aQCa=p~Yinq this fac:.~l. ,transmtttal $n•• t ia
,in'tand.ed only. far the usa of the 'individual or entity ta whom it
is 'addressed. '!'hi. Pl• • sage c:ollta:Lns informatJ.oD which' may be
privileged •. caDt1dan~ial or exempt, from disclasura under
applicable 1.11_ It;.;;her:eadu: at thLs message is nat the
. intended rBcipier:~t, ()r the employe. OJ::' &gllnt: r ••pol)sible for
dal1veri.ng 'th. _1S.all_ to th. inteftdeci rec1p:i.ea.t. you .43:'eheraby
not~f1ed that aA)~ dilBclasura. di•• em.nat:lon.copyiilg or
41stribut~on,
th~·ta.kin9''''of any action inra11anc•. on·tha
. contents ,ot ttus c:ommmication is strictly prahib.ited. .
or
-
�CLINTON LIBRARY PHOTOCOPY
�a~'iJ;;!~LU/J
..
A
/(~. ~ (J
1/dY/ 1'/
~e~~
CAROL H. RASCO
.
,
~
~
ASSISTANT To THE PRESIDEHT FOR DOMESTIC, POL~ 7!~O~
,~-r
TRAVEL CHECKLIST FORM
FUNCTION/
ACTIVITY'
INITIALS .OF
DPC STAFF PERSON
0U?1
COMMENTS/
PROBLEMS
DATE(S) OF TRAVEL?
DESTINATION?
TRAVEL AUTHORIZATION
FORM COMPLETED?
MODE OF TRAVEL?
RESERVATIONS MADE?
IF AIRLINE, WISH
. AISLE SEAT.
TICKETS OBTAINED FROM
TRAVEL OFFICE?
r:es//2/~ .
HOTEL RESERVATIONS
MADE?
·L.~·
'-?<.-tL·UJ 8/5 .
CONFIRMATION NUMBER?
NOTE: ~ PrLLONS
NOTE: KOK-smKDIG
v
,.V' .
COMPUTER' SET-UP
AVAILABLE AT HOTEL?
DEDICATED LINE?
HOTEL FAX NUMBER?
CAR
RENTAL READY?
RESERVATION NUMBER?
MATERIALS FOR TRIP
(MTG. FOLDERS/SPEECH
MATERIALS) READY?
.'
WH OPERATORS,
SIGNAL & STAFF?"
TO
."
,
CAR,RESERVATIONS
MADE WITHWH GARAGE?
CUR DEPARTURE:""'"
'1) TICKETS PACKED?
2) ITINERARY PACKED?
TRAVEL
"
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CUR SCHEDULE: FAXED
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DAB: _ _ _ ·naTIALS: _ __
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, Lodging:
4:30
6:00
'Westin Hotel
1900 5th Avenue
Seattle, WA 98101
Phone:·
206"-728-1000
Fax
206-728 2259
General Meeting Between representatives from
.the Federal Goverriment and Roundtable participants
concerning Future ADA Implementation
WEDNESDAY, AUGUST 24
1-800~-921-7576
PAGENET NUMBER
Bruce Reed will attend WH Staff Meeting at 8:15
8:45a.m.
1:00p.m.
8:36p.m
SPEECH
National Council on Disability Quarterly Meeting
LV Seattle/Tacoma
United Airlines Flight
1576
AR Washington Dulles
WH Car pick up enroute to West Basement
�_ TUESDAY AFTERNOON FLIGHT INFORMATION
; 23 'AUGUST 1994 .
12:20
1:15
Seat 8D
LV Orlando
AR Memphis
1:50
4:27
Seat 8D'
LV Memphis
AR Seattle
Taxi Ride:
- Northwest
Flight 957
Northwest Flight 987
approximately 30 minutes
cost, approximately $25. - $30.
Lodging:
Westin Hotel
,1..900 5th Avenue
Seattle, WA 98101
Phone:
206-728 1000
Fax
206-728-2259
CHR should indicate at hotel
-check-in desk that she is on
"NCD Room List" ,
4:30 - 6:00
General Meeting Between representatives from
-the Federal Government and Roundtable Participants
concerning Future ADA Implementation
(CHR hopes to attend last part of meeting)
Meeting Room: ' Cascade Room - 2nd floor)
Dinner:
Marca Bristo and approximately 10 - 15 people
at restaurant owned by deaf/blind person
Ragin' C a j u n '
~
(They will either see CHR at meeting (above) or
leave message at hotel reo where to meet, etc.)
�AUGUST 23, 1994
Bruce Reed will cover WH,8:15 meeting
Political Point Counterpoint Breakfast
7:30 a.m.
CHR:
seating at head table
Members of Panel:
'Moderator:
Speaker:
Speaker:
Others seated at head table:
Ron Zeigler
Marlin Fitzwater
Chris Matthews
Ron and Nancy Ziegler
Jack Futterman, Chairman of the Board, NACDS and
Chairman of CEO of Pathmark Stores, Inc.
Estelle Futterman
Stew Turley, Chairman and CEO, Eckerd Corporation
Frank Newman, Eckerd's President
Earl Heisey, Zeneca Pharmaceuticals, sponsor of th~ breakfast
Kathy Taylor, McNeil -Pharmaceutical
CHR SPEECH:
9:00 - 9:30 AM
(Address on Health care reform, and plans for welfare reform,
specifically Medicaid - these are requested topics)
THERE WILL BE NO,Q AND A'S FOLLOWING SPEECH
Note:
Pharmacy Press which normally cover events
have been invited and will be in attendance
Orlando Senti'nel, press hav,e been invited
and NACD folks-think they will attend
and called to see if CHR would meet w/rep.
following speech.
(C~R agreed apd message
'has been relayed that IF Sentinel reporter
is present after speech CHR will speak with
him/her)
ABC/CBS/NBC Affiliates in FL have been invited
to attend - no response as yet from them (8~19)
Chauffer driven car will bf;1 available at entrance to hotel
at 10:45 a.m. to drive CHR ,to airport. (These arrangements
were made by NACDS to make sure CHR at airport on'time
if CHR wishes to adjust time contact: (Sally Cramer 407-238-8716
or 407~239-4200 (hotel #)
�,
.
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
TRAVEL SCHEDULE
1-800-921-7576
PAGE NET NUMBER
MONDAY, AUGUST 22
1:00 pm
Depart West Basement enroute to National
WH Car
1:25 pm
Arrive National
1:45 pm
Depart USAIR Flight 1759
. 3: 53 pm:
Arrive Orlando
Lodging:
Orlando Marriott World Center
8701 Wor,ldCenter Drive
Conf. #:
8066448a
Phone:
40.7 -239 .:.4200
407-238-'8777
TUESDAY, AUGUST 23
1-800-921-7576
PAGENET NUMBER
Bruce Reed will attend WH Staff Meeting at 8:15a.m.
7:30 a.m.
Breakfast Meeting
9:00 a.m.
SPEECH
National Association of Chain Drug
Stores Conference
12:20p.m.
1:15 p.m.
LV Orlando Northwest # 957
AR Memphis
1:50p.m.
4:27p.m.
LV Memphis Northwest #987
AR Seattle
.
,.
�Bruce Reed will cover WH 8:15 meeting
WEDNESDAY, 24 AUGUST 1994
8: 45 - 9 :,15
SPEECH BY CHR
, as listed on agenda:
Current Major Activities of the DPC
Opportunities for Collaboration
Specific Areas for Collaboration
Meeting Room: Cascade Room
Taxi to Airport
Drive Time: Approximately 30 minutes
Cost:' $25 - $30
CHR MUST PICK UP BOARDING PASS IN SEATTLE AT AIRPORT!!!
(because this flight had been full and CHR was wait-listed
before space became available. Therefore,
American Express cannot issue boarding pass ~ CHR will
have to pick up at United counter in Seattle before
boarding plane)
1:00
8:36
LV Seattle/Tacoma
United Airlines Flight 1576
AR Washington Dulles
Seat 11C
WH Car pick up enroute to West Basement
Baggage claim level pick up
(approximate 35 - 40 min. drive time)
�AUGUST 22, 1994 TRAVEL ARRANGEMENTS
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
1:00,pm
Depart West Basement enroute to National
WH Car
1:25 pm
'Arrive National
1:45 pm
Depart USAIR Flight 1759
Seat 13C
Arrive Orlando-
3:53 pm
CHR will be, met at airport gate by Uniformed Chauffer
will be carrying sign: RASCO/NACDS (please note:
Ron Waspe , will be on same flight as CHR and will
travel with her, to hotel)
(approximate drive time to hotel:, 30 minutes)
CHR will be driven to:
Orlando Marriott World Center
8701 World Center Drive
',Conf. #:
80664482
Phone:
407-239~4200
Fax:
407-238-8777 '
Dinner:' Rob Waspe, Senior Vice President of Public Policy,
NACDS (dinner tentatively set for 6:30 p.m.)
NOTE* "
Mr. Waspe will be on same flight to Orlando
as CHR
�..
AUG - 8 REC'O
NATIONAL COUNCIL ON DISABILITY
An independent federal agency working with the President and the Congress to increase the
inclusion, independence, and empowerment of all Americans with disabilities.
August 3, 1994
The Honorable Carol Rasco
, White House Domestic Policy Council
White House
Washington, DC 20500
Dear Ms. Rasco:
On behalf of the Niltional Council op Disability ,'-[would 'lik~ 'to invite you to p~rt!Cipate
in our next quarterly meeting which wUl be held~~ugust 22-:-24, 1994 at the Westin",!
" . Hotel, 1900 Fifth Avenue, Seattle, Washington, (2~r728..1 000.\ This meeting will De
attended' by the Council's current Members and staff, leaders of Federal agenCies
serving people with disabilities, leaders from the disability community, and the public.
The meeting agenda will include an orientation for the 'President's recently confirmed
Members of the Council, a Council business'meeting, a strategic planning session, a day
long roundt~ble session on the Americans with Disabilities Act, and presentations on the
current status of Federally supported .programs serving people with disabilities •
. ', .
--
J
","
This would be an excellent opportunity for us to hear about the current and planned
activities of the White House Domestic Policy Council regarding Americans with
disabilities. It would also afford you an opportunity to identify areas in which the
Council might be able to assist the Domestic Policy Council in its important work. As
you might recall, we had a general discussion regarding this later issue during our
'recent meeting. Your attendance at our upcoming meeting would provide us with an
opportunity to follow-up in this area and engage in substantive work that would benefit
all Americans with disabilities.
I know there are many demands on your schedule. The ideal time for your presentation
would be at 9:00 am on August 24. However, we could schedule a presentation by you
or your designee at any time during the day on August 22, August 23, or August 24 .
(before noon). Please let us know what might work best for you or your designee. '
In closing, let me once again thank you for all of your efforts on behalf of Americans
with disabilities and express my wish that you will be able to join us in Seattle. Thank
you for your attention to this request.
.
cere
~
{J./ [fA
"
M rca Bristo
Cha'irPerSon,
1331 F Street, N.W. iii Suite 1050 II Washington, D.C. 20004-1107
(202) 272-2004 Voice _ (202) 272-2074 IT • (202) 272-2022 Fax
�..
i
,,/,1,
National ~sociation of Chain Drog Stores
M E··M 0 R AN D U·M
eAugust 18, 1994
, FAX TRANSMIIT~k FORM,
TO:,
FAX:
Pat Romani, The White House
202-456-2878
FROM:
LaW1l crnn,' ston, NACDS.
703/836-4869
'
PAX:
~
.
,',
,
NUMBER OF PAGES (including cover sheet):
\
.\
1
MESSAGE:'
As per our discussion today, we would be pleased if Carol could join us on two separate occasions while, ,
she is in attendance at the Pharmacy Conference.
.
The first is for a brief meeting with our Senior Vice President of Public Policy and General Counsel, Rob ~
rtunity t°edans:er an Y queshtionkseds~e mthay hhave abodut th1e \~f\
uld
...
W8Sped': Thi' S ':'nob ~~~e RObTh~ OPPOb
h h
,.au tence she Wl e s~lg to.
15 can e arrang
alter seas c ec
mto e ote1 an cau d
'-J
be done over dinner that evening, if Carol is in at that time.
Additionally, as I me~tioned we have a Political Point Counterpoint Breakfast on TuesdaI morning,
August 12nd at 7:30 AM~ We would be most pleased if Carol would join us at the head table. Those
who will be seated at the head table are:
.
Ron Ziegler, 'Presidelll &: CEO, NACDS
Nancy Ziegler
Jack Futterman, Chairman of the Board, NACDS and
Chairman &; .CEO '0/ Palhmark Slores, Inc.
Estelle Futterman
MorUn FillWater. speaker at the breaJifasl
Chris Matthews, speaker al lhe. breakfast, .
Stew Turley, Chairman and CEO, £Ckerd Corporation
Fra"" Newnzai1.. Eckerd's Presidelll .
Earl Heisey~ Ze1U!ca Pharmaceuticals. sponsor a/the breakfast
fIIarhY Taylor, McNeil Pharmaceutical
My assistan (~nge
. 1 fO~aId to me the flight arrangements for Carol, when Ihey are finaIiz.ed. Rob
Waspe will be ',"
oth Friday and Monday. If you or Carol have anyadditiorial questions, pleaseJeel
fre& to call the~. or contact me at the Marriott in Orlando. Thanks again for all of your assistance..
'PI..,"....
1n~-"4CMOOl
FAX: 103.836-4869
)::.(\\
\ (f.
�CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
TRAVEL' SCHEDULE
1-800-921-7576
.PAGE NET NUMBER
MONDAY, AUGUST 22
1': 00 pm
Depart West Basement·enroute to National
WH Car
1:25 pm
Arrive National,
1:45 pm
Depart USAIR Flight 1759
3:53 pm. Arrive Orlando
Lodging:
Or1c;mdo Marriott World Center
8701 World Center Drive
Conf. #:
80664482
·Phone:
407 -23 9-4200
Fax:
407~238-8777
'TUESDAY, AUGUST 23
1-800-921-7576
PAGENET NUMBER·
Bruce Reed will attend WH Staff Meeting at 8:15a.m.
7:30 a.m.
Breakfast Meeting
9:00 a.m.
SPEECH
National Association of Chain Drug
Stores Conference
12:20p.m.
1': 15 p.m.
LV Orlando Northwest # 957
AR Memphis
1:50p.m.
4:27p.m.
LV Memphis Northwest #987
AR Seattle
�Lodging:
Westin Hotel
1900 5th Avenue
Seattle, WA 98101
.Phone:
206-728-1000
Fax
206-728~2259
4:30 - 6:00
General Meeting Between representatives'from
the Federal Government and R-oundtable Participants
concerning Future ADA Implementation
WEDNESDAY, AUGUST 24
1-800-921-7576
PAGENET NUMBER
Bruce Reed will attend WH Staff Meeting at 8:15
8:45a.m.
SPEECH
National Council on Disability Quarterly Meeting
1:00p.m.
LV Seattle/Tacoma
8:36p.m
AR Washington Dulles
WH Car pick up enroute to West Basement
.
United Airlines Flight
1576
�CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
TRAVEL SCHEDULE
1-800-921-7576
PAGE NET NUMBER
MONDAY, AUGUST 22
1:00 pm
Depart West Basement enroute to National
WH Car
1:25 pm
Arrive National
1:45 pm
Depart USAIR Flight 1759
3:53 pm
Arrive Orlando
Lodging:
Orlando Marriott World Center
8701 World Center Drive
Conf. #: 80664482
Phone:
407-239-4200
Fax:
407-238-8777
TUESDAY, AUGUST 23
1-800-921-7576
PAGENET NUMBER
Bruce Reed will attend WH Staff Meeting at 8:15a.m.
7:30 a.m.
Breakfast Meeting
9:0Q a.m.
SPEECH
National Association of Chain Drug
Stores Conference
12:20p.m.
1:15 p.m.
LV Orlando Northwest # 957
AR Memphis
1:50p.m.
4:27p.m.
LV Memphis Northwest #987
AR Seattle
�Lodging:
Westin Hotel
1900 5th Avenue
Seattle, WA 98101
Phone:
206-728-1000
Fax
206-728-2259
4:30 - 6:00
General Meeting Between representatives from
the Federal Government and Roundtable Participants
concerning Future ADA Implementation
WEDNESDAY, AUGUST 24
1-800-921-7576
PAGENET NUMBER
Bruce Reed will attend WH Staff.Meeting at 8:15
8:45a.m.
SPEECH
National Council on Disability Quarterly Meeting
1:00p.m.
LV Seattle/Tacoma
8:36p.m
AR Washington Dulles
WH Car pick up enroute to West Basement
United Airlines Flight
1576
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2024561644
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#PAGES
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3
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0:01'29"
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XEROX TELECOPIER 7020
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
SUBJECTffITLE
DATE
Rasco to Miller and Romani re Gov's Phone Number (partial) (1 page)
08/22/1994
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: [Loose Documents]
20 I 0-0198-S
kc220
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(1) National security classified information [(b)(I) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�[00]1
E X E CUT I V E
OFF ICE
o
F
THE
PRE SID E N T
22-Aug-1994 11:46pm
TO:
Rosalyn A. Miller
FROM:
Carol H. Rasco
Economic and Domestic Policy
CC:
Patricia E. Romani
SUBJECT:
Gov. 's Ehone number
I thought the number for Voinovich had been written on my day card
or the schedule in my travel book but it is neither place. Please
make sure you feed it into beeper at 10 a.m. so that I can make
the call. ,Thanks.
~'
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Carol Rasco - Issues Series
Creator
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Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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Clinton Presidential Library & Museum
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92 folders in 7 boxes
Text
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Complete Scheduling per 10-11: [Loose Documents]
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 122
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Format
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Adobe Acrobat Document
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Reproduction-Reference
Date Created
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12/4/2013
Source
A related resource from which the described resource is derived
2010-0198-Sb-complete-scheduling-per-10-11-loose-documents
-
https://clinton.presidentiallibraries.us/files/original/26c9abbe034140adcae57dc38f0cb54d.pdf
04f3652d549a71d2166e5a3675e5e5b8
PDF Text
Text
WithdrawallRedaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECTrrITLE
RESTRICTION
00 I. itinerary
AmEx Travel, WDC to Minneapolis St Paul MN and ret, 09/23
09/24/94 (partial) (I page)
09/20/1994
P61b(6)
002a. report
Fax Transmission sheet (partial) (I page)
09/24/1994
P61b(6)
002b. schedule
Rasco, for Monday, September 26 (partial) (2 pages)
09126/1994
P61b(6)
003a. schedule
. Rasco, for Monday, September 26 (partial) (2 pages)
09/26/1994
P61b(6)
003b. schedule
Rasco, for Tuesday, September 27 (partial) (I page)
09/27/1994
P6/b(6)
003c. schedule
Rasco, for Friday, September 30 through Thursday, October 6
(partial) (2 pages)
09/30/1994
P61b(6)
004. list
Disability Leadership Forum Participants (4 pages)
nd
P6/b(6)
005. schedule
Rasco, Saturday, September 17 through Monday, September 19
(partial) (I page)
09/17/1994
P6/b(6)
006. form
overnight FedEx label (partial) (I page)
0911411994
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: Easter Seals Society Keynote, 23 Sep 94, 7 :OOpm
20 I 0-0 198-S
kc219
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(I) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
bel) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release Would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�~ENT
BY:Xerox Telecopier7020 ; 9-20-94: 12:31
2024566423'"
'EXECUTIVE OFFICE OFTHE PRESIDENT
OFFICIAL TRAVEL AUTHORIZATION
(PriNty Ac'
S.,."".'""d ;lIs""cllolll
Oil
62878:# 2
. I. TYPE OF AUTHORIZATION
Hel"
o Amendment Q""Nild
Sit",., imru
UTDY
I
o (No" EOP !£mplo:,:cll 0,,/.\,)0
Invitation..
I
Reloc:ation
Carol H.. Rasco
-3. nd.o'..... '.lcr
4. AGENCYIDIVISION
Assistant' to 'be President for Domestic Poli~y opc/ope
7~~'
6. omdat Out, SUltion . .
, S. Ollie. Phone
o Actual SUbsistenee ("""slIdl t:iIrIllrUIGIU:fS)
RDttW:
Washinqton, DC
456-2216
.. TRA.VELINI'ORMATION
Deliver Keynote address at National Ealter Seal Society and
Universit~ of MinnesotA"
Center for Citilenship and DemocraC1
Launch Proqram
.
DATE(S): Trave. Belin On ..L 11.1....9..4
Triv,l End On .L./..2.4/--9.4
rrtNERARY: ,Point or Orilin (Ctf1. $IQl,) _ _ _ _ _ _ _ _ _
W_a_s_h_i_n.:;q_t_o_n~,_'_D_C______________
Minneapolis, MN
PrnHOSE:
'
Place(s) or Official VJsilalion (CIty. SIGl~)
.
-----:--;;;...--~-------~----'------
Washington, DC
Polnof tteru m (CIIy.• Sl1I2Ie ,
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MODE OF TRAVEL
9.
10. ESTIMATED COST
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(a)
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. eo..:h TOllria.l -
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,
14(") I "nit)' dla' the travel here.. WII re"I...... and determined
10 be . .,nda. ror Ihe a«ompUahment of...-I:)' prop'allll
IIftdmlafou
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OAfOIM22
20.00
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11. SPECIAL EXPENSE AlJTHORIZED
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(tax!)
'
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.
�uENT BY:Xerox Telecopier 7020 ; 9-20-94 ; 12:32
2024566423~
62676;# 3
AUG - 9 REC'O
August 8, 1994
Carol H. Rasco
Assistant to the President.for
Do~estic Policy
The White House
Washington, D.C.: 20500
,: Dear Ms. Rasco I
We hope that you will join us as our keynote speaker when
the National Easter Seal Society and the University of
Minnesota's Center for Citizenship and Democracy launch the
first Community Leadership Train.inq Proqram for people with
disabilities. Our aim is to give people with disabilities
who are interested in greater community involvement Bome of
the skills they'll need to be more effective leaders in
.
,graaaz::oots community politics and on issues they choose.
As you know, people with diiabilities have not been
encouraged to get involved in their communities. Recentlr"
'there has been support for people with disabilities becom nq ,
,active in disabillty rights issues. But we're planning to
,
take this to the next step. We believe, and, people with
disabilities have told us, that disabled citizens can make a
very real impact on other issues, such as the environment,
educational reform, crime and drug abuse prevention. We
also believe that disabled citizens have mu'ch to ,offer a8
members of non-profit boards and civic commissions. This
conference is the beginning of anon-going program to
provide people with ,disabilities with the information and
the skills they need to add their VOices to issues beyond
disability.
Joe Romer, sr. v.p., publiC affairs, of the National Easter
Seal Society attenijed a meetin" in March where Sil.l Galston '
spoke about the administration 8 and Iour commitment to The '
New Citizenship program's initiative for reinventing ,
. qovernment. Our program expands Dr. Harry Boyte s and Dr.'
Benjamin Barber's ideas for developing greater citizen
involvement to include people with disa tltties in the
procesl.
The participants in this first weekend training program are
coming to learn how to'be more visible and influential in'
their communities. If you could tell them how you qot
involved" beginning as an advocate for your Bon and leading
'to your domestic policy-making roles in Arkansas and now for
the nation, it would provide participants with a wonderful
example of how people can make a difference. '
I
(more)
National Easter Seal Society
1:10 lV,'s/ ...../(JI!rf.ll' ,':ilr(.'('/
Suit" / H()CJ
.i..J..1.ill~tl.WJ.:).r It IInls r~~!'2g~ . .J,"m:!
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�2024566423"
. 62676:# 4
Letter to Carol H. Rasco .
Assistant to the President for DomestlcPolicy
August 8, 1994
page 2'
The 'f!rat community leadership development program will be
held at The 'Marquette Hotel in Minnea~li8. The keynote
addr.ea., which we woul~ like you to. deliver I ie ·;part .of the
opening dinner at ,.00 p.m. ' on Friday, September 23, 1994.
Of course we would be pleased if you would also join us that
afternoon fo~ the first working aession, and for as long ae
you.are interested.the entire weekend. '
Enclosed, for your further information, is a copy of ' the
Disability Leaaerahip Forum'. Community Leadershlp
.
Developm~nt Program registration packet.
.'
Sara Brewster.!s coordinating thi~.prograin for tha
National Easter Seal Society and will contact your office
the week of August15~ .1994. .
.
'
I hope you can j'oin UII.'
"
Sincerely,
~·L/'i.{~
I,,'
,
JUle. E. Williams" Jr.
P~esldent and CEO
JW/sb
, encl.
"
�-SENT BY:Xerox TelecoPier 7020 ; 9~20-94; 12:33
1312'7261494
N. E. S. S.tt1
,
AUG 2 6 REG'D
Auquat 24, 19'.
TO: pat. Romani' .
A•• i.tan~ to Ms. carol Rasco
Assistant to ~e P:r••id.ant.for D01D.estic Policy
The White Houae
. Washington, C.-c. 20500
sara Braw.tar, a. v. p.
corporate Communications
Nat10nal Eaater seal. Society .
0: am!J:)\)r...entfor Ks. bsco'. travel anc! lodging
R
expanse. tor Disability Lea4ars:!r Fo~'.Cammgnity
Development Trainil'l4 Proqr~.8p
inq enqaqament -
in KiM.apoli., saptDbar 23·, 1'94.
FIlOH:
I
0
,
.
.
Should )fa. Rasco agree to join us as our keynote; ~p.aJc:er
tor his conterence, the National Eastar,Saal Socie;,
t
would moat certainly raimbur•• harfor all 'travel, lOdqinq
and m••l axpenae..
.
' ,
'.
,
~
.
':
!
, I look forward to hearing from you ,about' Me. Ra.~o'.
'plans. It would. ba wonclarful to have her 'ain us' as
we ba;in to 1nteqtate people with Clisabi11tle. into '
the lar9'1lX' mov8l1Ient to truly anhance our communities '.
through citizens' involvement.'.
.
"atl~
Ea.,er .oaI8odd,.
230 Wf1S1
MOIIf/l(~
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312 726.62OC) (IJncmt!)
,
-, I? "12".42.';8 ITDD}
�'SENT BY:Xerox Telecopier 7020
9-20-94
l2:33
2024566423"
THE WHITE HOUSE
, WASHINGTON
.
',.
September 6,' 1994
MEMORANDUM FO& JENNIFER PALMERI
'Office of the Chief of Staff
FROM:
. ",
SUBJECT:
'~.
, 'Pat 'Roman '
"
,Offi~e " , mestic, POliCY,
PPROVAL,
TRAVEL
'
Please find attached a Travel Authorization form and
accompanying documents relating, to
~ravel
,H . Rasco , Assistant to the Presicient for
by Carol,
O~mestic
Policy.
Thank you for your assistance with this, matter.
,
Approval Offieal
Signature
,
62878;# 6
�, ~t:Nr BY:Xerox Te Iecopier 7020
9-20-94: 12: 31
(, 'JS75
. 2024555423"
,52676;# ,
SEP 18 Ra:'D I.r A:ontactperSon: Pat Romani
:trPhone number: 456-2216
Date of request: 6.September 1994
tU:CEPTANCE OF TRAVEL EXEENSES EROMQW'SIDE SOUBCE
In order to consider·wbether the Govenu:i1ent may accept from aD 'outside source payment of
your traveL subsistence aDd related expeDSes under the GSA travel ruI.e. ),ou must complete the
iaformatioD below. The outside source need IlOt be a 501(c)(3) org&D.ization. but if it is, pJ.euo
swc sO 00. this form and. lndude the IRS determination letter.
. .
Please indude a copy
of the letter of invitation if one was. received.
Your nallle and polltloD:
Carol H. Rasco
Assistant t~ the President for Domestic Policy
or
Nature of meetlnl liD1l1ar tuDcdon aDd hQ)! it Rlates to !pur omelar dytlell
I
.
Keynote Speech for the National Ealter Seal Society reo
Disability Issues
Date and place(.)· or lraytb
September '23 and 24, 1994
Minneapolis, MN
Penoai or entity mllda. &llepa)'IDeDC (please also Dote ur ft~da1 ~terell' orthi penoa or "
cailCy bon to )'ou lbat ma, be aaectect by the exercise ot ),ollr.Gov.rament, respon.lblllUa)1
.
.
,
National Easter Seal Society
Nature of expense(l) paid ron .
.R ound-Trip air .fare
Lodging and meals
.
Method and approximale.8JDount or Pl)'llleDC (p&)'IDeat ...y be .~d. either la.kliad or by
check lIlade pa)'able to U.s. Treasurr, you may Dol directl)' receive pa)'lllent 1ft cash or check
made out to )'ou):
.
.
Reimbursement to U.S. Treasury
.
.
.i:
This form and any accompanying memorqctum of approVal muSt be attached to your travel
authorization. You 1'Dl1St complete a travel voucher following the trip. Please sead completed
before COl1lmeCccme..at of tr.~~·
I I Ji!!"""
ronn to Room 128. OEOji, at least 3 d~·
.
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authorization Qf travel. This infonilation iscdllect~di'undertM'al!tnoritydf 31 U,S;C.,,6pa, 41, U.S,C. 3101,
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b.~: c.()mple~e,dJ)Y
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�SEP 16 REGLJ fY ';contact person: ..' Pat
Roman i
456-2216
Date of request: 6 September .1994
:<r Phone number:.
ACCEPTANCE OF TRAVEL ExpENSES FROM OpISIDE SOURCE "
,
,
In order to consider whether the Government may accept from an outSide source payment of
your travel. SUbsistence and related expenses under the GSA travel rule, you must complete the
information below. The outside source ne~d ~ot be a 501(c)(3} organization. but if it i~ please
state so on this form and include the IRS determination Ietter.
Please. include a copy ~f the letter of invitation if one was received .
. '. Your .name and position:
Carol H. Rasco
Assistant to the President for. Domestic Policy
Nature of meeting or similar function and how it relates to your official duties:
Keynote Speech f6i the National Easter Seal Society reo
Disability Iss~es
Date and place(s) of travel:.
.'
September 23 and 24, 1994
Minneapolis, MN
.
Persons or entity making the payment (please also note any nnancial interests of the penon or .
entity knoWn to you that maybe atTected by the exercise of your .Government responsibilities):
.
,
Nat~onal
.
Easter Seal Society
<
','
"
Nature of expense(s)' paid fon
R0und~Trip
air fare
Lodging and meals
. '
'
Method and approximate amount of payment (payment may be made ~ither in-kind, or by
check made payable to U~S. Treasury; YOil may not directly receive payment in cash or check
made out to you):'
,
.. '
Reimbursement to u.S. Treasury
This form and.,any accOmpanying memorandum of 'approv31must be attached .to your travel
authorization. You must complete a travel voucher following the trip,. Please send completed
form to Room 128, OEOB, at. least 3 da~ bef?re comm.en.ce!p-e..n t of trav~J.(-{ I '.f I I .;.
~W,l.;~ «.L,~ 1Z:) 6~ ~ J'S~-I,'f ~.''"J
'.
�SEP 1 6 RfC'D fy .A:ontact person:
Pat Romani
~ Phone number: 456-2216
Date of request: 6 September 1994
ACCEPTANCE OF IRAVEL ExpENSES FROM OUTSIDE SOURCE ..
In order to consider whether the Government may accept from an outside s~urce payment of
your travel, subsistence and related expenses under the GSA travel rule, you must complete the
information below. The outside source need not be a 501(c)(3) organization, but if it is, please
state so on this form and include the IRS determination letter.
Please include a copy of the letter of invitation if one was received.
Your name and position:
Carol H. Rasco
Assistant to the President for Domestic Policy
Nature of meeting or similar function and how it relates to your official duties:
Keynote Speech for the National Easter Seal Society reo
Disability Issues
Date and place(s) of travel:
September 23 and 24, 1994
Minneapolis, MN
Persons or entity making the payment (please also note any financial interests of the person or
entity known to you that may be affected by the exercise of your .Government responsibilities):
National Easter Seal Society
Nature ofexpense(s) paid for:
Round-Trip air fare
Lodging and meals
Method and approximate amount of payment (payment may be made either in-kind or by
check made payable to U.S. Treasury; you may not directly receive payment in cash or check
made out to you):
Reimbursement to U.S. Treasury
This fonn and any accompanying memoraI}dum of approval must be attached to your travel .
authorization. You must complete a travel voucher following the trip. Please send completed
fonn to Room 128, OEOB, at least 3 da)JS befor.ee coor:mmencement o'J}~v~ t-l I
J I. I ~
~~
~
<l"()
S5fr
.. J'~'4'·-I.'f'
I
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
00 I. itinerary
DATE
SUBJECTffITLE
AmEx Travel, WDC to Minneapolis St Paul MN and ret, 09/2309/24/94 (partial) (l page)
09/20/1994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Scheduling per lO-ll: Easter Seals Society Keynote, 23 Sep 94, 7:00pm
2010·0198·8
kc219
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)]
Freedom of Information Act· [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(1) National Security classified information [(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(h)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(I) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�:;;,'F~':--'~ ,---:---r'~~-"
. r:
Amertca.n Express
.
Travel Related Servlcei- Company, Inc:.
White House Travel OffIce
. Old ExecuflveOffke Building, Room 87
Wasn'ngton,"D.C. 20500-0001
INVOI6~ I ITINERARY
Phone: 202 .456·2250
fax: 202 456·6670
SALES PERSON: 50
ITINERARY/INVOICE NO. OOOS350
CUSTOMER NeR: 1695000023
RWJUUS
In Em~rgency After Hours Callt
, 800 847·0242 (Toll Free In the U.S.)
Ygurc;p~ n-'!mMrl.s KC52 '.
DATE: zO SEP 9Jf
PAGE: 01
TO: WHITE HOUSE TRAVEL
.1600 PENNSYLVANIA AVE
'~ASH DC 20500·
FOR:
RA~CO/CAROL
REF:
~(C5SXD4L08
I
,.. ••••• _;... " ....
_~ ... ,,_,,~~ _ _, ... ~_~"';.: .. '!"."... ·hJ. ;·,~,.:,· ..... ~·.~··: ... ··;,.·~;;,..,..··"I""'!1':"..~:r,':,..,.j...:.,<01'!1 .•. r. ...' ..... :v.·:.Iir<":~,~,·~.;.':"
.23 SEP 94
AIR
t.
: 24.SEP
"AIR
94
;''''''
·-.;,·r"':-:"
- FRIDAY
NORTHWEST AIRLINES FL T:195 . 'ECONOMY .
LV WASHINGTON NArL
220P
AR.MINNEAPOLI5 5T PL
354P
RASCO/CAROL
SEAT-17F
- SATURDAY
NO~THWEST AIRLINES
.FLT:314
LV MINNEAPOLIS ST PL "
.ARWASHINGTON NATL
RASCO/CAROL
SEAT-24B
EQP: AIRBUS A320
NON-STOP
SNACK
EIlP: IrC'-9 STRE:TCH
NOH-STOP
ECONOMY
935A
.1249P
'.' 23 MAR 95
- THURSDAY
OTHER WASHINGTON
AIR TICKET
NWl127662678
RASCO CAR L
BILLED TO
426.00
426.00*
SUB TOTAL:
NET CC BILLING
0.00
TOTAL AMOUNT DUE
• TOTAL AIR FARE U9D426.00
FOR AFTER HOUR EMERGENCIES
CALL SOO-847-0242/YOUR HOTLINE CODE IS S-KC52
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , • • • • • • • • • • • • fllltI • • • •
RE"IHDER •••••••••••••• ~ ••••••••••••
ALL F.REQUENT Fl.YER BENEFITS EARNED ON OFFICIAL TRAVEL
ARE THE SOLE PROPERTY OF THE U.S. GOVERNMENT AND CANNOT
BE REDEEMED FOR PERSONAL USE •
•• G ••••••••••••••
•
•
•
• .. •
•
•
•
.. .. ..
•
"
. . . . . . . . . . . . . . . III
. . . . . . . . . . . . . . . . . . III • • • • • • • • • • •
ALL UHUSED TICKETS ARE TO BE RETURNED TO AMERICAN
EXPRESS OR YOUR TRAVEL COORDINATOR IMMEDIATELY UPON
RETURN FROM TRAVEL OR IdHEN TRIP HAS BEEN .CANCELED.
.... "
•• 0
•• "
•••••••••••••••••••••••••••••••
•
••••• "
••••
THANK YOU FOR TRAVELING WITH AMERICAN EXPRESS.
•
)-e
PHOTOCOPY
PRESERVATION
•
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002a. report
DATE
SUBJECTrrITLE
09/2411994
Fax Transmission sheet (partial) (l page)
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAiBox Number:
8505
FOLDER TITLE:
Complete Scheduling per 10-11: Easter Seals Society Keynote, 23 Sep 94, 7:00pm
20 I0-0 J 98-S
kc219
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(1) of the PRA]
P2 Relating to the appoi.ntment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)( 4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) ofthe PRA]
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
.
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�&I CRJDxn;n..lIlII
CAJIIt.OL H.
A&lS%BTANT TO THB
Bta~~
8.:1.5
Mee~~ng.
aen.1.or
COS
a1:::_~f
6.45
!iJ;30
OPO
SEN~OR
!iII .... 5
:1.0.30
'WH
OPC
Conf ... r e n e .
1.:1..
~
:EtAS CO
PRBS%PKMT YOa POK8ST%O
O~~~ce
M . . . . e"- ....S'
STAFF
Oa:!.:!.
Sr"-uf.1.ng.
Hyde Amend=ent
L . t t e r 8 (ORR'. o~f1Q"')
Kev.1.n Thurm.
HHS
contact.
Ju:1..1.a &90-61.33
s t e v e N.uw"-rtb and .:1u ... t;l..o ...
0
rep.
or.1.ak/Martha
:J.:a,oo
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e_-Adam.. #:1..t.. ... f ... y ... t t e
#)
M __ t.1.ng/A:!.;l..ce R1v:!.:Ln
D"- .....b"-:J."-ty Rev!Lew (OEOB 24$)
OP~
Staf~.
B~.n
& Jeremy
3.00
2.00
POL%C~
Square
c a r d.... pare'''',..... ;erom We_t:. a ...... m.nt
",nrC/ute t o H;!.l.l.
s e n a t o r RocKo~e:l.:l.er
Kart, Room :LOg (d.epart. Kor • • • hoe)
WH
3.:1.0
.... 30
3.30
J u . . . . . Wh;!.te
(they w1:1.:I. c o n t a c t
contact.
Tr.1._h.
224-6"'?2
OPO sta;e~.
a.1.:J.:J. G_:1..ton
NEC
Sta~f.
Peeer YU
WK c a r p;!.QKUP
.A:l:"r:l'Ve ... t ·WN
.... 30
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... n r o u t e
to
WK .
TRANSMISSION REPORT
_ _ _- - - - - - - I
THIS DOCUMENT (REDUCED SAMPLE ABOVE)
WAS SENT
**
#
***
NO
1
COUNT
2
**
***
SEND
REMOTE STATION 1.
~
START TIME
\3-24-94
12: "
TOTAL
DURATION
#PAGES
"23"
:2
0:01'23"
COMMENT
2
XEROX TELECOPIER 7020
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002b. schedule
DATE
SUBJECTffITLE
Rasco, for Monday, September 26 (partial) (2 pages)
09/26/1994
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Schedul ing per 10-11: Easter Seals Society Keynote, 23 Sep 94, 7 :OOpm
2010-0 J98-S
kc219
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI National Security Classified Information (a)(1) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of tbe PRA]
P3 Release would violate a Federal statute «a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA)
P5 Release would disclose confidential advice between the President
and his advisors, or hetween such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(1) National security classified information [(b Xl) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(?) Release would disclose information compiled for law enforcement
purposes [(b)(?) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b )(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�[oo2J,J
SCHEDULE
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
MONDAY, SEPTEMBER 26
7:30 - 8:15
Staff Meeting, COS Office
8:15 - 8:45
WH Senior Staff Meeting
9:00 - 9:30
DPC SENIOR-STAFF
9:30 - 9:45
DPC Conference Call
10:30 - 11:30
Briefing: Hyde Amendment
Letters (CHR's office)
Kevin Thurm: HHS
contact: Julia 690-6133
Steve Neuwirth and Justice rep. will attend
12:00
square
2:00 - 3:00
Meeting/Alice Rivlin
Disability Review (OEOB 248)
DPC Staff: Stan & Jeremy
3:10
WH car departure from West Basement
enroute to Hill
Senator Rockefeller
Hart, Room 109 (depart: Horseshoe)
3:30 - 4:30
4:30
4:45
Jesse White (they will contact J. White)
Contact: Trish: 224-6472
bpC Staff: Bill Galston
NEC Staff: Peter Yu
WH car pickup at horseshoe enroute to WH
Arrive at WH
SCHEDULE CONTINUED ON NEXT PAGEl
�.~
5:15
Marca Bristo: Swearing-In Ceremony
Reception: Indian Treaty Room
Sworn in by: Vice President Gore
(5:30 p.m. target for sw~aring in
per Ramona Lessen in Bristo's office:
~:j;?R6ftbW6)'i,~~~)
CHR will return to office before departure to Dirksen building
6:30
6:45 - 7:15
WH car enroute to Dirksen Building
US Dept. of Ed. & Ctr. for Civic Education
Reception 'honoring State Co-ord. of
We the People ... The Citizen & the Constitution
Contact: Mark Molli
The Dirksen Building u..;.;,"'-"-=:~.:..J
E.o .m_1.0_6~~~
,-' ~6/'(~1(~i:-, _ '""
# to accept
ntrance: 1st and C Street
7:15
Car from Dirksen Building enroute to
The Hyatt Regency Hotel, 400 New Jersey Ave., NW
7:30
Dinner:
9:30 -10:00
10:00
Committee for Educational Funding
The Hyatt Regency Hotel
400 New Jersey Avenue, NW
202-543-6300
Contact: Susan Frost
WH car pick up enroute to West Basement
End of dinner/remarks/start of dessert BOAT
Dessert BOAT lasts approx. 30 min.
WH car pick up enroute to West Basement
[HAVE CRR ADVISE AS TO DEPARTURE TIME FROM DINNER]
Staff on leave:
Sara Rosenbaum
�WithdrawalIRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003a. schedule
DATE
SUBJECTrrlTLE
Rasco, for Monday, September 26 (partial) (2 pages)
09/26/1994
RESTRICTION
P6/b( 6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: Easter Seals Society Keynote, 23 Sep 94, 7:00pm
20 I 0-0 198-S
kc219
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(I) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b )(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�SCHEDULE
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
MONDAY, SEPTEMBER 26
7:30 - 8:15
Staff Meeting, COS Office
8:15 - 8:45
WH Senior Staff Meeting
9:00 - 9:30
OPC SENIOR STAFF
9:30 - 9:45
OPC Conference Call
10:30 - 11:30
Briefing: Hyde Amendment
Letters (CHR's office)
Kevin Thurm: HHS
contact: Julia 690-6133
Steve Neuwirth and Justice rep. will attend
12:00
#1 Lafayette Square
2:00 - 3:00
Meeting/Alice Rivlin
Disability Review (OEOB 248)
DPC Staff: Stan & Jeremy
3:10
WH car departure from West Basement
enroute to Hill
Senator Rockefeller
Hart, Room 109 (depart: Horseshoe)
3:30 - 4:30
4:30
4:45
Jesse White (they will contact J. White)
Contact: Trish: 224-6472
OPC St~ff: Bill Galston
NEC Staff: Peter Yu
WH car pickup at horseshoe enroute to WH
Arrive at WH
SCHEDULE CONTINUED ON NEXT PAGEl
�5:15
Marca Bristo: Swearing-In Ceremony
Reception: Indian Treaty Room
Sworn in by: Vice President Gore
(5:30 p.m. target for swearing in
er Ramona Lessen in Bristo's office:
';§!(
CH~
will return to office before departure to Dirksen building
6:30
6:45 - 7:15
WE car enroute to Dirksen Building
US Dept. of Ed. & Ctr. for Civic Education
Reception honoring State Co-ord. of
We the People ... The Citizen & the Constitution
Contact: Mark Molli l~:~i':i~§/(t5~(~)~:t;;t;
The Dirksen Building
,~Q,~,<,. <'."lijf
l(b)(6)wi~7t,;!::it1~
# to accept
Entrance: 1st and C Street
7:15
Car from Dirksen Building enroute to
The Hyatt Regency Hotel, 400 New Jersey Ave., NW
7:30
Dinner:
Committee for Educational Funding
The Hyatt Regency Hotel
400 New Jersey Avenue, NW
202-543-6300
9.:30 -10:00
10:00
Contact: Susan Frost
WE car pick up enroute to West Basement
End of dinner/remarks/start of dessert BOAT
Dessert BOAT lasts approx. 30 min.
WH car pick up enroute to West Basement
[HAVE caR ADVISE AS TO DEPARTURE TIME FROM DINNER]
Staff on leave:
Sara Rosenbaum
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003b. schedule
DATE
SUBJECTfrITLE
Rasco, for Tuesday, September 27 (partial) (I page)
09/27/1994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-1 J: Easter Seals Society Keynote. 23 Sep 94, 7:00pm
20 10-0198-S
kc219
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act· [5 U.S.C. 552(b)]
PI National Security Classified Information [{a)(1) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice hetween the President
and his advisors, or hetween such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
bel) National security classified information «b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�TUESDAY, SEPTEMBER 27
NOTE: Yeltzen Visit
7:30 - 8:15
Staff Meeting, COS Office
8:15 - 8:45
WH Senior Staff Meeting
option:
Yeltzen Arrival Ceremony
Enter So. Lawn via Palm Room
BEFORE 9:30 WITH TICKET
ceremony: 10:00 - 10:30
9:30 - 9:45
DPC conference Call
11:15 - 11:30 Dr.Lowe & Jackie Noyes
(Barbara Wooley : 6-2930)
Dr. Lowe speaking earlier:
this is only am time available
11:30 - 12:30
Patsy Fleming/CHR's office
General discussion
12:45
1:00
Car to Rayburn Building, Room 2105
Lunch: Congresswoman Pelosi: Good
Mothers in a Political World
WH car pick up enroute to West Basement
2:00
2:30
4:00
Meeting with Fleming: Interview: Morin
Contact: Joyce 690-5400 (CHR's office)
Steve Morin: 225-4965
4:20
WH car enroute to 4000 Wisconsin Ave.
Meeting
4:45
5:15
Meeting/Chris
Meeting/Nancy
6:00
car from Wisconsin Avenue Meeting to
Lansburg Theatre for Presentation
450 7th Street, NW
Arrive: Lansburgh Theatre
Award Presentation: Prepared Script
13th Annual Communication Awards
(Sister Jeanette Murray)
Ceremony conclusion
6:30
9:30
9:30 - 10:15
or 10:30
(? )
Staff on leave:
~~~~~
Post-Reception
WH car pick up enroute to West Basement
Black Tie
Sara Rosenbaum
�WEDNESDAY, SEPTEMBER 28
, Note:
Yel tzen Visi t
7:30 - 8:.15
Staff Meeting, COS Office
8:15 - 8:45
WH Senior
9:30 - 9:45
DPC Conference Call (?)
8:30 - 5:00
NEGP Meeting, (Sheraton Washington Hotel)
Hotel Phone number:
2660 Woodley Road, NW
Cotillion Ballroom South
contact: Ruth Cicone 632 0953
Hold:
3:10 - 5:00
5:00
f Meeting
hold: Media requests (che¢k with CHR)
Greg Fox taping (HOLD) they will call
Monday to copfirm time
10:00 - 11:00 Crime Bill' Implementation Meeting? [ck with CHR]
'Invitees:
J . Quinn; 'G. Stephanopoulos, J.
Angell, R. Emanual, D. Dryer, P. Griffin,l
M. Hale, A.Herman, R. Seidman/ J. Cerda,
B. Reed, R. ~lain',(514-6909')
Staff on leave:
Sara Rosenbaum
THURSDAY, SEPTEMBER 29
7:30
8:15
Staff Meeting, COS Office
8:15 - 8:45
WH Sen'ior Staff Meeting
9:30
DPC Conference Call
9:45
" option:
2:00 - 3:30
Staff on 1!=ave:
Federal Disability
Accommodation Working
Group OEOB 472,
Contact: Stan
Sara Rosenbaum
�WithdrawalIRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003c. schedule
SUBJECTffITLE
DATE
Rasco, for Friday, September 30 through Thursday, October 6
(partial) (2 pages)
09/3011994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ON Box Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: Easter Seals Society Keynote, 23 Sep 94, 7:00pm
201 0-0 198-S
kc219
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(I) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(1) National security classified information [(b)(I) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIAJ
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�FRIDAY, SEPTEMBER 30
7:30
-
8:15
Staff Meeting, COS Office
8:15
-
8:45
WH Senior Staff Meeting
9:30
-
9:45
DPC Conference Call
Lunch Karen Woodbridge
(HOLD)
1:15
5:00
6:00
COS, Long-Term Planning
SATURDAY, OCTOBER 1
9:30 - 10:00
National Parent Network on
Disabilities, St. James Hotel
Contact: Patty McGill Smith
SUNDAY, OCTOBER 2
MONDAY, OCTOBER 3
7:30 - 8:15
Staff Meeting, COS Office
8:15 - 8:45
WH Senior Staff Meeting
&29:00 - 9:30 DPC Senior Staff (CHR's office)
9:30 - 9:45
DPC Conference Call
2:00 - 3:00
A. Rivlin Meeting
(ck. w/Val AR
may be out of town)
5:00 - 6:00
DPC Program Staff
Presentation: Bill Galston
& Gaynor McGowan
Comprehensive Strategies for Children
and Families
option:
6:00 - 7:30
Reception/Sheraton Carlton
923 16th Street, N.W
Contact: Caroline
(responded: reception
POTUS will attend)
(dinner: definite)
old" to Caroline
�7:30
8:00 - 9:30
Car to DGA Dinner
Dinner: Home of Beth an d Ron Doz oretz
;~,i;',:;;r:j~;:)0~:~~r~~/ib)(6)i,~:1!,?~'~$e)~~}:'il
Note:
LETTER REQUESTS "INFORMAL REMARKS"
TUESDAY, OCTOBER 4
Mandela State Visit
7:30 - 8:15
Staff Meeting, COS Office
8:15 - 8:45
WH Senior Staff Meeting
9:30 - 9:45
option:
DPC Conference Call
9:00 - 10:00
Comprehensive Strategies for
Children and Families
DPC/Policy Exchange
Contact: Gaynor 6-6674
WEDNESDAY, OCTOBER 5
7:30 - 8:15
Staff Meeting, COS Office
8:15 - 8:45
WH Senior Staff Meeting
9:30 - 9:45
DPC Conference Call
10:00 - 11:00
Crime Bill Implementation Meeting
CHR's office
4:30 - 6:00
DPC Program Staff
OEOB 211.
6:30 - 8:30
DNC Reception/Womens's Leadership Forum
VP Residence
Contact: Elizabeth
863-7162
THURSDAY, OCTOBER 6
7:30 - 8:15
Staff Meeting, COS Office
8:15 - 8:45
WH Senior Staff Meeting
9:30 - 9:45
DPC Conference Call
�10:15
10:30
,11: 00
12: 00'.
Car to Capitol
Arrive:
Proceed to Room H~208
MANDELAADDRESS
Car from Capitol to Luncheon: .Omni Shoreham
12:00 - 2:30'
DNC Luncheon!HRc'
Womens's
rship Forum
Omni Shoreham Hotel
Contact:
izabeth .863-7162
4:30 - 5:00
Larry Echohawk (Dem.
Candidate
Gov.)
Timber Issues
Contact: M. Schmidt '65567
Location:, TBD
.
. 4 :45
5:00
Car to'Hall of States
Southerl1'~egionalProject
on
Infant Mbrtality
WH car pick up enroute to West Basement
FRIDAY,OCTOBER 7
7:30 - 8:15'.
Staff Meeting, COS 'Office
8:15 - 8:45
WH Sepior Staff Meeting
9:30
DPC Cbnference Call
9:45
.5:00 - 6:00
COS, Long-Term Planning
SATURDAY, OCTOBER 8
10:30 COS, Political Strategy
SUNDAY, OCTOBER 9
MONDAY, OCTOBER
FEDERAL HOLIDAY
�"
J
, SCHEDULE
CAROL H., RASCO
ASSISTANT TO
THEPR~SIDENT
FOR DOMESTIC "POLICY
FRIDAY, SEPTEMBER '23
M-M Student Holiday
, Reminder:
27 Sept. Black Tie Event
:'15
7: 30 -
8
8:15
8:4~
.9 : 3 0 -, 9 : 45
10: 3 0 -10. : 45
~taff Meeting, COS Office
WH Senior
f Meeting
DPC Conference'
.
"
POTUS BRIEFING:
(CHR AND BR)
1
SIGNING ','
CHR GOES IN MOTORCADE WITH POTUS .ENROUTE TO
DEPARTMENT OF AGRICULTURE AUDITORIUM FOR
SIGN~NG EVENT' (moved, to .Agricul ttlre be,ca:use"
of rain)"
,
Per PW,first two rows. special seating for WH dignitaries
info:
contact·Paul W.' 6-5577
LV Agw/motorcade enroute to WH
Arrive WH
12:00
?
,l' .
*********************~***~**~*'*******~********~*****
TRAVEL SCHEDULE:
1 :,30
,.?:20
3: 54 '
Depart West Basement enrqute
National
Nw Airlines to MN
ARMiimeapolis
Easter
R~p ~Sara Bre~ster)'~i~l pick~up CHR at airport
and be accompanied by'Dr. Harry'Boyte
Lodging::The Marquette Hotel'
Minneapolis', MN
710 Marquette Avenue
612-332-2351 (Phone)
I
6:35
Dinner
KEYNOTE: ADDRESS
7:00 - 10:00
Working Grou!)s
6: 00
�CLINTON LIBRARY PHOTOCOPY
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XEROX TELECOPIER 7020
�TH E WHITE HOUSE
NASHING7C:"J
FAX COVER SHEET
OF~ICE
TO: \ ;
FAX
OF THE ASSISTANT TO THE PRESIDENT ·FOR-DOMESTIC POLICY
SECOND FLOOR, '.-lEST HING
THE .mUTE HOUSE
WASHINGTON, DC 20500
(202)456-2216 PHONE
(202)456-2878 FAX
\0 Ve.lf\~e
#:\0 - 10+1
FROM: CAROL H. RASCO
DATE:
q--10 -q:t
NUMBER OF PAGES (including cover Sheet): ___ ________________ ._____
~~
___
COMMDftS: __~~ ._~_-~.~d~¥~.
________________~___________
h ve any p~ob~ems with the fax transmission,
1S~ at (202)456-2216.
p~ease
call
The document accompanying this facs~le transmittal shee~ is
intended only for the use of the individual or entity to whom it
is addressed. This message contains informat~on which may be
privileged. confidential or exempt from disclosure under
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If the reader of this message is not the
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notified that any disclosure. dissemination. copying or
distribution, or the taking of any action in reliance on the_
contents of this communication is strictly prohibited.
�.
'
EXECUTIVE OFFICE OF THE PRESIDENT
OFFICIAL TRAVEL AUTHORIZATION
1. TYPE OF AUTHORIZATION
(Privacy Act Statement and instructions on back)
U
TDY
Amendment
(Show items amended)
o (Non EOP EmpLoyees OnLy)0
Invitational
2. Traveler (First name, middle initial, /(lst name)
Relocation
Carol H. Rasco
3. Title of Traveler
4. AGENCYIDIVISION
Assistant to fue President for Domestic Poli:: :y
5. Office Phone
7·~~X~
6. Official Duty Station
o Rate(s):Subsistence (unusual circumstances)*
Actual
Washington, DC
456-2216
OPD/DPC
8. TRAVEL INFORMATION
Deliver Keynote address at National Easter Seal Soci~ty and
University of Minnesota's Center for Citizenship and Democracy
Launch Program
Travel Begin On ~ 1~..3.-' ~4
'Travel End On .9..:.- '-24./-9.4
PURPOSE:
DATE(S):
ITINERARY: Point of Origin (City. State) _ _ _ _ _ _ _W_a_s_h_l._·_n...;;g;....t_o_n_,_D_C ________________
_
Place(s) of Official Visitation (City. State)
Minneapolis, MN
Washington, DC
Pom t 0 f Reum (0 Stae )
.
t
t
IY.
..
MODE OF TRAVEL
to. 'ESTIMATED COST'
;
Commercial Transportation,:v; ' .. .::: :..:.::.. . ;. :~irL.. ;~~1>~1·~;;{.·~(
.
'Per DiemlActual Subsistence
Rail
Air
Transportation
Extra Fare*
Coach Tourist
'Business ..
First Class t
9."
"
'
(a)<
'J
:j: First Class must have approval or Aaency Head,or.Deputy
(b) "
Auto
Other
,
.
",'
,'"
'.w·
Miscellaneous
Privately,Owned.Vetiicle.
Rate nuth
per mile
I
0
0
.
AMOUNT,',
34.00
$
426.00
'
lRental Car "
'
'.~ ~
,/
"
Coach
,
Detennined more advantageous
to government"
,
For convenience of traveler
NTE common carrier cost
(c),D Gov't Owned Vebicle;j;i,
.. .':~ :
"
.
(taxi)
20.00
TOTAL
$
480.00
~:'lI;'SPECIAI:EXPENSE'AUTHORiZED'
0
0
., ,':
~~
','
,
Registration Fees (meeting, training. etc.)
'
Commercial Rental Car
o ,Excess Baggage "~ot to exceed
0
..
,
"
'
..
",
..
..
..
"
~
..'
""
..
Other (Please identify)
(d) 0 Otber (specify)
'12>AnVANCE REQtrESTED.,
"""~:,: $
, (meals and miscellaneous,e:r;oensesonh) '
13. * Special ProvisionsIRemarks (JustifICation for first chlss /business /extra fare travel, annlUJlleave enroute, actual subsistence, etc.)
14(a) R
l1uested by
• ( D
15. Accounting data (Appropriation"division, project, vendor number)
~~Ui...a 1lJf4.,()'
14(b) I certify that the travel herein w~s reviewed and determined
to be essential for the accomplishment of agency programs
and missions
Approval Official (Signature and Title)
16. Funds are available to defray travel cost specified above
Funds Manager's Certification (Signature)
17. Date
18. Travel Authorization No.
OAFORM22
ItMSED FEBRUARY 1993
ORIGINAL (RETURN WITH TRAVEL VOUCHER)
�.
AUG - 9 REC'D
'
'I i(
It 'f f ( '(
>
August 8, 1994
Carol H. Rasco
Assistant to the President for
Domestic Policy
The White House
Washington, D.C. 20500
Dear Ms. Rasco:
We hope that you will join us as our keynote speaker when
the National Easter Seal Society and the University of
Minnesota's Center for Citizenship and Democracy launch the
first Community Leadership Training Program for people with
disabilities. Our aim is to givepeo~le with disabilities
who are interested in greater commun1ty involvement some of
the skills they'll need to be more effective leaders in
grassroots community politics and on issues they choose.
As you know, people with disabilities have not been
encouraged to get involved in their communities. Recentlr,
there has been su~port for people with disabilities becom1ng
active in disabil1ty rights issues. But we're planning to
take this to the next step. We believe, and people with
disabilities have told us, that disabled citizens can make a
very real impact on other issues, such as the environment,
educational reform, crime.and drug abuse prevention. :We
also believe that disabled citizens have.much to offer as
members of non-profit boards and civic commissions. This
conference is the beginning of an on-going program to
provide people with disabilities with the information and
the skills they need to add their voices to issues beyond
disability.
Joe Romer, sr. v.p., public affairs, of the National Easter
Seal Society attended a meeting in March where Bill Galston
spoke about the administration's and your commitment to The
New Citizenship program's initiative for reinventing
government. Our,program expands Dr. Harry Boyte's and Dr.
Benjamin Barber "S ideas for developing greater citizen
.involvement to include people with disabilities in the
process.
The participants in this first weekend training pro~ram are
coming to learn how to be more visible and influent1al in
their communities. If you could tell them how you got
involved, beginning as an advocate for your son and leading
to your domestic policy-making roles in Arkansas and now for
the nation, it would provide participants with a wonderful
example of how people can make a difference.
(more)
National Easter Seal Society'
Suit,· U.;()()
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�Letter to Carol H. Rasco
Assistant to the President for Domestic Policy
August 8, 1994
page 2
The first community leadership development program will be
held at The Marquette Hotel in Minneapolis. The keynote
address, which we would like you to deliver, is part of the
opening dinner at 7:00 p.m. on Friday, September 23, 1994.
Of course we would be pleased if you would also join us that
afternoon for the first working session, and for as long as
you are interested the entire weekend.
.
Enclosed, for your further information, is a cop¥ of the
Disability Leadership Forum's Community Leadersh1p
Development Program registration packet.
.
Sara Brewster is coordinating this program for the
National Easter Seal Society and will contact your office
the week of August 15, 1994.
I
hope you can join us.
Sincerely,
~~
"'-/-(;.
!
1.,
/i
James E. Williams, Jr.
President and CEO
JW/sb
encl:
�Contact person: Pat Romani
Phone number: 456-2216
Date of request: 6 September 1994
ACCEPTANCE OF IRAVEL EXPENSES FROM OmIDE. SOURCE
In order to consider whether the Government may accept from an.. outside source payment of
your travel. subsistence and related expenses under the GSA travel rule, you must complete the
information below. The outside source need not be a 501(c)(3) organization. but if it is. please
state so on this form. and include the IRS determination letter.
Please iriclude a copy of the letter of invitation if one was received.
Your name and. position:
Carol H. Rasco
Assistant to the ~resident for Domestic Policy
Nature of meeting or similar function and how it relates to your official duties:
Keynote Speech for the National Easter Seal Society reo
Disability I_sues
Date and place(s) of travel:
September 23 and 24, 1994
Minneapolis, MN
Persons or entity making the payment (please also note any financial interests of the person or
entity known to you that may be affected. by the exercise of your .Government responsibilities):
National Easter Seal Society
Nature of expense(s) paid for:
Round-Trip air fare
Lodging and meals
Method and approximate amount of payment (payment may be made either in-kind or by
check made payable to U.s. Treasury; you may not directly receive payment in cash or check
made out to you):
Reimbursement to U.S. Treasury
This fonn and any accompanying memorandum of approval must be attached to your travel
authorization. You must complete a travel voucher following the trip. Please send completed
fonn to Room 12~ OEOB, at least 3 days before commencement of travel.
�13127261494
N. E. S. S.
~u
F-656 T-403 P-002/002 AUG 25 '94 16:58
, ie/pill!} Peopk t.LJilh Disabilirles AchifWC! Imlt:pl!llClt:'lIn'
AUG 2 6 REC'O'
Auqust 24, 1994
·TO: Pat Romani
Assistant to Ms. carol Rasco
Assistant to the president for Domestic policy
The White House
Washington, D.C. 20500
FROM: sara Brewster, a~v.p:
. co~orate Commun1cat10ns
Nat10nal Easter Seal Society
RE: Remibursement for Ks.Rasco's travel and lodging
expenses for Disability. Leadership Fo~'s community
Development Training Program speaking engagement
in Minneapolis, september 23, 1994.
Should Ms. Rasco agree to join us as our keynote: speaker
for this conference, the National Easter,Seal Society
would most certainly reimburse her for all travel, lodginq
and meal expenses.
' .
I.look forward to hearing from you about Ms. Rasco's.
plans. It would be wonderfUl to have her join us' as
we beqin to integrate people with disabil1ties into
the larger movement to truly enhance our communities
through citizens' involvement.
."
National Easter Seal Society
230 West MOllme S/I'(·'(·'
SuiW 1800
Chicago. Illinois 60006-4802
312 72C.620{} Ipfwrwl
:112726.4258 (TDD}
,1/2726, 14!-J4 (tux)
�~
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Of
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THE.WHITE HOUSE
i
WASHINGTON
I
I
I
September 6, 1994
I
I
I
MEMORANDUM FOR JENNIFER PALMERI
Office of the Chief of Staff
.
..
/l.v
FROM:
Pa t Roman,i J~/Iv-I"
Office (J):JJ6mestic Policy
SUBJECT:
TRAVEL APPROVAL
Please find attached a Travel Authorization form and
!
accompanying documents relating to travel by Carol
'1
1
H. Rasco, Assistant to the President for Domestic
1
:1
i
Policy.
Thank you for your assistance with this matter.
Approval Offical
Signature
�: }r:i.:'
N. E. S. S. tU
llelpi1l9 p(~op1(: 'Uilh DisabiliCies i\chifW(! 11I<ieptmde l l{"('
;;1,:
:~'7E?Ii?~;, T-403 P-002/002 AUG 25 '94 16:58
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,
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It
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;
AUG
26
REC'O
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"'I' .,
August 24, 1994,
,
"
, I::,
I"
"': .
TO: Pat Romani
Assistant to Ms. carol Rasco
Assistant to the president for Domestic policy
The White House
Wasll.ington, D.C. 20500
FROM: Sara Brewster, a.v.p.
co~orate Communications
'
Nat10nal Easter Seal Society
,
,
RE: Remibursement for Ms. RascQ';s travel and lodging
expenses for Di~a1?ility Le~~~I:j~hip.Fpl;'Um'S community
Development Tra1n1ng progrcmr:'i:~g,.t~~Jungengaqement
in Minneapolis, September 2;~;/ ;IW:r.9,4. '
'd~:' :' I
, ,
! ,.:
:. :.;:, L;~
• JI'! rlfl" :
"
11,"'11
:
l:'
,ShoUld Ms. Rasco agree to join us a~:~~r keynote: speaker
I, , '
for this conference, the National Ea~eer Seal Society
would most certainly reimburse her. ~?~ all,travel, lodqinq
and meal expenses.
:' i .
i
I took forward to heariJ;:lqfro,lD. :you about Ms. Ras~o's
plans. It would be wonderful'!:.9~have her join us' as
we beqin to integrate people ~ith disabil1ties ihto
the larger movement to truly enhance our communities
throuqhcitizens' involvement.
National Easter Seal Society
23() Wesl Mcmme
5(1'(-'1"
SuW~
1800
Ghkago. IWilc.)i$ 6()OOfj..4lW2
312 72G,(i:(.()() Iph()rl~~)
:1l2 726.4258 (TDD)
~H 2 726. 1494 (rux)
�AUG - 9 REC'D
Helpi1lg People with Disabilities Achieve Independence
August 8, 1994
Carol H. Rasco
Assistant to the President for
Domestic Policy
The White House
Washington, D.C. 20500
Dear Ms. Rasco:
We hope that you will join us as our keynote speaker when
the National Easter Seal Society and the University of
. Minnesota's Center for Citizenship and Democracy launch the
first Community Leadership Training Program for people with
disabilities. Our aim is to give peo~le with disabilities
who are interested in greater commun1ty involvement some of
the skills they'll need to be more effective leaders in
grassroots community politics and on issues they choose.
As you know, people with disabilities have not been
encouraged to get involved in their communities. Recentlr,
there has been su~port for people with disabilities becom1ng .
active in disabil1ty rights issues. But we're planning to
take this to the next step. We believe, and people with
disabilities have told us, that disabled citizens can make a
very real impact on other issues, such as the environment,
educational reform, crime and drug abuse prevention. We
also believe that disabled citizens have much to offer as
members of non-profit boards and civic commissions. This
conference is the beginning of an on-going program to
provide people with disabilities with the information and
the skills they need to add their voices to issues beyond
disability.
Joe Romer, sr. v.p., public affairs, of the National Easter
Seal Society attended a meeting in March where Bill Galston
spoke about the administration's and your commitment to The
New Citizenship program's initiative for reinventing
government. Our program expands Dr. Harry Boyte's· and Dr.
Benjamin Barber's ideas for developing greater citizen
involvement. to include people with disabilities in the
process.
The participants in this first weekend training pro<Jram are
coming to learn how to be more visible and influent1al in
their communities. If you could tell them how you got
involved, beginning as an advocate for your son and leading
to your domestic policy-making roles in Arkansas and now for
the nation, it would provide participants with a wonderful
example of how people can make a difference.
(more)
National Easter Seal Society
230 West Monroe Streel.
Suite 1800
j...:..Chicago. Illinois 60606-4802
l--3J. 2 726. 6200(j51'l1t(iD
312726.4258 (TD )
312 726.1494 (Fax)
�Letter to Carol H. Rasco
Assistant to the Presidentfbr Domestic Policy
August 8, 1994
page 2
"'
The first community leadership development program will be
held at The Marquette Hotel in Minneapolis. The keynote
address, which we would like ,you to deliver, is part of the ,
'opening dinner at 7:00 p.m. on Friday, September 23,,19'94.
Of course we would be pleased if you ,would also join'us that
afternoon for the first working session, and for as long 'as
you are interested the entire. weekend.
,
'
,Enclosed, for your further information, is a coP¥ of the
Disability Leadership Forum's Community Leadersh1p
, Development Program ,registration packet. '
Sara Brewster is qoordinating this program for the
National Easter Seal Society and will 'contact your office
the week of 'August 15, 1994.
.
"
I
hope you can join us.
Sincerely,
'(1A' ,W~
JI~Williams,
P~esident
and CEO
Jr.'
JW/sb
encl:
\
�Helping People with Disabilities Achieue Independence
-----
. #/J
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A~
~a--UA.~' ./~
fck?
.
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9/d-- ~ ~~ r
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r-- Cet1~
September 1, 1994
u
F _
Ms. Carol Hampton Rasco
Assistant to the President
for Domestic Policy
The White House
Washington, D.C. 20500
Dear Ms. Rasco:
We are thrilled that you will be joining us as the ke¥note
speaker when the Disability Leadership Forum's Commun1ty
Leadership Development Program convenes in Minneapolis on
September 23, 1994.
A room has been reserved for you at the Marquette. It is in
the executive towers so that you will have a second phone
line for your computer, foam pillows and a non-smoking room.
I will work closely with Pat Romani to coordinate your arrival
and departures. I will also let Ms. Romani know who will be
meeting your flight into Minneapolis on the 23rd and the
arrangements we've made for your return on the 24th.
In the meantime, I've enclosed some information about who will
be attending this first working group, who will be facilitating
the leadership program, and materials that have been sent to
participants.
A~ain, we look forward to meetin~ you and hearing you speak
w1th this group of people with d1sabilities who seek greater
involvement in their communities.
Sincerely,
~gfC/.
Sara Brewster, asst. v.p.
Corporate Communications
encl:
National Easter Seal Society
2:30 West Monroe St.reel
Suite 1800
Chicago. IWnois 60606-4802
312 726.6200 (phone)
312 726.4258 (TDD)
312726.1494 (f(Jx)
�Helping People with Disabilities Achieve Independence
Itinerary and Schedule for Carol Hampton Rasco
Disability Leadership Forum
community Leadership Development Program
The Marquette Hotel
710 Marquette Avenue
Minneapolis, Minnesota 55402
phone: 612.333.4545
fax:
612.376.7419
9/23
Washington to Minneapolis
Northwest Flight #195
arr. 3:54 p.m.
Sara Brewster from National Easter Seal Society will
meet Ms. Rasco at her gate with Harry Boyte and drive
her to .The Marquette.
A non-smoking room with foam pillows and a computer
hook-up has been reserved for 9/23. It is charged to
Easter Seals' master bill.
From 5:00-6:00 p.m. there is a welcoming reception.
At 6:00 p.m. dinner begins. Before dinner, DLF
participants and special guests will be welcomed to
Minnesota by Gov. carlson, and to the conference by
Harry Boyte from the University of Minnesota and
Sandra Gordon from the National Easter Seal Society.
Ms. Gordon also will acknowledge representatives
from conference funder 3M corporation.
We'll eat. Then, Sandy Gordon will introduce Ms.
Rasco -- between 6:30 and 6:45 p.m.
When Ms. Rasco has spoken, the grou~ may have
questions or and/or will move back 1nto their working
groups for another hour or so.
9/24
Minneapolis to Washington, D.C.
Northwest Flight # 314
dep. 9: 35 a. m.
Sara Brewster will either take Ms. Rasco to airport
or arrange for a limo from the hotel, whichever
Ms. Rasco prefers.
All meals and incidentals can simply be charged to
the room.
National Easter Seal Society
230 West Monroe Street
Suite 1800
Chicago, Illinois 60606-4802
312 726.6200 (phone)
312 726.4258 (TDD)
312726.1494 (fax)
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. list
SUBJECT/TITLE
DATE
Disability Leadership Forum Participants (4 pages)
nd
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: Easter Seals Society Keynote, 23 Sep 94, 7:00pm
20 I0-0 198-S
kc219
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(1) National security classified information [(b)(1) of tbe FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of tbe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of tbe PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of tbe PRA]
P5 Release would disclose confidential advice between tbe President
and his advisors, or between sucb advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of tbe PRA]
C. Closed in accordance witb restrictions contained in donor's deed
of gift.
PRM. Personal record misfile derined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�FRIDAY, SEPTEMBER 23
M-M Student .Holiday
Reminder: .27 Sept. Black Tie Event
Note: H. S. Advisory Committee? option
7:30 - 8:15
Staff Meeting, COS Office
8,:15 - 8:45
WH Senior Staff Meeting
9:30 - 9:45
DPC Co'nference Call
10:00
10:30
Taping/Interview
Greg Fox (NEGP)
'504-468-1100
11:~5
Presidential Signing:
Community Development
South Lawn
option:
11:00
ill
TRAVEL SCHEDULE:
1:40
Depart West Basement enroute
National
2:20
3:54
NW Airlines to MN
AR Minneapolis
Easter Seal Rep. will pick up CHR at airport
Lodging:
The Marquette Hotel
Minneapolis, MN
710 Marquette Avenue
612-332-2351 (Phone)
7:00
Dinner:
Staff on leave:
KEYNOTE ADDRESS
Sara Rosenbaum
�WithdrawallRedactionMarker
Clinton Library
DOCUMENT NO.
AND TYPE
005. schedule
DATE
SUBJECTfTITLE
Rasco, Saturday, September 17 through Monday, September 19
(partial) (I page)
0911711994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: Easter Seals Society Keynote, 23 Sep 94, 7:00pm
20 I0-0 198-5
kc219
RESTRICTION CODES
Presidential Records Act· [44 U.S.c. 2204(a)]
Freedom of Information Act • [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of the PRA]
Relating to tbe appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.c.
2201(3).
RR. Document will be reviewed upon request.
�SCHEDULE
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
SATURDAY, SEPTEMBER 17
Staff on vacation:
MONDAY, SEPTEMBER 19
Call Patsy Fleming reo Tuesday
Women's meeting/role as co-chair
690-5400 or 632-1090
7:30 - 8:15
Staff Meeting, COS Office
8:15 - 8:45
WH Senior Staff Meeting
9:00 -9:30
DPC Senior Staff
9:30 - 9:45
DPC Conference Call
10:30 - 10:50
Bill Milliken/B. Galston~~~~~
Contact: E. Bailey:,
11:30 - 12:30 Brown Bag Lunch:
2:00 - 3:00
Stan Herr (CHR's office)
Meeting/Alice Rivlin/A.Rivlin's office
OEB 252
3:00 - 4:00
Alice Rivlin/Shirley Chater
DPC Staff: Jeremy Ben-Ami ((6-5584)
Childrens's SSA Issues
Contaci: Jean Ashton 690-7782
Contact: Val
5-4840
OEB 248 (A. Rivlin's Conf. Room)
�I~,
DIARY NOTE:
TALKED WITH SARA BREWSTER
~TH:.E::.Y~AR=E:..:AB~L~E:..-:=.T.:::::.O---",-,PR"-,,,O~....-..............,.O:..:T..::E~L AND
AIRFARE FOR CHR
STATING 'THIS
.'
GRASS-ROOTS GROUP
30 ..: 40 PEOPLE
RE-INVENTING CITIZENSHIP
EXPANDING ON DR. HARRY BOYTE'S IDEAS (BILL GALSTON HAS WORKED
WITH HARRY BOYTE)
,
WOULD LOVE TO HAVE CHR
HOPE TO HEAR BACK FROM CHR
�~~::P
THE WHITE HOUSE
OFFICE OF DOMESTIC POLICY
CAROL H. RASCO
Assistant to the President for Domestic Policy
To:
Draft response for POTUS
ana forward to CHR by: _ _ _ _ _ _ _~
i
Draft response for CHR by: _ _ _ _ _ _ _ _ _ _ _ _ __
Please reply directly to the writer
I
(C?py to CHR) by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Please advise by:
I
Let's discuss: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
l.In formation: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
.
ReplJ using form code: _ _ _ _ _ _ _ ~_ _ _ ~_ _ _ _ __
For '{our
File:7-I_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _~_ _
I
Send copy to (original to CHR): _ _ _ _ _ _ _ _ _ _ _ __
I
Schedule? :
0 Accept
0 Pending
0 Regret
DeSi~nee to attend: _ _ _ _ _ _ _ _ _ _ _--,-_ _ _ _-I"I-_...
I
Rem(lrks:---'~..........&,.,.Ii'-'-"_t.~.t_\,*-l:::L..I.I~~~~~t_~~w-
CLINTON LIBRARY PHOTOCOPY
�.... \
,
Carol,
Following are flight options to Minneapolis
from DC National:
&
s~.:~rd:~~~p~ml:leF ~'4~'~~~"':.;\/~::::::""""::'..... ...:::-=-=-=~"-'::='
LV MN
9 : 35
AR DC
12:49
'{~
NW 314
------------------
cost: $426.00
contract carrier
government rate available
�Contact person: Pat Romani
Phone number: 456-2216
Date of request: 6 September 1994
ACCEPTANCE OF IRAVEL EXPENSES FROM OUTSIDE SOURCE
In order to consider whether the Government may accept from an outside source payment of
yqur travel, subsistence and related expenses under the GSA travel rule, you must complete the
information below. The outside source need not be a 501(c)(3) organization, but if it is, please
sth.te so on this form and include the ms determination letter.
I
.
Please include a copy of the letter of invitation if one was received.
I
d' •
Your name an poSition:
' .
caJo1 H. Rasco
Aslistant to the President for Domestic Policy
Nature of meeting or similar function and how it relates to your omcial duties:
I
.
Keynote Speech for the National Easter Seal Society reo
Dirability Issues
Qate and place(s) of travel:
i
September 23 and 24, 1994
Minneapolis, MN
I
Persons or entity making the payment (please also note a ..y financial interests of the person or
~ntity known to you that may be atTected by the exercise of your .Government responsibilities):
Nalional Easter Seal Society
I
Nature of expense(s) paid for:
id-
are .
Lqdging and meals
Method and approximate amount of payment (payment may be made either in-kind or by
bheck made payable to U.S. Treasury; you may not directly receive payment in cash or check
made out to you):
R qun
T'
r~p
··f
a~r
This form and any accompanying memorandum of approval must be attached to your travel
authorization. You must complete a travel voucher following the trip. Please send completed
.
form to Room 128, OEOB, at least 3 days before commencement of travel.
,
":
�..
EXECUTIVE OFFICE OF THE PRESIDENT
OFFICIAL TRAVEL AUTHORIZATION
1. TYPE OF AUTHORIZATION
(Privacy Act Statement and instructions on back)
U
Amendment
TI)Y
(Show items amended)
o Invitational
2. Travelh (First name, middle initial, last name)
3. Title of Tra veler
A sSlstant
. I
1
0
Rel()Cation
(Non EOP Employees Only)
I
Caro]J·H. Rasco
,
4. AGENCYIDIVISION
to he President for Domestic Poli ~y
I
S. Office IPhone
7.X] Per Diem
6. Official Duty Station
I
o Actual Sulisistence (unusual circumstances) *
1
456-2216
Washington, DC
I
OPD/DPC
Rate(s):
8. TRAVEL INFORMATION
I
r
Deliver Keynote address at National Easter Seal Society and
Univetsity.of Minnesota's Center for Citizenship and Democracy
Launch Program
PURPOSE:
.
.
/
'
DA'fE(S): Travel Begin On ~ UI ~4 .
. Travel End On .9-/.2.4./--9.4
j
Washington, DC
ITINERARY: Point of Origin (City, State) _ _ _ _...,-_ _ _ _ _-,---=--______________________
Place(s) of Official Visitation (City, State)
Point of Return (City, State
MODE OF TRAVEL
Minneapolis', r.fN·
Washington, DC .
9.;-;
I
.~lO;,ESTIMATED COST .'
AMOUNT'
_(""Ia;<.).,_.~-;-I_."-,-','_'_'.___C_o_mm,..,-e_rc_·1_·aI_Tr_ans"--'.!;.po-'-rta"--'ti.;..;.·o-'-n.;..;.·...:.\,_· ;.;.".... : :,;~; .;. :j";.;. .:·:; .•j.;.;;:;.;.;;!:;;...;·:-'-·:::;;;;;~!.;..;..,'.:."i;...;·'.i:.:.t:;,·Per Diem/Actual Subsistence
'
.. ;.;
.•
.$
I Rail
Air
I---------------l----------
Transportation
Coach Tourist
First Class :j:
. Business *
Coach
I Extra Fare·
!
I
:J: First :Class must· have approval ofAjlencyHead'or:Deputy ..
(b),
I
. ', Privately Owned VehiCle:'
Auto
Other
Rate auth
per mile
0
(d)
o Other (specify)
~ov't Owned Vehicle,
I
.
j
..
: I: _.
TOTAL
Determined more advantageous
to government •
$
J·'l1:-SPECIAL:EXPENSEAUTHORIZED
o
_--;::::::;-'__-'--'! --------l.-----_----------1
0
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DOCUMENT NO.
AND TYPE
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SUBJECTffITLE
DATE
overnight FedEx label (partial) (I page)
09/14/1994
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: Easter Seals Society Keynote, 23 Sep 94, 7:00pm
2010-0198-S
kc219
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�TRAVEL SCHEDULE
CAROL H. RASt;O
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
FRIDAY, SEPTEMBER 23
PageNet Number:
1-800-921-7576
1:30
2:20
Depart West Basement enroute National Airport
Northwest Flight #1~5
Seat 17F
3:54
Arrive' Minneapolis
CHR will be met a't arrival gate by Sara Brewster (asst. VP
Corporate Communications, Easter Seals) and Dr~ Harry Boyte,'
The University of Minnesota.
'
Lodging:
5:00
6:00
6 : 00 - 6 :.3 0,
The Marquette Hotel
'710 Marquette Avenue
Minneapolis~MN
55402·
Phone:
'612 -333·":4545
Fax:
612-376-7419
Disability Leadership ForUm
Welcoming Reception
Diruier
Welcome to Minnesota by:
Welcome to Conference by:
Welcome to Conference by:'
Gov. Carlson
Dr. Harry Boyte
, Sandra Gordon
6:30
CHR ,introduction by: Sandra Gordon
.
Senior Vice President, Corporate Communications
Easter S.eals (disability advocate)
6:35 - 7:00
KEYNO'rE ADDRESS BY CRR
After aqdress the 'group may have questions and/or go
back to working groups,f6r an hour or so.
They would be pleased if CHR joined groups - but
entirely up to CHR.
�SATURDAY, SEPTEMBER 24
suggestion:
National Easter Seal Society will be covering
hotel bill and have suggested that CHR may ,
wish to order room service for breakfast
and put on hotel'bill as well as other
meals and incidentals.
8:30
Sara Brewster will drive CHRto'airport
or arrange for limo from hotel
[whichever CHR prefers]
Airport: approximately '25 min. drive. time
9:35
12:49
Northwest Flight #314
Seat 2413 ' . '
Arrive DC Nat'iorial
12:49
WH Car pick up enroute to West Basement
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REMOTE STATION 1. D.
13127261494
START TIME
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DURATION
#PAGES
16:56
1'
17"
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TOTAL
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COMMENT
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XEROX TELECOPIER 7020
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TRAVEL ,SCHEDULE
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
FRIDAY, SEPTEMBER 23
PageNet Number:, 1:..800-921-7576
-;Depart West Basement enroute'Nationa1 Airport
Nprthwest Flight #195
Seat 17F
.
1:30
2:20
'
3:54
'Arrive Minneapolis,
CHR will be met at arrival gate by Sara Brewster (asst. VP
Corporate Communications, Easter Seals) and Dr. Harry,Boyte,
The University of Minnesota. '
Lodging:
5:00
6,: 00"
6:0'0 -6:,30
'The Marquette Hotel
710 Marquette .A:venue
Minneapolis, MN 55402
Phone:
612-333-4545
Fax:
612-376-7419
Disability Leadership Forum
Welcoming Recept'ion
pinner
Welcome to Minnesota by: .
Welcome to Conference by:
Welcome to Conferen'ce by:
Gov. Carlson
D:t. Harry Boyte
Sandra' Gordon
6:30
CHR introduction by: Sandra Gordon
Senior Vice President, Corporate' Communications
Easter Seals (disability advocate)'
'
6:35 - 7:00
KEYNOTE
ADDRE~S
BY CHR
After address,the group may have questions 'and/or go
, back to working groups for an hour or so.
'They would be piea~ed if CHR Joined' groups - b~t
entirely up toCHR.
,'
�SATURDAY, SEPTEMBER '24. '
suggestion:.
8:30
9:35
12:49
Na,tiona1 East,er SEi!a1 Society will be covering
hotel bill arid have suggested that CHR may
, wish to 'order room service for breakfast
and put on hotel bill as well ,as other
meals and incidentals.
Sara Brewster'wif1'drive CHR to airport
or arrange for limo from hotel
[whichever CHR prefers]
Airport: approximately 25 min. drive time
'Northw:est ,F1ig:Q.t. ,#314
Seat 24B
Arrive DC National'
WH Car pick up enroute to West Basement
�THE WHITE HOUSE
WASHINGTON
TRAVEL SCHEDULE
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
FRIDAY, SEPTEMBER 23
PageNet Number:
1-800-921-7576
1:40
Depart West Basement enroute National Airport
2:20
Northwest Flight
3:54
Arrive Minneapolis
Lodging:
The Marquette Hotel
710 Marquette Avenue
Minneapolis, MN 55402
Phone:
612-333-4545
Fax:
612-376-7419
5:00 - 6:00
Disability Leadership Forum
Welcoming Reception
6:00
Dinner
KEYNOTE ADDRESS
National Easter Seals Society and University
of Minnesota's Center for Citizenship and
Democracy Launch: Disability Leadership Forum
7:00 - 10:00
Working Groups
#195
SATURDAY, SEPTEMBER 24
9:35
Northwest Flight #314
12:49
Arrive DC National
12:49
WH Car pick up enroute to West Basement
�THE WHITE HOUSE
WASHI NGTON
TRAVEL SCHEDULE
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
FRIDAY, SEPTEMBER 23
PageNet Number:
1-800-921-7576
1:40
Depart West Basement enroute National Airport
2.: 20
Northwest Flight
3:54
Arrive Minneapolis
Lodging:
The Marquette Hotel
710 Marquette Avenue
Minneapolis, MN 55402
Phone:
612-333-4545
Fax:
612-376-7419
5:00 - 6:00
Disability Leadership Forum
Welcoming Reception
6:00
Dinner
KEYNOTE ADDRESS
National Easter Seals Society and University
of Minnesota's Center for Citizenship and
Democracy Launch: Disability Leadership Forum
7:00 - 10:00
Working Groups
#195
SATURDAY, SEPTEMBER 24
9:35
Northwest Flight #314
12:49
Arrive DC National
12:49
WH Car pick up enroute to West Basement
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Carol Rasco - Issues Series
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
Clinton Presidential Library & Museum
Extent
The size or duration of the resource.
92 folders in 7 boxes
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Complete Scheduling per 10-11: Easter Seals Society Keynote 23 Sept. 94 7:00pm
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 122
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Format
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Adobe Acrobat Document
Publisher
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Clinton Presidential Library & Museum
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
12/4/2013
Source
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2010-0198-Sb-complete-scheduling-per-10-11-easter-seals-society-keynote-23-sept-94-7-00pm
-
https://clinton.presidentiallibraries.us/files/original/36e934a833fe142c123cc31daa9f5187.pdf
c688fae6b342fd90a8e095caf55cd7ed
PDF Text
Text
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COSTS INCURRED IFTHISITHESE ITEMS(S) ARE LOST OR STOLEN.
.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Carol Rasco - Issues Series
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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Clinton Presidential Library & Museum
Extent
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92 folders in 7 boxes
Text
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Original Format
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Complete Scheduling per 10-11: CHR Personal Receipts
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 122
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Format
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Adobe Acrobat Document
Publisher
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Clinton Presidential Library & Museum
Medium
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Reproduction-Reference
Date Created
Date of creation of the resource.
12/4/2013
Source
A related resource from which the described resource is derived
2010-0198-Sb-complete-scheduling-per-10-11-chr-personal-receipts
-
https://clinton.presidentiallibraries.us/files/original/c9ff315f6efd00c22bc3b29be27d72ed.pdf
bd19f61d44c1108dc50ef4ebc7aabb54
PDF Text
Text
WithdrawallRedaction Sheet
,Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECTrrITLE
DATE
RESTRICTION
00 I a, schedule
Rasco, October 12 (partial) (I page)
1011211994
P61b(6)
00 I b. itinerary
AmEx Travel for Rasco from WDC to Little Rock AR to Cincinnati
OH and ret, 10112-10/13/94 (partial) (1 page)
10/07/1994
P61b(6)
002. itinerary
AmEx Travel for Rasco from WDC to Little Rock AR to Cincinnati
OH and ret, I 0112-101l3194 (partial) (l page)
10/0711994
P61b(6)
003. schedule
Rasco, October 13 (partial) (I page)
10113/1994
P61b(6)
004. note
handwritten re Sep 94 visit to Arkansas (1 page)
nd
P61b(6)
005. itinerary
AmEx Travel for Rasco from WDC to Little Rock AR to Cincinnati
OH and ret, 10/12-10/13/94 (partial) (1 page)
09/07/1994
P61b(6)
006. memo
Rasco to Romani re LR Trip, 4:56pm (partial) (1 page)
08/2611994
P61b(6)
007. list
October 12 Flight Options (partial) (l page)
nd
P6/b(6)
008. memo
Rasco to Romani re LR Trip, 5:59pm (I page)
08126/1994
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ON Box Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: AHSEA 50th Annual Training Conference (Hot
Springs AR) 10-13-94
20 I 0-0 198-S
kc225
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(l) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
bel) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regUlation of
financial institutionS [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�TH E: WH ITE: HOU5,E:
WASHINGTON
Mary Jo:
Thank you again very much for making the trip to Arkansas.
Please convey my greetings, continued thanks and best wishes to
this wonderful audience of people who continue to provide
services to Arkansans (Ar-CAN'-sans) ••• many of these audience
members day in and day out go above and beyond the call of duty!
A few notes on people:
Malvie Giles: scheduled to lead the National Anthem; as I
mentioned to you on the phone the President was very jealous that
I was going to get to hear her and now there are two-of us
jealous of you. She is a tradition in this role as well as her
service role through the years in DHS.
Tom Dalton, DHS Director: we first worked with Tom in his role
as City Manager of Little Rock and particularly a~ he served as
,chairman of the board of the Annie E. Casey Foundation's New
Futures for Little Rock Youth and his work in the Robert Wood
Johnson's Fighting Back project ••• both ongoing, both making a
difference in the lives of people.
Pam Burnett: I think she runs DHS •••• has been the administrative
assistant to numerous directors, is the continuity, knows whom in
the departments is responsible for what programs, ,a jewel!
Rich Howel~: deputy director of the department •••• his steadfast
service in a quiet manner keeps the trains running over there.
A number of individuals, too numerous to mention, worked with us
very, very hard as we struggled through the FSA of 1988
formulative stages. They then worked even harder in the
implementation in Arkansas forming county planning committees of
public and private sector individuals, other innovative methods
of carrying out the tasks.
Tell them all hello, that the President and I work hard to always
remember the front line lessons learned in Arkansas and we hope
to continue to hear from them about the new things they are
learning that can shape policy in the months/years ahead.
Thanks again!
CLINTON LIBRARY PHOTOCOPY
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XEROX TELECOPIER 7020
�THE WHITE HOUSE
WASHI NGTON
FAX COVER SHBBT
OFFICB OF THB.ASSISTAHT TO TBE PRESIDBNT FOR DOMESTIC POLICY
SBCOND FLOOR, nST WING
"THB WHITB HOOSB
WASHINGTON, DC 20500
(202)456-2216 PHONE
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(202t456~2878 FAX
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FAX #: 40/- 407~·
:
FROM:
NavyJ;
fun~
RASCO
The document accompanyinq this facsimile transmittal sheet is
intended. only for the use of the individual or entity to whom it
is addressed. This messaqe contains information which·may be
privileqed, confidential or exempt from disclosure under
applicable law. If the reader of this messaqe is not the
intended recipient, or the employee or aqent responsible for
deliverinq the messaqe to the intended recipient, you are hereby
notified that any disclosure, dissemination, copyinq or
distribution, or the takinq of any action in reliance on the
contents of this communication is strictly prohibited.
�CLINTON LIBRARY PHOTOCOPY
�•
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START TIME
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XEROX TELECOPIER 7020
�i
THE WHITE H<1USE
,
WASHINGTON
FAX COVER SHEET
I
OFFICE OF THE ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
,
,
SECOND FLOOR, WEST WING
: THE WHITE HOUSE
WASHINGTON, DCi 20500
~ (202) 456-2216 PHOHB
(202) 456",: 28178 FAX
TO: ,[
I
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am 13Llvnext
;
(501) {£; gJ it; 33{)
. FAX .:
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FROM: CAROL H, RASCO:
DATE:
/O/I!
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COIlMENTS.
~}2)C02'€.t
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have. any problems with the fax transmission, please call
~ Miller
at (202)456-2216l
,
i.
The document accompanyinq this facs~mile transmittal sheet is
intended only for the use of the individual or entity to whom it
is addressed, This messaqe contain~ information which may be
privileqed, confidential.or exempt ~rom disclosure under
applicable law. If the,reader of this messaqe is not the
intended recipient, or the employee I or aqent responsible for
deliverinq the messaqe to the intended recipient, you are hereby
notified that any disclosure, diss~ination, copyinq or
distribution, or the ta~inq of any ~ction in reliance on the
contents of this communication is strictly prohibited.
I
�OCT-11-1994
16: 16
FROM"
94562878
TO
P.02
XAllY JO BUB
.
I
.
,I
Assistant Secre~ary for Chi?--4ren aD4 J'amilies
Department of Health an4 BUaaDServices
.
Mary Jo Bane is the assistant secretary for children and
. I·
'.
fami.lies, Department of Health and Human Services.
She was sworn
in :)n October 8 I 1993 •
As assistant secretary, Bane ove'rsees the Administration for
I
.
Chil.dren and Families, th,e aqency thatbrinqs toqether the broad
I
I
ran ;,e of over 60 federal programs 1:.ha:t address the needs of
chi:.dren and families.
These
'pro9ra~
.
include Head start, Aid to
Fam :.11es with Dependent Children, Cb~ld Support Enforcement,
ref.lgee, Native Americans, and dQVQlipmental disability programs,
the Community Services, Social Services, and Low Income Home
Enel~gyAssistance block~rants,
and
~e~amiiY
Pre ;Jervation/Family suppqrt Services !program.
axe :~eds $30 billion.
.
ACF r s budget
Bane is also a co-chair of President
Clilton's Working Group on Welfare Reform, Family Support and
:Ind '!pendence.
Before coming to the 'Department of Health and Human
Ser ;7ices, Bane was the c9mmissioner of the New York state
Oep :lrtment of Social SerVices,' where she had also served as
exe:::utive deputy commissioner.
was a Malcolm wiener
pro~essor
For 11 years prior to that, she
of
so~iai
policy and director of
the Malcolm Wiener Center for Social Policy at the John F.
�OCT-11-1994
•
16:16
FROM
Kenlledy School of
TO
Gove~ent
94562878
at Harvard University.
.P.03
In 1980-81,
I
she served as deputy assistant secretary for plannin9and DUdget
at ':he US. Department of·Education.
She has also served as a
Pea!:e Corps volunteer in; Liberia and as a junior high .school
teal:.her.
Bane is the author of numerous books and articles in the
I
are; I of human services and public poilicy, including Welfare
Rea:,ities: . From Rhetoric to .RefRrm /(1994), with David EllwQod;
.
and Here to stay;
.
I
American Families in the Twentieth Cantuzy
Bane was born in Princeville, Ill.
in ,::ducation and a
Uni'j'ersity.
mast~r
She earned her doctorate
of arts il teachinq froiD. Harvard
She received a DaehelO~ of science deqree· in foreign
ser dee from Geor.getown. Uni versity •
SeptemDer 1994
�I
Withdraw:allRedaction Marker
Clinton Libr1ary
DOCUMENT NO.
AND TYPE
OOla. schedule
DATE
SUBJECTrrITLE
Rasco, October 12 (partial) (I page)
1011211994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number; 8505
I
FOLDER TITLE:
I
Complete Scheduling per 10-11: AHSEA 50th AnilUal Training Conference (Hot
Springs AR) 10-13-94
20 10-0 198-S
kc225
I
RESTRICTION ICODES
Presidential Records Act • [44 U.S.C. 2204(a))
Freedom of Information Act • [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(1) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the: PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
.
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a'c1early unwarranted invasion of '
personal privacy [(a)(6) of the PRA]
b(1) National security classified information [(b)(I) of the FOIA]
b(2) 'Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
I purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
! concerning wells [(b)(9) oftbe FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
I
I
i
I,
'
�;v~~.
~::/i==}-O/-t:/?d ~ ~(P5Z'(/I;) .
~/- ~g;;- ~F3~(~)
SCHEDULE
I
CAROL H. RASCO
I
ASSISTANT TO THE PRESI~ENTPORDOMESTIC POLICY
OCTOBER 12
PageNet Pager Number:
1-800-921-7576
11:00
11:40
12:57
Seat:
WH car departure fromlwest Basement
Northwest Airlines Flight ass
Arrive Memphis
2:20
3:16
Seat:
Northwest Airlines Flight 1546
Arrive Little Rock
13-D
Lodging:
The. Capitol Hotel
III W. M.rkham Street
Little Rock, Ar 7220'1
17-C
Phone:501-374-747~
I
:
Fax:
. 501-370-70911
eonfirmation # 1779
4:00
7:30
.
~fo'~1
~~
Gask1n
IJ '/1-
.
on voide machine 10-4, p.r.)
.
V-:¥~
~ &-:
/0-/1_ 9V
~' .3 ;;..ttPP? t?" sr
.~.~
e
�OCTOBER 13
CHR will Drive to Hot Springs (50 miles/one hour drive)
Keynote Addresss before ADHSEA:
Arlington Hotel
Conference Center Room, 2nd Floor
239 Central Avenbe
2nd FloorMeetin~ Rooms
Phone:
501-628-7771
.
I
Fax: .
5 0 1 - 62 [3 - 6191 .
9:00
Opening S.ession
9:45
CHR introduced Tom Dalton·
9:50
CHR KEYNQTE
(20 or 3d min. presentation)
I
ADDRE~S I~·
. I
Per Pam Burnett CHR can ,PLAN on departing if she wishes at
10:30 a.m.
CHR will drive back to Little Rock
3:00
5:22
Seat:
L~ LR Deita Airliries Flight 1214
AR Cincinatti
15C
6:21
7:35
Seat:
LV LR Delta AirliriesFlight 848
AR DC National
13C
7:35
WH car pick up enroute to West Basement
�.
:
I'"
. ' .
WithdrawalIRedaction Marker
'Clinton Library
I
DOCUMENT NO.
AND TYPE
.
00 I b. itinerary
DATE
SUBJECTffITLE
AmEx Travel for Rasco from WDC to Little Rock AR to Cincinnati
OH and ret, 10/12-10/13194 (partial) (l page)
10/0711994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAiBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: AHSEA 50th Annual Training Conference (Hot
Springs AR) 10-13-94
'
20 I0-0 198-8
kc225
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)J
PI National Security Classified Information [(a)(1) of the PRAJ
P2 Relating to the appointment to Federal office [(a)(2) of the ,PRAJ
P3 Release would violate a Federal statute [(a)(3) of the PRAJ:
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
Freedom of Information Act - [5 U.S.C. 552(b)J
bel) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) ofthe FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
. b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
�~
Management
Services~
"
I
INVOICE llTINERARY .
./
DAt~~rce~e8~r"4Is, KC52
PAGE: 01
SALES 'PERSON: 50 ~
ITINERARY/INVOICE NO. 0008633
CUSTOMER NBR: 1695000023
RRUIEW
TO: WHITE HOUSE TRAVEL
. 1600 PENNSYLVANIA AVE
WASH [lC 20500
FOR: RASCO/CAROL
12
REF:
bJ
.Ame,l<o" Ex."...
(
Travel Related Services Company, Inc:.
White House Travel Office
. Old Executive OffiCe Building, Room 87
Washington, D.C. 20500-0001
Phone: 202 456-2250
Fax: 202 456-6670
In Emergency After Hours CallI
1 800847-0242 (Toll Free In the U.S.,
'D'avel .
.
~-~
,~A~.·
·Lr~~)
~C5SXD5A0005
OCT 94 - WEDNESDAY
AIR NORTHWEST AIRLINES
FLT:855
ECONOMY
LV WASHINGTON NATL
1140A
AR MEMPHIS
1257P
RASCO/CAROL
SEAJ-17C
.
AIR NORTHWEST AIRLINES . FLT:154~
ECONOMY
lV' MEMPHIS
220P
AR LITTLE ROCK
316P
RASCO/CAROL
SEAT-13D
CA~ LITTLE ROCK
.. NATIONAL CAR RENTAL
, PInt Up·-:H6P
RETURN-130CT/3P
1-INtER CAR AUTO A/C,
RATE IS SUBJECT TO CHANGE
DAILY RATE-USD32.00
UNLIMITED MILEAGE
CONFIRMATIO"I NUMBER
0984099242COUNT
e
~
cPU. /1
7!-0 ~. ch
LUNCH
14'26/1/.17.
.~.~
EOF': BOE! t~G
~mt~-STOf'
'
13 OCT 94 - THURSDAY
AIR
DELTA ~I~ LINES INC FLT:1214
LV LITTLE ROCK
AR CINCINNATI
RASCO/CAROL
SEAT-15C
AIR
DELTA AIRLINES INC FLT:848.
LV CINCINNATI
AR WASHINGTON HATL
RASCO/CAROL
SEAT-t3C
ECONOMY
300P
522~
ECONOMY
621P
735P
EOf': DC':"9·
NON-STOP
EQP: MD-80
NON-STOP
EQP: MD-80
NON-STOP
13 APR 95 - THURSDAY
OTHER WASHINGTON
~tWl
B0584467
261.00*
SUB TOTAL
NET' CC IHLLIHG
TOTAL AMOUNT DUE .
.TR 6450 (12190) PRINTE~ IN U.S.A.
CONTINUED ON PAGE 2
261000
261.00*
0.00
ORIGINAL
�DH.S DIRE CTOR'S 0 FFIe E
TEL: 1-5 0 1""" 6 8 2- 8 6 5 0
Oc·t OS' 94
15:49.No:022 P.OI
Arkansas O:epartment of Human Services \
Office of the Dl'rector
329 Donaghey Building
JIm Guy Tuckor
Qon'no,
P.O. Box 1437
(
FACSIMilE COVER SHEET
DATE:
1~/s/q<j
I r
" :
'
/?
~
PLEASE DELIVER THE FOLLOWING PAGE(S) Td-7~~~:;~~;::~~~r---:. THESE PAGES ARE: BEING
TRANS~'ITIEO FRO;~~1L1J;t:::
TOTAL NUMBER OF PAGES INCLJOING THIS
COV~E: 4= :::>
IF YOU DO NOT RECEIVE ALL THE PAGES, PLEASE CALL: _ _ _ _ _ _ _ __
TELEPHONE: (501) 682·8650
Caring People. .. ' Quality Services
"The Arkansas Depanment of Human S~r"'lces is In compliance with Titles VI and VII of the Civil Rlghls Act and Is operated,
managod and delivers services whhout regard to age, religion. disability. sex. race. color Of national origin."
�THE WHITE HOUSE
WASHINGTON
SCHEDULE
: CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
OCTOBER 12
PageNet Pager Number:
1-800-921-7576
11:00
11:40
12:57
WH car departure from West Basement
Northwest ;Airlines Flight 855
Arrive Memphis
2:20
3:16
Northwest Airlines Flight 1546
Arrive Little Rock
Lodging:
The Capit9l Hotel
111 W. Markham Street
Little Rock, AR 72201
Phone:
I 501-374-7474
Fax:
501-370-7091
i
OCTOBER 13
Keynote Speaker: Annual Conference of the Arkansas Human
Services Employees Association
9:00
Arlington Hotel
Conference Center Room l 2nd Floor
239 Central Avenue
2nd: Floor Meeting Rooms
Phone:
501-623-7771
Fax:
501-623-6191
3:00
5:22
LV LR Delta Airlines Flight 1214
AR Cincinatti
,
6:21
7:35
LV LR Delta Airlines Flight 848
AR DC National
7:35
WH car pick up enroute to West Basement
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. itinerary
DATE
SUBJECTffITLE
AmEx Travel for Rasco from WDC to Little Rock AR to Cincinnati
OH and ret, 10112-10113/94 (partial) (I page)
10/0711994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: AHSEA 50th Annual Training Conference (Hot
Springs AR) 10-13-94
2010-01 98-S
kc225
RESTRICTION CODES
Presidential Records Act· [44 U.S.c. 2204(a)]
Freedom of Information Act· [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarrimted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(l) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the' PRA]
Release would violate a Federal statute [(a)(3) of the PRA) ,
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential ad\ice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion <If
personal privacy [(a)(6) of the PRA]
i
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.s.C.
2201(3).
RR. Document will be reviewed upon request.
�- -
1hJveI
~~~ Management
Services
INVOICE/ ITINERARY
SALES PERSON: 50
ITINERARY/INVOICE NO.' 0008633
CUSTOMER t,IBR: 169500002:3RRUIEW
- -
-
__ 0 -
[ivtJ
American Expreu'
'1
Travel Related Servlcel Company, Inc.
White House Travel Office
Old Executive OffIce Building, Room 87
Washington, D.C. 20500-0001
Phone.: 202 456-2250
Faxi 202 456·6670
In Emergency After Houl'll Calli
1 800 847·0242 (Toll Free In the U.S.)
YQ.ur code J1YD"Iber II. KC52
DATt: 07 ucr '14'
PAGE: 01
TO: WHITE HOUSE TRAVEL.
1600 PENNSYLVANIA AVE
!&.lASH DC 20500
!
I ~F70R~':~"~'A7SC~O~/~C~A7R70L----------~R~E=F~~~f(C~~='~~X~D=5A~0~0~0~5---------------------------"-------------
I
,
I
I
12 OCT 94
AI F:
I
I
I
AIR
CAR
- .WEDNESDAY
NORTHWEST AIRLINES
FLT:855
ECONOMY
LV WASHINGTON NATL
1140A
,.
AR MEI"iPHIS
1257P
RASCO/CAROL
SEAT-17C
NORTHWEST AIRLI.NES
FLT:1546
ECONOMY
LV MEMPHIS
220P
AR LI TTLE ROCf(
RASCO/CAROL
SEAT-UD
LI TTLE ROCf(
NATIONAL CAR RENTAL
PICf( UP-:316P
RETURN-130CT/3P
1-I~TER CAR AUTO AIC
RATE IS SUBJECT TO CHANGE
DAILY RATE-USD32~00
UNLIMITED MILEAGE
CONFIRMATION NUMBER .
098~099242COUNT
I
1:3 OCT 94 - THUF,SDAY
AII\
DELTA AIR LINES
AIR
FLT:1214
It~C
l.V LITTLE ROCf(
AR CINCINNATI
RASCO/CAROL
SEAT-15C
DEL TA AIR LINES INC FLT:848
LV CINCINNATI
AR WASHINGTON NATl
RASCO/CAROL
SEAT-DC
ECONOMY
.:300P
522F.'
ECONOMY
621F'
735P
LUNCH
EQP: BOE I ~lG 757
NON"';STOP
EQP: [lC-9
NON-STOP
CORP ID-5000300••
EQP: M[I-80
NON-STOP
EQP: MD-80
NON-STOP
13 ~PR 95) - THURSDAY
OTHER WASHINGTON
I
I
I
AIR TICf(ET
~IW11:30584467
261.00*
I
I
I
SUB TOTAL
NET CC BILLHm
I
TOTAL AMODNT DUE
I
261.00
261.00·x0.00
I----------------------------------------~~--~TA 6450 (12190) PAINTED IN U.S.A.
CONTI NUED ON PAGE 2
ORIGINAL
I
�iH E WHITE HOUSE
,'/ A S i-i I N G
i C
~J
,FAX COVER SHEET
OFFICE OF THE ASSZST~ ~O THE PRESZDENT FOR DOMESTZC POLICy
SECOND FLOOR.. t'IEST \'1ING
THE \·mZTE HOUSE
W~HZNGTON .. ' DC 20500
: (2021456-2216 PHONE
I
.
(2021456-2878 FAX
:: #~*ia!1:=
FROM: CAROL H, RASCO
± _;_______
____'
tO~1'.....;~(9
' ....
DATE: _ _
""!"'"_ __
NUMBER' OF PAGES (including cover sheet): __________________---.____
COMMEH'l'S:P/
LM,~ Cqi!
I -to' COOAtVYl
C£CCJIOi:
, I
The ciocument accompanyl.ng "this faclu.m.ile "transJlU.ttaJ. sbee&: is.
intended only for "the; use of the individual or entity "to wholll' ,it
is addressed. This message contains information whi~ may be
privileged .. confiden~ial or exempt frolll disclosure ,under
applicable law~ If the reader of t~s massaqe is not the
intended recipient .. or the employee or aqent responsihle for
delivering the messaqe to the ,intended reci:pient .. you are hereby,
notified that any disclosure. dissem;nation.' copyinq or
distribution.. or the taking of any action in reliance on the
contents of this coumiunicatiOn is stri ctly prohihited.
�".1
iHEWHITE HOUSE
.'J ASH I N G
i C :'-J
FAX COVER SHEET
OFFICE OF THE ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
SECOND FLOOR. ~-lEST HING
i THE HHItt HOUSE
WASHINGTON, DC 20500
(2021456-2216 PHONE
I
(202)456-2818 FAX
i
TO: -.::;;0.......;....:..1-1....:..>.5 ~lq~()_A_1--:;cp~'.~f.£~·A1D~;;;..;::;;.e...,;;;,;.,£ _ _ _ _ _ _ __
.....
·
FAX
:;: 81\9 -S13Q:
.
FROM: CAROL H, RASCO
DATE:
"lr211i 19:f .
,NUMBER OF PAGES (including cover shee1:): _ _ _ _ _ _~_ _- - . _
COMMENTS:
If~OU
(JI ~ fB € CA1 ( tu CJ)nf-( 12-11 iecuO!-'
;
hav,e any problems with the fax transmission, please call
. at· (2021456-2216.
nsten
The documen1: accompanY1ng this facs~le ~ransmittal snee~ is.
intended only for the use of the individual or entity to whoa it
is addressed. This message contains information which may be
privileged. confiden1:ial or exempt from disclosure under
applicable law. If the reader of this message is not the
.intended recipien1:, or the employee or- agent responsible for
delivering the messacje to the .intended recipient, you are hereby
notified that any disclosure. dissemiaation. copying or
distribution, or the.taking of any action in reliance on the
contents of this communication is strictly prohibited.
�I
TH E WH ITE: HOUSE:.
I
NASi-iINGIC~J
FAX COVER
~HE£T
OFFICE OF THE ASSISTANT ~o THE PRESIDENT FOR DOMESTIC POLICY
SE¢OND FLOOR. i-lEST HING
, THE mlITE HOUSE
WASHINGTON. DC 20500
, (2021) 456-2216 PHONE
(202)456-2878 FAX
TO:
~Rr....w.fl~'D~Fr 5ffl
__ "+F.I...I...ffJ.-;";-';"(:...",.;;,O~(fj;;;..;..Jl1~'e~j-..;:.B~e,;.;,...l~I@~f7j~5""'-' ~',~::Jf"..'J<--,-,,\
F~#:~0~{~O~~~[~'
FROM: CAROL H
DATE:
IDIll
Cctth='
__________________~_________
RASCO
rGfd
NUMBER OF PAGES (including cover sheet):
,Ple,$e ; oa ('{ to CJYrfl-e-rVl-~-b-C-G-(-~-j--'f1u+sg. dcst'fu luk -f\) <,5tAff} dtJa;)kS !
COMMENTS:'
If
y~~~~:;y
probLems with the fax transmission. pLease call
at' (202)456-2216.
__~~~I~~~~~~~~~
_____
accompanY1ng this facs~le transm1ttal snee~ is
intended only for the use of th.e individual or entity to whom ,it
is addressed. This message contains info:r::mation which may be
privileged. confidential orexemp~ from disclosure under
applicable law. If the reader of this message is not the,
intended recipient. or th.e employee or agent responsible for'
delivering the message to the ,~tended recipient. you are h~
notified that any disclosure. dissemination. copying or
'
distribution. or the taking of any action' in reliance on the,
. contents of thisco~ication is strictly prohibited.
Th~ documen~
�I
THE WHITE HOUSE
NASi-iING7CN
: FAX COVER SHEET
OFFICE OF THE ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
SECOND FLOOR. IvEST NING
THE HHITE HOUSE
WASHINGTON. DC 20500
i ( 202) 456-2216 PRONE
(2021456-2878 FAX·
TO:
LLh d~Ss
FAX:; :
1~L)S Z..
qe seA-fur
'.LJ:5CQ~~(o--l-±l:--,---i_ __ _ _...,--_ _ __
".
"
"
.!
FROM: CAROL H. RASCO
DATE:
.(o{ttlqj
)
I
NUMBER OF PAGES (including cover sheetl: ____________________.____
COMMENTS:
I~U
Pleas?; ,; cr+l { "10
have any
'41- ts+eQ)
e
C0!1n0rfl (£CfibT.
J
with ~he fax
at .(202)456-2216.
prob~ems
~ransmission.
please
cal~
The documen~ accompanying ~his facs~~e trans~tta~ shee~ is
intended only for the.use of the individual or entity to whom it
is addressed. This message contains information which may be,
privi~eqed. confiden~ial or exempt from disclosure under
applicable law. If the reader of this message is not the
intended recipient. or'the employee or agen;: responsible for
delivering the message to the.intended recipient. you are hereby
notified that any disclosure. dissemination. copying or
distribution. or the, ,taking of any action in reliance on the ' ,
contents of this commUnication is strictly prohibited.
�THE WHITE HOUSE
WASHINGTON
SCHEDULE
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
OCTOBER 12
PageNet Pager Number:
: 1-800-921-7576
11:00
11:40
12:57
WH car departure from West Basement
Northwest Airlines Flight 855
Arrive Memphis
2:20
3:16
Northwest: Airlines Flight 1546
Arrive Li,ttle Rock
Lodging:
The Capitol Hotel
111 W. M~rkham Street
Little Rock, AR 72201
Phone:
'501- 3 74 - 7474
Fax:
501-370-7091
OCTOBER 13
Keynote Speaker: Annual Conference of the Arkansas Human
Services Employees Association
9:00
Arlington Hotel
Conference Center Room, 2nd Floor
239: Central Avenue
2nd, Floor Meeting Rooms
Phone:
501-623-7771
Fax:
501 623-6191
3:00
5:22
LV LR Delta Airlines Flight 1214
AR Cincihatti
6:21
7:35
LV LR Delta Airlines Flight 848
AR DC National
7:35
WH car pick up enroute to West Basement
�THE WHITE HOUSE
WASH INGTON
SCHEDULE
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
OCTOBER 12
PageNet Pager Number:
11:00
11:40
12:57
1-800-921-7576
WH car departure from West Basement
Northwest Airlines Flight 855
Arrive Memphis
,
2:20
3:16
Northwest Airlines Flight 1546
Arrive Little Rock
Lodging:
The Capitol Hotel
111 W. Markham Street
Litt
Rock, AR 72201
Phone: . 501 374-7474
Fax:
501-370-7091
. l
OCTOBER 13
Keynote Speaker: Annual Conference of the Arkansas Human
Services Employees Association
9:00
Arlington Hotel
Conference Center Room, 2nd Floor
239 i Central Avenue
2nd Floor Meeting Rooms
Phone:
501-623-7771
Fax:
501-623-6191
I
3:00
5:22
LV LR Deita Airlines Flight 1214
AR Cincinatti
6:21
7:35
LV LR Delta Airlines Flight 848
AR DC National
7:35
WH car pick up enroute to West Basement
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003. schedule
DATE
SUBJECTrrITLE
1011311994
Rasco, October 13 (partial) (l page)
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: AHSEA 50th Annual Training Conference (Hot
Springs AR) 10-13-94
20 I0-0 198-S
kc225
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act· [5 U.S.C. SS2(b)]
PI National Security Classified Information [(a)(1) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRAI
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [aleS) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
.
bel) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
~~
,
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�\
'
[ooiJ
SCHEDULE
CAROL H. RASCO
ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
PageNet Pager Number:
1-800-921-7576
11:00
11:40
12:57
Seat:
WH car departure from West Basement
Northwest Airlines Flight 855
ArriveJMemphis
17-C
2:20
3:16
Seat:
Northwest Airlines Flight 1546
Arrive L±ttle Rock
13-D
Lodging:
The Capitol Hotel
111 W. Markham Street
Little R0Ck, Ar 72201
Phone:
J
501-374-7474
Fax:
501-370-7091
Confirmation # 1779
7:30
Dinner:
Sue Gaskin
(message left on voice machine 10-4, p.r.)
�i .
~
CAROL H. RASCO
ASSIS'l'AII'l' TO THE PRESIDEN'l' FOR DOMESTIC POLICY
TRAVEL C'IIECJILIS'l' FORM
FUNCTION/
ACTIVITY
DATE(S) OF
COMMENTS/
PROBLEMS
INITIALS OF
DPC STAFF PERSON
LJ2-~ ~~~
h-':lil
{d~13
~VEL?
CPt
~INATION? :--- ~
(
TRAVEL AUTHORIZATION ' ~~
FORM COMPLETED?
,
~ OF TRAVEL? ______
RESERVA'l' .LUl'ft) MADE? , -
l{~
IF AIRLINE, WISH
AISLE SEAT.
\1..
/
~t:/
TICKETS OBTAINED FROM
TRAVEL OFFICE?
0- '
"
CONFIRMATION NUMBER?
NOTE: POAII PILLOWS
NOTE: 1I01l-SJmIaBG.
\
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.'~~
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77l{9-l{J
.
HOTEL RESERVATIONS
MADE?
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COMPUTER SET-UP
AVAILABLE AT HOTEL?
DEDICATED LINE?
HOTEL FAX NUMBER?
CAR RENTAL READY?
'~-<J
RESERVATION,NUMBER?
,tYl~()-;:). R
MATERIALS. FOR TRIP
(MTG. FOLDERS/SPEECH
MATERIALS) READY?
CHR SCHEDULE'FAXED
TO WH OPERATORS',
SIGNAL 'STAFF?
.....
.
CAR RESERVATIONS
'MADE WITH WH- GARAGE?
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3:00p - 7:00p
7:0011' • BlOOp
7:' OOp - 8: OOp
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Director'£ Reception
8:30p - 12: 30p
Welc~e
U:;' ':M
Retiree'. Re~eption
(All Implcy•• a Invited)
Party - , ,
Pea~u~Ln9'
- Exhibit Center
Mltgnn~ia
Room
Magnolia Room
Crystal Ballrm
Oice Jockey J.B. 9taek.
Tbur.c!ay, October 13,
un,
Continental 2reakfastCrystal Sallrm
Resilt.ration" Membership
Bxhibit Center
9:00& - 12:00p OPINING .IISION
.......... Cont.Ctr S,C
* Invoc;;:atiun ...• '• ••• -•..•. '.••.. "'..mea Thomason
*Presentatioh ot Flags ....... Army Reserve
, ,. .Yle<.1ge ot Allegianc;;:e •••••.• Cbe~J'l Stuart_
*National Anthem ............. Malvie Giles
*Aeeompan1st .....•........... Stlmlul _Walters
'Welcome/Director' BR,emarks ........ Tom Dalton, .DRS Director
IntroQuction ot senator'CanaOa .... Tom Palton, DKS D!'~~~Qr
Welcome ............ .:.............. Sen. Bud Canada, Dist., 13
7tOOa - 8:30a
~:OOC:l - 6:00p
Mayor Hel~n selig
fresentation ot the ~Go~ernor ...... Tom Dalton, DHS Di~eetor
Governor's Remarks ....•....••..... Honorable Jim Guy 1\lcker
.
Governor (Invited)
Pr•••ntatioD of the:Preoidant of the 11ftiteCS States .••..
President'. Remarksl ... The Honorable Bill Clinton, President
(Invited)
,
Int;r:gauction of S'Peaker ••••. _.' .... Tom Dal ton, DMS Director
Keynote Speaker ........ Carol Rasco, Pomestic PolicyA~v18or
.••••.•••••• "0 ••••• :• •••• Office of Assistant' to t.he President
Busin:eaa Meeting ... :. ......... ~ .... President Christine Brown
Door Pr;'-P-A
12; OOp .. 1: lSp ...........••.•... ~ . t.uneh
l:lSp .. 2~4Sp ............. :; ...... Conc1.lrrent Workshop.
2:45p -3:00p •..•.................• Break
,
3: OOp ,;., 4: :& Op ...... ' .' ............. Cpncurrent workshops
4:30p .. ,:OOp ............
Dlnner - Blues in the Park
0
••••••••
(Provided)
6:00p .. 7:00p .............. : ...... Presidene's Reception
MAgnolia Room'
,
i:OOp.- 9:00p ....... : ....•........ Entertainment Show
!hOOp
FU.,_c,..-,. lif,,4£.
£O'd SZO'oN
~£!9t
1;001) ••••. : .•••••......... Dane,. C"ftt .Ct%.'. A,B,C
- , "
Fad
Disc Jockey, J. II. Stacks
3;,.,.- _'- #!, q.
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AlInA ••00.... OVERVIEW
. Coutizu:aed
PRIDAY, OC'1'OlSEIt 14,19.94
- lO:OOa .................... R.egistr&tion &: Membership
8:00&
~:1.5a ...................... Concurrent Worlc~hC)p8
,: l5a - 9 :30a ... , .' ...
Break
9: J Oa .. 10: loa •...... :............. Concurrent WorklllhopR
lO:30. - 12:10p ••.•.. f, • • • • • • • • • • • • Awards Bunch
Invoc.t1on ......... Roy Johncon
8~OOa
0
••••••••••••
Speaker ............ Tom Dalton, DRS Director
Preseneaeion ot Certific.te8/Awa~d8
Business Meeting .. President Christine Brown
Door Prizes ........ P1E:sident Chriotine Drown
*
~L!ASE ~EMAIN
STANnING
t76.S0 :j.:JO
OS98-Z89-!OS-!:131
3)1~~O S.~Ol)3~IO SHO
�"EXECUTIVE OFFICE OF THE PRESIDENt
OFFICIAL TRAVEL AUTHORIZATION .'
,1. TYPE OF AUTHORIZATION
.(Privacy Act Statemelll and instructions on back)
[X.TDY
o (Show items ame/lded)
Amendment
o l~vit;tional '
0
I.
:. Traveler (First name, middle initial, last name)
Relocation .
(Non EOP Employees Only)
("01 H. Rasco
t Title of Traveler
4. AGENCYIDIVISION
sistant to the President for Dome'stic
5. Office Phone
Polic~
6. Official Duty Stati~m
~jashington I
6-2216
OPDjDPC
7., [X Per Diem I.lUllX
.
, 0 Actual Sulisistence (unusual clrcumstclllces) *
Rate(s):
'
DC
It TRAVEL INFORMATION
PURPOSE: _ _
T_o_d_e:-l l.·v,,--e-::r_,_K_e-..:y:..n-::--o_t_e_s...:p:-.e_e_c_h_'_t_o-:::·_A_r_k_a_n,...s.-a_s=-,D....,e,..::p;-a_r_tm-=-e_n~t--,-o f_H_um-,-a_n_~_ _ _:
__
__
Services Annual Meeting reo Domestic Policy Issues
.~_!'91-.!.424.
DATE(S): Travel Begin.0n
ITINERARY: Point o(Origin (City, State)
.
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L
Travel End On 1
I
13, 94
Washington, DC
' .
.
. Little Rock, AR and Hot Springs., AR
Phice(s) of Offici~1 Visitation (City, State)
Washington, DC
P'
omtofReturn (C State
tty,
',>.;;MODEOFTRAVEL.
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Coach Tourist
Business *
(a):"
.
;
"
:
I
First Class '*
.,
or
;f: First ClaSs must bave approval ofAgency Head
Deputy
"
'.
(b)
Privately Owned Vehicle
Auto I Other
Rate auth
0 Determined more advantageous
to government ..
~
per mile'
o
"
For convenience of traveler
. ' NTE commOn carrier cost
(c)
.
'0 Gov•t Owned "ehicle .
(d)
o Other (specify)
"
"
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:,AMOUNT"
$.60~OO
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TOTAL
11~ SPECIAL EXPENSE AUTHORIZED'
0
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Registration Fees (meeting, training, (ftc.)
-
,~ Excess Baggage not to, exceed ,. .;.'_ _ _ _ _ _ _ _ __'_'
o
",
"
Commercial Rental Car '
,
--:'~_
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o Other (Please identifY)
,.! "
..
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Lodging au'thorized at ,~50%: 'no·govt. ~,ate aVCjl.ilable
at'hotel; only conference rate' available
':
certify that the travel herem as reviewed and det~rmined
to be essential for the accomplishment of agency programs
and missions
,
Approval Official (Signature and Title)
OAfORM22 '
'.'
'~'
li.ADYANCEREQllES~D " ,
$,
_ _~_ _ _ _ _ _ _ _ _ _ _,"",:"",_ _ _ _ _-:_ _~_-,,-I_,(mealS and iniscelkineous expensesoilly) '
, 13.· Special ProvisionslRemarks (Justifi~a't{onfor first class Ib~sjness lextrafare travel, annual leave enrouie, actual subsisteJlce, etc.)
note:
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':'/::.,:/~:, =;'
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Transponation
, ' Rental Car '
I
.'.
Per DterritActual SubSIstence
, I
I
,
lO.ESl'IMATED COST"
ravel cost specified above
'
,
.
.
�Contact person: Pat Romani
Phone number: 6 2 216 '
. Date of request: 8 - ;2 '9- 9 4
FILE, COpy
,
I:,'"
,
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,
. ACCEPTANCE OF ~VEL~EXPENSES< FROM OUTSIDE" SOURCE
In' order to consider whether the Government may accept from an outSide source payment of
your travel, subsistence and 'related :expenses under the GSA travel rule, yo~ must complete the'
information below. The outside s01:JIce need not be a 501(c)(3) org~tion, but if it is, please
state so on this form and include the IRS determination"letter:
.,
,
•
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'
·Please include a copy of the letter 'of iIivitation if one was received.
Your 'name and position:
Carol H'~ Rasco·
Assistant to the Presiden~ fdr Dom~sti6
·Policy'
.,1
I,
Nature of meeting or similar function and how it relates to your oroda] duties:,
,
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Speech (Keynot,e) ,to Arkansas Denartment . of Human Services
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Employees Annual Meeting' :re. : Health Care Issues and other
Domestic Policy matters!
'.
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Date and place(s)oftnivel:
October 1j~13, 1994
Little ,Rock, AR and
Hot Springs, AR
Persons or entity making the payment (please' also o~te 'aoy financial interests of the person'or"
entity ~own to you that may be affected' bythe exercise of your ,Government responsibilities):
..
"
\
, I
.
Arkansas Human Services Employees Association
Nature of expense(s) paid for:
'Round-trip airfare; lodging, rental car·
1 .
Method and approximate amount of payment (payment may be made either in-kind or by
check made payable to U.S. ~sury; you may not directly receive payment in cash or check
made out to you):
I
Reimbursement to U.S. Treasury
This form and any accompanying memorandum of approval must be attached t6 your travel
authorization. You must compl~te a travel voucher following
trip. ~leasesend completed
'
form to Room 128, OEOB~ at l~ast 3' days before cOIIUilencement of travel.
the
t>..~~~~ (:h>\-.~ ~~L\-\.L\~\,5" ~~~.
~ O\~L'~~'-~ ~ ~o.\.~,~;\~,~~~~-\~\~_
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DHS ,DIRECTOR'S OFF1CE
.
.
~,
TtL:1-5Q1-682-8650,
,
,May 17' 94,
13:08 No.OOl P.02
,
-'.
("
Arkansas :[)e'partmentof Hum2:in Services
if
, 'Office of the 'Director
329 Donaghey Building
- P.O. Box 1437,
I
Little Rock. Arkansas 72203·.1437
Teiephone(501) 682-8650
FAX (50l) 682-6~36
Jim Guy Tucli;er
, Governor
, Hay 1', 1994
,;
,
Caro;l Rasco, Domestic Policy Advisor
Office of the Assistant 'to the President
Second Floor~ West Wing.
The White House
l'
Washington,' DC 205'00 :'
Dear Ks •. Rases ,&;l£
:
/:
on, behalf o'f the' Arkant;as Human Services Employees Association, I
would like to invite to you to be our keynote speaker at our 50th
Annual' Training conference on Thursday, October. 13,1994 at'the
Arlington Hotel, Hot Springs, Arkansas.
'
•
" . .
<
As you are aware', the AHSEA officers, board, and' members work
diligently each year pianninq the array of traininq activities"
design~d to enhance ou~ skills, stimulate our minds and enrich
our hearts.
.t '
car,ol; I know from my conversations with Alexis that these are
, bUSy times ,for all of you', but we WOUld, consider' your presence an
honor.' In my opinion,: the President is the only other person Who
knows the challenges Arkansas Human Service wor~ers face daily
and understands our commitment to provide quality 'services to our
citizens, 'as well as you do. Please, let me know by June 1st if,'
your schedule will allow you to participate.
.
Thank you and best reqardsto Alexis and
- .
Rosalind~
Sincerely,
9~
Pearl Herman
DRS
Advocate
PH: lae
9C: Chris Brown, President, AHSEA-;;;:?&/6'{2~~5'O
Tom Dalton,
Direc~or
Caring' People. .. Quality Services
:
"The Arkan~as Deparlment ofHumaoSei"icea is in comptlance with Titles Viand VII of the Civil Rights Act and Is operated.
managed and delivers services without :regsrd to age. religion. disablllly. political afliliation. veteran status. sex, race.
, color or national origin,"
.
�DHS DIRECTOR'S
TEL:1-501-~82~~650
OF~ICE
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Rug '26' 94
1
11:09 No.006. P.04
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Ar,k'a'nsas Departme'nt of 'Human Services
"
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Office of the Directo'r .
Jim Guy Tucker
Gove,r>Of
,
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329 Donaghey Building .
P.O. Box 1 4 3 7 : '
Little Rock,Arkansa's 72203.:.1437 :
Telephone (501) 682-6650
.
F~X (501) 682-6836 .. :
"
:'. :
August 2'6,
'1994
Ms. Carol Rasco.
Assistant~ to. the Presid.Ci!nt
for D~mestic. Policy,
Second Floor,. west WiJig
The White House
Washington, DC, 20500:
Dear Carol:'
i
• :..'
.'
On behalf of ,the Arkansas Human se~ices,Employees
Association, I want to thank you.'for accepting·the
invitation to:be the keynote speaker, at our annual meeting
, on October 13, igg 4 in. Hot Springs ,Arkansas ...
The Association ,will ·reimburse you 'forround,tr~p airfare,
lod9in~, rental car, ~nd .oth~r incurred expen~es.
I
look. ;orward to seelng you!
;.
TD/pb
I"
Caring P~opJe. .
QualityServic~s
"The Arkansas Department of Human Service~ ie in compliance with Titie8 VI and VII of ttle Civil Rights Act and Is operated,
managed and delivers services wltl'lout regard to age, religion. disability, political affiliation. veteran status, sex, race.
,
I
color or national orig'in,".
�,,
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T H:E
W HIT
F='
H 0 USE
1F=====================-~======--='====-=-41
Sept.1 ,;17, i994
, .
1 .
LEON ;Caro~ Rasco~h~d al~e~dy
accepted theattacned 'speech
requests requiring travel
prior' to you becoming Chief 0
staff~'
,
She would like to' know as soo
as P9ssib;te if ,you have any
pr6b f ems with any of them
'since it would be difficult to
. cancel. '
I reeommend Yo~,appr.ov,e,
attached list.·
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�'THE'WHITE HOUSE
WASHINGTON
,
....
s~ptember
.
16, 1994
I
I
MEMORANDUM FOR Jodi, Torke"lson
'Assistant to t,he President for Manage,me.nt'
and,Ad~inistraeion
.
. .,
'
(\\\.D "
FROM:
SUBJECT:
"
"Carol H.' '~a13co Wr-Assistantlto the President for Domestic poli~i
,.
.
Invitations/Out-of-Town "Travel
, " Accepted' , I
,
, .... '
'
As.we have discussed ear+ier, I have aCcepted eng?lgements prior
to Leon Panetta's new procedures relating to travel .
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I have attached a memorandum prepared by ,my staff which lists
out-of-town commitments,: meeting' site, and other pertinent
data pertaining ,t'0t.hese: events.'
It is rare. I wouid accep't invitations so, far in advance
as the two listed· for 19:95. However, these were, very spe'.cial
circumstances:
1)
April 3, 1995
Keynote Speaker
Annual'Meeting~
S0ciety of Hospital
.Epidemiologist Ass9ciation .(SHEA)
The
2)
~ealthCare
Refor.m team recommended this acceptance.
May 17, 1995
Keynote Speaker
. ,
President's Commission on EmploYment of Peqple
with Disabilities Confererice
This was accepted at Tony Coehlo's,insi'stence as this is the
.group he Chairs.
I would appreciate your help if you anticipate any difficulties
,. in honoring .the commitments listed in this memorandum.
Thank you.
.
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TH E WH ITE HOUSe;:
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WASHINGTON'
Septetn.b.E;r 14,1994
I
"
MEMORANDUM FOR CAROL H. RASCO
,
~
ASSIS~AN~'iT0
H~RESID~' FOR.DOM~S7IC
Pat Roma
Staff A s'
From:
.
POLICY
,
,
nt/Scheduling
,,
,
.. Accepted 'Invitations!Out-bf-Town' Travel'
Sub.ject:
Following 'areout.":,of-to~ commitments on your s.chedule' ~hrough 'this
date. The inviting. orgaIiizati9n, meeting site, and other 'pertinent
c;lata are 'included. . '
I,,' ' , " ,
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September' 23, ,199'4
Keynote Speaker
.',
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Natioi1~l'.Easter SealSo'ciety' 'and the,
,University cif, Minnesota/)s Center'
,
i. for Citi.zenship and Democracy Launch,
I Program.';' '.
,:'
'Date:
Purpose:
I'
Organiza~ion:
!,
Meeting, Site:
.: Minneap9lis ,', 'MN,
Travel Paid .
'.
b y : , ": Inviting group
,,'.'
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* * ** *'.** **** ** ** ******* *1* **** * **~*;** * * * * * **** **',*:,~ 1".* * * * ** * * * ** * **.'* '
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Dat,e :.
. "Purpose:"
Organization:
I '
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October'i3, 1994,
-Keynote Speaker"
. '.
SOthAI1nual Training Conference:
,Arka~sas f{uman Services ,Employee
, Association.
_,'
.,1.
Meeting ,Site:
Travel Paid
by: "
,
, ,',
ijot: Springs,AR
",
InvitiI!-g group'
,
****************************************************************
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October~2S, 19~4.' ','
Keynote Speaker
' _
Summit, New Jersey.' Junior, League:;
Combined State Meetings~
Date:
Purpose :,
Organization:
,
,
.
'
Meeting Site:
,Travel Paid.
by::
Summit, "NJ
Inv'itfng' group
,
****~*~********~****~~********i************~*******************
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'Page Two
Travel Dates
'Carol H. 'Rasco
I,
Date:
Purpose:
Organization.:
,iNovember 5, 1994
Meeting Site:
,Travel p'aid
by:
:Morgantown ,WA
'Keynote Speaker
:West Virginia Rural Health Conference.
'OPD/DPC
(This w'ci.sa commitment mcide rov~r.a year ago at the request of the
Health Care team in 'the WhiteHouse.)
********~************~***********~******~************* *********
;'
Date:
Purpose:
Organization:
i
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November 1,8, 1994
; Keynote Speaker
: American Speec,h, Language, and
, Hearing Association National
Convention.
New Orleans,' LA
Meeting Site:.
Travel Paid
'by:
, Invi t ing group
**********************~~************.***************** *******
Date:
i
Purpose:
Organization:
I
Meeting ~ite:
'Travel Paid
by:
Apti~ 3,' 1995
'Keynote Speaker
Annual Meet.ing: Society of'
Hospital Epidemiologist
Association (SHEA)'.
San Diego, CA
Inviting group
***********************~****************************** ******
Date:
Purpose:
,Organiz~tion
May: 17,' 1995
Kevriote Speaker'
,President s Commission on
Employment of People with
D.isabilities ,Conference.
:
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Meeting Site:
Trav:el Paid
by:
Port-land, OR
.oPD/DPC
,
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�f:
,', ',' , EXECUTIVKOFFICKOFTHE'PRESIDENT';'"
OFFICIAL TRAVEL AUTHORIZATION
" , (Privacy Act Statement, and instructions,'on back) ,
I.
I
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, []tIDY
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:'"
2. Traveler (First name; middle initial,last name)
r", Carol l:I.
!! ~
~", ':
RasCo
. ;'
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, ;;D'in~iiation!ii':,,~:,~""--'~,::';,::D::Rei~atio~,',
;':--(NonEOP Employees Only)"
'
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".·:4~-,:AGENCYJDIVISION'·
-_--:-,,,.,.&... _ • ~~Q,?DIP.~C.._ .;_:~ _.;
Assistant to
:5.omcePbone
",
456-22~6
" DATE(S):'.Trave18eginOn.
14(a)
OAFORM22
II.MSEDFEBaUARYl993
-.-.': ;.:',
_...,:,." :': . ~ ...i~,' ~:~,
"c:7.'~erDiem':D~:':, ':,: ";,-:;:,~:i':~~~'i,.":·:':'-,;;:::::J,::'::"'"
O:ActuaJ Subsistence (unus~l circumstaJ,ces)~:.;;:~~<'::;~;J;i;'; '; :-~
:'..:- ':..~" ..:.:~.•,;~:~.~.:;: :~:-~\.'{:.:";.:': F,~ •
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004. note
DATE
SUBJECTrrrrLE
handwritten re Sep 94 visit to Arkansas (1 page)
nd
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: AHSEA 50th Annual Training Conference (Hot .
Springs AR) 10-13-94
201O-0198-S
kc225
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(1) National security classified information [(b)(I) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA)
National Security Classified Information [(a)(1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of thePRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�DHS DIRECTOR'S OFFICE
Aug ~6'94
TEL:I-501-682-8650
.L~~'+ 1U1~.a::.t\
t"KUuKAM UV1:.KVlliW
.
11:08 No.006 P.03
Wednesday, October 11..1294
3:00 p.m. ~ 6:00 p.m.
6:00 p.m. • 8:00 p.m.
8:30 p.m. • 12:30 a.m.
Registration and Membership
Director/Retiree Reception '
Welcome Party
,
Featuring: Disc Jockey, J.B. Stack;s
,f,!
.:.:
Thursday. October 13. 1924
I~
7:00 a.m. • 8:30 a.m.
8:00 a.m. • 6:00 p.m. .
9:00'a.m. " 12:00 p.m.
Continental Breakf~t :1.,:"
Registration ,and, Mc:hno!eiship
Opening Session
" :':l
t'il'
1
Invocation
Presentation of Flags
Pledge of Allegiance
National/Arkansas Anthem
Accompanist
Welcome/Director's Remarks
Introduction of Senator Canada
Welcome
~
,
James Thomason
Army Reserve
Army Reserve
Malvie Giles
Sandra Walters
Tom Da]ton.:DHS Director
Tom Dalton.,DHS Director
Senator Bud Canada, District 13
Presentation of the·Governor
Tom Dalton, DHS Director
Governor's Remarks
The Honorable Jim Guy Tucker
Governor, Arkansas (Invited)
."
Keynote Speaker
Carol Rasco, Domestic Policy Advisor, the
White House, Washington D.C.
President Chlistine Brow,n
,1
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Business Meeting
Door Prizes
I'
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12:00 p.m.• 1:15 p.m.
1:15 p.m.• 2:45 p.m.
2:45 p.m. • 3:00 p.m.
3:00 p.m.• 4:30 p.m.
4:30 p.m.• 6:00 p.m.
6:00 p.m. - 7:00 p.m.
. 7:00 p.m. • 9:00 p.m.
9:00 p.m. • 1:00 a.m.
Lunch,
Concurrent Workshops .: .' ';
!~
Break
ConcurrentWork,shops
1
Dinner - Blues in the Park
President's Reception
Entertainment Show
Dance
Featuring: Disc lockey, J.B. Stacks
•
·1
friday, October 14. 1294
8:00 a.m. ~ 10:00 a.m.
Registration and"Membership
8:00 a.m. • 9: 15 a.m.
Concurrent Workshops '
9:15 a.m. - 9:30 a.m.
Break
9:30 a.m. • 10:30 a.m.
Concurrent Workshops
10:15 a.m.• 12:30 p.m.
Awards Brunch
Jnvocation
Roy Johnson
Speaker
Tom Dalton, DHS qirector
Presentation of CertifiCates/Awards'
.:
Business, Meeting,
Christine Brown, Pr~siqe.t;lt
Door Pflzes
' !: :
Closing Remarks
'.'
,
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DATE: 30 SEP 94
PAGE: 01
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TO: WHITE HOUSE TRAVEL
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12 OCT 94 ...: WEDNESDAY'
ECONOMY .
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DAILY.RATE-USD32.00
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. 'CONFIRMATION NUMBER
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:CONTINUED ON. PAGE 2 .
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2~AUG94
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09:49 FROM 52029150 0721325M
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DATE: 29 AUG 94
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SALES PERSON: 50
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CONFIRMATION NUMBER
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13 O~T 94 - THURSDAY
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PAGE 2 OF 3
�,
29AUG94 09:49 FROM 62029160 0721326M
SALES PERSON: 50
CUSTOMER NBR: 1695000023
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DATE: 29 AUG 94
PAGE: 02
ITINERARY
RRUIEW
TO: WHITE HOUSE TRAVEL
1600 PENNSYLVANIA AVE
WASH DC 20500
FOR: RASCO/CAROL
U~
TOTAL AIR FARE
USE OF NON CONTR~R MUST B~ CERTIFIED
ON THE TRAVEL AUTHORIZATION FORM.
II
FOR AFTER HOUR EMERGENCIES
CALL 800-847-0242/YOUR HOTLINE CODE IS s-Kc52
REMINDER ..........
ALL FREQUENT FLYER BENEFITS EARNED ON OFFICIAL TRAVEL
ARE THE SOLE PROPERTY OF THE U.S. GOVERNMENT AND CANNOT
BE REDEEMED FOR PERSONAL USE •
••• + •••••••••••••
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ALL UNUSED TICKETS ARE TO BE RETURNED TO AMERICAN
EXPRESS OR YOUR TRAVEL COORDINATOR IMMEDIATELY UPON
RETURN FROM TRAVEL OR WHEN TRIP HAS BEEN CANCELED .
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PAGE 3 OF 3
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�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. itinerary
DATE
SUBJECTrrITLE
AmEx Travel for Rasco from WDC to Little Rock AR to Cincinnati
OH and ret, 10/12-10/13/94 (partial) (l page)
09/07/1994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: AHSEA 50th Annual Training Conference (Hot
Springs AR) 10-13-94
2010-0198-S
kc225
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(1) National security classified information [(b)(1) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA] .
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) ·Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice beiween the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�SALES PERSON: 50
.
CUSTOMER NBR I 1695000023
ITINERARY
RRUIEW
TO: WHITE HOUSE TRAVEL
1600 PENNSYLVANIA AVE
WASH DC 20500.
.
,
:1·
.1
FOR: RASCO/CAROL
12 OCT 94 - WEDNESDAY
AIR NORTHWEST AIRLINES
LV WASHING'lOIiNAt'L
FLTI855
ECONOMY
·.'i.ti;~~~l'i• •"'.
AR MEMPHIS
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11 20A
.AIR USAIR
FLT: 1441
ECONOMY
LV CHARLOTTE
11 50A
AR LITTLE ROCK
1242P
CAR LITTLE ROCK
NATIONAL CAR RENTAL
PICK UP-1242
RETURN-130CT/3P
I-INTER CAR AUTOA/C
RATE. IS SUBJECT TO CHANGE
DAILY RATE-USD33.00·
UNLIMITED MILEAGE
_______CONFIRMATION NUMBER
0972277123COUNT
13 OCT 94 - THURSDAY
AIR DELTA AIR LINES INC FLT:1214
LV LITTLE ROCK
AR CINCINNATI ~
RASCO/CAROL
~~
AIR DELTA AIR LINES INC FLTI848
LV CINCINNATI
AR WASHINGTON NA~
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7SEP94 15:16
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CUSTOMER NBR: 1695000023
ITINERARY
RRUIEW
TO: WHITE HOUSE TRAVEL
1600 PENNSYLVANIA AVE
WASH DC 20500
FOR: RASCO/CAROL
TOTAL AIR FARE USD 261.00
USE OF NON CONTRACT CARRIER MUST BE CERTIFIED
ON THE TRAVEL AUTHORIZATION FORM.
FOR AFTER HOUR EMERGENCIES
CALL 800-847-0242/YOUR HOTLINE CODE IS S-KC52
................................................... :. ..
............. ~ ... REMI NDER ......................... :. :
,
I
i
ALL FREQUENT FLYER BENEFITS EARNED ON OFFICIAL TRAVEL
ARE THE SOLE PROPERTY OF THE U.S. GOVERNMENT AND CANNOT
BE REDEEMED, FOR PERSONAL USE.
"/
I;
ALL UNUSED TICKETS ARE TO BE RETURNED TO AMERICAN
EXPRESS OR YOUR TRAVEL COORDINATOR IMMEDIATELY 'UPON
RETURN FROM TRAVEL OR WHEN TRIP HAS BEEN CANCELED.
THANK YOU FOR TRAVELING WITH AMERICAN EXPRESS. '
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PAGE 3 OF 3
�Contact person: Pat Romani
Phone number: 62216
Date of request: 8-29-94
ACCEPTANCE OF TRAVEL EXPENSES FROM OUTsIDE SOURCE
In order to consider whether the Government may accept from an outside source payment of
your travel, subsistence and related expenses under the GSA travel rule, you must complete the
information below. The outside source need not be a 501(c)(3) organizatio~ but if it is, please
state so on this form and include the IRS determination letter.
. ,. Please inClude a copy of the letter of invitation if one was received.
Your name and position:
Carol H. Rasco
Assistant to the President for Domestic
Policy
Nature of meeting or similar function and how it relates to your official duties:
Speech (Keynote) to 'Arkansas Department of Human Services
Employees Annual Meeting re.: Health Care Issues and other
Domestic Policy matters .
Date and place(s) of travel:
October 12 - 13, 1994
Little Rock, AR and
Hot Springs, AR
Persons or entity making the payment (please also note any financial interests of the person or
entity known to you that may be affected by the exercise of your -Government responsibilities):
Arkansas Human Services Employees Association
Nature of expense(s) paid for:
Round-trip airfare; lodging, rental car
Method and approximate amount of payment (payment may be made either in-kind or by
check made payable to U.S. Treasury; you may not directly receive payment in cash or check
made out to you):
.
Reimbursement to u.S. Treasury
This form and any accompanying memorandum of approval must be attached to your travel
authorization. You must complete a travel voucher following the trip. Please send completed
form to Room 128, CEOB, at least 3 days before commencement of travel.
�DHS DIRECTOR'S OFFICE
TEL:1-501-682-8650
May 17'94
13:08 No.001 P.02
Arkansas Department of Human Services
Office of the Director
329 Donaghey Building
P.O. Box 1431
Little Rock. Arkansas 72203"1437
Telephone (501) 682-8650
FAX (501) 682-6836
Jim Guy Tueller
Gove'nor
May 17, 1994
Carol Rasco, Domestic policy Advisor
Office of the Assistant to the President
Second Floor, West wing
Tl'le White House
Washington, DC 20500
Dear Ms.
Resee,~
/
On behalf of the Arkansas Human Services Employees Association, I
would like to' invite to you to be our keynote speaker at our 50th
Annual Training conference on Thursday, October 13, 1994 at· the
Arlington Hotel, Hot Springs, Arkansas.
As you are aware, the AHSEA officers, board, and members work
diligently each year planning the array of training activities
designed to enhance our skills, stimulate our minds and enrich
our hearts.
carol, I know from my conversations with Alexis that these are
busy times for all of you, but we would consider your presence an
honor. In my opinion, the President is the only other person who
knows the challenges Arkansas Human Service workers face daily
and understands our commitment to provide quality services to our
citizens, as well as you do. Please let me know by June 1st if
your schedule will allow you to participate.
Thank you and best regards to Alexis and Rosalind.
Sincerely,
9~
Pearl Herman
DRS
Advocate
PH:lae
cc: Chris Brown, President, AHSEA~~~-3'750'
Tom Dal t.on, Director
Caring People. .. Quality Services
"The Arkansas Department of Human ServiceD is in compliance with Titles VI and VII of the Civil RlghtD Act and Is operated.
managed and delivers Gervices without regard to age. religion, disability. political afliliation. veteran status. sex. race.
color or national origin."
.
�DHS DIRECTOR'S OFFICE
TEL:1-501-682-8650
Aug 26'94
11:09 No.006 P.04
Arkansas Department of Human Services
Office of the Director
Jim Guy Tucker
Goy.rnor
329 Donaghey Building
P.O. Box 1437
Little Rock, Arkansas 72203.:.1437
Telephone (501) 682-9650
FAX (501) 682-6836
"
August 26, 1994
Ms. Carol RasCO
Assistant to the President
for Domestic Policy
Second Floor, west Wing
The Wbite House
Washington, DC 20500
Dear Carol:
On behalf of the Arkansas Human services Employees
Association, I want to thank you for accepting the
invitation to be the keynote speaker at our annual meeting
on October 13, 1994 in Hot Springs, A~kansas •.
•!;
The Association will, reimburse you fo~ ~oundtrip airfare,
lodging, rental car, and other incurr~d :!expenses.
l'
I
look forward to seeing you!
"'
.
,.
TD/pb
Caring PeopJe... Quality, ~¢:rvices
"The Arkansas Department of Human Services ill in compliance with Titles VI and VII of m~ Civil Rights Act and Is operated,
managed and delivers services without regard to age, religion, disability. political afflll,8t,lon, veteran status, sex, race,
.
color or national origin."
.
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1994'
LEON :..
,
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Carol Rasco had already'
acc~pted'the attached speech
requests requiring travel ' ,
, prior to you becoming, Chief 0
, Staff.
>.'
She would like to know as soo
as possible if you have any: ,
problems with 'any ,of them, '
since it would' bedifficult,to
cancel~
I"recommend you approve
attached'list.
'.
"
�'.,
"
"
TH EWH ITE HOUSE
WASHINGTON
, Septemb~r 16, 1994 "
'MEMORANDUM FOR Jodi Torkelson
Assistant to th~,President ~or Management
and, Administration '
caro~
'FROM:
Ri3-SC~ ,~,
H."
Assistant to the President for'Domestic Policy
Accepted, Invitations/Out-of"'Town Travel
SUBJECT:
As we have discussed earlier, I have accepted 'engageIT1ents prior
to Leon Panetta's new procedures relating to travel.
I have attached a memorand~m::'prepared by my staff' which, lists
out-of town comm;itments, meeting site,' and other pertinent
data pertaining to these events.
,
,
It is rare I' would' accept' invitations, so' far' in adva,nce
as the two listed for 1995 . However, these'; were very special
circumstances':
1)
April 3, 1995
Keynote Speaker
Annual Meeting: Society of Hospital
Epidemiologist Association (SHEA)
The Health Care Reform Team recommended this acceptance.
2),
May 17, 1995
Keynote Speaker
President's
on Employmet;lt of People'
withDisabilitie~ Conferende
This was accepted at Tony Coehlo's insi'stence ,as this is the
group ,he Chairs.
"
Commis~ion
1
'
I would appreciate your help if you anticipate any difficulties
in honoring ,the commitments listed in this memorandum.
Thank you.
�:;; I,
THE WHI,TE HOUS,E,
WASHINGTON
September 14, 1994
MEMORANDUM 'FOR CAROL H. RASCO
AS~I~TAN~T,HyRES~~ENT ,FOR POMESTIC POLICY
TO "
From:
Subject:' ,
Pat Roma
'
'
Staff As' " nt/Schedu,ling
Acce'tite~'I~vitation~/ou~-'of-Town
Travel,
't
on
'
Following areout-of-,town commitments
'your schedule through this
date. The inviting organization; meeti,ng site, and other pertinent
data are~included.
'
D~te:
September 2'3" 199'4 ':,
Purpose, :.. ,
'Organization: ,
Keynote 'Speaker""
,Meeting Sit,e:
Travel Paid
by :
National Easter,Seal Society and,the
University of Minnesota's Center
, ,:for "Citizenship and, Democracy Launch,
'Program.
'
'"
'Min~eapolis,
MN',
Inv:i,ting group
******************~******.*********~****************** **********
Date:
Purpose:
Organization:
, Octbber 13, '1994 ,
',Keynote Speaker"
50th Annual Training Conference:,'
Arkansas HUman Services Empioyee'
Association~
Meeting Sit~:
Travel Paid
by:
Hot Springs, AR
\
Invitinggrpup
"
"
***********~******.***~******~*********************'*****~******
Date:
PUrpose:
Organization:
dctober 25, 19S4
Keynote Speaker
Su~mit, New Jersey Junior League;'
Combined State Meetings.
"
Meeting Site:
,Travel Paid,
by: "
Summi t .,NJ '
Inviting group
***********************************.***************************
.(
"
�...
Page Tr;o
Travel Dates
Carol H.' Rasco
November 5, 1:994
Date:
Purpose:
,Organization:
,
,
,
Keynote Speaker. "
West Virg'±nia Rural Health Conference.
Meeting Site:',
Travel Paid
by:
Morgantown, WVA
Date:
Purpose:
Organization':
,November 18,' '1994
OPD/,DPC
(This was'a 'co:muiitment made over a" year ago at the request of the
Health Care team, in ,the White House.,) ,
* * * * * ** *,* * * * *.* *'* *** *. -It'*, ****** ** *~ *,* *... * * * * * * * * * * * ** *** ** * * -Ii ** ** * *
Keynote Speaker'
American Speech', 'Language; and
'Hearing Asso'ciation National
Convention.
New Or,leans, LA'
Meeting Site:
"
Travel Paid
by:
Inviting: group
********~*********************~****~***~********~*~**~*******
April 3, 1995
Date:
PurPose:
Organization: .
Keynote' Speaker
Annual Meeting:', society of
;}iospital'Epidemiologist
Association, (SHEA)
.'
San Diego , .CA
Meeting Site:,
Travel Paid
by: '
'Invi'ting gr9up',
* * ** ** ** *.** ** * * * ** * * * *'* * * **** ** * ** * *~ * '* * * * * ***'*'* **** * * * *****
Date:
Purpose:
Organization: .
,.'
.
,May 17, 1995
Keynote Speaker
President's; Commission on
Employment of People with
Disabilitie's Conference.
'.
Portland, OR
Meeting Site:
Travel Paid'
,by:
OPD/DPC
.
~.
',"
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006. memo
SUBJECTrrITLE
DATE
Rasco to Romani re LR Trip, 4:56pm (partial) (I page)
08/26/1994
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: AHSEA 50th Annual Training Conference (Hot
Springs AR) 10-13-94
2010-0198-S
kc225
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.c. 552(b)]
PI
P2
P3
P4
b(l) National security classified information [(b)(I) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(I) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�•
E X E CUT I V E
\
OFF ICE
o
F
THE
PRES I DENT
26-Aug-1994 04:56pm
TO:
'FROM:
Patricia E. Romani
Carol H. Rasco
Economic and Domestic Policy
,~
SUBJECT:
LR trip
'~
~:...-....;.~~~~
d. I will want a rental car and a hot~l.,r90I\'l,~t;,tpe Capitol.
~
Make a note that if by chcl.nce I hav~' to go 'down the night of 'the "-0
11th,. r,willeither stay'at'rny'sister's that one night or r or
<""'"
Fea~ralL'd6ve'rnme'n~J~tif' I aCl.d ,,~Qusiness engagement besides the DHS
speech), not DHS o£ .Arkansas will pay for that extra night at the
hotel}" will make a final .decision later.
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007. list
SUBJECTffITLE
DATE
October 12 Flight Options (partial) (I page)
nd
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlSox Number: 8505
FOLDER TITLE:
Complete Scheduling per J0-11: AHSEA 50th Annual Training Conference (Hot
Springs AR) 10-13-94
2010-0198-S
kc225
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified information [(b)(l) of the FOIA]
b(2) Rt;lease would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b )(3) of the FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)( 1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�OCTOBER 12 FLIGHT OPTIONS:
LV DC
AR NASHVILLE
7:57
8:48
LV NASHVILLE
10:29
LV DC
AR CHARLOTTE
10:00
11:20
LV CHARLOTTE
Q~
9:20
AR LR
\ 11: 50
AR LR
US AIR
12z42
LV DC
AR ST. LOUIS
CL
AMERICAN AIRLJNES
10:20
11:40
LV ST. LOUIS
1:32
LV DC
AR MEMPHIS
11:40
12:57
>
12:20
AR LR
TWA
LV MEMPHIS
2:20
AR LR
NW
3:16
Hamp:
dinner
........................ ......................
~
OCTOBER 13 FLIGHT OPTIONS:
LV LR
AR MEMPHIS
12:25
1:06
NORTHWEST 1421
NORTHWEST 984
LV MEMPHIS
4:59
LV LR
AR CHARLOTTE
1:20
4:03
US AIR 874
LV CHARLOTTE·
4:40
US AIR 872
AR DC NAT'L
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2:00
AR DC NAT'L
5:54
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�FILE COpy
Contact person: Pat Romani
Phone number: 62216
Date of request: 8 - 2 9- 9 4
ACCEPTANCE OF TRAVEL ExpENSES FROM .OUTSIDE SOURCE
In order to consider whether the Government may accept from an outside source payment of
your travel, subsistence and related expenses under the GSA travel rule, you must complete the
information below. The outside source need not be a' 501(c)(3) organization. but if it is., please
state so on this form and include the IRS determination letter.
Please include a copy of the letter of invitation if one was received.
Your name and position:
Carol H. Rasco
Assistant to the President for Domestic
Policy
Nature of meeting or similar function and how it relates to your official duties:
Speech (Keynote) to Arkansas Department of Human Services
Employees Annual Meeting re.: Health Care Issues and other
Domestic Policy matters
Date and place(s) of travel:
October 12 - 13, 1994
Little Rock, AR and
Hot Springs, AR
Persons or entity making the payment (please also note any financial interests of the person or
entity known to you that may be affected by the exercise of your -Government responsibilities):
Arkansas Human Services Employees Association
Nature of expense(s) paid for:
Round-trip airfare; lodging, rental car
Method and approximate amount of payment (payment may be made either in-kind or by
check made payable to U.S. Treasury; you may not directly receive payment in cash or check
made out to you):
Reimbursement to U.S. Treasury
This form and any accompanying memorandum of approval must be attached to your travel
authorization. You must complete a travel voucher following the trip. Please send completed
form to Room 128. OEOB~ at least 3 days before commencement of travel.
�DHS DIRECTOR'S OFFICE
Ma~
TEL:1-501-682-8650
13:08 No.001 P.02
17'94
"
Arkansas Department of Human Service$
Office of the Director
329 Donaghey Building
P.O. Box 1437
Little Rock, Arkansas 72203"'1437
Telephone (501) 682-8650
FAX (501) 682-6836
Jim Guy Tuclo;er
Governor
May 17, 1994
Carol Rasco, Domestic Policy Advisor
Office of the Assistant to the President
Second Floor, West Wing.
The White House
Washington, DC 20500
Dear H&
fiLE COpy
aesee,~
.
I'
On behalf of the Arkansas Human Services Employees Association, I
would like to invite to you to be our keynote speaker at our'50th
Annual Training conference on Thursday, october 13, 1994 at· the
Arlington Hotel, Mot Springs, Arkansas.
As you, are aware, the AHSEA officers, board, and members work
dlliqently each year planning the array of training activities
desiqned to enhance our skills, stimulate our minds and enrich
our hearts.
carol, I know from my conversations with Alexis that these are
busy times for all of you, but we would consider your presence an
honor. In my opinion, the President is the only other person who
knows the challenges Arkansas Human Service workers face daily
and understands our· commitment to provide ..qual i'ty services to our
citizens, as well as you do.' Please let me know by June 1st if
your schedule will allow you to participate.
l
Thank you and best regards to Alexis and Rosalind.
Sincerely,
94
Pearl Herman
DHS Advocate
PH:lae
co: Chris Brown, President, AHSEA~~ ~ ~~5-u
Tom Dalton, Director
Caring PeopJe.
Quality Services
"The Arkansn Department of Human Services is in compliance with Titles VI and VII of Ihe Civil Rights Act and Is operated.
managed and delivers services without regard to ag8. religion, disability. political aftiliation, veleran statuI, SEllI. race.
. color or national origin."
�DHS DIRECTOR'S OFFICE
TEL:1-501-682-8650
Rug 26'94
11:09 No.006 P.04
Arkansas Department of Human Services
Office of the Director
Jim Guy Tucker
Governor
329 Donaghey Building
P.O. Box 1437
Little Rock, Arkansas 72203""1437
. Telephone (501) 682-9650
FAX (50') 682-6836
August 26, 1994
fiLE COpy
Ms. Carol Rasco
Assistant to the President
for Domestic Policy
Second Floor, west Wing
The White House
Washington, DC 20500
Dear Carol:'
On behalf of the Arkansas Human services Employees
Association, I want to thank you for accepting the
invitation to be the keynote speaker at our annual -meeting
on October 13, 1994 in Hot Springs, Arkansas.
.
The Association will reimburse you for roundtrip airfare,
lodging, rental car, and other incurred expenses.
I look forward to seeing you!
TO/pb
Caring People.
Quality Services
"The Arkansas Department 01 Human Services is in compliance with Titles VI and VII of t.he Civil Rights Act and Is operated,
managed and delivers services without regard to age, religion, disability. political affiliation, veteran status, sex, race,
color or national origin."
�Contact person: Pat Romani
Phone number: 62216
Date of request: 8-29-94
ACCEPTANCE OF TRAVEL EXPENSES FROM OUTSIDE SOURCE
In order to consider whether the Government may accept from an outside source payment of
your trave~ subsistence and related expenses under the GSA travel rule, you must complete the
information below. The outside source need not be a 501(c)(3) organization, but if it is, please
state so on this form and include the IRS determination letter.
Please include a copy of the letter of invitation if one was received.
Your name and position:
Carol H. Rasco
Assistant to the President for Domestic
Policy
Nature .of meeting or similar function and how it relates to your official duties:
Speech (Keynote) to Arkansas Department of Human Services
Employees Annual Meeting re.: H~alth Care Issues and other
Domestic Policy matters
Date and place(s) of travel:
October 12 - 13, 1994
Little Rock, AR and
Hot Springs, AR
Persons or entity making the payment (please also note anyJinancial interests of the person or
entity known to you that may be affected by the exercise ot your ,Government responsibilities):
Arkansas Human Services Employees Association
Nature of expense(s) paid for:
Round-trip airfarei lodging, rental car
Method and approximate amount of payment (payment may be made either in-kind or by
check made payable to U.S. Treasury; you may not directly receive payment in cash or check
made out to you):
Reimbursement to U.S. Treasury
This form and any accompanying memorandum of approval must be attached to your travel
authorization. You must complete a travel voucher following the trip. Please send completed
form to Room 128, OEOB, at least 3 days before commencement of travel.
�DHS DIRECTOR'S OFFICE
TEL:1-501-682-8650
Ma!:1 17'94
13:08 No.001 P.02
Arkansas Department of Human Services
Office of the Director
329 Donaghey Building
P.O. Box 1437
Little Rock, Arkansas 72203·1437
Telephone (501) 682·8850
FAX (501) 682-6836
Jim Guy Tuciler
Governor
Hay 11, 1994
Carol Rasco, Domestic policy Advisor
Office of the Assistant to the President
Second Floor, West Wing
The White House
Washington, DC 20500
Dear ME.
Resee,~
/
on behalf of the Arkansas Human Services Employees Association, I
would like to invite to you to be our keynote speaker at our 50th
,Annual Training' conference on Thursday, October 13, 1994 :'at the
Arlington Hotel, Mot springs, Arkan~as.
As you are aware, the AHSEA officers, board, and members work
diligently each year planning the array of training activities
designed to enhance our skills, stimulate our minds and enrich
our hearts.
carol, I know frOR my conversations with Ale~is that these are
busy times for all of you, but we would consider your presence an
honor. In my opinion, the President is the only other person Who
knows the challenges Arkansas Human Service workers face daily
and understands our commitment to provide quality services to our
citizens, as well as you do. Please let me know by June 1st if
your schedule will allow you to participate.
Thank you and best regards to Alexis and Rosalind.
!
Sincerely,
94
Pearl Herman
Advocate
DRS
PH:lae
cc: Chris Brown, President, AHSEA~~~-S~60
Tom Dalton, Director
Caring PeopJe. .. Quality Services
-'The Arkansas Department of Human Se(l,iC8a is in compliance wit" Titles VI and VII of loe Civil Rights Act and is operated.
managed and delivers services without regard to age. r9119ion, disability. political afliliation. veteran status, sex. race,
color O~ national origin."
�DHS DIRECTOR'S OFFICE
TEL:1-S01-682-86S0
Aug 26'94
11:09 No.006 P.04
Arkansas Department of Human Services.
Office of the Director
Jim Guy Tucker
Governor
329 Donaghey Building
P.O. Box 1437
Little Rock. Arkansas 72203~1437
Telephone (501) 682-9650
FAX (50') 682-6836
August 26, 1994
Ms. Carol Rasco
Assistant to the President
for Domestic Policy
, Second Floor, West Wing
The White House
Washington, DC, 20500
Dear Carol:
On behalf of the Arkansas Human services Empioyees
Association, I want to thank you for accepting the
invitation to be the keynote speaker at our annual meeting
on october 13, 19~4 in Hot springs, Arkansas •.
The Association will reimburse you for roundtrip airfare,
lodging, rental car, and other incurred expenses.
I look forward to seeing you!
TP/pb
Caring People. .'., Quality Services
"The Arkansas Department of Human Services i. in compliance with Titles VI and VII of the Civil Rights Act and Is operated.
managed and delivers services without regard to age. religion, disability. political affiliation. veteran ,tatuB. 8e". race.
color or national origin."
�·.
THE WHITE HOUSE
WASHINGTON
May 20, 1994.
Pearl 'Herman
DHSAdvocate
Arkansas Department of Human services
Office of the Director
329 Donaghey Building
P.O. Box 1437
Little Rock, AR 72203-1437
Dear Pearl:
As a follow 'up to our phone conversation this morning, I am
writing to formally accept your invitation for Carol Rasco to
address your 50th Annual Training conference on Thursday, October
13, 1994 in Hot Springs, Arkansas.
I look forward to working with you as time nears.
free to call me anytime at, (202)456-2216.
My best to you and your family.
SifrerelY,
,
I
Ck',
.
,/ Y{@aitryG
,
/Rosalyn tA. Miller
Executive Assistant for
Domestic Policy
Please feel
�-
THE WHITE HOUSE
H~Y
OFFICE OF DOMESTIC POLICY"
CAROL H. RASCO
Assistant to tile President for Domestic Policy
To:
Draft response for POTUS
and forward to CHR by:
Draft response for CHR by:
Please reply directly to the writer
(copy to CHR) by: _ _ _ _ _ _ _~ _ _ _ __
Please advise by: _ _ _ _ _ _ _ _ _ _ __
let's discuss:
For your information: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Reply using form code:
File: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Send copy to (original to CHR):
Schedule? :
o Accept
o Regret
o Pending
..
/'
?l_ .~.t
CLlNTON LIBrtl\R'f PHOTOCOPY
�DH$ DIRECTOR'S OFFICE
.... y .'
TEL:1-501-682-8650
Ma~
17'94
13:07 No.001 P.01
.(
~A"Y
I
17
Arkansas Department of Human Services
Office
of the Director
329 Donaghey Building
P.O. Box 1437
Little Rock, Arkansas 72203"'1437
Telephone (501) 682-8650
FAX (501) 582-6836
Jim Guy Tucker
GOIIIomot
DATE
FAX#
TO:
~/%/99f
(~) lifo. ·-1.87~
Name
(Jel) 45[p' JJ../Le
Phone Number
or9anization/Position
FROM:
Name
.
(So( ) {p&:J- 5(;60
Phone NumbClr
TOTAL NUMBER OF PAGES INCLUDING COVER SHEET
PROBLEMS RECEIVING THIS MESSAGE, PLEASE' CALL:
At
Name
(jO}) [p~'
d -kLo6D
Phone Number
REMARKS:
Caring Pyople. . _Quality Services
"The Arkansas Oopor!ment of Human Sorvlces Is In compliAnce witI'! Tilles Viand VII of Ihe Civil Rights Act and Is operated,
managed and delil/ers services without regard to age, religion, dlsabilily, sex. race, color or national orig,in."
�D~S
DIRECTOR'S OFFICE
TEL:1~501-682-8650
Rug 26'94
11:09 No.006 P.04
Arkansas Department of Human Services
Office of the Director
Jim Guy Tucker'
GOVlltltO'
329 Donaghey Building
P.O. Bo)( 1437 "
Little Rock. Arkansas 72203-1437,
Telephone (501) 682-9650
FAX (501) 682-6836
Auqust 26, 1994
Ms. Carol Rasco
Assistant to the President
for Domestic Policy
Second Floor, west'Wing
The White House
Washington, DC 20500
Dear Carol:
On behalf of the Arkansas Human services Employees
Association, I want to thank you for accepting the
invitation to be the keynote speaker at our annual meeting
on October 13, 1994 in Hot Springs, Arkansas.
The Associationw'ill reimburse you ,for roundtrip airfaro,
lodqing, rental car, and o~her incurred expenses.
I look forward to seeing you!
TD/pc
Caring People. .. Quality Services'
"The Arkansas Department of Human Services is in compliance with Titles VI and VII of the Civil Rights Act and Ie operated,
managed and delivers services without regard to age, religion, disability. political aftlllaUon, vEll9ran status, 88lt, rac:e,
color or national origin.~·'
'
�DHB DIRECTOR'S OFFICE
Rug 26'94
TEL:1-S01-682-86S0
,11:07 No.006 P.01
Arkansas Department of Human Services
Office 01 the Director
Jim Guy Tucker
GU'f.tno,
329 Donaghey Building
p,O, Box 1437
Little Rock, Arkansas 72203-1437
Telephone (501) 682-8650
FAX (501) 682-6836
FACSIMILE COVER SHEET
DATE:~'
.
•
PLEASE DELIVER THE FOLLOWING PAGE(S) T : ? A i :
THESE PAGES ARE BEING TRANSMITTED FROM:
Rc
~
.'
M
e
f
7A: ~ 15K c.n.e.i±"
!f- , '
.'
TOTAL,NUMBER OF PAGES INCLUDING THIS COVER PAGE:
IF YOU DO NOT RECEIVE ALL THE PAGES. PLEASE CALL;-:P;MA..
BY..rVt.:ej} .'
TELEPHONE: (501) 602·8650
'
Caring People.. . Ql1ajityServices
"The Arkansas Depanment 01 Human Services ill in compllanco with Titlol VI and VII of the Civil Ai!'lhls Act and is oporated.
managed and delivers services without regard to IIge. rollgion. disability. se.., race, color or national CJrigin,"
�DHS DIRECTOR'S OFFICE
TEL:1-S01-682-86S0
Aug 26'94
11:08 No.006 P.02
Arkansas Department of Human Services
Office of the Director
Jim Guy Tucker
QO••'Mor
329 Donaghey Building
P.O. Box 1437
Little Rock, Arkansas 72203 .. 1437
Telephone (501) 682-8650
. FAX (S01) 682-6836
August 26,· 1994
To:
From:
Pat Romani
Pam
.~~
BUrhet~
Pat, as we discussed, attached is the program overview for
the Arkansas Human Services Employees Association conference
on october 12-14, 1994.
Carol is .scheduled to speak at the opening session on
October 13th. This session begins at 9:00 a.M. As I
mentioned to you, Carol will probably begin her presentation·
at approximately 9:40 or 9:50 a.m. We have not received
confirmation from Governor Tucker regarding his attendance.
If he is there, he will make.remarks and then introduce
carol. If he is unable to. attend, Tom Dalton (DHS Director)
will introduce her.
Carol should plan on a 20-30 minute presentation. After her
presentation (Which I would estimate will be somewhere
between 10:15 and 10:30) we will take a break before.
beginning the business session. So, Carol can plan on being
finished by 10:30 a.m.
If there are other meetings Carol would like to have while
here, I will be glad to assist in arranging those. Also, if
she needs someone to pick her up at the airport or assist
with any travel arrangements, just let me know.
Thanks for your assistance!
Caring People. .. Quality Services
''The Arkansas Department of Human Services Is In compliance with Titlet VI and VII of the Civil Rightll Aot and is operated,
managea and delivers services without regard to age. religion. disability, political affiliation. veteran status. S8X: race,
color or nallonal orlgln~"
�D~S
DIRECTOR'S OFFICE
TEL:l-S01-682-86S0Aug 26'94
.l~~'"
JU1:tt:.1\. rKUvKA.M UVJ:.K VlliW
11:08 No.006 P.03
,
Wednesday. October 12,1294
3:00 p.m. • 6:00 p.m.
6:00 p.m. • 8:00 p.m.
8:30 p.m. • 12:30 a.m.
Registration and Membership
Director/Retiree Reception
Welcome Party
Featuring: Disc Jockey, J.B. Stacks
Thursday. October 13.1994
7:00 a.m. • 8:30 a.m.
8;00 a.m. • 6:~0 p.m. .
9.00 a.m. • 12.00 p.m.
Continental Breakfast
Registration and Membership
Opening Session
Invocation
Presentation of Flags
Pledge of Allegiance
National/Arkansas Anthem
Accompanist
Welcome/Director's Remarks
Introductlon of Senator Canada
Welcome
James Thomason
Army Reserve
Army Reserve
Malvie Giles
Sandra Walters
Tom Dalton. DHS Director
Tom Dalton., DHS Director
Senator Bud Canada, District 13
Presentation of the Governor
Tom Dalton, DHS Director
Governor's Remarks
The Honorable Jim Guy Tucker
Governor, Arkansas (Invited)
Keynote Speaker
Carol Rasco, Domestic Policy Advisor, the
White House, Washington D.C.
President Christine Brown
Business Meeting
Door Prizes
12:00 p.m.• 1:15 p.rn.
1:15 p.m. - 2:45 p.m.
2:45 p.m. • 3:00 p.m.
3:00 p.m.• 4:30 p.m.
4:30 p.m. - 6:00 p.m.
6:00 p.m. - 7:00 p.m.
7:00 p.m. • 9:00 p.m.
9:00 p.m.• 1:00 a.m.
Lunch
Concurrent Workshops
Break
Concurrent Workshops
Dinner· Blues in the Park
President's Reception
Entertainment Show
Dance
Featuring: Dise Jockey, J.B. Stacks.
[rld8l'. October 14. 1994
8:00 a.m.• 10:00 a.m.
Registration and Membership
Concurrent Workshops
8:00 a.m. • 9:15 a.m:
Break
9:15 a.m.· 9:30 a.m.
Concurrent Workshops
9:30 a.m. ~ 10:30 a.m.
10:15 a.m.• 12:30 p.m.
Awards Brunch
Roy Johnson
Invocation
. Tom Dalton., DBS Director
Speaker
Presentation of Certificates/Awards .
Business Meeting,
Christine Brown, President
Door Prizes
Closing Remarks
.
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008. memo
SUBJECTrrITLE
DATE
08/26/1994
Rasco to Romani re LR Trip, 5:59pm (l page)
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ON Box Number: 8505
FOLDER TITLE:
Complete Scheduling per 10-11: AHSEA 50th Annual Training Conference (Hot
Springs AR) 10-13-94
20 10-0 J98-S
kc225
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(I) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of tbe PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of tbe PRA]
P5 Release would disclose confidential advice between the President
and bis advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
bel) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of tbe FOIA]
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysicaJlnformation
concerning wells [(b )(9) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be re\iewed upon request.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Carol Rasco - Issues Series
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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Clinton Presidential Library & Museum
Extent
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92 folders in 7 boxes
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Complete Scheduling per 10-11: AHSEA 50th Annual Training Conf. (Hot Springs, AR) 10-13-94
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 122
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
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Adobe Acrobat Document
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Clinton Presidential Library & Museum
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Reproduction-Reference
Date Created
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12/4/2013
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Text
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Administration of William I Clinton, 1994 / Aug. 4
that anyone might have imagined. Thank
you, Amanda, for your commitment and your
courage.
Ladies and gentlemen, let me close with
what I always think of at moments like this.
These young people have reminded us, as
the Attorney General has said, ofthe·power
of one person to make a difference. Each
of us in our own way have that power. And
I think we would all admit, starting with the
President, that every day at the end of the
day we have done less than we might have
done to exercise that power that is within
us all, divinely inspired and given to us for
whatever time we're on this Earth. Let's look
at them and remember our obligations to
make the most ofevery day.
Thank you, and bless you all.
1627
consistent with the Administration's commit
ment to equal oppOrtunity. In reviewing our
activities, we must seek not only to eliminate
barriers to equal access and opportunity, but
also to identify opportunities for innovation.
No Federal office should be exempt from the
obligation to further the struggle for civil
rights. And every State and local government
should be encouraged to do the same.
On January 17,1994, I issued an Executive
order establishing a President's Fair Housing
Council to be chaired by the Secretary of
Housing and Urban Development. Working
across agencies and programs, this Council
will bring new focus and leadership to the
administration of the Federal Government's
fair hOUSing programs. On February 11,
1994, I issued an Executive order directing
agenCies to develop strategies to identify,
. NOTE: The President spoke at 4:32 p.m. in the analyze, and address environmental inequi
East Room at the White House.
ties that are the result of Federal policies.
That order will increase public participation
in the environmental deciSion-making proc
ess.
In addition to these efforts, I believe more
August 4, 1994
can be done to exercise leadership for civil
rights enforcement. That is why I hereby es
Memorancfum for the Heads of Executive
tablish a Civil Rights Working Group, under
.
Departments and Agencies
the auspices of the Domestic Policy Council,
Subject: Civil Rights Working Group
to evaluate and improve the effectiveness of
Federal civil rights enforcement missions and
I am writing to you about our responsibil
ity to promote equal opportunity for all policies. The Civil Rights Working Group
Americans. We have accomplished much in will identify barriers to equal access, impedi
ments to effective enforcement of the law,
our pursuit of a society in which all our peo
ple can achieve their God-given potential. and effective strategies to promote tolerance
and understanding in our communities and
But we still have a long way to go.
Americans believe that in spite o( our dif workplaces. More important, I expect the
ferences, there is in all of us a common core Working Group to de\'elop new approaches
of 'humanity that obliges us to respect one to address these issues.
The principal focus of the Working Group
another and to live in harmony and peace.
We must build on this belief and give real will be 'our civil rights enforcement efforts.
meaning to civil rights by tearing down all We must recognize, however, that yublic and
remaining barriers to equal opportunity-in private enforcement resources wil never be
education, employment, housing, and every fully adequate to the task, and all of the re
maining obstacles to opportunity cannot be
area ofAmerican life.
Throughout the Nation, each of us must removed through litigation alone. Therefore,
bring new energy to our efforts to promote I direct the Working Group to identify inno
an open and inclusive SOCiety. Those of us vative strategies that can leverage our limited
resources to provide new avenues for equal
who':'.re public servants have a special obliga
tim)'; i.( the Federal level, we will do this opportunity and equal r.!,:;!·;ts. Among those
by re-evaluating the civil rights missi':ms, potential strategies are new measures relying
poliCies, and resources of every agency, so on civic education and voluntary efforts to
that they carry out their missions in a manner engage citizens in overcoming the effects of
~~:;'~:~iviI~~
�1628
/
Aug. 4 I Administration of William J. Clinton, 1994
past discrimination. These new strategies
should be designed to complement our improved and reinvigorated enforcement efforts.
The Attorney General and the Director of
the Office of Management and Budget will
co-chair the Working Group. The following
Administration officials will serve as mem
bers: the Secretary of the Treasury, the Sec
retary of Commerce, the Secretary of Agri
culture, the Secretary of the Interior, the
Secretary of Education, the Secretary of
Health and Human Services, the Secretary
of Housing and Urban Development, the
Secretary of Labor, the Secretary of Trans
portation, the Secretary of Veterans Affairs,
the Administrator of the Environmental Pro
tection Agency, the Chair of the Equal Em
ployment Opportunity Commission, the As
sistant to the President for Economic Policy,
the Assistant to the President for Domestic
Policy, and the Assistant to the President and
Director of Public Liaison; I also have invited
the Chairperson of the Commission on Civil
Rights to participate in this crucial endeavor
on an informal basis, respecting the inde
pendent and critical voice we expect of that
Commission. Finally, this membership list is
not exclusive. I invite and encourage all Cabi
net officers and agency heads. to participate
in the Working Group.
The Working Group will advise appro
priate Administration officials and me on
how we might modify Federal laws and poli
cies to strengthen protection under the laws
and on how to improve coordination of the
vast array of Federal programs that directly
or indirectly affect civil rights. I direct the
Working Group to prOvide the Cabinet and
me with a brief progress. report no less than
every 6 months, and specifically to:
(a) examine each Federal agency with a
significant civil rights mission and pro
vide me with an evaluation of how well
that mission is being implemented.
These analyses should examine whether
each agency uses the experience gained
from enforcement activities of other
agenCies and other levels of govern
ment. Counterp'!'oductive and inconsist
ent practices should be identified and
proposals for change recommended:
(b) examine cross-cutting civil rights law
enforcement challenges such as voting
rights and equal access to government
benefit programs and identify innovative
means of coordinating and leveraging
resources;
(c) develop better measures of perform
ance for Federal chi! rights enforce
ment programs, taking into account the
real impact of programs on the daily
lives ofall Americans; and
(d) support and advise all agencies as we
reinvent . our strategies for the pro
motion of an open and inclusive society.
With this interagency effort, I underscore
the commitment of this Administration to
bring new energy and imagination to the op
portunity agenda. In departments and agen
cies throughout the Fooeral Government,
this work is already well underway. The
Working Group will provide a mechanism to
expand and accelerate that vital work. Its
work will be among our greatest contribu
tions to the people we serve.
William J. Clinton
:~
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Remarks on the Anniversary of the
Passage of the Economic Program
August 5, 1994
Well, thank you all. We've established one
thing beyond doubt. We all have enough
sense to come in out of the rain. [Laughter]
Thank you, Mr. QUimby, and thank all of
you. We've had representatives of four fine
companies speak here today: the head of one
of our largest corporations: the head of a me
dium-sized high-tech company, growin\and
growing into the world economy; the ead
of a small company that's doubled the num
ber of--or now a man that's moved from a
small job to a large job in a small company
that's growing very rapidly; and a new em
ployee. The Vice President and I wanted
these folks here for this announcement today
because they represent what our efforts are
all about.
I said the other night in my press con
ferencz; that there are a lot of lobby groups
in Washington, but I wanted the W~1ite
House to be known as the "home office of
the 'American association of ordinary citi
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Carol Rasco - Issues Series
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Carol Rasco
Issues Series
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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92 folders in 7 boxes
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Civil Rights Working Group
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Carol Rasco
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Box 122
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2010-0198-Sb-civil-rights-working-group
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ac7ccc5632b83931d71e680e034f4360
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Text
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THE 'EDNA McCONNELL ~LARK FOUNDATION '
, PROGRAM FOR CHII..DREN
STRATEGY STATEMENT
MARCH 1996
Susan J. Notkin, Director
, Jolie E. Kapelus, Associate
~haron B. Karow, Assistant
�Introduction
Over the past 20 ytrars, the Foundation's Program for Childrenhasworked to stref'!gthen the nation's-'
child welfare system in an effort to improve the lives ofchildren.and famil ies ..While the Children's {lro~m
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has always been guided by the principle that children need permanent, stable famili,es, 'our grantmaking
.strategies in pursuit of that principle have evolved significantly over time .. Early on, we fo~used on the "back .' .
,
,
end" of ,the child welfare system, seeking to expedite adoptions of children 'with special emotional,
behavioral, and physical needs. We then concentrated on the broader
popula~ion ofchildren
languishing in
the foster care system, and soughtreformthrough more effective permanency planning - a mecpanism that
would allow children tp b~'returned
mor~ promptly t~ 'their families or, if reunification were i~possible, to,
be freed for adoption. Recognizing the benefit .of preventing children from unnecessarily entering foster care.
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in the first place, we shifted our focus over the last decade to p"romoting intensive family preservation
services(IFPS) - short-term, home-based crisis intervention services to enable children to remain safely in
their homes.
With IFPS ha~ing l:iecome an important addition to the ~ontinuum :of se~ices, available to families
through the child welfare system; the Children's Program recently turned its attention to the need for change
at the "front door"- the child protection, system, For the'past two years, we have closelyexamined the publi~
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child 'protective services (CPS) system, and surveyed CPS workers and administrators, families,
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policymakers,.
advocates, service providers, citizen~;a,nd national experts about their ,perceptions of the
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present state of chilq protection and their vision for improving CPS. We posed a number of complex
questions: How can we better assure the safety of children reported to CPS? How.can we target CPS
involvement with families toonly those casesthat require a protective response? And how can communities'
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h~lp t<? meet familyn'eeds and avert abuse and negiect, so,that public agency intervention becomes
unnecessary?
•
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This strategy statement reflects the results of our discussions and our broader observations,
registering both a national consensus on thenee~' for new apprpaches to protecting children and a clear
�.'.
indication that innovations are already under way. Key dements of a new approach include enhancing
community capacity and wi II ingn:ess to playa role inkeeping children safe; helping CPS to redesign its role --, .
in child· protection; and. facilitating partnerships among <;PS and a wide range of neighborhood
"stakeholders" that will eventually lead to their assuming collective responsibility for protecting children
from harm, We have checked our ideas at ev~ry stage of development against the realities o,f the current
political climate, which has changed dramatically since 'we presented our new Program direction to the
Foundation's Board of Trustees in September 1994.
In a time of reduced federal funding for humari,
services; and of a possible increas~ in the number of familjes coming' irito an already overburdened CPS
system owing to changes in AFDC and other "safety ,net" programs, states and localities will'berequired to
rethink their existing child protection programs. The strategy outlined here is structured to be realistically
attu~ed to the'possibly far-reaching effects of governmental changes, but also to capitalize on the heightened
'receptivity to systemic reform in this period of change,
.We cannot predict the impact that proposed legislative ~hanges, including block-granting of funds
and reductions in benefits available to poor families, will have on the ability ofjurisdictions to implement
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the reform strategy we' eilVisiori here, If ~ore restrictive policies and reduced resources preoccupy the ma~y ,
stakeholders needed to develop and ~~s~ a_ l1 ew approach'to child protection, we may need to revise aspects
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of our strategy, For the presen~, we hope the Program can both build on 0pporfunities presented by changes
in federal policy -such as t~e d~volution 'of decisionmaking authority from feder~1 to state to local levels
- and respond to the many challenges inherent in ,the new policy environment. We remain optimistic that
the call for a renovated child protection framework that looks beyond public resources to carry out its tasks'
.
will indeed' be responsive to that new environment,
;
After an account of our phasedown offund,ing in faplily preservation,
we will describe the progress
to date in developing a vision and st~ategy for "Community Partnerships forPrcitecting Children,"
.2
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Completing Our Investment in Family Preservation
In September 1994, the Children's Program 'presented a plan to the Trustees that called for phasiJlg -.
out most of our grantmaking in family preservation within two years. By Septe~ber 1996, the phasedown '
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4
•
will be almost complete. While there remain a few projects for which we expe~t to recommend limited
support (see below), grants to support work related to IFPS policy and practice should comprise less th~n
20 percent ,of our program budget in fiscal year 1996, and the number of such proje,cts will decline further
in fiscal year. 1997.
The accomplishments and experiential ~'Iessons" of the Foundation's investment in IFPS are
addressed in the September 1994 strategy statement. ,Therefore, we will treat here only three topics bearing
on our exit from the family preservation arena: (1) the place ofIFPS in the child welfare field today, (2)
th~
status of our technical assistance activities in family preservation,and (3) our expectations r~garding nominal
grantmakingin this area that might extend beyond the two-year phased own period.
The "Future" of IFPS
With the passage of the federal- Family Preservation and Support Act in 1993,
a~d
with
35 states (there are over 200 family preservation
Homebuilders-style IFPS prograrris operating in more than
programs 'across the country), family preservation is now considered an effective crisis intervention service'
by many key participants at both the state and federal levels. At the same time, the future growth - and even _
the maintenance' - of family preservation programs faces several challenges:
Because the November 1994 elections resulted in many "new players" ~ssuming responsibility for
_
state social services, momentum for expanding the use of IFPS(generated partly by passage of the
federa'iiegisiationj slowed down, andadvoca~es of IFPS had to reintroduce family preservation to
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_an audience faced with cutting social services budgets. Thus, while we hope that IFPS is sufficiently
_institutionalized in core states that changes in administration will not seriously affect its status, this
- may not be the case.
3
�Congress continues to debate proposed legislation that would reduce federal support for child
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welfare by as much as 30 percent, and would effectively repeal the' Family Preservation and Support-·
Act through its inclusion in a block grant. If the propo~als are enacted, as seems likely, states will
face hard choices in determining which programs to continue funding. As block grants I,ead states
to further devolve new decisionrriaking authority to the local level, ultimate decisions about program
priorities will often be made at that level, and local commitment to family preservation services is
highly variable.
Family preservation has recently suffered from extensive media "backlash," due in part to several
highly publicized deaths of children whose cases were known to child welfare. Such backlash,
appears to occur regardless of whether the agency involved had provided soine kind of family
preservation services. Owing in part to understandable public outrage at the death of children
identified to CPS 'as abused or neglected, and in' part to the sensationalism of some media and
pol iticians,
'~child
prot~ction"
and "family preservation" are increasingly being posed as
incompatible if not antithetical concepts. As discussed below, and as the long history of child
.
.
welfare should indi~ate, they are fundamentally interdependent.
Despite these challenges, the commitmerit to IFPS remains strong in a number of states, including
five states we have worked with since 1994 on effective implementation of the federal Act: Alabama, Iowa,
Maryland, Michigan, and Missouri. Under grants to the Center for the Study of Social Policy and Metis
Associates, these states have conducted a documenting project that will result in a September 1996 report '
on their strategic use of the federal law's flexibility and community-based planning processes to expand their
systems for delivering family preservation and support services.
Further, while the federal Act may be repealed, it wilrleave a significant legacy. By mandating,
broad inclusion of stakeholders (including parents and other consumers) in a full-year planning process, the
Act heightened awareness of family preservation at the state and local level, established new working
4
�relationships among states and communities in an effort to move decisionmaking about service delivery to
the local level, and fostered development of community planning groups that are now committed to -.
improving the well-being of children and families. Even mor:e encouraging, some of these groups may
become local decisionmaking bodies in a prospective block-grant environment, and will thus be wellpositioned to advocate for funding ofIFPS programs in their communities should the, Act be repealed.
2.
Status of Technical Assistance ACtivities
In'the September 1994 strategy paper, as part of our phasedown, we identified six areas of technical
assistance key to consolidating gains made in family preservation. Our goal was to ensure that states and
localities had the tools and the knowledge to implement strong, sustainable IFPS programs. Our efforts were
more fruitful in some areas than in others, and were especially impaired where impending budget cuts
hindered execution.
For example, the Center for the Study of Social Policy had to discontinue a
demonstration project for "full access" to family preservation (every family at risk ofhaving a child removed
e
would receive IFPS, unless safety could not be assured or the family refused services) when the jurisdiction
l
became cautious about committing more than a year's worth offunds to expand IFPS availability.
The products developed in three of the six technical assistance areas are noteworthy. 'First, with
respect to the thorny issue of effective targeting offamily preservation (ensuring that services are offered
,
to families whose children would otherwise be
plac~din
foster care), the,past.two years have convinced us
there is no'single "right" answer to targeting. and that states and localities need solid infonnation on how
to think through this problem for themselves and adapt a solution from 'an array of possibilities. To this end,
the Child and Family Policy Center in Iowa produced a paper that gives technical assistance to program
administrators concerning factors that influence targeting,and affect caseworker decisions either to place a
child or to refer the family to IFPS.
The second area involves developing feasible evaluation and perfonnance tracking of IFPS to help
states gauge the effectiveness of their programs. Dr. Francine Jacobs of Tufts University has prepared a guide
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- to be dis~eminated in June 1996 - that will help state program administrators evaluate their IFPS programs
affordably and feasibly. In addition, Dr. CharJesL.(Lynn) Usher ofthe University of North Carolina has -.
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written a paper on self-evaluation of family preservation that. would allow programs to track their ow~
progress in serving the intended families. Third, recognizing that IFPS program quality could be jeopardized
.
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by services expansion or service-mod~1 "dilutio'n" (e.g., through increasing caseloads),. we fu~ded the
Behavioral Sciences Institute (BSI) to 'develop and test a strong quality-assurance mode) that could be used
by state IFPS programs. BSI will include guidelines for quality assurance in the Foundation-supported
Practitioners' Guide to Impl~~eriiation of Family Preservation Services, to be distributed
in-Ju~e
1996."
T~e remaining areas of technical assistance' were: support for implementingJFPS acrosssystems .
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(which BSI is currently advancing uride,r a June 1995 tenninal grant for its IFPS-related activities) and a .
forum for discussion of serviCe-model evolution .. A grant to the Intensive 'Family Preservation Services,
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National Network will help convene this forum on "challenges" to the Homebuildersmodel, including using
it with families affected b
3.
Additio"nal Grantmaking Related
to' Family Preservation
In light of the fiscal and political climate that exists as we wind down our active invo)vementin
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IFPS, we feel it will be, critical to lend continuecJ support beyond the two-y~aq)hasedown period in three
vital areas: I) promoting understanding that preserving families is one important component ·of an effective
child protection system; 2) capturing the
. "story" ,of family preservation and disseminating lessons learned;
,
,
and 3) helping to ensure that IFPS remains "on the board" nationally beyond the teITl1 of our investment. .
'Over the past ~everal months, there has been a notice~ble pendulum s.wing away from the philosophy.
that the interests ofabused and neglt:icted children are often best served by enabling them to remain .with their'
families. Some sectors of the media and certain policym.~Kers have incorrectly pitted child protection against .
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family' preservation as incompatible goals. We believe that we should not leave the area of famify ,
, preservation without joining our many colleagues who are working to articulate and ~d~ance an approach
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to child welfare that onites the principles of keeping children safe and supporting their families. The strategy
~e would endorse includes three main activities. The Children's Program will focus its efforts primarily on
one of them: formulating a series of "operating gui.delines" for. . .field that address the most '
the .
critical and
..,
"'
sensitive areas of child protection practice where the goals of child safety and .family preservation are
thought to conflict. For example, workersconfronting parental substan~e abuse or domestic' violence issues
need gUidance in working with such families~ath;er than assuming that child safety can only be. achieved by
removing children arid placing them in foster care. Because these g~idelines will be essential to our new
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child protection reform effort, we expect to recommend funding for this part of the strategy and to playa
leading role in overseeing its implementation.
.
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The other two activities comprising the strategy, co~ponents ofwhich are already under way, are
being carried out by leaders from the child welfare field. "They are: (l)developing a strong media message
.e
about effectivechild prote~tion that acknowledges the n~ed'for both aggressive promotion ofchild sa,fety
and family preservation, including op-ed pieces to appear in major media markets to articulate that message;
and (2) 'crafting a brief position statement' on child protection emphasizing that its primary goal is
safeguarding children, and that helping communities to s,trengthen families is essential to achieving that goal.
We expect that the statement - which would be signed by leaders from child welfare and related fields such
as pediatrics, education, and child development:- will be used, to assist policymakers and others responsible
for child safety and well-being to explain their philosophy ofchild protection. 'As our colleagues in the field
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proceed with this important work, we will determine the. appropriateness' of recommending some minimal
level of support for discrete compone~tsoftheir efforts.;
The second area of grantmaking related to family preservation that we believe demands further
attention beyond the two-year phasedown is ensuring that we have captured the nstory"~f family
preservation, including the Foundation's role in i'ts development, prior to completing ~ur investmerit in lFPS.
What are the essential lessons learned from our efforts in family preservation? What do we know about
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taking an individual social services program "to scale" across the country, that should now be shared with
a broader audience beyond the IFPS and child welfare fields? A giant to the University of Chicago's Chapin-.
Hall Center for C'hildren will begin this "documenting" process by supporting publication of a series of
.'
commissioned papers intended to capture the history of IFPS, the current state of policy arid practice,
ongoing challenges such as responding to media backlash, etc,
Finally, because the Foundationhas serv,ed for over a decade as the nationa.l "hub" ofIFPS-related
,
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information-sharing and activities, we believe that further institutionalizing family preservation will require
addition~l, focused support for organizations like the IFPS National Network, so it can assum~ a stronger
"'···coordinatingrole,and for projects with a national scope that would help IFPS sustain itself beyond our
involvement. One suchventure will be to have the Center for the Studyof Social Policy expand its "Peer to
Peer" network to enable experts in family preservation to lend technical assistance to one another, thus
ensuring that ongoing sources of help remain available to the field once the Foundation completes its
investment.
Changing Direction: The Decisi~ri to Focus on Child Protection Reform'
The September 1994 strategy ,paper presented to the Tru,ste'es 'charted
a new direction for the
Children's Program: forging a strategy to ~eform ,the child protective services (CPS) system and to enlist the
community at large as a partner in protecting children. While the proPQsed strategy has evolved significantly
(as discussed below),our work contiimesto be drfven by thefi~ consensus that th~ cu~ent approach to
child protection - including the pubiic CPS system's role in that task - is ripe for reform.
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Statistics about the prevalence of abuse and neglect rem~in daunting: in 1994, three million children
were reported to CPS agencies across the country as having 'been abused or neglected, and one million of
those reports were confirmed., Over 1200 children died as a result of maltreatment last year, and over
,e
600,000 children currently live inout-of-homecare.While some of those children enter substitute care
,
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8
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through the juvenile justice or mental health systems, the majorit:x are removed from their homes as a result
of maltreatment. The statistics.paint a picture of an approach to protecting children that has several major"':'
- and related - flaws. While the Septe~ber 1994 paper offered.a catalog of flaws focusing solely on CPS,
our understanding of the issues has evolved and has. led us to reformulate th~ way we talk and think about
problems ,in child protection:
.
. The "reach" of formal CPS has. expanded far beyond·original system. intentions,.with families being
unnecessarily reported to' CPS because no alternative avenues exist whereby
t~ey
can access basic
supports, such as housing or medical care. Because many problems relating to overall child and
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family well-being are coming to CPS' attention, the system cannottargel sufficient resources to
protect those children'whose families have been appropriately referre~,to.CPS.
•
~ fam il ~otsecure services or supPorts until they ".'.!- all~.~ed to hav~nned a chi I~
/I
Approximately 60 percent of cases where abuse or neglect cannot be "substantiated" re~urn to the
.
CPS system as,n.ew reports with more serious allegations of maltreatment., Because child protection
does not currently feature a mechanism for "early interVent'ion," families', problems often escalate
lothe point that CPS involvement becomes warranted.
CPS agencies typically provide
~ "one·size·fits-all"
response.10 ·the
I
extre~ J
fam il ies. In some instances, a report of neglect alleging that a fam ily lacks food in the home receives
~---"'''-..
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the, same investigative,evidence-gathering response as a report of physical harm to a child. By
failing to conduct a full assessment of, families' needs, strengths, and existing supports, and by'
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excluding families from the process of making decisions about their future, investigations often
serve only to determine whether an incident of maltreatment took place rather than to connect
families to, appropriate services and resources within their communities. In fact, child protection
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practitioners from Florida and Missouri, who are using both assessment and investigation practices,
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�estimate that 75 to 80 percent of the families reported to CPS in their states are being appropriately
served through a service-oriented assessment response rather than through traditional investigation.
The CPS system has not been successful at assuring the ~afety of children who come to its attention.
While no system 'can guarantee the safety of every child, it is estimated that children are re-abused
in almost one out of every three open CPS cases ..
Protecting children is too often viewed as the sole responsibility of the public CPS agency, rather
th;!n as a responsibility thatmust be shared between CPS agencies and the individual communities
they serve. Because the CPS system historically has been isolated from the very communities whose
children it is charged to protect, CPS has been insuffiCiently able to tap into the many informal
supports in neighborhoods - supports that could help CPS keep more children safe.. ,
A New Vision for Child Protection
Just as there is strong consensus as to what is "wrong" with the, current approach to protecting
children', there is considerable agreement about the need for a reformed approach, as well as an emerging
. common vision of what that
n~w approach should be.
As the Jl.S. Advisory Board on Child Abuse and.ll
Neglect argued in 1993, the focus of child protection.policymaking must be expanded from determining
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when the state is justified in interv~ning to answering a "broader question": "What cangovernnient and
social and nei~hborhood institutions do to prevent or ameliorate harm to children?" (U.S. ABCAN, 1993).
Over the past two years, we have sought to craft a novel approach' to protecting children that (1)
reflects)he vision of a new system emerging from reform efforts in selected states and communities across
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the country; (2) emphasizes the need for individual communities to reclaim responsibility for what happens
to their own children, with community members collectively determining the outcomes they desire for their
childrep and families, and (3) capitalizes on that portion of public sentiment which would have government
reduce its intrusiveness and move decisionmaking.relating to family issues to the local level.
. 10
�The idea of a "community partnership" envisions, within a re,latively small geographic area, the
active cooperation of an array of public and private sector community members (schools, law enforcement, ~.
mental health professionals, civic groups, nonprofit organizatio!1s, tenant groups, committed citizens), most
of whom are not currently involved in child protection, but many of whom are well-positioned to identify
and reach vulnerable families. Together with
C~S,
these
p~rtners
will design andrefine a neighborhood
strategy for child protection, and will determ ine which types of famil ies require CPS in'volvement, and which
could be safely and more appropriately served outside of the formal CPS system. While there will always
be some need for a public CPS agency that can effectively respond to the most serious cases, such as those
requiring removal, of a child, there is also significant room for the community to work with CPS and assume
a greater role in protecting the majority of children who currently come to CPS attention and who do not
require an intensive protective response.
e
As a crucial piece of their work, community,partnerships will strive to establish a comprehensive
network of neighborhood-based supports for at-risk families and children. This network would build upon
existing support structures, such as Head Start,programs, religious institutions, and local schools, and would
,be expanded byexplicitly encouraging the reemergence and growth of those informal supports that exist in
every Ileighborhood. , By developing this comprehensive network of individuals, groups, and local
institutions prepared to actively participate in protecting children and supporting families, each neighborhood
will create an "early intervention" capacity that can help avert abuse and neglect, and enable many families
, to avoid formal CPS involvement. For children whose families do come to the attention of CPS, the
community system would be act,ivated to better secure their safety and minimize,the risk of subsequent
,maltreatment. In other words, CPS would provide a thoughtfully differentiated response to maltreatment
reports tailored to each family'S particular circumstances.
11
�The refonned child protection system envis~oned here would be characterized by the following
attributes:
•
Aggressive promotion of child safety at all" points;
•
'Emphasis on an alert preventive approach to stemming maltreatment;
•
Development and nurturing of a local network-of fonnal and informal services and supports for atrisk families and for those already' identified to the public child welfare agency;
Provision of a customized, comprehensive range of responses to meet family needs once the risk of '
•
maltreatment is identified, including an iQtensive "crisis response" (carried out jointly by CPS and
law enforcement) for the most serious cases, en~uring quality s'ubstitute parental care for children
who must be removed from their families, and a "community-based response" for lower-risk cases
,that would enable families to receive help in their own neighborhoods and without the ongoing
involvement of the formal CPS agency;
•
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Coordinated involvement of a wide range of agencies,. organizations, and individuals iri protecting
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children; .
•
• Assumption, :over time, of shared responsibility and accountability by the broader community for
the majority of cases brought to CPS attention that do not require state-sanctioned intervention, such
, as removal of a child, rather than CPS' maintaining accountability for lill cases of child safety; and,
Increased involvement of law enforcement in responding to serious acts of maltreatment.
, Evolution of Our Child Protection Reform Strategy .
Starting in 1993, the Trustees approved a series of grants that pennitted the Children's Program to .
explore a prospective new direction - re~orm of the CPS system. These',initial grants helped us learn about,
12 '
�the myriad problems plaguing CPS. lind to consider 'possible . for addressing them. Some grants built
avenues
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on lessons learned from our work in family preservation, such as supporting Dr. Jill Kinney to incorpo~ate-"
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the principles and values of Homebuilders into family:-centeredtraining curricula for frontline CPS workers.
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Othe~s, such as a grant to Harva~d's Kennedy Schoo) of Government, convened the best thinkers in child '
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w;lfare to consider the ~omplex question of what a new child protection system ~ .look Hk~
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.Through these early grants, we recognized t~e need to 'find states, and localities that could
operation'alize and th~s test our conceptual p~emi~es. Toward this end, the September 1.994 strategy.
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statement' had three interrelated components:' (1) 'identifyirig model "diversion" pro~ratns to provide
, '-"---a~ernat!ves for families that might otherwise enter the5~PS system, and support for other families following
their in~~lvemenrwith CPS; (2) fom:ing community~CPS partnerships to define
a~agenda for community
oriented child protection; and (3) selecting pilot sites interested in ~estructuring their public CPS systems.
e
In September and December 1994, grants were awarded to support CPS reform efforts in Hawaii and .
Misso~ri,
for
~o essential
reasons: each state had
enablin~~t;:gislation :(~md
therefore a base of public
support) for CPS refonri; and we were determined (as in family preservation) to promote reform at the state
level under a state-centered strategy. What we learned, 'however, wasth!lt ~uch a strategy could not fulfill
the objective of testing community systems of child protection.
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Fur:ther, having
establi~hed
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that our three components -diversion;' community-CPS partnerships,
CPS agency reform:- should be addressed simultaneously within the same communities, the need for local
i (city o~ county) rather than state sites became clear. :We therefore refocused on mid-sized counties and cities'
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llS potential sites for testing and refining program str~tegy, Targeting reform efforts in these "demonstration
,communities" would both enhance the chances of getting a broad range ofneighborho?d stakeholders to
commit to community-baseq child protection and, increase our ability to measure more accurately the
correlation between strategy and effected change. At each site, a three-way partnership would be formed
among state government; l~al (county-, city-,or state-lev~l) public agencies, including CPS; and the local
13
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private s~ctor, including not only the nonprofit· sector, but also businesses, religious institutions, other
community-based groups, and individual community:residents. The Children's Program and its grantees-'
would act as a fourth ~elem~nt of "partnership," providing strategic guidance, technical assistance, and
•
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. finanCial support to sites as they pursued community,,:b<l.~ed systems of reform.
Our revised logic, t6 repeat, holds that the novelty and complexity ofthe envisioned reform demands
more manageable jurisdictions. At the same time, we recognize that the majorityof children involved with
the public"child welfare system live in such metropolitan centers as New York, Chicago, and Los Angeles,
, and thatpublic perception of the child protection system is based in large part on media coverage of child
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·de~~h ~r maltreatment that occurs in these cities. Consequently, we will strive throughout this initiative to
ensure t~at strategies developed in our sites can be used to protect children in larger cities and cQunties. To
I
make a ~tart in that direction, we awarded 'a grant in .
to help administrators of the nation's largest chiid w.elfare agencies develop strategies for child protection
"
reform.' The League's work will keep these larger ju~isdi~tions apprised of-reform efforts in our sites, while
informing our workas to the unique problems and needs of these major urban centers.
Selection of Sites
. In late 1994 and early 1995, we surveyed states and localities to learn about their CPS reform efforts
and made visits to
~even
promising sites around the country.· Despite the strategy's
evolutio~ during site
selecti9n~ we found that our selection c~iteria remained relatively tiri~hariged .. The crit,eria included:
,:demonstrated commitment to reform at the. state a~,d local levels, capable I~adership, the presence of key
stakeholders to champion reform, fiscal capacity, a ,track record ofinn ovation and c~lIaboration within the
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site, a strong services base' (such as family support and intensive family preservation services), and a
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substantial and diverse population ..
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�After conducting more site visits and narrowing our list of candidates, we invited teams from five
sites to submit proposals for planning grants. We limited the potential number Of sites to five to ensure that
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we could give adequate resources to each "effort to implement broad-based, labor-intensive reform. In
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September and· December 1995, four sites were
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award~ planning grants (as d iscussed belo~): lacksonvill e,
Florida; Cedar Rapids, Iowa; Jefferson CountylLoilisville, Kentucky; and, St.
,--,."
Missouri.
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Our work with sites on preparing proposals for planning grants led to another signific;:ant.revision"
in our strategy. Discussions with leaders in the sites helped usto grasp the great challenges inherent in
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building' new relationships between the public and pri~ate sectors, gaining thecommitI}1ent ofrieighborhood
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stakeholders to anew approach to childprotection, and building communitycapacity to supportfamifies
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and keep children safe. We determined, in concert,~ith our sites, that initial efforts within,sites would be
more fruitful if targeted atthe "neighborhood" rather than at the city or county level. While the range among
our sites 'is such that one will initially target three adjbining neighborhoods with a population of only 10,000
eople, and another will target five separate neighborhoods with a population of I 00,000, we believe that
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focusing the work at the neighborhood kvel
i;essenii~1 to cementing relationships and nurturing supports
critical to implementing a truly community-based approach to protecting children:
:' At the same time, we understand the challenges of seeking to carry out a complex reform effort at
the neighborhood level. While we are committedtoa change process that proceeds from the "bottom" up
- mobilizing block by block, neighbor by neighbor- we believe that change must also be supported by a
clear course of action from the "top," including state agency officials, elected officials, mayors, and key state
...,
legislators. State executive branch and legislative support is essential to allowing sites greater fiscal
flexibility, freedom from administrative constraints, and access to procedu"res (such as statutory waivers)
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facilitating reform. State backing (e.g., through pa"ssage ofepS reform I.egisl~ltion) can also support other
locali~ies interested in similar reform to adapt iesso~s learned from the charige processwithin our sites and
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implement neighborhood-based systems of child rrotection in their own comrnunities.,
15
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�·CtfR
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1VJc'S is 1ke cc "6 ~
PHOTOCOPY
PRESERVATION
. M.IuU
.
7J'W ",a.MJeQ.
~~~ft,
JbA_~~ ~
. ~t-
Colbert L King
c:J<A1nf<-r-
AHelping.Hand From JimmyJones _
wm
It was a day he thought would never for teenagers in fOster care. The iIim is girls who
viOiated, the school w-op. .•
high sdtool graduation. When
to help youngsters. generaUy described outs, the emotionaUy and physicaUJ;··
you've been in foster care, shuttled from as abused and neglected, make a smooth banged up who may have done ~ •.
family to family, now Hving in a group and successful ttansitiOn from the foster
banging up of their own. Jones takes tiL
home and facing an W'K.':ertain future, to care system to seIf~ency and inde
the teenagers who have been harmed bY:
get handed something with the penna
~dence.. During a meeting this week
the actionS or the inaction of adults wh.)':.
mince of a dip10ma is overwhelming. at the program's 4o-bed, 12-unit apart
should have been lOoking out for them/;.
NOw he looked out into the audience for ment building OIl East Capitol Street Jones gets the. boys who never had the;..
the &'weetener': HiS birth mother had aaoss from Eastern High School, Jones. firm hand of a father.
promised to coine from Philadelphia to put it another way: "We by to teacli
Since 1983, wheft the District
.-him walk aaoss the stage.·
them all those·things that we somehow accepted the idea of creating a
. Soon the ceremony was over, and the learned from our parents."
home for youngsters toleam life
crowds began to thin. Kids in caps and
It's not as easy as it may· soimd.. a reaI-life setting, nearly 600
gowns were walking off with family Jones's efforts pick up where our newa., people have passed through the.
pendent living program. About 50 .
members and friends, laughing. looking stories leave off.
forward to the evening ahead. FinaDy.
For many of us-readers and report
been lost. Some, said Jones,
be was alone.
ers alike-the story ends when the drugs. Otbers were locked up; a
It was only at that moment that drug-addicted mother who abandoned .
werekiUed.
James "funmy"' Jones stepped (orward. her YOWlg children is hauled off. for
But.what spellS success? Ukids
put his ann around the yOungster and observation, or when the father who the program without a high school
said. "C'moo, man. Let's go get some raped his young daugbter.is arrested, or 'ma, they leave with one, or at
thing to eat.· .
..
when the judge commits the withdrawn GED. They also are enoouraged to
Jones teII8 that story to make i larger and emotionally scarred yoWlgster with p/ete at least one semester of college
point. He estimates that he or one of. his an arrest record ~ the city's care. But find out what it's about and to make .
.. informed ~ whether they want to • . .•.
colleagues with his. nonprofit agency, those children don't stop living.
They eventually grow up and leave dmtinue," Jones says. Now he has
Jones and Associates. has atte:rtded more
than 200 graduation exercises. usually the city'a custody:Many, however, are important ally. President Clinton alsO,:
remaining in the backgrowtd but always not. ready to take care of. themselves.· wants to make two years of. college ~\, .
ready to stand in for the family member And that's usually when we in the press universa1 as a high school diploma." But)
who reneges on a promise.
pick up their stories again. A fortunate Jones, a District native and a star ath-~•.. ·
III a city of institutionalized indiffer
feW'~ as .~ as· the cash-strapped
Jete at Dunbar High School in the early>
ence and mediocrity, Jimmy Jones is a District can afford-receive a helping '50s. was there first. And he brinp"t
reassuring example, of your tax dolJai's . hand from Jones, through the courts.
espedalIy strong feelings to the subject; .•
at,work.
The independent living program gets
"If you are a middle-class kid in a
Jooes and his staff of 40 operate a the neglected YOWlgsters who watched family with money," he says, "tbere'slI ..
c::ity.funded independent Hving program their mothers slide doWnhill. It gets the coUegefor you somewhere in Americ:a.~""
tOme:
an ..
CLINTON LIBRARY PHOTOCOPY
�THE WASHINGTON POST
SATIJllDAY,OCTOUt:R 5,
r\
1996 ,
PHOTOCOPV
PAESERVAnON
pUy
It's the youngsters without parents and agreements, and where they learn to lars are being wasted on wannabe big
money who are out of luck. And Jones make mistakes and experience failure shots who trade on their conn~ns,
n~
wants as many inner-city youth as possi- Without having the world come down on color or both to get city contracts they
in ,ble to have that expoSure, too. Havirig' them.
don't deserve to do work they CaB't""
by been.told time and again that "you're not'
Until they ~ 21 and must leave the perform.
hO,college material," jones scoffs at the 'program, Jones is there for them. No
I go off becaUse contract hustlers are
m. wat'ds. "I was a C student who wasn't birthday passes without a celebration. living it up off money that jimmy Jones
:he suPix>sed to go to ioDege," he said. No prom goes unattended. Everyone could use to take in a few more abused
"Now I have more degrees than I can has a good graduation outfit to wear.
and neglected kids. becauSe D.C, gov
illy use."
'
,
When they go off to coUege-and 'emment-created "entrepreneurs" are
)UP
, Oops, my fault. Let me, properly in- Jones's students have attended more driving fine cars with moneythaCU~.,.t
3in trOduce James L. Jones, BS, Howard than 50, mostly historically black coDeg - schools need to hire a few more tea~
109 UniverSity, 1956; MA,,secondary school es and uniVersitjes.:-they are sent fuUy ers or buY a few more books. I go, Mf
de
;uiministration, George Washington Uni- prepared with paid-for clothes, books
ave ~ersity, 1964; EdP. guidanCe andcoim- and tuition and with two 1-800 phone because they are outfitting thernseJv~}-,:
ito ,~!ing" George ,Washington Uruversity, numbers-ooe (:onnected to the East their offices and their significant others,; •
,tOrI:
few 1969; Juris Doctoris, Howard UnivefSi.. Capitol Street program, the other to his with funds that foster care-could
hire more ~ workers, .becauS¢ th~S',.·
i;y School of Law, 1973-and a feDow honne,'
are out "stYJin' and profilin' " at c1u6!l; :
ilter
member of Kappa Alpha Psi fraternity,
Therfls one condition: They must bars and big benefit dinners with
iplo
st a whiCh I know from firsthand experience retuni during the holidays and summer money that could be uSed to fiU:jlQt:'
afforded hiri1 an uninhibited insight into vacations to help motivate other young
holes, fix street lights or clean, the'.'
:om
the fun that goes with college life.
sters;
curbs. Pardon me, but that's why I ~v~l'
~"to
But there's notbinghappy-go-lucky
There you have it, a positive Dis
thiS tendency to go off on the croWd
ean,
~ ::" ._, ,
It to about hisprofessWnalstaff. ,They've trict-supported program. So, why, you, that's numing this city.
There are, 0 weary hearts, pleOtY,'Ot··~
san heen a team for years, learning to make 'may ask, is there so much low-grade
unsung men and women who are ttyJJ.'g":
also it on dedication rather than salary, , rage against the'dty's leaders?
Every time I think of the mayor to rescue this city's endangered .ctUJ.'~:
e"as There is, how.ever, a sure-fire way to
'But get fired: Get caUght not treating the trying to give an undeserved $235,000 ,dren. They are the real pillars of' oUr!:·
kids as one of your own.
tax break to a tiiend and ,political sup- community. Remember and' re$pecl""
-ath
Tough love is practiced at IS19 East porter who'a1re;ldy is $90,000 deli,. them. After aU: It's not just for the.\dd$'J'
early
qumt in property'taxes, or come across ,that jones is there on graduation .WlY;-: •
lrings t.apitol St. That's where, yoUngsters
learn how to shop and prepare mealS,' caSes of spectacularly unqualified pals of he's also standing in for us.
Jject.
ina practice proper hygiene and grooming, pols getting lucrative city contracts, I'm
re's a keep appointment!! on time, maintain SOfrY, but I go off.
The writu is a member oftke"-'-':
tlleir apartments, handle personal disI go off because hard-earned tax dol
editorial page stoff.
use
City":
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MEMORANDUM
Carol Rasco
Jeremy Ben-Ami
Diana Fortuna
TO:
?- ,
FROM:
Linda M. shannonf.~
SUBJECT:
Illinois Ghild Welfare Waiver
DATE:
September 2'3, 1996
,
purpose of the Waiver: Illinois is seeking an alternative form
of placement for children who reside in long term foster care and
cannot be adopted.
'
The waivers will allow Illinois to use title IV:-E funds to:
implement subsidized guardianship agreements, expand services
normally not covered under title IV-E, and expand eligibility for
children and families who are not normally eligible under title
IV-E.
Background: The demonstration project must be cost ,neutral, to the
Federal government over the life of the project period. In
addition, the demonstration project is expected to:
•
Focus on improving outcomes for children and families;
•
Ensure that child safety is the primary concern;
•
Provide services in the least intrusive manner by the, State.
Target Population: Children in subsidized guardianships must meet
the following criteria:
•
fhe child must be in the custody of the State for two years
and must have lived with the long-term caregiver (relative
or non-relative) for at least one year; the one year
placement requirement will be waived for sibling groups' when
at least one sibling meets all other subsidized guardianship
criteria;
•
~he reunification of the chilq with his or her family must
'not be feasible;
•
Adoption must have been ruled out as a permanency plan for
:the chi ld; 'and
•
The child must have a strong attachment to the potential
guardian, and the guardian family must have a strong
:commitment to the child.
�All foster parents and relative caretakers will be eligible
with an emphasis on kinship care. 'Each guardianship will be
established by court order.
I
services Offered: Illinois will .offer a range of services and
supports for foster' care providers prior to and during subsidized
guardianship which parallel those offered to adoptive families.
These services include preliminary screening, home study,
assistance in applying for subsidized guardianship, and payment
of one ti~e court costs and legal fees if required.
Evaluation: A three-part evaluation process will include a
hypothesis testing analysis, a process study, and a cost benefit
analysis. The hypothesis testing analysis will test key areas
involving the benefits and risks of providing'monetary incentives
for fo'ster care providers to become private guardians for
children who would otherwise remain in foster care. The
follow,ing hypotheses will be tested for experimental and control
groups:
•
•
The demonstration will result in fewer disrupted placements.
•
The demonstration will not result in a higher rate of
indicated subsequent ,reports of abuse or neglect.
cc:
. ,.....
The demonstration will result in fewer ,children rema~n~ng in
long-term foster care with ongoing administrative oversight.
~yn
Hogan
Elizabeth Drye
�UNIVERSITY of PENNSYLVANIA'
OCT 2 8 1996
. School of Social Work
Office of the Dean
Caster Building
3701 Locust Walk
Philadelphia, PA 19104-6214
215-898-5541
215-573-2099 (FAX)
MEMORANDUM
TO:
FROM:
DATE: '
(k1X;t;e'f24, 1996
; It was good talking to you today. Enclosed are a few pages from the last chapter
of a book I'm writing on child welfare. Pages 187-190 address in a bit more detail the
idea we discussed about how to try and breath some new life into child welfare.
I' will give some thought to' your question about how much money it might take
to generate interest in this on the part of the states, counties and, where appropriate, '
cities. I finnly believe that there are national, regional, local, and community
foundat,ions that would contribute :fimds for this kind of effort. Some would be willing
to become part of a large public/private pool of fimds. Others, such as the William
Penn Foundation in Philadelphia who only give fimds locally,
coinmit resources
as part ,of a plan submitted from their fimding district.
can
I
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I was glad to hear that you are considering using the federal waivers as a
strategy for precipating,reforms. This, coupled with generating"some additional federai
and private sector resources I believe will make a real difference.
Also,. your thought that the FrrstLady might spearhead this effort would be
terrifi~. She would be ideal and for all the right reasons.
.I will be in touch again soon. Also, I'd be happy to stop by and discuss this in .
. more detail if it woUld be helpfuL
IMS:rk
c:\ims\bena.mem
�185
Chapter 7
Public Policy and Child Welfare:
National and State Implications
Introduction
The history of child welfare is littered with
intentioned but, largely failed reform efforts.
well~
Despite the
6illions in federal, state, and local dollars' poured into
child welfare systems annually, media scandals and class
action lawsuits, state and federal inquiries into child
welfare services, the recommendations of national standard
J
setting organizations,
~nd
effortS of private foundations
and child advocacy groups, no state or county is recognized
for having a model and humane system.
Child welfare systems have insatiable appetites.
History has shown they can absorb virtually any amount of
money thrown at them by desperate elected public officials
being pressured to do something about the increasing numbers
of child maltreatment complaints or class action lawsuits
steming from abusive and unprofessional practices. One
I
author has even observed that public child welfare systems
ar,e pernicious because of the way they manage to thrive in a
difficult fiscal environment when other services are being
cut back. The administrators of these agencies have, become
adept at scaring politicians by implying that children may
die or there may be scandals and. lawsuits if they don't get
the money they need for more child protective service
workers and foster care staff (Hagedorn). ,Obviously, hiring
�186
more child welfare workers to do the same old things in the
same way has not made a significant difference (Hagedorn).
Child welfare systems are also remarkably effective at co
opting reforms and giving the appearance that enlightened
practices are being implemented while resisting fundamental
change.
While this is a discouraging picture, we must keep
trying to develop 'new and more effective strategies for
reform.
The traditional approaches have not served us weIll
and they are not likely to serve us well in the future. In
light of this
l
where, do we go from here? The rest of this
chapter addresses this tough que~tion.
National Policy Considerations
A number of'respec.ted scholars (e.g., Lindsey and
Peltori), prominent child welfare professionals, and bhild
advocates believe we will not make any significant progress
toward preventing child abuse and neglect until we tackle
the issue of poverty, particularly child
for example
I
points out that
II • • •
pov~rty.
Lindsey,
child abuse is not the
major reason children are removed from 'their parents.
Rather, inadequacy of income, more than any other factor,
constitutes the reason that children are removed ll (LindseYI
p.i55). Lindsey has put forward several proposals for'
addressing the child poverty problem, including the creation
of: a social security system for children where the
beneficiaries would repay the benefits they received from
the wages they earn in adulthood (Lindsey, pp.312-13).
�187
The elimination of child poverty. in the United States
would have an enormous impact on reducing the incidence of
,
child abuse and neglect. While we strongly support this
goal, this will require a long term national commitment and
will take decades to achieve. Currently, there is no
national consensus that the elimination of child poverty be
adopted as a national goal. This would have to occur before
any meaningful strategy could be implemented. Also, tackling
this problem may have been further complicated by the .
federal "welfare reform" legislation recently'signed by
President Clinton. Various experts and child advocates are
already predicting that upwards,of a m'illion more children
may fall below the poverty line because of it.
In any event, there are some immediate and shorter term
action steps that could be taken to address the crisis in
child welf·are. These recommendations are discussed below.
1. About ten years ago the General Motors Company (GM)
announced plans to locate a site to build their new Saturn
automobile.
In making the announcement, GM officials
indicated they would entertain proposals from individual
states.
ev~ry
The prospect of winning this economic prize had
Governor salivating.
At stake were thousands of new
jobs and an enhanced· ability to attract many other new
businesses.
Governors across the country responded to the challenge
by launching campaigns to persuade GM to select their state.
Governors pulled together teams of key elected and appointed
�188
public officials, private sector representatives, university
officials and civic leaders to come up with reasons,
programs and incentives for convincing GM officials that
their state was best suited for the Saturn project.
end, GM selected the state of Tennessee.
In the
One of the key'
factors tilting the scale in Tennessee's favor was a long-'
term' commitment by elected public officials in Tennessee to
improve the state's public education system.
~his
commitment helped to ensure a well-trained labor force for
GM and other companies well into the future.
I
The process generated an extraordinary amount of
activity and creative thinking in the states about how to
best meet this
ch~llenge.
The process served as a catalyst
for'mobilizing some of the best brain power and leadership
to focus on the issue.
The proposals that were developed
had the necessary polit.ical and other kinds of support
needed to help make them a reality. If nothing else, the
process demonstrated just how energetic, creative, and
responsive elected public officials and others in the states
could be when the stakes were high and the potential payoff
great.
We think something similar is needed in child welfare.
Child welfare systems are an embarrassment in practically
every state and local jurisdiction a thorn in the side of
.
I
'
i
/goyernors and local offcials.
'-....
The Administration, perhaps
'
l
in collaboration with private foundations interested in
child welfare, should consider setting aside a substantial
�189
amount of money and awarding funds on a competitive and'
relatively lbng term basis as incentives to a small, but
carefully selected, number of states, counties, and cities
that develop innovative and data-driven plans to overhaul
their child welfare systems.
cre~tures
of the state.
Child welfare systems are
If real reforms in child welfare
are going to occur, they will have to be initiated from
within the states themselves and have the state and local
level political and public support needed to bring them
about and to sustain them.
Governors, county executives,
and mayors should be encouraged to reach out and involve the
legislature, representatives from the business community,
civic leaders, the media, child welfare professionals,
health and mental health professionals, local elected
officials and universities. While the process should be
v
designed to encourage ci~tive thinking and new approaches
... .
' ~/
with a minimum of federal bureaucratic interference and
regulation, the plans should clearly indicate how the most
difficult and challenging problems confronting state and
local child welfare systems will be addressed.
Universit
c~ild
can be particularly helpful in examining
welfare data for use in understanding how child
welfare systems really operate, identifying key issues
needing to be addressed, and making informed policy
decisions.
V impact
Universities can also help by evaluating the
of reforms. \~ The federal government can assist by
providing technical assistance and information about
�190
·resources.that states and localities can take advantage of
during the planning process.
Hopefully, this will result in
a few jurisdictions emerging as models for the rest of the
nation.
Conceivably, this strategy might generate ideas and
proposals for dismantling existing chi'ld welfare system
bureaucracies in favor of new, more exciting, more flexible,
more humane, and more comprehensive service delivery
systems.
In fact, we hope this approach would liberate
state and local officials to be creative and not be
constrained by existing bureaucratic structures and
programs. It may also lead to more innovative and effective
approaches involving the private not-for-profit and for
profit sectors in designing and delivering servcies as well.
2. The current mission of the child welfare system is
to both protect children and preserve families. The goal of
preserving families is a role that evolved as a result of
th~
growing popularity of family preservation services. At
the time the child welfare system started to take on the
role of strengthening and preserving families in the early
I
19\3,Os it was already failing in its basic mission of
pr~tecting
children. However, the
~hild
welfare
establishment, child advocates, and staff from influential
private foundations interested in child welfare chose to
overlook this important fact and saddled troubled child
welfare systems with the responsibility of trying to keep
parents who physically or sexually abused and/or severely
�,
\
MOTHERS IN PRISON:
WHAT BECOMES··OF THEIR CHILDREN?
May 1996
Susan Phillips. LMSW
The Parent Center
Centers for Youth & Famllles
5905 Forest Place
Little Rock. AR 72207
(501) 666·6833
Produced with the support of The Winthrop Rockefeller Foundation
CLIN"I'..., l •• _ . " ...KY PHOTOCOPY
�t.
Preface
In 1991, volunteers and stnjJfrom The Parent Center, a division of Centers for
Youth and Families, began teaching parent education courses for /TlDthers at the
Arkansas Department of Correction facility for women. Research shows that.
approximately 80% of these women were victims of ch1Idhood physical and sexual
abuse. Since a person's parenting skUIs tend to resemble those of their parents, it
made sense to teach these /TlDthers the healthy, nurtwtng parenting skills they may
not have learned as ch1Idren. In teaching parent education classes for /TlDthers in
prtson. our staff and volunteers became aware of the dire ctra.onstances of the
ch1Idren these women leave behind while they serve their sentences. The poUcy
recorrunendatlons made in this report are based on our experience working with
these famiUes and on research that was conducted with the support of the "Winthrop
Rockefeller Foundatlon. .
Susan PhlLUps. LMSW
Parentingfrom Prison
Cornrru..ud.ty Resource Coordinator
(
�MOTHERS IN PRISON:
WHAT BECOMES OF THEIR CHILDREN?
Blessing on the hand of women!
Angels guard iL."I strength and grace,
In the palace. cottage, hovel.
Dh. no matter where the place;
Would that never storms assailed it,
Rainbows ever gently curled;
For the hand that rocks the cradle
Is the hand that rules the world.
William Ross Wallace
The prison population in Arkansas has reached unprecedented numbers. In the decade
between 1984 and 1994. the total number of inmates In Department of Correction facilities
more than doubled (table 1). In anticipation of continued growth. the State of Arkansas plans
to add two new 600-bed facilities to its inventory, 'The number of women being sent to prison in
Arkansas is increasing at an evenfaster rate than the total prison population While the overall
prison population doubled in the .decade between 1984 and 1994. the number of women in
prison nearly tripled. There was a 189% increase in the female prison population compared to
a lO8% increase in the male population during that time period (figure 1).
Table 1.
Year
# OF INMATES PER YEAR
Total # of Inmates
# Male inmates
4368
4595
4682
4866
5361
5759
6455
7341
8165
8732
9249
1984
85
86
87
88
89
90
91
92
93
1994
4170
4362
4456
4651
5085
5500
6168
6892
7687
8163
8676
# Female Inmates
198
233
226
215
276
259
287
449
478
569
573
Fig. 1
200
,
n
::
.,
'"
100
'"
'"
Comparison qf rams qf increase infema,le and male prison population.
This expansion of the prison population has been driven by policies aimed at taking a
'bite out. of crime' and fighting a war on drugs', Whether or not increased incarceration actually
reduces crime is questionable, Some experts contend that factors such as shifting
demognlphics. changing patterns of drug use and drug trade. and changes in police tactics may
have a greater influence on crime rates than incarceration (The Edna McConnell Clark
Foundation, 1995),
�Women In prtson differ from male inmates in a number of significant ways that suggest
that. at best. criminal justice poliCies emphasizing incarceration as the solution to clime may be
misdirected when it comes to female offenders. Even more alarming than the fact that these
poliCies may be an ineffective deterrent to clime is evidence that suggests that by incarcerating
record numbers of mothers. policy makers are exacerbating factors that place children at rtsk for
child neglect. substance abuse. juvenile delinquency and future incarceration.
Women and Violent Crime
One factor that fuels the increase in the prtson population is a trend towards harsher
punishments in an attempt to reduce violent clime. While criminologists debate whether
violent clime has actually increased or not (table 2). It Is clear that female offenders most often
commit non-violent offenses. Exceleratlng the incarceration of non-violent offenders to combat
violent clime clearly misses the mark.
.
Table 2
According to a 1995 report prepared for The Edna McConneU Clark Foundation it is lear of crime.
rather than rising crime ltself, that has fueled the nation's rising incarceration rates." They cite the
following:
National Crime Victimization Survey INCYSl shows that between 1980 and 1992 the rate of
rape. robbery and assault went down by 3.6%; crime against households (burglary and larceny)
dropped 33.1 %; and crime against Individuals (theft without force or threat of force) declined 28.7%.
Uniform Clime Report rucR) indicates that the rate of violent crime(murder/non-negligent
manslaughter. rape. robbery and aggravated assault) Increased by 27% between 1980 and 1992.
Almost all of this increase Is In the category of aggravated assault which involves serious injury and
includes all assaults or threats of Injury with a deadly or dangerous weapon. According to UCR
figures the murder rate in 1993 was 9.9 per 100.000 people. This rate Is slightly higher than the
rate of 9.4 in 1973 and lower than the 1980 rate of 10.2.
The National Academy of Sciences concluded that greater gun availability leads to an Increase In
the percent of murders and felonies where guns are used. but does not affect general violence levels.
Center for Media and Public Affain found that even though crime rates had remained essentially
unchanged between 1992 and 1993. television coverage of crime and violence on the evening news
doubled during this period.
A proffie of climes called index crimes are commonly used to measure clime. Figure 2
compares the number of females arrested for index climes in Arkansas in IT 1994-95 with the
number.ofmales arrested for those same climes. Figure 3 compares the climes for which women
are most often arrested with the number of men arrested for those same climes. These climes
forgel)'. theft, fraud - are nonviolent climes.
It is important for policy makers to understand the difference in violent climes
committed by men and those committed by women. According to the Bureau of Justice
Statistics Bulletin. "Women in Prison", of the minortty of women serving sentences for violent
offenses, nearly two-thirds comitted the offense against a relative, intimate. or someone else
tlley knew. In contrast. the majority of violent climes Committed by men are cOmitted against
someone with whom they were not previously acquainted. Vel)' often women who are serving
time for: violent offenses committed those offenses against someone who previously victimized
them. Those women who commit violent acts are not a high risk to public safety.
J
�Iindex Crime I
'10000 ..,...----------------~...... -----.---
6000+.w.... .
w . . . . . . . . . . . . . . . . . . . . . . . . .• • ..
• • • • • • • • •
Figure 2
Female Arrests
•
III Male
9000
Arrests
. . . . . . . . . . . . . ._ - -
7000~------------------
6000
+.................................._. . .
. . . . . . . . . . . . . .
5000
..
4000 +.................................................................................................................
3000
20004· .. ·.... ·......................................................................
1000
o b..B:lb:..ti!m:c~
Murder
Rape
Robbery Ag. AssaultBurglary
Theft
M·V Theft
Arson
Comparison offemale and male arrests for index crimesfor year ending June 1995
I
Other Crimes
Figure S
I
10000 , ......................_..._ ................- ......................._......._ ..- ....-.-......:...........................................
9000
6000
7000 + .................._. . _
. ....._..._.....
6000 -1 ..........._ .....__........_.....
•
# Female Arrests
III Male
Arrests
sooo +---------
4000
3000 + - - - - - -
2000
+..........._. . . _._......_._._..
.
1000 -t----:;
O~RZ:II12d
Prostitution Runaway
Fraud
Vagrancy
Theft
Orugs
. Comparison qffemale and male arrests for crimes most typically comitted byfemales ..
year ending June 1995
Women and the 'War on I>ru(s'
Much of the growth in the prison population in the United States has resulted from a
doubling of the number of arrests for drug law violations and a tripling of the rate of
incarceration for convicted drug offenders (BJS, 1991). Anti·drug policies tax the criminal
justice system's ability to handle the increased number of arrests and convictions but have
little appreciable' impact on reducing the drug trade (EMCF. 1995). Based on a survey of inmates
in State prisons across the nation. the Bureau of Justice Statistics found that women are
substantially more likely than men to be serving time for a drug offense and; that regardless of
the measure of drug use. women who reported using drugs were less likely than nonusers to be
serving a sentence for a violent offense (BJS. 1994).
What Becomes of the Children?
. One of the unintended consequences of criminal Justice policies that send
unprecedented numbers of mothers to prison is the impact on the children these women leave
behind while they serve their sentence. A frequently overlooked difference between women in
prison and male inmates is their relationship to their children. According to Bureau of justice
statistics, 80 percent of female infnates. but only 56 percent of male inmates, lived with their
children prior to being incarcerated (figure 4). Other studies found that the mean number of
children per incarcerated mother ranges from 2.3.. 2.4 and the mean number of children per
incarcerated father is 2.0. If we assume that these figures are valid for individuals on parole.
then it is estimated that there were nearly 18.000 children in Arkapsas last year alone who are.
�or have been, separated from a parent because of the parent's
incarceration.] This figure is undoubtedly an underesUmate. It
does not include children who experienced the incarceration of a
parent if the parent was paroled prior to 1994-95 and it does not
include children whose mother may have served her sentence in
jail rather than prison. The difficulty in determining the size of
this population reflects the lack of attention this group of
chHdren has received.
Any family with an incarcerated member faces problems
adjusting to the loss, of a family member (Hannon, Martin. &
Martin. 1984). Children of women inmates suffer even more
trauma since the mother is usually the primary caregiver
(Fishman. 1983). While children may experience the incarceration
of a father more frequently than the incarceration of a mother. the
" 01 inmates IIviro with minor children
children of incarcerated mother's are more likely to experience
displacement and problems associated with separation from their
mothers (Bloom. unpublished).
When fathers go to prison. mothers generally assume
primary responsibility for their children. A Bureau of Justice Statistics survey reports that 90
percent of the children of male inmates lived with their mothers and 10 percent lived with their
grandparents or other caregivers (BJS. 1988). When mothers go to prison, however, fathers do
not generally assume primary care of their children. Results of a recent study found that about
65 percent of the children of imprisoned mothers were placed with a relative other than their
father. usually the maternal grandmother; 17 percent were placed with fathers; and 14 percent
in foster, homes and other placements (Bloom & Steinhart, 1993). A survey of 44 incarcerated
mothers in Arkansas suggests that this trend may hold true for children in this state. The
survey found that 60 percent of the children were living with a grandmother. 25 percent with
another ,family member, and 15 percent with their father or stepfather (Harm & Thompson.
1995).
Fig. 5
100
0 .......- -
w/grandmother
w/other parent
Living arrangement during parents incar
•
other
father in prison
III mother in prison
The phenomenon of grandmothers and other family members raising a relatives' children
is not a new one, but the numbers are increasing. Nationally, since 1980 there has been a 44
percent 'increase in the number of grandchildren living in homes maintained by their
grandparents. Approximately 12 percent of African-American children live in the home of a
grandparent. compared to 6 percent of Hispanic children and 4 percent of white children. It is
The following formula was used to estimate this number:
(II
(#
incarcerated females x .80 x 2.4) + (II incarcerated males x .56 x 2.0)+
female parolees x .80 x 2.4). + (# male parolees x .56 x 2.0) =
(573 x .80 x 2.4) + (9,249 x .56 x 2:0) + (563 x.80 x 2.4) + (4,593 x .56 x 2.0) = 17.684
�estimated that in some cities with large low-income African-American populations. between 30
and 70 percent of the children are living with grandparents. A 1993 study by Margaret Platt
Jendrek found that 34.4 percent of the caregIvers studied had assumed responsibility for the
care of a grandchild because of the mother being in trouble with the law' -- 52.4 percent
because the mother had a drug problem. and 44.1 percent because the mother had a problem
with alcohol.
Parenting is never an easy job. but relatives who care for children while the child's
mother is incarcerated face complex and unresponsive systems. The challenges facing these
families are immense. and the programs that might help them often make a dilllcult Situation
1mposstDle. Relatives who are raising a family member'S children are frequently the round peg
trying to fit into a square hole. These families may qualify for help but it is a dlfficult process.
Tasks as seemingly simple as enrollIng children in school or providing necessary medical care
can be complicated.
A Composite of the Needs of Incarcerated. Mothers. Their Chlldren and
Substitute Carelivers in Arkansas
Table 3 presents information obtained from mothers at the Department of Correction
Facility for Women in Tucker. Arkansas and interviews with children of incarcerated mothers
and caregivers from around the state (Harm & Thompson. 1995).
TableS
Mothers in Prison
65% of the incarcerated mothers who were interviewed were in prison for non-violent property offenses.
87% of these incarcerated mothers reported experiencing physical abuse as adults.
52% had also experienced sexual abuse as adults.
On the average. these mothers have 10.6 years of schooling.
ChUdren
For the most part. the children surveyed lived with another family member. usually the grandmother.
Counseling for the children. Medicaid. day care. Food Stamp. and transportation were listed as primary
needs.
Almost all of the children knew where their mother was and all the children wanted to visit their mother..
Only 50% of these children actually visited their mother at least once a month. The distance to the prison and
lack of transportation were frequently reported barriers to visiting.
29% of the children had been separated from siblings.
.
CaJre&iyers
About half of the caregivers interviewed had been the childrenf> primary caregiver before the mother went to
prison.
About 1/3 of the caregivers received the children when the mother was arrested and incarcerated.
13% of the caregivers entered into court proceedings to obtain custody of the children.
Caregivers & children confirm that a mother's incarceration is emotionally and psychologically difficult for
children.
Caregivers reported school problems. behavior problems at home. difficulty with the law. feelings of anger.
shame and despair.
Risk Factors
Studies estimate that children of inmates are five to six times more likely than their
peers to become incarcerated (Barnhill & Dressel, 1991). Three factors that place children of
inmates at greater risk in comparison with their peers have been suggested (Bloom. 1993):
Factor #1: These children are traumatized by events relating to parental crime and
arrest.
�•
Children of offenders have often been parented by adults who themselves were raised in
families where intergeneratIonal problems such as child phySical and sexual abuse.
domestlc violence. and substance abuse were common.
•
Often present at the arrest of their parents. these children may suffer the trauma of
separatlon in a context of violence and brutality (Kagan & Welssbourd, 1994).
Factor #2: These children are more vulnerable as a result of separation from their
parents.
Children of incarcerated mothers experience special problems. In most cases where
mothers are living with children prior to incarceratlon. the separation caused by
~prisonment is a major trauma for the children. Separatlon between mothers and
their young children may lead to emotlonal. psychological. and physical problems for
children (McGowan & Blumenthal. 1978. and Bowlby. 1983).
•
Young children do not recognize their parent as 'a completely separate individual: they
tend to experience injuries or threats to the parent as injuries or threats to themselves.
E;vents that result in parenti child separatlon. like parental arrest. are especially
traumatlc because they eliminate the opportunity for children to observe their parents
following trauma and be reassured of their well-being (Johnston. n.d.).
• In middle childhood. the development of children's abilitles to work and to get along
with others, including achievement in school and the control of emotions. may be
significantly impaired by parental crime. arrest and incarceratlon. The development of
trauma-related behaviors. particularly aggression. is characterIstlc of children of
offenders in middle childhood (Johnston. n.d.).
•
Teenage children of prisoners typically have experienced a lifetime of disruptlons related
to their parent's criminal activities, arrests and incarcerations. The cumulatlve effects of
repeated parent-child separatlons. enduring trauma, and/or inadequate care may be
expressed in their school performance, legal Socialization or other conduct.
Intergeneratlonal crime and incarceratlon begin to appear as a significant pattern in
families when children reach this age (Johnston, n.d.).
•
A number of studies document that children of incarcerated parents suffer emotlonal
stress related to the separation caused by a parent's imprisonment (Sack. Seidler &
Thomas 1976: McGowan & Blumenthal 1978: Stanton 1980: Sametz 1980: Fishman
1982). These children often exhibit behavior patterns that include anxiety. depression,
aggression. and learning disorder. More recent research indicates some children of
,inmates may suffer from post-traumatic stress syndrome (Kampfner 1990).
Factor #8: Poverty
•
A recent study noted that the caregivers of these children were unprepared
psychologically and economically to initially assume the substltute parental role
(Hungerford. 1993).
•
According to the Director. Center for Children with Incarcerated Parents. poverty is
associated with increased rates of every type of trauma that children suffer and is also
,at least partly responsible for the high levels of stress that prevent caregivers
from
providing children of offenders with adequate care and support.
•
Most incarcerated mothers plan to reunite with some or all of their children when they ,
are released from prison. The majority of these mothers enter prison lacking marketable
skills. education and employment opportunitles. Upon release from prison. parents are
�expected to find suitable housing for thetr families and become employed. Lack of·
a1Iordable housing and employment issues can present major obstacles to family
reunification following incarceration.
I
Policy Recommendations
Crtminal justice pollcy must begin to take into account the effect that mother-child
separation has on the children of female inmates. The following policy recommendations will
reduce factors which place children with incarcerated mothers at increased risk for child
abuse/neglect. substance abuse and juvenile delinquency.
•
Law enforcement officers are in a key position to minimize the trauma. that a
child experiences when a parent who is the child's primary caregiver is arrested
in the child's presence. Law enforcement officers should be trained to respond to
the needs. of children who witness their parent's arrest.
In field studies conducted with mothers who had been arrested while thetr children were
present. mothers repeatedly reported that. as a consequence of witnessing thetr arrest. thetr
children were subsequently fearful of law enf<;>rcemen t officers. While some mothers indicated
how appreciative they were of officers not handcuffing them in the presence of thetr children,
other mothers related stories to Interviewers about children being present while officers had
thetr weapons drawn: Others told of not beIng allowed to talk to thetr frightened children. Still
another told of an officer with his weapon drawn. demanding she lay face down on the floor
while she was holding an infant in her arms (Harm & PhUllps, 1996).
Law enforcement officer's must act to ensure' thetr safety when making an arrest.
However, once thetr safety Is assured they are in a key position to help children make the initial
adjustment to the arrest of thetr mother. WIt~esslng the arrest of a mother can have a profound
Impact pn children's psychological development and subsequent attitudes toward law
enforcement officers' (Johnston, n.d.). Interventions as simple as taking time to explain to a
child that the child is in no way responsible for what has happened can potentially have a
significailt impact on the child. Mental health professionals and law enforcement need to work
together to develop appropriate protocols for officers when arresting a mother in the presence of
her children.
•
Make alternatives to incarceration the sentencing standard for non-violent
offenders who are the primary caregiver for minor children.
An expanded range of sentencing options gives judges greater latitude to exercise
discretion in selecting punishments that more closely fit the circumstances of the crJrne and the
offender (EMCF. 1995). Where mothers of minor children are concerned, community
alternatives to incarceration· make tremendous sense as a way to mfn1mize the trauma of
mother-child separation for the children of female offenders. Sentencing options which allow
mothers ·to remain in the community with thetr children should emphasize drug treatment.
mental health groups for survivors of abuse. parent education, and job skill development. They
should take into account mothers' needs for daycare for young children as well as provide
therapeutic interventions for children.
In Arkansas,. one promising alternative to incarceration Is the Supervised Treatment and
Education Program (STEP) currently operating within the Sixth Judicial District. This program.
which diverts first-time offenders to drug treatment. provides remediation of the problem which
brought the offender into the crtminal justice system while allowing the offender to remain in
the community.
.
The Choices program. operated by the Department. of Community Punishment at the
Southeast Arkansas Community Punishment Center in Pine Bluff. provides another promising
alternative to traditional incarceration for mothers with a substance abuse problems. While
�this program is available to women from anywhere in the state. the program exists only in Pine
Bluff at, this time. If this program were available regionally it would be more feasible to
incorporate family members in the treatment process. Studies show that family support during
incarceration reduces the risk of recidivism. Other studies show the family involvement reduces
the risk. of relapse. Where minor children are at stake, it becomes increasingly important to
involve famtlles in the recovery process so that children do not experience repeated trauma.
At the Federal level, The Omnibus Crime Bill of 1994 authorized funds for Family Unity
Demonstration Projects. These projects involve housing certain non-violent offenders who are
the primary caregivers of children under age 7 in facilities with their children. Drug treatment.
parent education and other services that strengthen. families and are rehabilitative in nature
would be provided. Funding for projects of this nature could help to demonstrate the efficacy of
alternatives to a 'lock 'em up longer' approach to cr1m1naljustice.
•
Make drug treatment programs for mothers with dependent children more widely
available.
It is not suffiCient to leave mothers in the community with their children if help is not
available to address the root causes of the problems which lead to their involvement in the
cr1m1nal justice system. Drug abu~e is a Significant precursor of incarceration. It is critical that
the cr1m1nal justice system be part of a continuum of drug and alcohol abuse interventions
withIn the larger community. In order to do this. however. Arkansas needs to increase drug
treatment options for mothers with minor children. The Center for Substance Abuse Treatment
(CSAT) advocates a comprehensive treatment approach for women with drug and alcohol abuse
problems that addresses women's substance abuse in the context of her health and her
relationship with her children and other family members (CSAT. 1994). Treatment that
addresses alcohol and other drug abuse only may well fail and contribute to a higher potential
for relapse (CSAT. 1993). The National Institute of Drug Abuse shows that treatment programs
where women can live with their children at a treatment center. or safe. drug-free residence. are
especially successful (HHS. 1994).
Drug and alcohol treatment programs deSigned for women. if available. could be used in
coordination with intermediate sanctions such as intensive supervised probation. day
reporting. or electronic monitoring as alternatives to incarceration. Drug and alcohol treatment
programs that address the specIal needs of women are equally important to women returning to
the community from prison. A treatment and relapse prevention plan. deigned while the'mother
is incarcerated. should be continuously in place as she reenters the community (CSAT. 19931.
The criminal justice system and existing prevention programs should coordinate
efforts to target children who have a parent in prison.
In a 1995 study conducted by researchers from the UALR Graduate School of Social
.Work and UAMS College of Nursing (Harm & Thompson. 1995). relatives who were caring for
children while their mother was Incarcerated reported that these children were experiencing
school problems, behavior problems at horne. difficulty with the law. and feelings of anger.
shame and despair. Studies show that children with incarcerated parents are 5 to 6 times more
likely than their peers to become incarcerated. Nationally. 50% of juveniles in the correction
system have had a parent in prison. The preview of a study being conducted by the National
Institute of Justice shows that in addition to child abuse. child neglect is a strong predictor of
future violent behavior. These facts point to a clear need for existing prevention programs to '
work collaboratively with the cr1m1nal justice system to target children who have a parent in
prison..
•
Provide supportive services to caregivers.
There are five general parenting functions that a relative assumes when they take
responsibility for children while their mother is in prison: breadwinntng. home care. child
protection. child guidance and advocacy (aSAP. 1988). When the provision of basic necessities
�is a serious and chronic problem, caregivers have less energy and ability to fulfill other parental
responSibilities. Although the number of relatives caring for children who have a mother in
prison is, increasing, assistance for these relatives is fragmented at best.
In January 1996, the Parent Center piloted a program for children of incarcerated
parents :and the relatives who were caring for them. Among the more common problems
reported by the caregivers were issues that related to obtaining AFDC, medicaid and food stamps
to help with the expense of raising the children. One caregiver was being turned down for AFDC
because, eligibility was being calculated on the household's income rather then the children's
income alone. Another caregiver was being denied AFDC because Child Support Enforcement
was repOrting her as uncooperative -- her daughter had been released from prison and the
caregiver did not know an address. Because the grandmother was not able to furnish a
permanent address for the mother. she was denied AFDC and medicaid for the child who was
obviously experiencing developmental delays. Still another caregiver would not apply for
assistance because she was afraid that if Human Services knew she had eleven grandchildren
in her h<;>me they would remove the children (Phillips & Newell. 1996).
The children who participatc:;d in this program needed acute support. The children in
one family had witnessed numerous episodes of violence concluding with the death of their
father. Another family was trying to meet the needs of a child born addicted to crack cocaine.
During the course of this program, one of the children was the vicUn1 of a rape: and still
another ~as threatening suicide. Children in one family were separated because the caregiver
was not able to support both of them without assistance.
The following recommended actions would help increase the capacity of caregivers to
meet the basic needs of children 'during the period of their mother's incarceration:
Create a centralized point of service delivery within communities with high rates
of arrest where caregivers can get information and applications for a broad range
of services (e.g. AFDC. medicaid. food stamps. case management. mental health.
medical services. Kinship Care, disability services. WIC. immunizations. legal
services. FINS) in anticipation of the parent's incarceration.
The Kinship Care Act provides a mechanism for relatiVes to become foster care
providers. As foster care providers. relatives could receive income to otIset the
expense of housing the children in their care. This could potentially lessen the
financial hardship relatives assume and. perhaps, even decrease the number of
siblings who are separated. As it stands now, in order to become a kinship foster
care provider. the child must be in the legal custody of the state. When a mother
goes to prison, most of the time the state never becomes involved in the custody
of the child. In order for relatives who care for a child while their mother is in
prison to benefit from Kinship Care they would have to first ask the state to take
custody of the children. There is no guarantee that the child would then be
placed with the relative. Extending eligibility for Kinship Care so that relatives
who care for children while their primary caregiver is in prison will help relatives
to be able to support these children.
•
Provide programs that strengthen the mother-child bond during the mother's
incarceration
Children often respond to a mother's incarceration with a host of conflicting feelings -
anger, hurt. grief, loss. shame. Similarly. the relatives caring for a mother's children experience
feelings associated with the task they have taken on. These feelings do not just go away during
the mother's incarceration. In fact. these feelings can fester and hinder reunification of the
family. Mental health providers should be encouraged to work with families of offenders to
provide counseling services to addresses these issues. Services might be provided in
coordination with the parole division of the Department of Community Punishment or they
might be integrated into the visitation process within the Department of Correction.
Programs which minimize the trauma of separation for children during their mothers
�incarceration help set the stage for successful reunification. The stress and anxiety a child
experiences when separated from a mother can be relieved through visitation. The visitation
area should provide an environment that is child -friendly and encourages interactions between
mother and child.
Finally, a staggering number of women in prison have been victims of physical or sexual
abuse. Without intervention; a person's parenting style tends to mimic the style of their
parents. Parent education, then, is an essential part of laying the groundwork for improved
famlly functioning following a mother's release from prison. Mental halth services that address
the need's of survivors of abuse are necessary since abuse is often a predictor of substance
abuse_
•
Pi-ovide supportive services for family reunification.
In recent years a number of states have developed programs and adopted policies that
address the needs of incarcerated mothers and their children. However, a recent survey of social
agencies in Arkansas indicated that. while many agencies serve fonnerly incarcerated parents,
their children, and substitute caregivers, "it is clear that most agency directors and supervisors
have not developed special services for this unique population. Furthennore, few plans for
future.prograrnrntng for this population appear to be in place ..._" (Mercer, 1995 ).
Programs and services which help mothers to readjust to the 'free world' and re-establish
their parenting role are essential to successful reintegration into the community. Women are at
an economic disadvantage to men returning to the community. Typically women leaving prison
have less years of education and fewer years of work experience then men.Services which help
fonnerly incarcerated mothers meet their economic responsibility to their children are critical.
Programs that help these families with the role changes that mothers. children and caregivers
experience are also important for all concerned. Support for the reunification process can
reduce the stress of reintegrating into the community and decrease the risk of relapse and
recidivism.
�B..EFERENCES
Barnhill, S. & Dressel, P. (199l). Three Generations at Rlsk. Atlanta: Aid to Imprisoned Mothers.
Bough, C. (1985). Women In Jail and Prlson: A TrainIng Manual for Volunteers and Advocates.
National Council of Churches.
NY:
Bloom, B. (1993). Incarcerated Mothers and their Children: Maintaining Family Ties. in American
Correctional Association (Ed), Female offenders: Meeting needs of a neglected population,
Baltimore: United Book Press.
Bowlby. J. (1983). Attachment and Loss. NY: BasIc Books.
Bureau of Justice Statistic (1991).
Government Prlntlng Office.
Drugs and Crime
Facts.
1990. Washington.
D.C.:
U.S.
Bureau of Justice Statistics (1994). Women in Prlson. Washington. D.C.: U.S. Government Prlnting
Office.
Bureau of Juslice Statistics. (1988). Sourcebook of Criminal Justice Statistics 1987. Washlngton.
D.C.: U.S. Government Prlntlng Office.
Center for Substance Abuse Treatment (1993).' Relapse Prevention and the Substance . Abusing
Criminal Offender. Rockville. MD: U.S. Department of Health and Human Services. Public
Health Service.
Center for Substance Abuse Treatment (1994). Practical Agproaches in the Treatment of Women
Who Abuse Alcohol and Other Drugs. Rockville. MD: U.S. Department of Health and Human
Services. Public Health Service '
.
Center for Substance Abuse Treatment (1994). CSAT Comprehensive Treatment Model for Alcohol and
Other Drug abUSing Women and Their Children. Rockville. MD: U.S. Department of Health and
Human Services. Public Health Service.
Department of Health and Human Services (1994). Women and Drug Abuse. Washington. D.C.: U.S.
.
Government Printing Office.
Department of Health and Human Services (1994). Preliminary Estimates From the 1993 Household
Survey on Drug Abuse. Washington. D.C.: U.S. Government PrInting Office.
Edna McConneli Clark Foundation (1995). Seeking Justice: Crime and Punishment In America
Federal Bureau of Investigation (1994).
Government Prlnting Office.
Uniform Crime Reports. 1993. Washington. D.C.: U.S.
Fishman, S.H. (1983). The impact of incarceration on children of offenders. Journal of Children in
ContemDOralY Society. 15: 89-99.
Hannon, G.; Martin. D.. & Martin. M. (1984). Incarceration in the family: Adjustment to change. Family
Therapy. 11(3) 253-260.
Harm. N.J. & Phillips. S. (1996). When Mothers are Arrested. Little Rock. AR: Centers for Youth &
Families.
Hungerford. G.P. (1993). The Children Of Inmate Mothers in Ohio. Executive Su1lllI1alY. (Unpublished
manuscript).
Jendrek... Margaret Platt. (1993). Grandparents Who Parent Their Grandchildren: Findings and Policy
implications. Oxford. OH: Miami University
Johnston, D. (n.d.). ReDOrt No. 13: Effects of parental Incarceration. Pacific Oaks. CA:
Children of Incarcerated Parents.
The Center for
Kampfner. C.J. (1990). Post-traumatic Stress Disorder in the Children that Witnessed Their Mother's
Arrest. (Unpublished manuscript).
Kemp & Rlvara (1993). Parents In jail. Pediatrics. 92. (2).
�!
" . ' ..
'J
'
~
McGowan. B.G. & Bluementhal. (1978). Why punish the children? A study of children of women
prisoners. Hackensack. NJ: National Council on Crime & Delinquency.
Minkler. Meredith. and Kathleen M. Roe (1993). Grandmothers as Caregivers: Raising Children of the
Crack Cocalne Epidemic. Newbury Park, CA: Sage
Mustin. J. (Ed.) (1994). Families of offenders: A key to crime prevention. Family Corrections Network
Report. Issue I.
.
Office for Substance Abuse Prevention (OSAP)( 1992). Parent Training Is Prevention: Preventing Alcohol
and Other Drug Problems Among Youth In the Family. D.C.: U.S. Governm~nt Printing Office.
Phillips. S. & Newell. D (1996), Final Report to the Little Rock Task Force on Youth. Little Rock, AR:
Centers for Youth & Famllies
Sack. U.H., Seider. J .. & Thomas, S. (1976). The children of tmprisoned parents: A psychosocial
explanation. American Journal of Orthopsychiatry. 46. 618-628.
Sarnetz, L. (1980). Children of Incarcerated women, Social Work. 25; 298·303
Stanton. A.M. (1980). When Mothers Go to Jail. Lexington. Mass: Lexington Books
U.S. Department of Commerce, Bureau of the Census (1993). Marital Status and Living Arrangements
March 1993. Washington. D.C.: U.S. Government Printing Office.
I
�•
U.S.
DEPA~TMENT
"j'
OF HEALTH AND HUMAN SERVICES
HHS Press Office
(202) 690-6343
Contact:
September 1996
..
the Personal.Responsibilitv and Work Opportunity Reconciliation Act of 1996
I
•
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'
.
On August 22, President Clinton signed·-into law "The Personal Responsibility 'and Work
Opportunity Reconciliation Act of 1996 (P.L 104-1 ?_J)," a comprehensive bipartisan welfare
reform plan that will dramatically change the nation'swelfare system into one that requires work
in exchange for time-limited assistance. The l:;twcontains strong work requirements. a
performance bonus to reward states for moving welfare recipients into Jobs, state maintenance of
effort requirements, comprehensive child support enforcement, and supports for families moving
from welfare to work -- including increased funding for child care and guaranteed medical
coverage.
t
199~"
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Highlights of "The Personal Responsibility and Work.Opportunity Rec<?I1ciliation Act of
folloy\'.
.
MAKING WELFARE A TRANSITION TO WORK
o
\York requirements. Under the new law. recipients must work after two years on
aksistance, with few exceptions. Twenty-five percent of all families in each state must b~
. engaged in work activities or have left the rolls in fiscal year (FY) 1997, rising to 50
.percent in FY 2002. Single parents must participate for at least.20 hours per week the first
year. increasing toat least 30 r.ours per week by FY 2000. Two-parent families must work
35'!1ours per week by July 1. 1997 .
o
. Slupports for families transitioni.ng into jobs. The new welfare law provides $14 billion
child care funding over six years-- an increase of$3:5 billion over current law -- to help
more mothers move huo jobs. Tht: new Ia\\ also guarantees that women on welfare
continue to receive health coverage for their families. including at .least one year of
tr:ansitionalrvledicaid when the\ le:.lVe welfare for work.
,
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in
\\ork :\cti\:ities. To (punt to\~,'ard stale work requirements. recipients will be required to
part It:ipate in unsuhsiJizeJ or subsidized employment, on-the-job training, work
expl'rience. communil: service'. 1::: months of \'ocational,training, or provide child care
SI:f'It:I:S to indIviduals \\ho are; participating in community service. Up to 6 weeks ofjob
seare h (no marc than -I wnsccuti \'e \\,'eeks) would count toward the work requirement.
H()\\L'\er. no li10rc th:.l11 :0 percent of each state's case load may count toward the work
rcquireml:lll solely by p:micipating in vocational training or by being a teen parent in
s(;'wnd:;uy school. Single parents with a child under 6 who cannot find child care cannot be '"
penalized for failure to meet the work reqllirements. ,States can exempt from the work
r~4uln:mcnt singk parents with children under age one and disregard these individuals in .
the .calculation of participation rates for up to 12 months: .
.
�o
A five-year time limit. Families who have received assistance for five cumulative years
(or less at stareoption) will be ineligible for cash aid under the. new .we Ifare law. States
Will be pennitted to exempt up to 20 percent of their case load from the time limit, and
.states will have the option to provide non-cash assistance and vouchers to families that
reach the time limit using Social Services Block Grant or state funds.
o
Personal employability plans.. Under thenew plan, states are required to make an initial
assessment of recipients' skills. States can also develop personal responsibility plans for'
~ecipients identifying the educ;ation, training, and job placement services needed to move
into the workforce. '
.
o
State maintenance of ~ffortrequirements. The new welfare. law requires states to
maintain their own spending on welfare at at least 80 percent ofFY 1994 levels. States
htust also maintain spending at 100 percent of FY 1994 levels to access a $2 billion
contingency fund designed to assist states affected by high population growth or economic
downturn. In addition, states must maintain 100 percent of FY 1994 or FY 1995 spending
on child care (whichever is greater) to access additional child care funds beyond their
initial allotment.
.
I
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'Job subsidies. The law also allows states. to create jobs by taking money now used for
welfare checks and using it to create community service jobs or to provjde income
subsidies or hiring incentives for potential employers.
o
Performance bonus to .reward work. $1 billion will be available between FYs 1999
2003 fofperformance bonus'es .to reward states for moving welfare recipients into johs.
The Secretary of HHS. in consultation with the National Governors' Association (NGA)
and American Public Welfare Association (APWA), will develop criteria for measuring'
state performance.
.
o
State flexibility. Under the ne\\' la'.\', states which receive approval for welfare refonn
'~\'ai\ers before July 1. 1997 have the option to operate their cash assistance program under
some or all of these waivers. For states electing this option, some provisions of the new
law which are inconsistent with tilt: waivers would not take effect until the expiration of the
flPpl icable waivers in the geographical areas covered by the waivers.
.
i
PRO!\10TI~G
.
RESPONSIBI L1TY
Comrr'ehl'nsi\'c child. support l'nfn~ceml'nt. The new law includes the,child support
enl'urcc'ment measures President {linton proposed in 1994 -- the most sweeping crackdown on
nlln-p:l~in.:: parents in histor~. These meJsures could increase child support collections by $24
~illi\)n and n:duce federal \\ell~lr~'costsn: S4hillilln over 10 years. Under the new law, each state
. must (lPer~lle a child suppon en!prcement program meeting federal requirements iriorder to be .
diglnk, t'llr Temporary :\SSist~Hl'::.: to Need: Families (TANF) block grants. Provisions include:
(1
\aliimal' new hire n:porlmg system:' The law ~stablishes a-Federal CaSe Registry and:
~Jtl()nal Directory of 't'W Hires to track-delinquent parents across state lines. It also
. ireljuires thoten1ployers n:pon all new hires to state agencies for transmittal of new hire
~infllrmJtion to thl' :\JlIonal Directory of New Hires. This builds on President Clinton's
. 'June 1996 executi\'e action to track delinquent parents across state lines. The law also
expands and streamlines procedures for direct withholding of child support from wages.
�o
Streamlined paternity establishment. The new law streamlines the legal process for
,paternity e'stablishment; making it easier and faster to establish paternities. It also expands.
the voluntary in-hospital paternity estabIishmentprogram, started by the Clinton
.
Administration in 1993, and requires a state form for volOOtary 'paternity acknowledgment.
I In addition, 'the law mandates that states publicize the..availability and encourage the use of
yoluntary paternity establishment processes. Individuals who fail to cooperate with
paternity establishment will have their monthly cash assistance reduced by at least 25
- percent.
I
o
,Uniform interstate child support laws. The new law provides for uniform rules.
procedures, and forms for interstate cases.
o
Computerized state-wide ~ollections. The new law requires states to establish central
registries of child support orders and centralized collection and disbursement units. It also
requires expedited state procedu,res for child support enforcement.
o
;rough ,new penalties. Under the new law. states .can implement tough child support
enforcement techniques, The neW law will expand'wage garnishment, allow states to seize
assets. allows states to require community serVice in some cases, and enable states to .
, revoke drivers and professional licenses for parents who owe delinquel!.t child support.
~'Families First." Under a new "Family First" policy, families no longer receiving
o
~ssistance will have priority in the distribution ofchild support arrears. This new policy
;-vi II bring families who have I,d! welfare for work about $1 billion in support over the first
SIX \·ears.
o~"-ccess and visitationprogl·ams. .In an effort to increase noncustodial parents' '
in\"olvement in their childre:1's lives. the newlaw includes grants to help states establish
programs that support and faciiitale noncustodial parents' visitation with and access to their
children,
'
Teen Parent Provisions
,
()
(1
,Lin at home and stay in school requirements. Under the new law; unmarried minor'
rarenls wi II he required to Ii \'e \\lIh a resronsi ble adult or in an adult-supervised setting
~ndpJrticipale in educational :.lJ1JtrJinin~ :.tctl\'ities in order to receive assistance. States
~\ill he responsible for l\lC2l1ng orasslsl1~g in locating ad~lt-sLipervised settings forteens.
;[ct.'nPrcgnancy Prennlion. Starting in fY 1998. $50 million a year in mandatory funds
. ~\(lLJIJ be addcd to Ilh: arrroprialinns of the ;\1atemal and Child Health (MCH) Block
,- (Jr;II1I·i"or Jbstinence t.:Ju":JIHin,ln :.tddilion: the. Secretary ofHHS will establish and
Imrkmcnt J strate~: t\l I 1 I pre\L'J11 nOIl-marilJl teen births. and (2) assure that at least 25
,rerL',:nt 01" communille~ IU\'e teen pregnancy prevention programs. No later than January
1. I lit) 7. the A ttorne: (iL'nl..'rai: wi Ii establ ish a program that studies the linkage between
. ~talutory r::lpe ::lnJ tl'l'n rregnanc:. and,that educates law enforcement officials on the
prl'\cntionanJpH l secuti(ln o[statutory rape,
,
.
.
,
[
,
�IMPROVEMENTS OVER THE VETOED BILL
President Clinton vetoed.the previous welfare reform bill (H:R. 4) submitted by Congress
because it did too linie to move people into jobs and failed to provide the supports -- like child
- care and'health care -- that families need to move from welfare to work. "The Personal
ResponsIbility and Work Opportunity Reconciliation Act of 1996" includes several
improvements over the vetoed bill, including:
.
the
o
Guaranteed medical c~verage. The new law prese'rves
national guarantee of health
. care for poor children, the disabled, pregnant women;' the elderly, and people on welfare~
H.R. 4 would have ended the guarantee of Medicaid coverage for cash assistance
.
recip.ients.
o
Increased child, care funding and mandatory child care maintena~ce of effort. The
new law provides $14 bi Ilion in child care funding -- an increase of $3.5 billion over 6
years -- allowing more mothers to leave welfare for work. States will receive an initial
allotment each year from a fund of approximately $1.2 billion. To access additional funds,
states must maintain their own spending at 100 percent of their FY 1994 or 1995 spending
. dn child care (whichever ishigher). By contrast, H.R. 4 increased chilci care funding by
. just $300 million over current law, and did not require states to meet child care
maintenance of effort requirem,ents to access additional federal child car_e funding,
.' allowing states to lower-their own spending.
..
o
Incentives for states to move people intojobs. The new law includes a $1 billion
performance bonus to reward states that meet perforniance targets. H.R. 4 did ,not contain
a; cash performance bonus.
.' .
,
o
Preservation of nutrition programs. H.R. 4 would have. given states the option of block
granting food stamp benefits, the bill would~ have also capped federal food stamp program
expenditures, limiting maximum benefit increases to 2 percent per year, regardless of
gro\vth in need for assistance. The new law maintains the nationa] nutritional safety net by
eliminating the block grant option as well as the food stamp cap.
o
<urrent law child protection and adop·tion. Unlike H.R. 4, tbe new plan maintains
current law on child protection 2.nd adoption. and does not reduce funds'for child welfare,
.
.
child abuse. foster care and adoption scnlces,
o
Imprond contingency fund. The ncw law includes a $2 billion contingency fund to
p'rotccl siates in times of population grO\\1h .or economic downturn, 'H.R. 4 included a $1
billion contingency fund,
I
,0
o
.
.
Current law child care health and silfety.standards. The new law protects children by
JliI~iill~ining health and SJ!cty standards for day care. H.R.4 would have eliminated health
and safety protections.
I)rtlll'ction of disabkd children: H.R.4 would have cut SSI by 25 percent for many
. disJbled children. The new IJ\\' eliminates this proposed two-tier system.
1
o
'.
,
.
.
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Optional family cap. Uncier the new law: states have the option to implement a family
cap. H.R. 4 required states to deny cash benefits to children born to welfare recipients.
unless the state legislature explicitly voted to provide benefits.
�. NECESSARY IMPROVEMENTS
President Clinton has stated that the new law requires severaLimprovements. Specifically, he has
pledged ,to fix two provisions .of the welfare bill which he believes have nothing to do with welfare
, -reform:· I
o
Food Stamps. According to President Clinton, the new law cuts deeper than.it .should in
Rood Stamps, mostly for working families who have high shelter costs.
o
~egal Immigr~nts. The law includes provisions that would deny most forms of public
a,ssistance to most legal immigrants for five years or until they attain citizeI;lship. The
President has said that legal immigrants who fall on hard times through no fault oftheir
.dwn and need help should get it, although their sponsors should take additional
. .
responsibility for them.
t
BUILDING ON THE PRESIDENT'S WORK TO END WELFARE AS WE KNOW IT
Even before Congress passed welfare reform legislation acceptable to President Clinton~ states
were acting to try new approaches. With encouragement, support, and cooperation from the'
Clinton Administration, 43 states have moved forward with 78 welfare reform experiments. The
Clinton Administration has also required teen mothers to stay in school, required federai
employe~s to pay their child support, and cracked down on people .who owe child support and
cross sta~e lines. As a result of these efforts and President Clinton's efforts to strengthen the.
economy, child support collections have increased by 40 percent to $11 billion in FY 1995, and
there are, 1.9 million fewer people on welfare today than When President Clinton took office .."The
Personal: Responsibility and Work Opportunity Reconciliation Act of 1996," will build on these
effons b~' allowing states flexibility to reform their welfare systems and to build on
demonstr~tions initiated under the Clinton Administration.'
.
.
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1
�
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Carol Rasco - Issues Series
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Carol Rasco
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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92 folders in 7 boxes
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2010-0198-Sb-child-welfare-3
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PDF Text
Text
• \r'"'
I
",
September 15, 1996
To:
Carol Rasco
·From:
Lyn Hogan
Re:
Next Steps On Child Welfare
Attached are two documents on child welfare reform Jeremy and I
drafted and shared with Jen Klein. The top document is an
outline that presents what we think are the six key challenges to
._~. reforming the child welfare system.
The second document is a
more detailed analysis of the problems and potential solutions as
/ ../
.,./
they've been presented in our chat sessions and in the foundation
meeting the First Lady held.
Following are a few thoughts about how we might move the process
forward, using the attached documents as a starting point. We
look forward to your comments .
AJ
~
~
We might begin to run the attacheddocuments~by the
.
e
participants in our remaining chat sessions for a senSe of
whether or not we are on the right track.
:'.
e.
We might flesh out each of the problem are.as and solutions
in individual three or four-page policy memos. As memos are
completed, we might begin to run them by ~he experts for
their comments . .
.
I
We might use versions of the accompanying attachments as a
spring board for appointing a blue ribbon cbm~ission to
develop a legislative proposal and build consensus around
the ·outline and its principles.
e
Once the chat sessions end, we .might simply use versions of··
the accompanying attachments as a springboard for creating
your legislative agenda for the following term.
These are just a few ideas to move the process forward.
Please
let us know what you think and how you would like to proceed.
,", ~y:
:~
�POTENTIAL CHILD WELFARE REFORM. PRINCIPLES
Establish a New Goal for Child Welfare: Permanency
Challenge: The system's present focus on family preservation/reunification leads too
many children .to remain in foster care even though reunification may be neither
appropriate nor possible.
Principle #1: Rapid, appropriate placement in permanent healthy and safe arrangements
should be a central goal of child welfare. Options for permanency should include:
family preservation/ reunification; alternative guardianship with a focus on kinship
care; termipation of parental rights followed by adoption.
Improve the Court Process.
Challenge: The judicial system is not adequately equipped or organized to deal with
the flow of foster care and adoption cases, although model systems do exist in· places
like Grand Rapids,Mi. and .Cincinnati.
Principle #2: True reform requires a systematic look at court practices around the.
country, and development of a consensus, on court improvements, and court evaluation.
Restructure Federal FU,nding of the Child Welfare System
Challenge: Current funding structures create the wrong incentives and result in
misdirected funds, for example, ~ewarding foster care over adoption.
Principle #3: Financial incentives should encourage rapid movement to permanent
placement rather than lengthy stays in foster care. Other financing strategies including
the appropriate application' of managed care principles should also be explored~
Create New Options For Permanency
Challenge: Inflexible guardianship laws offer few options for permanency beyond,
foster care or adoption, though some states are exploring creative new arrangeinents.
Principle #4: We need new guardianship laws that provide alternatives to foster care
,and adoption such as joint guardianship; standby guardianship; subsidized
guardianship; or shared custody.
�Remove Barriers to Adoption
chil~ren
Challenge: Barriers to adoption are leaving adoptable
and driving adoptive parents away.
in foster. Care toa long
.
Principle #5: Reform should include a comprehensive evaluation of the adoption
process and ways to encourage and ease adoption in appropriate cases..
Improve and Expand Prevention Efforts
Challenge: The child welfare system continues to spend too-much on addressing abuse
once it occurs rather thari on prevention before it occurs.
.
'
Principle #6: A reformed child welfare system must support coordinated, community
based prevention efforts. Changes in the structure of funding incentives may help
encourage prevention, and coordination and simplification of federal support for'
. community based efforts in other disciplines must be part of the reform agenda.
�.~
.
The State of the Child·Welfare System
Since 1976, reports of child abuse have risen fourfold. Now,
over 3 million child abuse cases are reported annually, with
roughly one million cases confirmed. About 1,300 of those cases
end with a child's death. Further, abouthalf-a-million children
are in 'foster care on any given day, a number that· is also
growing rapidly. And of those children free for 'adoption, XXX
remain in limbo, hoping for adoptive parents.
This country's child wel,fare system is 'failing the children
it is designed· to serve. The system has been in a downward spiral
for more than a decade and there are few indications it will
improve •.
Toqate, there have been two major responses to the system's
failure:
the family preservation movement and the court takeover
__of_ state systems.
First, in the 1980s into the 1990s, academics and
practitioners alike forced a paradigm shift by stressing family
preservation and reunification as'an answer to an increasingly
failing child welfare system. The family preservation movement
has produced results and remains an important contribution to .
social policy. However, family preservation offers only a
treatment model when more is needed. Family preserv~tion does not
work for those whom no amount of family preservation will help.
Second, in response to the continually worsening system, the
courts began to intervene. Currently, there are pending class
action suits or judiCial consent decrees in XXX states.
.
<
Litigation has forced states to think about aggressive and
creative system reforms and to act on those ideas. But the
,approach and results have been unsystematic. Consent decrees are
,structured to satisfy the judge. A state must meet
'the law for every provision in a consent decree.
Instead of
promoting system change, consent decrees are creating compl'iance
mechanisms that .stifle meaningful change. There is no collective.
definition of problems and solutions for states to follow, so
there. has been only a piecemeal approach to reform to date.
Some small states are making progress: Vermont, North
Dakota, Delaware, and Idaho have interesting reforms underway.
Michigan is also progressing with its Families First program~
However, most states are struggling to address the problems and
don't know where to begin.
.
.
To truly reform the country's child welfare system, we need
a vision, a broad framework for change, and a roadmap for g~tting
there. But to be successful, we need to target all areas for
reform arid move ahead on several paths at the same time~
1
�,.... ,.i
The following document outlines critical problem areas in the
child welfare system and starting points for reform. '
•
Issue 1: No consensus oli goals, of the child welfare ,
system. There is no accepted definition of what a good child
welfare system should look like or what its end goals should
be.
Solution: We need to create a tight national definition
of the mission of the child welfare system." Once that
mission is drawn' up, ,we must require states to adhere to it.
•
Issue 2:
An' inadequate definition of "reasonabie efforts."
P.L. 96-272 requires that reasonable efforts be taken to
prevent placement of a child in foster care and make it
possible for that child to eventually return home'.
Determining reasonable efforts iS,left up to the states and
varies substantially from state to state. The result is
often a singular focus on family preservation/reunification,
even in ,cases where it is not appropriate or possible. In
turn, lengths of stay in foster care 'are unnecessarily
extended.
Solution: Make permanency planning 1;J1E;;• .99.§..! of reasonable
efforts. Within permanency should ~ee options:
family
preservation/reunification; alternati~e guardianship with a
focus on kinship care; and termination of parental rights
followed by adoption.
•
Issue 3: 'No nationallyac.:=ceI?ted measures of success .
Despite a decades-old child wel'fare system, there exist no
defined, agreed upon m~asures of success.
Measures of
success should be driven by the system goal(s).
Solution: We need a federal'definition of ,the broad goals
of the child welfare system and a'consensuson definitive
measures of those goals. '
•
Issue 4: A judicial system not adequately equipped or
organized to deal with flow of foster care and adoption
cases.
Solution: We need a systematic look at court practices
around the country, acorisensus on court improvements, and
court evaiuation.' Court reform might include reduced
caseloads for judges, community-based caseloads so' the same
judge sees a 'case through, chi+d,welfare-specific training
for judges, and a reorganization of court ope,rations. Good
working models include Grand Rapids, MI court and the
Cincinnati court. The federal government has made grants for
2
�court improvement. Feds could increase the number of
federal grants for court improvement.
•
Issue 5: Rising caseloads at the same time dollars are
shrinking.
Solution: In a political climate where new funds are
difficult if not impossible to come by, we need to seriously
review the feasibility of applying managed care to the child
welfare system.' Forty-one states are currently considering
forms of managed care for child welfare, but' few have moved
forward and there are no federal guidelines or suggestions
for doing so.
Instead of comprehensive managed care, we
might consider independent management changes such as
encouraging public/private partnerships; introducing
performance-based contracts for the privat'e sector; or
'pinpointing creative ways to_use title IV-:-E,funds.
•
Issue 6: Incongruent system goals and misdirected funds
driven by the structure of titles IV-E and IV-B. For
example, there is a reverse incentive funding structure that
rewards foster care over adoption. Also, dollars often flow
to populations and programs that don't need them while other
populations and programs remain underfunded.
Solution: Once an overall vision, goals, and outcome
measures are set, we need to review and reshape the funding
structures of tit,le IV-E and IV-B. We might shift financial
incentiv.es so adoption is rewarded, over foster care. We
might also target ,funds to localities with the highest rates
of poverty and largest foster care rolls.
•
Issue' 7: Not enough good data to accurately evaluate the
system. We have point in time data (a snapshot of a typical
day), but no full year data to 'let us know what the problems
are and how to fix the system'
Solution: We need more and better data collection and
evaluation; w,e need demonstration programs with evaluations,
starting with ,the HHS child welfare waivers; we need to
escalate/encourage creative waivers; and we need a
clearinghouse for child welfare information.
'
•
Issue 8: Inflexible guardianship laws that offer few
options other than foster, care or adoption.
Solution: We need new guardianship laws that 'provide
alternatives to foster care and adoption; e.g. temporary
'adoption, kinship care, jOint guardianship; s~?
,guardianship; subsidized guardianship: shared cus~ody.
3
�'."
"
•
Issue 9 : Barriers to adoption that frequently leave
adoptable children in foster care.
Solution: Jen--please add info. here if you have it.
Foster parenting should be viewed as a pre-adoption phase,
rather than an end in. itself .
.•
Issue 10: No supports ·for families once they adopt.
Solution: For a period of time after a family adopts, the
child welfare system should continue to offer supports to
th~t family and the adopted bhild or children., This is a
particularly poignant problem for grandparents who adopt
their grandchildren.,
•
Issue 11: Failure to address prevention of abuse and
neglect before the abuse occurs.
Solution: Community-based efforts can best address
stressors in a family that might cause abuse or neglect. A
coo~dinated, community-based effort can target problems and
help families before they are overcome by a crisis. This
might mean re-evaluating where family preservation funds
flow and reallocating them to early iri.t~rvention. '
"~
•
"
"
"
"
Issue 12: Lack of professionalism in the child welfare
field.
Solution: We ne~d to institute national standards for ,
social workers; need to create incentives for training and
professionalism; and need an accreditation and certification
process for the profession.
•
Is·sue 13: Insufficient public education on· child welfare
issues. Public attention is drawn to child welfare issues
primarily when a child dies. Communities need to become
more knowledgeable about child welfare issues so they can
help solve the problems.
solution: We can pursue ~~ a~gressive campaign to
educate the. public about child welfare is?\}es.
•
Issue i4: Failure of transition to independence programs
for children who age out of the foster care system. Once
£oster ~hildren turn 18 they "age-out" of the system and are
transitioned into independent or adult living.
Federal
funds for independent living are avaiiable, but ~unds are
insufficient and programs inadeq~ate. ;6ften foster kids·
4
",'
�transitioning into independent living
and/or homeless.
e~d
up on welfare
Solution:·
A system shift to permanency planning should
·reduce the number of children who age-out of the system.
However, for those who do age-out, new and better support
for independent living must be available.
5
�.
!I..
"'.,
,
\
TO:
FROM:
DATE:
RE:
.. ;J
~
~~.
.·fJ~. fL-~.
Distribution
-,
Jennifer Klein j.x
. ,Nicole Rabner
10/18/96
.
Materials for Monday Meeting on Adoption
~.
.~
Attached please find materials for Monday's meeting on adoption which will be held
in Room 100 at 5 :00 p.m. The first document is a short description of the goals and .
proposals that we are plaiming to announce. The second is the Department of Health and
Human Services' drafts of the Presidential Memorandum and of a document describing the
initiatives. Monday's meeting will be an opportunity to discuss our questions and concerns
about these drafts.
. .
�ADOPTION
GOAL 1: Double the number of children who are adopted by setting targets for the
number of children that should be placed ove'r the next 'three years~'
ACTIONS:
.
.
Help states that commit to meet these targets develop ways to help reach ~heir goals
and measure' their success. '.
..
Give special conimendations and hold' White House events to recognize states that
m~et targets.
.
Give states financial bonuses if they reach or come within 5% of reaching annual
targets.
~.
I.
2. .
3.
GOAL 2: Find permanent homes for waiting children ·within one year of entering the
"
,
.
child welfare system.'
ACTIONS:
1.
Change law so that hearings used to determine .whether a child should move from
f9ster care to' adoption are held more frequently in order to shorten the <m1ourit of'
time a child spends in foster care.
. .
.
2. . Require adoption agencies to work·toward finding children permanent homes at the
. same time as they consider whether to reunify ,children with their. birth families.
Today,agencies .must first determine whether children should be returned to their
birth parents and then begin the process of findjng adoptive parents. This causes
severe delays in finding permanent homes for waiting children.
..,.
3.
Give grants to states to Identify barriers to adoption and taplace children who have
been waiting particularly long times and those who are denied homes because there
.
are no families of the same race available. .
. GOAL 3: .Increase public awareness' about' the benefits of'a,doption.
.ACTIONS:
,
,
I.
2.
3.
4.
,
Direct the, Secretary of HeaJth and' Human Services to lead a public awareness effort,
including public service announce~ents, use of the internet and the appointment of
an advisory council made up of members of all sectors of the community'..
Direct the Secretary of the Treasury to disseminate inform~tion about adoption tax
benefits.
,.
, .
Direct the Director of the Office of Personnel 'Management to promote adoption
among Federal employees and make the Federal government. a model for adoption-
friendly work policies.
'
' .
Direct the Secretaries of Labor and Commerce to identify and .recognize companies
that have instituted, model adoption-friendly policies.
�~10/18/96
15:59
'6'202 690 6562
DHHS/ASPE/HSP
@002
DRAFT
Memorandum of October 25, 1996
ADOPTION ACTIONS
Memorandum for the Set.'1'eLaries of Health and Human Services, Treasury, Labor ahd
Commerce, arid the Director ofthe Office of Persoruiel Management
.
This memorandum'will confi~ my directive to you to develop a series of strategies dcsigD.ed to, .
by the year 2002, double the riumherof chilc1renwhoare adopted fros:n the public child welfare
system. To achieve this goal, I direct you to take the following steps:
I) Develop and implement a strategy, for stTengthening the adoption systeni which: assists
state~ and coIrlImwities with goal and larget·oriented planning, provides enhanced
technical assist~ce to achieve these goals and targets, and offers financial and non
,financial incentives to increase the llumbcr ofchildren who are adopted each year.
2) Develop and implement a strategy for strengthening the foster care system which:
decreases unnecesary procedural delays) refocuses activity on the critical issue of
permanency for-children; and gives states more opportunities to identify barriers and
propose and implementsoiutioIiS.·
..
~) Develop and implement strategies for buildj~g ollthe ~ork ofthlsAdrtrinistration to
'. make adoption a more realistic option for working parents. and a strategy for increasing
" public awareness about the numbers and experiences of waiti ng "dllldren..
,
,
The plan that I have outlined will help us meet the critical goal of signifiCan~y increasi.ng the .
number of chiltiren.whoareadopted each year.' Its swift implementation is vital to the lives and
futUres of tens ofthousands of ournation's most wlncrablc children.
[signature]
THE WIllTE HOUSE
October 25, 1996 .
�i
10/18/96
15:59
'5'202 690 6562
DHBS/ASPE/HSP
"
•.
:.
III 003 .
".
ADOPTION ACTIONS'
. GOAL; By the year 2002, double the number ofthildren who are adopted.
There are t~llS o,fthousands of children in 'tIle ~tion's fostercare System who cannot return safely to ..
· their homes, who need peImanent placement in new families and for whom adoption is a goaL Almost
one third ofthese children are legally :free for adoption and'~ waiting fora farnily. Almost halfhavc
been waiting for more than two years, and the numbers are increasing. Roughly half ofthese children
·~e children of color, and half arc white.
.
,
The federal government and sOciety at-large hnve Q compelling interest in seeing that these children's
lives are stabilized; arid that the backlog of waiting children is reduced. We must set measwable
. ~?~.s ~d work with states to move waiting' children toward pennanency_
'What is our goal? Through a series of t.arget~actions described below, our goal is to see a total
of40.000 cbildrell adopted out of the public child welfare system in the year 2002 -- about twice
'as many children as were adopted in 1994 (most recent year for which data are available). Each
year, states will increase adoptions: 23,000 c1iUdrell will be adopred by the end of 1998, an increase
of 15%; 26,000 children will be adopted by the end of i999, an increase of 30%,30,000 children
Will he adopted by the end of 2000. an increase of 50 %: 35.000 childien will be adopted by the end
oi2D01, an increase of 75% and 4Q,OOOchildren will'be adopted by the end of 2002, an increase
of 100% overthc five year period.
.
,.
A three-pronged strategy is proposed to get us
to this gba1: s~ngthening the adgption system,
strengthening the foster care system and increasing pub~ic awareness aboul adoption. '
Strategy #1: Strengthen the adoption system
TIle CL'Ulsi5tem and growing backlog of children awaiting adoption can be attributed. in large part, to
. history. In the past, acCountability for state child welfare Systems has been based on compliance with .
prescribed proCesses like case reviews. and counting the number of case visits or services. provided
· not on the permanency established for the children. Poor quality or: complete lack ofautomated data.
· systems have severely hampered states' ability to achleveeven this level ofaccoUntabitity.
a
.
'
,
To resolve these issues, the federal govenunenthas inv~stedsignificant1y in developing state and
federal data collection systems, and interim results areRositive. The administration has also tested
ways to shift accountability to child outcomes such as Safety, pcrmanencyandcl:iild well-being..
W~th the aid of these new tools, the fecleral government'is poised to collaborate \\lith states to
assure permanent homes for waiting children.
"
.
�, 10/18/9615: 59
'6'202 690 6562
DHHS/ASPE/HSP,
...;.
IlJ004
,
ACTIONS:
1.
'.
ProVide enhanced t«~bnical assistance
The Department of Health and Human Smric~s (HHS) will work with states to develop state
specific numerical targets to reach the national goals,tbat are baseq.on the' best possible datR
about waitirig children and current state program performance. The princip~ data source win
.be the new child welfare automated tracking 'system. being implemented by the Clinton
Administration.
• . The Department of Health and Human Ser~ces will work With ~tate 811dlocal governmenfs
to involve community leaders, parents,
business and faith communities and others to
develop a strategy for achieving the targets.
'
,
the
•
National resource centers will make W'onnation on best practices a~ailablc to states and
. will provide enhailCeq t,echnical aSsistance iumed at replicatirig th'ese strategies.
" Estimated Cost: $10 million/year. Funds for these aClivities woUld be included 1n the
discretionary portion of the Presid~n.t's FY 1998 budget request. These funds must be in
addition to HHS's FY 1998 budget request; the D.epattnH~nt Ims no ~oom t~ off-set the costs
Within its current request
"
.
,,
2~
•
.
Create incentives for lmprovedperfQrrriaIG,
"
',.-"
Consider fm.ancial incentives that will encourage states to increase, the number of children
adopted out ofthe public child wdfare. system, such as providing each state with a per child
bonus for every child adopted out of this'system, 'above the number adopted in FY 1997. The
bonus would be doubled forchHdrell adopted, excess of the' state's target. Bonus, funds
sho1.lld, be targeted to help e~ldren in the child ~eltar.c system.,'
in
•
The'administration will recognize successful stites throughth~ compilation and publication
of an annualstate-by·state report on success in meeting adoption targets.. 111e.c;e reports will
all>(.) cover best practices, promising approaches and creative strategi~s for meeting established
goals and targets. '
•
TIle adminIstration. wiHencouragc successful states through WhiteHouse events and
rec;ogrotion. ..
Estimated Cost: Theponus funds would be a,capped entitlement to states. If,for example,
a bonus was esmblished at $2,000 per child, total funds for the bonus would be $12 million
in FYs 1998 and 1999. $~4 million in FY 2000 'and $30 million in FYs 2001 and 2002.
The cost would he off-set to some degree by the fact that it is more expensive to keep a
child in foster care on a long-tenn basis tban it is to support him or her ,in an adoptive, home. ,
. '
.
.
i . . ·
,
.
.
,
,
�. 10/18/96
raJ 005
DDSI ASPE/HSP
'ft202 690 6562 .
16: 00
• t.!,
'Any new funds must be in additionto:HHSls FY 1998 budgct request; the Department has no
room to off-:set the costs withiIi itscurrellt requef\t.
Strategy #2: Strengthen thefoster,care.system
.,.. .
.
,
" The adoption process is too often hampered by unnece~saiy delays thatoccur while a chlldis still in
, the foster care system. Oelay;s may be caused. by inadequaie services to biological parents, failure to
conduct early and diligent searches Jor absent 'parents,' failure to initiate termination of parental
rights in a timely fashion. , .
'.
or
Currently. federal law requires that "reaSonable efforts u be made to prevent placement and to reunify
families when a placement occurs.' There 'is no comparable.requirement that reasonable efforts be
made to secure a pennanent placement once a decision hasbee'n made that the child cannot or should
nol r.etum home.. ' As a result" the system has not ;ulequately focuseci on the critica1 issue of ,
pennancncy for the child. As a complement
adoption, more systematic use
alternatives to
traditional notions of "pennanency, II such 3S gl1ardians~p or kinship care: shoUld:be encouraged to
decrease the number of waiting children. '
,
"
,
of
to
ACTIONS:
.
\,:
"I) Decrease' proce.dura1 delays and refocus on permanency
The administration will explore:
•
Shortening. tl1e period be.tween a childls' placement in' foster c~e and his. or her fust
dispositional hearing from the current '18 munths to 12 months. Dispositional hearings' ,
detennme whether achild returns home or moves forward toward an altemativepennanency
plan."
•
. •.
.
Changing ttdispositib~ hearings" t~ Itpennanen~y plaiming hearings" to clarify the purpose
ofthe hearing and include as options refeiTaIs fottennination of parental 'rights and adoption
'
or referrals to legal guardinnship or otller permanent placement.
Requiring states to rnakediligent ,efforts to se~ure permanency through adoption or·
, guardianship, after a decision has been nlade that the child cannot be returned home.
,
•
'
Examining the "reasonable effc:ilts"standard. ,
Estimated Cost: There ~e no' significant costs associated with these activities.
,
,
2. . Provide finanCial assistance for developing and implementinlv Solutions
•
As part of the president's FY 1998 discretionary budget request, an additional $10 million
,would be included for states to identify baItjers. propose and implement solutions, target funds
to placechlldren who have been waiting a particularly long,time, ~d further implement the
,
,
....
�DHHS/ASPE/HSP
~006
Interethnic Placement Act.. Details concerning this e)..llansion would be included 'in the
presidents annual budget submission in February. .
. Estimated Cost: $10 million Per year for five years. These funds mU$t be in addition to
HHS's FY.1998 budgel rt:quest;the Depru1ment has no room to off-set the costs within its
c,urrentreq~est., ,..
a
Strnt~gy #3:' Make .adoption more realistic option for working families and increase public
awareness about adoption . .
.
.
,
Experts across the field note the great needfOrincreasmg public awarclless a~out strategies to prevent
the family deterioration that leads to out ofhome placernent<i; about the numbers. characteriStics, and
experiences of waiting children, and about the need for mor~ families willing and able to adopt. .
M~g adoption a more realistic option. for working parents is a critical~ corollary to enhancing
. public a.warenessbccause the time and resources nece~sary to adopt remain prohibitive for many
potential fami lies.
. ,.'
"
". '
.
.
This administration has taken some important steps to promote adoption and make the federal
government adoption-friendly: .'. '
..
- Passing a $5,000 tax credit for ad~ptive par~nts ($6000for a.doption of aspecia1 needs..
. child) to help cover adoption-related expenses stich al\ h,ornes studies) leg'a! fees. purchasing
:i
. supplies and medical carc.
- Passing the Family and Mediea1 Leave Act~ through which cmployees adopting a child are
guaranteed up to 12 weeks ofuripaid leave;
.
. '
In addition, this administration has ~de the federal govemment !'l more adoption-friendly
employer bypassing legislation which allows f~deral employees Unlimited use of sick leave
specifically for purposes relating to the adoption of a child;.
.
ACTIONS
1)
The Secretary of HHS will dcvelop and lead a public awareness effort to include public service
anno.uncell1el1ts, print material and increased us~ ofIntemet resources on adoption. , '
Estimated Cust: ·$1 million. Funds for these ac:tivities would be included ill the discretionary .
portion of the presidents FY 1998 budget request 'These funds must be in addition to HflS's'
FY 1998 budget request; the Department has no room to off-set the costs within its currel~!
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request.
2)
The Secretary of ,the Treasury and the Secretary of HHS' will develop strategies for
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disseminating infonnation about tax benefits and other adoption benefits. ,
3)
The Director of th~ Office' of Persolin,el' Management wWdevelop a strategy to furiher P~01l10l\: .
adoption by federal employees and to' make the federalgovemnient a model of adoption-friendly
policies including:
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federal employe~s.for some adoption-:related
Explol"ing methods to reimburse.
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Directing all agencies to provide information and support to prospective adoptive
part:nts, such a~ by developing a bank. of agency employees who have adopted
. ,children and who have agreed to be mentors.
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. The Secretaries ofLabor:BI+d Conunerce "Will ideritify and recognize model aduption-friel1dly
policies in'the private. sector..
�To:
Fr:
Re:
Jeremy Ben-Ami
Jennifer Klein
Lyn Hogan
Subsidized Guardianship
Date: October 18, 1996
This memo proposes subsidized guardianship as a permanency option to consider during
Monday's adoption meeting. Subsidized guardianship could well provide a permanent
option for as large or greater a portion of the caseload as adoption.
Background
All across the country, child welfare agencies' are facing a crisis in the foster care system.
Caseloads have been exploding in recent years, while the number of potential caregivers has
decreased. Too many children are staying in foster care too long, delaying permanent
planning and driving up program and administrative costs for the state and Federal
governments.
Because of the increasing foster care caseloads and declining number of traditional foster care
providers, states have been relying on informal kinship care to meet their ongoing placement
. needs. Many of the children in both kin and nOQ-kin placements have no hope of retaining a
permanent home and will remain in the foster care system until they age-out. (Kinship care
providers do not have the legal standing that a foster parent or guardian does nor are they
eligible for cash or in-kind benefits, and cannot give consent for medical care or enroll. a child
in school.)
Currently, Federal law offers two permanency options: family reunification arid adoption.
For children in which reunification and adoption are not possible, permanency, as traditionally
defined, cannot occur.
With the large number of 'children in informal arrangements and aging out of care without a
permanent situation, it is all the more important to examine new and creative alternatives for
this population of ·children.
Subsidized Gual'dianship
Subsidized guardianship is one such new permanency planning· option. Subsidized·
guardianship allows a child's foster care case to be closed while still making financial and
other services available to the family. Subsidized guardianship is often used to make a
kinship care placement permanent, eliminating the need for ongoing supervision.
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Currently, 10 states have various forms of subsidiiedguardianship as' an altern,ative
permanency option 1, though at their own expense. Federal law does not permit IV -E funds to
be transferred to a guardian, except though waivers form Federal law. Recently HHS
approved two child welfare waivers to allow Illinois and Delaware to implement Federally
subsidized guardianship -- the only two waivers of their kind in the nation:
Change Needed In Law
To allow guardianship as a permanent option under title IV-E, the following change in
Federal law would be necessary.
The Federal government would have to amend Part E, Federal Payments For Foster Care and
Adoption Assistance, titles IV-B and IV-E of the Social Security Act, to parallel the foster
care and adoption sections to allow federal matching funds for guardianship maintenance
payments.
This change in law' would allow federal matching funds to states for eligible children placed
in permanent guardianship situations. In other words, all or a portion of title IV-E
maintenance funds would follow a child into a guardianship situation, thereby closing a child's
foster care case and creating a permanent situation for that child.
Costs
At minimum, subsidized guardianship is .cost-neutral. However, it is more likely that savings
will result. While a portion, or all, of the IV-E foster care maintenance payment would
transfer to the guardian, the foster care administrative and program costs would no longer be
applicable.
As part of its child welfare waiver application, Illinois conducted a cost-benefit analysis of
subsidized guardianship. Illinois's proposal estimates an accumulated savings of $22,000,000
over a five year period. The saving comes from reduction of administrative and program
costs.
Further, HHS estimated average monthly savings for subsidized guardianship at $508.00 a
month, or $6,096 a year. HHS estimates that if only 4 percent of the current IV -E foster care
caseload moved into guardianship status, annual savings would reach $63.4 million. The
percentage of those entering subsidized guardianship would likely be well above 4 percent.
lStates with non-federally subsidized guardianship proposals include
Alaska, Hawaii, Massachusetts, Nebraska, South Dakota, Washington, California,
Colorado, Illinois and New Mexico. Illinois and Delaware have the only two
existing federally subsidized programs.
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Questions and Concems
In adapting such a proposal, several questions would have to be answered that could affect
cost.
--Would any funds be available for administration and planning?
--How would a state determine a child's eligibility for guardianship status? (Several states
have minimum age requirements for children going into guardianship status since younger
children are more likely to be adopted than older children.)
--How long must a child remain in foster care before becoming eligible for guardianship?
. (States have set minimum foster care stays that vary from 6 months to 18 months.)
--What eligibility requirements must a guardian meet?
--How would a state design its guardianship program to ensure that guardianship is as
permanent as possible? (Guardianship is not as permanent as adoption because the birth
parents' rights are not terminated.) .
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When Child: Kills Parent
It Might Be Self~Defe~se
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'~BW YORK, FRIDA Yo' FBBRUARY 14,1992
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By DAVID MARGOUCK
Texas law that Permits a pe~
Until, stie took the stand, 17year-old Donna Marie Wisener . accUsed' at 'kUJIDI any family
seemed girlishly calm. twlrlinl a . member to introduce evidenee of
prior abuse; as well as expen
ballpoint pen and playinl with her
testimony on the pec:Wu.r pay
hair even as her diStraught mOlJ1.
cholojJy of victimlof ballerina.
, er testified, in her defense last
, week. But the girl's composure ,includina abused children. Five
qUickly collapsed as she recount , other states also allow. suc:ft e~ .
dence, but only With respect to
, ed,how. nine monthl earlier, she
battered wame'll,
picked up a .357-caUber Smith "
Yesterday, after eight and a
Wesson revolver and blasted bul
let holes in her father's head,hlp•. half hours of deliberation, the jury
acqUitted Miss Wisener 01 mur
hand. back and side.
der.
. . ' Thus ended the life of Glenn
In pleading her case, the teen
Wisener, the 49-year-old truck
age defendant also had the help of .
driver of whom the jury in. Tyler,
an unusual advocate: the co-coun
Tex:. had been given a posthu
sel in the case, Paul A, Mones of
mous portrait the prior few days.
.Mr. Wisener's wife. Mamie, testl· . Santa Monica. Calif., the only law
yer in the country whose clients
(ied that her husband was th'e
consist exclusively of boys 'and'
type 10 throw oak logs at her or
girls who kill Iheir mothers and
Donna Marie when' either dis
fathers_
pleased him, or smaSh a plate
Bryan Johnson of Tyler, Miss
containing his fried egs if they ,
Wisener'S chief defense lawyer.
were not su.fficiently runny. He
beat his stepson with brandies, . said the Texas statute enacted
last spnnl and Mr. Monet' were
belts. ropes, hoes and fists - in a
worse way. one witness recalled, 'crucia I factors in the acquittal. He
said the verdict reflected evolvii'll
than' he wOuld, ever have
public attitudes toWard cases of
,.·whupped;" his o~n livestock.
Miss Wisener offered her own children who kill their parents.
"May~ we've juinped that
grotesque version of life With fa
ther: He had once broken twO' hurdle oJ beinl able to show to a
SWllches on her buttocks. Other . jury and a community that a child
times, he handcuffed her to a .cannot endure years and years of
severe emotional. physiclal. and
chair lor his amusement or. when
~xual abuse ~ not be exPected ,
. her report cara was unsatisfac·
to defend herself at some poin,,"
tory. beat her .. unconscious. In
Mr. Johnson said. "And 'defend'
more affectionate moments, he
is the key word. It's not lashina
gave her, "rub downs" and sent
ou 1 iIi anger...·
.
,her sexually suggestive Valen
F~r clai",s of self-defense to be
tines.
The jury was able to hear Ihese
Conllnlled on Pose D20. Column J
chilling, stories because 01 a new
�THE NEW YOki{ T!'\1ES
LAW
FRIDAY, FEBRUARY 14, J992
When Child Kills Parent: for So~e, Self-Defense
Continued From Page AJ
upheld in slayings, the law has .
generally required a reasonable fear .
01 imminent deadly harm. CO)Jrts and.
juries have lound that element lac~·
ing in the killing ot husbands or par
ents, tor battered women and chil- .
dren ollen ambush their targets or
kill them while thev are asleep. The
Texas law allows "them to' use evi
dence of past abuse to p~ove that
thetr fears were subjectively reason·
ablfarlier th is month. in whai was the
tirs! such appellate ruling inthe coun
try. a court in Washington State over
turned the murder conviction of a 16
year-old boy sentenced 10 10 years in
prison lor killing his stepf'lther spe
cifically because the jury had not
been instructed about the "baltered
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child syndrome."
.. Neither' law nor logic suggests
any reason to limit 10 women recogni
tion of the impact a battering rela
tionship may have on the victim's
actions or perceptions," the court
held.
Mr. Mones, 39 kears old. author of
flWhen a thllllllls; Abused Chil
dren Who Kill Their Parents" (Pock·
et Books 1991), said: "Basically chil·
dren have been playing catch·up lor
decades in every area of the law,
including their right to defend .them
selves. We are now seeing the mClpl
ent stages.ol a movement, one that
recognizes an abused child's right to
act in sell~efense, Just as battered
women do..
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But the movement, he said, is inter
mittent. On Tuesday, a trial court in
Wisconsin sentenced a 15-year-old
boy to 20 years in prison for killing his
mother in a situation in which the
lacts resembled those 01 the Wash
mgton caSe.
As the plays of SophOCles and
Shakespeare attest, the crime Of. kill
ing one's parents IS as old as CIVIliza
tion itself, and as heinous as any aCt
can be: The prosecutor in America'S
most famous parental killing case.
the 1892 prosecution of Lizzie Borden,
told the court that "parricide" was
"the most horrible word that the Eng
lish language knows." i
"Children have been playing catch~~p for decades in every area of the' law, including their right to defend
themselves," said Paul A. Mones, whose clientele consists exclusively of children who kill their parents.
a teen-age boy who shot his tather. In
1986, he began a private practice de-.
VOted exclusively to juvenile issues.
Mr. Mones's lee, which was paid by
the lamily, was very reasonable, Mr,
Johnson said.
In a recent interview in Mr. John
son's law office in 'Tyler, Mr. Mones
said said that, effective defenses in
parricide cases consist largely of as-·
sembling posthumous prosecutions
against the victims. While the typical
, prosecutor has whatever he needs to iiatlng. ,
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convict, he said, the typical defendant
Rummaging through closets and
"doesn't have any sound recordings drawers. in the Wisener home, Mr,
of the scream or videotapes of the Mones looked for and found the kind
molestation."
of items other investigators might
It is, Mr, Mones maintains, a deli· have overlOOked: the handcuffs. the
cate and often tedious task: pori~g lewd Valentine .(" I would like. your
over. children's medical files, inter- . heart' and I assume the rest of you
viewing Iriends and ridatives, review· williollow") and the oak logs that Mr..
Ing school attendance records for air Johnson dropped on the floor in front,'
senses that CQuid correspond to peri· of the jury during his final argument.
ods of parental aQuse. In 90f 10 cases.
In the courtroom, Mr. Mones sat at
plea bargains are eventually struck, counsel table, feeding Mr. Johnson a
with Mr. Mones often doing ~h~ nego- ste~dy supJ?ly 01 questions, all wrmen
Sons Killing Fathers
According to the Federal Bureau of
Investigation figures, there are about
300 parricide cases a year. The case
load of Mr. Mones reflects the nation
al breakdown: more than three-quar·
ters of his clients are ·sons who kill
their fathers.
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Apart from her sex.' Miss Wisener
was in many ways the typical de
fendant in a parricide case; a white,
middle-class teen-ager of above aver
age imelligence, with no prior crimi
nal record.
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Like most perpetrators of parri
cide, she shot far more than she had
to' the first of her six bullets would
probably have sulficed. "I freaked
and began to shoot," she declared in a
signed statement. "He wasn't fallIng
so I emptied the cylinder."
A few moments later, a policeman
asked her what had happened. "Isn't
it obvious?" she replied. holding' up
her gunpowder·stain~d hands.
. It was an argument over the girl's
. job, some car keys and her boyfriend
.' that culminated in the killing of Mr.
Wisener in the kitchen of the family's
home on County Road 3147. When she
removed the gun from her father'S
nightstand, she testified at her trial, II
was with the idea 01 shooting herself;
only when he "had his hands out and
looked like he was going to choke me"
did she take aim at him. Miss Wi·
sener said.
Mr. Mones. a graduate of the State
University of New .York at Buffalo
and the Universitv 01 North Carolina
Law School, bega!" ~epresenting chil·
. dren in the late 19;0'5. 3S a staff
lawyer for West Virginia Legal Serv,
ices. It was as director of a juvenile
program In Morgantown, W.Va., that
he handled his first' arriCide case; 01
Chilling details of
how a father
terrorized his
family.
on lrayed tragments 01 yellow legal
paper. "The horror lies in the de
tails," he saId.
Mr. Johnson said at Mr. Mones: "I
think he made a key difference. we
could have put on testimony all day
about what things went on. But it's
one thing to talk about It, another to
see it, and he helped us present the
visual side 01 things."
By the time (he courts become in
volved, Mr. Mones s'aid, it is almost
inevitably too late. That is .why, he
said. a visit to the local sateway or
A.& P. IS' for him not an ordinary
experience. "I see a mother hitting a
kid in a supermarket, and I say some
thing," he said.
"In all 01 these cases, the greatest
tragedy for me is ·that people know
that children are being abused," he
said.., It becomes a Kitty Genovese
story, played out over and over and
over again in a much more silent and
insidious way. All over the country.
Every day:'
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Goals a~d Obie~tives of the Initiative
:The overarchinggoal of the "Community Partnerships" initiative is to enhance the ability of-·
indiviqual communities to keep children safe from abuse and neglect. This is admittedly a tall order:
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with high rates of maltreatment are the same communities struggling to combat extreme
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poverty, teen pregnancy, violence, high rates of unemployment, and a host of.other socioeconomic and
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environmental stresses that consistently correlate with widespread incidence of abuse and neglect. We are
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well aw,are that communities will need to address these underlying problems and to consider how decisions
in welf~re reform, for'example, will affect their capacity to help keep children safe. These larger concerns
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'cannot,however, become the focus of our program strategy. ,Once again, we believe that despite the many
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challen'ges to poor families and to the systems designed to serve them, there is now more than ever an
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impetu~ to reexamine how CPS conducts its business. In fact, because reformi~g the child protection system
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is suc~ a potentially daunting task in and of itself, we have narrowed the ~cope of the Community
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Partnerships initiative by defining a set of objectives critical to realizing that longer-term goal.
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: In the remainder ofthe paper, we will set out the three objectives we have selected and then delineat~
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a four~part grantmaking strategy intended to address both the goal and the objectives. At the end of the '
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paper. ~e define three essential outcomes that sites must pursue to achiev~ the initiative's goal, and conclude
by setling forth an evaluation plan for our sites and for the Community Partnerships initiative.
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The three objectives are: (I) assuring that children who come to the attention of the public CPS
agenc~ are safe and free from the recurrence of abuse and neglect; (2) providing adiffe'rentiated response
,to the:r;nge of cases reported to CPS: and (3) diverting families from CPS by reaching at-risk families
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earlier, through community-b~sed networks of formal and informal supports. While not a separate objective,
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we believe that for sites to be successful in meeting these objectives, they will need to "nest" their efforts
secur~ly in a broad community commitment to the safety and well-being of children and families.
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Strategies to Achieve the Goal
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We propose a four-part program strategy to address the overarching goal and the three
main;..~
objectives. We believe this strategy will capitalize on ongoing state and local efforts to reform child
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protection, permit us to work with these pioneering jurisdictions to implement sound approaches for
iniprovi~g community child-pro~ection capacity, and help to generate both. public support for and public
understanding of such reform across the country. The strategy includes: (I) supporting sites to plan for and
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implem~nt community systems for protecting children; (2) offering technical assistance to sites and the child
protecti?n field to advance neighborhood-based approilches to child protection; (3) ~eveloping, over time,
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an extended network ofjurisdictions pursuing child protection reform; and (4)further building and clarifying
a nationial consensus on the need for the proposed reform.
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,Support for Sites
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;a) Planning Grants:
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In order to test the proposed new approach to protecting. children, the
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Children's Program will commit significant resources over the next four years to support the work of four
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to five isites in developing community systems of child protection. To 9ate, the Children's Program has
recomrrtended support for four sites to receive planning grants. In September 1995, the Trustees approved
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grants to the Jacksonville Children's Commission and the State oflowa Department of Human Services,
making Jacksonville and Cedar Rapids the first two sites for the Community Partnerships initiative. In
December 1995, with Trustee approval of grants to the Jefferson County Public Schools and the Sigel
CommunityEducation Center. Inc., Jefferson County/Louisville and St Louis also became funded sites. The
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first two sites were funded for I"S-month planning periods, and the latter two for 12-month periods. We
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continiJe to look for a fifth site to partiCipate in the initiative.
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implemerltation·. For example, some sites have community collaboratives well-position~d to serve as
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governance bodies to oversee reform, yetthe collaboratives were originally formed to address issues apart -.
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from child maltreatment and must therefore undergo some potentially complex adaptation. In other sites, .
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reform has been driven almost exClusiveIX,.,by·the CPS agency and related legislation, and must therefore
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radiate o~tward to the community. Two siies have school-based delivery systems that were designed to
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address schooling success, and will now need to focus more sharply on one particular element necessary to
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that end: ihe protection of children from abuse and neglect. (Key cnara?teristics of each site are highlighted
. in Appendix A.)
the planning grants awarded to sites are funding"a co~e set of activities. First,- each site is
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establishing. a project steering committee that expands upon the working group that first obtained
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'commitments from community partners and prepared the proposal for Foundation support. The steering
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, committb~ will include the bro~der representation critic~1 t()having'the community ",invest" in reform - and," .
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eventual)y, to assu~e "ownership" of both the change process and the goal
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of improved child safety.
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with re~res~ntatives from the state and local child welfare agencies, other public agencies likely to. be
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represerited o'n site steering committees include schools, I~\V enforcement, 'health and mental health bodies,
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andjuv~nile and family courts. Private sector representation might include nonprofit providers, community
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based organizations, volunteer groups, retigiousinstitutions, the business community, civic leaders, parents,
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commuhity youth, and other interested " .
citizens.
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f Early
in the planning period, each site will begin work on a strategic plan or "strategy map" that
retlects:the state ofits child welfare/protection systems, its vision for a reformed system, the outcomes for
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children and families that the site hopes to a~hfeve, and specific steps forrealizing those outcome~. This map
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will be tevised throughoutthe planning year and by October, 1996, wiJlhave been translated into a written
strateg~c
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plan that will guide the site's next three years of implementation (see below). We have given sites
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'a sugg sted framework for this strategy map that sh6uldserve as an important preparatory tool and help them
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avoid a ,?ours.e of piecemeal changes in policy and practice. The framework pushes sites to consider the
linkages;among . program and service reforms, fiscal strategies, and projected outcomes for children and - ..
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families. Additional planning activities intended to enable sites to complete their strategic plans include,
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devising;: a financing strategy for ·reform and enhancing site data collection and analysis capacity.,
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IWhen
site leadership ~ndthebroadercom~unityhave a draft plan, each steering committee will
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take a "user':friendiy" version back out into the 'community for additional input. In this way, each site can'
verify it~ plan as an expression of community interests and can use i.15 development as a public "e~nrollment'"
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process. I Sites will submit their written plans to the Foundation at the end of the planning grant period. They
wi II then be used by the, Chi Idren' s Program to decide ·whether -to recommend implementation grants ·to the
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, !b) Testing New Practices During the Planning Period: In recognition ofthe fact that three ofour
, four sitbs were already implementing CPS reform' iegislation when .plamlirig grants were awarded (and to
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demons~rate to cQmmunities that this initiative is about action, not just planning),
each site will go beyo'nd
'its planbing activities to implement at least one specific pro~rammatic effort Intended to move the ·site closer·
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to achi~ving one or more of th~ three o~jectives o~ the initiative. Some' of the proposed strategies inClude:
Ellsuril~gfuture'safeiy following CPS involvement:
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; Using "wraparou.nd"services to provide ongoing monitoring of families where maltreatment has
: taken place, including the use of protective day care (Cedar Rapids);
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: Deploying CPS staff into the community so they can identify neighbors and other informal supports
; to serve as a "safety ,net" should familiesrelapse and require a prompt safety response, including
i remova.l ofa.child (all sites); al)d
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i Targeting children under theage of five (who constitute 88 percent ofall children w,ho die from
! maltreatment) by assigning' a clinical specialist to oversee eac~ open CPS case involving a child in
: that age group (Jefferson County/Louisville):
, Proviliing a differentiated response to abuse/neglect reports:
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, Enabling CPS to abbreviate i~s involvement with lower.;.risk families by having the family, CPS, and
a third person (neighbor, extended family' member, teacher) enter into a "community support
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~greement" that specifies the assistance or oversight the third party agrees to provide '(such as child
, bare or home visits), thereby allowing CPS to Close the case (Jacksonville);
<:::onducting an assessment of all families reported to CPS that examines child safety and'identifies
~oth fam ily needs and potential resources to me,et those needs before deciding whether the most
i'appropriate" CPS response would be law enforcement or court involvement, intensive family
preservation services, referral, to community-based programs,or no furth~r action (Cedar Rapids,
1acksonvi lie);and
Partnering CPS and neighborhood-based agencies that work with families (child care centers,
:domestic violence services, schools, health care providers) to conduct jointassessmentsofthose
:families when they are reported to CPS (St. Louis)~
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Preve~ting
unnecessary CPS involvement:
:Transferring calls that are "screened out" (not accepted for investigation by the state hotline) to it
!private, local 24-hour resource and referral agency that will link families to supports and services
lin their neighborhoods in an effort to avert subsequent reports to CPS (JackSonville);
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: Hiring family s~pport workers and stationing them at family resource 'or school-linked' service'
i'centers (\) to conduct extensive outreach in target neighborhoods informing at-risk families about' ,
: available resources in the community; arid (2) to recruit and train mentor families from the target
: neighborhoods to identify others needing assis,tance and li~k them to appropriate supports (Cedar
; Rapids, St. Louis); ,
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; Teaming CPS staff based at neighborhood service delivery centers with school personnel to jointly
: respond to cases of "educational neglect" (elementary age children with significant absenteeism),
; instead Of having those cases be reported to CPS for formal, investigation (Jefferson
; County/Louisville); and
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: Establishing a "Community Innovation Fund" to provide seed money to neighborhood associations,
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! churches, and other gf(;>Ups from the cOl11l11unity to nurture and' encourage grassroots efforts to
! support families (St. Louis).
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! c) lmplen;entation Grants: Provided si~e plans refle'ct so~mdstr~tegies for 'realizing all three main
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objectives of the initiative, and assuming sites effectively use the technical assistance available to them
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during I the planning grant period, we expect to rec~mmend implementation giants to all of the sites for three
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additi?nal years. The implementation grants, which should come before the Trustees in December 1996,
would1enable sites to operationalize innovative strategies - as well as pilofprograms ~ identified
o~tested
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during the planning year. While each site·wiil undoubtedly pursue a distinctive strategy and establish a
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distinctive partnership to achieve its outcomes, implementation 'should provide the field with a number of
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solid str~tegies for moving toward community systems of child protection. At the end of the. four-year.
funding period for sites (planning and implementation), and at interim points along the way, we will evaluate -.
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each
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sit~'s progress toward outcomes. Because of'the breadth and complexity of the systems reform work
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involved, taking stock after four years should help us to make a' cogent argument for one of two· possible,
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courses bf action.
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First, we might narrow the fairly broad agenda of the current strategy and make it more responsive
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to the p,?Ji.ticaJ climate and the corresponding needs ofjurisdictions. We might decide, for example, that we
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need to 60ncentrate exclusively on helping communities establish an "early intervention" capacity to d~vert
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at-risk families. New sites could be selected to participate in this "second phase," or current sites might
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receive tontinued support with a sharper focus .. As a second, alternative course, ~e might add sites . to the
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initiative as originally structured and fund a larger group to plan for and implement community child
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protectlpn systems.
:d) Companion GranlsforStalewide.RejormEfforts:: R~cpgnizing the benefit of working with sites
iri states that have passed legislation calling for local-level CPS reform, we will continue to recommend
small grants to states with sel~cted sites if ~tatewide refo~ (evidenced, e.g., by CPS legislation) is under.
way.
T~'date,
Iowa, Florida, and Missouri have received such "companion grants."
~his
modest support to
these st~tes (and, potentially, to the ,sta.te in which a fifth site will be located) will again be made available
I
. in fisc~1 years 1997, 1998, arid 1999..
.! The purpose of the grants is four-fol,d. First; the state receives direct support to further its reform
initiati~e; for example, in Iowa funds were used to develop training materials to help mandated reporters
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understand.the new "assessment approach." Second"the grants help to ensure that the strategic lessons of
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our sit,es' efforts inform the work of other lo~alities within states implementing reform legislation and
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movin~ toward neighborhood-based child protection. Third, the grants will enable our sites to benefit from'
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the innovations that emerge from the reform efforts of those localities. And fourth, the grants serve to keep
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the state i~volved as an active pamier in site refoim efforts.
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2.
Technical Assistance to Sites and Others Engaged in Child Protection Reform
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The work that sites have embarked on as part of the Community Partnerships initiative is both
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groundbreaking and complex. Unlike our work in family preservation, we. are not .urging adoption of a
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singular ~'ervice model that represents "best practice" in child protection. While the absence of a clear model
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may heighten the challenge of measuring success, on the positive side, the "door" to innovative thinking
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about neyv approaches to protecting children stands invitingly open. For this reason, sites participating in
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the initiative will likely benefit from significant technical assistance - and themselves participate in
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.developi,ng new technologies - in order to institute
thema~or
changes in policy and practice called for by
the anticipated reform. In short, we expect to expend a large portion of the Children's Program's annual
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budget for coordinating technical assistance activities, and for individual technical assistance grants.
,~)
. Mechanisms for Providing Technical Assistance: The Center for the Studyof Social Policy will
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coordinate all technical assistance related to the initiative. Lead technical assistance coordinators are
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assignec;i to each site to supervise the site's progress throughout the term of the initiative. Each coordinator
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works closely with the various "players" involved at the site level, and also acts as a liaison among the site,
individual grantees providing technical assistance to the site, and the Children's Program.
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b) Areas ofTechnical Assistance: From the diverse needs identified by our sites; we have developed
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six ke)' areas of technical. assistance. These areas were .establ ished (I) to ensure that sites are not
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overwhelmed by the many technical assistance providers working on separate components of the initiative;
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. and (2) to help grantees working in one area to coordinate their efforts within sites so that changes are not
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implemented in a "vacuum." For each area, one or two individuals connected closely with the initiative have
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been qesignated as coordinators. These coordinators are responsible for keeping abreast of innovations,
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research, and other developments within child protection and related fields that could inform the work of
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sites and the initiative .. The six areas (and their coordinators) are:
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Strategy and Accountability (Frank Farrow, Cent~r for the Study of Social Policy and Dr.
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Patricia Sfhene, University ofColorado)
Tdchnical assistance will include helping each site develop its strategic plan to guide reform efforts
. I
through the ptanning and implementation periods. Sites will be pushed to consider the relationship between
specific reform strategies and the outcomes desired for children and families. Dr. Piltricia Schene will help
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each site to identify desired outcomes ~s well as develop site-specific benchmarks to measure progress. A
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grant to the University of North Carolina will enable Dr. Lynn Usher and Dr. Raymond Kirk to help sites
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enhance data collection and analysis so they can become self-evaluating with respect to implementation.
Addition~1 technical assistance will likely be needed to help sites measure the effect of using informal
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*5 p'art oftheir community systems.
supports
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Firontline Practice (Charles Bruner, Child and Family Policy Center)
2..
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A new approach to protecting chi,ldren will redefine the way frontline stafffrom public and private
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agencies ~work with fami! ies, with one another, and with the many "natural helpers" that are integral to
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improving the community's ability to keep more children safe. T~chnicalassistance will be needed to revise
recruitmJnt and training practices in order to improve workers' decisionmaking skills~ to find new methods'
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of involv,ing families in decisionmaking processes; to help public agency workers move from an emphasis
on ihves~igating reports of abuse to assessing child safety, family needs, and family resources; and 'to assist
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professi1nals and informal helpers in collaborating on behalf of families at risk of abuse and neglect' Sites
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wi II also' need help in training CPS staff to improve their responses to serious cases requiring the expeditious
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removaliof a child or, perhaps, the involvement of law enforcement. Grantees include the American Humane
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Associa~ion
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(AHA), which is studying innovative practice methods (such as the Patch approach described
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in Appebdix A, and New Zealand's Family Group Conference) that CPS agencies might use as they move
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toward a family-centered; neighborhood..,based approach, and the Child Welfare League ofAmerica, which
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.is ,defining ,an assessment methodology that looks beyond "risk assessment" and addresses the service needs -.
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of familid within a community system of child protection.
3.
Community Engagement and Governance (Frank Farrow and Phyllis Brunson, Center for the
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Study of Social Policy)
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Many neighborhoods targeted by sites not only have high rates ofmaltreatmerit, but are also battling
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poverty, erime, substance abuse, and other social ,ills. With federal budget cuts further reducing funds
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10 families in, need, sites are struggling wi~h the question of how to make child protection a priority
available
for these neighborhoods. 'But these communities also possess great strengths, including both established
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structures
networks of support
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"tap into~' in order to better protect children. Strategies will be needed to help sites engage individual
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neighbor,hood residents -from block leaders and tenant organizers to teachers, ministers and parents - to
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,playa rdl,ein child safety, as well as t6gain the commitmen~of the broader community for reform. In order
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to ensure;that s'ites are aware of the, range of informal supports in th~ir communities,and that the supports
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are nurtured so that they can take on a greater role in child safety and well-being, sites will be helped to
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engage i,'n community outreach, asset mapping, ;anej community planning and development to strengthen
existing ,~mdfledglingsupport st~ctures within' the. target neighb~rhoods. (Some sites have aiready started
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this effort: Jacksonville, for example, recently identified and surveyed all houses of worship located in the,
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target n61ghborhoods regarding formal and informal supports available through each.) As public and private
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agencies and community memb~rs become partners in keeping children safe, sites will also need to grapple
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with the enormously complex question of who should - and is willing to - assume decisionmaking authority,
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, respon~ibility,
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and perhaps even legalliabilityfor the protection ofchildren. The Center for the Study of
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Social :Policy will ta.ke the lead on these govemanceand decisionmakingissues, helping,sites create
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structure~
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not only to manage this initiative but, eventually, to assume greater accountability for child and
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family 04tcomes.
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Financing (Norm Zimlich, Center for the Study of Social Policy)
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Since federal fU'nding for an
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a~ay ofhuman services programs (including child welfare and child
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protection) is likely to be reduced, sites will need to be proactive in their financing strategies if they are to
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successf\illy introduce reform in a block grant environment The Center will help sites examine public sector
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spending for child protection, forecast future spending, and garner resources for the Community P,artnerships.,
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, initiativ6. Possible strategies include redeployment of,funds and
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hu~anTesources from
the existing CpS
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system, refinancing, and revenue raising and maximization. The Center will also work with sites to analyze
private sector funding structures, the relationship betWeen ,implementing community child protection and
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managep care programs in child welfare, and the linkage between fiscal strategies and
desir~dolJtcomes.
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A grant:to the University of Chicago's Chapin Hall Center for Children will assist states and localities to
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implem:ent sound managed care programs in their child welfare systems.
Poli~y
5.
and Administration (Michael Weber, National Committee to Prevent Child Abuse)
As sites put.in place community-based systems, they will confront complex legal, administrative,
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and policy issues. For example~ one of oiJr objectives is to ensure that CPS provides a differentiated response
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to rep~rts of abuse and neglect. What are 'the implications of this proposed reform for the CPS agency?
Along;with reCJuiringchanges in agency policy, will'the site need to work with the state toward statutory
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chang~ (e.g.;
legislation
aut~orizing "dual-track"
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or "assessment" approaches)1 Technical assistance to sites
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by thel Youth Law Center will address,11.host of legal issues raised by public/private partnering in the
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protection of children, including the thQmy question of whether private sector partners assuming some
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respo~sibility for chiid protection simultaneously assume legal liability for the children and families with
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whom/they are involved. The Youth LawCenter will also analyze existing confidentiality laws, and promote
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inforn}ation-shating about CPS families among the public agency. and neighborhood-baSed service providers.
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C~mmunications (Joanne Edgar, Office of Communications)
6.
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The ultimate success ofour strategy will rest on engaging communities from the outset in the reform- .
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effort Only through such engagement will sites be able to build public will and public demand for a new
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approach ito protecting children. This public will is key to "protecting" the reform in the face of a highlyi
publicize~
case (cases which are generally atypical of CPS' primary case load), and public child welfare
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leaders ~ill need assistance to help them talk about such cases within the confines of current confidentiality
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laws. B~lding public will necessitates communicating a clear message regarding (i) why reform of CPS
is needed; and (2) what the site's specific strategies will be to keep children safe in . the. new community
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system. Technical assistance will therefore include, but go beyond, helping sites to work with and talk to
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local and national media. Sites will learn to "market" the reform to a wide audience, including"persons
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involveq in the CPS system (mandatory reporters, frontline workers, families), key participants in the
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neighborhood-based system (religious organizations, local service providers, parent support groups), local
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policymFkers, the media, and the general public. We expect to recommend support for one or more grantees
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to coordinate this technical assistance.
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3.
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iDeveloping an Extended Network of Jurisdictions Pursuing Child Protection Reform
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!Our past. two years' inquiry into promising child p~otection projects introduced us to several states
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and lo~alities engaged in innovative reform. Because some were working on more selective aspects of
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reform ~ such as moving the CPS agency to a more family-centered model of practice, or coordinating the.
role of 'CPS and law enforcement - they did not meet our criteria for participation in the initiative as funded
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sites. Nonetheless, we believe maintaining an ongoing, flexible relationship with these and other reform
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minde? sites presents opportunities on at least two fronts. First, because there are no prototypes for a new
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approJch to protecting children, the" expertise these states and localities have gained in specific areas of
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teforni could fill in the gaps as to policy and programmatic changes needed in our funded sites. Second,
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giving the~e jurisd,ictions "reports" on the funded sites can create a larger-scale momentum toward
community systems.
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To capitalize on these op~ortunities, we plan over the n:xt year to develop an "extended network"
of states, dounties, cities, and communities interested in 'crafting
community-bas~d systems and sharing·
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informatio,n about reform. Since many
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s~ates
and localities have responded to the call for child protection
.
reform by ~ontemplating neighborhood-based services, and since they are likely to be granted greater latitude
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in their sarvice approaches under federal block grants, networking will be an important resource for
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clarifyingtand realizing their visions of community-based child protection .
. !
aj Sharing Information'and Expertise Across Jurisdictions: While we do not intend to establish a
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formal n~twork at this early stage, there are a number of jurisdictions already connected to our initiati~e
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through project grants (discussed below) that would benefit from learning aboutthe work of our sites, and'
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from
sha~ing
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information with their peers in reform. For the present, jurisdi~tions in this emerging network
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will (I) c9mpare notes on reform efforts; (2) learn about the activities of the funded sites and other stales and
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localities involved in initiative projects; and (3) receive assistance from national experts working on
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Commuriity Partnerships to advance their efforts. Some of the mechanisms will include:
!
Distribution of Written Materials: All interested jurisdictions (regardless of their relation to the
~ommunity Partnerships effort) will receive the initiative newsletter, SafeKeepinfj. The newsletter
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~ill highlight reform efforts of our sites and report on innovations in child protection practice, as
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;well as on pertinent policy developments at .the federal and. levels. The first issue was
state
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Idistributed to approximately 400 organizations and individuals across the country in March] 996.
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:A smaller number of jurisdictions will receive' other documents emerging from the initiative,
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pLiblications produced by the Office of Communications and practice guides produced by
technical assistance grantees,
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. Cbnference Calls and Meetings. Conference calls and/or teleconferences will be planned around
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such issues as developing confidentiality policies that would support data-sharing among public and -.
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p~ivate agencies within a community child protection.. system. A subset of jurisdictions will be
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i~vited
to participate in one or two meetings each year focusing on a topic of common interest. The
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first meeting is tentatively scheduled to take place in November 1996. These meetings will enable
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u~ to learn more about the jurisdictions, their leadership, and their performance', and help us to select
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a l smaller group to participate in a formal extended network should we determine that such a
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~echanismwould further our goals.
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technical Assistance and Training. We expect that a few jurisdictions beyond our sites will be
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i~vited
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to take advantage oftechnical assistance provided by Children's Program grantees in order
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to broaden the geographical scope of the .reform. For example, while AHA will prepare training
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. rraterials to allow sites to implement programs such as the Patch approach and New Zealand's
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F;amily Group Conference (as noted earlier), AHA will also be available to work with other localities
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i,nterested in testing these practice methods. We also expect to invite somejurisdictions to attend
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~raining
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seminars arranged for the sites.
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p) Possible Small Grants: We will consider recommending small grants to certain jurisdictions (up
to 8) pu~suing innovations beneficial both to their own reform efforts and to our sites. These grants would
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support ~iscrete projects intended to fill a void in our current understanding or practice methodology. The
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Center for the Study of Social Policy will serve as the institutional "hub" for coordination of networking
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activities and development of an extended network. Center staff will work .in conjunction with Michael
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Weber.jformerly of the Chapin Hall Center for Children and currently Associate Director of the National
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Committee to Prevent Child Abuse .
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. Building a National Consensus
.4.
Sharing information among jurisdictions engaged in child protection reform is one imp~rtant step~.
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toward e~suring that design and iniplementation of a new approach is not confined to our funded sites, but
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is consid¢red, tested and refined in other localities across the country. At the same time, our work in family
preserv+on and in systems reform has taught us that itis imperative to generate support for new policies
and pro~rammatic initiatives outside of individual states and localities mounting reform efforts. This will
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be instriunental in an approach to protecting children that requires the involvement not only of the many
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"players" in the present CPS system, but ofa host of new partners equally committed to assuming a role in
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····child s~fety.
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To assure tha,t the new approach incorporates the critical thinking and experiences of
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legislatbrs, judges, child advocates, police, prosecutors, court-appointed special advocates, parents, and
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foster p~rents, resources must also be targeted at the national level, with the related goal of building support
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. among fhese group's for the approach that they help to refine. By engaging these constitUencies in supporting
and co~ceptuaJizing community~based systems, we would also hope to se~ them "buy into" operationalizing
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more rbponsive, responsible, and humane approaches to protecting children from abuse and n~glect.
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lOur initial grantmaking efforts inthis direction focused on 1:wo major players - family court judges
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and st~te legislators. The National Council of Juvenile and Family Court Judges' "diversion" project
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. provid:es for establis.hment of four model courts whose procedures will enable certain CPS cases to be
referrJd to neighborhood-based services and supports: We determined that one model court should be
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locate~ in one of our sites and ~elecied Louisville to benefit from Judge Richard FitzGerald's leadership; the
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other three model-court sites are: Cincinnati, Ohio; San Jose, California; and, Honolulu, Hawaii. This project
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will
r~ach
judges beyond the four sites by
dissemi~ating
.
a guide describing each participating court's
diver~ionefforts. Similarly, a grant to the National Conference of State Legislatures is supporting education
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and epgagement of a core group of state legislators interested in child protection reform. The grant will also
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be used t~
introduce community-based approaches to protecting children to the larger audience of state
legislator~ through national meetings and publications.
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Grants intended to continue this constituency-building process at the national level were awarded
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in March :1996 to the National Association of State-Based Child Advocacy Organizations (NACA) and the
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National Committee to PreventChild Abuse, and will allow for .infonnation-sharing about child protection
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refonn arhong these strong national advocacy organizations and their state-based members. These grants
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are espedally timely, given the decisionmaking authority likely to be devolved to states with the possible
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passage df child welfare block grant legislation, which will make the role of advocates at the state and local
'levels evbn more critical to advancing a refonn agenda.
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Other key organizations, such as the Child Welfare League of America, are already working with
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the Chil4ren's Program on select components of the strategy, and we expect to partner with a number of
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other nat:ional-level groups over the coming years to continue the process of building consensus for new
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approac~es to protecting children.
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Outcom~s for and Evaluation of Sites
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In order to gauge progress toward realizing the three major objectives of the initiative, each site will
need a set of measurable outcomes that can demonstrate advances for children and families as a result of site
refonn efforts. While each site will, with community participation, define other desired outcomes related to
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the safetY and wel1~being of its children and families, three essential outcomes must be pursued if sites are
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to achieye the overall. goal of the initiative: enhancing the ability of individual communities to protect
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1. Children in the neighborhoods targeted by this initiative will be less likely to be abused or
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neglecte!d.
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2. Cbihlren wbo come to the attention of CPS will be less likely to be re-abused or neglected.
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3. Tbe r~te ofserious injury to children due to abuse'or neglect will decrease.
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Brcause sites will set different performance t~gets, and because they have such differing capacities -,
to measur~ change (which will require the use of distinct indicators in each site), they will need to develop
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site-specific benchmarks to determine progress toward achieving these outcomes and to enable them to
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report back to the Foundation throughout the initiative.
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a) Development of Interim Benchmarks: Child welfare information systems have historically
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contained Jimited data regarding families involved with CPS, and most public agencies lack the capacity to
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track the lexperiences of children and fami] ies from a report of abuse or neglect thr~ugh provision of services.
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In order for our sites to determine whether their strategies are leading to realization of the outcomes outlined
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t~ey will need to develop a baseline with respect to how the current child protection system is
above,
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functioning before they can set appropriate interim benchmarks to measure progress over the next four years,
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Once this baseline is established, sites will then have to determine what sources of information can be
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, utilized to track progress toward the initiative's three outcomes. Because there is a limit to the "hard" data
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availablr to sites, some of the processes and information sources that may be used include tracking cohorts
of families that live in target neighborhoods and come to the community-based system's attention,
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condudi'ng focus groups to determine how families' experiences with the system change in relation to how
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the syst~m itself changes (e.g., by moving from investigation to assessment), and utilizing "proxy" indicators
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that would reflect changes in risk factors associated with abuse and neglect, such as numbers of '
families
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enrolle,~
in Head Start programs or receiving home visits by local public health nurses following the birth
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Working with Dr. LynnUsher and Dr. Raymond Kirk of the University of North Carolina, sites will
devel~p
their b!lselines, select interim benchmarks and begin to identify specific processes that can be used
,
to
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me~sure
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progress toward the three outcomes by Septem ber '1996.'
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j
. b.I Evaluation: As discussed above, the evaluation plan for the initiative includes both assisting sites
.
I
I
to fashion' outcomes and benchmarks closely tied to site strategies for achieving the three major objectives- .
I
. '.,
of the init,iative, and helping sites to conduct ongoing self-evaluation of their child protection systems. While
I
•
self-eval6ation is particularly valuable in enabling sites to make any necessary "mid-course" corrections
I
.•...,
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.
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I
during the term of the initiative, readying sites to become self-evaluating also entails ensuring that data can
I
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.
be gener4ted for sites to measure selected outcomes~ While Drs. Usher and Kirk will continue working with'
I
'
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sites to eJmance data collection and analysis capacities so ~at they might become capable of self-evaluation
I
...
.'
,
in the future, as noted above, there may be limitations as to what they can achieve to help sites measure
,
I '
.
certain aspects of reform .. While this is due in part to the fact that existing data on children and families in
!
.
. '
I
the CPS (system are so sparse, it is also a result of the nature of the proposed reform. For example, how will
,
,
.
sites mekure an increase in the use of informal supports such as neighbors or extended family? Will sites
I
.
be able to establish causal c'onnections betWeen the use of such supports and statistics related to reporting
I ,
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or substknti~tion rates?
,
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!We continue to believe that self-evaluation will be extremely valuable for assessing the impact of
I
.
site ref~'rm efforts (rather than relying on '''afte~ the fact" evaluation by an outsider). At the same time, we
recogni:ze the challenge inherent in attempting to evaluate a community'system that involves a host of
I
playersioutside offormal CPS, and understand the significance of the fact that some necessary "hard" data
I
.
may n9t exist and may be too costly to develop over the four-year term of the initiative. As a result, we are
I
also co:nsidering (as part of our further development of an evaluation approach) other mechanisms to allow
I
sites .J and the Childrel1's Program- to evaluate those reform efforts. This would help to .ensure that
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regard:less of how successful sites' are in 'achieving the outcomes established for the initiative, the many
i
essential lessons that emerge from site reform processes over the next four years will be. captured and
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.
recorged so that they may be shared with a broader audience.
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To this' . we plan 'to implement a documentation project'. would enable us to conduct 'more
end,
that
a
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,
"qualitati1e" evaluation of sites' reform achievements. Some methods for compiling information have been-'
built into the structure ofthe initiative, such as regular publication of the initiative's newsletter, SafeKeepinfj,
I
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•
i
quarterly!reporting by site teams, and' monthly reporting to the Children's Program by each of the lead
! .
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technical'assistance coordinators working with the sites. Other activities that we are exploring that could
.
I
I
potentially be used to capture the change process include: (1) commissioning case studies of each site and
J
updati~g !them
at six-month intervals to reflect evolution in site .reform processes; (2) conducting case
I
.
reviews ~ffamilies ,that were reported to CPS or served in the community and tracking those cases over the
J
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course o~the initiative; (3) interviewing site "leaders" (from public agency commissioners to block captains)
.
i '
,
.
i
throughqut the reform process to avoid "hindsight" reflections on the change process; and (4) using
i
. ethnogrJphic case studies to document the
experi~nces of families in sites' community systems of child
I
protecti<?n.
I
I
Outcorries for the Community Partnerships Initiative
I
. !While we recognize the importanceof ensuring at the outset that site efforts ~an be evaluated, we
At the end of the four years, how will we determine
will also need a plan to assess the profjram 's success.
I
whether our work with and investment in these sites helped them. to realize reform of their systems? Will
I
.
we knqw what aspects of the strategy were successful, or what we should have done differently over the
i
c9urse!ofthe initiative? Can'~e determine whether we made
acontribution outside of our sites, to the
I
broade,~ child protection and child welfare fields?
.: When we presented the Trustees with "benchmarks" we hoped to meet overthe next ten (rather than
L
.. ' .
"
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.
four) rears ~n our September 1994 program statement, we were still in the conceptual phase of strategy
*'
... '
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devel$pment. .Our experience over the past 18 months has led us to rethink those long-term benchmarks.
I
We hrtve already met a number of the interim indicators - such as selecting sites that wi'lfstudy and redefine
!
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'
. the public FPS agency's role - but our emphasis in evaluating the overall success of the program has shifted .
,
.
Rather tha'n simply measuring whether the proportion of substantiated cases rises in a site, or establishing -.
I
.
that CPS ~as developed protocols to work with community-b~sed partners, we need to ask a number of
,
broad~r q~estions about what we are aiming at, observing and
learning fro~ our efforts, and employing in'
I
the way of thresholds of site productivity and Program perfonnance: .
I
. ,
1.
.
6id Foundation-funded sites make measurable progress toward meetirig the outcomes delineated
i
I
I.
above?
i
I
'Yhat are the components of an effective community "system of child protection? Were
2.
t~ese
componehts present in ou~ sites at the end of the four-year period?
i
did the communitysyste~ of child protection divert families from fonnal CPS? Did it help those
3.
I
. . . . . ..
.
families learn to keep their children safe? What were the mechanisms critical to reaching at-risk families
. I
' .
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!
and enabling them to avoid public agency intervention?
I
I
4.
Ijlow does a community system for protecting children assure that more children who come to CPS'
I
.
I
.
attention, are safe and free· from the recurr nce of abuse and neglect? What specific strategies led to
7
I
increased child safety?
I
I
5.
. .
.
'fho are the players that· must partner in an effective community system of child protection? Who
must suJ,portboth the conceptual
premi~es behind the refonn, as well as the strategies adopted to achieve
I
change?! For example, was there support of frontline staff and supervisors? Was there a stakeholder at each
I ·
.
.
.
!
site to c.hampion the refonn? Did the broader community in.each site assume a role in the new system?
i
.
. .
. .
What w~s that role, and what ~as the·process that led the community to accept new responsibility?
6.
I
.
'.
IWas publk support generated for the refonn at the site and national levels? What methods were
I
used toI . and individual citizens in the .refonn effort?
~ngage organizations
.
.
I
I
34
�i
'
,
Because the proposed change process is extremely complex, and will potentially be affected by
I
'
factors be~ond the control of the Program or our sites, we will consider that strong progress has been made-'
I
if we hav~ arrived at answers to these questions at the end of the four years.
I
.
.
"
,
. Conclusion
}
I
I
' .
The strategy presented in this paper sets out Ii preliminary plan for working af thi:docal, state, and
i
national (evels not only tO,test - but to generate understanding of and support for - a new approach to '
I
i
protecting children. We believe the proposed reform agenda'could not be more timely. Not only has the
I
'incidencJ of child abuse and neglect reached
.I
~pidemic' proportions, but public concern about the inability
'
of the chi,ld protection system to stem further harm to children continues to rise. With elected officials, CPS
I
agencies,! service providers, advocates, families, and individual citizens calling for reform, ~nd with states
I
and localities wqrking with. enhanced vigor to change current policy and practice, the strategy offers a
1
.
promis;~g ne~ approach to those charged with
protecting children: engaging new partners in keeping
I
I
children 'safe,enlarging the community's capacity to protect its children, and aspiring to make child safety
j
,.
,"
,'
,
a community-wide responsibility. Only through assuming more cQllective responsibility for this critical task
j
I
I
,
.'
•
• •
'
,
'
can we strengthen and support our families and reduce the number of children' in this country whose lives
J
.
'
. '
are so tiagically darkened by abuse and neglect.
,
I
.
,
'
. '
.
.
I
r
. I
I
I
. I
i
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35
'
�',r
,
Appendix A
Jacksonville, Fla.
Cedar Rapids, Iowa
Jefferson
County!Lou isv iIIe,
Ky
St. Louis, Mo
700,000
175,000
665,0001270,000
400,000
108,000
(five zip codes)
10,000
35,000
24,000
27%
51%
32%
36%
Percent of Site's
I
AbuselNeglect
Reports that come
fromI Target
Neighborhoods
I
24%
27%
12%
19%
CPSiReform
Leghlation
Dual-track
approach
implemented
statewide in 1993
(investigation or
"family service
response"). As of
October 1995, (I )
state. classification'
system for
maltreatment
reports eliminated;
(2) CPS uses family
.service response
with approximately
75% of families;
law enforcement
takes the lead on
criminal
investigations and
partners with CPS
on protective '
investigations
involving serious
maltreatment.
"Assessment"
response to all
reports
implemented in five
. pilot sites in 1995,
including Cedar
Rapids; range of
responses are
available following
assessment that are
tailored to each
family's situation
and level of need
(no action, referral
to communitybased family
support services,
IFPS~ court
involvement, etc.) .
I
I
Total pbpulation
-
Tdrget
Neighoorhoods
I
!
FamilieS in Target
I
Neighborhoods
Living Below
- ----PovertY L-evel
!
I
I
I
,
I
i
I
I
i
.. '
I
I
I
!
I
i
J
I
i
I
I
",
None; however,
Dual-track response
under Kentucky
. implemented in five
Education Reform
areas of the state,
Act (KERA), over
including target
neighborhood
300 school-based
consisting of two
Family Resource
and Youth Service
zip codes in St.
Centers have been
Louis; reports are
developed, which
assigned to one of
. serve as
the two tracks
mechanisms to
(investigation or
identify and refer
assessment) by state
at-risk families to .
hotline staff
Neighborhood
Place centers (see
75-80% of reports
below)
are being assigned
.to assessment track
/
I
I
36
�. .,
I,
\
Neigh~orhoodI
•
based ,Ser:v1ce
Delivery
. I
i
I
I
1
,
-
I
i
..
Full Service
Schools Gointly
funded by Florida
Dept. Of
Education, United
Way, and the Dept.
Of Health and
Rehabilitative
Services) provide
range of supports
. from child care for
teen students to
emergency food
assistance; CPS
staff are
.outstationedat
schools
Neighborhood
"Patch" program is
. based in Family
Place centers house
public agency staff
Resource Centers in
who provide health,
target
mental health,
neighborhood;
,
employment,
public and private
protective and other
agency staff
services; each
(including CPS
school-based center
workers) use
has local decision
proactive team
. making council
approach to
comprised of
providing
neighborhood
preventive and
residents
protective services
in a geographic
"patch" of 10,006
persons
-j-
i
I
i
Other Unique
Features
I
i
,
,
I
I
Healthy Families
Jacksonville
provides home
visiting to all new
mothers in the
target
neighborhoods;
Family Transition.
Project provides
social services to
families moving
from welfare to
work
Decategorization
project pools
trad itiona lIy
segregated child
welfare funding
streams into single
fund that can be
used for
prevention/early
intervention
programs such as
Patch and
development of
Family Resource
Centers
37
! .
I
Significant
partnering among
county public
agencies; largescale public sector
redeployment of
agency staff into
neighborhood;
strong judicial
leadership for child
protection refonn
(Judge Richard 1.
FitzGerald)
Target
neighborhood is
area served by Sigel
Community
Education Center,
one of 15 such
Centers across the
city. The Sigel
Center provides on
. site services and
linkages to
community
supports, including
family counseling,
housing assistance, .
and drug abuse
prevention
programs (led by
S1. Louis Police
Dept.)
Sigel has active
Community
Council that
oversees the Center;
comprised of
residents, parents
with children
attending Sigel area
schools, youths,
service providers,
and local elected
officials. Sigel
Center is also a
"Caring
Communities" site
(state Initiati ve that .
provides pooled
funds to local
planning bodies to
design and
implement schoollinked services)
�
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Carol Rasco - Issues Series
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Carol Rasco
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2010-0198-Sb-child-welfare-2
-
https://clinton.presidentiallibraries.us/files/original/4853bc3ce9b0e797c7f286b82f785c17.pdf
dccfdedb61d44c6f3542529c64d908da
PDF Text
Text
~I
Memorandum
Federal Child Welfare Programs and
Current Program Authorizations and Appropriations
To:
Carol Rasco
Jeremy Ben-Ami
From:
Lyn Hogan
Date:
cc:
Elizabeth Drye
July 5, 1996
Summary
This' memo includes background information on child welfare
services, a breakdown of child welfare programs under the Social
Security Act, a breakdown of non-Social Security child w~lf~re
programs, an update on pending legislation, and the legi'slative
history of child welfare programs. This memo does not 'ihclude
child welfare progr-ams run by agencies outside of HHS orl DOJ, nor
does it include a review of child welfare system problems,
,
reforms, or recommendations ~ However, I will cover thes'e issues
in subsequent memos.
'
I'
Background
, Child welfare services focus on improving the conditions of
children and their families and on improving or providi~g
substitutes for functions the parents have difficulty p~rforming.
Many private, nonprofit and government entities work ,to Iprovide a
range of child welfare services to families and childre~ in need.
However, the primary government responsibility for child welfare
ser:ri<?es re~ts with the states. Each state has its own Ilegal and
adm~n~strat~ve structures and programs, and there are many
differences among the s t a t e s . '
,
"j'
The Federal government has also been involved in improv~ng the
welfare of children in areas of national concern since the 1900s.
Numerous Federal programs provide suppor-t for child welfare
services, the largest of which fall under titles IV-B arid IV-E of
.the Social Security Act.
'
I'
Title, IV-B authorizes funds to states for a broad range of child
welfare services, including family preservation and familyA,
,
support services. Ti tIe IV.,..E' authorizes foster- care, irtdependent"
living, and adoption assistance programs. Titles IV~B ~nd I¥-E
are intended to operate together to prevent the need for out-of
home p1acem~nts, and, when that is not pOSSible, to, off~r support
services and permanent placements.
Funds for. these programs
include both non?entitlement authorizations, and authorized
entitlements .
';
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'
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Additionally, funding is provided under foster care to assist
states with the maintenance' costs of AFDC children in fo~ter
care. Child welfare program funding is also avail~ble tal states
through the title XX social services block grant programi which
allows states to provide services relating to child welfare at
their discretion.
I
The federal government spends approximately $4 'billion ahnually
in FY 1995 to subsidize foster care, some adoptions, and~ to a
smaller extent" child protection programs.. eso breaks down FY
1995 spending to $3.28 billion for foster care and adopt~on .
assistance (state claims for IV-E Foster Care representrhe bulk
at around $2.9 billion while title IV-E Adoption Assistance state
claims were only around $378 million); $295 billion for bhild. ,
,welfare, and $150 billion for Family Preservation.
I
There are about half-a-million children in foster care on any
-g-iNen-day. As ,of 1993·, .reports of possible child abusesl had
risen to almost 3 million a year,' of which roughly 1 mi'lliion
abuse and neglect cases were.confirmed. About 1,300 of those
cases ended in a child's death.
(National Committee to Prevent
Child Abuse; HHS.) The number of reported' cases of childl abuse
and neglect h~ve more than quadrupled since 1976 (Ways a'nd Means
Greenbook, 1994).
.
,
,
I
Child welfare encompasses a variety of services including child -,
,
I
protection, care of the homeless and neglected, child sqcial and
nutrition,al development, and, children in out-of-home carie.
'
Services provided may be supportive, supplementary, or
substitutive.
The current school of thought in the child welfare world, says
that it is in the best interests"of children to live with their
families. Most child welfare programs are designed aroJnd family
.preservation and family reunification. PL 96-272 requir~s'that
reasonable efforts be taken to prevent placement Of a child in
foster care, prevent the need for foster care, and make. Ii t
possible for that child to eventually return home.
Determining
reasonable efforts is left up to the states and varies
substantially' from state to state. To receive title IV-E funding,
a State plan must include these provisions.
I
'
Child Welfare Programs Under the Sociai Security Act
Child Welfare Services (Title IV-S, Subpart 1): Permariently
authorizes grants to states ,for child welfare services. I States
have wide discretion in designing programs, but,must pr9vide
certain protection for all'foster children as a conditi<pn of
funding.
The federal matching rate is 75 percent and state
allocations are'"based on per capita income and populatibn age' 21
and under: This' program is not an entitlement, 1?ut is ~ubject to
the discretionary appropriations process. FY 1996 funding:
$277
2
I
.,..•.
'
..
�,
million.
FY 1997 Administration request:
,
$292 million.
Family Preservation and Family "Support (Title IV-B, Subpart 2):
Authorizes grants to states for family preservation and family
support services through FY' 1998. : The program is a capp~o '
entitlement to states. The ceiling began at $60 mill{on!in'FY
1994 and is 'scheduled to increase to $255 million in FY 1998.
(Beginning in FY 1995, a certain percentage of funds arelreserved
for grants to state courts to assess and improve their child
welfare proceedings'.) The federal matching rate is 75 p~rcent,
and state allocations are based on the number of children
receiving food stamps. FY 1996 funding: $225 ,million.
FY 1997
'Administrative request:
$240 million.
'Foster Care (Title IV-E): Federal matching funds are permanently
authorized and provided to states on an open-ended entitlement
basis for costs of maintaining children in foster care, khose
.__._:...._.biological families are .eligible for AFDC, and for relat~d ._
administrative, child placement, and training costs~
St~tes are
required to provide foster care maintenance payments to AFDGeligible children removed from the home if a child recei~ed, or
would have' been eligible for AFDC,prior to removal form ~he
home.
(Children in theJfoster care AFDC program are eligible for
,Medicaid.) Thefe~eral matching rate for title IV-E' fos~er care
is the state's Medicaid matching rate, which varies acco~ding to
state per capita income. Foster care may be provided inlI homes OL
institutions and must meet certain requirements.
Eligib~e
administrative and child placement costs are matched at ~o '
percent, and the federal match rate for training is 75 percent.
FY 1996 funding:
$3.7 billion; FY 1997 Administration r,lequest:
$3.8 billion.
I
IV~E):
Adoption Assistance (Title
Authorizes federal mJtching
funds on a permanent basis to states to provide adoption
assistance to parents who adopt children with special n~eds and
are eligible for SSIor AFDC. Federal matching is avai~able on
an open-ended entitlement basis for adoption assistance land for
related administrative, child placement, and training costs.
Matching 'rates are the same as under foster care. FY 1996
'
funding: $510 million; FY 1997 Administration request: 1$568
million.
'
,
'!
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Independent Living (Title IV-E): Authorizes grants to ,states for
services to older foster children to help them make ,the I e
transition to life on their own. The program is permanently
authorized as a capped entitlement to states. State aliocations
are based on each state's share of title IV~E foster children in'
FY 1994" and states must provide a 50 percent match fo~ their
share of the first $45 million in federal appropriations.
FY
1~96 .funding: $70 million; 1997 Administration request, 1$70
ml.lll.on.
. ,
3
'".
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I
Title XX:
This is an authorized entitlement of which 100 percent
is federally funded, with a ceiling. At their discretion; States
may provide services relating to child welfare using titieXx
funds. Detailed data on child welfare services spending ~y states
is not available. Funds available to states from title XX may,be
used for services to families and children without regard to
their eligibility for AFDC.
,
I
Non-Social Security Act Child Welfare Programs
I
Abandoned Infants ,Assistance Act: Authorizes discretioniry
grants to states for activities related to babies who have been
abandoned by their biological 'families, particularly inf~nts with
AIDS.
FY 1996 funding: $12 million; FY 1997 Administration
request: $14 million..
I '
Adoption 'Opportunities Act: Authorizes discretionary funding for
,a. range of ,adoption activities, facilitating the adoptionlof
special needs children and,providing, post-legal adoption
services'. FY 1996 funding $12 million; FY 1997 Administration
request: to consolidate this program with child welfare 'research
and training, and, CAPTA ,discretionary activities to forml a new
Child Welfare Innovation Program to be funded at·the programs'
combined FY 1995 funding level: $39 million.,
,
I '
Child Abuse Prevention and Treatment Act (CAPTA) state grants:
Authorizes grants to help states improve their child' pro1tective
service systems~ As a condition of funding, requires states to
establish mandatory child abuse, and neglect reporting sYjstems" FY
1996 funding:$21 million;FY 1997 Administration request,; $23
million
,"
I
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Community-Based Family Resource Centers: Grants for community
based family resource centers are authorized under CAPTl. FY
199'6 funding ;$23 'million; FY 1997 Administration reque$t: $50
million for consolidation of community-based family ~esburce
center grants, temporary child care and crisis nurserie~,and
family support centers, authorized under the stewart
Homeless Assistance Act.
McK~nney
'I
Child Abuse Prevention and Treatment, Act'discretionary grants:
,
1
Authorizes research and demonstration activities.
FY· 1996
funding: $14 million; FY 1997 Administration request" that" this
program be consolidated with adoption opportunities andlchild .
welfare research and training to form a new Child Welfa{e
Innovative Program to funded at the programs' combined funding
levels in FY 1995 ($39 million).
I
;:
4
�Temporary Child Care for Children with Disabilities and C~iSiS
Nurseries Act: Authorizes state demonstration grants fOrj
temporary nonmedical,child care for children with special needs
to alleviate stress' among children and their families; and crisis
nurseries to provide short-term care for abused and neglepted
children or those at risk of abuse. FY 1996 funding: '$101
million;, FY 1997 Administration , request, 'included in funding
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requested for consolidation of community-based family resource
center grants, temporary child care and crisis nurseries, and
family support centers, discussed a~ove.
Ti tIe V of the Juvenile Justice Delinquency Prevention Ae,t: 'Sends
money to states, with few restrictions, for use in juveni1le
delinquency prevention. The money may be used for Family I '
Preservation. The money is subgranted. out at the local l~vel.
Most of the dollars, are currently used for traditional pr:evention
P,rograms such as after school progr,amE!~ , FY 1996 funding:I' $20
million, of which'$19 million goes out, to the states; FY 1997
Administration Request: $20 million. DOJ Office of Juvenile
Justice and Delinquency Prevention and the HHS Administr~tion on
Children, Youth and Families ,have been exploring ways to!
coordinate their own programs and help states and local I
communities build a continuum ot: services aimed at prevention and
early intervention.
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Non-Welfare Reform Pending Child Welfare Legislation, l04th
Congress
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H.R. 3286 (Molinari): The Adoption Promotion and Stability Act
of '1996. Offers up to a $5,000 tax credit,for adoption ~xpenses
incurred during the year that the adoption is formalizedl
Only
families who make less than $75,,000 annually are eligiblck for the
full $5,000 tax credit. Also removes barriers to int:er-ckthnic
adoption.
The Admi~istration issued a SAP on May 9, 1996
strongly supporting HR 3286, without the inclusion of· Title III
(Title III--would allow state courts to pre-empt tribal
governments in decisions regarding the custody of Indian ,
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children.) Introduced May 1996, referred to Finance Committee.
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H. R. 586 (Maloney): Omnibus Foster Care Improvement Actl.
Amends
Title IV-E, introduced January 19, 1995, referred to Ways and
Means.
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H.R. 709
to allow
guardian
rights.
(Maloney):
Standby Guardianship Act. Amends Tlitle IV-E
chronically ill or dying parents to name a sta~dby
for minor children without relinquishing parental
Ihtroduced January 26, 1995, ,referred to Ways end Means.
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H.R. 1044 (Fawell): At~Birth 'Abandoned Baby Act, amends title
IV-E to preventC3;bandoned infants from experiencing proJ!onged
foster care.
lritroduced February 24,1995, referred tOIHouse
Ways and Means.
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H.R.1263{Payne)": Abandoned arid Medically Fragile Infants'
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Assistance Act, introduced March 16, 1995, referred to House
Economics and Educational Opportunities Committee.
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S. l201(Coats), similar bill introduced in. House, H.R. 2~87
(Wyden):
Kinship Care Act of 19Q5. Amends Title IV-E to promote
kinship care" and to authorize kinship care demonstratioris.
Introduced September 21, referred to House Ways and
Committee.
Mean!
S 919, (Coats): Child Abuse Prevention and Treatment Act
Amendments (CAPTA): Reauthorizes CAPTA and related progra'ms
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through FY 2000, included in HR 4 on' August II, 1995, pa~sed
Senate September 19, 1995, vetoed by President.
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S. 637 (McCain):
Adoption Anti-Discrimination Act, intrbduced
,.._.. . . . . . . . . . . .~_ _
.m~a_r_c_h 28, 1995, referred to· Senate Finance Committee.
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Legislative History of Child Welfare Programs
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Federal assistance for foster care first .became available in 1961 .
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under what was then called ADC (later renamed AFDC) under title
IV-A of the Social Security Act.
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The Adoption Assistance and' Child welfare Act of 1980 anb
Amendments to It (Public. Law 96-272)
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In 1980, title IV-A of the Social Security Act was amended by
Public Law 96-272. This legislation continued foster ca~re
funding but transferred it . to title·IV-E. This law also'I changed
child welfare services under IV-B by creating linkages between
the two programs. AFDC foster care remained an entitlement, but
funding was made contingentontitl~ IV~B.
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Also, under title IV-E, a new Federal matching·grant prqgram for
paYments to parents who adopt special needs children was
established and permanently authorized. Funding for ad6ption
assistance is on an open":ended entitlement basis.
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Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985,
Amendments to ,Child Welfare 'Programs (PL 99-272)
In the 99th Congress, COBRA established a new entitlemef:).t
program--the independent living program--under title IV+E ~o help
states facilitate the transition of children age 1'6 and older
from AFDC foster care to independent living.
PL 100-647, 'Extension of COBRA Changes
In the 100th CO.ngress, legislation was enacted to expanp the
independent liv~ng program for children 16 and older who are in
any foster care situation, and to provide services for kuch
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children for six months after foster care or foster care payments
end.
Tax Reform Act of 1986 (PL 99-514)
Also in the 99th Congress under the Tax
assistance program under title IV-E ""was
Federal matching funds for the one-time
children with special needs, whe,ther or
eligible for AFDC or SS1.
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Reform Act, the adoption
amended to provide
adoption expense~ of
not the children1are
Omnibus Reconciliation Act of 1989 (PL 101-239), 1990
508) and 1993 (PL 103-66)
(P~101-"
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During the first session of the 101st Congress authorization
levels for title IV-B were increased from $266 million to $325 ,
million; and extended the independent living program through
199?~~~~~easi~g the entitlement ceiling from.$45 to $50Jmilli~n
--------~i~n~FY 90 to $60 for FY '91 and $10 million for '92, and establish
a state match beginning FY "' 9 1 . .
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During the second session of the 101st Congress states were
required to distinguish/between administrative costs and child
placement costs (which previously had been counted as
administrative costs).
the 103rd Congress new legislation created a capped
enti tlement urider 1V-B for a broad range of services to :families"
(including foster, adoptive and extended families). Termed family
preservation and family support services, the legislatioh was
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designed to buttress the goals of "Federal ,child welfare :programs
of strengthening family life for children, and ensuring 'more
children in the child welfare system have a stable, per~anent·
home on a timely basis. The legislation also includes a set
aside for grants to State courts for assessments and improvements
of judicial child welfare proceedings. This new law. also
authorized a three~year enhanced match to States for pl~nning,
designing, developing or installing child welfare data qo11ection
systems.
The legislation permanently authorizes the independent
living program and authorizes a 75" percent matching tate for
certain State training expenses.
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'Du~ing
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�To:
Carol Rasco
Jeremy Ben-Ami
From:
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Lyn Hogan
Date:
July 5, 1996
Re:
cc:
Elizabeth Drye
. Brief Summary of Pending .Child Welfare Waivers
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Though we went over theE\e in our earlier meeting" I thought it
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might be useful to,review'them once more before Monday's Imeeting.
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~elfare
ve~s
The child
wai
were authorized by Congress at !the end
of 1994. Congress cre~ted a new special waiver authoritY:
------(section --1130) for HHS to award up to 10 states to condu¢t cost
neutral. demonstrations, ,with waiv.ers of IV-B and IV-E alliowed.
As you remember, after HHS issued state guidelines, 14 states
applied. Minnesota since dropped out. States that have1applied
include: ' Oregon, ,Delaware, DC, North Carolina, Georgia, iOhio, '
New Y<:>rk, Indiana, Illinois, California, Michigan,West\firginia,
and Maryland. Delaware has been approved. Two to four may be
approved in the coming months. HHS does not have to gi v~ all ten
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wa1vers.
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The most, common suggestions propose shifting dOllarsfrol,foster
care to family preservation. 'Other inte'resting proposal~ are:
a
Delaware proposed and received
waiver anClIllinoi~
proposed but has not yet received' a waiver for subsidi zed
guardianshi,p," a new status of guardianship where 'there is
no hope of family unification'and the foster parents want
the relationship. to be permanent, but don't want to I ado,pt.
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New york and Ohio have proposed managed care, with C?Pitated
payments for foster care rather than daily ,maintenance
payments, to encourage agencies to move quickly to resolve
the child's situation. Critics of this approach say this
may rush agencies to push out children they might npt have
otherwise. New York proposes cutting payments at the~same
time, and HHS does not like that. However, HHSfinas Ohio's
proposal very promising.
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Michigan and California proposed block grants. Cal;ifornia,
wants to sub-block down t'o the counties. HHS, as you know,
is not crazy about block grants.
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'Jp~t as, 'tela~ivel? were t>!1fytng Nadine, Loc~~': :tije .ce~~ral ~agency, ,~~ils~S"9~: ~9re' s~ripus case,~" . : :- '
,wood;'qie' l~t~st tr.agiC ,viCtim; of child ,ab~~e and I' "" ·1I(,t~e'.~?.st!rX!ep,si:v~',~ri~'·,~ffQrkLOs Angeles.'!,.! : ,
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negl~t[ tp~, ~e~d of, New<yot:k. Citr~,,<:hild' w~l,f~~~'. develoq~d _~5 nei~~:,n~orks" I~d by. lo~~l ' .
,'.agency ~nou,nc,ed th~~ he·~as'conslder~g,d~en~~ ",ch~~che.s;.::y~~th·c1L,lbs.anQ.~thElr groups;lili.at.k~p, ' ,..
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: traUzing' services', to 'troubledfilmilies,' to' prevent"'· an eye out,fo~: wlilerable: children' 'and, coordinaleC: ,', ' ';
, ': 'mor~,'deatli~;: ' Any <le~elltr4Uzation: pl<Ui'must: ~' ~isitS td~ jafn,1iies,' S(j1itlH~enthil itis :Ang~les,: OIle of:,.': ,;' ,, r
, '~a.re,~1,llJy,:~9u~lirQU~.; ~Ht~N.i~fi~I~'-SC~P
;~6~~: .: th~':CjtY;'~2@!~s~:;atl(HA!ls~,J~u~leQ' ~re~s;. r~port~';:: " ,
s Serv;::,', that die,numtier flf,children' ending upm lostercare
: ", missioner of the,AdmmlstratlOn for Chll
,"'~cesil s~~hjs: t(rbe~Qhih~ :F~~t~:~i,~ck: ,9iIjer;:cifi~~~:f ,'it.ill( te#1~!il~~L~f~~lejK:the~'to~tyear~ ~ince.' ,t~e:,,, ,
"have tried ,decentralization, witti positive results..· expei"iment "began;- Before' that;' die number' was" :
',~.r' :: ".:: ":r~iC~~l~; (~~.:' a~~ncy: 'inve:stigat~', a.:f~milY, ,',r~~tDg·6 p!!r~~t':a'~~~.:>:;,~/:.2·:';,: :' d/ :[:(f',;,,:-: :., ,: '
aftent receives a report'of abuse or neglec~, then. ,', ;:, ",New York already .has "a, broad network, of, ,
, ',' decides whether: tliechild;shoultlbE! removed: ,It h8s;;'::privat~:'agenci~s: that..·:work."wiilf'the:cliild~welfare ,::. ,
",.'" ,beeri"tiarshiy,criticize(Uor'moyirig'toQ,slowly, budi<:' 'agenty' iO·"provide'··follo\V~up:ser.vicesto families',;' ,
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the, child is.,at'.nsk,well before,. the' agency gets; of foster:' care, But' they do :not l particlpate, m the:,'
"('; "': <.iny~~v~d, an~. ~e's,o~i~i.~~~¥.ers. ,who: i!l~~rYe~~ ar~ ~~ :;~i~ia! ·~v~st~~~t.~#~~:!;},:~:> ..~<;:~,.::" ;/: .:::.J::'i: .:::,:, :,:',' ::.' '
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seen as intru!iive bureaucrats trymgto.,teltr~sentfuL~-t<. , Mr,. ScopP~,tta; Who was.brought-m:to run the '
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family members hOw"tO'run their lives:" :~'. ;,.:; ": .agenCy'OKra mandilte'of.'reform;has yetto articu> ..
. ~, ,. '~"" .:.,:s,~m~':.~iti~, ~d~~t~~ar.e; iryibg,: '8:'-(U~eren~/: latE!:·.~: ~~e~fyi~!~n:;o(w~~re:hf ~C19t~:tO' t~e ·i~,.. ~;."
, \f '~ppro~cIi, m~y~·:'w!tl.l.~as~~i~~c~ J~o~, ~e~, ;:rum,mg W:,C::9mm.unity'·b~~roups .~eems ~, ~:::::,
..\\, Mcq:;~~I~".Clarlt, Foyn~~tion~ ~The"~ss~~ce. of,~~ ~:. ~me..~r~~"s~~': pa~!:',bUk~fo~'. h~ ,takfi!s ',IV;: :
. :: approach,ls to give more,responsibiUtyfor,interven.. : Mr~ 'SCoppetta;has·to::address several important··
'. " tion~to\ruH$b6rhOOd~.or-commuiiity~baseagroups~~·;"quesiiOns:\"·){·i.'\ -i: ..:,:~:·::,':~"·,: ". ";·V:. J". ...... "
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, ,This.' l~adS) ~o:qis.iCkef~spOilS~ ~i~' . oidiil8tK,~;', ;:;';'('\v~uld ~~ ~m~~iy:gio~~,~~e~ptiritiUy :,
resentmentsJhatOCcur..~hen a, centr
" bureau'-:", responsibUit;y: for irivestigatibJi' and assessment? If , ': :
:{:,::- ,< cra~t's,tep~;~~;~m9t:l~~~s~a~~~~'.cit'~·~mf~inj}~>~~t.il~*$OO~.~CPW~ ~~~! ~'~p'~~:,~iDg?\Y,h~~, ;: .
. ,", " 'I . then: f9,cUS ~~ ,C?z:g1!l~1ty,-:~~~4 J)~~r"ships.ar~ \.... n~\\,.~rol~s~ ~0'P.~ l:iie ...pf1Y!l,~e~ agen9i~' th~t. nmv ','
'.1 ~orida. Missoufl;Iow~:~entuc~,'a~l(tLOs. ~n,ge1~s; ,provJde!o.uC?~·pp s.f!~ceB.l~!ay,? H9~I.~o¥,ld tne.r.~:
.\ " ,. ::A~th~¥~, tJ:1~~~r,lt~~I:;~~ncYL~~ldes:':w~~tper\: 'Y~rk'~.1nte8.r:~t~ ~,a,ne\VC9~m,~.ity. p~e.r::' . .,", .,:,' ,
,' ; interventlonJs .ne~essary,. th,e, community grouj:!is, sfllp'j); Would. ~ild·welfare caljleworkers, be .silifted"
. like~y, to ~o,w ,mQ!~ "~~~!'~-"C~ild,~~ .i;l~itPl,b?rh~;:: frO~: ,;. ceillrat(' hea?quarter~' .t.o iheF C(unrnuiiiiy. :~. ,;:
. envI~on~~nr~d, m~y ~verr~ f!'lmi~.~r w~th the:: grou~s? .\\1lJ~lPe loilg·~wfdted:compufer system ~ ..:, .
fa'i'111~ it~elf,· Its,interve~tion.l~ '~~~. as .less threat~ . ," totally functiopal, howWpuld' irlformati1on be coordi- : "
enmg than thesllddenap~arance"of:workers from',. nated,between central and community offices?", ;l , "
areino~ b~reauCr~~Y.:~:~~':, : ~':",:,,::. ~,:.,,;~ "'M' ",~t; 'sco~~ti~. an~ ~~iY, '~a1~ ~op~ to outline: a:',,> " . '.. ,
, ,•.. Followmg tI:l~ ml~laliI1vest1g~tioJl, responslbn~i , comprehenslv..e pUm in .the next' several weeks,'
ides. 'are divid~ up;·with:the ~ oomm:uriity ,groups Their plan' cannot c~mi.tsOOn enough ~ith so·many' ,
PI'O'<i4ing services ";OjY;r~k families wlineo~...r Nadhi~ lc>c-.ds at ~k,
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'1t'J('J('J(Issues in '.' "
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Manage4Care and
Child Welfare
Willit work?
By Tracey Feild
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her.e~ is an undeniable surge of support for,' ·welfare statutes and will have difficulty removing 'these
managed care as a quick fix for a range .6f . requirements, even if they sho~ld want to do so. As
p\lblic human service problems. Chil(i ws;:l1are
states begin to adjust to federal funding changes, child
___ ..... is, one area of human ,services that has tt:'ad its ' welfare will not be the only area ~ffecte~. States will also
share of problems-problems that seem to overwhelm
{eel the impact on income main~enance and Medicaid.
the system and that help put child welfare in a position
Any ~fforts to offset,federal fu~ding through state or
to become "managed." Child welfare is moving inevitalocal revenues undou,btedly will <!ffect funding available
bly toward managed care for several reasons.
, f o r child welfare.
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The child welfare system is seen as broken and in',
As funding changes, child welfiue managers will have
need of fixing. The myriad of class-action lawsuits and
to develop ways of rationing ser~ices while still protectservice integration and system reform initiatives,in the
ing children. In the past! family preservation programs
past 10 years attest to the "broken" state of child welfare. ",have been cutin favor offoster and residential care; but
Lawsuits in both child welfare and juvenile corrections ,the services being cut are relatively inexpensive, so there'
A . ;,assert a range of problems throughout the system, focus-, are few savings. In lieu of cutti~g family preservation
. . ing considerable attention' on the quality of care <;Ind the
programs, taking percentage cuts across all providers,
le2Pth of ~tay for children placed in, out-~f-home care. 'or sutting. investigative or foster dare staff, good manag
~emarkably, although most of these lawsuits havereers will attempt to find areas tha~ can be cut without sesuited in significantly increased resources for child welriously impairing the program. Overuse of residential
fare,most of the affected systems ate still plagued with
care is an obvious target in most j¥risdictions. One of the
problems-in some instailces, problems that have plainbest ways to control overuse is t~rough managed care.
tiffs' attorneys threatening contempt actions. "
. Managed care isbecomhlg wi~espread for Medicaid
Service integration and reforms have been developed
clients. Most .states are deve~oping primary-c~re
across systems yvithin local jurisdictions,and within enmanaged~care systems for Medicaid clients; many of
tire states, or ttiY have focused on single systems while
these managed-care systems include behavioral, health
attempting tif<!ddress the continuum of care. Some have
care as well. Managed care is generally perceived as suc
been supported financially and technically with genercessful in curtailing the rate of g'rowth 'in Medicaid ex
ous foundation grants. But although a few ofthese ini-.
p~nditures. In many states, m~naged. care has ,been
tiatives have produced interesting .and promising,
implemented for child welfare clients through other ser-.
service delivery alternatives, none have resulted in c~:m-' vice systems, mostly primary caie orbehaviora] health
sensus that the child welfare system is "fixed" or can be
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fixed through any particular approach.
In a managed-care system, the'~hild welfare worker is
Changes in federal funding will force more disciresponsible for making sure that clients get what they
pUne on the system. Inevitably, federal funding for
need but has little power in the aecision-making ph:ic
child welfare will change in the next couple of years~ and
ess. No longer can tlie worker simply take the client to
states will undertake a 'greater share of the costs. And',' the appropriate provider and :authorize treatment. The
although the federal government may reduce federal
worker· serves primarily as· an [advocate for services
'requirements, most states have codified federal child
rather than asthe authorizing agent.:
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One'solution to the dilemma of control over se~ice '
authorizatic:n is for the child welfare system itself to pay
for the servlCes; then no approval from managed-care
gatekeepers would be required. This alternative, how
~v~r, req~ires that the child welfare system forgo Med~
lCald reimbursement on the services. purchased.
Although the importance of this decision may chang~
under a Medicaid block grant, it is a costly decision un
der the current entitlement program.
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Where managed care under Medicaid is being imple
mented on a large scale, there is tremendous commit
ment to its success. Good news about its success fills
press releases, thus ensuring continued and growing
support. Child welfare is likely to be pulled into man
aged care as legislators and governors ask: If managed
care works in Medicaid, why can't it work in child
welfare?
Managed care is seen as the solution to out-of
control hU~lln service budgets. While managed care'
has become popular, if not mandatory, under Medicaid,
it is beco~ing the solution of choice for controllinghu- ,
man.servlCe budgets. After Medicaid,child welfare is
considered one of the most out~of-control itemrn many
state human service budgets. 1 After some gains in con
trolling the foster care population in the mid-1980s-as
a result of the Adoption Assistance and Child Welfare
Act of 1980-the costs of out-of-home care for children
and youth with special needs havesoared. 2
Private child welfare providers are, developing
managed-care systems for other payers. Although
children~s mental health, child welfare, and juvenile cor- '
r.ections o~ten are located in separate state or local pub
lIc agenCIes, the, prIvate agencies serving children,
,Youth, and families often'serve all three groups of clients
...;f!1d are paid by all thr~e systems. Many private child
,: :"elfare provIders already h?ve begun planning for or
Implementll1g managed care through the mental health
system. Since·it makes sense for them to design a system,
of care !ha~ serves all clientele, many private providers
are begm!1mg to approach child welfare agencies with
F;roposals for managed care.Through provider associa
tions and professional organizations, information, tech ,
nical assisJftce, and actual experience on how to.
un~ertakEi manag~d care are becoming increasingly
available ..There Will be tremendous pressure from pri
vate proViders over the next several years to privatize
segments of the.child welfare system.
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Child' welfare differs'
in several fundamental'
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ways fro~ other fields
that hav~ implemented
managed care.
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sy~tem
looking for help, unlike Ithe mental health and
pnm,ary health care sy~tems. Inithose systems, people
,lookIng for help want It badly Ejnough to advocate on
their own behalf: If they are sick,' they go to the doctor,
they take prescribed medicine; if they do not get well,
they go back to the doctor. Patients' interests in their
own well-being motivate t.hem t6 advocate on their own
beha~f.
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Child welfare chents do not usually come to the sys
tem looking for help. Once in thb system, they often are
resistant, if not hostile, to the h~lp that is offered. Fur
·ther, they do not have theoPFortunity to determine
:-vhen they are "well" and no l~nger in need of system
InterventIons. In fact/child welfare,interventions may be
imposed on unwilling families by the courts or police.
rhegoals of child welfare: A90ther Significant differ
ence between the child welfare system and other sys
tems that have implemented I managed care is the
overrid ing goals of protection aJid permanency and how
these goals affect the treatment process. Child welfare
cases are opened because the sy~tem assesses a threat to
the child's well-being:The factdrs that contribute to this
asse~sment includefilmily,hou:sehold, and community
conSiderations. UnlIke other systems, the goal of the in
tervention im'olves 1T10re"than Stabilization or improve
m~nt in the child's individual11evelof functioning. The
chtld welfare system concerns itself with the entire film
ily environment in which the ~hild will grow and de
,v~l<?p. The io:pact ofthis man~ate is that the family is
cnh~al to the~nterventi5m provided to the child. Further,
the Interventions proVided to the parents may be criti~ .
cal to, or may ~e the orily in~e+ention provided on be
half ?f~ the chtl9.!n some Inltances, the intervention
prOVided to .the child cannot be uridertaken apart from
the intervention· provided to t~e parent.
. The goal of permanency, which is fundamental to the
child v..:elfaie system, results inrcasedecisions that might
How Does Child Welfare Differ from.
be foreign to the mental health !,ystem. The child welfare
Other Systems with Managed Care?
worker must look at the long-range relationship be
hild welfare differs in several fundamental
tween the parent and child and' decide how best to main
" ways from other fields that have implem'ented . tai~ c:r strengthen that r~lationship until the age of
managed care. Because of this, managed-care'
maJonty. For example, a child r'elfareworker will place
models developed for child welfare will have· value on leaving the child inthe home for treatment to
to be different as well.
'
ensure parental involvement ~nd "connectedness" with
the child, versus removing tfte child to an alternative
. T~~ nature of child welfare. The primary and most
slgl1lfIcant difference is the involuntary nature of child
setting--even .when that alte~native may be an easier
welfare. Clients donot uSl1aJly come to thechiJd welfare. treatment setting .for the chila-if the worker believes
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PUIlLIC VVELFARE/SUMMER
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that the parents' in~~lvement 'would ' , w a n e . '
Rationing,can become
, Such a decision results from the overriding goal of per-; . ,"
'controversial when' it "
, manencyfor the child. , ' '.'.,
' , ' ;,> . '
,
. Conversely, the child may have to be removed f~om
results i~withholding
his or her home if the fisk of harm i~ deemed to be too
treatment from clients
high. Further, the' child may not return ,horne until the
in need.
risk factors within the horne are reduced. Under these
circumstances, the child's primary needs maybe iriter
ventions provided to the parents. Recalcitrant, hostile,
or uncooperative parent~ may prolong the intervention
required for a seemingly simple, problem.'
,
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,
"
, When parents are not available to the, child, the gdal '
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ampl~s of other related criteria,~ommonly used in be
of the system is to find parents or an otherwise suitable
and p.ermanent living airangementthatwill offer appro- , ,havioral health managed care indude
.
priate interventions, supervision, and guidance until the
'. family members o~ a guardihn will commit,to
necessary evaluations and treatments as a
child reaches adulthood, This responsibility is far
broader than any role defined in other systems wher~
, condition of admission and ~ontiruing stay;
managed care has been implemented. Although both
'I
'
'
primary hea.lt,h care and mental health may require in
,. the discharge residence is mown at the time of.
volvement by parents or other family'members in the
admission",
treatment process, this involvement is usually adjunct to
• the client is amenable to treatment and accepts
the intervention pn;>vided to the child. "
'
,.the need for treatment,andl ,
'
--' The,state/s role: Another major difference l5etween '
'. the child's benavior will fit within the treat
'I
the child welfare system and'otners that have'imple
mented managed care is the impact of the state's role as
' ment milieu.,
i
parent, which demands consideration of ethical issues.
In the child welfare system, the concept of custody
In both the primary health and mental health public sys-, 'means that the state is acting a~ the parent on eithera
terns, professionals maintain the right to refuse an ex
temporary, or a permanent basis., The system is
pensive treatment if the client is a poor candidate for" swamped with adolescents whode emotional and behav
success. Frait Ht or aged clients may not be given or pri
' ioralproblems are severe and fdr whom the likelihood
of 'successful "recoyery/' how~v~r defined, through
oritized for organ transplaryts; resistanfclients will not
be given substance abuse treatment.
costly residential treatment is either unknown or low.
Each system has procedures for assessing a client's
Part of the c1~ild's poor prognosi's may be due to the un
, Ii kelihood of successful completi<m of treatment, thus
willingness of family memberkto participate in the
aJJ.owing the system to uQdertake a cost-benefit analysis
treatment process, th~, failure of the child to accept the
~"-of providing the treatfnent to that client: Is the client, need fortrecitment, the child's b.~havior, or the parents'
likely to get better a;:; a result of the in~ervention, thus
refusal to care for the child after treatment. Some of
, making the expenditure of sca~ce resources on that c1i
these problems also may be cauped by the;child's longterm involvement in the child \",:elfare system. ,
ent worthwhile? If the answer is no, the intervention
" Although the mental health system may refuse to treat
may be denied or placed at such a low priority that'it
never will be provided. This procedure is a kind of triage
these youth based on a set of rriandatory conditions, it
and is othenv.ise known as the rationing of scarce re~ , would be unethical in the child ~elfare syst~m to refuse
treatment to a child because of 90ubt that the treatment'
sources. Thij/ationing process occurs within all human
services, influding primary health care. Rationing'canwould be effective. The state as parent must seek and
become controversial, however, when it results in with- . pay for treatment for a child in ineed, regardless of that
holding treatment from c1ients'in need.
child's potential for recovery. Tpere can be no rationing
The mental'health system always has viewed itself as
,of resources that excludes a child because he or she is
too sick" or does' not have the :family characteristics of
a vol untary service system-that is, clients must ask for.
, services. Because of scarce resources, the mental health ~ children who bEmefit from trea~ment. The child welfare
, , .
I
system always has been a~le to prioritize services.' Unfield does not accept the· premise that s9me children
der managed mental health,Clinical'protocols are the. ,may be ,beyond help.
,'. I
"
'
guidelines used to determine, whoqualifies for thevari
Control over conditions and interventions. A final
dIfference between child welfa~e anp other systems that
ous types of services based on symptoms. These proto
colsmay include criteria that exclude clients in need as
have implemented ma'naged cate is the degree of control
well. For example, a child's symptoms could meetall of ,over conditions and interventions. ,Child welfare prob
the clinical criteria for acceptance into the service but fail ,'lems are rooted in social probletps-poverty, unemploy- .
to meet other related mandatorycriteria~ which would' 'ment, poor education, adol~s<;entpregnancy, drugs, and
result in the child being rejected for that service. Exneighborhood violence. The
ditio~s that result in
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If
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"
:~,
symptorn.'s'cannot be
. a~d appropriate inter~"
ventions cannot 'be easily determined or achieved.
iNor does the solution.to a child welfare problem .a1- .'
ways lie within the expertise of the child welfare system
itself, unlike in medicine or mental health. In medicine,
a problem may require a range of medicalspecialisis to
resolve; in mental health, a problem may require a range
of mental health professionals. A child welfare problem,
on the other hand, may require child welfare expertise;
medical'specialists; mental health .specialists; an~ a, .
range of other professionals, including educators and
social service workers from housing experts to home
makers., The ability or willingness of the needed range
of professionals to understand and trea f their specialties
within the context of a broader set of problems and child '
welfare goals often is limited,. as each specialist priori
tizes his or her own professipriaLgoals. Moreover, the.
child welfare worker often'must deal with a juvenile
, judge whose..~ssessment of the problems and needed
. interventions may be very differ~nt and who may order'
speCific interventions regardless of diagnostic evidence
presented by the worker.
.' .
: I
Child welfare
managed care
'
should not simply
follow ti).e path
. of managed care
In prImary or
. behaviotal
,health c~re.
•
•
I
. they use to provide care to publi~ child welfare clients.
These providers are essential to tpe system. Yet in most
?tates, the piivatesector is viewed not as a partner in the
service delivery process, but as ajresource only. In sup
port of the current system, there are so few players in the
.system over which the child welf1re worker has any au
thority-the schools, the courts, 1nd medical and men
tal health professionals, for e~ample~that one can
I
Can Managed Care
understand a worker's reluctanc~ to take on a "partner."
Benefit Child Welfare?
Nevertheless, when tragedy occurs in the child wel
fare system, as it occasionally a~d inevitably does, the
he nature of the child welfare system compli
.
cates and changes' how managed care must be ,
system stands alone and often (s charged with hiding
.conceptualize,d and deSigned to meet the'
, behind confidentialitytocover incompetence. In fact, in
,
needs of the client population. Child welfare'
several child welfare class-actio1n lawsuits throughout
the country, private child-cariMg agencies have promanaged care should not simply follow the path of man
aged care in primary orbehavioral health care. Certainly: . vided some o~ the' most damaging.testimony against the
public system. Justified or not) in many areas of the
there will be pressure· merely to adapt. existing
managed-care 'systems without concern' for the unique
country there is little confidencb in the public system.
Partnering with the private sec~or iri a reasonable way
e!..<¥nents of child welfar!.:. This approach, however, is'
,nUt likely to serve the best interests ofchildren and fami
could serve to build or restore c'onfidence in the public
lies or the child welfare system itself.
system by separating direct ser1vice from oversight. In .
this way,responsibili ty for the system's actions could be
Understanding the nuances of the child welfaresys
shined.'
I
'
. tem will be paramount to undertaking this design effort.
Fiscal incentives. The currel~t systen; has financial'
Managed-care:companies ho~)ing to expand into child
incentives to keep children in placement rather than re
welfare will not be able to rely soJely on their primary
and behavioral health experience in the development
turn them home as quickly as pbssible. Private residen
process.i
",
'. ' .
tial child-caring agencies traditionally are paid per diem
. Jhe field etchild 'welfare requires an entirely new
rates. for each child in care. Regfud!ess of how the rates
conceptualization of managed care, incl\.!ding a clear' are determined, there is often little incentive built into,
the rate structure to serve the most difficult children. If .
delineation of goals. Policymakers may regard managed
a difficult child requires mor~ care than the average
care as a means to harness spiraling costs, but managed
care can have different, more programmatically positive
child within that program, it will cost the provider more
to serve that. child, And if a cl~ild is relatively easy to
goals within the context of chilq welfare. Designing
serve within a rate category, thb provider has an incen
managed care for child welfare should begin with iden
. tifyingweaknesses in the current system that can be
tive to keep the child in care-the bed is filled, and the
addressed through managed can~.
..'.
costs 'are low relative to what tHey might be with a more
difficuhchild.1f the bed is empty, there is no reimburse
Responsibility. In the current system, the major play
ers-private service providers-do not have and there-· ment Reducing the level of ~ervice provided to any
child because his or her level pf functioning improves
fore db not .take responsibility for how the system
operates, In most states, private child-caring agencies'
means a reduCtion in the payment.
provide a substantial portion of the care and servicesJo
All of·these factors serve as idcentives to keep children
in high levels of care. Added t9 these perverse financial
familiesinvolved in the child welfare system. Most of
in~entives is the tendency for· ,ublic agencyworkers to
these are voluntary agencies that raise some of the funds'
T
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PUBLIC WEU;ARE/SUMMEI~
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1996
•
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. "',',' ': 'I ',' :':? ::>.'~J~~j~{~~}~.
focus on emergency sitllations, thus ignoring .stable
placements. The result is a system that is likely to have
more children in out-of-home care than necessary for'
longer periods of time than necessary.'
.
.
Diagnostic capability. Child welfare diagnostic skills
are weak, and there is little ability to empirically link.
symptoms, diagnoses, interventions, and outcomes. In
the primary health care system, and, to a lesser extent,
in the mental health system,there is at least general
agreement regarding symptoms, Q.,iagnoses, treatments~
and expected outcomes. In child welfare, the relation":
ships among symptoms; diagnoses-:-used in the general
sense, not in reference to specific mental health or medi
cal diagnostic codes; ihterventions; and outcomes are
murky at best. The intervention needed to"cure" a child
welfare problem is not always clear.. The system has de
veloped a limited set of interventions that are offered to
address most identified problems. Frequently, these in
terventions are offered based more on availability than
on demonsltated need.
.
,
The diagnostic process in child welfare has not been'
well developed and has focused on risk assessment
thexis.b:_oUuture harm~and family assessmentgrprob
lem identification. Some of the instruments developed
require highly trained staff to exercise professional judg
ment in completing them. This can be problematic when
the neighborhoods and regions with, the highest
,caseloads and the most serious child welfare problems
are more likely to be stjffed with the least-experienced,
least-trained workers, Further, staff often are not com
,petent to diagnose some of the more serious en:otional
probJems common within the child welfare system
today.
"
,' .
.
Exacerbating or perhaps underlying the problem of
. 9iagnostic capability in child.welfare is the lackpf evalu
,}citive data linking sYJ1lptoms, diagnoses, 'interventions,
and outcomes. Unlike primary health care, and to some
extent the mental health field, child welfare has very
limited,if ahy, outconie data. Part of the reason for this
dearth of outcome data is a lack of consensus within the
field regarding outcome indicators 9r measures, There
have been fe,w long-term studies of the effects of vilrious
interventijWs on family or child functioning or on child
safety. R~{rdJess of eHorts to treat child abuse and un
derstand what interventions lead to ~uccessful out
comes, clinical research and' evaluation is extremely
limited. In child welfare, the relationships among symp
toms, diagnoses,interventions,and outcomes are mea
sured anecdotally rather than empirically. The result is
a decision-making process that relies on what interven
. tions are available, since it is. not always clear what is
needed.
This problem is one 9f the biggest impediments to the
image of child welfare. Child welfare professionalssim
ply do not have systematic evidence that the services
they provide do any good. Without this evidence, the
system is susceptible to attack at every budget hearing'
and-unanticipated family tragedy.'
.
. Those cqnsideriri~F}~::' .
manage1.child wel~are
must clarIfy whether
"saving money" means
spending less than is '
currently spent or _~.
curtailing,the growth
•
I
Inexper;tdOtures. '
1
,
Utilization data are fragmente,d or unavailable. In the
primary-care and ,mental health systems, utilization
data, ,essential to developing cap'itated rates, usually are
.available and relatively accurat~. This is due to the uni
form and detailed billing requir~ments of the Medicaid
program. 4 In child welfare, hovJever, systems develop
ment is not uniform across stJtes-and frequently· is .
frag~ented ,:"ithin a state. For Jxample, c1ient-trtlcking
data often are kept separatelyl from service payment
data. Further, it is not unusual for contracts to be paid
based on costs rather than service units provided to in
dividual clients. Developing utilization patterns, trends,
and costs based on per-client u!nits of service provided
therefore· becomes nearly impossible. Without these
data, managers often find it difficult to identify how
many clients received what services, at what cost, and
over what period 'of time. Leg~slators often view child
welfare as a large black box into which millions of dol
lars flow but from which emerges only a very general
.
picture of what happens to the; money.
Each of these areas can and must be addressed in child
welfare if managed care is to b~ impleinented. Address
ing each of these four areas would serve the field of child
welfare well, regardless of the success of managed care
in saviilg dollars.
Can Managed Child r"eifare
Save Money?
. I
's,ta,te and local public child welfare administ,rators
studying managed cate are doing so primarily
. due to budgetary conterns. Their budgets have
been cut or are about tp be cut, or they are antici
pating the effect of federal lhanges on their budgets.
Managed care has been touted as the way to bring hu
. man service budgets under c~ntroL But other than those
,portions of child welfare servkes that have fallen under
behavioral-health managed care, or very limited pilot
projects, there is no real evid~nce that managed care can
save money in child welfare'IFurther, those considering
managed child welfare must clarify whether "saving
money" means spending less than is currently spent or
.curtailing the growth in expenditures. Obviously, the
former is a more formidable/goaL
1996
9
�, ,,' ',:>',.">',
.
:;
Four competing factors within th~ current sys'!em,'
,will affect whether managed child welfare can save,
,
.'
"'!
:'f:.,,;', ,: ',:;:/~:'~~l',.;).~<~.i~~":'~'" : (~, '
f.'
-..
....
.,~,~.::,.:,,~:!
~.,~"",:t)\.,
1"
'~:h~
.'" ;;.;; .....
't;:'l
''''':~:;:l..?~ (~~"~'.',\'~:'1~"<~;" .. ~
-'
,
.~ ,:
The'develOpment.of<,~
, " "
child welfare managed '" ,,:.'
carecanno,be,'simply an
extension of Medicaid or
behavioral:·health
'managed que.
money. Each state:-and each county withincounty:
administered systems~will have to weigh its 'position
'A relative to each factor to gauge the potential for savings.
•
Current utilization' of high-cost residential place
,ments. The clearest cost-saving mechanism in managed
"I
care is reducing high-cost placement,~ays. Once child
, welfare agencies face a fiscal incentive to reduce ,the
level of care or the length of stay, they move childreri
home or to less-costly placements. Jurisdictions' with' "opened, The extent of this phenomenon is unknowri and
large numbers of children in high-cost residentialplace- ,'is probably best estimate,d at the IJcal intake level.
'
Additionally, there are a number; of specific managed- '
ments could save money under managed care. Jurisdictions that already, have made significant efforts to ,care design decisions, including the impact of imple
reduce these placements will see fewer, if any, savings.
mentation on the size ,andresBonsibility of public '
Current level of underserving children and families. " 'agency staff, that will affect the ability of managed care
In many jurisdictions, large numbers ofclients do not' to,save n:-oney for a system.
I
'
" ' get needed services because of funding limitati?ns.,
I
, Caseworkers da not bother 'to assess the need for,ser- , C h i l d welfare and managed care can be compat
vices that they Rnow are notav~ilable. Under managed "
" , ible'if the concepts and~echnologies of mancare, service provision w.ould be based ondinical pro~
aged care are configured to address the
tocols without reliance on waiting lists' to ration_Jeunique qualities and re~ponsibilities of child
sources. To the extent that these protocols define ~i'1evel
welfare. The development of child welfare managed
of service that heretofore has not been provided, costs
care cannot be ,simply an exte!lsicln of Medicaid or be
",havioral-health managed·care.ThJ child,welfare system
, will increase under managed care.
, Level of current provider payments. The donation of, requires a reconceptualiiation andl redesign of managed
a portion of the cost ,of care, virtually nonexistent in pri- 'care to meet its needs and respoAsibilities. This effort
will require the collective 'thinkinglof c~ild welfare ~an
mary or mental health, is' common in. the chi~d ~elfa~e,
system among voluntary, not-for-profIt agenCIes: Ifcur- , 'agement and line staff in both the pubhcand thepnvate
, rent provider payment levels are so low that the,cos,t ?f "sectors. The complexity of the issuesisJikely torequire
care is substantially subsidized by the private sedor;. ,more time and ,energy than most ~tates may be willing
, there will be less potential 'for saviAg money under manto allovy. Since it is quite possiblb .t~at tre decision to
aged, care.,"
"
,"
irrplement child welfare manage9care may occ~r wi!h•
Effect of the screening and inve'stigation ,process 'on , out the input, support, or concur;rence of publIc c1:lld
'cas~oad size. Currently inmost childwelfareagencies,. ' welfare administrators, ,it is crucial that this' plannmg
th(!1e is an informal relationship between the scr'een ing
begin immediately. Whether child welfare managed
a'nd inve;tigatio n process' and caseload size,'\'\1hen ,incare \vill produce savings is unknbwn, bura~ly effort to
take increases; screening' and investigatory'staff:" con- ' significantly charige the system t~rough managed c~re
tml" intake informally by <!pplying stricter standards'for 'for the purpose of cost savings should be accompanied
cases to investigate and ~ases to open. This may be'done , by a'n e(fort to impr.ove the systerh, If the only purpose
consciously or unconsciously, without a change 'in the ,of implementing managed care isi to cut costs,. there are
easier ways for the system,to acco~lplish that goal. Ma~
formal intake ct'teria-:-iust a SUb"t,Ie chang~ in ~ow staff
may'''read'' tl'1 ' Ituation. Neverthel~ssl ,thIS shift serves
aged care is a significant enough Jsystem, change that It '
informally tokl ntrol the caseload SIze. The number of
should not be undertaken unless its underlying goal and
phone reports not investigated,.or the nUmber of .cases" i;"tent is to achieve an-overall im~rovement in the child
',',... , , " I, ,',' " " PW
not opened,as a result of these mformal controls ,IS un-. ' welfare system.
known and likely varies from:agency to ag~l)cy ahd
from staff to' staff." .
,
Feild is n pnrtner at the Institl/tefor HlIl1lall Services
, Should a child welfare system privatize its ongoing " Mal1ngil1ll'llt, Bethesdn, Mnrylnlld,1 a ~ol1sllltillg,compnl1y
caseload through managed care .while, still undertaking.' 'that lOo;'ks {(lith ngenciesoll child we!fnre l11{//wge111el1t nnd
the investigation function, the public agency screening ',l1nl1ce isslies. She is n former {'xecut(ve director of the Soonl
and investigatory staff would have ,c:onsiderably less ,Sel:vices Adlllillistmtioll, Mnrylnndl Depnrtmel1t of Human
concern about the size of the caseload.,Private<!g·ency
Resourcl!s, Baltimore, nud afon/ler qeputy director for soCial
staff, paid out of someo'ne else'sbudget, wouldaddress
services nl/d income 11Inillfenance, Ohio Depnrtl1limt of Hu
ongoing· cases, Under this scenario, cowork~rs would' l1il111 Serl'ices, Colllmbus.
ji
not feel the impact of opening a higher percentage of
investigated case~ .. Hence, more case~ likely would be
page 52 for 1I0/e:' and 1'4<'1'<'11(<",
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·e 10,
PUBLIC
\~IElI:,\RE/SUMMER 1996
�j
. ,FAMILY TO FAMILY: RECONSTRUCTING FOSTER CARE
A 'Program of The Annie E. Casey Foundation
.
and
The States of Alabama, Maryland, New Mexico, Ohio, and Pennsylvania .
February, 1994
�The Annie E. Casey Foundation
The Annie E. Casey Foundation was established in 1948 by Jim Casey, a founder of United
Parcel Service, and his sister and brothers, who named the Foundation in honor of their mother.
, Today the Casey Foundation is the nation's largest .philanthropy dedicated exclusively to
improving the lives of disadvantaged children and families.
'
The Foundation is guided by the following set of principles which strongly influence' its work:
.
1.
Families play the single most critical role in determining a child's future. Public
policies and services must be redesigned. to support families in that role.
2.
More flexible service delivery, targeted to the particular needs of children and
their families, requires collaboration among all facets of the community ,
representing the interests of youth.
3.
More effective services for children will result from 'better uses of flnancial
resources, including the reallocation of funds toward services that intervene
,'earlier, that are community-based; and t.hat support parents and seek to preserve
families.
'
•
. '
<
Good data on ,the needs of families and children is essential if community services
are to be flexibly provided, while accurate data on the impact of family services
and supports is essential' if we are to, be able to hold public systems accountable
for the outcomes of their interventions.
The primary way in which the Foundation carries out its mission is to award grants to states and
communities that are interested in undertaking ambitious reforms of their child-serving systems
in order that they exemplify these same principles.
Family foster care, the mainstay of all state child welfare systems, constituteS a pivotal set
of services in need of such serious reform.' ,
�BACKGROUND
•
~l
Since the passage of the Adoption A.ssistance and Child Welfare Act of 1980' (P.L. 96-272),
fifty states have been required to provide supportive services which help families stay together'
and,when children have to be placed in foster care, to stress reunification with the family as a
primary' goal of services. This legislation established a legalbasis for the philosophy that the,
best place for a child to be raised is in a family environment, and that keeping children and
families together and affirming' the right of every child' to have a permanent home leads to the
best possible outcomes for children.
.
More than a decade has passed, and by their own admission public child welfare systems. in this
country still do not reflect these principles in practice--often because of enormous changes in the
broader societY over which they have no control. . There are more children iD. foster care, with
projections that the number will continue to rise, while the supply of family foster homes
conti~ues to decrease. Federal and state governments continue to spend significant portions of
their child welfare budgets on children in institutional placements, with family reunification and
preservation services still not funded to the extent nee~ed ..
.
.
The nation's public child welfare system's primary concern, in keeping with P.L. 96-272, should
be to assist in maintaining children with their families whenever possible and to enhance services
which prevent unnece~sary separations. When a family is having difficulty meeting certain needs .
of its children, the state's child welfare system ought ·to assure that everything required is done
.to help preserve that family, including the provision of necessary services and .assistance before
the child is placed away from home.
.
'.
.
.:' .
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e
There are emergency situations and other severe circumstances, however, that require the
separation of a child from his or her family. At such times, every effort should be' made to have
thechild live w:ith caring and capable relatives or with another family' within the child's own
cOlnmunity--rather than in a restrictive, remote, institutional setting. Family f~ster care should
be the next best alternative to a child's own home or to kinship care.
National leaders in family foster care and child welfare have come to realize, however, that
without major restructuring, the family foster care systein in the United States is not in a
. , poSition to meet many of the needs of children who must be separated from their families.
One indicator of the deterioration of the system has been the steady decline in the pool of
available foster families at the same time as the number of children coming into care has been
increasing. Further, there has been an alarming increase in· the percentage of children in
placement who have .special and exceptional needs. ,If the family foster care system is not.
significantly .reconstructed, the combination of these factors may result .in more disrupted
placements, longer lengths of stay, fewer successful family reunifications, and more damage
done to children by the very system which the state has. put in place to protect them.
Many states' child welfare systems are in severe crisis. State after state is experiencing serious
. budget deficits. Many states are facing class actiori lawsuits over the conditions 'of their child
a welfare systems. Such crises make this an opportune time for states to challenge themselves to
. . rethink the fundamental ro,Ie of family foster care and to consider very basic changes ~
�TIlE FAMILY TO FAMILY INITIATIVE
'iththe appropriate reforms in policy, in the use of resources, .and iIi program implementation,
family foster care can respond to the c~allenges of out-of-home placement and be a less
expensive and more humailechoice for children and youth than are' institutions or other group
settings. Family foster care reform; in.and of itself,.can yiefd important benefits for families
and children, although such reform is only one part of a larger agenda designed to address the
overall well-being of children and families currently in need of child protective services.
The FAMILY TO FAMILY Initiative was designed in consultation with national experts in
child welfare. In keeping with the Annie E. Casey Foundation's guiding principles, the
framework for the Initiative is grounded in the belief that reforms in family foster care must be
focused on changes that support a more family-centered approach that is: (1) responsive to the
individualiZed needs of children and their families, (2) rooted in the child's community (or even
better the child's neighborhood), (3) sensitive to cultural differences, and (4) able to serve many
of the children now placed in group homes and institutions.
The FAMILY TO FAMILY Initiative is an opportunity for states to reconceptualize, redesign,
and reconstruct their foster care system to achieve the following new systeDi~wide goals:
1.
. To develop a network of family foster care that is more neighborhood-based,
culturally sensitive, and located primarily in' the communities in which the
. children live.
.'
2.
To assure that scarce family foster home resources 'are provided to all those
children (but to only those children) who in fact must be removed from their
homes.
3.
,To reduce reliance on institutional or congregate care (in hospitals, psychiatric
centers, correctional faciiities, residentiai treatment programs, and group homes)-
, by meeting the needs of many more of the children currently in those settings
through family foster ,care.
.
4.
To increase the number and quality of foster families to meet pr<?jected needs.
5.
To reunify children with their f~ies as soon as. that can safely be accomplished,
based on the family's and children's neoos--not sin?-Ply .the system's timeframes.
6.
To reduce the
7.
To decrease the overall number of children coming into out-of-home' care.
len~
of stay. of children in out-of-home care.
With these goals in mind, the Annie E.' Casey Foundations frrst selected' and funded six states
for a nine-montn period to carry out a strategic planning process. States fundedthi'ough this
an,itiative were asked to develop famlly-centered, neighborhood-based family foster care
~ervice systems within one or more local areas. Local communities targeted for the Initiative
were to be those which have had a history of placing large numbers of children out of their
�homes. This site or these sites· would then become the fIrst phases of implementation of the
newly conceptualized family foster care system throughout the state and (hopefully) across the
country.
The Foundation has funded five states" FAMILY TO FAMILY plans for
implementation beginning September, 1993 (Alabama, New Mexico, and Ohio) and two states
(Maryland and Pennsylvania) beginning February. 1994 .
.The new system envisioned by FAMILY TO FAMILY will:
•
better screen children being considered for removal from' home, to determine
what services might be provided to safely preserve the faniili and/or what the
needs of the children are;
•
. be targeted to bring children in congregate or institutional care back to their
neighborhoods;
•
•
e
involve foster families as team members in family reunification efforts;
become a nefghborhood resource for children and families and invest in the
.capacitY of communities fro~ which the foster care population comes.
The Foundation's role ~ been to assist states and communities with a portion of the costs
involved in both planning and implementing innovations in their systems of services for children
. and families, and to make available techhical assistance and consultation throughout the process.
The Foundation will provide funds for development and for transitional costs that accelerate
system change. The states, however, are expected to maintain the dollar. base of their own
investment and sustain the changes they implement when Foundation funding comes to an end.
The Foundation is also committed to accumulating and disseminating both lessons from states'
experiences and information on the achievement of improved outcomes for children. We will
therefore .play a major role in seeing that the results of the FAMILY TO FAMILY Initiative are
actively communicated to all the states and the Federal government..
The states selected to participate in -the planning process are being funded to create major
-innovations in their family foster care system--to reconstruct rather than merely supplement
current operations. Such changes are certain to have major effects on the broader systems of
services for children, including other services within the mental health, mental retardation
/developmental disabilities, education, and juvenile justice systems, as well' as the rest of the
child welfare system. In most states, the foster care system serves' children who are also the
responsibility of other program domains. In order for the planning process to be successful (to
ensure, for example, that children are not inadvertently "bumped" from one system into
. another), representatives from each of these serVice systems will need to be involved in every
stage of planning and implementation at both the state and local level. These systems will need
to commit to the goals of the Initiative, .as well as redeploy resources (or priorities in the use
of resources) and may have to alter policies and practices within their own systems.
a As a result of the reform, family foster care services should also become a neighborhood
. , resource for children and families, investing in the capacity of communities from which the
foster care population comes.
.
�,
.'
e
In summary, the F AMILY TO F AMILY Initiative is founded on a few key value judgments:
Reforms in family foster care must be directed to producing 'a service that is less disruptive to
. the lives of .the people it affects, more community-based and culturally-sensitive, more
individualized to the needs of the child and. family, more available as an alternative to
institutional placement, and in general more family-centered .. Further, an enhanced family
foster care system also can be consistent with an increased emphasis upon developing alternatives
to out-of-home placement for children in the first place. Family foster care can be constructed
to serve as a less restrictive setting for children that can speed reunification and assure that out
of-home placements which are made are not undertaken until all reasonable efforts to preserve
families have been explored. ,
.
THE ·REFORM. EFFORT
The chart on the following page attempts to depict graphically the reform design of the F AMILY
TO FAMILY Initiative. THE FAMILY FOSTER CARE SYSTEM in each of the Initiative
states is seen as the key entry-point for reform. By targeting this portion of the state's children
services system as a focus for change, we anticipate a rebuilding effort for family foster care:
In order for this rebuilding to be successful, new and better training, recruitment, retention, and
support systems will need to be put in place within the family foster care system. Foster care
workers will need reasonable case loads if they are to be available 24-hours a day, 7-days a
week. New treatment foster homes wHl need to be developed. .Foster families' roles need to
be enhanced to make them part of the service team and to make them available as service
resources to birth families.
.
,
If the family foster care system is reformed, we believe that many more children currently
served in institutional and' group
c~re
will be able to be served in family foster care.
However, if only family foster care is enhanced, real reform will not have occurred. Family
foster care can only be truly reformed if the child welfare and child protection systems are.
reformed as well. For this enhanced reform to occur, better gatekeeping systems need to be put
in place within the child protection system, to make sure that oniy those children who must be
removed from their families are entering the foster care system. Otherwise a more robust family
foster care system will actually attract higher rates of placement. The child welfare system as'
a whole, therefore, will need to playa role in· the reform as well: comprehensive child and
family assessments, will need to be put in place, family preservation efforts increased,
community-based services created, etc.
e
If these systemwide reforms occur, less children will be removed from their families. Those
children who must be removed will be better cared for and will be in foster families within their
own communities. . Reunifications will occur more quickly, and 'the pattern of neighborhood
services available to families at risk will improve. These improved outcomes for families and
children can only occur, however, if other service systems take part in the reform as well.
Mental Health and Substance Abuse agency services, for example, will need to be made
available to families at risk in a timely manner, .ifplacement is to be avoided or reunification
to occur more quickly. The FAMILY TO FAMILY Initiative, therefore, envisions family foster
care as ·an entry-point to proader reform of the entire system of services for families in each
state.
�In~
e
J.1AIVIILll'U fi'AlVIILY K~.lfUKM U~Sl(jN
e
e
HEALTH SYSTEM
MH/MR SYSTEMS
Reform
Impact
~
JUVENILE JUSTICE SYSTEM
DRUG & ALCOHOL SERVICES
~EDUCATION
SYSTEM
.
FAMILIES AND
CHILDREN AT RISK
Reform
Impact
CHILD WELFARE
SERVICES
,
Reform
Impact
FAMILY FOSTER
CARE
Reform
Impact
.....
,
INSTITUTIONAL
GROUP CARE
--
• Less children removed
• Less time in placement
• More families reunited;
·sooner
• Stronger neighborhood
services and stronger
. neighborhoods
•. Bett,er gatekeeping/
screening for
placement.
• Comprehensive child/
family assessment
• Family preservation
services
• Realistic reunification
goals
.
• Agency takes lead in
reunification work.
., T ruly communi ty
centered services
• Enhanced training. for
staff
• Neighborhood Foster
Care
• Foster Families team
w/birth families
• Enhanced training for
foster families
• Reasonable case loads
• Fewer cross cultural
place~ents
.
• Fewer sibling splits
• Adequate reimbursement
• Better recruitment/
retention
• Enhanced specialized
family foster care
-~
....... - .
• Less children in group
• Reduction in lengths
of stay for children
in group care .
, ~
�e
THE PLANNING EFFORT
The chart on the following pages attempts to describe how each state's planning effort might'
'
unfold in FAMILY TO F AMILY. '
The Foundation provided up to $75,000 for planning purposes to each of the states involved in
the Initiative's planning effort. Between$eptember of 1992 and January 15 of 1994, the various
states worked to develop their own unique plans for implementingFAMILY TO FAMILY.
During that same period, the Foundation provided the states with our understanding of the status
of foster care across the country and our, vision, of how refomi could occur. A range of
technical assistance was also offered to each state, so that it could develop the kind of
comprehensive plan needed to achieve real reform in its family and children services system.
Working through the state's family and children serYices system leadership, Foundation staff
, directly supported the states' strategic planning efforts. Each state formed an interagency
planning group' involving key leaders from all those departments ,or divisions who play a role
in services to families and children. The responsibility to develop a plail for substantive reform
, of the system was to be vested in this group (and especially its leadership) by the stilte's
governor, legislative leaders, etc. The commitment to reform and the vision for what such
reform would entail' had to come from the very top.
e
Just as important, however, is the involvement of local community leaders in the planning
process. While state 'leadership need to, offer direction and provide the flexible funding and
policy changes for reform, the day-to-day agenda for change needed to be designed at the local
level, Further, while programs were to be designed and funded at tIie county/coinmunity level,
the deCisions about actual serVice delivery should be brought as close to the
community/neighborhood level as possible. Throughout the planning process, mechanisms
should be developed (and continually improved) to ensure that there is meaningful and ongoing
involvementof those most directly affected by family foster care in the design and improvement
of that system.'
'
�e
GOVERNOR
V
LEGISLATURE
~
SECRETARIES/
COMMISSIONERS
JUDICIAL
. LEADERSHI P
Inform.
Kecomm.
INTERAGENCY
STATEWIDE
PLANNING
,
I
I'
•
•
•
Leadership
Authority to change
Policies follow the
vision:
a) flexible
bi priority front-end
Regulations track
policies
Staffing supports
goals
cross-system collabora
tion
•
•
•
COMMUNITY / .
COUNTY'
PLANNING
Inform.
Recomm.
Resources
f---,Power
Qualit.y
Control
Resources "
V1s10n
State's Vision
• Commitment to Change
• Commitment to
• system reform cross• Commitment to
cultural responsive
ness
e
THE FAMILY TO FAMfy PLANNING EFFORT
/
Inform.
,,,.,
COMMUNITY/
NEIGHBORHOOD
PLANNING
-
.....
1
Qualit.y
Control
•
•
•
•
•
•
•
Family Preservation
policies/programs
Gatekeeping Systems
Family assessment
Caseloadsizes
r'educed
Interagency conflicts
mitigated
Service Integration
Training
•
•
Responsive to
changing community
needs'
•
~
Neighborhood-based
services
Community
ownership
�STRATEGIC PLANNING, TECHNICAL ASSISTAN.CE, AND SELF-:EVALUATION .
The chart on the following page summarizes the. various kinds of assistance which the.
Foundation made available to each state in the development of its plan for implementing the
F AMILY TO FAMILY Initiative.
.•
.
.
The Annie E. Casey Foundation staff assigned ~o the Initiative will be available to each state for
guidance and advice regarding strategic planning and the goals of the Initiative. Further, the
. _.- Foundation..has contracted with the Research Triangle Institute to help states design a reform
plan that they can self-evaluate a~ that reform is implemented--so .that mid-course corrections
. can occur ina timely manner throughout the Initiative. RTI will also be conducting the overall
. evaluation of FAMILY TO FAMILY.
.
Metis Associates aSsisted states in their efforts to determine what :they already know from their
current management information systems .about children and families at risk, and what more
they needed to know.
. .
.
'
.'
'.'
e
The Center for' the .Study of Social Policy was avaiiable to assist states to develop a plan for
fInancing the reform, both during the initial (PhaSe One) implementation stage ina few .
communities and statewide after the initial period.
The Center for Research and Public Policy was· available to teach state leaders how to listen to
what their systems are· telling them about what's working and what's not in the reform effort.
The Center' for Family Life in Sunset Park, Brooklyn was available for· visits from state and
community leaders interested in learning how neighborhood family services work, including
family foster care.
�e'
e
TECHNICAL ASSISTANCE PLAN
IPLAN~i~G ;H~~
PHASE I IMPLEMENTA TI~N] ,
•
r
r~TATE;~~~ I~;~EMENTA~IO:;J
Who is Target Population?
Community Services for Families
What are Their Needs?
Neighborhood Foster Care
Resources Available
Gatekeeping
Gaps in Services
Therapeutic Foster Care
Take Successes Statewide
Trend Analysis
Training for Staff
Learn from Failures
(METIS)
Trainirig for Families
Who are Stakeholders?
Family Preservation
What is Their Experience
(CRPP)
On-Going Assessment by
, Agency of Stakeholders Views
On-Going Community Assessment
Implementing Plan
Financing Available
How to Develop and Implement
a Plan to Finance the Reform
(CSSP)
>
.'
�t
•
THE OUTCOMES OF FAMILY TO FAMILY
....
States participating in the FAMILY TO FAMILY Initiative have committed themselves to
achieving the following outcomes:
1:
A reduction in the number of children served in institutional and congregate care.
2.
1\ shift of resources from congregate and institutional care to family foster care
and family-centered services across all child and family-serving systems.
3.
A decrease in the lengths of stay in out-of-home placement.
4.
An increase in the number of planned reunifications.
5.
6.
e
7.
. A decrease in the number of unplanned re-entries into care.
A decrease in the number of placement disruptions.
. A reduction in the total number ofchildren served away from their own families.
Filially, as a result of the reform, family foster care services should also become a neighborhood
resource for children and families, investing in the capacity of communities from which the
children are currently coming into care.
�-i.
SYSTEM CHANGE AT THE NEIGHBORHOOD LEVEL
Creating Better Futures
for
Children, Youth, and Families
DISCUSSION DRAFT
Prepared by Frank Farrow
Cenur for the Study a/Social Policy
jor tJu
National Uadership Symposium
on
OJmmunity Strategiesjor autdren.and Families:
Promoting Positive Outcomes
February 14-16, 1996
�SYSTEMCRANGE AT THE NEIGffBORHooD LEVEL
Creating ~ Fun.res for Children, Youth,and Families
A young mother in Las Angelis is reponed to Child Protective Services .
. hen her eigJu-year old daughter misses many days ofschool,.· and anives
w
one day 'With strap 1l1.IlTks on her legs. An investigation confinns excessive
discipline,' bUt instead ofreceiving numerous visits from a child protection. .
worker, the mother is Jrelped to join a group at a nearby church which has
opened a drop-in family resource cemer. A therapist from a recently
• opened, minority non-prOfit agency in the neighborhood works Wilh the
mother, her church; the mother's aulU, and ajob training program in the
neighboriwod lO assure good after school carefor the daughter and a work
. study program/or the mother... ·
.
A young Couple in Ced£lr Rapids, Iowa, falls far behind in their bills when
, the· husband is liJid.ojfwork. His drinking increases; and the tension in the
family begins affecting their three young children. A friend in their
neighborhood association (m 'Which the husband has participated by helping
£0 clean up a nearby vacant lot), observes their difficulties and tells lhe
husband about the help availabiefrom the family resource center which· the
neighborhood associaJion helpedlo sIan. Thefamily receives cash to pay
bills deb! management counseling, and [he husband is hr;.lped to develop
a new skill, leading co a new job...
.
I
A teenage mother in Louinille, Kentucky," drops ow. of school afier the
birth'o/her seConichild. She becomes' more and more isolated, and copes
. less well with the needs of her todtller and the new baby, A coinmunicy
palice officer suuioned at the ne.ar1Jy NeigJzborhood Place alerts colleagues
also starioned there -- a nurse' a:nd a sodal worker -- and' within three
months the young mother is reenrolled in school. She has a good child care
. arrangement provided by a neighbor's day care home andfwuled through
the AFDCIJOBS worker stationed at Neighborhood Place, with "."llOm she
regldarlyvisits to chat about her life ...
Widely separated by goography these three farnllies' share some similar experiences.
common bOnd is that they are all· being helped by people and places they know well:
relatives, their faith community, a drop-in family center, a neighborhood school. For
parents, this assistance from familiar faces and places in their neighborhoods seems to
happened in the natural course of events. '
j
.
One
their
these
have
In fact, these resources are not "there" for the fanlilies by chance. Los Angeles, Cedar Rapids,
and Louisville are among a number of places around the country that are deliberately creating
what can be called .neighborhoOd nernJorks offamily support. These networks include public
sector and private sector entities, service providers and other community organizations, working
�together in' ne~ ways to make life better for families and Gh-ildren, Originating for different
reasons, these networks share a common premise: that,condirions will not improve for many
families Unless they receive thehelp they need closer l<? home and in a form that is attuned to the
real conditions in which they live.
This paper describes' several approaches to neighborhOCld support networks that are emerging
around the 'country. We believe such strategies must be an important part of a broader movement
to improve conditions for families and children in this country, for several reasons. .
First, neighborhood-based strategies fill. an impOrtant gap that now exists in the "reform· work
underway in child welfare, education, mental health, health, ,and other service systems. Most
refonners' attention has-been at the program level or, at the opposite extreme, on matters of broad
policy and fiscal change. What is missing is knowledge and experience about how these two
levels of change come together to ,alter the immediaLe environment where families acrually live.
Neighborhood-based strategies try. to fill that void.
Second, neighborhexxi-based strategies are needed to ensure ~t services are family-driven, linked
to natural networks of support, and adapted to individual family needs and resources. There is
an emerging understanding that these'service characteristics. are critical attributes of effective
frontline practice. Servi~ designed and managed from outSide do not provide this discretion and
adaptability in working with individual families. Moreover, they do not create an ownership o~er
the services that workers need -to feel to problem-solve with the families they serve. Services
designed and implemented at the neighborhood level are needed in order io connect with and build
upon natural networks of support for families.
Third, neighborhood-based strategies are important for organizing support for a movement to
improve the conditions .affecting families and children. For most peOple,mobiliz~g on behalf .
of this· issue will be simpler if they believe that it is about changing conditions in their own
community. One reason tllat there has been so little popular support· for dramatic action to
improve children's well-being is that this cause has been too abstract. The call to action seems
to be on behalf of "other people's children." A focus on neighborhood-based strategies helps
clarify that this is about "my children," in "my community."
Finally, neighborhood-based strategies maybe iinportant so that success can be showrt sooner
rather than later. Manyof the changes that a movement would seek on a national level will
require decades to complete. Results can be shown for individual families in a neighborhood in
a matter of mooths, and for a neighborhood as a whole in a matter of years. Focussing on "what
works" at the neighborhood level can provide a showcase for successful strategies. This sense of
'accomplishment is one of the biggest gaps'in the current reform world ..
This paper provides a brief overview of neighborhood networks of support. It is organized in
three parts.
�Page 3.
•
TIle first section examines the rationale and core characteristics of a neighborhood suppon
networks;
•
The second section illustrates this approach with short summaries-of three cqmmunities'
. contrasting approaches;
•
The third 'section identifies several suppons that must t>e in place if the development of
nt?ighborhood networks is to grow in more communities.
I.
WHAT DISTINGUISHES THE NEIGHBORHOOD NETWORK APPROACH?
.
.
Neighborhood networks of family support are deIiherate, ongoing, and structured arrangements
at the neighboriuJod level among public' and priVIJ.U sector·o,.gaiuzations and infomud and
fomud supports, for the explicit purpose oj responding more immediately and flexibly to
families' needs in order 10 improve the ~ safety,· educational success and overall well-being
o/children.
.
. The essential part of this definition is the strong commitment to "place that distinguishes these
service delivery approaches. Focussing on neighborhood is a way' to ensure that assistance is
provided to families wmm they need, where they need it, and }ww they need it.
h
Efforts to locate Services in neighbOrhoods are not new, 'of coUrse. Most of the major social
service change initiatives of the past thirty years have given 'at least rhetorical commitment to this
goal. For example, the Great Society programs of the sixties had an explicit neighborhood· focus;
the "servke integration" projects that proliferated in the 1970's and early 1980's often incorporated
this direction; and more recent efforts .such as the Enterprise Zones and Empowerment
Communities reflect a strong value on "'place-based strategies." Most past work to develop
neighborhood based services, however,has suffered from serious weaknesses, in three important
ways..
First, past efforts uSually focussed on individual programs or collections of programs, rather than
. on trying to bring many sources of support ina neighborhood together as a more effective system..
For example, much of the ncighborllood focus in the past has been on CQ-,locating .agencies in the
same place, or on developing multi-service centers that bring multiple .entities under the Same
roof. Although there is nothing wrong with this approach, experience has shown that these
.changes by themselves produce little.
.
Even more important, past neighborhood-based strategies usually created new programs that
existed alongside the major public systems of suppon; but rarely tried. (let alone succeeded) to
transfonn or incoIporate those systems.. Since most past efforts were short-term, project-oriented
efforts, the failure to engage public child welfare, mental health, income support, employment and
�Page 4
training, and other systems in more than a token way was understandable. But the willingness to
create parallel systems of neighborhood services also doomed these efforts to limited success. The
reality is that the major public systems control important resources, have compelling mandates)
and affect many families in profound ways. They must be an integral part of any neighborhood
system, which requires transfonningthese systems to operate in a way which is genuinely useful
for neighborhood reSidents.· For this reason, .in many oommunities the development of
neighborhood support networks is part of a broader reform agenda at the stale and city/county
level aimed at transfonning'the mainline systems so they operate in a way which is genuinely
useful fOr neighborhood residents.
flaw
Put another way, a
in past neighborhood-based efforts has been, ironically, thal they often
._- -·"·Tocussed only at the neighborhood level. The reality is that what we· think of as "neighborhood
level" services are a mix of public and private support with linkages'to; and direction from,
Outside the neighborhood. These external ties can be as important as the connections within the
. neighborhood. Given the intergovernmental complexity of current funding and delivery systems,
it is not possible for a neighborhood to put together its own system of supports without policy,
fiscal, and personnel changes at higher levels of government. TIlls creates a fundamental
challenge: many of the key decisions about a neighborhood-based·servjce approach must be made
by policy makers and, adminIstrators who have probably never set foot in the neighborhood.
e.
Seen in this context, the developmentof neighborhood networks offamil)' support becomes a
complex task and must involve higher levels of government. Xt involves a host of changes in
service delivery, from a ~sea .change" in frontline practice to new ways of organizing agency staff
and offices. It requires innovation in fmancing arrangements, so that funds provided to
neighborhood-level staff do not inadvertently subvert the goals that the network has set for itself.
And ultimateJ.y, this approach requires that systems of accountability and governance be
redesigned as well~l Viewed from this perspective, the new strategies which·some communities
are developing could best be described as Ifsystems change at the neighborhood level If because
. these strategies embOdy all the component~ of system change~ and do so within a small,
identifiable geographic area.
Experience with this "new breed" of neighborhood-based service delivery is still at an early
stage- too early to identify hard and fast Mdo's" and "don'ts" of this approach. However, from
the limited experience that does exist, it is possible to suggest a number of characteristics that
lin many communities, new local governance entities are being formed'in pan to heip create and
suStain the kinds ofuneiihborhood level changes" described in this paper. Typically. these entities cover a
city or a county. !bey can be particularly effective in bringing about changes in the formal service
systems at the local level. Since stal.C agencies or statewide interagency structures cannOI work directly
'With hundreds of neighborhoods, community-wide governance entities are an essential intermediary
between the neighborhood and the State.
"
�Page 5
seem
to define this approach, and that provide at least a "working hypothesis" of the key
components of a neighborhoOd network approach. These characteristics are as follows.
1.
, Neighboriu)()(I based networkS bringservil:es and supports cwse to families, wcated in
places that are welcoming, accessible, arullikely to be used. As noted above, "place
is important to these networks, but sheer proximinity of services to families is not enough.
Tp.e real estate adage - Io<l0C3.tion, location, location" - may apply here. S~ces and
supports must be located and administered to families in places that are comfortable for
families, not intimidating, and that communiCate that these resources are part of the
ft
neighborhood .
2.
3.
NeighJxJrlwod ndWorlcs arebuik around or im'olve the community's own organizations,
and engage natural helping networks as supports for families. A major shift in these
approaChes is that much of the contact with families cOmes from entities that already exist
in the community: 'schools, churches, neighborhood organizations, ,and other groups that
are trusted by residents. This means that these entities must take on new roles. In
addition, these strategies' rely on explicit engagement of natural helping
networks - extended families, friends, neighbors, clergy - as the way to support families
in a sustained way.
Neighborhood networks involve dT'O.11Ul1ic chan e in the 0 era.tWn of public sector
mainline Systems. This is a critical litmus test of these new arrangemen . Do they':::;;
. change the frontline practice, staff deployment, and expendIture patterns 0 traditional
public systems, particularly the income support, mental health, child welfare, health, law
.enforcement, recreation, and employment and training systems?' In almost all
communiti~s,these systems need to look, "feel," and operate in a different fashion if the
major resources they represent are to be available to families the most productive way
possible.
. '
A\.. . . .
in
4.
Neighborhood networks often involve a new set of interactions among workers which
could be calkd "radical tea:ming ~ A common factor in most of these approaches is a
redefinition of frontline staff roles that comes from professionals of many systems working
together and joining with other neighborhood people in helping roles. This goes far
beyond the usual "joint staffings" of public and private agencies, and instead teams workers
so closely that workers' roles begin to change. Workers see themselves as team members,
and stnt doing "whatever it takes" for the ream to succt:.e.d, rather than clinging to a limited
definition of their. professional role. ProfeSsionals partner with community workers in new
ways that recognize the need for both professional and experiential expertise. Mutual aid
and self-help groups and activities become an integral part of the service system reforms.
�Page 6
5.
Nl!igh.horlwod n.etworlcs serve as a bridge between public sedor involvement (educmum,
social· work, po1idng, .etc.) with children, yolfJh, and families and neighbor!U)od
1tUJbilizPJion aruIadvocacy. They constitute the . locus around which the "helping
. professions" provide needed support. At the same time, they help in community-building "
and the strengthening of natural networks of support by providing a locus for residents to
congregate, advocate,
mobilize.
and
6.
Neighborhood. TUtWorks offer residents additional organizatUm activities and
opportunitil?s for personal and professional advancement. They create multiple avenues
for participation, including emplo'yment possibilities within their own organizational
settings. They help establish career pathways that enable neighborhood residents to take
on successively greater responsibilities and benefits withinthe network and the larger
community: In ShOll; these networks should model, within their own boundaries, what
the larger society must do to enable neighborhood residents to succeed.
7.
Neighboriwod networks assume that family support must be universally available, with
specialized help for Special needs in addition· to these supports for aU families. Some
neighborhood networks focus on specific neighborhood needs. Over time, however, most
adopt a broad-based mission of support for all families, with more intensive or specialized
help available for families who need it. The overall orientation is one that emphasizes
building on a neighborhood's assets; promoting the resiliency' of each child and the
of each family; and that refognizes that all familieS need support at some point,
. and that a commu,nity should provide that supPOrt.
capacitY
8.
Pi.n.an.cingarrangementsfor neighborlwod networks sJwuld (a)promote·morejle:xihilitJ,
in service planning at the frontline~ and (b) create incentives for earlier support.s and
interventions. The basic shift is that financing for these netWorks is not done "service by
service", but rather on a capitat:ed baSis per family, or for a core support network which
then has discretion about how best to deploy resources. Some network financing seeks to
fund "strategies for results", with the justification tor the funding being the results achieved
rather than the precise ingredients of the strategy.
·9.·
'
Neighborhood networks suggest that accountability and governan.ce Structures need to
(a) be redefined on die basis·o! geography, rather than on the basis of service iUJm.ain
or agency "tuif~ and (b) have substantial neighborJwodo~nership. This is an
in
area
which even the existing neighborhoOd networks are still evolving. However, experience
suggests that for these networks to be sustained, their governance and oversight
arrangements will have tobe shifted away from agency-by-agency accountability, and
toward community-wide governance structures that remain accountable for overall well
being of children and families"
�.'
Page 7
.
.
In addition to these characteristics, several of the emerging nelghborhood networks share other
attributes which may eventually turn out to be fundamental components of most of these
initiatives. For' example, several of the networks give consistent attention to the spiritual
dimension of serviceS, recognizing (in a way traditional soci.3.1 services have avoided) that
. addressing' this dimension of an individual's experience tan be an imJX)rtant key to changing
behavior. ntis openness to non-traditional approaches may tum out to be an importarit part of
h9W such networks succeed with families who have.notbeen helped by traditional services. As
more ex~ence is gained, it will be easier to identify additional factors that contribute to
neighboihood networks' success .
. Using the characteristics identified above as a lens, it is interesting to examine briefly different
approa9hes to creating neighborhood networks of family support .
. ll.
HOW DO NEIGHBORHOOD NETWORKS O~ERATE?
Los Angeles County, Louisville, KY ,and Cedar Rapids, lA, are pursuing different approaches
to developing neighborhood networks of family suppon. Their differences illustrate how flexibly
(and creatively) the characteristics identified above cin take shape based on neighborhoods' needs .
. U ls Angeles' netwOrks began when the COUJity Department of Family and Children '5 Services
(DFCS) developed its approach to family preservation inthe early 1990·s. Viewing family
preservation as a range of services and supports rather than a single program, the Department
sought to implement these services by' working with agel;lcies and organizations that were closer
to the families that needed help than were traditional· seIvice providers. The Department
developed a Neighborhood Family Preservation Plan as a way to start a new type of partnership
with organizations already working in target neighborhoods.
Now, after t.hree years of
implementation, there are many such networks in Los Angeles, and they are positioned to be a
service delivery infrastructure that tackles a range of community issues beyond family
preservation.
Los. AngeJe.s ' family preservation ;letWOrks are based on a contractual arrangemenJ
between DFCS and groups 0/ private and public agencies widiin ea'ch of nwnerous
community areas within the cowuy.' Priority in developing the networks was given to
neighporlwods, having the highest incidence 0/ removal, of children from their homes
because ofchild abuse. and neglect.
. '
The basic structure. oj the networks is as follows. The County DepamnelU invites a
neighborhood to form
nerwo'rk by identifying dollars that are available Jor tluu
geographic areafor the purpose ofworldng Withfamilies slr~ngthen their capaci.J:y to
maintain children safely at home. A core list of "required services" is id.enrified by the
a
to
�Page 8
Department, with the expeclOIion that neighborhoods will a.dd w this list based on their
own needs.
. Public and privale agencies, sCMoI,churches, and other orgarnzationswithin the
community then come lOgelher io decide how they will fonn a network to accept tJze
Depanment'schal/enge. A lead agency is designated lJy the community agencies
themselves, and the roles and responsIbilities ofeach member is defined. Some agencies
serve as case managers; others provide specijicservices. All are expected to advance the
. common goal ofsupponing and strengthening vulnerable families in some way.
After the network and the DepdnmelU agree on a cOntract, with specific perfonnance
expectaticns and agreed upon finandng, the n.eJW()rk implements its services. the network
has alnwSl wrai flexibility to arrange tIs service provision, as long as (he families referred
from the Depanment are served and core servicesare available. The prevailing approach
is one that 'lwaps arowui"se1Vices to respond to individual needs, rather than providing
any pre-packaged service model to a family.
.
Fundingfor the netWOrk is provided on a capitaIed basis, based on thelUUTlher offamilies
served and lhe level of severity ofihe families' needs. The nerwork receives the agreed
11fXJ')juiu1mg level as long as iE meets basic perfonnance e.xpecuuions. Wirhin the.dollars
received; the nerwork
reallocaIe dOllar:samong its members. as needs arise. Funds can
beshiftedfromintensive services wearlier intervenIions if necessary. or from one provider
to anOther ·based on actual service UliZtzation.
. . .
can
The DepartmeJ1J and the necworks are aware ofthe· ongoing need to build community and
provider agency capacity. Prior tojwuting a network, the Depanment makes available
an extended period (often a year or longer) of community organU.tuion, so thit
.
.
relationships among agencies can be cremed and potential nut issues resolved. Training
is an ongoing process aI all stages ojnetWOrkdevelopmeru.. And, recognizing the unusual
nature of much ofthis work, the lead agencies ofall ofthe networks meet regularly with
the Depanmeru. to fine-time this approach, and delennine how to strucwre their joim work
mcSI effectively.
Several aspects of Los Angeles' approach are Wo.rth noting. First, these netWorks are
accomplishing one of their'primary objectives: they are engaging and building o.n the strengths of
many resources which have not traditio.nally been a part o.f the publicly funded service system fo.r
vulne.rnble families. Churches, schools, minority o.wned and administered neighborhood agencies,
and community develo.pment o.rganizatio.ns are all key members o.f these netwo.rks. Thus, the
fro.ntline o.(support fo.r families tends no.w. to. be people who. have Io.ng lived andJo.r wo.rked in
these neighborhoods, ?Dd who. have a broadly-based stake in helping these families succeed and
these neighborhoods succeed.·
.
�Page 9.
The operating relationships among network members has created a much greater \.lse of natural
helping netWorks. Professional agencies are more likely-to call on the "house of pf3yer" on the
comer than in the past. Support groups and family resource programs abound as part of the
networks, with less reliance on traditional therapeutic counseling, and more use of peer support.
The network can respond more i.mffiediately when a'Specific problem becomes more severe, .using.
its funds to expand, for example, a substance abuse program if necessary, rather than having to
¥o through long approval processes for a ne..y use of funds.
.
"
.
Los Angeles' funding arraIlgements for the network take advantage of the fundingincenrives
created by capitated financing. Because the network members can project how much funding they
will receive for a specific group of families" they are free to consider how they can best "squeeze"
thanunount to finance priority services, particularly more preventive services.
.
.
.
.
.
, TIle results of the family preservation networks have been impreSsive even in these early years of
implementation. Judged by the.perfonnance standards set forth in their contracts, the networks
have produced. results forthcir neighborhoods which appear to be better than the results for
neighborhoods without networks. For' example, rates of foster care placement in the netWork
neighborhoods are Significantly lower than in "non-network~ neighborhoods, with no discernible
loss in child safety or other indicators.
are
creating a system of family services in these
Equally as'impressive,h6wever, the networks
neighborhoods which increasingly share a common set of values and are developing a
comprehensive set of lihked professional skills. Proponents of this approach in Los Angeles
believe that the n~orks can~ as a result, be even more important for these neighbothoods in the
future. This same grouping of entities' could devote its joint' efforts to other neighborhood
priorities t ranging from promoting the self-sufficiency of fanillies to improving the educational
success of child!en in their neighborhoods. In this view, the fact that.the networks began with a
focus on family preservation wasjusttheir "entry poinL Over time, the networks are expected
. to address a wider range of issues.
A
, I..ouisville"KY,. has used a very ~erent approach in starting to create networks of neighborhood-.
based family supports. Louisville's strategY,known as Neighborhood PLace, involves dramatic
decentralization of publie sector agency staff serving families and children ,into neighborhoods,
where staff are located together and begin joining with community-based organizations and
informal supports in new ways. It is led by the school dis'triet, the city, and the county
(Jefferson), and neighborhood councils; neighborhood networks will eventually be developed
..
. throughout the county.
Louisville developed its Neighborhood Place strategy in pan to help communiry sclwols
have higher rOIes' of success in educaJing children. The managers of {he 17/,(ljor public
sector systems in Louisville - inclUding publiC welfare, meruai health, heaZlh, child
welfare, employmenJ and training, and income suppon. in addition to the school sysrem
\
�Page 10
recognized thai many children cannot succeed in scJwol wzless they and the.ir families
~.
receive many other types ofsuppan.
1hejifst NeighborluJod Place was situated at a neighborJwod school. Staff/rom all the
other major public agencies were desigruued to be redeployed to [his school, andw
provide (heir services to the neighborhood from that base. Understanding [hal the goal
m:zs to change what agencies did as well as where they did it, these initial staffmembers
~re given a year to plan the new ways'in which they lVOuld use their sldlls once they were
Womng logeiher. Thus, teachers, nurses, social workers, income maintenance workers,
the community police officers, and Others w/w either were already, or were soon to be,
working together in the neighborhood designed the policies. procedures, roles, and
responsibilities by which they would do so.
Since that first Neighborhood Place opened its doors, theSIaf! there believe [hal the entire
l1A'1Y they 'KJOrk withfamilies has dw.n.ged. They now see themselves as teamed wich each
other and with families in an enIirely different way. Professional roles are nwre flexible,
with the decision aboUt '<who sJwuld do what" based on what makes sense, rather than
preexisting professwnallabels. Thus, the nurse may help with the daily decisions chaL are
more traditionally a social work junction. And the police officer may provide some ofthe
outreach to afamily !Izar. would othervvise bedone by (1 public health nurse.
The Neighborhood Place sLTalegy is overseen by a nuuzagemenr group made up of direcLOrS
or senior siafffrom all the public agencies involved, as well as county and ciry government
and the United Way. Meeting every week, this group has provided 1uuuis on "oversighl,
planning • . and problem-solving for this initiative. With (he success of the first
Neighhorlwod Place. this group developed a pian to have one such place as the hub ofa
neighborhood delivery system lhroughout Jefferson County. ' The second NeigJzborhood
Place opened in December, 1995, and a schedule jorfunher implememarion to [he
expected 16lieighborhood syslems is being developed.
The cornerstone of Louisville's s~tegy is an assumption tha.tthe major public agencies will
redeploy and decentralize large numbers of their staff to neighborhood settings, and will team
these staff with their public sector colleagues and with neighborhood organizations. The hoped- .
for result is that staff identify increasingly as part of a team .and as part of a neighborhood,
(Interestingly, staff in the first Neighborhood .Place cite as one of their perceived changes that they
now identify themselves as staff of the Neighborhood Place, rather than staff of a particular
. agency.)
The large movement of public agency staff into the neighborhoods poses. challenges for this
strategy . First, it is important that this be done in a way which is perceived by neighborhood
organizations and residents as helpful rather than intrusive. Handled poorly, this strategy can
appear to be the "strong hand of government" reaching deeper into a neighborhood, rather than
�Page 11
as useful resources becoming more accessible. Louisville is ensuring that its Neighborhood Places
are "part of' rather than Mimposed on" neighborhoods by having strong roles for neighborhood
'councils before and after each neighborhood network is'developed.
Second, this large scale shift requires a comparable large scale investment in training and
professional development. The designers of Louisville's system want the neighborhoOd networks
they are establishing to be empowering of falnilies' own abilities, and to be res}Xlnsive to families'
own needs. 'While several of the systems involved (for example, Louisville's child welfare
agency) have been leaders nationally in developing family-rentered approaches, Louisville now
is beginning the task of ensuring that all workers on the frontline share a similar perspective and
have the skills required to work with families in their homes, schools, and neighborhoods.
Finally, the fad that Louisville's strategy is built so firmly on public seCtor agencies requires great
care to ensure that the network does not continue to be dominated by public sector staff to the
eXClusion of infonnal and private sector supports. The balancing of public sector and indigenous
neighborhood in~rests will be crucial to how neighborhood residents view this approach in the
long run.
The approach being taken in Cedar Rapidsy Iowa, incorporates the core characteristics identified
above, but it also reveals the different operational forms these characteristics can take. Cedar
Rapids' evolving neighborhood service networks developed in large measure
as'a result of that
, community's work on decategorization. Under "decal", ""hich was authorized in state statute in
the early 1990's, the state human services agency designates certain counties as able to use more
than twenty federai and state funding streams in a flexible fashion. \, Community "decal boards~
can shift funds within this pool of dollars according to local needs. The result is that communities
are able to more directly reshape,their local sexvices systems. '
Cedar Rapids has used this new flexibility to begin building its neighborhood-based seIVice
system.
Cedar Rapids' approach co systems change at the neighborhood level unites a cityWide
approach w developing neighborhood-family supports with a,new approaCh to leaming
professionalsfrom multiple sysreJTlS so that they can proVide more intensive services. The
result comhines the efforts ofmeazy agencies into a W7ified delivery system.
The 11U)re intensive antlspecia1i.w:i services are provided through Cedo.r Rapids' use ofthe
PATCH model ofservice delivery. Developed initia1l)~ in Great Britain (hence the term
"paJCh It. which is a British lenn for neighborJwod), the Parch approach brings child
proieaion workers and representatives from other local organizations (from social service
organizations 10 housing inspection
10
community police) together in a·team located in a
neighborhood ceruer. Together. leam members are responsible for serving fami lies in tluu
neighborhood, and for ,worldng oUltamong them, rhe most effective lise oftheir combined
�"
)
'Page 12
skills. While each worker maintains lheir core profession.a1 role, [here is also flexibility
in team members' abilirylo stand-in for one anOlher, 'to switch roles when tJuu makes ,
sense, and to work withfamilies together. Workers repon tluu they begin thinking ofthe
r.e.tJJ1J. ,as the imponant resource for the family and the neighborhood, mIher rhnn its
individual members.
,While the Patch approach brough1 more imensive sei-vices close to neighhorhQo<i residems,
Cedar RiJpiils' puhlicaTut privale agencies were not satisfied thal it created the universal
availability offamily SUPPOl1.s tJuu they knew was ner;essary in order for manY families to
succeed. T1u;y establislWt a Family Resource De'",elopmentAssocianon (FRDA) whose
, goal is to implement family resource centers in all pans of Cedar Rapids. By combining,
their resources, and eSpecially using dollars "saved" through the DeCal Board's success
in reducing expe,nsive out-o.fhome placemenlS, FRDA 's plan calls for strategically located
family resource centers in all Cedar, Rapids' neighborhoods as well as throughout lite
cowuy (linn Cowuy). Four have been staned 10 daLe (three in Cedar Rapids and one in
a rural area). ,
1heSe two major service componentS come together. Patch teams are being located ar the
family resource centers, and [he family suppon and more intensive services are seen as one
system, blending the public seCTor agencies and privare sector resources.
Cedar Rapids' approach shares several characteristics with' Louisville ;md L,DS Angeles. Like
, Louisville, Cedar Rapids is emphasizing a "place" in each neighborhood where families can come
for help.' Cedar RaPids' versions of neighborhood centers are more explicitly drop-in centers that
, are "family friendly" (although Louisville expects to head in that direction). Also like Louisville,
Cedar Rapids believeS that teaming professionals in neighborhoods increases their effectiveness.
Cedar Rapids' public agenCies seem to be moving toward the broad scale commitments to staff
decentralization that Louisville is contemplating, and have begun expanding the Patch approach
to additional neighborhoods.
Like Los Angeles, much of Cedar Rapids' progress can be related to, the changed fiscal
arrangements that began with decategorization. That process created a new freedom of Cedar
Rapids' agenci.es to redesign their system, but also freed up previously committed dollars to help
this !edesign occur. ' Without these new fiscal incentives, ,the new service delivery approaches may
.
never have been conceived' as anything other than small-scale projects. '
,'
,
au
These three approaches are all relatively new, ;md
are still evolving.' Los Angeles' strategislS
'are now considering how their neighoorhOOd networks, which so far have been focussed primarily
on family preservation, can use, their structure for much more comprehensive purposes.
Louisville's approach is not only being "taken to scale" county wide, but local managers are also
considering how ~o make their Neighborhood Places even more receptive to families -:, perhaps ,
mOving in the direction of establiShing the type of family' resource centers that Cedar Rapids is
.
�\
..
Page 13
developing. In tum, Cedar Rapids is considering whether to decentralize systematically the staff
of its public agencies - as Louisville has done.
Thus, each of these approaches should be viewed as a "work in progress." . A neighbOrhood
service network should probably never·reach a static state. Instead, they are arrangements that
, should always continue to grow, evolve, and change in response to changing neighborhood needs
and "better ideas" a~ut how to achieve the neighborhood's goals .
.
IV. WHAT WlLL IT TAKE FOR THESE APPROACHES TO 1HRIVE?
Systems change at the neighborhood level cannot happen alone. These three cities' experiences
--'·-indica.tes how both the impetus and resources for change have to come from inside and outside,the
neighborhOOd. The policy and fiscil environments at the state, cciunty, and city leVels must not
just support these changes, but must help to lead them.
Within the dozens of ways that state and local policymakers can support ,this direction, several
cities' work to date.
seem particularly important, based on these
three
1.
Public agency 1tUlIUlgers' commitmelli to ruighhorJwod-based service delivery is perhaps·
the single most decisive factor. .'
.
None of these three examples would have been possible without the commitm~t of a small
group of public sector leaden>. Only they can shift the funding andJ or the staff that create
the "critical ma.Ss" of service delivery inthe neighborhood.
This does not mean that private sector and neighborhood leadership is' inconsequential ..
In all of these communities, ideas and leadership from neighborhood residents are acroally
making these approaches work once they get started. But the decisions to "tum the
system" to these new approaches can only come from the public officials who control
resources.
'These decisions are not without risk. Absent hard evidence that these approaches work..
public officials now are motivated by a conviction that these new connections to
nei~borhoods' lllllSt be better. Thus, support for public sector 'leaders t innovation -- from
state legislatureS, from other elected officials, or occasionally from foundations -~ is
important in the early stages. .
2.
New juru:Iing arrangements which allow local and even frontline jlexihility can promote
the growth ofthese approaches.
7; 1_ b·1 T I, I': 7; 0\ 7; , (1 T
,
. I
�Page 14
,
e
Two of the three examples above (LQs Angeles and Cedar Rapids) would not have·
occurred without financing innovations and incentives. Policy makers who want to move
systems in
direction should first oonsider how...to "shift the dollars", .because service '
delivery .shifts will follow. .
'
,
this
3.
New approaches ro:projes&ion.al development are necessary if neighborlwod networks are
to maintain their fresh approach and ensure service quality.
· Old models of training professionals within their separate categorical disciplines must be
·rnOdi.fied or discarded. Professional de:veJ.opm.Cnt for this approach must instead be "cross- .
professions". i.e., training people togeiher in a common Core of perspectives and skills,
and must also incorporate ne~ CO)1tent on issues such as working in teams with oolleagues,
working in partnership with families and .with infonnal supports, and so forth~ Louisville,
for example. is making cross-systems professional development a major coIDJXment in
· building its Neighborhood Pla.ce strategy.
In addition, the e~ential expertise of "community workers" or "para-professionals" must
be recognized and valued by credentialed staff; Professionals need to learn from and grow
by working with colleagues from the neighborhood~
4.
To sustain these approaches, .new methods of neighhorlwod-bpsed governance must be
developed, refleCting the same principles of inclusiveness and participation as are
.
embodied in these service delivery approaches.
Each of these three initiatives is now struggling with how best to govern these networks
over the long run. Professionally managing the service delivery is one issue here, but the
more challenging task is to develop methodsJor neighborhood residents to have a voice .
· in how these systems are administered, and some oversight in order to hold them
accountable. While neighborhood residents are played important roleS in the development
of all three ofthese approaches,· these issues ,of act)l3l "governance" still lie ahead for all
three.
CONCLUSION
, ..
Neighborhood networks are just one part of what must be a broader strategy to address the
problems facing many American families and children. Neighborhood networks, on their own:.
cannot reduce the poverty, isolation, and violence experienced .by many urban families in
American cities - although such networks may help more families succeed despite these factors.
However, as officials at all levels of government strive to reinvent the ways in which help is made
.available to families, these fledgling networks suggest productive approaches with many
impliCations for policy and practice.
I:>I/bl
3:J\id
�
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Carol Rasco - Issues Series
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Carol Rasco
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b(2) Release would disclose internal persom\el rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
b(4) Release would disclose trade secrets or/confidential or financial
information [(b)(4) of the FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or g~ophysical information
concerning wells [(b)(9) of the FOIA]
National Security Classified Information [(a)(1) of the PRA]
Relating to the appointment to Federal office [(a)(2) of the PRA]
Release would violate a Federal statute [(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.c.
2201(3).
RR. Document will be reviewed upon request.
I
i
I
I
'
�iTHE WHITE HOUSE
WASHINGTON
January 23, 1995
MEMORANDUM FOR SECRETARY RUBIN
ATTORNEY GENERAL RENO
SECRETARY REICH
SECRETARY CISNEROS
SECRETARY RILEY
CHAIR TYSON
ACTING SECRETARY ROMINGER
FROM:
CAROL H. RASCO
Subject:
Welfare Reform
A meeting is scheduled for Thursday, January 26, from 5:00
6:00pm, in OEOB 180, to discuss welfare reform and its current
-status. We will also discuss (a) the working session scheduled
for Saturday where Secretary -Shalal~, Director Rivlin ~nd Chief
of Staff Panetta will represent the cabinet and (b) thd
roundtable discussion to be held with all governors at !the White
House on Monday morning, to which you have been invited. We will
discuss on Thursday afternoon whether or not you wish to have a
short pre-bri~fing session on Monday 'morning prior to the
roundtable wh~'y- might be brought up to date on thJ session
held Saturday morning.
- ..
I
There will be no paper d'stributed prior to this meeting on
1
Thursday.
Please call Ju ie Demeo in my office at 456- 2216 as
soon as possible to confi m attendance at this meeting on
1
Thursday, as well as to ha e clearance information shared
regarding a staff member y u might wish to bring Thursday
afternoon.
Thank you.
cc: Secretary Shalala
Chief of Staff Panetta
Director Rivlin
�E X E CUT I V E
OFF ICE
o F
THE
P R E, I DENT
24-Jan-1995 11:15am
TO:
FROM:
Council
CC:
Jeremy D. Benami
SUBJECT:
Questions
~ bc,c ~~kt
{\hont-J"
C\\\~
'-
Are Kamarck, 'Hale and aa
(the~~~~ou-'V'lblind
the memo regarding the weI are briefing for the Cabin
to that briefing on Thursday from 5:00-6:00 in EOB 18
2. For the conference call/meeting (EOB 211), on
12:00-1:00pm" re: welfare prep for Sat, working group session for
staff of elected officials and Congresspersons -- Who/should I
invite other than you, Marcia, Susan, Pat Griffin, & Jeremy
Ben-Ami? Anna and Ann are taking care of the elected
official/Congressional staff invites. ~~
I dJJ Ii
~~I),~CL
(octD II~O
�WithdrawallRedaction Marker
Clinton Library
DATE
DOCUMENT NO.
AND TYPE
SUBJECTffITLE
001. memo
WAVES to Demeo re Confirmation: Appt Request for Rasco, Carol
(01/26/95@5pm) (partial) (I page)
RESTRICTION
I
01/25/1995
I
P61b(6), b(7)(C)
I
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8506
FOLDER TITLE:
I
Cabinet Briefing 26 Jan 1995 Welfare Working Group 5:00-6:00pm
I
I
!
20 I0-0 198-S
kc218
I
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(1) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice between the President
and his ad\isors, or between such advisors [a)(5) of the PRA]
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA]
b(l) National security classified information [(bXl) of the FOIA]
b(2) Release would disclose internal person~el rules and practices of
an agency [(b)(2) of the FOIA]
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets confidential or financial
I
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
I
b(8) Release would disclose information c6ncerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]!
I
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
i
ot
I
�E X E CUT I V E
OFF ICE
o
F
THE
PRE SID E N T
25-Jan-1995 04:36pm
TO:
Julie E. Demeo
FROM:
Mail Link Monitor
Office of Administration, 1ST
SUBJECT:
CONFIRMATION:
FROM:
Date:
Time:
APPT. REQUEST FOR RASCO, CAROL IH
WAVES OPERATIONS CENTER - ACO:
01-25-1995
16:33:43
This message serves as confirmation of an appointment
visitors listed below.
Appointment With:
Appointment Date:
Appointment Time:
Appointment Room:
Appointment Building:
Appointment Requested by:
Phone Number of Requestor:
Comments:
the
RASCO, CAROL H
1/26/95
5:00:00 PM
180
OEOB
DEMEO JULIE E.
65392
WAVES APPOINTMENT NUMBER:
fo~
U19677
If you have any questions regarding this appointment,
please call the WAVES Center at 456-6742 and have the
appointment number listed above availahle to the
Access Control Officer answering your call.
***********************************************************************
TOTAL NUMBER OF NAMES SUBMITTED FOR ENTRY:
TOTAL NUMBER OF NAMES OF CLEARED FOR ENTRY:
6
6
I
***********************************************************************
BANE, MARY
ELLWOOD, DAVID
HAAS, ELLEN
NASH, BOB
SMITH, MARSHALL
STEGMAN, MIKE
�Howard Dean. M.D.
Governor ofVcrmonr
Chair
·NATIONAL
". GOVERNORS
1
~ION
Tommy G. Thompson
Governor of Wisconsin
Vice Chair
Raymbnd C. Scheppach
Execu~ive Director
I
Hall of the States
444 ~orth Capitol Str~ct
Washington. D.C. 20001-1512
I
Telephone (202) 624·5300
I
I
January 25, 1995
TO ALL GOVERNORS:
Welfare refonn at both the national and state levels is a priority issue for Governors.
.
. '
I
Currerit NGA policy contains both a set of generai principles to guide the development of
national refonn and more detailed recommendations for specific' program changesl While many
of these principles and recommendations are still valid, they were developed ai a time when
federal constraints on program growth appeared unlikely and when there ~as significant
Congressional opposition to broadening state flexibility in program design and op~ration.
.
'
I
These conditions h~ve changed significantly and the Governors may wish to con~ider changing
NGA's welfare policy as well. Toward that end, the Governors-only session scheduled from
,
I
10:15 a.m. - 12:15 p.m. on Sunday, Jan. 29, will be devoted in part to a discussion of welfare
refonn.·
'.
I
While welfare refonn policy changes have not yet been proposed by the Commi~ee on Human
Resources, the Committee is prepared to consider such changes later on Sunday! if consensus
is reached at the Governors-only session. Should the committee decide to propose changes their
consideration at the closing plenary would require a three-quarters vote to susperid the rules and
a
.
a three-quarters vote to approve.
.. '
.
I ·
I
. .. .
Workmgtogether, the Governors With leadership responsibility on welfare have developed a
discussion document (Attachment I) that setS forth a set of tentative recommendations for your
consideration. While some Governors may want to discuss other issu'es, we are in general
agreement on this approach and we would like this document to serve as ttie basis for our
discussions on Sunday.
The second attachment outlines some concerns that are specific to Puert~ Rico and the
territories that currently participate in AFDC. We also would like to discu1ss this issue on
r
Sunday.
I
We hope that you .will review these materials carefully and be prepared Ito discilss your
I
reactions and suggestions frankly and openly.
I
I
The Governors-only sessions are closed to the press. Governors may have one staff member
accompany them to the meeting as an observer.
.
�If you have any questions or need any further infonnation prior to the meeting, please contact
Ray Scheppach (202/624-5320) or Barry VanLare (202/624-5342) at NGA.
We look forward to a productive discussion.
Sincerely,
l.f~1J-.
Governor Howard Dean, M.D.
J~~
Governor Torn Carper
Co-Lead Governor on Welfare Refonn
lfM-
Governor Mel Carnahan
Chair, Committee on Human Resources
c:
Washington Representatives
NGA State Contacts
I
Governor John Engler
Co-Lead Governor on Welfare Refonn
k~'H~~\'
Vice Chair, Committee on Hum~n Resources
�DETERMINED TO BE AN
ADMINISTRATIVE MARKING
!NITIALS: I'-C- DATE: U\cI\O\\,\0 .
ATTACHMENT 1
€ONFIDIBNTIAb DRAFT-- FOR DISCUSSION
NOT FOR DISTRIBUTION
ON~Y
Welfare Reform
Options Regarding Program Structure
January 24, 1995
Overview
The current federal programs that provide income assistance to families and children in need do
not work. These programs, which are outdated and overly complex, create a climate of
dependency and undercut the value and rewards of work. In their place we need.to cre1te a new
system that builds on the successful initiatives underway in individual states and com~unities.
The new system needs to recognize that one size does not fit all and that effective progriuns must
be tailored by the states to meet the needs and expectations of their communities. lristead we
need a new simpler structure that is fair to taxpayers and those who are in need of assistance.
.
.
I
I
Federal, state, and local governments have a responsibility to provide for the needs of poor
children. Governments must also, however,create a system that encourages meaningful work
and facilitates the move to independence for adults. In addition to rewarding work, issistance
programs should seek to discourage teenage pr~gnancies, support stable family relationships,
. ensure child support collection, and provide assistance to obtain the educational and job skills
necessary to long~term self-sufficiency. Cash benefits should be tiine-Iimited. Welfate should
be a transitional program that moves people from temporary assistance to self-su(ticiency.
Welfare benefits should be based on a social contract that sets forth the responsibilities and
obligations of both the recipient and the government. The goals of this temporary ~ssistance
should in91ude recognition of .the essential dignity, well-being, and responsibility of every
American.
Fiscal Constraints
-
,
All levels of government are facing severe fiscal constraints. Federal, state, and local budgets
already have experienced substantial reductions. State and federal efforts to maintain or achieve
- balanced budgets and to reduc~ the tax burden on middle income Americans will requi1re further
reductions.
Federal budget decisions should recognize that federal financial support for programs for needy
children should remain a high national priority. Any federal budget savings in this ar~a should
�come from simplifying the structure and efficiency of the program and not in areas thit would
interfere with the long-run goals of work and self-sufficiency. Most of the budget savings will
come from giving' states the flexibility to operate cost-effective systems. Arbitrary ~pending
limits without flexibility and the elimination of federal benefits to currently eligible grrlups will
likely shift costs to other levels of government. Instead, real savings must come from Iprogram
initiatives that will encourage responsible behavior: programs that will ensure that w6rk pays,
I
and programs that will support the education and training needed to find stable emp1loyment.
There should not be any new mandates imposed on states. However, if any new federal
mandates regarding benefits levels, eligible populations, or required programs or serl-ices are
I
created, they should be fully funded by the federal government. The federal share of the cost of
existing mandates that are retained in a reformed program must be maintained.
States are firmly committed to reform and have led the way over the past decade in developing
new and effective program initiatives at the state and local level. Given the aulli6rity and
fl.exibility they need, th~ states will quickly develop the programs needed to provide rekl budget
savings.
While states recognize the need to reduce the dependency costs associated with legal
immigration, many states will be unable to completely deny benefits to such individu~ls. As a
,
I
result, the States oppose the elimination of federal funding for legal immigrants an,d instead
I
support increased efforts to secure financial support from sponsors.
The Federal Role
All Governors recognize the importance ofa federal role in financing income assistance to
families and children. However, the continuation of the current welfare system is unabceptable.
Tinkering' and changes at the margin will not be sufficient. We need to create a neJ, simpler,
and more responsive federal role. At the same time, the rapid rate of change in the economy and
the demographics of the welfare population suggest the need for flexibility and;continued
innovation. A new program structure that provides states the option of an individual entitlement
program that allows wide state iatitude or a state entitlement block grant, will pr6~ide that
flexibility, encourage constructive experimentation, and ensure significant budget saJings over
time. A completely restructured individual entitlement should combine' certain minimum federal
standards with much greater flexibility for the states in setti~g the form and con1ditionsof
assistance. A state entitlement block grant should provide capped funding with no federal
restrictions except that the federal funds be used to assist poor families and children. I
A New State Entitlement Block Grant Program
The Governors believe states that wish should be given the option of substituting a state
_ entitlement block grant program for a national individual entitlement program for c~ildren and
, families. Under this concept, states would be required only to ens,ure that the fundin1g received
is used to provide services for poor children. While states would be required to describe their
program in a state plan and to provide' periodic reports to the public, the, plans wohld not be
subject to federal approval or federal revision. Financial audits would be conducted to ensure
that moneys were properly spent, and states would be required to pay back any misspe~t funds.
�In return for this broad flexibility, states electing the block grants would agree to an initial
allotment based on the average of several prior years, with restricted growth in futu~e years.
There would be no maintenance of effort provisions and states would be allowed to 'keep all
savings so long as the total federal allocation was spent. Unexpended federal fund~ should
remain available for at least three years to maximize flexibility and to encourage the crea1tion of a
. "rainy day" fund.
I
To provide for significant changes in the cyclical economy and for major natural disa~ters, an
additional amount equal to 2 percent of the total funds distributed in block grants should be set
aside each year for distribution to states that experience higher-than-average unemployn\ent or a
major disaster in their states.
I
An Indiyidual Entitlement PrQgram
The Governors also support the creation ofa new national program of individual entitlements to .
meet the needs of children and their families. This program would replace the curre~t AFDC
program. Such a national program should establish clear policy objective and certain rriinimum
standards, but provide states with broad flexibility to design key program elements.
Policy objectives and standards should include:
Tilne-Limited Cash Assistance. Assistance in the fonn of cash grants to families and children
should be available for a time-limited period during which activities that are designed Ito make
the transition from welfare to work take place.
.
.Social Contract. The expectations and responsibi lities of both the recipient and the' go~ernment
should be clearly defined and incentives and sanctions should be designed to ensure that those
responsibilities are carried out. States should be granted broad flexibility in defihing the
components of the social contract, including requirements to begin work before the rriaximum
time is exhausted. Receipt of assistance should be conditioned upon o~going compliahce with
the social contract.
Support Services. State programs should include the education,training, and support services
necessary to help participants become self-sufficient. Such services should be funded either as a
component ofthe income support program or through broader block grants.
,
Long Term Assistance. Continued federal, state, county, and local assistance under the
national
program after the time-limited period should be dependent upon a requirement of work or work
related activities unless no job, community service work opportunity, or communi~ service
.~ placement is available. Federal funds equivalent to the assistance payment should be av~ilable to
the states to support the creation of needed work. States should be allowed to create work
directly and through subsidies to the private sector~ The on-going financial needs' Of!children
.
I
must be addressed in any time-limited system.
�Flexibility. States are opposed to overly prescriptive federal management of the cash assistance
program. Federal guidelines should be reasonably general in nature and states should h~ve broad
flexibility to adjust benefit levels and to determine the form and condition of assistarice. This
flexibility should be in the form of allowable options and should not require federal ~aivers or
plan approval. Examples of flexibility include the use of voucher payments, incen~ives and
sanctions for school attendance, requirements that teenage mothers live with a responsible adult,
and the ability to limit benefits to mothers with additional children born while thJ y are on
welfare. Governors oppose federal legislation that would mandate such state policies.
States should have the flexibility to extend assistance as needed, with full federal I financial
participation, for a limited period beyond the federal standard on a case-by case basis ip order to
. ensure that recipients complete education or job training programs, complete training for
substance abuse or other physical or mental impairments, or resolve emergency situaiions such
as homelessness.
Fundini. Federal funding for time-limited assistance payments and for longer term work-based
assistance should remain an individual entitlement. Federal funding for administrativelcosts and
for services required under reformed program should remain as a state entitlement.
a
Program Consolidation
The Governors believe that maximum budget savings are possible only if flexibility is extended
beyond the in~ome assistance program. Therefore,Governors support efforts to consdlidate and
integrate employment and training programs, child care programs, and social service ptograms to
allow the states the flexibility to develop programs tailored to meet the needs and ptiorities of
individual communities in a coordinated and cost-effective manner.
Coordination with Other Programs
Successful state and local programs often rely upon incentives and sanctions that are designed to
encourage responsible behavior. States should be given broad flexibility in the desi~n of such
incentives, including income disregards. Federal policies in food stamps and housing programs
should be modified to ensure that such programs support, not counteract, the incehtives and
sanctions built into the state programs. In particular states should be allowed to casti out Food
Stamp benefits for AFDC recipients.
I .
In addition to rewarding meaningful work, the welfare· program should seek to suppbrt a long
term connection to the labor market and stable family relationships. Such assistance Jan only be
provided effectively if education, training, and employment policies are coordin~ted across
agencies at the federal, state, and local levels. Coordination also is needed with the earned
income tax incentive program and with· programs designed to provide child care kd health
services both to those on AFDC and for former or potential recipients who are employ~d.
I
��PU.£RTO lUCO' F.EDSliU..l• .A.n'AIBS ADlIiIlN1STJlA..TION
O,.,.ICC. 0,. THIt OOVERNO"
Sugested NatIoDal c;o.~. AaodadOD' Pulley
Welfare Reform
Puerto Kko
GovernoR believe that DaMna! v.'C!fare reform legislation provides Coogress with tbe
oppoI1llD.ity to implement social policy for Puerto Rico '&hat empowers the ~·s 3.6
million U.S. citizens. fO&terS economic sclf-aufficiency aJ\d promotes loug-aerln ecooomic
groWth.
Governors believe mat Pucno Rico should. receive equitable treatmem in any DeW welfare
reform proposal brought before Congress iDcluding full iDclusion in tbc workforce training, '
education BDCl job creation proposals crucial to economic cievelopmeDL
-/
Likewise, Governors believe that Puerto Rico's existing succ:essfuJ wc1tare reform effom
should be fOSlerCCl by equitable ti:deral funding levels for its existing AFDC block grant and
the implememation of programs -for children aod the elderly on tlu: lslmt I
CONTACT: Courte!lay McKilUlCn
202-778-0732
HOO 8ItVE"'ITCENTH BTtrfEET. N.w.. BUITE 80e. WASHINGTON. DoC. zoo~.
T'EL&~HONIE! (aOI,77.;'0710
"AX: CZoz, 778-07&'
�PUERTO RICO FEDERAL AFFAIRS ADMINISTRATION
OFFICE OF THE GOVERNOR
PEDRO ROSSELL6
GOVERNOR
WANDA RUBIANES
DIRECTOR
\
To:
Raymond Scheppach
NGA
FROM:
Courtenay
Office of the Governor, Puerto Rico
DATE:
January 24, 1994
RE:
Attached Policy - PUERTO RICO -- Backgn:mnd
MCKinn~
Inform~tion
Background - Section 1108 Block Grant in Puerto Rico
Puerto Rico is treated as a state for the majority of federal social services programs. The
exceptions are: AFDC, SSI, Foster Care, Adoption Assistance, Independent Li~ing, At-Risk
I
and Transitional Child Care programs. These programs have been block-granted since 1950.
.
I
The"capped grant has not been increased since 1988 when it was .set at $82 million.
Asin any state, demand for programs under the cap is large. Our government l110cates the
majority of funds to providing minimal benefits under AFDC and SSI. The Fo~ter Care
program is funded primarily through local monies; the. Adoption Assistance andi Ind~pendent
Living programs are limited, and the At-Risk and Transitional Child Care programs do not
operate on the Island.
Puerto Rico looks forward_ to implementing national reforms and to continuing ftsmove
toward economic self-sufficiency. However, to enable our 3.6 million U.S. citizens to fully
participate in the responsibilities and mandates of reforms, it is necessary to bri1ng programs
under the cap up to 1995 funding levels ·before we are capped again, along with other states.
Since the cap was last raised:
,
I
+ Puerto Rico's AFDC case load has more than doubled -- from 98,509 to
183,540 individuals.
Puerto Rico does not operate the UP program.
>
+ Monthly payments have been reduced to $32 for each adult, $24 for the first child, and $8
for the second child. The national average is $135 per individual and $405 pet family.
~oPulation
+ Payments
to 15,615 elderly, 260 blind and 28,000 disabled persons -- the
normally served by the Supplemental Security Income (SSI) program on the m;ainland - have
been- reduced to $32 per month for the elqerly and $37 per month for the disabled. These
populations receive an average of $446 and $549 per month on the mainland.
1100 SEVENTEENTH STREET, N.W., SUITE 800, WASHINGTON, D.C. 20036
TELEPHONE: (202) 778-0710
FAX: (202) 778-0721
�,;
Raymond Scheppach
. January 24, 1995 (
Page 2 of 2
I
+
Foster care cases have increased from 143 in 1984 to over 5,200 today. Currently, over
4,000 children are on a waiting list for Foster Care placement.
I
I
+ Puerto
Rico has spent about $12 million a year to provide Foster Care paymedts and about
$3 million a year to. provide preventive services. In the states, these expenditures would be
I
matched at between 50% and 83% percent, depending on FMAP, by the federal igovernment.
I
+ Child abuse cases have increased by 460% since 1978: . Currently, about 2,000 cases are
reported a month. Funding limitations have resulted in oniy. the most severe cases being
removed from the home. ' .
I
+ An estimated 179,000 children are eligible for,
but not receiving, child care.
I
I
I
LEGISLATIVE IllSTORY - SectIon 1108 Block Grant in Puerto Rico
Congress ·first established the capped block grant as an amendment to the SOCial! Security Act
in 1950; it appropriated $4.2 million to Puerto Rico for aid to families with dependent
. children,. aid to the blind, aid to the permanently and totally disabled, and aid. t6 the elderly. I
The legislative history does not indicate why a capped payment was establishedl but it
appears that Congress intended for the payment to be reviewed., and increased or a regular
basis. The cap was reviewed and increased yearly or bi-yearly for most years between 1956
to 1972..
' . .
I'
Since 1972 the cap has been increased only three times -- in 1978, 1980 and' 1988. The
1980 increase, $10 million, included new federal mandates to provide Foster Care and
Adoption services under the cap.
.
.
I
I
lSocial Security Act,Section 110S, "Limitation on Payments to Puerto Ricoand the Virgin
Islands." I1Ib. L. No. 734, c. S09,.section 361 (g) (1950), reprinted in 1950 U.S.C.C.S. 561, 63S.
I
The Act limited payments to the Virgin Islands to $160,000.
�E X E CUT I VE
OFF ICE
o F
THE
PRE SID E NT
I
25-Jan-1995 04:19pm
TO:
TO:
Carol H. Rasco
Jeremy D. Benami
FROM:
Julie ,E. Demeo
Domestic Policy Council
SUBJECT:
Cabinet Briefing
Katherine called all of the invitees for tomorrow's cJbinet
briefing on welfare, to see who would be coming. Her~ are the
results:
YES:
Rasco
LD. Ac;\~~
Tyson'
Reich + RtM4,W~o..\cle.,
Shalala
~
,
Ellwood
Bane
Hale
Brophy
Reno
SUBSTITUTES:
Bob Nash for (Acting Secretary Richard Rominger)
, Alicia Munnell for (Bob Rubin) q.. ~t. ~
Mike Stegman for (Secretary Cisneros)
John Angell for (Leon'Panetta)
NOT SURE YET:
Griffin
uia- Kamarck
~~- Rivlin
V'\,D Ellen Haas'
NpRiley (he will
***1 have signed in the people who need to be signed in.
�
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Carol Rasco
Issues Series
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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Clinton Presidential Records: White House Staff and Office Files
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92 folders in 7 boxes
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Cabinet Briefing 26 Jan. 1995 Welfare Working Group 5:00-6:00pm
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Domestic Policy Council
Carol Rasco
Issues Series
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2010-0198-S Segment 2
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Box 122
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
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Clinton Presidential Records: White House Staff and Office Files
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12/4/2013
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2010-0198-Sb-cabinet-briefing-26-jan-1995-welfare-working-group-5-00-6-00pm
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https://clinton.presidentiallibraries.us/files/original/c72f580d7e65974c7964690e58ccd84d.pdf
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Carol Rasco (Issue Papers)
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Carol Rasco - Issues Series
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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Clinton Presidential Library & Museum
Extent
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92 folders in 7 boxes
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
BC/BS
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 122
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
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Clinton Presidential Library & Museum
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The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
12/4/2013
Source
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2010-0198-Sb-bc-bs
-
https://clinton.presidentiallibraries.us/files/original/6f0ed97501a5fbdd0f4451f78bee6133.pdf
c650fd15ba50f55b99a07e02c21954fd
PDF Text
Text
OCT-09-199S
12:01
FROM
WHITE HOUSE
~IDS'
POLICY
TO
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.
P.01
.
WESTWING
.
Cc
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EXECUTIVE OFFICE OF THE PRESIDENT . \
.750 .17th Street, N.W.
Washington, DC. 20503
Phone: 202-632-1090
Fax: 202-632-1096
FAC~ECOVERSHEET
.TO: 'Carol Rasco
FAX NUMBER: 456-2878
FROM:. Richard Sorian
,DATE: October 9, 1995
PAGES INCLUDING
COVER SHEET:
4
COMMENTS:
These are· the talking points sent to Mike McCurry's office and to
select AIDS press.
.
A/.~'
o
V \5'«;
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......
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OCT-09-199S 12:02
FROM
P.02
WESTWING
TO
WHITE HOUSE AIDS POLICY
I
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. Talking bout. . .
A
I
.
.
.
..
I
White House Conference on mv &. AIDS .
.
,"
I
.
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For More Iniommti.on Call: .
Richard Sorian1632~ 1090
I
What:
White House Conference, on the status' of the epidemic of mv an:d AIDS
,
I
,
When: .
December
i .
W'b,ere:,
. The White House
To raise national attention to the problems being presented by the epidemic.
"
.
.
I
Approximately 175 individuals from around the U.S., including people living
with HIV and AIDS as well as experts in the areas of research, 'prevention,
I
care, discrimination, :an.d'health and income support.
Why:'
.
Who:
.
."
I
I
J
The'.President will convene a White House Conference on HIV and AIDS to disC11ss ·the
current status of the AlDS epidemic. Experts ftomaround the country will dikuss issues
': related to AIDS research, prevention, care, discrimination, and health and incrme support.
.
.
,
.
I
'
Since the AIDS epidemic began in 1981, more than 450,000 Americans have been diagnosed
,with the disease and more than 250,000 have died as a result of AIDS. In 1994 alone;
:
'nearly 81,OOOAmericans,were diagnosed with AIDS and 44,000 died. as a ~ult of that
. ,disease~ An estimated 800,000 1.2 million Americans are living with HIV~ the virus that
causes AIDS, and an estimated 40,000 Americans become infected with HIV ievery year.
to
.
.
I
I
Since ,he took offic~,in 1993, the epidemic of HIV and AIDS has been one of President
I
Clinton'S top priorities. Among, the actions taken to date:
..._'
�OCT-09-1995 ·12:02 FROM
WEST~ING
TO
WHITE HOUSE RIDS POLICY
P.03
I
I
I
I
Page· 2
•
AIDS Funding. In the tb.tee budgets that the President has presented to the
•
Disability Benefits. The eligibility criteria for· Social Security Disability jInsurance
have been reformed to make it easier for people with AIDS to qualify fo~ such .
i
benefits.
.
I
Medicaid Benefits. Changes in.Social Security eligibility also enabled Ittore people
to qualify for Medicaid coverage. As a result, today, more than half of People living
with AIDS are receiving coverage through this program, including 92 percent of
children with AIDS. .
..
Congress, funding for AIDS research, prevention, and care has increaSed/lbY 40
percent.
·
...
I
Ryan ·:Wbite CARE Act. Funding for the Ryan White CARE Act, Whibh provides
·di.red services to people living with AIDS, has been increased 108 perc~nt .. The
· President has· made reauthorization of the CARE Act a top priority for 1995 and has
urged the Congress· to complete action on this important legislation. I·
I
•
· Housing.· Funding for the Department of Housing and Urban Development's (HOD)
· Housing Opportunities for People with. AIDS (HOPWA). program haS b~ increased
.by· 46 percent and HUn has established the National Office of HIVI AIDS Housing to
assist 10w-m90me people with HlV/AIDS to pay· for housing.
•
· Policy Coordination. To provide a centIiJ. focus for governmental efforts against
HIV/AIDS, the President created the Office of National AIDS Policy Jithin the White
House, to advise him on AIDS policy issues and coordinate interdepart~ental
.a c t i v i t i e s . . .
.
I
.
Advisory Council. The President created a 30-member Presidential JdViSOfy .. .
Council on mv and AIDS to provide him and his Administration wi~ outside advice
on the ways in which the Federal government should respond to the mvI AIDS·
epidemic.
.1
•
Research Orga.nization. The President signed \the National Institutes 1of Health
.Revitalization Act. of 1993, placing full responsibility for planning, budgeting, and
evaluation of the AIDS research program at NIH in the Office of
Research.
A.Ids
.
e··
J
~S Education.
On September 30, 1993, the President issued a di~ective ~uiring .
· every Federal employee to have the opportunity to receive comprehensive workplace
education on HIV/AIDS.
.
.
i··
AnO-Discrimination. The Justice Department and the Equal
• .. . Opportunity Commission have vigorously enforced provisions Employment . with
of the .A.mericans
Disabilities Act that prohibit discrintination against people With HIV/AIDS.
.
.
I.
�OCT-09-1995
12:03
FROM
WHITE HOUSE AIDS POLICY
P.04
TO
Page 3
I
'I
-Drug Approval. The FDA has approved or provided new labelling mdic.l:ttions for
.sIx.new products
to
treat lIN or HIV-related conditions.
I,
'
'
,
. !
',
. -. Drug Dev~lopment. The President created the National Commlssion on ~S Drug
Development, an historic partnership between government, industry; aca~emia,
medicine, and community organizations to identify and eliminate all barriers to the
rapid development of drugs for HIV and H1V-related conditions. .
I
'
-
.
'
J
Prevention.. The Centers for Disease Control launched the Prevention Marketing .
Initiative aimed at young adults (ages 18-25) to change behaviors that coiltrlbute to the
transmission of HIV. The initiative features production of ftank, forward-thinking ,
public service announcements promoting both abstinence and the consist~t and
'
, cmrect use of latex condoms.'
I
,
!
1
1111#
I
I
I
I
,I
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Carol Rasco - Issues Series
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
Clinton Presidential Library & Museum
Extent
The size or duration of the resource.
92 folders in 7 boxes
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
AIDS Conference
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 122
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Publisher
An entity responsible for making the resource available
Clinton Presidential Library & Museum
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
12/4/2013
Source
A related resource from which the described resource is derived
2010-0198-Sb-aids-conference
-
https://clinton.presidentiallibraries.us/files/original/badd2317ce075003a83e08a7604c04ce.pdf
883ea536a2df5e4e5bb3bee67690d41c
PDF Text
Text
i·
,J
",
J
/
I .
,
\
\
January 20, 1997
\
Memo To:
Records Management
From:
Domestic Policy Council
West Wing - Carol H. Rasco's office
Re:
Contents of box 4 of 8 - Issue Papers, cont.
\The following is a list of files that are contained in b0x 4 of
8:
NGA/Welfare Reform
NGA/Medicaid
medicare/medicaid
DPC Meetings
BC/BS
welfare Reform
Affirmative Action
Civil Rights working Group
Crime
EZ/EC
Farm Bill
GAO Report
Health Care
Immigration
Minimum Wage
Perfomance Partnerships
Politicai Reform
Regulatory Reform
SSA
SSI for kids
Tax Cuts
unfunded mandates
Ta~k:1.ng
poi.nte
.... •••w. _ _ ~· • ~- , ••,,,, • • ,
;'--' .
Health Reform
Health Care meeting - 11/5/94
Health Care Meeting - 11/21/94
Potus Welfare Briefing, 1/26/95
Welfare Reform - working group folder
Crime Talking points
�i
January 20, 1997
Memo To:
Records Management
From:
Domestic Policy Council
West Wing - Carol H. Rasco's office
Re:
Contents of box 3 of 8 - Issue Papers
The following is a list of files that are contained in box 3 of
8:
Health Care Materials
Travel - miscellaneous xtra.documents
SSI for children
Disability Initiatives
�.
•
I
be~Ond
The President's commitment to racial progress is deeply rooted and
question.
Affirmative action has contributed to that progress. It is not, however, a perfect tool-
and no ~houghtful person would say that it is.
I
•
••
Administration officials are meeting on these issues for the same reason we have most
meetings: we have an' immediate problem requiring special attention.
This. is the problem: In recent decades the nation has seen too many periods when
politicians used race as a wedge issue to divide Americans. Now jwe hear some
politicians sharpening that wedge yet again. Devising a strategy of code word and
division. We- are searching instead for a strategy of healing and progreJs.
.
•
.
I
.
.
'od
I
W e are meetmg because .IS an Important Issue,' pen. Th' '. a b out how to move
It . ,
IS IS
forward. instead of backward. And, as throughout his career, President Clinton's strategy
will be to win not by dividing people by race or otherwise, but by pulling people together.
1
(
\
�Q}I/'
Draft: February 5, 1995
i:lda.alaffirm.1
.
.
.Affirmative Action l
1.
The Need
G..u- I .~ .
i~J). l~ NP:. r
~~.
~
A. Political
ide~tified
There is. no generally understood core set of civil· rights policies
with New
.
.
.
I
Democrats. The corollary is that Clinton's civil rights "definition is hazy. The political
challenge is to. provide the intellectual· content, and then a message arid communication
strategy to match.
If
Civil rights liberals, including most Blacks, assume· Bill Clinton is "s:ympathetic" to the
traditional. aspirations, but have nagging anxietY about whether this sy~pathy equates to
reliable support for efforts to reverse the Reagan Era retrenchments, or even reliable support
. for current legal doctrines and. public policies, such as business set-asides. Civil rights
conservatives assume Clinton is generally liberal In his racial sentiments, a!nd then divide into
I
two camps: the cynics expect pandering to the Democratic base in as disguised a way as
possib!e, but conservatives looking for a reason to support the Presidentjhope they will see
..
I
.
significant cracks in the orthodoxy.
·1
In truth, many civil rights liberals may also hope for a crack in the orthbdoxy -- at least in
the expression of the orthodoxy -~ because they fear that the old appr6aches and the old
language have sullIed our progress and. produced a crisis in persuasion. . .
Finally, there is a strong measure of weariness among civil rights liberals. After a difficult
decade of wedge politics, and· after the frightening deployment of Feder~l resources on the
.
.
I
opposite side of the barricades in several key litigation and policybatt~es, there is a deep
hunger for a politics of healing, grounded in moral vision rather thanlelectoral calculus.
Beneath that hunger is an even deeper need among civil rights liberals and among minorities
-- a need to know "Is the cause safe? Are we safe?"
..
I·
I
Notes:
This essay is written with reference to issues of race-based affinnative action, with specific concern for
the political issues related to the African American community.
.
I.
.
. This essay· does not represent Clinton Administration policy, nor the policy of any office, agency or
official.
i
1
1
�B. Substantive
·1
The Administration faces several policy issues that we should address Jithin a thoughtful
(conceptual and political) framework, rather Ithan piecemeal. The brbad categories of
immediate importance include:
.
. .
.
• The permissible reach of judicial remedies lin school and employment cases, especially
when de jure discr' . . and dis arate treatment have.
' andi the. remedy seeks
to address mgering effec;ts embedded in a web of economic and social joint causation.
I
I
I
• The reach of voluntary affirmative action in emplqyment and higher education, when
such measures benefit individuals who are ~ot themselves identified victims of specified
acts of discrimination.
.1
.
i
• The use . of set-asides to enhance business opportunities.
I
.
.. .
\
I
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• The upcoming California ballot initiative which, in the view of civil rights traditionalists, .
uses "color blindness" and anti-discriminatidn rhetoric to eviscerate affimiative measures
by the State.
It
Basic Policy Framework .
A. Moral Costs
I
1
Preferences have a moral cost, and therefore (i) must be justified and (ii); must be narrowly
tailored, in means and duration,. to fit that just~fication. .
I)
I.
..
1; There is an important ethical distinction between preferences adopted as a remedy for past
discrimination or exclusion, and those adopted to. further other imponant ends such as
djyersitY. The former purposes; being remedial in nature, generally ckaY more weight.
I
.
They have, however, a factual predicate of wrongdoing and specific injury which makes
them more difficult to use as justification fori a racial j"efererice.
I
.
D~tween
2. There is an important doctrinal distinction
preferences adopied by a court for
adjudicated remedial purposes, and those adbpted voluntarily by govefnments or private
persons.
• . Voluntary government actions deserve special scrutiny because, as the product of a
.
I
political process, there is the familiar risk of majority tyranny. The CrosoQ;fequirement
of legislative findings. is a valuablesafegu~rd, provided it is not interpreted to require
findings comparable in detail and specificitY to what would be required in court to prove
intentional discrimination against a specified individual. It is, in essexice, a requirem<:!!J
of deliberation which forces a politicallegi~lature to think and weigh carefully. This is
2
.
�"
a valuable check on state power, though not an absolute one.
,
~lso
deserve Iscrutiny because as wrong as it is when we '
• Voluntary government actions
injure one another, it is even worse wheI]. we are injured by our 'government. We
therefore have a heightened collective duty to prevent abuses at the hahd of government.
'"
I
'
I
• Voluntary private actions deserve scrutiny (but not generally as much as governmental
action) because of the risk,that even well-iqtentioned private action ~ill do unnecessary
and unwarranted injury to the interests ofl non-beneficiaries. Private action may not
.
I, , .
fairly balance the ethical costs and benefits~
,
'
'.
.
,
·1'
'B. Defining Affirmative Acti~n and PreferenceS
1. VariedTools.,
,
I
Affirmative action is a family of tools -- a r~nge of measures which in practice stretches
from low-intensity outreach, all the way to court-ordered goals and timdtables and, in very ,
rare cases, quotas .
• ' Quotas' are and should be rarely employed, and never outside the court-approved
remedial context. Voluntary quotas, pJblic or private, should b~ prohibited.
,
•
Set-asides are a form of affirmative
they are quotas,
I
I
act~on,
'
If they establish a rigid numerical test,
.j
,
2: Merit.
j'
Affirmative action, when used properly, isqonsistent with mer.!!. ~ere are very rare
"instances when, m a court-ordered remedy, spme aspects of merit havetto take a back seat
to ighting a wrong. But these instanceS arel and must be rare.·
r
.
.
....
• " When people design their affirmative astion, they should make every effort to define
a preference narrowly as a criterion for pulling someone into la pool for further
, consideration or, when the ultiIrtate hiririg or other decision is madb, as a tie-breaking
factor among comparably qualifie.Q individuals.
•.'
. ' I · ,
"Comparably qualified" means just th~L Qualifications that are sham devices to
exclude mean nothing,' Qualifications Ithat are not reasonably related the' work or
other tasks involved mean nothing. A~d when the "merits" are ~ague, the selection
process highly subjective, and the history suggests exclusion, then it is especially
, important to be inclusive in defining what "qualified" actually mbans.
''
J
.
..
. . an Aniencan vaIue. I ' one 011 the pnnclpIes that
'
..
. . .'
• .,,' Mem IS Important; ,Indeed , It IS' j .
tis
I
3
�,
,
"
I
distinguish us from other societies and cultures, now and histor,cally, where life, '
liberty andhappiness were contingent on heredity, caste and privilege.
•
~e
But
should also recognize that in maly areas of our social and economic life, we
look for "qualified" people or finns, and: then use something other fhaJi merit to make
the ultimate decision. We often make final decisions among the qualified randomly,
or based on conveniepce, familiarity, oi instinct. This is natural and fine, assuming
the selection isn't tainted with prejudice;. But we shouldn't confu~e these nonfonnal
ways of selecting among comparably qti'alified individuals with dgorous systems of
pure merit. They are not. And modifyi,ng such "fuzzy" s stems tb include narrowl
t~ilored affinnative action IS lust not a~ e
y objectionable as interfering w!!!J.
selection mecharusms truly based on ment.
I
I
C. Narrowly Tailoring Preferences: Preferences Have Costs
Because preferences are not costless, in ebical or moral tenns"any preference or
affinnative action measure should be tailored' to minimize the' injury (attual or perceived)
to the interests of non-beneficiaries, We tmust be' especially concJrned with legally
cognizable interests,' but not wjth those interests alone. And we rhust be especially
concerned with non-beneficiaries who have I not in any way benefited personally from
,.
patterns of ~xclusio~,:
1. "Tailoring" means:
....
Clarify what the objective is. That is, ~tate the intended result in ,tenns of removing
any vestiges of exclusion, or securing $e benehts of inclusion. This means being
clear about what the evidence is that leads us to believe there is a problem in the first
place -- typically a gross imbalance, vibwed in the totality of the circumstances. 2
I
1 '
'
Understand the interests at stake, on all sides.
' I .
.'
,
I
Try to state what constitutes acceptable progress and success.
preference have served its pUrpose and Ino longer be needed?
I
When will the
- 'd
. . I.
.
. I
COnsl er the range 0 f measures m mcreasmg order 0 f mtruSIveness.
listing these is: .
,
i
0 ne way ' 0 f
(i) review selection criteria to elimiilatethose not justified under true principles
,
•
I
I
,
of merit;
I'
"
,
(ii) broad outreach and recruiting; ,
, (iii) targeted, group-specific outreach and recruiting;
I
'
i
,
This tracks a formulation developed by the Department of Education, during the Clinton Administration,
to test the legality of minority scholarship programs.
2
I
4
�(iv) pullIng qualified minorities into the pool of "finalists";
(v) soft· goals or targets;
(vi) quotas.
•
Select the least intrusive measure that holds reasonable promise
.
,I .
J! effectiveness.
I ' ....
2. This emphasis on least intrusive methods is fundamental, but potentially controversial in'
two respects. It is fundamental because it atkIiowledges that there isl an ethical cost to
racial preferences, and that we must judge irl a given instance whethet that cost justifies
the pro~ress' that will result. By tailoring pteferences to the least inttusive method, we
minimize the ethical cost, and. hopefully ~he divisiveness and soc~al costs as well.
Effectiveness IS, of course, not an absolute. There is no running away from the balancing
implied by this fonnulation. But facing that !difficulty within a frame~ork that attempts
to respect the needs and aspirations of all cO!lcemed, is the best way dut of the mess we
,
are in.
This approach is potentially controversial because, first, it makes clear to conservatives that
. there will be circumstances --and not rare OIies -- when tailored race-cbnscious measures
.'
I
are desirable. But, second, the approach makes clear to liberals that they do not have a .
monopoly on virtue: that public policies Iand private practices mhst reflect ethi,:al.
sensitivity both' to the intended beneficiaries of preferences and to the unintended
consequences for others.
I
m.
Communications Framework: Curative and Remedial v. Aspirational and Empowering
A. An Edge for Pointed Clarity
To communicate the contrasts between our approach and those of the Idivisive Right and
Old Left, .we must sharp draw lines:.
.
I
'..
•
Discrimination still exists. Agencies must clearly communicate research and
enforcement data demonstrating that oid-fashioned discriminatioh is alive and too
well: Evidence produced b~ "teste:s" matche~ pairs of minority and majority job
applIcants, for example -- IS especIally compellmg.
I"
-1
. • Some voluntary and remedial measurls are too extreme. We should point to
examples that are unnecessarily intrusiJe, burdensome or injurioJs. And we should
. . describe better alternatives
I
I
•
Som~ specific measures that have been sharply criticized were,
in Ifact, fully justified
by the particular circumstances. Administration officials should explain a few of
these pointedly, defending the appropri~te use of tough medicinel
,
•
j
!
'5
�B. Curative and Remedial v. Aspirational and I.mpowering
As much as anything else, civic discourse on civil rights needs a langt;lage of healing rather
than division. Beyond the more narrowly jtlstifiabh~ matters of blarrte-based cure and
I
,
remedy, we pursue affirmative action and diversity to empower the indiv,idual beneficiaries
"'" rand because we have aspirations as a nation to build strength through inclusiveness. These
« are alternatives to, the languag~ of blame, gUiltjand reparations. .
I
. There is more to affirmative action than providing a remedy 'to a proven incident of
discrimination involving a victim and a perpettator -- the remedigJ cont~xt. There is also .
the more general problem of addressing the lihgering social and econorhic effects ·of past
wrongs. These are manifest as contributing fahors to the disadvantage Isuffered by t:nany
individually, and disproportionately by Africab Americans in the aggregate. This is the
curative context.
I
II.
cu~
But these are not enough. Both remedy and
are tenns that invoke the moral categories
of victims and perpetrators, of innocence and fault. They invoke the anJlytical framework
of cause and effect, of damages and reparatidJis.· As such, the terms Ilare nO( politically
I
effective when too many in the public simply dq not believe in the predicate of wrongdoing, .
or feel that the preference benefits individuals whose own link to the {vrongdoing is too
remote to justify the preference. Indeed, the tetms are inherently divisive;, precisely because
I
.
they invoke the language of blame. This does not mean that this framework is invalid or that .
we should scrap it. But we have to recognize the limits to its usefulnes~:
.
. ' 1
.
'I
.
.
An alternative framework stresses the affrrmatiye value of inclusiveness. 1 First, inclusion is
a means of empowering individuals to realize their full potential and thus contribute to the
well-being ,of their families and communIties .. S,econd,· inclusiveness betiefits America as a
whole, ~~cause are liyes are rieher as a r~sult of social diversity ,.1 ~nd because ?ur
commumttes and our economy are stronger wlien all of us are full partIcipants -- carry1Og· '
both a full load of responsibilities, and a full complement of opportuhities. These are
unifying themes of empowerment and aspiratidn.
I
C. Reacting v. Leading
•
I
From a political standpoint, there is an enormous difference between
reactions to the legislative or litigation developrhents thrust upon us, ve
that:
..
I'
P~OVl'C1.mI!!:::f!iee4~
'.
s leading in way
I
. ' sets the agenda for· public discourse, rlther than conveying the inisimpression that
New Democrats are politically timid abbut engaging in a debate
•
I.
bn the issues;'
.
l . way, to.' ke
·'
'.
.
"
procIalffis commItment and purpose by us10g edges, 10 a non-combatlve.
rna
fundamental purposes clea'r -- identifyirtg some measures we are Ijor, and some we
~-I are a g a i i l S t ; '
I
6
�•
in content, communicates to civil rights Itraditionalists that New Democrats have not
abandoned the Democratic commitment .to continuing racial progrds -- meaning boch
racial harmony and steady, tap.gible prpgress in eliminating disctimination and its
lingering consequences;
•
.
1 , . · . 1 · .'
.
communicates to civil rights conservatives and revisionists that New Democrats are
prepared to abandon, and even criticize, :private and governmental techniques that are
too divisive and intrusive for the results they produce; and , j, '
~oter
• (strategiCallY mixes narrowcayting to Ikey constituencies and
blocs, with
if
broadcasting to the Nation as a whole. Reliance exclusively on nJrrowcasting sends
l'
a message that the commitment is a polit1ically contingent one, r~thbr than the product
~
of a deeply rooted value.
'
I
D. Litigation v. Policy
Perhaps because civil rights discussions are h~avily populated with la\Viyers, they quickly
become debates over recent and pending litiglltion. We debate policy ;choices within the
fra~~work of contested legal d~ctr~es, .and e~en mistakenly believ7 ~h~~ most key pol~cy
deCISIons are about what to wnte m bnefs and how to amend a CIVll rIghts or set-asIde
•
statute. This legalistic conception is a dangen~l,lsly limited one. - ,
~nd
Purging,the lingering effects of past racial wrolgs must go beyond rights-based litigation
legislation to address directly the impedimendI to opportunity. • For exatnple, quality K-12
•
'
•
I
schools, combattmg teen pregnancy, and the commuruty secunty agenda must be seen by
civil rights traditionalists as absolutely criticaUneasures for saving the ndxt generation. (To
this list one might add voter registration and participation.) The Admirhstration can make
,
I
that link, and a populist and forceful demand! that we make progress on that social policy
agenda will translate for many as a demand for racial progress. Which it is.
'
,
.
I'
I
Even within the narrower range of conventional civil rights measures, it is a mistake limit
policy debate to the questions presented in' litigation. ,Research is l a good example.
Government and foundation funding cutbapks,' together with the 'igrowing "political
correctness" of conservative retreat on civil rights matters, jeopardize our intellectual capital.
There is too little und~rstanding of-effective tebhniques of outreach, rec~itment, affirmative
action, conflict management, 'persuasion and S0 forth. There is too little basic data-about the
extent arid consequences 'of continuing discbination in employmerlt, housing, credit,
delivery of public services, etc. (The FY 1996: Budget includes several ptoposed investments
to help rebuild our capacity, including resourcJs for the Civil Rights Divi:sion to use "testers"
for research and enforcement purposes, and added funding for the EEOC and the Civil
Rights Commission.)
.
I_
E. Policy v. Pulpit
7
�. '
,
b~c-ause
The legalistic perspective misses the point in a: more fundamental way,
its focus is
on public policy rather than civic vinues and ~he private practices those , virtues engender.
It is a cliche to note the President's role as First Preacher and Chief Teacher. That role is
often trivialized as First' Lobbyist, and it canibe dangerously inflated td that of Tiresome
Moralist. In between, however, is an honorab1le role that -calls us to ourl better selves, and
recalls the Nation to its deeper meaning. The closing message of the State of the Union was
I
" ,
quite explicitly in this vein. The question is h0w to sustain it in general,! and how to apply
it specifically in the civil rights a r e n a . '
I
'
We make the civil rights, agenda the domain of political tacticians; career litigators and
governance mechanics. But that is the wrong field of battle. Almost {vithout exception,
, when Bill Clinton has spoken from his soul onlcivil rights matters he has] communicated all
the qualities and themes needed to lift the natipnal discourse from the tr~nch _
warfare over
legal doctrine to the vastly more important plape of civic virtues.
Some Action Items
Translating the points above into concrete action items is difficult., , Here are some
possibilities: '
I
•
Work with California Democrats to fonnulate a Clinton-backed alternative ballot
proposition for California, and organize voters around it.
'
I
'
;I
Plan three high-pI-ofiie Presidential spe~ches over the next 9 months explicitly on the
civil rights agenda, delivered on the p,lain of values, virtues ana aspirations. On
selected policy speeches in education, dmployment, the Middle class Bill of Rights,
etc., occasionally add an explic.it linkage to the civil rights "oppdrtunity agenda."
,
•
,-
I
'
Have certain cabinet officers reinforce Ithe Presidential message above with parallel
'speeches of their own. Have a media strategy of background interviews' with
' "
thoughtful essayists and opinion-makers.,
I, "
::r«
•
- ,
Identify two or three programs or praJtices -- Federal or State":- that overstep the
bounds. For example, a minority set-aside that is too rigid or not narrowly drawn.
~
righ~
high-ViSibillty~
• ' Identify a civil
agency to streJgilien with a
initIative. - For
, example: new resources at EEOC to eiiminate the backlog, or m!w resources at the
Civil Rights Commission to rebuild a respectable research capability.
,
·
"
"
-,
I
-
Develop an initiative with a coalition of religious leaders,
I '
includ~ng
broadcasters.
8
�I
IV. Conclusion
From the perspective of civil rights· liberalsi, the Reagan-Bush years were a period of
unnervIng and even frightening behavior by the White House, the Depanrpent of Justice, and
the Congress. At times hostile, at times begtiudgingly benign, the political branches have
reminded anxious minorities that politics is a game designed for the majority. Compounding
the anxiety, the Judiciary has similarly moved ~ightward, in accord with tae Framers' design.
. The lesson is that even those doctrinal gainS rooted in Constitutionai interpretation are
I
evidently contingent on politics as well, albei~ with a lag.
'.
.'
.
I
,
.
The divisive quality of racial politics was largely quiescent on the nat~onal political stage
after George Wallace's 1968 bid and until th~ activist revisionism of Meese and Reynolds
ushered in what civil rights liberals understood to be an era of peril. They now ask whether
that era is over, and what will come n e x t : '
I
.
I
9
�THE WI:IITE HOUSE
WASHINGTON
Statement on the President:
The Supll~me Court's A darand Decision
The Supreme Court's decision sets a new legal standard for judging affirmativ~ action, but it'must
,
, I
not set us back in our fight to end discrimination and create equal opportunity for all.
Despite great progress, discrimination and exclusion on the basis of race and lender are stiH facts
of life in America. I have always believed that affirmative action is Ineeded to remedy
discrimination and to create a more inclusive society that truly provides equal opportunity: But
I have also said that affirmative action must be carefully justified and must be done the right
way. The Court's opinion in Adarand is not inconsistent with that view. I
I
,
_
I
It is regr~ttable that already, with the ink barely dry, maJ}y are using the <pourt's opinion as a
reason to abandon that fight. Exaggerated claims about the end of affirmati"'e action -- whether
in celebration or dismay -- do not serve the interest all of us have in a tesponsible national
conversation about how to move forward together and create equal opportuhity.
,
I
The Supreme Court has raised the hurdle, but it is not insurmountable. Make no mistake: the
Court has approved affirmative action that is narrowly tailored to achieve a icompelling interest.
The constitutional test is now tougher than it was, but I am confident that toe test can be met in
I
many cases. We kn<5'W that from the experience of state and local governments, which have
.,
operated, under the tougher standard for some years now.
I
'
Some weeks ago, I directed my staff conducting the review of federal affirmative action programs
to ask agencies a number of probing questions about programs that make rade or sex a condition
of eligibility for any kind of benefit. What, concretely, is the justificatioh for this particular
program? Have race and gender-neutral alternatives been considered? Is -tlie program flexible?
Does it avoid quotas, in theory and in practice? Is it transitional and tempolrary? Is it narrowly
I
drawn? Is it balanced, so that it avoids concentrating its benefits and its costs? These are tough
questions, but they are the right policy questions and they need answers.
.
I have instructed the team conducting the Administration's affirmative action review to include
an analysis of the A darand decision and its implications in their report.
-
,
�
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Carol Rasco
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<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
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Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
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<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
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