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Withdrawal/Redaction Sheet
Clinton Library
DATE
RESTRICTION
DOCUMENT NO.
AND TYPE
SUBJECTffiTLE
001. briefing
paper
General Targeting Strategy (38 pages)
nd
PS
002. memo
Chris Jennings to Hillary Clinton
Re: Meeting with Senator Tom Harkin (2 pages)
12/15/93
PS
COLLECTION:.
Clinton Presidential Records
Domestic Policy Council
Chris Jennings (Health Security Act)
OA/Box Number: 23754
FOLDER TITLE:
December 1993 HSA [ 1]
Gary Foulk
n 13
RESTRICTION CODES
Presidential Records Act- 144 U.S. C. ZZ04(a)J
Freedom of Information Act- (5 U.S.C. SSZ(b)J
PI
PZ
P3
P4
b(l) National security tlassified information J(b)(l) of the FOIAI
b(2) Release would distlose internal personnel rules and practices of
an agency J(b)(2) of the FOIAJ
b(3) Release would violate a Federal statute J(b)(3) of the FOIAJ
b(4) Release would disclose trade secrets or confidential or linancial
information J(b)(4) of the FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy J(b)(6) of the FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes J(b)(7) of the FOIAJ
b(8) Release would dlstlose Information concerning the regulation of
financial institutions J(b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
·
concerning wells [(b)(9) of the FOIAJ
National Security Classified Information ((a)(l) of the PRAI
Relating to the appointment to Federal office J(a)(Z) of the PRAJ
Release would violate a Federal statute J(a)(3) of the PRAI
Release would disclose trade secrets or confidential commercial or
flnanclal information J(a)(4) of the PRAJ
PS Release would disclose confidential advise between the President
and his advisors, or between such advisors Ja)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy J(a)(6) of the PRAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misnJe defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
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DETERMINED TO BE AN ADMINISTRATIVE
MARKING Per E.O. 12958 as amended, Sec. 32 (c:)
Tnitials:
.c2t Date:. B·{e·oS"
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PRIVILEGED AND CONFIBEN'f'b\:L MEMORANDUM
December 15, 1993
TO: H1llary Rodham Cllnton
FR: Chris Jennings
RE: Meeting with Senator Tom Harkin
cc: Melanne, Steve, Distribution
Tomorrow afternoo11 you are scheduled to meet wtth Senator Harkin, hts
Legislative Director and lo,ng-tlme health person Peter-Reinecke, and his
Health LA, Ann Ford. (FYI, Peter used to serve on the House Aging Committee
under Claude Pepper.)
•
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BACKGROUND
The precurser for this meeting was some information we recetved from
AFSCME, the anti-balanc~d budget vote counter, that asserted that Senator
Harkin is planning to vote jfor the balanced budget amendment. He has
apparently indicated that the most any one can expect from h~ is a
procedural cloture vote.th~t would support our position. We had thought you
would take this opportunity to have a similar conversation with Senator
Harkin that you and Dick parman had with the House conservative
Democrats. You may also 1want to discuss the deleterious Impact the
amendment would have on the appropriations process.
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.
The stated purpose fpr this meeting, however,. is to discuss his current
feelings about the Health Security Act. We have told his staff that we want to
take this opportunity -- a5 we are doing with others who, despite serious
reservations, cosponsored the btll --to thank Members for their support.
.
.
As you may recall, Senator Daschle has repeatedly stated that Senator
Harkin was his last and most difficult Member to get on board as a cosponsor.
Senator Harkin was very concerned that his cosponsorship would lead us to
take him for granted. Moreover, he was very upset that we did not explicitly
proVide any fund for additional dollars to be made available for a NIH research
trust fund. (He feels' he wa~ given fairly positive indications that we looked
favorably upon his idea; in ~dditlon, since there is a somewhat similar
provision in the Chafee btll ;-- that was pushed for by Senator Packwood, he
thinks our omission makesihim look particularly bad.) No doubt this issue
will come up during your C<?nversatton.
·
�...---------------..,....._--------~-
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Relat~d
to the research trust fund issue, Senator Harkin may raise
concerns that we are expecting too much money to be available from the
Appropriations Committee for· our investment ln Public Health and our needs
for Administrative costs. (He will argue that the caps are going to get in the
way.) Hts staff ls interested ln re-opening discussions on making dollars
available over the Appropriations cap, much as we are trying to do with the
WIC program. Today I suggested that we schedule a meeting with the staffs of
Senators Kennedy, Byrd, Sasser and Harkin. Senator Kennedy's office and
OMB expressed great interest in such a meeting. We are planning for such a
meeting to take place in early January.
The other health care issue that he willllkely raise concerns about wlll
be related to rural health care. He is particularly concerned about the size of
the Medicare cuts and how they will affect rural hospitals, especially those
facllltles now designated as Medicare dependent hospitals. He is also not
overly confident that our plan in general works well in rural areas. (In
response you can talk about how the majority of the Medicare hospital cuts
come from disproportionate share payments and Graduate Medical Eductatlon
-,... two sources that primarily have an impact on urban-based hospitals. You
may also want to indicate a continued wlllingness to be fle?ctble on this issue.
With regard to the other rural health issues, I believe you can focus as you
always do on all the benefits of the plan with regard to rural communities.
Attached ls a draft memo on this issue that I thought you might find useful.)
Senator Harkin serves as the co-chair of the Senate Rural Caucus.
Earller today, his staff (Peter Reinecke) requested that the Administration
conduct a briefing for the Caucus in early January. I said that we would be
happy to so, and it ts now in the process of being scheduled.
Lastly, ·rn. we sent an Administration witness (Deria Puskln) to a rural
health conference Senator Harkin held in Iowa on December 10, 11, and 12th.
Lots Quam was going to go as well, but had a last second problem crop up
with one of her kids. Senator Harkin's office was very understanding; in fact,
Senator Harkin's wtfe ts close to Lots Quam.
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Withdrawal/Redaction Sheet
Clinton Library
·
SUBJECTrriTLE
DATE
RESTRICTION
00 I. profiles
House of Representatives (4 pages)
nd
P5
002. memo.
Chris Jennings to Hillary Clinton
Re: Senate Leadership Lunch (2 pages)·
5/4/92
P5
003. profiles
Senate Democratic Leadership (8 pages)
5/2/93-
P5
004. memo
w/attach
Chris Jennings to Hillary Clinton
Re: Kassebaum/Glickman "BasicCare" Meeting (7 pages)
5/5/93
P5
005. memo
Chris Jennings to Hillary Clinton
Re: Meeting with Congressman McCurdy (I page)
5/5/93
P5
Chris Jennings to Hillary Clinton ·
Re: Summary of David Pryor's Aging Committee Event (3 pages)
5/5/93
P5
nd
P5
nd
P5
5/5/93
P5
DOCUMENT NO.
AND TYPE
lo'o6. memo
007, profiles
008. profiles
loo9. memo
wllittach
· Democrats on Senate Agirig Committee (5 pages)
Republican Members of the Senate Aging Committee
(6 pages)
Chris Jennings to Hillary Clinton
Meeting with Senator Wellstone and Single Payer Groups (4
pages)
~e:
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Chris Jennings (Health Security Act)
ONBox Number: 23754
FOLDER TITLE:
May 1993 HSA [2] .
Gary Foulk
f82
RESTRICTION CODES
Presidential Records Act -]44 IJ.S.C. 2204(a)]
Freedom of Information Act -15 IJ.S.C. 552(b)]
PI
P2
P3
P4
b(l) National security classified Information ](b)(l) of the FOIA)
b(2) Release would disclose Internal personnel niles and practices of
an agency ](b)(2) of the FOIA(
b(3j Release would violate a Federal statute ((b)(3) of the FOIA(
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) of the FQIAJ
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy ](b)(6) of the FOIAJ
b(7) Release would disclose Information compiled for law enforcement
purposes ](b)(7) of the FOIAI
b(8) Release would disclose information concerning the regulation of
financial institutions ](b)(S) of the FOIA)
b(9) Release· would disclose geological or geophysical Information
concerning wells ](b)(9) of the FOIA]
National Security ClassiOed Information ](a)(l) of the PRA]
Relating to the appointment to Federal office ](a)(2) of the PRA]
Release would violate a Federal statute ](a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)-·
P5 Release would disclose confidential advise between the President
and his advisors, or between such advisors (a)(5) of the PRA(
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA(
C. Closed in accordance with restrictions contained in ,donor's deed
of gift.'
PRM. Personal reeord misfile defined in accordance with 44 U.S.C.
2201(3).
RR: Document will be reviewed upon request.
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·PRIVILEGED AND €0NFIDEN:ri:M. MEMORANDUM
DETERMJN'ED TO BE AN ADiVii.NJSTRATIYE.
MARKING Per £.0.12958 as amended, Sec. 3.2 (c)
Initials:
q
Date:
I D • I 1. '" ~ .
./J
TO:
FR:
RE:
May 5, 1993
Hillary Rodham Clinton
Chris Jennings ·
·
Summary of David Pryor's Senate Aging Committee Event
T9morrow morning, you are scheduled .to join Democratic and Republican
Members of the Senate Aging Committee for a closed "healthy" breakfast meeting to
discuss aging issues and preventive health care. After the breakfast, the Aging
Committee will convene a hearing on preventive health for older per5ons. ·
While the hearing will explore the senior prevention topiC broadly, certain
witnesses will stress that tobacco and alcohol are leading causes of disease,
premature death, and health costs. Attached to this memo you will ijnd a schedule
for the morning and a copy of Senator Pryor's draft opening statement.
Purpose of the Hearing (Which Follows .Your Meeting)
The hearing will emphasize that the U.S. health care system 'is·aggressive in its
diagnostic and treatment efforts once serious illnesses and injuries have occurred, but
that it is negligent and short-sighted in investing in prevention. It will suggest that
many of these illnesses and injuries could be avoided not only by investing in
preventive services, but by individuals taking a greater 'degree of self-responsibility
for their own health status.
The three leading causes of preventable health problems will be explored in
detail: tobacco, alcohol, and poor diet. Specifically, one in four Americans will die as
a result of the use of tobacco and alcohol. Tobacco killed an estimated 417,000 in
1990. Alcohol killed 107;ooo in 1988.
Costs of tobacco and alcohol to society and the health car~ system will be
. quantified. The Aging Committee will release a Congressional Office of Technology
Assessment study documenting that in 1990 tobacco. cost society $68 billion, including
$21 billion to the health care system. The latest study on··alcohol concludes that the
1990 costs to society were $98 billion, including $12 billioil·to the health eare system.
This information will support any effort to,,·move to incre·ase disincentives (taxes) for
unhealthy behaviors, such as smoking. ::;)
;,
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~·.
·.}:
i:>_;·i;,:;.::·
·,:
�Background on the Senate Aging Committee
The Senate Aging Committee is a permanent oversight panel established in
1961. Although its House counterpart was recently elimin.ated, Senator Pryor
defeated an effort to kill the Aging Committee on the Senate floor by 56-43. Senator
Reid offered the amendment, even though he sits on the Committee (and will attend
the breakfast). Senator Pryor made an emotional appeal to save the Committee.
· The Committee remains at risk because a Joint Committee on the Organization of
Congress will put out a report as early as August which is likely to recommend
cutting back ori the number of Congressional committees.
Anything positive you can say about the Aging Committee would be deeply
and personally appreciated by Senator Pryor. Positive comments would be welcome
at the breakfast (because some of the Members voted against the· continuation of the
Committee), but particularly welcome at the 9:30 press availability .. You might want
to consider acknowledging some of the important work the Aging Committee has
produced over the years. In particular, you could highlight its work on controlling
drug costs, raising the special concerns of rural communities, highlighting the
importance of home- and community-based long term care coverage, and·
publicizing the importance of cost-effective preventive health care interventions.
Members Attending the Breakfast Meeting
The following members have ~ndicated they will attend:
Sen.
Sen.
Sen.
Sen.
Sen.
Sen.
Sen.
Sen.
Sen.
Pryor, Chairman
Glenn
Bradley
Breaux
Reid
Graham
Feingold
Krueger
Shelby
Sen. Cohen, Ranking Minority
Sen. Pressler
Sen. Grassley ·
Sen. Simpson
Sen. Jeffords
sen. {)urenberger
Sen. Craig
. Sen. Burns (arriving late)
Many of these Members are particularly critical to us,· especially Bradley, Breaux, :
Graham, Cohen, Jeffords, Durenberger, and Burns. Attached for your information is
a summary of the health backgrounds of each of the Aging Committee Members.
�~
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SCHEDULE.
· May 6, 1993.
8:00 - 9:15 a.m.
Breakfast Meeting with Senate Aging Committee
Russell Senate Office Building, Room 428A
(Small Business Com~ttee Hearing Room)
Meet with members of the Senate Special Committee on Aging.
Topics of discussion limited to aging issues arid preventive health
care. You can make a brief comment on these issues followed by
a disetJssion moderated by Senator Pryor. Closed to press.
Quick (two minute) photo opportunity for the media at the
beginning of the breakfast meeting. Breakfast will be low-fat,
speCially overseen by cable 1V personality Lynn Fischer, "The
Low Cholesterol Gourmet," who will attend.
(Lead staffer: Jonathan Adelstein for Senator Pryor. Other
majority and minority committee staff will be in the room fur
breakfast, but the hearingwill be closed to staff of committee
~m~rsJ
·
·
·
9:30- 9:45a.m.
Press Availability
Lisa has okayed a brief statement to the press on the importance
of aging issues, preventive health, and the role of the Senate
Aging Committee. You wiJl be joined only by Chairman Pryor
and Ranking.Republican Member Cohen. After a very brief
number of questions, Senator Pryor will cut it off.
·You then leave the Senate Office Building.
· 10:00 - 12:30 p.m. . Hearing of the Senate Aging Committee
· Title: "Preventive Health: · An Ounce of Prevention Saves a
Pound .of Cure."
.
.
Witnesses will testify about the cost-effectiveness of preventive
measures, even for the elderly. They Will discuss the costs to
society and the health eare system of risky choices such as ·
smoking,. drinking alcohol excessively, and eating high-fat foods.
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MARKlNG P~:r E.O. 12958 U3 arilcndcd, Sec. 3.2 (cj
A/ ·J= '. Date: If 8/12I r.
Wtials:
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PERSONAL AND -«~~AfMI!l«PmE!mEEEi- MEMORANDUM
Hillary Rodham Clinton
May 5, 1993
Chris Jennings, Steve Edelstein
Meeting with Senator Wellstone and Single Payer Groups
Melanne, Steve, Ira, Judy, Mike
TO:
FROM:
RE:
cc:·
Background:
. Following up on your telephone conversation with Senator
Wellstone last week, you are scheduled to meet with him and
representatives of organizations which support·the single payer
approach to health care reform. Senator Wellstone has tried to
ke.ep the meeting size manageable by allowing each group· to send
only one representative. There will probably be about 15 groups
represented at the lt)eeting.
··
Yesterday, Chris spoke with Senator Wellstone. and suggested
that he call Congressman McDermott to advise him about this
meeting and invite him to attend. Senator Wellstone assured him
that he would, but as of _this writing it is unclear whether the
Congressman will be attending. ·In addition, this morning, Chris
informed Barbara Smith of Congressman McDermott's staff of the
meeting. She thought it would be no problem if McDermott did not
attend.
·
Format:
Senator Wellstone will open the meeting and introduce you.
It is then expected that you give brief remarks (5-10 minutes).
After you~ remarks, Senator Wellstorie will then turn it over to
representatives of the organizations attending to give
presentations on issues they care about.
·
Points to Hit in Your Remarks:
(1)
Shared Principles. There is a lot of common ground between
our approach a.nd the single payer approach. We share a
commitment to providing coverage to all Americans to a
comprehensive set of benefits. We agree ori the need to
fundamentally overhaul our health care system to.better
control'costs, reduce paperwork and streamline
administration. We are also committed to maintaining
quality and consumer choice.
·
(2)
State Flexibility. State flexibility will be central to our
plan. This will allow states to implement single payer
models if they feel it _best meets the needs of the people of
that state.
�·-·-··------------------···-····
( 3)
Health Care This Year. We share your sense of the urgency
of the problem and the need to act sooner rather than later·
on health care reform. We have-a great opportunity to pass
health care reform this year.
(4)
Praise Senator Wellstone. You may wish to thank Senator
Wellstone for arranging this meeting and for his leadership
and deep commitment to this issue •.
Issues of Concern:
The groups will likely raise the following issues in their
presentations:
(ll
No Opt Outs. They advocate a single-tier system and feel
letting groups opt-out will undermin~ this and may leave
those left in the plan with inferior coverage and serv.ice.
(2)
Fair Financing. They favor progressive tax-based financing
rather than a premium.
(3)
Comprehensive Benefits. They want the benefit package to be
as comprehensive as possible ·including coverage· for longterm care, mental health, and rehabilitation services.
(4)
Public Accountability. They back consumer participation on
all oversight and governing boards.
( 5 ).
Freedom of Choice. They believe consumers should remain
free to pick their own doctors.
(6)
Affordability.· They oppose co-pays and deductibles_for
covered services.
(7)
Universality. They want
rapid phase-in.
-··
everyon~
covered with a'_fairly
Background Materials:.
Attached· for your information, is a background profile of
Senator Wellstone. and a memo by Mike Lux of Public Liaison on the ·
groups who will be attending.
�.----------------------
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SENATOR PAUL WELLSTONE (D-MN)
.
.
Senator Wellstone is very interested in health care reform. In March, he reintroduced
his single payer bill, the Senate counterpart of the McDermott bill. Despite his strong bias
toward single payer and .his suspicions of managed Competition, he has expressed a
willingness to work with you. His strong desire for reform and his belief that we must act
now make him likely to support the Administration plan.
Senator Wellstone has a strong interest in mental health and substance abuse benefits.
He modified his previous bill to strengthen its mental health provisions. Last week (4/29), he
attended a briefing by· Mrs. Gore on mental health issues for Members of Congress and staff.
Wells tone expressed his strong support for including mental health servcies in the benefits
package. He also raised the possiblity of forming a Senate Mental Health Working Group
along the lines of the group lead by Congressman Kopetski in the House. Other. concerns
include rural health, consumer choice and state flexibility -(so that Minnesota might .pursue a
single payer option). ·
. Recent Developments: Senator Wellstone indicated concern regarding talking points
distributed by the Task Force to the members of Congress, particularly how single payer was
characterized. At the retreat, he stated 'that he doesn't want anyone to be able to opt out of
the Purchasing Cooperative because he fears that healthy people will opt out.
�THE WHITE HOUSE
.WASHINGTON.
May 5, 1993
MEMORANDUM FOR CHRIS JENNINGS ·
SUBJECT:
HRC Meeting With Senator Wellstone
FROM:
Mike Lux·
I have divided the single payer.groups attending the Wellstone
meeting into three different categories: ·
1. Groups that are realistic and are working very constructively
with us to get a package they can support:
AFSCME
Communications Workers of America
National Farmers Union
ILGWU
2. Groups that have been very tough negotiators, and are a
little more purist than those in the first category. We can
probably get these groups on board in the end.
consUlllers Union
Citizen Action
National Council of Senior Citizens
Church Women United
National Association of Social Workers
.American Public Health Association
3. Groups that are more pure, and are totally committed to a
single payer approach. Whether we ever get them on board is a
real question.
Public Citizen
Neighbor to Neighbor
NETWORK
Gray Panthers
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Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECTfTITLE
RESTRICTION
001. briefing
paper
Re: Meeting with Senator Moynihan (3 pages)
1/24/94
P5
002. memo
Chris Jennings to Hillary Clinton
Re: Moynihan Meeting (1 page)
1/24/94
P5
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Chris Jennings (Health Security Act)
ONBox Number: 23745
FOLDER TITLE:
January 1994 HSA [1]
Gary Foulk
RESTRICTION CODES
Presidential Records Ad -(44 U.S.C. 2204(a)l
Freedom of Information Ad -IS U.S.C. 552(b)J
National Security Classified Information l(a)(l) of the PRA(
Relating to the appointment to Federal office ((a)(2) of the PRAJ
Release would violate a Federal statute ((a)(J) of the PRAI
Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA(
PS Release would disclose confidential advise between the President
and his advisors, or between such advisors (a)(S) of the PRA(
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6) of the PRA(
b(l) National security classified information ((b)(l) of the FOIAI
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIAJ
b(J) Release would violate a Federal statute ((b)(J) of the FOIAI
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIAI
b(6) Release would constitute a dearly unwarranted invasion of
personal privacy ((b)(6) of the FOJA(
·
b(7) Release would disclose hi formation compiled for law enforcement
purposes ((b)(7) of the FOIA(
b(8) Release would disclose information concerning the regulation of
financial institutions l(b)(8) of the FOIA(
b(9) Release would disclose geological or geophysical information.
concerning wells ((b)(9) of the FOIA(
·
'
PI
P2
PJ
P4
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misnle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
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�THE WHITE HOUSE
WASHINGTON
January 24, 1994
MEETING WITH SENATOR MOYNIHAN
DATE:
January 25, 1993
LOCATION: Oval Office
TIME:
TBA
FROM:
Pat Griffin
I.
PURPOSE
• .
To make a personal request that the Chairman work closely with you and
the rest of the Administration in reporting a health reform package out of
the Finance Committee, (which meets the "bottom line" requirements), by
no later than the Memorial Day recess. You need to ask Senator ·
Moynihan to adopt your priorities as his own.
•
To advise him that you believe we need to get the health care bill on the
floor and· passed by the July 4th recess in order to get an acceptable
package through a difficult conference and then onto final passage. To tell
him directly that you believe that he is indispensable to ensuring health
care is enacted.
•
To indicate that you will instruct the Administration to work closely w1th
him and his staff (as we are already doing) to address New York-specific
concerns about health care, e.g., impact on the Medicaid program, state
and local employees, and medical education and resear~h facilities.
•
To ask him if there is anything the Administration can do to better assist
him in crafting a legislative initiative that can .be passed through his
Committee, while retaining your "bottom line" priorities. You need to
advise him of your belief that the product of the Finance Committee will
carry the most weight on the Senate floor.
•
To re-emphasize your interest and commitment to welfare reform, to
outline a Spring timetable for introduction of such a bill, to describe how
closely you feel health care and welfare reform are linked, i.e., that you
can't achieve welfare reform without health reform and, finally, to tell him
that you will be making all of this clear in your State of the Union address.
�THE WHITE HOUSE
WASHINGTON
II.
BACKGROUND
Today Senator Mitchell made clear that he felt it would take a direct request
from you to keep Chairman Moynihan and the Finance Committee to a schedule
that ensured that a bill, reported out of the Finance Committee, could be debated
on the Senate floor by June. Without his personal commitment to doing so, it is
clear that the Finance Committee could drag its feet on producing such a bill
until at least the August recess. Should this occur, it would'be virtually impossible
to get a bill passed by the Congress that you were comfortable with signing. (This
is because the delayed legislative process would almost guarantee that no bill was
produced OR any bill that was produced would be watered down.)
Senator Mitchell suggested that you call Senator Moynihan. Following your
_conversation with the Finance Committee Chairman, he and you concluded a face
to face meeting tomorrow would be advisable.
,_,
Chairman Moynihan's damaging "fantasy" and "no health care crisis" remarks are
well known and ·do not need further mention. However, we must find ways to
ensure that, to the extent possible, there are no other such statements. The only
way most Moynihan followers believe this is possible is that he becomes as
invested in getting the. health care initiative passed as you do. Tomorrow's
meeting will hopefully begin to serve that purpose.
Other high priority issues besides welfare reform that the Chairman has recently
raised, and may do so again, are:
(1)
The Medicaid formula, which he believes disproportionately helps the
southern states and hurts New York;
(2)
'I)le impact of the reorientation of .an emphasis from specialty training to
primary care training of physicians on New York teaching and research
facilities; and
·
(3)
Making the Social Secu~ity Administration an Independent Agency outside
the confines of the Department of Health and Human Services.
�THE WHITE HOUSE
WASHINGTON
Lastly, a reminder of the "bottom line" issues that Ira forwarded to you today:
(1)
(2)
Comprehensive benefits that are defined.;
(3)
Insurance market reforms that guarantees an end to insurance
discrimination through the use
of coi1llnunity rating and large risk
pools;
·
(4)
Cost containment that has an enforceable backstop; and
(5)
IV.
Universal coverage by the end of the decade that utilizes an employerbased system; •
Upgraded senior benefits if there are significant Medicare savings.
PARTICIPANTS
The President
The First Lady
. Chairman Moynihan and his staff, Lawrence O'Donnell
Pat Griffin or Steve Ricchetti
George Stephanopoulos
V.
SEQUENCE OF EVENTS
Senator Moynihan arrives at to be announced time.
The President opens up meeting and calls on the First Lady to make a few
remarks about how appreciative i~portant she (also) believes that the Chairman
will be to the upcoming legislative process and how much she believes his
assistance will be critical to a successful outcome.
VI.
.PRESS PLAN
Closed press. (White House photographer will be present.)
�PRIVILEGED AND
~ONFIDENTIA~
MEMORANDUM
~LlEillifiNED TO BE AN ADMINISTRATIVE
~NG Per E.O. 12958 as amended, Sec. 3.2 (c)
. Date: 8 · I ~ '6 ; ·
JWti&l»; .r:·-- /).'1
TO:
FR:
RE:
cc:
Hillary Rodham Clinton
Chris J.
Moynihan meeting
Melanne
January 24, 1994
Attached is the memo Pat G. asked me to draft in preparation
for the tomorrow's meeting with Senator Moynihan, the President
and you.
The time has not been locked in yet (as of 8:30
tonight) and I do not believe it will be listed on the publicly
distributed schedule.
Update of info not included in the memo: Today we held our
New York Medicaid briefing with the Finance Committee staff. I.
believe it went very well and the staff all seemed to come to the
conclusion that our analysis was much more sound than that of the
State of.New York. During the course of the meeting, however, it
became clear that Chairman Moynihan is definitely concerned about
the medical education issue/impact on New York's teaching
facilities. We plan on holding another briefing on this subject
for his staff within the next week or so.
One additional bit of information: the Chairman is holding
a Members only meeting with his Committee this Wednesday to
discuss health care·. ·I am not sure what all is on the agenda,
but I do know that he plans to give the Members a list of about
17 hearings he wants their approval to hold from February through
mid April. In addition, he wants to discuss the advisability of
having a Finance Committee Members retreat in mid March. (I do
not believe we are supposed to know this information.) At any
rate, I think this is good news because it illustrates that he is
at least invested enough in this issue to start the Committee
process in earnest.
If you need any additional information, don't hesitate to
call me either at home tonight or tomorrow morning at the office.
�·--------·---------------------------------------.
I
I
I
I
If
I
I
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECTffiTLE
001. memo
. w/attach
Chris Jennings to Pat Griffen, Harold Ickes
Re: Meeting with President, First Lady and Moderate Republicans (3
.pages)
2/]3/94
P5
. Meeting with Senate Republicans/Mitchell and Dem Chairs (3 pages)
2/21194
P5
002.briefing
paper
DATE
RESTRICTION
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Chris Jennings (Health Security Act)
OA/Bo)( Number: 23754
FOLDER TITLE:
February 1994 HSA
Gary Foulk
f115
RESTRICTION CODES
Presidential Records Aet -(44 ·U.S.C. l:Z04(a)(
Freedom of Information Act -IS U.S.C. SSl(b)(
PI
P2
PJ
P4
b(l) National security classified Information l(b)(l) of the FOIAJ
b(l) Release would disclose Internal personnel rules and practices of
an agency J(b)(:Z) of the FOIAI
b(3) Relea.se would violate a Federal statute ((b)(3) of the FOIAI
b(4) Release would dlsclose·trade secrets or confldential or linanc:ial
information J(b)(4) of the FOIA(
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes i(b)(7) of the FOIA(
b(8) Release would disclose informalion concerning the regulation of
nnanclallnstitutions ((b)(8) of the FOiAJ
b(9) Release would disclose geological or geophysical information
·
concerning wells ((b)(9) of the FOIA)
National Security Class! lied Information ((a)(t) of the PRA(
Relating to the appointment to Federal office l(a)(l) of the PRAJ
Release would violate a Federal statute ((a)(3) of the PRA(
Release would disclose trade secrets or conndentlal commerdal or
nnandal information ((a)(4) of the PRAJ
P5 Release would disclose corilidentlal advise between the President
and h!s advisors, or between such advisors (a)(S) of the PRAI
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy ((a)(6) of the PRAJ
C. Closed in accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record mlslile deli ned in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
I
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�.----~~~~~--~-~---~--~~~~~~~----~~~~-
·----------~---·--·-··--···---------------=---=--~
vETERMJN.Go To BE ~N ADMiNisTRATIVE
/7 _
~
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<:C:::::::..------
~GPcrE.O.l29,8as~cnded,Sec.3.2@1......_;...}f\ j~
~~
4t
.
Date: lS · 18· 0 'S"
PRMLEGED AND .GONFH>E~ MEMORANDUM
·-
February 13, 1994
TO: Pat Grlflln. Harold Ickes
FR: Chris Jennings
RE: Meeting with President, First
moderate Republlcans
~dy
and
cc: The First Lady, Ira, Steve, Greg, Jeff... Maggte, Melanne, Jack
Following up on the proposal Senator Mitchell made at last week's
Leadership meeting to Invite and meet with a group of moderate Senate
Republtcans prior to the Senate Republlcan retreat In early March, I am
enclosing a draft scheduling request to Rtckl S. I would appreciate your
reviewing and, .If necessary. editing It, so that we can get It Into Rtcktln
enough time for her to schedule this critical meeting.
Senator Mitchell Is now reviewing the llst of Invitees that he would
suggest. As I mention In the attached, I have no doubt It will Include:
. Senators' Dole, Packwood, Danforth, Chafee, Durenberger, Kassebaum.
Jeffords, Cohen, and Hatfield. It may also Include the llkes of Senators'
Specter. Bond. Hatch. and Bennett. As soon as I know, I will forward 1t on for
final review.
·
As with any meeting with Republicans. we run the risk of making them
feel like we are attempting to "pick" them off. They are ultra paranoid about
this. Because .Senator Dole and most of the higher ranking Republicans on
the Committees of jurtsdtctton are on our list, we (and our Republican guests)
have some cover and should not be as vulnerable to this charge. (It would be
much more problematic 1f we attempted to conduct this mee~tng wtth our
House Republlcan moderates.) However, I mention this Issue because It
pervades the center and rtght ranks of the Republlcan Senate club, and It
makes for nervous relationships.
·
Lastly, 1f we are allth agreement that we should proceed with this
meeting. I would llke to tnforin Senator Dole's office as soon as possible -even 1f we do not have a time locked In yet. The sooner we Inform them that
we are trying for a meeting. the less likely they are to see It as an attempt to
Influence the work at their ·retreat.
·
�- - - · ............
,
____________
date
Schedule Proposal
___ACCEPT
.
_REGRET
2/13/94
_pENPING.
TO:
Ricki Seidman
FROM:
Pat Griffin, Steve Ricchetti, Chris Jennings
REQUEST:
Following up a suggestion by Majority .Leader Mitchell,
to host a meeting at the White House wi~h key moderate
·Senate Republicans, along with Senator Mitchell,
Chairman Moynihan, and Chai~an Kennedy.
PURPOSE:.
To send a much needed and strong signal to moderate
.Senate Republicans that the Administration is serious
about working with them to develop a bipartisan health
reform initiative. To halt an attempt to move these
Members to the right toward the other Republicans within
the Senate, thus making it more difficult to attract them
to our side and making a satisfactory reform proposal
more difficult to achieve.
BACKGROUND:
In early March, the Senate Republicans are· going to a
retreat. to, among other things, attempt to unify all 43
remaining Republicans (Senator Jeffords is already on our
bill) behind· a proposal that bridges the differences
between the Chafee proposal (that now has over 20
cosponsors) and the Nickles/Hatch/Gramm proposals (that
now have over 20 cosponsors as. well.) If this occui:s,
there may well be more than enough votes to sustain a
vote against cloture and a Republican led fillibuster could
kill the President's chances- in getting a bill. Regardless,
a unified Republican position would serve to water down
the reform. initiative that the President has proposed and
make it much more difficult to retain the liberal
Democratic base that the President needs to get a bill out
of the Senate and in a shape that. is acceptable to the
House.
�#
I
>
With this in mind, Senator Mitchell proposed (and the
President agreed at the Leadership meeing) that the
President meet with a select group of moderate
Republicans, the two Senate Democratic Chairmen of
primary jurisd.iction, and himself before March 2nd. The
list of suggested Republicans is now being reviewed by
the Majority Leader, but it is sure to include: senators'
Dole, Packwood, Danforth, Chafee, Dureiiberger,
Kassebaum, Jeffords, Cohen, and Hatfied. (There may be .
a few others.)
PREVIOUS PARTICIPATION:
NONE
DATE AND TIME:
Between February 22nd and February 28th, preferably
sooner rather than later.
·
DURATION:
To be determined
LOCATION:
The White House
PARTICIPANTS:
President, First Lady, and others to be determined
OUTLINE OF EVENTS:
To be determined
REMARKS REQUIRED:
To be determined ·
MEDIA COVERAGE:
aosed
FIRST LADY'S ATTENDANCE:
Yes
VICE PRESIDENT'S
ATTENDANCE:
To be determined
SECOND LADY'S
ATTENDANCE:
To be determined
RECOMMENDED BY:
Pat Griffin
CONTACT:
Chris Jennings
x62645
I
�THE WHITE HOUSE
WASHINGTON
February 2,1, 1994
MEETING WITH SENATE REPUBLICANS/MITCHELL AND DEM CHAIRS
February 22, 1994
DATE:
LOCATION: Red Room and Old Family Dining Room
7:30pm
TIME:
Pat Griffin
FROM:
I.
PURPOSE
•
~
To illustrate commitment to work with Republicans in the Senate who are
serious about health reform and (hopefully) to increase hesitation· among
moderate Republicans to be open to forming a coalition with conservative
Republicans .
•
II.
·· To reinstitute an open and constructive dialogue with Republicans without
giving any appearance (whether privately or publicly) of negotiating.
To lock in commitment for universal coverage and to hold frank discussion
about the political and policy concerns surrounding alternatives to the
combination employer/individual requirement included in the Health Security
Act (e.g. the shortcomings of the individual requirement).
BACKGROUND
On March 3rd and 4th, the Senate Republicans are holding a retreat to, among other
things, attempt to unify all 43 remaining Republicans (Senator Jeffords is already on
our bill) behind a proposal that bridges the differences between the Chafee proposal
and the Nickles/Hatch proposal .. (Each bill )las approximately half of the
Republicans.) If a compromise position emerges, there may well be more than
enough votes to sustain a vote against cloture on a filibuster. Regardless, a unified
Republican position would serve to water down the reform initiative that you have
proposed and make it much more difficult to retain the liberal Democratic base that
the Administration needs. With this in mind, Senator Mitchell proposed at the
Leadership meeting a week and a half ago to meet with a select group of Republicans
·
and the two Senate Democratic Chairmen of primary jurisdiction. The list of
Republicans: Dole, Kassebaum, Packwood, Chafee, and Nickles was selected by
Senator Dole.
�The fact that this dinner/meeting is taking place has become very public. This is
unfortunate because it raises all sorts of speculation, most problematic among the
House Democrats, that you are beginning a negotiation with the Senate Republicans
on health reform. (This feeds into their fear that ,the Administration will not back up
the House if they take a difficult position on the employer mandate.) We must go to
some efforts to make certain that no one leaves this meeting with that perception. We
suggest that an open and frank discussion about the shortcomings of an individual
mandate might be thebest way to achieve this. (See below.)
III.
AGENDA ITEMS
1.
Aru>reciation for Comin~ and Commitment of Desire to Work Together. With
the exception of Senator Nickles, the Republican invitees have worked for
years on health care policy at a Federal level. Dole, Chafee, Packwood, and
Kassebaum will be critical to us having any opportunity to attract and retain
Republican votes. Acknowledgement of their longstanding history in health
care is appropriate and should break some ice.
2.
Discussion of Commitment to Universal Coverage and How to Get There. All
of the Republican attendees have all stated their commitment to universal
coverage. That fact should be noted, but a discussion of the limited ways to
get there would be constructive. More specifically, you may want to outline
the problems surrounding an individual mandate.
•
I am sure we'd all agree there is little appetite for a major new tax to pay for
extending coverage to every American.
•
We don't believe you can achieve universal coverage with an individual
mandate. It is likely that an individual will be required to pay too large a
share of their personal income for health care or possibly require a Federal
subsidy the size of which would be prohibitive. ·
•
Tell me why I am wrong.
�IV.
PARTICIPANTS
The President
The Vice President
The First Lady
Mrs. Gore
Majority Leader Mitchelf
Republican Leader Dole
Chairman Kennedy
Chairman Moynihan
Senator Chafee
Senator Kassebaum
Senator Packwood
Senator Ni.ckles
V.
Pat Griffin
Harold Ickes
Ira Magaziner
Mack McLarty
GeorgeS.
John Hilley
Sheila Burke
SEQUENCE OF EVENTS
Members and staff arrive at 7:30 at the Red Room for Cocktails.
Informal greetings take place.
Guests go to Dinner in Old Family DiningRoom. The President and the First Lady
open up discussion, prefaced by statements of appreciation for attendance and sincere
desire to work together to craft a bipartisan health reform bill.
VI.
PRESS PLAN
Closed press. (White House photographer will be present.)
�I
I
I
I
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~
Withdrawal/Redaction. Sheet
Clinton Library
I)OCUMENT NO.
AND TYPE·
001. memo
SUBJECTrfiTLE
DATE
Chris Jennings to Hillary Clinton
Re: Information You Requested on Moynihan!Mitchell Meeting and
Buisnesses That Are Endorsing Us (8 pages)
. 2/17/94
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Chris Jennings (Health Security Act)
OA/Box Number:
23754
FOLDER TITLE:
.. March 1994 HSA (2]
Gary Foulk
fll6
RESTRICTION CODES
Presidential Records Act. 144 U.S.C. 2204(a)J
Freedom of Information Act ·IS U.S.C. SS2(b)J
National Security Classified Information l(a)(l) of the PRAI
Relating to the appointment to Federal orfice l(a)(2) of the PRAI
Release would violate a Federal statute l(a)(3) of the PRAI
Release would disclose trade secrets or confidential commercial or
financial information l(a)(4) of the PRAI
PS Release would disclose confidential advise between ihc President
and his advisors, or between such advisors Ja)(S) of the PRAI
P6 Release would constitute a dearly unwarranted Invasion of
personal privacy l(a)(6) of the PRAI
b(l) National security classified information l(b)(l) of the FOIAI
b(2) Release would disclose Internal personnel rules and practices of
an agency l(b)(2) of the FOIAJ
h(3) Release would violate a Federal statute J(h)(3) of the FOIAI
b(4) Release would disclose trade secrets or confidential or financial
information J(h)(4) of the FOIAI
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy l(b)(6) of the FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes l(b)(7) of the FOIAI
·
b(S) Release would disclose information concerning the regulation of
financial institutions l(b)(8) of the FOIAJ
b(9) Relclise would disclose geological or geophysical information
concerning wells J(b)(9) of the FOIAI
PI
P2
P3
P4
C. Closed In accordance with restrictions contained In donor~s deed
·or gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. ·Document will be reviewed upon request.
�.------------------------------·-----···--····----·--------- ....
MEMORANDUM
TO: Hillary Rodham Clinton
March 17, 1994
FR: Chris J.
RE: Information You Requested on Moynlhan/Mitchell meeting and
businesses that are endorsing us
cc: Melanne
I wlll try to talk to you tomorrow, but I thought I would give you a brief
update as to what went on in the Mitchell/Moynihan meeting· in case we don't
see you.
In summary, the goal of the meeting was to establlsh an agreement with
Senator Moynihan that it would be constructive to develop, to the extent
possible, a untfied Democratic Finance Committee Member health reform
position. The idea behind this strategy is that a untfied Democratic position
would increase pressure on moderate Republtcans to negotiate with
Democrats.
Senator Moynihan seemed generally receptive to the idea of working wtth
Democrats on a position. And, Senator Mitchell is going to work quickly to try
to implement this idea. However, the Chairman did say he felt that it is the
Republicans on his Committee who are most "passionate" about health care.
The only Democrat who he felt matched their passion was Senator Rockefeller.
Moynihan is still obviously pursuing a Dole strategy. He still is talking
about getting 75 votes OR 40 votes on the Senate floor. He said that "you (the
President) and the First Lady will be pleased to know that every one who has
come before his Committee -- including small business reps -- are
committed to seeing universal coverage, enacted into law." He gave no hints of
.what he thought would be in final bill.
The issue that got Moynihan most engaged was that of academic health
centers.· He feels they are "different and should be treated differently." He was
very interested to hear about the President's trip to Boston and said he would
be very interested to have his staff talk with Ira's staff about options to
lmprove·their plight. (He said he felt that the President's proposal accelerated
the negative trend of the current system.) We wlll be setting up a briefing very
soon.
. 'I
�.Senator Mitchell privately mentioned to the President that we got hit
hard from business witnesses at the Finance Committee hearing. We have
forwarded to his office the attached llst of big busin~ss supporters that you
wanted the President to have. (He has yet to see this.) In addition, we will be
forwarding our small business llst tomorrow.
A~ promised, I am forwarding a copy of the memorandum that was given
to the President in preparation for today's meeting with Chairman Moynihan. ·
.Lastly, Melanne, Jack and I think it would be a good idea lf we could get
together when you get a free moment to give you a briefing on the state of
affairs at the Committees. There is a lot going on that is quite interesting;
although 1t remains unclear where it will end up. Talk to you soon ...
�THE WHITE HOUSE
WASHINGTON
March 16, 1994
MEETING with CHAIRMAN MOYNIHAN and MAJORITY LEADER MITCHELL
DATE:
LOCATION:
TIME:
FROM:
I.
March 17,.1994
Oval Office Dining Room
4:45 to 5:15pm
Patrick Griffm
PURPOSE
PRIMARY PURPQSE:
•
To follow-up on Senator Mitchell's suggestion to begin a process to
hammer out the "bottom-line"policy parameters that Senator Mitchell and
Senator Moynihan believe will be necessary to get a bill out of the Finance
Committee.
·
SECONDARY BUT OTHER IMPORTANT PURPQSES:
I
·•
To thank the Chairman for his generally constructive comments during the
last few weeks, particularly those relating to the need for some type of
employer requirement and some sort of premium cap to assure cost
containment.
•
To praise him and his Committee for their very constructive, informative
hearings. (He is very proud of these hearings.)
•
To get a sense where the Chairman feels his Committee stands with regard
to health reform. (He has been holding one-on-one meetings with his
Members during the last few weeks).
•
To confmn that Chairman Moynihan remains resolute in his commitment
to get a bill out of Committee. that provides for universal coverage by early
June.
�II.
BACKGROUND
Last Week, in your meeting with Senator Mitchell and Senator KeMedy, the
'Majority Leader suggested a strategy to commence negotiations on the health reform
bill. He asked that he be empowered to attempt to work out "bottom-line" positions on
separate, but parallel tracks with the Finance and Labor Committees. He said he
thought he should begin with the two Chairmen in meetings with you.
(Assuming these meetings were constructive, Senator Mitchell said it would be his
intention to try to gain consensus on these issues with the Democrats on the respective
Committees; assuming success with the Democrats, he would then proceed with outreach
efforts to the moderate Republicans on the two Committees.) Tomorrow's meeting
represents the beginning of the implementation of this strategy.
In recent weeks, Senator Moynihan has been more constructive with his public
comments about health reform. His statements about the need for an employer role in
the financing of the plan, as well as the need for back-up premium caps have been very
encouraging. Even though he still has significant concerns about the Health Sec~ty
Act, his public comments about those concerns have been much more tame.
Among the Chairman's major concerns: (1) he believes the cost containment
targets are overly ambitious; (2) he believes the alliances could ·fall victim to
politicalization; (3) he believes that the employers should maintain the role of choice of
plans so they retain more of an interest in containing costs -in other words, he does not
believe our commitment to family choice of plans is essential; (4) although he believes in
the employer requirement, .he does not see it passing the Committee or the Senate
without an exemption for small fmns, and (5) he wants to make certain that he can say
New York got at least its fair share of Federal dollars in any health reform.
(On the latter point, he has particularly focused on the Medicaid Federal/State match
formula and the bill's impact on teaching hospitals.
Senator Moynihan loves being Chairman of the Finance Committee. He believes
that his Committee will produce a package that is closest to the bill that will eventually
make it to your desk.
In preparation for Committee action, Senator Moynihan. is hosting a bipartisan
retreat for all of his Members on Sunday and Monday. The Administration won't be
invited. The Administration · ha,s not been invited to attend; instead, he has asked a
number of notable economists and health policy specialists that we believe will be
generally balanced. Although we are not participating, we have tried to be as responsive
as possible to his staff in providing background policy information.
Moynihan's great desire is to report out a bill that has significant, bipartisan
support, including support from Bob Dole. He would like 15 Members of his 20
Member Committee to vote out the bill.
�·-·-
·-----------------------------------------------.
Our current read of the Membership is as follows: Without too many major
changes, we have six certain votes with Mitchell, Pryor, Daschle, Rockefeller, Baucus,
and Riegle. Bradley, Boren, Breaux, Conrad and Moynihan will want substantive ·
changes· in some .or all of the following: the employer mandate (will want less of a
.required contribution by business and likely exemptions for small flrms); the alliance
structure, and some state-specific issues.
Movements in the direction that the more conservative Democrats want will
hopefully attract some of the moderate Republican Members: Packwood, Dole, Chafee,
Danforth, and Durenberger. However, there is -little question that the Republicans will
p,robably want more than what is necessary to _attract Democrats. 'The trick here is to
fmd a process by Which we can get as many members of the Committee appeased by as
few as changes as possible. A discussipn on how best to achieve consensus among the
Finance Members might be useful to have with the Chairman.
ill.
AGENDA ITEMS
1.
IV.
Discussion of Best Strategy for Finance Committee Action.
PARTICIPANTS
The President
Majority Leader Mitchell
Chairman Moynihan
John Hilley
-Lawrence O'Donnell
Pat Griffm
Chris I ennings
Ira Magaziner
Steve Ricchetti
V. ·
SEQUENCE OF EVENTS
Infonnal. Greet and start meeting.
VI.
PRESS PLAN
Closed press. (White House photographer will" be preSent.) ·
�CORE BIG BUSINESS SUPPORT
NAME/CEO
COMPANY
Dwayne
Andreas,
Chairman and
CEO
Archer Danials
Midland
company
Curtis H.
"Hank"
.:Barnette,·
Chairman and
CEO
Bethlehem
Steel Company
Bill Wickert
August A.
Busch III,
Chairman and
President
AnheuserBusch,
Companies,
Inc.
Rich Keating
Garry N.
Drummond, CEO
Drummond
Company, Inc.
Joe Bilich
(only if Garry
is absent)
205/945-6502
205/945-6521
Wally Maher
313/956-6728
Robert J.
Eaton,
Chairman
Chrysler Corp.
John w.
Hechinger, Sr.
Chairman
Hechinger
Company
David H. Hoag,
Chairman and
CEO
The LTV Corp.
John F. Smith,
Jr. President
General Motors
Corp.
STAFF
TELEPHONE/FAX
CEO TELEPHONE
FAX
217/424-5515
217/424-5581
CLaudia
202/775-6200
202/775-6221
610/694-6137
617/694-?686
314/577-3316
202/293-9494
202/293-9594
Sharon
202/862-5400
'
Doug Brook
301/341-1000
216/622-5300
202/872-5523
James D.
Johnston
313/556-5000
202/775-5090
313/556-4671
Stewart
.Turley,
.Chairman,
President and
CEO
Eckerd Corp.
Alan L.
Wurtzel,
Chairman
Circuit City
Stores, Inc.
c. A. Corry,
Chairman and
CEO
USX Corp.
John Scheels,
Dir . Gov .
Affairs
813/399-6333
813/399-6329
202/265-3232
202/265-3019
Sharon
Terry Straub
202/783-6333
202/783-6309
412/433-1121
�r-----------------------------------···-·········--·-----··--·---
NAME/CEO
COMPANY
STAFF
TELEPHONE/FAX
CEO TELEPHONE
FAX
~obert "Bob"
L. crandall,
Chairman,
_President, CEO
American
Airlines
DeeGee Wilhelm
202/857-4202
Ed Faberman
202/857-4202
817/963-1234
Victor Lund
David Maher
American
Stores
Thomas M.
·Downs,
President and
Chairman
AMTRAK
.
801/539-4402
h801/582-6109
f801/531-1369
Tim Gillespie
202/906-3000
Owsley Brown,
II, President
and CEO
Brown Foreman
Corp.
AlexTrottman,
Chairman and
CEO
Ford Motor ·co.
Ell-iot Hall
202/962-5371
202/962-5456
Harold (Red)
Poling, Former
Chairman and
CEO
Ford Motor co.
Elliott Hall
202/962-5371
Martin Davis,
Chairman and
CEO
Paramont
Communications
Larry Levinson
202/429-9690
Roberto del
. Rosal,
.President and
.CEO
Bacardi Corp.
Earl,. Graves,
·CEO
Earl G.
Graves, Ltd.
Alex Grass,
Chairman and
. CEO
Rite Aid Corp.
James Krahulec
717/975-5710
717/975-3760
Peter Manos,
CEO
Giant Food
Barry Scher
301/341-4100
·George
McCarthy
Hiram Walker
Group
Nancy Jessick
202/628-5877
Robert Hannan~
President and
CEO
Thrift Drug
212/242-8000
717/975-5710
717/975-3760
313/965-6611
#275
519/971-5716
412/967-8745
412/967-8293
Lola Burkhart
�. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . ,
NAME/CEO
COMPANY
STAFF
TELEPHONE/FAX
CEO TELEPHONE
FAX
John
McDonnell,
Chairman and
CEO
McDonnell
~ouglas Corp.
Torn Culligan
703/412-3807
Ronald L.
Ziegler
NACDS
David F.
Lambert, III
703/549-3001
703/836-4869
703/549-3001
A. Malachi
"Mixon III,
Chairman of
the Board,
President and
CEO
Bernard
Schwartz,
Chairman and
CEO
Invacare Corp.
Loral Corp.
216/329-6000
216/366-9008
Fred Rhodes
703/412-0168
703/412-5508
212/697-1105
212/867-1147
�.-----
----------
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
00 1. briefing
paper
SUBJECT/TITLE
DATE
RESTRICTION
Meeting with Senator Feinstein (8 pages)
7/21194
P5
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Chris Jennings (Health Security Act)
ONBox Number:
23754
FOLDER TITLE:
July 1994 HSA
Gary Foulk
filS
RESTRICTION CODES
Presidential Retords Act -144 U.S.C. 2204(a)J
Freedom of Information Act - JS U.S.C. SS2(b)l
PI
P2
P3
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. an agenty l(b)(2) of the FOIA]
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·
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Release would violate a Federal statute l(a)(3) of the PRAI
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and his advisors, or between suth advisors la)(S) of the PRAI
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C. Closed in attordante with restrittions tontained in donor's deed
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PRM. Personal r«ord misfile defined in attordante with 44 U.S.C.
2201(3).
RR. Dotument will be reviewed upon request.
�.
----------------------------
.
.-----,---------;--;-:-;--;:-:----------------,-------------····-····--·--··--··
~ ·~~-:
·~·
(' ,'
I'
.
July 21, ·1994
MEETING WITH SENATOR FEINSTEIN
Date: July 22, 1994
Location: Oval Office
·'Time: 1:40 ...:. 2:10 PM
From: Patrick J. Griffin
i. .PURPOSE.
e.
To recognize. her difficult .political position while underscoring the importance of
health care reform to yo~r Presidency and the De~ocratic. Party.
·
•
To iUusfrate your flexibility and willingness to compromise for a bill that achieves·
universal coverage, particularly ,in .regard to issues reia~Cd to small business.
••
· To use· your coinmertts before the. NGA to· ym~r .advantage as a tangible example of
·your openness to alternatives ~hich r~ach your botto~ line goaL ·
·
•
To lock in her suppott for the Mitchel~ bill which addresses her c~ncerns partiCularly
with regard to small business and premium caps ..
II. BACKGROUND
Senator Feinstein's ·overriding concern is her red¢cdon which many now consider to
be a toss-up. Once a cosponsor of the He~lth Sec~rity Act, she is the only Senator to
remove his or her name from the bilL Pro-reforms groups are escalating their
pressure on her to try and win back hei: support and have reported some positive
. progress. Her Republican opponent, Rep: Mike Huffington, has critiCized her for
· backing. away·, saying: "it's the only principle of a caret:r 'politician. Save your own
skin."
.
.
.
On health care reform, she is sendi~g mixed signals and · is very vague about whether
. or not she will be there for the White HO\lSe when needed. The Senate vote-counters
are very ner\tous about gettingher Vote in the end. How~ver, the issues about which
she is concerned ~ smal.l business, bureaucracy, cost containme~t, and· premium qips ..:.
are all addressed· in the .Mitchell bilL She has said she ~ould ··be open to a ·
compr()mise if it helps small businesses.
/
�~a July
14 converSation with:se~retaryReich, Feinstein made de~r that she prefe~
CALPERS, California's voluntary pooi, to (!n employer mandate and she does not :
understand why a mandate is necesSary. While not completely closed to the mandate
.concept, she was getting more so every day. Second, ~he· expressed her displeasure
with the DNC ads, particularly the one featuring ~ep. Gingrich, beca1Jse:. she felt they
made all of Congress loOk'bad and hl1rt her re..:.electio~ chances; Finally, she noted
that she was. not ·hearing from .her constituents .on .,·
·
.
.
.
.,
.
. health care. .. .
·'
. A DNC surrogate speaker,
evening and reported:
Or.. Sue :B.ailey, met with Feinstein at a fundraiser. Monday.,
·
· ·.
• On health care reform: The senator. was very angry, arguing that Congress had ~ot
. · been adequately consulted about. constitJ.lent con~ms prior to introduction of the HSA.:
She said she was no longer a cosponsor because the bill was not popular at hom(:.
She could not support im 80-20 employer irtandate and wanted more state control.
She said the Finance Committee mark was closest to her current thinking. :
• 'On her re-election: She. felt she was not getting 'enough help from the DNC,
particularly financially. She would like inore help in her race from both the White .
House and the DNC.
· ·
·
··
·
Dr. Bailey's impression was that sufficient attention to her reelection concerns could
.
.
overcome the Senator:'s reservations ·on .health care reform.
III:
PARTICIPANTS
The President
S~nator Feinstein . · ·
Patrick Griffiii
Harold Ickes
·.:.·
·.:.
IV.
SEQUENCE OF EVENTS
·.·
Closed meeting with Senator Feinstein in the Oval Office.
V.
PRESS PLAN .. ·
Closed Press. (White House ph~tographer will..be' present.)
. .'
~·
.
·,.
.
·
�THE WHITE HOUSE
WASHINGTON
,,
July 19, 1994
/
/MEMORANDJJM FOR LEON PANEITA
FROM:
PATRICK GRIFFIN
SUBJECT:
HEALTII CARE STRATEGY OPTIONS
I
As we discussed •tast night, there are two legislative strategy options which should be
presented to the rtesident this evening. This memorandum will outline both options and the
pros and cons. for :each. Both choices are based on the same evaluation of where we are
today and the samle strategy for the remainder of this week.
PLAN FOR TillS WEEK
-&i~atJ's
_
majo~ity
cle~ly
ability to maintain a
for a mandate is
the factor' whicb js '
. The
most directly drivfng whether or not the mandate can survive congressional votes. The · ·
crucial task for this week is to make a final push to determine whether there are· fifty one
.votes in the Senatb or not. .In order 'to make this determination, the President needs to
'
j
engage with the swing Senate votes intensively. In his meetings with Senators, the President
will need to be v~ry direct about the stakes for both his Administration and the Democratic ·
' '
•'
party -- a seorch~d earth speech which hoi~ nothing ba~k.
strate~y
purposely ignores the House for .the balance of this week, during which
. This
time the leadership and the coriunittees would. complete work on· a consensus universal
coverage bill witll a mandate. This is consistent with the signals we are getting from the
1
House leadership which indicate that the only reason they would not move forward with such
a bill would be if the Senate fails to produce a majority for universa't coverage.
.
. By Friday, the President and Majority Leader .Mitchell must arrive at a conclusion
about whether or ln~t there is a realistic potential for a. majority in the Senate for a m'andate.
If there is, then Senator Mitchell will move forward with a bill that provides a -mechanism to
reach universal ~verage. We expect that this would include an autQmatic fallback to a
fifty/fifty mandatb if Congress fails to approve an alternative plan to achie~e universal
coverage.
.
If the President and Majority Leader Mitchdl determine :that it is unfikdy, or .
impo8sible, that ~ majority can be achieved in the Senate around a mandate approach, a
.
' strategic choice dtust be made aoout how to proceed.
�! .
------------,------------------------------.
··· .
. OfTION· ONE
.
Senate proceeds as quickly as possible to the floor with a bill which would provide for
· a mandate, with the clear understanding that a vote to strike the mandate is likely to pass. ·
The Administration and our Senate allies would make an all out effort to sustain the mandate,
with the outside chance of winning.
To have an adequate amount of time to sell the proposal, SenatorMitchell would
unveil his proposal as early as the beginning of next week. From that moment on,· we would
hilVe to haye five days in order to frame the debate, pOrtion of which would likely coincide
with t~e floor debate on this proposaL [As an alternative, Senator Mitchell could proceed in
the same manner, but reserve the option of substituting an alternative vehicle at the last ··
minute when the outcome is .clear, and thereby avoid losing a vote.]
a
If the vote to strike the mandate carries, the· President would convene a mini-:sunimit
with House and Senate Democratic leadership to decide whether to proceed imm~diately with
the underlying Senate bill (with the addition of a soft trigger .mechanism) or. to review other
substantive options (such as covering kid~ first).
The compromise Senate bill would. const~tute a non-.mandate fallback--a combination
of insurance reforms that provide as much protection as possible while minimizing increases
in-rates for the currently insured, and substantial targeted subsidies that would -increase the
number of insured to over ninety percent, but not attain universal coverage. [Fo.r House
liberals to be satisfied, the House ·bill would have to include medicaid integration as welL]
·1n either case, the objective would be to resume Senate action almost i~mediately to
pre-empt a campaign being waged against the remaining provisions. [If Senator Mitchell
chooses the alternative approach, the Senate would proceed directly to the substitute vehicle
(without losing a vote) -- which presumably will have a majority, and p<)tentially a filibuster
proof level of support.)
·
. . In order to pass 'even the scaled back. approach, there would still be a significant fight
in the Senate; but we can expect at least some Republican votes for a non-mandate approach
to increase -coverage. through subsidies and insurance reform.
ARGUMENTS IN FAVOR OF OPIION ONE
(1)
(2)
'(3)
Permits the President the opportunity to demonstrate strpng commitment to his original
principlt!S and avoid characterization of the President as too quick to compromise .
. Provides a vehicle for outside groups, congressional allies and other supporters to
:·· wage an all out fight right to 'the end.
·
· Provides opportunity to develop strongest message.
2
�(4)
Avoids putting House in the pos.ition of voting for a mandate and then being BTIJ'ed.
(5)
Provides time,.to determine with riear certainty whether or not there is a majority in the
Senate for mandates.
·
(6)
Allows time to develop the best possible .fallback while there is still a fight being
waged, maximizing the bargaining position of our allies. This would be particularly
true if the leadership follows the alternative approach and holds out the option of
avoiding a mandate vote.
'
·
(7)
.The left in the House will· not' feel abandoned.
ARGUMENTS AGAINST OWON ONE
(1)
(2)
I?.isks the appearance that the President is being dragged to a compromise deal after a
defeat.
.
.
If the mandate vote loses there is every reason to believe that Senator Mitchell will
lose leverage, and House leaders will lose leverage with their moderates. [If Senator
Mitchell substitutes a compromise vehicle to avoid losing a vote, this could be
prevented.]
(3)
Because time is so tight, the Semite effort to fight for the mandate may be
undermined since the House and Senate leadership will be simultaneously developing
and floating fallback positions for a non.,-mandate approach while the Senate is still
fighting for .the mandate.
( 4) · · Opponents will argue thatthe residual approach. is a tax and spend approach -- too
big,. creating expensive new entitlements, relying on new taxes for funding.
(5)
If there is a mini-summit to review alternatives; there is a risk of delay, which would
seriously undermine efforts to win a vote on a substantial fallback package. ·
(6)
There is not likely to be a single fallback bill, which will complicate the job of
communications. The House will need to include provisions important to the single
payor vot'es (poSsibly an opening ·of Medieare Part C in a voluntary world and
certainly a st.ate single payor option) which the ·Senate would be unlikely to include.
)
OPTION JWO
At the end of this week ack.Dowledge that there is ·not a majority in the Senate for a
:mandate. Have the President. take the lead !.n seeking a sustainable middle ground. The next
week would be spent developing a middle grouild an:d fighting ·for it rather than the mandate.
3
�,
------·-------,----------,-------------,
..
In order to achieve success with thisalternative, a massive outr.each effort will be
required with our base supporters in the Congress and with our groups. This will entail
numerous meetings between the President and our supporters. The time necessary for this
outreach effort. and for· developing the policy alternative will mean that the bill. could not
reach the respective Con~essional floors before the week of August 1st.
ARGUMENTS IN FAYOR OF OPTION IWO
(1)
President would be ahead of the debate rather than catching up after' a defeat.
(2)
The J:Jesident' will have the ability· to define ·the package in a way which confers
legitimacy upt>n it (even in teirns of the definition of universal coverage).
·The Administration .has the potential to be viewed as less dogmatic and ideological
abOut its approach and more aligned with a ·centrist legislative agenda.
(3)
'(4)
(5)
· The House will have .the ability to devise. a. package for floor cOnsideration with full
knowledge and disclosure of where the Senate majority is moving.
This package has a potential for real bi-partisan support up. front, satisfying the
request of some Senate Democratic moderates.
'
ARGUMENTS AGAINST .OPIION . TWO
(1)
Negotiations with moderates takes place . with very little leverage and the scope of the
· ·
fallback . is likely to shrink.. . ·
..
·. ·.
to.~ngage in final battle for his. top priority, and w'ill
· appear to be abandoning a central principle of his health care effort, and the real·
·
meaning of hi~ veto threat. ·
. (2)' . President appeats unwilling
. (3)
(4)
· Supporte~s, particularly on the outsid~. feel abandonef;l. They sincerely belieVed. his
veto threat and agreed to follow. the President down the difficult road of universal
coverage: This may.cause long term damage among .the groups a~d among some
·'
men1bersof .Congr~ss.
The elite media is extremeiy likely to charge· that you have broken your holding ·up the
pen veto ·promise and will spend weeks if not months suggesting that the President is a
"waffler." ·
·
·
· .
'
·(5)
Hou'se and Senate liberals may move away from the package permanently:
4
'.
�.
------------····....
;•
.
.
. ,THE WJ-i ITE HOUSE
WASHINGTON
MEMORANDUM
To:
Hillary Rodham Clinton
From: Chris Jennings
. Re:
Phone Calls to Senators
Dat.e: July 15, 1994
Following up on our meeting yesterday, we (Pat,· Ste~e and [).have developed an
updated list of where we believe our Senate members are in regards to health reform. As you
will note; we have 43 members who we. feel very good about and 4. addiiional members who
we believe are very likely possibii'ities and -.10" others who we belie':'~ could go ~ither way.
Previously; w~- shared· a similar list with Senator Mitchell's staff. . We will give this one to
them as well, to buck u'p th~ir spirits ..· . .
.·
From the. whip count list, we have produced a second list that outlines recommended
calls· and ·meetings for the President and yourself. For this exercise,: we arc targeting our core
group of supporters and likely supporters. If you appro.ve, we would. like to get started on
these right away.
··
·
·
-=-
~dJ.J«"
·. . ..-/(p (if'~
--~~~~--
··-
�THE WHITE HOUSE
WASHINGTON
July 14, 1994
RECOMMENDED TELEPHONE CALL
TO:
. DATE:
RECOMMENDED BY:
. PURPOSE:
BACKGROUND:
Democratic Senators who are core health care supports~
The names we are requesting you to call as soon as feasible are:
,Senators• Baucus, Boxer, Daschle, Dodd, Glenn, Graham,
Mathews, Reid, Rockefeller, Sarbanes, and Sasser.
July 15, 1994
Patrick Griffin
To call a number of our core group Democratic supporters, to
shore up their support for health reform and to re-energize their
effoJ;ts to successfully pass a bill out of the Senate.
Earlier today you, the Vice President and the First Lady
concluded it would be highly advisable to reach out to our
Democratic base. We are following up with our first cut list of
members.
The list of members are taken from our current analysis of
where Democratic Senators stand with regard to our whip
counts. This list is attached for your use.
TOPICS OF DISCUSSION: Attached are suggested talking points for these calls.
CONTACf PERSON AND
TELEPHONE NUMBERS:
White House Operator will connect.
DATE OF SUBMISSION:
July 14, 1994
....
ACfiON: _________________________________________________
�~--------------------------------------------------------------------------------
I
I
I
I
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
SUBJECTrfiTLE
DATE
Chris Jennings to Harold Ickes
Re: Upcoming Maine Event with Senator Mitchell (5 pages)
9/2/94
RESTRICTION
P5
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Chris Jennings (Health Security Act)
OA/Box Number: 23754
FOLDER TITLE:
September 1994 HSA [I]
fi 19
RESTRICTION CODES
Presidential Records Act- 144 U.S.C. 2204(a)l
Freedom of Information Act- 15 U.S.C. 552(b)l
National Security Classified Information l(a)(l) of the PRAI
Relating to the appointment to Federal office l(a)(2) of the PRAI
Release would violate a Federal statute l(a)(3) of the PRAI
Release would disclose trade secrets or confidential commercial or
financial information l(a)(4) of the PRAI
1'5 Release would disclose confidential advice between the President
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P6 Release would constitute a clearly unwarranted invasion of
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b(l) National security classified information l(b)(l) of the FOIAI
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an agency l(b)(2) of the FOIAI
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· b(4) Release would disclose trade secrets or confidential or financial
information l(b)(4) of the FOIAI
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personal privacy l(b)(6) of the FOIAI
b(7) Release would disclose information compiled for law enforcement
purposes l(b)(7) of the FOIAI
b(8) Release would disclose information concerning the regulation of
financial institutions l(b)(8) of the FOIAI
b(9) Release would disclose geological or geophysical information
concerning wells l(b)(9) of the FOIAI
PI
P2
P3
P4
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�I
DETERMINED TO BE AN ADMINISTRATIVE
. ""1 (4
Mf\.RKJNG Per E.O. 1295S r.s ::1r.1cnded, Sec. 3.2 (c)f'V'\h~ .
Initials: /}'1Da~·~:
oj
·
.
'a·,.,·
I I
rl
f"""\ J~ .
·
·
PERSONAL AND €0NFIDE~ MEMORANDUM .
To:
From:
Date:
. Re:
cc:
Harold Ickes
Chris Jennings
September 2, 1994
Upcoming. Maine Event wit~ Senator Mitchell
Pat, Ira, Steve, Melanne and Jack
As you requested, the following· is an update of the ongoing deliberations between the
"mainstream" coalition staff (now represented by the staffs of Senators Chafee, Breaux,
Durenberger and Kerrey) and Senator Mitchell's staff. In addition, you asked that I provide
you With a recommended approach for talking with Sen&tor Mitchell about C1 possible fallback minimalistic package that could be. acceptable to the President. I have also asked Jack
.
.
.
to· insert his reading on the current status of the House.
In short, although it remains difficu.lt to ·see bow any overly: substantive ·legislation
will emerge from the Congress this year, recent dev~IQpments make clear t~at-~t is more.
conceiyable than most people are currently thinking .. It. certainiy .is.·now. passible. to ... .
· imagine bow an agreement between Senator Mitchell. and .the "mainstream" grou(i could
.occur.
..
·
\·
Senate Status and OUtlOok
;
'
· On Tuesday, the· Mitchell and "mai~str¢am" coaliijt;>p staffs ~tarted me~tirig tt;> review
statutory language artd to deteimine areas of general agreement or likely disagreement. As a
gestUre of good will, Senator Mitchell agr~d· to work off ·of the·llmainstream's;, ·legisJation.
In addi~ion, he directed. his staff to conduct these negotjations with the: intent of reaching an
agreement -,... not finding problems.
····
· ·
· · · ·
....
. ..
to date, the discussions have been ·<::hai'acterize~. by .both sides. as oonst~ct~ve and of
good will. The "mainstream" group has apparently been operi to strengthening language
suggested by Senator Mitch~ll's ~aff on "B"-lev~J jSs~-es~·~d; )vher~. ~~~r~. ~s.fiJ~S!.~~~ent •.
both sides have avoided confrontation and have bucked the i'ssues ··in:. qu~stion~to.: tlie : .
princip~ls. . ·
.
. •·
.
· ·· · · . ·· . ..
> :- .·.
·. Last .night Se~(ltor Mitchell's staff completed a)i~t· ~f MeJriber:...;levefi~s~~s.)n dispute.. · ·
Despite the reported ·progreSs, there remain many outst~ding and unr~solved·:.prbv:~s~~Iis;: iDe
list includes app~oximately twenty items for which. the stafffeel there can be n~<nioveiPent . ·
without Member-level intervention.
· ·
·
. · · - ... ' . .
"'··
�.---------------------
..,...--------·----···-·····----------······-----------------------------•,.
~
.
'
.'
· The list also includes notable areas of disagreement such as the "mainstream's" tax
cap, their omission of a Medicare drug benefit, their very small long-term care benefit, and
their provision to limit community-rating to firms with fewer than.lOO (rather than 500)
workers. Moreover, the list does not include the disagreement they are. currently having .over
Senator Kerrey's (and others') insistence on $100 billion in defi~it reduction.· All of these
. issues of disagreement could potentially produce road blocks or even dead-ends to a
compromise.
·
As of this writing, there is no way to predict if· Senator. Mitchell will be .able to .
come to an agreement with the "mainstream•i group. However, Senator Mitchel.l's ·
extraordinary negotiating skills and his great desire. to achieve a ~om promise that
succeeds In getting the bill
the Senate. floor, combinoo with the "mainstream"
group's determination :to remain in the limelight and in the driver's seat, .could
conceivably yield an agreement. (For example, I could easily for~see an agreement that
reduces the Medicare. cuts and the deficit reduction· target, while eliminating the
Medicare prescripti~n drug .benefit to break their cu~ent financing logjam).
otT
What is also possible, however, is that Senator Mitchell will not be able to take a
consensus position to the floor and will suggest that the "JJtamstream" attempt to offer
individual amendment~ to the Mitcheti bill. If this :occurs, the question is how do the
"mainstreaiil" actors respond? ·Do they agree.to.do-this, praisiijg Senator Mitchell ·fpr all they
have achieved~ or do they take an. "all or nothing" position; Ev~p if they· do the foqner, :a
number of the liberal base Member:s may c.hoose. riof.to support ,what could. ~ell be an .·. ·
unaceeptably flawe~ package. Shoul<;f all ofth~~¢ an<i..~th~rJi~t9les: ·.b,e, cleared and '.the Senate
pass· a compromi~ •"nuHnstream"/MitchelLpackilge;t it. i~.':hi~lf.-iiniikety "that it will :receive a
•· • ' ...
wel~.o~ie_ receptio~ frem, ·the. House, partieul~ty :.frpin .th~)ij().tis~ .'.Ch~irs··:~d:· M,aj9rity Leader
'G~p,hard~~..
·
··
.· · ·
: .. ·
·. ; : } ) :.':";: ·,:: ; "; ·. :. · . .
'
•
. ·.
'
. .
'
.
••
•
'
•.
•··
·•·
1
'r"'
. ·
... ,
·•"
•
,.
',•
.·,
•,,,
'.
.,,
•. •
<·:·: ·, · .f' : ., ·. :.:- ...
.. :: .· :', :.,. . . .': ·.~ ;/~ :~:<./. ~. . . ~· >: :_.· : :. . '· ~·:::. ~ : · . ~ . . .
..
. . It .as lmpomalll' to' pou.~t .o~t the grea:t :f.e~li t,M~ the -.~:~.~·n~~r:e~~ ·~ .· ~epu~hca11s· ·
have is th~t. the Senate'. will act. too. soon an~l: enable ~~b{ ~o~e Jo,· pass :a djffe~nt. bill,thus allowing the joint ·confe~ll¢~ to ·"$crew up.",: -~~ir -~gr~~ent>As_a . result, It · , . .
appears to me-that·they b~v~q~v~ry reaso~ to.~,el~Y.~gree~~Q~·.Q~~il.tJ!~r~·isjust enougb.
time for· the Senate ~-pass. the.ir ·.bill· an.~ l~y :It .Qn·.~tb~-:H~~~ .J..ead~rs~ip's d®rstep ·for a
"takeit.orleave·it" vote.:·· '
."· . ·· ·· .. ,··~:-::·.~;: ::.·~· ·: . ' ... ·... ·:·
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:Excessive delay in th~ senate
make :ii :i~~~ji,}~ fo; .~·s iti~· i~ -~}i .si~iricant. way,
"fix" problems that may emerge a Senate .passed bilL· ·Mor.e importantly, as _always,- ·
delay strengt~ens the i)argai_ning _hand' <:)f Jh~ R;e'p~~~~~~$ .~.~~ ;en~!'~c~s J~ei~· ·_~b~lity_ ._tc:» .. · ..
cast Democrats as obstrucUoilists... Obviously, the ·w.orst ·o~tc.ome~ for ·:us. ~ou,14:·J:~e -~or the ,
Republicans tO force the Democrats· to kill ·bad l¢gi'slatlon lli,af b~s beeti suc'cess~lly. sold .
·· '·
·
· '· ·
. · .·
as incremental, but. "good" .tQ tl,le eli~ media.
in
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�''to guard against this problem, it may be advisable to discuss with the
Congressional Leadership. a· fall-back package of modest but politically and
substantively attractive provisions that could be used by Senator Mitchell and Majority
Leader Gepbardt. This substitute could be used at any strategicaily appropriate time.
Attached is the latest such ·package that we (Ira· et al) are developing (and the ·rationale
for it),' In many ways, tbis.sbould:be an easier sell because .it is much more modest,' bas
. virtually m>' risk in causing ~arm to the market (unlike the "mainstream" pro~sal), bas
· limited. Med.icare cutS and makes great contributions tOward providi1;1g coverag~ to · · ·
sympatb~tic gro~ps - kids and the elderly.
Interestingly, while the Mitchell,..."mainstream" negotiations are going on, our.
Democratic base support in the Senate (such as Rockefeller, Simon and perhaps· even Pryor)
is becoming increaSingly frustrated about being ·"shut-out" of the process and. are nervous
about what type of product. can or will emerge. Although this is mostly being expressed at
the staff level, it is clear that there are. Members who are not interest¢d iri relying solely on
. the Mitchell negotiations ..
Senators Harkin, Leviri, and Pryor, in particular, are working on a r~latively
minimalistic alternative that comes very close to the fallback proposal the President, the First
Lady, you, Ira, Jack, I and others have been discussing. The current draft of the Harkin/Levin
are begiilDing to provide modest
proposal is also attached for your review. (As an aside,
technical asSistance to the Harkin group ...,-with the copsent of Senator Mitch~ll's staft).
we
.
.
To dat~, however, Senator Mitchell and his staff ·have not expressed. much .inter.est in
working on· the. type of proposal being a9vocated by Senators' Harki~:· arid Ply or. · .While this
is .probably the case be~use they simply do not have time to .focus on anything but' the
Chaf~e discussions, it is importanft<>' ~~Pin 111ind t~at sut:h a ..propesal will likely go ·
nowhere: without the·. s.trong ownership· and support ;Of the Majority Leader··. . . : . .
. Of mote immediate cOncern, however, is thai the Mruority:. Leader;s negoti~iions
may produce something we do not· wish 'to support. AS senator ·Mitchell is. trying to
produce so~etbing·to attract Senator Cba(ee's support, Senator .Chafee.is a.ppareritly
also trying ·to reach out .to Senator Dole.. Should this be~op~~ a priority ro.- Cba.ree, It is
P<>ssible -~:if 110t l.ikely _,;;, .tha.t tbe bill ihat :emerges· froJI~ the MitcbeiVinainstream .
:politically ' .
negotiations wfil be so watered down that it will be substa_ntively
un.accepatable to:~! . . ..
··
.and
House &tatus and Outlook
.
..
.
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.
·At the present time the House remains on hold, ,with very little. action. during, .the
re~s to develop eitper a· fallback position or a proeedute. for arriving a fallback. . As a
.
p~~tigll.~atte~, the dynamics in the House make it· very risky f~r.the lead~~~ip t_<> ini.tiate a.
· prqa~five. effort to ·~ve at fallback. The general attitude among· HouSe members, w~ich
· could ::easily change based on what o~urs in the Senate, app~rs to be tha:t the heaith care . ·
.
.
.
reform effofl is over.
at
a
....
. ,·.
�The House leaderShip may be divided when they return. The Speaker Is clearly QIOre ·
inclined towards a minimalist approach than the Majority Leader.· Since the House continues
to be in a reactive mode, they do not need· to join this issue until the path in the Senate
becomes more clear. The risk; however, is that the Senate decisions may leave the: House
with nowhere to go other than the Senate position,· as much as .~hey niight object. .
If the leadership were to restart the process, there is a significant risk ·of losing control.
A leadership 'designed minimalist bill would almost cert~inly have to include. tobaccO tax
revenue in order to fund even small expansions in subsidies. This would most likeiy result"in
..
opposition from Republicans and would place in question support from tobaCco. stat~·
representatives. Even.the scaled-back and phased-in tobacco tax.Jju\y be imposs'ible :for them
to support in the context of a minimalist bill.
If a process is reopened, Members ~e.not likely to tolerate a deadlock which would
be blamed on them. In the event .that minimalist bill with acceptabie policy cannot p_ass, we
must take very Seriously the risk that an umicceptable alternative might gain a majority. The
. result could easily be passage of a.bi-:partisan bill with' insurance reform that we would find
unacceptable.
·
·
a
The alternative for the House is not a very pleasant orie.. If the Senate arrjves at a.
consensus on a bill that we do not think is good.p<)Hcy·, the House is ·not likely to let it die on
the House doorstep. In this event; we coUld easily end up in ,the same position as i.f the
leadership were to initiate the process on its own.
·
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.·If the Senate pa1iSeS Ci ,bill' wit~ ·borderline (or ~;learly.un~g:eptable} i~~uran~ueform·
. and Medi~aid· integration, it would~ strongly oppose~ ;by Jo~·J;;>lilg~ll:ID,tp{lienpr·(~Waxman.
Over the 'break, both qf thdr staffs have tx:oorne iiJcre{!SjJjgly ·of the :vi~w tlicif:~here!-is··no ·
po5si~i-lity at this late date ·of achieving the kind of Insurance ·,-refomi. that wo~l(f pemiii the ·
. integration to work.. We could' face the ugly' possibilitY of .the".House':l)eing .split apart; with
·conservative Democrats and Republicans supporting th~·Mitchdl comprorni~.and liberals
.
opposing it. It is not clear how the votes would: play ou~. . . . · .·. : ; . . · ; .
Perhaps the most desirable outcome· from the· ~~peetive of passing a .decent ·
minifualist bill in the House would be if a bill·atong)he lines of.the Harkin approach:were to ·
_p~s the Senate. There is a ch~ce that a bill li~e-th~~ co.~l~ p~ ~~~-~ou~.~: If ~j)~;. be~use
· Republicans oppose. it along with tobacco members anij:~ some fi~~l cOnservatives,. the
message would be that Republicans and special interests :killed the la8t; hope· for progress on
. health.care. As a matter of local'politics, this woul~ prob~bly:not be a significant problem
for· the tobaceorepresentatives,·whO:WOUld have the argu,I~ient .that th~y CoOl(f:nof'siippOrt <a
new entitlem~nt funded by a tobaCco tax for use at
home; ·. · :· ·· :··: ·:· ·' · ·.
�Approach to Mitchell
It is certainly possible that Senator Mitchell's bottom line may have a lower threshold
for acceptability than the Administration's. As a result; it is conceivable that we may find
ourselves parting company over policy and politics. As such, there is potential for strains in
, our reladonship with Senator· Mitchell in the upcoming weeks. It is therefore critieal that
. we be clear and direct with Senator Mitchell on any major concerns we have with where
·the Senate bill is or may be headed.
·
It is important that any discussion with Senator Mitchell not be viewed by him as in·
any way undermining his ongoing efforts to achieve an agreement with the "mainstream" ·
group. His staff is especially· sensitive to this issue and is not. yet particularly interested in
working on more incremental reforms than their current discussions are contemplating.
The President and First Lady may want to open up. a discussion with him about
our fears. regar~ing. t(Je Republican strategy tO do anything to label us as obstructionists.
There is nothing ~h~~-gets· ~~tor Mitc~elf~ore illlterested··~ri ·~ discussion than a point
· that illustrates how··&epublicans couBd hur(us··roemocrats) arid bow he can
outmaneuver them. · ·
·
Without pre~judging the likely outcome of Senator Mitchell's discussions, the
President or First Lady may want to raise .general ooncerns thatthe final product has the very
real potential to do more harm than good, particularly 'for currently insured workers. They
. may also want to raise specific concerns that comprehensive insurance reforms, in the absence
of .u~iversaf cover~ge, are very difficult to craft without .adverse conseqt1ences. If not done
right, the Adrilinistration·.and I>emocrats as ·~ whole will be. blamed and our credibility for
building 0~ this' year's reform will·be irreparably damaged. 'Lastly, they may wish to see if
the Majority Leader is interested· in discussing and possibly n,wiewing the attached one: page
alternative.- Again, I would strongly advise that this ·be presented solely as a backup; failsafe
option.··· ·
H~rol4, I will ,provide· for yo~ review, e~its, and .approval final talking p()ints
(and the alternative proposals -""' pending Ira's edits) for you ~ forward up to the
Presi~ent .and· the First Lady.
·Enclosures ·
· . ·. 9/'2[)4
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Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECTrrtTLE
001. briefmg
paper
Meeting with Senator Mitchell (5 pages)
9/4/94
P5
002. memo
Ptrick Griffen To Leon Panetta
Re: Health Care Strategy Options (4 pages)
7/19/94
P5
003. memo
w/attach
Patrick Griffen to POTUS
Re: Memorandum from Congressman Dan Rotenkowski (4 pages)
9/16/94
P5
004. memo
w/attach
Patrick Griffen to POTUS
Re: Short Term Legislative Strategy on Health Care (6 pages)
6/10/94
P5
DATE
RESTRICTION
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Chris Jennings (Health Security Act)
ONBox Number: 23754
FOLDER TITLE:
September 1994 HSA [2)
Gary Foulk
mo
RESTRICTION CODES
Presidential Records Ad -144 U.S.C. 2204(a)J
Freedom of Information Act -15 U.S.C. SSZ(b)J
National Security Classified Information ((a)(l) of the PRAJ
Relating to the appointment to Federal office ((a)(Z) or the PRAJ
Release would violate a Federal statute ((a)(3) of the PRAJ
Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRAJ
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and his advisors, or between such advisors (a)(5) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRAJ
b(l) National security classified information ((b)(l) ofihe FOIAI
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an agency ((b)(Z) or the FOIAJ
b(3) Release would violate a Federal statute ((b)(3) of the FOIAI
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information ((b)(4) of the FOIAJ
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PI
PZ
P3
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C. Closed in accordance with restrictions contained in donor's deed
or gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
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·!,
THE WHIT~. HOUSE
1,.,•
WASHINGTON
.., . . .
:·:·September. 4, 1994
MEETING~WITH SENATOR MITCHELL .
.
. •' .
-·
Date: "'September· 5, 1994 '
.· Location:~ Maine
·From: Patrick·J. Griffin and Harold Ickes.
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•·.·
:,
I.
PURPOSE
*· • ·
To rdteriite your,.appreciation for all the hard work Senator Mitchell has done on.
behalf of Administration throughoui the Congre:ss.
. To ..mustrate ho~ you recognize th~ difficult political position he is in with regard to
· crafting a compromise health reform bill that works.-~ both in terms of substance and
in attracting a sufficient ammmt of.votes.
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To raise real concern about the. type .'of policy. se·nator. Mitchell might· have to settle. for
iri order to get enough support from tbe moderate· Republicans (who are apparently: ·
trying to reach out to Dole) and<to indicate your nervousness that going too far
towards the right might produce. a bill- that eould do. more .barin than good ...
·· .To share with l;lim our perc;eption that th~ House Lead~rship'.(particularly Gephar~t
apd the Coirupittee ail~ Subcommittee. Chairs) is unlikely to to be receptive to a
signifiq\nt (but in their minds flawed) health reform initiative that they either thought
· . (ano frarucly hoped) was d~d OR.bave little or no control over shaping. (Interestingly
-- and not sutpisingly :__ the one exception to this position may wei! be the Speaker.)
·to find out where Senator Mi~cbell eurrently stands on the feasibility and advisability
of pivoting,off his current negotiating effort with Senator.Chafee et al (if it is not
going. well) into a much more incremental bill that u~es s~aller Medicare cuts and the
. tobacco tax t<;r pay f~r benefits for kids .and the. e,lderly. .
·
...
·.·.
•
II.
BACKGROUND
Although it remains very difficult to envision how any ~iverly substantive legislation
·_will emerge from the Congress '_this year, recent developments make dear that it. is ai ·
least conceivable. It. is even easi~r to imagine how an agreement between Senator~,
Mitchell. and the "ma~stream" group could be achieve~.
.
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..... , · - - - - - - - - - , - - - - - - . , . . . . . , - - - - - - - ; . _ _ - _ _ , . , . - - , ....
· .....
The M~joii'ty Leader's exceptional ~cgotiating skills and his great desire to obtain a·
compromise that succeed~ in'getting the bill off the Senate floor,·· combined ~ith the.
~·mainstream" ·group's determination to remain fu the limelight ·and in the driver's seat,
·· ·
-~
could well produce. a "deal."
.
'
A ¥itchelV"mainstr~am!' agreement has the potential to be extremely problematiC.
Drafted in the _current "eompromise" and "mov_irig to the. right'' environment,·the · ·
product cpuld raise premiums of the currently working insu·red by unacceptable levels, .
while still 'leaving large numbers of Americans without'· insurance. ·Should such a
p·ackage ~me law, ·we (and the Democtatic_party) would be very 'Vulnerable to
· being blamed for this ·and other· problems that ensued. Such an outcome would also ·.
further erode the public's ,confidence in the Government and would make it v~ry ·
·
·
difficult' to build on the reforms that we did pass. .
Of additional ~neem is the.factthat the "mainstrean/group has 'every reason to
delay a final-agreeme~t as long as possjble. -It is·clear"the Republicans w.ant to avoid
. a House/Senate oonference and are conteinpl~ting a strategy· that would lay the bill on
'the.. House's doorstep .for a "take it or leave .it" vote. ·
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_bel.ay stren~hens. the ·bargaining hand of the Republicaris 'arid. enhances their ability tO·
.cast .Dem6crats as obstructionists .. Moreover, it gives even more time for the
"mainstr~ani" Republicans to attempt (as they ~e.apparently now· doing) to reunite
.with Dole. Obviously, the WOrSt outcome for ys would be for .the Republicans to. '
force the Democrats to k_ill bad. letpslation that has been· successfully sold as' "good" ·
and "mQderate·~~o the elite inedi3.
·
·
Th·e. House is definitely di~ided on the health reform issue, with the Spe3ker clearly
more inclined towards a ininimidist 'approach than Majority t,eader Gephardt. Not · ·
surprisingly, the House' continues to be a reactive (to the Seriate's. actio·ns) mode. ·.
?Jley do not want ·to join this iSsue until the Senate's package beComes. clear ... l)le risk
with this:approach .. is that a delayed Senate bill is likely to leave the House with
nowhere to go otlier than the Senate position,. as much as sOine will obj~ct:
in
Even if the House initiated its own alternative health .reform initiative, it is not .
altogether clear it would be a package we. would bC cox:nforta~le with. In fact, the .
staffs of Gephardt an9 the .Coni.mittee Chairs thin,k if would .be at least a5 likely _ _: if. ·
· not' more --:- to be just the opposite. As such, the. House en-vironment underlies the
extraordinary importance of apy product 'emerging from the Senate.
··
I .
. · With.tb~ above.in ~ind, it'is ad~isable to make·&natorMitchell clt~iuly aware ofour
·concerns. It is also· advisab!C to g~t a se~~ of where he thinks he might go (or ·be ·
.forced to go) in his. pegotiations. It ap~-that this also would be an opportune time
to, once again, briefly kick around the concept of a faJl.:..back package_ of modest but
. politically anq substantively attractive provisions. (You started this conversation
'
during yout la5t meeting, b~t Senator Mitchell did not foeu_s.) Such a substiiutc could
'be used' at any strategically appropriate. tiine.
.
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�····-··-------,---~-------:--------------___,..,.....,
We may also wanf to engage the House LCadership in discussions about the .
advisability of a House fall .... back package. Despite the risks mentioned previously,
pushin·g something proactively .:.._ rather thari simply reacting to whatever the Senate
and Hou~e Republicans and conservative Democrats might produce -- might better
protect the Democrats against .the charge of being· obstructionists. Moreover, it could
give the 'i>arty the· opportunity to highlight .the Repub.licans true, obstructionists colors.
.
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'
Attached is the latest version· of the package that lra and others are developing. In
many ways, this alternative (which is similar to one being advocated by Senators'
Harkin, Levin and Pryor) could be .an easier sell because it· is much more modest,
should not harm the current market, has limited Medicare cuts and provides coverage
to sympathetic groups -- kids and the elderly. It .is cl~, however, that our close ·
associatiQn with it could do more harm. than good; in other words, we do this package
no favor :by ·claiming it as ours ·-:-it must remain a package' authored by. the Congress ..
We strongly advise ·that our version .of the alternaHve NOT be handed to .S~nat.or
· Mitchell ai this time. In addition,· the discussion around it should not. get overly
detailed. This conversation should be.used merely to gauge his openness to such an .
alternative. It is i~portant'to remember thatthe only ·W~Y for this back-up to succeed
is for Senator Mitchell to have ownership .over and investment in it. ·
It is certainly possible that Senator Mitchell's bottom line may have a lower threshold
for acceptability than the Administration's.' It is therefore critical .that the·.
·Administration be clear and direct with. Senator Mitchell on any major concerns
.. we have with where the Senate bill is or· may be beaded.
·
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·POUTICAL CONCLUSION .
This memo has been particularly focused 0~ our fears ~bout the type of 11awed policy
that could emerge from the legislative procesS if we do not engage .. It is equally
important to point out that engaging the Congress at any level also .carries risks.
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. N-o m·atter· how. careful we. are in assuring that it i~ th~ O>niress, and. not ..the .
Administration, who is. the lead spansor of any alternative,.we should not fool
ourselves into thinking that we can extricate ourselves entirely from such a package ..
The perception, if not the reality, is that we are bonded at 'he hip with the Leadership
-- particU'larly on the Senate side .. As a result, a failure to pass any alternative carrie.s
with it a ri'sk that the Administration will be labeled as a two...:.time failure .. Therefore,
an argument ·~uld be made' for co~pleteiy extricating ourselves [rom the legislative
proces~ now.and laying tJ'te blame. on the Congress.
'
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Having said the above, even if a ·minimalist effort fails, we believe it ~ould like!)·
achieve two. important ends: (1) it should stop a P9tentially flawed policy from being
passed (and then possibly vetoed by you) and (2) it would enable us to better defend
ourselves against beillg labeled obstructionists and better lay the more appropriate
blame.on the Republitans doorstep. With this in mind, 'we believe this c.ou~se of
action is worth the risk.. ·
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TALKING. POINTS
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· Jfiank you George fo~ all you· h~ve ·d~ne. It h~s been a·rough year' for both of us;· but
your. work. has _paid big dividends for us and the country as a whole. You have. no
.. :idea how inuch V-fe appreciate all'your work and how much· we· fear. your: absence' in
the ·Senate.
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I know yo~ .are in th~middle of a set of negotiatio~~ that will be extremely difficult to
'produce a package that is acceptable to the "mainstream" group, while' still retaining
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the support of ou'r bas~ supporters. I. don't envy your position. ,
}:·
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· ·.· But I have to· tell you how concerned I am about the direction you might find yourself
. having ·tO go to get dtal. 1: am worried that the RepubliCan "m(linstreamers" are not
going to move much -- if at all -- on many critical issues. I fear that their recent
7fforts to apparently _reach .out tq Doh: might' m(>v_e t~ein further to the right.
a
In
~my eve~i, th~ir' insistence.on ,some i~~ues might produ9e·Very real substa~tive and
.political problems for us. I am particularly concerned that the Republicans may
effect~vely la.bel us ob~tructionists if we end up bein'g uncomfortable·with the policy
they insist· on:
· · ·
· ·
•.
'I cert-ainly don't wa.nt to pre-:-judge the outcome of your negotiations, but I a~
· concerned that a compromise product rould do more harin than _good, particul:arly for
curren.tly insu~ed workers: As you know, major· insurance .reforms,. in the absen~ o.f.
universal coverage; are very difficult .to' craft without· ad~erse premium h'ike
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consequenCeS.
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George, ljust wanted to raise a red fia·g about my worries that, if we don't get these
reforms right, the Administration an9 Democrats as whole. will be. b!amed and our
credibility for bt~ilding on this year's reform will be irreparably damaged. I wanted to
talk to yo_u about this because it is becoming more ·and more dear that the House will
· .·.either d~ nothing or do alinos~ exa~tly what comes out of the Senate ...
•
If your m!gotiations do not work out well with the ."mainstream" group, what do you
· think about the possibility of your·,pivoting from .wqere ·you now are to something
more minimalistic. for kid~ and the elderly, financed from. the tobacco tax, relati~ely
. modest Medicare .c~ts, and,possibly som~. Medicaid. cuts).
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POSSIDLE
FALL~BACK
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OPTION
. ' This· package o'f reforms ~ould tak.e a 'significant' step towards ·u,niversal: coverage, wit, h.
li'ttlc risk of harin for those ·... . .
individuals an·d businesses who currently ·purchase insurance. · · ·
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-INSURANCE REFQRMS •
.
Insurance refonils would inClude Jileasuresdesigned to close many of the loophol'cs in
the current system, but n'ot inore.comprehensive changes (like community :rating) .that could ·
prove disruptive for some who riow ha.ve health insurance.
·
Limi~ on pre..:existing condition exclusions: Pre-existing ·conditio~')
. exclusions wbuld be ·limited to six months, ~d prohibited for people who
. change from .one plan to anothet (e.g.; when changing jobs).
.
·. .
Guaranteed r:enewal: Health plans would be required to renew coverage
(except for non-payment, fraud; or misrepresentation).
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. No lifetime limits (if effect ()D.,preJniu~s is mimimal): . Health pl~ns would
be ·prohibited from ·imposing lifetime limits on benefits.·.·
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AFFORDABLE. COVERAGE FOR CHILDREN
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Subsidies would be.provided to children in. families with income up to 300% of the
poverty.level (about $44,000 for a family of four). States would have broad flexib_i!.ity in
delivering coverage; but would be encourage~. to do .~o through priVate' health plans.
PROTECTION FOR WORKERS IN-BETWEEN JOBS
~f workable: and affordable, provide temporary· subsidies to workers (for' up to ·six
months) who have .lost their jobs to· purchase insurance~
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LONG TERM CARE
A limited. home anlcomm.unity'"'based .long term care progra~ wo~ld be phased in
over. a period 'of years. (The $95 billion $700 a' year deductible Medicare prescription drug
·benefit is. probably ·.. expensive -- .ab~ut twice as the envisioned. long: term .care benefit). ·
too :· .
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COST AND COVERAGE COMMISSION ·
.
A natiolia.l cost and :coverage commission would ·monitor health care cdsts and
coverage (with ~orne expanded data collection), and mak'e recorrnnendations for more
comprehensive refo~s to achieve universal coverage. It would issue a report at the ·
beginning·ofeach new Congress;: with the.first sched~Jed· out in March 1995 .. The , ...
~uthorizing language for this ·Commission might ·establish targ~ts for bot~ coverage and cost
containment and Co_ngress could be directeq to vote on its recommendations ihough an
expedited approval process. '
' .
'
'<.
•
.
•
•
•
.
FINANCING
· Expanded ~~erage. would be finqnced. through a~ increase in the tobacco tax· (at the
level proposed in the House an~ Senate Lead~rship bills) and relatively modest' Medicare and
possibly Medicaid savings. · .
'
.
'
.
:
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�. . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - · - - - - - · · - - · · -···
THE WHITE HOUSE
WASHINGTON
July 19, 1994
MEMORANDUM FOR LEON PANEITA
FROM:
PATRICK GRIFFIN
SUBJECf:
HEALTH CARE STRATEGY. OPTIONS
As we distussed last night, there are two legislative strategy options. which should be
presented tQ the President this evening. This memorandum will outline both options and ~he
pros and cons for ·~ach. Both choices are. based on the same evaluation' of where we are
strategy for the remaind~r of this week. .
.
.
today and the
same
PLAN FOR TIUS )YEEK
The Senate's ability to maintain a majority for a mandate is clearly the factor which is
most directly driving whether or not the mandate can survive congressional votes.· The ·.
crucial task for this week is to make a final push to determine whether there are fifty one
.votes in the Senate or not. In order to make this determination, the J>resident needs to
engage with the swing Senate votes intensiveiy. In his meetings with Senators, the PreSident
will need to be very direct about the stakes for both his Administration and the Democ:ratic
party -- a s~rched earth speech which holds nothing back.
This strategy purp<)sely ignores the House for .the balance of this week, during which
time the le<;~.de~hip and the coniniittees would complete work on a consensus universal
coverage bill with a mandate. This is eonsistent with the signals we are getting from the
House leadership which indicate that the only reason they would not mov·e forward with such
a bill would be if. the. Senate fails to produce a majority for universal cov~rage ...
By Friday, the President and Majority Leader Mitchell must arri:ve at a.·cond~sion
about whether or not there is a.reaiistic potential for a. majority in the senate for a mandate.
If there is, then Senator Mitchell will move forward with a bill that provides a .mechanism to
reach universal coverage. We expect that this would include an automatic fallback to a
fifty /fifty ·mandate if Congress fails to approve
alternative plan to achieve universal
. coverage.
an
If. the ~esident and Majority. Lcilder Mitch~ll determine 'that it is ~nlikel y~ .or
. impossible, that a majority can be achieved in the Senate· around a mandate approach,· a
strategic choice must be made about h9w to proceed. ·
�.
:·
,OPTION ONE
·.. Senate proceeds as' quickly as possible to the floor with a bill which would provide for
a mandate, with the.clear \,tnderstanding that a vote to strike the mandate is likely to pass~
The Administration and o~r Senate allies would make an all out effort to sustain the mandate,
with the. outside chanCe of winning ...
To have an adequate amount of tirrie to sell the proposal, Senator MitcheU would
unveil his proposal as early as. the beginning of next week. From that moment on,· we would
have to have five days in order to frame the debate, a portion of which would likely coincide
with the floor debate on·this proposal. [AS an alternative, Senator Mitchell could proceed' in
the same manner, ·but reserve the option of substituting an alternative vehicle at the l!lSt ·
minute when the outcome is clear, and thereby avoid losing a vote.)
If the vote to strike the mandate carries, the.President w~uld conven~ a mini-summit.
with House and Senate. Democratic leadership to decide .whether ·to proceed immediately with
the underlying Semite bill (with. 'the addition of a soft .tngger.mechanism) or to review other
substantive. options (such as covering kids first).
.
.
The compromise Senate' bill wo~ld ·COnstitute. a non-,mandate f~llback--a combination .
. of insurance reforms that provide. as much protection as possible while minimizing increases
· in rates for the currently insured, and substantiaUargeted subsidies that would increase the.
number of insured to· ov~r ninety percent, but not attain universal coverage. [For House ·
liberals to be satisfied, the Ho.use bill woul9 have to include medicaid integration as· well..]
In :either case, the objective w<:mld be to resume Senate action almost fQ1m.ediately to.
pre-empt a campaign being waged against the remaining provisions. [If Senator Mitchell
chooses the alternative approach, the Senate would proCeed directly to the substitute vehicle
. (without losing a vote) -- which presumably will have a majority, and potentially a filibuster
proof level of support.]
·
·
In order to pass even the scaled' back approach, there would still be a· significant fight
. in the Senate, but we. can expect at least some Republican votes for a non-manda~e approach . ·
to increase cOverage through subsidies and insurance reform.
ARGUMENTS IN FAVOR OF OPI10N ONE.
(1)
Permits the President the opportunity to d~monstrate strong commitment to his original ·
principles and avoid characterization ofthe President as too quick to compromiSe.
(2)
Provides a vehicle for outside' groups, congression~ allies and other supporterS to
:wage ~ all. out fight right to the end.. . ·
·
'
(3)
Provides· opportunity to develop strongest message.
2
'
�·····-······-················--------------'-----,..---
.
.
(4)
Avoids putting House in the position of voting for a mandate anq then being BTU'ed.
(5)
Provides time to determine with near Certainty whether or not there is a majority in the
Senate for mandates.
(6)
Allows time to develop the best possible fallback while there is still a fight being
waged, mCiXimizing the bargaining position Qf our allies. This would be particularly
true if the leadership,foUows the alternative approach and holds out the option of
avoiding a. mandate vote.
(7)
The left in the House will not feel abandoned.
.
..
.
.
.
J\RGUMENIS AGAINST OPTION ONE.
'. (1)
(2)
Risks the appearance that the _President is being dragged to a compromise deal.after a
defeat.
·If the mandate vote loses there is every reason to believe that. Senator Mitchell will
lose leverage, and House leaders will lose leverage with· their moderates. [If Senator
Mitchell substitutes a compromise vehicle to avoid losing a vote, this could be
prevented.]
(3)
Because time is so tight, the Senate effort to fight for the mandate may be ·
undermined since the House .and Senate leadership will be simultaneously developing
and floating fallback positions for non-mandate approach while. the Senate is still
fighting for· the mandate.
a
(4)
Opponents will argue that _the residual approach· is a tax and spend approach -- too
big, creating expensive new entitleme~ts, relying on new taxes for funding.
(5)
If there is a mini-summit to review alternatives, there is a risk of'delay, which would
serio·usly undermine efforts to. win a vote on a substantial. fallback package. ·
(6)
There is not likely to be a single faliback bill, which.wi.ll co.mplicate the job of
Communications. The House will need to include provisions imP<>rtant to the single
payor votes (possibly an oi>eriing of .Medicare Part C fu voluntary world and
certainly a state single payor option) which the Senate would be unlikely to include.
a
I
OPIION TWO
.
.
At the end of this week acknowledg~ that there is not a majority .in the Senate for a
mandate .. Have the ·President take the lead·in seeking: a sustrunable middk grqund. The next
week would be spent developing a middle ground arid fighting :for it rather than. the mandate.
3
�·-----------~--------------------------------------~------------~
In order to achieve suCcess with .this alternative, a massive outreach effort will be
required with our base supporters in the Congress and with our groups. This will .entail
numerous meetings between the President and our supporters. The time necessary for this
outreach effort and for developing the policy alternative will mean that the bill could not
reach the respective ·Congressional floors bt<fore the week of August 1st.
ARGUMENTS IN FAYOR OF OPIION IWO
(l)
· (2)
(3)
President would be ahead of the debate rather than catching ~p after a defeat.
The President will·. have the ability· to define the package in a way which confers
legitimacy upon·it (even in terms of the definition of universal coverage).
The Administration has the potential to be viewed as less dogmatic and ideological
about its approach and more aligned with ·a ce!ltrist legislative agenda.
(4)
The House will have the ability to devise a package for floor consideration with full
knowledge and disclosure of where the Senate majority is moving.
(5)
This package has a potential for real bi-partisan support up front, satisfying the .
request of some Senate Democratic moderates ..
ARGUMENTS AGAINST OPTION TWO
(1)
Negotiations with moderates takes place with very little leverage and the scope of the
fallback is likely to shrink.
(2)
President appears unwilling to.engage in final battle for his. top priority, and will
appear to be abandoning a central principle of his health care effort, and the. real
meaning of his veto threat.
(3)
Supporters, partiCularly on the outside, feel abandoned. They sincerely believed his
veto threat and agreed to follow the President down the difficult road of universal
coverage. This may cause long term damage among the groups and among some .
members of Congress.
(4)
The elite media is e:xtremely likely to charge that you have broken your holding up the
· pen veto promise and will spend weeks if not months suggesting that the President is a
"waffler."
.
(5)
,.
House and Senate liberals inay move away from the· package permanently.
4
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. notes
SUBJECTffiTLE
DATE
Health Care Strategy Meeting (4 pages)
nd
RESTRICTION
PS
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Chris Jennings (Health Security Act)
OA/Box Number: 23754
FOLDER TITLE:
October 1994 HSA
f121
RESTRICTION CODES
Presidential Records Act- 144 U.S.C. 2204(a)l
Freedom of Information Act- IS U.S.C. 552(b)J
PI
P2
PJ
P4
b(l) National security classified information l(b)(l) of the FOIAI
b(2) Release would disclose internal personnel rules and practices of
an agency l(b)(2) of the FOIAJ
b(J) Release would violate a Federal statute j(b)(J) of the FOIAJ.
b(4) Release would disclose trade secrets or confidential or financial
information j(b)(4) of the FOIAJ
·
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy j(b)(6) of the FOIAI
b(7) Release would disclose information compiled for law enforcement
purposes j(b)(7) of the FOIAJ
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financial institutions j(b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells j(b)(9) of the FOIAJ
National Security Classified Information j(a)(l) of the PRAJ
Relating to the appointment to Federal office j(a)(2) of the PRAJ
Release would violate a Federal statute j(a)(J) of the PRAI
Release would disclose trade secrets or confidential commercial or
financial information j(a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors ja)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy j(a)(6) of the PRAJ
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
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�Withdrawal/Redaction Sheet
·
Clinton Library
SUBJECTffiTLE
DATE
RESTRICTION
001. briefing
paper
Democratic Members of the House Committee on Energy and
Commerce I 03rd
Congress (7 pages)
nd
P5
002. memo
w/attach
Chris Jennings to Hillary Clinton
Re: Potential Rockefeller Problem and Jackson Hole Care Meeting
Invite ( 14 pages)
8/18/95
P5
DOCUMENT NO.
AND TYPE
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Chris Jennings (Health Security Act)
ONBox Number: 23754
FOLDER TITLE:
Undated HSA Files [4]
Gary Foulk
025
RESTRICTION CODES
Presidential Records Act - ]44 U.S.C. 2204(a)]
Freedom of Information Act - JS U.S.C. 552(b)]
National Security Classified Information ((a)(l) of the PRAJ
Relating to the appointment to Federal office J(a)(2) of the PRA]
Release would violate a Federal statute J(a)(3) of the PRA]
Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA]
PS Release would disclose confidential advise between the President
and his advisors, or between such advisors Ja)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted invasion of
personal privacy J(a)(6) of the PRA]
b(l) National security classified information ((b)(l) of the FOIAI
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIAJ
b(3) Release would violate a Federal statute ((b)(3) of the FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIAJ
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy l(b)(6) of the FOIAJ
b(7) Release would disclose information compiled for law enforcement
purposes J(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions J(b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning ~ells J(b)(9) of the FOIAJ
PI
P2
P3
P4
C. Closed in accordance with restrictions contained in donor's deed
·of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
·
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., ·· .,._. ':;·y:_.'·::: ;;.~-~-~~~l~~.c-~;it~·Jii·~;p~~~-congressman Slattert.li~-.wor~ed .towarct' in~~'a.Sfug'_~ccess· to b'eSitb· care .: ·
.. . .-. ;:, ;:··,-N;::: f~r ~ru~~--~9mm~nities-and introd.uc~cl':ih({ ~ationaf'H'e_aJilit~are ·Revitiilizatioii:~AcL_. .~. > : ·
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:' · ·. · :·. .-.- · ~.,:,~f'~~~:~_,-Part .of.:.Ql~ _;.P?~·, crowd,. Slattery WI!\_ ;~ppo_se;::w.. ~P:IP~<?y~r. -~.andate, as well. as any .
'· · ·'='global budgeting. He sits on the Subc~rilrillite'e"'on··HeiJ.ti{afiC:(the·Enviionm<mt and·
·
·. :: --·-:<> ··)·;.);d:_,. :~.::on:. ~~~-·-i'_\ye~erans Affairs /Committe~';~c,;~;:..Wirlcll:-~;·b~,.;:'_serves
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· . . ·· . CompenSation, Pension and Instirailce··,-Subco~ttee~i,_''~··O(:note·· also is- Slattecy'~ -~- ..
-~>.- .. : _ _, _ : . c~~tmen~ to ~Iiminating waste in government. ·He' bas introduced legislation to· · ·
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. establish a comniission on the issue· (H.' 353). Slattery bas representedTopeka and . .
·.its surrourtding _communities since 1983. . .
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, REP,•. JOHN . BRYANT (D-TX) . , .. .--:.,,:Jt,;,·-•··r.·;:.r:,·.,.·· .•. ·······e.-··-~~~---.......... ·.·.- . ,._.,;-.. -... ,. · .
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•' .-·- ':·~: f 'Congre~~an' Bryant serves' 'on. the:. H'ehlttthlia· .E~\1!6ffui~nt:·;s~bc~irfurlttee . and as.
~,~~i~;~:::~. :.-::,~~~,-~:;::~~/;.1~~~0tcijrina#·,of.the, Administi:ative. ~wand GQveriimenta.i Relations Subcommittee of
....."".,_....._,.,. :;·. _···., :·:~ :·.. · .:_ ~e-.'Ho~se Judiciary .Comfuittee;··: He1aiso·:sits':on.··the''~House· Budget COmmittee--.·
., .. · _,.. .·· T· · whicb/w(you_know, met with the Presi~ent yester~ay."_·A liberal Democrat, he has
· >:.':i ~-~~?~g-~~~a~o?Ship,with He,alth Subep~itee Cbair.\:Yaxma.D: Bxriilt introduced··
·.•_tb~.J-4b~fu.lg D~closure Act ofJ99~ m:.R.~23) and supports an mcre~ed regulatory_,:
··f4nctiori~
·
· · ---He ha5 :represented Dallas's ~oil iriterest5-ras· well as ·the.· :
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.anlHispalli_¢·.·~9Duiiuirlties ·.iii.ili.~~s_th)~tri~- _sfu.ee J9.8~~-~,~~;,;: '· · . · .
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REP. RICK BOUCHER (D-VA) ....,_:,:::\·.. ,·
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*f,-.:9:~\;{~'f:.;~~~ :~. ::..C~IJgressman·;.Bo~cher si~:t:;9I.l·.tlir'J~.9.~~W. ·.Co~ttee; and _t~e. _Commi~tee on
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SCience and Technology, for wh1ch.he serves as Chamnan of the. Subcomnuttee on
. Sci,~~ce. B~ucher has not ·:b,.e~,~(?X~~~~ .. ~~~i~e on the he~th .care issue,. but ~is ·
· cons1dered moderate to conservatlye;· -~ J:le:. worked extens1vely on the aCid ram
proposals for the Clean Air Act .Boucher bas represented southwest Virginia's 9th
dis~ct since 1983.
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+ REP. JIM COOPER (D-TN)
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As you know, Congresswan Cooper is· the primary advocate of a managed
competition approach. Congressman Cooper worked with Rep. Wyden on legislation
to require that drug manufacturers extend the lowest costs to medicare and medicaid
. recipie~ts.',.Jn,addition to Energy)n.d Goiiunerce,_he sits on the Budget Committee.
·.AS you know~ the Democrats from tii:a(Cci'n:iniittee met witl:i the .President yesterday
... conceming ..the Economic Plan_;:.:::Wbep Congressman co·oper entered the House in
·. ·1983 represent Shelbyville TcixU{essee:sj4th.district, he\vas. the youngest member .
of the House of Representatives._: . Since that time, Cooper bas emerged as an
advocate o( PAC reform and has taken on tobacco interests and the NRA We hope
·to schedule meeting for you With.'cOOper ·and Reps. Stenholm and Andrews (TX)
in the next two weeks.
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• .REP• ·RoY·.·.RO·WLAND (D-GA) ·•::.;··,:;·····: .·,{il>t.i·,;,::.:k.>·.. ·· . . . · .. . .....-.·.:. : . · ·. • .
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· · ·.· · :· . HaVing ·pr~ciked medicine bef~·re ·eriierlrig:.~ongress, Rep::Rowhirid has a tradition ..
. . of interest in health care, particularly. in t~~ 'ref<;>nn of medicare and the treatment
_.,·:·of AID~ ·.patients. He has· sp~nsored~~~~~atives to provide funding for cancer
·treatment for Veterans expose,d'to'nidiation during and after.. World War ll and for
AZT ~reatment for AIDS patients~'Hn.l990, Rowland sponsored a bill which would
. have ·desigru,lt~d. the Secretary o(HHS. responsible for detennirung whether to
allow ·persons infected with HIV t.~e . ~bilitY to immigrate to the United States. He
later· argiled. that the Secretary alieaczy· held this prerogative. · Most recently, be bas
introduced the ·Long-Term Care)Ii.Si.mince for the Elderly Act of 1993 (H.R. 862).
··. . Rowland serves on the Health· and :-EnVironment Subcommittee as well as on the
•. ·-<:·:.:. ·,.yet~r'aru;)W~ Co~u~~.ra.J.iq;i;~}~~an of it5.:Hospitals and Health Care
.. . Subcommittee; ~:Rowland, ·represehthig· southern Georgia's 8th district since 1983, is
:~; ..(_also a.strong~dvocate fo~ ..~~k!ss~e.~.:·:~-:,~edistricting left-him with an even more
· · rural. and ~9n.Servative district,·arid his yieWs may reflect tbis change. You will meet
· · with ·:Rowland,· along with Rep/:Montgomecy and Sen. Rockefeller, on Thursday
. aftemoon·m bis capacity·as.-Chair of the Veterans Affairs Subconun.lttee.
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+ REP. TFioMA.s·MA.NroN (D~NvfY;;~;'.}:'\:;::_:;,.-: ··. .
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.In addition. to Energy andcO~~t~~:··eongressm~ Manton.serves·as Chairman of
· . the Subcoimirlttee on PersoruieUuid~Police the House Adicinistration Committee
and Chairman· of the FisheriesM:anagement Subcoirunittee to the Merchant Marine
and Fisheries Committee. Manton, a form·er policeman, represents Queens in New
York's 9th c1istrict. He is an advoca:~e of the crime bill· and, in the last Congress,
int~oduced ~n amendment to provide _disability payments ~o public service officers
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.of 'the. Congress~on~ ~~~ck Cauttis~. Co-ngressman T<?i.Ds _ is. . an:-.
··of strengthening 'the ·Natioriat ':Health. Service· Corps and the':•Minority : ··.
< Health Initiative. He sits on the Health and Environment Subcommittee and serves
·_ . . · .GovenunentOperations Subcoffintittee _and as the Chairman of its _Human
· _ Resa·ur~es, and Intergovemmentai.';If~lations·,Sub~o~ttee ... While very. :supportive
of die .Adnlirustnhion,. he ·can be' -e~ected io p·ush his agenda of access. and
··: . minorities is~ues.. As With Richardsori, b~ will require additional attention, as he is
lm~~;M:..,.~~((~J~~i:::,c .,_ •so_met~es: susceptible to t~geted_loppyffi~::,,_. A- fo~e_r J~~cper, social W(.l~k~r ·_and._::·...
~f;~~i:~~;'ft.:~~-£~~hospital· a~mJI$.tFa:tor, To'fllS h(l$ r.epre~~P~~~ J~~o~kl~Jn tJ~w York's lJ t~ _g~trict :· ,, .•:n ........ r __ Chair
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• GERRY.:S'IJ.!D.D.~;.;(D•MA) \,~· . ;;,,~l'.;'.~~l~~~.:~·~·~~:·~~ 01 ~.~·.~,·~~~·;~:~;r:f.L .;'~;~>·~~·lf/-.~~~~.t: · '
·,, ,,~:1f;!l&d'~C~t \~~uf.ll /' ~·Y," \;~.11 '
?-'.1£~~~P~~~i!~~.:~--~- ;:·.co·ngiessri;i~\~~~dd.~. ~si~:;:,~_n. _,$~~l~e~t~faiid::E~Y4:o~e·~~-~Subcommit\~.e~{~~~~-is~~~t~·~;\~:,;~:;,)~·:.it:;
Chairman of the House Committee on ·Merchant Marine and Fisheries a5 weu·a.s its · :· . ·. · · ·
··Subcommittee··o'k~thei:EiiViionhie.~t{;~ct'~N~hlrir-R·esoiuces~·'-~~A former advoclte';'or:.;{-'··'~>; . ·:·..-::.•,
... ~-· a single: pay9~: p~o~am' ~~sembllrtg ;t.~~-:~~di~- syste~ ~tii~ds Will be supportiv~J~;·· .. . -. : .' . . .,,
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of the Adrrurustrat1on proposal, but_n~~dsto notbe t~~n for granted. S~d4~. :~~:.:::·, .
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REP. RICHARD LEHMAN (O,.CA~/- .-._:,~,:./!· t~f,f~{-~;·:~~<:-.-~'-.;·i.~~-- ~>~---:~.-.
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, 'In addition to Energy ,and Coiii.m.~r~e;•..Q9_9~~s~man .Lehman.serves on the Natural .
_. -' ,,. Res()utces·· CoimDittee 'and,· as<th~ ~ c:hamliaii~of Jts .Suocoininittee on Energy and ... ·
·. Min.eral Resources. Le~an represen~. Califonrl.a's. Centra) Valley region in the 18th·
·· ' 'district: As such, be -·IS concemed\\iith-:'.both" faimirig interests and agricultural
. processing.industries. Lehman is expect~d.,to .be__ helpful, although be is ·DOt very., .
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'~:\_,: :·::· ::::.:}..-<•' . •:~(~:·:::~!!~~j,G<Jp&r,~~~~~!,!. ~':?.~one · ,is .. ~'·· avid--. e~yironpte~tali~t-: _and.: .serves .. the. ?~~-~~.;~~d_,·; .::: ::-:'....· '
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· --- >:·'::· EnViroiunenCSuboommittee ·as. well as the Comnilttee. on Merchant' Marine. and , ·. · · · ·
.'-i ... : . ,;>:.";:_ -:-··· . :?-~~-Fisherl~~~;~-lPanone lias: represented. the 'Jersey Shore' in· the 3rd district siri:ce::\1988.'::.(. ·' ' ': •'
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. . .· _.,~ :,:::~ :_Pall~n~ .• ~accompanied ::~e ..President at .the National Se,rvice speec:h -:at :R,utgers . : .- · ..
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·· · '··· . . . . . +·-.REP. CRAIG\W~HINGTON'(D-TX)~~\~~t~?:::~<~~;·;~;·:~=~~:*~~.~~?i: :.:f~:.·;'\~~ :·':· . ·. '':~~:~~~~
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· ·'--~·._:_.-.:-. · House ·Committee ·on -Government Operations and the House Judiciary Coniinitteet~··. \. . . ·
· :'.-. :, Washington came to the House in 1989, winning a special election to replace the
,.::::.~:-~ighly.·pqpul~r Rep.·.Mickey Leland who_.,was killed in a plane crash; He·repr¢:sents.··
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Congresswoman Schenk is a new member of Congress~'-·· She represents. the newly
formed 49th district of California, which spans from La Jolla to the Mexican border. ·
Schenk c~mpaigned on commitment to community service and the creation ofjobs,
especially focussing on defense conversion. ·. Schenk is a strong environmentalist and,
in addition to Energy and Commerce, ha5 taken a seat on the MercbanJ Maririe and ·
. Fisheries Committee. By all reports, ~chenk will be very active and· supportive.
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+ REP. SHERROD BROWN (D-OH)
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Cqngresswoman Brown has taken · a seat - on the Health and Environment
Subcommittee and is expected to be particularly interested in the impact of health
care iegislation on seniors. He will also serve on the Foreign Affairs and Post Office
and Civil Service Committees. BroWn, a new member ·of Congress, represents a
district with obvious redistricting impact;· ·~·'·Ohio's· 13th district encompasses seven
counties and incl\}des both industrial Lorraine and the'r~ral communities surrounding
·Lake Erie~ .Brown campaigned on Jhe_ J~~u~s 'of: f.aiililY. values, sot~· energy. and
seniors· benefits. At times duri~g .his ·:~P.#gri;;;l:~e:,:promiSed~. that. h,e.;would not
accept his own health care benefits uri til aii 'the 'fesid'entS of his distiicfba~d msurailce
(although it is uncertain whether he follow~d through with this)~· ... , .· ..
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+ REP. BLANCHE LAMBERT (D·ARf·> ': ·
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.·.,.•
'-';, ;' · .
.·
As you know, Congresswoman tambert .1s the first ~oman to represent Arkansas'·.
first district. In addition to Energy and Commerce·,· she has taken. seats. on the
Agriculture and Merchant Marine and.:fisheries Committees and has joined the
· · ·
·
·
Congressional Women's Caucus.·,_- .
.
,
I
Congresswoman Margolies-MezvinslcYs 13th district iricludes both the.affluent Main.
. Une suburbs of Montgomery-County and-the lower income areas surrounding Valley
Forge. . Margolies-Mezvinsky won .a narrow victory in 'ihe .formerly ·Republican
district, which has traditionally been liberal on social issues and conservative fiscally.
As the mother of eleven children, some of whom she adopted from Asia, she is a
. strong ;,idvocate of family values and calls for full funding for Head Start, .controlling .
guns and violence and ensuring' a woman's. right. to choo_se. . . .
.
··;*~f:: . : •
~.
,·
.+· REP. MARJORIE MARGOLIES-MEZVINSKY (D-PA)
'
:'l
•.
,
a,
.....
.~d,~· > . : ,".:_·:.'
. ·/-~
: .... . ' . .
-
l'
.
.
.
.·
An Optometrist by profession, CongressmanJ<reidler understand the ~portance of
health care reform and has taken: seats. on: the . Health ~and·: Environment
Subcommittee as well as on the Veter~ Affai~s ·conuniitee·''and itS Subcoinmittee
on Hospitals and Health Care. Kreidler .~ new: member of Con~ess represent4lg
the newly created 9th district'of Washington.~ .'-His constituents -include ·commuters
working in Seattle and Tacoma as well as. a large number of veteranS and reservists.
Kreidler is t~us particularly concerned with transportation:and veterans isSues. He
is a also strong environmentalist and avidly pro-choice,·-which makes him popular.
with women's groups. Kreidler joined the President at Boeing last month· and flew
on Air Force 1, with the entire Washington delegation, back to DC.
·
. . < ·.·.' ,.
;:~:~-~~
'•
. t REP. MIKE KREIDLER (D-WA)
·'·-:" .. :.·..
.. ..
'
~-.
. .:.,:
�.---------------------------:-------·-------------····
;:;
August 18, 1995 · .
MEMORANDUM·
TO:
Hillary Rodham Clinton ·
Chris I.
. ..
. .·
.
.
..
. Potential Rockefeller. problem and Jackson Hole'health care meeting invite
Melanne · ·
FR:
RE:
cc:
~
Senator Rockefeller has raised serious ooncerns about how a recent HCFA regulation has
been handled. On September 1, we.aregoing to be releasing a regulation related to hospital
payment methodology that will seriously displease him~ [t is important .to note that the notfor-profit hospitals (particularly,· the Catholic Healt~· Association) will strongly support this ·
regulation. In case Senator Rockefeller raises this issue with the. President or you, I though~
·you might want to have the attached one-pager that describes this situation.
·
. .
..
'
On an unrelated matter, Pa~l Ellwood has sent you an invitation 'to p~rticipate in an upcoming
meeting (August 25th and 26th} with the Jackson Hole group.· Bruce Vladeck is already
scheduled to be there for the moming of the 25th··-- at Dorina Shalala's request. We_ are
already getting some media· calls about your--possible participation at the meeting -,.... CNN ·
being the most note.._vorthy .. (I' said I had no idea,· that we just got the invitation, but .that ·
. .I knew you were fairly heavily scheduled. already.)
·
.
.
.1·
The immediate .questions, of eotirse,· are do you want to attend and is it advisable for you to
attend? Bruce believes that your attenda-nce 'will mise this group's profjle. more than is
·desirable and thinks it would be unwise for· you to go; He _does not. wish to raise their profile .
because Jackson Hole continues to give intellectual cover for Republican's desire to change
the Medicare program. from a defined benefit to a defined contribution program. (Ira strongly
·agrees and believes if "you -~ or the 'President -- goes, he should go;")
. There certainly is evidenc.e to back-up the;."no-go'; recQmmendation by Bruce and Ira .. Just
recently, Alain Enthoven and Sara Singer submitted the attached oped to The New York
Times that-suggested that the Republicans are on the right.tr(!.ck with t~eir .desire to restructure
the Medicare program. On the other hand, Enthoven did effectively criticize the concept of
utilizing medical savings accounts for the Medicare program. Moreover, your participation
might signal a desire on your -and the Administration's part to reach out to some influential
"players" to illustrate that we too share the desire to restructure ·the Medicare program.
I •
�...
·
.
.
.
'
\
On balance, my recommendation is that you consider. sending regrets -- citing longstanding
schedulihg conflicts.. I believe that ·Bruce is senior· enough. I will ask that he be on his· best ..
behavior, illustrating his (and the Administration's)desire to modernize and restructure the .
Medicare program-:-- the .right way.· (His comments
be consistent with our e_xpanding.
manag~d .care options message, as well as with the suggestions outlined recently by Lynn
Etheredge). He will oppose the magnitude of the cuts the :Republicans are c.Onsideri~g and
will raise serious concerns with quick programmatic movements towards a defined
contribution ..
will
'
. .
.
.
'
.
.
.
'
,:
.Paul Ellwood talked with me today about the status of the invitation. He would love for you .
to come and believes .that you would find it to ·be very interesting. He asked that I forward
you the attached letter of invitation ·tO Bruce to give you a better idea of the type of meeting
the envision for the 25th. (fhe 26th will be a discUssion' about how much and. how quickly.
savings can be realistically expected to be produced-by a·restructured M.edicare program.)·
If you have any need for further information or want me to forward your response to their
invitation, you can contaCt me at ·hurricarie~infested Duck~ North Carolina and can be reached
--starting on Sunday-- at {919) 261-2396. I have. also left this.memo (and some more
detailed info)' on Metaline's chair. ·
·
··
�-------------------
--------------
----
--
-----
--------------~--.
H.OSPITAL TAX ISSUE
By September 1, HHS must release their allllual hospital reimbursementregulatory
directive in order for. fiscal intermediaries to appropriately reimburse hospitals for the new
fiscal year starting on October 1. Because ofcompeting, strong and vocaily expressed
interest by Senator Rockefeller, the for-profit hospitals, and the not...:.for-:profit hospitals a
great deal of attention has been focused on an issue dealing with whether or not HCFA
should change the reimbursement methodology to increase compensation for hospitals
·
(predominantly for profit hospitals) who pay ·property taxes.
Background
In 1991, Medicare implemented a prospective payment system for hospitals' capitalrelated costs. At that time, the proprietary hospitals argued that the new reimbursement
system created an inequity: the rate effectively assumed that all hospitals paid property taxes.
They contended that the .methodology undercompensated them for their costs .and
property taxes. Then HCFA Administrator
overcompensated those hospitals who ·had paid
Wilensky made a· commitment to considei: addressing this 'issue if a feasible adjustment to the
methodology could. be developed. However, since methodology changes need to be budget
neutral, any changes would effectively take money away from niany not-for-prOfits.
no
Despite int~mal misgivings, HCFA felt obligated to publish forpublic comment a
proposal to address the foi-,...,profit hospital concerns. The not-for-profits (particul~.rly the
Catholic Health Associatio_n) strongly weighed in their opposition. They argued there are .
many inequities ill the reimbursement system and singling one element of the methodology .
does not make sense and would effectively. replace one inequity with another.·; Purely on
policy grounds, HHS agrees with this position. . ·
'
. Recentl"y,. Senator Rockefeller advoc:ated on behalf of a number of for..,.profit hospit<;ils .
in his state. He had conversations with Administrator Bruce Vladeck and feels he. was given
the impression that the Department would rule in favor of the propfietary hospitals. (Bruce
arid Donn~ do not see how he came to this conclusion.) Subsequently, when Senator . .
Rockefeller.leamed the Department maybe going the other direction, he called Carol Rasco,
Secretary Shalala and Chris. Jennings to expresshisfrustration and an·ger,as well as to
prom~te some compromise approaches being suggested by the for profits.·
HHS Decision
/
..
After an extensive policy, and political vet, HHS has concluded that it is not advisable
. to change the reimbursement policy. They believe that the corilpromises put forward by the
proprietary hospitals are still problematic. Probably just as important; because of the statutory
requirement to publish the ne:.v rates by September 1st, they simply do not have sufficient
time to change their policy. It is important to know, however, that the HHS decision is likely
to result in significant ill feelings from both Senator Rockefell~r and the for profit hospital ·
community. HHS is npw i~ the process of dcvelopinga strategy (perhaps a West Virginiabased "field hearing on this issue) to assuage Senator Rockefeller.
�.
.
·~
·l.
l 't:lUG-18-'1995
14!36
FROM
TO·
12024567028
p. 001/011
·JACKSON HOLE GROUP_.- - - - - - - - - - -
FACSIMILE ·COVER LETTER
We are
\ \ · page(s) (including chis cover letter) to be delivered immediately.
transminin~
TRANSMITTING TO:
NAME:
Chri>
s.:lex)Y\<1.~5
c·oMPANY: _ _ _ _ _~-----'------------PHONE:_.-----'--...;._---'-------=--.,-------------
FAX:
<2{)'2. -46b~ 70'28
M.ESSAGE:
TRANSMITTING FROM:
NAME:
PHONE:
307-739·1176
FAX:
OAT~:
Teri Norris, Office Ac:1ministrator
307-739-1177
?5/18
TIME:
~·.'59
p
BY: ·ji\.)
Mailing ,.\ddress: P.O. Box 350 · Teron Village, WY 83025
Fed-Ex/UPS: 6700 North Ellen Crel?k Rood . )Jckson, WY R3001
. 307-i39-1176 Fax: 307-739-1177
�·--~~
.
l=ll.JG-18-1'395
15:20 FROM
1202455?028
·.TO
P.002/003
., .
Bruce Valdeck ·
Administrator
FaxedAugust17, 1995
HCFA
200 Independence Ave., SW, Room 314G
Washington, DC. 20201
·A1.1gust 17, 1995
Dear Bruce,
I am enclosing various pie·ces of information, including an ag~nda, concerning the ·
.
forthcoming meeting which begins August 24; 1995 at 4:00pm and conCludes August 27,
1995 at noon.
·
·
·
. ·
·The di.scussions of Medicar~ are undoubtedly the most timely and signifiCant ones that will
occur at theAugust 24-27, 19~5 meeting. I am expe<;tihgthat we can take away from your
·interaction a series of very positive and spe~ificsuggestions for consideration·by,Congress,
the Administration, and the public. Rather than send individual lists of topics to.each of
you, I will try in· this letter to identify what is anticipated from the various discussants of
Medicare. As usual, each pe'rson assigned to open up a topic will make a brief statement
based on their own observations and experience to be followed or interrupted by_
discussio~ from the rest of the·group,
·
.· We intend to dividethe Medicare session into two segments, the first o~ !5riday AM,
August '25 and the second Saturd~y AM, Aligust 26. The first session focusing on the
feasibility and the possible irr1pact of givfng the existing Medicare· program a more .
managed care orientation will be lead by you and len Schaeffer (see the enclosed paper by
lynn Etheredge on managing Medicare). You will start with the kinds of new authorities.
that hebelieves~ill allow'him to manage the program more effectively and will speculate
on the magnitude otsavings that might accrue. len is s'omeonewho has wn HCfA.and
now runs a large managed .care based Bl'u·e·cross plan. He will compare the ability of the
two systems to manage·care and will provide his own speculation as to the manageability· ·
··
of'care in the HCFA context.
..
..
�TO
12024567028
. P.003/e03
. ··.
From the second segmentol the Medicare discussion on Saturday AM, August 26, I hope
.
w~ will .elicit specific·recommendation~:on at least five topics:.:
Overview of Congressional
•
•
•
•
•
i .
Proposals~ What is lmple~entable?
Switching Medicare to a. defined contribu'tion program. .·
Capping and equalizing the Federal payment to risk contractors .
. Dismantring and privatizing HCFA.
·
Multiple equiv~Jent benefit packages .
Medicare MSA's .
You and Bill Gradisoh Will undertake the impossible task of summarizing the most likely
Republican and Democrat proposals forMedicare reform. Harry Cain will :give his. views.·
on what might aliow for Medicare to be switched from a defined benefit program to a
defined contribution prog~am. Bill Price, who heads FHP~ one ·of the largest Medicare risk
. contractors will discuss two hot topjcs- capping and equalizing MediCare contributions
across the country to risk ·contractors. Lucretia Myers ofFEHBP, draws the enviable
assignment of speculating about di~mantling and privatizing HCFA so that it more closely
resembles the Feder(ll Employees Health Benefits Program. ·Alain Entho"en will' discuss .
two of his favorite topics: competing without standardizing benefits and the implications of ·
. Medicare MSA's (see enclosed op-ed piece from August 16, 1995 New"Y:ork T;mesL ·I· ..
have been very arbitrary in setting each of you up as discussion le~ders on various topics, .
but I know. you all have opinions on every one of them and· free-for-alf is inevitable ..
Despite the scope of these discussions, I really hope that
can modify the initial set of
·.jackson Hole Group suggestions, which ·are enclosed, to' incorporate any new and b~tter
irl.,.::u; th~t r-n;,P frnni thP em11n.
·:
.
.
·TOTAL P.003
we
a
�·
~UG-18-1995
14=37· FROM
TO
. 12024567028
p. 004/011
Jackson Hole Group Meeting
August 24.·- 27, 1995 . ·
Jackson Hole, Wyoming
THE HEALTH CARE REVOLUTION'S MIDLIFE CHALLENGES
Thursday
August 24. 199.5
4:00pm7:00pm
Gqals of the Meeting
Paui.M ..Ellwood, MD, President.
Jackson Hole Croup
.
.
.
.
.Managed Care. Responds to.its Fans. and Crltks
· . Lou Ann Cash, Vice President- Benefits Pl.anning
American Express
John K. lglehart,National Correspondent
. New England louroal of Medicine
·
Friday
August 25. 1995
7:30am-·
11:30 ani
·Managing Traditional Medicare like M~naged Care
·
Bruce Vladeck, Administrator
HCFA
·
Leonard Schaeffer,· Chairman· & .CEO.
California Blue Cross·
Medicine Reinvents its Relationship with. Managed
.·
.
. ..
· ; Alan Nelson, MD, Executive Vice President
Qre.
American Society of Internal Medicine
·
Robert Doherty, Vice President for Government
·Affairs and Public ·Policy, ASIM
INFORMAL jACKSON HOLE ACTIVITY
Friday
August 25. 1995
4:00pm-. ·
7:00 .pm
Can the Oocto.rs Reqpture the New American Health
System?
Reinertsen, MD; CEO .
Health System Minnesota, .Park Nicollet Medical Center
Jim
�. 'AUG-18-19'35
14:37
FROM
TO
12024567028
P.005/011
Friday, August 25, 1995 Cont.
. Kirk Johnson, JD, General Counsel, Group Vice.
President for Health Policy Advocacy,AMA
·
Gi~ing Consumers "the .FAcets" About the.Qu~lity of
Managed Care
· Dwight McNeill, Information Manager
GTE Labs
.
.
.
jack Faris, President & CEO
NFIB
The Potential Value of Common Populati~n Based
· Approach~.s to Quaiity Accountability to D~vice and
Pharmaceliti'cal ManufaCturers, Information System·
Developers, ·and Policy Makers
Glen Nelsori, MD, Vice Chair~an
Medtron.ic
Fred Telling, PhD, Senior Vice President of Planning
arid Policy, Pfizer, Inc.
· ·
: Faye Baggiano, PhD,· Health Policy Advisor
EDS World Wide
Saturday
August 26. 1995 .
·7:30am. l1:30am
Can the .Combin.ation of Mapa~ed Care and
.
Managing Traditionai.Medicare Produce $250 Billion in .
·
Savings in the Ne~t Seven .Years?
Overview of Congressiorial Proposals:
What js lroplementable?
..
·A. Switching Medicare to a o·efined · . ·
Contribution Program.
· B. Capping and Equali·zing the Federal Payment
to Risk Contractors.
C. Dismantling and Privatizing HCFA.
D. Multiple Equivalent Benefit Packages.
E. Medicar~ MSA's.
2
..
.\
�AUG-18-1995
14:37
TO
FROM
Saturday. AuGust 26. 1995 Cont. .
· 12024567028
P.006/0ll
Bill Gradison, President
HlAA
Bruce Vladeck, Administrator·
I
HCFA
Harry Cain, Executive Vice president·
Blue Cross & Biue Shield Association .
Wescott W. Price, Ill, President & CEO
Family Health Plan
Lucretia Myers, Assistant Director for
Insurance Programs, FEHB P
Alain Enthoven, PhD, Marriner 5. Eccles ·
Professor of Public and Private
· Management, Stanford University
!NFORMAL jACKSON HOLE ACTIVITY.
·Saturday
Al;igust 26. J 995
4:00pm-·
7:00pm
Accom~odating Academic Health Centers to the
Restructured American Health System·. . .
Robert Waller, MD, President & CEO
Mayo Foundati6n
C. Thomas Smith, President & CEO . ·
VHA
(
· Ralph Snyderman, MD, Chancellor for Health Affairs,
Dean.: School of Medicine, Di:tke Uni~ersity Medi~al
Center ·
·
·
·3
�I
TO
I
12024567028
Sunday
AUgust 27. 199.5
7:30am11:30 am
I
Uniform Benefits Revisited
Michael Stocker, MD, President & CEO
Empire Blue Cro~s & Blue Shield
4
I
.P.007/011
�AUG.:.18-199S. 14:38
FROM
·m
Jackson Hole Group Meeting
·August 24- 27, 1995
Ja~kson Hole, Wyoming
Attendees:
.
Faye Baggiano, PhD
Health Poiicy Advisor
EDS World Wide
I
Frank Barker
Corporate Vice President ~·Corporate A(fairs
johnson & Johnson
Harry Cain
Executive Vice Preside.nt
Blue Cross & Bl.ue Shield·Association
LouAnn Cash
Vice Preside~t ~Benefits Planning
American Express
Robert B. Doherty .
Vice President for Government J\ffairs and Publi~ Policy
·
·American Society of Internal Medldne
Paul M: Ellwoo.d, MD
President . ' .
Jackson Hole Group
Alain Enthoven, PhD .
.
Marriner 5 Eccles Professor of Public and Private Managment
Stanford University '
·
·
·· · · ·
Trustee·- Jackson Hole Group
(
.
Peter Ernster
Senior Vice President
Merck & Company
12024567028 . . p. 008/01 i
�. . lrlUG-18-1995
14:38.
'TO '.
FROM
12024567028
P.009/011
'Jack Faris
.
Pre~ident & CEO
NFIB
Bill Gradison
President
HIAA
:,;
john Iglehart
National Correspondent . ..
New..Eogland lournal o(Medicine
.
.
..
Kirk B. Johnson, JD
'
General. Counsel
Group.Vke President for Health Polic:y
American Medical Association
·
'
Advocacy
'•
..
i
Margaret Jordan, BSN, MPH
Vice President
Sputhern California Edison Company
.Trustee- Jackson Hole Grciup
··'···
···.'
· Kermit Knudsen, MD
Director, Center for Outcomes Study
Scott & White
. Alic::e·tusk .
. · Corporate Vice
Pr~sident,
,,·
.....
.
'
.
Insurance and Healthcare Group
EDS
Trustee~. jackson Hole Group
Dwight McNeill
Information Manager
GTE'Labs
'2
'-,
�-----:-~-----------·--··---·-
. .
t=lUG-1.8-1995
12024567028
TO
14:38 'FROM
. ·,
P.010/01l
..
lucretia Myers
. .
Assistant Director for Insurance Programs
FEHBP ·
.
Alan Nelson, MD
Executive Vice President
ASIM
)·
Glen Nelson, MD
Vi~e Chairman
Medtronic, Inc.
.. • '
Wescott W. Price, Ill
President & CEO
· Family Health Plan .
james Reinertsen,· MD
CEO
Health System Minnesota/Park Nicollet Medical Center··
...
Daniel Roble, Esq
Ropes & Gray
Trustee~ jackson Hole Group.·
Gary Rudin*
Corporate Vice President & Group Executiv·e, Health Care Industries
EDS
.
.
. .
Leonard Schaeffer
Chairman & CEO
California Blue Cross
3
-···-···-
�f 1=lUG-18.:.1995 · 14:38
m·
FROM
Craig Sthub
· . President -Secure Horizons USA
Senior Vice President, Government Programs .
PadfiCare
C. Thomas Smith
President & CEO ·,
VHA
,
Chairman, Board 9f Jr.ustees- Jackson H~le 'GrOLIP
Ralph Snyderman, MD
Chancellor for Health Affai~s
Dean, School of Medicine
Duke University M~diCal Center
. Michael Stocker, MD
President & CEO
Empire Bl~e Cross & Blue Shield'
··Fred Telling, PhD
.·Senior Vice President of Planning & PoliCy
Pfizer, Inc.
·
·
Bruce Vladeck
Administrator
HCFA.
Robert Wal.ler, MD
President & CEO
Mayo Foundation
Trustee- Jackson Hole Group·
;
'.
* have not confirmed attendance.
4
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
. SUBJECTrriTLE
DATE
Chris Jennings to Hillary Clinton
· Re: Medicaid and Tennessee Information/Trustees' Quadrennial
Recommendation (2 pages)
RESTRICTION
4/13/95
P5
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Chris Jennings (Health Security Act)
OA/Box Number: 23754
FOLDER TITLE:
Undated HSA Files [5]
Gary Foulk
fl26
RESTRICTION CODES
Presidential Records Act - (44 U.S.C. 2204(a))
Freedom of Information Act.- (S U.S.C. SSZ(b)l
PI
PZ
P3
P4
b(l) National security classified Information ((b)(l) orthe FOIAJ
b(2) Release would disclose internal personnel rules and practices of
an agency l(b)(2) of the FOIAJ
b(3) Release would violate a Federal statute )(b)(3) of the FOIAJ
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIAJ
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) of the FOIAJ
b(8) Release would disclose Information concerning the regulation of
financial institutions ((b)(8) of the FOIAJ
·
b(9) Release would disclose geological or geophysical information
concerning wells l(b)(9) of the. FOIAJ
National Security Classified Information ((a)(l) of the PRA)
Relating to the appointment to Federal office )(a)(Z) of the PRAI
Release would violate a Federal statute )(a)(3) of the PRA)
Release would disclose trade secrets or confidential commercial or
finanCial information l(a)(4) of the PRAI
PS Release would disclose confidential advise between the President
and his advisors, or between such advisors la)(S) of the PRAI .
P6 Release would constitute a clearly unwarranted in.vasion of
personal privacy l(a)(6) of the PRAJ
C Ciosed in accordance with restrictions contained in donor's deed
..
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
.
RR. Documen·t will be reviewed upon request.
�-------------------------------------.
·····.
_
...
OETERMINED"TO BE AN
ADMINISTRATIVE MARKING
!NITIALS:!.2±.__ DATE:L.~-~-~':_-5
-€ 0 N -F I D E N I I A t-·
'·
TO:
FR:
RE:.
cc:
M E M 0 R A N ·n U M
April 13, 1995
Hillary Rodham Clinton
Chris J. ·
Medicaid and Tennessee Informationffrustees' Quadrennial ,Recommendation
Mel anne
Attached you will find an extensive and internal Medicaid background document, which was
prepared by OMB. It includes a fairly balanced description of the TennCare program starting
on page 21.
As you know (and as referenced today by Alice Rivlin), we take the "official" position that
our scoring for·the TennCare waiver is budget neutral. In its report released I.ast week, the
General Accounting Office actually concluded that TennCare was better than budget neutral.
Although they used differing scoring methodology, the GAO and OMB reached their
· conclusions primarily because their analysis assumed (as did the deal the Administration
cut with Tennessee) that the Federal Government would continue to fund the program at
pre-waiver levels, which (according to OMB) "had supported 21% annual growth rates
over the 5 years preceding the waiver." In other words, we accepted what appears to be a.
highly inflated base. ·
Not surprisingly, the incredible groWth rates of the late '80s and early 90s were the result of
unprecedented increases in the _State's disprop9rtionate share hospital program. The Federal
· GOvernment's funding for this program (approximately $430 million per year) was the result
of reven~e produced from the state's i~famous provider tax mechanism. Although no one can
·
say with absolute certainty what would have happened to Tennessee's financing situation
without its waiver, the fact that we have declared most of these provider financing schemes
illegal certainly casts doubt as to whether we or the Congress would have permitted their past
funding streams to continue.
Keeping the above in mind, questioning whether Tennessee's remarkable coverage
· achievement could have occurred without the large base as a foundation seems quite
reasonable.· Therefore, suggesting that we are probably paying more than we othenvise
would have also seems logical. Having said this; Tennessee has not spent all the Federal
dollars available to it and they apparently still have hundreds of thousands of newly insured
citizens. (Some suggest that the State's inability to collect premiums from the poor has made
it impossible to raise the dollars necessary to obtain the Federal matching dollars; this helps '
explain why the GAO study concluded that Tennessee ·is better than budget neutral.) In
addition, one of Tennessee's most remarkable a.chievements has been its apparent ability to
enact and maintain significant reimbursement reductions and successfully get providers to give
care to the newly insured.
�,,.,
./
I ,.-
..
....
As you know, the State waivers are under incredible scrutiny by the Republicans. They are
criticizing:usfor using financing mechanisms that-- evil of all evils -- expand coverage rather.
than reduce the deficit. Expanding coverage through Medicaid -- .even if it has meant some
creative Federal financing -- might not be something we wan.t to -publicly critique. In fact, we
may. want to take a "we have no apologies for expanding coverage" position.
On the other hand, preliminary analysis of Tennessee seems to indicate that the State may be
in. trouble iri terms of being able to maintain its coverage level or assurances of access to
quality care. It may we.ll be that Tennessee attempted to cover too many people, too quickly,
and will have to. downsize to more of an Oregon· model. Frankly,· based- on everything I know
at this moment, it is too early to tell just what is going on Tennessee .. I have a group of
people quietly analy~ing the "re.al truth" behind the Tennessee experiment and I hope to have
a more complete report sometime next week.
.
.
.
· In the interim, in dealing With Joe Klein (sp?), I would suggest that Melanne or I call him and
give him an off-the-record description of the. Tennessee budget neutrality issue. We could
explain why it was scored "budget rieutral," but also could explain the base issue. If you
think we should give him more on the cost issue, I might suggest that we forward him onto
someone like Diane Rowland of Kaiser. She would be more than happy to discuss this issue .
with him. Does this sound like a reasonable strategy to you?
Q.UADRENNIAL COMMISSION ISSUE
I did some quick checking about the Social Security Trustees recommendation vis a vis the
Medicare Quadrennial Commission. You will be pleased to know that they did make a
specific recommendation that legislation be passed to re-_establish the Quadrennial
.
Commission on Medicare to examine issues of insolvency in the program. (The authorization.
for the previous Commission was rep~aled in the legislation establishing an independent
Socia!: Security Administration.)
Despite the recommendation, the trustees made no· reference as to when recommendations
would be d~e. nor as to the membership of the Commission, nor as to who would make .the
appointments to the Commission. Having said this, if the legislation authorizing this
Commissio11 is consistent with that of prior quadrennials~ the language wo~ld read that the
.Secretary appoints and pays all the members. In the appointments the Secretary makes, she
would be directed to produce a non-political, balanced group. Past statutory authority has
given the Secretary (and therefore the Administration) fairly wide latitude, however. One last
important point'related to timing: If the past. is aity lesson, th~ Quadrennial Commission's
report usually comes out 12-18 months after. appointments in place.
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
DATE
· Chris Jennings to Distribution
· Re: Upcoming CBO Reports (2 pages)
RESTRICTION
4/15/93
SUBJECTfTITLE
P5
002. memo
Chris Jennings to Hillary Clintori
Re: Meeting with Senator Durenberger (2 pages)
3/8/94
P5
003. memo
Chris Jennings to Hilhiry Clinton
Re: Thursday Meeting with Ron Wyden (1 page)
.3/10/93
P5
004. memo
Chris Jennings, Steve Edelstein to Hillary Clinton
Re: Meeting with Senator Biden (2 pages)
3/8/94
P5
005. memo
w/attach
Linda Bergthold, Robert Valdez to Hillary Clinton
Re: President Clinton's Meeting with Congressional Caucus for
Women's Issues on Thursday, March 11, 1993 (9 pages)
3/10/93
P5
006. memo
............
Chris Jenn~ngs to Hillary Clinton
Re:.Meeting with Conservative/Moderate Democrats (i page)
:
.
3/16/93
P5
:·
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COLLECTION:
Clinton Presidential Records
. Domestic Policy Council
Chris Jennings {Health Security Act)
ONBox Number: 23758
FOLDER TITLE:
HRC Memos-HSA [4] .
Gary Foulk
n:n
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PRM. Personal record misfile defined In accordance with 44 U.S.C.
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RR. Document will be reviewed upon request.
�.
-------------------------------;-------------,
.DETERMINED TO BE AN
..
_ADMINISTRATIVE MARKING
INITIALS: ,;;27 DAfE: a·zJ·os
PRIVILEGED AND CONPIDEN'I'IAL
ME M0 R A N D U M
TO: Distribution
FR:· Chris Jennings
RE: Upcoming CBO reports
April 15, 1993
In not-for-attribution conversations with key Congressional
staffers, it has come to my.attention that tne Congressional
Budget Office (CBO) is about to r~lease four d~fferent reports
related to health.care. The reports and their projected release
·dates are:
CBO REPORT. SUBJECT
1.
PROJECTED RELEASE DATE
Single Payer/All Payer· Update
Within Two Weeks
Report. Apparently concludes that
all payer rates ~ould significantly'
reduce the subsidy level the Feds
would have· to pay for individuals
and/or employers (b/c it would ·
reduce plan'costs}. I believe
Stark will like this one, and might
well publici_ze.
2.
Managed Competition Report.
Within About a Month
Likely will conclude that .
traditional model of managed
cqmpetltion will not save money
over the·short term. If it will
save any money, the ·report apparently
· concludes it will take 7 to 10 years.
3.
·Report Evaluating Cost of
By the End ·of the Month
Uncompensated care. Apparently
c.oncludes that all uncompensated
care is recovered by hospitals, with.
at least 50 percent of it paid thro·ugh
private sources.
4.
Report Evaluating Simulated
About Two Months Away
.Models.· This reptirt reviews
bills that have already b~en
introduced and broadly models them
to determine how much they cost/save.
�--------------------------.
···----·------------
.-.
I
If handled well, none of the previously mentioned reports
should cause us much heartburn. To the contrary,. they could help·
.strengthen our case as long_as we know what·is in them and how to
best spin any response to questions about them.
'
In that vein, I am trying to obtain pre-publication copies
of the reports. I will keep all relevant parties apprised of the
luck I am having in this regard.
It· is possible that a discussion of these reports may come.
up in tomorrow's "let's try to. be· on the same page" meeting with
CBO, the House and Senate Leadership/Committee staff, and Ira.
Obviously, however, anydiscussion ·about the reports should not
be originated by ·us. We are NOT the Congress-and we should NOT
know about the reports unless we have been explicitly' informed
about them by the Chairmen who requested them.
Housekeeping on the CBO meeting with Ira, Ken and whoever
else goes. Attendees at the meeting are likely to be CBO's Chuck
Seagraves, Paul Van de Water (sp?) -- Chuck's boss, and Kathy
Langwell. These are the numbers crunchers and are very
influential people. Reischauer, I am informed, will NOT be in
attendance. From the Congress: Andie King, Mitchell's Bob
Rosen, the Hquse and Senate Budget Committees, the House.Ways and
Means Committee (the primary host), the Energy and Commerce
Committee, the Senate Finance Committee, arid the Senate Labor and
Human Resources Committee·.
�...
DETERMINED TO BE AN
ADMINISTRATIVE MARKING
INITIALS: 111 DATE: 8· 23·oS"
,:,.
PRIVILEGED AND CONFIBENTIAL MEMORANDUM
TO: Hillary Rodham Clinton
FR: Chris Jennings, Steve Edelstein
RE: Meeting with Senator Durenberger
March 8, 1994
cc: Distribution
Tomorrow you are scheduled to meet with Senator Dave Durenberger (R-MN).
Durenberger, serving on both Finance and Labor, is a Chafee and Breaux
cosponsor and is key 1f a bipartisan bill is to be achieved in the Senate.
BACKGROUND:
Senator Durenberger, who faces renewed legal difficulties, is thought by many
to be looking for· polttical redemption through passage of health care reform as
he concludes his Senate career.
Senator Durenberger wants to be a player on health care reform although it is
not completely clear how. He apparently is looking to work through the
Finance Committee, as opposed to the Labor Committee, to develop a
bipartisan compromise on health care reform. However, he does not want to
be singled out by the Administration for discussions and negotiations, feellng
that many Republicans already distrust him. It is his belief that he can be
more constructive working through the Republlcan Caucus reaching out to
other moderates.
In that regard, he recently sent a "Dear Colleague" letter that went to all
Republlcan Senators. In it, he cautioned them against giving into the Kristol
arguments, that there is not crisis and that modest incremental reforms
would suffice. He expressed the view that Republlcans needed to be major
players in this debate and that because the Administration has set no
parameters except universal coverage there was a lot of room for them to
operate. He goes on to try to attract other moderate members noting that even
more than the Democrats, moderate Republicans have the most experience in
developing middle ground solutions. (The letter is attached for your review.)
In separate meetings this year with Chris Jennings and Roger Altman,
Durenberger has raised a number of issues. Foremost among them is the
definition of universal coverage. He believes the linage of an Arrierican waving
his card is wrong and won't fly. In his view the problem isn't the uninsuredit's the cost. and universal coverage without Medicare/Medicaid reform isn't ·
viable. He could not get the Republicans to agree on a definition in Annapolis
but he'll be interested in our definition.
·
·
·
�He has consistently questioned the financing of the HSA and has real problems
with the employer mandate. Whlle he has left the door open on an employer
mandates, he does not belleve that it can pass at close to the 80% level that
has. been proposed in the plan. He also does not think the 7.9% employer cap
will hold and fears it is a promise we w111 not be able to keep.
He was reportedly disturbed that CBO projected health care spending rising
from the present 14% of GDP to 19% in 10 years 1f the HSA is adopted. He
made Hght, however, of the $132 billion difference between the HSA's and
CEO's short-term deficit estimates.
·
Senator Durenberger opposes premium caps but won't reject them out-ofhand. On alllances, he felt Florida's experience with voluntary alllances was
discouraging and that we were focusing too much on alliances and too Uttle on
accountable health plans. PubUcly, however, Durenberger has also ·expressed
doubts on the need for alUances to have exclusive regional authority, and cites
the MinneapoUs-St. Paul area, where a buying cooperative of 22 companies
has managed to drive down costs and to influence local health plans.
In a lengthy insert in the February 7 Congressional Record, Durenberger said
he was fearful of "personalizing reform" With. emphasis on Cooper, the
President, and .the First Lady. He emphasized the possib1l1ty for consensus "in
guaranteeing that every American w111 never have to, in the future, go without
the security of access to needed health care and medical services and longterm care service in this country." (The Record Statement is attached for your
. review.)
He has been engaged in ongoing discussions. With Senator Kennedy but
according to Kennedy's staff there has not been much movement.
TALKING POINTS:
General:
You may Wish to note that this ineettrig is part of an ongoing series
of discussions that you and the President are having with many members on
health care reform. This is not an attempt to single him out but rather an
opportunity to seek his advice on this issue.
Committee Action:
You may wish to ask him about the Labor and
Finance Committees and how he views the current state of those two
committees as well as his opin*on on how to work the process to attract
moderate Republicans.
·
�MEMORANDUM
TO: Hillary Rodham Clinton
FR: Chris Jennings
·RE:. Thursday Meeting with Ron Wyden
co: Melanne, Lorraine, Kim Tilley
March 10, . 1993
In response to his invitation, you are scheduled: to meet
with Ron Wyden ( D-Oregon) ~ .· Staffing him for. this meeting will be
David Schulke, a well respected and former David Pryor Senate
Aging Committee staffer.
BACKGROUND
Congressman Wyden is well.known in health reform circles.
He is very adept at picking hot topic health issues, moving
quickly to address them -~ particularly through the press, and·.
introducing relevant legislation. In recent years; he has been
at the forefront of such issues as prescription drug cost
containment, long-term care private insurance standards, and.
state flexibility •. (All"three of these issues have also been·
strongly advocated by Senator Pryor).
During last yearis ef;6i:t by the House to achieve a
Democratic consensus on health reform, Congressman·Wyden.and.
Congressman Synar attempted to play the mediator role between the
Gephardt/Stark government regulation approach.and the·
Cooper/Andrews/Stenholm managed competition approach. He
believes th~re is some middl~ ground and he wants to be one of ·
the Members who helps you find it. Although he will work closely
with Chairmen Dingell and Waxman, he views himself as a major
·
player as well and hopes you . will . treat him .as one. Apparentl.y,
FYI, he was very happy that you mentioned hi·s name in yesterday's
meeting with the Energy and Commerce Committee.
LIKELY DISCUSSION
A ·number of issues may come during your d·iscussion with
Congressman.Wyden, including: (1) How best to talk _about
revenues and·recapture provisions, (2) How best to target . .
wavering Members and what Wyden's role can be.in·this regard; and
(3) the provision of.state flexibility and, somewhat related, the
status of the Oregon waiver request. This visit is very
important to Congressman Wyden. If it turns ou~ like I believe
it will, you will have another strong and helpful al:)..y in the.·
House.
·
·
�.
.
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D~itRMINED TO BE AN
/·.! :·.. '~ "t:':TRATIVE. MARKING
·~
·- . "":!-·
··'····-·---
PRMLEGED AND..CONFID:BNTIAL MEMORANDUM
TO:
FR:
RE:
cc:
Hillary Rodham Clinton
Chris Jennings. Steve Edelstein
Meeting with Senator Blden
Distribution
March 8, 1994
DETERMINED TO BE AN
ADMINISTRATIVE MARKING
INITIALS: /27 DATE: lf· 2 3 ·as-
Tomorrow you are scheduled to meet with Senator Joseph Biden (D....:DE).
chairman of the Senate Judiciary Committee.
BACKGROUND:
Senator Blden has not focused very much attention on health care reform,
· dedicating himself almost exclusively to the passage of the crime blll. To date,
he has not cosponsored any major health reform bills. He has expressed
major reservations about the President's plan and how it has been perceived
by and sold to the general public. One of the consequences of this may be that
he has been one of the few Democratic members who have declined to sign
Senator Wofford's universal coverage letter.
In the past, Biden has said that he does not favor single payer and is
concerned that play-or-pay could lead to rationing. He has also been
skeptical about managed competition and Is especially concerned about HMOs
and their role.
·
·
He is naturally Interested In the malpractice and anti-trust provisions which
fall within his committee's jurisdiction. To date he has not expressed any
major objections to our formulations. Last spring, he expressed his opposition
to caps on non-economic damages and preferring caps on attorney's fees. He
will be nervous about moving too far from where we are toward the health
Industry positions.
His concerns go beyond the jurisdictional issues. Biden has an opinion on the
broader issue of reform as 'well. In previous meetings he has expressed the
general view that we have to be careful about loading up any legislative
package with too many bells and whistles and he would .think our bill goes to
far in that regard. Accordingly. he may advocate that some provisions be
jettisoned but he might not be ready to enumerate them until he has more of a
chance to focus. He has expressed specific concerns that the benefit package
may be too generous as well as the impact on small business. He has major
objections to a tax cap and believes that ultimately the Republicans will run
away from it.
.
�~--------------------------
-----------------------------------
Blden voted for Budget Reconciliation. National Service, and NAFTA. As Is his
style, he can be expected to be a bit long-winded and overly deferential in your
meeting.
TALKING POINTS:
Universal Coverage: You might want to talk to him about the Importance of
universal coverage. his reluctance to sign the Wofford letter and explore his
reservations in doing so.
Committee Action:
You may wish to discuss the time frame for his
Committee to report out their provisions and any problems he foresees in that
regard.
·
Seeking his Counsel: You may also wish to get his advice on more general
aspects of health reform beyond the issues of his committee's jurisdiction and
seek his counsel on how to proceed to achieve health care reform.
�,.-----,-----~----:--:----':--------------:---:--·- ..---·-·--· ..
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DETERMINED To" BE AN
ADMINISTRATIVE MARKING·
INITIALS: /)-:} DATE: 8 ·:J..3.·o.5"
1.
March 10, 1993 .
DRAFfCONFIBENTIAL MEMORANDUM
TO:
FROM:·
· . HILLARY RODHAM CUNTON
. LINDA BEAGTHOL$v- .
ROBERT VALD~t/
.
cc: Chris Jennings
Ira Magazlner
· Judy Feder
· Atui.Gawande
.J
RE:
PRESIDENT-CLINTON'S MEETING WITH CONGRESSIONAL CAUCUS
...
. FOR WOMI;N'S ISSUES ON THURSDAY, MARCH 11, 1993
.. .
..
.
~
Chris Jennings has ask.ed us to prepare a background memo for yoll In
preparation for President Clinton's meeting with the Congressional
Caucus for Women's Issues tomorrow. ·
· Members of the benefits coverage working .group •rep-resenting the
·.Congresslohal Caucu!) for Women's Issues and Senator Mikulski have
Indicated serious concerns about the coverage· of .abortion services in the
benefit package and the process for ·developing options. In President
Clinton's meeting with the Caucus. on Thursday, .we understand that he ·
be askeg specifically about these Issues..
will
BACKGROUND
bur working group was asked to explore all options related· to benefit
coverage as we proceed through the Tollgates. When the Issue of
·_ . coverage for abortloh· first carne up, several women In our group ·
objected to the fact .that we. were even considering a "no coverage"
option. They said that President Clinton .had clearly stated during the
- campaign that abortion Would be cOvered in the benefit package,. and he
had nqt' backed away from supporting abortion when this issue ·
confronted Secretary Shalala during preparation. for the corifirma~ion
hearings.
·
·
·
Draft 6oAfilii&Atiat-Memorandum
�. . . . - - - - - - - - - - - - - ; - - : - - - - - - - - - , - - - , - - - - - - - - - - - - - - -..-------.. -------.. - - - ·
2
The women·s·. advocates in our group emphasized that anything less than
clear support-for abortion coverage now would be a ''signaln to women
that the President was abandoning his original commitment. ·Following
discussion with you, Atul and Judy asked us to continue developing all
:options for consideration (see our options In Attachment A).
..
_ISSUES
Should abortion be covered In the core benefit package?
The problems with :including abortion services In the core benefit
package are clear. There are probably not enough Votes In the
Senate to pass a health care reform package that explicitly
includes abortion. Support in the. House m(ly also be· weakened.
Excluding. abortion from the core benefit package has obvious
political implications. Women's groups perceive .that abortion
.service guarantees can or will be addressed as part of overall
system reform. SOme women perceive that abortion has been
promised as part of the core benefit-'package.
If part of the core, should abortion be Implicitly covered as part of
pregnancy related care or as a-surgical procedure or explicitly
identified?
.
-
Making abortion· an lmplicitly_cover.ed service may postpone direct·
confrontation. fora short time; but the first time someone ask$ "Is
abortion covered?" a direct answer will be required~ Subjecting ·
.. abortion services to-medical necessity provisions is strongly
· opposed by the_ Congresswomen as: well, because it allows .for too
much ambiguity and returns power over the decision to medical
providers.
·
The· advocates In our working group have presented three options for
abortion· coverage. The options they have outlined are: 1) Establish a
comprehensive reproductive_ health benefit including family planning, ·
abortion as part ofmaternity related care, and post-reproductive care;
2) Integrate abortion services into prevention ~d maternity care; and 3)
Cover abortion as part of m(lternity-related care only. Their options do
'.-
Draft S~Rfidentlal Memorandum
�.-------------..,.,.----:--------:---·····------·-·····-
3
not exclude abortion, make it
necessity control. -
a· s~ate Issue, or subject it .to medical
We have developed. several options ·for cOvering abortion short of
maklng·lt a core benefit In Attachment A. We have also attached·
provisions for covering abortion In selected western countries In
Attachment B.·
·
. SUGGESTED TALKING POINTS
. Given. the complexity· of this ISsue and the. Importance of gaining as
much time as possible to resolve differences. among supp()rters, we
.would suggest the following talking points for the President In tomorrow's
meeting:
. . .
.
.
-. - .
•
Reaffirm support for a woman's. right to choose and Indicate that -·
he and you unders~d this Issue very well.
•
Explain the importance of maintaining the· integrity of the Tollgate
-proces~. which requires that all issu~s an·d ·options be explored
until th~ narrowing process bEJgir\s.
·. •
Indicate that treating abortion differe1:1tly from other Issues at this ·
time will create credibility· problem both within the Task Force
·work groups and outside.
·
·
•
Explain that you want to develop mechanisms that allow -all
WOrT!en to have access to the entire :range Of reproductive .
· seriices. This may .mean crf3at!ng provisions or. programs outside
the benefit package.
·
·
·
,·
.•
Draft
a
Ask.·for their patience and support during this planning phase.
· Ask them to work· with him to develop options and strategies that
. ·will support the passage of the overall health care reform bill and
guarantee the woman.'s rlghfto choqse. ·
·
b9Fifide~ti~emorandum
,·
�...--------,....----------:-------,..--------:------······---·--------·
4
.
ATTACHMENT A
.
.·
OPTIONS FOR COVERAGE OF REPRODUCTIVE HEALTH SERVICES
Our working group has considered several options .related to the coverage of
reproductive health services, including abortion. As we prepared ou~ Tollgate
papers, we colleCted information on current coverage of abortion In the U.S.
Mdabro~:
·
·
Many European countries cover abortion subject to· some conditions (see
·
Attachment B);
. Data on the coverage of abortl~n services in U.S. private Insurance plans
is difficult to obtain. Many private plans implicitly cov~r these services;
Some HMOs Md private insurers cover abortion subject to definitions of
"med.ical necessity" only;
·
··
·
· ·
.
.
.
Ten states have laws that require the exclusion of abortion services from
. afleast some private coverage. Only twelVE;! states fund Medicaid
abortions for _low Income women using state ftinds;
The Hyde Amendment restricts fec:leral funding except in cases where
the life of the· mother is endangered if the f~tus ·is carried to term.
This patchwork of coverage demonstrates the highly· sensitive nature of the
coverage and the lack of consensus· on financing arrangements in either the
public or private sector. ·
''
.
.
.
.
.
.
We think that there are four main options for coverage of abortion:
.
.
. •·
.
.
..
OPTION 1: Exclude abortion .services from the eore benefit package.
PRO:. Mollifies opponents of abortion.
Keeps the focus of health care reform on system change.
CON: Provokes strong attacks by mc;>st women's groups and
weakens support among critical allies.· Would be viewed as
serious breach of commitment by ·the President.
a
Draft CuiiHdefltial. Memorandum
�5
SUBOPTION A: Make abortion· coverage available In a
supplemental package, with subsidies for low Income women .
. '.
· ·· PRO: The subsioizing of abortion services for low Income
women may be acceptable to some women
supporters and has goo~ chance of gaining support
. from moderate groups. ·
Making abortion coverage a supplemental coverage
issu~ may soften' some of the opposition by abortion
opponents.
· CON: Including· abortion in a supplemental package may be
seen as backing down from broader support.
·
OPTION 2: Include abortion services Implicitly In the core benefit
package as part of maternity related care 9r outpatient surge·ry.
PRO: May avoid Immediate direct confrontation with opponents of
abortion and buy time fc;>r building bro.ader support ·among
women's groups.
·
.
.
.
I
,
,
.
CON: Strategy becomes apparent as soon as anyone asks, "Is
abortion covered or not?"
.
Raises "medical necessity" Issues.
OPTION 3: Mandate states to cover abort.lon services for low
Income women.
SUBOPTION A: States eould be given the option of covering
abortion. services. ·
·
·
·
·
··
PRO: Removes Issue from ce'ntral po.int'of attack: federal support
for abortion.
·
Supports states' rights.
Onift 6eAfiS&Atkal Memorandum
�..
.
.
. .,
... ·..
.
.6
.
coN: Bumping this down to the states will be politically
·contentious and potentiatly inequitable.
OPTION 4:. Cover abortion services subject to a amedically ~
~ec~ssarva..provision. ·
·
·
PRO: treat abortion coverage the same as other services subject
to determinations ·of medical necessity.
·
of
CON: Women's groups will strongly object .to the 'language
·medical necessity, because :of the potentially narrow legal · · · ·
definition of necessity, the violation of privacy concerns; and
possibility. of abuse by providers.
··
·within the context of managed competition, providers might·
withhold th-ese services selectively becaustf of .personal · ·
· convictions. Furthermore, sbme providers. may refuse to provide ·
them altogether by invoking th~ "conscience clause."
' ·.
.
'
,I
.
Draft eonfi~BAtial Memorandum .
'
�,4~H/2Nf
f3
ADORTION LAWS IN SEI..ECJ'ED COUNTRTE.c;
Trlmtsc~·
Cnrnifry
First
~nsf rio
12 weeks upon requ~t or
the pregnant woman
-,
•·
llt>Jglum
n..t.,.rlll
. Cn_nucta
Fmn-=e
(;umnny, Wnt
_. 12 weekS upon request _
12 weeks upon
requ~t
*
~ffnnd Trtm~t~r
Third
because or dan~er to the
health rir a prcgnRnt
woman or eugenic reRsons;
· if the prclflant woman is a
minor
·
because nr danger to the
health or a pregnant
woman or eugenic rcR~nns;
if -the pregnant _Woman is a
minor.
no further Information is
available
no further Information
available
nn upper limit for medical reasons
no
for medical
reasons
10 weetcs, upon request, for
. reason or distress
12 weeks In ease of rnpe.
·or ·~oeroeconomlc
no limit_ for thernpcullc
abortions
. 22 ~b for eugenic
reasons
beyond the 22-Wcc:ks . '
because or serious physical
or mental impairment or
the pregnant women ·
reasons
Urltafn
urrer limit
~
_
medical rensons
- Ctiitrcsi~-
.G~al
Trfm~f~r
risk lo the life or health;
· eugenic reasons
no upper legal limit; 28
weeks is prescribed,~ the
Infant Ufe Preservation
Acto( 1929
"'
...j
SO"WLce-~ "~~~~ ~ '/~ kws ~ /+dn~~Vr-
1t;W'did ~ ~·. ~ ~ f ~.
~ f9M,
LC
rll-:- 52
·
�s~den
12 weeks upon request
IR-19 weeks upon
authorization
the
or
Department of ~ial
Affain
Swlb~rlnnd ·
over IR weeks because of
serious threat lo the he11hh
or the
pregnant "WOman
the life or
the mother or lo avert a
fr1 order to save
great danger or permanent
harm; no lime limit sel
•• Thu hc:gl~:~nlng or. accond trimester haa ·been lnterJireted by lho medical pmresalon lobe between 1:\-14 wceb' aestatlon
depending on the reference point. The deOnlllon o( the end or lhe second trimester Is also Vllgue, rl'lnJ!Ing between 27-lR. wecb.
.·
:->·
...
\',.
~
�v>'
J ·.
M E M 0 R·A N D U M
...,:.
March 16, 1993
TO: Hillary Rodham Clinton
FR: · Chris Jennings
RE: Meetings with Conservative/Moderate Democrats
cc: Melanne, Lorraine, Steve
I
Last year, the House did not have·anywhere close.to a
sufficient amount of Democratic support to ·even consider a vote
·on last year's.Gephardt health care reform plan. One of the
major problems was that the moderate/conservative Democrats did
not fee~ it necessary or in their interest to sigri 6ri.
With the election of a new Democratic President, the
dynamics most definitely have changed. Having said this, as
evidenced by the conservative Democrats position on the
President's economic package, i·t cannot be assumed that these·
Members will jump.on board the President's health care reform
plan. If these Members can use the excuse that they have not
been consulted with or taken seriously, many may well not
hes·i tate to oppose the health reform proposal and offer an
.alternative that a numberof Republicans.might find attractive.
.
.
With the above. in mind, and even though I know how hectic
your schedule is, I believe/it is in your and the President's
. best interest for you to m~et with the three conservative
Democratic membership organizations that have formed.in the
House. Because of his·experience ·with these Members, Dick·
Gephardt strongly endorses this idea. The.three groups are:
(l)·the Budget ·study Group '7'- (fiscal but generally·not
social conservati.ves) ,· Chaired by Congressman Davi.d Price
from North Carolina;
(2) the Mainstream Forum -- (perceive themselves to be
generaliy moderate, but frequently vote conservative)~
Chaired by.Congressman Dave McCurdy from Oklahoma; .and
(3) the Conservative Democratic Forum -- (the most
organized group in the House), Chaired by
Congressman Charles Stenholm from Texas.
conse~a.tive
Although there is some membership o:verlap on the$e'groups,
particularly from the larger Budget Study Group, Melanne, Andie
King (from Gephardt's staff) and I believe that (unfortunately)
sepa·rate meetings are advisable. May we proceed and ask Patti to
start the process of scheduling.these meetings?
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
, SUBJECTffiTLE ·
RESTRICTION
001. memo
w/attach
Chris Jennings to Hillary Clinton
Re: Bipartisan Senators Meeting (54 pages)
4/29/93
P5
002. memo
w/attach
Chris Jennings to Hillary Clinton
Re: Tuesday Meeting with Congressman McDermott (5 pages)
4/28/93
P5
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Chris Jennings (Health Security Act)
ONBox Number: 23758
FOLDER TITLE:
HRC Memos-HSA [1]
Gary Foulk
fl28
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Freedom of Information Act -15 U.S.C. 552(b)J
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PS Release ·would disclose confidential advise between the President
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P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRAJ
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
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b(6) Release would constitute a clearly unwarranted invasion of
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b(8) Release would disclose information concerning the regulation of
financial institutions l(b)(8) of the FOIAI
b(9) Release would disclose geological or geophysical information
concerning wells l(b)(9) of the FOIAJ
PI
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C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
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RR. Document will be reviewed upon request.
�------------------------.
,. • •
,.
DETERMINED TO BE AN
ADMINISTRATIVE MARKIN~
INITIALS:./2_j. DATE: 8· 2 '·o~
'
-"1
It
I
I
I
J;.
. PERSONAL AND. CQNFIDBNT!&Ii MEMORANDUM
TO:
FR:
RE:
cc:.
.
I
April 29, 1993
Hillary Rodham Clinton
Chris Jennings
Bipartisan Senators Meeting
~~ Steve, Ira, Judy
.
I
\
Senator Mitchell and Senator Dole have extended invitations
to all their rank and file Members to attend tomorrow morning's
meeting with you, Ira, and Judy~ · The collection of Senators will
likely be diverse, but it remains unclear how many Members will
be iri attendance.
·
BACKGROUND
··Majority Leader Mitchell has asked that you start off at his
office about 5-10 minutes before the 9:00 start up time. The
Majority Leader-will then escort you to the Members meeting.
In the-front of the room will be a table for Senator
Mitchell, Senator Dole, you, Ira, and Judy. Similar to
Jamestown, Senator Mitchell will make a short introductory
statement. He will recognize Seriator Dole for a quick comment,
and then the floor will be yours. Senator Mitchell is expecting
you to g~ve a 10-15 minute presentation. He has suggested that
you stay .away from financing,· but focus more on the general
outline of the plan (see attachment 1) and the process by which
you envision it getting completed, introduced,· and passed.
.
.
Following your remarks, Senator Mitchell and Senator Dole
will call on their Members for questions, statements, etc. At
this point, you should feel free· to call on Ira and Judy to help
answer questions.
POINTS. TO HIT IN YOQR REMARKS
Although there a·n\lJnber. of.messages that.would be .wonderful
to convey in your pres~nta~ion, · fo_ur come iJI!lli~diately to mind':: .
.;
'
.
:~
.
'
.
··'·
n>· Health care Ttiis:Year. ·The President lu-id.you are rio less
:. ~, . · :_:>·
comroi tted tQ-;.;ij,.~ting. t1ealth care ·passed.) tlli,s year. . land we
be .wo:r;:~:~nQ; .g$Q~~tlY _wit~ ·the Democra_:ti~ ~pd. Republican
•i ·I :
· r.;C!!edership ..Of<;1P9th ij~uses . to d_etermine _
~rne :bes-r:.:ttm·etable · ·
:.:...'' . ., . for _·a.~~ur~pg:~·tn~~§-~i~l!rtcoine (the ·Panetta ·r~a.I:~si'. ha:o\i~:·: severely
.• . ':ot:ed.\.ic;ed· ex~e.e:·~~~~f~-~ )·;_
.
.
. . ~f:)',;'~'~-~~ ...
(:r:• ·· ·
~1,11·
· ··~·t:...;:.:- ·;. ·..:.
~a:l.~:.<:.~:
j:
Z·:. ..
�(
(2)
Bipartisan Issue. Health care is a bipartisan issue and we
intend to be ~penqing a great deal of time meeting with all
Members interested in achieving the President's goal of cost
. con.tainment and universal coverage. (The latest report is
that, despite the bipartisan Finance Committee meeting, the
.scheduled bipartisan Senate Labor and Human Resources
Committee meeting, and the scheduled Congressional
Republican Leadership meeting -~ see attachJilent 2 and its
list of meetings, the Republican Members still feel left out
of our process);
( 3) ·Uniquely American Plan. We believe we can learn from and
incorporate the best ideas of many Members into a workable,
uniquely American ·health c.e~.re reform proposal~ · ·(Few Members
have a good feel for what direction we are heading and it
might be somewhat comforting to cite examples of merging
principles of managed competition and ~ingle payer plans.)
(4)
Everyone is Held Accountable. Everyone will be held
accountable and to contribute to the new system. While we
w.ill ask businesses to contribute, employees will be asked
to do their fair share as well• Likewise, just as we will
ask insurers, pharmaceutical manufacturers, and other health
care providers to c~ntribute to this reform, we must require
that the Government be held accountable as.well. We can no
longer just cut reimbursement, without reducing the
·bureaucratic burdens we place on providers. Similarly, it
is high time we started to seriously address the medical
malpractice issue as well. (Republicans like to hear the
phrases: "no free loaders" and "individual·responsibility."
It is important for us to avoid the pe.rception that we will
be placing all the burdens on businesses; along these lines,
please try to avoid the word MANDATE.>
BACKGROUND MATERIALS
Attached for your review ·tonight is a ·list (attachment 3) of
all toe Senators and their .current placement on our health care
reform "whip" list. As you will note, we have 22 reliable votes
(all Democrats), 24 leaning yes votes (all Democrats), and 20
Members who are very achievable votes if we work them right (ten
Democrats and ten Republicans) for a total of 66 possible votes.
In addition, Steve Edelstein's War Room and I
to summarize the current health positions of every
lists (attachment 4) are divided into· a Democr~tic
list in .alphabetical· order. We hope you find this·
be useful.
have attempted
Senator. The
and Republican
information to
�------------·--·--------------------------------,
r
OVERVIEW OF HEALTH REFORM:
.I
ALL ·AMERICANS ARE GUARANTEED:
· •
COMPREHENSIVE BENEFITS .
•
.SECURITY AND PORTABILITY OF COVERAGE
•
•
CHOICE OF PLANS AND PROVIDERS·
HIGH QUALITY CARE
FEDERAL GOVERNMENT WILL:
•
•
DEFINE BENEFITS
DEVELOP QUALITY, ACCESS, INSURANCE STANDARDS
•
•
REFORM MALPRACTICE
ESTABLISH FRAMEWORK FOR STATE-RUN SYSTEMS
•
SET BUDGETS
STATES WILL:
•
SET UP ALIJANCE TO REPLACE FRAGMENTED INSURANCE
MARKET
• · GUARANTEE AFFORDABLE COVERAGE THROUGHOUT STATE .
•
ENFORCE QUALITY, ACCESS AND INSURANCE STANDARDS .
•
ENFORCE BUDGETS
HEALTH ALIJANCES WILL:
•
ENSURE AVAILABILITY OF VARIETY OF HEALTH PLANS
e
NEGOTIATE PREMIUMS WITH HEALTH P4NS
•
MANAGEENROLUMENT
PROVIDE CONSUMER EDUCATION AND PROTECTION
e
HEALTH PLANS WILL:
•
ACCEPT ALL APPLICANTS AT COMMUNITY RATE
e
PROVIDE GUARANTEED BENEFITS WITHIN AGREED-UPON
RATE
4-M-18 Bm~EAT · s ·
NrV~U~GED
waulli:a:Nuar
�.
ADDRESSING THE PROBLEMS: .THE WORK TEAM PROPOSALS ·
SOLtrriON
PROBLEM
LACK OF SECURITY
• ALL AMEmCANS ARE INSURED
• INSURANCE CANNOT BE DENIED OR TAKEN AWAY
REGARDLESS OF HEALTH STATUS
• BENEFITS AT A COMPARABLE LEVEL CONTINUE
REGARDLESS OF EMPLOYMENT OR INCOME STATUS
• ALL AMERICANS AND THEIR EMPLOYERS PAY INTO THE
-SYSTEM AT THE SAME RATE REGARDLESS OF THEIR·
HEALTH STATUS
· CONSUMER CONFUSION
• GREATER CHOicE OF PLANS FOR MANY AMERICANS ·
• ·SIMPLE UNDERSTANDABLE BENEFITS PACKAGE
• ONE COVERAGE PACKAGE FOR A FAMILY
I
'-
• NO COVERAGE BATI'LES AMONG INSURERS
• GUARANTEED ACCESS TO PLANS
e CONSUMER COMPLAINT MECHANISM IN PLANS AND
ALLIANCE
• SIMPLE REIMBURSEMENT AND CLAIMS"FORMS
• PUBLISHED QUALITY INFORMATION·
...... lllri'Bat.
IIII'IIL8IJID. Qll II - 6 ZUJr
·~·
�·
.
. ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS (CONT'D)
PROBLEM
SOLUTION
PROVIDER HASSLE
• STANDARD REIMBURSEMENT AND ENCOUNTER FORM
• SIMPLIFICATION OF REGULATIONS
..IDGH
ADMINISTRATIVE COSTS
.
• ELIMINATION.OF INSURANCE UNDERWRrriNG AND
MULTIPLE RISK PRODUCTS
• SIMPLIFICATION OF CLAIMS AND REIMBURSEMENT
-MOVE TOWARDS CAPITATED PAYMENT SYSTEMS
-SIMPLE UNIVERSAL CLAIMS AND REIMBURSEMENT
FORMS DRIVEN BY UNIVERSAL ENCOUNTER FORMS
• ELIMINATION OF DUAL COVERAGE AND COVERAGE .
· DETERMINATION PRAcriCES
• SIMPLIFICATION OF PRODUCI' REDUCES NEED FOR
AGENT TO ASSIST CONSUMERS
• REDUCI'ION IN COSTS OF SMALL GROUP .
ADMINISTRATION
·;~
• REDUCI'ION IN REGULATORY REQUIREMENTs -• FORM
FILLING
• REDUCTION IN MALPRACTICE PREMIUMS
e REDUCTION IN TIME SPENT BY PRoVIDERS AND
INSURERS INVESTIGATING OR DEBATING
· REIMBURSABILITY
6-IWI ai'IIU1' I
Nmi.8IJIDA<BS:_...,.
�---------
---------------------------------------:-----------------.
.
ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS (CONTD) :
PROBLEM
SOLU'I'ION
UNNECESSARY TESTS AND .
PROCEDURES
e· BUDGETED/CAPITATED SYSTEMS DISCOURAGE
UNNECESSARY trl'ILIZATION AND INTENSITY OF SERVICE
BY PROVIDERS
• GATEKEEPERS ON HMO& OR PPOs), SOME USE OF COPAYS
IN FEE FOR SERVICE PLANS AND PRICE COMPETITION ·WILL DISCOURAGE UNNECESSARY CONSUMER USAGE
• NATIONAL TECHNOLOGY ASSESSMENT AND BE'ITER
INFORMATION ON PRACTICE PATI'ERN DIFFERENCES AND
EFFECTIVENESS OF TREATMENT WILL ENHANCE COST
CONSCIOUSJHIGH QUALITY PRACTICE
• BUDGE'tED/CAPITATED SYSTEMS ENCOURAGE MORE
PRUDENT USE OF TECHNOLOGY AND MORE COST
EFFEcTIVE CAPITAL INVESTMENT
• MALPRACTICE REFORMS WILL Ct11' THE COSTS OF
MALPRACTICE INSURANCE AND DEFENSIVE MEDICINE -
UNDERSERVED POPULATIONS
• UNIVERSAL COVERAGE
• INCREASED INVESTMENTS IN INFRASTRUCl't.JRE IN
POOR URBAN AND RURAL AREAS AND IN PUBLIC HEALTH
• PREVEN'110N OF "RED LINING• OF HEAL111 ALLIANCES
• MSK ADJUSTMENT OF POOR POPULATIONS
• HEALTH ALUANCE RESPONSIBILITY FOR BUILDING
HEALTH NETWORKS WHERE NONE EXIST
..............
.........,aCLWil
IU.
..
..
�....
.·
..
ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS (CONTD)
. PROBLEM
SOLUTION
INADEQUATE LONG-TERM CARE
. • EXPANDED OPPORTUNITIES FOR HOME C~ AS ·
BEGINNING OF SOCIAL INSURANCE PLAN
e RAISING MEDICAID SPEND DOWN LIMITS
• INCENTIVES/REGULATION FOR PRIVATE INSURANCE
MARKET
.. ;I
.......... lllmiP.A,.
i .
l'lmUIIJID •ilOknzz 1 'llv
�HOW 1'HE NEW SYSTEM MAINTAINS WHAT
PEOPLE LIKE IN THE CURRENT SYSTEM
MAINTAIN NEGOTIATED BENEFITS
I • LARGE EMPWYERS AND EMPWYEES CAN MAINTAIN
THEIR CURRENT PLANS AS LONG AS THEY MEET
FEDERAL STANDARDS
-EMPLOYERS CAN CONTINUE TO PAY MORE GENEROUS
. PREMIUM SHARES AND COST-SHARING THAN
NATIONALLY GUARANTEED BENEFITS PACKAGE IN A
TAX SUBSIDIZED MANNER
MAINTAIN MGH QUALITY SYSTEM
I•
. ..
QUALITY OF SYSTEM WILL IMPROVE WITH BE'M'EK
PRACI'ICE GUIDELINE INFORMATION, QUALITY REPORT
CARD, CONSUMER SURVEYING
e QUALITY INFORMATION WILL BE MORE AVAILABLE TO
CONSUNmrnS
MAINTAIN CHOICE OF DOCTOR
•
..
.
DUI.IUD~ED
~
FEE FOR SERVICE NE'IWORK ALLOWS ALL
AMERICANS TO CHOOSE THEm DOCTORS AS THEY CAN
TODAY
.
• AVAILABILITY OF MULTIPLE PLANS OF DIFFEREN'l''.
TYPES ALLOWS CONSUMERS GREATER CHOICE OF TYPE
OF CARE THAN MANY HAVE TODAY
..............
P~mUJJ~DaeWWI
Etl
·-.:
.
�------------------.
t I
:·'1
:~ I
'MEETINGS WITH CONGRESSIONAL REPUBLICANS
From the onset of the.· Administration' s work ori the health
care reform proposal, the Health Care Task Force and its Work
Groups ~ave made a concerted effort to reach out to House· and
Senate Republicans for their g\.lidance and support. ~ We believe it
is essentiai to have their involvement to make.the· package as
strong as possible and to assure its prompt and necessary
passage. We are therefore concerned' that there is any perception
that the White_House, in any way, has not active~y sought the
advice and participation of Republicans from the beginning.
It is very important to note that the President.has insisted
on significant Republican involvement from the moment he
established the Health Care Task Force. On ·January 26th, he
requested that the House and Senate Democratic .and Republican
Leadership appoint representatives to the Task Force. Senator
Dole chose himself and Representative Michel appointed
Representative Dennis Hastert (R-IL) to serve on his behalf.
Since that time, Mrs. Clinton and/or Ira have attempted to
hold meetings on·a virtually weekly basis with House and Senate
Republicans and/or their staffs~ ·The House has choseri to send
its Members to the meetings, while the Senate Health Care Task
Force has chosen to send staff. The staff of the Senate
Republican Health Task Force has suggested that more active
Mem~er-level dis_cussions be delayed until there is a better sense
of what our final proposal will be.
Since.the President is now focusing and narrowing the
options for his proposal, we have begun an active-effort to hold
bipartisan meetings with House and senate ·Republicans. on April
20th, Mrs. Clinton participated in a bipartisan Finance-Committee
meeting. She will·hold a similar bipartisan·meeting with the
Senate Labor and Human Resources Committee on.May 4th. In
.
addition;. the President and. the First Lady have already scheduled
a meeting with the Republican Congressional Leadership on May 6th
to commence serious Presidential-level discussions.
.
Attached is a list of the numerous meetings that Mrs.
Clinton, Ira Magaziner, Judy Feder and their designees have held
with Senate Republicans. I. hope you will find this information
to be helfpul.
·
�..
..
DATE
MEMBER(S)
METWI1'H
2/4
DOLEJCHAFEE
HRC/ICM/JF ·
SUBJECT
· process, general
discussion
2/23
DURENBERGER
HRC/ICM
3/10
Senate Republican Members
HRC
Bond
Burns
general discussions
about process and
about directions
for/components of
reform
;·.
Chafee
Cohen
Craig
Danforth
Dole
Durenberger
.Gregg
Kassebaum
Mack
Murkowski
Nichols
Packwood
ROth
Simpson
Stevena
Thurmond
(others were present as well)
3/10
JEFFORDS
ICM·
3/11
KASSEBAUM
(as part of Women Senators
meeting)
HRC
Health· Reform
Issues of special ·
interest to women
I
3/12
Senate Republican Staff
ICM
3/23
Senate Republican Staff
Walter Zellman
Rick Kronick
Lois Quam
New System
Development
Governance
4/1
Senate Republican Staff
ICM
sho~-term
controls
Sheila Burke
Christy Ferguson
Ed Mihulski
4/19
Senate Republican staff
Gary Claxton
Insuranc.e Reform
4/20
DURENBERGER
ICM
Overall Reform
�,.
.
-~
•
Senate Finance Commitee:. bi-:
partisan meeting
4120
Overall reform, costs,
finanCing ·
HRC/ICM, JF
..
Chafee
Packwood
Danforth
.,
Roth
Grassley
Hatch
Wallop
st8fr
4129
Senate Republican
4130
Rural Health Care
Lois Quam
Entire Senate (including
Republicans)
HRC, ICM,JF
'
.
~
'.
s}'-f \
\
.•
..
~-.
..S QJ\Q,~ Labar J. fl"'"tl3N
~ucl.4f'UI ~hlr~ea
(_~,~+ifol\ ~Q;-1\~
I
Ov~H
Hec.)~\
'f..AA~
:r-r-
""':"',
sl.ec
.
we..)~~
.r£J\•~
,.J.. ~<.
f~~~~ Le.arl~rtNf
0.
sd-1-"'1 ri-
.
.
~~(P.-
~1\J\oolt...-tfo 11
-1
'
I
.
,
..
.
�.......- - - - - - - - - - · - - - - - - - - - - - - - - - - - - - - . _ . . , . . . - - - - - - - - , - - - - - - - - - - - .
SENATORS' CURRENT STATUS·
RELIABLE
.
NEED WORK
LEAN YES
~
Bldea
Boxer:
Bradley
~aachle
·Baucas
4/29/93
:~NO
NO
Shelby
Sennett
Blagamaa
Brown·
Coats
Breaux
Boiea
Bums··
Cochlun
Fe1Dgold
Bryan
DeCoaciDl
D~
Coverd~il
Fe!DateiD
Bump en
Exoa
Dole
Crcug
Harkin
Byrd
Hc111D.
Domentcl
Dole
JolmstOD
Gorton
Faircloth·
IDouye
. campbell
KeDDedy
CoDiad
Krueger
Grassley
Gramm
Leahy
Dodd
NUDD
Hatch
Gregg
Mikulski
~organ
Reid
Lugar
Helms
Mitchell
Ford
Bond
Pressler
Kempthome
MoseleyBraun
Glenn
Chafee.
Roth
Lott
Murray
Graham
Cohen
Specter
McCain
Pell
HolllDgs .
Do.r;lforth
McConnell
'·
Pryor
Kerrey
l)urenberger
MurkDwsld·
Riegle
Kerry
HalflSld ·
Nickles
Kohl
Jefford
Stmpson
Sarbanea
Lautenberg
Ko.sselKWm
Smith
Saaser
Levin
Mack
Steuens
Simon
Lleberma.D
.POckwood
Thurmond·
WeUatoae·
Mathen
WoU'ord
Metzeabaum
Rockefell~r
'
I.
Wallop.·.
Warner
\
MoyaJha.D.
'
Robb
Democrats 22
Demo~rata 24
Repu.bltco.ns 0
TOTAL 22
\
o
Democrats 10
Democrats 1
Democrats
·Republicans 0
Republicans l 0 ·
Republtco.ns 12
Republicans 21
TOTAL 24
TOTAL 20
TOTAL 13
TOTAL 21
�.------------------------
--
-------------------------------------------------.
"'!.....
PROFILES - SENATE DEMOCRATS
·April 29, 1993
SENATOR DANIEL AKAKA (D-HI}- State flexibility iS of primary importance to
Senator Akaka~ He wants a waiver to allow Hawaii to continue its present employer-based
system. He was cosponsor of Senator MitchelPs "Health,America" plan in the last Congress,
but is open to virtually any approach that achieves cost cOntainment. and universal access, as
long as it provides for signifi~t state flexibility .
a
..
Recent Developments: Hawaii is moving to press the House and Senate Comm~ttees to ·
obtain ERISA waiver as soon as possible even if that means before health care reform is
passed. Senator Akaka can be expected· to support this effort.
SENATOR MAX BAUCUS (D-MT)- Senator Baucus was a member of the Pepper
Commission. Most notably, however, he voted against the final access recommendations ~
they won by just an 8-7 vote-- primanly because ofhis concern about.the proposal's jmpaci
on small business. Baucus is .concerned about any proposal that utilizes any employer
requirement to help finance health care. As a. result of this concern, and because the
Canadian system is quite popular in Montana, he. is· a single· payer advocate.
He is a member of a 5-Member working group (Daschle, Kerrey, Bingaman, and Wofford)
that is looking at alternatives to employer.;. based models. This group wrote t.o. the First Lady
on February 3rd outlining principles which should be incorporated into a managed
competition framework including universal participation (no opt~outs), state or regional
administration, and phase-in of coverage for long-term care. More recently, on March 30, he
.sent a letter with eight Democratic SenatorS from rural states· stating their position that the
·allocation of }Jealth budgets amongstates should not be baSed' on historiCal costs but on the
true cost of providing an appropriate level of care to a state's residents.
Senator Baucus beli.eves health care reform must' include real eost CQntainment, sensitivity to
legitimate small business concerns, and special. consideration for rural concerns. We have
been advised· by staff that he is very committed to the concept of every citizen being in the
· HIPC or health alliance. In addition, because it is more broad-based than 'an employer
mandate, he apparently would~ supportive of a VAT tax for health care.
·· ·
Recent Developments: At the Aprll 20 meeting with .finance COmmittee members, Senator
Baucus stressed the need for the plan to oontain costs with some sort of global budget. He
shared the view of other committee members that the Administration should take longer if ·
· necessary, but make sure health reform is done right. At Jamesto\YD; he reiterated his view
on the need for strong cost containment and a global budget. He also wanted to know the
. administrative savings which would reduce the need for taxes. Senator Bauc\Js also stated
that he thought the First Lady was the best salesperson for health care reform.
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SENATOR JOE BIDEN (D~DE) . ;_ Senator Joseph Biden is the Chairman of the Judiciary
Committee.· This position will become increasingly important ·as the President sends to the
Hill a choice for the vacant seat on the Supreme Court. Confirmatio·n hearings might tie up
Senator Biden's time this summer. For the health care debate,. however; Biden bas been
relatively quiet. He bas said. in the past that be is still learning the i5sue. One key will be
·the DuPont Corp., which is pushing national health insurance. Biden has said that he does
not favor single payer and is concerned that play-or-pay could lead to rationing. He is noncommittal but skeptical on managed cOmpetition and is especially concerned about HMOS.
· His committee will be responsible for marking-up the portions of ~he reform package dealing
with malpractice or tort reform. In addition, any modifications to or clarifications of the
·anti-trust 'laws come under his jurisdiction as·well.
SENATOR JEFF BINGAMAN (D-NM)- Senator Bingaman joined the Labo·r and Human
Resources Committee in May of 1990. While he does not have a long record on the issue of
health care reform, he has been exhibiting increasing interest in the subject. He supports the
managed competition model's focus on market adjustment of health care costs but has also
supported an eventual cap on health care spending. He has cosponsored legislation with
Senator Durenberger to implement the Jackson Hole group re1=ommendations - a managed
competition model which rejects global budgets. However, in hearings last December of the
Labor Committee, Bingaman expressed strong support for the idea of a global budget to
"limit the amount of revenue going into the system, limit the amount of premiums that people
can pay into the HPICs." He is astrong advocate of rural health and prevention. He bas
exp~essed concern about the effects that employer.:..based health care reform could have on
small businesses.
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Recent Developments: Reportedly, Senator Bingaman was unhappy over our language
change from "HIPC" to "Alliance." He feels "cooperativ~" are ruralfriendly. At
Jamestown, Bingaman raised concerns about small business. He felt that a· payroll
contribution of 7 to 8 % ·was too high. In his view, we should lead with cost containment
and make sure small businesses are protected.
·
SENATOR DAVID BOREN (D...;QK)- Although not generally thought of as a health care
reform leader, Senator Boren is the lead sponsor of the Senate companion (S. 3299) to the
· House Conservative Democratic Forum's managed competition bill. In recent months,
however, he has become more sensitive to the inability of the Conservative Democratic
Forum's approach to adequately address the access or cost containment challenge. Uke
virtually every member of the Committee, he considers himself to be a strong supporter of
rural health and small business issues. With Senator Bradley, though, Boren has been
traditionally more focused on tax policy than health care~
There have been exceptions to the rule of Senator Boren's general non-interest/association
with health care .. In addition to the CDF bill, he is now supporting the ~oncept of significant
2
�state flexibility' within the,context of any health reform proposal (Oklahoma Governor Walters
is pushing a· major initiative now and wants some significant assistance/relief from the Federal
Government). In additiQit, Boren sponsored legislation last year to provide for an extension
of bi'gher pa:Yments to rural hpspitals· that disproportionately serve Medicare patien~. {lbis ·
legislation passed the Congress, but was included in the tax bill which was vetoed by thenPreSident Bush.)
Recent Developments: · On April 28,' his staff called saying Senator Boren was concerned
that the premium payroll approach sounded too much like a pay or play plait. He hates this
.concept. Chris Jennings assured staff that nothing could be further from the truth~ but he inay
need more copvincing.
·
SENATOR BARBARA BOXER ·(D-CA) - As a new member of the Senate, Senator Boxer
is very interested in working with the leadership. While in the House,' she cosponsored the
Russo single payer bill. (predecessor to the et.iirent McDermott Bill) but WaS not an enthusiast.
She is particularly interested ·in issues concerning women .and children. Senator Boxer
believes that health care reform sho!Jld cover reproductive services, including abortion
services.
Boxer outlined her basic approach to health care reform· in a letter to the. First Lady on
February S. In the letter, the Senator emphasized the following principles: care should be .
affordable and universal; benefits should not be based only on employment; and coverage
should include professionals other than doctors. To achieve these goals, the Senator called
.for a minimum benefits package, increased preventative care, coverage of reproduc.tive
services, increased public health education; serVices for women in ciisis, and _services for
children.· Finally, the Senator called for "full representation" for women on any ~cuds,
advisory committees or any other bodies-created by health reform le~slation.
In meetings with the HCI'F, she has also expressed concerns over how .the Veterans Health
System will be integrated into the plan.
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Recent Developments: At the Jamestown retreat, she h~ strongly. urged that abortion
services be covered up front in the benefit package and protected from any hostile ame_ndment
on the Senate floor. She also raised the -possibility of sin taxes being eaimarked for children.
SENATOR. BILL BRADLEY (D-NJ)- Senator Bradley is known more for his work on tax
policy than for his work ·o11 health care financing. He has indicated an interest in introducing .
health care reform legislation similar to the managed competition model that he believes .the
President has been advocating .. The one exception to his general support of the Clinton health
care approach may well be with regard to prescription drugs. As a Senator representing·-the
state which is the capital· of the pharmaceutical. industry, Bradley. i$ .a fierce adyocate for the
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�. industry and their concerns. With Senator Hatch, .he led the fight. against Senator PrYor's
effort to influence the industry to control price increases by ·linking their pricing behavior to
eligibility for tax credits. (The Pryor proposal was endorsed by the President during the
campaign.)
As a member of the Infant Mortality ·eommission, Senator Bradley is proud of his work
to
ensure that the Medicaid program was expanded to eventually cover pregnant women and
children. He also is a strong advocate· for preventatlve care services. He has sponsored
several bills on tobacco, including revised warning lal?els and tobacco as a drug to .be
included in the Dnig Free Schools program. Lastly, although he incurred the Wrath of some. ·.
aging groups with his opposition t9 prescription drug price constraints,· he has been a longtime supporter of home and community:-based long term car~ .services, particularly with
regard to respite care services.
.Recent D'eyelopments: At this week's Finance Committee meeting, Senator Bradley asked
for an estimate of how much the plan is going to cost and how much revenue is expected to
be needed. · He is very concerned about taxes and is a great advocate of going slow on this
issue. "It is more important to get it right."
SENATOR JOHN BREAUX (D-LA)- Senator Breaux is the second. most junior Member
of the Finan~ Committee. He is one of those up and coming "New Democrats" for whoin
· many see a bright future. His politics are moderate to conservative. bu~ he is knoWD more as
a pragmatist than a idealogue. In the area of health care, Breaux is yet another of the
Committee members who care d~eply about small businesses and rural health care.
Prior to this year; Senator Breaux was not ove~ly active in· health care issues. That changed
when he introduced the Conservative Democratic Forum's managed competition bill with
.
Senator Boren in 1992, He is very concerned; however, about' the bill's limitations with
regard to assuring adequate access· to health care in rural areaS. He is also concerned about .
whether this -approach will actually achieve broad-based cost savings. · .Despite this, he
remains uncomfortable with the alternatives and he will warit to make sure thai the
Conservative Democratic Forum's model is used as much as possible during the upcoming
debate. He opposes price caps arid freezes to control co~ts.
· Recent Developments: At. the Finance Committee meeting on April 20, Senator Breaux
stated that he was very· encouraged· about what he was hearing. He believes people· want
health care reform but it will be important to sell the benefits first (and sell people on what
they are getting). He. wants the plan to be bipartisan and thinks it should contain malpractice
reform. This .week he has made very positive public comments about the prospects for health
care reform and praised the consultative process with ·bOth Democrats and Republicans. In
addition, he invited· Ira Magaziner to join him and the Piesident at the Democratic Leadership
Conference meeting in New Orleans. (It is now unclear whether he will attend.)
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SENATOR RICHAim BRYAN'(D-NV) -.Senator Bryan is a former governor of Nevada
who was to fill the seat of retiring Senator Paul Laxalt. Not very vocal on health issues,
Bryan has significant small business and .rural concerns. He probably will be hesitant to
support a bill that at least some small businesses will not· support. He baS not taken. a
position on a particular plan, but he does not think single payer will work and is unsure about
managed competition's applicability to rural areas .. Senator ·Bryan has publicly supported
· ·Senator Pryor's prescription drug legislation and supparts insurance ·reform. Raising taxes
might frigbten him, and he does not think we need immediate access. He is up. for reelection in 1994.
SENATOR DALE BUMPERS (D-AR)- Senator Bumpers has waited to see ~hat the
White House will do and has resisted efforts to be pushed into Daschle's camp. As Chairman
of the Small Business Committee, Bumpers has a particular sensitivity to the needs o_f small
business.. He could well be an important surrogate speaker in his position as Committee ·
Chairman, especially if he not only suppo~s the bill but is comfortable enough to positively
talk it up. He .is known for his great concern about children's issues. He therefore can be
expected to support phasing-in coverage for children first, if such a J>haSe-in is necessary.
SENATOR ROBERT BYRD (D-WV) - Senator Byrd is one of the most senior members of
the Sen.ate and a former Majority (and Minority) Leader. As you know, Senator Byrd
publicly announced his intention to oppose the use of reconciliation ·to pass the IicrF bill.
. Senator Byrd mostly has funding concerns, especially. any specific directions. for the
Appropriations Committee on funding that might be inCluded· in a health care reform bill. He
is also concerned about jurisdiction, particularly ·if health care financing might "take over".
some discretionary programs. He ,generally puts his energies into "infrastructure." Byrd has
specifically mentioned possible redundant financing received by community health centers for
various health
s.ervices. ·He has no preference on the overall approach, and he· will likely
defer to Senator Rockefeller on this. Byrd has a "wait and see" approach with the·
Administration and will want to look at the whole package.
care
SENATOR BEN NIGHTHORSE CAMPBELL (D-CO).- Senator Campbell is.the only
member of the Senate· who is of Native American descent. He is. on· record in support of
managed competition, but has not taken a position on the Administration's deliberations. He
is, however, comfortable with the process. ·Senator Campbell has a special concern with the
Indian Health Service and will probably keep his eye out for any changes ..
.SENATOR KENT CONRAD (D-ND) ~Senator Conrad is the newest member of the
Senate Finance Committee. He is known as a "budget hawk.,; Strong cost controls will bC
critical for his support. He will look closely at the financing package and how the reform
· plan impacts the federal deficit. He opposes large new taxes to support reform.
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Senator Conrad's foremost health concern is rural health care. He is concerned both with how
. rural health care will be addressed in the Context of managed competition as well as_current
access and delivery issues. He is aware· of two successful models from his state - one, a
network of clinics, the other an HMO - which have been able to increase a~ss to primary
and preventive care. He signed the March 30 letter opposing the allocation of the global
budget among states based on historic costs. He is also·an advocate for the need to improve
and increase funding for the Indian Health Sc;rvice, where insufficient funding has led to
rationing of services. He also feels the lliS has not been sufficiently responsive to CongreSs
·or ·tribal leadership.
Recently, Chris Jennings and Christine Heenan gave him a general health c;:u-e background
briefing. (He had missed one given· by Ira and wanted a private meeting.) He was very
appreciative and, by the conclusion of the discussion, .appeared to feel much better about the ·
· direction in which the President and the First Lady are heading.
Recent Developments: At the Finance Committee Meeting this week Senator Conrad was '
very concerned about mandates._ He feat:& that small businesses will be saddled with too large
a burden. He advocated simple, understandable language and provisions that he could explain
to his largely rural constituents~ ·
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. SENATOR TOM DASCHLE (0-SD) -·senator Das.chle is the Co-Chair of the
Democratic Policy Committee (with Majority Leader Mitchell) and he is one of the more
well-informed Democratic memberS on health care issues. ·Senator Daschle and his staff are
participati.ng in Senator Mitchell's DPC working group, bui. he has also been a_ leader of a
separate working group (Keriey, Bingaman, Wofford, and Baueus) that was developing
alternative approaches to health care reform .. This group has been relatively quiet lately,
seeming to be comfortable working with and through the DPC health policy group.
Personally, Senator Daschle is much more comfortable with a single payer type approach to
health care, primarily because he believes it is a much easier political sell to his small
business folks· and the rest· of his constituents. He joined Senator Wofford in introducing
legislation (S.2513) ·to achi~ve this end. Daschle is a team phlyer, however. As part of the
Senate leadership, he can be counted on to push his agenda as far as it can go, but he will
also do everything he can to assure that we paSS compre~ensive reform and the President's
plan.
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In addition, Daschle is one of the signatories of a March 30 letter opposing the allocation of
the global budget among states based on historic costs. He is very concerned that rural states
would be discriininated against if such a formula were u~:
Senator paschle also worries _that people· do not understand the real costs of the current health
system - how much they are paying in di~ct and indirect spending. He raised this point in
· an op ed piece which appeared in the Washington Post this paSt t-1onday (April 24). He ·
6
�believes education regarding these costs is critical to insure that people don't feel the new
~ystem ·will Cf?St them too much money. Dasc~e also supports rest~cturing· grac:luate ·medical
education to emphasize primary care.
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Most recently, Senator Daschle requested that the First ~dy join him in South Dakota at a
health care event in June, July ot August., In addition, he asked that we send someone to a
health ev~nt in early May. :The Daschle office seems pleased that we are sending Working
Group Member, Lois Quan, to th~t event.
Recent Developments: At the meeting with the· Finan~ Committee members last week, he
again expressed his belief that we need to use new language in dCscrlbing the plan, for
example, using "system-wide" rather than· "Federal program". ·He believes that changing the
language will change people's perceptions.
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SENATOR Df:NNIS DECONCINI (D-AZ)-. Senator DeConcini, who is up for re-election
iD 1994 and recently separated from his wife, 'is opposed to new taxes paying for the health
care package~ While he is willing to work with the ~ncept of managed competition, he
wants to preserve some of the current system. He is particularly concerned about the effects
on small business and incentives for doctors to treat Medicaid patients. While he has not
raised it so far, he will presumably also be worried about undocumented .workers and Native
Amerlcans.
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Recent Developments: At the Jamestown Senate Retreat·, Senator Deconcini stated that he.
opposes including abortion in the benefit package and that, if it is included, a way must be
determined to separate out ·public financing.
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SENATOR CHRISTOPHER'DODD (D-C'I)- Senator Dodd chairs the Labor. and Human
Resources Subcommitt'e.e on Children, Families,· Alcohol and. Drugs. He has been one of the
chief architects of the· Act for Better Child ·Care and the Family and Medical !,.eave Act. He
has also championed full funding for Head Start and expansion of childhood immunization
programs. On health care reform, Dodd is keeping an open mind and is inclined to wait for
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ln the last Congress he cosponsored Senator Bentsen's health care reform legislation.
However, despite his. close friendship with Senator Keimedy, he did not cosponsor the "pay 'or
play" plan put forth as a Democratic leaderShip propgsal~ This may be attributable to the fact
that Conriecticut is the insurance capital of America with many large and midsize 'insurers
based there.. Connec~icut also is home t() many drug manufaCturers and he concerned that ·
they will be hit too hatd under. cost control proposals.. He notes that this is the only industry
in his state to have an increase in jobs over the last five years .. He is supportive of the.
Pharmaceutical Manufacturers Association's proposal to negotiate price. reductions with the
Administration.
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SENATOR BYRON DORGAN (D-ND))- Senator Dorgan can be:expected to back the
package as long as careful attention is given to the. problems of rural areas. In addition to
rural health care, his major concern is cost containment. He can also be expected to watch
out for coverage for Native_ Americans. Although his freshman status might not be influential
in the senate, Dorgan still has wide respect in the House where- be was a member of the
Ways and Means Committee.
SENATOR JAMES EXON (D-NE)- While Senator Exon has put forth a wait-and-see
attitude, he advocated "doing it this year" to Ira on March 4. -He consults closely with Frank
Barrett, chair of the Governor of Nebraska's Blue Ribbon Pan·el on Health Care. His
Nebraska colleague, Senator Kerrey, can influence him but KeiTey's support will not
guarantee Exon's.
Recent Developments: At the Senate retreat, Senator Exon asked if the program could be
funded by sin taxes alone and how VA and Indian Health facilities would be treated under
reform. He also wondered whether supplementary insurance would be available. He praised
the First Lady's explanation of how ·health care reform would work in the states, stressing· that
she had made his work easier.
SENATOR RUSSELL FEINGOLD (D-WD- Freshman Senator Feingold has also adopted
a wait-and-see attitude but is likely to support the President. In meetings· with the HCTF he
has discussed the need for long term health !care, particularly home and community baSed care
for the elderly and the disabled. Feingold is also· concerned abut coverage for farmers. At the
state level he was a sponsor of single payer legislation in Wisconsin.
SENATOR DIANNE FEINSTEIN (D-CA) -Just two-years after an unsuccessful run for
Governor, Feinstein was elected to· serve out the final two years of the Senate seat vacated by
Pete Wilson. Senator Feinstein focused her campaign on the economy and health care
reform, but, in an effort to overcome a reputation of weakness on women's issues, she also
raised issues like abortion rights, sexual harassment, equal pay, child care and breast cancer
·research.
Senator Feinstein has been very open to the proposals of the Health Care Task Force, but has
raised cOncerns that not enough attention is being foc1:1sed on women's heal_th issues. She
would like to ensure that reproductive rights are covered and that women are included in NIH
and FDA research.
Senator Feinstein is also very interested in cost containment mechanisms. · While she supports
strong upfront cost conta~ment, she questions whether the capping of costs wili work to
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control costs and has concerns regarding the impact of wage and price controls. As such, she
also strongly supports 'medical malpractice ·reform. The daughter of a physician, Feinstein
wants to ensure choice of doctors. She would also like to see the benefit package emphasize
prevention and primacy care. As a former mayor who lived through the crisis ofa hospital
strike, Senator Feinstein is concerned that spending limits would create a backlash from labor.
Finally, she is very concerned that enough attention and..financial resources go to the fight
against AIDS. ·
SENATOR WENDELL FORD (D-1\.Y) -Senator Ford, the Chairinan.o{ the Rules
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Committee and the Majority Whip, will want to support the President. During his reeleCtion ·
campaign this year he talked about wanting to work with a president who would sign health
care legishltiori passed by the Congress, but he is also a fierce protector of th.e interests of
state.· As he says, "if it is.not good for Kentucky,
not .for it." As a result Ford can be
expected to fight a tobacco tax. He is also nervous about mand.ated benefits and wants ·
freedom of choice for consumers .. He also has a personal i~terest in health care since his
brother-in-law is a pediatrician in Kentucky.
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Senator Ford oppposes giving states too much flexibility, ostensibly because some may not be
prepared for the responsibility. But more likely; it comes down to p(>litics. Kentucky's
Governor, Brereton Jones, has been working on his own sta_te reform plan. Unlike other
Congressional delegations which are promoting their state's reform efforts, Ford may be
looking to undercut Jones as a political payback. In 1991, Jones,. then the U. Governor,
.scared Ford out of the Democratic primary for Governor with his large war chest and by
commenting that the Governorship of Kentucky was a full-time job~ nor an interim step to
retirement. Democratic politics in Kentucky is a blood sport and the Governor's office is th~
most coveted prize. Senator Ford, a participant of longstanaing, Certainly has not forgotten ..
Recent Developments: At the . retreat in JamestoWn Senator Ford noted that his state
produces coal, liquor, and tobacco and that the Administration has .been hitting all of these·
iridustri.es and will continue to do so. ·He expressed a willingness to take the hit on sin taxes,
but needs a quid pro quo (something for his 95,000 farmers). Interestingly, he would like a
meeting with the First Lady to negotiate. ·
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�SENATOR JOHN GLENN (D-OH)- Senator Glenn has held heariilgs on the German and
French systems as models for health. care reform. He suppOrted pay or play but not the
Leadership's HealthAmerica bill. His· concerns include the impact of reform on small
business, retiree health benefits, and potential changes to Medicare and Medicaid. ·
In a previous meeting with the DPC, Glenn questioned where the savings would come from
in the new system. He ~hinks that doctors have been unfairly vilified in debates over health
care costs. He says that their .income a~unts for 1~ than one-fifth of health care Spending.
He is more intrigued by the large percentage of lifetime health care costs which occtir during
the last four months of life as an area for health savings.
As Chairman of the Government Affairs Committee, Glenn is likely to be interested in and
actively involved with any proposal that would fold the Federal Employees Health Benefit
Plan into the new system. Since advocates for federal employees ~e riow asking thatthey be
treated the same as other large employers, they are likely to express serious reservations about
the currently envisioned p~ogram .. It is therefore advisable to meet with Senator Glenn and
.other chairmen of jurisdiction before any decision is made public.
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SENATOR BOB GRAHAM (D-FL)- Senator Graham wants to support the President and,
not surprisingly, is most concerned about long term care oeing.included in the final package.
With F1orida recently enacting health care legislation, he may be sensitive about state
flexibility. He is supportive of employer mandates and wants ~o be a player on global
budgets.· However, ·he would be concemea if F1orida were somehow advers'ely affected in
comparis~n t~ other states. His staff is working on the White House Long Term Care.
Working Group.· In previous meetings with the HctF, he was worried about the role of the
PUblic Health System.
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SENATOR TOM HARKIN (D-IA) - Sen!ltor Harkin has not sponsored any reform
legislation or backed any particular refomi. approach. He has focused i~stead on specific
issues that will need to be components of an overall .Plan .. He has a strong interest in ·all rural
issues. He was recently named Co-Chair ofthe Se.nate Rural Health Care Coalition. ·Harkin
is a. leading advocate in the Senate for. anything related' to people with disabilities. (He has
brother who is deaf.) His sponsorship of the Americans with Disabilities Act is perhaps· the
major achievement. of his politica't career.: Ensuring that the plan provides access to health:
care, including long term care for people with disabilities, is a major concern.
a
Senator Harkin is especially interested in prevention; he sponsored a bill giving money to
states for preventi~e health programs. As a member of the I...abor Committee and Chairman ·
of its. Appropriations Subcommittc;e on Human Resources, he is a.key player on public health
legislation and funding. Inclusion of preventive services in the benefit package will be key as
· Senator Harkin opposes co-pays for these ·services.
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�SENATOR HOWELL HEFLIN (D-AL)- Senator Heflin has been noncommittal,
preferring to wait for the plan and concrete numbers on how and where the money is spent
before taking a position.. He appears to be open to the concept of reform but will need
education on the issue.
Recent Developments: Senator Heflin expressed concern about how health care reform
would be financed.· He likely will also have strong reservations about medical malpractice
·reform if it includes caps..
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SENATOR ERNEST HOLUNGS (D-SC)- While Senator Hollings wants to support the
President's plan, he· is worried -about· employer mandates without cost controls and rural
coverage. He is also concerned by the CBO testimony which stated when cost savings might
be realized under a managed competition plan. He steered clear of the h:adership bill,
expressing interest instead for a Medicaid buy-in. He believes the only way to get enough
money for health care reform is through a VAT. In meetings with Ira he has stated his hope
. that the money will be in hand when the bill is ready and his support. for a single vot.e on the
package.
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SENATOR DANIEL INOUYE (D-HJ)- According to Senator Rockefeller, Senator Inouye
is expected to be supportive of the President's plan. ·Specifieally, the Senator will want to
continue the special exemption to retain· Hawaii's current system. He is working with Senator
Akaka to secure a waiver through the House and Senate Committees.· He was a cosponsor of
. HealthAmerica in the last Congress, and he is a· current cosponsor of Senator Wellstone's
single payer bill. Senator Inouye is also Co-Chair of the Senate Committee on Indian Affairs
and may be watchful of changes to IHS.
SENATOR BENNETT JOHNSTON (D-LA) - Senator Johnston has been noneommittal on .
health reform but wants to be a constructive. player .. He may defer to his Louisianan
colleague, Senator Breaux, who has shown increasing interest in health care reform. They
share concerns on its impact on. small business and rural areas. Johnston's major concern is
preventive care and he will be Willing to compromise on other iss·ues if this is made a high
priority in the package. While he is not opposed to managed competition he sees proble~s
with regional pricing.· In discussions ~ith the HCfF in the past, he has asked whether
everyone will be in the purchasing cooperative and whether doctors will be able to charge
higher fees out~ide of the package. Johnston is also concerned with the financing of the
health care package.
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SENATOR EDWARD KENNEDY (D-MA)- Senator Ke~nedy, Chairman of the Labor and
Human. Resources Committee, is the Senator most closely associated. with health care issues.
He has been working on comprehensive health care reform issues for well over two decades.
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�Although previously a strong single payer advocate, in recent years, Kennedy has moved to
employer-based approaches;· He believes that using business to signifi~tly undetwrite the
cost of health· care reform will substantially reduce the need for. federal. tax increases, and
therefore make the package more sellable to.both the Congress and tbe_American public.
He joined with Majority Leader Mitchell, Senator Rockefeller and Senator Riegle in
introducing a play or pay employer-based health care model. . Despite the backing of these
Democratic leaders, it received surprisingly li~tle rank-alld-file support. ·Perhaps as a result
of this, Senator Kennedy has come to believe that only· a plan backed by the President can be
enacted. For this reason, Kennedy will likely be open to any comprehensive reform approach
that mee~s the criteria of univ~rsal coverage, east c6ntainrnent, ai,1d quality assurance.
He is also concerned about coverage for long term care. He introduced a substantial and
expensive ($45 billion a year when fully phased-in) long term· care plan with Senator"
Mitchell. This also garnered little support. Alternatively, he worked with Senators Pryor,
·Hatch, Packwood and Bentsen to pass .a long term care insurance standards bill. That attempt
was blocked because it did not include the tax clarifications that the insurance industry
sought.
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In addition to all these reform efforts, Senator Kennedy has been extremely active in the
public health service areas. His interests are broad ranging, i~clu~ing concerns about tobacco
advertising, adequate funding of AIDS research and. services, Head Start, extensive oversight
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of FDA, effective illicit drug strategy, and minority health.
·Recent Deyelopments: Most recently, Kennedy has been pressing for primary or sole
jurisdiction over Health Care Reform. Howard, Steve and Chris met with Labor Committee
Staff Director Nick Littlefield last week. At that meeting ~e was informed that we
appreciated their suggesiions but would d~fer to the Majority Leader on this highly · · ·
controversial issue. The Committee has also agreed to hold hearings that are consistent with
our message in early to mid-May. Specifically, they will focus on the coSt of not doing
health care reform and the cost effectiveness of mental health coverage in the benefit package
(Mrs. Gore is scheduled to testify.). Lastly, Senator Kennedy will want to be significantly
consulted in the upcoming weeks .. He had requested, and we have scheduled, a bipartisan
meeting for the First Lady with his committee for Tuesday, May 4. ·
SENATOR BOB KERREY (O-NE) -Senator Kerrey ha.S displayed a keen interest in the'
area of health care reform since first coming to the Senate. In his first year, he sat in on
deliberations of t.he· Pepper Commission although he was not a member. ·He also made health
reform one of the centerpieces of his presidential bid.
'In the last Congress, he introduced a comprehensive health reform bill which is. actu~lly _quite
similar to the framework being developed by the Task Force .. In the Kerrey bill, however,
except all businesses would be required to join state-run purchasing groups rather than
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privately-run groups. .At his last meeting with the First Lady on March 18, he· was very
complimentary about Ira's presentation at the March 4 .briefing for .the ·DemOcratic Senators.
In a note to Senator Rockefeller, Kerrey wrote that he "likes what he is hearing out of the
White House. n . . .
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He has made· financing a primary .focus·and advOcates creating a J,Jeaith care trust' fund- run on
a pay as. you, go basis. Sources of financi~g for his bill include: . a payroll tax on employers
and employees; current federal health spending except for Veterans (for whom he believes a
separate system must be maintained); new taxes on cigarettes and liquor, taxes on Social
Security benefits; and increaSing income subject to tax as well increasing the top rate. At .
hi~ last meeting with the First Lady he expressed interest in providing language to help sell
· th~ plan.
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Recent Developments: -·Senator Kerrey has recently circulated a proposal in the Senate to
: create a trust fund which would account for all health expenditures including the Federal .
Employee Health Benefit Package and .NIH. He suggests· proposing appropriate ta:Xes
designated for health care re'fQrm before the introduction of a comprehensive plan;
SENATOR. ~O~N KERRY (D-MA) :.. Sen'!otor Kerry has represented 'Massachusetts since
1984. He is Qest known for his involvement with the POW/MIA issue. While not a major
player on health policy in the Senate, Kerry does have some significant health views. He
favors a managed competition ·approach to reform and wants to support the President.
Administrative simplification and insurance r.eform are of particular interest to him. ·Kerry
wants to protectthe biomedical and biotechnology' industry, which is a growth sector in .
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Massachusetts. Senator Kc:rry is a Vietnam veteran and may be sensitive to major changes in
the VA. He warns that expectations are· high and urges regular ~eetings with Senators.
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. Recent Developments: In Jamestown, Senator Kerry expressed concern about the adverse
· impact: of managed competition on teaching hospitals.
SENATOR HERBERT KOHL (D,..WI):.... Senator Rockefeller believes Senator Kohl will
likely support the President. Senator Kohl is one of the wealthiest members of the Senate
and spent freely of his own money to win this seat. Using the slogan "Nobody's Senator But
Yours," Kohl tried to portray· himself in positive light as a candidate not beholden io special
ipterests. He is up for re-election in 1994. He does not support _single payer and has not.
taken a position on managed competition .. He is comfortable with employer mandates .if
coupled with adequate subsidies. Insurance companies are the secmid largest employer in
·wisconsin, which may be a eoncern for him.. He i~ a member .of the Mitchell working group
and members of his staff are· participating on the HcrF working groups.
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SENATOR BOB KRUEGER.:.. Senator Krueger is fighting for his political life trying to
hold onto Secretary Bentsen's fanner Senate seat to which he was· appointed. He .recogniZes
. the importance of the issue, but is preoccupied with his election May 1.
Recent Developments: . Mrs. Gore is going to Texas for a eampaign event on April 30.
SENATOR FRANK IAUTENIBERG (D-NJ)- Senator Lautenberg is very concerned that
health refonn will hit two big industries in New Je~ey: pharmaceuticals and insurance
.companies. This coupled with the fact that he is up for re-dection in 1994 means he is
skittish on certain aspects of the plans. Governor Florio's re-election effort in 1993 may also
influence Senator Lautenberg's vote: He was pushed by Senator Daschle on single payer; he
resisted saying he was in the managed competition mode. While nervous about employee
mandates, Lautenberg wants to be part of the whole team and believes he can serve as a
liaison with the business community. Lautenberg's otherconcerns include transportation
services to help provide access to health care in rural areas and the overuse of technology.
Recent Developments: Senator Lautenberg used the opportunity of the retreat in Jamestown
.to ask that the Administration tone down its anti-drug company rhetoric.
SENATOR PATRICK LEAHY (D-VT)- Senator Leahy is Chainnan of Agriculture
Committee. As such, he notes that one-quarter of all Americans live in rural areas and
provisions need to be made to ensure that they have access to needed health care services. .
He was one of the few cosponsors of the Leadership's HealthAmerica bill and is likely to
support the Administration's plan. Leahy will want to see provisions in the legislation for
state flexibility so that they can move ahead now. In the last Congress he sponsored the
Leahy-Payor bill, legislation endorsed by the NGA, to pr<?vide waivers to states willing to
undertake comprehensive health care refonn.
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Recent Deyelopmeots: Senator Leahy was recently upset about a rumor that the
Administration was going to name the provision on state flexibility in the refonn · legislation
for his Republican Sen~te colleague from Vennont, Jim Jeffords~ In conversations with, the
·Senator's office, Chris Jennings reassured his staff that there was no truth to this rumor and
·that we appreciated and understood the S.enator's longstanding interest in and leadership on
this issue. He is very interested in holding an event in Vennont, perhaps highlighting the
flexibility issue, and would like to work with us on it. He reiterated his strong support for
state flexibility in Jamestown. Lastly, in june, there will a Democratic. Governors Association
meeting which Leahywill likely attend. He and Governor Dean may ask the First Lady to
attend also.
14
�SENATOR. CARL LEVIN (D•MI) - Senator Cari.Levin ·has &erved Michigan since 1978.
His brother, Sander, is a Member of the House of Representatives, where he sits on the Ways
and Means.Committee. Along with Senator Riegle, they are protective of Michigan's auto·
industry, unions, and the unions' retirees. Senator Levin is con9erned about co~ control and
particularly about the President's plan having sufficient cost control m!=chanisms (a chief
.concern of organized labor and the large industrial manufacturers of his state). He want ·
states to have flexibility to design and implement their own cost control measures: . Senator
Levin is also worried that a tax cap will be a benefits reduction (another union coneem). He
has also wanted to know how many people will have greater. benefits. thah minimum benefits.
.Senator Levin also has rural and small business concerns .. The SCnator suppo11S inclusion Of .
good primary, preventive, hospice and home care services in the refonn ·package. A
cosponsor of HealthAmerica in the 102nd COngress, Senator Levin favors managed
competition and is on record as wanting to support the Administration's plan.
Recent Developments: In Jamestown, Levin worried about having two big tax votes in ·one
year. He also expressed concern about reduction in benefits for those who currently have
good benefi~s (i.e. unions).
SENATOR JOSEPH UEBERMAN (D-CT) - Senator Lieberman is in his first term and is
up. for re-election in 1994. Generaily, he is supporti:ve of managed competition (he liked the
CoOper Bill), but has a real problem with globaf budgets .·and caps. He believes, however,
that the plan needs to have· significant cost containment.
The Senator believes that before the plan is announced, the White House should have a ·
process to hear people's concerns. He als.o thinks that it is critical to educate the public so
people understand the problems with our health system, and what solutions are necessary.
He's very concerned we may lose the· middle class because of a big ·new. tax. · He is
e.ncouraged by what he has heard about the Administration's proposal; but has a wait and see
att·itude.
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Recent Deyelopments: Senator Lieberman felt more com.fortable abOut the process after the
First Lady's presentation at Jamestown. Interestingly, he raised small business much more
. than insurance .industry. concerns. He feels that if the middle class gets more benef.its they
will be willing to pay for reform.
SENATOR HARlAN MATHEWS (D-TN)- Senator Mathews was appointed to fill the .
. term of Vice President Gore. ·He is not interested in returning to the Senate, and will serve
until Tennesseans elect a new Senator to fill. the Vice }>resident's term.· Mathews is generally
supportive of the managed competition concept. · While he has not backed the·
Administration's reform efforts 'publicly, Mathews is supportive with some modifications. He
would like to see more action <;>n the state level, especially experimental programs. Vice
President Gore will be influential in getting his vote.
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Recept Deyelopmep_t: At Jamestown, Senator Mathews was worried. that sin taxes and
payroll taxes would kill the tobacco industry .
. SENATOR HOWARD METZENBAUM (D-OH)- Senator Mettenbaum strongly believes
in the need for health care reform and has cosponsored Senator Wellstone's single payer bill. . '
He is concerned about the managed competition approach because he fears that it is too easy
on the special interests, especially th~ insurance companies. ·He believes. to truly reform the
health care system, the Admjnistration must be willing to take on and defeat the special
interests an~ take the program to the American people. iie views health care as a social good
that should be· provided to all people and ·believes the system should be based on providing
services to people at the lowest possible cost.. Metzenbaum strongly favors rate setting and a
national budget.
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Senator MetZenbaum also fa.vors eliminating fraud and abuse in the system. He has major
criticisms of HCFA for not ferreting out fraud and abuse. Other concerns are anti_;trust (he
chairs the Judiciary subcommittee), malpractice reform and long term· care.
Recept Developments: Senator Metzenbaum's staff.has indicated a great C:oncern about the
apparent Administration infatuation with caps for medical malpractice. He is strongly
opposed to caps and might even oppose the legislation if they a_re included at the time of
introduction. He has also expressed cpncern that quality standards may be vulnerable to the
Administration's decisi'on to cut back on what we view as unnecessary regulation and he
.would like us to proceed cautiously in this area.
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SENATOR BARBARA MIKULSKI (D-MD) ~Senator Mikulski is known as an outspoken .
liberal. She supports the Clinton ·health care reform plan. in principle but is coneerned about
· the influence of the Jackson· Hole group who she calls "a bunch of geriatric Republicans that
represent everything that's Wrong with health care. As'. a foimer social worker she would like
to see greater use of non-physiCian health professionals to deliver care. ·
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She is a champion of women's health and ~n strong p'ro-choice advocate. .The plan's position
on women's reproductive health services will be critical. She is coneerned about improving
research into women's health and eliminating the gender bias of NIH research. She is also a
strong advocate for· seniors .. She introduced and passed the Spousal-Impoverishment
provisions in 1988 so that seniors did not have to spend down all of their assets to qualify for .
benefits. As the new Chair of the Labor Subcommittee on Aging, she is promoting the
expansion of home and community-based Jon~ term care serVices ..
On the Appropriations Committee, .she heads the HUONA and ln~ependent Agencies
Subcommittee. VA; the largest managed health care system, is a big concern for Mikulski.
She cites the Canadian experience where under the massive change·to a'single payer system,
vets lost out. She feels strongly that vets need a seat at ~he reform table.
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�Recept Deyelopmepts:· At the Senate retreat, Senator Mikulski stressed talk~ng the people's ·
language on health care reform and asked for amechanism to assure this happens. She also
said that the Democratic ·women Senators would lead the floor. fight for reproductive be8lth
benefits in the package.
SENATOR GEORGE MITCHELL (D-ME)- Few Majority Leaders in the Senate's history
have been as interested in and as committed to passing comprehensive health care reforms.
Senator Mitchell believes that the single payer approach is not pOlitically feasible. However,
at this point, his primary concet:n and ,commitment is ·to push tbtougb anything, which can be
defined as truly comprehensive, that will pass the Congress~ He bas repeatedly indicated his
intention to work closely with the President to help assure.that a. bill can make it. to the White
House before the end-of the 103rd Congress.
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Senator Mitchell was a strong advocate of incorporating the health care legislation into the
budget reconciliation bill. Having failed in that, he a~d hi~ lead staff are now relatively
pessimistic about attracting eno·ugh Republicans to support a health care reform initiative
. without having t9 make major, and perhaps unacceptable, concessions. Two weeks ago
(Sunday, April 18), he indicated· his opposition to price controls, his uneasiness with but
possible openness to a VAT· tax for health, and his desire to wean out all the fraud, abuse and
waste BEFORE contemplating large tax hikes.
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· Recent Deyelopmeots: He was so enthused about the First L3dy's presentation in Jamestown
and the meeting at the White House on Tuesday, April 27, that he invited the First Lady to
Friday's bipartisan meeting which is open to all Senators. Mitchell seems rededicated to
passing health care reform this year.
SENATOR CAROL MOSELEY-BRAUN (D-IL) -·Senator Moseley-Br:aun is one of the
freshman members of the Senate. She isa~ingle payer ~dvocate, and is somewhat skeptical
of the managed competition model. The Senator believes that there should be one entity
collecting revenues for the health care system, and that health care insurance providers
unnecessarily duplicate services.
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The Senator is particularly interested in financing mechanisms; and would have supported
Senator Wellstone's American Health SecurityAct, introduced March 3,-save for her
reservations over his approach to funding. Sh~ is concerned by public ·reports of the proposed ·
sin tax,.which she feels will not be sufficient to finance health. care reform. If a sin tax is rtot.
sufficient, and given the tax increases in the President's economiC proposal, the Senator is ,
cUrious about what other mechanisms the Health Care Task. Force is considering for revenue.
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Senator Moseley-Braun is also interested in the-composition and mechanism for creating a
basic package of services. She is interested in seeing an .increase in resources· and focus on
primary and preventive care. She would like to.make sure that lo~g term care is part of-the
17
�reform package, and was a little· concerned about signals. sent du~ng the meeting w:ith the
Congressional Black Caucus on this issue.
The Senator also feels that if managed competition is chosen as the avenue to ~ealth care
reform, a mechanism should be put iri' place to insure that health insurance provider
cooperatives have an incentive to serve consumers in urban and rural poverty areas.
Additionally, the Senator is interested in a slow phase .... in of veterans into an overall health
reform package.
Recerit Deyelopmepts: At the meeting with Democratic women Senators ai Jamestown,
Moseley voiced her support for the inclusion of reproductive serv.ices in the. final package.
SENATOR DANIEL P~TRICK MOYNIHAN (D-NY)- As you know, the new Fmance
Committee Chairman has· yet to take a position on national health care reform. His interests
lie primarily in the areas of Social SecuritY and welfare ref~rm. He is not a detail person
when it comes to the health care debate. Although a number of people have· discus.sed health
care with him, it is notable that the o~e who seemed to catch his fancy the most was Alain .
Enthoven.·
The only health care-specific issues that. the Senator is partiCularly known for are: his ·
advocacy and support of New York hospitals; his concern about the mentally ill and the
homeless; his support for chemical and substance abuse in a benefit package; and, most
recently, his support of innovational the state level. On the latter point, he introduced a
liberali~d Medicaid managed care measure that the NGA strongly supported. (This
legislation was opposed by the Chiidren's Defense. Fund because they felt that savings through·
·this cost containment approach would be at the expense of the Medicaid population.)
Recently, the .Chairman an~ his statf have been rather pessimistic about the chances for health
care reform this year. The complexity, controversy, and po~ential expense of it bighten them.
The Chairman, in comments that have beeri somewhat retracted by' staff, has indicated his
concern about any large new taxes to fund the .program and any use. o~ price controls to
contain costs.' Although he has stated his willingness to raise whatever tax· is necessary for
the elimination and integration of Medicaid into the new system, as well as .for a one-cardfor-all system, his nervous statements should not be totally written off.
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Recent· Developments: At the First Lady's meeting this week with the &,:nate Finance
Committee, Moynihan was among those who cautioned against rushing health care reform.
He expre~ed the view that. the Administration should take more time· if needed to do it right.
In Jame~town, he· adv.~ted combining the Health Card with the Speial Security Card, a view
he reiterated in a letter to the President. . We trust the First Lady's dinner with Senator
Moynihan and his wife on Tuesday went very well. ·
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SENATOR PAITY MURRAY CD~WA) ~Senator Murray was a state senator in
·Washington before being elected to the U.S. Sena~e this past fall. She serves on the Budget,
Appropriations and Banking Committees. As a former state legislator, Senator Murray will _
· be highly sensitive to ensuring state flexibility, especially in light of the Washington State
legislative health care initiative. Although she has not taken a public position on a particular
health plan, .'she has indicated she will liJ~ely support- the President as long as the plan extends
coverage and allows for state innovation. ·
Senator Murray is an advocate for women's health, including extreme concern about breast
caricer_and screenings. She aiso strongly backs long term care· as part of reform. She'· is very
concerned about eliminating pre-existing co~dition exclusions.. Senator Murray will soOn ·
introduce legislation (similar to Congressman Reynolds' bill) designed to raise the excise tax
on firearms .and earmark· the revenue for health care.
Recent Developments: ·At Jamestown, Senator Murray advocated including reproductive
rights in the final package.
·SENATOR SAM NUNN (D-GA)- Senator Nunn is known more for his Anned Services
Committee work than for health care. Treatment of CHAMPUS and other Department of
Defense· health programs under the reform plan wilr be a major concern. Senator Nunn hasn't
. ~aken a position on a type of plan. However, he is extremety opposed to employer mandates.
In fact, the Senator states that President Qinton has assured ·him the plan. will not include
employer mandates. He is strongly in favor of tight entitlement caps. He is unsure how a
global budget will work on private spending. As a Senator from Georgia, he also has strong
rural health concerns..
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Recept Developments: Senator Nunn co-chairs a commission which will soon be maki~g
recommendations on health care reform. Reports are that they are leaning towards a managed
compeddon type approach with an individu.al mandate. This sounds like the Republican plan
on which we believe Senator Chafee is working. It is unlikely that they will support even ·
temporary price controls. It is unclear whether they will endorse the concept of universality.
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SENATOR ClAIBORNE PELL (D-RI)- Senator Pell-is the most senior member of the
.Senate Labor and Human Resources Committee and a long-time advocate of "cradle. to
grave" health coverage·. On health care reform, he is not an ideologue and is not Committed
to any method of reform. In 1972, he joined in introducing legislation which would have
mandated employer-based health care reform .. As a member who has been working .on the
issue for sometime, he would enjoy seeing actual progress .. ·
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Because of his well-to-do elderly constituency; Senato~ Pell'voted to repeal the Catastrophic
. Health Care Reform legislation. This is significant because it may indicate that a prescription
drug benefit that most well-to-do elderly already have will not be adequately responsive to
19
�an influential constituency of his. This helps explain why Senator Pell'~ top health care
concerns include coverage for long term care - Rhode Island has one of the highest
percentages of elderly of any state in the country- preventive services and expanding the
use of non-physician health provider. He is opposed to smoking and has sponsored
legislation to provide grants to states for health promotion programs. He is also interested in
studying other countries' health care systems .and taking lessons from their ~xperiences.
SENATOR DAVID PRYOR (D-AR) - Senator Pryor is part of the Senate leadership
(Secretary of the Democratic. Conference).. As the Chairtnan of the Senate Special Committee
on Aging, he is well liked and respected by the powerful aging advocacy community. In
addition, be is one of the few Democrats that the small business community genuineiy trusts.
Further, as a former Governor his advocacy of state·-based approaches to comprehensive
reform bas gained him a great deal of good will. with· the Governors~ Although an
unassuming member and one who does not get overly involved in detailed policy discussions,
he bas emerged as one of the most influential and best liked members of the Senate. All of
these roles ensure that he will be a ·key player on the health care front.
In terms of health care. priorities, drug cost containment is the first, second, and third highest
priority for Senator Pryor. The concept of linking drug cost containm·ent to tax credits embodied in Pryor's Prescription Drug Cost Containment Act S. 2000) was endorsed by President Clinton.
In addition to his drug cost containment interests, Pryor also has a notable legislative
achievement record in rural health (relief for hospitals and iocentives for primary care doctors
in medically underserved ~eas), state-based reform (his NGA and Ointon candidateendorsed Leahy/Pryor bill), and long term c;are (his proposal for Federal standards for private
long term care insurance policies):
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Recent Developments: At the Finance Committee meeting April 20, Senator Pryor supported
the view that more time should be taken to assure that you do it right. He backs· the use of a
dedicated tax for health care, perhaps a VAT. He also supports the inclusion of a significant
long term care benefit. He believes that as long as we will be spending billions of-dollars,
we should make certain it attracts popular support for the plan. Of the Finance Committee
Republicans, he would rank Danforth, Packwood, Chafee, Durenberger in order of likelihood
to support the plan.
SENATOR HARRY REID (D-NV)- Senator ~eid is in his second term in the United
States Senate .. Traditionally ·not outspoken on health issues, be spends most of his time with·
his Appropriations and Environment and Pu~lic Works Committees. He bas yet to take a
'position on a particular reform model. He is waiting to see what the HCTF and .the President
have developed. The Senator stresses rural health issues, and wants· lead screening
emphasized. He's concerned about m~ndated benefit packages because he. believes they have
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not worked at the state level. He. is also worried about the impact of reform on physicians'
earnings.
SENATOR DONALD RIEGLE (D-MI) ""'Senator Riegle considers himself to be a major
player in the health care debate~ .He is Chairman of the Finance Subcommittee on Medicaid
and was a lead· sponsor of the Mitchell, Rockefeller, Kennedy "play or pay" health care ·
reform proposal. He has always felt he did not get adequate credit for his work on the bill.
Although. he sponsored this bill, he appears to be extremely willing to sign on to virtually any
approach that achieves universal coverage and. east containment.
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Senator Riegle is-very interested in many health issues, including: child immunization
programs; rural health care; Medicare. prescription drug coverage; retiree health liability
concerns; long term care; and a host of others. He strongly believes that cost containment
savings should. be used to help reform the health care system -- NOT for deficit reduction.
Recent Developments: At the April 20 ineeting with the Finance. Committee he· stated that
he wanted to look at longer budget periods 'than five years (he can't understand why we are
always locked into a. five year budget plan). He believes it is important to look at national
spending, not just Federal spending, because most of the savings will come from the private
sector. He also felt that we needed to look at and change the language used to explain the
plan.
SENATOR CHUCK ROBB (D-VA)- Senator Robb believes that cost-containment is.the
key and that it should be stringent. He has not taken a position on any particular health plan,
but likes what he hearS so far from the Task Force. He is likely to be supportive. He was an
active member of the Mitchell working group and. was comfortable- with its overall app~oach.
Also, he was a member of the Nationall..Cadership Commission on Health Care which
predated the National Leadership Coalition. Senator Robb is up for re-election in 1994.
Recent Developments: At the Senate retreat, the Senator was concerned ·about taxes needed
to finance ref~rm, especially· sin taxes.
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SENATOR JAY ROCKEFELLER (D-,WV)- Senator Rockefeller views himself beingand is - Bill Ointon's number one health care advocate.· He was a tireless campaigner and
defender of the Clinton health care plan arid was a National Co-Chair of the Clinton
campaign. Senator Rockefeller is the current Chairman of the Finance Subcommittee on
Medicare and Long Term Care and is the new chair of the Senate Veterans Committee. He
also has chaired the Pepper Commission and the National Commission on Children. In
addition, Senator Rockefeller is the founder and Chairman of the Alliance for Health Reform,
a nonpartisan organization dedicated to advancing health care reform through education of
public opinion leaders.
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Senator Rockefeller's health care priority is very simple: He desperately wants to .see a
comprehensive reform package enacted during the Clmton Presidency. Although he· thinks
the long-term outcome of such an achievement. is politically attractive, he is primarily
pushing this because he is sincerely committed to the.need for_ reform. In this vein, he is not
overly committed to any particUlar approach although be bas advocated an employer-based
approach. He, therefore, can be counted on tci support virtually anything the President ends
up proposing, as long as it achieves universal access and cost containment. ·
Recent Deyelopmepts: · At his one.:..on-one meeting with the First i..ady he was upset with
Vice President Gore, Secretary Bentsen, and Director Panetta who he thinks are less than
supportive of reform. He thinks Sen~tor Moynihan ~ be brought on board. He urged using
the phone more to increase contact with members. He felt that the Finance Committee
Republicans that we should go after are Senators Chafee, Danforth and Durenberger (he seemed less confident about Senator'Packwood). He also expressed his willingness to play
the heavy on taxes with the public, press, and members.
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SENATOR PAUL SARBANES (0--MD) - Senator.Sarbanes is in his third term and is up
for re-election in 1994~ He originally supported Kennedy's Singie Payer plan in 1972, but
realizes it won't work today. Currently, he is not committed to a specific approach and is
open to different options. He has a wait and se~ attitude on the HCI'F deliberations, but he
wants to help Clinton and will support Mitchell, Rockefeller and the- Democratic Leadership. •
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Recept Developments: In Jamestown, Senator Sarbanes. expressed interest in knowing who
would be hurt by health care reform -- what industries, what individuals. Because of his .
position as .Vice-Chair of the Joint Economic Committee, these questions were not surprising.
SE~ATOR JIM SASSER (D-TN) -.Senator Sasser is OQe of the more popular, populist-,
and liberal southern Democrats in the Senate; He· and his staff have been very supportive of
attempting. to develop consensus on health .care reform for years. But, like others; he never ·
could· find the dollars or support for a significant package. As a result,. he has focused on .
more incremental and populist reforms. He is most proud of his three year battle ·to pass
legislation to reform and clean up the fraud and abuse in the· durable medical equipment
industry. He introduced and passed le·gislation ·within last year's tax bill (later vetOed by ·
then-President Bush) .to place restrictions on how the industry could bill Medicare for _this
equipment: In addition, he was one of Senator ~Pryor~s strongest allies in the Senate when he
tried to take on the pharmaceutical industry pricing behaviors and their abuse of an offshore
tax credit.
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SENATOR RICHARD SHELBY (D-AL)'- As you know, the media has made much of the·
rift between Senator Shelby and the White· House. He is a conserVative Democrat' whose vote
is considered tough to get. While he has said that he is waiting to see what the President
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puts forth he ·has expressed some clei'r views regarding health care reform .. He opposes
"single payer" or any other "top-down" system. He believes there needs to be loccil control
and decision making. He is anti-employer mandates, anti-:rate setting, and has significant
small business concerns. Some self-h_1sured people have used managed care very well. in · .
AJabmna.
·
Recent Developments: Last month, ·Senator Shelby sent a "Dear Colleague" asking for·
cosponsors for his resolution expressing "sense of the Congress that any National Health Care
reform legislation must ensure that every person eovered under the plan has access to
coverage for medically and psychologically neeessary treatments for mental disorders. Such
access should be equitable to coverage provided to treatments for physical illnesses."
SENATOR PAUL SIMON (D-IL) -Senator Simon is very interested in health care refonil,
and leans toward a single payer approach tiut also cosponsored the Leadership's
HealthAmerica bill. He is close to organized labor and. sponsored antendrrients to strengthen
the cost containment provisions of HealthAmerica·proposed by the AFL-CIO. He has alsO
been one of the Senate's strongest advocates for long term care and· has cosponsored many
·.bills in this area. He is very interested in children's and minority issues. He. has a long
standing interest in education, particularly higher education. He is a strong supporter of
increasing. enrollment of minorities in health professic:mal schools.
·
Recept Developments: Senator Simon recently met with Robyn Stone and reiterated his avid ·
support of a significant long term care plan. He cites his Senate· campaign in which he
·advocated comprehensive long term care legislation which outlined specific tax· mechanisms ..
This plan received a great deal of support in the state, so much so that his opponent, thenSecretary· Lynn Martin, pulled ads attacking the tax because they were so negatively received
by the electorate.
·
SENATOR. PAUL WELLSTONE (D-MN)_.-: Senator Wellstone is· very interested in health
care reform. In .March; he reintroduced his single payer bill, the Senate counterpart of t~e ·
McDe.miott bill. Despite his strong bias toward single payer and his suspicions of.managed
eompeti~ion, he has expressed a ~illingriess to work with you. His strong desire for reform .
and his belief that we must act now make him likely to support the Administration plan. He
has a strong interest in mental health and substance abuse benefits. ,He modified his previous
bill to strengthen its mental health provisions. Other concerns include rural health, consumer
choice and· $tate flexibility (s.o that Minnesota might pul'$ue a single payer option).
Recept Developments: Senator Wellstone indicated concern regarding talking points ·.
distributed by the Task Force to the members of Congress, particularly how single payer was
characterized. At the retreat,. he stated that he doesn't· want. anyone to be able to opt ·out of
the PUrchasing Cooperative because he feCUl that healthy people will opt out: He 8Sked for a
meeting with Ira. Ira will conduct a telephone meeting on Friday and then determine if a
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discussion is necessary.
SENATOR HARRIS WOFFORD (D-PA)- Since his Senate race victory, ~hich was
Widely attributed to his support of health care reform, Senator Wofford has actively pursued
this issue in the Senate. He is .Part of .the group. of five (with Senators Daschle, Baucus,
K.errey and Bingaman)' on a single financing state-implemented health system with a national
health board approving state plans. Employers and individuals would pay a progressive
premium to a fund which would be returned. to the states on a percentage basis. The original
.Daschle-Wofford bill was called.the American Health Security Act, parthuly because
·
Wofford believes so strongly in the impOrtance of the success of the Social. Security·system.
· . He believes that his proposal took into aecount a middle road between the. sin.gle payer and
managed rom petition crowds. He believes· everyone should be required to participate in the
Health Alliances (no opt-outs), that the program must be state or regionally administered, apd
that long term care coverage is essential. He has previously expressed concern over what he
·felt was the lack ofdiscussion by the Administration of long term.care in connection with
reform.
He is working with the Democratic Policy·Committee health working group and is 'looking at
the health insurance purchasing cooperatives and how they could work. He is very .
intellectual and savvy about how difficult some. ·of the concepts are for the public to
comprehend. For example, he dislikes intensely the term "global budget,". believing that it is
too large· to understand and turns people off. He believes that President Clinton and
Congress must do a lot of educating on health care reform.
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Recent Deyelopmerits: It. haS been more and more clear to the Senator that his election is.·
tied to Health. Care Reform. He will be very helpful. Laflguage used to desclj~ and sell the·.
plan is very importa~t to hif1?. He is very appreciative that the First Lady attended his forum
in Harrisburg earlier this year. At the Senate retreat, Senator Wofford stated his support for
short term cost controls. He believes that abortion shouid be out of health reform and does
not want the federal government overriding state abortion restrictions.
)
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PROFILE~
- SENATE REPUBLICANS
April 29, 1993
SENATOR ROBERT F. BENNE'IT (R-UT)- Senator Roben F. Bennett of Utah at S9 is
the oldest member of the Senate's freshman class,. and enters having made a fonune in private
industry. He currently serves on the Committee on Energy and Natural Resources, the
Committee on Banking, Housing, and Urban Affairs, the Committee on Small Business, and
the Joint Economic Committee.
·
Senator Bennett has co-sponsored no
l~gislation
with significant health policy implications.
CHRISTOPHER "KIT" BOND (R-MO)- The junior Senator from Missouri reeently won
his first re-election campaign, arid is ready t9 continue his spirited panisanship. A former
chair of the Republican Governors Association, Senator Bond has opposed a number of
relatively popular initiatives, such as the Americans With .Disabilities Act and the 1990 Civil
Rights Act. Senator Bond currently serves on four business and money related committees:
the Banking Committee, the Appropriations Committee, the Budget Committee, and the
.Committee on Small Business. ·
In the 102d Congress, Senator Bond co-sponsored a Republican health Care initi'ative that
sought a $1SO billion solution to the lack of universal coverage, and when asked whether he
was submitting the bill over Bush Administration objections said, "(Sununu] is not driving our
bus." [NIT, 11/8/91]
·
Senator Bond recently Introduced an administrative reform bill addressing the high cost of
health care administration, and which also excludes the increased costs OT cancellation. for
sickness, saying "the loss of insurance coverage when a child becomes very ill is not
risk-sharing, it's risk-avoidance. The broad health care reform is vital. It is a very, very
complex problem, but there are cenain, I think, readily agreed upon steps that we ought to
take. I don't expect that we;re going to get ·health care reform solved within the first 100
days. I think we can take some very significant steps, and I hope we wilL" (~. 1/4/93]
Senator Bond was a leader of the eight Republican co-sponsors of the Family and Medical
Leave Act, and also co-sponsored Senator Dole's recent bill on Medicare (S. 176), which
revises Medicare rules with respect to rural and community hospitals and payment for new
providers, If a moderate Republican bloc forms to negotiate with the Democrats on health
reform as· it did on Family and Medical Leave, Bond could be key.
SENATOR HANK' BROWN {R-CO)- Senator Brown wa5 elected in 1990 to the United
States Senate. He prev~ously was a member of the House, where he served as a member of
the Ways and Means committee. Generally moderate with some liberal votes, Brown has
worked to protect Colorado's environment and is pro-choice. He railed against the 1987-88
Democratic Welfare Reform~ and persuaded the House to en~orse instea~ the workfare
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measure that became law. He also was on the ethics committee that investigated fanner
Speaker Wright. In the House he sponsored a tough campaign finance refonn.
SENATOR CONRAD BURNS
<R-MTI- Senator Bums is Montana's junior Senator. The
best description of him appeared in the 1992 edition of The Almanac of American Politics:
"Burris .. .is almost a stereotypical. Easterners' version of a western politician. He picks his
teeth with a pocketknife, chews tobacco, and tells deadpan jokes." Bums came to the Senate
in 1988, defeating incumbent 1o~. Melcher.·
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Senatof Bums is ·a quiet Senator with a conservative voting record.. Although he is on the
Republican Health Care Task Force and on Pryor's Aging committee,. he is ·not very· .
outspoken on health issues. He is a cosponsor of Senator Kassebaum's BasiCare Health
Refonn Bill and is interested in meeting with' you next week. He is particularly supportive of
the bill's f\Jral health. provisions.
SENATOR JOHN CHAFEE (R-RI) ..:. Senator· Chafee is the Ranking Republican on the·
Finance Committees Medicaid Subcommittee and
Chair of the Republican Task Force
on Health Care. He likes to point out that the bill they introduced in the last CongresS had
the most cosponsors of any major comprehensive health refonn bil.l. He was not pleased with
last year's health care debate with the Democrat~. He believes that, if not for .Presidential and
partisan politics, there was enough consens~s between his and many Democrats' bills to move
forward on many high priority health refonn proposals such as: ·self-employed tax deduction
increase to 100 percent, insurance market refonn, expansion of Community health centers and
other heaith ·care delivery systems, arid state experimentation.
On the Finance Committee, Senator Chafee is primarily known for his long-stan~ing interest
in providing alternative care settings -- through the Medicaid program -- to persons who are .
disabled. He and his staff are literally heroes with many· in this field, particularly those who
advocate non-institutional care approaches. He. is also. well known for his strong aqvocacy
of, and relationship with, community health care centers. In addition, he -- like a number of
the Finance Committee membership ..:.._ are growing weary of funding programs for the
elderly when there are so many needs in the non~elderly population.
.
. As you know, we have been trying for weeks to invite Senator 'Chafee .to talk with Ira. We
sense that he and his staff want desperately to come in; but are afraid to alienate Dole. On
April 16th; though; Task Force staff received a call· indicating that he ~ight come for a
meeting. A meeting has now been scheduled for next. week. .'
'
Recent Developments: Chafee's office has tentatively scheduled a 5/6 appointment with Ira.
At that time we think it would be appropriate and advisable .for yo·u to drop by or have him
drop by immediately following that discussion. .
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SENATOR DAN COATS (R-IN)- S~nator Dan Coats is more conservative across a wide
spectrum of social issues than almost any other member of.the committee. He is strongly
opposed to abortion. He is the author of several amendments to require parental consent in
the case of abortion for .minors (one ·Of which passed the Senate).
On the other hand, Coats., the ra~ing member on the Cbildren and Families subcommittee,
has. been a fairly strong advocate for·. child welfare and has broken with the Republican party
to these ends. He is viewed to have something of a pragmatic streak on certain issues and is
not afraid to differ with his party on these issues. He supported the Family and Medical
Leave Act and extending tax credits for families with children. He has been supportive of
Senator Dodd in his efforts an~· is more of an enabling ranking member rather than an
obstructing one. ·
SENATOR TIIAD COCHRAN (R-MS) .~ Senator Thad Cochran, Republican from
Mississippi was elected to the Senate in 1978, and has had relatively easy bids for .re-election
. · ·since then, He is up for re-election in 1996. He won his bid for the cbaiTnlanship of the
· Senate Republican Conference in ·1990, when he challenged Senator Chafee for the P<>sition
and won 22 to 21. His conservative stand on almost all issues and. chairmanship of the
conference reflects his Republican leadership .role in the Senate. He sits on the Committee on.
Governmental Affairs; the Committee on Appropriations; the Committee on Agriculture,
Nutrition, and Forestry; the Select Committee on Indian Affairs; and the Committee on Rules
and Administration.
·
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· Earlier this year, Senator. Cochran said, "[I]t needs to be understood that the Republican
contrib~tion on the health care issue discussion indicated a willingness to work together, and
an acknowledgement that this is one of the most serious problems we face in the country
today, and that it'ought to be given a very high priority. So I don't think we ought to
misunderstan~ what the commitment is. And the commitment is to try to work in a bipartisan
way to solve these problems that exist in the health care area~ acknowledging that they're
complicated, multifaceted." (Reuter Transcript _Report, 1/26/93]
Recent Deyelopmept: Recently he sided with Sena~or Reid in an attempt to eliminate the
. Senate Select Committee on Aging. The attempt failed and strained the previously cordial
relationship between Cochran and Senator Pryor. ·
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SENATOR WILLIAM "BILL" COHEN (R-ME)- Senator Bill Cohen from Maine was
elected to the Senate in 1978, winning against S~nator Hathaway by a large margin. His
platform then focused on military strength, and that won him a· seat on the Senate Armed
· Services Committee. He is currently on the Senate Committee Oil the Judiciary; the Senate
Committee on Governmental Affairs; the Senate Committee on Amled Services; the Senate
.Special Committee on Aging; and the Joint Committee on the Organization of Congress~ He ·
is considered to be. an unpredictable and at times a liberal Republican, whose home state
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priorities often override panisan votes.
Last session, Senator Cohen worked on a health care package which included a refundable tax
. credit for. health insurance premiums and a nationwide low-cost basic henefits package.
On January 27, 1993, Senator Cohen .submitted S. 223, the Access to Affordable Health Caie
Act, a bill to contain health care costs and increase access to affordable health care, and for
other purposes. The bill
a managed competition mOdel for refonn. It also has
provisions to improve health delivery in rural and underserved areas, reform malpractice,.
controls drug costs and erriptlasizes preventive health. Senator Cohen also co.,.sponsored
Senator Mitchell's Freedom of Choice Act.
uses
Senator Cohen is one of the ten Republican Senators it looks like we have a possibility of
getting at the present· time. He also requested that you attend an event in Maine at the same
time you we~e in Nebraska with Senator Kerrey. You may wish to extend your regrets.
Doing something in Maine which does not heavily involve Senator Mitchell is not
recommended. An underlying rivalry exists between Sens. Mitchell and Cohen.
,..
SENATOR PAUL COVERDELL (R-GA)- Senator Coverdell won a run-off election .
against Sen. Wyche Fowler in December. He headed the Peace Corps .under President Bush .•
and formerly chaired the Georgia Republican Party. His strength is in the rural areas, and
conservative areas of Southern Georgia. Known as a conservative, it is unlikely that. Senator
Coverdell will vote against the Republican leadership this early in his first term.
No significant health views are known at this time;
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SENATOR LARRY CRAIG (R-ID) - After ten years in the House, Senator Larry Craig
won his bid for. Senate.in 1990, filling the open Senate seat vacated by the retiring Senator
· McLure in 1990. As Idaho's junior senator, he believes strongly in economic development
and is opposed to environmental restrictions and government regulations. He currently sits on
the Senate Committee. on Energy and Natural Resources; the Senate Committee on
Agriculture, Nutrition, and Forestry; the Senate Special Committee on Aging; )and the Joint
Commin~e on Aging.
·
· Senator Craig co-sponsored Senator McCain's. Medicare. Provider Payment Equity Act of
1993, which is designed to amend the Social Security Act to repeal the reduced Medicare
payment provision for new providers. He also co-sponsored Senator Dole's recent -bill on
Medicare (S. 176).
4
�SENATOR ALFONSE D'AMATO (R-NY)- Senator D'Amato is New York's junior
Senator and a product of the political machine of Nassau County's Republican Party.'- ln the
· Senate, he has maintained a machine politician's attention to local concerns and constituent
services. n•Arnato has a good working relationship with his colleague fonn New York,
Senator Moynihan. He plays the role of "Senator Pothole" to Moynihan's more states~anlike role. .
·
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Having won the seat initially in a three~way race, he often been high on Democratic target
lists; Yet he has proved to be an elusive target. Last fall, he was reelected easily to a third
tenn over New York Attorney General Bob Abrams, after beating ethics charges back in
1991. For all these reasons, Senator D'Arnato has earned a reputation as a scrapper With an
instinct for survival -- a reputation which he cultivates at every opportunity..
D'Arnato is expected to be coql to the Administration's health care proposal. It is theorized
that he will be mainly interested in the impact on his large urban medical centers and
hospitals, the financial burden on his middle class suburban constituents and increases in
benefits for .the elderly. ·
·
SENATORJOHN DANFORTH (R~MO)- Senator Danforth, senior senator from Missouri
recently announced his plans not_ to run for reelection in 1994. Within the Republican Party,
Senator Danforth· is to cost containment what Bob Packwood is to mandates. He is the
Republican Senator most 'likely- t() advocate that. strong federal/state caps on spending must be
imposed to effectively contain health care costs. He states his strong views on this issue
repeatedly, despite admonitions from his staff and other Republicans that such statements are
not consistent with the Republican Party line.
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He. is one of two cosponsors of Sen. Kassebaum's BasicCare Health Access and Cost Control
Act. _A_t the press conference announcing the intrtiduction of the bill, Sen. Danforth again
focused on cost control noting, "the easiest thing to do is to introduce a· bill that provides for
universal coverage. The hardest thing to do is toprovide for cost control." [FNS, .:?./4/93]
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Although willing to support the need for strong government cost regulation, he also .believes
that to do so would require explicit rationing (He is a big fan of the 'Oregon waiver). What ·is -more, unlike most. Democrats, he desires to publicly proclaim that rationing is necessary and _
somethingwe must own up to.
The Senator has been vocal lately opposing the possibility of new taxes for health care
reform, saying, according to The New York Times, "it would be 'extremely difficult' for
Congress to pass new taxes for h!=alth care on top of those sought for deficit reduction."
is also quoted as saying, "How many big tax bills is Con~ess going to pass in a )•ear?... How
much is the country going to swallow in a year?": [NIT, 2/21193]
·
He
5
�Recent Developments: At 4120 Meeting with HRC and the Finance Committee, Sen.
Danforth stated that Democrats and Republicans· are not too far apart on this issue. He· also
. stated that universal coverage is. importapt, but that it should be phased in over a longer
·
· period of time. He believes the tax cap should apply to both employees and employers and
seemed happy with the First Lady's response to that point. Most recently, in conversations
with the Senator's senior staff, it appears likely that he and Sen. Kassebaum would ·like a
meeting with Ira and or the First Lady in the very near future. The meeting is being ~nged
now. The First Lady will likely invite him to a me.eting soon. (rev.'4/28)
SENATOR ROBERT DOLE (R-KS) -The Minority Leader is, without question, the most
influential Senator among Republicans. As an ally, he can be absolutely invaluable:· As an
enemy, he can be vicious and effective. Currently, it appearS he· is trying to deciqe whether.
health eare reform should be a partisan or a bipartisan issue. Dole and his staff will probably
opt to appear to be. willing to work with the Democrats, but will eventually choose to tum on
the new Administration on the reform issue.·
. Senator Dole has a strqng interest in rural health and is currently Co-Chair of the Senate
Rural Health Caucus. Legislatively, he has supported initiatives to protect the viability of
small rural hospitals as well as to expand civil rights pro~ections· and services for the
handicapped.
On Meet the Press (Sunday, ·April 18), he indicated his opposition to price contrpls, ·his
concern about large taxes without delivering on cosi containment first, and his hesitancy
abOut a VAT tax unless it is used. to replace or offset other taxes.
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' .Senator Dole continues to profess a d~ire to work with Democrats on health reform. Earlier
this year, Senator Dole said: "[i]fwe're going to have health care reform, it's gotto be
bipartisan. Nobody has .the votes for health care n:form'. We don't have the votes. We're the .
minoritv. Democrats don't have the votes because th'ey have different ideas. But it seems to
me this. issue is so important that it shouldn't be politjcized·.' · Now, politics--there~~ a place
for it, and there's a place not for it, and I think health c::are reform is one of those areaS." ·
(ReuterTranscript Report, :'!/16/93]
.
Although it may well be an impossible task; we must continue to work to at least try to gc~
him on board with us. If. we do not succeed, we might have some success in· attracting other
moderate Republicans for. making the effort to obtain Dole's support.
Recent Developments:· Along these lines, we recommend that you invite ·senator Dole in for
a meeting to discuss where he sees health care legislation when you see him at tomorrow
morning's meeting. Regardless of your success in bringing Dole on board, the very fact that
you attempted to do so pas a very real potential to attract other moderate Republicans who
will be given cover to .come in for individual 'meetings. .
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SENATOR PETE DOMENICI (R-NM)- Senator Pete Domenici of New Mexico was
elected to the Senate in .1972, and served as chairinari of the Senate Budget Committee from
1981 to 1987. Since then, he has served as ranking Republican on the Committee. Although
the growing budget deficit concerns him and he has tried to reduce the deficit, he is reluctant
to diverge publicly from the Republican party lines.· A partisan Republican, his willingness to
back higher taxes to cut the deficit has hun him with fiscal. conservatives.
Commenting on the President's economic team in December, the Senator said, "you can't get
the federal budget under control without dramatically reducing the increaSing costs of health
care." [Reuter Transcript Report, 12/10/92] Senator Dt>menici released a report last October
with Senator Numi that suggested that to control esCalating federal health care costs, Congress
should enact legislation by December 1993 to cap spending ·on entitlement programs such as
Medicare and Medicaid.
Senator Donienici is also extremely concerned about the issue of mental health and believes
that significant mental health provisions should be included in the benefit package. He has
introduced legislation to ensure that any reform plan contain mental health provisions.
Recent Developments: On April 29, Senator Domenici attended a briefing on the Hill on
Mental Health Issues by Mrs. Gore. In his remarks, he (lppeared to indicate that he would
support a health care reform bil.l but it. was not clear whether. this could be interpreted as
support for the Administration's plan.
SENATOR DAVE DURENBERGER.CR-MM .... Senator Durenberger, the ranking
Republican on the Finance Committee on Medicare, is one of the Committee's most well ·
versed Members on health care reform. He also is one of the few Members who has served
concurrently on the Labor and Human Resources Committee (the other major health care
. committee) and the Finance Committee. He is a moderate who is viewed by the Republican
leadership as somewhat of a loose cannon. Because of this and his long-standing interest in
health care reform, Durenberger, too, is a candidate to be a possible and im'portant ally.
In the last Congress, he joined Senator Bentsen as the lead-Republican on the Texas Senator's
incremental (insurance market reform, etc.) health reform initiative. lie has· been a key health.
care player for years, however. He now is the ranking Republiean. on' Jay Rockefeller's
Subcommittee on Medicare and Long Term Care, and he has served as either a Chairman or
ranking Member of this Committee for years. In addition, he served (as a Vice-Chair) on the
Pepper Commission. While he joined all the other Republicans in voting against the access
recommendations of this Commission, (he did vote for the long-term care recommendations)
it is important to note that it was unclear that Durenberger wa5 going to vote against the
Peppe'r Commission recommendations until very .late in the process. An important offshoot of
this experience, though, was the close working relationship he forged with Rockefeller.
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Most. reeently, Durenberg~r has focus~d on state-based health rCform initiatives. He does not .
believe that a consensus yet exists for national"reform and his own state is tired of waiting.
Minnesota has a long tradition of moving ahead <m health car~ reforms. It is one of the 5 or 6
states that has gone ahead and passed legislation to implement i.ts own reform pro~sal..
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Minnesota is also 11IE nation's capital of managed care/HMO delivery systems; As a result,
MVmesota has historically been more efficient than other states in terms of the delivery f)f
health care. Senator Durenberger will be very concerned about the allocation ofthe global
budget, particularly that it does not reward the inefficient at the expense of the efficie~t.
Senator Durenberger called Chris Jennings on April 17th to talk about health policy· substance
and strategy. He indicated his nervousness with any price controls. He said he thought we
could get some savings for speeding up implementation of the new physician payment system.
He also urged us to find a way to fold in Medicare into whatever we do. Lastly, he again
a5ked. for a meeting with. Ira and it was arranged for April 21st.
Recent Developments: At a meeting with Ira Magaziner on April 21, Durenberger stressed
that he, unlike some Republicans, thinks we can and should do health care this year, although
he expressed reluctance about universal coverage (and its associ~ted costs) in the near term.
Feedback from Gov. Carlson's office was very positive, but Duren berger is still telling the ·
press that he's against new taxes and isn't sure the bill can be moved this ·year.
SENATOR LAUCH FAIRCLOTH (R-NC)- Senator Lauch (pronounced "Lock") Faircloth
is a Republican Senator from North Carolina. He is a freshman member and won by
defeating incumbent Democrat Terry. Sanford. Senator Faircloth is a· conservative from a
tobacco-growing state. As such, he will have particular concerns about increa5es in taxes on
cigarettes and tobacco products. With the strong in~uence of fellow North Carolinian and
arch conservative Jesse Helms, it is not expected that he ·will be with us. 'It is even more
unlikely that he will support the Administration and go against the Republican Leadership.
SENATOR SLADE GORTON(R-WA)- senator Slade Gorton won and then lost his·first
Senate seat, and then afte~ saying he was through with politics, ran again in 1988 and' won;
He has taken the lead on CAFE standards and backed import fees on cars that did not comply
with the Clean Air Act. He. is up for re-election in ~994, and currently sits on the Senate
Committee on Commerce, Science,· and Transportation; the Senate Committee on
Appropriations; the Senate Select Committee on Indian· Affairs; the Senate Committee on the
Budget; and the Senate Select Committee on Intelligence. .· . .
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Senator Gorton is a co-sponsor of Senator Dole's Medicare reform bill. Senator Gorton
wrote to you on March 23rd, where he outlined that his most pressing concern is state
flexibility. He was encouraged by. the Oregon waiver and hope that the Administration plan
will be as equally flexible. "Like you I believe we absolutely must have nat·ional health care
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refonn as soon as possible," but did not elaborate.
SENATOR PffiL GRAMM (R-TX)- Phil Gramm is a highly partisan, extremely.
outspoken Senator who has strong convictions in his belief~. He is a fonner professor at
Texas A&M and previously served in the House of Representatives. He is a suppiy-sider
committed to carrying on the Reagan legacy .. Fonnefly a Democrat, Gramm was a lead
sponsor of two major pieces of budget legislaiion: the Gramm-Latta budget resolution of
1981, ·Reagan's budget "cutting" package, and the Gramm-Rudman-Hollings budget defiCit
reduction act of 1985.
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. Gramm is not expecteq 'to be helpful 'to the Adm'inistration.
In fact, he is in a heated debate
over how the Republicans should proceed. with health care. Gramm has joined with Senator ·
McCain and other conserVative Republicans promoting the use of Medical IRA's as· their
health refonn vehicle. The other side is favored by .Chafee and Packwood, who believe that
some sort of government program must be initiated .. Caught in the· middle of this struggle is
Senator Dole, who_ is trying to keep both sides together as he did on the stimulus plan.
Gramm is considered a leading candidate to succeed Dole as Minority .Leader.· He is also 1·
. rumored to be considering a nin for the presidency in 1996.
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SENATOR'CHARLES GRASSLEY (R-IA)- Senator Grassley is one of those Senatox:s
who can 'give the impression (since he is not a detail-oriented person) t_hat he is iess than .
sharp and not a significant player. This is not the case. Although he may QOt be extremely
quick, he has a very sensitive and accurate gut for. politics and policy-and, with a very
capable staff,· he has managed to become quite an effective member of the Finance
Committee. ·
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Gras51ey's primary health care· iinerest has been rural health care. He, ·again like most-other
F'mance Committee members, has been greatly concerned about perceived inequities ·in
reimbursement to. rural providers.
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Recent Development: Senator. Grass ley, as he stated in the recent Finance Committee
.meeting, appreciated your coming tq Iowa. He was, according to Senator Pryor, impressed
with your presentation before the Finance Committee and, again only according to Sen. Pryor;
said "Hillary is too smart for Republicans.'; He has also indicated his suppori for malpractice
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SENATOR, JUDP GREGG (R~NH) - Senator Judd Gregg, the newest member of the
Senate Labor and Human Resources, was elected governor of New Hampshire in 1988 and
re-elected in 1990. He is the son of Hugh Gregg, a fanner Republican governor of New
Hampshire. During his two tenns iri office, he showed a strong interest in and commitment
to environmental protection and econom-ic development .. He took a conservative position,.on
spending·and taxes.
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Senator Gregg was a member of the House of Representatives ·from 1980 until he assumed
the governorship of New Hampshire. He served on the Ways and Means Health
Subcommittee and voted along conservative lines. He was involved in the movement to
repeal Medicare Catastrophic. New Hampshire recently took flack in an article in the
Washingron Post where the staie shifted Medicaid funds to balance their state budgets.
Senator Gregg was Governor and said to approve of the plan.
.SENATOR ORRIN HATCH (R-U'I}- Senator Hatch is relatively new. to the Committee
having joined during the last Congress. He is one of the brightest Senators, but has yet to
really get a comfortable grasp of the Finance Committee. Although well known for his very
conservative philosophy, in recent ·years he has appeared to become more open to more
traditionally moderate approaches. ·For example, although close to the drug industry, he has
been willing to push them to be more responsive on pricing issues.
Up until 1993, he served as either the Chairman or the Ranking Republican of the much more
conflict-oriented Labor and Human Resources Committee. In this capacity: he became ·
extremely well informed about PHS, NIH, and FDA issues·. On health reform issues, he can
be expected to be very supportive of market:..oriented reforms to the health care· system. In
that vein, he will be extremely uncomfortable with employ~r mandates and discussions of .
global budgeting and enforcement . .He has introduced legislation to reform the medical.
malpractice system and sees it as an important means. for r~ducing health care costs.
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Recent DevelopmepJs: Senator Hatch has just hired a health care staff person straight from
Reagan/Bush DHHS. · It is unclear what impact this will have. on his willingness to be.
constructive on health care debates--more likely .to be negative. Sen. Kennedy, who is close
to l:fatch, believes we should· not write him off. He views Hatch as a potential coalition
builder between moderate Republicans and Democrats.
SENATOR MARK HATFIELD (R-OR)- Senator Mark .Hatfield, the senior Senator from
Oregon, is Ranking Minority Member on the Senate Appropriations .Committee. Senator
Hatfield is on our "Big 8" list, meaning he is one of our eight republican targets ..
Senator Hatfield is known to be deeply religious, and lias never voted for a defense
authorization bill. He was opposed to the Gulf war resolution;. as well as the alternative
economic sanctions. Hatfield is pro-life and we will lose· him if he perceives the plan to be
subsidizing abortion; However,-he did back amendments to allow family planning at Title X
. clinics. ·Senator Hatfield was a Republican co-sponsor .on the Family and Medical Leave .
Act.
Senator Hatfield would like to see the Administration stress medieal.research. He .believes it
is cost effective and is a worth while investment. He also has a concern about rural health
care delivery and medical education reform. State fl.cxibility will be a crucial to his vote.
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Along these lines, Hatfield is. pleased with the decision to approve Oregon waiver ..
SENATOR JESSE HELMS (R-NC) .-Senator Helms ..is arguably the mostconservative of
all the current Senators. .In ·fact, he has probably caught the ire of every liberal group· in the
country at one point or another. He· won re-election in 1990 in a racially charg!=d election ..
against Harvey Gant. Helms is th~ ranking member of the S~nate Foreign Relations
committee. He works hard to protect the tobacco farmers in North Carolina. It is probably
safe to put Senator Helms in the "no" ~egory.
~ENATOR
JIM JEFFORDS (R-VT) -Senator James Jeffords is a progressive Republican
. who has shown a fair amount of interest in health-related. matters. He has sponsore~ his own
bill (The Medi~e Health Act), a single-payer approach with 70% ·..federal financing. He
believes his is a unique approach and really hopes that the Administration considers his
· proposal seriously.
According to his staff, the main agenda item for Senator Jeffords this year will be the ERISA
preemption. This is an espeCially important issue for Vermont, which currently has a waiver
application in order to pursue comprehensive reform in the state. As· a result, he would also
like to see state flexibility built into a comprehensive reform in!tiative.
Senator Jeffords is an advocate ·of improvi11g access to health in rural areas. As part of health
reform, Jeffords believes there needs to be an emphasis on. primary care and efforts that
encourage providers to enter pri.mary care. He also favors ·loan deferment programs and
expansion of the National Health Service Corps (NHSC) which aim to address the provider
shortage issue in rural communities. Jeffords has ·raised questions regarding how managed
competition will effect the need for primary practitioners.
Jeffords has also taken an. active stance on lifting the ban on fetal tissue research, increasing
AIDS education, and eliminating the speCial market exclusivity for producers of orphan drugs
(drugs for rare diseases.)
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Recent Developments: Jeffords has been taking a lot of credit lately for the fact that the
President advises will be providing lots of state flexibili~y. This public credit-rating has
alienated Sen. ·Leahy. in particular because Senator I..Cahy believes he is the !ea~er in this area.
SENATOR NANCY KASSEBAUM CR-KS)- Senator Kassebaum is the new rariking- ·.
minority member of the Labor and Human Resources Committe~. As such,, she'll be ~orking
closely with Chairman Kennedy on many provisions the committee has jurisdiction over.
Kassebaum has taken a strong interest in health care reform and has introduced her own
reform bill, the BasiCare Health: Access and Cost Control Act (S. 325). This legislation
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provides tough cost cOntrols, focuSsing on controlling what insurance companies can charge
for premiums. She. wou.Jd· finance this bill through raiding the Social ·Security Trust Fund.
Whell the First Lady met· with the Senate Women's Caucus, Kassebaum pushed ~or a national
commission on abortion, like the base closure commission, so that. the members would have
one up or down vote on the .issue .
. She is very concerned about over-regulation.by HHS and the federal government generally.
Along with Senator Metzenbaum, Kassebaum authored legislation on orphan drugs; the.ir bill
· would have eliminated the current regime in which drugs for rare diseases enjoy special
market exclusivity for. the phanmiceutical.manufactUrer.
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While considered a moderate~ Sep. ~ebaum will toe the. pany line if she perceives an issue
is being politicized. If she· senses this is happening with health reform, we will have little
chance of winning her support.
Recent DevelopmeptS: · Her elderly mother lives 'at home, so Kassebaum as a particular
interest in long term care. We believe she is one of our top' Republican chances. She wishes
· to come. meet ,with you and Ira along w~th Sens. Danforth, Bums and Reps. Glickman and
McCurdy sometime next week.
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SENATORDIRK KEMPTHORNE (R-ID)- Senator Kempthome is a freshman member
from the State of Idaho.. He won the election and replaced retiring Sen. Steve Symms. idaho
is a very conservative state and one of the few states that have two Republican Senators. As
a freshman, it is not expected that he will break out of the pack and go against the
Republican leadership. Idaho is a frontier states like Wyoming, Montana and the Dakota's .
.The leadership of other frontier SenatorS like Simpson, Wallop, Cr~ig,.and Bums will
probably influence Kempthome.
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SENATOR TRENT LOIT (R-MS) -Senator Lott is from the State of Mississippi. He
was elected to the Senate in 1988, after serving in the House of Representatives. Senator LOtt
rose to the rank of Minority Whip in the House before moving ·on to the Senate. He has fit
into the Republican leadersh~p in the Senate. While in the House, he spearheaded a
combative and outspoken role for the minority, rather than the conciliatory, work within the
system longfavored by House Minority Leader Michel. Senator Lott is.an·obvious threat to
Dole, and may be one of the reasons why Dole has been so combatiye of late. As a result of
the defeat of the President's Economic Stimulus package, Dole has solidified his leadership .
position and has kept Lott at bay--for now.
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Lon is a partisan, ~ut is I)Ot afraid to go against the grain. He voted against the 1990 budget
deal, probably in pan because of his disli~e for John Sununu. ·· Lott has not made his health
views known publicly known, however; they are.expected ~o be conserVative.
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�SENATOR RICHARD LUGAR (R~IN)- Senator Richard Lugar is most known for his
work on foreign affairs. He is the former chair ofthe Foreign. Relations Committee, and is
widely recognized for his moderate foreign relations views, even though he was one of the
most ardent defender of the .Nicaraguan Contras. Lugar is a conservative, having a National
Journal rating of s·6% conservative on economic iSsues, 62% conservative on social issues
and 68% on foreign issues. As ranking member on the Agriculture committee, he helped
scale back the 1990 fann bill. some of which to the angst of Dole. Lugar has tried for years
. to become a more active pari of the leadership.
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His health views are not widely known. It is expected that they will be conservative,
watchful of rural health care delivery, and will probably follow Dole's lead: Even though
Indiana is an industrial state, he doesn't pay much heed to organized la~r.
SENATOR CONNIE MACK (R-FL)- Senator Mack was a Democrat until 1979 and a
· Republican Member of the House of Representatives from 1982 through 1988. In the House,
he was a member of the Gingrich crowd, taking full advantage of C-SPAN and railing
against the Democrats ·in Congress. A Reagan backer, Mack went to the Senate by touting.
his conservativeness: supply-sider, anti-choice (which he switched), support for the Contras,
and Gramm-Rudman. Mack won a narrow victory over now-Florida Lt. Governor Buddy
MacKay in 1988. Mack is up for re-election in 1994.
Mack has lost some of his ardent conservatism that won him. the Senate Seat in 1988. He has
a good working relationship with Graham. He is a strong supporter of Israel. He was
· oppased to Medicare Catastrophic in 1988, when everybody else loved it, and cashed in the
political benefits when sentiments turned.
He remains fairly quiet on health issues. Health reform may pose a difficult challenge in his
reelection effort. Aorida's recent state reform efforts may contribute to a pro-reform mindset
in the state. He also cannot ignore the huge senior citizen communities in Aorida. They will
undoubtedly scream bloody murder if there is any changes in Medicare or increases on
wealthy seniors without corresponding increases in benefits. If the plan includes prescription
drug coverage and long-term care services seniors support, his opposition could prove very
costly. At the same time, he has to appease Miami's Cuban community, which will want
expanded coverage for the poor and recent immigrants--they are also very conservative and
vote that way .
. SENATOR JOHN MCCAIN (R-AZ) -Senator John McCain of Arizona is conservative
with a career-military background. As a former prisoner. 9f war himself, he has focused on
the POW/MIA issue in his work on the· Armed Services Committee.
In the ·area'of health care, he sponsored the Children's Health Care Improvement Act of 1993
(S. 28), which seeks to improve the health of the Nation's children. He has also sponsored
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�the. Medicare Provider Payment Equity Act of 1993 (S. 31), which would repeal the reduced
Medicare payment provision for new providers. The Senator also co-sponsored Senator
Dole's Medicare reform bill.
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Senator McCain is siding ·with Senator Gramm in the health care rift in the Republican party.
As you know, there is a growing ideological debate among the Senate Republicans on how to .
·proceed on health care. On the one side is the Gramm-McCain groupwhich espouses the
use of Medical IRAs as a way to make health care available to consumers. On the other side
of the .debate is the Chafee side, which favors a more government-sponsored approach to
curing what ills our health care system. Senator McCain is sympathetic to the pharmaceutical
industry.
SENATOR MITCH MCCONNELL (R-KY)- Kentucky's.junior Senator, Mitch
McConnell, first came to the Senate on Reagan's coat-tails in 1984. He held his seat in a
narrow victory in 1990 in a widely Democratic state, by defeating a liberal physician running
for state-wide office for the fist time. Senator McConnell serves on the Appropriations
Committee, the Agriculture Committee; the Rules Comminee, and the Select Committee on
Ethics. He champions tobacco interests, arid opposed the 1990 Budget Agreement partially
. because of it's cigarette tax proposal.
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Senator McConnell is a co-sponsor of Senator Dole's Medicare reform bill. McConnell was
recently named head of the Bener.America Foundation,· which was developed to form
Republican positions on issues like health care reforin.
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SENATOR FRANK MURKOWSKI (R-AK)- Alaska Senator Frank Murkowski is
generally a free-market ·oriented conservative, supporting, for example, opening the Alaska
Natural Wildlife Reserve to oil exploration, an(;i ot~er forms of Alaskan development.
Senator Murkowski serv~s on the Foreign Relations Committee, the Veterans' Affairs
Committee (which he chaired in 1985 and 1986), and two committees erucial to Alaska:
Energy and Natural Resources, and Indian Affairs. Senator Murkowski won re-election last
fall by ·a 14 point margin.
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In the 102d Congress, Senator Murkowski co._sponsored Senator Hatch's Health Care Access
and Affordability Act.
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SENATOR DON NICKLES (R-OK)- Senator Don Nickles of Oklahoma recently won his
third terin to the Senate, and continues. to advocate the conservati~e views that brought him to
Washington with Reagan in 1980. Ht: has been very activ~ in setting the overall tone of
Republican policy as Chair of the Senate. Republican Policy Committee. On the Energy
Committee, Senator Nickles has actively sought increased energy exploration in places like
ANWR. In addition to his seat on Indian Affairs, Nickles also serves on two key money
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committees: Budget and Appropriations.
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Senator Nickles co-sponsored Senat~r Dole's Medicare reform bill. When asked for a point
of agreement between Republicans and Democrats, Senator Nickles said, "Stre.amlining and
. coordinating administrative costs in health care." [G<i.nneu, 12/18192] During his campaign
this fall, Senator Nickles emphasized medical malpractice reform and vouchers for people ·
unable to afford health insurance.
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SENATOR BOB PACKWOOQ (R-OR)- Senator PackwP<>d is an advocate of an
employer-based universal coverage plan.. He is the only Republican on the Finance
Committee that has publicly supported. an employer mandate. As a result, he finds himself. in
somewhat of an uncomfortable position with many in the Senate Republican leadership, who
vehemently oppose an employer mandate ..
During his campaign for reelection last fall, Packwood singled out' health care as an issue on
which he was closer to then-Gpvemor Clinton .than his opponent, .Representative Les AuCoin ..
He also attacked AuCoin's single-payer approach last year as a multi-billion dollar tax
.
increase that would result in a government run system. The primary criticism leveled again,st ..
PackWood's plan was that it didn't go far enough to control costs. Some aging advocacy
· groups also critici~d it for its lack of comprehensive long-term care·cov~rage. In Oregon, at
least, Packwood won the debate.
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Beyond the above-mentioned work, Senator Packwood ha5 had a ·notable health care career.
He has sponsored .quite a bit of. legislation dealing with rural health and long-term Care.
Specifically, he introduced a relatively extensive public/private long-term care bill in the
lOlst Congress: However, because it costed..:.out as a rather expensive initiative and 'because
the aging advocates were not enthralled with it, he decided to ~ick to Federal standards and
tax clarifications for private long-term care insurance poli~ies. In addition, working with
·Pryor, he introduced legislation that would provide. tax credits for primary care personnel to
· serve medically undeserved rural areas.
Recent Developments: At the Finance Committee meeting April 20, Packwood asked about
the structure and role of a tax cap and was interested in how much subsidies would be
required.
SENATOR lARRY PRESSLER (R.:.so)- Senator Larry Pressler is a mOderate to
conservative Democrat from the State of South Dakota. Known mostly for wanting.
Congressional reform, he has fought against pay raises and other issues that are popular back
home. Senator Pressler has a tendency to vote the ways the current political winds are .
blowing. Early in his career, he was knoWo as a liberal Republican, theri a conservative arid
is now known as a moderate Republican. Senator Pressler was narrowly re-elected to the ·
Senat.~ in 1990, and is expected tp face a ~trong challenge from the v~ry popular
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Congressman-at-large, Tim Johnson, next time around .. While. many negative articles written
about Pressler, much can happen in the four years.
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His health views are not widely known. And it also unclear whether he will fall tC? either the
Chafee or Gramm side of the current. Republican health . care debate..
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SENATOR WILLIAM (BILL) ROTH (R-DE)- Until the last couple of CongreSses,
· , Senator Roth was not known for his involvement in health care.. As Ranking Member of the
Government Affairs· Committee, he has had extensive involvement and interest in the ·
.Committee's Permanent Subcommittee on Investigation's inquiry into the multi-billion dollar
issue of health care fraud and abuse.
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More recently, Roth has actively advOcated that th~ Federal Employee Health Benefit
Pro~am, whi~h the Government Affairs Committee oversees, be extended to the working·
· uninsured and small businesses.. (This is similar· to, and builds on, a proposal that' has been
. championed by the Heritage Foundation.) Under this proposal, the self-employed and
working uninsured would have access to the FEHB. plans that were utilizing managed.
competition as a cost containment/quality assurance ·.mechanism. In so doing, these
individuals would have access. to the same rates that the insurers charge the federal
gove~ent and their employees for the benefits.
SENATOR AlAN SIMPSON (R-WY)- Wyoming's junior Senator, Alan Simpson, handily
won re-election in 1990, and currently serves in the Republican leadership as Minority Whip.
Simpson serves on the Judiciary Committee, the· Environment and Public Works Committee,
the Veterans' Affairs Committee, and the Special Committee on Aging.. He has taken partisan
positions on. issues.like the Clean Air Act and other environmental issues, but breaks with
many Republicans in his pro-choice stance. ·
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Senator Simpson rates the following as his top priorities: ~tate flexibility, rural and frontier
delivery problems, managed competition's applicability to.rural areas and incentives for
medical personnel to serve in underserved areas.
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RecerirQevelopment: Senator Simpson is currently siding with the Chafee-side of the
Senate Republican health care debate .. Nso in a letter to the First Lady ·in early March, he
was very complimentary about her meeting with the Republican Senators and her mastery. of
health care reform.
SENATOR BOB SMITH (R-NH) .;.. Senator Smith is the Senior Senator from the state of
New Hampshire. A former real estate.agent, he first lost his bid for Congress in 1980, lost in
the primary for Governor 1982 and finally won a House scat in 1984. Smith took over for
retiring Senator Gord~n Humphrey in 1990. Humphrey retired after serving two terms in the
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�&:nate, probably the only Republican pushing for term limits to actually hold t;ue to that
pledge.·
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He is knoWii as a conserVative who will toe the party line. He is deeply concerned about acid
·rain, and has worked h~d on that issue. However, acid rain is just about the only·issues ·
· where Senator Smith has strayed fr.om ConServatism. 'His health views are not widely. known,
but they are expected to be conservative~ Committee, ·and the Select Committee on
Intelligence.
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SENATOR ~N SPECTER (R-PA) - Pennsylvania's Senator Arlen Specter defeated
Lyon Yeakel last fall, despite the initial m()mentum generated by his opponent over the
. Senator's questioning of Anita HilL He pas long ·staked out claim to traditionally Democratic
issues, like support for labor and women's rights. He currently serves on the Judiciary .
Committee, the Energy and Natural Resources Committee, the Appropriations Committee, the
Veterans' Affairs Committee, and the Special Committee on Aging.
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During last fall's campaign, Senator Specter proposed a health eare .reform package focused
on preventative care, while increasing. federal funding for bealth_ care. He also touted his cosponsorShip of the "Health Care Access and Affordability Act' of-1992," a consumer choice
based .health care reform proposal. : ·
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SENATOR TED STEVENS (R-AK)- The senior Senator from ·Anchorage, Ted Stevens; is
very popular in Alaska. With Alaska's unusual r~lationship with the federal government,
Senator Stevens has taken an active role in matters related to federal employment, serving on
the Governmental Affairs subcommittee handling ~he civil.service. · An active legislator, ·
Senator Stevens serves on six other committees: Commerce, Appropriations,. Rules, Ethics,
· ·Intelligence, and the Joint Committee on the Organization of Congress. ·
Interestingly, Senator Stevens co-sponsored Senator Wellstone's Anti progestin Testing ~ct of
1993 (S. 222), which requires the Commissioner of Food and Drugs to collect· information
regarding the drug RU-486 and review the infQrmation to determine
whether to approve RU-486 fpr marketing as a new.drug. He also eo-sponsored Sen~ltor
Lautenberg's Preventing Our Kids From Inhaling Deadly Smoke (PRO-KIDS) Act of 1993
(S·. 261).
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Recept Deyelopme'pt: Senator Steyens appears to be siding with the Gramm-McCain
faction's health reform approach based on "Medical I~" and consumer choice.
SENATOR STROM THURMOND (R-SC)-: Senator Thurmond has not played a strong
role in health-related minters. The one area of health ·where Thurmond· has shown a strong
interest is in research .. He backed the NIH reauthorizat~on and supports fetal tissue research;
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He is also co~cerned about AIDS funding, which he thinks should be increased; he feels there
is an improper perception about funding imbalances between AIDS and other disease researt:h
activities. Thurmond has a daughter who is diabetic and testifies before the Appropriations
Committee on behalf of diabetes funding yearly. · He also supports m()re funding fot cancer
research.
Senator. Thurmond also has a longstanding interest iri alcohol education issues. He was the'
primary sponsor of the legislation which requires a Surgeon General's warning label on
alcohol beverage containers. He currently is advocating legislation requiring similar warnings
for alcohol advertising.
Thurmond has real concerns about the budget deficit and will interested in the impact of
refotm on the deficit.
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SENATOR MALCOLM WALLOP (R-WY)- Senator Wallop·was just renamed to the
Finance Committee this term. In h~s previous tenure (1979-1988) he demonstrated an interest
in rural health concerns but focused primarily on tax matters~ He is known for his very
strong conservative views. In the last CongreSs, he cosponsored the Republican reform bill
and Senator Hatch's bill to improve the medical liabilit)• system. He is very strong on state
flexibility, federal costs, frontier/rural issues, and adamantly opposed to employer mandates.
He has serious doubts about Managed Competition's applicability to serve rural areas.
Senator Wallop. wants us to be extremely cautious, because we can hurt far more than we can
· help. If there is one Member of the Committee we can almost certainly write off as a
possible supporter, it is Senator Wallop.·
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Recent Development: As you know, Senator Wallop was in attendance when you spok~ to
the members of the Senate Finance committee rc;cently but did not say anything.
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SENATOR JOHN W. WARNER (R-VA):- Senator John Warner of Virginia won
reelection in 1990 with no significant opposition, but has recently lost his position as Ranking
Minority Member of the Armed· ~rvices Committee to Sen. J'burmond. He has generally
taken conservative positions, but is pro~choice cind favors repeal of the Hatch Act. In
addition to Armed Services, Senator Warner serves on the Environment and Public Works
Committee, the Rules
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18
�Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
SUBJECTrriTLE
DATE
RESTRICTION
00 I. briefing
paper
Meeting with Senate Democrats at Democratic Policy Committee
Annual Democratic Conference (partial) (8 pages)
4/22/93
P5, b(6)
002. profiles
Profiles of Democratic Senators (6 pages)
nd
P5
003. inemo
Chris Jennings to Hillary Clinton
Re: Meeting with Chairman John Dingell (2 pages)
4/25/93
P5
004. memo
Chris Jennings to Hillary Clinton
Re: Congressional Leadership Meeting (I page)
4/26/93
P5
005. memo
w/attach
Chris Jennings to Hillary Clinton
Re: House Leadership and Chairman Meeting (6 pages)
4/27/93
P5
006. memo
Karen Politz to Chris Jennings
Re: House Leadership Meeting Agenda (4 pages)
4/1/93
P5
007. memo
Chris Jennings to Howard Paster, Steve and Lorraine
Re: Ways and Means Subcommittee on Health/ Interaction Meetings
(2 pages)
4/4/93
P5
008. memo
w/attach
Chris Jennings to Steve R.
Re: Republican Members and Staff Meetings/Contacts (4 pages)
4/9/93
P5
COLLECTION:
Clinton Presidential Records
Domestic Policy Council· .
Chris Jennings (Health Security Act)
OA/Box Number: 23755
FOLDER TITLE:
HRC Memos- HSA [2]
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Presidential Records Act- 144 U.S.C. 2204(a)l
Freedom of Information Act- JS U.S.C. 552(b)l
PI
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�------··-~----------
··~
THE WHITE HOUSE
WASHINGTON
April 22, 1993
MEETING WITII SENATE DEMOCRATS AT
DEMOCRATIC POUCY COMMfiTEE
ANNUAL DEMOCRATIC CONFERENCE
DATE:
LOCATION:
TIME:
From:
I.
SA'IURDAY, APRIL 24, '1993
JAMESTOWN, VA
8:00 pm Dinner
Steve Ricchetti
PURPOSE
To join Democratic members of the Senate. at a dinner during the
Democratic Policy Cotnrnittee's annual conference.
II.
I
BACKGROUND
This is the fourth annual Democratic Policy .Committee Senate Conference,
which is chaired by Senator Mitchell and co-chaired by Senator Daschle. ·
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The two day conference is an informal series of panels which examine
issues relevant to the legislative agenda. Forty-six of the fifty-seven
members of the Caucus will be attending, a record level of attendance.
See attached for background on Senators attending the Conference.
ill.
PARTICIPANTS
The First Lady
· The Vice President
See attached list of Senators.
IV.
PRESS PLAN
Oosed.
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SEQUENCE OF EVENTS
You will be participating in the dinner on Saturday evening at 8:00p.m.
One half hour into the dinner, Senator Mitchell will introduce Vice
President Gore. The Vice President \\ill make brief remarks. Senator
Mitchell will then introduce you, and you will make brief remarks (five .
minutes). An informal session of Q & A with Senators will follow.
VI.
REMARKS
See attached talking points.
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�TALKING POINTS FOR SENATE DINNER
- Thank you for all of your hard work on the major elements of our
economic package~
·
- Certainly we are disappointed with the C?Utcome of the vote on the jobs
·bill. I appreciate the fact that this Caucus stuck with us and that almost
everyone voted with us for cloture on the Mitchell/Byrd compromise.
- But I know that this is a long term game, we'll learn from this
experience and hopefully we'll be more help to you on our next initiative.
- We are approaching the hundred day mark of this Administration.
We've already accomplished a great deal in. three. months: Passage of the
budget in near record time, Family and· Medical Leave, and Motor Voter.
- We've also launched our reinventing government initiative, bave begun
to cut waste in government, have bad extensive bi-partisan consultation on
Russian aid, and made progress toward resolving an important regional
economic/environmental concern at the Forest Conference. Jllst last week
we introduced our proposal on educational reform.
- Next week we intencJ to formally introduce our initiatives on campaign
finance reform and national service. I will be working with you over the
next few months on reconciliation issues. A rapid completion of the
reconciliation bill is a high priority for me in moving ahead with the
economic plan.
·
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-- · In the next several weeks, the Health Care Task Force will be reporting
its recommendations to me. Many .or your staff have participated in this
extraordinary process ofdeveloping a comprehensive health· care reform
proposal.
- I am grateful for the work of your staff who have dedicated countless
hours to our effort.
· ·
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- I rely on your advice and counsel, and thank you for what you have
already done.
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BACKGROUND ON SENATORS
• Senator Akaka:
He has voted consistently with lis on the budgel
Senator Baucus:
He recently travelled with the First Lady to Montana for a
health care event. The Environment and Public Works
Committee, of which he is Chairman, had jurisdiction over
the EPA bill. The bill is pending and is scheduled to come
before the Senate on Tuesday for a vote. You should
reinforce that this is very important and that be protect the
bill, and stress to him that you want the bill left in its current .
form.
• Senator Bingaman:
He has invited you to come to New Mexico sometime in June
for a fundraising event. His wife Anne is in line for a
position (antitrust) at the Department of Justice, and we are
t.Jying to place her. He is very interested in defense
conversion issues.
Senator Boxer:
Her son,Doug, worked on the transition team and is now at
Legislative Affairs at HHS. She bas been very supportive.
She will likely want to talk to you about ca,mpaign finance
reform. specifically the proposed plan to eliminate bundling.
Many women Congressional Members are upset about the
effects of this on Emily's Usl
Senator Bradley:
He ba:s some pharmaceutical industry concerns· that be may
raise with you. iii connection· with the health care debate. · He
has asked for a meeting with you arid pharmaceutical CEOs
before the health care legislation is ouL He also bas concerns
and bas been critical about tax legislation.
Senator Breaux:
He was not satisfied with the Administration's.strategy on the
Stimulus Bill, and may communicate that to you. He is
. concerned we may be moving away from the "main stream•
message, which he believes, helped to secure your election.
He recently travelled with the First J_ady apd Senator
Johnston to Louisiana-for a health care evenL
Senator Bumpers:
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• Senator Conrad:
He is very concerned about the effects of the energy tax on
agriculture, particularly because of his bid for· reelection in
1994. We tried to accommodate him on some of those issues
in negotiations on the budget.. His wife, LUcy Calautt~ is
Senator Dorgan's AA. and was attacked on Capitol Hill last
year in a highly publicized mugging.
·
Senator Dascble:
He is the co-chair of the Democratic Policy Committee
(DPC), and is responsible for much of the weekend program.
The White House staff met with him this week to discuss
better coordination of White House message with the DPC.
· • Senator DeConcioi:
Senator Dodd:
Senator Dorgan:
He recently chaire~ a bearing on the White House budgel
Despite early skepticism, be is working with us on the White
House supplemental, over which he has jurisdiction. He
has asked for a grazing fee bearing to be held by the
Department of Interior in Arizona, a request that Secretary
Babbitt is prepared to grant. He has invited Vice President
Gore to attend a Washington D.C. fundraiser for him.
He may want to-discuss the effects of health care reform on
the coiiunercial insurance industry, much of which is based in
Connecticut He recently lost his well liked office manager,
Leslie Finn, to cancer.
· He bas requested a meeting with you regarding the taxation
of foreign businesses.. This request is pending.
·
Senator Exon:
There have been several occasions in which he vqted against
liS on the budgel He is a big St. Louis Cardinals fan.
Senator Feingold:
He is interested in overseas broadcasting consolidation
(dismantling Radio l.jberty and Radio Free Europe) and
thinks. we are backing away from this issue.
Senator Ford:
His daughter is \llldergoing chemotherapy for a recent
mastectomy. His committee bas jurisdiction over campaign
finance refo~ and be will be active in directing floor .
strategy for campaign finance reform. He is very concerned
about sin taxes, and may communicate his concerns.
Senator Glenn:
His committee has jurisdiction over reinventing government
proposals and over EPA ~binet level status. . .
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Senator Graham:
He is Chairman of the Democratic Senatorial Campaign
Committee. You should talk to him about Senator Krueger's
race and the Seriate Class of '94.
Senator Harkin:
His wife,· Ruth, has been appointed to head Overseas Private
Investment Corporation. ,
Senator Heflin:
In response to his concerns regarding the funding of a
fertilizer plant in Alabama, we modified the budget
successfully. He bas been helpful to us when we have
needed him on budget and stimulus votes. His wife's
nickname is Mike.
·
Senator Hollings:
He has been enormously helpful to us on budget votes. ·
Senator Johnston:
He travelled with the First Lady to Louisiana with Senator
Breaux for a health care event. He is concerned about the
completion of the Red River Waterway project ($ 1.8 billion
project) in Louisiana which was not funded for in the budget,
and inland waterway user fees. He also has strong
reservations on the energy tax.
• Senator Kennedy:
Try. to avoid discussing health care jurisdiction with him.
We are working with the Senate Leadership to work through
jurisdictional issues on health care. We have committed to
honoring a fundraising request in Massachusetts.
• Senator Kerrey:
He travelled with _the First Lady to Nebraska for a health
care event. He voted against us on amendments to the
Stimulus Bill.
• Senator Kerry:
As the former Chairman of the Select Committee on
• Senator Lautenberg:
Senator Leahy:
POW/MIA Affairs, be met with .General Vessey late this
week.
. He has some pharmaceutical industry concerns that be may
raise with you in connection with the health care debate. He
.is separated from his wife, and will be accompanied by
Bonnie Engelhart.
·
He said in the Wall Street Journal last week that be had not
been notified about Russian aid (see attached). Tony Lake
did notifY him.
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Senator Levin:
He may raise his concerns over CAFE standards and auto
emissions with you.
• Senator Lieberman:
He will probably bring up the Seawolf submarine issue with
you. We have committed to honor a fundraising request in
Connecticut, though the date is not yet set.
• Senator Mathews:
He voted consistently with us,:although he is considered to be
a deficit hawk.
• Senator Metzenbaum:
His daughter, Shelly, was· recently appointed to a top position
at the EPA We have thus far unsuccessfl.tlly tried to place
her husband, Steve Kelman, iil numerous agencie~ Senator
Metzenbaum .this week gave a fiery speech on the Senate
floor in opposition to the increased funding of the
intelligence budget.
Senator Mikulski:
You should avoid discussing the issue of her Appropriations ·
Subcommittee (VA, HUD and Independent Agencies)
gaining jurisdiction over National Service. (The decision will
ultimately be made by Senator Mitchell).
·
• Senator Mitchell:
We have accepted his fundraising r_equest in Maine on June ·
19th.
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Senator Moseley-Braun:
·Congratulate her on her engagement to Kgosie Matthews
(Pronounced Josie, with a Spanish •j). She bas consistently
supported us.
• Senator Moynihan:
He recently had a very productive meeting with the rll'St
.Lady. We are planning to set up a one-on-one meeting with
you and Senator Moynihan regarding reconciliation the week
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Senator M\lftay:
She bas been very helpful to us. As a former kindergart~n
teacher, she is particularly. concemed.with children's issues.
Senator Nunn: ·
He met with James Lee Witt this week to discuss his
disappointment with the FEMA declaration in Georgia.
FEMA did not declare affected areas in Georgia a major
disaster, because it did not meet those standards. Georgia is
contesting this decisio~ which was announced in March.
FEMA is likely to tum down the appeal. (There have been
no instances of overtUrning a. FEMA decision in· this
�Administration. Overturning of a FEMA decision has
occurred only a few times in the last decade).
Senator Pell:
He is interested in Russian aid, and is wary of a military
solution to the situation in Bosnia.
Senator Pryor:
Senat.or Reid:
He has been very supportive of us. He is concerned about
the Yucca Mountain nuclear waste repository. He and ·
Senator Bryan recently met with Mack McLarty regarding
their concerns· about Indian
· He was a ................
Policeman while in law school
• Senator Riegle:
He has requested a meeting between the Michigan
Congressional Democrats and Cabinet level agencies which
have jurisdiction over auto issues. This meeting will be
taking place soon.
·
• Senator Robb:
We just recently agreed to sign a fundraising letter for him.
l)le letter should be on your desk in the next few days for
signature.
·
Senator Rockefeller:
He has been very helpful to the First Lady in the health care
realm. He met with her this week.
• Senator .Sarbanes:
He has been eXtremely helpful to us on the economic
package. He is very concerned about the reductions for
federal employees in the budget, but bas not yoiced this
publicly.
Senator Simon:
He is very interested in a balanced budget constitutional
amendment.
Senator Wellstone:
He has been supportive of us.
• Senator Wofford:
We have committed to honor a fundraising request in
Pennsylvania, although the date is not yet set
Note:
• marks Senators who are up for reelection in 1994.
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he introduced a liberalized Medicaid managed care measure that the NGA strongly
supported. (This legislation· was opposed by the Children's Defense Fund because they
felt that savings through this cost containment approach would be at the expense of the
Medicaid population).
Recently, the Chairman and his staff have been rather pessimistic about the chances for
health reform this year. The complexity, controversy, and potential expense of it frighten
them. The Chairman, in comments that have been somewhat retracted by staff, has
indicated his concern about any large new taxes to fund the program and any use of
price controls to contain ·costs. Although be baS s,tated to you his Willingness to raise
whatever tax is necessary for the elimination and integration of Medicaid into the new
system, as well as a one card for all system, his nervo~ statements should not be totalJy
written off.
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Senator Moynihan's most recent communication was in a letter to the President, in which
. he reiterated his strong support for a health security eard and in which he proposes the
idea of merging the health card and Social Security card into one. In the letter, he also
expressed his strong concerns that the Social Security Commissioner bas not yet been
appointed.
Recent Developments: At your meeting this week with the Senate Finance Committee,
Moynihan was among those who agree not to rush this thing. He expressed the view that
the Administration should take more time if needed to do it right.
. SEN. PATrY Ml.JRRAY (D-WA)- Senator Murray was a state senator before being
elected to the U.S. Seriate this past fall. She serves on the Budget, Appropriations and
. Banking committees. As a former state legislator, she will be sensitive to ensuring state
flexibility, especially in light of the Washington state legislative health care initiative.
·While she bas not taken on a public position on a particular health plan, she bas
indicated she will likely support the President as long as it extends coverage and allows
for state innovation.
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Sen. Murray is an advocate for· women's health, including extreme concern about breast
cancer and screenings. She also strongly backs long-term care as part of reform. She is
very concerned about eliminating pre-existing conditions exclusions. Senator Murray will
soon introduce legislation (similar to Congressman Reynold's bill) designed to raise the
excise tax on firearms and earmark the revenue for health care.
SEN. SAM NUNN (D·GA)- Senator Nunn is known more for his Armed Services
.committee work, than for health care.. Treatment of CHAMPUS and other Department
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of Defense health programs under the reform plan will be a major concern. Senator
Nunn hasn't taken a position on a type of plan. However, he is extremely opposed to
employer mandates. In fact, the Senator states that President Ointon has assured him
the plan will not include employer mandates. He is strongly in favor of tight .entitlement
caps. He is unsure how a global budget will work on private spending. As the Senator
. from Georgia, he also has strong rural health concerns.
Recent Developments: Nunn co-chairs a Commission which will soon be making
recommendations on health care reform along the lines of managed competition.
Reports are that they are leaning towards an individual mandate and it is likely that they
will not support even temporary price controls. It is unclear whether they will endorse
the concept of universality.
·SEN. CLAIBORNE PELL (D-RI) - Senator Oaibome Pell is the most senior member of
the Senate Labor and Human Resources Committee and a long-time advocate of "cradle
to grave" health coverage. On health care reform. he is not an ideologue and is not
committed to any method of refonn. In 1972, he joined in introducing legislation which
would have mandated employer-based health care reform. As a member who has been
worlcing on the issue for sometime and would be joyous to see actual progress..
Because of his well-to~o elderly constituency, Senator Pell voted to repeal the
Catastrophic Health .Care Reform legislation. This is significant because it may.indica.te
that a prescription drug benefit that most well-to-do elderly already have will not be
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adequately responsive to an influential constituency of his. This helps explain why
Senator Pell's top health care concerns include coverage. for long-term care [Rhode
Island bas one of the highest percentages of elderly of any in the cOuntry] and preventive
services [be is opposed to smoking and baS sponsored legislation to provide grants to
states for health promotion programs] and expanding the use of non-physician health
providers. . He also interest in studying other country's health care systems and taking
·
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SEN. DAVID PRYOR (D·AR) • Senator Pryor is part of the Senate leadership (Secretary ·
of the Democratic Conference). As the Chairman of the Senate Special Committee on
Aging, he is well liked and respected by the powerful agmg advocacy community. In
addition, he is one of the few Democrats that the small busi~ess community genuinely
trusts. Further, his status as a former Governor and his advocacy of state-based
approaches to comprehensive reforms has gained him a great deal of good will with the
Governors. Although an unassuming Meml>er and one who does not get overly involved
in detailed policy discussions, he has also emerged as. one ofthe most jnfluential and
best liked Members of the Senate. All of these roles ensure that he will be a particularly
key player on the health care front.
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�In terms of health care priorities, drug cost containment is the first, second, and third
highest priority for Senator Pryor. The concept of linking drug cost containment to tax
credits (embodied in Pryor's Prescription Drug Cost Containment Act -- S. 2000) was
endorsed by President Ointon.
·
In addition to his drug cost containment interests, he also has a notable legislative
achievement record in rural health (relief for hospitals and incentives for primary care
doctors in. medically underserved areas), state-based rt~form (his NGA and Clinton
· candidate-endorsed Leahy/Pryor bill), and long-term care. (his proposal for Federal
standards for private long-term care insurance policies).
·
Recent Developments: At the Finance meeting April 20th, Sen. Pryor supported the view
that more time should be· taken to assure that you do it righl He backs the use of a.
dedicated tax for health care, perhaps a VAT•. He also backs the inclusion of a longterm care benefil He believes that as long as we will be spending billions of dollars, we
should make certain that it attracts popular support for the plan. You may wish to
acknowledge receiving the testimony Senator Pryor sent to you from the. hearing he held
recently on long-term care, particularly that of the 10-year-old which you found so
moving. Also Senator Pryor bas scheduled a hearing on May 6th focusing on individual
responsibility, You are currently scheduled to attend a b~eakfast he is holding
beforehand.
SEN. HARRY REID (D·NV) - Senator Harry Reid is inhis second term in the Senate.
Traditionally not outspoken on health issues, he spends most of his time with his ·
Appropriations and Environment and Public Works conunittees. He has yet to take a
position on a particular reform model. He is waiting to see what the HCfF and the
President have developed. The Senator stresses rural health issues, and wants lead
screening emphasized. Concerned about mandated benefit packages, because he
believes they have not worked at the state level. · He is also worried about the iinpact of
reform on physicians' earnings.
·
DONALD RIEGLE {D-MI) ·Senator Riegle considers himself to be a major player in
the health care debate. He is Chairman of the Finance Subcommittee on Medicaid and
was a lead sponsor of the Mitchel~ Rockefeller, Kennedy "play or pay" health care
reform proposal. He bas always felt be did not get adequate credit for his work on the
bill. Although he sponsored this bill, be appearS to be extremely willing to sign on io
virtually any approach that achieves universal coverage and cost conta~ent.
Senator Riegle is very interested in many health issues, including: child immunization
programs, rural health care, Medicare prescription drug coverage, retiree health liability
concerns, long.;.ierm care, and a host of others. Senator Riegle strongly believes that cost
containment savings should be used to help reform the health care system -- NOT for
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deficit reduction.
Most recently, Senator Riegle has pushed his outreach efforts with the Medicare
Qualified Medicare Beneficiary (QMB) program. The QMB program pays for the
deductibles, prentiums and copays of low-income Medicare beneficiaries. Unfortunately,
only about 50 percent of the eligible population receive the benefit. This program,
because it is partially underwritten by the states, is one of the most unpopular benefits
that the states support. (Most of the states believe there are higher priorities). At any
rate, Senator Riegle has introduced legislation to expand outreach efforts at SSA offices
and other areas. (The Administration has not yet take.n a formal position yet).
Recent Developments: At the April 20th meeting With the Finance Committee, he stated
his interest in looking at longer budget periods than five years (be can't understand .why
we are a1ways locked into a five year budget plan). · He believes it is important to look at
national, not just federal, spending because most of tile savirig will come from the private
sector. He also felt that we needed to look at and change the language used to explain
the plan.
SENATOR CHUCK ROBB (D-VA) ·Senator Robb believes that cost-containment is the
key and that it should be stringent He has not taken a position on any particular health
plan, but likes what he bears so far from the Task Force. He is likely to be supportive.
He was an active member the Mitchell working group and was comfortable With its
overall approach. Also, he was a member of the National Leadership Commission on
Health Care .which predated the National Leadership Coalition. Senator Robb is up for
re-election in 1994.
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. SEN. JAY ROCKEFELLER (D-WV) • Senator Rockefeller views himself as being (and
is) Bill Clinton's number one health care advocate: He was a tireless campaigner and
defender of the Clinton health care plan and was a National Co-Chair of the Ointon
campaign. Rockefeller is the eurrent Chairman of the Finance Subcommittee on
Medicare and Long Term Care. He also bas chaired the Pepper Commission and the
·
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National Commission on Children.
In addition, Senator Rockefeller is the founder and Chairman of the Alliance for Hea1tb
Reform, a nonpartisan organization dedicated to advance health care reform through
education of public opinion leaders. Lastly, as you well know, his is now serving as the
new Chairman of the Senate Veterans Committee.
·
•
·Senator Rockefeller's health care priority is very simple: He desperately wants to see a
comprehensive reform package enacted during the Clinton Presidency. Although he
thinks the long-term outcome of such an achievement is politically attractive, he is
primarily pushing this reform because he is sincerely committed to the need for r:eform.
In this vein. he is not overly committed to any one particular approach although he has
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advocated an employer-based approach. He, therefore, can be counted on to support
virtually anything the President ends up proposing, as long as it achieve~ universal access
and cost containment
·
Senator Rockefeller was very pleased with the Veterans' meeting last Thursday. He was
concerned about the AP story the day after, but from the beginning did not believe it
was true.
Recent Developments: At his one on one meeting with you he was upset with Gore,
Bentsen, Panetta who he thinks are less than supportive of reform. He thinks Moynihan
can be brought on board. He urged using. the phone more to increase contact with ·
members.. He felt that of the Finance Committee Republicans that we should go after
Chafee, Danforth and Durenberger (He seemed less confident about Packwood). Will ·
play the heavy on taxes with the public, press, and members~. It may well be worth
reiterating your desire to meet with him on a substantive level over the next few weeks.
SENATOR PAUL SARBANES (D-MD)- Senator Sarbanes is in his third term and is up
for re-election in 1994. He originally supported Kennedy's Single Payer plan in 1972. but
realizes it won't work today. Currently, he is not committed.to a specific approach and is
open to different options. He has a wait and see attitude on the HCfF deliberations.
but he wants to help Clinton and will support Mitchell, Rockefeller and the. Democratic
Leadership.
·
SENATOR PAUL. SIMON (D-IL)- Senator Simon is very interested in health care
reform, and leans toward a single payer approach but also cosponsored the Leadership's
Health America bill. He is close to organized labor and sponsored amendments to
strengthen the cost containment provisions of HealthAmerica proposed by the AFL-CIO.
He has also been one of the Senate's strongest advocates {or long-term care and has
cosponSored many bills in this area. He is very interested in children's and minority
issues. He bas a long standing interest in education issues, particularly higher education.
He is a strong supporter of increasing enrollment of minorities in health professional
schools.
·
Recent Developments: Sen. Simon recently met with Robyn Stone and reiterated his
avid support of a significant long-term care plan. He cites his Senate campaign in which
he advocated comprehensive long~term care legislatioQ which outlined specific tax
mechanisms. This plan received~ great deal of support in the state, so much so that his
opponent then-Secretary Lynn Martin pulled ads attacking the tax because they were so
negatively received.by the electorate.
SENATOR PAUL WELLSTONE (D-MN) ·Senator Wellstone is very interested in health
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care reform. In March, he reintroduced his single-payer bill,. the Senate counterpart of
the McDermott bill. Despite his strong bias toward single-payer and his suspicions of
managed competition, he has expressed a willingness· to work with you. His strong desire
for reform and his belief that we must act now make him likely to support the
Administration plan. He has a strong interest in mental health and substance abuse
benefits. He modified his previous bill to strengthen its mental health provisions. Other
concerns include niral health, consumer choice and state flexibility (so that Minnesota
might pursue a single payer option).
·
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Recent Developments: Indicated concern regarding talking points distributed by the Task
Force to the members of Congress particularly how single payer was characterized.
SENATOR HARRIS WOFFORD (D·PA) ·Since his Senate race victory which was widely
attributed to his support of health refon:n, Senator Wofford bas actively pursued this
issue in the Senate. He is part of the group of five (with Dascble, Baucus, Kerrey and
Bingaman) on a single financing state implemented health system with a national health
board approving state plans. Employers and individuals would pay a progressive
premium to a fund which would go back to the states on percentage basis. The original
Daschle-Wofford bill was called the American Health Security Act, partially because
Wofford believes so strongly in the importance of the success of the Sodal Security
system. He qelieves that his proposal took into account a middle road betWeen the
single payer and managed competition crowds. He believes everyone should be required
to participate in the Health Al.liances (no opt-outs), that the program must be state of
regionany administered and the long-term care coverage is essential. He bas previously
expressed concern over what be felt was the lack of discussion by the .Administration of
long-tenn care in connection with reform.
He is working with the Democratic Policy Committee health working group and is
looking at the health insurance purchasing cooperatives and how they could work. He is
very intellectual and savvy about how difficult some of the concepts are to comprehend
by the public. For example he dislikes intensely the term "global budget, believing that it
is too large to understand and turns people off. He believes that Clinton and Congress
must do a lot of educating on health care reform.
Recent Developments: It bas become clear to the Senator that hiS election is tied to
Health Care Reform. He will be very helpful. Language use to describe and sell the
plan are very important to him. He is very appreciative of your attending his forum in
Harrisburg earlier this year.
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DETERMINED TO BE AN
ADMINISTRATIVE M.ARKlNG
INJ.TIALS: LJJ. OAT;:.::~· 2Y,tS
--~
PERSONAL
AND~QKFIDENiiRL•MEMORANDUM
ri!lf.j.' '·
TO: · Hillary Rodham Clinton
FR: Chris Jennings
RE: House Leadership and Chairman Meeting
cc: Melanne, Steve, Lorraine, Ira
April 27, 1993
. Attached is Lorraine's memo to the President preparing him
for tomorrow night's health care dinner meeting with Speaker
Foley, Dick Gephardt, David Bonior, Barbara Kennelly, Dan
Rostenkowski, John Dingell, William Ford, Pete Stark, Henry
Waxman, and Pat Williams. This meeting, like the Senate retreat
and all the Congressional Leadership Meetings with the President.,
has the potential to turn the Members around from quiet naysayers
to strong advocates who can influence the rank and. file.
BACKGROUND
The feedback from today's meeting with the House and Senate
Leadership (from senior level staff) has been very positive. The
President and you have apparently succeeded in getting the
Leadership (at the very lea~t, Mitchell and Gephardt)
significantly invested in strategizing as to how best to get a
health reform bill passed.
If tomorrow's meeting with the rest of the House Leadership
achieves the same result, I believe the President and you will
have made important headway towards making health care reform an
initiative the Leadership and Chairmen WANT to pass -- not HAVE
to try to pass.
The two goals of the meeting are the same as always: First,
it is important to illustrate your understanding. 9f the
difficulties the Leadership faces in passing the, ·reconciliation
bill. Second, to emphasize· the commitment to pass health care
and the need for their assistance in order to accomplish this
goal.
One last bit of advice. It is also the same old tune:
Encourage and make a point of allowing a lot of time for the
Members to talk and give political advice. The worst outcome of
tomorrow's meeting would be for any one of the Members to be
silent for the night. Keep them talking and I am sure the
meeting will be a great success.
�.,--~-~-----'------------~----~-~-·---
... ·--------
THE WHITE HOUSE
WASHINGTON
April 27, 1993
HEALTH CARE DINNER WITH HOUSE MEMBERS
DATE:
LOCATION:
TIME:
FROM:
I.
April 27, 1993
Old Family Dining Room
a:oo pm
Lorraine Miller/Chris Jennings
PURPOSE
You wiil meet with ten Members of the House Leadership,
including the Chairmen and Subcommittee of the three primary
Committees of jurisdiction ove~ health care. The purpose of
this meeting· is to ascertain the willingness of these
Members to work together to pass a your health reform
initiative this year and to invest them in a strategy and
time frame to do s_o.
II •
BACKGROUND
Tomorrow's meeting builds on the discussion you held today
with the Speaker and the two Major.ity Leader$. Just as you
engaged the senior Congressional Leadership in your efforts
to pass health reform, the goal of the dinner meeting is to
do the same with the Members who must get the legislation
out of their Committees in a timely manner.
This meeting has the very real potential to set the tone for
the type of cooperation the Administration will receive in
its efforts to gain prompt consideration and p~ssage of your
health reform bilf. Similar to today's meeting, we believe
that tomorrow night's discussion will focus predominantly on
the problems of the introduction of a -health care bill could
cause to the prospects of the passage of reconciliation. In
addition, the Members will likely focus on the bottom-line
issues of cost and financing. They will also test to see if
you have the commitment and understanding .necessary to work
this complex and controversial through the Congress. They
may also want to see if you have the public message, as well
as the policy substance, necessary to incite the public to
push the Congress forward.
A successful meeting would invest the Members into the
process of strategizinq about the best time for introduction
of the bill, the timeframe for hearings and mark-up
(including Rules Committee consideration), and the most
opportune time for positive action on the House floor.
�··~~.:.-~·-·- -~-
• -
--~ · - .. --·--·--·-~-·-··-·--· .. ----·-·---------·-~------: ...... _
.. _ .
_ , , . . ,., . . ..J, ................... _ . . . _ _ . . . _ . . _ ..
_,_~--·-··-··-·
In addition, to timing strategy, the Members will want to
give their advice on how to gain the necessary political
support for the legislation through the policy development ·
process. Like most Members, they prefer to. talk, ·rather
than listen, and you should probably invite as much advice
and·guidance as possible.
III. PARTICIPANTS
(See·attached list).
IV.
PRESS PLAN
Closed·press.
V.
SEQUENCE OF EVENTS
*
*
VI.
President and First Lady enter Dining Room for greetings.
Dinner and Discussion Commences
REMARKS
*
•
Health care reform is a priority for me, and I believe
it is in both our economic and political best interest
to pass it this year •
*
Legislation of this magnitude obviously cannot pass
without the cooperation, guidance and supportof all of
you. I wanted to take this opportunity to tap into
your resevoir of experience about both the process,
politics, and substance of health care.
*
You all have been working on this issue for years and
years. If fact, some of you (Dingell) have beeri
working on this issue for decades.
*
I am well aware of the concerns abo~t the.potential
problems of introducing health care too soon to the
deliberations on the reconciliation package. However,
I do not want this potential problem to'unnecessarily
block progress on passing health care this year.
*
I need you to build on the assistance you have already
provided to the First Lady in developing a passable
plan in the first place. I need your help to develop a
legislative strategy that will work to secure passage
in the Ho.use. I need your assistance to work the ·bill
through the Committee process. I need your help to
gain the rank and file support necessary to pass this
bill. And I need your.help to place pressure on the
Seriate to do the same.
••
�.• ·
'
• ~·· ·.·--;;--.·..;-·~;;:;.:;; •• _\ __ ~ ...... --·····-~·-_· ... ~- · - . --·-··-·· .. ''"';"'~-:;-':"':'''"";"~'.""'7"7'"..,..-;;;:;";;-;.~~--.;-- .••--;-··,·
•· • • . •
'
PROFILES- HOUSE DEMOCRATIC LEADERSHIP
April 27,1993
SPEAKER ,TOM FOLEY (Speaker or the House)
For some time he has been saying publicly how he doubts that it can be passed this
year. It part this can be viewed as a reflection of signals he is picking up from the, members.
However, it should also be noted that health care reform has never been a priority issue for
the speaker. But he, certainly wouldnn't stand ,in the way of reform if he thought there was ,
sufficient support for it. He supports the use of a VAT if needed as a financing mechanism.
REP., DICK GEPIIARQT (Majority Leader)
The House Majority Leader has be;en a strong supporter of the health care reform
effort. He was very pleased with today's (4121) meeting. He will work the committee to pass
reconciliation quickly to remove any obstacles with regard to the health bill. He is pleased
that the tax requirements for .funding the health legislation are not as large as he has been
reading in the paper.
'
REP. DAN ROSfENKOWSKI (Chairman, House Ways and Means Committee)
•
Last Congress, Rostenkowski introduced an employer-b~ed, global. budget universal
aecess plan. It was more an initial attempt to enter the health care debate than any deep
commitment to the approach. His primary concern will be protecting the jurisdiction of his
committee rather than the details of the plan itself. Lately, he has been one of the members
preaching to take the time to ensure the plan is done right, even if it means missing the
deadline. He wants health care reform but remains to be seen whether he will go to it with
the enthusiasm he brought the 1986 Tax Reform Bill. There are some who feel he may be
playing down the possibility of passage this year so that he can come to the rescue, as he has
done in similar situations in the past.
REP. PETE STARK (Chairman, Ways and Means Subcommittee on Health)
For sometime Stark has backed a single-payer ,model for health care reform based on
extension of Medicare to the entire population. As vice-chairman of the Pepper Commission
he voted against its pay-or-play plan -- partly because it was not a single payer plan but ,
more importantly because in his view it made concession to more moderate to conservative
elements of the Commission without winning their support.· Stark recently released a letter
from the Director of Cal Pers (the insurance plan for California Public Employees) in which
the Director denied that his approach was managed competition. His behavior is often
unpredictable. However, he respects Rostenkowski and will be unlikely, to go against his
chairman.
,
'
�..
REP. JOHN DINGELL (Chairman, House Energy and Commerce Committee)
Chairman Dingell has been reintroducing his father's single-payer bill since be first
arrived nearly 40 years ago. However, like Rostenkowski, he is likely to be more concerned
by jurisdictional issues than the details of the plan. hi meetings he has expressed his view
that the plan should guarantee universal coverage to acute care services with state flexibility
to develop their own plans. He thinks the plan should also inciude cost containment,
malpractice reform and coverage for preventive services including family planning. He wants
reforin passed this year and was upset .by recent comment from Director Panetta.
.
REP. HENRY WAXMAN (Chairman, Energy and Commerce Subcommittee on Health
and ·the Environment)
Rep. Waxman is one of the most well-versed members of the Congress on the details
of health reform issues. His primary concerns will be assuring universal coverage as quickly
as possible and barring against substandard coverage for poor and low-income individuals.
To that end he will be wary of any plan that gives states to much flexibility and will push for
speCific federal standards. ·
REP. BILL FORD (Chairman, House Education and Labor Committee)
As a representative of a heavily industrial district in Michigan, Rep. Ford is very
concerned about the impact of health reform on the U.S. Auto industry, their workers and
retirees. Not surprisingly, he is a strong advocate for focusing on strong cost Containment, a
position adopted by many unions and big manufacturing corporations. He Ca.n also be
expected to oppose a tax cap on insurance benefits or any other proposal which might
·undermine negotiated union benefits. Like most Committee Chairs, he will be protective of
his jurisdiction and will want to be reassured that his committee will not take a back seat to
the Ways and Means and Energy and Commerce Committees.
REP. PAT WILLIAMS (Chairman, Education and Labor Subcommittee on LaborManagement Relations)
·
Williams is Chairman of the Education and LabOr Subcommittee dealing with ERISA
and Labor issues (including employer requirements). He wants his subcommittee and the full
committee to be taken seriously as one of the three Committees of jurisdictions, a full partner
with Ways and Means and Energy an Commerce, He is open to any option for reform as
long as it is comprehensive. The House Leadership has him on th.eir safe list, but he should
be given enough attention to make sure he is happy. His recent trip to Montana with the
First Lady should have gained some good
although he m~y harbor. some bruised feelings
over his perception that he was excluded from initial planning discussions about the trip.
will
�,.----------~-----
-------------------------------
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__ ______ ___-_----....
.-._---:_·-.-.. -..-....-_.-_-..... -.
. - ---------·-.-..
~~;-_
- - -
----------------,
_-_-
-.--.- .... ..- . ... . .
...-..-.. ..-__
REP. DAVID BONIOR. (Majority Wbip)
The First Lady met with Rep. Bonior today. He reiterated his strong support and
commitment-to passing health reform this year. Bonior_is one_of the most accurate vote
counters in the House and one of the most effective Whips in a number of years. He will be
critical to assuring sufficient votes on ~he House Floor in final passage. He has major
coneems, however, regarding abortion. He bas indicated to others that be would have
difficulty lobbying for a bill that includes abortion services unless it can be separated out is a
separate component of the legislation.
REP. BARBARA KENNELLY (Deputy Majority Wblp)
As a representative of Hartford, Cf, the insurance capitol of the United States, Rep.
Kennelly will be sensitive to the impact of reform on the insurance industry. She is
considered an expert on tax issues, particularly the taxation of insurance benefits. ·Despite her
insurance concerns, she wants health care reform. She Can be a valuable ally both with the
Congressional Women's Caucus and the House's Old Guard.
3
-'.
-_- - - - ,
�- _..
.•
April 1, 1993
mc>IW!DUM
T.O:
FROM:
REs
·Chris Jenninqa
Karan Pollitz
··aouae leadership meeting agenda
At your·request, this memorandum ~eviews the issues we
discussed.last night with staff to the House leadership and
Committee and Subcommittee chairs in preparation for the health
care reform·d~scusaion scheduled for tomorrow morning at 9:0~.
Attending this .meeting will oe speaker Foley, Majority
Leader Gephardt, Majority Whip Bonier, and Chairmen Rostenkowski,
Dingell, Ford, Stark, Waxman, and Williams and their staff.
As expressed by staff, the House leadership has strong
expectations for the content and' outcome qf tomorrow's meeting.
In order to be responsive to the concerns they have raised, the
discussion should focus on some key areas:
1. The lea~•rship naa4s to hear voioa4 a olear statement of the
President's intent to enact health care r•form this year.
This statement is most appropriately expressed by Howard
Paster as the President's senior liaison to the Congress.
While
the House leadership has appreciated. their meetings w~th Ira
Magaziner and Judy Feder on ~he policy of health care. reform,·
they strongly desire a serious discussion w-ith Howard on the
·politics or health care reform. In particular,. some have been
concerned that the decision not to include health care reform in
buaget reconciliation may signal a wavering of the President's
·intention to enact health reform in 1993. A restatement of the
President's commitment by his senior co~qressional advisor is
important. '
·
2. The leaaership woul4 appreciate a aub1tantive 41acuasion of
the timetable anc! strategy for enactinq health oare reform.
This discussion is impor.tant for several reasons. First
because the timeline for.House action is necessarily short, the
Committee chair111en will need specific instructions from the White
House and the House leadership on expedltinq consideration of. the
President•s·health reform bill. They would like to discuss the
practical problems that· will be taced in meeting such short
..
deadlines and how best to address these. Howard has discussed a
tarqet,date of Labor Day for House passage of health care reform.
This permits roughly ten weeks for House commit~e~.and floor
consideration, unless a shortening or cancellation. of the August
recess is contemplated. In addition to reviewing the feasibility
\
�W l,l,l.JI'''"'•"'n
...
• ..,,,....;..,,.. •• ,
••••
;
. ..
.
.,
paqe 2
of this schedule, the leadership also would appreciate Wh~te
.
Hous~ acknowledgment'of the enormous workload these·Committees
will need to undertake in order to enact both Reconciliation and
health care reform this year.
second the leadership would llke soma discussion of the
anticipated Senate strataqy and timetable. They are concerned
that delays in senate consideration increase time pressure on the
conference committee and political pressure on House. conferees to
recede.
Third the First Lady's absence durinq the·past three weeks
has ·hindered the Administration's process somewhat. The ·
Leadership wonders whether this will result in an extension of
the .President's May 3 deadline, If a two-week delay appears
inevitable at this point, ·it would be appropriate to inform the
leadership· at this· meeting.
3. · The leadership would appreciate discuaeion ot the
relationship l:Jetween budget reoonC?iliation and health oare
retorm.
In addition to the timing problems of completinq·conference
on budqet reconciliation as the President's health reform plan is
announced, the leadership has ·genuine c-:>noerns about the
political link between these two bills. First concerns nave been
expressed by Reps. stark and Waxman and others·over the
similarity between many of the Clinton Medicare and Medic~id
· budget proposals to earlier proposals by the Reagan and Bush
Administrations. several in particular (bundlinq inpatient
physician services into hospital payments, reducing payments to
for-profit nursinq homes, reducing payments to .teachinq ~
hospitals) have been considered and rejected by Congress in the
past. Further these proposals create political problems for
Committee members who are protective of those provi~er interests.
..
.
Second many in the leadership are concerned that focused
interest group opposition to the targeted budget.cuts will be
intense, slowing consideration of budget reconciliation. (It is
noteworthy that sorne·of this opposition is anticipatory and has
not yet materialized.) The.leaaership is also concerned that the
reconciliation conference will be· underway as the health reform
package is unveiled·, fueling health care interest qroup
opposit.ion and creating political risks tor the budqet
reconciliation bill.
Third Mr. Stark believes replacing the specific. budget
reconciliation proposals with a simple one year moratorium on
Medicare payment updates yields comparable budget savings, is
simpler to conference, ~ put all providers on notice that .
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.
4:34PM
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drastic cost cuts will be needed until comprehensive reforms are
enacted. Stark ·acknowledges .that freezes are bad policy.a;nd
maintains the freeze can and should ba replaced by more targeted
cuts in the ensuing health care rer·ot111 bill. ·
·
A s~rious discussion of this proposal is important to the
leadership. There are stronq political and· policy arguments on
both sides and the issues neea not be settled tomorrow.
Nevertheless it is important for the Administration to raise it
in order to acknowledge the Congressional concerns that have been
expressed repeat~dly •. The political implications of the timing
. and policy links between reconciliation and health care reform
must be identified an~ weighed, as.well. Finally, Mr. Stark's
particular sensitivity to his own role thus far in the health
care reform debate m1.1st be consider.ed. He believes his views
have not received appropriate consideration. The Administration
risks his opposition if this·belief persists.
4.
Th• laa4•rahip ·a.peota a 4etaile4 discussion ot the proce••
fer consultation
~•tween
the Admin1atrat1on an4 key conqreaaional
health playara batwe•n now a.n4 the unveiling
plan.
o~
the rrasi4ent' a
'l'he leadership has requested that staff level dis·cussione
take. place during the April recess as the policy options and
budget estimates become available. In addition, several Members
of congress have requested meetings durinq the recess to review
and comment on options. Immediately.upon return to washington,
an intense two ... tc three-week period of Congressional
consultation must beqin. Members have expressed repeatedly their
·willingness to provide the President a political reality check as
he weighs options and makes decisions. They have.expressed, as
well, their strong concerns tor the fate of health care reform
should s~ch meaningful consultation fail to o9cur.
The staff·raised the possibility of the Administration
preparinq a preliminary proposal for review by key Conqressional
leaders·before discuss!on.of the President's actual proposal.·
:Review of a preliminary document would ·permit this consuitation .
to occur before the President makes final decisions and declares
ownership of his own bill. Staff also expressed the critical
importance of this consultative process to include review of
written proposals. They acknowledge the problellls of leaks cmd
are willing for.all paper to be collected at the end of each
meeting. Oral staff briefi.ngs before member· meetings would be
acceptable, as well.
·
.
.
1
.
As soon.as we receive permission, we can begin to sc~edule
staff and. Meinber meeti.nqs. The MajorH:y Leader's staff hf,s
stressed the importance and ur9~mcy of this process. :
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A eubatantlve 4iaouaaion ot the polioy options ~rently on
th_e ta~le ahoul~ tate pla~e at the 10 &30 am meetinq witb
Damocratio membara ot way• and Heana, Enar~ and commerce, and
B~ucation an~·Labor.
.
1.
The leadership is most concerned that their discussion focus
_ on political strate9Y and process. They would like to engage. in
policy discussions, as well,.at the broader meeting with·their
· committee members immediately following this session. Ira and/or
Judy might conclude this meeting by announcing a summary of the
issues and options they are prepared to discuss at lO:JO.
�/'J()··\' "\\• (..') ll (I c
'
MEMORANDUM
TO:
FR:
Chris J.
RE:
Ways and Means Subc. on
April 4, 1993
Howard Paster, Steve and Lorraine
.
~~,..
Healt~Meetings
cc: v'Melanne, Susan
BACKROUND
As you know, last Wednesday, Ira was the recipient of a
classic Pete Stark personal attack. In the meeting, Congressman
Stark -- among many extraordinarily negative comments -- stated
he had no desire in meeting with Ira until after decisions and
paper were available to review~
Following the meeting, most of the Members -- embarassed by
the treatment Ira received -- expressly stated that they
disagreed with Congressman Stark and requested that we set up
meetings separately with them, even if the Subcommittee Chairman
would not attend. Hours later, Chairman Rostenkowski called to
apologize on behalf of the entire Committee for Congressman
Stark's behavior.
After this conversation, and following a discussion between
Majority Leader Gephardt, Mrs~ Clinton, and Ira, it was decided
that Ira should try to set up a meeting with Pete Stark to
attempt one more time to establish a more constructive
relationship. Ira did so, and arranged and held a meeting on
Thursday morning.
Although Congressman Stark did not apologize during the
meeting, Ira characterized the discussion as generally
constructive and substantive. In fact, they agreed that they
would hold another one-on-one conversation again either this week
or next.
'·
Before and a~ain following the Thursday morning meeting,
David Abernathy (the Subcommittee Staff Director who directly·
reports to Rostenkowski) made it clear that Pete Stark would ~ot
want to have any Subcommittee Members'·meeting without being
present. He also stated, however, that meetings would be
advisable and requested that they take place during the week of
.April 12th. Prior to these Members' meetings, he urged (and I
agreed to schedule) one or two Committee staff meetings.
.
�.. ·--··- -· ........
.
~
_______ - - - - - - - ,
....
CURRENT ISSUE
Karen Pollitz (from Jerry Klepner's shop) reports that
Congressman Levin, although he knows that Pete Stark an~ his
staff wants to wait until next week to hold Members' meetings,
feels extremely strongly that a meeting between .the.Members and
Ira should not wait a week. He believes (and I believe he.is
right) that most of the Subcommittee Members want a meeting
before then.
'
We could arrange for such a meeting, but
out
that I. should not risk further alienating Stark -- I
to defer to the Subcommittee Chairman for the moment
to schedule anything. I mention this to you for two
(1)
of a concern
have chosen ·
and have yet·
reasons:
Because I want to make certain you agr:ee with my current
call on a non-Pete Stark Subcommittee Members meeting; and
(2). Because I believe that Congressman Levin may feel so
strongly about proceeding with meetings that.he may actively
lobby you or me for.a Members' meeting.
Should Congressman Levin follow-up and call, I believe we
should be honest with him about our concerns about further
straining our relationship with Stark. If he still persists, I
recommend that we respond by holding a one-on-one meeting between
Congressman Levin and Ira and/or Judy ..
�
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