-
https://clinton.presidentiallibraries.us/files/original/fd7128e809589a5f3f2d5ca15d01d0e5.pdf
2fb68113856b5358fd51da246df23075
PDF Text
Text
WithdrawallRedaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
DATE
SUBJECTfJ'ITLE
Walter Zelman to Rasco re Personnel Matters (1 page)
10/13/1994
RESTRICTION
P61b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
ONBox Number: 8506
FOLDER TITLE:
Health Reform [I]
2010·0198·8
kc226
RESTRICTION CODES
Presidential Records Act· [44 U.S.c. 2204(a)]
Freedom of Information Act· [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(I) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
.
P4 Release would disclose trade secrets or confidential commercial or
financialinformation [(a)(4) of the PRA]
P5 Release would disclose confidential advice 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]
bel) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) 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 FOIA]
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 FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
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.
�11/08/94
12:02
IaI 002
Health care Qs and As - November 8, 1994
,
,
Q. Congress failed to enact your'bealth care, pI31l1asfyear and expectations are that
with a more conservative Congress next year, it will even be more difficult to pass health
care'refofmleglslation. Will you produce a 'modified approach, perhaps something that "
will gamer more Republican support - or will you introduce sf.)mething that C31l be used "
as • campaip issu, Ut19"?'
'
A. The,re have not been any decisions made on how we will approach health care next ·year.
The only decision made is that we are not going (0 give \1P ,the battle. Another million,
Americans 19St their health insurance last year and costs continue to escalate.. We Cannot
walk away just because the road to 'ref~rm IS diffIcult.
We o,bviously· want h~alth care to be handled in a bipartisan fashion. We always have. We
tried repcatedIyduring the last session to work with Republicans. They threatened to
filibuster in September and it put health care reform on the shelf for now.' But I think there
is a 'good' opportunity ~o provide people 'with the health securitY that they want - with quality,
affordable health'~ 'and private insurance coverage. And it is au 'opportunity that can be a
reality if we work together.
Q. The RepubUl'!8ns, with massive speela) interest help, successfully labeled your plaD ,as
'government-run aDd stated It would lead to rationing and ,massive job .losses. '. Will the
Adnlinis.tration do something belp change thiS public perception? WiD it abandoD
alliances, move at a slower pace, back away from unl'l'enal coverage?
.
.
to
"
'
,
A. Again, no decisions have been made .. We will obvio~ly try to better explain to the
American people that we are talking ~bout preserving what is good in our system and fixing'
what isn't working. And when we .talk. about preserving what is good; we mean preser:ving
the prlv~te insurance system. Providing Americans wi~ priva~ health insurance that can't be
taken away if a loved one g~ts sick or a job ,is loSt.
.
.
scare
,
I
Special interests spent bundieds of millions of dollars to
aud mislead the public. Yet, in
spite of their success in creating confusion, the American people still overwhelmingly believe
that we must act to provide health security to American families and make health tare more
, affordable.
'
Q. Reports from senior White House omclals last week stated that y~u were removing
the First Lady: and Ira MSgaziner as the leaden ill developing health care. legislation
aDd replacing them with Carol Rasco, and Bob Rubin. Istbis mov~ a recogn'ition that '
last year's process was a failure?
'.
:
,A. First, let me' state that reports that the First Lady will Dot be involved iIi health care are
ridiculO1J$. The First Lady. will play ·an ~ctive role in policy strategy and development,and
she will re~ the Admini~tion'spublic advocate on health care. At my request, Ira will'
,
'
�11/08/9412:02
III 003
also remain involved, in health
~e.
We are entering a different phase iIi the health care debate. The 'last two, years were sPent'
doing an. enormous amount of research and policy development. We arc now entering a .
phase that will aUo..v us to move health care through the same policy process that we USe for
, other major dom~1ic policy issues. The Domestic Policy Council (DPe) and the National
Economic Council (NEC) will coordinate our future health tefOInl efforts.
, Q. Given the ·dimculty iD enacting 8 bill with universal coverage last yea~, will·you .
pledge ODc.e again, in a more conservative Congressional environment, to veto a bill that,
does not adtieve universal coverage? . . , .
.
A. We still believe that every American deserves heaith care coverage. Our goal is univers3.J.
coverage. And. we're. going to do everything possible to assure that Americans have health
care coverage when, they need it. ~d we're going to' do everything po!;sible to control
escalatin,g heatth care costs .
. The American peoplc still overwhelmingly suPP9tt lJniversalcoverage. We mu.~t continue to
work toward achieving,'what the American people want and 'deserve.
.
.
Q. There is speculation that the Administration will be presenting recommendations to
CODgress on bealth care reform and that these recommendations will be part' of tbe'
budget. Are you going to submit a new plan and, if yes, have you given ·tbought to wbat
these recommendations will iD~fude?
. ,
we
or
A. We hav~ ·not had a chance to thi~ exactly about where
will go even in, what form
any such proposal would be presen[ed. Could recommendalions be submitted as part of the
budget? Yes, but it i~ also possible they won't be part of the budget.
.
�/
srJ
t
.
.'
.
.
~
�l~~-~-~~iv
--------
~~
-::;;.
4lv~tr
~~f;8~1(1 '? f1.~ +0 Pr;ms/iJlu
�-,
D R AFT - FOR YOUR COMMENTS
I
I
HEALTH CARE ISSUES
,
1)
,What can we do within the likely exLting budget;. e.g.,
within HHS, welfare reform, or other budgets?
.
I .
2) How does the pressure for additional deficit ·reduction
I
.
relate to what we might do on healtj care reform?
3) What would be a realistic list of alternative health care
I
reform proposals?
4) If the decision is made to continue using health care reform
as our an~wer to the pressure for mpre deficit reduction,
and if our '95. program consists of ,a large long-term vision
and a relatively moderate program, how can the latter
accommodate the former?
/
5) What ideas do we have about private sector cost controls
that might be congressionally real~stic?
. I
6)
,
i
Can we have Medicare and Medicaid cost reduction without
. private .sect9:i:' cost control?'
/
.
7) What are possible programs for reducing Medicare and
Medicaid? .
i
!
8) What's the relationship of health care reform to welfare
reform?
I
,
I .
.
9) What vehicles do we use for healtn care reform -- one bill,
I
or additions to the·HHS budget and the welfare plan and
other budgets? In other words, dd we have one bill or
several bills attached to other m~asures?
-'
.
10)
I.
Do we propose a program, or work jointly with Congress to
propose a program, or wait and respond to Congress?
.
11)
i ..
.
How do we pro,actively manage the message all through this
. process, including positioning oUf effort appropriat~ly now,
·putting.out a proactive message t~ counter leaks, and
characterizing whatever conclusions we reach?
.
. '. .
I
12) In a constructive mode, what lessons should be drawn from
~he health care effort thus far?/
.
I
�; ,
"
,
:
': ~
"
-,.1<>"
I
'
"
, ' 0..
..
. , , '..'
:
. ,"'" ':.t
c'"
.'"
,
~
• f
, '.. 't
,
-:
,
." ::.: ;,1
.
,
"
'\
..
, .
~':'...
" " .• '"
.: /' .:.
. '
~ ,"
• ••
.
;
,
i
. ,".
'",
.."
: .
~;:',', E~EC4T~~~",?F~l~~ Of,,'T:~E, 'p~ESI~E~T:::> ;'. .
,~FF.lCEOF:',M,A~AGE~Ef':IT, AN~ 8~~G.ET
", ','
.. ,;:\.:.
. .'
':\; ~ ,:<.. '-,I"
';" .
'~,J. ~'·";1:. · " :' '. ~-",:,:.; , . /'\.it:,.::',':'r,
DI~~C7qR~':'" :.:'
~:"'.'
"
~\{,;
','l'~. 4;'.\::'
....
·'I.;':d::
",1 ~. ,', ~;,',........
.'
• ;1"
:}.
. ': ...:"
:~
•
r
. .,
""
. : .. :.
. • .: ' .
,
'.',,:.
;"
•
'
,
I,
_.""~'
:n:~·.<'·
;. ". . . . !'
'.'
'CARO~"~scom':"
: ./"
. .\
"
~
.'
."
; .
•
. '
'. :
,.,.'...'
.:•. '
, '.•
~.;
..•• ,.' ••• " . :• •
.'
.,>:~:; ":,,,',
.' {;','
"'\"<~':.
., '
Heatth'Care 'Reform~Strategy;
:/
,,~
" . ' '.~<"'~; ··'l, 'iu ." ~.;' "IJ • .
,':'.
,~"..".
',.'
\"
..' .." '.:..?~ ;."i ··:.c.. . .l . ·~t;.:~:.\"
1 ' ". "
.'"
:}:': '.:
·O:;rv'(.\~~
'..
.,.: . . ,' 'i"">i~-~~'L:;!.'.;{~~ 'I"."".:~".t""
,.. '; ...,'.
j"
,?:.~~ ,:'
,'.,
':~~!J""
·M.UtP ;:';':'~·~'I.'~ '~:" ',.: '.-';-J. T, '
V . "", ~6!f:' " . '<l-" ~L :~,~;. ,
- ,,'. ':"";':,,' l;),I'·d,r.' ~~:", ,~(~
.,' ..
'.".
;':',
.
'. ,.
"'j:' ........
. : •• :,:
. "', ,'.; Ali~ M. Rivlin'"
s~:
'~.> ,',,~~"
,':",-.
.BOB' RUBIN.
.'
.~. ~~¥::
"":'~'.
.,"
"'<"'"
. .....
;'~":i':, .
r"
,,''''
. '.'
1994' <I'"
;' er '" ', ... ' .,: ..>.
":.
'"
r
-+
i" ••••
.•,' .,'. '. '
'/
; "Oc'rob' 14
. ·MEM·ORAND·UM· FOR'
,""
".
•. '
THE
_,:,:' ', '.'.;'
,"
WASH.IN.GTON.D.C•. 20503
~'it\
)."
..
.., . , '\;/
<. ,".' " '. '.'
,',
.. '."
'<"!' , :.;"
. ;.;
.'
XS:e.b~~~;~:trurik aOO~f~ptimlS';~n:h~thcareJid~im~han~:~:~stablish a"':
. " .framework for'evruUating the.ch9ices :tQ' beConsidered.Thls·memo~suggestS·a;possible': .
. JramewQrk fot begiimirig 4iScussioris.of how'to pt~ with a h~th policy. initiative for'
.' next year~ .Much"of"the' necessary ~hlYtic work was. pr~uce4.ovei~.~e,Past year·. tp .~tipport .
tlie~on~ressiona1'pr~s, 'anq ~~~ea~y av.ai1ab~e'1ous~·1 Assu~g wear~:.no. l?~g~r' :,,:.' .... .' .
.lookingat a'plan . which leads drrectly ro.uruverSal coverage; the challenge IS to rethink our. ..
approa~~ to .design ',jh~ ,~o's~ .ef(eCti~~ reform ~~ur¢ to ,?e1p' th~, most p~p~e, and cause ili.e
least dlsx:uption. ,To a conSIderable exte~t, the challenge.Is t9'~s~: sy~tematica1ly the . ~ . '.
. questions :tbat .Admilii~~tion· ~d congres~Qna1' 4,~i~on i~e~s.~ill n~to cOri~id~.r..~, ...
..
'
f
"'>
"
.,
'1
.
'.
.."
.','
" : . "
_'
.
•
'.
('.
. . .
•
• .
.'
<
•r
.. ,',.
,
";""
~
,'I •
,.
~
,
'/"
'
' '
'
,
•
C~teria, fota:~e:W"lI~lth C~r:eRefonn 'Propositi' !. ". '.',
'~,
>. \ ,...
,
,
.',",'
\
"
~""''''\~~\~I'' i·~I, . ;.....
"~' ',''''~: ... '. ,'~,
.', ,.'
There are 'Se~eral.~learcriteria' ';.- bot!) w~tive ~d.neg~tiye -- for.~Y heat~·~e" .
package~atwe.develop':.'t .,....
;",,:.,..,.. ~
:; ':'"
,
.'
••
'"
"
".'
."
,:
""':"':;'
.
,
Th~~hetilth· ~(fpro'PO' ·.m.'·.lIst::.·
.
.sal.·'
.
'.
. .:'/:.,-:'.' . .
/:, : . " .. ::
. :, '.
.
,,'
I
.~.."..... .
. :,<:,
'. t:
.';. '1'';-:.. ;: "-
v ··.·(I)Take:·clearly,.n~ ,r.~~(~ePs, to.l1i1ivefsaIc~ve~;e
..
,'.
. "; " ,,' ' . . . . . ."
"
!
,'.
In theabS¢nce.of.,..
.
'.'
universal'coverage, a ciJjefullytargetediJiltiauv.e should take mcremental·steps ••
towards: expandjng' cOverage. foipplmlati~ns m6st.Jikely to lack adeqUa~···. .' .. '
, 'in~urance'~ particularly: the welfare ~ 'wof>k target Popubltion'" Expanded ',-'
.,". coverage· ~hould help signjfic3n~ nilIn.~~. of ptmpleas soon' as possible: .' "
, ." ...:.
.;'~'"
' . "." .,'. "
a:
<:. ;':' :. ','.\. ",. .:. .' . '. '
. /. " :.." ..:.....:'. :',:.' '.1' ". "'.
(2)'~ ·M.ake pr~g~)o~aras c~c~ia~innienf:~The' plan should conthln 1;Ielievable' ',.
'.. : . .4i~ntives.to feQQeetliemte :ofgrowth .of health care ,Costsfor.the·,natiqn as. a
,
,.\vhol~. .
,
. .: .'; " ' : / " -". ' ...'
...' . :;:: .' .'.' . :::..... ." .. ". ." r .,'.. '.,. ,".; '. . '.,:. ...... . . " .
~
.
'(3).' JJe'fully"ai:td crediblyrmanced'--: A.hea1th·eare:billmtist b~,.fully fin~c¢d with
"
. }'" '~roo.ible s()\~rces,pf.~ds to cover anyn~W·expenditurecoinIni~,e.ntS.\:·The·.. ,., .' . ' i.
".: bill m!Jst'. be ~tJ~tdeficit .neuti:a1~· .arid ,fn the, outYears,> ·~ea1th Care~ r~f9i'~ ~~;.f:t;·1;:;..;
., .jn~st Contribute in a credible way to deficit teductioh.:Th~·ba1.ance,'betWeeIL :" '.,
.funding :Sourees shouid be carefully '. weighed so thaf pr6gram..Savings;; '~.(; '~'.'i/t: '.'
particularIY;lnMM,i~ ~a:'Medicai~',trre .believable:~ .. • ':": :;.:. '~,>
'. ' . .
",
,
~. ~
."
<','
~.
',.' •
.
• ".'
, c:"
'F'
r.:
,'.'·:}i '. ,;,1
,
''''.'~'
",
- .'-
.
/
' , .
.
00',-;"
,
' . > ',' .:,
00.
,~'
1.,\....,. ','
•
:,
,1Jf1.
••
>
;Jl~t~\~\,;:;: :;::tj ~:~,'r1':
':l~~ f-- '\~, ""./ r ~';t: "
x~t.,~·,'r\J~:' 'r
;:.", "".'
"I'! _
. ;.- ;~ _i'; :..:
':~. t~ ~ ,
#!'
f ,,".' "
•
�.'
(4) Enhance health security through incremental insurance refoim,-- ~ven if we
do not reach universal coverage, the plan should still make the most progress
possible to maint3.m coverage when people change or lose jobs' or .suffer a' .'
medical Catastrophe.
.
The health care proposal must not:
(1) '. Be
compl~ --
A health care proposal ;'sho~id be easy to explain, to Congress,
,the press and the public~
.'
care initiative must build to the maximum
extent possible on existing institutions', keeping to minimum any new
bureaucracy. If any new entities must beestal>lished, incentives for new
institutions should be favored over mandates that new institutions be created.
(2) Be overly bureaucratic,-- A health
a
,
(3)
Contain any mandates.
(4)
,
Contain, price controls.
Fundamental Components of H~h Care Reform
The building blocks which mone form or another are likely to be included 'in any
health care reform bill are familiar at this point. While most were addressed ina similar
manner in the end of session compromiSe efforts, inUght of our shift to developing.an .
incremental approach, there are significant issues that ~e may choose to reexamine. .
(1)' Insurance refomi-- In.order to substantially expand access to health insurance,
some.degree of insurance reform would be'necessary. An early decision will
be the extent to which 'any community rating is feasible'. If so,policy options
must be considered, whi~h would have the least disruptive impact on the
market.
..
.
,
In the context of a bill designed to achieve universal coverage, broad .
community rating' was essential, because it made affordable coverage, and a
mandate -- even if as a back-up-- feaSible. If the objective of insurance
. reform is more narrowly defmed, it might be preferable to take more modest
steps to close coverage· gaps when, people change jobs' and to have a high' risk
pool for people who would otherwise not be instJrable. Any insurance reform
will have winners and losers, but a more modest approach' would have less
dramatic redistributive consequences.
.
. In order for a more competitive health care system ,to evolve, consumers will
have to be presented with more standard options forcomparisol),. ,We will need
to consider whether there should be a single standard package or a range of
options. We will also need to reconsider whether standard benefits should be'
defined 'in law, or administratively based on actuarial values.'
�ord~r for individuals and small businesses to have access to ' '
affordable health insurance, some level'of risk,pooling is necessary.
(2) Risk pooling -- In
If risk pooling is voluntary, how can we ensure that all health individuals and '
low risk small businesses leave the pool, leaving only high risk people in the
pool? What rules can be developed to prevent adverse selection and how
would such a risk pool be administeroo without creating a new bureaucracy.
(3) Financing -- We will need to review all of the financing alternatives that were
considered last year -- including the tobacco tax and the various forms of tax
caps that were on the table. Since realistic funding and deficit reduction are
essential for even a scaled back plan to be successful, estimates of feasible
financing may well define the scope of what can be achieved overall.
(4) , Cost contaimDent :-- In the absence of universal coverage, and with premium
caps and price ' controls off the table, we will need to develop an alternate
credible plan for cost containment. I am inclined to review different tax cap
scenarios, much as, Senator Bradley did. ,
(5) Expanded coverage -- We need to consider various options for expanding
coverage -- including low-income families,children, etc. The
, availability of funding may well dictate a more modest subsidy scheme,
or a phased in approach. We should review additional options which
~ould be less expensive, but still make real progress towards expanded
coverage.
Additional 'building blocks likely to be included in any plan include information and
quality and access in underserved areas. I would suggest that we establish a second tier of
issues to discuss as we proceed in this process.
Next Steps
"
I propose that we spend some time over the next several weeks exploring these and
other questions. In order for the 'staff to have time to prepare option memos for our review,
we should meet early next week to define the ~pe of our policy review and set a timetable.
After we have the opportunity to review these options within each area, and possible
'
packages; it may make sense to block out some time, perhaps on a weekend, to make,
decisiqns on Qurrecommendations."
�(c) 1994 Detroit Free Press Inc. All rts. reserv.
07535699
WELCOME, CLINTON GOALS ARE SOUND; PURSUE THEM WITH STEADY CONVICTION
Detroit Free Press (FP) - TUESDAY October 11, 1994
Edition: METRO FINAL section: EDP Page: 6A
Word Count: 639
MEMO:
IN OUR OPINION
TEXT:
Bill Clinton's visit to Michigan today comes at a critical time in his
presidency. The Republican Party already is saying benediction over his
presidency.
The president mayor may not be able to cut his party's losses in November.
But we're. convinced .his goals are still sound and deserve ,to be put forward
with more clarity and vigor.
. '
Here's how that can be. done:
Foreign poliby: The perception of the president as a waffler began with
last year's ignomlnlous turna~ound of the US~ Harlan County in Haitian
waters 'in the face of a mob, and the dithering . afterward.
It was
exacerbated by the'.contrast between tough talk and mild or limited actions
in Bosnia, and confusion about tactics vis-a-vis North Korea~ The reverse
on China's most-favored-nation trade status was neces~ary but costly.
These things have obscured achievements: facilitating the'Middle East
peace process, aiding the transition in $outh Africa, helping Russia and
Eastern Europe deal with staggering challenges, pushing the British on
Northern Ireland.
'
The president finally has grabbed hold in Haiti, and his policy shows
clear signs of working. His unambiguous response to Saddam Hussein shows
he's learning ,how to act· like the commander in chief. If the president
could build on Haiti and devis~ a more creative strategy to end Cuba's long
nightmare and isolation, he might change the whole character of the
Caribbean basin.
Mr. Clinton also should refuse to let his Balkans p6licy be set ei~her
by the New York' Times or by his European allies; The realistic course
probably is less heroi~ than the morality play of press legend, and more
committeq to change than Europeans imagine.
. '. .
In short, the -president must remember the basic truth that his
interests,and. the' country's, are best served when he behaVes like the
commander .in ,chief, with both the cautions and the boldness that job
d~mands.
.
.
.
. Domestic policy:' The president's goals :"-expanding the .ecohomy, rf1!forming
.the . health care 'sy:stem" changing .welfare, cleaning"llP institutions, of
, government.. --:- are on target·. 'What obscured real aqhi;e'vements 'was the way he
set --or didn'tset'-';" priorities, and the way the: administration acted as
�if health or welfare
are technical rather than political questions.
Approach health care incrementally. Have a master plan and insist that
the pieces conform to it. But go for insurance reforms. Move to cover
children
first.
Borrow, . with appropriate safeguards, . the favorite
Republican gimmick of this year, the medical IRA, which has dangers but may
also have promise. Give the states more flexibility. Build gr~dually ..
Push welfare reform and political reform to the top ~fthe ag~nda.
Bring. the Republicans into the process of finding answers •. Hang onto such
basics as the need to eliminate disincentives and build in incentives in
welfare.
Put together a credible next-st~ge plan on deficit ~eduction_ Include a
middle-class tax cut,butpair it with tradeoffs such as finally protecting
federal assets such as mining rights and grazing lands. Accept a real
line-item veto. Get on with reshaping the courts expeditiously_ Shape up
your operation on the basics.
Finally, the president can show that, imperfect being though he is, he
has deeply held principles and will keep pursuing them. Sponer or later,
people will look around and say, hey, maybe the man really is trying to do
the right thing.
If he show~ steadiness, he 6an s~t a lot ~fthings
straight.
It's a . big mountain Mr. Clinton has to climb. But some of our better
presidents -- Abraham Lincoln and Harry Truman come to mind -- were beaten
up pretty badly at this stage of their presidencies. They figured out what
they had to do to be leaders, and they did it .
. Tough asssignment? Sure. But President
country will be better off if he does.
CAPTION:
PHOTO
Clinton: Priorities
Clinton
can do it, and the
�'.
E X E CUT I V E
OFF ICE
o F
THE
PRE SID E N T
20-0ct-l994 02:59pm
TO:
Carol H. Rasco
FROM:
Linda J. McLaughlin
Economic and Domestic Policy
CC:
Sylvia M. Mathews
SUBJECT:
Comments in Press
Carol,
I read the attached to Bob when he called from the airport. He
wanted me to ask you if you have any thoughts about how we can
deter the Secretary from such extensive comments?
�Date: 10/20/94
Time: 14:41
Shalala: Government to Scale Back Health Care Reform Plans in 1995
WASHINGTON (AP)
The Clinton administration, facing a public
fed up with government, will scale back its approach next year to
reforming the country's health care system, Health Secr~tary Donna
E. Shalala said Thursday.
Shalala said Americans feared that president Clinton's original
plan would have ushered in a government-run health system.
~~Whatever we propose in the future, it seems to me, cannot have
that handicap, '.' the Cabinet officer told health reporters.
~~We're going to try to be shrewder and more strategic about
what things need to be done first," said Shalala, who took a back
seat to Hillary Rodham Clinton and White House aide Ira Magaziner
in framing the original, 1,342-page Clinton health care proposal.
Next time, the administration likely will make its main health
recommendations as part of the regulatory budgetary process, with
the president making key decisions by mid-December on what changes
he will seek in 1995, Shalala said.
~~We are still enthusiastic about going back in and fighting the
good fight on health care reform," said the secretary of health
and human services.
~~You get another kick at the cat and hopefully we've learned
some things over the last couple of years," Shalala said. ~~We'll
try to refine our strategy this time around."
She said the president won't abandon his goals of expanding
health coverage and containing medical costs.
~~We have to layout for the president some options that will
get where he wants to get, but not necessarily with the same road
map that we used before, " Shalala said.
~~People in the United States told us ... they were very gun shy
over taking on the whole system, every aspect of it" in health
reform, she said. ~~They would like it to be in stages and see what
the implications are of each piece as we move along."
The Clinton proposal would have guaranteed health care for all
by forcing every employer and individual to buy coverage starting
in 1998, steering most Americans into huge, new
insurance-purchasing pools, and imposing standby controls on
premiums.
Democrats and Republicans alike picked apart Clinton's plan and
eventually killed health reform entirely for this year.
Shalala said jawboning may have persuaded physicians, hospitals,
drug companies and other providers to hold down increases, but
medical prices are still rising twice as fast as inflation, and
working Americans are still losing their health coverage.
~~The problems are still out there,"
said Shalala.
Clinton has not decided yet whether to try again for an employer
mandate, she said, ~~but I think the public has spoken out on that
issue and we have to take their views into account."
~~The public was against a government-run health care plan"
and
~~they interpreted employer mandates as the government imposing a
pOint of view on how the whole system should be financed," she
said.
Other options for expanding coverage include ~~using cigarette
tax money and anything else you can scare up to extend the Medicaid
program" to the working poor, she said.
Already passed is a law expanding Medicaid to cover all children
in poverty by 2002, she noted, adding, ~~One possibility is to
accelerate that.' I
Instead of a socialized health care system, she said, the
�government could regulate the health insurance market the way the
~ecurities and Exchange Commission oversees financial markets.
Shalala said she has found in her travels around the country "a
very anti-government feeling that government can't get anything
right."
It applied to government at all levels and was based on people's
real experiences, not "something that some (radio) talk show host
had fed," she said.
~~With all of our good intentions, we walked right into that
with health care reform," she said.
APNP-IO-20-94 1440EDT
�WithdrawallRedaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001. memo
DATE
SUBJECT/TITLE
Walter Zelman to Rasco re Personnel Matters (I page)
10/13/1994
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
Domestic Policy Council
Carol Rasco (Issue Papers)
OAlBox Number: 8506
FOLDER TITLE:
Health Reform [1]
2010-0198-S
kc226
RESTRICTION CODES
Presidential Records Act· [44 U.S.C. 2204(a)]
Freedom of Information Act· [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(I) of the PRA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
P3 Release would violate a Federal statute [(a)(3) of the PRA]
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRA]
P5 Release would disclose confidential advice 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]
b(1) National security classified information [(b)(l) of the FOIA]
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA]
b(3) 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 FOIA]
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOlA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning wells [(b)(9) of the FOIA]
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 re"iewed upon request.
�..
,.' ,
.
~-.'
• 'J'
."
,
~
'i'
'
.
,
-,'
F
~
"
',OCT "'/8
1,."
,
,
'
.\
1994,
.J
, 'j
THE SECRET~RV ~F HEALTH ANO H,I.)M'AN'SERVICES,
WA$.. INGTpN, C.C, 20201
,
:
';
'.
"',
. '-. .
.
'
,
OCT i 8 '1994'
)
.. '
,>'
•
I, '
,i
, :,'.
.
"
"
NOTE, FOR ALI~E RIVLIN " ~,J~'
Donna Shalala'Y',,'
FROM:,>
,"I
I'
",
f
, , ' 'SUBJECT:' ,c::omments, on: Health ' Reform ' Str~tegy, ."
,
.
,
~
'.
\
,
our heatth'
b:!forn(:¢liscUssio~s' arid basical'ly 'agree, orithe critical set, of'
iss~es'You, put 'forth. ',However, we':needa ,shift. in p~rspec,tivethat."
,',
'I .feel. your memo
'.'
.
"
~doesnotconvey.-
"
',"
/
.-' '
".
I'~l1atey~ur:'vi~w :on'~'~he'needrfor, a"fr~mew~:rk' ~or'
"
,
,I
I,
"
'\'
.:
'
,
..
'.
Crit;i.cs'oft>ur heCll1:.h refo:r:m proposi'll/emphasized d-istressw!th'
,.',
anything, that lookeq, like ,flbiClgovernl\,le~t~ tl, We ',werechar~cterized' "
as . stifling.i: 'riot, 'fa,cilita.:ti~9i' ,change.s·that, ,we. ,and others: '\
re'cOgnized '.as,:already·'~ndetway·in/,th~ "ltla:~-:~e.tplace,~·, ,A~though, we,
,'knOW. that :those~lianges, may ,be lim:itec;l or..even 'problematic without;
s9me, government :role, 'we' ',must f6c~s.' bur attention " on, ~how~-in' ,
substapce'andinfo.rD,l;;;'-to be helpful topriyate' secto.ririitiatives~:";
Th~t ',s.. w~a~ (~e'"n~ed ,',t(),'learn : from ~he' last :,two: ye~rfi". 'exp,eriericre~~
,.
.",' " ·~'l'o. ,tal,:){' o.f '~/" 'ttrtE!W . pi6poS~1,'" 'with' all' th~, tQ,Pi.~· ,are~s, , '~f . pur,
,····prevlous;. ·proposal. implies~that we ar.e continuing 'anapproachthat
, ·dictates'to',the . private . sector,' rather' tha'n, helping guide its
, " .d.e:v~19Pinent,~ Yo~'r.aof'feriI'lg·ac~earer :and smaller version of wha~1 "
i v e 'did befor.e."Ou:r·,jobistoget the rules straight for a mature" '
,',.,.'"
}.pr:L~atfi ,systeni~. ~
<',' ' ~ "', t
'. , ' , '
,beii~~e
, ..
~,
e~~'l.ic'i't~~" defin~':;'bur
.we:'snpuld
'task in' a' vet-y, :' "
different.way:proposingbui'lding .blocks.that'llelp,move an already
" ,ev91V,irig', priyate:system toward, ourg6als?f" .t;1niv:er~al coverage for,'
effici~ntly-deli~ered ,'care~
'.
.'," , , ! .'
"
: .'
\
."
.' '
" .
''-,'
'.
,.- .
~,
.
"
\
~.
'.
,1
,'This.persp~ctiv~:sh;ouid explicitly effE!ct ~he.,waywe' appr9ach
'. .
eaqh topic
-. .
,
'
:,1
!
, " ,.'
,','...,
.' .:\
.Insurance 'reform. . In: the 'currEmt"environment,,' '~ithout':·
.urii vtarsa1;:c,overage, 'h'o'v/ ,'can we . move 'toward .end.ing
'di,scriniination intheihsurancemarketJwhile'li:tinimizing
. tp.e ':r;isk 'o~disruption.?.'· How cariweshape,a, phased-in.
. :approach" to narrow 'gaps 'whiletransitionally retaining'
' . some dif'¥erenticils"(by age a.nd other factors)?
wp,at arl\i',
··.. the'.be.ne·fits· arid -risks qf, rnovingstep,-.by-step to. 'improve ' ..
. the .small "business an.d them ,the' individual market rather "
than.·a: combin~d app'~oach?,;..
.
"
"'For example;. "
ar~a'~
,
.'.
'.'
,
.~...
.
, "
.
"
.'
'
.;
,
, .
.
~
"
,
;.
"
,
).
I,',
.
,",,' .
L·
,\
,\. ,
,
'
'.
I
•
'.
"
\',
"I
I
)
"',I
,
,:
.l
\ '
,
".
,.'
.
'~
.'
�, I'.,
. t·
','
. '
"
,-
:'.
"
"
l ..
I"
,
,'
"
.'
\
"
. /,
..
"
,
",t ,.
\
.'
,)'
.'
~,
'. ,
,
,
"
'
I, '
~
,
'
,
• ",!
r
,
,
',',
'
.
I
"
"
'
I',
-
•
'I
'
"
",I'
'I
'",
.
.
, , ' .
.
•
' Cos,t' 'con~ailUDent." "Given :resistanc,e', to aggressive,
",promotion otl'llar~et 'competition;, (tax,',caps) ~s ',wefl' , a s ' "
're9ulatiori~ how can "wehelp,the marketplc;lcemove' ,in the:
, direc~ions '"ne,eded' ,t~. ,llli:t~e .:competitio~ w?rk?, "Market,
, refonn~ ~o, supP?r1; compet:,l.tJ.on(prom,otJ.on' 'of, vol~J)tary
cooper~tives, , pomparison" sh.opping" across
comparable "
i
, plans) d~nb~' promoted"as the basi's ,fOl; cost containment,
'everiif :not',immediately nscorabik~ """ ., ',~
,
.
,
, .
I,
-;.,
,
',"
.'
"
,
~
,
','
'....
., \ '
. ,.'
,:",
•
I ~ ••. '
I'"."
" ,
$ "
',-,
. " i
/ '~, '.,:, I:~beii~veO~~"diff~ren~e'sare m'ore in"'~Orie
'~ '"and Ildok.forwprd'to the ',an~lys1s to com:e~
"
,''',
,
:
".,
.,:
,,'
,"
I.
.:
, "
.,1,
"
I, :-
'de: ,Ciiro 1 Rasco '
,,' ..
.
".
.
th~ni~"'substance
t
"
\'
,/
,
",
Bob R),lbJ.n','
;'
'..
,
.'.i
.
,
'
,
. , )
",'1
'
'.'
i'
,
'
I~
"
, I
,"
~
':
,
"'
.,
'~
"
,
.
\
,
"
I •
, I
".
'.
7,
••
,)
"
,',
'\
r,
,
,,"
.'
.,;
,I
"
•
" ~, '.
~
"
I
"
.
,',
\.
•J ~ ,
(
,
."
':
'
,
(
i'
'. ,
,.,
I,'
I:
, ,r
,
\
J
:
\,
,
'!', •
•
,"
".
I
t'
"
"
,
\!.'
!
I
I
, ,pursue, expanded, coverage, in!?urapce' and' market reform
ah'~a4 of' the' nation?:" Can, 'WE!, re'solve,the' conflicts,
,between" big' business ,,;'and' .labor who ,want ,no. state,
:, , regulation', (want ,to r~ta'in, the,l!:RISApreemptlo'n'of I3tate
, ,'regulatioll'L ~nd states' seeking ERISA waiverst'o,achiev~'.
, flexi~i'lity for broadscale or specific reforms? ',How can
,Medica.id policy encourage, 'exp~nsions of' 'coverage?
,,,
.. /'
'
$tat.~fl'e~ibility. ',HOW 'can 'we help 'states >that , :want:to co"~
"
,
.~
..
.,
/,
'," ':Furthe:r;:,','Iw6uld~add toyour< list:"
'
"
�;
,
,
I
,
\
"
'.'
l
,
,
"
i
'
;;
,
<,\.
'i
.
I'
~',
'
,'.'
, To: - - Bob Rubin ruidtaroll~asco,
"
" '1
\
.....
"
.',
>
• •'
,I
Date:, October 19,1994
f.
l'
. Agenda and Talki~g Points- for ~qr)PC Meeting \
.
.
. ..
. ,', Re:
.
~
I · , ",'
.cc: '/,Gene Sperling
Bill Galston - '"
" . Sylv~a Mathews _",
Jeremy BeIl'::'Arrif'
"
..
'~
".'
,
,\
.
.
'
'\
'.
" . ' ,
~
"
,
.'..
','"
: Attached 'is a'o~e page' agenda' for'today's ~eeting. Also enclosed is a',tbree"page:sJocun'tenl':
of'talki~g points f<,lr yoUr ,usc. :
"
,
.,'.,',
.
.
,
'.
\.
\
, ' r J, ,
.
"\
As we discussed yestt~~day, I am prepared' to ,~ddies$ the issuts and r~tionale beh~nd the Six
key i~ues' within"ourworkplan. 'Rle~.review ,this document and·.retum 'it to m¢'with your
comments befor~,:our3pmmeeting.\
you::. :,'
': "
".,"
•
,
"
• "",
I
Tharur'
.
j
,.
,
"
,
-
'
<
•
/
I'
";
"
.J
I
','.
~.
. '.
"
,.
"
(
,
'.
•
l
,I'
,
'
,J' ."
'
,I
r ,•
...
"
'
,
�.j
"
,
"
i,
/
:\
, .
,i
'"
,
"
,,'
,
"
,,"
.
~
)
.....,
.
\
,
',\
\
,
.'
'
,
,,i
•
'Welcome, Update on Process, Appre~iation for ,Assistance
, 'I.,.,
,
,',
"
,
;
\'
",
B. ,;'I)~finition of Structure of 'Roles 'and Resptnisibilities for Staff,
.\
"
'
....
,
"
,',
.
, i
.
.'.',
'
m., ' , Outline Tight Ti mefta me
/.
I
,!
,"
,
,
,
.'
,
:'
•
•
I'
.
. •"-'
JV.
•
,
•
'
..
>,
~',
.\.
"
"
;
"
. '
•
~
.
. ; '
. • • • ~.
'
j'
"f):'
Tum to Chris"
,
,
'
options,
,
•
'
",
\~
'ID:sutance ,r~fo~' OPtiO~~" '
, (2)'
!
"
\
Cov~tage
(1)
•
"
. '
.
Discussion of Spedficlssues'WithinWorw1an-•
,
'
.' ,
f'~ "
,
~'
:,
(3),
State' ne:ki~i1itr, options'.
(4)
"
,
-t.
,
'Cost containment' options
<
,,'
;.,'
! 'r "(5) , .: Financing options '
'
'.
...
" , (6l::-, 'RegUlatoryoptions
• Second ,tier non':"core issues
I
,
"
,
,v".
.\.
"
".\
"
','
'
"
(RETURN TO CAROLAND/ORBOB),OutlineNee~ for Intense'and Quiet Staff
Work on Background In(onnatiQn, rolicy'Options, and Quantitative' (numI)Crs- ~,
run) Analysis
'
,
"
' "
,, "
,
,
.
.
~.,
,
.
.
" , '
: '
.
VI~
:.
~ ,
:
,
.
~
:'
.
.
R~iterate Sensitivity of Any, LeakS About this ,Work ~etting Out,,~, . ,
.
'/
"
.
\,',.
:
"
';
\
"
,
, ' ' ' ' ' ,
'
'
. , '
"
"
"
<,
\,
.,
'
I"
Ii
\'
\".
,
j
VB.
,Wlll.Keep, InToucb~ Thank ')'ou,Closti~e of Meeting.
v.
•
'
,;
(
.
'
'.
, .
" '
I,:. '
~'
.
,
(/.
�,.'\
'F
.,
'
- i,'
;-.'
, ;
,'.'
.
,
/'
""1
,.j
,r
, ,
. ,. ".
.' . . .AGENDA AND TALKING POiNTS' ,FOR 11/19 NECjDPC'MEETING
. .
'. .
.,
'.
.'
'
,
-,
".
':'
~
'
,Welco'me, Update on Proces,s, App~eciation'for Assista~'ce'
I.-
-
,
,
'
','
'.
.
<,
"
'
Will be :avery .open process whereallviews/approach~s/altematives are ~ired'
•
.
'.' -
I
J
I
"
' . . ' •
..'
~.I
.
. ,
)
.-
.;
,
)
~ _Pleas~d 'with e'arlY cooperation,., assistance, '(lI1d ad~i~. Wefee.1 it has been, and' will
continue to" be 'constructive. (Cite, for' example, Alice's memo and perhaps Donna's '
further elaboration, of President:s, HRC's, LeoQ's, and your, feeling that, propos'als .be "
viewed in cpntext of hlying foundationfof: acltiev~ng Pr~s,idenfs eventual goal.) ,
I
"
• "
"
I
~
\
••
•
(
-
.••••
•
. ' ,
- , ' '.
,' . ,
...
Ap~reciation of pnncipl'e~"'dedi~ti6n :~f' seii9f,staif res~urces,to helprwith this e~iori:'
•
'I
"
Their and, YO,ur (the, p,rinciples') ipvolyement _ already been' immeasiuably helpftil (in
has
terlnsof helping struc~reis~ues:'~dbackgrourid intormati()n th~t should' rece~ve ' ' '
priority ~nsideration.);' Such!help will be requested"and needed throughout the,',
,process. (Detailed disc~ssi'on re ,this' to follow).,
,\
' ':, " .
,", ,'.
;
-
'
,
,
~I
'
"
J
'.
;
',.
.'
. ;'.
',- : ,Assuming approval of ~'''issues, t~ be'analyzed"~orkplan,which Chfis \viil, outline in,
a moment, . . ' should be getting first....:cut iilfoQ11ation oii sOllIe ~of. .issues" ,.' . ,
we
these . .
.'
," , " beginning as early',asnext ,Monday.' " , ,
".
'.
'.
~
I
,
D.
'.
,
,
'
•
.
•
~
'.
••••
I
."
,,:
• ',' ,
.
.
.'
..
.,
,
','
I
I'"
" :
'
I.
,
R~ponsibilities for.~~,fT,
, Definition ofStructure of,Roles and
.'
.\
"
/"
i
1
.
, . . '
' . '
;
~
I,,'
" ,:
..
,
,1
•• '
,<
I
Ro.1e' o(Chrls as defined and implemented with regard to: Bob and' Carol, and '
-disc~~sion ,of _
how. you ,want -him'to in,teract with the 'Departments;aS'~ell 'as ,OMS;
CEA, etc.' ,
< '.'
I
.'
':
I,
'.
;"
,
- .,
.
,
'.,
,
_..
.:'
'1
'
.
'.
'.
'I
'.
.,
.,,'
,
I,;",
'
'
Role of Jennifer Klein"...,- analogous to Sylvia apd Jeremy, i.e:; is~empowered to,:_, .
·facilItate 'and direct pOlicy' work in' a m'annerconsistent 'with desires and discussions 'of
, you, the· principles!, and Chrl~: FUI:ther c~arifi~tion of :aI1yone dse,'s, r<~le that you',
, , , (Carol or Bob) feels is necessary/advisable!
'
, ' ,,
'
.1
•
,.
,
,
,
,,'
~
'~As we've s,tatidprevi'ously, Bil~ and' Geri~, will' play ,a~ inf~grarroll' in helping Chris'
,
and us focu'son~ealth policy issues within the contex(ofthe'budgetand other,
domestiC policy priorities.:' ',They ~illalso;pclrtiCipate i'n and' c()ntribtite to all
: discussions "regarding health care' policy i options , -~ both in terms of-the s'~bstance and' "
· theprocess"of developiiig.t'hese options. We and or Chris \vlll' keep you,appraise~ 'of.
other staff roles on this subject. ,"
,
..
-
I
•
' ..
"\
'.:::
,.
I
\"
:.'
"I
,
"
r
�,,',
,
,
,~
",'
Outline Tight Thrier~ame' "
, nI~
,
.'
,
'.
,
'\
/'
"
",
-/'
. , '
I,
J
,"',
'"
!
,',
/
,
.
Very little time leftbefo~e significant policy/politiCal meetipgstake pl,ace'immediately
/ after' the: election. (Perhaps outline other liiglr'priori'ty sclieduling/policy ooriflicts?) ,; ,
"
-.'.
"
',~"
'
'
, .
. "
'
_' -
.,
I
.)
r'
",'
,,;
'.,
",
!
'Hope to h~vepackage op~ions olltlii;I~dfo~ f~rs( p~rusal for this ~~up, with input and, ,
politicaVstrategic direction from Pat, ,George and others oDor 'abOut Noyember ;lOth: '
, ~(bbviously; no final decisions or i~Commendations wiWbe 'Wade at this tlme,b~t will ;
,help set the stage, on what and how n;c6mniendationS-are'iiiade/presented.) ,,'
..'
'
."\
" ' ,
" . ,
,
'
.'
"
.1
,
',As'a result" ~e' may want to' have further 'dis~ussions .to ddemiinehow' we want some
,of these options'layed o~t qefore such a meeting takes place:' If \Vethihk this ;
advisable, we think that'we should tentativelytarget'Noveinber1th for',such a " ,
, discussion to talee place. Because of the sensitivity to .the political tinieframe; we do '
nqt plan on'circuiating paper at 'this time. ' Ho~ever, it d~es see~ advisable·to get' ,
di~ectiOIi, particufarly with regard tq presentation 'of' options, from this' group before'
"
,.., '
','
.'
the larger ~oup meets:,
r
"
,
',.
. ' , '
'
•
,
'.
, I,
'
."
',',
' , ' ,
j.
'
I,
"fuiimy everi~,: aft6r tli~ November 'lO~hkeeting~:w~'\Yill need to 'move quicklyi'n '~'
, tight ealendar'before and immediat'tly after Thanksgiving tp m(lke any policy,option,
, presentations, tliat;'in 'particular, haveanyiJIlpact\vith .regard to'ongoing budget,
.
, priority discussions~'
:,
~
"
;
.,',
,
'l
l/Bob ~- do'you want to ~,'" ·s~ tht:m~ tha(:you, are alre~hinkirtg abo~t,~timing,
and pr ess issues' with regard to sc ,uling tbe Presiqent, albeit,
'no decisions, ,/
and sche '·rig having'yeno Occur? ' , ',,"
'
, ">"'-
.
"
.'
.;----. ......
/
.
:.'
"
i,
" . '"
Discussion of" :
Specific Issues Within W ~rkp'lan ,.--: Turri to' Chris'
,.
"
,
'..,"
•
,
'.
'
cpverage'
, iris~rance, reform
state flexibility ,
' costcontainmerit ,
, financing,
regul~tory, options
..
"
, ' , ' /
','
I'
;
'
,
,
,
.
-.~
\
.'
.
,\ '
,
,
, ,.r
~
,
/'
1,
.'
I
, /"
~
.
'
, I
"
"
~--.
'.
<',
'
,I
!
,
,
"
.
'
•
"
�~,
,
'
".
,
I·
'r
,
I
,
l,
<\.'
.'
.
'~
,
",
(RETURN TO CAROL'AND/OR BOB) Outline 'Need for'Intense and QUiet'Staff
Work,on Background Infon,nation;P~Ii~y Option~, and-Quallti~tive (numbers"7
nin)Analysis',, ."
~", , ' : ','~',
,'.',. " " ,
' . '," •. , ;
.,'
,
":
'"
,
"
I"
",
,
"
'In <:mle( for us to get this infonnation prep~ed anclcirculated arnongstou'rselves for
, consideration ~iid discussion"in a timely manfler~ the, staff work wHl need to get it. '~'
, done quiCkly and' quietly. ' Thi~ 'is,'particularly t,he case ~ith regard
any options'"
ielatiIjg ~-o numbers/Cost~rev~nueissue~;:" ',:
"
to
f r
\
.
':
• ' .. Chri~
'J'
will be consulting ,you tlu:oughout 'this process to:niake- cert~inthat you are
I
'comfortaDh~ with'how this is ',being done and who. is doing it. aut it must' get done'
.
.
~
.
~,,'
, \ ' ;
__
,"'"
"
'
"
soon~,
:'. ~
, i',' ~
~!',
.
'
,,'
','
,,','
. ,,'
:
"
"
".
'
' , ' . . ' /' ','
, ',:
"
I'
"
\. "",onsomefronts we can move quickly:and, bliild on, the ,information' base we have ,
,- : either thf9ughour own work 'or those: of the alternatives that ~ave:be~t:t outlined in'
t~eCbngress.However, there most dCfinitelY~ill,be exceptions to'~his that will entaiL _,'
,'new and detailed work,analysis arid.conslderatipn. The targeting and, admInistration '
,'of subsidies and the advisaoility and fe~lbility of providirig for s!at'e.flexibility 'in, a ' , ,',
n9n-universai cov,erage,proppsal serve as two p~icul~rly good ex3.m~les.
"f
,"
--'1'
,
"
1
Reiterate Sensitivity, of AIiy Le~ks Ah?ut this Work GeUing Out,"
,
VI.'
,
.,..
"
.'
.,..' -'
,_
•
'.
•
"
I'
'
'
"
.
/,
;-"
" J
,_
At the risk of beating,~'deaq hOrSe"we must 'continue to_reiterate' the 'importari~ of
hQiding this inforlnation-close:· If..anyofthese, options get outinto,press\ or ortto the
. Hill prior to 'early consultation, ,w~ have major problems that ,could underInin~ whoie ,: ,
proCes~ -:-- even)f a leak' occurs after'the election.
.
, '" . ,
'
,",
"
;
-:
,
I
, VII.
Will Kee'p'Io
\'
,,".
.,."
TQu~h~'TbankY~~Clos~re:of.~eeti~g
,
'
.\
'
'
,
,
, 4
I
.
,
I,: '
Asne~.inforinaiion '~nsubstance orSched~ling becomes available, we will be: i~ ..
\
:
, ,. ,touch.', Thank, 'you 'ait ag~!rifor all' )'o~r help and ~oper,ation. I thi~ we ji~e off tola:
. , . gr~at .~tart.
" '
' ',',
'
.
. 'J .
,,
'
.,
"
'
I
'.\
"
','"
"
:
.
,
"
. I
\1, ,
;
'I'
,
"
,
\
.
�,
MEMORANDUM FOR CAROL RASCO
FROM: KATHI WAY
RE: HEALTH CARE AND THE STATES"
You are aware that 36 Governors races are to be decided this
November. Ray estimates 20 new Governors with a possibility'of
even more. If the election really goes "down the tubes" the
largest state with a Democratic Governor could be North
Carolina. I include this for the following reason. The Health
Care policy we implemented in Seattle (will yo~ ever forget that
fiasco) is due t9 sunset this year. That means the January
meeting could include a full blown discussion of ,the Policy with
MANY new Governors. I met with Democratic leadership governors
earlier this week to discuss their strategy for that policy
discussion and the one likely to take place on welfare reform.
They will try to make the case for continuing current policy
BECAUSE the many new Gover:nors'will not have time to really
consider new policy prior to the meeting. At best we will delay
the conversation'until the summer meeting. Ray is not optimistic
this can be held off. I am,not certain but do believe we need to
continue to follow that discussion. If we can not hold off that
discussion, we should make certain our friends are up to speed on
the direction of the Administration so they can be as helpful as
possible in framing the policy.',
One more overarching issue. 'Ray indicates the end of the
session on Health Care was not helpful' for states and it seems we
need ,to do some damage control ,work with the states before we .
even talk' about new directions with Health Care Reform. Senator
Mitchell" s bill was a potential disaster for the states and
'.
Governors and their staff were locked out ofmo~t of th~
discussiops. (I always knew are triend Crittendon would come
back to haunt tis.) On the other hand, Dble plajed to Campbell
and the Governors felt the, Republicans were more sympathetic to
their concer,ns.
There are t'wo parts to the states concerns on heal th care
reform, substance and process. With regard to the substance I
will layout Ray's thoughts. He believes the mood of Congress
and people in general will not support a comprehensive, universal
proposal. The components that follow are based on a Federal
framework with state/local flexib~lity.
�INCLUDE:
PORTABILITY: There is a basic understanding and acceptance on
this issue.
It is importa:n~·to citizens and to businesses that
operate across stat~ lines.
.
COMMUNITY RATING:
Propose "a wide-band" that allows for
deviation for risk factors.
States.could be offered the "option"
of narrowing the bands. True community rating, one rate for all,
is too costly for the young healthy 'low cost population. ·This
provides a way to begin the process.
STANDARDS: Legislation from last session was loaded with
mandatory standards. Ray recommends breaking those in three
groups, mandatory--small number generally associated with quality
of care and outcomes, guidelines that provide suggestions to
states on standards they may' want to implement .and.optional-
those least important! He believes the various interested
parties may be willing' to sit down and categorize standards in
these three groups.
FINANCING:
In the "new" Congress, with conversations about
balanced budget, deficit reduct.;i.on, etc. it will be increasingly
difficult to produce dollars·for health care. Ray suggests ( I
think,this is one of the best suggestions) creating two "block
grants" for states. The first relatively small dollars, $1/$2
billion for infrastructure would allow states incentives to ,
create alliances, additional managed care for medicaid, etc. The
second $8/$10 billion allocated by state and available to
encourage states tb extend coverage to those currently uninsured
without expanding the medicaid program--either through the use of
subsidies, vouchers, etc. Actual dollars could be raised through
. the cigarette tax.
Three issues 'are conspicuously absent--ERISA, BASIC BENEFIT
pACKAGE and MEDICAID.
There are two ways to apprOach ERISA,
through legislation or regulation. We are not going to win
through legislation, business wil~ line up against us.
We may
have a chance to deal with the issue through regulation. Ray
indicates health care providers are increasingly concerned about
the lack of protection available through self-insured businesses.
Employees are dropped with no' notice or their·benefits are
substaritialiy changed. Ray belie~es the providers mai-be able to
buiid·enough support on this for regulations to be put in place.
Without the encouragement/support of outsiders it is really
.
unlikely we can get this one done ..
Achieving agreement on a BASIC ·BENEFI.T. PACKAGE is· unlikely.
Ray and most others bel'ieve this is a long term goal.
He
suggests we may want to put three "packages" on the table. One
that is just .catastrophic, one more comprehensive, one ideal.
�We know what a patch work the current MEDICAID program has
become. Ray suggests we just leave it alone initially.
Increase
the ability of states to use managed care for medicaid,but
otherwise keep hands off. We talked about the possibility of
"capping medicaid". Capping just the Federal portion won't fly
(big surprise)~ Evidently NGA worked out a deal with Dole to
include a cap on state expenditures also with the states having
the ability to reshape services to ,fit under the cap. That is
the only scenario that will fly with capped entitlement for
medicaid.
How we go about putting together this vers'ion of health care
reform may be as important as what we include in substance. Ray
suggests we think about development of a few white papers that
are shopped around at hearings, on the Hill and with states.
Clearly, whatever we do has to be bi-partisan and include the
Hill as well as states. Once the ideas are circulated, Ray
,suggests the President invite a representative group to Camp
David to hammer out the details and achieve agreement. He
believes, and so do most that know the President, this is, his
strong suit and the forum in which he excels. One additional
note--the intergovernmental process, John Hart" did not work well
last time.'It was very partisan and weighed in only
sporadically. This effort wili r~quire an ongoing dialogue with
a broadly representative group.
I think Ray is on targe,t with his direction. His views
certainly parallel information I hear from the states.
It does
not do it all but certainly heads us in the right; direction,.
It
is very similar to the ideas we talked about ,3-4 years ago.
I
will continue to have "casual" conversations with folks at the
Hall of the States 1:;0 get a read on their individual state
direction.
I w.ould also like to have a conversation with you at
some point ,about the advanta~es/disadvantages of s~lecting a
group, children, for government focus.
Let me know if you need
additional information.
�TO:
FROM:
DATE:
Carol Rasco
Jennifer Klein
October 21, 1994
Attached please find the Health Care Qs and As for the
President's press conference and a transcript of Shalala's
comments.
�..
\
H~alth,. Car~Qs and As '- October
.
,
','"
~"
'
"
'
"'
"
20, '1994 ':,
, ' , ,1'
'
Q. IS' th~ 'new health car~process a recognition tliat the TaskForce was a Caiiure?
',,'
I ,
'
"
,
"
-',
"
,','
" ,
,
'"
"
A.,We are simply moving health care through the same policy 'process', that we' use for other'
major:domestic policy issut?S. The Domestic Policy C6~n~il (DPC)and the Nationa(
, Econdmic" CounciL (NEC) 'will, coordinate oUr ',futUJ;e health reform'efforts. 'We are just
beginni~g thi~ process 'and ,it'will be a' while before decisions 'are reached.,
'
•
'/
j"
"
'.,
I
,
,Q.Secretary S)Ialahl saJd yeste~day that you will'be presenting ~ecommen~ations to, ,",
, Co-Iigress on health carel reform and that these 'recommendations will be part ,of yout
'budget.' Are.'you going to submit a new plan and; if yes, have ,you' gi~e!1 thought ~o' ~hat
',these reco,mmendatio,'ils: will inchlde?" ' , ' , ' "
',
"
,
'
'
:'
•
,,'
"
~
....
~,
~
,....
.
,
'
\
,
'"
.
"
\.
i
.
"
,
i._' "
,.'
,
"
'
.
"
.
.'
..'
'A.:lhavenot-'had a chance to'think,exactly about where we will ,go'or evertinwliatform, any , ,
such' proposal, would be presentecL Cpuld r~coriunendatio'nsbe' submitted as'pan:' of the,
'"
,,-'
,'
"
,
,,budget? Yes; but it is also possible it wqn't.
.
. '. .
'
\"
\
\,
~
, "Q. So,'S~cret~ryShalala '~;isspoke~yesterday? ,,'
if
'
,
,
'A. Secretary Shalala was speculating '.on possibie options. ;Again, no decisi:ons' hav~ b_~en
I
"
, reached. In fact, I have not- even discussed' options yet. Secretary Shalala herself said that
, decisions ha~e 'not been made. , " '
; ", "
'
"
, Q. Secretary Shalala also sa'id that obviousrevenue s'o~rces will be cuts in Medicare and
,
, a tobacco tax. Are these yo~r options that 'youare-~on~idering g~ven that tliey, were in '
your: original plan?,'
", ,
'
',,' ,
' ,
A. Let
first say tha't t4is'Administr~ti~n,wiltnot ~iash Medi6are:' In ~y"original prop9s~1; ,
we took the Medicare savings ~d used them to provide benefits to.older Americans. We -,' ,
like ¢very bill that'came,'out of Corrimittee ,- liad~ tobacco ,tax. ' Again, however, no
,decisions on any 'fi~ancing options for any proposal has even beeh discussed 'let alone
"decided.,
'; " , ~
,
"
"
' ' , '" "
, ",.",'
, ' , ' , '"
,
me
, , ' " Q.
,
Se~retary, Shalala i~dicat~d tli~tyouwould~~'produciQgascal,~d back 'health c~re
plan~ D~es this,meanthatY01i w~li give, up on your goal of univer:s'al covehlge?
Throughout this debate on liealth c¥e"r~forln,rhav~repe~ti':dlY'\stated that' coveiingeve~y ,
, Arrieri~all andc~ntrol1ing esca~atingh~alth care costs should be our goals!' My co~itment '
.
. , , to this' mission has nor changed. 1 still believe that every Allerican, deserves health care
,covenlge. Every ~onth that we' don't act to' reform oUr system" 100,OQO l1}ore Americans wil!
lose their insurance. And, if we ,want to ensure that the deficit that we have worked'so hard "
to contain does not palloon again over t~me; we ,need to 'add;ess riSIng health 'care 'costs.' '
,Americ~nl!
spend $982 bi1.lion on/health care s,etyicesin, 1994- pearly 14 p~rcerit of our.
gtoss qoinestlc product. ,If this trend contirpies, we !~ill spend $2)trlllion on, health care in '
2001 - ,20%
our 'GDP.
'I,
"
,'," A.
will
of
"
\
"
.
.',
;.,
,
,
.;
,
,I, '
'"
,
,
\
"
'
'
�'.
,~l
,"
'f,
i
.
,
r"
,I.'
'(
.'
'"
"
.
'.'.
•
1
·'.1
«
,
•
.'
There are 9bviously, decisions that neep to Qe made on how to proceed on health care reform. '
,"
"
The one thing that is sure 'is ~hat we are serious about continuing .our fight ~or reform. ' '
,
,
,
,
(
,
'
.
.,
t
I'
•
•
~
'
"
Q. Will 'you veto a bill that does ,not ,achieve universal coverage? ",'",
-
1,.'.
' .
:
."
I
•
'.
'I
, - '
.
,
'
"
,~,
.
A. ,r stillbeli,ev~ thate,very American deserves health care coverage. 'Our/goal is universal
, coverage. 'Ahdw~'re going to do everything possible to assure that Americans have health
, c'~e c~\verag~ when 'they 'need it. "J\ricl we'~e goi~,g to. do' everythirigp~ssibl~ to "control" '
escalatmg J1ealth care costs. ,;
r'
The Americ~ people still ove;\Vhelmingiysupport univ~rsalcov~rag~.,
latestNYT/CBS
, .News poll (September8-11)stated that nearly 70% of'the,publi y believes' that every.
"
'
American deserves 1 health care coverage., We must cO,ntinue to work toward achieving what
the American people wanUind deserve;'
"
,,
"
,
The
•
•
. ;
~
"
,
~
•
"
"'.
,"
I
, \
•
""\
'Q. Secretary Shalahl said that you have:,no't d'e~ided if you
will
canior ~n employer
mandate next yea~. ',Y~u li~lVe re'peat¢dlY stated ,that ~n employer,:mandate is ,the best:
way to provide coverage for every AmeriC.an.,:Are you backing away from requiring'
employers to ,share in, their ,employees heait,h care ,costs? "
"
,
i\
1
, , ,
.
"
'
/
,,"
on
A. I still' believe, ' shared" responsibility; . whidi,builds . ' the current system where " "
that
nine' out, '
,
,
,
,
,
'I
,
"
often America,ns get private insurance through the, workplace, 'is ,th~ b¢st w~y to ~nsure tllat' "
,all Americans have health coverage.'As I have :repeatedly said 1 a'rri open to any' kind of new'· ."
, ,idea.
"
~', '
'. '
; ,"
"
/j
,
'
,
,
,I
'. J .
.'
'"
,
, 'I
,
,
"
"
"
.~;
.
I,
.
..
,
•
,I'.
(
.1
,
,
'.
.
"
"...
I' '
.
;f ..
'.J'
•••
'.
,
I
I,.
"
,
1 ,,
I
,
'1,.1
"
"
)
,
,
,
'i
,
,
I'
"
,'.:
\
,',
'.
,\
:. .
,
'
.'-. /
.'
I
'
.L'
",/
"\\
r:,'
,
,'.'
':'i
\,
'.
I
,
, '
. .'
,,
"
\,
.'
1.1"
I'
.,
,I
.
,
I,:'.
�f
~, ) c i c T-2el--:199"1
:
~
FROM· 0A5PA "IEWS D1.1,1
.
TO
.9"1567"131
P.£a2
.
/
Not.estram Secretary Sheila-la'c pet. 20 meeting with the Health
communicatorc' Braak£agt ..
[Discu8sion of charts]
The problelltS are stlll.out there. The Clinton Ad:m.inictratian will.
have to comeback. Time ran out; comeone rang the bell. We will
pick up the momantwn' again,.
Q:
What format?
. A:
We I re thinking thrauqh' our strAtegy on - the. budget, welfar:ca
re!onr, health . care . roform.We get another. IC1ck a:t. 'Cbe Cilt.
Hopefully we learned. some thinqs in, the 'last. 2 _. years' that· will
Qn~ble us to retineour strategy.
Q:
What have you
le~rned?
usth~
idea o·f taking an every piece ort:he
A ,1:)1g' target creates .problems•. '
rt • s . the same as with the Republican contract; it creates a lot of'
negatives. 'We need to ,.dcoide what needs to b:edpne f1rst~
We·
haven • t decided which.' The public perceived it as', too. much '. and .
cant us: a messaqe that they want reform. but they want it in stag~.
A:
1l.\1blic clearly told
system,makQIi them· v~ry nervous.
Q:
Reconciliation?
will have to J?9.done wi~ th~ budgat. The Presiden~"
will submit proposals on Medicare, Medicaid.,. welfare, etc.. . This·
. wil.l not 1uatbe a discretionary budget. It'is l:1 natural vebicl.~ .
it has discipline in terms of ,timaf~s. The'bUdqet will 'i.ook' a'C'"
entitlements.· The Entitlement Commission will demand that •.
A; . Something
Q:
Insurance reforms'?
A:
GOtto think about how -t.o do it'without disrupting the. syaUlm'..
.Q:
,Are·you 'sayinq costs.aT.1! your focus not coverage?
A:
Both. ,We, will emphasize both. WQ· can't: do velfarerefor.m'
without expanding coverage for welfare 'recipients ana working
peop.l.e. '11iey need cost conta.lJUlltSnt '0.8, much O~ any;one.
QI.
Reconciliation could take financinq. away?
A; . 'We hAven't 'made those' deoi~ione ,'yElt.· Doficit reduction 19"a
priority but. we also want to qet going on health-care retorm.
Q:~
Question still is how do you pay for it?
There are no. trick.s here. There ~e two obvious sourcos:J ofrevenue:
Medioare aavinqs andciqar~tte taxes.
They are on
eVQryonetg list. No reason to l>elleve we won't go back. :r don't...
kid. myself tnat the pOlitic5 of the moment,on Medicare ~y change.
A~
�.-'
OCT-20-199'1
18:38
J=ROM . OASPANEWS 0 I1.I
TO
9'156?'131 . p.e3
2
The question 1s what size of cuts will be proposed.
Q:
Hec:Uoare pays;: less than costs now?
A: Hetve to talk about both privatosector and pUblic sector costs.,
No yay to back away from that. d1scussion .. ' What's qovern:m.entts .
contribution to helping- private se~or got more diQc1plined. Not
. a top down discussion of what qovernlllent can do 'to the privAte
sootor.·' to chanqe ~.havior •
We have it Cull-blown health·· caro
system, not llke30 years aqo when we, croated Ked:lcare. and.
Medicaid. The private sector wants 'help. They d.on't want to .. pick
up th'" cos:ts of 'the. uninspr.ed.
'
Q:
Elements of reform?
A: There's no new analys,1s beinq done here. The question is how
much you bite off. Our at,titudeis to find our approprl~te role in
co~tcann
Q:
rnvAraqe.
Employer mandate?
A: still a stumbling block. opti-ons include axpanding Hedi~id t.o"
cover the workinq poor. Conqregs· already passed. legislation for
kids and it I s boinq phased in' over a lOD9 period of time'. The Kicis
First. proposal would accelerate that. Another option is ·to cx:eate
larqe pools.
Like tho SECt qet the ma"t"ket: strai,qht and. en:torce
rule9.
. ,
Q':'EIIlploycr mandate?
A:
president hasn't made !il, dcoisionon that.'l'he public hiuJ ..
spoken and we will. take that discussion into' account 1nproviding,
. options for the President. Perhaps we c;:an qet' 'Vbere we .want to go;,
but. take 'a. different, r9ad..
Thcpublio, viewed'. the.mandato as a,,';
proxy for, a government run syst:.om•. Perception was the Pres1dent's;",·
plan was a qovernment-run system. ::t: l(Quld ar9ue. that.· it· wasn't but c"
taltinq 'on every aspect of the system fed that .... Reshould do things-,
that, would be helpful.Ra~ources are more ,limited. now than When we;
.started.,
Q:
.
Universal cover ago?
.
Comprebensive raform?
Comprehensivereform can be taking stronq' Qteps in. tho right'
We're, not qoinq to drop our overall O'oals. A:\way for.~ ,
everyone to qe't qoOCi 1nsurance; s\..rttU\jU.lEsn the -privo.t.e eynca.'
, Huge plans ilre difficult to qetthrough Congress. Need. avisiQn Of':
where you want to 90. The health care system is dift~rent than two .
year,; aqo.
A:
direction.
Q:Koynihan's opinion?
A;, We'll talk to him after tho eloction about his insights on--'
health care' and w@lfat'p. reform. Ploynihan alwa.ys had large goal's
and moved toward them.
�OCT-20-1994
18:38·
FROM.OASPA·NEldS DIU
·TO
94567431
P.04 .
Q:Lonq term care?
A: states want to do more exPerimentation. ppint of reform is you
can •t leave state experimentation. out. Have to look at 8tates ".
role.
,I
Q:
Would. California need a waiver if 1t· passeS single payer?
A:
Probably. We'd .have tq see what they ask fori it has to be
budget' neutral. . I. make i t a habit not· to talk abOut. waiver'.:
.requests ,par~icular ly those that. haven r t been made.
~Q:.
Have . you beencampa19l1inq? .
A: Doing a-.lotof campaigning- Kini~ of 2 .. daysaweek~nd all ..
of next. . week.. . About 10 st.11tes: NY I :rA, CA, WA, TXt· MA.
L!.m.:.
finding the same thinq I. 'did. during health ~are reform. A.very
anti-gQvernment feeling. A feelinq that the government can't::qet.. ·
.anythinq riqht~· It's . consistent.. Not.just with Washington' .bUt.
with pol!ticia.ns . in' .qtme,ral, , 'bureauc.l"ats, state, and' local"··
officials. It·s a challenqe.lt's ,pre~ty rig-ide So much so-that·
most· people .think that Social securit:y ..·is,a. privClte system.
1
I
; r.alsohear t:hat mo~peopl~.have ·had.n~qativeexperiences with
government. Thl$may be:reinforced~ytalkshow hosts but they,' re,
; not shaping public opinion. We~alked into that wi1:b health,care.
reform..
."
.
I
'Q:'
same~i~. welfare refO~?;
A:
No.
Thatts . s~
reducinq .. the amount· of"· government:
involvement in people's lives., Instead of' health~rereform.::that
navcrleavos you it· a.a t:r.ans..itionalproqram.
as·
,
Q: . Medicare
!
:
...
,.
un~erpays?
A.- VlacieCk.isworkinq onaHedi~ strateqy.. ' Some ·things tOiDake:.:
it- more efficient;· Same new approaches. Ac~major:integrity, effort::~
to eombat:waste; fraud,
Q:
an~
abuae.•,
.
.,
Is·n't· most waste overutilization?
A: Not. only.We have
off.
.
to
make sure the syste'Jll is not beinq r.ipp!d
..
Q: . Individuals can' treport 'overcharqes? '
. Ar
No
excuses abOut not. doing' something'
~ut
that.
Make .i't:;·"a·'
priority. for carriers. . OIG is 'underfunded because of 'discretionary
caps.
Medicare underpaying isanlnterestinq argum~nt·;. We're. accused of·
unaerpaylnq and they 1 re accused' of '. overutilization; EVerybody t S :
making money. .
�·\
"OCT-20-1994
Q:
18:39 . FROM
OASPA NEWS' DIU
TO
94567431
P;05
More managed care under "Medicare?
,.
.
want to offer a wider. range. Have to work on pricing •. ' We.
clearly would~ike a lot more flexibility.
A:
Q:
Don't Hl'ios shift cOsts to fee for service?
A:' You can cost shift only. as lonqas someone is willing to pay
the. bill.
There .is tremendous cost shifting going on in the
system.
~loyers are shiftinqcosts . to their- emp;Loyees. arid
shifting people. to . managed. care. Some of those costs. are' being"
shoved back and some efficiencies.' are resu~tinq. "Q~estion is are
,we getting quality under managed. care.· ..-JUst starc1ng to qet
informat.ionon that.;
'Q:
Underutilization? .
is so' fraqm:enteawe. cantt answer': that.
Governors are
desperate to slow costS; employers too. Trying to stabilize costs.
:HKOsare 'leaning on ,drUg companies for price discounts. with all
,this: 9'oinq on,'8TR pQople qettinqbetter care or'as good care?, We
.have a genm:ation used,to fe~for service and. one used to'managed
care.
;Oata
Q:. What do' 1.00 mean by "ran out~'of, ti1ne?'"
The .mainstream bill was ,out: there~
ItW8S different .but it. had
ConqresswoU.ld have. passed something if' they
Ididntt.,run out of tlme~ . Not.because·.tb:ey . lacked 'interest. Not'
· elements.
I;.~ink
because they: ran into a-br.iek.wallof opposition.
.
r;
Q:
On quality, ~(;m·t,.the:9'overnm.ent be'inte;-ferinq in medicine?
Informationandchoi.ces.
Quality comes from a competitive·
system' with consumer information.
A:
I
Q.:
Budqet :'veIlicle?
A: Have to'· identify financinq. GO throuqh the same committees.'
Timinq. Tradeoffs withi~'the pudget,.
. .
Q:
Will the President present a;plan this yoar?
, A: . Yes, he will present a pl.-an.
Q:
What if Republicans
contr~l.
the Senate?
. A: I.~ra .. not even thinking abou.t it..
sure of it-~
Q: . .
Are.p~oviders
I tmworking like ma.d. to make
driving up costs?
A:.
Not" necessarily because they're' evil.
They want to' do
everythinq .for ',their patl.nts. Pe~ple demand the very best' of care'
�~. OCr-20-1994
18:39
FROM
OASPA NEWS DIU
TO
94567431
P.06
5
,and they push the professionals. A .cul~ure ot health care in this·
·country to push to the maximum. We're all paying .the bill •
. Q:
White House staffing changes?
Ira?
,A: Most of the analytical work has been done. The question is
pickinq amonq the basic elements'. Financial and polltical choices.
Wetre·havinqa collegial discussion of the strategy. Ira is·yery
much part .of that discussion. Chris Jenninqs. is on my payroll and
. he' s coordinatinqthis. Most· of· the work has been done.· We neetl
: a financial and a political 'strategy. HoW much to ,bite off with'as
much public support and bipartisan support~ More' of astrateqic
, discussion.
Q:
. 'A:
Why December?
That's when the President-'makes his decisions on the. budget •..
/
Q:,. Hedicare spendinq?
'!'he iricraasQs may bQ a little lower than expected. That's not
new. It will red\lce the deficit a bit but it limits our options on'
financinq.
A:
·0:
Bipartisan?
A: I'ai:tiaU1ar~y in tbe Senate. Process is· important. It', sets'
tone and attitudes. ~esident will talk to the leadership after
the elections. senator. Dole says ·he wants to do health care 'reform '
next year~President will talk to the leaders about the agenda.
Q:
Will GOp· by willing to, bargain?
A: It's realistic to a-ssume that~no me'Diber of' conqress· is asking
to be elected to do,· nothing --, except the Congressman· from
'Califbrnia who's, runnincj 'for theSonate.
The. public wants'·
something .done... They lye. told us what they don't want' now we need
to make a case ,for what- needs to be done. Our. goals remain the
same:
costs,qui.'llity, coveraqe.,
We want to nudqe the systelD,
, alonq, , not 'rUn' it~
People out there without insurance ,are
Democrats and RepUblicans'.
.
. .
Q;
Will.the.President,use his veto pen?
A:
Presiden't. wi~1 &peisk. for himself.
g,:'
Deficit 'reduction?
A:·
Goinq. to ,be· a ,debate within the Administration on' that.
President· is·" committed to expanding- coverage and it will cost
money.. No newtr1clts out tne:re.'
Q:
GOP contract?
�OcT-20-199-1
18:-10
I=ROM
OASPA "IEWS DlI.I
TO
9-1567-131
P. en
A political exercise,.
Same problelll as Health care refo1:"Jll.·
Negative coalitions. Hit from every direction. liO~ a major vision
. of COP viGW for the futur~.A package of ideas for the elec,tion.
Q;
vaccines for children a Guccecc?
A: Small piece of an overall effort. Infrastruc'Cure expansion,
clinic hours, educ~tion, outreach, physician involvemen~. VFC 1s,
an at:.t:.ampt to qive kids vitnout coverage access. Part of a la.rger
strategy.
Had llQped to siqn all contracts by Oct. 1, . ..Price
contra.cts were done; deliyery contracts veran't; 1 apologiZe for
that_ As soon as tIle'delivery contracts are signed, we will qet'
th1s sy'stem goimf. We're goinq to qet it done a few months late.
Dru'1 "mnl'JI'lni P.S are happy they will qet to deliver the vaccines'.
'l11ey have onqoinq rela.tionships with the' doctors they want to,
proteQt.
.
Q:
Oruq companies say they get sot of theircoata?
AAle thcmt:
Wnat are their costzs?
What do theyche.rge .in'
Canada? We don't know. We ought to pay a fair price and it should
be neqotiat.ed.. If they say the pries1s too low, they have to
provide the d.a~a to congress. Last thinq I want to do is put an
industry out of business.
Layout :their caco, the facts.
I::::
believe drug co~panieG havQ th9 same qoals we have. They want to,
make. a decent income, We have to look at the overall proqram and,
. two' years from now look net. tho reBul ts. We need a system that
Qutomatically vaccinatos each generation of kidS.
A:
Q;.
A:
First Lady's profile?
I , don • t
qive hOI' advice on· he:.r: profile.
friend.
Q:
I'1II
ft
fan and
iI."
IL FDA says tobacco a 4ruq, bow pay for health care?
A:
I,t..d be ecstatic if less, people n.oJced.. particularly younq,
people. We t Ci save a lot' ot, money. l'r 1oim] of cig'arett.. i . "'a..:;.,
piece ot>that~,
Q:
Healtll 'care
on caJDpa1911?
A:' Yes, because it's me. They aSk me ·about health care, welfare,
Head. s't.art, ~oclal security. :t:llvu't get CL lot ofqucationl3 o.bOut-:
GATT or NAFTA'.,
Q:.
w~a't.
are you nearing?
A: Don I t want the government to run health ca're. Horror. stories,
of What thesys~emls doing to people. Tell the Preaidont to keep
going. The t.est of this Adminiatration 1~ hoW ,much we learned in
the first two years. We learne~ a lot.
�,"
,
•
FROM OASP8 NEWS DIY
.
TO
'.
Q:
'.'.
Havent.t heard about it toolllUch.
care and flexibility •
. Q.:
P.08.
.',
7
Prescription drugs .for the elderly?
iA:
94567431
Hear more about long tenr
DOf!sn' tLTC a1ternative cost more?
Issue is quality of life. Hy mother '-lsed to take me to nursinq
homes to visit some of her clients. I've seen institu:tion-.l care.
'The key is making people's, lives be'Cter..
'
. A:
..
: Q.
,
Rumors of yqur leaving?
'A: '
I'm not leaving.
Problems with Social Security transition?
A:
,
No.
VertslDooth.
No administrative, problems. '
.....
'.
,.'
�,I ",
\
:
,"~,' " ~CT,' 20 i994
I,'
"9FFICE ,OF PUBLIC "LIAISON '
,
,'.
~.
MEMORANDUM ,FOR ,ALEXIS HERMAN
,
From:.
.\
,
')
Caren Wilcox
,Subject:, options fo~ Business,o¥treach for Health\. 'Care Reform
,Date:Oct.ober 18, '199'4
.
,'I,
'",
"
BACKGROUND
'/
,
,
'(
i
,
:You have- requested ,a suggested process for busine~s'
, health care over the next several JDonths. , In light
',that the Businesf? Roundtable 'is meeting on December,
be clear on our activities" before then.
(See their
," attache,d.) ,
j
I
outreach ,for'
of the 'fact
6 we should'
letter'
I,
!. '
'"
A:s we knew in the c~mpaign, and over, 'this 'past year, many
"
businesses have been'inthis battle fot reform for,many'Years.·
Mobiliz ing .them to' supp,ort re~orm~ and getting' t.heir, buy- in to
, '. ,theproces',j; is the c.h~ll,enge.
Businesses, both formerlysuppo:ttiv~' a~d oppos;ed, would like/to.
, : be consulted before, a package 'is ,fully developed. ' ,As ,with most
other' issue~ i~yolving pul;>lic, policy 'and the private sector, they,'
want ·to feel that they" have. had real" input" to policy ,development,
before, ,being' presented ~ith hard;dra,fts of 'legislation whic,h
t
carm'ot be changed significantly. '/ sophisticated business, players
in this ,legislative game realize that they will no,t h~ve'all'
,~he~r ideas accepte4 in' the' drafting "game, b':lt they 'expect ,~ "
certain nlimPer of ,them to be ackllowledged, ,"massaged and
.'. de:veloped,,~"
'\,'
,,
"
!
,
1
1"'\ '.
, There is 'ceita:in~IY an opportunity for more of a buy~in from,
certa'in companies' and 'perhaps a . few trade associations, ',if we
take into account this desire' for participation and consultation'.,
.
\
, :
~:'
"
I
.! .
' : '
"
. ,
Generally:the business community , whether. fri,endly or hostile;,'
appears to be expecting a fairly ,',major i:nitiative from tpe, Whit'e
"House-on health care .ih the coming ,year~Seyeral have .cal1edfor "
advice,. or to ' . input, into what'is belngd.one"
s;eek
here.
"
" '
, ,~: ~
,
,
I'
"
,"
.
I'
,i
..
\,
': '·We ,hav~ 'spok~nt6 se~eral, orgailiz'ations~nd indi:yiduat~ about.
,this'interim .period and next year.
..
.
'
,
-
.
I
",
I
.'
\'
•
,
"",'..'.'
. '
,
'.
: ; '
t r-~
.
,
.
•
,small B~siness c~alitio:Jl for Health ,Care Reform ,- , This group has
,', remaine'd .relatively inta'ct',' anCi ,is hoping for continued '~ffortto '
. ,gain he,alth, care coverage, fQr ,small businesses ~; "They ,are. seekil1g
,\
",
,I
\
,
"
"
�,-I ,
,
,
\
.,'
'\
'I
('
,
I
~",
•
opportunities to help us on ,other. ''issues" such as urging member:s
,to go to the White House Conference on Small Business in 'their
'states etc. ; ,We must remember'that the sta'ffing for-this ,group
,comes from>' the drug, stores',' and' that they were ver.Y' interested in,',
our ,proposals on this subject.
,', '
'
;J
,
",
\
'
,
,
.
National Leadership Coalition 'for ,Health Care 'Reform- ,This'
'
/
,
(
'
I,
,
,group, most coilllnonly identified with Dr., Henry,'Simmons, contains
many of 'our ,most hard, core manufacturing'supporte~s. ,They ,have"
opinions, of what they b~lieve went, wrorigin' the \process, learned'
,',a few lessons themselves, a~d ,have r:"eceived a grant to conduct
grassroots meetings across the'country with business people to
'describe the n~ed for. universal co:verage. "Their focus is 'cost
conta.:lnment arjd uriiversal- co:verage. ' '
,
'
.
.
.
."
is'
I'
'Atlti,ns Group -' This group',
in' th~' proc~ss of determining
,'whether it shoul~ cont'inueas a coalition. 'They are planning, a
',retreat in January to, discuss strategy· for next year. Their
"',
, issues are ' mUlti-state "op~rations:problems aIld, ERISA pre';'emptlon.'
',IBM which is a member of this group, is worried about "its"
'
, :reputation' with, tile' administration, and how, much damage, th'ey
sustained in; 'the ',end' of the battle.' "
, ,
'var'iou~ Compa'nies -, Severa~' companies, such as, AlUericzm 'Airlines
are very anxioust~continue ,the ,battle for uniyersa~' coverage:.
Others such as ~RW want some dialogue, having opted out of an
'effective process during 'the debate., So~e large , companies are
'cleariy warning of ,their need tq 'dr~p,' coverageqr a're ,fearful "
,that others" including competitors will do so, placing them at/a
,competitive disad~antage.'
'"
\
;"
PAST,ADVERSARIES
,
',~.
Business Roundtable,- 'The attached'1etter signed by Bob Winters'
of Prudential is 'indicative of where some of the., insurers and,
, sqmeof :the large ,businesses remain -host~leand'l.fearfuL '"
Ho~ev~r, ~n the opinion of'some representing BRTcompanies, there
,is room for movement amoilgthe, rqore ' progressive companies.'
"
•
.'
' .
, ' "
"
. "
, ' ,
'
•
~,'
,
,
•
T
~
,
•
'
.'
I
.'
,1'
'Prudential's representative in Washingtcm, ,actually suggested"a,'
, meeting to discu,ss'the future/,but I did not express strong ,
. :interest, in tha,t ~ " I understand, that' Mr. WintersmaynQt continue'
as 'chair qi the BRT'H,ealth, We+fare andRetireni~nt Income Task '
For'ce, and may ,not continue' as CEO ,of, Prudential,' giyen their'
problems.
"f,"
I ' , ' ' \,
"
c,
,
,
,,'
\
\
,
l
I
'
'
,
'
'
" We 'h~vebeen,urged to hold a meeting withsome companies from -the,
BRT, so, that the, December m~et,ing cannot, take place :with ,the
,'statement 'being made ,that the "White House did, not meet and seek
,ppinions.
'
'ERIC AND'APPwP,~ The "Erlsalndustry commi'tte~ and the, Associ~tiori
of Private 'P~nsion,and Welfare Plans each had,problemsw.ith the,
,
.
:.
,
,
�, ".1
'"."
..
.
,I
'
,~
.'>
. '
/'
)
c..:. "
I,' ,
"Clinton, bill} but ,were i~iti'ailysupportive, of condepts.<Their
current" status is unclea,r, but will be, explored~'"
'
'"
"
-
'.,
"
•
J
,
•
"
1
'..
BcPC - 'This grou~ was" oppC?s~~, to"the ,Clinton' plan'dueto ' it's
", taxation of cafeteria plans: 'and was 'fearful of 'other aspects of
:theorganizational part o'f t.he bill.' It is. primarfly(:made up of
,beneflts managers, o'f,'la'rge manufacturers" with a few other' ,
companies such as Pepsico, which clearly lead the way toward'
,opposition,~ ,,'
',
" (
...
~.
,
,
,
"
,
\
,
They have,catled,and,'asked what w'e would think of a m~eting,of
groups, to determine what,they ~n live with in,
the future. I, indicated that t;hey ~hou'ldnot' look to us for
,permission to meet, but 'had a', long hard talk with them ,regarding
;firlat\cing solutions, because ,th<:l,t, is the',nub of business 'problems
,of insuring the uninsured now. '
'vario~sbusiness'
.
"
.,
,,'
'u.s.
Chambe,rlNF,IB, - "These ',two' grbups 'are soclosel'y' al~iedwith
the Republican Party,<that they, will probably. follow whatever~" '
path the Rep~blicans choose~to 'pursue.
,', '" "
"
,
,'
I
"
,I
'National'As~oci~tion",Of Manufacturers-,Th~y have' expressed; an
interest ~in incremental reform 'including s,omething' for chil~ren,
insurance portability ,"a' start toward universal. coverage" and
scaled back ' insurance reform."
' ,
-
:.
'
i
I
..'
,",',
'.".'
\
'Hovever'",;th'eir track record wi1;h the administration 'is such that
we ' need to rem~iri ca4tious about their cO'ntJmious 'use of many of
:our legislative'initiat,ives to'develop new, membership 'based' on
{' crit,iques' fo1.lowedby .promises to members to "save them from th~
'Clinton adniinistratiol1,."
',,' ' , \ "
-'
'
'f
.-
A
I,
a
•
We understand that:
few manufactur,ers did '~esign frc::,m NAM during
the, l1ealth care debat,e, ,arid, t have been forthright with other,:
'
, :,manufacturers about their' :being the losers'to the retailers, '
insurers' and some 'of their 'pth'er suppliers of servicesi 'inste'ad
",:6f more, effectively :influencing'the deba~eiritheir, fa~or.
~
"
-
.'
. ,.
. ..
-
': ' , ' .
.
,
'
..
, 'Special'ized Trade Ass'ociations-, Dependent on the ,financing,
:, formulas, and any {adverse' impact: on ,certain ,industrie~ "of, any,
-",reformpackage, we'may be able ,to attract ,quite 'a mimQer' of' thes,e;',
assoc'iations ,to 'a modified pac,kage. "
•(
"
.
'.
'.
I
~
\
.
.
-
.'
I
. '
'.•
•
'
....
'
.
'BaA - The'PJ:"in~ipal Fin~nciaiGro~pandtwoo~~hz:-eeother
companies in HIAA real;lze how counter productivetheir ef,forts
were. It may be possible to have': a dialogue with some' o'f them.
I
"
.,
I
I
"
\,
I
\'
•
~.-
•
I' •
\
I
National Restaura'nt' and Ret~iler~l; __ 'There -are < members ,in these, "
,orga'nizatigns, with whom 'there' cou]\d'~be, dialogue, 'but, the"
associations~l:lemsel "es,'should' not be 'expecte,~ 'to support much., ,I
.,' .
I
j,
,,'
I,
f
,
"
'.
"
""'-.
..I
"
,[
.
"'j
\.'.
,
\
'
l,
;
�,\
.
.
'.
.1,
'
\
~
,
,
L
.
, ,
OPflONAL RBCOMHBNDA'l'IONS,PORIMHBDIA'l'B,OU'l'RBACH
.
:The 'st,ruct,ure for' the ,out,reach would ,.incl~d~' continuing busine~s
': constituency political otitreachfrom jOPL a,nd; 'cooperatively with
'appropr~ate business l~aisons ',' :in ,varl,ous departmf,i!nts ~ ',OPL, would
facil'itate meetings'.an~policy ,exploration' discussions with,
,outsid¢ groups in, coordination with" individualsfrom Ithe 'NEe and
'D?C.:,
' ,
'
"
,I
"
. '
,
.
....
•
"
'.
~
\
,
,
.
':
,
,
,
•
_..'
,
i
:' There are()ptions-a~ itO \ the: "leve'l anq ·timing ofoutreajchto the
"business', community, '~lld 'tne i4entity of 'those included in the
',";outreach. ,possibilities incluc:ie:,,';( "~
,
\'
-.:-,
'./
, 1. " 'convene a 'meeting, of wasbinqton representati.f:e. from
'previousbar4core 'suppor~i ve ',~ompanies. 'Ask thei,r advice,
what, they are 'hearing fromstaff,on,the Hill an$i from o~her
, busin'esses. What, kind -of ,'a 'new package 'would they. like to
see,?
' ."
" " " . ' ,,' ' , , ' , '
"
,
"
, 2., ~Meet: with, belpf~l': cont~a'ct 'lobbyists ,(~m:the ;'past 'bi II.
, ,Ask ,their, advice" what ~hey:ar~ ,hearing' fromqlient,s,'Hill
anc:i colleag~es. ,What kind'of a,packagedotheY,think,is
realis~ic?
,/.'
,"
'
,,
",
3. -. Ask a: . few CEO,S, who were m'ost, visibly and ,continuous'ly,
,,'sqpportive Qfthe:administrationto meet with senior ,"White ,
- ' HoU;se staff ~and' possibly t~e First· Lady ,after: temperature '
','
, , taklng-meetings,with their, Washing'tonRepresentat~ves.,
/ Individualssuch as Bob Cran:dal1 , ' Hank· Barnette; David Haag,
'Chuck Corry, Chuck Johnson, and'Bob,Eaton; and'Paul Allaire
,come to mind. ' " , ',',' :' "
",', :" : " , ' , ,',
,
/
'
'.
•
I
,J
.
• •
•
,
.
~
,
,
r ..,
\/.
5. Mee~w,ith National Lea4e,rsbip Coalitlon fotJlealth-Care,
Reform and·discuss. wha,t:(they are hearing in thefield,at' ,
their: meetings and, what they ,would like,to~see in -a package.
<
"
"
' - .
'
,
'
"
-
, . ,
\
',',
•
,.
.'
'
\
' , ' , ...'
,.",
•
'.
.'
•
.'.~
,
I"
'7. ',FollOwingthes~' me~tings ~ith 'ma:!iY BRT' companies,,'
~
"
~
identify.next, tier\of BR'l'companies for meetings.
.
.. "...
..
I.,
_
"
-
"
.
<
'
'
~
;'
"
~'. -,
'\
-' ,
, . '
..';. .
"
. '
'
"
.
- , ' ,\
8 •. "Consider small meet'ings. 'with some friendly companies-in
unfrien4lyassoeiations' ,or· in4us'tries.:,. '.
,'.,'
.'
,
,\
,
:' '6. J c~nsider"a :meeting with the, so-calJed Atkins "Group, 'a
: . k~y ,swing group in thebusine'ss community, with, very'
" influential, members in the BRT. ,what elements of reform:.
wouldth$Y- like to "slee ina Pilckage? A n\lJlll}er of their' CEOs
should be consulted 'after we determine where this "group is
, , going,. '
! ".
.
-,
4 • ,Meet with. l~'ader~ .. o:f.the "sDiall'B~siness .coalition for"
,Healtb Care Reform, to det,ermine their' aspirations for a new, ,
'effort.'
,,' ,
-. '
.'
,
. ,:
~."
,
.
,I
�.
"'"
' ..
:..
9 •. 'Evaluate, 'dependent on,' package being developed', whether,
,uieetingspan be'heid with pharinaceutical~omp.Die8, 'some
larqe iDsur~r.etc.
.
"
~"
t
"'.'!
~
:
,"
,
.
.
,.
.
lO.·',~ont:inue priVate pialogue with BCPC to determ'ine (the
,results of . " ; consultations, with c;>ther'associations ..
,their
..
"
.
i
,
. '
,
"
I" be'lieve:' the :,i~edi~te next steps sho~ld include ~ meeting to'
x:eview. these ,options, ti~ing, 'ci:llenda~ and.- structur,e, for
.,coordination.'
'.
. .
.
'..
'" .
This' meeting' has been arranged forF:riday," October' 21 at 5· Ii .\m ..
in iyour office, 'following~ ~ , Panetta's meeting,and iittend~es ~t
this time include:,' ,Robert Rubin, Carol Rasco, Erskine Bowles,'
Marilyn Yag~r, sy~ via Matthews ,and myself., .
cc: 'Robert, Rubin
, Carol. Ra'sco,
,
, Er~kineBowles"
"Marilyn.Yager·
. ; Sylvia,Mattpews .
"
attachment· '
,
'
,,
\
.
.' t'
,,
.\
,
'I
',)
.
..
i·
! ..
,
.
I"
'.
'I'
/
.
, /'
:. i
,
I,
I,
.
\ ,
. "
, '. \'
.'
.
j'
!,
,
•
I.
,'<
•
"
"
,
I .
\
,
�..
.
."
,
,
.' \
, ~
.
"
,
f.;., ~,,:....
"
,
. . "/
""
,
1
'j
,\
,
.
,
"
'
,.
'i"~~iMO~~o,.----~'-~, -~.=~.=~~,
OIfilI,taIl,
'
i,
\
"
, ~"A.CCMTt ,
',>
•
,~"",
, fUcIhd J~ Mahonty :' "
: c.\I,'-' ,. ,
", '
Robert c.. want....
"
i'
CoIIII''-'
.
"
"
, 'Be.,' '
:
. : ~,
e~.AOacJ
....
.' . :
J
t .
'"
"
,.,
•
";
-
"• .
.-
"
,,
i
. . ..... "_.
,"
- .-. ~ ., .......
!,
.
'
I, '
,
,I
\
,.i
'
'"./
".:\,~~
:'
',:
TO: ,'Members ~fth.
RouDdf!bt~ He~ "
~ lYtlfvun4 Rttiremsnt Income l\'k EPtca '
'j
'J
::,.
'.
';,
",
..
'. .
.•~:'.o "".
.
-
- -'.'"
.
,
"
.
.
',;
\
,
,Ajtbo l~iDl~~~.~:'~~vi~.Oi_~,;,;~N.eJIIW\tI
'bit wifh,thc1dDCl'or~ ~ ota.tth w......
',01" '.'. .wi ·.uo"~,~acbIM:·tM':1cmrl'ot beI1dleire"tdxIi'
'I
.
\
"
. ,j_.,
'
"~::><
. . . !:"':(~;,,!;;:;>,_
.Co'
.
,
;'.
;
",'
.
"
'.'
"
\'
. . t.
"
/
"
..
"
.
,
j
. ~
;,-,'.,:,""
.,"
'
,"
;'.
"
•
.:
....
-:
'
";',
.
-I',:
e'
" .;.
:.".
',"
. .: '/.
"
~'"
,'J.
'
'"or';
... ''
, .-'
.
,
. -I
'\
'
\
,
�I
:
."
i'
,',.
/'
'
1-
.
",
. : ' , ,r
"
'.
'
,~
"
'"
','
,
.,.",'
."'.
.
,.
"
-,2
,'f
"". , - "-:"~ - ·~&stOri~S',·tho"~ltT ~haddlfticWt)'.marslW1ipJ ~ru.t.~~;.~~~~_IO'le!,_ ~~':'~-'~'--.~~' _.,'
"; . . aot&bl. ~gOGJ. w. need to conal_ 1lOW much eft"ott "" Ibowil put " " ."""'" .,--~~"-'- "
, }It40 .'tAt ln1~aiIv~ 0W1~ Yerri1s lookinato the,Jtafr""'ued "
orp.ri!DtIons Ub: """
6e.Cha.mbtt and NAM. \ "', '" ",: .'
i"
'i'"
."'
,".
"""
"""
."
,
I"
\
"
,"
.
"
,
-
'
;", : .', ""~Our~nT,T,I$k~o~~1sRheduiedtorTueJdaiD~"
:"_':'"
'\,_,
,
,
'
, ' ,
I
".
'
,
' . "
,
,
.~
. ~'.'
,
.
'.:
.'
<..OJ'
~',
".
., .
".'-.'
,-!"> "
. . '
,"
•
."
'
,
'
,
'
.
,
".,'
-
/"
,
"
",
;'" ", .
"._"0£
~
"
".:
,
.'
"
.....
.'
_
~
\.,:.
" . >".,' '
•
i '
"'.'
. ,
;
"
'
"
\,
l'
,"'.,"
, eRR'" to;. ,',.<
~
,PlannIni ~ommltt..
,'.
"
",
.
~~
...
1\
':,
:
'
"
,
,.
, ".
,I
"
. ..
......
,
,
'
"
"'
�THE WHITE HOUSE
WASHINGTON
october 25, 1994
MEHORABDUK TO CAROL RASCO, BOB RUBIN, AND ALEXIS BER.MAH
FROM:
MARILYN YAGER
cc:
Chris Jennings, Jennifer Klein
DISCUSSION OUTLINE FOR INTERIM OUTREACH ON ~TH
I.
CLOSEOUT ACTIVITIES FROM LAST CONGRESS
A.
Thank you letter from the President to supportive
groups and individuals (OPL).
B.
Health Care additions to White House Holiday Card List
(OPL).
C.
Thank you Reception with the President and First Lady.
A reception has been scheduled for November 10 at
4:00pm in the state Dining Room. OPL health staff will
submit a list to the Social secretary's. office by .
October 28 for invitations.
II. 104TH CONGRESS PLAHHING
A.
OPL health care staff liaisons are informally calling
contacts on health care to learn what. they are hearing
from both their membership and around town.
B.
Tentative consultative list has been compiled
(attached). This list of 22 meetings includes 'must
see' health care supporters, as well as key players in
the health care debate. The breakdown for Carol and Bob
is seven meetings and six meetings respectively. The
rest are to be handled by·the OPL health staff lead.
C.
Schedule consultative meetings (tentative schedule
attached) •
1. We suggest beginning these meetings late next week
and spreading them over five weeks (A potential
schedule has been attached).
o
�.j
"':
'
"
...;
,
...
'/
,
,
, \
\
2. Either ,Ghris Jennings or Jennifer Kleinwil1 ,staff, '
the ,consultative, meetings ,from a ,policy'.perspect i ve
and, ,wher~ ,th~y deem it appr,op,riate, they will include
other policy, staff.
'~,'
"
", '
".
,
\
,~
~<,
,3 . .w,e ha'{e't~ied t6', schedule key a'lr'ies earlier~ in' the
',process thanotp.ers.: Al't;hough 'sbm~ meetings will need,'
to be individual gr.oupmee:tingsi whet'e possible"
meetings will comprise ~everal like-minded
associatiohs~, " ,,' , '
,
,',,',
"
;1.
.
.t..
,I,
!, ."
'2.
i '
"
,
'
.
To 'listen to their thoughts and' :reco~E!ndatio'nsJ
prior to.the beginning'of Administration policy
an~strategy development.
'
i
,
" .
.
. M,ore speC!f l.Caliy to learn '~h~t' f6rms 'of, ( "
,incremental reform they would' support',' :and what'
incr~mental provisions' woiltdt~ey oppose. \,' "
,',
'
,,'\,
.
'
\
,',
" ,
'
3'., Since most of'these groups are allies' it wouJd
pro~a:bJY be: ;he'lpful if ,the meetings' w~re begun by ,
outlining the new health care strudture at,the
W:hite House, and touching 1;>riefly orithe"other key'
, , Pl;'esidential' initiatives' for the' next .Congress,
, Le.,. welfare reform" deficit reduct'ion" ,etc.' '
'"
E.
Followup toCbnsultative . Meetings
,'.
I,:
.:-'
,,'"
. '.,
.'
.
(,
1.0PL health '~taff wiil'draft summary of'"
, '
'recominendatii::m5\ ,mhde at each meeting to ,c,irculate
,', among .. ,appropriate' staff~
.
,('
'/'
2.,
'.)
3.
OPL:health',staff, wi'li ~~nd tharik you letteJ;:'S
, (dep~nding on who ',led t:tle me~ting)," to each group,
, thanking,. them for.the~r ,input. , " , , ' : :' , "
O~L heaith stfiff wili also· ,follow-up' wi:th phone
call to each group,inqicating hpw'helpf-ql the'
meeting w,as . for, ,the White House team ..
I '
,
,
j
,
I
•
.
F.R~quests for meetings with',Bobior Carol ;from groups' not
listed' on,the, 'atta'ched ", sdiedule. " \'le_ suggest," '
,
, forward,ing these' to OPL ,Healtli,staff for' quick'
recominendations: 1:0 either -:inime~iately schedule with,
Bob or: Carol/ or scl'\edule: with tbris,'Jennifer, 'Gene,
or ,Bill,' or 'hold for l~ter scheduling,
refer, toOPL
,staff to :;handl~, 'or·finally, regret.,' ;",
"
or
"
"
'
'"
,
,
'
�.:-
•
' .....
':'
I
),
\
C,?NSU~TATIVE MEETINGS
'"
','
",
'.
,
,
"
'
,\
Summary of Suggested Leads,- For the' 22" meetings outlinedbe;Low
,tpe breakdown of, meetings for ~ob and Carol over the next five
weeks is:, Bob - 7 mtgs i , Carol ..:. 7 mtgs,.
,
\
'
Busin~ss:
'
, 'Individual BusinessAllies'(Lobbyists), Bob'Rubin '
,BRT ' B o b Rubin' or Alexis
HIAA " ,
Bob "Rubin
'
,
'Grp. :Health Assn. ofAM~ ,Bob RubiI1;
','
,Other Bus. '('lmtg) ',',:Bob 'Rubin""
,
ECFC,' APPWP, ERISA Industry Cbmm.
Pharmaceutical' Man.
' Bob Rubin
'
'Small Business, Coalition Alexis Herman,
simmons 'Bu'siness\ Grotip , Alexis Herman
NAM
", ',
Alexis Herman
Chamber 'of commerce/NFIB Alexis Herman
Atkins 'Group , " ' "
Caren Wilcox
Gen~ Sm. Bus. (i mt.g)' ,
Phil Lader
, S m . Bus.,f'United,; Sm. BlJ,s.
"Legislatiyecpuncil" etc •
'
I
•
.;
,
:
'
..
,
'-
','
t" ,
.
,
f
.,
'
: Labor (One Meeting) : '
Bob'Rubin
,
AFL-CIO ,AFSCME', SEIU" CWA,
"
,UAW" Buil?ing Trades fcouncil
/'
'Seniors (One Meeting):
Carol Rasco
AARP, NCSC, NCOA, AJzheimers
"
,
"
,
'
,r
,'Providers :'
Hospital'Groups (1 mtg),' Carol Rasco
CHA', ,NAPH, NACHRI, :AAMC,
, " Protestal)t
! ,
"
'
,
,
, ,
"
" Physician Groups (1 'm:tg) Carol Rasco,
ACP" AAP, AA}:"P, 'ACOG,
,
,
, NMA,AMWA, NHPC,Redlener'"
, ,Nat. Assn.': of Homec,are
Carql' Rasco, ,
, ' 'f\-~'
,AHA " "
Marj,lyn Yager
L
"AMA,', ' , \ '
'.
Marilyn Yager
",',
ANA' &: 131ack ,Nurses, Ass,n. / Marilyn Yager
Allied, Health (l',mtg,) '" $kila Harris,
NASW, Mental Health"
Substance A~use
'
\
,/ '
. /,,'
,
,>
, '
I,'
, ,
;.
'~
"
�"
j,
'Base/Consumer Group~:
,
Families, USA
'CarqlRasco,
Consortium of citizens
Carol Rasco
,
, wit:h 'Disabilities'
,"
Gen. Base (1, mtg)
" " ,carol;. 'Rasco
Children's, Defense Fund; ,AIDS
'Actic;:>h council" Citizen~' Act'ion
NFU, Nat. council, of Churches, ,
Religiou's Action
'Women's G!OUps( 1 mtg)
~elanne Veryeer
MUW, 'NARAL, League, of Women",
Voters, Women's Le'gC'!-l Defense
"Fund
"
, '
,
"
"
"
\
,
, .,/
,.,1'
"
.. ",
" II'
r '
-I
\,
'
,/ "
�,
..
.,
"\
.
! .
\
\
,
'. ;~~ggested, Five Week Timeframe
-:,
, "
-
.
GROUP
.
.'
-
. BOB', RUBIN 1
CAROL.
"
'RASCO,. OR
-OTHER
.
I
-
"
'.
~
"
NoveliJ.ber 3'
November 4
Fami'lies, USA
,
\
\.
J
..,
,
'November 10
11
-Labor . - AFL-CIO,'
AFSCME, .BEIU,
CWA, UAW t,
. .
,Build~ng Trades
,council
\
'lQJl{( .
..
:
Bob
..
.',
Alexis Herman/
Caren Wilcox
\
,
"
,
"Alexis Herman/
Caren wilcox
"
.
;
,
.... ..
I
.Mike Lux
.
.'"
"
"
"
\
,
Carol
Rasco
Debbie' Fine,.
' ,
"
,
-.
,'.
..
.'
,
!
.'
.'
.
.
" t,
,
"
Alexis
. 'Herman
'
,
.
"
,
,.
Caren
wilcox
"
Caren wilcox
,
"
~
/
'
,Marilyn-Yager'
'.
.'
..
.
f
"
,
'.
..
"
.
/.
'.,' I " '
I
'.
/
"
'
,
.
.Caren Wilcox
"
:
'.
,
f
"
If
"
"
"
Mike Lux
,
,
Carol
Rasco
}
,
·1
Carol
,Ral?co:
!
"
\
,.
,
'.
I
~ubin
\
November 14'
November 18
S'enior Groups! .
AARP, NCOA, , NeSC,
Alzheimers'
,.
"
Simmons Busi'ness
Gro'Q-p
,,
:Atkins Group
'\\
Ca.rem Wilcox
,
..
\
/.
;Hospital' Grc:mps
CHA" NA~H,
NACHRI, AAMC,
Protestant
.'
.,
/
: Bob Rubin
,or Aiexis
Herman
'.
Nat. Assn,. of
Homecare
. .I
.'
,
,Mik.e ,Lux
"
"
,Bob Rubin
"
,
,
"
"
Herman
,
Individual
'Business Allies
"
'.
,
"
.
iq.. exis
•.,
"
·BRT
,
"
Carol
Rasco
. 'Small Business,
Coa'lition
,',I'
.
"
I
,
,
Marilyn, Yager'
will staff as
..
:well~ with
some
exceptions.
.
.
\
'1
alwaysno~~d,
j
:
.
OPL STAFF, ,'.
Although not:
POLICY STAFF
'Usually' Chris
Jennings or
Jennifer Klein
will staff
th~y will
invite' other
appropriate
staff
\
"
.
'
.
,
\
�'r
~,
f
"
...
Physician Groups
-'ACP,AAFP, AAP,
'c,ACOGi NMA'; AMwA,
NHPC, Redl~ner
,Carol
Rasco!
,
'Marflyn ¥ager,
'
Yager
" '!
'
Marilyn Yager
~,
'/
"Maril~nCJJ.t
,AHA'
"
\
,Mar i lyn:. Yager
AMA'"
,ANA, 'Black Nurses,
AI'lied ,Healtli~ "'7 '
Skila
NA5W, Mental' " , 'Harris
,
'Health; ,sustance' '~'
; 'Apuse
'
,f
, \,
\
,\ .
'
Debbie-Fine
\
,',Carol
RfisCO
Consortiumo'f
.
. ""
'Citizens with
, Disabilities,
Debbie Fin~
Marilyn'I\,U ,.
Yager' \ lj(t
,
,
: \'
Debbie Fine:
,
Melamle'
"Verveer
Women's Gr9uPS
AAUW, NARAL, ,,' '
League' of 'Women
v6ters~ Women's:
Legal Defense
Furid ,
'
/
"
~
,
,
,
Marilyn Yager
'
,
\
j
,
,
'.,
,
\'.-
Novem))er ,21 , 22,
'.
General Base
'Groups -'
Children's: , "
,bet en'se' ,Fund,
, ,AIDS Action
'Council, Citizen
Action,NFU, ,Nat".
council ,of,
'
Churches,
,
Re'ligious Action'
,
,Car,ql ' ..~
~aril.yn
.''',
,
....\
"
._. I
,I,'
"
,
I,
"
.
C~ren
Wilcox
Novem))er 28
December 2
'\ ,
, Alexis
,Herman
'NAM
"I
.
,"
:
I
,
'''',
\
Chamber of'
Commerce I NF'i B'
Alexis
Herm~n '
'
.
Caren "Wilcox "
Car~n
I
"
Wilcox
....
,
,
,
Yager
Rasco
other Busiri~ss ,..:.. 'Bob' Rubln,
ECFC i ERI SA, '
Industry
;
commi tte~, 'APPWP ,'.',
"
!'
\
'
�.',
,\.
"
}
~
, ,
"
"
HIM
.
'
, African";":Amer1can'
; GroupS-Black'
Leadership Forum
AI~xis
Herman
,
,
I
,
:
Ben 'Johnson·
1
,
,,'
.. -'
.. f
..
,
,
.'
,Bob Rubin·
"
..
~
,
"
Caren wflcqx'
,"
"
'
,',
..
..
I
-,
'.Group Hea'lth
Assn. of,America
,
Bob. Rubi,n
'l
·.General Small
Business
Small
.Business united, "
:Sm •• ,Bus.
Legislative' ,
Council" AssJl~
.
for Sel:f;..Einp+oyed'
Phil
Pharmaceutical
Research and. Man.
of' Ani. (formerly
PMA)
Bob Rubin
Caren' Wiloox
~ader
,
,
.... j
,
...
.,
,
,.
'\.
J
.
"
,'.
"
..
"
!
,
"
'.
..
J
,
"
I(
"
Marilyn . Y?i.ger
'.'
,
....
."
,
.'
."
I
.
.'
,.
,J
"
:
/
\
..
i
,
~
"
;
i~,
,
,
..
-
'.
C.ar'eJi.. wilcox:
,
.f
",':
./
.
,
,
.>
\
.
/-\
',,'
,
~
...
'
'J _
.,
-.'/
'
.. '-..
."1 '
.f
,
'.
.'
:;
;,'
"
/'
'.
" , I
.'
.
.,
-
/
I
.
.
'.,
,
.
, .<
:
.
(
"')
':
"
;;
,{
"
�, I
..
'
, '
. .7{y
.
,
.' .'
~
,
. I'
Heaith Car.~ 'f,alking:Poi~ts .:.. O~tober 24,1994'
"
.
• '1'
" Problems. :Remain .and Will' Escalate '.
,
.\
' \ .
,",
.
....
.':, " , '
,
"
. ,~' ~ .'
, . _'.
. ' ,
.')
..
. \.
.'
),'\
.'
\
.!
' .
,
.'
,
.;.
~
".* The. Pr'~sid~Iir ~ad' the'courag~ to. take. oQ 'the I~hali~hge of health ,car~ reform: be~~us~ tpe
'AinericaQ' 'people .want real health security'a:ndw~nt heaith.care· costs br~)Ught under cont'rol.
'This President ,wiil.'no.t walk awciy' from the ~hallenge. We will ret~m' next year in.Congress
;..'
be.calise our nation's heaithcare problems are not going away. ' "
.
i
!
l
-.
r'
.
\! •
,
'
. ,* Everyday,.theh~alth care pi~iure g~ts worse. On"any giv~~day,clos,eto 40 ~'illi~n
,
. . Americans "';"rilOst' of them w6rking' p'eople :- lack insurance; . Millions 'are locked in jobs·~hey :
"':~an't l~a~e for fear
losing their ,insurance:. Famiiies cfn'tget coverage \~eca~se of "pr'e- '.
, :existing cO,nditioris" arid 'other fO,mis of'insurance discrimination. ,Small'pusinesses face :.
health c~lTe premiums 35, percent higher than those· of large· corporations.~ a~d. those .'
" ..
premiums are'i'projected to grow at double~digit rates....... ',. ',,'..' ' . '. . : ' . '.',
"'\
of
•
I.
•
,
\
'
,
.
.
.
'.
,
.
.
,
.
\
'
"
\ '
. *.',our' health care pr~blems hot only take' a' human' toil' ii the! na~ion, 'the; ta~e ~n. econo,mic
6'
.
..
'. .
..
.
.
toll as welL This'Administration has worked hard to contain the deficit. But if we' wanUo
, eqstire that it does not ,balloon over time, w~ ,m~st ,control health, care costs.' Month after
" . ',month, y'ear after. year;' health care costs ar~ ~rthen~roding our savings, our investment, . . , '
capital'0l:lr public treasury, and our-ability to crea.tenewjobs in the ·pr~vatesecto~.. In ~994, :
.I.we will spend. nearly 14% of our ODp'on' .health care services. If this tr,end; <;6ntinues,' we wili.
'spend nearly 20% of our' GDP on he~lth care by,2001,:
, ,,':
'.,
',' ) .
.'
"
I'
~
"
\
I;
"..
j
j
.~
'
"
'The, Good New( ,
"',
,
,
-
. '
I
I ..
~
,.* W~ile as.a nation we must confroht our hea1th, care pro/blems, we'should a~so be proud ,of
'
..
I
, ' "
/'
,
the fact that the United States l1a~_ one of the. best health care'systems in the w~rld., We.must·
:a<;:tively work to preserve and build upon what' is good,in our system and provide support,'ahd
.. needed change for \V~at is hot ~orking In the system. ". ' "
'. " .' . . . .
- '.,
"
. 'j
I.
",1"'
I.'
.... *, Let.:me 'be cl~ar: this i\dmini~trati0i1'isseri~us~~6ut conti!1uingouT fight forrefo~~ We ..
are :notgoing, to stari~. still '~hile moieandriloreArrJeticans ~ee .~ealth care costse,ating away,
:,'at 'theh>family, budgets." And' we'·are.:not going ,to' standstill 'while 'American fa,milies live iIi:'· , "
:; fear' of behig one illness or job 16ss away' from losi~gthdr insurance.'
" "
.\
"
\ I ..
. ,* This Administration will fighno'ensiIr~', t~at the high quality of health care that Americans:
. i
•
.;' receive' is "protected.. Americans :hav~: the 'right to' high qu~lity, affordable health care from the _.
,'.' doctor ,of their-choice,. , .' .'
"""',."
. . . . .'.
,
., .
,; ."
I','
.\ •'Moving Forwa.rd
:.:'
1
"
••
,...
".
.'
:,
•
,",
'.'/",'.\'
<"""
'.
"
,
L
"
,
,'.
j'
".
:"
i'
*. Last year marked a 'milestone in the .long journey toward health care for 'all Americans: A
.(
, comprehensive proposal was developed' and' those recorrmiendations were presented -to :', .
'
I. ,
. , Congress.' . \ '
,"
"1
"
"
'
).
,
i.
\
I' :
.,:
,/
'\
I
I
.
�I: .
!>
,\
..
~:
,
"
~, The~ ~dm~nis:tratio~' de~e~op~d ari exten~ive' data base a~d: tech~icar expertise ~hi~h'
<,'
.'
.
. adva~ced th~' underst~ndinf9'~' pOlicy-~~~ers ~bout the difficul!:trad~'-:offs involved in '~eal~h ,
care r~form.
'
,"
,: ..
',,'
.
•
,,'
.'
.
,."
',I"
'.
'.
,
t:.
,
'; \ .
J,
".
. "
,!,'
.
.
',.
",'
'I, . .
'.
\
'
" ..
>-,'
",IThe Administration!sgroundbr~aking work put health ca~e at the .top ofthe. national agenda
and engaged ~he publ~c, the press' and C,?rigress in the most'seri9us arid thoughtful debate
'
"
,
"
. ~,
about. the American health care system' in sixty ye~rs:'
'.!
,'j "
I
:
1
J • .. "
' \ ' .
/1
\
"I
' . ,
•
'.
',',-
",
. 'r'
'
"
"
.'
..
\,
',
.
'" Building 'on, last year!~,health'Care.initiative,' the Administration w.ill' move its pealth care
" reform efforts fQrward through its normal policy processes. The DOmestic Policy Council
(DPC) ,and the National,E;conomic Council ~C) will"coordinate the futur~' health care
~ reform 'efforts ..' We are just beginning thIS PJ;ocess and' it ,wiUbe a,' while be{ore'de'cisions are' '
reached~"
.
".. '
.
" ,',' . .
"
,
""'We lo~k fo~~id to' ~orking ~lth Ci:m.gress, doctors, nurses,hospital.official~, small 'a.pd',
. ,llarge·businesses,)abor, older Americans ~md countless. others who want to make'our:health
i
•
,
care :sy'stem work .better ,for ,Ameri<;:an' families: '
"
",
. 1.
.
"
"
' . ,,: 'Questions ahd' Answers -:
. .
.
,"
,
,
,
Q., ~hy Istbe 'Whit~ l;Io~se'~eveiopin'g ~ ne~'health ca;epr:ocess?
,
"
.
I
'
We, are~impl~.
"
"
.
.
.-:.
\.'
'.~
".
,.
'j',.' ,
,
, .'
. ".'
.,
.
•
he~lth
thr~ugh
p~lic~ 'pro~es~.tha~ w~ "~se,
: A.
ih6virig
c;are
the 'same
for other
major domestic pol~cy ,issues. The ,Domestic Policy ~ouncil (DPC) arid 'the National;,
EConomic 'Council (NEC) will Icoordiriate bur 'future health rdorm· efforts.: "W_e 'are j~sf
,,'
", '
. ,
.be~innirig ,this process ~nd, it will' be,' a while' be,f~)r~ ,decis~on~ 'are' re~ched.:' .
" ',;
','
"
,
'
,,~.
~
,
..
.
:
, r '
~'
,'.-:
':
': .. '
~" ,',"
..
'''.:'
.- .. '., .. ,""" . , '
"Q. Indications':are that you will be producing, scaled back health. care' plan.Dges"thi,s
.
.
".,'
\',
'
.." '., m~~n that)ou will'giveup on
"
.'
I"
"', \ '
',(, ' ,
,".
"
- , .'
.'
,r
.
'.
,
your goal of univers~1 coverage? • :"
"
,
'
a
•
,.
• "
,"
';
,
.
,.,.'~'
~.
,'I . . . .
,
•
,
",
'
!
.\'
"
•
",'
i
we will
,
"
"
\,
,
.
,
)
~
'
\
"
.
.'
. ,'I".
/
'
, :~th'ere ar'e: decisi()~~ that need to. be' ~~ia:de ,on, how, to' proceec1qn!' health c?r,e' ,~efoim ... The:.one
'. thi,ng. that is' sure' is ·that we are 'serious about ·cQntinuing our fight' for .reforin. , We have ' .
learned from the past debate " and we.are .ready to.' ~ove'forward. ,: .. ', ) , \ '
,
. ;. ,r
...
".,
•
.'
'" ','(
,
,
,.
'
, " " A. :rmou~out this ~eb~te on ,healthc~re reform, we have repeatedly ,stated t?a~ covering' ,
every American and c,ontrolling escalating health care ,costs should be otirgoals: Our'
,commitment ,to' this' mission has not;chaIlged.· WestIll/belie~e .that' every 'American deserves
:' healthcar~ coverage.' Every .month 'that, we\don't act to reform our system,' 100,000' morc;
'Americ'ans win lose ,their insurance,. And, if we want to. ensure that' the deficit that we ,have
, .worked so harq tq contaiQ' does 'not "balloon again over time, we need;to address rising health ,
.' , , . ' care Costs.· Americans will spend $982 billion ,on health care 'services 'In: 1994 .:-:-' nearly 14' .
, '. percent'-of our gross domestic product.· I{ this.trend co~tinues,
spend $2.~' trillion ,on'
: ' , - ,-,',~ '" ,,: ',:.' -' ' \', '
. :' he~lth care' 'in 4001 - 20% of ,put I GDP~
~:
I,
'"
.\
'
..
'
"
I
~
,
"
'
�.,"
.
.,
"
,
~;
,:.
"
,
I'
•
,
,
,
'
,
'
'
,',!
, ' "
"
r
.'
'
I:
'.
"
"
'j
,
\
, ','
d~e~ ri~t ~cbi~ve uDivefs~1 coverage?
Q.:, Will the :PreSident 'veto 'a:,biU ihat
, "
','
'f
"
,
':
'
,\'
'
.'
f
': .
.'
"
, '
','
',,'
A. We still ,believe that every Ame.ric~n deserves ,health care coverage. 'Our goal is' universal
co·verage. And welre going 'to doeYerything possib'te to' assure th~t Ame~icans have health :' ,
, care coverage. when' they peed it. And we're going to do, everythipg pos'sible to control
escai'atin.g health.- ~are costs.
' .,
"
,.,.,'
',' ','
!
'.
I',
. '{ ,,'The American people still overWh~l~ingly·support ~ni~ersalcoyerage. The late,sf N)'T)CBS·:.
News poll:(S~ptember 8:-11) stated t~at nearly 70% of the public believes tliat every,
American deserves health ·care ~verage., We m~stCoritinue to wor,k towa~d achieving what \
:
"" the AIneric8n people 'Want ,and deserve.. '\
' . " " .' " . '
", ,,: . ' ' , '
,
"
.
\
I
-..
t'
~,
I
.
,.
. l,
':
,
'
I,
'-.
. Q~ihe~e is'~pecul~tion 'ihattiie Adfulnistration'will ' ! .
be presentin~:recorrirliendati6ns ~o ..
"
Congress on, health car(reform and tba~ these ·recommendations will' be' part of; the'
.
;, \ budget. Are yo~:going to~ubinit'anew plan and, if yes,haveyoo given' thought to·what ' ,
.',
,...
\'"
' .
these recoounendationswill include?
J
"
":',
!,
'
,
..
,.,', ' .;1 '
\
.'
A: We nave not'ha<;l acttaJ1cetothihkex~ctly about ~h~re we will go or'.even in what for'ip
.. any such proposal would bepn~seI,lted.' Could recommeridatipns, be submitte<i as part of the .
budget? Yes, but it is als~.possible they'won't be part of the budge~.
.
"' ,
.
,
t
!
'
i
,
',~
,
d'
.', ,
,
'.
'
,
,
,
" •
; , .
"
, "
,
,
!
~.
:'
'~,
"
'
' : " ,
-
,
•
'
,
•
,
:,
: Q. There isalso·spec\llation that.obvious revenue sources will'be cuts iri Medicare and a
.... ' ".t9bacco tax. \Are these your ~ptions that Y9u ~re considering given, tbat they were in' ,
'.: '"
.
1'
" your· original 'pla'n? ."
':
A.Let me ·first say:that this :Administra~ion' will: n~t ~~lash'MediCar~.':Ill the President's '
. origirial proposal,. we took the Medicare savin'gsaIiclused them, to provide benefits' to,'.older .
. , : .Ameri~ns. Our 'proposal - - like every bill that came out. of committee...;:'" .had atobacco '
, faX: ,Again,howevei; no' decisions' on :finam;'ing options for .any prop~sal have ev~n. been" '.' , . '
discussed let alone decided. "
, .
.
l
'.
'.
i
I:
"
,<
'f
,;
:1 .•. '
,
, ,
/
:
,.'
/
/.
"
.'
,
'
\
,
'!
,
,/
.
i
_.
'j'.
!
'.
..
,
,J
J',
,',
I
,
'
.
"
,
"
"
'
j"
.'
"
;.
"',
"
,
".1
"
,
'
:
(
,
.
~
.
,
.\
,\~
,
"
\"
\
'
,'
\
'
...
'
�,
"j
~"
I
I
:
,
, , '
-;
, !
,
,,'
"
,
,
.
Memorandum
:
!
,
,',
I,
"
,
'
,To: " O1rol'Rasco i ' ,
From:', LotrieMcHugh' , ' '
Re:' HealtI:t, care talking points
Date: October ~8, 1994,
I,
{,
,
"
,
"
~'"
J
Jemiifer asked'that I, forWard the, following talking' points to you'. Please''let mekllow ' '
,"
..
.
if, you have, any c9mments or suggestions,;--, or if you would like changes )nade after.' your
'first presentatior{, They hf,\ve beeri' reviewed- py Jennifer, bur Gene has' not had an
;op'portunity to look at'them given ,his, hectic sched~l(! .this wee.k,. " ::" .
'
"
.
.,
. '.
"
. -.
,
",
,
"
'\
~.
. '
"
,
,
~
,
,
,
,,~,
"
"
'
.;
'
f
;
1
I,
'
'
;
.
'
" '"
I diq' n,pUnclude a 'talking point involving ~ personal story. As yo,u know, we found,.'
dtiring' t,he ,firstroluid'of this: ~ffort .that: persOIial' stories really 'brought'lIte point hori;te that our
~nation's 'health 'care probl~ms are riQt:goingaway: ': Ifyou.~n~d any ,up-"'-dated examples,'" I '
.
,
.
.
wQuld pe happy t'o do 'some exploring. " " ,
,
'"
'
,
,.
,
,
'
_'
: '
I
..
\'"
,
'
"
:-
"
,
,
'
'
"
.... :,
·or••
'
\
.
I,' ,'
I'
, I
i ;,
I
,J'
""',
"
,
,I,
. ,
.
'"
;,'
",j
"
, ",
'"
,~,
,
'
,
("
'\
'.1 '
','
I,
.. "
'
'I
,
, i
,
'"
'"
"
'.'
, J
, I
'c'
"
,
"
,
'
'.
,
'/
,
!
I:'
"
f
"
."
"
.
\.
"
..,
/
I,
,
,'{
I"
,
<''-,
, 'f.
,
"
,
"
','
"
..
....
,\"
J
:'
,
:.'
,
,
,I
,1
\:
'
..
�E X E CUT I V E
o
J' J' ICE
03-Nov-l~94
o J'
T if E
PRE SID E
07:27pm
TO:
Carol H. Rasco
J'ROK:
stacey L. Rubin
Domestic Policy Council
CC:
CC:
CC:
Jennifer L. Klein
Sylvia M. Mathews
Jeremy D. Benami
SUBJECT:
Follow-up
KEMORANDUM
I
To:
, From:
Carol Rasco
Ch~s
Jennings
Date:
November 3, 1994
Re:
Follow-up with Bruce Vladeck
I just spoke with Bruce Vladeck regarding Sheila Burke's presentation on Tuesday night.
Bruce reported that Sheila went through the usual presentation about why health care failed
last Congress. Interestingly, she was generally soft in her critique of the Administration
--although she did have some implicit slaps at the First Lady and Ira (eg. the secrecy issue,
etc...). However, Sheila did say that Republicans did not get their act together:either and
contributed to its demise as well. Bruce characterized Sheila's presentation as conciliatory.
With regard to specifics, Sheila said that Senator Dole would generally approach state
flexibility issues as someone who is sympathetic to the Governors. She stated that there would
likely be many changes at the state executive level and Senator Dole would most likely be
responsive to Republican Governors interested in state-based reform. In that vein, Sheila
spoke about state-based managed care reform initiatives as well as some possible ERISA
changes. On the latter point, she acknowledged that Republicans would have a problem with
this issue, but implied that Senator Dole might be more sympathetic than some people may
think. Other than that, it was a pretty general presentation.
If you have any additional questions, please call me.
�E X E CUT I V E
OFF ICE
o
F
THE
PRE SID E N T
05-Nov-1994 07:36pm
TO:
RASCO C
FROM:
John Gilmour
SUBJECT:
health care proposal
Dear Ms. .Rasco:
It would 'be good policy -- and even better politics -- for the Clinton
Administration to offer as its health care plan the same health care plan
Nixon pr~posed in the 1970s.
Nixon proposed requiring employers to pay 75% of the cost of employees'
insurance; employees were not required to accept. This plan would not
solve all problems in health care, but it would be a big improvement, for
it would· increase the number of p·eople with insurance and reduce cost
shifting.
.
,
Politically this proposal would be unbeatable. Richard Nixon and Caspar
Weinberger were its major proponents. Republicans could not label it a
nutty plan. Perhaps even Weinberger could be persuaded to endorse the
plan anew.
Whatever happens, the Administration wins. If the plan passes, the
American people will win, and the President will look good.
If
Republicans refuse to accept even the plan proposed by Richard Nixon, the
American people will clearly see that they are opposed to broadening
access to health care, and that will help Democrats in 1996.
Embracing the Nixon proposal would be a bold stroke.
else it.could break the logjam on health care.
More than anything
Cordially,
John B.· Gilmour
Assistant Professor of Political Science -
*-----------------------------------------------------~--------------------*
John Gilmour
Voice: (314) 935-5817
Department of Political Science, Campus Box 1063
Fax: (314) 935-5856
Washington University
One Brookings Drive
st. L'ouis, Missouri 63130-4899
gilmour@wuecon.wustl.edu
*-----~-~------------------------------------------------------------------*
�RFC-822-headers:
Received: from gatekeeper.eop.gov by PMDF.EOP.GOV (PMDF V4.3-10 #6879)
id <01HJ4P5U1G6000BDI7@PMDF.EOP.GOV>j Sat, 05 Nov 1994 18:37:11 -0400 (EDT)
Received: by gatekeeper.eop.gov (5.65/fma-120691)j id AA03445j Sat,
5 Nov 94 18:37:09 -0500
Received: by wugate.wustl.edu (5.67b/WUSTL-0.3) with SMTP id AA11031j Sat,
·5 Nov 1994 17:37:01 -0600
Received: by wuecon.wustl.edu (4.1/SMI-4.1) id AA26996j Sat,
5 Nov 94 17:37:00 CST
X-Mailer: ELM [version 2.4 PL21]
Content-length: 1796
�-_.
THE WHITE HOUSE
WASHINGTON
�~
i
4208 Evergreen Lane, Suite 222
Annandale, VA 22003-3264
(703) 642-1070
FAX (703) 642-1075
CHRISTIAN
c>-O-----<1 LEGAL
1 SOCIETY
i
®
NOV I 5 1994
By Facsimile and First Class Mail
November 10, 1994
Joel!. Klein, Esquire.
Deputy Counsel to the President
Office of the Counsel to the President
The White House
Washington, DC 20500
Dear Joel:
On behalf of Christian Legal Society, we would like to express our gratitude for the recent
opportunities you have given us to provide input on matters of importance to America's religious
communities. The Adn:~inistratioll's actions.in Crystal and Chipkevich are truly encouraging.
.
~
.,"
,J,
••
;'
"
•
-
to."
-{
".
:
~
,:'.:;
:',
.;'
~,
••
~.
:.,.~.!
'; . :'....:'.. ! .•..•
'::"
:' ...•
",
;.:-',',i: ..:'::'
, .. ,. ,'J Desp-ite their significan,c~, the, political, religio1.l§ @g,moral sensitivity. of these matters does not
eve.n: begin;,tq.~p.p~oach:.tlie ·volatilitY.btYet.anQt4er.ifi:~~e::)llE(tt~a:tin~nt';dt hbortion in health care
reform:P!9P'OSEllS.,. ,...."_:" '.;:~.' ;., . ,.. ' .... '.:::: '... ,., ·'··r ,', ....;......., ... ;., ..... ,.... :.'i.'.'.;" ":. ',::"::.,'.':"'.1::: :.;'.).;.: '.. ::»:,
:>':~:J (.... ';,'
,'.'.. :.... ~:;:' ....~.:~ :.~.~ ::~::::; . :"',' ':'
.':\
'::f ;.l':;'{'"
~::{!:·::"·r.'l':_:;: ','"'~~:I
Milli~~; ~f '~~ri~,'~'oti~~ted 'b~' b~th' ;'~ligiotis ~d n~~-t:eliwollirnotions' of moriility; ae~~ly
oppose the taking of innocent human life through abortion. With regard to abortion, future proposals
are likely to resemble last term's unsuccessful initiatives. If enacted, such legislation would compel
sin,cerely conscientious citizens to do something that haS never been asked of them before: pay for
abortions and the construction of new abortion clinics. We believe that it is our duty, as an
organization familiar with and part of evangelical Christianity, to warn you of the grave political
dangers associated with such legislation. A fll'estorm of controversy almost certainly will erupt as the
enactment of such legislation comes close,to fruition.
We oppose any proposal that dermes a basic benefits package to include abortion. Such a
pt:ovision would increase access to abortion and therefore increase the number of abortions performed
in this country. This would frustrate President Clinton's stated goal that abortions be rare in America.
Moreover, many Americans committed to protecting the unborn would be required, through their
premiums, to fund abortions. The high visibility of health care reform, as such legislation neared
enactment, would galvanize religious communities and engender avoidable hostility towards the
Administration.
'.
.
......
, " , . . ;")':
,"
'\!
; ..
~'J~:~"~'
'::
-,'., . .
'.
,,-
,."
. ~
,- ';
i
1····:·
:,'
.
'~' . . '
We also oppose any proposal that: subsidizes abortionS .. Certainof'last term's tiriSuccessful; •
.init4ttives.41clu<ied large health care subsidies, yet there was no indication that such subsidies would
riot r~ach ,abortion. Again, t~ .propo!?al ,woul4in~re.~e the numper of abortions and force all
taxpaying"cit.iz~~tosuppor~a i>ractic<tl~an riUUiy.X~dm<?raUy,.t~~t,e0hi~~s~bie..: li":.~~:'·:,·
(;',:'~:.
,.....,;
We also
~ehement1y
oppose any proposal that might result in the construction
,'.
9f Dlore abortion
Equipping For Service
�-
"
i'
•
Lette~
to: Joel 1. Klein, Esquire
November 10, 1994
Page Two
clinics. Requirements regarding the availability of benefits arguably would mandate the establishment
of more such clinics. Millions of Americans will be horrified ,at the prospect of the federal government
I
using their tax dollars to construct facilities that are, to them, the moral equivalent of Auschwitz gas
chambers. Although one may not agree with this perspective, this characterization is no exaggeration.
The innocence of and consequences for their victims were and are the same. ,
In sum, the prospect of unquenchable political controversy looms, and almost certainly will
come to pass as such legislation approaches enactment. Such legislation represents a radical departure
from, the status quo in the abortion arena. Inciting vigorous and hostile opposition can be avoided.
We strongly recommend that any health care reform legislation proposed or signed by the
President be abortion-neutral. In other words,legislation should explicitly: (1) exclude abortion from
the basic benefits package; (2) deny subsidies for abortion; 'and (3) disclaim any mandate for the
construction of new abortion clinics. Legislation that ignor~s these recommendations will elicit the
passionate ire of the millions of religious and non-religious Americans who sincerely and fundamentally
oppose abortion.
:
,
Again, we thank you for the opportunity to alert the Administration of situations important to
this nation's religious communities. Please do not hesitate to contact us if there is any further input
we may provide on this or any other matter.
Steven T.' McFarland, Director
Center for Law & Religious Freedom
STM/bh
�Carol R. Rasco - Call List
CALLER
MESSAGE
DATE/TIME
Congo Pete Stark
225-8626
11-10
2:50pm
FOLLOW-UP
DISPOSITION
please calIon Monday
,
I
I
I
1
I
j
-----'~~.M~~
-
-
""'-
J~~'4:' ,
~.~
'1Y\QL~~ tMu
~ ~I 11\.t)~.
----
I
/1
I
i
/'
--
,<
'"
\
PHOTOCXPf
PRESERVATION
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Carol Rasco - Issues Series
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36305" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Description
An account of the resource
Carol Rasco's Issues Series collection consists of records relating to affirmative action, health care and reform, Medicare/Medicaid, immigration, disability, children, families and seniors, education, welfare reform, Middle Class Bill of Rights, and state and local economic issues. This collection consists of memos, letters, reports, schedules, itineraries, talking points, copies of legislation, and organizational material such as flyers and pamphlets.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
Clinton Presidential Library & Museum
Extent
The size or duration of the resource.
92 folders in 7 boxes
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Reform [1]
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Issues Series
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 124
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2010/2010-0198-S-IssuePapers.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763322" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Publisher
An entity responsible for making the resource available
Clinton Presidential Library & Museum
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
12/4/2013
Source
A related resource from which the described resource is derived
2010-0198-Sb-health-reform-1