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RECORD TYPE: PRESIDENTIAL
Page 1 of 1
(NOTES MAIL)
CREATOR: Elena Kagan ( CN;Elena Kagan/OU;OPD/O;EOP [ OPD 1 )
CREATION DATE/TIME: 5-DEC-1997 12:48:02.00
SUBJECT:
Re: Congressional Ball
TO: Elisa Millsap ( CN;Elisa Millsap/OU;WHO/O;EOP
READ:UNKNOWN
TEXT:
I didn't.
Am I invited??
@
EOP [WHO 1 )
�ARMS Email System
Page 1 of 13
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RECORD TYPE: PRESIDENTIAL
(NOTES MAIL)
CREATOR: Elena Kagan ( CN=Elena Kagan/OU=OPD/O=EOP
[ OPD )
)
CREATION DATE/TIME: 9-DEC-1997 18:51:26.00
SUBJECT:
TO: Laura Emmett
READ:UNKNOWN
( CN=Laura Emmett/OU=WHO/O=EOP @ EOP [ WHO)
)
TEXT:
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�,.
December 9,1997
MEMORANDUM FOR THE PRESIDENT
FROM:
BRUCE REED
GENE SPERLING
CHRIS JENNINGS
SUBJECT:
Initiative to Reduce Racial Disparities in Health
To support your race initiative, we have developed proposals that would commit the
nation to an ambitious goal of seeking to eliminate some of the most severe racial disparities in
health care by the year 2010. African-Americans, Hispanics, Native Americans, and Asian·
Americans suffer from certain diseases up to five times as often as whites. To reduce these
disparities, the government will have to make a sustained effort to find effective approaches and
apply them across all health programs. We recommend that the FY 1999 budget take a twopronged approach to this issue by (1) expanding our finest public health programs so that they
can address the problem of reducing these disparities, and (2) funding competitive grants to thirty
communities to test innovative and promising new approaches in this area.
Racial Disparities in Health Care
The initiative would focus on six of the most severe racial disparities in health care:
infant mortality, cancer, heart disease and stroke, AIDS, immunization, and diabetes. Some of
these disparities are quite startling. For example, infant mortality rates are 2 liz times higher for
African-Americans and 11/2 times higher for American Indians and many Hispanic groups than
they are for whites. African-Americans have a 35 percent higher cancer death rate than whites,
and African-Americans under 65 suffer from prostate cancer at nearly twice the rate of whites.
Similarly, Vietnamese women suffer from cervical cancer at nearly five times the rate of whites,
while Latinos have two to three times the rate of stomach cancer. African-American men also
suffer from heart disease at nearly twice the rate of whites. Native Americans suffer from
diabetes at nearly three times the average rate, while African-Americans suffer 70 percent higher
rates. Minorities account for 25 percent of the population yet make up 54 percent of all AIDS
cases. The Demographic changes anticipated over the next decade magnify the importance of
addressing these disparities. As minority populations grow, finding effective ways to close these
gaps will become a critical aspect of improving the overall health of the nation.
Validation
An initiative that sets the ambitious goal of reducing these health disparities would
receive overwhelming support from public health groups such as the American Public Health
Association, the American Heart Association and the American Cancer Society, as well as from
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minority groups such as the Intercultural Cancer Council, the American Indian Healthcare
Association, the National Hispanic Council on Aging, and the National Council of Black
Churches.
Proposal
HHS is proposing to spend $200 million in FY 1999 for this initiative. OMB is currently
recommending an investment of $30 million (along with some retargeting of existing funding
streams), with all the new money to go to established HHS programs, and none to the community
grant proposal discussed below. (OMB believes that most communities do not have the
infrastructure necessary to implement new public health projects in the most efficient manner.)
OMB's lack of enthusiasm for this initiative results partly from a fear that we will not be able to
reach our goals. DPCINEC strongly support both parts of this initative. We believe that the
initiative will require an additional $80 million and that $30 million of this money should go to
the new competitive grant program.
•
Applying Current Effective Public Health Approaches to Eliminate Disparities. We
recommend that you propose $50 million to apply some of our most effective public
health approaches directly to reducing racial disparities. Our best public health programs
already use effective prevention and education strategies to improve health care. These
programs would use additional funds to implement and adapt such proven public health
strategies to eliminate racial disparities. For example, CDC's breast and cervical cancer
screening program could use additional dollars to target minority communities better, as
well as to extend its efforts to other cancers (~, prostate and colorectal)
disproportionately afflicting minorities.
•
Community Grants to Develop New Strategies to Eliminate Disparities. Eliminating
racial disparities in health care will require not only the focused application of existing
knowledge and best practices, but also the development of new approaches. We
recommend that you propose $30 million in FY 99 to enable thirty communities to
develop innovative and effective ways to address racial disparities. Each community,
chosen through a competitive grant process, would commence an intensive program to
address one of the six health areas. (For example, a grant might go to a Native American
reservation to test innovative approaches relating to diabetes.) These grants would fund
education, outreach, and preventive approaches that have not been attempted elsewhere.
HHS would hold periodic conferences to educate the public health and minority
communities about effective strategies developed by these communities, with the aim of
extending these approaches across the nation.
•
Beginning Today to Reduce Disparities. To ensure that we begin this initiative
immediately, we are identifying ways in which the FY 1998 increases in health care can
be used to address racial disparities. For example, AIDS education and training centers
are beginning a new partnership with the Indian Health Service to develop new
approaches to educate health providers about training and prevention. In addition, the
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National Cancer Institute will expand efforts to recruit more Hispanics into clinical trials.
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�December 9, 1997
MEMORANDUM FOR THE PRESIDENT
FROM:
BRUCE REED
GENE SPERLING
CHRIS JENNINGS
SUBJECT:
Health Insurance Coverage Initiatives
Throughout your Administration, you have worked to enact legislation to expand access
to affordable health insurance. The Balanced Budget Act included an unprecedented $24 billion
investment for state-based children's health insurance programs. This historic initiative will
clearly reduce the number of uninsured. However, there are other deserving populations whom
we could target in our step-by-step reforms. These include the pre-65 year olds (referenced in the
Medicare memo), workers between jobs, and workers in small businesses. In addition, we are
working on possible proposals to expand Medicaid coverage to people with AIDS and
disabilities through pilot programs. The policy development of these proposals is still underway,
so we have not included them here.
Taken together, these initiatives total around $10 billion over 5 years. This amount is less
than half of the health investments enacted as part of the Balanced Budget Act and less than 4
percent of the premium assistance proposed in the Health Security Act. Having said this, none of
your advisors believe the Medicare and Medicaid savings left after last year's deficit reduction
effort are sufficient to fund these initiatives. There may be $0.5 to 1 billion over 5 years in
Medicaid savings, but those savings will be difficult to achieve and there may be other claims on
them (e.g., child care, benefits to immigrants). Another possible source of funds is the tobacco
settlement, given the natural link between tobacco and health care.
Your advisors uniformly agree that we need to take all actions possible to achieve if not
exceed your goal of increasing insurance coverage for 5 million children. A series of proposals
are described in this memo to help accomplish that goal. There is less agreement on whether we
should address a new group of uninsured people in this budget. The Department of Labor
strongly supports the workers-between-jobs demonstration; of all health initiatives in the budget,
it is their highest priority. OMB also supports that demonstration if sufficient funds are
available. HHS believes that this proposal has merit, but is skeptical that it will attract any more
support than it has in the past three years.
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�A.
CHILDREN'S HEALTH OUTREACH
The Children's Health Insurance Program (CHIP) provides funds for coverage of
millions of working families' uninsured children, a population that previously had trouble
affording coverage. It also builds upon the Medicaid program, which covers nearly 20 million
children. But important work remains to be done. In particular, we need to work with states to
enroll the millions of uninsured children in these programs.
Medicaid eligible children are especially at risk of remaining uninsured. Over three
million uninsured children are eligible for Medicaid. Educating families about their options and
enrolling them in Medicaid has always been a problem, but it has recently become even more
challenging. The number of children covered by Medicaid leveled off in 1995 and, according to
the Census, dropped by 6 percent in 1996. While some of this decline may be due to the lower
number of children in poverty, another part may result from families' misunderstanding of their
children's continued eligibility for Medicaid in the wake of welfare reform.
Options to Increase Outreach for Medicaid and the Children's Health Insuranc.e Program
To address the need for children's health outreach, we propose a series of policy options.
Together, these initiatives could cost $1 to 2 billion over five years (or more depending on policy
choices about the enhanced match). Preliminary discussions with NGA and some children's
advocates suggest they strongly sup,port these efforts. In addition, the Administration is
developing partnerships to encourage a complementary range of private outreach activities.
Enhanced match for outreach. One option for improving state outreach is to provide an
enhanced match to enroll children who are eligible for but not previously enrolled in Medicaid.
At the end of each year, if a state can document that it has increased its enrollment over its
baseline, it would receive an increased matching amount per newly covered child (possibly
through administrative payments). This policy rewards states only if they succeed in outreach,
rather than matching activities that mayor may not work. Depending on the amount of the
incentive and the administrative design, this option could cost to $0.5 to 1 billion over five years.
Moving outreach to schools and child care sites. We could build upon the
"presumptive eligibility" provision in the Balanced Budget Act to make it easier to enroll
children in Medicaid and CHIP. The BBA option allows limited sites (~., hospitals) to give
low-income children temporary Medicaid coverage on the spot while they are formally enrolled
in CHIP or Medicaid. This proposal would broaden these sites to include schools and
appropriate child care sites, at the state's option. HCFA actuaries preliminarily estimate that this
proposal would cost $400 million over 5 years. Also, under the BBA, states that use presumptive
eligibility must pay for its costs out of the CHIP allotment, reducing the amount available for
other coverage. States have advised us that this requirement discourages them from taking
advantage of the presumptive eligibility provision. HCF A actuaries preliminarily estimate that
dropping this requirement would cost $25 million over 5 years.
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�Accessing 90 percent matching funds for outreach. A third way to increase funding
for children's health outreach is to increase states' flexibility in using a special Medicaid fund set
aside in TANF for outreach for children losing welfare. This $500 million fund is currently
allocated to states with a 90 percent matching rate for outreach activities to certain children. We
could expand its use to all children, not just welfare children. HCF A actuaries preliminarily
estimate that this policy would cost $100 million over 5 years. NGA supports this change.
Simplifying enrollment. A simple, accessible enrollment process could encourage more
families to enroll their children in Medicaid or CHIP. To help create such a process, we propose
several actions, all of which are inexpensive. First, we could streamline the application process
by simplifying Medicaid eligibility and by encouraging the use of simple, mail-in applications.
HCFA has already developed a model single application form for both Medicaid and CHIP. We
could condition some of the financial incentives described above on using a single or simple
application. Second, we are reviewing the feasibility and cost of a nationwide 1-800 number that
will link families with their state or local offices. Such a number could be placed in public
service announcements, on the bottom of school lunch program applications, and on children's
goods like diaper packages.
Discussion
There is unanimous support across agencies for focusing on children's health outreach.
HHS and Treasury believe that such outreach should be the Administration's first priority.
NEC/DPC and OMB believe that aggressive outreach will be needed to meet or exceed the
Administration's goal of covering 5 million uninsured children. Although OMB is supportive, it
points out that because some children may be impossible to reach and some states may not use
these options, we are unlikely to enroll all 3 million children. NEC, also supportive, raises the
concern that spending on an outreach initiative may be a communications challenge so soon after
the enactment of the $24 billion base children's health program. However, policy experts,
Governors, and children's advocates alike will endorse this initiative.
One great challenge is the difficulty of finding savings from Medicaid to offset the costs
of this initiative. With this in mind, your advisors are considering the tobacco settlement as a
financing source. Specifically, we are exploring the advisability of allowing states to retain the
Federal share of the tobacco funds if they dedicate those funds to high-priority Administration
initiatives like child care, education, and health care. Governor Chiles would support such an
approach if we dedicate the funds to chi Idren' s health care, not just outreach.
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�B.
WORKERS BETWEEN JOBS DEMONSTRATION
Families who lose health insurance while they are between jobs are a small but important
group of uninsured Americans. These people pay for health insurance for most of their lives, but
go through brief periods without coverage when they are temporarily unemployed. If they
experience a catastrophic illness during this transition, the benefit of their years' worth of
premium payments is lost. In addition, they could lose protection under the provisions ofthe
Kassebaum-Kennedy legislation once they regain coverage. Coverage at that point could be
subject to a new pre-existing condition exclusion period.
.
Limited Demonstration
This policy option is a modification of the program that we have carried in our last two
budgets. It would award grants to several states to provide temporary premium assistance to
eligible low-income families. States would use this money to partially subsidize families'
premium payments for up to 6 months. To test how best to address this population's needs, we
would select states using a range of approaches like a COBRA-based subsidy, Medicaid, or
covering the parents of children covered by CHIP.
Since it is a grant program, we could make this program as large or small as we want.
To give a sense of the options, last year's $10 billion proposal over four years covered about 3.3
million people with incomes below 240 percent of poverty. Ifwe assume the same set of policy
parameters, a demonstration of $1 billion over 5 years would cover about 230,000 people; a
demonstration of$2.5 billion would cover about 600,000; and a demonstration of about $3.5
billion would cover about 800,000 people. OMB has suggested that we could limit the costs by
reducing the eligibility for assistance to people below poverty. However, NECIDPC advisors
oppose such a limitation because it shifts the target away from the middle-class families we
originally intended to help.
Discussion
On policy grounds, all of the agencies support this policy. It has been in our last two
budgets because of its merits. This policy remains Labor's first priority because it targets a
particularly vulnerable group and addresses the worker insecurity issues that played such a large
role in the debate over Fast Track. OMB would support this initiative if there are sufficient
funds. HHS believes that this policy is no more viable this year than it has been in the past; HHS
would also object to using Medicare and Medicaid savings to fund this proposal. DPCINEC are
concerned about dropping this policy altogether and support a demonstration that is large enough
to be viewed as improving coverage. If resources are limited, however, we would prefer the
children's outreach initiative to this proposal.
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�C.
VOLUNTARY PURCHASING COOPERATIVES
Workers in small firms are most likely to be uninsured. Over a quarter of workers in
firms with fewer than 10 employees lack health insurance - almost twice the nationwide
average. While 88 percent of workers in firms with 250 or more workers are offered health
insurance, only 41 percent of workers in firms with less than 10 workers are offered coverage.
This disparity reflects the poor functioning of the small group health insurance market. Studies
have shown that administrative costs are higher and that small busines.ses pay more for the same
benefits as larger firms.
Grants to States
Given the disadvantages faced by small firms, the question is: are there policies that can
make insurance more affordable for small businesses and their employees? In the last two
budgets, we have included a policy to provide seed money for states to establish voluntary
purchasing cooperatives. These cooperatives would allow small employers to pool their
purchasing power to try to negotiate better rates for their employees. This year, we propose both
the original policy and a variation: a competitive grant approach so that a more limited number of
states could receive a smaller, but more targeted, pool of funds. The total costs would be $50 to
$100 million over 5 years.
Discussion
All agencies remain supportive of this policy and believe it should be included in this
year's budget. In the past, we have failed to enact this proposal because Congressman Fawell has
pushed an alternative approach more attractive to small businesses. Fawell's proposal would
help small businesses to self-insure and in so doing escape all state regulation. Governors and
consumer groups have consistently opposed the Fawell approach, fearing that it would leave the
small group market with only the most risky and expensive groups, as low-risk groups move into
the self-insured, non-regulated market. Our recent conversations with Fawell suggest that he
may be open to compromise this year in a way that he has not been in the past.
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�December 9, 1997
MEMORANDUM FOR THE PRESIDENT
FROM:
BRUCE REED
GENE SPERLING
CHRIS JENNINGS
SUBJECT:
Reforms to Prepare Medicare for the
Retirement of the Baby Boom Generation
The Balanced Budget Act (BBA) that you enacted took critically necessary steps to
modernize the Medicare program and prepare it for the twenty-first century. It extended the life
of the Trust Fund to 2010, invested in preventive benefits, provided more choice of plans for
beneficiaries, strengthened our ongoing fraud activities, and lowered cost growth to slightly
below the private sector rate through provider payment reforms and modest beneficiary payment
increases. However, the BBA's policies were not intended to solve the long-term problems
posed by the retirement of the baby boom generation.
The Medicare Commission was established to address the demographic challenges facing
the program. However, a major policy and political question remains. Is there anything we can
and should do prior to the March 1999 Commission deadline that could further strengthen the
program and lay the groundwork for implementation of likely Commission recommendations?
The National Economic Council (NEC) and Domestic Policy Council (DPC) have led an
interagency examination of several targeted policy options. This memo examines options for
coverage for pre-65 year olds, Medicare coverage of patient care costs associated with clinical
trials, and a project to increase awareness of private long-term care insurance. Financing options
to pay for these proposals follow this description.
Your advisors have differing views on whether to pursue any new proposals while the
Medicare Commission is active and which proposals to pursue if you choose to do so. OMB and
to some extent Treasury have concerns about a pre-65 option, because it may open the door to
subsidies for a costly population and have the unintended effect of reducing employer coverage.
Both OMB and Treasury oppose the clinical cancer trials proposal because it could set a
precedent for every other disease group asking for the same treatment. In addition, altogether, it
may well be the case, that the traditional Medicare savings alone will not be sufficient to offset
the costs of these proposals. As such, a decision to propose a pre-65 policy may be feasible only
if the 'decision is made to propose an income-related premium or, much less likely, dollars from
any residual tobacco tax. It is worth noting that an income-related premium would clearly be
more politically acceptable to our Democratic base if it were linked to a benefit expansion.
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�A.
PRE-65 HEALTH INSURANCE OPTIONS
Although people between 55 and 65 years old are generally more likely to have health
insurance, they often face greater problems gaining access to affordable health insurance,
especially when they are sick. Individuals in this age group are at greater risk of having health
problems, with twice the probability of experiencing heart disease, strokes, and cancer as people
ages 45 to 54. Yet their access to affordable employer coverage is often lower because of work
and family transitions. Work transition increase as people approach 65, with many retiring,
shifting to part-time work or self-employment, as a bridge to retirement. Some of this transition
is involuntary. Nearly half of people 55 to 65 years old who lose their jobs due to firms
downsizing or closing do not get re-employed. At the same time, family transitions reduce
access to employer-based health insurance, as individuals are widowed or divorced, or as their
spouses become eligible for Medicare and retire.
As a result, the pre-65 year olds, more than any other age group, rely upon the individual
health insurance market. Without the advantages of having their costs averaged with younger
people (as in employer-based insurance), these people often face relatively high premiums and,
because of the practice of medical underwriting, may be unable to get coverage at any price if
they have pre-existing medical conditions. While the Kassebaum-Kennedy legislation improved
access for people with pre-existing conditions, it did not restrict costs.
These access problems will increase because of to two trends: the decline in retiree health
coverage and the aging of the baby boom generation. Recently, firms have cut back on offering
pre-65 retirees health coverage; in 1984, 67 percent oflarge and mid-sized firms offered retiree
insurance but in 1997, only 37 percent did (although this decline may be slowing). In addition, in
several small but notable cases (~, General Motors and Pabst Brewery), retirees' health
benefits were dropped unilaterally, despite the firm's prior commitment to their retirees. These
"broken promise" retirees do not have access to COBRA continuation coverage and could have
difficulty finding affordable individual insurance. An even more important trend is demographic.
The number of people 55 to 65 years old will increase from 22 to 30 million by 2005 and to 35
million by 2010, over a 50 percent increase. Assuming current rates of un insurance, this trend
could raise the number of uninsured in this age group from 3 million today to 4 million by 2005,
without even taking into account the decline in retiree health coverage.
The last reason for considering the coverage issues of this age group is the likelihood of
proposals to raise Medicare eligibility age to 67, consistent with Social Security. The experience
with covering a pre-65 age group now will teach us valuable lessons if we need to develop policy
options for the 65 to 67 year olds.
Policy Questions. Two central questions guide policy decisions in this area: what is the
target population, and what is the best way to cover these people.
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�Whom to Target. As with any incremental reform, targeting is essential to reduce the
chance that the policy does not unintentionally offset or reduce employer health coverage. While
this policy will not affect employers' decisions to offer coverage to their current workers, it may
affect employers' decisions to cover retirees, as well as employees' decisions to retire early. At
the same time, the current level of employer dropping suggests that a policy for the affected
people is needed. Although your advisors remain divided on the advisability of implementing a
new policy in this area, we all agree that any policy protect against substitution by limiting
eligibility to a subset of the pre-65 year olds. There are two design approaches to achieve this.
The first approach is to limit eligibility by age. We recommend an age break of 62, which
is already the most common retirement age. The 6 million people ages 62 to 65, compared to
people ages 55 to 59, work less (48 percent versus 74 percent), are more likely to have fair to
poor health (26 versus 20 percent), and are more likely to be uninsured or buy individual
insurance (28 versus 21 percent). In addition, it is also the age at which Social Security benefits
can be accessed. Within this 6 million, we could limit eligibility to the 2 million without access
to employer or public insurance, and would require that they exhaust COBRA coverage before
becoming eligible. These steps should reduce the likelihood that the policy will lead individuals
to retire or drop retiree coverage.
A second approach is to limit eligibility within a broader age group -~, 55 to 65 year
olds - to individuals who lack access to employer-based insurance for particular reasons:
(1) Displaced workers: About 60,000 people ages 55 to 65 lost their employer insurance when
they became lost their job because a firm closed, downsized, or their position was eliminated. (2)
Medicare spouses: As many as 420,000 people lost employer-based family coverage when their
spouses (almost all husbands) turned 65 and retired. This number could grow if employers drop
retirees' dependent coverage for these spouses as a result of this policy. (3) "Broken promise"
people: A small but visible and vulnerable group is the pre~65 retirees who lost retiree health
coverage due to a "broken promise" (ie., when the employer unexpectedly terminates coverage).
How to Provide Coverage. The second question is: what is the best way to increase
access to affordable insurance? One approach is to extend COBRA continuation coverage for
longer than 18 months. Currently, COBRA allows workers with insurance in firms with 20 or
more employees to continue that coverage for 18 months by paying 102 percent of the premium.
The major problems with extending COBRA are that (1) people in small firms are not eligible,
(2) businesses will consider the policy an unfunded mandate, and (3) the policy could le~d to
discrimination against hiring older workers. In addition, firms could use this longer COBRA
mandate as an excuse to not cover any employees. Despite these difficulties, a COBRA
extension appears to be the best option for the "broken promise" people, since the former
employer would bear some of the costs of its decision to terminate coverage and COBRA could
then serve as a "bridge to Medicare" for this population.
3
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�A second option, preferable for most of the target groups, is a Medicare "buy-in."
Eligible people could buy into Medicare at the age-adjusted Medicare payment rate, plus an addon for the extra risk of participants. Because the actuaries think that most participants will be
sicker than average, this add-on will be costly. To attract healthier people and make it possible
for more people to take advantage of the benefit, we could defer payment of the additional cost
until age 65 by "amortizing" this payment. Under this scheme, Medicare would pay part of the
premium as a loan up front, with repayment by the beneficiaries with their Part B premiums after
they tum 65. The HCFA actuaries have estimated that this Medicare "loan" in a worse-case
scenario would cost $1.1 billion per year assuming participation of no more than 300,000 people.
Because the preliminary estimates assumed that only sick people would participate and that all
would enroll in one year, and because they did not take into account the pay-back from
beneficiaries, the official estimates, expected soon, will probably be lower. Subsidies would be
considerably more costly and your advisors agree that we cannot afford it.
Option 1. "Broken Promise" People Only. All your advisors recommend a policy that
employers who break their promise of providing retiree coverage extend COBRA so that retirees
can buy into their active employer plan at a higher premium as has been done for other special
COBRA populations until age 65. This option' has no cost to the Federal government.
Option 2. Medicare Buy-In for Select Groups. The second option is to allow a limited
group of 55 to 65 year olds to buy into Medicare. If you decide to consider any of the Medicare
buy-in proposals, OMB favors undertaking only the "Medicare spouses" - primarily uninsured
women ages 55 to 65 whose husbands are already on Medicare. OMB argues that, if the goal is a
limited test of a buy-in for the pre-65 year olds, this is a discrete group whose eligibility would
likely have a smaller effect on the general trend in retiree health coverage or retirement. The
Department of Labor strongly supports a policy to help displaced workers, in line with the
broader theme of improving workers' security. In the absence of a buy-in, Labor would support a
COBRA extension, though this approach would help fewer people. HHS supports covering these
select groups, but is concerned that the enrollment be sufficient to justify the administrative
effort. The small size of these groups means that costs will be low.
Option 3. Medicare Buy-In for 62 to 65 Years Old Plus Selected Groups. The third
option is to permit eligibility for 62 to 65 year olds plus a group like displaced workers. The cost .
of this option is not yet known but will likely be less than $5 billion over 5 years. HHS and
NECIDPC think that this is a sufficiently narrow group to limit significantly the effects on retiree
health coverage or retirement. This group is also more representative of the 65 to 67 year old
population, giving a better sense of what would happen if Medicare eligibility were postponed to
67 years old. Although Treasury is concerned that this policy could become an underfinanced
policy expansion, some concerns would be allayed if the buy-in participants were enrolled only
in managed care, so that the insurers and not Medicare bore the risk. This approach, however,
could be politically difficult given the distrust of managed care. OMB thinks that the 62 to 65
group is not narrow enough and that the "unsubsidized entitlement" (the subsidy is in the
financing) will not stay that way for long. It is important to note that we are still waiting for
actuarial analyses, which could alter the recommendations of your advisors.
PRIVATE LONG-TERM CARE OPTIONS
B.
4
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�A second idea to improve access to insurance focuses on long-term care. Unlike acute
care, long-term care is not primarily financed by private insurance, which pays only 6 percent of
its costs. Medicaid pays for 38 percent, Medicare pays for 21 percent, and families pay for 28 of
the costs out of pocket. This large government role may not be sustainable as the baby boom
g~neration retires. Today, one in four people over age 85 lives in a nursing home. This could
increase substantially as the proportion of elderly living to age 90 is projected to increase from 25
percent to 42 percent by 2050. Thus, it is important to encourage the development of private
insurance options. The Kassebaum-Kennedy legislation took 'a step in this direction by clarifying
that certain long-term care insurance is tax deductible. But because many people incorrectly
assume Medicare covers all of their long-term care needs and do not know about private longterm care insurance, more action is needed. This action could include providing information to
Medicare beneficiaries about private insurance, funding a demonstration program to improve the
quality and price of private insurance, or both. None ofthese options includes a new Medicare
entitlement or subsidy.
Information on Quality Private Long-Term Care Insurance
We propose to leverage our role in Medicare to improve the quality of and access to
private policies. HCF A would work with insurers, state regulators, and other interested parties to
develop a set of minimum standards for private long-term care policies. If a plan met these
standards, Medicare would approve its inclusion in the new managed care information system.
(As a reminder, the BBA included provisions to provide annual information on managed care
choices to beneficiaries.) This proposal would build upon that system and cost up to $25 million
in discretionary funds over 5 years ($5 million in FY 1999), distinct from the user fees currently
authorized for the managed care information system. We also could propose a demonstration
that would test the feasibility of a partnership between Medicare and private long-terril care
insurance on a limited basis. The cost of a demonstration would depend on its size and policy
parameters, but could be limited to $100 to 300 million over 5 years.
Discussion
We believe this proposal has significant potential and is worth further developing. There
is some concern at HHS that coming to an agreement on a set of standards could be difficult and
that insurers may argue that our standards drive up the cost of the policies, making them
unaffordable. HHS also would prefer that any demonstration be funded through the mandatory
budget. However, these concerns may not be insurmountable, especially since one objective of a
demonstration could be to investigate high quality private options that are affordable. Finally, we
are still looking into the feasibility and advisability of using tax incentives to encourage the
purchase of private long-term care policies and/or the use ofIRAs for long-term care financing.
5
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�C.
MEDICARE COVERAGE OF CANCER CLINICAL TRIALS
Medicare has not traditionally covered patient care costs associated with clinical
trials. Scientists and advocates believe that we are not making sufficient progress in
treating cancer, in part because the lack of Medicare coverage limits participation in these
trials. HHS and DPC have been working on an approach that covers patient care for a
limited number of these trials. Because of concerns about its cost, OMB and Treasury
strongly oppose this option.
Nearly half of all cancer patients are covered by Medicare, yet Medicare does not
cover patient care costs associated with these trials. This care can often be prohibitively
expensive for cancer patients and their families, perhaps explaining why only 3 percent of
all cancer patients participate in trials. Expanding Medicare coverage could increase
access to trials for the many beneficiaries with cancer. Historically most insurers have
covered clinical trials for children. As a consequence, nearly 70 percent of children with
cancer participate in clinical trials. Scientists agree that this participation rate has helped
improve cancer treatments for children, and some argue that it is one reason for the
dramatically higher survival rates for children cancer patients.
This problem has significant implications for research in all cancer areas,
particularly for those cancers like prostate cancer where scientists still have no good
answers and where clinical trials are particularly undersubscribed. According to a former
National Cancer Institute director, if 10 percent of all cancer patients participated in such
trials, trials that currently take three to five years would take only one year. Additionally,
as the nation's largest insurer, Medicare plays a significant role in setting the standard for
the insurance companies. A commitment from Medicare to cover clinical trials would go a
long way to encourage private insurance companies to cover these trials.
Proposal
We have developed a proposal to expand Medicare to cover cancer clinical trials
conducted at the NCI and trials with comparable peer review. In addition, we would
require a National Cancer Policy Board to make further coverage recommendations, and
HHS to assess the incremental costs of such trials compared to conventional Medicarecovered therapies. Assuming the true incremental costs are substantialiy less than the
actuaries project, as we believe, additional trial coverage as recommended by the Board
could occur. The initial coverage would cost $1.7 billion over five years. Senators Mack
and Rockefeller have developed a more expansive and expensive proposal (co-sponsored by
26 Senators), which covers all FDA trials, many of which the experts believe do not meet a
scientifically-meritorious standard. However, we do believe that there may be some middle
ground between our proposal and the Senators' proposal that could be justifiable on policy
grounds but more costly.
6
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�A possible alternative way to cover clinical cancer trials' patient care costs is to
dedicate resources from any significant increases that NIH / NCI receive in the upcoming
budget. NCI could use these. increases to simplify and centralize their clinical trials system,
which has the potential to increase patient access. Although this option may be viable, the
cancer community has clearly stated its preference for extending Medicare coverage.
Another possibility is to require drug companies desiring Medicare coverage of additional
clinical trials to contribute to the part of the patient costs.
Discussion
HHS is supportive of this policy and believes that it would not only give Medicare
beneficiaries, who represent a significant portion of cancer patients, much-needed choices
but would encourage the private industry to cover clinical trials as well. There is no
question that this proposal is the highest priority for most of the cancer community as well
as many in the women's community who believe it is an essential step to improve breast
cancer treatment. However, the advocates have made it clear that they would strongly
prefer the more expansive and expensive Rockefeller/Mack approach. Conversations with
the Senators suggest that they would support this proposal as an important first step; this
support will weigh heavily with patient groups and the cancer community.
OMB and Treasury oppose the Medicare coverage option strongly. They note that
it would involve very substantial costs ($1 to 3 billion per year) to provide medical services
that are experimental, and therefore are unlikely to help the majority of beneficiaries.
Once an exception has been made for experimental cancer drugs and therapies, they argue
there is no reason that similar support won't be demanded for experimentation with
Alzheimer's, Parkinson's, and other maladies. As a result, these costs will grow as other
therapies are included. They also believe that Congress would likely expand the proposal
beyond coverage of NCI trials and that this expanded coverage will be very costly (up to $3
billion over five years). OMB also believes that rather than Medicare leading the way on
clinical trials, drug companies should be the first to contribute to improving access for
Medicare beneficiaries.
While recognizing the OMB and Treasury concerns, the DPC/NEC believes that this
policy has potential to contribute to important expansions of clinical trials and possible
break-throughs in cancer treatment. We believe that we should investigate the possibility of
amending the current policy to tap into the drug industry as a financing partner. In addition, we
believe that this policy will be even more attractive if we are unable to find the resources to
double the NIH budget. Although we support the cancer clinical trial policy, if we have
limited resources available in Medicare and it comes down to a choice between the pre-65
initiative and this one, we would recommend the former.
7
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�D.
PAYING FOR INITIATIVES: MEDICARE ANTI-FRAUD AND
AN INCOME-RELATED PREMIUM
We assume that the funding for these Medicare initiatives will require Medicare offsets.
One approach is to use Medicare anti-fraud initiatives. HHS and OMB believe that these offsets
could total about $2 billion over 5 years. This could fund some, but not all of the initiatives
described above. To fund a more expansive series of initiatives, you will probably have to
consider an income-related premium. As you know, Medicare subsidizes 75 percent ofthe Part
B premium for all beneficiaries, including the wealthiest. This policy is not only regressive; it
ignores the fact that higher income beneficiaries actually cost Medicare more than poor
beneficiaries. But the addition of an income-related premium would constitute a move away
from the concept of social insurance.
Anti-Fraud Provisions
In our ongoing efforts to reduce Medicare fraud, we have identified a number of small but
important policies that could sum to about $2 billion over five years. Several of them address
problems identified by the HHS Inspector General, such as. the overpayment by Medicare for
certain cancer drugs, highlighted in recent press reports.
Income-Related Premium
As you know, the Administration has publicly supported an income related premium.
However, it is not clear whether we should carry through on this support by including it in the
budget. The Medicare Commission will definitely consider and probably recommend this policy.
Yet, there remains some Democratic opposition to this policy and some of your advisors would
counsel not to move unilaterally in this direction. Because this issue is extremely controversial,
this description is not intended to present recommendations but to begin a discussion of the topic.
Building from our position last summer, the income-related premium would be
administered by the Treasury Department, not HCFA or the Social Security Administration.
Eligible people would fill out each year a Medicare Premium Adjustment form (a separate form
or a line on the 1040 form) and send a check to "The Medicare Trust Fund." The two open
questions are: who pay and how much do they pay. The answers to these questions determine
costs, but the more modest proposals generate about $8 billion over five years.
Who pays. The income thresholds determine how many people are paying the higher
amount. We proposed thresholds of$90,000 for singles and $115,000 for couples in the Health
Security Act. Last summer, the Senate, including most centrist Democrats, passed a policy
where the extra premium payment began at $50,000 for singles and $65,000 for couples. During
the budget debate, we did not state publicly our support for any particular thresholds.
8
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�How much. The amount of the payment for the wealthiest beneficiaries is a second
question. In the budget debate, we argued that a 100 percent premium (no subsidy) would cause
some healthy and wealthy people to opt out of Medicare. However, an analysis by the Treasury
Department this fall found that the effects of a 100 percent premium would be small. (About 5%
of beneficiaries who pay the full premium would drop.) HHS would strongly object to changing
our position and supporting an income-related premium that completely phases out the Part B
subsidy. Ifwe decide to change our past policy, it might be advisable to have a strategic
discussion about the timing of announcing such a change. It could be an important in negotiating
the give and take on this issue.
Discussion
The decision to include an income-related premium is a complicated one. On one hand, it
is almost certain that this policy will be recommended by the Medicare Commission. At that
point, however, we will have less opportunity to direct any of its revenue toward important
Medicare reforms like a Medicare buy-in. On the other hand, many Democrats and possibly
AARP will oppose the income-related premium as a beneficiary payment increase. A possible
exception is if it is explicitly linked to a Medicare investment or possibly a pre-65 policy. In
addition, Republicans might label it a new tax and use our support for it as an issue during the
1998 campaign.
Although our discussions are ongoing, the agencies believe that the decision to propose
an income-related premium depends on the context. OMB's position ultimately depends upon
the entire package of initiatives and savings being offered. OMB considers the income-related
premium to be a sound policy option, but believes that it should be considered as a means to
offset Medicare Trust Fund insolvency or provide benefit expansions for the currently eligible
Medicare population. HHS believes that if an income-related premium is pursued, its savings
should be used for Medicare. HHS further notes that Medicare has already contributed $115
billion in savings and that we may wish to preserve this option for the Commission
recommendations lest we have the Commission with no reasonable options. DPCINEC will
prepare for a separate meeting to discuss this issue.
9
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�_ c
<~. "
A"r.t;v1S Email System
Page 1 of6
i
~,
RECORD TYPE: PRESIDENTIAL
CREATOR: .Elena Kagan
CREATION DATE/TIME:
(NOTES MAIL)
( CN=Elena Kagan/OU=OPD/O=EOP
[ OPD )
)
9-DEC-1997 18:51:47.00
SUBJECT:
TO: Laura Emmett
READ:UNKNOWN
( CN=Laura Emmett/OU=WHO/O=EOP @ EOP
[ WHO)
)
TEXT:
==================== ATTACHMENT
1 ====================
ATT CREATION TIME/DATE:
0 00:00:00.00
TEXT:
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�.'
December 8, 1997
MEMORANDUM FOR THE PRESIDENT
FROM:
BRUCE REED
MIKE COHEN
SUBJECT:
Proposed Budget Initiatives for Indian Education
Last July, a coalition of education-oriented groups from Indian Country proposed a
Comprehensive Federal Indian Education policy statement, which emphasized the importance of
Tribal governance of Indian Education, the preservation and revitalization of Native languages
and cultures, and the need for equitable access to education resources. The coalition also
proposed an Executive Order to implement this policy vision,
This proposal has been under review by DPC staff and the Domestic Policy Council
Working Group on American Indians and Alaska Natives. Pending a determination as to
whether the proposed Executive Order is desirable and likely to be effective in accomplishing its
aims, we have begun to identify steps that can be taken right now to improve education for
Native American students in schools controlled by the BIA and Tribes, as well as in the public
schools attended by large numbers ofIndian students,
The full set of initiatives we have developed is summarized below. Most involve
ensuring that new education proposals and existing funding streams effectively target resources
to schools in Indian Country. In one area -- school construction and maintenance -- we are going
further by proposing a significant increase in funds over previous appropriations levels.
Tribal School Construction Proposal
The BIA operates 185 residential and day schools serving 51,000 Native American
students, approximately 10% of all Native American students in grades K-12. Enrollment in all
BlA schools has increased by 25% since 1987. Enrollment injust the day schools has increased
47% since 1987 and 24% since 1992. Consequently, BIA schools have experienced significant
problems with overcrowdi"ng. In addition, according to a forthcoming GAO report, BIA schools,
compared to schools nationwide, (1) are generally in poorer physical condition; (2) have more
"unsatisfactory environmental factors"; (3) more often lack key facilities required for education
reform (e.g., science labs); and (4) are less able to support computer and communications
technolo~W Overall, they are in worse condition than even inner-city schools.
We are recommending an increase of$51.4 million over the FY 1998 appropriations (and
an increase of $47.6 million over the Department of Interior FY 1999 request) for two Bureau of
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..
2
Indian Affairs accounts for New School Construction and Facilities Improvement and Repairs.
The proposed increase would double funding for new school construction and for significant
improvements and repairs of existing facilities. Compared to the BIA FY 1999 request, this step
would double the number of new schools to be built from 2 to 3, and increase the number of
schools undergoing significant improvements or repairs from 6 to 22. The higher budget request
also would provide funds for needed portable classrooms, roof replacements, and other repairs.
FY98 Appropriations
FY99 BIA Request
FY99 DPC
Recommendation
New School
Construction
$19.2 million
$20.8 million
$38.4 million
Facilities
Improvement and
Repairs
$32.2 million
$34.4 million
$64.4 million
Total
$51.4 million
$55.2 million
$102.8 million
The Tribes would view this proposal as a significant step forward in improving the
quality of education for Indian students. Congressional delegations from the affected states also
would receive the proposal warmly.
This proposal is especially important if you choose to propose a new school construction
initiative on the tax side, because Tribes do not issue bonds for this purpose. Even if you choose
to propose a school construction initiative on the spending side, this initiative would be valuable.
In the Administration's school construction proposal last year, 2 percent of the funds were set
aside for a direct appropriation for Tribal schools, over and above the accounts discussed here.
This funding, however, is contingent on the passage of a school construction proposal, and in any
event, is insufficient to meet the Tribes' needs.
We have developed this proposal with the involvement and support ofOMB, the
Department of the Interior and the Department of Education.
Other Initiatives
We are working to make sure that other education initiatives proposed for FY99 include
an appropriate set-aside for BIA schools and, where feasible, for public schools that serve a large
concentration of Native American students. These include:
•
Education Opportunity Zones. A percentage of grant funds will be set aside for
administration by the BIA, and the Education Department will be encouraged to provide
at least one grant to a rural school district with a large percentage of Native American
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�3
students.
•
Early Intervention College/School Partnerships. We are working to determine the best
ways to ensure that Tribal Colleges can effectively participate in this initiative, as well as
to fund other college/school partnerships in communities with a large percentage of
Native American students.
•
Child Care. The Child Care Block Grant already contains a set aside for administration
by BIA. Proposed funding increases in this program will automatically benefit programs
serving Native Americans on reservations.
•
Technology. This year the BIA launched Access Native America, an initiative to
implement the four pillars of your technology challenge and to connect all schools,
classrooms, and libraries to the Department ofInterior's Internet backbone by the year
2000. Within the past month, DPC arranged a meeting between BIA staff and the
Schools and Libraries Corporation to help Tribal schools take advantage of the e-rate. As
a result, the Corporation has agreed that BIA can apply for the e-rate on behalf of all
Tribal schools, and BIA has begun to develop materials and plan training so that schools
can complete the necessary applications.
•
Teacher Preparation and Recruitment. This initiative, which you announced at the
NAACP Convention on July 17, helps to prepare and recruit teachers to serve in highpoverty urban and rural communities. At the time this proposal was developed, we did
not target funds to Tribal schools. We are in the process of preparing new legislative
language to take care of that omission, and will work with our Congressional allies to
incorporate it into our proposal.
.
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�ARMS Email System
RECORD TYPE: PRESIDENTIAL
Page I of 1
(NOTES MAIL)
CREATOR: Elena Kagan ( CN;Elena Kagan/OU;OPD/O;EOP [ OPD 1
CREATION DATE/TIME:12-DEC-1997 11:22:34.00
SUBJECT:
$200 million Head Start increase
TO: Nicole R. Rabner ( CN;Nicole R. Rabner/OU;WHO/O;EOP [ WHO 1 )
READ:UNKNOWN
TO: Bruce N. Reed ( CN;Bruce N. Reed/OU;OPD/O;EOP [ OPD 1
READ:UNKNOWN
TO: Jennifer L. Klein ( CN;Jennifer L. Klein/OU;OPD/O;EOP @ EOP [ OPD 1 )
READ:UNKNOWN
TEXT:
---------------------- Forwarded by Elena Kagan/OPD/EOP on 12/12/97 11:22
AM ---------------------------
Emil E. Parker
12/12/97 10:47:51 AM
Record Type:
Record
TO:
Barbara Chow/OMB/EOP, Elena Kagan/OPD/EOP
cc:
Gene B. Sperling/OPD/EOP, Robert M. Shireman/OPD/EOP, Charles R.
Marr/OPD/EOP, Barry White/OMB/EOP
Subject:
$200 million Head Start increase
I spoke to Gene last night; he feels strongly that a $150 million increase
for Head Start (above the OMB-recommended level of $4.489 billion) is
inadequate. He is willing to accept $400 million for the Early Learning
fund only if there is also a $200 million increase in Head Start (above
the OMB recommendation, for a total increase of $334 million over FY 98
enacted). As you know, DPC is recommending, as part of the child care
initiative, about $500 million over four years to expand Early Head
Start.
I have not seen this item in any OMB materials.
A $200 million
overall increase for FY 99 would allow for an expansion of Early Head
Start in that year , should we decide to go that way in the context of
Head Start reauthorization.
Barbara, I know that you reached agreement with Bob Shireman and others on
$150 million for Head Start.
I apologize for the late notice on this.
Thank you.
Emil
�A}!MS Email System
Page lof8
RECORD TYPE: PRESIDENTIAL
(NOTES MAIL)
CREATOR: Elena Kagan ( CN=Elena Kagan/OU=OPD/O=EOP
[ OPD ]
)
CREATION DATE/TIME:15-DEC-1997 10:05:28.00
SUBJECT:
TO: Laura Emmett
READ:UNKNOWN
( CN=Laura Emmett/OU=WHO/O=EOP @ EOP [ WHO]
)
TEXT:
==================== ATTACHMENT
1 ====================
ATT CREATION TIME/DATE:
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�December 15,1997
MEMORANDUM FOR THE PRESIDENT
FROM:
Bruce Reed
Gene Sperling
Elena Kagan
SUBJECT:
New Initiatives on Discretionary Side of Budget
Assuming OMB can come up with another $5 billion for discretionary spending, the
DPC, NEC, and OMB all recommend that you propose to fund the new initiatives listed below in
your FY 1999 budget. We already have given you detailed memos on most of these initiatives.
If you approve the initiatives, you can announce them in the State of the Union.
Education
1. Education Opportunity Zones -- $225 million: This intiative will provide funding to about
25 high-poverty urban and rural school districts for agreeing to adopt a "Chicago-type" school
reform agenda that includes ending social promotions, removing bad teachers, reconstituting
failing schools, and adopting district-wide choice.
.
2. College-School Partnerships -- $170 million: This initiative, which builds on the Eugene
Lang model and Congressman Fattah's proposal, will provide funding for college-school
partnerships designed to provide mentoring, tutoring, and other support services to students in
high-poverty schools, starting in the sixth grade and continuing until high school gradutation.
The first year's investment could reach as many as 200,000 seventh graders at 1,800 high-poverty
schools. [check)
3. Teacher Recruitment and Preparation -- $67 million: This initiative, which you previewed
last July, will provide scholarships to nearly 35,000 new teachers over the next five years for
committing to work in high-poverty urban and rural schools. It also will upgrade the quality of
teacher preparation programs serving these communities.
4. Technology Teacher Training -- $80 million: This initiative will provide intensive training
in the use of technology to at least one teacher in every school and require that teacher to train his
or her colleagues.
5. Hispanic Education Dropout Plan -- $110 million: This initiative will increase funding for
a variety of existing programs -- Bilingual Education, TRIO College Preparation, Adult
Education, Migrant Education, etc. -- and take certain administrative actions to help Hispanic
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students complete high school and succeed in college.
6. After-School Program Expansion -- additional $60-160 million: This part ofa much larger
child care initiative (most of which is funded on the mandatory side of the budget) will provide
additional funding to the 21 st Century Community Learning Center Program (now funded at $40
million) for before- and after-school programs for school-age children at public schools.
Depending on the exact funding level chosen, this investment will create programs in 1,5004,000 new schools.
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�December 15, 1997
MEMORANDUM FOR THE PRESIDENT
FROM:
Bruce Reed
Gene Sperling
Elena Kagan
SUBJECT:
New Initiatives on Discretionary Side of Budget
Assuming OMB can come up with another $5 billion for discretionary spending, the
DPC, NEC, and OMB all recommend that you propose to fund the new initiatives listed below in
your FY 1999 budget. We already have given you detailed memos on most of these initiatives.
If you approve the initiatives, you can announce any or all of them in the State of the Union.
Because so many of the new initiatives involve education, we are attaching an appendix
to this memo that shows recommended funding levels for the Department of Education's major
base programs.
Education
1. Education Opportunity Zones ($225 million): This initiative will provide funding to about
25 high-poverty urban and rural school districts for agreeing to adopt a "Chicago-type" school
reform agenda that includes ending social promotions, removing bad teachers, reconstituting
failing schools, and adopting district-wide choice.
2. College-School Partnerships ($150 million): This initiative, which builds on Eugene Lang's
model ofheIping disadvantaged youth, will provide funding for college-school partnerships
designed to provide mentoring, tutoring, and other support services to students in high-poverty
schools, starting in the sixth grade and continuing through high school. The six-year funding
path would provide help to nearly 2 million students.
3. Campaign on Access to Higher Education ($20 million): This initiative will fund an
intensive publicity campaign on the affordability of higher education. The goal of the campaign
will be to make every family aware that higher education is now universally accessible -- and that
it is the key to higher earnings. As part of this effort -- and to complement the college-school
partnership program described above -- we will provide families at high-poverty middle schools
with an official notification of the $20,000 or more that is already available for their children to
go to college.
4. Teacher Recruitment and Preparation ($67 million): This initiative, which you previewed
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last July at the NAACP Conference, will provide scholarships to nearly 35,000 new teachers over
five years for committing to work in high-poverty urban and rural schools. It also will upgrade
the quality of teacher preparation programs serving these communities.
5. Technology Teacher Training ($222 million): This initiative dedicates 30 percent of the
Technology Literacy Challenge Fund to ensure that at least one teacher in every school receives
intensive training in the use of technology for education, so that they can train their colleagues.
An additional $80 million will begin an effort to train every new teacher in the latest technology.
6. Hispanic Education Action Plan -- ($195 million or more): This initiative will increase
funding for a number of existing programs to improve education for Hispanic Americans and
other limited English proficient (LEP) children and adults. It would double our investment in
training teachers to address the needs of LEP children; boost the Migrant Education Program by
16 percent; increase the TRIO college preparation program by 10 percent; and create a 5-year,
$100 million effort to disseminate best practices in ESL training for adults. We would
accompany these program increases with administrative actions to help Hispanic students
complete high school and succeed in college.
Child Care
We recommend placing most of the child care initiative -- in particular, the proposed
increase in the Child Care and Development Block Grant and the establishment of a new Early
Learning Fund -- on the mandatory side of the budget. The smaller pieces ofthe initiative that
we propose placing on the discretionary side are the following:
1. After-School Program Expansion ($150 million): This program expansion will increase
funding of the 21st Century Community Learning Center Program (now funded at $40 million)
for before- and after-school programs for school-age children at public schools. Depending on
the exact funding level chosen, this investment will create new programs in 1,500-4,000 schools.
2. Standards Enforcement Fund ($100 million): This new fund will support state efforts to
improve licensing systems and to enforce health and safety standards, particularly through
unannounced inspections of child care settings. The fund also will enable states to issue report
cards, for use by consumers, on the quality of the facilities inspected.
3. Provider Training ($51-60 million): A new Child Care Provider Scholarship Fund, which
you proposed at the Child Care Conference to fund at $50 million annually, will support 50,000
scholarships each year to students working toward a child care credential. The students will
commit to remaining in the field for one year for each year of assistance received, and will earn
increased compensation or bonuses when they receive their credential. An additional $1-10
million will allow the Department of Labor to expand its Child Care Apprenticeship Training
Program, which funds providers combining work toward a degree with on-the-job practice.
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3
4. Research and Evaluation Fund ($10-30 million): This new fund will provide grants for
research projects, establish a National Center on Child Care Statistics, and set up a national child
care hotline.
5. Paid Leave Demonstration Fund ($10 million): This small evaluation and demonstration
fund will support communities and organizations that are testing and/or studying innovative
approaches to providing financial assistance to parents who wish to stay home with their
newborns.
6. Early Head Start Expansion ($284-334 million): This level of increased investment in the
overall Head Start budget should permit doubling the set-aside for Early Head Start without
reducing the resources available for children 3-5. The doubled set-aside would enable more than
35,000 additional children to receive Early Head Start services in 2002.
Welfare,.Housing, Urban
1. Welfare-to-Work Housing Vouchers ($283 million): This initiative will provide 50,000
new housing vouchers to help welfare recipients in public housing who need to move in order to
find employment. HUD will distribute these vouchers on a competitive basis to public housing
authorities working with local T ANF agencies and/or grantees of the new $3 billion welfare-towork program. (A separate proposal, for which no new funding is needed, would allow families
in public or assisted housing to use vouchers to buy a home; HUD expects this proposal to help
some 25,000 people become homeowners over two years.)
2. Housing Portability/Choice ($20 million): In addition to the new welfare-to-work housing
vouchers discussed above, our proposed package on housing portability and choice expands
Regional Opportunity Counseling sites and takes administrative actions to eliminate obstacles to
portability in the Section 8 housing program.
3. "Play-by-the-Rules" Homeownership Proposal ($3Q million): This initiative would enable
the Neighborhood Reinvestment Corporation to assist approximately 10,000 families to buy their
own homes through downpayment assistance, interest rate buydowns, or rehabilitation loans.
The assistance will go to families that have a perfect track record of paying their rent on time and
otherwise "playing by the rules."
4. Homeownership Opportunity Fund ($11 million): This initiative will allow HUD to
develop a loan guarantee program to allow state and local governments to leverage current
HOME funds with private-sector investments to fund large scale, affordable housing
developments in distressed communities.
5. Community Empowerment Fund ($400 million): This initiative establishes a public/private
fund ("Eddie Mac"), which will invest in inner-city businesses and create a secondary market for
economic development loans (like Fannie Mae).
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Labor and Workforce
1. Child Labor ($89 million): This initiative is anchored by a $30 million commitment to the
International Program on the Elimination of Child Labor (IPEC). The initiative also will include
funding to improve Customs Service enforcement of U.S. law banning the import of goods made
with forced or bonded child labor ($3 million) and to double the Department of Labor's
enforcement of child labor laws in the agricultural sector ($4 million). Finally, the initiative will
provide additional funding to the Migrant Education Program so it can reach 50,000 more
migrant children ($50 million). We will develop non-budget items to fill out the package.
2. Community Adjustment ($50 million): This initiative will fund the creation of the Office of
Community and Economic Adjustment (OCEA), which we proposed as part of the Fast Track
debate. As you know, this office will be modeled after the Defense Department's Office of
Economic Adjustment -- the Administration's first point of contact with communities
experiencing a military base closure or defense plant closing. We expect the Office to help
35-40 communities in its first year of operation. The initiative also will fund a variety of
other efforts to assist communities that face sudden and severe economic dislocation.
Health
1. 21st Century Trust Fund ($1 billion): This initiative will provide substantial additional
funding to Nlli ($750 million) and NSC ($250 million), ramping up substantially over time, for
research activities, including into the treatment and cure of diseases. We will provide you with a
separate memo on this initiative in the next day or two. Funding for this initiative will come
from comprehensive tobacco legislation.
2. AIDS Programs Expansion ($165 million): A funding increase for the Ryan White Program
of about 15 percent will go principally toward ADAP, to ensure that new and effective treatments
of AIDS reach those who need them. Some of the funds will support education and prevention
programs operated by states, cities, and community health centers, as well as by the CDC.
3. Racial Disparities in Health Care ($80 milIion): This initiative will address racial
disparities in six areas of health care: infant mortality, breast and cervical cancer, heart disease
and stroke, diabetes, AIDS, and immunization. The proposal includes additional funding ($50
million) to established public health programs to adapt and apply their prevention and education
strategies to eliminate racial disparities. It also includes funding ($30 million) for thirty local
pilot projects to test innovative approaches to reach this goal.
Crime
1. Community Prosecutors ($50 milIion): This initiative will provide grants to prosecutors for
innovative, community-based prosecution efforts, such as Eric Holder adopted in the District of
Columbia. A fill 80 percent of the grants will go to pay the salaries and training costs associated
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5
with hiring or reassigning prosecutors to work directly with community residents.
A number of the above proposals --~, education opportunity zones, university-school
partnerships, housing vouchers -- can be presented as part of the race initiative, because they
target predominantly minority areas or provide disproportionate benefits to members of minority
groups. Other proposals described above -- the Hispanic dropout plan and the race and health
initiative -- have obvious and explicit race connections. In addition:
1. Civil Rights Enforcement ($68 million): This initiative will fund reforms to the EEOC and
the civil rights. offices at DOJ, HUD, HHS, Education, and DOL. Most importantly, additional
funding of$37 million will allow the EEOC to expand its mediation program (allowing more
than 70 percent of all complainants to choose mediation by the year 2000), increase the average
speed of resolving complaints (from over 9 months to six) and reduce the EEOC's current
backlog (from 64,000 cases to 28,000). The initiative also will fund a dramatic expansion of
HUD's civil rights enforcement office (in the 30th anniversary year of the Fair Housing Act) and
improve coordination among the government's civil rights offices. We are preparing a number
of non-budgetary administrative actions, especially involving fair housing and lending, to
accompany our budget proposals in this area.
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�6
Appendix -- Education Base Programs
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�ARMS Email System
RECORD TYPE: PRESIDENTIAL
Page 1 of 1
(NOTES MAIL)
CREATOR: Elena Kagan ( CN=Elena Kagan/OU=OPD/O=EOP [ OPD 1 )
CREATION DATE/TIME:16-DEC-1997 11:34:04.00
SUBJECT:
Re: Policy memo
TO: Andrew J. Mayock ( CN=Andrew J. Mayock/OU=WHO/O=EOP @ EOP [ WHO 1 )
READ:UNKNOWN
TEXT:
this afternoon
�APtMS Email System
Page 10f5
RECORD TYPE: PRESIDENTIAL
(NOTES MAIL)
CREATOR: Elena Kagan ( CN=Elena Kagan/OU=OPD/O=EOP
[ OPD )
)
CREATION DATE/TIME: 17-DEC-1997 09:31:29.00
SUBJECT:
TO: Laura Emmett
READ:UNKNOWN
( CN=Laura Emmett/OU=WHO/O=EOP @ EOP
[ WHO)
)
TEXT:
==================== ATTACHMENT
1 .====================
ATT CREATION TIME/DATE:
0 00:00:00.00
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�December 16, 1997
MEMORANDUM TO THE PRESIDENT
THROUGH: Sylvia Matthews
FROM:
Bruce Reed
Diana Fortuna
SUBJECT:
SSA Report on Implementation of Children's SSI Cutoffs.
The Social Security Administration intends to release a report this Thursday on its
implementation of the new definition of childhood disability for SSI. This report follows
Commissioner Ken Apfel's promise, at his corifirmation hearing in September, of a "top to
bottom" review of SSA's process for redetermining the eligibility of children.
As you know, the welfare law tightened the definition of childhood disability for SSI, and
required the Social Security Administration to redetermine the eligibility of approximately
288,000 children, out of about one million children now on the rolls. These reevaluations have
led to almost 140,000 terminations to date. (At the time the welfare law was enacted, CBO
estimated that 180,000 children would lose SSI; when SSA announced its interpretation of the
law, it projected that 135,000 children would become ineligible.) Advocates charge that SSA has
done a poor job on these reevaluations, causing eligible children to be dropped from the rolls.
The report concludes that SSA did a generally good job of redetermining eligibility for
these children. The report, however, identifies three areas of concern and announces actions to
address them.
First, SSA will review the cases of all children "coded" as mentally retarded who were
cut from the rolls and have not appealed. This action addresses SSA's finding that some of these
children may have been terminated incorrectly. Second, SSA will review a portion of every
state's unappealed terminations, choosing the kinds of cases most needing review in each state
and focusing heavily on states that SSA has found to have a relatively high error rate. This
review will allow SSA to give special attention to states with the highest error rates, without
singling them out as "bad actors." Third, SSA will offer all 70,000 families who did not appeal
its termination decisions a new opportunity to do so. These actions, and the problems they
address, are further described in an appendix attached to this memo.
In all, SSA will review the cases of 48,000 children dropped from the program. (Another
70,000 have appealed.) As a result of these actions, SSA now projects that approximately
100,000 children ultimately will lose SSI benefits.
With the report, SSA also plans to release case studies of a random sample of 151
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�children who have lost benefits. This document is intended to explain to the public what kinds of
children are no longer eligible. Most of the children have mental disabilities other than mental
retardation, including learning disabilities and attention deficit disorder. Over a third have
improved since they were first found eligible. The majority are teenagers; only a handful are age
SIX or younger.
Advocates will probably have a mixed reaction to the report -- generally pleased about the
actions, but still arguing that SSA's regulation interpreting the statute is needlessly strict. The
report does not address the latter issue. The Republican leadership in Congress has been
extremely supportive of SSA's implementation of the law to date, but probably will criticize this
report on the ground that it bends over backwards to restore benefits.
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,.
SSA Report on Childhood Disability Process
SSA's report examined three areas of concern raised by advocacy groups:
I. Mental Retardation
Advocates' Charge: Too many children with mental retardation were cut from the rolls.
SSA Finding: Of the 136,000 children tenninated to date, 42,000 were "coded" as mentally
retarded (MR). However, most of these children do not actually have MR, because until recently
SSA's systems did not have all the necessary codes. Instead, most of these children have other
mental disorders, such as learning disabilities or "borderline intellectual functioning" (which falls
short offull-fledged MR). Some unknown subset of the 42,000 do have MR, but either their
impainnents are not severe enough to qualify them for SS1, or they were denied incorrectly.
Even with these tenninations, approximately 350,000 children coded as MR will remain on the
rolls, out of the total of one million children on SSI.
SSA Action: SSA will review all cases tenninated that were coded as MR, to ensure that all
those decisions were made properly.
II. State Variations in Cutoffs
Advocates' Charge: Errors in cutoffs appear likely, since tennination rates varied widely by
state, from 32% in Nevada to 82% in Mississippi. Also, SSA may not have acquired all
documentation, such as school records, needed to judge a child's disability. Finally, some states
were disqualifying too many families for failure to cooperate without making adequate efforts to
reach them.
SSA Findings: SSA data show that on average 93% oftennination decisions were both
accurate and complete (i.e., they included all required documentation). This exceeds SSA's
required level of overall state perfonnance for SS1, which is 90.6%. However, 10 states had
accuracy/completion rates below 90%. Another 9 states had accuracy/completion rates below the
national average. (SSA's experience is that about one-third of the errors identified in these
measures will ultimately prove to be accurate decisions that simply lacked documentation.) SSA
found that many inaccurate decisions stem from an overly strict interpretation of the new rules
for children who exhibit maladaptive behavior.
Claims that SSA did not acquire all needed documentation were detennined to be largely
unfounded. However, SSA found wide state variations in the percentage of children cut off
because their families did not cooperate with the redetermination. In a study of such cessations,
SSA found that 68% of the cases did not include documentation that all required efforts to
contact the family had been made.
Automated Records Management System
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�-2SSA also perfonned a regression analysis to detennine whether wide state-to-state variations in
overall termination rates should be expected because oflegitimate factors, such as the child's age
and impainnent and whether the child was initially added to the rolls based on the less strict
criteria eliminated by the welfare law. SSA found that these factors would lead you to expect the
cutoff rate to vary from 40% in Idaho to 78% in Mississippi. While this regression analysis does
not fully explain the actual state-by-state variance, it does convince SSA that most of the
variance among states is due not to errors, but to characteristics of the children.
SSA Action: SSA will review a portion of the decisions in all states, focusing more on states
with lower accuracy rates. All cases tenninated as a result of failure to cooperate will be
reviewed. SSA will also provide more training on maladaptive behavior.
III. Appeal Rights
Advocates' Charge: Too few families are appealing because SSA's notice to families was
confusing, and workers discouraged appeals. Also, SSA discouraged families from requesting
that benefits be continued during the appeal, and didn't do enough to publicize free legal
services.
SSA Finding: SSA found that its workers did not discourage appeals, although this may have
occurred in isolated instances. At the same time, a survey conducted by SSA confinns that many
families did not understand their appeal rights.
SSA Action: All 70,000 families of children who were tenninated and did not appeal will be
given a new opportunity to do so. In addition, all families of children who appealed but did not
request continuation of benefits during the appeal will also be given a new opportunity to make
that request. SSA will also publicize the availability of free higal services for families.
Automated Records Management System·
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�ARMS Email System
RECORD TYPE: PRESIDENTIAL
Page 1 of 1
(NOTES MAIL)
CREATOR: Elena Kagan ( CN=Elena Kagan/OU=OPD/O=EOP [ OPD 1 )
CREATION DATE/TIME:17-DEC-1997 18:56:43.00
SUBJECT:
Re: haitians
TO: Emily Bromberg ( CN=Emily Bromberg/OU=WHO/O=EOP @ EOP [ WHO 1 )
READ:UNKNOWN
TEXT:
there is no policy and no decision.
you. call me.
i was as surprised by the NYT as
�ARMS Email System
Page I of I
RECORD TYPE: PRESIDENTIAL
(NOTES MAIL)
CREATOR: Elena Kagan ( CN=Elena Kagan/OU=OPD/O=EOP [ OPD 1 )
CREATION DATE/TIME: 18-DEC-1997 13:41:19.00
SUBJECT:
Re: Weekly Reports
TO: Phillip Caplan
READ:UNKNOWN
CN=Phillip Caplan/OU=WHO/O=EOP @ EOP [ WHO 1 )
CC: Michelle Crisci ( CN=Michelle Crisci/OU=WHO/O=EOP @ EOP
READ:UNKNOWN
[ WHO 1 )
CC: Suzanne Dale ( CN=Suzanne Dale/OU=WHO/O=EOP @ EOP [ WHO J )
READ:UNKNOWN
CC: Maria Echaveste ( CN=Maria Echaveste/OU=WHO/O=EOP @ EOP [ WHO 1 )
READ:UNKNOWN
CC: Bruce N. Reed ( CN=Bruce N. Reed/OU=OPD/O=EOP [ OPD 1 )
READ:UNKNOWN
CC: Jonathan A. Kaplan ( CN=Jonathan A. Kaplan/OU=OPD/O=EOP @ EOP [ OPD 1 )
READ:UNKNOWN
CC: Rahm I. Emanuel ( CN=Rahm I. Emanuel/OU=WHO/O=EOP @ EOP [ WHO 1 )
READ:UNKNOWN
CC: Mickey Ibarra ( CN=Mickey Ibarra/OU=WHO/O=EOP @ EOP [ WHO 1 )
READ: UNKNOWN
CC: Marjorie Tarmey ( CN=Marjorie Tarmey/OU=WHO/O=EOP @ EOP [ WHO 1 )
READ:UNKNOWN
CC: joshi_m ( joshi_m
READ:UNKNOWN
@
a1
@
cd
@
lngtwy [ UNKNOWN 1 )
(NSC)
CC: Russell W. Horwitz ( CN=Russell W. Horwitz/OU=OPD/O=EOP @ EOP [ OPD 1 )
READ:UNKNOWN
TEXT:
I'm glad to know DPC is in such august company.
�ARMS Email System
RECORD TYPE: PRESIDENTIAL
Page 1 of 1
(NOTES MAIL)
CREATOR: Elena Kagan ( CN;Elena Kagan/OU;OPD/O;EOP [ OPD 1 )
CREATION DATE/TIME: 18-DEC-1997 15:24:28.00
SUBJECT:
Re: Weekly Reports
TO: Phillip Caplan
READ:UNKNOWN
TEXT:
what did they threaten to do to you?
�ARMS Email System
RECORD TYPE: PRESIDENTIAL
Page 1 of 1
(NOTES MAIL)
CREATOR: Elena Kagan ( CN;Elena Kagan/OU;OPD/O;EOP [ OPD 1 )
CREATION DATE/TIME:18-DEC-1997 13:39:59.00
SUBJECT:
Re: haitians
TO: Emily Bromberg
READ:UNKNOWN
TEXT:
I think it's leaning that way, but yes.
�A:RMS Email System
RECORD TYPE: PRESIDENTIAL
Page 1 of9
(NOTES MAIL)
CREATOR: Elena Kagan ( CN=Elena Kagan/OU=OPD/O=EOP [ OPD ) )
CREATION DATE/TIME:23-DEC-1997 14:18:00.00
SUBJECT:
NEW DPC PHONE AND ISSUE LISTS
TO: Laura Emmett ( CN=Laura Emmett/OU=WHO/O=EOP @ EOP [ WHO)
READ:UNKNOWN
)
TEXT:
please print for me.
---------------------- Forwarded by Elena Kagan/OPD/EOP on 12/23/97 02:17
PM --------------------------Paul J. Weinstein Jr.
Record Type:
12/23/97 01:22:01 PM
Record
To:
See the distribution list at the bottom of this message
cc:
Bruce N. Reed/OPD/EOP, Elena Kagan/OPD/EOP
Subject:
NEW DPC PHONE AND ISSUE LISTS
PLEASE DISREGARD THE LISTS SENT EARLIER THIS WEEK.
ERRORS. THESE LISTS ARE ACCURATE.
THEY HAD A COUPLE OF
Message Sent
TO:~=_--------~~--~----~~~----------------------------------
BALDERSTON A @ A1 @ CD @ LNGTWY
Sarah A. Bianchi/OPD/EOP
Michael Cohen/OPD/EOP
Laura Emmett/WHO/EOP
Cathy R. Mays @ EOP @ LNGTWY
Leanne A. Shimabukuro @ EOP @ LNGTWY
Diana Fortuna/OPD/EOP
Thomas L. Freedman/OPD/EOP
Jose Cerda III/OPD/EOP
Christopher C. Jennings/OPD/EOP
Andrea Kane/OPD/EOP
William R. Kincaid/OPD/EOP
Jennifer L. Klein/OPD/EOP
Jeanne Lambrew/OPD/EOP
Nicole R. Rabner/WHO/EOP
Cynthia A. Rice/OPD/EOP
Christa Robinson @ EOP @LNGTWY
Mary L. Smith/OPD/EOP
Todd A. Summers/OPD/EOP
Neera Tanden/WHO/EOP
Essence P. Washington/OPD/EOP
Julie A. Fernandes/OPD/EOP
==================== ATTACHMENT
1 ====================
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0 00:00:00.00
TEXT:
Unable to convert ARMS_EXT: [ATTACH.D7)MAIL49971565T.316 to ASCII,
�December 21,1997
December 21,1997
Domestic Policy Council Staffllssue List
Issue Area
Staffer
Phone
Fax
Room Number
AIDS
Sandy Thurman
Todd Summers
632-1090
632-1090
632-1096
632-1096
4700EOB
808 17th Street
Adoption
Jen Klein
Nicole Rabner
Neera Tanden
6-2599
6-7263
6-6275
6-2878
6-2878
7-2878
WW2FL
WW2FL
WW2FL
Agriculture/
Rural Development
Carl Whillock
720-2406
720-9286
Budget
Cynthia Rice
6-2846
6-7431
212ROEOB
Choice
Elena Kagan
Jen Klein
6-5584
6-2599
6-2878
6-2878
WW2FL
WW2FL
Children & Families
Jen Klein
Nicole Rabner
Neera Tanden
6-2599
6-7263
6-6275
6-2878
6-2878
6-2878
WW2FL
WW2FL
WW2FL
Civil RightslRace
Initiative
Elena Kagan
Julie Fernandes
6-5584
6-6558
6-2878
6-5581
WW2FL
217ROEOB
Christa Robinson
6-5165
6-7431
2070EOB
Consumer Issues/
Food Safety
Tom Freedman
Mary Smith
6-6587
6-5571
6-7431
6-7431
213 OEOB
213 1, OEOB
Crime
Jose Cerda
Leanne Shimabukuro
6-5568
6-5574
6-7028
6-7028
224ROEOB
224LOEOB
Community Development!
Housing
Jose Cerda
Leanne Shimabukuro
Paul Weinstein
6-5568
6-5574
6-5577
6-7028
6-7028
6-7028
224ROEOB
224LOEOB
2140EOB
Disabilities
Diana Fortuna
6-5570
6-7431
212LOEOB
Drugs
Jose Cerda
Leanne Shimabukuro
6-5568
6-5574
6-7028
6-7028
224ROEOB
224L OEOB
Education
Mike Cohen
Bill Kincaid
Tanya Martin
6-5575
6-2857
6-5228
6-5581
6-5581
6-5581
218LOEOB
2200EOB
218ROEOB
Environment
Paul Weinstein
6-5577
6-5581
2140EOB
Health Care
Chris Jennings
Jeanne Lambrew
Sarah Bianchi
6-5560
6-5377
6-5585
6-5557
6-7431
6-5557
216ROEOB
2090EOB
2160EOB
Communications/
. Scheduling/Events
1400 Independence Ave., SW,
Room 216
Administration
Building
Automated Records Management System
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<.
Immigration
Julie Fernandes
6-6558
6-5581
217ROEOB
Labor
Elena Kagan
6-5584
6-2878
WW2FL
National Service
Diana Fortuna
6-5570
6-7431
212LOEOB
Policy Planning
Tom Freedman
Mary Smith
Tanya Martin
6-6587
6-5571
6-5228
6-7431
6-7431
6-5581
213 OEOB
213 Y, OEOB
218ROEOB
Political/Government
Reform
Paul Weinstein
6-5577
6-5581
2140EOB
Product Liability
Elena Kagan
6-5584
6-2878
WW2FL
Public Health
Chris Jennings
Jeanne Lambrew
Sarah Bianchi
6-5560
6-5377
6-5585
6-5557
6-7431
6-5557
216ROEOB
2090EOB
2160EOB
Tobacco
Tom Freedman
Mary Smith
6-6597
6-5571
6-7431
6-7431
2130EOB
213 Y, OEOB
Welfare Reform
Cynthia Rice
Diana Fortuna
Andrea Kane
6-2846
Q-5570
6-5573
6-7431
6-7431
6-7431
212ROEOB
212L OEOB
2100EOB
Automated Records Management System
Hex-Dump Conversion
�;.:.:
DOMESTIC POLICY
STAFF PHONE LIST
Person
Phone
Fax
Location
BALDERSTON, Allison
65543
65581
217,OEOB
BIANCHI, Sarah
65585
65557
216,OEOB
CERDA, Jose
65568
67028
224R,OEOB
COHEN, Michael
65575
65581
218L,OEOB
EMMETI', Laura
65565
62878
2FLlWW
FERNANDES, Julie
66558
65581
217R,OEOB
FORTUNA, Diana
65570
67431
212L,OEOB
FREEDMAN, Tom
65587
67431
213,OEOB
GEISBERT, Donna
65594
65557
216,OEOB
JENNINGS, Chris
65560
65557
216R,OEOB
KAGAN, Elena
67928/65584
62878
2FLlWW
KANE, Andrea
65573
67431
210,OEOB
KINCAID, Bill
62857
65581
220,OEOB
KLEIN, Jennifer
62599
62878
2 FLfWW
LAMBREW, Jeanne
65377
67431
209,OEOB
MARTIN, Tanya
65228
65581
218R,OEOB
MAYS, Cathy
66515
62878
2 FLlWW
RABNER, Nicole
67263
66244
2 FLfWW
REED, Bruce
66515
62878
2 FLlWW
RICE, Cynthia
62846
67431
212R,OEOB
ROBINSON, Christa
65165
67431
207,OEOB
SHIMABUKURO, Leanne
67028
65574
224L,OEOB
SMITH, Mary
65571
67431
213
TANDEN, Neera
66275
66244
2 FLlWW
WASHINGTON, Essence
67732
67028
224,OEOB
WEINSTEIN, Paul
65577
67028
214,OEOB
\/2,
OEOB
-----------------------------------------------------------------------------------------
RAINES, Ashley
COMPUTER SUPPORT
WH COMMENT LINE
WAVES CENTER
62023
57370
61111
66742
61655
145,OEOB
'utomated Records Management System
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�...
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RECORD TYPE: PRESIDENTIAL
Page 1 of21
(NOTES MAIL)
CREATOR: Elena Kagan ( CN;Elena Kagan/OU;OPD/O;EOP [ OPD 1
CREATION DATE/TIME:29-DEC-1997 14:06:59.00
SUBJECT:
Re: Needles/Embryos/Abortion and Other Selected L/HHS General Provisions
TO: Laura Emmett ( CN;Laura Emmett/OU;WHO/O;EOP @ EOP [ WHO 1 )
READ:UNKNOWN
TEXT:
please print the attached chart.
---------------------- Forwarded by Elena Kagan/OPD/EOP on 12/29/97 02:07
PM ---------------------------
Thomas Reilly
12/29/97 11:54:38 AM
Record Type: Record
To: Thomas Reilly/OMB/EOP
cc: See the distribution list at the bottom of this message
bcc:
Subject: Re: Needles/Embryos/Abortion and Other Selected L/HHS General
Provisions
I'm told that some of you may not have access to WordPerfect 7, so here is
the same file as below saved as WP 6.1.
Thomas Reilly
12/29/97 11:38:17 AM
Record Type: Record
To: See the distribution list at the bottom of this message
cc: See the distribution list at the bottom of this message
Subject: Needles/Embryos/Abortion and Other Selected L/HHS General
Provisions
Josh Gotbaum does not have access to his e-mail system this morning and
has asked me to forward this note to all of you for him.
Attached is a table of selected Labor/HHS General Provisions related to
health that will require policy decisions in order to print the FY 1999
Budget Appendix.
Traditionally, the Budget shows the prior year's (i.e.,
FY 1998 enacted) appropriations language, and brackets language proposed
for deletion, and italicizes any new or revised language.
Due to the FY 1999 Budget print schedule, we are requesting your
views/comments on these General Provisions by January 5.
Please let us
know by then whether or not you agree with the recommendations in the
attached file, or if you think we need to meet on any of these issues.
�"
ARMS Email System
Page 2 of21
The file to the right shows:
1. The FY 1997 enacted language.
2. Our proposed language in the FY 1998 Budget.
3. The FY 1998 enacted language.
4. OMB staff and HHS (where available) recommendations for the FY 1999
Budget.
The provisions we've included are:
1. Needle Exchange - Probably the stickiest issue this year.
It will
require extensive consultation within the Administration. Detailed
background on this issue is included below.
2. Human Embryos/cloning - The recommendation would repeat the FY 1998
Budget policy of deleting the language with a footnote saying we don't
recommend addressing this issue in legislation.
However, the world of
cloning has changed in the past year, and we may need to rethink our
position.
Detailed background on this issue is also included below.
3. Abortion/Hyde Amendment - We would repeat the FY 1998 Budget policy of
deleting the language with a footnote saying we'll work with Congress to
address the issue.
Note that while the FY 1998 enacted language was more
expansive than in past years, we would still recommend returning to the FY
1998 Budget policy.
4. Family Planning - We would repeat the FY 1998 enacted language.
5. Limitation of the use of funds for promotion of controlled substances We would repeat the FY 1998 enacted language, which is the same as was
proposed in the FY 1998 Budget.
CLICK ON THE SECTIONS BELOW FOR BACKGROUND ON NEEDLES AND CLONING
NEEDLE EXCHANGE
Statutory Restrictions on the Use of Federal Funds for NEPs:
Since 1988, US Appropriations or Authorization law has placed a
conditional prohibition on the use of Federal funds for the operation of
needle exchange programs.
Currently, there are three statutory restrictions on the use of Federal
funds for the operation of needle exchange programs:
The Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA)
Reorganization Act of 1992, prohibits the use of Substance Abuse and
Mental Health Services Administration Block grant funds for needle
exchange programs unless the Surgeon General determines that they are
effective in reducing the spread of HIV and the use of illegal drugs.
The
statute does, however, allow Federal research and evaluation of existing
needle exchange programs.
Section 422 of the 1996 Ryan White CARE Act reauthorization places a flat
prohibition on the use of Ryan White funds for needle exchange.
Sections 505 & 506 of the FY 1998 L/HHS / Ed Appropriations bill read:
http://172.28.127.30:8082/ARMS/servletigetEmaiIArchive?URL] ATH=/nlcp-lIArms40S/whoIWHO_1996 ...
�ARMS Email System
Page 3 of21
505: Not withstanding any other provision of this Act, no funds
appropriated under this Act shall be used to carry out any program of
distributing sterile needles or syringes for the hypodermic injection of
any illegal drug.
506: Section 505 is subject to the condition that after March 31, 1998, a
program for exchanging such needles and syringes (referred to in this
section as an "exchange project") may be carried out in a community if (1)
the Secretary of Health and Human Services determines that exchange
projects are effective in preventing the spread of HIV and do not
encourage the use of illegal drugs; and (2) the project is operated in
accordance with criteria established by such Secretary for preventing the
spread of HIV and for ensuring that the project does not encourage the use
of illegal drugs.
This limitation has been in Labor/ H appropriations language in some form
since 1990.
In the FY 1998 Appropriations bill, the Appropriators split
the provision into two provisions and added the six-month moratorium on
certification and the language requiring that the exchange programs must
be operated in accordance with criteria established by the Secretary.
In the past, the Administration has worked to avoid an outright ban on the
use of Federal funds for NEPs (like the current Section 505) and maintain
the authority of the Secretary to certify that Federal funds can be used
for such programs.
RECOMMENDATION:
There have been several studies done on the efficacy of NEPs in recent
years, and there is current data available to meet the first requirement
in this language (e.g. that NEPs are successful in preventing the spread
of HIV) , but HHS maintains that the data on the second provision (that
NEPs do not encourage the use of illegal drugs) is still inconclusive.
HHS is expecting the results of additional studies on NEPs in the coming
year and wants to maintain the Secretary's authority to continue to
evaluate the evolving scientific data on this issue and to certify that
Federal funds can be used for NEPs.
To maintain maximum flexibility for the Secretary, we recommend bracketing
(deleting) Section 506 and modifying Section 505 by re-proposing the
language that was proposed in the FY 1998 Budget on this issue:
505: Not withstanding any other provision of this Act, no funds
appropriated under this Act shall be used to carry out any program of
distributing sterile needles or syringes for the hypodermic injection of
any illegal drug unless the Surgeon General determines that such programs
are effective in preventing the spread of HIV and do not encourage the use
of illegal drugs.
[Note: The words "or syringes" were added in FY 1998 enacted language -Our recommendation would repeat
they were not proposed in the 98 Budget.
"or syringes" in the FY 1999 Budget.]
ALTERNATE RECOMMENDATION:
In addition to bracketing section 506, we could add a footnote similar to
that placed on the Hyde language deletions:
The Administration proposes
to delete this provision and will work with Congress to address this issue.
Also, rather than repeat the language in the FY 1998 Budget that gave the
authority to certify NEPs to the Surgeon General to the Secretary of
Health and Human Services, we could maintain the language that was made by
Congress in the FY 1997 Labor/HHS/Ed Appropriations bill that gave such
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Page4of21
authority to the Secretary of Health and Human Services.
This may be
something the Administration wants to consider given the upcoming
confirmation hearings for Surgeon General nominee David Satcher.
Background on Human Embryos/Cloning
Both the House and Senate L/HHS bills for FY 1998 extended the FY 1996 and
FY 1997 appropriations Act ban on using Federal t'unds on human-embryo
research, and modified it to include research involving "human diploid
cells." NIH staff advise that in practice, this extension does not differ
from the original ban on human embryo research and would have no effect on
NIH's present research efforts.
The words "human diploid cells" were
apparently added in an attempt to address cloning.
A diploid cell is produced after fertilization occurs in humans -- it is
one stage of a developing embryo. Diploid cells could theoretically be
produced via somatic cell nuclear transfer, which is more commonly
referred to as "cloning." The FY 1996 and FY 1997 L/HHS Acts barred
Federal funding for the creation of human embryos for research purposes or
performing research on human embryos that subjects them to significant
risk. The prohibition on creating embryos for research purposes would, de
facto, prohibit creating a human embryo through cloning technology.
This
is why including diploid cells in the embryo research ban does not differ
practically from banning the creation of human embryos.
The FY 1998 Budget proposed to delete the embryo research ban, stating
that the Administration "does not support addressing this issue in
legislation." In December 1994, the President had issued a statement
barring the use of Federal funds for creating human embryos for research
purposes. On June 9, 1997, the President announced that he was sending
proposed legislation to the Congress, the "Cloning Prohibition Act of
1997," which would prohibit any attempt to create a human being using
somatic cell nuclear transfer.
The Administration did not oppose the
language in the FY 1998 bill in its letters or SAP's.
Observations: Last year's budget's proposal to delete this provision came
before the cloning debate of last spring (e.g., Dolly).
Given the President's proposed legislation on prohibiting cloning, and the
fact that SAP's did not oppose the language during the FY 1998
appropriations process, the Administration may not want to bracket the
language again, even with the footnote that says the Administration does
not support addressing this issue'in legislation.
Message Sent
TO: ________~~~~~_=~----------------------------------------
Bruce N. Reed/OPD/EOP@EOP
Elena Kagan/OPD/EOP@EOP
Christopher C. Jennings/OPD/EOP@EOP
Maria Echaveste/WHO/EOP@EOP
Sandra Thurman/OPD/EOP@EOP
Janet L, Crist/ONDCP/EOP@EOP
Message Copied
To:
Jos-hu--a--G-o-t7b-a-u-m-/~O~M~B~/~E~O~P~@~E~O~P-----------------------------------------
http://172.28.127.30:8082/ARMS/servlet/getEmaiIArchive?URL]ATH=/nlcp-1/Arms405/whoIWHO_1996 ...
�'.
AR,'\1S Email System
Page 5 of21
Charles E. Kieffer/OMB/EOP@EOP
Jacob J. Lew/OMB/EOP@EOP
Janet Himler/OMB/EOP@EOP
Barry T. Clendenin/OMB/EOP@EOP
Richard J. Turman/OMB/EOP@EOP
Mark E. Miller/OMB/EOP@EOP
Corey G. Lee/OMB/EOP@EOP
Ann Kendrall/OMB/EOP@EOP
Jill M. Pizzuto/OMB/EOP@EOP
Richard P. Emery Jr./OMB/EOP@EOP
Message Copied
TO: ________~~~~---------------------------------------------bruce n. reed/opd/eop
elena kagan/opd/eop
christopher c. jennings/opd/eop·
maria echaveste/who/eop
sandra thurman/opd/eop
janet 1. crist/ondcp/eop
joshua gotbaum/omb/eop
charles e. kieffer/omb/eop
jacob j. lew/omb/eop
janet himler/omb/eop
barry t. clendenin/omb/eop
richard j. turman/omb/eop
mark e. miller/omb/eop
corey g. lee/omb/eop
ann kendrall/omb/eop
jill m. pizzut%mb/eop
richard p. emery jr./omb/eop
==================== ATTACHMENT
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The following is a HEX DUMP:
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L/HHS/Ed. General Provisions for FY 1999 Budget
"Side-by-Side" Comparison for Selected Provisions
Titles II and V of LlHHS Bill
FY 1998 Enacted
Section No.1
Provision
Sec. 505. Needle
Exchange
FY 97 Enacted
FY98
President's Budget
FY 98 Enacted
Recommended
FY 99 Language
SEC. 505. Notwithstanding any other provision of this Act, no funds appropriated
under this Act shall be used to carry out any program of distributing sterile
needles for the hypodermic injection of any illegal drug unless the Secretary of
Health and Human Services determines that such programs are effective in
preventing the spread of HIV and do not encourage the use of illegal drugs.
SEC. 505. Proposed
transfer of authority from
the "Secretary of Health and
Human Services" to the
"Surgeon General".
Sec. 505. Notwithstanding any other provision of this Act, no funds
appropriated under this Act shall be used to carry out any program of
distributing sterile needles or syringes for the hypodermic injection
of any illegal drug.
OMB Staff: Repeat FY
98 Budget language.
HHS: No position yet.
Alternatives: (I) Give
authority to Secretary as
opposed to Surgeon
General; (2) use footnote
approach, i.e., delete
provision and say the
Administration will work
with Congress to
resolve.
Sec. 506.
Condition on
Needle Exchange
Sec. 513. Use of
funds for embryo
research-limitations
,
;
Sec. 506. Section 505 is subject to the condition that after March
31, 1998, a program for exchanging such needles and syringes for
used hypodermic needles and syringes (referred to in this section as
an "exchange project") may be carried out in a community if - (I)
the Secretary of Health and Human Services determines that
exchange projects are effective in preventing the spread of HIV and
do not encourage the use of illegal drugs; and (2) the project is
operated in accordance with criteria established by such Secretary
for preventing the spread of HIV and for ensuring that the project
does not encourage the use of illegal drugs.
SEC. 512. (a) None of the funds made available in this Act may be used for- (I)
the creation of a human embryo or embryos for research purposes; or (2) research
in which a human embryo or embryos are destroyed, discarded, or knowingly
subjected to risk of injury or death greater than that allowed for research on
fetuses in utero under 45 CFR 46.208(a)(2) and section 498(b) of the Public
Health Service Act (42 U.S.c. 289g(b)). (b) For purposes of this section, the term
"human embryo or embryos" include any organism, not protected as a human
subject under 45 CFR 46 as of the date of the enactment of this Act, that is derived
by fertilization, parthenogenesis, cloning, or any other means from one or more
human gametes.
Proposed deletion with a
footnote that states that the
Administration does not
support addressing this
issue in legislation.
Sec. 513. Same as FY 97 enacted except end oflast sentence
changed to " ... or more human gametes or human diploid cells."
OMB Staff: Delete.
Alternative: Footnote
saying we will work with
Congress.
HHS: No position yet.
OMB Staff and HHS:
Repeat FY 98 Budget,
i.e., propose deletion
with the same footnote:
"The Administration
proposes to delete this
provision and does not
support addressing this
issue in legislation."
�Automated Records Management Sys._...
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FY 1998 Enacted
Section No.1
Provision
Sec. S09.
Appropriation
limitations for
abortion procedures
(Hyde language)
2
SEC. S08. None of the funds appropriated under this Act shall be expended for
any abortion except when it is made known to the Federal entity or official to
which funds are appropriated under this Act that such procedure is necessary to
save the life of the mother or that the pregnancy is the result of an act of rape or
incest.
FY98
President's Budget
Proposed deletion with
footnote that the
Administration will work
with Congress to address
this issue.
Sec. SIO.
Appropriation
limitations for
abortion procedures
(H yde language)
Sec. 212.
Appropriation of
funds for entities
under title X of the
Public Health
Service Act
SEC. S18. None of the funds appropriated in this Act may be made available to any
entity under title X of the Public Health Service Act unless it is made known to the
Federal official having authority to obligate or expend such funds that the
applicant for the award certifies to the Secretary that it encourages family
participation in the decision of the minor to seek family planning services.
SEC. 513 .
Same as FY 97 Enacted.
Sec. S14. Use of
funds for
promotions of
controlled
substances-limitations
SEC. 513. (a) LIMITATION ON USE OF FUNDS FOR PROMOTION OF
LEGALIZATION OF CONTROLLED SUBSTANCES.-None of the funds
made available in this Act may be used for any activity when it is made known to
the Federal official having authority to obligate or expend such funds that the
activity promotes the legalization of any drug or other substance included in
schedule I of the schedules of controlled substances established by section 202 of
SEC. SI!. Same as FY 97
enacted.
FY 98 Enacted
Recommended
FY 99 Language
Sec. S09. (a) None of the funds appropriated under this Act shall be
expended for any abortion. (b) None of the funds appropriated under
this Act shall be expended for health benefits coverage that includes
coverage of abortion. (c) The tenn "health benefits coverage" means
the package of services covered by managed care provider or
organization pursuant to a contract or other arrangement.
OMB Staff and HHS:
Repeat FY 98 Budget,
i.e., propose deletion,
and add footnote: "The
Administration proposes
to delete this provision
and will work with
Congress to address this
issue."
(New provision)
Sec. SIO. (a) The limitations established in the preceding section
shall not apply to an abortion - (1) if the pregnancy is the result of an
act ofrape or incest; or (2) in the case where a woman suffers from a
physical disorder, physical injury, or physical illness, including a
life-endangering physical condition caused by or arising from the
pregnancy itself, that would, as certified by a physician, place the
woman in danger of death unless an abortion is perfonned. (b)
Nothing in the preceding section shall be construed as prohibiting
the expenditure by a State locality, entity, or private person of State,
local, or private funds (other than a State's or locality's contribution
of Medicaid matching funds). Nothing in the preceding section shall
be construed as restricting the ability of any managed care provider
from offering abortion coverage or the ability of a State or locality to
contract separately with such a provider for such coverage with State
funds (other than a State's or locality's contribution of Medicaid
matching funds).
FY 97 Enacted
OMB Staff and HHS:
Delete provision and add
footnote: "The
Administration proposes
to delete this provision
and will work with
Congress to address this
issue."
Sec. 212. None of the funds appropriated in the Act may be made
available to any entity under title X of the Public Health Service Act
unless the applicant for the award certifies to the Secretary that it
encourages family participation in the decision of minors to seek
family planning services and that it provides counseling to minors on
how to resist attempts to coerce minors into engaging in sexual
activities.
OMB Staff: Repeat FY
98 enacted.
Sec. S14. Same as FY 97 enacted and FY 98 President's Budget.
OMB Staff: RepeatFY
98 Budget language.
Same as enacted.
HHS: No position yet.
--
.
..
�3
FY 1998 Enacted
Section No.1
Provision
FY 97 Enacted
FY98
President's Budget
FY 98 Enacted
Recommended
FY 99 Language
the Controlled Substances Act (21 U.S.c. 812). (b) EXCEPTIONS.-The
limitation in subsection (a) shall not apply when it is made known to the Federal
official having authority to obligate or expend such funds that there is significant
medical evidence of a therapeutic advantage to the use of such drug or other
substance or that Federally-sponsored clinical trials are being conducted to
determine therapeutic advantage.
Automated Records Management System
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�.' .e·
FOIA Number:
SysKagan
Clinton Presidential Records Automated
Records Management System [EMAIL]
This is not a presidential record. This is used as an
administrative marker by the William J. Clinton Presidential
Librarv Staff.
Hex Dump file is not in a recognizable format, has been incorrectly
decoded or is damaged.
Attachment Number: [ATTACH.D57]MAIL45641526N.316
�ARMS Email System
RECORD TYPE: PRESIDENTIAL
Page I of 1
.(NOTES MAIL)
CREATOR: Elena Kagan ( CN=Elena Kagan/OU=OPD/O=EOP [ OPD 1 )
CREATION·DATE/TIME: 6-JAN-1998 15:52:18.00
SUBJECT:
Re: Senator Robb Reply
TO: Andrew J. Mayock ( CN=Andrew J. Mayock/OU=WHO/O=EOP @ EOP [ WHO 1 )
READ:UNKNOWN
TEXT:
yes and yes
�ARMS Email System
Page 1 of 1
RECORD TYPE: PRESIDENTIAL
CREATOR: Elena Kagan
(NOTES MAIL)
( CN=Elena Kagan/OU=OPD/O=EOP [ OPD ] )
CREATION DATE/TIME: 7-JAN-1998 16:21:03.00
SUBJECT:
Treatment of Abortion Provisions in the President's Budget
TO: Laura Emmett ( CN=Laura Emmett/OU=WHO/O=EOP @ EOP [ WHO]
READ:UNKNOWN
TEXT:
Unable to convert ARMS_EXT: [MESSAGE.D58]MAIL4673~6602.026
The following is a HEX dump of the file:
==================== ATTACHMENT
1 ====================
ATT CREATION TIME/DATE:
0 00:00:00.00
TEXT:
Unable to convert ARMS_EXT: [ATTACH.D58]MAIL467316603.026 to ASCII,
The following is a HEX DUMP:
================== END ATTACHMENT
1 ==================
2 ====================
==================== ATTACHMENT
ATT CREATION TIME/DATE:
0 00:00:00.00
TEXT:
Unable to convert ARMS_EXT: [ATTACH.D58]MAIL487316604.026 to ASCII,
The following is a HEX DUMP:
================== END ATTACHMENT
2 ==================
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RECORD TYPE: PRESIDENTIAL
Page I of 1
(NOTES MAIL)
CREATOR: Elena Kagan ( CN=Elena Kagan/OU=OPD/O=EOP [ OPD 1 )
CREATION DATE/TIME: 7-JAN-1998 16:19:00.00
SUBJECT:
Re: Affirmative Action guidance
TO: Dawn M. Chirwa ( CN=Dawn M. Chirwa/OU=WHO/O=EOP @ EOP [ WHO 1 )
READ:UNKNOWN
CC: William R. Kincaid ( cN=william R. Kincaid/OU=OPD/O=EOP @ EOP [ OPD 1 )
READ:UNKNOWN
TEXT:
I did finally manage to look at this -- you and bill and i should talk.
(and thanks for your patience)
�ARMS Email System
Page I of 1
RECORD TYPE: PRESIDENTIAL
(NOTES MAIL)
CREATOR: Elena Kagan ( CN=Elena Kagan/OU=OPD/O=EOP [ OPD 1 )
CREATION DATE/TIME: 8-JAN-1998 14:09:56.00'
SUBJECT:
Re: Memo Julie and I need to you to clear
TO: Diana Fortuna ( CN=Diana Fortuna/OU=OPD/O=EOP [ OPD 1 )
READ:UNKNOWN
CC: Laura Emmett ( CN=Laura Emmett/OU=WHO/O=EOP @ EOP [ WHO 1 )
READ:UNKNOWN
CC: Bruce N. Reed ( CN=Bruce N. Reed/OU=OPD/O=EOP [ OPD 1 )
READ:UNKNOWN
.CC: Julie A. Fernandes ( CN=Julie A. Fernandes/OU=OPD/O=EOP @ EOP [ OPD 1 )
READ:UNKNOWN
CC: Cathy R. Mays
READ:UNKNOWN
( CN=Cathy R. Mays/OU=OPD/O=EOP @ EOP [ OPD 1 )
TEXT:
Looks good to me, but (1) I think the Americorps glossery should go up
front, so that he knows what Young Heroes, CityYear, etc. are as he's
reading the options; (2) do we really need to give him 11 options? aren't
the first five enough?; and (3) I don't think white and black are
capitalized.
�ARMS Email System
RECORD TYPE: PRESIDENTIAL
Page 1 of22
(NOTES MAIL)
CREATOR: Elena Kagan ( CN=Elena Kagan/OU=OPD/O=EOP [ OPD ] )
CREATION DATE/TIME: 8-JAN-1998 12:29:14.00
SUBJECT:
Re: Needles/Embryos/Abortion and Other Selected L/HHS General Provisions SPEAK N
TO: Laura Emmett (. CN=Laura Emmett/OU=W.HO/O=EOP
READ:UNKNOWN
@
EOP [ WHO ] )
TEXT:
---------------------- Forwarded by Elena Kagan/OPD/EOP on 01/08/98 12:29
PM --------------------------JOSHUA
GOTBAUM
01/08/98 11:47:41 AM
Record Type:
Record
To:
See the distribution list at the bottom of this message
cc:
See the distribution list at the bottom of this message
Subject:
Re: Needles/Embryos/Abortion and Other Selected L/HHS General
Provisions SPEAK NOW OR ...
On 12/29, we sent to you the attached note seeking input on several
sensitive L/HHS General Provision issues that we need to address to
complete and print the FY 1999 President's Budget. We really need to hear
from each of you by tomorrow (1/9) in order to meet the Budget print
schedules.
My main concern is that there may be differing views on some
of these (e.g., Needle Exchange) and follow-up discussions may be
necessary.
If so, they would have .to occur as early next week as possible.
We also sent to you yesterday morning an e-mail on the treatment of
abortion provisions throughout the Budget. As requested yesterday, we'd
appreciate hearing from you on these by tomorrow as well.
[This file is
a WordPerfect v.6.1 version of the original table.]
Thomas Reilly
12/29/97 11:38:17 AM
Record Type: Record
To: See the distribution list at the bottom of this message
cc: See the distribution list at the bottom of this message
Subject: Needles/Embryos/Abortion and Other Selected L/HHS General
Provisions
Josh Gotbaum does not have access to his e-mail system this morning and
has asked me to forward this note to all of you for him.
Attached is a table of selected Labor/HHS General Provisions related to
health that will require policy decisions in order to print the FY 1999
�ARMS Email System
Page 2 of22
Budget Appendix.
Traditionally, the Budget shows the prior year's (i.e.,
FY 1998 enacted) appropriations language, and brackets language proposed
for deletion, and italicizes any new or revised language.
Due to the FY 1999 Budget print schedule, we are requesting your
views/comments on these General Provisions by January 5.
Please let us
know by then whether or not you agree with the recommendations in the
attached file, or if you think we need to meet on any of these issues.
The file to the right shows:
1. The FY 1997 enacted language.
2. Our proposed language in the FY 1998 Budget.
3. The FY 1998 enacted language.
4. OMB staff and HHS (where available) recommendations for the FY 1999
Budget.
The provisions we've included are:
1. Needle Exchange - Probably the stickiest issue this year.
It will
require extensive consultation within the Administration.
Detailed
background on this issue is included below.
2. Human Embryos/cloning - The recommendation would repeat the FY 1998
Budget policy of deleting the language with a footnote saying we don't
recommend addressing this iss~e in legislation.
However, the world of
cloning has changed in the past year, and we may need to rethink our
position.
Detailed background on this issue is also included below.
3. Abortion/Hyde Amendment - We would repeat the FY 1998 Budget policy of
deleting the language with a footnote saying we'll work with Congress to'
address the issue.
Note that while the FY 1998 enacted language was more
expansive than in past years, we would still recommend returning to the FY
1998 Budget policy.
4. Family Planning - We would repeat the FY 1998 enacted
lan~uage.
5. Limitation of the use of funds for promotion of controlled substances We would repeat the FY 1998 enacted language, which is the same as was
proposed in the FY1998 Budget.
CLICK ON THE SECTIONS BELOW FOR BACKGROUND ON NEEDLES AND CLONING
NEEDLE EXCHANGE
Statutory Restrictions on the Use of Federal Funds for NEPs:
Since 1988, US Appropriations or Authorization law has placed a
conditional prohibition on the use of Federal funds for the operation of
needle exchange programs.
Currently, there are three statutory restrictions on the use of Federal
funds for the operation of needle exchange programs:
The Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA)
Reorganization Act of 1992, prohibits the use of Substance Abuse and
Mental Health Services Administration Block grant funds for needle
exchange programs unless the Surgeon General determines .that they are
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Page 3 of22
effective in reducing the spread of HIV and the use of illegal drugs.
The
statute does, however, allQw Federal research and evaluation of existing
needle exchange programs.
Section 422 of the 1996 Ryan White CARE Act reauthorization places a flat
prohibition on the use of Ryan White funds for needle exchange.
Sections 505
&
506 ·of the FY 1998 L/HHS / Ed Appropriations bill read:
505: Not withstanding any other provision of this Act, no funds
appropriated under this Act shall be used to carry out any program of
distributing sterile needles or syringes for the hypodermic injection of
any illegal drug.
506: Section 505 is subject to the condition that after March 31, 1998, a
program for exchanging such needles and syringes (referred to in this
section as an "exchange project") may be carried out in a community if (1)
the Secretary of Health and Human Services determines that exchange
projects are effective in preventing the spread of HIV and do not
encourage the use of illegal drugs; and (2) the project is operated in
accordance with criteria established by such Secretary for preventing the
spread of HIV and for ensuring that the project does not encourage the use
of illegal drugs.
This limitation has been in Labor/ H appropriations language in some form
since 1990.
In the FY 1998 Appropriations bill, the Appropriators split
the provision into two provisions and added the six-month moratorium on
certification and the language requiring that the exchange programs must
be operated in accordance with criteria established by the Secretary.
In the past, the Administration has worked to avoid an outright ban on the
use of Federal funds for NEPs (like the current Section 505) and maintain
the authority of the Secretary to certify that Federal funds can be used
for such programs.
RECOMMENDATION:
There have been several studies done on the efficacy of NEPs in recent
years, and there is current data available to meet the first requirement
in this language (e.g. that NEPs are successful in preventing the spread
of HIV) , but HHS maintains that the data on the second provision (that
NEPs do not encourage the use of illegal drugs) is still inconclusive.
HHS is expecting the results of additional studies on NEPs in the coming
year and wants to maintain the Secretary's authority to continue to
evaluate the evolving scientific data on this issue and to certify that
Federal funds can be used for NEPs.
To maintain maximum flexibility for the Secretary, we recommend bracketing
(deleting) Section 506 and modifying Section 505 by re-proposing the
language that was proposed in the FY 1998 Budget on this issue:
505: Not withstanding any other provision of this Act, no funds
appropriated under this Act shall be used to carry out any program of
distributing sterile needles or syringes for the hypodermic injection of
any illegal drug unless the Surgeon General determines that such programs
are effective in preventing the spread of HIV and do not encourage the use
of illegal drugs.
[Note: The words "or syringes" were added in FY 1998 enacted language -Our recommendation would repeat
they were not proposed in the 98 Budget.
"or syringes" in the FY 1999 Budget.]
ALTERNATE RECOMMENDATION:
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In addition to bracketing section 506, we could add a footnote similar to
that placed on the Hyde language deletions: The Administration proposes
to delete this provision and will work with Congress to address this issue.
Also, rather than repeat the language in the FY 1998 Budget that gave the
authority to certify NEPs to the Surgeon General to the Secretary of
Health and Human Services, we could maintain the language that was made by
Congress in the FY 1997 Labor/HHS/Ed Appropriations bill that gave such
authority to the Secretary of Health and Human Services.
This may be
something the Administration wants to consider given the upcoming
confirmation hearings for Surgeon General nominee David Satcher.
Background on Human Embryos/Cloning
Both the House and Senate L/HHS bills for FY 1998 extended the FY 1996 and
FY 1997 appropriations Act ban on using Federal funds on human embryo
research, and modified it to include research involving "human diploid
cells." NIH staff advise that in practice, this extension does not differ
from the original ban on human embryo research and would have no effect on
NIH's present research efforts. The words "human diploid cells" were
apparently added in an attempt to address cloning.
A diploid cell is produced after fertilization occurs in humans -- it is
one stage of a developing embryo.
Diploid cells could theoretically be
produced via somatic cell nuclear transfer, which is more commonly
referred to as "cloning." The FY 1996 and FY 1997 L/HHS Acts barred
Federal funding for the creation of human embryos for research purposes or
performing research on human embryos that subjects them to significant
risk. The prohibition on creating embryos for research purposes would, de
facto, prohibit creating a human embryo through cloning technology.
This
is why including diploid cells in the embryo research ban does not differ
practically from banning the creation of human embryos.
The FY 1998 Budget proposed to delete the embryo research ban, stating
that the Administration "does not support addressing this issue in
legislation."
In December 1994, the President had issued a statement
barring the use of Federal funds for creating human embryos for research
purposes. On June 9, 1997, the President announced that he was sending
proposed legislation to the Congress, the "Cloning Prohibition Act of
1997," which would prohibit any attempt to create a human being using
somatic cell nuclear transfer.
The Administration did not oppose the
language in the FY 1998 bill in its letters or SAP's.
Observations:
Last year's budget's proposal to delete this provision came
before the cloning debate of last spring (e.g., Dolly).
Given the President's proposed legislation on prohibiting cloning, and the
fact that SAP's did not oppose the language during the FY 1998
appropriations process, the Administration may not want to bracket the
language again, even with the footnote that says the Administration does
not support addressing this issue in legislation.
Message Sent
To: ________~~--~~--~~------------------------------~--------Bruce N. Reed/OPD/EOP@EOP
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Elena Kagan/OPD/EOP@EOP
Christopher C. Jennings/OPD/EOP@EOP
Maria Echaveste/WHO/EOP@EOP
Sandra Thurman/OPD/EOP@EOP
Janet L. Crist/ONDCP/EOP@EOP
Message Copied
To:
JOs~h-u-a~G~o~t~b-a-u-m-/70~M~B~/=E~O~P~@~E~O~P~~-------------------------------------
Charles E. Kieffer/OMB/EOP@EOP
Jacob J. Lew/OMB/EOP@EOP
Janet Himlei/OMB/EOP@EOP
Barry T. Clendenin/OMB/EOP@EOP
Richard J. Turman/OMB/EOP@EOP
Mark E. Miller/OMB/EOP@EOP
Corey G. Lee/OMB/EOP@EOP
Ann Kendrall/OMB/EOP@EOP
Jill M. Pizzuto/OMB/EOP@EOP
Richard P. Emery Jr./OMB/EOP@EOP
Message Copied
TO: __________~--77____- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - bruce n. reed/opd/eop@eop
elena kagan/opd/eop@eop
christopher c. jennings/opd/eop@eop
maria echaveste/who/eop@eop
sandra thurman/opd/eop@eop
janet 1. crist/ondcp/eop@eop
joshua gotbaum/omb/eop@eop
charles e. kieffer/omb/eop@eop
jacob j. lew/omb/eop@eop
janet himler/omb/eop@eop
barry t. clendenin/omb/eop@eop
richard j. turman/omb/eop@eop
mark e. miller/omb/eop@eop
corey g, lee/omb/eop@eop
ann kendrall/omb/eop@eop
jill m. pizzut%mb/eop@eop
richard p. emery jr./omb/eop@eop
Message Sent
To:
Bru-c-e~N~.~R~e-e-d~/~O~P~D~/7E=O~P----------------------------------------------
Elena Kagan/OPD/EOP
Christopher C. Jennings/OPD/EOP
Maria Echaveste/WHO/EOP
Sandra Thurman/OPD/EOP
Janet L. Crist/ONDCP/EOP
Message Copied
To:
Cha-r71-e-s-=E~.-=K~i~e~f~f~e-r-/70=M~B~/=E~O=P~---------------------------------------
Jacob J. Lew/OMB/EOP
Janet Himler/OMB/EOP
Barry T. Clendenin/OMB/EOP
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Hex-Dump Conversion
LlHHS/Ed. General Provisions for FY 1999 Budget
"Side-by-Side" Comparison for Selected Provisions
Titles II and V of LlHHS Bill
FY 1998 Enacted
Section No.1
Provision
Sec. 505. Needle
Exchange
FY 97 Enacted
FY98
President's Budget
FY 98 Enacted
Recommended
FY 99 Language
SEC. 505. Notwithstanding any other provision of this Act, no funds appropriated
under this Act shall be used to carry out any program of distributing sterile
needles for the hypodermic injection of any illegal drug unless the Secretary of
Health and Human Services determines that such programs are effective in
preventing the spread of HIV and do not encourage the use of illegal drugs.
SEC. 505. Proposed
transfer of authority from
the "Secretary of Health and
Human Services" to the
"Surgeon General".
Sec. 505. Notwithstanding any other provision of this Act, no funds
appropriated under this Act shall be used to carry out any program of
distributing sterile needles or syringes for the hypodermic injection
of any illegal drug.
OMB Staff: Repeat FY
98 Budget language.
HHS: No position yet.
Alternatives: (I) Give
authority to Secretary as
opposed to Surgeon
General; (2) use footnote
approach, i.e., delete
provision and say the
Administration will work
with Congress to
resolve.
Sec. 506. Section 505 is subject to the condition that after March
31, 1998, a program for exchanging such needles and syringes for
used hypodermic needles and syringes (referred to in this section as
an "exchange project") may be carried out in a community if - (I)
the Secretary of Health and Human Services determines that
exchange projects are effective in preventing the spread of HI V and
do not encourage the use of illegal drugs; and (2) the project is
operated in accordance with criteria established by such Secretary
for preventing the spread of HIV and for ensuring that the project
does not encourage the use of illegal drugs.
Sec. 506.
Condition on
Needle Exchange
Sec. 513. Use of
funds for embryo
research-limitations
"
SEC. 512. (a) None of the funds made available in this Act may be used for- (I)
the creation of a human embryo or embryos for research purposes; or (2) research
in which a human embryo or embryos are destroyed, discarded, or knowingly
subjected to risk of injury or death greater than that allowed for research on
fetuses in utero under 45 CFR 46.208(a)(2) and section 498(b) of the Public
Health Service Act (42 U.S.C. 289g(b)). (b) For purposes of this section, the term
"human embryo or embryos" include any organism, not protected as a human
subject under 45 CFR 46 as of the date of the enactment of this Act, that is derived
by fertilization, parthenogenesis, cloning, or any other means from one or more
human gametes.
Proposed deletion with a
footnote that states that the
Administration does not
support addressing this
issue in legislation.
Sec. 513. Same as FY 97 enacted except end oflast sentence
changed to " ... or more human gametes or human diploid cells."
OMB Staff: Delete.
Alternative: Footnote
saying we will work with
Congress.
HHS: No position yet.
OMB Staff and HHS:
Repeat FY 98 Budget,
i.e., propose deletion
with the same footnote:
"The Administration
proposes to delete this
provision and does not
support addressing this
issue in legislation."
�Automated Records Management System
Hex-Dump Conversion
FY 1998 Enacted
Section No.1
Provision
Sec. S09.
Appropriation
limitations for
abortion procedures
(Hyde language)
FY 97 Enacted
FY98
President's Budget
Proposed deletion with
footnote that the
Administration will work
with Congress to address
this issue.
Sec. SIO.
Appropriation
limitations for
abortion procedures
(Hyde language)
Sec. 212.
Appropriation of
funds for entities
under title X of the
Public Health
Service Act
SEC. S18. None of the funds appropriated in this Act may be made available to any
entity under title X of the Public Health Service Act unless it is made known to the
Federal official having authority to obligate or expend such funds that the
applicant for the award certifies to the Secretary that it encourages family
participation in the decision of the minor to seek family planning services.
SEC. 513 .
Same as FY 97 Enacted.
Sec.SI4. Useof
funds for
Rromotions of
SEC. S13. (a) LIMITATION ON USE OF FUNDS FOR PROMOTION OF
LEGALIZATION OF CONTROLLED SUBSTANCES.-None of the funds
made available in this Act may be used for any activity when it is made known to
the Federal official having authority to obligate or expend such funds that the
activity promotes the legalization of any drug or other substance included in
schedule I of the schedules of controlled substances established by section 202 of
SEC. SII. Same as FY 97
enacted.
~ontrolled
substances-limitations
Recommended
FY 99 Language
Sec. S09. (a) None of the funds appropriated under this Act shall be
expended for any abortion. (b) None of the funds appropriated under
this Act shall be expended for health benefits coverage that includes
coverage of abortion. (c) The term "health benefits coverage" means
the package of services covered by managed care provider or
organization pursuant to a contract or other arrangement.
OMB Staff and HRS:
Repeat FY 98 Budget,
i.e., propose deletion,
and add footnote:"The
Administration proposes
to delete this provision
and will work with
Congress to address this
issue. "
(New provision)
Sec. SIO. (a) The limitations established in the preceding section
shall not apply to an abortion - (I) if the pregnancy is the result of an
act of rape or incest; or (2) in the case where a woman suffers from a
physical disorder, physical injury, or physical illness, including a
life-endangering physical condition caused by or arising from the
pregnancy itself, that would, as certified by a physician, place the
woman in danger of death unless an abortion is performed. (b)
Nothing in the preceding section shall be construed as prohibiting
the expenditure by a State locality, entity, or private person of State,
local, or private funds (other than a State's or locality's contribution
of Medicaid matching funds). Nothing in the preceding section shall
be construed as restricting the ability of any managed care provider
from offering abortion coverage or the ability of a State or locality to
contract separately with such a provider for such coverage with State
funds (other than a State's or locality's contribution of Medicaid
matching funds).
SEC. S08. None of the funds appropriated under this Act shall be expended for
any abortion except when it is made known to the Federal entity or official to
which funds are appropriated under this Act that such procedure is necessary to
save the life of the mother or that the pregnancy is the result of an act of rape or
incest.
FY 98 Enacted
OMB Staff and HRS:
Delete provision and add
footnote: "The
Administration proposes
to delete this provision
and will work with
Congress to address this
issue,"
Sec. 212. None of the funds appropriated in the Act may be made
available to any entity under title X of the Public Health Service Act
unless the applicant for the award certifies to the Secretary that it
encourages family participation in the decision of minors to seek
family planning services and that it provides counseling to minors on
how to resist attempts to coerce minors into engaging in sexual
activities.
OMB Staff: Repeat FY
98 enacted.
Sec. S14. Same as FY 97 enacted and FY 98 President's Budget.
OMB Staff: Repeat FY
98 Budget language.
Same as enacted.
RRS: No position yet.
2
�3
FY 1998 Enacted
Section No.1
Provision
FY 97 Enacted
FY98
President's Budget
FY 98 Enacted
Recommended
FY 99 Language
the Controlled Substances Act (21 U.S.C. 812). (b) EXCEPTIONS.-The
limitation in subsection (a) shall not apply when it is made known to the Federal
official having authority to obligate or expend such funds that there is significant
medical evidence of a therapeutic advantage to the use of such drug or other
substance or that Federally-sponsored clinical trials are being conducted to
determine therapeutic advantage.
Automated Records Management System
Hex-Dump Conversion
�FOIA Number:
SysKagan
Clinton Presidential Records Automated
Records Management System [EMAIL]
This is not a presidential record. This is used as an
administrative marker by the William 1. Clinton Presidential
Librarv Staff.
Hex Dump file is not in a recognizable format, has been incorrectly
decoded or is damaged.
Attachment Number: [ATTACH.D57JMAIL45641526N.316
�ARMS Email System
RECORD TYPE: PRESIDENTIAL
Page 1 of 1
(NOTES MAIL)
CREATOR: Elena Kagan ( CN=Elena KaganjOU=OPD/O=EOP [ OPD 1 )
CREATION DATE/TIME: 8-JAN-1998 14:40:20.00
SUBJECT:
Re: Child Care & Disability
TO: William H. White Jr.
READ:UNKNOWN
CN=william H. White Jr./OU=WHO/O=EOP @ EOP [ WHO 1 )
CC: Diana Fortuna ( CN=Diana Fortuna/OU=OPD/O=EOP [ OPD 1 )
READ:UNKNOWN
CC: Jennifer L. Klein ( CN=Jennifer L. Klein/OU=OPD/O=EOP @ EOP [ OPD 1 )
READ:UNKNOWN
TEXT:
Not that I particularly want to have a meeting ever (I have to say that
these advocates should work on their phone manner), but next week is
better than this one.
�ARMS Email System
RECORD TYPE: PRESIDENTIAL
Page 1 of 1
(NOTES MAIL)
CREATOR: Elena Kagan ( CN=Elena Kagan/OU=OPD/O=EOP [ OPD 1 )
CREATION DATE/TIME: 9-JAN-1998 10:53:29.00
SUBJECT:
Re: OMB's latest on child support budget proposal
TO: Cynthia A. Rice ( CN=Cynthia A. Rice/OU=OPD/O=EOP @ EOP [ OPD 1 )
READ:UNKNOWN
CC: Diana Fortuna ( CN=Diana Fortuna/OU=OPD/O=EOP [ OPD 1 )
READ:UNKNOWN
CC: Emil E. Parker ( CN=Emil E. Parker/OU=OPD/O=EOP @ EOP [ OPD 1 )
READ:UNKNOWN
CC: Bruce N. Reed ( CN=Bruce N. Reed/OU=OPD/O=EOP [ OPD 1 )
READ:UNKNOWN
CC: Andrea Kane ( CN=Andrea Kane/OU=OPD/O=EOP @ EOP [ OPD 1 )
READ:UNKNOWN
CC: Emily Bromberg ( CN=Emily Bromberg/OU=WHO/O=EOP @ EOP [ WHO 1 )
READ:UNKNOWN
TEXT:
sounds generally ok, though I would say that we'll work with Congress on
legislation, rather than send it ourselves.
�Afu\llS Email System
RECORD TYPE: PRESIDENTIAL
Page 1 of 10
(NOTES MAIL)
CREATOR: Elena Kagan ( CN=Elena
~agan/OU=OPD/O=EOP
OPD ] )
CREATION DATE/TIME: 9-JAN-199B 15:40:00.00
SUBJECT:
TO: Laura Emmett ( CN=Laura Emmett/OU=WHO/O=EOP @ EOP [ WHO]
READ:UNKNOWN
)
TEXT:
==================== ATTACHMENT
1 ====================
ATT CREATION TIME/DATE:
0 00:00:00.00
TEXT:
Unable to convert ARMS_EXT: [ATTACH.D42]MAIL433685805.026 to ASCII,
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�,;"..
January 9, 1997
MEMORANDUM FOR THE PRESIDENT
FROM:
Bruce Reed
Elena Kagan
SUBJECT:
DPC Weekly Report
1. Child Care -- Response to Announcement: We are pleased with the response so far
to your child care initiative. Children's advocates and child care experts are overjoyed at both
the level offunding and the composition of the package (~, the ratio of subsidies to tax cuts).
Hill Democrats and some moderate Republicans are enthusiastic about the package, as you heard
at Thursday's congressional meeting. Governors -- including a few Republicans -- have praised
the extent of state flexibility in the plan. Even conservative Republicans in Congress had a hard
time attacking your proposal. Rep. Pryce, whom Speaker Gingrich asked to respond to the
proposal for the House Republican leadership, admitted that you had "resisted the urge to have
the federal government control child care." Some Republicans alternated between accusing you
of spending too much money and claiming that they had spent even more for child care in the
past.
The most serious criticism, which we knew we would face, is that the package does little
to help parents who want to stay at home to care for their children. (A similar point was made in
the opinion piece by David Blankenhorn appearing in the New York Time that you asked us
about; as you recall, he criticizes tax cuts fQr child care and supports expanding the child tax
credit to help parents of young children stay at home.) As you know, we can blunt this charge
somewhat by coming out for an expansion of the FMLA in the State of the Union to allow more
workers to stay at home for longer periods with their newborns. We are also open to discussing
with members of Congress an expansion of the child tax credit, although we found such
proposals too expensive to incorporate into our package. Most important, we cannot let anyone
forget your record of providing families with real choices -- for example, through the child tax
credit, FMLA, EITC, minimum wage, and CHIP.
2. Health -- Response to Medicare Buy-in Announcement: Your Medicare buy-in
proposal provoked a great deal of comment. Some Republicans, including Senator Gramm and
Rep. Bill Thomas, were extremely critical of the proposal: they argued that it would only
exacerbate Medicare's financial problems. (Gramm compared Medicare to the Titanic and
warned about putting extra passengers on.) The base Democrats were very pleased with the
proposal -- particularly after Republicans strongly opposed it. Though liberal groups also were
pleased that we are addressing this issue, they believe we must include some kind of subsidy for
low-income Americans. Elite validators gave this policy mixed reviews: while uniformly
Automated Records Management System
Hex-Dump Conversion
�recognizing the need of this population for affordable insurance, some (including the New York
Times) praised the self-financing feature ofthe program, while others expressed concern that the
proposal would create the demand for further, less fiscally responsible subsidization.
3. Drugs -- Substance Abuse and Prisoners: The National Center on Addiction and
Substance Abuse released a study on Thursday finding that drug or alcohol use helped lead to the
incarceration of 80 percent of all inmates in the nation's prisons and jails. According to the
report, 1.4 million prisoners (out of a total 1.7 million) were high when they committed their
crimes, stole property to buy drugs, andlor had a history of drug and alcohol abuse.
As you know, the 1994 Crime Law mandates that 100 percent of all federal prisoners
defined as eligible receive substance abuse treatment by 1997. According to the Bureau of
Prisons, the federal prison system has met this requirement. Since 1994, we have made some
form of substance abuse treatment available in every federal prison facility, tripled the total
number of inmates treated in the federal system, and increased the number of residential
treatment centers in federal prisons by 30 percent (from 32 to 42). In addition, legislation you
offered requires states to submit comprehensive plans of testing, sanctions, and treatment by
March 1998 as a condition ofreceiving prison construction funding.
To build on these efforts, we are preparing a directive from you to the Attorney General
to: (1) require states, as part of their testing and treatment plans, to estimate current drug use in
prisons and measure progress yearly; (2) draft legislation to allow states to use prison
construction funds to implement their testing and treatment plans; and 3) draft legislation to
require states to enact increased penalties for smuggling drugs into prisons as a condition of
receiving prison construction monies. An event focusing on this directive is tentatively
scheduled for Monday.
4. Drugs -- Anti-Drug Media Campaign: The anti-drug media campaign began on
Thursday in Washington, D.C. -- the first city in the 12-city pilot. Anti-drug advertisements have
started to air in the District during prime-time network television shows, with radio and Internet
ads to commence next week. ONDCP will roll out the media campaign in the remaining pilot
cities throughout the month of January. The other 11 pilot cities and rollout dates are as follows:
Atlanta (1120), Baltimore (1/13), Boise (1113), Denver (1/16), Hartford (1/23), Houston (1/15),
Milwaukee (1121), Portland (1/22), San Diego (1/9), Sioux City (1/20), and Tucson (1/15).
5. Crime -- Brady Checks: As you know, Arkansas remains the only state that is not
conducting background checks prior to handgun sales. Although Attorney General Winston
Bryant issued an opinion saying that state police have the legal authority to conduct checks,
Governor Huckabee has ordered the police to refuse to do so. In response, Bryant has asked the
Treasury and Justice Departments to make him (rather than the state police) the designated chief
law enforcement officer for the entire state; under this scheme, federally licensed dealers would
refer the names of potential purchasers to the AG's office, and employees of that office would
check the names in the FBI's NCIC (rather than the state police's) database. Justice and Treasury
2
Automated Records Management System
Hex-Dump Conversion
�are currently inclined to grant Bryant's request later this month. This action may provoke a
strong response from Huckabee, who is currently not aware of Bryant's request.
6. Crime -- Slain Officers: The National Law Enforcement Officers Memorial Fund
(NLEOMF) reported last week that the number of officers killed in the line of duty increased by
nearly 40% in 1997, from 116 in 1996 (the lowest number since 1959) to 159 last year. The
1997 figure exceeds the 1990s average of 151 line-of-duty deaths per year. NLEOMF attributes
the rise in deaths to: (1) an increase in firearms-related deaths (70 in 1997, as compared to 56 in
1996); (2) an unusually high number of traffic fatalities; and (3) 10 multiple-death incidents, in
which a total of 22 officers were killed.
7. Welfare -- Child Support Computer Systems: We are working closely with a
House-Senate group convened by Rep. Clay Shaw's staff on the child support computer systems
issue you discussed with Senator Feinstein this fall. Our goal is to put in place a new system of
penalties that are large enough to ensure that states develop effective computer systems, but not
so large as to disrupt states' child support collection efforts. As you know, current law requires
us to withhold all federal child support funds from a state without a statewide child support
computer system -- a penalty we intend to retain in the legislation (at least as a threat) for
egregious cases. Shaw's initial proposal, which we think makes sense, would impose an initial
penalty of 4 percent of federal child support funds in the first year, with higher penalties in later
years. Once a state's system is complete, it could earn back a portion of the penalty. Shaw wants
to introduce legislation the first day of Congress and move it through the House by the second
week of February. As always, the Senate is expected to move more slowly, but could pass the
legislation by April. By then, HHS expects nine states to remain without statewide computer
systems: California, Michigan, Illinois, Ohio, Pennsylvania, Indiana, Hawaii, Oregon, and New
Mexico.
8. Welfare -- Welfare Recipients in College: You recently asked us about a report in
the Washington Post that some college students on welfare are dropping out of school to meet
new work requirements. As you know, the welfare law does not count education that is not
directly related to a job toward the work participation rates. States, however, have significant
flexibility to excuse college students from work, given that the required participation rate is now
at 30 percent and peaks at 50 percent. In addition, welfare recipients can combine work with
their studies (as most college students do), particularly if work-study jobs are available. To
encourage this result, we asked Secretaries Riley and Shalala to write to the nation's college
presidents in September to explain the law and stress the importance of providing work-study
jobs to welfare recipients enrolled in their schools. (Most work-study jobs are only 10 hours per
week, but the letter explained that this is not a legal requirement.)
9. Welfare -- Delaware Evaluation: Governor Carper released on Monday an
evaluation of the state's welfare reform waiver program called A Better Chance (ABC). The
program began in 1995 as one of the first comprehensive statewide waivers granted by the
Administration. Initial results are encouraging: by the fourth quarter after the program started,
3
Automated Records Management System
Hex-Dump Conversion
�j.
program participants had 24 percent higher employment, 16 percent higher earnings, and 18
percent lower average benefits than the participants in the control group. The evaluation found a
fairly high rate of sanctioning: 49 percent of the participants were sanctioned at least once for
failing to comply with the program's employment or family responsibility (immunization, school
attendance) requirements. It is interesting to note in evaluating these results that Delaware's
caseloads have not gone down as dramatically as those of many other states; the decline since
January 1993 has been 21 percent. This relatively low decline may result from ABC's "make
work pay" incentive that allows recipients to keep more earnings and still remain eligible for
welfare.
10. Education -- California Math Standards: Proposed new math standards in
California have provoked a heated debate in the last few months, pitting educators who
emphasize problem solving against those who favor a more basic skills approach. The California
State Board of Education last month adopted the more conservative view, over the objection of
Superintendent Delaine Eastin. The head ofthe Education Directorate at the National Science
Foundation subsequently sent a letter to the Chair of the California State Board strongly
criticizing the decision and implying that it would jeopardize continued NSF funding for six
Urban Systemic Improvement sites in California. The letter upset conservatives (and others),
who viewed it -- in our view, correctly -- as an example of inappropriate federal intrusion in state
curriculum matters. Diane Ravitch warned us immediately that it could give Bill Bennett a
pretext for withdrawing his support of your national testing initiative. As a result, we worked
with NSF this week to draft a letter from NSF Director Lane to the California State Board
clarifying that NSF would not second-guess state standards and emphasizing the importance of
basic skills. Based on recent conversations with Ravitch, we believe this step has been sufficient
to prevent Bennett's reversal.
11. Education -- Urban Education Report: Education Week issued its annual report
on education reform in the 50 states on Thursday, focusing on the progress in urban school
districts. The study noted that approximately 40 percent of students in urban districts reached the
basic level on the most recent NAEP 4th grade reading and 8th grade math and science exarns in
1994 and 1996, compared to over 60 percent in each of these subj ects in non-urban areas. The
study also found discrepancies in resources, with urban districts spending about $500 less per
child annually than non-urban districts. The Education Week issue also detailed a dozen
promising reform strategies to raise achievement in districts around the nation -- ~, setting high
standards; holding schools accountable for results and giving schools greater flexibility; creating
small, more intimate schools or schools-within-schools; recruiting well-prepared teachers and
providing them with continuing training and support; training principals to be effective school
leaders; and promoting school choice. Your existing and planned initiatives -- including the new
Education Opportunity Zones proposal that you previewed in December -- match up very well
with these reform prescriptions.
12. Education -- Life-long Learning Card: You recently asked us about Bob Reich's
idea of a life-long learning card -- essentially a bank card consolidating all federal education
4
Automated Records Management System
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�benefits (Pell, IRAs, education tax credits and deductions, and job-training funds), against which
education expenses could be credited. DPC and NEC staff have begun to look into this proposal,
but we do not yet have a specific recommendation. The Education Department is currently
intending to begin a pilot project by October 2000 to use bank cards to disburse federal aid to
post-secondary students. Our instinct is that bank cards may be effective to deliver grants and
loans, but less useful for tax credits and deductions. DPC and NEC will continue to explore this
Issue.
5
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�ARMS Email System
RECORD TYPE: PRESIDENTIAL
Page 1 of 1
(NOTES MAIL)
CREATOR: Elena Kagan ( CN=Elena Kagan/OU=OPD/O=EOP [ OPD 1 )
CREATION DATE/TIME: 9-JAN-1998 08:11:12.00
SUBJECT:
weekly
TO: Phillip Caplan ( CN=Phillip Caplan/OU=WHO/O=EOP @ EOP [ WHO 1 )
READ:UNKNOWN
TEXT:
when is he away until? I'm going away for the weekend and want to figure
out what I need to do by when.
thanks.
�ARMS Email System
RECORD TYPE: PRESIDENTIAL
Page I of 1
(NOTES MAIL)
CREATOR: Elena Kagan ( CN=Elena Kagan/OU=OPD/O=EOP [ OPD 1 )
CREATION DATE/TIME: 9-JAN-1998 08:09:32.00
SUBJECT:
You're right ...
TO: John Podesta ( CN=John Podesta/OU=WHO/O=EOP @ EOP [ WHO 1 )
READ:UNKNOWN
Sara M. Latham ( CN=Sara M. Latham/OU=WHO/O=EOP @ EOP [ WHO 1 )
READ:UNKNOWN
CC:
TEXT:
Nothing ventured, nothing gained.
PS:
Let's go for it . . And thanks.
I suspect Melanne would also be supportive.
�" I..
r.
I~
....
" .• ARMS Email System
Page I of2
RECORD TYPE: PRESIDENTIAL
(NOTES MAIL)
CREATOR: Elena Kagan ( CN=Elena Kagan/OU=OPD/O=EOP [ OPD ] )
CREATION DATE/TIME:
SUBJECT:
9-JAN-1998 09:21:23.00
ag entry
TO: Andrew J. Mayock ( CN=Andrew J. Mayock/OU=WHO/O=EOP @ EOP
READ:UNKNOWN
[ WHO]
)
TEXT:
Hope this is what you're looking for.
==================== ATTACHMENT
1 ====================
ATT CREATION TIME/DATE:
0 00:00:00.00
TEXT:
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Domestic Policy Council
Follow-Up on Small Farmers Meeting
January 8,1998
Working Group on Highlighting Issues in Farm Policy
The DPC is establishing a working group to research and promote issues of interest to
fanners. The group will emphasize finding issues of importance to rural communities that
deserve to be part of the President's public agenda. Tom Freedman ofDPC will coordinate the
working group, which will include representatives from USDA, NEC, CEA, Treasury and OPL.
Meetings With Tobacco Farmers and Response to Senator Robb
Bruce Reed and/or Elena Kagan will hold meetings with interested tobacco fann
representatives, including Ralph Paige, to explain the Administration's position on tobacco and
consider ways to meet the needs of tobacco fanners. DPC staff also has drafted a response from
you to Senator Robb on his tobacco fanner proposal.
Automated Records Management System
Hex-Dump Conversion
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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
Elena Kagan
Description
An account of the resource
<div>
<p>Elena Kagan worked as Associate White House Counsel from 1995-1996 and Deputy Assistant to the President for Domestic Policy and Deputy Director of the Domestic Policy Council (DPC) from 1997-1999.</p>
<p>During her work at the White House Justice Kagan worked on many topics including, but not limited to: AIDS, budget appropriations, campaign finance reform, education, health, labor, race, tobacco, Native Americans, and welfare.</p>
<p>In 1999 President Clinton nominated Kagan to the U.S. District Court of Appeals, no hearing was ever scheduled and she was thereby never confirmed.</p>
<p>Note: These records were made available in response to a <a href="http://clinton.presidentiallibraries.us/freedom-of-information-act-requests">Freedom of Information Act (FOIA)</a> request, FOIA 2009-1006-F. This collection contains both records created by Elena Kagan and records concerning Elena Kagan. </p>
<p><strong>Descriptions of the Sub Collections:</strong></p>
<ul><li><strong><a href="http://clinton.presidentiallibraries.us/items/browse?search=&advanced%5B0%5D%5Belement_id%5D=70&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=Elena+Kagan%27s+White+House+Counsel+Files&range=&collection=&type=&user=&tags=&public=&featured=&exhibit=&submit_search=Search+for+items">White House Counsel Files</a></strong><br /> These records consist of files created and received by Elena Kagan when she served as Associate Counsel to President Clinton from 1995 to 1996. The files include but are not limited to records concerning Amtrak, campaign finance reform, gaming/gambling (especially as it relates to Native Americans), timber, regulatory reform, and welfare. The records include memoranda, notes, correspondence, articles, reports, executive orders, bills, and directives.</li>
<li><strong><a href="http://clinton.presidentiallibraries.us/items/browse?search=&advanced%5B0%5D%5Belement_id%5D=70&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=Elena+Kagan%27s+Domestic+Policy+Council+Files&range=&collection=&type=&user=&tags=&public=&featured=&exhibit=&submit_search=Search+for+items">Domestic Policy Council Files</a></strong><br />These records contain files created and received by Elena Kagan when she served as Deputy Assistant to the President for Domestic Policy and Deputy Director of the Domestic Policy Council (DPC) from 1997-1999. The files include records concerning domestic policy topics such as AIDS, budget appropriations, campaign finance reform, education, health, labor, race, tobacco, and welfare. The records include memoranda, correspondence, articles, and reports.</li>
<li><strong><a href="http://clinton.presidentiallibraries.us/items/browse?search=&advanced%5B0%5D%5Belement_id%5D=70&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=White+House+Staff+%26+Office+Files+re+Elena+Kagan&range=&collection=&type=&user=&tags=&public=&featured=&exhibit=&submit_search=Search+for+items">White House Staff Files re Elena Kagan</a></strong><br />These records are compiled from a variety of staff office files including the Chief of Staff, Personnel, Office of First Lady, Counsel, and DPC and include correspondence, memorandum, forms, and reports all concerning or having to do with Elena Kagan.</li>
<li><strong><a href="http://clinton.presidentiallibraries.us/items/browse?search=&advanced%5B0%5D%5Belement_id%5D=70&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=White+House+Office+of+Records+Management+Files+re+Elena+Kagan&range=&collection=&type=&user=&tags=&public=&featured=&exhibit=&submit_search=Search+for+items">White House Office of Records Management Files (WHORM)</a></strong><br />These records are from the White House Office of Records Management (WHORM) subject file series. The Clinton Presidential Library inherited a document-level index maintained by WHORM during the Clinton Administration which tracked some incoming correspondence and other documents as they were circulated throughout the White House and filed by WHORM. The records contain files created and received by Elena Kagan that were tracked by the WHORM Subject File index. The files include records related to a variety of topics such as memoranda, correspondence, and Domestic Policy Council weekly reports. The records are tracked by an alpha/numeric code, and are listed as such.</li>
<li><strong><a href="http://clinton.presidentiallibraries.us/items/browse?search=&advanced%5B0%5D%5Belement_id%5D=70&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=Elena+Kagan%27s+1999+Nomination+to+U.S.+Court+of+Appeals&range=&collection=&type=&user=&tags=&public=&featured=&exhibit=&submit_search=Search+for+items">Elena Kagan's 1999 Nomination to U.S. Court of Appeals</a></strong><br />After serving as the Deputy Director of the Domestic Policy Council, Elena Kagan was nominated to serve on the U.S. Appeals Court for the District of Columbia (D.C. Circuit) in1999. Her nomination expired in 2000 without Senate action. The files in this opening contain records from the White House Staff and Office Files, Counsel’s Office and Presidential Personnel, concerning her nomination. The records consist of Senate Judiciary Committee questionnaires, correspondence, law review files, news articles, briefs, and press briefings.</li>
<li><strong><a href="http://clinton.presidentiallibraries.us/items/browse?search=&advanced%5B0%5D%5Belement_id%5D=70&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=Email+Received+by+Elena+Kagan&range=&collection=&type=&user=&tags=&public=&featured=&exhibit=&submit_search=Search+for+items">Email Received by Elena Kagan</a></strong><br />These records consist of email received by Elena Kagan during her time as Associate White House Counsel from 1995-1996 and Deputy Assistant to the President for Domestic Policy and Deputy Director of the Domestic Policy Council (DPC) from 1997-1999. In addition to the email proper, these messages include forwards, reply chains, and attachments. The attached documents include notes, memorandum, articles, reports, executive orders, bills, and directives. These email concern a myriad of topics including but not limited to Amtrak, campaign finance reform, gaming/gambling (especially as it relates to Native Americans), timber, regulatory reform, welfare and domestic policy topics such as AIDS, budget appropriations, education, health, labor, race, and tobacco.</li>
<li><strong><a href="http://clinton.presidentiallibraries.us/items/browse?search=&advanced%5B0%5D%5Belement_id%5D=70&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=Email+Sent+by+Elena+Kagan&range=&collection=&type=&user=&tags=&public=&featured=&exhibit=&submit_search=Search+for+items">Email Sent by Elena Kagan</a></strong><br />These records consist of email sent by Elena Kagan during her time as Associate White House Counsel from 1995-1996 and Deputy Assistant to the President for Domestic Policy and Deputy Director of the Domestic Policy Council (DPC) from 1997-1999. In addition to the email proper, these messages include forwards, reply chains, and attachments. The attached documents include notes, memorandum, articles, reports, executive orders, bills, and directives. These email concern a myriad of topics including but not limited to Amtrak, campaign finance reform, gaming/gambling (especially as it relates to Native Americans), timber, regulatory reform, welfare and domestic policy topics such as AIDS, budget appropriations, education, health, labor, race, and tobacco.</li>
<li><strong><a href="http://clinton.presidentiallibraries.us/items/browse?search=&advanced%5B0%5D%5Belement_id%5D=70&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=Elena+Kagan%27s+Records+re+Native+Americans&range=&collection=&type=&user=&tags=&public=&featured=&exhibit=&submit_search=Search+for+items">Elena Kagan's Records re Native Americans</a></strong><br />These records were created or received by Elena Kagan during her service as Deputy Assistant to the President for Domestic Policy and Deputy Director of the Domestic Policy Council (1997-99). These ten folders were previously opened as part of a Freedom of Information Act request related to Native Americans (FOIA case <a href="http://www.clintonlibrary.gov/Documents/Finding-Aids/2006/2006-0197-F%28seg%203%29.pdf" target="_blank">2006-0197-F</a>).These records consist of memoranda, emails, reports, notes, and clippings.</li>
<li><strong><a href="http://clinton.presidentiallibraries.us/items/browse?search=&advanced%5B0%5D%5Belement_id%5D=70&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=Additional+Materials+re+Elena+Kagan&range=&collection=&type=&user=&tags=&public=&featured=&exhibit=&submit_search=Search+for+items">Additional Materials re Elena Kagan</a></strong><br />These records were taken from the files of Elena Kagan. They include memos to, from, and relating to Elena Kagan’s work on Domestic Policy issues. The records include some memos from Elena Kagan to President Clinton.</li>
<li><strong><a href="http://clinton.presidentiallibraries.us/items/browse?search=&advanced%5B0%5D%5Belement_id%5D=70&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=Federal+Email+re+Elena+Kagan&range=&collection=&type=&user=&tags=&public=&featured=&exhibit=&submit_search=Search+for+items">Federal Email re Elena Kagan</a></strong><br />The federal email re: Elena Kagan consists of 114 email messages that were part of the Federal side of the Clinton White House. The email generally consists of summaries of meetings or telephone conversations in which Elena Kagan was a participant.</li>
</ul></div>
Identifier
An unambiguous reference to the resource within a given context
2009-1006-F
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
Clinton Presidential Records: Automated Records Management System
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Creator
An entity primarily responsible for making the resource
Office of the Counsel to the President
Domestic Policy Council
First Lady's Office
White House Office of Records Management
Chief of Staff
White House Office for Women's Initiative and Outreach
Automated Records Management System
Tape Restoration Project
Security Office
Presidential Personnel
Date
A point or period of time associated with an event in the lifecycle of the resource
1995-1999
Extent
The size or duration of the resource.
2945 folders
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
Magnetic Disk: Hard Drive
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
[12/15/1997 – 01/09/1998]
Creator
An entity primarily responsible for making the resource
Automated Records Management System
WHO
Identifier
An unambiguous reference to the resource within a given context
2009-1006-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Email Sent by Elena Kagan
<a href="http://catalog.archives.gov/id/574745" 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: Automated Records Management System
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.
6/18/2010
Source
A related resource from which the described resource is derived
ARMS - Box 013 - Folder 003
574745