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53
3
3
3
�ID:
NOV 18'93
15:06 No.014 P.01
DATE:
TIME:
Executive Office of the President
Office of Management and Budget
Health Policy
725 17th Street, NW, Room 7021
Washington, DC 20503
FAX: (202)395-3910
Voice: (202) 395-3844
To: J W v d Ox^S
F A X #:
Voice #:
From
Notes:
Number of Pages (including cover sheet):
�CM
O
CL.
o
Chart 1 - Medicare Spending
Proposed Changes Under Health Care Reform V
o
o
Fiscal year
to HI Outlays
^SMI Outlays
' OfEsetting Receipts 21
o Medicare Baseline (Net Current Federal)
Annual Growth
2
Average Annual Growth Rate (1980-2000)
Average Annual Growth Rate (1980-1995)
Average Annual Growth Rate (1996-2000)
Reform Baseline
Annual Growth
Q Average Annual Growth Rate (1980-2000)
~ Average Annual Growth Rate (1980-1995)
Average Annual Growth Rate (1996-2000)
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
23802 28916 34354 38005 41476 47841 49018 49976 52022 57433 65912
10152 12351 14813 17493 19475 21808 25166 29937 33682 36867 41498
-2935 -3340 -3856 -4253 •4942 -5562 -5739 -6520 -8798 -11590 -11607
31,019 37,927 4531 51,245 56,009 64,087 68,445 73^93 76,906 82,710 95,803
22.27 19.47 13.10
9.30 14.42
6.80
7.23
4.79
7.55
15.83
11.27
11.79
9.71
31,019 37,927 45,311 51,245 56,009 64,087 68,445 73^93 76,906 82,710 95,803
22.27
19.47
13.10
9.30
14.42
6.80
7.23
4.79
7.55
15.83
10.69
11.79
732
�o
9
o
o
KO
o
in
cn
co
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
68705 80784 91404 101738 111248 121367 131867 142485 153962 166433
45514 48627 54942 62170 71593 80190 89851 100524 112410 125674
-12154 -132^2 -15143 -17429 -19912 -20426 -23199 -26319 -29867 -33152
102,065
6.54
102^)65
6.54
116479
13.83
116479
13.83
131003
12.93
131,203
12.93
14M79
11.64
146,329
11.53
162,929
11.23
161,899
10.64
181,131
11.17
198,519
216,690
236^05
9.60
9.15
9.14
179,333
196,556
10.77
9.60
204,307
3.94
258^55
9.49
216,431
232,385
5.93
7.37
�o
3
^ Notes from HFB
Fiscal year
£ Proposed Law: Health Care Reform
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
in
Drugs w/Rebate
Advanced Practice Nurses
ro $124 8. Package; Ver I •
- $124 B. Package; Ver D *
2 $124 B. Package; Ver ffl*
Total Proposed Medicare Baseline 4/
<w/$124 b. Ver 0
<w/$124b. Ver ID
(w/$124b.VernD
Reform Baseline
31,019
37,927 45,311
51,245
56,009 64,087 68,445
73,393 76^06
82,710 95,803
.. * Not on Bob Anderson tables; reflects most recent HCFA pricing of options, submitted 10/29/93
Q
t-H
(Medicare Outlays include Administrative Costs)
1/ MEDICARE OUTLAYS 1980 -1992, HISTORICAL TABLES OF FY 1994 BUDGET; 1993-1999 ARE FROM FY 1995 HCFA BUDGET JUSTOICATION
2/ OFFSETTING RECEIPTS FOR 1980 -1992 TAKEN FROM HISTORICAL TABLES; FOR 1993 -1999, TAKEN FROM BUDGET JUSTTFIOATTON
3/ ESTIMATES FOR YEAR 2000 DERIVED BY APPLYING 1999 GROWTH RATES TO ARRIVE AT 2000 FIGURES
4/ EFFECT OF HEALTH CARE REFORM TAKEN FROM BOB ANDERSON TABLES, EXCEPT WHERE NOTED
�IT)
O
0)
T—t
o
o
1994
1995
1996
1997
1998
1999
2000
16,214
2,040
<8A05)
3,700
{40,919)
{40^34)
(41,544)
o
in
to
co
aso)
(ISO)
(150)
1,450
0830)
(2340)
<1£30>
6,594
13/499
O/WO)
2,800
(10,192>
(10,202}
llOfiiZ)
<3^00>
2,900
{15,432)
014,562)
(14,582)
14,240
15,220
2^00
1,470
(8/395) (8.100)
3/400
3,150
(23,378) (32^84)
(22,908) (32,S44)
OSJOOS) (32^44)
146,329
146,329
146,329
162349
161,539
16^549
179^33
179^23
179,483
196,486
197A56
197,336
204,077
204^47
204/447
216,141
216/481
216,181
231^85
231,970
231,260
146,329
161^99
179^33
196,556
204,307
216,431
232^85
�O
QT-H
Chart 2 -- Federal Share for Medicaid
o
o
o
IT)
to
03
Fiscal year
Medicaid Baseline
Annual Growth
1980
1981
1982
1983
1984
1985
1986
1987
1988
13,957 16,833 17,391 18,985 20,061 22,655 24,995 27,435 30,462
20.61
3J1
9.17
5.67
12.93
1033
9.76
11.03
Average Annual Growth Rate (1980-2000)
Average Annual Growth Rate (1980-1995)
Average Annual Growth Rate (1996-2000)
Reform Baseline Net Non-Cash Groups
Annual Growth
13.74
14.23
1235
13,957
Average Annual Growth Rate (1980-2000)
Average Annual Growth Rate (1980-1995)
Average Annual Growth Rate (1996-2000)
Source: OMB, Using HCFA, OACT estimates, November 1993
16^33 1 7 3 1 18,985 20,061 22,655 24,995 27,435 30,462
20.61
3.31
9.17
5.67
12J»
1033
9.76
11.03
11.33
14.23
2.64
�9
o
o
o
O
in
Medicaid (continued)
1994
1991
1992
1993
1995
1996
1997
1989
1990
1998
1999
2000
34,604 41,103 52,533 67,827 75,663 87,400 99,900 112,000 126,000 141,000 159,000 178^00
11.90 12.77
13.60 18.78 27.81 29.11 1135
1531
14J0 12.11 1230
11.95
00
CD
34,604 41,103 52^33 67,827 75,663 87,400 99^00 107,400 111^35 105^35 104,460 113,030
13.60 18.78
27^1
29.11
11.55 1531
1430
731
4.13
-5.37
-1.30
8.20
�00
o
T-H
O
o
CO
o
ID
NO
2)
- 'Year
1993 1994 1995 1996
1997 1998 1999 2000
Bob Anderson
FY
Medicare Total
Per Capita
Medicaid
Per Capita
113
9.4
16.4
13.5
10.9
9JZ
15
11.9
9.5
7.9
12.5
11.1
9.8
8.4
11.7
9.2
9.8
8.6
11.1
8.9
9.6
8.6
11
8.7
9.4
8.4
11
8.7
CY
Medicare Total
Per Capita
Medicaid
Per Capita
11.2
9.4
16.1
13.1
10.6
8.9
14.4
11.7
9.6
8.0
123
10.6
9.8
8.5
11.6
9.1
9.8
8.6
11.1
S3
9.6
8.6
11.0
8.7
7.1
63
83
8.7
201782
222005
243185
268134
294734
10.4
10.0
9.5
103
9.9
cn
oo
a
HCFA's -- Post OBRA 93 Estimates \a
FY
145190
164066
182792
Medicare
% Increase
11.4
13.0
#Benes
33.7
Per Capita
Medicaid
% Increase
# Recipients \b
Per Capita
75000
33.0
34.3
MA
3S.2
35J6
35.9
36.2
36A
11.0
9.8
9.1
8.8
8.6
93
93
87400
99900
111600
124500
138400
1S37O0
170500
16.5
143
11.7
11.6
11.2
11.1
10.9
34.4
35.7
36.7
38.0
39J
40.7
11.7
10.1
8.6
7.9
7^
73
7.4
�»
—
•(
cn
o
(D
Q-
O
\a = unless otherwise noted, estimates from HCFA, OACT, September 1993
\b = HCFA, OACT, revised July 1993
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0
0 0 0*0
Q
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�To: Gene
Fr: Jason
Re: Medicare/Medicaid savings in alternative plans
Date: November 10, 1993
Medicare/Medicaid savings
1996-2000
Chafee/Dole
Source: Chafee's office, Democratic Policy Committee
$213 billion
Cooper
$219 billion
Source: The Medicare number ($40 billion) comes from Cooper's office and Cooper
on Meet The Press on 10/31; the Medicaid number ($179) comes from last year's legislation •
- CBO estimate (These Medicaid numbers seem the least solid)
Gramm/McCain
Source: Their legislation
$174 billion
Stark
$104 billion
Source: HHS estimates
McDermott/Wellstone
Source: HHS estimates
$208-$275 billion
Note:
I would concentrate on comparing ours to Chafee, Cooper, and Gramm plans. The singlepayer don't present their numbers in terms of Medicaid/Medicare savings since Medicare and
Medicaid will no longer exist.
Attached is the following documentation:
1) HHS estimates of the cost of alternative proposals
2) two pages from the Gramm/McCain legislation
3) Democratic Policy Committee comparison of the different plans
4) Cooper stuff
�ESTIMATED
IMPACT
OF VARIOUS
ON MEDICARE
(Note:
HEALTH
AND
CARE
M_S
PROPOSALS
Hill Proposals Have not Beta Officially
Admuufttratvoti
Proposal
Ctofoe
Proposal
\
MEDICAID
Costod
Git)
xMcDciutt ' \
Impact
,
[
Proposal
J
McDerawtt
Proposal
Scenario 2
Start
Proposal
$274.9 W»on
$104.0 bfflion
Medicare & Medicaid Savings
$ i ? 3 j j i i m o i i _ -$207^bilU0»v
199^2000
$2303 bHHon
Medicare Savings
1996 2000
$116.3 billion*
$119.3 billion
$127 9binion
^$148>t>H»on-
$104.0 Union
Medicaid Savings
1996 2000
$114 0 billion
$74 3 billion
$79 9 billion
$126 1 billion
N/A
1996 2000
6 7%
7 4%
76%
6 6%
8 4%
Average Annual Growth
Medicare
1996 2<XX)
7 4%
7 0%
7 2%
6 6%
6.5%
Average Arm ual Growth
Medicaid
1996 21JU0
5 6%
8.1%
8 3%
6 6%
11.3%
Growth Rate in the year 2000
Medicare A Medicaid
7 8%
7.0%
8 2%
6 4%
8.1%
Growth Rate m the year 2000
\
Medicare
9.2%
6.9%
8 1%
6 4%
6.0%
GnWth Rate in the year 2000
Medicaid
5.5%
7.2%
84%
64%
11.1%
Average Annual Growth
Medicare A Medicaid
|
Dons not include $8.1 billion revenue proposal requiring Slate and Local Employees lo pay HI lax. Including Ihis
±
�ia- U - 93
u cn • .
ct.t»« u/Auld chen be given theflexibilityto insutme the
and the nik classes they fall imo. Sutes ^
^ ^
by the increase
reforms outlined in section vm. The payment to states womo uro
ir. ihs medical price inflation index.
u
d
m
0
e a c h
y c a r
pavings
(in billions of S)
1994
1995
1996
1991
1998
"999
TOTAL
$74
$13.8
$198
$26 3
$33.5
r..a.
$100 7
Medicaid
Savings from
Capitation and
State
Flexibility
Second, with the introduction of pnce compeuuon in health ^ Ojrough
cho^e conta:ned in sectons 0 and m the airrent ^ ^ ^ J
^ „ %™7ov five
inflttion index and the consumer price index u projected to decrease oy one-hmi over
years The resulting Medicaid savings are as follows
3
0
c
W
Savinga
(in billions of $)
1994
Medicaid
Savings from
Lower Medical
Inflation
1995
1996
1997
1998
1999
TOTAL
$3
$9
$2.0
$3 8
n.a.
$7
T^rd with the mtrocuction of a high-risk individual subsidy and a universal tax exclusion.
m ^ ' M e l ^ d r^ents will be bought under private plans. The resulting savings are as
follows:
Suing*
(in billions of $)
1994
Transfer out of
Medicaid to
Private
Insurance
1995
$6
1996
$1 3
Page 7
1997
$1 4
1998
$1 5
1999
n.a
TOTAL
$48
�B) MEDICARE
;
The ntroducaon of price competiuon in health care generated by the reforms in aecucns II and
vm'is assumed to cut the current difference between the rate of growth in Medicare and the
medical pnce index in half over five years With ths change, we assume savings of only naif
of the Medicare savings assumed by the ?resdem
;
Savingii
(ir. billions of S)
Medicare
Savings
1994
1995
$3.5
$7 5
$11
1997
1993
1999
TOTAL
$16.5
$23
n.a.'
$61.5
C) OTHER OFFSETS
With creation of die nsk pool coverage and universal access to catastrophic health care
coverage, the use of the present deduction of health care costs in excess of 7.5% of income
will drop dramaticail;- This estimate assumes a total reduction of 50%.
Savings
(in billions of $)
Less Use of
Medical
Deduction
199';
1995
1996
1997
1998
1999
TOTAL
$2.8
$2.9
$3 1
S3 3
$3 6
n.a."
$15 7
TOTAL SAVINGS (in billions of $)
1994
1995
1996
1997
1998
1999
TOTAL
$13 7
$15 I
$36.1
$49.5
$65 3
n.a.*
$189.7
S4S.S Billion
Deficit Reduction
* "p..a." refers to not applicable Savings in the sixth year are not applicable because the first five
years of achieved savings will be used to fund benefits paid in each of the following years.
Cost and savings esuma:es and assistance provided by the National Center for Policy Analysis
using the NCPA/Piscal Associates Health Care Model, stauc estimates
Page 6
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A M
mCONG
M I K E
A N D R E W S
HJL 59M, MANAGED COM?ETmON ACT OF 1992 51
TABLE 7.
ESTIMATED BUDGETARY EFFECTS OF RR. 5936
(Byfiscalyear, in bULionj of dollan)
1995
1996
1997
1998
1999
2000
131
141
149
158
171
Outlay*
Low-Income AMlsiance
For people in poverty
95
For people with Income between 100
percent and 200 percent of poverty .1
Subtotal
99 .
Repeal of Medicaid
Assistince for Long-Term Care
Authorizations of Appropriations^
Total, Outlays
141
-2
152
12
Ji
163
175
JI
190
J2
-75
1
-1
•113
1
•126
1
_a
-a
-142
a
-1
•160
0
_i
-179
0
_l
25
30
27
22
15
11
10
15
17
18
19
20
-3
•10
-11
-11
•12
-12
•1
-2
-2
-2
•2
-3
•1
•1
-1
•2
-2
-3
_2
_7
8
10
10
-a
u
11
22
17
12
5
•1
Revenues
Income and Payroll Taxes
on Additional Income
Deduction of Employee Share
of Health Insurance Premiums
Deduction of Health Insurance
for the Self-Employed
Tax Deductions for the
Previously Uninsured
Repeal of Limit on Earninp
Subject to Medicare Tax
Total, Revenues
11
-i
Dcfldt
Total Effect of RR.S936
14
SOURCE! Cowyduuil B<idf«! Oder Joint Coaaluec oa TacKioo.
i.
Loa than SSOO afflloa.
b.
Th««<aant««ouldoo(»«eouAUdforpty^yeu-io teeriai tutdor iho Btidt«i Bnfertiaam Act.
�1 I\^-u>< 0 ^ - I \ j . r i .
JRESS/ ARMEY,
/
x
i\iiiir^i\i.'^
COOPER, STARK
PAGE 6 10/31/93<
x x Indeed. <
MR. BRODER:
Are you j u s t abandoning t h a t now?<
REP. STARK: No, indeed n o t . Last year Dick Gephardt and I p u t
i l l t o g e t h e r . We c o u l d n ' t g e t t h e managed c o m p e t i t i o n people t o n e g o t i a t e
Tth us, b u t I w i l l support any b i l l t h a t w i l l g e t t o t h e p r e s i d e n t ' s g o a l s .
Our committee i s g o i n g t o have t o work on r a i s i n g t h e money f o r most any b i l l
and we may have o t h e r p a r t s o f t h e b i l l . And I t h i n k t h a t t h e r e ' s no one b i l l
now t h a t c o u l d pass. Nobody has 100 v o t e s . And so we're g o i n g t o have t o take
pieces o f each b i l l and p u t them t o g e t h e r t o g e t c o s t containment and
u n i v e r s a l coverage and f i g u r e o u t how t h e American people w i l l agree t o pay
f o r t h i s . I t ' s g o i n g t o be tough.<
<
MR. BRODER: As an e x p e r t i n t h i s whose committee has t o pay
the b i l l , a r e you convinced t h a t t h e p r e s i d e n t ' s p l a n does now l e g i t i m a t e l y
f i n a n c e what he i s p r o p o s i n g t o g i v e t h e American people?<
<
REP. STARK: I n s o f a r as anybody knows, and we w i l l n o t know
t h a t u n t i l CBO has t h e numbers. A l l these o t h e r numbers a r e i r r e l e v a n t . CBO
numbers a r e t h e ones t h a t a l l t h r e e o f us have t o march to.<
<
MR. BRODER: Could I ask Armey and Cooper j u s t t o comment on
the f i n a n c i n g o f t h e p r e s i d e n t ' s plan? Does i t add up? You're an economist --<
<
REP. ARMEY: No, i t hasn't added up. Nobody b e l i e v e s i t adds
up. Q u i t e f r a n k l y , even t h e Democrat chairman o f t h e Senate Finance Committee
s a i d t h e y were f a n t a s y numbers. The f a c t o f t h e m a t t e r i s t h a t we have a
b a s i c process by t h e White House, p u t t o g e t h e r a happy t a l k t h i n g , and then
l e t t h e hard core numbers t r i c k l e o u t over time.<
REP. COOPER: David, we're w o r r i e d t h e p r e s i d e n t ' s p l a n assumes
$124 b i l l i o n i n Medicare c u t s t h a t w i l l s i m p l y n o t be enacted by Congress and
p r o b a b l y s h o u l d n ' t be enacted by Congress. So t h a t ' s a r e a l f l a w i n t h e
president's plan, a t least at t h i s point.<
<
MR. RUSSERT:
Your p l a n assumes how much i n cuts?<
<
REP. COOPER: W e l l , see, o u r p l a n i s a l o t more a f f o r d a b l e .
Ours c o s t s about 25 --<
<
MR. RUSSERT:
But you assume -- how much do you --<
<
REP. COOPER: About $40 b i l l i o n over f i v e years as opposed t o
the p r e s i d e n t ' s $124 b i l l i o n over f i v e years --<
.ETX<
MEET THE PRESS/ARMEY,COOPER,STARK
.STX<
PAGE 7 10/31/93<
MR. RUSSERT: Congressman S t a r k r a i s e d t h e CBO, t h e
Congressional Budget O f f i c e . . T h e y say, Congressman, your p l a n w i l l c r e a t e -c o n t r i b u t e $70 b i l l i o n over f i v e years t o t h e d e f i c i t , and t h a t 22 m i l l i o n
Americans w i l l be u n i n s u r e d . Do you b e l i e v e every American has a fundamental
r i g h t t o h e a l t h care?<
<
�3UDGET
Horn Budget Amendment Would Cut $361 B i l l i o n ...
Freshman Rep. Stephen Horn, R - C a l i f . , has j o i n e d a growing
—
l i s t o f would-be budget c u t t e r s by p r o p o s i n g an amendment
r e q u i r i n g a c r o s s - t h e - b o a r d spending c u t s of 1.65 p e r c e n t i n a l l
but seven f e d e r a l programs i n FY94 and i n each of the next seven
f i s c a l years. A summary of Horn's amendment r e l e a s e d by h i s
o f f i c e c l a i m s i t would save $361 b i l l i o n over f i v e years and $798
b i l l i o n over the seven f i s c a l years t h r o u g h FY2000. C u t t i n g 1.65
percent each year from the p r i o r year's spending would balance
the budget by the year 2000, Horn claimed. Medicare, S o c i a l
S e c u r i t y , m i l i t a r y and v e t e r a n s pensions, c i v i l s e r v i c e
r e t i r e m e n t , Head S t a r t and i n t e r e s t on the n a t i o n a l debt would be
exempt from c u t s under the p l a n .
Horn hopes t o o f f e r the p l a n Nov. 20, the same time Reps. Tim
Penny, D-Minn., and John Kasich, R-Ohio, o f f e r t h e i r $103 b i l l i o n
b u d g e t - c u t t i n g amendment t o a much s m a l l e r a d m i n i s t r a t i o n proposed c u t s package. A group headed by Reps. Barney Frank, DMass., Jolene Unsoeld, D-Wash., and C h r i s t o p h e r Shays, R-Conn.,
t h i s week u n v e i l e d a $22 b i l l i o n , f i v e - y e a r b u d g e t - c u t t i n g p l a n
t h a t slashes f i v e programs, i n c l u d i n g the space s t a t i o n and "Star
Wars."
To h e l p p r o t e c t s m a l l e r f e d e r a l programs from a b s o r b i n g the
same s i z e c u t as l a r g e r programs, Horn's amendment g i v e s the
p r e s i d e n t the f l e x i b i l i t y t o i d e n t i f y programs and exempt them
from a l l o r p a r t o f the 1.65 p e r c e n t annual c u t . But i f he does
so, he has t o c u t o t h e r programs by an equal amount. " I n no case
can the p r e s i d e n t cut more than 4 p e r c e n t of a program beyond t h e
new, lower l e v e l , " s a i d the Horn amendment summary. "Also, no
more than 30 p e r c e n t o f the aggregate d o l l a r r e d u c t i o n s made by
the p r e s i d e n t may come from any one program, thus c r e a t i n g a
f i r e w a l l t o a v o i d r a i d i n g any one account."
The Congress D a i l y
Friday
November 12, 1993
,
.
/\f\ij^\( f\{\j~v
/
�^ W i l l GOP Doom Penny-Kasich? I f t h e $103 b i l l i o n budget c u t t i n g
amendment spearheaded by Reps. Tim Penny, D-Minn., and John
' Kasich, R-Ohio, f a i l s t o pass i n a scheduled House f l o o r v o t e
Nov. 20, freshman Republicans may be p a r t l y t o blame. Rather t h a n
l i n i n g up b e h i n d t h e Penny-Kasich p l a n , "maybe h a l f " o f t h e 48member GOP freshman c l a s s 'is b a c k i n g a l e s s s p e c i f i c , $361
b i l l i o n f i v e - y e a r , a c r o s s - t h e - b o a r d b u d g e t - c u t t i n g amendment
c r a f t e d by freshman Rep. Steve Horn, R - C a l i f . , a House GOP source
s a i d . "The problem w i t h these freshman Republicans i s t h e y want
t o c u t something out b u t t h e y don't want t o be accountable f o r
a n y t h i n g , " the GOP source s a i d . "They don't want t o p r o v i d e any
s p e c i f i c s . " The danger, s a i d the GOP source -- who backs t h e
Penny-Kasich p l a n -- i s t h a t " i f t h e Republican freshmen don't
s t i c k t o g e t h e r and pass something, then, i n e f f e c t , t h e y j o i n t h e
[Democratic Penny-Kasich] opponents and the end r e s u l t w i l l be no
cuts a t a l l . "
I f a l l 175 House Republicans backed Penny-Kasich, t h e
amendment would o n l y need 43 Democratic v o t e s t o reach a m a j o r i t y
of 218 -- and t h a t g o a l appears t o be r e a c h a b l e . But i f a couple
dozen House Republicans l i n e up behind Horn's amendment i n s t e a d ,
the p r o s p e c t s f o r Penny-Kasich p a s s i n g dim.
Why would GOP freshmen -- t h e g r e a t m a j o r i t y o f whom a r e
w i d e l y b e l i e v e d t o be d e f i c i t hawks -- r e j e c t Penny-Kasich? I t ' s
simple, a House GOP source s a i d . Many o f t h e more p a r t i s a n GOP
freshmen don't want t o h e l p p r o v i d e p o l i t i c a l cover t o Democrats
who v o t e d a few months ago f o r P r e s i d e n t C l i n t o n ' s huge d e f i c i t
r e d u c t i o n p l a n and t h e $250 b i l l i o n i n new taxes i t c o n t a i n e d .
Some freshman Republicans f e e l "the Democrats who v o t e d f o r t h e
C l i n t o n taxes a r e now g e t t i n g cover" i f t h e y v o t e f o r PennyKasich' s a d d i t i o n a l c u t s , t h e source s a i d . The source s a i d many
GOP freshmen t h i n k t h a t keeping Penny-Kasich from p a s s i n g would
help e l i m i n a t e t h a t p o l i t i c a l cover. But t h e Penny-Kasich backers
s-ee i t a n o t h e r way. "Penny guaranteed cover f o r a l l those people
the moment t h e speaker agreed t o t h e second v o t e [on a d d i t i o n a l
spending c u t s ] , " s a i d a source.
The Congress D a i l y
Friday
November 12, 1993
�A Note on Medicare and Medicaid
1.
2.
Medicare - Medicare w i l l be l a r g e l y u n a f f e c t e d by h e a l t h
care reform. The only changes are:
•
There w i l l be cuts of about $124
•
Employers w i l l pay f o r Medicare people who are working
("Medicare o f f s e t " ) .
Medicaid
•
-
billion.
Medicaid w i l l be changed more s u b s t a n t i a l l y .
Where the people go:
Noncash
Medically Needy*
Pregnant Women**
Children**
Off
Medcaid
Cash
AFDC r e c i p i e n t s
SSI r e c i p i e n t s
On Medicaid; choose
A l l i a n c e plans
Elderly
Nursing Home***
Unaffected
* People who are on Medicaid because they have h i g h
medical b i l l s and are thus poor when income net of
medical b i l l s i s considered.
** Congressional action over the 1980s expanded
e l i g i b i l i t y f o r Medicaid t o pregnant women and c h i l d r e n
who are not r e c e i v i n g cash assistance. There w i l l be
some "wrap around" services t o disabled c h i l d r e n who
would otherwise lose r e h a b i l i t a t i o n s e r v i c e s because
they are not covered i n the plan.
*** E l d e r l y people who "spend down" w h i l e i n a n u r s i n g
home.
Remaining cash r e c i p i e n t s
These people w i l l be " i n the A l l i a n c e " . They w i l l
choose plans l i k e everybody else, and Medicaid w i l l
c o n t r i b u t e i t s current payment f o r them. Medicaid
b e n e f i t s f o r two reasons: ( i ) the slower growth r a t e of
costs i n the A l l i a n c e ; and ( i i ) some of t h e payments
f o r these people are c u r r e n t l y t o pay f o r the uninsured
(Disproportionate Share Payments = DSH), which w i l l be
eliminated [ t h i s i s e f f e c t i v e l y j u s t a lower p e r - c a p i t a
payment over t i m e ] .
�(§1
MEDICARE BENEFIT OUTLAYS*
Growth With and Without President's Health Reform
(Effect of $123.4 Billion Savings Package Only)
Dollars in Billions
-14.7%,
$260
-13.0%/
$240
Without Reform
a.
33
W
a.
$220
-10.0%-
33
33
-7.0%
$200
.
.i
With Reform
CM
O
I-
-4.8%
$180
$160
-1.6%
.
Average Annual Growth (1995-2000}:
Without Reform = 1 1 . 1 %
With Reform = 8 . 0 %
$140
1994
i
i
1995
1996
1997
Fiscal Year
• Net of Offsetting Receipts
IDOM Not Inclode Effect of State Employes Revenue Proposal}
i
i
1998
1999
2000
�MEDICARE BENEFIT OUTLAYS*
Growth With and Without President's Health Reform
(Effect of Savings, Drug Benefit, and Worker Offset]
Dollars in Billions
$260 $240 -
$140
1994
1995
1996
1997
Fiscal Year
Nat of Offsetting Receipts
(Does Not Include Effect of State Employee Revenue Proposal!
1998
1999
2000
11/3/83
�fsf CM.
ro
MEDICAID BENEFIT OUTLAYS*
Oi
Growth Before and After President's Health Reform
CD
Dollars In Billions
ro
o
ro
^1
CJ
ro
33
BS
CO
>
cn
TJ
CU
\
93
"13
Average Annual Growth (1996-2000):
- Before Reform = 12; 5%
After Reform = 7.8%
$85
1994
1995
1996
J
i
i
1997
Fiscal Year
1998
1999
2000
* Based on 10/23 detailed table. Does not include administrative savings.
IS
O
o
�To:
Fr:
Re:
Gene
Christine
Medicare/Medicaid savings in other plans (5 year numbers)
Medicare/Medicaid savings
1996-2000
1
Chafee/Dole
$193 .6 billion
Cooper
S 40 billion
($70 billion added to deficit)
Gramm/McCain
$189.7 billion
($45.5 b to deficit reduction)
Stark*
$104 billion
(see attached back-up)
McDermott/Wellstone*
$208 - 275 billion
2
3
* both of these are savings calculations based on the budgeted growth rates for the whole
health care system under these bills, versus projected growth in these programs. The
single-payer people get upset, however, when we refer to their plans as cutting projected
spending from programs that would no longer exist under reform.
1
See attached HHS analysis
2
As per Cooper on Meet the Press (documented in the transcript)
3
See attached pages from their plan
�ESTIMATED IMPACT OF VARIOUS HEALTH CARE PROPOSALS
ON MEDICARE
AND MEDICAID
J i ^
(Note: H i l l Proposals Have not Beat OffidaUy Costed Out) ^
Impact
^
t
/
/^cDennotl
\
McDermott
Propoul
)
Propoul
^ J -
Scenario!
Stark
Propoul
$274^11100
$104.0 billion
$148>ttWon-
$104.0 billion
$79.9 billion
$126.1 billion
N/A
7 4%
7.6%
6.6%
8.4%
7.4%
7.0%
7 2%
6.6%
6.5%
5.6%
8.1%
8.3%
6.6%
11.3%
7.8%
7.0%
8.2%
6.4%
8.1%
9.2%
69%
8.1%
6.4%
6.0%
5.5%
7
8.4%
6.4%
11.1%
Administration
Chafee
j
Proposal
Proposal
$230.3 billion
$193.6 btllkm
$207.8 biUion
$116.3 billion-
$119.3 billion
$127.9 billion
S i 14 o billion
$74.3 billion
6.7%
Medicare & Medicaid Savings
1996-2000
Medicare Savings
1996-2000
X
Medicaid Savings
1996 2000
Average Annual Growth
Medicare &. Medicaid
1996 2000
Average Annual Growth
Medicare
1996-2000
Average Annual Growth
Medicaid
1996-2000
Growth Rate in the year 2000
Medicare & Medicaid
Growth Rate in the year 2000
\
Medicare
1
Growth Rate in the year 2000
Medicaid
nnos not include $8.1 billion revenue proposal requiring Slate and Local Employees to pay HI lax. Including this
S
-
^
�i o : 02
and the risk classes they fall into. States would then be given the flexibility to insutme the
reforms outlined in section vm. The payment to states would grow each year by the increase
ir: the medical price inflation index
Savings
(in billions of $)
Medicaid
Savings from
Capitation and
State
Flexibility
1994
1995
1996
1997
1998
1999
TOTAL
$7.4
$13.6
SI9.8
$26 3
$33.5
n.a."
$100 7
Second, with the introduction of price competition in health care through expanded consumer
choice contained in sections n and Vm, the current differential between the medical price
inflation index and the consumer price index is projected to decrease by one-hau over five
years. The resulting Medicaid savings are as follows
(in billions of $)
1994
Medicaid
Savings from
Lower Medical
Inflation
1995
1996
1997
1998
1999
TOTAL
$3
$.9
$2.0
$3.8
n.a*
$7
Third, with the introduction of a high-risk individual subsidy and a universal tax exclusion,
many Medicaid recipients will be brought under private plans. The resulting savings are as
follows:
Samoa
(in billions of $)
1994
Transfer out of
Medicaid :o
Private
Insurance
1995
$.6
1996
$1 3
Page 7
199?
1998
1999
$1 4
$15
n.a/
TOTAL
$4.8
�19/14, SI
IS: 22
NO.355
MEDICARE
The introduction of price competition in health care generated by the reforms in sections II and
Vm is assumed to cut the current difference between the rate of growth in Medicare and the
medical pnce index in half overfiveyears. With this change, we assume savings of only half
of the Medicare savings assumed by the President
Savings
(in billions of S)
Medicare
Savings
1994
1995
1996
1997
1993
1999
TOTAL
$3.5
$7.5
$11
$16.5
$23
n.a.'
$61.5
C) OTHER OFFSETS
With creation of the nsk pool coverage and universal access to catastrophic health care
coverage, the use of the present deduction of health care costs in excess of 7.5% of income
will drop dramatically This estimate assumes a total reduction of 50%.
Savings
(in billions of $)
Less Use of
Medical
Deduction
1994
1995
1996
1997
1998
1999
TOTAL
$2 8
$2.9
$3 1
$3 3
$3 6
n.a.«
$15.7
TOTAL
fOTAL SAVINGS (in billions of $)
1994
1995
1996
199:
1998
1999
$13.7
$25.1
$36.1
$49.5
$65 3
n.a.
$189.7
$45.5 Billion
Deflcit Reduction
* "n.a." refers to not applicable. Savings in the sixth year are not applicable because the first five
years of achieved savings will be used to fund benefits paid in each of the following years.
Cost and savings estimates and assistance provided by the National Center for Policy Analysis
using the NCPATiscal Associates Health Care Modei, static estimates
Page 8
Si I
�SPECIFIC MEDICARE SAVINGS
i: What are the s p e c i f i c Medicare savings proposals?
Ansvey:
• There are a large number of proposed changes to the
Medicare program that w i l l reduce the rate of growth i n
Medicare expenditures. Some of the changes are l i s t e d
below.
• reduce the hospital market basket update
• reduce payments for hospital inpatient c a p i t a l
• phase down the Disproportionate Share Hospital
adjustment by 1998
• reduce Indirect Medical Education adjustment
• establish cumulative expenditure goals for physician
expenditures
- 78 -
�Other Medicare Cost Savings
• expand centers of excellence
• use r e a l GDP to adjust for volume and intensity
• extend freeze on updates to routine service costs fo
s k i l l e d nursing f a c i l i t i e s
• reduce the Medicare fee schedule conversion factor for
1995
• impose limitations on payment for physicians' services
furnished by high-cost hospital medical s t a f f s
• use Medicare incentives for physicians to provide primary
care
• eliminate formula-driven overpayments for certain
outpatient hospital services
• contract competitively for a l l Part B laboratory services,
except in r u r a l areas
• competitively bid other Medicare Part B services
• extend the Medicare Secondary Payor data match with
and IRS
SSA
• e s t a b l i s h a threshold of 20 employees for Medicare
Secondary Payor for the disabled
• extend Medicare Secondary Payor provisions for ESRD
patients
• improve HMO
payment
• require a 10% coinsurance on certain home health v i s i t s
• e s t a b l i s h a 20% coinsurance
for laboratory services
• set Part B premium into law
- 79 -
�Medicare Cuts Backed to Fund Health Plan
Trimming $124 Billion OveyFive Years Would Not Put Elderly at Risk, Ptinel Is Told
liorate rather than worsen" the problem of
doctors avoiding Medicare patients, he said.
Reps. Thomas J. Wiley Jr. (R-Va.) and J.
Medicare administrator Bruce
Alex McMillan (R-N.C) questioned the accutestified yesterday that the Medicare program racy of the Medicare savings projecUons in
can be cut $124 billion overfiveyearstohelp view of past errors in estimating the cost of
finance President Clinton's health plan without various health proposals by the Congressional
"putting Medicare beneficiaries at risk."
Budget Office and others.
The cuts, mainly in payments to hospitals
Vladeck said the estimates relating to Mediand doctors, "will only reduce the growth in care had been done by the office of Medicare
Medicare spending from triple the inflation
rate to double " he told a House Energy and
Commerce subcommittee.
"In the context of a plan that will bring
down private-sector costs, we can achieve
Medicare savings without shifting costs or
endangering beneficiaries' access to services,"
Vbdeck said as he provided Congress with a
detailed list of the proposed cuts for the first
time.
actuary Roland E. "Guy" King, who is,"very
"I am disturbed by the magnitude of these conservative in his estimates."
cuts," said Rep. Henry A. Waxman (D-Calif.).
Bliley called the Clinton plan a "guarantee for
chairman of the subcommittee on health and insolvency." He said it could vastly increase the
: the environment. 1 believe they are excessive use of health care while limiting what the govand could adversely affect the quality and ernment and various insurers have to pay.
availability of services for beneficiaries."
The American Medical Association said the
Watrtttiraakf that Medicare already pays proposed Medicare cuts reflect "cynicism about
doctors 30 percent less than private-sector physicians as 'deep pockets' from which either
insurers pay and asked who will treat Medi- reduction in the deficit or health system reform
tcare patients if payment rates are cut even can be funded."
tnore?
The American Hospital Association said,
\ "That's why we want to do it only in tan- "Faced with Medicare cuts of the size proposed
dem" with controls over the growth of costs in by President Clinton," on top of the $56 billion
the private sector, Vladeck said. In that way over five years just voted as part of the budget
the differential between Medicare and private bill, hospitals "might have to reduce their work
fees will "shrink" instead of grow, and "ame- forces, reduce services or both."
By Spencer Rich
By far tlie biggest Medicare cuts in the $124
billion package come from hospitals. The administration proposes to: reduce annual hospital
payment increases ($18 billion); reduce special
bonuses for the training of interns and residents
($17.8 biltkm); reduce Medicare payments to
cover hospitals' capital expenditures ($10.3 billion); change the payment formula for outpatient
services to eliminate an overpayment in the current formula ($12.6 billioafc and phase down
special payments to hospitals with a disproportionate share of low-income and uninsured patients ($14.6 billion). Vladeck said the latter will
be needed less as the Clinton health plan covers
all people now uninsured, so that insurance pays
their hospital bills.
Doctors also would face cuts in Medicare payment levels; patients would have to pay more,
including copayments for home health services
and clinical lab services and a higher premium if
they have incomes over $90,000 ($115,000 for
couples).
As Vladeck was testifying. Sen. Don Nickles
(R-Okla.) and 23 other senators announced a
proposal to provide refundable tax credits—in
effect, vouchers—to help Americans buy health
insurance policies, with eased rules to prevent
exclusions. The credits would be financed by
eliminating employer deductions for health insuraaoe costs and by $141 billion in cuts in
tfcdfcffe aad Medicaid over the next five years.
Akio ynterday, congressional aides said the
presideot's Health Security Act, which Clinton
announced in a speech in September and "relaunched" three weeks ago, will be introduced
formally "within days."
The biggest reductions in
the package would come
from hospitals.
�MEDC
IARE TO STOP
PUSHING PATIENTS
TO ENTER ma's
GREATER COSTS ARE SEEN
In Discovery With Bearing on
Health Plan, Study Finds
Flaw in Setting Payment
By ROBERT PEAR
Special loThc New York Timei
WASHINGTON, Dec. 26 - In a significant policy change, Clinton Administration officials say they will not prod
elderly Medicare patients to join health
maintenance organizations, In part because they have discovered that the
Government loses money on people
enrolled in such private health plans.
Bruce C. Vladeck, head of the Federal Health Care Financing Administration, which runs Medicare, said he
would not aggressively promote
H.M.O.'s for beneficiaries until he
could guarantee consistent high-quality care and had a better way of paying
for il.
"Our payment methodology is so
primitive that it doesn't save money,"
Mr. Vladeck said in an interview. "We
are losing money on H.M.O. patients.
Before we undertake aggressive promotion of H.M.O.'s for Medicare beneficiaries, we have io make progress on
both issues: payment methodology and
quality assurance."
The Problem With H.M.O.'s
In the Reagan and Bush Administrations, Medicare officials insisted that
H.M.O.'s would both raise the quality of
care for elderly people, by coordinating
services, and save money for the Government.
But a new study by Mathematica
Policy Research, a private consulting
concern, said the Government paid 5.7
percent more for Medicare patients in
H.M.O.'s than it would have paid If
those people had been in the regular
Medicare program. Medicare "is not
achieving its goal to save money"
through H.M.O.'s, said the study, done
under contraci to the Government.
The problem, essentially, is this:
while Medicare paid the H.M.O.'s a
per-capita fee close to the cost of services used by the average Medicare
beneficiary, the patients who enrolled
in the H.M.O.'s tended to be healthier
than the average, meaning that they
would probably have used fewer services anyway.
The report does not discuss President Clinton's plan to remake the nation's health care system, which seeks
to hold down health spending by Inducing large numbers of consumers to
enroll in H.M.O.'s and other forms of
managed care But the findings suggest that it may be difficult to achieve
the large savings that his plan enviContinued on Page A}4, Column 4
ConUmted From Page Al
deemed to have a high risk of costly
illness. Medicare covers everyone entitled to benefits,regardlessof illness or
skms.
"HMO's reduce utilization and disability, and one of Mr. Clinton's major goals in his health plan is to end the
4on1 seem to cut the quality of care," widespread
practice of discrimination
•aid Randall S. Brown, chief author of against sick people by private insurers.
the Mathematica study. "But if you
Under Federal law. Medicare benefiwant to reap any savings, you better ciaries still have the option of joining
set the payments right"
H.M.O.'s, and the Government is not
Under Mr. Clinton's plan, organiza- discouraging this option. Indeed, Meditions known as regional alliances care officials say beneficiaries may get
would buy coverage for large numbers excellent care from some H.M.O.'s. But
of people in a particular area. Just as elderly people have beenreluctantto
the Government has not found a reli- join. Fewer than 2.5 million of the 36
able way of adjusting its payments to million Medicare beneficiaries are in
H.M.O.'s toreflectthe expected health H.M.O.'s, and Mr. Vladeck said the
needs of Medicare beneficiaries, so the Government would not "actively realliances may have difficulty adjusting cruit elderly folks" for such plans at
their payments to networks of insurers, this time.
doctors and hospitals to reflect the
Disclosure of the Mathematica study
needs of alliance members.
comes two months after the General
Proponents of an alternative to the Accounting Office, an investigative
President's plan argue that instead of arm of Congress, said there was "little
seeking elusive savings through managed care, all Americans should be
lumped into a Government-run "single
payer" plan like the one in Canada.
But Administration officials argue
that the nation is not yet ready for a
health care system financed entirely
by taxes — or the tax increases such a
system would require — and that the
market forces that would be unleashed
by the President's plan would succeed
in holding down costs.
Health maintenance organizations
normally charge a flat sum, fixed in empirical evidence" of savings from
advance, for each member, regardlessH.M.O.'s and other forms of managed
of how much care the person uses. By care used by employers for their workcontrast, under traditional fee-for- ers. Two trade groups that represent
service arrangements, which most H.M.O.'s, the Group Health Association
Medicare beneficiaries use, doctors of America and the American Manare paid separately for each service or aged Care and Review Association, disprocedure. Many health policy experts pute those findings. They say that presay these arrangements give doctors a paid group plans achieve substantia)
financial incentive to perform extra savings.
services.
There is some evidence that people
The four-year Mathematica study under 65 behave like people 65 and
said that the Medicare payment rates over. The data are open to different
to the H.M.O.'s did not fully reflect the interpretations, but Mr. Brown of
makeup of the people who chose to Mathematica said, "Some employers
enroll. Had these people obtained their have found that younger, healthier
care through fee-for-service, the Gov- workers are more likely to choose
ernment would have paid less than it H.M.O.'s than older, sicker workers."
Medicare patients with a history of
paid the H.M.O.'s.
After more than a decade of experi- cancer, heart disease and stroke are
ence with H.M.O.'s in the Medicare less likely to join H.M.O.'s, apparently
program, the study said, the Govern- because they want complete freedom
ment has not found a completely satis- to consult doctors they have used in the
factory way of adjusting payments to past, the study said.
The Government's primary goal in
reflect the health status and medical
needs of the people who join a particu- establishing the H.M.O. program for
lar plan. Under Mr. Clinton's proposal, Medicare beneficiaries was to save
the Government would devise a formu- money for the Government while exla to make such adjustments, but actu- J
aries and other experts say this will not ]
be easy, and many H.M.O.'s complain
that Medicare payments are already
too low.
The study said that H.M.O.'s ap
peared to reduce the intensity and f re
quency of medical services used, espe
cially hospital stays, without harming
the quality of care. But it found that
Medicare paid an average of $413 a
month for each person in an H.M.O., or
J22 more than it would have paid for
the same person in the regular Medicare program, even taking into account
the additional services that that patient
would presumably have used in a fee
for-service arrangement
H.M.O.'s provide Medicare beneficiaries with all the services covered
under the standard Medicare program
and may offer additional benefits like
preventive care or prescription drugs,
at little or no additional cost.
The Government does not approach
Medicare with the actuarial sophistication of private insurance companies,
which ofteh refuse to cover people
A hard look at
H.M.O.'s topples
a long-held hope
for cutting costs.
�panding choices for pa tier cs. By design, the program should lower Federal costs 5 percent because, under a
statutory formula, the Government
pays health maintenance organizations
95 percent of the average per capita
cost for people enrolled in the regular
Medicare program.
But the Mathematica study said the
people in H.M.O.'s were so healthy that
the Government would have spent even
less — about 90 percent of the average
per capita cost — if they had been in
the regular Medicare program.
"Thus," the study said, "rather than
saving 5 percent as intended, the
Health Care Financing Administration
spends 5.7 more" when Medicare beneficiaries get their care through
H.M.O.'s.
Mr. Vladeck was deeply involved in
developing President Clinton's proposal to control health costs and guarantee coverage for all Americans. Before he took office in May,"Mr. Vladeck '
was president of the United Hospital
Fund of New York, a philanthropy that
does health services research.
•We Are Not Ready'
"The Bush Administration invested
heavily in the marketing of H.M.O's,"
Mr. Vladeck said. "We are not ready to
do that. 1 don't want to get into a big
marketing campaign until we can tell
beneficiaries that" quality is really
good, that every H.M.O. is doing a good
job by our beneficiaries.
"We're trying to get past the idea
that managed care is good or evil," Mr.
Vladeck said. "The question is: How do
we tell the good from the bad, and
eliminate the bad?"
Mr. Vladeck said he wanted to encourage new hybrid forms of managed
care that would attract elderly people.
"H.M.O.'s earned their spurs taking
care ol young employed populations,'*
he observed. "They do a lot of maternity care and pediatrics." But to serve
Medicare beneficiaries, he said, "they
need to enlist more orthopedists, cardiac surgeons, ophthalmologists, urologists and oncologists."
Gail R Wilensky, head of the Health
Care Financing Administration wider
President George Bush, said that increasing Medicare enrollment
in
H.M.O.'s had been a major goal for her
and her predecessor, Dr. William L.
Roper.
"The quality and coordination of
care can be much better in managed
care than when services are provided a
la cane, on a fee-for-service basis,"
she said.
2
A
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Medicare Cuts (and Deficit)
Creator
An entity primarily responsible for making the resource
Task Force on National Health Care
White House Health Care Task Force
Paul Jamieson
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 23
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12093080" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Preservation-Reproduction-Reference
Date Created
Date of creation of the resource.
2/6/2015
Source
A related resource from which the described resource is derived
42-t-12093080-20060885F-Seg2-023-006-2015
12093080