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Withdrawal/Redaction Sheet Clinton Library DOCUMENT NO. SUBJECT/TITLE DATE RESTRICTION AND TYPE 001. memo Maria Echaveste to Distribution re: First Lady's Box (3 pages) 01/12/1998 b(6) COLLECTION: Clinton Presidential Records First Lady's Office Melanne Verveer OA/Box Number: 20023 FOLDER TITLE: Budget '99 [2] 2013-0534-S rc1690 RESTRICTION CODES Presidential Records Act - [44 U.S.C. 2204(a)] Freedom of Information Act - [5 U.S.C. 552(b)] P1 National Security Classified Information [(a)(1) of the PRA] b(1) National security classified information [(b)(1) of the FOIA] P2 Relating to the appointment to Federal office [(a)(2) of the PRA] b(2) Release would disclose internal personnel rules and practices of P3 Release would violate a Federal statute [(a)(3) of the PRA] an agency [(b)(2) of the FOIA] P4 Release would disclose trade secrets or confidential commercial or b(3) Release would violate a Federal statute [(b)(3) of the FOIA] financial information [(a)(4) of the PRA] b(4) Release would disclose trade secrets or confidential or financial P5 Release would disclose confidential advice between the President information [(b)(4) of the FOIA] and his advisors, or between such advisors [a)(5) of the PRA] b(6) Release would constitute a clearly unwarranted invasion of P6 Release would constitute a clearly unwarranted invasion of personal privacy [(b)(6) of the FOIA] personal privacy [(a)(6) of the PRA] b(7) Release would disclose information compiled for law enforcement purposes [(b)(7) of the FOIA] C. Closed in accordance with restrictions contained in donor's deed b(8) Release would disclose information concerning the regulation of of gift. financial institutions [(b)(8) of the FOIA] PRM. Personal record misfile defined in accordance with 44 U.S.C. b(9) Release would disclose geological or geophysical information 2201(3). concerning wells [(b)(9) of the FOIA] RR. Document will be reviewed upon request. Document NO. WHITE HOUSE STAFFING MEMORANDUM Date: 1/12 ACTION / CONCURRENCE / COMMENT DUE BY: ASAP Subject: First Lady's Box ACTION FYI ACTION FYI VICE PRESIDENT NASH PODESTA REED ECHAVESTE RUFF RICCHETTI SOSNIK LEW SPERLING BEGALA STEIN BERGER STERN BLUMENTHAL STREETT FRAMPTON TRAMONTANO IBARRA VERVEER KLAIN WALDMAN LANE YELLEN LEWIS LINDSEY LOCKHART MARSHALL MOORE REMARKS: Please advise- Comments to Maria or Chara Shin RESPONSE: Staff Secretary's Office staffing WPD 1/4/99 Ext. 62702 Withdrawal/Redaction Marker Clinton Library DOCUMENT NO. SUBJECT/TITLE DATE RESTRICTION AND TYPE 001. memo Maria Echaveste to Distribution re: First Lady's Box (3 pages) 01/12/1998 b(6) COLLECTION: Clinton Presidential Records First Lady's Office Melanne Verveer OA/Box Number: 20023 FOLDER TITLE: Budget '99 [2] 2013-0534-S rc1690 RESTRICTION CODES Presidential Records Act - - [44 U.S.C. 2204(a)] Freedom of Information Act [5 U.S.C. 552(b)] P1 National Security Classified Information [(a)(1) of the PRA] b(1) National security classified information [(b)(1) of the FOIA] P2 Relating to the appointment to Federal office [(a)(2) of the PRA] b(2) Release would disclose internal personnel rules and practices of P3 Release would violate a Federal statute [(a)(3) of the PRA] an agency [(b)(2) of the FOIA] P4 Release would disclose trade secrets or confidential commercial or b(3) Release would violate a Federal statute [(b)(3) of the FOIA] financial information [(a)(4) of the PRA] b(4) Release would disclose trade secrets or confidential or financial P5 Release would disclose confidential advice between the President information [(b)(4) of the FOIA] and his advisors, or between such advisors [a)(5) of the PRA] b(6) Release would constitute a clearly unwarranted invasion of P6 Release would constitute a clearly unwarranted invasion of personal privacy [(b)(6) of the FOIA] personal privacy [(a)(6) of the PRA] b(7) Release would disclose information compiled for law enforcement purposes [(b)(7) of the FOIA] C. Closed in accordance with restrictions contained in donor's deed b(8) Release would disclose information concerning the regulation of of gift. financial institutions [(b)(8) of the FOIA] PRM. Personal record misfile defined in accordance with 44 U.S.C. b(9) Release would disclose geological or geophysical information 2201(3). concerning wells [(b)(9) of the FOIA] RR. Document will be reviewed upon request. 501-0800 50/- Marsha Scott 01/15/99 12:40:55 PM Record Type: Record To: Shirley S. Sagawa/WHO/EOP CC: Subject: NEH building Please find out from Melanne if she has spoken to Bill Ferris at NEH about GSA wanting them to move in 2001. I know that she has spoken to Bill Ivey of NEA and he is willing to move. Bill Ferris feels VERY strongly about not moving and, instead, raising the money to preserve the building. There are all sorts of implications and issues involved with whatever is done. Dave Barram, Administrator of GSA, has spoken with Bill Ferris but wants to know where Melanne is on this issue and especially whether she has conveyed her sentiments to Bill Ferris. Please call me at 62109 or get back to me today if you can so I can get back to Dave. Dave and I plan to meet with Bill next week to try and get this settled in a way that everyone is comfortable. re: SOTU - \ think the ACorps sectur is too sell servin - "I forght L create Amen Cryss It: the they 1 an must proud 7 1 challenge Congren L supgret 1 think it should acknowledge bipartisen thin as it is was + is. Support that still creaked it, is about bringing problems people shundn't be together to ACmps solve community divisive 01/15/99 11:50 202 690 7595 HHS OFF OF SEC 001 HUMAN SERVICES THE SECRETARY OF HEALTH AND HUMAN SERVICES WASHINGTON. D.C. 20201 USA FACSIMILE PLEASE NOTIFY OR HAND-CARRY THIS TRANSMISSION TO THE FOLLOWING PERSON AS SOON AS POSSIBLE: 1/15/99 DATE: TIME: TO : Melanne Verveer COMPANY : WH FAX NUMBER: 456-6244 TELEPHONE NUMBER FROM: Donna E. Shalala OFFICE OF THE SECRETARY 200 INDEPENDENCE AVENUE, S.W. WASHINGTON, D.C. 20201 (202) 690-7000 FAX NO. (202) 690-7595 COMMENTS: 01/15/99 11:50 202 690 7595 HHS OFF OF SEC 5. 002 IMPROVING HEALTH CARE ACCESS FOR UNINSURED WORKERS January 15, 1999 Overview: The Clinton Administration has taken a number of important steps since 1993 to expand coverage and respond to rapid changes in the U.S. health care system. We have given states the flexibility to insure more low-income workers, allowed Americans to take their health care with them when they change jobs, expanded health coverage to the children of low-income families, and proposed both making Medicare available to Americans aged 55 to 65 and making Medicare and Medicaid available to disabled Americans who work. This new initiative complements these strategies by addressing the need for health care delivery systems serving the 32 million adult Americans still without insurance. Many providers of free or low-cost health care services currently do not have the resources or technical capacity necessary to coordinate their efforts with other providers. This initiative, funded at $1 billion over 5 years, will help fill that gap. The bulk of the funding would provide federal grants to help community health clinics, public hospitals, academic health centers, and other providers of free or low cost health services to create networks that strengthen comprehensive care for the uninsured. This coordination of services will help uninsured workers receive more efficient and higher quality care and gain entry into a "seamless" system of care for low-income working families. A key emphasis in the early years of the program will be assisting communities and providers in the development of the infrastructure necessary to participate in networks or other coordinated care arrangements. Funds will be available for the development of the financial, information, and telecommunications systems needed to appropriately monitor and manage patient needs. The initiative will also target substantial funding toward service gaps that can be identified within coordinated systems of care for the uninsured, reaching approximately 100 communities over five years. Although need will vary by community, the focus will be on expanding access to primary health care and ensuring that it is coordinated with other health care needs, including mental health and substance abuse services. Millions of Americans still lack health insurance. In 1997, the number of Americans without health insurance stood at over 43 million. While the Children's Health Insurance Program and increased Medicaid outreach can potentially provide insurance coverage for about half of the approximately 11 million uninsured children, roughly 32 million adults between the ages of 19 and 64 remain uninsured. Among these uninsured adults, about 17 million have incomes below 200 percent of the poverty level. Many of them receive their care at community health clinics and local hospitals. Many of these Americans suffer from multiple health problems and require access to a coordinated set of health care services. Yet data show that these needs are not being met. In 1997, 30% of uninsured adults did not receive needed medical care and 55% postponed needed medical care because they could not afford it. They were only about half as likely to receive a routine check-up as insured adults. Among those who 01/15/99 11:51 202 690 7595 HHS OFF OF SEC 1 003 did have a regular source of care, uninsured adults were about five times more likely than insured adults to use the emergency room as their regular source of care. Yet, health care providers that help uninsured Americans face many pressures. These providers consist of institutions, facilities, and individual health professionals that provide a significant volume of health care services, either without payment or on a reduced fee basis, to those who are uninsured. They face a number of challenges, such as increases in the number of uninsured workers, reduced Medicaid revenues due to the pressures of Medicaid managed care, and a growing need for mental health and substance abuse services. The Clinton Administration proposes strengthening health services for uninsured workers. To respond to these needs, the President's FY 2000 budget will propose a competitive grant program that would provide $1 billion over five years to strengthen public and private entities in 100 communities, increasing the availability of comprehensive, coordinated health care for uninsured workers. The President will request $25 million for the first year of this initiative in his FY 2000 budget proposal, which will be sent to Congress on February 1, 1999. The intent of these grants is to establish patient-focused systems of care to serve low-income, uninsured workers with greater efficiency and improved quality of care. Those who provide health care to the uninsured will get help to create the infrastructure they need to provide quality care. A key emphasis in the early years of the program will be assisting communities and providers to develop the infrastructure necessary to participate in networks or other coordinated care arrangements. Funds will be available for the development of the financial, information, and telecommunications systems needed to appropriately monitor and manage patient needs. This support will improve the ability of providers to track patient care needs and receipt of service over time; permit more clients to be served; and strengthen the financial standing of providers by enhancing their ability to compete for business from Medicaid and commercial managed care organizations. Once a coordinated system has been established within a community, uninsured workers will gain entry into a coordinated health care system that meets their individual needs. Once health services are coordinated in a community, gaps in service can be identified and filled. The initiative will also target substantial funding toward service gaps that can be identified within coordinated systems of care for the uninsured. Although need will vary by community, the emphasis will be on expanding access to primary health care and insuring coordination with other health care needs, including mental health and substance abuse services. There is a history of bipartisan support for coordinating health care for uninsured workers. In the last Congress, a bipartisan bill was supported by the conservative "Blue Dog" Democrats and House Republicans that would have created "telehealth networks" for linking rural health services. While the proposal is similar, our initiative would actually reach a greater number of uninsured workers, in both rural and urban areas. In 01/15/99 11:52 202 690 7595 HHS OFF OF SEC 5. 004 the 103rd Congress, Senator Dole introduced a bill that would have funded greater integration of services for the uninsured in a grant program similar to what we are now proposing. The history of coordinating community services for the uninsured has been bipartisan, and the Administration looks forward to building that kind of consensus around this new initiative. The Clinton Administration builds on a strong record of extending health care services to more Americans. Since 1993, HHS has approved Medicaid demonstration programs to extend health insurance coverage to 2.2 million Americans who would otherwise be uninsured. In 1996, the President signed the Kassebaum-Kennedy act, which ensured that Americans could take their health care with them when they changed jobs. In 1997, under the Balanced Budget Act, the Administration successfully supported the Children's Health Insurance Program (CHIP). Since then, 49 states and territories have had their CHIP plan approved by the U.S. Department of Health and Human Services. MEMORANDUM TO: All Interested Parties FR: Communications\Research # DATE: February 5, 1999 RE: President Clinton's Bold Plan to Save Social Security Attached please find a document, signed off on by Gene, outlining how President Clinton proposed a bold, sweeping plan to save Social Security following Republican calls for him to take the first step. We have also included three newspaper clips with particularly strong headlines. Feel free to distribute this material. Thanks PRESIDENT CLINTON RESPONDED WITH BOLD PLAN TO REPUBLICAN CALLS FOR LEADERSHIP ON SOCIAL SECURITY For months a number of Republicans have been saying that they were willing to work with President Clinton on saving Social Security if he would show leadership on the issue and take the first step by submitting a specific plan. On January 19, 1999, the President laid out a bold framework in his State of the Union that meets America's challenges -- ensuring the solvency of Social Security until 2055. Newspapers around the country referred to the President's plan as "bold" and called it "the most sweeping changes to Social Security ever proposed." Republicans Said They Were "Willing to Work With The President" If He Would "Show Leadership" on Social Security Senate Majority Leader Lott: "The President's Going to Have to Show Leadership" On the December 6, 1998 "Meet the Press," Senate Majority Trent Lott (R-MI) was asked "what must be done" to save Social Security. He responded, "What must be done is the president's going to have to show leadership. He's going to have to show some courage. He's going to have to make a proposal. I'm willing to work with the president and the Democrats, but they 've got to propose something. [NBC's "Meet the Press," 12/6/98 (emphasis added)] Ways & Means Chairman Archer Called on the President to "Grab the Bull by the Horns" In a December 2, 1998 letter to President Clinton, House Ways and Means Committee Chairman Bill Archer (R-TX) called on President Clinton to submit a specific plan to save Social Security. Archer wrote: "If ever there was a need for strong Presidential leadership. the time is now. I respectfully submit that you need to 'grab the bull by the horns' before it is too late. We have a small window of opportunity in which Social Security can be saved. I urge you to seize this moment and I commit to work with you on a bipartisan basis to get the job done. ["President Should 'Grab the Bull by the Horns' on Social Security, Says Chairman Archer Citing Growing Factionalism, Chairman Sends Letter to the President," Rep. Archer press release, 12/2/98, Archer web page (emphasis added)] Senate Budget Committee Chairman Domenici Urged President to Announce His Plan In a November 21, 1998 article entitled "Domenici Wants Clinton Plan Soon," the Albuquerque Journal reported, "Sen. Pete Domenici is urging President Clinton to waste no time in announcing his plan to ensure the solvency of the nation's Social Security system." Senate Budget Committee Chairman Pete Domenici (R-AZ): "The longer we wait in dealing with Social Security, the more we spend the surplus on other things. The sooner we get an approach as to how we're going to deal with Social Security, The sooner we can determine how much we have for tax cuts. [Albuquerque Journal, 11/21/98] 1 House Social Security Subcommittee Chairman Clay Shaw: To Save Social Security, "Mr. President, You Need to Lead Our Nation" House Ways and Means Subcommittee on Social Security Chairman Rep. Clay Shaw (R-FL): "To save and strengthen Social Security, Mr. President, you need to lead our nation. It's that simple. You need to submit to the Congress, a specific plan to save Social Security soon, or the job may not get done. [The White House Bulletin, 12/8/98 (emphasis added)] In his December 5, 1998 Republican Response to the President's Radio Address, Rep Shaw said, "Because the president is elected by all of the people, he alone is best positioned to build a bipartisan consensus to get the job done. I look forward to hearing from President Clinton at this historic summit. Together, and with the support of all Americans, we can and we will strengthen Social Security because it embodies what's best for all Americans." ["Clay Shaw Delivers Republican Response to the President's Radio Address" (Federal Document Clearing House), 12/5/98 (emphasis added)] Sen. Rick Santorum: "We Need You to Go Out and Lead This Debate" Co-Chair of the Senate Majority Leader's Task Force on Social Security Senator Rick Santorum (R-PA): "We need this administration Mr. President, we need you to go out and lead this debate in the American public's eyes, to lead it here in the Congress, and together we can really have a secure Social Security.' [Pittsburgh Post-Gazette, 12/9/98 (emphasis added)] Sen. Judd Gregg: If President Says "Where and When" Republicans "Will Be There" Senate Budget Committee member Senator Judd Gregg (R-NH): "Mr. President, if you simply tell us where and when, Republicans will be there and will work with you. [United Press International, 12/12/98] Gregg: "What we need to hear from the president is which of the options that are out there he would be willing to consider [A]s long as he is functioning on a plane of the ethereal, we can't move. [Associated Press, 11/19/98] Rep. Jerry Weller: "We Need Leadership" from the President "to Get the Ball Rolling" In a November 19, 1998 press release, House Ways and Means Committee and Social Security Subcomittee member Rep. Jerry Weller (R-IL) said, "I am prepared to help President Clinton enact Social Security reform legislation. The American people expect us to work together and we cannot allow Social Security reform to fall prey to politics. We need leadership and a specific plan from the President to get the ball rolling. To his credit the President has made Social Security reform his number one priority. I look forward to reviewing the President's plan for Social Security reform. ["Weller Ready to Save Social Security," Rep. Weller press release, 11/19/98 (emphasis added)] 2 Newspapers Around the Country Called The President's Plan To Save Social Security "Bold" and "The Most Sweeping" Boston Globe: "A Bold Plan" To Save Social Security According to a Boston Globe news article, President Clinton "offered an ambitious agenda to save Social Security and improve education [H]e offered a challenging array of ideas and programs for governing in the next two years, including a bold plan to commit a large share of the budget surplus to Social Security and invest part of it in the stock market." [Boston Globe, 1/20/99 (emphasis added)] Washington Post: "The Most Sweeping Change to the Program Since Its Creation" According to a Washington Post new article, "[President Clinton's] two-pronged proposal [to save Social Security] would represent the most sweeping change to the program since its creation in the depths of the Depression." [Washington Post, 1/21/99] Los Angeles Times Headline: "Ambitious Plan" The following is the headline of a January 20, 1998 Los Angeles Times page one news article "Clinton Addresses Nation; President Outlines Agenda; Speech lays out ambitious plan, calling for the shoring up of Social Security and for programs to protect Americans health" [Los Angeles Times, 1/20/99] Seattle Post-Intelligencer: "Clinton Laid Out A Bold Proposal" To Save Social Security According to a Seattle Post-Intelligencer news article, "Delivering his sixth annual address to a joint session of Congress, Clinton laid out a bold proposal to allow the government to invest a portion of the Social Security trust fund in stocks..." [Seattle Post-Intelligencer, 1/20/99 (emphasis added)] New York Daily News: "The Most Sweeping Changes to Social Security Ever Proposed" According to a news article in the New York Daily News, "President Clinton defiantly brushed aside his historic impeachment trial last night, presenting Congress with an ambitious agenda that ranged from the most sweeping changes to Social Security ever proposed, to more education and military spending. Urging 'a new hour of healing and hopefulness,' a confident and comfortable Clinton never mentioned the sex scandal that has threatened his presidency and shaken his legacy." [Daily News (New York), 1/20/99 (emphasis added)] The Plain Dealer Headline: "Clinton's Bold Plan for Social Security" The following is the headline of a January 20, 1998 The Plain Dealer page one news article: "Clinton's Bold Plan for Social Security" [The Plain Dealer (Cleveland), 1/20/99] Note: The article that appeared in The Plain Dealer under that headline was a reprint of a New York Times story. Buffalo News Headline: "Message Offers Bold Plan To Save Social Security" The following is the headline of a January 20, 1998 Buffalo News page one news article: "Message Offers Bold Plan to Save Social Security and Medicare.' [Buffalo News, 1/20/99] 3 Los Angeles Times Clinton Addresses Nation; President Outlines Agenda; Speech lays out ambitious plan, calling for January 20,1999 20, the shoring up of Social Security and for programs to protect Americans' health. By JAMES GERSTENZANG, TIMES STAFF WRITER WASHINGTON-President Clinton proposed a rescue plan for the Social Security system Tuesday night, using his sixth State of the Union address to offer the most sweeping domestic agenda of his second term. Eight hours after his lawyers began telling the Senate why he should not be removed from of- fice, the president offered to the nation a road map of social pro- grams Intended to protect Ameri- cans' health and retirement. Admonishing the nation not to become complacent at a time of continuous prosperity, Clinton de- clared: "How we fare as a nation far into the 21st century depends upon what we do as a nation to- day. "With our budget surplus grow- ing, our economy expanding, our confidence rising, now is the mo- ment for this generation to meet our historic responsibility to the 21st century," he said. His program is built on a strict parceling of the anticipated budget surplus over the next 15 years. He would allocate 62%-more than $2.7 trillion-to Social Security, and the rest pri- marily to Medicare, a new retire- ment savings program dependant on. private investment and mili- tary and education needs. The budget surplus is expected to be $4.4 trillion over that period. Speaking at one of the more extraordinary junctures in the his- tory of the presidency, Clinton made no reference to his Impeach- ment by the House of Representa- tives and his trial now under way. in the Seriate. Reflecting the divisions caused by the trial, six members of the House and one senator, all Repub- licans, said that they would boy- cott the address. Some Republi- cans had said that the president should postpone the speech. House Speaker J. Dennis Hastert Please see UNION, A14 A14 WEDNESDAY, JANUARY 20, 1999 /NA create a trust fund, overseen by private managers, to make equity investments-a course that has drawn deep skepticism from labor UNION: Clinton unions and others in the tradi- tional Democratic constituency. The plan, likely to run into sharp controversy in Congress, which must approve it before it Has Ambitious could take effect, would limit the investment to no more than 15%. of the Social Security fund. As projected by the Office of Agenda for U.S. Management and Budget, the use of the surplus largely to meet the demands imposed on the Social Security system by the baby Continued from A1 boom generation would so sharply of Illinois reminded members of reduce the government's need to In a moment of drama, Clinton Congress earlier that they borrow that the publicly held debt shouldgreet Clinton in a dignified said that the Justice Department would fall by two-thirds. would sue the tobacco industry to manner. The test will be whether Clin- recover the accumulated costs An introductory plea for "civil- ton, if he remains in office, is able ity and bipartisanship" was borne by federal taxpayers of to fend off pressure coming greeted with applause from both treating people with smoking-re- largely from the narrow Republi- lated diseases. The suit would sides of the aisle, and the presi- can majority in the House to use seek to recover hundreds of bil- dent was rewarded with the con- the surplus to pay for an across- lions of dollars from the nation's ventional cheering and standing the-board tax cut and from some ovation upon his arrival in the five major tobacco companies, Democrats and allied groups to chamber where House members, At its heart, the program Clin- produce even greater increases in one month ago to the day, voted ton presented to the joint session spending for domestic programs. of Congress this year was built to impeach him. But Republicans Signaling what aides said was around the need to tackle the appeared noticeably restrained as his intention to fulfill an activist most pressing problems facing the Clinton, his face unlined but his role for the final two years of his nation as it nears a new century hair grown noticeably more silver, second term, Clinton set out doz- and the opportunities presented outlined a program that would ex- ens of goals. by the extended period of eco- pand the federal government's They included strengthening nomic growth that has marked role in an array of domestic the nation's education system by the end of the decade and the first arenas. stressing academic achievement, federal budget surplus since 1969. For Clinton, the speech repre- particularly in low-peforming "Our fiscal discipline gives us sented his grandest opportunity schools, putting 100,000 more an unsurpassed opportunity to ad- to remind the nation. of his teachers in classrooms over the dress a remarkable new chal- strengths-those of a president next seven years and toughening lenge: the aging of America," focused on the domestic and eco- discipline and promotion require- Clinton said. "With the number of nomic issues that the public, in ments. elderly Americans set to double opinion surveys, lists time and "While our fourth-graders out- by 2030, the baby boom will be- again as its greatest concerns. come a senior boom. So first and perform their peers in other coun- Taking advantage of that op- tries in math and science, our above all, we must save Social Se- portunity in the midst of the im- eighth-graders are around aver- curity for the 21st century." peachment drama offered the age and our twelfth-graders rank Appealing for bipartisan coope- president perhaps the most force- ration at a moment of sharp parti- near the bottom," the president ful defense he can present. If his said. "We must do better." san division, the president said: "I Senate trial, as many political sci- The president also proposed a reach out my hand to those of you entists think, is ultimately a po- $6.1-billion program to help fami- of both parties in both houses and litical rather than judicial test, lies pay for long-term health care, ask you to join me in saying: We then maintaining strong poll rat- a $2-billion plan to help potential will save Social Security now." ings may be his ultimate weapon. workers with disabilities sur- The goal is to extend the actu- Perhaps more than those of his mount barriers to finding jobs and arial security of the retirement recent predecessors, Clinton's a $1-billion effort to help 200,000 program to 2055. Without revi- State of the Union speech-and welfare recipients join the sions, analysts have predicted the budget he will present on Feb. workforce. that the demands of an aging 1-offer the president what White By using the surplus to pay for population combined with low- House counselor Doug Sosnik Medicare and Social Security, ered payroll taxes from a reduced called a "center of gravity" to rather than spending the surplus workforce would deplete the fund project his most ambitious goals on other programs, administration in 2032. for the coming year. Tuesday's officials argued that they would In addition to transferring call for reform of Social Security bring the publicly held national nearly two-thirds of the budget was as dramatic as any program debt to a level, when compared surplus .to the Social Security he has espoused since 1994, when with the gross domestic product; fund over 15 years, Clinton would he called for universal health in- that would be lower than at any surance. point since 1917. It is currently about 45% of the gross domestic product, the value of the nation's economic output of goods and services, and it would fall to 10% in 2014 under the ad- would give Americans incentives intended to halt the flow of jobs to "It is time to reverse the de- fective U.N.," he said. "I want to ministration's projections, officials to save, particularly those who countries where production is cline in defense spending that be- work with this new Congress to said. If borrowing is reduced, gov- are not participating in such re- cheap because wages are low and gan in 1985," thé president said. pay our dues and our debts." ernment interest payments would tirement programs as a 401(k) environmental concerns are ig- Clinton also pointed proudly to He also called for an increase in be lower and more capital would plan. nored. what he described as administra- research on vaccines to protect be left in private hands for invest- As structured by the adminis- "We must tear down barriers, tion diplomatic successes in against chemical and biological ment elsewhere in the economy. tration but subject to reworking open markets and expand trade. Northern Ireland, Bosnia and the weapons and the training of po- Under Clinton's plan, 15% of by Congress, Sperling said, the at the same time, we must ensure Middle East peace process. But he lice, firefighters and medical per- the surplus, or $650 billion to $700 program would be built around a that ordinary citizens in all coun- gave no hint of what he hoped to sonnel to counteract such weap- billion, would be spent on Medi- distribution by the government of tries benefit from trade-pressing do this year to build on U.S. world: ons in major metropolitan areas. care, the federal program of medi- a specific amount to each worker, for trade that promotes the dig- leadership. cal insurance for the elderly. It Samuel R. Berger, the presi- perhaps $200 or $300, so that ev- nity of work, the rights of work- "No nation in history has had would be intended to make sure dent's assistant for national secu- ery American could open a retire- ers, the protection of the environ- the opportunity and responsibility that the program remains finan- rity affairs, said that Clinton was ment savings account. If individu- ment," the president said. we now have to shape a world cially sound for 20 years. seeking a 70% increase-to a five- als chose to contribute more, the The president also called for Clinton is planning to seek a more peaceful, secure and free," year total of $4.2 billion-in the sums would be matched at pro- $12-billion increase beyond origi- Clinton said. steps to expand insurance cove- budget for programs aimed at pre- gressive levels and up to a certain nal plans in the Pentagon's budet He called on the Senate to rage of prescription drug costs for venting the economically pressed limit by the government. Those the elderly. for fiscal 2000, which begins on ratify the comprehensive nuclear Russian government from trying with lower incomes would receive Oct. 1, 1999, and a $110-billion in- test ban treaty, which has lan- Another large part of the sur to solve its cash problems by sell- larger matches-say $1 from the guished there for two years since plus, 11%, would go toward estab- crease over six years. Most of the ing weapons of mass destruction government for every $1 an indi- lishing what the administration is increase would be spent on weap- Clinton signed it. And he urged inherited from the collapsed So- vidual set aside in the investment calling universal savings ac- account. ons modernization and a 4.4% pay Congress to pay almost $1 billion viet Union. increase for personnel. Many in back dues to the United Na- counts. It would earmark $33 bil- Times staff writers Norman Kempster, Sam Clinton also proposed initiating servicemen are being lured by tions. lion a year, or $500 billion over 15 Fulwood and Judy Lin contributed to this a new round of global trade talks years, to help individuals save pri- higher pay to the private sector. "America needs a strong and ef- story. vately for retirement. As sketched by Gene Sperling, who heads Clinton's National Economic Council, the program THE PLAIN DEALER EST NEWSPAPER 350 FINAL CLEVELAND, WEDNESDAY, JANUARY: January 20, 1999 Clinton's bold plan for Social Security By JAMES BENNET NEW YORK TIMES WASHINGTON President The president's Social Security plan draws GOP's fire. 8-A Clinton proposed last night that the federal government invest for is contrary to free enterprise," Clinton called for maintaining the first time in the stock market said Bill Archer, the Texas Re- Social Security as a "defined ben- to strengthen Social Security, as publican who is chairman of the efit" plan, that is, one with a guar- he delivered a confident report on House Ways and Means Commit- anteed payout. But last night he the State of the Union to a Con- tee. also proposed the system of per- gress considering cutting short The remainder of the surplus sonal savings accounts, which are his presidency. money Clinton hopes to reserve similar to what Republicans are Appearing in the grand cham- for Social Security - about $2 seeking as at least a partial re- ber of the House of Representa- trillion- would, like the money placement for Social Security. tive a month to the day after he he would set aside for Medicare, For the president, the new ac- was impeached there, Clinton go to pay off the federal debt. counts. would supplement Social also urged Congress to begin con- That would simultaneously re- Security, not replace it. tributing $33 billion a year to a duce the amount of government Each worker would receive new system of retirement ac- debt and increase Social Securi- some flat payment, say $100, to counts for American workers. ty's financial reserves. open an account, similar to a 401- Clinton also proposed that $2.7 trillion of a projected $4.4 trillion in surpluses in the next 15 years (k). If he or she then chose to de- the hum of our prosperity to luli be reserved for Social Security. posit more money, administration us into complacency." In all, the administration pro- officials said, the government He announced last night that posed investing up to 25 percent would match a portion of it, per- of the new money for Social Secu- haps in the form of a tax credit. the Justice Department was pres rity, or $700 billion, in stocks over paring to sue tobacco companies; During his address last night, opening a new front in a war that the next 15 years. Gene Sperling, the president never mentioned the director of the National Eco- the trial, steps away in the Senate, has repeatedly gained him politic nomic Council, said that under cal ground. He argued. that, fed where lawyers began defending this plan, Social Security would eral programs like Medicare him just a few hours earlier, as he never have more than 15 percent were due hundreds of billions of envisioned using the rest of his of its assets in the market, a level term to strengthen the nation's dollars for the costs of treating he called "far, far more conserva- lung cáncer and other diseases. schools, military forces and pro- Va, tive than any pension plan in the The president left it to his law grams for the elderly. country dóes." "America is working again," yers to attack the charges he But Republicans signaled they Clinton said. "The promise of our broke the law to cover up his af had no interest in the president's future is limitless. But we cannot fair with Monica Lewinsky, this suggestion. "Government- former intern. realize that promise if we allow controlled investment in markets SEE CLINTON/8-A Clinton proposes spending billions on Social Security CLINTON But with the surpluses growing FROM 1-A and a new politics of prosperity firing legislators' imaginations, The president presented his Senate Republicans declared that legislative shopping list - from they would seek a 10 percent cut an initiative to ease traffic con- this year in personal income tax gestion to a $1 billion program to rates. help people switch from welfare Last night, Clinton argued that to. work - to a Republican Con- 62 percent of forthcoming federal gress with far different plans for surpluses should be earmarked to spending the surpluses accumu- preserve Social Security, a pro- lating after decades of deficits. gram that was at the heart of the Calling this time "a new dawn Democratic New Deal but that for America," he urged his listen- has since developed overwhelm- ers to "put aside our divisions" ing popular support. and find "a new hour of healing Another 15 percent of the sur- and hopefulness." pluses, Clinton said, should go to With the justices of the Su- protect the Medicare program, preme Court and his antagonists which assists the elderly with and allies in both houses of Con- health care. The president would gress before him, the president spend about 11 percent of the sur- recognized several people in the pluses to create new retirement galleries to underscore his points. savings accounts, called "univer- Among them, he singled out his sal savings accounts." wife, Hillary. Rodham Clinton, The remainder of the surpluses whose loyalty and advice have - roughly another 11 percent, been key to his political stamina. according to the administration He praised her for "for all she has - would go to defense and do- done for our children" and for mestic initiatives. "advancing our ideals at home The administration also hopes and abroad." to amend the law governing aid to Illustrating the peculiar politi- public schools to demand that cal dynamic unfolding here, Re- states and school systems begin publican Senate leaders also testing new teachers for compe- seemed eager to play down the tence, identify failing schools and trial. They laid out their own leg- shut them down if necessary, and islative agenda in the morning, end practices like "social promo- insisting that mulling the first re- tion," or routinely moving chil- moval ever of a sitting president dren into the next grade even if would not divert them from what they have not gained the neces- the Majority Leader, Trent Lott, sary skills. called "the people's business." "Each year the government in- Though the president called for vests more than $15 billion in our sure-fire political initiatives like public schools," Clinton said. "I putting 50,000 more police offi- believe we must change the way cers on the street, he also used his we invest that money, to support speech, to push beyond his short- what works and to stop support- term predicament. In urging a ing what does not work.' long-term fix for the Social Secu- The president also proposed a rity system, according to his asso- series of narrowly targeted tax ciates, he hopes he will shine credits, rather than the kind of through the historic blot of im- broad-based tax cuts that Repub- peachment. licans favor. He said that he Clinton urged Congress in his would seek a $1,000 credit to help State of the Union Message last families pay for long-term care year to "Save Social Security and another $1,000 credit to help first." disabled peopled return to work. Weather THE Savings on horizon In Local, Gov. Pataki proposes BUFFALO trimming income tax rates Page B1 Shoppers' paradise In Business, area consumers enjoy the sales tax holiday. Page B7 Mostly cloudy: College cage clash high around 40; In Sports, Bona outlasts UB in Page A2 SOUTH SUBURBAN EDITION a Big 4 matchup. Page D1 40 PAGES WEDNESDAY, JANUARY 20, 1999 Message offers bold plan to save Social Security and Medicare By ROBERT A. RANKIN surplus to give most working people seed Knight-Ridder Newspapers money to open their own retirement ac- counts. WASHINGTON - President Clinton's The government also would help match plan to save Social Security and Medicare is people's personal investments as they built the biggest, boldest proposal he has made up those accounts over time, giving more since his abortive 1993-94 health-care re- money to those with low incomes. This ap- form crusade, and may prove. equally con- proach might satisfy GOP desires to rest troversial. more of the nation's retirement system on Clinton proposes to spend $3.4 trillion private savings accounts, though it would over the next 15 years to solve the two big- not go so far as to privatize the Social Se- gest financial challenges facing the govern- curity system itself. ment for the next generation, to rescue Without reforms, Social Security will be both popular programs without the pain of able to pay only 72 cents of every dollar it raising taxes or reducing benefits. promises retirees in pension benefits start Another part of the proposal would cre-: ing in 2032, according to the system's trust- ate a new type of individual savings pro- gram, devoting $500 billion from the federal See Benefits Page A6 "It really is big news, big in ev- Benefits: ery sense of the term. I think he does have something for every- one. For the general publiè, he is saying, 'Look, we can do this GOP objects without asking too much of people in terms of sacrifices.' Everything else will look like castor oil com- to lack of cuts pared to this," said John Rother, chief lobbyist for AARP, the influ- ential senior citizens lobby. He too in income tax was favorable toward Clinton's proposals. One big question mark, howev- er, is whether the expected $4.4 Continued from Page Al trillion surplus turns up, ees. But Clinton's plan to channel "These surpluses apparently* $2.7 trillion into Social Security sume 15. more years of economic would cover all current benefit growth. We've always been worried costs until 2055. ? about: how. realistic those surpluses In addition, Medicare - which are," said Craig Cheslog, spokes- man for the Concord Coalition, B covers most medical expenses for the elderly - is projected to go bipartisan pressure group devoted bankrupt in 2008. But Clinton's to fiscal discipline. Nevertheless, Cheslog stressed, "we think it's an proposal to give Medicare up to $700 billion extra over 15 years interesting first step." The most controversial element would pay for all current benefits through 2020. of Clinton's plan calls for creating to Many Republicans objected to a new government mechanism to oversee investment of hundreds of the mechanics of Clinton's plan. billions of dollars in the stock Some accept parts of it but prefer market. his to devote more of the expected surplus to tax cuts. The federal. budget is projected "We didn't balance the budget to run the $4.4 trillion surplus over the next 15 years; Clinton so the government could grown" complained Senate Budget Com- proposes putting 62 percent of it into the Social Security trust mittee Chairman Pete Domenici, funds: A new board would oversee R-N,M., who sharply criticized investment of about 25 percent 01 Clinton's seizure of the entire our that in stocks; the rest would:be plus, saying his plan would pre- invested in Treasury bonds. clude any income-tax cuts "for the next 15 years. Conservatives fear that permit- We think tax- payers should get that money." ting government to invest so much But analysts of every stripe ac- directly in stocks. could lead.to knowledged that Clinton's bold federal pressure, through owner proposals were a political master- ship power, on private corpora- stroke, certain to ignite a great na- tions to follow politically directed tional debate over how to spend policies rather than ones set purcly the looming surplus funds - if on business interests. the Senate finishes his impeach- No, no, a thousand times HOW ment trial reasonably soon. said Rep. Bill Archer, R-Texas, chairman of the House Waysand Clinton thus posed an implicit choice to Congress and the coun- Means Committee, which oversees try, between bogging down in im- Social Security and taxes. Archics peachment or governing imagina- passionately wants to cut taxes as tively for the future. well as craft Social Security "My instinct is, if the Senate forms this Congress: Government-controlled invest- starts calling witnesses and the im- peachment trial drags on mib ment in markets is contrary to-free April, you can probably kiss thy enterprise. It will open the door to significant legislation goodbye,' all kinds of mischief involving govt said Henry Aaron, an economist at ernment dictates, favoritism and the Brookings Institution, a cert- cronyism. If there is to be an int trist think tank, who liked The vestment in the stock market it thrust of Clinton's plan. Hav must be at the discretion of free individuals, not at the dictates of the federal government," Archer said. THE WHITE HOUSE WASHINGTON November 24, 1998 MEMORANDUM TO THE FIRST LADY J.K. FROM: Chris Jennings, Jennifer Klein, Jeanne Lambrew SUBJECT: Response to Questions about Coverage Expansions cc: Melanne Verveer, Neera Tanden, Nicole Rabner In a recent discussion of the uninsured, you asked about several coverage expansion proposals, including a 55 to 65 coverage option, a Medicaid buy-in, a Federal Employees Health Benefit Plan (FEHBP) buy-in, and a new health insurance option for young adults. This memo summarizes these proposals, discusses their rationale, and provides you with a budget and Congressional status update. As was discussed in the memo to the President on the uninsured, the absence of substantial subsidies and the omission of an individual or employer mandate significantly limits the number of Americans who will be newly insured as a result of these policies. Having said this, each of these options (or modifications to them) can improve access to needed health insurance and are being considered for the FY2000 budget. Medicare Buy-In / Health Insurance Options for People Ages 55 to 65 Policy. In our FY 1999 budget, we proposed three policies: (1) a Medicare buy-in for people ages 62 to 65 that is fully self-financed through an unsubsidized, two-part premium (an up-front premium plus a smaller, post-65 premium to compensate for any risk selection); (2) a similar Medicare buy-in for displaced workers ages 55 and over who have involuntarily lost their jobs and health care coverage; and (3) guaranteed access to former employers' insurance for retirees age 55 and over whose retiree health benefits have been ended. According to CBO, this entire initiative costs about $1.5 billion over 5 years (mostly a temporary cost until the participants begin contributing their post-65 premium) and would assist about 300,000 people. Rationale. This initiative, according to the latest data, is needed more than ever. Although still low, the number of uninsured people ages 55 to 65 grew the fastest in 1997 and will grow exponentially in the future since the number of people in this age cohort is projected to rise by over 60 percent by 2010. Moreover, we have increasing evidence that the individual insurance market - relied on by this age group more than any other - is raising its rates dramatically. Kaiser Permanente, for example, will double its individual insurance premiums for its older enrollees on January 1. This initiative gives people in this age group options to purchase insurance that they might not otherwise have. It also would be the bare minimum policy needed if the age eligibility for Medicare were raised an idea seriously being contemplated by the Medicare Commission. Issues. Despite the need, this initiative was victimized by conflicting "too much - too little" criticisms. Republicans (and some conservative Democrats) claimed that the buy-in creates a huge loophole in Medicare that will ultimately lead to large costs. In part, this reflects a disbelief in our technical ability to set premiums that are self-financing in the long run. But mostly, it results from a strong belief that, even if the premium estimates are accurate, we will eventually succumb to the pressure to subsidize these premiums to make them more affordable for the lower income uninsured. In contrast, a number of traditionally liberal advocates and academics criticized the policy for helping too few people to justify the political capital that would be necessary to expend to get the proposal any serious attention by the Republican Congress. Regardless of its political viability in this Congress, this proposal addresses a population in need, remains generally popular outside the beltway, and will continue to be seriously considered for inclusion in the FY 2000 budget. It is unclear whether it will make the final cut, however. The short-term savings needed to finance this initiative are controversial and/or likely to be used for other priorities (such as for underwriting the costs of the Jeffords/Kennedy disability coverage expansion bill). Also, there is concern about putting this proposal out so close to the final report released by the Medicare Commission this March. No matter how we resolve the budget question, however, we expect Senators Moynihan and Daschle as well as Congressman Gephardt to introduce this bill at the beginning of the next Congress. Medicaid Buy-In Policy. A Medicaid buy-in would allow states to charge income-related premiums for people in optional eligibility groups with income above 150 percent of poverty (the level at which states may charge cost sharing under the Children's Health Insurance Program (CHIP)). This proposal could be broadened to allow all people below a fixed income level -- not just those in current optional eligibility groups -- to buy into Medicaid. Currently, states cannot charge premiums to Medicaid beneficiaries. A lesser known fact is that Medicaid law limits who can be covered as well. Historically, adults were eligible for Medicaid only if they were: (a) single parents, or married but unemployed parents, who receive welfare; (b) low-income elderly or people with disabilities who receive SSI; or (c) nursing home residents. During this Administration, however, new Medicaid eligibility options have been created. Welfare reform gave states the option to cover higher income single parents and unemployed married parents. The exclusion of married employed parents -- which is anti-work and anti-family was changed last summer with "100-hour rule" regulation. This lets states define "unemployed" as working more than 100 hours a month -- meaning that they may cover parents working 40-hour weeks if they so choose. And, in the Balanced Budget Act, we created a Medicaid buy-in for people with disabilities with incomes below 250 percent of poverty. Rationale. A Medicaid buy-in could be an incentive for states to expand coverage to working adults, since even small family contributions improve the acceptance of such expansions. It also gives all states the flexibility that we have permitted through Medicaid waivers and supported in CHIP, as well as in the Medicaid buy-in for workers with disabilities. 2 Issues. Despite its sound policy basis, the likelihood that a Medicaid buy-in will significantly reduce the uninsured is low. Since large subsidies are required to encourage low-income, uninsured people to purchase health insurance, states would have to charge the families low premiums and pay for most of the costs themselves in order to get meaningful participation. Moreover, only states that have already expanded coverage to 150 percent of poverty could charge premiums to all new participants. Unfortunately, states typically cover few adults with incomes above 50 percent of poverty. Thus, premiums collected through a Medicaid buy-in would not come close to offsetting the large Federal and state costs. Additionally, while allowing premium payments from beneficiaries may be attractive to states, Republicans, and moderate Democrats, it would be vehemently opposed by advocates and liberal Democrats who believe that this opens the door to high premiums for lower-income Medicaid beneficiaries. One idea that could possibly address the financial limitations of this proposal is to link the Medicaid buy-in proposal to a tobacco recoupment bill. The recent state tobacco settlement will likely lead to legislation about whether and under what terms states may keep the Federal share of that settlement. In such legislation, we could make expansion through a Medicaid buy-in one of the uses (or the sole use) of the Federal share. Congressional Democrats and advocates have long argued that tobacco settlements should be directly linked to health care, health insurance expansions, and Medicaid. It is possible they would accept a buy-in in a recoupment bill that assures Medicaid expansions. States, obviously, do not want any strings on the uses of the Federal share of the settlement, but may have the hardest time arguing against Medicaid investments since the settlement itself is premised on Medicaid costs resulting from tobacco use. The clear downside to this option is that money spent on expansions would limit the money used for other priorities like child care. This issue will be debated in our budget process. FEHBP Buy-In Policy. Another proposal for expanding coverage is opening up the Federal Employees Health Benefits Plan (FEHBP) to various groups of people (e.g., workers in small businesses, people ages 55 to 65 years old). In order to participate in FEHBP, health plans would have to offer health insurance to the designated group of eligibles. There are two options for how premiums would be set: first, new participants could be charged the same premiums as Federal employees; second, new participants could be charged premiums separately, depending on their own costs. Rationale. The FEHBP buy-in would give certain groups of uninsured people the benefit of accessing the health plan options, information and possibly premiums that Federal government negotiates for its employees. It also reinforces our support for group health insurance purchasing, plan choices, and adequate information with which to make such choices. Issues. Depending on how premiums are set, the FEHBP buy-in would either be costly to new participants or affect the premiums and choices of all Federal employees. Because newly eligible people who wish to purchase insurance who are healthy can likely find individual insurance that is cheaper, the population that decides to go into FEHBP is likely to be sicker. This will increase premiums of all current Federal employees if they are charged the same premium. It could also reduce plans participating in FEHBP if their enrollees include more costly, new participants than 3 Federal employees (which could happen in rural areas). As a consequence, most FEBHP buy-in proposals assume a risk pool separate from that of Federal employees for setting premiums. But because this pool would be a smaller and include less healthy people, premiums would be more expensive than FEHBP. As a consequence, most analysts project a relatively small effect on coverage. The only way to address this would be subsidies which carry significant cost implications. These complexities explain why there have been few FEHBP buy-in bills. Given concerns about its use as a source of coverage, FEHBP may be better used as a model for other coverage expansion proposals. What makes FEHBP successful -- purchasing power for a large group of people; consumer information; plan choices -- could be incorporated into small businesses purchasing coalitions. These coalitions, promoted in previous budgets, provide any small business in the area with a set of plan choices and more affordable premiums. This year, we are examining options to aggressively encourage their development. For example, FEHBP managers could provide technical assistance in establishing these coalitions. They could also be granted non-profit status to facilitate private foundation support. Catastrophic Coverage for Young Adults Proposal. You mentioned an interest in policy options that would provide catastrophic coverage for young adults. Medicare, Medicaid, and FEHBP all provide comprehensive coverage, although we could conceivably develop a special program for catastrophic coverage. It is also possible through regulation to require individual insurers to offer such coverage to young adults. Rationale. Young adults are more likely than any other age group to be uninsured -- nearly one in three 18 to 24 year olds lacks insurance. In part, this problem results because young adults are usually healthy and do not think that their need justifies the cost of comprehensive coverage. Thus, catastrophic coverage may be the best option for young adults since it is cheaper and protects them from the real risk of illness or injury that can be financially devastating. Issues. Catastrophic coverage options probably would not insure many young adults. Few young adults would purchase even the lowest-cost catastrophic coverage without significant subsidies. In fact, some analysts believe that only an individual mandate will make young adults pay any level of premium for health insurance. This is because they rarely recognize their financial risk (e.g., one in four young adults sustains major injuries in a year and one in 20 is hospitalized). Second, while catastrophic coverage makes economic sense, people interested in insurance do not appear to like it. The lack of interest in the medical savings account (MSA) demonstration has shown that people prefer lower cost sharing and coverage of primary care. Recognizing these challenges, we continue to examine policies to allow young adults to buy into Medicaid. Some of the most needing of insurance in this age group are foster care children who have aged past their 18th birthday (and thus last year of Medicaid eligibility.) We are working with OMB to provide a new state option for those Governors interested in expanding Medicaid coverage to this population. We believe it will be affordable (about $50 million over 5), sound policy that a number of states will pick up. As of this writing, the chances of this proposal being included in the budget appear to be quite good. 4 THE WHITE HOUSE WASHINGTON November 13, 1998 INFORMATIONAL MEMORANDUM TO THE PRESIDENT me FROM: Chris Jennings and Jeanne Lambrew THROUGH: Bruce Reed, Gene Sperling SUBJECT: Recent Uninsured Trends and Analyses As you know, the Census Bureau recently estimated that 43.7 million Americans are uninsured -- an increase of 1.7 million from 1996 and nearly 5 million from 1992. Insurance coverage is one of the few social indicators that has not improved in the last several years. This contradicts the theory that a strong economy with low unemployment yields a high demand for workers, and thus better benefits like health insurance. It is even more disappointing given record-low health care cost growth in Rate of Uninsured Among the the last several years, which should make insurance more Non-Bderly, 1987-1997 20% 17.3% 17.4% 18.3% 15.7% 16.3% affordable and thus more common. This increase has 14.8% 15% important consequences since the uninsured are four times more likely to not receive needed health care, have 10% hospitalization rates for preventable conditions that are 50 5% to 75 percent higher, and place growing uncompensated 0% 1987 1989 1991 1993 1995 1997 care burdens on the nation's providers. Sarce: EBRI. 1998 Because of the importance of this problem and your expressed interest in these data, we are providing you an analysis of the numbers and recent insurance coverage trends, as well as a summary of their policy implications. Uninsured by age: Most of the uninsured in America are young; over 80 percent are under age 45 (35.2 million). These uninsured are disproportionately ages 18 to 24 -- 30 percent of whom are uninsured compared to 15 percent of children. The number of uninsured children did not increase in 1997, remaining at 10.7 million. This contrasts dramatically with last year's data that showed that 800,000 of the 1.1 million additional people who were uninsured were children. The change appears to be the result of the unprecedented focus on Rate of Uninsured by Age, 1997 children's health in 1997. Beginning with the State of the 30% Union and ending with the establishment of your Children's 30% 23% Health Insurance Program (CHIP), the Federal Government 17% 20% 15% 14% 14% and the states started taking actions to address this serious problem. Next year, after Census' data reflects a full year's 10% <1% operation of CHIP, we would expect the number of 0% uninsured children to fall. <18 18-24 25-34 35-44 45-54 55-64 65+ While the likelihood of being uninsured is higher among younger adults, the number of uninsured is growing faster among older adults. One million of the additional 1.7 million uninsured people in 1997 were age 35 or older. The increase is particularly concentrated among people ages 55 to 65; the number of uninsured people in this age group grew faster than all other age groups (7 percent growth). This trend is cause for concern because people ages 55 to 65 become more likely to develop a health problem and less likely to have employer insurance (because their spouses retire and join Medicare, they move to part-time or self-employment which typically does not offer insurance, or they retire). As a result, this age group is disproportionately relies on individual health insurance - where premiums have been skyrocketing in recent years and underwriting practices remain prevalent. Because of the demographics, there is no doubt that the coverage problem will increase exponentially as the number of people in this age cohort is projected to rise by over 60 percent by 2010. Uninsured by income: Not surprisingly, people with less Uninsured by Income, 1997 income are less likely to have health insurance. Although only 40% 32% 13 percent of the U.S. population, poor Americans (with 26% 30% income less than $16,000 for a family of 4) represent 26 16% 20% 8% percent of the uninsured fully one-third have no insurance. 10% However, reflecting the strong economy, the poverty rate 0% continues to fall and the number of uninsured below 100 <DO% DO- 200- 300% 200% 300% + percent of poverty did not increase between 1996 and 1997. Despite the link between lack of insurance and low income, over 80 percent of the uninsured are in working families. The lack of insurance is growing among the middle class; all of last year's additional 1.7 million uninsured had income above the poverty level, with the greatest concentration of people between 100 and 200 percent of poverty. Inexplicably, although still small in number, the uninsured with income above 500 percent of poverty (over $80,000 for a family of 4) rose at an extraordinary 20 percent growth rate in 1997. Job characteristics and the uninsured: Workers in small firms are less likely to have access to affordable, job-based health insurance. Nearly half of uninsured workers are in firms with fewer than 25 employees. Compared to over 95 percent of large Uninsured Workers by Firm Size, 29% firms, about half of firms with fewer than 10 employees and 30% 27% 1997 19% three-fourths of firms with 10 to 24 employees offer 20% 14% 11% coverage. These facts underscore the need to find better 10% ways for small businesses to pool resources and leverage to 0% <10 10-24 25-99 100-499 500+ bargain for more affordable benefits. The rate of being uninsured is also high among people who work full time but only for part of the year, most likely due to job change or loss (27 percent). A recent Census study found that over 40 percent of workers with at least one job interruption had a gap in coverage. Because most people are insured through work, insurance coverage often ends with employment changes underscoring the importance of the Kassebaum-Kennedy portability and COBRA protections. 2 TRENDS IN EMPLOYER-SPONSORED INSURANCE. On the face of it, it does not appear that the increase in the uninsured is directly linked to a decline in employer-sponsored health insurance (ESI). The erosion that occurred in the late 1980s and early 1990s has ended. About 64 percent Nonelderly Americans Covered by of nonelderly Americans had employer-based Employer-Sponsored Insurance insurance in 1997, virtually unchanged from 1995 and 80% 69% 69% 66% 64% 64% 64% 1996. In recent years, access to job-based health 60% insurance has actually increased, even among small 40% businesses. However, this has not translated into 20% increased ESI coverage because a smaller proportion 0% 1987 1989 1991 1993 1995 1997 of people with access to ESI are purchasing it. Saroe EBRI, 1998 Even though more employers are offering health insurance, fewer employees are taking this coverage, primarily because they have to pay more of the premiums. The employee share of premiums has risen, especially in smaller firms. As a result, fewer employees are purchasing this coverage. For example, in 1987, 90 percent of Change in Family Share of Premium workers in firms with fewer than 10 workers who had 50% 44% 38% 1988 1996 access to employer-based coverage took it, compared 40% 34% 28% 29% 30% to 85 percent in 1996. These take-up rates drop as 30% the share of the premium paid by the employee 20% 10% increases. This trend clearly affirms that health 0% insurance affordability plays the most significant role Firms < 10 Firms <200 Firms > 200 in people's likelihood of buying health insurance. Source: Gobel et d., 1997 TRENDS IN MEDICAID. The most notable drop in insurance coverage in 1997, reported by both the Census Bureau and HCFA, appears to come from the number of people covered by Medicaid. There are three possible explanations for this trend. The first and likely most significant factor is that, as the economy has strengthened, fewer people are eligible for Medicaid. This is supported by the fact that the poverty rate has declined, the number of poor covered by ESI has increased, and there was no increase in the number of uninsured children eligible for Medicaid (still 4.7 million). Second, there may be fewer people aware of their continuing Medicaid eligibility in the wake of state and Federal welfare reform. Third, it is becoming more likely that Medicaid beneficiaries misreport that they are covered by private insurance in the Census survey. States have been taking actions People Covered by Medicaid Millions 33.4 33.6 33.4 30.9 33.2 32.1 to "destigmatize" Medicaid by changing the 28.3 30 name of their programs (e.g., TennCare, 20 MinnesotaCare). Also, about 50 percent of Medicaid beneficiaries are enrolled in managed 10 care plans, which are usually private plans. 0 Thus, beneficiaries can easily mistake their 1991 1992 1993 1994 1995 1996 1997 Source HCFA; coverage for private coverage. 3 FUTURE TRENDS IN THE UNINSURED. Given the complexity of these trends, it is unclear whether the rise in the number of uninsured will continue. Several compelling factors suggest that it will not and may actually decrease modestly. The Office of National Health Statistics projects that the proportion of Americans covered by employment-based insurance will rise as continued low unemployment will make employers more likely to use insurance to attract workers. Medicaid coverage may increase as well as additional low-income parents become eligible because of the "100-hour rule" welfare-to-work regulation you instituted this past summer and/or due to the states' continued use of Medicaid waivers, which have already covered over one million Americans. We also expect to see a decrease in the number of uninsured children beginning to showing up in next year's Census Report as the effects of CHIP take hold. As the baby boom generation ages, however, more people will move into the 55 to 65 year old age bracket -- where the proportion of people with ESI is declining and uninsured is increasing. Furthermore, significant premium increases for next year, as some recent reports have projected, may make insurance unaffordable to greater numbers of Americans. While these conflicting trends make it extremely difficult to predict the future with any sense of confidence, it seems unlikely that we will see another significant increase in the uninsured next year. IMPACT OF ECONOMIC AND EDUCATION SUCCESSES ON THE NATION'S HEALTH. This problem of the uninsured contrasts with tremendous improvements in other national health indicators. Your impressive economic accomplishments have had an impact on the costs of health insurance. For the first time in well over 30 years, health inflation was below general inflation in 1995 and 1996, thus actually reducing the real costs of health insurance. Moreover, gains in education, income and employment have contributed towards record high life expectancy (76.5 years for those born in 1997), a record low infant mortality rate (7.1 deaths per 1,000 live births), an AIDS death rate that is half of what it was in 1992, and a record-high immunization rates. And, historic increases in the investment in biomedical research during your Administration offer real hope for new (and hopefully cost-effective) treatments and cures for the diseases that will otherwise place unprecedented burdens on the nation's economy and health care system when the baby boom retires. POLICY IMPLICATIONS. The uninsured in America remains one of the most challenging domestic social problems. Not only is the problem large in size, it is complex, crossing income, age and geographic boundaries. Despite its complexity, one fact is clear: making health insurance affordable is and always will be the key to significantly expanding coverage. Even for an employee whose employer pays for 80 percent of the premium, the family share of the premium is typically over $1,100 per year more than one out of every $10 of income for a minimum-wage worker. This cost is obviously much higher for people without access to employer-based insurance, especially if they have a history of illness. While traditional insurance regulation can help reduce insurance premium variation and discrimination, independent analysts will not project any substantial coverage expansions resulting from these interventions. In a non-mandate environment, they believe that only significant subsidies can induce a substantial reduction in the uninsured. 4 Ironically, our ability to propose policies to make insurance more affordable is limited by our success in reducing national health spending. In the last 5 years, hundreds of billions of dollars in excess Medicare and Medicaid spending have been squeezed out of these programs and used productively to help eliminate the deficit, finance children's health coverage, extend the life of the Medicare Trust Fund, and to make the Medicaid program a much more predictable and affordable safety net. However, substantial reductions in Medicare and Medicaid mean that these traditionally utilized funding sources cannot be relied on as offsets for major coverage expansions, let alone long-term Medicare reforms. With this in mind, outside funding sources from the tax code, tobacco, or elsewhere would be needed for a significant coverage expansion. Administration & Republican coverage expansion ideas. The range of coverage options, currently being prepared through the traditional NEC/DPC/OMB budget process, will include some previous and new targeted coverage expansions. As this memo has documented, the most recent data validate the case for coverage expansions to the pre-65 and "workers-in between- jobs" populations. We also will continue to focus on administrative and possibly legislative outreach policies to encourage enrollment in CHIP and Medicaid to ensure your children's health initiative is a success. However, recognizing the questionable political and budgetary viability of these proposals, we are also reviewing options more likely to be well received in this Congress. First, we are contemplating policies to encourage states to expand using existing options. With the 100-hour rule regulation, all states can now cover parents of children on Medicaid. Other states have used Medicaid 1115 waivers to cover all people up to certain income levels. Because this would likely require greater financial incentives, one option is making coverage expansions a priority on a short list of acceptable uses for the Federal share of state tobacco settlements. As an alternative to coverage expansion options, we expect Secretary Shalala to advocate for a significant investment in public health infrastructure. This investment would be used to adapt the safety net to the rapidly changing health system. This idea would likely be better received than a coverage expansion by Republicans. However, if not a capped mandatory grant program, it would either require raising the discretionary caps or place a major strain on the current caps. Also, it would likely be perceived by some Democrats as giving up on coverage expansions. Since there is bipartisan concern about small businesses' problem in accessing insurance, we are also considering enhancing our previously-proposed small business purchasing coalition grant initiative. We could more aggressively encourage these coalitions by directing OPM to provide technical advice for their establishment and operation, so that they more closely resemble FEHBP. We are also examining granting them non-profit status, to facilitate foundation support. In 1999, Republicans, too, may consider small business group purchasing policies (although in the past, their versions have been significantly flawed). It is more likely, however, that, if Republicans decide to address the coverage issue at all, they will focus on the use of tax incentives for the purchase of individual health insurance. Encouraging individual insurance is intriguing because nation's reliance on voluntary, employer-based coverage has clearly not been an unqualified success. Moreover, if there is to be any significant investment in health care that the Republicans could possibly support, it would almost inevitably come from the tax code. 5 While acknowledging that tax credits are at least initially appealing, they are no panacea. They are extremely inefficient and expensive, as many of the assumed recipients would already have coverage. For independent experts to validate that the previously uninsured would take advantage of this policy, the credit would have to be quite large. In addition, if used for individual (rather than employer-based) insurance, they would require the type of major insurance reforms that have been historically opposed by Republicans. The individual market is the least regulated, most expensive, most "cherry-picked" and most unstable insurance market. Notwithstanding legitimate concerns, we believe that tax credits may be the only health coverage expansion vehicle that could be produced by this Congress. As such, we are reviewing possible options for your consideration. For example, it might be possible to merge policies to promote small group purchasing coalitions with tax credits for participating employers or employees. Limiting the tax credit to such entities could further encourage a long-overdue expansion of small business coops. However, such approaches also raise equity concerns (e.g., why discriminate against an employee/employer who does not have access to, or does not want to be in, a purchasing coop) and political arguments (e.g., isn't this too similar to the Health Security Act). DPC, NEC, OMB, Treasury and HHS are reviewing this purchasing coalition/tax credit idea and other tax incentive approaches. We will keep you apprised of developments in this area, as well as other coverage options, as the budget process unfolds. 6 International Organizations and Programs (IO&P) ($ in thousands) FY 1998 FY 1999 FY 2000 Acual Estimate Request ECONOMIC PROSPERITY 210,600 215,300 191,300 Broad-based Growth 210,500 215,000 191,000 United Nations Development Program (UNDP) 98,000 100,000 80,000 United Nations Children's Fund (UNICEF) 100,000 /1 105,000 /1 101,000 United Nations Development Fund for Women (UNIFEM) 1,000 1,000 1,000 OAS Development Assistance Programs 6,500 6,500 6,500 International Fund for Agricultural Development (IFAD) 5,000 /2 2,500 2,500 Open Markets 100 300 300 International Civil Aviation Org. (ICAO) Aviation Programs 100 300 300 GLOBAL ISSUES 74,500 64,200 90,700 Protection of Global Environment 49,500 64,200 65,700 United Nations Environment Program (UNEP) 9,000 13,000 13,000 Montreal Protocol Multilateral Fund 28,000 34,450 34,450 International Conservation Programs 3,750 6,000 6,000 UNFCCC / IPCC 5,000 6,500 8,000 Int'l. Contributions for Scientific, Educational & Cultural Activities 2,250 2,250 2,250 World Meteorological Org./Voluntary Cooperation Program 1,500 2,000 2,000 Stabilization of World Population Growth 25,000 0 25,000 United Nations Population Fund (UNFPA) 25,000 13 0 /4 25,000 DEMOCRACY AND HUMAN RIGHTS 4,900 7,000 7,000 UN Vol. Fund for Technical Coop. in Field of Human Rights 900 1,500 1,500 UN Voluntary Fund for Victims of Torture 1,500 3,000 3,000 OAS Fund for Strengthening Democracy 2,500 2,500 2,500 HUMANITARIAN ASSISTANCE 4,500 5,500 4,000 World Food Program (WFP) 4,000 5,000 3,500 Afghanistan Emergency Trust Fund 500 500 500 TOTAL 294,500 292,000 293,000 /1 Appropriated under Child Survival Programs /2 Includes $2.5 million transferred from Development Assistance 13 Does not reflect $5 million withheld for congressional prohibition of U.S. funding for UNFPA's China Program /4 Funding for UNFPA is prohibited by the FY 1999 Omnibus Appropriations Act. 50 98 (TUE) 18:02 US SEN COM UN ARD M. KENNEDY MASSACHUSETTS United States Senate WASHINGTON, DC 20510 December 18, 1998 MEMORANDUM FOR THE PRESIDENT FROM SENATOR EDWARD M. KENNEDY "PROPOSED DEMOCRATIC PRIORITIES FOR THE 106th CONGRESS" The November elections reaffirmed the key Democratic priorities on which you have worked so effectively over the past two years. As a result, we are poised to move forward on a number of popular issues, especially: -- The Patient's Bill of Rights; -- The increase in the minimum wage; -- Education reforms to reduce class size and facilitate school construction; -- Aid for disabled Americans who are able to work and want to work; -- Medicare "buy-in" for the near-elderly; and -- Saving Social Security. I encourage you to include in the Democratic agenda three new ideas that will help millions of Americans and expand our base of support for the year 2000. 1. Prescription Drug Coverage under Medicare: We should help seniors by guaranteeing this coverage under Medicare. In 1965, when Medicare was enacted, most private insurance plans did not offer this coverage. Today, 99 percent of private insurers provide it -- but Medicare does not. Millions of senior citizens struggle lo afford the expensive prescription drugs needed to maintain their health and avoid hospitalization. In 1994 and 1996, Democrats received 48 percent of the senior citizen vote. This year, that support dropped slightly, to 44 percent. The elderly represent 28 percent of the voting public. We cannot afford as a party 10 lose this powerful and growing voting bloc. There is no better way to attract these voters than lo fight for their health care. Providing prescription drug coverage is expensive- which is why seniors are struggling so hard to afford it. But the need is (TUE) 18:03 US SEN CUM UN LANR 2 great, and the long-term benefit for the Democratic Party is great too. 2. A Well-Qualified Teacher in Every Classroom: You deserve great credit for directing the national education debate to the all-important issues of quality and standards. Your two key proposals to reduce class size by funding 100,000 new teachers and to modernize schools have resonated throughout the country. To fill out the education picture, we must also assure that teachers are well-trained to meet high standards and raise student achievement. You are already providing funds to hire new teachers. I propose that we help existing teachers, loo. We need mentoring programs for novice teachers as they adjust to the classroom. We need more resources for teacher training, for professional development, and for appropriate recertification requirements - while avoiding the divisive issue of teacher testing. With your leadership, we can assure parents and students that we are doing all we can to guarantee a well- trained teacher in every classroom in America. 3. Ready to Learn: We must do a better job of enabling children to start school ready to learn. Experts agree that the attention given children in their formative years often determines their ability to learn and succed over their lifetime. You have led the way on child care. We need to expand Headstart, Early Start, pre-K, and other programs with a proven record of preparing children for school, and we also need to focus these programs more effectively on early learning. I believe that tobacco funding can provide the resources needed to pay for these initiatives, and that the iniatives will have widespread support from the American people and strengthen your hand in dealing with the tobacco companies. For example, the governors could be permitted to keep the federal share of the state tobacco settlement, provided that the funds are used to prepare children to start school ready to learn. In addition, the federal government should insist on compensation from the tobacco companies for the costs to the federal government of treating tobacco-related illnesses under Medicare, veterans' health programs, and other public health programs. The compensation could be pursued both in court and through legislation. To strengthen these approaches, we should earmark every cent collected from the tobacco companies for prescription drug coverage for our senior citizens under Medicare. I believe this linkage would receive broad support. Thank you for your continued leadership on so many issues of vital importance to the nation. As always, 1 look forward to working with you to bring greater opportunities for working families. (TUE) 18:03 US SEN COM UN L&NR 2 great, and the long-term benefit for the Democratic Party is great too. 2. A Well-Qualified Teacher in Every Classroom: You deserve great credit for directing the national education debate to the all-important issues of quality and standards. Your two key proposals to reduce class size by funding 100,000 new teachers and to modernize schools have resonated throughout the country. To fill out the education picture, we must also assure that teachers are well-trained to meet high standards and raise student achievement. You are already providing funds to hire now teachers. I propose that we help existing teachers, loo. We need mentoring programs for novice teachers as they adjust to the classroom. We need more resources for teacher training, for professional development, and for appropriate recertification requirements -- while avoiding the divisive issue of teacher testing. With your leadership, we can assure parents and students that we are doing all we can to guarantee a well- trained teacher in every classroom in America. 3. Ready to Learn: We must do a better job of enabling children to start school ready 10 learn. Experts agree that the attention given children in their formative years often determines their ability to learn and succeed over their lifetime. You have led the way on child care. We need to expand Headstart, Early Start, pre-K, and other programs with a proven record of preparing children for school, and we also need to focus these programs more effectively on early learning. I believe that tobacco funding can provide the resources needed to pay for these initiatives, and that the iniatives will have widespread support from the American people and strengthen your hand in dealing with the tobacco companies. For example, the governors could be permitted to keep the federal share of the state tobacco settlement, provided that the funds are used to prepare children to start school ready to learn. In addition, the federal government should insist on compensation from the tobacco companies for the costs to the federal government of treating tobacco-related illnesses under Medicare, veterans' health programs, and other public health programs. The compensation could be pursued both in court and through legislation. To strengthen these approaches, we should earmark every cent collected from the tobacco companies for prescription drug coverage for our senior citizens under Medicare. I believe this linkage would receive broad support. Thank you for your continued leadership on SO many issues of vital importance to the nation. As always, 1 look forward to working with you to bring greater opportunities for working families. DEC. -22' 98 (TUE) 18:03 US SEN COM ON L&HR TEL: 202 224 5128 P. 004 TOBACCO TALKING POINTS- DECEMBER 21, 1998 1) The Administration should renew its effort to substantially raise the federal tax on cigarettes. The budget should propose increasing the cigarette tax by at least 70 cents per pack. A majority of the Senate -- 58 members -- supported a $1.10 per pack increase in the last session. The cost of the state settlement is approximately 40 cents per pack. This leaves 70 cents per pack -- approximately $40 billion over five years -- to finance our initiatives. 2) Raising the price of cigarettes produces a double benefit -- it is an important deterrent to youth smoking and it produces badly needed revenue. 3) The federal government incurs enormous costs each year to provide health care for those suffering from tobacco-induced disease. Estimates place the federal cost at approximately $22 billion per year, of which roughly half is incurred in Medicare. 4) The successful state lawsuits already established the principle that the tobacco industry is liable for the costs which government incurs treating sick smokers. Whenever people ask me about tobacco issues, they want to know why the federal government has not filed suit. 5) The best way, probably the only way, to get Congress to enact a substantial cigarette tax increase is for the federal government to file suit against the industry. That is our leverage to bring the industry to the table and negotiate a strong legislative package. 6) T know you are hearing from the Justice Department that the federal government does not have a good case. Many of the foremost experts in the country disagree. 7) I (along with Senators Conrad and Bob Graham) have had several meetings about this issue with Attorney General Reno. She personally is very favorably disposed to bringing a suit, but the staff keeps raising obstacles to going forward. 8) At her invitation, T have put together a group of experts -- both legal academics and trial lawyers -- who believe the federal government has astrong case and who are willing to meet with the Attorney General and her staff on an ongoing basis to persuade them to file suit and to help them put the case together. It includes Larry Tribe, Robert Blakey (the RICO expert), Einer Elhauge (an anti-trust expert from Harvard), Mike Ciresi (the lead trial counsel in the Minnesota case) and Dick Scruggs (the lead counsel in the Mississippi case). We've already been meeting with them, and the first meeting with the Attorney General is scheduled for early in January. 9) They have identified four viable causes of action -- 1) civil RICO, 2) the Medical Care Recovery Act, 3) the federal common law of nuisance (used successfully in environmental cases prior to EPA), and 4) antitrust. DEC. -22' 98 (TUE) 18:03 US SEN COM ON L&HR TEL: 202 224 5128 P. 005 10) Such a lawsuit would clearly give us enonmous leverage to negotiate strong lobacco legislation including a substantial price increase and FDA regulatory authority. 11) I believe we could further strengthen the legislative argument for a 70 cent per pack price increase by proposing that the money be spent to provide prescription drug benefits for seniors through Medicare. You know how popular that issue is, but we've never been able to fund it. Since much of the tobacco-related cost the federal government incurs is in Medicare, this would be a particularly appropriate use of the money. It is a much more potent message than spreading the money over a number of different programs. 12) I would try to use the federal share of the tobacco money which the states recovered in their Medicaid suits to address our child care and child development initiatives. We should only agree to waive the federal claim to those Medicaid dollars if the states agree to use the federal share for children's programs. The states are worried about losing that money, and an agreement along these lines can be negotiated. THE WHITE HOUSE washington February 24, 1999 TO: Gene S., Bruce R., Elena K., Larry S., Steve R. FROM: Chris J. and Jeanne L. RE: HCFA MEDICARE COMMISSION ANALYSIS Last night, Senator Breaux released an analysis from the HCFA actuaries on the latest version of Senator Breaux's Medicare Commission reform packages. Senator Breaux's cover note suggests that premium support saves $347 to 372 billion over 10 years. A closer reading of the analysis shows that premium support by itself saves about $75 to 100 billion over 10 years ($26 to 37 billion over 5 years). The $347 to 372 billion "savings" also includes about $100 billion in revenue from an income-related premium that is earmarked in its entirety for low-income protections and about $50 billion in reduced Medicare liability from transferring direct medical education out of the Medicare Trust Fund. As a consequence, almost one half -- about $150 of the $347 to 372 billion - does not represent Federal savings. The following is a brief description of the package and analysis: SENATOR BREAUX'S PACKAGE Premium support ($26 to 37 billion over 5, $75 to 102 billion over 10). The actuaries estimated savings from Senator Breaux's "alternative" model that was described for the first time in a memo from the Commission on 2/17. The higher savings estimate assumes that there is no ability for private plans to vary their benefits. The lower savings estimate assumes a limited amount of variation. These savings are higher than expected because Senator Breaux has made important modifications in his proposal, specifically reducing the benefits flexibility, even in the more "flexible" model. Income-related premium ($36 to 38 billion over 5, $95 to 96 billion over 10). This plan would start increasing the Medicare premium for beneficiaries with income at $24,000 for singles, $30,000 for couples. These income thresholds are half as high as the 1997 Chafee- Breaux proposal, and would affect more than twice as many people - about 30 percent of beneficiaries (about 12 million beneficiaries) would pay higher premiums. Assuming 1999 costs, this premium would be $125 a month each for an elderly couple with $50,000 annual income more than a 100 percent increase. All $38 billion in revenue from this income- related premium, according to the description, would be reinvested in a yet- to-be designed low-income protections and therefore would be budget neutral (no savings). Raising the age eligibility ($2 billion over 5, $25 billion over 10). The real savings from this proposal are in the long-run -- a separate analysis indicated that this policy alone would produce as much savings as premium support over the 30-year period. The analysis does not include any proposal to assist people losing Medicare eligibility in finding new sources of coverage (e.g., Medicare buy-in). Cost sharing and Medigap changes ($14 billion over 5, $31 billion over 10). This plan would make a number of changes to Medicare cost sharing which, in total, would increase the amount that beneficiaries pay out-of-pocket ($9 billion over 5, $20 billion over 10). This primarily results from a new 10 percent home health copay. The plan would also prohibiting Medigap from covering Medicare's deductible ($5 billion over 5, $11 billion over 10). Fee-for-service reforms ($16 billion over 5, 79 billion over 10): This includes extending most Balanced Budget Act proposals from 2003 to 2007 ($7 billion over 5, $57 billion over 10) (note: since the BBA expires in 2002, only 2003 and 2004 savings count toward the 5 year savings). The plan would also modernize Medicare fee-for-service by giving it additional flexibility used by private health plans ($9 billion over 5, $22 billion over 10). These savings are more than we expected, and probably are more than CBO would estimate. Transferring direct medical education out of Medicare ($20 billion over 5, $46 billion over 10). This proposal does not actually save the Federal government any money -- it simply moves DME spending from Medicare to some other, unnamed place in the budget. WHAT IS NOT IN SENATOR BREAUX'S PACKAGE Surplus: The plan contains no revenue proposals. Prescription drug benefit: Under the more flexible benefits version of premium support, plans could offer a limited drug benefit and possibly receive a government subsidy for it if its premium is below average. People in traditional Medicare or without access to a low-cost private plan would have no drug option. Defined benefit: Despite improvements in their structure, both premium support options allow some flexibility around the core benefits (e.g., offer varying but actuarially equivalent levels of physician visit coverage, home health, outpatient care). The more flexible option allows plans to offer whatever additional benefits they desire, so long as the value of those benefits doesn't exceed a limit. Benefits variability not only reduces effective competition, but could cause risk selection and confusion among beneficiaries faced with a wide array of slightly different benefits options. Medicare buy-in: The proposal raises age eligibility without offering any options whatsoever for people who lose Medicare eligibility as a result of the change. There are also unanswered questions, like whether beneficiaries choosing private plans will pay more or less depending on where they live. We will you posted as we learn more. SENATOR BREAUX'S MEDICARE REFORM PROPOSALS (Calendar years, dollars in billions) 00-04 00-09 Premium Support Limited Flexible Benefits -26 -75 No Flexible Benefits -37 -102 Income Related Premium (Begins $24/30 ends $40/50) Limited Flexible Benefits -36 -96 No Flexible Benefits -38 -95 Raising Age Eligibility -2 -25 Cost Sharing / Medigap Changes Cost sharing changes (including unlimited home health copay) -9 -20 Medigap: Prohibiting coverage of deductible -5 -11 Subtotal -14 -31 Medicare Fee-For-Service Reforms BBA Extenders -7 -57 Modernizing fee-for-service -9 -22 Subtotal -16 -79 Removing direct medical education from Medicare -20 -46 Drug Coverage Not Included Surplus Not Included Interactions 1 6 MEDICARE SAVINGS Total Package Plus Premium Support #1 -114 -346 Total Package Plus Premium Support #2 -126 -373 FEDERAL SAVINGS (Minus Income-Related Premium; DME) Total Package Plus Premium Support #1 -58 -204 Total Package Plus Premium Support #2 -69 -231 2/24/99 Package 1-Draft Medicare legislative package introduced by Senator Breaux at January 26 Commission meeting Category Provision Comment Fee-for-service: Cost sharing Combined A & B deductible of $350 (indered to CPD 10% colneurance on inpatient and proventive care; 10% colnsurance m home health care, present law OPD colnstrance, 20% cotusurance on all other services Modernization Standard BCV package BBA extenders NBCFM package (through 2007) uxcept: no M+C / no DSH Medical education Remove DME funding from Médicare: по ME provision DSH No provision Medigup reforms Prohibit coverage of Medicare deductible(s) Premium supports Administration Medicare Board would have considerable authority to negotiale premiums & benefit packages, financial & quality standards, approve saving area, CIC. Benefit packages Option (1): Standardized "Date" package required " minimum Additional benefits beyond core package are allowed Private plan packages must be R government FFS plan Accurial value of package may not cicred 1 1056 of are value Peripheral benefitsisneh as dontal cara casmede surgery, vislou care, OTC drugs are not permitted Option (2): Standardized "card" package only, no benefit package flexibility Premium allocation Govy FFS plan must bid nationAlly, others may bid nationally # regionally Partial geographic adjustment of payments full risk adjustment 3-hendpoint premium allocation formula; based on full plan bids: At or below 85% of WAP, 100% 1 0% Medicare 1 beneficiary allocation A1 100% of WAP, 88%/12% Above 100% of WAP. gov'l cancrib - 88% of WAP Income related Single bene's: 12% at $24,000 25% at 540,000+ premium Bene couples: 12% at $30,000 25% II 550.000+ Bracksts indexed by CPI Revenue circussided for improving low tocome beneficiary coverage No specific provision FFS and PS: Eligibility age Increase age of eligibility following OASDE schedule Vohmtary average No provided Drug coverage No provision Budget surplus revenue No provision 1 Specifications reflect clarifi cations and modifications received from Robby Andal Darla Ramfo. and Sarah Lyuns on 1-29-99, 2-11-99, 2-12-99, 2-17-99 and 2-22499. Office of the Acarry February 23. 1999 Estimated costs (+) or savings H under Mo atternative versions of Medicare legislative package Introduced by Sensior Breaux ml Jamary 20 Commission meeting (Calonder year estruates; amounts in billions) -Option (3): United varialion m benefit package- Total sendmes, nomicral Total envings, % of PL expends Proposal 2000 2001 2002 2000 2004 2005 2008 2007 2000 2009 2000-04 2000-09 2000-04 2000-09 2000-10 BBA entenders sao $0.0 SOA -$2A -$1.9 $6.6 98.9 -311.0 -811.9 $122 -$7.1 $57.1 -0,5% -9.7% 28% Coal sharing changes -LB -18 $ -19 -1.9 -B.O to & -21 pg -61 -19.5 D.P.S 00% "ars Modiumbration proposats -1.7 -1.7 -1.0 -8.8 -2.1 e2 -2.9 -25 -27 29 -9.2 -21.8 -0.7% -0.6% -0.6% Renoved of DME -3.6 -3.8 -10 -42 -45 -4.7 -19 52 -BA -5.7 -201 -48.1 -1.4% .1.3% 29% Perman support 2.4 -85 5.4 -6.7 -7.7 -8.3 -90 07 101 -15.4 28.1 -74.9 -1.9% 22% 256 6.6 -7.0 -7.5 -B.1 -8.6 "If -10.5 -11.4 -125 -13.7 36.1 -859 27% 28% 01% Change An aga of eligibility 0.0 0.0 O.D -0.7 AA -22 -10 -4.2 -5.8 -7.8 -21 -25.2 -0.1% .07% 1.7% Medigap regulation changes.. -10 -1.0 -10 -1.1 ..1.1 -1.1 -1.2 .12 -1.3 -1.3 -52 -11.3 CAX -0.3% 0% Interactions 0.1 at 0.1 as 0.4 as 0.7 as 1.0 1.1 10 52 0.1% 0.2% 0.2% Total savings. -17.0 122 -21.9 -28.0 JIA -36D -41.1 -46.5 .50.7 560 -116.2 -316.6 -8.2% -10.1% -11.2% Total plesent law expends 251 284 279 297 321 246 373 404 436 475 - - - - - Savings as % of expend's -6,8% -7.3% -7.8% -9.0% -1,8% -10.4% -11.0% -11.5% -11.6% -11.8% - - - I - No tax: 1. Balarta specification signature for description of provisions. 2. Estimates shown for each provision are on a 'stand zlose" basis, that is. the thandal Impact of that provision only, relative la presention. Total savings for the package reflect intellsctions. 3. "Savings" are defined as other expenditure reductions or increase In premium revenues. 4. Estimates are preliminaly and subject m change pending Improved data and more refined methoddogies. In particular, estimates of Interactions among proposels are very mugh. Fdo PROPI REV.XLS Option (1) abbrov page 1 Olitce of the Actuary Health Can Financing Admin 2/23/89 Estimated costs (+) or savings (-) under alternative versions of Medicare legislative package Introduced by Senator Breaux at January 26 Commission meating (Calender year extinates; amounts M billions) -Option (2): No variation to benefits package- Total asvings, nominal s Total savings, % of PL expend's Proposal 2000 2001 2002 2003 2004 2005 2008 2007 2000 2009 2000-04 2000-08 2000-04 2000-09 2000-30 BBA extenders $0.0 $0.0 -$0.4 -$2A 44.3 -$8.6 -$8.8 -$11.0 $11.3 -$12.2 -$7.1 -$57.0 -05% -1.7% -2.4% CODE thang Changes -1.8 -1.8 -1.8 -1.0 -139 -20 20 F -2.1 2 AP FEA 5 -00% U.T. Mod emization proposals -1.7 -1.7 -1.0 -1.9 -2.1 .22 -2.3 -25 -27 20 -8.2 -21.B -0.7% :0.6% -0.6% Rennoval al DME -0.6 -3.6 -4.0 -1.2 -4.5 -4.7 -1.8 -5.2 -6.4 -5.7 -20.1 -46.1 -1.4% -1.3% -0.8% Premium support 4.1 -5.8 -7.6 -9.1 -10.3 -11.1 -11.0 -12.8 -140 -15.2 -06.9 -1020 -25% -20% -1.2% income-related premium 66 -7.0 -7.5 -8.1 -BA -8.6 -10.4 HIA 121 -116 -37.6 -95.3 27% -20% -1% Cha nge In age of effgibility 0.0 0.0 D.D -0.7 -1.4 -2.2 -3.0 -4.2 -5,8 -7.9 21 -252 -0.1% -0.7% -1.7% Medigap regulation changes... -1.0 40 -1.0 -1.1 -2.1 -1.1° -1.2 -1.2 -1.3 -1.9 -52 -11.3 -0.4% -03% -0.2% Internactions 0.1 0.8 0.2 as 0.5 0.7 de 10 1.2 L4 12 63 0.1% 0.2% 0.2% Total savings -18.6 -21.0 -24.0 -20.0 -33A -38B -43.9 -49.5 -53.0 -59.5 -1205 -372.0 0.0% -F0,8% -11.9% Total present law expend's 251 284 279 287 321 346 373 404 438 475 - - - - - Savings as % of expends -7.A% -8.0% -8.6% -9.6% -10.6% -11.2% -18.8% -123% -12.3% -12.5% - - - - - Notes: 1. Floter to specification for description of provisions. 2. Extimates shown for each-provision are on a "stand alone" bank, that is. the Inancial Impact of that provision only. relative to present few. Totalsavings for the package reflect Interactions. 3 "Savings" ass defined as either expanditure reductions or Increases its premium revenues. 4. Emimates are prefininary and subjèct to change pending improved data and more refined methodologies. Importicular, estimates of interactions arrong proposals are very mugh. TOTAL P.04 Fle PROP1REV.XLS Option (2) abbrev page 1 Office of the Actuay Health Care Financing Admin. 2/23/99 02/13/99 10:41 202 331 9363 UNDP WASH, DC. J. 001/001 The Administrator United Nations Development Programm Suctainable human development undp 11 February 1999 Dear Mrs. Clinton, I would like to bring to your attention the very difficult position in which UNDP finds itself at this particular juncture. As you are aware, the Administration requested a very low figure, $80 million, (a dramatic drop of $25 mi ion from last year's request) for UNDP for FY 2000. I hope to secure your help in remuing UNDP from what is clearly a very negative signal being sent by the Administ tion to the United Nations, and most importantly, to the sustainable development work of the United Nations. When I communicated this news to Melanne Vervier on the eve of the budget disclosure, she indicated that you would do whatever you. could to help turn this situation around. It is most important that we support each agency at the highest possible level so that each may carry out its specific mantlate, be it for children, health, population, environment or development. I would therefore like to request your personal support so that UNDP can reach a level of $110 million for FY 2000. One possible avenue would be for the Administration to request supplemental funds that could be directed to UNDP. Our programme is hard at work both in Central America and in the West Bank and Gaza. Additional support is urgently required for our longer-term recovery and reconstruction initiatives in the aftermath of Hurricane Mitch. The recent Wye Accords underscore the need for our strengthened development efforts with the Palestinian people. I think it is absolutely critical that we find a way 10 restore funding to UNDP, and I know I can count on your good offices to achieve 1]1is goal. I look forward to talking with you at your earliest convenience. With best personal regards. Yours sincerely, Jane. Amtave Speth James Gustave Speth First Lady Hillary Rodham Clinton Office of the First Lady The White House Washington, DC 20500 One United Nations Plaza New York, NY 10017 President Clinton Continues to Fight to Improve the Health of Our Nation's Children Children and Prescription Drug Testing. Today's announcement requiring manufacturers to do studies on pediatric populations for new prescription drugs and those currently on the market builds on an impressive array of children's initiatives advocated by President Clinton. Children and Insurance Coverage. The President fought hard to ensure that the Balanced Budget Act included $24 billion -- the largest investment in children's health care since the passage of Medicaid in 1965 -- to provide meaningful health care coverage to as many as five million of our nation's uninsured children. He also fought to include revenue from a 20 cent tobacco tax which will not only further reduce the number of uninsured children, but it will also serve as a financial barrier to help prevent our children from starting to smoke in the first place. Children and Tobacco. The President issued guidelines to eliminate easy access to tobacco products and to prohibit companies from advertising tobacco to kids. Each day about three thousand children become regular smokers and 1,000 of them will die from a tobacco-related illness. According to former FDA Commissioner David Kessler, the possibility of a comprehensive, public health oriented settlement with the tobacco industry could not have come about without the President's leadership in this area. Children and Insurance Reform. By signing the Kassebaum-Kennedy bill into law last year, the President helped millions of American children keep their health care coverage when their parents lose or change jobs. Children and Juvenile Diabetes. The President fought to include $150 million ($30 million annually for five years) for research to help find the cure for diabetes. Americans with this disease often suffer severe consequences, such as blindness and kidney disease, even when they receive the best treatment and care. The HHS Secretary will have discretion to target the new funds toward the best scientific opportunities. This represents the largest single new investment in Juvenile Diabetes. Children and Immunization. As the President recently announced, over 90 percent of America's toddlers in 1996 received the most critical doses of each of the routinely recommended vaccines -- surpassing the goal set by the President in 1993. Children and the Environment. Earlier this year, the President signed an Executive Order to reduce environmental health and safety risks to children by requiring agencies to strengthen policies and improve research to protect children and ensure that new regulations consider special risks to children. Children and Medicaid. Throughout his Administration, the President has fought to preserve and strengthen the Medicaid program; its coverage of about 20 million children, makes it the largest single insurer of children. The Administration has partnered with states through Medicaid waivers to expand coverage to hundreds of thousands of children. Draft THE 1999 DEMOCRATIC AGENDA Continue on the path of. fiscal responsibility to keep our economy growing; Invest now to meet the challenges of the 21st century, including quality education for children and secure retirement and quality care for seniors; and enable families to meet their responsibilities at home and at work. Invest the Surplus to save Social Security and Medicare and Pay Down the Debt Save Social Security: Reserve 62 percent of the projected budget surpluses to save Social Security until 2055; Allow the trust fund to invest about one-fifth of the transferred surpluses in the private sector to achieve higher returns for Social Security just as any state or local government, or private pension does. Strengthen Medicare for the 21st Century: Reserve 15 percent of the projected surpluses for Medicare, ensuring the Medicare Trust Fund is secure for 20 years, and achieve broader reforms -- including a covering prescription drugs. Pay Down the Debt: Investing 77% of the surplus into Social Security and Medicare will reduce the national debt to the lowest level since 1917 and save taxpayers billions of dollars in interest charges. Quality Education: Modernize Schools, Reduce Class Size and Provide Accountability School Modernization: Federal tax credits will enable state and school districts to modernize and renovate 6,000 local public schools, to improve learning conditions, end overcrowding and make room for smaller classes. Smaller Classes: Finish the job of hiring 100,000 new teachers over the next seven years to reduce class size in grades 1-3 to a national average of 18, making sure that every child gets a solid foundation in the basics. Teacher Training and Recruitment: Increase support for teacher training in subject- matter knowledge and teaching expertise; new incentives to recruit highly qualified teachers. Build Accountability Measures into federal support for education to ensure that school districts and states provide every student with a high quality education, building on proven reforms now being implemented in states and cities Education Technology: Continue to provide schools with Internet capacity and resources for teacher training and integrating technology into the curricula; protect the e- rate discount for schools and libraries and new teacher training Secure Retirement and Quality Care for Seniors Social Security: In addition to devoting 62% of the surplus to the Social Security system, we will work to enact further policies to strengthen the system, reduce poverty among elderly widows, and eliminate the earnings limit within the context of Social Security reform. Medicare: Reserve 15% of the surplus to strengthen Medicare; work to enact further changes to strengthen and improve the Medicare program, including badly needed prescription drug benefit. Protect Pensions Expand Pension Benefit Coverage: Create a new plan that will make it easier for small businesses to start private pension plans that provide predictable and secure benefits, and for employees to save in IRAs through payroll deductions; Permit employees to rollover benefits from different types of retirement plans. Strengthen Women's Retirement Security: Allow workers to count time taken under the Family and Medical Leave Act toward their retirement benefits. Call for pension plans to offer a 75 percent joint and survivor annuity option -- so that families can choose to reduce benefits while both are alive in order to guarantee that a surviving spouse would get higher benefits; Targeted Tax Cuts for Retirement Savings, Child Care, and Long Term Care Retirement Savings: Devote 12% of the surplus to USA Accounts, enabling working families to save for their own retirement in private accounts. Child Care: Provide greater tax relief for working families who pay child care expenses in order to work, tax credit credits to businesses that provide child care services, and tax credits for stay at home parents. Long Term Care: Provide $1,000 tax credits to families who provide care for elderly and disabled family members; support caregivers; and provide long term care insurance for federal employees. Enable Families to Succeed at Home and at Work Protecting Patients through a Strong, Enforceable Patients Bill of Rights: The Patients' Bill of Rights should contain a range of protections, including guaranteed access to needed specialists, access to emergency room services when and where the need arises, access to a meaningful independent and external appeals process for consumers to resolve differences with their health plans, and the right to be compensated when a health plan's decision causes a patient to be harmed or die. Continue to Expand Access to Quality, Affordable Health Care by enabling Americans age 62-65 and displaced and retired workers ages 55 to 65 to buy into Medicare if they lose coverage. Ensure Opportunity for Americans with Disabilities by enabling workers with disabilities to buy into Medicaid and Medicare a $1,000 tax credit and support for assistive technologies. Targeted Tax Cuts for Retirement Savings, Child Care, and Long Term Care Child Care: Improve the accessibility and safety of child care through expansion of the child care and development block grant to help working families meet costs and improve quality by increased training and support services for care givers. After School Care: increase after school care to enable 1.1 million children each year to participate in after school and summer school programs by using public school facilities and existing resources. 50,000 More Cops with 21st Century Tools More Police on the Streets: The 21st Century Policing Initiative builds on the successful COPS program by helping communities hire and redeploy up to 50,000 more law enforcement officers over five years, with an effort to target new police officers to crime "hot spots" and to help retain those officers recently hired. Raise the Minimum Wage and Enforce Fair Pay Raise the Minimum Wage: Recognize the value of work and support working families; give millions of Americans a pay raise by increasing the minimum wage. Ensure Equal Pay: Help guarantee equal pay for women and men by stronger enforcement of equal pay laws, ending wage discrimination, and improving access to wage information for all workers. Protect the Environment and Improve Livability Protect Our Environment and our families' safety by ensuring clean air, clean water, and safe food; continue accelerated toxic waste clean up and make polluters pay; protect our national parks and other great places. Improve our Parks and Help Communities Improve Livability: Expand federal efforts to save America's natural treasures. Provide new tools and resources to states and local governments to help communities across America grow in ways that ensure a high quality of life and preserve green space for future generations. Crackdown on Crimes Against Seniors Give Law Enforcement Officials Additional Tools to prosecute criminals who target seniors, such as telemarketing fraud and health care, and strengthen penalties for criminal behavior that harms seniors physically and financially. Reduce Unnecessary and Illegal Medicare Costs by cracking down on fraud and abuse in the Medicare system. Privacy Protect Individuals' most personal records by ensuring appropriate treatment for medical records, affording notice and opportunity for consent to sharing of financial information, and enhancing enforcement to prevent abuses. THE WHITE HOUSE WASHINGTON March 15, 1999 TO: Steve R., Gene S., Bruce R., Larry S., Elena K., Jack L., Dan M. David B., Melanne Y Sarah B., Neera T., Janet M. FROM: Chris J. and Jeanne L. RE: BREAUX-THOMAS MEDICARE PLAN Attached is the final Breaux-Thomas Medicare plan. They released it at a 5pm press conference. Highlights of the plan include: No specific plan for Medicare financing: The plan contains no options for raising new revenue for Medicare specifically it does not include the President's proposal to dedicate part of the surplus to Medicare. Instead, it states that once Medicare appears to be close to becoming insolvent (using a new definition), Congress would be notified. This would result in a Congressional debate on legislation to authorize any additional funding. No meaningful prescription drug benefit: The plan would require private managed care plans, Medigap, and possibly Medicare fee-for-service to offer a drug benefit, but only provides a subsidy for that coverage for people below 135 percent of poverty. This is troubling because it moves Medicare towards a means-tested, Medicaid-like program, and would probably result in large adverse selection in the unsubsidized Medicare fee-for- service option. Age eligibility increase without a viable insurance alternative: Although there is a suggestion that vulnerable sick people ages 65 to 67 would get Medicare, the proposal explicitly states that the Medicare buy-in would be unsubsidized and would not begin at 62 (which is truly conforming to Social Security). This plan would likely lead to an increase in the uninsured. No income-related premium: This was dropped since the last draft -- reportedly because some Republicans considered it too similar to a tax (since it is administered through Treasury). There are probably other issues that we have not yet noticed; we will be working on a more complete memo of the issues for the morning. Please call or page with questions. SUMMARY OF BREAUX/THOMAS PROPOSAL Medicare Board: The Board would provide information to beneficiaries, negotiate with plans, compute payments to plans (including risk, geographic, and other adjustments), and compute beneficiaries premiums. Board would approve plan service areas and benefit package designs. Benefits Package: The standard benefits package is specified in law and would consist of all services covered under the existing Medicare statute. Plans could establish their own rules as to how the benefits would be provided. Board approval would be required for all benefit design offerings and the Board would allow variation only within a limited range as the risk adjusters were proven over time. Prescription Drugs: Private Plans All private plans would be required to offer a high option that includes at least the standard benefits package plus coverage for prescription drugs. Low-Income The proposal would immediately extend coverage of prescription drugs for beneficiaries under 135 percent of poverty ($10,568/individual) under Medicaid with full federal funding of the additional cost. That coverage could be provided through high option plans when the premium support system was implemented. Fee-For-Service The government-run FFS plan could offer a high option plan which includes prescription drugs. The Medicare Board would approve the benefit package as it does for private plan offerings. HCFA would work with third-party contractors to offer its high option plan. Government contracts would be based on prices commonly available in the market, without recourse to price controls or rebates. Medigap All Medigap plans would include basic coverage for prescription drugs. One plan would be drug-only. Plans would vary regarding the degree Medicare coinsurance was covered. Premium Formula Basics: Beneficiaries would pay 12 percent of the premium for the standard benefits package on average, pay no premium for plans less than about 85 percent of national weighted average, and pay all of the additional premium for plan premiums above national weighted average. Only the cost of standard benefits (Medicare covered services) would count toward the computation of the national weighted average premium. Plans with only a high option would be required to separate out the cost of extra benefits in their submission to the Board. In areas where only the government-run fee-for-service plan operated, the beneficiary obligation would be limited to the lower or 12 percent of the fee-for-service premium or 12 percent of the national weighted average premium. Fee-for-Service Benefits: The government-run fee-for-service plan would have a $400 combined deductible, indexed to the growth in Medicare costs. 10 percent coinsurance would be charged for home health, laboratory services, and certain other services not currently subject to coinsurance. No coinsurance would be charged for inpatient hospital stays and preventive care. Special Payments: Direct Medical Education (DME) would be carved out of Medicare. DME funding would continue through either a mandatory entitlement or multi-year discretionary appropriation program separate from Medicare. The proposal would also recommend exploring funding Indirect Medical Education (IME) and other non-insurance subsidies outside of the Medicare program and financing those items through a mandatory or multi-year discretionary appropriation program. Any special payments remaining in Medicare would not be included in the calculation of premiums for the government-run fee-for-service plan or private plans. Retirement Age: The normal age of eligibility would be gradually raised from 65 to 67 to conform with that of Social Security. A non-subsidized buy-in would be available at age 65. Congress should develop a special category of eligibility based on specific needs-based criteria (i.e. ADLs) for individuals between 65 and the then-current eligibility age. Long-Term Care: Long-term care issues should be separated from Medicare (an acute care program), and long-term care improvements should be made through pension, Social Security, and investment reforms. The proposal would require a study of various long-term care issues. Financing: Part A and Part B trust funds should be combined into a single Medicare Trust Fund and a new concept of solvency for Medicare should be developed. In any year in which the general fund contributions are projected to exceed 40% of annual total Medicare outlays, Congress would be required to authorize any additional contributions to the Medicare Trust Fund. This new test (40% of outlays) would probably not be reached until after 2005. Even if general revenue contributions were limited to 40% of program outlays, this proposal would extend solvency to 2013 (2017 under CBO's new baseline.) Budgetary Impact: Between 2000 and 2009, this proposal would save approximately $100 billion. Over the longer term, the proposal would reduce the growth of Medicare spending by approximately 1 percent a year. Although the savings would accumulate slowly over time, by 2030 the annual budgetary savings would range from $500 to $700 billion. SUMMARY OF BREAUX/THOMAS PROPOSAL Medicare Board: The Board would provide information to beneficiaries, negotiate with plans, compute payments to plans (including risk, geographic, and other adjustments), and compute beneficiaries premiums. Board would approve plan service areas and benefit package designs. Benefits Package: The standard benefits package is specified in law and would consist of all services covered under the existing Medicare statute. Plans could establish their own rules as to how the benefits would be provided. Board approval would be required for all benefit design offerings and the Board would allow variation only within a limited range as the risk adjusters were proven over time. Prescription Drugs: Private Plans All private plans would be required to offer a high option that includes at least the standard benefits package plus coverage for prescription drugs. Low-Income The proposal would immediately extend coverage of prescription drugs for beneficiaries under 135 percent of poverty ($10,568/individual) under Medicaid with full federal funding of the additional cost. That coverage could be provided through high option plans when the premium support system was implemented. Fee-For-Service The government-run FFS plan could offer a high option plan which includes prescription drugs. The Medicare Board would approve the benefit package as it does for private plan offerings. HCFA would work with third-party contractors to offer its high option plan. Government contracts would be based on prices commonly available in the market, without recourse to price controls or rebates. Medigap All Medigap plans would include basic coverage for prescription drugs. One plan would be drug-only. Plans would vary regarding the degree Medicare coinsurance was covered. Premium Formula Basics: Beneficiaries would pay 12 percent of the premium for the standard benefits package on average, pay no premium for plans less than about 85 percent of national weighted average, and pay all of the additional premium for plan premiums above national weighted average. Only the cost of standard benefits (Medicare covered services) would count toward the computation of the national weighted average premium. Plans with only a high option would be required to separate out the cost of extra benefits in their submission to the Board. In areas where only the government-run fee-for-service plan operated, the beneficiary obligation would be limited to the lower or 12 percent of the fee-for-service premium or 12 percent of the national weighted average premium. Page 1 March 15, 1999 (4:09PM) BUILDING A BETTER MEDICARE FOR TODAY AND TOMORROW I. INTRODUCTION This recommendation is in three parts: the design of a premium support system, improvements to the current Medicare program, and financing and solvency of the Medicare program. We believe it is important to address the current program now because of the transition time necessary to implement this premium support system. We assume the enactment of this proposal in 1999 and that the premium support system would be fully operational in 2003. We believe a premium support system is necessary to enable Medicare beneficiaries to obtain secure, dependable, comprehensive high quality health care coverage comparable to what most workers have today. We believe modeling a system on the one Members of Congress use to obtain health care coverage for themselves and their families is appropriate. This proposal, while based on that system, is different in several important ways in order to better meet the unique health care needs of seniors and individuals with disabilities. Our proposal would allow beneficiaries to choose from among competing comprehensive health plans in a system based on a blend of existing government protections and market-based competition. Unlike today's Medicare program, our proposal ensures that low income seniors would have comprehensive health care coverage. Because the implementation of a premium support system will take a number of years, we recommend immediate improvements to the current Medicare program. In Section II we outline the incremental improvements to enhance the beneficiaries' security and quality of care now. We recommend immediate federal funding of pharmaceutical coverage through Medicaid for seniors up to 135% of poverty ($10,568 for an individual and $13,334 for a couple). This would also expand beneficiary participation in currently available subsidies for premiums and cost-sharing. In reviewing the three parts of this proposal, it is important to keep in mind the different government roles in the premium support system and in current law. We believe the guarantee our society makes to every senior is to ensure that they can obtain the highest quality health care, and that their health care coverage not be allowed to fall behind that available to people in their working years. We believe that our society's commitment to seniors, the Medicare entitlement, can be made more secure only by focusing the government's powers on ensuring comprehensive coverage at an affordable price rather than continuing the inefficiency, inequity, and inadequacy of the current Medicare program. Page 2 March 15, 1999 (4:09PM) I. PREMIUM SUPPORT SYSTEM TO PROVIDE COMPREHENSIVE COVERAGE The Medicare Board A Medicare Board should be established to oversee and negotiate with private plans and the government-run fee-for-service plan. Some examples of the Board's role are: direct and oversee periodic open enrollment periods; provide comparative information to beneficiaries regarding the plans in their areas; transmit information about beneficiaries' plan selections and corresponding premium obligations to the Social Security Administration to permit premium collection as occurs today with Medicare Part B premiums; enforce financial and quality standards; review and approve benefit packages and service areas to ensure against the adverse selection that could be created through benefit design, delineation of service areas or other techniques; negotiate premiums with all health plans; and compute payments to plans (including risk and geographic adjustment). This Board would operate under a government charter that would describe its responsibilities and operating standards including the ability to hire without regard to civil service requirements and salary restrictions. Ensuring Plan Performance and Dependability All plans (private plans and the government-run FFS plan) would compete in the premium support system; all plans would have Board-approved benefit designs and premiums. The Board would ensure that the benefits provided under all plans are self-funded and self-sustaining, determining whether plan premium submissions meet strict tests for actuarial soundness, assessing the adequacy of reserves, and monitoring their performance capacity. Management of Government-run Fee-for-service in Premium Support The government plan would have to be self-funded and self-sustaining and meet the same requirements applied to all private plans, including whether its premium submissions meet strict tests for actuarial soundness, the adequacy of reserves, and performance capacity. Cost containment measures would be necessary. The provisions of the Balanced Budget Act of 1997 should be extended, or comparable savings achieved. In any region where the price control structure of the government run plan is not competitive, the government-run fee-for-service plan could operate on the basis of contracts negotiated with local providers on price and performance, just as is the case with private plans. The government plan would be run through contractors as it is today; contractors in one region would be able to bid in other regions; the Board should have powers to assure that the government-run plan would not distort local markets. Page 3 March 15, 1999 (4:09PM) Benefits Package A standard benefits package would be specified in law. This benefits package would consist of all services covered under the existing Medicare statute. Plans would be able to offer additional benefits beyond the core package and plans would be able to vary cost sharing, including copay and deductible levels, subject to Board approval. Benefits would be updated through the annual negotiations process between plans and the Board, although the Board would not have the power to expand the standard benefit package without Congressional approval. Health plans would establish rules and procedures to assure delivery of benefits in a manner consistent with prevailing private standards and procedures offered to employer groups and other major purchasers. The Medicare Board would approve benefit offerings and could allow variation within a limited range, for example not more than 10% of the actuarial value of the standard package, provided the Board was satisfied that the overall valuation of the package would be consistent with statutory objectives and would not lead to adverse or unfavorable risk selection problems in the Medicare market. New benefit to be instituted in the premium support system: Outpatient prescription drug coverage and stop-loss protection In Private Plans: Private plans would be required to offer a high option that includes at least Medicare covered services plus coverage for outpatient prescription drugs and stop-loss protection. Plans would be able to vary copay and deductible structures. Minimum drug benefits for high option plans would be based on an actuarial valuation. High option and standard option plans each would be required to be self-funded and self-sustaining. In Government-run Fee-For-Service Plan: The government-run fee-for-service plan would be required to offer high option (including outpatient prescription drugs and stop-loss) in addition to standard option plans. The Medicare Board approval process would be the same as for private plans. High option and standard option plans would be required to be separately self-funded and self-sustaining. Government contracts would be based on prices commonly available in the market, without recourse to price controls or rebates. Comprehensive coverage for low-income beneficiaries: Coverage would be provided through high option plans. The federal government would pay 100% of the premiums of the high option plans at or below 85% of the national weighted average premium of all high option plans for all eligible individuals up to 135% of poverty ($10,568 for an individual and $13,334 for a couple) on a fully federally funded basis. This financial support does not limit Page 4 March 15, 1999 (4:09PM) these beneficiaries' choice of plans nor restrict plans' design with regard to cost- sharing or other flexibility authorized by the Board. State would maintain their current level of effort, but the federal government would pay 100% of additional costs for these individuals. In this context, Congress should review DSH payments to ensure that double payments do not occur. Premium Formula Basics On average, beneficiaries would be expected to pay 12 percent of the total cost of standard option plans. For plans that cost at or less than 85 percent of the national weighted average plan price, there would be no beneficiary premium. For plans with prices above the national weighted average, beneficiaries' premiums would include all costs above the national weighted average. Only the cost of the standard package would count toward the computation of the national weighted average premium. Plans with a high option, whether private plans or government-run, would separately identify the incremental costs of benefits beyond the standard package in their submissions to the Board, and the government contribution would be calculated without regard to the costs of these additional benefits. Premium for government-run fee-for-service plans The government-run fee-for-service plan would be treated the same as private plans. Government-run plan premium excludes costs of special subsidies in premium calculation All non-insurance functions and special payments now in Medicare would not be included in calculation of premiums for the government-run FFS plan or private plans. Guaranteed premium levels where competition develops more slowly In areas where no competition to the government-run fee-for-service plan exists, beneficiaries' obligations would be no greater than 12 percent of the FFS premium or the national weighted average, whichever is lower. The Medicare Board should periodically review those areas with a fixed percentage premium to ensure that the fixed percentage premium is not anti-competitive. Medicare's Special Payments in a Premium Support System Congress should examine all non-insurance functions, special payments and subsidies to determine whether they should be funded through the Trust fund or from another source. For example, payments for Direct Medical Education (DME) would be financed and distributed independent of a Medicare premium support system. Since the Part A and Part B trust funds would be combined and the traditionally separate funding sources of payroll taxes and general revenues would be blurred, Congress should provide a separate mechanism for continued funding through either a mandatory entitlement or multi-year discretionary appropriation program. On the other hand, Indirect Medical Education (IME) presents a unique problem since it is difficult to identify the actual statistical difference in costs between teaching and non-teaching hospitals. Page 5 March 15, 1999 (4:09PM) Therefore, for now Congress should continue to fund IME from the Trust Fund as an adjustment to hospital payments. II. IMMEDIATE IMPROVEMENTS TO THE CURRENT MEDICARE PROGRAM AND OTHER ASPECTS OF SENIORS HEALTH CARE SPENDING Provide Outpatient Prescription Drug Coverage for 3 million more low-income beneficiaries Immediately provide federal funding for coverage of prescription drugs under Medicaid for beneficiaries up to 135 percent of poverty ($10,568 for an individual and $13,334 for a couple). This would also expand beneficiary participation in currently available subsidies for premiums and cost-sharing. All funding obligations related to the coverage under this provision would be federal. Improve access to outpatient prescription drug coverage for seniors Revise federal directives to National Association of Insurance Commissioners (NAIC) to develop new Medigap state model legislation immediately. All private supplemental plans would include basic coverage for prescription drugs. One plan would be a prescription drug-only plan. Combine Parts A and B Health care delivery changes have blurred the distinctions originally contemplated when Parts A and B of Medicare were enacted. Parts A and B should be combined in a single Medicare Trust Fund. (See Section III on Financing and Solvency.) Lower deductible for 8 million beneficiaries The current Medicare program subjects beneficiaries entering the hospital to extremely high costs just at a time when they face the many other expenses associated with serious illness. Virtually no private health plan imposes such costs. We propose to combine the current Part A ($768) deductible and B ($100) deductible, and replace it with a single deductible of $400, which should be indexed to growth in Medicare costs. Improve utilization of health care services A fee-for-service plan is best maintained by financial incentives, without which costs spiral out of control or freedom of choice must be restricted. To protect against unnecessary rises in beneficiary Part B premiums, 10% coinsurance would be established for all services except inpatient hospital stay and preventive care, and except where higher copays exist under current law. Revise federal directives to NAIC to develop new state model legislation to conform to the changes proposed for Medicare cost-sharing. These directives should also be Page 6 March 15, 1999 (4:09PM) designed to achieve more affordable and more efficient supplemental insurance and to minimize Medicare outlays. The new single Medicare deductible and coinsurance schedule would be insurable in part or in whole. Eligibility Age Medicare eligibility age should be conformed to that of Social Security. A non-subsidized buy- in should be available at age 65. In addition, Congress should develop a special category of eligibility based on specific needs-based criteria, for example selected activities of daily living, for individuals between age 65 and then-current eligibility age. III. FINANCING AND SOLVENCY The changes proposed in this document are intended to put Medicare on surer financial footing by creating savings due to competition, efficiency and other factors, and by slowing the growth in Medicare spending. In addition, these reforms would result in Medicare offering a benefit package that is more comparable to health care benefits offered in the private sector and would enhance our ability to meet our commitment to today's and future beneficiaries. Without these changes, quality of care could suffer, and significantly greater revenues and/or beneficiary sacrifices would be required. Beneficiaries and the taxpayers would not receive the greatest value for the total health dollars spent on seniors' behalf. Medicare's financing needs would be dictated by the Medicare growth rate achieved under the premium support system. By moving to a premium support system, Medicare's growth rate would be reduced by 1 to 1.5 percentage points per year from the current long-term annual growth rate of 7.6 percent (Trustees Intermediate) or 8.6 (Commission's No Slowdown Baseline.) If this reduction in growth rate can be achieved, the fiscal integrity and Medicare would be significantly improved. Even if the estimated reduction in growth rate is achieved, Medicare will require additional resources as the percent of population that is eligible for Medicare increases. As revenue is needed, how much should be funded through the payroll tax, through general revenue, and through beneficiary premiums? The answer to this question is difficult because it would require knowing today the health care system of the future. We do not know what the future holds in terms of the evolution of the health care delivery system, or the impact that technology will have on health care costs. At the Commission's first meeting, Federal Reserve Chairman Alan Greenspan said that "the trajectory of health spending in coming years will depend importantly on the course of technology which has been a key driver of per-person health costs" Yet he went on to underscore what could be the absurdity of attempting now to determine funding levels necessary decades into the future "technology cuts both ways with respect to both saving medical expenditures and Page 7 March 15, 1999 (4:09PM) potentially expanding the possibilities in such a manner that even though unit costs may be falling, the absolute dollar amounts could be expanding at a very rapid pace. One of the major problems that everyone has had with technology--and I could allude to all sorts of, forecasts over the most recent generations--one of the largest difficulties is in forecasting the pattern of technology. It is an extremely difficult activity." Notwithstanding the magnitude of uncertainty contained in the task, the statute establishing the Commission directed us to recommend measures to attain the long-term "solvency" of the Medicare program. Because of recent history the meaning of "solvency" has come under question. We believe a new measure of solvency must be developed that couples the uncertainty inherent in the task with the real need for the public to evaluate the cost of Medicare and how we should choose to fund this program over time. The solvency test that has been applied to Social Security is not an apt model for Medicare. Social Security Trust Funds are funded exclusively through payroll taxes; Medicare is paid for by a combination of payroll taxes, general revenue and beneficiary premiums. These ratios have changed over time such that a greater portion of program expenses is now paid by general revenues and a relatively smaller portion is paid by payroll taxes and beneficiary premiums. In addition, the payroll tax supporting the OASDI Trust Funds is limited both by its rate and the wage base on which that rate is applied. No portion of Medicare's funding contains these limitations. In Medicare, there is no cap on the wage base; the Part A Trust Fund is funded by a payroll tax of 2.9% on all earnings, and pays only for the Part A benefits of Medicare. Medicare's Part B benefits are paid 75% by general revenues and 25% by beneficiaries. Consequently, the historic concept of Medicare's solvency is one that has been partially and inappropriately borrowed from Social Security and has never fully reflected the fiscal integrity, or lack thereof, of the Medicare program. In Medicare, "solvency" has meant only whether the Part A Trust Fund outlays were poised to exceed Part A reserves and collections. That is all. Recently even this partial proof of fiscal integrity has been shattered. The notion of Part A "solvency" or rather "insolvency" has been used to shift more program costs to the general fund. An act of Congress shifted major home health expenditures from Part A to Part B in 1997, thus extending the fiction of the Part A Trust Fund "solvency" from 2002 through 2008 by shifting obligations to the general fund. The general fund, in great part, became the source of Part A "solvency". The ever increasing estimates of general fund exposure should be part of any definition of solvency. Absent reform, general fund exposure jumps from 37% of program funding in FY2000 to 43% in FY2005 and 49% in FY2010. General fund demand will increase from $92 billion in FY2000 to $156 billion in FY2005 to $261 billion in FY2010. Page 8 March 15, 1999 (4:09PM) Consequently, the "solvency" of the Part A Trust Fund is not useful as a guide to policy making or even as a tool to educate the public on the security and financial condition of the Medicare program. Therefore, Part A and Part B Trust Funds should be combined into a single Medicare Trust Fund and a new concept of solvency for Medicare should be developed. This concept should more accurately reflect the implications of the program's financing structure, i.e., the ratio of relative financing burdens on the general fund, the Hospital Insurance payroll tax, and the premiums beneficiaries pay. Because beneficiary premiums and the payroll tax rate can only be amended by law, and have proved very difficult to modify over time, the only meaningful solvency test of this entitlement program is one based on the amount of general revenues needed to fund program outlays. This could be referred to as a programmatic solvency test. Congress should enact this revised definition of Medicare solvency so that decisions can be made in the context of competing demands for general revenue. Congress should require the Trustees to publish annual projections regarding the ratio in program financing. In any year in which the general fund contributions are projected to exceed 40% of annual total Medicare program outlays, the Trustees would be required to notify the Congress that the Medicare program is in danger of becoming programmatically insolvent. The Trustees Report should provide for necessary and important public debate leading to potential adjustments to the payroll tax and/or the beneficiary premium as well as any adjustment of the general fund devoted to Medicare. Congressional approval would be required to authorize any additional contributions to the Medicare Trust Fund. With the reforms contemplated under this proposal, that new test would probably not activated until after 2005. Even if we limit general revenue contributions to 40% of program outlays, however, this proposal would extend the solvency of Medicare to 2013. This calculation, based on the most recent CBO baseline, would indicate that solvency under this test would extend to 2017 or beyond. Long-term care The Commission recognizes that its proposal is focused on acute care, and does not address the issue of long-term care. In 1995, Americans spent an estimated $91 billion on long-term care, with 60 percent coming from public sources. Despite these large public expenditures, the elderly face significant uncovered liabilities. The Commission recommends that the Institute of Medicine conduct a study to 1) estimate future demands for long-term care; and 2) analyze the long-term care financing options available to seniors, including long-term care insurance, tax policy and community-based, state and federal government programs. To: Medicare Commission 3/14/99 From: Jeff Lemieux Subject: Cost estimate of March 14 proposal The attached estimate is based on the proposal specified below. The estimate is displayed in annual figures for the 10-year budget window used in the Senate (and slightly beyond). Long-term tables developed by the Modeling Task Force, which display the impact of the proposal using several different measures, are also included. In addition, a simulation of a combined trust fund is attached. The explanation of the basis of the estimate is limited to new items in the proposal. The February 17 estimate of the original Breaux proposal contains a general explanation of the premium support plan. Since the current proposal is similar to the nontraditional estimate on February 17, simulations of the impact on beneficiary premiums from that estimate continue to apply. DESCRIPTION OF THE PROPOSAL Medicare Board: The Board would provide information to beneficiaries, negotiate with plans, compute payments to plans (including risk, geographic, and other adjustments), and compute beneficiaries' premiums (collected via Social Security system as with Part B premiums now). Board approval would be required for plan service areas and benefit package designs. Benefits: The standard benefits package specified in law would consist of all services covered under the existing Medicare statute (Medicare covered services). Plans could establish their own rules as to how the benefits would be provided. Board approval would be required for all benefit design offerings and the Board would allow variation only within a limited range as the risk adjusters were proven over time. Prescription Drugs: Private Plans All private plans would be required to offer a high option that included at least the standard benefits package plus coverage for prescription drugs. The minimum drug benefit for high option plans would be based on an actuarial valuation, with standards and examples set by the Board. Low-Income The proposal would immediately extend coverage of prescription drugs to qualifying beneficiaries under 135 percent of poverty under Medicaid with full federal funding of the additional cost. That coverage could be provided through high option plans when the premium support system was implemented. (A special premium support schedule could be used to combine premium and drug subsidies for low- income beneficiaries.) Fee-For-Service The Health Care Financing Administration (HCFA) would be allowed to contract with or enter joint marketing arrangements with private insurers offering prescription drug benefits. That would allow a public/private high option plan or plans, with HCFA providing coverage for Medicare covered services and its private partner(s) providing coverage for drugs. HCFA's share of the premium in a public/private high option plan would simply be the premium for its standard option plan. In the longer run, HCFA would be allowed to transition the government-run fee-for-service plan to a more private- managed basis overall, possibly with different alternatives available regionally. Medigap The National Association of Insurance Commissioners would develop new model plans immediately under a federal directive. All plans would include basic coverage for prescription drugs. One plan would be drug-only. Plans would vary regarding the degree Medicare coinsurance was covered. Premium Formula Basics: Beneficiaries would pay 12 percent of the premium for the standard benefits package on average, pay no premium for plans less than about 85 percent of national weighted average, and pay all of the additional premium for plan premiums above national weighted average. (An example of this type of premium schedule was included in the estimate from February 17.) Although all plans would be available on the national premium schedule, only the cost of standard benefits (Medicare covered services) would count toward the computation of the national weighted average premium. Plans with only a high option would be required to separate out the cost of extra benefits in their submission to the Board for that purpose. If early versions of the risk adjuster would otherwise fail to prevent excessive premium differences between high and standard option plans, the Board's actuaries could require that differences in premiums reflect the difference in value of benefits offered for private plans with multiple benefit options. In areas where only the government-run fee-for-service plan operated, the beneficiary obligation would be limited to the lower of 12 percent of the fee-for-service premium or 12 percent of the national weighted average premium. Fee-for-Service Benefits: The government-run fee-for-service plan would have a $400 combined deductible, indexed to the growth in Medicare costs. Ten percent coinsurance would be charged for home health, laboratory services, and certain other services not currently subject to coinsurance. No coinsurance would be charged for inpatient hospital stays and preventive care. Management of the Government-Run Fee-for-Service Plan: All plans, private plans and the government-run fee-for-service plan, would compete in the premium support system; all plans would have premiums and would be available on the national schedule. The fee-for-service plan would have a premium like any other plan-it would adjust its premium in subsequent years based on its cost experience. The proposal recommends that efforts to contain costs in the fee-for-service plan continue. Toward that end, HCFA would be allowed to pursue competitive purchasing strategies in areas where its payments were not appropriate. The estimate assumes that the growth of fee-for-service spending would be moderated somewhat by a combination of HCFA and Congressional efforts. Without some such ongoing savings, the fee-for-service plan could gradually lose its competitive position with private plans. Special Payments (Education, Disproportionate Share, Rural Subsidies): Under the proposal, federal support for Direct Medical Education (DME) would be carved out of Medicare. DME funding would continue through either a mandatory entitlement or multi-year discretionary appropriation program separate from Medicare. Depending on the nature of the replacement program for DME, the federal budget as a whole might not be affected by the carve-out. The proposal would also recommend exploring funding disproportionate share hospitals (DSH) and Indirect Medical Education (IME) outside of the Medicare program and financing those items through a mandatory or multi-year discretionary appropriation program. Any special payments remaining in Medicare would not be included in premiums for the government- run fee-for-service plan or private plans. Retirement Age: The normal age of eligibility would be gradually raised from 65 to 67 to conform with that of Social Security. Congress would develop an exemption process for affected beneficiaries with special needs, such as those unable to work and otherwise get health coverage. Eligibility requirements under that exemption process would not necessarily be the same as the requirements for eligibility based on disability for those under 65, although the waiting period for eligibility based on disability could also be waived or shortened for those affected by the change. Long-Term Care: The proposal indicates that long-term care issues should be separated from Medicare (an acute care program). The proposal would require a study of various long-term care issues. The cost estimate does not include any impact on the budget from long-term care items. Financing: The proposal would implement a combined trust fund, with guaranteed general revenue funding to grow at the same rate as overall program costs if it otherwise would exceed 40 percent of the program's cost (without further Congressional approval). The initial balance in the combined fund would equal the balance in the Part A and Part B funds at the time of enactment. BUDGETARY IMPACT Table 1 lays out the estimate in the style of an annual Congressional cost estimate. The savings attributed to the individual policies result from a top-down ordering of the estimate. Premium support was estimated first, in the absence of any other policies. Then the subsequent policies were added one by one-the savings represent the incremental impact of that policy on Medicare spending. Because Medicare spending would be reduced compared with current law, premium collections from beneficiaries would be reduced as well. That is why the impact of the proposal on premiums is displayed as a cost item in the table-lower government premium collections reduce the budget surplus (or increase the deficit). Excluding the optional items, the proposal would be approximately budget neutral in the 5-year budget window between 2000 and 2004. That is because the new assistance for low-income beneficiaries would begin immediately, while the savings provisions would not be implemented until 2003. Over the 10 years between 2000 and 2009, the proposal would save approximately $100 billion. Tables 2-6 show the detailed cost estimate of the March 14 plan in the format developed by the Modeling Task Force. That format was designed to gauge the impact of proposals using many different measures. Because the Part A trust fund would be replaced by a combined fund, tables 2-6 do not show results for the Part A fund under the proposal. Over the longer term, the proposal would reduce the growth of Medicare spending by approximately 1 percent a year. Although the savings would accumulate slowly over time, by 2030 the annual budgetary savings would range from $500 to $700 billion. Table 7 shows the projected impact of a combined trust fund under the proposal, with general revenue funding growing at the same rate as program costs overall. As noted in the February 17 estimate, the growth of Medicare spending slowed significantly in 1998, and will probably remain slow in 1999. Reasons for the slowdown include payment restraints enacted in the Balanced Budget Act of 1997 and efforts to ensure compliance with billing rules spurred by enactment of the Health Insurance Portability and Accessibility Act of 1996 and other laws. Although those changes will reduce the projected path of Medicare spending in the next few years, they are not likely to slow the long-run growth of spending in the program. Therefore, the 30-year baselines used by the Commission remain appropriate. Because of interest payments, however, trust fund calculations can be greatly affected by short-run changes in spending or revenues. Estimates of the expected life of the Part A fund under current law will probably be extended from 2008 or 2009 to 2012 or 2013 by CBO and HCFA in the coming months. To be consistent with the latest estimates, the insolvency date of the combined trust fund in Table 7 should be extended by 3 or 4 years as well, to 2016 or 2017. BASIS OF THE ESTIMATE AND DISCUSSION Premium Support The basic estimate of the premium support plan is largely unchanged from the February 17 estimate. Tying the national average to the cost of Medicare covered services reduces transition costs by a small amount, increasing slightly the savings attributed to premium support. The provision protecting beneficiaries in areas with only one plan from paying more than 12 percent of the cost of that plan or the national weighted average would add slightly to the cost of the proposal. Requiring all plans to offer a high option plan and allowing the Board to maintain an appropriate price difference between plans' high and standard options until the risk adjuster was proven over time greatly reduces concerns about adverse selection in high option plans. Low-Income Subsidies Currently, state Medicaid programs cover drugs for only so-called dually-eligible Medicare beneficiaries, often limiting such coverage to those well under the poverty line. Medicaid covers Medicare premiums and cost sharing for those between the limit of Medicaid dual eligibility and the poverty line. Between 100 and 135 percent of poverty, Medicaid covers Medicare premiums only. The cost of such Medicaid coverage under current law is split between the states and the federal government. About 50 percent of beneficiaries between the limit of dual eligibility and the poverty line participate in premium and cost sharing subsidies; about 20 percent of beneficiaries between 100 and 135 percent of poverty participate. This estimate assumes that the federal government would pay 100 percent of the cost of extending drug coverage to qualifying beneficiaries under 135 percent of poverty via the Medicaid program. (States would continue to be responsible for their share of the cost of drug coverage for dually-eligible beneficiaries.) In addition, the federal government would make grants to the states in amounts set to cover 100 percent of the cost of the extra participation in the current assistance programs (for premiums and cost sharing) that the new drug coverage would cause. The estimate assumes that the participation rate for those under 135 percent of poverty, but not dually eligible, would be 60 percent. Thus the federal government would effectively cover the cost of expanding participation for those not dually eligible but under poverty from 50 to 60 percent, and from 20 to 60 percent for those between 100 and 135 percent of poverty. Management of the Fee-for-Service Plan In the short run, the proposal would allow the government-run fee-for-service plan to partner with private plans to offer drug benefits under one high option premium. The estimate assumes that such partnerships would not involve HCFA regulation of that industry. The estimate assumes that a combination of HCFA and Congressional initiatives would slow the growth of spending in the fee-for-service program somewhat. That slowdown was explained in the description of the nontraditional estimate of February 17. The estimated impact of the specified cost sharing changes in the fee-for-service plan is shown separately. Financing The Part A fund covers only part of Medicare spending, and an act of Congress recently aided the fund simply by transferring a portion of its spending out of Part A into Part B (which is funded mostly by general revenues). Current budget proposals would transfer additional funds from the general Treasury to the Part A fund in order to postpone its insolvency date. Because the Part A fund never covered all of Medicare, and because of the recent and proposed transfers of obligations and funds, the Part A fund no longer adequately summarizes the financial condition of the Medicare program. A combined fund could make it more clear who pays for Medicare and would allow a more transparent discussion of how to aid Medicare's finances. Table 1. March 14 Proposal (by calendar year) 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 00-04 00-09 Cost (+) or Savings (-) in Billions of Dollars 0 -2 -4 -6 -9 -11 -15 -19 -23 -29 -35 -42 -5 -65 Premium Support 0 0 Drug Coverage up to 135 Percent of Poverty 11 2 2 2 3 3 3 3 4 4 5 5 6 6 7 12 31 Extra Participation in Current Low-Inc. Programs 12 2 2 2 3 3 3 3 4 4 4 4 5 5 5 12 30 Cost sharing Changes and Medigap 0 0 0 -1 -2 -3 -3 -4 -5 -5 -6 -7 do do -4 -24 -5 -5 -5 -5 6 9 -6 -7 -7 -7 -9 -36 Removal of DME 13 0 0 0 -4 Age of Eligibility 0 0 0 -1 -1 -1 -1 -2 -2 -3 -4 -4 -5 -5 -1 -11 Slowdown of Growth in Govt FFS plan 14 0 0 0 -1 -2 -4 -5 -7 -9 -10 -12 -14 -17 -19 -4 -39 Premiums 0 0 0 -2 -1 0 1 2 4 5 7 9 11 13 -4 9 Limit Enrollee Share to 12% in Areas Where There is no Alternative to the FFS Plan 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 3 Total 4 4 5 -6 is -11 -16 -20 -24 -29 -34 -41 -48 -55 -1 -102 Average Monthly Premium: Government-run FFS plan $76 $80 $84 $89 $93 $98 $103 $108 $114 $119 $125 Government-run plan in no alternative areas $75 $79 $84 $88 $92 $96 $101 $106 $111 $116 $120 Private plans $75 $79 $82 $86 $90 $93 $97 $102 $106 $110 $114 Average of all plans $75 $79 $84 $88 $92 $96 $101 $106 $111 $116 $120 Monthly Part B Premium under Current Law $71 $77 $84 $91 $98 $106 $115 $123 $132 $141 $151 Source: Medicare Commission Staff. Notes: Stacking order is from top to bottom. Except for premium interaction, can peel off from bottom to top without affecting other items. Estimate assumes enactment in 1999, with implementation of the premium support system and most other policies in 2003. The estimate assumes that 30% of beneficiaries were in areas where FFS was the only alternative in 2003. Over time, that percentage would gradually fall; if national private plans developed, it would fall to zero. In this time period, the results are approximately the same using either of the Commission's baselines. The premium support schedule is calibrated to Medicare spending after the home health transfer is fully phased in (2006). \1 Assumes 100% federal funding with a state maintenance of effort for dually-eligible beneficiaries. Participation rate assumed to be about 60 percent. \2 Assumes 100% federal funding for the cost of expanded participation in current assistance (premiums and cost sharing). 13 Savings to Medicare, but not necessarily to the overall budget. \4 Follows the method of the nontraditional estimate of Feb. 17, which assumed that the fee-for-service plan would compete to some extent. Table 2. March 14 Proposal DRAFT 14-Mar-99 Medicare Medicare Medicare as Medicare Part A or Premiums as Budgetary Spending Spending as a Percent of Spending Combined a Percent of Costs (+) or Growth a Percent of Federal (in billions of Fund Beneficiaries' Savings (-) Rate, 2000- GDP /1/2 Revenues dollars) /3 Insolvency /4 Income (in billions) /5 2015 2030 2015 2030 2015 2030 2015 2030 2015 2030 2015 2030 Baselines Trustees Intermediate 8.2% 7.6% 4.4% 6.3% 19% 28% 801 2,212 2008 7% 7% 0 0 No Slowdown 8.3% 8.6% 4.5% 8.5% 19% 38% 817 2,972 2008 7% 10% 0 0 Viability Standard Based on Spending Slow Growth of Per Beneficiary Spending to that of Per Capita GDP Trustees Intermediate 6.0% 6.2% 3.2% 4.3% 14% 19% 591 1,501 ~2028 5% 5% -182 -615 No Slowdown 6.0% 6.2% 3.2% 4.3% 14% 19% 591 1,501 ~2028 5% 5% -195 -1272 Preliminary Estimate March 14 Proposal Trustees Intermediate 6.9% 6.4% 3.7% 4.5% 16% 20% 676 1,596 ~2013 5% 5% -99 -514 No Slowdown 7.1% 7.4% 3.8% 5.9% 17% 27% 688 2,087 ~2013 5% 6% -101 -740 Policy: The Part B premium and the Medicare+Choice system for private plans would be replaced by a premium support with standard and high options under formula that allowed zero-premium plans. Normal age of eligibility would be gradually increased, but waiting period for eligibility for disabled would be waived or reduced for those affected. Low-income subsidies expanded with drug coverage for qualifying beneficiaries under 135 percent of poverty Benefits package change would include coinsurance for home health and lab services with combined deductible (indexed to program costs). Direct education carved out. HCFA can organize public/private fee-for-service plan, with standard and high option. Premium formula anchored to standard option/Medicare covered services. SOURCE: Medicare Commission Staff. 1. In 2000, Medicare spending will be 3 percent of GDP and 12 percent of the federal budget (revenues). Total projected Medicare spending will be $247 billion in 2000. 2. Payroll is approximately half of GDP. For example, in 2015 under the Trustees Intermediate baseline, Medicare spending would be 9.0 percent of payroll. 3. All spending estimates after Part A fund insolvency are hypothetical. 4. Updated estimates from HCFA and CBO will probably extend insolvency date by 3 or 4 years under current law. This cost estimate does not include that update. 5. Medicare cost or savings in the year shown. Table 3. DRAFT 14-Mar Medicare Spending: March 14 Proposal (Current Law Baseline = Trustees Intermediate) (by selected calendar year) 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 Medicare Spending as a Percent of GDP Trustees Intermediate Baseline 0.7 1.0 1.3 1.7 1.9 2.5 2.7 3.1 3.7 4.4 5.0 5.7 6.3 March 14 Proposal 0.7 1.0 1.3 1.7 1.9 2.5 2.7 3.0 3.3 3.7 4.0 4.3 4.5 Medicare Spending as a Percent of Payroll \1 Trustees Intermediate Baseline 1 2 3 4 4 5 6 6 8 9 10 12 13 March 14 Proposal 1 2 3 4 4 5 6 6 7 8 8 9 9 Medicare Spending as a Percent of the Federal Budget \2 Trustees Intermediate Baseline 3 5 6 8 9 11 12 14 16 19 22 25 28 March 14 Proposal 3 5 6 8 9 11 12 13 14 16 18 19 20 Medicare Spending in Billions of Dollars Trustees Intermediate Baseline 7 15 36 70 108 180 247 363 536 801 1,148 1,611 2,212 March 14 Proposal 7 15 36 70 108 180 247 341 476 676 922 1,217 1,596 Average Annual Growth in Spending from Previous Year Shown Trustees Intermediate Baseline 16.7 18.1 14.5 9.0 10.8 6.5 8.0 8.1 8.4 7.5 7.0 6.6 March 14 Proposal 16.7 18.1 14.5 9.0 10.8 6.5 6.7 6.9 7.2 6.4 5.7 5.6 Average Annual Growth in Spending Above the Impact of Demographics (from Previous Year Shown) Trustees Intermediate Baseline 8.2 14.7 11.8 6.8 8.5 4.8 6.4 6.3 6.0 4.9 4.3 4.2 8.2 14.7 11.8 6.8 8.5 4.8 5.1 5.1 4.9 3.8 3.0 3.2 March 14 Proposal Memorandum: Monthly Part B Premium (as a percent of enrollees' average income) 13 3 4 5 6 7 7 7 7 Trustees Intermediate Baseline 3 4 5 5 5 5 5 5 March 14 Proposal Source: Medicare Commission Staff. Note: Trustees Intermediate scenario based on Congressional Budget Office (January 1998), using Trustees' Intermediate (1997) assumptions. 1. Total Medicare spending as a percent of wage and salary disbursements. Under current law, Part A of Medicare is funded by a 2.9 percent payroll tax. 2. Medicare spending net of premiums as a percent of federal receipts. 3. Assumes enrollees average income rises at the same rate as percapita GDP. Table 4. DRAFT 14-Mar Medicare Spending: March 14 Proposal (Current Law Baseline = No Slowdown) (by selected calendar year) 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 Medicare Spending as a Percent of GDP No Slowdown Baseline 0.7 1.0 1.3 1.7 1.9 2.5 2.7 3.1 3.7 4.5 5.5 6.9 8.5 March 14 Proposal 0.7 1.0 1.3 1.7 1.9 2.5 2.7 3.0 3.3 3.8 4.4 5.1 5.9 Medicare Spending as a Percent of Payroll \1 No Slowdown Baseline 1 2 3 4 4 5 6 6 8 9 11 14 17 March 14 Proposal 1 2 3 4 4 5 6 6 7 8 9 10 12 Medicare Spending as a Percent of the Federal Budget 12 No Slowdown Baseline 3 5 6 8 9 11 12 14 16 19 24 30 38 March 14 Proposal 3 5 6 8 9 11 12 13 14 17 19 23 27 Medicare Spending in Billions of Dollars No Slowdown Baseline 7 15 36 70 108 180 247 363 537 817 1,258 1,949 2,972 March 14 Proposal 7 15 36 70 108 180 247 341 477 688 1,002 1,448 2,087 Average Annual Growth in Spending from Previous Year Shown No Slowdown Baseline 16.7 18.1 14.5 9.0 10.8 6.5 8.0 8.2 8.7 9.0 9.2 8.8 16.7 18.1 14.5 9.0 10.8 6.5 6.7 6.9 7.6 7.8 7.6 7.6 March 14 Proposal Average Annual Growth in Spending Above the Impact of Demographics (from Previous Year Shown) No Slowdown Baseline 8.2 14.7 11.8 6.8 8.5 4.8 6.4 6.4 6.4 6.4 6.4 6.4 8.2 14.7 11.8 6.8 8.5 4.8 5.1 5.1 5.3 5.2 4.9 5.2 March 14 Proposal Memorandum: Monthly Part B Premium (as a percent of enrollees' average income) 13 3 4 5 6 7 8 9 10 No Slowdown Baseline 3 4 5 5 5 6 6 6 March 14 Proposal Source: Medicare Commission Staff. Note: No Slowdown scenario created as an illustration by Commission staff. It assumes a constant rate of growth in Medicare spending above the impact of demographics. That rate of growth is roughly consistent with Medicare's spending performance over the last decade. 1. Total Medicare spending as a percent of wage and salary disbursements. Under current law, Part A of Medicare is funded by a 2.9 percent payroll tax. 2. Medicare spending net of premiums as a percent of federal receipts. 3. Assumes enrollees average income rises at the same rate as percapita GDP. Table 5. DRAFT 14-Mar Medicare Financing: March 14 Proposal (Current Law Baseline = Trustees Intermediate) (by selected calendar year) 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 Billions of Dollars Trustees Intermediate Baseline Medicare Premiums 1 2 2 3 8 17 25 43 69 110 156 217 299 Payroll Taxes 5 12 24 48 72 98 130 164 206 259 324 401 497 General Revenue or Other Funding Needed 1 2 10 19 28 65 92 156 261 432 668 992 1,416 Total, Medicare Spending 7 15 36 70 108 180 247 363 536 801 1,148 1,611 2,212 March 14 Proposal Medicare Premiums 1 2 2 3 8 17 25 43 59 84 114 150 196 Payroll Taxes 5 12 24 48 72 98 130 164 206 259 324 401 497 General Revenue or Other Funding Needed 1 2 10 19 28 65 92 135 211 333 484 666 902 Total, Medicare Spending 7 15 36 70 108 180 247 341 476 676 922 1,217 1,596 Percent Distribution Trustees Intermediate Baseline Medicare Premiums 12 12 5 5 8 9 10 12 13 14 14 13 13 Payroll Taxes 68 74 66 68 67 55 53 45 38 32 28 25 22 General Revenue or Other Funding Needed 20 14 29 28 26 36 37 43 49 54 58 62 64 Total, Medicare Spending 100 100 100 100 100 100 100 100 100 100 100 100 100 March 14 Proposal Medicare Premiums 12 12 5 5 8 9 10 12 12 12 12 12 12 Payroll Taxes 68 74 66 68 67 55 53 48 43 38 35 33 31 General Revenue or Other Funding Needed 20 14 29 28 26 36 37 40 44 49 53 55 57 Total, Medicare Spending 100 100 100 100 100 100 100 100 100 100 100 100 100 Memorandum: Part A Fund (in billions of dollars) Trustees Intermediate Baseline Inflows 6 13 26 51 80 115 146 181 222 279 349 432 536 Outflows 5 12 26 48 67 118 146 192 262 388 607 949 1,450 Net 1 1 1 5 13 -3 1 -10 -40 -109 -258 -517 -914 Balance 3 11 14 21 99 130 110 87 (49) (438) (1,388) (3,411) (7,090) Source: Medicare Commission Staff. Note: Trustees Intermediate scenario based on Congressional Budget Office (January 1998), using Trustees' Intermediate (1997) assumptions. Part A estimates here computed by Commission staff. All spending estimates after Part A Fund insolvency are hypothetical. Includes interest paid and received. (Interest is an intragovernmental transfer, which does not affect the budget surplus.) Table 6. DRAFT 14-Mar Medicare Financing: March 14 Proposal (Current Law Baseline = No Slowdown) (by selected calendar year) 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 Billions of Dollars No Slowdown Baseline Medicare Premiums 1 2 2 3 8 17 25 43 69 112 171 263 401 206 259 324 401 497 Payroll Taxes 5 12 24 48 72 98 130 164 General Revenue or Other Funding Needed 1 2 10 19 28 65 92 156 261 445 763 1,285 2,073 Total, Medicare Spending 7 15 36 70 108 180 247 363 537 817 1,258 1,949 2,972 March 14 Proposal Medicare Premiums 1 2 2 3 8 17 25 43 59 85 124 179 257 Payroll Taxes 5 12 24 48 72 98 130 164 206 259 324 401 497 General Revenue or Other Funding Needed 1 2 10 19 28 65 92 135 211 344 555 868 1,333 Total, Medicare Spending 7 15 36 70 108 180 247 341 477 688 1,002 1,448 2,087 Percent Distribution No Slowdown Baseline Medicare Premiums 12 12 5 5 8 9 10 12 13 14 14 13 14 Payroll Taxes 68 74 66 68 67 55 53 45 38 32 26 21 17 General Revenue or Other Funding Needed 20 14 29 28 26 36 37 43 49 55 61 66 70 Total, Medicare Spending 100 100 100 100 100 100 100 100 100 100 100 100 100 March 14 Proposal 12 12 12 Medicare Premiums 12 12 5 5 8 9 10 12 12 12 Payroll Taxes 68 74 66 68 67 55 53 48 43 38 32 28 24 General Revenue or Other Funding Needed 20 14 29 28 26 36 37 40 44 50 55 60 64 Total, Medicare Spending 100 100 100 100 100 100 100 100 100 100 100 100 100 Memorandum: Part A Fund (in billions of dollars) No Slowdown Baseline 6 13 26 51 80 115 146 181 222 279 349 432 536 Inflows Outflows 5 12 26 48 67 118 146 192 263 397 669 1,159 1,969 Net 1 1 1 5 13 -3 1 -10 -41 -117 -320 -727 -1434 3 11 14 21 99 130 110 87 (49) (457) (1,581) (4,308) (9,872) Balance Source: Medicare Commission Staff. Note: No Slowdown scenario created as an illustration by Commission staff. It assumes a constant rate of growth in Medicare spending above the impact of demographics. That rate of growth is roughly consistent with Medicare's spending performance over the last decade. Part A estimates computed by Commission staff. All spending estimates after Part A Fund insolvency are hypothetical. Includes interest paid and received. (Interest is an intragovernmental transfer, which does not affect the budget surplus.) Table 7. A Combined Trust Fund Under the March 14 Proposal 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Billions of Dollars Inflows Premiums 32 36 39 42 46 50 55 60 65 70 77 Payroll Taxes 149 156 164 171 180 188 197 206 216 226 237 General Revenues 117 128 140 150 161 172 184 198 212 228 245 Interest 9 9 9 9 9 8 7 5 3 0 0 Total, Inflows 307 329 352 373 395 418 443 469 496 525 559 Outflows Medicare Spending 307 329 352 376 402 431 461 494 530 570 613 Interest 0 0 0 0 0 0 0 0 0 0 3 Total, Outflows 307 329 352 376 402 431 461 494 530 570 617 Net 0 0 0 (3) (7) (13) (18) (25) (34) (45) (57) Balance 150 150 150 147 140 127 109 84 49 4 (53) Memorandum: General Revenue Share of Medicare Financing 38% 39% 40% 40% 40% 40% 40% 40% 40% 40% 40% Source: Medicare Commission Staff. Note: The growth of Medicare spending slowed significantly in 1998, and will probably remain slow in 1999. Reasons for the slowdown include payment restraints enacted in the Balanced Budget Act of 1997 and efforts to ensure compliance with billing rules spurred by enactment of the Health Insurance Portability and Accessibility Act of 1996 and other laws. Although those changes will reduce the projected path of Medicare spending in the next few years, they are not likely to slow the long-run growth of spending in the program. Therefore, the 30 year baselines used by the Commission remain appropriate. Because of interest payments, however, trust fund calculations can be greatly affected by short run changes in spending or revenues. Estimates of the expected life of the Part A fund under current law will probably be extended from 2008 or 2009 to 2012 or 2013 by CBO and HCFA in the coming months. To be consistent with the latest estimates, the insolvency date of the combined trust fund in this table should be extended by 3 or 4 years as well, to 2016 or 2017. TO. Melanne (gare copy to Nees) THE WHITE HOUSE WASHINGTON March 1, 1999 TO: Steve R., Gene S., Bruce R., Larry S., Elena K. FROM: Chris J. and Jeanne L. RE: RESPONSE TO BREAUX PLAN BY ALTMAN AND TYSON Today, Stuart Altman and Laura Tyson sent a list of suggested changes to Chairmen Breaux and Thomas on their reform plan. They have informed us that it is their belief that these changes are not negotiable but, rather, are what would be minimally acceptable for them to even consider voting to report out a Commission plan. Their recommendations are generally consistent with the principles for reform that the President outlined. For example, they suggest including the surplus or an analogous proposal, adding an optional prescription drug benefit accessible and affordable to all beneficiaries, ensuring guaranteed benefits, and allowing 62 to 64 year olds to buy into Medicare. However, the list also includes controversial elements such as raising the age eligibility from 65 to 67 so long as there is a subsidized Medicare buy-in and adding an income-related premium beginning at $50,000 (which is twice as high as recommended by the Commission but much lower than most of the Democratic base would contemplate). Although consistent with their past statements, the document reiterates their openness to premium support that meets the goals that they outline (e.g., adequate government payment, defined benefits). This paper was sent confidentially, but we would be surprised if it doesn't soon become public. If it does, Senator Daschle, Congressman Gephardt and others can be expected to be critical on both substantive and political grounds. They will be particularly upset that the President's appointees continue to negotiate with Senator Breaux and Congressman Thomas at a time when they feel they have disregarded Democratic concerns. Having said this, it is unlikely that Senator Breaux will be able to obtain Republican support for all of Stuart and Laura's recommendations. If this is the case, then the Commission will likely report out with 9 or 10 votes, not the supermajority (11 votes) needed. We will keep you posted on any news. CONFIDENTIAL-NOT TO BE QUOTED DRAFT 3/1/99 Recommended Changes to the Breaux Medicare Reform Plan Stuart H. Altman Laura Tyson The Medicare program which began in 1965 has been among the most mccessful programs developed by the Federal government. It has allowed millions of Americans, mostly over age 65, to have access to the best health care our nation offers, and provided critically needed funding to enable the health care system to support its ever changing structure and the use of increasingly expensive technology. But, Medicare has croblems, problems which will grow much worse in the years ahead. To greatly simplify these problems can be put into three categories: A. Inadequate Benefits Medicare currently covers about 53 percent of the health care spendin: of Americans 65 years of age and over. Among the benefits not covered the most important are outpatient prescription drugs and long-term care. B. Future High Cost The combination of Medicare spending on a per capita basis growing mister than the growth in GNP and the number of Medicare beneficiaries doubli over the next 30 years, every projection indicates that spending under the current Medicare program will consume an ever larger proportion of our national incon With that said, it should also be emphasized that Medicare will be required cover a much larger proportion of the US population and that Medicare spending per capita must be related to the medical cost growth in the general economy or the program will cease to provide adequate coverage for "mainstream" dical care. C. Inflexible Program Medicare is a major federal program which is governed by the laws Congress and administered by an agency of the federal government. As a rest. it is often restricted in its operation and the creation of new programs by polin infighting within the Congress and between the Congress and the Administrat These political problems are compounded by the bureaucratic inertia of a governmental program. PROPOSED CHANGES TO BREAUX REFORM PLAN To address the problems listed above and still maintain the integrity and valu.. this vital program requires that we not replace three of Medicare's critical underlying principles: 1. A government guarantee that a specified set of benefits will be covered approved and financed Medicare plan. 2. A sufficient government contribution such that adequate coverage will available and affordable to all beneficiaries regardless of their income geographic location. 3. A premium and cost sharing structure that does not invalidate the social insurance aspects of Medicare such that it no longer is a preferred plan income groups. A premium support plan with defined benefits and expanded coverage for outpatient prescription drug expenses that has limited income related premium and/or co-payments can meet these requirements if it is designed correctly and adequately financed. The specifics outlined by Senator Breaux could be the foundation for such but, fails to include a number of important factors and includes other components could undermine the basic integrity of Medicare as a social insurance program. summarized these issues below along with proposed changes we believe are nece to make the reform plan adequate for the 21ˢᵗ century and meet the high goals origni established for the Medicare program. 1. Lacks a specified and adequate set of benefits. In order for adequate benefits to be available and affordable to all Medical beneficiaries they must be specified in law and available in all approved plans including the one administered by the federal government. They al include sufficient payments to providers that they will in fact be available sufficient funds from the Medicare program that they will be affordable beneficiaries. To that end, we would propose the following additions to Breaux plan. A. All health insurers approved by Medicare including the program op by the federal government must provide for beneficiaries to select as an (() basic coverage a plan which includes at least the following coverage outpatient prescription drug expenses. -- Following a special drug benefit deductible of $500, the plan will pay 75 per cent of all outpatient drugs prescribed by an approved Medicare provider. After an individual reaches an out-of-pocket payment including the deductible of $2500 per year, the plan would pay all additional drug expenses. For a couple living together the spending limit would be $4000. For the basic Medicare plan, the federal government will contract with a limited number of private prescription drug benefit managers to administer the program. It is expected that such PBMs will use the same techniques developed by private health plans to help control spending including volume discounting, mail order dispensing and approved pharmacy formularies. The prescription drug option would require a special premium which would equal 50 percent of its expected costs. Beneficiaries would pay more or less than this average premium based on an income related schedule consistent with the design established for the basic Medicare plan. For low income beneficiaries, the deductible would vary from $0 up to 135% of poverty to the full $500 at 300% of poverty. B. A detailed set of benefits covered under all Medicare plans must be specified in law. At a minimum, benefits would include all services covered under the existing Medicare program plus an option for outpatient prescription drugs. All plans, including the one administered by the federal government, can establish their own rules as to how these benefits will be provided. Also permitted will be small variations requested by plans from the exact magnitude of the benefits subscribed in law. The Board which will oversee the operation of the premium support plan must approve all benefit designs and develop sufficient oversight competence that it can assure the Congress and the President that all plans do in fact provide the approved benefits and comply with all other aspects of the relevant statutes. 2. Income related payments could jeopardize social insurance aspects of Medicare A. Any income related aspects of the reform plan will not consider family income below $75,000 ($50,000 for an individual) to be subject to a higher than average payment amount. The income related schedule should also recognize that some government payment amount is appropriate even for the highest income groups as they are also the groups which pay the largest tax amounts. Furthermore, any individual whose annual income is equal to or less than 135% of the poverty level will not be required to pay any premium or co- payment amounts. 3. Raising age could increase uninsured A. The age when an individual becomes eligible for the full Medicare program will gradually be raised from age 65 to age 67. In tandem with this change all otherwise eligible individuals could buy into the Medicare program at age 62. For those aged 65-67, the premium charged would be income related for the lowest income groups using the same schedule as discussed above. 4. The core Medicare program must continue to be affordable to all A. The modernized Medicare plan operated by the federal government must continue to be primarily a fee-for-service plan open to all qualified and approved providers except for certain select high cost procedures and where clear quality differences are shown to exist. The basic Medicare plan should also be given the necessary authority to engage in the kinds of competitive bidding schemes used by private health plans for laboratory services, durable medical equipment and other similar services. Since this plan will retain much of its current character it should continue to have the power of federal government pricing and contracting authority. B. The system used to allocate funds to different regions of the US and to price the national basic Medicare plan must not create a regional bias against particular regions or in favor of the non basic plan except where clear regional or plan inefficiencies exist. To this end, all extra legislated payments to providers beyond what the market for patient care requires should be calculated on a per patient basis (including both basic Medicare and private health plans) and paid by the government from the Medicare trust fund independent of the calculations used to determine beneficiary premiums and the regional payment to private health plans.] Specifically, the extra payments for Indirect Teaching Costs and Disproportionate Share, or the special subsidies to rural providers should not be paid only by the Basic Medicare plan or required of patients of private plans who live in areas where such programs exist. 5. Need an adequate financing plan A. The plan must include a detailed structure on how it will be financed. While the exact dollar amounts need not be included since predictions of future spending become increasing suspect beyond 10 years, the proportions required from the different sources of funds should be specified and in general how such funds will be generated. Specifically, while the Breaux plan includes a number of provisions which will increase beneficiary liabilities, it does not mention how the additional governmental funds will be raised. This is a serious omission since the legislation which established the Commission required that we develop plans to restore the solvency of the Federal Hospital Insurance Trust Fund and maintain the financial integrity of the Supplemental Medical Insurance plan. In that connection, the plan should include either the proposal stated by the President to use a portion of the expected federal surplus to help fund Medicare in the future or indicate how the needed federal revenues will be generated. Most importantly, the plan should indicate what proportion of the expected costs of the program should come from beneficiaries and the federal government, and how much should come from reduced payment growth to providers. 6. No discussion of Long-term care needs. A. No mention is made in the Breaux plan for how the aged will pay for the increasingly expensive costs of long-term care in the future. At a minium, recognizing the complex nature of this problem and its very high costs, the plan should contain some general statements about a preferred direction of future policy. 002/008 03/23/99 13:21 FAX DISCUSSION OF COMPETITIVE APPROACHES TO MEDICARE DRAFT: March 22, 1999 I. Concept of "Premium Support" II. Issues and Alternatives III. Policy Pros and Cons IV. Political Pros and Cons 003/008 03/23/99 13:21 FAX I. CONCEPT OF "PREMIUM SUPPORT" Current Medicare Managed Care: Government payments: Medicare pays managed care plans based on a payment schedule. This schedule is set using the local costs of traditional Medicare. All plans in the area get paid the same rate. If a plan can offer Medicare benefits for less than the payment rate, it must use the excess payments to give beneficiaries extra benefits. Beneficiary premiums: All Medicare beneficiaries pay the same premiums regardless of their plan choices or place of residence. Enrollment: Today, about 16 percent or 6 million beneficiaries are enrolled in Medicare managed care. About 70 percent of beneficiaries live in areas where managed care plans operate. Over two-thirds of managed care enrollees receive prescription-drug coverage, reduced cost sharing or other supplemental benefits. The Concept of Premium Support: Government payments: Medicare would pay plans an amount per beneficiary up to a limit. This limit could be a percent up to a cap (e.g., the national average premium) or a regional average premium. Beneficiary premiums: Beneficiaries' premium would vary based on their plan choices. In general, those choosing higher-cost plans would pay more, those choosing lower-cost plans would pay less. In most models, traditional Medicare's premiums would be included in the formula, and could be higher if Medicare is a high-cost plan. Savings: Medicare costs would be reduced if (a) the new payment system pays managed care plans less than they are paid today; and (b) more beneficiaries enroll in private plans. 004/008 03/23/99 13:21 FAX BREAUX-THOMAS PREMIUM SUPPORT PROPOSAL Flexible Benefits: Requires that private plans offer at least the same benefits as traditional Medicare, but allows flexibility in how benefits are delivered. Government Payments: Percent to a cap: Medicare's payments would be based on the national weighted average premium for all plans. The government would pay: 100 percent of the premium if the plan's premium is less than 85 percent of the national average premium; From 100 to 88 percent of the premium if the plan's premium is between 85 and 100 percent of the national average premium; and No more than 88 percent of the national average premium if the plan's premium is above 100 percent of the national average premium. Beneficiary payments: Beneficiaries would pay the difference between the government payment and the plan's premium - including all of the additional premium for plans above the national average premium. EXAMPLE: HOW PLANS WOULD BE PAID Total Premium Gov't Payment Beneficiary Payment $ % of Nat'l $ % of Total $ % of Total Average $5,100 85% $5,100 100% 0 0% $5,500 92% $5,180 94% $320 6% $6,000 Avg 100% $5,280 88% $720 12% $6,100 FFS 102% $5,280 87% $820 13% $6,500 108% $5,280 81% $1,320 20% * If beneficiaries in fee-for-service pay 12% of costs, they would pay $732. 005/008 03/23/99 13:22 FAX II. ISSUES AND ALTERNATIVES MAJOR ISSUES Most beneficiaries would pay more for traditional Medicare: The Breaux-Thomas plan would result in Medicare premiums that are 10 to 20 percent above current law, according to the independent Medicare actuary. Although the plan limits the Medicare premium for beneficiaries with no private plan option, it does nothing for people with limited or unattractive plan options. Competition based on benefits, not price: The proposal would allow private plans to vary their benefits within some limits. This could result in adverse selection as plans tailor their benefits to attract the healthiest beneficiaries. Beneficiaries would pay more or less for private plans, depending on where they live: Although the final version of the plan included no reference to how it would adjust payments for geographic differences, the previous versions suggested that the government would only pay part of the local costs of care -- in an effort to constrain the current, wide variation in payments. However, the consequences of this approach are that plans will over- or under-charge for their benefits to compensate for the partial geographic adjustment. As a result, beneficiaries will pick up part of the local costs -- paying more in high-cost areas and less in low-cost areas for a typical plan. Somewhat aggressive transition: The Breaux-Thomas premium support plan would be implemented in 2003. HHS would probably be better able to transition to a change as large as this over a longer period of time. 006/008 03/23/99 13:22 FAX ALTERNATIVE: MANAGED CARE PAYMENT REFORM Guarantee defined benefits: Clear, defined guaranteed benefits. Private plans could buy down Medicare's cost sharing, but could not offer extra benefits (note: assuming that prescription drug benefit is added). Protecting the fee-for-service premium and improving adjustments: Options include: (1) anchoring the Medicare's payments to the national fee- for-service premium (not the national weighted average premium) so that beneficiaries would always pay the same percent premium; or (2) exempting fee-for-service from the private plan payment system.. The government would pay the full amount of risk adjustment and all (not part) of the geographic adjustment. Lower savings: Relative to the Breaux-Thomas plan, this approach will save much less money - in large part, because it does not rely on higher fee-for- service premiums for its savings. It is not clear how much more efficient than current law this would be. d. 007/008 03/23/99 13:22 FAX III. POLICY PROS AND CONS PROS Would likely reduce Medicare costs through competition. Although there would not be significant savings from a well-designed model, this approach probably saves more than current managed care payment systems. Better aligns Medicare with private health insurance. Relies less on explicit changes to Medicare reimbursement levels to control program costs. Medicare spending growth would be affected by private plans' ability to achieve efficiency and attract beneficiaries, which should better align Medicare with private spending growth. Gives beneficiaries lower-cost options. Beneficiaries could lower their Medicare premiums by enrolling in low-cost plans. CONS Variable and less beneficiary premiums. Unlike today, all beneficiaries would not pay the same premiums. The Medicare fee-for-service premium would likely be higher than that of private plans - even if it is protected against being higher than current law. Also, beneficiaries choosing private plans could face premiums that vary considerably from year to year. Could reduce extra benefits that current Medicare managed care enrollees receive. Currently, Medicare managed care plans compete for enrollment by offering beneficiaries additional benefits such as lower cost sharing, preventive care, and outpatient prescription drugs. Under competitive approaches, a greater share of the efficiency accrues to the government, reducing the amount that can be provided as additional benefits. Significant regulation would be required to avoid two-tiered Medicare. To promote competition based on price and quality -- not enrollment of the healthiest beneficiaries -- significant new rules and oversight would be needed. Without such rules, or because of imperfect implementation, this policy could have the unintended effects of creating higher premiums for people who are sick and low-income. J. 008/008 03/23/99 13:23 FAX IV. POLITICAL PROS AND CONS PROS Increases the likelihood of bipartisan agreement on Medicare and Social Security. Without some variation of premium support, it is unlikely that Republicans will consider any type of Medicare legislation - especially a bill that includes the surplus or a prescription drug benefit. A drug benefit and the dedication of the surplus could be worth some version of premium support. The complexity and controversy surrounding premium support will necessitate it being phased in and otherwise altered to make it more acceptable. However, it is possible that the drug benefit, the surplus transfer and other reforms would begin sooner and remain intact. Confirms willingness to reform Medicare. Most economist and elite media consider premium support "real" reform. An openness to it would end Republican criticism that we only want an election issue or only more revenues and benefits for Medicare. CONS Would alienate Democratic base, particularly in the House, who think that premium support undermines Medicare's guarantees. Base Democrats generally think that the risk of something bad coming out of any negotiation with Republicans far exceeds any potential for a positive outcome - even if that means a prescription drug benefit. Even if accompanied by a drug benefit and the surplus, the fear of higher premiums and elderly dissatisfaction may outweigh benefits. High costs and less certainty will always be much more threatening and politically volatile to the elderly than the promise of a new benefit. This is particularly the case given the low odds that a good drug benefit and premium support proposal could emerge from a Republican Congress. Opposition to premium support could unify beneficiary and provider groups. BACKGROUND ON PRESCRIPTION DRUGS DRAFT: April 12, 1999 PRESCRIPTION DRUGS: A GROWING PART OF MODERN MEDICINE Increasing reliance on drugs. Prescription drugs have become an essential part of health care, and are expected to play an even greater role in the next century. They serve as complements to medical procedures (e.g., anti-coagulents with heart valve replacement surgery); substitutes for surgery and other interventions (e.g., lipid lowering drugs that lessen need for bypass surgery) and new treatments where there previously were none (e.g, drugs for HIV/AIDS). Some of the major advances in public health -- the near eradication of polio and measles and the decline in infectious diseases -- are largely the result of vaccines and antibiotics. And, as the understanding of genetics increases, the possibility for pharmaceutical and biotechnology interventions will multiply. Elderly and people with disabilities rely more on prescription drugs. Over 85 percent of Medicare beneficiaries use at least one prescription drug in the course of a year. Although the elderly comprise 12 percent of the U.S. population, they account for over one-third of all prescription drug spending. The elderly's per capita spending on drugs is over three times as high as that of non-elderly adults, and nearly 10 times that of children. This reflects the greater prevalence of chronic conditions like arthritis and high blood pressure that are best managed through medication. Rising share of national health spending. The increased Prescription Drugs as a Percent of National Health importance of prescription drugs is reflected in national Spending 9% health spending trends. In the past 10 years, spending on 10% 8% 7% prescription drugs has risen as a percent of total spending 8% 6% 6% by 20 percent. In the next 10 years, its share of national 6% 4% health spending is projected to increase by nearly 30 2% percent. This means that nearly one in ten health care 0% dollars will be spent on drugs. 1988 1993 1998 2002 2007 Drugs may reduce need for other services. Studies have found that elderly, ill Medicare beneficiaries whose Medicaid drug coverage was limited were twice as likely to enter nursing homes. The increased cost of institutionalization exceeded the savings from reduced drug utilization by 20 fold. And, stroke patients treated promptly with drugs to thin clots had lower health care costs. DRUG COVERAGE AMONG MEDICARE BENEFICIARIES Medicare Beneficiaries' Drug Coverage, 2000 Private supplemental drug coverage is low and Changed During Year No Coverage declining: Only 23 percent of Medicare (2.2 m) 6% (15.5m) 40% beneficiaries are expected to have private insurance for drug coverage (retiree coverage or Medigap) in Employer (6.6 ml 17% 2000 (according to the Medicare actuary) -- down Medicaid (4.3 ml 11% from 38 percent in 1995. Both sources of coverage Medigap (2.4 m) 6% Medicare have been declining rapidly as the cost of coverage HMOs rises and therefore cannot be relied upon to provide (7.8 m) 20% needed insurance in the future. Retiree health insurance: Employer-sponsored retiree insurance, the most generous type of drug coverage for beneficiaries, is an important but eroding source of coverage. Between 1993 and 1997, the percent of large firms offering retiree health benefits for Medicare eligibles dropped about 20 percent. The Medicare actuaries project that, by 2000, only 17 percent of beneficiaries will have retiree drug coverage -- down from [28 percent] in 1995. Medigap: Medigap, the standardized private insurance supplement for Medicare, offers prescription drugs in some of its plans. Its drug benefit has a $250 deductible, 50 percent coinsurance, and a cap on benefits spending of $1,250 or $3,000. Medigap premiums are expensive and virtually always underwritten, meaning that premiums are based on the person's health. The median premium for a plan with prescription drug coverage is about $1,100 more than a Medigap plan without drug coverage ($2,073 V $913 in 1998). Medigap premiums have been rising at double-digit inflation. At the same time, Medigap coverage has been declining. The actuaries project that only 6 percent of beneficiaries will have Medigap drug coverage in 2000, down from 10 percent in 1995. Public coverage exceeds private coverage: More beneficiaries are projected to have public (30%) than private (23%) drug coverage -- suggesting that concerns about a new benefit "crowding out" private coverage are exaggerated. Medicare managed care: Over 90 percent of beneficiaries in Medicare HMOs have some type of drug coverage. Typical Medicare managed care plans have no deductibles and relatively low copayments, but limit the amount that they pay for benefits. In 1998, 42 percent of beneficiaries had coverage limited to $1,000 or less. Rising costs and lower Medicare payments could reduce benefits in the future. Medicaid: Only about 4.3 million Medicare beneficiaries who are fully eligible for Medicaid (e.g., who receive Supplemental Security Income (SSI) or are medically needy) receive prescription drug coverage. This represents less than half of Medicare beneficiaries below poverty since Medicaid eligibility is typically only up to 75 percent of poverty. Moreover, even those beneficiaries who are eligible have low participation rates; only about 55 percent of beneficiaries eligible for SSI participate. BENEFICIARIES WITHOUT DRUG COVERAGE: CHARACTERISTICS AND CONSEQUENCES About 16 million beneficiaries (40%) are projected to have no drug coverage in 2000. Lack of drug coverage is not just a problem for low-income beneficiaries; 40 percent of beneficiaries without drug coverage have income above 200 percent of poverty (about $17,000 for a Medicare Beneficiaries Without Any 4.,rug Coverage By Income: 2000 single, $23,000 for a couple in 2000). Nearly one in 5 3.6 4 three (30 percent) of nonelderly Medicare 2.7 2.6 beneficiaries with disabilities does not have any Millions 1.9 coverage for prescription drugs. Older beneficiaries 0 are less likely to have drug coverage, as are rural 400% 100- 130% 130-200% 200-300% 300+ Income As %Poverty beneficiaries. Nearly half of rural beneficiaries have no insurance coverage for drugs. Many beneficiaries with drug coverage have high drug spending. According the Medicare actuaries' projections for 2000, beneficiaries with some type of insurance coverage (private or public) have higher spending and Medicare Beneficiaries' Drug 9.5 utilization than those with no insurance coverage for 10 Spending: By Drug Coverage 8 prescription drugs. Most research has found that lack Coverage No Coverage Millions 6 4.1 4.1 4.4 3.8 of coverage reduced needed drug utilization. Despite 3.1 3 4 2.5 2.5 1.8 this, nearly half of beneficiaries without any insurance 2 o coverage for prescription drugs have annual out-of- so $1-250 $250-500 $500-1000 $1000 + pocket spending of greater than $500. Drug Spending in 2000 Elderly without coverage pay higher prices. Medicare beneficiaries without drug coverage pay higher prices than large HMOs, employers and the Veterans' Administration COMPARISON OF PRICES FOR DRUGS pay for the same drugs. Moreover, American Drug Use Price for Preferred Regular senior citizens pay higher prices for drugs Customers Price Prilosec Ulcers $56.38 $111.94 than citizens in other nations. For example, Zocor Cholesterol $42.95 $104.80 the average retail price for the top ten drugs Procardia Heart $67.35 $126.86 for seniors are 72 percent higher in the U.S. Zoloft Depression $123.88 $213.72 versus Canada. Source: Minority staff report to Committee on Gov't Reform Larger financial burden. Elderly with private insurance for drugs have about half the out- of-pocket financial burden for drugs than those without coverage. About 1 million beneficiaries without drug coverage have annual out-of-pocket expenses that exceed $3,000 - which more than 20 percent of income for at least half of these beneficiaries. Rural elderly have out-of-pocket costs that are 35 percent higher than urban elderly, and women have, on average, costs that are 20 percent higher than men, primarily because many are widowed and lower income. ISSUES WITH RAISING THE AGE ELIGIBILITY FOR MEDICARE DRAFT: April 12, 1999 PROPOSAL: Increase the Medicare age eligibility from 65 to 67, one month per year, parallel to Social Security. Some proposals include an unsubsidized Medicare buy-in proposal, similar to what the President has proposed for certain people ages 55 to 65. ISSUES: There has been no improvement in the availability or affordability of health insurance for people in their early 60s that would justify raising Medicare's eligibility age. - People ages 55 to 65 are the fastest growing group of uninsured. The number of uninsured ages 55 to 65 increased by nearly 7 percent in 1998 -- as fast as people ages 35 to 45 and faster than all other age groups. - Fewer have employer-based health insurance. Compared to younger adults, people approaching retirement are less likely to have employer-sponsored health insurance -- which is the least expensive type of insurance. For example, about 73 percent of people ages 45 to 55 have employer-based health insurance, but this drops to 64 percent for all people ages 55 to 65 -- and only 54 percent of 64 year olds. In part, this reflects changes in employment as workers retire, cut down on hours, or take "bridge" jobs (e.g., consulting, new careers), forfeiting health insurance. It also results from younger spouses losing their health coverage when their older spouses retire and goes on Medicare. - More are forced to turn to expensive individual insurance or have no options at all. People ages 55 to 65 are twice as likely as younger people to purchase individual private health insurance -- despite the fact that, in virtually all states, it is most expensive and inaccessible for older Americans. In 1998, 36 states allowed insurers to deny people individual insurance outright and many more allow insurers to charge more for older and/or sicker people. Thus, unlike Social Security, where the effects of gradually raising age eligibility to 67 are mitigated by the increased wealth and longer work lives of Americans, there is no comparable improvement in the health insurance system -- making it hard to extend it if the age eligibility for Medicare were raised. More difficult to postpone health care needs than retirement. Retirement is a fairly predictable event that most families plan for years in advance. Illness and disability, in contrast, are rarely foreseeable and are increasingly likely as people age. People ages 55 to 65 are twice as likely to experience health problems such as heart disease, emphysema, heart attack, stroke and cancer than those ages 45 to 55. The likelihood of developing health problems is even greater at ages 65 and 66. Thus, raising Medicare's eligibility age would take away guaranteed health insurance from people with the greatest risk of health problems and lowest probability of finding affordable private health insurance options. Raising Medicare's age eligibility could have serious consequences. Although the Federal government and Medicare Trust Fund would save from raising Medicare's eligibility age, it could create other costs and problems. Increase the uninsured. In 1998, 16 percent of people age 64 were uninsured. If the 3.7 million people age 65 and 66 were to lose Medicare, it could be assumed that 16 percent Health Insurance Coverage: of this group would also be uninsured -- nearly Americans Age 64 600,000. This would likely be higher since Medicare Medicaid Uninsured more people in this age group have health 6% 8% 16% problems and would be unable to access or VA/Other afford private individual health insurance. Individual 2% 14% Similarly, it is not clear that all of those who Employer- Based had employer-based insurance when they were 54% 64 could maintain it until they are 67. Cost shift to employers. About half of people age 64 have insurance through their employers. If Medicare's eligibility age were raised, these employers would have to continue coverage of these older workers. Costs would result not only from covering workers longer, but from higher premiums for all workers. This is because the older workers would raise the average costs of all employees. The Federal government would also incur costs since employer-based health coverage gets special tax treatment. Unfunded mandate to states. State Medicaid programs would incur significant new costs from raising Medicare's eligibility age. Not only would states continue to be the primary payer for the 8 percent of the 64 year olds on Medicaid who turn 65, but Medicaid would become primary payer for the additional elderly who become eligible for Supplemental Security Income (SSI) at age 65. No viable policy has been offered to prevent the elderly uninsured from increasing. Medicare buy-in cannot replace Medicare. Some proponents of raising the age eligibility of Medicare have suggested that the President's Medicare buy-in proposal as a health insurance alternative for people ages 66 and 67. It is true that, relative to the coverage options facing people ages 55 to 65, it is an affordable, attractive option, even without a subsidy. However, it is not designed to be a substitute for Medicare. According to the Congressional Budget Office, about 9 percent of the uninsured and 5 percent of the total eligible population ages 62 to 65 would participate in the buy-in. Applying these rates to the population age 65 to 67, this suggests that only about 185,000 of the 3.7 million who would lose Medicare would opt for coverage through the buy-in. Costs of subsidies for buy-in would reduce savings. The Medicare buy-in proposal could be subsidized to encourage low-income people to participate. However, since about 35 percent of people ages 65 and 66 have income below 200 percent of poverty (about $18,000 for a single, $22,000 for a couple), the savings would be much lower. ADDRESSING MEDICARE'S CHALLENGES DRAFT April, 1999 ADDRESSING MEDICARE'S CHALLENGES I. Overview Importance of Medicare Challenges Facing Medicare II. Medicare Commission III. President's Plan for Strengthening Medicare 1 I. OVERVIEW IMPORTANCE OF MEDICARE Medicare now pays for health care for 39 million elderly and disabled Americans: About 34 million elderly and 5 million people with disabilities receive Medicare. Helps those who would otherwise be uninsured: Before Medicare, almost half (44 percent) of the elderly were uninsured. Given the recent rapid rise of the uninsured ages 55 to 65, this problem would inevitably be worse today. Improves life expectancy, access to care and reduces poverty: Since 1965: Life expectancy of the elderly has increased by 20 percent (79 to 82 years) Access to care has increased by one-third (elderly seeing doctors: 68 to 90%) Poverty has declined by nearly two-thirds (29.0 to 10.5%) 2 RECENT SUCCESS IN SLOWING MEDICARE GROWTH In the early 1990s, Medicare spending growth outpaced private health insurance growth. However, due to the policy changes in 1993 and 1997, as well as aggressive efforts to reduce fraud, Medicare spending growth has slowed. In 1999, it is projected to be below inflation. The slow Medicare spending growth is expected to continue through 2002 -- at which point many of the policies in the Balanced Budget Act (BBA) of 1997 expire. Medicare and Private Spending Growth Per Capita 12.0%12.1% 11.4% 12.0% Medicare Private 8.7% 9.0% 7.1% 7.3% 6.7% 6.2% 6.0% 4.9% 4.1% 3.0% 0.0% 1980-85 1985-90 1990-95 1995-00 2000-05 3 MEDICARE'S TRUST FUND STATUS HAS IMPROVED In 1993, when President Clinton took office, the Hospital Insurance (HI) trust fund was projected to be exhausted in 1999. Through commitment to a strong economy, coupled with actions that improves Medicare benefits while constraining cost growth, the trust fund now is projected to be solvent until 2015. Its actuarial deficit (measure of long-run solvency) is the best that it has been since this measure has been reported. Medicare Trustees' Projections for When 2020 Medicare Becomes Insolvent 2010 2000 1990 1980 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 4 CHALLENGES FACING MEDICARE: FINANCIAL STRAIN OF CHANGING DEMOGRAPHICS More beneficiaries: Enrollment in Medicare Medicare Hospital Insurance Enrollment: 80 76 will climb when the baby boom generation 80 2000-35 69 61 retires: from 39 to 80 million by 2035 -- from 13 60 53 47 40 42 percent to about 20 percent of the population. Millions 40 20 Fewer workers: The ratio of workers who support Medicare to beneficiaries is expected to 0 2000 2005 2010 2015 2020 2025 2030 2035 decline by 40 percent by 2030 (3.6 workers per beneficiary in 2010; 2.3 in 2030). Cost growth will rise: Although Medicare has recently reined in cost growth, as recent policy changes wear off, it is expected to rise to the level of private health growth. Inadequate financing: Medicare's Trust Fund will become insolvent in 2015 -- about 20 years earlier than Social Security and just as the baby boom generation starts to retire. Even with reforms that substantially slow cost growth, the revenues coming to the Medicare trust fund will not support this larger number of beneficiaries. 5 ADDITIONAL CHALLENGES FACING MEDICARE Inadequate benefits: Medicare's benefits are not very generous. In particular: No prescription drug coverage: Even though pharmaceuticals are an increasingly important part of health care, Medicare does not pay for them. As a result, America's elderly pay the highest price for drugs -- either by buying them without discounts or by paying for expensive Medigap insurance. High beneficiary payments for hospital care: Today, Medicare beneficiaries pay a $768 deductible for hospital care, and $192 per day after two months, when beneficiaries are the sickest. Cost sharing for preventive care: Requiring beneficiary payments for preventive services (e.g., screening mammography) can discourage use. Medigap insurance: Because of Medicare's sub-standard benefits, about one-third of beneficiaries pay for expensive and inefficient Medigap coverage. Insufficient private tools for reducing costs: Current law does not permit Medicare to adopt the most effective private sector tools to increase competition and save Medicare money. 6 II. MEDICARE COMMISSION SUMMARY OF THE BREAUX-THOMAS PROPOSAL Breaux-Thomas Proposal: Its centerpiece is a SAVINGS UNDER THE BREAUX-THOMAS PROPOSAL "premium support" proposal which saves a net of (Dollars in Billions, Commission estimates) $53 billion (Commission staff estimates) over 10 years. Most of the proposal's savings come from 00-04 00-09 other policies, including: Premium Support -9 -56 Rural Adjustment +0 +3 Modernizing traditional Medicare Modernizing Medicare -4 -39 Plus Extenders Extending the BBA savings proposals Adding an unlimited home health copay Raising Age Eligibility -1 -11 Raising Medicare's eligibility age to 67 Cost Sharing Changes -4 -24 Savings small relative to the size of Medicare's Removing medical ed.* -9 -36 problem. Commission staff claims $102 billion in Medicaid Drug Benefit, net savings (including the $36 billion GME shift). Increased Participation +24 +61 These savings are less than: MEDICARE SAVINGS -3 -102 BUDGET SAVINGS* +6 -66 One-third of BBA savings proposals and One-third of amount from committing 15 * Graduate medical education would still be funded but not by Medicare; thus, not budget savings. percent of the surplus to Medicare. 7 CONTRIBUTIONS OF THE MEDICARE COMMISSION Focused attention on Medicare: The year-long deliberations of the Medicare Commission, along with President's call for Medicare reform in the State of the Union, helped highlight the challenges facing the Medicare program. The Breaux-Thomas proposal has advanced the debate. The plan has recommended a number of ideas worth serious consideration, including: Making Medicare's traditional plan more competitive: It recommends that Medicare adopt many of the competitive management tools that are used in the private sector. Rationalizes Medicare's complicated, confusing cost sharing: It takes important steps like eliminating cost sharing for preventive services. Recognizing the need for expanded coverage of prescription drugs: By expanding Medicaid drug coverage for beneficiaries with income below 135 percent of poverty, the Breaux-Thomas proposal takes a modest but positive step towards providing drug coverage to Medicare beneficiaries. 8 SHORTCOMINGS OF PREMIUM SUPPORT PROPOSAL Increases premiums for millions of beneficiaries: The Breaux-Thomas "premium support" proposal caps the government contribution at the national average, which would cause the premium for the traditional program to rise by 18 to 30 percent (or 10 to 20 percent if traditional program reforms were enacted), according to the independent Medicare actuary (2/24/99). Although beneficiaries in an areas without private plan options are supposed to be protected against higher premiums in traditional Medicare, this protection ends if even one private plan becomes available. For these beneficiaries, traditional premiums would rise suddenly. States would face a significant increase in costs since Medicaid pays for premiums for beneficiaries with income below 135 percent of poverty. Unclear commitment to defined guarantee of benefits: Allowing a board to approve benefit variations over time could erode Medicare's promise of a defined benefit package. Creates regional inequities by failing to adequately adjust for regional cost differences. Urban Areas. Beneficiaries in urban areas would face higher premiums in both traditional Medicare and private plans, since the government would pay for only part of the local costs. Rural Areas. Rural beneficiaries would face a dilemma. When no private plans are available, their premiums remain at current levels. If a private plan becomes available, they would face lower premiums for the private plan (because the government overpays plans in low-cost areas), but their premium for traditional Medicare would increase significantly. 9 OTHER SHORTCOMINGS OF THE BREAUX-THOMAS PLAN Does not address Medicare's long-term solvency: The Breaux-Thomas proposal ignores the need for new revenues to finance the care of the growing numbers of new beneficiaries. The plan's net Medicare savings of around $100 billion over 10 years are not nearly large enough to meaningfully address the long-term shortfall -- trust fund solvency will only be extended by several years. The lack of financing makes the problem much larger to solve in the future and shifts more of the burden to our nation's children. Raises the age eligibility for Medicare: The most rapidly growing group of the uninsured are ages of 55 to 65. Raising the Medicare eligibility age without a policy to prevent even more uninsured would exacerbate this problem. Includes an unlimited home health copay: Beneficiaries would be charged 10 percent coinsurance for all home health visits. For the over 1 million beneficiaries who have more than 60 visits in a year, this copay could represent a large financial burden. Removes Direct Medical Education from Medicare: Shifts funding for direct medical education from Medicare to an unspecified part of the budget. This policy does not produce Federal budget savings and does not assure that the nation's teaching hospitals are funded to continue their important mission. 10 INADEQUATE & INEFFICIENT PRESCRIPTION DRUG BENEFIT Not a Medicare benefit. One of Medicare's strengths is that it provides all beneficiaries, regardless of their residence, income or health status, with basic health services. The Breaux-Thomas proposal to extend Medicaid to beneficiaries with income below 135 percent of poverty (about $11,000 a year for a single senior) does not constitute a Medicare prescription drug benefit. Helps only a fraction of beneficiaries without drug coverage: Nearly 60 percent of beneficiaries without drug coverage would not qualify. For example, a widow with $15,000 in income would not receive drug coverage. Fewer people enroll in Medicaid programs: Experience with Medicare premium assistance programs shows that usually only about half of people eligible for Medicaid-run benefits enroll (barriers include the welfare stigma, administrative complexity, lack of knowledge of eligibility). In contrast, nearly 100 percent of beneficiaries enroll in the voluntary Part B program. Medigap proposal is unworkable. The Breaux-Thomas proposal would also require all Medigap insurance plans to include drug coverage. However, premiums would be high and rise rapidly since the heavy users would sign up first, driving up costs. Over time, insurers would likely stop offering coverage, leaving less access than before. 11 III. PRESIDENT'S PLAN TO STRENGTHEN MEDICARE President's commitment to develop a plan to strengthen Medicare: Neither the President nor his four appointees to the Commission could endorse all of aspects of the Breaux-Thomas proposal. However, the President is committed to working with Congress to develop and pass a plan this year to strengthen Medicare for the next century. To that end, he has instructed his advisors to develop a plan that conforms to the principles that he outlined in January: Making Medicare more efficient and competitive; Maintaining and improving Medicare's guaranteed benefits, including a prescription drug benefit; and Assuring adequate financing by dedicating 15 percent of the surplus to Medicare. 12 MAKING MEDICARE MORE EFFICIENT AND COMPETITIVE Providing private sector purchasing tools for traditional Medicare: Medicare should be allowed to use the same, effective practices that private health insurers use to constrain costs, including: Competitive pricing for services like medical supplies; and Selectively contracting with lower-cost, high-quality providers. Examining other policies to reduce overpayment and increase competition: The Administration will also examine specific options to reduce fraud, constrain costs and make both the traditional program and managed care payments more competitive and efficient. 13 MAINTAINING AND IMPROVING MEDICARE'S GUARANTEED BENEFITS Ensuring that Medicare's guarantee is strong: Medicare protects some of our most vulnerable citizens -- the elderly and people with disabilities -- from excessive health care costs. Proposal to strengthen Medicare must not do so at the expense of this guarantee to a defined set of benefits. Providing a long-overdue prescription drug benefit: Critical to modern medicine: Nearly all Medicare beneficiaries use prescription drugs, and their costs are over three times as high as that of other adults, and nearly 10 times that of children. Medicare Beneficiaries' Drug Coverage, 2000 Changed Existing coverage is unstable and expensive: The During Year No (2.2 m) 6% Coverage few beneficiaries who have private coverage are (15.5% 40% Employer vulnerable, since employers are dropping retiree (6.6 m) 17% Medicaid coverage and Medigap is becoming more costly and (4.3 m) 11% Medigap (2.4 m) 6% Medicare less accessible. HMOs (7.8 m) 20% Essential component of legislation to strengthen Medicare: Any proposal should provide prescription drug coverage that is available and affordable. 14 DEDICATING PART OF THE SURPLUS TO MEDICARE Providing new financing by dedicating part of the surplus to Medicare: The President's proposal would transfer 15 percent of the projected unified budget surplus to the Medicare Hospital Insurance (HI) Trust Fund for the next 15 years. This amount would equal $686 billion over the period and extend the life of the trust fund for another decade. Investing now prevents larger problem later. Even though the Medicare shortfall is projected to accumulate to over $1 trillion over the next quarter century, the President's $686 billion investment can fill this hole because it is done now -- allowing it to build interest and prevent borrowing later. One-time, fixed contribution: The plan does not create an unlimited tap on general revenues. Instead, it invests a fixed proportion of the surplus in Medicare to cover the temporary but overwhelming influx of retirees. Funded by the baby boom generation -- not tomorrow's workers: The surplus was largely created by the baby boom generation, and makes sense as a one-time funding source for Medicare. In contrast, waiting until future generations are faced with raising taxes to support Medicare would shift this burden to younger and low-income workers. 15 HELPING WORKING FAMILIES REACH THE POVERTY LINE, 1998 $17,117 99.9% Poverty Line for Family Food Stamps of Four $3,444 79.7% EITC EITC Annual Income $3,756 $3,756 Full-time Minimum Wage Full-time Minimum Wage Job (less withholding) Job (less withholding) $9,893 $9,893 With Food Stamps Without Food Stamps How Much Can Food Stamps Raise the Incomes of Low-Income Working Families (Table assumes families spend $350 monthly for rent and utilities) Earnings 30 hours, 34 hours, Full-time, minimum wage $6.50 per hour $7.50 per hour Monthly take-home earnings: $618 $884 $1,200 Food Stamps for a family of 3: $253 $149 $57 % Increase in monthly take-home earnings: 41% 17% 5% Note: "Take-home" earnings equals earnings minus federal payroll taxes and does not include the EITC or the effects of state taxes. Changes in the Number of Poor People and Food Stamp Participation 1995-1997 0% -2.3% or -5% 850,000 -10% -16.6% or -15% 4.4 million -20% Change in the Change in Average Number of Poor Monthly Food Stamp Participation Child Program Participants As a Percent of Children Poor After Receiving Social Insurance Benefits (in thousands) Number of Children Number of Percent of Poor Number of Percent of Poor Poor After Receiving Child Food Stamp Children Receiving Child AFDC Children Receiving Social Insurance Recipients Food Stamps Recipients AFDC 1994 16,324 14,391 88.2% 9,440 57.8% 1997 14,890 11,871 79.7% 7,527 50.6% 1998* 14,454 10,585 72.8% 6,898 47.4% Change: '94 - '97 -8.8% -17.5% -9.6% -20.3% -12.6% '94 - '98 -11.5% -26.4% -17.5% -26.9% -18.0% Source: CBPP calculations based on Census and HHS data . Based upon decline in total recipients and average decline in poverty Estimated vs. Actual Food Stamp Spending $34 $32 $30 CBO March 1996 CBO Post-PRWORA $28 $26 OMB FY 1998 CBO March 1997 (Billions) $24 $22 CBO March 1997 (adjusted for lower $20 unemmployment) $18 Actual Food $16 Stamp Spending $14 $12 1997 1998 1999 2000 2001 2002 *Projected from data for first five months of fiscal year. Comparing Current Participation Path with OMB Baseline 26 24 Average Participation in Millions 22 OMB FY2000 Baseline 20 18 FY99 Actual* Decline Continues 16 14 1996 1997 1998 1999 2000 2001 2002 2003 2004 *Average FY99 participation to date. Fiscal Year Budget 1999 DRAFT-FY2001 BUDGET ROLLOUT ITEMS--DRAFT (A/O 12/23/99) POSSIBLE HOLIDAY SEASON ADVANCES: NOTE: Rollout strategy should be coordinated with both the Office of the Vice President and the Office of the First Lady. Expanding Charter Schools, Second-Chance Schools, and Public School Choice. With a $30 million increase in the FY01 budget, from $145 to $175 million, the President will surpass his goal of creating 3,000 charter schools. We are also providing seed money for innovative public school choice projects, and are continuing to support universal public school choice for students in failing schools. At the same time, the Department of Education's 4th Year Charter School Report, which details the continued growth of charter schools, is ready for release. (Now planned for January 3). Enhancing the Nation's Food Safety System. CDC estimates that contaminated food kills up to 5,000 Americans and sickens 76 million more each year. This $35 million initiative will increase the number of imported and domestic food inspections by over 7,000, with a special emphasis on high-risk domestic foods such eggs and unpasteurized juice. It will also place an additional 100 inspection agents in the field. The FDA expects that this new investment will prevent over 100,000 illnesses per year. 120,000 New Housing Vouchers for America's Hard-Pressed Working Families. The FY 01 budget will include $690 million for 120,000 additional rental assistance vouchers to meet the critical housing needs of America's low income families, including 18,000 vouchers for homeless families and 32,000 to help those moving from welfare to work. These vouchers will subsidize the rents of America's hard-pressed working families and enable families to move closer to economic opportunities. Families with such vouchers pay about a third of their income in rent, with the vouchers paying the remainder of the cost. This November, only because of the President's leadership, were 60,000 new vouchers added to the final budget after having been left out of both the House and Senate bills and last year, the President secured 50,000 vouchers, the first in four years. (Now planned December 29). THE CHILD AND DEPENDENT CARE TAX CREDIT AND REFUNDABILITY December 20, 1999 Currently, the Child and Dependent Care Tax Credit (CDCTC) is not refundable, meaning that only families with incomes high enough to have a tax liability can benefit from it. For a single parent with 2 children, that would be $14,000. However, because of interactions with other refundable or partially-refundable tax credits (e.g. the EITC and the Child Tax Credit, which are claimed first), families do not actually benefit from the CDCTC unless they make roughly $21,000. While subsidies for child care are the most effective mechanism to help families with child care costs, we know that the Child Care and Development Block Grant (CCDBG) serves a fraction of the need. In 1998, the CCDBG served 1.5 of the 15 million children who are eligible under federal law. And, states set eligibility levels far below what is allowed by federal law. Therefore, there is a real gap in assisting working families with the high costs of child care. The CCDBG today effectively provides subsidies to the very lowest end of the income ladder. And, the CDCTC serves moderate to higher income families. Families between 100-200 percent of poverty, however, can receive no assistance with child care costs through either mechanism. Making the CDCTC refundable could help to close that gap and ensure that these working families can stay afloat and out of poverty. JANUARY EVENT RECOMMENDATIONS: NOTE: Rollout strategy should be coordinated with both the Office of the Vice President and the Office of the First Lady. Federal Firearms Enforcement Budget Initiatives and Gun Violence Reduction Strategy. This initiative puts an unprecedented level of resources into firearms enforcement, and includes: 1) 500 new ATF agents and inspectors, to investigate more gun trafficking cases and to bring the successful Youth Crime Gun Interdiction Initiative to more cities, and to crack down on unscrupulous dealers, manufacturers and distributors; 2) a comprehensive crime gun tracing package; 4) 1,000 new gun prosecutors and additional funds to help cities create community gun prosecutors; 5) a major expansion of existing ballistics testing systems; 6) funding for better Brady background checks; and 7) a new national notification system tied to NICS that speeds certain Brady denials (felons and other restricted persons) to local authorities. We could also release our gun violence reduction strategy, developed in response to the President's directive earlier this year. The report will also lay the groundwork for current and new legislative/budget proposals: more resources at the state/federal level, stronger gun laws, industry accountability, prevention and local partnerships. NOTE: This is our highest priority event, and must be done before the January 21st Gun Industry Annual Trade Show. Medicare Fraud. This new $30 million initiative will create a team of over 100 anti-fraud analysts to be placed in the offices of Medicare contractors nationwide to ensure a swift and coordinated response to suspected instances of fraud. In addition, it will invest new funds to implement new, financial management computer systems to accurately track and identify claims payments and prevent Medicare claims processors and auditors from defrauding the program. This initiative was developed in response to a critical GAO report detailing a myriad of abuses and a range of fraudulent activity by Medicare contractors. Any announcement on this front should be coordinated with the early January release of an HHS-DOJ report detailing our current success in fighting fraud, waste and abuse in Medicare. Teacher Quality Initiatives. The Teaching to High Standards block grant is a $1 billion initiative that includes: 1) a pay-for-pcrformance and peer review program; 2) Troops to Teachers; 3) teacher recruitment proposal that would provide a down payment on the Vice President's 21st Century Teachers Corps (modeled after Teach for America), and an OMB initiative to recruit future teachers while they're still in high school; 4) principals initiative to fund independent School Leadership Centers to recruit nontraditional candidates and to focus on effective management, school design, technology, and district governance; and 5) a continuation of the President's class size reduction initiative. The President could announce this budget initiative at the Department of Education's Teacher Quality Summit, January 10-12, which will include participation by university presidents, deans, professors, and teachers (approx. 800 participants). Health Insurance Coverage. This initiative to expand access to affordable health insurance to working Americans represents the most significant investment in health coverage in recent years. Its cénterpiece is a proposal to give states financial incentives to cover uninsured parents of children eligible for Medicaid or the Children's Health Insurance Program (CHIP). The initiative could also help: (1) people without access to job-based insurance by offering a 15 percent tax credit towards individual health insurance; (2) people ages 55 to 65 buy into Medicare and offers them a new tax credit to make this option more affordable; (3) workers in small businesses by providing firms a 25 percent tax credit for small businesses that join purchasing coalitions; (4) workers between jobs by providing them and their former employers a tax credit towards COBRA coverage; and (5) legal immigrants by allowing states to cover them in Medicaid or CHIP at states' option. These policies to expand access to affordable insurance would be complemented by an investment of an additional $175 million in community-based efforts to strengthen the safety-net (e.g., community health centers, public hospitals). This announcement could be timed to coincide with the January 13 release of a HIAA / Families USA / RWJ study on this issue. Preventing Medical Errors and Improving Health Care Quality. This initiative will respond to the recent Institute of Medicine study and the President's request to develop new avenues for the prevention of medical errors. It will include new funding to increase medical errors prevention, patient safety research, information dissemination, and create a new Center for Patient Safety at HHS. It will also include new funds to strengthen FDA's post-market surveillance system for prescription drugs and its voluntary adverse event reporting system for health professionals and consumers, and to implement new requirements for the naming, labeling, and packaging of drugs designed to prevent medical errors. The FY 2001 budget will include steps to develop a consistent national architecture for health care information technology. This could be combined with patient safety regulatory actions at both the DVA and HCFA - for instance, requiring hospitals participating in Medicare to implement error reduction programs. Any action we take on this front could be timed with an announcement that we are creating a private sector Task Force on this issue to complement ongoing Federal efforts. (This piece is currently being reviewed to ensure that it is not duplicative.) Tax Cut Radio Address (i.c., long-term care, faith-based) (DEFER TO NEC) AVAILABLE FOR ADVANCES BEFORE STATE OF THE UNION: NOTE: Rollout strategy should be coordinated with both the Office of the Vice President and the Office of the First Lady. EDUCATION SAT and ACT Test Preparation. This program would support partnerships among high schools, proven providers of college test prep courses (such as Kaplan and Princeton Review), and community-based organizations to offer high-need students college test preparation and other services related to college admissions. (Policy still in development.) AP Online. This distance learning initiative aims to ensure that students in underserved areas get access to high-quality academic courses and ESL programs online. In order to ensure high- quality content, the proposal also calls for a partnership with leading course software developers like APEX, which would subsidize the cost of high quality Web-based course development in return for cut-rate prices for high poverty school districts. Higher Education Initiatives (DEFER TO NEC) Special Education. HEALTH CARE Internet Drug Sales Initiative. This $10 million initiative would invest new funds in the investigation and prosecution of entities selling drugs illegally over the Internet. It would establish new Federal certification requirements for all Internet pharmacy sites to ensure that they meet all state and Federal requirements. It would also update the current penalty structure to create new civil money penalties of up to $500,000 for dispensing without a valid prescription over the internet or for selling drugs without Federal certification; give Federal agencies authority to require internet service providers to verify the identity and business location of domain name registrars; and provide FDA with new administrative subpoena authority in order to gather the information necessary to build a case against offenders. Children's Health Insurance Program Outreach Initiative. This initiative promotes school-based CHIP and Medicaid enrollment by: (1) allowing school lunch application information to be shared with Medicaid and CHIP for outreach; (2) letting enrollment in the school lunch program serve as a proxy for Medicaid or CHIP eligibility while formal applications are being processed; and (3) allowing additional sites like child care referral centers and homeless programs to determine presumptive eligibility. The initiative would also simplify the enrollment process. Finally, it creates a $10 million competitive state grant program in Medicaid to coordinate programs and increase enrollment of homeless children and families in Medicaid, CHIP, and other social service programs. Its rollout could be combined with the release of a new report announcing that 2 million children have been enrolled in CHIP - a doubling in enrollment in the past year. This announcement could be timed to coincide with the January 4 release of a RWJ / Kaiser Family Foundation study on outreach and enrollment. Cost: TBD, about $1-1.5 billion/5 years. Finishing The Job on Kennedy-Jeffords. This proposal rounds out the Work Incentives Improvement Act by removing the arbitrary limit on Medicare coverage imposed in the final compromise. The final legislation limits Medicare coverage for people returning to work, postponing rather than eliminating the disincentive to work. of Announcing A Major Increase In The War On Emerging Infectious Diseases. This $20 million initiative will dedicate new funds to further the development of a national electronic disease surveillance network to track newly emerging infectious diseases, such as West Nile- like encephalitis, new strains of influenza, and new hospital acquired infections, and provide essential information to public health clinics, hospitals, and health care providers. Funds will also be used to enhance local investigations, education, and focused disease monitoring nationwide, and promote the dissemination of new software for outbreak detection. & Determining The Environmental Causes Of Diseases, Including Breast And Prostate Cancer. This initiative will invest $7.5 million to: evaluate the exposure of men, women, and children to toxic substances that cause cancer; assist state and local public health officials to ensure the thorough investigation of cancer clusters; and support local efforts to rapidly evaluate the impact of public health disasters, such as chemical spills and groundwater contamination, on local residents. It will also provide an additional $5 million for breast cancer screening programs at CDC. Unveiling Major New Investment To Combat HIV And AIDS. This initiative would invest an additional $50 million in domestic community based interventions to: help 150,000 individuals who are not aware of their infection learn their status and access prevention counseling and treatment services; expand community prevention planning, with a special emphasis on racial and ethnic minorities, women, injection drug users and their partners, and young gay men; and building a data infrastructure to assist local public health officials in targeting their prevention efforts. It will also invest an additional $40 million in efforts in activities to prevent AIDS worldwide, including: providing care for children who have been orphaned by AIDS; implementing workplace prevention programs through international labor unions; and providing treatment for the opportunistic infections associated with the disease. Finally, the new investment in Ryan White and ADAP would shorten the waiting time to access the comprehensive range of drugs needed to effectively treat this disease. Total investment $225 million. (Note: Ryan White is up for reauthorization this year.) Increasing Prevention And Treatment Services For Mental Illness And Substance Abuse. This $170 million proposal would invest new funds in treatment for the severely mentally ill and establish a new local mental health enhancement program that would provide new prevention, early intervention, and treatment services for Americans with less severe mental illnesses. It would also provide new funds for substance abuse treatment services nationwide, with an emphasis on ethnic and racial minorities. (POTENTIAL MEG EVENT.) Eradicating Polio Worldwide. Medical and scientific experts estimate that we will be able to eradicate polio worldwide by the end of the year 2000. HHS believes that a $15 million increase will intensify current efforts to eradicate this disease, including: providing estimate 187 million doses of polio vaccine for use during worldwide National Immunization Days. In addition, funds will be used to develop permanent systems of disease surveillance, especially important for polio, where only one in 200 cases causes weakness or paralysis, thus allowing most polio infections to go undetected. Improving Nursing Home Quality. This $16.8 million initiative provides new funds to help states strengthen nursing home enforcement tools and increase Federal oversight of nursing home quality and safety standards. Funding will be provided for new enforcement provisions and increased surveys of repeat offenders and improve surveyor training, to address the backlog of nursing home appeals, and handle increased legal advice, litigation support, and hearings on nursing home enforcement cases. This initiative could be combined with new regulatory actions by HCFA to improve its survey and certification efforts. Increasing Family Planning Efforts Nationwide. These grants fund family planning clinics providing reproductive health services and clinical care to over 5 million low income women. These new funds ($35 million) will be used to prevent over a million unintended pregnancies year by improving the delivery of comprehensive reproductive health services, including STD and cancer screening and prevention, and HIV prevention, education and counseling; providing educational programs that encourage adolescents to postpone of sexual activity; increase the accessibility of contraceptive counseling and services; increasing efforts to provide effective contraceptives to those in need; and developing partnerships with other community based providers to conduct outreach to adolescents at risk. & Providing Education Funds To Children's Hospitals. This initiative doubles to $80 million our funding level to provide freestanding children's hospitals with Federal financing for the cost of providing direct graduate medical education (GME) associated with the provision of care to Medicaid patients. While some states have funded GME through Medicaid, most programs are ending as more states move to Medicaid managed care. NON-BUDGET EVENTS: Releasing Prescription Drug Cost Report. In October, the President directed the Secretary Donna Shalala to produce the first-ever Health and Human Services (HHS) study of prescription drug costs and trends for Medicare beneficiaries with and without coverage. The study will investigate: price differences for the most commonly used drugs between people with and without coverage; drug spending by people of different ages, as a percentage of income and as a percentage of total health spending: and trends in drug expenditures by people of different ages, as a percentage of income and total health spending. CHILDREN AND FAMILIES Create a New Paid Leave Demonstration Program. This is a new $18.5 million competitive grant fund to support innovative state efforts to provide partial wage replacement to workers on some form of family leave. States could use the Unemployment Insurance system (subject to final DOL rule-making), Temporary Disability Insurance programs; or some other vehicle. CRIME Smart Gun Technology. (Anytime in January). We could highlight the $10 million that will be provided in the budget to fund smart gun and other personalized gun technology development at DOJ/National Institute for Justice. Ex-Offenders Initiative. We could highlight a new Justice-Labor initiative that funds a range of programs to prisoners after their release make the transition to work and community life and also creates police-social service partnerships to provide effective supervision of these ex-offenders. The budget will contain $60 million for a DoJ initiative to establish reentry partnerships and reentry courts, and $75 million for a complementary DoL initiative to connect ex-offenders to jobs skills training. HUD Gun Initiative. We could announce a new $30 million HUD gun violence reduction initiative to promote public education on gun safety, implement local gun violence reduction programs, and fund technology such as computer crime mapping to target gun crimes. IMMIGRATION AND CIVIL RIGHTS ESL/Civics Initiative. This proposal funds English as a Second Language Programs that are linked to civics and lifeskills instruction. In FY2000, the President requested $70 million and received $25.5 million. In FY2001 budget request is $75 million. Naturalization Testing Process Streamlining. This proposal would streamline and improve the current naturalization citizenship test process. NATIVE AMERICANS INITIATIVE Native American Initiative. We could announce our over $1 billion Native American FY2001 budget initiative, which brings together all agencies to address the needs of Native American communities. Highlights include: increased funding for BLA school construction; initiatives to address the "digital divide" such as encouraging Native Americans to enter information technology fields; funding 500 new Native American school administrators; an over $200 million increase for the Indian Health Service, and over $100 million for new roads in Indian Country. HOMELESSNESS HUD Budget and Mainstream Homeless Initiative. We could announce our FY2001 homelessness budget, which is over $1 billion in HUD funding and includes continuum of care and emergency shelter grants. We could also highlight a new initiative that would create, for the first time, a mechanism by which states are provided assistance in order to ensure that so-called "mainstream" programs - - Medicaid, CHIP, TANF, Food Stamps, and the Mental Health and Substance Abuse Block Grant -- are accountable to the homeless. ENVIRONMENT Lands Legacy Initiative. The POTUS would announce a major increase in funding to protect sensitive lands at all levels of government and would once again call for creation of a permanent trust to provide dedicated funding for this purpose in the future. The announcement could also be combined with a POTUS status on the possible creation of new national monuments. Climate Change Initiative. The POTUS would announce a major increase in support for climate activities. The announcement would have four major parts: (1) the next installment in the multi-year Climate Change Technology Initiative, including tax proposals; (2) a renewed call for the EPA's innovative Clean Air Partnership Fund; (3) vigorous implementation of the President's executive order on biofuels to promote renewable energy sources; (4) increased funding for the Global Environment Facility, the lead U.S. entity for promoting positive international action on climate change; and (5) a new international effort to promote clean U.S. technologies abroad. Tropical Forest Conservation. The proposal would expand AID's work on tropical forest, implement the Congressionally authorized Tropical Forest Conservation Act at Treasury, and provide technical assistance to struggling developing countries through USDA. The initiative would be designed in part to help the U.S. to respond to criticisms heard during the WTO process about the impacts of international trade on forests. Salmon Recovery. This proposal consists of a Salmon Recovery Fund, which funds state efforts in the Pacific NW and the implementation of the treaty with Canada, and Endangered Species Act money for NOAA. The FY 2001 proposal maintains FY 2000 proposed level of $160 million for the Fund. SCIENCE & TECHNOLOGY Research and Development Initiative ($1.5 billion) -including restoration of balance between biomedical and other scientific research -clean energy AGRICULTURE (DEFER TO NEC) -Farm Safety Net -AgNet Registry for Farmworkers OTHER Equal Pay Initiative. We could rollout our joint Department of Labor and Equal Employment Opportunity Commission equal pay. initiative. This rollout would include announcement of a 20m new $10 million initiative (paid for by the fees from HIB visas) in order to provide training to women in nontraditional jobs in the high tech industry. Supporting Youth-Driven Solutions to Community Problems through National Service Three new initiatives to support the President's continuing commitment to community service and to respond to the growing need to empower youth in developing their own solutions to community problems. The budget for the Corporation for National Service includes: a $5 million Community Coaches initiative: $3 million for Youth Empowerment Fellowships; and $5 million to begin an AmeriCorps Reserves. Philanthropy/Faith-Based Initiatives. Among the possible announcements we can make are 1) steps to increase involvement of community- and faith-based groups in after-school and other important programs; and 2) new tax incentives to promote increased charitable giving by all taxpayers. Hispanic Agenda Budget Items. -Education Package -Welfare -Food Stamps -Immigration Tobacco Penalty. TO BE HELD FOR STATE OF THE UNION: NOTE: Rollout strategy should be coordinated with both the Office of the Vice President and the Office of the First Lady. Universal After-School to Lift Standards in Failing Schools. This package includes the following initiatives: 1) Universal After-School: by more than doubling after-school funding in the FY 2001 budget (from $453 million in FY 2000 to $1 billion in FY 2001), we can meet an urgent goal, which is to provide after-school and summer school to every student in a failing school; 2) Reward High Performance: from FY 2001- 2003, states would receive awards for adopting statewide accountability systems --- including high school exit exams, teacher quality requirements, and school report cards - ahead of the timetable called for in the President's ESEA proposal. After 2003, the Reward Fund would incorporate student performance measures as well; 3) Title I Accountability Fund: This year the President's budget will increase the set-aside for Title I accountability from $134 million to $250 million. This funding helps states and localities fix failing schools or shut them down. School Construction: A New Initiative to Repair Existing Schools. In addition to our existing plan which would leverage $20 billion in school construction over 5 years, this year we are proposing a discretionary initiative for FY2001 that would provide funds for immediate repairs. As part of the discretionary budget, this plan will make it more difficult for Congress to ignore school construction in the budget debate next fall. A Small Schools Initiative to Reform the American High School. This initiative would offer competitive grants to school districts for opening smaller schools (including charter schools), or for breaking up larger schools and using strategies such as schools-within-schools, career academics, or restructured school days. Child Care Initiative. (1) $818 million increase in the Child Care and Development Block Grant (discretionary) to serve 275,000 additional low-income children with child care subsidies; (2) Early Learning Fund (funding TBD) to help local communities promote early learning and improve child care quality, through a variety of allowable activities including licensing, accreditation, parent education, etc.; (3) Expansion of the Child and Dependent Care Tax Credit to provide low and moderate income families with greater tax relief for child care costs (cost/refundability TBD); (4) new tax credit for businesses that offer child care services to their workers; (5) increase in campus- based child care ($ TBD); and (6) new Early Childhood Professional Development Grants to provide grants to partnerships between universities, child care providers, and school districts to offer training and professional development to child care providers around language and literacy ($ TBD). Dramatic increase in Head Start funding. Announce $1 billion increase in Head Start funding for FY 01, the largest increase in the program's history. The $1 billion could provide 2014 resources to reach nearly 1 million children with Head Start services (roughly 950,000). Responsible Fatherhood Initiative: Promoting responsible fatherhood is the critical next stage of welfare reform and one of the most important things we can do to reduce child poverty. We could a) announce new data showing the dramatic increases in child support collections made by this Administration and at the same time put forward a package of proposals to b) ensure every unemployed parent who owes child support goes to work and supports his children; c) collect more child support from parents who can afford to pay; d) revise outdated rules to ensure mothers and children receive more of the support the father pays; and e) promote efforts to ensure fathers returning from prison become responsible fathers and responsible members of society. Digital Divide. New initiatives: subsidized home Internet access for low-income familics, and major boost for community technology centers. (NEC has more information). Gun Initiatives. Universal Banking. (NEC) One of Several Possible Tax Cuts (i.e., DCTC, faith-based, EITC) (NEC)