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Response to the Concord Coalition
By any measure, the charge that the comparative Medicare savings in the
Health Security Act are higher than the current Republican Medicare proposal
is simply wrong.
The Republican Budget Resolution would reduce Medicare spending by $168
billion over 6 years, 14% larger than the $148 billion savings in the Health
Security Act over a comparable time frame.
On a per beneficiary basis, the Health Security Act would have provided over
$800 more per person in 2002 than the current Republican proposal. (The
Health Security Act spent $7,700 per beneficiary, while the Republican
proposal would have spent $6,900 per beneficiary in 2002).
The Health Security Act limited Medicare to the same level of growth as
CBO projects for the private sector. The Republican cuts would constrain
Medicare to well over 20% below the private sector premium growth rate,
making beneficiaries vulnerable to declines in quality and services. [CBO's
projects a 7% per capita growth rate for Medicare under the Health Security
Act as well as for private sector premium growth rates; the Republican
Budget Resolution per capita growth rate is approximately 5%].
Moreover, virtually every penny of Medicare savings in the Health Security
Act was reinvested in providing much needed long-term care and prescription
drug coverage for Medicare beneficiaries.
Finally, of course, the savings in Medicare in the Health Security Act were in
the context of broad reform that would have provided affordable quality
health care for every American. Unlike the Republican proposals, the savings
were not used to offset unnecessary and excessive tax cuts.
Comparison of Medicare Savings
Health Security Act VS. 1996 Republican Budget Resolution
(Dollars in Billions. Fiscal Years, CBO Baselines and Estimates)
yr.1 yr 2 yr.3 yr. 4 yr. 5 yr. 6 Total
Health Security Act¹
-$7
-$12
-$19
-$28
-$37
-$45
-$148
Health Security Act Net2
$0
$2
-$8
-$16
-$24
-$30
-$76
Savings, including new
drug benefit
Rep. Budget Resolution³
-$7
-$12
-$22
-$32
-$42
-$54
-$168
¹Aggregate Program Savings
²Net Program Savings, including spending on new drug benefit and includes savings from
working beneficiaries in the reform system.
³Republican Budget Resolution released spring 1996.
MEDICARE
MEDICARE: Medicare is a compact between all generations. Before it was enacted three
decades ago, only 50 percent of our nation's elderly had any insurance. It provides peace of mind
not only to 38 million elderly and disabled beneficiaries, but to their family members as well. It
faces financial challenges that require reforms. My balanced budget proposal clearly illustrates my
commitment to reforming the program. But my proposals strengthen the Medicare trust fund
without new premium increases and without threatening to undermine the quality services the
program provides to beneficiaries.
I. Key Answer Points
I rejected the $270 billion in Medicare cuts (reductions) and flawed policy changes
proposed by Senator Dole and Speaker Gingrich. And I would do it again and again.
Their cuts (reductions) tripled anything previously enacted and their policy changes would
create new health plans that would skim the healthy and wealthy beneficiaries from all
others. Virtually every organization representing the elderly, people with disabilities,
doctors, nurses, and hospitals (including the AARP) concluded that the Dole/Gingrich
proposals were excessive and would threaten quality services for beneficiaries.
Moreover, the Dole/Gingrich budget proposal's Medicare premium hikes of $1,700 per
couple -- $268 in 1996 alone -- would have placed an unnecessary and excessive burden
on beneficiaries and their families.
My balanced budget proposal reforms Medicare, achieves over $116 billion in (CBO-
scored savings), and strengthens the Medicare Trust Fund by a decade from today
WITHOUT extreme and ill-advised policies and unnecessary new premium increases.
II. Dole Contrast
Dole led the fight against strengthening the Medicare Trust Fund in 1993. In 1993,
Dole and all of his Republican colleagues voted against Medicare savings and policy
changes that extended the Medicare Trust Fund for 3 years.
Dole voted against Medicare and proudly trumpeted that fact 30 years later.
"I
was there, fighting the fight, one of twelve, voting against Medicare in 1965 because we
knew it wouldn't work." [10/24/95]
Dole's Medicare beneficiary cuts were more draconian than Gingrich's proposals.
Dole's proposal not only doubled Medicare premiums, but also doubled the Part B
physician deductible (from $75 to $150).
Dole even tried to raise the Medicare eligibility age from 65 to 67, thus threatening
to add to the number of uninsured. Today, the pre-age 65 senior population is one of
the most difficult to insure and most discriminated against age groups in the nation. Bob
Dole's proposals would have made these vulnerable people wait even longer before they
qualified for Medicare.
III. Likely Questions and Responses
Question: How can the Republican budget proposals be a cut when CBO says that actual
spending per beneficiary would have increased from $4,900 to $7,100 between 1996 and
2002? This is much greater than an inflation increase.
Response: The key question for tens of millions of people on Medicare is whether or not the
savings called for will cut the benefits, the services or the quality of care they receive. By any
standard, the $270 billion in savings the Dole-Gingrich budget called for would have led
to higher out-of-pocket costs and less quality health care for millions of older Americans.
Where I come from, if you pay more and get less, that is a cut.
Consider the following: spending per Medicare beneficiary was cut $1400 lower per person --
20% below the private sector level -- while the Republican Medicare premium increases would
have raised out-of-pocket costs by $1,700 per couple. Furthermore, I believe that the policies
they have would create plans that would divide healthy beneficiaries from those who are
unhealthy.
Question: If Bob Dole's budget had Medicare cuts, don't your Medicare proposals also
"cut" the program?
Response: My current balanced budget proposal does have Medicare savings and I have never
hid that. Yet, I believe that the levels of our savings are prudent and the policies are carefully
designed to strengthen the Medicare trust fund by taking out unnecessary costs without cutting
quality health care.
The Dole/Gingrich proposed cuts are excessive and are used to pay for
unneeded tax cuts. My proposal does not use Medicare as a $270 billion cash
cow for $245 billion in unnecessary tax cuts. Now Bob Dole says he wants to
more than double that tax cut and is suggesting he will lower the Medicare cuts.
The numbers don't add up without an even higher Medicare cut.
Question: If Bob Dole's and your current Medicare proposals are "cuts," why did
you label the Medicare cuts in your Health Security Act as "reductions in growth"?
Response: The goal of my health care plan was to reduce the overall costs of health
care so that the growth of all health care costs -- including Medicare -- could come
down through a smarter health care system without cuts in quality or services.
Furthermore, we plowed our savings back into new benefits like prescription drugs and
long-term coverage.
The Republican plan I vetoed simply sought to lower Medicare costs below what
everyone else needed to keep up with the costs of health care. It is one thing to lower
the cost of all health care through making health care more productive; it is another
thing to simply cut Medicare alone -- giving it second class status.
Most aging representatives did not label my proposal as a "cut" because of
the reinvestments in prescription drug and long-term care coverage. In fact,
because of these new benefits, AARP and the National Council of Senior Citizens
specifically did not label my proposals as "cuts."
Question: Aren't you simply "demagoging" the Medicare issue and using it as an effective
scare tactic against Bob Dole? Your own Secretaries of Health, Labor and Treasury say
the Medicare program will be bankrupt in 5 years or less. The Republican proposal allows
for a growth rate in excess of inflation. How can you shamelessly scare the elderly into
believing that the Republicans are going to hurt the Medicare program?
Response: First, it is not only myself but the American College of Physicians, the American
Hospital Association, the Catholic Hospital Association, and the AARP who all criticized the
Republican plan as a severe and extreme cut. Their plan was three times larger than the largest
Medicare cut in history, I am not going back off one bit from defending against such excessive
cuts.
Two, it is my Administration that strengthened the Medicare trust fund by three years in 1993
-- and was opposed by every single Republican. We were also opposed when we presented
another plan in 1994 to protect the trust fund for another five years. Currently, we have
enough savings and policies in common to extend the life of the trust fund 10 years to give us
time to address our long-term challenges. First, it is not only myself but the American
College of Physicians, the American Hospital Association, the Catholic Hospital Association,
and the AARP, who all criticized the Republican plan as a severe and extreme cut. Their plan
was three times larger than the largest Medicare cut in history. I am not going back off one
bit from defending against such excessive cuts.
There is a need to strengthen the trust fund and I have a plan. My balanced budget
proposal illustrates how to extend the life of the Medicare trust fund for ten years from
today.
But we must reject excessive cuts and policy changes that are used to help pay for a
tax cut that has more than doubled from last year to over $540 billion.
Last year there were $270 billion in Medicare cuts and $245 billion in tax cuts. Next
year, one can only imagine how many more Medicare cuts will be necessary to pay
for the over half a trillion dollar tax cut?
While the medical inflation rate is low today, the Congress' own congressional
budget experts project that this will not be the case for the next seven years. I simply
don't believe we should gamble the health of Medicare beneficiaries on a proposal that
says no matter what happens with inflation, we will arbitrarily cap expenditures to a
certain level.
Question: Even the bipartisan Concord Coalition says that you are demogoguing
Medicare. They point out that your cuts in the Health Security Act were larger than the
Medicare savings being proposed today. You are just playing politics.
Response: First, the Medicare savings in the Health Security Act were lower than the cuts in the
current Republican Medicare proposal. The Republican Budget Resolution reduces Medicare
spending by $168 billion over 6 years -- 14% larger than the $148 billion in savings the Health
Security Act over the same number of years.
The Health Security Act would have provided over $800 more per person in 2002 than the
current Republican proposal. Under the Health Security Act, Medicare spending growth was the
same as the growth CBO projected for the private sector. The current Republican cuts constrain
Medicare to well over 20% below the private sector premium growth rate, threatening quality and
services for beneficiaries.
Second, every penny of Medicare savings in the Health Security Act was reinvested in much
needed long-term care and prescription drug coverage for Medicare beneficiaries. The
Republican Medicare cuts are used to pay for unnecessary and excessive tax cuts.
Question: The First Lady testified on the Hill that the Health Security Act would constrain
the rate of growth of Medicare to 6%. Yet when Republicans proposed to constrain the
rate of growth to 7%, you said it would devastate the Medicare program.
Response: The First Lady testified that the Health Security Act would have allowed Medicare to
grow at a per person growth rate of 6% or 7%. According to CBO, the Health Security Act
would have allowed Medicare to grow at 7% per person. In contrast, the Republican Medicare
cuts would limit Medicare to 5% per person growth rates -- over 20% below CBO's projected
private sector rate. Limiting spending this far below the private sector will threaten quality of
care for people on Medicare. In addition, the Medicare reforms in the Health Security Act were
done in the context of broader health care reforms that not only provided insurance coverage for
all Americans, but also reinvested the savings into much needed prescription drug and long-term
care benefits. [Republicans use aggregate spending numbers as opposed to per person spending
numbers because they are larger and camouflage the extent of their reductions.]
Question: Are you concerned about the recent JAMA report that concludes that HMOs
provide substandard care and worse outcomes for elderly and low-income populations?
Response: I share the concern about the recent report about negative outcomes for elderly
Medicare beneficiaries who are in managed care plans. I believe this report validates my approach
to reforming the Medicare program. I have proposed to expand choices to Medicare
beneficiaries, including providing more managed care options. However, my plan rejects the
Republican proposals that would, in effect, force low-income elderly into managed care plans.
My plan would also ensure that people could return to fee-for-service at any time, without having
to fear Medigap plans underwriting them and disallowing future coverage.
The health care system is rapidly changing. We are witnessing an unprecedented
increase in the use of manage care, and there have been abuses. I was pleased that
the Congress responded to my call to enact the 48-rule which assures that new
mothers and their babies can stay in the hospital 48 hours after a delivery, ending
"drive by deliveries." I have also asked Congress to pass legislation which would
prohibit health plans from restricting patients and health care providers from
discussing treatment options. And finally, I recently signed an Executive Order to
establish a bipartisan advisory panel that will focus on the need for quality
assurance and consumer protections in our changing health care system.
Question: What is wrong with asking higher income seniors to pay more in premiums?
The so-called means-testing premium was in the Republican plan and you even included a
similar provision in the Health Security Act. Aren't you once again playing political games
on this issue?
Response: I am not opposed in principle to higher income beneficiaries paying more for their
Medicare. I did support this concept in my health reform proposal, but beneficiaries received
additional benefits in return for their increased contribution. The Republican means testing
proposal provided no significant new benefits and the savings they achieved through this proposal
would help offset unneeded and excessive tax cuts. I do not believe we should be asking older
Americans to use their limited savings to help pay for such an unwarranted tax cut.
Question: The difference between your $124 billion and their $158 billion in Medicare cuts
over 7 years is extremely small. Why don't you stop playing politics with this issue and
come up with a compromise? Why not do what is best for America?
Response: The difference between my proposal and the Republican plan is still larger than
you state: indeed it is over 50% larger than my plan. Furthermore, it has policies that I and
many experts believe will lead Medicare beneficiaries to become divided by wealth and health.
But more important, my opponent and Newt Gingrich still to this day criticize me harshly for
vetoing $270 billion cuts, and I think most experts believe that in order to pay for their
excessive tax cut, they will go back to the deep -- and even deeper Medicare cuts as the only
way to pay for more than doubling their new tax cut proposal.
Senator Dole's numbers for his tax cut just don't add up without extremely high
Medicare and Medicaid cuts. Until I leave office, I will categorically reject excessively
high Medicare and Medicaid cuts and policy changes that will hurt these programs and the
beneficiaries they serve.
Even if one assumes $168 billion in cuts and a compromise on the number is
imaginable, the Republicans have still not rejected their old and flawed policy that
pits healthy and wealthy beneficiaries against the sick. They have not rejected a full-
blown, untested Medicare Medical Savings Account (MSA) that has every potential to
attract only the youngest and healthiest of the Medicare population. They have not
rejected their new health plan that eliminates all beneficiary payment protections and
allows doctors to charge whatever they want. And lastly, they have not rejected the
arbitrary caps that locks in Medicare expenditures at a certain level -- regardless of what is
happening in the economy. These policy differences are very real and concern me greatly.
Question: Aren't you just committed to protecting the status quo at a time when we must
modernize Medicare? What is wrong with providing more choices to beneficiaries?
Response: My plan is to strengthen the trust fund and provide more choices to Medicare beneficiaries,
but I want to do so in a way that preserves the integrity of our Medicare program. Rather than
dismantle our existing Medicare program, I want to build on the solid foundation we have created by
providing Medicare beneficiaries new health plan options that provide new choices to beneficiaries
(PPOs, PSOs, and HMOs with a point of service option). I evaluate any new option on its ability to
compete on cost and quality rather than selecting on the basis of cherry picking" the healthy and
wealthy. Many of the Republicans' proposals (e.g. Medicare MSAs and physician plans without
overbilling protections) would segment the healthy from the sick and would undermine the
Medicare program in so doing.
Question: Why are you so opposed to a small premium increase? Aren't you just waging a
campaign to needlessly frighten the elderly?
Response: Raising Medicare premiums would hurt the millions of Medicare beneficiaries who have
limited incomes. A recent study revealed that nearly 75 percent of Medicare beneficiaries have incomes
below $25,000. Moreover, increasing premiums for Medicare beneficiaries is not necessary to
strengthen the Medicare trust fund or to balance the budget. I simply will not stand for an excessive
increase in premiums that is used to pay for an unnecessary tax cut for the well to do.
Question: Isn't it true that there was only a $7 difference between premiums under the
Republican plan and your proposal by 2002?
Response: There was never only a $7 difference a month between premiums proposed by the
Republicans and premiums in my plan. Some used that number incorrectly using preliminary or
inaccurate projections. A true "apples to apples" comparison reveals that had I not fought and
eventually vetoed their Medicare plan, every couple on Medicare would have paid premiums that were
at least $1,700 higher over seven years and $268 higher per couple this year alone.
Question: You have supported Medical Savings Accounts, and yet you continue to opposed
Medicare MSAs. Isn't that hypocritical?
Response: Although I have agreed to a limited test of MSAs for non-Medicare beneficiaries, I am
particularly concerned that they would have an adverse effect on the Medicare program. Because
certain Medicare beneficiaries are extremely expensive, there are greater incentives for health plans to
"cherry pick" the healthier and wealthier. The Republicans have insisted on exposing opened-ended
unconstrained Medicare MSAs to the entire beneficiary population. Such an untested proposal has a
great potential to attract healthier and wealthier beneficiaries, leaving sicker and more costlier
beneficiaries in a weakened traditional Medicare program leaving Medicare to "wither on the vine."
Question: Clearly the Medicare trust fund is in trouble. What are you doing to address both the
short-term and long-term problems of the trust fund?
Response: I am absolutely committed to working with Congress towards this end and have illustrated
how this can be done without excessive cuts, ill-advised structural changes, and unwarranted premium
increases.
My 1993 budget extended the life of the Medicare trust fund by three years, without the
vote of a single Republican.
My balanced budget proposal extends the life of the Medicare trust fund until the year
2006, ten years from today.
We must take this first step to strengthen the trust fund, and, as the Medicare trustees have
recommended, we must establish a bipartisan process that would work to provide specific
recommendations to address the long-term financing challenges facing the trust fund.
Question: You say your Medicare proposal extends the life of the trust fund for ten years, but
without your home health gimmick, your proposal would only extend the life of the trust fund
one year. Don't you think we need real savings to save the Medicare trust fund?
Response: My Medicare proposal extends the life of the Medicare trust fund until 2006, according to
the trust fund actuaries and until the year 2005 according to the Congressional Budget Office. The
proposal that you refer to a gimmick is the same one that every Republican in the House supported this
year in the budget reconciliation bill. My proposal to transfer a portion of home health financing from
Part A to Part B recognizes that Part A covers short-term, post-acute care services and allows Part B to
financial other home health care services, just as was intended and implemented until 1980.
Without the home health transfer, we would have to make devastating cuts to hospitals
that would undermine the quality of care, especially in rural and other underserved areas.
HEALTH CARE
HEALTH CARE: I remain committed to working toward providing affordable, quality, health care to
all Americans. But as the last two Congresses have taught us, we must reform our health care system in
a step-by-step manner that attracts bipartisan support. In so doing, we must reverse the trend of
Americans losing their health insurance. We must ensure that the quality health care system we have is
not undermined by rapid changes in our delivery system. And, as we do this, we must guard against a
return to excessive health care inflation that makes insurance more unaffordable.
I.
Key Answer Points
I am pleased that the Congress responded to my State of the Union challenge to pass the
Kennedy-Kassebaum health insurance reform legislation. As many as 25 million Americans will
benefit from the important portability and other insurance reforms.
I am proud of a host of other achievements including: requiring health plans to allow mothers of
newborns to stay in the hospitals for at least 48 hours, requiring plans to move toward covering
mental health illnesses on a level playing field with other disorders, helping tame health care
inflation, increasing investments in biomedical research, expediting FDA's review and approval
of new drugs, increasing funding for the VA health care system, and taking actions to protect
kids from tobacco products and advertising.
But there is more we can and should do. My balanced budget includes a provision to help
worker's in-between jobs retain their insurance for themselves and their families. Each year it
would help 3 million Americans, including 700,000 children. While we reject assaults on
Medicaid's guarantee of coverage for children, elderly and people with disabilities, we should
also provide more flexibility to states to help them to preserve and expand coverage. In addition,
we should empower small businesses to purchase more affordable insurance through voluntary
purchasing coalitions.
And we should place a heavy emphasis on assuring that the quality of health care is not
undermined by changes in our delivery system. We should start by passing legislation that
prohibits health plans from limiting communications between health care professionals and
patients about treatment options.
II.
Contrast with Senator Dole
Dole's Medicaid block grant and $163 billion in cuts threatened the coverage of 8 million
Americans, including 3.8 million kids. Going backwards in coverage and increasing hospital's
uncompensated care burden is a bridge we should not cross.
Dole proposed to expand the Medicare eligibility age to 67, thus threatening to add to the
number of the uninsured. His plan would add to the number of seniors seeking insurance
the group that is already the amongst the most discriminated against.
Dole allowed Republicans to prevent the Kennedy/Kassebaum bill from even coming to a
vote. For months, Senate Republicans placed "holds" on the bill, making a vote impossible. The
Congress couldn't pass the bill until after he left the Senate.
Dole offers no plan to help any American keep or afford their insurance.
Question: Wasn't the Health Security Act a not-so veiled government take-over of the
health care system? You called employer mandates, billions of dollars in subsidies,
premium caps. Was that not advocating for a government run health care system?
Response: Of course not. It was a proposal to build on our current system of a privately-
financed, employer-based system and provide affordable, quality private health insurance to every
American. By any definition it was not a government-run system. What I have said all along,
however, is that we bit off more than we could chew. But that doesn't mean that we shouldn't
take steps to improve our health care system. From the end of 1994 on, I advocated for insurance
reforms that we couldn't get passed until after you left. I advocated for the 48-hour rule and
mental health parity that we couldn't get passed before you left. I think we can do more, but it
will be done on a step-by-step basis that attracts bipartisan support.
Question: Your proposal would have created 200 new regional health cooperatives run by
thousands of new bureaucrats and nearly 1,000 new federal powers and responsibilities.
Response: No system is more complex and full of red tape than our current health care system.
My health care plan would have simplified it. Many experts conclude that my proposal would
have substantially reduced the administrative hassle and produced large administrative savings.
My record of reducing government and regulation is unmatched in the last thirty years. I have
downsized the Department of Health and Human Services by 5,000 employees -- nearly ten
percent -- and significantly reduced the regulatory burden imposed on consumers and providers.
Question: The total new tax burden imposed under your health care plan was a staggering
$1.584 trillion, and the average working family would have had a massive new tax bill of
$3,056 per year.
Response: The number cited by Senator Dole was almost entirely made up of projected private
premiums for private health care. These were premiums that employers and households would
have paid anyway. Private premiums for private insurance aren't taxes. Moreover, most
employers and their workers who already had insurance would have had lower health care costs
under the President's health care plan. Even the bipartisan Congressional Budget Office said that
in 2004 businesses alone would pay $90 billion less and projected that "total spending for health
would be $150 billion -- or 7 percent -- below where it would be if current policies and trends
continue."
Question: Do you still support an employer mandate? Can you pledge to businesses that
you will not endorse or propose an employer mandate to provide health coverage in your
next term?
Response: There is not sufficient support for an employer mandate. This approach was rejected
and, as I have said, I am now committed to improving the health care system in a step-by-step
manner. That does not mean that we should not pursue proposals that make health care more
accessible and affordable for all Americans. I still think we should find ways to help businesses
insure their workers. The Kennedy-Kassebaum bill that I signed this spring did just that. It raised
the self-employed tax deduction to 80%. I have also proposed voluntary purchasing cooperatives,
which make it easier for small business to pool together so they have the collective bargaining
power to buy affordable health care.
Question: Is it true that the Health Security Act would have destroyed between 600,000
and 3.8 million jobs?
Response: That is absolutely wrong. Even the CBO study that the Dole campaign cites, says that
my plan, would have had only a small effect on employment. Also, the same people who alleged
this huge job loss have been saying that a minimum wage increase would cause millions of
Americans to lose their jobs. Yet every time we have asked employers to raise the minimum
wage, there has been either no impact or a rise in employment levels. Moreover, a number of
studies conducted by non-partisan, respected economists, predicted that low or no job loss would
have resulted from my health care reform plan.
The health care debate should not be about misleading numbers but rather how we can improve
our health care system. I wish that Senator Dole and I could have worked together to fix our
health care system back in 1993 and 1994, but as he told Senator Bennett and others, no bill was
his strategy. I wish we could work together to reform the health care system today. But, Senator
Dole we had to wait until you left the Senate before we could pass any real health care reform.
Question: Why do you think you failed in passing the Health Security Act?
Response: I am disappointed that we were not able to achieve broad-based bipartisan support for
any health reform. There were lots of reason for that, and I certainly take my fair share of the
blame. There is no question that my Administration bit off more than it could chew. However, it
is also true that many Republicans, including Senator Bob Dole, had no intention of passing any
health reform. As even Republican Senator Bennett (R-UT) has said: "Dole made it very clear
that no bill is the strategy." I hope that we have both learned that health care reform, like all good
legislation, needs broad-based, bipartisan support. That is why the Kennedy-Kassebaum
insurance reform legislation was so successful.
Question: Isn't it true that your recently proposed Advisory Commission on Consumer
Protection and Quality in the Health Care Industry represents the next step of a
government takeover of our health care system?
Response: That is preposterous. This commission has already received the strong support of a
broad range of organizations including those who were critical of the Health Security Act, such as
the Health Insurance Association of America (HIAA), the American Medical Association (AMA),
and the Business Roundtable. Most Americans are extremely concerned about the rapidly
changing health care system and its potential effect on quality and consumer protections. This
advisory commission has a narrow but important charge. The only people I am aware who have
raised concerns about this advisory panel on consumer protections and quality are a few
Republicans. Nevertheless, I hope and expect both Republicans and Democrats will work
together on this advisory panel, and I look forward to their report.
Question: Ira Magaziner, the liberal architect of your government-run health care plan
stated, "Certainly his views have not changed President Clinton remains committed to the
idea. Indeed, the President will try again if a more receptive Congress is ever elected."
Reponse: Mr. Magaziner was referring to the fact that I do believe that all Americans should
have quality, affordable health care. But as I have said before, we need to work toward reform
one step at a time and with bipartisan support. We should build on the health care successes we
have had this year like the Kennedy-Kassebaum insurance reform legislation, legislation which
moves toward ending discrimination in mental health coverage, and the 48-hour rule which ends
"drive by deliveries" and assures that new mothers and their babies can stay in the hospital 48-
hours after a delivery.
We can do more. We should help working families pay for health care coverage while they are in-
between jobs. We should also end insurance company rules which prevent doctors and other
health care providers from fully discussing treatment options with their patients.
Question: Hillary Clinton recently told reporters she still believes there is a need for more
"sensible government regulation" of the US health care system and that it will eventually
happen. Referring to the Clinton bill, she said "I think the basic model is still the right
model."
Response: What the First Lady meant I think was that there are certain instances when consumer
protections are necessary. I have passed a number of bipartisan health care initiatives this year
that protect consumers. The Kennedy-Kassebaum law ensures that individuals will not be denied
health care coverage when they change jobs, or because they or their family member has a pre-
existing condition. The mental heath parity provision that I recently signed into law is a
regulation that moves towards eliminating discrimination against people with a mental illness.
Also, the recently passed 48-hour rule protects new mothers and their babies from being
discharged from the hospital until 48 hours after the delivery. These are just a few examples of
where the President has called for consumer protections. I just recently signed an executive order
to create a broad-based bipartisan health care commission that will examine the rapidly changing
health care industry and make recommendations about possible reforms to ensure high quality
health care.
Question: President Clinton has already begun efforts to revive his government-run health
care plan. In fact a new plan is already being drafted by those who developed the original
Clinton plan that includes health insurance purchasing cooperatives, government-defined
benefit packages, and premiums subsidies, all key structures of the original Clinton plan.
Response: That is ridiculous. I have already said that I favor a step-by-step approach to health
care reform. I am, however, continuing to work for broad-based bipartisan health initiatives
which will provide high quality health care to all Americans. This year we have passed important
legislation which improve our health care system. I am delighted that Congress answered my call
pass legislation which moves towards parity in mental health coverage and the 48-rule which
allows new mothers and their babies stay in the hospital 48 hours after a delivery and ending
"drive by deliveries". I am also proud that we could work together to pass the Kennedy-
Kassebaum legislation which eliminates discrimination in health insurance.
I have been working on new initiatives that build on theses legislative successes. It is true that I
have proposed an initiative which provides temporary premium assistance for families who are in
between jobs. This proposal has received support from both sides of the aisle, including Senator
Dole who recently reminded The Washington Times that he has been a long-time supporter of this
reform. I wish that we could have worked together in passing some of these moderate reforms
that would help millions of Americans. However, Senator Dole insists on making false charges
rather than acknowledging the common ground on health reform. As such, we had to wait until
Senator Dole left the Senate before the Congress could pass this much-needed bipartisan reform.
Question: In 1993-1994, you and your Administration stated that incremental health
reforms could not be achieved without undermining the health care system. Less than two
years later, you advocated the Kennedy-Kassebaum legislation by any measure. How do
you reconcile these two positions?
Response: As I have stated many times before, the experience of the Health Security Act led me
to conclude that we bit off more than we could chew. In taking a step-by-step approach, we have
had to be extremely careful in developing measures that do not undermine the health care delivery
system. Working closely with Senator Kassebaum and Senator Kennedy this year on insurance
reform, we believe we achieved that delicate balance. It is clear that we must continue to reach
out to members on both sides of the aisle and a broad array of policy makers as we develop new
incremental bipartisan proposals that improve our health care system.
Question: We haven't heard you use the term universal coverage for quite awhile now.
Does your vision of health reform include covering every American?
Response: I am still strongly committed to working towards developing health policy reforms
that expand quality affordable health care to Americans. However, we must make progress on a
step by step basis that creates much greater bipartisan consensus on the direction this nation
should go with regard to this issue. I am confident that we can build on the successes of the
enactment of the Kennedy-Kassebaum law for future legislative action. I have, for example, a
proposal in my balanced budget plan to provide health insurance for up to six months for workers,
who through no fault of their own, have lost their job.
Question: What health-care reform would you hope to achieve in a second term?
Response: I am still committed to providing quality, affordable health care to all Americans. I
believe this goal must achieved in a step-by-step manner that attracts bipartisan support much like
we have done so successfully this year with the passage of the Kennedy-Kassebaum bill, the 48-
hour rule for mothers of newborns, and the progress we have made towards achieving mental
health parity.
I have also proposed new initiatives which will give more Americans access to high
quality, affordable health care. My balanced budget includes the Workers' Transition Initiative,
which would provide premium assistance for up to six months for individuals who are in-between
jobs and would help an estimated 3 million people a year, including 700,000 children. It also
includes reforms that would make it easier for small businesses to buy and maintain health
insurance for their workers through the use of voluntary purchasing coalitions.
I have called for a serious commitment to assuring quality in our health care system.
Building on the 48-hour rule, I have asked Congress to pass "anti-gag" legislation which would
prohibit health plans from limiting discussion of treatment options between health care
professionals and patients. In addition, I am in the process of establishing a bipartisan advisory
panel that will focus on changes in our health care system and the need for quality assurance and
consumer protections. I believe that we must redouble our efforts to target and prosecute
perpetrators of fraud and abuse in our health care system and also promote incentives to cover
cost-effective preventive care. And finally, because of my long-standing interest in and
commitment to children, I am also reviewing policy options to provide states more flexibility to
expand insurance coverage to children, in the context of a balanced budget.
Question: What have you done to improve the quality of health care in managed care
plans?
Response: While managed care plans of today often provide cost-effective, high quality plan
choices, we believe that in certain instances, consumer protections are necessary. For example, I
believe that protecting the health of mothers and infants is a clear case of where government
safeguards are needed. To ensure that these patients are receiving high quality care, I have
endorsed legislation that prevents "drive by deliveries" and allows mothers and their newborns to
remain in the hospital for a minimum of 48 hours after a normal delivery and 96 hours after a
Caesarean section. I have consistently opposed any 'gag rules' which prevent physicians and
other health care providers from fully discussing treatment options with their patients. I hope to
sign these measures into law before Congress adjourns.
I have also established by executive order an Advisory Commission on Consumer Protection and
Quality in the Health Care Industry. This panel is charged with studying changes in our rapidly
changing health care system to determine what impact they are having relative to quality,
consumer protections, and the availability of services. Where appropriate, it will also make,
recommendations on what, if any, further actions should be taken by the federal government to
ensure high quality health care. Similarly, we also are actively engaged in ensuring quality
standards in Medicare HMOs and other managed care plans.
Question: Your Health Security Act was built around managed care. Why are you
attacking managed care with this commission?
Response: This commission is not an attack on managed care. It will bring together experts,
insurers, business and consumers to make recommendations on quality, consumer protection, and
the availability of treatment and services in managed care plans as well as other health plans. The
health care market is changing quickly and this commission will allow some of the best minds in
the field to analyze and make recommendations on how to ensure that people get the best quality
care possible.
Question: What do you mean by "the availability of services"? Isn't this your next attempt
to guarantee universal coverage?
Response: The President is committed to continuing to work to reform the health care system,
but this advisory commission is not "health reform part two". It is a small panel of experts
charged with looking at quality, consumer protections, and availability of treatment and services.
The panel will look at availability because one of the problems in the health care system is that
some people who have insurance are being denied appropriate services.
Question: You and the First Lady have on more than one occasion mentioned your desire
to provide health care coverage for all children. However, we have seen no proposal or cost
estimate. What do you have in mind?
Response: The first thing we will do is continue to protect the Medicaid program and not
threaten the high quality coverage for the millions of children on Medicaid. Second, it is plainly
unacceptable that there are approximately 10 million uninsured children in this nation and I think
everyone who cares about health care is always looking for ways that we can do more to expand
health insurance to at least cover children. Also, my program for workers who are in between
jobs would provide coverage for 700,000 children each year. But we also need to look carefully
at reforms that are aimed at expanding access to health insurance or at least health care services to
children. However, we must do this in the context of a balanced budget.
Question: What are you going to do to face the in long term care challenges facing this
country?
Response: First, I was pleased to recently sign into law the Kennedy-Kassebaum bill which
provides for private long term care tax clarification and for consumer protections for these
product. As a result, for the first time long term care policies will be treated on a level playing
field with other health care policies. Second, my balanced budget proposal includes a provision
to provide a new respite benefit for families of Medicare beneficiaries who are afflicted with
Alzeimers. My balanced budget proposal also has a provision to make it much easier for state
Medicaid programs to provide health care based services as an alternative to institutional care.
We face an unprecedented demographic challenge with the aging of our population, but I am
confident that all generations of Americans can work together to develop long-term care
assistance.
10% percent -- and significantly reduced the regulatory burden imposed on consumers and
providers.
Attack 3: Throughout 1993 and 1994, you said that anything less than a complete overhaul
would undermine the health care system. Less than two years later, you supported the
incremental Kennedy-Kassebaum health legislation. These positions are completely
inconsistent.
Response: During the debate on my health care bill, I realized that we bit off more than we
could chew. That is why I now believe we must reform the system one step at a time. As we
do that, however. we must be careful not to take steps that in isolation will threaten the health
care delivery system.
We worked closely with Senators Kassebaum and Kennedy to achieve that delicate balance.
This law puts in place uniform. national reforms in the health insurance market that will make
a difference for as many as 25 million Americans. But these are all reforms that states have
implemented with proven success -- reforms that have improved access to health care, but have
not raised premiums for people who currently have insurance.
The Kennedy-Kassebaum law also addresses other problems in the health care system. It
makes it easier and less expensive for people who are self-employed to buy health insurance.
Second, it prevents fraud and abuse in the health care system. Third, it reduces paperwork and
costs by setting up a uniform electronic system for paying health care claims. And it helps
with long-term care by adding consumer protections and making long-term care insurance
more affordable.
Attack 4: Your recent proposal of an Advisory Commission on Consumer Protection and
Quality in the Health Care Industry that you proposed recently is the next step toward a
government takeover of our health care system.
Response: This advisory commission has a narrow but important mission: to help protect
health care consumers. It will bring together a small panel of experts, insurers, business and
consumers to make recommendations on quality, consumer protection, and the availability of
treatment and services in managed care plans as well as other health plans. The health care
market is changing quickly and this commission will allow some of the best minds in the field
to analyze and make recommendations on how to ensure that people get the best quality care
possible. The commission has already received the strong support of a broad range of
organizations including insurers, health care providers, businesses and consumers -- some of
which were critical of the health care bill.
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Question: Wasn't the Health Security Act a not-so veiled government take-over of the
health care system?
Response: Of course not. It was a proposal to build on our current system of a privately-
financed, employer-based system and provide affordable, quality private health insurance to
every American. By any definition it was not a government-run system. What I have said all
along, however, is that we bit off more than we could chew. Ironically, I think the
Republicans repeated the same mistake in reverse. They tried to bite off more than the
American public or I would swallow with their excessive Medicare and Medicaid cuts and
policy changes.
Question: How can you say that a bill that had over 1,300 pages of text calling for
numerous boards, employer mandates, billions of dollars in subsidies, premium caps and
mandatory alliances was not advocating for a government run health care system?
it
on
Response: Reforming our extraordinarily complex health care system is complicated. As
such, legislation that attempts to reform the system tend to be detailed. Senator Dole's health
care reform bill in 1994 also had hundreds of pages in statutory language and billions of
dollars in subsidies for low income individuals. One of the bills he cosponsored mandated
that every individual pay for health insurance, but did not call their employers to contribute.
I thought the financing of health care should be a shared responsibility Both approaches
were complicated and controversial Both build on the private insurance system we have
today. Neither bill/can be fairly labeled as a government takeover of the health care system.
Leave
could
in
Question: Do you still support an employer mandate? Can you pledge to businesses
that you will not endorse or propose an employer mandate to provide health coverage in
your next term?
Nixon did too.
Answer: I supported a proposal that called for shared responsibility between employers and
employees to help pay for health care. Throughout the debate, I was always open to other
ways to achieve coverage for all Americans. This approach was rejected and, as I have said,
I am now committed to improving the health care system in a step-by-step manner.
for
copyen
HEALTH CARE
Opening Line: I will continue to work toward ensuring that all Americans have affordable, high
quality health care. However, we must reform the health care system one step at a time and with
bipartisan support.
I. Key Answer Points:
I am pleased that the Congress responded to my challenge in the State of the Union to
pass the Kennedy-Kassebaum health insurance reform legislation. This law will help as
many as 25 million Americans. No longer will workers fear losing their insurance if they
lose a job or change jobs. No longer will insurance companies be able to deny coverage
to people with preexisitng medical conditions.
I am also proud of our record of other health care accomplishments. To take just a few
examples, we have: protected the guarantee of Medicaid coverage for children, pregnant
women, older Americans and people with disabilities; expedited the Food and Drug
Administration's review and approval of new drugs; increased funding for AIDS
prevention and research to historic levels; protected children from tobacco products and
advertising; helped slow health care cost inflation to the lowest rate in 23 years; and
passed legislation requiring hospitals to allow new mothers and babies stay in the hospital
for at least 48 hours and stopping health plans from imposing stricter limits on annual and
lifetime limits for coverage of mental illness.
But there is more we can and should do. My balanced budget includes a plan to help
workers who are between jobs pay for health insurance coverage. This would give peace
of mind to 3 million Americans, including 700,000 children. We should help small
businesses buy more affordable insurance through voluntary purchasing pools. And we
should assure that high quality care is not threatened by rapid changes in the health care
system; we can start by passing legislation that prevents health plans from limiting
communication between health care professionals and their patients about treatments and
referrals.
II. Dole Contrast
The Dole-Gingrich Medicaid plan would have ended the guarantee to health coverage for
8 million Americans, including 3.8 million children. The Republicans insisted on cutting
$163 billion from Medicaid, and combined state and federal Medicaid cuts could have
exceeded $400 billion if states spent only the minimum required under the plan.
The Dole-Gingrich Medicare plan would have cut S270 billion from the program,
increased premiums for beneficiaries, and raised the eligibility age from 65 to 67 --
threatening to add to the number of uninsured Americans.
Dole allowed Republicans to place a "hold" on the Kennedy-Kassebaum bill and prevent
it from coming up for a vote. Congress could not pass the bill until Dole retired from the
Senate.
Dole has no plan to help Americans keep and afford health insurance coverage.
III. Likely Dole Attacks and Responses
Attack 1: Now that the Kassebaum-Kennedy bill has passed, you are trying to take credit
for a Republican initiative. Three years ago, you would have refused to sign it because it
did not guarantee universal coverage.
Response: I do believe that all Americans should have affordable, high quality health care.
There are still 40 million Americans without health insurance, and that is wrong. But it became
clear during the debate on the Health Security Act that we must work toward reform one step at a
time and with bipartisan support.
In the last Congress, a few Republicans responded to pressure from some health insurers and
refused to allow the Kennedy-Kassebaum bill to come up for a vote. I urged Congress to pass
the Kennedy-Kassebaum bill in my State of the Union address, and the bill began to move
forward.
Republicans and Democrats worked together to write a reasonable bill that will help as many as
25 million Americans. Workers will no longer fear losing insurance if they lose a job or change
jobs, and insurance companies will no longer be allowed to deny coverage to someone with a
preexisting medical condition. Virtually every provision in the Kennedy-Kassebaum law was
included in my balanced budget and in the Health Security Act. Many of the provisions were in
Republican bills as well.
Attack 2: Your Health Security Act would have created a huge new bureaucracy that
would have led to a government takeover of our health care system.
Response: The Health Security Act was not a government run program. People would have
been given access to private insurance through their employers, just as many Americans do
today. Like Senator Dole's health care bill, it reformed the insurance system and provided
financial assistance to the uninsured.
My record of reducing government and regulation is unmatched in the last thirty years. I have
downsized the Department of Health and Human Services by 5,000 employees -- nearly ten
percent -- and significantly reduced the regulatory burden imposed on consumers and providers.
Attack 3: Throughout 1993 and 1994, you said that anything less than a complete overhaul
would undermine the health care system. Less than two years later, you supported the
incremental Kennedy-Kassebaum health legislation. These positions are completely
inconsistent.
Response: During the debate on the Health Security Act, I realized that we bit off more than we
could chew. That is why I now believe we must reform the system one step at a time. As we do
that, though, we must be careful not to take steps that in isolation will threaten the health care
delivery system.
We worked closely with Senators Kassebaum and Kennedy to achieve that delicate balance.
This law puts in place uniform, national reforms in the health insurance market that will make a
difference for as many as 25 million Americans. But these are all reforms that states have
implemented with proven success -- reforms that have improved access to health care, but have
not raised premiums for people who currently have insurance.
The Kennedy-Kassebaum law also addresses other problems in the health care system. It makes
it easier and less expensive for people who are self-employed to buy health insurance. Second, it
prevents fraud and abuse in the health care system. Third, it reduces paperwork and costs by
setting up a uniform electronic system for paying health care claims. And it helps with long-term
care by adding consumer protections and making long-term care insurance more affordable.
Attack 4: The Advisory Commission on Consumer Protection and Quality in the Health
Care Industry that you proposed recently is the next step toward a government takeover of
our health care system.
Response: This advisory commission has a narrow but important charge. It will bring together a
small panel of experts, insurers, business and consumers to make recommendations on quality,
consumer protection, and the availability of treatment and services in managed care plans as well
as other health plans. The health care market is changing quickly and this commission will allow
some of the best minds in the field to analyze and make recommendations on how to ensure that
people get the best quality care possible. The commission has already received the strong
support of a broad range of organizations including insurers, health care providers, businesses
and consumers -- some of whom were critical of the Health Security Act.
GENERAL HEALTH CARE
Attack 1: Isn't it true that the Kassebaum/Kennedy bill is really a Republican initiative that
you could have signed three years ago if you hadn't threatened to veto any bill that did not
have universal coverage?
Response: No, that is untrue. What happened is that soon after our long health care debate, those
of us who care deeply about health care began to look at what steps could be taken to move
forward the health security for Americans I called for this type of reform in 1994 and in my
State of the Union address Unfortunately, in the last Congress, it became clear that Republicans
had no desire to pass any health care reform.
It was the Republicans who consistently threatened the passage of Kassebaum/Kennedy this
year, due to pressure from some insurers, by making it impossible to bring up a vote.
But all of us -- Republicans and Democrats -- can and should share in the credit for the
enactment of the Kassebaum-Kennedy bill. Virtually every provision that I sign into law was
included in my balanced budget and in my Health Security Act. Many of the provisions were
in Republican bills as well.
Health care reform, like all good legislation, should be bipartisan. That is why the Kennedy-
Kassebaum bill has been a success on which we can build.
Attack 2: Isn't it true that your Health Security Act would have created a huge new
bureaucracy that would have led to a government takeover of our health care system?
Response: That is totally absurd. The Health Security Act was not a government run program. It
built on the private insurance, employment-based system we now have. Like Senator Dole's bill, it
provided financial assistance for the uninsured and a revamped insurance system.
In fact, my record in reducing government and regulation is unparralled in the last thirty years. I
have downsized the Department of Health and Human Services by 5,000 employees, nearly ten
percent, and significantly reduced the regulatory burden it imposes on consumers and providers.
Attack 3: In 1993-1994, you and your Administration stated that incremental health reforms
could not be achieved without undermining the health care system. Less than two years
later, you advocated the Kennedy-Kassebaum legislation by any measure. How do you
reconcile these two positions?
Response: As I have stated many times before, the experience of the Health Security Act led me
to conclude that we bit off more than we could chew. In taking a step-by-step approach, we have
had to be extremely careful in developing measures that do not undermine the health care delivery
system. Working closely with Senator Kassebaum and Senator Kennedy this year on insurance
reform, we believe we achieved that delicate balance. It is clear that we must continue to reach
out to members on both sides of the aisle and a broad array of policy makers as we develop new
incremental bipartisan proposals that improve our health care system.
Attack 4: We haven't heard you use the term universal coverage for quite awhile now. Does
your vision of health reform include covering every American?
Response: I am still strongly committed to working towards developing health policy reforms that
expand quality affordable health care to Americans. However, we must make progress on a step
by step basis that creates much greater bipartisan consensus on the direction this nation should go
with regard to this issue. I am confident that we can build on the successes of the enactment of
the Kennedy-Kassebaum law for future legislative action. I have, for example, a proposal in my
balanced budget plan to provide health insurance for up to six months for workers, who through no
fault of their own, have lost their job.
Attack 5: You and the First Lady have on more than one occasion mentioned your desire to
provide health care coverage for all children. However, we have seen no proposal or cost
estimate. Is this political rhetoric or do you have a plan in mind?
Response: The first thing we will do is continue to protect the Medicaid program and not threaten
the high quality coverage for the millions of children on Medicaid. Second, it is plainly
unacceptable that there are approximately 10 million uninsured children in this nation and I think
everyone who cares about health care is always looking for ways that we can do more to expand
health insurance to at least cover children. But we would have to look carefully at reforms that
would be aimed at expanding access to health insurance or at least health care services to children.
For any reform must be paid for in the context of a balanced budget.
Attack 6: Isn't it true that your recently proposed Advisory Commission on Consumer
Protection and Quality in the Health Care Industry represents the next step of a government
takeover of our health care system?
Response: That is preposterous. Most Americans are extremely concerned about the rapidly
changing health care and its potential effect on quality and consumer protections. This advisory
commission has a narrow but important charge. It has already received the strong support of a
broad range of organizations including those who were critical of the Health Security Act. We
have already received numerous letters of support from insurers, provider groups, the business
community, and consumers. The only people I am aware who have raised concerns about this
advisory panel on consumer protections and quality are a few Republicans. Nevertheless, I hope
and expect both Republicans and Democrats will work together on this advisory panel, and I look
forward to their report.
Attack 7: What do you mean by "the availability of services"? Isn't this your next attempt
to guarantee universal coverage?
Response: The President is committed to continuing to work to reform the health care system, but
this advisory commission is not "health reform part two". It is a small panel of experts charged
with looking at quality, consumer protections, and availability of treatment and services. The panel
will look at availability because one of the problems in the health care system is that some people
who have insurance are being denied appropriate services.
Attack 8: Your Health Security Act was built around managed care. Why are you attacking
managed care with this commission?
Response: This commission is not an attack on managed care. It will bring together experts,
insurers, business and consumers to make recommendations on quality, consumer protection, and
the availability of treatment and services in managed care plans as well as other health plans. The
health care market is changing quickly and this commission will allow some of the best minds in
the field to analyze and make recommendations on how to ensure that people get the best quality
care possible.
This (3 only protect
NO offining line; key pts; w
Contrast section.
Her Hh Line -- acart from +
medicare - " important
needs doing
HEALTH CARE
HEALTH CARE: I remain committed to working toward providing affordable, quality,
health care to all Americans. But as the last two Congresses have taught us, we must reform
our health care system in a step-by-step manner that attracts bipartisan support. In so doing,
we must reverse the trend of Americans losing their health insurance. We must ensure that
the quality health care system we have is not undermined by rapid changes in our delivery
system. And, as we do this, we must guard against a return to excessive health care inflation
that makes insurance more unaffordable.
I.
Key Answer Points
I am pleased that the Congress responded to my State of the Union challenge to pass
the Kennedy-Kassebaum health insurance reform legislation. As many as 25 million
Americans will benefit from the important portability and other insurance reforms.
I am proud of a host of other achievements including: [This should soon pass:
requiring health plans to allow mothers of newborns to stay in the hospitals for at least
48 hours, requiring plans to move toward covering mental health illnesses on a level
playing field with other disorders,] helping tame health care inflation, increasing
investments in biomedical research, expediting FDA's review and approval of new
drugs, increasing funding for the VA health care system, and taking actions to protect
kids form tobacco products and advertising.
But there is more we can and should do. My balanced budget includes a provision to
help worker's in-between jobs retain their insurance for themselves and their families.
Each year it would help 3 million Americans, including 700,000 children. While we
reject assaults on Medicaid's guarantee of coverage for children, elderly and people
with disabilities, we should also provide more flexibility to states to help them to
preserve and expand coverage. In addition, we should empower small businesses to
purchase more affordable insurance through voluntary purchasing coalitions.
And we should place a heavy emphasis on assuring that the quality of health care is
not undermined by changes in our delivery system. We should start by passing
legislation that prohibits health plans from limiting communications between health
care professionals and patients about treatment options.
II.
Dole Contrast
Dole's Medicaid block grant and $163 billion in cuts threatened the coverage of
8 million Americans, including 3.8 million kids. Going backwards in coverage and
increasing hospital's uncompensated care burden is a bridge we should not cross.
Dole proposed to expand the Medicare eligibility age to 67, thus threatening to
add to the number of the uninsured. His plan would add to the number of seniors
seeking insurance -- the group that is already amongst the most discriminated against.
Dole allowed Republicans to prevent the Kennedy/Kassebaum bill from even
coming to a vote. For months, Senate Republicans placed "holds" on the bill, making
a vote impossible. The Congress couldn't pass the bill until after he left the Senate.
Dole offers no plan to help any American keep or afford their health insurance.
Question: Wasn't the Health Security Act a not-so veiled government take-over of the
health care system?
Response: Of course not. It was a proposal to build on our current system of a privately-
financed, employer-based system and provide affordable, quality private health insurance to
every American. By any definition it was not a government-run system. What I have said all
along, however, is that we bit off more than we could chew. Ironically, I think the
Republicans repeated the same mistake in reverse. They tried to bite off more than the
American public or I would swallow with their excessive Medicare and Medicaid cuts and
policy changes.
Question: How can you say that a bill that had over 1,300 pages of text calling for
numerous boards, employer mandates, billions of dollars in subsidies, premium caps and
mandatory alliances was not advocating for a government run health care system?
Response: Reforming our extraordinarily complex health care system is complicated. As
such, legislation that attempts to reform the system tend to be detailed. Senator Dole's health
care reform bill in 1994 also had hundreds of pages in statutory language and billions of
dollars in subsidies for low income individuals. One of the bills he cosponsored mandated
that every individual pay for health insurance, but did not call their employers to contribute.
I thought the financing of health care should be a shared responsibility. Both approaches
were complicated and controversial. Both build on the private insurance system we have
today. Neither bill can be fairly labeled as a government takeover of the health care system.
Question: Do you still support an employer mandate? Can you pledge to businesses
that you will not endorse or propose an employer mandate to provide health coverage in
your next term?
Answer: I supported a proposal that called for shared responsibility between employers and
employees to help pay for health care. Throughout the debate, I was always open to other
ways to achieve coverage for all Americans. This approach was rejected and, as I have said,
I am now committed to improving the health care system in a step-by-step manner.
ABORTION
Opening line: I believe that abortion should be rare, but that it also should be safe and legal.
Any decision about abortion should be between a woman, her doctor, and her conscience.
I. Key Answer Points:
I've worked hard to ensure that abortion becomes rare, by focusing on the prevention of
teen pregnancy and by encouraging adoption, through a tax credit and other measures.
The abortion rate is dropping today, and all of us must do all we can to make sure it
continues to do so.
But I've also insisted that abortion be safe and legal. I believe that in most
circumstances, each individual -- not the government -- should make, and take
responsibility for, this most difficult and intensely personal decision. I agree with the
Supreme Court that placing this decision in the hands of the woman involved is a
fundamental aspect of our constitutional system.
That is why I ended the Bush Administration's gag rule, which prevented women using
federally funded clinics from getting the information they needed to make informed
reproductive decisions.
It's why I proposed and signed legislation that ensures safety at women's health clinics,
preventing violence and intimidation against women and their doctors.
It's why I allowed states to use Medicaid funds to provide abortion services for poor
women who are the victims of rape and incest, as well as those whose life is endangered.
And it's why I nominated two Supreme Court Justices who support the constitutional
right to privacy.
I do not believe the right to reproductive choice is unlimited. I have long opposed late-
term abortions except where necessary to protect the life or the serious health interests of
the mother. And I have long supported parental notification requirements. But usually
women themselves are best placed to consider and weigh reproductive alternatives, and I
believe we should trust them to do so.
II. Dole Contrast
My opponent and his party favor a constitutional amendment to prohibit women from
having an abortion, [even in cases where the woman is the victim of rape or incest.]
I strongly oppose such an amendment, which by forcing every state to forbid every
abortion would take this serious and intensely personal decision away from the women
affected and place it in the hands of the government. The Constitution should, as it today
does, protect-- not deny -- the right of a woman to make this decision, in consultation
with her family and doctor and in accordance with her own faith and conscience.
III. Likely Dole Attacks and Responses
Attack: President Clinton believes in abortion on demand. The proof is that he vetoed a bill
prohibiting partial-birth abortion, which is a procedure that amounts to infanticide.
Response:
I vetoed HR 1833 for one reason: because it failed to include an exemption permitting the
use of this procedure in those rare cases where a physician says its use is necessary to
protect a woman from serious risk to her health. I could not sign a bill that would have
abandoned women facing such serious health risks.
The procedure described in the bill troubles me deeply and I do not support its use on an
elective basis. I told Congress that I would willingly sign the bill if an exemption were
added for those rare circumstances where the procedure is the best hope of preventing
grave harm, including the ability to have children in the future. But Congress refused to
amend the bill in this way.
These are tough and tragic cases. Criminalizing the use of this procedure when a
woman's doctor believes it is her best chance to avoid serious injury is no answer. And
politicizing the debate serves no one. I stand for a common sense solution on this issue
and I am willing to work with Congress to achieve it.
Attack: President Clinton says he wants abortion to be legal and rare. He's done everything he
can to make it legal, but nothing to make it rare.
Response:
That is just not true. I have made the prevention of teen pregnancy a priority for this
Administration, and for the first time in years, the teen pregnancy rate has leveled off and
even begun to drop. I have expanded support for community-based prevention program S
that teach abstinence and demand responsibility. I have called for strict enforcement of
statutory rape laws against men preying on underage women, who cause almost half of
teen pregnancies. And because government alone cannot solve this problem, I have
challenged community, business, and religious leaders to form a national campaign to
keep the teen pregnancy rare going down.
At the same time, I've encouraged adoption, by signing legislation providing for a tax
credit for families who adopt and making it easier to adopt across racial lines. During
this Administration, the number of children with special needs who have been adopted
with federal assistance has increased by 60%. That's a record I'm proud of.
HEALTH CARE
HEALTH CARE: I remain committed to working toward providing affordable, quality,
health care to all Americans. But as the last two Congresses have taught us, we must reform
our health care system in a step-by-step manner that attracts bipartisan support. In so doing,
we must reverse the trend of Americans losing their health insurance. We must ensure that
the quality health care system we have is not undermined by rapid changes in our delivery
system. And, as we do this, we must guard against a return to excessive health care inflation
that makes insurance more unaffordable.
I.
Key Answer Points
I am pleased that the Congress responded to my State of the Union challenge to pass
the Kennedy-Kassebaum health insurance reform legislation. As many as 25 million
Americans will benefit from the important portability and other insurance reforms.
I am proud of a host of other achievements including: [This should soon pass:
requiring health plans to allow mothers of newborns to stay in the hospitals for at least
48 hours, requiring plans to move toward covering mental health illnesses on a level
playing field with other disorders,] helping tame health care inflation, increasing
investments in biomedical research, expediting FDA's review and approval of new
drugs, increasing funding for the VA health care system, and taking actions to protect
kids form tobacco products and advertising.
But there is more we can and should do. My balanced budget includes a provision to
help worker's in-between jobs retain their insurance for themselves and their families.
It would help 3 million Americans, including 700,000 children. While we reject
assaults on Medicaid's guarantee of coverage for children, elderly and people with
disabilities, we should also provide more flexibility to states to help them to preserve
and expand coverage. In addition, we should empower small businesses to purchase
more affordable insurance through voluntary purchasing coalitions.
And we should place a heavy emphasis on assuring that the quality of health care is
not undermined by changes in our delivery system. We should start by passing
legislation that prohibits health plans from limiting communications between health
care professionals and patients about treatment options.
II.
Dole Contrast
Dole's Medicaid block grant and $163 billion in cuts threatened the coverage of
8 million Americans, including 3.8 million kids. Going backwards in coverage and
increasing hospital's uncompensated care burden is a bridge we should not cross.
Dole proposed to expand the Medicare eligibility age to 67, thus threatening to
add to the number of the uninsured. His plan would add to the number of seniors
seeking insurance -- the group that is already amongst the most discriminated against.
Dole allowed Republicans to prevent the Kennedy/Kassebaum bill from even
coming to a vote. For months, Senate Republicans placed "holds" on the bill, making
a vote impossible. The Congress couldn't pass the bill until after he left the Senate.
Dole offers no plan to help any American keep or afford their health insurance.
CRIME, DRUGS and GUN CONTROL
Opening Line: When it comes to crime, George Bush has made a lot of promises and posed
for a lot of photos. We've learned the hard way that photo opportunities don't stop bullets or
save police officers' lives. They haven't kept our country from setting an all-time record for
violent crime. My plan to put 100,000 cops on the streets and keep handguns out of the hands
of criminals will.
Key Answer Points
Under Bush, the U.S. has set all-time records for murder, rape and violent crime;
America is now the most violent nation on earth. This will be the first four-year period
in history in which 90,000 Americans will be killed.
George Bush has spent $30 billion for his anti-drug program, but we have more cocaine
addicts and more heroin addicts in this country today than we did in 1988 -- more than
3 million Americans now use cocaine or heroin every week. Almost 1 million drug-
affected babies have been born since Bush's election.
White collar criminals have been treated with leniency. Two years ago, the Bush
Administration promised to set up S&L Fraud Task Forces in 27 cities across the nation;
so far, only two are up and running.
I have a plan to fight crime:
-
Cut 100,000 federal bureaucrats and put 100.000 more cops on the beat;
-
Sign the Brady Bill and ban military assault-style weapons;
-
Launch a real fight against the drug epidemic, making sure that every child in this
country gets comprehensive drug education in school, and every drug addict is
taken off the streets and put into treatment or prison;
-
Crack down on street crime, gangs, and the violence in our streets, with tough
punishments from boot camps to the death penalty;
-
No special breaks for white collar criminals like the S&L cheats.
I'm supported by the largest police group to take a stand in this election (NAPO) and the
police in George Bush's home state of Texas (CLEAT).
As President, I will do everything that I can to ensure that every American can walk on
any street, in any neighborhood in this country, without fear.
Likely Bush Attacks and Responses
Attack: Crime is up in Arkansas under Clinton.
Response: As the nation set an all-time record for murders under George Bush, the number of
murders fell in my state, down 12%. If you live in Arkansas today, you are much less likely
to be the victim of a crime than if you live in some other part of the country.
Attack: Clinton has commuted the sentences of 39 first-degree murderers - five after he
made an election-year promise never to commute another murderer's sentence again.
Response: Over the past ten years, I have received over a thousand applications for clemency
from murderers - and I have granted only five.
I limited clemency to very special cases where I believed some injustice had been done,
or where the offender was quite elderly and infirm.
There are many times when the clemency board unanimously recommended clemency
for offenders, but I said no.
I made each of these decisions carefully and thoughtfully, as I made the decision on four
occasions to send men to death for the murders they committed in my state.
Under George Bush, every Colombian drug kingpin in our prisons -- including the most
notorious trafficker ever, Carlos Lehder -- has received either a reduced sentence, an
enormous monetary fee, or flat-out freedom in exchange for testifying against Noriega.
Attack: Under Bill Clinton, criminals serve just a fraction of their sentenced jail time.
Response: We are now putting more criminals in jail and making them serve longer sentences
than ever before in Arkansas. Today, if you are sentenced for a crime in my state, you are
going to serve about 20% longer than the national average.
Attack: Clinton is soft on murderers.
Response: I've carried out the death penalty four times. For four years, George Bush has had
the power to get the death penalty against drug killers; there were 4,000 drug murders in the
first 1,000 days he had this power, but Bush won a death sentence against just one drug killer.
Attack: Clinton supports gun registration, confiscation, and the banning of hunting rifles.
Response: These are lies. As Governor of Arkansas, I've never supported any such laws --
and as a life-long hunter, I never will. I've been against the NRA -- but I have always been for
hunters and law-abiding gun owners. As Governor, I signed a law to protect hunters' rights,
one of the strongest in the country.
MEDICARE
Opening Line: Medicare is a compact between all generations. Before it was enacted three decades
ago, only 50 percent of our nation's elderly had any insurance. It provides peace of mind to not only
nice
to 38 million elderly and disabled beneficiaries, but to their family members as well. It faces financial
talk
challenges that require reforms. My balanced budget proposal clearly illustrates my commitment to
shout
reforming the program. But my proposals strengthen the Medicare Trust Fund without new premium
inv Tsn'-
increases and without threatening to undermine the quality services the program provides to
need
beneficiaries.
make
ang.
I. Key Answer Points
sharper
I rejected the $270 billion in Medicare cuts (reductions) and flawed policy changes proposed by
Senator Dole and Speaker Gingrich. And I would do it again- and again
Their cuts (reductions) tripled anything previously enacted and their policy changes would create
new health plans that would skim the healthy and wealthy beneficiaries from all others. Virtually
every organization representing the elderly, people with disabilities, doctors, nurses, and hospitals
concluded that the Dole/Gingrich proposals were excessive and would threaten quality services for
beneficiaries.
Moreover, the Dole/Gingrich budget proposal's Medicare premium hikes of $1,700 per couple
complexted
$268 in 1996 alone -- would have placed an unnecessary and excessive burden on beneficiaries
and their families.
My balanced budget proposal reforms Medicare, achieves over $116 billion in savings, and
strengthens the Medicare Trust Fund by a decade from today WITHOUT extreme and ill-advised
policies and unnecessary new premium increases.
II. Dole Contrast
Dole led the fight against strengthening the Medicare Trust Fund in 1993. In 1993, Dole and
all of his Republican colleagues voted against Medicare savings and policy changes that extended
the Medicare Trust Fund for 3 years.
Dole voted against Medicare and proudly trumpeted that fact 30 years later. "I was there,
fighting the fight, one of twelve, voting against Medicare in 1965 because we knew it wouldn't
work." [10/24/95]
Dole's Medicare beneficiary cuts were more draconian than Gingrich's proposals. Dole's
proposal not only doubled Medicare premiums, but also doubled the Part B physician deductible
(from $75 to $150)
in
95-6
?
Dole even tried to raise the Medicare eligibility age from 65 to 67, thus threatening to add to
the number of uninsured. Today, the pre-age 65 senior population is one of the most difficult
to insure and most discriminated against age groups in the nation. Bob Dole's proposals would
have made these vulnerable people wait even longer before they qualified for Medicare.
III. Likely Attacks and Responses
Attack 1: How can the Republican budget proposals be a cut when CBO says that actual
spending per beneficiary would have increased from $4,900 to $7,100 between 1996 and
2002? This is much greater than an inflation increase.
Response: The key question for tens of millions of people on Medicare is whether or not the
needs
+v
savings called for will cut the benefits, the services or the quality of care they receive. By any
be
Shar
sharper
standard, the $270 billion in savings the Dole-Gingrich budget called for would have led higher
out of pocket costs and less quality health care for millions of older Americans. Where I come
from, if you pay more and get less, that is a cut.
The
And don't take my word for it. the American College of Physicians, the American Hospital
Association the Catholic Hospital Association, AARP all criticized the Republican plan as a
severe and extreme cut.
Consider the following: spending per Medicare beneficiary was cut $1400 lower per person -- 20%
below the private sector level -- while the Republican Medicare premium increases would have
raised out-of-pocket costs by $1,700 per couple. Furthermore, I believe that the policies they have
very
would segment and divide the Medicare and between health and wealth instead of being a program
that all Americans can count on.
My opponent had to cut $270 when he had a $245 billion tax cut and he still criticizes my
decision to veto that Medicare cut. If he goes to $550 billion tax cut, I believe the savings will
be at least that large and the impact on Medicare could be severe.
Attack 2: If Bob Dole's budget had Medicare cuts, don't your Medicare proposals also "cut"
the program?
Response: My current balanced budget proposal does have Medicare savings and I have never hid
that. Yet, I believe that the levels of our savings are prudent and the policies are carefully designed
to strengthen the Medicare Trust Fund by taking out unnecessary costs without cutting quality health
care.
The Dole/Gingrich proposed cuts are excessive and are used to pay for unneeded tax
cuts. My proposal does not use Medicare as a $270 billion cash cow for $245 billion in
unnecessary tax cuts. Now Bob Dole says he wants to more than double that tax cut and is
suggesting he will lower the Medicare cuts. The numbers don't add up without an even
higher Medicare cut.
not "32rmgs" Cuts-
+ not at Least'
that lerge
Attack 3: If Bob Dole's and your current Medicare proposals are "cuts," why did you label
the Medicare cuts in your Health Security Act as "reductions in growth"?
Response: The goal of my health care plan was to reduce the overall costs of health care so that
the growth of all health care costs -- including Medicare -- could come down through a smarter
health care system without cuts in quality or services. Furthermore, we plowed our savings back
into new benefits like prescription drugs and long-term coverage.
a
evasing
The Republican plan I vetoed simply sought to lower Medicare costs below what everyone else
needed to keep up with the costs of health care. It is one thing to lower the cost of all health care
through making health care more productive; it is another thing to simply cut Medicare alone --
giving it second class status.
Most aging representatives did not label my proposal as a "cut" because of the
reinvestments in prescription drug and long-term care coverage. In fact, because of these
new benefits, AARP and the National Council of Senior Citizens specifically did not label my
proposals as "cuts."
Attack 4: Aren't you simply "demagoging" the Medicare issue and using it as an effective
scare tactic against Bob Dole? Your own Secretaries of Health, Labor and Treasury say the
Medicare program will be bankrupt in 5 years or less. The Republican proposal allows for a
growth rate in excess of inflation. How can you shamelessly scare the elderly into believing
that the Republicans are going to hurt the Medicare program?
Response: First, it is not only myself but the American College of Physicians, the American
Hospital Association, the Catholic Hospital Association, AARP who all criticized the Republican
plan as a severe and extreme cut. Their plan was three times larger than the largest Medicare cut in
history, I am not going back off one bit from defending against such excessive cuts.
Two, it is my Administration that strengthened the Medicare Trust Find by three years in 1993 --
and was opposed by every single Republican. We were also opposed when we presented another
plan in 1994 to protect the Trust Fund for another five years. Currently, we have enough savings
and policies in common to extend the life of the trust fund 10 years to give us time to address our
long-term challenges.
There is a need to strengthen the Trust Fund and I have a plan. My balanced budget
proposal illustrates how to extend the life of the Medicare Trust Fund for 2 ten years from
today.
But we must reject excessive cuts and policy changes that are used to help pay for a tax
cut that has more than doubled from last year to over $540 billion.
Last year there were $270 billion in Medicare cuts and $245 billion in tax cuts. Next
year, one can only imagine how many more Medicare cuts will be necessary to pay for
the over half a trillion dollar tax cut?
While the medical inflation rate is low today, the Congress' own congressional budget
experts project that this will not be the case for the next seven years. I simply don't
believe we should gamble the health of Medicare beneficiaries on a proposal that says no
matter what happens with inflation, we will arbitrarily cap expenditures to a certain level.
Attack 5: What is wrong with asking higher income seniors to pay more in premiums? The
*
so-called means-testing premium was in the Republican plan and you even included a similar
provision in the Health Security Act. Aren't you once again playing political games on this
issue?
Response: I am not opposed in principle to higher income beneficiaries paying more for their
Medicare. I did support this concept in my health reform proposal, but beneficiaries received
additional benefits in return for their increased contribution. The Republican means testing
proposal provided no significant new benefits and the savings they achieved through this proposal
would help offset unneeded and excessive tax cuts. I do not believe we should be asking older
Americans to use their limited savings to help pay for such an unwarranted tax cut.
Attack 6: The difference between your $124 billion and their $158 billion in Medicare cuts
over 7 years is extremely small. What don't you stop playing politics with this issue and
come up with a compromise? Is it because it is such a politically attractive hammer to use
on Bob Dole on the Republicans? Why not do what is best for America?
the 1/erence can't be 50% larger them my plan
Response: The difference between myself and the Republican plan is still larger than you state:
indeed it is over 50% larger than my plan. Furthermore, it has policies that I and many experts
believe will lead to Medicare to become divided by wealth and health.
But more important, my opponent and Newt Gingrich still to this day criticize me harshly for
vetoing $270 billion cuts, and I think most experts believe that in order to pay for their excessive tax
cut, they will go back to the deep and even deeper Medicare cuts as the only way to pay for more
than doubling their tax cut.
Senator Dole's numbers for his tax cut just don't add up without extremely high
Medicare and Medicaid cuts. Until I leave office, I will categorically reject excessively high
Medicare and Medicaid cuts and policy changes that will hurt these programs and the
beneficiaries they serve.
Even if one assumes $168 billion in cuts and a compromise on the number is imaginable,
the Republicans have still not rejected their old and flawed policy that pits healthy and
wealthy beneficiaries against the sick. They have not rejected a full-blown, untested
Medicare Medical Savings Account (MSA) that has every potential to attract only the
youngest and healthiest of the Medicare population. They have not rejected their new health
plan that eliminates all beneficiary payment protections and allows doctors to charge whatever
they want. And lastly, they have not rejected the arbitrary caps that locks in Medicare
expenditures at a certain level regardless of what is happening in the economy. These
policy differences are very real and concern me greatly.
EHKK
Signing
Attack 7: Aren't you just committed to protecting the status quo at a time when we must
modernize Medicare? What is wrong with providing more choices to beneficiaries?
Response: My plan is to strengthen the trust fund and provide more choices to Medicare
beneficiaries, but I want to do so in a way that preserves the integrity of our Medicare program.
Rather than dismantle our existing Medicare program, I want to build on the solid foundation we
have created by providing Medicare beneficiaries new health plan options that provide new choices
to beneficiaries (PPOs, PSOs, and HMOs with a point of service option). I evaluate any new
option on its ability to compete on cost and quality rather than selecting on the basis of "cherry
picking" the healthy and wealthy. Many of the Republicans' proposals (e.g. Medicare MSAs
and physician plans without overbilling protections) would segment the healthy from the sick
and would undermine the Medicare program in so doing.
Attack 8: Why are you so opposed to a small premium increase? Aren't you just waging a
campaign to needlessly frighten the elderly?
Response: Raising Medicare premiums would hurt the millions of Medicare beneficiaries who
have limited incomes. A recent study revealed that nearly 75 percent of Medicare beneficiaries
have incomes below $25,000. Moreover, increasing premiums for Medicare beneficiaries is not
necessary to strengthen the Medicare trust fund or to balance the budget. I simply will not stand
for an excessive increase in premiums that is used to pay for an unnecessary tax cut for the well to
do.
Attack 9: Isn't it true that there was only a $7 difference between premiums under the
Republican plan and your proposal by 2002?
Response: There was never only a $7 difference a month between premiums proposed by the
Republicans and premiums in my plan. Some used that number incorrectly using preliminary or
inaccurate projections. A true "apples to apples" comparison reveals that had I not fought and
eventually vetoed their Medicare plan, every couple on Medicare would have paid premiums that
were at least $1,700 higher over seven years and $268 higher per couple this year alone.
Attack 10: You have supported Medical Savings Accounts, and yet you continue to opposed
Medicare MSAs. Isn't that hypocritical?
Response: Although I have agreed to a limited test of MSAs for non-Medicare beneficiaries, I am
particularly concerned that they would have an adverse effect on the Medicare program. Because
certain Medicare beneficiaries are extremely expensive, there are greater incentives for health plans
to "cherry pick" the healthier and wealthier. The Republicans have insisted on exposing opened-
ended unconstrained Medicare MSAs to the entire beneficiary population. Such an untested
proposal has a great potential to attract healthier and wealthier beneficiaries, leaving sicker and
more costlier beneficiaries in a weakened traditional Medicare program leaving Medicare to
"wither on the vine."
Attack 11: Clearly the Medicare trust fund is in trouble. What are you doing to address
both the short-term and long-term problems of the trust fund?
Response: Since the beginning of my Administration, I have aggressively moved to strengthen the
Medicare trust fund. I am absolutely committed to working with Congress towards this end and
have illustrated how this can be done without excessive cuts, ill-advised structural changes, and
unwarranted premium increases.
My 1993 budget extended the life of the Medicare trust fund by three years, without the
vote of a single Republican.
My balanced budget proposal extends the life of the Medicare trust fund until the year
2006, ten years from today.
We must take this first step to strengthen the trust fund and, as the Medicare trustees have
recommended, we must establish a bipartisan process that would work to provide specific
recommendations to address the long-term financing challenges facing the trust fund.
Attack 12: You say your Medicare proposal extends the life of the trust fund for ten years,
but without your home health gimmick, your proposal would only extend the life of the trust
fund one year. Don't you think we need real savings to save the Medicare trust fund?
Response: My Medicare proposal extends the life of the Medicare trust fund until 2006, according
to the trust fund actuaries and until the year 2005 according to the Congressional Budget Office.
The proposal that you refer to a gimmick is the same one that every Republican in the House
supported this year in the budget reconciliation bill. My proposal to transfer a portion of home
health financing from Part A to Part B recognizes that Part A covers short-term, post-acute care
services and allows Part B to financial other home health care services, just as was intended and
implemented until 1980.
Without the home health transfer, we would have to make devastating cuts to hospitals
that would undermine the quality of care, especially in rural and other underserved areas.
1 A mess. way two long
I 84224 Throughout v/a
level of detail shited to L
febate between health experts
at KAiser.
Needs to be sheap, simple +
to lethal
Medicare wts in HSA. -
HSA - high income Premium 1 -
Premiums.
20% below private suctor
inflation
rute
7 y r - $118.5
5yr $ 79.3
0
002
OMB AD HP
09/10/96 11:14
MEDICARE AND HEALTH CARE
Opening Line: Medicare is a compact between all generations. Before it was enacted three
decades ago, only 50 percent of our nation's elderly had any insurance. It provides peace of mind
to not only to 38 million elderly and disabled beneficiaries, but to their family members as well. It
faces financial challenges that require reforms. My balanced budget proposal clearly illustrates my
commitment to reforming the program. But my proposals strengthen the Medicare Trust Fund
without new premium increases and without threatening to undermine the quality services the
program provides to beneficiaries.
I. Key Answer Points
I rejected the $270 billion in Medicare cuts (reductions) and flawed policy changes
proposed by Senator Dole and Speaker Gingrich. And I would do it again and again.
Their cuts (reductions) tripled anything previously enacted and their policy changes would
create new health plans that would skim the healthy and wealthy beneficiaries from all
others. Virtually every organization representing the elderly, people with disabilities,
doctors, nurses, and hospitals concluded that the Dole/Gingrich proposals were excessive
and would threaten quality services for beneficiaries.
Moreover, the Dole/Gingrich budget proposal's Medicare premium hikes of $1,700 per
couple -- $268 in 1996 alone -- would have placed an unnecessary and excessive burden
on beneficiaries and their families.
My balanced budget proposal reforms Medicare, achieves over $116 billion in savings, and
strengthens the Medicare Trust Fund by a decade from today WITHOUT extreme and ill-
advised policies and unnecessary new premium increases.
II. Dole Contrast
Dole led the fight against strengthening the Medicare Trust Fund in 1993.
In 1993, Dole and all of his Republican colleagues voted against Medicare savings and
policy changes that extended the Medicare Trust Fund for 3 years.
Dole voted against Medicare and proudly trumpeted that fact 30 years later. "I
was there, fighting the fight, one of twelve, voting against Medicare in 1965 because we
knew it wouldn't work." [10/24/95]
Dole's Medicare beneficiary cuts were more draconian than Gingrich's proposals.
Dole's proposal not only doubled Medicare premiums, but also doubled the Part B
physician deductible (from $75 to $150).
Dole even tried to raise the Medicare eligibility age from 65 to 67, thus threatening
to add to the number of uninsured. Today, the pre-age 65 senior population is one of
the most difficult to insure and most discriminated against age groups in the nation. Bob
Dole's proposals would have made these vulnerable people wait even longer before they
qualified for Medicare.
003
OMB AD HP
09/10/96
11:15
III. Likely Attacks and Responses
Attack: How can the Republican budget proposals be a cut when CBO says that
actual spending per beneficiary would have increased from $4,900 to $7,100 between
1996 and 2002? This is much greater than an inflation increase.
Response: The key question for tens of millions of people on Medicare is whether or
not the savings called for will cut the benefits, the services or the quality of care they
receive. By any standard, the $270 billion in savings the Dole-Gingrich budget
called for would have led higher out of pocket costs and less quality health care
for millions of older Americans. Where I come from, if you pay more and get less,
that is a cut.
And don't take my word for it. the American College of Physicians, the American
Hospital Association the Catholic Hospital Association, AARP all criticized the
Republican plan as a severe and extreme cut.
Consider the following: spending per Medicare beneficiary was cut $1400 lower per
person - 20% below the private sector level -- while the Republican Medicare
premium increases would have raised out-of-pocket costs by $1,700 per couple.
Furthermore, I believe that the policies they have would segment and divide the
Medicare and between health and wealth instead of being a program that all Americans
can count on.
My opponent had to cut $270 when he had a $245 billion tax cut and he still
criticizes my decision to veto that Medicare cut. If he goes to $550 billion tax cut, I
believe the savings will be at least that large and the impact on Medicare could be
severe.
Attack: If Bob Dole's budget had Medicare cuts, don't your Medicare proposals
also "cut" the program?
Response: My current balanced budget proposal does have Medicare savings and I
have never hid that. Yet, I believe that the levels of our savings are prudent and the
policies are carefully designed to strengthen the Medicare Trust Fund by taking out
unnecessary costs without cutting quality health care.
The Dole/Gingrich proposed cuts are excessive and are used to pay for
unneeded tax cuts. My proposal does not use Medicare as a $270 billion cash
cow for $245 billion in unnecessary tax cuts. Now Bob Dole says he wants to
more than double that tax cut and is suggesting he will lower the Medicare cuts.
The numbers don't add up without an even higher Medicare cut.
004
09/10/96
11:15
OMB AD HP
Attack: If Bob Dole's and your current Medicare proposals are "cuts," why did you
label the Medicare cuts in your Health Security Act as "reductions in growth"?
Response: The goal of my health care plan was to reduce the overall costs of health
care so that the growth of all health care costs including Medicare - could come
down through a smarter health care system without cuts in quality or services.
Furthermore, we plowed our savings back into new benefits like prescription drugs and
long-term coverage.
The Republican plan I vetoed simply sought to lower Medicare costs below what
everyone else needed to keep up with the costs of health care. It is one thing to lower
the cost of all health care through making health care more productive; it is another
thing to simply cut Medicare alone -- giving it second class status.
Most aging representatives did not label my proposal as a "cut" because of
the reinvestments in prescription drug and long-term care coverage. In fact,
because of these new benefits, AARP and the National Council of Senior Citizens
specifically did not label my proposals as "cuts."
Attack: Aren't you simply "demagoging" the Medicare issue and using it as an
effective scare tactic against Bob Dole? Your own Secretaries of Health, Labor and
Treasury say the Medicare program will be bankrupt in 5 years or less. The
Republican proposal allows for a growth rate in excess of inflation. How can you
shamelessly scare the elderly into believing that the Republicans are going to hurt
the Medicare program?
Response: First, it is not only myself but the American College of Physicians, the
American Hospital Association, the Catholic Hospital Association, AARP who all
criticized the Republican plan as a severe and extreme cut. Their plan was three times
larger than the largest Medicare cut in history, I am not going back off one bit from
defending against such excessive cuts.
Two, it is my Administration that strengthened the Medicare Trust Find by three years
in 1993 - and was opposed by every single Republican. We were also opposed when
we presented another plan in 1994 to protect the Trust Fund for another five years.
Currently, we have enough savings and policies in common to extend the life of the
trust fund 10 years to give us time to address our long-term challenges.
There is a need to strengthen the Trust Fund and 1 have a plan. My balanced
budget proposal illustrates how to extend the life of the Medicare Trust Fund for a
ten years from today.
But we must reject excessive cuts and policy changes that are used to help
pay for a tax cut that has more than doubled from last year to over $540
billion.
Last year there were $270 billion in Medicare cuts and $245 billion in tax
cuts. Next year, one can only imagine how many more Medicare cuts will be
necessary to pay for the over half a trillion dollar tax cut?
005
09/10/96
11:16
OMB AD HP
While the medical inflation rate is low today, the Congress' own
congressional budget experts project that this will not be the case for the next
seven years. I simply don't believe we should gamble the health of Medicare
beneficiaries on a proposal that says no matter what happens with inflation, we will
arbitrarily cap expenditures to a certain level.
Attack: What is wrong with asking higher income seniors to pay more in
premiums? The so-called means-testing premium was in the Republican plan and
you even included a similar provision in the Health Security Act. Aren't you once
again playing political games on this issue?
Response: I am not opposed in principle to higher income beneficiaries paying more for
their Medicare. I did support this concept in my health reform proposal, but beneficiaries
received additional benefits in return for their increased contribution. The Republican
means testing proposal provided no significant new benefits and the savings they achieved
through this proposal would help offset unneeded and excessive tax cuts. I do not believe
we should be asking older Americans to use their limited savings to help pay for such an
unwarranted tax cut.
Attack: The difference between your $124 billion and their $158 billion in Medicare
cuts over 7 years is extremely small. What don't you stop playing politics with this
issue and come up with a compromise? Is it because it is such a politically attractive
hammer to use on Bob Dole on the Republicans? Why not do what is best for
America?
Response: The difference between myself and the Republican plan is still larger than
you state: indeed it is over 50% larger than my plan. Furthermore, it has policies that I
and many experts believe will lead to Medicare to become divided by wealth and
health.
But more important, my opponent and Newt Gingrich still to this day criticize me
harshly for vetoing $270 billion cuts, and I think most experts believe that in order to
pay for their excessive tax cut, they will go back to the deep -- and even deeper
Medicare cuts as the only way to pay for more than doubling their tax cut.
Senator Dole's numbers for his tax cut just don't add up without extremely
high Medicare and Medicaid cuts. Until I leave office, I will categorically reject
excessively high Medicare and Medicaid cuts and policy changes that will hurt
these programs and the beneficiaries they serve.
Even if one assumes $168 billion in cuts and a compromise on the number is
imaginable, the Republicans have still not rejected their old and flawed
policy that pits healthy and wealthy beneficiaries against the sick. They have
not rejected a full-blown, untested Medicare Medical Savings Account (MSA) that
has every potential to attract only the youngest and healthiest of the Medicare
population. They have not rejected their new health plan that eliminates all
beneficiary payment protections and allows doctors to charge whatever they want.
And lastly, they have not rejected the arbitrary caps that locks in Medicare
expenditures at a certain level - regardless of what is happening in the economy
These policy differences are very real and concern me greatly.
006
OMB AD HP
09/10/96 11:16
Attack: Aren't you just committed to protecting the status quo at a time when we
must modernize Medicare? What is wrong with providing more choices to
beneficiaries?
Response: My plan is to strengthen the trust fund and provide more choices to Medicare
beneficiaries, but I want to do so in a way that preserves the integrity of our Medicare
program. Rather than dismantle our existing Medicare program, I want to build on the
solid foundation we have created by providing Medicare beneficiaries new health plan
options that provide new choices to beneficiaries (PPOs, PSOs, and HMOs with a point of
service option). I evaluate any new option on its ability to compete on cost and quality
rather than selecting on the basis of "cherry picking" the healthy and wealthy. Many of
the Republicans' proposals (e.g. Medicare MSAs and physician plans without
overbilling protections) would segment the healthy from the sick and would
undermine the Medicare program in so doing.
Attack: Why are you so opposed to a small premium increase? Aren't you just
waging a campaign to needlessly frighten the elderly?
Response: Raising Medicare premiums would hurt the millions of Medicare beneficiaries
who have limited incomes. A recent study revealed that nearly 75 percent of Medicare
beneficiaries have incomes below $25,000. Moreover, increasing premiums for Medicare
beneficiaries is not necessary to strengthen the Medicare trust fund or to balance the
budget. I simply will not stand for an excessive increase in premiums that is used to pay
for an unnecessary tax cut for the well to do.
Attack: Isn't it true that there was only a $7 difference between premiums under
the Republican plan and your proposal by 2002?
Response: There was never only a $7 difference a month between premiums proposed by
the Republicans and premiums in my plan. Some used that number incorrectly using
preliminary or inaccurate projections. A true "apples to apples" comparison reveals that
had I not fought and eventually vetoed their Medicare plan, every couple on Medicare
would have paid premiums that were at least $1,700 higher over seven years and $268
higher per couple this year alone.
Attack: You have supported Medical Savings Accounts, and yet you continue to
opposed Medicare MSAs. Isn't that hypocritical?
Response: Although I have agreed to a limited test of MSAs for non-Medicare
beneficiaries, 1 am particularly concerned that they would have an adverse effect on the
Medicare program. Because certain Medicare beneficiaries are extremcly expensive, there
are greater incentives for health plans to "cherry pick" the healthier and wealthier. The
Republicans have insisted on exposing opened-ended unconstrained Medicare MSAs to
the entire beneficiary population. Such an untested proposal has a great potential to
attract healthier and wealthier beneficiaries, leaving sicker and more costlier beneficiaries
in a weakened traditional Medicare program leaving Medicare to "wither on the vine."
007
OMB AD HP
09/10/96
11:17
Attack: Clearly the Medicare trust fund is in trouble. What are you doing to
address both the short-term and long-term problems of the trust fund?
Response: Since the beginning of my Administration, I have aggressively moved to
strengthen the Medicare trust fund. I am absolutely committed to working with Congress
towards this end and have illustrated how this can be done without excessive cuts, ill-
advised structural changes, and unwarranted premium increases.
My 1993 budget extended the life of the Medicare trust fund by three years,
without the vote of a single Republican.
My balanced budget proposal extends the life of the Medicare trust fund
until the year 2006, ten years from today.
We must take this first step to strengthen the trust fund and, as the Medicare trustees have
recommended, we must establish a bipartisan process that would work to provide specific
recommendations to address the long-term financing challenges facing the trust fund.
Attack: You say your Medicare proposal extends the life of the trust fund for ten
years, but without your home health gimmick, your proposal would only extend the
life of the trust fund one year. Don't you think we need real savings to save the
Medicare trust fund?
Response: My Medicare proposal extends the life of the Medicare trust fund until 2006,
according to the trust fund actuaries and until the year 2005 according to the
Congressional Budget Office. The proposal that you refer to a gimmick is the same one
that every Republican in the House supported this year in the budget reconciliation bill.
My proposal to transfer a portion of home health financing from Part A to Part B
recognizes that Part A covers short-term, post-acute care services and allows Part B to
financial other home health care services, just as was intended and implemented until
1980.
Without the home health transfer, we would have to make devastating cuts
to hospitals that would undermine the quality of care, especially in rural and other
underserved areas.
GENERAL HEALTH CARE
Attack: Isn't it true that the Kassebaum/Kennedy bill is really a Republican
initiative that you could have signed three years ago if you hadn't threatened to veto
any bill that did not have universal coverage?
what is that after Sen
Response: No, that is untrue. In the last Congress it became clear that Republicans had
no desiret pass any health care reform.
calle 5ypc traitles 1.19L Fically of this
As laze Senator debatejon Bennett (R-UT) stated, her "Dole myself made it very clear of that others no bill is the take 150ld
move
strategy." And William Kristol, a key Republican strategist consistently advocated to
that Republicans should oppose any health reform bill (cite unseen).
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